bluuebunny/crossref_metadata_2025_split huggingface dataset:
Platelet Activation and PDGF-AB Release during Dialysis
Authors: Donati G. , Cianciolo G. , D'addio F. , Colì L. , La Manna G. , Feliciangeli G. , Stefoni S. 
Published: January 2018

During hemodialysis the blood-membrane contact causes a release of platelet granule content, which contains Platelet Derived Growth Factor (PDGF-AB). In view of its possible role in accelerated atherosclerotic processes, we evaluated the intra- and post-dialytic changes in PDGF-AB serum levels during hemodialysis sessions performed with Hemophan and Polysulfone membranes. PDGF-AB, PF4, ßTG and MPV levels were determined in the peripheral blood in 30 patients each of whom underwent 6 dialysis sessions: 3 with Hemophan (HE) membrane and 3 with Polysulfone (PS) membrane, interpolated by a wash out session with PS membrane. Blood samples were taken at times 0’, 30’, 120’, 180’, 240’ during dialysis sessions and at 1, 4 and 20 hours after the end of the session. Statistical analysis was done using the ANOVA one way test and Student's t test. PDGF-AB serum levels initially increased and, except for a sharp fall at 120’, remained constantly high during HD with both membranes tested, not returning to basal values until 20 hours after the end of the session. PF4, ßTG and MPV all showed a similar trend to PDGF. No statistically significant difference was found between the two membranes tested. PDGF-AB, a powerful growth factor in cells of mesenchymal origin, is released during dialysis mainly as a result of the blood-membrane contact. This we found regardless of the type of dialyzer we tested, and, above all, proved to return very slowly to basal values. We speculate that the release of PDGF-AB could play a part like other atherosclerosis risk-factors in the appearance and worsening of atherosclerotic lesions in hemodialysis patients.
Heart Rate Effect on Hemodynamics during Mechanical Assistance by the Intra-Aortic Balloon Pump
Authors: Papaioannou T.G. , Terrovitis J. , Kanakakis J. , Stamatelopoulos K.S. , Protogerou A.D. , Lekakis J.P. , Nanas J.N. , Stamatelopoulos S.F. 
Published: January 2018

Heart rate (HR) has been characterized as an important cardiovascular parameter that affects acute hemodynamic performance of intra-aortic balloon counterpulsation (IABC). However, the effect of HR on hemodynamics during mechanical assistance by the IABC has neither been clarified nor quantified. We sought to evaluate the relationship between IABC and HR and also to examine whether there is a range of HR with optimum hemodynamic response to IABC. Methods. 20 patients (14 males - 6 females, mean age 64.4±11.4 years) with post-infarction cardiogenic shock undergoing IABC treatment were evaluated. Hemodynamics were recorded for each patient once per day during the assistance period; 131 measurements were taken and thus a wide range of heart rates was obtained (64–141 bpm). The following changes in aortic pressures were used to evaluate acute IABC performance on: a) the maximal increase of diastolic aortic pressure induced by IABC and b) the reduction in systolic and end-diastolic aortic pressure. Results. Non-linear regression analysis and analysis of variance revealed that a significant correlation exists between IABC performance indices and heart rate. At HR<80 bpm, IABC performance tended to be reduced, whereas the increase in HR above 110 bpm resulted in a significant reduction of all IABC performance indices. In contrast, IABC operating at 80–110 bpm resulted in optimum hemodynamic performance. In conclusion, the effect of heart rate on IABC performance is non-linear indicating that IABC may be more effective when operating within 80–110 bpm.
Impact of Continuous Veno-venous Hemofiltration on Acid-base Balance
Authors: Rocktäschel J. , Morimatsu H. , Uchino S. , Ronco C. , Bellomo R. 
Published: January 2018

Background Continuous veno-venous hemofiltration (CVVH) appears to have a significant and variable impact on acid-base balance. However, the pathogenesis of these acid-base effects remains poorly understood. The aim of this study was to understand the nature of acid-base changes in critically ill patients with acute renal failure during continuous veno-venous hemofiltration by applying quantitative methods of biophysical analysis (Stewart-Figge methodology). Methods We studied forty patients with ARF receiving CVVH in the intensive care unit. We retrieved the biochemical data from computerized records and conducted quantitative biophysical analysis. We measured serum Na+, K+, Mg2+, Cl-, HCO3-, phosphate, ionized Ca2+, albumin, lactate and arterial blood gases and calculated the following Stewart-Figge variables: Strong Ion Difference apparent (SIDa), Strong Ion Difference Effective (SIDe) and Strong Ion Gap (SIG). Results Before treatment, patients had mild acidemia (pH: 7.31) secondary to metabolic acidosis (bicarbonate: 19.8 mmol/L and base excess: −5.9 mEq/L). This acidosis was due to increased unmeasured anions (SIG: 12.3 mEq/L), hyperphosphatemia (1.86 mmol/L) and hyperlactatemia (2.08 mmol/L). It was attenuated by the alkalinizing effect of hypoalbuminemia (22.5 g/L). After commencing CVVH, the acidemia was corrected within 24 hours (pH 7.31 vs 7.41, p <0.0001). This correction was associated with a decreased strong ion gap (SIG) (12.3 vs. 8.8 mEq/L, p <0.0001), phosphate concentration (1.86 vs. 1.49 mmol/L, p <0.0001) and serum chloride concentration (102 vs. 98.5 mmol/L, p <0.0001). After 3 days of CVVH, however, patients developed alkalemia (pH: 7.46) secondary to metabolic alkalosis (bicarbonate: 29.8 mmol/L, base excess: 6.7 mEq/L). This alkalemia appeared secondary to a further decrease in SIG to 6.7 mEq/L (p <0.0001) and a further decrease in serum phosphate to 0.77 mmol/L (p <0.0001) in the setting of persistent hypoalbuminemia (21.0 g/L; p=0.56). Conclusions CVVH corrects metabolic acidosis in acute renal failure patients through its effect on unmeasured anions, phosphate and chloride. Such correction coupled with the effect of hypoalbuminemia, results in the development of a metabolic alkalosis after 72 hours of treatment.
Inflammatory Response of a New Synthetic Dialyzer Membrane. a Randomised Cross-over Comparison between Polysulfone and Helixone
Authors: Stefoni S. , Colì L. , Cianciolo G. , Donati G. , Ruggeri G. , Ramazzotti E. , Pohlmeier R. , Lang D. 
Published: January 2018

Hemodialysis patients suffer from chronic inflammation due to intradialytic contact of blood with artificial materials. The FX 60 dialyzer which belongs to the new FX-class series of dialyzers is composed of the new membrane Helixone®. This membrane is derived from the original Fresenius Polysulfone® membrane. The FX-class design is based on modified geometry of fibres and housing and has resulted in a new dialyzer with improved efficiency, safety and ease of handling compared to the F series (F 60S) dialyzer. The aim of the study was to investigate whether the biocompatibility pattern in terms of inflammatory parameters of the new type of polysulfone dialyzer has changed compared to the standard. A clinical in vivo study was conducted to compare the intradialytic inflammatory response of the two dialyzers, FX 60 and F 60S. Eight chronic dialysis patients were selected for the study: mean age 65.5±15.5 years, mean time on dialysis 100±95 months. The randomized cross-over study involved a treatment period of 2 weeks (total 6 sessions), one week with each dialyzer, starting with one or the other according to the randomization scheme. Blood samples were taken at 0 (T0), 15, 60, and 240 minutes to evaluate white blood cell (WBC) count, complement factor C5a, leukocyte elastase, soluble intercellular adhesion molecule 1 (sICAM-1), platelet count, C-reactive protein (CRP). At 15 min, WBC count showed a comparably, low decrease for both dialyzers: −7.6 % for FX 60 versus −6.6 % for F 60S, p=not significant (ns). At the same time the C5a concentration decreased from 15.0±7.5 ng/ml to 13.5±6.7 ng/ml (p=ns) for FX 60, and from 15.1±12.5 ng/ml to 14.9±25.0 ng/ml for F 60S (p=ns). The elastase concentration progressively increased over time with no statistical difference between the two dialyzers. The levels of sICAM-1, CRP, and platelet count were similar at each time point for both dialyzers, varying around the baseline values (p=ns). No significant difference emerged in terms of inflammatory response between the two dialyzers, demonstrating that the biocompatibility of the F-series was maintained in the FX-class series of dialyzers and is independent of design factors.
Successful ex Vivo Normothermic Liver Perfusion with Purely Artificial Products using Artificial Blood
Authors: Nui A. , Katsuramaki T. , Kikuchi H. , Kukita K. , Nagayama M. , Meguro M. , Kimura H. , Isobe M. , Hirata K. 
Published: January 2018

We tried to make an ex vivo functioning liver with an artificial perfusate that consisted of artificial blood in the pig liver. A liver graft from a female pig weighing 20 kg was harvested in the usual manner. The perfusion solution consisted of artificial blood, L-15 medium, distilled water, bovine serum albumin, NaHCO3, NaOH, KCl, human regular insulin, 50% glucose solution, and dexamethasone. The isolated liver was perfused with this oxygenated perfusate through the portal vein at a rate of 300 ml/min for 9 hours. Seven livers were perfused for 9 hours in this system. Five of the livers showed mean oxygen consumption of over 8 ml-02/min during perfusion. Histological findings showed that the hepatic architecture was almost completely preserved and numerous hepatocytes exhibited PAS-positive cytoplasmic glycogen deposits in these livers. These observations indicate that we have succeeded in developing an ex vivo functioning liver with an artificial perfusate employing artificial blood.
Impact of Blood and Dialysate Flow and Surface on Performance of New Polysulfone Hemodialysis Dialyzers
Authors: Mandolfo S. , Malberti F. , Imbasciati E. , Cogliati P. , Gauly A. 
Published: January 2018

Optimization of hemodialysis treatment parameters and the characteristics of the dialyzer are crucial for short- and long-term outcome of end stage renal disease patients. The new high-flux membrane Helixone® in the dialyzer of the FX series (Fresenius Medical Care, Germany) has interesting features, such as the relationship of membrane thickness and capillary diameter which increases middle molecule elimination by convection, as well as higher capillary packing and microondulation to improve the dialysate flow and distribution. Blood flow, dialysate flow and surface area are the main determinants of the performance of a dialyzer, however the impact of each parameter on small and middle molecule clearance in high flux dialysis has not been well explored. In order to find the best treatment condition for the new dialyzer series, we evaluated urea, creatinine, phosphate clearances and reduction rate of ß2-microglobulin in ten stable patients treated with different blood flows (effective Qb 280 and 360 ml/min), dialysate flow (Qd 300 or 500 ml/min) and dialyzer surfaces (1.4 and 2.2 m2, FX60 or FX100). KoA and Kt/V were also calculated. Blood flow, dialysate flow and surface area demonstrated a significant and independent effect on clearance of urea, creatinine and phosphate, as well as on Kt/V. Small solute clearance was stable over the treatment. In contrast to small solutes, reduction rate of ß2-microglobulin was related to increasing dialyzer surface only. The new dialyzer design of the FX series proves highly effective due to improved dialysate distribution and reduced diffusive resistance as shown by the small solute clearance. A high reduction rate of ß2-microglobulin is favored by improved fiber geometry and pore size distribution. These findings have potential long-term benefits for the patient
Peritoneal Leukocyte Survival and Respiratory Burst Responses in Patients Treated with a Low Glucose Degradation and High pH Peritoneal Dialysis Fluid
Authors: Jonasson P. , Albrektsson A. , Ljungman S. , Wieslander A. , Braide M. 
Published: January 2018

The discovery of toxicity related to glucose degradation products (GDP) has initiated the development of new PD fluids with low GDP concentrations and higher, more physiological, pH levels. Cell numbers, differential counts and the respiratory burst responses of peritoneal leukocytes were compared between patients treated with the low GDP, high pH fluid Gambrosol-trio® (n=10) and a conventional fluid (n=12). Effluents from over-night dwells were collected and leukocytes were evaluated morphologically and by luminol-amplified chemiluminescence (CL) after stimulation with opsonized zymosan. The frequency of necrosis and early apoptosis was quantified by means of annexin V binding and propidium iodide uptake. The Gambrosol-trio® group produced significantly higher (p<5%) macrophage counts and stronger CL responses (p<10%) than did the conventional fluid group. The cell compositions did not differ significantly between the groups. Necrosis was significantly more common among the cells in the conventional fluid group. The occurrence of apoptosis did not differ between the fluids.
Demand Dynamic Bio-girdling in Heart Failure: Improved Efficacy of Dynamic Cardiomyoplasty by LD Contraction during Aortic Out-flow
Authors: Carraro U. , Rigatelli G. , Rossini K. , Barbiero M. , Rigatelli G. 
Published: January 2018

Purpose The value of dynamic cardiomyoplasty has been brought into question by the disappointing results produced by slow contraction-relaxation cycle and possibly degeneration of the latissimus dorsi muscle (LD) secondary to temporary tenotomy and chronic daily electrical stimulation. Objective of our study is to determine whether daily periods of rest introduced by demand stimulation in the continuous contraction protocol produce systolic assistance and improve clinical results. Methods Twelve dynamic cardiomyoplasty patients (mean age 58.2±5.8 years, M/F=11/1, sinus rhythm/atrial fibrillation=11/1) with dilated myocardiopathy were enrolled in an unrandomized trial of Demand Dynamic Heart Bio-Girdling in a public regional teaching hospital. Periods of LD inactivity, each lasting several hours, were introduced daily on a heart rate-based demand regime. To avoid full transformation of LD, fewer impulses per day were delivered, daily providing the LD with long periods of rest (Demand light stimulation). The contractile properties were measured by transcutaneous non-invasive LD tensiomyogram interrogation (LD tensiomyogram). Bio-Girdle activation was synchronized to heart beat by combining tensiomyogram and echocardiography. Clinical, echocardiographic and hemodynamic records, as well as aortic flow measurements by Doppler aortic flow wire were taken during the follow-up. Main findings Mean duration of the demand stimulation follow-up was 40.2+13.8 months. At five years, “Demand stimulation” shows: 1) no operative death; 2) 83% actuarial survival; 3) highly significant 47.4% decrease of the NYHA class (from 3.17±0.38 to 1.67±0.77, p=0.0001); 4) 41.6% improvement of LVEF (from 22.6±4.38 to 32.0±7.0, p=0.001); 5) 7.5±3.0% increase in aortic flow velocity peak in assisted vs. unassisted beats, and 6) preservation of LD from slowness (TFF value 33±7.86 at follow-up versus 15.8±11.1 Hz just before switching from continuous to demand stimulation, p=0.0001) and muscle degenerative atrophy. Conclusions In dynamic cardiomyoplasty the demand light stimulation maintains LD contraction properties over time, produces effective systolic assistance, and improves clinical results. Demand dynamic bio-girdling is a safe and effective treatment for end-stage heart failure in selected patients.
AnyHeart: A Single-piece Heart-saving Implantable Artificial Heart (BVAD) - Monitoring and Estimation
Authors: Park J.W. , Choi J. , Lee J.J. , Nam K. , Chung J. , Park S.K. , Park C.Y. , Sun K. , Kim W.G. , Kim J. , Min B.G. 
Published: January 2018

AnyHeart is a single-piece, implantable biventricular assist device. This electromechanical BVAD has a moving-actuator mechanism. To monitor the status of AnyHeart from anywhere at any time, a portable personal digital assistant (PDA) monitor and web-based remote monitoring system were developed. The PDA local monitoring system has replaced bulky personal computer monitoring systems. The web-based remote monitoring system has several functions such as data collecting, storing, and posting through the internet. Basically, interventricular pressure (IVP) is a parameter indicating the filling level of the blood chambers of AnyHeart. The pump output can be estimated using IVP, which is acquired noninvasively from AnyHeart. With the proposed method, we can estimate the pump output with a small margin of error.
Applications of the Pulsatile Flow Versatile ECLS: In Vivo Studies
Authors: Rho Y. R. , Choi H. , Lee J.C. , Choi S.W. , Chung Y.M. , Lee H.S. , Hwang C.M. , Lee H.S. , Ahn S.S. , Lee R.Y. , Son H.S. , Choi M.J. , Baek K.J. , Kim J.S. , Suh G.J. , Won Y.S. , Sun K. , Min B.G. 
Published: January 2018

Introduction T-PLS (Twin-Pulse Life Support) is the first commercial pulsatile ECLS (Extra Corporeal Life Support) device (1). The dual sac structure of T-PLS can effectively reduce high membrane oxygenator inlet pressure and hemolysis. To verify both the use of T-PLS for ECLS and the advantages of T-PLS, we tested various models. Method and Results In the partial CPB (cardio pulmonary bypass) model (swine), T-PLS (N=6), and Biopump (N=2), a single pulsatile pump (N=2), were compared. In the case of single pulsatile flow, during pump systole, pressure increased to 700 - 800 mmHg at the inlet port of the membrane oxygenator. fHb, a hemolysis measurement value, was about 80 mg / dL at 3 hours. On the contrary, because of T-PLS's dual sac system, the pressure of T-PLS had a maximum value of about 250 mmHg and fHb was similar to that of the commercial centrifugal pumps. In the total CPB model (bovine, N=6), the heart was stopped via cardioplegia (Kcl). T-PLS flow was maintained at 3.0 - 4.5 L/min. T-PLS functioned like a natural heart, having a pulse pressure of 26 - 43 mmHg and a pulse rate of 40 - 60 bpm (beats per minute). In the emergency case model (canine, N=6), T-PLS was started 10 minutes after cardiac arrest from electronic shock. In spite of cardiac arrest for a period of 40 minutes, the heart was recovered after defibrillation. In the ARDS (Acute Respiratory Distress Syndrome) model (canine, N=6), minimal ventilator parameters were set: tidal volume 130 ml, respiration rate = bpm, FiO2 = 10%. Three hours after starting T-PLS, PO2 of the carotid artery blood (after 2 hours: 195 ±89.4; after 3 hours: 258 ±99.3 mmHg) was above half the value of the femoral artery but was within normal range. Conclusion It is suggested that a portable pulsatile ECLS like T-PLS may be used as a CPB device and as an alternative CPR (cardiopulmonary resuscitation) device in the case of cardiac arrest. Due to the pulsatile flow, oxygenated blood is delivered to the patient without overloading the ARDS patient's heart.
Diacap® α-Polysulfone HI PS: a New Dialysis Membrane with Optimum β2-Microglobulin Elimination
Authors: Mann H. , Al-Bashir A. , Melzer H. , Stiller S. 
Published: January 2018

Background Plasma concentration of β2-microglobulin (β2-m) in the case of renal insufficiency is about 20 to 30 times higher than normal. β2-m is associated with secondary amyloidosis, a late complication of regular dialysis therapy. To prevent the complications of secondary amyloidosis β2-m should therefore be eliminated as efficiently as possible during dialysis treatment. This can be accomplished with dialysis membranes which guarantee sufficient clearance for this molecule. It is a matter of discussion whether removal of β2-m by dialysis may be able to prevent secondary amyloidosis. Methods The dialyzers Diacap HI PS 15 (B. Braun Melsungen) and F70 S (Fresenius Medical Care) were compared in five anuric dialysis patients. Arterial blood was taken at the start and at the end of dialysis. Dialysate samples were taken after 30 and 210 minutes and filtrate samples after 60 and 240 minutes from the start of dialysis. β2-m and total protein concentration were measured in plasma, filtrate and dialysate. SDS-PAGE of proteins in the filtrate was carried out and kinetics of β2-m (Kt/Vβ2-m) were calculated using the Stiller/Mann model (4, 5). Results In both dialyzers β2-m is detectable at any time in the dialysate leaving the dialyzer. In the filtrate β2-m concentration is about 10 times higher than in the dialysate. Protein pattern in filtrate of both dialyzers is similar and corresponds to that of the glomerulum filtrate. β2-m reduction ratio is slightly lower than urea reduction ratio. Using both dialyzers Kt/Vβ2-m was 0.80, removing about 60% of the generated β2-m. Conclusions In both dialyzers there is considerable removal of β2-m. Examination of β2-m kinetics showed an optimum of Kt/Vβ2 of 0.80 which can not be surpassed. Only 60% of generated β2-m can be removed by three times per week hemodialysis therapy using high-flux dialyzers.
Coencapsulation of Hepatocytes and Bone Marrow Stem Cells: In Vitro Conversion of Ammonia and in Vivo Lowering of Bilirubin in Hyperbilirubemia Gunn Rats
Authors: Liu Z.C. , Chang T.M.S. 
Published: January 2018

Backgrounds/aims This study investigates the ammonia removal capacity of coencapsulated hepatocytes and bone marrow stem cells in culture, and the treatment effect on hyperbilirubinemia Gunn rats when transplanted. Methods The hepatocytes and bone marrow stem cells isolated from Wistar rats were encapsulated alone or coencapsulated. In vitro, the encapsulated cells were cultured in media supplemented with 2.4 mMol/L concentration of ammonium chloride and the ammonia removal and urea synthesis were evaluated. In vivo, the encapsulated cells were transplanted intraperitoneally into hyperbilirubinemia Gunn rats and plasma bilirubin levels were measured before and after transplantation at intervals of 85 days. Results The ammonia removal capacity was maintained longer in the different ammonia concentration media in the coencapsulated hepatocytes and bone marrow cells culture. In the coencapsulation transplantation group, the plasma bilirubin levels were significantly lower than those in the group of hepatocytes encapsulation transplantation during the period of 3 to 10 weeks posttransplantion. Conclusions The coencapsulated heaptocytes and bone marrow cells when compared to encapsulated hepatocytes could improve the maintenance of hepatocyte function both in vitro of ammonia removal in culture, and in vivo of the lowering the Gunn rats blood total bilirubin when transplanted.