bluuebunny/crossref_metadata_2025_split huggingface dataset:
Significant Decrease in Dialysate Albumin Concentration during Molecular Adsorbent Recirculating System (M.A.R.S.) Therapy
Authors: Gong D. , Ji D. , Ren B. , Tao J. , Xu B. , Ronco C. , Li L. 
Published: January 2018

Aim The molecular adsorbent recirculating system (M.A.R.S.) is widely used as liver support therapy in patients with hepatic dysfunction. The goal of this study was to measure changes in dialysate albumin and bilirubin concentrations during clinical MARS treatments. Methods Eight patients with acute liver dysfunction and hyperbilirubinemia were enrolled in this study. Five of them received a total of 10 treatments with MARS, in which 600 mL of 20% human albumin was used as dialysate, continuously regenerated by two adsorbent columns in the circuit. Three patients received 4 treatments of a modified MARS, in which the two adsorbent columns were bypassed in the first course for 4 h, and then connected to the circuit in the second course for another 4 h. The total, conjugated and unconjugated bilirubin (TB, CB, UCB) and albumin concentrations in serum and albumin dialysate were dynamically measured, and the adsorbent column inlet pressures were recorded during each session. In one session, dialysate albumin levels were measured during the priming process, at the time points prior to the priming process, immediately after priming, and at the end of the treatment. Results During MARS therapies, the reduction ratio of serum TB, CB and UCB was 26.6±9.0%, 29.5±9.6% and 14.8±12.3%, respectively. The molar ratio of TB/albumin in serum was approximately 20-fold higher than dialysate at all time points. A significant albumin concentration decrease from baseline in the dialysate was found (mean±SD, 34.6±16.6%). For the first four hours of modified treatments, in which only albumin dialysis without albumin regeneration by adsorbent columns was performed, the dialysate albumin decrease was substantially smaller (mean, 8.3±1.5%). After switching to standard MARS, there was a further decrease in the dialysate albumin concentration of 35.1±14.5%. In one session, dialysate albumin concentrations were measured during the priming process, and levels decreased from 196.9 g/L to 144.4 g/L. Adsorber inlet pressure increased from 40±10mmHg at the start of priming to 150±50mmHg at the end of priming, and further increased to 340±100mmHg at the end of treatment. Conclusion There is a significant reduction in dialysate albumin concentration during MARS therapy. Binding of albumin to the adsorbent columns used for albumin regeneration is largely responsible for this decrease.
High Serum Levels of Soluble Fas (sFas) in Ckd Patients: Effects of Renal Clearance, Reabsorption and Synthesis
Authors: Dalboni M. A. , Cenedeze M. A. , Manfredi S. R. , Cruz Andreoli M. C. , Paväo Dos Santos O. , Canziani M. E. , Boim M. A. , GÓes M. Â. , Draibe S. A. , Balakrishnan V. , Cendoroglo M. 
Published: January 2018

Purpose Increased serum concentrations of soluble Fas (sFas) have been reported in patients with chronic kidney disease (CKD). However, little is known about the renal clearance of sFas, whether sFas is reabsorbed in the renal tubules, or the behavior of sFas synthesis in CKD. Materials and Methods We studied 69 patients with CKD (60±15 years old, creatinine clearance 37+19 ml/min/1.73 m2) and 14 healthy subjects (61±17 years, creatinine clearance 79±24 ml/min/1.73 m2). ELISA was used to measure the levels of sFas (pg/mL) and retinol binding protein (RBP - mg/L). RT-PCR was used to quantify sFasmRNA of leukocytes. Results Serum sFas levels were significantly higher in patients with CKD (2781±1214 vs. 2196±773, p=0.02). The concentrations of sFas in 24-hour urine samples (23±27 vs. 40±17, p=0.006) and sFas Clearance (0.019±0.022 vs. 0.036±0.020, p=0.01) were significantly lower in patients with CKD. sFas clearance correlated with creatinine clearance (r=0.25, p=0.02). Urine concentrations of RBP correlated with sFas concentrations in the urine (r=0.80, p<0.001). sFasmRNA were higher in patients with CKD (3.9±1.8 vs. 2.5±0.9, p<0.001). Conclusions In CKD patients, the decrease in renal function is followed by a decrease in sFas clearance and an increase in serum sFas. In patients with proximal tubule dysfunction (high urinary RBP concentrations), urinary sFas is also increased, suggesting that sFas is reabsorbed by the proximal tubule. It is possible that an increase in sFas synthesis also contributes to the increase of serum sFas concentrations in uremia.
The Importance of Dialysate Sodium Concentration in Determining Interdialytic Weight Gains in Chronic Hemodialysis Patients: The PanThames Renal Audit
Authors: Davenport A. , Cox C. , Thuraisingham R. 
Published: January 2018

Background and Objectives There is controversy as to the optimum dialysate sodium to be used for hemodialysis patients, with reports of hypertension and increased interdialytic weight gains with high sodium dialysates and intradialytic hypotension and cramps with low sodium dialysates. Methods We analyzed the effect of different dialysate sodium concentrations during a one-week period in an audit of 2187 established patients regularly receiving dialysis three times a week. Patients were given general dietary advice to restrict dietary sodium intake, but no systematic assessment of dietary sodium intake was undertaken. Results The prescription of a dialysate sodium concentration of 140 mmol/L and >140 mmol/L, was associated with greater interdialytic weight gains, 3.5% and 4.1% respectively, compared to 2.8% and 2.7% for those using dialysate sodium concentrations of 137 and 136 mmol/L, respectively (p<0.05). The mean pulse pressure was greater patients dialyzing using a sodium of 140 mmol/L, compared to 136 mmol/L, 70 (13) vs 63 (15) mmHg (p<0.011). In addition, 13.5% of patients using the highest sodium dialysate suffered symptomatic intradialytic hypotension requiring intravenous fluid resuscitation, compared to 2.7% who used the lowest sodium concentrate (p<0.05). Conclusions This analysis would support the use of lower dialysate sodium concentrations to aid in reducing interdialytic weight gains and subsequent intradialytic hypotension.
Effect of Dynamic Compression on in vitro Chondrocyte Metabolism
Authors: Tsuang Y.-H. , Lin Y.-S. , Chen L.-T. , Cheng C.-K. , Sun J.-S. 
Published: January 2018

Background Chondrocytes can detect and respond to the mechanical environment by altering their metabolism. This study was designed to explore the effects of dynamic compression on chondrocyte metabolism. Methods Chondrocytes were harvested from newborn Wistar rats. After 7 days of expansion, chondrocytes embedded in agarose discs underwent uniaxial unconfined dynamic compression loads at different amplitudes (5%, 10%, and 15%) and frequencies (0.5 Hz, 1.0 Hz, 2.0 Hz, and 3.0 Hz) with a duration of 24 hours. The delayed effects on the chondrocytes were studied at 1, 3, and 7 days after the experiment. Results The results showed that at 10% strain, higher-frequency compression pressure can enhance the proliferation of chondrocytes. The synthesis of glycosaminoglycan (GAG) increased at 10%-15% strain and a 1-Hz load. The synthesis of nitric oxide (NO) increased at the 0.5-Hz load; while decreasing at the 15% strain. With 10% strain, 1 Hz dynamic compression, the proliferation of chondrocytes and GAG synthesis increased and persisted for 7 days, and NO synthesis decreased at the third and seventh days of culture. Conclusions This study showed that chondrocytes respond metabolically to compressive loading, which is expected to modulate the growth and the resultant biomechanical properties of these tissue-engineered constructs during culture.
Effect of Vitamin E-Coated Dialysis Membranes on Anemia in Patients with Chronic Kidney Disease: An Italian Multicenter Study
Authors: Cruz D.N. , De Cal M. , Garzotto F. , Brendolan A. , Nalesso F. , Corradi V. , Ronco C. 
Published: January 2018

Background Increased oxidant stress is increasingly recognized as a crucial factor in anemia in patients with chronic kidney disease. Vitamin E-coated membranes (VECMs) consist of a multilayer membrane with liposoluble vitamin E on the blood surface allowing direct free radical scavenging at the membrane site, which is of potential clinical benefit. Our objective was to examine the effect of VECMs on anemia in chronic hemodialysis (HD). Methods We enrolled 172 stable chronic HD patients (94 men, 78 women, age 65.4 ± 13.4 years) in an open-label multicenter study. They were shifted from their previous dialyzer to VECM for 1 year. Hemoglobin (Hb) levels and recombinant human erythropoietin (rHuEpo) dosage were analyzed after 4, 8, and 12 months on the VECM and compared with baseline values using paired tests. Results Hb significantly increased from 10.9 ± 1.2 g/dL at baseline to 11.7 ± 1.2 g/dL after 12 months (p<0.001) on VECMs. Conversely, the rHuEpo dosage decreased from 7,762 ± 5,865 IU/week at baseline to 6,390 ± 5,679 IU/week after 12 months (p<0.001). The proportion of patients who were at target Hb levels (European Best Practice Guidelines) increased from 49.4% at baseline to 80% after 12 months (p<0.001). Conclusions Dialysis with VECM in stable chronic HD patients was associated with significantly improved Hb levels and lower rHuEpo requirements. These results suggest that the antioxidant properties of VECMs may impact favorably on anemia management in chronic HD patients. Possible mechanisms include enhanced membrane biocompatibility, reduced oxidative stress and inflammation with VECMs, resulting in improved red blood cell survival and/or rHuEpo responsiveness. This therapy may potentially contribute to more effective anemia management in hemodialysis patients, and merits further rigorous study.
Monitoring Chronic Hemodialysis Patients: A Questionnaire-Based Survey
Authors: Presta P. , Fuiano L. , Comi N. , Andreucci M. , Gigliotti P. , Tozzo C. , Fuiano G. 
Published: January 2018

Background The monitoring program for patients on regular hemodialysis treatment (RDT) is not well defined yet by current international guidelines (CIG). Methods To evaluate the extent to which CIG are implemented, we sent a questionnaire to 100 Italian hemodialysis units (DU) with questions concerning: (a) the frequency with which routine tests were performed for the follow-up of patients on RDT; (b) which other non-routine tests were performed. We analyzed the response data and compared them with the CIG. Results We received 37 replies. We found several differences between the monitoring program of our respondents and the CIG. Conclusion Because of the small number of responses, this survey is only preliminary; however, it shows the difficulty nephrologists have in using the CIG to create a correct monitoring program in patients on RDT. Although our analysis is limited to 37 DUs, it suggests that specific guidelines are necessary to optimize the management of patients on RDT.
Hemodialysis Modality, Percentage of Body Fat, and Patient Survival
Authors: Stosovic M. , Stanojevic M. , Radovic M. , Simic-Ogrizovic S. , Lezaic V. , Naumovic R. , Jovanovic D. , Ristic G. , Djukanovic L. , Marinkovic J. 
Published: January 2018

Background A number of studies have reported lower mortality of overweight hemodialysis patients. This post hoc analysis of an observational prospective single-center study was aimed at elucidating whether both being overweight and surviving longer could result from changes in the hemodialysis modality. Methods The study included a cohort of 242 patients who were gradually switched from cuprophane membrane and acetate dialysis to polysulfone (including high-flux) membranes and bicarbonate dialysis. The analysis involved 12 months of baseline data obtained during the first calendar year after the patients entered the study (1994–2001) and repeated measurements for up to 132 months of follow-up (until 2004). Anthropometric measurements were made during the winter season and the percentage of body fat (%fat) was calculated from triceps, biceps, subscapular, and suprailiac skinfolds (K/DOQI guidelines). Kt/V, normalized protein catabolic rate, and cardiovascular comorbidity were also determined and laboratory analyses undertaken. Results Significant correlations were found between %fat and bicarbonate dialysate as well as polysulfone membrane and high-flux membrane. The linear mixed model showed dependence of %fat on polysulfone and high-flux membrane (p<0.01) Multivariate Cox regression (time-dependent covariates) found %fat to be an independent factor for longer survival, in addition to polysulfone and high-flux membranes. Conclusion Changes in hemodialysis modality were followed by both higher body fat percentage and patient survival. The reverse epidemiology of overweight patients might be at least partially the result of the influence of nonnutritional factors, such as a change in hemodialysis modality (introducing biocompatible high-flux and low-flux membranes and bicarbonate dialysis).
Terlipressin for Hepatorenal Syndrome: A Meta-Analysis of Randomized Trials
Authors: Fabrizi Fabrizio , Dixit Vivek , Messa Piergiorgio , Martin Paul 
Published: January 2018

Background Hepatorenal syndrome (HRS) is a severe complication of end-stage renal disease whose management still constitutes a big challenge. Various approaches have been used for hepatorenal syndrome treatment, including vasoconstrictor therapy. Terlipressin, a vasopressin analogue, has frequently been used. Aim To evaluate the efficacy and safety of terlipressin in patients with HRS by performing a systematic review with a meta-analysis of controlled, clinical trials. Methods Only prospective, placebo-controlled, randomized clinical trials (RCTs) were included. We used the random effects model of DerSimonian and Laird, with heterogeneity and subgroups analyses. The primary end-point of interest was the HRS reversal after terlipressin (or placebo) therapy in study patients vs. control patients (as a measure of efficacy). The secondary outcome was the rate of ischemic side-effects in study patients vs. placebo patients (as a measure of tolerability). The additional end-point was the impact of terlipressin on survival in the HRS population. Results We identified five studies involving 243 unique patients with HRS. Pooling of study results showed a significant increase in HRS reversal among study (terlipressin) versus control (placebo) patients; the pooled odd ratio (OR) of HRS reversal was 8.09; 95% CI, 3.521; 18.59; p=0.0001. The p-value was 0.5 for our test of study heterogeneity. In a subgroup analysis excluding case-control trials these results did not change. The rate of severe ischemic events was higher in study than control patients, pooled OR=2.907; 95% CI, 1.094; 7.723 (p=0.032). The test for heterogeneity was not significant. Terlipressin use had no significant impact upon survival (pooled OR for survival rate, 2.064; 95% CI, 0.939; 4.538; p=0.07). No significant heterogeneity (NS) was found. Conclusions Our meta-analysis shows that terlipressin has higher efficacy than placebo in reversing renal function in the HRS population. There was no apparent impact of terlipressin therapy on survival in HRS patients but further large-size trials are needed. Terlipressin use in the HRS population requires careful selection of patients and close clinical surveillance. These results support the use of terlipressin for reversal of renal function in the HRS population.
Risk Factors for Aortic Valve Calcification in Patients on Regular Hemodialysis
Authors: Petrović Dejan , Obrenović Radmila , Stojimirović Biljana 
Published: January 2018

Introduction Aortic valve calcification (AVC) accelerates development of aortic valve stenosis and cardiovascular complications. Hyperphosphatemia is one of the key risk factors for aortic valve calcification. Aim The aim of this study was to evaluate the prevalence of AVC in patients on regular hemodialysis and to assess the impact of different factors on its appearance. Method: The study investigated a total of 115 patients treated in the Hemodialysis Department of the Urology and Nephrology Clinic at the Kragujevac Clinical Center in Serbia. The variables investigated were: serum albumin, C-reactive protein (CRP), homocysteine, total cholesterol, LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), triglycerides (TG), Apolipoprotein A-I (Apo A-I), Apolipoprotein B (Apo B) and lipoprotein (a), calcium, phosphate and parathormone, and calcium-phosphorus product (Ca × P). Patients were evaluated by echocardiography for AVC. Statistical analysis included univariate and multivariate logistic regression analysis. Results Univariate regression analysis showed that serum phosphate levels and Ca × P are the most important risk factors for AVC (p<0.001). Multivariate logistic regression analysis revealed that hyperphosphatemia is an independent risk factor for AVC (p<0.001). Conclusion Hyperphosphatemia is an independent risk factor for aortic valve calcification.
Fixed Bearing Knee Congruency – Influence on Contact Mechanics, Abrasive Wear and Kinematics
Authors: Grupp Thomas M. , Stulberg Dave , Kaddick Christian , Maas Allan , Fritz Bernhard , Schwiesau Jens , Blömer Wilhelm 
Published: January 2018

The objective of our study was to evaluate the in vitro wear behavior of fixed bearing designs for total knee arthroplasty in relation to contact mechanics and resultant kinematics for different degrees of congruency. A finite element model was created for three knee articulations with increasing degrees of tibio-femoral congruency (flat, curved, and dished design). For the three different knee design configurations, in vitro wear simulation was performed according to ISO 14243–1. Contact areas increased with increasing knee congruency, whereas the peak surface contact stresses decreased. The wear rates for the knee design configurations differed substantially between the three test groups (flat, curved, and dished). Our observations demonstrate that increased congruency in conjunction with decreased surface contact stresses significantly contributes to reducing wear in fixed bearing knee articulations.
Effect of Hemodialysis on Whole Blood Viscosity
Authors: Vaisman S. , Kensey K. , Cho Y. I. 
Published: January 2018

Purpose The purpose of the present study was to examine the effect of hemodialysis procedures on the hemoconcentration status of end-stage renal disease (ESRD) patients. Methods We measured whole blood viscosity (WBV) of 30 ESRD patients using a scanning-capillary-tube viscometer before and after hemodialysis. The blood sample size required for WBV measurements was approximately 3 mL. Pre-dialysis specimens for viscosity measurements were obtained via the fistula needle or Perma catheter prior to initiating hemodialysis, and post-dialysis specimens were drawn from the arterial sample port of the hemodialysis line 3.5 hours after initiation of dialysis treatment. Results Changes in WBV were measured at high and low shear rates: 80% of patients showed an increased high shear viscosity, whereas 73% of patients demonstrated an increased low shear viscosity. The actual percentage increase in WBV observed after hemodialysis at high and low shear rate ranges varied broadly in the 30 patients. Conclusions The observed increase in the WBV of ESRD patients over hemodialysis procedures indicates that a segment of patients experience increased flow resistance, particularly at the microcirculatory level. In addition, for the segment of patients experiencing marked increases in WBV during hemodialysis, the vessel wall at the dialysis fistula is exposed to blood with a higher viscosity than at the beginning of the process. The higher blood viscosity at the dialysis fistula is directly related to increased kinetic force and shear stress on the vessel wall, which may be playing a role in increasing the risk of stenosis.
Surface Protein EF3314 Contributes to Virulence Properties of Enterococcus faecalis
Authors: Creti Roberta , Fabretti Francesca , Koch Stefanie , Huebner Johannes , Garsin Danielle A. , Baldassarri Lucilla , Montanaro Lucio , Arciola Carla Renata 
Published: January 2018

Purpose Identification of putative new virulence factors as additional targets for therapeutic approaches alternative to antibiotic treatment of multi-resistant enterococcal infections. Methods The EF3314 gene, coding for a putative surface-exposed antigen, was identified by the analysis of the Enterococcus faecalis V583 genome for LPXTG-motif cell wall anchor surface protein genes. A non-polar EF3314 gene deletion mutant in the E. faecalis 12030 human clinical isolate was obtained. The wild type and the isogenic mutant strain were investigated for biofilm formation, adherence to Hela cells, survival in human macrophages and a Caenorhabditis elegans infection model. The aminoterminal portion of the EF3314 protein was overexpressed in E. coli to obtain mouse polyclonal antibodies for use in Western blotting and immunolocalization experiments. Results The EF3314 gene has an unusually high GC content (46.88% vs. an average of 37.5% in the E. faecalis chromosome) and encodes a protein of 1744 amino acids that presents a series of 14 imperfect repeats of 90 amino acids covering almost the entire length of the protein. Its global organization is similar to the alpha-like protein family of group B streptococci, enterococcal surface protein Esp and bio film associated protein Bap from S. aureus. The EF3314 gene was always present and specific for E. faecalis strains of human, food and animal origin. Differences in size depended on variable numbers of repeats in the repetitive region. Conclusions EF3314 is a newly described, surface exposed protein that contributes to the virulence properties of E. faecalis.
Evaluation of a Novel System for Hypothermic Oxygenated Pulsatile Perfusion Preservation
Authors: Doorschodt Benedict M. , Schreinemachers Marie-Claire J.M. , Florquin Sandrine , Lai Wei , Sitzia Mario , Zernecke Alma , Tolba Rene H. 
Published: January 2018

Background Recently, a novel innovative machine perfusion (MP) system for hypothermic oxygenated pulsatile perfusion called the Airdrive (AD) has been developed. The aim of the study was to evaluate the biological safety of the AD system for perfusion preservation of kidney grafts in a porcine autotransplantation model using the low-viscosity perfusion solution Polysol (PS) in comparison with cold storage (CS) using PS or the University of Wisconsin solution (UW). In addition, we evaluated real-time microcirculation parameters. At sacrifice, grafts were retrieved for histological analysis and immunohistochemistry Methods After assessment of the microcirculation, left kidneys were retrieved. Following the washout, kidneys were preserved for 20 hr using AD-PS, CS-PS or CS-UW. Thereafter, contralateral kidneys were removed followed by heterotopic autotransplantation of the preserved graft. Seven days after transplantation animals were sacrificed with retrieval of the grafts for histological analysis. Renal function, renal microcirculation and tissue injury including the proliferative response of tubular epithelial cells (TECs) were compared. Results Preservation using AD-PS or CS-PS resulted in higher microcirculatory flow compared with CS-UW. Improved recovery of renal function was seen in the AD-PS and CS-PS groups compared with CS-UW. Structural integrity was better preserved using AD-PS compared with both CS groups. Proliferative response of TECs was higher in CS-UW preserved grafts compared to grafts preserved using AD-PS. Conclusion This study demonstrates the biological safety of the AD system in a porcine autotransplantation model. Also, the microcirculation was better preserved and less morphological injury was observed after 20 hr MP compared with CS.