Recovery of pacemakers and defibrillators for analysis and device advance directives: electrophysiologists' perspectives

Background: Following high‐profile device failures, the Heart Rhythm Society emphasized the need for postmarketing surveillance by recommending that physicians return all explanted devices to the manufacturer for analysis. Methods: We conducted a national survey of electrophysiologists (EPs) regarding recovery for analysis of explanted pacemakers and implantable cardioverter defibrillators (devices), and attitudes toward device‐specific advance directives to facilitate return of devices. Online survey invitations were sent in four waves from December 2008 to June 2009 to 300 e‐mail addresses from the Heart Rhythm Society member database. Results: From 250 invitations, there were 95 responses (38%). Demographics included average age 50 years (range, 31–87); 95% male; 81% Caucasian. Only 23% reported returning all explanted devices to the manufacturers. Of all the respondents, 32% discarded >10 devices/year as medical waste, 42% stored devices in a box in the electrophysiology lab, and 10% donated at least 1 device/year to charity for reuse overseas. Sixty‐seven percent felt that it would not be helpful to have an advance directive specifying what the patient would want done with their device postmortem. Conclusions: Few EPs return all explanted devices or send interrogation reports to the manufacturers, though nearly all said it was easy to do so. A majority either dispose of explanted devices as medical waste or store them in laboratories or offices, and a small percentage donate for reuse in underserved nations or to veterinary hospitals. This study suggests a need for initiatives such as educational campaigns to increase the retrieval and return of devices, either for analysis or reuse. (PACE 2011; 659–665)     

Safety, efficacy, and performance of implanted recycled cardiac rhythm management (CRM) devices in underprivileged patients

Introduction: Patients in underdeveloped nations have limited access to life‐saving medical technology including cardiac rhythm management (CRM) devices. We evaluated alternative means to provide such technology to this patient population while assessing the safety and efficacy of such a practice. Methods: Patients in the United States with clinical indications for extraction of CRM devices were consented. Antemortem CRM devices were cleaned and sterilized following a protocol established at our institution. Surveillance in vitro cultures were performed for quality assurance. The functional status of pulse generators was tested with a pacing system analyzer to confirm at least 70% battery life. Most generators were transported, in person, to an implanting institution in Nicaragua. Recipients with a Class I indication for CRM implantation, and meeting economical criteria set forth, were consented for implantation of a recycled device. Results: Between 2003 and 2009, implantation was performed in 17 patients with an average age of 42.1 ± 20.3 years. Of the 17 patients, nine were male and eight were female. Mean follow‐up was 68 ± 38 months. Device evaluation occurred prior to discharge, 4 weeks post implantation, and every 6 months thereafter. There were three deaths during the follow‐up period secondary to myocardial infarction, stroke, and heart failure. Hematoma formation occurred in one patient. No infections, early battery depletion, or device malfunction were identified during follow‐up. Conclusions: Our case series is the longest follow‐up of recipients of recycled antemortem CRM devices. Our findings support the feasibility and safety of this alternative acquisition of life‐saving technology. (PACE 2011; 653–658)     

透析器重复使用的临床效果评估

目的 评估重复使用的透析器对尿毒素清除效果是否充分.方法 随机选择14位血液透析病人,平均透析月数为91.2±34.8(30-162)个月,分别连续使用1.6M2的polysufone膜透析器共计五次.结果 初次使用的透析器与重复使用的透析器对于小分子尿毒素和大分子尿毒素的清除百分比没有统计学上的差异(P<0.05).结论适当处理重复使用的透析器不会影响透析器的清除力.     

新常态下中药产业废弃物资源化的思考——新结构经济学的视角

我国中药产业在发展过程中,废弃物的不科学处置对环境和资源造成双重压力,但企业缺乏废弃物资源化的动力。新常态下我国加快推进经济结构战略性调整已刻不容缓,新结构经济学对中国经济转型和产业结构升级提供了一个分析框架。文章从新结构经济学的视角对中药产业废弃物的产生、中药废弃物资源化的现实意义以及市场和政府在中药废弃物资源化中的作用进行分析。根据产业发展的阶段性特征判断中药产业属于战略型产业,提出市场机制下中药企业实行废弃物资源化的条件,并指出为鼓励企业对中药废弃物进行资源化处置,政府可通过补贴增加其私人收益或产权制度安排增加其私人成本2个方面来实现,以促进中药产业的可持续发展。     

一次性使用无菌医疗器械回收再利用管理研究

一次性使用无菌医疗器械在临床上日益剧增的使用给人们带来了安全和便利,但同时其使用后的处理也给环境带来了压力。一次性无菌医疗器械的回收再利用已成为社会关注问题。首先介绍美国FDA对一次性无菌医疗器械的回收再利用管理方式,再结合中国国情提出对我国一次性无菌医疗器械回收再利用管理方法的建议。     

探针的纯化与否对基因芯片重复利用的影响

目的观察探针的纯度对基因芯片重复利用的影响。方法将探针分为未纯化、纯化两部分并分别与基因芯片杂交,扫描芯片后,用探针剥脱液洗涤芯片;同等条件成像后,进行下一轮杂交。结果未纯化的探针杂交结果背景高,阳性信号界限不清楚;经探针剥脱液洗涤后,仍留有较高强度的背景和原与靶基因片段杂交的阳性信号,即使洗脱4次后,仍有背景和阳性信号存在。纯化的探针杂交结果显示背景低,一般经2次探针剥脱液洗过后,可以完全去除信号并进行下一轮杂交。结论未纯化的探针与基因芯片杂交后,此芯片不能应用于下一轮的杂交;而纯化的探针杂交后,芯片可以再次利用。由此说明探针的纯化是基因芯片重复利用的前提条件。     

空心纤维型透析器复用疗效的临床观察

目的：探讨空心纤维型透析器复用的有效次数肯定其应用价值。方法：再生后透析器经判定符合标准者方能重复使用。每次血透前后留取血标本进行BUN、Cr、UA等项测定。统计学处理采用t检验或秩和检验。结果：新透析器及各次复用透析器血透前后血BUN、Cr、UA等均值比较有显著性差异（P＜0．01）；复用后至8次以上只有血BUN、Cr的排除率及CO2CP上升率与新透析器比较时才有显著性差异（P均＜0．05）。结论：空心纤维透析器复用以8次为合适，最多不能超过10次。