消化内镜清洗消毒的规范化管理体会

目的通过对消化内镜清洗消毒的规范化管理,有效的预防和控制由内镜诊疗所造成的医源性感染,提高医疗质量,确保医疗安全。方法从内镜室的建筑布局入手,按照2004年卫生部颁布的《内镜清洗消毒技术操作规范》(以下简称《规范》)标准,加大硬件设施和洗消设备的投入,完善各种规章制度,规范内镜清洗消毒流程,强化医务人员及清洗消毒人员的消毒灭菌观念。结果 2008年4月至2011年4月,本院自应用迈尔集成内镜洗消中心清洗消毒内镜后,有效地提高了工作效率,保证了清洗消毒质量,使消化内镜的清洗消毒合格率为100%。结论认真做好消化内镜清洗消毒的规范化管理,制定符合本院实际情况的清洗消毒管理制度,从各个环节把好内镜清洗消毒与灭菌的质量关[1]。使内镜的清洗消毒工作走上科学化、规范化的轨道,是预防内镜室发生交叉感染的根本手段。     

护理干预在内镜清洗消毒质量控制中的应用

目的探讨护理干预在内镜清洗消毒质量控制中应用价值。方法本研究回顾分析我院内窥镜中心2017年6月至2018年5月之间使用200件内镜设备为观察对象,护理干预措施应用前后各100件。对比分析护理干预措施实施前后,内镜内腔和外表面清洗消毒质量合格率情况。结果护理干预措施应用前内镜清洗消毒质量内腔与外表面合格率分别为82%和90%,护理干预措施应用后内镜清洗消毒质量内腔与外表面合格率分别为98%和100%,二者对比差异存在统计学意义(P<0.05)。结论在内镜清洗消毒质量控制中应用护理干预措施,有助于提高其内外部清洗消毒质量,降低医院内感染的发生率,提高临床医疗护理工作的质量和安全性,因而应用价值较高。     

基层医院内镜室医院感染存在问题及对策

目的了解基层医院内镜室在医院感染管理中存在的问题。方法通过对10家基层医院各内镜室采取现场检查的方法。结果对医院感染认识不足，医院内镜室存在制度不健全、工作人员知识缺乏、清洗不彻底、清洗消毒与诊疗操作未分室进行、设备配备不全等。结论建立医院感染监控有效机制，加强基层医院内镜室医务人员的培训，加强消毒隔离措施，提高防护意识，防止交叉感染的发生。     

内镜的感染管理——清洗与消毒方法研究

目的：为了预防和减少内镜检查引起的感染,医生要通过清洗和消毒彻底清除内镜黏附的细菌和病毒。方法：（1）内镜的清洗：①床边清洗。内镜检查结束后,要用纱布将内镜表面黏附的黏液和血液擦干净;进行送气、送水及吸引;清除管口,送气、送水洗管道的污物。②洗净槽清洗。加盖防水帽,检查内镜是否漏水;在温流水下用手洗净内镜表面,再用海绵蘸中性剂将内镜的插入部分认真擦洗干净;活检口胶盖,送气、送水和吸引按钮要取下洗净。首先对吸引和活检管道进行冲洗,再用专用毛刷反复刷洗3遍。清洗干净后用流水充分清洗,不能有清洗剂残留在内镜上。（2）内镜的消毒：清洗干净的内镜用高效消毒剂进行异地时间的浸泡就可以达到消毒作用。①人工消毒：笔者用2%戊二醛浸泡内镜10min（ERCP检查设备要浸泡20min）。②全自动清洗机消毒。内镜洗净、消毒后,用蒸馏水擦洗后用70%的乙醇注入管道内干燥后保存。结果：笔者对经过清洗、消毒后的内镜表面、内镜内腔进行生物学检测无细菌生长（如大肠埃希菌、H.pylori/葡萄球菌等）。结论：严格按照卫生部内镜的清洗、消毒标准是能够达到预防和减少内镜检查引起的感染的。     

影响消化内镜清洗质量的因素分析

消化内镜在医院的广泛应用，使内镜清洗与消毒已成为不容忽视的问题。由于其材质特殊、精密度高、结构复杂，很难完全除去污染，不完全的清洗使细菌在消毒过程中可继续存活，任何残留的有机物都会在微生物的表面形成保护层，妨碍消毒灭菌的作用。医疗器械使用彻底的清洗，去掉附着在上面的血液、脓血、体液等有机物是控制医院感染的关键环节。因此，严格的清洗才能保证消化内镜的消毒、灭菌完全，达到预防控制医院感染的目的。我们对某市开展消化内镜诊疗工作的9家三级医院内镜室的清洗环节进行了专项调查，找出影响其清洗质量的因素并加以分析。     

内镜室医院感染控制与预防

目的为了保障内镜室的工作质量,预防内源性和外源性感染的发生,探讨内镜室控制感染的措施。方法分析内镜室管理的危险因素,采取相应的管理对策。结果通过建立健全各项管理规章制度,操作规程、消毒隔离、内镜器械清洗、消毒灭菌、监测、及职业防护等。结论有效保障内镜室的工作质量,降低了医源性感染的发生。     

内窥镜医源性交叉感染的预防措施

目的：探讨进一步加强内镜的清洁消毒以及灭菌质量管理，严格预防和控制因内镜消毒质量问题而导致医源性交叉感染的发生。方法：制定完善的内镜室各项管理制度；严格执行内镜的清洗、消毒技术操作规范；正确的内镜储存方式及严密的内镜消毒灭菌、生物学指标监测及控制；强化内镜室从业人员的职业安全防护意识。结果：各项制度完善，措施到位，有效的控制了医源性交叉感染的发生。确保了内镜的消毒质量、医疗质量和医疗安全问题。结论：建立健全内镜室的各项规章制度，加强从业人员的职业素质教育．医护人员的慎独精神贯穿于医源性交叉感染的预防之中，使内镜的清洗工作走上科学化、规范化的轨道，是预防内镜室发生交叉感染的根本手段。     

规范化流程管理对提高消化内镜室医院感染控制率的效果分析及其对策

目的:探究规范化流程管理对消化内镜室医院感染控制率的效果与意义及其对策。方法:抽取2017年1月—6月间进行常规清洗消毒灭菌的消化内镜500件资料作为管理前组;另抽取2018年1月—6月间采用规范化流程管理干预后清洗消毒灭菌的消化内镜500件资料作为管理后组;比较不同干预措施对消化内镜消毒灭菌效果的影响(消毒灭菌的合格率、医院感染发生率)以及消化内镜清洗消毒灭菌不合理(消毒液浓度配制不当、消毒不全面、操作过程不规范、浸泡周期不合理、重复操作和存放不规范)发生率差异。结果:经规范化流程管理后,消化内镜清洗消毒灭菌的临床各项操作的合格率均显著优于管理前组(P<0.05),院内感染发生率显著低于管理前组(P<0.05)以及消毒灭菌的合格率高于管理前组(P<0.05)。结论:消化内镜室采用规范化流程管理消化内镜消毒灭菌,有效提高了工作人员临床操作水平及内镜消毒灭菌的合格率,减少或避免了医院感染的发生,确保了患者治疗安全性,减少医患间纠纷的发生。     

CSSD对内镜、口腔诊疗器械实施集中管理的探讨

目的对内镜、口腔诊疗器械的集中管理模式进行探讨。方法由消毒供应中心对内镜、口腔器械的清洗消毒灭菌质量进行集中管理,制定制度和操作流程,进行人员培训,提供技术指导,定期检查评价。结果内镜、口腔诊疗器械的清洗、消毒及灭菌工作的条件得以改善、人员素质得到提高、工作质量大幅提升,达到了消毒供应中心三项规范的要求。结论通过消毒供应中心的集中管理,进一步规范了内镜、口腔诊疗器械的清洗、消毒及灭菌工作,对提高工作质量、有效地控制医院感染、保障患者安全有着十分重要的意义。     

现代化内镜洗消中心内镜清洗消毒效果监测分析

目的观察现代化内镜洗消中心对内镜（胃肠镜）有效消毒灭菌效果。方法采用四槽清洗消毒法和内镜洗消中心清洗消毒两种方法对内镜进行生物学监测。结果按卫生部标准监测，60件使用四槽清洗消毒合格率为98．3％，60件使用内镜洗消中心消毒合格率为100％。结论运用现代化内镜洗消中心对内镜进行清洗消毒，可以提高内镜消毒效果，提高内镜使用率。     

Affective and Anxiety Disorders and Alcohol and Drug Dependence:

Depression and anxiety frequently coexist in patients with substance use disorders. This clinically-oriented article examiens the relationship between these conditions and emphasizes data showing that substances of abuse can cause signs and symptoms of both depression and anxiety. These substance-related syndromes appear to have a different course and prognosis than uncomplicated, independent anxiety and major depressive disorders, and clinicians should consider the role of alcohol and other drugs in all patients presenting with these complaints. The authors will also outline an approach for diagnosing and managing patients with the combination of a substance use and depressive or anxiety disorder.     

Synthesis and anti-nociceptive and anti-inflammatory effects of gaultherin and its analogs

The synthesis of gaultherin (1) and its analogs was carried out to provide 11 glycosides under phase-transfer catalytic conditions. The activities of all synthesized compounds were evaluated by nitric oxide production inhibitory assay in vitro. Methyl 2-O-(4-O-β-d-galactopyranosyl)-β-d-glucopyranosylbenzoate (5f) showed significantly anti-nociceptive and anti-inflammatory effects by the evaluation in vivo. Structure–activity relationships within these compounds were discussed.     

Modelling and simulation of variability and uncertainty in toxicokinetics and pharmacokinetics

Two important methodological issues within the framework of the variability and uncertainty analysis of toxicokinetic and pharmacokinetic systems are discussed: (i) modelling and simulation of the existing physiologic variability in a population; and (ii) modelling and simulation of variability and uncertainty when there is insufficient or not well defined (e.g. small sample, semiquantitative, qualitative and vague) information available. Physiologically based pharmacokinetic models are especially suited for separating and characterising the physiologic variability from the overall variability and uncertainty in the system. Monte Carlo sampling should draw from multivariate distributions, which reflect all levels of existing dependencies in the intact organism. The population characteristics should be taken into account. A fuzzy simulation approach is proposed to model variability and uncertainty when there is semiquantitative, qualitative and vague information about the model parameters and their statistical distributions cannot be defined reliably.     

成骨细胞的功能与损伤和骨质疏松的防治

骨质疏松是一种全身性骨骼疾病,导致骨折风险增加。成人的骨量通过破骨细胞的骨吸收和成骨细胞的骨形成作用来维持动态平衡,治疗骨质疏松症的理想策略是抑制破骨细胞的骨吸收和/或增强成骨细胞的骨形成功能。目前针对保护成骨细胞及增强其功能的骨质疏松疗法相对较少。因此,本文针对成骨细胞相关功能蛋白、各种细胞损伤机制（内质网应激、氧化应激、机械过载、微小RNA和长链非编码RNA的影响等）及骨质疏松的治疗与预防作一综述,以期为针对增强成骨细胞功能的骨质疏松治疗策略提供新思路。     

Self-stimulation and amphetamine: Tolerance to d and l isomers and cross tolerance to cocaine and methylphenidate

The effects of the d and l isomers of amphetamine on self-stimulation responding were tested following acute and chronic administration. Tolerance and post-drug depression of responding occurred in tests with both isomers, indicating no role for p-hydroxynorephedrine (PHN) which is one of the metabolites of d-amphetamine. In the second experiment, d-amphetamine, methylphenidate and cocaine all produced quantitatively and qualitatively similar effects on self-stimulation responding following acute administration. Following chronic administration of d-amphetamine, animals showed tolerance to all three drugs, indicating cross-tolerance among them. These data are consistent with an hypothesis that tolerance and post-drug depression following chronic amphetamine treatment are the result of decreases in postsynaptic receptor sensitivity, which would lead to a decreased effectiveness of all three drugs, regardless of their pre-synaptic mechanisms.     

益生菌与肿瘤防治

益生菌广泛存在于自然界中,通过维持宿主体内菌群平衡、影响肠屏障功能和调节免疫应答等作用,提高宿主健康水平,被公认为"肠道健康卫士".一些益生菌可以增强机体的免疫功能,抑制致癌物质,影响肿瘤细胞的基因表达,对肿瘤具有拮抗作用.大量研究表明,益生菌在未来的肿瘤防治中有很好的应用和发展前景.     

Acamprosate and naltrexone treatment effects on ethanol and sucrose seeking and intake in ethanol-dependent and nondependent rats

Rationale  Two pharmacotherapies are approved for treating alcohol craving (acamprosate and naltrexone), but both have shown mixed findings in animals and humans. Objectives  The present experiments utilized a “reinforcer blocking” approach (i.e., rats were able to consume ethanol during treatment) to better understand the efficacy of these treatments for ethanol seeking and drinking using ethanol-dependent and nondependent rats. Materials and methods  In “nondependent” experiments, drugs (acamprosate 50, 100, and 200 mg/kg; naltrexone 0.1, 0.3, and 1.0 mg/kg) were administered over 3-week periods prior to operant sessions with a low response requirement to gain access to reinforcers for 20 min. For “dependent” experiments, rats were made dependent in vapor/inhalation chambers. Results  Acamprosate and naltrexone had similar effects on intake in nondependent and dependent rats; neither drug was selective for ethanol over sucrose drinking. In nondependent animals, naltrexone was more efficacious at more doses than acamprosate, and acamprosate’s effects were limited to a dose that also had adverse effects on body weight. Both pharmacotherapies showed more selectivity when examining reinforcer seeking. In nondependent rats, acamprosate and naltrexone had response-attenuating effects in ethanol, but not sucrose, groups. In dependent animals, acamprosate had selective effects limited to a decrease in sucrose seeking. Naltrexone, however, selectively decreased ethanol-seeking in nondependent rats. Conclusions  The naltrexone-induced decreases in seeking suggested a change in incentive motivation which was selective for ethanol in nondependent rats. The “nondependent” paradigm may model early stages of “problem drinking” in humans, and the findings suggest that naltrexone could be a good intervention for this level of alcohol abuse and relapse prevention.     

Antiinfective and encrustation-inhibiting materials--myth and facts

Catheters, urethral and ureteral stents and other urological implants are frequently affected by encrustration and infection due to their permanent contact with urine. Indwelling urinary catheters provide a haven for microorganisms and thus require extensive monitoring. Several surface modification techniques have been proposed to improve the performance of devices including the immobilization of biomolecules, the incorporation of hydrophilic grafts to reduce protein adsorption, the creation of hydrophobic surfaces, the creation of microdomains to regulate cellular and protein adhesion, new polymers and antimicrobial coatings. Physico-chemical explanation to elucidate the mechanism of such encrustation or infection inhibiting materials is still not available. Our series of experiments showed a marked decrease of silver-activity in biological fluids which corresponds with the controversial clinical results obtained with silver coated urinary catheters. Rifampicin/minocycline coated catheters had very low activity against Gram-negative rods, enterococci and Candida spp., the main causing organisms of urinary catheter infection. Surface engineered materials and antimicrobial drug delivery systems will be the next generation of sophisticated urinary catheters and stents, if both efficacy as well as efficiency has been proved clinically.     

Alprazolam and lorazepam single and multiple-dose effects on psychomotor skills and sleep

Summary The effects of alprazolam 0.5 mg and lorazepam 2 mg on cognitive and psychomotor skills were assessed in twelve normal volunteer subjects in a randomised, double-blind, crossover design. Single and multiple dose effects were monitored using a battery of tests comprising critical flicker fusion threshold (CFFT), choice reaction time (CRT), simulated car tracking, and subjective ratings of perceived sedation (LARS) and of sleep behaviour (LSEQ). Compared with placebo baseline scores, treatment with lorazepam 2 mg (both single and multiple doses) resulted in a widespread impairment of CRT, tracking accuracy, and CFFT. Single doses of alprazolam 0.5 mg reduced CFFT with respect to the placebo baseline. Single and multiple dose treatment with both drugs resulted in subjective reports of sedation, a reduction of sleep onset latency, and improved sleep quality. Only lorazepam 2 mg significantly disrupted the integrity of behaviour on waking from sleep. These results suggest important pharmacodynamic differences between the two drugs in the doses used.