International Journal of Artificial Organs最新文献

Background: Decannulation from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is frequently associated with the clinical onset of systemic inflammatory response syndrome (SIRS). However, the cytokine profile underlying this response remains unclear. This study aimed to determine whether pro-inflammatory cytokine levels change in patients with SIRS following VA-ECMO decannulation.

Methods: We conducted a prospective observational pre-post study at a single tertiary academic center. Thirty consecutive adult patients who developed clinical SIRS within 24 h of successful VA-ECMO decannulation were included. Plasma concentrations of interleukin (IL)-1α, IL-1β, IL-6, and tumor necrosis factor-alpha (TNF-α) were measured at four time points: 1 h before, and 1, 12, and 24 h after decannulation. Repeated measures analysis of variance (ANOVA) was used to evaluate temporal changes in cytokine levels.

Results: Of 110 screened VA-ECMO patients, 30 (27.3%) met the inclusion criteria. The mean age was 48.8 ± 10.9 years. Baseline cytokine levels prior to decannulation were as follows: IL-1α 6.68 ± 10.99 pg/mL, IL-1β 0.28 ± 0.21 pg/mL, IL-6 18.21 ± 55.76 pg/mL, and TNF-α 5.62 ± 5.89 pg/mL. No significant changes were observed in IL-1α, IL-1β, or IL-6 levels across all time points. TNF-α showed a statistically significant decline at 24 h post-decannulation (4.15 ± 4.65 pg/mL) compared to baseline (p = 0.044).

Conclusions: In patients developing SIRS following VA-ECMO decannulation, plasma levels of key pro-inflammatory cytokines remained largely unchanged over a 24-h period. These findings suggest that the clinical manifestations of SIRS in this context may not be directly driven by traditional pro-inflammatory cytokine surges, warranting further investigation into alternative inflammatory mediators or mechanisms.Registered in clinical trials registry:NCT04678518, MRC-01-20-155.

Rotary blood pumps (RBPs), used as Ventricular assist devices (VADs), feature a suspended impeller (rotor) within a housing (stator). Titanium alloys are mostly used for those parts, but their limited wear resistance in critical contact areas, leading to scratches and promoting thrombus formation. Therefore, hard material coatings (HMCs) can be applied to increase wear resistance and bonding agents ensure stable coatings on the bulk material. Still, coating damage may occur and expose the material to blood, requiring hemocompatibility assessment. Therefore, their hemocompatibility must be evaluated as well as that of the HMCs. Platelet adhesion as thrombus formation indicator was investigated using an in vitro flow chamber and fluorescence microscopy for the following materials: Silicon diamond-like carbon (SiDLC), titanium nitride with and without droplets (TiN_D, TiN), bonding agents chrome (Cr), chrome nitride (CrN), uncoated Ti6Al4V (Ti), and aluminum (Alu) as positive control. CFD simulations determined wall shear rates, averaging 5730.5 1/s on the evaluated area. The normalized percentage of the covered surface (NCSA) area was statistically evaluated (p-values, Wilcoxon effect size). NCSA analysis showed that Alu had the highest value (8.7), significantly exceeding CrN and SiDLC (both 0.3, p < 0.05). Cr (3.6) exhibited significantly more platelets than CrN with a medium effect compared to CrN, Ti (0.2), TiN (0.3), and SiDLC, and a weak effect compared to TiN_D (0.4) and Alu. No significant differences were observed among HMCs, Ti, and CrN. This study highlights Cr's elevated thrombogenicity, whereas the other surfaces (except Alu) showed hemocompatibility comparable to Ti, supporting their use in VADs.

Introduction: Stroke remains a leading cause of disability and death globally, with carotid stenosis as a major contributor. Carotid endarterectomy with patch angioplasty reduces restenosis risk, but current patch materials often lack biocompatibility and biodegradability. This study introduces a novel vascular patch composed of poly-L-lactic acid (PLLA) and chitosan, coated with heparin, designed to promote tissue integration and safe degradation.

Method: A true experimental in vivo study was conducted using 54 Wistar rats, divided into three groups: (1) PLLA scaffold (Group K1/K2), (2) PLLA-chitosan scaffold (Group P1/P3), and (3) PLLA-chitosan with heparin coating scaffold (Group P2/P4). Histological analyses at 14 and 56 days post-implantation evaluated inflammatory response, fibrous capsule formation, and angiogenesis. Statistical analysis included ANOVA, T-test, and Mann-Whitney U test (significance p < 0.05).

Results: At 14 days, inflammatory cell infiltration differed significantly among groups (p = 0.019), with the PLLA-chitosan patch showing the lowest inflammatory cell count. By 56 days, inflammation had subsided in all groups (p = 0.989). Initial fibrous capsule thickness at 14 days was higher in the heparin-coated group and differed significantly among groups (p = 0.019), but by 56 days all groups showed stable fibrous encapsulation with no significant differences (p = 0.916). All implants supported neovascularization, with evidence of new blood vessel formation (angiogenesis) around the patch materials. No excessive fibrous tissue formation or cytotoxic effects were observed in any group.

Conclusion: The heparin-coated PLLA-chitosan patch displayed good biocompatibility, modulating inflammation, and supporting neovascularization. These findings suggest its potential as a vascular graft for large vessel reconstruction, though further long-term studies are needed.

Background: Cardiogenic shock (CS) secondary to acute decompensated heart failure (ADHF) is a life-threatening condition that may require the use of mechanical circulatory support (MCS). Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) represents one of the first-line temporary MCS options.

Methods: We conducted a single-center, retrospective observational cohort study of adult patients with CS secondary to ADHF that required VA ECMO at our institution from 2014 to 2023. Patients requiring extracorporeal cardiopulmonary resuscitation (ECPR) or initially placed on venovenous (VV) ECMO were excluded. Baseline characteristics, ECMO support details, and clinical outcomes were analyzed. The primary outcomes were survival to hospital discharge and at 2 years.

Results: A total of 69 patients were included. The median age was 55 years old and 60.9% were male. All patients were cannulated peripherally, with a median duration of support of 10 days. ECMO weaning was achieved in 73.9% and 56.5% survived to hospital discharge. The 2-year survival rate was 46.3%. From the total number of patients, 36.2% were bridged to durable MCS, 16% were weaned and survived to discharge, and 13% underwent heart transplantation. The most common complications included renal replacement therapy (34.8%), bleeding (20.3%), and infection (16%). Notable complications that were associated with worse outcomes included neurologic events, bleeding complications, and renal replacement requirement.

Conclusion: In patients with ADHF-CS, VA ECMO is a viable short-term support strategy that facilitates bridging to recovery or advanced therapies.

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.