International Journal of Artificial Organs最新文献

Collagen is an abundant component in the human body and plays a fundamental role in the integrity and function of various tissues, including skin, bones, joints, and connective tissues. This natural polymer also contributes to physiological balance and individual health. Within this context, this article reviews the structure of collagen, describing intrinsic characteristics that range from its molecular composition to its organization into bundles. Additionally, the review highlights some of the applications of collagen in tissue engineering, particularly its mimicry of the skin's extracellular matrix. For this review, searches were performed in PubMed, Scopus, and Web of Sciences. The inclusion criteria were established based on the relevance of the studies for the objectives of the review and methodological quality. After selection of the articles, a critical analysis of their content was conducted and the information was synthesized and presented concisely. Analysis of the properties of collagen revealed its key importance for the design of bioactive materials in regenerative applications. However, challenges such as the need for improvement of the integration of implanted materials and a better understanding of the underlying biological processes remain.

Given the growing obesity pandemic, the impact of obesity on outcomes of Extracorporeal Membrane Oxygenation (ECMO) would be increasingly relevant to our daily practise. This meta-analysis aims to evaluate the impact of obesity on ECMO outcomes, integrating the latest evidence. Systematic literature search was conducted from inception until December 2024 on MEDLINE, Embase and the Cochrane Library using the terms 'ECMO', 'obesity', and their related terms. Twenty-eight studies were included from 2013 to 2024, including a total of 74,330 ECMO patients (Mean age 52.84 ± 13.55 years). Obese patients had a similar risk of in-hospital or 30-day mortality when compared to non-obese patients (Risk difference -2%, 95%CI -5% to -1%, I² = 85%, p = 0.25). Subgroup analysis of patients on V-V-ECMO showed a trend towards lower mortality in obese patients which did not reach statistical significance (risk difference -6%, 95%CI -13% to 0%, I² = 53%, p = 0.06). Subgroup analysis of patients on V-A-ECMO showed significantly higher mortality in obese patients (risk difference 5%, 95%CI 1% to 9%, I² = 54%, p = 0.007). Regarding secondary outcomes, obesity had no significant association with major bleeding or thrombotic complications (Risk difference 0%, 95%CI -1% to 2%, I² = 15%, p = 0.63). Obesity was associated with significantly shorter hospital length-of-stay (Mean difference -2.92 days, 95% CI -5.03 to -0.80, I² = 74%, p = 0.007), but had no impact on ECMO duration (Mean difference 0.35 days, 95%CI -0.03 to 0.74, I² = 41%, p = 0.07). In summary, our meta-analysis showed that obesity was a favourable prognostic factor in V-V-ECMO. However, obesity increased mortality in V-A-ECMO patients. The modality of ECMO support should be taken into consideration when evaluating ECMO candidacy in individual obese patients.

Significant changes in pre-dialytic partial pressure of CO₂ (pCO₂) during a week-long cycle of hemodialysis (HD) can be an effect of the intermittent supplementation of bicarbonate to correct chronic acidosis in patients. Mathematical modeling efforts carried out using the same parameters before each HD session might fail to produce accurate predictions of pCO₂ and plasma bicarbonate concentration (C_Bic) because of this variability. A numerical model describing acid-base equilibrium changes during HD was applied to predict pCO₂, pH, and C_Bic in 24 chronic HD patients, using both fixed parameters for the whole week and estimating a new value of minute ventilation (V_E) and net acid generation rate (G_H) for each interdialytic interval. Dialysances of bicarbonate and dissolved CO₂ were also estimated independently for each HD session. The error of the model compared to the pre-dialytic data of C_Bic and pCO₂ significantly decreased when V_E and G_H were estimated piecewise throughout the week. To fit the data, V_E changed from 3.9 ± 1.0 mL/min before HD1, to 3.8e1 mL/min after HD1, 3.6 ± 1.0 mL/min after HD2, and 3.9 ± 1.1 mL/min after HD3 (p < 0.05). G_H changes after each session were not statistically significant. V_E values strongly correlated with pre-dialytic pCO₂ (Spearman's ρ = -0.97), but G_H only weakly correlated with pre-dialytic C_Bic (ρ = -0.30). Acid-base equilibrium is extremely sensitive to respiratory regulation. When attempting to predict the evolution of pCO₂ a C_Bic during the HD cycle, changes in the respiration parameters must be accounted for by the model, at the risk of a significant loss of prediction accuracy.

Background: as we look to extend ex vivo lung perfusion times (EVLP) to improve preservation, the metabolic activity of the lungs will require support from other organ functions. Active functional liver support, including detoxification, synthesis, and regulation, can improve lung preservation during EVLP. This study aimed to demonstrate the effects of hepatic conditioning of the EVLP perfusate on lung endothelium, via the receptor of advanced glycation end-products (RAGE)-nuclear-factor-κB (NF-κB) signaling in vitro.

Methods: we performed in vitro experiments using human lung microvascular endothelial cells (HLMVECs), human hepatocytes, and perfusate (Steen solution). Four experimental groups: 1) fresh Steen (negative controls, NC), 2) EVLP'ed Steen control, this solution collected after 12 h of EVLP of human lungs, 3) hepatocyte conditioned EVLP'ed Steen (Hep-cond.), and 4) a RAGE inhibitor added in EVLP'ed Steen (RAGE inhibitor). HLMVECs were incubated in each testing condition and exposed to hypoxia (1% O₂/8% CO₂) for 24 h. Media were collected to investigate NF-κB signaling and endothelial glycocalyx damage.

Results: HLMVECs incubated under hypoxia in EVLP'ed Steen showed significantly upregulated NF-κB signal and endothelial damage denoted by increased glycosaminoglycans and matrix metalloproteinase-2 activity among the groups. The Hep-cond. solution significantly attenuated those findings, while the RAGE inhibitor attenuated the NF-κB signal but not endothelial glycocalyx damage.

Conclusion: Our study demonstrates that hepatic function incorporated into EVLP can ameliorate pulmonary endothelial cells injury under hypoxic normothermic perfusion exposure. Our data supports the concept of incorporating other organ functions into an organ perfusion platform, to enhance lung graft preservation.

Introduction: To the best of our knowledge, a possible predictive relationship between the systemic coagulation-inflammation index (SCI) and arteriovenous fistula (AVF) failure following AVF creation has not yet been examined. We therefore designed this study to examine the predictive ability of SCI on postoperative early AVF failure in patients undergoing primary radiocephalic AVF operation.

Methods: A total of 189 patients who underwent primary radiocephalic AVF operation for hemodialysis access were included in this retrospective observational cohort study, and then divided into two groups according to whether AVF failure occurred within the first 3 months after the operation; as failed AVF group (n = 44) and non-failed AVF group (n = 145). The patients' baseline clinical characteristics and laboratory parameters were recorded and then compared between the groups.

Results: Patients in failed AVF group were significantly older and had higher smoking rate than those in non-failed AF group. The median values of fibrinogen, platelet-to-lymphocyte ratio and SCI were significantly higher in failed AVF group than in non-failed AVF group. With regards to other clinical characteristics and laboratory parameters, no significant differences were detected between the groups in the univariate analyses. Only age and SCI maintained their significances in the multivariate logistic regression analysis, and were therefore considered as the independent predictors of AVF failure. ROC curve analysis revealed that SCI of 37.9 constituted the optimum cut-off value with 97.7% sensitivity and 94.5% specificity rates for predicting AVF failure.

Conclusion: The present study demonstrated for the first time in the literature that SCI significantly and independently predicted early AVF failure following radiocephalic AVF creation.

Cardiopulmonary bypass (CPB) is an indispensable technique in cardiac surgery; however, its impact on gut microbiota and metabolites remains insufficiently studied. CPB may disrupt the intestinal mucosal barrier, altering the composition and function of gut microbiota, thereby triggering local immune responses and systemic inflammation, which may lead to postoperative complications. This narrative review examines relevant literature from PubMed, Web of Science, Google Scholar, and CNKI databases over the past decade. Keywords such as "gut microbiota," "cardiopulmonary bypass," "cardiac surgery," and "postoperative complications" were employed, with Boolean operators used to refine the search results. The review examines changes in gut microbiota before and after CPB, their role in postoperative complications, and potential strategies for modulation to improve outcomes.

We reported the cytokine profile in children <18 years old who received extracorporeal blood purification (EBP) for sepsis, rhabdomyolysis, hyperbilirubinaemia, acute respiratory distress syndrome or cytokine storm, and determined the factors affecting the cytokine removal kinetics. Plasma levels of 38 types of cytokine/chemokine were measured at pre-EBP, 12 and 24 h after initiating EBP. Altogether there were 11 eligible episodes admitted between April 2021 and December 2023. 72.7% were male with a median (25th, 75th percentile) age of 8.7 (5.4, 15.7) years old. The overall mortality rate was 45.5% but there was no EBP-associated mortality. EBP modalities included Cytosorb^® haemoadsorption (63.6%) and Oxiris^® haemodiafiltration (36.4%). Thirty-seven (97.4%) cytokines exhibited a concentration reduction following EBP, and 60.5% achieved a ≥50% concentration reduction. The median removal ratio was 35.0 (21.0, 53.7)% at 12 h and 55.0 (42.1, 83.1)% at 24 h. Survivors showed a significantly higher number of cytokines with ⩾50% removal ratio at 24 h (28 vs 7, p = 0.017) and better removal ratio of anti-inflammatory cytokines at 12 h (67.9% vs 0%, p = 0.030). A higher pre-EBP cytokine concentration and higher blood flow rate were significantly associated with better removal in 16 (42.1%) and 32 (84.2%) cytokines respectively. Our study demonstrated that both devices can safely and effectively reduce the cytokine and chemokine levels in critically ill children with various conditions.

Objective: To evaluate the effectiveness and safety of artificial intermittent infusion hemodiafiltration (I-HDF) in maintenance hemodialysis (MHD) patients with intradialytic hypotension (IDH), and to determine the optimal infusion dosage.

Methods: This single-center, prospective, self-controlled study included 30 MHD patients with IDH, treated from December 2022 to July 2023. Patients underwent three sessions of I-HDF as treatment group and conventional hemodialysis as control group. Comparisons were made between the two groups regarding changes in blood pressure, hypotension symptoms, changes in body water content, and achievement of infusion doses.

Results: 1. The fluctuation amplitude of SBP in the treatment group was 18.96 ± 10.400, while in the control group it was 27.4 ± 11.796. There was a significant difference between the two groups (p < 0.05). 2. During 90 sessions of dialysis, 39 interventions were needed in the treatment group, compared to 59 interventions in the control group. The treatment group required fewer interventions, with a significant difference (p < 0.05). 3. No hypotension symptoms occurred in the treatment group, whereas six cases were observed in the control group, which was significantly higher (p < 0.05). 4. One patient in the 250 ml infusion group experienced chest tightness. Among the three infusion groups, the 250 ml group had the greatest fluctuation in DBP, with a significant difference (p < 0.05). 5. Among the three infusion volumes groups, there was a significant difference between the theoretical and actual infusion volumes in the 150 and 200 ml groups (p < 0.05).

Conclusion: The artificial I-HDF mode effectively improves the occurrence of IDH. An infusion dose of 150-200 ml is deemed appropriate.

Objective: To evaluate the effect of early rehabilitation on therapeutic outcomes of patients in the ICU requiring mechanical ventilation.

Methods: Electronic databases up to June 15, 2024 were searched. Randomized controlled trials (RCTs) that compared early rehabilitation with standard rehabilitation for patients in the ICU on mechanical ventilation were included. The effects of early rehabilitation on outcomes such as duration of mechanical ventilation (days), ICU length of stay (days), hospital length of stay (days), ICU and in-hospital mortality, and ICU-acquired weakness (ICU-AW) were evaluated using a random-effects model.

Results: Nineteen RCTs met the inclusion criteria for this study, involving 3076 patients in the ICU on mechanical ventilation. Meta-analysis based on the random-effects model showed that early rehabilitation significantly reduced the duration of mechanical ventilation, ICU-AW risk, ICU length of stay, and total hospital length of stay. Analysis of the timing of early rehabilitation indicated that implementing early rehabilitation within ⩽48 or ⩽72 h after ICU admission or mechanical ventilation had varying effects on the duration of mechanical ventilation, ICU length of stay, and total hospital length of stay.

Conclusion: Early rehabilitation can improve the therapeutic outcomes for ICU patients on mechanical ventilation. The optimal time for implementing early rehabilitation appears to be 48-72 h after ICU admission or initiation of mechanical ventilation, but further research is needed.

Clinical trial number: INPLASY202470068.

Introduction: Amikacin is sequestered in polyacrylonitrile filters. Methods mitigating sequestration are unknown. Amikacin elimination in a polyacrylonitrile-derived filter preloaded with amikacin was studied in a preliminary study.

Methods: Amikacin concentrations were determined using an immunochemical method. Prismaflex™, Baxter-Gambro, and the ST™150 filter were used. Sessions were performed in a continuous diafiltration mode. Diafiltration flow rate was set to 2500 mL/h and filtration to 500 mL/h pre- and 1000 mL/h post-dilution. Net loss was set to zero. In sessions with preload, a 150 mg dose of amikacin was injected in the first 1 L bag of physiological saline when starting the priming. NeckEpur^® method was used for pharmacokinetic calculations.

Results: In the central compartment (CC), the mean initial concentration in the sessions without and with preload was 81.8 ± 6.0 mg/L. There were no significant differences in the AUC_cc and AUC_inlet without or with preload. The preloading dose induced a significant increase in the AUC_outlet. Compared with sessions without preload, the clearance from the CC in sessions with preload decreased from 4.94 ± 0.43 to 3.75 ± 0.32 L/h, respectively. The elimination rates by diafiltration and sequestration in the sessions without and with preload were 82.3 ± 6.2/17.8 ± 6.2% and 125 ± 9.2%/0 ± 0%, respectively. The 150 mg loading dose was eliminated by diafiltration (42.5%) and by sequestration (57.5%).

Conclusion: Preloading filter with amikacin modifies the disposition of amikacin by preventing further sequestration. Studies are needed to define an efficient preloading dosage regimen in actual condition of use.