Portable Pump Research Articles

Biochemical stabilization of glucagon at alkaline pH.

For patients with type 1 diabetes mellitus, a bihormonal artificial endocrine pancreas system utilizing glucagon and insulin has been found to stabilize glycemic control. However, commercially available formulations of glucagon cannot currently be used in such systems because of physical instability characterized by aggregation and chemical degradation. Storing glucagon at pH 10 blocks protein aggregation but results in chemical degradation. Reductions in pH minimize chemical degradation, but even small reductions increase protein aggregation. We hypothesized that common pharmaceutical excipients accompanied by a new excipient would inhibit glucagon aggregation at an alkaline pH. As measured by tryptophan intrinsic fluorescence shift and optical density at 630 nm, protein aggregation was indeed minimized when glucagon was formulated with curcumin and albumin. This formulation also reduced chemical degradation, measured by liquid chromatography with mass spectrometry. Biological activity was retained after aging for 7 days in an in vitro cell-based bioassay and also in Yorkshire swine. Based on these findings, a formulation of glucagon stabilized with curcumin, polysorbate-80, l-methionine, and albumin at alkaline pH in glycine buffer may be suitable for extended use in a portable pump in the setting of a bihormonal artificial endocrine pancreas.

Community Nurse-led clinic: competence and accountability in the management of complex chronic cardiac care within the integrated Hospital-Territory network

With the progressive aging of the population, the widespread increase in chronic and degenerative diseases and the need for constant improvement in the quality of services, outpatient nursing represents a new model of community organization and management of nursing care which can respond with competence to the diverse needs of the community. Nurse-led Clinic takes care of patients with chronic heart disease (486 pts), heart failure (260 pts) and advanced heart failure (173 pts), outpatient and home management of patients with end-stage heart failure (continuous infusion of positive inotropic with portable insulin pumps, 14 pts), management of patients on oral anticoagulant therapy and new oral anticoagulants (398 pts). Across the clinics, the triage nurse takes care of patients who access the clinic through direct access or dedicated phone line for urgent assessment/monitoring of health needs. Out of 46.1% of patients who had a cardiovascular event and/or an active problem, only 1.3% was kept under observation in the ER or hospitalized. These patients had a greater hemodynamic instability that met criteria for activation of hospitalization (severe hypotension, desaturation, brady/ tachyarrhythmias, symptoms and signs of acute heart failure). The rest of the patients, with a minor instability were referred to the clinic nursing program with telephone and/or clinical follow-ups. This allows the activation of specific interventions needed to prevent hospitalization. Where necessary, local services (either district/home and/or social) are activated in order to respond to the needs expressed by the patient and his/her family. Role of Nurses: Nursing interventions are initially done in conjunction with physician's visits to provide education and counseling for patients and caregivers to improve outcomes (mortality, readmissions to hospital, hospital length of stay). Patients and/or caregivers deemed requiring specific assessment and/or support are referred to a psychologist who also provides specific training and counseling supervision allowing for a steady update and strengthening of nurses' communication and educational skills. Follow-ups vary in frequency (e.g. monthly or bi-monthly) while medical followups still tend to be scheduled quarterly to yearly according to the clinical severity of the patient. The patient's letter contains both medical and nurses' information integrating the both assessments. Conclusions: The Nurse-led Clinic may allow the improvement of health services and is a key tool for integrating hospital and community care within a health/social care framework of services which accompany the complexity of chronic care from the onset of the disease through supportive and palliative care assistance.

How To Minimize Toxic Exposure to Pyridine during Continuous Infusion of Ceftazidime in Patients with Cystic Fibrosis?

Ceftazidime is particularly efficient against Pseudomonas aeruginosa in cystic fibrosis patients. Thus, the spontaneous production of pyridine, which is a toxic product, raises some concern. Our aim was to examine the kinetics of degradation of ceftazidime in portable infusion pumps either at 4°C, 22°C, or 33°C and to propose some recommendations in order to reduce the pyridine exposure. Two administration models were studied in vitro. In model 1, we administered 12 g of ceftazidime infused over 23 h (once-daily infusion) compared to 6 g infused over 11.5 h in model 2 (twice-daily regimen). Samples were collected at 0 h and then every 4 and 2 h after the shaping of portable infusion pumps in models 1 and 2, respectively. Both ceftazidime and pyridine were analyzed using an ultraviolet high-performance liquid chromatograph. Production of pyridine is highly depending on the temperature. The in situ production of pyridine per day of treatment decreases at a ratio close to 1/6 and 1/3 between 33°C and 4°C in models 1 and 2, respectively. Regardless of the conditions, the production of pyridine is significantly lower in model 2, whereas the total delivery amount of ceftazidime is significantly higher at 4°C and 33°C compared to that in model 1. According to a the precautionary principle, these findings lead to three major recommendations: (i) exposing a solution of ceftazidime to over 22°C should be strictly avoided, (ii) a divided dose of 6 g over 11.5 h instead of a once-daily administration is preferred, and (iii) infusion should be administered immediately after reconstitution.

Enterale Ernährung mit Sonden

Tube feeding is an integral part of medical therapies, and can be easily managed also in the outpatient setting. Tube feeding by the stomach or small intestine with nasogastral or nasojejunal tubes is common in clinical practice. Long-term nutrition is usually provided through a permanent tube, i. e. a percutaneous endoscopic gastrostomy (PEG). Modern portable nutrition pumps are used to cover the patient's nutritional needs. Enteral nutrition is always indicated if patients can not or should not eat or if nutritional requirements cannot be covered within 3 days after an intervention, e. g. after abdominal surgery. Industrially produced tube feedings with defined substrate concentrations are being used; different compositions of nutrients, such as glutamine fish oil etc., are used dependent on the the condition of the patient. Enteral nutrition may be associated with complications of the tube, e. g. dislocation, malposition or obstruction, as well as the feeding itself, e. g.hyperglycaemia, electrolyte disturbances, refeeding syndrome diarrhea or aspiration). However, the benefit of tube feeding usually exceeds the potential harm substantially.

Faults Diagnosis Design and Realization of Underground Linear Motor Pump Valve

The linear motor pump bears the pumping work and other important work, once the valve failure, it threats to the safety of staff seriously. In order to ensure the safety of underground working environment, the abnormal current signal, vibration signals, differential pressure signal and absolute pressure signal are taken as the recognition base, a portable linear motor pump fault detection system is designed. The modular design process of hardware system and software system in detail are given. The data which collected from Victory Oil Field are taken for system test and detection instrument assembly. Test results show that the system can effectively collect failure signal and make an accurate diagnosis. It has the good performance in man-machine interaction, and it has very nice engineering application prospect.

Endotracheal tube cuff inflation with and without a pressure gauge to minimise sevoflurane pollution during intermittent positive pressure ventilation

Editor,Possible health hazards from exposure to trace concentrations of inhalational anaesthetics cannot yet be definitively excluded.1 We have previously reported that the concentrations of the commonly used volatile anaesthetic sevoflurane were significantly higher in the proximity of the intubate

Comparison of Raman spectroscopy vs. high performance liquid chromatography for quality control of complex therapeutic objects: Model of elastomeric portable pumps filled with a fluorouracil solution

This study compares the performance of a reference method of HPLC to Raman spectroscopy (RS) for the analytical quality control (AQC) of complex therapeutic objects. We assessed a model consisting of a widely used anticancer drug, i.e., 5-fluorouracil, which was compounded in a complex medical device, i.e., an elastomeric portable infusion pump. In view of the main objective, the two methods provided excellent results for the analytical validation key criteria, i.e., trueness, precision and accuracy, ranging from 7.5 to 50mg/mL and in either isotonic sodium or 5% dextrose. The Spearman and Kendall correlation tests (p-value<1×10−15) and the statistical studies performed on the graphs confirm a strong correlation in the results between RS and the standard HPLC under the experimental conditions. The selection of a spectral interval between 700 and 1400cm−1 for both the characterization and quantification by RS was the result of a gradual process optimization, combining matrix and packaging responses. In this new application, we demonstrate at least eight benefits of RS: (a) operator safety, (b) elimination of disposables, (c) elimination of analysis waste, which contributes to the protection of the environment, (d) a fast analytical response of less than 2min, (e) the ability to identify the solubilizing phase, (f) reduction of the risk of errors because no intrusion or dilution are needed, (g) negligible maintenance costs and (h) a reduction in the budget dedicated to technician training. Overall, we indicate the potential of non-intrusive AQC performed by RS, especially when the analysis is not possible using the usual techniques, and the technique's high potential as a contributor to the safety of medication.

Laparoscopic-assisted percutaneous endoscopic transgastrostomy jejunostomy.

Background and Objectives:New therapeutic protocols for patients with end-stage Parkinson disease include a carbidopa/levodopa combination using continuous, modulated enteral administration via a portable pump. The typical approach involves a percutaneous endoscopic transgastrostomy jejunostomy (PEG-J), which requires a combination of procedures designed to ensure that no organ is interposed between the abdominal wall and the gastric surface. Lack of transillumination in maximal endoscopic light settings is a major contraindication for PEG-J, and we decided to use a different approach to establish enteric access for long-term medication delivery via pump, using a minimally invasive procedure.Methods:In all patients, we performed a laparoscopic-assisted percutaneous transgastrostomy jejunostomy (LAPEG-J) after an unsuccessful endoscopic transillumination.Results:Five patients with end-stage Parkinson disease were referred to our department after successful therapeutic testing with administration of levodopa/carbidopa via naso-jejunal tube. All patients failed the endoscopic transillumination during the endoscopic procedure and were considered for LAPEG-J. In all patients, the LAPEG-J procedure was uneventful. The most common reason identified for failed transillumination was a high position of the stomach, followed by interposition of the liver or colon between the stomach and anterior abdominal wall. There were no complications regarding the LAPEG-J procedure, and all patients were discharged during the second postprocedural day.Conclusions:LAPEG-J provides a simple and safe option for placing a jejunostomy after an unsuccessful PEG-J attempt.

S0220105 携帯型軸流血液ポンプの流体力学特性に関する研究([S022-01]循環器系医療機器セッション(1),バイオエンジニアリング部門)

Though many kinds of implantable LVADs are available nowadays in the world, portable circulatory assist pumps for bridge-to-decision use are lacking. The purpose of the present study is to develop a portable axial-flow pump for bridge-to-decision use. We have developed an axial-flow pump whose priming volume is only 11 ml and pump volume is 50 ml. The blood contacting surfaces are all polymer. The pump performance was found experimentally to be sufficient for bridge-to-decision use.

2C13 携帯型軸流血液ポンプの流体力学特性に関する研究(OS11-1:医療機器レギュラトリーサイエンス(1))

2C13 携帯型軸流血液ポンプの流体力学特性に関する研究(OS11-1:医療機器レギュラトリーサイエンス(1))

Design and Perfromance Characteristics of a Portable Solar-Driven Thermoelectric Heat Pump under Thunder Bay Extreme Cold Conditions in Northwestern Ontario, Canada

Renewable & alternative non-conventional green energy technologies used for heat-pumping applications have shown real merits and received renewed interest in recent years especially in small-scale portable heating applications. Solar-driven thermoelectric heat pumping is one of these innovative technologies. In this paper, a thermoelectric heat pump that utilizes the Peltier effect has been designed, constructed and instrumented for suitable experimentation and characterization under Thunder Bay city extreme cold weather conditions in Canada. The thermoelectric test setup is powered using a renewable solar photovoltaic system and tested under different operating conditions. It was found that the PV-powered thermoelectric heat pump system has shown an acceptable performance with COP ranging from 0.98–1.22. Typical results showed that the average heat pumping power for the system was 72.1 W when the system was operated at an ambient temperature of –17 o C with an inside system temperature increased from approximately –5 o Ct o 25 o C.

Quality of Life Analysis During Transition From Stationary to Portable Infusion Pump in Home Parenteral Nutrition Patients

Quality of life (QOL) of patients receiving home parenteral nutrition (HPN) may be impacted by device technology. Historically, our HPN patients used pole-mounted pumps which can hinder activities and affect QOL. Patients receiving HPN with a pole-mounted pump completed Short Form 36 (SF-36®) and pump-specific questionnaires. Patients were then enrolled in a 2-month prospective crossover open study. Patients were randomized to use a pole-mounted pump or a portable pump. After 1 month, each arm crossed over. Measurements were repeated at 4 and 8 weeks. Participants included 5 males, 15 females; age 52.8 ± 3.3 (mean ± SEM) years; 50% had short bowel syndrome; received HPN for 83.3 ± 15.9 months; infused HPN over 11.2 ± 0.3 hours/day; 4.3 ± 0.4 days/week. Portable pump users scored 53.75 ± 5.64, 61.25 ± 6.14, and 40.31 ± 4.94 in SF-36v2 physical, social, and health vitality, respectively, while the stationary pump users scored 45.50 ± 4.82, 55.00 ± 5.97, and 35.31 ± 4.63, respectively (NS). They reported ease of movement between rooms (4.11 ± 0.21 vs 1.44 ± 0.20; P = .001); when traveling (5.00 ± 0.00 vs 3.00 ± 0.45; P < .02) (1 = very difficult, 5 = very easy); 5.0% were sleep disturbed with the portable compared to 42.1% with pole-mounted pump (P < .04). Overall, patients were significantly happier with the portable vs pole-mounted pump (4.53 ± 0.19 vs 2.68 ± 0.22; P < .001) (1 = very unhappy, 5 = very happy). Our HPN patients reported improved happiness and satisfaction regarding ease of use and function with a portable vs pole-mounted pump.

Subcutaneous immunoglobulin replacement therapy

Rapid subcutaneous immunoglobulin (SCIg) infusions have been used as an important method of delivering replacement immunoglobulin (Ig) to patients with primary immune deficiencies (PIDs) in Europe over the last 25 years. This review provides a comprehensive interpretation of the literature relating to the administration of SCIg and the services that have been developed alongside. Using rates of at least 20 ml/h per infusion site and simultaneous sites, the infusion time once per week is short (1-2 h in adults) and using small portable pumps, the child or adult is free for other activities during the therapy. The rapid SCIg infusions have been documented as well tolerated, efficacious and acceptable to infants and their parents, children, adults and elderly patients, and more recently to patients with autoimmunity requiring immunomodulatory Ig doses. As part of PID diagnostic and management services, educational programmes for self-infusion of both intravenous Ig and SCIg at home have been developed throughout Europe, resulting in increased patient compliance and patient empowerment as well as cost-savings for healthcare providers.

ANALISIS SERAPAN KEBISINGAN DENGAN PEMASANGAN ROCK WOOL KETEBALAN 5 CM

The noise affects to working quality at the same degree as those to workforce and people health, therefore,appropriate noise control is indispensable. This study is aimed at evaluating of rockwool (5cm) absorptioncoefficient and analyzing its effectivity on noise control. The room for simulation is equipped with known noisesource. In this case a sound system instrument and portable fire pump were used. The tested noise frequencieswere in the range of human hearing threshold for which an equalizer instrument was used to identify the soundfrequencies.Based on this study, the rockwool absorption coefficients were 0.8, 0.96, 0.98, 0.82 for sound frequency of 500Hz, 1000 Hz, 2000 Hz and 4000 Hz respectively. By installing the rockwool on 37.97% of room area of 72 m2,this rockwool was able to reduce the noise intensity by 10.16 dBA, 10.75 dBA, 10.5 dBA, 9.58 dBA, 9.25 dBA forfrequency of 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz and multiple frequencies respectively.The rockwool is an effective sound absorber in noise control owing to have high absorption coefficient (almostunity) and ease for installment.

Research Status and Key Technology of Portable Open-Loop Insulin Pump

Diabetes becomes the third-largest chronic disease after cardiovascular disease and cancer which threatens human health. Insulin injection is the most effective way to treat diabetes, and a lot of research institutions at home and abroad are dedicated to the insulin pumps. Insulin pump belongs to continuous subcutaneous insulin injection system, which can simulate physiological insulin secretion and large doses of delay when the patients are dining. At present, portable open-loop insulin pumps have been put into market. In this paper, the development history and research status-quo of insulin pump and the key technology of the pump are analyzed.

Mechanisms of glucagon degradation at alkaline pH

Glucagon is unstable and undergoes degradation and aggregation in aqueous solution. For this reason, its use in portable pumps for closed loop management of diabetes is limited to very short periods. In this study, we sought to identify the degradation mechanisms and the bioactivity of specific degradation products. We studied degradation in the alkaline range, a range at which aggregation is minimized. Native glucagon and analogs identical to glucagon degradation products were synthesized. To quantify biological activity in glucagon and in the degradation peptides, a protein kinase A-based bioassay was used. Aged, fresh, and modified peptides were analyzed by liquid chromatography with mass spectrometry (LCMS). Oxidation of glucagon at the Met residue was common but did not reduce bioactivity. Deamidation and isomerization were also common and were more prevalent at pH 10 than 9. The biological effects of deamidation and isomerization were unpredictable; deamidation at some sites did not reduce bioactivity. Deamidation of Gln 3, isomerization of Asp 9, and deamidation with isomerization at Asn 28 all caused marked potency loss. Studies with molecular-weight-cutoff membranes and LCMS revealed much greater fibrillation at pH 9 than 10. Further work is necessary to determine formulations of glucagon that minimize degradation and fibrillation.

Study of long-term viability of endothelial cells for lab-on-a-chip devices

Biosensors that employ live mammalian cells as sensing elements require precise information about the cell longevity. These biosensors could be stored in an incubator and used during the lifetime of the cells. This paper is a study of the longevity of bovine aortic endothelial cells (BAECs) that are used as sensorial component for cell-based biosensors. Different types of polydimethylsiloxane (PDMS) cell culturing chambers along with the culturing conditions required for BAECs to survive long term in lab on a chip systems are presented. The electric cell-substrate impedance (ECIS) technique was used to monitor cell viability over extended time periods. Media was automatically recirculated over the cells by a portable pump, in order to create the conditions required for testing the sensor in the field. It was demonstrated the BAECs could survive up to 37 days.

Physical and chemical stability of high-dose ifosfamide and mesna for prolonged 14-day continuous infusion

Ifosfamide plus mesna have been used recently in a high-dose regimen that allows this chemotherapy to be given to outpatients with less toxicity over 14 days using a portable pump. However, there is a need for published stability information. The aim of this study was to investigate the physicochemical stability of ifosfamide with mesna in normal saline at room temperature over a prolonged period of 14 days. Infusion solutions of 1:1 ifosfamide and mesna at final concentrations of 10, 20 and 30 mg/mL were prepared with 0.9% sodium chloride in PVC bags. Solutions were stored at room temperature. Concentrations of ifosfamide and mesna were measured at 0 and 1, 3, 7 and 14 days using a stability-indicating reversed phase high-performance liquid chromatography (HPLC) assay with ultraviolet detection. Ifosfamide and mesna were both physicochemically stable (>94%) for 14 days in all tested infusion solutions (10, 20 and 30 mg/mL). Our stability data indicate that ifosfamide and mesna (1:1) combination can be administered as a prolonged continuous infusion with portable pump in an outpatient setting without replacement of the infusion bag. We suggest 20 mg/mL as a reasonable concentration for infusion rates of about 2-4 cc/hr over prolonged periods of time.

Treating Intractable Phantom Limb Pain with Ambulatory Continuous Peripheral Nerve Blocks: A Pilot Study

There is currently no reliable treatment for phantom limb pain (PLP). Chronic PLP and associated cortical abnormalities may be maintained from abnormal peripheral input, raising the possibility that a continuous peripheral nerve block (CPNB) of extended duration may permanently reorganize cortical pain mapping, thus providing lasting relief.Three men with below-the-knee (2) or -elbow (1) amputations and intractable PLP received femoral/sciatic or infraclavicular perineural catheter(s), respectively. Subjects were randomized in a double-masked fashion to receive perineural ropivacaine (0.5%) or normal saline for over 6 days as outpatients using portable electronic infusion pumps. Four months later, subjects returned for repeated perineural catheter insertion and received an ambulatory infusion with the alternate solution ("crossover"). Subjects were followed for up to 1 year.By chance, all three subjects received saline during their initial infusion and reported little change in their PLP. One subject did not receive crossover treatment, but the remaining two subjects reported complete resolution of their PLP during and immediately following treatment with ropivacaine. One subject experienced no PLP recurrence through the 52-week follow-up period and the other reported mild PLP occurring once each week of just a small fraction of his original pain (pretreatment: continuous PLP rated 10/10; posttreatment: no PLP at baseline with average of one PLP episode each week rated 2/10) for 12 weeks (lost to follow-up thereafter).A prolonged ambulatory CPNB may be a reliable treatment for intractable PLP. The results of this pilot study suggest that a large, randomized clinical trial is warranted.

携帯型持続注入ポンプ内の薬液の混合性と安全な薬液充填法の検討

It has been reported that 5-fluorouracil (5-FU) and saline were not mixed homogeneously in some portable infusion pumps when saline was loaded first and then 5-FU was added.We evaluated whether the homogeneity of the mixture can be improved by modifying the loading method. The ratio between a glucose solution instead of 5-FU and saline and the order of their loading were changed, and differences in the glucose concentration were evaluated by labeling with ethyl hydroxybenzoate. While characteristic unevenness of the concentration was noted when glucose solution was loaded after saline, as has been reported, the unevenness was reduced by mixing the contents by inverting the pump after loading regardless of the mixing ratio. Therefore, in loading drugs with high biological toxicity such as 5-FU, the homogeneity of the mixture is considered to be improved, and the safety of the procedure to be improved by reducing the risk of exposure if the drug is loaded after physiologic saline and mixed by inversion.