Objective To analyze the causes for the biological monitoring abnormal results of the pressure steam sterilizer to eliminate non-standard operation and hidden risks during biological monitoring.Methods Totally 34 secondary or above medical institutions in Chongqing were selected randomly,and questionnaire survey was carried out over biological monitoring abnormal results and main influencing factors of the pressure steam sterilizer.Results Of the 126 abnormal results,there were 63 positive results (accounting for 50％) and the main influencing factors included expiration,aged seal ring,low-efficiency vacuum pump,nonstandard loading,bioindicator reproduction before sterilization,false positive result,polluted moist incubator and etc;There were 35 cases of results related to fast reader (accounting for 27.78％) and the main factors consisted of failure of reading light,improper input of bioindicator,dusts in the reading hole and etc;There were 18 cases of bioindicator discoloration before culture (accounting for 14.28％) and the main factor was reproduction occurred before the gemma was inactivated;There were l0 cases of nondiscoloring in case of positive control (accounting for 7.94％) and the main factors included non-crushed indicating mediostratum cultured in the incubator,insufficient shaking after crushing mediostratum and etc.Conclusion The main factors for abnormal biological monitoring of the sterilizer involve in equipment,personnel and material,and the quality control has to be executed from the three aspects.

Objective: To improve clinical nutritional support, Ten years′ experience of nutritional support in critical patients was reviewed. Methods: The 2 590 critical patients came from 19 departments in our hospital, including 20 kinds of diseases. The nutritional support ways included parenteral nutrition (PN) and enteral nutrition (EN).At the same time, some nutritional indexes were examined in patients operations for with guttural cancer and heart and in older critical patients. Results: There was a rising in enteral nutritional support for critical patients. It was obvious that the patients′ nutritional indexes had been improved after nutritional support. Conclusions: The right nutritional support is beneficial to critical patients in improving the immunity and is one of the important ways to improve the level of treatment.

Objective The study aimed to evaluate the application effect of clinical pathways in laparoscopic cholecystectomy patients by using the meta-analysis.Methods Published randomized controlled trials (RCT) about laparoscopic cholecystectomy patients were searched and screened in China National Knowledge Infrastructure (CNKI),China Scientific Journal Database by VIP,Wanfang Database under present standards.The quality of the included studies was evaluated by certain standards.The Review Manager 5.2 software was used for analysis.Results Totally 29 studies including 5 570 cases were eligible to the criteria (2 753 in the experimental group and 2 853 in the control group) altogether.The meta-analysis showed that the hospitalization time and hospitalization costs in the clinical nursing pathway group were significantly less than those of the control group (SMD=-1.69 and-3.75),the satisfaction degree and the mastering of health knowledge in the clinical nursing pathway group were significantly higher than those of the control group (RR=1.16 and 1.26),the differece had statistical significance.Conclusions Application effect of clinical nursing pathways is superior to the traditional nursing method in laparoscopic cholecystectomy patients.

OBJECTIVE: To measure the upper airway of obstructive sleep apnea-hypopnea syndrome by speed CT. We can predict the airway obstruction plane with the airway plane data and compliance in OSAHS patients. Through this measurement, we can provide assistance for clinical diagnosis and treatment. METHOD: This study randomly selected 82 patients diagnosed with OSAHS and 45 cases non-snoring healthy people as control group by the PHILIPS 256-slice CT. The zone volume, sagittal diameter, coronary diameter and cross-sectional area of the narrowest plane in nasopharyngeal area, velopharyngeal area, glossopharyngeal area, hypopharynx area in two groups of quiet respiration and Müller's status were measured. RESULT: In the OSAHS group underwent quiet breathing and Müller movement during CT scanning, the two states about nasopharyngeal coronary diameter, the hypopharynx sagittal diameter and cross-sectional area showed no significant difference, while other groups showed differences between the parameters (P<0.05). There was significant difference (P<0.01) in the velopharyngeal volume, tongue sagittal diameter and volume. Under Müller movement in the OSAHS group and the control group, the hypopharynx volume showed no significant difference. The nasopharyngeal coronary diameter and volume, velopharyngeal cross-sectional area and tongue sagittal diameter were different (P<0.05). The remaining set of parameters showed significant differences (P<0.01). Compared the airway compliance (Müller phase) of the OSAHS group and the control group,the parameters of each group were different (P<0.05), of which the nasopharyngeal sagittal diameter, velopharyngeal volume showed significant difference (P<0.01). Meanwhile, in the same plane, coronary diameter was greater than sagittal diameter (P<0.05) in both the OSAHS group and the control group. The pharyngeal volume measurement was basically consistent to the fiber endoscopy. CONCLUSION The obstruction plate of OSAHS patients is mostly in the velopharyngeal area and glossopharyngeal area measured with a high speed CT. The volume measurement of upper airway with speed CT can predict airway obstruction plate in patients with OSAHS.
Case-Control Studies ; Humans ; Hypopharynx ; Nasopharynx ; diagnostic imaging ; Pharynx ; diagnostic imaging ; Sleep Apnea, Obstructive ; diagnostic imaging ; Tomography, X-Ray Computed ; Tongue ; diagnostic imaging

Objectives:To summarize the experience of nutrition management in pancreaticorenal transplantation patients. Methods:The principle of enteral nutrition before operation is high energy,rich protein and vitamin,and increased insulin usage,in order to ameliorate malnutrition for operation.Intravenous nutrition, intravenous nutrition plus enteral nutrition, and enteral nutrition were applied respectively during the postoperative stage. Results:The body weight,circumference of upper arm and skin fold thickness of triceps muscle increased in two patients,plasma albumin and hemoglobin increased in four,and total plasma protein increased in three. Conclusions:Nutrition management of the patients is very necessary for pancreaticorenal transplantation patients,and the stepwise nutrition support after operation is feasible.Appropriate calories and nutritional elements are essential to the nutrition support,and the nutritional amelioration correlates with the condition and period of nutrition support.

OBJECTIVE: To analyze the expression of transforming growth factor-beta1 (TGF-beta1) in human vocal fold polyps, and explore the pathogenesis of vocal fold polyp. METHOD: The expression of TGF-beta1 were detected in 37 examples of vocal fold polyps and 11 healthy vocal folds by immunohistochemical staining (SP method). Meanwhile, the positive results were compared. RESULT: The percent of positive expression of TGF-beta1 was 56.76% and the number of positive cells was 22.55 +/- 27.31 in vocal fold polyps, both of which were significantly increased compared with the percent of positive expression of TGF-beta1 (18.18%) and the number of positive cells (2.53 +/- 3.75) in healthy vocal folds (P<0.05). The positive expression of TGF-beta1 in stroma cells of vocal cord polyps was significantly higher than that in the healthy vocal cords. There was no significant difference of TGF-beta1 between the vocal fold polyps of male and female (P>0.05). CONCLUSION TGF-beta1 may participate in some pathologic changes in vocal cord polyps, such as extracellular matrix accumulation, local fibrosis and formation and development of vocal cord polyps. Manipulating the TGF-beta1 expression in vocal cord polyps may supply a new treatment method.
Adult ; Aged ; Case-Control Studies ; Female ; Humans ; Laryngeal Diseases ; metabolism ; pathology ; Male ; Middle Aged ; Polyps ; metabolism ; pathology ; Transforming Growth Factor beta1 ; metabolism ; Vocal Cords ; metabolism ; pathology ; Young Adult

OBJECTIVE: To evaluate the expression of endothelin-1(ET-1) and matrix metalloproteinase-9 (MMP-9) in laryngeal carcinoma and their correlations with clinical features. METHOD: The expression of ET-1 and MMP-9 was detected by immunohistochemical method in 58 specimens of laryngeal carcinoma, 28 specimens of polyps of vocal cord and 19 specimens of normal laryngeal tissues. RESULT: The expressions of ET-1, MMP-9 in laryngeal carcinoma were remarkably higher,compared to polyps of vocal cord and normal laryngeal tissues (P < 0.05). The expression of ET-1, MMP-9 was associated with clinical stage, T stage and lymph node metastasis. Expression levels of ET-land MMP-9 correlated significantly with each other (r(s) = 0.693, P < 0.05). CONCLUSION The expression of ET-1 and MMP-9 may be the vital indexes in laryngeal carcinoma.
Adult ; Aged ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Endothelin-1 ; metabolism ; Female ; Humans ; Laryngeal Neoplasms ; metabolism ; pathology ; Male ; Matrix Metalloproteinase 9 ; metabolism ; Middle Aged ; Neoplasm Staging

Objective:To investigate the etiological characteristics and drug resistance patterns of multidrug-resistant organism (MDRO) infection in patients after cardiac surgery, so as to help clinicians rationally prescribe antimicrobials recommended by guidelines, increase the success rate of empirical antibacterial therapy and improve the prognosis of inpatients.Methods:Clinical data of 409 patients diagnosed with nosocomial infection (NI) after cardiac surgery from January 2018 to October 2021 were retrospectively collected. According to the results of culture, these cases were divided into two groups: MDR bacterial infection group (MDR, n=176) and non-MDR bacterial infection group (non-MDR, n=233). The etiological characteristics of MDRO infection and the patterns of drug resistance to commonly used clinical antibiotics were analyzed. Meanwhile, the etiological distribution, drug resistance and clinical outcome corresponding to different surgical types and clinical infection types were statistically analyzed. Results:A total of 306 strains of MDR bacteria were detected. Among the 176 patients, 97 (55.1%) were infected with more than one kind of MDRO and the mix infections were mainly caused by Klebsiella pneumoniae, Acinetobacter baumannii and/or Pseudomonas aeruginosa. Carbapenem-resistant (CR) bacteria accounted for 69.6% (213/306). Regardless of surgical type and clinical infection type, Acinetobacter baumannii (114/306, 37.3%) was the most common pathogenic bacteria, followed by Klebsiella pneumoniae (72/306, 23.5%) and Pseudomonas aeruginosa (55/306, 18.0%). Most of the clinical specimens were sputum specimens (528/601, 87.9%) and most of the isolated strains were carbapenem resistant, MDR and extensively drug-resistant (XDR). The positive rates of MDR bacteria were 53.7% and 53.1% in patients undergoing coronary artery bypass grafting (CABG) and aortic surgery, respectively, while the positive rates of pandrug-resistant bacteria were relatively low. In vitro drug sensitivity test results showed that MDR bacteria were highly resistant to levofloxacin (64.4%) and cefepime (61.4%), and then to ciprofloxacin (54.6%), ceftazidime (53.9%) and cotrimoxazole (52.4%). However, the resistance rates to polycolistin (5.5%) and amikacin (7.2%) were low. Compared with non-MDR bacteria, MDR bacteria were less susceptible to ceftazidime (χ 2=156.663, P<0.001), ceftriaxone (χ 2=27.844, P<0.001), cefepime (χ 2=210.181, P<0.001), imipenem (χ 2=173.242, P<0.001), levofloxacin (χ 2=201.521, P<0.001), ciprofloxacin (χ 2=180.187, P<0.001), amikacin (χ 2=16.661, P<0.001), gentamicin (χ 2=46.047, P<0.001), tobramycin (χ 2=106.546, P<0.001), piperacillin (χ 2=7.325, P=0.007), ampicillin/sulbactam (χ 2=5.415, P=0.020), piperacillin/tazobactam (χ 2=139.506, P<0.001), cefoperazone/sulbactam (χ 2=102.832, P<0.001), cotrimoxazole (χ 2=121.217, P<0.001), aztreonam (χ 2=6.977, P=0.008) and minocycline (χ 2=53.107, P<0.001). Although there was no significant difference in the detection rates of pathogenic bacteria between patients undergoing different types of surgery or having different types of infection, the mortality rate of NI after cardiac surgery, especially MDR bacterial infection, was as high as 30.0%. Moreover, the mortality rate was closely related to the types of clinical infection. The all-cause mortality of common pulmonary infection and bloodstream infection (BSI) was 10.0% to 20.0%, and once the patient′s condition was not under control and progressed to severe infection or even septic shock, the all-cause mortality would double. Conclusions:MDR bacterial infections would bring great challenges to patients after cardiac surgery, especially gram-negative bacteria (GNB) such as Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. More than half of the patients would have mixed infections caused by carbapenem resistant, XDR or even pandrug-resistant bacteria, resulting in limited choice of anti-infective drugs and poor prognosis in hospitalized patients.

Objective:To evaluate the perioperative and follow-up data of carotid artery stenting (CAS)+ coronary artery bypass grafting (CABG) and CABG alone, and to assess the safety and efficacy of CAS in the treatment of severe stenosis of the carotid artery in combination with asymptomatic carotid artery stenosis.Methods:A retrospective analysis of 700 CABG patients combined asymptomatic carotid artery severe stenosis at Beijing Anzhen Hospital, Beijing Chaoyang Hospital, and Beijing Tiantan Hospital from January 2018 to December 2022 was performed. According to whether or not underwent CAS treatment, they were divided into the CAS-CABG group(116 cases)and the CABG-only group(584 cases). The mean age of the CAS-CABG group was (64.8±7.3) years, and all of them underwent unilateral CAS surgery only; the mean age of the CABG only group was (65.5±7.6) years. The main results of the patients in the two groups were compared at 30 days after the operation and follow-up period.Results:The early postoperative stroke rate was significantly lower in the CAS-CABG group(2.6% vs. 9.1%, P=0.02), while the combined procedure did not increase the rates of mortality and adverse events during follow-up. Subgroup analysis revealed that there was no significant difference in stroke rates between the two procedures for asymptomatic unilateral carotid artery stenosis, advanced age, history of atrial fibrillation, and history of stroke were independent risk factors for early stroke in CABG for asymptomatic unilateral carotid artery stenosis. Conclusion:CAS-CABG is safe and effective in the treatment of coronary artery disease combined with asymptomatic carotid artery stenosis, and can reduce the incidence of early postoperative stroke in patients. CABG patients with asymptomatic carotid stenosis should be rationally screened for prophylactic CAS to reduce the risk of postoperative stroke in these patients.

ObjectiveTo investigate the regulatory effects of Xuanfu Daizhetang on a mouse model of allergic asthma induced by ovalbumin （OVA）. MethodSixty female BALB/c mice （6-8 weeks old， SPF） were randomly divided into groups. Ten mice were assigned to the normal group and given 0.2 mL of saline， while the remaining groups received intraperitoneal injections of Al（OH）₃ at 5 g·L^-1 and OVA at 1 g·L^-1. The mice were divided into normal group （10 mL·kg^-1 saline）， OVA model group （10 mL·kg^-1 saline）， dexamethasone group （OVA+DEX， 1 mg·kg^-1）， OVA+ low-dose Xuanfu Daizhetang group （OVA+XL， 7.065 g·kg^-1）， OVA+ medium-dose Xuanfu Daizhetang group （OVA+XM， 14.13 g·kg^-1）， and OVA+ high-dose Xuanfu Daizhetang group （OVA+XH， 28.26 g·kg^-1）. An OVA-induced asthma model was established in mice. Hematoxylin-eosin （HE） and periodic acid-Schiff （PAS） staining methods were used to observe bronchial tissue pathological changes. Enzyme-linked immunosorbent assay （ELISA） was performed to measure the levels of immunoglobulin E （IgE）， interleukin-4 （IL-4）， IL-5， IL-13， IL-17A， and γ interferon （IFN-γ） in bronchoalveolar lavage fluid. Western blot was used to detect the phosphorylation of extracellular signal-regulated kinase （ERK）， p38 mitogen-activated protein kinase （MAPK）， and c-Jun N-terminal kinase （JNK） proteins in lung tissue. ResultCompared with the normal group， the OVA model group showed increased inflammatory cell infiltration in mouse alveoli， elevated levels of IL-4， IL-5， IL-13， IL-17A， IFN-γ in bronchoalveolar lavage fluid， and IgE in serum （P<0.05， P<0.01）， and promoted phosphorylation of MAPK signaling pathway-related proteins. Compared with the model group， the OVA+XL， OVA+XM， and OVA+XH groups showed reduced inflammatory cell infiltration in mouse alveoli， decreased levels of IL-4， IL-5， IL-13， IL-17A， IFN-γ in bronchoalveolar lavage fluid， and IgE in serum （P<0.05， P<0.01）， and inhibited phosphorylation of MAPK signaling pathway-related proteins. ConclusionThe results of this study suggest that Xuanfu Daizhetang has potential anti-allergic asthma activity， providing a theoretical basis for its future clinical application.