Objective:To analyze the epidemiological characteristics and changing trends of elderly patients with drug-resistant pulmonary tuberculosis(DR-PTB)at Beijing Chest Hospital, Capital Medical University, in order to provide references for clinical prevention and treatment.Methods:Data were retrospectively collected from all DR-PTB cases hospitalized in the electronic medical record system of Beijing Chest Hospital from 2019 to 2023.The epidemiological characteristics including classification, gender, age, occupation and their changing trends among elderly DR-PTB patients were analyzed.Results:Among 1 981 hospitalized DR-PTB patients, 400(20.19%)were elderly[aged 60-92 years, mean(68.67±7.01)years], showing an overall increasing trend from 2019 to 2023.Mono-resistant PTB was the most common(198 cases, 49.50%), followed by multidrug-resistant PTB(170 cases, 42.50%), extensively drug-resistant PTB(21 cases, 5.25%), and polyresistant PTB(11 cases, 2.75%).Among the elderly DR-PTB patients, 287 cases(71.75%)were male, 200 cases(50.00%)were initial treatment cases, 377 cases(94.25%)were Han nationality, 165 cases(41.25%)were Beijing residents, 185 cases(46.25%)were employees of enterprises and institutions, 109 cases(27.25%)were farmers, 68 cases(17.00%)were unemployed individuals, 202 cases(50.50%)were pathogen-positive cases(smear and culture positive), and 228 cases(57.00%), 331 cases(82.75%), 196 cases(49.00%)were patients with comorbidities, complications, and extrapulmonary tuberculosis, respectively.There were no significant differences between elderly and non-elderly groups in ethnicity, treatment classification, or comorbidities(all P>0.05).However, significantly differences were found in gender ( χ2=12.718, P<0.001), occupation ( χ2=97.500, P<0.001), patient origin ( χ2=119.771, P<0.001), pathogen detection results ( χ2=10.101, P=0.001), and drug resistance patterns ( χ2=15.990, P=0.001).The proportion of elderly DR-PTB patients showed an overall increasing trend, with rises in females(25.64%-28.70%), unemployed individuals(7.69%-20.37%), other occupations(5.13%-19.40%), Han ethnicity(91.03%-99.07%), initial treatment(33.33%-57.41%), smear-negative but culture-positive cases(46.15%-53.70%), polyresistant PTB(1.28%-9.26%), and extensively drug-resistant PTB(1.28%-3.70%). Conclusions:Among elderly DR-PTB patients, the proportions of female, unemployed individuals and other occupations, initial treatment cases, smear-negative but culture-positive cases, polyresistant PTB, and extensively drug-resistant PTB are increasing annually.Future efforts should focus on targeted prevention and treatment for key populations to further reduce the rate of elderly DR-PTB.

Objective To investigate the bacterial contamination of water specimens at different pre-discharge time of flexible endoscopic final rinse water before daily use,and provide reference basis for choosing the optimal pre-dis-charge time in clinical work.Methods From August to December 2023,the water produced by the purified water equipment of the digestive endoscopy centers of 4 tertiary first-class medical institutions in Jiangxi Province,as well as the final rinsing water at the terminal-point at different pre-discharge times(before pre-discharge,discharge of 1,3,5,and 10 minutes)were subjected to on-site sampling,the collected water specimens were performed microbio-logical cultures by pouring and filter membrane methods,unqualified water specimens were performed bacterial i-dentification.Results 48 specimens of water produced by purified water equipment were collected,with qualified rate of 100％.480 final water specimens were collected,with a qualified rate of 0 before pre-discharge.The quali-fied rates of pre-discharge at 1,3,5,and 10 minutes were 0,21.88％,55.21％,and 73.96％,respectively.Bac-terial colony counts in the final rinse water with different pre-discharge times in 4 medical institutions showed statis-tically significant differences(all P＜0.001).As the pre-discharge time increased,bacterial colony counts in the fi-nal rinse water of all four medical institutions showed a decreasing trend.The pairwise comparison of the overall bacterial colony count of the final rinse water at different pre-discharge time showed that there was no statistically significant difference in the bacterial colony count of the final rinse water at 5 and 10 minutes of pre-discharge(P＞0.05),while the pairwise comparison between other time points showed statistically significant differences(all P＜0.001).Environmental contaminated bacteria such as Micrococcus luteus,Cupriavidus paucula,and Sphin-gononas paucimobilis were detected from the unqualified water specimens.Conclusion With the extension of pre-discharge time,the degree of bacterial contamination in the final rinse water significantly decreases.All levels of medical institutions need to pre-discharge the final rinse water daily,and the pre-discharge time should last for at least 5 minutes.

Objective To investigate the current status of cleaning and disinfection of endoscopic biopsy valves in three digestive endoscopy centers in Jiangxi Province,and evaluate the effectiveness of establishing a standard opera-tional procedure(SOP)of cleaning and disinfection for flexible endoscopic biopsy valves.Methods The cleaning and disinfection procedures of biopsy valves in three digestive endoscopy centers were recorded using on-site investi-gation method(the control group).Based on relevant literature and manufacturer manuals at home and abroad,SOP was established and cleaning and disinfection training for cleaning professional was provided(the trial group).Biop-sy valve specimens from two groups were taken.The disinfection qualified rate,microbial positivity rate before dis-infection,and microbial load after disinfection before and after procedure improvement were compared between two groups.Results A total of 180 biopsy valve specimens were taken from two groups(60 specimens from endoscopy centers A,B,and C each).On-site investigation showed that the cleaning and disinfection procedure for biopsy valves was inconsistent among the three endoscopy centers.The total qualified rate of disinfection in the trial group was higher than that in the control group(95.5％vs 83.3％),with statistically significant difference(P＜0.05).The total microbe positive rate of biopsy valves from the trial group was lower than that from the control group(25.0％ vs 57.2％),with statistically significant difference(P＜0.05).The difference in microbial load after disin-fection between two groups of biopsy valves was statistically significant(Z=-6.47,P＜0.05).Conclusion Al-though being a tiny accessory,the flexible endoscopic biopsy valve can be a potential source of infection if not tho-roughly cleaned and disinfected.Developing SOP can help improve the cleaning effectiveness of biopsy valves.At present,there is no unified standards for the cleaning and disinfection procedure of endoscopic biopsy valves.In the future,standardization of the SOP for biopsy valves should be continuously explored,so as to reduce the risk of cross infection.

Objective To compare the effectiveness of cobalt chloride test papers and borescope in evaluating the drying of endoscopes,providing a reference for clinical selection of appropriate assessment tools.Methods 10 gastroscopes and 10 colonoscopes procedures were selected from November 2023 to March 2024 for circulation experiments.After endoscope reprocessing,they were randomly divided into five groups with different drying times(30 s,3 min,6 min,9 min,and 12 min)with 200 samples.Cobalt chloride test paper and borescope were used to evaluate the drying effectiveness.Results The qualified rate of gastrointestinal endoscope by borescope was significantly higher than that by cobalt chloride test paper,but cobalt chloride test paper was obviously better than that by borescope in convenience and cost-effectiveness.The borescope had the function of visualization,and the quantitative positioning observation of residual droplets showed that there were a large number of droplets left after gastrointestinal endoscope drying for 30 s,and the number of droplets was obviously reduced after drying for 3 min.Among them,the gastroscope was mainly light(1～5 drops/strip)and none(0 drops/strip),and the colonoscope was mainly moderate(6～10 drops/strip)and light droplets.Compared with different drying times,there was a significant statistical difference in the number of residual droplets in the endoscope(P<0.01),and the localized droplets mainly remained in the distal bending part and the proximal bifurcation part of the lumen.Conclusion Both cobalt chloride test papers and borescope are important methods for assessing endoscope drying efficacy,each with its own advantages and limitations.Clinicians can use both methods in combination to comprehensively evaluate the overall dryness of endoscopes,thereby ensuring the safety and effectiveness of the endoscope reprocessing process.

Objective To understand the current status of application,management,and maintenance of automa-ted endoscope reprocessors(AERs)in China.Methods A questionnaire survey was conducted using convenience sampling method on the application,management,maintenance,and monitoring of AERs,as well as personnel training in digestive endoscopy centers of 292 medical institutions(MIs).Results A total of 316 questionnaires were distributed,and 292 were available,with an effective response rate of 92.41％.Among the 292 MIs,198(67.81％)were equipped with AERs,with equipment rates of 75.11％in tertiary MIs and 41.27％in secondary MIs.88.38％of MIs performed manual cleaning before placing endoscopes into AERs,while 2.02％of MIs still didn't perform this step,mainly in tertiary MIs.The most common problems in the application of AERs were the detachment or damage of connecting pipes(83.33％),followed by disinfectant leakage of AERs(43.94％),mal-function of control panel(43.94％),and failure or poor water flow of AER pipeline(42.93％).92.42％of MIs regularly disinfected AERs,72.73％of MIs regularly replaced AER air filters,and 80.30％of MIs regularly re-placed AER water filters.96.46％of MIs monitored the concentration of disinfectants before daily application of AERs,87.88％of MIs regularly monitored the final rinse water of AERs,and 96.97％of MIs provided professio-nal training for new employees to use AERs for the first time.Conclusion The equipping rate of AERs at all levels of MIs in China still needs to be improved.Most MIs are able to monitor and maintain AERs well,but there are still many problems in the application process.Due to the large volume of endoscopic diagnosis and treatment as well as insufficient execution rate of manual cleaning in tertiary MIs,it is necessary to optimize workflow and strengthen training.Secondary MIs face challenges such as equipment shortages and low monitoring execution rates,requiring increased funding and regulatory efforts.It is recommended that manufacturers continuously optimize AER design,MIs establish standardized AER application protocol,and relevant departments improve AER application and ma-nagement standards,in order to improve the quality of endoscopic cleaning and disinfection and ensure patient safety during diagnosis and treatment.

Objective:To Investigate the impact of blood glucose fluctuations within 24 hours of admission on the short-term (3-month) prognosis of patients with acute pancreatitis.Methods:A total of 416 patients with acute pancreatitis admitted to the Department of Gastroenterology of the First Affiliated Hospital of Nanchang University from November 2022 to October 2023 were enrolled as the research subjects. According to whether re-admission occurred within 3 months after discharge, they were divided into good prognosis group ( n=352) and poor prognosis group ( n=64). General data, laboratory indicators, and blood glucose values within 24 hours of admission [including initial blood glucose, 24-hour average blood glucose, maximum blood glucose, minimum blood glucose, standard deviation of blood glucose (SDBG), and largest amplitude of glycemic excursion (LAGE)] were compared between the two groups. Logistic regression analysis was used to identify risk factors affecting the prognosis of patients with acute pancreatitis. Receiver operating characteristic curves (ROC) were plotted and the area under the curve (AUC), sensitivity, and specificity were calculated, so as to evaluate the predictive efficacy of each indicator for the prognosis of patients with acute pancreatitis. Results:Compared with the good prognosis group, the poor prognosis group showed significantly higher levels of initial blood glucose [12.80(7.13, 17.75) mmol/L vs 8.90(6.80, 11.60) mmol/L], maximum blood glucose [16.15(13.45, 21.10) mmol/L vs 11.2(9.10, 14.40) mmol/L], SDBG [4.19(2.47, 5.03) mmol/L vs 1.79(1.15, 2.81) mmol/L], and LAGE [5.15(3.58,7.65) mmol/L vs 4.05(2.40, 5.70) mmol/L], as well as a significantly longer length of hospital stay [10.5(6, 26.75) days vs 9(6, 15) days], with all differences being statistically significant (all P value <0.05). Multivariate logistic regression analysis showed that initial blood glucose ( OR=1.201, 95% CI 1.099-1.313), SDBG ( OR=1.681, 95% CI 1.306-2.164), LAGE ( OR=1.848, 95% CI 1.524-2.240), and length of hospital stay ( OR=1.136, 95% CI 1.082-1.193) were influencing factors for the prognosis of patients with acute pancreatitis. ROC analysis showed that the AUC values for initial blood glucose, SDBG, LAGE, and length of hospital stay were 0.741(0.676-0.806), 0.794 (0.728-0.860), 0.836(95% CI 0.793-0.879), and 0.847(95% CI 0.807-0.887), respectively, with sensitivities of 80.1%, 91.8%, 60.8%, and 64.8%, and specificities of 56.3%, 56.3%, 93.8%, and 93.8%. Conclusions:Blood glucose fluctuations within 24 hours of admission are risk factors for poor prognosis in patients with acute pancreatitis.

Objective To understand the current status of application,management,and maintenance of automa-ted endoscope reprocessors(AERs)in China.Methods A questionnaire survey was conducted using convenience sampling method on the application,management,maintenance,and monitoring of AERs,as well as personnel training in digestive endoscopy centers of 292 medical institutions(MIs).Results A total of 316 questionnaires were distributed,and 292 were available,with an effective response rate of 92.41％.Among the 292 MIs,198(67.81％)were equipped with AERs,with equipment rates of 75.11％in tertiary MIs and 41.27％in secondary MIs.88.38％of MIs performed manual cleaning before placing endoscopes into AERs,while 2.02％of MIs still didn't perform this step,mainly in tertiary MIs.The most common problems in the application of AERs were the detachment or damage of connecting pipes(83.33％),followed by disinfectant leakage of AERs(43.94％),mal-function of control panel(43.94％),and failure or poor water flow of AER pipeline(42.93％).92.42％of MIs regularly disinfected AERs,72.73％of MIs regularly replaced AER air filters,and 80.30％of MIs regularly re-placed AER water filters.96.46％of MIs monitored the concentration of disinfectants before daily application of AERs,87.88％of MIs regularly monitored the final rinse water of AERs,and 96.97％of MIs provided professio-nal training for new employees to use AERs for the first time.Conclusion The equipping rate of AERs at all levels of MIs in China still needs to be improved.Most MIs are able to monitor and maintain AERs well,but there are still many problems in the application process.Due to the large volume of endoscopic diagnosis and treatment as well as insufficient execution rate of manual cleaning in tertiary MIs,it is necessary to optimize workflow and strengthen training.Secondary MIs face challenges such as equipment shortages and low monitoring execution rates,requiring increased funding and regulatory efforts.It is recommended that manufacturers continuously optimize AER design,MIs establish standardized AER application protocol,and relevant departments improve AER application and ma-nagement standards,in order to improve the quality of endoscopic cleaning and disinfection and ensure patient safety during diagnosis and treatment.

Objective To investigate the current status of cleaning and disinfection of endoscopic biopsy valves in three digestive endoscopy centers in Jiangxi Province,and evaluate the effectiveness of establishing a standard opera-tional procedure(SOP)of cleaning and disinfection for flexible endoscopic biopsy valves.Methods The cleaning and disinfection procedures of biopsy valves in three digestive endoscopy centers were recorded using on-site investi-gation method(the control group).Based on relevant literature and manufacturer manuals at home and abroad,SOP was established and cleaning and disinfection training for cleaning professional was provided(the trial group).Biop-sy valve specimens from two groups were taken.The disinfection qualified rate,microbial positivity rate before dis-infection,and microbial load after disinfection before and after procedure improvement were compared between two groups.Results A total of 180 biopsy valve specimens were taken from two groups(60 specimens from endoscopy centers A,B,and C each).On-site investigation showed that the cleaning and disinfection procedure for biopsy valves was inconsistent among the three endoscopy centers.The total qualified rate of disinfection in the trial group was higher than that in the control group(95.5％vs 83.3％),with statistically significant difference(P＜0.05).The total microbe positive rate of biopsy valves from the trial group was lower than that from the control group(25.0％ vs 57.2％),with statistically significant difference(P＜0.05).The difference in microbial load after disin-fection between two groups of biopsy valves was statistically significant(Z=-6.47,P＜0.05).Conclusion Al-though being a tiny accessory,the flexible endoscopic biopsy valve can be a potential source of infection if not tho-roughly cleaned and disinfected.Developing SOP can help improve the cleaning effectiveness of biopsy valves.At present,there is no unified standards for the cleaning and disinfection procedure of endoscopic biopsy valves.In the future,standardization of the SOP for biopsy valves should be continuously explored,so as to reduce the risk of cross infection.

Objective To compare the effectiveness of cobalt chloride test papers and borescope in evaluating the drying of endoscopes,providing a reference for clinical selection of appropriate assessment tools.Methods 10 gastroscopes and 10 colonoscopes procedures were selected from November 2023 to March 2024 for circulation experiments.After endoscope reprocessing,they were randomly divided into five groups with different drying times(30 s,3 min,6 min,9 min,and 12 min)with 200 samples.Cobalt chloride test paper and borescope were used to evaluate the drying effectiveness.Results The qualified rate of gastrointestinal endoscope by borescope was significantly higher than that by cobalt chloride test paper,but cobalt chloride test paper was obviously better than that by borescope in convenience and cost-effectiveness.The borescope had the function of visualization,and the quantitative positioning observation of residual droplets showed that there were a large number of droplets left after gastrointestinal endoscope drying for 30 s,and the number of droplets was obviously reduced after drying for 3 min.Among them,the gastroscope was mainly light(1～5 drops/strip)and none(0 drops/strip),and the colonoscope was mainly moderate(6～10 drops/strip)and light droplets.Compared with different drying times,there was a significant statistical difference in the number of residual droplets in the endoscope(P<0.01),and the localized droplets mainly remained in the distal bending part and the proximal bifurcation part of the lumen.Conclusion Both cobalt chloride test papers and borescope are important methods for assessing endoscope drying efficacy,each with its own advantages and limitations.Clinicians can use both methods in combination to comprehensively evaluate the overall dryness of endoscopes,thereby ensuring the safety and effectiveness of the endoscope reprocessing process.

Objective To investigate the bacterial contamination of water specimens at different pre-discharge time of flexible endoscopic final rinse water before daily use,and provide reference basis for choosing the optimal pre-dis-charge time in clinical work.Methods From August to December 2023,the water produced by the purified water equipment of the digestive endoscopy centers of 4 tertiary first-class medical institutions in Jiangxi Province,as well as the final rinsing water at the terminal-point at different pre-discharge times(before pre-discharge,discharge of 1,3,5,and 10 minutes)were subjected to on-site sampling,the collected water specimens were performed microbio-logical cultures by pouring and filter membrane methods,unqualified water specimens were performed bacterial i-dentification.Results 48 specimens of water produced by purified water equipment were collected,with qualified rate of 100％.480 final water specimens were collected,with a qualified rate of 0 before pre-discharge.The quali-fied rates of pre-discharge at 1,3,5,and 10 minutes were 0,21.88％,55.21％,and 73.96％,respectively.Bac-terial colony counts in the final rinse water with different pre-discharge times in 4 medical institutions showed statis-tically significant differences(all P＜0.001).As the pre-discharge time increased,bacterial colony counts in the fi-nal rinse water of all four medical institutions showed a decreasing trend.The pairwise comparison of the overall bacterial colony count of the final rinse water at different pre-discharge time showed that there was no statistically significant difference in the bacterial colony count of the final rinse water at 5 and 10 minutes of pre-discharge(P＞0.05),while the pairwise comparison between other time points showed statistically significant differences(all P＜0.001).Environmental contaminated bacteria such as Micrococcus luteus,Cupriavidus paucula,and Sphin-gononas paucimobilis were detected from the unqualified water specimens.Conclusion With the extension of pre-discharge time,the degree of bacterial contamination in the final rinse water significantly decreases.All levels of medical institutions need to pre-discharge the final rinse water daily,and the pre-discharge time should last for at least 5 minutes.