Objective:To explore the quality management status of the final rinse water for flexible endoscope in medical institutions in Jilin Province, and analyze the factors affecting the quality of purified water.Methods:From January to May 2020, 75 medical institutions in Jilin Province were selected as subjects by convenience sampling. A self-designed Flexible Endoscopic Final Rinse Water Quality Management Questionnaire was used to investigate the managers of the Endoscopy Center in 75 medical institutions. The final rinse water of medical institutions was sampled on site, and 159 water samples were collected from the water treatment equipment terminal, water storage tank outlet and use terminal outlet, and the total number of bacteria was detected by pouring and filtration method. A total of 75 questionnaires were distributed, and 72 valid questionnaires were recovered, with a valid recovery rate of 96.00%.Results:A total of 40.28% (29/72) of medical institutions passed the final rinse water biological test results, and there was no statistically significant difference in the rate of passing the final rinse water biological test between different levels of medical institutions ( P>0.05) . In terms of the final rinse water production equipment configuration of medical institutions, the type of final rinse water, the availability of water treatment equipment, water treatment process, the installation of raw water pretreatment device, and the installation of disinfection device were the influencing factors of the biological test results of final rinse water, and the difference was statistically significant ( P<0.05) . In terms of the maintenance of the final rinse water production equipment, whether to record the maintenance of the final rinse water, whether to replace the filter membrane regularly, whether to disinfect the water storage tank and the disinfection of the pipeline in the medical institutions that installed the raw water pretreatment and filter membrane and other equipment were the influencing factors of the biological test results of the final rinse water, and the difference was statistically significant ( P<0.05) . In terms of the final rinse water quality monitoring, the establishment of the final rinse water quality monitoring system and the monitoring record were the influencing factors of the final rinse water biological detection results with a statistical difference ( P<0.05) . Conclusions:Medical institutions should pay attention to the quality control of the final rinse water for endoscope by relevant departments, increase financial support and scientific research support, formulate and improve relevant specifications, and unify industry standards and behaviors, so as to ensure the quality of the final rinse water for flexible endoscope and medical safety.

Objective:To explore the risk factors and follow-up outcomes of pediatric heart transplantation(HT).Methods:Between January 2018 and June 2022, perioperative data are retrospectively reviewed for 41 pediatric HT recipients aged <18 years and donor-recipient weight data for infants aged under 3 years at Guangdong Provincial People's Hospital.Perioperative survivors are followed up until August 31, 2022 through out patient visits and telephone calls.Postoperative survivals are examined by Kaplan-Meier method and possible risk factors for perioperative survival identify with Logistic regression.Results:There are 22 boys and 19 girls with a median age of 120(58~138)months.After preoperative adjuvant therapy of extracorporeal membrane oxygenation(ECMO), 8 cases had a successful transition to HT and 2 children underwent ABO incompatible(ABOi)HT.Six children aged under 3 years had a donor-recipient weight ratio of 2.95.Among 17 children, there are one or more complications, including continuous renal replacement therapy(CRRT, 9 cases, 21.95%), tracheotomy (3 cases, 7.32%), delayed chest closure or redo of sternotomy(6 cases, 14.63%)and acute graft dysfunction(4 cases, 9.76%). Five children died during perioperative period.The possible risk factors for perioperative mortality include preoperative ECMO assistance[ HR: 32.00, 95% CI: (2.83~361.79), P<0.05], preoperative CRRT[ HR: 11.33, 95% CI: (1.15~111.69), P<0.05] and total bilirubin [ HR: 1.02, 95% CI: (1.002~1.040), P<0.05]. During follow-ups, one child died from Epstein-Barr virus (EBV)associated post-transplant lymphoproliferative disease; another case of EBV-associated hepatic leiomyoma underwent transcatheter arterial embolization.With an overall survival rate of 85.37%, the cumulative survival rate is 96.97% for children without preoperative ECMO assistance( P<0.05). Postoperative mortality rate spiked markedly in children with preoperative ECMO assistance ( P=0.0013). However, follow-up results of perioperatively survivors indicate that preoperative usage of ECMO will not affect follow-up survival( P=0.53). In ABOi group or infants aged under 3 years, no mortality occurres postoperatively or during follow-ups. Conclusions:In infant aged under 3 years, the strategies of ABOi HT and large-weight donor HT are both safe and effective and it has no effect upon perioperative and follow-up survivals.Preoperative ECMO assistance, total bilirubin and preoperative use of CRRT are risk factors for perioperative survival.

Objective    To explore the correlation between perioperative blood transfusion and acute kidney injury (AKI) after heart transplantation. Methods    A retrospective study was performed on 67 patients who underwent heart transplantation in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital from January 2016 to December 2018, and finally 63 patients were included according to the exclusion criteria. There were 53 males and 10 females with an average age of 44.3±12.9 years. Twenty patients who adopted continuous renal replacement therapy (CRRT) after heart transplantation were divided into a RT group and the other 43 patients who did not use CRRT were divided into a non-RT group. Baseline characteristics, perioperative blood transfusion data and clinical prognosis were compared between the two groups. Results    The preoperative baseline characteristics of the two groups were basically the same. There were significant differences in perioperative infusion of red blood cells and plasma, postoperative 24 h bleeding and re-exploration (P<0.05) between the two groups. The area under the receiver operating characteristic (ROC) curve was 0.923 (95%CI 0.852 to 0.995, P<0.001). The ROC curve showed that perioperative infusion of red blood cells more than 18 mL/kg would increase the incidence of AKI after heart transplantation. Conclusion    Perioperative blood transfusion is closely related to AKI after heart transplantation. The more blood transfusion is in clinics, the higher incidence of renal injury is and the worse prognosis is. It is suggested that various blood-saving measures can be carried out.