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。     

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。     

胃镜采用戊二醛和邻苯二甲醛消毒的效果比较

目的探讨胃镜采用戊二醛和邻苯二甲醛消毒的效果。方法以120例胃镜检查术后的胃镜作为研究对象,将其根据消毒剂的不同分为对照组与观察组,每组60例。对照组采用2%碱性戊二醛进行消毒,观察组采用邻苯二甲醛进行消毒,通过现场采样对比分析两组的消毒效果、消毒时间、工作效率等。结果观察组和对照组消毒合格率均为100%,且消毒后均无致病菌生长,两组消毒效果比较,差异无统计学意义(P0.05)。观察组消毒时间、工作效能优于对照组,差异显著(P0.05)。结论 2%碱性戊二醛和邻苯二甲醛用于胃镜消毒均具有良好的消毒效果,其消毒合格率高,但邻苯二甲醛较2%戊二醛的消毒时间短;二者合理使用可显著提高功作效能,缓解内镜供给压力。     

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     

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…     

三种消毒剂对胃镜消毒效果的系统评价与Meta分析

目的 评估戊二醛、邻苯二甲醛和过氧乙酸对胃镜的消毒效果。 方法 计算机检索Medline (PubMed)、Cochrane Library、web of science、Embase、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(VIP),收集所有戊二醛、邻苯二甲醛及过氧乙酸对胃镜消毒效果的随机对照试验,按照纳入与排除标准筛选文献并提取资料,采用RevMan 5.3.4.0软件进行Meta分析。 结果 最终纳入18篇文献,根据Meta分析结果,邻苯二甲醛的消毒效果和邻苯二甲醛差异有统计学意义(OR=2.02,95%CI：1.88～2.17,P<0.000 01),过氧乙酸的消毒效果和戊二醛差异有统计学意义（OR=2.79,95%CI：1.52～5.11,P=0.000 9),邻苯二甲醛的消毒效果和过氧乙酸差异无统计学意义(OR=1.30,95%CI：0.62～2.73,P=0.49)。 结论 邻苯二甲醛和过氧乙酸对胃镜的消毒效果相近,两者均明显优于戊二醛。但由于过氧乙酸相比邻苯二甲醛价格低廉且无腐蚀性,因此胃镜消毒剂选择过氧乙酸优于戊二醛和邻苯二甲醛。     

消化内镜清洗消毒规范化培训研究

目的 调查消化内镜清洗消毒人员对内镜清洗消毒规范的掌握情况,探讨短期有效、理论结合实践的培训方法,提高消化内镜的清洗消毒水平.方法 参照2004年《内镜清洗消毒技术操作规范》及2012年《软式内镜清洗消毒技术规范》草案自行设计两套试题,对参加清洗消毒培训班的110名学员考核,然后进行1天理论培训和半天“手把手”操作培训.培训后再次理论和操作考核,应用现场采样监测内镜洗消是否达到灭菌标准.结果 110名学员中,来自省、市和县级医院分别为23(20.9％)、57(51.8％)和30(27.3％).以80分(总分100)为理论考核合格,培训前总合格率为50.0％,其中省级(56.5％)和市级(52.6％)两组接近(P＞0.05),均显著高于县级学员(40.0％,P＜0.05).培训后理论考核总合格率提高至96.4％,3组(省级100％、市级96.5％和县级93.3％)无显著差异.97.3％(107/110)学员内镜洗消达到无菌标准(省级100％、市级98.2％和县级93.3％,P＞0.05).结论 短期理论及操作培训是针对内镜清洗消毒规范普及的一种有效教学和培训方法,可快速显著提高从业人员的理论和操作水平.     

不同消毒方法对普通手术室空气消毒效果的比较北大核心CSCD

目的分析并评价等离子体空气消毒器、空气层流净化系统及紫外线消毒对普通手术室空气消毒的效果。方法选取本院面积相近、位置相邻的3间普通手术室,随机分别采用空气层流净化系统、等离子体空气消毒器和紫外线进行空气消毒。在各手术室进行空气采样作细菌培养,依据菌落数计算消毒后的空气质量合格率,并比较手术室消毒前后不同时间点的消毒效果。结果等离子体空气消毒器、空气层流净化系统和紫外线消毒后的手术室空气质量合格率分别为92.00%、100.00%和86.00%。消毒前10 min三组间比较和消毒后60 min三组间比较,手术室菌落数差异均无统计学意义(F值分别为0.055和2.506,均P>0.05);消毒120 min空气层流净化系统消毒组与等离子体空气消毒器组和紫外线消毒组比较手术室菌落数显著减少(F=8.429,P<0.01)。等离子体空气消毒器组手术室消毒60 min和120 min时的菌落数显著少于消毒前10 min的菌落数(t值分别为47.226和40.436,均P<0.01),消毒结束后120 min时的菌落数显著多于消毒结束后60 min时的菌落数(t=-3.105,P<0.01);空气层流净化系统组手术室在消毒60 min和120 min时的菌落数显著少于消毒前10 min菌落数(t值分别为50.200、48.419,均P<0.01),消毒结束后120 min与消毒结束后60 min比较菌落数差异无统计学意义(t=-1.083,P>0.05);紫外线组手术室消毒60 min和120 min时的菌落数显著少于消毒前10 min菌落数(t值分别为62.070和54.924,均P<0.01),消毒结束后120 min与消毒结束后60 min时比较菌落数差异有统计学意义(t=-2.493,P<0.05)。结论空气层流净化系统消毒后的手术室空气质量合格率和消毒后不同时间点的消毒效果均优于等离子体空气消毒器消毒和紫外线消毒,适合普通手术室采用。     

不同消毒方法对普通手术室空气消毒效果的比较

目的分析并评价等离子体空气消毒器、空气层流净化系统及紫外线消毒对普通手术室空气消毒的效果。方法选取本院面积相近、位置相邻的3间普通手术室,随机分别采用空气层流净化系统、等离子体空气消毒器和紫外线进行空气消毒。在各手术室进行空气采样作细菌培养,依据菌落数计算消毒后的空气质量合格率,并比较手术室消毒前后不同时间点的消毒效果。结果等离子体空气消毒器、空气层流净化系统和紫外线消毒后的手术室空气质量合格率分别为92.00%、100.00%和86.00%。消毒前10 min三组间比较和消毒后60 min三组间比较,手术室菌落数差异均无统计学意义(F值分别为0.055和2.506,均P0.05);消毒120 min空气层流净化系统消毒组与等离子体空气消毒器组和紫外线消毒组比较手术室菌落数显著减少(F=8.429,P0.01)。等离子体空气消毒器组手术室消毒60 min和120 min时的菌落数显著少于消毒前10 min的菌落数(t值分别为47.226和40.436,均P0.01,消毒结束后120 min时的菌落数显著多于消毒结束后60 min时的菌落数(t=-3.105,P0.01);空气层流净化系统组手术室在消毒60 min和120 min时的菌落数显著少于消毒前10 min菌落数(t值分别为50.200、48.419,均P0.01,消毒结束后120 min与消毒结束后60 min比较菌落数差异无统计学意义(t=-1.083,P0.05);紫外线组手术室消毒60 min和120 min时的菌落数显著少于消毒前10 min菌落数(t值分别为62.070和54.924,均P0.01),消毒结束后120 min与消毒结束后60 min时比较菌落数差异有统计学意义(t=-2.493,P0.05)。结论空气层流净化系统消毒后的手术室空气质量合格率和消毒后不同时间点的消毒效果均优于等离子体空气消毒器消毒和紫外线消毒,适合普通手术室采用。     

198例老年患者无痛胃镜和无痛肠镜检查的临床分析

目的 探讨老年人无痛胃镜及无痛肠镜检查的安全性、可行性及效果.方法 对96例老年无痛胃镜组及102例老年无痛肠镜组,同期和同年龄段普通胃镜组90例及普通肠镜组98例,同期90例青中年无痛胃镜及94例青中年无痛肠镜组,在检查过程中观察患者生命体征、血氧饱和度、患者感受及不良反应. 结果 普通胃镜和普通肠镜组患者血压升高和心率增快的例数明显高于相应的无痛胃镜组及无痛肠镜组,尤其原有高血压及冠心病的患者增高更明显,普通内镜组原有高血压患者检查过程中血压升高者占86.7%～91.3%,而无痛内镜组无1例血压升高;普通内镜组原有冠心病患者检查过程中,心率增快者占90.0%以上,无痛内镜组原有冠心病患者心率增快仅占10%左右,差异有统计学意义(P＜0.05).无痛内镜老年组与无痛内镜青中年组的各项指标改变,差异均无统计学意义(P＞0.05),各组呼吸加快和血氧饱和度下降,差异均无统计学意义(P＞0.05).不良反应:无痛胃镜组恶心、呕吐、贲门撕裂等不良反应明显低于普通胃镜组(P＜0.05),呃逆、呛咳等稍高于普通胃镜组(P＞0.05),无痛肠镜组的腹痛、腹胀等不良反应明显低于普通肠镜组(P＜0.05),而老年组与青中组比较差异无统计学意义(P＞0.05).无痛胃镜及无痛肠镜患者感受明显好于普通组(P＜0.05),检查成功率达100%.结论 老年患者在严密监测下行无痛胃镜及无痛肠镜检查安全、舒适、可行.     

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.