International Journal of Artificial Organs最新文献

Objective: This systematic review and meta-analysis aimed to identify the risk factors for acute kidney injury (AKI) in patients with severe acute pancreatitis (SAP).

Methods: A comprehensive literature search was conducted using the PubMed, Embase and Cochrane Library databases for case-control studies comparing the clinical characteristics of patients with SAP with and without AKI. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated using fixed- or random-effects models, based on heterogeneity.

Results: Five studies involving 795 patients with SAP were included, of whom 173 (21.8 %) developed AKI. All studies were of high quality according to the NOS. Among the 17 potential risk factors that were analysed, a history of alcohol consumption (OR = 2.36, 95% CI = 0.54-10.43, p < 0.001), elevated serum amylase (OR = 4.50, 95% CI = 1.77-11.43, p = 0.002) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score (OR = 1.57, 95% CI = 0.49-2.64, p = 0.004) were significantly associated with an increased risk of AKI. However, hypertension (OR = 1.14, 95% CI = 0.60-2.16, p = 0.69) and diabetes (OR = 1.88, 95% CI = 0.51-6.95, p = 0.34) were not significantly associated with AKI risk. Based on funnel plots, no obvious publication bias was detected.

Conclusions: A history of alcohol consumption, elevated serum amylase and APACHE II score are significant risk factors for AKI in patients with SAP. For early intervention, clinical physicians should be vigilant about the risk of AKI in patients with SAP with these factors. More high-quality studies are needed to validate these findings and explore other potential risk factors.

Background: Most of the modeling of the Left Ventricular Assist Devices (LVADs) coupled with the cardiovascular system is based on the assumption of constant rotational speed. Compared with the traditional inertial model, the validated hysteresis model can take into account the unsteady characteristics of LVADs, but it fails to work under the condition of variable speed modulation.

Method: This study takes into consideration the impact of speed variations on the unsteady hysteresis effects. The time constant in the hysteresis model is treated as a time-varying parameter, thereby developing a new model applicable to variable speed modulation. Under sinusoidal speed modulation at various phases, a comparative analysis was undertaken among the steady-state model, inertial model, and the new model. Transient Computational Fluid Dynamics (CFD) simulations and existing experimental results are used for validation.

Results: The new model provides a more accurate method for the predicting the characteristics of LVAD in the coupled model under varying pump speeds, and exhibits higher linearity in the work done by the left ventricle and the blood pump, and $R^2=0.9998$, which is aligning closely with the experimental results. This enhancement renders it applicable for proactive control predictions and passive control validations.

Introduction: To explore the association between serum Dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP) and abdominal aortic calcification (AAC) in peritoneal dialysis (PD) patients.

Methods: A total 128 PD patients and 120 healthy controls were enrolled into the study. Serum dp-ucMGP was measured by enzyme-linked immunosorbent assay. Abdominal lateral plain radiography was used to evaluate the abdominal aortic calcification score (AACS). PD patients were divided into two groups according to the presence or absence of AAC. The relationships between dp-ucMGP levels and AACS were assessed by Spearman analysis and the value of dp-ucMGP in predicting AAC was evaluated by receiver operating characteristic (ROC).

Results: Serum dp-ucMGP in PD patients were significantly higher than controls (p < 0.05). And PD patients with AAC had higher serum dp-ucMGP than that of PD patients without AAC (p < 0.05). The serum dp-ucMGP levels was positively associated with AACS (r = 0.794, p < 0.0001) in PD patients. The multivariate logistic regression analyses showed that serum dp-ucMGP was independent factors of AAC in PD patients (OR = 2.555, 95% CI = 1.415-4.609). The area under ROC curve of dp-ucMGP was 0.9227, the corresponding sensitivity was 0.86, and the specificity was 0.92.

Conclusion: Serum dp-ucMGP levels were positively associated with the AACS in PD patients. Higher serum dp-ucMGP level is independently associated with AAC in PD patients.

Current online hemodiafiltration devices can be used to determine the absolute blood volume in clinical practice using the dialysate bolus method. Most of publications on this method have focused on preventing intradialytic complications. The influence of absolute blood volume on long-term prognosis has not been reported yet. A total of 79 participants in a previous study about absolute blood volume were followed for 5 years. Patients with a specific blood volume above (n = 45) and below 75 ml/kg (n = 34) respectively were compared with regard to survival using Kaplan-Meier analysis. Patients with a specific blood volume below 75 ml/kg had a significantly higher overall 5-year survival rate than patients above 75 ml/kg (70% vs 39%, p = 0.0233). In patients without cardiac dysfunction, there were no significant differences in 5-year survival between a specific blood volume below or above 75 ml/kg (66% vs 51%). A specific blood volume above 75 ml/kg was associated with an increased mortality in patients with mildly impaired left-ventricular systolic ejection fraction of 40%-59%, whereas in patients with normal blood volume this cardiac impairment did not impact mortality (22% vs 90% 5-year survival, p = 0.0036). This demonstrates the significance of optimum volume control for long-term survival particularly in cases of reduced cardiac function.

This study aims to develop an effective hemostatic agent in the management of irregular and deep wounds that can accelerate the hemostatic process. The background revealed the importance of rapid treatment of bleeding, with data showing a significant risk of death from blood loss. Current treatments use conventional hemostatic dressings, but they are less effective on irregular surgical wounds. Several studies have developed chitosan, hyaluronic acid, and CaCl₂-based hydrogels that have hemostatic, regenerative, and antibacterial potential. However, there is still a need to develop hydrogels that are thermally stable, biocompatible, and able to accelerate the hemostatic process. This research will synthesize self-healing hydrogels by modifying the structure of chitosan and hyaluronic acid, using a certain ratio of ingredients. The research procedure was carried out with the preparation of N-succinyl chitosan (NSC) and oxidized hyaluronic acid (OHA) as the main ingredients which were then added with CaCl₂ to produce self-healing injectable hydrogel. First, NSC and OHA were dissolved in phosphate buffer solution (pH = 7.4 PBS) to obtain 60 mg/mL NSC and OHA solution respectively. Calcium chloride was then dissolved in water to obtain 120 mg/mL CaCl₂ solution. Then NSC-OHA-CaCl₂-based hydrogels were synthesized through rapid and full solution mixing above room temperature with the composition of (1-1-0.1; 1-1-0.2; and 1-1-0.3). The targeted findings of this research are sample characterization results that explain and prove the best NSC-OHA-CaCl₂ composition variation that can be used as a hemostatic agent for irregular and deep wounds. The results of the analysis obtained FTIR test data with the formation of C = N functional groups in the four samples; blood clotting time test for sample K0, K1, K2, and K3 with time 4.6, 3.33, 2.66, and 1 s; MTT assay with cell viability percentage of 77.82% for sample K0, 84.18% for sample K1, 89.30% for sample K2, and 89.50% for sample K3; hemolysis index percentage of 0.373% for sample K0, 0.555% for sample K1, 0.625% for sample K2, and 0.201% for sample K3; Viscosity test obtained data of 13 dPa s for sample K0, 15 dPa s for sample K1, 16 dPa s for sample K2, and 18 dPa. The injectability test yielded an injectability percentage of 96.84% for sample K0, 95.03% for sample K1, 94.78% dPa s for sample K2, and 94.61% for sample K3; the DSC test results of the four samples obtained a transition peak at the exothermic peak of 62.27°C for sample K0, 70.23°C for sample K1, 73.77°C for sample K2, and 74.49°C for sample K3; and the characteristic graph of the TGA test results, the weight profile of the hydrogel during heating which showed a mass change of 21.64 mg in sample K0, 16.89 mg in sample K1, 15.37 mg in sample K2, and 11.43 mg in sample K3 (°C).

Background: Patients with continuous flow left ventricular assist devices (CF-LVADs) are at increased risk of gastrointestinal bleeding (GIB). Statins are commonly prescribed in LVAD patients for cardiovascular disease prevention. However, their impact on GIB events is controversial. Importantly, literature regarding statins impact on GIB in CF-LVAD patients is lacking.

Methods: A single-center, retrospective review of adult patients who underwent CF-LVAD implantation between May 2016 and January 2020 was performed. Patients were categorized based on statin use throughout the study period. The primary outcome was the composite of arteriovenous malformation confirmed GIB and major GIB events for up to 1-year post-LVAD implantation.

Results: Of 123 patients included in the final analysis, 66 (54%) received statin therapy during the study period. No difference was observed in the primary outcome between the statin and control groups (RR: 1.73; 95% CI: 0.75-3.98; p=0.20). Multivariable Cox regression revealed that older age and higher baseline creatinine were associated with an increased risk of GIB within 1-year of CF-LVAD implantation.

Conclusion: Among patients with CF-LVADs, there was no significant difference in the incidence of major GIB events associated with the use of statin therapy. Further studies are needed to assess whether a true association exists.

Introduction: New dialysis membranes with new properties are being developed to improve efficacy and tolerance. The hemocompatibility of a polymeric biomaterial is influenced by the layer of water at the blood membrane interface. The new dialyzer TORAY NV-U^® has a membrane Hydrolink™, designed to suppress platelet adhesion and to improve the hemocompatibility. Until now, there is no experience in online hemodiafiltration (OL-HDF).The objective of the present study is to evaluate the efficacy of this new membrane in OL-HDF therapy compared to another membrane commonly used. Other objectives are to evaluate the inflammatory response, hemodynamic tolerance, and the anticoagulation regimes.

Methods: This is a prospective pilot study performed in five anuric patients receiving OL-HDF. For 1 month patients were kept with their usual dialyzer FX1000^® (FMC). Subsequently, the dialyzer was changed to TORAY NV-U^® (Hydrolink^®) for 1 month. In the last dialysis session of each dialyzer, blood tests were performed to evaluate inflammation and depurative capacity.

Results: We did not find differences in medium size removal molecules and convective volume: FX1000^®: 31 ± 9 l per session and Hydrolink™ 30 ± 8 l; p = 0.7); β2microglobulin reduction ratio (RR) FX1000^® FMC 83 ± 3%; Hydrolink™ 79 ± 4; p = 0.14; Myoglobin RR FX1000^® FMC 72 ± 7%; Hydrolink™ 76 ± 4; p = 0.28. We did not find differences in inflammation parameters: serum IL6 with FX1000^® 6.0 ± 4.2 pg/mL; Hydrolink™ 7.6 ± 5.0 pg/mL; p = 0.3.During all sessions with the two dialyzers there was adequate plasmatic filling, reaching 85 % filling. All patients had "good" dialyzer status in all dialysis sessions with TORAY NV-U^®, while the dialyzer status with FX1000^® was "good" in 20% of the sessions, "medium" in 30%, and "dirty" in the remaining 50% dialysis sessions.

Conclusions: The new dialyzer Hydrolink™, TORAY NV-U^® is not inferior to perform OL-HDF compared to dialyzers usually used for this therapy, and could allow decrease heparin doses. Further studies with a bigger sample size and longer follow-up will answer if Hydrolink improves inflammation and assess a better hemodynamic tolerance.

Objective: The interaction between blood from end-stage renal failure patients undergoing hemodialysis treatment and the hemodialysis (HD) membranes used may lead to DNA damage, contingent upon the biocompatibility of the membranes. Given that this process could impact the disease's course, it is crucial to assess the efficacy of DNA repair mechanisms.

Methods: In our study, we investigated the gene expression levels of XRCC1 and PARP1 enzymes, which are involved in the base excision repair (BER) repair mechanism crucial for repairing oxidative DNA damage, in 20 end-stage renal disease (ESRD) patients undergoing HD treatment both before and after dialysis sessions. Additionally, we compared our findings with those from 20 healthy controls. We assessed gene expression levels using real-time polymerase chain reaction (qRT-PCR).

Results: We observed that the HD process utilizing a polysulfone membrane did not impact the expression levels of genes. However, we noted a lower expression level of the PARP1 gene in ESRD patients undergoing HD compared to the control group (0.021 ± 0.005 vs 0.0019 ± 0.0013, p = 0.0001).

Conclusion: Although our study findings indicate that HD membranes do not affect gene expression overall, the specific decrease in PARPI gene expression suggests that the effectiveness of the BER DNA repair mechanism is impaired in ESRD patients, which may play a significant role in the progression of the disease.

Using decellularized small-diameter vascular bypass substitutes (<6 mm) is an efficient method for bypass grafting. A solution containing 0.5% SDS (weight/volume) is commonly used for extended periods to generate acellular tissues. However, this solution causes damage to the microfibril structure and alters the mechanical forces. Hence, the objective of this study is to reduce the concentration of SDS to preserve the structure and achieve efficient decellularization. The study employs a diluted solution of 0.3% SDS (weight/volume) to treat fresh and frozen swine small-diameter arteries, utilizing physical methods such as freezing and thawing. The effectiveness of cell removal was evaluated using histological analysis and the remaining DNA content of the sample. Furthermore, the acellular circuit also assesses the cytotoxicity and proliferation of HUVECs to gauge their safety. Through the use of 0.3% SDS, a bioreactor system, and freezing-thawing, the pig arteries are successfully decellularized, resulting in residual DNA levels of less than 50 ng/mg dry weight. This process does not cause any major changes to the biomechanical or structural properties of the arteries. The acellular samples exhibit no toxicity on the L929 cell line and promote the growth of HUVECs at their highest rate on the fourth day. This allows for the placement of acellular vascular grafts to evaluate physiological processes within the animal body. This is an important requirement in clinical blood vessel transplantation.

Introduction: Intra-dialytic hypotension (IDH) remains the commonest problem associated with routine haemodialysis treatments. Fluid shifts from intracellular(ICW) and extracellular(ECW) compartments to refill plasma volume during haemodialysis with ultrafiltration.

Methods: We studied the effect of relative changes in ICW and ECW indifferent body segments using multifrequency segmental bioimpedance during haemodialysis and IDH episodes.

Results: Of 42 haemodialysis patients,16 patients (38.1%) developed IDH within the first hour of dialysis. Patients with and without early IDH were well-matched for demographics and starting bioimpedance measurements. However, after 60 min, the relative change in in ECW/ICW ratio between the non-fistula arm and leg was significantly different for the early IDH group median -1.07 (-3.33 to 0.8) versus 0.61 (-0.78 to 1.8), p < 0.05, whereas there no differences in ultrafiltration rate, relative blood volume monitoring or on-line clearance.

Conclusion: Monitoring serial changes in fluid status in different body compartments with bioimpedance may potentially prevent IDH in the future.