Objective To compare one point and two points brachial plexus block anesthesia effect below the elbow surgery anesthesia.Methods 70 patients with elective elbow following orthopedic surgery were randomly divid-ed into two points group (group A)and one point group (group B)by random number table,each group had 35 cases.Analgesic effect of anesthesia was compared.The toxic reactions,neurovascular damage and other vascular complications of anesthesia were observed.Results The effective rate and incidence rate of complication of group A were 97.1% and 8.6%,those of group B were 77.1% and 11.4%(χ2 =6.248,0.159).The analgesic effect of group A was significantly better than group B (P <0.05),the incidence of anesthetic complications between the two groups showed no significant difference (P >0.05).Conclusion Axillary brachial plexus block of two points simul-taneous injection has better analgesic effect,block more perfect,it is the first selection of orthopaedics below the elbow surgery anesthesia method.

Objective To investigate the status of disinfection and sterilization quality of different levels of medical institu-tes in Xi’an,and improve the management level of disinfection and sterilization of medical institutes. Methods Disinfection and sterilization efficacy of 69 medical institutes were monitored and evaluated according to Standardization for Disinfec-tionTechniques (2002 edition)and Sanitary Standards for Hospital Disinfection (GB15982-1995). Results From 2011 to 2013,2 224 specimens were tested,1 766 (79.41% )were qualified.The qualified rate of tertiary medical institutes was higher than second and below medical institutes (83.67% vs 77.50% ,P= 0.001),the qualified rate between public medical institutes and private medical institutes was not statistically different (79 .64% vs 78 .20% , P= 0.532),the qualified rate of comprehensive medical institutes was higher than specialized medical institutes (80.18% vs 74.92% ,P= 0.030). Of different detected specimens,the qualified rates of disinfectant in use and pressure steam sterilizers (including test pack and process challenge device)were higher (98.46% ,100.00% ,and 98.06% respectively),while the hands of health care workers (HCWs)and glutaraldehyde were lower(58.48% and 43 .28% respectively).Conclusion Disinfection and sterilization quality in different medical institutes in Xi’an is dif-ferent,and different disinfected and sterilized objects are also varied .It is necessary to intensify the management of hand hygiene of HCWs and concentration of glutaraldehyde.

Objective To investigate the method and application of measurement uncertainty in clinical biochemical tests .Meth-ods The synthetic uncertainty and expanding uncertainty of 13 emergency biochemical tests items were compared between Hitachi 7600 and Beckman DXC800 automatic biochemical analyzer by usingmodel method.The test items included aspartate aminotrans-ferase ,total protein ,albumin ,glucose ,urea ,creatinine ,creatine kinase ,lactate dehydrogenase ,amylase ,potassium ,sodium ,calcium and chloride .Results Measurement uncertainty of aspartate aminotransferase and lactate dehydrogenase were 3 .66% and 3 .51%respectively ,which were the top two on Hitachi 7600 analyzer ;measurement uncertainty of calcium and creatinine were 4 .00% and 3 .90% respectively ,which were the top two on Beckman DXC800 .Compared between the two analyzers ,the test item with the lar-gest difference of measurement uncertainty was sodium(2 .62% ) ,and the second was creatinine(2 .40% ) .The difference of meas-urement uncertainty of the 13 emergency biochemical test items between the two analyzers were relatively small .Conclusion The two analyzer both have good performance ,Model methodis suitable for the evaluation of regular test items′measurement uncer-tainty in clinical biochemical laboratory .

Objective To understand the status quo of our young doctors' doctor-patient communi-cation and related influencing factors. Methods Among the doctors under the age of 40 in various clinical departments, according to 30% proportion, we randomly selected 32 doctors, and combined with revised Liverpool communication skills assessment scale (LCSAS) and standardized patients (SP), the doctors' ability of doctor-patient communication was evaluated. Descriptive statistics, t test and variance analysis were per-formed by SPSS 21.0 lines. Results The average score of communication etiquette of young doctors was (2.00±0.15), and the average score of their communication skills was (1.74±0.29), and the average score of their communication technical ability was (3.74±0.39). The detection rate of communication etiquette, communication skills and communication skills evaluation (less than 2) was 33.3%, 81.5%, and 85.2%, respectively. Physicians and surgeons' scores in communication etiquette and communication skills dimen-sion had significant difference (P<0.05). Significant difference was found in different ages doctor communi-cation protocol (F=3.641, P=0.028), and 20 to 25 years old doctors' score in communication manners was significantly lower than other ages (P<0.05). There were significant differences in the scores of doctors of different title in communication etiquette (F=4.410, P=0.023), and the trainee doctors' communication etiquette score was significantly lower than the physician and surgeon (P<0.05). Conclusion The commu-nication skills of young doctors in our hospital are generally in the middle state, and their communication etiquette is good, communication skills are general. There are great individual differences. Hospital should begin from those whose communication ability are low, cultivate their biology-psychology-social medicine thinking mode of the doctor-patient relationship , help new employees complete the role transformation , emotion management, and professional commitment, and encourage patients to participate in the medical process, so as to improve the doctors' communication ability in all directions and at different levels.

To discuss the clinical situation and treatment of cervical intramedullary spinal teratoma, two cases of it in our department were presented, and the related literatures were reviewed. A concomitant anomaly of the cervical vertebral canal was found to be accompanied by cervical intramedullary spinal teratoma. MRI showed the tumors with mixed signal intensity. During operation the tumor was found to have both cysts and hard bony nodules. It was very difficult to remove the total tumor. It is concluded that the plain film of cervical vertebra and cervical spine MRI are sensitive to differentiate teratomas from other tumors. Surgery should be the first choice for treatment.

To correlate the ultrasound and MR imaging of carotid atherosclerotic plaque with its histologic compositions,20 patients(22 lesions) scheduled for carotid endarterectomy were examined by B mode ultrasound and MRI preoperatively. The specimens were also examined postoperatively and the images of carotid plaque were recorded. The transverse pathological sections of plaques were made and matched with images of ultrasound and MRI. 256 gray scale ultrasound densitometric analysis of carotid plaque compositions was performed. Ultrasonic density of calcium, fibrous tissue, hemorrage/thrombus and lipid deposits was (89?12), (53?8), (37?6) and (39?3) respectively in vivo , and was (168?11), (136?12), (85?12) and (89?10) respectively in vitro . In vivo relative signal intensities of calcium, fibrous tissue, old hemorrhage/thrombus and lipid deposits were low, equal, equal and very high respectively on T 1 W MR image, and very low, equal, high and high respectively on PDW MR image, and low, equal or slightly high, high and high respectively on T 2 W MR image. Signal intensities of plaque contents ex vivo were correlated to signal intensities in vivo. Densitometric analysis of ultrasound images of carotid plaques can quantify possible components of plaque, and MRI has the feasibility to identify the components of plaque.

To study the distribution of two different phenotype mast cells in atherosclerotic lesions of human carotid arteries, 32 samples of endarterectomy and 10 autopsies of normal carotid specimens were fixed and embeded in paraffin, sections were stained with hematoxylin-eosin, toluidine blue,monoclonal antibodies against the two major proteases of mast cells(tryptase and chymase) and monoclonal antibodies against CD-3 of T lymphocytes and CD-68 of macrophages. The quantity,distribution and degranule of two different phenotype mast cells in atherosclerotic lesions of human carotid arteries were investigated,and the ratio of mast cells to T lymphocytes and macrophages in atherosclerotic lesions was calculated. The density(cells/mm 2 ) of mast cells in shoulder region of plaque(6 3?4 0) was much higher than that in normal intima,cap and core region(1 3?2 3,2 3?2 6,2 2?3 7) .The proportion of chymase-containing mast cells to tryptase-containing mast cells was 0 36,0 51,0 47 and 0 39 respectively in normal intima,cap,core and shoulder region of plaque.The propotion of degranulated mast cells was the highest in shoulder region of plaque(65%).The ratios of mast cells to T lymphocytes and to macrophages were 0 25 and 0 14 respectively in shoulder region of plaques.Light microscopic studies of mast cells revealed that mast cells were more commonly observed in thrombus and around calcification and blood vessels of plaque.Mast cells play a role in the formation of plaque,and participate in the destabilization of plaque.

Objective Discuss the methodology and significance of clinical transfusion assessment,establish an effective evaluation system for blood transfusion,identify rational indexes for the evaluation,and promote quality of clinical transfusion.Methods Development of the clinical blood transfusion assessment regulations,tightened blood transfusion approval system,enhanced medical record check for blood transfusion,better statistics for the data collected,and analysis of data in 2012 to compare changes in blood volume before and after tighter management in place.These efforts aim at improving the assessment system for optimal clinical blood transfusion.Results Compared to Jan.-June in 2012,patients discharged and surgical cases in Dec.of the same year dropped 2.15％ and 0.73％ respectively.However,the volume of blood transfusion decreased 22.7％,the percentage of blood transfusion for inpatients decreased from 8.78％ to 7.17％,and the average use of blood for inpatients decreased from 0.73U to 0.57U.Conclusion Reasonable and scientific assessment for blood transfusion and better clinical blood use management can improve blood transfusion therapeutic efficacy and save blood resources.

Objective To observe the behavioral effects of acute administration of dizocilpine (MK-801) in rats,and to determine an appropriate doses of the drug to mimicking memory deficits of schizophrenia.Methods 192 rats were randomly divided into model groups and control group,and given different doses of MK-801 or saline.Locomotor activity,pre-pulse inhibition (PPI) test and novel object recognition test were studied respectively.Results The spontaneous activity increased in a dose-dependent manner after the treatment of MK-801.The total distances of locomotor activity in 0.3 mg/kg group((127.04 ± 32.35) m) exhibited a significant difference compared with control group((35.34 ± 12.81) m,P ＜ 0.05).MK-801 decreased PPI in dose-dependent manner(P ＜ 0.01).MK-801 0.1 mg/kg((103.45 ± 68.04) ％) and 0.3 mg/kg ((41.55 ± 62.93) ％) groups showed significant differences compared to control group ((200.39 ± 30.97) ％) in PPI.The discrimination index of 0.03 mg/kg group((15.78 ± 6.23) ％) and 0.1 mg/kg group((22.42 ± 3.85) ％) were lower than that in control group((39.42 ±3.86)％,P＜0.05).Conclusion It is necessary for select right doses for model different endophenotypes of schizophrenia by MK-801.0.03 mg/kg of MK-801 is a relatively appropriate dosage to cause recognition memory damage.

Objective To alleviate or prevent the complication of propoful sedation and anesthesia during gastroscopy. Methods One thousand three hundred and fifty eight patients were undergone gastrosco-py under propoful sedation and anesthesia. Results Although some patients with intravenous use of propofol their blood pressure, heart and respiratory rate decreased in different extents, but others remained in normal range. During the operation, two cases(0. 15% )had hypotension which could be corrected after intravenous use of ephetonin; three cases (0. 22% ) had bradycardia that was restored after intravenous use of atropine; three hundred and eighteen cases (23. 42% )had cough which could be prevented by increasing the first dose of propofol and avoiding the pharyngeal simulation derived from operation; sixteen cases( 1. 18% )had serious chock accompanied with decreasing of blood oxygen saturation which could be alleviated by aspirating the guttural secretion, driving up the patients mandible and increasing oxygen inhalation, keeping the gastroscope dry and avoiding pumping water or air as passing through epiglottis are the effective methods in preventing chock. Forty six cases (3. 39% ) complained of pain in the injection site which could be alleviated by choosing a major vein and injecting drug slowly; forty three cases(3. 17% ) had nausea and two cases(0. 15% ) had phreno muscular spasm which could be alleviated or prevented by skilled manipulation; thirty nine cases (2. 87% )had vertigo after regaining consciousness, keeping in bed or deferring to wake the patient up are very effective in preventing and alleviating this symptom. Conclusion Although gastroscopy under propoful' s sedation and anesthesia is safe and effective, logical precautions are the keys to attain success and lessen complications.