bluuebunny/crossref_metadata_2025 huggingface dataset:
Staphylococcus Biofilm Components as Targets for Vaccines and Drugs
Authors: Visai L. , Arciola C. R. , Pietrocola G. , Rindi S. , Olivero P. , Speziale P.
Published: January 2018

Staphylococci have become the most common cause of nosocomial infections, especially in patients with predisposing factors such as indwelling or implanted foreign polymer bodies. The pathogenesis of foreign-body associated infections with S. aureus and S. epidermidis is mainly related to the ability of these bacteria to form thick, adherent multilayered biofilms. In a biofilm, staphylococci are protected against antibiotic treatment and attack from the immune system, thus making eradication of the infections problematic. This necessitates the discovery of novel prophylactic and therapeutic strategies to treat these infections. In this review, we provide an overview of staphylococcal biofilm components and discuss new possible approaches to controlling these persistent biofilm-dwelling bacteria.
Prometheus: From Legend to the Real Liver Support Therapy
Authors: Rifai K. , Tetta C. , Ronco C.
Published: January 2018

Background

A large number of patients develop liver disease that may evolve into progressive chronic failure. Artificial liver support systems (e.g., MARS and Prometheus) are considered in the framework of the steady increase in the number of patients who could possibly benefit from these blood purification devices. Albumin dialysis and adsorption are now two integrated concepts. The present know-how enabling us to appropriately modify several intrinsic characteristics of the adsorbents - e.g., their chemical nature, the particle and pore size distribution, as well as a larger surface offered to adsorption - has helped in better fine-tuning liver support systems to improve adsorption kinetics and flow characteristics specifically for the intended clinical application. These properties together with an improved biocompatibility have made possible the development of adsorptive techniques for which clearances and total removal rates of target compound would be unthinkable with conventional hemodialysis or hemofiltration. Several adsorptive techniques are already available commercially for the treatment of sepsis and septic shock and of acute liver failure, but controlled studies with clinical end points are still lacking.
Design of an Advanced Temporary Hip Prosthesis for an Effective Recovery of Septic Mobilizations: A Preliminary Study
Authors: Danti S. , Rizzo C. , Polacco G. , Cascone M. G. , Giusti P. , Lisanti M.
Published: January 2018

The purpose of this study was the design and preliminary feasibility study of an advanced temporary hip prosthesis acting as an in-site drug dispensing system. An interactive device was designed to improve the recovery of bone infections compared to the mechanical spacers currently used in septic mobilizations. A commercial device was chosen and modified specifically for the purpose. First of all, the device was provided with a hydraulic multi-channel system connected via catheter to a subcutaneous valve, refillable with a drug aqueous solution from the outside. Moreover, since it allows samples of biological fluids for analyses to be drawn directly from the implantation site, this chemical dispensing system was designed to allow the course of infections to be monitored and customized therapies to be dosed. The insertion of biocompatible membranes inside the channel ends was considered essential to prevent their occlusion by fibrous tissue growth, thereby preserving the device functionality. Moreover, a biodegradable spongy ring was designed to be fixed onto the stem in distal position both to give primary stability to the implant and to act simultaneously as a scaffold for bonelike cell growth.
Access Flow Measurement by Indicator Dilution without Indicator Injection: Effect of Switch Location
Authors: Schneditz D. , Van Der Sande F. M. , Bachler I. , Rosales L. M. , Wijnen E. , Levin N.W.
Published: January 2018

It is well known that the measurement of access flow by one of the various dilution techniques requires the reversal of blood flow drawn from and returned to the peripheral vascular access. But it was only recently recognized that the line switch itself constitutes a dilution experiment for certain blood and dialysate components and properties, so that a subsequent injection of indicator is no longer required. New switches introduced at different locations in the extracorporeal circulation not only simplify manual operation for standard access flow measurement but also provide an essential tool for the new technique, which is based on continuously measuring certain blood and/or dialysate characteristics and their changes caused by switching the bloodlines. In this study, the effects of switching the bloodlines at two different locations were studied when extracorporeal temperatures were used as a marker. The study shows that the temperature changes depend on the location of the switch relative to the extracorporeal temperature sensors, and that different algorithms to calculate access flow have to be used for the two possible switching positions to account for this dependence.
High Cut-off Point Membranes in Septic Acute Renal Failure: A Systematic Review
Authors: Haase M. , Bellomo R. , Morger S. , Baldwin I. , Boyce N.
Published: January 2018

Objectives

To review the literature on the experimental, physiological and clinical effects of blood purification with high cut-off (HCO) point membranes in septic acute renal failure (ARF).

Study Design

MEDLINE and PubMed database search combining relevant terms and integrating data from studies on the use of HCO membranes.

Setting and Population

Ex vivo studies of endotoxemia, animal studies of bacteremia and clinical studies using HCO membranes in patients with septic ARF. Selection Criteria for Studies: Original data from primary publications. Interventions: HCO membrane-based hemodialysis, hemodiafiltration or hemofiltration. Outcomes: Plasma cytokine clearance, immunological and physiological effects and safety parameters of HCO membranes.

Results

HCO membranes effectively remove cytokines from blood. Treatment using HCO membranes has beneficial effects on immune cell function and increases survival in animal models of sepsis. Preliminary clinical studies show that HCO membranes decrease plasma cytokine levels and the need for vasopressor therapy. HCO membrane-based blood purification has now been applied in four pilot randomized controlled studies of 70 patients with septic ARF with no reports of serious adverse effects.

Limitations

Because of substantial heterogeneity, no formal quantitative analysis could be performed.

Conclusions

The available evidence on HCO blood purification justifies larger randomized controlled trials in patients with septic ARF.
Peritoneal Dialysis-Related Peritonitis in Southern Thailand
Authors: Nakwan N. , Dissaneewate P. , Lim A. , Vachvanichsanong P.
Published: January 2018

Objective

To evaluate peritonitis in children receiving peritoneal dialysis (PD) in southern Thailand.

Patients and Methods

We reviewed the records of patients who received PD at the Department of Pediatrics, Prince of Songkla University from January 1994 to December 2003.

Results

Forty-six patients had PD performed for 228.6 patient-months. Their mean age was 9.5±4.8 years (range 3.0 months-16.7 years). Twenty-eight patients had complications with 61 episodes of peritonitis. The age, sex and causes of renal failure did not display any differences between patients who had or did not have peritonitis (p=0.2, 0.6 and 0.6, respectively). The first peritonitis occurrence was on average at 2.7±4.0 patient-months (median 0.4, range 0–12.5) following catheter insertion, with an average incidence rate of one infection per 3.5±4.8 patient-months (median 1.0, range 0–23.2). The causative agents were both gram-positive and gram-negative bacteria, and fungi at 24%, 44%, and 8% respectively (24% of the cultures did not grow). There was no significant difference in causative agents between home- and hospital-acquired peritonitis (p=1.0).

Conclusion

PD-related peritonitis in this study occurred earlier and more often than in other studies, probably because all of our PDs were performed immediately after catheter insertion.
The Pathophysiology of Cardiac Surgery-Associated Acute Kidney Injury (CSA-AKI)
Authors: Bellomo R. , Auriemma S. , Fabbri A. , D'Onofrio A. , Katz N. , Mccullough P.A. , Ricci Z. , Shaw A. , Ronco C.
Published: January 2018

Cardiac surgery associated acute kidney injury (CSA-AKI) is a significant clinical problem. Its pathogenesis is complex and multifactorial. It likely involved at least six major injury pathways: exogenous and endogenous toxins, metabolic factors, ischemia and reperfusion, neurohormonal activation, inflammation and oxidative stress. These mechanisms of injury are likely to be active at different times with different intensity and probably act synergistically. Because of such complexity and the small number of randomised controlled investigations in this field only limited recommendations can be made. Nonetheless, it appears important to avoid nephrotoxic drugs and desirable to avoid hyperglycemia in the peri-operative period. The duration of cardiopulmonary bypass should be limited whenever possible. Off-pump surgery, when indicated, may decrease the risk of AKI. Invasive hemodynamic monitoring focussed on attention to maintaining euvolemia, an adequate cardiac output and an adequate arterial blood pressure is desirable. Echocardiography may be useful in minimizing atheroembolic complications. The administration of N-acetylcysteine to protect the kidney from oxidative stress is not recommended. There is marked lack of randomised controlled trials in this field.
The Acid-Base Effect of Changing Citrate Solution for Regional Anticoagulation during Continuous Veno-Venous Hemofiltration
Authors: Egi M. , Naka T. , Bellomo R. , Langenberg C. , Li W. , Fealy N. , Baldwin I.
Published: January 2018

Purpose

To compare the acid-base balance effects of two different citrate doses for regional citrate anticoagulant (RCA) for continuous veno-venous hemofiltration (CVVH).

Methods

We used a commercial citrate fluid (citrate concentration: 11mmol/L) from July 2003 to July 2004 (period A) in 22 patients; then changed to a new citrate fluid (citrate concentration: 14mmol/L) from July 2004 to Feb 2005 (Period B) in 21 patients. Replacement fluid rate was fixed at 2,000 ml/h. We measured all relevant variables for acid-base analysis according to the Stewart-Figge methodology.

Results

After commencement of RCA-CVVH, there was a change in bicarbonate and base excess (BE) toward acidosis for both fluids. This change was significantly different between period A and B at 6 and 12 hours (pH: p<0.01, BE: p<0.05) with greater decreases with the 11 mmol/L citrate fluid. These changes were mostly secondary to an increase in the strong ion difference (SID) and occurred despite an increased strong ion gap (SIG) (+0.5 mEq/L vs. +1.5 mEq/L; p<0.01) in the higher citrate concentration fluid. Cessation of RCA-CVVH was associated with short-lived differences in bicarbonate and SIG which were similar to those seen on initiation of RCA-CVVH but in the opposite direction.

Conclusions

A small increase This was partly offset by an increase in SIG, consistent with increased citratemia. Cessation of treatment showed a differential improvement in SIG also consistent with disposal of therapy-associated citrate. These observations might assist clinicians in interpreting acid-base changes during RCA-CVVH.in citrate infusion rate caused an alkalinizing increase in SID.
ECG-triggered Skeletal Muscle Stimulation Improves Hemodynamics and Physical Performance of Heart Failure Patients
Authors: Lapanashvili L.V. , Buziashvili Y.I. , Matskeplishvili S.T. , Lobjanidze T.G. , Bockeria L.A. , Huber P.P. , Hess O.M. , Walpoth B.H.
Published: January 2018

Background

Muscular counterpulsation (MCP) was developed for circulatory assistance by stimulation of peripheral skeletal muscles. We report on a clinical MCP study in patients with and without chronic heart failure (CHF).

Methods and Results

MCP treatment was applied (30 patients treated, 25 controls, all under optimal therapy) for 30 minutes during eight days by an ECG-triggered, battery-powered, portable pulse generator with skin electrodes inducing light contractions of calf and thigh muscles, sequentially stimulated at early diastole. Hemodynamic parameters (ECG, blood pressure and echocardiography) were measured one day before and one day after the treatment period in two groups: Group 1 (9 MCP, 11 no MCP) with ejection fraction (EF) above 40% and Group 2 (21 MCP, 14 no MCP) below 40%. In Group 2 (all patients suffering from CHF) mean EF increased by 21% (p<0.001) and stroke volume by 13% (pp<0.001), while end systolic volume decreased by 23% (pp<0.001). In Group 1, the increase in EF (6%) and stroke volume (8%) was also significant (pp<0.05) but less pronounced than in Group 2. Physical exercise duration and walking distance increased in Group 2 by 56% and 72%, respectively.

Conclusions

Noninvasive MCP treatment for eight days substantially improves cardiac function and physical performance in patients with CHF.
Chronic Heart Failure Induced by Multiple Sequential Coronary Microembolization in Sheep
Authors: Schmitto J.D. , Ortmann P. , Wachter R. , Hintze E. , Popov A. F. , Kolat P. , Liakopoulos O.J. , Waldmann-Beushausen R. , DÖrge H. , Grossmann M. , Seipelt R. , Schöndube F. A.
Published: January 2018

Objective

Although a large variety of animal models for acute ischemia and acute heart failure exist, valuable models for studies on the effect of ventricular assist devices in chronic heart failure are scarce. We aimed to establish a stable and reproducible animal model of chronic heart failure in sheep.

Methods

Sheep (n=8, 77 ± 4 kg) were anesthesized and a 5F sheath was implanted into the left carotid artery. The left main coronary artery was catheterized under flouroscopic guidance and bolus injection of polysterol microspheres (90 μm, n=25.000) was performed. Microembolization (ME) was repeated up to three times in two to three week intervals until animals started to develop stable clinical signs of heart failure. Clinical and echocardiographic data were analyzed at baseline (base) and at three months (3 mo) after first ME. All animals were followed for 3 months after first microembolization and then sacrificed for histological examination. Another four healthy sheep (79±6 kg) served as control animals.

Results

All animals developed clinical signs of heart failure as indicated by increased heart rate at rest (68±4 bpm (base) to 93 ± 5 bpm (3 mo) (p<0.05)), increased respiratory rate at rest (28±5 (base) to 38 ± 7 (3 mo) (p<0.05)) and increased body weight 77 ± 2 kg to 81 ± 2 kg (p<0.05) due to pleural effusion, peripheral edema and ascites. Echocardiographic evaluation revealed significantly an increase of left ventricular enddiastolic diameter from 46 ± 3 mm (base) to 61 ± 4 mm (3 mo) (p<0.05). Clinically and echocardiographically no significant changes were revealed in healthy control animals.

Conclusions

We conclude that multiple sequential intracoronary microembolization can effectively induce myocardial dysfunction with clinical and echocardiographical signs of chronic ischemic cardiomyopathy. The present model may be suitable in experimental work on heart failure and left ventricular assist devices, e.g. for studying the impact of mechanical unloading, mechanisms of recovery and reverse remodeling.
Vascular Access: Past, Present, and Future
Authors: Lew S. Q. , Ing T. S.
Published: January 2018

Vascular access is the Achilles’ heel of hemodialysis. Current vascular access approaches for hemodialysis include arteriovenous (AV) fistula, AV graft, and central venous catheter. Strengths and weaknesses of each access type are described. New technology and procedures in introducing an access, monitoring access function, and salvaging a non-functioning access are also described.
Mesenchymal Stem Cell-Based Repair of Articular Cartilage with Polyglycolic Acid-Hydroxyapatite Biphasic Scaffold
Authors: Zhou X. Z. , Leung V. Y. , Dong Q. R. , Cheung K. M. , Chan D. , Lu W. W.
Published: January 2018

This study investigates the capacity of a composite scaffold composed of polyglycolic acid-hydroxyapatite (PGA-HA) and autologous mesenchymal stem cells (MSCs) to promote repair of osteochondral defects. MSCs from culture-expanded rabbits were seeded onto a PGA and HA scaffold. After a 72-hour co-culture period, the cell-adhered PGA and HA were joined together, forming an MSCs-PGA-HA composite. Full-thickness cartilage defects in the intercondylar fossa of the femur were then implanted with the MSC-PGA-HA composite, the PGA-HA scaffold only, or they were left empty (n=20). Animals were sacrificed 16 or 32 weeks after surgery and the gross appearance of the defects was evaluated. The specimens were examined histologically for morphologic features, and stained immunohistochemically for type 2 collagen. Specimens of the MSCs-PGA-HA composite implantation group demonstrated hyaline cartilage and a complete subchondral bone formation. At 16 weeks post-implantation, significant integration of the newly formed tissue with surrounding normal cartilage and subchondral bone was observed when compared to the two control groups. At 32 weeks, no sign of progressive degeneration of the newly formed tissue was found. A significant difference in histological grading score was found compared with the control groups. The novel MSCs-seeded, PGA-HA biphasic graft facilitated both articular cartilage and subchondral bone regeneration in an animal model and might serve as a new approach for clinical applications.
Chondrocyte Response to High Regimens of Cyclic Hydrostatic Pressure in 3-Dimensional Engineered Constructs
Authors: Candiani G. , Raimondi M.T. , Aurora R. , Laganà K. , Dubini G.
Published: January 2018

Purpose

Despite widespread use of 3-dimensional (3D) micro-porous scaffolds to promote their potential application in cartilage tissue engineering, only a few studies have examined the response to hydrostatic pressure of engineered constructs. A high cyclic pressurization, currently believed to be the predominant mechanical signal perceived by cells in articular cartilage, was used here to stimulate bovine articular chondrocytes cultured in a synthetic 3D porous scaffold (DegraPol).

Methods

Construct cultivation lasted 3 days with applied pressurization cycles of amplitude 10 MPa, frequency 0.33 Hz, and stimulation sessions of 4 hours/day.

Results

At 3 days of culture, with respect to pre-culture conditions, the viability of the pressurized constructs did not vary, whereas it underwent a 16% drop in the unpressurized controls. Synthesis of α-actin was 34% lower in all cultured constructs. Synthesis of collagen II/collagen I did not vary in pressurized constructs, was 76% lower in unpressurized controls, and was around 230% higher in pressurized constructs with respect to unpressurized controls. Chondrocytes showed a phenotypic spherical morphology at time zero and at 3 days of pressurized culture.

Conclusions

Although the passage from 2D expansion to 3D geometry was effective to guide cell differentiation, only mechanical conditioning enabled the maintenance and further cell differentiation toward a mature chondrocytic phenotype.
The Role of Extracorporeal Blood Purification Therapies in the Prevention of Radiocontrast-Induced Nephropathy
Authors: Cruz D.N. , Perazella M.A. , Ronco C.
Published: January 2018

Radiocontrast-induced nephropathy (RCIN) is a common and potentially serious complication following diagnostic and therapeutic cardiology procedures using radiocontrast media. The first and most important step in reducing the likelihood of RCIN is to identify patients at risk, by medical history and measurement of serum creatinine concentration to allow calculation of estimated glomerular filtration rate (GFR). Extracorporeal blood purification effectively removes radiocontrast media from the circulation. Periprocedural extracorporeal blood purification (hemodialysis or continuous renal replacement therapy) does not reduce the incidence of RCIN compared with standard medical therapy, and cannot be recommended at this time. The potential benefit of continuous venovenous hemofiltration published by a single center should be confirmed with further studies before it can be recommended or disregarded, and higher doses of continuous renal replacement therapy may also merit further investigation.
Operational Characteristics of Continuous Renal Replacement Modalities Used for Critically Ill Patients with Acute Kidney Injury
Authors: Huang Z. , Letteri J.J. , Clark W.R. , Ronco C. , Gao D.
Published: January 2018

Renal replacement therapy (RRT) is required in a significant percentage of patients developing acute kidney injury (AKI) in an intensive care unit (ICU) setting. One of the foremost objectives of continuous renal replacement therapy (CRRT) is the removal of excess fluid and blood solutes that are retained as a consequence of decreased or absent glomerular filtration. Because prescription of CRRT requires goals to be set with regard to the rate and extent of both solute and fluid removal, a thorough understanding of the mechanisms by which solute and fluid removal occurs during CRRT is necessary. The following provides an overview of solute and water transfer during CRRT and this information is placed in the appropriate clinical context with a discussion of recent clinical trials assessing the relationship between CRRT dose and patient survival. Moreover, the differences between solute removal in CRRT and other dialysis modalities, especially sustained low-efficiency dialysis (SLED) and extended daily dialysis (EDD), along with the potential clinical implications are discussed.
Hepatitis C Virus Infection and Post-Transplant Diabetes Mellitus among Renal Transplant Patients: A Meta-Analysis
Authors: Fabrizi F. , Messa P. , Martin P. , Takkouche B.
Published: January 2018

Objective

To examine the association between HCV infection and the occurrence of post-transplant diabetes mellitus (PTDM) among renal transplant patients.

Design

Meta-analysis of observational studies.

Data Sources

We retrieved studies published in any language by systematically searching Medline, and Embase and by manually examining the references of the original articles, reviews, and monographs retrieved.

Review Methods

We included cohort and case-control studies reporting relative risk estimates and 95% confidence intervals (CIs) for PTDM occurrence with HCV after renal transplantation. Thirteen studies providing information on a total of 30,099 unique patients were included in our meta-analysis.

Results

Study-specific relative risks were weighted by the inverse of their variance to obtain fixed- and random-effects pooled estimates. The pooled relative risk (RR) for PTDM after RT was 2.73 with a 95% confidence interval (CI) of 1.94; 3.83 (10 studies). In a stratified analysis including only large studies (2 studies), the pooled RR was 1.36 (95% CI, 1.21; 1.54). Egger's regression test showed some evidence of publication bias (p=0.0001), but our sensitivity analysis showed that this issue did not meaningfully change the results.

Conclusions

Our study shows a marked increase of the risk of post-transplant diabetes mellitus in anti-hepatitis C virus-positive renal transplant recipients. The excess risk of death in hepatitis C virus-positive renal transplant recipients may be at least partially attributed to post-transplant diabetes mellitus with its attendant complications.
The Effect of Three Different Miniaturized Blood Purification Devices on Plasma Cytokine Concentration in an Ex Vivo Model of Endotoxinemia
Authors: Haase M. , Bellomo R. , Baldwin I. , Haase-Fielitz A. , Storr M. , Krause B. , Boyce N. , Svobodova S. , Li W. , Bagshaw S. M. , Warrillow S. , Langenberg C. , Morgera S.
Published: January 2018

Purpose

A novel type of adsorptive plasma filtering device (ETX-A) capable of removing endotoxin from blood in a single step has recently been developed using nanotechnology.

Methods

In a miniaturized, ex vivo model of extracorporeal circuits, we tested the capacity to reduce plasma cytokine concentration of ETX-A filters in comparison to standard high-flux (HF) filters, high cut-off (HCO) filters and a control. Blood from six healthy volunteers was spiked with endotoxin and then circulated through closed (ETX-A, control) or open (HF, HCO) circuits. Blood flow was set at 16 ml/min and filtration flow at 1 ml/min. Samples for measurement of IL-1ra and IL-6 were taken at baseline and at 4 hours.

Results

Compared to control (703.3 [850.6] pg/mL), in HCO (383.5 [1144.1] pg/mL) and ETX-A (490.1 [683.2] pg/mL) filters, plasma IL-1ra pooled pre- and postfilter concentrations were lower at the end of the experiment (P=0.002; P=0.050, respectively) whereas, in standard HF filters, IL-1ra concentration was higher than control. HCO showed a trend toward a reduced relative increase in IL-6 concentration from commencement to end of experiment compared to control (P=0.07). After pooling end-of-experiment plasma cytokine values of novel blood purification devices, we found HCO + ETX-A superior to H with regard to reduction of IL-1ra (-27.0 [−20.5]% vs. 8.1 [18.9]%; P<01) and IL-6 (-18.0 [38.3]% vs. −1.1 [24.3]%; P=0.050) compared to control.

Conclusions

HCO and ETX-A appeared to significantly reduce plasma IL-1ra and, when combined, plasma IL-6 concentration as well. It appears desirable to manufacture full-size blood purification devices using this technology and to explore their effect on cytokine removal.
Five-Year Survival in Comparable HD and PD Patients: One Center's Experience
Authors: Andrikos E. , Tseke P. , Balafa O. , Pappas M.
Published: January 2018

Several studies have yielded conflicting results regarding morbidity and mortality in peritoneal dialysis (PD) and hemodialysis (HD) patients. We performed a retrospective analysis in end-stage renal disease (ESRD) patients in our department, who were equally distributed between HD and PD, in order to compare 5-year survival probabilities and hospitalization rates in the two modalities. Of the total 94 new ESRD patients who initiated dialysis in our department from January 1995 to December 2000, 48 were allocated to PD and 46 to HD. All patients were followed up for five years. There were no significant differences regarding demographics and serious co-morbidities upon dialysis initiation between HD and PD patients. Unadjusted 5-year survival probability in as-treated analysis was higher in PD patients (0.79 vs 0.6, p=0.04), whereas there was no significant difference in intent-to-treat analysis between HD and PD patients (p=0.5). Hospitalization rates were similar in both modalities. Despite the small number of patients included in our study, it seems that when HD and PD are both available in one department they have equivalent results regarding morbidity and mortality rates. Therefore we suggest that, when possible, PD and HD should be equally offered to all ESRD patients.
Biofilm Formation is not Necessary for Development of Quinolone-Resistant “Persister” cells in an Attached Staphylococcus Epidermidis Population
Authors: Knobloch K.-M. , Von Osten H. , Horstkotte M. A. , Rohde H. , Mack D.
Published: January 2018

Staphylococcus epidermidis is a common pathogen in device-associated infections which is able to attach onto polymeric surfaces and develop multilayered biofilms. Attached S. epidermidis displays reduced susceptibility to antimicrobial agents. In this study we investigated the influence of ciprofloxacin and the group IV quinolones gatifloxacin, gemifloxacin, and moxifloxacin with the minimal attachment killing (MAK) assay. MAK concentrations were determined for three biofilm-positive wild-type strains and their isogenic biofilm-negative mutants Depending on strain and investigated quinolone, it was possible to distinguish between a heterogeneous MAK (MAKhetero), and a homogeneous resistance (MAKhomo) which corresponds to the model of a few persisting cells under antibiotic treatment. A lower MAKhomo was detected for the biofilm-negative mutants as well as for the corresponding wild-types for some of the tested quinolones, which seems to be a result of higher bacterial inocula, whereas the MAKhetero concentrations were comparable for mutants and wild-types for nearly all of the tested antibiotics and strains. These data indicate that biofilm formation is not necessary for persistence of attached S. epidermidis cells under treatment with quinolones and could explain therapeutic failure in foreign body-associated infections due to biofilm-negative S. epidermidis isolates. The individual resistance phenotypes of investigated strains indicate that the determination of MAK concentrations might help to predict the therapy outcome of foreign body-associated infections with both biofilm-positive and biofilm-negative S. epidermidis. Thus, the relatively high activity displayed by group IV quinolones against individual attached staphylococcal isolates indicates a possible treatment option with the respective quinolones for foreign body-associated infections due to these isolates. (Int J Artif Organs 2008; 31: 752–60)
Suppression of Biofilm Related, Device-Associated Infections by Staphylococcal Quorum Sensing Inhibitors
Authors: Kiran M. D. , Giacometti A. , Cirioni O. , Balaban N.
Published: January 2018

Staphylococcal spp. are notorious for causing biofilm-related device-associated infections, leading to tens of thousands of deaths per year. In this paper, we review quorum sensing inhibitors as potential therapeutics for even the most persistent infections. The animal models reviewed are subcutaneous graft, central venous catheter (CVC), ureteral stent and wound models, and a wound case study. The therapeutic approaches reviewed are the use of RNAIII inhibiting peptide (RIP) and its non-peptide analog. These have been shown to prevent or treat infections caused by any staphylococcal strain tested, including antibiotic-resistant strains like CA-MRSA USA300. (Int J Artif Organs 2008; 31: 761–70)
Intermediate Coronary Revascularization using the Deltastream Blood Pump: Results from an Experimental Study
Authors: Litmathe J. , Hansen E. , Feindt P. , Kurt M. , Boeken U. , Gams E.
Published: January 2018

Background

Myocardial revascularization using a complete heart-lung machine may involve many problems, as do complete off-pump attempts. Thus, it was the aim of this study to evaluate the effects of intermediate on-pump/off-pump myocardial revascularization using the miniaturized Deltastream blood pump, on ischemia and hemolysis, in comparison with standard myocardial revascularization.

Methods

In a group of 8 mini-pigs, combined on-pump/off-pump myocardial revascularization was performed using the Deltastream blood pump as beating-heart support for the on-pump part of the operation (group A). Seven other animals served as controls and underwent standard myocardial revascularization with the same device as integrated pump of a complete heart-lung machine (group B). Blood samples for blood gas metabolism, creatine kinase (CK), troponin I, lactate dehydrogenase (LDH), and hydroxybutyrate dehydrogenase (HBDH) were taken before and after the entire operation.

Results

Comparing the baseline values, the increase of CK was more pronounced in group B than in group A (176.4 ± 41.2 to 279.7 ± 29 U/L vs. 274 ± 142.7 to 288.1 ± 118.6 U/L, respectively; p=0.0006). Increase of troponin I was significantly higher in group B than in group A (1 ± 0.3 to 2.9 ± 1 ng/mL vs. 1.1 ± 0.9 to 3 ± 3.8 ng/mL, respectively; p=0.002). LDH increase was also more pronounced in group B (231.7 ± 54.3 to 299.9 ± 39.8 U/L vs. 274.9 ± 59.7 to 263.8 ± 57.9 U/L, respectively; p=0.01). HBDH values increased significantly in group B after the operation (group A: 215.9 ± 34.7 to 200 ± 39.2 U/L vs. group B: 195.4 ± 41.7 to 274.9 ± 51.6 U/L; p=0.02). Hemodynamic measures and LDH values under luxation (group A: 1.9 ± 0.6 U/L; B: 3.5 ± 1 U/L, p=0.001) were also superior in the study group.

Conclusion

The current set-up might be superior to conventional extracorporeal circulation and thus be an alternative for high-risk candidates to avoid the adverse events of a complete heart-lung machine, when they are scheduled for complete myocardial revascularization.
Cell-Based Regeneration of Intervertebral Disc Defects: Review and Concepts
Authors: Freimark Denise , Czermak Peter
Published: January 2018

During the last century low back pain has emerged as a widespread disease often caused by intervertebral disc degeneration (IDD). IDD is a complex problem in which a variety of causes play a role. As IDD causes high costs, corporate interest has led to a number of therapies being developed. Today, these therapies focus not only on minimizing the pain caused by this disease but also on restoring intervertebral disc function. These approaches are often biological and aim to stimulate the regeneration of the intervertebral disc by injection of activator proteins, biomaterials, different cell types or complex cell matrix composites. Genetic engineering of disc cells and in vitro tissue engineering also offer a possibility for curing IDD. This article gives an overview of these concepts.
Left heart decompression by atrial stenting during extracorporeal membrane oxygenation
Authors: Haynes Susan , Kerber Richard E. , Johnson Frances L , Lynch William R. , Divekar Abhay
Published: January 2018

Persistent severe left ventricular dysfunction during extracorporeal membrane oxygenation (ECMO) requires left heart decompression. We describe stenting of the atrial septum as an alternative emergency approach for left heart decompression during ECMO in addition to the already published surgical and transcatheter approaches.
Non-Pulsatile Axial flow Ventricular Assist Device for Right Systemic Ventricle failure Late after Senning Procedure
Authors: Jouan Jérôme , Grinda Jean-Michel , Bricourt Marie-Odile , Iserin Laurence , Fabiani Jean-Noël
Published: January 2018

Cardiac transplantation is an ever more frequent requirement for patients presenting with end-stage right systemic ventricular failure late after atrial switch operations. But as the time on the donor waiting list lengthens, the clinical conditions of these patients can easily and abruptly deteriorate, sometimes requiring systemic ventricular assistance. We document the first case of right systemic ventricular assistance with a De Bakey VAD axial pump in a patient presenting with systemic ventricular failure 23 years after procedure. He rapidly recovered total autonomy and was thus able to participate in a rehabilitation program to optimize his condition for heart transplantation.
In Vitro Large-Scale Cultivation and Evaluation of Microencapsulated Immortalized Human Hepatocytes (HepLL) in Roller Bottles
Authors: Yu Cheng-Bo , Lv Guo-Liang , Pan Xiao-Ping , Chen Yan-Shan , Cao Hong-Cui , Zhang YI-MING , Du Wei-Bo , Yang Shi-Gui , Li Lan-Juan
Published: January 2018

Background/Aims

Microencapsulated hepatocytes have been proposed as promising bioactive agents for packed-bed or fluidized-bed bioartificial liver assist devices (BLADs) and for hepatocyte transplantation because of the potential advantages they offer of high mass transport rate and an optimal microenvironment for hepatocyte culture. We developed a large-scale and high-production alginate-chitosan (AC) microcapsule roller bottle culture system for the encapsulation of HepLL immortalized human hepatocytes. In this study, the efficacy of upscaling encapsulated HepLL cells production with roller bottle cultivation was evaluated in vitro.

Methods

Microencapsulated HepLL cells were grown at high yield in large-scale roller bottles, with free cells cultured in roller bottle spinners serving as controls. The mechanical stability and the permeability of the AC microcapsules were investigated, and the growth, metabolism and functions of the encapsulated HepLL cells were evaluated as compared to free cells.

Results

The microcapsules withstood well the shear stress induced by high agitation rates. The microcapsules were permeable to albumin, but prevented the release of immunoglobulins. Culture in roller bottles of immortalized human hepatocytes immobilized in the AC microcapsules improved cell growth, albumin synthesis, ammonia elimination and lidocaine clearance as compared with free cells cultured in roller bottles.

Conclusions

Encapsulated HepLL cells may be cultured on a large scale in roller bottles. This makes them possible candidates for use in cell-based liver assist therapies.
A Long-Term Retrospective Review of 5 Cases using Daptomycin for Prosthetic Device Infections after Surgery
Authors: Quetglas Emilio G. , Julian Mikel San , Tutor Emilio García , Vazquez Blanca , Lucena Felipe , Landecho Manuel , Azanza Jose Ramon
Published: January 2018

Purpose

To review the antimicrobial possibilities for limb-sparing due to infectious complications after surgery in patients diagnosed with osteosarcoma and with implantation of prosthetic devices.

Patients and Progress

After several episodes of relapsing infection or even re-infection and failure of previous therapies, 5 patients (2 young, female / 1 young, male / 2 middle-aged, female) were subject to a long-term ambulatory regimen consisting of intravenous administration of daptomycin.

Results

Showed improved outcome with preservation of the limbs or devices involved.

Conclusion

Five patients with post-operative gram-positive suspected infections of prosthetic devices that were unresponsive to a variety of other antibiotics and combinations appeared to respond to compassionate use of daptomycin. Its effectiveness is probably due to its activity against biofilm-producing microorganisms. Controlled, double-blind randomized trials are needed to confirm the potential of daptomycin in such patients.
Decreased Acute Rejection and Improved Renal Allograft Survival Using Sirolimus and Low-Dose Calcineurin Inhibitors without Induction Therapy
Authors: Tsai Meng-Kun , Wu FE-LIN LIN , Lai l-RUE , Lee Chih-Yuan , Hu Rey-Heng , Lee PO-HUANG
Published: January 2018

Background

Chronic nephrotoxicity of calcineurin inhibitors (CNIs) causes irreversible renal dysfunction and shortens renal transplant survival. We conducted a retrospective cohort study to test a hypothesis that de novo CNI minimization combined with sirolimus (SRL) improves graft survival in renal transplant patients without antibody induction therapy.

Methods

Between October 2000 and August 2007, we performed 100 cases of renal transplantation with de novo CNI (either cyclosporine or tacrolimus) minimization combined with sirolimus (SRL group). The initial target trough levels were 100–200 ng/ml for cyclosporine (CsA) and 4–8 ng/mL for tacrolimus (TAC). SRL was given at a loading dose of 6 mg plus 2 mg/day for maintenance. The results for the SRL group were compared to those of 104 transplant recipients given standard CNI- (CsA- or TAC-) based immunosuppressive regimens including mycophenolate mofetil (MMF group) during the same period.

Results

The 1-year rejection-free survival (94.8%) and 5-year graft survival (87.7%) rates of the SRL group were significantly better than those of the MMF group (85.5% and 75.2%, respectively). On univariate analyses, 6-month estimated glomerular filtration rate (eGFR), acute rejection and SRL therapy had a significant impact on graft survival, and SRL therapy and tacrolimus therapy had a significant impact on rejection-free survival. Multivariate analyses identified 6-month eGFR as the only prognostic factor for graft survival. Acute rejection and SRL therapy were significant for post-transplant renal function.

Conclusions

De novo CNI minimization combined with SRL could decrease acute rejection and improve renal function and graft survival after renal transplantation without the use of antibody induction therapy.
Health-Related Quality of Life in Dialysis Patients with HCV Infection
Authors: Fabrizi Fabrizio , Messa Piergiorgio , Martin Paul
Published: January 2018

Measuring the impact of chronic kidney disease (CKD) treatment on patient quality of life has become increasingly recognized as an important outcome measure. Despite improvements in the treatment of chronic kidney disease, health-related quality of life (HRQOL) is lower than in the general population. HRQOL measures, particularly the Physical Component Summary (PCS), have predictive validity for risk of both mortality and hospitalization in dialysis populations. For every 10-point lower PCS score, the relative risk (RR) of death increases by 29% (RR=1.29; 95% Cl=1.23 to 1.35; p<0.001) and the risk of hospitalization increases by 15% (RR=1.15; 95% Cl=1.11 to 1.19, p<0.001), according to the Dialysis Outcomes and Practice Patterns Study (DOPPS). Hepatitis C virus (HCV) infection remains prevalent among dialysis patients with a recent meta-analysis showing that anti-HCV seropositive status was an independent and significant risk factor for death in patients on maintenance dialysis. Seven studies with 11,589 unique patients on maintenance dialysis were identified; the summary estimate for adjusted relative risk (aRR) (all-cause mortality) was 1.34 with a 95% confidence interval (CI) of 1.13–1. 59. In non-uremic populations HCV diminishes HRQOL, and individuals with HCV scored lower than controls across all scales of the short form 36 (SF-36). Patients achieving sustained virological responses (SVR) scored higher across all scales versus patients without SVR, especially in the physical health domains. Whether the adverse influence of HCV on survival in dialysis population is related to the negative impact of HCV on HRQOL requires further research. Information on HRQOL indices in patients with HCV on maintenance dialysis is extremely limited but the available evidence shows that HCV infection impairs HRQOL, especially in mental aspects, among patients on maintenance hemodialysis.
Dialysis Initiation and Survival in Patients with Refractory Congestive Heart Failure
Authors: Fabbian Fabio , Cantelli Stefano , Molino Christian , Pala Marco , Longhini Carlo
Published: January 2018

Background

It has been reported that more than 30% of patients present with congestive heart failure at the initiation of renal replacement therapy (RRT). We followed up a cohort of patients with refractory congestive heart failure (RCHF) who started dialysis between 2005 and 2006 and conducted an observational cohort study in order to evaluate the clinical features at the time RRT was started, and the survival rate of patients with RCHF.

Methods

Data were collected on 33 uremic subjects (24 male) with RCHF, referred by cardiologists, who started dialysis between 2005 and 2006 and were followed-up for 42 months. The following parameters were derived from clinical records: age, sex, history of ischemic heart disease (IHD), cerebro-vascular disease (CVD), peripheral vascular disease (PVD), diabetes, smoking, hypertension, myeloma or malignancies, the cause for dialysis and procedure used to initiate treatment.

Results

RCHF was the cause of initial RRT in 15 patients in 2005 and in 18 the following year, with an incidence of 27 out of 100 patients per year. Diabetes was diagnosed in 51% (n=17) of cases. More than 80% of patients with RCHF had histories of hypertension and smoking. IHD, CVD and PVD were present in 66%, 30% and 54% of cases, respectively. Cancers were recorded in 36% of subjects. Fluid overload was the cause of urgent dialysis in 73% of cases; a central venous catheter (CVC) was placed in 75% of patients. Mean survival of patients with RCHF was 23 months. Eighteen patients died because of cardiovascular events after a mean follow-up of 365±387 days; they had higher prevalence of a smoking history (100% vs. 73%, p=0.02) and CVD (44% vs. 13%, p=0.05) than the survivors.

Conclusions

In uremic patients starting dialysis, RCHF appears to be a frequent condition, comorbidity is high and they require urgent treatment by CVC because of fluid overload. Since RCHF is time- and resource-consuming, nephrologists need to ameliorate its management.
Pulmonary Tissue Engineering using Dual-Compartment Polymer Scaffolds with Integrated Vascular Tree
Authors: Fritsche Clemens S. , Simsch Oliver , Weinberg Eli J. , Orrick Brian , Stamm Christof , Kaazempur-Mofrad Mohammad R. , Borenstein Jeffrey T. , Hetzer Roland , Vacanti Joseph P.
Published: January 2018

Objectives

The persistent shortage of donor organs for lung transplantation illustrates the need for new strategies in organ replacement therapy. Pulmonary tissue engineering aims at developing viable hybrid tissue for patients with chronic respiratory failure.

Methods

Dual-chamber polymer constructs that mimic the characteristics of the pulmonary air-blood interface were fabricated by microfabrication techniques using the biocompatible polymer polydimethylsiloxane. One compartment (“vascular chamber”) was designed as a capillary network to mimic the pulmonary microvasculature. The other compartment (“parenchymal chamber”) was designed to permit gas exchange. Immortalized mouse lung epithelium cells (MLE-12) were cultured on the surface of polystyrene microcarrier beads. These beads were subsequently injected into the parenchymal chamber of the dual-chamber microsystems. The vascular compartment was perfused with cell culture medium in a bioreactor and the construct was maintained in culture for 1 week.

Results

The microcarriers evenly distributed MLE-12 cells on the parenchymal compartment surface. Confluent cell layers were confirmed by fluorescent and electron microscopy. Adequate proliferation of MLE-12 cells within the construct was monitored via the DNA content. Viability of the cells was maintained over 1 week. Finally, cellular specificity and functional capacity in situ were demonstrated by immunostaining for proSP-B and proSP-C (alveolar epithelium), and by using MLE-12 cells transfected to overexpress green fluorescent protein.

Conclusion

We conclude that functional hybrid microsystems mimicking the basic building plan of alveolar tissue can be engineered in vitro.
INR Deviations in Hemodialyzed Patients under Low Dose Oral Anticoagulant Therapy
Authors: Gompou Athina , Griveas Ioannis , Kyritsis Ilias , Agroyannis Ioannis , Tsakoniatis Manonis , Agroyannis Basilis
Published: January 2018

The aim of this retrospective study was to evaluate the International Normalized Ratio (INR) in hemodialyzed uremic patients under treatment with oral anticoagulation drugs. Eleven out of one hundred and forty-two uremic hemodialyzed patients in our unit were included in the study. These 11 patients aged from 70 to 85 (mean: 76 years) were under oral anticoagulation treatment for protection from thromboembolic events. They received 1 mg acenocumarol daily with the therapeutic goal of achieving an INR between 2 and 2.5 units. During the last year, the number of total INR determinations was 129. Based on the INR levels, measurements were classified into three categories of anticoagulation, termed “under-anticoagulation”, “target-anticoagulation”, and “over-anticoagulation”. The number, the percentage, and the mean value (±SD) of INR measurements for each category, respectively, were under-anticoagulation: 39, 30%, 1.78 ± 0.14; target-anticoagulation: 48, 37.5%, 2.20 ±0.14; and over-anticoagulation: 42, 32.5%, 3.14 ± 0.64. The mean value ±SD of all INR determinations (n=129) was 2.34 ±0.65. No thromboembolic or major bleeding events occurred in our patients with these INR. In conclusion, in elderly, hemodialyzed uremic patients with indications for oral anticoagulation treatment, adequate and safe INR levels can be achieved in a high proportion without serious deviations from the therapeutic goal by using low doses of drugs. Therefore, oral anticoagulation therapy should not be considered automatically contra-indicated in this patient group.