内镜手工清洗消毒研究及自动清洗消毒机消毒效果抽样调查

目的 了解消化内镜清洗消毒现状,选择实用可靠的内镜清洗消毒方法。方法 在北京部分三级甲等医院进行内镜清洗时加或不加酶洁液、2％戊二醛7min消毒效果的测试;并抽查国产自动清洗消毒机的消毒效果。结果 测试部分:使用酶洁液清洗组301例,2％戊二醛浸泡消毒7min,不长菌例数为283例（94、02％）;不使用酶洁液组155例,2％戊二醛浸泡消毒7min,不长菌例数为137例（88.39％）。以清洗消毒后每条胃镜≤20个非致病细菌数为合格标准,使用酶洁液组合格为298例（99.00％）,不使用酶洁液组147例（94.84％）,两组清洗消毒效果差异有统计学意义（P<0.01）。抽查部分:清洗消毒机135例,清洗消毒3 min后不长菌为4例（11.43％）,以清洗消毒后每条胃镜≤20个非致病细菌数作为合格标准,合格为5例（14.29％）;清洗消毒机 Ⅱ29例,清洗消毒 3min,不长菌为2例（6.90％）,合格例数为6例（20.69％）;清洗消毒机Ⅱ20例,更换消毒液,清洗消毒3 min 2次,不长菌为17例（85.00％）,合格例数为18例（90.00％）。结论 内镜使用后各个部分的彻底清洗是保证消毒质量的重要环节,清洗过程中使用酶洁液明显增加了清洁度,在此基础上2％戊二醛浸泡消毒7min可达到内镜消毒标准。目前使用的国产内镜清洗消毒机常规单一的3min和6min的消毒程序达不到     

酶洁液和氧化电位水在胃镜全浸泡式消毒中的效果观察

目的评价酶洁液清洗氧化电位水(EOW)全浸泡对胃镜消毒的效果。方法对120例接受胃镜检查的病人按清洗方法随机分成酶洁液组(60人)和流动水组(60人),两组于胃镜清洗、酶洁液浸泡及流水清洗前后留取镜身、钳道和操作部样本行细菌培养,检测清洗效果。两组胃镜清洗后按EOW浸泡消毒时间2min和4min各分两个时间组,每组30例,消毒后留取镜身、钳道和操作部样本进行细菌培养,检测EOW的消毒效果。结果①清洗前胃镜污染情况严重,细菌培养阳性为:操作部115例(95.8%),镜身、钳道120例(100%);②酶洁液清洗后操作部阳性11例(18.3%),镜身、钳道细菌培养阳性14例(23.3%),而流动水清洗后操作部阳性19例(31.7%),镜身、钳道细菌培养阳性26例(43.3%),两组具有显著性差异(P<0.05);③酶洁液组消毒2min后,细菌培养阳性均为0,而流动水组清洗消毒2min后镜身及钳道7例(23.3%)阳性,操作部6例(20.0%)阳性,两组有显著性差异(P<0.05);消毒4min两组细菌培养均为阴性。结论酶洁液清洗消毒更彻底,经EOW消毒4min可以达到消毒标准。     

胃镜清洗消毒前后幽门螺杆菌的检测

目前国内常规胃镜清洗消毒方法多为三步法,即清洗、消毒和冲洗,现观察两种常用消毒剂对胃镜幽门螺杆菌（Hp）的清除效果。 一、材料与方法 1.胃镜清洗消毒方法:在每例胃镜检查后,均用金鱼洗涤剂刷洗胃镜表面以去除粘液及血液,并进行抽吸以冲洗胃镜各通道,时间约 30s;然后用戊二醛消毒剂浸泡镜身及活检通道3 min或用四环牌清洗消毒剂（含有效氯消毒剂）浸泡5 min,同时用毛刷刷洗活检通道;最后用流动水冲洗镜身表面及进行抽吸冲洗通道,以去除残留的消毒剂,时间约1min,然后用于下一个患者检查。     

胃镜乙型肝炎表面抗原消毒模拟试验

胃镜的临床应用日益广泛，带来了乙型肝炎病毒的污染问题，其消毒越来越受到重视犤１犦。由于给HBsAg阳性患者行胃镜操作时，粘附在胃镜的镜身、活检钳上的病毒含量不同，难以标准化。为此，我们用已知浓度的HBsAg涂布在胃镜镜身、活检钳钳瓣上，然后对胃镜进行手工清洗、戊二醛消毒及不同时间超声雾化内镜消毒机清洗消毒。收集消毒前、后的标本，分别检测HBsAg，以探讨胃镜污染HBsAg后手工消毒效果与机器消毒所需最短时限。一、材料乙型肝炎表面抗原：纯抗原HBsAg（１g／L），由浙江省疾病控制中心惠赠，将原液用５％小牛血清稀释成…     

新型过氧乙酸溶液消毒消化内镜的效果评价

目的 探讨新型过氧乙酸溶液应用于消化内镜消毒的临床价值.方法 选择消化内镜40条分成两组,每组胃镜和肠镜各10条,观察组接受新型过氧乙酸溶液消毒10 min,对照组接受常规2％戊二醛溶液消毒10 min,比较两组消毒合格率,评价新型过氧乙酸溶液消毒的有效性.有效性获得证实后,再选择消化内镜80条分成四组,每组胃镜和肠镜各10条,分别接受新型过氧乙酸溶液消毒2 min、3 min、4 min和5 min,比较消毒合格率,探讨新型过氧乙酸溶液消毒的高效性.结果 对照组胃镜消毒合格率为100％ (10/10),肠镜消毒合格率为90％(9/10),消毒后胃镜和肠镜均能检出菌落;观察组胃镜和肠镜消毒合格率均为100％,且消毒后胃镜和肠镜均不再检出菌落,明显优于对照组.新型过氧乙酸溶液消毒3 min组、4 min组和5 min组胃镜消毒合格率均为100％(10/10),明显高于2 min组的30％ (3/10) (P ＜0.05),但3 min组仍可检出菌落;2 min组肠镜消毒均不合格,4 min组和5 min组肠镜消毒合格率均为100％,明显高于3 min的80％ (8/10) (P ＜0.05),但4 min组仍可检出菌落.结论 新型过氧乙酸溶液可用于临床消化内镜的消毒,较2％戊二醛溶液更符合消化内镜高水平消毒的要求.     

四步法对污染胃镜的消毒效果

内镜检查与治疗引起的交叉感染时有报道,因此,内镜的有效消毒显得非常重要。我院内镜室用四步消毒法对内镜进行清洗消毒,经验证,消毒效果肯定,现报道如下。 操作方法:先用酒精纱布擦净内镜镜身表面粘液及污迹,放入1:200的84消毒液（青岛产）中,擦洗镜身并持续吸引冲洗内管道,然后取出置于高压自来水多孔冲洗槽中,用自来水反复冲洗镜身,再将内镜放入1:2000的氧氯灵-100（北京产）液中浸泡3 min,并不断送气吸水。最后将胃镜放入无菌蒸馏水中冲洗1～2 min。取出胃镜,垂直吊起,取内管道中流出液体2 ml于无菌试管中。再用无菌盐水纱布环绕镜身反复擦拭（工作刻度以下）,将纱布放入无菌生理盐水中浸泡2 min,将2 ml洗脱液置另一无菌试管中。将2     

氧化电位水对消化内镜消毒效果的研究

目的 检测氧化电位水(electrolyzed oxidizing water，EOW)对消化内镜的消毒效果并与2％戊二醛相比较。方法 (1)对一般细菌的消毒效果：顺次抽取检查患者后的消化内镜，EOW组和2％戊二醛组均分别浸泡消毒1、3、5min，每时间组均为30例，进行细菌培养。(2)对幽门螺杆菌(Hp)的消毒效果：顺次抽取快速尿素酶试验阳性者使用过的以及Hp人为污染后的内镜，2种消毒剂按消毒时间分组同上，PCR法检测Hp残留。(3)对乙肝病毒(HBV)的消毒效果：用HBV阳性血清稀释液污染内镜，2种消毒剂分别作用1、3、5、10min，每时间组30例，PCR法检测HBV残留。结果 (1)一般细菌：消毒1、3、5min后，EOW组细菌培养均为阴性，2％戊二醛组分别有阳性5例、4例、1例。(2)Hp：EOW组作用1min后2例阳性，3、5min后的均为阴性；2％戊二醛作用1、3、5min后分别有3例、4例、4例阳性。(3)HBV：EOW组作用1、3、5、10min各组均为阴性；2％戊二醛组作用后各时间组分别有2例、5例、4例、5例阳性。结论 EOW对一般细菌、Hp、HBV等有较强的杀灭作用，较2%戊二醛消毒力强、快速，可推荐为临床内镜消毒。     

戊二醛三槽法消毒胃镜使用后肝功及HBsAg评析

目的：探讨在基层医院使用戊二醛消毒胃镜的某些方法。方法：总结分析现有226份较为完整的资料，观察使用戊二醛三槽法消毒内镜后，HBsAg阴性患者肝功能复查情况。结果：全部HBsAg阴性患者肝功能复查结果均正常。结论：规范使用戊二醛三槽法消毒内镜后，能最大限度减少乙肝病毒感染机率。     

影响戊二醛消毒内镜的效果观察

1997年以来,我院将 2％戊二醛用于胃镜消毒。由于戊二醛易挥发,易受多种因素的影响,直接影响到消毒效果,现将几种影响因素报告如下。 　　1.一般资料：使用者为各种需作胃镜的患者,（乙肝除外）,包括上消化道肿瘤,消化性溃疡,急慢性胃炎等。 　　2.配制方法： 25％的戊二醛溶液 100ml,加蒸馏水 1 250ml,加 3％碳酸氢钠 3.75g,配制成 2％碱性戊二醛。 　　3.检查方法及分组： (1)取少量 2％戊二醛消毒液 2份作对照,一份密封,一份暴露于空气中。胃镜使用后,用 1： 200 84消毒液及清水冲洗各部件及镜身全部活动旋钮,吸引冲洗 10…     

Ⅲ型过氧乙酸消毒液用于消化内镜的消毒效果观察

目的评估Ⅲ型过氧乙酸消毒液的内镜消毒效果。方法按照2016版《软式内镜清洗消毒技术规范》规定的内镜清洗消毒流程,分别使用2%戊二醛和Ⅲ型过氧乙酸消毒液对内镜进行消毒,在指定步骤通过内镜活检通道采样,对采样标本进行细菌培养计数和致病菌检测。采用化学免疫发光法检测Ⅲ型过氧乙酸消毒液消毒后样本的乙型肝炎病毒表面抗原（HBsAg）、丙型肝炎病毒抗体（抗-HCV）及梅毒螺旋体特异性抗体（TP-Ab）水平。选取部分使用Ⅲ型过氧乙酸消毒液进行消毒的内镜连续采集样本5 d。结果使用2%戊二醛消毒剂的胃镜56条、肠镜16条（戊二醛组）,使用Ⅲ型过氧乙酸消毒液的胃镜46条、肠镜15条（过氧乙酸组）,戊二醛组及过氧乙酸组消毒后胃、肠镜菌落计数均明显减少（P＜005）,过氧乙酸组胃镜消毒合格率和总合格率均高于戊二醛组[胃镜消毒合格率：9783%（45/46）比9286%（52/56）,P＞005;总合格率：9836%（60/61）比9444%（68/72）,P＞005],2组肠镜消毒合格率均为10000%（15/15,16/16）。Ⅲ型过氧乙酸消毒液消毒后胃、肠镜取样样本中HBsAg、抗-HCV及TP-Ab均为阴性;连续采样5 d的内镜在各时间点测得的菌落数目差异无统计学意义（P＞005）。结论Ⅲ型过氧乙酸消毒液能够达到对消化内镜高水平消毒标准,且经Ⅲ型过氧乙酸消毒后的内镜活检管道内壁无明显不易清除的细菌残留附着,可安全应用于临床。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.