OBJECTIVE To explore the best method of cleaning and sterilization of laparoscopic apparatus.METHODS Laparoscopic apparatus useed in the hospital was divided into four groups at random:with artificial cleaning and sterilization by ethylene oxide(EO),with machine-cleaning and sterilization by EO,with artificial cleaning by hydrogen peroxide plasma,and with machine-cleaning and sterilization by hydrogen peroxide plasma.And The sterilization effect of four groups was observed.RESULTS The positive cleaning result of manual with ultrasonic cleaning was 97.5%,but with autowash cleaner was 73.3%.The rate of qualification of artificial-groups was higher than machine groups obviously(P

BACKGROUND: Neuron-specific enolase, γtype isoenzyme that is specially present in the cytoplasm of neurons and neuroendocrine cells, is considered as a sensitive predictor for neuronal damage.OBJECTIVE: To observe the changes of serum neuron-specific enolase in patients with transient brain ischemic attack, so as to explore its relationship with the degree of neuronal damage.DESIGN: Case-control observation.SETTING: Department of Neurology, Jinan No. 4 People's Hospital.PARTICIPANTS: A total of 29 patients who were hospitalized in the Department of Neurology, Jinan No. 4 People's Hospital, due to transient brain ischemic attack (all called for emergent medical treatment within the onset of 6 hours) between March 2002 and May 2004 were enrolled in this study. There were 18 males and 11 females with the average age of(60.36t11.67) years. According to the duration of neural functional deficits, all subjects were divided into two groups, namely, transient-symptom group (≤ 6 hours) of 19 cases and lasting-symptom group (＞ 6 hours)of 10 cases. At the same time, 25 healthy controls, 15 males and 10 females with the average age of (62.34±9.65) years, rere selected from those who came for routine health examination.METHODS: Fasting elbow venous blood of 1 mL was collected only once from the subjects in control group; the same amount of blood was collected from the patients in transient ischemic attack group immediately after hospitalization, and at days 2, 3, 4 and 5. Roche Elecsys 2010 automatic analyzer was used to detect serum neuron-specific enolase. Neuronal damage was assessed with neurological deficit scale (defined as practical recovery if scores were reduced by 90%-100%; remarkable improvement if scores were reduced by 46%-89%; improvement if scores were reduced by 18%-45%; ineffective if scores were reduced by less than 17% or even the disease aggravated).MAIN OUTCOME MEASURES: The daily changes of serum neuronspecific enolase.RESULTS: All the54 subjects remained in the final result analysis. [1]Comparison of neuron-specific enolase density: It was significantly higher in transient brain ischemic attack group than in control group [(23.53±12.35) vs(14.29±6.83) μg/L, t=2.678, P ＜ 0.01]. [2] Curve of neuron-specific enolase changes during the acute stage: It began to increase at the early stage,reached the peak level on the next day, and gradually declined to the normal level in 4-5 days. [3] The level of serum neuron-specific enolase in the two groups with various durations of neurological deficit symptoms: It was obviously higher in transient-symptom group than in control group [(19.24±8.95)vs (14.29±6.83) μg/L, t=1.893, P ＜ 0.05], and higher in lasting-symptom group than in control group [(28.87±13.15) vs (14.29±6.83) μg/L, t=4.367,P ＜ 0.001]. [4] The level of neuron-specific enolase was positively correlated with the duration of neuronal damage (r=0.815, P＜0.01).CONCLUSION: Serum neuron-specific enolase increases within a short term after transient brain ischemic attack and reaches the peak level at around 24-36 hours, suggesting that the detection of serum neuron-specific enolase has a guiding value in assessing the severity of transient brain ischemic attack.

Background:The incidence of inflammatory bowel disease( IBD ) is increasing in recent years,however,its pathogenic mechanism has not been fully clarified. Previous studies revealed that adipokines played crucial roles in regulating intestinal inflammation. Aims:To investigate the role of visfatin,an adipocytokine,and its clinical significance in active IBD. Methods:Ninety-one patients with active IBD including 61 Crohn’s disease( CD)and 30 ulcerative colitis ( UC)at the First Affiliated Hospital of Soochow University and Suzhou Municipal Hospital from May 2015 to Dec. 2015 were enrolled in this study,and 48 healthy subjects were served as controls. Serum level of visfatin was determined by ELISA. Correlation of serum visfatin level with clinical features of IBD was analyzed,its diagnostic performance for IBD was assessed by ROC curve. Results:Serum level of visfatin was significantly higher in patients with active CD and UC than in healthy controls[(385. 24 ± 112. 64)pg/mL and(378. 91 ± 118. 57)pg/mL vs. (321. 11 ± 96. 27)pg/mL, P all ﹤0. 05]. Significant positive correlation was found between serum visfatin level and disease activity index(Mayo score)of UC( r =0. 398,P ﹤0. 05 ),however,no correlations were found between serum visfatin level and disease activity index of CD,CRP and ESR,two common inflammatory indicators for IBD and location of IBD(P all ﹥0. 05). The area under curve( AUC)of serum visfatin for diagnosis of CD and UC were 0. 654 and 0. 622,respectively;the diagnostic accuracy was relatively low. Conclusions:Serum visfatin might be associated with the active intestinal inflammation in IBD and has the potential to be served as a clinical index for active UC.

Background:The abnormal expression of costimulatory molecules is closely related to immune escape of tumor cells. Programmed death-1(PD-1)is an important negative costimulatory molecule,and can induce and maintain the immune tolerance of tumor cells by binding with related ligands,thus promotes the development and progress of tumor. Aims:To investigate the expression of peripheral blood PD-1 and its clinical significance in patients with colorectal cancer. Methods:Eighty-eight patients with colorectal cancer from March 2015 to September 2015 at the First Affiliated Hospital of Soochow University were enrolled,and 16 healthy volunteers were served as controls. Level of soluble PD-1(sPD-1)was determined by ELISA. The expression of PD-l on CD3 + T cells in peripheral blood was measured by flow cytometry. Results:Level of sPD-1 and expression of PD-l on CD3 + T cells in peripheral blood in colorectal cancer patients were significantly higher than those in controls(P ﹤ 0. 05). Level of sPD-1 in colorectal cancer patients was closely related to tumor differentiation,lymph node metastasis and Dukes’stage( P ﹤ 0. 05),but not related to gender,age and tumor location(P ﹥ 0. 05). Conclusions:Peripheral blood PD-1 is highly expressed in patients with colorectal cancer,and is positively correlated with tumor stage and metastasis. The detection of PD-1 is helpful to estimate the progress of colorectal cancer,and it may become a new tumor marker or a target for anti-tumor targeted therapy.

Objective : To investigate the status of occupational stress and analyze its influencing factors among frontline employees working in a chemical fiber manufacturing enterprise, so as to provide insights into the development of occupational stress interventions. Methods : The frontline employees working in a chemical fiber manufacturing enterprise were selected as the study subjects using a cluster sampling method in October 2018. The status of occupational stress was investigated using the Chinese version of the effort-reward imbalance ( ERI ) questionnaire. The influencing factors for occupational stress were identified using a multivariable logistic regression model. Results : A total of 1 780 questionnaires were sent out, and 1 115 valid ones ( 62.64% ) were recovered. Among the 1 115 respondents, there were 427 men ( 38.30% ) and 688 women ( 61.70% ), and 71.22% were at ages of 21 to 39 years. There were 561 respondents with < 1 year of service ( 50.31% ), and the longest length of service was 11 years. In addition, there were 1 069 respondents ( 95.87% ) exposed to high noise, and 346 respondents ( 31.03% ) were diagnosed at a high occupational-stress state and 769 ( 68.97% ) at a low state. Multivariable logistic regression analysis identified 5 years or longer of service ( OR=1.540, 95%CI: 1.057-2.245 ) and exposure to high noise ( OR=1.917, 95%CI: 1.004-3.659 ) as risk factors for occupational stress among frontline employees in the chemical fiber manufacturing enterprise. Conclusions There are 31.03% of frontline employees at a high occupational-stress state in the chemical fiber manufacturing enterprise, and a high occupational-stress state is associated with exposure to high noise and 5 years or longer of service.

Objective:To characterize the clinical and epidemiological changes, treatments, and prognoses of primary esophageal small cell carcinoma (PESC). Methods:A retrospective analysis was conducted using the clinical epidemiology data of 529 PESC patients se-lected from the clinical databases of 500,000 esophageal and gastric cardiac carcinomas of the Henan Key Laboratory for Esophageal Cancer Research (1992-2015). Among these patients, 241 cases were included in the survival analysis. The five-year survival rate was calculated using Kaplan-Meier analysis, and the differences in survival rates were compared using the Log-rank analysis model. Re-sults:All 529 PESC cases were analyzed, which accounted for 0.2%of esophageal cancers diagnosed in the same period. The incidence of PESC increased annually (R2=0.574). The survival rates for 1-, 2-, 3-, and 5-year of 241 PESC patients were 55%, 40%, 29%, and 9%, respectively, and the median survival time was 21.9 months. On the basis of the VALSG criteria of lung small cell carcinoma, a statisti-cal difference was observed in the overall survival rates for limited and extensive diseases (P=0.003), with the median survival time of 24.3 and 17.5 months, respectively. Furthermore, significant differences were observed on survival with various treatment modalities (P=0.004). The median survival time of PESC patients treated with combined surgery and radiochemotherapies (28.8 months) was lon-ger than those with either chemotherapy (17.8 months, P=0.015) or chemoradiotherapy (14.5 months, P=0.004). In limited disease pa-tients, the median survival time was longer in patients treated with surgery (27.7 months) than in those without surgery (16.2 months, P=0.007). Notably, the biopsy diagnosis before surgery for PESC was only 40.8%. Conclusion:PESC is a rare malignant carcinoma with increasing incidence. PESC presents poor prognosis, and the survival rate can be improved through combined therapies based on sur-gery. A high misdiagnosis rate for PESC is observed before surgery with biopsy.

Objective To establish the quality standard of Wuji-Jianwei granules. Methods The contents of Bupleuri Radix, Codonopsis Radix, Paeoniae Radix Alba, Corydalis Rhizoma in Wuji-Jianwei granules were identified by using the thin layer chromatography (TLC) method. The contents of peoniflorin was determined by the high performance liquid chromatography (HPLC) method. Results The TLC had strong specificity and high separation, negative control without interference. The linear range was 0.124 8-0.748 8 μg for peoniflorin (r=0.999 6). The average recovery was 94.42% (RSD=1.46%) and the content of peoniflorin was 0.725 3 mg/g. Conclusions The method is accurate and reasonable, and can be used for the quality control of Wuji-Jianwei granules.

Objective:To establish microbial limit test methods for three Hospital Preparations: the Jianer Granule, Anti-inflammatory and anti-itching Liquor and Baicao Lotion. Methods:According to the four general principles of the Chinese Pharmacopoeia (edition 2015), to test the applicability for three kinds of hospital preparations with microbial count method using outine method, medium dilution method, membrane filtration method and neutralizer combined membrane filtration method. The applicability test of control bacteria test for three kinds hospital preparations was carried out by routine method, membrane filtration method and neutralizer combined with membrane filtration method. Results:The microbial limit test of Jianer Granule was tested by routine method. The microbial limit test of Anti-inflammatory and anti-itching Liquor was tested by membrane filtration method. The microbial limit test of Baicao Lotion was tested by neutralizer combined with membrane filtration method. Conclusions:Established the methods of microbial limit test for three kinds hospital preparations which are accurate and reliable.

Objective To investigate the current status of application of the Confusion assessment method for the Intensive Care Unit (Cam-ICU),and to explore its influencing factors.Methods A total of 300 patients admitted to were enrolled.The researchers and nurses used Cam-ICU to assess patients' delirium,respectively,and the differences in deliriun assessment were analyzed.Results For delirium assessment,the Kappa value was 0.546 between the researchers and nurses.The consensus rate was 17.6％ for hypoactive delirium,and 77.8％ for hyperactive delirium in 44 delirium patients.Logistic regression analysis showed that APACHE Ⅱ score,RASS score and delirium type were influencing factors of accurate assessment of delirium.Conclusion The consistence of assessment of delirium by ICU nurses is generally good,but the accuracy of assessment of hypoactive delirium is the worst.

Objective:To compare the efficacy of pericapsular nerve group (PENG) block combined with lateral femoral cutaneous nerve (LFCN) block versus fascia iliaca compartment block (FICB) in elderly patients undergoing total hip arthroplasty under general anesthesia.Methods:Fifty-eight patients of both sexes, aged 65-85 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective direct anterior approach to total hip arthroplasty, were divided into 2 groups ( n=29 each) using a random number table method: PENG block plus LFCN block group (PL group) and FICB group (F group). In group PL, the mixture (20 ml) of 0.375% ropivacaine hydrochloride and dexamethasone 3.3 mg was injected around the nerve innervating the hip joint capsule under ultrasound guidance.In group F, the mixture (30 ml) of 0.375% ropivacaine hydrochloride and dexamethasone 5 mg was injected around the nerve innervating the fascia iliaca compartment under ultrasound guidance.All the patients received patient-controlled intravenous analgesia with oxycodone after surgery.When visual analogue scale scores≥4 points, oxycodone 1 mg was intravenously injected as rescue analgesic.The intraoperative consumption of remifentanil was recorded.First time to ambulation, discharge destination, length of hospital stay, and effective pressing times of analgesic pump, requirement for rescue analgesia and the incidence of quadriceps weakness, nausea and vomiting and nerve block related complications within 48 h after surgery were recorded. Results:Compared with F group, intraoperative consumption of remifentanil was significantly decreased, effective pressing times of analgesic pump and incidence of quadriceps weakness were decreased, first time to ambulation and length of hospital stay were shortened, and first discharge destination was prolonged ( P<0.05), and no significant change was found in the requirement for rescue analgesia and the incidence of nausea ( P>0.05) in group PL. Conclusion:PENG block combined with LFCN block can reduce intraoperative consumption of opioids, be helpful for inhibiting postoperative pain sensitivity, and improve early recovery than FICB when used for total hip arthroplasty under general anesthesia.