bluuebunny/crossref_metadata_2025 huggingface dataset:
Kidney Failure Associated with Liver Transplantation or Liver Failure: The Impact of Continuous Veno-Venous Hemofiltration
Authors: Naka T. , Wan L. , Bellomo R. , Wang B. ZONG , Jones R. , Berry R. , Angus P. , Gow P.
Published: January 2018

Background and Aims

The short-term outcome of critically ill patients with kidney failure combined with severe liver failure or orthotopic liver transplantation (OLTx) is poor. We sought to test the hypothesis that, with the exclusive use of continuous veno-venous hemofilration (CVVH) with minimal heparin-anticoagulation, the short and long-term outcomes of these patients would be improved.

Patients

Sixty-six consecutive patients with combined liver and kidney failure

Setting

Intensive Care Unit of tertiary hospital

Design

Retrospective interrogation of prospectively collected databases

Intervention

Treatment of all patients with continuous veno-venous hemofiltration (CVVH) by protocol with 2L/h of ultrafiltration rate and minimal use of circuit heparinization. Retrieval of specific information on demographic, clinical, therapeutic and outcome details.

Measurements and Main Results

From July 1995 to April 2004, 66 patients with combined liver and renal failure received continuous veno-venous hemofiltration (CVVH). Of these, 26 received liver transplantation and 40 did not. There were no significant differences in age, APACHE II score, bilirubin, ALT, INR or albumin on admission. The average duration of CVVH was 9.5 days for OLTx patients and 5 days for non-transplanted patients (p=0.013). Heparin anticoagulation was used in only 12% of OLTx patients and 20% of non-transplanted patients. ICU mortality was 15% in OLTx patients and 63% in non-transplanted patients (p<0.0005); hospital mortality was 23% compared to 70% (p<0.001). Mean survival time at follow up was 1,120 days compared to 358 days (p<0.0001).

Conclusions

ARF associated with OLTx has a much better outcome than ARF without OLTx. Furthermore, management based on a conservative anticoagulation policy and CVVH as the exclusive form of renal support was associated with the best ICU, hospital and long term survival reported so far.
Fulminant Hepatic Failure and the Potential Role of Liver Dialysis
Authors: Akdogan M. , Aladag M. , Rashwan S. , Shrago S. , Warner E. , Sebastian A. , Wright H. , Nour B. , Gurakar A.
Published: January 2018

Fulminant hepatic failure (FHF) carries a high mortality. We aimed to review the prognostic factors and explore the potential role of Liver Dialysis (LD).

Fifty-two patients were reviewed. The etiologies were acetaminophen toxicity (33%), viral hepatitis (18%), autoimmune (10%), idiosyncratic drug reactions (8%), others (6%) and undetermined (25%). Patients with acetaminophen had a significantly higher survival compared to the non-acetaminophen group (p=0.04). Patients with grade 3 encephalopathy had a mortality of 68%, among 5 patients with grade IV encephalopathy, 2 survived and both had had treatment with LD.

Chi-square with Fisher's exact test was used for statistical analysis.

Our study confirmed that the diagnosis of non-acetaminophen induced FHF and reduced initial serum factor V level are associated with fatal outcome. Timely OLT significantly improved the survival. The role of LD in hepatic regeneration or as a bridge to OLT needs to be further studied with prospective control trials.
Physical and Computer Modelling of Blood Flow in a Systemic-to-pulmonary Shunt
Authors: Małota Z. , Nawrat Z. , Kostka P. , Mizerski J. , Nowinski K. , Waniewski J.
Published: January 2018

The aim of this work was the application of computer and physical in vitro simulation methods for estimating surgery procedure hemodynamics. The modified Blalock-Taussig (mB-T) palliative surgical procedure is performed to increase the pulmonary blood flow in children with congenital heart defects. Such a systemic-to-pulmonary shunt yields substantial modification in the blood flow within the large blood vessels. The objective of the present study was to investigate basic characteristics of the flow, flow pattern and pressure-flow efficiency, before and after opening of the mB-T graft.

Methods

The model was based on the vessel geometry obtained from the Visible Human Project and included the arch of aorta, the three arteries branching from the arch, the pulmonary trunck, and the left and right pulmonary arteries. The graft was added between the left subclavian artery and the left pulmonary artery. The glass model of the vessels was produced and investigated in a physical model of the cardiovascular system with an artificial ventricular device as the blood pump. Flow rate and hydrostatic pressure were measured at the inlet to and outlets from the glass model and in a few points within the system. Laser flow visualization was also performed. Computer simulations were done using the boundary conditions from the physical model.

Results

The opening of the mB-T graft changed flow distribution in all branches (including inflow). A complex flow pattern with large eddies and channelling of the flow in the vicinity of the graft and within it was observed in flow visualization and in computer simulations. Because of that complexity the local measurements of hydrostatic pressure at the vessel wall could not predict the average flow rate. The reversed flow in the graft was observed during the systole.

Conclusions

The complex flow pattern developed in the physical model of the mB-T graft. The channelling of the flow and the formation of large eddies may yield high shear stress and modify blood properties. The rigid wall model can describe only some flow characteristics observed in vivo. Computer simulation is a very fast and accurate method which permits earlier qualification of cardiac surgeons on how to change cardiac vascular blood flow after operations.
High Volume Hemofiltration (HVHF) in Sepsis: A Comprehensive Review of Rationale, Clinical Applicability, Potential Indications and Recommendations for Future Research
Authors: Honore P. M. , Joannes-Boyau O.
Published: January 2018

HVHF can be still seen as a potent powerful immunomodulatory treatment in sepsis. Pleiotropical properties of HVHF give this treatment the possibility to affect not only SIRS but also cardiovascular compounds, clotting and post septic-insult immunoparalysis. By this multimodal approach, HVHF can alter the sepsis network through many targets.

The crucial relationship between immunological changes, hemodynamics and survival must be found in future prospective randomised studies. Circulatory cytokines are no longer valuable players except for catecholamine-resistant septic shock. Definitions are of upmost value as ultrafiltrate volume has been correlated in terms of response and survival with the type of disease (sepsis or not) and severity (catecholamine-resistant shock or not). This latter condition can be seen as the best indication for HVHF and probably even more for very high volume hemofiltration (VHVHF). More studies are needed to clarify the role of HVHF in hyperdynamic septic shock (with or without acute renal failure), sepsis and SIRS. They can be seen as potential indications up to now. Possible interferences with activated protein C deserve more attention as both treatments can be given sequentially in the same septic patient or even concomitantly.
Cardiovascular Risk Markers in Hemodialysis Patients
Authors: Urso S. , Garozzo M. , Milone F. , Battaglia G.
Published: January 2018

Cardiovascular events are the main cause of death in hemodialysis patients. Nevertheless, acute myocardial infarction may be misdiagnosed in uremic patients, because typical markers have a high rate of false positivity. A recent two-year prospective study showed that predialytic high serum concentrations of troponin T and CK-MB mass were associated with high mortality, cardiac mortality, myocardial infarction and unstable angina (MACEs). We studied 16 uremic patients (13 M; 3 W) on standard HD and 6 patients (4 M; 2 W) on on-line HDF, who had been taking folic acid for at least three months. Patients who suffered from acute or chronic cardiac ischemic disease were excluded. Anthropometric parameters, pre and post-dialytic pH, HCO3 and electrolytes did not differ between the two groups. Kt/V and URR % were lower in conventional HD vs on-line HDF (p<0.04; p<0.04). ORR % was strongly elevated in on-line HDF compared with HD (p<0.005). In conventional HD, ORR % was directly correlated with Kt/V and URR% (r = 0.49, p<0.04; r = 0.48, p<0.04, respectively). Even in on-line HDF ORR % was directly correlated with Kt/V and URR % (r = 0.79, p<0.04; r = 0.76, p<0.05, respectively). Troponin I and CK-MB mass were not significantly different in pre vs post-dialysis, both in standard HD and on-line HDF. Nevertheless, in standard HD postdialytic troponin I correlated with serum sodium concentration (r = 0.93, p < 0.000), potassium (r = 0.67, p < 0.004) and serum chlorine (r = 0.92, p < 0.92, p < 0.000). CK-MB mass showed a correlation with serum chlorine (r = 0.49, p < 0.05). Postdialytic CK-MB mass correlated with serum potassium in on-line HDF (r = 0.83, p < 0.03). Our data suggest that hemodialytic treatments, both standard HD and on-line HDF, do not modify serum troponin I and CK-MB mass. Consequently, we can use these parameters for the diagnostic approach in acute or chronic ischemic heart disease in hemodialysis patients.
Hepatocyte Organoid Culture in Elliptic Hollow Fibers to Develop a Hybrid Artificial Liver
Authors: Fukuda J. , Mizumoto H. , Nakazawa K. , Kajiwara T. , Funatsu K.
Published: January 2018

A novel organoid culture was developed in which hepatocytes maintain high liver functions for more than several weeks in vitro. The main disadvantage of tissue-engineered organoids is the lack of a blood vessel structure between the aggregated cells. Because of depletion of oxygen, the thickness from the surface of an organoid at which hepatocytes can survive is limited. This study showed that a rat hepatocyte organoid that forms by using centrifugal force in a hollow fiber (HF) had a survival limit thickness of about 80 - 100 μm from the surface of the organoid. Based on the value, we designed an elliptic HF having less than 150 μm minor diameter by using a simple annealing method. All hepatocytes were supplied with oxygen and formed an organoid without a dead cell layer in this HF. A hepatocyte organoid in an elliptic HF maintained ammonia removal activity twice as high as in the original HF for at least one month during culture. Albumin secretion activity of an organoid in an elliptic HF was also maintained for at least one month and was the same level as that of liver in a living body. In conclusion, organoid culture by using an elliptic HF seems to be a promising technique to develop a hybrid artificial liver.
A Technique for the Measurement of Renal ATP in a Large Animal Model of Septic Shock
Authors: May C. , Wan L. , Williams J. , Wellard M.R. , Pell G. , Jackson G. , Bellomo R.
Published: January 2018

Background

The mechanisms responsible for acute renal failure in sepsis are not understood. Measurement of tissue ATP might help to understand this process but, in the large animal, it is hampered by major technical difficulties.

Objective

To develop a technique to monitor ATP in the kidney of a large mammal during the induction of septic shock and then circulatory arrest.

Methods

Implantation of a custom-made phosphorus coil around the left kidney. Induction of septic shock by intravenous E. coli administration. Acquisition of 31P magnetic resonance (MR) spectroscopic data at 3-tesla before and during septic shock over several hours. Induction of euthanasia and measurement of the same 31P signal immediately and thirty minutes after circulatory arrest.

Results

Clear reproducible 31P MR spectra were obtained before and after the induction of septic shock and euthanasia. They indicated limited changes in ATP during septic shock. An expected rapid and dramatic decrease in ATP occurred with euthanasia.

Conclusions

It is possible to sequentially monitor renal bioenergetics in a large mammal during septic shock using an implanted custom-made phosphorus coil and 3-tesla MR technology. This technique offers a novel approach to the investigation of septic renal failure.
Cytokines and Growth Factors Involved in Peritoneal Fibrosis of Peritoneal Dialysis Patients
Authors: Oh K.-H. , Margetts P.J.
Published: January 2018

Peritoneal fibrosis is initiated by exposure of peritoneal tissues to numerous harmful agents encountered during peritoneal dialysis. These agents interact with cells within the peritoneum to induce growth factors and cytokines that are important in the initiation, progression and maintenance of fibrosis. Some of the mediators implicated in the pathogenesis of peritoneal fibrosis include transforming growth factor (TGF) ß, connective tissue growth factor (CTGF), fibroblast growth factors (FGF), and platelet derived growth factor (PDGF).
Possible Role of Hepatocyte Growth Factor in Regeneration of Human Peritoneal Mesothelial Cells
Authors: Naiki Y. , Matsuo K. , Matsuoka T. , Maeda Y.
Published: January 2018

Human peritoneal mesothelial cells (HPMCs) play an important role in peritoneal functions. During long term peritoneal dialysis, it has been reported that HPMCs are damaged by high glucose solution via the signal of transforming growth factor (TGF)- ß1 produced by HPMCs. In this study, we focused on the effect of hepatocyte growth factor (HGF), known as an anti-fibrotic and anti-TGF-ß1 agent, on HPMCs damaged by high glucose solution. HPMCs were isolated from specimens of the omentum from nonuremic patients after informed consent had been obtained. After confirming adhesion for 6 hours, 100 μL of DMEM with 0.5%FCS were added at different concentrations (D-glucose; 6, 30mM) with or without HGF (10, 30, 100 ng/mL) for 48 hours. We examined the effects of a high concentration of glucose and then focused on following four critical points: 1) the production of HGF from HPMCs exposed to a high concentration of glucose, 2) the expression of c-Met on HPMCs, 3) the viability of those cells, and 4) matrix metalloproteinase-2 (MMP-2) and tissue inhibitors of metalloproteinase-2 (TIMP-2). The following significant changes are described herein: high glucose solution and TGF-ß1 i) decreased HGF production from HPMCs and ii) up-regulated expression of c-Met on HPMCs, and addition of HGF iii) restored viability of HPMCs damaged by glucose, iv) suppressed TGF-ß1 production by HGF, and v) induced up-regulation of MMP-2 and decreased TIMP-2 production by HPMCs. Levels of HGF decreased by high concentrations of glucose in the peritoneal cavity may induce the loss of HPMCs and thereby result in peritoneal fibrosis. These results suggest that HGF is an effective agent in the regeneration of peritoneal membrane damaged by high glucose solution.
Serum Potassium and Acid-base Parameters in Severe Dialysis-associated Hyperglycemia Treated with Insulin Therapy
Authors: Tzamaloukas A.H. , Rohrscheib M. , Ing T.S. , Siamopoulos K.C. , Qualls C. , Elisaf M.S. , Vanderjagt D.J. , Spalding C.T.
Published: January 2018

We analyzed the changes in serum potassium concentration ([K]) and acid-base parameters in 43 episodes of dialysis-associated hyperglycemia (serum glucose level > 33.3 mmol/L), 22 of which were characterized as diabetic ketoacidosis (DKA) and the remaining 21 as nonketotic hyperglycemia (NKH). All episodes were treated with insulin therapy only. Age, gender, initial and final serum values of glucose, sodium, chloride, tonicity and osmolality did not differ between DKA and NKH. At presentation, serum values of [K] (DKA 6.2 ± 1.3 mmol/L; NKH 5.2 ± 1.5 mmol/L) and anion gap [AG] (DKA 27.2 ± 6.4 mEq/L; NKH 15.4 ± 3.5 mEq/L) were higher in DKA, whereas serum total carbon dioxide content [TCO2] (DKA 12.0 ± 4.6 mmol/L; NKH 22.5 ± 3.1 mmol/L), arterial blood pH (DKA 7.15 ± 0.09; NKH 7.43 ± 0.07) and arterial blood PaCO2 (DKA 26.2 ± 12.3 mm Hg; NKH 34.5 ± 6.7 mm Hg) were higher in NKH. At the end of insulin treatment, serum values of [K] (DKA 4.0 ± 0.7 mmol/L, NKH 4.0 ± 0.5 mmol/L), [AG] (DKA 16.3 ± 5.4 mEq/L, NKH 14.9 ± 3.0 mEq/L), [TCO2] (DKA 23.5 ± 5.0 mmol/L, NKH 24.1 ± 4.2 mmol/L), arterial blood pH (DKA 7.42 ± 0.09, NKH 7.51 ± 0.14) and arterial blood PaCO2 (DKA 31.8 ± 6.7 mm Hg, NKH 34.2 ± 8.3 mm Hg) did not differ between the two groups. Linear regression of the decrease in serum [K] value during treatment, (Δ[K]), on the presenting serum [K] concentration,([K]2), was: DKA, Δ[K] = 2.78 – 0.81 × [K]2, r = −0.85, p < 0.001; NKH, Δ[K] = 2.44 – 0.71 × [K]2, r = −0.90, p < 0.001. The slopes of the regressions were not significantly different. Stepwise logistic regression including both DKA and NKH cases identified the presenting serum [K] level and the change in serum [TCO2] value during treatment as the predictors of Δ[K] (R2 = 0.81). Hyperkalemia is a feature of severe hyperglycemia (DKA or NKH) occurring in patients on dialysis. Insulin administration brings about correction of DKA and return of serum [K] concentration to the normal range in the majority of the hyperglycemic episodes without the need for other measures. The initial serum [K] value and the change in serum [TCO2] level during treatment influence the decrease in serum [K] value during treatment of dialysis-associated hyperglycemia with insulin.
Pharmacokinetics of Intraperitoneal Cefazolin and Ceftazidime Coadministered to CAPD Patients
Authors: Elwell R.J. , Manley H.J. , Frye R.F. , Bailie G.R.
Published: January 2018

Purpose

Guidelines for empiric treatment of PD-related peritonitis published in 2000 recommend concurrent intraperitoneal (IP) cefazolin and ceftazidime. The pharmacokinetics (PK) of these agents combined have not been studied. This study was designed to determine the PK of combined IP cefazolin and ceftazidime in CAPD patients.

Design

Prospective PK study in seven non-infected CAPD patients.

Procedures

Patients had a peritoneal equilibration test (PET), then received one IP dose of cefazolin and ceftazidime (15 mg/kg each) co-administered over a 4-hour dwell, then performed three CAPD exchanges over the next 16 hours. Serum and dialysate samples collected over the 20-hour study period were assayed for drug concentrations by HPLC.

Outcome measures

PK parameters.

Statistical methods

Correlations were tested between PET and PK parameters using the Pearson-product correlation coefficient.

Main findings

Serum cefazolin and ceftazidime levels exceeded the minimum inhibitory concentrations for susceptible organisms (8 mg/L) throughout the 20 hour study period. Mean cefazolin and ceftazidime PK parameters included: bioavailability, 71% and 63%; elimination rate constant, 0.031 and 0.045 h−1; total clearance, 5.8 and 16.0 ml/min; peritoneal clearance, 1.6 and 3.9 ml/min; renal clearance, 2.3 and 3.9 ml/min, respectively. Predictive equations suggest that 1000 mg IP of cefazolin and of ceftazidime every 24 hours would produce average steady-state trough serum cefazolin and ceftazidime concentrations of 70 ± 52 mg/L and 17 ± 7 mg/L, respectively. There was no correlation between PET and PK parameters.

Conclusions

Co-administration did not adversely affect the PK of either agent. IP cefazolin and ceftazidime (15 mg/kg) produced adequate serum and dialysate concentrations in CAPD patients for 20 hours. PK predictions suggest that most patients would achieve adequate cefazolin and ceftazidime concentrations with 1000 mg IP once-daily. Anuric patients and those with significant residual renal function may require a more individualized approach.
Hypertriglyceridemia: Apheretic Treatment
Authors: Giannini G. , Valbonesi M. , Morelli F. , Carlier P. , De Luigi M.C. , Dejana A.M. , Ruzzenenti M.R.
Published: January 2018

Patients with extremely high triglyceride levels and associated lipemia are at high risk for acute pancreatitis. Two factors can increase triglyceride-rich lipoproteins; one is overproduction and other is a defect in clearance. Either mechanism can cause hypertriglyceridemia and both may exist simultaneously. Causes can be either primary or secondary.

Plasmapheresis is efficacious for severe hypertryceridemia in patients who have not responded to previous therapies.

We have treated 15 cases of hypertrygliceridemia complicating the course of patients receiving Cyclosporin A after bone marrow transplantation. Five patients were treated with plasmapheresis, the other ten with cascade filtration. The removal rate for triglycerides was 58.0% for patients treated by cascade filtration and 63.5% for patients treated by plasmapheresis. The removal rates for triglycerides were low possibly as a consequence of early saturation of the filter.
Molecular Genetics of Staphylococcus Epidermidis Biofilms on Indwelling Medical Devices
Authors: Vadyvaloo V. , Otto M.
Published: January 2018

Staphylococcus epidermidis is an opportunistic pathogen associated with foreign body infections and nosocomial sepsis. The pathogenicity of S. epidermidis is mostly due to its ability to colonize indwelling polymeric devices and form a thick, multilayered biofilm. Biofilm formation is a major problem in treating S. epidermidis infection as biofilms provide significant resistance to antibiotics and to components of the innate host defenses. Various cell surface associated bacterial factors play a role in adherence and accumulation of the biofilm such as the polysaccharide intercellular adhesin and the autolysin AtlE. Furthermore, recent studies have shown that global regulators such as the agr quorum sensing system, the transcriptional regulator sarA and the alternative sigma factor sigB have an important function in the regulation of biofilm formation. Understanding the many complex mechanisms involved in biofilm formation is a key factor in the search for new anti-staphylococcal therapeutics.
Pathogenesis of Implant Infections by Enterococci
Authors: Baldassarri L. , Creti R. , Montanaro L. , Orefici G. , Arciola C.R.
Published: January 2018

Enterococci are commensals of human and animal intestinal tract that have emerged in the last decades as a major cause of nosocomial infections of bloodstream, urinary tract and in infected surgical sites. Enterococcus faecalis is responsible for ca. 80% of all enterococcal infections while Enterococcus faecium accounts for most of the others; among the most relevant risk factors for development of enterococcal infections is the presence of implanted devices.

The pathogenesis of such infections is poorly understood, but several virulence factors have been proposed. Among them, the ability to form biofilm has recently been shown to be one of the most prominent features of this microorganism, allowing colonization of inert and biological surfaces, while protecting against antimicrobial substances, and mediating adhesion and invasion of host cells and survival within professional phagocytes. Biofilm formation has been shown to be particularly important in the development of prosthetic valve enterococcal endocarditis and stent occlusion. Enterococci are also able to express other surface factors that may support colonization of both inert and biological surfaces, and that may be involved in the invasion of, and survival within, the host cell.
Factors Affecting Microbial Adhesion to Stainless Steel and Other Materials Used in Medical Devices
Authors: Verran J. , Whitehead K.
Published: January 2018

The role of biofilm in medical device associated infections is well documented. Biofilms are more resistant to antibiotics than planktonic cells, these are extremely difficult to treat. Prevention strategies include efforts to insert implants under stringent aseptic conditions, and also encompass the development of novel materials which interfere with the initial attachment of microorganisms to the surface of the device.

Microbial cells also attach onto hygienic surfaces in the hospital setting, and thereby pose a cross-infection problem. In this case, vigorous cleaning and sanitizing regimes may be employed in addition to any surface modifications.

Many factors affect the initial attachment of organisms to inert substrata, and their subsequent retention or removal/detachment, including the physical and chemical nature and location of the substratum, the type of organic material and microorganisms potentially fouling the surface, and the nature of the interface (solid-liquid in the body; solid-air on environmental surfaces). Focusing on one factor, surface topography, it is apparent that many further variables need to be defined in order to fully understand the interactions occurring between the cell and surface. It is therefore important when modifying one substratum surface property in order to reduce adhesion, to also consider other potentially confounding factors.
Hospitalization in Hemodialysis Patients in One Region of Lithuania
Authors: Vaičiūnienė R. , Kuzminskis V. , Bumblytė I.A.
Published: January 2018

Introduction and Methods

The objective of our study was to evaluate hospitalization rates in hemodialysis patients in the region of Kaunas, the second largest city in Lithuania. We analysed ambulatory case records of 187 ESRD patients dialysed in all 7 hemodialysis centers in the Kaunas region over the year 2002.

Results

During the year 2002 the unadjusted hospitalization rate over a 1 year period in all dialysed patients (the prevalent patients, n=187) was 1.4 hospitalizations per patient year at risk. There were 17.5 hospital days per patient year at risk, the mean length of one hospitalization being 12.5 days. The most frequent causes of hospitalization were cardiovascular diseases (25%), infections (22%), and access related complications (10%). Of the 187 patients, 55 started hemodialysis in the year 2002 (incident patients). The comparison of prevalent patients with incident patients revealed a higher hospitalization rate in the incident patients (unadjusted hospitalization rate was 1.9 hospitalizations per patient year at risk). The length of hospitalization (29.1 hospital days per patient year at risk) and the mean length of one hospitalization (15.1 days) were longer in the incident patients than the prevalent patients. In the year 2002, the National Sickness Fund paid $361 per year for hospitalizations of one hemodialysis patient and $10,800 per year for the dialysis procedures of one hemodialysis patient.

Conclusions

The hospitalization rate in Lithuania for patients undergoing hemodialysis is similar to that of other European countries while hospitalization costs are lower.
Effects of Modified Collagen Matrices on Human Umbilical Vein Endothelial Cells
Authors: Markowicz M. , Heitland A. , Steffens G.C.M. , Pallua N.
Published: January 2018

The most commonly used biomaterials fail to ensure sufficient angiogenesis for fast in vivo incorporation. This results in central necrosis and consequent infection. One way of obtaining a high angiogenic response is the application of vascular endothelial growth factor (VEGF). To obtain a sustained release of these cytokines, heparin was incorporated into collagen matrices using 1-ethyl-3(3-dimethyl-aminopropyl) carbodiimide (EDC) and N-hydroxysuccinmide (NHS). The functionality of the heparinized collagen matrices was then enhanced by immobilization of VEGF via its heparin-binding domain. This procedure changed in vitro degradation behavior and water-binding capacity. Accelerated endothelial cell proliferation was also achieved. A range of different heparin and EDC/NHS concentrations in combination with VEGF induced variation in endothelial cell growth and tubulogenic formation.

Polymerized collagen scaffolds presented biointeractive systems with integrated angiogenic activity. This may become a useful tool in the clinical therapy of disorders connected with wound healing.
Disease Management Improves ESRD Outcomes
Authors: Sands J.J.
Published: January 2018

Renal disease management organizations have reported achieving significant decreases in mortality and hospitalization in conjunction with cost savings, improved patient satisfaction and quality of life. Disease management organizations strive to fill existing gaps in care delivery through the standardized use of risk assessment, predictive modeling, evidence based guidelines and process and outcomes measurement. Patient self-management education and the provision of individual nurse care managers are also key program components. As we more fully measure clinical outcomes and total health-care costs including payments from all insurance and government entities, pharmacy costs and out-of-pocket expenditures, the full implications of disease management can be better defined. The results of this analysis will have a profound influence on United States healthcare policy. At present, current data suggests that the promise of disease management, improved care at reduced cost, can and is being realized in ESRD.
Continuous Renal Replacement Therapy in Patients following Traumatic Injury
Authors: Mccunn M. , Reynolds H.N. , Reuter J. , Mcquillan K. , Mccourt T. , Stein D.
Published: January 2018

In critically injured patients, the incidence of acute renal failure has been reported to occur in as many as 31% of patients. The use of CRRT modalities for patients following traumatic injuries is becoming more common, albeit slowly, and this therapy may impact upon long-term recovery of renal function and mortality. Historical studies investigating the early use of intermittent dialysis reported significant improvement in survival in patients who were dialyzed earlier and more vigorously than in control subjects. Early trauma patients also showed improved survival following war injuries when dialyzed prophylactically. Although there is a growing acceptance in favor of earlier renal replacement therapy, the published consensus and the practice in many centers has been to dialyze/filter relatively ill rather than relatively healthy patients. The R Adams Cowley Shock Trauma Center (STC) in Baltimore, Maryland, USA, admits over 8,000 trauma patients each year. Within the STC, a program of continuous renal replacement therapy was established in the early 1980's. We review both historical and current literature on the use of renal replacement therapies after traumatic injury, and suggest some future areas of investigation and indications for these modalities.
Development of the Isolated Dual Perfused Rat Liver Model as an Improved Reperfusion Model for Transplantation Research
Authors: 'T Hart N.A. , Van Der Plaats A. , Moers C. , Leuvenink H.G.D. , Wiersema-Buist J. , Verkerke G.J. , Rakhorst G. , Ploeg R.J.
Published: January 2018

The Isolated Perfused Liver (IPL) model is a widely used and appreciated in vitro method to demonstrate liver viability and metabolism. Reperfusion is performed in a controlled setting, however, via the portal vein only. To study transplant related questions concerning bile and transport of bile, the in vitro Isolated dual Perfused Liver model is revisited. The IdPL is an in vitro reperfusion model, using both portal vein and hepatic artery. Livers from 12 Wistar rats were flushed with University of Wisconsin-organ preservation solution, procured and reperfused in either the conventional IPL-model (n=6) or the new IdPL-model (n=6). Liver injury, assessed by the release of aspartate amino transferase and lactate dehydrogenase, showed similar levels during both IPL and IdPL reperfusion, only alanine amino transferase showed an improvement. Cumulative bile production showed an improvement: 176.3 ± 8.4 in the IdPL compared to 126.1 ± 12.2 μg/g-liver in the IPL (p<0.05). Clearance of phenol red (PR) and taurocholic acid (TC) remained similar. At 90 minutes reperfusion the PR clearance showed 0.11 ± 0.01 and 0.11 ± 0.02 mg/30min/g-liver and the TC clearance 1.01 ± 0.10 and 1.01 ± 0.07 μmol/ml/30min/g-liver in the IPL and IdPL, respectively. Increasing the reperfusion time beyond the normally used 90 minutes resulted in a significant increase in transaminases and LDH and a decrease in bile production, liver morphology remained intact and glycogen content was appropriate. In conclusion, the IdPL-model showed similar or better results than the IPL-model, but the liver could not endure an extended reperfusion time using the IdPL.
Multi-Scale Analysis of the Toraymyxin Adsorption Cartridge Part I: Molecular Interaction of Polymyxin B with Endotoxins
Authors: Vesentini S. , Soncini M. , Zaupa A. , Silvestri V. , Fiore G.B. , Redaelli A.
Published: January 2018

Endotoxins or lipopolysaccharides are the main constituents of the outer leaflet of Gram-negative bacteria membrane and play a central role in the pathogenesis of the septic shock. Polymyxin B has both antibacterial and antiendotoxin capability; indeed it is able to destroy the bacterial outer membrane and bind endotoxin neutralizing its toxic effects. Cartridges containing polymyxin B-immobilized fibers (Toraymyxin PMX-F, Toray Industries, Japan) are used in extracorporeal hemoperfusion to remove circulating endotoxin.

The aim of this study is the characterization of the polymyxin B-endotoxin system at the molecular level, thus providing quantitative evaluation of the binding forces exerted in the molecular complex. Polymyxin B was interfaced with five molecular models of lipopolysaccharides differing in their structure and molecular mechanics simulations were performed at different intermolecular distances aimed at calculating the interaction energies of the complex. Binding forces were calculated by fitting interaction energies data.

Results show that in the short range the polymyxin B-endotoxin complex is mediated by hydrophobic forces and in the long range the complex is driven by ionic forces only. From a mechanical standpoint, polymyxin B-endotoxin complex is characterized by maximum binding forces ranging between 1.39 nN to 3.79 nN. The knowledge of the binding force behavior at different intermolecular distances allows further investigations at higher scale level (Part II).
Residual Blood Loss in Single Use Dialyzers: Effect of Different Membranes and Flux
Authors: Kalocheretis P. , Vlamis I. , Belesi C. , Makriniotou I. , Zerbala S. , Savidou E. , Zorbas S. , Arvanitis N. , Iatrou C.
Published: January 2018

Aim/Background

The aim of this study was to evaluate the residual blood loss in new type single use dialyzers under the usually prevailing conditions during hemodialysis and to investigate whether or not this loss is dependent on dialyzer membrane composition or flux characteristics.

Materials and Methods

In 158 hemodialysis (HD) patients, 158 single used dialyzers were studied in corresponding HD sessions. 52/158 dialyzers were made from modified cellulose (acetate, CA or triacetate, CTA) membrane and 106 from synthetic ones (58 with ethyl-vinyl-alcohol (EVAL), 48 with polyacrilonitrile (AN69)). Of those dialyzers 85/158 (58 EVAL+27CA) were low flux (LF) while the other 73 were high flux (HF). Patients underwent 4 hour HD sessions and at the end of the session blood was drawn for the measurement of hematocrit (Ht) and hemoglobin (Hb). Additionally, after the end of dialysis the used dialyzers were rinsed with 1000mL of 0.05% NH3 solution in distilled water. The wash was collected and subsequently Hb was measured using the benzidine method. From the volume of the solution and its concentration of Hb, total Hb of the solution was measured and blood loss in terms of red blood cell (RBC) volume was estimated by the use of the formula: RBC (mL) = Total Hb (g) in the solution x patient's Ht (ml/dL) / Patient's Hb (g/dL). For results to be comparable between dialyzers, RBC volume/m2 of dialyzer membrane was expressed. In 5/158 patients blood loss was also estimated in 6 consecutive HD sessions using the same type of dialyzer.

Results

For the sum of the dialyzers, blood loss / dialyzer in terms of RBC volume, expressed as median (range), was 0.978 mL (0.01–23.9). There was statistically significant (p<0.001 or p<0.05) higher blood loss with the use of AN69 dialyzer than with the other three. RBCHF>RBCLF (p<0.001) constrained the first group of patients to use a 6% higher dosage of ferrum and 3.5% higher dosage of erythropoietin than the other group to achieve the optimal hemoglobulin values. No difference existed regarding RBC between CA, CTA and EVAL membranes. RBC measured in the small group of 5/158 patients for 6 consecutive HD sessions with the same dialyzer showed a wide range of RBC loss indicating an effect of the human factor.

Conclusions

Blood loss during HD sessions due to residual blood cell volume inside dialyzers is usually slight using new type single use dialyzers but, sometimes, it can be significant and may contribute to the development or deterioration of preexisting iron deficiency anemia. The results of this study indicated that this loss can be attributed to the membrane composition of the dialyzer or to the human factor and has nothing to do with the ultrafiltration coefficient of the dialyzer.
Ischemic Type Biliary Lesions in Histidine-Tryptophan-Ketoglutarate (HTK) Preserved Liver Grafts
Authors: Moench C. , Otto G.
Published: January 2018

Ischemic type biliary lesions lead to considerable morbidity following orthotopic liver transplantation. The exact pathogenesis is unknown. One major hypothesis is that insufficient perfusion of the arterial vessels of the biliary tree, especially under perfusion with the high viscous University of Wisconsin solution, might be responsible for ischemic type biliary lesions. Due to low viscosity, HTK solution is reported to have a lower incidence of biliary complications. However, there is no data concerning ischemic type biliary lesions in HTK preserved livers. In this paper we report our results after orthotopic liver transplantation with special regard to ischemic type biliary lesions in liver grafts preserved with HTK solution. Between 09/1997 and 01/2005 300 liver transplantations were performed in our center. Thirty-two (10.7%) liver grafts were preserved with HTK solution, 268 (89.3%) were preserved with UW solution. Six and 43 grafts showed ischemic type biliary lesions after orthotopic liver transplantation in HTK- (18.8%) and UW- (16.0%) groups, respectively (p=0.696). There was no statistical significant difference between the two groups. Donor related factors, recipient age, indication for transplantation, transplantation technique, immunosuppression and ischemia time were comparable in both groups.

Ischemic type biliary lesions occurred with the same frequency in HTK preserved livers compared to UW preserved organs. We suggest that low viscosity of the preservation fluid by itself does not guarantee reliable perfusion of the small arteries of a liver graft and a pressure perfusion might be beneficial even in HTK solution.
Antibiotic Resistant Pathogenic Bacteria and Their Resistance Genes in Bacterial Biofilms
Authors: Obst U. , Schwartz T. , Volkmann H.
Published: January 2018

Biofilm-forming bacteria are ubiquitous in the environment and also include biofilm-forming pathogens. Environmental biofilms may form a reservoir for risk genes and may act as a challenge for human health. Examples of the health relevance of biofilms are the increase in antibiotic resistant bacteria hosted in biofilms in hospital and environment and consequently the interaction of these bacteria with human cells, e.g. in the immune system.

Although data concerning the occurrence and spread of resistant bacteria within hospital care units are available, the fate of these bacteria in the environment and especially in the aquatic environment has barely been investigated. Once antibiotic resistant bacteria have entered the environment, a back coupling by ingestion or other possible entry into the host has to be prevented. Therefore a strategy to investigate paths of entry, accumulation and spread of resistant bacteria in environmental compartments has been developed using quantitative determination of genetic resistance determinants. Additionally a bacterial bioassay assessed bioeffectivity thresholds of low antibiotic concentrations. This approach enables an evaluation of the potential of contaminated waters to exert a selection pressure on bacterial communities and thus promote the persistence of resistant organisms. Completed with an indicator system for the identification of sources of multiresistant bacteria a concept for monitoring and evaluation of environmental compartments with respect to their potential of antibiotic resistance dissemination is suggested.
Animal Models of Osteomyelitis
Authors: An Y.H. , Kang Q.K. , Arciola C.R.
Published: January 2018

There are numerous reports in the literature using animal models of osteomyelitis for investigating pathogenesis, diagnosis, and treatment of bone infections. Rabbits, rats, and dogs are commonly used animals, and, less frequently, chickens, guinea pigs, miniature pigs, goats, and sheep. Commonly used bones for creating local osteomyelitis include tibia, femur, and radius, and, less frequently, mandible and spine. When designing a specific model, one should consider which animal and which bone will be used, which route for inoculation (either local injection or systemically through vascular injection), which bacterial species and how many bacteria should be applied, if and what sclerosing agent, foreign body or implant should be employed, and if local trauma is needed. Basic methods of evaluation include clinical observation, radiography, microbiology, and histology.
Automated Ribotyping to Distinguish the Different nonSau/ nonSep Staphylococcal Emerging Pathogens in Orthopedic Implant Infections
Authors: Campoccia D. , Baldassarri L. , An Y.H. , Kang Q.K. , Pirini V. , Gamberini S. , Pegreffi F. , Montanaro L. , Arciola C.R.
Published: January 2018

Several species belonging to Staphylococcus genus, other than Staphylococcus aureus and Staphylococcus epidermidis (nonSau/ nonSep species), exhibit increasing abilities as opportunistic pathogens in the colonisation of periprosthetic tissues. Consequently, the availability of means for accurate identification is crucial to assess the pathogenic characteristics and to clarify clinical relevance of the individual species. Here, 146 clinical staphylococcal isolates belonging to nonSau/ nonSep species from prosthesis-associated orthopedic infections were analyzed by conventional enzymatic galleries and by automated ribotyping. Twelve different species were recognised: S. capitis, S. caprae, S. cohnii, S. equorum, S. haemolyticus, S. hominis, S. lugdunensis, S. pasteuri, S. sciuri, S. simulans, S. warneri, S. xylosus. Ribotype identifications were compared with the phenotypes obtained by the Api 20 Staph system and/or ID 32 Staph system. ID 32 Staph profiles were more consistent with ribotyping results than Api Staph profiles. Across the different staphylococcal species investigated, correct identifications with Api Staph were 45%, while with ID 32 Staph they were 59%. It has, however, to be mentioned that ID 32 Staph was mostly applied to discriminate unmatched ribotyping and Api Staph identifications, thus to a subpopulation of strains with “atypical” metabolic profile. Automated ribotyping provided a correct identification for 91% of the isolates. These results confirm automated ribotyping as a convenient rapid technique, still subject to improvements, which will accurately and rapidly recognise the newly emerging staphylococcal pathogens in implant-related orthopedic infections.
Management of Inguinal Hernia on Peritoneal Dialysis: An Audit of Current Polish Practice and Call for a Standard
Authors: ŚMietańSki M. , Renke M. , Bigda J. , ŚMietańSka I. , Rutkowski B. , Witkowski P. , ŚLedzińSki Z.
Published: January 2018

Peritoneal dialysis is becoming more and more common as a method of treating patients at the final stage of renal failure. In the year 2002 the number of patients treated with this method in Poland amounted to 1324. Studies have demonstrated that inguinal and abdominal hernias develop more frequently in chronic renal failure patients. The percentage of patients with hernia diagnosed within the first five years of dialysis is about 10%. Continuation of dialysis with the hernia condition left untreated may result in severe complications which are the third most frequent cause of converting treatment method into hemodialysis in PD patients. Currently in Poland there is no national standard in existence as to the management of hernias, and the only British standard from 1998 does not reflect the present expertise of either surgical treatment or dialysis methods. The aim of the current questionnaire based study investigating Polish peritoneal dialysis centers was to assess the treatment when hernia had been diagnosed in the PD patient. Of 49 dialysis centers in Poland, 39 do have protocols on managing the patient before and after the operation. A considerable diversity has been found as to surgical techniques used and the ways the patients are managed in hospital. Following the need expressed by 33 dialysis centers in Poland for some standard for relevant procedures, the authors formulated principles of modern hernia treatment in PD patients. Accordingly, the main principles include: 1) consulting a surgeon collaborating with the center before qualifying for peritoneal dialysis and when hernia symptoms have manifested; 2) Tension-free methods used in a treatment of choice (recommended by PHS); 3) Application of antibiotic prophylaxis (preferably first generation cephalosporin); 4) Induction of local or epidural anesthesia; 5) Peritoneal dialysis programme does not need to be discontinued but low volume dwells or preferably intermittent APD is recommended immediately after surgery.
Gene-Activated Matrices for Cartilage Defect Reparation
Authors: Guo T. , Zeng X. , Hong H. , Diao H. , Wangrui R. , Zhao J. , Zhang J. , Li J.
Published: January 2018

A cartilage defect has a very limited ability to repair itself spontaneously due to the shortage of blood. Many attempts have been made to restore the integrity of cartilage in clinical and experimental studies. Recently, tissue engineering has emerged as a new protocol for lost tissue regeneration. Meanwhile, the defect-repairing environment can be improved by gene therapy methods. Gene-activated matrices (GAM) fabricated with biomaterials and plasmids fill the cartilage defects to restore the integrity of joint surface, facilitating repair cell adhesion and proliferation as well as the synthesis of extracelluar matrix. And they also serve as a local gene delivery system, inducing therapeutic agent expression at the repair site. In the present study, we fabricated two- and three-dimensional matrices from chitosan and gelatin, then added a plasmid DNA encoding transforming growth factors-β1 (TGF-β1) for cartilage defect regeneration. First, we demonstrated primary chondrocytes could maintain their biological characteristics and secrete therapeutic proteins when they were cultured onto GAM in vitro. Subsequently we inserted three-dimensional GAM into cartilage defects of rabbit knee joints. With the results of the new cartilage tissue formation, we came to the conclusion that GAM was helpful for new tissue production and this therapeutic protocol provided a cheap, simple, and effective method for cartilage defect reparation.