对新型冠状病毒肺炎疫情期间口腔器械使用原则、洗消、管理的思考

自新型冠状病毒肺炎疫情暴发至今，国内外都出现了大量的确诊病例。随着疫情的蔓延，感染病例数的增加，尤其是最新报道指出存在气溶胶传播途径感染的可能，引起了口腔行业的重视，并由此引发了口腔工作者们对口腔诊疗日常感染控制工作的思考：如何在日常口腔诊疗工作中控制感染，避免医源性交叉感染的发生?本文根据各级疫情防控经验，结合多年传染病专科医院口腔科门诊工作经验，着重从器械使用、洗消及管理方面对口腔科门诊的防控工作提出一些建议和思考，期望对口腔科的日常诊疗工作，尤其是针对烈性呼吸道传染病、血源性传染病患者的诊疗工作提供一定的指导和帮助。     

新型冠状病毒肺炎疫情防控期间急诊内镜防控管理

目的探讨新型冠状病毒肺炎(COVID-19)防控期间消化内镜中心感染控制管理与内镜诊疗的安全。方法在COVID-19疫情防控期间,通过组织与防控培训,包括成立应急防控小组、拟定疫情期间消化内镜诊疗规范及重新布局诊疗区域、疫情培训、岗位调整等,从急诊内镜诊疗前对COVID-19的筛查到诊疗过程中的防控,以及隐匿患者应急处理等方面设定科学合理防护工作规范及感染防控方案。对2020年2月在解放军总医院第七医学中心消化内镜中心行急诊内镜检查患者的COVID-19疫情防控情况进行评估分析。结果 2020年2月1日至2020年2月28日,共行急诊内镜检查及治疗患者24例,男∶女为19∶5,中位年龄61.5岁(12～89岁);行胃镜检查10例(41.67%),行结肠镜检查5例(20.83%),行ERCP 9例(37.5%)。其中6例患者CT显示肺部感染。在此期间,所有内镜操作间空气消毒达标。对24例患者及家属进行随访发现均未感染COVID-19。结论适应防控形势发展趋势,拟定特殊时期防控诊疗规范,做法科学性强,措施有效可行。     

集束化管理策略在血透室新型冠状病毒肺炎防控中的应用效果观察

目的 观察集束化管理策略在新型冠状病毒肺炎防控工作中的应用效果及透析患者疫情防控认知行为的改变。方法 对血透室实施全员集束化管理策略,采用自行设计调查问卷,对155例门诊透析患者进行调查。结果 在血透室应对新型冠状病毒肺炎疫情防控工作中,应用集束化管理策略后,工作人员职业防护合理规范,疫情期间医务人员及透析患者零感染。疫情对患者规律透析、正常生活及心理健康影响不大。疫情期间患者认知及行为有所改变,透析患者普遍能够配合各项防控措施执行。结论 在血透室应对新型冠状病毒肺炎防控工作中实施集束化管理策略效果显著,可明显提高患者对疫情防控的认知,并能够积极配合医疗护理工作,确保血透室各项防控工作有序开展,避免相关院内感染发生。     

口腔门诊护理危机管理在新型冠状病毒肺炎疫情防控中的应用

新型冠状病毒肺炎疫情防控形势严峻复杂,且口腔门诊因其诊疗特殊性,感染风险较高。实施护理危机管理,加强预检分诊管理从而有效识别传染病可疑患者,树立护理人员感染防控意识,诊疗操作中严格执行标准预防措施,对环境、物体表面、器械设备等进行规范管理,可降低感染风险。     

疫情防控模式下消化道息肉日间手术的安全管理

本文探讨了新型冠状病毒肺炎疫情期间及防控常态化下太钢总医院消化内科和新安国际消化内科实施日间手术的情况,旨在为在特殊时期的临床工作提供安全及有效性的依据.我们医院消化内镜中心按照卫生行政部门及医院防控要求,结合科室工作特点,制定了一系列防控管理措施并准确落实,使临床工作在安全防护的基础上取得良好的效果.2020-2021消化内镜中心共完成日间手术2000余例,无疑似手术感染和新型冠状病毒肺炎病例.严格的疫情防控及高质量的管理为该中心日间手术的积极开展发挥了积极有效作用;安全优化的诊疗流程,让患者及家属安心;医务人员严格执行防护措施,保证了手术的安全和工作效率的流畅高效.     

从新型冠状病毒疫情演变看传染病流行期间消化内镜如何做好感染防控

新型冠状病毒感染可以表现为多种消化道症状。消化内镜作为一项侵入性的具有高度感染传播风险的诊疗项目更是感染防控的重点及难点。多个国家在感染防控措施中积累了一定的经验，该综述总结了现有的国内外关于消化内镜诊疗的感染防控指南及建议，旨在为消化内镜常态化疫情防护及有序恢复诊疗工作提供参考。     

新型冠状病毒肺炎疫情防控期间胶囊内镜诊疗工作指导意见

依照《中华医学会消化内镜学分会在新型冠状病毒感染防控期间对消化内镜诊疗工作的指导意见》等相关标准及意见,中华医学会消化内镜学分会胶囊内镜协作组制定了新冠肺炎疫情期间胶囊内镜诊疗工作指导意见,旨在规范诊疗流程与防控、洗消措施,在确保医患双方诊疗安全基础上,最大限度的实现患者获益。     

2019新型冠状病毒感染疫情防控期间开展支气管镜诊疗指引(试行)

2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)感染主要通过呼吸道飞沫传播、空气传播及接触传播,结合支气管镜操作的特点,制订了当前疫情下支气管镜诊疗操作的流程、要求及注意事项.进行支气管镜诊疗操作时须严格执行传染病防控相关标准,强调支气管镜检查不作为诊断新型冠状病毒感染采样的常规手段,在按要求做好防护的基础上,严格掌握支气管镜诊疗适应证,如非病情急需,建议暂缓检查.     

新型冠状病毒肺炎疫情期间心血管疾病管理与诊治策略

2019年底在我国武汉出现了新型冠状病毒感染,短时间内感染人群积聚增加,国家做出迅速反应将新冠病毒感染定为甲类传染病防控。对发病人群的流行病学研究发现患病和死亡病例中,中老年人多见,合并基础疾病特别是心血管疾病患者占据死亡率的第一位,为10.5%,合并高血压病患者的死亡率为6%。检测新型冠状病毒的感染时间较长,而心血管疾病中许多疾病都属于危急重症,在诊疗时需要争分夺秒。针对心血管疾病患者在新冠肺炎疫情期间的管理和诊治的特殊性,国家和相关权威部门发布的防控和诊疗方案、心血管疾病专家们提出的共识和建议,为我们在新冠肺炎疫情期间能够安全和有效的完成医疗救治工作提供了强有力的理论依据。     

胆囊结石伴急性胆囊炎患者在新型冠状病毒肺炎疫情期间的防控和诊治

目前,新型冠状病毒肺炎疫情依然十分严峻,全国各地高度重视疫情防控工作。胆囊结石伴急性胆囊炎作为肝胆外科常见的急腹症之一,发病急、进展快,需要早期诊断和及时有效的治疗。在疫情防控的特殊时期,应合理收治患者,减少院内交叉感染。胆囊结石伴急性胆囊炎常伴有发热,要明确是否合并有新型冠状病毒感染的情况,合理选择治疗方案,制订个体化治疗措施。在确保患者得到及时有效的诊治的同时,落实落细患者及陪护人的防控工作,切实防止院内感染的发生。重视医务人员的个人防护工作,科学施救,切实保障医务人员的人身安全。     

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.     

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.     

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.     

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.