Avaliação do crescimento microbiano em sondas de uso único para vitrectomia reprocessadas na prática assistencial

O objetivo deste estudo foi avaliar o crescimento microbiano em sondas para vitrectomia de uso único, reprocessadas na prática assistencial. Foram investigadas nove sondas reusadas e reprocessadas por diferentes métodos. As sondas foram segmentadas, individualmente, em porções de 3,5 cm, totalizando em 979 unidades amostrais (extensões, conectores e ponteiras) inoculadas em meio de cultura e incubadas a 37ºC, por 14 dias. Os resultados mostraram crescimento microbiano em 57 (5,8%) unidades amostrais, das quais, 25 foram esterilizadas por Óxido de Etileno, 16 por Plasma de Peróxido de Hidrogênio e 16 por Vapor à Baixa Temperatura e Formaldeído. Foram identificadas 17 espécies microbianas, sendo as mais prevalentes o Micrococcus spp., Staphylococcus coagulase negativa, Pseudomonas spp. e Bacillus subtilis. O reuso de sondas de uso único para vitrectomia não se mostrou seguro, portanto tal prática não é recomendada.

Temperatura e umidade no armazenamento de materiais autoclavados: revisão integrativa

São diversificadas as recomendações referentes à temperatura (T°) e umidade relativa do ar (UR) no armazenamento de materiais esterilizados em Centrais de Material e Esterilização (CME), sem que essas recomendações estejam embasadas em referenciais teóricos ou experimentos. A prática mostra dificuldades em controlar esses parâmetros, suscitando dúvidas quanto ao risco para a manutenção da esterilidade dos materiais. Este artigo propôs, por meio de uma revisão bibliográfica integrativa, identificar e analisar as recomendações referentes à T° e UR indicadas para o setor de guarda dos materiais na CME. Não foi encontrada literatura que justifique tais recomendações. Foram incluídas sete publicações que analisaram as variáveis T° e UR da área de armazenagem como fatores que podem afetar a manutenção do material esterilizado, e apresentaram resultados contraditórios quanto à interferência desses fatores na manutenção da esterilidade dos materiais.

Entwicklung und Charakterisierung von Gassterilisationsprozessen am Beispiel der Oberflächensterilisation mittels Wasserstoffperoxid und Ethylenoxid

Bei der Auswahl einer Sterilisationsmethode stehen, gemäß den Vorgaben des Europäischen Arzneibuches, die Sterilisation mittels Hitze (Dampf bzw. Heißluft) oder ionisierender Strahlung im Vordergrund. Diese so genannten Referenzverfahren verfügen neben einem breiten Wirkungsspektrum über eine hohe Effektivität und zeichnen sich durch eine gute Reproduzierbarkeit aus. Häufig jedoch verbieten die physikalisch – chemischen Eigenschaften des zu sterilisierenden Gutes eine Anwendung der Referenzverfahren. In derartigen Fällen muss nach geeigneten Alternativverfahren gesucht werden, will man eine aseptische Herstellung vermeiden. Besonders bei thermolabilen Gütern hat sich der Einsatz von gasförmigen Agenzien mit keimtötender Wirkung bewährt. Bei entsprechenden Rahmenbedingungen ist hier eine Sterilisation unterhalb der Raumtemperatur möglich. Die vorliegende Arbeit untersucht die Anwendbarkeit der Ethylenoxidsterilisation bzw. der Sterilisation mittels gasförmigen Wasserstoffperoxids (Vapour Phase Hydrogen Peroxide) auf verschiedene Materialoberflächen am Beispiel zweier aktueller Anwendungen aus der pharmazeutischen Industrie. Dabei werden die Vor- und Nachteile der beiden Verfahren aufgezeigt und in Relation zu den Referenzverfahren gestellt. Im Rahmen der abschließenden mikrobiologischen Leistungsbeurteilung beider Verfahren werden verschiedene methodische Ansätze, wie Halbzyklus und Fraction Negative Analysis zur Anwendung gebracht und bewertet.

Ricerche di campo per lo sviluppo della tecnologia del maschio sterile nella lotta ad Aedes albopictus (Skuse)

Aedes albopictus (Skuse), comunemente detta Zanzara Tigre, ha invaso, negli ultimi anni, molti paesi, soprattutto in modo passivo attraverso il commercio di pneumatici usati. Questa specie è particolarmente adatta all'applicazione della tecnica dell'insetto sterile (SIT), basata su allevamento massale, sterilizzazione e rilascio in campo di un gran numero di maschi della specie vettrice. I maschi sterili rilasciati devono essere in grado di volare, di disperdersi sul territorio, di sopravvivere, di essere sessualmente attivi abbastanza a lungo per coprire il tempo tra una fase di rilascio e la successiva, di individuare le femmine vergini selvatiche e competere con successo per l'accoppiamento con i maschi selvatici. La dispersione e la sopravvivenza dei maschi di Ae. albopictus allevati in laboratorio, sono state studiate mediante tecniche di marcatura, rilascio e ricattura. Le catture sono state eseguite da tecnici specializzati, in un raggio di 350 m dal sito di rilascio. Gli esperimenti condotti hanno dimostrato che i maschi sono in grado di disperdersi, dal sito di rilascio, per circa 200 m ma la loro longevità in campo è fortemente dipendente dalle condizioni climatiche. In studi di semi-campo e di campo è stato valutato uno speciale dispositivo progettato per essere incluso nella stazione di rilascio dei maschi in grado di fornire loro fonti energetiche per migliorarne le prestazioni. I risultati ottenuti sono stati positivi. Studi di competitività sono stati condotti in tunnel costruiti in un ambiente naturale al fine di validare un protocollo per studi sulla competitività dei maschi in questo modello sperimentale. Maschi irraggiati mediante l'applicazione di raggi gamma alla dose di 30 Gy sono stati messi in competizione con maschi fertili per l'accoppiamento con femmine vergini con diversi rapporti. I risultati ottenuti hanno dimostrato le buone prestazioni e l'affidabilità di questo modello sperimentale rimanendo però irrisolto il problema dell’elevata variabilità.

Dielectrophoresis (dep) and electrowetting (ewod) as an anti-fouling process for antibacterial surfaces

Nowadays the medical field is struggling to decrease bacteria biofilm formation which leads to infection. Biomedical devices sterilization has not changed over a long period of time. This results in high costs for hospitals healthcare managements. The objective of this project is to investigate electric field effects and surface energy manipulation as solutions for preventing bacteria biofilm for future devices. Based on electrokinectic environments 2 different methods were tested: feasibility of electric gradient through mediums (DEP) reinforced by numerical simulations; and EWOD by the fabrication of golden interdigitated electrodes on silicon glass substrates, standard ~480 nm Teflon (PTFE) layer and polymeric gasket to contain the bacteria medium. In the first experiment quantitative analysis was carried out to achieve forces required to reject bacteria without considering dielectric environment limitations as bacteria and medium frequency dependence. In the second experiment applied voltages was characterized by droplets contact angle measurements and put to the live bacteria tests. The project resulted on promising results for DEP application due to its wide range of frequency that can be used to make a “general” bacteria rejecting; but in terms of practicality, EWOD probably have higher potential for success but more experiments are needed to verify if can prevent biofilm adhesion besides the Teflon non-adhesive properties (including limitations as Teflon breakthrough, layer sensitivity) at incubation times larger than 24 hours.

Effects of exposure to physical factors on homeopathic preparations as determined by ultraviolet light spectroscopy

Clinical trials have reported statistically significant and clinically relevant effects of homeopathic preparations. We applied ultraviolet (UV) spectroscopy to investigate the physical properties of homeopathic preparations and to contribute to an understanding of the not-yet-identified mode of action. In previous investigations, homeopathic preparations had significantly lower UV light transmissions than controls. The aim of this study was to explore the possible effects of external factors (UV light and temperature) on the homeopathic preparations. Homeopathic centesimal (c) dilutions, 1c to 30c, of copper sulfate (CuSO(4)), decimal dilutions of sulfur (S(8)), 1x to 30x, and controls (succussed potentization medium) were prepared, randomized, and blinded. UV transmission was measured at six different time points after preparation (from 4 to 256 days). In addition, one series of samples was exposed to UV light of a sterilization lamp for 12 h, one was incubated at 37 degrees Celsius for 24 h, and one was heated to 90 degrees Celsius for 15 min. UV light transmission values from 190 or 220 nm to 340 nm were measured several times and averaged. After each exposure, UV transmission of the homeopathic preparations of CuSO(4) was significantly reduced compared to the controls, particularly after heating to 37 degrees Celsius. Overall, the nonexposed CuSO(4) preparations did not show significantly lower UV transmission compared to controls; however, the pooled subgroup of measurements at days 26, 33, and 110 yielded significant differences. UV light transmission for S(8) preparations did not show any differences compared to controls. Our conclusion is that exposure to external factors, incubation at 37 degrees Celsius in particular, increases the difference in light transmission of homeopathic CuSO(4) preparations compared to controls.

Elevated glycodelin-A concentrations in serum and peritoneal fluid of women with ovarian endometriosis

The aim of this study was to evaluate serum and peritoneal fluid (PF) glycodelin-A concentrations in women with ovarian endometriosis. Ninety-nine matched pairs of serum and PF samples were included in our study. The case group comprised 57 women with ovarian endometriosis and the control group 42 healthy women undergoing sterilization or patients with benign ovarian cysts. Glycodelin-A concentrations were measured using ELISA. Endometriosis patients had significantly higher serum and PF glycodelin-A concentrations compared to controls, and this increase was observed in both proliferative and secretory cycle phases. Glycodelin-A concentrations were more than 10-fold higher in PF than in serum and correlated with each other. Intensity and frequency of menstrual pain positively correlated with glycodelin-A concentrations. Sensitivity and specificity of glycodelin-A as a biomarker for ovarian endometriosis were 82.1% and 78.4% in serum, and 79.7% and 77.5% in PF, respectively. These results indicate that Glycodelin-A has a potential role as a biomarker to be used in combination with other, independent marker molecules.

General principles of therapy of pyogenic meningitis

In bacterial meningitis, several pharmacodynamic factors determine therapeutic success-when defined as sterilization of the CSF: (1) Local host defense deficits in the CNS require the use of bactericidal antibiotics to sterilize the CSF. (2) CSF antibiotic concentrations that are at least 10-fold above the MBC are necessary for maximal bactericidal activity. Protein binding, low pH, and slow bacterial growth rates are among the factors that may explain the high antibiotic concentrations necessary in vivo. (3) High CSF peak concentrations that lead to rapid bacterial killing appear more important than prolonged suprainhibitory concentrations, probably because very low residual levels in the CSF prevent bacterial regrowth, even during relatively long dosing intervals. (4) Penetration of antibiotics into the CSF is significantly impaired by the blood-brain barrier and thus, very high serum levels are necessary to achieve the CSF concentrations required for optimal bactericidal activity. Beyond these principles, recent data suggests that rapid lytic killing of bacteria in the CSF may have harmful effects on the brain because of the release of biologically active products from the lysed bacteria. Since rapid CSF sterilization remains a key therapeutic goal, the harmful consequences of bacterial lysis present a major challenge in the therapy of bacterial meningitis. Currently, dexamethasone represents that only clinically beneficial approach to reduce the harmful effects of bacterial lysis, and novel approaches are required to improve the outcome of this serious infection.

Pharmacodynamics of antibiotics in experimental bacterial meningitis--two sides to rapid bacterial killing in the cerebrospinal fluid

In bacterial meningitis, several pharmacodynamic factors determine therapeutic success--when defined as sterilization of the cerebrospinal fluid (CSF); (i) local host defense deficits require the use of bactericidal antibiotics; (ii) CSF antibiotic concentrations that are at least 10-fold above the MBC are necessary for maximal bactericidal activity; (iii) high CSF peak concentrations that lead to rapid bacterial killing appear more important than prolonged suprainhibitory concentrations, probably because very low residual levels in the CSF prevent bacterial regrowth even during relatively long dosing intervals; (iv) penetration of antibiotics into the CSF is significantly impaired by the blood-brain barrier, thus requiring high serum levels to achieve the CSF concentrations necessary for rapid bacterial killing. Beyond these principles, recent data suggest that rapid lytic killing of bacteria in the CSF may have harmful effects on the brain because of the release of biologically active bacterial products. The conflict between the need for rapid CSF sterilization and the harmful consequences of bacterial lysis must be addressed in the therapy of meningitis.

Late onset and pregnancy-induced congenital thrombotic thrombocytopenic purpura.

UNLABELLED We report on our patient (case 2) who experienced a first acute episode of thrombotic thrombocytopenic purpura (TTP) at the age of 19 years during her first pregnancy in 1976 which ended in a spontaneous abortion in the 30th gestational week. Treatment with red blood cell concentrates was implemented and splenectomy was performed. After having suffered from several TTP episodes in 1977, possibly mitigated by acetylsalicylic acid therapy, an interruption and sterilization were performed in 1980 in her second pregnancy thereby avoiding another disease flare-up. Her elder sister (case 1) had been diagnosed with TTP in 1974, also during her first pregnancy. She died in 1977 during her second pregnancy from a second acute TTP episode. DIAGNOSIS In 2013 a severe ADAMTS13 deficiency of <10% without detectable ADAMTS13 inhibitor was repeatedly found. Investigation of the ADAMTS13 gene showed that the severe ADAMTS13 deficiency was caused by compound heterozygous ADAMTS13 mutations: a premature stop codon in exon 2 (p.Q44X), and a missense mutation in exon 24 (p.R1060W) associated with low but measurable ADAMTS13 activity. CONCLUSION Genetic analysis of the ADAMTS13 gene is important in TTP patients of all ages if an ADAMTS13 inhibitor has been excluded.

Invasive plant species do not create more negative soil conditions for other plants than natives

Abstract A major task in ecology is to establish the degree of generality of ecological mechanisms. Here we present results from a multi-species experiment that tested whether a set of invasive species altered the soil conditions to the detriment of other species by releasing allelopathic compounds or inducing shifts in soil biota composition, and whether this effect was more pronounced relative to a set of closely related native species. We pre-cultivated soil with 23 exotic invasive, 19 related native and 6 related exotic garden species and used plain soil as a control. To separate allelopathy from effects on the soil biota, we sterilized half of the soil. Then, we compared the effect of soil pre-cultivation and sterilization on germination and growth of four native test species in two experiments. The general effect of soil sterilization was positive. The effect of soil pre-cultivation on test species performance was neutral to positive, and sterilization reduced this positive effect. This indicates general absence of allelopathic compounds and a shift toward a less antagonistic soil biota by cultivation species. In both experiments, pre-cultivation effects did not differ systematically between exotic invasive, exotic garden or native species. Our results do not support the hypothesis that invasive plants generally inhibit the growth of others by releasing allelopathic compounds or accumulating a detrimental soil biota.

Effects of Antiseptic Solutions Commonly Used in Dentistry on Bone Viability, Bone Morphology, and Release of Growth Factors

PURPOSE Antiseptic solutions are commonly used in dentistry for a number of sterilization procedures, including harvesting of bone chips, irrigation of extraction sockets, and sterilization of osteonecrotic bone. Despite its widespread use, little information is available regarding the effects of various antiseptic solutions on bone cell viability, morphology, and the release of growth factors. MATERIALS AND METHODS The antiseptic solutions included 1) 0.5% povidone iodine (PI), 2) 0.2% chlorhexidine diguluconate (CHX), 3) 1% hydrogen peroxide (H2O2), and 4) 0.25% sodium hypochlorite (HYP). Bone samples collected from porcine mandibular cortical bone were rinsed in the antiseptic solutions for 10 minutes and assessed for cell viability using an MTS assay and protein release of transforming growth factor (TGF-β1), bone morphogenetic protein 2 (BMP2), vascular endothelial growth factor (VEGF), interleukin (IL)-1β, and receptor activator of nuclear factor κB ligand (RANKL) using an enzyme-linked immunosorbent assay at 15 minutes and 4 hours after rinsing. RESULTS After antiseptic rinsing, changes to the surface protein content showed marked alterations, with an abundant protein layer remaining on CHX-rinsed bone samples. The amount of surface protein content gradually decreased in the following order: CHX, H2O2, PI, and HYP. A similar trend was also observed for the relative cell viability from within bone samples after rinsing, with up to 6 times more viable cells found in the CHX-rinsed bone samples than in the HYP- and PI-rinsed samples. An analysis of the growth factors found that both HYP and PI had significantly lower VEGF and TGF-β1 protein release from bone samples at 15 minutes and 4 hours after rinsing compared with CHX and H2O2. A similar trend was observed for RANKL and IL-1β protein release, although no change was observed for BMP2. CONCLUSIONS The results from the present study have demonstrated that antiseptic solutions present with very different effects on bone samples after 10 minutes of rinsing. Rinsing with CHX maintained significantly higher cell viability and protein release of growth factors potent to the bone remodeling cycle.

Panels of cytokines and other secretory proteins as potential biomarkers of ovarian endometriosis.

Endometriosis is a gynecologic disease that is characterized by nonspecific symptoms and invasive diagnostics. To date, there is no adequate noninvasive method for the diagnosis of endometriosis. Although more than 100 potential biomarkers have been investigated in blood and/or peritoneal fluid, none of these has proven useful in clinical practice. The aim to find a suitable panel of biomarkers that would allow noninvasive diagnosis thus remains of interest. We evaluated the concentrations of 16 cytokines and other secretory proteins in serum and peritoneal fluid of 58 women with ovarian endometriosis (cases) and 40 healthy women undergoing sterilization or patients with benign ovarian cysts (controls) using multiplexed double fluorescence-based immunometric assay platform and enzyme-linked immunosorbent assay. Significantly higher concentrations of glycodelin-A were shown in serum, and significantly higher levels of glycodelin-A, IL-6, and IL-8, and lower levels of leptin were measured in the peritoneal fluid of cases versus controls. In serum, the best performance was shown by models that included the ratio of leptin/glycodelin-A and the ratio of ficolin 2/glycodelin-A, whereas in the peritoneal fluid the best models included the ratio of biglycan/leptin, regulated on activation normal T-cell expressed and secreted/IL-6 and ficolin-2/glycodelin-A, and IL-8 per milligram of total protein, all in combination with age. The models using serum and peritoneal fluid distinguished between ovarian endometriosis patients and controls regardless of the menstrual cycle phase with relatively high sensitivity (72.5% to 84.2%), specificity (78.4% to 91.2%), and area under the curve (0.85 to 0.90).

A novel treatment planning methodology for high dose 166Ho-DOTMP therapy in patients with multiple myeloma

Bone marrow ablation, i.e., the complete sterilization of the active bone marrow, followed by bone marrow transplantation (BMT) is a comment treatment of hematological malignancies. The use of targeted bone-seeking radiopharmaceuticals to selectively deliver radiation to the adjacent bone marrow cavities while sparing normal tissues is a promising technique. Current radiopharmaceutical treatment planning methods do not properly compensate for the patient-specific variable distribution of radioactive material within the skeleton. To improve the current method of internal dosimetry, novel methods for measuring the radiopharmaceutical distribution within the skeleton were developed. 99mTc-MDP was proven as an adequate surrogate for measuring 166Ho-DOTMP skeletal uptake and biodistribution, allowing these measures to be obtained faster, safer, and with higher spatial resolution. This translates directly into better measurements of the radiation dose distribution within the bone marrow. The resulting bone marrow dose-volume histograms allow prediction of the patient disease response where conventional organ scale dosimetry failed. They indicate that complete remission is only achieved when greater than 90% of the bone marrow receives at least 30 Gy. ^ Comprehensive treatment planning requires combining target and non-target organ dosimetry. Organs in the urinary tract were of special concern. The kidney dose is primarily dependent upon the mean transit time of 166 Ho-DOTMP through the kidney. Deconvolution analysis of renograms predicted a mean transit time of 2.6 minutes for 166Ho-DOTMP. The radiation dose to the urinary bladder wall is dependent upon numerous factors including patient hydration and void schedule. For beta-emitting isotopes such as 166Ho, reduction of the bladder wall dose is best accomplished through good patient hydration and ensuring a partially full bladder at the time of injection. Encouraging the patient to void frequently, or catheterizing the patient without irrigation, will not significantly reduce the bladder wall dose. ^ The results from this work will produce the most advanced treatment planning methodology for bone marrow ablation therapy using radioisotopes currently available. Treatments can be tailored specifically for each patient, including the addition of concomitant total body irradiation for patients with unfavorable dose distributions, to deliver a desired patient disease response, while minimizing the dose or toxicity to non-target organs. ^

Scanned Ion Beam Therapy for Thoracic Tumors

Although frequently cured of Hodgkin lymphoma, adolescents and young adults can develop radiation induced second cancers. These patients could potentially benefit from scanned ion radiotherapy yet likely would require motion mitigation strategies. In theory, four-dimensional (4D) optimization of ion beam fields for individual motion states of respiration can enable superior sparing of healthy tissue near moving targets, compared to other motion mitigation strategies. Furthermore, carbon-ion therapy can sometimes provide greater relative biological effectiveness (RBE) for cell sterilization in a target but nearly equivalent RBE in tissue upstream of the target, compared to proton therapy. Thus, we expected that for some patients with Hodgkin lymphoma, carbon-ion therapy would reduce the predicted risk of second cancer incidence in the breast compared with proton therapy. The purpose of this work was to determine whether 4D-optimized carbon-ion therapy would significantly reduce the predicted risk of radiation induced second cancers in the breast for female Hodgkin lymphoma patients while preserving tumor control compared with proton therapy. To achieve our goals, we first investigated whether 4D-optimized carbon beam tracking could reduce dose to volumes outside a moving target compared with 3D-optimized carbon beam tracking while preserving target dose coverage. To understand the reliability of scanned carbon beam tracking, we studied the robustness of dose distributions in thoracic targets to uncertainties in patient motion. Finally, we investigated whether using carbon-ion therapy instead of proton therapy would significantly reduce the predicted risk of second cancer in the breast for a sample of Hodgkin lymphoma patients. We found that 4D-optimized ion beam tracking therapy can reduce the maximum dose to critical structures near a moving target by as much as 53%, compared to 3D-optimized ion beam tracking therapy. We validated these findings experimentally using a scanned carbon ion synchrotron and a motion phantom. We found scanned carbon beam tracking to be sensitive to a number of motion uncertainties, most notably phase delays in tracking, systematic spatial errors, and interfractional motion changes. Our findings indicate that a lower risk of second cancer in the breast might be expected for some Hodgkin lymphoma patients using carbon-ion therapy instead of proton therapy. For our reference scenario, we found the ratio of risk to be 0.77 ± 0.35 for radiogenic breast cancer after carbon-ion therapy versus proton therapy. Our findings were dependent on the RBE values for tumor induction and the radiosensitivity of breast tissue, as well as the physical dose distribution.