bluuebunny/crossref_metadata_2025_split huggingface dataset:
Placement, Performance and Complications of the Ash Split Cath™ Hemodialysis Catheter
Authors: Gallieni M. , Conz P.A. , Rizzioli E. , Butti A. , Brancaccio D. 
Published: January 2018

A tunneled catheter is the alternative vascular access for those patients in need of hemodialysis who cannot undergo dialysis through an arterio-venous fistula or a vascular graft. This study was undertaken to evaluate the performance of the Ash Split Cath™, a 14 French chronic hemodialysis catheter with D-shaped lumens and a Dacron® cuff. After tunneling through a transcutaneous portion the catheter enters the venous system, where it splits into two separate limbs. Data regarding catheter positioning, function and adequacy of dialysis were collected from two hemodialysis facilities. Twenty-eight Ash-split catheters were placed in 28 patients, with no complications, and immediate technical success was 100%. Patients were followed up for a total of 7,286 catheter days. No catheter-related infections were observed. Only one catheter failed after 15 days, with a primary catheter patency of 96% for the whole study length. Mean blood flow was 303 ± 20 ml/min at 1 week after insertion, 306 ± 17 ml/min at 3 months, 299 ± 44 ml/min at 6 months, and 308 ± 16 ml/min at 12 months. With a mean dialysis session duration of 234 ± 25 minutes, adequate dialysis dose was observed for 96% of catheters, as reflected by a mean urea reduction ratio (URR) of 71%±8 or a mean urea kinetic modeling, or Kt/V, value of 1.51±0.3 during follow up. In conclusion, compared with previous studies we report the best permanent catheter performance, confirming that the Ash-split catheter is a good alternative for vascular access in hemodialysis patients who are not candidates for surgical A-V fistula or graft placement.
Intraindividual Comparison of two Extracorporeal LDL Apheresis Methods: Lipidfiltration and HELP
Authors: Julius U. , Metzler W. , Pietzsch J. , Faßbender T. , Klingel R. 
Published: January 2018

Low density lipoprotein (LDL) apheresis is an effective treatment option for patients with severe hypercholesterolemia not adequately responding to diet and drug therapy. Membrane differential filtration (MDF), synonymous with double filtration plasmapheresis (DFPP), here named Lipidfiltration, and heparin-induced extracorporeal LDL-precipitation (HELP) are two of the five methods available for extracorporeal LDL apheresis. In this prospective investigation 6 patients with severe LDL-hypercholesterolemia and CAD were treated in a cross-over design with Lipidfiltration at two stages of technical development and HELP to compare the efficacy of these two LDL apheresis methods with respect to lowering and modifying plasma lipids and rheologically relevant plasma proteins, especially fibrinogen. In total, 44 LDL apheresis sessions were investigated. In weekly intervals, patients were treated with consecutive LDL apheresis sessions with either Lipidfiltration and HELP, treating identical plasma volumes. In one part of the investigation Lipidfiltration was performed with the novel Lipidfilter EC-50, combined with a newly developed blood and plasma therapy machine allowing optimized plasma heating. The results showed that the reduction rates of LDL-cholesterol, lipoprotein(a) and triglycerides were essentially identical for both methods. Also pretreatment levels of total cholesterol, triglycerides, LDL-cholesterol and HDL-cholesterol were not significantly different in both treatment groups. Both methods lead to a significant reduction of serum lipoproteins, especially for LDL-cholesterol, which was decreased by 61.4% with Lipidfiltration (treated plasma volume: 2998 ml) and 61.3% with HELP (treated plasma volume: 3013 ml). With respect to Lipidfiltration LDL-cholesterol reduction was more efficient with the novel Lipidfilter EC-50. Mean pretreatment HDL cholesterol concentrations remained unchanged. Comparing Cascadeflo AC-1770 with the novel Lipidfilter EC-50 reduction rates of HDL-cholesterol (17.4% versus 6.4%) and total protein (17.9% versus 7.8%) were significantly reduced. Lipidfiltration and HELP both resulted in a reduction of plasma viscosity and hemorheologically relevant plasma proteins, like fibrinogen.
Acellular Scaffold Implantation – No Alternative to Tissue Engineering
Authors: Walles T. , Puschmann C. , Haverich A. , Mertsching H. 
Published: January 2018

Objective Degradation mechanisms of cardiovascular bioprostheses may play an important role in bioartificial implants. The fate of acellular implanted and cellular cardiovascular scaffolds was examined in an in vivo model. Methods Decellularized or native ovine carotid artery (CA, n=42) and aorta (AO, n=42) were implanted subcutaneously into rats for 2, 4 and 8 weeks. Immunohistochemical methods were used to monitor repopulation. Desmin-vimentin, CD31-, CD4- and CD18-antibodies for myocytes, endothelium, and inflammatory cell-infiltration, respectively. Calcification was detected by von-Kossa staining. Cell density was quantified by DNA-isolation. Results Acellular AO and CA matrices showed progressive calcification. Cellular AO and CA matrices trigger a strong inflammatory reaction which subsides after two weeks. CA scaffolds are revascularized progressively, whereas AO biocomposites degenerate. Calcification is less pronounced in cellular AO scaffolds and lacking in CA. Conclusions Acellular bioartificial implants demonstrate degradation mechanisms similar to currently applied cardiovascular bioprostheses. Cellularized viable implants are promising clinical alternatives.
Continuous Renal Replacement Therapy: Does Technique Influence Electrolyte and Bicarbonate Control?
Authors: Morimatsu H. , Uchino S. , Bellomo R. , Ronco C. 
Published: January 2018

Background and objectives Different techniques of continuous renal replacement therapy (CRRT) might have different effects on electrolyte and acid-base control. The aim of this study was to determine whether continuous veno-venous hemodiafiltration (CVVHDF) or continuous veno-venous hemofiltration (CVVH) achieve better control of serum sodium, potassium and bicarbonate concentrations. Design Retrospective controlled study. Setting Two tertiary intensive care units. Patients Critically ill patients with acute renal failure (ARF) treated with CVVHDF (n=49) or CVVH (n=50). Interventions Retrieval of daily morning sodium and potassium values and arterial bicarbonate levels from computerized biochemical records before and after the initiation of CRRT for up to 2 weeks of treatment. Statistical comparison of findings. Measurements and results Before treatment, abnormal (high or low) values were frequently observed for sodium (65.1% for CVVHDF vs. 80.0% for CVVH; NS), potassium (45.9% vs. 34.0%; NS), and bicarbonate (73.3% vs. 68.0%; NS). After treatment, however, CVVHDF was more likely to achieve serum sodium concentrations within the normal range (74.1% vs. 62.9%; p=0.0026). Both treatments decreased the mean serum potassium concentration over the first 48 h (p=0.0059 and p <0.0001, respectively), but there was no difference in terms of the normalization of serum potassium concentration during the entire treatment period (88.3% vs. 90.5%; NS). Both treatments increased the mean arterial bicarbonate concentration over the first 48 hours (p=0.011 and p <0.0001, respectively). However, CVVH was associated with a lower incidence of metabolic acidosis (13.8% for CVVH vs. 34.5% for CVVHDF; p <0.0001) and a higher incidence of metabolic alkalosis (38.9% vs. 1.1%; p <0.0001) during the entire treatment period. Conclusions CRRT strategies based on different techniques have a significantly different impact on sodium and bicarbonate control.
Role of Inflammation and Ischemia after Implantation of Xenogeneic Pulmonary Valve Conduits: Histological Evaluation after 6 to 12 Months in Sheep
Authors: Wilhelmi M.H. , Rebe P. , Leyh R. , Wilhelmi M. , Haverich A. , Mertsching H. 
Published: January 2018

Objective Commercially available biological heart valve prostheses undergo degenerative changes, which finally lead to complete destruction. Here we evaluate the role of inflammation and ischemia after implantation of xenogeneic heart valve conduits (XPC) generated by novel concepts of tissue engineering. Methods Acellularized (a-)XPC and autologus re-seeded (s-)XPC were implanted into sheep. Samples were taken as follows: after acellularization (n=2), after re-seeding (n=2), 6 months (seeded/non-seeded: n=3/5), 9 months (n=2/5), and 12 months (n=3/2) post implantation. Five native porcine conduits served as control. Using histological methods, samples were evaluated for pathological changes and existence/density of microvessels. Results Prior to implantation a-XPC were completely free of cells. Six months after implantation, leaflets and pulmonary arteries of s-XPC and a-XPC showed good endothelial surface coverage. Microvessel density within the myocardial cuffs and pulmonary vessel walls were comparable to control in all grafts. However, 6, 9 and 12 months after implantation pathological severe microvessel ingrowth, calcification and cellular infiltrations were observed on a-XPC and s-XPC valves, whereas myocardial cuffs and XPC-artery walls showed only mild degenerative alterations. Conclusions Inflammatory reactions play a pivotal role in the degeneration of a-XPC and s-XPC. Thus, since ischemia seems to have little or no influence on this process, inflammation inductive factors should be the center of interest.
Long-Term Therapy with Paricalcitol for Secondary Hyperparathyroidism in Hemodialysis Patients
Authors: Pai A. Barton , Lin S. , Arruda J.A.L. , Lau A. H. 
Published: January 2018

Purpose The efficacy of the vitamin D analog paricalcitol has mainly been shown in short-term studies. There are limited data regarding long-term treatment with this agent. This purpose of this study was to determine long-term effects of paricalcitol therapy on parathyroid hormone (PTH) suppression and serum levels of calcium, phosphorus and calcium-phosphorus product (Ca × P). Patients and Methods Patients who received paricalcitol for ≥ 3 months had the following data collected: demographics, drug dosage, serum PTH, corrected serum calcium concentration, serum phosphorus concentrations and serum Ca × P values. Results Sixteen patients received paricalcitol for a mean of 18 months. The mean ± SD dose of paricalcitol was 0.13 ± 0.12 mcg/kg. The mean ± SD pre-paricalcitol serum PTH concentration was 705 ± 423 pg/mL. PTH concentration did not change significantly over the duration of treatment (mean ± SD: 821 ± 480 pg/mL). The number of patients who had at least one corrected serum calcium concentration ≥ 11.5 mg/dL, one serum phosphorus concentration ≥ 6.5 mg/dL, or one Ca × P level ≥ 70 were 75%, 94% and 82%, respectively. Hypercalcemia and elevated Ca × P value resulted in a mean of 17% of doses being withheld during therapy. Conclusion During the study, PTH was not adequately suppressed by paricalcitol. This was primarily attributed to withholding paricalcitol doses due to elevated serum calcium and Ca × P levels.
Retinoic Acid Maintains Differentiated Cell Morphology and Functions in Long-term Cultured Porcine Hepatocytes: Obtaining Functional Cells for Prolonged Treatments with Bioartificial Liver
Authors: Bertagnolo V. , Puviani A.C. , Brogli M. , Carini C. , Brugnoli F. , Colamussi M.L. , Bellini G. , Morsiani E. , Capitani S. 
Published: January 2018

Porcine hepatocytes show several immunological characteristics and enzymatic activities of human liver, representing an ideal xenogenic source of cells as biological component of bioartificial liver (BAL). Isolated hepatocytes rapidly lose their specific metabolic activities and their typical morphology when cultured in the presence of serum. Since in BAL porcine hepatocytes are perfused by the patient's plasma, procedures able to minimize de-differentiation of cells could be useful for long-term treatment of acute liver failure (ALF). In this work we found that, in the presence of micromolar concentration of All trans-retinoic acid (ATRA), porcine parenchymal liver cells undergo to a lower extent the de-differentiating effects of long-term culture in the presence of serum. The evaluation of lidocaine metabolism showed that ATRA-treated cells retain specific hepatocyte function for a significantly longer time when compared to control hepatocytes. A tyrosine phosphorylation of PLC-γ1 was observed in concomitance with the ATRA-induced maximal functional activity. An increased expression of PLC-ß3 and PKC-α and -ß2 was also evidentiated at the longer time points explored, when the effects of ATRA in preservation of the differentiated morphology were maximal. These results provide the first evidence that ATRA plays a differentiating role in adult porcine hepatocytes cultured under de-differentiating conditions. The administration of ATRA to isolated parenchymal cells from pig liver may provide functional hepatocytes for prolonged treatment with BAL.
Changes in Serum Electrolytes during Treatment of Patients in Liver Failure with Molecular Adsorbent Recirculating System
Authors: Doria C. , Doyle H.R. , Mandalà L. , Marino I.R. , Caruana G. , Gruttadauria S. , Lauro A. , Magnone M. , Foglieni C. Scotti , Lamonaca V. , Scott V.L. 
Published: January 2018

Purpose To study the effect of MARS on serum electrolytes during liver failure. Design Twenty-three patients admitted to a quaternary health care facility from September 2000 to May 2002, 22 adults and 1 child, 11 males (48%) and 12 females (52%), age 15–70 (median 53), treated with MARS for: 12 acute-on-chronic liver failure (52%); 4 fulminant hepatic failure (17%); 3 intractable pruritus (13%); 2 primary-non-function (9%); 2 following major liver resection (9%). Procedures Sodium, potassium, chloride, phosphorus, calcium, and magnesium were measured in the serum, ultrafiltrate and albumin circuit before and after MARS. Statistical methods A comparison of electrolyte concentrations, before and after MARS, was performed using a paired t test. Main findings Serum electrolyte concentrations before and after MARS, while statistically significant in some cases, were very small, and of no clinical relevance. Conclusion MARS exchanges potassium, chloride, calcium, and magnesium by ultrafiltration; sodium by the albumin dialysis.
Enhanced in Vitro Maturation of Subcultivated Fetal Human Hepatocytes in Three Dimensional Culture using Poly-L-Lactic Acid Scaffolds in the Presence of Oncostatin M
Authors: Hanada S. , Kayano H. , Jiang J. , Kojima N. , Miyajima A. , Sakoda A. , Sakai Y. 
Published: January 2018

Fetal human liver cell fractions, which contain large numbers of hepatocyte progenitors, have high proliferation potential in vitro. To create an engineered liver tissue equivalent of a clinically significant size, however, repeated subcultivation and functional maturation are necessary in vitro. A commercially available human fetal liver cell fraction that was cultivated for some time in vitro has been reported to lose liver specific functions almost completely. We therefore investigated the effects of oncostatin M (OSM) and hepatocyte growth factor (HGF) in long term three-dimensional (3D) culture using macroporous poly-L-lactic acid (PLLA) scaffolds on the restoration of such liver-specific functions of the fraction. 3D culture using PLLA scaffolds with OSM remarkably enhanced the albumin production and cytochrome P450 1A1/2 capacity with the culture time. HGF alone had no preferable effect on these functions even in 3D culture. α-fetoprotein production was consistently suppressed in the 3D culture compared with that in monolayers. This suppression was not observed in the same types of culture of hepatocarcinoma Hep G2 cells. Despite these favorable observations on the 3D culture with OSM, the final attained functional levels at the 5th week were still over ten-times lower than those of Hep G2 cells when standardized with a cellular DNA amount. Although further improvement is needed for the complete functional restoration and maturation in vitro, these results demonstrate that a combination of 3D culture using PLLA scaffolds and OSM offers promising culture conditions for in vitro maturation of human hepatocyte progenitors.
Biomaterials in Orthopedic Surgery: Effects of a Nickel-Reduced Stainless Steel on in Vitro Proliferation and Activation of Human Osteoblasts
Authors: Torricelli P. , Fini M. , Borsari V. , Lenger H. , Bernauer J. , Tschon M. , Bonazzi V. , Giardino R. 
Published: January 2018

A new austenitic stainless steel compound, P558, has been widely recognized to have good mechanical properties, excellent potential for corrosion resistance and negligible nickel ion release, making it a promising substitute for more expensive metallic prostheses with limited machinable features. The effect of P558 was studied in vitro and human osteoblast- like cells (MG63) were cultured directly on P558, Ti6Al4V alloy (Ti), and polystyrene (Control) for 72 hours. Osteoblast functions were evaluated by assaying cell proliferation and synthetic activity after 1.25(OH)2D3 stimulation. Results demonstrated that growth of MG63 on P558 was not negatively affected when compared to the Ti and Control groups and showed no alteration in the production of ALP, NO and PICP. Moreover, IL-6 was lower, whereas OC and TGFß1 were significantly higher. SEM images revealed that cells proliferated and differentiated on P558 without any alteration in their morphology. The current findings have demonstrated that P558 promotes osteoblast proliferation, activation and differentiation without negative effects and, thus, its good biocompatibility when used for orthopedic application.
Elimination of Microbubbles from the Extracorporeal Circuit: Dynamic Bubble Trap versus Arterial Filter
Authors: Martens S. , Dietrich M. , Pietrzyk R. , Graubitz K. , Keller H. , Moritz A. 
Published: January 2018

Background Open heart surgery is associated with important risk of cerebral and peripheral organ dysfunction, attributed in part to microbubbles generated in or not eliminated from the ECC. For elimination of microbubbles, a dynamic bubble trap (DBT(tm)) was developed for the arterial line of ECCs. Methods Bubble eliminating properties of an arterial filter were evaluated in four CABG patients and compared to the performance of the DBT in four patients. One patient received both devices. Results Elimination of bubbles between 40–120μm was significantly higher with the DBT (88% vs. 57% with arterial filter, p=0.034). Reduction of bubbles below 40μm was equivalent in both groups. The combination of both devices was most effective (94% for bubbles >40μm). Conclusion Arterial filter and DBT are equally effective in elimination of smaller gas bubbles. However, bigger bubbles possibly causing cerebral and peripheral organ damage are eliminated to a greater degree by the DBT.
Pregnancy-Associated Plasma Protein a during Hemodialysis with Polyamide and Diacetate Cellulosic Membranes
Authors: Kalousov¡ M. , Lachmanov¡ J. , Mokrejšov¡ M. , Míkov¡ B. , Fialov¡ L. , Malbohan I.M. , Tesař V. , Zima T. 
Published: January 2018

Pregnancy-associated plasma protein A (PAPP-A) is a new prognostic factor of acute coronary syndrome in the general population. It is elevated in hemodialysis (HD) patients and at baseline, it was shown to be related to inflammation and oxidative stress. The aim of the study was to examine the relationship of PAPP-A and oxidative stress and inflammatory markers to HD treatment. Studied parameters were determined in 10 chronic HD patients treated with low flux polyamide (1st session) and diacetate cellulosic membranes (2nd session) at the beginning, after 15 minutes and at the end of the dialysis session. TRACE method (Time Resolved Amplified Cryptate Emission) was used for PAPP-A assessment. Results were evaluated with ANOVA. PAPP-A levels did not depend on the type of HD membrane but changed significantly with the time of the HD session. They increased significantly from the beginning of HD to 15 min and then decreased to the end of the HD session – p<0.05 15 min of HD vs start, p<0.01 end vs start, p<0.0001 end vs 15 min of HD for polyamide membrane and p=0.05 15 min of HD vs start, p<0.01 end vs start, p<0.0001 end vs 15 min of HD for diacetate cellulosic membrane. Changes in other parameters and differences between membranes were only minimal. We can conclude that PAPP-A as a marker of cardiovascular damage shows significant changes during the HD session. Its initial increase might be ascribed to its release from complexes or storage. During dialysis, it might be destroyed or cleaved and removed as free fragments. Its levels both before and after the HD session are higher than in healthy subjects.
Hemofiltration in Heart Failure
Authors: Marenzi G. , Agostoni P. 
Published: January 2018

In patients with severe congestive heart failure (CHF), removal of edema by hemofiltration is associated with significant clinical and hemodynamic improvement, correction of hyponatremia, restoration of urine output and diuretic responsiveness, and with a striking fall in neurohormonal activation. Through these effects, hemofiltration is able to interrupt the progression of CHF toward refractoriness, and to revert the clinical condition of CHF patients to a lower functional class. Fluid refilling from the overhydrated interstitium is the major compensatory mechanism in the prevention of hypovolemia during hemofiltration. Hemofiltration can also be beneficial in patients who have only moderate cardiac insufficiency (NYHA classes II and III) and in whom over-hydration is restricted to the pulmonary district significantly contributing to limiting patients functional capacity. In this setting, hemofiltration, differently from diuretics, is able to remove the increased lung water content and to improve clinical condition, exercise capacity and lung function.
Two Spent Dialysate Samples are Sufficient for Hemodialysis Efficacy Assessment
Authors: Kovacic V. , Ljutic D. 
Published: January 2018

Introduction The measure of dialysis efficacy is expressed as Kt/V value (calculated from predialysis and postdialysis blood urea concentration). The aim of this study was to assess the possibility of direct calculation of Kt/V value from two spent dialysate samples by using the regular blood-based Kt/V calculation formula with dialysate samples used as surrogates for blood samples, and to detect the most appropriate couple of dialysate samples for Kt/V estimation. Patients and Methods Fifty-two single hemodialysis treatments in 34 anuric patients on chronic bicarbonate low-flux hemodialysis were observed. Kt/V values according to Daugirdas formula from two blood samples and from two dialysate samples were calculated. Results Kt/V values calculated according to Daugirdas 2nd generation formula from blood samples (Kt/Vsp Daugirdas) were in significant correlation with all Kt/V values obtained from two spent dialysate samples. The highest correlation coefficient (r = 0.74, p & 0.001) and the least standard error of mean of the differences were found between Kt/Vsp Daugirdas and value obtained with substitution of urea concentration from dialysate samples taken 60 minutes after dialysis start and at the end of the dialysis into Daugirdas 2nd generation formula (Kt/VDCD(60)-CD(e)), which can be expressed as a equation of linear regression y = 0.47 + 0.86x. The highest correlation coefficient (r = 0.74, p & 0.001) was found between Kt/Vsp Daugirdas values equilibrated according to Daugirdas rate formula, and Kt/VDCD(60)-CD(e) value, which can also be expressed as an equation of linear regression y = 0.43 + 0.73x. Conclusion The results of this study clearly show the sufficiency of only two spent dialysate samples for direct estimation of the Kt/V values, with no blood sample required.