60 kg/m侧磨钢轨疲劳试验研究

对60kg/m侧磨钢轨进行了疲劳试验研究,得到了侧磨量与疲劳寿命及疲劳应力与疲劳寿命两个回归方程,为控制调边钢轨下道提出了理论依据。     

除菌过滤器验证(四):兼容性验证

兼容性验证是过滤器工艺验证项目之一,以证实工艺及工艺条件对过滤器的特定性能没有产生负面影响。文中介绍了兼容性的概念、兼容性验证的目的和除菌过滤器兼容性验证实验的方法,同时介绍了重复使用过滤器的兼容性验证和同系列药品在兼容性验证中的分组原则。     

UF-1000i尿沉渣分析仪过滤装置的重新利用

目的降低UF-1000i尿沉渣分析仪过滤装置消耗成本,评价过滤网重新利用后的各项技术指标。方法将滤孔堵塞变形后的过滤网有效处理后装入仪器,对其进行精密度、线性范围及与装有配套新过滤网的相同仪器进行对比试验。结果装有重新利用的过滤网的仪器对白细胞、红细胞、上皮细胞、管型、细菌、电导率的测定之精密度、线性范围均达到厂家的性能要求,并与装有配套新过滤网的相同仪器的相关性良好,相关系数均大于0.99。结论 UF-1000i尿沉渣分析仪再利用的过滤网完全达到临床应用要求,可重新利用,值得推广。     

Noradrenaline and dopamine-beta-hydroxylase levels in rat salivary glands after preganglionic nerve stimulation: Evidence for re-use of amine storage granules in transmitter release

Summary The levels of endogenous noradrenaline (NA) in rat salivary glands were reduced to about 40 per cent after 1 hour of preganglionic stimulation at 4 Hz. Following 2 to 3 hours of rest the NA values had recovered to normal and remained normal for 6 hours after the stimulation. The recovered NA could be depleted by renewed nerve stimulation. After treatment with reserpine the NA disappeared almost completely. The recovered NA is discussed to be mainly present in amine storage granules that are re-used for storage and transmitter release. The axonal down-transport of new granules to the nerve terminals appears to be too small, as based on earlier results, for being of any quantitative importance in the experimental situation. The dopamine--hydroxylase (DBH) level in the glands did not significantly change after the period of stimulation. The DBH content remained mainly unchanged following either post-stimulation recovery, repeated stimulation, or reserpine treatment. First when the glands were stimulated for 4 hours, there was a small decrease of the DBH levels. The mainly unchanged levels of DBH after stimulation does not appear to be explained by trapping in the tissue of released DBH, or recovery of the DBH by a marked axonal down-transport of new granules, as based on earlier results. The results of the DBH estimations support the view that the granules are not consumed to any marked extent at nerve activity, but can be re-used for nerve transmission. Furthermore, the results are in agreement with lack of correlation between released NA and released DBH.     

Germicidal effectiveness of Dialox, a new stable peroxyacetic acid solution, in the re-use of high-flux dialysers

In this study we evaluate the effectiveness of a newly available peroxyacetic acid solution (Dialox) as a disinfecting agent in the re-use of highly permeable dialysers. The germicidal properties of Dialox were tested in an in vitro trial on previously used haemodiafilters (HF80, Fresenius) highly contaminated with Pseudomonas aeruginosa, Mycobacterium smegmatis or sporulated Bacillus cereus. Complete freedom from bacterial contamination was observed 5 min after the reprocessing treatment on a Renatron reprocessing machine, using the currently marketed Dialox concentrate.     

Residual Formaldehyde in Dialyzers: Quantity, Location, and the Effect of Different Methods of Rinsing

When formalin-sterilized dialyzers were rinsed by our standard technique (similar to that used in many other dialysis centres) undesirable concentrations of formaldehyde were found in the dialyzers at the start of dialysis. When the technique was modified by passing part of the saline through the blood compartment immediately before connection and discarding the saline left in the dialyzer at the time of connection, the concentration of formaldehyde infused into the patient fell below 2 μg/ml. However, the dialyzers still contained up to 13 mg of formaldehyde which leached slowly from the dialyzer during simulated dialysis. Some residual formaldehyde was found in several components of the dialyzer but the great majority was contained in the cellulose membrane.     

Re-used pacemakers--as safe as new?: A retrospective case-control study

Abstract Re-use of pacemakers is of interest in an era of declininghealth care resources if it is proven safe and without risksto the patients. In order to investigate the safety of re-useof pacemakers we performed a retrospective case-control study.One hundred patients, who received a re-used pacemaker, werematched for date of implantation and mode (AAI;VVI; DDD) to100 others who received a newly manufactured pacemaker and werefollowed for a mean of 32±11 months for complicationsdefined as infections and signs of pacemaker malfunction andpacemaker replacement earlier than anticipated due to batterydepletion. Patients who received re-used pacemakers were significantlyolder than those who received new units (79±9 vs 68±21years;P<0·0001). The number of complications did notdiffer significantly between groups. There were no early replacementsdue to battery depletion in either of the two groups. A cost-benefitanalysis revealed a substantial economical advantage Conclusions The re-use of pacemakers can be carried out withoutincreased risk to the patients provided a proper routine fortechnical control and sterilization is followed. Re-use meanssubstantial savings which possibly could make advanced pacemakertreatment available to all eligible patients irrespective ofage. Whether re-use is feasible with implantable defibrillatorsremains to be determined.     

Re-use of a liver allograft; an exceptional opportunity to enlarge the organ donor pool

Liver allograft re-use is an exceptional way of enlarging the donor pool. We describe here a case of a re-used liver allograft, originating from an insulin-intoxicated donor and transplanted at first into a recipient presenting with hyperacute liver failure due to paracetamol intoxication. Because the original recipient developed an irreversible cerebral oedema, the allograft was re-implanted electively 55.5 h later into a patient with post-viral C cirrhosis and solitary hepatocarcinoma. Both donor and recipient operations were technically successful; liver function after the second use of the graft was normal.     

Cost-Effective Laparoscopic Cholecystectomy

INTRODUCTION

There is wide variation in costs, both theatre and ward, for the same operation performed in different hospitals. The aim of this study was to compare the true costs for a large number of consecutive laparoscopic cholecystectomy (LC) cases using re-usable equipment with those from an adjacent trust in which the policy was to use disposable LC equipment.

PATIENTS AND METHODS

Data were collected prospectively between January 2001 and December 2007 inclusive for all consecutive patients undergoing LC by two upper gastrointestinal (UGI) consultants at the Royal Berkshire Hospital. Data were collected for all the instruments used, in particular any additional disposable instruments used at surgeons'' preference. Sterilisation costs were calculated for all re-usable instruments. Costs were also obtained from an adjacent NHS trust which adopted a policy of using disposable ports and clip applicators. Disposable equipment such as drapes, insufflation tubing, and camera sheath were not considered as additional costs, since they are common to both trusts and not available in a re-usable form.

RESULTS

Over 7 years, a total of 1803 LCs were performed consecutively by two UGI consultants at the Royal Berkshire Hospital. The grand total for 1803 LC cases for the re-usable group, including initial purchasing, was £89,844.41 (an average of £49.83 per LC case). The grand total for the disposable group, including sterilisation costs, was £574,706.25 (an average of £318.75 per LC case). Thus the saving for the trust using re-usable trocars, ports and clip applicators was £268.92 per case, £69,265.98 per annum and £484,861.84 over 7 years.

CONCLUSIONS

This study has demonstrated that considerable savings occur with a policy of minimal use of disposable equipment for LC. Using a disposable set, the instrument costs per procedure is 6.4 times greater than the cost of using re-usable LC sets. It behoves surgeons to be cost-effective and to reduce unnecessary expenditure and wastage. There is no evidence to support use of once-only laparoscopic instruments on grounds of patient safety, ease of use or transmission of infection. If the savings identified in this study of two surgeons'' work (savings of £484,861.84 in a 7-year period) was extended not only across the hospital but across the NHS, large savings could be made for laparoscopic cholecystectomy. Even greater savings would accrue if the results were extrapolated to cover all laparoscopic surgery of whatever discipline.     

In Vitro Interleukin-1 Production by Different Dialysis Membranes

This study investigates the Il-1 production in vitro by normalperipheral blood monocytes or non-T cells following contactwith different dialysis membranes (cuprophan, polysulphone,polymethylmethacrylate and polyacrylonitrile), in the presenceor absence of lipopolysaccharide. The results of this studyshow that the physical contact between dialysis membranes andIl-1 producing cells is not by itself able to induce abundantIl-1 production unless exogenous lipopolysaccharide is added.A modest Il-1 production, however, could be observed with syntheticmembranes (polysuiphone and polyacrylonitrile), but not withcellulose membranes (cuprophan). Used membranes are completelyineffective as a trigger of Il-1 synthesis.