bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Novel Manufacturing Technology on Blood and Dialysate Flow Distribution in a New Low Flux “α Polysulfone” Hemodialyzer
Authors: Gastaldon F. , Brendolan A. , Crepaldi C. , Frisone P. , Zamboni S. , D'Intini V. , Poulin S. , Hector R. , Granziero A. , Martins K. , Gellert R. , Inguaggiato P. , Ronco C. 
Published: January 2018

The main target for low flux hemodialyzers is an efficient low molecular weight solutes clearance. Such efficiency is largely dependent on the optimization of diffusion between blood and dialysis solution. The diffusion process can be impaired if there is a mismatch between blood and dialysate flow distribution in the dialyzer. Thus optimized flow distribution both in the blood and dialysate compartment becomes quintessential for the maximal efficiency of the diffusion process within the hemodialyzer. The present paper describes the distribution of the blood and dialysate flows in a new low flux polysulfone hollow fiber hemodialyzer characterized by a specific undulation of the fibers and a new cutting technology of the fibers for an improved micro-flow condition in the blood compartment headers. Twelve Diacap α Polysulfone LO PS 15 (1.5 sqm) (B.Braun Medizintechnologie, Melsungen Germany) were employed for the study. Six were analyzed in vitro and six were studied in vivo. Blood flow distribution was studied in vitro by dye injection in the blood compartment during experimental extracorporeal circulation utilizing human blood with hematocrit adjusted at 33%. Sequential images were obtained with a helical scanner in a fixed longitudinal section of the dialyzer 1 cm thick. Average and regional blood flow velocities were measured utilizing the reconstructed imaging sequence. The method allowed the calculation of single fiber blood flow (SF Qb) and the mass transfer zone (MTR) definition in digitally subtracted images. The patterns 20–10 and 40–30 were utilized. The same technology was used to evaluate flow distribution in the dialysate compartment after dye injection in the Hansen's connector. Regional dialysate flow was calculated in central and peripheral sample areas of 1 cm2. Six in vivo hemodialysis treatments on patients with end stage renal disease were performed at three different blood flow rates (250–350 and 450 ml/min) in order to measure urea, creatinine and phosphate clearance. Macroscopic and densitometrical analysis revealed that flow distribution was homogeneous in the blood compartment while in the dialysate compartment a slight difference between the peripheral and central regions in terms of flow velocity was observed. This however was not generating channeling phenomena. Urea creatinine and phosphate clearances were remarkably high and so were the Kt/V observed in all sessions, especially in relation to the studied blood flows. In conclusion, a significant blood to dialysate flow match with optimized countercurrent flow condition was observed in the studied hollow fiber hemodialyzers. Such optimization might be due both to the improved dialyzer design at the level of the blood header and to the specific fiber undulation that prevents dialysate channeling.
Hemofiltration during Cardiopulmonary Bypass for High Risk Adult Cardiac Surgery
Authors: Raman J.S. , Hata M. , Bellomo R. , Kohchi K. , Cheung H.L. , Buxton B.F. 
Published: January 2018

Aims The role of hemofiltration (HF) during cardiopulmonary bypass (CPB) in adult cardiac surgery is controversial. It may be beneficial during prolonged CPB in high-risk surgery. Accordingly, we sought to compare two groups of patients undergoing high-risk cardiac surgery with or without HF. Methods One hundred and eighteen patients who underwent complex cardiac surgical procedures during a 12-month period were divided into two groups. Group I (n=61) comprised patients who were treated with hemofiltration during CPB. Group II (n=57) were not filtered. Estimated risk of death, standard demographic, clinical and surgical features were obtained and predetermined outcomes were studied. Statistical comparisons were made. Results Age, procedure times and mortality rates were similar in both groups. The mean volume of fluid removed in group I was 3.4 L. The preoperative mean Parsonnet score was 24.8 in group I and 22.5 in group II (ns). Postoperative serum hemoglobin, hematocrit, platelet, and albumin levels were all significantly higher in group I patients (p = 0.0015) indicating hemoconcentration. Post-operative chest drainage showed a trend toward decreased post-operative bleeding in group I (p=0.065). Postoperative pleural effusions requiring chest tube drainage were significantly less in group I (9.8% vs. 29.8% 6; p = 0.0062). The incidence of lung infection was also decreased from 26.3% to 13.1% (p=0.05). Operative mortality was similar in both groups (11.4% in group I, 10.5% in group II, ns). Conclusion Hemofiltration during CPB attenuates postoperative anemia, thrombocytopenia and hypoalbuminemia, may reduce post-operative bleeding and appears to decrease post-operative pulmonary complications.
Platelet Loss across the Hemofilter during Continuous Hemofiltration
Authors: Mulder J. , Tan H.K. , Bellomo R. , Silvester W. 
Published: January 2018

Background Thrombocytopenia is a common finding in patients in the intensive care unit receiving continuous renal replacement therapy (CRRT). It is unknown if the hemofilter itself contributes to the platelet loss. Objective To measure the direct effect of the hemofilter on platelet counts during CRRT. Design Prospective, observational study Setting Intensive care unit of a University hospital Patients Critically ill patients with acute renal failure receiving CRRT. Methods Two samples of blood were drawn simultaneously, pre-filter and post-filter, and analyzed for platelet count. A correction factor was applied to the post-filter platelet count to adjust for the hemoconcentrating effect of net ultrafiltration. Results Forty-eight sets of paired data from 22 patients were studied. There was a small but significant decrease in mean platelet count across the hemofilter. The mean platelet count drop was 2.32 ×109/L (s.e. 1.06, p=0.0487, 95% CI (0.01,4.62)). Blood flow was strongly related to degree of platelet loss, with a decreased loss of 0.07 ×109/L for every ml/min increase in blood flow (p=0.015). There was no overall decrease in concurrently measured red cell counts across the hemofilter. However, there was a machine-specific affect on red cell loss (p<0.0001). The total calculated daily platelet loss across the filter was 625 ×109 cells. Conclusion The hemofilter may contribute to the thrombocytopenia seen during CRRT, by means of either destruction or retention of platelets during passage. This affect appears attenuated by higher blood flows. This information is useful in the assessment of a low platelet count in patients receiving CRRT.
In Vitro Construction of Urinary Bladder Wall using Porcine Primary Cells Reseeded on Acellularized Bladder Matrix and Small Intestinal Submucosa
Authors: Gabouev A.I. , Schultheiss D. , Mertsching H. , Köppe M. , Schlote N. , Wefer J. , Jonas U. , Stief C.G. 
Published: January 2018

Background Partial or radical cystectomy requires replacement of the urinary reservoir normally achieved by using small or large bowel segments. Our aim was to establish tissue engineering of an bioartificial bladder wall using primary cultures of porcine urothelial (pUC) and bladder smooth muscle cells (pSMC) to be reseeded on different acellular biological matrices. Methods Primary porcine cultures of pUC and pSMC were established from open bladder biopsy material 25 mm 2 in size. Acellular matrix was generated either from a) porcine bladder wall segments or b) tubular small intestinal submucosa with the still attached decellularized muscularis layer. Reseeding of these matrices with primary cells was done in a two-dimensional static model and in a three-dimensional rotating bioreactor perfused with cell culture medium for a period of 6 weeks. Results Prior to reseeding the cultured cells were characterized as pUC and pSMC by immunohistochemical staining with either anti-keratin 7 or anti-alpha actin. For both matrices a reseeded double layer cell system of pUC and pSMC could be identified after incubation in the described systems for 6 weeks. Conclusions Our results document successful generation of tissue engineered urinary bladder wall, which can be used in further large animal transplantation experiments.
Microencapsulation and Culture in Vitro of Rat Pinealocytes
Authors: Hua L. , Dachuan X. , Lei Y. , Shaohu X. , Xiaojing L. , Tao H. , Shizheng Z. 
Published: January 2018

Background Melatonin is a powerful anti-aging reagent for scavenging free radicals. However, the effect of exogenous melatonin on age-dependent diseases is uncertain. Immune rejection has limited xenotransplantation or allotransplantation of the pineal gland. The aim of this study was to assess cell viability and the function of rat pinealocytes encapsulated in APA capsules and offer experimental suggestions for pineal microencapsulation grafting to resist aging. Methods The pineal glands of neonatal rats were removed. Pinealocytes were isolated and encapsulated in APA microencapsulation and cultured. Morphological appearance of the microencapsulation was observed. Trypan blue staining and 5-HT immunocytochemical assay were used to detect cell viability and identify pinealocytes. The expression of AA-NAT mRNA was confirmed by RT-PCR. Melatonin release was measured and compared by HPLC. Results Both control and encapsulated pinealocyte cultures survived well. The majority of the encapsulated pinealocytes as well as unencapsulated cells remained 5-HT positive. No significant difference in melatonin secretion and the expression level of AA-NAT mRNA between encapsulated and unencapsulated pinealocytes was found. Conclusions Pinealocytes survive and remain functionally competent in vitro at least 2 weeks after microencapsulation.
EPO or Not-EPO? An Evidence Based Informed Consent
Authors: Mezza E. , Piccoli G.B. , Pacitti A. , Soragna G. , Bermond F. , Burdese M. , Gai M. , Motta D. , Jeantet A. , Merletti F. , Vineis P. , Segoloni G.P. 
Published: January 2018

Background Informed consent is crucial in therapeutic choices; however, the forms presented to patients are often locally developed and information may not be homogeneous. Objective To prepare an evidence-based model for informed consent, applied in the case of erythropoietin therapy (EPO) as a teaching tool for medical students. Methods Methodological tools of Evidence-Based Medicine (EBM) were developed within the EBM Course in the Medical School of Torino, Italy, as problem solving and patient information tools (5th year students work in small groups under the supervision of statisticians, epidemiologists and experts of internal medicine - nephrology in this case). Results Methodological and ethical problems were identified: in the pre-dialysis field, evidence from randomized clinical trials (RCT) is scant; how to use evidence gathered in dialysis? How to deal with implementation? How with the mass media? Do we need to discuss the drug choice with the patients? How to deal with rare and severe side effects?). The “evidence” was searched for on Medline/Embase, by using key-words and free terms. About 680 papers were retrieved and screened. Forms available on the Internet were retrieved and a general scheme was drawn: it included 5 areas: title, aim and targets (patients and family physicians); search strategies and updating; pros and cons of therapy; alternative options; open questions. Conclusions EBM may offer valuable tools for systematically approaching patient information; the inclusion of this kind of exercise in the Medical School EBM courses may help enhance the awareness of future physicians of the correct communication with patients.
Reverse Remodeling by Net Cardioplasty in a Model of Dilated Cardiomyopathy: Results of an Animal Study
Authors: Feindt P. , Litmathe J. , Boeken U. , Gams E. 
Published: January 2018

Aim End-stage heart failure is a growing clinical problem with only a few satisfactory therapeutical options. Dilated cardiomyopathy (DCM) is associated with a progressive decline in cardiac function. Our hypothesis was to arrest this worsening of cardiac function by mechanically containing the dilated heart with a special net. Methods In 16 pigs (50 ± 7 kg) DCM congestive heart failure was initiated by rapid ventricular pacing (220 b/m). In series 1 (n=8) a polyester net was placed around both ventricles before pacing was induced, whereas in series 2 (n=8) ventricular wrapping was performed when DCM was established. Results Comparing hemodynamic data before re-operation of group II-animals, the decrease of CO and dp/dtmax was significantly lower in series 1 than in series 2 compared to the baseline values before pacing (CO: series 1:-22.6±3.3%, series 2:-52.4±6.4%, P&0.05; dp/dt: series 1: +16.4±2.8%, series 2: −51.5±5.9%, P&0.05). In series 2, after net implantation, we could furthermore show that deterioration of the animal stopped and hemodynamic data improved significantly in the following 2 weeks (CO: +62.9±10.5% and dp/dt +37.0±6.8%). Conclusion Ventricular containment with a polyester net seems to be a therapeutic option in cardiac insuffiency caused by ventricular dilation. This cardioplasty induced a reverse remodeling of the dilated hearts with a significant improvement in diastolic and systolic ventricular function.
Effect of Lipoprotein Apheresis on Oxidative Stress and Antioxidant Status in Familial Hypercholesterolemic Patients
Authors: Kurtoglu E. , Ugur A , Gonen M. SAIT , KiSAKOL G. 
Published: January 2018

Extracorporeal low-density lipoprotein (LDL) apheresis is an established and highly effective therapy for the patients with familial hypercholesterolemia (FH) not adequately responding to diet and drug therapy alone. This study was designed to measure the effect of lipid apheresis on oxidant and antioxidant status in a patient with FH. The levels of plasma lipid peroxidation were determined as thiobarbituric acid-reactive substances. The activities of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) were established in one subject with FH before and after lipid apheresis. The pre- and post lipid apheresis procedures witness a significant decrease in oxidative stress (p<0.05) but the erythrocyte levels of CAT, SOD and GPx were unchanged.
Plasma Leakage of Oxygenators in ECMO Depends on the Type of Oxygenator and on Patient Variables
Authors: Meyns B. , Vercaemst L. , Vandezande E. , Bollen H. , Vlasselaers D. 
Published: January 2018

This study was conducted to identify the causes of plasma leakage of oxygenators in extra corporeal membrane oxygenation (ECMO). From 1996 through 2002, 91 oxygenators were used in 62 patients undergoing ECMO for respiratory and/or cardiac failure. Several types of oxygenators were used (Medtronic Maxima, Minima, PRF, Medos Hilite). Patient variables and variables related to the ECMO set-up were analysed for their relationship with oxygenator failure by a time related multiple regression analysis (Cox). Oxygenator failure occurred in 26% of the cases. The analysis identified the type of oxygenator (p=0.0016), younger patient age (p=0.04) and the number of oxygenators used (p=0.03) as the independent significant risk factors. The type of oxygenator used has the most overwhelming effect (significantly less leakage with the Medos Hilite). In conclusion, leakage of oxygenators is predominantly caused by the type of oxygenator used. Patient variables (younger age and the number of oxygenators used in one patient) are also significant and allude to an inflammatory process as underlying mechanism of plasma leakage.
Early Results of Valved Bovine Jugular Vein Conduit for Right Ventricular Outflow Tract Reconstruction
Authors: Mert M. , Cetin G. , Turkoglu H. , Ozkara A. , Akcevin A. , Saltik L. , Paker T. , Gunay I. 
Published: January 2018

Objective Many congenital cardiac anomalies present with accompanying severe right ventricular outflow tract (RVOT) obstruction or interruption requiring surgical correction. RVOT reconstruction by means of a conduit is often necessary in the majority of these patients in the early years of life and there are several proposed conduits for this purpose. Methods Fourteen patients with different congenital cardiac pathologies underwent RVOT reconstruction with the newly developed bovine valved jugular vein conduit (The Contegra conduit). The function of the conduit is observed by echocardiographic examinations at the hospital discharge and at follow-up visits with special attention to the function of the venous valve and to any gradient on the RVOT. Results There were two perioperative mortalities. All the surviving patients are followed for a mean period of 8.07 months (range 2 to 33 months). The function of the venous valve was determined, in 4 patients (33.33%) as without regurgitation, in 7 patients (58.3%) as mild regurgitation and in 1 patient (8.33%) as mild-to-moderate regurgitation. The reconstructed RVOT was free of any significant gradient at the hospital discharge (mean 10.83 ±10.18 mmHg) and at the follow-ups (mean 12.916 ±12.33 mmHg). There was not a trend towards an increase in the gradients following discharge. Conclusion The early results of the Contegra valved conduit are very satisfactory. This graft can be a good alternative for RVOT reconstruction, particularly in the neonatal and infant patient group. These patients can be managed by homograft replacement of their conduit in later years.
Effectiveness of Aluminum Hydroxide Timing Administration in Relation to Meals in Controling Hyperphosphatemia in Dialysis Patients
Authors: Katopodis K.P. , Andrikos E. , Pappas M. , Siamopoulos K.C. 
Published: January 2018

Phosphate binder compounds contribute to the control of hyperphosphatemia in hemodialysis (HD) patients. However, the most effective schedule of administration of phosphate binders in relation to meals is not well documented. We examined the effectiveness of aluminum hydroxide intake as the sole phosphate binder in relation to meals. Eighty-five patients on regular HD (45 male, 40 female), age 21–72 years, with a duration of 6–216 months HD participated in the study. In all patients, phosphate binders were discontinued for a one month period. Thereafter, and according to the protocol, all patients were advised to take aluminum hydroxide [Al(OH)3] 30 min before, during and 30 min after meals for 3 periods of one month each, in a random order. One month washout period preceded the periods of Al(OH)3 ingestion. When Al(OH)3 was administered 30 min prior to the meals, serum phosphate decreased by 7.0% (0.59 mg/dL), while when administrated with or 30 min after meals, it decreased statistically significantly by 28.5% (2.08 mg/dL), and 16% (1.29mg/dL) respectively. Our results suggest that the efficacy of Al(OH)3 to bind phosphate salts and thus to prevent the hyperphosphatemia in HD patients is higher when this drug is taken with meals.
Extracorporeal Blood Oxygenation and Ozonation (EBOO): A Controlled Trial in Patients with Peripheral Artery Disease
Authors: Di Paolo N. , Bocci V. , Salvo D.P. , Palasciano F. , Biagioli M. , Meini S. , Galli F. , Ciari I. , Maccari F. , Cappelletti F. , Di Paolo M. , Gaggiotti E. 
Published: January 2018

Background Since 1990 our group has been using extracorporeal circulation to ozonate blood by an original method, known as extracorporeal blood oxygenation and ozonation (EBOO), with the aim of amplifying the results observed with ozone autohemotherapy. Objective To verify the hypothesis that EBOO improves the skin lesions typical of peripheral artery disease (PAD) patients. Methods Twenty-eight patients with PAD were randomized to receive EBOO or intravenous prostacyclin in a controlled clinical trial. The primary efficacy parameters were regression of skin lesions and pain, and improvement in quality of life and vascularisation. Results Patients treated with EBOO showed highly significant regression of skin lesions with respect to patients treated with prostacyclin. Other parameters that were significantly different in the two groups of patients were pain, pruritus, heavy legs and well-being. No significant differences in vascularisation of the lower limbs before and after treatment were found in either group. No side effects or complications were recorded during the 210 EBOO treatments. Conclusion EBOO was much more effective than prostacyclin for treating skin lesions in PAD patients and also had a positive effect on patient general condition without any apparent change in arterial circulation. This suggests other mechanisms of action of EBOO.
Modern Strategies in the Prevention of Implant-Associated Infections
Authors: Von Eiff C. , Kohnen W. , Becker K. , Jansen B. 
Published: January 2018

The application of medical devices either for temporary or permanent use has become an indispensible part of almost all fields of medicine. However, foreign bodies are associated with a substantial risk of bacterial and fungal infections. Implant-associated infections significantly contribute to the still increasing problem of nosocomial infections. To reduce the incidence of such infections, specific guidelines providing evidence-based recommendations and comprising both technological and nontechnological strategies for prevention have been established. Strict adherence to hygienic rules during insertion or implantation of the device are aspects of particular importance. Besides such basic and indispensable aspects, the development of new materials which could withstand microbial adherence and colonization has become a major topic in recent years. Modification of surface by primarily physico-chemical methods may lead to a change in specific and unspecific interactions with microorganisms and, thus, to a reduction in microbial adherence. Medical devices made out of a material that would be ideally antiadhesive or at least colonization-resistant would be the most suitable candidates to avoid colonization and subsequent infection. However, it appears impossible to create a surface with an absolute “zero”-adherence due to thermodynamical reasons and due to the fact that a modified material surface is in vivo rapidly covered by plasma and connective tissue proteins. Therefore, another concept for the prevention of implant-associated infections involves the impregnation of devices with various antimicrobial substances such as antibiotics, antiseptics, and/or metals. In fact, already commercially available materials for clinical use such as antimicrobial catheters have been introduced, in part with considerable impact on subsequent infections. However, future studies are warranted to translate the knowledge on the pathogenesis of device-associated infections into applicable prevention strategies.
Influence of Sub-Inhibitory Concentrations of Antimicrobial Agents on Biofilm Formation in Indwelling Medical Devices
Authors: Henriques M. , Cerca N. , Azeredo J. , Oliveira R. 
Published: January 2018

Biofilms of Staphylococcus epidermidis and Candida spp. are two of the most frequent factors of infections associated with the use of indwelling medical devices. Several strategies have been proposed and/or developed to prevent infection. The aim of this study was to compare the effect of sub-inhibitory concentrations of anti-microbial agents on biofilm formation. Biofilms of three strains of S. epidermidis and two of both Candida albicans and Candida dubliniensis were formed in the presence of three antibiotics and two antifungal agents respectively. Based on the control samples, the percentage of biofilm formation inhibition by the different agents was determined and compared. The results showed that the influence of the antibacterial and antifungal agents tested is strain dependent, with the effect of the different agents also varying among strains, even though they have the same mechanism of action.