bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Hemodialysis and Dialyzer Biocompatibility on Erythrocyte Glutathione-Defense System in Chronic Hemodialysis Patients
Authors: Alhamdani M.S. , Al-Najjar A.F. , Al-Kassir A.H. 
Published: January 2018

Background Uremic patients, especially those receiving regular hemodialysis (HD) treatment, are at high risk of oxidative damage by noxious free radicals and reactive oxygen species (ROS). The erythrocyte glutathione-defense system (GSH-DS) is one of the major enzymatic means of scavenging and detoxifying ROS. This study aimed to elucidate the effect of HD and dialyzer biocompatibility on erythrocyte GSH-DS in uremic patients on maintenance HD treatment. Methods Twenty-five healthy volunteers and 42 HD patients were enrolled in this study. Blood samples were drawn immediately before and after HD session, and erythrocyte glutathione (GSH) level as well as the activities of the enzymes glucose-6-phosphate dehydrogenase (G6PD), glutathione peroxidase (GSH-Px), glutathione reductase (GSSG-Rd), and glutathione S-transferase (GST) were measured. To evaluate the effect of dialyzer type on the studied parameters the patients were were subdivided into two groups: those who had dialysis with cuprophane (CU) membranes (n=23) and those who received dialysis with the aid of polysulfone (PS) membranes (n=19). Results The activities of G6PD and GSH-Px as well as GSH level were significantly decreased in HD patients as compared with controls. On the other hand, the activities of GSSG-Rd and GST were significantly elevated among HD patients in comparison with control values. A single HD session, regardless of the type of dialyzer, did not induce any significant effect on any of the measured parameters, although G6PD activity increased significantly after dialysis. CU membrane did not result in any change in GSH or its metabolizing enzymes, while PS dialyzers exerted a minor but significant restoration in GSH-DS. Conclusion The antioxidant pool, as represented by GSH-DS, is significantly affected by dialyzer type in HD patients being significantly corrected with polysulfone dialyzer.
Development of Microporous Covered Stents: Geometrical Design of the Luminal Surface
Authors: Nakayama Y. , Nishi S. , Ishibashi-Ueda H. , Okamoto Y. , Nemoto Y. 
Published: January 2018

To reduce in-stent restenosis rates we have developed newly designed covered stents, in which a stent strut is buried into a microporous elastomeric cover film to provide a physical barrier against tissue ingrowth and a pharmacological reservoir for drug-eluting. The covered stents were prepared by dip-coating balloon expandable stents mounted on a stainless steel rod in a segmented polyurethane (SPU) solution, and were subsequently subjected to laser-processed microporing (pore diameter, 100 μm; interpore distance, 200 μm). The covered stents, which possessed flat luminal surfaces and micropores that were homogeneously arranged on the whole surface of the covering film, were deployed into the bilateral common carotid arteries of normal New Zealand white rabbits. Angiography after one month of implantation showed all stents were patent with little thrombus formation. The mean thickness of the formed neointimal layers was 292 ± 177 μm (n=8), which was close to the size in non-covered bare stent (231 ± 58 μm, n=7), but markedly decreased (about 2/3) from that in the previously developed wrapping-type covered stents (415 ± 173 μm, P<0.01, n=8).
Assessment and Improvement of Liver Specific Function of the AMC-Bioartificial Liver
Authors: Van De Kerkhove M.P. , Poyck P.P.C. , Van Wijk A.C.W.A. , Galavotti D. , Hoekstra R. , Van Gulik T.M. , Chamuleau R.A.F.M. 
Published: January 2018

The variety of methods for measuring bioactive mass and functionality of bioartificial livers (BAL) is confusing and prevents accurate comparison of reported data. Here we present a comparison of different hepatocyte quantification methods and propose that estimation of cell pellet volume after centrifugation generates a reliable, useful and fast method. In addition a correlation is made between several function tests performed in 26 bioreactors to assess their predictive value. The ammonia eliminating capacity was found to be most predictive for other liver functions, except for lidocaine elimination as a measure of mixed function oxidase activity, which should therefore be determined separately. The oxygen consumption test proved to be an easy and predictive parameter as well. The first generation of our BAL system needed further development to assure optimal treatment of acute liver failure (ALF) patients. Changes in the porcine hepatocyte isolation method and bioreactor loading as well as changes in bioreactor configuration, including use of different materials, resulted in a significantly improved level and maintenance of in vitro BAL function. A fourfold increase in ammonia eliminating capacity, which is only reduced to 75% after seven days of culturing, offers promising prospects for further clinical application. Conclusion The current second generation of our BAL and improvement of hepatocyte isolation and testing protocols have led to a significant increase in the level as well as the maintenance of hepatocyte specific function in our BAL. Finally, consensus on definition of the bioactive mass to be loaded in the bioreactor and insight in the variation and reliability of the functional and metabolic parameters enhances comparison of the different types of bioartificial livers presented in literature.
Microcirculation as a Novel Marker of Membrane Biocompatibility
Authors: Teatini U. , Ballerini L. , Romei Longhena G. , Savino R. , Maltagliati L. , Masi F. , Colombo R. , Cimino R. , Manfredi A. 
Published: January 2018

Background It is possible to consider microcirculation as a kind of “witness” of the complex biological reactions triggered by the dialytic treatment. The reactivity of microcirculation to the dialytic stress may represent a measure of the overall biocompatibility of the membrane. In this study we tested the hypothesis that different synthetic membranes may have different biological effects, particularly related to microcirculation. Subjects and Methods In this crossover study, we observed 16 chronically hemodialyzed patients. All patients were treated with the EVAL membrane; we recorded the TcPO2 during the second treatment of the week. All patients were then switched to the hf-PS membrane. During the study observation we did not change the dialytic prescription or the pharmacologic treatment. Results From the beginning of the session until 90', the behavior of TcPO2 is similar for both the membranes. From 120' to the end of the treatment in sessions with the EVAL membrane, the TcPO2 values come back to the starting level, whereas in the treatments with hf-PS the TcPO2, the values remain at a lower level; there was a significant difference between EVAL and hf-PS in the values recorded. Arterial blood gas values of paO2 and paCO2 are quite similar in the treatments with both the membranes, without any significant difference. Conclusions The analysis of microcirculation by means of TcPO2 measurement is a useful tool to obtain a “clinical” measure of biocompatibility of the dialytic treatment and different membranes may have different impacts on TcPO2.
Reduced Complications during Hemodialysis by Automatic Blood Volume Controlled Ultrafiltration
Authors: Garzoni D. , Keusch G. , Kleinoeder T. , Martin H. , Dhondt A. , Cremaschi L. , Tatsis E. , Ibrahim N. , Boer W. , Kuehne S. , Claus M. , Zahn M. , Schuemann E. , Engelmann J. , Hickstein H. , Wojke R. , Gauly A. , Passlick-Deetjen J. 
Published: January 2018

Background Intradialytic morbid events (IMEs, mostly hypotension) are frequent complications during hemodialysis (HD). This study investigated whether automatic feedback control via adjustment of the ultrafiltration rate reduces IME frequency. Methods In this multi-center cross-over study, 56 hypotension-prone patients were treated both with standard HD (sHD, applying a constant ultrafiltration rate) and HD applying a blood volume controlled ultrafiltration rate (cHD). The relative blood volume (RBV) was continuously monitored. The individual relative blood volume limit (RBVcrit) was determined from the measured RBV during initial sHD. During cHD, the ultrafiltration rate was automatically adjusted to keep the actual RBV above RBVcrit. Results In 3,081 HD treatments, slightly fewer IMEs were observed during cHD than during sHD (0.785±0.613 versus 0.695±0.547 per treatment, P=0.144). Less symptomatic events were seen during cHD: -13% for symptomatic hypotension (0.594 versus 0.685 per treatment, P=0.120), and -32% for cramps (0.049 versus 0.072 per treatment, P=0.009). Thirty-one patients with the highest IME rate (IME in at least every second treatment) especially benefited from cHD: 1.185±0.554 versus 0.979±0.543 IME per treatment (P=0.004). The reduction in blood pressure (BP) and the increase in heart rate were lower during the treatments with cHD than with sHD: systolic BP: -18.8±26.7 versus -22.2±28.9 mmHg (P=0.007), diastolic BP: -7.8±14.8 versus -9.1±15.3 mmHg (P=0.064), heart rate: 1.8±10.4 versus 2.3±11.6 per minute (P=0.014). Neither treatment duration nor ultrafiltration volume was significantly different between cHD and sHD. Conclusion For cHD, less intradialytic morbid events were observed than for sHD, and pre- to post-dialytic changes in blood pressure and heart rate were less pronounced.
Prevalence of the Metabolic Syndrome in Hemodialysis
Authors: Tsangalis G. , Papaconstantinou S. , Kosmadakis G. , Valis D. , Zerefos N. 
Published: January 2018

Background Recently, the concept of the metabolic syndrome (MS) has emerged in an effort to group and study as a whole several cardiovascular risk factors. The definition of the metabolic syndrome requires the presence of 3 or more of the following parameters: high blood pressure (≥30/85), waist circumference >102 cm in men and >88 cm in women, HDL<50 mg/dL in men and <40 mg/dL in women, serum triglycerides >150 mg/dL and fasting blood glucose ≥110 mg/dL. Objectives: To investigate the prevalence of the MS and the specific patient characteristics in a cohort of hemodialysis patients. Mterials and Methods 102 stable patients on maintenance hemodialysis (63 male/39 female with a mean time on dialysis of 57.19 ± 47.16 months) were studied for 12 months. Results The prevalence of the MS is high (56.25%) during the first year on dialysis and gradually declines (44.8% from 2–5 years and 29.7% for >5 years). In total 41/102 patients had MS (40.19%); 28/41 were men (68.29%) and 13/41 women (31.7%). The prevalence of MS in males was 44.4% (28/63) and 33.3% (13/39) in females, while the most frequent combination of risk factors in MS patients was high blood pressure-high waist circumference-high levels of serum triglycerides (36.58%). Serum triglycerides >150 mg/dL is the most frequent component of the MS both in well-nourished patients and according to the duration of dialysis (58.53% for 0–5 years and 19.51% for >5 years on dialysis). MS patients had a better nutritional status and were on dialysis for less time than their non-MS (NMS) counterparts. Actual or anamnestic cardiovascular events and infections did not differ between the 2 groups. Conclusions Our study provides new data concerning the prevalence of the MS and the specific patient characteristics in a hemodialysis population. The prevalence of MS in hemodialysis patients is high (40.19%) and seems to reflect a state of good nutrition compared to patients without the MS. Furthermore, the MS is more common in the first years of dialysis (42.46±34.29 months) than later on (67.25±52.15 months) probably reflecting the long term consequences of the hemodialysis treatment. Our results also indicate that although patients in the MS group were well-nourished and for a shorter time on dialysis, they were not protected from cardiovascular disease and infections. Our study provides new data concerning both the prevalence of the MS and a variety of patient characteristics in a hemodialysis population. Further research and a larger number of patients are required in order to clarify the precise role of this syndrome in patients on MHD.
Interferon Therapy for HCV-Associated Glomerulonephritis: Meta-Analysis of Controlled Trials
Authors: Fabrizi F. , Bruchfeld A. , Mangano S. , Dixit V. , Messa P. , Martin P. 
Published: January 2018

Background A relationship between hepatitis C virus (HCV) infection and chronic glomerulonephritis (GN) has been asserted on the grounds of epidemiological and experimental data. Although this suggests a role for an antiviral approach to HCV-associated GN instead of the more conventional immunosuppressive (or supportive) therapy, the optimal management of HCV-related glomerulonephritis remains controversial. Objective To compare antiviral with immunosuppressive therapy for HCV-associated GN. Design Meta-analysis of controlled clinical trials (CCTs) of the two treatments (antiviral versus immunosuppressive) of HCV-associated GN. Methods We used the fixed or random effects model of DerSimonian and Laird, with heterogeneity and sensitivity analyses. The rate of proteinuria and serum creatinine decrease after therapy for HCV-associated GN were regarded as the most reliable outcome end-points. Results We identified six studies involving 145 unique patients with HCV-associated GN. Pooling of study results demonstrated that proteinuria decreased more commonly after IFN than corticosteroid therapy (OR 1.92 (95% CI, 0.39; 9.57), NS), P-test for heterogeneity, 0.06 (I2=52.9%). In a sensitivity analysis including only CCTs using standard IFN-doses, OR was 3.86 (95% CI, 1.44; 10.33, (P=0.007)), P-test for heterogeneity, 0.18 (I2=35.9%). No improvement of serum creatinine after IFN compared to immunosuppressive therapy was noted (OR, 0.59 (95% CI, 0.21; 1.65), NS), P-test for heterogeneity, 0.76 (I2=0%). Only three CCTs gave information on the rate of proteinuria decrease over follow-up (OR, 5.08 (95% CI, 0.69; 37.31), NS). A few major side effects were noted after IFN administration. Conclusions Our meta-analysis indicates that standard IFN-doses were more effective than immunosuppressive therapy in lowering proteinuria of patients with HCV-related glomerulonephritis. However, no significant improvement in serum creatinine was seen by IFN or steroid therapy across the studies. Also, information on proteinuria recurrence after the completion of antiviral therapy was not sufficient. Prospective, randomized trials based on combined antiviral therapy (pegylated IFN plus ribavirin) with adequate dose and follow-up are required to assess the efficacy and safety of antiviral treatment of HCV-associated glomerulonephritis.
Hyperphosphatemia in Dialysis Patients: The Therapeutic Role of Lanthanum Carbonate
Authors: Cozzolino M. , Brancaccio D. 
Published: January 2018

Phosphate overload is a dramatic consequence in end-stage renal disease (ESRD) patients. Recent studies have well documented that abnormalities in mineral and bone metabolism in these patients are associated with increased cardiovascular morbidity and mortality. Elevated serum phosphate and calcium-phosphate product levels play an important role in the pathogenesis of secondary hyperparathyroidism and extra-skeletal calcification in dialysis patients. Furthermore, inorganic phosphate may cause vascular calcification directly through a real “ossification” of the tunica media in the vasculature of ESRD patients. The “classical” treatment of secondary hyperparathyroidism and hyperphosphatemia in ESRD patients consists of either calcium- or aluminum-based phosphate binders and calcitriol administration. Unfortunately, this “old generation” therapy is not free of complications. This review paper suggests that new calcium- and aluminum-free phosphate binders, such as lanthanum carbonate, can be used to treat hyperphosphatemia and secondary hyperparathyroidism in ESRD patients.
On-Pump vs. Off-Pump Coronary Artery Bypass Surgery at a Non-Academic Community Hospital: Have Biocompatibility Improvements Eliminated the Superiority of Off-Pump Surgery?
Authors: Madden N.J. , Demarsico A.J. , Schocker L. A. , Venkataraman R. , Kellum J. A. 
Published: January 2018

Objectives Standard coronary artery bypass grafting (CABG) surgery involves cardiopulmonary bypass (CPB) but given concerns over neurological and inflammatory complications related to CPB, many patients receive so-called off-pump procedures (OPCABG). Our objective is to determine if the recent improvements in the biocompatibility of CPB circuitry have improved post-operative outcomes at the community hospital level, particularly in terms of hospital length of stay (LOS), stroke and post-operative infection. Methods We analyzed hospital LOS, incidence of stroke, infection, and mortality along with several clinical variables in 209 patients (38% underwent OPCABG) at a single, non-academic community hospital. We constructed a series of forward, stepwise, multiple-variable regression models using mediastinal infection, hospital LOS, and stroke as dependant variables. Results OPCABG was associated with a shorter median hospital LOS (3 days vs. 4 days; p=0.0001) and a reduced occurrence of stroke (0% vs. 7.6%; p=0.03). However, mediastinal infections occurred more commonly in OPCABG cases (10% vs. 2.2%; p=0.02). CABG and pre-existing renal disease were predictors of increased hospital LOS (p< 0.0001) whereas CABG was the only factor associated with decreased risk of mediastinal infection (OR=0.21 (0.05–0.80); p=0.02). Conclusions At the community level, OPCABG appears to be superior in terms of LOS and incidence of stroke. Paradoxically, CABG surgery demonstrates a reduced rate of mediastinal infection. (Int J Artif Organs 2007; 30: 338–44)
Experimental Validation of Numerical Simulations: A Comparison of Computational Fluid Dynamics and the Oil Film Method
Authors: Stoiber M. , Grasl C. , Pirker S. , Huber L. , Gittler P. , Schima H. 
Published: January 2018

Background Today Computational Fluid Dynamics (CFD) is used for simulating flow in many applications. The quality of the results, however, depends on various factors, like grid quality, boundary conditions and the computational model of the fluid. For this reason, it is important to validate the performed computation with experimental results. In this work, a comparison of numerical simulation with the oil film method was performed for two cardiovascular applications. Methods The investigations were conducted at various geometries, such as a bended cannula tubing, an impeller of a magnetically levitated rotary blood pump and tips of inflow cannulas. The oil film for the experimental validation was composed of black oil color and varnish. In the numerical simulation, color abrasion was displayed with a special post-processing tool by means of wall-attached pathlines. Results With the proper choice of numerical parameters, the computer simulations and the oil film method demonstrated good correlation. Improper generation of the simulation grid did lead to divergent results between the numerical simulation and the experiment. For the pump impeller as well as for the inflow cannulas, the calculation and the experiment showed similar flow patterns with backflow and stall zones. Conclusion The oil film method represents a fast and simple approach to help validate numerical simulations of fluid flow. The experimentally generated near wall flow patterns can be easily compared with the solution of the CFD analysis.
β2-Microglobulin Removal and Plasma Albumin Levels with High Cut-off Hemodialysis
Authors: Haase M. , Bellomo R. , Baldwin I. , Haase-Fielitz A. , Fealy N. , Morgera S. , Goehl H. , Storr M. , Boyce N. , Neumayer H.-H. 
Published: January 2018

Purpose. β2-microglobulin (β2MG) is pivotal to the pathogenesis of dialysis-related amyloidosis. We compared the effects of high cut-off hemodialysis (HCO-HD) with those of standard high-flux hemodialysis (HF-HD) regarding the concentration and clearance of β2MG and albumin. Design. We enrolled ten patients with acute renal failure in a double-blind, cross-over, randomized controlled trial. Procedures Each patient received four hours of HCO-HD (estimated in vivo cutoff 50–60 kDa) and four hours of HF-HD (estimated in vivo cutoff 15–20 kDa) in random order. Statistical methods and outcome measures: As data lacked normal distribution, we used non-parametric statistical analysis. Plasma and dialysate concentrations of β2MG and albumin were measured at baseline and after four hours of each study treatment. Main findings. We found significantly greater diffusive β2MG clearances for HCO-HD compared to HF-HD (at the start: 71.8 ml/min vs. 5.1 ml/min; P=0.008 and at the end: 68.8 ml/min vs. 5.7 ml/min; P=0.008). We found a reduction in plasma β2MG concentrations of -31.6% during HCO-HD compared to an increase by 25.7% during HF-HD; P=0.008. At baseline (HCO-HD: 26.0 g/L vs. HF-HD: 26.5 g/L), and at the end of both treatments, plasma albumin concentrations were comparable (HCO-HD: 25.5 g/L vs. HF-HD: 26.5 g/L; P=0.25). During HCO-HD, albumin clearance was 1.9 ml/min at the start and decreased significantly to 0.8 ml/min at the end; P=0.008. HF-HD had an albumin clearance of 0.01 ml/min. Conclusions. HCO-HD was more effective in decreasing plasma β2MG concentrations than standard HF-HD and did not reduce plasma albumin levels. Further studies of HCO-HD in the treatment of dialysis-related β2MG accumulation appear warranted. ( ClinicalTrials.gov number, NCT00333593 [ ClinicalTrials.gov ]) (Int J Artif Organs 2007; 30: 385–92)
Plasma Filtration on Mediators of Thrombotic Microangiopathy: An in Vitro Study
Authors: Peng Z. Y. , Kiss J. E. , Cortese-Hassett A. , Carcillo J. A. , Nguyen T. C. , Kellum J. A. 
Published: January 2018

Objectives. Sepsis-induced thrombotic microangiopathy is successfully treated by plasma exchange therapy However, certain putative mediators of thrombotic microangiopathy may not be removed by plasma filtration. Methods. We conducted an in vitro study to determine whether plasma filtration can remove ultra-large von Willebrand factor (ULvWF) multimers and other mediators. In separate experiments, human umbilical venous endothelial cell (HUVEC) supernatant enriched with ULvWF or human whole blood was passed through a therapeutic plasma exchange (TPE 2000, PRISMA) filter and samples were taken for measurement of ULvWF, vWF ristocetin cofactor, vWF antigen and PAI-1. Results. The sieving coefficients for vWF and PAI-1 were above 0.9. The ULvWF was gradually eliminated, and nearly disappeared after four circulations. Conclusion. The TPE 2000 filter can directly remove potential mediators of sepsis-induced thrombotic microangiopathy.
Possible Role of Milky Spots in Mesothelial Transplantation
Authors: Sacchi G. , Di Paolo N. , Venezia F. , Rossi A. , Nicolai G. , Garosi G. 
Published: January 2018

Milky spots are very small omental organs, in contact with peritoneal membrane, devoid of capsule and consisting of macrophages, lymphocytes and a few plasma cells supported by blood and lymphatic vessels. The exact role of these particular organs is still not clear, but they are similar to lymphatic structures and it is clear that they play a role in peritoneal infection and abdominal tumors. Peritoneal dialysis seems to activate the milky spots changing their morphology. The authors try to formulate some hypotheses on the role played by these little omental organs during autologous mesothelial transplant.