International Journal of Artificial Organs最新文献

Objective: This study aimed to investigate the impact of different ultrafiltration (UF) volumes (UFVs) during haemodialysis (HD) on cardiac function and myocardial work (MW) indices in patients with kidney failure (KF) undergoing maintenance HD (MHD).

Methods: A total of 58 participants were enrolled. The patients with KF were stratified into two groups based on their UFV. Data were collected between July 2023 and August 2024 at the Second Affiliated Hospital of Baotou Medical College. Cardiac parameters were measured using echocardiography before and after HD.

Results: Compared with healthy controls, the KF groups exhibited significantly elevated systolic blood pressure, heart rate and early diastolic mitral inflow velocity to early diastolic mitral annulus velocity ratio, along with reduced global longitudinal strain (GLS), global work efficiency (GWE), global constructive work (GCW) and global work index (GWI; all p < 0.05). Post-HD, the ⩽3% group showed improvements in GLS and GWE, whereas GCW, global wasted work and GWI decreased significantly (p < 0.05). In contrast, the >3% group experienced reductions in left atrial and ventricular size, GCW, GWE and GWI following dialysis (p < 0.05), without significant changes in GLS.

Conclusion: Ultrafiltration volumes during HD significantly affect MW and cardiac function. Ultrafiltration ⩽3% of dry weight appears to mitigate the adverse impact on cardiac parameters, offering potential clinical value for optimising HD protocols.

Background: Coupled plasma filtration and adsorption (CPFA) is a non-selective extracorporeal technique designed to modulate systemic inflammation through plasma filtration combined with resin-based adsorption. While preclinical data were promising, randomized trials in septic shock yielded conflicting results and raised safety concerns, leading to its discontinuation. Nonetheless, selected patients might benefit from CPFA when adequately delivered.

Methods: We performed a retrospective, single-center observational study of 36 critically ill patients treated with CPFA between 2019 and 2022. A total of 56 CPFA sessions were analyzed, evaluating clinical indications, plasma-treated volume (VPT), hemodynamic changes, and clinical outcomes.

Results: The main indication was sepsis (75%), followed by rhabdomyolysis and intoxications (8% each). Most patients received one to two sessions, with a mean duration of 9 ± 1 h and a VPT of 10,103 ± 4275 mL. Survival at 72 h and 28 days was 85% and 61%, respectively, with no early deaths. Patients achieving a VPT ⩾18% of estimated plasma volume had better 28-day survival (81% vs 42%, p = 0.03), although they had lower initial severity scores. A non-significant trend toward vasopressor reduction was observed. No major adverse events occurred.

Conclusion: In this cohort, CPFA was feasible and safe, with possible hemodynamic and survival benefits when a sufficient plasma-treated volume was reached. Patient selection and optimized treatment delivery appear crucial. However, the retrospective design and lack of a control group limit definitive conclusions. Future research should focus on more effective and targeted extracorporeal strategies for immune modulation in critically ill patients.

This research introduces a meticulously designed dual-port antenna tailored to operate within the 2.3-2.4 GHz frequency spectrum. The design specifically addresses challenges of achieving high isolation, reducing envelope correlation, and maintaining robust diversity performance in compact multi-antenna systems. The configuration prioritizes optimal performance metrics to meet stringent communication demands. Notably, the isolation between antenna elements surpasses 20 dB, ensuring minimal interference and enhanced signal integrity in diverse communication environments. Achieving impressive radiation performance, the antenna promises robust signal transmission capabilities while adhering to strict power consumption constraints. Its exceptionally low ECC of less than 0.1 contributes to heightened data reliability, crucial in modern communication systems. Moreover, the antenna exhibits a remarkable diversity gain, nearing 10 dB, facilitating improved signal reception and effectively combating fading and multipath propagation. Notably, its measured channel capacity of 8 bps/Hz underscores its potential for high-bandwidth applications. Fabrication and measurement outcomes meticulously align with theoretical projections, confirming successful synchronization between the antenna's designed specifications and real-world performance, validating its practical viability for diverse wireless communication systems.

As a surgical treatment option for heart failure, left ventricular assist devices (LVAD) help to restore function in failing hearts. Recent studies suggest possible negative impacts of this therapy, as LVAD reduces blood flow and allows potential for coronary remodeling and increased intimal alteration. Our study examined patients with clinically diagnosed non-ischemic cardiomyopathy (NICM) and subsequent heart failure necessitating transplantation and the use of LVAD as a bridge to transplant. Surgically explanted heart specimens were identified and both semi-quantitatively scored and quantitatively assessed for the degree of cross-sectional coronary artery luminal narrowing. Non-parametric statistical analysis of semi-quantitative scored cases was conducted to examine differences between the test population and a control population of NICM patients undergoing transplant without the use of LVAD bridge to therapy. Parametric analysis of the quantitative digitally assessed cases was conducted to corroborate these results. The test population demonstrated a statistically significant difference in coronary artery luminal narrowing compared to the control population. Our findings suggest increased coronary artery disease in previous NICM patients receiving LVAD as a bridge to transplantation regardless of the time with the implanted device. Further work is necessary for future correlation, as these findings bear importance for improving transplant patient outcomes.

This study aimed to evaluate the efficacy of different irrigation activation systems in removing calcium hydroxide from simulated internal resorption cavities using standardized Three-Dimensional (3D) printed root canal models and objective volumetric analysis. A maxillary central incisor was scanned via micro-computed tomography and reconstructed to create standardized 3D-printed teeth with simulated internal resorption cavities. Sixty-four samples were divided into four groups (n = 16) according to the irrigation method: Conventional Needle Irrigation (CNI), Irrigation Ultrasonic Agitation (IUA), EndoActivator (EA), and XP-endo Finisher (XPF). Following calcium hydroxide placement and incubation, different irrigation protocols were applied. Residual calcium hydroxide volume was assessed using CBCT imaging and segmented with 3D Slicer software. Statistical analysis was performed with one-way ANOVA and Dunnett's T3 post-hoc test (α = 0.05). XPF removed significantly more calcium hydroxide than CNI and EA (p < 0.05). No statistically significant difference was found between XPF and IUA. None of the tested activation systems, except for one specimen in the IUA group, completely removed the calcium hydroxide from simulated internal resorption cavities. XPF removed significantly more calcium hydroxide than CNI and EA, while XPF and IUA exhibited similar performance.

Globally, heart disease (HD) persists as a major contributor to mortality rates, requiring accurate and efficient diagnostic models. While machine learning has shown promise in early detection, challenges such as missing data, class imbalance, suboptimal feature selection, and inefficient hyperparameter tuning hinder predictive accuracy and reliability. Many existing models fail to effectively preprocess medical datasets, leading to biased and computationally expensive predictions. To address these issues, this study proposes a strong hybrid framework for HD prediction. The Balanced Imputation-Normalization Framework incorporates K-Nearest Neighbors (KNN) imputation, StandardScaler normalization, and the Synthetic Minority Oversampling Technique (SMOTE). KNN imputation effectively handles missing data, ensuring reliable representation, while StandardScaler normalization standardizes feature values to enhance model stability. SMOTE is applied to address class imbalance, synthetic samples are generated to augment the minority class. Feature selection is optimized using the Hungarian algorithm, which systematically selects the most relevant attributes while reducing redundancy. Additionally, Bayesian optimization fine-tunes hyperparameters to improve classification performance. For prediction, an ensemble learning approach combines Random Forest (RF), Decision Tree (DT), K-Nearest Neighbors (KNN), Naïve Bayes (NB), and Extreme Gradient Boosting (XGBoost). The Voting Ensemble aggregates predictions using hard and soft voting mechanisms, improving robustness and generalization. Experimental results on benchmark heart disease datasets demonstrate that XGBoost attained a peak accuracy of 96.43%, with subsequent results from the Voting Ensemble at 95.66%, significantly outperforming traditional models and demonstrating that ensemble learning effectively improves accuracy and reduces computational complexity.

Introduction: Renal replacement therapy efficiently eliminates cefepime. A published in vitro study concluded to minimal adsorption of cefepime in a polysulfone derived filter. We aimed at assessing cefepime adsorption in filters used in critically ill patients.

Methods: Two filters were used, ST™150 and AV™1000. Adsorption was assessed in two modes, including diafiltration and filtration set to flow rates of from 2.5 to 1 L/h, respectively. Routes of elimination were assessed using NeckEpur^® method for 6-h session duration.

Results: The mean initial concentration in the 5-L central compartment (CC) in the 10 sessions was 47.7 ± 2.9 mg/L. Using the diafiltration mode, the mean adsorption rates in the ST™150 and AV™1000 were 1.3 ± 2.3% and 19.7 ± 1.2% (n = 3), respectively. Using the filtration mode at 1 L/h, the mean adsorption rates in the ST™150 and AV™1000 were 1.7% (n = 2) and 18.5% (n = 2), respectively.

Conclusion: ST™150 filter sequestrated very limited quantities of cefepime. In the diafiltration and filtration modes, AV™1000 sequestered cefepime at about 19%. The adsorption rate seems independent of the flow rate. Further studies would be needed to assess, in particular, the clinical relevance of these results in adults as well as drug adsorption in the pediatric population.

Achieving optimal unloading in patients with left ventricular assist devices (LVADs) is associated with improved outcomes but remains unattainable in some cases. We retrospectively reviewed 33 patients with a HeartMate 3 LVAD who underwent speed optimization with concomitant echocardiography and right heart catheterization for inadequate left ventricular (LV) unloading between January 2016 and December 2023. Patients were stratified based on left ventricular transmural pressure (LVTMP) into two groups: LVTMP ⩽7 mmHg and LVTMP >7 mmHg using a median split approach. Pulmonary capillary wedge pressure (PCWP) decreased in both groups with increased LVAD speed; however, the mean PCWP change per 100 rpm was significantly smaller in patients with LVTMP ⩽7 mmHg (-0.50 vs -0.99 mmHg per 100 rpm, p = 0.003). Comparative analysis demonstrated LVTMP's superiority over established RV markers, with the strongest interaction effect for predicting speed optimization response. Changes in cardiac output were similar between the two groups. In univariate analysis, multiple hemodynamic parameters were significantly associated with reduced LVTMP, including right atrial pressure (OR = 1.27, p = 0.036), TPG (OR = 1.25, p = 0.037), DPG (OR = 1.69, p = 0.012), and PAPi (OR = 0.35, p = 0.019).LVTMP, as a surrogate for true LV preload, particularly in the context of RV failure, may offer predictive value for the success or failure of LV unloading with LVAD speed optimization.