bluuebunny/crossref_metadata_2025 huggingface dataset:
Generation of Nitrate During Dialysis as a Measure of Nitric Oxide Synthesis
Authors: Mårtensson Lena , Hegbrant Jörgen , Thysell Hans
Published: July 2010

Abstract: Nitric oxide (NO) is a recently identified mes senger, which influences the local regulation of blood flow and platelets as well as neuronal and inflammatory pathways. Disturbed NO information might be involved in the uremic syndrome and might also cause hypotension during dialysis. To clarify these issues, we analyzed plasma and dialysis fluid concentrations of nitrate, the stable NO metabolite, in 9 patients during hemodialysis. Plasma nitrate was raised at the onset of dialysis as compared with healthy subjects (83 ± 9 versus 26 ± 2 μ, mol/L). The plasma concentration decreased to 20 ± 2 μ, mol/L (p < 0.01) during the dialysis. The relative decrease was more pronounced than the relative reduction in creatinine, phosphate, and urea concentrations. A parallel decrease in nitrate was seen in effluent dialysis fluid (32 ± 4 to 14 ± 1 μ mol/L; p < 0.01). Calculations of the amount of nitrate coming to and from the dialyzer were performed in 7 of the 9 patients, and in 5 of the 7 patients, generation of nitrate within the dialyzer could be postulated. This might explain the paradoxical venodilation noted during hemodialysis.
Adaptation Drift Suppression in Blood Glucose Self‐Tuning Control
Authors: Domingo Juan Francisco Casanova , Ruiz Ricardo , Aldana Fernando , Serrano‐Ríos Manuel
Published: July 2010

Abstract: To improve the glycemic regulation in clamping, a modification of the recursive least squares (RLS) estimation to be applied to any self‐tuning adaptive control algorithm has been developed. It has been used in combination with a pole assignment controller, and its results have been compared through computer simulation in 12 test models with 3 other algorithms. It produces an improvement in the efficiency and the control cost, and it shows indications of ameliorating the stability. It also has been observed that for glycemic control, a minimum variance controller (control advance moving average controller [CAMAC]) is very efficient, whereas an empirical type of controller (Clemens) requires low control action. Some recommendations are made for the use of the algorithm in clamping in a hypothetical electromechanical endocrine artificial pancreas.
In Vivo and In Vitro Optimization of Depletion of IgM and IgG Xenoantibodies by Immunoadsorption Using Cell Membrane Proteins
Authors: Lucchiari Newton , Azimzadeh Agnès , Wolf Philippe , Regnault Véronique , Cinqualbre Jacques
Published: July 2010

Abstract:A system of immunoadsorption was developed for in vitro depletion of xenoreactive natural antibodies of classes IgG and IgM from monkey and human plasma. Porcine endothelial cell membrane proteins, platelet membrane proteins, and endothelial cells were used as affinity ligands, and cyanogen bromide‐activated Sepharose 6 Fast Flow and Sepharose CL4B gels were used for chromatography. Adsorption capacity was evaluated by means of ELISA, immunonephelometry, and cytotoxicity testing. Several consecutive adsorption‐desorption cycles were performed. Different parameters influencing immunoadsorption were examined: ligand density on the column gel, adsorbent‐plasma contact time, ratio of plasma volume to immunoadsorbent volume, desorption conditions, and temperature. After 2 adsorption‐desorption cycles, 99% and 82 to 85% of IgG and IgM antipig antibodies were adsorbed, respectively. Furthermore, there was a 74 to 77% decrease in cytotoxicity. In vivo, we observed that after one adsorption‐desorption cycle, 97% of antipig IgG antibodies and 96% of antipig IgM antibodies were adsorbed, and there was an 85% decrease in cytotoxicity. The immunoadsorption method studied and optimized in vitro and in vivo therefore efficiently depleted xenoantibodies and reduced the cytotoxicity. Thus, it can be used in xenotransplantation experiments without eliminating nonspecific antibodies.
Effects of Stimulated Free Latissimus Dorsi Muscle Graft on LVEDV and LVSW: A New Dynamic Cardiomyoplasty Technique
Authors: Dudra Jan , Matsui Yoshiro , Suto Yukio , Yarnauchi Hidetoshi , Gou Megumi , Yasuda Keishu
Published: July 2010

Abstract: The effectiveness of dynamic cardiomyoplasty (DCMP) remains controversial. We hypothesized that effectiveness of DCMP using the latissimus dorsi muscle graft (LDMG) depends on the wrapping method. We analyzed pressure‐volume relations (PVR), the left ventricular stroke work (LVSW), and the left ventricular end diastolic volume (LVEDV) changes during nonstimulation and stimulation of the LDMG to evaluate the effect of a new wrapping method of DCMP on the LVSW and the LVEDV changes. The new wrapping technique was evaluated in an acute animal experimental model. In 12 mongrel dogs, we performed continuous measurement of the dimensional and pressure dates of the left ventricle (LV) after the DCMP. The measurement was performed 15 min after wrapping during 5 periods. The duration of one measurement period was 15 s. The animals were divided into 2 groups according to the wrapping method. The heart was wrapped with the LDMG using 2 different methods. For Method 1, Carpentier's method, the heart was wrapped primarily with the distal part of the LDMG, the lateral segment. The vasculoneural pedicle of the latissimus dorsi muscle (LDM) was preserved. For Method 2, the LDM was separated, and the vasculoneural pedicle was cut. The medial sternotomy was performed. The thoracodorsal artery of LDMG was anastomosed to the right internal mammary artery, and the thoracodorsal vein was anastomosed to the right atrial appendage. The heart was wrapped primarily with the proximal part of the “free LDMG,” the transverse segment. Based on the PVR loops, the changes of the LVSW and the LVEDV in both experimental groups were analyzed. The paired t‐test was used for statistical analysis. Using Method 1, the LVSW and the LVEDV showed no significant changes during stimulation (stim) of the LDMG, compared with non‐stimulation (nonstim) (LVSW: nonstim, 970 ± 168 erg × 103; stim, 1,181 ± 203 erg ± 103; p = 0.126 and LVEDV: nonstim, 36.6 ± 6.7 ml; stim, 37.2 ± 6.8 ml; p = 0.36). Using Method 2, the LVSW was increased, and the LVEDV was decreased during stimulation of the free LDMG, compared with nonstimulation (LVSW: nonstim, 694 ±117 erg ± 103; stim, 846 ± 104 erg ± 103; p < 0.001 and LVEDV: nonstim, 47.7 ± 2.8 ml; stim, 46.8 ± 2.7 ml; p < 0.001). The stimulated free LDMG wrapping of the heart seems to be a more effective wrapping method for DCMP, and it results in an increase of the LVSW and a decrease of the LVEDV, compared with the original Carpentier's rnethod.
Hemolysis in Different Centrifugal Pumps
Authors: Kawahito Koji , Nosé Yukihiko
Published: July 2010

Abstract: Different types of centrifugal pumps cause different amounts of hemolysis based on shear stress and blood exposure time. However, the hemolytic characteristics of centrifugal pumps in each clinical condition are not always clear. We compared the hemolytic characteristics of one cone‐type centrifugal pump (Medtronic Bio‐Medicus BP‐80) and 2 impeller‐type centrifugal pumps (Nikkiso HMS‐12 and Terumo Capiox) under experimental conditions simulating their use in cardiopulmonary bypass (CPB), extracorporeal membrane oxygenation (ECMO), and percutaneous cardiopulmonary support (PCPS) as well as their use as left ventricular assist devices (LVADs). The normalized indexes of hemolysis (NIHs; grams free plasma hemoglobin per 100 L blood pumped) during use as LVADs were not significantly different among the 3 pumps. The BP‐80 pump produced almost 3–fold more hemolysis than the HMS‐12 and Capiox pumps during CPB, 3– to 4–fold more hemolysis during ECMO, and 5.5–fold more hemolysis during PCPS. The 2 impeller‐type centrifugal pumps will therefore cause less hemolysis under high flow, high pressure difference (as in CPB) and low flow, high pressure difference (as in ECMO and PCPS) conditions than the cone‐type pump.
Alterations in Echinocyte Transformation and Erythrocyte Sedimentation Rate During Hemodialysis
Authors: Agroyannis B. , Dalamangas A. , Tzanatos H. , Soubassi L. , Fourtounas C. , Kopelias I. , Bovoleti O. , Bosiolis V. , Koutsikos D.
Published: July 2010

Abstract: In 18 uremic patients under regular hemodialysis (HD) with bicarbonate dialysate, the echinocytes and erythrocyte sedimentation rates (ESR) were determined in 4 blood samples collected from the arterial line at 0, 45, 120, and 240 min (end‐HD) in one HD session by a bio‐incompatible dialyzer and in another by a biocompatible one. In the HD session by a bioincompatible dialyzer, the mean values (±SEM) of echinocytes (%) at 0. 45, 120, and 240 min were 8.89 ± 1.15, 20.77 ± 2.35, 7.39 ± 1.1, 5.27 ± 0.66 and of ESR (mm/h) were 65.00 * 6.26, 47.05 ± 3.89, 66.72 ± 6.00, 68.44 ± 5.92, respectively. According to these findings, echinocytes show a transient significant increase at 45 min HD in comparison to those at 0 (p < 0.001), 120 (p < 0.001), and 240 (p < 0.001) min while ESR shows a transient significant decrease at 45 min HD compared with the rates at 0 (p < 0.05), 120 (p < 0.05) and 240 (p < 0.01) min. In the HD sessions with the biocompatible dialyzer, the mean values (±EM) of echinocytes at the aforementioned 4 time points were 8.55 ± 1.10, 17.05 ± 2.40, 17.05 ± 1.19, and 5.11 ± 0.75%, and the ESR values were 60.89 i 6.08, 44.33 ± 4.18, 62.94 ± 6.55, and 65.61 ± 6.13 mm/h, respectively. These values also show a transient significant increase of echinocytes at 45 min HD in comparison with those at 0 (p < 0.01), 120 (p < 0.01), and 240 (p < 0.001) min, with a parallel transient decrease of ESR at 45 min HD as compared to the ones at 0 (p < 0.05), 120 (p < 0.05), and 240 (p < 0.05) min. Although the echinocytosis at 45 min HD was more prominent in HD by the bioincompatible than by the biocompatible dialyzer, the comparison between these values indicates no significant difference in the echinocytes or the ESR. In conclusion, uremic patients receiving HD exhibit echinocytes, the percentage of which shows a transient increase at 45 min HD that returns to about baseline at 120 min HD. In parallel with the changes in echinocytes, the ESR shows an inverse change at 45 min HD which returns to baseline at 120 min HD.
Platelet Damage Caused by the Centrifugal Pump: In Vitro Evaluation by Measuring the Release of α‐Granule Packing Proteins
Authors: Kawahito Koji , Mohara Jun , Misawa Yoshio , Fuse Katsuo
Published: July 2010

Abstract: Platelets are more vulnerable to damage than erythrocytes because platelets are easily activated by contact with extracorporeal circuits and by exposure to shear forces. However, the degree of platelet damage caused by centrifugal pumps is unclear. To evaluate platelet damage in different pumping conditions, the rates of increase for specific proteins in platelet α‐granules, β‐thromboglobulin (β‐TG), and platelet factor 4 (PF‐4) were measured in both in vitro simulated left ventricular assist device (LVAD) and cardiopulmonary bypass (CPB) conditions and compared with the erythrocyte trauma. A flow of 5.0 Llmin with ΔP of 100 mm Hg for LVAD (low pressure head condition) and a flow of 5.0 Limin with ΔP of 350 nim Hg for CPB (high pressure head condition) were investigated. Each condition was tested 4 times for 3 h in a mock circuit with a Capiox (Terumo, Tokyo, Japan) centrifugal pump using fresh human blood. Blood was sampled at 1 h intervals, measuring plasma free hemoglobin (Mb). β‐TG, and PF‐4. To evaluate the degree of damage. the rates of increase of fHb, β‐TG, and PF‐4 were calculated for each condition as ΔfHb/ΔN, Δβ‐TG/ΔN, and ΔPF‐4/ΔN where ΔfHb is the increase in plasma free hemoglobin, Δβ‐TG is the increase in β‐TG. ΔPF‐4 is the increase in PF‐4, and ΔN is the increase in the passing number. The passing number is defined in the following equation: N = Qt/V where t is the time, V is the priming volume, and Q is the flow rate. There was no significant difference between the 2 conditions (low pressure head condition versus high pressure head condition) in the rate of increase of fHb (0.0035 ± 0.0004 vs. 0.0034 ± 0.0010 g/100 L. NS). Contrary to this, the rates of increase for specific proteins in platelet α‐granules in the high pressure head condition demonstrated a significantly higher rate of increase than in the low pressure head condition. The mean rate of increase for β‐TG in the low pressure head condition was 0.22 ± 0.03 ng/ml and in the high pressure head condition was 0.51 ± 0.05 ng/ml (p < 0.05). The rate of increase for PF‐4 in the low pressure head condition was 0.11 ± 0.02 ngiml and in the high pressure head condition was 0.30 ± 0.06 ng/ml (p < 0.05). These results suggest that measurements of β‐TG and PF‐4 may be more sensitive parameters than hemolysis for evaluating blood cell trauma and that platelets are more vulnerable to mechanical damage by a centrifugal pump than erythrocytes.
LDL Apheresis in a Homozygous Familial Hypercholesterolemic Child Aged 4.5
Authors: Stefanutti C. , Notarbartolo A. , Colloridi V. , Nigri A. , Vivenzio A. , Bertolini S. , Bosco G. , Berni A. , Giacomo S. Di , Matzarella B.
Published: July 2010

Abstract: Preliminary experience with the efficacy and safety of dextran sulfate cellulose low‐density lipoprotein (LDL) apheresis for the treatment of a 4.5‐year‐old girl with homozygous familial hypercholesterolemia and coronary artery disease is reported. The decrease of the most atherogenic apolipoprotein B‐containing lipoproteins, low‐density lipoprotein (LDL) and lipoprotein(a) (Lp [a]), were in the ranges of 63.1–68.7%, and 52.5–58.6%, respectively. The child tolerated LDL apheresis without any clinically significant complications. Therefore, she was submitted to a long‐term program of treatment at intervals of 15 days. The experience suggests the possibility of an early beginning of extracorporeal treatment with LDL apheresis in children severely affected by homozygous or double heterozygous familial hypercholesterolemia.
Effects of Pulsatile Flow on Gas Transfer of Membrane Oxygenator: MENOX EL‐4000 and Gyro C1‐E3 Pulsatile Mode
Authors: Tayama Eiki , Niimi Yoshinari , Takami Yoshiyuki , Ohashi Yukio , Ohtsuka Goro , Nakazawa Tadashi
Published: July 2010

Abstract: It is acknowledged that pulsatile flow enhances the gas exchange performance of membrane oxygenators. However, the data for currently developed oxygenators are limited. In this study, the effect of pulsatile flow was assessed utilizing the MENOX EL‐4000 oxygenator. The in vitro test was performed following the Association for the Advancement of Medical Instrumentation (AAMI) standards. Pulsatile flow was produced by the Gyro C1‐E3 centrifugal pump with periodical changing of the impeller speed. In Study 1, the following 3 groups were created and examined: nonpulsatile flow, pulsatile flow of 40 bpm, and pulsatile flow of 60 bpm. The blood flow rate was maintained at 3 LImin, and the VIQ ratio was I. In Study 2, four groups were examined, nonpulsatile flow with V/Q = 1, nonpulsatile with V/Q = 2, pulsatile with VIQ = 1, and pulsatile with V/Q = 2. The blood flow rate was maintained at 4 LImin, and the pulse frequency was set at 40 bpm. In study 1, although 0, transfer was not enhanced. CO2, transfer was significantly improved (40–50%) by pulsatile flow, regardless of pulse frequency. Study 2 demonstrated that pulsatile flow resulted in improved CO2 transfer as did higher ventilation (VIQ = 2). Furthermore, even after applying higher ventilation, the pulsatile mode enhanced CO2 transfer more than the nonpulsatile mode. It was considered that the pulsatile mode induced an active secondary flow and enhanced mixing effects, and consequently CO2 transfer was improved. In conclusion, the pulsatile flow significantly enhanced the CO2 transfer of the MENOX oxygenator. It is indicated that applying the pulsatile mode is a unique and effective method to improve the gas exchange performance for a current membrane oxygenator.
Canine Latissimus Dorsi Muscle: An Apparatus for Isometric Force Measurements
Authors: Cesturi I. A. , Oshiro M. S. , Marques E. , Leirner A. A.
Published: July 2010

Abstract: This paper describes a device used to measure the isometric forces generated during electrical stimulation of the canine latissimus dorsi muscle in vivo with a preserved neurovascular supply. This device uses 2 strain gauge force sensors linked to a movable alignment frame to which the muscle is attached. The muscle length is controlled by the application of known weights to the system. The device has a frequency of response of 17.5 Hz and compliance of ‐0.1 mm N‐1, and its experimental performance was tested in the anesthetized mongrel dog.
Packed‐Bed Type Reactor to Attain High Density Culture of Hepatocytes for Use as a Bioartificial Liver
Authors: Ohshima Norio , Yanagi Kennichi , Miyoshi Hirotoshi
Published: July 2010

Abstract: In an attempt to develop a bioartificial liver using cultured hepatocytes, we investigated the short‐term and long‐term viability and metabolic functions of hepatocytes cultured in a new type of packed‐bed type reactor using reticulated polyvinyl formal (PVF) resin as a supporting material. Perfusion culture experiments using this reactor, as well as monolayer cultures using conventional collagen‐coated Petri dishes as control experiments, were performed. It was found that the highest density of immobilized hepatocytes attained with PVF resin was on the order of 107 cells/cm3 PVF and that hepatocytes cultured in this type of module for up to a week showed a sufficient level of liver‐specific metabolic functions, such as ammonium metabolism, urea‐N synthesis, and albumin secretion, to be comparable to those in the monolayer culture. It is concluded that the packed‐bed reactor system utilizing PVF resin is a promising means to develop a bioartificial organ using hepatocytes.
Fetal Pig Neural Cells as a Restorative Therapy for Neurodegenerative Disease
Authors: Jacoby Douglas B. , Lindberg Charles , Ratliff Judson , Wunderlich Michelle , Bouquet Joyce , Wetzel Kristie , Beaulieu Laura , Dinsmore Jonathan
Published: July 2010

Abstract: With proper immunosuppression, interspecies transplantation of porcine as well as other species of neural cells survive, mature, and integrate into the host in a manner which reconstructs much of the appropriate neural circuitry. These transplants have been shown to alleviate many of the symptoms of various disorders of the central nervous system. In this study, we addressed immunological and maturation issues with regards to intracerebral transplantation of fetal porcine neural cells. First, we compared fetal neural xenograft survival in athymic nude rats versus rats immunosuppressed with cyclosporin A and found that there is little discernible difference between porcine grafts in the 2 recipients. We also found that ectopic transplantation of cells isolated from the porcine striatal primor‐dium can survive and develop into grafts composed of both neuronal and glial phenotypes within the rat hippocampus. This fact raises the possibility that cells of a particular neurotransmitter type (e.g., GABAergic cells) developing from the striatal precursor cells can be transplanted outside the striatum of the adult brain and have physiological effects.
An Evaluation of the System to Control Blood Flow in Maintaining Goat Fetuses on Arterio‐Venous Extracorporeal Membrane Oxygenation: A Novel Approach to the Development of an Artificial Placenta
Authors: Unno Nobuya , Baba Kazunori , Kozuma Shiro , Nishina Hidenori , Okai Takashi , Kuwabara †Yoshinori , Taketani Yuji
Published: July 2010

Abstract: We compared various methods to control blood flow for extrauterine incubation of goat fetuses without lung respiration using arterio‐venous extracorporeal membrane oxygenation via umbilical vessels to develop a suitable system for a long‐term life support system for premature neonates. In twenty‐seven consecutive preparations of goat fetuses, 4 designs (System 1, manual flow control without a reservoir; System 2, manual flow control with an arterial open‐top reservoir; System 3, semiautomatic flow control with an arterial open top reservoir; and System 4, semiautomatic flow control with a tube occluder and an arterial open top reservoir) were tested in terms of the duration of incubation periods during which fetuses were kept under stable conditions. The incubation periods be‐came prolonged with the advancement of the system (System 1, 5.4 h; System 2, 11.6 h; System 3, 64.8 h; and System 4, 159.8 h medians of the incubation periods). The incubation periods with System 4 were significantly longer compared to those with System 1 and System 2. These results suggest that, for extrauterine incubation of goat fetuses using arterio‐venous extracorporeal membrane oxygenation via umbilical vessels, the method to control blood flow is of utmost importance for long‐term maintenance, and thus a control system with the fixed vascular resistance of the extracorporeal circuit is applicable to long‐term maintenance of premature goat fetuses.
Etiopathogenesis of Hemolytic Reactions in Total Artificial Heart Recipients
Authors: Vaˇků Jaromír , Urbánek Petr
Published: July 2010

Abstract: Hemolysis in total artificial heart (TAH) recipients was analyzed. From a total of 66 long‐term experiments lasting from 30–314 days performed in the Brno Research Center, in 53 animals, the total red blood cell (RBC) count, hematocrit, total hemoglobin, and free plasma hemoglobin were investigated. We could essentially divide the whole group of calves in 2 subgroups. The first subgroup was calves with hemolytic reactions, and the second subgroup was calves without any hemolytic reaction at all. In the first subgroup, hemolysis occurred in 47% of the overall number of animals during extracorpo‐real circulation (ECC), in 15% during ECC and later periodically during the experiment, in 8% during ECC and then continuously during the experiment, and finally in 10% not during ECC but repeatedly during the experiment. In 20% of the animals from the overall number, hemolysis did not occur at all (second subgroup). These results testify to the great individual differences within 1 breed (Bohemian with a substantial component of Hol‐stein). These differences are further modified by exogenous and endogenous factors. First, the inborn resistance of the RBC membrane and also thrombi formation and the mineralization of the driving diaphragm are very important. The extreme situation of decreased RBC membrane resistance was proved using a calf from another breed, the slow growing Scottish Highland breed, which did not survive 22 days of pumping due to intractable lethal hemolysis. These factors are also indicated by the hemolytic action of some drugs (e.g., Dopegyt) used during the experiment for another reason. Also important are the mechanical forces of pumping, surface moieties of the biomaterial, mineralization of the driving diaphragms, thrombi formation, infection, etc. Essentially, the hemolytic reaction in the TAH recipient has a multifactorial character. Hemolysis is undoubtedly an important factor, which can have a profound impact on the length of survival. The experimental and clinical experiences must be continuously integrated, and conclusions valid for human TAH application must be considered as very important for further TAH experimental and clinical research.
Variable Effects of Cardiomyoplasty on Left Ventricular Function
Authors: Chiang Benjamin B.Y. , Ali Ahsan T. , Riordan Chris , Montgomery William , Slater A. David , Santamore William P.
Published: July 2010

Abstract: Cardiomyoplasty (CMP) has been considered as a possible treatment for patients with heart failure. Symptomatic improvements occur almost uniformly among survivors with CMP, but changes in left peak ventricular systolic pressure (PVSP) and stroke volume vary in patients. This study examined whether there is variability present shortly after cardiomyoplasty surgery. Cardiomyoplasty was performed in 11 mongrel dogs with normal ventricular function. Nine to twelve days after CMP, left ventricular (LV) function was evaluated by simultaneously measuring LV volume (conductance catheter) and pressurc (Millar catheter). The latissimus dorsi muscle (LDM) was stimulated synchronously with ventricular systole in a ratio of 1:4 to 1:7 to avoid muscle fatigue. Data were analyzed on a beat by beat basis. The PVSP, and maximum dP/dt (+dP/ dt) increased, but the absolute value of minimum dP/dt (‐dP/dt) decreased in stimulated beats in 7 dogs while 4 dogs did not respond. The net changes in stimulated beats versus nonstimulated beats of PVSP were 6.1 ± 1.8 mm Hg (4.3%), of stroke work was 4.5 ± 1.9 gm. m (29.5%), of +dP/dt was 185 ± 47 mm Hg/s (So/,), and of ‐dP/dt was 168 ± 43 mm Hg/s (7.8%) (p < 0.05) for all these net changes in the responding group while these variations were not significant in the nonresponding group. From the results of our study, active LDM assist improves left ventricular systolic function, occurring in only 7 of 11 experiments. This improvement is inconsistent and varied individually. The integrity of the LDM, tightness of wrapping, and adhesions might contribute to the variability which is present early after surgery and before the LDM is converted into a fatigue resistance muscle.
Video‐Assisted Cardioscopic Staple Closure for Atrial Septal Defect
Authors: Inoue Yoshito , Yozu Ryohei , Mitsumuru Atsuhiro , Ueda Toshihiko , Kawada Shiaki
Published: July 2010

Abstract: Our goal was to determine the feasibility of video‐assisted cardioscopic closure of atrial septal defect (ASD) without cardiopulmonary bypass using a staple catheter device and guiding catheter in an experimental setting. An artificial linear atrial septal defect (AASD) was created in 7 swine under video‐assisted cardioscopic view, and slaple closure was attempted at the AASD with a stapler inserted through a trocar guiding catheter via the right atrium under median sternotomy. The staple device was successfully and safely anchored in 4 animals. The whole process of stapling could be monitored by cardio‐scope and by post mortem macroscopic examination. In conclusion, although the size and flexibility of the stapler and the guiding catheter must be improved, our results demonstrate that there is a strong potential for video‐assisted staple closure of ASD using this novel technique, which could contribute to the reduction of the number of open heart operations and thereby iatrogenic morbidity.
The Simple In Vitro Thrombogenic Test: Modified Methods for Same Priming Pumps
Authors: Tayama Eiki , Ohtsubo Satoshi , Nakazuwa Tadashi , Takami Yoshiyuki , Niimi Yoshinari , Makinouchi Kenzo , Glueck Julia A. , Nosé Yukihiko
Published: July 2010

Abstract: The improvement of antithrombogenicity is one of the major objectives for the development of blood pumps. Previously we reported that an in vitro thrombogenic test was useful as a pilot study, especially to predict thrombogenic areas. In this study we modified the method for testing pumps with identical priming volumes by eliminating the blood reservoir. Identical compact mock loops (priming volume of 53 ml. without pump) were constructed and tested with the same priming volume of Nikkiso centrifugal pumps, noncoated verus heparin‐coated. Two pumps were run simultaneously using the same source of fresh heparinized human blood (activated clotting time [ACT] 150–250 s) for 4 or 6 h. Results indicated that the heparin‐coated pump had a longer thrombus free period than the noncoated one. The thrombi location and forms were consistently in the same places the in vivo study had identified. It is suggested that this modified in vitro thrombogenic test is a feasible pilot study, as well as the one previously reported. The minimal priming volume will allow evaluation of multiple pumps simultaneously with the same source blood.
Errors in the Selection of Dialysate Concentrates Cause Severe Metabolic Acidosis During Bicarbonate Hemodialysis
Authors: Navarro Juan F. , Mora‐Fernández Carmen , García Javier
Published: July 2010

Abstract: Severe metabolic acidosis occurred during bicarbonate hemodialysis as the result of an error made in the selection of the dialysate concentrate. We questioned whether or not it was possible for the dialysis equipment to regulate the proportions in the dialysate fluid using an incorrect dialysate concentrate and still obtain the proper conductivity. We simulated this situation in vitro and found that during bicarbonate dialysis an inappropriately acidic dialysate fluid could replace the normal dialysate with an adequate range of conductivity still being maintained and therefore no triggering of alarms. The investigation showed that the dialysis machines were not adequately adjusted for sensitivity to the concentrates being employed during dialysis. We concluded that dialysis equipment should be fitted with on‐line pH meters with alarm systems.
Proportional Changes in Body Fluid with Hemodialysis Evaluated by Dual‐Energy X‐Ray Absorptiometry and Transthoracic Bioimpedance with Particular Emphasis on the Thoracic Region
Authors: Metry George , Mallmin *Hans , Wikström Björn , Danielson Bo G.
Published: July 2010

Abstract: Alterations in body composition during extra‐corporeal hemodialysis (HD) were investigated in 12 hemodialysis patients (9 males and 3 females, mean age 50 ± 15 years) with a mean ultrafiltration of 2.6 ± 1.0 L. Analysis was performed using a dual‐energy x‐ray absorptiometry technique (DXA), which measures 3 principal components of the body: fat mass (FM); lean body mass (LBM), i.e., all soft tissues excluding fat; and bone mineral content (BMC). These 3 components were calculated for the whole body and for different body regions (namely, the thorax, trunk, lower limbs, and upper limbs). The thoracic cage region could be defined manually, separately from the trunk, and its tissue composition was calculated. DXA analysis was performed concomitant with a measurement of the basal thoracic impedance (TFI) by bioimpedance cardiography prior to and 1 h after dialysis. We found a significant decrease in the total LBM, from 55.8± 8.8 to 53.3 ± 9.3 kg (p < 0.05), but no change in either the FM or BMC. Moreover, there was a disproportional reduction in the LBM in different regions, being significantly greater in the thorax (7.47 ± 3.7%) than in the other body regions (trunk 4.3 ± 2.0%, lower limbs 5.4 ± 2.1%, and upper limbs 4.7 ± 1.5%). Regarding bioimpedance, a stronger significant correlation was detected between the percentage changes in the TFI and the changes in thoracic fluid (r = 0.80, p < 0.01) than between the changes in the TFI and the changes in the total body fluid (r = 0.63, p < 0.01). The absolute values of the TFI were also significantly and negatively correlated to the thoracic lean mass to fat mass ratio, both before and after HD (r = 0.82, p < 0.001 and r = 0.86, p < 0.001, respectively). In conclusion, DXA is a very sensitive technique to detect fluid changes during HD in the thorax when the thoracic cavity is defined as a region of interest as well as for the whole body. The data also indicate an extracellular compartmental imbalance between different regions with a significantly greater change in the thoracic region. Trans‐thoracic bioimpedance is a useful technique for evaluating the HD induced changes in the thoracic fluid, rather than total body fluid.
Cyclosporine and Therapeutic Plasma Exchange in Treatment of Progressive Autoimmune Diseases
Authors: Schiel Ralf , Bambauer Rolf , Latza Reinhard , Klinkmann Jens
Published: July 2010

Abstract:Despite treatment with intensive immunosup‐pressive drug regimens, the prognosis of patients suffering from severe progressive autoimmune diseases like systemic lupus erythematosus (SLE), nephrotic syndrome (NS), and Behqet's disease is poor. Side effects (infections and malignant tumors) often occur. In the present trial, 35 patients suffering from autoimmune diseases (SLE, n = 21; NS, n = 10; and Behqet's disease, n = 4) were treated for 3.7 ± 2.0 years with 2.5 ± 0.6 mg cyclosporine/kg body weightlday in addition to corticosteroids alone or in combination with azathioprine and/or cyclophosphamide. In active stages of the diseases with extremely high concentrations of anti‐ds‐DNA‐antibodies, antinuclear antibodies, circulating immunocomplexes, and reduced complement concentrations, therapeutic plasma exchange (TPE) has been applied. Compared with previous treatment mo dalities, significantly (p < 0.05) more effective and rapid reductions of the antibodies were reached. Clinical disorders improved within 1–6 weeks. All patients reported increased performance and a better quality of life. After 1–12 months, the previously required doses of immuno‐suppressive drugs and the frequency of TPE could be reduced by 40–100%. After 13.4 ± 11.8 months in 17 of 35 patients (8 with SLE, 5 with NS, 4 with Behqet's disease), cyclosporine was established as the monotherapy. No severe side effects were registered. In treating active stages of severe progressive autoimmune diseases and forms with persistent high antibody levels, the addition of TPE to conventional therapy was very effective, as observed in both clinical and laboratory parameters.
Granulocytapheresis in the Treatment of Patients with Rheumatoid Arthritis
Authors: Ohara Morihiro , Saniabadi Abby R. , Kokuma Seiichiro , Hirata Ichiro , Adachi Masakazu , Agishi Tetsuzo , Kasukawa Reiji
Published: July 2010

Abstract: The G‐1 column is an extracorporeal type granulocytapheresis device packed with 220 g cellulose acetate beads to which granulocytes and monocytes specifically adhere. A total of 59 rheumatoid arthritis patients with elevated granulocyte counts from 4 hospitals in Japan received 2 apheresis sessions of 1 h duration/week for a total of 8 times over a period of 4 weeks. About 55 % of the leukocytes which entered the G‐1 column were adsorbed onto the beads; 95% were granulocytes, 3.5% monocytes, and 0.4% lymphocytes. Clinical and efficacy assessments showed improvements in swollen joints (p < 0.01), tender joints (p < 0.001), the active joint score (p < 0.001), duration of morning stiffness (p < 0.01), and grip strength (p < 0.001). In good responders, the improvements were observed for up to 12 weeks following the last apheresis. Exacerbation was noted in 2 patients. It is suggested that the efficacy of the G‐1 column is attributable to the removal or suppression of hyperactive leukocytes and inflammatory cytokines, inducing a kind of immunomodu‐lation.
Tissue Reactions to Various Percutaneous Materials with Different Surface Properties and Structures
Authors: Shin Yoshiharu , Akao Masaru
Published: July 2010

Abstract: Tissue responses to various percutaneous materials with different surface properties and structures were investigated. Dense hydroxyapatite (HA), tricalcium phosphate (TCP), glassy carbon (GC), and 2 types of porous HA were used. Cutaneous and subcutaneous tissues were tightly attached to the surface of the penetrating portion of an HA percutaneous device (PD). Neither bacterial infection nor serious epidermal downgrowth were observed in the area surrounding the shaft of the HA‐PD. At the margin of the epidermis, fibroblasts and collagen fibrils of fibrous connective tissue were well oriented and formed perpendicular to the shaft. The tissue response to the TCP was mild and nearly the same as that to the HA. The GC induced serious epidermal downgrowth and inflammatory cell infiltration. In contrast to dense HA‐PD, the insertion of both types of porous HA‐PDs, 1 with a spongy structure and 1 with close pores was followed by acute infection within 1 month. Based upon these results, it was concluded that the dense HA was the best percutaneous material of those tested.
Characterization of Modified Alginate‐Poly‐L‐LysineMicrocapsules
Authors: Lee Chang‐Sheng , Chu I‐Ming
Published: July 2010

Abstract: Various modifications of alginate‐poly‐L‐lysine microcapsules were made, such as the inclusion of polyethylenimine (PEI) or carboxyl methyl cellulose (CMC) in the core and the coating of bis(polyoxyethylene bis‐[amine]) (PEGA) onto the microcapsule membrane surface. A characterization of the modified microcapsules in terms of mechanical and mass transfer properties as well as their chemical composition was performed. The PEI treatment greatly enhanced the mechanical stability of the microcapsules, and this treatment did not affect the coating process of poly‐L‐lysine or PEGA. PEGA was found to be able to coat the microcapsules while the mass transfer property was similar to the poly‐L‐lysine coated ones.
Glutaraldehyde Treated Bovine Pericardium: Changes in Calcification Due to Vitamins and Platelet Inhibitors
Authors: Vasudev Sindhu C. , Chandy Thomas , Sharma Chandra P.
Published: July 2010

Abstract:Cardiovascular calcification, the formation of calcium phosphate deposits in cardiovascular tissue, is a common endstage phenomenon affecting a wide variety of bioprostheses. The purpose of the present paper is to study the possibility that some antiplatelet drugs (aspirin and persantine) and certain vitamins (vitamin C, vitamin B, and vitamin E) and their combinations might prevent the mineralization of glutaraldehyde treated bovine pericardium (GABP) by modifying the pericardial surface. In this experimental protocol, we used Golomb and Wagner's (1991) in vitro model for studying GABP calcification and a diffusion cell with 2 compartments for evaluating the diffusion of calcium across the GABP. The results showed that a combination of aspirin and vitamins (0.5 mg% aspirin, 1.5 mg% vitamin C, 4 mg% vitamin B, and 2 mg% vitamin E) in a metastable calcium phosphate solution not only reduced the transport of calcium ions through GABP, but along with the combinations of 0.5 mg% aspirin and 5 mg% persantine also produced significant reductions in GABP calcification. The exact mechanism of these changes in the calcification of GABP are still unknown. From these in vitro findings, it appears that a combined vitamin therapy with low doses of aspirin may be beneficial for platelet suppression and thereby prevent thrombosis. In addition, the vitamins may modify calcium transport and interfere with the adsorption at the surface, thus reducing GABP calcification. However, an important question that remains unanswered is whether this inhibitory effect would continue if the antiplatelet drugs and vitamins were discontinued. For the answer, more in vivo studies are needed to develop applications.
Treatment of Infectious Skin Defects or Ulcers with Electrolyzed Strong Acid Aqueous Solution
Authors: Sekiya Shuichi , Ohmori Kitaro , Harii Kiyonori
Published: July 2010

Abstract: A chronic ulcer with an infection such as methicil‐lin‐resistant Staphylococcus uureus is hard to heal. Plastic and reconstructive surgeons often encounter such chronic ulcers that are resistant to surgical or various conservative treatments. We applied conservative treatment using an electrolyzed strong acid aqueous solution and obtained satisfactory results. The lesion was washed with the solution or soaked in a bowl of the solution for approximately 20 min twice a day. Fresh electrolyzed strong acid aqueous solution is unstable and should be stored in a cool, dark site in a sealed bottle. It should be used within a week after it has been produced. Here we report on 15 cases of infectious ulcers that were treated by electrolyzed strong acid aqueous solution. Of these cases, 7 patients were healed, 3 were well granulated, and in 5, infection subsided. In most cases the lesion became less reddish and less edematous. Discharge or foul odor from the lesion was decreased. Electrolyzed strong acid aqueous solution was especially effective for treating a chronic refractory ulcer combined with diabetes meli‐tus or peripheral circulatory insufficiency. This clinically applied therapy of electrolyzed strong acid aqueous solution was found to be effective so that this new therapeutic technique for ulcer treatment can now be conveniently utilized.
The Physiological Property and Function of the Electrolyzed‐Ionized Calcium Aquamax on Water Molecular Clusters Fractionization
Authors: Hatto Makoto , Sakai Yoshitaka , Ohtsuka Hiroyuki
Published: July 2010

Abstract: Aquamax, the ionized mineral (Ca, 21 mg/ml; Mg. 0.068 mg/ml; Na, 0.13 mg/ml; K, 0.006 mg/ml) is a fermented organic acid mineral extract. The fundamental physiological property and function of this mineral is to promote the molecular level mineral apply to the cell inside. The contained minerals exist at a molecular level to fractionize the molecular clusters of water and to make water's penetration ratio into objects higher only at 0.1–0.2% concentration. Existing minerals, especially the calcium, were barely dissolved in water. and its low penetration was caused by its low electrolyzed behavior plus the effects from an anion mineral, such as phosphorus, sulfur, nitrogen, or any oxalic acid combining with a colloidal calcium to construct and crystallize as the calcium phosphate and the calcium sulfate. Aquarnax minerals penetrate into objects to fractionize water molecular clusters and to make water functional, neutralize the anion mineral and oxalic acid elements, raise the object's electric conductivity. and preserve perishables.
Fixation of Various Porcine Arteries with an Epoxy Compound
Authors: Sung Hsing‐Wen , Hsu Chin‐Sheng , Chen Hsiu‐Chin , Hsu Hung‐Liang , Chang Yen , Lu Jen‐Her , Yang Ping‐Cheng
Published: July 2010

Abstract: The clinical results of biological vascular grafts have been unsatisfactory. The poor results of these vascular grafts may be attributed to the fixatives, aldehydes, used in fixing tissues. In an attempt to overcome this problem, a new fixative, epoxy compound, has recently been used to fix biological vascular grafts. The study was undertaken to investigate the crosslinking characteristics, fixation index and denatur‐ation temperature, of various porcine arteries fixed with an epoxy compound. The porcine arteries investigated in the study were the common carotid artery, internal thoracic artery, abdominal aorta, and saphenous artery. In addition, the effects of sonication on the porcine arteries before fixation on their cross‐linking characteristics were analyzed. The fresh and glutaral‐dehyde‐fixed arteries were used as controls. It was noted that glycine, proljne, and alanine were the most abundant amino acids found in the porcine internal thoracic artery. In the amino acid analysis, it was observed that the amino acids in the porcine arteries reacted with epoxy compound or glutaraldehyde were lysine, hydroxylysine, histidine, and arginine. Of these amino acids, lysine was the most reactive. In general, the fixed arteries were relatively stiffer than their fresh counterparts. The fixation indices and denaturation temperatures of various porcine arteries were comparable throughout the entire fixation process. The amounts of free amino groups of the sonicated arteries were significantly lower than those of their unsonicated counterparts (p < 0.05). It is speculated that the diminishing free amino groups of the sonicated arteries may be attributed to the removal of the destroyed cell debris and adherent proteins of the arteries after sonication. However, it was learned that sonication on the porcine arteries before fixation did not seem to affect their fixation indices and denaturation temperatures. The results obtained in this study may help one in selecting the raw materials for developing a small‐diameter biological vascular graft.
Priming of Anesthesia Circuit with Xenon for Closed Circuit Anesthesia
Authors: Saito Hayato , Saito Mieko , Goto Takahisa , Morita Shigeho
Published: July 2010

Abstract: Xenon is an inert gas with a practical anesthetic potency (1 MAC = 71%). Because it is very expensive, the use of closed circuit anesthesia technique is ideal for the conduction of xenon anesthesia. Here we describe our methods of starting closed circuit anesthesia without excessive waste of xenon gas. We induce anesthesia with intravenous agents, and after endotracheal intubation, denitrogenate the patient for approximately 30 min with a high flow of oxygen. This is done to minimize accumulation of nitrogen in the anesthesia circuit during the subsequent closed‐circuit anesthesia with xenon. Anesthesia is maintained with an inhalational anesthetic during this period. Then, we discontinue the inhalational agent and start xenon. For this transition, we feel it is unacceptable to simply administer xenon at a high flow until the desired endtidal concentration is reached because it is too costly. Instead. we set up another machine with its circuit filled in advance (i.e., primed) with at least 60% xenon in oxygen and switch the patient to this machine. To prime the circuit, we push xenon using a large syringe into a circuit, which was prefilled with oxygen. Oxygen inside the circuit is pushed out before it is mixed with xenon, and xenon waste will thus be minimized. In this way, we can achieve close to 1 MAC from the beginning of xenon anesthesia, and thereby minimize the risk of light anesthesia and awareness during transition from deni‐trogenation to closed‐circuit xenon anesthesia.
Biventricular Assist Using a Portable Driver in Combination with Implanted Devices: Preliminary Experience
Authors: von Segesser Ludwig K. , Tkebuchava Tengis , Leskosek Boris , Marty Bettina , Pei Yao‐Chang , Turina Marko
Published: July 2010

Abstract: Left ventricular assist systems with portable drive units are increasingly used in the clinical setting. However, such systems usually are not suitable for right ventricular support, and therefore, in the case of biventricular heart failure, they must be combined with other support devices that require additional drive consoles. As a result, most of the benefits of the wearable drive units (early mobilization and outpatient care) are lost. This present study was performed to evaluate biventricular support with implanted assist devices and a portable DC/battery‐powered driver (Thoratec TLC‐II). Electronic control by nonvolatile RAM accessible via RS232 interface, internal backup emergency battery, and optional manual activation are additional features of this 6 kg biventricular drive unit. In 3 bovine experiments (body weight 70 ± 5 kg) partial cardiopulmonary bypass (CPB) was established, and two ventricular assist devices were implanted into a preperitoneal pocket on each side after connection to the right atrium and the pulmonary artery and to the left atrium and aorta, respectively.
Histopathological Impacts of Hepatitis Virus Infection in Hemodialysis Patients: Should Liver Biopsy Be Performed Before Renal Transplantation?
Authors: Özdoĝan Mete , Özgür Orhan , Gür Gürden , Boyacioĝlu Sedat , Özderin Yasemin , Demirhan Beyhan , Telatar Hasan , Haberal Mehmet
Published: July 2010

Abstract:To evaluate the histologic changes in the livers of renal transplant candidates who were infected with hepatitis viruses, we performed a percutaneous liver biopsy in each of 74 regular hemodialysis patients. Forty percent of them were seropositive for the antibody to hepatitis C virus (anti‐HCV) whereas 29.7% had anti‐HCV and antibody to hepatitis B surface antigen (anti‐HBs) concomitantly. Seven (9.5%) were seropositive for only hepatitis B surface antigen HBsAg. Histopathological examination revealed that 30% of patients had chronic active hepatitis (CAH), 11% had chronic persistent hepatitis (CPH), and 3% displayed histopathological evidence of cirrhosis. Eleven of 22 patients with CAH were positive for only anti‐HCV, and 2 of 22 were positive for only HBsAg. One patient had HBsAg and anti‐HCV together, and 8 of 22 had anti‐HBs and anti‐HCV concomitantly. None of the anti‐HBs positive patients exhibited abnormal histopathological changes. We found no statistically significant difference in histopathological findings between the HBsAg positive and anti‐HCV positive patients. As 32 of 74 patients (43%) had some degree of chronic liver disease, we concluded that it is prudent to evaluate liver histology in HBsAg and anti‐HCV seropositive renal transplant candidates before transplantation.