bluuebunny/crossref_metadata_2025_split huggingface dataset:
Augmentation of Abdominal Organ Perfusion during Cardiopulmonary Bypass with a Novel Intra-aortic Pulsatile Catheter Pump
Authors: Gu Y.J. , De Kroon T.L. , Elstrodt J.M. , Van Oeveren W. , Boonstra P.W. , Rakhorst G. 
Published: January 2018

Background Current pulsatile pumps for cardiopulmonary bypass (CPB) are far from satisfactory because of the poor pulsatility. This study was undertaken to examine the efficiency of a novel pulsatile catheter pump on pulsatility and its effect on abdominal organ perfusion during CPB. Methods Twelve pigs weighing 89±11 kg were randomly divided into a pulsatile group (n=6) and a non-pulsatile group (n=6). All animals had a CPB for 120 min, aorta clamped for 60 min, temperature down to 32°C, and a perfusion flow of 60 ml/kg/min. In the pulsatile group, a 21 Fr intra-aortic pulsatile catheter, which was connected to a 40 mL membrane pump, was placed in the descending aorta and activated by a balloon pump driver during the first 90 minutes of CPB until aortic declamping. Hemodynamics, organ blood flow, body metabolism, and blood trauma were studied during experiments. Results Compared with the non-pulsatile group during CPB, the pulsatile group had a higher systolic blood pressure (P&0.01), higher mean arterial pressure (P&0.05), and higher blood flow to the superior mesenteric artery (P&0.05). The hemodynamic energy, indicated by the energy equivalent pressure (EEP) was higher in the gastrointestinal tract and kidney in the pulsatile group (P&0.01, P&0.01). Abdominal organ perfusion status, as indicated by SvO2 in the inferior vena cava, was higher in the pulsatile group (P&0.05) 30 min after cessation of CPB. Hemolysis indicated by release of free hemoglobin during CPB was similar in the two groups. Conclusion Applying the pulsatile catheter pump in the descending aorta is effective in supplying the pulsatile flow to the abdominal organs and results in improved abdominal organ perfusion during the ischemic phase of CPB.
Myofibroblastic Differentiation in Simple Peritoneal Sclerosis
Authors: Del Peso G. , Jiménez-Heffernan J.A. , Bajo M.A. , Hevia C. , Aguilera A. , Castro M.J. , Sánchez-Tomero J.A. , LÓPez-Cabrera M. , Selgas R. 
Published: January 2018

Objective To analyze the presence of myofibroblasts in a series of peritoneal dialysis (PD) patients with simple sclerosis and non-PD, uremic patients. Since there is a close correlation between active fibrosis and myofibroblastic differentiation we wanted to test if myofibroblasts are present in uremic, non-PD peritoneal samples. To determine if there are correlations between myofibroblastic presence and other functional and morphologic peritoneal parameters. Methods Biopsies were collected from three patient groups: 1) Normal control samples (n=15) of parietal and visceral peritoneum 2) non-PD uremic patients (n=16); and 3) uremic patients on PD (n=32). Peritoneal morphologic and functional parameters and immunohistochemical expression of α-smooth muscle actin was analyzed in each case. Vascular endothelial growth factor (VEGF), bcl-2 anti-apoptotic protein, and progesterone receptor was evaluated in a subset of cases. Results Myofibroblasts were present in 56.3% of the patients with PD-related simple sclerosis. In most cases they were distributed in the upper submesothelial area. None of the biopsies from normal controls and uremic, non-PD patients showed myofibroblasts. Within the group of PD patients, myofibroblasts showed no correlation with time on dialysis, urea/creatinine MTAC, episodes of peritonitis, submesothelial thickening, hyalinizing vasculopathy or mesothelial status. In a subset of PD patients VEGF expression was observed in submesothelial fibroblastic cells. No expression of progesterone receptor or bcl-2 was observed. Conclusions Myofibroblasts are a reliable and simple indicator of fibrosis since they appear in early stages of PD treatment and in patients with minor morphologic anomalies. They are not exclusive of patients with sclerosing peritonitis, ultrafiltration loss or long standing treatment. Their absence in non-PD, uremic patients suggest that uremia-related fibrosis takes place without a significant participation of myofibroblasts.
Management of Fluid Balance in CRRT: A Technical Approach
Authors: Ronco C. , Ricci Z. , Bellomo R. , Baldwin I. , Kellum J. 
Published: January 2018

Background The possibility of making fluid balance errors during continuous renal replacement therapy has been identified since the beginning of this modality of treatment. The advent of automated machines has partially overcome this problem. Nevertheless, there are conditions and operation modes in which the potential for fluid balance errors is still present. Objective To analyse fluid balance management in CRRT therapies across a range of currently marketed machine. Methods The tests were conducted in vitro, utilizing saline solution for the blood circuit and regular dialysate/reinfusate for the dialysate/reinfusion circuit. The methodology used was based on the voluntary creation of a fluid balance error by altering the correct flow in the circuit of the different machines. Subsequently, the time for alarm occurrence and the threshold value for fluid balance error was evaluated. The alarm was overridden and the overall fluid error allowed by the machine was evaluated. Each machine was tested in conditions of different dialysate/filtrate flow rates and in different simulated treatment modalities. Results Fluid balance errors can be easily avoided not only by a correct and careful adherence to the protocols of use of the current CRRT machines, but also by the compliance to prescriptions and programmed controls during therapy. Most importantly, if an alarm appears on the machine, one can try to override it without major problems; major problems may occur when multiple override commands are operated without identifying the problem and solving it adequately. Conclusion Machines seem to be designed with adequate safety features and accurate alarm systems. However, features and alarms can be manipulated by operators creating the opportunity for serious error. Physicians and nurses involved in prescription and delivery of CRRT should have precise protocols and defined procedures in relation to machine alarms to prevent major clinical problems.
Ex Vivo Evaluation of a New Extracorporeal Lung Assist Device: NovaLung® Membrane Oxygenator
Authors: Jegger D. , Revelly J.-P. , Horisberger J. , Mallabiabarrena I. , Seigneul I. , Jachertz M. , Von Segesser L.K. 
Published: January 2018

When lung function is compromised, alternative devices need to be deployed in order to maintain blood oxygenation. A new device, NovaLung®, has been designed for acute lung failure. We went about evaluating its gas exchange capability. Three calves (79.5±7.8 kg) were connected to the NovaLung® System with a priming volume of 240 mL, gas exchange surface area of 1.3 m2 and exhibiting a biologically coated surface. A standard battery of blood samples were taken before implantation and over a six hour period. Hematocrit remained stable ranging from 27±4% (baseline) to 29±5% (6 hrs). Platelets were preserved ranging from 882±27.4 U/L (baseline) to 734±147 (6 hrs). LDH remained stable at 719±85 U/L (baseline) vs 686±190 U/L (6 hrs) and the pressure drop was maintained below 20 mmHg. Minimal hemolysis was observed. Oxygen transfer peaked at two hours acute extracorporeal lung support (ECLS) with a mean value of 130±50 ml/min. In conclusion, the device is easy to use, provides adequate O2 and CO2 transfer for partial lung support in an acute setting. Shows minimal signs of hemolysis and platelets levels are maintained throughout the six hour ECLS period.
The “Ronco” Catheter for Continuous Flow Peritoneal Dialysis
Authors: Ronco C. , Dell'Aquila R. , Rodighiero M.P. , Di Loreto P. , Nalesso F. , Spanò E. , Parkhill R. , Amerling R. , Levin N. 
Published: January 2018

To perform CFPD, a two way access must be available in order to allow continuous inflow and outflow of the solution. This is most likely achieved with a double lumen peritoneal catheter. To design a double lumen catheter does not necessarily mean to increase the size of the tube or to increase the discomfort of the patient. However, the real challenge is to find a design in which minimal re-circulation is experienced. The two tips of the catheter must be positioned such that a maximal exposure of the peritoneal surface to the fluid is guaranteed during one single passage of the fluid from one lumen to another. Double lumen catheters with one short branch and another long of straight and of spiral shape were originally designed. Ash and coworkers have designed a catheter with a t-shape configuration in order to distantiate to the maximum the tips of the two lumens. Recently we have designed a novel catheter for CFPD equipped with a thin walled silicone diffuser used to gently diffuse the inflow dialysate into the peritoneum. The holes on the round tapered diffuser are positioned to allow dialysate to perpendicularly exit 360 degrees from the diffuser. The diffuser design and hole locations disperse the high-flow dialysate fluid at 360 degrees, reducing trauma to the peritoneal walls and allowing the dialysate to mix into the peritoneum. The dispersed fluid infused into the peritoneal cavity is then drained through the second lumen whose tip is placed into the lower Douglas cavity. The new catheter with diffuser is also equipped with a special removable hub that allows for easy creation of the subcutaneous tunnel without increasing the size of the skin exit site. The results so far achieved seems to offer advantages in terms of high flows, minimal pressure regimes and negligible recirculation.
The Catheter as Ariadne's Thread to Follow the Path of Peritoneal Dialysis (PD) through the Long-Term Experience of a Center
Authors: Pacitti A. 
Published: January 2018

In our institution, the first patient was treated by HD in 1955. In the middle of the '60s, the PD technique, revised by Maxwell (1), was implemented. The access to peritoneum was obtained by repeated puncturing of the abdomen, the catheter being removed after each session. In 1966, our first results on one year of PD were published (20 patients treated, 13 affected by ARF and 7 by CRF, for a total number of 150 sessions). Since 1967, the procedure of the repeated punturing was improved by the Seldinger technique. The efficiency of the PD intermittent treatment was increased with the “fast shift” schedule and PD automation was pursued with the project of a cycler (1968). The first CRF patients were treated by fast shift PD. In the late intermittent PD phase, the adoption of permanent catheters, destined to endure in our practice, the rigid and the soft indwelling for long-term treatments, allowed us to launch programs of home and nocturnal PD. With the incoming CAPD age, the greatest care was directed to the role of the catheter. The adoption of the surgical insertion by paramedian approach through rectus muscle, minimized, in our experience, the early complications. With the reduction of peritonitis rate, the later catheter complications increased in terms of patient discomfort, hospitalization and technique survival. On those grounds, in our institution a prospective trial on a ten year period was undertaken to compare, in terms of late complications rate, new versions of the classic Tenckhoff straight catheter (ST). The surgical insertion method was adopted for all the types, for a total of 196 catheters in 163 CRF patients. The tip displacement rate (12.2% with ST) decreased, albeit non significantly, with Swan Neck (7.9%), but was markedly and significantly reduced (1.0%) with the Self-Locating (SL) catheter experience. The surgical insertion of SL was comparable to that of ST. For those reasons, in recent years, in our institution the SL catheter became the first choice catheters for CRF patients.
Evaluation of Hygiene and Safety Controls for On-Line Paired Hemodiafiltration (PHF)
Authors: Mandolfo S. , Corsi A. , Wratten M.L. , Sereni L. , Imbasciati E. 
Published: January 2018

Background On-line hemodiafiltration is gaining popularity due to increasing evidence of clinical benefits however it also requires strict attention to hygiene and safety as notable quantities of liquid are reinfused into the patient. Although most centers are improving their attention to water quality, a frequent concern is the inadvertent or accidental contamination of water and whether the redundant safety controls are sufficient to protect the patient. In the present study, in order to simulate a worst-case safety condition, we tested in vitro the reliability of paired hemodiafiltration – (PHF), under low, moderate and high bacterial contamination of the water supply. Tests were performed using various bacterial concentrations (range 85–2000 cfu/mL) of Pseudomonas Aeruginosa. Samples were analyzed from different sites throughout the entire on-line hemodiafiltration circuit for bacteria endotoxin, fungus and ability to stimulate whole blood production of TNF α. Results In the in vitro contamination study, with the three bacterial concentrations tested at various points of the circuit, bacteria were below the level of detection and endotoxins were < 0.01 UE/mL. Addition of dialysate samples taken after the first stage of microfiltration, as well as after the first and second stage of ultrafiltration and incubated with whole blood were not associated with stimulated production of TNFα. Conclusions PHF appeared to be a safe and feasible method for on-line hemodiafiltration even in the unforeseen presence of bacterial contamination of the feed water or water distribution system.
Antibacterial Activity of Zinc Modified Titanium Oxide Surface
Authors: Petrini P. , Arciola C.R. , Pezzali I. , Bozzini S. , Montanaro L. , Tanzi M.C. , Speziale P. , Visai L. 
Published: January 2018

Titanium-based implants are successfully used for various biomedical applications. However, in some cases, e.g. in dental implants, failures due to bacterial colonization are reported. Surface modification is a commonly proposed strategy to prevent infections. In this work, titanium oxide, naturally occurring on the surface of titanium, was modified by promoting the formation of a mixed titanium and zinc oxide, on the basis of the idea that zinc oxide on titanium surface may act as the zinc oxide used in pharmaceutical formulation for its lenitive and antibacterial effects. The present work shows that it is possible to form a mixed titanium and zinc oxide on titanium surfaces, as shown by Scanning Electron Microscopy and XPS analysis. To this end titanium was preactivated by UV on crystalline titanium oxide, both in the anatase form or in the co-presence of anatase and rutile. By performing antibacterial assays, we provide evidence of a significant reduction in the viability of five streptococcal oral strains on titanium oxide surfaces modified with zinc. In conclusion, this type of chemical modification of titanium oxide surfaces with zinc might be considered a new way to reduce the risk of bacterial colonization, increasing the lifetime of dental system applications.
Ventricular Assistance with Microaxial Flow Pump following Mitral Repair for Dilated Cardiomyopathy
Authors: Onorati F. , Cristodoro L. , Borrello F. , Esposito A. , Merola S. , Renzulli A. 
Published: January 2018

Background Postcardiotomy heart failure is still the main cause of death in patients undergoing palliative surgery for end-stage dilative cardiomyopathy. New micro-axial flow ventricular assisting devices (LVAD) have been suggested in such cases. Objective Evaluate the effect of the new LVAD on short-term outcome of a patient admitted for endstage heart failure. Study Design Case report. Data Sources One patient admitted for severe mitral regurgitation secondary to end-stage dilative cardiomyopathy and chronic atrial fibrillation (AF). Intervention Preoperative intraaortic balloon pump (IABP) insertion, mitral plasty with radiofrequency ablation of AF, microaxial flow LVAD support. Results The patient was unweanable from cardiopulmonary bypass until microaxial flow LVAD unloaded the left ventricle and restored adequate cardiac function. The patient was discharged home and is still well at 5 months folllow-up Conclusions The miniinvasive insertion and withdrawal, low anticoagulation protocols, and the possibility of coupling with IABP make the microaxial flow LVAD promising for patients with end-stage heart failure undergoing surgery.
Titanium Oxide Modeling and Design for Innovative Biomedical Surfaces: A Concise Review
Authors: De Nardo Luigi , Raffaini Giuseppina , Ebramzadeh Edward , Ganazzoli Fabio 
Published: January 2018

The natural oxide layer on implantable alloys insulates the reactive underlying metal from the physiological environment, preventing substrate corrosion and device failure. This type of oxide film has had a major role in the minimization of functional failure and toxic response after implantation in the first generation biomaterials. Recent advances in theoretical, computational, and experimental surface engineering tools provide the foundation for the design of novel devices with improved performances in this regard based on conventional implantable metal alloys. An increasing number of technologies provide the possibility of tailoring chemico-physical and morphological parameters of the surface oxide layers. For some applications, such as dental implants, surface modifications result in substantial innovation and economic success. However, the selection of novel surfaces is in general based on experimental studies and has a limited theoretical and computational foundation. In this review, we offer a perspective analysis of the correlation between theoretical studies and chemical surface modification technologies, with a special emphasis on titanium oxide on Ti alloys. Theoretical approaches for the surface behavior at an atomistic level of description are presented, together with some adsorption studies on a rutile surface. The role of chemical and electrochemical surface modification technologies in modifying the TiO2 structure, morphology, and chemistry to tailor in vivo biological response is then briefly reviewed. Finally, we discuss the role of surface modeling as a powerful design tool for a new generation of implantable devices in which metal oxide surface can be tuned to yield specific biological response.
Angiopoietin-2/Tie2 Signaling Involved in TNF-α Induced Peritoneal Angiogenesis
Authors: Yuan Jiangzi , Fang Wei , Lin Aiwu , Ni Zhaohui , Qian Jiaqi 
Published: January 2018

Purpose Angiopoietin-2/Tie2 signaling has been found to play an important role in producing a vasculature in a variety of conditions. However, whether angiopoietin-2/Tie2 signaling is involved in peritoneal angiogenesis induced by TNF-α is not clear. In this study, we investigated the role of TNF-α on the function of human omental tissue microvascular endothelial cells (HOTMECs) and whether angiogenesis is inhibited by blocking angiopoietin-2/Tie2 signaling. Methods Primary cultured HOTMECs were exposed to complete medium as control, medium containing 10 ng/ml TNF-α, a mixture of 10 ng/ml TNF-α plus 2 μg/ml sTie2/Fc or 2 μg/ml sTie2/Fc alone, respectively, as experimental groups. The proliferation of HOTMECs was measured by MTT assay. Expression of vascular endothelial growth factor (VEGF), Angiopoietin-2, and Tie2 were assessed by real-time PCR. We also investigated the angiogenesis of the HOTMECs by tube formation assay, their migration as well as their permeability to FITC-labeled BSA. Results Compared to the cells in control, exposure to TNF-α or sTie2/Fc had no effect on proliferation of HOTMECs. TNF-α up-regulated the gene expression of VEGF, Angiopoietin-2, and Tie2 (p<0.05). TNF-α significantly promoted tube formation, migration and enhanced permeability of HOTMECs (p<0.05). Supplement with sTie2/Fc partially inhibited tube formation and migration (p<0.05). However, sTie2/Fc did not inhibit the increased permeability induced by TNF-α (p>0.05). Conclusions Angiopoietin-2/Tie2 signaling involved in TNF-α induced peritoneal angiogenesis may provide an alternative way to prevent peritoneal angiogenesis.
Survival in Critically Ill Patients with Acute Kidney Injury Treated with Early Hemodiafiltration
Authors: Boussekey Nicolas , Capron Benoit , Delannoy Pierre-Yves , Devos Patrick , Alfandari Serge , Chiche Arnaud , Meybeck Agnes , Georges Hugues , Leroy Olivier 
Published: January 2018

Purpose Early renal replacement therapy (RRT) initiation should theoretically influence many physiological disorders related to acute kidney injury (AKI). Currently, there is no consensus about RRT timing in intensive care unit (ICU) patients. Methods We performed a retrospective analysis of all critically ill patients who received RRT in our ICU during a 3 year-period. Our goal was to identify mortality risk factors and if RRT initiation timing had an impact on survival. RRT timing was calculated from the moment the patient was classified as having acute kidney injury in the RIFLE classification. Results A hundred and ten patients received RRT. We identified four independent mortality risk factors: need for mechanical ventilation (OR = 12.82 (1.305 - 125.868, p = 0.0286); RRT initiation timing >16 h (OR = 5.66 (1.954 - 16.351), p = 0.0014); urine output on admission <500 ml/day (OR = 4.52 (1.666 - 12.251), p = 0.003); and SAPS II on admission >70 (OR = 3.45 (1.216 - 9.815), p = 0.02). The RRT initiation <16 h and RRT initiation >16 h groups presented the same baseline characteristics, except for more severe gravity scores and kidney failure in the early RRT group. Conclusions Early RRT in ICU patients with acute kidney injury or failure was associated with increased survival.
Triage: A new group technique gaining recognition in evaluation
Authors: Gervais Marie , Pépin Geneviève 
Published: January 2018

TRIAGE, or Technique for Research of Information by Animation of a Group of Experts, is an inductive and structured method for collecting information that aims to obtain a group consensus. The goal of this technique is to provide quality informative material quickly and efficiently to enable decision-making or to develop more sophisticated survey tools. TRIAGE both distinguishes itself from, and complements, the main group techniques used in evaluation up until now. These are the Delphi technique, the Nominal Group Technique (NGT) and the focus group (Delbecq, Van de Ven & Gustafson, 1975). The definition, the context for use as well as the different parts of the usual process of TRIAGE technique (recruiting of participants, individual production phase, collective production phase with visual support, validation of results) will firstly be presented then compared to these advocated in the Delphi, NGT and focus group techniques. Also, examples of TRIAGE being applied in different evaluation contexts, such as the development of measurement instruments and the evaluation of health programs, will be presented. These examples will illustrate the richness, the flexibility and the potential of this technique as an assessment tool. Finally, the strengths and shortcomings of TRIAGE will be discussed.