Gasparyan method of total autologous reconstruction of the aortic valve

Abstract In this case report, I describe a new technique for total reconstruction of the aortic valve with autologous pericardium. The parameters of the cusps were calculated using very simple formulas after measurement of the aortic root intercommissural distances. Glutaraldehyde-treated pericardium was trimmed along the marked line, leaving 2 mm of tissue along the fibrous annulus attachment margin for the suture and small wings on both commissural margins to secure the commissural coaptation between right and noncoronary cusps. The annular margin of each pericardial cusp was sutured to the corresponding fibrous annulus with running 4/0 polypropylene suture. The commissures of pericardial patch and the commissural coaptation between right and noncoronary cusps were secured with mattress 4/0 polypropylene sutures. The coaptation of the three cusps was checked with negative pressure on the left ventricular vent before closure of the aortotomy. Intraoperative transesophageal echocardiogram revealed a peak pressure gradient of 10 mmHg and trivial aortic regurgitation.

Immediate outcomes of aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium: a multicenter study

Abstract Objective: To determine the feasibility of aortic valve neocuspidization (AVNeo) with glutaraldehyde-treated autologous pericardium. Methods: One hundred and seventy (170) AVNeo (84 males/86 females) were performed from January 2017 through March 2019 in three centers. All the records were prospectively collected and retrospectively reviewed. Results: Most of the patients were older than 60 years and over 95% were operated for aortic stenosis. Preoperatively, pressure gradients were 69.9±21.3 mmHg for patients with aortic stenosis, and the surgical annular diameter was 21.0±2.0 mm for all patients. Effective orifice area (EOA) and indexed EOA (iEOA) averaged 0.7±0.3 cm2 and 0.4±0.2 cm2/m2 for patients with aortic stenosis before surgery, respectively. There was no conversion to prosthetic aortic valve replacement. Eight patients needed reoperation for bleeding, but no patient needed reoperation due to early infective endocarditis. There were five in-hospital deaths due to noncardiac cause. Compared to preoperative echocardiographic measurements, postoperative peak pressure gradient decreased significantly (-58.7±1.7 mmHg; P<0.001) and reached 11.2±5.6 mmHg, and mean pressure gradient also decreased significantly (-36.8±1.1 mmHg; P<0.001) and reached 6.0±3.5 mmHg. Accordingly, EOA and iEOA increased significantly 2.0 cm2 and 1.0 cm2/m2 (both P<0.001) to reach 2.7±0.6 cm2 and 1.4±0.3 cm2/m2 after surgery, respectively, with minimal significant aortic regurgitation (0.6% > mild). Conclusion: AVNeo is feasible and reproducible with good clinical results. Hemodynamically, AVNeo produces immediate postoperative low-pressure gradients, large EOA, and minimal regurgitation of the aortic valve. Further studies are necessary to evaluate mid- and long-term evolution.

Biological properties of the transcatheter heart valve surface with RGD and EC anti-calcification treatments / 中华胸心血管外科杂志

Objective Anti-calcification and surface modification of the transcatheter heart valve is the priority research area and development direction of bioprosthesis heart valve.In present study,the Arginine-Glycine-Aspartic acid(RGD) coating technology and anti-calcification with epoxy chloropropane(EC) treatment were applied to investigate surface modification property of the transcatheter heart valve compared to the traditional anti-calcification method with glutaraldehyde (GA) treatment to demonstrate the improvement of structure and surface biological properties of the transcatheter heart valve.Methods Morphological characteristics of mesenchymal stem cells(MSCs) seeded on the transcatheter heart valve with the various anticalcification treatments were observed by scanning electron microscopy and the apoptosis rates of MSCs seeded on the transcatheter heart valve with the various anti-calcification interventions were studied by TUNEL staining.The cell adhesion and expression of the cytoskeletal protein,Vinment of MSCs treated as described were analyzed by cell-counting method and fluorescence immunohistochemical method respectively.Results The apoptosis rate of MSCs was markedly decreased while the expression of vinment and the cell adhesion strength of MSCs were elevated in the groups of GA-EC and RGD-EC treatments.The biological indices of RGD-EC group has significant difference(P ＜ 0.05) compared with GA group.Conclusion Biological properties of the surface of transcatheter heart valve can be remarkably improved by GA-EC and RGD-EC anti-calcification treatments.

Durability comparison and cost-effectiveness analysis of three disinfectants / 中华消化内镜杂志

Objective To compare the durability and cost-effectiveness of slightly acidic electrolyzed oxidizing water(SAEOW),ortho-phthalaldehyde (OPA) and glutaraldehyde (GA) in two conditions,i.e.,continuous machine cleaning and continuous manual cleaning.Methods The maximal numbers of endoscopes which were disinfected by the three disinfectants at its minimal effective concentration,as well as the corresponding costs were compared.The cost-effectiveness of three disinfectants were evaluated with revenue-incremental cost analysis.Results The number of endoscopes disinfected by ortho-phthalaldehyde was larger than that by two other disinfectants,140 ± 2 by machine wash and 226 ± 1 by hand washing;followed by glutaral disinfectant,88 ± 2 and 108 ± 2 by machine wash and hand wash,respectively;slightly acidic electrolyzed oxidizing water disinfected the least endoscopes,34 ± 2 and 39 ± 1 by machine wash and hand wash.There were significant differences among these three disinfectants (all P ＜ 0.05).Compared with GA,one more Yuan invested to OPA yielded 2.24 yuan more under the condition of machine wash and 3.14 yuan more under the condition of hand wash.Compared with GA,one Yuan invested in SAEOW produced 47.14 yuan by machine wash and 45.6 Yuan by hand wash.Conclusion Under full workload,orthophthalaldehyde shows the best durability among the three disinfectants,while slightly acidic electrolyzed oxidizing water shows the highest economic benefit.

The feasibility of slightly acidic electrolyzed oxidizing water for the disinfection of gastrointestinal endoscopes / 中华消化内镜杂志

Objective To evaluate the feasibility of slightly acidic electrolyzed oxidizing water for the disinfection of gastrointestinal endoscopes.Methods Electrolyzed oxidizion water generator was utilized to produce the water,which was applied for the disinfection of gastrointestinal endoscopes.The disinfectant efficiency and effect were evaluated.Results A total of 215 samples were taken for bacterial culture after the disinfection.The mean sterilization efficiency of slightly acidic electrolyzed oxidized water and 2％ glutaraldehyde by machine were 99.92％ and 99.85％,respectively,while the mean sterilization efficiency were 99.85％ and 99.84％ by manual disinfection.There were no statistical significance between the two groups.The effective rates of both groups were 100％.No deformation or aging was observed in the endoscopes.The disinfectant caused no damage to the cleansing and disinfection.Conclusion It is feasible to apply slightly acidic electrolyzed oxidizing water to the disinfection of endoscopes.

Glutaraldeído: avaliação das condições sanitárias da solução em uso para o reprocessamento de endoscópios / Glutaraldehyde: evaluation of sanitary conditions of the solution in use for reprocessing of endoscopes / Glutaraldehído: evaluación de las condiciones sanitarias de la solución en uso para el reprocesamiento de endoscopios

Estudo transversal, descritivo, realizado em 20 serviços de endoscopia digestiva alta da cidade de Goiânia-GO, em 2007, cujo objetivo foi avaliar as condições do glutaraldeído em uso para o reprocessamento de endoscópios. Os dados foram obtidos por meio de um roteiro sobre as condições sanitárias, pela aferição do pH e concentração do glutaraldeído em uso. A maioria dos serviços não realizava o controle de concentração e pH do glutaraldeído e, quando aferidos pelos pesquisadores, metade estava de acordo com as recomendações para um dos parâmetros e apenas 3(15%) estavam adequados simultaneamente. Quanto aos rótulos, foram encontrados 7(35%) no frasco de ativação do produto e 13(65%) no recipiente do produto em uso. Em 17(85%) serviços, o glutaraldeído era inadequadamente desprezado diretamente na pia. Os parâmetros de qualidade do reprocessamento químico utilizando o glutaraldeído para a desinfecção de alto nível em endoscópios, nos serviços investigados, podem representar risco para os usuários.

Cross sectional, descriptive study, conducted in 20 services of High Digestive Endoscopy in the city of Goiânia, GO, Brazil, in 2007, whose objective was to evaluate the conditions of glutaraldehyde in use for reprocessing of endoscopes. Datawere collected through a script about sanitary conditions, by pH assessment, and concentration of glutaraldehyde in use. Most services performed neither concentration control nor pH of glutaraldehyde. When assessed by researchers, half of them follow recommendations to only one of the parameters, and only 3(15%) were adequate simultaneously. As for labels, there were 7(35%) in the bottle of activation of the product and 13(65%) in the container of the product in use. In 17(85%) services, the glutaraldehyde was discarded directly and inadequately into the sink. Quality parameters of chemical reprocessing using glutaraldehyde for highlevel disinfection of endoscopes, in the investigated services can bring risk to users.

Estudio transversal, descriptivo, realizado en 20 servicios de endoscopia digestiva alta en la ciudad de Goiânia-GO-Brasil, en 2007, cuyo objetivo fue evaluar las condiciones del glutaraldehído en uso para el reprocesamiento de endoscopios. Los datos fueron recolectados a través de un guión sobre las condiciones sanitarias, por la aferición del pH y concentración del glutaraldehído en uso. La mayoría de los servicios no realizaba el control de concentración y pH del glutaraldehído y, cuando aferidos por los investigadores, la mitad se encontraba de acuerdo con recomendaciones para uno de los parámetros y solo 3(15%) estaban adecuados simultáneamente. Cuanto a los rótulos, fueron encontrados 7(35%) en el frasco de activación delproducto y 13(65%) en el recipiente del producto en uso. En 17(85%) servicios, el glutaraldehído era descartado directamente en el fregadero. Los parámetros de calidad del reprocesamiento químico utilizando el glutaraldehído para la desinfección de alto nivel en endoscopios, en los servicios investigados, pueden representar peligro para los usuarios.

Substituição do tronco da artéria pulmonar em carneiros utilizando heteroenxerto tubular valvado com preservação não-aldeídica / Replacement of pulmonary artery trunk in sheep using tubular valved heterograft in non-aldehydic preservation

INTRODUÇÃO: As biopróteses valvares cardíacas estão relacionadas a eventos tromboembólicos, infecciosos e degenerativos. Seu desgaste é atribuído principalmente à desnaturação do colágeno. O glutaraldeído, método predominante de preservação de biopróteses, favorece o processo de calcificação e limita sua durabilidade. Diversas técnicas tentam conter o processo degenerativo das biopróteses. OBJETIVO: Avaliar o processo de calcificação, in vivo, de heteroenxertos pulmonares valvados, preservados em meio não-aldeídico (L-Hydro®). MÉTODOS: Dezessete carneiros foram submetidos à substituição do tronco da artéria pulmonar por enxerto tubular valvado de pericárdio bovino. Os animais foram distribuídos em dois grupos: Grupo L-Hydro® (teste / n=14) e Grupo Glutaraldeído (controle /n=3). Cerca de 150 dias pós-implante os animais foram sacrificados, necropsiados e as próteses submetidas a estudo anatomopatológico, avaliação radiológica e dosagem do cálcio por espectrofotometria de absorção atômica. A análise estatística foi obtida por meio dos testes exato de Fisher, T de Student ou Mann-Whitney (significância: 5%). RESULTADOS: A avaliação radiológica, macroscopia, microscopia e dosagem de cálcio por espectrofotometria de absorção atômica demonstraram maior calcificação nas próteses do Grupo Glutaraldeído, quando comparadas às próteses do Grupo L-Hydro® (P=0,001). Sete animais do Grupo L-Hydro® (50%) apresentaram aderência das cúspides à parede do tubo (P=0,228). CONCLUSÕES: As próteses preservadas em L-Hydro® demonstraram-se mais resistentes à calcificação, quando comparadas às preservadas em glutaraldeído.

INTRODUCTION: The cardiac bioprostheses are related to thromboembolic events, infectious and degenerative diseases. Wear is mainly attributed to the denaturation of collagen. Glutaraldehyde, the predominant method of preservation of bioprostheses, favors the calcification process and limits their durability. Several techniques try to contain the degenerative process of bioprostheses. OBJECTIVES: To evaluate the process of calcification in vivo pulmonary valve heterografts preserved in non-aldehydic (L-Hydro®). METHODS: Seventeen sheep underwent replacement of the pulmonary artery valved tubular grafts of bovine pericardium. The animals were divided into two groups: Group L-Hydro® (test / n = 14) and Group Glutaraldehyde (control / n = 3). About 150 days after implantation the animals were sacrificed, necropsied and implants subjected to a pathological study, radiological evaluation and measurement of calcium by atomic absorption spectrophotometry. Statistical analysis was obtained through the Fisher's exact test, Student's t or Mann-Whitney test (significance: 5%). RESULTS: The radiological evaluation, the macroscopic and microscopic measurement of serum calcium by atomic absorption spectrophotometry showed increased calcification of the prosthetic group Glutaraldehyde, when compared to denture-HydroR Group L (P = 0.001). Seven animals in Group L-Hydro® (50%) had adherence of the leaflets to the wall of the tube (P = 0.228). CONCLUSIONS: Prostheses preserved in L-Hydro® were more resistant to calcification when compared with glutaraldehyde preserved.

Estrutura física das unidades de endoscopia: a realidade do reprocessamento / The physical structure of endoscopy units: the reality of reprocessing / Estructura física de las unidades de endoscopía: la realidad del reprocesamiento

Pesquisa descritiva realizada nas unidades de Endoscopia Digestiva Alta em 2007, que objetivou analisar a estrutura física da área destinada ao reprocessamento dos endoscópios no município de Goiânia-GO. Os dados foram obtidos e registrados em um check-listmediante observação direta da estrutura física e dos recursos materiais do local de reprocessamento dos endoscópios.Constatou-se que a maioria (95,0%) das unidades de endoscopia possui um fluxo de reprocessamento inadequado. Deficiências estruturais foram observadas nos locais de reprocessamento, tais como tipo de revestimento, piso, forro contínuo, presença de pia para higienização das mãos, ausência de exaustor e ponto de ar comprimido. Concluiu-se que as deficiências estruturais identificadas potencializam o risco químico e biológico tanto para o profissional, quanto para o usuário e ainda podem comprometer o reprocessamento adequado dos endoscópios.

This descriptive study was performed at several digestive endoscopy units in 2007, with the objective to analyze the physical structure of the area devoted to endoscope reprocessing at units located in Goiânia-GO. The data were obtained through direct observation of the physical structure and the material resources of the endoscope reprocessing area and recording these characteristics on a checklist.Most (95.0%) endoscopy units have an inadequate reprocessing flow. It was observed that the reprocessing areas had structural deficiencies in terms of the type of wall covering, floor tiles, continuous ceilings, the presence of a sink for hand washing, no exhaust fans and compressed air outlets. In conclusion, the identified structural deficiencies increase the chemical and biological risk for professionals and clients, and may also compromise the adequacy of endoscope reprocessing.

Investigación descriptiva realizada en unidades de Endoscopía Digestiva Alta en 2007, objetivó analizar la estructura física del área destinada al reprocesamiento de endoscopios en unidades de endoscopía del municipio de Goiânia-GO. Datos obtenidos mediante observación directa de estructura física y recursos materiales del local de reprocesamiento de endoscopios y registrados en check-list. La mayoría (95,0%) de unidades endoscópicas posee un flujo de reprocesamiento inadecuado. Fueron observadas deficiencias estructurales en los locales, como tipo de revestimiento, techado, piso, revestimiento continuo, presencia de pileta para higienización de manos, ausencia de exhaustor y compresor de aire. Se concluye en que las deficiencias estructurales verificadas potencian riesgos químicos y biológicos para el profesional y el paciente, y puede también comprometer el reprocesamiento adecuado de los endoscopios.

A new peracetic acid solution for disinfection of digestive endoscope / 中华消化内镜杂志

ObjectiveTo evaluate the disinfective effect of a new peracetic acid solution for digestive endoscope.MethodsForty endoscopes were divided into experimental group and control group,10 gastroscopes and 10 enteroscopes in each group,the experimental group was disinfected with the new peracetic acid solution for 10 min,the control group was disinfected with 2％ glutaral for 10 min,the disinfection effect was compared.Subsequently,80 other endoscopes were divided into 4 groups,10 gastroscopes and 10 enteroscopes in each group,each group was disinfected for 2 min,3 min,4 min and 5 min,the disinfection efficiency was evaluated.ResultsThe disinfection rates of gastroscopes and enteroscopes in the control were 100％ (10/10)and 90％ (9/10)respectively.Bacteria were found in both endoscopes.In the experimental group,disinfection rates of both gastroscopes and enteroscopes were 100％ (10/10),and no bacterium was found,which was superior to the control.disinfection rates of gastroscopes of 3 min,4 min and 5 min were all 100％ (10/10),which were higher than that of 2 min group (30％) (P ＜0.05).Bacteria were found in 3 min group.Disinfection rates of 4 min and 5 min group were 100％ ( 10/10),which were higher than that of 3 min group (80％)(P ＜0.05).Bacteria were found in 4 min group,and 2 min group was not disinfected.ConclusionThe new peracetic acid solution is effective for clinic digestive endoscope disinfection,and is superior to 2％ glutaral.

Endoscope reprocessing using glutaraldehyde in endoscopy services of Goiânia, Brazil / O reprocessamento de endoscópios pelo uso do glutaraldeído: a realidade em serviços de endoscopia de Goiânia, GO

CONTEXT: The endoscopic procedure safety depends on the use of an adequately reprocessed device which quality is related to each of its operational steps. OBJECTIVE: To characterize the reprocessing of endoscopes using glutaraldehyde in endoscopy services METHODS: Study was conducted by observing the reprocessing of 60 endoscopes from 20 medical practices of the municipality of Goiânia, GO, central area of Brazil. RESULTS: This study showed failure in all reprocessing steps. The pre-washing was performed in 24 (40.0 percent) of the endoscope. In the cleaning steps, was identify the improper use of enzymatic detergent, and in 27 (45.0 percent) cases, the brushing of internal channels was not performed. All 60 endoscopes were submitted to this disinfectant. However, for 33 (55.0 percent) of the cases the internal channels was not filled. The total immersion of endoscope in the glutaraldehyde was not performed in 39 (65.0 percent) cases. The recommended minimum total immersion time for exposure to 2 percent glutaraldehyde solution was followed only for 12 (20.0 percent) endoscopes. There was no filter for water treatment used in the rinse of most endoscopes 54 (90.0 percent) and to dry the internal channels only 6 (10.0 percent) of them used compressed air. Adequate storing conditions were identified. CONCLUSION: Considering the particularities of the endoscope and its reprocessing, it is imperative to establish protocols to ensure the quality of the disinfection and the prevention of cross-contamination.

CONTEXTO: A segurança do procedimento endoscópico depende do uso de um aparelho adequadamente reprocessado e a qualidade do reprocessamento está relacionada a cada uma das etapas operacionais desse processo. OBJETIVO: Caracterizar o reprocessamento de endoscópios pelo uso do glutaraldeído em serviços de endoscopia. MÉTODOS: Estudo conduzido em 20 serviços de endoscopia digestiva do município de Goiânia, GO. A amostra se constituiu de endoscópios utilizados para endoscopia digestiva alta. Os dados foram obtidos mediante observação direta de 60 reprocessamentos de endoscópios. Resultado - Foram observadas falhas em todas as etapas do reprocessamento. Em 24 (40,0 por cento) endoscópios foi realizada a pré-lavagem. Na etapa da limpeza, foi identificado o uso inadequado do detergente enzimático e em 27 (45,0 por cento) não foi realizada a escovação dos canais internos. Todos os 60 endoscópios foram submetidos ao desinfetante, entretanto para 33 (55,0 por cento) não foi aspirado o produto nos canais internos. O tempo de exposição ao glutaraldeído foi observado apenas para 12 (20 por cento) dos endoscópios. O enxágue de 54 (90,0 por cento) dos endoscópios ocorreu com o uso de água não-filtrada e, para a secagem dos canais internos, apenas 6 (10,0 por cento) utilizaram o ar comprimido. Foram identificadas condições adequadas para o armazenamento. CONCLUSÃO: Considerando as particularidades do reprocessamento dos endoscópios é imperativo estabelecer protocolos para assegurar a qualidade da desinfecção e a prevenção da contaminação cruzada.

Cost-effectiveness analysis of o-phthalaldehyde and glutaraldehyde as endoscope disinfectors / 中华消化内镜杂志

Objective To compare the durability and economic value of o-phthalaldehyde(OPA)and glutaraldehyde as endoscope disinfectors in continuous use of cleaning machine.Methods Compare the maximal number of endoseopes which could be disinfected by the two disinfectors at its minimal effective concentration,as well as the corresponding costs.The cost-effectiveness of two disinfectors were evaluated with Revenue-Incremental Cost Analysis.Results The number of endoscopes disinfected by OPA were 1.56 times as compared with glutaraldehyde,and an additional 2.95 yuan could be gained with OPA at the cost of 1 yuan.Conclusion When cleaning machine is full loaded,OPA is more durable than glutaraldehyde,and Can gain more benefit at the same cost.

Avaliação da utilização, manipulação e descarte do glutaraldeído pela equipe de enfermagem em instituições de saúde pública e privada / Evaluation of utilization, manipulation and reject of glutaraldehyde by professionalïs nursing in establishment public and private of health

Introdução - Este estudo objetivou avaliar a manipulação, descarte e adequação do glutaraldeído. Por ser eficaz e acessível, esses esterilizantes são utilizados como desinfetantes de alto nível de instrumentos críticos e semicríticos e aparelhos em hospitais, consultórios médicos e odontológicos, levando à preocupação em questões de saúde, segurança e ambiental, pelo volume e constância do descarte inadequado em rede de esgoto sanitário, o que não é permitido sem a autorização por escrito da rede de saneamento básico de cada município, criando assim um ambiente insidioso e sua exposição pode causar várias reações adversas. Material e Métodos - Trata-se de um estudo descritivo com abordagem qualitativa e quantitativa. Foi aplicado um questionário a 68 profissionais da área da saúde, aprovados pelo CEP/UNIP. Resultados - Foi constatado que a maioria dos profissionais não cumpre com as regras determinadas por órgãos responsáveis pela utilização do produto e seu descarte, além de manipulá-lo sem nenhum tipo de treinamento e não utilizar Equipamentos de Proteção Individual (EPI), os quais muitas vezes não estão disponíveis. Conclusões - Cabe aos profissionais atuarem na educação continuada, na prevenção e conscientização de que o manuseio e uso inadequado do glutaraldeído irão refletir danos diretamente na saúde do profissional e da população em geral.

Introduction -The aim of this study was to evaluate the manipulation, reject and fit of the glutaraldehyde. From be efficient and accessible, the progress of making sterile are used like disinfectant with high level of critical and semi critical tools and hospital tools, medicals and dentists room. However, take the health worry, security and environment, from the volume and often of inadequate reject in sewerage system, what is not allowed without written authorization of a basic sanitation at each city council, creating a danger environment in addition to cause several reaction at it exposition.Material and Methods - It treats of a descriptive study with a qualitative and quantitative approach. In laboratorial analysis to show signals of glutaraldehyde in the environment and questions to 68 professionals in the health area. Results - The results showed that the most of the professionals do not execute with determinates rules made by the responsible manufacturer, beyond they handle without any kind of trainee and do not use IPE (Individual Equipment Protection), each ones are normally not available. Laboratorial analysis discovers glutaraldehyde at all physical structure analyzed in HAE (Health Assistance Establishment). Conclusions - Detect glutaraldehyde in public places means that professionals and patients are in risk because it is a malefic product to humans health and environment, establish all professional act in continuous education, prevention and become aware of the handling and inadequate use of glutaraldehyde will affect in damaging direct in the health of the professional and indirect, in the health populations.

Risco ocupacional pela exposição ao glutaraldeído em trabalhadores de serviços de endoscopia / Occupational risk for the glutaraldehyde exposition in endoscope services workers / Riesgo ocupacional por lá exposición al glutaraldehido en trabajadores del servicio de endoscopia

O glutaraldeído, amplamente utilizado no reprocessamento de endoscópios pelas vantagens e baixo custo, apresenta alta toxicidade e pode expor os profissionais a riscos ocupacionais. Pesquisa descritiva realizada em 2007 em serviços de endoscopia digestiva de Goiânia-GO/Brasil que caracterizou por meio de um questionário e observação direta registradas em check list, a exposição ocupacional dos profissionais que reprocessam endoscópios, verificando as manifestações clínicas relatadas por eles e a ventilação do ambiente. As manifestações clínicas relatadas foram de origem gástrica, oftalmológica, dermatológica, neurológica e respiratória, mais freqüentes nas três últimas. Dentre as respiratórias, as mais citadas foram: resfriado (72,73%) e constipação nasal (59,09%), entre as neurológicas: cefaléias (72,73%), sonolência (72,73%) e tensão (54,55%) e dermatológicas: pele ressecada (59,09%) e prurido (54,55%). A maioria dos serviços não possui janelas nem exaustor, e os aparelhos de ar condicionado além de não possuírem filtros químicos apropriados produzem turbulência do ar, impedindo a eliminação dos vapores tóxicos emanados. Os dados sobre o ambiente de trabalho, o uso incorreto dos Equipamentos de Proteção Individual e as manifestações clínicas relatadas pelos trabalhadores sugerem evidências que os serviços de endoscopia estudados podem oferecer risco químico ocupacional aos trabalhadores durante o manuseio do glutaraldeído.

The glutaraldehyde widely used in the reprocessing of endoscope for the advantages and low cost presents high toxicity and can expose the professionals to occupational risks. Descriptive research carried through digestive endoscope services in Goiânia-GO/ Brazil by means of a questionnaire and direct observation registered in check list, characterized the occupational exposure in professionals who reprocess endoscopes verifying the clinical manifestations reported by them and the environment ventilation. The clinical manifestations reported had been gastric, ophthalmic, dermatological, neurological and respiratory origins, more frequent in the three last ones. Amongst respiratory, the most cited ones had been: cold (72.73%) and nasal constipation (59.09%), between the neurological ones: chronic headaches (72.73%), sleepiness (72.73%) and tension (54.55%) and dermatological: dry skin (59.09%) and pruritus (54.55%). The majority of the services does not have windows nor exhaust fan, and the air conditioning devices beyond not having appropriate chemical filters produce air turbulence, impeding the emanated toxic vapors elimination. The data of the work environment, the incorrect use of the Individual Protection Equipment and the clinical manifestations reported by the workers suggest evidences that the studied endoscope services may offer occupational chemical risk to the workers during the management of glutaraldehyde.

El glutaraldehído, ampliamente utilizado en el reprocesamiento de endoscopios por las ventajas y bajo coste, presenta alta toxicidad y puede exponer los profesionales a riesgos laborales. Investigación descriptiva realizada en servicios de endoscopia de Goiânia-GO/Brasil que se caracterizó a través de un cuestionario y observación un check list, la exposición ocupacional de los profesionales que reprocesan endoscopios, observando los síntomas notificados por ellos y la ventilación del ambiente. Las manifestaciones clínicas relatadas fueron de origen gástrico, oftalmológico, dermatológico, neurológicos y respiratórios más frecuentes en los últimos tres. Entre las vías respiratorias, los más citados fueron: resfriado (72,73%) y constipación nasal (59,09%), entre las neurológicas: cefalea (72,73%), somnolencia (72,73%) y la tensión (54, 55%) y dermatologicas: la piel resecado (59,09%) y prurito (54,55%). La mayoría de los servicios no tienen ventanas tampoco exaustores, y los aparatos de aire acondicionado no tienen buenos filtros químicos apropiados y producen turbulencia de aire, impedindo la eliminación de los gases tóxicos que emanan. Los datos sobre el ambiente de trabajo, el uso incorrecto de los equipos de protección individual y los síntomas las manifestaciones clinicas relatadas por los trabajadores sugieren evidencias que los servicios de endoscopia estudiados pueden ofrecer riesgo química ocupacional a los trabajadores durante el manoseo del glutaraldehído.

Infecção por micobactérias de crescimento rápido após procedimentos videocirúrgicos: a hipótese do glutaraldeído / Rapidly growing mycobacteria infection after videosurgical procedures: the glutaraldehyde hypothesis

Between August 2006 and February 2007, in the state of Rio de Janeiro, Brazil, a massive outbreak of RGM infections after video laparoscopy was mainly associated to the recently described Mycobacterium massiliense species. All confirmed and probable cases reports described the use of high-level disinfection of medical devices by using 2 percent glutaraldehyde (2 percent GA) for 30 min before the surgical procedures. We investigated the susceptibility of the M. massiliense isolates recovered during the outbreak to high-level disinfection after 30 min, 1h, 6h and 10h of exposure to the commercial disinfectants. Reference strains for official mycobactericidal tests such as Mycobacterium abscessus, Mycobacterium bovis, Mycobacterium chelonae, Mycobacterium neoaurum and Mycobacterium smegmatis were included as controls. Although all the reference strains were eliminated in 30 min of exposure to 2 percent GA, we observed the recovery of all M. massiliense clinical isolates even after 10h of exposure. This study suggests that failures in high-level disinfection and the high tolerance of these M. massiliense clinical strains to the 2 percent GA were strongly associated to the magnitude of the outbreak.

Glutaral Solution Conternts Determined by Enzyme-labeled Device / 中华医院感染学杂志

OBJECTIVE To study the analytic method for assaying of glutaral concentration by enzyme-labeled device at one time.METHODS Controlled solution of glutaral and sample solution were taken out and kept until the room temperature.Optical density value was detected at 450 nm.Content of sample was calculated by comparison with the known concentration of glutaral.RESULTS In the range of 0.75-2.50%,concentration of glutaral had linear relationship with the optical density value.Reproductive test:relative average error was within 2%,RSD≤2.51%;interference test:oxidation-resistant-sodium nitrite could make the result negative error.0.1% Sodium nitrite could make the test result decrease by 1.5% relatively.CONCLUSIONS The method is simple,fast and convenient,with accuracy which has met the requirement of hospital infection monitoring and acceptable interfering range made by additives,which is highly practical.

Avaliação da alteração dimensional em modelos de gesso tipo IV obtidos a partir de moldes de silicona de adição após desinfecção por imersão em glutaraldeído a 2% / Evaluation of the dimensional alterations in type IV plaster models obtained from addition silicone impressions after disinfection by immersion in 2% glutaraldehyde

Objetivo: Verificar por meio de microscopia as alterações dimensionais produzidas em modelos de gesso tipo IV obtidos a partir de moldes de silicona de adição, que passaram por processo de desinfecção por imersão em Glutaraldeído a 2%.Método: A partir de uma matriz metálica retangular contendo dois cilindros com marcações para mensuração da alteração dimensional foram criados 4 grupos e realizadas 10 moldagens para cada grupo, utilizando moldeiras individuais de resina acrílica e silicona de adição como material de escolha, variando o processo de desinfecção e vazamento de gesso, para a obtenção dos seguintes grupos: Grupo A: moldes de silicona de adição com processo de desinfecção por imersão em glutaraldeído 2% e vazamento com gesso tipo IV através de espatulador à vácuo; Grupo B: moldes de silicona de adição sem processo de desinfecção e vazamento de gesso tipo IV por espatulação manual; Grupo C: moldes de silicona de adição com desinfecção por glutaraldeído 2% e vazamento de gesso tipo IV por espatulação manual; Grupo D: moldes de silicona de adição sem processo de desinfecção e vazamento através de espatulador ?? vácuo. Os modelos foram examinados ao microscópio óptico com aumento de 100 vezes para mensuração das distâncias entre os pontos pré-determinados. Os dados foram comparados entre os grupos e os grupos com a matriz inicial. Resultados: Nenhum dos grupos demonstrou diferença estatisticamente significante (teste não paramétrico de Kruskal-Wallis) em relação a matriz inicial.Conclusão: O método de desinfecção por imersão em Glutaraldeído a 2% não provocou alterações dimensionais significantes em relação a matriz inicial, sendo indicado para utilização na clínica diária. O método de espatulação mecanizada a vácuo demonstrou superioridade em relação ao método mecânico manual.

Infecção por micobactéria após videoartroscopia: o glutaraldeído pode ser o culpado? Estudo experimental in vitro / Mycobacterial Infection after videoarthroscopy: could glutaraldehyde be the culprit? An in vitro experimental study

OBJETIVO: Os autores avaliaram in vitro o poder de degermação do glutaraldeído a 2,2 por cento por 30 minutos, nas lâminas de shaver de 3,2mm de diâmetro, usadas em videoartroscopias. MÉTODOS: Foram utilizadas 40 lâminas, de 3,2mm, subdivididas em quatro grupos. Grupo I: 10 lâminas esterilizadas em óxido de etileno foram colocadas de forma estéril no meio de cultura Brain-heart infusion (BHI). Grupo II: 10 lâminas esterilizadas em óxido de etileno foram deliberadamente contaminadas pelas bactérias Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Streptococcus faecalis e Mycobacterium fortuitum e posteriormente colocadas no meio de cultura BHI. Grupo III: 10 lâminas esterilizadas em óxido de etileno foram contaminadas pelas mesmas bactérias e posteriormente imersas por 30 minutos em glutaraldeído e, após limpeza com soro fisiológico, colocadas no meio de cultura. Grupo IV: 10 lâminas esterilizadas em óxido de etileno foram utilizadas em artroscopias, posteriormente lavadas e imersas em glutaraldeído, também colocadas em meio de cultura. Nos meios onde houve crescimento bacteriano, este foi verificado em 72 horas de incubação, sendo esse tempo prolongado para sete dias para recuperação da micobactéria. RESULTADOS: Não houve crescimento de germes nos meios de cultura dos grupos I, III e IV, mas houve crescimento em todas as amostras do grupo II. CONCLUSÃO: A solução de glutaraldeído a 2,2 por cento, dentro do prazo de validade, utilizada por 30 minutos, mostrou-se eficaz, in vitro, na degermação de lâminas de shaver de 3,2mm de diâmetro, mesmo quando deliberadamente contaminadas por micobactéria de crescimento rápido.

OBJECTIVE: The authors made an in vitro assessment of the degermation power of 2.2 percent glutaraldehyde for 30 minutes in 3.2 mm diameter shaver blades used in videoarthroscopy. METHODS: 40 3.2 mm blades were used after being subdivided into four groups: Group I - 10 blades sterilized with ethylene oxide were placed in sterile state in a Brain-heart infusion (BHI) culture medium; Group II - ten blades sterilized with ethylene oxide were deliberately contaminated with Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Streptococcus faecalis, and Mycobacterium fortuitum and later placed in a BHI culture medium; Group III - 10 blades sterilized with ethylene oxide were contaminated by the same bacteria and later immersed in glutaraldehyde for 30 minutes, and after they were cleaned with saline solution, they were placed in the culture medium; Group IV - 10 blades sterilized with ethylene oxide were used in arthroscopic procedures , then washed an immersed in glutaraldehyde, and also placed in the culture medium. In the media were bacterial growth did occur, such growth was seen within 72 hours of incubation, such period being extended to seven days to retrieve mycobacteria. RESULTS: There was no germ growth in the culture media of Groups I, III, and IV, but bacteria grew in all samples of Group II. CONCLUSION: The 2.2 percent glutaraldehyde solution, within the validity period, used for 30 minutes, showed to be effective "in vitro", in the degermation of 3.2 mm Shaver blades even when they were deliberately contaminated by fast-growing mycobacteria.

Improved immunodetection of human papillomavirus E7

Human papillomavirus E7 (HPV E7) is a viral oncoprotein that plays an important role in cervical carcinogenesis through binding with retinoblastoma protein (Rb). Inactivation of Rb by E7 is necessary but not sufficient for cellular transformation, suggesting other protein-protein interactions are required for E7-mediated cellular transformation aside from the interaction with Rb. However, studies on the oncogenic function of HPV E7 have been limited by its poor immunoreactivity. In this report, we show that the fixation of purified recombinant HPV E7 on blotted nitrocellulose membrane with glutaldehyde markedly enhanced the immunoreactivity of HPV E7 protein. Using HeLa and Caski cell line which are infected with HPV 18 and HPV 16, respectively, we demonstrated that native HPV E7 proteins also could be detected by this method. These results therefore can provide the experimental conditions for detection of HPV E7 proteins with greater sensitivity and may help to analyze E7 functions.

The effect of glutaraldehyde disinfectant on the dimension stability of four high polymer impression materials / 实用口腔医学杂志

Objective:To measure the effect of disinfection on dimension stability of four high polymer impression materials which were separately immersed in 20 ml/L glutaraldehyde solution.Methods:Fifteen plaster replication models of four high polymer impression materials(Impregum Penta polyether, Express-Putty silicone, Silagum-Putty silicone, GC EXAFINE silicone) were made on the same metal master cast respectively. Vertical and horizontal dimensions between landmarks on the masters and plaster casts were measured with an optical microscope,one-way ANOVA was used to compare the measurements among the materials.Results:The difference between the masters and Casts in horizontal distances measured on Express-Putty silicone impression material produced models was longer than those on other high polymer impression materials produced ones after disinfection for 20 minutes and beyond clinical requirement. Compared with metal master cast, the difference became significant when these four silicone impression materials were disinfected for 40 minutes. Conclusion: Among the four kinds of impression materials, the Express-Putty silicone material is relatively the most accurate one after disinfection for 20 minutes.