bluuebunny/crossref_metadata_2025_split huggingface dataset:
Switching from Three Times a Week to Short Daily Online Hemodiafiltration: Effects on Acid-Base Balance
Authors: HernáNdez-Jaras J. , Torregrosa De Juan E. , Pons-Prades R. , RÍus-Peris A. , Fenollosa-Segarra M.A. 
Published: January 2018

Aims This study examines the effect of a change from the standard 4–5 hours 3 times a week of online hemodiafiltration (OL-HDF) to 2–2.5 hours daily (6 times a week) OL-HDF, on acid-base balance, and attempts assess the modifications of acid-base parameters, ionic concentration, and electrical charges of albumin and phosphate available for diffusion and convection mechanisms across the membrane and subsequent infusion. Methods In 18 patients on online HDF, blood gas, electrolytes (Na, K, Cl), lactate, phosphate, albumin, apparent strong ion difference (SIDa), effective strong ion difference (SIDe), strong ion gap (SIG), anion gap (AG), and bicarbonate and pH time-averaged concentration (TAC) and time-averaged deviation (TAD) variables were evaluated at baseline, and 1, 3, 6, 9, and 12 months after patients were switched to daily OL-HDF. Additionally, in 12 patients, the same parameters measured simultaneously at dialyzer inlet, outlet, and after reinfusion were studied. Results Throughout the study, weekly single-pool Kt/V, equilibrated Kt/V, and TAC urea remained constant. However, standard Kt/V increased and TAD urea decreased on daily OL-HDF. There were no statistical differences during the time span of 12 months in pH, cations (Na, K), anions (Cl, HCO–3 AG, and lactate), or SIDa, SIDe, and SIG pre-HDF; while pH and HCO3– TAD decreased from 0.02 and 1.02 ± 0.74 mEq/L, to 0.01 and 0.64 ± 0.52 mEq/L, respectively (p<0.01). Net albumin charge and AG increased significantly at dialyzer outlet and decreased after reinfusion. Conclusions We did not observe changes in the acid-base balance in patients who switched from 3 times a week to short daily OL-HDF. The main benefit observed was a lower pH and bicarbonate TAD. This shows a better physiology for daily OL-HDF.
Disturbed Cerebral Circulation during Opening of the Venoarterial Bypass Bridge in Extracorporeal Membrane Oxygenation
Authors: De Mol A. C. , Van Heijst A. F. , Van Der Staak F. H. , Liem K. D. 
Published: January 2018

Purpose To describe the effects on cerebral blood flow velocity (CBFV) of intermittent opening of the venoarterial bridge (VA bridge) during venoarterial extracorporeal membrane oxygenation (VA-ECMO). Study design Prospective study in 22 newborns during VA-ECMO. CBFV was measured in the perical-losal artery by Doppler ultrasound. Changes in peak systolic flow velocity (PSV), end diastolic flow velocity (EDV) and time-averaged mean flow velocity (TAM) on day 1, 2, 3, and 5 and at low ECMO flow (50–150 ml/min) were analyzed (mean percentage±standard deviation (t-tests, p<0.05)). Changes >25% were considered relevant. The relationship between changes in CBFV and ECMO flow rate (Pearson correlation, p<0.01) was studied. Results Opening of the VA bridge resulted in statistically significant and relevant decreases in PSV (35 ± 18%), EDV (93 ± 15%) and TAM (68 ± 13%), persisting during the consecutive days of treatment. Smaller changes in CBFV at low ECMO flow were statistically significant and mostly relevant: PSV (15 ± 7%), EDV (76 ± 21%) and TAM (40 ± 12%). Changes in CBFV were positively correlated to the ECMO flow. Conclusion: Use of the VA bridge results in significant and relevant ECMO flow-dependent changes in CBFV, persisting during the treatment. The VA bridge should be used in such a way as to allow regular unclamping to be omitted.
Pumpless Extracorporeal Lung Assist as Supportive Therapy in a Patient with Diffuse Alveolar Hemorrhage
Authors: Renner A. , Neukam K. , RÖsner T. , Elert O. , Lange V. 
Published: January 2018

Our 18-year old female patient suffered from microscopic polyangiitis. After invasive diagnostics, a diffuse alveolar hemorrhage occurred, leading to acute lung failure. In spite of differential ventilation, respiratory insufficiency and lactate-acidosis increased quickly. Due to the massive hemorrhage, a pumpless extracorporeal lung assist was implanted and, after six hours, low-dose heparinization was started. In response to this therapy, hypercapnia and acidosis improved quickly and were completely eliminated within 24 hours. Simultaneously, treatment with prednisolon and cyclophosphamid was started. After 7 days, the patient's conditions allowed weaning from the pumpless extracorporeal lung assist and after 9 days she was extubated. In conclusion, the pumpless lung assist was shown to be a very practical option to treat the most serious forms of hypercapnia, especially for patients disposed to diffuse bleeding.
Hyperglycemia and the Outcome of Pediatric Cardiac Surgery Patients Requiring Peritoneal Dialysis
Authors: Egi M. , Morimatsu H. , Toda Y. , Matsusaki T. , Suzuki S. , Shimizu K. , Iwasaki T. , Takeuchi M. , Bellomo R. , Morita K. 
Published: January 2018

Objective To study the nature of the association between glycemia and ICU mortality in pediatric cardiac surgery patients treated with peritoneal dialysis (PD). Materials and methods Retrospective observational study in the ICU of a tertiary hospital involving forty pediatric cardiac surgery patients treated with PD. We selected patients requiring PD, extracted glucose measurements and nutritional intake data during ICU stay and calculated mean and maximum blood glucose values i) during ICU stay; ii) during dependence on PD; and iii) during independence from PD. We statistically assessed the relationship between glycemia-related variables and ICU mortality. Measurements and Results Twenty-two patients treated with PD died (mortality 55%). In the PD cohort, 9725 blood glucose measurements were performed (every 3.3 hours on average). The mean glycemia during dependence on PD was significantly higher in non-survivors than survivors (p<0.0001), but not during independence from PD (p=0.49). The area under the receiver operator characteristic curve for the mean glycemia during dependence on PD was significantly greater than that obtained during independence from PD. Even after adjustment for severity of illness using multivariate logistic analysis, the mean glycemia and calorie intake during PD were significant and independent predictors of ICU mortality. Conclusions A higher mean blood glucose concentration during PD, but not during PD-free periods was associated with greater ICU mortality. Mean glycemia and calorie intake during PD were significant and independent predictors of ICU mortality.
Citrate Anticoagulation for Postdilutional Online Hemodiafiltration with Calcium-Containing Dialysate and Infusate: Significant Clotting in the Venous Bubble Trap
Authors: Buturovic-Ponikvar J. , Gubensek J. , Ponikvar R. 
Published: January 2018

Background The aim of this prospective clinical study was to assess safety and antithrombotic efficacy of a regional citrate anticoagulation protocol for postdilutional online hemodiafiltration (HDF) with calcium-containing dialysate and infusate. Methods Nineteen postdilutional online HDF procedures with citrate anticoagulation were performed in 9 end-stage renal disease patients. Calcium-containing (1.25 mmol/L) dialysate/infusate, 15% (0.51 mol/L) trisodium citrate and 1 mol/L calcium chloride (when necessary) were used; the blood flow was 300 ml/min. Antithrombotic effect was assessed visually after HDF at 3 points: the dialyzer, arterial bubble trap, and venous bubble trap, using a score of 5 (excellent anticoagulation) to 1 (total clotting). The study was terminated prematurely due to frequent clotting in the venous bubble trap. Results The mean duration of HDF was 4.3 ± 0.9 hours; infusion volume was 13 ± 2 L. Almost half of the HDF procedures (9/19, 47%) were completed with some difficulty: in 1 case (1/19, 5%) there was total system clotting; in the other 8 cases, system clotting was threatening and dialysis was terminated prematurely, but in only 4/19 cases (21%) prior to 4-hour duration. The main point of clot formation was the venous bubble trap (score 2.6 ± 1.0), while anticoagulation was very good at the dialyzer (4.0 ± 1.2) and excellent at the arterial bubble trap (4.8 ± 0.9). No side effects were noted, and metabolic consequences were moderate. Conclusions Regional citrate anticoagulation using calcium-containing dialysate/infusate during postdilutional online hemodiafiltration results in a high incidence of venous bubble trap clotting.
Willingness of Nigerian Healthcare Workers to Donate Kidneys
Authors: Agaba E. I. , Ocheke I. E. , Agaba P. A. , Idoko O. T. , Ugoya S. O. , Yerima Y. , Iroezindu M. 
Published: January 2018

Background The attitude of healthcare workers (HCW) towards organ donation is cardinal to the successful implementation and sustainability of transplant programs. We present the outcome of a survey among HCW in a single tertiary institution in Nigeria regarding their willingness to be living-related kidney donors. Methods Self-administered questionnaires were randomly distributed to HCW evaluating their attitude towards living-related kidney donation. Results Of the 650 questionnaires distributed only 502 responded (clinical medical students 51%, physicians 31.7% and nurses 17.3%); 75.6% of respondents were willing to be living donors while 5.8% were against it, and 18.5% were undecided. Multivariate analysis identified willingness to receive, perceived risk associated with kidney donation, and attitude towards cadaveric donation as independent predictors of willingness of HCW to be living donors. Conclusion Nigerian HCW have a positive attitude toward kidney donation.
Selective Albumin Exchange: A Novel and Simple Method to Remove Bilirubin
Authors: Gong D. , Ren B. , Ji D. , Tao J. , Xu B. , Liu Z. , Li L. 
Published: January 2018

Purpose Owing to its non-selectivity, plasma exchange has limited use in the treatment of patients with hepatic failure, although it is effective in removal of protein-bound toxins. This study reports a novel way to perform selective albumin exchange (SAE) by using a secondary plasma separator and aims to study its depurative capacity in the removal of bilirubin. Method In ex vivo experiments, the sieving coefficients (SCs) of plasma proteins for two secondary plasma separators, EC20W and EC30W (Asahi Medical, Tokyo, Japan), were measured. The EC20W membrane was chosen for use in clinical treatment because of its higher selectivity in separating albumin from plasma than the EC30W. The SCs of albumin, immunoglobumin G, A and M (IgG, IgA, IgM) for the EC20W were 0.3±0.021, 0.017±0.012, and 0, respectively. Five inpatients with plasma total bilirubin (TB) more than 200 μmol/L were enrolled in the present study and received a total of 10 SAE therapy sessions. Each session lasted 10 hours. SAE using the EC20W was conducted, making it similar to post-dilution continuous veno-venous hemofiltration (CVVH), with a filtrate rate of 2000 ml/h. Replacement fluid was composed by adding human albumin into conventional CVVH replacement fluid, with a final albumin concentration of 0.6%. During each treatment, the parameters of plasma and filtrate TB, direct bilirubin (DB), indirect bilirubin (IDB), and proteins were dynamically monitored. Hemostasis parameters were measured before and after sessions. Results The reduction ratio of plasma TB, DB, and IDB after a single session was 29.1±3.0%, 31.3±4.5%, and 18.7±10.2%, respectively. The clearance of TB at initiation was 11.1±1.3 mL/min and declined to 4.4±0.5 ml/min at the end (p<0.01). This decline was accompanied by a reduction in albumin SC from 0.3±0.021 to 0.13±0.05. The molar ratio of bilirubin to albumin in filtrate was comparable to that in plasma. After a single treatment, plasma protein concentration including total protein, albumin, IgA and IgM remained unaffected, except for globulin and IgG, which were reduced by 11.5±7.8% and 11.1±2.3%, respectively. An improvement in hemostasis parameters, including plasma fibrinogen, prothrombase time and INR, was found after treatment. No obvious side effects were reported during any of the sessions. Conclusion Selective albumin exchange is a simple and effective method to remove bilirubin. However, further studies are required to verify its effects on clinical outcome.
Functional Hepatocyte-Like Cells Derived from Human Bone Marrow Mesenchymal Stem Cells on a Novel 3-Dimensional Biocompatible Nanofibrous Scaffold
Authors: Kazemnejad S. , Allameh A. , Soleimani M. , Gharehbaghian A. , Mohammadi Y. , Amirizadeh N. , Esmaeili S. 
Published: January 2018

Aim To supporting growth and functional differentiation of adult stem cells into hepatocytes in a well-controlled manner, we performed differentiation of human bone marrow mesenchymal stem cells (hBMSCs) to hepatocytes-like cells on a constructed 3-dimensional (3D) nanofibrous biocompatible scaffold. Methods After characterization of the hBMSCs isolated from human bone marrow, the performance of the cells seeded and their proliferation on the scaffold was evaluated by scanning electron microscopy (SEM) and 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Different approaches such as immunocytochemistry, reverse transcriptase polymerase chain reaction (RT-PCR), and biochemical assays were used to estimate the ability of hBMSC-derived cells to express hepatocyte-specific markers. Results Scanning electron micrographs and MTT analysis revealed the cells were able to expand and remained biologically and metabolically active for 21 days. Immunocytochemical analysis of albumin and α-fetoprotein showing the accumulation of these markers in differentiated cells was confirmed by RT-PCR. Additional markers such as cytochrome P450 3A4, cytokeratin-18, and cytokeratin-19 detected by RT-PCR showed progressive expression during 3 weeks of differentiation on 3D scaffold. The hepatocyte-like cells displayed several characteristics of metabolic functions as judged by production of albumin, urea, transferrin, serum glutamic pyruvic transaminase (SGPT), and serum oxaloacetate aminotransferase (SGOT). Levels of above-mentioned markers, except SGOT in differentiated cells on scaffold, were found to be significantly greater than in the 2D culture system (p<0.05). Conclusion Overall data suggest that the engineered nanofibrous scaffold is a conductive matrix for functional hBMSC-derived hepatocyte-like cells and is promising for maintenance of hepatocytes suitable for implantation.
Thrice-Weekly In-Center Nocturnal Hemodialysis: An Effective Strategy to Optimize Chronic Dialysis Therapy
Authors: Cravedi P. , Ruggenenti P. , Mingardi G. , Sghirlanzoni M.C. , Remuzzi G. 
Published: January 2018

Objectives Daily nocturnal hemodialysis (NHD) has been proposed as a valuable strategy to improve outcomes for patients on conventional hemodialysis (CHD), but it is burdened by high costs and logistic issues. Thrice NHD might represent a more affordable approach to improve hemodialysis patient outcome. Methods Here we retrospectively analyzed the data on blood pressure, body weight, and hematochemical parameters in a cohort of 7 patients (mean age 50.4 ± 11.0 years, duration of CHD 14.3 ± 11.5 years) who registered in the NHD program at the dialysis unit of Ospedali Riuniti, Bergamo, Italy. Data for the 2 first years of NHD were compared with those of the last year on CHD. Results At 2 years after start of NHD, we found a significant decrease in systolic (149.4 ± 16.6 vs. 128.4 ± 26.0 mm Hg, p<0.001) and diastolic (87.7 ± 11.1 vs. 79.6 ± 16.7 mm Hg, p<0.05) blood pressure, along with a significant reduction in the use of per-patient antihypertensive agents (1.17 ± 1.19 vs. 0.47 ± 0.89, p<0.05) and an increase in dry body weight (61.4 ± 21.8 vs. 67.1 ± 16.4 kg, p<0.001). Moreover, patients had a significant reduction in phosphate levels (6.2 ± 2.4 vs. 5.4 ± 3.0 mg/dL, p<0.01). The procedure was safe and well tolerated and did not require extra cost for ad hoc facilities. Conclusion NHD is an effective approach to optimize chronic dialysis therapy.
Subjective Satisfaction and Quality of Life in Patients Prior to Listing for Liver Transplantation
Authors: Minazzato L. , Amodio P. , Cillo U. , Zanus G. , Schiff S. , Bombonato G. , Salari A. , Bianco T. 
Published: January 2018

Objectives Differences in health-related quality of life (HR-QoL) perception between alcohol-abusing and non-substance-dependent subjects with liver cirrhosis could depend on differences in personality profile and influence management of patients awaiting liver transplant. Methods We compared the perceptions of disease state in 78 male patients of similar disease severity divided into 2 groups based on etiology of cirrhosis: 47% had alcoholic cirrhosis, and 53% had hepatitis C virus (HCV)-related cirrhosis without alcohol abuse. Patients’ perception of disease state was determined using the SAT-P questionnaire (a self-administered questionnaire that provides a global assessment of perceived HR-QoL and subjective well-being). The assessment yields 2 scales: an analytic scale based on 32 variables and a synthetic scale based on 5 factors. Results In patients with alcohol-related disease, “psychological function” was found to be more impaired, while “sleep, diet, and free time” was less impaired compared with subjects with HCV-related cirrhosis, suggesting dysfunction related to substance abuse with personality disturbance. Conclusions The perception of disease state is different in alcohol-abusing patients with cirrhosis compared with those with cirrhosis unrelated to alcohol.
Application of Wavelet Analysis to the Phonocardiographic Signal of Mechanical Heart Valve Closing Sounds
Authors: Bagno Andrea , Anzil Federico , Tarzia Vincenzo , Pengo Vittorio , Ruggeri Alfredo , Gerosa Gino 
Published: January 2018

Heart valve disorders, caused by congenital defects, rheumatic fever, calcification, myocardial infarction and other cardiovascular diseases, often require native valves to be replaced by bio-prosthetic devices or mechanical heart valves (MHVs). Among MHVs, bileaflet valves are usually preferred for their hemodynamic features, similar to physiological ones, and their durability, but they are prone to complications due to thromboembolic events. Due to the asynchronous closure of the leaflets, bileaflet MHVs are also known to produce closing sounds typically characterized by the presence of two peaks in the time domain. The detection of this “double click” in the signal may be useful for the early diagnosis of bileaflet MHV malfunction. The closing sound is actually a non-stationary signal that can be properly explored by means of time-frequency analysis. This paper describes a preliminary approach to the investigation of bileaflet MHV closing sounds performed by Continuous Wavelet Transform (CWT) analysis. Signals were collected from 3 patients immediately after surgery by means of the Myotis 3C, which is a traditional phonocardiographic apparatus. Signals were analyzed by two algorithms: one embedded in the Myotis 3C, based on the Fast Fourier Transform (FFT); and one specifically created for the purposes of the present study, based on CWT. The performance of these algorithms was compared and the results showed that the proposed CWT technique correctly classifies as “double” a large number of clicks that are recognized as “single” by the Myotis 3C.
Occupational Stress is Associated with Impaired Work Ability and Reduced Quality of Life in Patients with Chronic Kidney Failure
Authors: Neri Luca , Rey Lisa A. Rocca , Gallieni Maurizio , Brancaccio Diego , Cozzolino Mario , Colombl Antonio , Burroughs Thomas E. 
Published: January 2018

Background About 300,000 patients in the United States with Chronic Kidney Failure (CKF) are of working age, but up to 70% lose their job within the first year of renal replacement therapy. No study has examined how work ability and perceived health are influenced by the subjects’ adjustment to their job. We assessed the association of occupational stress (Effort-Reward Imbalance, ERI), work ability (WAI) and health-related quality of life (QoL) in hemodialysis. Methods 40 employed hemodialysis patients completed a self-administered questionnaire. Associations between ERI, Short Form 12 (SF-12), Short Form - 6 Dimensions (SF-6D), Kidney Disease QOL - 36 (KDQOL-36) and WAI were tested with partial Spearman's correlation adjusted for age, income, and comorbidity burden. Results Study subjects were mainly low-income (82%), African-American (73%), men (75%); 16 were manual laborers and 9 worked in the industrial sector. Study subjects reported low levels of Occupational Stress: ERI scores indicated an imbalance between Job Efforts and Rewards in only 3 subjects. Nevertheless, ERI scores were inversely and strongly associated with WAI (ρ=-0.41, p<0.012) and all QoL scales even after adjustment for known confounders. Conclusion Our study suggests that psychosocial workplace factors may play a substantial role in modulating patients’ health perception and ability to continue working. The causal relationship between Occupational Stress, perceived health, and work ability should be further investigated. Occupational Health professionals and nephrologists should closely collaborate to meet the needs of occupationally active hemodialysis patients.
Functional Evaluation of the Endotics System, a New Disposable Self-Propelled Robotic Colonoscope: in vitro tests and clinical trial
Authors: Cosentino Felice , Tumino Emanuele , Passoni Giovanni Rubis , Morandi Elisabetta , Capria Alfonso 
Published: January 2018

Objective Currently, the best method for CRC screening is colonoscopy, which ideally (where possible) is performed under partial or deep sedation. This study aims to evaluate the efficacy of the Endotics System, a new robotic device composed of a workstation and a disposable probe, in performing accurate and well-tolerated colonoscopies. This new system could also be considered a precursor of other innovating vectors for atraumatic locomotion through natural orifices such as the bowel. The flexible probe adapts its shape to the complex contours of the colon, thereby exerting low strenuous forces during its movement. These novel characteristics allow for a painless and safe colonoscopy, thus eliminating all major associated risks such as infection, cardiopulmonary complications and colon perforation. Methods An experimental study was devised to investigate stress pattern differences between traditional and robotic colonoscopy, in which 40 enrolled patients underwent both robotic and standard colonoscopy within the same day. Results The stress pattern related to robotic colonoscopy was 90% lower than that of standard colonoscopy. Additionally, the robotic colonoscopy demonstrated a higher diagnostic accuracy, since, due to the lower insufflation rate, it was able to visualize small polyps and angiodysplasias not seen during the standard colonoscopy. All patients rated the robotic colonoscopy as virtually painless com-pared to the standard colonoscopy, ranking pain and discomfort as 0.9 and 1.1 respectively, on a scale of 0 to 10, versus 6.9 and 6.8 respectively for the standard device. Conclusions The new Endotics System demonstrates efficacy in the diagnosis of colonic pathologies using a procedure nearly completely devoid of pain. Therefore, this system can also be looked upon as the first step toward developing and implementing colonoscopy with atraumatic locomotion through the bowel while maintaining a high level of diagnostic accuracy.