bluuebunny/crossref_metadata_2025 huggingface dataset:
Linking Sociology Majors to Labor Market Success
Authors: Ciabattari Teresa , Lowney Kathleen S. , Monson Renee A. , Senter Mary Scheuer , Chin Jeffrey
Published: March 2018

Colleges and universities face pressures from multiple stakeholders to attend to the labor market success of their graduates. In this article, we argue that it is in the best interests of sociology students and the discipline that sociology programs respond proactively to these pressures. We encourage sociology programs to design curricula that develop student skills in critical sociological thinking as well as explicitly connect skills to career-related interests. After reviewing research on what employers expect, what students want to learn, and sociology graduates’ first labor market experiences, we offer suggestions about how programs can respond to the requests for accountability for employment outcomes without substantially revising the traditional undergraduate sociology curriculum or expending excessive amounts of faculty time on new initiatives. We argue that integrating liberal learning and applied learning is the best way to serve students and the discipline.
Factors determining labor underutilization in Spain by gender before and after the economic crisis
Authors: Rodríguez Hernández José Enrique
Published: March 2018

This article analyzes separately for men and women the main factors associated with labor underutilization (underemployment and unemployment) in Spain before and after the economic crisis. It does so by means of a novel application of the mixed logit econometric model, which has not been used before in the specialized literature on this topic and which represents a significant advance with respect to previous models. The results evidence significant modifications during this period of crisis and underscore important differences between men and women pertaining to these two conditions of labor underutilization.
Staying Well in a Sea of Harm
Authors: Deutsch Ellen S.
Published: March 2018

Physician psychological wellness is an emergent outcome resulting from dynamic interactions among complex conditions. We may enhance opportunities for physician wellness by applying principles developed to improve another emergent outcome: patient safety. The Safety I approach to patient safety focuses on “what went wrong” and considers humans a liability. Safety II is a powerful complementary approach that focuses on “what went right” and values human creativity. These contrasting perspectives are described in the context of patient safety, but the underlying principles have relevance for physician psychological wellness. We can create conditions that interfere with wellness and conditions that support wellness. We can learn from exploring and reinforcing successes and improving routine processes; together, these approaches may have a greater cumulative positive impact than just addressing problems. In addition to learning from failures, there is much we can learn from success.
Associations of child emotion recognition with interparental conflict and shy child temperament traits
Authors: Schermerhorn Alice C.
Published: March 2018

Severe early adversity, such as maltreatment and neglect, has been associated with alterations in children’s recognition of emotion. We sought to build on such findings by testing whether children’s exposure to interparental conflict, a much less severe form of adversity, is also associated with children’s emotion recognition. Further, we sought to examine the role of temperamental shyness in these associations. We presented 99 9- to 11-year-olds (56 males) with photographs of actors posing as a couple portraying interpersonal anger, happiness, and neutrality, and children classified the emotions in the photos. Children reported on interparental conflict, and their mothers reported on children’s shyness. Children’s perceptions of threat regarding interparental conflict interacted with trial type (angry, happy, neutral) to predict accuracy; greater threat perceptions predicted less accuracy for neutral expressions, a relatively ambiguous stimulus type. Additionally, shyness interacted with children’s threat perceptions. At low levels of shyness, low levels of threat perceptions predicted high accuracy, whereas high threat, high shyness, and their combination predicted poorer accuracy. Results suggest the significance of interparental conflict in altering children’s emotion recognition and of shyness in strengthening such adaptations. These findings suggest that even forms of adversity that are less severe than maltreatment and neglect have substantial implications for emotion processing, particularly for children with shy traits.
Beauty still matters: The role of attractiveness in labour market outcomes
Authors: Anýžová Petra , Matějů Petr
Published: March 2018

The main objective of the study is threefold: first, to examine the role of attractiveness in the Czech labour market; second, to assess gender differences in returns of attractiveness; and third, to show that the positive association between attractiveness and earnings does not disappear even when cognitive skills, social background, occupational status and individual characteristics are controlled for. The study uses data from the first large-scale sociological survey focusing on attractiveness carried out in the Czech Republic. The results provide strong evidence for the hypothesis that, in general, more attractive people have a better chance of higher socioeconomic occupational status as well as higher incomes than less attractive individuals even when controlling for cognitive skills, social background, occupational status and personality. However, the analysis also shows that the relationships are different for men and women. The study finds that the income premium for attractiveness is markedly higher among prime-aged women than men. The authors conclude that there have been profound changes in the last 30–40 years in the Western world and that the importance of physical attractiveness and erotic capital has been increasing, especially for women.
Six hours of task-oriented training optimizes walking competency post stroke: a randomized controlled trial in the public health-care system of South Africa
Authors: Knox Megan , Stewart Aimee , Richards Carol L
Published: March 2018

Objective:

To evaluate a minimal dose intervention of six 1-hour sessions of task-oriented circuit gait training including a caregiver over a 12-week period to persons post stroke in the South African public health sector.

Design:

Stratified, single blinded, randomized controlled trial with three intervention groups.

Participants:

Persons post stroke ( n = 144, mean age 50 years, 72 women), mean 9.5 weeks post stroke.

Interventions:

Task group ( n = 51)—accompanied by a caregiver; task-oriented circuit gait training (to improve strength, balance, and task performance while standing and walking). Strength group ( n = 45); strength training of lower extremities while sitting and lying. Control group ( n = 48); one 90-minute educational session on stroke management.

Measures:

The six-minute walk test (6MinWT) was the primary outcome; the secondary outcomes included comfortable and fast gait speeds, Berg Balance Scale (BBS), and Timed Up and Go (TUG). Particpants evaluated at baseline, post intervention (12 weeks), and at follow-up 12 weeks later. Change scores were compared using generalized repeated measures analysis of variance (ANOVA).

Results:

Task group change scores for all outcomes post intervention and at follow-up were improved compared to the other groups ( P-values between 0.000005 and 0.04). The change scores (mean, 1SD) between baseline and follow-up for the Task, Strength, and Control groups, respectively, were as follows: 6MinWT:119.52 m (81.92), 81.05 m (79.53), and 60.99 m (68.38); comfortable speed 0.35 m/s (0.23), 0.24 m/s (0.22), and 0.19 m/s (0.21); BBS: 9.94 (7.72), 6.93 (6.01), and 5.19 (4.80); and TUG: –14.24 seconds (16.86), –6.49 seconds (9.88), and –5.65 seconds (8.10).

Conclusion:

Results support the efficacy of a minimal dose task-oriented circuit training program with caregiver help to enhance locomotor recovery and walking competency in these persons with stroke.
Is there a specific Vivaldi effect on verbal memory functions? Evidence from listening to music in younger and older adults
Authors: Giannouli Vaitsa , Kolev Vasil , Yordanova Juliana
Published: March 2018

Brief exposure to music has been reported to lead to transient improvement of cognitive functions in no-music domains. Regarding the possible roles of working memory, processing of acoustic regularities, arousal and emotions in mediating the effects of music on subsequent cognition, the present study explored if brief listening to music might produce a subsequent transient change of verbal functions. A large sample ( n = 448) of younger (mean 28 years) and older (mean 72 years) individuals were studied to represent different background abilities. Verbal working memory (WM) and phonologically-cued semantic retrieval were assessed using the forward digit span test (F-DST) and word fluency test (WFT). To account for arousing, emotional and previous expertise effects, F-DST and WFT scores were measured only in non-musicians after listening to novel (unknown) excerpts of three different composers (Mozart, Vivaldi and Glass) and after silence, with individual preference for each condition subjectively rated. It was found that brief exposure to music had no beneficial effect on verbal WM, with even a transient impairment emerging after Vivaldi. In contrast, Vivaldi’s excerpt induced a marked enhancement of word fluency, but only in young adults, whereas listening to Mozart’s composition was followed by decreased WFT scores in the two age groups. These results show that depending on composer- or excerpt-specific music features, listening to music can selectively facilitate or inhibit ongoing verbal functions. It is suggested that these effects are mediated by pro-active priming or interference of residual activations induced by music in working memory loops.
Beyond Ability to Pay: Procedural Justice and Offender Compliance With Restitution Orders
Authors: Gladfelter Andrew S. , Lantz Brendan , Ruback R. Barry
Published: March 2018

Restitution to victims is rarely paid in full. One reason for low rates of payments is that offenders lack financial resources. Beyond ability to pay, however, we argue that fair treatment has implications for offender behavior. This study, a survey of probationers who owed restitution, investigated the links between (a) ability to pay, (b) beliefs about restitution and the criminal justice system, and (c) restitution payment, both the amount paid and number of payments. Results indicate that perceived fair treatment by probation staff—those most directly involved with the collection of restitution payments—was significantly associated with greater payment, net of past payment behavior, intention to pay, and ability to pay. Because restitution has potentially rehabilitative aspects if offenders pay more of the court-ordered amount and if they make regular monthly payments, how fairly probation staff treat probationers has implications for both victims and for the criminal justice system.
A New Set of Spatial-Interaction Models: The Theory of Competing Destinations
Authors: Fotheringham A S
Published: March 2018

Members of the family of spatial-interaction models commonly referred to as gravity models are shown to be misspecified. One result of this misspecification is the occurrence of an undesirable ‘spatial-structure effect’ in estimated distance-decay parameters and this effect is examined in detail. An alternative set of spatial-interaction models is formulated from which more accurate predictions of interactions and more accurate parameter estimates can be obtained. These new interaction models are termed competing destinations models, and estimated distance-decay parameters obtained in their calibration are shown to have a purely behavioural interpretation. The implications of gravity-model misspecification are discussed.
Development of aluminum alloy 6063 T6 and T7 material models and their effects on energy-absorbing characteristics of cross-axial members
Authors: Eboreime Ohioma , Ali Muhammad , Kraft Frank , Alam Khairul
Published: March 2018

This article presents a new and detailed study on the characterization of material properties of AA 6063 T6 and T7 tempers and their effects on crushing response and energy absorption in a novel tubular structural member for design for crashworthiness purposes. These properties were characterized into three regions: the elastic, the uniform plastic, and the ductile damage regions. Standard tensile tests were used to ascertain the elastic and plastic properties up until uniaxial instability. To characterize the ductile damage, a phenomenological model was employed using a decaying exponential fit of triaxial stresses versus equivalent plastic strain data obtained from finite element and experimental models of flat notched specimens. A new theoretical model for predicting the crushing behavior of the novel cross tube was developed. A numerical, experimental, and theoretical comparison of the mean crushing force for novel extruded cross-shaped specimens of both tempers was also presented. The results of this study provide valuable insights into the applications of T6 and T7 tempers of aluminum as energy-absorbing materials for novel cross-shaped structural members for improved crashworthiness.
Integral method coefficients for the ring-core technique to evaluate non-uniform residual stresses
Authors: Barsanti Michele , Beghini Marco , Santus Ciro , Benincasa Alessio , Bertelli Lorenzo
Published: March 2018

The ring-core technique allows for the determination of non-uniform residual stresses from the surface up to relatively higher depths as compared to the hole-drilling technique. The integral method, which is usually applied to hole-drilling, can also be used for elaborating the results of the ring-core test since these two experimental techniques share the axisymmetric geometry and the 0°–45°–90° layout of the strain gage rosette. The aim of this article is to provide accurate coefficients which can be used for evaluating the residual stress distribution by the ring-core integral method. The coefficients have been obtained by elaborating the results of a very refined plane harmonic axisymmetric finite element model and verified with an independent three-dimensional model. The coefficients for small depth steps were initially provided, and then the values for multiple integer step depths were also derived by manipulating the high-resolution coefficient matrices, thus showing how the present results can be practically used for obtaining the residual stresses according to different depth sequences, even non-uniform. This analysis also allowed the evaluation of the eccentricity effect which turned out to be negligible due to the symmetry of the problem. An applicative example was reported in which the input of the experimentally measured relaxed strains was elaborated with different depth resolutions, and the obtained residual stress distributions were compared.
Effect of Methodological Choices on Pavement Life-Cycle Assessment
Authors: Yang Rebekah , Al-Qadi Imad L. , Ozer Hasan
Published: March 2018

The use of life-cycle assessment (LCA) to assess the environmental impacts of pavement systems has become more prevalent in recent years. When performing an LCA study, a series of methodological choices must be defined. As these decisions can change from study to study, it is important to understand the significance or insignificance of the methodological choices relevant to pavement LCA. This paper evaluated the sensitivity of five choices commonly made in pavement LCA; cut-off criteria, end-of-life (EOL) allocation, asphalt binder allocation, traffic growth, and type of energy reported. Eight case studies and four environmental indicators, that is, global warming potential, primary energy as fuel, total primary energy, and a unitless single score, were considered in the sensitivity analyses. Varying the cut-off criteria and asphalt binder allocation only had a significant impact on the environmental indicators when the use stage of the life-cycle is excluded and only the materials and construction, maintenance and rehabilitation, and EOL stages are considered. Using different EOL allocations, traffic growths, and types of energy reported had significant effects on the overall life-cycle results. Common methodological choices made in a pavement LCA are expected to have an impact on LCA results and subsequent interpretation, with the magnitude of the impact dependent on the scope of the analysis.
Muscle Strength Is a Poor Screening Test for Predicting Lower Extremity Injuries in Professional Male Soccer Players: A 2-Year Prospective Cohort Study
Authors: Bakken Arnhild , Targett Stephen , Bere Tone , Eirale Cristiano , Farooq Abdulaziz , Mosler Andrea B. , Tol Johannes L. , Whiteley Rod , Khan Karim M. , Bahr Roald
Published: March 2018

Background:

Lower extremity muscle strength tests are commonly used to screen for injury risk in professional soccer. However, there is limited evidence on the ability of such tests in predicting future injuries.

Purpose:

To examine the association between hip and thigh muscle strength and the risk of lower extremity injuries in professional male soccer players.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Professional male soccer players from 14 teams in Qatar underwent a comprehensive strength assessment at the beginning of the 2013/2014 and 2014/2015 seasons. Testing consisted of concentric and eccentric quadriceps and hamstring isokinetic peak torques, eccentric hip adduction and abduction forces, and bilateral isometric adductor force (squeeze test at 45°). Time-loss injuries and exposure in training and matches were registered prospectively by club medical staff throughout each season. Univariate and multivariate Cox regression analyses were used to calculate hazard ratios (HRs) with 95% CIs.

Results:

In total, 369 players completed all strength tests and had registered injury and exposure data. Of these, 206 players (55.8%) suffered 538 lower extremity injuries during the 2 seasons; acute muscle injuries were the most frequent. Of the 20 strength measures examined, greater quadriceps concentric peak torque at 300 deg/s (HR, 1.005 [95% CI, 1.00-1.01]; P = .037) was the only strength measure identified as significantly associated with a risk of lower extremity injuries in multivariate analysis. Greater quadriceps concentric peak torque at 60 deg/s (HR, 1.004 [95% CI, 1.00-1.01]; P = .026) was associated with the risk of overuse injuries, and greater bilateral adductor strength adjusted for body weight (HR, 0.75 [95% CI, 0.57-0.97; P = .032) was associated with a lower risk for any knee injury. Receiver operating characteristic curve analyses indicated poor predictive ability of the significant strength variables (area under the curve, 0.45-0.56).

Conclusion:

There was a weak association with the risk of lower extremity injuries for 2 strength variables: greater quadriceps concentric muscle strength at (1) high and (2) low speeds. These associations were too small to identify an “at-risk” player. Therefore, strength testing, as performed in the present study, cannot be recommended as a screening test to predict injuries in professional male soccer.
High Molecular Weight Kininogen Adsorption on Hemodialysis Membranes: Influence of pH and Relationship with Contact Phase Activation of Blood Plasma. Influence of Pre-Treatment with Poly(Ethyleneimine)
Authors: Thomas M. , Valette P. , Mausset A.-L. , Déjardin P.
Published: March 2018

Protein adsorption is an essential parameter for the evaluation of the hemocompatibility of biomedical materials. In effect, protein adsorption often generates unfavorable, complex, biochemical reactions and precedes cell adhesion on artificial interfaces. It is therefore necessary to modify the surface in contact with blood in order to minimize the onset of undesirable, biochemical, cascade reactions. Adsorption of high molecular weight kininogen (HK), which participates in the contact phase activation of the endogenous blood coagulation cascade, was evaluated at 37°C. This paper also presents the results of contact phase activation tests carried out in vitro with 1:20 diluted human plasma flowing through minidialyzers containing hollow fibers of synthetic hemodialysis membranes. These tests showed that contact phase activation is strongly dependent on pH around the physiological value (ranging from 7.35 to 7.80) for negatively-charged membranes. The same pH effect was observed on the AN69® membrane as regards HK adsorption from binary labeled solutions of 125I-HK and 131I-Fibrinogen at concentrations corresponding to 1% diluted plasma. It is suggested that the influence of pH could be related to imidazole pKa values in histidine residues of kininogen D5H domain. The same study was also conducted with hemodialysis membranes pretreated with poly(ethyleneimine). Both HK adsorption and contact phase activation proved to be greatly reduced, irrespective of the pH value (between 7.0 and 7.8). Hence, positively-charged poly(ethyleneimine) adsorbed on the membrane through strong ionic interactions with sulfonate groups of the surface probably constitutes a repelling, water-swollen layer for the kininogen molecule. In addition, the advantages of the high levels of adsorbance of small molecules on the AN69® membrane leading to blood epuration, due to its high porosity and for some of them to its charge density, should not be lost by such a surface treatment. (Int J Artif Organs 2000; 23: 20–6).
Direct Infusion of Ascites into the Blood Circuit during Hemodiafiltration in Uremic Patients with Cirrhosis
Authors: Asakimori Y. , Yorioka N. , Kumagai J. , Kawanishi H. , Tsuchiya S.
Published: March 2018

Two chronic dialysis patients with massive ascites caused by cirrhosis were treated by infusion of their ascites directly into the blood circuit. This stabilized their hemodynamics during dialysis, facilitating the control of weight gain and ascites, and thus markedly improving their general condition. Long-term use of this therapy was able to prevent the accumulation of ascitic fluid. Interestingly, fever occurred when this therapy was performed with hemodialysis, but not with hemofiltration or hemodiafiltration, suggesting that a pyrogen in the ascites was removed by filtration.
Development of Acute Ischemic Heart Failure in Sheep
Authors: Mihaylov D. , Reintke H. , Blanksma P. , De Jong E.D. , Elstrodt J. , Rakhorst G.
Published: March 2018

The goal of the present study was to develop a large animal model of acute ischemic left ventricular heart failure (LVHF) that can be used to assess the influence of the PUCA pump on the heart and circulatory system under realistic conditions. We tested the hypothesis that mild stenosis of the coronary artery in combination with mild ventricular pacing induces an acute heart failure condition, whereas the separate phenomena themselves do not lead to impaired heart function. Mean aortic pressure (AoP), left ventricular end-diastolic pressure (LVEDP), stroke volume (SV) and myocardial systolic shortening (MSS) were compared 30 minutes after a pacemaker (PM) induced tachycardia in anaesthetized sheep (n=3) without and with ± 50% stenosis of the proximal LCx. All parameters measured restored to basic levels when stenosis was absent. When the LCx was partially occluded, mild PM-induced tachycardia resulted in decreased AoP (P=0.045) as well as in decreased SV (P=0.048); the LVEDP remained high (P=0.002). Also the recovery of MSS was impaired when stenosis was present (P=0.002). These values indicate that acute heart failure conditions were present. The technique used proved to be safe and allowd fine-tuning of the demand ischemia by adapting heart frequency to the required heart failure conditions. The model can be used to study the effect of LV mechanical support during acute heart failure conditions.
Biocompatibility and Functional Performance of a Polyethylene Glycol Acid-Grafted Cellulosic Membrane for Hemodialysis
Authors: Sirolli V. , Di Stante S. , Stuard S. , Di Liberato L. , Amoroso L. , Cappelli P. , Bonomini M.
Published: March 2018

In order to improve the biochemical reactivity of the cellulose polymer, which is mainly attributed to the presence of surface hydroxyl groups, derivatized cellulosic membranes have been engineered replacing or masking some or all of the hydroxyl groups in the manufacturing process of the membrane. The present study was set up to analyze both biocompatibility and functional performance of two different derivatized cellulosic membranes (cellulose diacetate; polyethylene glycol, PEG, acid-grafted cellulose) as compared to a synthetic membrane (polymethylmethacrylate, PMMA). Cellulose diacetate is prepared by substituting hydroxyl groups with acetyl groups; PEG cellulose is obtained by grafting PEG chains onto the cellulosic polymer with a smaller amount of substitution than cellulose diacetate.

While the three dialyzers provided similar urea and creatinine removal, the dialyzer containing cellulose diacetate showed a reduced ability to remove β2-microglobulin compared to that containing PEG cellulose or PMMA. A transient reduction in leukocyte count was observed for both derivatized cellulosic membranes. The neutrophil and monocyte counts throughout the entire dialysis session showed a closer parallelism with the cellular expression of the adhesive receptor CD15s (sialyl-Lewis x molecole) than with CD11b/CD18 expression. Platelet activation, as indicated by the percentage of cells expressing the activation markers CD62P (P-selectin) and CD63 (gp53), occurred with all membranes at 15 min of dialysis and also with PMMA at 30 min. An increased formation of platelet-neutrophil and platelet-monocyte coaggregates was found at 15 and 30 min during dialysis with cellulose diacetate and PMMA but not with PEG cellulose. Generally in concomitance with the increase in platelet-neutrophil coaggregates, an increased hydrogen peroxide production by neutrophils occurred.

Our results indicate that derivatizing cellulose may represent a useful approach to improve the biocompatibility of the cellulose polymer, though some homeostatic reactions remain activated. Our results also indicate that there may be a great variability in the biocompatibility profile of derivatized cellulosic membranes which most likely stem from the different type of structural modification rather than from the degree of hydroxyl group replacement.
Membrane Distillation of Human Plasma Ultrafiltrate and its Theoretical Applications to Haemodialysis Techniques
Authors: Capuano A. , Memoli B. , Andreucci V.E. , Criscuoli A. , Drioli E.
Published: March 2018

Membrane Distillation (MD) is a technique that allows the extraction of water from aqueous solutions. The basic principle is that vapour, but not liquid water, can pass through hydrophobic micro-porous membranes, along a temperature gradient, with consequent separation of water from solutes. In this study we evaluated the possibility to utilise MD to extract water from Plasma Ultrafiltrate (PU) of patients with Chronic Renal Failure (CRF). The experiments were carried out in vitro by a hydro-phobic polypropylene hollow-fibre distillation module; PU was obtained by a CRF patient utilising a high permeability polisulphone membrane. The results show that water can be extracted by MD from PU of CRF subjects at a constant rate and that none of the substances analysed in PU was able to pass through the polypropilene membrane. In the future MD could integrate extra-corporeal blood purification techniques allowing the re-utilisation of plasmatic water thus ameliorating the treatment of uraemia.
Tissue-Engineered Heart Valve Leaflets: An Effective Method for Seeding Autologous Cells on Scaffolds
Authors: Kim W.G. , Park J.K. , Park Y.N. , Hwang C.M. , Jo Y.H. , Min B.G. , Yoon C.J. , Lee T.-Y.
Published: March 2018

Background

A precondition for the successful formation of tissue-engineered heart valves is the generation of a proper matrix on biodegradable scaffolds over a limited period of time. The aim of this study was to find an effective method of seeding autologous cells on these scaffolds to create a new matrix for heart valves.

Methods

Myofibroblasts and endothelial cells were isolated and cultured from an ovine artery. A synthetic biodegradable scaffold consisting of polyglycolic and polylactic acids was seeded first with the myofibroblasts, then coated with endothelial cells. Three different methods of myofibroblast seeding were compared: I) daily seeding of myofibroblasts (1×106) for ten days and culture for four days; II) seeding of myofibroblasts (1×107) and culture for 14 days with the use of a simple medium; III) seeding of myofibroblasts (1×107) with the use of a medium containing collagen and culture for 14 days. Light and electron microscopic analyses were perfomed.

Results

The group that used the medium containing collagen showed the best results in terms of seeding efficiency.

Conclusion

Seeding autologous cells with a medium containing collagen onto the scaffold showed the largest cell population and might generate the best matrix on the scaffold.
Acute Intravascular Hemolysis in Two Patients Transfused with Dry-Platelet Units Obtained from the Same ABO Incompatible Donor
Authors: Valbonesi M. , De Luigi M.C. , Lercari G. , Florio G. , Bruni R. , Van Lint M.T. , Occhini D.
Published: March 2018

Since 1989 we have been collecting dry-platelets on a routine basis. Dry-platelets are those collected along with 25–30 ml of contaminating plasma cell with separators such as the Amicus, AS 104 and the Excel Pro. Platelets are resuspended in non plasma media for storage and for at least 60 hours their viability and functionality are not impaired. In this article we report on two hemolytic crises determined by two O Rh D + units of single donor platelets (SPD) taken from the same donor in a double-apheresis session. The two split units were admistered to two A Rh D + patients suffering from metastatic breast cancer and severe aplastic anemia (SAA) respectively. In both cases the hemolytic reaction was of the intravascular type, with a drop in hemoglobin (Hgb) level from 8.6 to 5.4 and from 8.8 down to 5.3 g/dl respectively. From the patients’ RBC only α - agglutinins were eluted and donor's indirect antiglobulin test (IAT) was negative with extended panel RBCs. In the first case the clinical course after erythroexchange (Erex) was uneventful whereas in the second one, that suffering from SAA, after Erex, acute renal failure and shock did complicate the clinical course and the patient died seven days after the incriminated platelet transfusion.
The Measurement of Cytokine Production Capacity during Dialysis - a New Dynamic Method for the Evaluation of Biocompatibility?
Authors: Guth H.-J. , Gruska S. , Kraatz G.
Published: March 2018

The activation of monocytes and other immunocompetent cells during hemodialysis can be attributed to their contact with immunogenic structures such as membranes, blood lines, and endotoxins. The simple measurement of cytokines in blood cannot completely describe the whole dimension of this event. Stimulation of monocytes and other immunocompetent cells in whole blood with lipopolysaccharides (LPS) for IL-6 and phytohemagglutinine (PHA) for TNF at the start and end of dialysis may make it possible to better analyze cellular response during dialysis. Ten healthy volunteers and 10 patients suffering from chronic renal failure were tested with the commercial whole-blood stimulation assays “Dynamix”-IL-6-DIA and -TNF-alpha-DIA (Biosource Diagnostics, Ratingen, Germany). Then 24 patients undergoing hemodialysis with hemophane (n=12) and polyamide (n=12) membranes were examined before and after dialysis treatment. The unpaired Wilcoxon t- test was used for statistical analysis. Healthy volunteers and patients with chronic renal failure showed no statistical differences in concentrations of TNF-alpha and IL-6 before or after whole blood stimulation (WBS). In comparison to patients with chronic renal failure, pre-WBS concentrations of both cytokines (p<0.034) were increased in patients of each membrane group before dialysis. After whole blood stimulation, no differences were observed. At the end of dialysis treatment, the pre- and post-WBS IL-6 values were both significantly higher in the hemophane group (p=0.049 and p=0.0038, respectively) TNF-alpha concentrations were unchanged. No significant differences in the polyamide group were found between the start and end of treatment for either cytokine. A comparison of these membrane groups showed that only the pre-WBS IL-6 concentration in the hemophane group was elevated (p=0.022) after dialysis. In conclusion, the presence of uremia alone could not influence the cytokine production and release capacity. In our patients, dialysis elevated pre-WBS concentrations of TNF-alpha and IL-6, and increased IL-6 release from immunocompetent cells after whole blood stimulation in the hemophane group. The use of polyamide membranes decreased the action of monocytes and other immunocompetent cells, but could not completely prevent this phenomenon. The whole blood stimulation assays for measurement of TNF-alpha and IL-6 may represent a new, dynamic method for evaluating biocompatibility.
Heparin-Free DALI LDL-Apheresis in Hyperlipidemic Patients: Efficacy, Safety and Biocompatibility
Authors: Wendler T. , Lennertz A. , Heinemann O. , Duhr C. , Samtleben W. , Bosch T.
Published: March 2018

Background and Aim of Study

In routine DALI apheresis - the first technique for direct adsorption of lipoproteins from whole blood - heparin plus citrate (ACD-A) is used as anticoagulation regimen. However, recently several publications have warned of heparin-induced thrombocytopenia as a rare but potentially life-threatening complication of heparin administration (HIT type 2). The aim of the present study was therefore to test the efficacy and biocompatibility of DALI using a heparin-free anticoagulation regimen consisting exclusively of citrate.

Methods

Four symptomatic hypercholesterolemic patients on regular DALI apheresis were switched to the heparin-free protocol for two sessions each. Two of the patients were on oral anticoagulation using phenprocoumon. In the weekly sessions, 1.3 patient blood volumes were processed at a blood flow rate of 60 ml/min using ACD-A at a ratio of 1:20 (v/v) during adsorber priming and the session.

Results

Clinically, all sessions were essentially uneventful. Uncorrected lipoprotein reductions amounted to 65% for LDL-C, 62% for Lp(a), 53% for VLDL-C, 24% for HDL-C, 17% for triglycerides and 19% for fibrinogen. Cell counts remained virtually constant. No signs of hemolysis or clotting could be detected. Thromboplastin time (Quick) was slightly prolonged and partial thromboplastin time (PTT) moderately elevated in all patients. In constrast, whole blood coagulation time acc. to Lee-White and activated clotting times were increased only in orally anticoagulated patients. Biocompatibility in terms of complement, leukocyte and thrombocyte activation was excellent. Bradykinin activation was moderate peaking at 3038 pg/ml in the efferent line. Systemic thrombin-antithrombin complex (TAT) reflected perfect anticoagulation in orally anticoagulated patients and adequate anticoagulation in the patients without phenprocoumon.

Conclusion

In this pilot study, heparin-free DALI apheresis was safe and effective and may thus be performed in LDL-apheresis dependent patients who suffer from heparin intolerance.
Regulation of Perfusion Pressure during Cardiopulmonary bypass using Sevoflurane
Authors: Ueda T. , Mizuguchi K. , Tsuji T. , Tabayashi N. , Abe T. , Naito H. , Takewa Y. , Taniguchi S.
Published: March 2018

In hypothermic cardiopulmonary bypass (CPB), various vasodilators are used to control the perfusion pressure. These agents, however, often decrease the pressure excessively, and the low perfusion pressure may persist until the end of CPB. In this study we evaluate the safety and characteristics of the regulation of perfusion pressure during CPB using a volatile anesthetic, sevoflurane which has an extremely low partition coefficient. Twenty adult patients who underwent cardiac surgery were studied. Sevoflurane was applied by a vaporizer inserted into the oxygenator gas supply line. Pump flows were fixed at 2.4 L/min/m2 during the hypothermic period. Sevoflurane concentration was adjusted to keep mean arterial pressure (MAP) between 40 and 70 mmHg during CPB. Hemodynamic and metabolic parameters were measured and compared to the group we previously treated with chlorpromazine. In all cases, MAP could be maintained adequately. In the sevoflurane group, systemic vascular resistance indices (SVRI) during the rewarming period and at the end of CPB were higher, and doses of norepinephrine needed at the end of CPB were significantly lower than in the chlorpromazine group. The regulation of perfusion pressure during CPB using sevoflurane was safe and could easily maintain adequate SVRI.
Evaluation of Systemic Metal Diffusion after Spinal Pedicular Fixation with Titanium Alloy and Stainless Steel System: A 36-month Experimental Study in Sheep
Authors: Brayda-Bruno M. , Fini M. , Pierini G. , Giavaresi G. , Rocca M. , Giardino R.
Published: March 2018

It is known that titanium alloys cause more extensive local metallosis due to fretting corrosion than stainless steel implants.

The aim of the present study was to investigate possible systemic metal releases (Ti, Al, V, Cr, Ni) in sheep where L4–L5 were implanted with titanium alloy (Ti6Al4V, ASTM F 136) and stainless steel (AISI 316 L). 16 sheep were used: 8 were implanted with Ti6Al4V and 8 with stainless steel. At 6, 12, 24 and 36 months, the following examinations were performed: histology, atomic absorption spectrophotometry (AAS) and scanning electron microscopy (SEM), on liver, lung, kidney, brain, spleen and lumbo-aortic lymph nodes. Hair, urine and arteria blood samples were also analysed by AAS before implantation and at sacrifices. A histologic and ultrastructural study was performed on peri-implant tissues, too. Particular attention was paid to avoid contamination from dissection instruments or use of containers. In basal and in samples at 6 and 12 months, no metals were found in blood, urine, hair or other target tissues of the animals implanted with either Ti6Al4V or stainless steel. Regarding Al, V, Co and Ni, negative results in all tissues and body fluids were obtained also at 24 and 36 months. On the contrary, Ti traces were found in lumbo-aortic lymph nodes and lungs of one sheep only (10 and 30 ng/g, respectively) at 24 months. At 36 months, a systemic diffusion of Ti was observed in all tissues of both sheep instrumented with Ti6AI4V (2-16.5 ng/g), except for body fluids and hair.

Metal research in target tissues by light and SEM micro-probe analysis provided negative results. Current data suggest that the amount of Ti found in organs after stable pedicular fixation is extremely low and not biologically available. This observation would lead us to exclude the hypothesis of any toxic reaction and such a release seems to be due to the passive diffusion through lymphatic fluids. Additional studies are needed to confirm if this long-term release of Ti particles might cause tissue damage.
A semi-automatic algorithm for reducing the time spent on routine follow-up of cardioverter defibrillators
Authors: Boriani G. , Biffi M. , Renzi R. , Capestro F. , Pierantozzi A. , Sgarbi E. , Scarfó S. , Alboni P. , Migani L. , Sallusti L. , Frabetti L. , Branzi A.
Published: March 2018

Background

The routine follow-up of cardioverter defibrillators (CD) is a time-consuming procedure.

Aim of the Study and Methods

The present study was a prospective randomized cross-over evaluation on the clinical usefulness of a specific semi-automatic software algorithm (Quick Check) for CD follow-up, available in CPI Guidant systems (CD and programmer). Time-saving, while ensuring all the required data and patient safety, was evaluated in a large group of patients (105), recruited in different centers. In the same session and under a physician's supervision all patients underwent a follow-up with the aid of Quick Check or a standard follow-up, in a randomized sequence. Each patient served as his own control.

Results

In the overall population of 105 patients, the time spent for follow-up was reduced by Quick Check from 186±105 sec to 106±67 sec (p<0.0001) (43% reduction). The reduction in time spent for follow-up with Quick Check was the same (43% reduction) in patients with detected episodes (n=38) (from 241±144 sec to 138±95 sec (p<0.0001)) and in patients without detected episodes (n=67) (from 154±52 sec to 88±34 sec (p<0.0001)). No adverse events or deletion of potentially useful data was detected by the supervising physician.

Conclusions

Use of a specific software algorithm for routine follow-up of implanted CDs allows a significant shortening of the time spent on routine follow-up, thus reducing costs. The supervision of a physician is a guarantee of patient safety.
Cardiomyoplasty: Long-term results in ischemic cardiomyopathy
Authors: Driever R. , Bugenhagen R. , Fuchs S. , Minale C. , Vetter H.O.
Published: March 2018

Introduction

Cardiomyoplasty was introduced into clinical practice in 1985 by Alain Carpentier. Since then, the procedure has been performed on more than 400 patients worldwide. The latissimus dorsi muscle is prepared maintaining the vascular supply, then the muscle flap is wrapped around the heart and connected to a cardiomyostimulator. The muscle is later stimulated synchronously with ventricular systole to augment the cardiac contractility.

Methods

To evaluate the long-term outcome of cardiomyoplasty, we investigated 3 patients electively undergoing this procedure in our hospital. All of these patients (2 male, 1 female) had severe chronic heart failure which did not respond to optimal medical treatment. The mean follow-up time was 42 months (range 24 - 60). All patients showed symptoms corresponding to NYHA class III, and one patient intermittently showed class IV despite conventional medical therapy. Patients were evaluated at 6-month intervals for 2 years with right heart catheterization, radionuclide scans, echocardiography, as well as questionnaires for assessing quality of life.

Results

There was no operative mortality. One patient experienced sudden death 2 years after operation. There were no significant changes in hemodynamic variables at 6, 12 or 24 months after surgery, respectively. Left ventricular ejection fraction increased from 20.0 (9.2 to 40.0 ± 7.1 % (p = 0.05) 1 year after operation. Considerable improvement of symptoms was seen in all, and 1 patient returned to work. NYHA-class decreased from 3.1 to 2.0 (p = 0.02).

Conclusions

Following cardiomyoplasty, patients may exhibit impressive clinical improvement with less striking changes of objective hemodynamic parameters. Thus, in our patients, dynamic cardiomyoplasty improves quality of life. We do not consider this treatment to be an alternative to heart transplantation. It does, however, provide a therapeutic option for patients for whom transplantation is contraindicated.
Phosphatemic Control during Acute Renal Failure: Intermittent Hemodialysis versus Continuous Hemodiafiltration
Authors: Tan H.K. , Bellomo R. , M'Pisi D.A. , Ronco C.
Published: March 2018

Background

Achieving “adequacy of dialysis” includes the maintenance of normal serum phosphate concentrations and is an important therapeutic goal in the treatment of acute renal failure (ARF). It is unknown whether this goal is best achieved with intermittent or continuous renal replacement therapy.

Methods

We compared the effects of continuous veno-venous hemodiafiltration (CVVHDF) and intermittent hemodialysis (IHD) on serum phosphate concentrations using daily morning blood tests in 88 consecutive intensive care patients half of which were treated with IHD and half with CRRT.

Results

Mean patient age was 54 ± 14 years for IHD and 60 ± 14 years for CVVHDF (NS). However, patients who received CVVHDF were more critically ill (mean APACHE II scores: 24.4 ± 5.1 for IHD vs. 29.2 ± 5.7 for CVVHDF, p<0.003). Before treatment, the serum phosphate concentration was 2.04 ± 0.16 mmoll L for IHD and 1.96 ± 0.17 mmoll L for CVVHDF (NS), with abnormal values in 79.4% of IHD patients and in 64.8% of CVVHDF patients (NS). During treatment, CVVHDF induced a greater reduction in serum phosphate (p=0.02) during the first 48 hours and conferred superior subsequent control of hyperphosphatemia (achieved in 64.6% of observations during CVVHDF vs. 41.8% during IHD; p<0.0001). The serum phosphate concentration was also more likely to be within the normal range during CVVHDF (55.3% vs.36.2%; p<0.0001). There was a trend toward more frequent hypophosphatemia (9.3% vs. 5.6%; P<0.1) during CVVHDF.

Conclusions

Abnormal serum phosphate concentrations are frequent in ARF patients before and during renal replacement, however, normalization of phosphatemia is achieved more frequently with CVVHDF.
Standard 19mm St Jude aortic valves in patients with body surface less than 1.7m2
Authors: Renzulli A. , De Feo M. , De Santo L.S. , Corte A. Della , Dialetto G. , Cotrufo M.
Published: March 2018

Although new models of bileaflet valves with improved orifice have been devised, aortic valve replacement with 19mm prostheses still raises concerns about long term effects of residual transprosthetic gradient.

We reviewed our experience with 19 mm standard model St Jude prostheses in 68 patients operated on between January 1983 and December 1995. Clinical late assessment was performed to evaluate the incidence of valve related complications. Postoperative echocardiography was performed to evaluate hemodynamic performance of the prostheses.

Mean body surface area was 1.66±0.14m2. Late postoperative peak gradient was 53.85±7.16 mmHg; mean gradient was 34.80±5.55 mm Hg; effective orifice area was 1.93±0.05 cm2. Thirteen-year actuarial survival has been 90.89 ± 0.6%; thirteen-year freedom from embolism 89.41 ± 0.7% and freedom from hemorrhage 98.25 ± 0.02%. No case of prosthetic endocarditis, thrombosis, or reoperation was observed during follow-up.
Severe hepatitis treated with an artificial liver support system
Authors: Lanjuan L. , Qian Y. , Jianrong H. , Xiaowei X. , Yuemei C. , Yagang C. , Weihang M. , Zhi C. , Suzhen F.
Published: March 2018

We designed an artificial liver support system (ALSS) including plasma exchange, charcoal hemoperfusion, plasma bilirubin absorption, charcoal plasma perfusion, hemofiltration and hemodialysis. We chose different methods or their combinations according to the patients’ conditions. We investigated the effect of ALSS in 154 patients with severe hepatitis, 72 of whom survived. All data were analyzed by SPSS. The effectiveness of ALSS treatment was compared at different stages (i.e. early, middle and end stages). After each ALSS treatment, the liver function of these patients greatly improved, serum endotoxin and HBV-DNA concentrations were significantly decreased, and the serum concentration of aromatic amino acids (AAA) such as methionine decreased while BCAA/AAA ratio increased. Patients treated with ALSS in the early or middle stages of disease had much higher survival rates than patients in the end stage of disease. Thus, we concluded that ALSS is a reliable therapy for advanced liver diseases and treatment in early or middle stages is appropriate.