OBJECTIVE To investigate the current status and existing problems in pretreatment of digestive endo-scopes in medical institutions of Jiangsu Province so as to optimize the pretreatment procedures.METHODS From Nov.7,2024 to Nov.17 2024,a questionnaire was preliminarily designed based on the current endoscope-related guidelines and standards by the infection control team of digestive endoscopy center of The Affiliated Drum Tower Hospital of Nanjing University Medical School.A cross-sectional survey was conducted for various levels of medi-cal institutions of Jiangsu Province by Wenjuanxing platform.The content of the survey covered basic information of the digestive endoscopy center,implementation status of pretreatment,operation status of pretreatment,quali-ty monitoring and management.RESULTS A total of 122 medical institutions were finally included in the survey,61 of which were tertiary hospitals,35 were secondary hospitals,and 26 were primary hospitals.97.54％of the medical institutions could implement the pretreatment procedures after every endoscopes use,while there was significant difference in the concrete details of pretreatment among the various grades of hospitals.64.75％of the medical institutions used dedicated buttons for pretreatment,however,there was significant difference in the cause for failed change of dedicated buttons among the various grades of medical institutions(x2=14.657,P＜0.001).76.23％of the medical institutions carried out the pretreatment for special sites of the endoscopes(pli-ers' pipelines,auxiliary water rinsing pipelines).Gas and water insufflation were maintained for over 10 seconds(77.87％).The suction duration was judged mainly based on subjective knowledge.The enzyme solution was the major pretreatment solution(94.26％).The changing frequency was dominated by'one use per change'(45.08％).There was significant difference in the time interval between pretreatment and cleaning among the va-rious grades of medical institutions(x2=10.032,P=0.012).57.38％of the medical institutions evaluated the quality of the pretreatment,and visual observation was the major method for quality assessment(53.28％).There was significant difference in the establishment of pretreatment system among the various grades of medical institu-tions(x2=7.033.P=0.030).CONCLUSIONS The pretreatment of the endoscopes is overall performed well in the 122 medical institutions of Jiangsu Province;however,the details of pretreatment procedure,quality monito-ring and management need to be improved.It is suggested that the related departments should accelerate the revi-sion of endoscope pretreatment-related standards so as to standardize professional behavior.

OBJECTIVE To explore the optimal preprocessing protocols for colonoscopes based on the orthogonal experimental design combined with cost analysis.METHODS An orthogonal design experiment was conducted in Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical Hospital.Totally 4 influen-cing factors for preprocessing and 3 corresponding levels were formed to 9 types of preprocessing protocols on the bases of orthogonal design.The colonoscopes that were used for diagnosis and treatment of 180 patients were ran-domly divided into 9 groups,each group was treated with one preprocessing protocol.The adenosine triphos-phatase(ATP)test and microbial culture were carried out after the preprocessing,cleaning and disinfection.The costs of the 9 preprocessing protocols were analyzed.RESULTS There were significant differences in the ATP val-ue and bacterial colony counts between the factor A(the type of preprocessing solution)and the factor C(prepro-cessing suction time)after the preprocessing(all P＜0.05);A3 and C2 were the optimal levels.There were no significant differences in the ATP value and bacterial colony counts among the factor A(the type of preprocessing solution),the factor B(the change frequency of preprocessing solution),the factor C(the preprocessing suction time)and the factor D(the interval between preprocessing and the cleaning).The qualified rates of cleaning of all the 9 groups reached up to 100.00％,and the qualified rates of disinfection were no less than 90.00％.The result of rank sum test showed that there were no significant differences in the ATP value(H=5.449,P=0.709)and the bacterial colony counts(H=1.770,P=0.987)among the 9 groups after the disinfection.The cost analysis showed that the cost was lowest when water was used as the preprocessing solution.CONCLUSION The optimal protocol for preprocessing of colonoscopes is that the alkaline solution is used as the preprocessing solution,with the change frequency changing every 4 hours,the suction time 20 seconds;the delay time should be determined based on the specific clinical condition,and the colonoscopes should be cleaned as early as possible.

Objective To explore the association between levels of peripheral blood systemic im-mune-inflammatory indicators in early pregnancy and the risk of gestational diabetes mellitus(GDM).Methods A total of 348 pregnant women in early pregnancy who underwent regular prenatal exami-nations and established medical records were enrolled as subjects.According to whether they devel-oped GDM,the participants were divided into GDM group(n=76)and non-GDM group(n=272).General characteristics,glycemic parameters and peripheral blood systemic immune-inflammatory in-dices were compared between two groups.The predictive value of peripheral blood systemic immune-inflammatory indicators for GDM was analyzed using receiver operating characteristic(ROC)curves and binary Logistic regression analysis.Results Among 348 pregnant women in early pregnancy,76 were diagnosed with GDM,with an incidence rate of 21.84％.The gestational weight gain,hemoglobin A1c(HbA1c),fasting plasma glucose(FPG),fasting insulin(FINS)and homeostasis model assessment-insulin resistance(HOMA-IR)were significantly higher in the GDM group than those in the non-GDM group(P＜0.05).The monocyte-to-lymphocyte ratio(MLR),systemic im-mune-inflammation index(SII),systemic inflammation response index(SIRI)and C-reactive protein(CRP)levels were sig-nificantly elevated in the GDM group compared with the non-GDM group(P＜0.05).Increased levels of MLR,SII,SIRI,aggregate index of systemic inflammation(AISI)and CRP were all inde-pendent risk factors for GDM in early pregnancy(P＜0.05).The areas under the curve(AUC)of MLR,SII,SIRI,AISI and CRP levels alone and their combination for detecting the risk of GDM in the first trimester of pregnancy were 0.918,0.932,0.700,0.918,0.767 and 0.995,respective-ly.The combined detection of each index had the highest predictive value.Conclusion The ele-vated levels of MLR,SII,SIRI,AISI and CRP in peripheral blood during the first trimester of preg-nancy are associated with an increased risk of GDM,and the combined detection of the above indi-cators has higher predictive value for the occurrence of GDM.

OBJECTIVE To investigate the current status and existing problems in pretreatment of digestive endo-scopes in medical institutions of Jiangsu Province so as to optimize the pretreatment procedures.METHODS From Nov.7,2024 to Nov.17 2024,a questionnaire was preliminarily designed based on the current endoscope-related guidelines and standards by the infection control team of digestive endoscopy center of The Affiliated Drum Tower Hospital of Nanjing University Medical School.A cross-sectional survey was conducted for various levels of medi-cal institutions of Jiangsu Province by Wenjuanxing platform.The content of the survey covered basic information of the digestive endoscopy center,implementation status of pretreatment,operation status of pretreatment,quali-ty monitoring and management.RESULTS A total of 122 medical institutions were finally included in the survey,61 of which were tertiary hospitals,35 were secondary hospitals,and 26 were primary hospitals.97.54％of the medical institutions could implement the pretreatment procedures after every endoscopes use,while there was significant difference in the concrete details of pretreatment among the various grades of hospitals.64.75％of the medical institutions used dedicated buttons for pretreatment,however,there was significant difference in the cause for failed change of dedicated buttons among the various grades of medical institutions(x2=14.657,P＜0.001).76.23％of the medical institutions carried out the pretreatment for special sites of the endoscopes(pli-ers' pipelines,auxiliary water rinsing pipelines).Gas and water insufflation were maintained for over 10 seconds(77.87％).The suction duration was judged mainly based on subjective knowledge.The enzyme solution was the major pretreatment solution(94.26％).The changing frequency was dominated by'one use per change'(45.08％).There was significant difference in the time interval between pretreatment and cleaning among the va-rious grades of medical institutions(x2=10.032,P=0.012).57.38％of the medical institutions evaluated the quality of the pretreatment,and visual observation was the major method for quality assessment(53.28％).There was significant difference in the establishment of pretreatment system among the various grades of medical institu-tions(x2=7.033.P=0.030).CONCLUSIONS The pretreatment of the endoscopes is overall performed well in the 122 medical institutions of Jiangsu Province;however,the details of pretreatment procedure,quality monito-ring and management need to be improved.It is suggested that the related departments should accelerate the revi-sion of endoscope pretreatment-related standards so as to standardize professional behavior.

OBJECTIVE To explore the optimal preprocessing protocols for colonoscopes based on the orthogonal experimental design combined with cost analysis.METHODS An orthogonal design experiment was conducted in Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical Hospital.Totally 4 influen-cing factors for preprocessing and 3 corresponding levels were formed to 9 types of preprocessing protocols on the bases of orthogonal design.The colonoscopes that were used for diagnosis and treatment of 180 patients were ran-domly divided into 9 groups,each group was treated with one preprocessing protocol.The adenosine triphos-phatase(ATP)test and microbial culture were carried out after the preprocessing,cleaning and disinfection.The costs of the 9 preprocessing protocols were analyzed.RESULTS There were significant differences in the ATP val-ue and bacterial colony counts between the factor A(the type of preprocessing solution)and the factor C(prepro-cessing suction time)after the preprocessing(all P＜0.05);A3 and C2 were the optimal levels.There were no significant differences in the ATP value and bacterial colony counts among the factor A(the type of preprocessing solution),the factor B(the change frequency of preprocessing solution),the factor C(the preprocessing suction time)and the factor D(the interval between preprocessing and the cleaning).The qualified rates of cleaning of all the 9 groups reached up to 100.00％,and the qualified rates of disinfection were no less than 90.00％.The result of rank sum test showed that there were no significant differences in the ATP value(H=5.449,P=0.709)and the bacterial colony counts(H=1.770,P=0.987)among the 9 groups after the disinfection.The cost analysis showed that the cost was lowest when water was used as the preprocessing solution.CONCLUSION The optimal protocol for preprocessing of colonoscopes is that the alkaline solution is used as the preprocessing solution,with the change frequency changing every 4 hours,the suction time 20 seconds;the delay time should be determined based on the specific clinical condition,and the colonoscopes should be cleaned as early as possible.

Objective To explore the experiences of family caregivers in dealing with the care-resistance behaviors in elderly patients with dementia,to improve the quality of care for elderly patients with dementia,and to enhance the ability of family caregivers to cope with resistance behaviors.Methods Utilizing purposeful sampling,we conducted in-depth interviews with 16 family caregivers of elderly patients with dementia between February 2024 and May 2024.The participants were recruited from a tertiary-grade hospital and the surrounding community in Zhengzhou,Henan Province.The interview data were subjected to thematic analysis using the Colaizzi 7-step method.Results A total of 19 interviews were conducted in this study,with each caregiver being interviewed for 30-44 minutes.The total transcription was about 82,000 words,and 4 themes and 11 sub-themes were identified:the considerable physical and psychological burden(persistent negative emotions,gradually increasing physical burden),realization of self-worth(sense of filial responsibility,care benefit feeling),subjective adjustment of coping strategies(actively seeking external support,resorting to restrictions and protection,passively coping out of helplessness),and facing multiple coping challenges(difficulty in establishing effective communication,poor sleep quality,lack of caregiving skills,unmet diverse support needs).Conclusion Family caregivers experience a heavier burden of care and develop various negative emotions when dealing with resistance behaviors.Different caregivers gradually adapt and develop different coping strategies in the care process.However,there are still some coping dilemmas that need to be resolved.Healthcare professionals should pay timely attention to caregivers'experiences in dealing with resistance behaviors,correct their attitudes towards care-resistance behaviors,strengthen health education on managing care-resistance behaviors,and improve their ability to cope with care-resistance behaviors.

Objective To explore the experiences of family caregivers in dealing with the care-resistance behaviors in elderly patients with dementia,to improve the quality of care for elderly patients with dementia,and to enhance the ability of family caregivers to cope with resistance behaviors.Methods Utilizing purposeful sampling,we conducted in-depth interviews with 16 family caregivers of elderly patients with dementia between February 2024 and May 2024.The participants were recruited from a tertiary-grade hospital and the surrounding community in Zhengzhou,Henan Province.The interview data were subjected to thematic analysis using the Colaizzi 7-step method.Results A total of 19 interviews were conducted in this study,with each caregiver being interviewed for 30-44 minutes.The total transcription was about 82,000 words,and 4 themes and 11 sub-themes were identified:the considerable physical and psychological burden(persistent negative emotions,gradually increasing physical burden),realization of self-worth(sense of filial responsibility,care benefit feeling),subjective adjustment of coping strategies(actively seeking external support,resorting to restrictions and protection,passively coping out of helplessness),and facing multiple coping challenges(difficulty in establishing effective communication,poor sleep quality,lack of caregiving skills,unmet diverse support needs).Conclusion Family caregivers experience a heavier burden of care and develop various negative emotions when dealing with resistance behaviors.Different caregivers gradually adapt and develop different coping strategies in the care process.However,there are still some coping dilemmas that need to be resolved.Healthcare professionals should pay timely attention to caregivers'experiences in dealing with resistance behaviors,correct their attitudes towards care-resistance behaviors,strengthen health education on managing care-resistance behaviors,and improve their ability to cope with care-resistance behaviors.

Renal interstitial fibrosis (RIF) is the crucial pathway in chronic kidney disease (CKD) leading to the end-stage renal failure. However, the underlying mechanism of Shen Qi Wan (SQW) on RIF is not fully understood. In the current study, we investigated the role of Aquaporin 1 (AQP1) in SQW on tubular epithelial-to-mesenchymal transition (EMT). A RIF mouse model induced by adenine and a TGF-β1-stimulated HK-2 cell model were etablished to explore the involvement of AQP 1 in the protective effect of SQW on EMT in vitro and in vivo. Subsequently, the molecular mechanism of SQW on EMT was explored in HK-2 cells with AQP1 knockdown. The results indicated that SQW alleviated kidney injury and renal collagen deposition in the kidneys of mice induced by adenine, increased the protein expression of E-cadherin and AQP1 expression, and decreased the expression of vimentin and α-smooth muscle actin (α-SMA). Similarly, treatmement with SQW-containing serum significantly halted EMT process in TGF-β1 stimulated HK-2 cells. The expression of snail and slug was significantly upregulated in HK-2 cells after knockdown of AQP1. AQP1 knockdown also increased the mRNA expression of vimentin and α-SMA, and decreased the expression of E-cadherin. The protein expression of vimentin increased, while the expression of E-cadherin and CK-18 significantly decreased after AQP1 knockdown in HK-2 cells. These results revealed that AQP1 knockdown promoted EMT. Furthermore, AQP1 knockdown abolished the protective effect of SQW-containing serum on EMT in HK-2 cells. In sum, SQW attentuates EMT process in RIF through upregulation of the expression of AQP1.
Drugs, Chinese Herbal/pharmacology* ; Humans ; Animals ; Mice ; Male ; Cell Line ; Rats ; Kidney/physiology* ; Fibrosis/drug therapy* ; Renal Insufficiency, Chronic/drug therapy* ; Adenine ; Epithelial-Mesenchymal Transition ; Aquaporin 1/metabolism*

Objective:To analyze the characteristics of immune cross-reaction between herpes simplex virus type 1 (HSV-1) and HSV-2 in terms of serology and clinical protection aiming to provide data for the control and prevention of diseases caused by the two viruses.Methods:An attenuated HSV-1 strain M3 was used to immunize BALB/c mice. Specific immune responses indicated by the production of neutralizing antibodies were detected. Wild-type HSV-1 and HSV-2 strains were respectively used to infect the mice through different ways 28 d after the immunization to observe the protective immunity in the M3-immunized mice against HSV-1/2 infection.Results:M3 strain could not induce specific neutralizing antibodies against HSV-2. Therefore, viral loads in tissues of the immunized mice increased significantly following different modes of HSV-2 exposure. However, no obvious abnormal clinical manifestations were found and the histopathological damage was only slight inflammatory reaction. In contrast, HSV-1-specific neutralizing antibodies were elicited in the M3-immunizaed mice with significant protective effects against HSV-1 infection.Conclusions:The immune response induced by attenuated HSV-1 strain M3 in mice exhibited immune-protective effects characterized by production of neutralizing antibodies and inhibition of virus proliferation in vivo against wild-type HSV-1 infection. For HSV-2, instead of neutralizing virus in form of antibodies, it featured by more of clinical cross-immunoprotective abilities to control virus growth.

Objective:To observe the effect of spectral-domain OCT with different subfoveal choroidal areas on choroid vascular index (CVI) in normal healthy eyes.Methods:Retrospective clinical study. From October 2017 to May 2018, 174 eyes of 87 healthy people who visited in the Ophthalmology Department of Beijing Friendship Hospital and had no eye abnormalities were included in the study. All patients received single line scan of macular fovea by enhanced depth imaging OCT. After binary processing of the collected choroidal images, CVI as the center radius of 750, 1500, 3000 and 4500 μm were calculated. Repeated measurement analysis of variance was performed for comparison of CVI between groups.Results:The mean values of CVI in the 750, 1500, 3000 and 4500 μm groups were 0.681±0.003, 0.678±0.002, 0.677±0.002 and 0.676±0.002, respectively. The difference between the 750 μm group and the 4500 μm group was 0.005±0.002 ( P=0.009). The other pairwise comparison results showed no statistically significant difference ( P>0.05). Conclusion:The CVI is different in healthy eyes with the different distance from macular fovea.