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INTERNAL MEDICINE (178 journals)                     

Showing 1 - 180 of 180 Journals sorted alphabetically
Abdomen     Open Access  
ACP Hospitalist     Full-text available via subscription   (Followers: 9)
ACP Internist     Full-text available via subscription   (Followers: 10)
ACP Journal Club     Full-text available via subscription   (Followers: 11)
Acta Clinica Belgica     Hybrid Journal   (Followers: 1)
Acute and Critical Care     Open Access   (Followers: 11)
Acute Medicine     Full-text available via subscription   (Followers: 9)
Advances in Hepatology     Open Access   (Followers: 4)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
African Journal of Primary Health Care & Family Medicine     Open Access   (Followers: 6)
African Journal of Thoracic and Critical Care Medicine     Open Access  
American Family Physician     Full-text available via subscription   (Followers: 38)
American Journal of Hypertension     Hybrid Journal   (Followers: 31)
Anales de Medicina Interna     Open Access   (Followers: 1)
Anatomy & Physiology : Current Research     Open Access   (Followers: 9)
Angiology     Hybrid Journal   (Followers: 5)
Annals of Colorectal Research     Open Access   (Followers: 1)
Annals of Internal Medicine     Full-text available via subscription   (Followers: 392)
AORN Journal     Hybrid Journal   (Followers: 27)
Apollo Medicine     Open Access  
Archives of Drug Information     Hybrid Journal   (Followers: 5)
Archivos de Medicina Interna     Open Access   (Followers: 1)
Asia Oceania Journal of Nuclear Medicine & Biology     Open Access   (Followers: 4)
Asian Pacific Journal of Tropical Disease     Full-text available via subscription   (Followers: 3)
Australasian Physical & Engineering Sciences in Medicine     Hybrid Journal   (Followers: 1)
BMI Journal : Bariátrica & Metabólica Iberoamericana     Open Access   (Followers: 1)
BMJ Open Diabetes Research & Care     Open Access   (Followers: 35)
BMJ Quality & Safety     Hybrid Journal   (Followers: 69)
Bone & Joint Journal     Hybrid Journal   (Followers: 139)
Brain Communications     Open Access   (Followers: 4)
Brain Science Advances     Open Access  
Canadian Journal of General Internal Medicine     Open Access   (Followers: 2)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Case Reports in Internal Medicine     Open Access   (Followers: 1)
Cell Death & Disease     Open Access   (Followers: 3)
Cellular and Molecular Gastroenterology and Hepatology     Open Access   (Followers: 3)
Cephalalgia     Hybrid Journal   (Followers: 8)
Cephalalgia Reports     Open Access   (Followers: 4)
Chronic Diseases and Injuries in Canada     Free   (Followers: 1)
Clinical Ethics     Hybrid Journal   (Followers: 13)
Clinical Liver Disease     Open Access   (Followers: 5)
Clinical Nutrition     Hybrid Journal   (Followers: 98)
Clinical Thyroidology     Full-text available via subscription   (Followers: 1)
CNE Pflegemanagement     Hybrid Journal  
Communication Law and Policy     Hybrid Journal   (Followers: 5)
Current Diabetes Reports     Hybrid Journal   (Followers: 30)
Current Hepatology Reports     Hybrid Journal  
Current Research: Integrative Medicine     Open Access  
CVIR Endovascular     Open Access   (Followers: 1)
Der Internist     Hybrid Journal   (Followers: 12)
Diabetes     Full-text available via subscription   (Followers: 603)
Diabetes Care     Full-text available via subscription   (Followers: 577)
Diabetes Internacional     Open Access  
Diabetes Spectrum     Full-text available via subscription   (Followers: 17)
Diagnosis     Hybrid Journal   (Followers: 1)
Egyptian Journal of Bronchology     Open Access  
Egyptian Journal of Internal Medicine     Open Access   (Followers: 1)
Egyptian Journal of Neurosurgery     Open Access  
Egyptian Liver Journal     Open Access   (Followers: 2)
Egyptian Spine Journal     Open Access  
EMC - Aparato Locomotor     Hybrid Journal  
Endovascular Neuroradiology / Ендоваскулярна нейрорентгенохірургія     Open Access   (Followers: 1)
eNeuro     Open Access   (Followers: 3)
Ergonomics     Hybrid Journal   (Followers: 24)
European Journal of Inflammation     Open Access   (Followers: 2)
European Journal of Internal Medicine     Full-text available via subscription   (Followers: 10)
European Journal of Translational Myology     Open Access  
European Radiology Experimental     Open Access   (Followers: 2)
Head and Neck Tumors     Open Access   (Followers: 1)
Health Sociology Review     Hybrid Journal   (Followers: 14)
HemaSphere     Open Access   (Followers: 2)
Hepatology Communications     Open Access  
Hepatoma Research     Open Access   (Followers: 3)
Human Physiology     Hybrid Journal   (Followers: 5)
ImmunoHorizons     Open Access  
Immunological Medicine     Open Access  
Infectious Diseases: Research and Treatment     Open Access   (Followers: 5)
Inflammation and Regeneration     Open Access   (Followers: 2)
Inflammatory Intestinal Diseases     Open Access  
Innere Medizin up2date     Hybrid Journal   (Followers: 1)
Internal and Emergency Medicine     Hybrid Journal   (Followers: 5)
Internal Medicine Journal     Hybrid Journal   (Followers: 9)
International Journal of Abdominal Wall and Hernia Surgery     Open Access   (Followers: 1)
International Journal of Anatomy and Research     Open Access   (Followers: 2)
International Journal of Angiology     Hybrid Journal  
International Journal of Artificial Organs     Hybrid Journal   (Followers: 3)
International Journal of Hyperthermia     Open Access  
International Journal of Internal Medicine     Open Access   (Followers: 3)
International Journal of Noncommunicable Diseases     Open Access  
International Journal of Psychiatry in Clinical Practice     Hybrid Journal   (Followers: 6)
Iranian Journal of Neurosurgery     Open Access   (Followers: 1)
Italian Journal of Anatomy and Embryology     Open Access   (Followers: 1)
JAC-Antimicrobial Resistance     Open Access   (Followers: 4)
JAMA Internal Medicine     Full-text available via subscription   (Followers: 363)
JCSM Clinical Reports     Open Access   (Followers: 3)
JHEP Reports     Open Access  
JIMD Reports     Open Access  
JMV - Journal de Médecine Vasculaire     Hybrid Journal   (Followers: 1)
Joint Commission Journal on Quality and Patient Safety     Hybrid Journal   (Followers: 41)
JOP. Journal of the Pancreas     Open Access   (Followers: 2)
Journal of Basic & Clinical Physiology & Pharmacology     Hybrid Journal   (Followers: 1)
Journal of Bone Oncology     Open Access   (Followers: 1)
Journal of Cancer & Allied Specialties     Open Access  
Journal of Clinical and Experimental Hepatology     Full-text available via subscription   (Followers: 3)
Journal of Clinical Movement Disorders     Open Access   (Followers: 3)
Journal of Community Hospital Internal Medicine Perspectives     Open Access  
Journal of Cutaneous Immunology and Allergy     Open Access  
Journal of Developmental Origins of Health and Disease     Hybrid Journal   (Followers: 2)
Journal of Endoluminal Endourology     Open Access  
Journal of Gastroenterology and Hepatology Research     Open Access   (Followers: 4)
Journal of General Internal Medicine     Hybrid Journal   (Followers: 23)
Journal of Hypertension     Hybrid Journal   (Followers: 14)
Journal of Infectious Diseases     Hybrid Journal   (Followers: 48)
Journal of Interdisciplinary Medicine     Open Access  
Journal of Internal Medicine     Hybrid Journal   (Followers: 11)
Journal of Liver : Disease & Transplantation     Hybrid Journal   (Followers: 7)
Journal of Medical Internet Research     Open Access   (Followers: 24)
Journal of Movement Disorders     Open Access   (Followers: 2)
Journal of Pain and Symptom Management     Hybrid Journal   (Followers: 46)
Journal of Pancreatic Cancer     Open Access  
Journal of Renal and Hepatic Disorders     Open Access  
Journal of Solid Tumors     Open Access   (Followers: 1)
Journal of Sports Medicine and Allied Health Sciences : Official Journal of the Ohio Athletic Trainers Association     Open Access   (Followers: 1)
Journal of the American Board of Family Medicine     Open Access   (Followers: 11)
Journal of the European Mosquito Control Association     Open Access  
Journal of Translational Internal Medicine     Open Access  
Jurnal Vektor Penyakit     Open Access  
La Revue de Medecine Interne     Full-text available via subscription   (Followers: 3)
Lege artis - Das Magazin zur ärztlichen Weiterbildung     Hybrid Journal   (Followers: 1)
Liver Cancer International     Open Access  
Liver Research     Open Access  
Molecular Diagnosis & Therapy     Hybrid Journal   (Followers: 3)
Molecular Therapy - Oncolytics     Open Access  
Multiple Sclerosis and Demyelinating Disorders     Open Access   (Followers: 7)
MYOPAIN. A journal of myofascial pain and fibromyalgia     Hybrid Journal   (Followers: 18)
Neuro-Oncology Advances     Open Access   (Followers: 1)
Neurobiology of Pain     Open Access   (Followers: 2)
Neurointervention     Open Access   (Followers: 6)
Neuromuscular Diseases     Open Access  
Nigerian Journal of Gastroenterology and Hepatology     Full-text available via subscription  
OA Alcohol     Open Access   (Followers: 5)
Oncological Coloproctology     Open Access  
Open Journal of Internal Medicine     Open Access  
Pleura and Peritoneum     Open Access  
Pneumo News     Full-text available via subscription  
Polish Archives of Internal Medicine     Full-text available via subscription   (Followers: 2)
Preventing Chronic Disease     Free   (Followers: 2)
Progress in Transplantation     Hybrid Journal   (Followers: 1)
Prostate International     Open Access   (Followers: 2)
Psychiatry and Clinical Psychopharmacology     Open Access   (Followers: 1)
Pulmonary Therapy     Open Access   (Followers: 2)
Quality of Life Research     Hybrid Journal   (Followers: 20)
Research and Practice in Thrombosis and Haemostasis     Open Access  
Revista Chilena de Fonoaudiología     Open Access   (Followers: 1)
Revista de la Sociedad Peruana de Medicina Interna     Open Access   (Followers: 4)
Revista del Instituto de Medicina Tropical     Open Access  
Revista Hispanoamericana de Hernia     Open Access   (Followers: 1)
Revista Médica Internacional sobre el Síndrome de Down     Full-text available via subscription   (Followers: 1)
Revista Virtual de la Sociedad Paraguaya de Medicina Interna     Open Access   (Followers: 1)
Romanian Journal of Diabetes Nutrition and Metabolic Diseases     Open Access   (Followers: 1)
Romanian Journal of Internal Medicine     Open Access  
Russian Journal of Child Neurology     Open Access   (Followers: 1)
Scandinavian Journal of Primary Health Care     Open Access   (Followers: 8)
Schlaf     Hybrid Journal  
Schmerzmedizin     Hybrid Journal  
Scientific Journal of the Foot & Ankle     Open Access   (Followers: 1)
SciMedicine Journal     Open Access   (Followers: 3)
SEMERGEN - Medicina de Familia     Full-text available via subscription   (Followers: 1)
The Journal of Critical Care Medicine     Open Access   (Followers: 9)
Therapeutic Advances in Chronic Disease     Open Access   (Followers: 8)
Therapeutic Advances in Musculoskeletal Disease     Hybrid Journal   (Followers: 6)
Thieme Case Report     Hybrid Journal   (Followers: 1)
Tijdschrift voor Urologie     Hybrid Journal  
Tissue Barriers     Hybrid Journal   (Followers: 1)
Transactions of the Royal Society of Tropical Medicine and Hygiene     Hybrid Journal   (Followers: 3)
Transgender Health     Open Access   (Followers: 3)
Trends in Anaesthesia and Critical Care     Full-text available via subscription   (Followers: 23)
US Cardiology Review     Open Access  
Vascular and Endovascular Review     Open Access   (Followers: 1)
Ожирение и метаболизм     Open Access  

           

Similar Journals
Journal Cover
International Journal of Artificial Organs
Journal Prestige (SJR): 0.431
Citation Impact (citeScore): 1
Number of Followers: 3  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0391-3988 - ISSN (Online) 1724-6040
Published by Sage Publications Homepage  [1151 journals]
  • Experimental investigation of the influence of the hydraulic performance
           of an axial blood pump on intraventricular blood flow
    • Authors: Guang-Mao Liu, Fu-Qing Jiang, Xiao-Han Yang, Run-Jie Wei, Sheng-Shou Hu
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Blood flow inside the left ventricle (LV) is a concern for blood pump use and contributes to ventricle suction and thromboembolic events. However, few studies have examined blood flow inside the LV after a blood pump was implanted. In this study, in vitro experiments were conducted to emulate the intraventricular blood flow, such as blood flow velocity, the distribution of streamlines, vorticity and the standard deviation of velocity inside the LV during axial blood pump support. A silicone LV reconstructed from computerized tomography (CT) data of a heart failure patient was incorporated into a mock circulatory loop (MCL) to simulate human systemic circulation. Then, the blood flow inside the ventricle was examined by particle image velocimetry (PIV) equipment. The results showed that the operating conditions of the axial blood pump influenced flow patterns within the LV and areas of potential blood stasis, and the intraventricular swirling flow was altered with blood pump support. The presence of vorticity in the LV from the thoracic aorta to the heart apex can provide thorough washing of the LV cavity. The gradually extending stasis region in the central LV with increasing blood pump support is necessary to reduce the thrombosis potential in the LV.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-04-28T11:24:01Z
      DOI: 10.1177/03913988211013046
       
  • Optimization of a decellularization protocol of porcine tracheas.
           Long-term effects of cryopreservation. A histological study
    • Authors: Lara Milian, María Sancho-Tello, Joan Roig-Soriano, Giovanna Foschini, Néstor J Martínez-Hernández, Jorge Más-Estellés, Amparo Ruiz-Sauri, Javier Zurriaga, Carmen Carda, Manuel Mata
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Objective:The aim of this study was to optimize a decellularization protocol in the trachea of Sus scrofa domestica (pig) as well as to study the effects of long-term cryopreservation on the extracellular matrix of decellularized tracheas.Methods:Porcine tracheas were decellularized using Triton X-100, SDC, and SDS alone or in combination. The effect of these detergents on the extracellular matrix characteristics of decellularized porcine tracheas was evaluated at the histological, biomechanical, and biocompatibility level. Morphometric approaches were used to estimate the effect of detergents on the collagen and elastic fibers content as well as on the removal of chondrocytes from decellularized organs. Moreover, the long-term structural, ultrastructural, and biomechanical effect of cryopreservation of decellularized tracheas were also estimated.Results:Two percent SDS was the most effective detergent tested concerning cell removal and preservation of the histological and biomechanical properties of the tracheal wall. However, long-term cryopreservation had no an appreciable effect on the structure, ultrastructure, and biomechanics of decellularized tracheal rings.Conclusion:The results presented here reinforce the use of SDS as a valuable decellularizing agent for porcine tracheas. Furthermore, a cryogenic preservation protocol is described, which has minimal impact on the histological and biomechanical properties of decellularized porcine tracheas.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-04-17T06:21:04Z
      DOI: 10.1177/03913988211008912
       
  • Characterization of the competing role of surface-contact and shear stress
           on platelet activation in the setting of blood contacting devices
    • Authors: Silvia Bozzi, Yana Roka-Moiia, Tatiana Mencarini, Federica Vercellino, Ilenia Epifani, Kaitlyn R Ammann, Filippo Consolo, Marvin J Slepian, Alberto Redaelli
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Supraphysiological shear stress and surface-contact are recognized as driving mechanisms of platelet activation (PA) in blood contacting devices (BCDs). However, the competing role of these mechanisms in triggering thrombogenic events is poorly understood. Here, we characterized the dynamics of PA in response to the combined effect of shear stress and material exposure. Human platelets were stimulated with different levels of shear stress (500, 750, 1000 dynes/cm2) over a range of exposure times (10, 20, and 30 min) within capillary tubes made of various polymeric materials. Polyethylene (PE), polytetrafluoroethylene (PTFE), ethylene tetrafluoroethylene (ETFE), and polyether ether ketone (PEEK), used for BCDs fabrication, were investigated as compared to glass and thromboresistant Sigma™-coated glass. PA was quantified using the Platelet Activity State assay. Our results indicate that mechanical stimulation and polymer surface-contact both significantly contribute to PA. Notably, the contribution of the mechanical stimulus ranges between +36% and +43%, while that associated with polymer surface-contact ranges from +48% to +59%, depending on the exposure time. In more detail, our results indicate that: (i) PA increases with increasing shear stress magnitude; (ii) PA has a non-linear, time-dependent relationship to exposure time; (iii) PA is largely influenced by biomaterials, with PE and PEEK having respectively the lowest and highest prothrombotic potential; (iv) the effects of polymer surface-contact and shear stress are not correlated and can be studied separately. Our results suggest the importance of incorporating the evaluation of platelet activation driven by the combined effect of shear stress and polymer surface-contact for the comprehensive assessment, and eventually minimization, of BCDs thrombogenic potential.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-04-13T06:57:04Z
      DOI: 10.1177/03913988211009909
       
  • Hemodynamic impact of molecular adsorbent recirculating system in
           refractory vasoplegic shock due to calcium channel blocker poisoning
    • Authors: Christophe Beyls, Stéphanie Malaquin, Pierre Huette, Aurélien Mary, Patricia Besserve, Pierre-Alexandre Roger, Michaël Bernasinski, Mathieu Guilbart, Osama Abou-Arab, Hervé Dupont, Yazine Mahjoub
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Objective:To report the hemodynamic effect of to the molecular adsorbent recirculating system (MARS™) therapy for patients in refractory vasoplegic shock due to calcium channel blocker (CCB) poisoningMethods:We report a retrospective cohort of patients who were hospitalized for CCB poisoning with refractory vasoplegic shock and treated by MARS therapy, at Amiens Hospital University, from January 2010 to December 2019. Improvement in hemodynamic was assessed by dynamic changes in mean arterial pressure (MAP) and norepinephrine levels over a 24-h period after MARS therapy. Cardiac function was assessed by transthoracic echocardiography.Results:MARS therapy was performed on seven patients for CCB poisoning. CCB poisoning included nicardipine (n = 3, 43%) amlodipine (n = 3, 43%), and verapamil (n = 1, 14%). The median time to start MARS therapy was 24 [14–27] h after drug ingestion and 6 [2–9] h after ICU admission. Cardiac output was preserved for all patients. MAP values improved from 56 [43–58] to 65 [61–78] 16 mmHg (p = 0.005). Norepinephrine dose significantly decreased from 3.2 [0.8–10] µg/kg/min to 1.2 [0.1–1.9] µg/kg/min (p = 0.008) and lactate level decreased from 3.2 [2.4–3.4] mmol/l−1 to 1.6 [0.9–2.2] mmol/l−1 (p = 0.008). The median length of ICU stay was 4 (2–7) days and hospital stay was 4 (4–16) days. No complication related to the MARS therapy were reported. No patient died and all were discharged from the hospital.Conclusion:We reported the largest case-series of MARS therapy for refractory vasoplegic shock due to CCB poisoning. We observed that MARS therapy was associated with an improvement of hemodynamic parameters.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-04-05T09:59:43Z
      DOI: 10.1177/03913988211007865
       
  • A novel intra-ventricular assist device enhances cardiac performance in
           normal and acutely failing isolated porcine hearts
    • Authors: Daniël IM van Dort, Jos Thannhauser, Wim J Morshuis, Guillaume SC Geuzebroek, Dirk J Duncker
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Background:We recently demonstrated that a novel intra-ventricular membrane pump (IVMP) was able to increase the pump function of isolated beating porcine hearts. In follow-up, we now investigated the impact of the IVMP on myocardial oxygen consumption and total mechanical efficiency (TME) and assessed the effect of IVMP-support in acutely failing hearts.Methods:In 10 ex vivo beating porcine hearts, we studied hemodynamic parameters, as well as arterial and coronary venous oxygen content. We assessed cardiac power (CP), myocardial oxygen consumption (MVO2), and TME (CP divided by MVO2) under baseline conditions and during IVMP-support. Additionally, five isolated hearts were subjected to global hypoxia to investigate the effects of IVMP-support on CP under conditions of acute heart failure.Results:Under physiological conditions, baseline CP was 0.36 ± 0.10 W, which increased to 0.65 ± 0.16 W during IVMP-support (increase of 85% ± 24, p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-04-05T09:59:14Z
      DOI: 10.1177/03913988211003912
       
  • Impact of gender in patients with continuous-flow left ventricular assist
           device therapy in end-stage heart failure
    • Authors: Alina Zubarevich, Marcin Szczechowicz, Anja Osswald, Arian Arjomandi Rad, Robert Vardanyan, Michel Pompeu BO Sá, Jef Van den Eynde, Bastian Schmack, Daniel Wendt, Achim Koch, Nikolaus Pizanis, Markus Kamler, Arjang Ruhparwar, Alexander Weymann, Konstantin Zhigalov
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Background:There is an ongoing debate about the influence of the female gender on postoperative outcomes after durable left ventricular assist device (LVAD) implantation. Despite the differences in pathophysiology of heart failure in females, therapy concepts are the same as in the male population. The aim of this study was to investigate the role of the female gender in surgical heart failure therapy.Materials and methods:Between August 2010 and January 2020, 207 patients were treated with durable LVAD at out institution. We matched 111 patients in two groups to compare the outcomes in male and female patients and to stratify the risk factors of mortality.Results:The groups were matched 2:1 and were comparable after matching. We found no difference in in-hospital and follow-up mortality between male and female patients. Postoperative adverse events and complications were found to be unvaried across male and female patients. Female patients had higher rates of postoperative LVAD-thrombosis compared to their male counterparts (13.5% vs 0, p = 0.001) and the rates of renal replacement therapy lasting over 90 days were also higher in the female group (33.8% vs 56.8%, p = 0.021). Furthermore, the female gender was not an independent predictor neither of in-hospital nor follow-up mortality.Conclusions:Durable continuous flow left ventricular assist devices as a bridge to transplantation or recovery in female patients are associated with a higher risk of acute kidney injury requiring RRT and are at a higher risk of LVAD-thrombosis. Nevertheless, survival rates between genders are similar.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-03-31T05:36:58Z
      DOI: 10.1177/03913988211006715
       
  • Regional citrate anticoagulation versus low molecular weight heparin for
           CRRT in hyperlactatemia patients: A retrospective case-control study
    • Authors: Lu Li, Ming Bai, Wei Zhang, Lijuan Zhao, Yan Yu, Shiren Sun
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Introduction:There were controversial opinions on the use of regional citrate anticoagulation (RCA) versus low molecular weight heparin (LMWH) for continuous renal replacement therapy (CRRT) in hyperlactatemia patients, which was considered as one of the contraindications of citrate. The aim of our present study is to evaluate the efficacy and safety of RCA versus LMWH for CRRT in hyperlactatemia patients.Methods:Adult patients with hyperlactatemia who underwent RCA or LMWH CRRT in our center between January 2014 and March 2018 were retrospectively recruited. Filter lifespan, ultrafiltration, purification, bleeding, citrate accumulation, filter clot, and the infusion of blood production were evaluated as endpoints.Results:Of the 127 patients included in the original cohort, 81 and 46 accepted RCA and LMWH CRRT, respectively. The filter lifespan was significantly prolonged in the RCA group compared to the LMWH group (44.25 h [2 -83] vs. 24 h [4 -67], p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-03-31T05:30:15Z
      DOI: 10.1177/03913988211003586
       
  • Mathematical models for shear-induced blood damage based on vortex
           platform
    • Authors: Xu Mei, Min Zhong, Wanning Ge, Liudi Zhang
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Non-physiological shear stress in Ventricular Assist Device (VAD) is considered to be an important trigger of blood damage, which has become the biggest shackle for clinical application. The researches on blood damage in literature were limited to qualitative but did not make much quantitative analysis. The purpose of this study was to investigate the quantitative influence of two flow-dependent parameters: shear stress (rotational speed) and exposure time on the shear-induced damage of red blood cells and von Willebrand Factor (vWF). A vortex blood-shearing platform was constructed to conduct in vitro experiments. Free hemoglobin assay and vWF molecular weight analysis were then performed on the sheared blood samples. MATLAB was used for regression fitting of original experimental data. The quantitative correlations between the hemolysis index, the degradation of high molecular weight vWF and the two flow-dependent parameters were found both following the power law model. The mathematic models indicated that the sensitivity of blood damage on red blood cells and vWF to exposure time was both greater than that of shear stress. Besides, the damage of vWF was more serious than that of red blood cells at the same flow condition. The models could be used to predict blood damage in blood-contacting medical devices, especially for the slow even stagnant blood flow regions in VAD, thus may provide useful guidance for VAD development and improvement. It also indicated that the vortex platform can be used to study the law of blood damage for the simple structure and easy operation.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-03-20T05:29:21Z
      DOI: 10.1177/03913988211003587
       
  • Antiphospholipid antibody syndrome and LVAD: What are the chances' A
           case report and literature review
    • Authors: Vincenzo Tarzia, Chiara Tessari, Assunta Fabozzo, Chiara Cavalli, Chiara Pagnin, Biancarosa Volpe, Tomaso Bottio, Gino Gerosa
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Left-ventricular-assist-device (LVAD) implantation in patients with antiphospholipid-syndrome (APS) is considered a high-risk procedure and its indication still represents an open challenge. Herein, we report a 63-year-old man with APS and end-stage heart failure, for whom a HeartMate3-LVAD and a continuous rheologic profile monitoring with a multiparametric assessment resulted the optimal therapeutic strategy.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-03-18T06:17:23Z
      DOI: 10.1177/0391398821996726
       
  • The impact of intradialytic exercise on immune cells expressing CCR5+ in
           patients with chronic kidney disease: A cross-over trial
    • Authors: Maria Isabel Fuhro, Francini P Andrade, Gilson P Dorneles, Fabio S Lira, Pedro RT Romão, Alessandra Peres, Mariane Monteiro
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      The C-C chemokine receptor type 5 (CCR5) plays a role in the immunopathogenesis of chronic kidney disease (CKD). Exercise has anti-inflammatory properties that may contribute to the rehabilitation of CKD patients. To date, the impact of the intradialytic exercise on CCR5 expression in monocytes and lymphocytes of CKD patients is unknown. We aimed to evaluate the effects of an acute intradialytic moderate-intensity exercise on CD4+CCR5+ T-cells and CD14+CCR5+ monocytes of elderly individuals with Chronic Kidney Disease (CKD). Eight CKD elderly patients performed a single bout of 20 min intradialytic exercise and a control hemodialysis (HD) session. Blood samples were collected at baseline, during and immediately after the trials. HD therapy increased the peripheral frequency of CD4+CCR5+ T-cells. The systemic CCL5 levels and the peripheral CD14+CCR5+ proportions increased during and after HD therapy. No significant alterations in CD4+CCR5+ and CD14+CCR5+ proportions or CCL5 levels were identified in CKD patients during and after intradialytic exercise. A negative correlation between the peripheral frequency of CD14+CCR5+ and the creatinine levels was identified in the intradialytic exercise session. A single moderate-intensity intradialytic exercise imposes an immunomodulatory impact in CKD elderly patients, preventing an excessive inflammatory response induced by hemodialysis.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-03-17T06:26:32Z
      DOI: 10.1177/03913988211001388
       
  • Rest ventilator management in children on veno-venous extracorporeal
           membrane oxygenation
    • Authors: Matthew L Friedman, Samer Abu-Sultaneh, James E Slaven, Christopher W Mastropietro
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Background:We aimed to use the Extracorporeal Life Support Organization registry to describe the current practice of rest mechanical ventilation setting in children receiving veno-venous extracorporeal membrane oxygenation (V-V ECMO) and to determine if relationships exist between ventilator settings and mortality.Methods:Data for patients 14 days to 18 years old who received V-V ECMO from 2012-2016 were reviewed. Mechanical ventilation data available includes mode and settings at 24 h after ECMO cannulation. Multivariable logistic regression analysis was performed to determine if rest settings were associated with mortality.Results:We reviewed 1161 subjects, of which 1022 (88%) received conventional mechanical ventilation on ECMO. Rest settings, expressed as medians (25th%, 75th%), are as follows: rate 12 breaths/minute (10, 17); peak inspiratory pressure (PIP) 22 cmH2O (20,27); positive end expiratory pressure (PEEP) 10 cmH2O (8, 10); and fraction of inspired oxygen (FiO2) 0.4 (0.37, 0.60). Survival to discharge was 68%. Higher ventilator FiO2 (odds ratio:1.13 per 0.1 increase, 95% confidence interval:1.04, 1.23), independent of arterial oxygen saturation, was associated with mortality.Conclusions:Current rest ventilator management for children receiving V-V ECMO primarily relies on conventional mechanical ventilation with moderate amounts of PIP, PEEP, and FiO2. Further study on the relationship between FiO2 and mortality should be pursued.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-03-15T11:54:05Z
      DOI: 10.1177/0391398821999386
       
  • Effect of single and multilevel artificial inter-vertebral disc
           replacement in lumbar spine: A finite element study
    • Authors: Jayanta Kumar Biswas, Masud Rana, Anindya Malas, Sandipan Roy, Subhomoy Chatterjee, Sandeep Choudhury
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Degenerative disc disease (DDD) in lumbar spine is one of the major musculoskeletal disorders that cause low back pain (LBP). The intervertebral disc structure and dynamics of the lumbar spine are significantly affected by lumbar DDD, leading to a reduced range of motion (ROM), muscle weakness and gradual degradation. Spinal fusion and inter-vertebral disc replacement prostheses are two major surgical methods used for treating lumbar DDD. The aim of this present study is to examine biomechanical impacts of single level (L3-L4 and L4-L5) and multi level (L3-L4-L5) inter-vertebral disc replacement in lumbar spine (L2-L5) and to compare the performance with intact spine. Finite element (FE) analysis has been used to compare the mobility and stress distribution of all the models for four physiological movements, namely flexion, extension, left and right lateral bending under 6, 8 and 10 Nm moments. Spinal fusion implants completely restrict the motion of the implanted segment and increase disc stress at the adjacent levels. In contrast to that, the results single level ADR models showed closer ROM and disc stress to natural model. At the spinal segments adjacent to the implantation, single level ADR shows lower chance of disc degeneration. However, significantly increased ROM was observed in case of double level ADR.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-03-12T07:14:28Z
      DOI: 10.1177/03913988211001875
       
  • Biocompatible chicken bone extracted dahllite/hydroxyapatite/collagen
           filler based polysulfone membrane for dialysis
    • Authors: Shafiq Uz Zaman, Muhammad Khaliq U Zaman, Muhammad Irfan, Sikander Rafiq, Masooma Irfan, Nawshad Muhammad, Saif-ur-Rehman, Salman Wajeeh, Gul Naz
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      In the current study, dahllite/hydroxyapatite/collagen filler extracted via calcination of wasted chicken bone was blended with PSf polymer to obtain highly biocompatible, and antifoulant hemodialysis membranes. FTIR and Raman spectroscopic analysis was done to obtain information about the bonding chemistry of the obtained filler. The intermolecular interaction that existed between dahllite/hydroxyapatite/collagen filler and pristine PSf was confirmed by Raman spectroscopic study. The PSf polymer exhibited a sponge-like structure owing to its high thickness and slow exchange with non-solvent in coagulation bath whilst the instantaneous de-mixing course produced finger-like capillaries in dahllite/hydroxyapatite/collagen filler based PSf membranes as exposed by SEM photographs. The presence of different wt. % of filler composition in the PSf matrix improved the mechanical strength as revealed by fatigue analysis. The hydrophilic character improved by 78% while leaching consistency adjusted to 0%–4%. Pure water permeation (PWP) flux improved by nine times. The pore profile improved with the addition of filler as revealed by hydrophilicity experiment, PWP flux, and SEM micrographs. Fouling evaluation results disclosed that filler based membranes showed 36% less adsorption of protein (BSA) solution together with more than 84% flux recovery ratio. The biocompatibility valuation analysis unveiled that membranes composed of filler showed extended prothrombin and thrombin coagulation times, reduced activation of fibrinogen mass, and less adhesion of plasma proteins in comparison with pristine PSf membrane. The adsorption capacity of fabricated membranes for urea and creatinine improved by 31% (in the case of urea) and 34% (in the case of creatinine) in contrast with pristine PSf membrane. The overall results showed that the M-3 membrane was optimized in terms of surface properties, protein adhesion, anticoagulation activity, and adsorption amount of urea and creatinine.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-03-12T07:12:49Z
      DOI: 10.1177/0391398821994119
       
  • Bilirubin adsorption for the treatment of severe hyperbilirubinemia after
           cardiac surgery: A retrospective cohort study
    • Authors: Xiaolan Chen, Lu Li, Ming Bai, Shiren Sun, Xiangmei Chen
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Objective:Severe hyperbilirubinemia after cardiac surgery increases in-hospital and 1-year mortality. Our present study aimed to analyze the safety and efficacy of bilirubin adsorption (BA) in patients with post-cardiac-surgery severe hyperbilirubinemia.Methods:We retrospectively included patients who underwent BA due to severe hyperbilirubinemia after cardiac surgery in our center between January 2015 and December 2018. The change of serum bilirubin, alanine aminotransferase, aspartate aminotransferase, and 30-day and 1-year mortality were assessed as endpoints. Univariate and multivariate analyses were employed to identify the risk factors of patient 30-day mortality.Result:A total of 25 patients with 44 BA treatments were included. One BA treatment reduced total bilirubin (TB) concentration from 431.65 ± 136.34 to 324.83 ± 129.44 µmol/L (p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-03-08T09:51:47Z
      DOI: 10.1177/0391398821997841
       
  • How to improve sleep disorder and depression following left ventricular
           assist device implantation
    • Authors: Teruhiko Imamura
      Abstract: The International Journal of Artificial Organs, Ahead of Print.

      Citation: The International Journal of Artificial Organs
      PubDate: 2021-03-01T12:15:55Z
      DOI: 10.1177/0391398821999398
       
  • Effects of conform, non-conform, and hybrid conformity toward stress
           distribution at the glenoid implant and cement: A finite element study
    • Authors: Abdul Hadi Abdul Wahab, Nor Aqilah Mohamad Azmi, Mohammed Rafiq Abdul Kadir, Amir Putra Md Saad
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Glenoid conformity is one of the important aspects that could contribute to implant stability. However, the optimal conformity is still being debated among the researchers. Therefore, this study aims to analyze the stress distribution of the implant and cement in three types of conformity (conform, non-conform, and hybrid) in three load conditions (central, anterior, and posterior). Glenoid implant and cement were reconstructed using Solidwork software and a 3D model of scapula bone was done using MIMICS software. Constant load, 750 N, was applied at the central, anterior, and posterior region of the glenoid implant which represents average load for daily living activities for elder people, including, walking with a stick and standing up from a chair. The results showed that, during center load, an implant with dual conformity (hybrid) showed the best (Max Stress—3.93 MPa) and well-distributed stress as compared to other conformity (Non-conform—7.21 MPa, Conform—9.38 MPa). While, during eccentric load (anterior and posterior), high stress was located at the anterior and posterior region with respect to the load applied. Cement stress for non-conform and hybrid implant recorded less than 5 MPa, which indicates it had a very low risk to have cement microcracks, whilst, conform implant was exposed to microcrack of the cement. In conclusion, hybrid conformity showed a promising result that could compromise between conform and non-conform implant. However, further enhancement is required for hybrid implants when dealing with eccentric load (anterior and posterior).
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-03-01T12:14:55Z
      DOI: 10.1177/0391398821999391
       
  • The biomechanical study of cervical spine: A Finite Element Analysis
    • Authors: Pechimuthu Susai Manickam, Sandipan Roy
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      The biomechanical study helps us to understand the mechanics of the human cervical spine. A three dimensional Finite Element (FE) model for C3 to C6 level was developed using computed tomography (CT) scan data to study the mechanical behaviour of the cervical spine. A moment of 1 Nm was applied at the top of C3 vertebral end plate and all degrees of freedom of bottom end plate of C6 were constrained. The physiological motion of the cervical spine was validated using published experimental and FE analysis results. The von Mises stress distribution across the intervertebral disc was calculated along with range of motion. It was observed that the predicted results of functional spine units using FE analysis replicate the real behaviour of the cervical spine.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-03-01T12:13:10Z
      DOI: 10.1177/0391398821995495
       
  • Reply from the authors to ‘How to improve sleep disorder and depression
           following left ventricular assist device implantation’
    • Authors: Rita D’Aoust, Inga Antonsdottir, Chakra Budhathoki, Jesus Casida
      Abstract: The International Journal of Artificial Organs, Ahead of Print.

      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-27T09:59:47Z
      DOI: 10.1177/0391398821999390
       
  • Mental health and demographic correlates of loneliness after left
           ventricular assist device implantation
    • Authors: Sarah C Griffin, Yasmine M Eshera, Eileen J Burker
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Loneliness is a risk factor for coronary heart disease, stroke, and hospital readmission, yet there are no studies to our knowledge examining loneliness in left ventricular assistance device (LVAD) patients. This study used a cross-sectional survey design on a convenience sample of LVAD patients (n = 73). Logistic regression was used to identify demographic correlates of loneliness; linear regression was used to examine the relationship between loneliness and both stress and depression. Loneliness was measured via the loneliness item from the Center for Epidemiologic Studies Depression (CESD), depression via the CESD (excluding the loneliness item), and stress via the Perceived Stress Scale. In bivariate analyses, older age (OR per year = 0.958, 95%CI = 0.919–0.998) and being partnered (OR = 0.245, 95%CI = 0.083–0.724) were associated with less loneliness. In the multivariate model, there was an interaction effect between age and partnership (p = 0.0212), where older age was protective against loneliness for non-partnered, but not partnered, patients. Higher loneliness was associated with higher stress (β = 0.484, B = 5.687, 95%CI = 3.195–8.178) and depression (β = 0.618, B = 7.544, 95%CI = 5.241–9.848). Patients who are not partnered and younger may be at increased risk of loneliness after LVAD. Loneliness in turn is associated with higher stress and depression. Longitudinal research is necessary to speak to direction of effects.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-25T06:06:38Z
      DOI: 10.1177/0391398821997840
       
  • Structure design and mechanical performance test of a direct ventricular
           assist device pneumatic flexible actuator
    • Authors: Zhong Yun, Kang Xu, Fan Yang, Xiaoyan Tang
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      The purpose of this research is to overcome the shortcomings of the current direct ventricular assist device in structure design, material selection and design a pneumatic flexible actuator that can be used to drive a fully flexible cup-shaped direct ventricular assist device according to the human heart shape. In this study, the structural parameters of the flexible actuator are initially determined based on the existing research, then the flexible actuator model is constructed with SOLIDWORKS, then the model is imported into ABAQUS for finite element simulation, lastly, the actuator structure is optimized according to the simulation results. The flexible actuator is made by molding, and its mold is made by 3D printing. Finally, the final structural plan is determined by testing the mechanical properties of the flexible actuator. The pneumatic flexible actuator designed in this research can be combined into the required direct ventricular assist device in a reasonable way, which will provide ideas for the design of a fully flexible direct ventricular assist device.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-25T05:59:17Z
      DOI: 10.1177/0391398821995824
       
  • Effects of mouse fetal liver cell culture density on hematopoietic cell
           expansion in three-dimensional cocultures with stromal cells
    • Authors: Hirotoshi Miyoshi, Kenji Abo, Daiki Hosoya, Kazuyuki Matsuo, Yoshio Utsumi
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Objective:An effective ex vivo expansion system of primitive hematopoietic cells (HCs) is required for wider application of hematopoietic stem cell transplantation. In this study, we examined effects of culture density on mouse fetal liver cells (FLCs) used as an HC source for the expansion of primitive HCs in three-dimensional (3D) cocultures with two kinds of mouse stromal cell lines (OP9 or C3H10T1/2).Materials and methods:FLCs were seeded at different densities (1, 2, and 10 × 107 cells/cm3) into porous polymer scaffolds with or without stromal cell layers and HCs were expanded in the cultures for 2 weeks without exogenous cytokines.Results:Differential effects of culture density on HC expansion were observed between cocultures and solitary FLC controls. In stromal cell cocultures, high expansion of HCs was achieved when FLCs were seeded at low densities. In contrast, the expansion in the controls was enhanced with increasing culture densities. With respect to expansion of primitive HCs existing in the FLCs, cocultures with C3H10T1/2 cells were superior to those with OP9 cells with a 29.3-fold expansion for c-kit+ hematopoietic progenitor cells and 8.3-fold expansion for CD34+ hematopoietic stem cells. In the controls, HC expansion was lower than in any cocultures, demonstrating the advantages of coculturing for HC expansion.Conclusion:Stromal cell lines are useful in expanding primitive HCs derived from FLCs in 3D cocultures. Culture density is a pivotal factor for the effective expansion of primitive HCs and this effect differs by culture condition.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-22T08:53:53Z
      DOI: 10.1177/0391398821996377
       
  • Changes in extracellular water with hemodialysis and fall in systolic
           blood pressure
    • Authors: Kamonwan Tangvoraphonkchai, Andrew Davenport
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Introduction:Intra-dialytic hypotension (IDH) remains the most common complication with outpatient hemodialysis (HD) sessions. As fluid is removed during HD, there is contraction of the extracellular volume (ECW). We wished to determine whether the fall in ECW was associated with a fall in systolic blood pressure (SBP).Methods:We retrospectively reviewed the records of adult dialysis outpatients attending for their midweek sessions who had corresponding pre- and post-HD bioimpedance measurements of ECW.Result:We reviewed 736 patients, median age 67 (54–76) years, 62.8% male, 45.7% diabetic with a median dialysis vintage of 24.4 (9.2–56.8) months. The percentage fall in ECW (ECW%) was associated with post-dialysis systolic blood pressure (SBP) (r = −0.14, p 20 mmHg had a greater fall in ECW% compared to patients with stable SBP 7.6 (4.6–10.1) vs 6.0 (4.0–8.5), p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-20T09:05:10Z
      DOI: 10.1177/0391398821995503
       
  • A novel protocol to reduce bleeding associated with alteplase treatment of
           HVAD pump thrombosis
    • Authors: Tyler C Lewis, Amy Emmarco, Claudia G Gidea, Alex Reyentovich, Deane E Smith, Nader Moazami
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Pump thrombosis remains a feared complication for patients implanted with durable left ventricular assist devices. Optimal treatment is unknown, but consists of either pharmacologic fibrinolysis or surgical pump exchange. Fibrinolysis is less invasive, but carries a significant risk of intracerebral hemorrhage. We present four cases of LVAD pump thrombosis successfully treated with a novel protocol that consists of low-dose four-factor prothrombin complex concentrate to reverse baseline INR elevation prior to alteplase administration to minimize the risk for intracerebral hemorrhage.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-18T09:14:23Z
      DOI: 10.1177/0391398821995499
       
  • ABO incompatibility and mild factor VIII deficiency in the neonate: Not
           too much of a problem but a challenge on ECMO
    • Authors: Anna Hofer, Barbara Prandstetter, Markus Bruckner, Gabriele Leithner
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Coagulopathy and bleeding on extracorporeal membrane oxygenation (ECMO) contribute to a worse outcome, and hyperbilirubinemia is an additional threat for newborn babies. We report a case of a newborn boy with congenital diaphragmatic hernia (CDH) associated with ABO incompatibility and an inherited mild hemophilia A. Due to respiratory failure he needed ECMO on his first day of life. During ECMO an exchange transfusion was performed after an extensive hyperbilirubinemia had evolved. Thereafter severe bleeding occurred, and a very low factor VIII level was found causative for that. After factor VIII substitution bleeding was under control and the baby eventually could be weaned from ECMO, underwent corrective surgery, and recovered.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-18T09:14:03Z
      DOI: 10.1177/0391398821994113
       
  • Corrigendum to “Selection of suitable pedicle screw for degenerated
           cortical and cancellous bone of human lumbar spine: A finite element
           study”
    • Abstract: The International Journal of Artificial Organs, Ahead of Print.

      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-18T05:05:45Z
      DOI: 10.1177/0391398821995051
       
  • High rate of infection eradication following cementless one-stage revision
           hip arthroplasty with an antibacterial hydrogel coating
    • Authors: Antonio Pellegrini, Claudio Legnani
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Purpose:We conducted a retrospective study to evaluate the outcomes of one-stage revision total hip arthroplasty (THA) following periprosthetic joint infection (PJI) in terms of eradication of the infection, improvement of pain and joint function. We hypothesized that this treatment strategy could lead to satisfying results in selected patients after preoperative microorganism isolation.Methods:Ten patients underwent cementless one-stage revision hip arthroplasty with antibacterial hydrogel coating for the treatment of an infected THA. Inclusion criteria were: the presence of a known organism with known sensitivity, patients non-immunocompromised with healthy soft tissues with minimal or moderate bone loss. Mean age at surgery was 69.4 years. Assessment included objective examination, Harris hip score, visual analog scale pain score, standard X-rays.Results:At a mean follow-up of 3.1 years (range, 2–5 years), none of the patients had clinical or radiographic signs suggesting recurrent infection. Follow-up examination showed significant improvement of all variables compared to pre-operative values (p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-17T10:15:38Z
      DOI: 10.1177/0391398821995507
       
  • Management of a mechanical aortic valve during left ventricular assist
           device implantation in a previously replaced aortic root
    • Authors: Tamam Tulimat, Bassam Osman, Jean Beresian, Pierre Sfeir, Jamil Borgi
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      The use of left ventricular assist device (LVAD) in patients with mechanical aortic valves may result in thromboembolic events due to blood stasis around the valve and intermittent valve opening. Mechanical aortic valves encountered during LVAD implantation are managed by replacement with a tissue valve, or closure of the valve with a patch. Closure of the valve carries the risk of sudden death in cases of LVAD stoppage. Replacing the whole mechanical valve conduit is time consuming and carries a significant risk of bleeding and right ventricular (RV) failure. We describe an alternative technique of replacing a mechanical aortic valve by breaking its inner leaflets and sewing a tissue valve on top of the mechanical valve ring.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-15T05:56:07Z
      DOI: 10.1177/0391398821990667
       
  • Effects of tocilizumab versus hemoadsorption combined with tocilizumab in
           patients with SARS-CoV-2 pneumonia: Preliminary results
    • Authors: Giorgio Berlot, Stefania Pintacuda, Edoardo Moro, Giacomo Paluzzano, Alice Scamperle, Antonino Chillemi, Irene Longo, Roberto Dattola, Erik Roman-Pognuz, Ariella Tomasini
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Objective:To assess the variations of Interleukin-6 (IL-6) in patients with SARS-CoV-2 infection treated with Tocilizumab (TCZ) alone or in association with hemoadsorption (HA).Design:Retrospective.Setting:An Intensive Care Unit (ICU) admitting mechanically ventilated patients with SARS-CoV-2 pneumonia.Patients:Four adult patients.Interventions:We compared the blood values of IL-6, C-reactive protein (CRP) and of other biochemical variables including the PaO2/FiO2 in two patients who received TCZ alone and in other 2 in whom it was associated with the HA (TCZ-HA) due to the presence of impending or established organ failures other than the lung. All variables were measured before, during and after the treatment.Main results:In all patients, the IL-6 increased during the treatment; after its termination, its values sharply decreased only in those treated also with HA; conversely, the CRP decreased in all patients; the PaO2/FiO2 increased in three patients and remained stable in the remaining one. Both the TCZ and the HA were well tolerated; all patients were weaned from the mechanical ventilation and discharged from the hospital.Limitations:Although the limited number of patients does not allow to draw firm conclusions, the increase of the IL-6 of can be ascribed to its displacement from cellular and soluble receptors, whereas its decrease is likely due to the scavenging effect exerted by the HA. Although the association TCZ-HA could be valuable in the treatment of the Cytokine Release Storm (CRS) associated with the SARS-CoV-2, the HA could be more effective as it neutralizes a wider panel of inflammatory mediators.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-12T05:35:42Z
      DOI: 10.1177/0391398821989334
       
  • Prophylactic use of vacuum-assisted closure system for cannula sites: A
           case of extracorporeal biventricular assist devices for 295 days
    • Authors: Yoshiyuki Takami, Shin-ichi Tanida, Naoki Hoshino, Yusuke Sakurai, Kentaro Amano, Kiyotoshi Akita, Ryosuke Hayashi, Atsuo Maekawa, Hideo Izawa, Yasushi Takagi
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      We report wound management using a vacuum-assisted closure (VAC) system for the cannula sites of extracorporeal biventricular assist devices (BiVADs) for 295 days in a 23-year old Chinese female patient with fulminant giant cell myocarditis, who finally underwent heart transplantation. When the cannula sites appeared necrotic 3 months after BiVADs placement, she received negative pressure wound therapy prophylactically for four cannula sites, using a VAC system for 3 months, followed by no infections. Such prophylactic VAC therapy, using the skin barrier paste usually used for the ostomy pouching system to create a flatter surface and airtightness, may be useful to avoid cannula site infections, which is still a fatal complication causing sepsis, especially in patients with extracorporeal BiVADs.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-03T06:17:49Z
      DOI: 10.1177/0391398821991156
       
  • Peak troponin predicts successful weaning from VA ECMO in patients with
           acute myocardial infarction complicated by cardiogenic shock
    • Authors: Monique North, Peter Eckman, Michael Samara, Ivan Chavez, Christian Schmidt, Ross Garberich, Katarzyna Hryniewicz
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Background:In patients treated for refractory cardiogenic shock (RCS) following acute myocardial infarction (AMI), predicting successful weaning from veno-arterial extracorporeal membrane oxygenation (VA ECMO) has important implications for decision-making and prognosis.Methods:We performed a retrospective review of adult VA ECMO patients with RCS complicating AMI at our institution from 2010 to 2019. We evaluated use of peak troponin I as a predictor of successful decannulation.Results:Sixty-two patients were analyzed; mean age 61.1 ± 9.8 years, 73% males, 62% presented with STEMI. Forty-five patients were successfully weaned (group I). Seventeen patients did not wean (group II); seven patients received a durable LVAD, 10 died. Patients from group I had significantly lower peak troponin I (89 vs 434 ng/mL, p = 0.0001). Receiver operating characteristic curves showed a peak troponin I cutoff of 400 ng/mL correctly classified patients by weaning status 90% of the time, with associated sensitivity of 71% and specificity of 98%. With each 50 ng/mL increase in troponin I, the likelihood of weaning decreased by 33%.Conclusions:Peak troponin I above 400 ng/mL may be helpful in predicting unsuccessful weaning from VA ECMO support for refractory cardiogenic shock following myocardial infarction and facilitate triage decisions regarding need for advanced therapies.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-03T06:15:48Z
      DOI: 10.1177/0391398821991155
       
  • Custodiol-MP for ex vivo lung perfusion – A comparison in a porcine
           model of donation after circulatory determination of death
    • Authors: Katharina Kalka, Zoe Keldenich, Henning Carstens, Björn Walter, Ursula Rauen, Arjang Ruhparwar, Alexander Weymann, Markus Kamler, Gerald Reiner, Achim Koch
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Introduction:Ex vivo lung perfusion (EVLP) is an established technique to evaluate and eventually recondition lungs prior to transplantation. Custodiol-MP (C-MP) solution is a new solution, designed for clinical machine perfusion, that has been used for kidneys. The aim of this study was to compare the effects of EVLP with Custodiol-MP on lung functional outcomes to the gold standard of EVLP with Steen Solution™.Material and Methods:In a porcine EVLP model of DCDD (Donation after Circulatory Determination of Death), lungs were perfused with Steen Solution™ (SS, n = 7) or Custodiol-MP solution supplemented with 55 g/l albumin (C-MP, n = 8). Lungs were stored cold for 4 h in low potassium dextran solution and subsequently perfused ex vivo for 4 h. During EVLP pulmonary gas exchange, activities of lactate dehydrogenase (LDH) and alkaline phosphatase (AP) as well as levels of lactate in the perfusate were recorded hourly.Results:Oxygenation capacity differed significantly between groups (averaged over 4 h: SS 274 ± 178 mmHg; C-MP 284 ± 151 mmHg p = 0.025). Lactate dehydrogenase activities and lactate concentrations were significantly lower in Custodiol-MP perfused lungs.In a porcine model of DCDD with 4 h of EVLP the use of modified Custodiol-MP as perfusion solution was feasible. The use of C-MP showed at least comparable lung functional outcomes to the use of Steen SolutionTM. Furthermore C-MP perfusion resulted in significantly lower lactate dehydrogenase activity and lactate levels in the perfusate and higher oxygenation capacity.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-03T06:13:48Z
      DOI: 10.1177/0391398821990663
       
  • Cardiohelp System use in school age children and adolescents at a center
           with interfacility mobile extracorporeal membrane oxygenation capability
    • Authors: Teodora Ignat, Ajay Desai, Andreas Hoschtitzky, Rosie Smith, Tim Jackson, Diane Frall, Eleri Evans, Richard Trimlett, Stephane Ledot, Amy Chan-Dominy
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Cardiohelp System use for pediatric extracorporeal membrane oxygenation (ECMO) beyond the transport setting is sparsely described in literature. We report the use of Getinge’s Cardiohelp System in children and integrated utilization of Mobile ECMO Retrieval Team (MERT) at an all-age specialized cardiorespiratory center. Electronic database of all patients under 16 years of age who received ECMO with use of the Cardiohelp System between January 2018 and March 2020 was retrospectively reviewed and analyzed for demographics, set-up, complications, and outcomes. Out of 41 patients, seven patients (four in middle childhood, three in early teenage) with median age of 10 years (range 8.8–15.6) were supported with use of Cardiohelp System. Median weight and height were 34 kg (range 28–53) and 145 cm (range 134–166) respectively. Initial ECMO deployment was veno-arterial (V-A) in five patients and veno-venous (V-V) in two. There were three interhospital transfers by our MERT, and 12 intrahospital transfers for interventions or imaging. The median ECMO therapy was 7 days (range 4–25), with standard 3/8-inch tubing and ECMO flow rate range at 56–100 mL/kg/min (1.89–5.0 LPM). There were two circuit changes and three reconfigurations of support. Two patients received continuous veno-venous hemofiltration via ECMO circuit. The 90-day and 180-day survival rates were 100% (including two heart transplants at day 7 and day 8). There were no transport-related or circuit-related complications during the 1750 h of Cardiohelp use. Cardiohelp System use is safe in pediatric patients for diverse application of ECMO support including inter- and intrahospital transfers.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-02-03T06:12:28Z
      DOI: 10.1177/0391398821990659
       
  • Observational study of thrombosis and bleeding in COVID-19 VV ECMO
           patients
    • Authors: Brianda Ripoll, Antonio Rubino, Martin Besser, Chinmay Patvardhan, William Thomas, Karen Sheares, Hilary Shanahan, Bobby Agrawal, Stephen Webb, Alain Vuylsteke
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Introduction:COVID-19 has been associated with increased risk of thrombosis, heparin resistance and coagulopathy in critically ill patients admitted to intensive care. We report the incidence of thrombotic and bleeding events in a single center cohort of 30 consecutive patients with COVID-19 supported by veno-venous extracorporeal oxygenation (ECMO) and who had a whole body Computed Tomography Scanner (CT) on admission.Methodology:All patients were initially admitted to other hospitals and later assessed and retrieved by our ECMO team. ECMO was initiated in the referral center and all patients admitted through our CT scan before settling in our intensive care unit. Clinical management was guided by our institutional ECMO guidelines, established since 2011 and applied to at least 40 patients every year.Results:We diagnosed a thrombotic event in 13 patients on the initial CT scan. Two of these 13 patients subsequently developed further thrombotic complications. Five of those 13 patients had a subsequent clinically significant major bleeding. In addition, two patients presented with isolated intracranial bleeds. Of the 11 patients who did not have baseline thrombotic events, one had a subsequent oropharyngeal hemorrhage. When analyzed by ROC analysis, the area under the curve for % time in intended anticoagulation range did not predict thrombosis or bleeding during the ECMO run (0.36 (95% CI 0.10–0.62); and 0.51 (95% CI 0.25–0.78); respectively).Conclusion:We observed a high prevalence of VTE and a significant number of hemorrhages in these severely ill patients with COVID-19 requiring veno-venous ECMO support.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-01-28T10:54:09Z
      DOI: 10.1177/0391398821989065
       
  • Severe hepatopulmonary syndrome with hypoxemia refractory to liver
           transplant: Recovery after 67 days of ECMO support
    • Authors: Rodrigo Piltcher-da-Silva, Marcio Fernandes Chedid, Tomaz Jesus Maria Grezzana Filho, Ian Leipnitz, Alexandre de Araújo, Marcelo Basso Gazzana, Mauricio Guidi Saueressig, William Lorenzi, Mario Gurvitez Cardoni, Priscila Bellaver, Mario Reis Alvares-da-Silva, Flavia Heinz Feier, Aljamir Duarte Chedid, Cleber Rosito Pinto Kruel
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Hepatopulmonary syndrome (HPS) is a complication of end stage liver disease (ESLD) and is manifested by severe hypoxemia, which usually responds to liver transplantation (LT). As compared to patients undergoing LT for other etiologies, patients with HPS present an increased risk of postoperative morbidity and mortality. There is no effective treatment for patients whose hypoxemia does not respond to LT. This subset of patients is at a highly increased risk of death. There are very few reports on the use of extracorporeal membrane oxygenation (ECMO) in this setting with rapid response. However, there is no prior report of ECMO utilization for longer than 4 weeks. We present the case of a 17 year-old male patient who underwent LT for ESLD secondary to chronic portal vein thrombosis and HPS. He received a liver from a deceased donor and presented with severe HPS after LT, requiring ECMO support for 67 days. The patient was discharged home and is breathing in ambient air. He is currently asymptomatic and has a normal liver function.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-01-22T07:17:55Z
      DOI: 10.1177/0391398821989067
       
  • Impact of anatomical position of the inflow cannula on stroke in patients
           with left ventricular assist devices
    • Authors: Takuma Takada, Tomohiro Nishinaka, Yuki Ichihara, Satoshi Saito, Yasutaka Imamura, Noriko Kikuchi, Hidetoshi Hattori, Atsushi Suzuki, Kyomi Ashihara, Tsuyoshi Shiga, Shinichi Nunoda, Nobuhisa Hagiwara, Hiroshi Niinami
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Objectives:Stroke is a substantial complication of left ventricular assist device (LVAD) implantation. The relationship between stroke and the anatomical position of the inflow cannula of patients who underwent LVAD implantation was investigated.Methods:We enrolled 15 patients with advanced-stage heart failure who underwent implantation of continuous-flow-LVAD. Data of patients who suffered a stroke within 6 months after LVAD implantation were retrospectively compared to those who remained free of stroke. The distance between the inflow duct and left ventricular (LV) septum (duct-sep distance) and its ratio to LV diastolic diameter (LVDd) were measured from echocardiography at 1 month after LVAD implantation. Receiver operating characteristic curves for the endpoint of stroke using the duct-sep distance to LVDd ratio was created and the cut-off value was calculated. The incidence of stroke during the 6 months after LVAD implantation according to this ratio was estimated using the Kaplan-Meier method.Results:At 1 month after LVAD implantation, there were no significant differences in baseline characteristics and echocardiography parameters between the stroke and stroke-free groups. Receiver operating characteristic curve analysis for the endpoint of stroke using the duct-sep distance to LVDd ratio revealed 0.217 as a cut-off value (sensitivity: 80%, specificity: 80%, area under the curve: 0.72). Stroke was more frequent in patients with a duct-sep distance to LVDd ratio ⩾0.217 at 1 month than in those with a lower ratio.Conclusion:The duct-sep distance to LVDd ratio was associated with the occurrence of stroke, suggesting that inflow cannula position influences the incidence of stroke.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-01-21T09:14:01Z
      DOI: 10.1177/0391398820988297
       
  • Angiotensin receptor neprilysin inhibitor use in patients with left
           ventricular assist devices: A single-center experience
    • Authors: Shudhanshu Alishetti, Lorenzo Braghieri, Douglas L Jennings, Nir Uriel, Paolo C Colombo, Melana Yuzefpolskaya
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Though left ventricular assist devices (LVADs) are an increasingly common therapy for ACC/AHA Stage D heart failure, the optimal medical therapy for patients with LVADs is not known. We sought to evaluate the safety and efficacy of angiotensin receptor neprilysin inhibitor (ARNi) therapy in our single center LVAD patient experience. We evaluated patients implanted with LVADs at Columbia University Irving Medical Center between August 2010 and May 2019, and who were treated with an ARNi for at least 3 months. Thirty patients met this criteria. Eighteen (60%) patients transitioned to an ARNi from an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB), while all were on a beta blocker (BB) at the time of ARNi initiation. The primary outcome, NT-proBNP levels at time of initiation and 3 and 6 month follow up, significantly decreased from a median of 1265 pg/mL at initiation to 750 pg/mL at 3 months and 764 pg/mL at 6 months (p = 0.01). No significant change was seen in serum creatinine, BUN, or potassium levels.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-01-20T06:25:13Z
      DOI: 10.1177/0391398821989066
       
  • Extracellular vesicles from three dimensional culture of human placental
           mesenchymal stem cells ameliorated renal ischemia/reperfusion injury
    • Authors: Xuefeng Zhang, Nan Wang, Yuhua Huang, Yan Li, Gang Li, Yuxin Lin, Anthony J. Atala, Jianquan Hou, Weixin Zhao
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Background:Three-dimensional (3D) culture has been reported to increase the therapeutic potential of mesenchymal stem cells (MSCs). The present study assessed the therapeutic efficacy of extracellular vesicles (EVs) from 3D cultures of human placental MSCs (hPMSCs) for acute kidney injury (AKI).Methods:The supernatants from monolayer culture (2D) and 3D culture of hPMSCs were ultra-centrifuged for EVs isolation. C57BL/6 male mice were submitted to 45 min bilateral ischemia of kidney, followed by renal intra-capsular administration of EVs within a 72 h reperfusion period. Histological, immunohistochemical, and ELISA analyses of kidney samples were performed to evaluate cell death and inflammation. Kidney function was evaluated by measuring serum creatinine and urea nitrogen. The miRNA expression profiles of EVs from 2D and 3D culture of hPMSCs were evaluated using miRNA microarray analysis.Results:The 3D culture of hPMSCs formed spheroids with different diameters depending on the cell density seeded. The hPMSCs produced significantly more EVs in 3D culture than in 2D culture. More importantly, injection of EVs from 3D culture of hPMSCs into mouse kidney with ischemia-reperfusion (I/R)-AKI was more beneficial in protecting from progression of I/R than those from 2D culture. The EVs from 3D culture of hPMSCs were more efficient against apoptosis and inflammation than those from 2D culture, which resulted in a reduction in tissue damage and amelioration of renal function. MicroRNA profiling analysis revealed that a set of microRNAs were significantly changed in EVs from 3D culture of hPMSCs, especially miR-93-5p.Conclusion:The EVs from 3D culture of hPMSCs have therapeutic potential for I/R-AKI.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-01-20T06:21:34Z
      DOI: 10.1177/0391398820986809
       
  • Analysis of extracorporeal membrane oxygenation in trauma patients with
           acute respiratory distress syndrome: A case series
    • Authors: Friederike Weidemann, Sebastian Decker, Jelena Epping, Marcus Örgel, Christian Krettek, Christian Kühn, Michaela Wilhelmi
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Background:Thoracic trauma is the most common injury in polytrauma patients. Often associated with the development of an acute respiratory distress syndrome (ARDS), conservative treatment options are very restricted and reach their limits quickly.Objective:Extracorporeal membrane oxygenation (ECMO) is a wellestablished therapy in cardio-thoracic surgery and internal medicine intensive care units. The purpose of this study is to analyse the potential benefit of ECMO therapy in ARDS treatment in polytrauma patients.Design:Retrospective case series.Setting:Level 1 trauma centre, Germany, 04/2011-04/2019.Patients:Nineteen patients with ARDS treated with a veno-venous ECMO system.Main outcome measures:This study focused on the time leading to therapy initiation, the severity of thoracic and overall injury. The Sequential Organ Failure Assessment (SOFA) Score, the Murray Score, the Abbreviated Injury Scale (AIS) 2005 level and the Injury Severity Score (ISS) were analysed. The results were analysed regarding survival and death.Results:The survival rate was 53%. The ISS was the same for survivors and deceased patients (p = 0.604). Early initiation of ECMO therapy showed a significant trend for survivors (p = 0.071). The SOFA Score level before ECMO therapy was significantly lower in the survivors than in those who died (p = 0.035). The AISThorax level for survivors showed a significantly higher score level than the one for deceased patients (p = 0.05).Conclusion:ECMO therapy in polytrauma patients is a safe and effective option, in particular when used early in ARDS treatment. The overall severity of organ failure determined the likelihood of survival rather than the thoracic trauma itself.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-01-13T12:27:12Z
      DOI: 10.1177/0391398820980736
       
  • Sequential versus mono double plasma molecular adsorption system in
           acute-on-chronic liver failures: A propensity-score matched study
    • Authors: Jing Zhang, Hui Luo, Ying Han, Xinmin Zhou
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Aims:Efficacy of sequential double plasma molecular adsorb system (DPMAS) and plasma exchange (PE) on patients with acute on chronic liver failure (ACLF) has been rarely reported. We hereby reported the outcomes of a consecutive cohort of ACLF patients treated with sequential and mono DPMAS.Method:Patients treated with artificial liver support system between January 2011 and December 2016 in XiJing hospital were retrospectively reviewed. A toal of 125 ACLF patients either received mono (DPMAS only) or sequential DPMAS (PE followed by DPMAS) therapy. One to one propensity-score matching (PSM) was used to compare the effects of sequential and mono DPMAS on survival and liver function.Results:After PSM, 80 patients were included with 40 patients in each group. Sequential therapy achieved significantly higher removal of total bilirubin, alanine aminotransferase, glutamic oxaloacetic transaminase, and alkaline phosphatase than mono DPMAS, but stabilized international normalized ratio. The effects of both regimens on white blood cell, platelet, creatinine, and liver function scores were similar. Survival rate on 90-day was 50% in the sequential group and 47.5% in the mono group.Conclusion:For ACLF patients, sequential DPMAS and PE seemed to have a better effect on liver function improvement but provided no survival benefit compared with mono DPMAS.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-01-13T07:14:04Z
      DOI: 10.1177/0391398820987565
       
  • Feasibility of long-term continuous flow total heart replacement in calves
    • Authors: Andrew CW Baldwin, Courtney J Gemmato, William E Cohn, OH Frazier
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Introduction:Implementation of continuous flow (CF) technology in modern ventricular assist devices (VAD) has afforded a wealth of engineering and design advantages in the development of a total artificial heart (TAH). However, clinical application of CF has created a unique physiologic state, the consequences of which remain largely unknown. We sought to evaluate clinical and biochemical markers of end-organ function in calves supported with biventricular CF VADs for more than 30 days.Methods:Eight calves survived longer than 30 days following biventriculectomy and implantation of dual CF VADs. Four types of CF pumps were utilized for the study. Serial hematologic and biochemical profiles were drawn as markers for end-organ function, and hemodynamic data—including pump flows and intravascular pressures—were continuously monitored.Results:The eight calves survived an average of 58.8 days (range 30–92 days). Two of the calves were electively terminated at the conclusion of the study period, while the remaining animals were euthanized as a result of respiratory distress (n = 2) or impaired pump flows (n = 4). In each case, serial biochemical and hematologic values were suggestive of preserved end-organ function. Six animals successfully participated in treadmill exercise evaluations. No evidence of end-organ damage was encountered upon necropsy or histologic tissue analysis.Conclusion:Biventricular CF VAD implantation permits a viable bovine CFTAH model capable of demonstrating long-term survival. After 30 days of completely nonpulsatile flow, cumulative hemodynamic, clinical, biochemical, and histological analyses were consistent with preserved end-organ function, suggesting previously unreported long-term feasibility of a CFTAH design.
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-01-11T09:32:08Z
      DOI: 10.1177/0391398820987851
       
  • Validation of transcutaneous carbon dioxide monitoring using an artificial
           lung during adult pulsatile cardiopulmonary bypass
    • Authors: Lawrence Garrison, Jeffrey B Riley, Steve Wysocki, Jennifer Souai, Hali Julick
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Measurements of transcutaneous carbon dioxide (tcCO2) have been used in multiple venues, such as during procedures utilizing jet ventilation, hyperbaric oxygen therapy, as well as both the adult and neo-natal ICUs. However, tcCO2 measurements have not been validated under conditions which utilize an artificial lung, such cardiopulmonary bypass (CPB). The purpose of this study was to (1) validate the use of tcCO2 using an artificial lung during CPB and (2) identify a location for the sensor that would optimize estimation of PaCO2 when compared to the gold standard of blood gas analysis.tcCO2 measurements (N = 185) were collected every 30 min during 54 pulsatile CPB procedures. The agreement/differences between the tcCO2 and the PaCO2 were compared by three sensor locations. Compared to the earlobe or the forehead, the submandibular PtcCO2 values agreed best with the PaCO2 and with a median difference of –.03 mmHg (IQR = 5.4, p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2021-01-09T10:51:07Z
      DOI: 10.1177/0391398820987855
       
  • Intermittent hemodiafiltration as a down-step transition therapy in
           patients with acute kidney injury admitted to intensive care unit who
           initially underwent continuous venovenous hemodiafiltration
    • Authors: Patricia Faria Scherer, Ilson Jorge Iizuka, Adriano Luiz Ammirati, Marisa Petrucelli Doher, Thais Nemoto Matsui, Bento Fortunato Cardoso dos Santos, Julio Cesar Martins Monte, Marcelo Costa Batista, Virgilio Gonçalves Pereira, Oscar Fernando Pavão dos Santos, Marcelino de Souza Durão
      Pages: 223 - 228
      Abstract: The International Journal of Artificial Organs, Volume 44, Issue 4, Page 223-228, April 2021.
      Background/Aims:Continuous renal replacement therapies (CRRT) are initially employed in patients with acute kidney injury (AKI) in ICU setting. After the period of serious illness, hemodialysis is usually used as a mode of transition from CRRT. Intermittent hemodiafiltration (HDF) is not commonly applied in this scenario.Objectives:To evaluate the feasibility of using HDF as transition therapy after CVVHDF in critically patients with AKI.Methods:An observational and prospective pilot study was conducted in ICU patients with dialysis-requiring AKI. Patients were initially treated with CVVHDF and, after medical improvement, those who still needed renal replacement therapy were switched to HDF treatment.Results:Ten Patients underwent 53 HDF sessions (mean of 5.3 sessions/patient). The main cause of renal dysfunction was sepsis (N = 7; 70%). The APACHE II mean score was 27.6 ± 6.9. During HDF treatment, the urea reduction ratio was 64.5 ± 7.5%, for β-2 microglobulin serum levels the percentage of decrease was 42.0 ± 7.8%, and for Cystatin C was 36.2 ± 6.9%. Five episodes of arterial hypotension occurred (9.4% of sessions). There were 20 episodes of electrolytic disturbance (37.7% of sessions), mainly hypophosphatemia. No pyrogenic or suggestive episode of bacteremia was observed.Conclusion:Hemodiafiltration was safe and efficient to treat critically ill patients with acute kidney injury during the transition phase from continuous to intermittent dialysis modality. Special attention should be paid regarding the occurrence of electrolytic disturbance, mainly hypophosphatemia.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-09-10T07:30:16Z
      DOI: 10.1177/0391398820952801
      Issue No: Vol. 44, No. 4 (2020)
       
  • The impact of arteriovenous fistulas and tunneled cuffed venous catheters
           on morbidity and mortality in hemodialysis patients: A single center
           experience
    • Authors: Serhat Celik, Ebru Gok Oguz, Gulay Ulusal Okyay, Tamer Selen, Mehmet Deniz Ayli
      Pages: 229 - 236
      Abstract: The International Journal of Artificial Organs, Volume 44, Issue 4, Page 229-236, April 2021.
      Background/aim:Hemodialysis is the most used renal replacement therapy option for patients with end-stage renal disease. Arteriovenous fistulas (AVFs) and tunnel-cuffed venous catheters (tCVC) are commonly used vascular access routes and have advantages and disadvantages compared to each other. This study focuses on the effects of AVFs and tCVCs on morbidity and mortality in hemodialysis patients.Methods:The records (between January 2015 and January 2017) of 110 patients (55 patients with AVF and 55 patients with tCVC) under hemodialysis therapy for at least 6 months were evaluated retrospectively. The data about blood tests, hospitalizations, and mortality were compared between patients with AVF and tCVC.Findings:Fifty-five patients (25 male, 58 ± 14 years old) were undergoing hemodialysis via AVF. Fifty-five patients (17 male, 63 ± 14 years old) were undergoing hemodialysis via tunneled CVCs. Thirty (54.5%) of the hospitalization patients had AVF and 46 (83.6%) had CVCs (p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-09-23T06:14:30Z
      DOI: 10.1177/0391398820952808
      Issue No: Vol. 44, No. 4 (2020)
       
  • Predicting post-LVAD outcome: Is there a role for cognition'
    • Authors: Marykay A Pavol, Amelia K Boehme, Joshua Z Willey, Joanne R Festa, Ronald M Lazar, Shunichi Nakagawa, Jesus Casida, Melana Yuzefpolskaya, Paolo C Colombo
      Pages: 237 - 242
      Abstract: The International Journal of Artificial Organs, Volume 44, Issue 4, Page 237-242, April 2021.
      Background:Cognition has been found to influence risk of stroke and death for a variety of patient groups but this association has not been examined in heart failure (HF) patients undergoing left ventricular assist device (LVAD) implant. We aimed to study the relationship between cognition, stroke, and death in a cohort of patients who received LVAD therapy. It was hypothesized that cognitive test results obtained prior to LVAD placement would predict stroke and death after surgery.Methods:We retrospectively identified 59 HF patients who had cognitive assessment prior to LVAD placement. Cognitive assessment included measures of attention, memory, language, and visualmotor speed and were averaged to produce one z-score variable per patient. Survival analyses, censored for transplant, evaluated predictors for stroke and death within a follow-up period of 900 days.Results:For patients with stroke or death during the follow up period, the average cognitive z-score predicted post-LVAD stroke (HR = 0.513, 95% CI = 0.31–0.86, p = 0.012) and death (HR = 0.166, 95% CI = 0.06–0.47, p = 0.001). Cognitive performances were worse in the patients who suffered stroke or died. No other variable predicted stroke and death within the follow up period when the cognitive variable was in the model.Conclusion:Cognitive performance was predictive of post-LVAD risk of stroke and death. Results are consistent with findings from other studies in non-LVAD samples and may reflect early signs of neurologic vulnerability. Further studies are needed to clarify the relationship between cognition and LVAD outcomes in order to optimize patient selection, management, and advanced care planning.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-09-10T07:23:33Z
      DOI: 10.1177/0391398820956661
      Issue No: Vol. 44, No. 4 (2020)
       
  • First in vivo assessment of RAS-Q technology as lung support device for
           pulmonary hypertension
    • Authors: Tom Verbelen, Michael Halwes, Bart Meyns
      Pages: 243 - 250
      Abstract: The International Journal of Artificial Organs, Volume 44, Issue 4, Page 243-250, April 2021.
      Objectives:To assess the in vivo hemodynamic effects on the pressure overloaded right ventricle of RAS-Q® technology, the world’s first gas exchanger with a fully integrated compliance.Methods:In six acute in vivo trials RAS-Q was implanted in sheep between the pulmonary artery and left atrium. Right ventricular pressure overload was induced by pulmonary artery banding. Pressures and flows were recorded in baseline, moderate and severe pulmonary hypertension conditions. In one trial, RAS-Q was benchmarked against the pediatric Quadrox-i®.Results:With 1.00 and 1.17 L/min, RAS-Q delivered 31% and 39% of the total cardiac output in moderate and severe pulmonary hypertension, respectively. Pulmonary artery pressures and mean pulmonary artery pressure/mean arterial blood pressure ratio successfully decreased, implying a successful right ventricular unloading. Cardiac output was restored to normal levels in both pulmonary hypertension conditions. With both devices in parallel, RAS-Q provided three times higher flow rates and a 10 times higher pressure relief, compared to the pediatric Quadrox-i.Conclusion:A gas exchanger with a fully integrated compliance better unloads the right ventricle compared to a non-compliant gas exchanger and it can restore cardiac output to normal levels in cases of severe pulmonary hypertension.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-09-10T07:26:56Z
      DOI: 10.1177/0391398820954217
      Issue No: Vol. 44, No. 4 (2020)
       
  • Structural improvement study of streamline design method, conical hub, and
           auxiliary blades for axial blood pump
    • Authors: Zheqin Yu, Jianping Tan, Shuai Wang, Bin Guo
      Pages: 251 - 261
      Abstract: The International Journal of Artificial Organs, Volume 44, Issue 4, Page 251-261, April 2021.
      The blood pump is a medical device used to assist or replace the diseased heart. Research on the structure of blood pumps has been committed to achieving better hemolysis and hydraulic performance. The purpose of this study was to find some effective ways to improve design methods and hydraulic structures. The research contents of improvement include: (1) improved blade streamline design method; (2) conical impeller hub; (3) additional auxiliary blades. Characteristic analysis and parameter design were carried out on the above three aspects. The methods used in this study included Dynamics (CFD) simulation, hydraulic experiments, and Particle Image Velocimetry (PIV) experiments. The results showed that this improved streamline design method could improve the distortion of blades and ensure a smaller impeller length. And, in the enhanced design of the hub, it is designed to be conical with inlet and outlet diameters of 7.5 and 12.8 mm, respectively. Furthermore, the auxiliary blades between the main blades are analyzed and designed. The results have the best performance optimization effect when the length of the auxiliary blades is 55% of the main blades. In general, the structural improvements in this study achieved the effect of improving hydraulic performance and avoiding increased hemolysis. These methods can be considered as an effective means of improving blood pump performance.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-09-22T06:54:06Z
      DOI: 10.1177/0391398820959344
      Issue No: Vol. 44, No. 4 (2020)
       
  • Atrial septostomy in patients supported with venoarterial extracorporeal
           membrane oxygenation: Analysis of the IMPACT registry data
    • Authors: Shriprasad R Deshpande, Kevin F Kennedy, Robert N Vincent, Kevin O Maher
      Pages: 262 - 268
      Abstract: The International Journal of Artificial Organs, Volume 44, Issue 4, Page 262-268, April 2021.
      Background:Patients with severe cardiac dysfunction, supported on extra-corporeal membrane oxygenation (ECMO), develop left atrial hypertension and often warrant atrial decompression. The procedural risks and outcomes, however, are not well established. Objective of this study is to understand the utilization, safety, and outcomes of atrial septostomy in children supported on venoarterial ECMO utilizing the IMPACT registry database.Methods:Data from 55 independent sites reporting to the registry was used for this descriptive study. Patients supported with cardiac ECMO that underwent percutaneous atrial septostomy (PAS) were included and data analyzed.Results:Between 2011 and 2018, 223 patients underwent atrial septostomy and were reported to the registry. Mean age was 4.65 years with 52% being males. Diagnoses of heart failure, sepsis, arrhythmia, and renal insufficiency were commonly noted prior to ECMO. The procedure was performed urgently or emergently in most cases (80%). PAS was associated with significant procedural complications such as arrhythmia (6.8%), tamponade (5.4%), and unplanned surgery (3.6%) but no procedural mortality. Overall hospital mortality was 46% (103/223) with 46 of these deaths occurring within 7 days of procedure. Regression analysis showed that African American race (vs Caucasian), race other than Caucasian, chronic lung disease and emergent procedure need were significantly associated with early post-procedural mortality (all p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-09-10T07:28:56Z
      DOI: 10.1177/0391398820953860
      Issue No: Vol. 44, No. 4 (2020)
       
  • Cell-derived decellularized extracellular matrix scaffolds for articular
           cartilage repair
    • Authors: Wenrun Zhu, Lu Cao, Chunfeng Song, Zhiying Pang, Haochen Jiang, Changan Guo
      Pages: 269 - 281
      Abstract: The International Journal of Artificial Organs, Volume 44, Issue 4, Page 269-281, April 2021.
      Articular cartilage repair remains a great clinical challenge. Tissue engineering approaches based on decellularized extracellular matrix (dECM) scaffolds show promise for facilitating articular cartilage repair. Traditional regenerative approaches currently used in clinical practice, such as microfracture, mosaicplasty, and autologous chondrocyte implantation, can improve cartilage repair and show therapeutic effect to some degree; however, the long-term curative effect is suboptimal. As dECM prepared by proper decellularization procedures is a biodegradable material, which provides space for regeneration tissue growth, possesses low immunogenicity, and retains most of its bioactive molecules that maintain tissue homeostasis and facilitate tissue repair, dECM scaffolds may provide a biomimetic microenvironment promoting cell attachment, proliferation, and chondrogenic differentiation. Currently, cell-derived dECM scaffolds have become a research hotspot in the field of cartilage tissue engineering, as ECM derived from cells cultured in vitro has many advantages compared with native cartilage ECM. This review describes cell types used to secrete ECM, methods of inducing cells to secrete cartilage-like ECM and decellularization methods to prepare cell-derived dECM. The potential mechanism of dECM scaffolds on cartilage repair, methods for improving the mechanical strength of cell-derived dECM scaffolds, and future perspectives on cell-derived dECM scaffolds are also discussed in this review.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-09-18T12:09:20Z
      DOI: 10.1177/0391398820953866
      Issue No: Vol. 44, No. 4 (2020)
       
  • Association between splenic volume and pulsatility index in patients with
           left ventricular assist devices
    • Authors: Hiroaki Hiraiwa, Takahiro Okumura, Akinori Sawamura, Toru Kondo, Shingo Kazama, Yuki Kimura, Naoki Shibata, Yoshihito Arao, Hideo Oishi, Hiroo Kato, Tasuku Kuwayama, Shogo Yamaguchi, Kenji Furusawa, Ryota Morimoto, Kazuro Fujimoto, Masato Mutsuga, Akihiko Usui, Toyoaki Murohara
      Pages: 282 - 287
      Abstract: The International Journal of Artificial Organs, Volume 44, Issue 4, Page 282-287, April 2021.
      The spleen serves as a blood volume reservoir for systemic volume regulation in heart failure (HF) patients. Changes are seen in spleen size in advanced HF patients after left ventricular assist device (LVAD) implantation. The pulsatility index (PI) is an indicator of native heart contractility with hemodynamic changes in patients using LVAD. We hypothesized that the splenic volume was associated with the PI, reflecting the hemodynamics in advanced HF patients with LVADs. Herein, we investigated the relationship between splenic volume and PI in these patients. Forty-four patients with advanced HF underwent implantation of HeartMate II® (Abbott, Chicago, IL, USA) as a bridge to heart transplantation at the Nagoya University Hospital between October 2013 and June 2019. The data of 27 patients (21 men, median age 46 years) were analyzed retrospectively. All patients underwent blood tests, echocardiography, right heart catheterization, and computed tomography (CT). Spleen size was measured via CT volumetry; the splenic volume (median: 190 mL) correlated with right arterial pressure (r = 0.431, p = 0.025) and pulmonary capillary wedge pressure (r = 0.384, p = 0.048). On multivariate linear regression analysis, the heart rate (β = −0.452, p = 0.003), pump power (β = −0.325, p = 0.023), and splenic volume (β = 0.299, p = 0.038) were independent determinants of PI. The splenic volume was associated with PI, reflecting the cardiac preload in advanced HF patients with LVADs. Thus, spleen measurement using CT may help estimate the systemic volume status and understand the hemodynamic conditions in LVAD patients.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-09-12T08:04:58Z
      DOI: 10.1177/0391398820957019
      Issue No: Vol. 44, No. 4 (2020)
       
  • Extracorporeal multiorgan support including CO2-removal with the ADVanced
           Organ Support (ADVOS) system for COVID-19: A case report
    • Authors: Wolfgang Huber, Georg Lorenz, Markus Heilmaier, Katrin Böttcher, Philipp Sahm, Moritz Middelhoff, Barbara Ritzer, Dominik Schulz, Elias Bekka, Felix Hesse, Alexander Poszler, Fabian Geisler, Christoph Spinner, Roland M Schmid, Tobias Lahmer
      Pages: 288 - 294
      Abstract: The International Journal of Artificial Organs, Volume 44, Issue 4, Page 288-294, April 2021.
      A substantial part of COVID-19-patients suffers from multi-organ failure (MOF). We report on an 80-year old patient with pulmonary, renal, circulatory, and hepatic failure. We decided against the use of extracorporeal membrane oxygenation (ECMO) due to old age and a SOFA-score of 13. However, the patient was continuously treated with the extracorporeal multi-organ- “ADVanced Organ Support” (ADVOS) device (ADVITOS GmbH, Munich, Germany). During eight 24h-treatment-sessions blood flow (100–300 mL/min), dialysate flow (160–320 mL/min) and dialysate pH (7.6–9.0) were adapted to optimize arterial PaCO2 and pH. Effective CO2 removal and correction of acidosis could be demonstrated by mean arterial- versus post-dialyzer values of pCO2 (68.7 ± 13.8 vs. 26.9 ± 11.6 mmHg; p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-09-28T09:58:51Z
      DOI: 10.1177/0391398820961781
      Issue No: Vol. 44, No. 4 (2020)
       
  • 3D perfusion culture of mouse insulinoma in macro-porous scaffolds
           enhanced insulin production response
    • Authors: Karn Changsorn, Yuan Pang, Hiroaki Matsumoto, Haofeng Hong, Pierre Wüthrich, Wei Sun, Yasuyuki Sakai
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      To address the remaining issue of poor cell immobilization and insufficient mass transfer in scaffold-based tissue engineering approach for future islet transplantation, we employed a macro-porous poly-l-lactide (PLLA) scaffold immobilizing mouse insulinoma cells and studied its function toward an implantable pancreatic tissue in 7-day perfusion culture. The murine pancreatic β cells could be immobilized in the PLLA scaffold at a high density of 107 cells per cm3 close to the estimated range in normal pancreas. The perfusion culture promoted the 3D cellular organization as observed with live/dead staining and histological staining. The insulin production was significantly enhanced in comparison with static 2D culture and 3D rotational suspension culture by two and six folds, respectively (p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-31T07:27:55Z
      DOI: 10.1177/0391398820985515
       
  • Measures of anticoagulation and coagulopathy in pediatric cardiac
           extracorporeal membrane oxygenation patients
    • Authors: Mouhammad Yabrodi, Carrie Ciccotello, Ajay K Bhatia, Joel Davis, Kevin O Maher, Shriprasad R Deshpande
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Introduction:Pediatric cardiac Extracorporeal Membrane Oxygenation (ECMO) is effective, however, bleeding and clotting issues continue to cause significant morbidity and mortality. The objective of this study was to assess the correlation between measures of anticoagulation, the heparin dose in pediatric cardiac ECMO patients as well as to assess covert coagulopathy as measured by thromboelastography (TEG).Methods:Retrospective study of cardiac ECMO patients in a large, academic referral center using anticoagulation data during the ECMO support.Results:Five hundred and eighty-four sets of anticoagulation tests and 343 TEG from 100 patients with median age of 26 days were reviewed. ECMO was post-surgical for congenital heart disease in 94% with resuscitation (ECPR) in 38% of the cases. Mean duration of support was 6.3 days. Overall survival to discharge was 35%. There was low but statistically significant correlation between individual anticoagulation measures and low correlation between Anti-Xa levels and heparin dose. There was no correlation between PTT and heparin dose. 343 TEG with Heparinase were reviewed to assess covert coagulopathy which was present in 25% of these. The coagulopathy noted was pro-hemorrhagic in almost all of the cases with high values of reaction time and kinetics and low values for angle and maximum amplitude.Conclusion:Coagulation monitoring on ECMO may benefit from addition of Heparinase TEG to diagnose covert coagulopathy which can contribute to significant hemorrhagic complications. There is a need for a prospective, thromboelastography guided intervention trial to reduce coagulopathy related morbidity and mortality in ECMO.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-29T12:53:23Z
      DOI: 10.1177/0391398820985525
       
  • Sleep quality and depression in adults with durable left-ventricular
           assist devices
    • Authors: Rita F D’Aoust, Inga Antonsdottir, Chakra Budhathoki, Jesus Casida
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Poor sleep quality and depression remain understudied in patients implanted with a left-ventricular assist device (LVAD). This study aimed at describing sleep quality and depression pre and 6 months post LVAD implantation, examining the change in sleep quality and depression over time, and exploring the relationships among sleep quality and depression. An observational research design was used in this study involving 23 patients with LVADs. Patients’ demographics, clinical characteristics, subjective and objective sleep data, and depression were collected pre and 6 months post-LVAD implantation hospitalization. Descriptive and inferential statistics were employed in data analysis. We found that poor sleep quality and depression were highly prevalent during pre and post LVAD. Comparing pre to post LVAD, there was a significant change in depression, sleep efficiency, and sleep quality. Differences between sleep quality and depression scores pre to post LVAD were negatively correlated, although there were positive correlations between depression sleep quality scores. These findings are fundamental to informing future research further to understand the sleep-depression phenomenon in the LVAD population. Research is needed to understand the mechanism of the phenomenon and identify
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-25T09:07:11Z
      DOI: 10.1177/0391398820982622
       
  • Dynamic motion analysis of impeller for the development of real-time flow
           rate estimations of a ventricular assist device
    • Authors: Shuya Shida, Toru Masuzawa, Masahiro Osa
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Implantable ventricular assist devices are used in heart failure therapy. These devices require real-time flow rate estimation for effective mechanical circulatory support. We previously developed a flow rate estimation method using the eccentric position of a magnetically levitated impeller to achieve real-time estimation. However, dynamic motion of the levitated impeller can compromise the method’s performance. Therefore, in this study, we investigated the effects of dynamic motion of the levitated impeller on the time resolution and estimation accuracy of the proposed method. The magnetically levitated impeller was axially suspended and radially restricted by the passive stability in a centrifugal blood pump that we developed. The dynamic motions of impeller rotation and whirling were analyzed at various operating conditions to evaluate the reliability of estimation. The vibration response curves of the impeller revealed that the resonant rotational speed was 1300–1400 revolutions per minute (rpm). The blood pump was used as a ventricular assist device with rotational speed (over 1800 rpm) sufficiently higher than the resonant speed. The rotor-dynamic forces on the impeller (0.03–0.14 N) suppressed the whirling motion of the impeller, indicating that the dynamic motion could be stable. Although the temporal responsiveness should be determined based on the trade-offs among the estimation accuracy and time resolution, the real-time estimation capability of the proposed method was confirmed.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-25T09:06:52Z
      DOI: 10.1177/0391398820984485
       
  • Polypropylene oxygenators: Risk of SARS-CoV-2 contamination in the
           operation theatre'
    • Authors: Caetano Nigro Neto, Eric Benedet Lineburger, Alexandre Slullitel
      Abstract: The International Journal of Artificial Organs, Ahead of Print.

      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-22T10:00:20Z
      DOI: 10.1177/0391398820981586
       
  • Postcardiotomy mechanical support in patients with mitral valve prostheses
           is associated with poor survival
    • Authors: Clarence Pingpoh, Alaa Salama, Nawras Diab, Maximillian Kreibich, Paul Puiu, Martin Czerny, Christoph Benk, Friedhelm Beyersdorf, Matthias Siepe
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Aims:To elaborate on early survival in patients with mitral valve replacement requiring temporary extracorporeal life support system (ECLS).Methods:We analyzed survival, significant bleeding, wound infection, and ECLS duration in 421 from 14,400 patients with postoperative need for ECLS from January 2008 to December 2017 at our institution. Finally, patients were stratified according to the type of surgery performed: the mitral group (mitral valve replacement) n = 63 and the control group (any cardiac surgery excluding the mitral valve) n = 358. In order to adjust for preoperative patient characteristics, a propensity matching analysis was performed. Differences in in-hospital mortality were analyzed accordingly.Results:In-hospital mortality was significantly higher in the mitral group as compared to the control group before and after adjustment (p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-19T07:28:22Z
      DOI: 10.1177/0391398820982621
       
  • A target-oriented algorithm for maintaining serum calcium stability
           automatically in regional citrate anticoagulation
    • Authors: Ruan-Mei Sheng, Wen-Biao Zhao, Li-Hong Huang, Jian-Qin Chen, Zhen-Juan Dai, Xue-Min Wang
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Background:Regional citrate anticoagulation (RCA) for renal replacement therapy is widely practiced in critically ill patients. However, concern exists regarding its labor-intensiveness for monitoring and the associated hypocalcemia. In this study, we provided an algorithm for prescribing RCA and evaluated its safety in patients.Methods:During 18 hemofiltration treatments with calcium-free replacement solution, participants were randomized to receive algorithm-based or trial-and-error RCA protocol. The effluent volume, post-filter and in vivo ionized calcium (iCa), and calcium in the sera and effluents were periodically measured at an interval of 1 to 2 h.Results:For patients received algorithm-based RCA protocol, no one had a serum iCa less than 0.9 mmol/L, and none needed calcium supplement adjustment to maintain serum calcium stability. For patients accepted trial-and-error protocol, all patients had a serum iCa below 0.9 mmol/L, their serum iCa and calcium levels fluctuated dramatically, and all patients need additional calcium supplement adjustment during RCA. None of the participants showed a post-filter iCa > 0.4 mmol/L.Conclusion:We provided a safe algorithm for calculating calcium supplementation doses that could maintain serum calcium stability without additional adjustment during RCA.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-19T07:27:52Z
      DOI: 10.1177/0391398820982620
       
  • Interdialytic weight gain of less than 2.5% seems to limit cardiac damage
           during hemodialysis
    • Authors: Junko Goto, Ulf Forsberg, Per Jonsson, Kenichi Matsuda, Bo Nilsson, Kristina Nilsson Ekdahl, Michael Y Henein, Bernd G Stegmayr
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Aims:To investigate if a single low-flux HD induces a rise in cardiac biomarkers and if a change in clinical approach may limit such mechanism.Material and methods:A total of 20 chronic HD patients each underwent three different study-dialyses. Dialyzers (low-flux polysulfone, 1.8 sqm) had been stored either dry or wet (Wet) and the blood level in the venous chamber kept low or high. Laboratory results were measured at baseline, 30 and 180 min, adjusted for the effect of fluid shift. Ultrasound measured microemboli signals (MES) within the return line.Results:Hemodialysis raised cardiac biomarkers (p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-19T07:27:34Z
      DOI: 10.1177/0391398820981385
       
  • Haemoadsorption by CytoSorb® in patients with acute liver failure: A
           case series
    • Authors: Dana Tomescu, Mihai Popescu, Corina David, Romina Sima, Simona Dima
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Acute liver failure (ALF) is a life-threatening disease associated with multi-organ failure and increased mortality. Severe inflammation is now considered the main pathophysiological mechanism for organ dysfunction, thus rebalancing pro- and anti- inflammatory cytokines may improve liver function and outcome. The aim of this study was to assess the clinical effects of a haemoadsorption column on biochemical parameters in patients with ALF. We prospectively included 28 patients with ALF who were treated with three consecutive sessions of continuous venovenous haemofiltration in combination with CytoSorb®. Our results show an improvement in liver functional tests and a decrease in Creactive protein. Thrombocytopenia remains one of the most important side effects of this treatment and careful consideration should be made before initiation of treatment.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-11T05:58:52Z
      DOI: 10.1177/0391398820981383
       
  • Effectiveness of distal arterial bypass with porcine decellularized
           vascular graft for treating diabetic lower limb ischemia
    • Authors: Zhu Tong, Zeqin Xu, Yisha Tong, Lixing Qi, Lianrui Guo, Jianming Guo, Yongquan Gu
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Background:Application of tissue engineered vascular grafts for small-diameter artery reconstruction has been a much anticipated advance in vascular surgery. The aim of this study is to assess the effectiveness of small-diameter decellularized vascular grafts in below-knee bypass surgery for diabetic lower extremity ischemia.Methods:Three patients with diabetic lower limb ischemia were admitted to the Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University between May, 2010 and June, 2010. Decellularized porcine arteries with modified surface were implanted in the lower extremity for below-knee arterial revascularization. Imaging examination was performed for assessment of graft mechanical stability and patency at 1 month and 6 months after implantation.Results:At 6 months after implantation, all three grafts were patent with no stenosis or aneurysm formation of the grafts were found on imaging assessment with primary patency rate of 100% (3/3) both at 1 month and 6 months after graft insertion.Conclusion:Decellularized vascular graft with surface modification for the small-diameter artery reconstruction had good clinical results after 6 months follow-up in three patients with diabetic lower limb ischemia.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-11T05:58:31Z
      DOI: 10.1177/0391398820980021
       
  • Real-time, non-invasive thrombus detection in an extracorporeal circuit
           using micro-optical thrombus sensors
    • Authors: Nobutomo Morita, Daisuke Sakota, Akiko Oota-Ishigaki, Ryo Kosaka, Osamu Maruyama, Masahiro Nishida, Kazuki Kondo, Toshihiro Takeshita, Wataru Iwasaki
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Introduction:Real-time, non-invasive monitoring of thrombus formation in extracorporeal circuits has yet to be achieved. To address the challenges of conventional optical thrombus detection methods requiring large devices that limit detection capacity, we developed a micro-optical thrombus sensor.Methods:The proposed micro-optical thrombus sensor can detect the intensity of light scattered by blood at wavelengths of 660 and 855 nm. Two thrombus sensors were installed on in vitro circuit: one at the rotary blood pump and one at a flow channel. To evaluate the variation in the ratio of incident light intensity at each wavelength of the two sensors, Rfluct (for 660 nm) and Ifluct (for 855 nm) were defined. Using fresh porcine blood as a working fluid, we performed in vitro tests of haematocrit (Hct) and oxygen saturation (SaO2) variation and thrombus detection. Thrombus tests were terminated after Rfluct or Ifluct showed a larger change than the maximum range of those in the Hct and SaO2 variation test.Results:In all three thrombus detection tests, Ifluct showed a larger change than the maximum range of those in the Hct and SaO2 variation test. After the tests, thrombus formation was confirmed in the pump, and there was no thrombus in the flow channel. The results indicate that Ifluct is an effective parameter for identifying the presence of a thrombus.Conclusion:Thrombus detection in an extracorporeal circuit using the developed micro-optical sensors was successfully demonstrated in an in vitro test.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-10T10:21:56Z
      DOI: 10.1177/0391398820978656
       
  • Renal replacement therapy in patients on extracorporeal membrane
           oxygenation support: Who and how
    • Authors: Berhane Worku, Sandi Khin, Mario Gaudino, Ivan Gambardella, Erin Iannacone, Haleh Ebrahimi, Sergey Savy, Lilia Voevidko, Charles Oribabor, Nicos Hadjiangelis, Brinda Desiraju, Iosif Gulkarov
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Patients undergoing extracorporeal membrane oxygenation (ECMO) support frequently develop renal failure requiring renal replacement therapy (RRT). RRT may be performed via a dialysis catheter based approach or via the ECMO circuit. We describe our experience with both techniques. A total of 68 patients undergoing ECMO support at our institution were retrospectively analyzed. Predictors of renal failure requiring RRT were determined. Patients undergoing RRT via a dialysis catheter were compared with those undergoing RRT via the ECMO circuit. 10 of the 68 patients required RRT support prior to ECMO. Of the remaining 58 patients, 25 (43%) required new RRT support on ECMO. Lower albumin levels and postcardiotomy shock were predictive of new renal failure requiring RRT on ECMO. RRT performed via the ECMO circuit demonstrated similar efficacy as via a dialysis catheter. Outcomes were much worse for patients requiring new RRT on ECMO support, with a doubling of the length of ECMO support and less that one-third the survival rate of patients not requiring RRT on ECMO support. New renal failure requiring RRT occurs in nearly one-half of patients on ECMO support, with poor outcomes. RRT may be performed via the ECMO circuit with similar efficacy as via a dialysis catheter.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-10T10:21:46Z
      DOI: 10.1177/0391398820980451
       
  • Design and numerical simulation for the development of an expandable
           paediatric heart valve
    • Authors: Monica M Kerr, Terence Gourlay
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Current paediatric valve replacement options cannot compensate for somatic growth, leading to an obstruction of flow as the child outgrows the prosthesis. This often necessitates an increase in revision surgeries, leading to legacy issues into adulthood. An expandable valve concept was modelled with an inverse relationship between annulus size and height, to retain the leaflet geometry without requiring additional intervention. Parametric design modelling was used to define certain valve parameter aspect ratios in relation to the base radius, Rb, including commissural radius, Rc, valve height, H and coaptation height, x. Fluid-structure simulations were subsequently carried out using the Immersed Boundary method to radially compress down the fully expanded aortic valve whilst subjecting it to diastolic and systolic loading cycles. Leaflet radial displacements were analysed to determine if valve performance is likely to be compromised following compression. Work is ongoing to optimise valvular parameter design for the paediatric patient cohort.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-10T10:21:26Z
      DOI: 10.1177/0391398820977509
       
  • Improved hand prostheses control for transradial amputees based on hybrid
           of voice recognition and electromyography
    • Authors: Omer Saad Alkhafaf, Mousa K Wali, Ali H Al-Timemy
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      The control of prostheses and their complexities is one of the greatest challenges limiting wide amputees’ use of upper limb prostheses. The main challenges include the difficulty of extracting signals for controlling the prostheses, limited number of degrees of freedom (DoF), and cost-prohibitive for complex controlling systems. In this study, a real-time hybrid control system, based on electromyography (EMG) and voice commands (VC) is designed to render the prosthesis more dexterous with the ability to accomplish amputee’s daily activities proficiently. The voice and EMG systems were combined in three proposed hybrid strategies, each strategy had different number of movements depending on the combination protocol between voice and EMG control systems. Furthermore, the designed control system might serve a large number of amputees with different amputation levels, and since it has a reasonable cost and be easy to use. The performance of the proposed control system, based on hybrid strategies, was tested by intact-limbed and amputee participants for controlling the HANDi hand. The results showed that the proposed hybrid control system was robust, feasible, with an accuracy of 94%, 98%, and 99% for Strategies 1, 2, and 3, respectively. It was possible to specify the grip force applied to the prosthetic hand within three gripping forces. The amputees participated in this study preferred combination Strategy 3 where the voice and EMG are working concurrently, with an accuracy of 99%.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-08T06:54:54Z
      DOI: 10.1177/0391398820976656
       
  • Left atrial assist device function at various heart rates using a mock
           circulation loop
    • Authors: Yuichiro Kado, Anthony R Polakowski, Barry D Kuban, David J Horvath, Takuma Miyamoto, Jamshid H Karimov, Randall C Starling, Kiyotaka Fukamachi
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      We are developing a new left atrial assist device (LAAD) for patients who have heart failure with preserved ejection fraction (HFpEF). This study aimed to assess the hemodynamic effects of the LAAD under both normal heart conditions and various diastolic heart failure (DHF) conditions using a mock circulatory loop. A continuous-flow pump that simulates LAAD, was placed between the left atrial (LA) reservoir and a pneumatic ventricle that simulated a native left ventricle on a pulsatile mock loop. Normal heart (NH) and mild, moderate, and severe DHF conditions were simulated by adjusting the diastolic drive pressures of the pneumatic ventricle. With the LAAD running at 3200 rpm, data were collected at 60, 80, and 120 bpm of the pneumatic ventricle. Cardiac output (CO), mean aortic pressure (AoP), and mean LA pressure (LAP) were compared to evaluate the LAAD performance. With LAAD support, the CO and AoP rose to a sufficient level at all heart rates and DHF conditions (CO; 3.4–3.8 L/min, AoP; 90–105 mm Hg). Each difference in the CO and the AoP among various heart rates was minuscule compared with non-pump support. The LAP decreased from 21–23 to 17–19 mm Hg in all DHF conditions (difference not significant). Furthermore, hemodynamic parameters improved for all DHF conditions, independent of heart rate. The LAAD can provide adequate flow to maintain the circulation status at various heart rates in an in vitro mock circulatory loop.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-01T06:27:15Z
      DOI: 10.1177/0391398820977508
       
  • Venovenous ECMO treatment, outcomes, and complications in adults according
           to large case series: A systematic review
    • Authors: Jun Hyun Kim, Marina Pieri, Giovanni Landoni, Anna Mara Scandroglio, Maria Grazia Calabrò, Evgeny Fominskiy, Rosalba Lembo, Min Hee Heo, Alberto Zangrillo
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Background:Venovenous extracorporeal membrane oxygenation (VV ECMO) has gained popularity for the treatment of refractory respiratory failure during and after the 2009 influenza pandemic, and still represents a precious therapeutic resource for severe novel coronavirus 2019 infection. However, most of the published studies are small case series, and only two randomized trials exist in literature.Aim:Aim of this systematic review is to describe trends in VV ECMO treatment outcomes according to large studies only.Methods:We searched and included studies with more than 100 VV ECMO cases dated up to August 1st, 2019.Results:Thirty-three studies published in the period 2011–2019 met inclusion criteria, for a total of 12,860 patients (age 46.3 ± 17.4 years). ARDS was mainly by pneumonia, in 3126 (37%) cases; further 401(7%) patients had H1N1 Influenza A infection. Cannulation-related complications occurred in 502 (7%) cases. Weighted mean (95% confidence interval) of VV ECMO duration was 8.9 (8.7–9.1) days, and ICU stay was 23.6 (22.4–24.8) days. Mortality at the longest follow up available was 40%. Data collection in 70% of the studies had a duration of >5 years.Conclusion:This study reveals the characteristics of large case VV ECMO studies.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-01T05:48:38Z
      DOI: 10.1177/0391398820975408
       
  • Molecular adsorbent recirculating system (MARS) and continuous veno-venous
           hemodiafiltration (CVVHDF) for diltiazem removal: An in vitro study
    • Authors: Nicolas Fabresse, Islam Amine Larabi, Elodie Lamy, Bruno Mégarbane, Jean-Claude Alvarez
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      The objective of the present study was to evaluate the efficacy of the molecular adsorbent recirculating system (MARS) vs continuous veno-venous hemodiafiltration (CVVHDF). Diltiazem poisoning was simulated in a central compartment consisting in a 5L dialysis solute spiked with diltiazem at two different toxic concentrations: 750 and 5000 µg/L. For CVVHDF, mean extraction coefficients (EC = (in concentration − out concentration)/in concentration) were concentration-dependent with a decrease all along the dialysis. At the end of the sessions the mean amounts remaining in the central compartment were 8% and 7% of the initial dose at 750 and 5000 µg/L, respectively. The mean cumulative amounts found in the effluent were 60% and 75% of the initial dose, respectively. The missing amounts accounted for 32% and 18% of the initial dose, respectively, corresponding to an adsorption to the dialysis membrane. In contrast, the different compartments of the MARS resulted in undetectable output concentration earlier that the end of the session. The mean concentrations of diltiazem remaining in the central compartment were
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-01T04:10:00Z
      DOI: 10.1177/0391398820975041
       
  • A two-phase flow approach for modeling blood stasis and estimating the
           thrombosis potential of a ventricular assist device
    • Authors: Wei-Feng Dai, Peng Wu, Guang-Mao Liu
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Thrombosis and its related events have become a major concern during the development and optimization of ventricular assist devices (VADs, also called blood pumps), and limit their clinical use and economic benefits. Attempts have been made to model the thrombosis formation, considering hemodynamic and biochemical processes. However, the complexities and computational expenses are prohibitive. Blood stasis is one of the key factors which may lead to the formation of thrombosis and excessive thromboembolic risks for patients. This study proposed a novel approach for modeling blood stasis, based on a two-phase flow principle. The locations of blood residual can be tracked over time, so that regions of blood stasis can be identified. The blood stasis in an axial blood pump is simulated under various working conditions, the results agree well with the experimental results. In contrast, conventional hemodynamic metrics such as velocity, time-averaged wall shear stress (TAWSS), and relative residence time (RRT), were contradictory in judging risk of blood stasis and thrombosis, and inconsistent with experimental results. We also found that the pump operating at the designed rotational speed is less prone to blood stasis. The model provides an efficient and fast alternative for evaluating blood stasis and thrombosis potential in blood pumps, and will be a valuable addition to the tools to support the design and improvement of VADs.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-12-01T04:10:00Z
      DOI: 10.1177/0391398820975405
       
  • Decellularization of porcine carotid arteries using low-concentration
           sodium dodecyl sulfate
    • Authors: Jin Cheng, Ji Li, Zhiwen Cai, Yuehao Xing, Cong Wang, Lianrui Guo, Yongquan Gu
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Background:The decellularized scaffold is a promising material for producing tissue-engineered vascular grafts (TEVGs) because of its complex, native-like three-dimensional structure and mechanical properties. Sodium dodecyl sulfate (SDS), one of the most commonly used decellularization reagents, appears to be more effective than other detergents for removing cells from dense tissues. The concentrations of SDS used in previous studies and their effects on decellularization are not consistent.Methods:In this study, porcine carotid arteries were decellularized using detergent-based protocols using Triton X-100 followed by SDS at different concentrations and exposing time. Cell removal efficiency and composition were evaluated by histological analysis, and DNA and collagen quantification. Ultrastructure, mechanical properties, pore size distribution, and in vivo biocompatibility of decellularized arteries were also evaluated.Results:The DNA content of decellularized scaffolds treated with 0.3% SDS for 72 h or 0.5% SDS for 48 h was significantly less than that treated with 1% SDS for 30 h. There was a significant loss of soluble collagen after treatment with 1% SDS relative to native arteries. The extensive loss of elastin and glycosaminoglycans was observed in decellularized arteries treated with 0.5% SDS or 1% SDS. The basement membrane and biomechanics were also damaged by these two protocols. Moreover, decellularized scaffolds became more porous with many large pores after treatment with 0.3% SDS.Conclusion:Low-concentration SDS could be a suitable choice for artery decellularization. Decellularized porcine carotid arteries, prepared using Triton X-100 followed by 0.3% SDS, may be a promising biological scaffold for TEVGs.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-11-23T08:01:40Z
      DOI: 10.1177/0391398820975420
       
  • An easy disinfection strategy for pipes connecting hemodialysis equipment
    • Authors: Masashi Tagaya, Yosuke Oda, Aki Kimura, Ryuji Irifune, Shinya Okano, Takuo Murataka, Hiroki Handa, Shunsuke Takahashi
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Introduction:A hemodialysis room has pipes connecting the console and central fluid equipment. While these pipes require disinfection, reports detailing disinfection strategies are unavailable. Therefore, we aimed to compare two easy disinfection strategies differing in sanitization frequency and sanitizer concentration.Methods:Reverse osmosis water (ROW) purifying equipment and six dialysis consoles were connected by 20 m of pipes. Only ROW flowed through these pipes, because the dialysate solution was constituted at each console. The pipes were sanitized by two strategies: (1) strong and monthly (hypochlorite concentration: 100 ppm) or (2) weak and weekly (5 ppm). Both strategies were easy because the sodium hypochlorite was simply added to the ROW tank. To estimate sanitization efficacy, endotoxin counts at the ROW tank outlet, the end of the pipe, and the pipe after the endotoxin-cutting filter in each console were measured monthly for six continuous months. These counts were compared between the two sanitization strategies.Results:The endotoxin counts at the ROW tank outlet and the end of the pipe were 0.004–0.017 and 0.012–0.081 EU/mL, respectively, in the strong and monthly strategy, and 0.001–0.003 and 0.001–0.005 EU/mL, respectively, in the weak and weekly strategy. The endotoxin counts at the pipe after the endotoxin-cutting filter were less than 0.001 EU/mL during the study period in both strategies.Conclusion:A weekly disinfection strategy was more effective than a monthly one, despite the lower hypochlorite concentration. The present study suggests that frequency is the most important factor in the disinfection of pipes in a dialysis room.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-11-21T09:48:30Z
      DOI: 10.1177/0391398820975034
       
  • Elimination of fluconazole during continuous renal replacement therapy. An
           in vitro assessment
    • Authors: Frédéric J Baud, Vincent Jullien, Tarik Abarou, Benoît Pilmis, Jean-Herlé Raphalen, Pascal Houzé, Pierre Carli, Lionel Lamhaut
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Introduction:Continuous renal replacement therapy (CRRT) efficiently eliminates fluconazole. However, the routes of elimination were not clarified. Adsorption of fluconazole by filters is a pending question. We studied the elimination of fluconazole in a model mimicking a session of CRRT in humans using the NeckEpur® model. Two filters were studied.Methods:The AV1000®-polysulfone filter with the Multifiltrate Pro. Fresenius and the ST150®-polyacrylonitrile filter with the Prismaflex. Baxter-Gambro were studied. Continuous filtration used a flowrate of 2.5 L/h in post-dilution only. Session were made in duplicate. Routes of elimination were assessed using the NeckEpur® model.Results:The mean measured initial fluconazole concentration (mean ± SD) for the four sessions in the central compartment (CC) was 14.9 ± 0.2 mg/L. The amount eliminated from the CC at the end of 6 h-session at a 2.5 L/h filtration flowrate for the AV1000®-polysulfone and the ST150®-polyacrylonitrile filters were 90%–93% and 96%–94%, respectively; the clearances from the central compartment (CC) were 2.5–2.6 and 2.4–2.3 L/h, respectively. The means of the instantaneous sieving coefficient were 0.94%–0.91% and 0.99%–0.91%, respectively. The percentages of the amount eliminated from the CC by filtration/adsorption were 100/0%–95/5% and 100/0%–100/0%, respectively.Conclusion:Neither the ST150®-polyacrylonitrile nor the AV1000®-polysulfone filters result in any significant adsorption of fluconazole.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-11-21T09:48:29Z
      DOI: 10.1177/0391398820976144
       
  • Evaluation of a hospital-wide vancomycin-dosing nomogram in patients with
           continuous-flow left ventricular assist devices
    • Authors: Sylvie F Hall, Vasilios Athans, Matthew R Wanek, Lu Wang, Jerry D Estep, Brad Williams
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Introduction:Hemodynamic derangements due to heart failure are associated with alterations in pharmacokinetics. Although use of mechanical circulatory support mitigates such derangements, little evidence is available regarding pharmacokinetics in patients with LVADs. A previous pharmacokinetic analysis of vancomycin among patients with LVADs observed a reduced volume of distribution and clearance compared with estimates based on population kinetics.Methods:A total of 28 adult patients with LVADs hospitalized between January 2014 and May 2018 who received vancomycin through a pharmacist dosing consult were included. Internal medicine patients without heart failure receiving vancomycin were enrolled in a 2:1 fashion to make a control group. Exclusion criteria were unstable renal function, ESRD, acute decompensation, cardiac surgery within the preceding 5 days, or weight >110 kg.Results:No difference was observed in the proportion achieving goal trough (64% of LVAD patients vs 71% control patients, p = 0.50). However, mean trough was significantly higher among LVAD patients (23.4 mg/L vs 17.7 mg/L, p = 0.017). Furthermore, there was a significant difference in the distribution of trough levels (p = 0.025) with LVAD patients being more likely to attain levels >25 mg/L (32% vs 14%) and less likely to have troughs
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-11-21T09:48:28Z
      DOI: 10.1177/0391398820975037
       
  • Finding a proper “Mate”: Comparison of left ventricular assist devices
           using cerebral oximetry
    • Authors: Morgan L Montgomery, Blaine Stannard, Siarhei Dzedzik, Hung-Mo Lin, Anelechi Anyanwu, Matthew A Levin, Muoi Trinh
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Introduction:Axial-flow and centrifugal-flow left ventricular assist devices (LVAD) have been utilized in the management of heart failure, but it remains unknown whether these devices differ in end-organ perfusion. Our goal was to evaluate the association between device type and regional cerebral oxygen saturation (rSO2), and determine if this confers any benefit in short-term postoperative outcomes.Methods:Adult patients who underwent primary LVAD implantation at our institution from 2014 to 2019 were retrospectively analyzed. Patients were stratified into axial-flow and centrifugal-flow groups. Intraoperative rSO2 readings were used to calculate the change in mean rSO2 from pre- to post-bypass. Multivariable modeling was performed to compare delta rSO2 between groups, and to analyze the association between LVAD type and postoperative outcomes.Results:There were 152 patients included, of which 76 had an axial-flow device and 76 had a centrifugal-flow device implanted. The rSO2 level increased from pre-bypass to post-bypass on average 3.5% (CI: 2.1 to 5.0) for the axial group compared to 0.1% (CI: −1.2 to 1.4) for the centrifugal group, which was a significant difference (β = −2.22, CI: −4.21 to −0.32, p = 0.022). Axial devices approached significance for lower odds of postoperative complications (OR: 0.35, CI: 0.11 to 1.06, p = 0.063), and were associated with significantly shorter ICU LOS (β = −0.36, CI: −0.60 to −0.11, p = 0.004).Conclusion:Axial devices resulted in a greater increase in rSO2 than centrifugal pumps after separation from CPB. Further investigation is warranted to evaluate the effect of LVAD selection on long-term end-organ perfusion and subsequent patient outcomes.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-11-20T08:56:54Z
      DOI: 10.1177/0391398820973679
       
  • Circulatory support for prolonged electro-mechanical standstill in
           fulminant pediatric myocarditis
    • Authors: Shriprasad R Deshpande, Renee C Willett, Karthik Ramakrishnan, Syed Murfad Peer, Pranava Sinha
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Pediatric patients with fulminant myocarditis can rarely present with complete heart block with severe hemodynamic compromise, cardiac arrest and require circulatory support. Additionally, patients with cardiac dysfunction that require extracorporeal membrane oxygenation (ECMO) support sometimes develop cardiac stun or standstill. These factors are associated with extremely poor survival. We present a case of fulminant myocarditis presenting with dense heart block, no ventricular electrical activity resuscitated with ECMO that developed prolonged cardiac standstill. We present the clinical course, management including ECMO followed by biventricular assist devices, pacing and review supporting literature. We hope that the case will highlight challenges in management and decision making in such patients.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-11-13T09:42:22Z
      DOI: 10.1177/0391398820972708
       
  • Comparison of intra-wound drainage tubes after cardiac surgery: Blake
           drains versus Multichannel drains
    • Authors: Yuichiro Hirata, Eiki Tayama, Tomohiro Ueda, Hikaru Uchiyama, Tatsushi Onzuka, Kojiro Furukawa, Shigeki Morita
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Background:Blake and Multichannel drains have been used in our department. Although both are made up of silicone, they differ in structure. We investigated the drainage effects of these two types of drains and the factors related to their occlusion.Methods:We enrolled 100 consecutive cases (50 using Blake drains and 50 using Multichannel drains) of cardiovascular surgery performed in our department from July 2017 to April 2018. The formation of thrombi in the groove and tube of the drains was evaluated in each case. The tube portion was checked for the presence of occlusion, and the groove portion was examined for the number and ratio of thrombi formed in the grooves.Results:The clot formation rate in the groove part was slightly higher in the Multichannel cases than in the Blake cases. In addition, analysis within the Multichannel cases revealed that the thrombus formation rate between the catheter lumen and the three grooves (without the catheter lumen) was significantly different, with the highest groove clot formation rate occurring in the catheter lumen. Out of 34 cases of occlusions, there were 26 cases (52%) of Multichannel drains, and only 8 cases (16%) of Blake drains (p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-11-13T09:41:23Z
      DOI: 10.1177/0391398820972413
       
  • Nanocontainers for drug delivery systems: A review of Halloysite nanotubes
           and their properties
    • Authors: Melika Hasani, Majid Abdouss, Shahrokh Shojaei
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Halloysite nanotubes (HNTs) are known as inexpensive and available nanomaterials that are rich in functionality, environmentally benign, and also safe and easy to process. As well, good particle size (i.e. nanoscale) and perfect tubular microstructures of these materials make them to be used extensively as drug carriers. Also, the unique physical and chemical properties of their internal and external surfaces are the greatest priority for the drug encapsulation controlling and releasing. In this review, is tried to emphasis on the main properties of HNTs to manage and develop effective drug delivery tools in the biomedical and pharmaceutical fields.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-11-11T05:12:48Z
      DOI: 10.1177/0391398820968836
       
  • The effects of age at cochlear implantation on balance in children: A
           pilot study
    • Authors: Banu Mujdeci, Sevginar Önder, Serpil Alluşoğlu, Süleyman Boynuegri, Oguzhan Kum, Dogan Atan
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Aim:The evaluation of the effects of age at cochlear implantation on balance in children.Research design:Cross-sectional study.Study sample:Twenty children who received their cochlear implants (CI) before the chronologic age of 48 months (Early CI Group), and 20 children who received their CI at 48 months chronologic age or later (Late CI Group).Intervention:All children underwent Tandem Romberg (TR) test, Single-Leg stance (SLS) test, Pediatric Clinical Test of Sensory Interaction for Balance (P-CTSIB), Pediatric Balance scale (PBS) and Timed Up and Go (TUG) test.Data collection and analysis:The scores of TR, SLS and P-CTSIB and TUG tests and PBS were recorded. Mann Whitney U test and Independent-samples t-test were used to compare data between groups.Results:TR (eyes opened-EO), SLS (EO), PBS, and TUG scores and incidence in dizziness symptoms did not show significant differences between the groups (p > 0.05). Duration of TR and SLS tests (eyes closed-EC), P-CTSIB-positions 5, and 6 were significantly longer in the Early CI Group than the Late implanted group(p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-11-04T07:46:42Z
      DOI: 10.1177/0391398820967367
       
  • Desialylation of platelet surface glycans enhances platelet adhesion to
           adsorbent polymers for lipoprotein apheresis
    • Authors: Lucia Lauková, René Weiss, Vladislav Semak, Viktoria Weber
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Background:Lipoprotein apheresis is an important therapeutic option in homozygous familial hypercholesterolemia, progressive atherosclerosis, or when depletion of lipoprotein(a) is indicated. It is generally regarded as safe, but drops in platelet counts as well as sporadic episodes of thrombocytopenia have been reported. We assessed the influence of platelet desialylation, which may be induced by endogenous or pathogen-derived neuraminidases, on platelet adhesion to polyacrylate-based adsorbents for whole blood lipoprotein apheresis.Methods:Medical grade platelet concentrates were incubated with neuraminidase in vitro and were circulated over adsorbent columns downscaled from clinical application.Results:Cleavage of terminal sialic residues resulted in platelet activation with significantly elevated expression of platelet factor 4 (PF4) and in enhanced platelet adhesion to the adsorbent, accompanied by a pronounced drop in platelet counts in the column flow-through.Conclusion:Alterations in endogenous neuraminidase activity or exogenous (pathogen-derived) neuraminidase may trigger enhanced platelet adhesion in whole blood lipoprotein apheresis.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-11-04T07:45:43Z
      DOI: 10.1177/0391398820968849
       
  • Linoleic acid-modified liposomes for the removal of protein-bound toxins:
           An in vitro study
    • Authors: Yue Shen, Yuqi Shen, Xiao Bi, Jiaolun Li, Yingjie Chen, Qiuyu Zhu, Yifeng Wang, Feng Ding
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Introduction:Protein-bound uremic toxins (PBUTs) and liver failure-related cholestatic solutes are associated with adverse outcomes in patients with chronic kidney disease (CKD) and liver failure, respectively, and are not easily removed by traditional dialysis therapies. We constructed linoleic acid-modified liposomes (LA-liposomes) as indirect adsorbent in the dialysate, and evaluated their effects on the clearance of the representative PBUTs and cholestatic solutes.Methods:The LA-liposomes were prepared by the thin-film hydration method. The binding rates of liposomes and protein-bound solutes were detected by the ultrafiltration column. The in vitro dialysis experiments were performed using both non-current and current devices to assay the clearing efficiency of the dialysate supported by LA-liposomes.Results:The LA-liposomes exhibited good binding properties to the PBUTs, bilirubin and bile acids. The LA-liposome dialysate showed higher solute reduction rates of the representative PBUTs and cholestatic solutes than the traditional dialysate or dialysate supported by the unmodified plain liposomes. Also, albumin binding of the PBUTs was significantly inhibited by the addition of linoleic acid (LA), and the removal efficiency of PBUTs was greatly enhanced by the combination of indirect adsorbent LA-liposomes and LA as the competitive displacer.Conclusion:LA-liposomes were efficient in the clearance of the representative PBUTs and liver failure-related solutes. Moreover, the combination of indirect adsorbent LA-liposomes and competitive displacer suggested a potential application for the extremely highly-bound solutes.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-11-02T11:44:59Z
      DOI: 10.1177/0391398820968837
       
  • More continuous flow, better learning' The effect of aortic valve
           opening in patients with left ventricular assist device
    • Authors: Mehmet Karahan, Sinan Sabit Kocabeyoglu, Umit Kervan, Dogan Emre Sert, Emel Erdogan Bakar, Emre Aygun, Muharrem Tola, Burcu Demirkan, Semra Mungan, Zeki Catav, Mustafa Pac
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Purpose:The aim of this study was to analyze neurocognitive function in patients who underwent continuous flow left ventricular assist device (LVAD) implantation.Material and Method:This cross-sectional study included three groups: LVAD (n = 31), heart failure patients (n = 26), and healthy volunteers (n = 27). The Rey Auditory-Verbal Learning Test (RAVLT), Judgement of Line Orientation Test (JLOT), Trail Making Test (TMT), Stroop Color-Word Interference Test (SCWIT), Verbal Fluency Test (VFT), Symbol-Digit Modality Test (SDMT) were used to assess the neurocognitive functions. Data were analyzed at a median 12 (3–47) months after LVAD implantation. The LVAD patients were also divided by aortic valve opening (AVO) into three subgroups as “closed” (n = 9), “1–6” (n = 8) and “7–10” (n = 14) opening per ten beats and data were re-analyzed accordingly.Results:There was no significant difference among the groups according to SCWIT, JLOT, SDMT, TMT, and VFT scores. Post-hoc analyzes of RAVLT scores showed significant differences between the LVAD and the other two groups in favor of the LVAD group. Also, the patients with AVO “7–10” the response times were longer and learning scores were found to be lower than those without AVO.Conclusion:With continuous-flow LVAD, neurocognitive functions were not impaired. The learning performance was better in cases where there was no AVO and flow was completely device dependent. We may speculate that neurocognitive functions are not worsening with continuous cerebral blood flow and even it may improve learning performance.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-10-23T07:55:17Z
      DOI: 10.1177/0391398820963284
       
  • Bleeding, thrombosis and transfusion in patients on ECMO: A retrospective
           study in a tertiary center in Hong Kong
    • Authors: Ka Man Fong, Shek Yin Au, George Wing Yiu Ng, Anne Kit Hung Leung
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Purpose:Use of anticoagulation in patients on ECMO, especially in Chinese, has always been difficult. This study aimed to review the incidence of bleeding, thrombosis, and transfusion requirement in Chinese ECMO patients and to identify risk factors for bleeding complications.Materials and Methods:This was a retrospective observational study of a tertiary hospital from 2010 to 2018. Patients aged ⩾18 years who received ECMO were included. The primary outcome was incidence of bleeding. Secondary outcomes included ICU mortality, hospital mortality, and length of the ICU and hospital stay.Results:Of the 130 patients, 55(42.3%) had at least one bleeding events and thrombosis occurred in 37(28.5%). A lower fibrinogen level (adjusted OR 0.56 (0.36–0.86), p = 0.009), bloodstream infection (adjusted OR 2.76 (1.01–7.53), p = 0.047) and longer duration on ECMO (adjusted OR 1.14 (1.02–1.27), p = 0.018) were independently associated with occurrence of bleeding. APTT (adjusted OR 0.99 (0.97–1.01), p = 0.370) and platelet count (adjusted OR 1.00 (0.98–1.01), p = 0.632) were not statistically significant risk factors for bleeding events.Conclusions:Bleeding and thrombosis were common complications in Chinese patients receiving ECMO. Hypofibrinogenemia and bloodstream infection, but not APTT nor platelet counts, were independent risk factors for bleeding events.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-10-17T11:41:13Z
      DOI: 10.1177/0391398820965584
       
  • ECCO2R with cytokine filtering in COVID-19 patients: Who wants to go down
           this road'
    • Authors: Ignazio Condello, Pasquale Mastroroberto, Giuseppe Santarpino
      Abstract: The International Journal of Artificial Organs, Ahead of Print.

      Citation: The International Journal of Artificial Organs
      PubDate: 2020-10-16T09:05:35Z
      DOI: 10.1177/0391398820965582
       
  • Vascular calcification by conventional X-ray and mortality in a cohort of
           predominantly African descent hemodialysis patients
    • Authors: Maria Tereza S Martins, Cácia M Matos, Marcelo B Lopes, Angiolina C Kraychete, Gildete B Lopes, Márcia Tereza S Martins, João Luiz Fernandes, Maurício K Amoedo, Carolina L Neves, Antonio A Lopes
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Background/objective:There is a lack of studies describing the prevalence of vascular calcification (VC) and its association with mortality in maintenance hemodialysis (MHD) patients of African descent. We investigated if a VC score based on the number of calcified vascular beds was associated with mortality in MHD patients.Methods:We analyzed data from 211 MHD patients enrolled from January 2010 to January 2011 in the prospective cohort study, “The Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO),” developed in Salvador, BA, Brazil. VC was evaluated using radiographs of the hands, abdomen, hip, and chest; the score was calculated by the number of calcified sites as 0 (absence of calcification), 1 (one calcified site), 2 (two sites), 3 (⩾3 sites). We used Cox’s regression to estimate the hazard ratio (HR) and 95% confidence interval (CI) of associations between VC and mortality with adjustments for age and comorbidities.Results:VC was detected in 114 (54.0%) patients; 37 (17.5%) with a VC score = 1; 21 (10%) with VC score = 2 and 56 (26.5%) with VC score = 3. Compared with VC score = 0, the adjusted hazard of death was 2.67 (95% CI: 1.12, 6.33) for patients with VC score = 1; HR = 2.89 (95% CI: 0.95, 7.63) for VC score = 2; and HR = 3.27 (95% CI: 1.47, 7.28) for VC score = 3.Conclusion:The present study in an African descent MHD population provides support for the VC score based on conventional radiography as a prediction tool for the clinical practice. As shown, the VC score was monotonically and independently associated with mortality.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-10-16T09:04:35Z
      DOI: 10.1177/0391398820962805
       
  • Anticoagulation with temporary Impella device in patients with
           heparin-induced thrombocytopenia: A case series
    • Authors: Benjamin Hohlfelder, Michael A Militello, Michael Z Tong, Edward G Soltesz, Matthew R Wanek
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      The Impella device is a percutaneous ventricular assist devices that requires administration of heparin via a continuous purge solution. Patients on Impella device support may experience hemolysis with accompanying thrombocytopenia generating suspicion for heparin-induced thrombocytopenia (HIT). However, data and recommendations for use of non-heparin anticoagulants with Impella device are lacking. Therefore, we performed a retrospective cohort analysis of patients requiring bivalirudin during Impella device support to describe the safety and efficacy of bivalirudin as an alternative anticoagulant during Impella device support. Nine patients were included in the evaluation which analyzed Impella device purge flow and purge pressure along with bivalirudin dosing requirements, incidence of thrombosis, and incidence of pump failure. All patients had a positive platelet factor-4 IgG ELISA test, and the serotonin release assay was positive in four patients. After initiation of bivalirudin, the median (15th, 85th percentile) nadir purge flow decreased by 76% (5%, 88%) and the median (15th, 85th percentile) peak purge pressure increased by 86% (21%, 143%). At the time of bivalirudin discontinuation, the median final purge flow and pressure were 2.4 mL/h (74% decrease) and 969 mmHg (89% increase), respectively. Zero patients experienced catastrophic pump failure. Adding low concentration bivalirudin to the purge solution along with systemic bivalirudin may be a reasonable approach.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-10-14T07:17:14Z
      DOI: 10.1177/0391398820964810
       
  • Selection of suitable pedicle screw for degenerated cortical and
           cancellous bone of human lumbar spine: A finite element study
    • Authors: Pushpdant Jain, Mohammed Rajik Khan
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Pedicular arthrodesis is the traditional procedure in terms of increase in the biomechanical stability with higher fixation rate. The current work aims to identify the effect of three spinal pedicle screws considering cortical and cancellous degeneracy condition. Lumbar section L2-L3 is utilized and various load and moment conditions were applied to depict the various biomechanical parameters for selection of suitable screw. Three dimensional model is considered in finite element analysis to identify the various responses of pedicle screw at bone screw juncture. Computed tomography (CT) images of a healthy male were considered to generate the finite element vertebral model. Generated intact model was further utilized to develop the other implanted models of degenerated cortical and cancellous bone models. The three fused instrumented models with different cortical and cancellous degeneracy conditions were analyzed in finite element analysis. The results were obtained as stress pattern at bone screw boundary and intervertebral disc stress. FE simulated results represents significant changes in the von Mises stress due to various load and moment conditions on degenerated bones during different body movement conditions. Results have shown that among all pedicle screws, the 6.0 mm diameter screw reflects very less stress values at the juncture. Multiple results on biomechanical aspects obtained during the FE study can be considered to design a new stabilization device and may be helpful to plan surgery of critical sections.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-10-13T07:30:00Z
      DOI: 10.1177/0391398820964483
       
  • Comparison of changes in albumin binding capacity during hemodiafiltration
           or hemodialysis with middle cut off membranes
    • Authors: Sebastian Koball, Christina Westphal, Silvius Frimmel, Michael Hinz, Sebastian Klammt, Steffen Mitzner
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Background:Albumin is important for the transport of protein-bound substances (PBS). Albumin binding capacity (ABiC) is reduced in dialysis patients. This can contribute to worsening of uremic symptoms. It is presumed that open-porous middle cut off filters that is, HDx (Baxter-Theranova) remove high molecular substances more efficiently than conventional treatment. To evaluate HDx for the improvement of ABiC and removal of PBS, HDx was compared to hemodiafiltration (Fresenius-FX80, HDF).Methods:We included 32 chronic patients on HDF. After inclusion patients were treated with HDx for 14 days. Blood samples were drawn before/after treatments at study entry, first HDx and sixth HDx, to determine ABiC and other study parameters.Results:ABiC improved in HDx (68.4% vs 72.4%) and HDF (69.9% vs 72.4%) without differences between both therapies. No reduction of albumin concentration during HDx treatment was observed.Conclusion:HDx is accepted as a safe and equally efficient therapy for removing albumin bound uremic toxins compared to HDF with high flux dialyzers.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-10-09T06:24:24Z
      DOI: 10.1177/0391398820961780
       
  • Utility of gas inlet pressure monitoring in extracorporeal membrane
           oxygenation
    • Authors: Yuki Nakamura, Takafumi Nakakita, Kazuhiko Yamamoto, Aki Kamada, Shinichi Iguchi, Koichi Umimoto
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Purpose:Purpose: Condensation that clogs the hollow fibers of the oxygenation and accumulation of plasma leaks reduces oxygenated lung capacity. In this study, artificial We evaluated whether monitoring changes in lung gas inlet pressure was a way to predict these complications.Methods:Changes in gas inlet pressure and oxygenation capacity of three different prostheses (BIOCUBE6000, EXCELUNG PRIME, and Capiox-LX) Evaluated the relationship. When simulating plasma leakage using BIOCUBE6000, sodium dodecyl sulfate (SDS) (1%, 0.1%, A solution of 0.01%, and RO water) reduced surface tension. During 120 minutes of circulation, changes in gas inlet pressure and leakage from the membrane into the gas flow path The amount of fluid was measured.Results:There was a significant negative correlation between the gas inlet pressure changes and the oxygenation capacity of all three oxygenators (BIOCUBE6000: R2 = 0.957, EXCELUNG PRIME: R2 = 0.946, Capiox-LX: R2 = 0.878). After 120 min of SDS solution circulation using the BIOCUBE6000, both the gas inlet pressure and the volume of fluid leaking from the membrane into the gas flow path increased in proportion to the SDS solution concentration: RO water (0.56 ± 0.11 mmHg and 16.67 mL ± 0.94 mL), 0.01% SDS (0.98 ± 0.11 mmHg and 23.3 ± 0.47 mL,) 0.1% SDS (1.64 ± 0.21 mmHg and 29.0 ± 1.63 mL), and 1%SDS (14.3 ± 0.27 mmHg and 36.7 ± 0.47 mL) (n = 3).Conclusion:This study confirmed that monitoring the gas inlet pressure changes of an oxygenator during ECMO is clinically useful.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-10-09T06:15:52Z
      DOI: 10.1177/0391398820962122
       
  • Multidisciplinary shock team is associated with improved outcomes in
           patients undergoing ECPR
    • Authors: Katarzyna Hryniewicz, Michael Hart, David Raile, Yale Wang, Michael Mooney, Karol Mudy, Peter M Eckman, Michael A Samara, Jay Traverse, Benjamin Sun, David M Williams, Kelly J Wilson, Matthew Pavlovec, Miranda Kunz, Danielle Lyon, Ivan Chavez
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Objectives:Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has been increasingly used in cardiopulmonary resuscitation (ECPR) in select patients. Few centers have published their experience or outcomes with ECPR. The aim of our study was to evaluate outcomes of adult patients in cardiac arrest placed on VA ECMO in the catheterization laboratory.Methods:We performed a retrospective analysis of adult patients in refractory cardiac arrest who underwent ECPR at the Minneapolis Heart Institute (MHI) at Abbott Northwestern Hospital from January 2012 to December 2017. Relevant data were obtained from electronic medical records, including arrest to ECMO flow time, total ECMO support time, and outcomes.Results:Twenty-six adult patients underwent ECPR at the study site during the defined time period. Seven patients (27%) sustained cardiac arrest out of hospital, 19 patients arrested in-hospital with eight of those occurring in the catheterization laboratory. Seventeen (65%) patients had initial rhythm of ventricular fibrillation or tachycardia (VF/VT). All patients underwent mechanical CPR with LUCAS device. Overall 30 day and 6 month survival was 69%. Median time from arrest to ECMO flow was 46 mins (21,68) vs 61 mins (36,71) in survivors and non-survivors, respectively. Sixteen of 18 survivors discharged with a CPC score of 1 or 2.Conclusions:We demonstrate that adult patients in cardiac arrest initiated on VA ECMO in the cardiac catheterization laboratory and cared for by a multidisciplinary shock team in the critical care unit have superior long-term survival and functionally favorable neurologic recovery when compared to current literature.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-10-08T07:34:29Z
      DOI: 10.1177/0391398820962807
       
  • Impacts of age, diabetes, gender, and access type on costs associated with
           vascular access among Chinese patients on hemodialysis
    • Authors: Yuqin Xiong, Yang Yu, Yuan Yang, Liya Wang, Ping Shi, Yuchen Deng, Yi Li, Ping Fu
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Objectives:Examine the impacts of age, diabetes, gender, and access type on vascular access (VA) associated costs among Chinese hemodialysis (HD) patients.Methods:We retrospectively included patients whose first permanent VA was created at the West China Hospital. Clinical characteristics, maturation, intervention, utilization, and exchange of every VA, as well as VA-related infection were collected. The study period for each patient was from HD initiation to the last follow-up. VA-related costs, including those for placement and intervention procedures, were calculated according to the standards set in 2019 for Chinese tertiary hospitals. Mann-Whitney U and Chi-square tests were conducted for comparisons between groups.Results:A total of 358 Chinese HD patients experienced functionally 143 arteriovenous fistula (AVF), 22 arteriovenous graft (AVG), and 439 tunneled cuffed central venous catheter (tcCVC) during a median study period of 26 (IQR 13–44) months, of which 42.5% used more than one permanent VA. The median annual VA-related cost in the groups of age >75 years and ⩽75 years, diabetes and non-diabetes, male and female, was $525 and $397 (p = 0.016), $459 and $462 (p = 0.64), $476 and $445 (p = 0.94), respectively. The median monthly costs for AVF ($18), AVG ($289), and tcCVC ($37) were significantly different.Conclusion:HD patients aged >75 years had significantly higher annual VA-related costs. However, the annual VA-related costs did not differ across the diabetes groups or the gender groups. AVF was the most cost-effective permanent VA type in China, partly due to the inexpensive materials used compared to AVG or tcCVC.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-10-05T05:23:12Z
      DOI: 10.1177/0391398820962112
       
  • Comparison of small-diameter decellularized scaffolds from the aorta and
           carotid artery of pigs
    • Authors: Zhijuan He, Guofeng Liu, Xu Ma, Daping Yang, Qingchun Li, Ning Li
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      Aim:Tissue-specific extracellular matrix promotes tissue regeneration and repair. We aimed to identify the optimal decellularized matrices for tissue-engineered vascular graft (TEVG).Methods:Decellularized aorta of fetal pigs (DAFP, n = 6, group A), decellularized aorta of adult pigs (DAAP, n = 6, group B), and decellularized carotid artery of adult pigs (DCAP, n = 6, group C) were prepared. Scaffolds were compared using histology and ultrastructure. Endothelial cell (EC) and myofibroblast (MFB) infiltration assessments were performed in vitro. Cell infiltration was measured in vivo. Biomechanical properties were also determined.Results:Almost original cells were removed by the acellularization procedure, while the construction of the matrix basically remained. In vitro, monolayer ECs and multi-layer MFBs were formed onto the internal surface of the specimens after 3 weeks. In vivo, cell infiltration in group A significantly increased at the 6th and 8th week when compared with groups B and C (p 
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-09-29T05:40:50Z
      DOI: 10.1177/0391398820959350
       
  • Enhanced cellular functions of hepatocytes in the
           hyaluronate-alginate-chitosan microcapsules
    • Authors: Yanhong Zhang, Juan Lu, Zuhong Li, Danhua Zhu, Xiaopeng Yu, Lanjuan Li
      Abstract: The International Journal of Artificial Organs, Ahead of Print.
      The study aimed to develop a biocompatible microcapsule for hepatocytes and create a bio-mimic microenvironment for maintaining hepatic-specific functions of hepatocytes in vitro. The work is proposed for the bioartificial liver system in the treatment of liver failure. In this study, microcapsules were prepared with hyaluronate (HA)/sodium alginate (SA) as an inner core and an outer chitosan (CS) shell via one-step spraying method. C3A cells were encapsulated in microcapsules to examine the biocompatibility of HA-SA-CS microcapsules. MTT and fluorescence microscopy indicated that C3A cells had high viability in the HA-SA-CS microcapsules. The liver-specific functions, such as urea and albumin synthesis, and CYP1A2 and CYP3A4 activities from encapsulated cells were increased in the HA-SA-CS microcapsules compared to the SA-CS microcapsules. The gene expressions of CYP450 related genes were also increased by HA on day 3. The study suggests that HA-SA-CS microcapsules have good biocompatibility and can maintain a favorable environment for hepatocytes. This approach has improved the preservation of liver cells’ metabolic functions and could be a candidate for the bioartificial liver system.
      Citation: The International Journal of Artificial Organs
      PubDate: 2020-09-24T09:22:32Z
      DOI: 10.1177/0391398820959345
       
 
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