bluuebunny/crossref_metadata_2025 huggingface dataset:
Categorical Omega With Small Sample Sizes via Bayesian Estimation: An Alternative to Frequentist Estimators
Authors: Yang Yanyun , Xia Yan
Published: January 2018

When item scores are ordered categorical, categorical omega can be computed based on the parameter estimates from a factor analysis model using frequentist estimators such as diagonally weighted least squares. When the sample size is relatively small and thresholds are different across items, using diagonally weighted least squares can yield a substantially biased estimate of categorical omega. In this study, we applied Bayesian estimation methods for computing categorical omega. The simulation study investigated the performance of categorical omega under a variety of conditions through manipulating the scale length, number of response categories, distributions of the categorical variable, heterogeneities of thresholds across items, and prior distributions for model parameters. The Bayes estimator appears to be a promising method for estimating categorical omega. M plus and SAS codes for computing categorical omega were provided.
The Prospects of Ending Epistemicide in Africa: Some Thoughts
Authors: Masaka Dennis
Published: January 2018

In this article, I seek to explore the prospects of ending epistemicide in Africa. The literature that challenges epistemicide in Africa largely addresses epistemicide’s impact on the indigenous people of Africa’s knowledge paradigm and call for its reversal. I argue that not much has been written in regard to the prospects of ending epistemicide in Africa. I regard this task as necessary given that the dominance of one epistemological paradigm in the educational curriculum continues to prevail. The position that I am defending here is that the quest for epistemic liberation ought to shift from the theoretical level to consideration of how this noble idea can be put into practice.
Engaging in Creative Work: The Influences of Personal Value, Autonomy at Work, and National Socialization for Self-Directedness in 50 Nations
Authors: Chiu Warren Chi-Kwan , Lun Vivian Miu-Chi , Bond Michael Harris
Published: January 2018

This study aims to examine why and how individuals’ self-reported engagement in creative work is separately and jointly influenced by dispositional, situational, and national-cultural factors worldwide. Using data abstracted from the World Value Survey, we proposed a multi-level model testing how the relationship between individuals’ creative value orientation and their self-reported creative work engagement is contingent on perceived job autonomy and how such interaction is further moderated by the dimension of national socialization for Self-Directedness in developing its human capital. Data provided by a total of 35,120 employees from 50 nations were included in our hierarchical linear modeling (HLM) analyses. As hypothesized, the relationship between an employee’s creative value orientation and creative job engagement is moderated by job autonomy, such that the relationship is stronger when the job held is more autonomous rather than less. However, the relationship of this Person × Situation interaction to creative work engagement was not as extensive as expected—It is stronger in nations emphasizing Self-Directedness in socializing its children. Our findings thus offer conceptual guidelines and practical insights to national and firm leaders aspiring to effect actions for creativity using both personal and situational factors in a given national-cultural context.
FGF8 Signaling Alters the Osteogenic Cell Fate in the Hard Palate
Authors: Xu J. , Huang Z. , Wang W. , Tan X. , Li H. , Zhang Y. , Tian W. , Hu T. , Chen Y.P.
Published: January 2018

Fibroblast growth factor (FGF) signaling has been implicated in the regulation of osteogenesis in both intramembranous and endochondral ossifications. In the developing palate, the anterior bony palate forms by direct differentiation of cranial neural crest (CNC)–derived mesenchymal cells, but the signals that regulate the osteogenic cell fate in the developing palate remain unclear. In the present study, we investigated the potential role of FGF signaling in osteogenic fate determination of the palatal mesenchymal cells. We showed that locally activated FGF8 signaling in the anterior palate using a Shox2Cre knock-in allele and an R26RFgf8 allele leads to a unique palatal defect: a complete loss of the palatine process of the maxilla as well as formation of ectopic cartilaginous tissues in the anterior palate. This aberrant developmental process was accompanied by a significantly elevated level of cell proliferation, which contributes to an abnormally thickened palatal tissue, where the palatine process of the maxilla would normally form, and by a complete inhibition of Osterix expression, which accounts for the lack of bone formation. The coexpression of Runx2 initially with Sox9 and subsequently with Col II in the ectopic cartilaginous tissues indicates a conversion of osteogenic fate to a chondrogenic one. Consistent with the unique palatal phenotype, RNA-Sequencing analysis revealed that the augmented FGF8 signaling downregulated genes involved in ossification, biomineral tissue development, and bone mineralization but upregulated genes involved in cell proliferation, cartilage development, and cell fate commitment, which was further supported by quantitative real-time reverse transcription polymerase chain reaction validation of selected genes. Our results demonstrate that FGF8 signaling functions as a negative regulator of osteogenic fate and is sufficient to convert a subset of CNC cell-derived mesenchymal cells into cartilage in the anterior hard palate, which will have implications in future directed differentiation of CNC-derived precursor cells for clinical application.
Ins and outs of the cultural polis: Informality, culture and governance in the global South
Authors: Mbaye Jenny , Dinardi Cecilia
Published: January 2018

This article provides an epistemological critique of informality by focusing on cultural governance in two cities of the global South, Rio de Janeiro, Brazil, and Dakar, Senegal. Aiming to enrich debates about urban creativity and urban cultural policy, which are still mainly focused on and articulated from the global North, we consider the broad field of ‘informality’ research as an entry point for such a discussion. Using case studies from African and Latin American contexts, we focus on the interstices of cultural policy and the borderlands of (in)formality, examining how governmental institutions are entangled in informal processes, and how grassroots cultural interventions become part of mainstream cultural circuits. The analysis sheds light on how these creative spaces of cultural production, located in Southern contexts of urban extremes, contribute to the vitality of informal urbanisms and unsettle predominant views that see them merely as sites of infrastructural poverty and social exclusion. The article suggests that a creative remapping of informality, through an inquiry of the ‘ins’ and ‘outs’ of the cultural polis, could improve our translating capacity of academic discourse into institutional/policy-related operations.
The Poster Child of the “Second” Cultural Revolution: Huang Shuai and Shifts in Age Consciousness, 1973–1979
Authors: David Kyle E.
Published: January 2018

This article charts fluctuations in age consciousness during the waning years of China’s Cultural Revolution (1966–1976) and its immediate aftermath. It argues that between 1973 and 1979, a dramatic shift occurred in normative perceptions of children and what the experience of childhood should entail. During the Cultural Revolution, the ideal child had a good class background, was anti-intellectual, and challenged authority. After Mao’s death in 1976, however, the new leadership reimagined children along more conservative lines. Their child was naive, studious, and, most importantly, politically disenfranchised. In juxtaposing the prevailing attitudes of these two periods, we witness a reorientation of childhood whereby the post-Mao leadership sought to move children away from revolution toward a more normative understanding of childhood that involved play, study, and growth into economically productive citizens. As a case study in what the ideal child was meant to be, the article examines the public life of Huang Shuai, a twelve-year-old primary school student who rose to national prominence in late 1973.
Displacing air conditioning in Kingdom of Saudi Arabia: An evaluation of ‘fabric first’ design integrated with hybrid night radiant and ground pipe cooling systems
Authors: Hijazi Jamil , Howieson Stirling
Published: January 2018

This paper presents an investigation into the viability of ‘fabric first’ intelligent architectural design measures, in combination with a hybrid cooling system.The specific aim is to displace air conditioning (AC) and reduce carbon dioxide, while maintaining thermal comfort, in a typical housing block in KSA. The results of thermal modelling and prototype field trials suggest that passive design measures combined with night radiant cooling and supply ventilation via ground pipes, can negate the requirement for a standard AC system. Such a strategy may also have a remarkably short payback period when energy savings, in use, are set against the additional capital costs associated with improved building fabric performance.

Practical application: This study suggests that a significant proportion of AC cooling energy can be displaced by improving building fabric performance in combination with supply ventilation via ground pipes. As radiometer readings fell as low as 2.8℃ when the night sky is clear, roof-mounted high emissivity hydronic radiant panels can also provide a significant opportunity for additional heat flushing. In hybrid combination, these strategies have the potential to lower the carbon footprint of a typical housing block in KSA by over 80% and these measures and strategies will be equally applicable and cost-effective in all geographic regions of the world where cooling loads represent the predominant domestic energy use.
Role of the Diabetes Educator in Inpatient Diabetes Management
Authors:   American Association of Diabetes Educators
Published: January 2018

It is the position of American Association of Diabetes Educators (AADE) that all inpatient interdisciplinary teams include a diabetes educator to lead or support improvement efforts that affect patients hospitalized with diabetes or hyperglycemia. This not only encompasses patient and family education but education of interdisciplinary team members and achievement of diabetes-related organizational quality metrics and performance outcomes.
Functions of Utopia: How Utopian Thinking Motivates Societal Engagement
Authors: Fernando Julian W. , Burden Nicholas , Ferguson Adam , O’Brien Léan V. , Judge Madeline , Kashima Yoshihisa
Published: January 2018

Images of ideal societies, utopias, are all around us; yet, little is known of how utopian visions affect ordinary people’s engagement with their societies. As goals for society, utopias may elicit processes of collective self-regulation, in which citizens are critical of, or take action to change, the societies they live in. In three studies, we investigated the psychological function of utopian thinking. In Study 1, measured utopianism was correlated with the activation of three utopian functions: change, critique, and compensation. In Study 2, primed utopian thinking consistently enhanced change and criticism intentions. Study 3 also provided evidence that mental contrasting—first imagining a utopian vision and then mentally contrasting the current society to this vision—underlies the facilitative effect of utopian thinking on societal engagement.
Convergence of naïve coders and participant report ratings of attachment to a former partner: When we should be me
Authors: Borelli Jessica L. , Sbarra David A. , Mehl Matthias
Published: January 2018

Using a Brunswik lens framework, this study examined whether lay observers could accurately detect participants’ attachment to a former partner following romantic breakup or divorce. We predicted that the ratings of post-breakup attachment (completed after reading participants’ transcribed stream-of-consciousness discussions of the recent separation) would be associated with participants’ self-reported ratings of attachment to a former partner and that participants’ natural language use in their narratives would act as the behavioral residue explaining these associations. To enhance the generalizability of our findings, we explored our hypotheses in two samples of adults who had recently undergone romantic relationship dissolutions—people experiencing non-marital breakups ( N = 161) and divorce ( N = 132). Consistent with hypotheses, in both samples, naïve judges generated assessments of participant attachment that were (a) reliable, (b) strongly associated with participants’ own attachment ratings, and (c) associated with participant breakup-related distress. Of the linguistic cues we examined as behavioral residue, only we-talk (first person plural pronoun use) operated indirectly to link rater and participant attachment scores. We discuss the implications of this work for a deeper understanding of attachment to former romantic partners and for using person-perception paradigms to study attachment relationships.
Microfinance: Where are we today and where should the research go in the future?
Authors: Chen Juanyi , Chang Amber Y , Bruton Garry D
Published: January 2018

Over the past two decades, there have been substantial efforts to expand the impact of microfinance around the world, especially in emerging economies. This commentary and Special Issue of International Small Business Journal, seeks to better the understanding of both the contributions and limitations of microfinance in terms of fostering entrepreneurship and economic development. Specifically, we review prior research to understand whether and how microfinance can help to encourage entrepreneurial activity as well as to reduce poverty. We then highlight the gaps in the existing literature and lay out an agenda for future research in this domain.
Financialisation and small firms: A qualitative analysis of bioscience and film and media firms
Authors: Pollard Jane , Richter Paul , Down Simon , Ram Monder
Published: January 2018

How, if at all, does financialisation affect small firms that have no direct exposure to capital markets? This article argues the need to address this lacuna empirically, conceptually and politically drawing on research from a qualitative longitudinal analysis of UK small businesses in bio-business and film and media sectors. We identify three potential conduits through which financialising principles and practices may be perceived, translated and resisted for owners, managers and staff. More broadly, the article argues that financial relations should figure more prominently and move from their relatively marginal location into the heart of socio-economic analysis of small firms. As such, the research connects with and extends an important social science tradition of research on managerial control in small firms to include issues of financialisation and financial governance.
Caring for a family member or friend with dementia at the end of life: A scoping review and implications for palliative care practice
Authors: Broady Timothy R , Saich Freya , Hinton Tom
Published: January 2018

Background:

Although people with dementia receive substantial care from informal sources, there is limited research available that investigates how these carers experience end-of-life care.

Aim:

This review aimed to identify what is currently known about carers’ experiences of providing end-of-life care to a family member or friend with dementia and draw implications for palliative care policy and service provision.

Design:

A scoping literature review was conducted, first using a targeted key word search, followed by assessments of eligibility based on title and then abstract content.

Data sources:

Records were sourced through PsycINFO, PubMed and CINAHL databases. Peer-reviewed papers published between 2000 and 2016, reporting on data collected directly from carers, were included for review.

Results:

Carers’ experience centred on relationships (with care recipients, family and friends and health care professionals) and the specific context of caring for someone with dementia. These broad categories of carers’ experiences had clear influences on them personally, particularly in relation to their sense of self and their wellbeing.

Conclusion:

Palliative care services would benefit from ensuring holistic approaches to supporting people with dementia, their carers and wider family networks. Tailoring services to the specific context of dementia would enable effective, personalised support throughout extended periods leading up to care recipient death as well as through the challenges faced beyond bereavement.
Posterior reversible encephalopathy syndrome in stroke-prone spontaneously hypertensive rats on high-salt diet
Authors: Herisson Fanny , Zhou Iris , Mawet Jerome , Du E , Barfejani Arnavaz H , Qin Tao , Cipolla Marilyn J , Sun Philip Z , Rost Natalia S , Ayata Cenk
Published: January 2018

Stroke-prone spontaneously hypertensive rats (SHRSP) on high-salt diet are characterized by extremely high arterial pressures, and have been endorsed as a model for hypertensive small vessel disease and vascular cognitive impairment. However, rapidly developing malignant hypertension is a well-known cause of posterior reversible encephalopathy syndrome (PRES) in humans, associated with acute neurological deficits, seizures, vasogenic cerebral edema and microhemorrhages. In this study, we aimed to examine the overlap between human PRES and SHRSP on high-salt diet. In SHRSP, arterial blood pressure progressively increased after the onset of high-salt diet and seizure-like signs emerged within three to five weeks. MRI revealed progressive T2-hyperintense lesions suggestive of vasogenic edema predominantly in the cortical watershed and white matter regions. Histopathology confirmed severe blood–brain barrier disruption, white matter vacuolization and microbleeds that were more severe posteriorly. Hematological data suggested a thrombotic microangiopathy as a potential underlying mechanism. Unilateral common carotid artery occlusion protected the ipsilateral hemisphere from neuropathological abnormalities. Notably, all MRI and histopathological abnormalities were acutely reversible upon switching to regular diet and starting antihypertensive treatment. Altogether our data suggest that SHRSP on high-salt diet recapitulates the neurological, histopathological and imaging features of human PRES rather than chronic progressive small vessel disease.
Quantitative contrast-enhanced ultrasound for monitoring vedolizumab therapy in inflammatory bowel disease patients: a pilot study
Authors: Goertz Ruediger S , Klett Daniel , Wildner Dane , Atreya Raja , Neurath Markus F , Strobel Deike
Published: January 2018

Background

Microvascularization of the bowel wall can be visualized and quantified non-invasively by software-assisted analysis of derived time-intensity curves.

Purpose

To perform software-based quantification of bowel wall perfusion using quantitative contrast-enhanced ultrasound (CEUS) according to clinical response in patients with inflammatory bowel disease treated with vedolizumab.

Material and Methods

In a prospective study, in 18 out of 34 patients, high-frequency ultrasound of bowel wall thickness using color Doppler flow combined with CEUS was performed at baseline and after 14 weeks of treatment with vedolizumab. Clinical activity scores at week 14 were used to differentiate between responders and non-responders. CEUS parameters were calculated by software analysis of the video loops.

Results

Nine of 18 patients (11 with Crohn’s disease and seven with ulcerative colitis) showed response to treatment with vedolizumab. Overall, the responder group showed a significant decrease in the semi-quantitative color Doppler vascularization score. Amplitude-derived CEUS parameters of mural microvascularization such as peak enhancement or wash-in rate decreased in responders, in contrast with non-responders. Time-derived parameters remained stable or increased during treatment in all patients.

Conclusion

Analysis of bowel microvascularization by CEUS shows statistically significant changes in the wash-in-rate related to response of vedolizumab therapy.
Demographic determinants and outcome of in vitro fertilization (IVF) services in Saudi Arabia
Authors: Almaslami Faisal , Aljunid Syed Mohamed , Ghailan Khalid
Published: January 2018

Objectives

To assess the demographic characteristics and outcomes of couples undergoing in vitro fertilisation (IVF) treatment at a private hospital in Al Qassim district, Saudi Arabia.

Methods

For this retrospective study, information was extracted from the hospital electronic database and IVF unit medical records.

Results

2259 couples underwent 2703 IVF/ICSI cycles during 2014 to 2016. The utilization rate was approximately 1000 cycle per million of inhabitants. Mean ages ± standard deviation (SD) for women and men were 32.9 ± 5.7 and 39.2 ± 7.4 years, respectively. More couples were diagnosed with secondary infertility (55.2%) than primary infertility (44.8%). Male factor was the commonest single indication for IVF (36.2%). Mean ± SD infertility duration was 4.70 ± 4.03 years. Overall, 949 couples had a successful pregnancy. Age-specific pregnancy rates (PR) were highest for women <35 years (39.8%) and lowest for women >40 years (11.6%). Male age and infertility duration had no effect on PR but sperm source (fresh vs. frozen) and female age had significant impacts. However, fresh sperm was used in 90.6% cycles whereas frozen sperm was used in 9.4% cycles.

Conclusions

IVF treatment outcomes in the Al Qassim district are within the boundaries of average international success rates. Infertile couples seeking IVF services should be counselled with regard to important prognostic factors
Plexiform Vasculopathy in Feline Cervical Lymph Nodes
Authors: Jungwirth Nicole , Junginger Johannes , Andrijczuk Christoph , Baumgärtner Wolfgang , Wohlsein Peter
Published: January 2018

Plexiform vasculopathy refers to an endothelial proliferative disorder affecting cervical or inguinal lymph nodes of cats. The cause of this disorder and the origin of the proliferating endothelial cells are still unknown. In 4 cats with a history of a slowly growing, well-demarcated, nonpainful mass adjacent to the thyroid gland, an enlarged dark brown to red lymph node was removed. Histologically, the lymph nodes showed severe loss of lymphoid tissue with accumulations of erythrocytes. In addition, networks of capillary structures with well-differentiated endothelial cells on a collagen-rich stroma were observed, consistent with benign plexiform vasculopathy. Immunohistochemistry revealed the expression of the vascular endothelial markers CD31 and factor VIII–related antigen. In addition, immunolabeling with a Prox-1 antibody indicated a lymphendothelial origin. With respect to our findings, a lymphendothelial origin has to be considered in cases of intranodal vascular neoplasms.
Immunohistochemical Expression of CD31 (PECAM-1) in Nonendothelial Tumors of Dogs
Authors: Ramos-Vara José A. , Miller Margaret A. , Dusold Dee M.
Published: January 2018

CD31 immunoreactivity has been reported in human nonendothelial tumors of both epithelial and mesenchymal origin. This study examined CD31 immunoreactivity of 347 formalin-fixed, paraffin-embedded normal, nonneoplastic, and neoplastic canine tissues. CD31 expression was considered positive if at least 10% of the cell population had membranous reactivity. Labeling with the CD31 antibody (clone JC/70A) was observed in 16 samples of normal organs (liver, kidney, lymph node), 6 of 6 specimens of hepatic nodular hyperplasia, 3 of 3 hepatic regenerative nodules, 1 of 4 anal sac carcinomas, 6 of 6 hemangiosarcomas, 18 of 20 hepatocellular carcinomas, 1 of 6 mammary carcinomas, 3 of 5 plasmacytomas, 18 of 53 renal cell carcinomas, and 1 of 5 cutaneous histiocytomas. CD31 expression did not correlate with case outcome in hepatocellular or renal cell carcinomas. Although distinguishing hemangiosarcoma from other neoplasms is typically straightforward, pathologists should be aware of potential cross-reactivity when relying on CD31 immunohistochemistry for diagnosis, particularly in small biopsy samples or when faced with an epithelioid or poorly differentiated vascular neoplasm.
Effects of Novel Manufacturing Technology on Blood and Dialysate Flow Distribution in a New Low Flux “α Polysulfone” Hemodialyzer
Authors: Gastaldon F. , Brendolan A. , Crepaldi C. , Frisone P. , Zamboni S. , D'Intini V. , Poulin S. , Hector R. , Granziero A. , Martins K. , Gellert R. , Inguaggiato P. , Ronco C.
Published: January 2018

The main target for low flux hemodialyzers is an efficient low molecular weight solutes clearance. Such efficiency is largely dependent on the optimization of diffusion between blood and dialysis solution. The diffusion process can be impaired if there is a mismatch between blood and dialysate flow distribution in the dialyzer. Thus optimized flow distribution both in the blood and dialysate compartment becomes quintessential for the maximal efficiency of the diffusion process within the hemodialyzer. The present paper describes the distribution of the blood and dialysate flows in a new low flux polysulfone hollow fiber hemodialyzer characterized by a specific undulation of the fibers and a new cutting technology of the fibers for an improved micro-flow condition in the blood compartment headers. Twelve Diacap α Polysulfone LO PS 15 (1.5 sqm) (B.Braun Medizintechnologie, Melsungen Germany) were employed for the study. Six were analyzed in vitro and six were studied in vivo. Blood flow distribution was studied in vitro by dye injection in the blood compartment during experimental extracorporeal circulation utilizing human blood with hematocrit adjusted at 33%. Sequential images were obtained with a helical scanner in a fixed longitudinal section of the dialyzer 1 cm thick. Average and regional blood flow velocities were measured utilizing the reconstructed imaging sequence. The method allowed the calculation of single fiber blood flow (SF Qb) and the mass transfer zone (MTR) definition in digitally subtracted images. The patterns 20–10 and 40–30 were utilized. The same technology was used to evaluate flow distribution in the dialysate compartment after dye injection in the Hansen's connector. Regional dialysate flow was calculated in central and peripheral sample areas of 1 cm2. Six in vivo hemodialysis treatments on patients with end stage renal disease were performed at three different blood flow rates (250–350 and 450 ml/min) in order to measure urea, creatinine and phosphate clearance. Macroscopic and densitometrical analysis revealed that flow distribution was homogeneous in the blood compartment while in the dialysate compartment a slight difference between the peripheral and central regions in terms of flow velocity was observed. This however was not generating channeling phenomena. Urea creatinine and phosphate clearances were remarkably high and so were the Kt/V observed in all sessions, especially in relation to the studied blood flows.

In conclusion, a significant blood to dialysate flow match with optimized countercurrent flow condition was observed in the studied hollow fiber hemodialyzers. Such optimization might be due both to the improved dialyzer design at the level of the blood header and to the specific fiber undulation that prevents dialysate channeling.
The Influence of Ozonated Autohemotherapy on Oxidative Stress in Hemodialyzed Patients with Atherosclerotic Ischemia of Lower Limbs
Authors: Tylicki L. , Nieweglowski T. , Biedunkiewicz B. , Chamienia A. , Debska-Slizien A. , Aleksandrowicz E. , Lysiak-Szydlowska W. , Rutkowski B.
Published: January 2018

Ozonated autohemotherapy is used as a complementary medical approach in the treatment of vascular disorders. One of the greatest problems concerning an application of ozone in medicine is its induction of oxidative stress. The standards of ozonotherapy were elaborated recently making this treatment useful and probably non toxic. The aim of the present study was to investigate the influence of ozonated autohemotherapy on the oxidative stress extent in hemodialyzed patients, known to be particularly exposed to generation and deleterious effects of free radicals. Twelve continuously hemodialyzed subjects with atherosclerotic ischemia of the lower limbs were examined in a prospective, controlled, single blind study. Autohemotherapy with blood exposure to oxygen served as a control. The protein and lipid peroxidation products, the reduced glutathione level in red blood cells and free hemoglobin plasma concentration were measured. The study showed that ozonated autohemotherapy with ozone concentration 50 μg/ml per gram of blood induced a significant decrease in glutathione level after 9 sessions of this procedure. Therapy did not cause either the enhancement of protein and lipid peroxidation, or erythrocytes damage. It seems likely that the antioxidant defense system, part of which is glutathione, neutralizes oxidative properties of ozone in this concentration and protects against oxidative cell damage.
Study of Severe Hepatitis Treated with a Hybrid Artificial Liver Support System
Authors: Qian Y. , Lanjuan L. , Jianrong H. , Jun L. , Hongcui C. , Suzhen F. , Xia Y. , Shuhong Y.
Published: January 2018

Artificial liver support system (ALSS) has been used to treat hepatic failure and has significantly decreased the mortality. TECA hybrid artificial liver support system (TECA-HALSS), which combines the hollow fiber bioreactor with a plasma exchange circuit, was used to assess the efficacy, safety and feasibility in treating severe hepatitis patients. The hybrid artificial liver support system (HALSS) consists of a bioreactor containing more than 5 ×109 porcine hepatocytes and plasma exchange device. Fifteen patients with severe hepatitis were treated with this hybrid system. All patients experienced a reduction in symptoms such as fatigue, abdominal distention or ascites. After each treatment serum total bilirubin decreased markedly while prothrombin activity increased. There were ten patients whose progress of hepatocyte necrosis was stopped after HALSS treatment, and finally they recovered completely. One patient received liver transplantation after HALSS therapy and survived. No serious adverse events were noted in the fifteen patients.
Hemofiltration during Cardiopulmonary Bypass for High Risk Adult Cardiac Surgery
Authors: Raman J.S. , Hata M. , Bellomo R. , Kohchi K. , Cheung H.L. , Buxton B.F.
Published: January 2018

Aims

The role of hemofiltration (HF) during cardiopulmonary bypass (CPB) in adult cardiac surgery is controversial. It may be beneficial during prolonged CPB in high-risk surgery. Accordingly, we sought to compare two groups of patients undergoing high-risk cardiac surgery with or without HF.

Methods

One hundred and eighteen patients who underwent complex cardiac surgical procedures during a 12-month period were divided into two groups. Group I (n=61) comprised patients who were treated with hemofiltration during CPB. Group II (n=57) were not filtered. Estimated risk of death, standard demographic, clinical and surgical features were obtained and predetermined outcomes were studied. Statistical comparisons were made.

Results

Age, procedure times and mortality rates were similar in both groups. The mean volume of fluid removed in group I was 3.4 L. The preoperative mean Parsonnet score was 24.8 in group I and 22.5 in group II (ns). Postoperative serum hemoglobin, hematocrit, platelet, and albumin levels were all significantly higher in group I patients (p = 0.0015) indicating hemoconcentration. Post-operative chest drainage showed a trend toward decreased post-operative bleeding in group I (p=0.065). Postoperative pleural effusions requiring chest tube drainage were significantly less in group I (9.8% vs. 29.8% 6; p = 0.0062). The incidence of lung infection was also decreased from 26.3% to 13.1% (p=0.05). Operative mortality was similar in both groups (11.4% in group I, 10.5% in group II, ns).

Conclusion

Hemofiltration during CPB attenuates postoperative anemia, thrombocytopenia and hypoalbuminemia, may reduce post-operative bleeding and appears to decrease post-operative pulmonary complications.
Platelet Loss across the Hemofilter during Continuous Hemofiltration
Authors: Mulder J. , Tan H.K. , Bellomo R. , Silvester W.
Published: January 2018

Background

Thrombocytopenia is a common finding in patients in the intensive care unit receiving continuous renal replacement therapy (CRRT). It is unknown if the hemofilter itself contributes to the platelet loss.

Objective

To measure the direct effect of the hemofilter on platelet counts during CRRT.

Design

Prospective, observational study

Setting

Intensive care unit of a University hospital

Patients

Critically ill patients with acute renal failure receiving CRRT.

Methods

Two samples of blood were drawn simultaneously, pre-filter and post-filter, and analyzed for platelet count. A correction factor was applied to the post-filter platelet count to adjust for the hemoconcentrating effect of net ultrafiltration.

Results

Forty-eight sets of paired data from 22 patients were studied. There was a small but significant decrease in mean platelet count across the hemofilter. The mean platelet count drop was 2.32 ×109/L (s.e. 1.06, p=0.0487, 95% CI (0.01,4.62)). Blood flow was strongly related to degree of platelet loss, with a decreased loss of 0.07 ×109/L for every ml/min increase in blood flow (p=0.015). There was no overall decrease in concurrently measured red cell counts across the hemofilter. However, there was a machine-specific affect on red cell loss (p<0.0001). The total calculated daily platelet loss across the filter was 625 ×109 cells.

Conclusion

The hemofilter may contribute to the thrombocytopenia seen during CRRT, by means of either destruction or retention of platelets during passage. This affect appears attenuated by higher blood flows. This information is useful in the assessment of a low platelet count in patients receiving CRRT.
“All in One” Cardiopulmonary Bypass Circuit for Aortic Surgery
Authors: Ueda T. , Kawata T. , Tsuji T. , Sakaguchi H. , Tabayashi N. , Yoshikawa Y. , Nagasaka S. , Abe T. , Naito H. , Taniguchi S.
Published: January 2018

We devised an “all in one” cardiopulmonary bypass circuit for aortic surgery, and evaluated its efficacy and safety. The circuit consisted of a venous line, reservoir, single centrifugal pump, membrane oxygenator and arterial line bifurcated into two lines for systemic perfusion and selective branch perfusion. The perfusion volume was regulated by an occluder and measured by a flow sensor. A closed partial bypass was established using a shunt line bypassing the reservoir. We applied this circuit to 25 patients with aortic disease. Regulation of both the selective cerebral perfusion (SCP) and the selective branch perfusion was easily performed. There was neither stroke nor organ dysfunction postoperatively. There are some cases in which it is difficult to decide the necessity for SCP preoperatively; the use of this circuit may resolve this problem. This circuit can be easily and safely applied to any type of aortic surgery.
In Vitro Construction of Urinary Bladder Wall using Porcine Primary Cells Reseeded on Acellularized Bladder Matrix and Small Intestinal Submucosa
Authors: Gabouev A.I. , Schultheiss D. , Mertsching H. , Köppe M. , Schlote N. , Wefer J. , Jonas U. , Stief C.G.
Published: January 2018

Background

Partial or radical cystectomy requires replacement of the urinary reservoir normally achieved by using small or large bowel segments. Our aim was to establish tissue engineering of an bioartificial bladder wall using primary cultures of porcine urothelial (pUC) and bladder smooth muscle cells (pSMC) to be reseeded on different acellular biological matrices.

Methods

Primary porcine cultures of pUC and pSMC were established from open bladder biopsy material 25 mm 2 in size. Acellular matrix was generated either from a) porcine bladder wall segments or b) tubular small intestinal submucosa with the still attached decellularized muscularis layer. Reseeding of these matrices with primary cells was done in a two-dimensional static model and in a three-dimensional rotating bioreactor perfused with cell culture medium for a period of 6 weeks.

Results

Prior to reseeding the cultured cells were characterized as pUC and pSMC by immunohistochemical staining with either anti-keratin 7 or anti-alpha actin. For both matrices a reseeded double layer cell system of pUC and pSMC could be identified after incubation in the described systems for 6 weeks.

Conclusions

Our results document successful generation of tissue engineered urinary bladder wall, which can be used in further large animal transplantation experiments.
Microencapsulation and Culture in Vitro of Rat Pinealocytes
Authors: Hua L. , Dachuan X. , Lei Y. , Shaohu X. , Xiaojing L. , Tao H. , Shizheng Z.
Published: January 2018

Background

Melatonin is a powerful anti-aging reagent for scavenging free radicals. However, the effect of exogenous melatonin on age-dependent diseases is uncertain. Immune rejection has limited xenotransplantation or allotransplantation of the pineal gland. The aim of this study was to assess cell viability and the function of rat pinealocytes encapsulated in APA capsules and offer experimental suggestions for pineal microencapsulation grafting to resist aging.

Methods

The pineal glands of neonatal rats were removed. Pinealocytes were isolated and encapsulated in APA microencapsulation and cultured. Morphological appearance of the microencapsulation was observed. Trypan blue staining and 5-HT immunocytochemical assay were used to detect cell viability and identify pinealocytes. The expression of AA-NAT mRNA was confirmed by RT-PCR. Melatonin release was measured and compared by HPLC.

Results

Both control and encapsulated pinealocyte cultures survived well. The majority of the encapsulated pinealocytes as well as unencapsulated cells remained 5-HT positive. No significant difference in melatonin secretion and the expression level of AA-NAT mRNA between encapsulated and unencapsulated pinealocytes was found.

Conclusions

Pinealocytes survive and remain functionally competent in vitro at least 2 weeks after microencapsulation.
Artificial in Vivo Biofiltration: Slow Continuous Intravenous Plasmafiltration (SCIP) and Artificial Organ Support
Authors: Handley H.H. , Ronco F. , Gorsuch R. , Peters H. , Cooper T.G. , Levin N.W.
Published: January 2018

An intravenous plasmafiltration (SCIP) catheter has been developed and is proposed for clinical investigation into the alleviation of acute fluid overload by SCUF of the extracted plasma. The system utilizes a unique backflushing technique, high intravenous shear flow rates and biocompatible polymers to minimize protein and platelet aggregation along the filter surfaces. The absence of platelets from the extracted plasma promotes the longevity of ultrafiltration cartridges, thus theoretically minimizing attendant labor associated with continuous renal replacement therapies. Clinical studies are currently being planned for the near future. Plasma SCUF is envisioned as a predecessor technology to future applications in therapeutic apheresis, tissue engineering, therapeutic sorbent technologies. Further, with improved longevity profiles, intravenous SCUF or dialysis and implantable or wearable artificial organs based upon artificial in vivo biofiltration are possible.
EPO or Not-EPO? An Evidence Based Informed Consent
Authors: Mezza E. , Piccoli G.B. , Pacitti A. , Soragna G. , Bermond F. , Burdese M. , Gai M. , Motta D. , Jeantet A. , Merletti F. , Vineis P. , Segoloni G.P.
Published: January 2018

Background

Informed consent is crucial in therapeutic choices; however, the forms presented to patients are often locally developed and information may not be homogeneous.

Objective

To prepare an evidence-based model for informed consent, applied in the case of erythropoietin therapy (EPO) as a teaching tool for medical students.

Methods

Methodological tools of Evidence-Based Medicine (EBM) were developed within the EBM Course in the Medical School of Torino, Italy, as problem solving and patient information tools (5th year students work in small groups under the supervision of statisticians, epidemiologists and experts of internal medicine - nephrology in this case).

Results

Methodological and ethical problems were identified: in the pre-dialysis field, evidence from randomized clinical trials (RCT) is scant; how to use evidence gathered in dialysis? How to deal with implementation? How with the mass media? Do we need to discuss the drug choice with the patients? How to deal with rare and severe side effects?). The “evidence” was searched for on Medline/Embase, by using key-words and free terms. About 680 papers were retrieved and screened. Forms available on the Internet were retrieved and a general scheme was drawn: it included 5 areas: title, aim and targets (patients and family physicians); search strategies and updating; pros and cons of therapy; alternative options; open questions.

Conclusions

EBM may offer valuable tools for systematically approaching patient information; the inclusion of this kind of exercise in the Medical School EBM courses may help enhance the awareness of future physicians of the correct communication with patients.
Reverse Remodeling by Net Cardioplasty in a Model of Dilated Cardiomyopathy: Results of an Animal Study
Authors: Feindt P. , Litmathe J. , Boeken U. , Gams E.
Published: January 2018

Aim

End-stage heart failure is a growing clinical problem with only a few satisfactory therapeutical options. Dilated cardiomyopathy (DCM) is associated with a progressive decline in cardiac function. Our hypothesis was to arrest this worsening of cardiac function by mechanically containing the dilated heart with a special net.

Methods

In 16 pigs (50 ± 7 kg) DCM congestive heart failure was initiated by rapid ventricular pacing (220 b/m). In series 1 (n=8) a polyester net was placed around both ventricles before pacing was induced, whereas in series 2 (n=8) ventricular wrapping was performed when DCM was established.

Results

Comparing hemodynamic data before re-operation of group II-animals, the decrease of CO and dp/dtmax was significantly lower in series 1 than in series 2 compared to the baseline values before pacing (CO: series 1:-22.6±3.3%, series 2:-52.4±6.4%, P&0.05; dp/dt: series 1: +16.4±2.8%, series 2: −51.5±5.9%, P&0.05). In series 2, after net implantation, we could furthermore show that deterioration of the animal stopped and hemodynamic data improved significantly in the following 2 weeks (CO: +62.9±10.5% and dp/dt +37.0±6.8%).

Conclusion

Ventricular containment with a polyester net seems to be a therapeutic option in cardiac insuffiency caused by ventricular dilation. This cardioplasty induced a reverse remodeling of the dilated hearts with a significant improvement in diastolic and systolic ventricular function.
Effect of Lipoprotein Apheresis on Oxidative Stress and Antioxidant Status in Familial Hypercholesterolemic Patients
Authors: Kurtoglu E. , Ugur A , Gonen M. SAIT , KiSAKOL G.
Published: January 2018

Extracorporeal low-density lipoprotein (LDL) apheresis is an established and highly effective therapy for the patients with familial hypercholesterolemia (FH) not adequately responding to diet and drug therapy alone. This study was designed to measure the effect of lipid apheresis on oxidant and antioxidant status in a patient with FH. The levels of plasma lipid peroxidation were determined as thiobarbituric acid-reactive substances. The activities of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) were established in one subject with FH before and after lipid apheresis.

The pre- and post lipid apheresis procedures witness a significant decrease in oxidative stress (p<0.05) but the erythrocyte levels of CAT, SOD and GPx were unchanged.
Prevention of Contrast Nephropathy in Critically Ill Patients Using Acetylcysteine and Theophylline
Authors: Mueller C.
Published: January 2018

Compared with periprocedural hydration alone, acetylcysteine with hydration significantly reduces the risk of contrast nephropathy in patients with chronic renal insufficiency by 50%. For elective contrast procedures, acetylcysteine should be given in a dose of 600 mg twice daily the day before and on the procedure day. For emergency procedures, a high dose intravenous regimen (150 mg/kg in 500 mL normal saline over 30 minutes immediately before contrast followed by 50 mg/kg in 500 mL normal saline over 4h) is effective. Given the low cost and good side-effect profile of acetylcysteine, it would seem prudent to give this drug with intravenous fluids to all critically ill patients scheduled for intravenous or intraarterial contrast procedures. Theophylline in a dose of 200 mg or 2.5 mg/kg IV 30 minutes before contrast may be an effective alternative for emergency procedures. Although its benefit compared with periprocedural hydration alone seems less well established, theophylline is a particularly attractive option for emergency procedures.
Plasma Leakage of Oxygenators in ECMO Depends on the Type of Oxygenator and on Patient Variables
Authors: Meyns B. , Vercaemst L. , Vandezande E. , Bollen H. , Vlasselaers D.
Published: January 2018

This study was conducted to identify the causes of plasma leakage of oxygenators in extra corporeal membrane oxygenation (ECMO). From 1996 through 2002, 91 oxygenators were used in 62 patients undergoing ECMO for respiratory and/or cardiac failure. Several types of oxygenators were used (Medtronic Maxima, Minima, PRF, Medos Hilite). Patient variables and variables related to the ECMO set-up were analysed for their relationship with oxygenator failure by a time related multiple regression analysis (Cox).

Oxygenator failure occurred in 26% of the cases. The analysis identified the type of oxygenator (p=0.0016), younger patient age (p=0.04) and the number of oxygenators used (p=0.03) as the independent significant risk factors. The type of oxygenator used has the most overwhelming effect (significantly less leakage with the Medos Hilite).

In conclusion, leakage of oxygenators is predominantly caused by the type of oxygenator used. Patient variables (younger age and the number of oxygenators used in one patient) are also significant and allude to an inflammatory process as underlying mechanism of plasma leakage.