- MeSH
- celiakie patofyziologie MeSH
- fekální transplantace * metody MeSH
- idiopatické střevní záněty * mikrobiologie terapie MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- střevní mikroflóra MeSH
- syndrom dráždivého tračníku mikrobiologie terapie MeSH
- ulcerózní kolitida * mikrobiologie terapie MeSH
- Check Tag
- lidé MeSH
1 Prerequisites. The clinical service provider should obtain confirmation from the endoscope washer-disinfector (EWD) manufacturer that all endoscopes intended to be used can be reprocessed in the EWD. 2 Installation qualification. This can be performed by different parties but national guidelines should define who has the responsibilities, taking into account legal requirements. 3 Operational qualification. This should include parametric tests to verify that the EWD is working according to its specifications. 4 Performance qualification. Testing of cleaning performance, microbiological testing of routinely used endoscopes, and the quality of the final rinse water should be considered in all local guidelines. The extent of these tests depends on local requirements. According to the results of type testing performed during EWD development, other parameters can be tested if local regulatory authorities accept this. Chemical residues on endoscope surfaces should be searched for, if acceptable test methods are available. 5 Routine inspections. National guidelines should consider both technical and performance criteria. Individual risk analyses performed in the validation and requalification processes are helpful for defining appropriate test frequencies for routine inspections.
- MeSH
- dezinfekce přístrojové vybavení metody normy MeSH
- dokumentace MeSH
- endoskopy mikrobiologie normy MeSH
- kontaminace zdravotnického vybavení prevence a kontrola MeSH
- opakované použití vybavení normy MeSH
- řízení kvality * MeSH
- směrnice jako téma MeSH
- validační studie jako téma MeSH
- Publikační typ
- časopisecké články MeSH
Patients should be informed about the benefits and risks of endoscopic retrograde cholangiopancreatography (ERCP)Only specially trained and competent personnel should carry out endoscope reprocessing.Manufacturers of duodenoscopes should provide detailed instructions on how to use and reprocess their equipment.In the case of modifications to their equipment, manufacturers should provide updated instructions for use.Detailed reprocessing protocols based on the manufacturer's instructions for use should clearly lay out the different reprocessing steps necessary for each endoscope model.Appropriate cleaning equipment should be used for duodenoscopes in compliance with the manufacturer's instructions for use. Only purpose-designed, endoscope type-specific, single-use cleaning brushes should be used, to ensure optimal cleaning. As soon as the endoscope is withdrawn from the patient, bedside cleaning should be performed, followed by leak testing, thorough manual cleaning steps, and automated reprocessing, in order to: · Remove debris from external and internal surfaces;. · Prevent any drying of body fluids, blood, or debris;. · Prevent any formation of biofilms.. In addition to the leak test, visual inspection of the distal end as well as regular maintenance of duodenoscopes should be performed according to the manufacturer's instructions for use, in order to detect any damage at an early stage.The entire reprocessing procedure in endoscope washer-disinfectors (EWDs) should be validated according to the European and International Standard, EN ISO 15883. Routine technical tests of EWDs should be performed according to the validation reports.Microbiological surveillance of a proportion of the department's endoscopes should be performed every 3 months, with the requirement that all endoscopes used in the unit are tested at least once a year.In the case of suspected endoscopy-related infection, the relevant device (e. g., endoscope, EWD) should be taken out of service until adequate corrective actions have been taken. Outbreaks should be managed by a multidisciplinary team, including endoscopy, hygiene, and microbiology experts, manufacturers, and regulatory bodies, according to national standards and/or laws. In the case of suspected multidrug-resistant organism (MDRO) outbreaks, close cooperation between the endoscopy unit and the clinical health provider is essential (including infection control departments and hospital hygienists).
- MeSH
- dekontaminace metody normy MeSH
- duodenoskopy mikrobiologie normy MeSH
- infekce spojené se zdravotní péčí mikrobiologie prevence a kontrola MeSH
- kontaminace zdravotnického vybavení prevence a kontrola MeSH
- kontrola infekce metody MeSH
- lidé MeSH
- mnohočetná léková rezistence * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- směrnice pro lékařskou praxi MeSH
BACKGROUND: Bile salts likely contribute to liver injury in patients with primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC). Fibroblast growth factor 19 (FGF19) is a bile salt-induced enterokine with hepatoprotective potential as it suppresses de novo bile salt synthesis. Here, we evaluated the bile salt receptor FXR/FGF19 gut-liver axis in PSC and PBC patients. METHODS: Fasted patients with PSC (n = 12) and PBC (n = 10), and healthy controls (HC; n = 10) were orally challenged with the natural FXR agonist chenodeoxycholic acid (CDCA 15 mg/kg). Blood was sampled hourly until 8 h afterwards. Serum FGF19 and bile salt excursions were determined. Serum levels of 7α-hydroxy-4-cholesten-3-one (C4), reflecting bile salt synthesis, were measured as a biomarker of FGF19 response. RESULTS: Baseline serum FGF19 levels were comparable between groups, while fasted bile salt levels in PSC patients were elevated. Upon CDCA challenge, HC and PBC patients showed a serum FGF19 peak after 4 h followed by a decline. PSC patients showed a prolonged and elevated serum FGF19 response up to 8 h, combined with a sustained serum elevation of CDCA and other bile salts. In general, C4 levels declined following FGF19 elevation. In PSC patients with less favorable prognosis, baseline C4 levels were drastically suppressed and did not further decline. CONCLUSION: Following an oral CDCA challenge, PSC patients showed an impaired clearance of CDCA and a prolonged serum FGF19 response. FXR agonist therapy in PSC could cause prolonged exposure to elevated levels of FGF19, and we propose careful monitoring for detrimental side effects in patient studies.
- MeSH
- aplikace orální MeSH
- cholestenony krev MeSH
- dospělí MeSH
- fibroblastové růstové faktory krev metabolismus MeSH
- játra metabolismus MeSH
- klinické protokoly MeSH
- kyselina chenodeoxycholová aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- purgativa aplikace a dávkování MeSH
- senioři MeSH
- sklerozující cholangitida krev farmakoterapie metabolismus MeSH
- střeva metabolismus MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- kouření škodlivé účinky MeSH
- lidé MeSH
- nádory slinivky břišní farmakoterapie prevence a kontrola MeSH
- nemoci slinivky břišní * etiologie prevence a kontrola terapie MeSH
- pankreatitida * etiologie prevence a kontrola terapie MeSH
- pití alkoholu škodlivé účinky MeSH
- simvastatin terapeutické užití MeSH
- statiny terapeutické užití MeSH
- Check Tag
- lidé MeSH
- MeSH
- Barrettův syndrom chirurgie MeSH
- choledocholitiáza chirurgie MeSH
- cholestáza chirurgie MeSH
- endoskopické operace přirozenými otvory * metody MeSH
- ezofágoskopie metody MeSH
- gastrointestinální endoskopie * MeSH
- kongresy jako téma MeSH
- lidé MeSH
- nemoci jícnu chirurgie MeSH
- randomizované kontrolované studie jako téma MeSH
- stenty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- zprávy MeSH
- MeSH
- antibakteriální látky škodlivé účinky MeSH
- Clostridioides difficile MeSH
- infekce spojené se zdravotní péčí MeSH
- inhibitory protonové pumpy škodlivé účinky MeSH
- kampylobakterové infekce * prevence a kontrola přenos terapie MeSH
- klostridiové infekce * diagnóza farmakoterapie terapie MeSH
- lidé MeSH
- nemoci přenášené potravou MeSH
- pseudomembranózní enterokolitida diagnóza farmakoterapie terapie MeSH
- Check Tag
- lidé MeSH