bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond Global Englishes: Teaching English as a Dynamic Language
Authors: Mahboob Ahmar
Published: April 2018

Currently, a growing number of teaching approaches focus on aspects of variation in language (e.g. English as a Lingua Franca (ELF), World Englishes, English for Specific Purposes (ESP), genre theories, etc.); however, each of these approaches tends to focus on particular (specific) aspects of language variation and do not fully account for the range or dynamicity of linguistic variations. This article, based on a discussion of language variation, proposes a model of language proficiency that considers the dynamic nature of language variation and is not dependent on static (native-speaker defined) norms of language. Using the Dynamic Approach to Language Proficiency as a model of language proficiency and grounded in understandings of language variation, this article introduces the concept of Teaching English as a Dynamic Language (TEDL). The article includes evidence for the need to develop such a model and also points out ways in which current and future work can contribute to further development of this approach. Finally, the article also identifies some socio-economic implications of this work and explicitly supports the need to recognize and empower local (including endangered) languages through TEDL.
The impact of different proportions of knitting elements on the resistive properties of conductive fabrics
Authors: Liu Su , Liu Yanping , Li Li
Published: April 2018

Conductive yarn is the key factor in fabricating electronic textiles. Generally, three basic fabric production methods (knit, woven, and non-woven) combined with two finishing processes (embroidery and print) are adopted to embed conductive yarns into fabrics to achieve flexible electronic textiles. Conductive yarns with knit structure are the most flexible and effective form of electronic textiles.

Electronic textiles present many advantages over conventional electronics. However, in the process of commercialization of conductive knitted fabrics, it is a great challenge to control the complicated resistive networks in conductive knitted fabrics for the purpose of cost saving and good esthetics. The resistive networks in conductive knitted fabrics contain length-related resistance and contact resistance. The physical forms of conductive yarns in different fabrication structures can be very different and, thus, the contact resistance varies greatly in different fabrics. So far, study of controlling the resistive property of conductive fabrics has not been conducted.

Therefore, establishing a systematic method for the industry as a reference source to produce wearable electronics is in great demand. During the industrialization of conductive knitted fabrics, engineers can estimate the resistive property of the fabric in advance, which makes the production process more effective and cost efficient. What is more, the resistive distribution in the same area of knitted fabrics can be fully controlled.
Commitment Readiness and Relationship Formation
Authors: Hadden Benjamin W. , Agnew Christopher R. , Tan Kenneth
Published: April 2018

The concept of being ready for a relationship is pervasive in popular culture, but theoretical and empirical research on readiness is lacking. We offer a conceptualization of commitment readiness and provide some of the first empirical work examining readiness among single individuals—specifically how this construct shapes various aspects of relationship formation. Using data from five independent samples of individuals not involved in romantic relationships, we first establish that commitment readiness is associated with more interest in developing a close romantic relationship (Studies 1a, 1b, 2) and with active pursuit of relationship initiation (Study 2). We then test whether readiness among single individuals longitudinally predicts both the likelihood of later entering a relationship and, ultimately, how committed individuals are to a future relationship (Studies 3a, 3b, 3c). Implications of commitment readiness specifically, and perceived personal timing more generally, for the social psychology of relationships are discussed.
Transcendent Marginality
Authors: Wilson Janelle Lynn
Published: April 2018

This short essay provides a summary of various interpretations of the concept, marginality, with particular focus on positive conceptualizations. From this backdrop, a new term, transcendent marginality, is presented. It is suggested that this term more clearly highlights the emancipatory potential of marginality—both for those occupying marginal positions and for those who may be at (or near) the center but who recognize the inherent oversimplistic, monolithic view of center–periphery dichotomies.
Multigroup Propensity Score Approach to Evaluating an Effectiveness Trial of the New Beginnings Program
Authors: Tein Jenn-Yun , Mazza Gina L. , Gunn Heather J. , Kim Hanjoe , Stuart Elizabeth A. , Sandler Irwin N. , Wolchik Sharlene A.
Published: April 2018

We used a multigroup propensity score approach to evaluate a randomized effectiveness trial of the New Beginnings Program (NBP), an intervention targeting divorced or separated families. Two features of effectiveness trials, high nonattendance rates and inclusion of an active control, make program effects harder to detect. To estimate program effects based on actual intervention participation, we created a synthetic inactive control comprised of nonattenders and assessed the impact of attending the NBP or active control relative to no intervention (inactive control). We estimated propensity scores using generalized boosted models and applied inverse probability of treatment weighting for the comparisons. Relative to the inactive control, NBP strengthened parenting quality as well as reduced child exposure to interparental conflict, parent psychological distress, and child internalizing problems. Some effects were moderated by parent gender, parent ethnicity, or child age. On the other hand, the effects of active versus inactive control were minimal for parenting and in the unexpected direction for child internalizing problems. Findings from the propensity score approach complement and enhance the interpretation of findings from the intention-to-treat approach.
Smartphones distract parents from cultivating feelings of connection when spending time with their children
Authors: Kushlev Kostadin , Dunn Elizabeth W.
Published: April 2018

In the U.S., 95% of smartphone users admit to having used their smartphones during their latest social gathering. Although smartphones are designed to connect us with others, such smartphone use may create a source of distraction that disconnects us from the people in our immediate social environment. Focusing on one fundamental social relationship—between parents and their children—we examined whether smartphones made parents feel distracted, thereby undermining key benefits parents reap when spending time with their children. Ina field experiment at a science museum (Study 1), we randomly assigned parents to use their phones frequently or infrequently. Frequent phone use led parents to feel more distracted, which in turn impaired feelings of social connection and the meaning that parents derived when spending time with their children. In an additional weeklong diary study (Study 2), we found further evidence that smartphones can distract parents from reaping a sense of social connection when spending time with their children. These studies suggest that being constantly connected to the Internet may carry subtle costs for the fabric of social life.
Albumin priming improves the efficiency of the Minntech HPH Jr. hemoconcentrator
Authors: Burnside Jeffrey L. , Ratliff Todd M. , Salvator Ann , Hodge Ashley B.
Published: April 2018

The desired use of the HPH Jr. is optimal due to the low priming volume; however, the lower rate of volume removal necessitates utilization of a larger hemofilter. Larger hemofilters carry a higher prime volume, which is impactful in the pediatric setting. Pediatric cardiac surgery patients under 18 kilograms requiring cardiopulmonary bypass were randomly assigned to one of two study groups. Group 1 (coated) contained an HPH Jr. hemofilter that was primed with the addition of 25% albumin and heparin. Group 2 (non-coated) contained an HPH Jr. hemofilter that was primed with only Normosol-R®. After cardioplegia delivery, zero balance ultrafiltration (ZBUF) was initiated and maintained for thirty consecutive minutes. The flow through the hemofilter was standardized at 70 ml/min and the vacuum applied to the effluent line was set at -150 mmHg. Effluent fluid removal was measured at the termination of thirty minutes and compared between the groups. Group comparisons between the coated vs non-coated hemofilter groups were assessed using two-sample t-tests or the Mann-Whitney U test, when appropriate. Forty-two patients were included in the analysis. There were 22 patients who had the non-coated hemofilter and 20 patients with a coated hemofilter. The differences between the two groups are illustrated in Table 1. There was a statistically significant higher ultrafiltration volume with the coated hemofilter group (p=0.008) (Figure 1). These results illustrate the improved efficiency of the HPH Jr. with the addition of 25% albumin and heparin during the priming process.
Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation
Authors: Cashen Katherine , Reeder Ron , Dalton Heidi J. , Berg Robert A. , Shanley Thomas P. , Newth Christopher J. L. , Pollack Murray M. , Wessel David , Carcillo Joseph , Harrison Rick , Dean J. Michael , Tamburro Robert , Meert Kathleen L
Published: April 2018

Introduction:

Our objectives are to (1) describe the pathogens, site, timing and risk factors for acquired infection during neonatal and pediatric ECMO and (2) explore the association between acquired infection and mortality.

Methods:

Secondary analysis of prospective data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Clinical factors associated with acquired infection were assessed with multivariable Cox regression. Factors associated with mortality were assessed with logistic regression.

Results:

Of 481 patients, 247 (51.3%) were neonates and 400 (83.2%) received venoarterial ECMO. Eighty (16.6%) patients acquired one or more infections during ECMO; 60 (12.5%) patients had bacterial, 21 (4.4%) had fungal and 11 (2.3%) had viral infections. The site of infection included respiratory for 53 (11.0%) patients, bloodstream for 21 (4.4%), urine for 20 (4.2%) and other for 7 (1.5%). Candida species were most common. Median time to infection was 5.2 days (IQR 2.3, 9.6). On multivariable analysis, a greater number of procedures for ECMO cannula placement was independently associated with increased risk of acquired infection during ECMO (Hazard Ratio 2.13 (95% CI 1.22, 3.72), p<0.01) and receiving ECMO in a neonatal ICU compared to a pediatric or cardiac ICU was associated with decreased risk (Hazard Ratio pediatric ICU 4.25 (95% CI 2.20, 8.20), cardiac ICU 2.91 (95% CI 1.48, 5.71), neonatal ICU as reference, p<0.001). Acquired infection was not independently associated with mortality.

Conclusion:

ECMO procedures and location may contribute to acquired infection risk; however, acquired infection did not predict mortality in this study.
Risk factors to predict leg ischemia in patients undergoing single femoral artery cannulation in minimally invasive cardiac surgery
Authors: Tarui Tatsuya , Miyata Kazuto , Shigematsu Sayaka , Watanabe Go
Published: April 2018

Background:

In peripheral cannulation for cardiopulmonary bypass, there is always a risk of ischemia in the extremities, caused by femoral artery cannulation. This report aimed to evaluate the outcome and the risk factors in patients undergoing minimally invasive cardiac surgery in mitral valve surgery.

Methods:

We retrospectively reviewed all minimally invasive mitral valve surgery at our institute from May 2014 to December 2016. Operative outcomes and intra-operative monitoring for distal leg saturation were measured by the near-infrared spectroscopy values. For post-operative outcomes, the creatinine phosphorus kinase level was measured for the assessment of leg ischemia. Risk factors were evaluated for the elevation of post-operative creatinine phosphorus kinase.

Results:

There were 162 patients who underwent single femoral artery cannulation for minimally invasive mitral valve surgery. The mean operation, cardiopulmonary bypass and aortic cross-clamp time were 212±44, 124±30, 76.6±22 minutes (min), respectively. The factors related to increased creatinine phosphorus kinase were male, body mass index, larger cannula size, operation time, cardiopulmonary bypass time and aortic cross-clamp time. The measurement of minimum near-infrared spectroscopy values did not show any association with creatinine phosphorus kinase elevation. There were significant associations between body mass index, cannula size and operation time and post-operative creatinine phosphorus kinase increase by multiple regression analysis. Two male patients had extremely high post-operative creatinine phosphorus kinase (18188 U/L and 16831 U/L) and they had high body mass index, large cannula size and longer operation time.

Conclusions:

In peripheral cannulation for minimally invasive cardiac surgery, body mass index, cannula size and operation time can be considered as risk factors for leg ischemia.
The potential mechanism of mitochondrial dysfunction in septic cardiomyopathy
Authors: Pan Pan , Wang Xiaoting , Liu Dawei
Published: April 2018

Septic cardiomyopathy is one of the most serious complications of sepsis or septic shock. Basic and clinical research has studied the mechanism of cardiac dysfunction for more than five decades. It has become clear that myocardial depression is not related to hypoperfusion. As the heart is highly dependent on abundant adenosine triphosphate (ATP) levels to maintain its contraction and diastolic function, impaired mitochondrial function is lethally detrimental to the heart. Research has shown that mitochondria play an important role in organ damage during sepsis. The mitochondria-related mechanisms in septic cardiomyopathy have been discussed in terms of restoring mitochondrial function. Mitochondrial uncoupling proteins located in the mitochondrial inner membrane can promote proton leakage across the mitochondrial inner membrane. Recent studies have demonstrated that proton leakage is the essential regulator of mitochondrial membrane potential and the generation of reactive oxygen species (ROS) and ATP. Other mechanisms involved in septic cardiomyopathy include mitochondrial ROS production and oxidative stress, mitochondria Ca2+ handling, mitochondrial DNA in sepsis, mitochondrial fission and fusion, mitochondrial biogenesis, mitochondrial gene regulation and mitochondria autophagy. This review will provide an overview of recent insights into the factors contributing to septic cardiomyopathy.
A pilot investigation of a mobile phone application and progressive reminder system to improve adherence to daily prevention treatment in adolescents and young adults with migraine
Authors: Ramsey Rachelle R , Holbein Christina E , Powers Scott W , Hershey Andrew D , Kabbouche Marielle A , O'Brien Hope L , Kacperski Joanne , Shepard Jeffrey , Hommel Kevin A
Published: April 2018

Background

Effective management of migraine requires adherence to treatment recommendations; however, adolescents with migraine take their daily medications only 75% of the time. Low-cost adherence-focused interventions using technology may improve adherence, but have not been investigated.

Methods

Thirty-five adolescents and young adults (13–21 years) with migraine participated in an AB-design pilot study to assess the use of a mobile phone adherence-promotion application (“app”) and progressive reminder system. Adherence was calculated using electronic monitoring during the baseline period and medication adherence intervention.

Results

Relative to baseline, adherence significantly improved during the first month of the intervention. Specifically, improvements existed for older participants with lower baseline adherence. Self-reported app-based adherence rates were significantly lower than electronically monitored adherence rates. Participants rated the intervention as acceptable and easy to use.

Conclusions

“Apps” have the potential to improve medication adherence and are a promising intervention for adolescents and young adults with low adherence. Involving parents in the intervention is also helpful. Providers should assess barriers to adherence and use of technology-based interventions, encourage parents to incorporate behavioral incentives, and provide referrals for more intensive interventions to improve long-term outcomes. Further, tracking adherence in an app may result in an underestimation of adherence. Future full-scale studies should be conducted to examine adherence promotion app interventions.
Chronorisk in cluster headache: A tool for individualised therapy?
Authors: Barloese Mads , Haddock Bryan , Lund Nunu T , Petersen Anja , Jensen Rigmor
Published: April 2018

Background

The mechanisms behind the severe pain of cluster headache remain enigmatic. A distinguishing feature of the attacks is the striking rhythms with which they occur. We investigated whether statistical modelling can be used to describe 24-hour attack distributions and identify differences between subgroups.

Methods

Common hours of attacks for 351 cluster headache patients were collected. Probability distributions of attacks throughout the day (chronorisk) was calculated. These 24-hour distributions were analysed with a multimodal Gaussian fit identifying periods of elevated attack risk and a spectral analysis identifying oscillations in risk.

Results

The Gaussian model fit for the chronorisk distribution for all patients reporting diurnal rhythmicity (n = 286) had a goodness of fit R2 value of 0.97 and identified three times of increased risk peaking at 21:41, 02:02 and 06:23 hours. In subgroups, three to five modes of increased risk were found and goodness of fit values ranged from 0.85–0.99. Spectral analysis revealed multiple distinct oscillation frequencies in chronorisk in subgroups including a dominant circadian oscillation in episodic patients and an ultradian in chronic.

Conclusions

Chronorisk in cluster headache can be characterised as a sum of individual, timed events of increased risk, each having a Gaussian distribution. In episodic cluster headache, attacks follow a circadian rhythmicity whereas, in the chronic variant, ultradian oscillations are dominant reflecting a loss of association with sleep and perhaps explaining observed differences in the effects of specific treatments. The results demonstrate the ability to accurately model chronobiological patterns in a primary headache.
Mitigation of Impacts to Groundwater Quality from Highway Runoff in a Karst Terrain
Authors: Barrett Michael E.
Published: April 2018

There is a concern that urban development and the construction and operation of highways in particular represent a substantial threat to groundwater quality in areas underlain by karst geology. The objective of this paper is to determine whether common stormwater treatment practices are effective at preventing adverse impacts. The Barton Springs portion of the Edwards Aquifer, a karst system in Central Texas, presents a unique opportunity to address this issue, in that stormwater treatment requirements have been in place over a period of 20 years, when a substantial amount of development, including new highways, has been undertaken. This paper analyzes water quality data from Barton Springs over this period to identify constituents that exhibit changes in concentration and identifies potential causes of these changes. This analysis indicates that the constituents for which water quality has exhibited degradation appear to be due mainly to increases in pumping for water supply and onsite disposal of wastewater. No changes in constituent concentrations were observed for those most closely associated with highway operation, including total suspended solids, heavy metals, pesticides, and bacteria. It was found that sand filters produce an effluent quality equal to or better than runoff from undeveloped land. Consequently, it can be concluded that sand filtration, or an equivalent treatment, is an effective strategy for preventing groundwater degradation from highway operation in karst terrains.
Universal Method to Measure Water Infiltration into Asphalt Pavements Independent of Pavement Preservation Surface Treatment
Authors: Cox Ben C. , Howard Isaac L. , Hopkins Chase A.
Published: April 2018

In recent years, greater focus has been placed on pavement preservation treatments, where one of the primary goals is to seal an existing pavement (especially cracks) to preserve it from further oxidation (i.e. decrease its permeability). The industry needs the ability to measure the effectiveness of these surface treatments; a single universal method that could be used for this purpose would be ideal, especially if traditional asphalt pavement surfaces could also be evaluated or field and laboratory measurements successfully related. This paper’s objective is to present a simple permeameter device, the Mississippi permeameter (MSP), for measuring water infiltration into asphalt pavements independent of the surface (e.g. dense-graded asphalt (DGA), chip seal). In this paper, the MSP was evaluated against traditional field and laboratory permeameters (e.g. NCAT permeameter) on a range of surfaces from open-graded friction course (most permeable) to DGA (most common) to chip and scrub seals (least permeable, roughest texture, most difficult to measure). The MSP provided measurements as reasonable as those of existing permeameters and was also successfully used to test chip and scrub sealed cracks, which is beyond existing permeameters’ abilities. Additional refinements are needed for relating field and laboratory measurements, but the MSP concept appears promising and worth pursuing given the increasing pavement preservation focus.
Assessing Roadway Contributions to Stormwater Flows, Concentrations, and Loads with the StreamStats Application
Authors: Stonewall Adam J. , Granato Gregory E. , Haluska Tana L.
Published: April 2018

The Oregon Department of Transportation (ODOT) and other state departments of transportation need quantitative information about the percentages of different land cover categories above any given stream crossing in the state to assess and address roadway contributions to water-quality impairments and resulting total maximum daily loads. The U.S. Geological Survey, in cooperation with ODOT and the FHWA, added roadway and land cover information to the online StreamStats application to facilitate analysis of stormwater runoff contributions from different land covers. Analysis of 25 delineated basins with drainage areas of about 100 mi2 indicates the diversity of land covers in the Willamette Valley, Oregon. On average, agricultural, developed, and undeveloped land covers comprise 15%, 2.3%, and 82% of these basin areas. On average, these basins contained about 10 mi of state highways and 222 mi of non-state roads. The Stochastic Empirical Loading and Dilution Model was used with available water-quality data to simulate long-term yields of total phosphorus from highways, non-highway roadways, and agricultural, developed, and undeveloped areas. These yields were applied to land cover areas obtained from StreamStats for the Willamette River above Wilsonville, Oregon. This analysis indicated that highway yields were larger than yields from other land covers because highway runoff concentrations were higher than other land covers and the highway is fully impervious. However, the total highway area was a fraction of the other land covers. Accordingly, highway runoff mitigation measures can be effective for managing water quality locally, they may have limited effect on achieving basin-wide stormwater reduction goals.
Tyrosinase Immobilized within Artificial Cells for Detoxification in Liver Failure: I. Preparation and in Vitro Studies
Authors: Shu C.D. , Chang T.M.S.
Published: April 2018

The in vitro removal of tyrosine by means of perfusion over immobilized tyrosinase within artificial cells was studied. The assayed activity of the microencapsulated tyrosinase was about half the value of the same amount of enzyme in free solution. Further studies were conducted to determine the stability, kinetics, and clearance of this system. The results obtained suggest that immobilized tyrosinase within artificial cells is efficient in removing tyrosine in vitro and further study in an animal model is feasible.
The Synthesis of Poly-L-Lysine-Succinyl-Nadp: An Analogue for Nadp/H
Authors: Wills R.A. , Southard W.M. , Sofer S.S.
Published: April 2018

Poly-L-lysine-succinyl-NADP, an analogue for nicotinamide adenine dinucleotide phosphate (NADP/H), has been synthesized by linking NADP/H to poly-L-lysine hydrobromide. This analogue (PL-SNP) was assayed with N, N dimethylaniline (DMA) in the presence of hepatic microsomal oxidase. A regeneration system of G-6-p and G-6-PD was used for reducing the PL-SNP+ to PL-SNPH. This reaction scheme with PL-SNP was found to exhibit up to 100% of the initial activity of pure NADP+ based on Polarographic studies. Reaction rate of production for dimethylaniline oxide (DMA-0) was determined by oxygen consumption and by oxide formation. One of the potential uses of this analogue is as a cofactor in a membrane/liver enzyme detoxification system.
The Role of Biomaterials in Insulin Delivery Systems
Authors: Bruck S.D.
Published: April 2018

The control of blood glucose levels in diabetes involving devices are critically reviewed, and the role of blood-contacting biomaterial components analyzed. These include mechanical insulin-delivery systems of the closed-loop type that require an electronic glucose sensor and feedback, and open-loop systems that deliver insulin without a sensor and feedback. Whole pancreatic and islet transplantations, islet encapsulation, and the potential role of polymeric sustained drug delivery systems are discussed. The medical and social impacts of diabetes mellitus are of prime public health concern and of even greater magnitude than those of heart disease in the United States. While future advances in device design, miniaturization, and biometrials technology will significantly add to the arsenal of therapeutic alternatives, devices capable of controlling blood glucose levels ought to be viewed as mere interim phases rather than as final goals of the problem.
Studies on Amino Acids in Diabetic Patients Undergoing Capd
Authors: Giordano C. , De Santo N.G. , Capodicasa G. , Di Serafino A. , Di Leo V.A. , Fiore R. , Damiano M. , Buonadonna L. , Iorio B.
Published: April 2018

Studies in patients with uremia due to diabetes mellitus treated with CAPD show that the kinetics of amino acid equilibration between dialysate and plasma behave differently from those in patients with uremia of different etiology. Diabetics also have larger amino acid losses in dialysate.
Massive Pulmonary Infarction during Total Cardiopulmonary Bypass in Unanesthetized Spontaneously Breathing Lambs
Authors: Kolobow T. , Spragg R.G. , Pierce J.E.
Published: April 2018

We provided total cardiopulmonary support for 1-18 hours in unanesthetized tethered lambs by peripheral vascular cannulation, using a roller pump and the spiral membrane lung. Respirations were allowed to remain spontaneous and unaided. A Swan-Ganz catheter was placed for retrograde pulmonary artery blood flow sampling. Within a few minutes following induced ventricular fibrillation the PCO2 of sampled blood flowing retrograde through the lungs fell below 10 mm Hg, the PO2 rose to near 150 mm Hg, the pH rose to above 7.8, and the glucose level fell to less than 20 mg %. All of these values later gradually shifted, approaching mixed venous blood values within minutes. After 1-18 hrs of perfusion the animals went into shock and were sacrificed. At autopsy, the lungs of animals breathing room air were beefy and hemorrhagic.

In lambs that were «breathing» CO2 enriched air the retrograde pulmonary artery blood pH and PCO2 was usually maintained close to the mixed venous blood values. The observed pulmonary changes were considerably less abnormal, and the microscopic abnormalities were at times nonexistent.

We believe the integrity of pulmonary blood flow is vital to the survival of the lungs as a functioning organ. Cessation of total forward pulmonary blood flow (unlike partial cardiopulmonary bypass), combined with spontaneous pulmonary ventilation, rapidly leads to massive, pulmonary infactions, shock, and death.
Intraperitoneal Administration of Insulin during Peritoneal Dialysis of Diabetics with Terminal Renal Failure
Authors: Andersen K.E. Hemmeløff , Petersen P. Hyltoft
Published: April 2018

The effect on plasma glucose and serum insulin of varying amounts of insulin added to the dialysis fluid was studied in a total of 10 diabetic patients on chronic peritoneal dialysis (PD). The studies were carried out in a 3-day and a 14-day model, using dialysis fluid with two different concentrations of glucose (75 mmol/l (isotonic and 200 mmol/l (hypertonic)) and with addition of either 0, 6, 12 or 24 U/l of immunoreactive insulin (IRI) to the dialysis fluid. Plasma glucose and serum insulin were determined before, during and after dialysis. Dialysate concentrations of glucose and insulin were determined for each cycle. Addition of 12 and 24 U of IRI/I resulted in a significant rise in serum insulin. With the isotonic dialysis fluid no insulin was required to control plasma glucose during PD. With the hypertonic dialysis fluid addition of 12 U of IRl/l was optimal for the control of plasma glucose, while 24 U/l produced post-dialytic hypoglucemia.
In vivo Hemoperfusion Studies of Bilirubin Removal from Jaundiced Dogs
Authors: Thaler L. Mor. I. , Brandes J.M. , Sideman S.
Published: April 2018

Removal of bilirubin by hemoperfusion (HP) on a macroreticular ion-exchange resin is suggested as a novel clinical procedure for the treatment of jaundiced newborn babies. The efficiency and biocompatibility of the proposed macroreticular (MR) ion exchange column was tested in vivo with jaundiced dogs. An animal model with a choledocho-suprarenal vein shunting allowed to test the column capacity for the adsorption of conjugated and unconjugated bilirubin. A second animal model, based on infusing unconjugated bilirubin directly into the blood stream, enabled to test the column operation at desired unconjugated bilirubin concentrations.

The results of the in vivo hemoperfusion tests are very encouraging and compare favorably with bilirubin removal from babies by exchange transfusion (ET). Operating a column containing 10 ml resin per kg body weight for 3 hours removed over 1.7 times the initial unconjugated bilirubin content. Furthermore, the animals seemed to be unaffected by the HP procedure; the changes due to hemoperfusion on blood chemistry, hematology and some hormone levels were practically insignificant.
Complications of Subclavian Catheter Hemodialysis: A 5 Year Prospective Study in 257 Consecutive Patients
Authors: Vanholder R. , Lameire N. , Verbanck J. , Van Rattinghe R. , Kunnen M. , Ringoir S.
Published: April 2018

The complications related to the use of subclavian catheters for hemodialysis were prospectively studied in 257 consecutive acute and chronic renal failure patients.

Using 394 catheters, 3006 single needle dialyses were performed. Indications for starting catheter dialysis were mainly the absence or disappearance of an adequate vascular access.

Most hazardous complications were sepsis (9), malposition (6), hemothorax (3), bleeding (2), vena cava thrombosis (2) and pneumothorax (2). A number of mechanical problems occurred, where the obstructed catheter could easily be replaced by a modified Seldinger technique. No mortal complications occurred. Patient tolerance was excellent.

It is concluded that single needle subclavian hemodialysis is a valuable alternative vascular access method in acute situations. It enables the continuation of hemodialysis on an ambulatory basis.
Failure to Show a Temperature-Dependent Vascular Stability during Hemofiltration
Authors: Schaefer K. , Von Herrath D. , Hüfler M.
Published: April 2018

The effect of different blood temperatures on the vascular stability during hemofiltration was evaluated in 10 patients being in the regular chronic hemofiltration program. In contrast to recent data, no differences could be observed with regard to the heart rate, systolic blood pressure or mean arterial pressure, when the blood returned to the patient either with a temperature of 34.68°C or 36.22°C. According to these data it is therefore presently not justified to consider differences in the blood temperature as a critical determinant for the vascular stability during HF.
Long-term Cytapheresis in the Treatment of Sézary-syndrome
Authors: Müller N. , Lange C.-E.
Published: April 2018

Lymphocytaphereses using the Fenwal CS 3000 cell separator were performed in three patients with far advanced disease of Sézary-syndrome that was refractory to standard form of therapy. Patients underwent cytapheresis two to three times per week until the WBCs counts were regressed. Thereafter, one pheresis per week was performed for a total of 29 (Pat. A), 18 (Pat. B) to 70 (Pat. C) procedures during periods of 13 (A), 4 (B) to 19 (C) months.

During each pheresis the volume of blood processed was 6-7000 mls. The cytaphereses resulted in an average WBCs reduction of 25 to 35% and of 35-56% of the original peripheral blood Sézary-cell counts. Lymphocytes counts dropped by 47 ± 12% and 87 to 95% of the collected cells were lymphocytes. In addition to the fall in absolute numbers of circulating lymphocytes a change in the relative portions of lymphocytes subpopulations was observed. T-cells were reduced and concurrently B-cells increased. Significant side effects did not occured during or following cytaphereses. Long-term pheresis can effectively treat symptmoms also in older patients resulting in preferential loss of T-cells and Sézary-cells without exposing the patients to dangerously large shifts in fluid volume. The results suggest also that there may be selected patients for whom lymphocytapheresis is an useful therapy, but no in vitro test can reliably separate responders from non-responders, and some patients become refractory to further cytapheresis-therapy after initial clinical remission. While cytapheresis does not appear to be sufficient as a sole therapeutic modality in this disease, it may be for some patients, if initiated early in the course of the disorder, result in clinical improvement. It may also be safely used even when the peripheral WBCs count is normal and for some patients there appears to be additive benefit of the procedure.
In vitro Complement-Independent Activation of Human Neutrophils by Hemodialysis Membranes: Role of the Net Electric Charge
Authors: Tetta C. , Segoloni G. , Camussi G. , Neumann S. , Griva S. , Piva S. , Pacitti A. , Vercellone A.
Published: April 2018

Polymethylmethacrylate (PMMA) membranes with different net electric charges and percentage water contents (anionic 71%, neutral 70%, cationic 75%) were evaluated for their ability to stimulate plasma-free human polymorphonuclear neutrophils (PMN), and compared for potency to cuprophan (Cu), already described as being a potent trigger of PMN. The release of lysozyme, β-glucuronidase, lactic dehydrogenase (LDH), and the generation of a platelet aggregating activity were studied in the supernatants from plasma-free human PMN incubated with different membranes. The PMN intracellular content of neutrophil cationic proteins (NCP), elastase, and cathepsin G were also studied by immunofluorescence using specific antisera on smears of PMN before and after incubation with each membrane.

Only cationic, but not anionic or neutral PMMA induced a marked release of lysozyme (range 20-25% of the sonicated control, assumed as 100%), and β-glu-coronidase (40-43%), and marked depletion of the intracellular content of NCP, elastase, and cathepsin G, suggesting a degranulation process. Platelet aggregating activity was generated and referred to the release of platelet activating factor (PAF) only in the supernatants from PMN incubated with cationic, but not with anionic, or neutral PMMA membranes.

These results indicate that modification of the net electric charge can per se turn PMMA, commonly recognized as inert, into a material with marked PMN activating effects, comparable to those of Cu, a highly reactive polymer.
Flow Analysis for Optimal Configuration of Hemoperfusion Device
Authors: Chang V. , Battistin A. , Rodrigue R. , Chang T.M.S.
Published: April 2018

The objective of this experiment was to determine the flow characteristics of a hemoperfusion device. The standard device consists of a cylindrical container which is tapered towards the outlet end. Flow enters the column through a small inlet tube into the wide frontal area of the column. Having passed through the column containing collodian coated activated charcoal spheres, it leaves by the tapered outlet. In order to achieve our aim, we designed and built a two-dimensional plexiglass model consisting of a vertical cross section of the actual hemoperfusion device. Glass beads were used to simulate the artifi-cal carbon cells and a colored solution was used to enable us to visualize the flow. In the normal configuration, it was determined that stagnation and channelling were present. The model was then analysed in the inverse configuration. This way, flow inlet is through the tapered end and flow outlet is towards the wider cylindrical end. This inverse flow configuration improved the flow characteristics and eliminated most of the channelling and stagnation.
Inorganic Phosphate Removal during Different Dialytic Procedures
Authors: Zucchelli P. , Santoro A.
Published: April 2018

In order to clarify the influence of membrane surface, membrane composition, dialysate buffer and convective transfer on the dialytic removal of inorganic phosphate (Pi), 11 uremic patients were studied. Each patient underwent 7 different dialysis techniques: conventional hemodialysis with acetate buffer and different surface or composition of the membrane, bicarbonate dialysis and a “soft” hemodiafiltration, also termed biofiltration, with post-dilution infusion of 4 liters. The treatment time was fixed at 4 hours.

Our study showed that the dialyzer surface area and the ultrafiltration rate were the major factors in dialytic inorganic phosphorus (Pi) removal. The dialysate buffer does not modify dialytic Pi removal but may influence the rebound phenomenon.
Antibiotic Treatment of Chronic Central Venous Hemodialysis Catheter inFection without Catheter Removal
Authors: Domoto D.T. , Kennedy D.J.
Published: April 2018

Most catheter or shunt infections in hemodialysis patients require the removal of the access before the infection is eradicated. A hemodialysis patient is reported who had multiple previous vascular accesses which failed and thus who had very limited sites for future access placement. When a recurrent Proteus mirabilis catheter infection occurred, a 6-week course of ampicillin intraluminal and tobramycin systematically, eradicated the infection and thus the central venous catheter was salvaged. Serum bactericidal levels with these two antibiotics were obtained early in the course and supported the continued use of antibiotics alone to treat the infection.
Hyperprolactinemia as a Marker of Neurotransmitter Imbalance in Uremic Population
Authors: Biasioli S. , D'Andrea G. , Micieli G. , Feriani M. , Borin D. , Chiaramonte S. , Cananzi A. , La Greca G.
Published: April 2018

Serum prolactin (PRL) levels are elevated in patients with chronic renal failure (CRF) but the mechanisms responsible for these abnormalities are not fully understood. PRL secretion is undoubtedly influenced by many substances, which can be variously altered in uremia: monoamines, endogenous opiates and PTH. Our data suggest that in early renal failure PRL levels are already significantly high and the 24-h pattern of PRL secretion is significantly different from that in controls.

PRL derangements could be due in mild renal failure, to unknown factors (GABA?); in severe CRF, to a major change in dopaminergic activity; in hemodialysis (HD), to a low turnover of monoamines, and in peritoneal dialysis (PD) to increased activity of sero-toninergic and dopaminergic systems.
Effect of Different Dialyzer Membranes on Serum Angiotensin-Converting Enzyme during Hemodialysis
Authors: Docci D. , Delvecchio C. , Turci F. , Baldrati L , Gollini C.
Published: April 2018

The effects of different dialyzer membranes on serum concentration of angiotensin-converting enzyme (ACE) and white blood cells during hemodialysis were examined on a cross-over basis in 20 chronically uremic patients. Hemodialysis with cuprophane membranes was associated with a significant (p < 0.001) fall in the mean leukocyte count during the 1st hour of treatment. The use of polymethylmetacrylate membranes resulted in a more attenuated form of leukopenia and with polyacrylonitrile membranes no change was observed during hemodialysis. Hemodialysis with each membrane caused a comparable, significant (p < 0.005) increase in serum ACE, independent of the degree of leukopenia but significantly (p < 0.001) correlated with the increases in serum proteins. We conclude that this increase in serum ACE concentration after hemodialysis does not reflect acute damage of the pulmonary vascular endothelium during treatment and most probably is a result of hemoconcentration. Therefore, serum ACE analysis is not an indicator of dialyzer membrane biocompatibility.
Mechanisms of Platelet Aggregation Disturbances and Their Relation to Treatment in Patients with Chronic Uremia
Authors: Komarnicki M. , Pietrzak I.
Published: April 2018

We have examined platelet aggregation in patients with chronic uremia using ADP, thrombin and calcium ionophore A23187 as inducers. The study was performed on patients treated conservatively, by hemodialysis and peritoneal dialysis. Platelet aggregation was most significantly depressed in patients treated conservatively and by hemodialysis. Different mechanisms are responsible for platelet dysfunction.
The WBW Jugular Catheter as Long Term Vascular Access for Hemodialysis
Authors: Huraib S.O. , Wijeyesinghe C.R. , Brady H.R. , Holtzer C. , Watson A.R. , Uldall P.R.
Published: April 2018

Single-lumen silastic catheters were placed in the jugular veins of 12 patients to provide vascular access for hemodialysis. In all cases construction of arteriovenous fistulas had been difficult or impossible. The catheters have provided adequate dialysis with a single needle system for periods up to 32 months. Only one case of blood stream infection occurred, in a confused patient who damaged his catheter. There has been no evidence of venous thrombosis or other complications. Jugular vein catheters should be considered as long-term alternatives when A-V fistula construction is not possible.
Does Immunodeficiency in Uremic Patients Promote Dialysis-Related Amyloidosis?
Authors: Simon P. , Ang K.S. , Cavarle Y. , Cam G. , Catheline M. , Genetet N.
Published: April 2018

The present study was undertaken to evaluate the immune function of 5 hemodialysis patients with dialysis-related amyloidosis as compared to 6 without, both groups having a dialytic age from 7 to 21 years, and 5 healthy controls. We investigated serum levels of immunoglobulins (IgG, IgA, IgM), made skin tests and measured peripheral lymphocyte subsets using monoclonal antibodies.

1) The absolute numbers of T3, T4 and T8 cells were significantly lower in hemodialysis patients than controls and T3, T4 cells were lower in patients with amyloidosis than in those without: T3 (m ± SD/μl), 387 ± 253 vs 744 ± 207 (p = 0.03); T4, 262 ± 115 vs 589 ± 297 (p = 0.04).

2) Serum levels of IgG and IgM were significantly lower in patients with amyloidosis than in the others: IgG (m ± SD, g/l), 10.2 ± 1.4 vs 15.4 ± 3.2 (p < 0.001); IgM, 0.65 ± 0.28 vs 1.65 ± 0.37 (p < 0.001).

3) Delayed hypersensitivity studied by skin tests showed less than 3 positive antigens in 4/5 patients with amyloidosis against 1/6 patients without. These data suggest there is a marked defect of T-cell help in uremic patients with dialysis-related amyloidosis.
Hemodynamic and Energetic Assessment of Calves Implanted with a Left Ventricular Assist Device (LVAD)
Authors: Pantalos G.M. , Marks J.D. , Riebman J.B. , Burton N.A. , Depaulis R. , Kolff W.J.
Published: April 2018

Hemodynamic and ventricular energetic parameters were measured in calves implanted with the air driven Utah Ventricular Assist Device (UVAD). Uptake site was varied to determine the effect of control mode and vacuum augmentation of filling. Uptake was drawn solely from the left atrium or combined with a left ventricular apical vent. LVAD outflow returned to the descending, thoracic aorta. Control modes examined included asynchronous pumping as well as 1:1 and 1:2 synchronous diastolic counterpulsation. The 85cc LVAD, vacuum formed from PELLETHANE®, was implanted acutely in four animals and chronically in six (7, 49 and 116 days paracorporeally, 1, 28 and 32 days intrathoracically). Instantaneous blood pressures, intramyocardial pressure, aortic outflow, oxygen consumption, LVAD output and drive parameters were recorded.

LVAD output was independent of control mode when the natural heart rate was ≥ 80 beats per minute. Intrathoracically positioned LVADs pumped a mean flow of ≈5 liters/min without vacuum augmentation of filling. Paracorporeally positioned LVADs pumped ≈3 liters/min mean flow without vacuum augmentation and up to ≈6 liters/min with 38 mm Hg of vacuum augmentation of filling. Instantaneous ascending aortic pressure and flow showed distinct beat-to-beat variation depending on LVAD control mode. Lower average ventricular afterload was observed when pumping the LVAD asynchronously or 1:2 synchronously. In one acute preparation, left ventricular myocardial oxygen consumption was reduced from the unassisted average control level by 37% for the asynchronous and 1:1 synchronous control modes with left atrial uptake. With combined uptake, oxygen consumption was reduced an additional 30% during asynchronous control or 11% during 1:1 synchronous control without any change in LVAD output. Endocardial/epicardial blood flow ratio was similar and ≥1.12 for all test conditions. Renal and brain blood flow was maintained, or slightly elevated during ventricular assistance. Intramyocardial pressures were monitored using Millar catheter tip transducers. In an acute preparation, left ventricular assistance reduced peak intramyocardial pressure. Changing from atrial to combined uptake cannulation further reduced peak intramyocardial pressure for asynchronous and 1:1 synchronous LVAD control. Reduced end-diastolic intramyocardial pressures were seen with all modes of LVAD control.

These data demonstrate excellent UVAD pumping function and suggest that left ventricular assistance does not compromise endocardial blood flow while sustaining blood flow to other major organs. Regardless of the uptake site, asynchronous or 1:2 synchronous LVAD control may be clinically preferable for effective reduction of left ventricular myocardial oxygen consumption.