bluuebunny/crossref_metadata_2025 huggingface dataset:
First Two ABO-Incompatible Living Kidney Transplantations in the Balkans - Should it be a Procedure of Choice in a Developing Country?
Authors: Spasovski G.B.
Published: January 2018

Kidney transplantation is the best available medical intervention for the treatment of end-stage renal failure. However, as a consequence of the growing gap between organ supply and demand, many patients die waiting for an organ each year. In order to increase the number of organs, living donor (LD) transplantation from unrelated and ABO-incompatible (ABOi) donors have been introduced over the last few decades. While in the past ABOi transplantation resulted in hyperacute or acute antibody-mediated rejection, the tremendous progress in this area in recent years has shown that it can be overcome by careful patient management, including protocols to remove or lower antibodies, along with stronger immunosuppression and intensive monitoring. The organ shortage problem is even more prominent in regions such as the Balkans where cadaver transplantation has not been well developed. In addition to the introduction of expanded criteria for living donation (elderly and marginal donors), we performed the first two ABOi/LD transplantations in the Balkans in the last 2 years using an already established preconditioning regimen and maintenance therapy with cyclosporine, mofetil mycophenolate and prednisolon. We report our modest experience of a case in which the patient developed lymphadenopathy sarcomatosis and died after one year; and a second case with accelerated acute rejection and hemorrhagic necrosis with explantation of the graft after a month.

Taking into account the high cost of the desensitization procedure and induction therapy as well as the need for intensive monitoring throughout the standardized procedures and facilities, we might reconsider whether ABOi living kidney transplantation should be a procedure of choice in developing countries.
Citrate Anticoagulation during CVVH in High Risk Bleeding Patients
Authors: Cubattoli L. , Teruzzi M. , Cormio M. , Lampati L. , Pesenti A.
Published: January 2018

Background

Regional citrate anticoagulation (RCA) is an effective form of anticoagulation for continuous renal replacement therapy (CRRT) in patients with contraindications to heparin. Its use has been very limited, possibly because of the need for special infusion solutions and difficult monitoring of the metabolic effects.

Objective

To investigate the safety and the feasibility of an RCA method for continuous veno-venous hemofiltration (CVVH) using commercially available replacement fluid.

Methods

We evaluated 11 patients at high risk of bleeding, requiring CVVH. RCA was performed using commercially available replacement fluid solutions to maintain adequate acid-base balance. We adjusted the rate of citrate infusion to achieve a post-filter ionized calcium concentration [iCa] <0.4 mmol/L when blood flow was <250 ml/min, or <0.6 mmol/L when blood flow was >250 ml/min. When needed, we infused calcium gluconate to maintain systemic plasma [iCa] within the normal range.

Results

Twenty-nine filters ran for a total of 965.5 h. Average filter life was 33.6±20.5 h. Asymptomatic hypocalcemia was detected in 6.9% of all samples. No [iCa] values <0.9 mmol/L were observed. Hypercalcemia (1.39±0.05 mmol/L) occurred in 2.5% of all samples. We observed hypernatremia (threshold 153 mmol/L) and alkalosis (threshold 7.51) in only 9.3% and 9.4% respectively of all samples, mostly concomitantly. No patient showed any signs of citrate toxicity. Conclusions: We developed a protocol for RCA during CVVH using commercially available replacement fluid that proved safe, flexible and applicable in an Intensive Care Unit (ICU) setting.
Incidence and Risk Factors of Coronary Artery Disease in Patients on Chronic Hemodialysis
Authors: Soubassi L.P. , Papadakis E.D. , Theodoropoulos I.K. , Poulos G.D. , Chaniotis D.I. , Tsapakidis I.P. , Zerefos S.N. , Douli M. , Chiras Th. Ch. , Kouvelis A. , Daglas G.K. , Soubassi S.P. , Valis D.N. , Zerefos N.S.
Published: January 2018

Aim of the study was to estimate the incidence of coronary heart disease (CAD) in patients (pts) with end stage renal disease (ESRD) maintained on chronic hemodialysis (HD) and its association with the presence of predisposing factors. The study included 171 dialysis pts (107 male (M) and 64 female (F)). Mean age of pts was 67±13 years, mean time on dialysis 52.7±44 months and Body Mass Index (BMI) 25.9±3.7 kg/m2. Fifty pts (29.2%) were clinically diagnosed with CAD. The diagnosis was established by coronary angiography in 24 (48%) and in 26 by combined dipyridamole - exercise thallium imaging (52%). Pts’ data in association with the development of CAD that were recorded included age, sex, smoking habits, hypertension, obesity, the presence of diabetes mellitus (DM), hyperlipidemia, anemia, low albumin levels, secondary hyperparathyroidism (SHP), the presence of chronic inflammation, as evidenced by the presence of elevated levels of CRP and hyperhomocystinemia. There was a statistically significant association of increasing age and CAD (p<0.0001). Relative risk (RR) was significantly increased i) in male pts compared to female pts (RR: 8.56, p<0.001), ii) in anemic pts compared to pts with hemoglobin levels ≤11 g/dL (RR: 8.26, p<0.0001), iii) in obese pts compared to pts with BMI ≤ 30 (RR: 5.09, p<0.005) and iv) in pts with increased levels of homocysteine compared to pts with levels of homocysteine <15 μM (RR: 4.14, p<0.0001). Using linear regression analysis, CAD was associated with the inadequacy of HD (r =-0.05, p<0.0001), time on HD (r =0.04, p =0.012) and increasing age (r =0.24, p<0.001). There was no statistically significant association between CAD and the presence of the other traditional risk factors. The incidence of CAD in dialysis pts is significantly increased with age, male sex, obesity, time on dialysis, the presence of anemia, hyperhomocysteinemia and inadequacy of HD.
The Relationship between Carotid and Coronary Atherosclerotic Damage in Dialysis Patients
Authors: Fabbian F. , Cacici G. , Franceschini L. , Russo G. , Vassanelli C. , Catizone L. , Lupo A.
Published: January 2018

Background

Data relating carotid ultrasound (CU) to atherosclerotic damage evaluated by coronary angiography in hemodialysis patients are scarce.

Methods

We carried out a cross-sectional study in 33 uremic subjects (age 55±12 years, 22 male, 7 diabetic), who have been on dialysis for 41±48 months (range 2–192). Twenty-two underwent a coronary angiography in order to complete clinical evaluation for inclusion on the kidney transplantation waiting list, and 11 because of coronary artery disease (CAD); Gensini's score was calculated. Intima-media thickness (IMT) and presence of plaques were related to the degree of coronary stenosis and to cardiovascular risk factors. Patients were divided into two groups depending on mean IMT (group 1 IM ≤ 0.9 mm, n=18; group 2 IMT>0.9 mm, n=15).

Results

Group 2 was older (60±8 vs 50±12 year, p=0.01), had higher frequency of CAD (53 vs 16%, p=0.02) and had higher prevalence of coronary artery stenosis ≥75% in the right (60 vs 22%, p=0.02), left anterior descending (46 vs 16%, p=0.06) and left circumflex coronary arteriers (60 vs 11%, p=0.05) than group 1. IMT was not related to the degree of CAD evaluated by Gensini's score. IMT sensibility and specificity in detecting the presence of hemodynamically significant coronary stenosis were 64% and 68%, respectively. Coronary narrowing was correlated with the degree of stenosis of common, internal and external carotid arteries (Spearman's rank correlation coefficient). During two years of follow-up, six major cardiac events were recorded and they were related to Gensini's score. Conclusions: In uremic patients, ultrasonographic evaluation of carotid arteries is a simple, non-invasive examination that could be a helpful tool in detecting coronary atherosclerotic damage, but IMT does not appear to add more information regarding risk stratification of CAD. (Int J Artif Organs 2007; 30: 315–20)
Prevalence and Correlates of Anemia and Uncontrolled Anemia in Chronic Hemodialysis Patients – The Campania Dialysis Registry
Authors: Di Iorio B. , Cirillo M. , Bellizzi V. , Stellato D. , De Santo N. G. ,   Campania Dialysis Registry Research Group, Aquino A , Anastasio P , Barchiesi S , Bonanno D , Buccino A , Cappabianca F , Cesaro A , Cestaro R , Chiuchiolo L , Chiuchiolo L , Ciaccia L , Cicchella T , Cillo N , Cioffi M , Cirillo E , Confessore N , Costanzo R , D'Apice L , De Felice E , Delgado G , De Luca M , De Luca P , De Luna V , De Maio A , De Pascale C , Della Volpe L , De Simone V , De Simone W , Di Benedetto A , Di Costanzo L , Di Donato R , Di Serafino A , Fabozzi GM , Fiorentino P , Fragetta G , Fumante M , Galise A , Giangrande C , Giobbe A , Gnasso A , Granato P , Guastaferro P , Iacono G , Iandolo R , Iengo G , Lamberti C , La Verde A , Liccardo D , Maddalena L , Mancini L , Manfreda L , Mari R , Marinelli G , Marinelli G , Martignetti V , Mascolini N , Maurodopoulos C , Migliorati M , Memoli M , Milone A , Milone D , Monaco G , Monteleone E , Natale G , Oggero AR , Pavese F , Petrelli P , Pizzola AR , Raucci B , Rubino R , Salvati G , Santoro D , Saviano C , Savignano M , Sforza C , Spitali L , Staulo P , Stellato D , Taddeo U , Terracciano V , Tomasino G , Tramontano P , Veniero P , Ventre M , Verrillo E , Violante B , Vitiello P , Viola G
Published: January 2018

Background

This study investigated prevalence and correlates of anemia and uncontrolled anemia in chronic hemodialysis patients.

Methods

A cross-sectional analysis was performed on registry data for 2,746 chronic (<6 months) hemodialysis patients aged 25–84. Data collection included years of dialysis, hours of dialysis/wk, disease causing hemodialysis, body mass index (BMI), erythropoietin (EPO) treatment, hemoglobin, markers of viral hepatitis, serum albumin, calcium, and phosphorus.

Results

Prevalence was 88.7% for anemia (hemoglobin <11 g/100 mL and EPO treatment at any Hb level), 39.4% for uncontrolled anemia (hemoglobin<11 g/100 mL). Gender, years of dialysis, hereditary cystic kidney disease (HCKD), and low BMI (<24 kg/m2) were independent correlates of anemia (P<0.001). Gender, HCKD, low BMI, serum albumin and calcium were independent correlates of uncontrolled anemia (P<0.05). An interaction was found between age (not correlated with anemia and uncontrolled anemia) and the association of gender with uncontrolled anemia (P<0.05). EPO doses were higher in patients with high prevalence of uncontrolled anemia than in patients with low prevalence (i.e., women vs men, other diseases vs HCKD, low vs not-low BMI, P<0.01). Gender, years of dialysis, HCKD, BMI, serum albumin, and calcium were independent correlates of the hemoglobin/EPO dose ratio in patients on EPO treatment (P<0.05).

Conclusion

Anemia and uncontrolled anemia are more frequent in hemodialysis patients with short-term dialysis, diseases other than HCKD, low BMI, and female gender. Gender effect was lower in elderly patients. Uncontrolled anemia was also associated with low serum albumin and calcium, suggesting that these parameters are indices of EPO resistance.
Enhancement of Viability of Muscle Precursor Cells on 3D Scaffold in a Perfusion Bioreactor
Authors: Cimetta E. , Flaibani M. , Mella M. , Serena E. , Boldrin L. , De Coppi P. , Elvassore N.
Published: January 2018

The aim of this study was to develop a methodology for the in vitro expansion of skeletal-muscle precursor cells (SMPC) in a three-dimensional (3D) environment in order to fabricate a cellularized artificial graft characterized by high density of viable cells and uniform cell distribution over the entire 3D domain. Cell seeding and culture within 3D porous scaffolds by conventional static techniques can lead to a uniform cell distribution only on the scaffold surface, whereas dynamic culture systems have the potential of allowing a uniform growth of SMPCs within the entire scaffold structure.

In this work, we designed and developed a perfusion bioreactor able to ensure long-term culture conditions and uniform flow of medium through 3D collagen sponges. A mathematical model to assist the design of the experimental setup and of the operative conditions was developed. The effects of dynamic vs static culture in terms of cell viability and spatial distribution within 3D collagen scaffolds were evaluated at 1, 4 and 7 days and for different flow rates of 1, 2, 3.5 and 4.5 ml/min using C2C12 muscle cell line and SMPCs derived from satellite cells. C2C12 cells, after 7 days of culture in our bioreactor, perfused applying a 3.5 ml/min flow rate, showed a higher viability resulting in a three-fold increase when compared with the same parameter evaluated for cultures kept under static conditions. In addition, dynamic culture resulted in a more uniform 3D cell distribution. The 3.5 ml/min flow rate in the bioreactor was also applied to satellite cell-derived SMPCs cultured on 3D collagen scaffolds. The dynamic culture conditions improved cell viability leading to higher cell density and uniform distribution throughout the entire 3D collagen sponge for both C2C12 and satellite cells.
Fluid Balance Error in Continuous Renal Replacement Therapy: A Technical Note
Authors: Bagshaw S. M. , Baldwin I. , Fealy N. , Bellomo R.
Published: January 2018

Background.

The reliability and safety of continuous renal replacement therapy (CRRT) machines have improved, yet there still remains the potential for fluid balance errors to occur during treatment.

Methods.

In vitro testing of two Kimal Hygieia CRRT machines (Plus and Ultima) was performed. Normal saline to simulate the blood circuit and standard bicarbonate-based fluid for replacement were used. All tests were performed in CVVH mode at four ultrafiltration (UF) rates. The testing was based on creation of a voluntary fluid balance error by clamping the line that fills the replacement fluid chamber to stop flow to the (simulated) patient. The time to alarms and fluid balance errors were recorded. The alarms were overridden and the accumulated fluid balance error allowed by the machine was determined.

Results.

The alarm occurred approximately 1 minute after the replacement fluid line was clamped at all UF rates. There was no limit to the number of times the alarm could be overridden and the accumulated negative fluid balance was proportional to the prescribed UF rate. After the replacement fluid chamber was allowed to re-fill, the machine attempted to correct the fluid deficit and consistently delivered excess fluid to generate a positive fluid balance error.

Conclusions.

The Hygieia machines appear designed with appropriate alarm and safety features. However, simulated fluid balance errors raise caution for operators. Clinicians and nurses need to understand the clinical implications of alarm overrides. Fluid balance errors caused by failure to acknowledge and correct replacement fluid failure alarms may cause harm to patients.
Prevention of Dialysis Disequilibrium by use of CVVH
Authors: Bunchman T. E. , Hackbarth R. M. , Maxvold N. J. , Winters J. W. , Barletta G.-M.
Published: January 2018

Objective.

Dialysis disequilibrium occurs due to a rapid shift of osmols when hemodialysis is used in cases of extreme uremia. Continuous veno-venous hemofiltration (CVVH) with citrate anticoagulation may offer a safe method of urea reduction.

Design.

Retrospective, clinical observation.

Setting.

Tertiary pediatric intensive care unit and nephrology program.

Patients

Two males, ages 10 and 12 years of age.

Intervention.

CVVH with citrate anticoagulation.

Results.

Three to four day reduction of BUN from 180 mg/dL to 22 mg/dL and from 279 mg/dL to 23 mg/dL.

Conclusion.

Slow and safe improvement of severe urea, hyperphosphatemia, hypocalcemia, and anemia without untoward side effects.
Feasibility of Mesothelial Transplantation during Experimental Peritoneal Dialysis and Peritonitis
Authors: Hekking L.H.P. , Van Den Born J.
Published: January 2018

The mesothelial cell layer lining the peritoneum orchestrates peritoneal homeostasis. Continuous exposure to peritoneal dialysis fluids and episodes of peritonitis may damage the monolayer irreversibly, eventually leading to adhesion formation and fibrosis/sclerosis of the peritoneum. Autologous mesothelial cell transplantation is thought to be one of the options to reduce dysfunction of the peritoneal membrane. In this article we will review the mesothelial cell transplantation experiments performed in the field of peritoneal dialysis and peritonitis. In addition we will focus on the trouble shooting using cultured autologous mesothelial cells for transplantation.
Circulatory Assist with Centrifugal Pump as a Bridge to Recovery: Mathematical Analysis
Authors: Arpesella G. , Mikus E. , Arabia M. , Loforte A. , Mikus P. M.
Published: January 2018

Mechanical circulatory support is an essential issue in the management of patients with end-stage cardiac failure. The aim of this study is to evaluate the efficacy of temporary support with a centrifugal blood pump as bridge to heart function recovery or bridge to transplantation.

Heart recovery is achieved by improving ventricular mechanical working conditions with proper modifications of preload and afterload.

This article assesses the advantages of a novel “cardiac chambers” cannulation setting versus the traditional one, in the case of biventricular or isolated right ventricular failure. The study was conducted using a numerical computer model based on the work by Guyton, Sagawa, Westerhof, and Noordergraaf. Simulation of the planned trials was achieved by changing the model parameters, the pump angular velocity, and the inflow and outflow settings. (Int J Artif Organs 2007; 30: 604–10)
Expansion and Chondrogenic Differentiation of Human Mesenchymal Stem Cells
Authors: Weber C. , Gokorsch S. , Czermak P.
Published: January 2018

The potential of human mesenchymal stem cells (hMSC) to differentiate into various types of mesenchymal tissue, such as chondrocytes, makes them a potential cell source in cartilage tissue engineering. Because of the requirement of high cell amounts for the generation of cartilage implants or for the extensive experimental studies to investigate the culture parameters, the initial cells have to be expanded, which leads to high population doubling numbers. It is known that hMSC can differentiate into chondrocytes at least up to the 15th population doubling. To monitor the differentiation status, the protein MIA (melanoma inhibitory activity), which is only synthesized by malignant melanomas and chondrocytes, can be used. In this study the chondrogenic differentiation potential of hMSC beyond the 15th population doubling was investigated using MIA as a chondrocyte marker. A chondrogenic potential of hMSC at higher population doubling numbers may be of interest due to the requirement of less frequent isolations of cells. Therefore hMSC were cultured in a monolayer until the 37th population doubling. Cells of different passages were cultured as pellets for two weeks in transforming growth factor (TGF)-β3 containing differentiation medium. The MIA contents in medium on the last three cultivation days were measured for each case using an MIA-ELISA-kit. A significant difference between MIA content in medium of the pellet and non-stimulated monolayer reference cultures was detectable until the 32nd population doubling. In addition, the hMSC were seeded at lower densities to investigate whether the cells may be expanded faster and with less amount of work due to higher population doubling numbers per passage. The reduced inoculation density led to an increased growth rate. (Int J Artif Organs 2007; 30: 611–8)
Does the Ventrica Magnetic Vascular Positioner (MVP®) for Coronary Artery Bypass Grafting Significantly alter Local Fluid Dynamics? a Numeric Study
Authors: Morbiducci U. , Lemma M. , Ponzini R. , Boi A. , Bondavalli L. , Antona C. , Montevecchi F.M. , Redaelli A.
Published: January 2018

Objective

Automatic devices have been recently introduced to make the anastomosis procedure quick and efficient when creating a coronary bypass on the beating heart. However, the implantation of these devices could modify the graft configuration, consistently affecting the hemodynamics usually found in the traditional anastomosis. As local fluid dynamics could play a significant role in the onset of vessel wall pathologies, in this article a computational approach was designed to investigate flow patterns in the presence of the Ventrica magnetic vascular positioner (Ventrica MVP®) device.

Methods

A model of standard hand-sewn anastomosis and of automated magnetic anastomosis were constructed, and the finite volume method was used to simulate in silico realistic graft hemodynamics. Synthetic analytical descriptors - i.e., time-averaged wall shear stress (TAWSS), oscillating shear index (OSI) and helical flow index (HFI) - were calculated and compared for quantitative assessment of the anastomosis geometry hemodynamic performance.

Results

In this case study, the same most critical region was identified for the 2 models as the one with the lowest TAWSS and the highest OSI (TAWSS=0.229, OSI=0.255 for the hand-sewn anastomosis; TAWSS=0.297, OSI=0.171 for the Ventrica MVP®). However, the shape of the Ventrica MVP® does not induce more critical wall shear stresses, oscillating flow and damped helicity in the graft fluid dynamics, as compared with conventional anastomosis.

Conclusions

We found that the use of the Ventrica MVP® for the case study under investigation was not associated with more critical fluid dynamics than with conventional hand-sewn anastomosis. Thereby, the device could facilitate beating heart and minimally invasive coronary artery bypass grafting without increasing local hemodynamic-related risks of failure. (Int J Artif Organs 2007; 30: 628–39)
Medicolegal Reflections about a Case of Cardiac Death after Renal Transplantation
Authors: Di Paolo M. , Guidi B.
Published: January 2018

Cardiovascular disease is the most common cause of death in patients with renal transplant. Acute coronary syndrome due to coronary artery disease, and left ventricular hypertrophy leading to chronic heart failure account for the majority of sudden arrhythmic deaths after transplantation. Furthermore death with functioning graft represents the main cause of graft loss, particularly after the first post-transplantation year. Although cardiovascular disease leads to morbidity and mortality in renal transplant recipients, its pathogenesis is poorly understood. The high incidence of cardiovascular disease in patients after renal transplant is chiefly due to high occurence and accumulation of traditional risk factors before and after transplantation. Hypertension, post-transplant diabetes mellitus and hyperlipidemia increase the risk for cardiovascular events. Also “non traditional” risk factors are associated with cardiovascular disease. Moreover several immunosuppressive drugs interfere with the cardiovascular system.

The authors present a case of cardiac death following renal transplant in a patient with history of cardiovascular disease prior transplantation. Initially treated by hemodialysis, after 3 years he received a cadaveric renal transplant. The post-transplantation period was without surgery complications, immunological or infectious, except for a scarce control of blood pressure. A month after the operation, the patient developed thrombophlebitis, plus extra-peritoneal swelling. After ten days in hospital he suddenly died.

The aim of the manuscript is to remark on the legal relevance of patient's consensus to transplant. It is necessary to well inform patients of an operation's risks and complications. Furthermore, the exceeding demand with respect to organ availability raises ethical issues about organ allocation. (Int J Artif Organs 2007; 30: 649–55)
Prevalence of Genes Encoding for Staphylococcal Leukocidal Toxins among Clinical Isolates of Staphylococcus Aureus from Implant Orthopedic Infections
Authors: Arciola C.R. , Baldassarri L. , Von Eiff C. , Campoccia D. , Ravaioli S. , Pirini V. , Becker K. , Montanaro L.
Published: January 2018

Staphylococcus aureus has emerged as a major cause of implant infections. It is known that it is able to produce several toxins that contribute to its armory of virulent weapons, but there are still no data on their prevalence among isolates recovered from biomaterial-centered infections. In this study, 200 Staphylococcus aureus isolates from infections related to different types of orthopedic implants (hip and knee arthroprostheses, internal and external fixation devices) were tested by polymerase chain reaction for the prevalence of genes encoding for leukotoxins. Although almost all isolates were positive for the γ-hemolysin gene (99%), none was positive for lukM. The leukotoxin genes lukE/lukD were found in 67% of isolates. The presence of lukE/lukD was significantly associated with that of Accessory Gene Regulatory locus agr II. The lukE/lukD-positive isolates were significantly more prevalent in the staphylococcal isolates from knee arthroprostheses than in the isolates from the other implant types. The genes encoding Panton-Valentine leukocidin components were detected in only one isolate that, curiously enough, was taken solely from a knee arthroprosthesis infection.
Biotechnological War against Biofilms. Could Phages Mean the End of Device-Related Infections?
Authors: Del Pozo J.L. , Alonso M. , Arciola C.R. , Gonzalez R. , Leiva J. , Lasa I. , Penades J.
Published: January 2018

Microorganisms universally attach to surfaces, resulting in biofilm formation. These biofilms entail a serious problem in daily clinical practice because of the great prevalence of implantable device-related infections. Differences in antibiotic activity against planktonic and sessile bacteria may relate to clinical failures in the treatment of biofilm-related infections (BRI). Bacteriophages have several characteristics that make them potentially attractive therapeutic agents in some selected clinical settings, like for example BRI. They are highly specific and very effective in lysing targeted bacteria, moreover, they appear to be safe for humans. Many studies have shown the potential of phages for the treatment of infectious diseases in plants and animals, including infections with highly drug-resistant bacteria. The therapeutic use of bacteriophages, possibly in combination with antibiotics, may be a valuable approach in BRI. However, many important questions still remain that must be addressed before phages can be endorsed for therapeutic use in humans.
Clinical Evaluation of Desferrioxamine (DFO) for Removal of Thallium Ions in Rat
Authors: Fatemi S. J. , Amiri A. , Bazargan M. H. , Tubafard S. , Fatemi S. N.
Published: January 2018

An investigation was conducted to evaluate the ability of DFO following the administration of thallium salt in male Wistar rats. Thallium was introduced to several groups of weanling male Wistar rats via different means, through drink, food and intraperitoneal injection. A control group was fed on a diet containing a normal level of iron. After a period of 30 days, all the rats administered thallium were severely anemic and showed toxicity symptoms through loss of hair, an increase in thallium and a decrease in iron levels in the blood. Chelation therapy was carried out to remove the toxic element from the body. The ability of desferrioxamine (DFO) in removing thallium was investigated by injection of this chelator for one week to the remaining rats of similar groups. The results showed that the thallium level present in the blood was significantly reduced and, at the same time, the iron concentration returned to the normal level. It was concluded that DFO chelator is able to remove thallium from the body and could be used for the treatment of complications and eradication of symptoms of thallium intoxication.
Potential Adverse Effects of Replacing High Volume Hemofiltration Exchanges on Electrolyte Balance and Acid-Base Status Using the Current Commercially Available Replacement Solutions in Patients with Acute Renal Failure
Authors: Davenport A.
Published: January 2018

The original substitution and/or dialysates used for continuous hemofiltration and/or dialysis were either based on peritoneal dialysis fluids, or peritoneal dialysates themselves. Although these fluids have been refined over the years, by changing the anionic base from acetate or racemic d+ l-lactate, to bicarbonate or l-lactate, the fluids remain designed for low volume hourly exchanges. Even at relatively low volume exchanges, the composition of these fluids can affect systemic acid-base balance. Those fluids which contain a higher concentration of lactate with a corresponding lower chloride, predispose to a hypochloremic alkalosis, whereas those with a lower concentration of lactate with a corresponding higher chloride potentially lead to a hyperchloremic acidosis. In addition, cation balance, differs when using the same fluid as a replacement solution, compared to dialysate. In particular, sodium balance is greater for post-dilutional fluid replacement, due to the lower sieving coefficient.

More recently, citrate has been introduced as an extracorporeal anticoagulant, and a variety of dialysates/replacement fluids have been developed, due to the difference in citrate clearance between dialysis and convection based extracorporeal circuits.

Over the last decade, there has been a general increase in the standard hourly dialysate and exchange volumes used in the management of patients with acute kidney injury, from 1 to 2.5–3 l/h. Indeed, even larger volume exchanges, some 6–8 l/h have been advocated to improve patient outcomes. However, before embarking on such continuous high volume exchanges, a new generation of fluids may need to be developed to prevent acid-base and electrolyte imbalances. (Int J Artif Organs 2008; 31: 3–5)
Acid-Base Disturbances in the Intensive Care Unit: Current Issues and the Use of Continuous Renal Replacement Therapy as a Customized Treatment Tool
Authors: Bouchard J. , Mehta R. L.
Published: January 2018

Continuous renal replacement therapies (CRRT) are often used to manage complex acid-base problems in critically ill patients. These techniques allow a constant manipulation of the plasma composition. Several technical factors from CRRT influence the acid-base status; namely, the effluent rate, the operational characteristics of the technique, the content of the solutions and the metabolic rate of the buffer. This article reviews the common acid base disorders occurring in the intensive care unit, using both the anion gap and the strong ion gap approaches, and describes the influence of CRRT on acid-base physiology. The use of CRRT as a customized therapy for acid-base disorders is discussed, allowing an integration of both physiological and technical concepts. (Int J Artif Organs 2008; 31: 6–14)
Citrate Anticoagulation Protocol for Slow Extended Hemodialysis with the Genius® Dialysis System in Acute Renal Failure
Authors: Schneider M. , Liefeldt L. , Slowinski T. , Peters H. , Neumayer H.-H. , Morgera S.
Published: January 2018

Background

The Genius® dialysis system is increasingly used as an intermittent hemodialysis device in the setting of acute renal failure. Slow extended hemodialysis is preferred in the case of critical ill patients. In this study we established a safe and feasible citrate anticoagulation protocol for slow extended hemodialysis (SLED) with the Genius® system.

Methods

We compared six anticoagulation protocols using SLED in 34 critically ill patients with acute renal failure. One group (A) received only citrate anticoagulation. Four groups (B - D) were treated with citrate and different additional systemic anticoagulation. Patients in the last group (F) were anticoagulated with heparin and were free of citrate anticoagulation. The total number of treatments was 103. A 4% sodium citrate solution was infused into the arterial line of the dialysis device for citrate anticoagulation. The dialysis solution contained one mmol/L of calcium. No additional calcium supplementation was done. We monitored electrolyte, acid-base and cardiovascular status prospectively.

Results

Hemodialysis was well tolerated hemodynamically. Electrolytes remained stable throughout hemodialysis in all groups. The decrease in ionized and total calcium was within the expected, clinically acceptable range. Bicarbonate and pH levels increased during dialysis, especially if citrate was used.

Conclusions

Slow extended Genius® hemodialysis with citrate is well tolerated and offers a safe and effective alternative to systemic anticoagulation. (Int J Artif Organs 2008; 31: 43–8)
A Randomized Comparative Crossover Study to Assess the Affect on Circuit Life of Varying Pre-Dilution Volume Associated with CVVH and CVVHDF
Authors: Davies H. T. , Leslie G. , Pereira S. M. , Webb S.A.R.
Published: January 2018

Objective

To determine if circuit life is influenced by a higher pre-dilution volume used in CVVH when compared with a lower pre-dilution volume approach in CVVHDF.

Design

A comparative crossover study. Cases were randomized to receive either CVVH or CVVHDF followed by the alternative treatment.

Subjects

All patients ≥ 18 yrs of age who required CRRT while in ICU were eligible to participate, but excluded if coagulopathic, thrombocytopenic or unable to receive heparin. Based on an intention-to-treat, 45 patients were randomized to receive either CVVH or CVVHDF followed by the alternative treatment. Setting: A 24-bed, tertiary, medical and surgical adult intensive care unit (ICU).

Intervention

Blood flow rate, vascular access device and insertion site, hemofilter, anticoagulation and machine hardware were standardized. An ultrafiltrate dose of 35 ml/ kg/h delivered pre-filter was used for CVVH. A fixed pre-dilution volume of 600 mls/h with a dialysate dose of 1 L was used for CVVHDF.

Results

Thirty-one patients received CVVH or CVVHDF out of 45 participants followed by the alternative technique. There was a significant increase in circuit life in favor of CVVHDF (median=16 h 5 min, range=40 h 23 min) compared with CVVH (median=6 h 35 min, range=30 h 45 min). A Mann-Whitney U test was performed to compare circuit life between the two different CRRT modes (Z=-3.478, p<0.001). Measurements of circuit life on the 93 circuits which survived to clotting (50 CVVH and 43 CVVHDF) were log transformed prior to under taking a standard multiple regression analysis. None of the independent variables - activated prothrombin time (aPTT), platelet count, heparin dose, patient hematocrit or urea - had a coefficient partial correlation >0.09 (coefficient of the determination=0.117) or a linear relationship which could be associated with circuit life (p=0.228).

Conclusion

Pre-diluted CVVHDF appeared to have a longer circuit life when compared to high volume pre-diluted CVVH. The choice of CRRT mode may be an important independent determinant of circuit life.
Extruded Ceramic Microelectrodes for Biomedical Applications
Authors: Perale G. , Giordano C. , Daniele F. , Tunesi M. , Colombo P. , Gottardo L. , Maccagnan S. , Masi M.
Published: January 2018

A new process, based on the micro-co-extrusion of preceramic precursors, has been studied for manufacturing ceramic microelectrodes to be used in biomedical applications. Commercially available silicon polymers were applied and proper doping resulted in electrically conductive ceramic filaments. Chemical reticulation and high-temperature pyrolysis were applied to convert the polymeric resins into Si-O-C ceramic materials. Circular microelectrodes were manufactured with diameters between 100 μm and 5 mm with a different number of inner conductive lines (from 1 to 80). The flexural strength of the filaments depended on the outer diameter size; doping with carbon black produced filaments with an average conductivity of approximately 0.4 S/cm for a 50% weight carbon black load. The results achieved by in vitro studies confirmed a good biological performance of Si-O-C ceramic structures with both hard and soft tissue cell models.
Acid-base Balance in Combined Severe Hepatic and Renal Failure: A Quantitative Analysis
Authors: Naka T. , Bellomo R. , Morimatsu H. , Rocktaschel J. , Wan L. , Gow P. , Angus P.
Published: January 2018

Background

Severe hepatic failure (SHF) commonly leads to major changes in acid-base balance status. However, the direct effects of liver failure per se on acid base balance are poorly understood because this condition is usually associated with acute renal failure (ARF).

Aim

To assess the effect of SHF on acid-base balance.

Design

Retrospective laboratory investigation.

Subjects

Thirty-seven critically ill patients with SHF complicated by ARF, and 42 patients with severe ARF without liver failure prior to renal replacement therapy.

Intervention

Retrieval of clinical and laboratory data from prospective unit and laboratory databases.

Methods

Quantitative acid-base assessment using Stewart-Figge methodology. Comparison of findings between the two groups. Comparison of demographic and clinical features.

Results

Patients with combined SHF and ARF were younger and had significantly higher mean bilirubin, ALT and INR levels (p<0.0001). Their mean lactate concentration was higher (6.4 vs. 2.1 mmol/L; p<0.0001) leading to a greater anion gap (25.8 vs. 16.1 mmol/L; p<0.0001). The ionized calcium concentration (1.00 vs. 1.15 mmol/L; p<0.0001) was lower but the strong ion difference apparent (SIDa) was greater (42.0 vs. 38.0 mEq/L; p<0.005) due to hypochloremia. The albumin concentration was low but higher than in control patients (28 vs. 24 g/L; p<0.01) and the calculated strong ion gap (SIG) was greater (12.6 vs. 9.3 mEq/L; p<0.01). The base excess was similar to controls and the pH was preserved in the near normal range by marked hypocapnea.

Conclusions

Combined SHF and ARF is a syndrome with unique acid-base changes due mostly to lactic metabolic acidosis and, in smaller part, to the accumulation of unmeasured anions. This acidosis, like that of ARF, is attenuated by hypoalbuminemia, by a unique preservation of the SIDa due to hypochloremia, and by marked hypocapnea.
Treatment of Dialysis Patients with Chronic Hepatitis C Using Pegylated Interferon and Low-Dose Ribavirin
Authors: Carriero D. , Fabrizi F. , Uriel A. J. , Park J. , Martin P. , Dieterich D. T.
Published: January 2018

Background

No safe and effective therapy exists for chronic hepatitis C in dialysis patients. Available data on the antiviral treatment of hepatitis C in dialysis population is mostly based on standard interferon monotherapy.

Objectives

We conducted a prospective, cohort trial with combined therapy (pegylated-interferon-alpha-2a (135 mcg/week) plus low dose ribavirin (200 mg/day)) for chronic hepatitis C in 15 patients undergoing long-term dialysis. Twelve patients had HCV genotype 1a/1b, three were co-infected with human immunodeficiency virus (HIV), and two had compensated cirrhosis. End-points were sustained viral response and adverse effects.

Results

Sustained virological response was obtained in four patients (including two with HCV genotype 1); the SVR rate was 28.6% (4/14), on an intention-to-treat analysis. One subject with SVR had compensated cirrhosis. All HIV co-infected patients had well controlled HIV and one of them (33%) reached SVR. Seven (50%) of the 14 patients were non-responders, two of which relapsed after discontinuation of therapy. Drop-out rate was 71.4% (10/14). The most frequent side-effect was anemia, which required ribavirin discontinuation in three patients; seven (47%) patients received blood transfusions. Two patients died (week 4 and 14) of causes related to cardiovascular disease, which was frequent in our cohort. Two subjects were hospitalized and discontinued therapy (week 1, and 27).

Conclusions

Results from this study showed that about one-third of HD patients achieved sustained virological response with pegylated-interferon-alpha-2a plus low-dose ribavirin; however, tolerance to antiviral treatment was unsatisfactory. Well-controlled HIV infection should not be a contraindication to HCV therapy in dialysis patients. Prospective, controlled clinical trials of combined antiviral therapy targeted at HCV in chronic kidney disease population are indicated.
Plasma levels of Th1/Th2 Type Cytokine are Associated with Change of Prolactin and GH/IGF-I in Hemodialysis Patients
Authors: Liu M.-L. , Xu G. , Xue S.-R. , Zhong X.-C. , Chen G.-X. , Chen Z.-J.
Published: January 2018

Patients undergoing chronic hemodialysis (HD) have an impaired immune system involving both B and T cell-mediated immune responses. Since T helper type 1 (Th1) and type 2 (Th2) cytokines are implicated in regulating the immune responses, while the pituitary hormones, prolactin (PRL) and growth hormone (GH) are known to be involved in the regulation of the immune response, all of them may, therefore, be involved in impaired status. The aims of the present study were to estimate the serum concentrations of Th1-Th2 cytokine, GH, insulin-like growth factor-I (IGF-I) and PRL, and to determine whether there are any correlations between the release of T-cell cytokines and disturbance of hormones in a group of patients on maintenance hemodialysis (MHD). The study included 35 HD patients (23 males and 12 females, mean age 56.8±12.8 years) and a control group of 20 age-matched healthy subjects. Baseline serum concentrations of GH/IGF-I, PRL, IL-2, sIL-2R, IFN-γ, IL-4 and IL-10 were measured in all patients and control subjects. Our results demonstrate that the fasting serum concentration of IGF-I, PRL, sIL-2R and Th1-type cytokine, including IL-2 and IFN-γ, were significantly higher in HD patients compared to the healthy subjects. GH and Th2-type cytokine including IL-4 and IL-10 levels were slightly reduced, but no significant differences were observed between HD patients and the control group. In the group of HD patients, PRL correlated directly with IFN-γ and correlated inversely with IL-10; IFN-γ correlated inversely with IL-4; and GH also correlated inversely with IGF-I and IL-4. However, IGF-I correlated directly with IL-2 and IL-10. These data suggest that the Th1/Th2 imbalance in HD patients with an increase of Th1 type cytokines, associated with the altered GH/IGF-I axis and prolactin and immuno-endocrine dysfunction, probably plays a role in an impaired immune system in HD patients.
The Italian Sidem Registry for Apheresis: An Overview of the 2005 Statistics
Authors: De Silvestro G. , Bagatella P. , Vicarioto M. , Tison T. , Marson P.
Published: January 2018

Data collection on apheresis activities in Italy throughout 2005 including techniques, types of blood cell separators, clinical indications and adverse effects was performed by means of a standardized questionnaire. These data provided by 83 Apheresis Units from 16 Italian regions, albeit rough, are sufficiently informative, mainly in comparison with previous surveys on these statistics (1997 and 2000). In 2005 a total number of 204,746 apheresis procedures were carried out, with a clear-cut prevalence of apheresis production (87.7%), performed by 66 out of 83 Apheresis Units (79.5). Lombardy, Veneto and Tuscany were the most active regions for therapeutic apheresis (51.1% of the total national procedures). An increasing number in extracorporeal photochemotherapy as compared to the 2000 national survey (3,386 vs. 704 procedures) is the most striking observation to emerge from the 2005 data collection on therapeutic apheresis in Italy. Adverse effects, predominantly mild ones (i.e., paresthesia due to citrate-induced hypocalcemia), occurred in 0.12% of apheresis production and 6.04 of therapeutic sessions, particularly in the course of peripheral blood stem cell collection (20.79%), as already reported in the 2000 national survey.
Acetaminophen-Induced Acute Liver Failure Treated with Single-Pass Albumin Dialysis: Report of a Case
Authors: Karvellas C. J. , Bagshaw S. M. , Mcdermid R. C. , Stollery D. E. , Gibney R.T.
Published: January 2018

Background

Acetaminophen (paracetamol) overdose is a leading cause of acute liver failure (ALF). When patients fulfill the King's College criteria for acetaminophen-induced ALF (AALF), they have a poor prognosis for survival without liver transplantation. Recent advances in artificial liver support have used albumin as a binding and scavenging molecule in ALF. One method, single-pass albumin dialysis (SPAD), involves dialyzing blood against an albumin-containing solution across a high-flux membrane to remove albumin-bound toxins. Herein, we describe our protocol for SPAD and report its use in a case of AALF as a bridge to native liver recovery.

Case

A 41-year-old female with no documented history of liver disease presented with acute acetaminophen toxicity and developed hepatic encephalopathy, coagulopathy and lactic acidosis. The patient met King's College criteria for liver transplantation, based on pH and INR, but was deemed not suitable as a candidate due to psychosocial comorbidities. On day 3 of her ICU admission, she received the first of five consecutive daily runs (total ∼77 hours) of SPAD. The patient's course was complicated by cerebral edema requiring mannitol. She was extubated on day 11 and transferred to the ward by day 13. At ICU discharge, her liver function (INR 1.9, bilirubin 435 mmol/L) and kidney function were recovering. She did not have any long-term neurological sequelae. By hospital discharge (day 46) her native liver function had recovered with a bilirubin <100mmol/L.

Conclusion

We describe a case of a patient with acetaminophen-induced acute liver failure who was successfully bridged to spontaneous native liver recovery as a result of SPAD treatment. In patients with ALF, SPAD may be an additional intervention for temporary extracorporeal support. Further investigation in larger prospective studies is warranted.
Three-Dimensional Dialysate flow Analysis in a Hollow-Fiber Dialyzer by Perfusion Computed Tomography
Authors: Kim J.C. , Kim J.H. , Kim H.-C. , Kim K.G. , Lee J.C. , Kang E. , Kim H.C. , Min B.G. , Ronco C.
Published: January 2018

Perfusion computed tomography (PCT) is a means to rapidly and easily evaluate cerebral perfusion in patients presenting with acute stroke symptoms, which provides insights into capillary-level hemodynamics. In this study, we used PCT to analyze the 3-dimensional dialysate flow in a low-flux hemodialyzer equipped with a standard fiber bundle. The dynamic CT studies were performed with 64-channel multi-detector row CT (MDCT) at a dialysate flow rate of 500 ml/min and a 1.0 ml/sec injection rate of contrast agent. Central volume principle was used to calculate hydrodynamic parameters by deconvolution of time-density curves (TDCs). Functional maps of dialysate flow (DF), dialysate volume (DV), and mean transit time (MTT) could quantitatively describe the dialysate flow maldistribution, variations in fiber packing, and perfusion pressure distribution in a hemodialyzer, respectively. PCT by means of analysis was able to overcome the limitations of conventional imaging techniques for analyzing dialysate flow distributions in hollow-fiber dialyzers. Not only local hydrodynamic phenomena at microscopic level but also macroscopic flow behavior of dialysate were visualized quantitatively. Therefore, we concluded that PCT is a quantitative analysis method to provide better insights into hydrodynamics of hollow-fiber dialyzers and is expected to contribute to optimization of artificial kidneys.