bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Analysis of Metabolism of Medium-and Plasma Perfused Primary Pig Hepatocytes Cultured around a 3-D Membrane Network
Authors: Unger J.K. , Catapano G. , Horn N.A. , Schroers A. , Gerlach J.C. , Rossaint R.
Published: March 2018

Culture media are frequently used in the evaluation of metabolical functions of hepatocytes in hybrid liver support systems (hLSS). However, media compositions differ substantially from those of plasma. Therefore, our study was designed to investigate whether current in vitro studies with medium are suitable to assess the metabolical competence of hLSS-cultures during clinical application as well as to explore whether the cell nutrition with medium provides a suitable modus operandi for stand by cultivation. Paired bioreactor cultures were perfused with either Williams’ Medium E (MPB) or human plasma (PPB). About 6x108 primary pig hepatocytes (>97% viability) were cultured in three laboratory scale bioreactors designed according to Gerlach's bioreactor-concept. Different perfusion protocols were initiated after a standardised period allowing for cell attachment and reorganisation in aggregates. Whereas patterns of enzyme release were similar in both protocols the metabolical behaviour was different between MPB (anabolic state) and PPB (catabolic state). Furthermore, compared to MPB the lidocaine-MEGX-tests for PPB demonstrated lower MEGX-concentrations and a different reaction pattern. We conclude that the nutrition of hepatocytes with medium during the stand by period itself might influence the cell function and subsequently the efficacy of the hLSS-treatment during clinical application. (Int J Artif Organs 2000; 23: 104–10)
Extracorporeal Blood Oxygenation and Ozonation (EBOO) in Man. Preliminary Report
Authors: DI Paolo N. , Bocci V. , Garosi G. , Borrelli E. , Bravi A. , Bruci A. , Aldinucci C. , Capotondo L.
Published: March 2018

Autohemotherapy with ozone has been used for four decades with encouraging results but, owing to the lack of clinical studies, it has never been adopted by orthodox medicine. Confident of the valid principles of ozone therapy, we have endeavoured to increase its therapeutic efficacy. Over a ten-year period we have developed an apparatus that makes it possible to treat large quantities of blood with ozone in extracorporeal circulation (extracorporeal blood oxigenation and ozonation EBOO). One of us volunteered to test the system and after six treatments noted the disappearance of two lipomas. This prompted us to treat a patient with Madelung disease and several patients with atherosclerotic vasculopathy. Besides showing therapeutic effects, the preliminary results indicate that EBOO is clinically valid, without side-effects and worthy of testing in various diseases.
Heparin Coating of Extracorporeal Circuits Inhibits Cytokine Release from Mononuclear Cells during Cardiac Operations
Authors: Giomarelli P. , Naldini A. , Biagioli B. , Borrelli E.
Published: March 2018

Purpose

To evalute whether the production of interleukin 2 (IL 2), interlukin 6 (IL 6) and interlukin 10 (IL 10) from stimulated peripheal blood mononuclear cells (PBMC) was affected by coating extracorporeal circuits in patients undergoing cardiopulmonary bypass (CPB). In addition, postoperative clinical parameters were compared between patients with heparin-coated and uncoated CPB.

Design

Prospective, controlled in vivo/ex vivo study.

Procedure

Blood samples were drawn immediately before, at the end and 24 hours after the end of CPB using either a conventional circuit (n=10) or a heparin-coated circuit (n=10) in patients undergoing CPB. Cytokine release on the supernatants of activated PBMC was detected. Cardiopulmonary parameters were measured before CPB, at ICU admission, 3 hours and 24 hours after ICU admission in both groups of patients. Statistical difference intragroups and between groups were investigated with the analysis of variance for repeated measures.

Results

IL 6 and IL 10 release was significantly less (p<0.05) in the heparin-coated group. No differences in clinical parameters were observed between the two groups.

Conclusions

These results suggest that with the use of heparin-coated circuits there is a lower production of IL 6 and IL 10 from isolated PBMC than with uncoated circuits.
Experimental Model for Studying the Effects of 2-Ethylhexyl-Phthalate and Dialysate on Connective Tissue
Authors: Stabellini G. , Berti G. , Calastrini C. , Mariani G. , Scapoli L. , Marcucci A. , Bedani P.L.
Published: March 2018

In order to have a model for studying the possible implications of 2-ethylhexyl-phthalate and dialysate on connective tissue, we evaluated their direct effects on the air pouch lining tissue and on fibroblast cultures. Air pouches were formed on the backs of 60 ten-week-old Wistar rats by subcutaneous injections of 10 ml sterile air. On the tenth day 2 ml sterile air, or 2 ml 5μg/L or 2 ml 10 μg/L 2-ethylhexyl-phthalate in olive oil, or 2 ml olive oil alone, or 2 ml 5 mg/ml or 12 mg/ml lyophilized dialysate were injected into the air pouches. After sampling at seven or twenty-one days, the rats were killed. The biochemical data showed an increase in sulphated glycosaminoglycans with 2-ethylhexyl-phthalate and dialysate. Electron microscopy findings revealed cellular alterations such as vacuolation and cell remnants with 2-ethylhexyl-phthalate, while the cells of the air pouches treated with dialysate showed regular organelles with increased and dilated cisternae of rough endoplasmic reticulum. Moreover, an increase in collagen fibres surrounding the damaged zones was noticed in 2-ethylhexyl-phthalate and dialysate treated rats. The glycosaminoglycan modifications and collagen fibre increase seem to suggest that the morfological changes, with the features of fibrosis, could be the result of 2-ethylhexyl-phthalate and dialysate action on connective tissue. Moreover, the air pouch technique can be considered a good model for studying the direct effects of 2-ethylhexyl-phthalate and other substances, such as uremic toxins, on connective tissue.
ARDS in Fulminant Ornithosis and Treatment with Extracorporeal Lung Assist
Authors: Wichert A. , Lukasewitz P. , Häuser M. , Bittersohl J. , Lennartz H.
Published: March 2018

We report a 47-year-old male patient with fulminant ornithosis who developed severe respiratory failure leading to acute respiratory distress syndrome (ARDS) complicated by gastrointestinal, neurological and renal symptoms. ARDS was successfully treated by extracorporeal lung assist. As leukocytosis is typically absent in ornithosis, C-reactive protein, interleukin 6 and procalcitonin were used as infection parameters in order to monitor clinical development. The English-language literature on severe cases of ornithosis requiring respiratory support over the past 30 years is reviewed.
Effect of Hemodiabsorption and Sorbent-Based Pheresis on Amino Acid Levels in Hepatic Failure
Authors: Steczko J. , Bax K.C. , Ash S.R.
Published: March 2018

Changes in plasma amino acid concentrations were measured in patients with hepatic failure during extracorporeal hemodiabsorption (using the Liver Dialysis Unit, “the Unit”) or hemodiabsorption plus sorbent-based pheresis treatment (using the Liver Dialysis Plasmafilter Unit, “the PF-Unit”) Systems.

Eight patients with hepatic failure, grade 3 or 4 encephalopathy, elevated bilirubin and/or creatinine levels and respiratory or renal failure were treated for 1–3 days with the Unit alone. Three of these were also treated with the Unit containing 10 g of BCAA in the sorbent suspension. Four patients with hepatic failure treated with the PF Unit also had 10 g of branched chain amino acid (BCAA) added to the sorbents of the Unit portion of this device. Pre- and post-plasma samples were drawn and high performance liquid chromatography (HPLC) was used to separate and detect amino acids in the plasma.

Both the Unit and the PF-Unit have the capability to selectively remove various amino acids, especially aromatic amino acids (AAA). The pre-treatment amino acid profiles of plasma were typical for hepatic failure, with abnormally high levels of phenylalanine, tyrosine, tryptophan, and methionine and decreased levels of valine, leucine and isolucine.

The average pre-treatment Fischer ratio (BCAA/AAA) for both Unit and PF-Unit patients was 1.43 (±0.58). Treatments by both systems resulted in an increase of BCAA levels in blood and concomitant decrease of AAA levels, with an average Fischer ratio improvement of 30–38% for the Unit and PF-Unit without BCAA. The Fischer ratio improved by 90% (average) for the Unit with BCAA. Levels of many other amino acids (such as alanine, glycine, proline or lysine) increased during both Unit and PF-Unit treatments. The removal of strongly protein-bound toxin and amino acids such as tryptophan and sulphydryl amino acids was more effective by the PF-Unit.

Both the Unit and the PF-Unit have the unique capability to remove toxic aromatic amino acids while increasing BCAA levels in patient. The increase in many amino acid levels may be related to the removal of toxins that interfere with normal amino acid metabolism. The addition of the PF module improves the removal of bilirubin and similarly protein-bound chemicals. Changes in amino acid profiles by the Unit and the PF-Unit contrast markedly with other extracorporeal devices.
Dialysate Flow Distribution in Hollow Fiber Hemodialyzers with Different Dialysate Pathway Configurations
Authors: Ronco C. , Brendolan A. , Crepaldi C. , Rodighiero M. , Everard P. , Ballestri M. , Cappelli G. , Spittle M. , La Greca G.
Published: March 2018

The efficiency of a hemodialyzer is largely dependent on its ability to facilitate diffusion, since this is the main mechanism by which small solutes are removed. The diffusion process can be impaired if there is a mismatch between blood and dialysate flow distribution in the dialyzer. The objective of the paper was to study the impact of different dialysate compartment designs on dialysate flow distribution and urea clearances.

Eighteen hollow fiber 1.3 m2 hemodialyzers were studied, 6 each of 3 designs: Type A- standard fiber bundle (PAN 65DX Asahi Medical, Tokyo, Japan); Type B - spacing filaments external to the fibers (PAN 65SF Asahi Medical, Tokyo, Japan); Type C - fibers waved to give Moiré structure (FB130 Nissho-Nipro, Osaka, Japan). In vitro studies: 3 dialyzers of each type were studied following dye injection into the dialysate compartment. Dynamic sequential imaging of longitudinal sections of the dialyzer were undertaken, using a new generation helical CT scanner (X-Press/HS1 Toshiba Corporation, Tokyo, Japan). In vivo studies: 3 dialyzers of each type were studied, in randomized sequence, in 3 different patients under standardized dialysis conditions. Blood- and dialysate-side urea clearances were measured at 30 and 150 minutes of treatment.

Macroscopic and densitometrical analysis revealed that flow distribution was most homogeneous in the dialyzer with Moiré structure (Type C) and least homogeneous in the standard dialyzer (Type A). Space yarns (Type B) gave an intermediate dialysate flow distribution. Significantly increased urea clearances (p<0.001) were seen with Types B and C, compared to the standard dialyzer. Type C (Moiré) had the highest clearances although these were not significantly greater than Type B (space yarns).

In conclusion, more homogeneous dialysate flow distribution and improved small solute clearances can be achieved by use of spacing yarns or waved (Moiré structure) patterns of fiber packing in the dialyzer. These effects are achieved probably as a result of reduced dialysate channeling resulting in a lower degree of mismatch between blood and dialysate flows. The new radiological technique using the helical CT scanner allows detailed flow distribution analysis and has the potential for testing future modifications to dialyzer design.
Is there a Role for Hemoperfusion/Hemodialysis as a Treatment Option in Severe Tricyclic Antidepressant Intoxication?
Authors: Frank R.D. , Kierdorf H.P.
Published: March 2018

Objective

Suicidal self-poisoning with tricyclic antidepressants like doxepin is a major therapeutic problem in emergency medicine with a high fatality rate. Deaths are mainly caused by cardiotoxicity with arrhythmias, intraventricular conduction disturbances and myocardial depression. For treatment, alkalinization and hypertonic saline are recommended. The role of extracorporeal treatment procedures is not clear. The possible benefit of hemoperfusion/hemodialysis is discussed in a case report with respect to the published literature.

Case Report

After ingestion of an amount of at least 5000 mg doxepin a 37-year-old man with endogenous depression developed cardiac arrest. After preclinical resuscitation with prolonged external cardiac massage, he was admitted to the intensive care unit with persistently severe hypotension and wide QRS complexes (230–260 ms). Despite fluid load, alkalinization, hypertonic saline and high-dose vasoactive substances the patient's condition did not improve. Hemoperfusion over hemoresin combined with hemodialysis led to an impressive clinical improvement with shortening of QRS duration (from 230 to 120 ms) and hemodynamic stabilization. The patient fully recovered without neurologic deficits.

Conclusion

We report a successful treatment with hemoperfusion over hemoresin and hemodialysis in a patient with life-threatening doxepin poisoning intractable with the generally recommended treatment. In such acute TCA intoxication with severe cardiotoxicity, hemoperfusion/hemodialysis should be considered a potential treatment option, as the “toxicokinetics” of drugs may totally differ from their usual pharmacokinetic behaviour. Experimental and clinical studies are needed to clarify the toxicokinetics of TCA in order to improve the therapeutic approach.
Electrical Current Leakage during Hemodialysis May Increase Blood-Membrane Interaction
Authors: Jonsson P. , Forsberg U. , Niklasson J. , Stegmayr B.G.
Published: March 2018

During hemodialysis blood - membrane interaction causes complement activation. During dialysis there may be an electrical current leakage to the dialyzer, especially if there is a broken ground or a defect in another electrical device coupled to the patient.

This study investigated whether an electric current of 1.5 mA DC could alter blood membrane interaction as measured by changes in C3d in the blood. Such a high current leakage could occur because there is no protection in the dialysis machine (Class 1B) against auxiliary current leakage. Such a current could come from a defective external device in contact with the patient during hemodialysis.

Materials

A dialysis machine (Fresenius 2008C) with a filled blood-line system containing about 350 ml whole blood from each of 8 different donors was used in vitro. Each of the eight test-runs also contained 1000 U added heparin. The dialysis procedure was performed using hemophan membranes (GFS +12, Gambro) with bicarbonate and potassium 3.0 (D210, Gambro) as dialysate. Two electric poles were placed in the blood line, before and after the dialyzer (connected in parallel) and the ground was placed at entry and exit of the dialysate fluid coming from the machine to the dialysis filter. C3d was measured before the start of “dialysis” and at 15, 30, 45 and 60 min, during dialysis. Thereafter the 1.5 mA current was switched on and additional samples were drawn at 75 and 90 min. The mean C3d values were calculated. Paired non-parametric statistical analyses were performed.

Results

There was a significant and continuous increase in C3d as compared to the “predialysis” level. The increase during 0 to 30 minutes was greater than that from 30 to 60 minutes (p=0.018); the increase in C3d during 60 to 90 min, was greater than that from 30 to 60 min (p=0.018) and there was no difference between the 0 to 30 and the 60 to 90 min increases.

Conclusions

A current, used in this study, was able to induce a blood membrane interaction during in vitro dialysis. Even a weaker current leakage might have such adverse effects and similar interactions seem possible during regular dialysis depending on the extent of the leakage.
Influence of Intravenous Iron Therapy on Novel Markers of Iron Deficiency
Authors: Chinnappa Shanmugakumar , Bhandari Sunil
Published: March 2018

Background

Detection of iron deficiency in patients with end-stage renal disease (ESRD) remains challenging due to the lack of reliable markers. The immature reticulocyte fractions (IRF) RET-Y and RBC-Y may serve as useful novel markers. We investigated the ability of IRF to detect functional iron deficiency in ESRD patients in comparison to Serum ferritin (SF) and Transferrin saturation (TSAT) and the influence of intravenous iron therapy on these markers.

Methods

Cross sectional (n=40) and prospective (n=20) studies of hemodialysis patients were performed; 20 patients received intravenous iron (200 mg) monthly and were followed up for 5 months. Iron deficiency was defined as SF ≤200μg/L and/or TSAT ≤20%. A RBC-Y ≤171 and/or RET-Y ≤168.7 were criteria for iron deficiency. Correlations between traditional and novel markers were examined. Results are given as mean±SEM. Paired t-test was used to test for significance.

Results

27 male and 13 female patients, mean age of 56.7±3.02 years were enrolled in the crosssectional study. TSAT correlated with RBC-Y and RET-Y, r=0.47 and 0.61, respectively. Correlations for SF with RBC-Y and RET-Y were r=0.23 and 0.22, respectively. In the prospective component (11 males and 9 females of mean age 60±3.4 years), RET-Y and RBC -Y remained stable during iron therapy. The coefficients of variation were RBC-Y 2.54%, RET-Y 4.23%, TSAT 28.74% and SF 35.34%.

Conclusions

RBC-Y and RET-Y correlated with TSAT and SF allowing detection of functional iron deficiency. These measures were less susceptible to fluctuations than traditional markers.
Biocompatibility of Charcoal Hemoperfusion. Effects of Long-Term Treatment on Lymphocyte Characteristics and Function
Authors: Stefoni S. , Costa A. Nanni , D'Arcangelo G. Liviano , Biavati M. , lannelli S. , Bonomini V.
Published: March 2018

Biocompatibility of charcoal hemoperfusion was studied in a group of 15 uremic patients, evaluating the effects of long-term treatment on some structural and functional parameters of circulating lymphocytes: in vivo distribution of T-cell subsets; surface T3, T4 and T8 antigen expression, in vivo and in vitro DNA synthesis. A comparative analysis was performed with patients on conventional dialysis using cuprophan membranes.
Osmotic Agents for Peritoneal Dialysis
Authors: Khanna R. , Twardowski Z. J. , Oreopoulos D.G.
Published: March 2018

Glucose has more advantages than drawbacks and is now the sole agent used in clinical practice. Yet there is interest in finding a substitute for glucose as an osmotic agent in peritoneal dialysis solution. Work has identified several promising agents such as albumin, amino acids, gelatin and glycerol but it appears that every one of them, including glucose, would be useful for a short-dwell or for a long-dwell exchange but not for both. Some of them, such as albumin and the amino acids, are close to being an ideal osmotic agent but are prohibitively costly to manufacture. We predict that interest in the future will focus on dialysis solutions containing a mixture of osmotic agents. Such a solution would be acceptable for both short and long-dwell exchanges. It will have a sufficiently low concentration of different agents to minimize toxicity and long-term undesirable side effects. We expect that solutions will be available to better meet patients needs in the near future.
Donor Plasmapheresis: A Comparative Study using four Different Types of Equipment
Authors: Perseghin P. , Pagani A. , Fornasari P.M. , Salvaneschi L.
Published: March 2018

From September 1985 to May 1986, 106 healthy volunteers underwent automated plasmapheresis in our Institution (CT-AVIS, PAVIA) using four different types of equipment. The aim of this study was to verify the feasibility of harvesting plasma from a single donor and to ascertain:

1) the acceptability of the procedure to donors;

2) the speed, economy and safety of the different types of equipment;

3) the quality of the plasma.

The equipment employed in this study was:

a) PCS (Plasma Collection System-Haemonetics)

b) FILTRA (Dideco)

c) PLASMAPUR (Organon Teknika).

d) AUTOPHERESIS C™ - (Hemascience).

All four used a single-needle technique.

Procedures were well tolerated by donors; no significant changes were observed in pre- and post- procedure laboratory values.
Heparinized Polyurethane Surface through Ionic Bonding of Heparin
Authors: Barbucci R. , Magnani A. , Albanese A. , Tempesti F.
Published: March 2018

Surface heparinization through an ionic bond is one of the methods used to improve polyurethane blood compatibility. Chains of poly(amido-amine), a tertiary aminic polymer capable of forming stable complexes with heparin, were either surface-grafted on polyurethane or interconnected with polyurethane chains using hexamethylenediisocyanate as cross-linking agent. In the latter case, a new material (PUPA) is formed with a heparin adsorbing capacity higher than poly (amido-amine) surface-grafted polyurethane. By changing the percentages of the components, different series of PUPA materials can be obtained with different physico-chemical properties. The ATR/FT-IR technique was used to characterize the new materials in the native and in the heparinized state. PUPA solution was used to coat commercial biomedical devices and they were also characterized physico-chemically using ATR/FT-IR.
Cardiac-Related Sympathetic Nerve Activity during Circulation with Only the Left Ventricular Assist Device
Authors: Yambe T. , Nitta S. , Katahira Y. , Sonobe T. , Naganuma S. , Akiho H. , Chiba S. , Kakinuma Y. , Hayashi H. , Izutsu K. , Kikuchi Y. , Naganuma T. , Sugawara S. , Tanaka M. , Miura M. , Sato N. , Mohri H. , Yoshizawa M. , Takeda H.
Published: March 2018

Circulatory maintenance with a left ventricular assist device (LVAD) alone during cardiac arrest until heart transplantation has been evaluated. To assess the effect on the autonomic nervous system, the sympathetic neurogram was analyzed by power spectrum and coherence function. LVAD were inserted between the left atrium and the descending aorta in seven adult mongrel dogs and ventricular fibrillation was induced electrically. Renal sympathetic nerve activity (RSNA) was detected by bipolar electrodes attached to the left renal sympathetic nerve. Values of squared coherence between the arterial pulse wave and RSNA were calculated. Under the condition of circulatory maintenance with only LVAD, coherence at the cardiac rhythm frequency was decreased, and coherence at the LVAD pumping rhythm frequency was increased. These results indicate that the arterial pulse wave observed during maintenance of the circulation with only LVAD contributed to the sympathetic neurogram.
Formation of Thrombin-Antithrombin III Complex Using Polyamide and Hemophan Dialyzers
Authors: Schultze G. , Hollmann S , Sinah P.
Published: March 2018

The recently developed ELISA for the thrombin-antithrombin III complex (TAT) is a sensitive, specific, and simplified means of detecting intravascular coagulation. For further evaluation of the thrombogenicity of a polyamide (P) and a Hemophan (H) hollow-fibre dialyzer a cross-over study was done in ten stable patients on maintenance hemodialysis. At the same doses of heparin (mean bolus of 30 U/kg bw and maintenance doses of 86 U/kg bw), thrombin time and partial thromboplastin time were significantly lower using H. At the end of dialysis TAT was significantly higher in H (mean ± SEM before HD 3.57 ± .56, at 240 min 14.9 ± 6.5 ng/ml, p < 0.05, Wilcoxon-test) than in P (before HD 4.36 ± .98, at 240 min 8.95 ± 3.0 ng/ml, p ± 0.05 H 240 vs. P 240, Wilcoxon-test). Visible clotting was more pronounced in the H filter. Among other favourable features of blood compatibility the polyamide/polyvinylpyrrolidone copolymer with a hydrophilic/hydrophobic microdomain structure has less thrombogenicity. The modified cellulosic membrane H has advantages in complement activation and leukocyte depression, but thrombogenicity seems less favourable since the incorporated diethyl-amino-ethyl groups with their positive charge bind and inactivate negatively charged heparin.
Some Mechanical/Hydrodynamical Problems of Contemporary Vascular Grafts
Authors: Žáček M. , Konfršt J. , Klimeš F.
Published: March 2018

In view of the importance of properly matching vascular grafts and replaced arteries, we measured some mechanical properties of a set of eleven vascular grafts. The deformation response of inflated grafts for a set of Czechoslovak-made warp and weft knitted grafts was also measured on a special experimental device. A simple two-parameter model describing the stress-strain behavior of the grafts is given. Proper pre-elongation of the graft during implantation is important. From the hydrodynamic point of view it is essential to optimize the size and shape of the crimping, especially for small-diameter grafts. Our experiments indicate that the warp knitted grafts are more distensible than the weft knitted ones, but they are all more rigid than the replaced arteries.
Induction of Neointima Formation by Platelet Derived Angiogenesis Fraction in a Small Diameter, Wide Pore, PTFE Graft
Authors: Lado M.D. , Knighton D.R. , Cavallini M. , Fiegel V.D. , Murray C. , Phillips G.D.
Published: March 2018

Enhancement of endothelialization and patency of a small diameter (2 mm), wide pore, PTFE graft was attempted by coating the luminal surface with a platelet derived angiogenesis fraction (PDAF) and implanting it in a rat model. PDAF was delivered to the grafts by combining it with a carrier polymer. PDAF-treated grafts were initially implanted in the retroperitoneum for 21 days followed by removal of one for histology and in situ end to side bypass to the infrarenal aorta for the other. Vascularized grafts were examined at 14 days for patency and 100 days for patency and histology. Significant differences were noted in transmural ingrowth of capillaries and tissue at 21 days post implantation in PDAF-treated verses untreated grafts. Similarly, near significance was noted in capillary ingrowth and significance was noted in tissue ingrowth at 100 days in PDAF-treated grafts. Despite favorable trends particularly early in the time course, no significant differences in graft patency, endothelialization, or hydroxyproline content was demonstrated between PDAF-treated and untreated grafts. Results of this preliminary study are encouraging for further study of PDAF-treated PTFE grafts and the potential that rapid vascularized neointima formation results improved in graft patency rates.
Elimination of Meropenem by Continuous Hemo(Dia) Filtration: An in Vitro One-Compartment Model
Authors: Schroeder T.H. , Krueger W.A. , Hansen M. , Hoffmann E. , Dieterich H.J. , Unertl K.
Published: March 2018

Meropenem is a carbapenem antibiotic with a wide spectrum of activity against most gram positive and gram negative bacteria including anaerobes. Dose adjustments are necessary during continuous renal replacement therapies of acute renal failure. This in vitro study was conducted to investigate the influence of different filter materials, surface areas (AN-69 0.6 m2 and 0.9 m2, polysulfone 0.75 m2, polyamide 0.6 m2), and increasing flow rates (from 3.3 - 26.7 ml/min) on the elimination of meropenem in an in vitro continuous hemo(dia)filtration model. Meropenem was measured using HPLC with UV-detection. While the clearance increased proportionally to increasing dialysate flow rates in filters with a surface area of 0.9 m2, a peak clearance was reached in the small filters at flow rates of 10.0 ml/min (polyamide 0.6 m2) and 18.3 ml/min (AN-69 0.6 m2), when tested under the same conditions. This indicated incomplete dialysate saturation due to the diminished time available for meropenem to equilibrate with the dialysate solution. No adsorption to either of the tested membranes was detected. Dosage recommendations derived from clinical studies might be appropriate when different filter materials, but similar operational settings of the continuous replacement therapy, are applied. Reduction of the recommended dose might be necessary, when renal replacement therapies with lower flow rates and/or filters with smaller surface areas are carried out.
Severe Gastrointestinal Bleeding in a Uremic Patient Treated with Estrogen-Progesterone Therapy
Authors: Mosconi G. , Mambelli E. , Zanchelli F. , Isola E. , Perna C. , De Pascalis A. , Raimondi C. , Ventrucci M , Stefoni S.
Published: March 2018

Gastrointestinal bleeding is a frequent complication in hemodialysis patients; angiodysplasia is a potential cause, with a higher incidence in uremic patients. We describe a case of severe anemia (Hemoglobin up to 3.5 g/dl) secondary to diffuse angiodysplastic lesions in a hemodialysis patient with mixed connective tissue disease. The case is characterised both by the severity of the clinical picture (extension and entity of angiodysplastic lesions, frequency of bleeding episodes) and by the patient's religious faith which made her reject blood transfusions. We underline the efficacy of estrogen-progesterone therapy in view of the modest results obtained with other therapeutic strategies on bleeding.
Endoscopy as a Tool for Diagnosing and Treating Gastrointestinal Angiodysplasia in Haemodialysis Patients
Authors: Di Liberato L. , Sirolli V. , Lattanzio R. , Amoroso L. , Del Rosso G. , Cappelli P. , Bonomini M.
Published: March 2018

Gastroenteric angiodysplasia is an important cause of haemorrhage in chronic renal failure patients. This paper reports on 2 patients on maintenance haemodialysis with upper gastrointestinal bleeding due to different manifestations of angiodysplasic lesions (sudden appearance of haematemesis and melaena in one case, progressive anaemia with apparent resistance to erythropoietin in the other case). Exploratory endoscope examination of the first digestive tract showed in both cases the presence of bleeding angiodysplasic lesions. Both patients were there and then submitted to surgical endoscopy, during which the bleeding angiodysplasic lesion was sclerosed with physiological salt solution plus adrenaline 1/10000 and 1% polydocanol. In one patient, bleeding occurred again ten days later, making renewed surgical endoscopy necessary. In the course of this an elastic ligature was made to the superangular angiodysplasia. A year later in both cases there were no direct or indirect signs of further bleeding; an endoscopic check-up showed the treated lesions to be sclerosed. Endoscopy offers the unique possibility of being used for both diagnostic and therapeutic purposes in a single session. In expert hands, endoscope therapy is effective and markedly reduces the risk of side effects.
In Vitro and in Vivo Evaluation of a New Polysulfone Membrane for Hemodialysis. Reference Methodology and Clinical Results: (Part 1: In Vitro Study)
Authors: Ronco C. , Brendolan A. , Cappelli G. , Ballestri M. , Inguaggiato P. , Fortunato L. , Milan M. , Pietribiasi G. , La Greca G.
Published: March 2018

Different high flux membranes have been recently developed. The present study is aimed at describing the technical features and the clinical performances of a new high flux polysulfone membrane (T-sulfone, Toray Japan). The study has been carried out on two different dialyzers (surface area = 1.3 and 1.8 m2). The filters have been tested in vitro under definite experimental conditions. The hydraulic flow resistance, the pressure drop in the blood compartment and the hydraulic permeability have been determined in a wide range of in vitro experimental conditions. The in vitro sieving coefficients for various solutes have also been determined utilizing human blood. Hydraulic permeability was found in the range of 28.4 ml/h/mmHg/m2 and sieving coefficients were between 0.96 and 1.0 for all low molecular weight solutes. The sieving coefficient for inulin was 0.95. The pressure drop in the filter at 300 ml/min of blood flow was 95 mmHg for the 1.3 m2 and 57 mmHg for the 1.8 m2. The filters are then designed to operate in the presence of high blood flows without excessive resistance in the blood compartment. The blood compartment analyzed by means of a special radiological sequence obtained with a helical scanner after dye injection confirmed the homogeneous distribution of the blood flow in several cross sections of the bundle. Adequate distribution of dialysate was confirmed with a similar method applied to the dialysate compartment. The new imaging techniques utilized were greatly helpful to determine adequacy of filter design and flows distribution.
Saline-induced Dilutional Acidosis in a Maintenance Hemodialysis Patient
Authors: Mirza B.I. , Sahani M. , Leehey D.J. , Patel S.B. , Yang V.L. , Ing T.S.
Published: March 2018

A patient with end-stage renal disease developed severe hyperchloremic acidosis (venous serum total CO2 level of 10 mmol/L) after treatment with 16 L of isotonic saline. Analysis of this case and published literature indicates that dilutional acidosis may result when very large volumes of isotonic saline are administered intravenously, especially in patients with impaired or absent renal function.
Numerical Solution for Blood Flow in a Centrifugal Ventricular Assist Device
Authors: Wood H.G. , Anderson J. , Allaire P.E. , Mcdaniel J.C. , Bearnson G.
Published: March 2018

A very small centrifugal pump, fully supported by magnetic bearings, is being developed for use as a ventricular assist device to be implanted in humans. In this paper, we apply computational fluid dynamics to model the blood flow to aid in the design of the ventricular assist device. The flow of blood through the pump has been modeled using computational fluid dynamics (CFD) software that is commercially available from AEA Technology, UK. The flow regions modeled in version 3 of the Continuous Flow Ventricular Assist Device (CF3) are the fully shrouded four bladed impeller and the two clearance regions around the impeller that are bounded by the pump hub and shroud. This paper describes the geometry and computational grids developed for the flow regions, and the equations of motion for the blood flow are developed. The overall numerically-evaluated flow rates and head rise have similar trends to the flow parameters experimentally measured, indicating that future pump designs can be effectively modeled numerically before being constructed and tested. Numerical solutions are presented and compared with experimentally-obtained overall pump performance results. These solutions are used to predict shear stress levels to be experienced by the blood flowing through the pump, and it is predicted that hemolysis will be insignificant. The solutions also indicate no regions of flow stagnation that can be a source of thrombosis in pumps. The calculations provide a viable design method to achieve improved efficiency in future versions of this pump.
Conservation Leadership: A Developmental Model
Authors: Sullivan Theresa K. , Syvertsen Amy K.
Published: March 2018

Dealing with environmental issues requires citizens who adopt conservation behaviors, influence those around them to follow suit, and lead local and global policy initiatives. The purpose of this study is to advance our understanding of the developmental processes that undergird young people’s emergence as conservation leaders with the capacity to take on these roles. A qualitative, grounded theory analysis of transcripts from focus groups and interviews with 76 adolescent and young adult participants of a national conservation leadership program provided the empirical foundation for a developmental model of conservation leadership. The model has four phases: seed, sprout, bloom, and propagate. Within each phase, there are three qualitatively distinct and integrated domains: action, motivation, and understanding. Data in this study indicate that conservation leadership development is ongoing and cumulative, with subsequent developmental experiences promoting new capacities and propensities that expand young people’s conservation repertoires within each domain. The emergent developmental model of conservation leadership proposed in this article puts forth a comprehensive theory about how conservation leadership unfolds in adolescence and young adulthood. This model serves both to instigate further research and provide insights on how youth programs might intentionally promote the development of conservation-oriented action, motivation, and understanding.
Melatonin preserves ovarian tissues of rats exposed to chronic TCDD: An electron microscopic approach to effects of TCDD on ovarian cells
Authors: Gül Semir , Gül Mehmet , Yigitcan Birgül
Published: March 2018

2,3,7,8-Tetrachlorodibenzo- p-dioxin (TCDD) is a toxic agent and has disruptive effects on reproductive tissues in females. TCDD disrupts the hormonal regulation of the body and decreases the production of melatonin. In this study, we investigated the protective effects of melatonin supplements against the toxic effects of TCDD on ovaries of female rats. TCDD caused a significant decrease in the average number of corpora lutea and follicles per tissue section (2.1 ± 0.7; 2.3 ± 0.8, respectively), whereas these numbers were maintained in the melatonin supplemented group (5.0 ± 0.8; 5.1 ± 0.8, respectively) and were similar to the control group (5.3 ± 1.0; 5.9 ± 0.9, respectively). Electron microscopic analysis showed that the disruption of ultrastructure components such as cell membrane and organelles due to TCDD exposure was inhibited by melatonin supplements. This study suggested that melatonin has a protective and a possible ameliorative effect over histopathological damage of rat ovaries exposed to TCDD.
Long-Term Outcomes From Repeated Smoking Cessation Assistance in Routine Primary Care
Authors: Bailey Steffani R. , Stevens Victor J. , Fortmann Stephen P. , Kurtz Stephen E. , McBurnie Mary Ann , Priest Elisa , Puro Jon , Solberg Leif I. , Schweitzer Rebecca , Masica Andrew L. , Hazlehurst Brian
Published: March 2018

Purpose:

To test the association between repeated clinical smoking cessation support and long-term cessation.

Design:

Retrospective, observational cohort study using structured and free-text data from electronic health records.

Setting:

Six diverse health systems in the United States.

Participants:

Patients aged ≥18 years who were smokers in 2007 and had ≥1 primary care visit in each of the following 4 years (N = 33 691).

Measures:

Primary exposure was a composite categorical variable (comprised of documentation of smoking cessation medication, counseling, or referral) classifying the proportions of visits for which patients received any cessation assistance (<25% (reference), 25%-49%, 50%-74%, and ≥75% of visits). The dependent variable was long-term quit (LTQ; yes/no), defined as no indication of being a current smoker for ≥365 days following a visit where nonsmoker or former smoker was indicated.

Analysis:

Mixed effects logistic regression analysis adjusted for age, sex, race, and comorbidities, with robust standard error estimation to account for within site correlation.

Results:

Overall, 20% of the cohort achieved LTQ status. Patients with ≥75% of visits with any assistance had almost 3 times the odds of achieving LTQ status compared to those with <25% visits with assistance (odds ratio = 2.84; 95% confidence interval: 1.50-5.37). Results were similar for specific assistance types.

Conclusions:

These findings provide support for the importance of repeated assistance at primary care visits to increase long-term smoking cessation.
How Social Participation Benefits the Chronically Ill: Self-Management as a Mediating Pathway
Authors: Ang Shannon
Published: March 2018

Objective: Few studies have tested the purported causal mechanisms between social participation and health, especially among those in poor health. This study aimed to determine whether self-management of chronic disease operates as a pathway through which social participation affects health-related quality of life. Method: I utilized causal mediation analysis among 600 low-income older Singaporeans living with chronic conditions, to test whether self-management mediates the association between social participation and health-related quality of life. Results: Results show that self-management fully mediated the positive effect of informal social participation on health-related quality of life. Formal social participation was found to have a negative direct effect on health-related quality of life. Discussion: These findings reiterate the primacy of family and friends for older adults, but highlight that a better understanding of formal engagement with the low-income population is still needed.
How Married Couples Make Charitable Giving Decisions
Authors: Einolf Christopher J. , Curran Hillary Darville , Brown Katie C.
Published: March 2018

This research note reports the results of interviews with 29 married couples about how they make charitable giving decisions. Most couples in the sample made decisions about donating small amounts separately and large amounts jointly. Most couples engaged in cooperative, not competitive, bargaining, as they tended to support the same charities and rarely disagreed about giving decisions. When couples did disagree, it was usually about the amount given, not the target, for large donations, and the target, not the amount given, for small ones. Sometimes one partner would act as the “gas pedal” and tend to want to donate money, while their spouse would act as the “brakes” and argue in favor of making a smaller donation or no donation. Cooperative bargaining also marked the process of increasing a donation, as one spouse would make a small initial decision and would later consult with the other about increasing the amount.
The role of positional knowledge and tonal approaches in cellists’ sight-reading
Authors: Wolfs Zyxcban G. , Boshuizen Henny P. A. (Els) , van Strien Johan L. H.
Published: March 2018

Sight-reading is an important skill for amateur and professional musicians. Several factors seem to play a role in sight-reading skills, such as expertise level, ear training, mental speed and improvisation skills. If we are right in supposing that these factors cannot easily be generalized for all musicians, one of the reasons for this must surely lie in the fact that different musical instruments set different technical requirements for the player. The purpose of this study was to investigate which factors help cello students have better sight-reading abilities. Amateur cello students ( N = 79) were tested for position knowledge, use of tonal and positional approaches and actual sight-reading ability, and their sight-reading performance was measured by counting pitch and fluency errors they made in short pieces of varying complexity. This study used a partly correlational (use of tonal/positional approaches, technical level, experience, and position knowledge) and a partly experimental repeated-measures design (key complexity). The findings suggest that position knowledge shows a very strong negative correlation with the number of sight-reading errors and a weak correlation with pauses. Use of positional approaches shows no significantly stronger correlation with the number of sight-reading errors than the use of tonal approaches. In addition, it appears that an increase in the key complexity leads to more sight-reading errors and more pauses. Finally, the position knowledge and technical level of participants explain 83% of the variation in the total pitch errors. Experience and use of tonal approaches explain 40% of the variation in the number of short pauses.
Psychometric Properties of the FACIT-Pal 14 Administered in an Outpatient Palliative Care Clinic
Authors: Shinall Myrick C. , Ely E. Wesley , Karlekar Mohana , Robbins Samuel G. , Chandrasekhar Rameela , Martin Sara F.
Published: March 2018

Background:

The Functional Assessment of Chronic Illness Therapy-Palliative (FACIT-Pal) 14 instrument measures the quality of life in palliative care patients but its psychometric properties are not well characterized.

Objectives:

To establish the reliability and validity of the FACIT-Pal 14 in an outpatient palliative care clinic population.

Methods:

The FACIT-Pal 14 was administered to 227 patients in an outpatient palliative care clinic at a large, urban academic medical center. Internal consistency reliability was assessed with Crohnbach’s α, and principal component analysis was used to investigate for multiple underlying latent variables. Construct validity was tested by comparing mean scores in various subgroups.

Results:

The FACIT-Pal 14 has Crohnbach’s α of 0.76, which increases to 0.79 if 2 items are removed. Principal component analysis supports a single latent variable underlying the instrument. Significantly lower mean scores were found in patients with Eastern Cooperative Oncology Group (ECOG) functional status 3 to 4 compared with patients with ECOG functional status 1-2 ( P = .007), in patients with life expectancy under 6 months compared to those with 6 months or greater ( P = .003), and in patients referred to clinic for pain and symptom management compared with patients referred for other reasons ( P = .038). Instrument scores did not significantly differ between men and women or between white and nonwhite patients ( P = .525 and P = .263, respectively).

Conclusions:

In an outpatient palliative care clinic population, the FACIT-Pal 14 has good internal consistency, but removal of 2 items would improve consistency. One latent variable underlies the instrument and there is evidence of construct validity.
Ethics of Liver Transplantation: The Role of the Anesthesiologist
Authors: West James M.
Published: March 2018

Anesthesiologists have clearly established their place in the history of medical ethics. Our involvement goes back to 1966 when Henri Beecher published his landmark paper on research and informed consent. Participation in the ethics of transplantation is no less important than our previous work. Organ transplant has been life saving for many but also has given rise to many misunderstandings not just from the public but also among our own colleagues. These include methods of allocation and donation, the role that affluence may play in receiving an organ, the definition of death and donation after circulatory death. As perioperative physicians and important members of the transplant team, anesthesiologists are expected to participate in all aspects of care including ethical judgments. This article discusses some of the issues that seem to cause the most confusion and angst for those of us involved in both liver transplantation and in the procurement of organs. It will discuss the definition of death, donation after circulatory death, the anesthesiologists’ role on the selection committee, living donor liver transplantation, and transplantation of patients with alcohol-related liver disease.