医疗器械监管中致癌性试验研究进展

目的：为完善我国医疗器械监管,提高医疗器械致癌性方面的研究水平提供一定参考。方法：通过查阅相关文献,介绍医疗器械的定义分类以及致癌性试验的有关模型,并且对现有医用材料致癌性试验进行论述。结果与结论：医疗器械监管中的致癌性试验是在对试验动物进行浸提液或植入物暴露试验后测定其致癌潜能的试验,根据试验结果初步估计产生不良影响的剂量指标,为建立人体暴露的安全标准提供参考依据。当前我国医疗器械相关的规范性文件有所欠缺,提高国产医疗器械的检测技术和相关标准,实现医疗器械风险性评价有助于完善监管体系,加快相关医疗器械产品进入市场。     

《医疗器械临床试验现场检查要点》解读

目的：通过解读医疗器械临床试验现场核查要点,以规范医疗器械临床试验过程。方法：从临床试验条件与合规性、临床试验部分、临床试验数据管理、受试产品的管理4个方面,分析现场检查的注意事项。结果：目前,我国医疗器械临床试验质量距离"核查要点"还有一定的差距,申办者、合同研究组织、研究者、临床试验机构都应该进一步学习相关法规,提高临床试验质量,确保上市后的产品安全。结论：以《医疗器械临床试验现场检查要点》为标准,是保证试验数据真实、完整、规范的重要途径。     

有源植入医疗器械核磁共振成像安全性评价方法研究

目的：在同样标准、尺度下进行有源植入医疗器械“MR兼容”性评价，确保有源植入医疗器械的使用安全和有效。方法：本文依据ISO/TS 10974：2018标准，结合中国食品药品检定研究院的工作，针对标准中要求的各个试验的试验依据、试验方法、接收准则进行了研究。结果：标准共涉及6项已知或可预见的风险，分别为温升、振动、力、力矩、非预期的刺激以及器械故障。为了评价这些风险，本文介绍了和6项风险相对应的9个试验项目，以此评价有源植入医疗器械的核磁兼容性。结论：目前国内针对有源植入医疗器械核磁兼容性的评价刚刚起步，一些检测手段和方法处在借鉴和摸索之中，本文系统性介绍了评价项目的考虑角度和方法，为国内从事有源植入物核磁兼容性设计及评价者提供参考。     

动物源性医疗器械精准风险评价的关键技术研究

目的：动物源性医疗器械的主要安全风险是外源因子污染和不可预测的免疫学及毒理学反应。本文概述最新动物源性医疗器械的精准风险评价关键技术,为相关产品研发和注册审评提供参考,为科学监管提供技术支持。方法：总结自主研发的针对动物源性医疗器械安全风险和质量控制的检测与评价关键技术、方法、标准,以及免疫毒理学评价的几点专家共识。结果和结论：动物源性生物材料DNA残留量测定、残留α-Gal抗原检测方法及标准已发布实施;研究建立了淋巴细胞增殖试验、采用Gal抗原缺失小鼠的免疫学评价方法等免疫毒理学评价技术手段。部分检测项目被《动物源性医疗器械注册技术审查指导原则》（2017修订版）收录。这些技术为动物源性医疗器械的精准风险评价和风险控制提供了技术支持。同时,作者展望了正在研究的风险评价新技术,提出了系统的精准风险评价体系仍需不断完善。     

辅助生殖培养用液中庆大霉素临床前安全评价思考

目的：归纳总结庆大霉素对配子和胚胎的影响,并对辅助生殖培养用液临床前评价需要考虑的问题进行分析,为辅助生殖培养用液产品中庆大霉素的临床前安全评价提供参考。方法：以辅助生殖培养用液中添加的药物庆大霉素为研究对象,结合庆大霉素在产品中的应用,采用文献调研法总结归纳了庆大霉素对生殖细胞、胚胎以及胚胎干细胞产生的影响,并根据辅助生殖用液产品监管现状,提出临床前安全评价思考。结果与结论：庆大霉素被广泛应用在辅助生殖培养用液中,安全、规范地使用庆大霉素在辅助生殖技术中具有重要意义。目前有关庆大霉素对配子及胚胎毒性的研究较少,已知的结论都是基于鼠胚试验及其他动物试验得出的结果扩展到人类胚胎,有必要关注庆大霉素对人类配子及胚胎发育的影响。其次,对于辅助生殖用液产品中庆大霉素添加量的确定、原料质量控制以及检测方法等方面存在的问题提出有针对性的建议,为加强辅助生殖用液的质量控制和产业监管提供思路,从而促进辅助生殖技术的发展。     

我国医疗器械标准法规解读和思考

目的：为我国医疗器械标准化管理工作提供参考。方法：总结分析我国医疗器械标准管理法规的基本架构,重点解读深化标准化工作改革方案出台后部分相继修订的法规内容,并对其中的差异性变化及标准化发展趋势进行分析。结果与结论：行业标准和国家标准保持了较好的衔接,后续工作建议进一步完善医疗器械标准法规体系架构,建立科学合理的技术标准体系,优化医疗器械标准组织管理体系,研究落实医疗器械标准实施评价机制,逐步实现标准全生命周期的管理。     

我国医疗器械分类目录修订框架设计的研究

目的：为行业监管人员和分类管理相对人深入理解新版分类目录提供参考。方法：在对现行医疗器械分类目录充分研究的基础上,结合医疗器械分类管理改革的要求,借鉴发达国家的管理模式和经验,提出改革医疗器械分类目录框架的建议和新框架方案,介绍了新版医疗器械分类目录框架设计过程、综合考虑因素。结果和结论：对比现行有效的分类目录,新版医疗器械分类目录的层级结构和内容更丰富,产品覆盖面更广,更有利于与国际接轨。     

药品检验信息化数据标准编制研究

目的：编制药品检验机构检验信息化数据标准,解决数据不完整、不规范、质量低的问题,实现信息共享、挖掘数据价值、提升信息化水平。方法：根据检验机构业务和信息化的实际,参考相关标准研制的实践,从内容、原则、流程方面开展标准编制工作的研究。结果与结论：本研究完成广东省药品检验数据地方标准的研制,可为今后开展同类标准的编制提供参考。     

IMDRF个性化医疗器械术语解读

目的：解读个性化医疗器械术语，为未来个性化医疗器械监管要求的建立提供参考。方法：本文主要介绍了国际医疗器械监管机构论坛（IMDRF）发布的《个性化医疗器械术语》指南，解读和对比定制式医疗器械、患者匹配医疗器械和适应性医疗器械三类个性化医疗器械。结果与结论：在医疗器械的设计、生产和使用环节，三类个性化医疗器械的个性化程度不同。     

真实世界研究用于医疗器械临床评价的探讨

目的：探究真实世界研究（RWS）如何在遵循伦理和法规的基础上,形成支持医疗器械上市监管决策的真实世界证据。方法：基于国内外关于RWS在医疗器械临床研究的相关政策、指导原则和研究现状,从研究方案设计要点、真实世界数据质量控制、数据统计分析以及实例分析等方面,分析RWS在医疗器械临床评价中的要求。结果与结论：RWS因其宽松的患者入组标准、广泛的覆盖人群以及庞大的样本量等特点,为医疗器械上市提供了有力的支持。科学、合理地设计临床试验方案,确保临床试验实施过程的可追溯性和质量可控,合理运用统计分析方法,是将真实世界数据转化为真实世界证据的关键。推动RWS在医疗器械临床试验中的应用,将加快医疗器械上市,促进整个医疗器械行业的健康快速发展。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.