Preface |
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xix | |
Authors |
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xxi | |
Chapter 1 Safety Evaluation of Medical Devices |
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1 | (10) |
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1 | (1) |
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1 | (1) |
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Fundamentals of Biocompatibility Tests |
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2 | (2) |
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Scope of Devices and the Medical Device Market |
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4 | (1) |
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5 | (1) |
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Nonspecific Regulatory Considerations |
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6 | (2) |
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Good Laboratory Practices |
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6 | (1) |
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7 | (1) |
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7 | (1) |
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Organizations Regulating Drug and Device Safety in the United States |
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7 | (1) |
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8 | (3) |
Chapter 2 Regulatory Aspects and Strategy in Medical Device and Biomaterials Safety Evaluation |
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11 | (34) |
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11 | (9) |
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Regulations: General Considerations for United States |
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11 | (2) |
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13 | (1) |
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Organizations Regulating Device Safety in the United States |
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13 | (1) |
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Classification of Devices |
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14 | (6) |
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Toxicity Testing: Medical Devices |
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20 | (22) |
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Device Categories: Definitions and Examples |
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23 | (1) |
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24 | (5) |
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United States Pharmacopeial Testing |
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29 | (1) |
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30 | (1) |
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31 | (1) |
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32 | (5) |
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37 | (1) |
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37 | (1) |
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38 | (1) |
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38 | (1) |
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38 | (1) |
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38 | (1) |
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38 | (1) |
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38 | (7) |
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38 | (1) |
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39 | (1) |
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Perchloroethylene Solvent |
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40 | (1) |
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40 | (1) |
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41 | (1) |
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41 | (1) |
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42 | (1) |
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42 | (3) |
Chapter 3 Road Map to Test Selections |
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45 | (28) |
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45 | (24) |
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45 | (1) |
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Materials, Components, and Products |
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46 | (1) |
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Chemical and Physical Property Considerations |
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46 | (11) |
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49 | (1) |
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49 | (1) |
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49 | (1) |
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By-Products from Irradiation |
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49 | (1) |
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49 | (1) |
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50 | (1) |
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50 | (1) |
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50 | (1) |
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Specific Material Considerations |
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50 | (5) |
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Physical Properties of Polymers, Elastomers, and Silicones |
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55 | (1) |
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Biologically Derived Materials |
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56 | (1) |
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Factors Influencing Test Selection |
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57 | (1) |
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57 | (1) |
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57 | (1) |
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58 | (1) |
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58 | (1) |
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58 | (1) |
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58 | (7) |
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Miscellaneous Reference Sources |
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60 | (2) |
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62 | (1) |
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Monitoring Published Literature and Other Research in Progress |
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62 | (1) |
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63 | (1) |
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Kinds of Available Information (Always Changing, Ever Faster, in the Digital Age) |
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63 | (2) |
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PC-Based Information Products: Laser Disc |
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65 | (1) |
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65 | (1) |
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65 | (1) |
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Qualifications versus Process Control |
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66 | (1) |
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Tiers of Concern: Consumers, Health-Care Providers, and Manufacturing Employees |
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66 | (2) |
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Sterilization and Cleanliness |
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68 | (1) |
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69 | (4) |
Chapter 4 Materials in Medical Device Design |
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73 | (28) |
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73 | (1) |
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74 | (3) |
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74 | (2) |
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76 | (1) |
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76 | (2) |
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76 | (1) |
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77 | (1) |
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77 | (1) |
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77 | (1) |
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78 | (11) |
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85 | (3) |
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88 | (1) |
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89 | (1) |
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89 | (1) |
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89 | (1) |
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89 | (1) |
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Biologically Sourced Materials |
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90 | (5) |
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90 | (5) |
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Surface-Modifying Materials |
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95 | (1) |
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Tissue Engineering Scaffolds |
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95 | (1) |
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96 | (1) |
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96 | (1) |
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97 | (1) |
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97 | (1) |
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97 | (1) |
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97 | (4) |
Chapter 5 What to Test: Sampling and Sample Preparation |
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101 | (10) |
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101 | (1) |
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102 | (1) |
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103 | (5) |
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107 | (1) |
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108 | (1) |
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108 | (1) |
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109 | (2) |
Chapter 6 Cytotoxicity Testing |
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111 | (12) |
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111 | (1) |
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111 | (3) |
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114 | (1) |
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Silicone Microphysiometer |
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114 | (1) |
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114 | (1) |
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Neutral Red Uptake (NRU) Assay |
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114 | (1) |
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114 | (3) |
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117 | (1) |
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118 | (1) |
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118 | (1) |
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Colony-Forming Assay (CFA) |
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119 | (1) |
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Correlation with In Vivo Results |
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119 | (1) |
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119 | (1) |
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120 | (3) |
Chapter 7 Hemocompatibility (ISO 10993-4) |
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123 | (16) |
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125 | (1) |
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External Communicating Devices |
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125 | (1) |
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126 | (1) |
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127 | (1) |
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128 | (3) |
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The Osmotic Fragility Test |
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131 | (1) |
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132 | (1) |
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Whole Blood Clotting Time |
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132 | (1) |
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133 | (1) |
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134 | (1) |
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134 | (1) |
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134 | (1) |
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135 | (1) |
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136 | (1) |
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136 | (3) |
Chapter 8 Local Tissue Tolerance |
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139 | (28) |
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139 | (4) |
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Primary Dermal Irritation Test |
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141 | (2) |
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143 | (1) |
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Ocular Irritation Testing |
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143 | (5) |
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Primary Eye Irritation Test |
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145 | (1) |
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146 | (2) |
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Other Nonparenteral Route Irritation Tests |
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148 | (2) |
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Parenteral Irritation/Tolerance |
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150 | (1) |
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150 | (4) |
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Test Systems for Parenteral Irritation |
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151 | (3) |
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Acute Intramuscular Irritation in the Male Rabbit |
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151 | (1) |
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Acute Intravenous Irritation in the Male Rabbit |
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152 | (2) |
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154 | (1) |
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Intracutaneous Irritation |
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154 | (7) |
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154 | (1) |
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155 | (1) |
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Reference Standard and Control Standard Endotoxins |
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156 | (1) |
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157 | (1) |
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Inhibition or Enhancement Test |
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157 | (1) |
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158 | (1) |
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158 | (1) |
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159 | (1) |
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Calculation and Interpretation |
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159 | (1) |
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159 | (15) |
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160 | (1) |
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Factors Affecting Irritation Responses and Test Outcome |
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161 | (1) |
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162 | (5) |
Chapter 9 Immunotoxicology (ISO 10993-20) |
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167 | (56) |
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Overview of the Immune System |
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168 | (4) |
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172 | (1) |
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172 | (2) |
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174 | (6) |
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175 | (3) |
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178 | (2) |
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Evaluation of the Immune System |
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180 | (4) |
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180 | (4) |
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The CDRH Testing Framework |
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184 | (1) |
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Immunopathologic Assessments |
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184 | (3) |
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187 | (1) |
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188 | (2) |
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190 | (1) |
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191 | (1) |
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192 | (18) |
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Objectives and General Features |
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194 | (1) |
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195 | (18) |
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Modified Buehler Procedure |
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196 | (4) |
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Guinea Pig Maximization Test |
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200 | (5) |
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Mouse Ear Swelling Test (MEST) |
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205 | (5) |
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Local Lymph Node Assay (LLNA) |
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210 | (3) |
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213 | (2) |
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Suggested Approaches to Testing |
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213 | (1) |
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Suggested Approaches to Evaluation of Results |
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213 | (2) |
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Problems and Future Directions |
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215 | (1) |
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216 | (7) |
Chapter 10 Implantation Biology and Studies |
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223 | (20) |
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223 | (2) |
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225 | (1) |
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ISO 10993 Implantation Test |
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225 | (5) |
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Preparation of Specimens for Implantation |
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226 | (1) |
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Solid Specimens (Excluding Powders) |
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226 | (1) |
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Nonsolid Specimens (Including Powders) |
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226 | (1) |
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226 | (1) |
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226 | (1) |
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227 | (1) |
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228 | (1) |
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228 | (1) |
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228 | (1) |
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Evaluation of Biological Response |
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228 | (1) |
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228 | (1) |
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Preparation for Histology: Implant Retrieval and Specimen Preparation |
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228 | (1) |
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229 | (1) |
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229 | (1) |
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229 | (1) |
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Retrieval and Histological Procedure |
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229 | (1) |
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229 | (1) |
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Test Method for Implantation in Subcutaneous Tissue |
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230 | (11) |
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230 | (1) |
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230 | (1) |
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230 | (1) |
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Test Animals and Implant Sites |
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230 | (1) |
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230 | (3) |
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Implantation along Dorsal Midline |
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230 | (1) |
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230 | (1) |
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231 | (1) |
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Evaluation of Biological Response |
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231 | (1) |
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Test Method for Implantation in Muscle |
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231 | (1) |
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Test Method for Implantation in Bone |
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232 | (1) |
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233 | (1) |
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Long-Term Implant Studies |
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233 | (5) |
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Number of Test and Control Implants |
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236 | (1) |
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237 | (1) |
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237 | (1) |
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237 | (1) |
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Sacrifice and Implant Retrieval |
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237 | (1) |
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238 | (1) |
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238 | (2) |
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Tissue Sample Preparation |
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238 | (1) |
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Histopathological Observations |
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238 | (1) |
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239 | (1) |
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Granulomatous Inflammation |
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240 | (1) |
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240 | (1) |
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241 | (2) |
Chapter 11 Acute Systemic Toxicity Testing and Device Safety Evaluation |
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243 | (12) |
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243 | (1) |
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Acute Systemic Toxicity Characterization |
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243 | (9) |
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245 | (2) |
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Body Weight Considerations |
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247 | (2) |
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Factors That Can Affect Acute Tests |
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249 | (6) |
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Number, Size, and Sex of Dosage Groups |
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249 | (3) |
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252 | (3) |
Chapter 12 Genotoxicity |
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255 | (50) |
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255 | (1) |
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255 | (11) |
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257 | (1) |
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257 | (1) |
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257 | (1) |
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258 | (1) |
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258 | (1) |
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258 | (1) |
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259 | (1) |
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The Adaptive Repair Pathway |
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259 | (1) |
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259 | (1) |
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260 | (1) |
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Nature of Point Mutations |
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260 | (2) |
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262 | (1) |
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262 | (1) |
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Mutations Due to Insertion Sequences |
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263 | (1) |
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The Link between Mutation and Cancer |
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263 | (1) |
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Genotoxic versus Nongenotoxic Mechanisms of Carcinogenesis |
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264 | (1) |
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Genetic Damage and Heritable Defects |
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264 | (1) |
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265 | (1) |
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266 | (30) |
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Cytogenetic Damage and Its Consequences |
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266 | (1) |
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Individual Chromosome Damage |
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266 | (1) |
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267 | (1) |
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268 | (2) |
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270 | (1) |
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270 | (1) |
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270 | (1) |
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In Vitro Metabolic Activation |
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270 | (1) |
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Cell-Free versus Cell-Based Systems |
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271 | (3) |
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271 | (1) |
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Standard Method of S9 Fraction Preparation |
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272 | (1) |
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272 | (1) |
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273 | (1) |
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Reversion Tests: Background |
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274 | (1) |
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Genetic Makeup of Tester Strains |
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274 | (1) |
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Use of the Plasmid pkM101 |
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274 | (1) |
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Escherichia coli Tester Strains |
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274 | (1) |
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Storage and Checking of Tester Strains |
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275 | (1) |
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Plate Incorporation Assay |
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275 | (15) |
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Protocol for Dose Ranging and Selection |
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275 | (2) |
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277 | (1) |
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278 | (2) |
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Eukaryotic Mutation Tests |
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280 | (1) |
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In Vitro Tests for the Detection of Mammalian Mutation |
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281 | (7) |
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In Vivo Mammalian Mutation Tests |
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288 | (1) |
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In Vitro Cytogenetic Assays |
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289 | (1) |
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290 | (4) |
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Chinese Hamster Cell Lines |
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290 | (1) |
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Human Peripheral Blood Lymphocytes |
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290 | (1) |
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Positive and Negative Controls |
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290 | (1) |
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291 | (1) |
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292 | (1) |
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292 | (1) |
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292 | (1) |
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In Vitro Cytogenetics Assays |
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293 | (1) |
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293 | (1) |
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293 | (1) |
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Heritable Chromosome Assays |
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294 | (1) |
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Germ Cell Cytogenetic Assays |
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294 | (1) |
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Sister Chromatid Exchange Assays |
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294 | (1) |
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Relevance of SCE in Terms of Genotoxicity |
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294 | (12) |
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295 | (1) |
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296 | (9) |
Chapter 13 Subchronic and Chronic Toxicity and Reproductive and Developmental Toxicity |
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305 | (28) |
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305 | (1) |
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305 | (1) |
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Regulatory Considerations |
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306 | (1) |
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Good Laboratory Practices |
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306 | (1) |
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306 | (1) |
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Regulatory Requirements for Study Design |
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306 | (1) |
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307 | (1) |
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307 | (1) |
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307 | (1) |
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308 | (2) |
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308 | (1) |
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308 | (1) |
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308 | (1) |
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309 | (1) |
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310 | (4) |
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Study Interpretation and Reporting |
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314 | (1) |
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Reproductive and Developmental Toxicity |
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315 | (1) |
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315 | (1) |
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315 | (4) |
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Male and Female Fertility and Early Embryonic Development to Implantation |
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316 | (3) |
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317 | (1) |
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Pre- and Postnatal Development |
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317 | (1) |
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Single-Study and Two-Study Designs for Rodents |
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318 | (1) |
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Dose and Sample Preparation |
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319 | (1) |
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319 | (5) |
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319 | (1) |
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319 | (2) |
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320 | (1) |
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Implant Counts and Determination of Pregnancy |
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320 | (1) |
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321 | (2) |
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Examination of External Genitalia |
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321 | (1) |
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Visceral Fetal Examinations |
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322 | (1) |
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Skeletal Fetal Examination |
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322 | (1) |
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323 | (1) |
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323 | (1) |
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Detecting Effects on Male Reproduction |
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324 | (1) |
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324 | (5) |
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Use of Statistical Analyses |
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324 | (2) |
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Associations between Developmental and Maternal Toxicity |
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326 | (1) |
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327 | (2) |
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329 | (4) |
Chapter 14 Carcinogenicity |
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333 | (10) |
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333 | (2) |
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335 | (4) |
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335 | (4) |
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335 | (1) |
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335 | (1) |
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335 | (1) |
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336 | (1) |
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337 | (1) |
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338 | (1) |
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Interpretation of Results |
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339 | (1) |
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Criteria for a Positive Result |
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339 | (1) |
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Use of Historical Controls |
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339 | (1) |
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340 | (3) |
Chapter 15 Degradation Products and Impurities: Processes in Medical Devices |
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343 | (28) |
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343 | (1) |
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343 | (6) |
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344 | (3) |
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347 | (2) |
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349 | (1) |
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350 | (8) |
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350 | (1) |
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351 | (4) |
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352 | (1) |
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353 | (1) |
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354 | (1) |
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354 | (1) |
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355 | (1) |
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356 | (1) |
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356 | (1) |
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Unreacted Monomer and Additives |
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357 | (1) |
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358 | (6) |
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358 | (5) |
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358 | (1) |
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359 | (2) |
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361 | (2) |
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363 | (1) |
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363 | (1) |
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Sterile Empty or Prefilled Syringes |
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364 | (1) |
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Interpretation of Sterility Test Results |
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364 | (1) |
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364 | (1) |
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364 | (1) |
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365 | (1) |
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History and Objectives of Compendial Heavy Metal Tests |
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365 | (1) |
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Scope and Limitations of the Present Pharmacopeial Heavy Metals Test |
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366 | (1) |
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366 | (1) |
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366 | (5) |
Chapter 16 Special Case Devices |
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371 | (16) |
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371 | (1) |
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Respiratory and Inhalation Devices |
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371 | (4) |
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Complexity of Inhaled Materials |
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372 | (1) |
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Complexity of Exposure Profile for Inhaled Test Materials |
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373 | (1) |
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Potential Patient Contact with Gas Passing through Device |
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373 | (1) |
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Potential Patient Contact with Gas and a Liquid Component (Condensate or Liquid Aerosol in Gas Stream) |
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373 | (2) |
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One or More New Materials Incorporated into Device |
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375 | (1) |
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375 | (1) |
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Contact Lenses, Gels, and Their Solutions |
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375 | (1) |
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Biocompatibility Testing Requirements for Contact Lenses |
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375 | (1) |
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Solutions and Lens: Solution Interactions |
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376 | (1) |
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Cardiovascular Devices and Prostheses |
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|
376 | (4) |
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377 | (1) |
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377 | (1) |
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Extracorporeal Oxygenators, Hemodialyzers, Therapeutic Apheresis Equipment, and Devices for Absorption of Specific Substances from Blood |
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|
378 | (1) |
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Ventricular-Assist Devices |
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|
378 | (1) |
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|
378 | (1) |
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|
379 | (1) |
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Inferior Vena Cava (IVC) Filters and Stents |
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|
379 | (1) |
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|
379 | (1) |
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|
379 | (1) |
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Sensitization (Guinea Pig Maximization Method) |
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|
380 | (1) |
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|
380 | (1) |
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Material-Mediated Pyrogenicity |
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|
380 | (1) |
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Endotoxin-Mediated Pyrogenicity |
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|
380 | (1) |
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380 | (3) |
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In Vitro Evaluation of the Effects of Potential Tampon Materials on PH and Growth of Vaginal Microflora |
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|
381 | (6) |
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381 | (2) |
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383 | (1) |
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|
383 | (4) |
Chapter 17 Combination Products |
|
387 | (12) |
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Device/Drug Combination Products |
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387 | (1) |
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|
387 | (11) |
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|
387 | (12) |
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Device Programs That CDER and CBRH Will Administer |
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|
392 | (1) |
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|
392 | (1) |
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|
392 | (1) |
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|
393 | (5) |
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|
398 | (1) |
Chapter 18 Clinical Studies for Medical Devices |
|
399 | (20) |
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|
399 | (11) |
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|
400 | (1) |
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|
401 | (1) |
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|
402 | (1) |
|
Assignment of Intervention |
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403 | (1) |
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|
403 | (1) |
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|
404 | (1) |
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|
405 | (1) |
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|
405 | (1) |
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Comparability of Patients in Study Groups |
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|
406 | (1) |
|
Other Design Considerations |
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|
406 | (2) |
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407 | (1) |
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|
407 | (1) |
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|
407 | (1) |
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Institutional Review Board |
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|
408 | (2) |
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|
409 | (1) |
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|
410 | (5) |
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|
410 | (1) |
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Epidemiological Study Designs |
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411 | (4) |
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411 | (2) |
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|
413 | (2) |
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415 | (4) |
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415 | (1) |
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|
415 | (1) |
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|
415 | (1) |
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|
415 | (1) |
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|
416 | (3) |
Chapter 19 Leachables and Extractables from Medical Devices |
|
419 | (50) |
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|
419 | (4) |
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|
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Qualitative Evaluation of Materials |
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|
422 | (1) |
|
Quantitative Evaluation of Materials |
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|
422 | (1) |
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|
423 | (1) |
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|
423 | (5) |
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|
424 | (1) |
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Sample Preparation Considerations |
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|
425 | (1) |
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Solvent to Test Sample Ratio |
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|
425 | (1) |
|
Extraction Conditions or Methods |
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|
425 | (1) |
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Choice of Extraction Vehicles |
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|
426 | (1) |
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Determining Appropriate Extraction Methods |
|
|
427 | (1) |
|
Containers for Extraction |
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|
427 | (1) |
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Other Points to Consider When Selecting Extraction Conditions |
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|
427 | (1) |
|
General Principles of Leachables and Extractables Under ISO 10993 |
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|
428 | (12) |
|
|
Characterization of Materials |
|
|
430 | (12) |
|
Chemical Characterization of Extracts |
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|
432 | (6) |
|
Infrared Analysis of Nonvolatile Residue |
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|
438 | (2) |
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|
440 | (29) |
|
GC/MS: Volatile Organic Compounds |
|
|
440 | (1) |
|
GC/MS: Semivolatile Organic Compounds |
|
|
440 | (1) |
|
|
440 | (1) |
|
LC/UV: Nonvolatiles (Screening) |
|
|
441 | (1) |
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|
441 | (1) |
|
|
442 | (10) |
|
Chromatographic Analysis of Extracts |
|
|
442 | (1) |
|
Electrochemistry and Atomic Spectroscopy |
|
|
443 | (1) |
|
Classical Chemical Analysis |
|
|
443 | (1) |
|
Ion-Selective Electrode Analysis |
|
|
443 | (1) |
|
Atomic Absorption and Inductively Coupled Plasma Spectroscopy |
|
|
443 | (1) |
|
Bioavailability of Extractables and Leachables |
|
|
444 | (2) |
|
Extraction of Biomaterials |
|
|
446 | (1) |
|
Using Chemical and Material Characterization to Demonstrate Equivalency |
|
|
447 | (1) |
|
Change Control and Material Equivalency |
|
|
448 | (1) |
|
|
448 | (1) |
|
USP Physicochemical Tests |
|
|
449 | (1) |
|
|
450 | (1) |
|
|
450 | (1) |
|
Gel Permeation Chromatography |
|
|
450 | (1) |
|
Acceptance Criteria for Equivalency |
|
|
450 | (2) |
|
Risk Assessment of Extracted Moieties |
|
|
452 | (6) |
|
Background Information on Risk Assessments |
|
|
453 | (1) |
|
Components of Risk Assessment |
|
|
454 | (2) |
|
|
456 | (1) |
|
Practical Assessment of Complex Extractables Mixtures |
|
|
457 | (1) |
|
|
458 | (1) |
|
Introduction to (Q)SAR for Leachable and Extractable Evaluation |
|
|
458 | (3) |
|
|
|
459 | (1) |
|
|
460 | (1) |
|
QSAR for Assessing Safety |
|
|
460 | (1) |
|
Risk Assessment for Leachables and Extractables |
|
|
461 | (4) |
|
|
Introduction to Risk Assessment |
|
|
461 | (1) |
|
Interpreting a Chemical Characterization Report |
|
|
462 | (1) |
|
|
463 | (2) |
|
|
465 | (4) |
Chapter 20 Toxicokinetics in Biomaterial and Device Safety Evaluation |
|
469 | (34) |
|
|
469 | (1) |
|
|
470 | (1) |
|
|
470 | (16) |
|
|
473 | (4) |
|
Absorption from the Pulmonary System |
|
|
475 | (1) |
|
Absorption across the Skin |
|
|
476 | (1) |
|
Parameters Controlling Absorption |
|
|
476 | (1) |
|
|
477 | (2) |
|
|
478 | (1) |
|
|
478 | (1) |
|
|
479 | (1) |
|
Metabolism/Biotransformation |
|
|
479 | (5) |
|
|
483 | (1) |
|
Sex-Related Differences in Rodents |
|
|
483 | (1) |
|
|
484 | (1) |
|
|
484 | (1) |
|
|
485 | (1) |
|
|
485 | (1) |
|
|
485 | (1) |
|
Physiologically Based Pharmacokinetic Modeling |
|
|
485 | (1) |
|
|
486 | (12) |
|
|
486 | (1) |
|
|
487 | (2) |
|
Sampling Methods and Intervals |
|
|
489 | (2) |
|
|
489 | (1) |
|
|
490 | (1) |
|
|
490 | (1) |
|
|
490 | (1) |
|
|
490 | (1) |
|
|
491 | (1) |
|
|
492 | (2) |
|
|
494 | (1) |
|
|
494 | (2) |
|
Use of Data from Metabolism and Pharmacokinetic Studies |
|
|
496 | (1) |
|
Design of Toxicity Studies |
|
|
496 | (1) |
|
Whole-Body Autoradiography |
|
|
496 | (2) |
|
Physiologically Based Pharmacokinetic (PBPK) Modeling |
|
|
498 | (1) |
|
Biologically Derived Materials |
|
|
499 | (1) |
|
|
500 | (3) |
Chapter 21 Special Studies |
|
503 | (14) |
|
|
503 | (1) |
|
|
503 | (8) |
|
|
503 | (8) |
|
|
504 | (7) |
|
21-Day Eye Irritation Study in Rabbits |
|
|
511 | (1) |
|
|
511 | (1) |
|
|
511 | (2) |
|
|
513 | (1) |
|
|
513 | (1) |
|
Production of Toxic Shock Syndrome Toxin-1 (TSST-1) |
|
|
513 | (1) |
|
|
514 | (4) |
|
|
514 | (1) |
|
|
514 | (1) |
|
|
514 | (1) |
|
Inflammatory Responses to Biomaterials |
|
|
514 | (1) |
|
|
515 | (2) |
Chapter 22 Case Histories and Problem Resolution |
|
517 | (30) |
|
Phthalates Leaching from Polymer Devices |
|
|
517 | (1) |
|
|
518 | (5) |
|
Potential Modes of Exposure to Bisphenol A |
|
|
519 | (1) |
|
Potential Bisphenol A Health Effects |
|
|
519 | (1) |
|
|
519 | (1) |
|
|
520 | (1) |
|
|
520 | (1) |
|
Selection of Uncertainty Factors for TI Derivation |
|
|
521 | (1) |
|
|
521 | (1) |
|
Interpretation of Dose/TI Ratios |
|
|
521 | (1) |
|
Uncertainties in Exposure and Toxicity Assessment |
|
|
522 | (1) |
|
|
522 | (1) |
|
Protection of Sensitive Subpopulations |
|
|
522 | (1) |
|
Tolerable Intake Value versus Allowable Limit Value |
|
|
522 | (1) |
|
Talc on Gloves and Condoms |
|
|
523 | (1) |
|
|
524 | (3) |
|
|
525 | (1) |
|
Immediate Hypersensitivity |
|
|
525 | (2) |
|
Silicones in Devices (Historical) |
|
|
527 | (4) |
|
|
531 | (2) |
|
Dalkon Shield (Historical) and Copper 7 |
|
|
531 | (2) |
|
Toxic Shock Syndrome (Historical) |
|
|
533 | (8) |
|
|
535 | (2) |
|
Justifying Use of the Material |
|
|
536 | (1) |
|
|
537 | (4) |
|
|
537 | (1) |
|
|
538 | (3) |
|
|
541 | (1) |
|
|
541 | (1) |
|
|
541 | (1) |
|
|
541 | (1) |
|
|
542 | (5) |
Appendix A: Selected Regulatory and Toxicological Acronyms |
|
547 | (4) |
Appendix B: Contract Testing Laboratories |
|
551 | (4) |
Appendix C: Notable Regulatory Internet Addresses |
|
555 | (4) |
Appendix D: Non-U.S. Medical Device Regulators |
|
559 | (2) |
Appendix E: Definition of Terms and Lexicon of "Clinical" Observations in Nonclinical (Animal) Studies |
|
561 | (2) |
Index |
|
563 | |