bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microbiology of Infection in Mechanical Circulatory Support
Authors: Holman W. L. 
Published: January 2018

The results of MCSS therapy for patients with severe heart failure are improving, and there are increasing numbers of implants as device therapy enters the era of permanent use (i.e., destination therapy). Device-related infection of implanted pumps and sepsis remain important risk factors for death, and once infections are established on biomaterial surfaces they usually persist despite prolonged antimicrobial therapy. This paper covers the topic of infection in mechanical circulatory support. Methods to prevent and manage infection are described. Recent information from the field of microbiology that is relevant to understanding device-related infection is reviewed, including the mechanisms for microbial adhesion to prosthetic surfaces, quorum sensing, and biofilm formation. Characteristics that are important to antimicrobial resistance of microbes dwelling in biofilms are described (e.g. responses to microenvironmental conditions that result in resistance to antibiotics). This information may lead to new therapies that further diminish rates of device infection, and allow complete eradication of infections when they occur.
Prometheus: From Legend to the Real Liver Support Therapy
Authors: Rifai K. , Tetta C. , Ronco C. 
Published: January 2018

Background A large number of patients develop liver disease that may evolve into progressive chronic failure. Artificial liver support systems (e.g., MARS and Prometheus) are considered in the framework of the steady increase in the number of patients who could possibly benefit from these blood purification devices. Albumin dialysis and adsorption are now two integrated concepts. The present know-how enabling us to appropriately modify several intrinsic characteristics of the adsorbents - e.g., their chemical nature, the particle and pore size distribution, as well as a larger surface offered to adsorption - has helped in better fine-tuning liver support systems to improve adsorption kinetics and flow characteristics specifically for the intended clinical application. These properties together with an improved biocompatibility have made possible the development of adsorptive techniques for which clearances and total removal rates of target compound would be unthinkable with conventional hemodialysis or hemofiltration. Several adsorptive techniques are already available commercially for the treatment of sepsis and septic shock and of acute liver failure, but controlled studies with clinical end points are still lacking.
High Cut-off Point Membranes in Septic Acute Renal Failure: A Systematic Review
Authors: Haase M. , Bellomo R. , Morger S. , Baldwin I. , Boyce N. 
Published: January 2018

Objectives To review the literature on the experimental, physiological and clinical effects of blood purification with high cut-off (HCO) point membranes in septic acute renal failure (ARF). Study Design MEDLINE and PubMed database search combining relevant terms and integrating data from studies on the use of HCO membranes. Setting and Population Ex vivo studies of endotoxemia, animal studies of bacteremia and clinical studies using HCO membranes in patients with septic ARF. Selection Criteria for Studies: Original data from primary publications. Interventions: HCO membrane-based hemodialysis, hemodiafiltration or hemofiltration. Outcomes: Plasma cytokine clearance, immunological and physiological effects and safety parameters of HCO membranes. Results HCO membranes effectively remove cytokines from blood. Treatment using HCO membranes has beneficial effects on immune cell function and increases survival in animal models of sepsis. Preliminary clinical studies show that HCO membranes decrease plasma cytokine levels and the need for vasopressor therapy. HCO membrane-based blood purification has now been applied in four pilot randomized controlled studies of 70 patients with septic ARF with no reports of serious adverse effects. Limitations Because of substantial heterogeneity, no formal quantitative analysis could be performed. Conclusions The available evidence on HCO blood purification justifies larger randomized controlled trials in patients with septic ARF.
Peritoneal Dialysis-Related Peritonitis in Southern Thailand
Authors: Nakwan N. , Dissaneewate P. , Lim A. , Vachvanichsanong P. 
Published: January 2018

Objective To evaluate peritonitis in children receiving peritoneal dialysis (PD) in southern Thailand. Patients and Methods We reviewed the records of patients who received PD at the Department of Pediatrics, Prince of Songkla University from January 1994 to December 2003. Results Forty-six patients had PD performed for 228.6 patient-months. Their mean age was 9.5±4.8 years (range 3.0 months-16.7 years). Twenty-eight patients had complications with 61 episodes of peritonitis. The age, sex and causes of renal failure did not display any differences between patients who had or did not have peritonitis (p=0.2, 0.6 and 0.6, respectively). The first peritonitis occurrence was on average at 2.7±4.0 patient-months (median 0.4, range 0–12.5) following catheter insertion, with an average incidence rate of one infection per 3.5±4.8 patient-months (median 1.0, range 0–23.2). The causative agents were both gram-positive and gram-negative bacteria, and fungi at 24%, 44%, and 8% respectively (24% of the cultures did not grow). There was no significant difference in causative agents between home- and hospital-acquired peritonitis (p=1.0). Conclusion PD-related peritonitis in this study occurred earlier and more often than in other studies, probably because all of our PDs were performed immediately after catheter insertion.
The Acid-Base Effect of Changing Citrate Solution for Regional Anticoagulation during Continuous Veno-Venous Hemofiltration
Authors: Egi M. , Naka T. , Bellomo R. , Langenberg C. , Li W. , Fealy N. , Baldwin I. 
Published: January 2018

Purpose To compare the acid-base balance effects of two different citrate doses for regional citrate anticoagulant (RCA) for continuous veno-venous hemofiltration (CVVH). Methods We used a commercial citrate fluid (citrate concentration: 11mmol/L) from July 2003 to July 2004 (period A) in 22 patients; then changed to a new citrate fluid (citrate concentration: 14mmol/L) from July 2004 to Feb 2005 (Period B) in 21 patients. Replacement fluid rate was fixed at 2,000 ml/h. We measured all relevant variables for acid-base analysis according to the Stewart-Figge methodology. Results After commencement of RCA-CVVH, there was a change in bicarbonate and base excess (BE) toward acidosis for both fluids. This change was significantly different between period A and B at 6 and 12 hours (pH: p<0.01, BE: p<0.05) with greater decreases with the 11 mmol/L citrate fluid. These changes were mostly secondary to an increase in the strong ion difference (SID) and occurred despite an increased strong ion gap (SIG) (+0.5 mEq/L vs. +1.5 mEq/L; p<0.01) in the higher citrate concentration fluid. Cessation of RCA-CVVH was associated with short-lived differences in bicarbonate and SIG which were similar to those seen on initiation of RCA-CVVH but in the opposite direction. Conclusions A small increase This was partly offset by an increase in SIG, consistent with increased citratemia. Cessation of treatment showed a differential improvement in SIG also consistent with disposal of therapy-associated citrate. These observations might assist clinicians in interpreting acid-base changes during RCA-CVVH.in citrate infusion rate caused an alkalinizing increase in SID.
ECG-triggered Skeletal Muscle Stimulation Improves Hemodynamics and Physical Performance of Heart Failure Patients
Authors: Lapanashvili L.V. , Buziashvili Y.I. , Matskeplishvili S.T. , Lobjanidze T.G. , Bockeria L.A. , Huber P.P. , Hess O.M. , Walpoth B.H. 
Published: January 2018

Background Muscular counterpulsation (MCP) was developed for circulatory assistance by stimulation of peripheral skeletal muscles. We report on a clinical MCP study in patients with and without chronic heart failure (CHF). Methods and Results MCP treatment was applied (30 patients treated, 25 controls, all under optimal therapy) for 30 minutes during eight days by an ECG-triggered, battery-powered, portable pulse generator with skin electrodes inducing light contractions of calf and thigh muscles, sequentially stimulated at early diastole. Hemodynamic parameters (ECG, blood pressure and echocardiography) were measured one day before and one day after the treatment period in two groups: Group 1 (9 MCP, 11 no MCP) with ejection fraction (EF) above 40% and Group 2 (21 MCP, 14 no MCP) below 40%. In Group 2 (all patients suffering from CHF) mean EF increased by 21% (p<0.001) and stroke volume by 13% (pp<0.001), while end systolic volume decreased by 23% (pp<0.001). In Group 1, the increase in EF (6%) and stroke volume (8%) was also significant (pp<0.05) but less pronounced than in Group 2. Physical exercise duration and walking distance increased in Group 2 by 56% and 72%, respectively. Conclusions Noninvasive MCP treatment for eight days substantially improves cardiac function and physical performance in patients with CHF.
Chronic Heart Failure Induced by Multiple Sequential Coronary Microembolization in Sheep
Authors: Schmitto J.D. , Ortmann P. , Wachter R. , Hintze E. , Popov A. F. , Kolat P. , Liakopoulos O.J. , Waldmann-Beushausen R. , DÖrge H. , Grossmann M. , Seipelt R. , Schöndube F. A. 
Published: January 2018

Objective Although a large variety of animal models for acute ischemia and acute heart failure exist, valuable models for studies on the effect of ventricular assist devices in chronic heart failure are scarce. We aimed to establish a stable and reproducible animal model of chronic heart failure in sheep. Methods Sheep (n=8, 77 ± 4 kg) were anesthesized and a 5F sheath was implanted into the left carotid artery. The left main coronary artery was catheterized under flouroscopic guidance and bolus injection of polysterol microspheres (90 μm, n=25.000) was performed. Microembolization (ME) was repeated up to three times in two to three week intervals until animals started to develop stable clinical signs of heart failure. Clinical and echocardiographic data were analyzed at baseline (base) and at three months (3 mo) after first ME. All animals were followed for 3 months after first microembolization and then sacrificed for histological examination. Another four healthy sheep (79±6 kg) served as control animals. Results All animals developed clinical signs of heart failure as indicated by increased heart rate at rest (68±4 bpm (base) to 93 ± 5 bpm (3 mo) (p<0.05)), increased respiratory rate at rest (28±5 (base) to 38 ± 7 (3 mo) (p<0.05)) and increased body weight 77 ± 2 kg to 81 ± 2 kg (p<0.05) due to pleural effusion, peripheral edema and ascites. Echocardiographic evaluation revealed significantly an increase of left ventricular enddiastolic diameter from 46 ± 3 mm (base) to 61 ± 4 mm (3 mo) (p<0.05). Clinically and echocardiographically no significant changes were revealed in healthy control animals. Conclusions We conclude that multiple sequential intracoronary microembolization can effectively induce myocardial dysfunction with clinical and echocardiographical signs of chronic ischemic cardiomyopathy. The present model may be suitable in experimental work on heart failure and left ventricular assist devices, e.g. for studying the impact of mechanical unloading, mechanisms of recovery and reverse remodeling.
Chondrocyte Response to High Regimens of Cyclic Hydrostatic Pressure in 3-Dimensional Engineered Constructs
Authors: Candiani G. , Raimondi M.T. , Aurora R. , Laganà K. , Dubini G. 
Published: January 2018

Purpose Despite widespread use of 3-dimensional (3D) micro-porous scaffolds to promote their potential application in cartilage tissue engineering, only a few studies have examined the response to hydrostatic pressure of engineered constructs. A high cyclic pressurization, currently believed to be the predominant mechanical signal perceived by cells in articular cartilage, was used here to stimulate bovine articular chondrocytes cultured in a synthetic 3D porous scaffold (DegraPol). Methods Construct cultivation lasted 3 days with applied pressurization cycles of amplitude 10 MPa, frequency 0.33 Hz, and stimulation sessions of 4 hours/day. Results At 3 days of culture, with respect to pre-culture conditions, the viability of the pressurized constructs did not vary, whereas it underwent a 16% drop in the unpressurized controls. Synthesis of α-actin was 34% lower in all cultured constructs. Synthesis of collagen II/collagen I did not vary in pressurized constructs, was 76% lower in unpressurized controls, and was around 230% higher in pressurized constructs with respect to unpressurized controls. Chondrocytes showed a phenotypic spherical morphology at time zero and at 3 days of pressurized culture. Conclusions Although the passage from 2D expansion to 3D geometry was effective to guide cell differentiation, only mechanical conditioning enabled the maintenance and further cell differentiation toward a mature chondrocytic phenotype.
Hepatitis C Virus Infection and Post-Transplant Diabetes Mellitus among Renal Transplant Patients: A Meta-Analysis
Authors: Fabrizi F. , Messa P. , Martin P. , Takkouche B. 
Published: January 2018

Objective To examine the association between HCV infection and the occurrence of post-transplant diabetes mellitus (PTDM) among renal transplant patients. Design Meta-analysis of observational studies. Data Sources We retrieved studies published in any language by systematically searching Medline, and Embase and by manually examining the references of the original articles, reviews, and monographs retrieved. Review Methods We included cohort and case-control studies reporting relative risk estimates and 95% confidence intervals (CIs) for PTDM occurrence with HCV after renal transplantation. Thirteen studies providing information on a total of 30,099 unique patients were included in our meta-analysis. Results Study-specific relative risks were weighted by the inverse of their variance to obtain fixed- and random-effects pooled estimates. The pooled relative risk (RR) for PTDM after RT was 2.73 with a 95% confidence interval (CI) of 1.94; 3.83 (10 studies). In a stratified analysis including only large studies (2 studies), the pooled RR was 1.36 (95% CI, 1.21; 1.54). Egger's regression test showed some evidence of publication bias (p=0.0001), but our sensitivity analysis showed that this issue did not meaningfully change the results. Conclusions Our study shows a marked increase of the risk of post-transplant diabetes mellitus in anti-hepatitis C virus-positive renal transplant recipients. The excess risk of death in hepatitis C virus-positive renal transplant recipients may be at least partially attributed to post-transplant diabetes mellitus with its attendant complications.
The Effect of Three Different Miniaturized Blood Purification Devices on Plasma Cytokine Concentration in an Ex Vivo Model of Endotoxinemia
Authors: Haase M. , Bellomo R. , Baldwin I. , Haase-Fielitz A. , Storr M. , Krause B. , Boyce N. , Svobodova S. , Li W. , Bagshaw S. M. , Warrillow S. , Langenberg C. , Morgera S. 
Published: January 2018

Purpose A novel type of adsorptive plasma filtering device (ETX-A) capable of removing endotoxin from blood in a single step has recently been developed using nanotechnology. Methods In a miniaturized, ex vivo model of extracorporeal circuits, we tested the capacity to reduce plasma cytokine concentration of ETX-A filters in comparison to standard high-flux (HF) filters, high cut-off (HCO) filters and a control. Blood from six healthy volunteers was spiked with endotoxin and then circulated through closed (ETX-A, control) or open (HF, HCO) circuits. Blood flow was set at 16 ml/min and filtration flow at 1 ml/min. Samples for measurement of IL-1ra and IL-6 were taken at baseline and at 4 hours. Results Compared to control (703.3 [850.6] pg/mL), in HCO (383.5 [1144.1] pg/mL) and ETX-A (490.1 [683.2] pg/mL) filters, plasma IL-1ra pooled pre- and postfilter concentrations were lower at the end of the experiment (P=0.002; P=0.050, respectively) whereas, in standard HF filters, IL-1ra concentration was higher than control. HCO showed a trend toward a reduced relative increase in IL-6 concentration from commencement to end of experiment compared to control (P=0.07). After pooling end-of-experiment plasma cytokine values of novel blood purification devices, we found HCO + ETX-A superior to H with regard to reduction of IL-1ra (-27.0 [−20.5]% vs. 8.1 [18.9]%; P<01) and IL-6 (-18.0 [38.3]% vs. −1.1 [24.3]%; P=0.050) compared to control. Conclusions HCO and ETX-A appeared to significantly reduce plasma IL-1ra and, when combined, plasma IL-6 concentration as well. It appears desirable to manufacture full-size blood purification devices using this technology and to explore their effect on cytokine removal.
Intermediate Coronary Revascularization using the Deltastream Blood Pump: Results from an Experimental Study
Authors: Litmathe J. , Hansen E. , Feindt P. , Kurt M. , Boeken U. , Gams E. 
Published: January 2018

Background Myocardial revascularization using a complete heart-lung machine may involve many problems, as do complete off-pump attempts. Thus, it was the aim of this study to evaluate the effects of intermediate on-pump/off-pump myocardial revascularization using the miniaturized Deltastream blood pump, on ischemia and hemolysis, in comparison with standard myocardial revascularization. Methods In a group of 8 mini-pigs, combined on-pump/off-pump myocardial revascularization was performed using the Deltastream blood pump as beating-heart support for the on-pump part of the operation (group A). Seven other animals served as controls and underwent standard myocardial revascularization with the same device as integrated pump of a complete heart-lung machine (group B). Blood samples for blood gas metabolism, creatine kinase (CK), troponin I, lactate dehydrogenase (LDH), and hydroxybutyrate dehydrogenase (HBDH) were taken before and after the entire operation. Results Comparing the baseline values, the increase of CK was more pronounced in group B than in group A (176.4 ± 41.2 to 279.7 ± 29 U/L vs. 274 ± 142.7 to 288.1 ± 118.6 U/L, respectively; p=0.0006). Increase of troponin I was significantly higher in group B than in group A (1 ± 0.3 to 2.9 ± 1 ng/mL vs. 1.1 ± 0.9 to 3 ± 3.8 ng/mL, respectively; p=0.002). LDH increase was also more pronounced in group B (231.7 ± 54.3 to 299.9 ± 39.8 U/L vs. 274.9 ± 59.7 to 263.8 ± 57.9 U/L, respectively; p=0.01). HBDH values increased significantly in group B after the operation (group A: 215.9 ± 34.7 to 200 ± 39.2 U/L vs. group B: 195.4 ± 41.7 to 274.9 ± 51.6 U/L; p=0.02). Hemodynamic measures and LDH values under luxation (group A: 1.9 ± 0.6 U/L; B: 3.5 ± 1 U/L, p=0.001) were also superior in the study group. Conclusion The current set-up might be superior to conventional extracorporeal circulation and thus be an alternative for high-risk candidates to avoid the adverse events of a complete heart-lung machine, when they are scheduled for complete myocardial revascularization.
In Vitro Large-Scale Cultivation and Evaluation of Microencapsulated Immortalized Human Hepatocytes (HepLL) in Roller Bottles
Authors: Yu Cheng-Bo , Lv Guo-Liang , Pan Xiao-Ping , Chen Yan-Shan , Cao Hong-Cui , Zhang YI-MING , Du Wei-Bo , Yang Shi-Gui , Li Lan-Juan 
Published: January 2018

Background/Aims Microencapsulated hepatocytes have been proposed as promising bioactive agents for packed-bed or fluidized-bed bioartificial liver assist devices (BLADs) and for hepatocyte transplantation because of the potential advantages they offer of high mass transport rate and an optimal microenvironment for hepatocyte culture. We developed a large-scale and high-production alginate-chitosan (AC) microcapsule roller bottle culture system for the encapsulation of HepLL immortalized human hepatocytes. In this study, the efficacy of upscaling encapsulated HepLL cells production with roller bottle cultivation was evaluated in vitro. Methods Microencapsulated HepLL cells were grown at high yield in large-scale roller bottles, with free cells cultured in roller bottle spinners serving as controls. The mechanical stability and the permeability of the AC microcapsules were investigated, and the growth, metabolism and functions of the encapsulated HepLL cells were evaluated as compared to free cells. Results The microcapsules withstood well the shear stress induced by high agitation rates. The microcapsules were permeable to albumin, but prevented the release of immunoglobulins. Culture in roller bottles of immortalized human hepatocytes immobilized in the AC microcapsules improved cell growth, albumin synthesis, ammonia elimination and lidocaine clearance as compared with free cells cultured in roller bottles. Conclusions Encapsulated HepLL cells may be cultured on a large scale in roller bottles. This makes them possible candidates for use in cell-based liver assist therapies.
A Long-Term Retrospective Review of 5 Cases using Daptomycin for Prosthetic Device Infections after Surgery
Authors: Quetglas Emilio G. , Julian Mikel San , Tutor Emilio García , Vazquez Blanca , Lucena Felipe , Landecho Manuel , Azanza Jose Ramon 
Published: January 2018

Purpose To review the antimicrobial possibilities for limb-sparing due to infectious complications after surgery in patients diagnosed with osteosarcoma and with implantation of prosthetic devices. Patients and Progress After several episodes of relapsing infection or even re-infection and failure of previous therapies, 5 patients (2 young, female / 1 young, male / 2 middle-aged, female) were subject to a long-term ambulatory regimen consisting of intravenous administration of daptomycin. Results Showed improved outcome with preservation of the limbs or devices involved. Conclusion Five patients with post-operative gram-positive suspected infections of prosthetic devices that were unresponsive to a variety of other antibiotics and combinations appeared to respond to compassionate use of daptomycin. Its effectiveness is probably due to its activity against biofilm-producing microorganisms. Controlled, double-blind randomized trials are needed to confirm the potential of daptomycin in such patients.