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Case Study: Compatibility Testing of Pre-Filled Syringe Stopper Technology with Vaporized Hydrogen Peroxide Terminal Sterilization Process. 案例研究:预灌封注射器瓶塞技术与蒸发过氧化氢终端灭菌工艺的兼容性测试。
Q3 Medicine Pub Date : 2024-08-23 DOI: 10.5731/pdajpst.2024.012965
Juha Mattila, Michael Kienzle, Arja Ruley

STERIS and W.L. GORE collaborated on a case study testing the compatibility of a new prefilled syringe plunger design with VHP terminal sterilization. VHP chamber conditions require deep vacuum pulsing, which may represent challenges to prefilled syringe container integrity. The growing industry trend toward VHP sterilization is driven by the FDA search for alternative sterilization methods to EO and the recent publication of a VHP specific process standard. The purpose of the study is to test and report compatibility of the new 0.5 mL GORE IMPROJECT plunger, a silicone free syringe solution for ophthalmic application, with VHP sterilization. Various challenges have been reported when using conventional, siliconized, prefilled syringe systems for intravitreal injections such as subvisible particles, inflammation, silicone floaters, and intraocular pressure increases. The GORE plunger eliminates the need for silicone oil as a lubricant on the plunger and barrel, while meeting strict container closure and terminal sterilization requirements of ophthalmic applications. This case study presents successful results of deep vacuum VHP terminal sterilization process compatibility with the GORE plunger design and material composition. Test results include primary container integrity, stopper off-gassing/ingress, and visual inspection. Principles of VHP vacuum sterilization process, test cycle configuration, and its main parameters are presented.

STERIS 和 W.L. GORE 合作开展了一项案例研究,测试新型预灌封注射器柱塞设计与 VHP 终端灭菌的兼容性。VHP 室条件要求深真空脉动,这可能会对预灌封注射器容器的完整性构成挑战。美国食品及药物管理局(FDA)正在寻找环氧乙烷的替代灭菌方法,最近又发布了 VHP 特定工艺标准,这推动了 VHP 灭菌成为行业发展的趋势。这项研究的目的是测试和报告眼科应用的新型 0.5 mL GORE IMPROJECT 柱塞(一种无硅注射器解决方案)与 VHP 灭菌的兼容性。据报道,在使用传统的硅化预填充注射器系统进行玻璃体内注射时会遇到各种挑战,如亚可见颗粒、炎症、硅胶漂浮物和眼内压升高。GORE 柱塞无需在柱塞和针筒上使用硅油作为润滑剂,同时还能满足眼科应用中严格的容器封闭和终端灭菌要求。本案例研究成功展示了深真空 VHP 终端灭菌工艺与戈尔柱塞设计和材料成分的兼容性。测试结果包括主容器完整性、塞子脱气/压力和目视检查。介绍了 VHP 真空灭菌工艺的原理、测试循环配置及其主要参数。
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引用次数: 0
Ebeam Technology - Transfer Technology for Pre-Sterilized RTU Components. Ebeam Technology - RTU 预灭菌组件的转移技术。
Q3 Medicine Pub Date : 2024-08-23 DOI: 10.5731/pdajpst.2024.012978
Manfred Holzer

With increased demand on sealed packed, pre-sterilized ready-to-use (RTU) components like Syringes & Vials, the ebeam technology is used as transfer technology with surface decontamination for transfer of the RTU in a GRADE A environment like an Isolator.

随着对注射器和小瓶等密封包装、预灭菌即用型(RTU)组件的需求增加,ebeam 技术被用作传输技术,在隔离器等 A 级环境中进行表面净化,以传输 RTU。
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引用次数: 0
Reusable vs Single Use: what Are the Device Trade-Offs in Improving Sustainability. 可重复使用与一次性使用:提高可持续发展能力的设备权衡。
Q3 Medicine Pub Date : 2024-08-23 DOI: 10.5731/pdajpst.2024.012981
Alastair Willoughby

As autoinjector requirements become increasingly diverse and pharma companies look for quicker routes to market, with lower costs and improved sustainability, there is an increasing trend towards devices with a reusable element. The flexibility in reusable elements can be beneficial for pharma companies with access to these platforms, allowing a relatively rapid transition between different drug combinations. However, it can also lead to devices designed to cover a wide range of requirements which are over designed for their actual more limited end use. The challenge of creating both a cost and sustainability optimised platform device is significantly harder than if developing a single use device with a specific purpose in mind. This paper looks at the range of reusable products on the market, examining some of the assertions around the cost and sustainability benefits of these devices as well as where there are trade-offs relative to current single use format devices.

随着自动注射器的需求日益多样化,制药公司希望以更低的成本和更高的可持续发展能力加快产品上市速度,采用可重复使用元件的设备成为一种趋势。可重复使用元件的灵活性有利于制药公司利用这些平台,在不同的药物组合之间实现相对快速的转换。然而,这也可能导致为满足广泛需求而设计的设备,在实际的有限最终用途上设计过度。与开发具有特定用途的单次使用设备相比,制造成本和可持续性都最优化的平台设备要困难得多。本文探讨了市场上的一系列可重复使用产品,研究了这些设备在成本和可持续发展方面的一些优势,以及与当前一次性设备相比存在的权衡问题。
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引用次数: 0
Evaluating Unmet Needs in Large-Volume Subcutaneous Drug Delivery: US Payer Perspectives on a Novel, Large-Volume On-Body Delivery System. 评估大容量皮下给药系统中未满足的需求:美国付款人对新型大容量体外给药系统的看法。
Q3 Medicine Pub Date : 2024-08-23 DOI: 10.5731/pdajpst.2024.012980
Mehul Desai, James Kenney, Edmund Pezalla

This research sought to evaluate payer perspectives around OBDS's through semi-structured interviews with 17 US payers representing approximately 227 million covered lives. When asked about the perceived advantages of the novel on-body delivery system (OBDS), 70.6% of payers independently cited simplicity, ease-of-use, and convenience as the most beneficial features, with the potential to replace IV infusion by facilitating at-home HCP- or self-administration being the second most frequent response. Most payers (88.2%) believed that the novel OBDS could fulfill unmet needs such as cost of IV infusion, convenient administration, and improved patient compliance in large-volume SC delivery by enabling safe, easy, self-administration. Nearly all payers (88.2%) stated they would consider covering and managing pharmaceutical products packaged with the novel OBDS, with the remaining payers considering the total cost compared to other routes. A significant proportion of payers (82.4%) acknowledged that a drug delivered via the novel OBDS could warrant a price premium above the cost of the standalone SC drug vial, with half stating the premium would range from 5% to 20% and the other half citing an unspecified premium dependent on the individual drug situation.Conclusions: Given the ability to help address critical unmet needs for the patient and healthcare system, a large proportion of the payers stated that the novel OBDS would fulfill unmet needs and warrant a price premium versus the cost of the standalone SC vial and certainly over the IV counterpart. Future research to quantify the value that OBDS efficiencies could bring to healthcare delivery is warranted.

这项研究试图通过半结构式访谈,评估支付方对 OBDS 的看法,访谈对象为 17 家美国支付方,代表了约 2.27 亿被保险人。当被问及新型体外给药系统 (OBDS) 的优势时,70.6% 的付款人都认为简单、易用和方便是其最有利的特点,其次是通过促进在家由医护人员给药或自行给药来取代静脉输液的潜力。大多数付款人(88.2%)认为,新型 OBDS 可以满足尚未满足的需求,如静脉输液的成本、方便给药以及通过实现安全、简便的自我给药提高患者对大量 SC 给药的依从性。几乎所有付款人(88.2%)都表示,他们会考虑支付和管理使用新型 OBDS 包装的药品,其余付款人则会考虑与其他途径相比的总成本。相当大比例的付款人(82.4%)承认,通过新型 OBDS 给药的药物可能需要比独立 SC 瓶装药物的成本溢价,其中一半付款人表示溢价将在 5% 到 20% 之间,另一半付款人表示溢价不明确,取决于个别药物的情况:鉴于新型 OBDS 能够帮助满足患者和医疗保健系统尚未得到满足的关键需求,很大一部分付款人表示,新型 OBDS 将满足尚未得到满足的需求,与独立 SC 瓶的成本相比,肯定比静脉注射药物的成本要高。未来有必要开展研究,量化 OBDS 效率可为医疗服务带来的价值。
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引用次数: 0
Using Digital Instructions to Address on-Market Product Complaints and Improve User Experiences. 利用数字指令解决市场上的产品投诉并改善用户体验。
Q3 Medicine Pub Date : 2024-08-23 DOI: 10.5731/pdajpst.2024.012979
Thomas Grant

Manufacturers of medical devices are legally required to carry out post-market surveillance and respond to any on-market complaints they receive about their device. When it comes to addressing use issues experienced on market, manufacturers often focus on revising the instructions for use (IFU) and labeling. One of the challenges with this approach is the potential need to re-validate via a human factors validation study, without knowing whether the changes made will be effective in addressing the identified issues. With populations becoming increasingly technically literate, there is now great potential to rethink the way we can support self-injection through digital and web-based tools. This paper introduces the potential of digital instructions to improve the user experience of self-injection and address known use issues, as well as the challenges of incorporating them in medical device design.

法律规定,医疗器械制造商必须进行上市后监督,并对收到的任何有关其器械的上市投诉做出回应。在解决市场上出现的使用问题时,制造商通常侧重于修订使用说明 (IFU) 和标签。这种方法面临的挑战之一是可能需要通过人为因素验证研究进行重新验证,而不知道所做的更改是否能有效解决已发现的问题。随着人们对技术的了解越来越多,我们现在有很大的潜力重新思考如何通过数字和网络工具来支持自我注射。本文介绍了数字说明在改善用户自我注射体验和解决已知使用问题方面的潜力,以及将其纳入医疗设备设计所面临的挑战。
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引用次数: 0
Nonlinear Tissue Permeability Drives Tissue Pressure and Injection Distribution: A Computational Investigation of Subcutaneous Injections. 非线性组织渗透性驱动组织压力和注射分布:皮下注射的计算研究。
Q3 Medicine Pub Date : 2024-08-23 DOI: 10.5731/pdajpst.2024.012969
Scott Lovald, Shashank Agarwal, Anuradha Radhakrishnan, Vincent Casey, Andrew Rau

There is a significant opportunity to expand the understanding of subcutaneous injection mechanics with an aim to increase injectable volume while controlling tissue strain and associated subject pain. Computational modeling can evaluate the mechanics of subcutaneous injections as a supplement to experimental, animal and clinical studies. The objectives of this study are to (1) develop a computational model for subcutaneous injection in tissue, (2) investigate the influence anisotropic tissue permeability has on bolus formation, and (3) explore the effects that injection flow rate and viscosity have on injection flow and tissue strain. Poroelastic models with subsurface flow were implemented in finite element software (COMSOL, ABAQUS). Pore pressure and injectate distribution showed excellent agreement with experimental results when evaluated at multiple injection rates (20 ml/hr, 120 ml/hr and 360 ml/hr). Including the anisotropy of tissue permeability causes the injectate to preferentially spread horizontally, similar to experimentally observed bolus distributions. Cases are presented to provide additional insight into injection mechanics, including variations on the delivery rate, the injection volume, viscosity and the thickness of the subcutaneous layer. The results support the use of computational modeling as a valid tool for understanding tissue strains and injectate distributions for large volume injections.

我们有很大的机会扩大对皮下注射力学的了解,以增加注射量,同时控制组织应变和相关的受试者疼痛。计算模型可以评估皮下注射的力学,作为实验、动物和临床研究的补充。本研究的目标是:(1) 建立组织中皮下注射的计算模型;(2) 研究各向异性组织渗透性对栓剂形成的影响;(3) 探讨注射流速和粘度对注射流动和组织应变的影响。在有限元软件(COMSOL、ABAQUS)中实现了具有地下流动性的透射弹性模型。在多种注入速度(20 毫升/小时、120 毫升/小时和 360 毫升/小时)下进行评估时,孔隙压力和注入物分布与实验结果非常吻合。将组织渗透性的各向异性考虑在内会导致注入物优先水平扩散,这与实验观察到的栓剂分布类似。研究还提出了一些案例,包括注射速度、注射量、粘度和皮下层厚度的变化,以提供对注射力学的更多了解。结果支持将计算建模作为了解大容量注射的组织应变和注射剂分布的有效工具。
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引用次数: 0
Best Practices for Microbial Challenge In-Use Studies to Evaluate the Microbial Growth Potential of Parenteral Biological Products; Industry and Regulatory Considerations. 评估肠外生物制品微生物生长潜力的微生物挑战在用研究的最佳实践;行业和监管注意事项。
Q3 Medicine Pub Date : 2024-08-23 DOI: 10.5731/pdajpst.2022.012806
Camellia Zamiri, Danielle L Leiske, Patricia Hughes, J Paul Kirwan, Evelyn Der, Emily Cox, Rob Warburton, Monica Goss, Sarah Weiser, Janet Perez-Brown, Ganapathy Gopalrathnam, Jing Liu, Shyam B Mehta, Shebeer Shereefa, Sebastian Specht, Sandra J Aedo, Pierre Goldbach, Feng Jia, Barbara Kuehnle, Scott Page, Liesbeth Voeten, Li Yi, Chen Zhu

Microbial challenge in-use studies are performed to evaluate the potential for microbial proliferation in preservative-free single-dose biological products after first puncture and potential accidental contamination during dose preparation (e.g., reconstitution or dilution) and storage. These studies, in addition to physicochemical in-use stability assessments, are used as part of product registration to define in-use hold times in Prescribing Information and in the pharmacy manual in the case of clinical products. There are no formal guidance documents describing regulator expectations on how to conduct microbial challenge in-use studies and interpret microbial data to assign in-use storage hold times. In lieu of guidance, US Food and Drug Administration (FDA) regulators have authored publications and presentations describing regulator expectations. Insufficient or unavailable microbial challenge data can result in shortened in-use hold times, thus microbial challenge data enables flexibility for health care providers (HCPs) and patients while ensuring patient safety. A cross-industry/FDA in-use microbial working group was formed through the Innovation & Quality (IQ) Consortium to gain alignment among industry practice and regulator expectations. The working group assessed regulatory guidance, current industry practice via a blinded survey of IQ Consortium member companies, and scientific rationale to align on recommendations for experimental design, execution of microbial challenge in-use studies, and a decision tree for microbial data interpretation to assign in-use hold times. Besides the study execution and data interpretation, additional considerations are discussed including the use of platform data for clinical stage products, closed system transfer devices (CSTDs), transport of dose solutions, long infusion times, and the use of USP <797> by HCPs for preparing sterile drugs for administration. The recommendations provided in this article will help streamline biological product development, ensure consistency on assignment of in-use hold times in biological product labels across industry, and provide maximum allowable flexibility to HCPs and patients while ensuring patient safety.

进行使用中的微生物挑战研究,以评估首次穿刺后无防腐剂单剂量生物制品中微生物增殖的潜力,以及剂量制备(如重建、稀释)和储存过程中的潜在意外污染。除了物理化学使用稳定性评估外,这些研究还被用作产品注册的一部分,以在处方信息和临床产品的药房手册中定义使用中的保留时间。没有正式的指导文件描述监管机构对如何进行使用中的微生物挑战研究和解释微生物数据以分配使用中的储存保持时间的期望。美国食品药品监督管理局(FDA)监管机构编写了描述监管机构期望的出版物和演示文稿,以代替指导。微生物挑战数据不足或不可用可能导致使用暂停时间缩短,因此微生物挑战数据为医疗保健提供者(HCP)和患者提供了灵活性,同时确保了患者的安全。通过创新与质量联盟成立了一个跨行业/美国食品药品监督管理局在用微生物工作组,以使行业实践和监管机构的期望保持一致。工作组通过对IQ Consortium成员公司的盲法调查,评估了监管指南、当前行业实践,以及与实验设计建议、使用中微生物挑战研究的执行以及微生物数据解释决策树相一致的科学依据,以分配使用中暂停时间。除了研究执行和数据解释外,还讨论了其他考虑因素,包括临床阶段产品平台数据的使用、封闭系统转移装置(CSTD)、剂量溶液的输送、长输注时间,以及HCP使用USP制备给药无菌药物。这份手稿中提供的建议将有助于简化生物产品开发,确保整个行业生物产品标签在用保留时间分配的一致性,并为HCP和患者提供最大限度的灵活性,同时确保患者安全。
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引用次数: 0
Worldwide Regulatory Reliance: Launching a Pilot on a Chemistry, Manufacturing, and Control Post Approval Change for a Vaccine. 全球监管依赖:启动A疫苗化学、制造和控制审批变更试点。
Q3 Medicine Pub Date : 2024-08-23 DOI: 10.5731/pdajpst.2023.012850
Thierry Gastineau, Cynthia Ban, Ana Basso, Franziska Brehme, Ana Luisa Silva, Olivier Faure, Lyne Le Palaire, Priya Persaud, Heraclio Rodriguez

When an initial marketing authorization of a pharmaceutical product is granted, a substantial number of chemistry, manufacturing, and control (CMC) post approval changes (PACs) have to be managed by the manufacturers. Despite efforts undertaken over the years by multiple regulatory jurisdictions, there is still heterogeneity in terms of regulatory requirements and timelines across national regulatory authorities (NRAs). This creates complexity in managing global CMC PACs, putting the supply of medical products at risk. Regulators have developed regulatory mechanisms that aim at accelerating the reviews and approvals of PACs by NRAs. The World Health Organization (WHO) is supporting the concept of "reliance" among NRAs, which are encouraged to rely on the assessment completed by a "highly performing authority". The objective is to accelerate the overall process for PACs, ultimately fostering more equitable and timely access to medical products for populations who need them. With the support of Health Canada, WHO, Pan American Health Organization, and the Paul-Ehrlich-Institut, Sanofi has launched a pilot using the principles of reliance for a CMC PAC for a vaccine, with 21 NRAs who accepted to participate in the pilot. The objective of this pilot was to apply these principles to reduce the approval timeline to a maximum of 6 months in all countries after an initial approval is granted by a reference authority. We discuss the opportunities and challenges of implementing reliance principles for CMC PACs. We also describe the pilot experience by sharing initial lessons learned from the Step 1 of this pilot, which consisted of engaging the reference authority and the NRAs.

当药品的初始上市许可被授予时,制造商必须管理大量的化学、制造和控制(CMC)批准后变更(pac)。尽管多个监管管辖区多年来做出了努力,但各国监管机构(nra)在监管要求和时间表方面仍然存在差异。这增加了管理全球CMC pac的复杂性,使医疗产品的供应面临风险。监管机构已经制定了监管机制,旨在加快国家监管机构对pac的审查和批准。世界卫生组织(世卫组织)正在支持国家评估机构之间的"依赖"概念,鼓励它们依赖一个″高绩效机构″完成的评估。其目标是加快药品供应计划的总体进程,最终促进有需要的人群更公平和及时地获得医疗产品。在加拿大卫生部、世卫组织、泛美卫生组织和保罗-埃利希研究所的支持下,赛诺菲启动了一个试点项目,利用CMC疫苗评估委员会的依赖原则,有21个国家认可机构接受参与该试点项目。该试点的目标是应用这些原则,在参考当局给予初步批准后,在所有国家将批准时间缩短到最多6个月。我们讨论了CMC pac实施依赖原则的机遇和挑战。我们还描述了试点经验,通过分享从该试点的第1步获得的初步经验教训,其中包括与参考权威机构和nra的接触。
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引用次数: 0
Sensitization Assessment of Extractables and Leachables in Pharmaceuticals: ELSIE Database Analysis. 药品中萃取物和浸出物的致敏评估:ELSIE 数据库分析。
Q3 Medicine Pub Date : 2024-08-23 DOI: 10.5731/pdajpst.2022.012811
Patricia Parris, Geraldine Whelan, Anders Burild, Jessica Whritenour, Uma Bruen, Joel Bercu, Courtney Callis, Martyn L Chilton, Jessica Graham, Esther Johann, Candice Johnson, Troy Griffin, Martin Kohan, Elizabeth A Martin, Melisa Masuda-Herrera, Brad Stanard, Maureen T Cruz, Lee Nagao

Quality by design is the foundation of the risk management framework for extractables and leachables (E&Ls) recommended by the Extractables and Leachables Safety Information Exchange (ELSIE). Following these principles during the selection of materials for pharmaceutical product development minimizes the presence of highly toxic substances and decreases the health risk of potential leachables in the drug product. Therefore, in the context of the broad arena of chemicals, it is important to distinguish E&Ls as a subset of chemicals and evaluate this relevant chemical space to derive appropriate analytical and safety thresholds. When considering the health hazards posed by E&Ls, one area presenting a challenge is understanding the sensitization potential and whether it poses a risk to patients. A dataset of E&Ls compiled by ELSIE (n = 466) was analyzed to determine the prevalence and potency of skin sensitizers in this chemical subset and explore a scientifically justified approach to the sensitization assessment of potential leachables in parenteral drug products. Approximately half of the compounds (56%, 259/466) had sensitization data recorded in the ELSIE database and of these, 20% (52/259) are potential skin sensitizers. Only 3% (8/259) of the E&L dataset with sensitization data were considered potent (strong or extreme) sensitizers following in silico analysis and expert review, illustrating that potent sensitizers are not routinely observed as leachables in pharmaceutical products. Our analysis highlights that in silico potency prediction and expert review are key tools during the sensitization assessment process for E&Ls. The results confirm where material selection is anticipated to mitigate the risk of presence of strong and/or extreme sensitizers (e.g., extractable testing via ISO 10993-10), and that implementing thresholds per ICH M7 and/or Masuda-Herrera et al. provides a reasonably conservative approach for establishing the analytical testing and safety thresholds.

质量源于设计是萃取物和浸出物安全信息交换所(ELSIE)推荐的萃取物和浸出物(E&Ls)风险管理框架的基础。在医药产品开发的材料选择过程中,遵循这些原则可以最大限度地减少药物产品中高毒性物质的存在,并降低潜在浸出物对健康造成的风险。因此,在广泛的化学品领域中,必须将 E&L 区分为化学品的一个子集,并对这一相关化学空间进行评估,以得出适当的分析和安全阈值。在考虑 E&Ls 对健康的危害时,一个具有挑战性的领域是了解其致敏性以及是否会对患者构成风险。我们对 ELSIE 编制的 E&L 数据集(n = 466)进行了分析,以确定该化学子集中皮肤致敏物质的普遍性和有效性,并探索一种科学合理的方法来评估肠外药物产品中潜在浸出物的致敏性。约有一半的化合物(56%,259/466)在 ELSIE 数据库中记录了致敏数据,其中 20%(52/259)是潜在的皮肤致敏物质。在具有敏化数据的 E&L 数据集中,只有 3%(8/259)的化合物在经过硅学分析和专家审查后被认为是强效(强或极强)敏化剂,这说明强效敏化剂在医药产品中并不是作为可浸出物被常规观察到的。我们的分析突出表明,在 E&L 的敏化评估过程中,硅学效价预测和专家审查是关键工具。结果证实,在材料选择方面,预计可以降低强致敏剂和/或极端致敏剂存在的风险(例如,通过 ISO 10993-10 进行可萃取测试),而按照 ICH M7 和/或 Masuda-Herrera 等人的方法实施阈值,则为建立分析测试和安全阈值提供了合理的保守方法。
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引用次数: 0
Prefilled Ophthalmic syringes - New Possibilities in Terminal Sterilization. 预灌封眼科注射器--终端灭菌的新可能性。
Q3 Medicine Pub Date : 2024-08-23 DOI: 10.5731/pdajpst.2024.012968
Bernd Zeiss, Eric Offermann, Annick Gillet, Erik Haghedooren, Markus Bischof

In a joint study carried out by Gerresheimer, Sterigenics and Früh, it could be shown that also NO2 is well suited to terminally sterilize prefilled ophthalmic syringes. In detail 5 topics were addressed: (1) Compare EtO vs. NO2 penetration into the filled syringe; (2) Analyze gas ingress though 4 different plunger stoppers including silicone oil free and standard rubber plungers; (3) Scrutinize gas ingress through 2 different cap designs based on different elastomer properties; (4) Investigate gas permeation through COP plastic barrels compared to glass; (5) Check if the Tyvek®-layer has an influence on either sterilization.Depending on the needs a suitable sterilization method, packaging and syringe type can be suggested to customers.

Gerresheimer 公司、Sterigenics 公司和 Früh 公司联合进行的一项研究表明,二氧化氮也非常适合对预灌封眼科注射器进行最终灭菌。详细讨论了 5 个主题:(1)比较环氧乙烷与二氧化氮对填充注射器的渗透;(2)分析 4 种不同柱塞塞(包括无硅油和标准橡胶柱塞)的气体进入情况;(3)根据不同的弹性体特性,检查 2 种不同盖帽设计的气体进入情况;(4)调查 COP 塑料桶与玻璃桶的气体渗透情况;(5)检查特卫强® 层是否对灭菌有影响。根据需要,可向客户推荐合适的灭菌方法、包装和注射器类型。
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引用次数: 0
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