Sterilisation von Instrumenten in kochenden Desinfektionslösungen (Baktol,Carvasept, Sagrotan und Zephirol)

Ohne Zusammenfassung     

全硬盘自动播出网络系统探析

介绍了吉安电视台全硬盘自动播出网络系统设计指导思想及系统构成,该系统采用网络技术实现资源共享,采用多级安全措施确保安全播出.     

Effects of human epidermal growth factor on endothelial wound healing of human corneas.

Paired human donor corneas (age, 73 +/- 12 yr), preserved in organ culture medium, were used to evaluate the effect of human epidermal growth factor (hEGF) on endothelial wound closure rate (WCR), on morphometric parameters (cell size, shape, and density), and on cell division in the wound area. The endothelium of the corneas was mechanically wounded (area, 4.9 +/- 0.9 mm2). For each pair, one cornea was treated with 10 ng/ml hEGF, while the mate served as control. WCR was assessed by daily staining of the corneas with trypan blue. Morphometric data were obtained after alizarin staining. Mitotic activity was assessed using 3H-thymidine autoradiography. Addition of hEGF significantly increased the WCR compared to the control group. In the closed wound (between 4-9 d), the mean cell size in the center averaged 1940 microns2 in the control group and 1287 microns2 in the hEGF-treated group (P less than 0.01). Fifteen days after wounding, the mean cell sizes averaged 1910 microns2 and 1427 microns2 in the control and hEGF-treated group, respectively (P less than 0.01). All corneas exposed to hEGF had higher endothelial cell densities than the control corneas. In the early stages of wound closure, the cells in the transitional zone in hEGF-treated corneas had a somewhat more elongated shape. However, hEGF did not affect the final cell shape within the closed wound. Autoradiographic results revealed that hEGF accelerated DNA-synthesis, although only to a limited extent. The results indicate that, in human corneas, hEGF promotes endothelial wound healing predominantly by cell migration, at least in corneas from senior donors.     

The effects of 5-fluorouracil and mitomycin C on the corneal endothelium.

5-Fluorouracil (5-FU) and Mitomycin C (MMC) are used as adjunct chemotherapy during glaucoma filtering surgery to suppress conjunctival fibroblast proliferation. Since part of these agents may gain access to the anterior chamber and cause cytotoxicity to the corneal endothelium we set up an in vitro system to establish a dose-response effect. Cytotoxicity of MMC and 5-FU was quantified using Mosmann's colorimetric assay in a bovine endothelial cell culture system. In this assay the respiratory activity of the cells is used as a marker for cell viability. After incubation for 5 minutes the 3.0 mg/ml concentration of MMC showed endothelial cytotoxicity, whereas no endothelial toxicity of 5-FU was noted in concentrations up to 50 mg/ml. After incubation for 30 minutes endothelial cytotoxicity was demonstrated for 50 mg/ml of 5-FU and 1 mg/ml of MMC. After an exposure-time of 60 minutes the toxicity level remained 50 mg/ml for 5-FU but decreased to 0.5 mg/ml for MMC. We conclude that with respect to the clinically used concentrations and methods of application of 5-FU and MMC in vivo endothelial toxicity is not to be expected. However, in cases of accidental access of MMC to the anterior eye chamber and following a reduction of aqueous turnover rate the safety of MMC is unwarranted.     

Introducing managed care in Switzerland: impact on use of health services

The objectives of this study were to assess changes in the self-reported use of health care services after gatekeeping by general practitioners and a global budget were introduced in the health insurance plan for students at the University of Geneva, Switzerland, in October 1992. A random sample of 336 members of the University plan answered questions about their use of health care services during the year before (1992) and the year after (1993) the introduction of managed care. Similar data were collected among a random sample of 300 members of a comparison plan. All participants were 18–44 y old in 1992, spoke French and lived in Geneva. The proportion of insurees who visited specialists decreased by 10% in the University plan between 1992 and 1993 and remained unchanged in the comparison group. The proportion of insurees who visited general practitioners increased by 12% in the University plan and remained unchanged in the comparison group. No effects on the total number of health care visits, on hospitalisations or on use of medications were detected. The introduction of gatekeeping and of a global budget managed by physicians was associated with a transfer of patient visits from specialists to general practitioners.     

Organ-culture preservation of human corneas

Human corneas were preserved up to 40 days in a modified tissue culture medium at 31 degrees C. The corneal endothelium was examined by light microscopy before and after culture. After staining with trypan-blue the number of dead cells was counted and by swelling of the intercellular borders in a 1.8 per cent sucrose solution the cellular mosaic was observed. A loss of endothelial cells was found varying from 0-30 per cent. During culture the stroma increased considerably in thickness. Prior to transplantation the cornea was thinned during 24 h in culture medium containing 5 per cent Dextran T500. The combination of the organ culture procedure and the evaluation of the endothelium enables preservation of human corneas for at least 30 days. In addition the quality of the endothelium is guaranteed and the transport of corneas can be carried out at room temperature.     

Prehospital stroke diagnostics based on neurological examination and transcranial ultrasound

Background

Transcranial color-coded sonography (TCCS) has proved to be a fast and reliable tool for the detection of middle cerebral artery (MCA) occlusions in a hospital setting. In this feasibility study on prehospital sonography, our aim was to investigate the accuracy of TCCS for neurovascular emergency diagnostics when performed in a prehospital setting using mobile ultrasound equipment as part of a neurological examination.

Methods

Following a ‘911 stroke code’ call, stroke neurologists experienced in TCCS rendezvoused with the paramedic team. In patients with suspected stroke, TCCS examination including ultrasound contrast agents was performed. Results were compared with neurovascular imaging (CTA, MRA) and the final discharge diagnosis from standard patient-centered stroke care.

Results

We enrolled ‘232 stroke code’ patients with follow-up data available in 102 patients with complete TCCS examination. A diagnosis of ischemic stroke was made in 73 cases; 29 patients were identified as ‘stroke mimics’. MCA occlusion was diagnosed in ten patients, while internal carotid artery (ICA) occlusion/high-grade stenosis leading to reversal of anterior cerebral artery flow was diagnosed in four patients. The initial working diagnosis ‘any stroke’ showed a sensitivity of 94% and a specificity of 48%. ‘Major MCA or ICA stroke’ diagnosed by mobile ultrasound showed an overall sensitivity of 78% and specificity of 98%.

Conclusions

The study demonstrates the feasibility and high diagnostic accuracy of emergency transcranial ultrasound assessment combined with neurological examinations for major ischemic stroke. Future combination with telemedical support, point-of-care analysis of blood serum markers, and probability algorithms of prehospital stroke diagnosis including ultrasound may help to speed up stroke treatment.     

Intravenous magnesium sulphate for aneurysmal subarachnoid hemorrhage: an updated systemic review and meta-analysis

Introduction  

Previous meta-analyses of magnesium sulphate infusion in the treatment of aneurysmal subarachnoid hemorrhage (SAH) have become outdated due to recently published clinical trials. Our aim was thus to perform an up-to-date systemic review and meta-analysis of published data on the use of magnesium sulphate infusion in aneurysmal SAH patients.