bluuebunny/crossref_metadata_2025 huggingface dataset:
Interrelationship between Cardiac Structure and Function and Incidence of Arrhythmia in Peritoneal Dialysis Patients
Authors: Renke M. , Zegrzda D. , Liberek T. , Dudziak M. , Lichodziejewska-Niemierko M. , Kubasik A. , Rutkowski B.
Published: March 2018

Cardiovascular complications in patients with end-stage renal disease requiring dialytic therapy are frequent and account for approximately 40% of all deaths in these patients. The aim of this study was to analyze the occurrence of cardiac arrhythmia in peritoneal dialysis (PD) patients with respect to the changes in left ventricular structure and function. To determine characteristics of arrhythmia in patients on PD for chronic renal failure, 30 patients (18 male and 12 female; aged 54.1±13.8 years) underwent twice (interval of 20±4.1 months) ambulatory 24 hour Holter ECG monitoring. At the same time all the patients were analyzed by echocardiography and pulsed Doppler echocardiography to estimate cardiac structure and function. Ventricular arrhythmias were seen in 9 patients (30%) during the first examination and in 13 patients (43.3%) on the second. Ventricular arrhythmias were observed only in patients with left ventricular hypertrophy (LVH). Supraventricular arrhythmias were seen in 12 (40%) and 17 (56.7%) patients. The majority of these patients also had LVH, with 11/12 (91.7%) patients at the first examination and 15/17 (88.2%) at the second respectively. We conclude that the incidence of arrhythmia is primarily dependent on the presence of LVH in PD patients. It appears that peritoneal dialysis does not provoke or aggravate arrhythmia.
Severe wear from Retrieved Alumina-on-Alumina Coupled Implant: A Case Report
Authors: Affatato S. , Sudanese A. , Brizio L. , Squarzoni S. , Toni A.
Published: March 2018

This study details the in vivo wear behavior of an alumina acetabular cup and a femoral head on a retrieved non-cemented hip prosthesis.

A commercial alumina ceramic-on-ceramic prosthesis was retrieved from a patient previously treated for bilateral hip arthrosis in “coxa profunda”. Massive wear was found on the retrieved alumina ceramic head and acetabular cup. The total measured penetration depth was 1.9 mm while the total calculated weight loss for the acetabular cup was 6.06 g.

The study underlines the head-cup instability caused by cup loosening as major cause of severe ceramic wear.
Tibial Implants: Biomechanical and Histomorphometric Studies of Hydroxyapatite-Coated and Uncoated Stainless Steel and Titanium Screws in Long-Term Ovariectomized Sheep
Authors: Rocca M. , Fini M. , Giavaresi G. , Aldini N. Nicoli , Giardino R.
Published: March 2018

This study was designed to evaluate osteointegration of HA-coated and uncoated titanium and stainless steel screws in the cortical bone of long-term (24 months) ovariectomized sheep (OVX group), in comparison with Sham-aged sheep (control group). The screws were tested biomechanically (extraction torque) and histomorphometrically (affinity index: Al) 12 weeks after their implantation in tibial diaphyses. Tibial cortical bone parameters showed significant differences between the groups, showing a reduction of the selected parameters in the OVX group. ANOVA showed significant effects for both material and ovariectomy factors on obtained extraction torque (material: F=159.26, p < 0.0005; ovariectomy: F=20.04, p < 0.0005) and Al data (material: F=8.04, p < 0.001; ovariectomy: F=7.17, p < 0.05). In both groups the extraction torque for coated screws of both materials was significantly higher than for uncoated screws, and uncoated titanium had a better extraction torque than uncoated stainless steel. In the OVX group, the HA-coated stainless steel and titanium Al data were significantly higher than uncoated Al data. In conclusion, the biomechanical and histomorphological results obtained suggest employing HA-coated screws in the presence of osteopenic cortical bone.
Different Types of Aortic Stenosis and Simulation of their Morphological-Hydrodynamic Interdependence - in Vitro Study with Allografts and Stenotic Valve Models
Authors: Pohl M. , Meyer R. , Kühnel R. , Talukder N. K. , Wendt M.-O.
Published: March 2018

Biological valves display a dependence of valve resistance and valve area on flow and a phase shift between systolic flow through the valves and pressure difference across the valves. The pressure-flow relations of stenosed valves raise questions about the “best measure of stenosis”. There is a need for quantitative evaluation of the hydrodynamic performance of homografts and allografts. In the present paper, we report on in vitro studies of the hydrodynamic behavior of homografts from human donors, allografts from different animal species as well as three valve models. Valve model I was designed to simulate flow-dependence of valve area, valve model II was designed to simulate restricted valve opening independent of flow, and valve model III was designed to simulate a flow-dependent movement of valve root in flow direction. Among other aspects, the effect of increased viscosity of the test fluid on the pressure difference and the effects of water absorption by valve tissue on valve characteristics were investigated. The results of the present studies clearly indicate that any biological valve may be modelled as a serial connection of a model I type valve and a model II type valve. From the results, the dependence of the characteristic pressure-flow relationship of a valve on valve size and valve distensibility can be clearly seen and the clinical significance of the characteristic coefficients of the pressure-flow relationship of a valve can be elucidated. Further, it was shown that the characteristic phase shift between flow and pressure difference displayed by biological valves is due to their movable valve plane similar to that of valve model III.
Determination of Time Delay between Blood and Interstitial Adipose Tissue Glucose Concentration Change by Microdialysis in Healthy Volunteers
Authors: Wientjes K.J.C. , Schoonen A.J.M.
Published: March 2018

For the development and use of subcutaneous glucose sensors it is important to know the time lag between changes in blood glucose and subcutaneous interstitial glucose concentration.

To determine the time lag we inserted a microdialysis probe into the abdominal subcutaneous adipose tissue of healthy volunteers (n =19) and performed oral glucose tolerance tests (n=39) over a 7-day period. After correction for the microdialysis system time lag, we compared the change in dialysate glucose concentration with the capillary blood glucose concentration.

We found no significant delay time between a change in capillary blood glucose concentration and subcutaneous interstitial fluid glucose concentration using the Mann-Whitney test. The substantial interindividual variation of glucose recovery and the changing recovery in time makes it difficult to draw unambiguous conclusions about the exact physiological time lag.

Based on the present experimental findings and theoretical calculations of glucose transport in adipose tissue, the physiological lag time is short and negligible compared to the system delay time of a glucose sensor.
Osteoclastic Bioresorption of Biomaterials: Two- and Three-Dimensional Imaging and Quantification
Authors: Winkler Thomas , Hoenig Elisa , Huber Gerd , Janssen Rolf , Fritsch Daniel , Gildenhaar Renate , Berger Georg , Morlock Michael M. , Schilling Arndt F.
Published: March 2018

Purpose

Bioresorbable materials have been developed in the hope that the body will replace them with newly formed tissue. The first step of this remodeling process in bone is the bioresorption of the material by osteoclasts. The aim of this study was to analyze osteoclastic resorption of biomaterials in vitro using the commonly used two-dimensional methods of light-microscopy (LM) and scanning electron microscopy (SEM) in comparison with infinite focus microscopy (IFM), a recently developed imaging method allowing for three-dimensional surface analysis.

Methods

Human hematopoietic stem cells were cultivated in the presence of the cytokines M-CSF and RANK-L for 4 weeks directly on dentin and a calcium phosphate cement. Osteoclast development was surveyed with standard techniques. After removal of the cells, resorption was characterized and quantified by LM, SEM and IFM.

Results

Osteoclast cultures on the biomaterials presented the typical osteoclast-specific markers. On dentin samples LM, SEM as well as IFM allowed for discrimination of resorption. Quantification of the resorbed area showed a linear correlation between the results (LM vs. SEM: r=0.996, p=0.004; SEM vs. IFM: r=0.989, p=0.011; IFM vs. LM: r=0.995). It was not possible to demarcate resorption pits on GB14 using LM or SEM. With IFM, resorption on GB14 could be visualized and quantified two- and three-dimensionally.

Conclusions

In this paper we introduce IFM as a technology for three-dimensional visualization and quantification of resorption of biomaterials. Better understanding of the bioresorption of biomaterials may help in the design of better materials and might therefore constitute an important step on the avenue to the development of artificial bone.
Raman Spectroscopy as a Tool for Quality and Sterility Analysis for Tissue Engineering Applications like Cartilage Transplants
Authors: Pudlas Marieke , Koch Steffen , Bolwien Carsten , Walles Heike
Published: March 2018

At present, the production of tissue engineered cartilage requires the concurrent production of two identical transplants. One transplant is used for destructive quality control and the second one is implanted into the patient. A non-invasive characterization of such tissue engineering samples would be a promising tool to achieve a production process of just one transplant that is both implanted and tested. Raman spectroscopy is a method that satisfies this requirement by analyzing cells without lysis, fixation or the use of any chemicals. This pure optical technique is based on inelastic scattering of laser photons by molecular vibrations of biopolymers. Characteristic peaks in Raman spectra of cells could be assigned to typical biochemical molecules present in biological samples. For the analysis of chondrocytes present in cartilage transplants, the determination of the cell vitality as well as the discrimination of another cell type have been studied by Raman spectroscopy. Another bottleneck in such biological processes under GMP conditions is sterility control, as most of the commonly used methods require long cultivation times. Raman spectroscopy provides a good alternative to conventional methods in terms of time saving. In this study, the potential of Raman spectroscopy as a quality and sterility control tool for tissue engineering applications was studied by analyzing and comparing the spectra of cell and bacteria cultures.
Dose Conversion Ratio one year after Switching from Epoetin Alpha to Darbepoetin Alpha in Japanese Hemodialysis Patients
Authors: Hirai Takayuki , Nakashima Ayumu , Shiraki Nobuaki , Takasugi Norihisa , Yorioka Noriaki
Published: March 2018

Background/Aims

Darbepoetin alpha is effective for renal anemia when epoetin is insufficient. We previously reported that the dose conversion ratio from epoetin alpha to darbepoetin alpha was 1:350.5 after 24 weeks of follow-up. This study assessed the conversion ratio in stable Japanese hemodialysis patients after 52 weeks.

Methods

A total of 104 hemodialysis patients who were stable on intravenous epoetin alpha were switched to intravenous darbepoetin alpha according to the 1:200 rule. Then they were followed for 52 weeks to assess changes of hemoglobin and the darbepoetin alpha dose.

Results

Eighty-five patients completed the study. Their hemoglobin increased very rapidly during the first 8 weeks. The final conversion ratio was 1:286.6 at 52 weeks. Darbepoetin alpha showed similar efficacy in diabetics and non-diabetics. Patients switching from a high epoetin alpha dose (≥4500 IU/week) had a higher conversion ratio compared with those switching from a low dose (<4500 IU/week).

Conclusions

The dose conversion ratio of 1:200 was unsuitable and led to a rapid increase of hemoglobin. A conversion ratio of 1:250 to 1:300 should be employed when switching from epoetin alpha to darbepoetin alpha in Japanese patients.
Conventional versus Ultrapure Dialysate for Lowering Serum Lipoprotein(a) Levels in Patients on Long-Term Hemodialysis: A Randomized Trial
Authors: Tao Jianling , Sun Yang , Li Xuemei , Li Hang , Liu Shiqin , Wen Yubing , Duan Lin , Li Yan , Li Xuewang
Published: March 2018

Purpose

In patients on long-term hemodialysis, high lipoprotein(a) [Lp(a)] levels are difficult to lower with medications, although they remain a risk factor for cardiovascular disease. We investigated whether ultrapure dialysate (UPD) could lower Lp(a). Methods: We randomly assigned patients stabilized on long-term dialysis to either a low-flux synthetic polysulphone membrane (the UPD group; n=14) or to a conventional dialysate (the CD group; n=13). Blood samples were collected 1 week before dialysis and 1 week, 1 month, 6 months and 12 months after dialysis; Lp(a) was measured by the immunotur-bidimetry method. Hemoglobin, interleukin-6, hypersensitive C-reactive protein, β2 microglobulin and albumin were also measured. The erythropoietin dosage, Kt/V, and normalized protein catabolic rate were recorded monthly.

Results

At 12 months, mean (SD) serum levels of Lp(a) in the CD patients increased from 143.46 (125.11) to 283.89 (145.81) mg/L (p<0.01), whereas levels in the UPD group remained unchanged: 131.38 (201.45) to 120.90 (122.11) mg/L. Endotoxin levels in the 10 CD patients who completed the study ranged from 0.116 to 0.349 EU/mL and were undetectable in the 11 UPD patients who completed the study. The cultures were less than 200 CFU/mL in CD patients and negative all the time for all UPD patients. Changes in Lp(a) from baseline values were lower in the UPD group than in the CD group (p<0.05). However, changes in other variables did not differ between groups.

Conclusions

Ultrapure dialysate can prevent the rise of Lp(a), potentially decreasing the risk of cardiovascular disease in hemodialysis patients.
Characterization of Two Subpopulations of the PICM-19 Porcine Liver Stem Cell Line for use in Cell-Based Extracorporeal Liver Assistance Devices
Authors: Talbot Neil C. , Caperna Thomas J. , Willard Ryan R. , Meekin John H. , Garrett Wesley M.
Published: March 2018

Two cell lines, PICM-19H and PICM-19B, were derived from the bipotent PICM-19 pig liver stem cell line and assessed for their potential application in artificial liver devices (ALD). The study included assessments of growth rate and cell density in culture, morphological features, serum protein production, γ-glutamyltranspeptidase (GGT) activity and hepatocyte detoxification functions, i.e., inducible P450 activity, ammonia clearance, and urea production. The PICM-19H cell line was derived by temperature selection at 33–34°C. After each passage, PICM-19H cells grew to a nearly confluent monolayer of cells of hepatocyte morphology, i.e., cuboidal cells with centrally located nuclei joined by biliary canaliculi. No differentiation and self-organization into multi-cellular bile ductules, as observed in the parental PICM-19 cell line, occurred within the PICM-19H cell monolayers. The PICM-19H cells contained numerous mitochondria, Golgi apparatus, smooth and rough endoplasmic reticulum, vesicular bodies and occasional lipid vacuoles. The cells had a doubling time of 48–72 h and reached a final density of 1.5 x 105 cells/cm2 at ∼10 d post-passage from a 1:6 split ratio. PICM-19H cells displayed inducible P450 activity, cleared ammonia, and produced urea in a glutamine-free medium. The PICM-19B cells were colony-cloned after spontaneous generation from the PICM-19 parental cell line. PICM-19B cells grew as a tightly knit dome-forming monolayer with no visible biliary canaliculi. Their doubling time was 48–72 h with a final cell density of 2.6 x 105 cells/cm2. Ultrastructural analysis of the PICM-19B monolayers showed the roughly cuboidal cells displayed basal-apical polarization and were joined by tight junction-like complexes. Other ultrastructure features were similar to those of PICM-19H cells except that they possessed numerous cell bodies resembling mucus vacuoles. The PICM-19B cells had relatively high levels of GGT activity, but did retain some inducible P450 activity, and some ammonia clearance and urea synthesis ability. PICM-19B cells produced markedly less serum proteins than PICM-19H cells. These data indicated that both cell lines, either together or alone, may be useful as the cellular substrate for an ALD.
Alternatives to Dimethylsulfoxide for Serum-Free Cryopreservation of Human Mesenchymal Stem Cells
Authors: Grein Tanja A. , Freimark Denise , Weber Christian , Hudel Klaus , Wallrapp Christine , Czermak Peter
Published: March 2018

Human mesenchymal stem cells (hMSCs) have some favorable characteristics like high plasticity, multilineage differentiation potential, and comparably easy handling in vitro, making them of interest for many clinical and therapeutic approaches including cell therapy. For routine applications, these cells have to be stored over a certain period of time without loss of cell vitality and function. An easy way to preserve cells is to store them at temperatures between -80°C and -196°C (liquid nitrogen). To prevent cells from the damage caused by the cryopreservation process and to achieve high cell recovery and vitality, cryoprotectants are used. Typically dimethylsulfoxide, often in combination with serum, is used as a cryoprotectant. However, for clinical approaches, the use of dimethylsulfoxide and serum in patients is problematic for several reasons. Therefore, the cryopreservation of human mesenchymal stem cells for cell therapeutic applications without dimethylsulfoxide and serum demands investigation. In this work, non-toxic alternatives to dimethylsulfoxide such as glycerol or the compatible solutes, proline and ectoin, were analyzed in a serum-free cryomedium with respect to their cryoprotective properties. Different concentrations of the cryoprotectants (1–10% (w/v) ectoin or proline, respectively, or 5–20% (v/v) glycerol) and certain incubation times (0–60 minutes) were investigated with regard to post-thaw cell vitality and cell growth. Our results showed that, in general, cryopreservation with ectoin led to high post-thaw cell survival of up to 72% whereas after cryopreservation with glycerol and proline, the hMSC cells were completely dead (glycerol) or had only poor cell survival (proline, 22%). Moreover, the morphology of the hMSC cells changed to a large and flat phenotype after cryopreservation with proline. These results indicate that glycerol and proline are not suitable for cryopreservation of hMSC. In contrast, ectoin has the potential to replace dimethylsulfoxide as a cryoprotectant in a serum-free cryomedium.
A Clinical Appraisal and Comparison of Double Pump Single Needle Dialysis Systems
Authors: Hoenich N.A. , Pearson S. , Downing N. , Woffindin C. , Ward M.K.
Published: March 2018

Six recently developed double pump tidal flow single needle systems have been assessed clinically and the magnitude of recirculation, efficiency of dialysis determined and compared with the classical system (Bellco BL 760). Results indicate that the problems of designing twin pump systems with instantaneous response, occlusive rollers capable of generating clinically acceptable blood flow rates has been largely overcome and such systems offer a high degree of patient acceptance, flexibility, safety and an efficiency of dialysis comparable with that obtained using two needle access.
Adverse Effects Secondary to the Treatment with Plasma Exchange
Authors: Puig LI. , Mazzara R. , Torras A. , Castillo R.
Published: March 2018

Side effects and their relationship with the material used were analyzed in 748 plasma exchanges (PE) performed in 75 patients.

The total incidence of acute and mild adverse effects (chills and/or fever, paraesthesias, allergic reactions, acute anaemia, vasovagal reactions, abdominal pain and hypotension) was 18.04%. Two patients developed an episode of left cardiac insufficiency. One patient in whom all PE were performed with fresh frozen plasma (FFP) developed metabolic alkalosis. Three patients developed sepsis during treatment with repeated PE and immunosupressive drugs; in these three patients a permanent vascular inlet was used (shunt or catheter). All patients in whom only FFP was used as replacement solution developed non-A, non-B hepatitis. Neither haemorrhagic nor thrombotic episodes were observed in these patients. It is of the greatest importance to choose the most suitable material for each patient and to develop a careful technique in order to avoid these complicatios during treatment with PE.
Experiments with Continuous Hemofiltration and Hemofiltrate Regeneration in the Rat
Authors: Böttcher M. , Falkenhagen D. , Nebe B. , Holtz M. , Neumann J. , Ryan C. , Wüstenberg P.W. , Dörp E. , Klinkmann H.
Published: March 2018

Experimental studies were made with continuous hemofiltration treatment for bilaterally nephrectomised rats and initial observations regarding the effects of such treatment on leukocyte and thrombocyte counts are reported. Hemofiltration of unanesthetised rats able to move freely within their cage could be continued for up to 30 h using a pump-driven ECC system. Blood parameters recorded during this treatment indicate that the detoxification was effective.

In another series of experiments the water and electrolyte reabsorption capacity of the colon ascendens of healthy rats was tested by continuously supplying NaCI solution into the colon via a fistula. A large proportion, if not all, of the hemofiltrate can be discharged into the colon without diarrhoea.

A final series of experiments showed that the three-stage operation (implantation of permanent catheters, connection of a permanent intestinal fistula and bilateral nephrectomy) is possible with the rat.
Deranged Concentrations of Water-Soluble Vitamins in the Blood of Undialyzed and Dialyzed Patients with Chronic Renal Failure
Authors: Marumo F. , Kamata K. , Okubo M.
Published: March 2018

Blood concentration of water-soluble vitamins were measured in patients with mild chronic renal insufficiency, uremic undialyzed and dialyzed patients and control subjects. The whole blood concentration of B1 was significantly lower in dialyzed patients. Plasma levels of B2 were elevated in uremic and dialyzed patients and plasma B6 was significantly increased in dialyzed patients. Serum levels of B12 and folic acid were elevated in uremic and dialyzed patients. The results of this study differ from those reported from Europe and the U.S.A. These geographical differences may arise primarily from differences in staple food, vegetable intake, and traditional methods of food preparation.
Design and Fabrication of a Capillary Cell Culture Chamber for the Study of Convective Flow
Authors: Wolf C.F.W. , Lauffer L.L.
Published: March 2018

The use of capillary culture chambers as artificial pancreas and artificial liver devices would be aided by an improved ability to control the movement of molecules through the capillary walls. The modeling and analysis of the flow and mass transfer in capillary cell culture chambers in which cultured mammalian cells are grown to form masses with tissue density in the extra-capillary spaces is desirable as a basis for scaleup and optimization of the particular microenvironment. The relative roles of diffusion and ultrafiltration with convection in enhancing mass transfer across the capillary membranes are poorly understood in real cell cultures and the effects on culture viability of flow conditions chosen to promote convective flow across the capillary membranes and through the cultured cell masses are also of interest. In this report, experience with materials and techniques for fabricating capillary culture chambers with a more readily analyzed fully defined regular geometric relationship between 90 to 100 capillaries in a parallel bundle is described. High and low pressure capillaries were interspersed in a regular array. Evidence is presented for retention of cell viability during flow conditions which were chosen to induce convective flow through the cultured cells in such a chamber.
Depletion Lymphocytapheresis in Chronic Lymphocytic Leukemias: Criteria for Predicting Which Patients Will Respond to Treatment
Authors: Rossi P.L. , Alfano G. , D'Onofrio G. , Menichella G. , Mango G.
Published: March 2018

Depletion lymphocytapheresis therapy using the continuous-flow separator was used in twenty-two cases of chronic lymphocytic leukemia. Applying the Montserrat scoring system, a prediction can be made, to a good approximation, whether the patient will be a “responder” or a “non-responder” to leukapheresis.

Criteria have been formulated for decisions on when depletion lymphocytapheresis is absolutely or only relatively indicated, on the basis of total scores from 2 through 6 using the Montserrat criterion.
Total Body Fluid Volume Determination Based on Urea Kinetics in Hemofiltration as an Index of Basal Body Weight in Uremic Patients
Authors: Kimura G. , Satani M. , Kojima S. , Saito F. , Kawano Y. , Ito K. , Omae T.
Published: March 2018

Assuming that urea is distributed uniformly within the total body water, urea-space or total body fluid volume was determined in six uremic patients based on urea kinetics in hemofiltration.

The total body fluid volume before hemofiltration was 36.0 ± 3.6 L (61.8 ± 2.6% BW) and after hemofiltration 32.5 ± 3.4 L (59.3 ± 2.8% BW), suggesting that the total body fluid volume was nearly normalized by hemofiltration. It is concluded that urea-space, easily measurable based on urea kinetics during hemofiltration, is useful in evaluating the fluid balance in patients undergoing artificial kidney therapy.
The Occurrence of Fever during Hemodialysis and Hemofiltration. A Comparative Study
Authors: Schaefer K. , von Herrath D. , Hüfler M. , Pauls A.
Published: March 2018

The occurence of fever during various blood purification methods was evaluated in a retrospective study. It could be demonstrated, that patients treated chronically by conventional hemodialysis experience six times more febrile episodes than patients on chronic hemofiltration (4.84% versus 0.81%). Since many of the increased temperatures could not be explained by conventional means, it has to be assumed that the treatment itself caused the fever, possibly activating the monocyte hormone interleukin 1. It is of further note that there was no difference in the mangnitude of the temperature due to septicaemia or to no obvious cause. This finding necessitates in our opinion an early antibiotic therapy in those cases where fever develops without clear explanation.
Technical Aspects of Hemoperfusion
Authors: Piskin E.
Published: March 2018

A review of the different types of adsorbents being used in hemoperfusion. The different types of polymers used in coating charcoal are also reviewed.
Preclinical Evaluation of Haemosorbents
Authors: Ryan C.J. , Courtney J.M. , Aslam M. , Falkenhagen D. , Böttcher M. , Klinkmann H.
Published: March 2018

The selection of assessment procedures for the preclinical evaluation of haemosorbents and the relationship between such procedures and the intended application are exemplified by examination of the design and utilization of procedures based on the rat. Procedures are described for haemoperfusion and for membrane plasma separation followed by on-line sorbent treatment of plasma (plasma perfusion).

These procedures are suitable for single or repeated use, with the animal in an unrestrained and conscious state. The relevance to the intended application is demonstrated with respect to artificial liver support by the ability of rat extracorporeal circuits to provide information on the relationship between sorbent properties and liver regeneration as determined by the proliferative response following partial hepatectomy.
Hemoperfusion in Reduced-Time Programmes for Chronic Uremia. Long-Term Results
Authors: Stefoni S. , Colì L. , Feliciangeli G. , Scolari M.P. , Bonomini V.
Published: March 2018

This paper reports the Authors' 8 year experience in the clinical use of charcoal hemoperfusion as a means to reduce the weekly time of treatment in chronic uremic patients. Two different programmes were applied. Programme A (34 patients) which involved substituting the 3 procedures per week of standard dialysis (4 hours duration each) by 2 procedures of combined hemodialysis and hemoperfusion, again of 4 hours duration each. Programme B (18 patients) which involved substituting the 3 procedures per week of 4 hours duration by 3 procedures of 3 hours each, 2 of combined hemodialysis and hemoperfusion, 1 of conventional dialysis. The net weekly reduction was 33% for Programme A and 25% for Programme B. The efficacy of the two Programmes was evaluated by clinical, hematochemical, nutritional and instrumental parameters.
Combined Hemoperfusion/Hemodialysis in the Treatment of Uremic Patients with Vascular Access Problems: Case Reports
Authors: Espinosa-Meléndez E. , Bourgouin P.A. , Chang T.M.S.
Published: March 2018

Case reports of the use hemoperfusion-hemodialysis to reduce the frequency of dialysis in patients with vascular access problems.
Kinetic Modeling of Powder Charcoal Haemoperfusion
Authors: van Berlo Ad MW , Parchen R.R. , van Rjsingen P.H. , Massen K.H. , Verkooyen Ad H.M.
Published: March 2018

The aim of this study was to achieve more understanding of the mass transfer characteristics of the filmadsorber haemoperfusion device. First, a structural model with mathematical description of the different diffusion steps was developed. Exact quantification appeared very difficult, resulting in insufficient fit of predicted and measured concentration curves. Moreover, the mathematics turned out simple, since the concentration courses could be described with one exponential power. Therefore, a formal model was developed, assuming linear isotherms and adsorption, proportional to the average concentration in the column. With this model predicted in-vitro inlet and outlet concentrations could be fitted to the measured data accurately. A relation between both models is given under the condition of high intraparticle mass transfer, which is allowed in case of powder adsorbents. It can be concluded that structural models do not yield predictive tools for optimization of device geometry. A formal model with two constants determining device performance enables device optimization with the help of some in-vitro experiments.
Removal of Unconjugated Bilirubin by Macroreticular Resin in Hemoperfusion
Authors: Chang-Zhi Chen , Hui-Ming Wang , Ming-Rong Tong , Yao-Ting Yu , Ji-Chang Song , Shao-Cheng Qian , Hui-Zhen Chang
Published: March 2018

Macroporous polystyrene and polyvinylpyridine beads with quaternary ammonium and tertiary groups were tailor-made for the adsorption of unconjugated bilirubin.

In vitro studies in order to obtain high adsorption capacity, the synthesized macroporous resin should have an average pore size of about 160 Å and with surface area as large as possible. As the crosslinking of the resin increased from 4%-40% the amount of bilirubin adsorbed increased from 0.17 mg/g to 2.0 mg/g. Resins containing strong basic groups have higher adsorption capacities than their corresponding weak base groups. Adsorption mechanism studies showed that both chemical and physical adsorption took place. Adsorption of bilirubin in plasma was some what lower than in buffer solution.
Enzyme-Based Hemoperfusion and Blood Treatment
Authors: Lotan N. , Grynspan E. , Grunfeld H. , Brunner G. , Sideman S.
Published: March 2018

Enzyme-based artificial organs are being developed as metabolic assist devices. These are required when normal metabolism is impaired, or when the body is overloaded by undesired metabolites or toxins. The implementations of this approach for treating a genetic disease, and for metabolic support in liver failure are envisaged. The kinetic aspects and mass transfer characteristics of bioreactors for these systems are considered in detail.
Blood Detoxification by Membrane Plasma Filtration
Authors: Malchesky P.S. , Horiuchi T. , Usami M. , Emura M. , Nose Y.
Published: March 2018

The recognition of macromolecule abnormalities in various metabolic or immunologic related disease states has led to the use of plasma exchange for therapeutics. Limitations of plasma exchange, however, exist. Membrane plasma filtration provides a practical alternative. Solute removal can be made selective by the choice of operating conditions as temperature and the selection of the membrane/module design. The optimal temperature range is a function of the plasma type, solute concentrations and membrane system. Operation at below physiologic temperature (cryofiltration) is particularly suited for the removal of cold aggregative solutes, while operation at near or above physiologic temperature is more suited for the separation of solutes having large size differences at normal physiologic temperature. Membrane filtration is simple and safe to perform, is more selective than plasma exchange, does not require plasma product infusion and is more versatile than selective sorption in its applications.
Hypervitaminosis B12 in Maintenance Hemodialysis Patients Receiving Massive Supplementation of Vitamin B12
Authors: Mangiarotti G. , Canavese C. , Salomone M. , Thea A. , Pacitti A. , Gaido M. , Calitri V. , Pelizza D. , Canavero W. , Vercellone A.
Published: March 2018

We have administered routinely a multivitamin preparation containing a megadose of B12 to 106 hemodialysis patients after dialysis treatments. We found that these patients had very high levels of serum vitamin B12 which returned to original values only after a period of three years after stopping the vitamin. Discontinuing therapy had no effect on hemoglobin, mean erythrocyte corpuscular volume, or motor nerve conduction velocity. It is not known whether maintaining a prolonged high level of vitamin B12 is harmful. However, animal and epidemiologic studies have suggested that both cobalamin and cobalt may be potentially toxic. In view of the absence of demonstrable benefit and the possible risk of toxicity, we believe that the use of such megadose vitamin compounds in dialysis patients should be re-evaluated.
Plasma Exchange with Prostaglandin I2 and ACD Solution: Comparative Effects
Authors: Camici M. , Gremignai G. , Pecori F. , Evangelisti L. , Fosella P.V.
Published: March 2018

Discontinuous plasma exchange with prostaglandin I2 (5ng/kg/min) and low dosage heparin (5-6 IU/kg/min) (treatment I), and ACD solution alone (treatment II) was studied. During both treatments the activated partial thromboplastin time remained within the normal range. After treatment I platelet count was not decreased but in vitro platelet aggregation was reduced (p < 0.001). After treatment II platelet count was reduced and in vitro platelet aggregation unchanged.

Prostaglandin I2 at this dosage caused no cardiovascular complications. The physiopathological implications of these differences are discussed.
Physical Work Capacity in Chronic Renal Disease
Authors: Kettner-Melsheimer A. , Weiβ M. , Huber W.
Published: March 2018

We studied the physical fitness of 71 patients with renal disease before dialysis, after starting dialysis, and after successful renal transplantation. Maximal muscle strength was determined in 58 patients and maximal cardiovascular capacity was assessed in 36 patients. Before dialysis there was a 31 percent reduction in muscle strength in men and 47 percent in women. The loss of muscle strength was most pronounced in the leg extensors. Cardiovascular capacity and muscle strength was positively correlated in the dialysis patients (p ≤ 0.05). The cardiovascular capacity was decreased 29% in predialysis patients, 45% in dialysis patients and 37% in transplanted patients compared to untrained healthy controls. The predialysis patients had a 19% greater cardiovascular capacity than the dialysis patients and a 9% greater cardiovascular capacity than the transplanted patients. While hemoglobin concentrations showed a positive correlation (p ≤ 0.05) with maximal cardiovascular capacity and creatinine concentration showed a negative correlation (p ≤ 0.05) with maximal cardiovascular capacity in the predialysis patients, hemoglobin concentrations and creatinine concentrations did not correlate with cardiovascular capacity in the dialysed and transplanted patients. In dialysis patients as well as in patients after kidney transplantation hemoglobin and creatinine concentrations, muscle strength, height, weight, and age are factors influencing the physical work capacity, but none of these variables alone seems to be a strong determination factor. Besides the complications of kidney disease which may itself reduce physical fitness, the lack of physical training is an important factor in determining the residual muscle strength and cardiovascular capacity for all patients with renal insufficiency.
Glucose Concentration in the Dialysate and Lipid Abnormalities in Chronic Hemodialysis Patients
Authors: Ramirez G. , Butcher D.E. , Morrison A.D.
Published: March 2018

In order to assess the effect of varying glucose concentrations on plasma lipids, we first compared the hormonal response of nine non-diabetic patients during dialysis with a high (200 mg/dl) and a low (100 mg/dl) glucose bath. Insulin and growth hormone production increased (p < 0.05) only with the high glucose bath, and no hemodynamic differences were noted during either dialyses. We then compared lipid profiles of 18 patients for 6 months, changing the glucose dialysate concentrations in each patient after three months. We found that all patients had hypertriglyceridemia, mild hypercholesterolemia, low HDL, normal LDL, and high VLDL cholesterol. We therefore conclude that episodic hyperinsulinemia and episodic excessive growth hormone secretion do not contribute significantly to the lipid abnormalities of the dialysis patients.
Plateletapheresis with “Haemonetics 30” through a new three-way reinfusion set®
Authors: Pennisi S. , Del Fabro E.
Published: March 2018

The main disadvantages of the discontinuous flow cell separator Haemonetics 30 (Haemonetics Corp. Natick, Mass.) compared to continuous flow separators are that there is a longer course procedure and a larger amount of donor's blood in extracorporeal circulation. These drawbacks can be reduced by means of a simple technical set-up.

Since plasma reinfusion may commence as soon as the bowl filling stage is completed, the amount of blood in extracorporeal circulation can be greatly reduced simply by substituting a three-way setfor the two-way reinfusion set (BT 293).
Comparison of Polyamide and Polypropylene Membranes for Plasma Separation
Authors: Gupta B.B. , Ding L.H. , Jaffrin M.Y. , Baurmeister U.
Published: March 2018

Plasma separation experiments were made with polyamide experimental prototype hollow-fiber plasma filters with surface areas between 0.025 m2 and 0.1090 m2 using bovine blood collected in acid citrate dextrose (ACD). The maximum filtration velocity rose with the wall shear rate γw as γw0.72± 002 and decreased with the length of fiber L as L-0.41 with a correlation coefficient of 0.97 ± 0.02. The results were similar to those with polypropylene fibers. We also investigated the occurrence of hemolysis as a function of shear rate and transmembrane pressure. The free hemoglobin concentration of filtered plasma was checked using a U.V. spectrophotometer. It was concluded that polyamide membrane filters can be safely used for plasma separation from blood.
Albumin Recovery Enhancement in Membrane Plasma Fractionation using Pulsatile Flow
Authors: Ding L. , Charcosset C. , Jaffrin M.Y.
Published: March 2018

In therapeutic plasmapheresis using cascade filtration, it is important to maximize albumin recovery while rejecting as many γ-globulins as possible. Several membrane fractionation techniques were investigated using fresh bovine and human plasma and cellulose acetate filters (PF 100, AKZO). In dead end mode the sieving coefficients were found to decrease as transmembrane pressure increased. This was due to membrane plugging during the course of filtration after about 20 minutes which lead to a rapid increase in transmembrane pressure. In single pass mode the albumin recovery factor generally remains around 40% since the permeate flux is much less than the inlet flow. When strong pulsations (4 to 6 Hz) were superposed on the inlet plasma flow in single pass mode, the albumin sieving coefficient remained at about 0.95 while the permeate flux was increased by 106%. As a result a recovery factor of more than 80% could be sustained for at least 90 minutes without membrane plugging. Therefore pulsatile flow plasma fractionation seems to be an interesting approach to combine continuous operation with high albumin recovery
Intraperitoneal Thrombolytic Agents in Relapsing or Persistent Peritonitis of Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Murphy G. , Tzamaloukas A.H. , Eisenberg B. , Gibel L.J. , Avasthi P.S.
Published: March 2018

Urokinase or streptokinase was instilled intraperitoneally as an adjunct to the antibiotic therapy in 16 episodes of relapsing or persistent peritonitis in CAPD patients. In eight patients the combination of antibiotics and intraperitoneal thrombolytic agents resulted in clearing of the infection with no recurrences. The treatment failed in eight other patients, who had their peritoneal catheters removed. Six of the last eight patients had either abdominal wall abscesses or persistence of the bacteria on the wall of the peritoneal catheter. Elevated post-intraperitoneal instillation peritoneal fluid neutrophil counts and positive post-instillation peritoneal fluid cultures predicted failure of the intraperitoneal instillation of thrombolytic agents in most instances. Intraperitoneal instillation of urokinase or streptokinase may help cure approximately 50% of the episodes of relapsing for persistent peritonitis. Post-instillation peritoneal fluid cell counts and cultures should be monitored. Radiologic investigation for abdominal wall or intraabdominal abscesses is indicated if intraperitoneal instillation of urokinase or streptokinase fails to eradicate peritonitis.
Successful Haemodialysis via an Unusually Sited Subclavian Catheter
Authors: Nand N. , Scott S.J. , Main J.
Published: March 2018

A 38-year old woman with a history of congenital rubella required temporary venous access for haemodialysis. A left sided subclavian catheter was inserted percutaneously and on check radiography it was found to be on the left side of the mediastinum. Contrast radiography showed that the catheter was in a left sided superior vena cava which drained into the right atrium via the coronary sinus. Haemodialysis was performed without any difficulty
Recurrent Focal Segmental Glomerulosclerosis after Renal Transplantation
Authors: Datta A.R. , Sakhuja V. , Minz M. , Joshi K. , Chugh K.S.
Published: March 2018

In a young adult male with chronic renal failure from focal segmental glomerulosclerosis, massive proteinuria appeared within two weeks after transplantation. Although allograft biopsy at eight weeks was normal, a second biopsy eight months after transplant showed focal segmental glomerulosclerosis again. Sixteen months after transplantation maintenance hemodialysis had to be restarted.
Comparison of Hemostasis with two High-Flux Hemocompatible Dialysis Membranes
Authors: Leitienne Ph. , Trzeciak M.C. , Adeleine P. , Ville D. , Dechavanne M. , Traeger J. , Zech P.
Published: March 2018

Eight adults with chronic renal failure were dialyzed using polyacrylonitrile (AN 69) or polysulfone (PS) membranes with a high (HHR) or low (LHR) continuous non-fractionated heparin regimen –- a total of either 90 or 50 IU/kg body weight. With the HHR, for a mean anti-Xa (aXa) activity of around 0.40 IU/ml, no plasma activation of coagulation was observed; fibrinopeptide A (FPA) was in agreement with the residual blood volume (RBV) and the state of the bubble trap, especially with the PS membrane. With the LHR, for a mean aXa below 0.21 IU/ml, there was only moderate activation of coagulation. The PS membrane gave different results from the AN 69 membrane, RBV values on the HHR and aXa being lower on both the HHR and LHR, with FPA values being regularly lower on the LHR. The decrease in plasma beta-TG on the LHR was more marked with the PS than with the AN 69 membrane due to loss on dialysis or adsorption, as shown by the arterio-venous difference. The increase in plasma PF4 was related to the effect of heparin. However, there was no platelet activation. On the LHR, platelet count and intraplatelet beta-TG and PF4 levels remained very stable. The two high-flux membranes were very hemocompatible and require only low doses of heparin, but the dialyzer with AN 69 membrane need its geometry improving.
Impaired Efficacy of Selective Ldl-Apheresis in Primary Biliary Cirrhosis
Authors: Busnach G. , Franceschini G. , Chiesa G. , Brando B. , Cappelleri A. , Isa L. , Minetti L.
Published: March 2018

Low-density lipoprotein apheresis (LDL-apheresis) was done with either cascade filtration (DF) or dextran sulfate cellulose adsorption (DSC) in a patient with primary biliary cirrhosis who developed severe dyslipidemia associated with cholestasis and accumulation of lipoprotein-X (LP-X). The extracorporeal treatment was initially performed weekly, and resulted in a sharp drop in total cholesterol from 1038 to 430 mg/dl. During the next four months the patient was treated every 10-15 days, and pre-apheresis cholesterol levels were maintained between 438 and 505 mg/dl, until an orthotopic liver transplantation was successfully performed. With semi-selective DF a mean 47.1% of total cholesterol was removed per procedure compared to 30.0% with DSC, although the volume of treated plasma was 38.0 vs 49.9 ml/kg body weight. The changes in plasma cholesterol levels during DSC and DF showed that the kinetics of cholesterol removal were similar with both techniques, but the efficacy differed; DF removed both LDL and LP-X from plasma, whereas DSC selectively lowered the LDL content. Cascade filtration may therefore be considered as a first-choice treatment for patients with LP-X accumulation due to cholestasis.