bluuebunny/crossref_metadata_2025 huggingface dataset:
Conformational Flexibility in DNA Duplexes Containing Single G · G Mismatches
Authors: Lane Andrew N. , Peck Brian
Published: July 2010

Purine‐purine mismatches can base‐pair in a variety of configurations depending on solution conditions. The G • G mismatch, which also occurs in the G‐quartet structure, has been showm by both x‐ray crystallography and NMR to adopt G(anti) · G(syn) mispairs, with very different hydrogen bonding patterns [Skelly, J., Edwards, K., Jenkins, T. C. & Neidle, S. (1993) Proc. Natl Acad. Sci. USA 90, 804–808; Cognet, J. A. H., Gabarro‐Arpa, J., Le Bret, M., van der Marel, G. A. van Boom, J. H. & Fazakerley, G. V. (1991) Nucleic Acids. Res. 19, 6771–6779] while we have recently suggested the presence of weakly hydrogen‐bonded G(anti) · G(anti) pairs in solution [Borden, K. L. B., Jenkins, T. C., Skelly, J. V., Brown, T. & Lane, A. N. (1992) Biochemistry 31, 5411–5422]. Spectral overlap and additional exchange processes have made detailed structural analysis difficult in these mismatched oligomers. We have used NMR to characterise the conformations of four duplexes containing single G • G mismatches, including a nonamer d(CATCGGATG), two undecamers d(GCATTGAATGC) and d(CATGTGACGTG) that can each form a self‐complementary duplex with a single G · G mispair in the centre, and the non‐self‐complementary d(GTAACGACATG) · d(CATGTGGTTAC).

The three self‐complementary duplexes have a single set of NMR resonances, and all four duplexes show evidence of conformational exchange at the mismatch site. The N1H resonances of the mismatched G residues each integrate to two protons, ruling out the enol tautomer. They resonate between 10.5–10.7 ppm, far upfield of the Watson‐Crick hydrogen‐bonded GN1H and exchange readily with water protons.

Intraresidue GH8‐H1′ NOE intensities are two–threefold larger for the mismatched G residues than in G · C base pairs, indicating the presence of syn conformations. NOE time courses for the self‐complementary duplexes were consistent with an equimolar mixture of G(syn) · G(anti) and G (anti) · G(syn) states. By symmetry, these states must be interconverting at a rate that is fast on the chemical shift timescale. In the non‐self‐complementary undecamer, the NOE data indicated that the distinguishable mismatched G residues also spend a significant, but different, fraction of the time in both the syn and anti conformations.

The rate constant for the syn/anti transition in the non‐self‐complementary undecamer was determined as ≈ 14000 s−1 at 303 K from rotating frame T1 measurements, and the apparent frequency difference was > 250 Hz.

Calculations based on NOEs and coupling constants showed that the duplexes are overall in the B form. Improved agreement with the NOE data for the mismatched residues could be obtained by constructing linear averages of conformations for the mismatched bases.
Bone morphogenetic protein signaling in limb outgrowth and patterning
Authors: Robert Benoît
Published: July 2010

Bone morphogenetic proteins (BMPs) are multifunctional growth factors belonging to the transforming growth factor beta (TGFβ) multigene family. Current evidence indicates that they may play different and even antagonistic roles at different stages of limb development. Refined studies of their function in these processes have been impeded in the mouse due to the early lethality of null mutants for several BMP ligands and their receptors. Recently, however, these questions have benefited from the very powerful Cre‐loxP technology. In this review, I intend to summarize what has been learned from this conditional mutagenesis approach in the mouse limb, focusing on Bmp2, Bmp4 and Bmp7 while restricting my analysis to the initial phases of limb formation and patterning. Two major aspects are discussed, the role of BMPs in dorsal‐ventral polarization of the limb bud, together with their relation to apical ectodermal ridge (AER) induction, and their role in controlling digit number and identity. Particular attention is paid to the methodology, its power and its limits.
Hepatitis B and C virus infections and anti‐tumor necrosis factor‐α therapy: Guidelines for clinical approach
Authors: Nathan Debbie M , Angus Peter W , Gibson Peter R
Published: July 2010

Anti‐tumor necrosis factor‐α (TNF) therapy has recently been recognized to be associated with activation of hepatitis B virus (HBV) infection, with a potentially fatal outcome, mirroring experience in the setting of immune suppression and subsequent reconstitution in cancer chemotherapy and transplantation. Although there is no current evidence that anti‐TNF therapy influences the natural history of hepatitis C virus (HCV) infection, the involvement of TNF in the pathogenesis of hepatic injury and extrapolation from other clinical situations heighten awareness of a potential conflict. Preventive strategies should be mandatory. These include screening of all patients for HBV and HCV infection prior to commencement of anti‐TNF therapy, and active monitoring of aminotransferases and, for HBV, viral load during and for 3 months after therapy has terminated. Prophylactic or early intervention strategies with nucleoside analogs are recommended for patients with evidence of HBV infection.
Optimal management of hepatocellular carcinoma: Challenges and opportunities
Authors: Lin Chih‐Lin , Kao Jia‐Horng
Published: July 2010

See article in J. Gastroenterol. Hepatol. 2010; 25: 1426–1434.
Endoscopic management of intraabdominal and pelvic collections
Authors: Ang Tiing Leong , Fock Kwong Ming
Published: July 2010

See article in J. Gastroenterol. Hepatol. 2010; 25: 1416–1419.
Fiber, FODMAPs, flora, flatulence, and the functional bowel disorders
Authors: Gwee Kok‐Ann
Published: July 2010

See article in J. Gastroenterol. Hepatol. 2010; 25: 1366–1373.
LEARNING CURVE FOR ENDOSCOPIC SUBMUCOSAL DISSECTION OF LARGE COLORECTAL TUMORS
Authors: Hotta Kinichi , Oyama Tsuneo , Shinohara Tomoaki , Miyata Yoshinori , Takahashi Akiko , Kitamura Yoko , Tomori Akihisa
Published: July 2010

Background and Aim:  No studies have previously described the learning curve for colonic endoscopic submucosal dissection (ESD). The aim of the present study was to describe the learning curve for ESD of large colorectal tumors based on a single colonoscopist's experience.

Methods:  ESD was carried out for 120 colorectal tumors in 115 patients (68 males, median age 70 years). All procedures were carried out by a single experienced colonoscopist. The cases were grouped chronologically into three periods: (1st): cases 1–40; (2nd): cases 41–80; and (3rd): cases 81–120.

Results:  The learning curve was the changes in proficiency over time. Proficiency was expressed as procedure time per unit area of specimen. In the 1st, 2nd and 3rd periods, the proficiencies were 18.9, 12.6 and 12.9 (min/cm2), respectively. The proficiencies in the 2nd and 3rd periods were significantly shorter than in the 1st period (t‐test, P < 0.05). The en‐bloc resection rates of the 1st, 2nd and 3rd periods were 92.5% (37/40), 90% (36/40) and 97.5% (39/40), respectively. The en‐bloc and R0 resection rates of the 1st, 2nd and 3rd periods were 85% (34/40), 77.5% (31/40) and 92.5% (37/40), respectively. The perforation rates of the 1st, 2nd and 3rd periods were 12.5% (5/40), 5% (2/40) and 5% (2/40), respectively.

Conclusion:  Based on our analysis of the learning curve, approximately 80 procedures must be carried out to acquire skill with ESD for large colorectal tumors. However, approximately 40 procedures were sufficient to acquire skill in avoiding perforations during the ESD procedure.
DIAGNOSIS AND CLINICAL COURSE OF ULCERATIVE GASTRODUODENAL LESION ASSOCIATED WITH ULCERATIVE COLITIS: POSSIBLE RELATIONSHIP WITH POUCHITIS
Authors: Hisabe Takashi , Matsui Toshiyuki , Miyaoka Masaki , Ninomiya Kazeo , Ishihara Hiroshi , Nagahama Takashi , Takaki Yasuhiro , Hirai Fumihito , Ikeda Keisuke , Iwashita Akinori , Higashi Daijiro , Futami Kitaro
Published: July 2010

Background and Aim:  Ulcerative colitis (UC) is not only characterized by pathological lesions localized to colonic mucosa, but also to various complications involving other organs, including postoperative pouchitis. Among these complications, diffuse gastroduodenitis with lesions resembling colonic lesions has been reported, albeit rarely. The aim of the present study was to attempt to characterize the lesions of the upper gastrointestinal tract occurring as a complication of UC, and to assess the frequency and clinical course of these lesions.

Methods:  A total of 322 UC patients who had undergone upper gastrointestinal endoscopy were retrospectively analyzed. We assessed the frequency of endoscopic findings, including diffuse gastroduodenal lesions resembling colonic lesions. Ulcerative gastroduodenal lesion (UGDL) associated with UC was diagnosed if lesions satisfied the following criteria: (i) improvement of the lesions with treatment of UC; and/or (ii) resemblance to UC in pathological findings.

Results:  UGDL satisfying the aforementioned criteria was found in 15 (4.7%) of 322 patients. All the 15 patients had UGDL accompanied by pancolitis or after proctocolectomy. Frequency in 146 patients with pancolitis was 6.2% (nine patients) and that in 81 patients who had undergone proctocolectomy was 7.4% (six patients). Four patients with diffuse ulcerative upper‐gastrointestinal mucosal inflammation (DUMI) had pouchitis. In all patients except one, the lesions resolved easily with medical treatment.

Conclusions:  In more than half of the post‐proctocolectomy patients, UGDL was related to the occurrence of pouchitis. The existence of characteristic UGDL must be taken into account in the diagnosis and treatment of UC, and UGDL is possibly related to the occurrence of pouchitis.
Does a vitrified blastocyst stage embryo transfer program need hormonal priming for endometrial preparation?
Authors: Kim Yong Jin , Choi Young Sik , Lee Won Don , Kim Ki Chul , Jee Byung Chul , Suh Chang Suk , Kim Seok Hyun , Moon Shin Yong
Published: July 2010

Aim:  To compare the clinical outcomes of a vitrified blastocyst stage embryo transfer (ET) program among natural, ovulation induced and artificial cycles.

Material & Methods:  The clinical outcomes were retrospectively analyzed in three groups according to endometrial preparation (natural cycle group [n = 34], ovulation induced [n = 21], and artificial cycles [n = 70]) among women that underwent vitrified blastocyst stage ET.

Results:  The overall pregnancy rate was 48.8%. There were no significant differences in the duration of endometrial preparation, endometrial thickness on the day of progesterone or human chorionic gonadotropin administration, implantation and clinical pregnancy rates among the three groups. Triple‐line endometrial patterns were more frequently observed in the natural and ovulation induced groups than in the artificial cycle group (85.3% vs 64.3%, P = 0.021; 90.5% vs 64.3%, P = 0.016).

Conclusion:  Our findings suggest that the types of endometrial preparation may have no significant effect on the clinical outcomes of vitrified blastocyst ET. Hormonal priming does not appear to be a prerequisite for endometrial preparation for vitrified blastocyst ET.
Case of polyhydramnios complicated by Opitz G/BBB syndrome
Authors: Tajima Hiroko , Itoh Hiroaki , Mochizuki Ayako , Nakamura Yuki , Kobayashi Yukiko , Hirai Kyuya , Suzuki Kazunao , Sugihara Kazuhiro , Ohishi Akira , Ohzeki Takehiko , Kanayama Naohiro
Published: July 2010

Opitz G/BBB syndrome is a congenital disorder characterized by midline defects, such as hypertelorism, cleft lip and/or palate, hypospadias, and by dysphagia often caused by laryngo‐tracheo‐esophageal abnormalities. We experienced a case of polyhydramnios in a male dichorionic diamniotic (DD) twin, who was diagnosed with Opitz G/BBB syndrome after birth. It is suggested that severe dysphagia was causatively associated with the development of polyhydramnios. In cases of Opitz G/BBB syndrome, boys are usually more heavily affected than girls, who generally manifest only hypertelorism. In the differential diagnosis of polyhydramnios of unidentified cause in male fetuses, it may be helpful to consider maternal facial characteristics, especially hypertelorism.
Baseline serum 25‐hydroxyvitamin D concentrations in the Tromsø Study 1994–95 and risk of developing type 2 diabetes mellitus during 11 years of follow‐up
Authors: Grimnes G. , Emaus N. , Joakimsen R. M. , Figenschau Y. , Jenssen T. , Njølstad I. , Schirmer H. , Jorde R.
Published: July 2010

Diabet. Med. 27, 1107–1115 (2010)

Aims  We wanted to test the hypothesis that low serum 25‐hydroxyvitamin D (25(OH)D) concentrations are associated with increased risk of developing Type 2 diabetes mellitus (DM) in a population‐based cohort during 11 years of follow‐up.

Methods  The analyses included 4157 non‐smokers and 1962 smokers from the Tromsø Study 1994–95 without diabetes at baseline. Subsequent Type 2 DM was defined using a hospital journal‐based end‐point registry, completed through the year 2005. Participants were allocated into quartiles of serum 25(OH)D within each month to account for seasonal variation, and serum 25(OH)D values both as a continuous variable and in quartiles were used in Cox regression models. The analyses were stratified by smoking. Adjustments were made for age, sex, body mass index (BMI), physical activity and, in non‐smokers, former smoking.

Results  Type 2 DM was registered in 183 non‐smoking and 64 smoking participants. Using the fourth (highest) quartile of serum 25(OH)D as the reference, non‐smoking participants in the third, second and first quartiles had age‐ and sex‐adjusted hazard ratios (95% confidence intervals) of incident Type 2 DM of 1.00 (0.62–1.61), 1.50 (0.97–2.31) and 1.89 (1.25–2.88), respectively, whereas the corresponding values for smokers were 1.79 (0.77–4.19), 2.33 (1.02–5.35) and 2.68 (1.18–6.08). Adjustment for BMI attenuated the hazard ratios, and they were no longer significant.

Conclusions  Baseline serum 25(OH)D was inversely associated with subsequent Type 2 DM in a population‐based 11 year follow‐up study, but not after adjustment for BMI. Randomized trials are needed to define the possible role of serum 25(OH)D status, and thereby the role of supplementation, in the prevention of Type 2 DM.
Metformin action on AMP‐activated protein kinase: a translational research approach to understanding a potential new therapeutic target
Authors: Boyle J. G. , Salt I. P. , McKay G. A.
Published: July 2010

Diabet. Med. 27, 1097–1106 (2010)

Clinical studies in Type 2 diabetes mellitus have shown that the effects of metformin go beyond improving HbA1c and include reductions in cardiovascular endpoints. Metformin therapy has been widely used in the treatment of Type 2 diabetes for many years, yet the precise mode of action remains uncertain. It has recently been proposed that metformin‐mediated stimulation of hepatic AMP‐activated protein kinase (AMPK) underlies the hypoglycaemic effects of metformin. AMPK is a heterotrimeric enzyme that is expressed in many tissues and plays a central role in the regulation of energy homoeostasis. Furthermore, there is increasing evidence that AMPK is implicated in the pathophysiology of cardiovascular and metabolic diseases. The generation of more specific and potent activators of AMPK, however, could have additional metabolic and vascular benefits for patients with Type 2 diabetes.
Red meat and colorectal cancer: a critical summary of prospective epidemiologic studies
Authors: Alexander D. D. , Cushing C. A.
Published: July 2010

Meat consumption and cancer has been evaluated in hundreds of epidemiologic studies over the past three decades; however, the possible role of this food group on carcinogenesis is equivocal. In this comprehensive review, the currently available epidemiologic prospective studies of red meat intake and colorectal cancer are summarized to provide a greater understanding of any potential relationships. Specifically, salient demographic, methodological and analytical information is synthesized across 35 prospective studies. Collectively, associations between red meat consumption and colorectal cancer are generally weak in magnitude, with most relative risks below 1.50 and not statistically significant, and there is a lack of a clear dose–response trend. Results are variable by anatomic tumour site (colon vs. rectum) and by gender, as the epidemiologic data are not indicative of a positive association among women while most associations are weakly elevated among men. Colinearity between red meat intake and other dietary factors (e.g. Western lifestyle, high intake of refined sugars and alcohol, low intake of fruits, vegetables and fibre) and behavioural factors (e.g. low physical activity, high smoking prevalence, high body mass index) limit the ability to analytically isolate the independent effects of red meat consumption. Because of these factors, the currently available epidemiologic evidence is not sufficient to support an independent positive association between red meat consumption and colorectal cancer.
‘Only children’ and their coalition of parents: Considering grandparents and parents as joint caregivers in urban Xiamen, China
Authors: Goh Esther C. L. , Kuczynski Leon
Published: July 2010

This article presents the important, but overlooked, role that is played by grandparents in contemporary China as joint caregivers with parents in raising only children. Grounded on empirical data, collected through ethnographic and survey methods in urban China, the article identifies the ‘intergenerational parenting coalition’ as a culturally appropriate unit of analysis for understanding child rearing within the multigenerational family in China. The social forces that have given rise to the contemporary multigenerational family in China are reviewed. Qualitative analyses of four such families are used to illustrate the unique family dynamics and patterns of influence particular to the intergenerational parenting coalition.
SHOULD WE DE‐MORALIZE ETHICAL THEORY?
Authors: McElwee Brian
Published: July 2010

Some philosophers, such as Roger Crisp and Alastair Norcross, have recently argued that the traditional moral categories of wrongness, permissibility and obligation should be avoided when doing ethical theory. I argue that even if morality does not itself provide reasons for action, the moral categories nevertheless have a central role to play in ethical theory: they allow us to make crucial judgements about how to feel about, and react to, agents who behave in anti‐social ways, and they help motivate us to act altruistically.
SIMULTANEITY IN DISPOSITIONAL INTERACTION?
Authors: Tugby Matthew
Published: July 2010

My aim is to question an assumption that is often made in the philosophical literature on dispositions. This is the assumption that, generally, the stimulation (or ‘triggering’) of a disposition temporally precedes the manifesting of that disposition. I will begin by examining precisely what the trigging of a disposition may be thought to consist in, and will identify two plausible views. I will then argue that on either of these views about triggering, a case can be made against the view that the triggering of a disposition always occurs before the manifesting of that disposition. More precisely, if the first view about triggering is accepted, and certain plausible assumptions about dispositions are put into place, a metaphysical argument can be formulated for the claim that the stimulation of a disposition never occurs before that disposition manifests. If the second view about triggering is accepted, the question concerning simultaneity becomes an empirical one. There are, however, examples of dispositional interaction which, on the second view about triggering, clearly seem to involve simultaneity.1
Current Status of Artificial Organs in Japan
Authors: Inou T.
Published: July 2010

The Current Status of Artificial Organs in Japan and several artificial organs (artificial kidney, extracorporeal circulation, artificial heart, biomaterials, artificial liver and artificial pancreas) which are presented at the 2nd International Symposium for Artificial Organs is presented briefly.
The Characteristics of a New Glucose Sensor for Use in an Artificial Pancreatic Beta Cell
Authors: Clarke W. L. , Santiago J. V.
Published: July 2010

A new glucose sensor has been developed for the continuous extracorporeal monitoring of blood glucose concentrations in conjunction with an artificial pancreatic beta cell simulator. This sensor has a rapid ninety percent response time (<1 min), is stable for periods of up to 140 hours of accumulated use and can be calibrated without the use of a reference glucose analyzer. Its reliability has been confirmed in over 100 clinical studies. A comparison of this sensor to other glucose sensors designed for artificial pancreatic beta cell devices is made and the sensor is shown to be the most advanced glucose sensor presently available for extracorporeal continuous glucose monitoring in man.
Hematologic Observations Made in Patients With Acute Respiratory Distress Syndrome in the Cooperative ECMO Project
Authors: Rodvien Robert
Published: July 2010

In a recently completed three‐year multicenter trial, 90 individuals with adult acute respiratory distress syndrome (ARDS) were randomly allocated to conventional therapy with or without long‐term extracorporeal membrane oxygenation (ECMO). This study conclusively demonstrated that ARDS is associated with frequent major bleeding and thrombotic episodes and that the bleeding correlates best with the degree of thrombocytopenia and is enhanced by the machine. Neither heparin's therapeutic efficacy nor its ability to increase bleeding could be proven. ARDS is associated with a complex coagulation disturbance. Besides thrombocytopenia, there were lowered circulating levels of factors VII and XII which may be related to changes in the pulmonary endothelium. ECMO was associated with relative leukopenia and a marked shift to immature circulating leukocytes. Further studies are needed to better define the clinical importance of thrombosis and bleeding in the lung, the role for heparin in treatment, and the meaning of reductions in coagulation factors in defining the course, prognosis and response to therapy of patients with ARDS.
Mathematical and Experimental Methods for Design and Evaluation of Membrane Oxygenators
Authors: Eberhart Robert C. , Dengle Satish K. , Curtis Robert M.
Published: July 2010

Three categories of membrane oxygenators are considered: passive flow, secondary flow induced by the mainstream, secondary flow induced by an external application of energy. The current status of mathematical methods for analysis of fluid mechanics, O2 and CO2 exchange for these categories are briefly reviewed. Emphasis is given to approximate methods for calculation of gas exchange. Practical methods for experimental design optimization studies are outlined; these methods are extended to evaluation of O2 and CO2 exchange in clinical operation. A new method for estimation of internal ventilation and perfusion maldistribution and diffusion resistance is described. A brief assessment of blood damage in clinical application of the oxygenator is presented from the point of view of deterioration of gas exchange performance.
Human Thoracic Anatomy Relevant to Implantable Artificial Hearts
Authors: Jacobs Gordon B. , Agishi Tetsuzo , Ecker Robert , Meaney Thomas , Kiraly Raymond J. , Nosé Yukihiko
Published: July 2010

The objective of this study is to define the human thorax in a quantitative statistical manner such that the information will be useful to the designers of cardiac prostheses, both total replacement and assist devices. This paper pertains specifically to anatomical parameters relevant to the total artificial heart.

Methods were developed for generating an integrated, statistical model of the anatomical structures within the human thorax. These methods involve definition of the anatomy in four areas: chest wall, pericardium, vascular connection locations, and great vessels.

Results are presented in three dimensional scale views of the human thorax showing the main features pertinent to cardiac prosthesis implantation. Statistical variability of this data is also included. Measurements were obtained from a number of sources and represent both normal and diseased patients. The ERDA total artificial heart was shown to successfully fit the fiftieth percentile adult male human.
Hemodynamic Studies, Acid‐Base Status and Osmolality in Different Hemodialysis Procedures
Authors: Hampl Hannelore , Paeprer Horst , Unger Volker , Ryzlewicz Thomas , Fischer Christoph , Cambi Vincenzo , Kessel Michael
Published: July 2010

Three patients on maintenance dialysis were each treated with three different procedures: A) twenty‐liter recirculation dialysis with bicarbonate buffering, B) recirculation‐adsorption dialysis and C) single‐pass dialysis. Hemodynamic parameters were measured invasively and procedures A, B and C were compared for each patient. In this intra‐individual comparative study, the authors attempted to establish a relationship between the varying hemodynamic parameters and the changes in osmolality and acid‐base status. There were indications of some causal relationship to circulatory stability: in A and B, there were peripheral resistance increases of 24.5% and 38.4%, respectively, with stable circulation; in C., there was a 6.1% increase and unstable circulation. Additionally, the influence of acidosis is shown in B, with disproportionately strong reductions of cardiac output (21.9%) and pulmonary artery pressure (44.9%). In spite of a decrease of osmolality (A: 15.6 mOsm/L), stable circulation could be achieved if the peripheral resistance was substantially increased and acid‐base status was equalized.
Present and Future Uses of Hemoperfusion with Sorbents
Authors: Winchester James F. , Gelfand Michael C. , Knepshield James H. , Schreiner George E.
Published: July 2010

International interest in the clinical uses of hemoperfusion has increasingly grown in the last ten years and, as a result, sorbent hemoperfusion has emerged as first‐line management in several areas. This center and many others have shown that there is a clear role for hemoperfusion in severe self‐poisoning. Plasma extraction ratios for most drugs are significantly higher for hemoperfusion over both resin (0.8) and activated charcoal (0.5; CHP) than for hemodialysis (0.27), under similar conditions of blood flow, plasma drug concentrations, etc. Using appropriate pharmacokinetic models in the analysis of plasma drug profiles, it has been shown that CHP can increase drug elimination rate constants and whole body clearance rates in experimentally intoxicated animals. Enhancement of drug elimination broadens the scope of sorbent hemoperfusion to other areas of application, such as the removal of anticancer drugs (e.g., methotrexate, adriamycin) after cancer chemotherapy.

Evaluation of the role of hemoperfusion in hepatic encephalopathy or uremia is limited by the lack of knowledge regarding specific toxic molecules in these syndromes. Nevertheless, in the authors' series of ten patients with fulminant hepatic failure, four survived, in contradistinction to an 80–90% mortality for untreated patients, and virtually all awoke from deep coma. Accompanying reversal of coma, there were significant changes in plasma and cerebrospinal fluid amino acids and in cerebrospinal fluid cyclic AMP concentrations. This suggests that hemoperfusion over charcoal in hepatic encephalopathy may be a useful technique. In this series of uremic patients, although hemoperfusion with charcoal has been shown capable of adsorbing putative uremic toxins including middle molecules up to the present, hemoperfusion alone is only marginally superior to standard hemodialysis. Fouremia, it is likely that multiple specific sorbents will be required, and several compounds for urea and creatinine sorption are presently under investigation.
Renin, Growth Hormone and Insulin in Hemodialyzed Uremic Diabetics
Authors: Avram Morrell Michael
Published: July 2010

In order to detect metabolic aberrations which could account for the poor therapeutic response of the diabetic to dialysis, a comparative study of nondiabetic and diabetic uremia patients treated with hemodialysis was undertaken. Plasma renin activity and levels of growth hormone, glucose and insulin were investigated.
Treatment of Metabolic Alkalosis with Peritoneal Dialysis in a Patient with Renal Failure
Authors: Vilbar R. M. , Ing T. S. , Shin K. D. , Gandhi V. C. , Viol G. W. , Chen W.‐T. , Geis W. P. , Hano J. E.
Published: July 2010

Peritoneal dialysis using a chloride‐rich dialysate succeeded in correcting systemic metabolic alkalosis in a patient with renal failure. The present approach may have a place in the therapy of metabolic alkalosis.
Isolated Ultrafiltration in the Treatment of Dialysis Ascites
Authors: Shin Kee Dong , Ing Todd S. , Popli Subhash , Daugirdas John T. , Ghantous Wallid N. , Vilbar Remegio M. , Geis W. Peter , Hano Jessie E.
Published: July 2010

Three patients with dialysis ascites improved markedly after treatment with isolated ultrafiltrations. This simple, noninvasive technique should be applied first to patients with dialysis ascites before resorting to more drastic therapeutic measures.
Digoxin Removal from a Patient with Renal Failure by Hemoperfusion with Amberlite XAD‐4 Resin
Authors: Hoy Wendy , Gibson Thomas P. , Biddle Theodore
Published: July 2010

A digitoxic patient with severe renal failure underwent two hemoperfusion treatments with Amberlite XAD‐4 resin. Digoxin clearances calculated from plasma flow rates and plasma digoxin concentrations, as well as from the amount of digoxin eluted from the used columns, were superior to those previously described for peritoneal dialysis, hemodialy‐sis and charcoal hemoperfusion. There was a temporary improvement in the patient's life‐threatening digitoxic cardiac rhythm with the first hemoperfusion, and a permanent improvement after the second hemoperfusion. It is submitted that hemoperfusion with this resin may significantly lessen manifestations of digoxin poisoning and may hasten digoxin elimination in digitoxic patients with renal failure.
Long‐Term Clinical Assessment of Combined ACAC HemoperfusionUltrafiltration in Uremia
Authors: Chang Thomas Ming‐Swi , Chirito Edward , Barre Paul , Cole Craig , Lister Colin , Resurreccion Emma
Published: July 2010

ACAC hemoperfusion was used in series with a small fluid removal system for a clinical trial in the treatment of uremia. A 22‐month trial included a pretest control period, test period and a post‐test control period. The most significant observations from this trial are: 1) the predialysis body weight of the patient could be maintained closer to the patient's dry weight; 2) there was a significant increase in hematocrit; and 3) there was insufficient removal of urea. With the development of an effective urea removal system, a more compact artificial kidney than any presently available will become feasible.
A Model Enzymic Extracorporeal Detoxification System
Authors: Sofer Samir S. , Wills Robert A. , Van Wie Bernard J.
Published: July 2010

Preliminary studies at the University of Oklahoma have incorporated the use of a continuous, seal‐less blood centrifuge as an extracorporeal detoxification unit to aid in the removal of foreign chemicals from the blood. Detoxification is performed by immobilized enzymes in conjunction with a cofactor (NADPH) bound to a water‐soluble macromolecule.

A drug enters the device with the plasma and then passes across a semipermeable membrane which serves to retain the cofactor. At this point, a combination of the drug, the cofactor and the enzyme react to form the drug‐oxide. The oxide then passes back through the membrane into the blood and back into the body. Concurrently, the macroNADP+ is reduced by G‐6‐P and G‐6‐PD in the cofactor regeneration portion of the device.

To facilitate detoxification, the centrifuge is employed to provide plasma rich in toxins, but void of potentially interfering blood components such as platelets and whole blood cells. These components tend to dilute the toxins or adhere to the interfacing membrane, decreasing the permeability of these toxins into the detoxification unit. It is felt that the centrifugedetoxification combination will provide a potentially efficient hepatic assist device.
A Detoxification Scheme for Liver Assist Utilizing Plasmapheresis, Bioincompatible Sorbents and Dialysis
Authors: Maini Roshan
Published: July 2010

The rationale behind the design of a sorbent‐based detoxification system for use as a liver assist is presented. A membrane‐based plasmapheresis' system giving high plasma flows (>40 ml/min) with maximum transmission of albumin makes this concept feasible.
The Current Status of Home Total Parenteral Nutrition
Authors: Grundfest Sharon , Steiger Ezra , Sattler Laura , Washko Susan , Wateska Leon
Published: July 2010

The history and current status of home total parenteral nutrition are reviewed. Patients without a functional intestinal tract are able to lead a relatively normal life, infusing their essential nutrients through a Silastic® central venous catheter while they sleep at night. The average catheter life is nine months. Suspected sepsis and obstruction of the catheter were the leading causes for catheter removal.
Performance of Baffled Bubble Blood Oxygenators
Authors: Ohshima Norio , Yoshido Fumitake
Published: July 2010

Bubble blood oxygenators equipped with baffles of various types in the oxygenating column were studied. The rate of hemolysis, the volumetric coefficient for oxygen absorption into blood, and the fractional gas holdup were found to be affected mainly by the superficial gas velocity. When compared with the conventional bubble blood oxygenator without baffles, the bubble oxygenators equipped with various types of baffles (i.e., horizontal perforated baffles, radial vertical baffles, and a concentric hollow cylinder with and without horizontal perforated baffles) showed less hemolysis, larger gas holdup and higher values of the coefficient for oxygen absorption. Values of the heat transfer coefficient on the surface of the cylindrical baffle, which is useful as a built‐in heat exchanger, were several times greater than those for single‐phase heat transfer in conventional blood heat exchangers.
Artificial Organs: Thoughts & Progress:Orally Diluting Hemofiltration
Authors: Agishi Tetsuzo , Yamashita Norimase , Ozaku Yasuo , Era Kazuo , Ota Kazuo
Published: July 2010

Orally diluting hemofiltration (ODHF), herein reported, is a new technique where the body fluid is purified by cooperative procedures of dilution‐supplementation with oral electrolyte solution and filtration using the RP‐6 dialyzer. One uremic patient was maintained for two months on a five‐hour, three‐times‐per‐week ODHF schedule, and another patient was maintained for four months on the same regimen with no supportive hemodialysis.
Semibiological Left Heart Assist: In Vitro Evaluation
Authors: Bodnar Endre , Ross Donald N.
Published: July 2010

A semibiological left heart assist device has been designed and built at the Cardiothoracic Institute and National Heart Hospital, London, England. This device is a Dacron/polyurethane conduit between the left ventricle and aorta in which part of the conduit assumes the function of a pumping chamber. This segment is enclosed by two biological valves and has a side arm. A polyurethne balloon is inserted through this side arm, and is pumped in a synchronously counter‐pulsating manner. Upon completion, the balloon can be removed without tho‐racotomy and with the conduit left in situ. Under simulated physiologic pressure and rate conditions, the pumping device gives reasonably good performance.
Hemodynamic Studies in Long‐Term Peritoneal Dialysis Patients
Authors: Schurig Randolf , Gahl Gerhard M. , Becker Helmut , Schiller Renate , Kesel Michael , Paeprer Horst
Published: July 2010

A study was undertaken to evaluate the acute hemodynamic effects in ten patients from this clinic's long‐term peritoneal dialysis program. With a Swan‐Ganz catheter, the following parameters were measured in each patient during peritoneal dialysis: cardiac index, pulmonary artery pressure, right atrial pressure, inferior vena cava pressure, heart rate and arterial pressure.

Mean predialysis cardiac index, stroke volume index and heart rate were normal. Predialysis pulmonary artery pressure and arterial pressure were slightly elevated. Mean weight loss during peritoneal dialysis was 1.6 kg. The most striking post‐dialysis changes were a significant 20% decrease of the cardiac index and a 17% decrease of the pulmonary artery pressure. Heart rate and arterial pressure remained constant due to a 25% increase of total peripheral resistance. After filling the abdomen with one, two and three liters of dialysate, intra‐abdomi‐nal pressure and inferior vena cava pressure increased up to 150 and loo%, respectively, whereas central hemodynamic parameters (pulmonary artery pressure, cardiac index, stroke volume index, heart rate and arterial pressure) were unchanged.
Preparation of Parietal Peritoneum for Measurements of In Vitro Permeability
Authors: Knapowsk Jan B. , Simon M. P. , Feder E. M.
Published: July 2010

An experimental method for in vitro studies of permeability of parietal peritoneal membrane was developed in rats. Sodium and potassium fluxes across the peritoneum lining two different regions (the diaphragm and the anterior abdominal wall) were estimated and electrical resistance of the isolated membranes were determined. A significant reciprocal correlation was observed between the two indices. Quantitative differences between the two types of membranes were found, the diaphragmatic region being more permeable than the other. It is suggested that a monolayer of mesothelial cells covering the membranes is partially responsible for these differences. The parietal peritoneum was found to be less permeable than visceral peritoneum (mesentery) studied under identical conditions.
Acceleration of Peritoneal Mass Transport by Drugs and Hormones
Authors: Maher John F.
Published: July 2010

The major restrictions to the transport of solute and solvent across the peritoneum are the limited peritoneal blood flow, area and permeability. Recent investigations have demonstrated that several vasoactive drugs influence transport parameters. Isoproterenol, nitroprusside, dipyridamole and dopamine exemplify drugs that dilate the splanchnic vasculature, thereby augmenting transport, whereas vasoconstriction induced by Q‐norepine‐phrine decreases clearances. The tissue prostaglandins affect peritoneal mass transport in accord with their known vasoactive effects, suggesting a role in modulating peritoneal blood flow. The gastrointestinal hormones vasodilate the splanchnic circulation. Exposure of the endothelial surface to glucagon markedly increases peritoneal mass transport, while secretin increases the ultrafiltration rate significantly. These preliminary studies suggest the possible future clinical use of drugs and hormones to augment the efficiency of peritoneal dialysis.
The Use of Hemoperfusion as an Adjunct to Hemodialysis
Authors: Trafford Anthony , Ireland Robin , Evans Rhianydd
Published: July 2010

Studies are reported on the use of short dialysis, sequential ultrafiltration/short dialysis and hemoperfusion in chronic renal failure. Short dialysis (<12 hourdweek) is a satisfactory regime with good patient acceptance, adequate small and middle molecule clearance and control of fluid and blood pressure. Sequential ultrafiltration in the first hour improves fluid removal and reduces the side effects of dialysis. The addition of hemoperfusion increases clearance of small and middle molecules and has little effect on the osmolality of the serum. Thus, it does not increase the side effects of dialysis. Preliminary results suggest that hemoperfusion may be useful in the treatment of chronic renal failure in combination with ultrafiltration and dialysis.
Experimental and Clinical Studies on the Effect of Intra‐Aortic Balloon Pumping for Cardiogenic Shock Following Acute Myocardial Infarction
Authors: Okada Masayoshi , Shiozawa Takuo , Iizuka Masashi , Okuno Kunio , Chen Chuan Chung , Matsuda Shozo , Yoneda Kozo , Yano Atsushi , Kawai Masaru , Asada Sakae
Published: July 2010

The effect of intra‐aortic balloon pumping (IABP) on cardiogenic shock following acute myocardial infarction was studied experimentally and clinically. Effects of IABP on hemodynamic and electro‐cardiographic changes were studied with cardiogenic shock which was produced by multiple ligation of the coronary artery in dogs. Consequently, the hemodynamics as well as the ECG could be improved by diastolic augmentation and systolic unloading during IABP. But, these favorable effects of IABP were not seen in dogs whose infarcted area involved more than 50% of the free wall of the left ventricle. These facts were seen clinically in three autopsied cases.

IABP was also attempted in dogs with complications such as ventricular septal defect (VSD) and mitral regurgitation (MR) following acute myocardial infarction, and significant improvement was obtained by IABP. No effects of IABP were seen in these series, however, when the value of the pulmonary‐to‐systemic flow ratio was over 4.5 in the VSD group and the mean left atrial pressure was more than 30 mmHg in the MR group.

Clinically, IABP was employed in 16 patients with cardiogenic shock secondary to acute myocardial infarction. Six (37.5%) were weaned from IABP. It can be concluded that IABP is effective in improving hernodynamics as well as the ECG.
Artificial Organs: Thoughts & Progress:Determination of Cardiac Output of the Artificial Heart from the Drive Air Flow
Authors: Hanzelka P. , VaŠkå J. , Urbdáek P. , VaŠkå J. , Urbánek E.
Published: July 2010

An indication chamber, inserted between the right heart drive and the pump proper, was designed to provide continual measurement of the quantity of blood pumped by the pneumatic artificial heart. The flow is evaluated from the motion of a piston provided with a photoelectric transducer. The effect of compressibility of the drive gas on measurement accuracy is eliminated. The indication chamber provides for automatic replenishment of gas that escapes by diffusion and through minor leakage. During testing in an artificial circulation within the range of physiological conditions, measurement inaccuracies did not exceed 5%.
Bloodless Cardiac Surgery Utilizing a New Low‐Prime Oxygenator
Authors: Urzua Jorge , Irarrazaval Manuel , Moran Sergio , Maturana Gustavo , Valdks Francisco , Quiroga Martita , Allende Mario , Dubernet Juan
Published: July 2010

One undred consecutive patients undergoing openheart surgery were subjected to a prospective protocol designed for reduction of homologous blood utilization. The main points of this protocol were careful surgical hemostasis, normovolemic hemodilution, and retransfusion of blood lost to the operating field. It included use of the new Bentley BOS‐10 Spiraflom oxygenator (Bentley Laboratories, Inc., Irvine, California, U.S.A.).

The patients' ages ranged from 6 to 68 years and their weights from 18 to 84 kg. Fifty‐four patients were subjected to valvular surgery, 30 to coronary revascularization, 13 to congenital defects repair, and 3 to resection of atrial myxomas.

All patients could be weaned from bypass without receiving any blood. Eighty patients completed their surgery, and 60 were discharged from the intensive care unit without receiving any homologous blood or its derivatives. Total blood usage for the series throughout the entire stay in hospital was 1.32 units/patient, which included six reoperations for excessive bleeding.

This reduction in blood utilization was achieved without excessive hemodilution and did not produce significant complications.
Enzyme Reactors Consisting of Matrix‐Bound or Entrapped Red Cell Ghosts
Authors: Schmer G.
Published: July 2010

Potent enzyme reactor systems could be synthesized using red cell ghost membranes containing urease and coval‐ently binding these “semi‐artificial” cells to polydextran gels (Sephadex) or entrapping them in agarose gel. In vitro studies as well as in vivo studies in sheep indicate excellent physicochemical stability of the system. Limitations of the method include insufficient diffusion of certain substrates through the cell membrane, or a tight binding of the substrate to carrier proteins.
An Artificial Endocrine Pancreas Containing Cultured Islets of Langerhans
Authors: Sun Anthony , Parisius Wolf , Macmorine Hilda , Sefton Michael , Stone Robert
Published: July 2010

This study was directed toward the development of an artificial endocrine pancreas. The device contains functioning Islets of Langerhans sequestered in a chamber equipped with an internal, looped semipermeable fiber which may be attached to a blood vessel. Our experiments showed that when the device was attached to diabetic monkeys by an arteriovenous shunt, the islets responded to increased levels of blood glucose by increased flow of insulin across the semipermeable barrier and that a normoglycemic state was attained. These findings are in agreement with those of others, and with our published data, but a major drawback to practical application of previously described devices is the necessity of preventing thrombi in the lumen of the fiber by a high dosage of circulating anticoagulants. We have addressed this problem and have developed a fiber which contains heparin covalently bonded to the lumen. The coating has been found to be irreversibly bound to the surface of the fiber. After attachment of the device, containing the modified fiber, to monkey blood vessels, function was maintained for as long as six days after which the anastomosis between the blood vessel and the fiber was found to have been occluded by a thrombus. The lumen remained patent. Further work is needed to resolve this problem but it would appear that the device has practical application in the treatment of the diabetic.
Cells Cultured on Artificial Capillaries and Their Use as a Liver Assist Device
Authors: Wolf Carl F.W.
Published: July 2010

Mammalian cells in culture can be maintained and, in some cases, will proliferate to form tissue‐like masses on the exterior surfaces of artificial capillaries made of semi‐permeable membrane when nutrient medium is circulated within the capillaries. Published experience with the system in a variety of applications is reviewed with particular attention to the use of cells of liver origin to provide hepatic metabolic functions when the blood of a host animal replaces the nutrient medium and a symbiotic relationship is established between host and device through the semipermeable capillary walls. The rationale for liver assist in acute fulminant hepatic failure (FHF) and animal models for FHF are reviewed. Exploratory studies of bil‐irubin metabolism with congenitally jaundiced host rats are described which provide a quantitative measure of the capillary culture liver assist device's functional capacity and suggest that substantial increases in the metabolic capacity of the device are needed. Potential means to increase capacity are considered, especially the use of con vective mass transfer to supplement diffusion by inducing ultrafiltration through the capillary walls, and the application of relevant theoretical methods for the analysis of convective transfer in the capillary culture chamber is proposed.