bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bacterial Communications in Implant Infections: A Target for an Intelligence War
Authors: Costerton J.W. , Montanaro L. , Arciola C.r. 
Published: January 2018

The status of population density is communicated among bacteria by specific secreted molecules, called pheromones or autoinducers, and the control mechanism is called “quorum-sensing”. Quorum-sensing systems regulate the expression of a panel of genes, allowing bacteria to adapt to modified environmental conditions at a high density of population. The two known different quorum systems are described as the LuxR-LuxI system in gram-negative bacteria, which uses an N-acyl-homoserine lactone (AHL) as signal, and the agr system in gram-positive bacteria, which uses a peptide-tiolactone as signal and the RNAIII as effector molecules. Both in gram-negative and in gram-positive bacteria, quorum-sensing systems regulate the expression of adhesion mechanisms (biofilm and adhesins) and virulence factors (toxins and exoenzymes) depending on population cell density. In gram-negative Pseudomonas aeruginosa, analogs of signaling molecules such as furanone analogs, are effective in attenuating bacterial virulence and controlling bacterial infections. In gram-positive Staphylococcus aureus, the quorum-sensing RNAIII-inhibiting peptide (RIP), tested in vitro and in animal infection models, has been proved to inhibit virulence and prevent infections. Attenuation of bacterial virulence by quorum-sensing inhibitors, rather than by bactericidal or bacteriostatic drugs, is a highly attractive concept because these antibacterial agents are less likely to induce the development of bacterial resistance.
Is β2-Microglobulin-Related Amyloidosis of Hemodialysis Patients a Multifactorial Disease? a New Pathogenetic Approach
Authors: Cianciolo G. , Colì L. , La Manna G. , Donati G. , D'addio F. , Comai G. , Ricci D. , Dormi A. , Wratten M. , Feliciangeli G. , Stefoni S. 
Published: January 2018

Purpose β2-microglobulin amyloidosis (Aβ2M) is one of the main long-term complications of dialysis treatment. The incidence and the onset of Aβ2M has been related to membrane composition and/or dialysis technique, with non-homogeneous results. This study was carried out to detect: i) the incidence of bone cysts and CTS from Aβ2M; ii) the difference in Aβ2M onset between cellulosic and synthetic membranes; iii) other risk factors besides the membrane. Methods 480 HD patients were selected between 1986 to 2005 and grouped according to the 4 types of membranes used (cellulose, synthetically modified cellulose, synthetic low-flux, synthetic high-flux). The patients were analyzed before and after 1995, when the reverse osmosis treatment for dialysis water was started at our center, and the incidence of Aβ2M was compared between the two periods. Routine plain radiography, computer tomography (CT) and nuclear magnetic resonance imaging (MRI) as well as electromyography were used to investigate the clinical symptoms. Results Bone cysts occurred in 29.2% of patients before 1995 vs. 12.2% after 1995 (p<0.0001). CTS occurred in 24% of patients before 1995 vs. 7.1% after 1995 (p<0.0001). Bone cysts and CTS occurred in older patients, who began dialysis at a late age, with high CRP, low albumin, low residual GFR, and low Hb. Cox regression analysis showed that the risk factor for bone cysts was high CRP (RR 1.3, p<0.01), while albumin (RR 0.14, p<0.0001) and residual GFR (RR 0.81, p<0.0001) were revealed to be protective factors. Cox analysis for CTS confirmed CRP as a risk factor (RR 1.2, p<0.01), and albumin (RR 0.59, p<0.0001) and residual GFR (RR 0.75, p<0.0001) as protective factors. The comparison obtained between membranes did not suggest any protective effect on Aβ2M. Conclusions The findings that the inflammatory status as well as low albumin and the residual GFR of the uremic patient are predictive of Aβ2M lesions suggests that Aβ2M has a multifactorial origin rather than being solely a membrane- or technique-related side effect.
The Curative Effect of ALSS on 1-month Mortality in AoCLF Patients after 72 to 120 Hours
Authors: Chen Y.-S. , Wu Z.-W. , He J.-Q. , Yu J. , Yang S.-G. , Zhang Y.-M. , Du W.-B. , Cao H.-C. , Li L.-J. 
Published: January 2018

Background Hepatitis B virus (HBV)-related acute-on-chronic liver failure (AoCLF) is associated with a high mortality rate. An artificial liver support system (ALSS) creates a better environment for the self-regeneration of retained hepatocytes. Aim and Patients We investigated the curative effect of ALSS on 1-month mortality at 72–120 h post-ALSS in 289 AoCLF patients. Methods Of the 289 patients, 117 who survived for at least 1 month post-ALSS comprised the survival group; the remaining cases who died within 1 month served as controls. The improvements in laboratory data and clinical syndromes at 72–120 h post-ALSS were compared with those at 24 h. Results Total bilirubin, international normalized ratio, and creatinine levels, and encephalopathy were significantly improved at 24 h post-ALSS in both the groups (p<0.05); however, these variables showed deterioration at 72–120 h; a rebound occurred in the nonsurvivors (p>0.05). The improvements in these variables in the nonsurvivors were considerably smaller than those in the survivors (p<0.05), particularly at 72–120 h. One-month mortality was more accurately predicted by the logistic regression model at 72–120 h than at 24 h. Conclusions The prognosis of AoCLF patients was highly dependent on the improvement in encephalopathy, total bilirubin, international normalized ratio, and creatinine levels at 72–120 h post-ALSS. These variables are useful, therefore, as disease severity indexes to determine organ allocation priorities for liver transplant.
Rheopheresis in Vascular Diseases
Authors: Ferrannini M. , Vischini G. , Staffolani E. , Scaccia F. , Miani N. , Parravano M.C. , Louis M.M. , Splendiani G. , Di Daniele N. 
Published: January 2018

Background Endothelial dysfunction is a common condition in many microvascular diseases, such as Age-related Macular Degeneration (AMD) and Peripheral Arterial Occlusive Disease (PAOD). Rheopheresis therapy improves ematic viscosity, shear stress and endothelial function while decreasing fibrinogen, LDL-cholesterol and alpha-2-macroglobulin levels. Objective To evaluate the therapeutic efficacy of rheopheresis in patients with microcirculatory diseases. Materials and Methods Eight patients (7 male and 1 female) were treated with rheopheresis: 3 males were affected by AMD, 4 male and 1 female by uremia and PAOD. We used Membrane Differential Filtration (MDF) with an ethinylvinylalcohol copolymer membrane as plasmafiltrator. Patients with AMD were treated once a week for ten weeks. Patients affected with PAOD were treated twice weekly for 3 weeks and then were placed on a once-a-week program. Results In all treated patients with AMD, visual acuity improved. In all patients affected with PAOD, we observed a complete resolution of pain; 3 out of 5 had a complete remission of ulcers. There was partial reduction of ulcers in the other patients and no adverse effects were observed. Conclusion: Rheopheresis is a safe, effective form of hemorheotherapy
The Association of the Sodium “Setpoint” to Interdialytic Weight Gain and Blood Pressure in Hemodialysis Patients
Authors: Keen M. L. , Gotch F. A. 
Published: January 2018

Introduction Hemodialysis patients lack the normal mechanisms to regulate body water volume and osmolality The dialysis treatment is expected to adequately regulate both body water volume and body Na+ content, which is the primary action determining body water osmolality Data in subjects with normal renal function indicate that an individual has a specific osmolality value above which thirst is generated and fluid will be ingested. This specific osmolality value or “setpoint” varies among individuals, but is quite reproducible within an individual. It was postulated that hemodialysis patients also may have a Na+ “setpoint”, which if increased by the use of higher dialysate Na+ concentration, might be associated with increased interdialytic weight gain and blood pressure. Methods Monthly laboratory and treatment data were abstracted on 58 hemodialysis patients and included pre- and post-dialysis serum Na+ concentrations, interdialytic weight gain and blood pressure over 9 to 16 months. The Na+ concentrations were averaged to determine the individual Na+ “setpoint” and the Na+ gradient (Dialysis Na+ concentration - mean Na+ concentraton) was determined for each patient. Results Linear regression analyses showed that there was a statistically significant association between the magnitude of the Na+ gradient and interdialytic weight gain and blood pressure. Conclusions These data suggest that interdialytic weight gain in individual patients may be associated with the use of dialysate Na+ concentration in excess of the patient's desired Na+ “setpoint”. More individualization of dialysate Na+ concentration may be indicated.
The Impact of Visceral Mass on Survival in Chronic Hemodialysis Patients
Authors: Kotanko P. , Levin N. W. 
Published: January 2018

In chronic hemodialysis, patient survival is positively correlated with body weight and body mass index (BMI). This relationship extends even to obese patients with a BMI >30 kg/m. We have put forward the hypothesis that this survival benefit may be due to a lower average synthesis rate of uremic toxins (expressed as amount per time per unit of body weight) in larger patients, because the relative contribution of the high metabolic rate organs (HMRO) to body weight in these patients is lower and HMRO are most likely to be the prime source of uremic toxins. In addition, the average uremic toxin concentration in larger patients may be lower because of the larger distribution volume. Based on these assumptions, a better survival in patients with a lower HMRO to body weight fraction (HMRO%BW) can be predicted. To test this hypothesis we estimated gender- and race-specific HMRO mass by means of recently published regression models in 2,004 incident hemodialysis patients. Cox proportional hazards models were used to assess the association between age, serum albumin concentration, eKt/V, and HMRO%BW and mortality. High HMRO%BW was significantly associated with increased mortality (hazard ratio 1.323 [95% CI: 1.186 to 1.477]). Mean survival time was longest in the low HMRO%BW tertile (1,031 days [95%CI: 974 to 1,087]), 935 days [95%CI: 886 to 984] in the middle, and 876 days [95%CI: 825 to 926] in the high HMRO%BW tertile (p<0.0001; log rank test). These results support the hypothesis predicting that a low HMRO mass per unit of weight confers a beneficial effect on survival.
Cardiovascular Risk in Hemodialysis Patients: A Mechanistic Approach
Authors: House A. A. , Ronco C. 
Published: January 2018

A new formula is proposed to express the excess burden of cardiovascular risk faced by hemodialysis patients as a function of various inherent, acquired and potentially modifiable factors. The proposed equation CVRHD = CVRB X f(([CKD+HD]/[HDtech+Dr])+X) includes the terms: CVRHD (cardiovascular risk in hemodialysis patients); CVRB (baseline cardiovascular risk); CKD (risk associated with chronic kidney disease); HD (risks associated with the process of hemodialysis); HDtech (benefits of new hemodialysis technologies); Dr (benefits of drug therapies) and X (unknown or putative factors influencing cardiovascular morbidity). We review the various factors included in this proposed formula, touching upon the epidemiology, pathophysiology and therapeutic implications, including possible strategies to modify risk. As is apparent from the formula, CKD and HD in particular act as risk multipliers in augmenting or amplifying the baseline cardiovascular risk, while new hemodialysis technologies may provide an opportunity for “cardioprotective dialysis.” Drug treatment may serve to mitigate some of the risk unique to this population.
Gas Exchange in a Virtual Respiratory System -Simulation of Ventilation without Lung Movement
Authors: Golczewski T. 
Published: January 2018

Aims The aim of this study was to supplement a previously developed virtual respiratory system (RS) with gas exchange and gas transfer in airways and circulation (GETAC); and to analyze arterial blood oxygenation during apnea when pure O2 is the ambient gas, with and without extracorporeal CO2 removal (ER), for different inspiratory O2 fractions (FiO2) before respiratory halt. Methods The virtual RS consists of the RS mechanics model and a model of GETAC consisting of three modules. The values of the model parameters correspond to the average values for a human being, which gave the “standard” virtual patient. This patient was artificially ventilated in supine position with FiO2=20%, 27%, and 34%, and then the respiration was stopped, FiO2 was changed to 99%, and ER was activated or not. The percent of oxygenated hemoglobin (HbO2%) and alveolar partial pressure of O2 (PAO2) were analyzed during 40 minutes after the beginning of apnea. Both cardiac output and oxygen consumption was assumed to be independent from HbO2%. Results Without ER, HbO2% decreased from 98% to 90% when FiO2=34% before apnea, while it decreased below the safety level (70%) for smaller FiO2. However, if ER was activated, HbO2% fell to 76%, 94%, and 97% from 95%, 97%, and 98%, respectively. For FiO2=27%, PAO2 was equal to 15.9, 15.1, 14.3, and 13.6 kPa after 10, 20, 30, and 40 minutes after the beginning of apnea, respectively. Thus, in the case of this particular (“standard”) patient, FiO2=27% before apnea and FiO2=99% during apnea provides proper blood oxygenation with approximately normal PAO2 if ER is activated. Conclusions If ER is available, it is possible to keep both sufficient blood oxygenation and a normal level of CO2 in the blood as well as a relatively low partial pressure of toxic O2 in the lungs without cyclic mechanical action on the diseased lungs or chest.
A Pilot Randomized Controlled Comparison of Extended Daily Dialysis with Filtration and Continuous Veno-Venous Hemofiltration: Fluid Removal and Hemodynamics
Authors: Baldwin I. , Bellomo R. , Naka T. , Koch B. , Fealy N. 
Published: January 2018

Objectives Extended intermittent dialytic techniques are increasingly being reported in the treatment of ARF in the ICU but few randomized controlled trials exist. We compared one such technique to a technique of continuous renal replacement therapy with regard to fluid removal and hemodynamics. Methods Sixteen critically ill patients with ARF were enrolled in a randomized controlled trial at the ICU of a tertiary hospital. We randomized eight patients to three consecutive days of treatment with either Extended Daily Dialysis with filtration (EDDf) or Continuous Veno-Venous Hemofiltration (CVVH) and compared fluid removal and hemodynamics during treatment. Results A total of 16.6 liters of fluid were removed during EDDf (830 mL/day over 20 treatment days) compared with 15.4 liters (700 ml/day over 22 treatment days) during CVVH. Median fluid removal per day was 1837 mL in the EDDf group compared with 1410 mL per day in the CVVH group, p=0.674. Median hourly fluid removal rate was 252 mL for EDDf and 128 mL for CVVH (p<0.01). Mean arterial pressure in the EDDf group was lower at two hours after starting treatment (76 mmHg vs. 94 mmHg) in the CVVH group; p= 0.031. There was no significant difference between groups for heart rate, CVP and noradrenaline dose at all time intervals measured. Conclusions Adequate prescribed fluid removal was achieved with both techniques. However, as expected, fluid was removed at a faster rate during EDDf. This was initially associated with a lower blood pressure than during CVVH where blood pressure increased.
The Effect of Vascular Access Location and Size on Circuit Survival in Pediatric Continuous Renal Replacement Therapy: A Report from the PPCRRT Registry
Authors: Hackbarth R. , Bunchman T. E. , Chua A. N. , Somers M. J. , Baum M. A. , Symons J. M. , Brophy P. D. , Blowey D. , Fortenberry J. D. , Chand D. , Flores F. X. , Alexander S. R. , Mahan J. D. , McBryde K. D. , Benfield M. R. , Goldstein S. L. 
Published: January 2018

Purpose Well-functioning vascular access is essential for the provision of adequate CRRT However, few data exist to describe the effect of catheter size or location on CRRT performance in the pediatric population. Methods Data for vascular access site, size, and location, as well as type of anticoagulant used and patient demographic data were gathered from the ppCRRT registry. Kaplan-Meier curves were generated and then analyzed by log-rank test or Cox Proportional Hazards model. Results Access diameter was found to significantly affect circuit survival. None of the 5 French catheters lasted longer than 20 hours. Seven and 9 French, but not 8 French, catheters fared worse than larger diameter catheters (p=0.002). Circuits associated with internal jugular access survived longer than subclavian or femoral access associated circuits (p<0.05). Circuit survival was also found to be favorably associated with the CVVHD modality (p<0.001). Conclusions Functional CRRT circuit survival in children is favored by larger catheter diameter, internal jugular vein insertion site and CVVHD. For patients requiring catheter diameters less than 10 French, CRRT circuit survival might be optimized if internal jugular vein insertion is feasible. Conversely, when a vascular access site other than the internal jugular vein is most prudent, consideration should be given to using the largest diameter catheter appropriate for the size of the child. The CVVHD modality was associated with longer circuit survival, but the mechanism by which this occurs is unclear.
Successful Pregnancy in a Uremic Patient Treated with Single Needle Hemodialysis
Authors: Ferrannini M. , Vischini G. , Miani N. , Staffolani E. , Di Daniele N. 
Published: January 2018

Background Pregnancy is uncommon in patients on maintenance hemodialysis (HD) and it carries a high risk of fetal and maternal complications. Several reports have shown that application of an intensive dialysis regimen is associated with improved infant survival and better clinical conditions of the mother. Methods We report the case of a 35-year-old black woman with a prosthesic cardiac valve who was treated daily with single needle HD because of difficult vascular access. Result A healthy full-term female infant with a normal birth weight was electively delivered at 37 weeks. We did not register any complications during or after pregnancy. Conclusion In our experience, single needle HD is able to provide the patient with adequate depuration during pregnancy, the delivery of a full-term healthy infant, and preservation of the arterial-venous fistula from twice-daily vein puncture.
Impaired Brachial Artery Endothelial Flow-Mediated Dilation and Orthostatic Stress in Hemodialysis Patients
Authors: Gallieni M. , Butti A. , Guazzi M. , Galassi A. , Cozzolino M. , Brancaccio D. 
Published: January 2018

Purpose Chronic kidney disease (CKD) is associated with an impaired endothelial function, which may contribute to cardiovascular events. Whether impairment in endothelial function is involved in the circulatory response to orthostatic stress is unknown. We assessed endothelial function via brachial artery flow-mediated dilation (BAFMD), an index of endothelial-dependent vasodilation. Methods We measured changes in brachial artery diameter (BAD) and blood flow by Doppler ultrasound in 35 CKD patients on hemodialysis, 37 young healthy controls (HC) and 50 non-uremic matched controls (MC), in the supine position and after 60° head-up tilting (HUT). Results: In the supine position, endothelial flow-mediated BAD was significantly increased in HC (P<0.001) and MC (P<0.01) while no significant changes were detected in CKD. Mean percent blood flow changes were HC+323.5%, MC+195.1% and CKD+158.8% (HC vs. CKD P<0.001; HC vs. MC P<0.001; MC vs. CKD p=0.04). Similarly, during HUT mean BAD and blood flow increases were significantly impaired in CKD patients. Conclusion In CKD patients, an impaired response in the physiologic vascular reactivity, suggesting endothelial dysfunction, was found in the supine position and after orthostasis by BAFMD. Our results are in favor of a possible adjunctive role of uremia in the abnormal brachial artery response. (Int J Artif Organs 2008; 31: 34–42)
Evaluation of a Hybrid Artificial Liver Module with Liver Lobule-Like Structure in Rats with Liver Failure
Authors: Aoki K. , Mizumoto H. , Nakazawa K. , Funatsu K. , Kajiwara T. 
Published: January 2018

We studied the recovery of rats with fulminant hepatic failure (FHF) by treating them with our original hybrid artificial liver support system (HALSS). We developed an original artificial liver module having a liver lobule-like structure (LLS). This module consists of many hollow fibers regularly arranged in close proximity and hepatocyte aggregates (organoids) induced into the extra capillary space of the module by centrifugal force. The LLS module can express some liver specific functions at high levels and maintain them for several months in vitro. In this study, we evaluated the efficacy of our LLS-HALSS by using rats with FHF induced by a method that combined partial hepatectomy with hepatic ischemia. In the animal experiments, blood ammonia levels rapidly increased in the control group (sham-HALSS group). These rats died during or immediately after application of the sham-HALLS. On the other hand, in the LLS module application group (LLS-control group), the increase in blood ammonia was completely suppressed and all rats recovered. Blood constituents at 4 weeks after application were at normal levels, and the weight of the liver was the same as that of a normal rat. These results indicate that HALSS may be useful for treating liver failure patients until liver transplantation can be performed or until regeneration of the native liver occurs. (Int J Artif Organs 2008; 31: 55–61)
Electrospun Bioresorbable Heart Valve Scaffold for Tissue Engineering
Authors: Del Gaudio C. , Grigioni M. , Bianco A. , De Angelis G. 
Published: January 2018

Currently marketed mechanical or biological prosthetic heart valves are regarded as valid substitutes for native heart valves suffering from degenerative pathologies. These devices require strict follow-up due to dysfunctions or post-surgical complications. Potential drawbacks of these medical devices are calcification, tearing of the cusps, thromboembolism and hemolysis. In this context, a tissue engineering approach offers a promising alternative scenario. In this paper, a trileaflet poly(∊-caprolactone) (PCL) heart valve scaffold prototype has been manufactured by electrospinning technique using a custom-made rotating target. Process parameters were selected in order to achieve suitable microstructure and mechanical performance. The electrospun heart valve prototype was functionally characterized by means of a pulse duplicator in order to evaluate the mechanical/hydraulic response to the imposed testing conditions. Leaflets synchronously opened in the ejection phase and the proper apposition of the leaflets prevented high leakage volumes in the diastolic phase. This preliminary study suggests a successful perspective for the proposed approach in designing a novel tissue engineered bioresorbable heart valve.