bluuebunny/crossref_metadata_2025 huggingface dataset:
Peritonitis in Peritoneal Dialysis
Authors: Voinescu C.G. , Khanna R.
Published: January 2018

Peritonitis, an infectious complication of peritoneal dialysis, continues to account for much of the morbidity associated with this techniques. The clinical presentation and laboratory data used in diagnosis the peritonitis, as well as its differential diagnosis will be reviewed in this article. The distribution of pathogens is an important outcome determinant, Gram-negative infections being associated with greater rates of catheter loss and higher death rates. Among the five routes of peritoneal contamination, intraluminal and periluminal contamination account for most of the infections. Due to the two prevention methods implemented in the care of the PD population, the incidence of peritonitis has decreased over the last two decades. The recommendations for empiric treatment of peritonitis have changed over the years, as more was learnt about antibiotic resistance and drug toxicity. Future research to address enteric peritonitis, as well as biocompatible dialysis solution or biocompatible catheter materials is needed to further reduce the incidence of PD peritonitis.
Long-Term Control of Hypertension in Dialysis Patients by Low Dose Atenolol
Authors: Vlassopoulos D. A. , Mentzikof D. G. , Hadjiyannakos D. K. , Noussias C. V. , Karras S. M. , Hadjiconstantinou V. E.
Published: January 2018

Hypertension in dialysis patients is considered a major factor in cardiovascular mortality.

We investigated long-term efficacy of intermittent atenolol (AT) administration in 10 (7M/3F) hypertensive dialysis patients, age 60.5 (38–72), on dialysis for 56.5 months (8–156) thrice per week (10.5–13.5 h/w) (A). A similar group of 11 normotensive patients served as controls (B). Hypertension was defined as BP>140/90 (day) and >120/80 mmHg (night) by a 44-h ambulatory BP monitoring (ABPM) after the mid-week session. Dialysis ultrafiltration, hematology, biochemistry were similar in A and B. Atenolol was started on an alternate day, 37.5 mg/w and increased as needed. After 34 days (6–80) and a dose of 68.75 (37.5–450) mg/w, BP dropped (ABPM: MAP 104±11.5 to 95.6±10.4 mmHg, P=0.0025) similar to controls and daytime HR dropped: 84.6±9.2 to 69.3±8.2, P=0.0008 and at night: 79.5±7.6 to 68.6±8.6 b/1' becoming lower than in B: 83±10.8/69.3±8.2, P=0.009 and 80.5±11.7/68.6±8.6 b/1' (P=0.02). Six months later ABPM in A as well as echocardiography in A and B remained unchanged.

Moderate, volume independent hypertension in stable dialysis patients is easily controlled during the interdialytic period by small intermittent atenolol doses.
Force to Restore the Shape of an Asymmetric Extracorporeal tube as the Basis for Non-invasive Pressure Measurements
Authors: Andersson R. , Ask P.
Published: January 2018

A zero-balance principle is described where intraluminal pressure is estimated from the counter force needed to restore the tube shape of an elastic extra corporeal tube. The aim was to optimise cross-sectional tube geometry for tube expansion due to pressure and to reduce the sensitivity to variation in mechanical tube characteristics using an experimental statistical and factorial design. The main application is pressure monitoring in blood and dialysate tubes during hemodialysis. Improving the monitoring of the dialysis process will reduce complications, such as sudden decreases in systemic blood pressure or occlusion at the artero-venous fistula. The factorial design indicated strong influence from the geometrical characteristics of the tube as well from the geometrical design parameters of the pressure transducer. We found a consistent relationship between the intraluminal pressure and the applied force needed to restore the tube shape. The modified cross-sectional tube geometry enhances measurement sensitivity and facilitates the desired behavior of tubes during pressure applications.
Study of Systolic Pressure Variation (SPV) in Presence of Mechanical Ventilation
Authors: Clemente F. , De Lazzari C. , Darowski M. , Ferrari G. , Mimmo R. , Guaragno M. , Tosti G.
Published: January 2018

Systolic pressure variation (SPV) and its components (dUp and dDown) have been demonstrated to be of interest in assessing preload in mechanically ventilated patients. The aim of this paper is to analyse the sensitivity of these variables to preload and volemic changes during mechanical ventilation in different conditions of the cardiovascular system. Computer simulation experiments have been done using a modular lumped parameter model of the cardiovascular system. The effect of mechanical ventilation has been reproduced operating on intrathoracic pressure. Experiments have been performed varying preload through filling pressure. Sensitivity of SVP, dUp and dDown is described varying separately left ventricular elastance (Ev), systemic arterial resistance (Ras) and systemic arterial compliance (Cas). The sensitivity of SPV and dDown to preload and filling pressure is appreciable for high values of Ev and for a wide variation of Ras. Preliminary clinical data concerning the three parameters show good correlation with simulation results.
Improving the Fixation of an Artificial Intervertebral Disc
Authors: Eijkelkamp M.F. , Hayen J. , Veldhuizen A.G. , Van Horn J.R. , Verkerke G.J.
Published: January 2018

The fixation of an artificial intervertebral disc has been studied especially with respect to the dimensions, the convexity of the endplates and the size of the fixation elements.

From literature and cadaveric vertebrae, the dimensions and shape of the lumbar vertebral endplates were determined and the dimensions of fixation ribs for the artificial intervertebral disc were calculated.

To withstand shear forces and prevent dislocation, two sagittal ribs, each 3.5 mm in height and at least 20 mm in length and four transversal ribs, each 1.5 mm in height and with a total length of 60 mm are sufficient.

A range of five different sagittal diameters was selected as sufficient for all patients. At least 72.6 % of the endplate of the vertebrae is covered. A convexity with a radius of 140 mm limits the gap to 0.62 mm.
Various Clinical Approaches to Minimise Complications in Peritoneal Dialysis
Authors: Stegmayr B.
Published: January 2018

The main reason for a failure of peritoneal dialysis is due to technical problems or infections. By starting PD immediately after the insertion of a dialysis catheter (instead of starting HD before optimal healing of the PD-catheter) it may be easier to achieve acceptance for PD by the patients. An easy and tight access is achieved when inserting the PD-catheter through the rectus muscle, fixing it with three purse string sutures, two of them fixing the inner cuff between the peritoneal membrane and the inner rectus fascia. Thereby early and late leakage will be rare and good drainage is normally achieved besides a low risk for exit site infections. Using Coloplast® adhesive insulin can be injected into the PD bags in a simple way even by patients with bad vision. Using ultraviolet light, as additional exchange device (UV-box), the risk for peritonitis is reduced compared to classic manual connection. Using the Y-set or duo-bag system the risk for peritonitis is further lowered. Malfunction by dislocation of the intraperitoneal part of the catheters can often be corrected without surgery using a bent stylet. A controlled study showed that antibiotic prophylactics could significantly reduce the risk for peritonitis in the follow up after insertion of PD catheters. Additionally the risk for peritonitis is reduced using a special connector for the PET-sampling procedures. X-ray of catheter location in the abdominal cavity can be performed by injection of 20-ml contrast media into 100 ml of PD fluid residing in the PD-bag. After mixing, small portions of this fluid can be infused into the abdomen for X-ray determination of the location. An increased ultrafiltration failure during PD may be due to use of beta-blocker medication. After ceasing this medication recovery may occur. Avoiding pets in the room used for PD-exchange may lower the risk for peritonitis further. A devoted nurse and physician will keep up the patients' spirit and help to convert patients not suitable for PD to HD or the other way round. By such measures the incidence of peritonitis can be reduced to 1 in 40 treatment months or less.
Vitamin E as an Antioxidant Agent in CAPD Patients
Authors: Mydlík M. , Derzsiová K. , Rácz O. , Šipulová A. , Boldizsár J. , Lovásová E. , Hríbiková M.
Published: January 2018

Oxidative stress, increased lipid peroxidation and decreased activity of antioxidant systems may contribute to the accelerated development of atherosclerosis in chronic renal failure patients during renal replacement therapy. The aim of the study was to investigate the influence of vitamin E (400 mg/day) on some antioxidant defense parameters in CAPD patients. In fourteen CAPD patients, erythrocyte antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GPX) and catalase (CAT), the concentration of plasma malondialdehyde (MDA), vitamin A, vitamin C and vitamin E were investigated. The study was divided into two periods. Each period lasted six weeks. In the first period patients received orally vitamin E 400 mg/day, in the second period they did not receive vitamin E or other antioxidant drugs. Each parameter was determined at the beginning of the study and at the end of each period. Six CAPD patients were treated by erythropoietin (EPO) and received orally pyridoxine 20 mg/day and the others without EPO treatment received pyridoxine 5 mg/day. Six-week treatment by vitamin E (400 mg/day) led to the significant increase of serum vitamin E (from 33.6±9.0 to 49.3±15.5 μmol/L) and to the significant decrease of MDA (from 2.62±0.5 to 2.36±0.4 μmol/L). The mean values of erythrocyte enzymes were in or under the lower margin of normal range and were not influenced by vitamin E in CAPD patients.

The results of our study showed that orally administered vitamin E is a very important antioxidant agent for CAPD patients.
Filtration Fluid for Hemodialysis Treatment
Authors: Ikonomov V. , Haase G. , Stefanidis I. , Melzer H. , Mann H.
Published: January 2018

Bacterial contamination of dialysis fluid has long been recognized as a problem in hemodialyis. Cytokines released as a consequence of contaminated dialysis fluid are believed to be responsible for many acute and chronic side effects in patients undergoing renal replacement therapy. For several years now, attempts have been made to eliminate pyrogenic substances and ensure a sterile and endotoxin-free dialysis fluid. A recent dialysis fluid filter known as DIASAFE®, containing a membrane based on Polysulfone® (Fresenius), was tested for a period of 1,000 hours (approx. 14 weeks). Dialysis fluid samples were collected once weekly before and behind the filter and cultivated for detection of microorganisms and endotoxins. Additionally, starting after the fourth week of the study, serum samples were collected weekly and the ß2-microglobulin concentration was determined.

The filter reduced microorganisms at a rate of at least 105 and in the majority of cases (86% of samples) by more than 106. Under clinical conditions the stability and microbiological functionality of the filters could be demonstrated for more than 1,000 hours and 150 disinfecting cycles. In four cases of endotoxin burden (>0.5 IU/ml) in the dialysis fluid in front of the filter the concentration behind the filter was lower than 0.1 IU/ml, indicating effective reduction of endotoxins. A tendency to a reduction of ß2-microglobulin in serum from 32.5 ± 3.9 mg/L to 21.5± 5.3 mg/L was observed. These results indicate that the dialysis fluid filter used was effective, dramatically reducing the bacterial contaminants in dialysis fluid, thus protecting patients from the potentially harmful acute and long-term life-threatening consequences of contaminated dialysis fluid.
Dialysis in Adults in Year 2000 in the Republic of Macedonia
Authors: Polenakovic M.H. ,   the Dialysis Working Group, Sikole A. , Grozdanovski R. , Amitov V. , Stojkovski Lj. , Oncevski A. , Grcevska L. , Dzikova S. , Cakalaroski K. , Bogdanovska S. , Gerasimovska V. , Gerasimovska B. , Milovanceva M. , Stojceva-Taneva O. , Krstanovski B. , Kovaceski S. , Serijat M. , Mustafa Z. , Capova O. , Bajalska A. , Nikolovski A. , Filipovic R. , Neskovski J. , Selja Lj. , Janakievska P. , Lamova K. , Hristova V. , Sarajlija E. Karceva , Romeo M. , Mitrevski Z. , Ivanovski K. , Dimitrov S. , Velinova B. , Panova B.
Published: January 2018

1,019 adult patients with terminal renal failure were treated with dialysis (D) in the first part of the year 2000 in the Republic of Macedonia. 1,010 patients (99%) were treated with chronic intermittent (maintenance) hemodialysis (HD) while nine patients (1%) were on continuous ambulatory peritoneal dialysis (CAPD). For the children, a special peritoneal dialysis program was developed; 509 patients per million of the population (PMP) were on dialysis.

The Republic of Macedonia is, therefore, among those central and eastern European countries with a higher PMP number in the treatment of end-stage renal disease, following Croatia, the Czech Republic and Slovenia.

The patients were treated at 18 Centers in a network of HD Centers at a distance of 30–50 km. from their place of residence in order to facilitate their access to treatment and to work. All patients who have had symptoms indicating need for treatment with D were accepted for treatment. The government payed all the expenses of the treatment and the salaries of the staff. 56% were male and 44% were female patients. The youngest patient was aged 9 and the oldest was 82 years old. There has been an increase in the age of the patients on D as well as an increase in their number. In 1993 we had 727 patients being treated with D, and now we have 1,019 with a constant increase in the number of patients with ESRD and a need for D and renal transplantation. Mortality per year at the different Centers ranged from 8–19% in 1999 and the average is 12%.

Glomerulonephritis (GN) – both primary and secondary – is the main cause of renal failure (RF) in some Centers up to 45%. Tubulo-interstitial disease follows GN. ADPKD patients constitute 9.4% with a difference among the Centers of 3–29%, and diabetic nephropathy is found in 10%, 5–15% in different Centers. 11–61% of patients have an unknown etiology.

352 patients are on treatment with human recombinant erythropoietin (rhuEPO) – in some Centers up to 60%. The mode of application was subcutaneous and the initial dose is 20 U/kg body weight and the mean maintenance dose of EPO per patient weekly is 4,000 U.

The Cimino-Brescia arteriovenous fistula is being applied as a standard vascular access. The survival rate of our patients treated with maintenance HD at 5 years was 58%. CAPD and particularly renal transplantation are to be further developed as alternative methods in treating terminal renal failure.
Psychophysiological comorbidity and computerized biofeedback
Authors: Pop-Jordanova N. , Pop-Jordanov J.
Published: January 2018

Our previous research on basic and applied psychophysiology comprised the quantum model for subcellular brain processes, the psychosomatic health risk assessment and management, as well as the electrodermal biofeedback psychometrics and therapy. Based on this experience, in the present paper the stress-related psychophysiological disorders in patients dependent on hemodialysis and insulin are considered. The most frequent comorbid psychological disorders appeared to be anxiety and depression, and they are generally under-diagnosed and under-treated. It is concluded that the quality of life of these patients needs to be considerably enhanced. The application of biofeedback, as a complementary cost-effective and non-invasive psychophysiological tool is recommended. In terms of ESAO vocabulary, this technique could be viewed as some kind of artificial ANS/CNS support. Simultaneously, the concept of biocompatibility may be viewed in a larger perspective as “psychobiocompatibility”.
Biodegradable polymeric matrices for bioartificial implants
Authors: Pişkin E.
Published: January 2018

Biomaterials made of polymers, metals or their alloys, ceramics and their composites, are used as implants to restore or to replace the damaged soft and hard tissue/organ functions for an intended time period. Biomaterials made of synthetic materials are very simple materials compared to their natural counterparts, they only replace very simple functions of the damaged tissue during healing. Natural tissues have been used for both soft and hard repair and replacement, but they do have serious limitations such as: shortage of donor tissue, donor site morbidity, unpredictable resorption characteristics, immunogenic response, risk of disease transmission, and ethical limitations. Tissue engineering is a relatively new approach, in which healthy mammalian cells are used with supporting matrices, usually made of either natural or synthetic polymers as composite bioartificial implants. Primary cells, especially embryonic stem cells, cell lines, hybridomas, genetically modified cells are considered as potential sources for this application. Both closed and open matrices are used as support matrices. Nondegradable and biocompatible microcapsules and hollow fibers are utilized in closed systems, especially for immunoprotection of the transplanted cells. Biodegradable polymers, both natural and synthetic are used in the preparation of bioartificial implants carrying only autogenic cells.
MARS in the Treatment of Liver Failure: Controversies and Evidence
Authors: Chiu A. , Fan S.T.
Published: January 2018

Molecular Adsorbent Recirculation System (MARS) is a form of extracorporeal detoxification system used as an artificial liver support system. Numerous studies have been published on the topic, with the majority of them describing the capability of MARS in removing albumin-bound toxins and improving systemic hemodynamics. Whether such improvement could be translated into survival benefit is still uncertain, given the paucity of randomized controlled trials available. The outcome of patients receiving MARS treatment is difficult to analyze because liver failure patients constitute a heterogeneous population and different subgroups carry different prognoses. An evidence-based recommendation on the timing of MARS initiation is not available and currently MARS is usually commenced for hyperbilirubinemia or presence of complications of liver failure. MARS is in general a safe procedure, but there are still potential complications that need to be cautioned, along with various operative issues that are worth attention. The future prospects of MARS would rely on the completion of adequately powered randomized controlled trials
Hepatitis C Virus Infection and Diabetes Mellitus in End-Stage Renal Disease: Evidence of a Negative Association
Authors: Fabrizi F. , Mangano S. , Aucella F. , Dixit V. , Martin P.
Published: January 2018

Epidemiological studies have implicated hepatitis C virus (HCV) infection in the pathogenesis of diabetes mellitus (DM) both in the population as a whole and after solid organ transplantation. Whether this association exists in patients with end-stage renal disease (ESRD) undergoing dialysis is unclear. The aim of this study is to investigate the relationship between HCV and DM in a large group (n = 742) of patients with ESRD from Europe and North America. The presence of diabetes was ascertained by using American Diabetes Association guidelines based on fasting glucose measurement and medication history. Presence of HCV infection was assessed by serum testing for anti-HCV antibodies. The prevalence of anti-HCV antibody positive patients was 15% (112/742); the frequency of DM was higher among anti-HCV positive than -HCV negative patients but the difference did not approach statistical significance, 32% (36/112) vs 29.5% (186/630). The frequency of patients with diabetic nephropathy was not higher in anti-HCV positive than -negative patients; 21.4% (24/112) vs 23.3% (147/630), NS. Logistic regression model showed an independent and significant link between anti-HCV seropositive status and raised GPT (P = 0.032), male gender (P = 0.0462), positive history of prior renal transplant (P = 0.0006), and longer time on dialysis (P = 0.00001). In summary, no link between anti-HCV antibody and DM occurred in this ESRD population; there was no association between rate of anti-HCV antibody and diabetic nephropathy.
A New Mathematical Approach to Modelling Thrombin Generation
Authors: Orfao S.M.C. , Jank G. , Mottaghy K.
Published: January 2018

The plasma coagulation system is a biochemical chain reaction where inactive proenzymes are converted to active enzymes in a cascade pattern. One of the problems encountered in the modelling of thrombin generation in plasma is that neither the reaction mechanism nor the reaction constants and initial concentrations are precisely known. Therefore, these quantities are taken as unknown parameters in the theoretical model and are estimated by fitting experimental data. In the literature there are two different mathematical models for approaching a part of the blood coagulation mechanism. Both models comprise a stiff system of non-linear differential equations. We aimed to analyze both systems after linearization, to steer or influence the system and to calculate the period of time for it to attain a final equilibrium as a basis for model extension.
In vitro Bioactivity of Poly(∊-Caprolactone)-Apatite (PCL-AP) Scaffolds for Bone Tissue Engineering: The Influence of the PCL/AP Ratio
Authors: Taddei P. , Di Foggia M. , Causa F. , Ambrosio L. , Fagnano C.
Published: January 2018

Porous poly(∊-caprolactone) (PCL) is used as long-term bioresorbable scaffold for bone tissue engineering. The bone regeneration process can be enhanced by addition of carbonated apatites (AP). This study was aimed at evaluating the influence of the PCL/AP ratio on the in vitro degradation and bioactivity of PCL-AP composites. To this purpose, PCL-AP samples were synthesised with the following PCL/AP weight/weight ratios: 50/50, 60/40 and 75/25.

Vibrational IR and Raman spectroscopies coupled to thermogravimetry (TG) and differential scanning calorimetry (DSC) were used to investigate the in vitro degradation mechanism in different media: 0.01 M NaOH solution (pH = 12), saline phosphate buffer at pH 7.5 (SPB), esterase in SPB and simulated body fluid (SBF) at pH 7.5. The latter medium was used to evaluate the bioactivity of the composites. A control PCL sample was analysed before the addition of the AP component.

As regards the untreated samples, the method of synthesis utilised for preparing the composite was found to enhance the crystallinity degree. The AP component revealed to be constituted of a B-type carbonated hydroxyapatite with a 3% carbonate content. After 28 days of treatment, the samples showed different degradation patterns and extents depending on the degradation medium, the starting PCL crystallinity and composite composition. Weight measurements, Raman and TG analyses revealed deposition of an apatitic phase on all the composites immersed in SBF. Therefore, all the samples displayed a good bioactivity; the sample which showed the most pronounced apatitic deposition was 50/50, i.e. that containing the highest amount of AP.
Whole Blood Selective LDL-Apheresis: A Comparison of Two Different Adsorbers
Authors: Poli L. , Busnach G.
Published: January 2018

The effects of LDL-apheresis with whole blood adsorption were compared in five patients with severe familial and ARH hypercholesterolemia, using two different sorbents, polyacrylic acid with the DALI system and dextran sulfate with the DX21 system. The patients were treated bimonthly with both systems at random. For each patient, the same number of procedures with both systems was considered, ranging from 2 to 11 for each technique. During a period of observation of 26 months, a total of 80 LDL-apheresis, 40 with the DALI system and 40 with the DX21, with equivalent volumes of treated whole blood was evaluated (mean blood volume treated: 8151 mL). Total and LDL cholesterol were effectively lowered with both techniques. The mean percentage reduction of total cholesterol and LDL-cholesterol respectively was 54.1±7.7% and 62.3±9% with the DALI system, 52.7±7.8% and 59.2±9.5 with the DX21: t-test for paired data showed p: 0.01 for LDL-cholesterol. The reduced removal of LDL-C with dextran sulfate, either within the same patient or all the patients taken together was of a very limited amount compared to polyacrylic acid. The superiority of one over the other sorbent cannot be affirmed: further studies on a higher number of procedures and patients, together with an evaluation of biocompatibility effects, compared to polyacrylic acid may clarify and make evident a significant difference in efficacy between the two systems.
A Small Scale Oxygenator for Cardiopulmonary Bypass in Rats
Authors: Ordodi V.L. , Paunescu V. , Mic A.A. , Ionac M. , Sandesc D. , Mic F.A.
Published: January 2018

Cardiopulmonary bypass (CPB) devices replace transiently the function of both heart and lungs, allowing the investigator to work safely on a stopped heart. Although this technology has greatly improved since its first applications in the early 1950's there is still no definitive rat CPB model, various experiments reporting drawbacks like pulmonary edema, large priming volumes, etc. We present a new oxygenator that can be used in cardiopulmonary bypass experiments in rats, simple in design and efficient in function, in which the process of blood oxygenation takes place in a vertical cylinder filled up with air or oxygen, with blood being spread onto the wall and then trickling down in a thin layer that facilitates the oxygen transfer. The oxygenation is efficient, the pO2 reaches levels of almost 150 mmHg (physiological level is around 100 mmHg) in conditions of oxygen saturation of over 99% (normal levels 95%-98%).
Mechanical Properties of Alginate Beads Hosting Hepatocytes in a Fluidized Bed Bioreactor
Authors: David B. , Barbe L. , BarthèS-Biesel D. , Legallais C.
Published: January 2018

Fluidized bed bioartificial liver has been proposed as a temporary support to bridge patients suffering from acute liver failure to transplantation. In such a bioreactor, alginate beads hosting hepatocytes are in continuous motion during at least six hours. After having shown in vitro the functionality of such a device, the present study aims at analyzing the potential mechanical alterations of the beads in the bioreactor, perfused by different surrounding media. Compression experiments are performed and coupled for analysis with Hertz theory. They provide qualitative and quantitative data. The average value of the shear modulus, calculated for the different cases studied varied from 2.4 to 10.4 kPa, and could therefore be considered as a quantitative measure of the beads mechanical properties. From the compression experiments and the estimated values of the shear modulus, we could now evaluate the effect of different operating conditions (fluidization, presence of cells, surrounding medium) on the mechanical behavior of alginate beads. On the one hand, the motion during six hours in the bioreactor does not alter the beads significantly. On the other hand, the presence of different substances in the fluid phase might change their mechanical strength. These results can be considered as new encouragements to use such a device as a bioartificial organ.
A Case Report of Fracture of Ceramic Head in Total Hip Arthroplasty: Histological and Biochemical Features of Perimplant Tissues
Authors: Stea S. , Visentin M. , Bordini B. , Traina F. , Squarzoni S. , Toni A.
Published: January 2018

The authors analyzed the case of a patient with a non-cemented hip prosthesis with a ceramic-ceramic coupling. As a consequence of trauma the head fractured. Although the patient could feel the joint grinding, there was no pain and he continued daily living activities for nearly six months, which led to marked wearing of the ceramic head. SEM analysis with microprobe showed “planed” surfaces on the ceramic head, suggesting repeated movements between the fractured components. Inside the cone of the head, signs of TiAlV, which is an alloy of the prosthetic stem, could be seen.

Periprosthetic tissues were packed with ceramic wear particles of sizes ranging between 0.2 and 10 microns, according to the harvest site. Metal and mixed particles were also found. IL1, IL6, IL8 and IL10 assays in the synovial liquid confirmed the inflammatory state and a modest induction of bone resorption, which was less than that observed in patients with loosened metal-polyethylene couplings. The humoral picture was compatible with the radiological aspect, which did not show marked signs of bone resorption. In revision surgery both ceramic components were replaced by a metal head and polyethylene liner. The clinical outcome after 12 months was very good.
Biomaterials Surface Characterization and Modification
Authors: Morra M. , Cassinelli C.
Published: January 2018

This paper presents several examples of recent work in the field of surface modification and characterization of biomaterials. Due to the explosion of techniques and approaches in this area, a complete review would be unmanageable in a single paper. Rather selected examples taken from such different areas as bone-contacting devices, drug eluting stents, and immobilization of novel biomolecules are presented. The aim is to place the existing and quickly developing background of analytical and synthetic biomaterial surface science into the current perspective of this rapidly evolving discipline.
Can Circuit Lifetime be a Quality Indicator in Continuous Renal Replacement Therapy in the Critically Ill?
Authors: Kleger Gian-Reto , FäSsler Edith
Published: January 2018

Purpose

Continuous renal replacement therapy (CRRT) is frequently used in critically ill patients with acute renal failure and sepsis. Frequent circuit changes increase nursing workload, blood loss and costs, and also compromise achievement of the filtration rate goal. Circuit downtime is the most important factor that compromises the cumulative filtration goal.

Methods

We used continuous venovenous hemodiafiltration (Prismaflex®, Gambro, Meyzieu Cedex, France) in our 12-bed medical intensive care unit (ICU). Circuit lifetimes, indication to start CRRT, anticoagulation protocol, reason for circuit change, and location of the vascular access were prospectively documented for 12 months in consecutive patients. Unfractionated heparin was the first choice for anticoagulation. No anticoagulation was used in patients with severe coagulation abnormalities or hepatic failure; regional citrate-based anticoagulation (CBA) was used in patients with recurrent circuit clotting or with bleeding predisposition. Our aim was to assess the suitability of circuit lifetime as a quality indicator, evaluated by survival analysis.

Results

Median circuit lifetime was significantly longer for CBA (log rank χ2=8.08; p=0.018). This is consistent with the literature. There were no differences in vascular access site, proportion of sepsis, or vasopressor dependency between the three anticoagulation groups.

Conclusions

In addition to monitoring the complication rate, the evaluation of circuit lifetime using survival analysis stratified by anticoagulation strategy is a simple and feasible means of assessing the quality of CRRT in the ICU.
Host Defense Against Implant Infection: The Ambivalent Role of Phagocytosis
Authors: Arciola Carla Renata
Published: January 2018

Bacteria embedded in biofilms resist both antibiotics and host defense mechanisms. However, biofilms are not inherently protected against the attack of phagocytic cells. The weapons that polymorphonuclear neutrophils employ against implant infection are phagocytosis, degranulation, with release of antimicrobial molecules, and formation of Neutrophil Extracellular Traps (NETs). NETs contain DNA, histones, and neutrophil elastase, which enable neutrophils to fulfill their role of limiting both microbial spread and the collateral damage from granular contents. It is not yet clear whether the DNA released by neutrophils would support biofilm formation by adding to bacterial extracellular DNA (eDNA), an integral part of the biofilm extracellular matrix. In spite of the evidence of somewhat effective phagocytosis around an implant infection, biofilm-embedded staphylococci persist, tissue destruction occurs and, in the case of orthopedic implant infection, osteolysis prevails. The mechanism for tissue destruction is based on the infiltration and persistence at the site of infection of neutrophils which are unable to effectively perform phagocytosis, but able to inflict tissue damage and cause osteolysis by the release of proteolytic and collagenolytic enzymes. Phagocytosis thus has an ambiguous and ambivalent role: it carries out an antibacterial strategy and at the same time is responsible for osteolysis.
Characterization of 26 Staphylococcus warneri isolates from orthopedic infections
Authors: Campoccia Davide , Montanaro Lucio , Visai Livia , Corazzari Tolmino , Poggio Claudio , Pegreffi Francesco , Maso Alessandra , Pirini Valter , Ravaioli Stefano , Cangini Ilaria , Speziale Pietro , Arciola Carla Renata
Published: January 2018

Staphylococcus warneri is a coagulase negative Staphylococcus (CNS) commonly present in the flora of human epithelia and mucosal membranes. Over the last two decades, similarly to other CNS species, S. warneri has been reported as a new emerging pathogen, capable of causing serious infections usually in association with the presence of implant materials, but, at times, even in the absence of a foreign body and in patients considered immunocompetent. At present, there is still a lack of scientific data on the pathogenesis and epidemiology of this species. The present study investigated a collection of 26 clinical isolates derived from orthopedic infections, some associated with implant materials and others not. Automated ribotyping showed the existence of 5 distinct ribogroups. Except for the least numerous ribogroup consisting of a single isolate, all other ribogroups included at least one strain obtained from an infection not associated with implant materials, suggesting that putative virulence factors necessary for infections even in the absence of a foreign body could be transversal to most ribogroup categories. Orthopedic infections were found to involve S. warneri strains with low antibiotic resistance potential, differing in this respect from the strains isolated at neonatal intensive care units, where this species has been described to figure among the principal causative agents and exhibit an alarming profile of antibiotic resistance.
Destruction of Bacterial Biofilms by Polymorphonuclear Neutrophils: Relative contribution of Phagocytosis, DNA Release, and Degranulation
Authors: Meyle Eva , Stroh Petra , GüNther Frank , Hoppy-Tichy Torsten , Wagner Christof , HäNsch G. Maria
Published: January 2018

Bacteria organized in biofilms are a common cause of relapsing or persistent infections, and the ultimate cause of implant-associated osteomyelitis. In these patients, biofilms of staphylococci are prevalent. Bacteria organized as biofilms are relatively resistant towards antibiotics and biocides, and it is also assumed that they may escape host defense mechanisms. In this context, we have studied how polymorphonuclear neutrophils (PMN), the “first line of defense” against bacterial infection, interact with biofilms generated in vitro. We found that PMN recognize biofilms and activate defense-associated reactions, including phagocytosis, degranulation of lactoferrin and elastase, and DNA release as well. Destruction of biofilms ensues, showing that biofilms are not inherently protected against the attack by phagocytic cells.
Surface Coating Strategies to Prevent Biofilm Formation on Implant Surfaces
Authors: Bruellhoff Kristina , Fiedler JöRg , MöLler Martin , Groll JüRgen , Brenner Rolf E.
Published: January 2018

Implant surfaces should ideally be designed to promote the attachment of target tissue cells; at the same time, they should prevent bacterial adhesion, achievable through modification strategies comprising three lines of defense. As the first criterion, selective adhesion can be realized by means of non-adhesive coatings that can be functionalized with small peptides, thereby supporting osteogenic cell attachment for implants in bone contact but not bacterial adhesion. The second line of defense, defined by bacterial survival, quorum sensing and biofilm formation, can be addressed by various antimicrobial substances that can be leaching or non-leaching. The possibility of a third line of defense, the disruption of an established biofilm, is just emerging. Since microorganisms are quite “ingenious” at finding ways to overcome a certain line of defense, the most promising solution might be a combination of all these antibacterial strategies. Coating systems that allow such different approaches to be combined are scarce. However, ultrathin multifunctional NCO-sP(EO-stat-PO)-based layers may represent a promising platform for such an integrated approach.
In Vivo Evaluation of the Effect of Intramedullary Nail Microtopography on the Development of Local Infection in Rabbits
Authors: Moriarty Thomas F. , Campoccia Davide , Nees Stephanie K. , Boure Ludovic P. , Richards Robert G.
Published: January 2018

Background and Aim

Fractures of the tibia and femoral diaphysis are commonly repaired by intramedullary (IM) nails, which are currently composed of either electropolished stainless steel (EPSS) or standard, non-polished titanium-aluminum-niobium (TAN). Once the fracture has fully healed, removal of IM nails is common, but the strong adhesion of bone to standard TAN complicates removal. Polishing the surface of TAN IM nails has been shown to reduce bony adhesion and ease implant removal without compromising fixation. Polished TAN nails are, therefore, expected to have significant clinical benefit in situations where the device is to be removed. The aim of the present study was to determine the effect of polishing TAN IM nails on susceptibility to infection in an animal model.

Materials and Methods

Solid IM nails (Synthes, Betlach, Switzerland) composed of standard TAN were compared with polished equivalents and also to clinically available EPSS nails. The surface chemical and topographical properties of the materials were assessed by X-ray photon spectroscopy (XPS), white light profilometry, and scanning electron microscopy (SEM). An in vivo infection study was performed using a clinical isolate of Staphylococcus aureus that was characterized with respect to various virulence factors.

Results

Polishing TAN IM nails caused no significant change to the chemistry of the nails, but the topography of the polished TAN nails was significantly smoother than standard TAN nails. In the infection study, the rank order based on descending infectious dose 50 (ID50) was: standard TAN, polished TAN, and finally EPSS. The ID50 values did not differ greatly between any of the groups.

Conclusions

Polishing the surface TAN IM nails was not found to influence the susceptibility to infection in our animal model.
Influence of the oral status on cardiovascular diseases in an older Italian population
Authors: De Angelis Francesca , Basili Stefania , Giovanni Fratto , Dan Trifan Pompiliu , Di Carlo Stefano , Manzon Licia
Published: January 2018

Oral diseases have been adversely associated with cardiovascular diseases (CVD), which are also the most frequent cause of death in older population. The aim of this study was to investigate the association among oral status indexes and CVD in patients aged more than 65 years attending in the Oral department of a public hospital Policlinico Umberto 1 of Rome. The study population consisted of 533 patients. Dental status was detected measuring the Decayed, Missing, and Filled Teeth (DMFT) and Community Periodontal Index (CPI) indexes. The chi-square test with a 95% confidence level was used to assess qualitative variables. Odds ratios (ORs) and stepwise logistic regression were used to calculate risk estimates; the independent variables: age, gender, DMFT, CPI index, Geriatric Oral Health Assessment Index (GOHAI) score, and tooth loss were included in the statistical model. P value <0.05 was considered a statistically significant cut-off. No differences were found between females and males for DMFT and CPI. GOHAI data were worst for females. Patients with CVD had less education and oral care ( P < 0.05), and higher CPI index and number of missing teeth ( P < 0.05). Data show that patients with more than 18 missing teeth have 2.5 times greater risk of CVD. CVDs are associated with type 2 diabetes mellitus, underweight, and obesity ( P < 0.05). From the findings of this study, it can be confirmed a significant link between CVD and oral health. A cooperation among geriatrician, cardiologist, and dentist is suitable to counteract the development of CVD and to early identify patients at risk of CVD.
Profit Squeeze in the Duménil and Lévy Model
Authors: Thompson Stephen
Published: January 2018

This article looks at the implications of labor-supply limits and endogenous wage growth in the Duménil and Lévy model. A long-run relationship is established between the employment rate and capitalists’ decisions to reinvest profits. Elements of a Marxian approach to macroeconomic policy are sketched. New conditions are derived for being Kaleckian/Keynesian in the short run and classical Marxian in the long run.
Conceptualizing Learning in the Climate Justice Movement
Authors: Kluttz Jenalee , Walter Pierre
Published: January 2018

This article extends Scandrett et al.’s conceptual framework for social movement learning to understand learning and knowledge creation in the climate justice movement. Drawing on radical pluralist theoretical approaches to social movement learning, learning in the climate justice movement is conceptualized at the micro, meso, and macro levels, along two continua of (a) unorganized and organized learning and (b) individual and collective learning. Two critical themes of learning about power and learning about place are used as examples to illustrate learning across the three levels. Article conclusions discuss strengths and limitations of the conceptual framework and directions for further research to better understand adult learning within the climate justice movement.
Free Appropriate Public Education and Endrew F. v. Douglas County School System (2017): Implications for Personnel Preparation
Authors: Yell Mitchell L. , Bateman David F.
Published: January 2018

The purpose of this article is to examine the free appropriate public education (FAPE) requirements of the Individuals With Disabilities Education Act (IDEA). The authors first briefly examine the definition of FAPE in the IDEA. Second, they delve into the U.S. Supreme Court’s decisions in Board of Education v. Rowley and Endrew F. v. Douglas and how these decisions have affected the definition of FAPE. They next address the procedural, substantive, and implementation errors school district personnel often make when developing students’ special education programs. They offer suggestions on how faculty members can prepare their preservice teachers to understand and avoid these errors and develop educationally meaningful and legally correct special education programs that confer a FAPE.
Breaking the Cycle: Preparing Pre-Service Teachers for Disability-Related Discussions
Authors: Bialka Christa S. , Hansen Nicole , Wong Sarah Jin
Published: January 2018

Teacher preparation programs play a seminal role in the development of prospective teachers, as they provide future educators with information regarding the rights of students with disabilities and the pedagogical means to support them in the classroom. Yet, few programs focus on how to discuss disability with students (Abernathy & Taylor, 2009; Cosier & Pearson, 2016). Once they enter into practice, many teachers hesitate to engage students in conversations about disabilities because they are unsure of what to say or fear offending students with disabilities (Crowson & Brandes, 2014; Gay & Howard, 2000). Because there is scant literature on how to best prepare pre-service teachers to hold disability-related discussions in their future classrooms, in this article, the authors aim to fill a void in current practice by providing examples of activities, assessments, and related materials that enable pre-service teachers to talk about disabilities.
Influences of Cesarean Delivery on Breastfeeding Practices and Duration: A Prospective Cohort Study
Authors: Chen Cheng , Yan Yan , Gao Xiao , Xiang Shiting , He Qiong , Zeng Guangyu , Liu Shiping , Sha Tingting , Li Ling
Published: January 2018

Background:

Mothers are encouraged to exclusively breastfeed for the first 6 months. However, cesarean delivery rates have increased worldwide, which may affect breastfeeding.

Research aim:

This study aimed to determine the potential effects of cesarean delivery on breastfeeding practices and breastfeeding duration.

Methods:

This was a 6-month cohort study extracted from a 24-month prospective cohort study of mother–infant pairs in three communities in Hunan, China. Data about participants’ characteristics, delivery methods, breastfeeding initiation, use of formula in the hospital, exclusive breastfeeding, and any breastfeeding were collected at 1, 3, and 6 months following each infant’s birth. The chi-square test, logistic regression model, and Cox proportional hazard regression model were used to examine the relationship between breastfeeding practices and cesarean delivery.

Results:

The number of women who had a cesarean delivery was 387 (40.6%), and 567 (59.4%) women had a vaginal delivery. The exclusive breastfeeding rates at 1, 3, and 6 months were 80.2%, 67.4%, and 21.5%, respectively. Women who had a cesarean delivery showed a lower rate of exclusive breastfeeding and any breastfeeding than those who had a vaginal delivery ( p < .05). In addition, cesarean delivery was related with using formula in the hospital and delayed breastfeeding initiation. Cesarean delivery also shortened the breastfeeding duration (hazard ratio = 1.40, 95% confidence interval [1.06, 1.84]).

Conclusion:

Healthcare professionals should provide more breastfeeding skills to women who have a cesarean delivery and warn mothers about the dangers of elective cesarean section for breastfeeding practices.
Kinship ‘matters’: Continuity and change in children’s family relations across three generations in Rwanda
Authors: Pontalti Kirsten
Published: January 2018

Studies of children and youth in Africa increasingly document fundamental changes in young people’s lived experience. However, most studies neglect to locate children’s experiences and actions within their broader historical, social and institutional context. Drawing from 10 consecutive months of historical and ethnographic fieldwork in Rwanda, this article examines how young people have reproduced and changed their kinship relationships across three generations as they live at the interface of multiple rule systems, ‘traditional’ and ‘modern’.