bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Neo Red Cells on the Canine Hemorrhagic Shock Model
Authors: Usuba A. , Motoki R. , Miyauchi Y. , Suzuki K. , Takahashi A. 
Published: March 2018

This study evaluated the newly developed artificial red blood cells named Neo Red Cells (NRC) after hemorrhagic shock in mongrel dogs. NRC is prepared as microcapsules by a method in which stroma-free hemoglobin is encapsulated using a bimolecular lipid membrane called liposome. The particle size is 0.2 μm, methemoglobin content is less than 5% and the hemoglobin concentration is 5.6 g/dl. We analyzed blood gases and hemodynamics and carried out laboratory examinations after 59-88% blood exchange using NRC. The hemodynamic parameters returned to the normal range after NRC. Inhaling normal room air, oxygen carried by NRC was 60.40% at the exchange rate of 88%. Renal and hepatic function and other laboratory findings were normal after administration of NRC. After further study and improvement NRC could be considered suitable as artificial blood for treatment of hemorrhagic shock.
Mechanical Bridge to Transplantation with the Vienna Heart in TAH and LVAD Configuration
Authors: Moritz A. , Rokitansky A. , Schima H. , Prodinger A. , Laufer G. , Hiesmayer M. , Wolner E. 
Published: March 2018

The Vienna heart uses a vacuum formed, pellethane pulsatile ventricle and is available in left ventricular assist (LVAD) and total artificial heart (TAH) configurations. This device was used as mechanical support of the failing heart in nine patients intended for heart transplantation. In two patients with cardiomyopathy an orthotopic TAH was implanted; one survived despite severe preoperative ischemic liver damage, and the other died of sepsis. In seven patients an atrio-aortic LVAD was implanted; six had suffered an acute myocardial infarction with cardiogenic shock, and one could not be weaned off bypass. Three patients survived. These included one 65-year-old with incipient ARDS at operation, and a 40-year-old with preoperative liver and kidney insufficiency who was transplanted in septicemia. In this patient the septic focus, natural and artificial heart, were removed at transplantation. Four patients died. In one we were unable to establish satisfactory circulation, one died after failure of the transplanted heart, one suffered a lethal cerebral embolism and one developed multi-organ failure after repeated attacks of ventricular fibrillation. With the Vienna heart sufficient circulatory support could be established with cardiac outputs between 6 and 8 l/min for the TAH and 3.5 to 4.5 I/min for the LVAD. With this type of support an overall survival rate of 44% could be achieved. Mechanical hemolysis was not a clinical problem and no device failure occurred.
Specific Removal of Transthyretin from Plasma of Patients with Familial Amyloidotic Polyneuropathy: Optimization of an Immunoadsorption Procedure
Authors: Regnault V. , Costa P.M.P. , Teixeira A. , Rivat C. , Stoltz J.F. , Saraiva M.J.M. , Costa P.P. 
Published: March 2018

Familial amyloidotic polyneuropathy is characterized by the presence in patients plasma of a genetic variant of transthyretin. No specific treatment has been found and extracorporeal immunoadsorption on immobilized anti-transthyretin antibodies appears as a potentially attractive procedure. Parameters involved in specific immunoadsorption of transthyretin were studied and optimized. Several monoclonal anti-TTR antibodies were compared as affinity ligands and one of them was found to be suitable for such purposes. Optimum quantities of antibodies to be immobilized on the gel were determined. Three desorption agents were tested for regenerating immunoadsorbents and best results were obtained with basic variation of pH, allowing total desorption of TTR and possibility of multiple use without loss of adsorption capacity. Simulation of an immunoadsorption procedure in well-defined conditions showed efficiency and specificity of adsorption to remove TTR and the system thus should be subjected to clinical trials.
Improved Endothelialization of Postfixation Treated Biological Vascular Grafts
Authors: Moritz A. , Grimm M. , Eybl E. , GrabenwöGer M. , Böck P. , Siegl H. , Wolner E. 
Published: March 2018

Preliminary in vitro and in vivo studies have shown that endothelialization is improved by a detoxifying postfixation treatment of glutaraldehyde (GA) fixed bovine pericardial patches and grafts. To test whether this is also true for GA tanned human vein (HUV) grafts, patches of commercially available HUV grafts (MHUV), postfixation treated HUV grafts (PTHUV) and GA fixed HUV granfts (GAHUV) were endothelialized in vitro. Eight pairs of MHUV and PTHUV grafts were implanted as femoropopliteal grafts in eight sheep. Endothelial cell adherence was significantly better on PTHUV (11910 ± 4413 cells/cm2) than on MHUV (6545 ± 2835 cells/mm2; p = 0.0007) and on GAHUV (3563 ± 1638; p = 0.0001) one day after cell seeding. After eight days of culture significantly more cells spread on PTHUV material than on MHUV (p = 0.0002), but none of the cultures on GAHUV remained viable. Four PTHUV grafts occluded in the femoropopliteal position, mostly because of kinking, so that only in four pairs of grafts could the thrombus-free surface be compared by planimetry. Again PTHUV material was covered more by endothelial cells than was MHUV material. On PTHUV endothelial cells spread directly on the graft material while on MHUV these cells spread on a layer of fibrin and macrophages. Postfixation treatment of GA-fixed biological graft material by aminoacid solutions improves the biocompatibility of the material and enhances in vitro as well as spontaneous in vivo endothelialization.
Pregnancy in Chronic Dialysis: A Review and Analysis of the Literature
Authors: Chan W.S. , Okun N. , Kjellstrand C.M. 
Published: March 2018

Pregnancy is uncommon in end-stage renal failure, particularly in patients requiring dialysis. We reviewed the literature from 1965 to date, seeking an optimal way of dialyzing pregnant women after encountering one such patient. Methods We searched the English literature by cross-referencing “pregnancy” with “hemo-” or “peritoneal dialysis” and “renal failure”. Eighty-six pregnancies worldwide were found to which we added one case of our own. Various independent factors were studied against gestational age at delivery using uni- and multivariate analysis. These factors included mother's age, previous delivery, diagnoses of renal disease, dialysis duration prior to pregnancy, gestational age at onset of dialysis, dialysis type, level of hemoglobin during pregnancy, BUN and creatinine targets, BUN/creatinine ratio, dialysis intensity at the beginning and end of pregnancy, influence of erythropoietin and dialysis complications. Results Of the 87 pregnancies, 12% resulted in stillbirths, 9% of neonates died prior to discharge. The mean gestational age at delivery was 32 ± 5 weeks, and the mean birth weight 1604 ± 652 g. Two congenital abnormalities and one twin pregnancy were reported. 48% of deliveries were premature. Pre-eclampsia was reported in 11%, and worsening hypertension in 17%. CAPD was used in 25 and hemodialysis in 62 patients. Fetal survival was similar in both cases (72% vs 82%), although incidence of various dialysis complications differed. The conventional dialysis goals of a low target BUN level and hemoglobin for pregnant patients were not factors in predicting fetal outcome. The number of hemodialyses/week were negatively correlated (R = -0.35, P = 0.061), but the hours of dialysis positively correlated (R = 0.42, p = 0.035) to gestational age. Fetal survival was independently influenced by creatinine level [564 µmol/L when baby survived vs 788 µmol/L when baby died (p = 0.021)], BUN/creatinine ratio (50 vs 30, p = 0.053), and hours of dialysis (5.6 hrs vs 3.6 hrs, p=0.013). There was no relation of either frequency or volume of peritoneal dialysis exchanges to gestational age or fetal survival. Conclusions Greater attention to a high intake of protein (>1.5 g/kg) and higher dose of hemodialysis, achieved by longer, every other day dialysis, may be the optimal approach to pregnant patients on hemodialysis. Our first attempt to define the goal of hemodialysis is to keep the predialysis creatinine below 600 mmol/L and the protein intake high enough so the predialysis BUN level is >25 mmol/L. There are no clear guidelines on how to best perform CAPD.
Development and Initial in Vivo Testing of a New Hydraulic Drive System (Paedipump) for Circulatory Support in Infants
Authors: Reiß N. , Morshuis M. , Landich R. , Frerichs I. , Frerichs A. , Hellige G. , Illian M. , Dramburg W. , Scheid P. , Minami K. , KöRfer R. 
Published: March 2018

The main limitation in the use of circulatory support in children is the lack of an adequate system with regard to size and pumping capacity Recently, two pneumatically driven ventricular support systems with low volume chambers for use in a pediatric population became available. We have developed a hydraulic drive system with an advantageous exact control of the stroke volume. The system enables two different modes of operation: the full-empty and the filled-empty modes. In both cases the ventricle is empty at the end of systole. This new system was tested in experimental animals (6 pigs, body weight 9.5–14.0 kg) with normal and reduced left ventricular function (MAP<45 mmHg). A 25 ml ventricle (HIA-Medos) was implanted. The full-empty and the filled-empty mode used led to a significant load reduction, both in animals with normal and impaired cardiac function. Plasma lactate levels, pH-values and total body 0 2 consumption were in the normal range during circulatory support indicating adequate organ perfusion. Results showed that sufficient ventricular support was achieved during all pumping modes due to the possibility of controlling and modifying the stroke volume of the hydraulically driven support system employed according to necessity. This is a promising feature for its future application in infants with congenital or acquired heart diseases.
Mechanical Circulatory Support after Orthotopic Heart Transplantation
Authors: Tenderich G. , Koerner M.M. , Stuettgen B. , Minami K. , El-Banayosy A. , Arusoglu L. , Mirow N. , Wlost S. , Gromzik H. , Kleesiek K. , Meyer H. , Koerfer R. 
Published: March 2018

Frequently the only therapy for primary graft- and right heart failure, as well as low output syndrome from acute of chronic rejection, is implantation of a mechanical circulatory support system, until recompensation or retransplantation. At our institution, mechanical assist devices were implanted in 25 heart recipients for a cute rejection (n=9), primary graft failure (n=7), acute right heart failure (n=7), and chronic rejection with low output syndrome (n=2). Patients (pts) with primary graft failure (n=3) received an intraaortic balloon pump (IABP), one pt an IABP plus Abiomed®-System for left ventricular support, one pt the Thoratec®-System for biventricular support. Patients with right heart failure (RHF) received the Biomedicus® centrifugal pump for right ventricular support. Nine pts suffered from acute rejection. Six pts received an IABP, one the Biomedicus® as femoro-femoral bypass, one the Abiomed®-System for biventricular support, two the Thoratec®-System for biventricular support and two within this group switched from the Biomedicus® pump to the Thoratec®-System for biventricular support. Patients with chronic graft failure (n=2) received the Novacor®-System (LVAD) for left ventricular support, one received a Tojobo®-System and an oxygenator for biventricular support post coronary artery bypass surgery. Support time ranged from 0.5-h to 73 days. Five pts were weaned. Two (8%) of 25 pts were retransplanted, 18 (72%) died in spite of mechanical support from multiple organ failure. The use of a mechanical assist device after heart transplantation is encouraging only in the case of early right heart failure, as well as primary and chronic graft failure. In view of the poor results, the use of mechanical assist devices should not be recommended in the case of heart failure caused by acute rejection.
Intradialytic Hypotension in Relation to Pre-Existent Autonomic Dysfunction in Hemodialysis Patients
Authors: Straver B. , De Vries P. M.J.M. , ten Voorde B.J. , Roggekamp M. C. , Donker A.J.M. , ter Wee P.M. 
Published: March 2018

After having monitored haemodynamics during haemodialysis, we examined autonomic nervous function in rest prior to a next dialysis session in 28 patients on chronic intermittent haemodialysis. The aim was to compare intradialytically hypotensive with stable patients to assess whether blood pressure regulating mechanisms were related to basal autonomic function, assessed as heart rate variability (HRV) tested by means of the deep breathing test, the lying-to-standing test, and the Valsalva maneuver. Impedance cardiography was used to determine stroke volume and cardiac output during dialysis. In addition, blood pressure was registered automatically and systemic vascular resistance calculated. Blood volume variation was monitored by an on-line optical device. Intradialytic hypotension was observed in 10 patients (36%). Systemic vascular resistance in hypotensive patients decreased considerably (-14.0 ± 5.9%), while it increased in stable patients (+9.9 ± 4.6%, p = 0.004). Heart rate rose significantly in hypotensive patients (11.5 ± 3.8%>) in comparison to stable patients (-0.2 ± 2.8%, p = 0.02). However, no significant differences in autonomic function were observed between hypotensive and stable patients. Although both groups showed impaired autonomic function, no significant correlation between changes in haemodynamics during dialysis and autonomic function at rest could be ascertained. In conclusions, hypotension during haemodialysis is not related to a patient's autonomic function at rest. This suggests that structural neuronal differences are not responsible for the severe decrease in systemic vascular resistance in intradialytic hypotension.
Hemodynamic Properties of the Hemopump HP14
Authors: Lachat M. , Jaggy C. , Leskosek B. , Von Segesser L. , ZÜnd G. , Vogt P. , Turina M. 
Published: March 2018

Background The Hemopump HP14 is a catheter-mounted, transvalvular, left ventricular assist device intended for femoral percutaneous insertion. The pump was developed for patients with postoperative or postinterventional low cardiac output and for CABG surgery on the beating heart. Little is known about the effect of afterload and hematocrit on the pump performance. Methods The influence of hematocrit and afterload on the pump flow was tested using an in vitro model filled with heparinized bovine blood. Regression analysis of the pump flow with respect to three hematocrit values (20%, 30%, 40%) and ten afterload levels (30 mmHg-120 mmHg in 10 mmHg increments) was performed for all pump speed levels (n = 7). Results At all pump speed levels reduction of afterload and hematocrit were significant predictors for increasing pump flow (p<0.001). For hematocrit values between 40% and 20% and highest pump speed, mean pump flow at lowest afterload ranged between 2.34 and 2.53 L/min; and at highest afterload between 1.31 and 1.53 L/min. For speed level 1, afterload of 120 mmHg and hematocrit of 40% there was a maximal retrograde flow of 230 ± 35 ml/min. Conclusions Pump performance is significantly improved by both afterload and hematocrit reduction. In the weaning phase and during the removal of the device, the pump should run at a speed level of at least three to prevent retrograde flow in the pump. Estimates for pump flow in vivo can be extrapolated from our diagrams. Our results show that the Hemopump HP14 is a valuable alternative to intra-aortic balloon counterpulsation.
On-line Monitoring of the Intravascular Volume during Haemodialysis by Continuous Refractometry
Authors: Kuhlmann U. , Buuren F. V. , Aziz O. , Lange H. 
Published: March 2018

The control of intravascular volume (IVV) by continuous on-line measurement of protein concentration would optimise the patients’ specific rate of ultrafiltration. To prove the accuracy of a refractometric device, plasma was continuously drawn by haemofiltration during 10 haemodialysis treatments of male patients. Refractometry reflects highly significant changes in the concentrations of filtrate proteins (r = 0.862, p < 0.001) and blood proteins (rtotal = 0.593, ptotal < 0.001). In vitro, the refractometric device detected a change of protein concentration of 0.041 g/L through a refraction increase of 0.1 mV. The power of discrimination was 0.067 % of IVV. However, in vivo, the accuracy of IVV refractometric monitoring is reduced by interference factors such as sodium (0.141 mV/mmol/L), glucose (0.034 mV/mg/dl) and triglycerides (–0.040 mV/mg/dl). Adjustment of the refraction data using sodium and glucose electrodes and plasma filters with a cutoff below the size of chylomicrons is recommended.
Effects of Unprocessed and Processed Cardiopulmonary Bypass Blood Retransfused into Patients after Cardiac Surgery
Authors: Walpoth B.H. , Eggensperger N. , Hauser S.P , Neidhart P. , Kurt G. , Spaeth P. J. , Althaus U. 
Published: March 2018

Background The aim of this prospective study was to compare the effect of autologous unprocessed to processed residual cardiopulmonary bypass blood (CPB) on patients’ laboratory and clinical parameters and outcome. Methods 20 patients undergoing elective coronary artery bypass surgery were randomized to receive either unprocessed CPB blood (control group) or processed CPB blood employing the Continuous AutoTransfusion System (CATS; Fresenius, Bad Homburg, Germany). We have shown that this method eliminated >93% of activated mediators. Serial laboratory parameters including complement activation, coagulation factors and the stimulation of IL-6 and IL-8 were compared with clinical side effects and patients’ outcome. Results Compared to control patients, retransfusion of unprocessed CBP blood significantly increased heparin, free plasma hemoglobin and D-Dimers. Postoperatively, three patients in the control group and two patients in the CATS group required prolonged mechanical ventilation or developed infections associated respectively with elevated C3a (desArg) or IL-6 concentration. Conclusions CATS-processing of CPB blood provided a high-quality red blood cell concentrate, resulting in a reduced load of retransfused activated mediators.
Acute Tubulo-Interstitial Nephritis Requiring Dialysis Associated with Intermittent Rifampicin Use: Case Report
Authors: Gallieni M. , Braidotti P. , Cozzolino M. , Romagnoli S. , Carpani P. 
Published: March 2018

Rifampicin is one of the most effective antibiotics used for the treatment of tuberculosis and severe staphylococcal infections. Intermittent administration of high doses of rifampicin has been associated with frequent adverse reactions, including hepatotoxicity and nephrotoxicity, sometimes resulting in acute renal failure. We describe a case of rifampicin-associated acute renal failure, with biopsy findings of tubulointerstitial nephritis; inflammatory cells were characterized by immunohistochemistry which showed immunoreactivity for CD3 and CD5 (T lymphocytes) and for CD68 (macrophages). The patient presented with a very rapid systemic reaction to the offending drug and rapid deterioration of renal function, which required dialysis treatment. The response to rifampicin discontinuation was excellent: no further therapy was required, as renal function began to improve within several days and returned to normal values (serum creatinine 1.17 mg/dl) seven months after the onset of symptoms. When prescribing rifampicin the physician should investigate previous use of the drug, because re-exposure is a critical factor in predicting the possibility of drug-induced acute renal failure.
Chronic Heart Failure Model Induced by Coronary Embolization in Sheep
Authors: Zietkiewicz M. , Perek B. , Meyns B. , Mesotten L. , Dispersyn G. , Nishimura Y. , Flameng W. 
Published: March 2018

Objective To create a model of chronic heart failure in a large animal. Methods Heart failure was induced in sheep by single intracoronary injection of polymer macrobeads, which were administered into left main coronary artery (n=3) or selectively into left anterior descending (n=4) or left circumflex (n=5) coronary artery. The animals were followed by echocardigraphy for 20 weeks. Measurements comprised fractional area change (FAC), and diastolic ventricular area (EDVA) and regional wall-thickening fraction (WT%). Results EDVA increased from 14.2±2.1 cm2 prior to embolization to 16.9±3.1 cm2 on day 1 (p<0.05), and remained significantly increased until completion of the follow-up period. FAC dropped from 47.9±4.6% at baseline to 29.3±4.4% on day 1 (p<0.001) and remained significantly depressed until 20 weeks later. In 9 selectively embolized animals WT% of the embolized area decreased from 33.8±8.0% at baseline to 5.3±2.6% on day 1 and remained significantly decreased. Conclusions A simple model of chronic heart failure was developed. It shows relatively high stability over time and may prove beneficial in experimental work on ventricular assist devices.
Surface-Immobilized Biomolecules on Albumin Modified Porcine Pericardium for Preventing Thrombosis and Calcification
Authors: Chandy T. , Das G.S. , Wilson R.F. , Rao G.H.R. 
Published: March 2018

The search for a noncalcifying tissue material to be used for valve replacement application continues to be a field of extensive investigation. A series of porcine pericardial membranes was prepared by modifying the glutaraldehyde - treated tissues with albumin and subsequently immobilizing bioactive molecules like PGE1, PGI2 or heparin via the carbodiimide functionalities. The in vitro calcification and collagenase degradation of these modified tissues were studied as a function of exposure time. Furthermore, the biocompatibility aspects of such novel interfaces were established by platelet adhesion and fibrinogen adsorption. The results reported in this article propose that the treatment with antiplatelet agents such as albumin, heparin and prostaglandins (PGE1 or PGI2) change the surface conditioning of pericardial tissues, suggesting a possible role of deposited serum components in affecting mineralization process on bioprosthesis. Therefore, it is worthy to hypothesize that besides inhibiting the accumulation of calcium in the devitalized cells, the early formation of a conditioning layer on the bioprosthesis surface may affect salt precipitations, determining the propensity of the implant to calcify. More detailed studies are needed to understand the involvement of plasma proteins and cellular components of the recipient blood in tissue-associated calcification.