OBJECTIVE To explore an effective cleaning method to improve the quality of sterilization,in order to control infections in the hospitals. METHODS To adopt orthogonal experimental forms of L_9(3~4) and take water temperature,cleaning agent type and cleaning method as experimental factors,in this way to investigate decontamination method for surgical instruments,using TOSI indicator cards and Browne STF load device to test the effectiveness of cleaning results. RESULTS It showed that by KQ-4200SY medical digital full-automatic ultrasonic cleaner with washing water at 33-35℃ an optimal cleaning result would be obtained. CONCLUSIONS It is practical to clean surgical instruments by KQ-4200SY medical digital full-automatic ultrasonic cleaner,and by TOSI indicator cards and Browne STF used as test method.

Objective To analyze the clinical infection distribution and drug resistance status of 442 strains of Escherichia coli to provide the basise for the treatment of Escherichia coli infection and the control of nosocomial infection.Methods The clinically submitted various kinds of specimens during 2013 were performed the bacterial culture and identification.The susceptibility of Escherichia coli to commonly used bacterial drugs were detected by adopting the MIC method.The data were analyzed by WHO-NET V5.5 and SPSS V13.0 softwares.Results 442 strains of Escherichia coli were isolated from the middle urine and secretion. The detection rate of ESBLs-producing Escherichia coli was 61.3%.442 strains of Escherichia coli had the high resistance to peni-cillins,cephalosporins and fluoroquinolones,better sensitivity toβ-lactam/β-lactamase inhibitor compounds and highest sensitivity to carbapenems.ESBLs-producing Escherichia coli had the higher resistance to commonly used antibacterial drugs than non-ESBLs-producing Escherichia coli .Conclusion The drug resistance of Escherichia coli is severe.ESBLs-producing Escherichia coli are u-sually resistant to many different types of antimicrobial drugs.Carbapenems are the first choice to treatment of severe infections of Escherichia coli .

Objective:To investigate the safety and effect of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) and sorafenib on large hepatocellular carcinoma (HCC) patients treatment.Methods:From Jan 2012 to Dec 2017, 36 patients (Male: 33, Female: 3, average age: 51.8) with large HCC lesions(5-7 cm) received TACE plus with RFA and sorafenib in the Third Affiliated Hospital of Sun Yat-sen University. Efficacy was evaluated after TACE. Each patient was received follow-up after RFA procedure. The occurrence rate of complications and overall survival (OS) were recorded. Log-rank univariate analysis was used to analyze the OS data.Results:The median TACE time was 4, and the RFA time was (1.7±0.7) . Mean duration time of sorafenib administration was (37.7±28.8) months. Adverse events of sorafenib: 26(72.2%) hand-foot skin reaction, 6(16.7%) hypertension, 22(61.1%) diarrhea, 17(47.2%) alopecia, 3(8.3%) oral ulcer and 1(2.8%) gastrointestinal hemorrhage. Median OS was 63.0 months, and 1-year, 3-year and 5-year survival rate was 100%, 72.7% and 52.6%. The cumulative survival rate of patients taking whole course of sorafenib ( n=21) was better than that of patients taking remedial ( n=15); the cumulative survival rate of patients with alpha fetal protein (AFP) <200 μg/L ( n=26) before treatment was better than ≥200 μg/L ( n=10); the cumulative survival rate of patients with good TACE response ( n=19) was better than that of patients with no response ( n=17), and the differences were statistically significant (all P<0.05). Conclusions:TACE plus with RFA and sorafenib are safe and effective for large HCC patients with 5-7 cm lesions and this treatment might improve OS. The whole-course sorafenib, lower base AFP value (<200 μg/L) and good TACE response were considered as the good factors for the combination therapy in large HCC patients.

Objective To investigate the influence of different prompt measures on the quality of cardiopulmonary resuscitation (CPR) chest compressions in the standardized training of residents in Chinese medicine hospitals. Methods There were 84 participants who were the first year standardized training residents recruited from Guangdong Provincial Hospital of Chinese medicine during July to August 2016, and eleven of them were excluded because of incomplete chest compression data collected from the feedback system. Finally, 73 participants being volunteers were enrolled. They were divided randomly into phone metronome group (n = 16), music metronome group (n = 15), depth display group (n = 22), and blank control group (n = 20). In phone metronome group, a mobile phone metronome was applied in the duration of CPR, with a frequency of 110 beats per minute, beat 2/4; in the music metronome group, it was accompanied by the music Staying Alive during the compression period, with frequency of 107 beats per minute, beat 4/4; in depth display group, a model electronic displayer was used in the duration of the compressions to feedback the real time compression depth and its rebound situation in CPR; there was no any intervention measure in blank control group. Each participant performed 5 cycles of CPR on a manikin. A chest compression feedback device was placed on the pressing point, on which the participants places the hand for CPR. The chest compression fraction 1 (CCF1), compression depth, compression rate, too slow frequency, too fast frequency, too shallow frequency, the total times of compressions, the correct times of compressions, correct rate, and the rate of compression retention were record as preliminary evaluation data by using the dual sensor and the pressure sensor built in the chest compression feedback device. At the same time, the correct compression ratio, correct ventilation ratio, the chest compression fraction 2 (CCF2) displayed on the human electronic displayer of the manikin were used as the review criteria. The quality of chest compression among the four groups of volunteers was compared. Results The compression rate and the too fast frequency in the depth display group were significantly higher than those in the music metronome group [compression rate (bpm): 140.59±17.90 vs. 124.27±21.43, the too fast frequency (times): 134.18±49.88 vs. 95.40±53.76, both P < 0.05], and the total compression times in depth display group were significantly higher than either in music metronome group or in blank control group (times: 152.73±27.05 vs. 135.60±10.38, 144.60±12.56, all P < 0.05), the rate of compression retention in depth display group was significantly higher than that in blank control group [37.50% (4.75%, 88.25%) vs. 12.00% (2.75%, 47.00%)]. Consistency detection of two sets of feedback systems for chest compression showed that the chest compression ratio in music metronome group evaluated by the chest compression feedback device was obviously lower than that assessed by the analog human electronic displayer [(53.60±9.87)% vs. (58.20±28.17)%], and it was suggested that the chest compression ratio in depth display group evaluated by the chest compression feedback device be markedly higher than that assessed by the analog human electronic displayer [(56.32±7.77)% vs. (43.86±27.63)%, P < 0.05], and it was shown that the correct rates of chest compression assessed by the chest compression feedback device were significantly lower than those evaluated by the analog human electronic displayer in metronome, music, depth and blank control groups [phone metronome group: 0.00% (0.00%, 60.75%) vs. 38.50% (24.25%, 92.00%), music metronome group: 0.00% (0.00%, 7.00%) vs. 60.00% (32.00%, 89.00%), depth display group: 0.00% (0.00%, 0.25%) vs. 34.00% (20.75%, 68.25%), blank control group: 0.00% (0.00%, 1.75%) vs. 61.50% (30.75%, 84.25%), all P < 0.05], suggesting that the consistency of this two feedback systems be poor and their degrees of reliability low. Conclusion The effects of intervention measures on the quality of chest compressions vary from person to person, and the quality of chest compressions can be really elevated only by systematic training and repeated practice.

Parkinson's drug-induced dyskinesia is a common complication after levodopa treatment,and its clinical manifestations are complex.A case of Parkinson's L-dopa-induced dyskinesia misdiagnosed as epilepsy in our hospital is reported.The patient,a 69-year-old male,was hospitalized on May 2,2018 due to "15 years of retardation,recurrent limb twitching with breathing for more than 6 months,sudden loss of consciousess for 10 minutes".The patient took madopar for a long time and had obvious drug complications.In July 2017,the use of rasagiline improved manifestations slightly.In November 2017,repeated limb twitches began to occur.The onset time ranged from several minutes to one hour,and there was a gradual occurrence of twitching accompanied by obvious breathing.On May 1,2018,the patient was sent to our hospital for emergency treatment after limb twitching again.Due to the long-term history of hormone use,and tranquilizers and antiepileptic drugs were used to control the condition of the patient,the patient was misdiagnosed as epilepsy at first.With the adjustment of drugs and the change of condition,the patient was finally diagnosed as Parkinson's L-dopa-induced dyskinesia.The clinical manifestations of the disease include peak dyskinesia,bipolar dyskinesia and dystonia.The pathogenesis of Parkinson's disease is not completely clear and its clinical manifestations are diverse.However,there are few reports of Parkinson's disease,whose manifestation is loss of consciousness due to paroxysmal breath holding and hypoxemia.Therefore,in order to diagnose epilepsy in patients with Parkinson's disease,the possibility of dyskinesia should be excluded first.Therefore,the rational use of drugs is particularly important in the middle and late period of Parkinson's disease.

Objective To make biomechanical evaluation on ultimate pullout strength of the suture anchors based on the angle of suture anchor (SA) implanted into the humerus during arthroscopic rotator cuff repair (RCR) surgery. Methods Polyurethane materials with densities of 0.16 g/cm3 and 0.32 g/cm3 were used to simulate osteoporosis and normal cancellous bone, and polyurethane materials with densities of 0.64 g/cm3 and 3 mm thickness were used to simulate human cortical bone. The two kinds of cancellous bone models were respectively adhered together with cortical bone model to construct human humerus model. Titanium metal suture anchors were inserted into humerus models at 45°, 60°, 75° and 90° angle, then the continuous tensile experiments were performed, and 45° pulling direction between the humerus model surface and suture anchor was used to simulate the supraspinatus physiological traction direction, and each group was continuously tested 8 times, recording the pullout strength and failure modes. ResultsThe pullout force of high-density bone models was significantly higher than that of low-density bone models (P＜0.001), and at the same density, compared with 45°, 60° and 75°, the implant angle of 90° has a larger pullout force (P＜0.01). Conclusions In the model of humerus, the 90° implantation of suture anchor showed better biomechanical properties, and the vertical implantation of anchor in the repair of rotator cuff was beneficial to the knotting during operation and postoperative recovery of the supraspinatus.

Objective To explore the influence of hook deflection angle and inclination angle on mechanical properties of the soft tissue suture passer hook. Methods Taking the end face far away from the tip of the needle (end face 1) as the study object, a mathematical model was established with the moment as dependent variable and the hook deflection angle and inclination angle as the independent variable. The moment was solved by the mathematical model with the deflection angle and inclination angle of 0°, 10°, 20° and 30°. Based on the finite element analysis method, 16 three-dimensional geometric hook models with deflection angle and inclination angle of 0°, 10°, 20° and 30° were established by SolidWorks. The stress analysis was carried out by ANSYS Workbench. Under the same puncture force, the maximum von Mises stress of each hook and the reaction moment of end face far away from the tip of the needle were calculated. Results The results from theoretical analysis and numerical simulation showed that the reaction moment of end face 1 increased with the increase of deflection angle, and increased with the decrease of inclination angle. The hook with deflection angle of 0° and inclination angle of 30° had the minimum reaction moment. The finite element analysis results showed that with the deflection angle of 0°, the maximum von Mises stress of the hook was the smallest and did not change with the inclination angle of the hook changing. Conclusions The established mathematical model can accurately explain the relationship between the moment at the end face of the hook and the deflection angle and inclination angle of the hook. This study provides the theoretical basis for designing hook geometry of the soft tissue suture passer, and improves the safety of the soft tissue suture passer in operation process.