bluuebunny/crossref_metadata_2025 huggingface dataset:
Accuracy of Epiluminescence Microscopy among Practical Dermatologists: A Study from the Emilia-Romagna Region of Italy
Authors: Stanganelli Ignazio , Serafini Monica , Cainelli Tullio , Cristofolini Mario , Baldassari Laura , Staffa Mauro , Bucchi Lauro
Published: April 2018

Aims and background

The accuracy of epiluminescence microscopy (ELM) for pigmented skin lesions (PSLs) is still unclear. The large scale utilization of the technique is generally discouraged. The present study was aimed at comparing the accuracy of ELM with that of clinical examination alone in a group of 20 practical dermatologists.

Methods and study design

Thirty digital clinical images of benign and malignant PSLs and their digital ELM counterparts were used. A set of cumulative accuracy measures reported in the combined clinical/ELM diagnosis was compared with that reported in the clinical diagnosis alone.

Results

The proportion of nonmelanocytic lesions (NMLs), melanocytic nevi, and melanomas correctly identified, the predictive value of such diagnoses, and the proportion of melanomas detected by referral for biopsy (irrespective of the diagnosis reported) increased significantly. The cases referred for biopsy despite a “benign” impression decreased significantly among NMLs.

Conclusions

The observed tendency towards a greater accuracy suggests that even in the routine dermatology practice ELM has the potential to improve the clinical examination of PSLs.
Pharmacokinetics of Intraperitoneal Gemcitabine in a Rat Model
Authors: Pestieau Sophie R. , Stuart O. Anthony , Chang David , Jacquet Pierre , Sugarbaker Paul H.
Published: April 2018

Background

Gemcitabine (2'-2’ difluorodeoxycytidine) has been shown to possess a broad spectrum of antitumor activity against various malignancies, particularly pancreatic carcinoma. For cancers occurring within the abdominal cavity, the advantage of intraperitoneal (ip) chemotherapy over intravenous (iv) chemotherapy is the high drug concentration that can be achieved locally. In addition, the cytotoxic effect of several anticancer agents can be enhanced by hyperthermia. Using a rat model, this study was designed to compare ip vs iv gemcitabine and to evaluate the effect of hyperthermia on ip gemcitabine.

Methods

In the first phase of this study, 18 Sprague Dawley rats were given a single dose of gemcitabine then randomized into three groups according to dose and route of delivery of chemotherapy (12.5 mg/kg - iv, 12.5 mg/kg - ip or 125 mg/kg - ip). In a separate experiment (phase 2), 12 Sprague Dawley rats were given a continuous ip perfusion of gemcitabine (12.5 mg/kg in 150 mL total perfusate) and randomized into two groups according to the temperature of the peritoneal perfusate (normothermic or hyperthermic). During the course of both experiments, peritoneal fluid and blood were sampled using a standardized protocol. At the end of the procedure the rats were sacrificed and all urine was extracted. Selected tissue samples were taken from rats in the second phase of the study. The concentration of gemcitabine in all samples was determined by high performance liquid chromatography (HPLC).

Results

When gemcitabine was delivered at 12.5 mg/kg (phase 1) the area under the curve (AUC) was significantly higher with ip administration as compared to iv administration ( P = 0.001). The AUC ratio (AUC peritoneal fluid/AUC plasma) was 12.5 ± 3.2 for ip delivery as opposed to 0.2 ± 0.2 for iv delivery ( P = 0.0002). The AUC ratio for ip gemcitabine at 125 mg/kg was 26.8 ± 5.8. Although there was no significant difference in drug concentrations between samples from the normothermic and hyperthermic groups, all tissue samples (except stomach) in the hyperthermic group exhibited increased gemcitabine concentrations.

Conclusion

These experiments demonstrated that the exposure of peritoneal surfaces to gemcitabine is significantly increased with ip gemcitabine. Intraabdominal hyperthermia had no significant effect on the pharmacokinetics of ip gemcitabine but there was evidence of increased absorption of gemcitabine in most intraabdominal tissues. Due to the likelihood of a high incidence of microscopic residual disease after resection of a pancreatic carcinoma, clinical studies to evaluate ip hyperthermic gemcitabine may be indicated.
Non-Conventional Treatment of Hepatic Failures
Authors: Sofer S.S. , Hare L.H.
Published: April 2018

It is our intention to present a short review of various approaches to the non-conventional treatment of hepatic failures of the fulminant type. Our review is directed to the scientist, technologist, and clinician with a budding interest in the hepatic assist area. We shall discuss parabiosis, liver transplants, and various extracorporeal devices including hemoperfusion, hemodialysis, and enzymic detoxification systems.

We feel that the present technological approaches to the treatment of hepatic failure are very primitive at this stage. Some of the recent advances are very encouraging, and it is our opinion that these approaches show great promise in the long term.
The Effect of Radiolabeling of Human Fibrinogen on Its Adsorption Behaviour on a Polystyrene Surface
Authors: Elhorst J. Klein , Olthuis F.M.F.G. , Bargeman D. , Smolders C.A. , Feijen J.
Published: April 2018

Human fibrinogen (HFB) was labeled with different radioactive labels (Technetium −99m and Iodine −125) in various ways. Characterization by chromatographic and electrophoretic methods did not show differences between the labeled and the nonlabeled proteins.

The effect of the label and the labeling method on the adsorption behaviour of 99mTc and 125l labeled HFB at a polystyrene surface was investigated.

In all cases labeled HFB showed preferential adsorption as compared to nonlabeled HFB. The preferential adsorption was expressed in terms of a factor ø (van der Scheer et al. 1978a), which will be 1, when no preferential adsorption occurs. 99mTc – and 125| – HFB showed ø values from 1.48 – 1.88. It is concluded that only meaningful adsorption experiments with labeled proteins can be performed when the possible occurrence of preferential adsorption has been investigated by appropriate methods. The results of prior work on protein adsorption at biomaterials using radiolabeled proteins have to be reconsidered.
Effect of Isoosmolar volume Reduction during Hemofiltration on Plasma Antidiuretic Hormone in Patients with Chronic Renal Failure
Authors: Vaziri N.D. , Skowsky R. , Warner A.
Published: April 2018

The effect of isoosmolar volume reduction on plasma ADH level was studied in 8 patients with chronic renal failure utilizing hemofiltration technique. Plasma ADH fell significantly (P < 0.001) after one hour of hemofiltration despite volume reduction which was expected to elevate the ADH level. After two hours of hemofiltration, ADH remained low in 5 patients and increased in 3. Posthemofiltration mean blood pressure was generally lower in patients whose ADH rose than those whose ADH remained low. The two groups were otherwise comparable with respect to total fluid loss, hemofiltration rate, and fluid removed expressed as percent body weight. It can thus be suggested that in these patients a rise in plasma ADH in response to fluid reduction may require a fall in the arterial blood pressure below a critical level. While the rise in plasma ADH observed with continued fluid removal in some patients can be readily explained, we have no clear explanation for the paradoxical initial fall of ADH in all patients and subsequent maintenance of low levels observed in the majority of patients. This unusual ADH response to isoosmolar volume reduction may represent some unidentified mechanism of ADH regulation in patients with end-stage renal disease.
Cardiothoracic Ratio as a Guide to Ultrafiltration Therapy in Dialyzed Patients
Authors: Poggi A. , Maggiore Q.
Published: April 2018

This study evaluated the cardiothoracic ratio (CTR) and the roentgenologic heart volume (RHV) as indexes of body fluid retention in 37 uremics on maintenance dialysis therapy. Both indexes related to a highly significant degree with the variations of body fluids balance assessed by the changes in body weights. Cardiomegaly (CTR > .500) subsided with adequate ultrafiltration therapy in most patients including those having blood pressure values within the normal range. It is concluded that the measurements of CTR provides an useful guide to ultrafiltration therapy expecially in those patients whose blood pressure fails to sense the body fluid retention.
Continuous Uv Photometric Monitoring of the Efficiency of Hemodialysis
Authors: Gál G. , Gróf J.
Published: April 2018

Process and efficacy of hemodialysis can be readily monitored by continuous measurement and registration of transmittance at 254 nm of the dialysate.

An additional advantage of the method is that it can be easily authomatized.
Experimental Myringoplasty
Authors: Feenstra L. , Van Der Ven B.W.C. , Kohn F.E. , Feijen J.
Published: April 2018

Artificial eardrums made from biodegradable poly(D, L-lactic acid), poly(glycolic acid) and poly(ß-benzyl-L-aspartate-co-L-leucine) 50/50, and made from the microporous poly(tetrafluoroethylene) and bisphenol-A poly(carbonate) membranes were implanted into the ear and as a reference subcutaneously in rats.

The implants were histologically examined for periods up to one year. From the biodegradable polymers studied the poly(ß-benzyl-L-aspartate-co-L-leucine) 50/50 evoked the least tissue reaction and the newly formed tympanic membranes are the best in terms of thickness and overall integrity. The microporous poly(tetrafluoroethylene) membrane can be considered as a valuable support for the formation of a reinforced tympanic membrane.
Absence of Anemia in Maintenance Hemodialysis
Authors: Charles G. , Lundin A.P. , Delano B.G. , Brown C. , Friedman E.A.
Published: April 2018

Anemia is usual in untreated uremia. Persistent anemia is thought to be universal in uremic patients treated by maintenance hemodialysis (MH). A retrospective chart analysis of 549 patients on (MH) at five facilities in Brooklyn, found that eleven (2%) of these patients had a hematocrit (Hct) in the normal range (40%). To distinguish this subset of patients from the majority of MH, we compared both groups for: (1) etiology of the renal disease, (2) presence of residual renal function, (3) dialysis prescription, (4) decreased arterial O2 saturation, (5) greater use of vitamins or anabolic steroids, (6) absence of parathyroid disease. The relatively high hematocrit was not explained by any factor evaluated in this small subset of MH patients.
The Immunological State in Chronic Renal Insufficiency
Authors: Giacchino F. , Alloatti S. , Quarello F. , Bosticardo G.M. , Giraudo G. , Piccoli G.
Published: April 2018

To evaluate the immunological state in chronic renal insufficiency, the Authors studied cellular and humoral immunity in 292 patients with chronic renal failure.

They were divided into 3 groups: 1) 37 with creatinine clearance between 50 and 20 ml/min; 2) 57 with creatinine clearance between 20 and 8 ml/min; 3) 178 treated by hemodialysis.

In vivo and in vitro tests, that is DNCB, PPD skin tests, spontaneous, active and EAC rosettes, surface membrane immunoglobulin test, complement (C3, C4) and serum immunoglobulins were taken as markers of the immune response.

Cell-mediated immunity was found to be significantly impaired in patients with terminal renal insufficiency or on hemodialysis and also markedly reduced in patients with non-terminal renal insufficiency.

Humoral immunity produced less significant results: the B lymphocyte count and serum immunoglobulins were normal; only C3 levels were found below normal range.

Thus it would seem that cell-mediated immunodeficiency appears in an early stage of chronic renal failure and that hemodialysis does not improve this deficiency.
The Effect of Hemoperfusion over Uncoated and Polymer — Coated Charcoal on Hematological Levels in the Conscious Rat
Authors: Ryan C.J. , Courtney J.M.
Published: April 2018

An investigation has been made of the suitability of a rat hemoperfusion system for the evaluation of hematological changes induced by charcoal hemoperfusion. The investigation studied the influence on erythrocyte, leucocyte and thrombocyte levels of repeated hemoperfusion over Norit RBX1 charcoal, hemoperfusion over polymer-coated Norit RBX1 and hemoperfusion over uncoated spherical charcoal. Controls included animals subjected to hemoperfusion through empty columns and animals cannulated only. The results indicate that changes in erythrocyte and leucocyte levels are due principally to passage of blood through the extracorporeal circuit rather than contact with the adsorbent but that changes in thrombocyte levels are dependent on the type of charcoal and the nature and extent of polymer coating. The investigation suggests that the rat hemoperfusion system is a suitable procedure for the assessment of the compatibility of adsorbents to be used in hemoperfusion.
Quantification of Extracorporeal Fibrin Deposits in Haemodialysis with Minimal and Conventional Heparinization
Authors: Buttermann G. , Vogel G.E. , Kalinowski H. , Blümel G. , Pabst H.W.
Published: April 2018

The effects of minimal intermittent heparinization and of conventional heparinization on endogen fibrinogen concentration as well as on fibrin depositis were studied on 17 on patients hemodialysis. It was shown that the minimal intermittent heparinization did non reduce dialysis efficiency and that a total heparin dosage of 6,000 units is the lowest safe limit.
Catecholamines, Renin, Aldosterone and Arterial Pressure in Patients on Chronic Hemodialysis Treatment
Authors: Ratge D. , Augustin R. , Wisser H
Published: April 2018

To assess the interaction between adrenergic activity and blood pressure regulation, plasma catecholamines (CA), plasma renin activity (PRA) and plasma aldosteron (PA) were measured in 66 normal subjects and 18 dialysis patients. Prior to dialysis, blood levels of free norepinephrine (NE), epinephrine (E) and PRA were normal, but total (free and conjugated) CA as well as PA were significantly elevated.

There was a spectrum of response during hemodialysis. On an average mean arterial blood pressure (MAP) fell during the first two hours of treatment, concomitantly followed by an increase in mean NE level. Whereas PRA and PA were highest at the end of treatment, mean free NE returned promptly to predialysis values through the late dialysis period. Severe hypotensive episodes during dialysis were associated with a baroreceptor-mediated adrenergic stimulation. These results indicate a qualitatively normal reaction of dialysis patients to volume removal and the importance of the renin-angiotensin-system in maintaining blood pressure during dialysis.
Polymer Resins with Amino Acid Containing Pendants for Sorption of Bilirubin. I. Comparison of Merrifield and Polyamide Resins
Authors: Henning D.S. , Lajoie G.A. , Brown G.R. , St-Pierre L.E. , St-Pierre S.
Published: April 2018

Merrifield resins with various amino acid containing pendants and a water swellable polyamide resin with the peptide alanine-alanine-alanine-arginine as the pendant group have been prepared by solid phase peptide synthesis. Merrifield resins with either arginine or lysine pendants are capable of sorbing bilirubin from aqueous solution (pH = 7.8) but those with other amino acid pendants gave no indication of sorption. The polyamide-arginine resin showed, on a functional group basis, a higher capacity for bilirubin than does cholestyramine. It is proposed that the formation of salt linkages causes a strong interaction of bilirubin with arginine and lysine.
Preliminary Study on Plateletpheresis with the CS-3000 Blood Cell Separator Using a Single Phlebotomy Technique
Authors: Steenssens L. , Verbeelen D. , Verbruggen R. , Van Den Broeck M. , Jonckheer M. , Van Camp B.
Published: April 2018

A coaxial dual flow catheter has been tested for thrombapheresis with a continuous flow blood cell separator in order to render the procedure as comfortable as possible for our donors.

Therefore, two groups of five donors underwent a standard plateletpheresis: 3500 ml of blood were withdrawn at a speed of 35-45 ml per minute and were anticoagulated with ACD-A in a 1/9 ratio to whole blood.

In the first group one vein puncture was effectuated with the coaxial catheter after local anesthesia. Two 14G catheters were used in the second group. In both groups the platelet yield was studied as well as the half life of 111-Indium-oxinate labeled platelets after autologous transfusion.

Although the comfort of the donors was greatly improved, the one needle procedure resulted in a mean platelet yield of 1,28.1011 while the two needle procedure yielded 3,46.1011 platelets.

In contrast, the survival of the platelets after autologous transfusion did not differ significantly in the two groups: t 1/2 in group I was 3,94 d, in group II 3,66 d.

It is advocated that the poor efficacy of the single needle procedure might be due to recirculation.
Pathology of Endocrine Organs in Chronic Renal Failure - An Autopsy Analysis of 66 Patients
Authors: Elias A.N. , Vaziri N.D. , Farooqui S. , Martin D.C. , Mirahmadi M.K.
Published: April 2018

Gross and microscopic findings at autopsy are reported in 66 patients with end-stage renal disease (ESRD). Nineteen patients received renal transplant, and 47 were maintained on chronic dialysis. Thyromegaly was seen in over half of the dialysis patients and in a third of the transplant recipients. The mean weight of the thyroid gland in the two groups was similar (26.2 ± 4.5 g in the transplant group and 27.2 ± 6 g in the group on dialysis). The parathyroid glands were hyperplastic in 10/11 dialysis patients (91%), but of normal size in 78% of the transplant recipients. Adrenal gland atrophy was common in the transplant group, probably reflecting adrenal suppression by glucocorticoids. Seminiferous tubular atrophy was observed in 12/16 dialysis patients and small testes were noted on gross examination in 50% of the transplant recipients. Prominent autopsy findings were goiter, parathyroid gland hyperplasia, and testicular atrophy. Following transplantation parathyroid gland hyperplasia declined, whereas goiter and testicular atrophy appeared to persist.
In Vitro Study of Combined Convection- Diffusion Mass Transfer in Hemodialysers
Authors: Gupta B.B. , Jaffrin M.Y.
Published: April 2018

Clearance measurements have been obtained for urea, Vit B12 and myoglobin by simultaneous hemodialysis and ultrafiltration (UF) techniques, using various commercially available hemodialysers. The experimental results confirm that the overall clearance is less than the clearance of each process occuring separately due to interaction between convection and diffusion.

Adequate urea clearance (100 ml/min) can be obtained either by using high ultrafiltration (60 ml/min) with low dialysate flow rate (70 ml/min) or moderate ultrafiltration (< 30 ml/min) with higher dialysate flow rate (120 ml/min).

The comparaison of experimental clearance with the predictions of theoretical model (1) for urea are found to be in good agreement for dialysate flow rates of more than 300 ml/min and for smaller dialysate flow rates the predicted clearances are higher than measured ones. An approximate correlation for the overall clearance is CL = CLD + QF/2 where CLD is the dialytic clearance and QF the UF flow rate.
Hemodialysis-Associated Platelet Loss: Study of the Relative Contribution of Dialyzer Membrane Composition and Geometry
Authors: Docci D. , Turci F. , Del Vecchio C. , Bilancioni R. , Cenciotti L , Pretolani E.
Published: April 2018

To evaluate the relative contribution that dialyzer membrane composition and geometry make to hemodialysis-associated platelet loss, the effect of a single dialysis with three different types of dialyzers on platelet count was examined on a cross-over basis in 19 uremic patients on maintenance hemodialysis. Also, the plasma levels of antithrombin-lll before and after dialysis were measured, but no significant variations were found regardless of which dialyzer was in use. Our patients suffered significant platelet loss during cuprophan dialysis, but not polyacrylonitrile dialysis. More than 99% of initial circulating platelets were recovered at the end of polyacrylonitrile dialysis, whereas cuprophan dialysis did leave a significantly lower percentage of circulating platelets (p < 0.05).

The internal comparison of results obtained with the two cuprophan dialyzers used shows no difference as to the dialyzer geometry (flat plate or hollow fiber). This indicates that the membrane composition is the major factor influencing hemodialysis-associated platelet loss. We suggest that patients with low platelet count and/or with risk of bleeding may benefit from polyacrylonitrile dialysis.
Plasma Volume Changes Induced by Sequential Ultrafiltration-Hemodialysis and Sequential Hemodialysis-Ultrafiltration
Authors: Di Maggio A. , Basile C. , Scatizzi A.
Published: April 2018

Isolated ultrafiltration (UF) has been shown to preserve plasma volume (PV) by means of a high plasma refilling rate, mediated by a rapid rise in oncotic pressure. This mechanism contributes to the good tolerance of sequential ultrafiltration-hemodialysis (SUH). This study compared PV changes induced by SUH and sequential hemodialysis-ultrafiltration (SHU). Seven dialysis patients underwent two sets of SUH and SHU, in which 2 h of UF (≃ 3L) respectively preceded or followed 2 h of no-weight-change hemodialysis (ISO HD). VEM (volume of extravascular mobilization), VEM/VUF (percent of plasma refilling rate) and ΔPV were calculated by mathematical formulas. Results showed: 1) a high VEM/VUF during the UF period, either before or after ISO HD: 80 and 77% respectively; 2) a significant increase in PV during ISO HD after UF, compared to ISO HD before UF: + 229 ml and + 43 ml, P < 0.05; 3) VEM/VUF significantly higher during SUH than during SHU: 87 and 80%, P < 0.01. In conclusion, the decrease in PV was lower in SUH than in SHU (11 vs. 19%, P < 0.001) because the plasma refilling persisted through the ISO HD period.
RBC Aggregometer head as a Warning Monitor of Flow Disturbance in Extracorporeal Systems
Authors: Tomita M. , Tanahashi N.
Published: April 2018

A simple photoelectric apparatus is described, to monitor the flow condition of whole blood in an extracorporeal system. It can raise an immediate alarm on disturbance of flow. The apparatus comprises an RBC aggregometer head, described previously, for measuring the rate of RBC aggregation in whole blood. Its construction was modified for easy attach-ability and detachability without causing tube damage. In practice, the apparatus was applied by hooking it to the tube of the extracorporeal system in animals and in a clinical case of blood dialysis in a patient with renal failure, in which stoppage of blood flow elicited a dramatic change in the baseline record of light transmission of the mobile blood. The signal of the apparatus was fed to an alarm system via a voltage comparator switch. The apparatus is inexpensive, solid and durable, easy to operate by untrained personnel, and has excellent stability and reproducibility.
Single Donor Plasma in Therapeutic Plasma Exchange for Myasthenia Gravis
Authors: Mantegazza R. , Bruzzone E. , Regi B. , Peluchetti D. , Marconi M. , Sirchia G. , Borroni V. , Cornelio F.
Published: April 2018

Thirty-seven myasthenic patients were treated with therapeutic plasma exchange (TPE) on different performance schedules using either random or single donor plasma. The two schedules had the same effects in terms of efficacy but single donor replacement gave significantly less side effects in the short and long term. A two exchange procedure on alternate days associated with immunosuppression seems to be an optimal schedule for the treatment of myasthenic patients. A single donor two-exchange on alternate days procedure appears to be safe, useful and can be repeated in patients who need frequent TPE.
Toxicity in Uremia 2. Correlation between PTH Levels and Impaired Aspecific Immunity
Authors: Esposito R. , Romano-Carratelli C. , Lanzetti N. , Hohenegger M. , Pluvio M. , Capodicasa G. , Nuzzo I. , Giordano C.
Published: April 2018

The role of PTH in depressing polynuclear leucocyte (PMN) phagocytosis in uremia was investigated. The hydrophobicity and phagocytic activity of normal PMN was tested in presence of uremic patients’ serum with low (Group A) or high (Group B) levels of plasma PTH.

The PMN phagocytic index was lowered by serum of both groups, but more in presence of Group B serum (p A vs B < 0.002). Similarly, the contact angle of cells was affected more in presence of serum of patients with high PTH levels (p B vs A < 0.003; p B vs C < 0.002).
Quantitative Estimation of Dietary Intake in Patients on Hemodialysis
Authors: Kimura G. , Kojima S. , Saito F. , Kawano Y. , Imanishi M. , Kuramochi M. , Omae T.
Published: April 2018

A simple method to calculate the amount of dietary (protein, sodium and potassium) intake in hemodialyzed patients was developed. In 8 nutritionally stable patients, the amount of dietary intake was monitored conventionally by a dietary record method. In contrast, assuming that the amount of dietary intake was equal to the amount of accumulation in the body, the former was calculated as the change in the product of serum concentrations and total body fluid volume, which was estimated based on the sex and body build of each patient. The urea accumulation was converted to the protein intake. The interdialytic dietary protein and sodium intake calculated by this method, 120 ± 10 g and 240 ± 40 mEq, respectively, was not significantly different from that obtained by the dietary record, while the interdialytic potassium accumulation, 60 ± 7 mEq, was significantly smaller than the dietary intake, 110 + 9 mEq, obtained by the record method, though the correlation was significant. Thus, the amount of protein and sodium intake can be calculated simply without diet research or body fluid volume measurements. Although potassium intake can not be calculated exactly because of intestinal loss, this simple method gives us a rough estimate. In addition, multiple regression analysis showed that the amount of energy intake obtained by the record method may be explained by the protein and sodium intake estimated by simple calculation.
Aspects of Biocompatibility of Two Different Dialysis Membranes: Cuprophane and Polysulfone
Authors: Amato M. , Salvadori M. , Bergesio F. , Messeri A. , Filimberti E. , Morfini M.
Published: April 2018

Intradialytic hypoxemia, leukopenia and coagulation system activation were monitored in 9 uremic patients during hemodialysis with cuprophane (Cu) and polysulfone (Psf) membranes, using the following parameters: polymorphonuclear count (PMN), elastase alpha-1 proteinase inhibitor (EI-α1PI) complex, platelet count, β-thromboglobulin (BTG), fibronectin (FN) and arterial oxygen tension (PaO2).

Our results indicate that 1) intradialytic hypoxemia observed with both membranes does not seem to be exclusively related to the well-known membrane-dependent leukopenia; 2) platelet activation, as demonstrated by the plasma BTG increase, appears to be an exclusive cellulosic membrane-related phenomenon; 3) at the same time platelet activation seems to be the major factor responsible for high FN levels, the highest FN levels occurring concurrently with the lowest platelet count.
Removal and Recovery of Cholesterol in Thermofiltration
Authors: Takeyama Y. , Malchesky P.S. , Cressman M.D. , Yamashita M. , Horiuchi T. , Usami M. , Koo A.P. , Pence G. , Nose Y.
Published: April 2018

Thermofiltration, a system of membrane plasmapheresis for LDL apheresis, was applied to the treatment of hypercholesterolemic patients to assess its lipid lowering potential, clinical feasibility and post-treatment lipid recovery.

Plasma separated by a membrane separator was warmed above physiologic temperature, filtered with a plasma filter and returned to the patient on-line without requiring supplemental plasma product infusion. One calculated plasma volume was treated. Treatment schedules were weekly, biweekly or monthly. Patients treated by thermofiltration in this study were diagnosed as type II hypercholesterolemia. Reductions and sievings of high density lipoprotein (HDL) cholesterol and low density lipoprotein (LDL) cholesterol were evaluated. In addition, post-treatment solute recovery was assessed.

The reduction ratios of HDL cholesterol and LDL cholesterol were 0.31 ± 0.08 and 0.58 ± 0.08, respectively (mean ± S.D. of 7 patients). Sieving coefficients of the plasma filter for HDL cholesterol and LDL cholesterol were 0.62 ± 0.12 and 0.03 ± 0.02, respectively (mean ± S.D. of 32 treatments). Cholesterol reduction fitted well to a single pool model. HDL cholesterol recovered significantly faster than LDL cholesterol and LDL cholesterol recovery differed among individuals. For some patients total cholesterol and LDL cholesterol levels were lowered by the biweekly treatment while for others the weekly treatment was required. Significant removal of LDL cholesterol with sparing of HDL cholesterol was achieved without the requirement for plasma products.
Clinical Effect of Recombinant Human Erythropoietin on Anemia Associated with Chronic Renal Failure. A Multiinstitutional Study in Japan
Authors: Akizawa T. , Koshikawa S. , Takaku F. , Urabe A. , Akiyama N. , Mimura N. , Otsubo O. , Nihei H. , Suzuki Y. , Kawaguchi Y. , Ota K. , Kubo K. , Marumo F. , Maeda T.
Published: April 2018

Clinical effect and safety of recombinant human erythropoietin (r-HuEPO) were evaluated in 66 hemodialysis patients with intractable anemia. Initially, 50U/kg dry weight (DW) of r-HuEPO was administered intravenously at the end of every hemodialysis procedure for 4 weeks, then the dosage was increased to 100 and 200U/kg DW for poor responders. The patients’ hematocrits rose from 19.8 ± 2.3% (pretreatment) to 30.2 ± 4.9% after 12 weeks. From 206 U of blood transfusion requirement in the 3-month period before the study, only 34 U were needed after treatment. Serum iron and ferritin levels fell significantly during the study, and iron storage was considered to be one of the decisive factors in the response to r-HuEPO. Blood pressure rose in the course of r-HuEPO administration, but uncontrollable hypertension was rarely observed. There was no significant adverse effect of r-HuEPO except for this mild hypertension. These results indicate that r-HuEPO is an excellent therapeutic aid for the anemia associated with chronic renal failure.
Suppression of Neutrophil Superoxide Production by Conventional Peritoneal Dialysis Solution
Authors: Ing B.L. , Gupta D.K. , Nawab Z.M. , Zhou F-Q. , Rahman M.A. , Daugirdas J.T.
Published: April 2018

The pH of conventional peritoneal dialysis solution is normally in the range of 5.0 to 5.5, because acid has been added during the manufacturing process to prevent caramelization of dextrose during sterilization. We studied the effects of normalizing the pH of conventional peritoneal dialysis solution on superoxide production by normal human neutrophils. At a pH of 6.0, superoxide generation was 4.07±2.56 (SD) nanomoles per million cells. With normalization of pH to 7.4, superoxide production was 19.3± 7.3 (p < 0.001).

The results suggest that the unphysiologic acidity of conventional peritoneal dialysis solution has deleterious consequences on neutrophil superoxide formation.
Glucose Metabolism, Lipidic Pattern, Apolipoprotein A and B during Hemodialysis with Cuprophan and Hemodialysis-Hemoperfusion
Authors: Allegra V. , Mengozzi G. , Vasile A.
Published: April 2018

We studied differences in the glucose metabolism, lipid pattern and apolipoprotein A and B after one month of combined hemodialysis-hemoperfusion (HD-HP) in eight regular maintenance hemodialysis (HD) patients.

After one month of HD-HP predialytic serum creatinine and phosphate were lower than during the preceding HD period; the lipidic pattern and apolipoproteins were unchanged. A single HD-HP session significantly reduced triglycerides; this does not occur during HD. Postdialytic changes of all other lipoprotein metabolism parameters are identical in the two techniques.

As regards glucose metabolism, after one month of regular HD-HP treatment glycemic curves during the intravenous glucose tolerance test (IVGTT) were perfectly matched with those in HD. However, insulin production was lower, with a reduction of the insulin resistance index. Differences did not reach statistical significance.

The Authors infer that activated charcoal, even though it achieves better blood purification in uremia, may be unable to remove specific substances which hamper some key enzyme activities of the carbohydrate and lipid metabolism.
Influence of Different Dialyzer Membranes on Plasma Fibronectin Levels in Hemodialyzed Patients
Authors: Pertosa G. , Pasture A. , Schena F.P.
Published: April 2018

Plasma fibronectin (FN) was assayed in 30 patients with chronic renal failure under conservative therapy, 60 uremic patients undergoing periodic hemodialysis, and 7 patients treated by hemofiltration.

Plasma FN was significantly lower in uremic patients on conservative therapy and in those who received intermittent hemodialysis than in the control group. No difference was seen between mean FN concentrations using different dialyzer membranes. Nevertheless, plasma FN levels were significantly higher in subjects after intermittent hemofiltration. There was no evidence of activation of the coagulation system or of any correlation between FN and fibrinogen values.

These findings suggest that conventional hemodialysis is not effective in improving the low levels of plasma FN found in uremic patients, whereas intermittent hemofiltration raises FN. These differences may be due to the fact that during hemofiltration, even when using the same dialyzer membranes as in conventional hemodialysis, some “substances” with high molecular weight that could block the synthesis of FN could be removed.
Radionuclide Assessment of the Natural Heart Ejection Fraction before and after LVAD Implantation
Authors: Moritz A. , Napoli C. A. , Feiglin D. , Uchida N. , Harasaki H. , Smith W. A. , Nose Y.
Published: April 2018

Complete pressure unloading of the ventricles can preserve ischemically damaged myocardium. Most clinical left heart assist device (LVAD) systems used after ischemic injury of the heart apply atrial cannulation which does not ensure pressure unloading. In order to assess the effect of the implantation of an intracorporeal LVAD on the function of the natural heart, we determined the ejection fraction (EF) in four male Holstein calves (90–105 kg) before and after insertion of a Cleveland Clinic pneumatic LVAD. A gated blood pool scan was obtained with a gamma camera after injection of 40 mCi Tc-labelled albumin. The animals were restrained in a sling to avoid movement artifacts.

All animals showed a drop of 65 ± 12% to 42 ± 14% EF in the first postoperative (p.o.) week. Left ventricular output did not maintain sufficient blood pressure as assessed by pump-off tests. Systolic blood pressure dropped from 122 ±6.5 mm Hg to 81 ± 6 mm Hg without pump support on the morning of the first p.o. day.

Apical coring and possible restrained heart movement by the implanted LVAD may lead to impaired myocardial function that renders the individual LVAD dependent until adaptative corrections take place.
Effectiveness of Erythrocytapheresis in Idiopathic Hemochromatosis. Report of 14 Cases
Authors: Conte D. , Mandelli C. , Cesana M. , Ferrini R. , Marconi M. , Bianchi A.
Published: April 2018

Thirteen men and one woman (mean age 48.8 yr ± 6.9, range 36–63) with idiopathic hemochromatosis were treated by erythrocytapheresis. Iron depletion followed 9–60 months treatment (median 24), with 21–203 erythrocytaphereses (mean 93 ± 61) and total iron removal of 4.2–40. 6 g (mean 19 ± 11.9). Trasferrin saturation decreased from 90 ± 8.7% to 17 ± 10.6% and serum ferritin from 3164 μg/L ± 1488 to 60.5 μg/L ± 77.5, and liver iron content normalized in all cases. Initial serum ferritin in the patients who were iron-depleted at 18 months (50%, cumulative percentage) was significantly lower than in those still iron loaded at that time (2280 μg/L ± 940 vs 4049 μg/L ± 1444, p<0.02). Clinical improvement was noted in all cases with about a 30% decrease in insulin requirement in most diabetics. Thus erythrocytapheresis appears to be effettive and safe in obtaining iron depletion in idiopathic hemochromatosis.
Therapy of Venous Hypertension in Calves with Total Artificial Heart (TAH)
Authors: Vašků JAR. , Vašků J. , Černý J. , Dostál M. , Doležel S. , Vašků A. , Guba P. , Urbánek P. , Petržilka J. , Šotolová O. , Bednařík B. , Nečas J.
Published: April 2018

Vasomotor disregulation, preponderantly expressed by a pathological increase of central venous pressure (CVP) in calves with total artificial heart (TAH), starts to be evident from about the 50th day of pumping. The main cause of this state is an imbalance in cardiac receptor areas. Ventricular vasodepressor mechanisms are eliminated with the ventricular tissue, which is replaced by the artificial blood pump. In the stumps of both atria, which remain in situ, all neural elements disappear immediately after TAH implantation, but within two months they are fully regenerated. Regenerated atrial receptors are the starting points of afferent neural stimuli, which in the vasomotor center of the brainstem, increase the activity of the vasoconstricting functional component. A general tendency to vasoconstriction, now not well counterbalanced, increases, and the progressive venous hypertension causes loss of liver function and morphology. Two therapeutic approaches were tried: afferent therapy by atrial electrical stimulation, and efferent therapy by the administration of antihypertensives. Both kinds of this therapy were sufficiently effective in reducing CVP, protecting the liver, and prolonging average survival.
Gore-Tex versus Oreopoulos Peritoneal Catheters: Clinical Evaluation and Comparison
Authors: Böss H.-P. , Gänger K. H. , Glück Z.
Published: April 2018

Ten Gore-tex and ten Oreopoulos peritoneal catheters were evaluated in a comparative clinical trial with an average follow-up of 13 1/2 months per catheter. Catheter survival was significantly poorer in the Gore-tex group (p= 0.0016) because of catheter-related complications like tunnel infections, fissure, migration and painful catheter which made it necessary to remove seven Gore-tex catheters. Substantial corrections of the Gore-tex catheter design are proposed.
Clinical Application of Cascade Filtration Combined with Glassbead Adsorbents in Cancer Patients
Authors: Shiozaki S. , Sakagami K. , Miyazaki M. , Matsuoka J. , Uchida S. , Saito S. , Fujiwara T. , Orita K.
Published: April 2018

Cascade filtration (CF) was applied to patients with advanced cancers. To selectively remove immunosuppressive factors with molecular weight lower than albumin, adsbor-bents combined with CF were examined. Among 11 kinds of adsorbents, glassbead adsorbents with pore size 100A were the most effective in adsorbing such substances. Clinically, a column packed with glassbead adsorbents was concomitantly used with CF. The second filtrate was passed through the column and returned to the patient. The removal rate of immunosuppressive substances with molecular weight lower than albumin was only 20% by CF alone, but more than 50% by CF combined with glassbead adsorbents. Clinical symptoms such as severe back pain and general malaise were drastically improved during and after therapy. These results suggest that CF combined with glassbead adsorbents is an effective adjunctive modality to cancer therapy.
A New Approach to Evaluate Platelet Function in Hemodialysis Patients –- Saponin Susceptibility of the Platelet
Authors: Tanaka H. , Tatsumi N. , Ito S. , Ikeuchi H. , Ohno Y. , Kishimoto T. , Maekawa M.
Published: April 2018

Saponin susceptibility of the platelet was studied in 10 healthy men (ages 24 to 39) and 31 male hemodialysis (HD) patients (ages 24 to 49) in order to assess platelet abnormalities in HD patients. Platelet-rich plasma (PRP) was added to 50 ml of saline containing 5 mM phosphate buffer (pH 7.0) and 0.3% saponin. Platelet mean particle volume (MPV) was observed continuously for 200 seconds by a continuous mean particle analyzer model CC-108 (Sysmex, Kobe, Japan).

Initial MPV (Vo, fl) was 7.12 ± 0.89 and 7.68 ± 0.56 respectively for the control and HD patients (p< 0.05), and maximum MPV (V1) was 9.80 ± 1.06 and 9.78 ± 0.83, respectively (n.s.). The time of start of swelling (seconds) was 51.2 ± 14.6 and 63.4 ± 15.6 (p< 0.05) and the time of V1 was 110.4 ± 15.3 and 112.3 ± 16.1 (n.s.), respectively. The expansion rates (V1/Vo) were 1.38 ± 0.05 and 1.27 ± 0.06, respectively (p< 0.01).

The low expansion rate means that the platelet is less responsive to saponin in HD patients, and this may be related to the cholesterol concentration in the platelet membrane and membrane flexibility. This new method offers a useful way of obtaining information about the platelet.
Strategies in Renal Failure and the Impact of Lipids
Authors: Bonomini V. , Scolari M.P. , Mosconi G. , Todeschini P. , Cianciolo G. , Stefoni S.
Published: April 2018

The main points to note in terms of strategies in renal failure and the impact of lipids are: 1) Timing and typing of dyslipidemia; 2) Occurrence of dyslipidemia in the course of strategies (conservative, dialysis and transplantation); 3) How the strategies can handle the impact of lipids. Analysis of point 1 confirms what a complex profile uremic dyslipidemia presents, involving the type, class, composition and enzyme systems involved in lipid metabolism. In conservative and dialysis, type IV (triglycerides) predominates; in transplantation, type II (cholesterol). Examination of point 2 shows the non obligatory relationship between dyslipidemia and the various strategies of treatment. Lipid abnormalities, type IV or II, occur in 50-60% of patients. Uremic factors for dyslipidemia include: 1) enhanced hepatic stimulation or altered removal in conservative strategies; 2) the same causes plus “specific” promotors in dialysis (dialysis fluid, plasticizer leaching; bioincompat-ibility, etc.); 3) steroid therapy and other “accessories” in transplantation. A genetic predisposition is very likely present in all patients. Point 3, finally, analyzes the various “supplements” that each strategy requires to cope with the lipid impact. Generic rules (ranging from doing nothing, to diet, drugs, etc.) are of value in all strategies when dyslipidemia occurs. More specific rules include: a) Conservative strategies: appropriate dietetic optimization and modulation (protein-lipid-carbohydrate ratio in terms of calories); b) Dialysis: timing treatment and improving biocompatibility; c) Transplantation: reducing steroids as much as possible.
The Role of Hemapheresis Technology in Allogeneic Bone Marrow Transplantation
Authors: Di Bartolomeo P. , Olioso P. , Papalinetti G. , Bavaro P. , Di Girolamo G. , Angrilli F. , Accorsi P. , Quaglietta A.M. , D'Antonio D. , Piergallini A. , Dell'isola M. , Angelini A. , Ciancarelli M. , Fioritoni G. , Iacone A. , Torlontano G.
Published: April 2018

In this paper the impact of hemapheresis technology on 238 allogeneic bone marrow transplants performed in Pescara from 1982 through 1993 is described. Granulocyte transfusions were limited to patients with neutrophil level <0.2x109/L. An average of 4 units of packed red blood cells were required to maintain adequate hemoglobin levels. Patients with major ABO incompatibility showed an increased requirement of red blood cell support as compared to patients ABO-matched and ABO minor mismatched. For platelet support single-donor platelets collected on a blood-cell separator were given. A total of 1548 platelet transfusions were examined. The median number of platelet transfusions for each patient was 5. Platelet refractoriness occurred in 44% of patients. The hemorrhage related mortality was 0.9%.

The advancement made in the field of hemapheresis technology, as well as the improved transplant technique, have contributed to increase the post-transplant survival from 17% in the early experience (1976-1982) to 88% in the recent years (1992-1993).
The Use of Erythropoietin in the Treatment of Post-bone Marrow Transplatation Anemia
Authors: Vannucchi A.M. , Bosi A. , Grossi A. , Guidi S. , Saccardi R. , Bacci P. , Lombardini L. , Rossi-Ferrini P.
Published: April 2018

The issue of the role of erythropoietin (Epo) in the erythroid reconstitution after bone marrow transplantation (BMT) has been addressed in several recent studies. A defective Epo production in response to anemia has been shown to occur in patients undergoing allogeneic BMT unlike in most of those subjected to an autologous rescue. The factors involved in the inadeguate Epo production in BMT are discussed, with particular attention to the role of the immunosuppressive drug cyclosporin-A, which has been shown to inhibit Epo production in both in vivo and in vitro models. The observation of defective Epo production eventually led to the development of clinical trials of recombinant human Epo (rhEpo) administration in BMT patients; the aims of these studies were to stimulate erythroid engraftment, hence reducing blood transfusion exposure. Although the number of patients studied up to now is relatively small, a benefit from rhEpo administration in terms of accelerated erythroid engraftment seems very likely, and it may also be associated with decreased transfusional needs in most treated patients. However, further studies are needed to better define indications, dosages and schedules of rhEpo in BMT patients.
Five-year Experience in PBSC Collection: Results of the Catholic University of Rome
Authors: Menichella G. , Pierelli L. , Vittori M. , Serafini R. , Foddai M.L. , Rossi P.L. , Leone G. , Sica S. , Scambia G. , Panici P.L. Benedetti , Bizzi B.
Published: April 2018

Several authors have reported a faster immunological and hemopoietic post- transplant reconstitution using autologous peripheral blood stem cell (PBSC) than using autologous bone marrow stem cells. A large number of PBSC can be collected by leukapheresis during the hematological recovery after induction or salvage chemotherapy. In our experience we demonstrated that several separators, even if they have different results in mononuclear cell (MNC) yields, red blood cell and platelet contaminations, are able to collect PBSC for autotransplantation in patients with several malignant diseases and different status of disease. Eighty three patients were submitted to 590 leukapheresis procedures using 4 different blood cell separators: the results showed that all employed protocols are efficient in the collection of peripheral MNC even if after the widespread use of granulocytecolony stimulating factor (G-CSF) in the harvesting phase, the blood cell separator efficiency in terms of MNC is reduced. The use of GCSF in combination with other growth factors, during chemotherapy mobilization could simplify, in the future, this therapeutical program even if improvements in the efficiency of PBSC collection protocols are required.