Application of Pulsating Vacuum Cleaning Technology to Medical Devices Cleaning

This study aims to solve existing problems in cleaning medical devices, such as the cumbersome loading of minimally invasive surgical instruments, the incomplete cleaning of instruments with complex structures, and the low cleaning efficiency of ordinary instruments. A pulsating vacuum cleaning machine was combined with ultrasonic cleaning and boiling cleaning technology to clean various complex medical devices through a pressure pulsating process (i.e., repetitive pump-out and pumpin until the cleaning results meet the cleaning standards for medical devices). The cleaning results of spay washing, ultrasound cleaning and pulsating vacuum cleaning were compared among four groups of medical devices, including silica gel hoses, chamber instruments, whole box of minimally invasive instruments and surgical instruments. The amount of protein residues was tested using the spectrophotometric method. The testing results revealed that the loading capacity of a pulsating vacuum cleaning machine is 3–4 times as much as that of an ordinary spray cleaning machine, without manual placement and connection operation required, which reduced the workload of pretreatment. The protein residue after cleaning meets the requirements of the YY/T0734 standard for the cleaning effect of medical devices. Pulsating vacuum cleaning technology has an overall better loading capacity, when compared to spay washing and ultrasound cleaning, and this can make up for the shortcomings of commonly used cleaning machines, such as the low cleaning efficiency and unsatisfactory cleaning results of medical devices with complex structures.

Minimally invasive endoscopic approach to perform complete coccygectomy in patients with chronic refractory coccydynia: illustrative case

BACKGROUND Coccydynia refers to debilitating pain in the coccygeal region of the spine. Treatment strategies range from conservative measures (e.g., ergonomic adaptations, physical therapy, nerve block injections) to partial or complete removal of the coccyx (coccygectomy). Because the surgical intervention is situated in a high-pressure location close to the anus, a possible complication is the formation of sacral pressure ulcers and infection at the incision site. OBSERVATIONS In this case report, the authors presented a minimally invasive, fully endoscopic approach to safely perform complete coccygectomy for treatment of refractory posttraumatic coccydynia. LESSONS Although this is a single case report, the authors hope that this novel endoscopic approach may achieve improved wound healing, reduced infection rates, and lower risk of penetration injury to retroperitoneal organs in patients requiring coccygectomy.

Postmortem brain 7T MRI with minimally invasive pathological correlation in deceased COVID-19 subjects

Background Brain abnormalities are a concern in COVID-19, so we used minimally invasive autopsy (MIA) to investigate it, consisting of brain 7T MR and CT images and tissue sampling via transethmoidal route with at least three fragments: the first one for reverse transcription polymerase chain reaction (RT-PCR) analysis and the remaining fixed and stained with hematoxylin and eosin. Two mouse monoclonal anti-coronavirus (SARS-CoV-2) antibodies were employed in immunohistochemical (IHC) reactions. Results Seven deceased COVID-19 patients underwent MIA with brain MR and CT images, six of them with tissue sampling. Imaging findings included infarcts, punctate brain hemorrhagic foci, subarachnoid hemorrhage and signal abnormalities in the splenium, basal ganglia, white matter, hippocampi and posterior cortico-subcortical. Punctate brain hemorrhage was the most common finding (three out of seven cases). Brain histological analysis revealed reactive gliosis, congestion, cortical neuron eosinophilic degeneration and axonal disruption in all six cases. Other findings included edema (5 cases), discrete perivascular hemorrhages (5), cerebral small vessel disease (3), perivascular hemosiderin deposits (3), Alzheimer type II glia (3), abundant corpora amylacea (3), ischemic foci (1), periventricular encephalitis foci (1), periventricular vascular ectasia (1) and fibrin thrombi (1). SARS-CoV-2 RNA was detected with RT-PCR in 5 out of 5 and IHC in 6 out 6 patients (100%). Conclusions Despite limited sampling, MIA was an effective tool to evaluate underlying pathological brain changes in deceased COVID-19 patients. Imaging findings were varied, and pathological features corroborated signs of hypoxia, alterations related to systemic critically ill and SARS-CoV-2 brain invasion.