P0542EVALUATION OF BLOOD CELL ADHESION AND SOLUTE REMOVAL PERFORMANCE BY AN EX VIVO EXPERIMENT OF A POLYSULFONE HEMOFILTER USING AN NV POLYMER MEMBRANE FOR CONTINUOUS RENAL REPLACEMENT THERAPY

Abstract Background and Aims Since hemofilters used for continuous renal replacement therapy (CRRT) come in prolonged contact with blood during treatment, clotting and cell adhesion induced by contact of blood with the membrane often occur, increasing the risk to the patient and burden on the staff. Suppressed platelet adhesion and better biocompatibility have been reported with the use of a dialysis membrane whose surface has been modified with an NV polymer in patients on maintenance hemodialysis. Therefore, it may be advantageous to use the NV membrane as a hemofilter for CRRT. In the present study, we evaluated the solute removal performance change and blood cell adhesion on the NV membrane after it comes in contact with blood, to clarify the characteristics of the NV membrane for long-time use. Methods A new polysulfone membrane containing the NV polymer (SNV) and a conventional polysulfone membrane (SHG) were used for the ex vivo blood filtration experiment. To compare the solute removal performance change and blood cell adhesion after blood comes in contact with the membranes, porcine blood collected from a single animal was divided into two portions, and a 24-hour of continuous hemofiltration (CHF) experiment was performed. The circulation conditions were as follows; blood flow rate, 100 mL/min; filtrate flow rate, 20 mL/min; heparin dose adjusted as appropriate to maintain the activated clotting time from 300 to 400 sec during the experiment. We evaluated the time-courses of the transmembrane pressure (TMP) and pressure drop at the hemofilter and the change in the sieving coefficients of dextran of different molecular weights (molecular weight cutoff curve) before and after the experiment, and blood cell adhesion. The amount of blood cell adhesion was evaluated based on the hemoglobin content and lactate dehydrogenase (LDH) activity in the eluate from the residual blood clots on the hemofilter 24 hours after the CHF experiment. Results The changes in the TMP and the pressure drop were significantly lower with the use of SNV as compared to SHG (n = 9, p < 0.01). From the molecular weight cutoff curves before and after the experiment, the molecular weights when the sieving coefficient was 0.1 to 0.4, which reflect the pore size of the pores through which relatively small molecules can pass, decreased to a lower extent after blood contact with SNV as compared to SHG (n = 3, SC = 0.1-0.3, p < 0.05; SC = 0.4, p < 0.01).The hemoglobin content and LDH activity in the blood clots adhering to the membrane after the experiment were significantly lower in SNV as compared to SHG (n = 9; Hb, p < 0.01; LDH, p < 0.05), indicating that blood cell adhesion on SNV was less pronounced than that on SHG. Conclusion SNV suppressed the increase in the TMP and also the pressure drop, allowed a high rate of solute removal performance to be maintained, and suppresses blood cell adhesion to a greater extent as compared to the conventional polysulfone membrane.

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Ex VivoEvaluation of Secretion-Clearing Device in Reducing Airway Resistance within Endotracheal Tubes

Critical Care Research and Practice ◽

10.1155/2018/3258396 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Christopher Waters ◽

R. Constance Wiener ◽

Hamed M. Motlagh

Keyword(s):

Pressure Drop ◽

Airway Resistance ◽

Ex Vivo ◽

Prolonged Mechanical Ventilation ◽

Performance Testing ◽

Field Performance ◽

Primary Objective ◽

Endotracheal Tubes ◽

Significant Difference ◽

Before And After

Background. Secretions accumulate in endotracheal tubes’ (ETT) lumens upon their placement in patients. The secretions impact airway resistance and pressure. Secretions potentiate prolonged mechanical ventilation and ventilator-associated pneumonia. Our primary objective in this study was to evaluate an ETT-clearing device (ETT-CD) in its ability to remove secretions fromex vivoETT lumens.Methods. Forty ETTs, obtained from intensive care patients at extubation, were individually placed into a ventilator field performance testing simulator at 37°C. The pressure drop through the ETTs was measured at a flow rate of 60 L/min before and after cleaning with the ETT-CD and compared with unused, similarly sized controls tubes. The ETT-CD was inserted into an ETT until the tip reached Murphy’s eye (hole in the side) of the ETT. The wiper, set back from the tip, was expanded by ETT-CD handle activation. As the ETT-CD was removed, the distal wiper extracted secretions from the ETT lumen.Results. Forty ETTs were tested with nonparametric Wilcoxon signed-rank tests. Before being cleared with the ETT-CD, the median pressure drop in the extubated 7.5 mm ETTs was 17.8 cm H2O; after ETT-CD use, it was 12.3. The cleared ETTs were significantly improved over the ETTs before being cleared (p<0.001); however, there remained a significant difference between the cleared ETTs and the control tubes (p=0.005), indicating the clearing was not to the level of an unused ETT. Similar results were determined for the 8.0 mm ETTs.Conclusions. For the 7.5 mm and the 8.0 mm EETs, the ETT-CD improved effective patency of the ETTs over the uncleared ETTs, independent of occlusion location, tube size, or length of tube. However, there remained a significant difference between the cleared tubes and controls.

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Comparative Arterial Antithrombotic Activity of Clopidogrel and Acetyl Salicylic Acid in the Pig

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646307 ◽

1992 ◽

Vol 68 (05) ◽

pp. 500-505 ◽

Cited By ~ 32

Author(s):

Ch M Samama ◽

Ph Bonnin ◽

M Bonneau ◽

G Pignaud ◽

E Mazoyer ◽

...

Keyword(s):

Platelet Aggregation ◽

Femoral Artery ◽

Bleeding Time ◽

Ex Vivo ◽

Flow Reduction ◽

Cyclic Flow ◽

Left Femoral Artery ◽

Before And After ◽

The Right ◽

Induced Aggregation

SummaryWe investigated the comparative antithrombotic properties of clopidogrel, an analogue of ticlopidine, and aspirin, using the Folts' model on femoral arteries in 22 pigs. On each animal, clopidogrel or aspirin were used to treat the thrombotic process on the left femoral artery and to prevent this process on the right femoral artery. Sequentially: an injury and stenosis were carried out on the left femoral artery; the thrombotic process was monitored with a Doppler during a 30-min observation period for cyclic flow reductions or permanent cessation of flow; after the first cyclic flow reduction occurred, clopidogrel (5 mg kg-1) or aspirin (2.5, 5, 100 mg kg-1) were injected intravenously; if cyclic flow reductions were abolished, epinephrine (0.4 µg kg-1 min-1) was injected to try to restore cyclic flow reductions and/or permanent cessation of flow; then injury and stenosis were applied on the right femoral artery. Before and after injection of clopidogrel or aspirin, ear immersion bleeding times and ex-vivo platelet aggregation were performed. Clopidogrel (n = 7) abolished cyclic flow reductions in all animals and epinephrine did not restore any cyclic flow reduction. On the right femoral artery, cyclic flow reductions were efficiently prevented, even for two injuries. Basal bleeding time (5 min 28) was lengthened (>15 min, 30 min after clopidogrel and remained prolonged even after 24 h). ADP-induced platelet aggregation was inhibited (more than 78%). Comparatively, aspirin had a moderate and no dose-dependent effect. Aspirin 2.5 mg kg-1 (n = 6) abolished cyclic flow reductions in 2 animals, CFR reoccurred spontaneously in one animal and epinephrine restored it in a second animal. Aspirin 5 mg kg-1 (n = 6) abolished cyclic flow reductions in only 3 animals and epinephrine always restored it. Aspirin 100 mg kg-1 (n = 3) was unable to abolish cyclic flow reductions. On the right femoral artery, aspirin did not significantly prevent cyclic flow reductions which occurred in all animals after one (n = 14) or two injuries (n = 1), except for one animal. Basal bleeding time was lengthened but it shortened rapidly, reaching its basal value after 24 h. ADP-induced aggregation was not significantly inhibited, whereas arachidonic acid induced aggregation was always inhibited. Clopidogrel appears as a more potent antithrombotic drug than aspirin in this model, in treating and preventing spontaneous or epinephrine-induced cyclic flow reductions and lengthening bleeding time.

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Benefit/Risk Profile of Combined Antiplatelet Therapy with Ticlopidine and Aspirin

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648180 ◽

1991 ◽

Vol 65 (05) ◽

pp. 504-510 ◽

Cited By ~ 20

Author(s):

Raffaele De Caterina ◽

Rosa Sicari ◽

Walter Bernini ◽

Guido Lazzerini ◽

Giuliana Buti Strata ◽

...

Keyword(s):

Platelet Function ◽

Low Dose ◽

Bleeding Time ◽

Ex Vivo ◽

Stable Coronary Artery Disease ◽

High Dose ◽

Single Drug ◽

Before And After ◽

Serum Thromboxane ◽

Artery Disease

SummaryTiclopidine (T) and aspirin (ASA) are two antiplatelet drugs both capable of prolonging bleeding time (BT), with a different mechanism of action. A synergism in BT prolongation has been reported and is currently considered an argument for not recommending their combination. However, a profound suppression of platelet function might be a desirable counterpart of a marked prolongation of BT, with a possible use in selected clinical situations. We therefore studied ex vivo platelet function (aggregation by ADP 0.5-1-2.5 μM; adrenaline 0.75-2.5 μM; collagen 1.5-150 μg/ml; arachidonic acid 1 mM; PAF 1 μM; adrenaline 0.17 μM + ADP 0.62 μM; serum thromboxane ([TX]B2 generation) and BT (Mielke) in 6 patients with stable coronary artery disease receiving such combination. Patients underwent sequential laboratory evaluations at baseline, after 7 days of T 250 mg b.i.d., before and after the intravenous administration of ASA 500 mg, respectively, and, finally, after a minimum of 7 days of sole ASA oral administration (50 mg/day). The experimental design, therefore, allowed a comparison of T and ASA effects (2nd and 4th evaluation), and an assessment of the combination effect (3rd evaluation). Platelet aggregation in response to all doses of ADP was depressed more by T than by ASA. Conversely, responses to adrenaline, and arachidonate were affected more by ASA than by T. For all other agents, differences were not significant. T + ASA combination was more effective (p <0.05) than either treatment alone in depressing responses to high-dose collagen (% over control, mean ± SEM: T: 95 ± 3; ASA: 96 ± 5; T + ASA: 89 ± 4). Serum TXB2 (basal, ng/ml: 380 ± 54) did not change with T (372 ± 36), dropped to <1 ng/ml on ASA injection and slightly re-increased to 9.1 ± 3.1 ng/ml on oral low-dose ASA. BT (basal 7.4 ± 0.6 min) was affected similarly by T (9.2 ± 0.8) or ASA (9.7 ± 0.9) alone, but increased to 15.0 ± 0.7 min on combination treatment (106% increase over control). Thus, the strong synergism in BT prolongation by ASA-T combination has a counterpart in the inhibition of platelet function in response to strong stimuli such as high-dose collagen, not otherwise affected significantly by single-drug treatment. This effect is a possible rationale for the clinical evaluation of T + ASA combination.

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Evaporation Heat Transfer and Pressure Drop in Micro-Fin Tubes Before and After Tube Expansion

Journal of Enhanced Heat Transfer ◽

10.1615/jenhheattransf.v12.i1.40 ◽

2005 ◽

Vol 12 (1) ◽

pp. 59-72 ◽

Cited By ~ 4

Author(s):

Yun Wook Hwang ◽

Min Soo Kim ◽

Yongchan Kim

Keyword(s):

Heat Transfer ◽

Pressure Drop ◽

Evaporation Heat ◽

Before And After ◽

Evaporation Heat Transfer ◽

Fin Tubes ◽

Tube Expansion

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Interactions between programmable shunt valves and magnetically controlled growing rods for scoliosis

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.6.peds20299 ◽

2020 ◽

Vol 26 (6) ◽

pp. 667-670

Author(s):

Thomas Larrew ◽

Mohammed Alshareef ◽

Robert F. Murphy ◽

Ramin Eskandari ◽

Libby Kosnik Infinger

Keyword(s):

Remote Control ◽

Ex Vivo ◽

Shunt Valve ◽

Growing Rods ◽

Growing Rod ◽

Before And After ◽

Magnetically Controlled Growing Rods ◽

Ex Vivo Study

OBJECTIVEAlthough the advent of magnetic growing rod technology for scoliosis has provided a means to bypass multiple hardware lengthening operations, it is important to be aware that many of these same patients have a codiagnosis of hydrocephalus with magnet-sensitive programmable ventricular shunts. As the magnetic distraction of scoliosis rods has not previously been described to affect the shunt valve setting, the authors conducted an investigation to characterize the interaction between the two devices.METHODSIn this ex vivo study, the authors carried out 360 encounters between four different shunt valve types at varying distances from the magnetic external remote control (ERC) used to distract the growing rods. Valve settings were examined before and after every interaction with the remote control to determine if there was a change in the setting.RESULTSThe Medtronic Strata and Codman Hakim valves were found to have setting changes at distances of 3 and 6 inches but not at 12 inches. The Aesculap proGAV and Codman Certas valves, typically described as MRI-resistant, did not have any setting changes due to the magnetic ERC regardless of distance.CONCLUSIONSAlthough it is not necessary to check a shunt valve after every magnetic distraction of scoliosis growing rods, if there is concern that the magnetic ERC may have been within 12 inches (30 cm) of a programmable ventricular shunt valve, the valve should be checked at the bedside with a programmer or with a skull radiograph along with postdistraction scoliosis radiographs.

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