bluuebunny/crossref_metadata_2025 huggingface dataset:
Spectrum of Poisoning Requiring Haemodialysis in a Tertiary Care Hospital in India
Authors: Agarwal S.K. , Tiwari S.C. , Dash S.C.
Published: March 2018

We report our experience in 66 cases of acute poisoning requiring haemodialysis (HD) in the last 17 years. Barbiturate poisoning was the commonest poisoning (30 cases). Mean blood barbiturate level was 8.9 mg%. Twenty four were in grade IV coma at the time of presentation. Twenty five required one HD and 5 cases needed 2 HD. Four died due to respiratory infection or hypotension. Copper sulphate poisoning was encountered in 19 cases. Common features in this group were: acute renal failure (ARF) (19), haematuria (3), gastrointestinal bleeding (7), intravascular haemolysis (9), jaundice (11), hepatocellular toxicity (8), methaemoglobinuria (8) and circulatory collapse (5). The indication for HD in all these cases was ARF. Seven patients died. There were 9 cases of mercuric chloride poisoning requiring 2-5 HD. Common features in this group were; ARF (9), gastrointestinal bleeding (9), anaemia (8), jaundice (2). Two patients died. Other patients had Mandrax, Naphthalene, Tincture Iodine, Ethylene Bromide and Lithium poisoning. Overall mortality in our study was 24.2%. It is concluded that HD is not the primary mode of therapy for drug intoxication. Adequate supportive management is most important in determining final outcome of these patients.
Cardiac Pathology in Patients with End-Stage Renal Disease Maintained on Hemodialysis
Authors: Ansari A. , Kaupke C.J. , Vaziri N.D. , Miller R. , Barbari A.
Published: March 2018

We report the spectrum of cardiovascular pathology found on autopsy examination in 106 consecutive patients with end-stage renal disease. Cardiovascular pathology was present in nearly all patients, and was the most frequent cause of death (36%), with acute myocardial infarction accounting for 15%. Particularly frequent pathologic findings were left ventricular hypertrophy, coronary and aortic atherosclerosis, pericarditis with effusion, myocardial fibrosis, and valvular dilatation. Cardiovascular death rate was higher during the first year than after the fifth year of dialysis. Nearly all patients had a history of hypertension. The nature of the underlying cause of renal failure and pre-existing cardiovascular disease, specifically diabetes mellitus and hypertension, were the principal predictors of cardiovascular mortality rather than maintenance hemodialysis therapy per se.
A Simulation Study on a Self-Tuning Portable Controller of Blood Glucose
Authors: Brunetti P. , Cobelli C. , Cruciani P. , Fabietti P.G. , Filippucci F. , Santeusanio F. , Sarti E.
Published: March 2018

A self-tuning, nonlinear controller was developed to drive portable or implantable micro-pumps for blood glucose control in diabetic subjects. The parameter estimation is based on a recursive least-square algorithm applied to a discrete time simplified mathematical model of the glucose system; the controller, which is integrated with the estimator, uses an-extended minimum-variance method. The software was designed to drive a micro-controller wearable unit, operating with different kinds of glucose sensors, in order to perform chemical and biological experimentations. Some strategies were introduced to avoid hypoglycaemia, even tolerating a reduction in control speed and accuracy. The whole system was tested in a simulation study, performed on a mathematical model implemented on a personal computer. The tests were performed while simulating different controller structures and settings, and patient responses. They showed a satisfactory control behaviour, mostly as far as stability and robustness are concerned, in all simulated conditions.
Hemolysis Reduction in Plasmapheresis by Module Design: Operating with Pulsed Flow Filtration Enhancement
Authors: Philp J.L. , Jaffrin M.Y. , Ding L.H.
Published: March 2018

This study is an investigation into the effects of module design on hemolysis levels during the filtration enhancement of plasmapheresis using pulsed blood flow. Two polypropylene hollow fiber modules (F1 and F2) were compared under steady and pulsed flow conditions. The fiber lengths and membrane areas of the respective filters were 136 mm, 0.1 m2 and 226 mm, 0.25 m2 and were used at wall shear rates of 400 and 600 s-1. Fresh citrated bovine blood was circulated at 90 ml/min through their fibers with permate and retentate being recirculated. Plasma samples were analysed by the Cripps method to obtain the mean free hemoglobin concentration. A comparison of the average hemoglobin released with time per fiber, and per unit length allowed an assessment of the effects of fiber length and shear rate on hemolysis levels. It was concluded that a reduction in area and fiber length would reduce hemolysis levels and design equations are suggested to find the optimum length.
Hepatocyte Transplantation: An Alternative System for Evaluating Cell Survival and Immunoisolation
Authors: Gupta S. , Kim S.K. , Vemuru R.P. , Aragona E. , Yerneni P.R. , Burk R.D. , Rha C.K.
Published: March 2018

To evaluate systems for barrier immunoisolation of transplanted hepatocytes, we used transgenic mouse hepatocytes that secrete HBsAg. Hepatocytes were rapidly encapsulated in chitosan, a cationic polymer derived by deacetylation of chitin. Chitosan was allowed to electrostatically bond with anionic sodium alginate for creating an outer bipolymer membrane of the capsules. After encapsulation, hepatocyte viability remained unchanged for seven days in vitro with secretion of HBsAg into the culture medium throughout this period. Following intraperitoneal transplantation of encapsulated hepatocytes, HBsAg promptly appeared in blood of recipients. In congeneic recipients, serum HBsAg peaked at two weeks. Hepatocytes were present in recovered chitosan capsules and expressed HBsAg mRNA. In allogeneic recipients, however, serum HBsAg disappeared within one week and recovered chitosan capsules showed lymphomononuclear cells but not hepatocytes. Transplantation of chitosan encapsulatd HbsAg secreting hepatocytes failed to induce an anti-HBs response, suggesting modulation of the host immune response. These results indicate that transplantation systems using genetically modified hepatocytes which secrete gene products in the blood of recipients should facilitate evaluation of hepatocyte encapsulation.
Biochemical Changes following Parathyroidectomy
Authors: Chandran P.K.G. , Ulahannan T.J. , Skiles M.
Published: March 2018

Biochemical changes that had appeared after subtotal parathyroidectomy (PTx) in 26 patients with end-stage renal failure were observed. The volume of excised parathyroid glands was also measured. Serum calcium and inorganic phosphorus levels fell after PTx; only to rise in due course. Serum alkaline phosphatase levels rose after PTx, reaching a peak by the 14th postoperative day. These elevated levels returned to normal range at about three months after PTx. Strong correlation was noted among the degree of postoperative hypocalcemia, and increase in serum alkaline phosphatase, but not between absolute pre or postoperative alkaline phosphatase levels and changes in serum calcium or phosphorus concentrations. Nevertheless, significant correlation was seen between pre-PTx levels of alkaline phosphatase and its short-lived postoperative rise, indicating hastened osteoblastic activity.
Clinical and Radiological Features of Bone Disease in Long-Term (15 or more years) Hemodialysis Patients
Authors: Bedani P.L. , Orzincolo C. , Storari A. , Perini L. , Soffritti S. , Gilli P.
Published: March 2018

Fifteen patients on regular dialytic treatment for more than 15 years were given X-rays of the skull, spine, shoulders, wrists, pelvis and knees with the purpose of studying the principal skeletal and articular alterations due or not due to the uraemic status. Serum calcium, phosphorus, parathyroid hormone, alkaline phosphatase and basal aluminium were recorded. Osteopenia was evident in all the patients. Ten of whom (67%) showed alterations due to hyperparathyroidism. Nine patients presented the marks of dialysis spondyloarthropathy; in 14/15 cases geodes were present in the wrists, humeral heads or hip-joints; in ten patients there were multiple amyloid lesions. Two patients with serum basal aluminum above 100 μg/L showed the typical radiographic marks of osteomalacia. The majority of the long-term survivors showed multifactorial osteo-articular alterations resulting mainly from the combination of hyperparathyroidism and dialysis-related amyloidosis. The less frequent joint alterations were represented by arthrosis, enthesopathy and Chondrocalcinosis. Disability and decreased articular mobility resulted in being mainly due to amyloid osteo-arthropathy.
Changes of Arterio-venous Differences in pH and pCO2 by Hemodialysis
Authors: Agroyannis B. , Tzanatos H. , Konstadinidou I. , Tsoutsos D. , Tserkezis G. , Logothetis E. , Koutsikos D.
Published: March 2018

Normally the differences in arterial-venous pH (A-VpH) and veno-arterial pCO2 (V-ApCO2) are small and constant. This study deals with A-VpH and V-ApCO2 and their effect on arterial-venous saturation hemoglobin percentage (A-VSHb%) in uremic patients under hemodialysis (HD). In 17 uremic patients under HD with acetate, blood samples were collected anaerobically in heparinized syringes from artery (fistula) and vein (forearm without fistula) pre- and post-HD. In these samples pH, pCO2 and SHb% were determined and A-VpH, V-ApCO2 and A-VSHb% were estimated. Comparison between the values pre- and post-HD of A-VpH, V-ApCO2 and A-VSHb% shows that these three values were decreased significantly post-HD (p<0.001). The correlation of all values (pre- and post-HD) of A-VpH and V-ApCO2 with that of A-VSHb% was significant and positive (r=0.514 p<0.01, r=0.505 p<0.01, respectively).
A Computer Controlled Versatile Pulse Duplicator for Precision Testing of Artificial Heart Valves
Authors: Schichl K. , Affeld K.
Published: March 2018

Numerous devices and mock circulations have been described for the measurement of pressure loss, closure time, closing and leakage volumes and energy loss in artificial heart valves. However, all the devices have been troubled with difficulties in generating and assessing the precise flow through the valve, and problems in defining the arterial load, i.e. the artificial aorta. The new test device follows a radically different approach: a computer controlled piston forces the fluid through the test valve only — with no afterload. During systole, outflow follows a physiological curve which is identical for all types of heart valves of a given size. During diastole a mathematically defined physiological pressure difference curve is followed. Consequently, the measurements are independent of the individual machine, the lab where testing takes place, the scientist who executes the test, the time when measurements are taken and all other external influences.
Cell Biology and Molecular Mechanisms in Artificial Device Infections
Authors: Gristina A.G. , Giridhar G. , Gabriel B.L , Naylor P.T. , Myrvik Q.N.
Published: March 2018

Biomaterials are being used with increasing frequency for tissue substitution. Complex devices such as total joint replacement and the total artificial heart represent combinations of polymers and metal alloys for system and organ replacement. The major barrier to the extended use of these devices is bacterial adhesion to biomaterials, which causes biomaterial-centered infection, and the lack of successful tissue integration or compatibility with biomaterial surfaces. Adhesion-mediated infections are extremely resistant to antibiotics and host defenses and frequently persist until the biomaterial or foreign body is removed. The pathogenesis of adhesive infections is related, in part, to preferential colonization of “inert” substrata whose surfaces are not integrated with healthy tissues composed of living cells and intact extracellular polymers. Tissue integration is an interesting parallel to microbial adhesion and is a desired phenomenon for the biocompatibility of certain implants and biomaterials. Tissue integration requires a form of eukaryocytic adhesion or compatibility with possible chemical integration to an implant surface. Many of the fundamental principles of interfacial science apply to both microbial adhesion and to tissue integration and are general to and independent of the substratum materials involved. Interactions of biomaterials with bacteria and tissue cells are directed not only by specific receptors and outer membrane molecules on the cell surface, but also by the atomic geometry and electronic state of the biomaterial surface. An understanding of these mechanisms is important to all fields of medicine and is derived from and relevant to studies in microbiology, biochemistry, and physics. Modifications of biomaterial surfaces at an atomic level will allow the programming of cell-to-substratum events, thereby diminishing infection by enhancing tissue compatibility or integration, or by directly inhibiting bacterial adhesion.
Cytokine production and nutritional status in hemodialysis patients
Authors: King A.J. , Kehayias J.J. , Roubenofp R. , Schmid C.H. , Pereira B.J.G.
Published: March 2018

Malnutrition is an important predictor of mortality in patients on chronic hemodialysis, however the pathogenesis of wasting in this population remains unclear. Experimental data suggest that the dialysis procedure per se leads to enhanced catabolism, as well as direct loss of plasma amino acids and proteins into the dialysate. In the present study, the primary hypothesis examined is that hemodialysis-induced cytokine production is associated with reductions in lean body mass and other plasma markers of nutrition. We used the production of interleukin-1 receptor antagonist (IL-1Ra) by peripheral blood mononuclear cells (PBMC) as an indicator of cytokine production. PBMC were obtained pre-dialysis on the first and second sessions of the week in a cohort of 16 patients on chronic hemodialysis using reprocessed cellulose dialyzers who fulfilled rigorous entry criteria designed to eliminate known etiologies of increased cytokine production, e.g. chronic infections. PBMCs were either immediately frozen (cell content) or incubated for 24 hours at 37°C in the presence or absence of endotoxin 10 ng/ml and total IL-1Ra was measured by radioimmunoassay. Nutritional staus was assessed using body mass index (BMI), total body potassium (TBK), anthropometry-derived arm muscle area (AMA), and measurements of plasma albumin, transferrin, total cholesterol, and triglycerides. Over the subsequent 3 months, patients were monitored carefully for pyrogen reactions, hemodynamic stability and intra-interdialytic symptoms. There was a direct correlation of cell content of IL-1Ra with several indices of nutritional status including BMI (r = 0.90, p = 0.0001), AMA (r = 0.77, p = 0.0008), serum total cholesterol (r = 0.57, p = 0.03) and serum triglycerides (r = 0.73, p = 0.002). Endotoxin-stimulated IL-1Ra production correlated directly with AMA (r = 0.59, p = 0.02), TBK (r = 0.71, p = 0.01) and serum triglycerides (r = 0.51, p = 0.05). These studies suggest a direct correlation between nutrition and cytokine production, and that malnutrition could depress cytokine production and potentially contribute to reduced immune responsiveness in patients on chronic hemodialysis. (Int J Artif Organs 1998; 21:4–11)
Fatal hepatic failure caused by miliary tuberculosis in a hemodialysis patient: Case report
Authors: Kushihata S. , Yorioka N. , Nishida Y , Amimoto D. , Takasugi T. , Taniyama K. , Yamakido M.
Published: March 2018

A 57 year-old male dialysis patient died soon after the onset of high fever, hypoglycemia, and disturbance of consciousness. Autopsy revealed granulomatous lesions associated with caseous necrosis mainly found in the liver, despite the absence of pulmonary changes on chest radiographs performed during the patients illness. It appears that tubercle bacilli were hematogenously disseminated mainly to the liver causing miliary tuberculosis without producing typical diffuse lesions in the lungs. Since tuberculosis is a common complication in hemodialysis patients, the potential development of atypical miliary tuberculosis should always be borne in mind. (Int J Artif Organs 1998; 21:23–5)
Pregnancy in Chronic Dialysis: A Review and Analysis of the Literature
Authors: Chan W.S. , Okun N. , Kjellstrand C.M.
Published: March 2018

Pregnancy is uncommon in end-stage renal failure, particularly in patients requiring dialysis. We reviewed the literature from 1965 to date, seeking an optimal way of dialyzing pregnant women after encountering one such patient.

Methods

We searched the English literature by cross-referencing “pregnancy” with “hemo-” or “peritoneal dialysis” and “renal failure”. Eighty-six pregnancies worldwide were found to which we added one case of our own. Various independent factors were studied against gestational age at delivery using uni- and multivariate analysis. These factors included mother's age, previous delivery, diagnoses of renal disease, dialysis duration prior to pregnancy, gestational age at onset of dialysis, dialysis type, level of hemoglobin during pregnancy, BUN and creatinine targets, BUN/creatinine ratio, dialysis intensity at the beginning and end of pregnancy, influence of erythropoietin and dialysis complications.

Results

Of the 87 pregnancies, 12% resulted in stillbirths, 9% of neonates died prior to discharge. The mean gestational age at delivery was 32 ± 5 weeks, and the mean birth weight 1604 ± 652 g. Two congenital abnormalities and one twin pregnancy were reported. 48% of deliveries were premature. Pre-eclampsia was reported in 11%, and worsening hypertension in 17%. CAPD was used in 25 and hemodialysis in 62 patients. Fetal survival was similar in both cases (72% vs 82%), although incidence of various dialysis complications differed. The conventional dialysis goals of a low target BUN level and hemoglobin for pregnant patients were not factors in predicting fetal outcome. The number of hemodialyses/week were negatively correlated (R = -0.35, P = 0.061), but the hours of dialysis positively correlated (R = 0.42, p = 0.035) to gestational age. Fetal survival was independently influenced by creatinine level [564 µmol/L when baby survived vs 788 µmol/L when baby died (p = 0.021)], BUN/creatinine ratio (50 vs 30, p = 0.053), and hours of dialysis (5.6 hrs vs 3.6 hrs, p=0.013). There was no relation of either frequency or volume of peritoneal dialysis exchanges to gestational age or fetal survival.

Conclusions

Greater attention to a high intake of protein (>1.5 g/kg) and higher dose of hemodialysis, achieved by longer, every other day dialysis, may be the optimal approach to pregnant patients on hemodialysis. Our first attempt to define the goal of hemodialysis is to keep the predialysis creatinine below 600 mmol/L and the protein intake high enough so the predialysis BUN level is >25 mmol/L. There are no clear guidelines on how to best perform CAPD.
Veno-Venous Extracorporeal Lung Assist with Concurrent Distal Aortic Perfusion: Repair of Ruptured Aorta in a Patient with Dense ARDS
Authors: Borg U. R. , Reynolds H. N. , Habashi N. M.
Published: March 2018

Extracorporeal lung assist (ECLA) allowed surgical repair of a ruptured descending thoracic aorta to be performed in a patient with profound respiratory failure. Dense acute respiratory distress syndrome (ARDS) developed during his 15-day hospitalization at a regional trauma center. After transfer to a Level I facility, an additional injury was diagnosed: traumatic rupture of the aorta, contained within a pseudoaneurysm. ECLA by the veno-venous route was required immediately preoperatively and distal aortic perfusion was performed during the aortic repair. Despite deflation of the left lung, the patient was oxygenated and ventilated adequately during surgery. Cross-clamp time was 48 minutes. The patient was weaned from ECLA by the fifth postoperative day. To our knowledge, this is the first report of concurrent veno-venous pulmonary support with distal aortic perfusion.
Pain Perception following Subcutaneous Injections of Citrate-Buffered and Phosphate-Buffered Epoetin Alpha
Authors: Yu A.W. , Leung C.B. , Li P.K.T. , Lui S.F. , Lai K.N.
Published: March 2018

Subcutaneous injection of citrate-buffered epoetin alpha (EPO-α) causes pain. Substitution of citrate buffer with a phosphate buffer in the EPO-α resulted in a significant reduction in duration and severity of pain. It is possible that sodium citrate which is present in the EPO-α may be the agent that causes discomfort in the patients.
Development and Initial in Vivo Testing of a New Hydraulic Drive System (Paedipump) for Circulatory Support in Infants
Authors: Reiß N. , Morshuis M. , Landich R. , Frerichs I. , Frerichs A. , Hellige G. , Illian M. , Dramburg W. , Scheid P. , Minami K. , KöRfer R.
Published: March 2018

The main limitation in the use of circulatory support in children is the lack of an adequate system with regard to size and pumping capacity Recently, two pneumatically driven ventricular support systems with low volume chambers for use in a pediatric population became available. We have developed a hydraulic drive system with an advantageous exact control of the stroke volume. The system enables two different modes of operation: the full-empty and the filled-empty modes. In both cases the ventricle is empty at the end of systole.

This new system was tested in experimental animals (6 pigs, body weight 9.5–14.0 kg) with normal and reduced left ventricular function (MAP<45 mmHg). A 25 ml ventricle (HIA-Medos) was implanted. The full-empty and the filled-empty mode used led to a significant load reduction, both in animals with normal and impaired cardiac function. Plasma lactate levels, pH-values and total body 0 2 consumption were in the normal range during circulatory support indicating adequate organ perfusion.

Results showed that sufficient ventricular support was achieved during all pumping modes due to the possibility of controlling and modifying the stroke volume of the hydraulically driven support system employed according to necessity. This is a promising feature for its future application in infants with congenital or acquired heart diseases.
Mechanical Circulatory Support after Orthotopic Heart Transplantation
Authors: Tenderich G. , Koerner M.M. , Stuettgen B. , Minami K. , El-Banayosy A. , Arusoglu L. , Mirow N. , Wlost S. , Gromzik H. , Kleesiek K. , Meyer H. , Koerfer R.
Published: March 2018

Frequently the only therapy for primary graft- and right heart failure, as well as low output syndrome from acute of chronic rejection, is implantation of a mechanical circulatory support system, until recompensation or retransplantation. At our institution, mechanical assist devices were implanted in 25 heart recipients for a cute rejection (n=9), primary graft failure (n=7), acute right heart failure (n=7), and chronic rejection with low output syndrome (n=2).

Patients (pts) with primary graft failure (n=3) received an intraaortic balloon pump (IABP), one pt an IABP plus Abiomed®-System for left ventricular support, one pt the Thoratec®-System for biventricular support. Patients with right heart failure (RHF) received the Biomedicus® centrifugal pump for right ventricular support. Nine pts suffered from acute rejection. Six pts received an IABP, one the Biomedicus® as femoro-femoral bypass, one the Abiomed®-System for biventricular support, two the Thoratec®-System for biventricular support and two within this group switched from the Biomedicus® pump to the Thoratec®-System for biventricular support. Patients with chronic graft failure (n=2) received the Novacor®-System (LVAD) for left ventricular support, one received a Tojobo®-System and an oxygenator for biventricular support post coronary artery bypass surgery.

Support time ranged from 0.5-h to 73 days. Five pts were weaned. Two (8%) of 25 pts were retransplanted, 18 (72%) died in spite of mechanical support from multiple organ failure. The use of a mechanical assist device after heart transplantation is encouraging only in the case of early right heart failure, as well as primary and chronic graft failure. In view of the poor results, the use of mechanical assist devices should not be recommended in the case of heart failure caused by acute rejection.
The DOQI Guidelines in Peritoneal Dialysis
Authors: Enia G.
Published: March 2018

The DOQI initiative produced 32 guidelines for peritoneal dialysis. The guidelines on adequate dose of peritoneal dialysis and criteria for starting dialysis treatment constitute the core of the document and are expected to have the most important impact on clinical practice. These guidelines are based mainly on circumstantial evidence and observational studies, thus they must be considered for what they are, i.e. useful operational tools open to discussion and not absolute truth. The potential impact of the DOQI guidelines in a dialysis programme is shown using the anthropometric data of 1061 adult patients on file in the Calabrian Registry of Uremia, Dialysis and Transplantation.
Tissue Factor and Tissue Factor Pathway Inhibitor in Hemodialysis Patients
Authors: Yorioka N. , Taniguchi Y. , Yamashita K. , Ueda C. , Nakamura C. , Harada S. , Yamakido M.
Published: March 2018

Tissue factor and tissue factor pathway inhibitor are important in extrinsic coagulation. We investigated their clinical significance in hemodialysis patients. We took blood samples, prior to initiation of routine hemodialysis, from 73 patients on hemodialysis (35 men and 38 women aged 56.1 ± 11.7 years on dialysis for 82.1 ± 61.0 months), and determined tissue factor and tissue factor pathway inhibitor levels by ELISA. In the patients the tissue factor level was 704.5 ± 141.6 pg/ml and the tissue factor pathway inhibitor level was 44.5 ± 23.3 ng/ml; both values were significantly higher than in normal controls (192.7 ± 36.6 pg/ml and 18.6 ± 5.7 ng/ml, respectively). In patients with shunt obstruction, tissue factor pathway inhibitor levels were significantly higher than in those without it. Therefore, the tissue factor pathway inhibitor level may be a marker of shunt obstruction.
Intradialytic Hypotension in Relation to Pre-Existent Autonomic Dysfunction in Hemodialysis Patients
Authors: Straver B. , De Vries P. M.J.M. , ten Voorde B.J. , Roggekamp M. C. , Donker A.J.M. , ter Wee P.M.
Published: March 2018

After having monitored haemodynamics during haemodialysis, we examined autonomic nervous function in rest prior to a next dialysis session in 28 patients on chronic intermittent haemodialysis. The aim was to compare intradialytically hypotensive with stable patients to assess whether blood pressure regulating mechanisms were related to basal autonomic function, assessed as heart rate variability (HRV) tested by means of the deep breathing test, the lying-to-standing test, and the Valsalva maneuver. Impedance cardiography was used to determine stroke volume and cardiac output during dialysis. In addition, blood pressure was registered automatically and systemic vascular resistance calculated. Blood volume variation was monitored by an on-line optical device.

Intradialytic hypotension was observed in 10 patients (36%). Systemic vascular resistance in hypotensive patients decreased considerably (-14.0 ± 5.9%), while it increased in stable patients (+9.9 ± 4.6%, p = 0.004). Heart rate rose significantly in hypotensive patients (11.5 ± 3.8%>) in comparison to stable patients (-0.2 ± 2.8%, p = 0.02). However, no significant differences in autonomic function were observed between hypotensive and stable patients. Although both groups showed impaired autonomic function, no significant correlation between changes in haemodynamics during dialysis and autonomic function at rest could be ascertained.

In conclusions, hypotension during haemodialysis is not related to a patient's autonomic function at rest. This suggests that structural neuronal differences are not responsible for the severe decrease in systemic vascular resistance in intradialytic hypotension.
Assay to Detect Inhibitory Substances in Serum of Patients with Acute Liver Failure
Authors: Anderson C. , Thabrew M. I. , Hughes R. D.
Published: March 2018

Patients with acute liver failure accumulate toxic substances in the circulation which may impair recovery of hepatic function. The aim of this study was to test an in vitro assay to detect inhibitory substances in the serum of patients with acute liver failure. Human liver-derived HepG2 cells were incubated for 24h in 96 well plates (30,000 cells/well) with sera (10%) from 24 patients with acute liver failure due to paracetamol overdose or NANB hepatitis and 11 normal controls. DNA synthesis was determined from the incorporation of 3H-thymidine and cell viability by the metabolism of the tetrazolium dye MTS. HepG2 cells exposed to acute liver failure sera incorporated significantly less 3H-thymidine (median 30% of control, range 0.2–169%) than normal sera (100%, 76–133%, p=0.002). Cell viability was also reduced (75%, 33–112% vs 100%, 96–105%, p<0.00l). There was no correlation between these values and patient outcome or levels of plasma TNF-α or serum interferon-γ. The assay detected inhibitory substances in sera of patients with acute liver failure and could be used to monitor the use of liver support systems.
Hemodynamic Properties of the Hemopump HP14
Authors: Lachat M. , Jaggy C. , Leskosek B. , Von Segesser L. , ZÜnd G. , Vogt P. , Turina M.
Published: March 2018

Background

The Hemopump HP14 is a catheter-mounted, transvalvular, left ventricular assist device intended for femoral percutaneous insertion. The pump was developed for patients with postoperative or postinterventional low cardiac output and for CABG surgery on the beating heart. Little is known about the effect of afterload and hematocrit on the pump performance.

Methods

The influence of hematocrit and afterload on the pump flow was tested using an in vitro model filled with heparinized bovine blood. Regression analysis of the pump flow with respect to three hematocrit values (20%, 30%, 40%) and ten afterload levels (30 mmHg-120 mmHg in 10 mmHg increments) was performed for all pump speed levels (n = 7).

Results

At all pump speed levels reduction of afterload and hematocrit were significant predictors for increasing pump flow (p<0.001). For hematocrit values between 40% and 20% and highest pump speed, mean pump flow at lowest afterload ranged between 2.34 and 2.53 L/min; and at highest afterload between 1.31 and 1.53 L/min. For speed level 1, afterload of 120 mmHg and hematocrit of 40% there was a maximal retrograde flow of 230 ± 35 ml/min.

Conclusions

Pump performance is significantly improved by both afterload and hematocrit reduction. In the weaning phase and during the removal of the device, the pump should run at a speed level of at least three to prevent retrograde flow in the pump. Estimates for pump flow in vivo can be extrapolated from our diagrams. Our results show that the Hemopump HP14 is a valuable alternative to intra-aortic balloon counterpulsation.
Correction of CAPD Catheter Displacement Using Gastric Biopsy Forceps: The Push-Pull Method
Authors: Ohira N. , Yorioka N. , Ito T. , Takasugi K. , Takasugi N.
Published: March 2018

We corrected malpositioned continuous ambulatory peritoneal dialysis catheters in six patients using a new technique named the “push-pull method”. A gastric biopsy forceps was advanced through the catheter to near its tip. After manipulating the tip of the forceps through the abdominal wall, the forceps was opened and pulled out slowly. Repeated insertion and removal of the forceps induced the catheter to return to the pelvic cavity. This push-pull method was successful for Swan neck straight (n=2) and coiled (n=4) catheters in all patients. The time required for the procedure was only 5–10 minutes and there were no complications.
On-line Monitoring of the Intravascular Volume during Haemodialysis by Continuous Refractometry
Authors: Kuhlmann U. , Buuren F. V. , Aziz O. , Lange H.
Published: March 2018

The control of intravascular volume (IVV) by continuous on-line measurement of protein concentration would optimise the patients’ specific rate of ultrafiltration.

To prove the accuracy of a refractometric device, plasma was continuously drawn by haemofiltration during 10 haemodialysis treatments of male patients. Refractometry reflects highly significant changes in the concentrations of filtrate proteins (r = 0.862, p < 0.001) and blood proteins (rtotal = 0.593, ptotal < 0.001). In vitro, the refractometric device detected a change of protein concentration of 0.041 g/L through a refraction increase of 0.1 mV. The power of discrimination was 0.067 % of IVV. However, in vivo, the accuracy of IVV refractometric monitoring is reduced by interference factors such as sodium (0.141 mV/mmol/L), glucose (0.034 mV/mg/dl) and triglycerides (–0.040 mV/mg/dl). Adjustment of the refraction data using sodium and glucose electrodes and plasma filters with a cutoff below the size of chylomicrons is recommended.
Effects of Unprocessed and Processed Cardiopulmonary Bypass Blood Retransfused into Patients after Cardiac Surgery
Authors: Walpoth B.H. , Eggensperger N. , Hauser S.P , Neidhart P. , Kurt G. , Spaeth P. J. , Althaus U.
Published: March 2018

Background

The aim of this prospective study was to compare the effect of autologous unprocessed to processed residual cardiopulmonary bypass blood (CPB) on patients’ laboratory and clinical parameters and outcome.

Methods

20 patients undergoing elective coronary artery bypass surgery were randomized to receive either unprocessed CPB blood (control group) or processed CPB blood employing the Continuous AutoTransfusion System (CATS; Fresenius, Bad Homburg, Germany). We have shown that this method eliminated >93% of activated mediators. Serial laboratory parameters including complement activation, coagulation factors and the stimulation of IL-6 and IL-8 were compared with clinical side effects and patients’ outcome.

Results

Compared to control patients, retransfusion of unprocessed CBP blood significantly increased heparin, free plasma hemoglobin and D-Dimers. Postoperatively, three patients in the control group and two patients in the CATS group required prolonged mechanical ventilation or developed infections associated respectively with elevated C3a (desArg) or IL-6 concentration.

Conclusions

CATS-processing of CPB blood provided a high-quality red blood cell concentrate, resulting in a reduced load of retransfused activated mediators.
Vagal Nerve Activity and the High Frequency Peak of the Heart Rate Variability
Authors: Yambe T. , Nanka S. , Kobayashi S. , Tanaka A. , Yoshizawa M. , Abe K. , Tabayashi K. , Takeda H. , Nitta S.
Published: March 2018

For the Quality of life (QOL) of patients with an artificial heart system, monitoring an information of the cardiovascular control system may be important. We have been evaluating the autonomic nervous system for that purpose. Recently, fluctuations in hemodynamic parameters including heart rate variability (HRV) were evaluated by means of spectral analysis and nonlinear mathematical analysis. Respiratory wavers in HRV were thought ro reflect ongoing information of the parasympathetic nerve activity. Is it true? In order to confirm this hypothesis, we recorded vagal nerve activity directly in the chronic animal experiments. Six healthy adult goats were anesthetized with Halothene inhalation and thoracotomy were performed by the fourth lib resection during mechanical ventilation. Arterial blood pressure, right and left atrial pressures were continuously monitored with the catheter insertion. Cardiac output was measured by the electromagnetic flowmeter attached to the ascending aorta. After the chest was closed, incision was made to the left neck and left vagal nerve was separated. Stainless steel electrodes were inserted into the vagal nerve and fixed by the plasticizer. After the incision was closed, the goats were transferred to the cage and extubated after waking. Hemodynamic parameters and vagal nerve activity were measured in the awake condition. The results showed that clear observation of the autonomic nerve discharges were embodied by this experimental system. The vagal nerve discharges were synchronized with heart beat and respiration. The vagal nerve tonus was significantly influenced by the hemodynamic alteration. However in some condition, the respiratory wave was not always consistent with tonus of the vagal nerve activity, thus suggesting that we should check another information to evaluate the parasympathetic tone. We must continue this study to evaluate an autonomic nerve during artifical heart circulation.
Acute Tubulo-Interstitial Nephritis Requiring Dialysis Associated with Intermittent Rifampicin Use: Case Report
Authors: Gallieni M. , Braidotti P. , Cozzolino M. , Romagnoli S. , Carpani P.
Published: March 2018

Rifampicin is one of the most effective antibiotics used for the treatment of tuberculosis and severe staphylococcal infections. Intermittent administration of high doses of rifampicin has been associated with frequent adverse reactions, including hepatotoxicity and nephrotoxicity, sometimes resulting in acute renal failure. We describe a case of rifampicin-associated acute renal failure, with biopsy findings of tubulointerstitial nephritis; inflammatory cells were characterized by immunohistochemistry which showed immunoreactivity for CD3 and CD5 (T lymphocytes) and for CD68 (macrophages). The patient presented with a very rapid systemic reaction to the offending drug and rapid deterioration of renal function, which required dialysis treatment. The response to rifampicin discontinuation was excellent: no further therapy was required, as renal function began to improve within several days and returned to normal values (serum creatinine 1.17 mg/dl) seven months after the onset of symptoms.

When prescribing rifampicin the physician should investigate previous use of the drug, because re-exposure is a critical factor in predicting the possibility of drug-induced acute renal failure.
Chronic Heart Failure Model Induced by Coronary Embolization in Sheep
Authors: Zietkiewicz M. , Perek B. , Meyns B. , Mesotten L. , Dispersyn G. , Nishimura Y. , Flameng W.
Published: March 2018

Objective

To create a model of chronic heart failure in a large animal.

Methods

Heart failure was induced in sheep by single intracoronary injection of polymer macrobeads, which were administered into left main coronary artery (n=3) or selectively into left anterior descending (n=4) or left circumflex (n=5) coronary artery. The animals were followed by echocardigraphy for 20 weeks. Measurements comprised fractional area change (FAC), and diastolic ventricular area (EDVA) and regional wall-thickening fraction (WT%).

Results

EDVA increased from 14.2±2.1 cm2 prior to embolization to 16.9±3.1 cm2 on day 1 (p<0.05), and remained significantly increased until completion of the follow-up period. FAC dropped from 47.9±4.6% at baseline to 29.3±4.4% on day 1 (p<0.001) and remained significantly depressed until 20 weeks later. In 9 selectively embolized animals WT% of the embolized area decreased from 33.8±8.0% at baseline to 5.3±2.6% on day 1 and remained significantly decreased.

Conclusions

A simple model of chronic heart failure was developed. It shows relatively high stability over time and may prove beneficial in experimental work on ventricular assist devices.
Efficacy of Nafamostat Mesilate for Improving the Performance of a Bioartificial Liver Using Porcine Hepatocytes
Authors: Fujioka H. , Eguchi S. , Sugiyama N. , Kawazoe Y. , Kawashita Y. , Kamohara Y. , Azuma T. , Furui J. , Kanematsu T.
Published: March 2018

Our bioartificial liver (BAL) consists of porcine hepatocytes attached to beads and plasma perfused through the system. The function of our BAL lasts for approximately 7 hours. The objective of the present study was to investigate the efficacy of Nafamostat Mesilate (NM), a protease inhibitor and potent complement inhibitor, for improving the performance of the BAL. The experimental groups were divided as follows; the NM group (n=7) where the BAL had porcine hepatocytes with 3.8×10−4 M, of NM, and the control group where the BAL had no NM. Plasma obtained from patients suffering from hepatic failure was perfused through the BAL for 10 hours. The viability of the porcine hepatocytes and the levels of alanine aminotransferase (ALT) in the human plasma were measured during perfusion. After the 10-hour perfusion, another human hepatic failure plasma was perfused for an additional 1 hour and then the function of the BAL was evaluated. After the 10-hour perfusion, the viability of the hepatocytes in the NM group was 51± 7 %, whereas that in the control group was rapidly reduced by 35 ± 5 %. Although the levels of ALT in the human plasma in both groups increased with the perfusion time, those in the NM group were significantly lower than those in the control group (p < 0.05). These results suggest that NM prevented damage to the porcine hepatocytes in human hepatic failure plasma as compared to the control group. In the human hepatic failure plasma before perfusion, the partial thrombin time (PT) and the plasma ammonia (NH3) levels were 19.8 ± 12 % and 288 ± 102 μg/dl, respectively. Fischer's ratios were 0.98 ± 0.39. Even after the 10- hour perfusion, the BAL in the NM group significantly improved the levels of PT (38 ± 10 %; p < 0.05), NH3 (214 ± 34 μg/dl; p < 0.05) and Fischer's ratios (1.4 ± 0.3; p < 0.05). On the other hand, the BAL in the control group did not show any improvement in those parameters. In conclusion, NM was found to help in maintaining the viability of porcine hepatocytes in human hepatic failure plasma, thereby allowing the porcine hepatocyte-based BAL to function much better.
Atomic Absorption Spectrophotometry (AAS) for the Evaluation of Metallosis in Prostheses and Artificial Organs: A New Approach
Authors: Pierini G. , Fini M. , Giavaresi G. , Dallari S. , Brayda Bruno M. , Rocca M. , Nicoli Aldini N. , Giardino R.
Published: March 2018

To study the presence of metals in body fluids and tissues after implantation of metallic biomaterials and possible related diseases, a new approach in Atomic Absorption Spectrophotometry (AAS) was developed. This technique was compared to three traditional methods: mineralisation with acid digestion (method A) also known as “wet method”, dry ashing (with or without oxygen) (method B); classic Kjeldaal (method C). The new approach (method D) modifies the mineralisation phase and the instrument operating instructions. Al, Na, Cr, K, Ni, Co, Ti, Fe, Hg, Pb, V, Sb and Cu levels were tested with the four methods on bone, muscle, cartilage, skin, brain, lymph nodes, blood, urine, and hair. Test results were checked by the addition method. Results demonstrated a significantly higher percentage of Al, Cr, Ni, Ti and Hg recovery with the new approach. The advantages of method D are no residue, no redox reaction, insignificant loss of analytes and enhanced sensitivity (at ppb level vs ppm of the other methods). This approach should be considered especially when testing heavy metals and complex matrices. Its disadvantages are that it is more time consuming and requires the presence of an operator.
Surface-Immobilized Biomolecules on Albumin Modified Porcine Pericardium for Preventing Thrombosis and Calcification
Authors: Chandy T. , Das G.S. , Wilson R.F. , Rao G.H.R.
Published: March 2018

The search for a noncalcifying tissue material to be used for valve replacement application continues to be a field of extensive investigation. A series of porcine pericardial membranes was prepared by modifying the glutaraldehyde - treated tissues with albumin and subsequently immobilizing bioactive molecules like PGE1, PGI2 or heparin via the carbodiimide functionalities. The in vitro calcification and collagenase degradation of these modified tissues were studied as a function of exposure time. Furthermore, the biocompatibility aspects of such novel interfaces were established by platelet adhesion and fibrinogen adsorption.

The results reported in this article propose that the treatment with antiplatelet agents such as albumin, heparin and prostaglandins (PGE1 or PGI2) change the surface conditioning of pericardial tissues, suggesting a possible role of deposited serum components in affecting mineralization process on bioprosthesis. Therefore, it is worthy to hypothesize that besides inhibiting the accumulation of calcium in the devitalized cells, the early formation of a conditioning layer on the bioprosthesis surface may affect salt precipitations, determining the propensity of the implant to calcify. More detailed studies are needed to understand the involvement of plasma proteins and cellular components of the recipient blood in tissue-associated calcification.
A Simple Method for Hepatocyte Attachment in Hollow Fibre Bioreactors
Authors: Karlik W. , Jóźwiak A. , Wiechetek M. , Werynski A.
Published: March 2018

A new method for hepatocyte attachment in hollow fibre (HF) bioreactors was proposed and verified. A flow of medium with suspended hepatocytes, evoked by transmembrane pressure (TMP), and directed across the membrane into the fibre lumen, has accelerated and improved hepatocyte contact with the HF. It was found that seeding of hepatocytes onto the membrane was optimal at TMP of 50–80 mmHg. Ammonia utilisation and ureagenesis rates in hepatocytes seeded in the bioreactor suggests that the proposed method warrants proper conditions for cell functionality and allows for extended culture of hepatocytes in HF bioreactors. It is speculated that time cutback between introduction of hepatocytes into the bioreactor and the start of the cell attachment process, accomplished by the presented method, leads to substantially improved recovery of freshly isolated hepatocytes, and consequently to better overall performance of HF bioreactor.
Microspheres Based Detoxification System: In Vitro Study and Mathematical Estimation of Filter Performance
Authors: Willinger M. , Schima H. , Schmidt C. , Huber L. , Vogt G. , Falkenhagen D. , Losert U.
Published: March 2018

Because of the closed plasma (secondary) circuit in the Microspheres based Detoxification System (MDS), a convective blood purification system, the same amount of filtrated plasma is backfiltrated into the blood circuit. Therefore, there is no direct way to determine the ultrafiltrate production rate, which is an important factor of efficiency. The only possible way to estimate the filtration properties of the filter is to consider pressure values. In this study the pressure distribution in the filter was investigated in vitro. To explain the results and to calculate inaccessible parameters, a mathematical model was estabilshed which also considered the asymmetric behaviour of the filter membrane. The result was a linear pressure gradient, agreement with the measurements was reasonably good (calculated primary pressure loss differes <13% from measured value when using mean measured filter resistance as model parameter). Linear pressure distribution offers the possibility of easily calculating the filtration length, a parameter which can be used to estimate the filter condition. The comparison between calculated filtration and backfiltration rates offers an instrument of control for these values.