环氧乙烷灭菌生物指示物抗力及其测试的影响因素

<正>20世纪50年代起环氧乙烷开始用于医院灭菌,国内医疗机构引入环氧乙烷灭菌器始于上世纪90年代中期,主要用于怕热怕湿医疗器械的灭菌。随着环氧乙烷灭菌器在国内的不断普及,环氧乙烷灭菌监测中的问题也引起了广泛的关注。而环氧乙烷灭菌生物指示物的抗力水平在灭菌效果监测中尤为重要。用于环氧乙烷灭菌效果监测的生物指示菌为国际通用菌株,即枯草杆菌黑色变种(ATCC9372)芽孢,其生物学特性是易于培养与保存、在固     

台式环氧乙烷灭菌器对医疗器械灭菌效果的试验观察

目的观察一种台式环氧乙烷灭菌器的灭菌效果。方法用生物指示剂和模拟现场灭菌试验方法,对该台式环氧乙烷灭菌器的灭菌效果进行了试验观察。结果在灭菌器内温度为50℃、相对湿度为60%条件下,接触灭菌物品的环氧乙烷用量为600 mg/L,作用4 h后,布放在灭菌器内各层的枯草杆菌黑色变种芽孢生物指示剂培养结果均为阴性。在与上述条件完全相同的情况下,染于电刀刀头、塑料注射器顶部、镊子齿痕部、全棉清洁手术巾上的枯草杆菌黑色变种芽孢均达到完全杀灭,培养结果均为阴性。在该灭菌器运行期间,工作场所环境空气中环氧乙烷的浓度低于短时间接触容许浓度2 mg/m3。结论该台式环氧乙烷灭菌器对医院常用怕热怕湿医疗器械上污染的枯草杆菌黑色变种芽孢可以达到完全杀灭,工作场所环境空气中环氧乙烷浓度在允许范围。     

过氧化氢低温等离子体灭菌生物监测方法探讨

摘要 目的 探讨过氧化氢低温等离子体灭菌的最佳生物监测方法,以便及时、准确地判断灭菌效果,保证无菌物品的质量。方法 2013年4-12月,每天第一锅次同时使用过氧化氢低温等离子体灭菌自含式生物指示剂（嗜热脂肪杆菌芽孢）和环氧乙烷（EO）灭菌快速生物培养指示剂（枯草杆菌黑色变种芽孢）对2台低温等离子体灭菌器进行生物监测。结果 2台灭菌器共进行两种生物监测各520次,其中合格515次,不合格5次,合格率均为99.04%,两种生物监测结果一致,快速生物监测结果合格后可及时放行灭菌物品,满足了手术和诊疗需要;监测不合格时及时处理。结论 自含式生物指示剂（嗜热脂肪杆菌芽孢）和EO灭菌快速生物培养指示剂（枯草杆菌黑色变种芽孢）配合使用是目前过氧化氢低温等离子体灭菌理想的生物监测方法。     

3例环氧乙烷灭菌失败的原因分析

<正>医院怕湿怕热的医疗器材常用环氧乙烷灭菌。2000年11月～2001年11月,我院在1m3环氧乙烷灭菌柜内,用30％(g/g)环氧乙烷与70％(g/g)二氧化碳混合气体对导管、瓣膜及氧合器等医疗器材进行灭菌时,曾有3次用于检测灭菌效果的生物指示剂(枯草杆菌黑色变种芽孢)培养后为阳性(其中有1次化学指示剂亦未正常变色)。现对这3次灭菌失败的原因分析如下。     

不同培养基对枯草杆菌黑色变种芽孢抗力影响的研究

目的研究不同培养基对枯草杆菌黑色变种芽孢抗力的影响。方法采用悬液定量和载体定量杀菌试验方法,对不同培养基培养出的枯草杆菌黑色变种芽孢抗力进行比较。结果相同培养条件下,胰蛋白胨大豆琼脂培养基与普通营养琼脂培养基培养制备出的20 ml芽孢悬液的浓度分别为4.52×109cfu/ml和2.15×109cfu/ml。湿热100℃作用20 min、干热160℃作用10 min、5 000 mg/L的邻苯二甲醛溶液作用40 min、2 000 mg/L的二氯异氰尿酸钠溶液作用15 min,对两种培养基培养的枯草杆菌黑色变种芽孢的杀灭率均为99.99%。结论两种培养基培养的枯草杆菌黑色变种芽孢的抗力无明显差异。     

温度和相对湿度对环氧乙烷灭菌生物指示卡的影响

<正> 作者在试验条件下测定了温度和相对湿度对环氧乙烷生物指示卡的影响。试验用Spordex细菌指示卡进行。该卡染有6×10~6个枯草杆菌黑色变种芽胞。所用灭菌剂为88%二氯二氟烷和12%环氧乙烷混合气体。     

环氧乙烷工业大型灭菌设备对乙型肝炎表面抗原的破坏试验

在大型灭菌柜(20m~3)中观察了环氧乙烷对HBsAg的破坏作用。结果表明,温度上升可提高其消毒效果;柜室内上层物品较底层易于消毒;摆放方法对灭菌效果无明显影响;HBsAg对环氧乙烷抗力较枯草杆菌黑色变种芽胞为强。     

高等级生物安全实验室三种关键消毒灭菌设备相关性能评价

目的评价高等级生物安全实验室3种关键消毒灭菌设备相关性能,为生物安全实验室安全性评价及相关标准的建立提供依据。方法通过灭菌效果指示物,对国内某三级生物安全实验室3个关键设备进行消毒灭菌性能验证与评价。结果高等级生物安全实验室内配备的压力蒸汽灭菌器,经化学指示物、生物指示物和B-D测试包等3项验证,全部合格。生物安全室内配备的污水处理系统,经嗜热脂肪芽孢杆菌芽孢验证,符合安全排放要求。生物安全室内配备的汽化过氧化氢消毒器,经枯草杆菌黑色变种芽孢菌片对消毒效果进行验证,亦达到合格要求。结论依据我国现有通用性标准规范,对高等级生物安全实验室关键消毒灭菌设备(压力蒸汽灭菌器、污水处理系统和汽化过氧化氢消毒器)性能进行验证,均达到规定的指标要求。     

几种压力蒸汽灭菌指示剂的比较

采用化学和生物指示剂作压力蒸汽灭菌监测效果比较,若以嗜热脂肪杆菌芽胞菌片为标准,3M指示剂胶带较为可靠。硫磺管、苯甲酸管、枯草杆菌黑色变种芽胞、金黄色葡萄球菌与HBsAg均不宜作为湿热灭菌的指示剂。     

简易呼吸器使用环氧乙烷和压力蒸汽灭菌的效果观察

目的比较简易呼吸器使用环氧乙烷灭菌和压力蒸汽灭菌的效果。方法 60件简易呼吸器,30件使用环氧乙烷灭菌,包装时在呼吸器球形气囊内放入枯草杆菌黑色变种芽胞株生物指示剂;30件使用压力蒸汽灭菌,包装时在呼吸器球形气囊内放入嗜热脂肪杆菌芽胞株生物指示剂。灭菌后,观察快速生物阅读器培养和采样细菌培养合格率、湿球比率及呼吸器损伤率。结果两种灭菌法的生物监测和细菌培养合格率均为100%,但用压力蒸汽灭菌时呼吸器损伤和湿球现象明显高于环氧乙烷灭菌法,呼吸器损伤率比较,x2=21.82,P<0.01;湿球率比较,x2=49.09,P<0.01。结论简易呼吸器使用环氧乙烷灭菌优于压力蒸汽灭菌。     

Meta-analysis of interventions for medication adherence to antihypertensives

OBJECTIVE: To identify methods targeted at improving adherence to antihypertensives and determine their effect on adherence using meta-analytic techniques. METHODS: A literature search from 1970 to December 2000 using MEDLINE, International Pharmaceutical Abstracts, PsychLit, ERIC, and EMBASE was performed using the terms compliance, adherence, and medication. Randomized articles with an intervention directed at a patient/caregiver, a comparator group, and a minimum of 10 subjects in each intervention group were identified by 3 independent reviewers. Articles that did not report sample size data or adequate results of the intervention were excluded. Sixteen citations focusing on antihypertensive adherence were identified. Of the 16 citations, 6 studied either more than one intervention in the same population or different interventions in different patient populations, yielding 24 cohorts with 2446 patients. RESULTS: Fifty-eight percent of the methods focused on behavioral interventions (BIs), 29% studied the effect of a combination of behavioral and educational interventions (BEIs), and 13% utilized educational interventions (EIs) alone. Overall, the study groups were nonhomogenous (Q = 183.92; p < 0.001). However, when the groups were separated by the intervention type, the BIs were homogenous (Q = 1.19; p = 1.00) with an overall effect size (ES) of 0.04 (95% CI -0.01 to -0.09), indicating a trend toward improved adherence. Fifty percent of the BIs were performed in the physician's office; however, setting did not influence the intervention's impact (p = 0.13). Within the BIs, no single intervention improved adherence over others. CONCLUSIONS: Based on the interventions included in this meta-analysis, there is no single intervention that improves adherence to antihypertensives over others; therefore, a patient-specific approach should be modeled.     

Effects of polyether-modified poly(acrylic acid) microgels on doxorubicin transport in human intestinal epithelial Caco-2 cell layers.

Novel microgels composed of cross-linked copolymers of poly(acrylic acid) and Pluronics were evaluated as possible permeation enhancers for doxorubicin transport using Caco-2 cell monolayers as a gastrointestinal model. Pluronic, triblock copolymers of ethylene oxide (EO) and propylene oxide (PO), were chosen to represent the most hydrophobic (Pluronic L61 and L92 with average compositions of EO(3)PO(30)EO(3) and EO(8)PO(52)EO(8), respectively) and the relatively hydrophilic (Pluronic F127 with average formula EO(99)PO(67)EO(99)) extremes of this class of block copolymers. The weight ratio of Pluronic to poly(acrylic acid) in the microgels was set at 45:55. By inhibiting the P-glycoprotein (P-gp)-mediated doxorubicin efflux from the cells and enhancing the passive influx, the microgels were shown to enhance the overall cell absorption of doxorubicin. The enhancement effect was more pronounced than with a known penetration enhancer, Pluronic L61, and was comparable to that of Pluronic L92. Microgels exhibited synergism of the doxorubicin transport enhancement with Verapamil, a known inhibitor of the P-gp. The effects of the microgels were studied using the hydrophilic marker ([14C]mannitol) test and the MTT assay. Transepithelial electrical resistance (TEER) studies demonstrated that the microgels decreased TEER to about 80% of initial values, but these minor effects were fully reversible, indicating viability of the cells after incubation with microgels. No significant enhancement of [14C]mannitol transport by microgels was observed, relative to Carbopol 934NF (control polymer). Cytotoxicity studies confirmed that the transport-enhancing properties of the microgels were not due to damage of the Caco-2 cell monolayers.     

Overflow using proprioceptive neuromuscular facilitation in post-stroke hemiplegics: A preliminary study

Hemiplegia is the classic condition resulting from a stroke. To assist in recovery, the overflow method can be employed to stimulate the affected limb, using the healthy contralateral lower limb (LL) to activate the plegic upper limb (UL) musculature. The aim of this study was to evaluate the immediate effect of overflow using the PNF method on the plegic upper limb muscles of post-stroke individuals in the acute and chronic stages, as well as on the muscles of healthy individuals. A total of 22 individuals participated in the work, comprising 8 healthy individuals (control group), 6 post-stroke acute stage individuals (acute group), and 8 post-stroke chronic stage individuals (chronic group). The participants were assessed using a questionnaire with sections for personal and disease data and application of the ICF scale and the Fugl-Meyer index. The three groups were submitted to electromyographic evaluation, using the posterior deltoid (PD), anterior deltoid (AD), pectoralis major (PM), and external oblique (EO) muscles in four different positions: P1 (resting the UL, with the LL contralateral to the affected limb positioned in diagonal); P2 (resting the UL, with manual resistance in the contralateral LL); P3 (affected UL positioned in diagonal, with manual resistance in the contralateral LL) e P4 (affected UL positioned in diagonal, with fixed point and manual resistance in the contralateral LL). The electromyography results revealed no significant differences between most of the positions for the four muscles evaluated (p > 0.05). However, high clinical relevance (d > 0.8) was found for muscle activation in positions 2 and 4. It could be concluded that for post-stroke individuals in the acute and chronic stages, overflow using PNF effectively increased activation of the PD, AD, PM, and EO muscles in the P2, as well as position 4.     

Clinical characteristics and 28-d outcomes of bacterial infections in patients with hepatitis B virus-related acute-on-chronic liver failure

BACKGROUND Acute-on-chronic liver failure(ACLF),which includes hepatic and multiple extrahepatic organ failure,is a severe emergency condition that has high mortality.ACLF can rapidly progress and requires an urgent assessment of condition and referral for liver transplantation.Bacterial infections(BIs)trigger ACLF and play pivotal roles in the deterioration of clinical course.AIM To investigate the clinical characteristics and 28-d outcomes of first BIs either at admission or during hospitalization in patients with hepatitis B virus(HBV)-ACLF as defined by the Chinese Group on the Study of Severe Hepatitis B(COSSH).METHODS A total of 159 patients with HBV-ACLF and 40 patients with acute decompensation of HBV-related chronic liver disease combined with first BIs were selected for a retrospective analysis between October 2014 and March 2016.The characteristics of BIs,the 28-d transplant-free survival rates,and the independent predictors of the 28-d outcomes were evaluated.RESULTS A total of 194 episodes of BIs occurred in 159 patients with HBV-ACLF.Among the episodes,13.4%were community-acquired,46.4%were healthcare-associated,and 40.2%belonged to nosocomial BIs.Pneumonia(40.7%),spontaneous bacterial peritonitis(SBP)(34.5%),and bloodstream infection(BSI)(13.4%)were the most prevalent.As the ACLF grade increased,the incidence of SBP showed a downward trend(P=0.021).Sixty-one strains of bacteria,including 83.6%Gramnegative bacteria and 29.5%multidrug-resistant organisms,were cultivated from 50 patients with ACLF.Escherichia coli(44.3%)and Klebsiella pneumoniae(23.0%)were the most common bacteria.As the ACLF grade increased,the 28-d transplant-free survival rates showed a downward trend(ACLF-1,55.7%;ACLF-2,29.3%;ACLF-3,5.4%;P<0.001).The independent predictors of the 28-d outcomes of patients with HBV-ACLF were COSSH-ACLF score(hazard ratio[HR]=1.371),acute kidney injury(HR=2.187),BSI(HR=2.339),prothrombin activity(HR=0.967),and invasive catheterization(HR=2.173).CONCLUSION For patients with HBV-ACLF combined with first BIs,pneumonia is the most common form,and the incidence of SBP decreases with increasing ACLF grade.COSSH-ACLF score,acute kidney injury,BSI,prothrombin activity,and invasive catheterization are the independent predictors of 28-d outcomes.     

医用外科口罩细菌气溶胶过滤效果评价

目的评价不同企业生产的医用外科口罩对细菌气溶胶阻留效果。方法采用人工发生细菌气溶胶和定量空气采样方法进行了过滤效率测试。结果2004年国内某企业生产的口罩对金黄色葡萄球菌气溶胶颗粒平均过滤效果达到98%,依照标准规定合格率达到100%。2005年抽检国内5个企业生产的口罩,其中有4个企业产品对金黄色葡萄球菌气溶胶过滤效率合格率达到100%。2006年抽检国内6个企业生产的口罩,只有1个企业生产的口罩全部符合标准要求;其中有2个企业生产的口罩全部不合格。结论连续检测2004~2006年12个企业生产的医用外科口罩,其对细菌气溶胶过滤效率全部达标的企业只有6个;不同企业生产的医用外科口罩质量参差不齐。     

Use of Shear Wave Elastography to Quantify Abdominal Wall Muscular Properties in Patients With Incisional Hernia

Shear wave elastography (SWE) is a potential modality that quantitatively measures the elasticity (shear wave speed [SWS]) of musculoskeletal structure. This SWS was bilaterally measured in the rectus abdominis (RA), external oblique (EO) muscle, internal oblique (IO) muscle and transversus abdominis (TrA) using SWE in 28 patients with incisional hernia and 14 healthy controls. The differences in muscle thickness for IO and TrA were significant between the two groups (p < 0.05). The SWS of RA, EO, IO and TrA was significantly higher in the incisional hernia patient group than in the healthy controls (p < 0.05). Significant differences were also observed between the upper and lower points in both groups (p < 0.05). The measurements of SWS help in evaluating the elastic properties of abdominal wall muscles, which could further aid in preparing treatment plans to improve muscle strength.     

Composition chimique de l’huile essentielle d’Artemisia herba-alba provenant de la région de Biskra (Algérie)

Artemisia herba-alba Asso (Asteraceae) essential oil (EO), obtained by hydrodistillation from aerial parts, and was investigated using GC-FID and GC-MS techniques. The EO yield, based on dry weight, was 0.95% (v/w). Forty six components corresponding to 92.61% of the oil were identified. The EO contained in majority: cis-chrysanthenyl acetate (25.12%); (2E,3Z) 3,5-heptadienal-2-ethyliden-6-methyl (8.39%); α-thujone (7.85%); myrtenyl acetate (7.39%); verbenone (7.19%), chrysanthenone (4.98%). Chemical composition was very specific for this Algerian plant.     

Antioxidant Activity and Lipid-Lowering Effect of Essential Oils Extracted from Ocimum sanctum L. Leaves in Rats Fed with a High Cholesterol Diet

It has been reported that Ocimum sanctum L. (OS) leaves decrease serum lipid profile in normal and diabetic animals. No experimental evidences support the anti-hyperlipidemic and antioxidative actions against hypercholesterolemia. Moreover the identity of the specific chemical ingredients in OS leaves responsible for these pharmacological effects are unknown. Since OS leaves are rich in essential oil (EO). Therefore the present study was conducted to investigate the anti-hyperlipidemic and antioxidative activities of EO extracted from OS leaves in rats fed with high cholesterol (HC) diet. EO was extracted by the hydrodistillation method and the chemical constituents were then identified by Gas Chromatography-Mass Spectrometry. The experiment was performed in Male Wistar rats fed with 2.5 g%(w/w) of cholesterol diet for seven weeks. During the last 3 weeks, rats were daily fed with EO. The results showed that phenyl propanoid compounds including eugenol and methyl eugenol were the major constituents of EO. EO suppressed the high serum lipid profile and atherogenic index as well as serum lactate dehydrogenase and creatine kinase MB subunit without significant effect on high serum levels of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase in rats fed with HC diet. In addition, EO was found to decrease the high levels of thiobarbituric acid reactive substances (TBARS), glutathione peroxidase (GPx) and superoxide dismutase (SOD) without impacting catalase (CAT) in the cardiac tissue while in the liver, it decreased high level of TBARS without significantly effecting GPx, SOD and CAT. Histopathological results confirmed that EO preserved the myocardial tissue. It can be concluded that EO extracted from OS leaves has lipid-lowering and antioxidative effects that protect the heart against hypercholesterolemia. Eugenol that is contained in EO likely contribute to these pharmacological effects.     

HBsAg ELISA试剂对亚型检出能力的分析

目的考查HBsAg ELISA试剂对乙型肝炎病毒（HBV）亚型弱阳性标本的检出能力,减少血站HBsAg弱阳性标本的漏检,提高试剂对弱阳性标本检测结果的一致性。方法用国家参考品的HBV亚型定值血清对ELISA试剂进行考核。结果国产和进口试剂对HBV亚型最低检出量的检出能力均符合国家标准,进口试剂对HBV亚型最低检出量的检出能力强、灵敏度高。结论国产与进口HBsAg ELISA试剂的灵敏度存在差距。     

IN ACTIVATION OF B. SUBTILIS SPORES AND E. COLI ENDOTOXIN BY ETHYLENE OXIDE

Exposure of Bacillus subtilis spores to ethylene oxide (EO) showed correlation between the killing rate and the EO concentration, when the temperature was kept at 55 degrees C and the relative humidity at 100%. The co-efficient of dilution was calculated to be 0.9. The effect of EO on Escherichia coli endotoxin was investigated by the chromogenic Limulus Amebocyte Lysate (LAL) test. A solution of endotoxin was dried on glass tubes and exposed to 450 or 900 mg EO/l during 1-46 h under the same conditions as the spore inactivation. The LAL activity of the endotoxin was reduced to about 30%. The EO-treated endotoxin was tested in the rabbit pyrogen test. The summed temperature increase for three rabbits was 0.9 degrees C, while the same assay using untreated test pieces showed an increment of 3.7 degrees C. Administration of the same quantity of EO-treated and untreated endotoxin to the rabbits, as adjusted by the LAL-test, produced the same temperature increment. The addition of polymyxin B (PB) to an endotoxin solution reduced the LAL activity by 75%. Had the endotoxin been exposed to EO, thereby reducing the LAL activity by 70%, addition of PB further reduced the activity by 99%. The reaction of EO on the endotoxin reduced the LAL activity as well as the pyrogenic response and increased the affinity to PB.