bluuebunny/crossref_metadata_2025 huggingface dataset:
Left Heart Bypass in the Pig with a Centrifugal Pump Using Cannulae Prepared for Percutaneous Placement
Authors: Walpoth B.H. , Mehan V. , Rogulenko R. , Aeschbacher B. , Vucic G. , Mettler D. , Althaus U. , Meier B.
Published: March 2018

A rapid and efficient circulatory support system may save a patient in cardiogenic shock. Left heart bypass with percutaneous and trans-septal placement of the aspiration cannula simplifies the circuit and eliminates the need for an oxygenator. In this pre-clinical study we assessed left heart bypass support with a centrifugal pump using new cannulae prepared for percutaneous placement (14 F arterial catheter and 16 F left atrial aspiration line) in 5 anaesthetized pigs. Animals were supported for two hours at a mean flow of 3.2 l/min (4,033 rpm), a mean haematocrit of 29% and low heparinisation (ACT double baseline). Hemodynamic measurements and blood samples were taken at baseline (A), 10 minutes (B), one hour (C) and 2 hours (D) on support. Results show maintenance of hemodynamic parameters throughout the 2 hour support period. Only systolic arterial and left ventricular pressure decreased by 12% and 20% respectively from baseline to the end of the support period with a 13% increase in cardiac output. When the pump was turned on (0–3 l/min) there was usually a decrease in heart rate, systolic pressure and left ventricular pressure, with unchanged cardiac output (non failing model). Potassium increased from 3.9 to 4.2 mmol/l (ns), and plasma hemoglobin from 6.0 to 18.2 mg/dl (p<0.05). Thrombocytes decreased from 187 to 155 109/1 (ns). In conclusion, this preclinical study demonstrated the feasibility of an efficient left heart bypass of short duration with a centrifugal pump using cannulae prepared for percutaneous placement. Left heart bypass was well tolerated hemodynamically and no significant laboratory change occurred within the two hours of support. This opens several possibilities for the short term support of patients in cardiogenic shock and eventually also for patients submitted to minimally invasive cardiac surgery.
Mass Balance Index: An Index for Adequacy of Dialysis and Nutrition
Authors: Raj D. S.C. , Tobe S.W. , Saiphoo C.S. , Manuel M.A.
Published: March 2018

Determining adequacy of dialysis has remained a problem for the nephrologist despite the results of the National Cooperative Dialysis Study published more than 20 years ago. Urea Kinetics Modelling (UKM) which requires computer data entry is time-consuming for the dialysis staff but is the only method that has been rigorously studied. Furthermore, it is unclear today what value of Kt/V represents ideal dialysis; the technique is subject to a number of errors associated with estimation of dialyser clearance (K) and volume of distribution of urea (V) but it is useful for calculating protein catabolic rate (PCR). Methods that use urea reduction ratios (URR) is widely used because it is simpler but not always accurate and suffer from an inability to calculate PCR. Direct dialysis quantification (DDQ) can overcome a number of these problems but it is too cumbersome for routine use. Simpler methods to determine dialysateside kinetics have the advantage of solving a number of these problems and also facilitate the calculation of PCR to determine the patient's nutritional state. In our study, we have demonstrated that by taking two dialysate samples at the beginning and at the end of dialysis (2-DSM), it is possible to determine total urea removal (TUR) which is equivalent to DDQ. By taking blood samples after dialysis and before the next dialysis, it is possible to calculate the total urea generated (TUG). The ratio of TUR/TUG will provide an index of dialysis which places emphasis on removal of solute that has accumulated in the inter-dialytic interval thus re-establishing a state of equilibrium. We refer to this index as the Mass Balance Index (MBI). The MBI is also useful in helping to identify those patients whose PCR is inadequate since the mean MBI for patients with an nPCR <0.8 was 0.93 ± 0.03 vs 1.08 ± 0.02 in those with a PCR >0.8. In these two groups of patients the Kt/V was not significantly different, 1.49 ± 0.07 vs 1.53 ± 0.06, p -0.64. We suggest that the emphasis for adequacy of dialysis should shift away from Kt/V to maintaining a state of equilibrium by removing the solutes that accumulate between dialysis and by identifying those patients with an inadequate PCR.
Monocyte Activation and Humoral Immune Response to Endotoxins in Patients Receiving On-Line Hemodiafiltration Therapy
Authors: Weber C. , Stummvoll H.K. , Passon S. , Falkenhagen D.
Published: March 2018

With the on-line preparation of substitution fluid, an easy-to-operate and cost-effective alter-native to conventional hemodiafiltration (HDF) has been realized. The continuous filtration of dialysis fluid, furthermore, allows high volumes of exchange. Microbial contamination and subsequently endotoxins, however, may be present in dialysis fluid, and thus the microbiological safety has become a pivotal issue.

In this clinical study we evaluated the safety of the Fresenius Medical Care on-line HDF system which is based on a two-stage filtration of dialysis fluid with upstream DIASAFE® and downstream on-line HDF filter. During the three-month study period we failed to detect germs or endotoxins in the substitution fluid. Augmented plasma interleukin-1β (IL-1β) and tumor necrosis factor α (TNFα) concentrations were found neither during the intradialytic period nor when pre-session values at study begin and study end were compared. In addition, changes in the anti-endotoxin core antibody levels and soluble CD14 (sCD14) concentration, or pyrogenic episodes were not observed.

On-line HDF with DIASAFE® and on-line HDF filter thus represents a safe treatment modality by effectively depleting dialysis fluid of cytokine-inducing substances.
Evidence of Profiled Hemodialysis Efficacy in the Treatment of Intradialytic Hypotension
Authors: Colì L. , La Manna G. , Dalmastri V. , De Pascalis A. , Pace G. , Santese G. , Stefanio C. , Ursino M. , Zacà F. , Stefoni S.
Published: March 2018

In the last 10 years the percentage of dialysis patients suffering from clinical intradialytic intolerance has greatly increased.

Profiled hemodialysis (PHD) is a new technical approach, alternative to standard hemodialysis (SHD) for the treatment of intradialytic symptomatic hypotension. It is based on intradialytic modulation of the dialysate sodium concentration, using a dialysate sodium concentration profile elaborated by a new mathematical kinetic model.

The aim of PHD is to reduce the intradialytic blood volume decrease, thanks to a dialysate sodium profile, which allows a reduction in the plasma osmolarity decrease, thereby boosting intravascular fluid refilling.

This work aims at clinically validating the PHD technique, by testing its ability, against SHD, to maintain a more stable intradialytic blood volume; this evaluation was supported by monitoring some hemodynamic parameters.

Twelve dialysis patients on SHD treatment were selected because of their intradialytic symptomatic hypotension. Twelve SHD (one per patient) and 12 PHD sessions (one per patient) were performed to achieve the same sodium mass removal and body weight decrease on both PHD and SHD. During these sessions we monitored the blood volume variation % by the critline (a non invasive blood volume monitoring device), the mean blood pressure and heart rate directly and, finally, the stroke volume and cardiac output indirectly by bidimensional doppler-echocardiography.

Comparison of the results obtained with the two techniques shows PHD to achieve a significantly more stable blood volume, blood pressure and cardiovascular function than SHD, in particular during the second and the third hour of the dialysis session.
Effects of Dialysis Membranes on the Kinetics of Tumor Necrosis Factor-α Production by Peripheral Mononuclear Cells in Chronic Hemodialysis Patients
Authors: Kushihata S. , Yorioka N. , Oda H. , Ye X.F. , Yamakido M.
Published: March 2018

To evaluate the biocompatibility of dialysis membranes, blood samples were collected from 10 hemodialysis patients immediately before dialysis and peripheral blood mononuclear cells were isolated. The 3.0 x 105 cells/ml were then passed 30 times through modules made of a polyethylene glycolgrafted cellulose membrane, a polyacrylonitrile membrane, and a polysulfone membrane. Expression of messenger RNA for tumor necrosi factor-α (TNF-α) was determined. Cells were also cultured for 2 h with and without lipopolysaccharide and TNF-α levels in the supernatant were measured.

TNF-α messenger RNA expression was significantly higher immediately after passage through the polyacrylonitrile membrane compared with the other membranes. Cells cultured without lipopolysaccharide, produced significantly less TNF-α after passage through the polysulfone membrane, while lipopolysaccharide significantly increased TNF-α production by cells passed through the polyacrylonitrile membrane. These results suggest that biocompatibility differs even among dialysis membranes believed to cause no complement activation.
Long-Distance Transportation of Patients with a Paracorporeal Left Ventricular Assist Device
Authors: Mestres C.A. , SáNchez-Martos A. , RodríGuez-Ribó A. , DáValos R. , Galcerá J. , Fuentes M.
Published: March 2018

Patients in cardiogenic shock refractory to basic medical therapy may require specialised assistance in a multispeciality environment distant to the institution where they are first admitted. In such situations, transportation of these critical patients may be difficult and involve many risks. Here we describe the case histories of two patients who underwent implantation of a paracorporeal left ventricular assist device and were transferred to specialised institutions for extended treatment. The distance of transportation was 400 km and the patients were transported by ambulance and helicopter. Some aspects of logistics and complexity of long-distance transportation are also commented on.
Comparison among Three Different Biocoatings for Orthopaedic Prostheses. An Experimental Animal Study
Authors: Rocca M. , Orienti L. , Stea S. , Moroni A. , Fini M. , Giardino R.
Published: March 2018

One-hundred-eighty cylindrical monocortical titanium implants, 4mm diameter and 12mm long, with three different coatings: fluorohydroxyapatite (group A), hydroxyapatite (group B), and titanium oxide (group C), all applied by vacuum plasma spray were bilaterally, randomly implanted into the femurs and tibiae of twelve adult mongrel sheep. The sheep were divided into four groups (1, 2, 3 and 4) numbering three sheep each. Sheep of groups 1, 2, 3 and 4 were euthanized at two weeks, one month, three and nine months after implantation, respectively. Biomechanical and histomorphological analysis were performed. Extraction torque increased over time in all groups until the nine months period. At all the studied periods, the bone-implant contact was higher in Groups A and B compared to Group C. However, only at nine months did this difference reach statistical significance (p<0.005 comparing Groups A and B to C). The results of this study show that all the three coatings could be recommended for clinical applications.
Quality of Health Care: The Responsibility of Health Care Professionals in Delivering High Quality Services
Authors: Giangrande A.
Published: March 2018

According to a recent definition, quality of care consists of the degree to which health services increase the likelihood of desired health outcomes and are consistent with current professional knowledge; a definition that introduces both requirements of outcomes and the appropriateness of the process used. Clearly many different figures are interested in quality assessment initiatives in the health care field and these include patients, administrators and doctors each having different perspective. Doctors obviously pay greater attention to technical quality and results, giving greater emphasis to the health of the individual patient, tending to give priority to technical excellence and interaction between patient and doctor. Although the perspective of health care professionals is widely acknowledged to be important and useful, other perspectives on quality have been emphasised in recent years. The most important of these is the recognition that care must be responsive to the preferences and values of the consumers of health care services. In complete harmony with one's own professional commitment, the attention to the perspectives of patients must give physician the chance to identify methods of measuring and verifying quality which take account of the expectations of the many groups with an interest in improving the functioning of the health system. A global approach in the health field is needed the more specialization advances. The quality of medicine lies in its capacity to integrate what science says is appropriate and to be recommended, what can be reconciled with human rights and the self determination of the patient and what can be achieved by optimising available resources. In this complex context, the doctor could take on both the role of the person who decides on the use of resources and the one of social mediator.
Quality Improvement Measures Adopted by the Italian National Health Service
Authors: Langiano T. , Martin S.J.
Published: March 2018

The reform process underway within the Italian National Health System is aimed at making decision makers responsible for appropriate and efficient resource utilisation and at ensuring quality of care, eliminating conflict between fairness, quality and cost control. The risk for the quality of the services provided entailed by resource rationalisation is avoidable and controllable.

This article explains how the Italian NHS has managed the reform process assuring quality improvement, and describes the policy and the tools adopted.

As well as involving all players and the system as a whole in constant improvement, the Italian NHS's policy in pursuing quality of care is based on the adoption of a wide range of measures: measurement of health care and of clinical outcomes, systematic data collection, team work and protocols.

The tools adopted, currently under implementation, to support quality control are: an integrated system of indicators for measuring efficiency and quality of NHS structures (demand and accessibility indicators, resource related indicators, activity indicators and result indicators); compulsory accreditation as a prerequisite for health care providers; a system to monitor and control the effects of the new prospective payment system; clinical guidelines (each related to a specific clinical problem); a menu of services (Carta dei Servizi) released by all NHS accredited service providers with full information and warranties regarding the services provided and their quality.
Reasons for Producing Guidelines on Anemia of Chronic Renal Failure: Dialysis Outcome Quality Initiative of the National Kidney Foundation
Authors: Triolo G. , Canavese C. , Di Giulio S.
Published: March 2018

Guidelines for the treatment of anemia in chronic renal failure (CRF) patients were recently published by NKF-DOQI. The background was provided by the fact that anemia in CRF patients fulfills all the criteria requested for the outlining of guidelines. In fact: 1) anemia is a clinically relevant problem for CRF patients; 2) it may be prevented by adequate erythropoietin (EPO) therapy; 3) a great variability in its management exists, not only concerning the optimal hematocrit (HCT) level, but also the treatment schedule as well as iron supplementation. More than eight hundred forty five scientific articles were retrieved in full text, eventually leading to 530 structurally reviewed papers (349 cited in the final text) thus providing the basis for the strength of recommendations (evidence or opinions): all topics were subdivided into 7 main issues (diagnostic and therapeutic). Main results were the following: HCT, hemoglobin (Hb), red blood cell, serum iron binding capacity, percent transferrin saturation (TSAT) and serum ferritin (FERR), to evaluate the degree of anemia and iron status; HCT 33 to 36% and Hb 11 to 12 g/dl as possible target levels; TSAT >20% and FERR >100 ug/dl as acceptable lower values for iron status; oral iron administration not <200 mg/day of elemental iron and intravenous iron 50–100 mg/week or 500–100 mg/month (for patients on predialysis or peritoneal dialysis) as therapeutic schedules; subcutaneous route for EPO administration at 80–120 U/kg body weight/week as starting doses. Some issues may be debatable, such as, the underestimation of dialysis efficacy among the causes of inadequate response to EPO as well as the risk of thrombosis among the possible side effects of EPO therapy, or the lack of recommendation for upper limits of FERR values. However, this exhaustive study is an important demonstration of efforts to improve the quality of care in CRF patients.
Surface Modification of Polyurethane Heart Valves: Effects on Fatigue Life and Calcification
Authors: Bernacca G.M. , Wheatley D.J.
Published: March 2018

Polyurethane heart valves can be functionally durable with minimal calcification, in vitro. In vivo, these characteristics will depend on the resistance of the polyurethane to thrombogenesis and biodegradation. Surface modification may improve the polyurethane in these respects, but may adversely affect calcification and durability.

This study investigates the effects of surface modifications of two polyurethane heart valves (PEU and PEUE) on their in vitro fatigue and calcification behaviour. Modifications included heparin, taurine, 3-aminopropyltriethoxysilane and polyethylene oxide (PEO). Neither hydrodynamic function nor leaflet thickness distribution was significantly altered by surface modification.

PEO-modification was detrimental to valve fatigue durability and calcification. Heparin, taurine or aminosilane modifications of PEU valves increased durability. Aminosilane modification of PEUE valves increased durability compared with PEO modification.

Appropriate surface modification may be useful to improve blood compatibility of implantable polyurethanes, and may also be advantageous as regards fatigue durability of flexing materials in long-term applications.
Symptoms in Hemodialysis Patients and Their Relationship with Biochemical and Demographic Parameters
Authors: Virga G. , Mastrosimone S. , Amici G. , Munaretto G. , Gastaldon F. , Bonadonna A.
Published: March 2018

Symptoms can markedly influence the hemodialysis patients well-being and quality of life. The aim of this paper is to study the frequency of symptoms at home and how these relate to biochemical and treatment variables.

Seventy-three hemodialysis patients were questioned on the absence, occasional presence or daily recurrence (score = 0, 1, 2) of 14 symptoms and a record was made of their biochemical parameters, age, time on treatment and KtIV as a function of each symptom.

The following relationships were detected: thirst with high Osm and BUN; asthenia with old age and hypoalbuminemia; insomnia with hypercalcemia; hypersomnia with hypoxemia and hypernatremia; anorexia with hypokalemia; dyspnea with old age, hypernatremia and hypokalemia; dysgeusia with hypoxemia; nausea with alkalemia, hypoxemia and low BUN; vomiting with alkalemia. Pruritus, arthralgia, restless legs syndrome, cramp and tremor showed no relationships.

Monitoring acid-base balance and plasma electrolytes could help to alleviate symptoms and ameliorate quality of life of hemodialysis patients.
Static State Hemodynamic Variables Estimation Model for the Moving-Actuator Type Total Artificial Heart Part. II - Aortic Pressure Estimation
Authors: Om K.S. , Jo Y.H. , Min B.G.
Published: March 2018

Aortic pressure (AoP) estimation is a very important study for the artificial heart. In this paper, we developed a AoP estimation model for the moving-actuator type total artificial heart (MHTAH) that was being developed at Seoul National University Hospital. The proposed model is simple and provides beat-by-beat mean AoP estimation. Moreover, it uses non-invasively acquired signals. Model parameters were adjusted with in vitro data by least mean square (LMS) algorithm. Results showed that the proposed scheme gives a mean estimation error of about 8 (mmHg). This ensures the suitability of the proposed model. The proposed approach can also be applied to the model setup of pulmonary arterial pressure (PAP) estimation by using the symmetric characteristics between AoP and PAP.
Changing Acute Renal Failure Treatment from Intermittent Hemodialysis to Continuous Hemofiltration: Impact on Azotemic Control
Authors: Bellomo R. , Farmer M. , Bhonagiri S. , Porceddu S. , Ariens M. , M'Pisi D. , Ronco C.
Published: March 2018

Background

Continuous renal replacement therapy is increasingly used in the management of acute renal failure in critically ill patients. The advantages of continuous renal replacement therapy (CRRT) over intermittent hemodialysis (IHD), however, are not yet fully documented. In particular, it is unknown whether continuous veno-venuous hemodiafiltration (CVVHDF) provides better control of azotemia than IHD.

Objectives

To study the effect on azotemic control of changing acute renal failure treatment from IHD to CVVHDF.

Settings

Tertiary intensive care unit.

Patients

Forty seven consecutive critically ill patients with multiorgan failure and acute renal failure treated with IHD and 47 similar patients treated with CVVHDF.

Methods

Analysis of daily morning urea and creatinine concentrations over the period of renal replacement therapy in the ICU. Statistical comparison of data.

Results

The two groups of patients were comparable for mean age (55 years for IHD vs. 60 years for CVVHDF; NS) and number of failing organs prior to therapy (mean of 4.2 for IHD vs. 3.7 for CVVHDF; NS). Severity of illness at admission as assessed by APACHE II score, however, was greater for patients receiving CVVHDF (29.4 vs 25.7; p<0.003). CVVHDF was associated with a significantly lower plasma urea (p< 0.0001) and serum creatinine (p<0.01) level at 24 hours of treatment despite similar levels at the start of therapy. Throughout the duration of therapy, mean urea levels (35.0 mmol/L for IHD vs 23.4 mmol/L for CVVHDF) and mean serum creatinine levels (513 micromoles/L for IHD and 263 micromoles/L for CVVHDF) showed significantly (p <0.0001) better control of uremia with CRRT.

Conclusions

Changing the form of renal replacement therapy from intermittent hemodialysis to continuous hemofiltration is associated with improved control of azotemia. The superior adequacy of small solute clearance achieved during CVVHDF provides additional support for its preferential use in the management of acute renal failure in the ICU.
Bioelectrical Impedance Analysis before and after Novacor Implantation
Authors: Stellato D. , Cirillo M. , De Santo L.S. , Maiello C. , Marra C. , de Vivo F. , Anastasio P. , Di Iorio B.
Published: March 2018

In this study Bioelectrical Impedance Analysis was performed in 5 patients with end stage heart failure in whom a left ventricular assist device (Novacor) was successfully implanted. Whole body measurements of bioelectrical indices resistance and reactance were taken before surgery and 3, 7, 12, and 15 days after it. After surgery there was a significant decrease in reactance, indicating a shift of body fluids from intra- to extra-cellular space.
Functionally Adapted Surfaces on a Silicone Keratoprosthesis
Authors: Langefeld S. , Völcker N. , Kompa S. , von Fischern T. , Bienert H. , Klee D. , Höcker H. , Reim M. , Schrage N. F.
Published: March 2018

Background

Silicone intraocular lenses as well as silicone sponges and encircling bands on the bulbar surface are widely used and are well tolerated. The aim of this project is a new one-piece silicone keratoprosthesis with enhanced cell adhesion in the haptic region to optimize the keratoprosthesis stability. These investigations show how enhanced profileration of conjunctival fibroblasts and, therefore, improved tissue compatibility can be achieved by hydrophilizing and by protein immobilisation on a hydrophobic silicone surface. This allows a combination of desired chemical and mechanical properties of the silicone bulk material with surfaces of improved tissue compatibility.

Methods

Silicone foils with surface modifications of different kinds were tested. Experiments were done using cell cultures with murine fibroblasts L-929 and human conjuctival fibroblasts. Cytotoxicity assays were carried out with cells grown on the material in direct contact, as well as in indirect contact, with extracts (EN 30993-5). Viability stains by means of fluoresceindiacetate and ethidiumbromide together with morphology analyses by hemalaun-staining were performed.

Results

For the unmodified and modified foils themselves and their extracts any negative influence on cell cultures of murine and human cells could be excluded. There was a gradual improvement of cell morphology, spreading and proliferation dependent on the degree of surface modification. Covalently immobilised fibronectin showed the best results in contrast to adsorptive binding.

Conclusions

Silicone surfaces can be modified chemically with bioactive proteins. These modifications are cell compatible and do not result in toxic reactions. The degree and type of silicone hydrophilization results in improved development of cell morphology, spreading and proliferation. Even better results are obtained after covalent binding of bioactive proteins like fibronectin. Improved biocompatibility with enhanced cellular overgrowth has been demonstrated in vitro for the modified silicone of the haptic region. We believe that this type of modification will help in reducing extrusion problems observed with former keratoprostheses.
Effects of Anticoagulants on Porcine Hepatocytes in Vitro: Implications in the Porcine Hepatocyte-Based Bioartificial Liver
Authors: Eguchi S. , Kawazoe Y. , Sugiyama N. , Kawashita Y. , Fujioka H. , Furui J. , Kanematsu T.
Published: March 2018

For the clinical treatment with porcine hepatocyte-based bioartificial liver (BAL), the use of an anticoagulant in the extracorporeal system is essential. In this experiment, we studied the effect of various anticoagulants on cultured porcine hepatocytes. Porcine hepatocytes were isolated and seeded at a density of 2 × 105 cells on a collagen-coated plate in Dulbecco's modified Eagle's medium (DMEM) with 10% fetal calf serum (FCS). Twenty-four hours later, the medium was changed to DMEM with various anticoagulants such as nafamostat mesilate (NM), sodium heparin (SH) and sodium citrate (SC) at concentration used clinically. As a control, the hepatocytes were cultured in only DMEM. After culturing for 6 hours, the viability of the porcine hepatocytes, lactate dehydrogenase (LDH) release, lidocaine clearance (cytochrome p450 function) and albumin synthesis were investigated. SC did not affect either the viability or the p450 function of the hepatocytes. In the NM group, the viability of porcine hepatocytes and lidocaine clearance were decreased significantly more than in the other groups. SH did not affect the viability of porcine hepatocytes, however, it seemed to reduce the p450 function. In conclusion, SC may therefore be the optimal anticoagulant available for hepatocyte-based BAL circuit in terms of its cell toxicity.
Large Volume Leukapheresis for Collecting Hemopoietic Progenitors: Role of CD 34+ Precount in Predicting Successful Collection
Authors: Menichella G. , Lai M. , Serafini R. , Pierelli L. , Vittori M. , Ciarli M. , Rumi C. , Puggioni P. , Scambia G. , Sica S. , Leone G.
Published: March 2018

In this work we evaluated the efficacy of stem cell collection with Large Volume Procedures. (LVP), and analysed the importance of the CD34+ cell precount in promoting the collection of a sufficient number of CD34+ cells for transplantation, using the Univariate Logistic Regression analysis. Eighty-nine leukapheresis were performed in 49 patients with hematological malignancies and solid tumors, mobilized with chemotherapy plus Granulocyte Colony Stimulating Factor (G-CSF). For each procedure 15.8 liters of blood were processed. The median value of Nucleated Cells (NC) and CD34+ cells precount was respectively 8.29 × 109/ml (range 1.13÷45.4) and 43.08 × 103/ml (range 1.06÷795.2). Results show the capability of LVP to collect large quantities of hemopoietic progenitors with a median CD34+ cell total yield of 215.02 × 106 (range 5.03÷2210). The yields per patients’ body weight were: CD34+ cells 3.23 × 106/kg (range 0.081÷41.58). The regression analysis between blood cell precounts and collection yields gave the following correlations: the CD34+ cell precount correlates with CD34+ yield (r = 0.78 p < 0.00) and with CD34+ cell yield/kg (r = 0.76 p < 0.00). The number of CD34+ cells processed correlated with the number of CD34+ cells collected/kg (r = 0.83 p < 0.000). To investigate the importance of CD 34+ cell precount in promoting CD34+ cell yields ≥2.5 × 106/kg we performed a Univariate Logistic Regression analysis that showed in our patients a probability of collecting ≥2.5 × 106 CD34+/kg that rose from 0.6 to 0.95 for CD 34+ precounts that oscillated from 30 to 40 × 103 CD34+ cells/ml, respectively. The Univariate Logistic Regression gave a probability of collecting ≥2.5 × 106 CD34+ cells/kg that oscillated between 0.64÷0.98 for values of CD34+ cells processed from 6 × 106/kg to 8 × 106/kg, p <0.000. Sixty-three percent of patients reached the target dose of 2.5 × 106 CD34+ cells/kg with only one LVP. Until now 12 patients have been transplanted and all have had a prompt and complete lasting recovery. These results confirm the efficacy of LVP in harvesting hemopoietic progenitors and their ability in reconstituting hemopoiesis of transplanted patients, enabling the estimation of CD34+ precounts and CD34+ cells processed values, highly predictive for the collection of ≥2.5 × 106 CD34+ cells/kg. Furthermore, the Logistic Model suggests that the best strategy to plan a successful CD34+ cell collection procedure is to identify for each patient the amount of CD34+ cells/kg to be processed rather than the fixed processing of 3÷5 blood volumes in all patients.
Prolonged Nonpulsatile Left Heart Bypass Diminishes Vascular Contractility
Authors: Nishimura T. , Tatsumi E. , Nishinaka T. , Taenaka Y , Nakata M. , Takano H.
Published: March 2018

We investigated possible functional changes in the vascular system accompanying the morphological change in prolonged nonpulsatile left heart bypass (LHB). Three adult goats underwent pulsatile LHB. Two weeks postoperatively, the pulsatile ventricular assist device was replaced with a centrifugal pump and nonpulsatile LHB was subsequently conducted for 4 weeks. The mean aortic pulse pressure was 39 and 16 mmHg during the pulsatile and nonpulsatile LHB, respectively. Systemic vascular resistance (SVR) and plasma norepinephrine levels were measured at the end of pulsatile LHB (PUL), and at the end of 1st, 2nd, 3rd, and 4th week of nonpulsatile LHB (NP1w, NP2w, NP3w, NP4w, respectively). At each point, 50 μg/kg nitroglycerin and 1μg/kg norepinephrine were injected and the minimal and maximal values of SVR after injection were calculated as parameters reflecting the vascular tonus and contractility. The SVR and plasma nor epinephrine level did not significantly change during the entire course (SVR: 1106, 895, 982, 920, and 938 dyne·sec·cm−5; norepinephrine level: 0.3, 0.2, 0.1, 0.2, and 0.1 ng/ml; at PUL, NP1w, NP2w, NP3w, and NP4w, respectively). The minimal value of SVR after nitroglycerin injection remained unchanged, indicating that vascular tonus was stable during the entire course (618, 687, 623, 560, 653 dyne·sec·cm−5, respectively). In contrast, the maximal value of SVR after norepinephrine injection at NP3w and NP4w (1695 and 1759 yne·sec·cm−5) became significantly reduced compared to that at PUL (2346 dyne·sec·cm−5). These results indicated that prolonged nonpulsatile left heart bypass did not affect the vascular tonus, but significantly diminished the vascular contractility.
Changes in HCV Viremia following LDL Apheresis in a HCV Positive Patient with Familial Hypercholesterolemia
Authors: Marson P. , Boschetto R. , De Silvestro G. , Martini S. , Gabelli C. , Buoro S. , Giordano R. , Palù G.
Published: March 2018

It has been suggested that hepatitis C virus (HCV) can be associated with beta-lipoprotein in human serum. According to this, the LDL receptor could promote endocytosis of such a virus. In the present study, we evaluated the changes in HCV viremia in a HCV positive patient with familial hypercholesterolemia, undergoing both selective (DALI System, Fresenius) and non-selective (plasma exchange) LDL apheresis. HCV-RNA levels did not decrease following selective LDL apheresis, on the contrary showed a random, odd variation pattern (from –35% to +72%). Conversely, plasma exchange steadily induced a drop in HCV viremia (–35/43%), to a lower extent than that of a totally intravascular plasmaprotein, i.e., alpha 2-macroglobulin (–53/54%). These data indicate that beta-lipoprotein may not function as a plasma carrier of HCV, at least in the present case. Moreover, a continuous, quantitatively unforeseeable circulation of HCV virions from the intravascular plasma compartment to other extravascular and intracellular sites, seems to occurr during an apheresis session.
Ozonation of Blood during Extracorporeal Circulation. I. Rationale, Methodology and Preliminary Studies
Authors: Bocci V. , Di Paolo N. , Garosi G. , Aldinucci C. , Borrelli E. , Valacchi G. , Cappelli F. , Guerri L. , Gavioli G. , Corradeschi F. , Rossi R. , Giannerini F. , Di Simplicio P.
Published: March 2018

We investigated whether exposure of blood ex-vivo to oxygen-ozone (O2-O3) through a gas exchanger is feasible and practical. We first evaluated the classical dialysis-type technique but we soon realized that semipermeable membranes are unsuitable because they are hydrophilic and vulnerable to O3. We therefore adopted a system with hydrophobic O3-resistant hollow fibers enclosed in a polycarbonate housing with a membrane area of about 0.5 m2. First we tested the system with normal saline, determining the production of hydrogen peroxide (H2O2) at O3 concentrations from 5 to 40 μg/ml. We then evaluated critical parameters by circulating swine blood in vitro; this revealed that heparin is not an ideal anticoagulant for this system. Finally, we performed several experiments in sheep and defined optimal anticoagulant dose (sodium citrate, ACD), priming solution, volume of blood flow per min, volume and concentration of O2-O3 mixture flowing counter-current with respect to blood and the time necessary for perfusion in vivo. The biochemical parameters showed that an O3 concentration as low as 10 μg/ml is effective; this means that gas exchange and O3 reactivity are rapid and capable of inducing biological effects. The sheep showed no adverse effects even after 50 min of extracorporeal circulation at higher O3 concentrations (20 to 40 μg/ml) but the exchanger became less effective (low pO2 values) due to progressive clogging with cells.
Optimization of the Pump Driven Venous Return for Minimally Invasive Open Heart Surgery
Authors: Tevaearai H.T. , Mueller X.M. , Jegger D. , Augsburger M. , Stumpe F. , Von Segesser L.K.
Published: March 2018

Blood return into the cardiotomy reservoir is usually reduced when a cardiopulmonary bypass (CPB) is initiated through a peripheral access, even if the tip of the venous cannula is pushed into the right atrium. A centrifugal pump can be placed on the venous line to increase the negative pressure. Surgery involving the right atrium requires selective cannulation of both vena cavae. Because of the small diameter of the vena cava as compared to the right atrium, the benefit of the centrifugal pump may have limitations. We analyze the factors influencing the active venous return when the cannula is maintained into the vena cava. In 4 calves (83.0±14.9 Kg) a CPB was initiated through carotid and jugular access, with the tip of the venous cannula placed into the superior vena cava, before ventricular fibrillation was provoked. Venous drainage was progressively increased thanks to the centrifugal pump. Considering the negative pressure induced on the venous line, we analyzed the performance expressed in l/min of blood drained, of four one stage cannulae (“lighthouse” tip 24F, 28F or 32F, and percutaneous 28F). The performance of all cannulae were highly dependent on the central venous pressure (CVP) with better drainage for higher CVP The size and type of cannula also significantly affected blood drainage. Active drainage was best with the percutaneous 28F cannula. This cannula was specially attractive at low CVP conditions.
Significantly Improved Survival Time in Pigs with Complete Liver Ischemia Treated with a Novel Bioartificial Liver
Authors: Flendrig L.M. , Calise F. , Di Florio E. , Mancini A. , Ceriello A. , Santaniello W. , Mezza E. , Sicoli F. , Belleza G. , Bracco A. , Cozzolino S. , Scala D. , Mazzone M. , Fattore M. , Gonzales E. , Chamuleau R.A.F.M.
Published: March 2018

Aim of the study was to evaluate treatment efficacy and safety of a scaled-up version of our porcine hepatocytes based BAL system in pigs with complete liver ischemia (LIS).

Thirty-one pigs underwent total devascularization of the liver (LIS) by termino-lateral porta-caval shunts and sutures around the bile duct, the common hepatic and gastroduodenal arteries and their accessory branches. The hepato-duodenal ligament was completely transected. Four experimental groups were studied: the first control group (LIS Control, n = 10) received glucose infusion only, the second control group (LIS Plasmapheresis, n = 8) was connected to a centrifugal plasma-separator with a bottle representing the bioreactor volume, the third control group (LIS Empty-BAL, n = 5) received BAL treatment without cells, and the treated group (LIS Cell-BAL, n = 8) was connected for a maximum period of 24 hours to our scaled-up BAL seeded with around 14 billion viable primary porcine hepatocytes.

BAL treatment significantly prolonged life in large animals (-35 kg) with complete LIS (Controls, mean ± SEM: 33.1 ± 3 h, Cell-BAL: 51.1 ± 3.4 h; p = 0.001; longest survivor 63 h). In addition, blood ammonia and total bilirubin levels decreased significantly, indicating metabolic activity of porcine hepatocytes in the bioreactor. No significant differences were noticed among the three control groups, indicating that there was no device effect and that the plasmapheresis procedure was well tolerated. No important adverse effectes were observed.
Morphological and Functional Evaluation of Isolated Rat Hepatocytes in three Dimensional Culture Systems
Authors: Puviani A.C. , Lodi A. , Tassinari B. , Ottolenghi C. , Ganzerli S. , Ricci D. , Pazzi P. , Morsiani E.
Published: March 2018

Various three-dimensional configurations, such as polyester tissue and woven-nonwoven, hydrophilic polyester fabric, either collagen-coated or uncoated, were investigated as potential scaffold for hepatocyte culture, in view of their use in bioreactors for hybrid liver support systems. Attachment, morphology and ultrastructure of primary adult rat hepatocytes were evaluated, as well as urea production and ammonium detoxification during a 24h incubation period in serum-free tissue culture medium. As control, hepatocytes were also plated onto collagen-coated dextran microcarriers and on plastic petri dishes, either collagen-coated or uncoated. In all the three-dimensional cultures, hepatocytes appeared morphologically intact without any statistically significant difference in metabolic activity. Collagen-coating did not influence cell attachment to polyester substrates, whereas woven-nonwoven hydrophilic polyester fabric may offer some potential advantages as three-dimensional system for hepatocyte culture in hybrid liver support systems.
Which Organic Acids does Hemofiltrate Contain in the Presence of Acute Renal Failure?
Authors: Guth H.-J. , Zschiesche M. , Panzig E. , Rudolph P. E. , Jäger B. , Kraatz G.
Published: March 2018

It is not generally possible to measure most organic acids in the serum of critically ill patients, due to rapid metabolism and methodological problems. Only the regular measurement of lactic acid and the arterial ketone body ratio (acetoacetate/beta-hydroxybutyrate, AKBR) have been introduced in clinical practice, but these parameters can represent only a part of the disturbed metabolism. In pediatric patients, a chromatographical urine analysis has been established for detection of inborn errors of metabolism, which allows the determination of more than 50 organic acids simultaneously (gas chromatographic (GC) analysis in combination with mass spectrometry (MS)]. In continuous treatment of acute renal failure, hemofiltrate is always available, but it contains only low protein concentrations and after the filtration process, metabolism is rapidly stopped. The sieving coefficient of lactic acid is nearly one in hemofiltration. The aim of our study was to compare results of the regular and CG/MS methods in blood and hemofiltrate for lactic acid, and to find other organic acids of possible clinical importance. We investigated serum (lactic acid) and hemofiltrate of 40 critically ill patitens, similar to the urine analysis method for infants. All patients suffered from acute renal failure and were treated by continuous veno-venous hemofiltration (CVVH). The conditions of treatment were standardized (spontaneous ultrafiltration in the first hour), and the material (blood/hemofiltrate) was taken one hour after the beginning of extracorporeal circulation. Statistical methods included correlation analysis, nonparametric ANOVA with Wilcoxon scores (ranks of data), and stepwise discriminant analysis. Regular and GC/MS methods in hemofiltrate showed a good correlation for lactic acid. The best correlation with lactic acid was found for 4-hydroxy-phenyllactic acid (n=20, r=0.866), 2-hydroxy-valeric acid (n=22, r=0.7491) and 2-hydroxybutyric acid (n=32, r=0.5148). Age, sex, diagnosis, and APACHE II score play a subordinate role, but the presence of glyceric and citric acid possibly have prognostic importance [nonparimetric ANOVA with Wilcoxon scores (ranks of data)], as does the combination of 3-hydroxypropionic acid, glyceric acid, and threonic-acid-4-lacton (stepwise discriminant analysis). It can be concluded that in acute renal failure, the measurement of lactic acid and AKBR can reflect only a small part of disturbed metabolism. Hemofiltrate can be a useful medium in describing metabolic processes in critically ill patients with acute renal failure. Some inherited metabolic diseases in infants (phenylketonuria, maple syrup disease) and ketoacidosis show similar metabolic modifications.
Design of the Solar Cell System for Recharging the External Battery of the Totally-Implantable Artificial Heart
Authors: Dan Tchin-Iou A.V. , Min B.G.
Published: March 2018

The solar cell as the advanced alternative energy resource was found to be acceptable for increasing battery running time of the totally-implantable artificial heart. A sample of the wireless charging system with solar cell base gives a maximum battery running time around 9 hours and some physical and psychological freedom to the patient. This improvement will assist the application of the implantable artificial heart for a longer period of time and with added convenience to the recipient.
The Role of usable Length in the Compliance Measurement of Vascular Prostheses
Authors: Grigioni M. , Daniele C. , Gensabella R. , D'avenio G. , Barbaro V.
Published: March 2018

In this study we investigated the dependence of the mechanical properties and in particular of the radial compliance of a vascular prosthesis as a function of its usable length. Radial compliance was measured at 60 bpm and in the pressure range 80–120 mmHg. Starting from compliance measurements a simple model was used to calculate the pulse wave velocity and the reflection coefficients between 6 mm and 8 mm grafts (knitted and woven) with iliac and subclavean artery of similar diameter. The results provide an indication of the influence of usable length on the compliance and diameter mismatch at the anasthomosis between graft and host artery.
Development of a New Biodegradable Intravascular Polymer Stent with Simultaneous Incorporation of Bioactive Substances
Authors: Blindt R. , Hoffmeister K.M. , Bienert H. , Pfannschmitt O. , Bartsch G. , Thissen H. , Klee D. , Dahl J. Vom
Published: March 2018

Objective

Due to the thrombogenicity and permanent implant nature of metallic stents, bioresorable synthetic polymers have been proposed for stents and local drug delivery systems. Bioresorbable polyesters like poly(D,L-lactide) demonstrated excellent biocompatibility in various tissues. This paper describes a novel method for the molding of these polymers. The specific CESP-process (Controlled Expansion of Saturated Polymers) is characterised by the use of the plasticizer carbon dioxide and allows the incorporation of bioactive substances at physiologic temperatures into the polymer bulk and the production of complex designed implants.

Methods

The CESP-process is characterised by the exposure of an amorphous polymer to an inert gas at high pressure with a significant lower glass transition point. The plasticizing effect makes it possible to process polylactides at a temperature close to room temperature. The low process temperature constitutes a key advantage for thermally sensitive polymers and allows the incorporation of thermally sensitive pharmaceutical additives. To obtain some preliminary information on the biocompatibility, in vitro cell toxicity testing as well as drug release assessment was performed.

Results

Different polymer sheets were produced using the CESP-process. Cytotoxicity was not observed in any molded polymer material. According to the mechanical and biocompatibility results Poly(D,L-lactide) (P-DL-LA) was investigated in the CESP-process. Finite element analysis was used to test the possible geometry of an adequate stent. A helical design was chosen and a stent-prototype was produced using the CESP-process. Peroxidase activity as an incorporated marker enzyme could be measured over 6 weeks. DIfferent drug release profiles were obtained due to various pore sizes of the polymer.

Conclusions

The new CESP-process can be used to process biodegradable polymers and to mold different stent geometries without inducing cytotoxic effects to the material. Furthermore, this procedure permits the simultaneous incorporation of bioactive substances during the molding process. Drug release kinetics can be regulated by different pore sizes of the material.
The Hospice Patient’s Right to Oral Care
Authors: Soileau Kristi , Elster Nanette
Published: March 2018

The hospice philosophy embraces palliative care for the terminally ill, for whom quality of life is the central focus of comfort care management. Often, caregivers hesitate or simply do not elect to extend oral care for patients nearing the end of life, due to difficulties encountered in patient compliance, a sense of futility in doing so, staff time constraints in prioritizing care, underfunding, or a lack of education as to how and why such care should be delivered to the hospice patient. This article aims to show physiological and psychosocial reasons why the hospice patient has a need for properly and regularly implemented oral care and why dental professionals have an ethical responsibility to address the current void that exists in hospice-centered oral care. Varying viewpoints are discussed regarding the need for oral health monitoring and maintenance in both the capable patient with capacity and in the patient who lacks capacity and is totally dependent, yet who exhibits no particular signs of oral distress nor desire for hygiene measures. Consideration is given to family dynamics in such care. Oral care of the elderly patients and terminally ill is sorely lacking, and dental educators are challenged to cultivate in students a sense of professional duty toward caring for the vulnerable elderly patients. Dental professionals should create initiatives in developing, promoting, and implementing an appropriate standard of oral care for the hospice patient.