Ethylene oxide derived glycol ethers: A review of the alkyl glycol ethers potential to cause endocrine disruption

The 'ethylene glycol ethers' (EGE) are a broad family of solvents and hydraulic fluids produced through the reaction of ethylene oxide and a monoalcohol. Certain EGE derived from methanol and ethanol are well known to cause toxicity to the testes and fetotoxicity and that this is caused by the common metabolites methoxy and ethoxyacetic acid, respectively. There have been numerous published claims that EGE fall into the category of 'endocrine disruptors' often without substantiated evidence. This review systematically evaluates all of the available and relevant in vitro and in vivo data across this family of substances using an approach based around the EFSA/ECHA 2018 guidance for the identification of endocrine disruptors. The conclusion reached is that there is no significant evidence to show that EGE target any endocrine organs or perturb endocrine pathways and that any toxicity that is seen occurs by non-endocrine modes of action.

The COVID-19 pandemic and N95 masks: reusability and decontamination methods

BACKGROUND

With the current SARS-CoV-2 pandemic, many healthcare facilities are lacking a steady supply of masks worldwide. This emergency situation warrants the taking of extraordinary measures to minimize the negative health impact from an insufficient supply of masks. The decontamination, and reuse of healthcare workers' N95/FFP2 masks is a promising solution which needs to overcome several pitfalls to become a reality.

AIM

The overall aim of this article is to provide the reader with a quick overview of the various methods for decontamination and the potential issues to be taken into account when deciding to reuse masks. Ultraviolet germicidal irradiation (UVGI), hydrogen peroxide, steam, ozone, ethylene oxide, dry heat and moist heat have all been methods studied in the context of the pandemic. The article first focuses on the logistical implementation of a decontamination system in its entirety, and then aims to summarize and analyze the different available methods for decontamination.

METHODS

In order to have a clear understanding of the research that has already been done, we conducted a systematic literature review for the questions: what are the tested methods for decontaminating N95/FFP2 masks, and what impact do those methods have on the microbiological contamination and physical integrity of the masks? We used the results of a systematic review on the methods of microbiological decontamination of masks to make sure we covered all of the recommended methods for mask reuse. To this systematic review we added articles and studies relevant to the subject, but that were outside the limits of the systematic review. These include a number of studies that performed important fit and function tests on the masks but took their microbiological outcomes from the existing literature and were thus excluded from the systematic review, but useful for this paper. We also used additional unpublished studies and internal communication from the University of Geneva Hospitals and partner institutions.

RESULTS

This paper analyzes the acceptable methods for respirator decontamination and reuse, and scores them according to a number of variables that we have defined as being crucial (including cost, risk, complexity, time, etc.) to help healthcare facilities decide which method of decontamination is right for them.

CONCLUSION

We provide a resource for healthcare institutions looking at making informed decisions about respirator decontamination. This informed decision making will help to improve infection prevention and control measures, and protect healthcare workers during this crucial time. The overall take home message is that institutions should not reuse respirators unless they have to. In the case of an emergency situation, there are some safe ways to decontaminate them.

Reprocessing of N95 masks: Experience from a resource-limited setting in India

OBJECTIVES

Due to the surge in demand for N95 masks during the Covid-19 pandemic, and considering the situation in countries grappling with acute shortages of N95 masks, this study investigated the possibilities of decontamination and reuse of masks.

METHODS

Three N95 masks of different makes (A, B and C) were subjected to six decontamination methods: ultraviolet (UV) irradiation, isopropyl alcohol (IPA) dip, plasma sterilization (Sterrad®), ethylene oxide (ETO, 3M®), dry heat sterilization, and moist heat sterilization (autoclaving). The integrity of the N95 masks was assessed by measuring their particle filtering efficiency at particle sizes ranging 0.3-0.5 microns.

RESULTS

All the masks decontaminated with ETO and plasma sterilization retained over 95% particle filtering efficiency. Masks decontaminated using IPA dip and autoclaving showed a drop, and UV irradiation showed variations in particle size efficiency degradation after decontamination.

CONCLUSIONS

Plasma sterilization is recommended for decontamination of N95 masks in low-resource settings. ETO is not recommended due to hazards associated with handling of ethylene oxide, although the filtering efficiency was retained. Since the UV irradiation method showed variations in results, evaluation of UV decontamination for N95 masks needs to be performed on a case-by-case basis.

Decontamination of N95 masks for re-use employing 7 widely available sterilization methods

The response to the COVID-19 epidemic is generating severe shortages of personal protective equipment around the world. In particular, the supply of N95 respirator masks has become severely depleted, with supplies having to be rationed and health care workers having to use masks for prolonged periods in many countries. We sought to test the ability of 7 different decontamination methods: autoclave treatment, ethylene oxide gassing (ETO), low temperature hydrogen peroxide gas plasma (LT-HPGP) treatment, vaporous hydrogen peroxide (VHP) exposure, peracetic acid dry fogging (PAF), ultraviolet C irradiation (UVCI) and moist heat (MH) treatment to decontaminate a variety of different N95 masks following experimental contamination with SARS-CoV-2 or vesicular stomatitis virus as a surrogate. In addition, we sought to determine whether masks would tolerate repeated cycles of decontamination while maintaining structural and functional integrity. All methods except for UVCI were effective in total elimination of viable virus from treated masks. We found that all respirator masks tolerated at least one cycle of all treatment modalities without structural or functional deterioration as assessed by fit testing; filtration efficiency testing results were mostly similar except that a single cycle of LT-HPGP was associated with failures in 3 of 6 masks assessed. VHP, PAF, UVCI, and MH were associated with preserved mask integrity to a minimum of 10 cycles by both fit and filtration testing. A similar result was shown with ethylene oxide gassing to the maximum 3 cycles tested. Pleated, layered non-woven fabric N95 masks retained integrity in fit testing for at least 10 cycles of autoclaving but the molded N95 masks failed after 1 cycle; filtration testing however was intact to 5 cycles for all masks. The successful application of autoclaving for layered, pleated masks may be of particular use to institutions globally due to the virtually universal accessibility of autoclaves in health care settings. Given the ability to modify widely available heating cabinets on hospital wards in well-resourced settings, the application of moist heat may allow local processing of N95 masks.

Filtration Efficiency of Hospital Face Mask Alternatives Available for Use During the COVID-19 Pandemic

IMPORTANCE

Procuring respiratory protection for clinicians and other health care workers has become a major challenge of the coronavirus disease 2019 (COVID-19) pandemic and has resulted in nonstandard practices such as the use of expired respirators and various decontamination processes to prolong the useful life of respirators in health care settings. In addition, imported, non-National Institute for Occupational Safety and Health (NIOSH)-approved respirators have been donated or acquired by hospitals as a potential replacement for limited NIOSH-approved N95 respirators.

OBJECTIVE

To assess fitted filtration efficiencies (FFEs) for face mask alternatives used during the COVID-19 pandemic.

DESIGN, SETTING, AND PARTICIPANTS

For this quality-improvement study conducted between April and June 2020, we used the Occupational Safety and Health Administration's Quantitative Fit Testing Protocol for Filtering Facepiece Respirators in a laboratory atmosphere supplemented with sodium chloride particles to assess the FFEs of a variety of respirators worn by a male volunteer and female volunteer.

MAIN OUTCOMES AND MEASURES

The FFEs of respirators commonly worn by clinicians and other health care workers and available respirator alternatives during the COVID-19 pandemic.

RESULTS

Of the 29 different fitted face mask alternatives tested on 1 man and 1 woman, expired N95 respirators with intact elastic straps and respirators subjected to ethylene oxide and hydrogen peroxide sterilization had unchanged FFE (>95%). The performance of N95 respirators in the wrong size had slightly decreased performance (90%-95% FFE). All of the respirators not listed as approved in this evaluation (n = 6) failed to achieve 95% FFE. Neither of the 2 imported respirators authorized for use by the Centers for Disease Control and Prevention that were not NIOSH-approved tested in this study achieved 95% FFE, and the more effective of the 2 functioned at approximately 80% FFE. Surgical and procedural face masks had filtering performance that was lower relative to that of N95 respirators (98.5% overall FFE), with procedural face masks secured with elastic ear loops showing the lowest efficiency (38.1% overall FFE).

CONCLUSIONS AND RELEVANCE

This quality-improvement study evaluating 29 face mask alternatives for use by clinicians interacting with patients during the COVID-19 pandemic found that expired N95 respirators and sterilized, used N95 respirators can be used when new N95 respirators are not available. Other alternatives may provide less effective filtration.

Effect of Ethylene Oxide Sterilization on Polyvinyl Alcohol Hydrogel Compared with Gamma Radiation

This study investigated the effects of terminal sterilization of polyvinyl alcohol (PVA) biomaterials using clinically translatable techniques, specifically ethylene oxide (EtO) and gamma (γ) irradiation. While a few studies have reported the possibility of sterilizing PVA with γ-radiation, the use of EtO sterilization of PVA requires additional study. PVA solutions were chemically crosslinked with trisodium trimetaphosphate and sodium hydroxide. The three experimental groups included untreated control, EtO, and γ-irradiation, which were tested for the degree of swelling and water content, and mechanical properties such as radial compliance, longitudinal tensile, minimum bend radius, burst pressure, and suture retention strength. In addition, samples were characterized with scanning electron microscopy, differential scanning calorimetry, X-ray photoelectron spectroscopy, and water contact angle measurements. Cell attachment was assessed using the endothelial cell line EA.hy926, and the sterilized PVA cytotoxicity was studied with a live/dead stain. Platelet and fibrin accumulation was measured using an ex vivo shunt baboon model. Finally, the immune responses of PVA implants were analyzed after a 21-day subcutaneous implantation in rats and a 30-day implantation in baboon. EtO sterilization reduced the PVA graft wall thickness, its degree of swelling, and water content compared with both γ-irradiated and untreated PVA. Moreover, EtO sterilization significantly reduced the radial compliance and increased Young's modulus. EtO did not change PVA hydrophilicity, while γ-irradiation increased the water contact angle of the PVA. Consequently, endothelial cell attachment on the EtO-sterilized PVA showed similar results to the untreated PVA, while cell attachment significantly improved on the γ-irradiated PVA. When exposing the PVA grafts to circulating whole blood, fibrin accumulation of EtO-sterilized PVA was found to be significantly lower than γ-irradiated PVA. The immune responses of γ-irradiated PVA, EtO-treated PVA, and untreated PVA were compared. Implanted EtO-treated PVA showed the least MAC387 reaction. The terminal sterilization methods in this study changed PVA hydrogel properties; nevertheless, based on the characterizations performed, both sterilization methods were suitable for sterilizing PVA. We concluded that EtO can be used as an alternative method to sterilize PVA hydrogel material. Impact statement Polyvinyl alcohol (PVA) hydrogels have been used for a variety of tissue replacements, including neural, cardiac, meniscal, cartilage, muscle, pancreatic, and ocular applications. In addition, PVA can be made into a tubular shape and used as a small-diameter vascular graft. Ethylene oxide (EtO) is one of the Food and Drug Administration-approved methods for sterilization, but its effect on PVA has not been studied extensively. The outcome of this study provides the effects of EtO and γ-irradiation of PVA grafts on both the material properties and the in vivo responses, particularly for vascular applications. Knowledge of these effects may ultimately improve the success rate of PVA vascular grafts.

Decontamination of N95 masks for re-use employing 7 widely available sterilization methods

The response to the COVID-19 epidemic is generating severe shortages of personal protective equipment around the world. In particular, the supply of N95 respirator masks has become severely depleted, with supplies having to be rationed and health care workers having to use masks for prolonged periods in many countries. We sought to test the ability of 7 different decontamination methods: autoclave treatment, ethylene oxide gassing (ETO), low temperature hydrogen peroxide gas plasma (LT-HPGP) treatment, vaporous hydrogen peroxide (VHP) exposure, peracetic acid dry fogging (PAF), ultraviolet C irradiation (UVCI) and moist heat (MH) treatment to decontaminate a variety of different N95 masks following experimental contamination with SARS-CoV-2 or vesicular stomatitis virus as a surrogate. In addition, we sought to determine whether masks would tolerate repeated cycles of decontamination while maintaining structural and functional integrity. All methods except for UVCI were effective in total elimination of viable virus from treated masks. We found that all respirator masks tolerated at least one cycle of all treatment modalities without structural or functional deterioration as assessed by fit testing; filtration efficiency testing results were mostly similar except that a single cycle of LT-HPGP was associated with failures in 3 of 6 masks assessed. VHP, PAF, UVCI, and MH were associated with preserved mask integrity to a minimum of 10 cycles by both fit and filtration testing. A similar result was shown with ethylene oxide gassing to the maximum 3 cycles tested. Pleated, layered non-woven fabric N95 masks retained integrity in fit testing for at least 10 cycles of autoclaving but the molded N95 masks failed after 1 cycle; filtration testing however was intact to 5 cycles for all masks. The successful application of autoclaving for layered, pleated masks may be of particular use to institutions globally due to the virtually universal accessibility of autoclaves in health care settings. Given the ability to modify widely available heating cabinets on hospital wards in well-resourced settings, the application of moist heat may allow local processing of N95 masks.

Microbiological Load of Ethylene Oxide Sterilized Medical Devices and its Elimination by Cobalt 60 Source

OBJECTIVE

To determine the residing microbial flora of ethylene oxide (EtO) sterilized medical devices and optimization of safe dose of gamma radiation (Cobalt 60 source) for the complete elimination of microbial load.

STUDY DESIGN

Experimental study.

PLACE AND DURATION OF STUDY

Department of Biotechnology, Lahore College for Women University, Lahore, Pakistan from September 2014 to June 2015.

METHODOLOGY

Thirty-six samples of EtO sterilized medical devices of same batch of three different companies were collected for this study. Isolation and enumeration of microbes were done by using different selective and differential media. Gram staining and biochemically characterization by API 20 (Bio Merieux, France) kit was done for identification of the microorganisms. The medical devices having high microbial load were sent to Pakistan Radiation Services (PARAS) for gamma irradiations at 3 different selected doses (20 KGy, 25 KGy, and 30 KGy).

RESULTS

Different types of Gram positive bacteria (Staphylococcus epidermidis, Staphylococcus aureus andBacillus subtilis) were isolated from the EtO sterilized samples. Gram negative bacteria and fungi were not detected on these medical devices. Gamma irradiations results showed that 30 KGy was optimized dose for complete elimination of microbial flora on endotracheal, Nelaton, and tracheostomy tubes.

CONCLUSION

Gamma radiations (Co 60 source) effectively decontaminate the microbial flora on the equipment previously sterilized by the ethylene oxide gas; and 30 KGy is the optimized dose for all these medical devices.

[Effect of sterilisation with formaldehyde, gamma irradiation and ethylene oxide on the properties of polyethylene joint replacement components]

PURPOSE OF THE STUDY

Each method of sterilisation has some effect on the structure and properties of UHMWPE and thus also on joint replacement longevity. This study was designed to compare, using objective methods of measurement, several kinds of sterilisation and to recommend the one which has the best prospect for making joint replacements last longer.

MATERIAL AND METHODS

Two groups of UHMWPE samples were tested. Group 1 included virgin GUR 1020 polyethylene, non-modified and non-sterilised (Meditech, Germany). Group 2 comprised of three sets of samples sterilised with formaldehyde, gamma irradiation and ethylene oxide, respectively. In both groups, physicochemical properties were assessed by infrared spectroscopy (IR), and the oxidation (OI) and trans-vinyl (VI) indices, which show the degree of oxidation of a material, were determined. Free-radical concentrations were measured by the method of electron spin resonance (ESR). The mechanical properties of each sample were studied using small punch tests (SPT) and testing microhardness (MH). Any change in mechanical properties can affect, to various degrees, the quality and longevity of a prosthetic joint.

RESULTS

The samples sterilised by gamma irradiation showed higher values of both the OI (0.37) and the VI index (0.038) than the other samples (OI, 0.02 to 0.05 and VI, 0). Also, the free-radical concentration was detectable only in the gamma-sterilised sample. Values obtained for mechanical properties were as follows: peak load in the range of 58.48 N (gamma irradiation) to 59.60 N (ethylene oxide); ultimate load in the range of 46.69 N (gamma irradiation) to 57.50 N (ethylene oxide); ultimate displacement in the range of 4.29 mm (gamma irradiation) to 4.58 mm (virgin polyethylene and formaldehyde); and work to failure in the range of 185.18 mJ (gamma irradiation) to 205.89 mJ (virgin polyethylene). Microhardness values were obtained in the following ranges: 41.2 to 44.6 MPa (virgin polyethylene); 40.2 to 44.1 MPa (formaldehyde); 46.1 to 49.3 MPa (gamma irradiation); and 40.3 to 44.2 MPa (ethylene oxide).

DISCUSSION

The samples sterilised with formaldehyde and ethylene oxide have mechanical properties very similar to virgin polyethylene, they are not damaged by oxidation and do not contain free radicals. Owing to these characteristics, the immediate and long-term oxidation stability of the three samples is higher. The sample sterilised by gamma irradiation showed the presence of free radicals and immediate and long-term oxidative degradation. This results in the deterioration of mechanical properties and the growth of crystallinity due to enhanced oxidation and leads to higher polyethylene microhardness.

CONCLUSIONS

Sterilisation with gamma irradiation results in oxidative degradation and mechanical property deterioration, which is one of the potential risks of a shorter life span of joint replacements. The use of ethylene oxide or formaldehyde does not change polymer properties nor has any effect on oxidation of materials. Therefore, a longer life expectancy of the joint replacements sterilised with ethylene oxide can be expected. The life span of their joint replacements is a key issue for the patients. Prosthetic joint loosening is painful and the patient often requires re-implantation. A higher number of re-implantations is associated with higher costs for the institution involved and, consequently, for the whole health care system. Although this study basically deals with chemical issues, it informs the surgeon of the latest developments leading to the improvement of implanted materials, which can increase the life expectancy of joint replacements and patients' satisfaction.

Effects of ethylene oxide resterilization and in-vitro degradation on mechanical properties of partially absorbable composite hernia meshes

BACKGROUND AND AIM

Prosthetic mesh repair for abdominal wall hernias is widely used because of its technical simplicity and low hernia recurrence rates. The most commonly used material is pure polypropylene mesh, although newer composite materials are recommended by some centers due to their advantages.However, these meshes are more expensive than pure polypropylene meshes. Resterilization of a pure polypropylene mesh has been shown to be quite safe, and many centers prefer slicing a large mesh into smaller pieces, suitable for any hernia type or defect size. Nevertheless there is no data about the safety after resterilization of the composite meshes. The present study was carried out to investigate the effects of resterilization and in vitro degradation in phosphate buffered saline solution on the physical structure and the mechanical properties of partially absorbable lightweight meshes.

METHODS

Two composite meshes were used in the study: One mesh consists of monofilament polypropylene and monofilament polyglecaprone -a copolymer of glycolide and epsilon(ε)- caprolactone - (Ultrapro®, 28 g m2, Ethicon, Hamburg,Germany), and the other one consisted of multifilament polypropylene and multifilament polyglactine (Vypro II®, 30g m2, Ethicon, Hamburg, Germany). Two large meshes were cut into rectangular specimens sized 50 x 20 mm for mechanical testing and 20 x 20 mm for in vitro degradation experiments.Meshes were divided into control group with no resterilization and gas resterilization. Ethylene oxide gas sterilization was performed at 55°C for 4.5 hours. In vitro degradation in 0.01M phosphate buffered saline (PBS, pH 7.4) solution at 37 ± 1°C for 8 weeks was applied to one subgroup in each mesh group. Tensiometric measurements and scanning electronmicroscopic evaluations were completed for control and resterilization specimens.

RESULTS

Regardless of resterilization, when the meshes were exposed to in vitro degradation, all mechanical parameters decreased significantly. Highest reduction in mechanical properties was observed for Ultrapro due to the degradation of absorbable polyglecaprone and polyglactin parts of these meshes. It was observed that resterilization by ethylene oxide did not determine significant difference on the degradation characteristics and almost similar physical structures were observed for resterilized and non-resterilized meshes. For VyproII meshes, no significant mechanical difference was observed between resterilized and non-resterilized meshes after degradation while resterilized Ultrapro meshes exhibited stronger characteristics than non-resterilized counterparts, after degradation.

CONCLUSION

Resterilization with ethylene oxide did not affect the mechanical properties of partially absorbable compositemeshes. No important surface changes were observed inscanning electron microscopy after resterilization.

Mechanical strength of cortical allografts with gamma radiation versus ethylene oxide sterilization

We investigated the effects of gamma irradiation versus ethylene oxide (ETO) sterilization on the mechanical strength of cortical bone grafts. Tibias were collected from cadavers of mature goats. Sixty test specimens were randomized into four groups: fresh (no processing), frozen (freezing at -70 degrees C), gamma-irradiated, and ETO-sterilized specimens. Torsion, three-point bending, and compression testing were separately performed with a material testing machine. Parameters studied included maximum stress, strain, deflection, extension, load, shear modulus, and E-modulus. Compared with findings for the fresh specimens, findings were as follows for gamma-irradiated specimens: maximal shear modulus, reduced by 48%; shear stress, by 55%; deflection, by 71%; bending stress, by 51%; bending strain, by 74%; extension, by 60%; and compression strain, by 50%. However, there were no reductions in those parameters for the frozen specimens or the ETO-sterilized specimens. These findings confirm that shear, bending, and compression strength of cortical allografts are weakened by gamma irradiation at room temperature. To maintain optimum mechanical properties, ETO sterilization of allografts is better than gamma sterilization, especially for cortical bone, because it is usually used in load-bearing settings.

Monodisperse nonionic isoprenoid-type hexahydrofarnesyl ethylene oxide surfactants: high throughput lyotropic liquid crystalline phase determination

The neat and lyotropic phase behavior of eight new ethylene oxide amphiphiles (EO = 1-8) with a hexahydrofarnesyl chain (3,7,11-trimethyldodecyl) and narrow polydispersity (>98.5% purity) is reported. Below five EO units the behavior of the neat surfactants show only a glass transition, Tg ∼ -90 °C. Above four EO units, crystallization (Tcrys) and crystal-isotropic liquid (Tm) transitions are also observed that increase with degree of ethoxylation of the surfactant headgroup. The lyotropic liquid crystalline phase behavior spans a complex spectrum of surfactant-water interfacial curvatures. Specifically, inverse phases are present below ambient temperatures for EO < 4, with HFarn(EO)2 exhibiting an inverse hexagonal (H(II)) phase stable to dilution. The phase diagram of HFarn(EO)3 displays both the gyroid (Ia3d) and double diamond (Pn3m) inverse bicontinuous cubic phases, with the latter being thermodynamically stable in excess water within the physiological regime. There is a strong preference for planar bilayer structures at intermediate headgroup ethoxylation, with the crossover to normal phases occurring at HFarn(EO)(7-8) which exhibits normal hexagonal (H(I)) and cubic (Q(I)) phases at ambient temperatures. The toxicity of colloidal dispersions of these EO amphiphiles was assayed against normal breast epithelial (HMEpiC) and breast cancer (MCF7) cell lines. The IC50 of the EO amphiphiles was similar in both cell lines with moderate toxicity ranging from ca. <5 to 140 μM in an in vitro cell viability assay. Observations are qualitatively rationalized in terms of the molecular geometry of the surfactant. The physicochemical behavior of the HFarnesyl ethylene oxide amphiphiles is compared to other ethylene oxide surfactants.

Microbial contamination and the sterilization/disinfection of surgical guides used in the placement of endosteal implants

PURPOSE

The purpose of this study was twofold: (1) to estimate the level of microbial contamination found on commercial guides (CG) and in-house laboratory guides (LG) prior to use, and (2) to evaluate the antimicrobial potential of disinfectants commonly used in dentistry to decontaminate heat-sensitive surgical guides. Ethylene oxide gas was used as the positive control; sterile water served as a negative control.

MATERIALS AND METHODS

Evaluation of CGs and LGs for bacterial contamination occurred soon after their arrival in the laboratory. Some guides went directly into tubes of trypticase soy broth solution, vortexed and equally divided into two tubes. One tube went into an 80°C bath for 19 minutes, while the other stayed at room temperature. After plating, half of the samples underwent anaerobic incubation. All incubation was for 48 hours at 37°C. Other guides underwent water rinsing or disinfection by various methods for 5 or 15 minutes or ethylene oxide gas sterilization prior to sampling.

RESULTS

Untreated CG specimens showed modest levels of bacterial contamination, with most colonies coming from liquid specimens not exposed to 80°C. LG specimens had more bacteria from both heat-treated and non-heat-treated aliquots. Chlorhexidine gluconate, diluted bleach, and water rinsing were not able to completely eliminate microorganisms on the specimens, but no viable microorganisms were present on specimens treated with gas sterilization or 70% ethanol for 15 minutes.

CONCLUSION

CGs and LGs, on average, had different levels of bacterial contamination prior to disinfection. Water, chlorhexidine gluconate, and diluted bleach were not totally successful in decontaminating the surgical guides, but no growth was found after 15 minutes of immersion in 70% ethanol. Preferably, surgical guides should be submerged in 70% alcohol for a minimum of 15 minutes or undergo sterilization using ethylene oxide gas.

[Low-temperature sterilization for the surgical infection prophylaxis]

The comparative characteristic of the accepted methods of low-temperature sterilization of medical equipment is given. Special attention is devoted to the surgical infection prophylaxis. The efficacy, expediency and safety of gas sterilization with ethilenoxide is proved. Plasmic methods of sterilization is recommended for use together with other methods of low-temperature sterilization.

A new 5-acyl-2-methylpyrrole from the endophytic fungus S20 of Cephalotaxus hainanensis

A new 5-acyl-2-methylpyrrole, isolated from the endophytic fungus S20 of Cephalotaxus hainanensis, was elucidated as 1-(5-methyl-1H-pyrrol-2-yl)-2-((2S*,3R*)-3-((E)-prop-1-enyl)oxiran-2-yl)ethanone (1) on the basis of spectroscopic evidence, including 1D- and 2D-NMR (HMQC, 1H-1H COSY, HMBC and ROESY) and MS analysis. Compound 1 showed inhibitory effects on Staphylococcus aureus and methicillin-resistant S. aureus by the filter paper disc agar diffusion method.

Comparative sporicidal effects of disinfectants after release of a biological agent

Because of spore formation, Bacillus anthracis is considered the most resistant biological warfare agent known. The present study aimed to assess and compare well-known decontamination routes to inactivate the spores on daily-use environmental tools contaminated previously. To simulate the agent, Bacillus atrophaeus was used. Various environmental samples (such as tile, fabric clothing, wood, protective suit, glass, paper, soil, water, plastic, and metal) that may be contaminated after a biological incident were used as test carriers and inoculated with B. atrophaeus. Sodium hypochlorite, free chlorine, autoclaving, ethylene oxide, hydrogen peroxide, ultraviolet irradiation, and boiling decontaminated the samples. Glutaraldehyde (2%) and free chlorine solution (10,000 mg/L) were also found to be effective in decontaminating the samples and are recommended as alternatives to the use of sodium hypochlorite solution. Soil, tile, paper, and metal were determined to be the most difficult materials to decontaminate. It was concluded that 5% hypochlorite adjusted with acetic acid might also be used for decontamination. Decontamination strategies to reduce contamination of the environment by biological warfare agents need to be applied to mitigate the number of victims, in terms of prominent characteristics like cost-effectiveness and user-friendliness.

Comparative sterilization effectiveness of plasma in O2-H2O2 mixtures and ethylene oxide treatment

We investigated the influence of variable parameters of plasma sterilization and compared its effectiveness with that of ethylene oxide using a reactive ion etching plasma reactor at 13.56 MHz. Gases tested were pure oxygen and oxygen-hydrogen peroxide mixtures in 190/10, 180/20, and 160/40 sccm ratios with constant gas flow at 200 sccm, pressure at 0.100 torr, radio-frequency power at 25 W, 50 W, 100 W, and 150 W, and temperature below 60 degrees C. Ethylene oxide sterilization was performed using 450 mg/L at 55 degrees C, 60% humidity, and -0.65 and 0.60 kgf/cm2 pressure. The biological indicator was Bacillus atrophaeus ATCC 9372, with exposure times of 3 to 120 min. Observed D values were 215.91, 55.55, 9.19, and 2.98 min for pure oxygen plasma at 25 W, 50 W, 100 W, and 150 W, respectively. Oxygen-hydrogen peroxide plasma produced D values of 6.41 min (190/10), 6.47 min (180/20), and 4.02 min (160/40) at 100 W and 1.47 min (190/10), 3.11 min (180/20), and 1.94 min (160/40) at 150 W. Ethylene oxide processes resulted in a D value of 2.86 min. Scanning electron microscopy analyses showed damage to the spore cortex.

Effects of sterilization on an extracellular matrix scaffold: part I. Composition and matrix architecture

The impact of peracetic acid (PAA), lyophilization, and ethylene oxide (EO) sterilization on the composition and three dimensional matrix structure of small intestinal submucosa (SIS), a biologic scaffold used to stimulate the repair of damaged tissues and organs, was examined. Fibronectin and glycosaminoglycans are retained in SIS following oxidation by peracetic acid and alkylation using ethylene oxide gas. Significant amounts of FGF-2 are also retained, but VEGF is susceptible to the effects of PAA and is dramatically reduced following processing. Further, matrix oxidation, lyophilization, and sterilization with EO can be performed without irreversibly collapsing the three dimensional structure of the native SIS. These structural features and growth promoting extracellular matrix constituents are likely to be important variables underlying cellular attachment, infiltration and eventual incorporation of SIS into healing host tissues.

Bacterial factors influencing adhesion of Pseudomonas aeruginosa strains to a poly(ethylene oxide) brush

Most bacterial strains adhere poorly to poly(ethylene oxide) (PEO)-brush coatings, with the exception of a Pseudomonas aeruginosa strain. The aim of this study was to find factors determining whether P. aeruginosa strains do or do not adhere to a PEO-brush coating in a parallel plate flow chamber. On the basis of their adhesion, a distinction could be made between three adhesive and three non-adhesive strains of P. aeruginosa, while bacterial motilities and zeta potentials were comparable for all six strains. However, water contact angles indicated that the adhesive strains were much more hydrophobic than the non-adhesive strains. Furthermore, only adhesive strains released surfactive extracellular substances, which may be engaged in attractive interactions with the PEO chains. Atomic force microscopy showed that the adhesion energy, measured from the retract curves of a bacterial-coated cantilever from a brush coating, was significantly more negative for adhesive strains than for non-adhesive strains (P<0.001). Through surface thermodynamic and extended-DLVO (Derjaguin, Landau, Verwey, Overbeek) analyses, these stronger adhesion energies could be attributed to acid-base interactions. However, the energies of adhesion of all strains to a brush coating were small when compared with their energies of adhesion to a glass surface. Accordingly, even the adhesive P. aeruginosa strains could be easily removed from a PEO-brush coating by the passage of a liquid-air interface. In conclusion, cell surface hydrophobicity and surfactant release are the main factors involved in adhesion of P. aeruginosa strains to PEO-brush coatings.

Development of a bacteriophage model system to investigate virus inactivation methods used in the treatment of bone allografts

Bone allografts are commonly used in a variety of surgical procedures, to reconstruct lost bone stock and to provide mechanical support during the healing process. Due to concerns regarding the possibility of disease transmission from donor to recipient, and of contamination of grafts during retrieval and processing procedures, it is common practice to sterilise bone allografts prior to issue for clinical use. It is vital that the sterilisation processes applied to allografts are validated to demonstrate that they achieve the required level of bioburden reduction, and by extension that validated models are used for these studies. Two common sterilisation protocols applied to bone allografts are gamma irradiation and ethylene oxide gas sterilisation, and there are currently no validated models available for measuring the anti-viral efficacy of ethylene oxide treatment with regard to bone allografts or readily useable models for assessing the anti-viral efficiency of gamma irradiation treatment. We have developed and validated models for both these sterilisation processes, using the bacteriophage varphix174, and utilised the models to measure the antiviral activity of the standard ethylene oxide and gamma irradiation sterilisation processes applied to bone allografts by the National Blood Service. For the irradiation model, we also utilised bacterial spores (Bacillus pumilus). Our results show that ethylene oxide sterilisation (which can only be applied to lyophilised grafts) inactivated > 6.1 log(10) of the model virus, and gamma irradiation (at 25 -40 kGy and applied to frozen allografts) inactivated 3.6 - 4.0 log(10) of the model virus and > 4 log(10) of the bacterial spores. Gamma irradiation at this dosage is therefore not in itself a sterilisation process with respect to viruses.

Viridenepoxydiol, a new pentasubstituted oxiranyldecene produced by Trichoderma viride

A new pentasubstituted oxiranyldecene, named viridenepoxydiol, has been isolated (0.9 mg/L) from the culture filtrate of a strain of Trichoderma viride showing in vitro and in vivo antagonistic activity against Sclerotium rolfsii, which is the causal agent of crown and stem rot of artichoke. Viridenepoxydiol was characterized as 3,5,9-trimethyl-2-oxiranyl-dec-8-ene-2,5-diol (3) using spectroscopic methods. It showed inhibitor effect on mycelial growth of S. rolfsii and its minimum inhibitory concentration (over 90% inhibition) was found to be 396 mug/mL. This is the first time that viridenepoxydiol was reported.

A histological and immunohistochemical study of tissue reactions to solid poly(ortho ester) in rabbits

In many cases only the temporary presence of a biomaterial is needed in tissue support, augmentation or replacement. In such cases biodegradable materials are better alternatives than biostable ones. At present, biodegradable polymers are widely used in the field of maxillofacial surgery as sutures, fracture fixation devices and as absorbable membranes. The most often used polymers are aliphatic polyesters, such as polyglycolic acid (PGA) and polylactic acid (PLA). Poly(ortho ester) is a surface eroding polymer, which has been under development since 1970, but is used mostly in drug delivery systems in semisolid form. The aim of this study was to evaluate the tissue reactions of solid poly(ortho ester) (POE), histologically and immunohistochemically. Resorption times and the effect of 2 different sterilization methods (gamma radiation and ethylene oxide) upon resorption were also evaluated. Material was implanted into the tibia and subcutaneously into the mandibular ramus area of 24 rabbits. Follow-up times were 1-10, 14 and 24 weeks. Histological studies showed that POE induces a moderate inflammation in soft tissue and in bone. At 24 week follow-up, inflammation was mild in soft tissue and moderate in bone. In immunohistochemical studies, no highly fluorescent layer of tenascin or fibronectin was found adjacent to the implant. Resorption of gamma-sterilized rods was faster than ethylene oxide-sterilized rods. The total resorption time was more than 24 weeks in both groups. Clinically the healing was uneventful and the implants the well tolerated by the living tissue. This encourages these authors to continue studies with this interesting new material to search for the ideal material for bone filling and fracture fixation.

Sugar derivatives containing oxiranes and alpha,beta-unsaturated gamma-lactones as potential environmentally friendly insecticides

A range of novel sugar derivatives containing oxiranes or alpha,beta-unsaturated gamma-lactones in their structure were evaluated as potential insecticides with the added possible benefit of being benign in the environment. A number of arthropod species were chosen to represent those in the terrestrial, aerial and aquatic environments, covering target adult insects such as Musca domestica L (housefly) and Trialeurodes vaporariorum (Westwood) (glasshouse whitefly), which are public health and horticultural pests, Drosophila melanogaster Meig (fruitfly), both adult and larva, and a marine non-target crustacean, Artemia salina L. The tested compounds possessed efficacy and selectivity against these insect species, but were not toxic to brine shrimps, a reference organism in assays to evaluate the potential toxicity hazard to invertebrates in ecosystems.

Gamma irradiation and ethylene oxide in the sterilization of native reindeer bone morphogenetic protein extract

BACKGROUND AND AIMS

For human use, it is necessary to sterilize bone morphogenetic proteins (BMPs), in order to reduce the risk of infections and associated complications. We compared the effects of ethylene oxide and gamma irradiation in the sterilization of native reindeer BMP extract with regard to bone induction in the Balb/C mouse thigh muscle pouch model.

MATERIALS AND METHODS

BMP extract, sterilized with ethylene oxide gas (Steri-Vac 4XL, temperature 29 degrees C, exposure time 4 h, ethylene oxide concentration 860 mg/l), or gamma irradiation at doses of 3.15 MRad was administered in implants containing 5 or 10 mg of BMP extract with collagen carrier. Non-sterilized collagen implants served as controls. New bone formation was evaluated based on the incorporation of Ca45 and radiographically three weeks after implantation.

RESULTS

The collagen was not able to induce new bone visible in radiographs. The mean Ca45 incorporation in the gamma sterilized group containing 5 mg of BMP extract was 30% (p = 0.04) and that containing 10 mg of BMP extract was 60% (p = 0.02) higher than seen in the corresponding ethylene oxide sterilized groups. The mean new bone areas were 45% higher in the gamma sterilized groups than in the corresponding ethylene oxide sterilized groups, but the differences were not significant. The mean optical density of new bone in the gamma sterilized group containing 5 mg of BMP extract was 75% (p = 0.00) and in that containing 10 mg of BMP extract was 70% (p = 0.00) higher than seen in the corresponding ethylene oxide sterilized groups.

CONCLUSION

Native reindeer BMP extract is more sensitive to the effects of ethylene oxide gas sterilization than gamma irradiation. These results suggest that gamma irradiation is recommendable for the sterilization of BMP extracts.

The effect of choice of sterilisation method on the biocompatibility and biodegradability of SIS (small intestinal submucosa)

SIS (small intestinal submucosa) is a 3D extracellular matrix (ECM) material of porcine origin. It has a complex composition predominantly composed of collagen type I. SIS is rapidly absorbed, supports early and abundant new vessel growth, and serves as a template for the reconstructive remodelling of several body tissues. Currently SIS products are sterilised using ethylene oxide, gamma irradiation and e-beam irradiation. It is not known how they affect the materials properties such as structure, mechanical strength and biocompatibility. This study investigated the influence of each sterilisation method on the biocompatibility and biodegradation of SIS using L929 mouse fibroblasts. SIS samples were sterilised by each of the above methods under standard conditions. The samples were subjected to hydrolytic degradation conditions for specific periods of time. All sterilisation methods resulted in an increase in the rate of sample degradation. The study indicated that over time e-beam irradiation caused the greatest % weight loss. Applying sample extracts to L929 mouse fibroblasts assessed the biocompatibility of the degradation products. The % cellular protein and % metabolic activity were then assessed using the BCA assay and MTT assay, respectively. All SIS samples caused an increase in both cellular protein production and metabolic activity. Initially samples sterilised by ETO had the greatest effect but this decreased after 28 days. Unsterile samples were found to have a slower more prolonged influence. It is thought that the components released may include extractable growth factors and further studies are required to confirm this.

Evaluating the formulae for integrated lethality in ethylene oxide sterilization using six different endospore forming strains of bacteria, and comparisons of integrated lethality for ethylene oxide and steam systems

Bacterial endospores from six different species of bacteria were exposed to a spectrum of ethylene oxide (EtO) sterilizing conditions. Temperature was varied from 40 to 60 degrees C and the ethylene oxide concentration was varied from 300 to 750 mg/L. Relative humidity was maintained at 60+/-10% RH. The fraction negative procedure was used to determine the D value for each of the test conditions. Bacterial species tested included Bacillus atrophaeus ATCC # 9372, Bacillus smithii ATCC # 51232, Bacillus subtilis "5230" ATCC # 35021, Bacillus subtilis, DSM # 4181, Bacillus pumilus ATCC # 27142, and Geobacillus stearothermophilus ATCC # 7953. All spore preparations were inoculated on filter paper strips packaged in blue, sterilizable glassine pouches. G. stearothermophilus was the least resistant organism tested. The most resistant organisms tested were B. atrophaeus and B. subtilis "5230". The B. subtilis "5230" strain was slightly more resistant than B. atrophaeus at conditions of 54C and EtO concentrations of 400, 600, and 750 mg/L, as well as at 60C/750mg/L EtO. The other species were between these extremes. This empirical data allowed the application of the recently published formula for converting D values from one set of conditions to another and evaluations of accuracy. The measured D values also allowed the determination of Z values based on temperature variations. These formulae, when applied to process temperatures independent of gas concentration, result in a Z value of approximately 32 degrees C that appears to be similar for all species tested. These data support the application of the previously published formulae 1-6 and allow the same approach to integrated lethality for ethylene oxide processes as is commonly applied to steam sterilization. A review of steam sterilization and related principles was conducted for comparison of integrated lethality for these two methods of sterilization. Errors associated with D values, Z values, extrapolation, and integrated lethality for both methods of sterilization are discussed.

Viruses adsorbed on musculoskeletal allografts are inactivated by terminal ethylene oxide disinfection

In 1987 it was anticipated that unsterilized tissues would transmit virus diseases such as hepatitis and HIV-1 from infected donors so a freeze-drying process for musculoskeletal tissue was developed to include terminal ethylene oxide (EO) exposure for 14 h. We found no studies of EO efficacy when viruses were associated with human allografts so we studied the antiviral effect of terminal EO disinfection using all but the final freeze-drying phase of this clinical processing protocol (CPP). Specifically we looked at EO inactivation of HIV-1, a human hepatitis B surrogate and test viruses known to be highly resistant to disinfecting agents, including irradiation. Freeze-drying, ordinarily required after EO disinfection and part of the CPP, was not done. Suspensions of HIV-1, Bovine viral diarrhea, Reovirus type 3, Duck hepatitis B, Poliomyelitis and Canine parvovirus were adsorbed on glass, demineralized bone powder, and preprocessed strips of femoral cortex, iliac wedges, cancellous blocks and patellar bone-tendon-bone preparations and subjected to EO disinfection. Test viruses were inactivated at the end of 7 h of EO disinfection, providing a safety factor in the CPP of at least 100%. Because allografts can transmit viruses, terminal EO disinfection should provide safer musculoskeletal allografts than non-disinfected tissues or those irradiated with a standard irradiation dose. New spontaneously appearing viruses would probably be inactivated with this terminal EO disinfection but they and viral bioweapons will require individual validation to assure viral inactivation.

Use of peracetic acid to sterilize human donor skin for production of acellular dermal matrices for clinical use

We previously reported methods for sterilizing human skin for clinical use. In a comparison of gamma-irradiation, glycerol, and ethylene oxide, sterilization with ethylene oxide after treatment with glycerol provided the most satisfactory dermis in terms of structure and its ability to produce reconstructed skin with many of the characteristics of normal skin. However, the use of ethylene oxide is becoming less common in the United Kingdom due to concerns about its possible genotoxicity. The aim of this study was to evaluate peracetic acid as an alternative sterilizing agent. Skin sterilized with peracetic acid was compared with skin sterilized using glycerol alone or glycerol with ethylene oxide. The effect of subsequently storing peracetic acid sterilized skin in glycerol or propylene glycol was also examined. Acellular dermal matrices were produced after removal of the epidermis and cells in the dermis, processed for histological and ultrastructural analysis, and the biological function was evaluated by reconstitution with keratinocytes and fibroblasts. Results showed that sterilized acellular matrices retained the integrity of dermal structure and major components of the basement membrane. There were no overall significant differences in the ability of these matrices to form reconstructed skin, but peracetic acid alone gave a lower histologic score than when combined with glycerol or propylene glycol. We conclude that peracetic acid sterilization followed by preservation in glycerol or propylene glycol offers a convenient alternative protocol for processing of human skin. It is suggested that this sterile acellular dermis may be suitable for clinical use.

In vivo mutagenicity and mutation spectrum in the bone marrow and testes of B6C3F1 lacI transgenic mice following inhalation exposure to ethylene oxide

The lacI mutant frequency and mutation spectrum were determined in the bone marrow and testes of B6C3F1 lacI transgenic mice exposed by inhalation to ethylene oxide (EO). Groups of male transgenic lacI B6C3F1 mice were exposed to 0, 25, 50, 100 or 200 p.p.m. EO for up to 48 weeks (6 h/day, 5 days/week) and were killed at 12, 24 or 48 weeks of EO exposure for determination of lacI mutant frequency. In the bone marrow, the lacI mutant frequency was significantly increased at the two highest exposure levels (100 and 200 p.p.m.) and at the 48 week exposure time point. The shape of the exposure-response curve for lacI mutant frequency in the bone marrow was non-linear. DNA sequence analysis of the bone marrow mutation spectrum revealed that only AT-->TA transversions occurred at an increased frequency in EO-exposed mice: 25.4% in EO-exposed mice for 48 weeks (200 p.p.m.) compared with 1.4% in air controls. In testes, the lacI mutant frequency was increased at a single exposure level of 200 p.p.m. for 24 weeks. At 48 weeks, the lacI mutant frequency in testes was significantly increased to an equal degree at 25, 50 and 100 p.p.m. EO but not at 200 p.p.m. Analysis of the testes mutation spectrum in air control mice and in mice exposed to 200 p.p.m. EO for 48 weeks revealed that no single mutational type occurred at an increased frequency. In the testes, there was a small increase across all mutational types that was sufficient to increase the overall lacI mutation frequency although not significant individually. The mutation spectrum in testes of EO-exposed mice also revealed that the increased lacI mutant frequency observed at 25 or 50 p.p.m. EO was not due to an increase in mutant siblings (clonality). These data demonstrate that inhalation exposure to EO for up to 48 weeks produces distinct mutagenic responses in bone marrow and testes.

Antiretroviral efficacy of a 98% solution of glycerol or ethylene oxide for inactivation of feline leukemia virus in bone

OBJECTIVE

To determine whether infectious retrovirus was inactivated in bones from FeLV-infected cats after ethylene oxide (ETO) sterilization or preservation in a 98% solution of glycerol in an in vitro cell culture system.

SAMPLE POPULATION

Metatarsal bones obtained from 5 FeLV-infected cats and cultured with feline fibroblast cells.

PROCEDURE

Metatarsal bones were treated with 100% ETO, a 98% solution of glycerol, or left untreated. Twenty-five flasks of feline fibroblast cells were assigned to 5 groups: negative control, positive control, ETO-treated bone, glycerol-treated bone, and untreated bone with 5 replicates/group for 4 passages. Media and cell samples were harvested from every flask at each passage to measure FeLV p27 antigen and the number of copies of provirus per 100 ng of DNA, respectively.

RESULTS

All negative control and ETO-treated group replicates were negative for FeLV p27 antigen and provirus throughout the study. All positive control group replicates were positive for FeLV p27 antigen and provirus at passages 1 to 4. Untreated bone group replicates were positive for FeLV p27 antigen at passages 3 and 4 and provirus beginning at passage 2. Glycerol-treated group replicates had delayed cell replication and were negative for FeLV p27 antigen and provirus at passages 1 to 4 and 2 to 4, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

Ethylene oxide sterilization of bone from FeLV-infected cats appeared to abrogate transmission of infectious retrovirus and effectively sterilized bone allografts. Impact for Human Medicine-Additional studies to confirm effectiveness of ETO treatment of allograft tissues for prevention of pathogen transmission via transplantation are warranted.

Assessment of methods of destruction of Syphacia muris eggs

An investigation was performed to identify methods suitable for decontamination of equipment being transferred from a facility contaminated with Syphacia muris to a new facility. Perianal samples were taken on clear sticky tape from rats known to be infected with S. muris. Tapes and attached worm eggs were treated with ethylene oxide, formaldehyde fumigation, potassium peroxysulphate, chlorine dioxide and didecyl di-methyl ammonium chloride, chlorine dioxide, alcohol/chlorhexidine, 100 degrees C dry heat for 30 min, ultraviolet light (UV), or left for 4 weeks at room temperature. The subsequent viability of the eggs was compared to untreated control samples. Heat and ethylene oxide produced a 100% kill rate of S. muris eggs. Formaldehyde gas and chlorine dioxide treatments showed marked effectiveness, with the number of eggs killed at 94% and 96%, respectively, while the other agents showed less efficacy (36-78% eggs killed). The percentage of eggs not hatching in the controls was 21%. Since so few agents were effective against S. muris eggs, care should be taken when choosing a method for decontaminating a facility.

Mutagenic activity of ethylene oxide and propylene oxide under XPG proficient and deficient conditions in relation to N-7-(2-hydroxyalkyl)guanine levels in Drosophila

Ethylene oxide (EO) and propylene oxide (PO) are direct acting mutagens with high Swain-Scott s-values, which indicate that they react preferentially with ring nitrogens in the DNA. We have previously described that in the X-linked recessive lethal (RL) assay in Drosophila postmeiotic male germ cells EO is, per unit exposure dose, 5-10 times more mutagenic than PO. Furthermore, at the higher dose range of EO tested, 62.5-1000 ppm, up to 20-fold enhanced mutation rates were measured in the absence of maternal nucleotide excision repair (NER) compared to repair proficient conditions. The lower dose range of EO tested, 2-7.8 ppm, still produced a small increased mutation rate but without a significant elevated effect when the NER system is being suppressed. The lowest dose of PO tested, 15.6 ppm, produced only in NER- condition an increased mutation rate. The aim of the present study was to compare the mutagenic effect of EO and PO in the RL assay under XPG proficient and deficient conditions with the formation of N-7-(2-hydroxyethyl)guanine (7-HEG) and N-7-(2-hydroxypropyl)guanine (7-HPG), respectively, the major DNA adducts formed. The formation of 7-HEG and 7-HPG was investigated in Drosophila males exposed to EO and PO as a measure of internal dose for exposures ranging from 2 to 1000 or 2000 ppm, respectively, for 24h. Analysis of 7-HEG and 7-HPG, using a highly sensitive 32P-postlabelling assay, showed a linear increase of adduct levels over the entire dose range. The non-linear dose-response relationship for mutations could therefore not be explained by a reduced inhalation or increased detoxification at higher exposure levels. In analogy with the four times higher reactivity of EO the level of N-7-guanine alkylation per ppm was for EO 3.5-fold higher than that for PO. Per unit N-7-guanine alkylation EO was found to be slightly more mutagenic than PO, whereas PO was the more potent clastogenic agent. While this research has not identified the DNA lesions that cause the increase in repair deficient flies, it supports the hypothesis that efficient error-free repair of some N-alkylation products can explain why these agents tend to be weakly genotoxic or even inactive in repair-competent (premeiotic) germ cells of the mouse and the Drosophila fly.

Pluronic L61 accelerates flip-flop and transbilayer doxorubicin permeation

It has recently been found that Pluronics (block copolymers of ethylene oxide, EO, and propylene oxide, PO) favor the permeability and accumulation of anthracycline antibiotics, for example doxorubicin (Dox), in tumor cells. In an effort to understand these results, the interaction of EO(2)/PO(32)/EO(2) (Pluronic L61) with unilamellar egg yolk vesicles (80-100 nm in diameter) was examined. A partition coefficient K(p)=[Pl](membrane)/[Pl](water)=45 was determined. This corresponds to adsorption of about 20 polymer molecules to the surface of each vesicle in a 20 microM polymer solution. Despite this rather weak adsorption, Pluronic has a substantial effect upon the transmembrane permeation rate of Dox and upon the phospholipid flip-flop rate within the bilayers. Thus, the Dox permeation rate increases threefold and the flip-flop rate increases sixfold in 20 microM Pluronic. The two rates increase linearly with the amount of adsorbed polymer. The obvious ability of Pluronics to increase the mobility of membrane components may have important biomedical consequences.

Inadequacy of manual cleaning for reprocessing single-use, triple-lumen sphinctertomes: simulated-use testing comparing manual with automated cleaning methods

BACKGROUND AND AIMS

Despite widespread reuse of single-use sphinctertomes, publications regarding the adequacy of reprocessing are conflicting and the cautery wire channel is seldom evaluated. Our objective was to use thickened artificial test soil containing microorganisms to perform simulated-use tests combined with in-situ and destructive testing to evaluate cleaning efficacy and ethylene oxide sterilization of single-use triple lumen sphinctertomes.

METHODS

New triple-lumen sphinctertomes were soiled with thickened artificial test soil containing 6 log(10) per milliliter of Enterococcus faecalis and Bacillus stearothermophilus by inoculation through the distal end and dried for 1 hour, 24 hours, or 7 days before cleaning. The efficacy of manual cleaning was compared with that of automated cleaning with the Medisafe SI-Auto narrow-lumen cleaner. After cleaning, Bradford's reagent was injected into the channels as a direct method of detecting residual protein. Destructive testing was done to determine the levels of residual protein, carbohydrate, hemoglobin, endotoxin, and viable bacteria in the cleaned device. Destructive sterility testing of the devices also was performed after ethylene oxide sterilization.

RESULTS

Both in-situ and destructive testing demonstrated that manual cleaning and automated washers connected via the luer ports did not remove soil or organisms from the cautery wire channel. Only retro-flushing in the SI-Auto provided adequate cleaning of all 3 channels. If reprocessing was delayed for more than 24 hours, retro-flush cleaning was no longer effective. Ethylene oxide sterilization failure was detected only for devices held for 7 days before cleaning and sterilization. In-use testing showed that patient secretions gained access to the cautery wire channel.

CONCLUSIONS

Only retro-flushing done within 24 hours of use provided adequate cleaning for multi-lumen, single-use sphinctertomes. Our data validate the efficacy of reprocessing sphinctertomes once with SI-Auto retro-flush cleaning followed by 2 hours of ethylene oxide sterilization.

The performance of gamma- and EtO-sterilised UHWMPE acetabular cups tested under severe simulator conditions. Part 1: role of the third-body wear process

Due to its excellent combination of properties, ultra-high-molecular-weight-polyethylene has been used for the last 30 years in the replacement of damaged articulating cartilage for total joint replacement surgery. However, in some cases, wear, failure and delamination have been observed. Polyethylene performance may be affected by oxidation during consolidation of the resin, sterilisation of the finished specimens and post-irradiation storage. In order to evaluate the influence of the sterilisation method (gamma-irradiation and ethylene oxide(EtO)-treatment) and third-body particles on the ultra-high-molecular-weight-polyethylene wear behaviour, gamma- and EtO-sterilised ultra-high-molecular-weight-polyethylene acetabular cups were tested against CoCrMo femoral heads in a hip joint simulator run for 2.5 million cycles in bovine calf serum in the presence of third-body PMMA particles. Weight loss measurements revealed that the gamma-sterilised acetabular cups exhibited a significantly lower wear rate than those EtO-sterilised. Moreover, significant differences were found for each type of sterilisation between the gravimetric wear trends obtained until 2.5 million cycles in the presence and in the absence of PMMA particles.

Ethoxylated rapeseed oil derivatives as novel adjuvants for herbicides

Ethoxylates of rapeseed oil and of methylated rapeseed oil were synthesized and tested as adjuvants for 2,4-D and phenmedipham. Provided they had less than 6 units of ethylene oxide (EO), 1.0 to 10 g litre(-1) ethoxylates in water induced droplet spreading on barley leaves. In an acetone-based medium all derivatives strongly promoted the foliar uptake of 2,4-D, with no clear influence of the ethoxylation degree. In the same medium there was a negative influence of ethoxylate chain length on the foliar uptake of phenmedipham. In a water-based medium, phenmedipham applied with rapeseed oil emulsified with ethoxylated (20 EO) rapeseed oil displayed uptake rates close to a commercial preparation. The same was true for phenmedipham applied with ethoxylated (2 EO) methylated rapeseed oil. In bioassays, phenmedipham prepared with methylated rapeseed oil emulsified with ethoxylated (20 EO) rapeseed oil was as efficacious on barley as a commercial formulation. The same was true for phenmedipham prepared with ethoxylated (2 EO) methylated rapeseed oil. However, neither rapeseed oil nor methylated rapeseed oil emulsified with ethoxylated (2 EO) methylated rapeseed oil conferred good efficacy to phenmedipham. Hence, ethoxylated rapeseed oil derivatives are promising adjuvants or formulants for herbicides.

Effects of ethylene oxide and steam sterilization on dialysis-induced cytokine release by cuprophan membrane

The effects of sterilization modalities on dialysis-induced cytokine release are still unknown. To investigate these effects, 8 patients on chronic hemodialysis were enrolled for evaluating at different intervals interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) production (pg/ml/106). They were using a 1.3 m2 ethylene oxide (E3) or steam (E3S) sterilized Cuprophan membrane. The patients underwent a basal test with E3 (A1) and 2 following tests after 1 (B1) and 2 (B2) months of E3S treatment, respectively. Finally, the last test was performed 1 month after the switch to E3 (A2). Il-1beta predialysis release by mononuclear cells was 162 +/- 114 pg/ml/106 in A1, 185 +/- 129 pg/ml/106 in B1, and 226 +/- 138 pg/ml/106 in B2, then decreased to 123 +/- 134 in A2 (p < 0.07). Il-1beta postdialysis levels were 234 +/- 238 pg/ml/106 in A1, 429 +/- 285 pg/ml/106 (B1), and 438 +/- 473 pg/ml/106 (B2) with the steam membrane, decreasing to 204 +/- 134 pg/ml/106 in A2 (p < 0.01). TNF-alpha predialysis basal release (A1) was 826 +/- 817 pg/ml/106, 720 +/- 496 in B1, and 1079 +/- 515 pg/ml/106 in B2, and finally 680 +/- 588 pg/ml/106 in A2 (p < 0.03). In postdialysis TNF-alpha levels were 963 +/- 542 pg/ml/106 in A1, 1,226 +/- 541 pg/ml/106, and 1,183 +/- 776 in B1 and B2 respectively, and 388 +/- 297 pg/ml/106 in A2 (p < 0.003). Steam sterilization seems to induce a higher cytokine release by mononuclear cells when a Cuprophan membrane is used. This finding may be related to a less physiologic action of the steam in the case of Cuprophan membranes. Further studies are needed to clarify this hypothesis.

Effects of ethylene oxide gas sterilization on physical properties of poly(L-lactide)-poly(ethylene glycol)-poly(L-lactide) microspheres

The aggregation of poly(alpha-hydroxy acid) microspheres during ethylene oxide (EO) gas sterilization makes it difficult for the microspheres to be used in clinical applications. In this study, six kinds of PLLA-PEG-PLLA triblock copolymers (TriPLE) were synthesized with various composition ratios of PEG/PLLA in the range of 0.012 to 0.103. TriPLE microspheres were prepared by the oil-in-water emulsion method. TriPLE microspheres were characterized by using 1H-NMR, gel permeation chromatography (GPC), and differential scanning calorimetry (DSC). After sterilization by EO gas at 55 degrees C, the microspheres were analyzed by scanning electron microscope (SEM), laser diffractometry, standard sieves, X-ray diffraction (XRD), GPC, and DSC. When the composition ratio of PEG/PLLA was above 0.02, the initial crystallinity of TriPLE in microspheres was as high as 50%, and the microspheres were suitable to be sterilized by EO gas. On the other hand, TriPLE microspheres, which had composition ratios of PEG/PLLA below 0.02, had low initial crystallinities of about 30%, and aggregated during EO gas sterilization. For these microspheres, crystallinity increased up to 50% during the sterilization, whereas other TriPLE microspheres did not show any changes in crystallinity. Therefore, the aggregation of TriPLE microspheres during EO gas sterilization was markedly reduced as the initial crystallinity of TriPLE in the microspheres was increased.

Antifungal sordarins. part 3: synthesis and structure-activity relationships of 2',3'-fused oxirane derivatives

A number of new 2',3'-fused oxirane derivatives were synthesized for structure-activity relationship study. Many of these derivatives exhibit high potency against Candida spp. In addition, sordarin manno epoxide derivative 6 presents in vivo therapeutic effect in mice and is considered a promising antifungal lead within this series.

Effects of the sterilisation method on the wear of UHMWPE acetabular cups tested in a hip joint simulator

Ultra-high molecular-weight-polyethylene is the most commonly used bearing material in total joint replacement. Wear of polyethylene is a Serious Clinical problem that limits the longevity of orthopaedic implants. Information on degradative changes in the material properties and on the methods used for the sterilisation of polyethylene may help in the selection process of orthopaedic implants with the best wear resistance. This study was performed to investigate the effects of the sterilisation method (gamma irradiation and ethylene oxide treatment) on the wear and on the changes in physical properties of polyethylene acetabular cups. At this purpose, gamma-sterilised and ethylene oxide (EtO)-sterilised acetabular cups were tested against CoCr femoral heads in a hip joint simulator run for 5 million cycles in bovine calf serum. The crystallinity of the cups was evaluated by micro-Raman spectroscopy as a function of the inner surface position. The partial least square calibration was used to correlate the Raman spectra with the crystallinity of the polymer measured by differential scanning calorimetry. The analysis performed on soak control acetabular cups demonstrated that the gamma-sterilised cups are significantly more crystalline than the EtO-sterilised ones. The mean crystallinity values obtained for the gamma-sterilised and EtO-sterilised soak control cups were 65.0% and 63.4%, respectively. Weight loss measurements revealed that the gamma-sterilised acetabular cups exhibited a lower wear rate than that by EtO-sterilised. Thc Raman results obtained on gamma-sterilised and EtO-sterilised acetabular cups showed that the changes in surface crystallinity were mainly caused by irradiation rather than by the mechanical friction during the in vitro tests.

A radiological evaluation of allografts (ethylene oxide sterilized cadaver bone) and autografts in anterior cervical fusion

Serial roentgenograms of 40 patients who had 70 cervical intervertebral spaces grafted with ethylene oxide sterilized cadaver bone and 28 patients who received 44 iliac crest auto grafts for anterior cervical spine fusion, were studied. The radiological evaluation was made on the basis of settlement of intervertebral spaces, fusion rate, delayed union, non-union, graft collapse and extrusion of the graft. Indigenous methodologies were designed for the assessment of settlement of grafted intervertebral spaces in percentage. Disc space settlement was more common in autografts (93% cases) than in allografts (80% cases). The average percentage of settlement of intervertebral disc space (S%) was 22 in autografts and 28 in allografts during the first four months. By the end of eight months, allograft disc spaces settle more. No significant difference was noted in fusion rate at the end of one year viz. allografts (90% cases) and autografts (93% cases). Autograft and allograft (ethylene oxide sterilized cadaver bone) are equally useful in anterior cervical spine fusions.

Physical effects of reuse and repeated ethylene oxide sterilization on transscleral cyclophotocoagulation laser G-probes

PURPOSE

The authors documented the physical effects of reuse and repeated ethylene oxide sterilization on transscleral cyclophotocoagulation laser G-probes.

METHODS

Transscleral cyclophotocoagulation was performed using G-probes on fresh porcine eyes. Each of two G-probes was used for four transscleral cyclophotocoagulation procedures, with three cycles of ethylene oxide sterilization in between. The power output from the G-probes was measured by a laser output meter before and after each transscleral cyclophotocoagulation procedure. The G-probes were also examined under a slit lamp for signs of physical damage.

RESULTS

Repeated use of the G-probe in transscleral cyclophotocoagulation, with ethylene oxide sterilization in between, resulted in an average decrease of 3% in laser energy delivered per repeated cycle of use up to the fourth cycle. No signs of physical damage were found.

CONCLUSIONS

Laser G-probes remain functional after repeated use and ethylene oxide resterilization for up to four cycles. No visible physical damage to the probes was identified. It is safe and cost-effective to reuse G-probe for transscleral cyclophotocoagulation with ethylene oxide sterilization, provided the surgeon stays alert for signs of probe damage. This alertness should be retained regardless of whether new or old G-probes are used.

The effect of repeated ethylene oxide sterilization on the mechanical strength of synthetic absorbable sutures

The purpose of this study was to determine the effect of repeated ethylene oxide sterilization using a standard clinical protocol on sutures, a type of medical device labeled for single use and reported to be reprocessed for use after being opened but not used. Four types of commonly used synthetic absorbable sutures were subjected to 1 and 2 ethylene oxide resterilization cycles. Knot tensile strength was determined for new sutures and for sutures that had been subjected to 1 and 2 ethylene oxide resterilization cycles. As has been found with other types of single-use devices, no general conclusions can be made for absorbable sutures. The strengths of different types of sutures increased, decreased, or stayed the same after repeated sterilization. In addition, the inner packages of some sutures were not intact after reprocessing, possibly exposing the sutures to increased humidity, which can produce degradation leading to loss of strength both immediately and after additional shelf aging and degraded performance after clinical use.

DNA damage induced by gamma-radiation in combination with ethylene oxide or propylene oxide in human fibroblasts

To estimate the effects of interaction of gamma-rays and an epoxide, cell survival and induction of DNA double-strand breaks (DSBs) following combined exposure to ionizing radiation and ethylene oxide (EtO) or propylene oxide (PO) were studied in human fibroblasts. Two treatment protocols were applied: (a) the cells were pre-exposed to different doses of gamma-rays and then treated with epoxide, and (b) the cells were pretreated with epoxide and then exposed to different doses of gamma-rays. Here we show that order of the treatment did not play a role in cell survival and that the effect of combined exposure on cell killing was additive for both epoxides. As to DNA DSBs induction, however, a difference dependent upon the order of the treatment was observed. While EtO or PO treatment followed by gamma-rays exposure led to an increased number of DSBs at higher gamma-ray doses (2-3 Gy), no significant increase of DSBs was detected after the opposite order of the treatment (gamma-ray exposure followed by EtO or PO treatment).