Introduction: Hospitals in the Netherlands generate approximately 1.3 million kg of waste from the polypropylene (PP) wrapping paper (WP) used to wrap surgical instruments each year. The aim of... Show moreIntroduction: Hospitals in the Netherlands generate approximately 1.3 million kg of waste from the polypropylene (PP) wrapping paper (WP) used to wrap surgical instruments each year. The aim of this study was to develop a method to recycle WP waste into new medical devices.Methods: WP was recovered from Maasstad Hospital, Netherlands. The WP was melted into bars, granulated, and mixed with virgin material at different ratios and temperatures. Dog bones were injection-molded from volume (v.%) virgin, mixed (%R), and recycled (100%R) granulate, and a tensile testing machine was used to compare the material properties before and after ten disinfection cycles at the sterilization department. Then, 25 instrument openers were made from the 50%R material and circulated for four weeks.Results: The data indicated no significant differences in the mechanical properties at different melting temperatures. For dog bones made from the 100%R, 50%R, and virgin granulate, the Young's moduli were 1021 (SD13), 879 (SD13), and 795 (SD14) MPa, and the strains were 8%, 12%, and 14%. Ten disinfection cycles did not significantly change the material properties. After one month, the openers did not show any deterioration or damage other than surface scratches.Discussion: The results indicated that the initial WP melting temperature did not influence the mechanical properties. Although devices could be produced directly from the recycled WP granulate, increasing the recycled granulate in the mix ratio increased the strength and brittleness.Conclusions: It is feasible to recycle WP waste into a high-quality raw material for the injection molding of medical devices without using additives. This would allow hospitals to become more compliant with the circular economy enabling economically viable and circular processes that positively contribute to cleaner technical processes, sustainable products, and the reduction of medical waste. Show less
Dopamine-beta-hydroxylase (D beta H) deficiency is a rare genetic syndrome characterized by the complete absence of norepinephrine in the peripheral and the central nervous system. D beta H... Show moreDopamine-beta-hydroxylase (D beta H) deficiency is a rare genetic syndrome characterized by the complete absence of norepinephrine in the peripheral and the central nervous system. D beta H-deficient patients suffer from several physical symptoms, which can be treated successfully with L-threo-3,4-dihydroxyphenylserine, a synthetic precursor of norepinephrine. Informal clinical observations suggest that D beta H-deficient patients do not have obvious cognitive impairments, even when they are not medicated, which is remarkable given the important role of norepinephrine in normal neurocognitive function. This study provided the first systematic investigation of neurocognitive function in human D beta H deficiency. We tested 5 D beta H-deficient patients and 10 matched healthy control participants on a comprehensive cognitive task battery, and examined their pupil dynamics, brain structure, and the P3 component of the electroencephalogram. All participants were tested twice; the patients were tested once ON and once OFF medication. Magnetic resonance imaging scans of the brain revealed that the patients had a smaller total brain volume than the control group, which is in line with the recent hypothesis that norepinephrine has a neurotrophic effect. In addition, the patients showed an abnormally small or absent task-evoked pupil dilation. However, we found no substantial differences in cognitive performance or P3 amplitude between the patients and the control participants, with the exception of a temporal-attention deficit in the patients OFF medication. The largely spared neurocognitive function in D beta H-deficient patients suggests that other neuromodulators have taken over the function of norepinephrine in the brains of these patients. Neuropsychopharmacology (2011) 36, 1608-1619; doi:10.1038/npp.2011.42; published online 6 April 2011 Show less
Objective. To evaluate how continuation of and alterations to initial year 1 combination etanercept-methotrexate (MTX) therapy and MTX monotherapy regimens affect long-term remission and... Show moreObjective. To evaluate how continuation of and alterations to initial year 1 combination etanercept-methotrexate (MTX) therapy and MTX monotherapy regimens affect long-term remission and radiographic progression in early, active rheumatoid arthritis. Methods. Subjects were randomized at baseline for the entire 2-year period; those who completed 1 year of treatment with combination or MTX monotherapy entered year 2. The original combination group either continued combination therapy (the EM/EM group; n = 111) or received etanercept monotherapy (the EM/E group; n = 111) in year 2; the original MTX monotherapy group either received combination therapy (the M/EM group; n = 90) or continued monotherapy (the M/M group; n = 99) in year 2. Efficacy end points included remission (a Disease Activity Score in 28 joints [DAS28] < 2.6) and radiographic nonprogression (change in the modified Sharp/van der Heijde score <= 0.5) at year 2. A last observation carried forward analysis from the modified intention-to-treat population (n = 398) and a post hoc nonresponder imputation (NRI) analysis (n = 528) were performed for remission. Results. At year 2, DAS28 remission was achieved by 62/108, 54/108, 51/88, and 33/94 subjects in the EM/EM, EM/E, M/EM, and M/M groups, respectively (P < 0.01 for the EM/EM and M/EM groups versus the M/M group). This effect was corroborated by a more conservative post hoc 2-year NRI analysis, with remission observed in 59/131, 50/134, 48/133, and 29/130 of the same respective groups (P < 0.05 for each of the EM/EM, EM/E, and M/EM groups versus the M/M group). The proportions of subjects achieving radiographic nonprogression (n = 360) were 89/99, 74/99, 59/79, and 56/83 in the EM/EM (P < 0.01 versus each of the other groups), EM/E, M/EM, and M/M groups, respectively. No new safety signals or between-group differences in serious adverse events were seen. Conclusion. Early sustained combination etanercept-MTX therapy was consistently superior to MTX monotherapy. Combination therapy resulted in important clinical and radiographic benefits over 2 study years, without significant additional safety risk. Show less
