bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma Exchange or Immunoadsorption in Patients with Rapidly Progressive Crescentic Glomerulonephritis a Swedish Multi-Center Study
Authors: Stegmayr B.G. , Almroth G. , Berlin G. , Fehrman I. , Kurkus J. , Norda R. , Olander R. , Sterner G. , Thysell H. , Wikström B. , Wirén J.E.
Published: March 2018

A therapeutic removal of antibodies may be achieved by immunoadsorption (IA) or by plasma exchange (PE). The aim of this prospective randomised study was to compare the efficacy of these different techniques with regard to treatment of patients with rapidly progressive glomerulonephritis (RPG) having at least 50% crescents. Forty-four patients with a RPG were included for treatment either by IA or PE (with albumin as substitution for removed plasma). All patients were additionally treated with immunosuppression. A median of 6 sessions of PEs were performed in 23 patients compared with 6 IAs in 21 patients. Goodpasture's syndrome (GP) was present in 6 patients (PE 3, IA 3). All of them started and ended in dialysis, two died. Among the remaining 38 patients (26 men, 12 women) 87% had antibodies to ANCA. Creatinine clearance for PE versus IA were at a median at start 17.1 and 19.8 ml/min, and at 6 months 49 and 49 ml/min, respectively. At 6 months 7 of 10 patients did not need dialysis (remaining: IA 0/5 and PE 2/5, n.s.). The extent of improvement did not differ between the groups. Three patients died during the observation period of 6 months (IA 2; PE 1, on HD). Although no difference was found between the IA or the PE group this study shows that the protocol used was associated with an improved renal function in most patients (except for Goodpasture's syndrome) whereas 70% of them could leave the dialysis program.
Physiological Saline is not a Biocompatible Peritoneal Dialysis Solution
Authors: Wang T. , Heimbürger O. , Qureshi A. Rashid , Waniewski J. , Bergström J. , Lindholm B.
Published: March 2018

We have previously demonstrated that daily exposure to dialysis fluid results in significantly increased peritoneal lymphatic flow. In this study, we investigated if daily intraperitoneal infusion of saline (isotonic, glucose free) could cause similar changes.

Methods

Sixteen male SD rats received daily infusion (i.p) of 20 ml saline for ten days (Saline group). Twenty-four hours after the last infusion, a 4 hour dwell study using 25 ml 3.86% glucose dialysis solution with frequent dialysate and blood sampling was done in each rat as well as in rats which did not receive daily infusion (Control, n=8). Radiolabeled human albumin (RISA) was added to the solution as an intraperitoneal volume marker. Radioactivity, glucose, urea, sodium, and potassium were measured for each sample. In a separate study, the RISA absorption to peritoneal tissue was also determined.

Results

The net ultrafiltration was significantly decreased in the daily infusion group (p<0.05). However, the apparent volume at 3 minutes of the dwell was markedly increased; this was due to a significant increase in the RISA binding (1.5–12.0% in the Saline group vs. 0.45–1.12% in the Control group) to peritoneal tissues as assessed by measurement of RISA recovery at 3 min of the dwell. This resulted in a significant overestimation both of the intraperitoneal volume (IPV) at 3 min and the (apparent) fluid absorption rate (as estimated by the transport of RISA out of peritoneal cavity): 0.087±0.026 ml/min in the Saline group vs. 0.052±0.007 ml/min in the Control group, p<0.001. The direct lymphatic flow as estimated by the clearance of RISA to plasma (which should not be affected by the RISA binding) also increased markedly (0.021±0.005 ml/min in the Saline group vs. 0.008±0.001 ml/min in the control group). There was no significant difference in the D/P values for small solutes (urea, sodium, potassium, urate) and D/D0 for glucose between the two groups.

Conclusions

1) Daily infusion of physiological saline into peritoneal cavity may increase the peritoneal lymphatic flow; 2) The significant (apparent) increase in IPV shortly after infusion may suggest increased RISA binding to peritoneal tissues (which may be related to the damage of the tissues, and results in overestimation of the peritoneal fluid absorption rate); 3) Saline is not a biocompatible peritoneal dialysis solution, and should therefore not be used as a control or flush solution.
Mathematical Modeling of Solute Kinetics and Body Fluid Changes during Profiled Hemodialysis
Authors: Ursino M. , Colì L. , Brighenti C. , De Pascalis A. , Chiari L. , Dalmastri V. , La Manna G. , Mosconi G. , Avanzolini G. , Stefoni S.
Published: March 2018

A mathematical model of solute kinetics oriented to improve hemodialysis treatment is presented. It includes a two-compartment description of the main solutes (K+, Na+, Cl–, urea, HCO–3, H+, CO2), acid-base equilibrium through two buffer systems (bicarbonate and non-carbonic buffers) and a three-compartment model of body fluids (plasma, interstitial and intracellular). The main model parameters can be individually assigned a priori, on the basis of body weight and plasma concentration values measured before beginning the session.

Model predictions are compared with clinical data obtained during 11 different hemodialysis sessions performed on six patients with profiled sodium concentration in the dialysate and profiled ultrafiltration rate. In all cases, the agreement between the time pattern of model solute concentrations in plasma and clinical data turns out fairly good as to urea, sodium, chloride and potassium kinetics. Finally, the time patterns of plasma bicarbonate concentration and pH can be reproduced fairly well with the model, provided CO2 concentration remains constant. Only in two sessions, blood volume was directly measured in the patient, and in both cases the agreement with model predictions was good.

In conclusion, the model allows a priori computation of the amount of sodium removed during hemodialysis, and may enable the prediction of plasma volume changes and plasma osmolarity changes induced by a given sodium concentration profile in the dialysate and by a given ultrafiltration profile. Hence, it can be used to improve the dialysis session taking the characteristics of individual patients into account, in order to minimize intradialytic imbalances (such as hypotension or disequilibrium syndrome).
Long-term Renal Allograft Recipients from South-East Asia in the Pre-Cyclosporin Era
Authors: Tang S. , Lui S.L. , Li F.K. , Lo W.K. , Chan T.M. , Lai K.N.
Published: March 2018

The clinical outcome of long-term renal allograft recipients in the Chinese population has not been reported previously. We analysed patients from the pre-cyclosporin era who had grafts that functioned for > 10 years. Forty-five patients (31 men, 14 women; mean age 30, follow-up duration 13.3 years), representing a 10-year graft survival of 53%, were included. Thirty-six patients (80%) received living-related allografts and 9 (20%) received cadaveric or living-unrelated renal transplantation. The mean serum creatinine at last follow-up was 1.36 mg/dl (range, 0.83–4.08). Major posttransplantation complications included: hypertension in 25 (56%), infection in 16 (36%), acute rejection in 15 (33%), lipid disorder in 13 (29%), liver disease in 7 (16%), osteonecrosis in 5 (11%), malignancy in 4 (9%), coronary artery disease in 3 (7%), and diabetes mellitus in 3 (7%). Five grafts were lost: 3 to chronic rejection, and 2 to patients with stable function who died of non-renal causes. Proteinuria correlated strongly with graft function and survival, and marginally with hypertension. In hepatitis B carriers, serum α-feto protein is useful in the early detection of hepatocellular carcinoma. We conclude that while patients in the pre-cyclosporin era can survive with excellent graft function beyond the first decade, the risk of complications leading to significant morbidity still remains even when patients are receiving minimal doses of immunosuppression in the second decade.
Oedema, Starling and Pulse Reverse Osmosis: Towards a Possible Biochemical Marker for Oedema
Authors: Prior F.G.R. , Morecroft V. , Fergusson R. , Gourlay T. , Taylor K.M.
Published: March 2018

Several conflicting theories have been proposed to explain the devlopment of oedema. Pulse reverse osmosis (PRO) suggests that oedema occurs when the mean pulse capillary pressure exceeds the osmotic gradient between the plasma and the interstitial fluid. In order to test this concept mean arterial blood pressures and colloid osmotic pressures were taken in a group of healthy volunteers, a group of patients with bilateral ankle oedema and a group of treated hypertensives. Patients with oedema were found to have colloid osmotic pressures (COP's) which were significantly less than those of the healthy volunteers (p <0.001) and the treated hypertensives (p <0.001). The results support the oedema mechanism proposed by PRO and indicate that the relationship between blood pressure and COP may be a useful biochemical marker of oedema and its treatment. Further study is required to numerically quantify this relationship.
Surface Characterization of Polymers for Medical Devices
Authors: Werner C. , Jacobasch H.-J.
Published: March 2018

A survey is given on analytical techniques currently applied to the surface characterization of biomedical polymers. The techniques include spectroscopies, thermodynamic and electrochemical measurements and microscopies, respectively. To illustrate the motivation for surface analysis, the hypotheses on the correlations between surface parameters and hemocompatibility of polymers are briefly examined.

The applications of the examined methods are illustrated by a number of examples. These examples include the characterization of cellulose membranes (low-flux hemodialysis membranes) by streaming potential measurements and by inverse contact angle measurements. The use of surface spectroscopies (ATR-FTIR and XPS) is demonstrated by considering the optimization of surface modification procedures of vascular prostheses made from poly(tetrafluoroethylene). Furthermore, the characterization of water-swollen cellulose membranes by scanning force microscopy is shown. Finally, the extended application of physico-chemical surface analysis to the investigation of protein adsorption is considered. An example deals with in situ spectroscopic ellipsometry used to study the adsorption of fibrinogen onto a plasma-deposited hydrophobic fluoropolymer and onto poly(ethyleneoxide)-grafted fluoropolymer, respectively.
Push-pull Sorbent-Based Pheresis Treatment in an Experimental Canine Endotoxemia Model: Preliminary Report
Authors: Peter A.T. , Ash S.R. , Steczko J. , Turek J.J. , Blake D.E. , Carr D.J. , Knab W.R. , Bosley R.H.
Published: March 2018

The Biologic-DTPF System™ (DTPF), an extracorporeal blood treatment device with potential to treat sepsis, was tested in a preliminary study using a canine endotoxemia model. Six dogs were used and they formed four treatment groups, as control group (n=1) and three groups based on the type of sorbent present in the plasma filter (PF) system: sham treatment with no sorbent (n=1), charcoal as sorbent (n=2), and charcoal/silica as sorbent (“silica” group, n=2). Cardiodynamic data were recorded before treatment and every 30 minutes, and blood samples were collected to determine blood chemistry and to detect the levels of endotoxin and selected plasma cytokines: interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor (TNF). The dogs were given Escherichia coli endotoxin (2 mg/kg) as an intravenous drip (extended over a period of 30 minutes). Thirty minutes after the end of infusion all animals except the control were treated with the DTPF system for four hours.

To determine the effect of treatment, data collected at one hour from the initiation of treatment until the end of treatment were compared between control and treated dogs. The endotoxin levels in the control dog were higher (P < 0.05) than other groups. The control dog had lower levels of TNF than other groups. The control dog had similar levels of IL-1 (P > 0.05) and higher levels (P < 0.05) at 4 hours into treatment compared to other groups. The control dog had similar levels of IL-6 as other groups (P > 0.05).

In the control dog, the mean arterial pressure (MAP) fell and then remained low but stable at 1–4 hours. The charcoal group had lower MAP than the control dog at 1–4 hours (P < 0.05). The silica group had higher MAP levels similar to the control dog. After treatment, the control dog had higher (P < 0.05) values of hematocrit, hemoglobin, calcium, potassium, and albumin compared to the treated groups.

As expected for a system removing plasma during sepsis, the DTPF System had some adverse effects on the physiologic status of the dogs, especially when loaded with charcoal sorbent only. The findings of the present study suggest that the filters are capable of eliminating endotoxin and there is some evidence of cytokine removal. Although the charcoal dogs did poorly, addition of silica to the sorbent offset any negative effects. Further work is underway to improve the efficiency of the system, primarily, to enhance the capacity of the sorbents for cytokines. A more realistic canine sepsis model with mortality after several days (the Escherichia coli- infected intraperitoneal clot) will also be considered in future studies.
A Simple Method for Emax Trend Evaluation: In Vitro and in Vivo Results
Authors: Ferrari G.F. , Mimmo R. , Mercogliano D. , De Lazzari C. , Menichetti A. , Di Natale M. , Tosti G. , Tritapepe L. , Clemente F. , Giardino R.
Published: March 2018

The aim of this study is the evaluation of end systolic ventricular elastance trend (as a measure of heart contractility) by hemodynamic variables available in intensive care units or during heart surgery: heart rate, cardiac output, left atrial, mean and diastolic arterial pressure. Its basic assumption is the description of ejection as the interaction between variable left ventricular and arterial compliances (reciprocal of the corresponding elastances) connected in parallel. As pressure is the same in each compliance at systole beginning and ending, ventricular elastance can be estimated by assuming that energy variation is the same on both compliances. The algorithm has been tested on a numerical simulator of the circulatory system and on six sheep at basal conditions and during drug infusion. Correlation function in numerical simulation, between true and computed ventricular elastance (range 0.45÷5 mm Hg-cm-3), yields 0.985. In vivo comparison between computed ventricular elastance trend and ventricular dp/dt trend yields a correlation function ranging between 0.87 and 0.99.

The result of the algorithm cannot be assumed to be Emax value. However, it can be considered a contractility index as it closely follows any change in dp/dt. It can be computed by simple calculations and needs no variables other than those usually measured in intensive care. It allows the extrapolation of useful information for evaluating the trend in heart contractility and for setting up a control strategy for mechanical or pharmacological assistance during heart recovery.
Hip Prothesis: An in Vitro Wear Protocol Based on a Comparison between Gravimetric and Profilometric Analysis
Authors: Affatato S. , Tagliati M. , Toni A.
Published: March 2018

Ultra high molecular weight polyethylene acetabular cups were analysed by means of a shadowgraph method (using a profile projector) to measure linear wear. The results were compared with those of previous wear tests performed on a hip joint simulator. Twelve polyethylene acetabular cups were analysed.

The specimens were evaluated visually for evidence of polyethylene wear. Examination of the polyethylene inner surface did not reveal evidence of surface failure such as delamination, fatigue cracks or scratches.

Volumetric wear was calculated using a formula based on dimensional change due to the penetration of the femoral head in the acetabular cup. It was found to be of the same order of magnitude as the wear obtained in in vitro experimental tests.
Autotransfusion with Predeposit-Haemodilution and Perioperative Blood Salvage: 20 Years of Experience
Authors: Borghi B. , Fanelli G. , Celleno D. ,   Rizzoli Study Group on Orthopaedic Anaesthesia, IRCSS Rizzoli Orthopaedic Institutes, Bologna, Caroli G.C. , Pignotti E. , Montebugnoli M. , De Simone N. , Righi U. , Bugamelli S. , Laguardia AM. , Cataldi F. , Feoli MA. , Bonfatti Paini M. , Bombardini T. , Lorenzini L. , Castellazzi L. , Baroncini S.
Published: March 2018

Background

Through a prospective study, we evaluated the efficacy of an integrated autotransfusion regimen comprised of predeposit-hemodiluition and intra and post-operative blood salvage in major orthopaedic surgery.

Methods

We examined the records of 2303 consecutive patients (1524 females and 779 males, mean age 62.7, standard deviation 11 years (range 16–90 yrs), pre-operative haemoglobin (Hb) concentration 13.5 (SD 1.4) (range 6.7–19.3) g/dl undergong total hip arthroplasty (THA 1582 patients), THA after the removal of internal fixation devices (RFD+THA, 25 patients), total knee arthroplasty (TKA, 347 patients), revision surgery of the hip (HR, cup+stem revision, 248 patients; cup revision 64 patients; stem revision 23 patients) and total knee revision (TKR 14 patients). We estimated that the number of predonations (MSBOS - maximum surgery blood order schedule) was 2 units for THA, TKA and TKR, and 3 units for partial or total hip revision and for total hip arthroplasty with fixation removal.

Results

It was possible to obtain the MSBOS in 2070 patients (89.8%). Homologous red blood cell (HRBC) transfusion were carried out in 184 patients (8%). We found that the need to use HRBC was significantly associated with failure to meet the number of MSBOS, female sex, lower pre-operative Hb concentration, use of calcium heparin for antithrombosis prophylaxis, more extensive surgery, a higher ASA rating and co-existing diseases such as coronary artery disease.

Conclusions

Cooperation among anaesthesis, transfusionists and surgeons in the application of an integrated autotransfusion regimen enabled us to treat 92% of our patients with only autotransfusion.
The Enabler Cannula Pump: A Novel Circulatory Support System
Authors: Nishimura Y. , Meyns B. , Ozaki S. , Racz R. , Dohmen P. , Flameng W.
Published: March 2018

Background

The enabler circulatory support system is a catheter pump which expels blood from the left or right ventricular cavity and provides pulsatile flow in the ascending aorta or pulmonary artery. It is driven by a bedside installed pulsatile driving console. The device can easily be implanted by a minimal invasive approach, similar to the Hemopump.

Purpose

To demonstrate the hemodynamic performance of this new intracardiac support system.

Methods

In a series of 9 sheep, hemodynamic evolutions were recorded in various conditions of myocardial contractility (the non-failing, the moderately failing and the severely failing heart). Heart failure was induced by injection of microspheres in the coronary arteries.

Results

Introduction of the cannula through the aortic valve was feasible in all cases. Pump flow by the enabler was gradually increased to a maximum of 3.5 L/min. Diastolic (and mean) aortic blood pressure is significantly increased in the non-failing and moderately failing condition (counterpulsation mode). In heart failure, cardiac output is significantly increased by the pump (p<0.0001). A drop in left atrial pressure (indicating unloading) is achieved in all conditions but reaches significant levels only during heart failure (p=0.0068).

Conclusions

This new circulatory support system contributes to stabilization of the circulation in the presence of cardiac unloading. In heart failure it actually supports the circulation by increasing cardiac output and perfusion pressure.
Extracorporeal Therapies: Should We Use Plasma Instead of Blood?
Authors: Ronco C.
Published: March 2018

The evolution of extracorporeal therapies has required the parallel evolution of devices designed to extract the blood from the patient and to move it in the extracorporeal circuit. Blood is a peculiar fluid in which viscosity may be strongly affected by the contingent operational conditions of the extracorporeal circuit. Because hematocrit is an important component of blood viscosity, and viscosity may definitely affect the performance of blood purification devices, major problems arise when high hematocrits are present in the patient. All these problems might be avoided if plasma could be used instead of whole blood. Plasma treatment is already performed in various therapies, but the treated plasma is obtained by separation from whole blood in the extracorporeal environment. In this paper we propose a new approach to perform different plasma treatments. Plasma is extracted directly from the patient thanks to a special catheter or plasma extraction device. Utilizing plasmafiltration technology to create a membrane that is placed on the tip of an intravascular catheter, plasma extraction may become easy to perform. The extracted plasma is then available for any type of treatment before being restituted to the patient via a second lumen in the same catheter.
Presence of Factor-VII and -XIII Activity in Ultrafiltrate during Hemofiltration
Authors: Guth H.-J. , Klingbeil A. , Wiedenhöft I. , Rose H.-J. , Kraatz G.
Published: March 2018

Bleeding complications during renal replacement therapies can be attributed to coagulation system and platelet function alterations in uremia, and the application of heparin in extracorporeal circulation. Small protein losses during hemofiltration are always described, however the high molecular weight of coagulation factors should significantly prevent their removal during hemofiltration. To exclude degradation of coagulation factors under conditions of spontaneous ulrafiltration, the hemofiltrate of 40 patients with acute renal failure (treated with continuous veno-venous hemofiltration, CVVH) was sampled from the filtrate line after 1 h from the beginning of treatment and in 5 patients also after 12 and 24 h. Samples were investigated with human factor deficient plasma (VII, X, XI, XII) from donors with a congenital deficiency and with human plasma depleted of factor V, VIII, IX, and protein S and C. Factor XIII was detected photometrically. Subsequently the presence of factor- XIII and -VII activity was investigated in plasma and hemofiltrate from 16 patients treated with intermittent hemofiltration before (plasma) and after (plasma, hemofiltrate) therapy. These patients also suffered from acute renal failure and needed renal replacement therapies. Quality control was carried out with a buffer solution (<1% activity in the assays according to recommended protocols). Results: Factor-V, -VIII, -IX, -X, -XI, and -XII activity, and protein C and S could not be detected in the hemofiltrate from continuous hemofiltration. Factor-VII and -XIII activity was present in the hemofiltrate (mean activity in CVVH: 1.93% for factor VII and 6.9% for factor XIII, mean activity in intermittent hemofiltration: <1% for factor-VII and 7.3 % for factor-XIII). Three were no significant differences (Student's t-test) in plasma activity before and after intermittent hemofiltration of factor VII (44 vs. 47%, p = 0.39) and factor XIII (44 vs. 52%, p = 0.24). The presence of factor-VII and -XIII activity in the hemofiltrate cannot influence plasma activities in intermittent hemofiltration. Rapid new synthesis and short half-life should neutralize these effects. Elimination of coagulation factor-XIII activity should be excluded by the next generation of highly permeable membranes and on-line hemodiafiltration.
In Vitro and in Vivo Assessment of Bone-Implant Interface: A Comparative Study
Authors: De Benedittis A. , Mattioli-Belmonte M. , Krajewski A. , Fini M. , Ravaglioli A. , Giardino R. , Biagini G.
Published: March 2018

The present in vitro and in vivo comparison of three bioactive (HA, AP40, RKKP) and three bioinert (Ti6-Al4-V, Al2O3, ZrO2) materials was undertaken to identify which of them provide(s) the most suitable coating for prostheses implanted in patients with altered metabolic status.

The experimental design included in vitro tests with human osteoblasts and morphological observations by scanning electron microscopy. For the in vivo evaluation, the materials were implanted in the femoral condyle of ovariectomised and intact female rats, and two months after surgery an X-ray microanalytical study was performed.

The in vitro study showed good biocompatibility with all materials. Microanalysis evidenced a similar behaviour with all materials except the two biological glasses. The differences in Ca and P content observed between intact and ovariectomised rats can be explained by the intrinsic capability of biological glasses to undergo surface modifications in the presence of alterations of the bone metabolism. Thus, their use seems to be indicated in recipients with osteoporotic pathologies.
Leukocyte Adhesion Molecules and Leukocyte-Platelet Interactions during Hemodialysis: Effects of Different Synthetic Membranes
Authors: Sirolli V. , Ballone E. , Amoroso L. , Di Liberato L. , Di Mascio R. , Cappelli P. , Albertazzi A. , Bonomini M.
Published: March 2018

Membranes made from synthetic polymers, in general, are considered as being biocompatible membranes and tend to be treated as a homogeneous group. However, all of these membranes have multiple and different characteristics that may contribute to interactions with blood components. As a consequence, the biocompatibility profile of synthetic membranes may vary. In the present cross-over study, we examined by flow cytometry the effects (expressed as % change from predialysis values) of three different synthetic polymers (polysulfone, PSF; polyacrylonitrile-co-sodium methallyl sulfonate, AN69; ethylenevinylalcohol, EVAL) on the expression of leukocyte adhesion molecules (CD11b/CD18, CD15s) and the interactions between leukocytes and platelets under conditions of routine clinical use.

For neutrophils, a statistically significant difference was found in CD15s expression for EVAL as compared to AN69 (p<0.05) and in CD11b/CD18 expression for PSF as compared to both EVAL (p<0.01) and AN69 (p<0.05). No difference between membranes was found on the expression of such adhesive molecules on monocytes. Significant differences in platelet-neutrophil (but not in platelet-monocyte) coaggregate formation were observed between PSF and both EVAL (p<0.001) and AN69 (p<0.01). Reactive oxygen species production by neutrophil population during hemodialysis was significantly different between each pair of synthetic polymers (PSF vs EVAL, p<0.001; PSF vs AN69, p<0.001; AN69 vs EVAL, p<0.05).

Our data demonstrate that in terms of leukocyte adhesion receptors and platelet-leukocyte interactions, the biocompatibility profile of the synthetic membranes polysulphone, AN69 and EVAL shows many similarities but also several significant differences. Our results support the concept that biocompatibility evaluation of each membrane should be based exclusively on data generated by that membrane in order to avoid errors based on assumptions about group characteristics.
A Case of Antiphospholipid Antibody Syndrome Diagnosed after Thrombosis of an Arteriovenous Shunt
Authors: Naito T. , Yorioka N. , Kyuden Y. , Yamashita K. , Ueda C. , Usui K. , Shigemoto K. , Harada S. , Yamakido M.
Published: March 2018

A 32-year-old male dialysis patient with lupus nephritis was admitted because of shunt obstruction. The arteriovenous fistula was reconstructed, but obstruction recurred twice within several hours after surgery. A high blood level of anticardiolipin β2-glycoprotein I antibody suggested that shunt obstruction was caused by a thrombotic tendency related to the antiphospholipid antibody syndrome. Accordingly, for the third shunt procedure, antiplatelet therapy (which had been commenced for systemic lupus erythematosus) was combined with dalteparin sodium from before surgery and warfarin was added postoperatively. This regimen prevented shunt obstruction. In conclusion, hemodialysis patients who suffer repeated shunt obstruction should be examined for antiphospholipid antibody syndrome.
Platelet Function and Hemolysis in Centrifugal Pumps: In Vitro Investigations
Authors: Steines D. , Westphal D. , Göbel C. , Reul H. , Rau G.
Published: March 2018

The effects of centrifugal pumps on blood components other than erythrocytes, namely platelets and their interaction with the coagulation system, are not very well known. In a comparative study with three centrifugal pumps (BioMedicus BP-80, St. Jude Isoflow, and Sarns Delphin) and the Stöckert roller pump hemolysis, platelet counts, thromboplastin and partial thromboplastin times, as well as resonance thrombography (RTG) parameters for the assessment of platelet and coagulation function were evaluated in vitro. Normalized indices of hemolysis (NIH) with ACD anticoagulation after 360 minutes were 0.008 ± 0.004 (Isoflow), 0.018 ± 0.017 (BP-80), 0.085 ± 0.051 (Delphin), and 0.049 ± 0.010 g/1001 (roller pump). Plasmatic coagulation was activated in all circuits. Platelet function was severely inhibited by the BP-80, indicated by increase in RTG platelet time to 358% ± 150% of initial values compared to 42% ± 29% (Isoflow), 40% ± 20% (Delphin), and 12% ± 10% (roller pump). Fibrin polymerization was affected similarly. The large surface area of the BP-80 leads to an extensive activation of platelets and plasminogen.
Evaluation of the PD Adequest Program in Japanese Patients on Peritoneal Dialysis
Authors: Katsutani M. , Yorioka N. , Ito T. , Naito T. , Kanahara K. , Oda H. , Yamakido M.
Published: March 2018

To perform adequate peritoneal dialysis, it is necessary to individualize the dialysis regimen. PD Adequest is a software program based on the three-pore model that can be used to predict solute clearance and ultrafiltration volume during peritoneal dialysis. We evaluated the ability of this program to predict the solute clearance and ultrafiltration volume in Japanese patients on peritoneal dialysis. The weekly creatinine clearance and weekly urea Kt/V were determined in 45 patients. The PD Adequest was used to simulate their current dialysis regimens and the predicted values of these parameters were calculated. Strong positive correlations were obtained between the actual and predicted weekly creatinine clearance (r=0.993) and weekly urea Kt/V (r=0.991). In conclusion, this program is potentially useful for designing peritoneal dialysis regimens in Japanese patients, even though they have a smaller body mass than Canadians and Americans for whom it was designed.
Intra-Aortic Balloon: Evaluation of Heparin-Coating under Various Experimental Conditions
Authors: Mueller X.M. , Tevaearai H.T. , Von Segesser K.
Published: March 2018

In a calf model, heparin coated intra-aortic balloon (IAB) was compared with standard balloon. In group 1, 9 of each IAB type were set to the automatic mode for 15 min, 45 min and 6 hours respectively, while in group 2, 3 of each IAB type were left deflated during 20 minutes to simulate balloon dysfunction. At the end of the procedures, 3 samples of each IAB were analyzed with scanning electron microscopy (SEM) for surface deposits. Macroscopically the 12/12 heparin coated IAB of both groups and the 9/9 standard IAB of group 1 were free of deposits, whereas the 3/3 standard IAB of group 2 exhibited clot deposits. SEM revealed deposit-free surfaces in the 36/36 heparin coated samples of both groups, while 14/27 standard samples of group 1 (p < 0.01 when compared with heparin coated samples) and 8/9 standard samples of group 2 (p = 0.02, same comparison) disclosed blood cells and fibrin deposits. Morphometrically the proportion of standard sample surfaces covered with deposits, estimated according to a score system (0% = 0; 0.1–25% = 1; 25.1–50% = 2; 50.1–75% = 3; 75.1–100% = 4), was 0.69 ± 0.82 in group 1 (p<0.01 when compared with heparin coated samples) and 1.22 ± 0.83 in group 2 (p < 0.01, same comparison). Thus heparin coated IAB presents no deposits either after 6 hours of intravascular ballooning or after 20 minutes of stagnation. It seems to be a promising strategy for patients with absolute or relative contraindications to systemic heparinization.
Trillium Coating of Cardiopulmonary Bypass Circuits Improves Biocompatibility
Authors: Tevaearai H.T. , Mueller X.M. , Seigneul I. , Burki M. , Horisberger J. , Stumpe F. , Von Segesser L.K.
Published: March 2018

Coating of cardiopulmonary bypass circuits may be a solution to prevent adverse effects induced by contact of blood elements with foreign surfaces. Using an animal model, we investigated the Trillium™ coating of cardiopulmonary bypass circuits (a new process involving polyethylene oxide, sulphonate groups and heparin) at low systemic heparinization, focusing on haemolysis and clot formation.

Cardiopulmonary bypass was initiated through jugulo-carotid acess with ACT maintained around 180 sec. Treated circuits (Trillium group) were evaluated in 3 calves (mean weight of 66.0±8.7 kg), vs. untreated circuits in 3 control calves (mean weight of 60.7±7.5 kg). Blood samples were drawn at regular intervals for biochemical, hematological and blood gas analyses. After 6 consecutive hours, the animals were weaned from CPB and were awakened. The circuits were analyzed for clot deposits. After 7 days the animals were sacrificed and an autopsy was carried out. Red cell and white cell counts did not change over the 6 hours. Platelet counts dropped to 75.9±7.3% of the baseline value in the Trillium group after 6 hours whereas counts dropped to 57.2±26.0 in the control group (p<0.05). Plasma free Hb remained constant in the Trillium group but increased significantly to 280±65% of baseline value in the control group (p<0.05). The amount of clots were significantly higher in the control group, in the connectors, the reservoir, the heat exchanger, and the oxygenator. No renal emboli were seen in the Trillium group whereas the mean number of emboli was 3.0±2.4 in the control group. We conclude that Trillium coating significantly improves the biocompatibility of artificial surfaces exposed to blood.
Effects of Predeposit and Intentional Perioperative Haemodilution on Blood Saving Program in Major Orthopaedic Surgery
Authors: Burbi L. , Gregoretti C. , Borghi B. , Pignotti E.
Published: March 2018

In this study we evalutated the effects of predeposit and intentional perioperative haemodilution on a blood saving program in major orthopaedic surgery. We demonstrated that autologous blood phlebotomy and maintenance of optimal levels of perioperative haemodiluition by delaying blood transfusion, even autologus, are efficient techniques in reducing homologous, red blood cell (HRBC) transfusion. Patients who received autologous red blood cell (ARBC) or HRBC more than one day after surgery, while having Hb values < 8 g/dl, are less at risk of needing the first or additional HRBCs. In conclusion, predeposit and intentional haemodilution obtained by delaying blood transfusions, even autotransfusional, is a correct way of conducting a blood saving program (BSP) in major orthopaedic surgery. These techniques are clinically effective in avoiding or reducing HRBC transfusion.
Telemedicine Technology and Applications for Home Hemodialysis
Authors: Agroyannis B. , Fourtounas C. , Romagnoli G. , Skiadas M. , Tsavdaris4 C. , Chassomeris C. , Tzanatos H. , Kopelias I. , Lymberopoulos D. , Psarras J.
Published: March 2018

Home hemodialysis (HD) for the treatment of patients with end-stage renal disease (ESRD) was first put into practice about 30 years ago. In this paper we describe the application of telematics monitoring services (TMS) for supporting patients who need home or satellite HD (SHD). For the clinical trials two modified HD machines were located in the renal unit and a central control station (UNIX workstation with multimedia PC-terminal) was located in another room of the hospital. Bi-directional communication between modified HD machines and central control station was managed via ISDN (Integrated Services Digital Network) links.

Using these HD-machines 150 HD sessions were performed in nine patients over a period of five months. This system enabled on-line remote supervision of the HD machine-related functions (air in the blood, leak of blood, low conductivity etc.) and the clinical condition of patients through measurement of blood pressure (BP), pulse rate, PO2 (pulse oxymetry) and electrocardiogram (ECG) from the central control station (CCS). The user checked the type of alarm/warning, its appearance on HD machines and multimedia terminal units (MTU), the action of the protective system and the appearance of consultative messages from CCS on the remote terminal unit RTU. According to the data collected, the disturbances of HD machine function were visible and audible in the CCS and the user messages were always observed on the RTU. No unusual dialysis-associated complications were observed, all data and alarms/warnings were transmitted correctly and patients had adequate HD treatment.
Thrombosis of Angiographic Catheters in Humans: Experimental Study
Authors: Bailly A.L. , Lautier A. , Laurent A. , Guiffant G. , Dufaux J. , Houdart E. , Labarre D. , Merland J.J.
Published: March 2018

One of the major problems in the use of catheters is their thrombogenicity since the embolization of clots near the central nervous system or the coronary arteries can cause permanent damage.

Catheter thrombogenicity was evaluated in humans during angiographic procedures by their tendency to become occluded. Characterization of catheters was achieved using roughness measurements, FTIR with ATR, DSC and ESCA. The catheters were 5 commercially available catheters, made mainly of polyethylene, Pebax® or polyamide sterilized and ready for clinical use. Thirty-one patients due to have an angiographic procedure and with normal blood and hemodynamic parameters were included in the study. The 50 cm catheter test sample was inserted through an introducer into the femoral artery at the beginning of an angiographic procedure. The outcoming blood flow rate (BFR) was continuously monitored by a special computerized device for 15 min or until the total amount of blood reached 30 ml. The angiographic procedure was then normally resumed.

DSC and FTIR showed results consistent with the expected composition of catheters. ESCA results showed very high Si/C ratios and could not be explained in all instances.

Occlusion of the catheters occurred in 44 % of the cases and the average time to obtain occlusion was 8.5 min (3–15 min). Values of the decrease rate of BFR in ml/min2 allowed separation of the catheters into 3 groups of low, medium and high thrombogenicity. However, occlusion occurred at least one time for each type of catheter.

Blood volume and BFR curves vs. time allowed the determination of 3 main types of thrombotic behavior: type I shows no significant reduction of BFR; type II shows a progressive decrease in flow rate; type III is much less frequent and shows an abrupt decrease of BFR either quickly followed by a compensatory increase and resuming of a steady flow or by abrupt occlusion. In type II curves the pattern of occlusion follows a classical diffusion model because the Peclet number is greater than 1 and then the classical Higbie solution for diffusion could be used (33).

The most thrombogenic material was the smoothest. There was no correlation between surface chemical composition and thrombogenicity. However, catheters that were based on PE appeared less thrombogenic than PA catheters in this study.
Femoral Catheters: Safety and Efficacy in Peripheral Blood Stem Cell Collection
Authors: Adorno G. , Zinno F. , Bruno A. , Lanti A. , Ballatore G. , Masi M. , Cudillo L. , Del Poeta G. , Riccitelli A. , Del Principe M.I. , Pepe R. , Marchitelli E. , Morosetti M. , Meloni C. , Isacchi G. , Amadori S.
Published: March 2018

Central venous access is necessary in patients candidate for peripheral blood stem cell (PBSC) collection. We report our experience with a dual lumen femoral catheter (Gamcath, 11 french), initially designed for hemodialysis. We studied 147 patients and performed 488 collections after mobilization with either G-CSF alone or chemotherapy + G-CSF, when the white blood cell count exceeded 1 × 109 /L, or when a measurable population of CD34+ cells (20 / μL) was detected in peripheral blood. All patients received systemic anticoagulation with a low weight heparin and ultrasound examination was performed after the removal of the catheter. Seven patients developed thrombosis (4.7%), ten experienced hematomas at the site of catether placement (6.8%) despite prophylactic platelet transfusions, while only one patient (0.6%) had a catheter-related infection. In conclusion, the short-term use of large bore femoral catheters in setting up PBSC collection seems to be associated with minimal risk of infection and low thrombotic incidence.
Hemoperfusion Study with Carbamazepine in Vitro
Authors: Derzsiová K. , Mydlík M. , Petríková V.
Published: March 2018

Sorption efficacy of active charcoal, Amberlite XAD-2 and Amberlite XAD-4 in hemoperfusion with carbamazepine was investigated in vitro. Authors carried out 15 hemoperfusions with carbamazepine in a closed system using the above mentioned sorbents; The perfusion solution used was 3,000 ml of 0.9% NaCl. The carbamazepine concentration in the solution was 52.5±3.0 mg/L. In addition, two in vitro hemoperfusions with carbamazepine using Amberlite XAD-2 sorbent and 1.500 ml of human plasma as a perfusion solution, were also performed. The concentration of carbamazepine in plasma was 50.4±1.2 mg/L. Individual hemoperfusions lasted 5 hours. Zero values of carbamazepine were achieved after 120 min of Amberlite XAD-2 or Amberlite XAD-4 hemoperfusion in 0.9% NaCl and after 240 min of hemoperfusion in human plasma. The results gathered suggest that the most effective in vitro hemoperfusion with carbamazepine was obtained with Amberlite XAD-2 or Amberlite XAD-4 and the least effective was with active charcoal. The authors recommend the use of hemoperfusion with Amberlite XAD-2 or Amberlite XAD-4 for acute intoxications with carbamazepine in humans. In addition, authors successfully performed 5-hour hemoperfusion using Amberlite XAD-4 in vivo, in an 18-year-old girl, who suffered from acute carbamazepine intoxication after a suicidal attempt. This treatment led to the rapid survival.
Survival after Massive Ethylene Glycol Poisoning: Role of an Ethanol Enriched, Bicarbonate-based Dialysate
Authors: Nzerue C.M. , Harvey P. , Volcy J. , Berdzenshvili M.
Published: March 2018

A 38-year old man presented with drowsiness 14 hours after ingesting about 1200 mls (40 ounces) of antifreeze in a suicide attempt. He was successfully treated with an ethanol enriched, bicarbonate based-dialysate. With a concomitant peripheral intravenous infusion of ethanol, this enrichment of the dialysate helped maintain the intradialytic ethanol concentration between 97–135 mg/dl over an 8 hour dialysis session. The patient developed acute tubular necrosis and required further dialysis. He made a complete recovery after three weeks and was discharged with a serum creatinine of 1.4 mg/dl.
A Three-dimensional Analysis of Flow in the Pivot Regions of an ATS Bileaflet Valve
Authors: Kelly S.G.D. , Verdonck P.R. , Vierendeels J.A.M. , Riemslagh K. , Dick E. , Van Nooten G.G.
Published: March 2018

Bileaflet heart valves are currently the most commonly implanted type of mechanical prosthetic valve, because of their low transvalvular pressure drop, centralised flow and durability. However, in common with all mechanical heart valves, implanted bileaflet valves show an inherent tendency for blood clot formation at the valve site. Fluid dynamical phenomena associated with blood clotting are elevated blood shear stresses and regions of persistent blood recirculation, particularly when both occur together. Using three-dimensional CFD modelling, combined with enlarged scale experimental modelling, we investigated the blood flow through the ATS bileaflet valve during forward flow, with particular attention to the leaflet pivot regions. Recirculating regions were found both within and downstream of the valve housing ring. Qualitative assessment of the entire cardiac cycle suggested that recirculating blood within the housing ring will be washed away whilst the valve is closed, but as with all bileaflet valve designs recirculating blood downstream of the valve may have a residence time much longer than one cardiac cycle.
Influence of Different Assist Devices on Survival after Orthotopic Heart Transplantation
Authors: Tenderich G. , Arusoglu L. , El-Banayosy A. , Morshuis M. , Mirow N. , Hornik L. , Wlost S. , Koerfer R. , Koerner M. M.
Published: March 2018

Background

In 1995, a risk factor of 1.88 was indicated for one-year mortality in connection with bridging to heart transplantation (1). Both one-year and three-year survival rates in patients bridged to transplantation were less than 80% (2).

Methods

From 3/89 to 12/98, 903 orthotopic heart transplantations were performed at our center in 888 recipients. Bridging was necessary in 142 patients.

Results

The one-year survival rate was 76% in pts without VAD, 86% in pts bridged with VAD and 66% in pts with VAD due to postcardiotomy syndrome. The three-year survival rates were 73%, 80% and 55% respectively.

Conclusions

Early and late results in patients bridged to transplantation remarkably improved over 1995 (1). One-year and long-term survival rates are significantly lower when assist devices are used in patients with postcardiotomy syndrome. Despite a high incidence of assist-related complications, electively bridged patients showed significantly better early and long-term results than the control group.
Development of a Non-Transformed Human Liver Cell Line with Differentiated-Hepatocyte and Urea-Synthetic Functions: Applicable for Bioartificial Liver
Authors: Yoon J-H. , Lee H. V-S. , Lee J.S. , Park J.B. , Kim C.Y
Published: March 2018

There is a need to develop human hepatocyte cell lines which retain both replicating capacity and highly differentiated functions to facilitate the development of an efficient bioartificial liver. The present study was undertaken to differentiate, using sodium butyrate, the actively replicating immortalized human liver cell line.

The effects of butyrate on cell growth and cell cycle were analyzed, and the albumin synthesis, cytochrome P450 and ammonia-detoxifying activity of the butyrate-treated cells were measured. Butyrate treatment resulted in G2/M arrest of the cell cycle and polygonal changes in the cell morphology. Neither the control nor the butyrate-treated cells showed transformed characteristics. Butyrate treatment increased the amount of albumin secretion, cytochrome P450 activity, and the urea production rate of the cells.

The present study provides non-transformed human hepatocytes, which can replicate unlimitedly and then restore differentiated hepatocyte-specific functions by butyrate, and therefore, have applications for the development of an efficient bioartiflcial liver