Ophthalmologic adverse effects of systemic corticosteroids

The article reviews the ophthalmologic side effects of systemic corticosteroids. These side effects include involvement of both anterior (cataract, ocular hypertension) and posterior (serous central chorioretinopathy) segements of the eye. We review the clinical presentations and detail the advance in the knowledge still incomplete of the pathophysiological mechanisms involved in the occurrence of these complications. The clinical knowledge of the ophthalmologic side effects of systemic corticosteroids is essential to inform our patients, and prevent or detect these complications to treat them appropriately.     

分散式污水处理系统研究进展

介绍了分散式污水处理系统的概念、类型及特点.综述了近年来国内外分散式污水处理系统的研究现状,以德国DEUS 21系统为例着重介绍了分散式污水处理工艺、处理技术等方面的研究进展.     

胰岛素笔用针头重复使用现状调查与分析

目的：了解糖尿病患者胰岛素笔用针头重复使用现状及相关知识的教育情况。方法：采用采用自行设计的胰岛素笔注射针头使用情况问卷调查表,对使用胰岛素笔注射的105例糖尿病患者进行调查。结果：胰岛素笔用针头重复使用率为96．19％,对重复使用危害性知晓率为10．48％,重复使用的主要影响因素为：经济因素、经验、风险教育。结论：目前在糖尿病患者中正确使用胰岛素笔用针头的现状很不容乐观,护理人员在指导胰岛素注射时,必须针对病人的特点、学历、经济状况等因素进行个体化的教育干预,并把风险教育贯穿其中。     

Risk of infection by reprocessed and resterilized virus-contaminated catheters; an in-vitro study.

AIMS: In spite of increasing reuse of disposable catheters, there are few scientific data on potential viral transmission and infection after reuse. To determine the theoretical risk of virus transmission during reuse of catheters an in vitro study was performed using an RNA virus (echovirus-11) and a DNA virus (adenovirus-2). METHODS AND RESULTS: After deliberate contamination of the catheters, reprocessing and reuse of the cleaned and glutaraldehyde sterilized catheters was simulated. The presence of residual virus was determined by cell culture and by polymerase chain reaction (PCR). After the sterilization step, infectious enterovirus was detectable in one (10%) of the samples, whereas two (20%) contained detectable enterovirus RNA. After simulated reuse, enterovirus was cultured from one (10%) of the catheters, but no less than six (60%) of the samples were enterovirus PCR positive and one (10%) contained detectable adenovirus DNA. After sonification of the catheter tips no infectious virus could be detected, but enterovirus RNA was detected in two (20%) and adenovirus DNA in three (30%) of the samples. CONCLUSIONS: It has been clearly demonstrated in this in vitro study that, even after rigorous cleaning and sterilization, virus was still present in the catheter. Reuse of catheters, labelled for single-use only, is dangerous and should be prevented.     

悉尼奥运会生活垃圾管理对北京奥运会的启示

介绍了悉尼奥运会期间对生活垃圾管理的政策和措施,包括对垃圾的分类,生活垃圾的回收管理,以及时生活垃圾最后的处置措施。总结了悉尼奥运会在生活垃圾处理方面的成功之处,提出了可供北京奥运会借鉴的经验。     

不同类型透析膜对维持性血液透析患者血清C-反应蛋白水平变化的影响

 目的观察尿毒症维持性血液透析患者血清C-反应蛋白(C reactive protein,CRP)水平的变化以及不同类型透析膜初次与复用对其的影响,从机体免疫功能的角度对透析膜的生物相容性进行评价.方法采用免疫速率散射比浊法测定尿毒症维持性血液透析患者初用和复用醋酸纤维素膜(CA)、血仿膜(HE)和聚砜膜(PS)透析器进行透析时患者血清CRP水平的变化,并加以比较.同时检测健康查体和尿毒症非透析患者的CRP水平作为对照.结果尿毒症血液透析治疗患者透析前及尿毒症非透析患者血清CRP水平均较健康查体对照组显著增高.尿毒症患者透析开始后4.5 h血清CRP水平与透析前相比明显升高(P＜0.05),HD后1.5 h后差异更为明显.使用醋酸纤维素膜(CA)透析器患者的血清CRP水平更明显高于使用血仿膜(HE)和聚砜膜(PS)透析器的患者(P＜0.05).结论血液透析可导致尿毒症血透患者血清CRP水平的增高,这种变化与透析膜的生物相容性有关,而透析器复用可在一定程度上减轻这种变化.     

A Quality and Cost-Benefit Analysis of Dialyzer Reuse in Hemodialysis Patients

Background. To evaluate the benefits of dialyzer reuse for hemodialysis (HD) patients, including the cost of HD treatment and patient's survival, a comparison was made regarding the standard practice of single-use dialysis. Methods. From January 1, 2005, to December 31, 2005, a total of 128,232 successive HD treatments in 822 patients in Chang Gung Memorial Hospital-Kaohsiung Medical Center were included in this study. Results. Approximately 54.25% (446/822) of patients reused dialyzers. The average times of dialyzer reuse was 2.54. The annual hollow fiber cost is reduced by $241,054.08 U.S. dollars (NT $7,834,257.60). The annual cost of hollow fiber was reduced by $540.48 U.S. dollars (NT $17,565.60) in one patient with dialyzer reuse. The mortality rates in dialyzer reuse and single use groups were 3.1% and 10.9% within one year (p < 0.0001). Multiple logistic regressions showed that single use compared with reuse was associated with higher mortality after adjusting co-morbid conditions including age, diabetes mellitus, etc. Conclusions. We concluded that the benefits of dialyzer reuse included safety in our center and reduction in cost during a 12-month period. Dialyzer reuse may be a safe alternative.     

The Safety of Reusing Ablation Catheters with Temperature Control and the Need for a Validation Protocol and Guidelines for Reprocessing

The objective of this study was to evaluate the safety of reusing ablation catheters with temperature control, which has not previously been reported. A review of previously conducted studies on the feasibility of reusing electrode catheters is also presented. From September 1994 to December 1997, 74 deflectable ablation catheters with temperature control (Cordis-Websters and Osypkas) were used during mean 7.6 ± 8.0 ablation sessions. The catheter tests included visual inspection for surface defects using a magnification glass, impedance measurements, evaluation of the catheter deflection capability, and the integrity of the thermistor and thermocouple. The catheters were sterilized by Sterrad(tm) after each use. A total of 41 catheters were rejected after an average 9.1 ± 8.8 uses (range 1–31). The main reasons for rejection were inaccurate temperature measurements by the thermistor or thermocouple (19 %), breakage of or defect in the internal pulling wire (12%), loss or disturbance of electrogram (9%), and loss of deflection capability (8%). The reuse of the catheters has not resulted in any major catheter failures or any major adverse clinical complications. There were no local or systemic infections. It can be concluded that these types of ablation catheters will sustain repeated uses and resterilizations without untoward harm to the patient provided that a thorough validation protocol and guidelines for quality control and rejection of catheters are used. There seems to be no rational for setting a limit for the number of reuses, since most failures occurred at any time of reuse.     

软件重用在基于TMN的网络管理系统中的应用

本文针对软件重用技术在基于TMN网络管理系统中的应用进行了研究与探讨。在基于TMN的网络管理系统中 ,包括了基于功能实体的重用、基于功能单元的重用和基于基本管理应用单元的重用。最后 ,给出了软件重用在实际的ATM网络管理系统设计中的应用。     

Effect of First and Subsequent Use of Hemodialyzers on Patient Well-Being: The Rise and Fall of a Syndrome Associated with New Dialyzer Use

In a single large dialysis unit in which dialyzers are routinely subjected to multiple use, the incidence rates of intradialytic symptoms during first use and reuse were compared. Dialyses administered during two periods were analyzed: During the first (26,592 treatments), dialyzers were processed by a manual method before both first and subsequent use. During the second (12,395 treatments), dialyzers were processed by an automated machine method before first and subsequent use. During the first (manual processing) period, 12 symptoms were found to occur more frequently during first use than during reuse. The most striking findings related to chest pain (2.8 times more frequent with first use), back pain (6 times), and concurrent chest and back pain (42 times). Thus, a "first-use syndrome" characterized by chest and back pain was clearly evident. During the second (machine processing) period, the previously noted increased symptom incidence during first use was no longer present. In particular, the incidence of chest pain and back pain was no longer greater during first use than during reuse. Our results suggest that subjecting dialyzers to an automated reuse processing system before first use can markedly diminish the incidence of first-use syndrome.