International Journal of Artificial Organs最新文献

Objective: Sex-specific differences in the epidemiology of chronic kidney disease, such as higher prevalence of women on pre-dialysis and men on chronic dialysis treatment, have been reported worldwide. In this regard, data from non-high-income countries are scarce. We aimed to compare the demographic, clinical, and dialysis characteristics of incident dialysis patients, both men and women, in a large cohort of Brazilian patients over a 12-year period.

Methods: This was a multicentric retrospective cohort study coordinated by the Brazilian Society of Nephrology. The study included all adult incident dialysis patients in the Brazilian Dialysis Registry from January 2011 to December 2022. The variables studied encompassed age, skin color, education, CKD etiology, predialysis nephrologist care, dialysis characteristics, and geographic region. Additionally, the sample was analyzed for each of the three 4-year periods over the 12 years of data collection.

Results: A total of 24,632 incident dialysis patients were included. Men were 59.1% of the dialysis population, remaining stable over the three 4-year periods. Besides other differences, women started dialysis younger (58.5 ± 16.2 years vs 59.5 ± 14.4 years; p < 0.001), had a lower educational level (less than 8 years at school: 54% vs 44%; p < 0.001), received more predialysis nephrologist care (46.2% vs 44.2%; p = 0.04), and had a higher prevalence of peritoneal dialysis (4.4% vs 3.5%; p = 0.03).

Conclusion: We consistently observed a higher prevalence of men on dialysis and differences in demographic, clinical, and dialysis characteristics. The underlying reasons for these sex differences still necessitate further clarification.

Background: mRNA vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) became common. We investigated the optimal timing for inoculation against SARS-COV-2 in the candidates for cardiac surgery under cardiopulmonary bypass (CPB).

Methods: In 100 patients with preoperative vaccination, who underwent CPB surgery between July 2021 and February 2022, the IgG against the receptor binding domain (RBD-IgG), with a threshold of >100 binding antibody unit (BAU)/mL for adequate immunity, was measured.

Results: The vaccines, including 87 BNT162b2 (Pfizer/BioNTech) and 13 mRNA-1273 (Moderna), were inoculated at 98.8 ± 59.4 days before surgery. The median RBD-IgG titers before surgery, 1 day after surgery, and 1 month after surgery were 166.8, 100.0, and 84.0 BAU/mL, respectively. The standby interval (SBI) from the vaccination to the surgery showed a significantly negative correlations with the RBD-IgG titer before the surgery (p < 0.001). A cut-off SBI for RBD-IgG >100 BAU/mL before surgery was <81 days with a sensitivity of 76%, specificity of 62%, and area under ROC value of 0.73 (p = 0.03). The patients with SBI <81 days (n = 48) had significantly higher RBD-IgG (>100 BAU/mL) than those with SBI ⩾81 days (n = 52) at all perioperative periods.

Conclusions: Although 40% of the RBD-IgG titers reduce 1 day after CPB surgery, the patients who received the SARS-COV-2 vaccination within an 81-day window prior to the surgery maintained a desirable RBD-IgG level, even up to 1 month after surgery. It may be important to schedule the surgery no later than 81 days after the vaccination.

Aim: Use of microaxial mechanical circulatory support (MCS) has been reported for severe graft rejection or dysfunction after heart transplantation (HTx). We aimed to assess utilization patterns of microaxial MCS after HTx in adolescents (ages 18 and younger) and adults (ages 19 and older).

Methods: Electronic search was performed to identify all relevant studies on post-HTx use of microaxial support in adults and adolescents. A total of 18 studies were selected and patient-level data were extracted for statistical analysis.

Results: All patients (n=23), including adults (n=15) and adolescents (n=8), underwent Impella (Abiomed, Danvers, MA) microaxial MCS after HTx. Median age was 36 [IQR 18-56] years (Adults, 52 [37-59]; adolescents, 16 [15-17]). Primary right ventricular graft dysfunction was an indication exclusively seen in the adults 40% (6/15), while acute graft rejection was present in 46.7% (7/15) of adults. Median time after transplant was 9 [0-32] months (Adults, 4 [0-32]; adolescents, 11 [4.5, 45]). Duration of Impella support was comparable between adults and adolescents (5 [2.5-8] vs 6 [5-8] days, p = 0.38). Overall improvement was observed both in median LV ejection fraction (23.5% [11.3-28] to 42% [37.8-47.3], p < 0.01) and cardiac index (1.8 [1.2-2.6] to 3 [2.5-3.1], p < 0.01). Retransplantation was required in four adolescents (50%, 4/8). Survival to discharge was achieved by 60.0% (9/15) of adults and 87.5% (7/8) of adolescents respectively (p = 0.37).

Conclusion: Indications for microaxial MCS appear to vary between adult and adolescent patients. Overall improvement in LVEF and cardiac index was observed, however, with suboptimal survival to discharge.

Several similarities have been found between shear stress-induced erythrocyte damage and physiological aging of erythrocytes in terms of elevated mechanical fragility, increased erythrocyte aggregation, and decreased membrane surface charge. Accordingly, we hypothesized that blood pump circulation, which generates shear stress, would accelerate erythrocyte aging, manifesting as oxidation. Therefore, the purpose of this study was to investigate the effect of blood pump circulation on erythrocyte oxidation. Fresh porcine blood was acquired from a slaughterhouse and anticoagulated with sodium citrate. About 500 mL of anticoagulated whole blood was circulated for 180 min in an in vitro test circuit comprising a BP-80 blood pump with a pump speed and a pump pressure head of 100-120 mmHg. A blood sample was taken at the start of the circulation and 180 min afterward. The hemolysis level and oxidation amount of the erythrocyte membrane were analyzed and compared between samples. Hemolysis increased with the prolongation of shear exposure inside the pump circuit. After 180 min of blood pumping in circuit, the oxidation level of the erythrocyte membrane showed an increase of 0.1 nmol/mg protein. Moreover, the membrane oxidation levels of sheared erythrocytes were greater than those of control erythrocytes. These results suggest that blood pump circulation accelerates erythrocyte aging and give us a greater understanding of the effects of blood pump perfusion.

With rates of ECMO utilization on the rise, prevention of nosocomial infections is of paramount importance. Candida auris, an emerging highly pathogenic multidrug resistant fungus, is of particular concern as it is associated with persistent colonization of environmental surfaces, inability to be recognized by many diagnostic platforms, inconsistent laboratory susceptibility results, and high mortality rates. We describe a case of C. auris in a VV-ECMO patient successfully managed with a combination of anidulafungin, amphotericin B, and flucytosine.

Introduction: To understand the behavior of platelet volume indices and the von Willebrand factor (VWF), in vitro experiments using whole human blood were performed with extracorporeal circulation (ECC) circuits, including membrane oxygenators coated with acrylate copolymer (ACP) or immobilized heparin (IHP).

Methods: Heparinized blood was circulated through two distinct experimental circuits: an ACP-coated reservoir and tubes, as well as membranes coated with either ACP or IHP (comprising five pieces of each type). The platelet distribution width, mean platelet volume (MPV), platelet large cell ratio (P-LCR), VWF quantity (VWFQ), and VWF activity (VWFA) were measured at 0, 8, 16, 24, and 32 h in each experiment. A two-way analysis of variance (ANOVA) was performed to determine whether the coating type or circulation duration affected the transition of each measurement.

Results: Two-way ANOVA indicated that the transitions of MPV, P-LCR, and VWFA were significantly affected by the circulation duration (p = 0.030, 0.001, and <0.001, respectively) and that the transitions of VWFQ and VWFA were significantly affected by the coating type (p = 0.022 and 0.006, respectively). Factor interactions between the coating type and circulation duration were not observed for each transition (p > 0.05).

Conclusions: Our findings suggest that P-LCR is a good index for platelet activation in blood-circulating ECC and that VWFA and VWFQ are significantly attenuated in blood-circulating ECC with ACP-coated membranes, indicating the advantage of IHP coating regarding platelet activation.

Musculoskeletal diseases are often related with postural changes in the neck region that can be caused by prolonged cervical flexion. This is one of the contributing factors. When determining the prevalence, causes, and related risks of neck discomfort, having a solid understanding of the biomechanics of the cervical spine (C1-C7) is absolutely necessary. The objective of this study is to make predictions regarding the intervertebral disc (IVD) stress values across C2-C7 IVD, the ligament stress, and the variation at 0°, 15°, 30°, 45°, and 60° of cervical neck angle using finite element analysis (FEA). In order to evaluate the mechanical properties of the cervical spine (particularly, C2-C7), this investigation makes use of computed tomography (CT) scans to develop a three-dimensional FEA model of the cervical spine. A preload of 50 N compression force was applied at the apex of the C2 vertebra, and all degrees of freedom below the C7 level were constrained. The primary objective of this investigation is to assess the distribution of von Mises stress within the IVDs and ligaments spanning C2-C7 at various flexion angles: 0°, 15°, 30°, 45°, and 60°, utilizing FEA. The outcomes derived from this analysis were subsequently compared to previously published experimental and FEA data to validate the model's ability to replicate the physiological motion of the cervical spine across different flexion angles.

This case study delineates the proficient creation of a silicone finger prosthesis, tailored for a patient contending with partial digit amputation. The prosthesis was devised with the overarching goal of reinstating not only the physiological dexterity of the hand but also its aesthetic integrity and the patient's psychological equilibrium. The crafting process entailed a meticulous technique to replicate the intricate texture of the skin in order to guarantee a near normal appearance. Post-prosthesis integration, the patient exhibited enhancements in manual functionality and articulated a heightened self-assuredness because of the indiscernible prosthesis. This illustrative case underscores the efficacy of silicone finger prosthetics in conferring both functional and aesthetic restitution to those afflicted with partial digit amputations.

Background: A subset of patients with COVID-19 acute respiratory distress syndrome (ARDS) require extracorporeal membrane oxygenation (ECMO). Veno-pulmonary (VP) ECMO provides support to the right ventricle and decreased risk of recirculation.

Methods: A retrospective analysis of patients with COVID-19 ARDS and VP ECMO was performed. Patients were separated into groups by indication (1) "right ventricular (RV) failure," (2) "refractory hypoxemia," and (3) "recurrent suck-down events (SDEs)." Pre- and post-configuration vasoactive inotropic scores (VIS), fraction of inspired oxygen (FIO₂), and resolution of SDEs were reported. A 90-day mortality was computed for all groups. Patients were also compared to those who underwent conventional venovenous (VV) ECMO.

Results: Forty-seven patients underwent VP ECMO configuration, 18 in group 1, 16 in group 2, and 8 in group 3. Ninety-day mortality was 66% for the entire cohort and was 77.8%, 81.3% and 37.5% for groups 1, 2, and 3, respectively. Mean VIS decreased in group 1 (8.3 vs 2.9, p = 0.005), while mean FIO₂ decreased in the group 2 and was sustained at 72 h (82.5% vs 52.5% and 47.5%, p < 0.001). Six of the eight (75%) of patients with recurrent SDEs had resolution of these events after configuration to VP ECMO. Patients with VP ECMO spent more days on ECMO (33 days compared to 18 days, p = 0.004) with no difference in mortality (66% compared to 55.1%, p = 0.28).

Conclusion: VP ECMO in COVID-19 ARDS improves hemodynamics in patients with RV failure, improves oxygenation in patients with refractory hypoxemia and improves the frequency of SDEs.