bluuebunny/crossref_metadata_2025 huggingface dataset:
The New Wave of Mobilisation in Kashmir: Religious or Political?
Authors: Mohanty Simple
Published: March 2018

The intractability of the Kashmir conundrum continues despite the success of counter-insurgency operations carried out by the Indian state which can be seen in militancy levels climbing down since the early 2000s. While in part, this is because India and Pakistan are unable to break new ground on Kashmir, a key factor is that alienation still runs deep among Kashmiri people despite duly elected governments being in place. It does not help when their anxieties are further stoked by religio-political mobilisation, such as the Amarnath land agitation in Jammu in 2008, when Hindutva forces enforced a blockade of essential supplies to the Kashmir Valley. A spate of protests have since wracked Kashmir with stone-pelters confronting security persons who use disproportionate violence to quell them. Though each street protest, whether in 2008, 2009, 2010, 2013 or 2016, had a different trigger, the underlying restlessness and alienation are constants which pose a very real danger of breeding anarchy. This article seeks to explore whether this new wave of mobilisation in Kashmir is religious or political or both in nature, its causal factors and how it is different from the armed insurgency that erupted in 1989. It contends that the state must address and fix such alienation urgently to prevent things going further downhill in the Valley.
Book review: T.K. Oommen, Social Inclusion in Independent India: Dimensions and Approaches
Authors: Roul Kamalakanta
Published: March 2018

T.K. Oommen, Social Inclusion in Independent India: Dimensions and Approaches. New Delhi: Orient BlackSwan, 2014, 342 pp., ₹795, ISBN: 9788125056294.
Book review: Devesh Kapur and Pratap Bhanu Mehta (Eds), Navigating the Labyrinth: Perspectives on India’s Higher Education
Authors: Prakash Amit
Published: March 2018

Devesh Kapur and Pratap Bhanu Mehta (Eds), Navigating the Labyrinth: Perspectives on India’s Higher Education. Hyderabad: Orient BlackSwan, 2017, x + 273 pp., ₹895, ISBN 9789386296993 (Hardcover).
Book review: Subhash Sharma, Why People Protest: An Analysis of Ecological Movements
Authors: Dogra Bharat
Published: March 2018

Subhash Sharma, Why People Protest: An Analysis of Ecological Movements. New Delhi: Publications Division, Government of India, 2016, 240 pp., ₹255, ISBN 9788123021201 (Paperback).
Formal or informal—which learning approach do music majors prefer?
Authors: Mok Annie O.
Published: March 2018

Although formal aural musicianship learning is prevalent in university and conservatory music curricula, an informal “ear-copying” approach can be an alternative. In this study, the formal “Written task” approach was taught weekly to a class of university music majors by the teacher–researcher, but an extra ear-copying “Listen & copy” task was added as part of the course requirements. The students formed friendly groups, chose a piece of music they liked, copied it by ear and then performed it in class. The aim was to compare the students’ perceived effectiveness in and perceptions of these two approaches, and to identify the approach they preferred. Data were collected from a questionnaire that included qualitative as well as quantitative questions, and which was processed using paired sample t-tests. The results showed that overall there was no perceived difference in the effectiveness of the two approaches in helping the students improve their aural musicianship. However, for the group who preferred the informal approach (almost double the number of students preferred the formal task), it showed statistically significant differences between the perceived effectiveness of both approaches. The active nature of informal learning was perceived as an enjoyable experience, although some students may require scaffolding in their learning.
Activity-dependent neuronal Klotho enhances astrocytic aerobic glycolysis
Authors: Mazucanti Caio H , Kawamoto Elisa M , Mattson Mark P , Scavone Cristoforo , Camandola Simonetta
Published: March 2018

Mutations of the β-glucuronidase protein α-Klotho have been associated with premature aging, and altered cognitive function. Although highly expressed in specific areas of the brain, Klotho functions in the central nervous system remain unknown. Here, we show that cultured hippocampal neurons respond to insulin and glutamate stimulation by elevating Klotho protein levels. Conversely, AMPA and NMDA antagonism suppress neuronal Klotho expression. We also provide evidence that soluble Klotho enhances astrocytic aerobic glycolysis by hindering pyruvate metabolism through the mitochondria, and stimulating its processing by lactate dehydrogenase. Pharmacological inhibition of FGFR1, Erk phosphorylation, and monocarboxylic acid transporters prevents Klotho-induced lactate release from astrocytes. Taken together, these data suggest Klotho is a potential new player in the metabolic coupling between neurons and astrocytes. Neuronal glutamatergic activity and insulin modulation elicit Klotho release, which in turn stimulates astrocytic lactate formation and release. Lactate can then be used by neurons and other cells types as a metabolic substrate.
Seeing Through the Avatar’s Eyes: Effects of Point-of-View and Gender Match on Identification and Enjoyment
Authors: Ferchaud Arienne , Sanders Meghan S.
Published: March 2018

This study examines the mediating role of identification in the relationship between gameplay point-of-view, gender-swapping, and enjoyment of the gaming experience, taking a multidimensional perspective of identification. In a 2 × 2 factorial experiment, we manipulated avatar point-of-view and gamer-avatar gender match and measured the influence on physical similarity, homophily, customization, perspective-taking, wishful identification, and liking. In addition, we tested both how the independent variables influence enjoyment and how each identification dimension may predict enjoyment. Results provided initial support for a multidimensional view of gaming identification. In addition, some of the identification dimensions were found to mediate the relationship between game point-of-view and enjoyment, but the nature of these relationships depended on gender match. Implications for conceptualizations of identification and video game experiences, as well as the theoretical implications for understanding awareness, are discussed.
Imaging of symptomatic total knee arthroplasty with cone beam computed tomography
Authors: Jaroma Antti , Suomalainen Juha-Sampo , Niemitukia Lea , Soininvaara Tarja , Salo Jari , Kröger Heikki
Published: March 2018

Background

Computed tomography (CT) can be used to assess the rotational alignment of prosthesis components to identify possible underlying causes of symptomatic total knee arthroplasty (TKA). The use of cone beam computed tomography (CBCT) for the imaging of extremities is relatively new, although it has been widely used in dental imaging.

Purpose

To assess the intra- and inter-observer reproducibility of CBCT, as well as to validate CBCT for TKA component and periprosthetic bone diagnostics.

Material and Methods

CBCT scans were performed on 18 patients the day before a scheduled revision TKA, from which the intra- and inter-observer reproducibility were assessed. Component rotation and loosening were evaluated. Perioperative bone defects were classified.

Results

The inter-observer intraclass coefficient correlation (ICC) for femoral component rotation was 0.41 (95% confidence interval [CI] = 0.12–0.69). For the tibial component, the ICC was 0.87 (95% CI = 0.74–0.94). Intra-observer reproducibilities were 0.70 (95% CI = 0.35–0.87) and 0.92 (95% CI = 0.80–0.97), respectively. The sensitivity for tibial component loosening was 97% and the specificity was 85%. The reliability of bone defect classification was only weak to moderate.

Conclusion

Two-dimensional (2D) CBCT scanning provides reliable and reproducible data for determining the rotation of femoral and tibial components, while showing minor overestimation of tibial component loosening. CBCT is a promising new tool for the evaluation of symptomatic knee arthroplasty patients, with a substantially lower radiation dose compared to conventional 2D multi-slice CT.
Public awareness of the need to call emergency medical services following the onset of acute myocardial infarction and associated factors in Japan
Authors: Yonemoto Naohiro , Kada Akiko , Yokoyama Hiroyuki , Nonogi Hiroshi
Published: March 2018

Objectives

Early recognition of acute myocardial infarction (AMI) and early activation of emergency medical services (EMS) are essential to reduce delays in patient care. We investigated public awareness of the need to call EMS at onset of AMI and evaluated associated factors.

Methods

In January 2008, a nationwide population-based survey using quota sampling was conducted in Japan. The primary outcome measure was responsiveness to promptly calling EMS at AMI onset, subdivided by on-time (daytime) and off-time (nights and holidays) hours.

Results

In total, 1200 participants were surveyed. Their mean age was 46.3 years (standard deviation, 17.4), and 50.3% (n=604) were women. A total of 11.6% (n=139) answered that they would call EMS during on-time hours, and 27.5% (n=330) stated that they would call during off-time hours. Multivariable analysis showed that the participants’ age, female sex, education level, and self-confidence regarding their understanding of AMI were significant associated factors. The associated factors were almost identical during the off-time hours; only sex was no longer significant.

Conclusions

Public awareness of the need to call EMS at AMI onset in Japan was low. Previous intervention studies that were not effective may not have targeted groups with significant risk factors.
Association between Toxoplasma gondii infection and history of blood transfusion: a case-control seroprevalence study
Authors: Alvarado-Esquivel Cosme , Sánchez-Anguiano Luis Francisco , Hernández-Tinoco Jesús , Ramos-Nevarez Agar , Estrada-Martínez Sergio , Cerrillo-Soto Sandra Margarita , Medina-Heredia Gonzalo Elías , Guido-Arreola Carlos Alberto , Soto-Quintero Araceli Alejandra , Beristain-Garcia Isabel
Published: March 2018

Objectives

This study was performed to determine the association between seropositivity to Toxoplasma gondii and a history of blood transfusion.

Methods

Patients who had undergone blood transfusion (n = 410) and age- and sex-matched controls who had not undergone blood transfusion (n = 1230) were examined for anti- T. gondii IgG and IgM antibodies using enzyme-linked immunoassays.

Results

Anti- T. gondii IgG antibodies were detected in 57 (13.9%) patients and in 129 (10.5%) controls with a borderline difference [odds ratio (OR) = 1.37, 95% confidence interval (CI) = 0.98–1.92]. High anti- T. gondii IgG antibody levels (>150 IU/mL) were found in 27 (47.4%) of the 57 anti- T. gondii IgG-positive patients and in 37 (28.7%) of the 129 anti- T. gondii IgG positive controls with a significant difference (OR = 2.23, 95% CI = 1.17–4.26). Anti- T. gondii IgM antibodies were found in 13 (22.8%) of the 57 seropositive patients and in 37 (28.7%) of the 129 seropositive controls, but the difference was not significant (OR = 0.73, 95% CI = 0.35–1.52). Seroprevalence was significantly higher in patients aged >50 years than in controls of the same age and in female patients than in female controls.

Conclusions

These findings indicate that a history of blood transfusion is a risk factor for T. gondii infection.
Prevention of Catheter Related Infections in Patients on CAPD
Authors: Thodis E. , Passadakis P. , Vargemezis V. , Oreopoulos D.G.
Published: March 2018

Catheter-related infections remain a serious problem for patients on peritoneal dialysis. Such infections can be reduced by careful patient selection and training, by the use of the best connection technology and screening and treating nasal carriage. To date, treatment is less than optimal and therefore, the primary goal should be prevention of catheter-related infections. Prevention is based on improving catheter design and implantation technique, while providing careful exit-site care. Regardless of how it is implemented, we must aggressively pursue the prevention of catheter-related infections by eradicating S.aureus exit-site carriage in PD patients. Based on its effectiveness in adult PD patients, its low rate of adverse effects, and its reasonable cost-effectiveness, application of mupirocin ointment at the exit-site is the current method of choice for preventing PD catheter infections caused byS. aureus. In addition to reducing S. aureus exit-site infections, mupirocin seems to reduce the rates of staphylococcal peritonitis and PD catheter loss. Whether the ointment should be applied in the nares, to the exit-site or both, and whether it should be used only in staphylococcal nasal carriers or all PD patients requires further study.
Nanoscale Modulation of the Pore Dimensions, Size Distribution and Structure of a new Polysulfone-Based High-Flux Dialysis Membrane
Authors: Ronco C. , Bowry S.
Published: March 2018

Current haemodialysis therapy modalities such as haemodiafiltration enhance the removal of larger uraemic solutes from the blood of patients on end-stage renal disease. A number of clinical investigations have demonstrated the clinical benefits of such therapies in contributing towards better patient survival rates and an improved quality of life.

A fundamental prerequisite to the application of convective treatment modalities is the availability of appropriate, technologically-advanced high-flux dialysis membranes that are able to eliminate larger uraemic substances with high efficiency but without causing an excessive leakage of useful proteins. A new membrane, Helixone®, has been developed specifically to meet the present-day requirements of high-flux dialysis and haemodiafiltration therapies involving large substitution rates. The application of nanotechnology fabrication principles and procedures has enabled the development of a membrane having highly-defined inner, separating layer surface structures that offer minimal resistance to the removal of large molecular weight substances across the membrane; for the first time, pore size dimensions, pore size distribution and pore geometry have been modulated and controlled at the nanoscale level for Helixone®.

This paper describes the characterisation of the essential structure- and permeation-related parameters of the new membrane using a number of physical analytical techniques.
Regulation of Base Balance in Bicarbonate Hemofiltration
Authors: Santoro A. , Ferrari G. , Bolzani R. , Spongano M. , Zucchelli P.
Published: March 2018

The purpose of this study was to investigate the feasibility of bicarbonate as a substitute for acetate or lactate in hemofiltration solutions using a new bag for the bicarbonate substitution fluid. We analysed 24 hemofiltration sessions with different HCO3– concentrations (30, 35 and 40 mEq/L) in the substitution fluid. The increase in the HCO3– concentration in the substitution fluid resulted in a more positive HCO3– balance. The Net Base Gains (NBG) were, respectively, 73.7 ± 92 with 30, 138.2 ± 97 with 35 (p < 0.05 vs 30) and finally 201 ± 65.9 with 40 mEq/L (p < 0.001 vs 30). The physical separation between the base losses and gains could facilitate the modelling approach in hemofiltration. By means of a stepwise regression analysis, we studied a series of variables that could influence end-treatment HCO3–, which was significantly and directly dependent (F = 6.003, r = 0.747, p = 0.0027) on the HCO3– concentration in the substitution fluid and the apparent HCO3– space. HCO3– values predicted by the statistical model correlated well with those actually measured (r = 0.757; p < 0.001). This mathematical modelling approach allowed us to predict the quantities and concentrations of HCO3– to be infused in order to obtain an ideal acidosis correction, tailored to individual patient needs.
Preliminary Report on Cell Encapsulation in a Hydrogel Made of a Biocompatible Material, AN69, for the Development of a Bioartificial Pancreas
Authors: Honiger J. , Darquy S. , Reach G. , Muscat E. , Thomas M. , Collier C.
Published: March 2018

The occurence of an inflammatory reaction represents the major obstacle to the development of any implantable system including micro and macroencapsulation. The purpose of this study was to describe an encapsulation method for cells using a membrane made of AN69, a copolymer of acrylonitrile which is considered as a reference in biocompatibility in the field of haemodialysis. The hydrogel of AN69 was obtained after a coagulation step at room temperature followed by a solvent/non-solvent (water) exchange phase. Microcapsules were obtained by co-extrusion of AN69 collodion and saline (with or without cells). The function of encapsulated cells was assessed in vitro, demonstrating cell survival after the microencapsulation procedure. These preliminary data are consistent with the potential interest for the development of the microencapsulation procedure aimed at realising a bioartificial pancreas
In vivo monitoring of lactate and glucose with microdialysis and enzyme reactors in intensive care medicine
Authors: De Boer J. , Korf J. , Plijter-Groendijk H.
Published: March 2018

Methods for the monitoring of glucose and lactate in intensive care units (ICU) based on microdialysis and continuous flow enzyme reactions plus some in vitro and in vivo characteristics of the probes used and the detection systems are described. Two microdialysis techniques were developed for clinical use: in sepsis patients a subcutaneous device for lactate monitoring was placed and in prematurely born infants a transcutaneous device was used for nearly non-invasive sampling of glucose from the skin. There was a relatively strong relationship between transcutaneously sampled and blood glucose in the neonates, on the other hand the relationship between subcutaneously sampled and blood lactate was highly significant but relatively weak. These results and our preliminary results obtained with transcutaneous ethanol monitoring (not presented here) show that in vivo possibilities of our techniques depend on the location of the sampling/detection devices and the chemical nature of the analyte, because these properties determine diffusion characteristics in vivo. The present approach may be an alternative to the use of the more integrated biosensor technology in vivo, since it avoids major problems related to biocompatibility.
Effectiveness and Safety of Recombinant Human Erythropoietin (r-HuEPO) in the Treatment of Anemia of Chronic Renal Failure in Non Dialysis Patients
Authors: Kulzer P. , Schaefer R.M. , Krahn R. , Schaefer L. , Heidland A. ,   For The European Multicentre Studygroup, Friedberg D. , Steffensen G. , Pasternak A. , Jahn H. , Mery J.P. , Edel H. , Grabensee B. , Krause D.W. , Temminghoff M. , Dahl K. , Saltvedt E. , Fauchald P. , Lindholm T. , Lundberg M.
Published: March 2018

Seventy-five non-dialized patients with chronic renal failure (CRF) and severe renal anemia were enrolled in a study, receiving r-HuEPO subcutaneously thrice weekly for 6 months. In 64 patients (85%) 7 weeks of treatment with a weekly dose of 158 U/kg were required to achieve Hb concentrations within the target range of 10 to 12 g/dl. Of the 11 patients (15%) who failed to achieve the target Hb range, none were considered to be non-responders as they were excluded for unrelated reasons prior to week 16 (8 cases), or were iron deficient (2 cases), or had bleeding complications (1 patient). Maintaining the Hb concentration at a level of 10.5 g/dl required a mean r-HuEPO dose of 92 U/kg per week. Adverse events were generally mild or moderate. The most commonly reported were hypertension (8%), viral infection/including flu-like syndrome (7%), nausea (7%), and dizziness (5%). Statistically significant increases in mean creatinine concentrations observed after 12 and 24 weeks were most likely due to the progression of renal disease. These results confirm that 50 U/kg of r-HuEPO given 3 times per week subcutaneously provide a safe and effective therapy for anemic predialysis patients.
Reconstruction of Anal Function by Transposed Gracilis Muscle with Electral Stimulation: Rabbit Model
Authors: Shatari T. , Sugiyama Y. , Teramoto T. , Kitajima M. , Minamitani H.
Published: March 2018

For the reconstruction of anal function for fecally incontinent patients, it could be practicable to transpose the gracilis muscle around the anal canal, with electrical stimulation to maintain contraction. It is necessary to keep continuous tonus, so tetanic contraction or “summation” would be essential for fecal continence, with a stimulation which permits prolonged contraction. Transposition of the gracilis muscle around the rectum was performed in thirteen Japanese white male rabbits. The muscles of the conditioning group (n=8) were stimulated at 10 Hz for 6 weeks before the procedure. By stimulation at 15 Hz, a low frequency to permit prolonged contraction, the neoanal pressure increased maximally to 134.2 ± 55.6 cmH2O (mean ± s.d.) in the conditioning group, and to 115.0 ± 37.1 cmH2O in the non-conditionin group (n=5) (N.S.). But, the basal pressure with stimulation rose 82.3 ± 12.4% (mean ± s.d.) of the increase in the conditioning group, while that of the non-conditioning group remained at resting pressure (p<0.001). The conditioning made it possible for the rabbit's gracilis muscle to create anal pressure with a sufficient rise in the basal pressure at a frequency permitting prolonged contraction.
Glycerol Toxicity for Human Peritoneal Mesothelial Cells in Culture: Comparison with Glucose
Authors: Witowski J. , Knapowski J.
Published: March 2018

Glycerol has been proposed as a substitute osmotic agent for glucose in peritoneal dialysis fluids. We have compared the effect of glycerol and glucose on the function of human peritoneal mesothelial cells (HPMC) in vitro. The viability of HPMC was not affected by glycerol (up to 250 mM), whereas it was reduced by glucose in a time- and dose-dependent manner, as assessed by the LDH release. Although the incubation of HPMC with glycerol induced a dose-dependent decrease in HPMC proliferation, the effect was significantly less inhibitory than that produced by glucose. In HPMC treated with 90 mM of glycerol or glucose the incorporation of [3H]-thymidine had reached 79.0±19.3% and 55.3+4.0% of the control (p<0.05 and p<0.01), respectively. As measured by the [methyl-14C]-choline incorporation, the intracellular amount of newly synthesized phospholipids was reduced from (cpm/μg cellular protein) 147±58 in control HPMC to 59+15 in cells exposed to 90 mM of glucose (p<0.01), but not affected by glycerol (163±65). On the other hand, both glycerol and glucose (90 mM) decreased the synthesis of proteins (as assessed by the [3H]-proline incorporation) and interfered with potassium (86Rb) transport mechanisms in HPMC. Our data suggest that there exist some possibly advantageous aspects of glycerol as far as mesothelial cell biocompatibility profile is concerned.
Intradialytic Oral Iron Therapy
Authors: Dunea G. , Swagel M.A. , Bodiwala U. , Arruda J.A.L.
Published: March 2018

In order to test the limits of what can be achieved with oral iron therapy and eliminate the factor of noncompliance, we conducted a series of observational studies in an 140-patient inner city dialysis unit. In these studies the patients received supervised iron therapy as 3-4 ferrous sulfate (325 mg) tablets during each dialysis. Acceptance and tolerance was high, less than 10% refusing to take the tablets. In two separate observational studies oral intradialytic iron yielded a hematocrit 28% in 69% of patients and 30% in 42-52%. There was no correlation between the final hematocrit and serum ferritin or transferrin saturation. The response to iron therapy could frequently not be predicted by the ferritin levels or transferrin saturation. We conclude that in view of the known hazards of intravenous iron dextran, oral intradialityc therapy should be tried first and that a good response can be expected in one half to two thirds of hemodialysis patients.
Relationship between Some Design Characteristics and Wear in the Bicarbon Heart Valve Prosthesis
Authors: Arru P. , Rinaldi S. , Stacchino C. , Vallana F.
Published: March 2018

The hinge design of a new bileaflet valve (Bicarbon) is presented in relation to the long-term durability characteristics. Theoretical considerations supported by experimental findings, lead to the identification of two different wear mechanisms acting in bileaflet valves, i.e. impact and friction wear. Impact wear, caused by the collision between the hinge stops and inflow surface of the leaflet pivots, is the predominant phenomenon; it is mostly influenced by the design of the coupling elements. The wear due to friction is significantly less important, given a proper kinematic coupling and a thorough washout. These different mechanisms can significantly affect the wear resistance and long-term reliability of bileaflet valves; therefore, they have been properly taken into account in designing the new valve model. The safety of the overall material and design solutions adopted in the Bicarbon valve has been confirmed by extensive accelerated durability tests resulting in no mechanical failure or loss of functionality
Comparative Evaluation of Different Methods to Estimate Urea Distribution Volume and Generation Rate
Authors: Cappello A. , Grandi F. , Lamberti C. , Santoro A.
Published: March 2018

Eight methods to estimate urea distribution volume and generation rate from blood urea samples measured in dialysis patients are reviewed. An analytical solution has been provided for a double-pool variable volume kinetic model to allow for faster and more accurate simulation and identification. The reliable parameter estimates provided by the double-pool kinetic model starting from seven samples, were assumed as references for the estimates obtained by the remaining methods. These include three kinetic models and four methods based on urea mass-balance. In particular, the estimation techniques differ in the number of compartments where urea is assumed distributed (double- and single-pool) or in the number of blood urea samples. Among the methods based on mass-balance, two techniques neglecting the weight loss or the urea generation during dialysis, were also analysed. The results obtained during hemofiltration sessions using three samples, usually available in clinical practice at the beginning and at the end of dialysis, demonstrate that a new method based on double-pool kinetics provides, on average, the most reliable estimates. Moreover, methods belonging to a single pool view and including both weight loss and urea generation during dialysis seem to underestimate by 1÷2 liters the urea distribution volume. However, neglecting the weight loss or the urea generation can overcompensate this error, resulting in a significant overestimation of the distribution volume. Finally, it has been experimentally proved that the single-pool kinetic methods overestimate the urea production rate, while techniques based on mass balance provide more reliable values.
Dialyser Reuse: An Automated System Using Peracetic Acid
Authors: Francoeur R. , Vas S. , Uldall R.
Published: March 2018

For 3 years starting in April 1989, in a 17-station, in-centre haemodialysis unit at the Toronto Western Hospital, re-use of dialysers was performed using the Renatron-2 Dialyser Reprocessing System with peracetic acid as a sterilant. During this period 40,234 treatments were carried out and dialysers were used an average of 4.2 times. Net savings, after taking into account the total costs of re-use, averaged Can $309,000,000 per year. There were no deaths and no discernible morbidity attributable to the practice of re-use. We conclude that dialyzer re-use is an effective way to reduce the costs of haemodialysis and is entirely safe providing that it is carried out properly.
Cerebral Blood Flow Velocity during High Volume Plasmapheresis in Fulminant Hepatic Failure
Authors: Larsen F.S. , Hansen B.A. , Jørgensen L.G. , Secher N.H. , Bondesen S. , Linkis P. , Hjortrup A. , Kirkegaard P. , Agerlin N. , Kondrup J. , Tygstrup N.
Published: March 2018

High volume plasmapheresis has previousy been found to improve neurological statuses in patients with fulminant hepatic failure. We investigated the relationship between the neurological status and cerebral blood flow velocity (Vmean) during high volume plasmapheresis in 18 consecutive patients (ten females and eight males) with fulminant hepatic failure, with a mean age of 43 (range 9 to 57) years. The mean arterial pressure (MAP) and intracranial pressure (ICP) were also recorded. A total of 16% of body weight was exchanged with fresh frozen plasma per day. Thirty-six plasma exchanges were performed with a median of 2 (range 1 to 8) per patient. Eleven of the patients survived (61%), nine after liver transplantation. Following the first high volume plasmapheresis, the coma score improved from 6 (1-8) to 2 (0-8) (p < 0.05), Vmean increased from 40 (14-152) to 62 (16-186) cm S−1 (p < 0.05), and MAP from 72 (35-118) to 94 (47-138) mmHg (p < 0.05). The intracranial pressure (ICP) was monitored and remained unchanged in nine patients whereas the cerebral perfusion pressure (MAP minus ICP) increased in the surviving group from 55 (40-74) to 80 (50-91) mmHg (p = 0.07) in contrast to no changes in the non survival group. In conclusion this study suggests that the neurological status, may improve during high volume plasmapheresis as MAP and Vmean increase the cerebral oxygen delivery.
Long-Term Comparative Evaluation of Synthetic and Cellulosic Membranes in Dialysis
Authors: Bonomini V. , Colì L. , Feliciangeli G. , Costa A. Nanni , Scolari M.P.
Published: March 2018

A long-term retrospective evaluation (5 years) compares two groups of RDT patients (group 1 on continuous treatment with cellulosic membranes and group 2 with synthetic membranes) regarding survival, general clinical morbidity, and β2M-related morbidity. The results showed no significant long-term differences between the groups either for survival or general morbidity despite some differences in biocompatibility. The higher intradialytic removal of β2M by synthetic membranes did not lead to a reduction in either pre-dialysis β2M values or β2M related morbidity. The higher cost of synthetic over cellulosic membranes and the disappointing of many clinical expectations suggest that the use of such membranes, in association with alternative techniques, should take place only according to certain “elective” indications such as old age, diabetes, vascular instability or intradialytic disequilibrium syndrome.
IgA nephropathy: common nephritis leading to end-stage renal failure
Authors: Lai K.N. , Wang A.Y.M.
Published: March 2018

IgA nephropathy (IgAN) characterized by mesangial proliferative glomerulonephritis with predominant mesangial IgA deposition is the commonest glomerulonephritis worldwide. In contrast to the initial report indicated a favorable prognosis, subsequent reports have shown a highly variable outcome leading to end-stage renal failure (ESRF) in a significant proportion of patients. Many centers report a high incidence (ranging from 10-22%) of patients with idiopathic IgAN amongst the total population of patients on maintenance dialysis. Most of these patients develop ESRF at their middle-age and hence, will pose a significant and important workload in the dialysis and transplantation programme. Because IgAN is a disease with a variable rate of progression leading to chronic renal failure amongst younger patients and with neither effective nor specific treatment, identification of the clinical and pathologic prognostic indicators for these patients is of paramount importance in planning the long-term renal replacement program.
The outcome of critically ill elderly patients with severe acute renal failure treated by continuous hemodiafiltration
Authors: Bellomo R. , Farmer M. , Boyce N.
Published: March 2018

Objectives

To study the outcome of critically ill elderly patients with severe acute renal failure managed by continuous hemodiafiltration.

Design

Prospective study.

Setting

Intensive Care Unit of tertiary institution

Patients

Seventy-two consecutive critically ill patients of 65 years or older admitted to the ICU with severe acute renal failure. Seventy similar control patients of age < 65 years.

Intervention

Treatment of all patients with continuous hemodiafiltration. Measurements and main results: Safety and effectiveness of therapy were assessed. Main outcome measures were duration of oliguria, of ICU stay, and hospital stay for survivors, and survival to ICU discharge and to hospital discharge. Mean APACHE II score on admission was 29.8 (95% confidence interval: 28.5 to 31.1) and mean organ failure score prior to initiation of continuous hemodiafiltration was 3.9 (95% confidence interval: 3.6 to 4.2). Sepsis was present in 51 cases (70.8%) and bacteremia or fungemia in 24 (33.3%). Fifty-three (73.6%) required mechanical ventilation for > 3 days. Vasopressor drugs were used in 65 (90.2%). Continuous hemodiafiltration controlled azotemia in all patients and was only associated with minor complications. Thirty-four patients (47.2%) survived to ICU discharge and 30 (41.6%) to hospital discharge. Among survivors, duration of oliguria was 11.6 days (95% confidence interval: 9.1 to 14.1), mean duration of ICU stay 8.6 days (95% confidence interval: 6.1 to 11.) and mean duration of hospital stay 33.1 days (95% confidence interval: 28.8 to 37.4). No statistically significant difference in survival was found when these patients were compared to a control group of similar but younger patients who also received ICU care and continuous hemodiafiltration for the treatment of severe acute renal failure.

Conclusions

A greater than 40% survival was achieved in critically ill elderly patients with severe acute renal failure by the use of continuous hemodiafiltration. These patients had an in hospital survival comparable to that of younger patients. These findings support an aggressive renal replacement approach in such patients and suggest that continuous hemodiafiltration may be ideally suited to their management.
Prophylactic use of intravenous prostaglandin E1 for radial arterial spasm in uremic patients undergoing construction of arteriovenous hemodialysis fistulas
Authors: Owada A. , Saito H. , Nagai T. , Iwamoto H. , Shiigai T.
Published: March 2018

Radial arterial spasm in uremic patients undergoing construction of internal arteriovenous (AV) dialysis fistulas was investigated transcutaneously using ultrasonic Doppler flowmetry. In 6 of 16 control patients, the radial arterial blood flow was significantly decreased for 20 min after anastomosing, indicating vasospasm. Vasospasm did not occur in 15 patients who were continuously administered prostaglandin E1 (PGE1) intravenously (10 ng/kg/min) during surgery. The arterial blood flow was significantly increased in patients receiving PGE1 in comparison with control patients not receiving PGE1 and in whom vasospasm did not occur. Regarding patency of hemodialysis access, the fistula was obstructed in one control patient with radial arterial spasm, but not in patients with PGE1 infusion. Our study suggests that PGE1 may be effective in preventing vasospasm in patients undergoing placement of internal AV dialysis fistulas.
On line filtration of dialysate: structural and functional features of an asymmetric polysulfone hollow fiber ultrafilter (Diaclean®)
Authors: Ronco C. , Cappelli G. , Ballestri M. , Lusvarghi E. , Frisone P. , Milan M. , Dell'Aquila R. , Crepaldi C. , Dissegna D. , Gastaldon F. , La Greca G.
Published: March 2018

The endotoxin transfer across dialysis membranes has been investigated using specific in vitro circuits. Backdiffusion and backfiltration have been analyzed and most dialysis membranes have shown to be permeable to LAL positive substances. Synthetic membranes however display the better capacity of retention of these products despite their higher porosity and permeability. For such reason synthetic polysulfone ultrafilters are used as pyrogen filters to obtain ultrapure dialysate. We have investigated the characteristics of a polysulfone ultrafilter named Diaclean and manufactured by Amicon Ireland. The capacity of endotoxin retention has been investigated both in filtration and backfiltration modes on new and used ultrafilters. The capacity of endotoxin adsorption was investigated as well. Used ultrafilters appeared to maintain the retention capacity and the adsorption capacity up to 4 months of use. Only slight differences were noted from the baseline values (p = n.s.). The best adsorption capacity is always displayed by the outer layer of the membrane suggesting its best utilization in back filtration mode with tangential flow. No morphological changes were observed in the used membrane analyzed by scanning electron microscopy.
Peritoneal dialysis prescription: the “Clearance Peak” model
Authors: Virga G. , Amici G. , Da Rin G.
Published: March 2018

Creatinine clearance (CRCL) was studied in 20 patients on CAPD in relation to the dwell times (DT), in order to establish a personalised dialysis schedule with the best clearance (CL) results, while respecting the patient's life-style. By calculating the CRCL from the two exchanges with dwell-times of 4 and 8 hours (2 1, 2.27%), curves (2nd degree polynomial regression) were plotted with three points (Oh, 4h, 8h) for CRCL and the ultrafiltration rate (UF) as a function of the DT. The DT corresponding to the CRCL peak (CLPeak-time) was calculated for each subject with the first derivative of the function. On the basis of the CRCL obtained with the three most common DT (4h, 6h, 8h), we divided the patients into three categories (CLPeak-time <5h: “fast”, 5-7h: “normal”; >7h: “slow”) for the best CRCL correspondence of the 4h, 6h or 8h exchanges respectively. Also the 8h/4h ratio was used to determine CLPeak-time. For each of the three categories there is a corresponding dialysis schedule for the best CRCL and UF results of the exchanges with DT of 4, 6 and 8 hours, plus the theoretical calculation of the daily CRCL obtainable (“fast”: APD; “normal”: CAPD 4 exchanges/DAPD 4 exchanges; “slow”: CAPD 4 exchanges). The “CLPeak” dialysis prescription model therefore identifies the most advantageous DT for each patient by using the CRCL values of two 2.27% exchanges of 4 and 8h respectively. Functional classification into three categories may give a rational orientation to dialysis prescription in order to reach the maximum CRCL possible with the individual peritoneal transport rates.
Blood compatibility of two different types of membrane oxygenator during cardiopulmonary bypass in infants
Authors: Gu Y.J. , Boonstra P.W. , Akkerman C. , Mungroop H. , Tigchelaar I. , Van Oeveren W.
Published: March 2018

The contact of blood with the artificial extracorporeal circuit causes a systemic inflammatory response due to blood activation. In this study, we compared two different paediatric membrane oxygenators used for extracorporeal circulation: a hollow fibre membrane oxygenator (Dideco Masterflo D-701, n=10), and a flat sheet silicone membrane oxygenator (Avecor Kolobow 800-2A, n=10). Blood compatibility was indicated by measuring complement activation as well as leukocyte and platelet activation. In patients perfused with a flat sheet membrane oxygenator, concentrations of complement split products C3a were significantly increased 30 minutes after the start of bypass (p<0.01), whereas only a mild increase of C3a was found in patients perfused with a hollow fibre membrane oxygenator. Leukocyte and platelet counts dropped uniformly in both groups after the start of bypass mainly due to hemodilution. Activation of leukocytes and platelets identified by both plasma β-glucuronidase and β-thromboglobulin was similar in both groups. Infants perfused with a flat sheet membrane oxygenator received significantly more donor blood than those perfused with a hollow fibre oxygenator (p<0.05). These results indicate that when used during paediatric cardiopulmonary bypass, a flat sheet membrane oxygenator has a higher complement activity than a hollow fibre membrane oxygenator, which is probably due to the relatively larger blood-surface contacting area of the oxygenator.
Hybrid liver support system in a short term application on hepatectomized pigs
Authors: Gerlach J. , Trost T. , Ryan C.J. , Meißler M. , Hole O. , Müller C. , Neuhaus P.
Published: March 2018

A short term application of a hybrid liver support system in circuits with continuous plasma-separation was investigated in a model of hepatectomized pigs under general anesthesia. Primary pig hepatocytes were immobilized in a bioreactor with three independent capillary systems. An immune barrier is achieved by avoiding the direct contact of blood cells with the hepatocytes by a plasmaseparation step and by an outflow filtration within the reactor. In three groups (hepatectomized pigs and system with- or without hepatocytes as well as untreated pigs with system without hepatocytes), the short term metabolism of the reactors was positively demonstrated by investigating ammonia detoxification, phenylalanine- and lactate metabolism. Limitations of the presented model are discussed.
Heparin surface coated hard shell venous reservoirs: experimental evaluation ex vivo
Authors: von Segesser L.K. , Mihaljevic T. , Tönz M. , Leskosek B. , Pei P. , Turina M.
Published: March 2018

The present study was designed for ex vivo evaluation of a heparin coated hard shell venous reservoir in comparison to uncoated control reservoirs. An open chest bovine right heart bypass model (n=9, bodyweight 72 ± 6 kg) with passive blood drainage from the right atrium into the venous reservoir and active retransfusion into the pulmonary artery (roller pump) was selected for this purpose. Clear priming was used for the open perfusion circuit. No heparin was given before or during the evaluation period which was scheduled for 6 hours. Reservoir blood flow was at the beginning 3.5 ± 0.6 I/min for coated versus 3.4 ± 0.3 l/min for uncoated (NS). After 6 hours, blood flow was 3.3 ± 0.1 I/min for coated versus 2.7 ± 0.4 l/min for uncoated (p<0.05). Hematocrit moved from a baseline level of 30 ± 2% for coated versus 28 ± 3% for uncoated (NS) to 28 ± 3% for coated versus 27 ± 5% for uncoated (NS) after 6 hours. Prebypass platelet levels of 100% in both groups moved to 84 ± 3% for coated versus 78± 23% for uncoated (NS) after 6 hours. Activated coagulation time (ACT) before bypass was 148 ± 12 s for coated and 153 ± 6 s for uncoated (NS). After 6 hours, ACT was 160 ± 9 s for coated versus 152 ± 5 s for uncoated (NS). Thrombin time before bypass was 15 ± 2 s for coated versus 16 ± 2 s for uncoated (NS). After 6 hours, thrombin time was 17 ± 2 s for coated versus 18 ± 4 s for uncoated (NS). Baseline antithrombin III levels were 91 ± 25% for coated versus 96 ± 17% for uncoated (NS). After 6 hours antithrombin III levels were 95 ± 23% for coated versus 93 ± 19% for uncoated (NS). Baseline fibrinopeptide A levels were 2.6 ± 0.4 ng/ml for coated versus 2.6 ± 0.8 ng/ml for uncoated (NS). After 10 minutes of perfusion fibrinopeptide A moved to 4.8 ± 0.9 ng/ml for coated versus 8.8 ± 3.2 ng/ml for uncoated and reached 10.7 ± 2.6 ng/ml after 2 hours for coated versus 15.3 ± 0.1 for uncoated (p<0.01). We conclude, that despite the open perfusion mode, the tested heparin surface coated venous hard shell reservoirs have improved thromboresistance. Heparin surface coating increases the reservoir flows and reduces fibrinopeptide A production.
Peritoneal Equilibration Test Performed in Predialysis Patients
Authors: Petersen L.J. , Nielsen A.L.
Published: March 2018

The aim of the study was to perform peritoneal equilibration test (PET) in predialysis patients, and compare to PET results in patients on chronic peritoneal dialysis (PD). Two groups of patients were enrolled in the study. Group 1: eleven uremic patients who had never been subjected to PD, and group 2: fourteen patients on maintenance PD. The PET was performed as the four hour standard PET, using a 2 liter bag (Dianeal 2.5% glucose) as test fluid. The transport of creatinine through the peritoneum did not differ significantly between the groups corresponding to the dialysate to plasma (DIP) ratios, neither did the glucose ratios differ significantly. After two hours dwell time a significant difference was found in DIP ratio of urea (p=0.001), in group 1 the median DIP of urea was 0.90 (0.80–1.14) and 0.75 (0.52–0.84) in group 2. No significant difference was found at dwell time zero or four hours. The current study shows that the distribution of PET results is identical in a group of predialysis patients, as compared to a group of chronic PD patients, except for D/P of urea at two hours dwell time
Neutrophil Intracellular pH after Exposure of Neutrophils to a Euhydric, Lactate-Based Peritoneal Dialysis Solution and its Euhydric, Bicarbonate-Based Counterpart
Authors: Zhou X.J. , Yu A.W. , Zhou F.Q. , Wong F.K.M. , Ing T.S. , Vaziri N.D.
Published: March 2018

The effects of euhydric, lactate-based peritoneal dialysis solutions and those of their euhydric, bicarbonate-based counterparts, on neutrophil intracellular pH are comparable. This similarity in effects on intracellular acidity may have bearings on the influences of these solutions on cellular functions in general.
Closed Loop Control of PaCO2 During ECC
Authors: Chauveau N. , Lautier A. , Frikha M.R. , Barthelemy R.
Published: March 2018

A prototype for the control of blood gases during extracorporeal circulation (ECC) has been built. It is composed of a CDI300 continuous gas blood analyzer, a programmable gas blender and an IBM PC. The air blender is composed of three mass flow controllers (air, oxygen and total flow rate). The microcomputer commands these controllers in order to obtain the desired mixture of air and oxygen. The system acquires the data sent by the blood gas analyzer every 6 seconds and commands the gas blender in order to maintain the desired arterial dioxide partial pressure (PaCO2) in the arterial line. The first experimental results on sheep show that if blood gas parameters are stable when beginning the closed loop control, then the desired PaCO2 value may be obtained. Otherwise, the value of PaCO2 under control is slightly different but a stable value is obtained after 10 minutes. More experiments must be done in order to establish the real limits of such a system and optimize the gain of the control system.
Intraoperative Blood Salvage: A New Artificial Organ?
Authors: Valbonesi M. , Frisoni R. , Florio G. , Ferrari M.
Published: March 2018

Optimal blood supply is critical to modern medical practice. Among the different possibilities of improving the quality and safety of blood, it is generally felt that autologous donation has played an important role and has contributed to changing transfusional practices, mainly since the appearance of HIV and HCV on the blood transfusion scene. At the San Martino Hospital Immunohematology Service, the autotransfusion era began in 1985. Autologous predeposit donation was the first to be introduced, followed by intentional perioperative hemodilution, intraoperative blood salvage with DFC apparatuses and lastly post-operative blood salvage. From about 200 autologous donations in 1985 we reached 5,372 in 1993 and more than 6,000 autologus donations are expected for 1994. Only 189 intraoperative blood salvages, were carried out in 1986, 593 in 1989, 1,207 in 1993 and more than 1,500 blood salvage sessions are anticipated for 1994. In the meantime, the total number of homologous RBC units employed in the Hospital dropped from 45,000 in 1985 to 18,000 in 1994, with the Onco-hematological Divisions using approximately 10,000 units of packed RBC.