bluuebunny/crossref_metadata_2025 huggingface dataset:
Making of Selfie Nationalism: Narendra Modi, the Paradigm Shift to Social Media Governance, and Crisis of Democracy
Authors: Rao Shakuntala
Published: January 2018

The 2014 general elections in India marked a new media beginning. It catapulted Narendra Modi onto the national political scene through his clever use of digital media space as a form of public relations. This article uses rhetorical analysis to analyze 1,230 of Modi’s tweets between April 15 and August 15, 2017. I suggest that Modi’s emphasis on social media governance leads to “selfie nationalism,” a clear break from Mohandas Gandhi’s advocacy of “spiritual nationalism.” Modi’s nationalism is based on a belief in right-wing Hinduism, a relentless advocacy for business, his presentation of himself as both a global leader and a commoner who can identify with Indians of all castes and classes, and his silence on minority rights, poverty, free press, judiciary and legislative processes, and India’s plural religious traditions. I conclude that with the rise of Modi’s brand of “selfie nationalism,” coupled with increasing rural-urban polarization, democracy in India is more akin to what O’Donnell refers to as “delegative” rather than representational democracy.
Mutual Fund Characteristics and Investment Performance in India
Authors: Babbar Sonal , Sehgal Sanjay
Published: January 2018

In this study, we examine the role of fund characteristics in determining mutual fund performance in India. The data comprises of 237 open-ended Indian equity (growth) schemes during the period April 2007 to March 2013. Using daily dividend adjusted net asset values (NAVs), the risk-adjusted performance is estimated employing conditional version of Carhart (1997) four factor model in a time series regression framework. A range of fund characteristics, namely, the size of fund, growth in size of fund, expense ratio, portfolio turnover, NAV and age of fund, are examined in predictive model in a panel data regression framework that may determine the future performance of the fund. The Hausman specification test is conducted to decide if individual effects are random or fixed. The results of panel regression, based on fixed effects estimator, show that the size of fund, growth in size of fund and NAV negatively affect one period ahead risk-adjusted performance in India, while the age of fund has a positive impact. Expense and portfolio turnover ratios do not play a significant role. Identification of significant fund characteristics offer valuable insights to investors as it will allow them to make prudent selection of mutual funds and make judicious investment decisions.
Rio de Janeiro’s favela assemblage: Accounting for the durability of an unstable object
Authors: Richmond Matthew Aaron
Published: January 2018

Assemblage thinking offers a new conceptual toolkit for analysing the relationship between society and space. However, major questions remain regarding both its ontological propositions and how it might be applied to the analysis of specific socio-spatial objects. This article contributes to these debates by using assemblage thinking to trace the long-term development of Rio de Janeiro’s favelas. These territories have undergone a range of seemingly contradictory changes over recent decades. On one hand, expanded infrastructure and service provision and improved social outcomes have meant favelas have moved closer to, and in some cases surpassed, areas officially designated as “formal”. On the other, they continue to be heavily stigmatised, targeted by exceptional forms of governance, and subject to militarisation and abuse by police and non-state armed groups. Tracing these developments over time, I argue that the favela is best understood as an assemblage of heterogeneous, interacting elements that operate according to diverse logics. Despite continual pressures to deterritorialise, or break apart, a density of components and relations has ensured the continual reterritorialisation of the “favela” as a distinct object of perception and action over more than a century, with far reaching consequences for residents and the wider city.
Financial literacy, role models, and micro-enterprise performance in the informal economy
Authors: Engström Pontus , McKelvie Alexander
Published: January 2018

This article analyses how financial literacy and role models contribute to explaining the performance of micro-enterprises in the informal economy. Grounded in human capital reasoning and social learning theory, we argue that financial literacy and personal knowledge of role models lead to improved firm performance. We test our hypotheses on a unique dataset of 739 micro-enterprises in Ecuador. We find that financial literacy is an important predictor of financial performance but not growth, and the use of role models predicts return on assets but not other performance metrics. Our results have implications for future work on micro-enterprises and the nature of the human and social capital of their founders.
Microfinance and entrepreneurship: An introduction
Authors: Newman Alexander , Schwarz Susan , Ahlstrom David
Published: January 2018

As microfinance gains increasing attention and application as a financing mechanism for entrepreneurs at the base of the economic pyramid, this Special Issue of International Small Business Journal aims to enhance scholarly understanding of how microfinance fosters entrepreneurial activity. Microfinance brings a range of financial services, including microcredit loans, savings, and insurance, within the reach of millions of poor households not served by traditional banks. This introduction summarizes the articles in this Special Issue of International Small Business Journal on ‘Microfinance’, which address a range of topics in this important domain of research and practice.
Working the crowd: Improvisational entrepreneurship and equity crowdfunding in nascent entrepreneurial ventures
Authors: Brown Ross , Mawson Suzanne , Rowe Alexander , Mason Colin
Published: January 2018

Equity crowdfunding has rapidly established itself as an important part of the funding landscape for nascent entrepreneurial ventures. To date, however, little is known about the nature of the demand for equity crowdfunding or its impact on recipient firms. This article draws on an interview-based study of entrepreneurs of 42 equity crowdfunded start-ups in the United Kingdom. The study found strong demand for this funding from these experimental and improvisational entrepreneurs within innovative, consumer-focused, early stage firms. Many entrepreneurs were classic ‘discouraged borrowers’ attracted by the ability to obtain finance quickly with relatively little diminution of their equity or autonomy. In terms of impact, equity crowdfunding seems to confer important intangible benefits to investee companies which amount to more than money. Given their strongly improvisational nature, the concept of entrepreneurial bricolage seems a suitable theoretical lens explicating the behavioural aspects of the entrepreneurs examined.
The role of prior domestic experience and prior shared experience in young firm internationalization
Authors: Bruneel Johan , Clarysse Bart , Autio Erkko
Published: January 2018

This article examines how the prior domestic experience of a founding team influences an entrepreneurial firm’s ability to grow international sales. We argue that such experience leads to domestic mind-sets, which limit a team’s ability to perceive and interpret international stimuli and impact negatively upon international sales growth. Previous studies have overlooked the shared component of such experience. Prior shared experience allows ventures to learn faster from internationalization as a result of team familiarity and transactive memory systems. In uncertain environments, such as geographically distant regions, ventures that have founding teams with prior shared experience are able to outperform those without such experience.
How do micro-firms manage coopetition? A study of the wine sector in France
Authors: Granata Julien , Lasch Frank , Le Roy Frédéric , Dana Léo-Paul
Published: January 2018

Research on coopetition – the simultaneous occurrence of competition and cooperation among firms – is usually limited to the realm of large firms. While some research has examined the motives and outcomes of coopetition among small- and medium-sized business, little is known about how coopetition is managed among micro-firms. The French wine sector is dominated by micro-firms, among which coopetition is common. Focusing on the Pic Saint Loup area in south-eastern France, this article analyses how micro-firms manage coopetition. While we observe similarities in coopetition with respect to large firms, a distinct micro-firm coopetition mode is identified: (a) contrary to expectations, the management of coopetition is highly formalised in micro-firms; (b) as with large firms, the management of micro-firm coopetition requires a separation between competition and cooperation, but such separation occurs outside the firm – in the form of a collective structure; and (c) in contrast to large firms, small firms exhibit an increase in individual-level dimensions of coopetition with decreasing firm size. We conclude that policy should encourage coopetition among micro-firms provided that it is tailored to micro-firm specificities.
Entrepreneurial alertness and new venture performance: Facilitating roles of networking capability
Authors: Adomako Samuel , Danso Albert , Boso Nathaniel , Narteh Bedman
Published: January 2018

An ability to act upon an entrepreneurial opportunity is a major driver of new venture success. However, scholarly knowledge is limited on how and when entrepreneur alertness to entrepreneurial opportunities drives new venture success. This article addresses this gap arguing that variations in new venture performance are a function of levels of entrepreneurial alertness and networking capabilities. Using primary data gathered from 203 new ventures operating in a sub-Saharan African economy, Ghana, we find that increases in the levels of entrepreneurial alertness are related to increases in new venture performance. Additionally, we find that, under conditions of increased use of social and business networking capabilities, the potency of entrepreneurial alertness as a driver of new venture success is amplified. Theoretical, managerial and policy implications of these findings are discussed.
A cluster randomised feasibility trial of clinically assisted hydration in cancer patients in the last days of life
Authors: Davies Andrew N , Waghorn Melanie , Webber Katherine , Johnsen Sigurd , Mendis Jeewaka , Boyle Julia
Published: January 2018

Background:

The provision of clinically assisted hydration at the end-of-life is one of the most contentious issues in medicine.

Aim:

The aim of this feasibility study was to answer the question ‘can a definitive (adequately powered) study be done?’

Design:

The study was a cluster randomised trial, with sites randomised on a one-to-one basis to intervention ‘A’ (regular mouth care and usual other care) or intervention ‘B’ (clinically assisted hydration, mouth care and usual other care). Participants were assessed every 4 h, and data collected on clinical problems, therapeutic interventions and overall survival.

Setting/participants:

The study was conducted at 12 sites/‘clusters’ with specialist palliative care teams (4 cancer centres and 8 hospices), and participants were cancer patients in the last week of life who were unable to maintain sufficient oral fluid intake.

Results:

The study achieved its pre-determined criteria for success. Two hundred patients were recruited to the study, and 199 participants completed the study, over a 1-year period. A total of 38.5% participants discontinued clinically assisted hydration due to adverse effects: none of these adverse events were rated as ‘severe’ or worse in intensity. The primary reasons for discontinuation were site problems ( n = 2), localised oedema ( n = 13), generalised oedema ( n = 5), respiratory secretions ( n = 6) and nausea and vomiting ( n = 1).

Conclusion:

The results of this feasibility study suggest that a definitive study can be done, but that minor changes are needed to the protocol to standardise the administration of clinically assisted hydration (which may reduce the incidence of certain adverse effects).
Development of the HOOSglobal to Assess Patient-Reported Outcomes in Patients Undergoing Hip Preservation Procedures
Authors: Jacobs Cale A. , Peabody Michael R. , Duncan Stephen T. , Muchow Ryan D. , Nunley Ryan M. ,   the ANCHOR Group, Clohisy John C. , Beaule Paul E. , Kim Young Jo , Millis Michael B. , Podeszwa David A. , Schoenecker Perry L. , Sierra Rafael J. , Sink Ernest L. , Sucato Daniel J. , Trousdale Robert T. , Zaltz Ira
Published: January 2018

Background:

The creation of a single patient-reported outcome (PRO) platform validated across hip preservation, osteoarthritis (OA), and total hip arthroplasty (THA) populations may reduce barriers and streamline the routine collection of PROs in clinical practice. As such, the purpose of this study was to determine if augmenting the Hip disability and Osteoarthritis Outcome Score–Joint Replacement (HOOS, JR) with additional HOOS questions would result in a PRO platform that could be used across a wider spectrum of hip patient populations.

Hypothesis:

The HOOS, JR would demonstrate a notable ceiling effect, but by augmenting the HOOS, JR with additional HOOS questions, a responsive PRO platform could be created.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

Using preoperative and postoperative HOOS responses from a sample of 304 patients undergoing periacetabular osteotomy (PAO), additional items were identified to augment the HOOS, JR. The psychometric properties of a newly created PRO tool (HOOSglobal) were then compared with the HOOS, JR and other PRO instruments developed for patients with hip OA and/or undergoing THA.

Results:

By augmenting the HOOS, JR with 2 additional questions, the HOOSglobal was more responsive than all other included PRO tools and had significantly fewer maximum postoperative scores than the HOOS, JR ( P < .0001), HOOS–Physical Function Short form ( P < .0001), Western Ontario and McMaster Universities Osteoarthritis Index ( P = .02), University of California, Los Angeles activity scale ( P = .0002), and modified Harris Hip Score ( P = .04). The postoperative HOOSglobal score threshold associated with patients achieving the patient acceptable symptom state (PASS) was 62.5.

Conclusion:

The HOOSglobal is a valid and responsive PRO tool after PAO and may potentially provide the orthopaedic community with a PRO platform to be used across hip-related subspecialties. For patients undergoing PAO, a postoperative HOOSglobal score ≥62.5 was associated with patients achieving the PASS.
The Current Status of Therapeutic Apheresis Devices in the United States
Authors: Siami G.A. , Siami F.S.
Published: January 2018

Over the last 40 years, plasmapheresis technology and its indications for use have been continually evolving. With the growing incidence for autoimmune diseases, unsatisfactory therapeutic options, side effects of drug therapy, and economic relevance, apheresis clinicians have been leaning toward more selective plasmapheresis techniques through the use of plasma fractionators and immunoadsorption columns. Plasma fractionators are mostly used in Asia, and rarely utilized in the U.S. The majority of plasma filters approved by the Food and Drug Administration (FDA) are primary membrane plasma separators, which still require replacement fluid. The secondary plasma fractionators available in the U.S. are limited in used and mostly investigational. Immunoadsorption columns, mostly used in Europe, are gaining popularity in the U.S. Some FDA-approved immunoadsorption columns include the Prosorba protein-A silica column, Immunosorba tryptophan and phenylalanine columns, Immunosorba protein-A sepharose column, and Liposorber dextran sulfate column. In addition, the heparin-induce extracorporeal lipoprotein precipitation (HELP) system is also FDA-approved. However, there are other immunoadsorption technologies used in Europe, such as direct adsorption lipoprotein LDL-hemoperfusion, not yet available in the U.S. While each method of apheresis carries its own risks and benefits, it is the opinion of the authors that these additional apheresis techniques be available to U.S. researchers and clinicians as a therapeutic option. The authors believe that the U.S. need to aggressively investigate more specific plasmapheresis modalities and establish appropriate dialogue with regulatory and reimbursement officials for FDA-approval of these devices.
The Effect of Heparin Rinse on the Biocompatibility of Continuous Veno-Venous Hemodiafiltration
Authors: Opatrný K. , Polanská K. , KroužEcký A. , Vít L. , Novák I. , Kasal E.
Published: January 2018

The aims of our cross-over randomized study were (1) to assess hemostasis in patients with acute renal failure (ARF) and (2) to determine whether or not the generally recommended heparin rinse of the extracorporeal circuit (ECC) prior to the procedure affects thrombogenicity, complement activation, and leukocyte count in blood during continuous venovenous hemodiafiltration (CVVHDF). Eleven critically ill ARF patients were treated, in random order, using CVVHDF in postdilution setup following ECC rinse with saline (A) with heparin at a concentration of 2,000 IU/L (10 procedures), (B) with heparin at a concentration of 10,000 IU/L (7 procedures), and (C) without heparin (9 procedures). Except for the rinse, anticoagulation therapy did not differ in individual patients during the procedures. Blood was withdrawn before, and at minutes 15, 60, and 360, invariably at diafilter inlet and outlet. Compared with healthy individuals, patients showed lower blood thrombocyte counts (153 vs 233*109/L, p<0.01, arithmetic means, Student's t test), longer aPTT (44 vs 36 s, p<0.05), higher plasma levels of heparin (0.1 vs 0.0 U/mL, p<0.05), D-dimer (1129 vs 36 ng/mL, p<0.001) and beta-thromboglobulin (BTG) (159 vs 37 U/mL, p<0.001) prior to CVVHDF. The comparison of procedures with different rinsing technique did not reveal any significant difference in their effects on blood thrombocyte and leukocyte counts, aPTT, plasma levels of heparin, BTG, thrombin-antithrombin III complexes, D-dimer, or the C5a complement component. Conclusions: (1) Patients indicated for CVVHDF show impaired hemostasis involving thrombocytes, coagulation, and fibrinolysis, (2) no beneficial effect of heparin rinse on CVVHDF ECC thrombogenicity, complement activation or blood leukocyte counts was demonstrated.
Cell Activation and Cellular-Cellular Interactions during Hemodialysis: Effect of Dialyzer Membrane
Authors: Sirolli V. , Ballone E. , Di Stante S. , Amoroso L. , Bonomini M.
Published: January 2018

During hemodialysis (HD), circulating blood cells can be activated and also engage in dynamic interplay. These phenomena may be important factors behind dialysis membrane bio(in)compatibility. In the present prospective cross-over study, we have used flow cytometry to evaluate the influence of different dialysis membranes on the activation of circulating blood cells (leukocytes, platelets) and their dynamic interactions (formation of circulating platelet-leukocyte and platelet-erythrocyte aggregates) during in vivo HD. Each patient (n = 10) was treated with dialyzers containing membranes of cellulose diacetate, polysulfone and ethylenevinylalcohol (EVAL) in a randomized order.

Upregulation of adhesion receptor expression (CD15s, CD11b/CD18) occurred mainly with the cellulosic membrane, though an increase in CD11b/CD18 circulating on neutrophils was also found with both synthetic membranes. Circulating activated platelets (P-selectin/CD63-positive platelets) increased during HD sessions with cellulose diacetate and polysulfone. An increased formation of platelet-neutrophil aggregates was found at 15 and 30 min during dialysis with cellulose diacetate and polysulfone but not with EVAL. Platelet-erythrocyte aggregates also increased with cellulose diacetate and at 15 min with polysulfone as well. Generally in concomitance with the increase in platelet-neutrophil coaggregates, there was an increased hydrogen peroxide production by neutrophils.

The results of this study indicate that cellular mechanisms can be activated during HD largely depending on the membrane material, EVAL causing less reactivity than the other two membranes. It appears that each dialysis membrane has multiple and different characteristics that may contribute to interactions with blood components. Our results also indicate that derivatizing cellulose (cellulose diacetate) may be a useful way to improve the biocompatibility of the cellulose polymer and that there may be great variability in the biocompatibility profile of synthetic membranes, dialysis with polysulfone being in general associated with a higher degree of cell activation than EVAL membrane.
Digoxin Poisoning and Anuric Acute Renal Failure: Efficiency of the Treatment Associating Digoxin-Specific Antibodies (Fab) and Plasma Exchanges
Authors: Chillet P. , Korach J.M. , Petitpas D. , Vincent N. , Poiron L. , Barbier B. , Boazis M. , Berger PH.
Published: January 2018

Digoxin-specific antibodies (Fab) are currently the treatment of choice for digoxin intoxication. These fragments bind to digoxin, leading to Fab-digoxin complexes, and promote the release of receptor-bound digoxin. These complexes are renally excreted. In the case of anuria, they could be dissociated and lead to renewed intoxication.

In this case plasma exchanges are proposed. We report the case of an anuric patient with digoxin intoxication, treated with a Fab injection, followed by a plasma exchange 16 hours later, a second Fab injection was given followed by two plasma exchanges, 38 and 86 hours later. The disappearance of cardiac abnormalities showed the efficiency of the Fab, the drop in serum digoxin concentration and the high digoxin concentration in the exchanged plasma indicate effective elimination.

The association of Fab and plasma exchanges could be proposed in the case of digoxin intoxication in the anuric patient.
A Method to assess Biochemical Activity of Liver Cells during Clinical Application of Extracorporeal Hybrid Liver Support
Authors: Mundt A. , Puhl G. , Müller A. , Sauer I. , Müller C. , Richard R. , Fotopoulou C. , Doll R. , Gäbelein G. , Höhn W. , Hofbauer R. , Neuhaus P. , Gerlach J.
Published: January 2018

Biochemical activity of a hybrid liver support system based on porcine liver cells was investigated in patients suffering from acute liver failure, coma stage III-IV. Patient plasma was drawn systemically and after circulation through the bioreactor at four hour intervals. A method is used that takes into account the rate of plasma flow and the differences in plasma concentration systemically and after circulation through the liver support system to determine the net release or uptake of metabolites such as ammonia, urea and glucose. Urea release (mean 2.28 ± 0.37 μmol/h/g cells) and ammonia uptake (mean 0.17 ± 0.11 μmol/h/g cells) was seen during treatment, an active role of the system in glucose metabolism was observed. All patients were bridged successfully to liver transplantation.
Application of the Moving-Actuator Type Pump as a Ventricular Assist Device: In vitro and in Vivo Studies
Authors: Lee H.S. , Rho Y.R. , Park C.Y. , Hwang C.M. , Kim W.G. , Sun K. , Choi M.J. , Lee K.K. , Cheong J.T. , Shim E.B. , Min B.G.
Published: January 2018

A moving actuator type pump has been developed as a multifunctional Korean artificial heart (AnyHeart™). The pump consists of a moving actuator as an energy converter, right and left sacs, polymer (or mechanical) valves, and a rigid polyurethane housing. The actuator containing a brushless DC motor moves back and forth on an epicyclical gear train to produce a pendular motion, which compresses both sacs alternately. Of its versatile functions of ventricular assist device and total artificial heart use, we have evaluated the system performance as a single or biventricular assist device through in vitro and in vivo experiments. Pump performance and anatomical feasibility were tested using various animals of different sizes. In the case of single ventricular assist device (VAD) use, one of the sacs remained empty and a mini-compliance chamber was attached to either an outflow or inflow port of the unused sac. The in vitro and in vivo studies show acceptable performance and pump behavior. Further extensive study is required to proceed to human application.
Acute Renal Failure and Multiple Organ Dysfunction in the ICU: From Renal Replacement Therapy (RRT) to Multiple Organ Support Therapy (MOST)
Authors: Ronco C. , Bellomo R.
Published: January 2018

Renal replacement therapy (RRT) has evolved from the concept that we need to treat the dysfunction of a single organ (the kidney). As intensive care units have become more and more complex, it has become clear that the majority of patients with acute renal failure often have dysfunction of several other organs. In order to facilitate single organ support in this setting, continuous renal replacement therapy (CRRT) techniques have been developed. However, CRRT has opened the door to the concept that targeting renal support as the only goal of extracorporeal blood purification may be a simplistic view of our therapeutic aims. In this article we argue that it is now time to move from the simple goal of achieving adequate renal support. The proper goal of extracorporeal blood purification in ICU should be multi-organ support therapy (MOST). We explain why MOST represents the most logical future conceptual and practical evolution of CRRT and illustrates the biological rationale, supplying animal and clinical evidence that confirms the need to move rapidly in this direction theoretically, practically and technologically.
On-Line Monitoring of Solutes in Dialysate Using Absorption of Ultraviolet Radiation: Technique Description
Authors: Fridolin I. , Magnusson M. , Lindberg L.-G.
Published: January 2018

Purpose

The aim of this work was to describe a new optical method for monitoring solutes in a spent dialysate using absorption of UV radiation.

Method

The method utilises UV-absorbance determined in the spent dialysate using a spectrophotometrical set-up. Measurements were performed both on collected dialysate samples and on-line. During on-line monitoring, a spectrophotometer was connected to the fluid outlet of the dialysis machine, with all spent dialysate passing through a specially-designed cuvette for optical single-wavelength measurements. The concentrations of several substances of various molecular sizes, electrical charge, transport mechanism, etc. were determined in the dialysate and in the blood using standard laboratory techniques. The correlation coefficient between UV-absorbance of the spent dialysate and concentration of the substances in the spent dialysate and in the blood was calculated from data based on the collected samples.

Results

The obtained on-line UV-absorbance curve demonstrates the possibility to follow a single hemodialysis session continuously and to monitor deviations in the dialysator performance using UV-absorbance. The experimental results indicate a very good correlation between UV-absorbance and several small waste solutes removed such as urea, creatinine and uric acid in the spent dialysate and in the blood for every individual treatment at a fixed wavelength of 285 nm. Moreover, a good correlation between the UV-absorbance and substances like potassium, phosphate and β2-microglobulin was obtained. The lowest correlation was achieved for sodium, calcium, glucose, vitamin B12 and albumin.

Conclusions

A technique for on-line monitoring of solutes in the spent dialysate utilising the UV-absorbance was developed. On-line monitoring during a single hemodialysis session exploiting UV-absorbance represents a possibility to follow a single hemodialysis session continuously and monitor deviations in dialysis efficiency (e.g. changes in blood flow and clearance). The UV-absorbance correlates well to the concentration of several solutes known to accumulate in dialysis patients indicating that the technique can be used to estimate the removal of retained substances.
Age-Related Extracellular to Total Body Water Volume Ratio (ECV/TBW) - Can it be Used for “Dry Weight” Determination in Dialysis Patients? Application of Multifrequency Bioimpedance Measurement
Authors: Lopot F. , Nejedlý B. , Novotná H. , Macková M. , Sulková S.
Published: January 2018

The article suggests a novel method for quantitative determination of optimal dry weight in dialysis patient based on their extracellular volume (ECV) to total body water (TBW) ratio and its relation to age. Values of ECV and TBW are evaluated by means of whole body multifrequency bioimpedometry. In an effort to find a suitable marker of hydration status in an individual from bioimpedance data, significant correlation has been found between ECV/TBW ratio and age in health. Assuming that all excess fluid in dialysis patients is stored exclusively in ECV and that distribution of their TBW at the state of optimal dry weight corresponds to that of a healthy person of the same age, the pre-dialysis ECV/TBW could be used for quantitative determination of optimal dry weight and/or of the ultrafiltration to reach this weight. Practical bioimpedance measurement of ECV/TBW in a group of dialysis patients both pre- and post-dialysis confirmed both above assumptions, i.e. nearly exclusively extracellular origin of ultrafiltration as well as normalisation of the ECV/TBW ratio towards the end of dialysis. Supporting evidence of increasing ECV/TBW value with age was also found in literature. Although the suggested method needs detailed analysis of possible disturbing factors (ethnic “specificity” of the reference ECV/TBW vs. age characteristics in health, possible difference in “biological” and “physical” age of dialysis patient and others), the article is published at this early stage to enable wider testing of the proposed novel method by different investigators.
Exposure of Procoagulant Phospholipids on the Surface of Platelets in Patients Undergoing Cardiopulmonary bypass Using Non-Coated and Heparin-Coated Extracorporeal Circuits
Authors: Weerwind P.W. , Caberg N.E.H. , Reutelingsperger C.P.M. , Lindhout T. , De Jong D.S.
Published: January 2018

Cardiopulmonary bypass (CPB) is associated with a generalized hemostatic defect, in which platelet dysfunction seems to play a central role. The present study was designed to elucidate whether the potential procoagulant activity of platelets, detected as annexin V binding, was altered during coronary bypass surgery, using non-coated and heparin-coated extracorporeal circuits. Thirty patients undergoing elective coronary artery bypass grafting were prospectively randomized using either a standard untreated extracorporeal circuit (n = 15) or a heparin-treated extracorporeal circuit (n=15). Besides measurement of the procoagulant phospholipid activity, the mediastinal blood loss after surgery, and the blood transfusion requirements were also monitored. CPB induced a decrease in the percentage of activated platelets in whole blood, manifest directly after start of CPB, which was significantly attenuated using a non-treated system. Postoperatively, the percentage of activated platelets recovered in both systems, reaching a point of significance 24 hours after the operation, compared to the values 2 hours after the operation. The differences among the groups for mediastinal blood loss during the first 2 and 24 postoperative hours coincided with the differences in procoagulant phospholipid activity. Furthermore, there was no statistical difference among the groups for blood transfusion requirements. The platelets in both groups showed a significantly lower ability to generate ionomycin-induced procoagulant activity after blood-material interaction when compared to the baseline values. These observations are compatible with the notion that during CPB, irrespective of the heparin coating, platelets become modestly activated.
Biodegradable Polymer (D,L-Lactide-ε-Caprolactone) in Aortic Vascular Prosthesis: Morphological Evaluation in an Animal Model
Authors: Valente M. , Pettenazzo E. , Di Filippo L. , Laborde F. , Rinaldi S. , Thiene G.
Published: January 2018

Biodegradable D,L-Lactide-ε-caprolactone copolymer was used in substitution to bovine collagen to seal porosity in nine Dacron vascular Sorin Carbografts®. One served as control and 8 were implanted in mini-pigs as vascular by-pass in the thoracic aorta. The grafts were explanted at 7 days (4 animals), 30 (2 animals) and at 90 days (2 animals), and submitted to gross examination, X-ray, histology and electron microscopy.

Aim of the study was to assess the safety and the reliability of these polyester vascular prostheses impregnated with the copolymer in terms of containment of the bleeding in the perioperative period, host inflammatory response, copolymer biodegradation and prostheses “healing”.

All the grafts were patent at angiographic and X-ray examination. At 7 days blood infiltration between Dacron and copolymer lining was detected. Inflammatory granulocyte infiltrates and granulomatous reaction with polymer degradation was observed at 30 days and fibrous tissue healing at 90 days. Luminal surface was covered by thin thrombi at 7 and by a neointima at 30 and 90 days.

We conclude that D,L-Lactide-ε-caprolactone copolymer is effective in preventing perigraft bleeding, even though an early hematoma between Dacron and the copolymer coating occurs. Copolymer is degraded through a mild inflammatory reaction, with eventual evolution to fibrous healing.
Omnicarbon™ 21 mm Aortic Valve Prosthesis: In Vitro Hydrodynamic and Echo-Doppler Study
Authors: Dumont K. , Segers P. , Vandenberghe S. , Van Nooten G. , Verdonck P.
Published: January 2018

The aim of this study was to perform combined hydrodynamic and Doppler echocardiographic tests of the Omnicarbon 21 mm cardiac valve in aortic position in our Pulse Duplicator System for simultaneous assessment of valve performance and valve leakage data. During forward flow conditions, measured mean pressure gradients are between 4.5 and 20.2 mmHg (11.9 ± 4.4 mmHg) for cardiac outputs between 3.6 and 5.3 l/min (4.5 ± 0.4 l/min). Doppler-derived mean pressure gradients are between 2.0 and 17.0 mmHg (9.3 ± 3.9 mmHg) for the same flow conditions. Effective Orifice area is 1.31 ± 0.08 cm2 and the performance index is 0.74 ± 0.04, using the actual geometric orifice area, and 0.38 ± 0.02, using the tissue annulus diameter, for a cardiac output of 4.5 ± 0.4 l/min. Regurgitation volumes are below 3 ml. There is a trend to an effect of valve orientation on hemodynamics.
Is Steam Sterilization Really Making Any Difference in Dialysis-Induced Cytokine Release?
Authors: Aucella F. , Tetta C. , Tessore V. , De Nitti C. , Vigilante M. , Gatta G. , Grandone E. , Margaglione M. , Colaizzo D. , Cappucci G. , Modoni S. , Stallone C.
Published: January 2018

Ethylene oxide (ETO) is presently the most commonly used sterilization method for medical devices. Although alternative sterilization modes such as steam sterilization have been suggested, the effect of steam on dialysis-induced cytokine release is unknown.

We enrolled 9 patients on chronic hemodialysis and evaluated at different intervals IL- 1βproduction while treated with ETO (NC1785–Bellco) and steam sterilized NC 1785S-Bellco) Synthetically Modified Cellulose (SMC). A basal test during treatment with NC 1785 was performed (A); the same test was set up 4 weeks after treatment with NC 1785S (B) and, lastly, 4 weeks after returning to NC 1785 (C). Peripheral blood mononuclear cells (PBMC) were purified before and after the dialysis session, were isolated on a Ficoll/Hypaque gradient and incubated for 24 h. Spontaneous IL-1β release was evaluated in the supernatant and in the lysate.

In A, IL-1βlevels were (in pg/ml/106 cells, in supernatant and lysate, respectively): 5.8 ± 4.8 and 7.6 ± 5.2 in pre-HD and 4.68 ± 3.6 and 9.7 ± 6.65 in post-HD. These levels showed a clear reduction in B: 2.5 ± 2.2 and 4.4 ± 3.1 in pre-HD, and 4.35 ± 6.6 and 7.52 ± 7.22 in post-HD. In the C test, 4 weeks after the return to the ETO membrane, IL-1βlevels remained unchanged: 2.9 ± 1.8 and 4.5 ± 3.1 in pre-HD; and 2.6 ± 3 and 5.7 ± 6.6 in post-HD. Statistical analysis showed significant changes in the pre-HD levels both in supernatant (p < 0.04) and in lysate (p < 0.04).

Steam sterilization of SMC induced a lower spontaneous IL-1β release, but this effect was not statistically significant due to the large inter-individual variation. Hence, contrary to claims of better biocompatibility, steam sterilization does not result in a reduced production of pro-inflammatory IL-1β.
Hemodialysis (HD) versus Peritoneal Dialysis (PD): Latent Overhydration in PD Patients?
Authors: Oe B. , De Fijter C.W.H. , Geers T.B.M. , Vos P.F. , De Vries P.M.J.M.
Published: January 2018

Data on the difference in fluid status between hemodialysis (HD) and peritoneal dialysis (PD) patients are scarce. Bio-electrical impedance analysis (BIA) is able to detect total body water (TBW) and its distribution in intracellular (ICW) and extracellular water (ECW). Echographic determination of the diameter of the inferior caval vein (VCD) provides information about the intravascular space (IVS).

Nineteen PD-patients and 20 HD-patients in stable clinical condition were studied. In HD-patients a significant decrease in VCD, mean arterial pressure (MAP), TBW and ECW was noted due to ultrafiltration. Both ratios of VCD to ICW/ECW and of VCD to ECW/TBW decreased. No significant differences were found in these variables between PD-patients and HD-patients before HD. In both patient groups the measured variables pointed towards overhydration and the increased ratios both of VCD to ICW/ECW and VCD to ECW/TBW towards the storage of surplus of fluid in the intravascular space.

It can be concluded that both PD-patients and HD-patients before HD have a surplus of fluid in the extracellular compartment, predominantly stored in the intravascular space.
Epidemiology of End-Stage Renal Disease and Current Status of Hemodialysis in Yugoslavia
Authors: Djukanović L. , Radović M. , Baković J. , Budošan I. , Bukvić D. , Cvetičanin A. , Davinić S. , Dragoljić B. , Djordjević V. , Djurić S. , Haviža-Lilić B. , Ilić M. , Janoš B. , Jelačić R. , Jelić S. , Kostić N. , Mandić M. , Oštrić V. , Plješa S. , Radišić M. , Radojević M. , Rakić N. , Rangelov V. , Ratković M. , Stojanović M. , Stojanović R. , Tintor D. , Vasić V.
Published: January 2018

Maintenance hemodialysis (HD) in Yugoslavia started in the sixties and followed the dialysis trends in the Western Europe. However, in the last decade the development of renal replacement therapy (RRT) slowed down. In this report the epidemiology of ESRD from 1997–1999 and the survey of the status of HD treatment in Yugoslavia in 1999 are presented.

Epidemiological data are obtained by the annual center questionnaires (response rate: 92.6 −94.2%). The survey of HD status is based on a specific questionnaire and covered 2108 patients (65%).

At the end of 1999 there were 56 RRT centers in Yugoslavia treating 3939 patients: 3232 (82%) patients by HD, 248 (6.3%) by peritoneal dialysis, and 459 (11.7%) living with transplanted kidney. In a three year period, incidence of ESRD ranged from 108–128 pmp, point prevalence from 435–463 pmp and mortality rate from 20.7–17.9. Numerous refugee patients were treated over the last 10 years. Main causes of ESRD were glomerulonephritis (30%); Balkan nephropathy represented 11% and diabetic nephropathy 7% of all primary renal diseases. Cardiovascular and cerebrovascular diseases were the most common causes of death of RRT patients. Most centers are overcrowded and HD machines are worn out. Mean Kt/V was 1.19±0.08, mean URR% 58.8±7.4. The shortage of drugs prevented adequate management: 83% of HD patients had hemoglobin level less than 100 g/L but only 10.3 −17.8% were treated with rHuEpo; 64.5% of patients had phosphate levels higher than 1.7 mmol/L but only 33.5% used phosphate binders; 47% of patients had hypertension despite the antihypertensive therapy. The prevalence of hepatitis B remained unchanged (about 14%) in HD population during the last three years, but the prevalence of anti-HCV positive patients decreased (31–23%).

In conclusion, there is a well developed dialysis service in Yugoslavia but insufficient conditions for adequate treatment.
Potential Mechanical Blood Trauma in Vascular Access Devices: A Comparison of Case Studies
Authors: Grigioni M. , Daniele C. , Morbiducci U. , Di Benedetto G. , D'Avenio G. , Barbaro V.
Published: January 2018

Since vascular access devices may cause disturbances in blood flow, possibly damaging red blood cells (RBCs), the correlated risk of lysis must be assessed. The monodimensional approach for the evaluation of cannulae hydrodynamic behaviour (in vitro measured flow curves) does not furnish information on the local flow field occurring in specific clinical conditions. Researchers consider the prediction of blood trauma, induced by mechanical loading, to optimize the design phase, and to furnish indications on their optimal clinical use. In this study, a model of cannula inserted in a non compliant wall vessel was used as a test bench in a Computational Fluid Dynamics (CFD) problem. By means of CFD the flow field was 3D analysed to achieve information on velocity and shear stress local values, when cannula is used for inflow and outflow cannulation. A prediction of potential blood corpuscle damage, based on a power law, quantified the potential blood damage. Several numerical simulations, with different cannula/vessel flow rate ratios were provided, to investigate the incidence of local sites in the design on blood damaging potential during cannulation. Several regions appeared to be sensitive to the flow rate not only inside the cannula but also in the space between cannula and vessel, suggesting new indications for the assessment of a quality factor based on the evaluation of induced blood cells injury.
Fabricated HyalS Micropatterns and Surface Guidance of NCTC 2544 Continuous Cell Line: An in Vitro Study
Authors: Mattioli-Belmonte M. , Gabbanelli F. , Casoli T. , Delfino A. , Giantomassi F. , Biagini G. , Giavaresi G. , Torricelli P. , Fini M.
Published: January 2018

Surface topography is important in establishing tissue organisation adjacent to implants, smooth surfaces generally being associated with fibrous encapsulation. By virtue of its large hydrated molecular volume and its capacity to form molecular matrix, hyaluronic acid can expand the interfibrillar collagen spaces to allow the movement of cells, although it can also hamper their locomotion. Low molecular-weight hyaluronan can also stimulate cell proliferation, especially at low concentrations.

The aim of the present work was to evaluate in vitro the growth and migratory behaviour of NCTC 2544 keratinocytes cultured on different materials microstructured with hyaluronic acid or sulfated hyaluronic acid to assess the possibility of using these devices in the repair process of soft tissues. Ultrastructural morphological analyses, morphometric evaluations and detection of cytoskeletal elements were performed.

Our observations provide evidence that micrometer-size parallel grooves of hyaluronic acid can influence cell growth behaviour since cells seeded onto the microstructured substrate arranged themselves according to a shape and an orientation that clearly reflected the chemotropism exerted on them by the two forms of acid. These data also highlight the importance of accurate microtexture fabrication.

We intend to follow up these in vitro studies with in vivo experimental applications using PET and gelatin substrates structured with HyalS to evaluate wound healing responses, and to extend our investigations of the cytoskeletal modifications induced by different microstructures.
Review of Methods to Remove Protein-Bound Substances in Liver Failure
Authors: Hughes R.D.
Published: January 2018

A wide range of toxic substances accumulates in the circulation of patients with liver failure, including more lipid-soluble substances, which bind to plasma proteins. Serum albumin is the most important binding protein for ligands such as bilirubin and bile acids, which are potentially toxic and can cause apoptosis in astrocytes and hepatocytes respectively in vitro. Resin haemoperfusion was originally investigated to remove these compounds, as well as inflammatory cytokines. Current effective methods for removal of protein-bound compounds in patients with liver failure include high volume plasmapheresis and different forms of albumin dialysis. Bioartificial liver support systems need adsorbent and/or dialysis modules to replace the lack of excretory function.
Extracorporeal Treatment in Fulminant Hepatic Failure: Pathophysiologic Considerations
Authors: Kramer L. , Bauer E.
Published: January 2018

Fulminant hepatic failure is a life-threatening clinical syndrome following severe hepatic injury leading to cerebral edema and brainstem herniation. Excessive mortality can be currently reduced only by timely orthotopic liver transplantation. Due to the shortage of donor organs, a considerable proportion of patients develop irreversible neurological damage, multiorgan failure or death while waiting for transplantation. Consequently, alternatives to orthotopic liver transplantation and methods of stabilizing patients on the waiting list including extracorporeal detoxification treatment are currently investigated. Recent advances in the pathophysiology of cerebral edema have challenged some of the traditional assumptions on which many blood detoxification systems are based. This article aims to integrate pathophysiology of hepatic encephalopathy and cerebral edema into a proposed future concept of liver support.
Advanced Technology for Extracorporeal Liver Support System Devices
Authors: Borra M. , Galavotti D. , Bellini C. , Fumi L. , Morsiani E. , Bellini G.
Published: January 2018

Acute Liver Failure (ALF) still presents high mortality rates, and liver transplant is the only treatment with proven efficacy. However transplant is not always possible and systems for Extracorporeal Liver Support (ELS) are being developed which can treat patients with ALF, for whom a transplant is not available, or is delayed. They can also treat patients with chronic liver disease who develop ALF.

There are two types of ELS: artificial systems (hemoperfusion, plasmaperfusion, therapeutic plasma exchange, continuous hemodialysis and high volume continuous hemofiltration) and bioartificial systems. These are based on a biological component (animal or human hepatocytes) inserted into a bioreactor, whose main function is to perform the metabolic activity and synthesis that the liver can no longer perform. The results obtained in clinical trials have so far shown that the best results in terms of compensating for lost metabolic function and detoxification are obtained inserting artificial components in the bioartificial circuit.