bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cytokine Removal with a Large Pore Cellulose Triacetate Filter: An Ex Vivo Study
Authors: Uchino S. , Bellomo R. , Goldsmith D. , Davenport P. , Cole L. , Baldwin I. , Panagiotopoulos S. , Tipping P. , Ronco C. , Everard P. 
Published: January 2018

Objective To test the hypothesis that hemofiltration using a new large pore cellulose triacetate hemofilter can achieve effective ultrafiltration of cytokines. Design Ex-vivo study. Setting Laboratory of Intensive Care Unit in tertiary hospital. Subjects Six healthy volunteers. Interventions Blood from 6 volunteers was incubated for 4 hours with 1 mg of endotoxin and then circulated through a closed hemofiltration circuit with a large pore cellulose triacetate hemofilter (nominal cut-off point: 60 kilodaltons). Hemofiltration was conducted at 1 L/h or 6 L/h of ultrafiltrate (UF) flow at the start of extra-corporeal circulation, and after 2 and 4 hours. Samples were taken from the arterial, venous and UF sampling ports. Measurements and main Results IL-Iβ, IL-6, IL-8, IL-10, TNFα, and albumin were measured. Sieving coefficients (SC) above 0.6 were achieved for IL-Iβ and IL-6 and SCs above 0.3 were achieved for IL-8 and TNF-α at 1 L/h. Sieving coefficients of all cytokines (except IL-10, p=0.22) were reduced when the ultrafiltration rate was increased from IL/h to 6 L/h (p<0.01), but the increase in ultrafiltration rate resulted in an overall increase in the clearance of all cytokines (p<0.001). The highest SC for albumin was 0.07 at 4 hours at 1 L/h, and fell to 0.01 at 6 L/h. The SCs for IL-8 fell at 4 hours (p<0.01), but the SCs for other cytokines did not change. No adsorption of cytokines and albumin was observed. Conclusion High volume hemofiltration (HVHF) using a new large pore cellulose triacetate filter achieved cytokine clearances greater than those reported with currently available hemofilters.
Clearance of Quinupristin-Dalfopristin (Synercid®) and their main Metabolites during Continuous Veno-Venous Hemofiltration (CVVH) with or without Dialysis
Authors: Kim M.-K. , Banevicius M.A. , Zhong M. , Shi X. , Hu M. , Nightingale C.H. , Nicolau D.P. 
Published: January 2018

Background Quinupristin-dalfopristin (Q/D) is often utilized in critically ill patients, some of whom require CVVH. This study was undertaken to determine the clearance of Q/D and their main active metabolites (RPR 100391, RP 69012, RP 12536) via CVVH in the swine model. Methods Q/D 7.5 mg/kg was intravenously administered over 0.5 h to 12 swine after induction of acute renal failure by ligation of the renal arteries. At 0.5 h post injection, the CVVH procedure was initiated and continued for 8 hours at the following pump rates: (1)100 mL/min, (2)180 rnL/min, and (3)100 mL/min with dialysis (flow rate: 1 L/h). Blood and ultrafiltrate samples were collected at 1 h intervals and assessed by a validated HPLC method. Results Plasma analysis suggests rapid metabolism to the main active metabolites which are appreciably cleared as demonstrated by high clearance and sieving coefficient estimates. Mean clearance estimates for RP 69012, RP 100391, and RP 12536 are 729, 777, and 578 mL/h in the 100 mL/min CVVH group, 772, 785, 685 mL/min in the 180 mL/min CVVH group, and 753, 791, 616 mL/min in the 100 mL/min CVVH group with 1L/h dialysis, respectively. Conclusion These data reveal that Q/D is rapidly metabolized and the metabolites are cleared to a large extent via CVVH. Due to the considerable contribution of the metabolites to overall in vivo activities, additional studies are required to fully quantify their removal before final dosage modifications for patients undergoing CVVH can be recommended.
Development of a Hybrid Artificial Liver Using Polyurethane Foam / Hepatocyte Spheroid Culture in a Preclinical Pig Experiment
Authors: Nakazawa K. , Ijima H. , Fukuda J. , Sakiyama R. , Yamashita Y. , Shimada M. , Shirabe K. , Tsujita E. , Sugimachi K. , Funatsu K. 
Published: January 2018

We describe a preclinical study of our original hybrid artificial liver support system (HALSS) for a clinical trial. We designed a HALSS comprising a multi-capillary polyurethane foam packed-bed module (MC-PUF module) containing a total 200 g (2 × 1010 cells) porcine hepatocytes, and an extracorporeal circulation device. Almost all porcine hepatocytes in the MC-PUF module formed many spherical multicellular aggregates (spheroids). This extracorporeal circulation device was improved to promote solute exchange between a living body and a MC-PUF module by including a plasma bypass line in the circulation loop. The efficacy of the HALSS was evaluated using a 25-kg pig with warm ischemic liver failure by portocaval shunt and ligation of hepatic artery (HALSS group, n=3). As a control experiment, the same system without hepatocytes in the module was used with the same kind of liver failure pig (Control group, n=3). The blood ammonia in the control group was 143 N-μg/dl at the start of circulation, and rapidly increased to 351 N-μg/dl at 2 hours and to 704 N-μg/dl at 6 hours. But the blood ammonia in the HALSS group was completely suppressed, and remained less than the hepatic coma level (over 200 N-μg/dl) during the circulation time. The blood glucose in the control group gradually decreased, and became less than 40 mg/dl within 6 hours of circulation. But the blood glucose in the HALSS group was maintained well, and remained the normal glucose level (50 – 105 mg/dl) for more than 20 hours of circulation. Improvement in blood creatinine and lactate, and the stabilization of vital signs and urinary excretion, were observed in the HALSS group. The survival time of the pigs in the HALSS group was 19.3 hours compared with 8.9 hours in the control group. In conclusion, our HALSS was effective to stabilize the general conditions of the body in addition to supporting various liver functions. These results suggest that our HALSS has a strong possibility to be used in treating liver failure patients. We have applied for approval of the clinical trial of our HALSS to our institutional ethics committee.
Autologous Cardiomyocyte Transplantation in an Ovine Myocardial Infarction Model
Authors: Kim W.G. , Park J.J. , Chung D.H. , Na C.Y. 
Published: January 2018

Background To evaluate the possibility of autologous cardiomyocyte transplantation, we transplanted cultured autologous cells into an infarct region developed by coronary artery ligation in an ovine model. Materials and Methods A chronic heart failure model with a considerable portion of myocardial infarction was created in sheep using sequential ligation of the homonymous artery and its diagonal branch. Autologous cardiomyocytes were cultured and isolated from the right ventricular infundibulum. After a predetermined interval (one animal for two months and the other for three months), the two animals were reanesthetized and a suspension of cultured autologous vetricular cells in 0.3 ml of culture medium (1.2 × 107 cells) was injected into the center of three out of the four sites in the infarcted area using a tuberculin syringe. The same amount of culture medium was injected with an identical procedure into the center of the remaining site, as control. The animals were kept alive for a further month, and then sacrificed for postmortem heart examinations. Light microscopic analysis and immunohistochemical study for myoglobin were done. Results and Conclusions On postmortem gross examination, well-demarcated thin-walled anteroseptal infarcts with chamber enlargement were clearly seen in specimens from the two animals. Microscopic analysis showed homogenous fibrosis throughout the infarcted areas. In both animals, one of the three sites of cardiomycyte injection showed an islet of cardiomyocytes in the mid-myocardium, while none were observed in the control site of either animal. A layer of cardiomyocytes was observed in subendocardial regions, as it was in the control areas. In conclusion, cardiomyocyte transplantation into the infarct regions developed by coronary artery ligation in an ovine model was achieved with only limited success. An understanding of why only 33% of cardiomyocyte-injection sites demonstrated viable cardiomyocytes, in the form of tiny cell islets, remains to be elucidated.
Patient Knowledge and Interest on Dialysis Efficiency: A Survey
Authors: Piccoli G.B. , Mezza E. , Pacitti A. , Iacuzzo C. , Bechis F. , Quaglia M. , Anania P. , Garofletti Y. , Martino B. , Peirano G. , Aglì I. , Jeantet A. , Segoloni G.P. 
Published: January 2018

Background Therapeutic compliance is fundamental on dialysis; however following a therapy requires a prior understanding of it. Aim of the study was to assess the need and interest for information on dialysis efficiency and to prepare a dedicated teaching tool. Methods 72 patients, on hemodialysis in two limited-care satellite units, were given a questionnaire testing knowledge and interest on dialysis efficiency. In a subsequent second phase, following patients' suggestions, a cartoon book was prepared and opinions recorded. Results 63 patients' returned the questionnaire. 79.4% had basic knowledge on routine blood tests, 30.1% were aware of their specific meaning. All patients asked for further information, preferring books to other media. The book “Kt/V as cartoon” was distributed; 71.2% read it, 93% scored it as good-very good. In the Unit employing flexible dialysis schedules, 22/42 patients increased dialysis time. Conclusions Despite insufficient knowledge on dialysis efficiency, patient interest is high. An educational program is feasible and may also give practical results, such as self-increase in dialysis time.
A New Expandable Cannula to Increase Venous Return during Peripheral Access Cardiopulmonary Bypass Surgery
Authors: Jegger D. , Mueller X. , Mucciolo G. , Mucciolo A. , Boone Y. , Seigneul I. , Horisberger J. , Von Segesser L.K. 
Published: January 2018

Peripheral cannulation for cardiopulmonary bypass (CPB) is of prime interest in minimally invasive open heart surgery. As CPB is initiated with percutaneous cannulae, venous drainage is impeded due to smaller vessel and cannula size. A new cannula was developed which can change shape in situ and therefore may improve venous drainage. An in vitro circuit was set-up with a penrose latex tubing placed between the preload reservoir and the cannula, encasing the cannula's inlet and simulating the vena cava. The preload (P) was stabilised at 2 and at 5mmHg respectively. The maximum flow rate was determined for 4 conditions: passive venous drainage (PVD) and assisted venous drainage (AVD) using a centrifugal pump at the 2 preload settings. We compared the results of the prototype cannula to classical femoral venous cannulae: basket 28Fr, a thoracic 28Fr and a percutaneous 27Fr. Under PVD conditions and a CVP of 2mmHg, the prototype cannula's flow rate outperformed the next best cannula by 14% (p=0.0002) and 13% under AVD conditions (p=0.0001). Under PVD conditions and a CVP of 5mmHg, the prototype cannula outperformed the percutaneous cannula by 19% (p=0.0001) and 14% under AVD conditions (p=0.0002). The new cannula outperforms the classical percutaneous venous cannulae during all of the four conditions tested in vitro.
Dialysis Membranes Today
Authors: Bowry S. K. 
Published: January 2018

In recent years, hemodialytic therapies have evolved from the simple, diffusion-dependent removal of small molecular weight substances from blood to advanced therapy modalities involving the convective removal of larger uremic sloutes. The clinical benefits of removal of substances such as ß2-microglobulin (ß2-m) have been reported by several authors: elimination of large-molecular weight “uremic toxins” is now widely accepted as being beneficial to the overall quality of life of patients. This trend would not have been possible without parallel technical developments, especially that of new membranes having more open pore structures resulting in higher sieving coefficients and increased hydraulic permeability. Not all polymer types are suitable for the manufacture of high-flux membranes required for convective therapies in which large fluid volumes are exchanged. Amongst the more important criteria are: the selected polymer must be able to undergo steam sterilisation, have high endotoxin retention capabilities, be versatile for the fabrication of a range of hydraulic permeabilities and, of course, have high blood compatibility. The aim of this paper is, firstly, to review the major membrane development phases over the last quarter of a century. Secondly, the suitability of current membrane materials to meet the aforementioned requirements will be examined. Thirdly, in view of the recent, rapid proliferation of polysulfone-based membranes, dialysis membranes of the polysulfone ‘family’ are placed under scrutiny; membranes of this class represent a significant portion of the product portfolio of dialyser manufacturers today, yet, few end-users are able to distinguish between the salient features of the respective products because of a combination of confusing membrane nomenclature, classification, tradenames and product claims.
Polymers in Nephrology Characteristics and Needs
Authors: Vienken J. 
Published: January 2018

Polymers employed as biomaterials in nephrology serve for different applications: they form membranes for dialysis and plasmapheresis, are used as materials for dialyser housings and as a potting mass for capillary membranes, they make up tubing-systems for extracorporeal circuits and – in the form of beads – act as parts of adsorber columns for hemoperfusion or immunoadsorption. However, generally speaking, many polymers have not yet been designed for their final application. To date, many polymers are still taken from the chemist's shelf according to their alleged performance properties or to their sterilisability. When used in medical application, polymers must show a high purity. Uncontrolled leaching of oligomers from the polymer backbone or of additives from or during the manufacturing process must be avoided. Blood and other body fluids are extremely effective in extracting any loosely bound polymers. During long-term application, e.g. in patients suffering from chronic diseases, these effects may lead to an accumulation of these compounds in circulating blood, tissue, or joints. Consequently, polymers should show an excellent biostability and not degrade during their ageing process. The amount of extractable material should be kept low in order to avoid inflammatory reactions. Polymers must have high blood compatibility in terms of minimized cell-and complement activation. Polymers for medical application should at best be able to stand high temperatures in order to survive steam sterilisation. If this is impossible, their release kinetics for residual quantities of sterilizing agents should be fast. Finally, protein adsorption should appear under controlled conditions, otherwise a reduced performance through protein adsorption will take place. Further, the uncontrolled activation of biochemical cascades, such as the coagulation, complement or contact phase cascade, following blood/material contact must be minimized. A final aspect has been recently made responsible for adverse patients reactions, the interaction between polymers and medicinal drugs. This drug/material interaction must be low, at best zero, apart form those situations, where a controlled drug-release is wanted. The chemical variety of polymers for medical application is large. However, all typical requirements cannot be met by one single polymer. Compromises have to be found between properties and application. Polymer selection for application in nephrology has always to be made under the premise of final application.
Acid-Base Balance during Continuous Veno-Venous Hemofiltration: The Impact of Severe Hepatic Failure
Authors: Naka T. , Bellomo R. , Morimatsu H. , Rocktaschel J. , Wan L. , Gow P. , Angus P. 
Published: January 2018

Background Continuous renal replacement therapy (CRRT) affects acid-base balance but the influence of severe hepatic failure (SHF) on this effect is unknown. Aim To assess the effect of SHF on acid-base balance in patients receiving CVVH. Design Retrospective laboratory investigation. Subjects Forty patients with SHF and acute renal failure (ARF) treated with CVVH and 42 critically ill patients with severe ARF but no liver disease also treated with CVVH (controls). Intervention Retrieval of clinical and laboratory data from prospective unit and laboratory databases. Methods Quantitative acid-base status assessment using the Stewart-Figge methodology. Comparison of findings between the two groups. Results Although CVVH had a major effect on acid base balance in both groups, patients with SHF had a higher mean lactate concentrations (4.8 vs. 3.1 mmol/L; p<0.0005), a greater base deficit compared to controls (-1 vs. 4.1 mEq/L; p<0.0001) and a lower PaCO2 tension (36.8 vs. 42.5 mmHg; p<0.0001), despite the use of bicarbonate replacement fluid. The acidifying effect of hyperlactatemia was slightly worsened by an increased strong ion gap (9.3 vs. 4.9 mEq/L; p<0.0001). It was, however, attenuated by an increased strong ion difference apparent (SIDa) (43.6 vs. 41.9 mEq/L; p<0.05) secondary to hypochloremia (96 vs. 100 mmol/L; p<0.0001) and by hypoalbuminemia, although hypoalbuminemia in SHF patients (26 vs. 23; p<0.005) was less pronounced than in controls. Conclusion The use of CVVH does not fully correct the independent acidifying effect of liver failure on acid-base status. Increased lactate and strong ion gap values maintain a persistent base deficit despite the alkalinizing effects of hypoalbuminemia and hypochloremia. The correction of acidosis in SHF patients may require more intensive CVVH.
Comparison of Kinetic Characteristics of Amino Acid-Based and Dipeptide-Based Peritoneal Dialysis Solutions
Authors: WeryńSki A. , Waniewski J. , Wang T. , Anderstam B. , Lindholm B. , BergströM J. 
Published: January 2018

A mixture of dipeptides (DP) has been proposed as alternatives (to glucose and amino acids, (AA)) osmotic agent in peritoneal dialysis (PD) solutions. DP based solutions may have metabolic and nutritional advantages compared to AA based solutions, as some sources of AA (such as tyrosine) are poorly soluble in water. In a previous study, we compared the kinetic characteristics of DP and AA based solutions; however, the amount of AA differed substantially. The aim of the present study was to compare solutions with almost equal amounts of AA. Methods The following solutions were used: (1) amino acid (AA) solution containing leucine, valine, lysine, isoleucine, threonine, phenylalanine and histidine (tyrosine was omitted because of its poor solubility), (2) dipeptide (DP) solution containing leucyl-valine, lysyl-isoleucine, threonyl-phenylalanine and histidyl-tyrosine. Sixteen Sprague-Dawley rats were divided in two groups and were subjected to intraperitoneal injection of either 25 mL of AA (n=8) or DP solution. Dialysate and blood samples were taken frequently postinfusion for measurement of AA and DP concentrations as well as AA from DP. Results Kinetic models were developed for estimation of diffusive mass transport coefficient between peritoneal cavity and blood (KBD), DP hydrolysis rate coefficient (KH) and AA clearance in the body (KC). Calculations showed that KH is about ten times lower than KBD. Thus, hydrolysis rate in peritoneal cavity is much lower than the diffusive transport rate of DP. KBD for AA appeared to be similar to KBD for dipeptides. KC was much higher than KBD for AA. This finding explains the rapid clearance of amino acids from blood. Nevertheless, the AA-based solution resulted in much higher peak concentrations of AA in blood after 120 min of the dwell than AA concentrations achieved following the use of the DP-based solution. Conclusions Peritoneal transport characteristics of AA and DP were similar; however their kinetics in blood differs substantially. The DP solution resulted in a less pronounced increase in AA concentrations in blood, suggesting that DP solution could provide AA in a more physiological way.
Role of B-Type Natriuretic Peptide in Cardiovascular State Monitoring in a Hemodialysis Patient with Primary Amyloidosis
Authors: Fabbian F. , Stabellini N. , Sartori S. , Molino C. , Russo G. , Russo M. , Cantelli S. , Catizone L. 
Published: January 2018

Background Cardiac involvement occurs in up to 50% of patients with primary or AL amyloidosis (ALA) and is associated with very poor prognosis. B-type natriuretic peptide (BNP) has been proposed as a guide for treatment of heart failure patients and as an index of myocardial dysfunction in patients with ALA. Data about BNP dosage for cardiovascular monitoring of patients with ALA on renal replacement therapy are lacking. Case A 64 year old Caucasian man was admitted because of nephrotic syndrome in July 2003. Renal diagnosis was ALA. Melphalan and prednisolone were given but renal function worsened and in April 2004 standard bicarbonate hemodialysis was started. In March 2004 thalidomide was added to his therapy. During the follow-up ejection fraction was stable and was 65% on the contrary E/A ratio gradually increased and overtook 1. BNP plasma levels were increased and the values recorded during the follow-up were: 2505 pg/mL in October 2003 (normal reference values Conclusion In ALA patients a powerful prognostic role of BNP has been reported whose expression is increased in ventricular myocytes of patients with cardiac involvement. BNP level monitoring does not appear to be superior to standard echocardiography in evaluating cardiovascular status of uremic patients with ALA.
A New Chemical Etching Process to Improve Endosseous Implant Osseointegration: In Vitro Evaluation on Human Osteoblast-Like Cells
Authors: Giordano C. , Sandrini E. , Busini V. , Chiesa R. , Fumagalli G. , Giavaresi G. , Fini M. , Giardino R. , Cigada A. 
Published: January 2018

The development of novel mechanical and chemical surface modification treatments to improve the osteointegration properties of osseointegrated dental implants is nowadays a topic of great applicative interest. The aim of the present study was to analyse the role of surface topography and chemistry of four different surface treatments on titanium by an in vitro human osteosarcoma immortalised cell line model (MG63). The surface treatments considered were (a) machined titanium, (b) chemical etched on machined titanium, (c) sandblasted titanium and (d) chemical etching on sandblasted titanium. Chemical and physical surface properties were investigated by Scanning Electron Microscopy, Thin Film-X ray Diffraction and by Laser Profilometry. The in vitro biological response was characterised using the MG63 cell line by elution cytotoxicity tests, cell morphology, adhesion, proliferation activity, alkaline phosphatase activity and total DNA content in order to show a relationship between osteoblast response and surface features. Chemical and physical characterisation showed that the considered treatments differently modify the surface morphology in the micro and sub-micrometric scale. Although some differences in alkaline phosphatase activity were observed in the biological characterisation, depending on the specific material's surface finishing, the results showed that cells were well responsive on all the tested materials and grew and differentiated with similar proliferation rate.