Optimization of Heparin Anticoagulation during Membrane Plasma Separation

1988 ◽  
Vol 11 (4) ◽  
pp. 313-316 ◽  
Author(s):  
G.M. Frascà ◽  
A. Buscaroli ◽  
L.C. Borgnino ◽  
A. Vangelista
Keyword(s):  
Plasma Exchange ◽  
Plasma Flow ◽  
Distribution Volume ◽  
Blood Levels ◽  
Heparin Concentration ◽  
Sieving Coefficient ◽  
Heparin Anticoagulation ◽  
Membrane Plasma Separation ◽  
The Individual ◽  
Heparin Dosage

This study analyses 75 membrane plasma exchanges carried out in 18 patients where various amounts of heparin were used to define the heparin kinetic during plasma exchange and the appropriate anticoagulation. A specific assay was employed to measure heparin concentration. Our results showed that: 1) the heparin distribution volume exceeded the expected value by 10 to 25%; 2) the drug is filtered with a sieving coefficient = 1; 3) the appropriate concentration range is within 0.2 and 0.5 Ul/ml.; 4) the heparin blood levels strictly correlate with a PTT (p<0.001); 5) the individual need for heparin is related to the patient Hct (p<0.001) and plasma flow (p<0.001). Simple quidelines are provided to determine the appropriate heparin dosage in single patients.

scholarly journals Association between serum biomarkers and postoperative delirium after cardiac surgery

2019 ◽  
Vol 26 (1) ◽  
pp. 8-10 ◽  
Author(s):  
Mindaugas Gailiušas ◽  
Judita Andrejaitienė ◽  
Edmundas Širvinskas ◽  
Darijus Krasauskas ◽  
Milda Švagždienė ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Delirium ◽  
Neuronal Damage ◽  
Artery Bypass ◽  
Neuron Specific Enolase ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Blood Levels ◽  
Increased Risk ◽  
The Individual

Background. In cardiac surgery, patients face an increased risk of developing postoperative delirium (POD) that is associated with poor outcomes. Neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP) have shown some promising results as potential tools for POD risk stratification, diagnosis, monitoring, and prognosis. Methods. Prospective single-centre study enrolled 44 patients undergoing elective coronary artery bypass grafting (CABG) and/ or valve procedures using cardiopulmonary bypass (CPB). The patients were assessed and monitored preoperatively, during surgery, and in the early postoperative period. The blood levels of NSE and GFAP were measured before and after surgery. The early POD was assessed by CAM-ICU criteria and patients were assigned to the POD group (with POD) or to the NPOD group (without POD) retrospectively. Results. The incidence of POD was 18.2%. After surgery, NSE significantly increased in the whole sample (p = 0.002). Comparing between groups, NSE significantly increased in the POD group after surgery (p = 0.042). ΔGFAP (before/after operation) for the whole sample was statistically significant (p = 0.022). There was a significant correlation between ΔGFAP and the lowest MAP during surgery in the POD group (p = 0.033). Conclusions. Our study demonstrated that NSE and GFAP are associated with early POD. An increase in NSE level during the perioperative period may be associated with subclinical neuronal damage. Serum GFAP levels show the damage of glial cells. Further studies are needed to find the factors influencing the individual limits of optimal MAP during surgery.

Phase I study of a combination of recombinant interferon-alpha and recombinant interferon-gamma in cancer patients.

1986 ◽  
Vol 4 (11) ◽  
pp. 1677-1683 ◽  
Author(s):  
R Kurzrock ◽  
M G Rosenblum ◽  
J R Quesada ◽  
S A Sherwin ◽  
L M Itri ◽  
...  
Keyword(s):  
Interferon Gamma ◽  
Interferon Alpha ◽  
Maximum Tolerated Dose ◽  
Blood Levels ◽  
Recombinant Interferon ◽  
Starting Dose ◽  
The Individual ◽  
Dose Levels ◽  
Recombinant Interferon Alpha

Combinations of interferon-alpha and interferon-gamma demonstrate synergistic antiviral and anti-proliferative activity in vitro. Therefore, we initiated a clinical study of combination interferon therapy in humans. Eighteen patients with metastatic solid tumors received daily intramuscular (IM) injections of recombinant interferon-alpha-A (IFN alfa-2a, Roferon-A; Hoffman-LaRoche, Nutley, NJ) and recombinant IFN-gamma (rIFN-gamma) for 6 weeks. The dose levels were 0.5, 1.0, 2.0, and 5.0 X 10(6) U/m2/d of each interferon. A minimum of two patients were entered sequentially at each dose level. Fever, chills, fatigue, and a greater than or equal to 50% drop in granulocyte counts were observed at all doses. Severity of symptoms corresponded to increasing dose levels. In contrast to the tachyphylaxis to these symptoms that usually develops in patients treated with the individual interferons, many patients on this study experienced persistent fever and worsening fatigue over 6 weeks. The maximum tolerated dose was 1 X 10(6) U/m2/d of each interferon. One patient with renal-cell carcinoma achieved a partial remission (duration, 3 months). Enzyme-linked immunoassay analysis in all four patients for whom complete data were available revealed that peak blood levels of IFN alfa-2a on day 22 were about tenfold higher than on day 1. Because of the possibility of cumulative toxicity, the recommended starting dose for further studies is 0.5 X 10(6) U/m2/d of each interferon, with escalation to 1.0 X 10(6) U/m2/d after 1 month if tolerance is acceptable. Phase II investigations to explore the antitumor efficacy of this regimen are planned.

Paraprotein levels in assessing effectiveness of polychemotherapy plus selective plasma exchange for multiple myeloma patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e19511-e19511
Author(s):  
Irina B. Lysenko ◽  
Nailya Guskova ◽  
Oleg Ivanovich Kit ◽  
Natalya Dmitrievna Ushakova ◽  
Nadezhda Golomeeva ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Plasma Exchange ◽  
Treatment Effect ◽  
Reduction Rate ◽  
Main Group ◽  
Response To Treatment ◽  
Light Chains ◽  
Control Group ◽  
Blood Levels

e19511 Background: Our purpose was to analyze levels and types of paraprotein in polychemotherapy combined with selective plasma exchange in patients with multiple myeloma. Methods: Blood levels of paraprotein (PP) were studied by capillary electrophoresis (Helena Bioscience V8), and content of plasma cells was determined in the bone marrow of 16 patients (main group) with multiple myeloma (MM) during polychemotherapy (PCT) plus selective plasma exchange (SPE). 14 patients receiving standard PCT were the controls. Results: MM patients in both groups were characterized with the presence of PP in the blood serum with the M-peak in the gamma-globulin zone. Only heavy IgG chains were found, bound to lambda (λ) light chains in 48% and to cappa (κ) light chains in 57.15%. The initial PP level in MM-IgGλ was 91.01±0.79 g/L and was 2.4 times higher than in MM-IgGκ (38.3±0.34 g/L). Significant differences in were found in PP reduction rate and intensity depending on the treatment. PP in the main group reduced by 42.4% after course1, by 41.4% after course 2, by 52.2% after course 3 and by 24% after course 4; in the control group – by 17.2%, 19.3%, 27.9% and 47.3%, respectively. PP levels decreased by 87.4% and 74.6% by the end of the treatment, respectively. The data were confirmed by a decrease in plasma cell content in the bone marrow of patients: up to 1.2% in the main group and 6.2% in the controls. Response to treatment in the main group was registered at the early stages of therapy, and at the late stages in the control group. Treatment effect was associated with the type of secreted PP. In MM-IgGκ, PP levels in the main group decreased by 59.7% after course 1, by 40.6% more after course 2 and by 51.9% after course 3; in MM-IgGλ – by 25.1%, 42.1% and 52.5%, respectively. Treatment effect was noted earlier and PP reduction was more intensive in MM-IgGκ than in MM-IgGλ. PP levels decreased by the end of the treatment by 85.4% in MM-IgGκ and by 73% in MM-IgGλ. Similar changes were observed in the control group. Conclusions: Increased rates and intensiveness of paraprotein reduction reflect effectiveness of polychemotherapy plus selective plasma exchange for multiple myeloma. Patients with MM-IgGκ are more sensitive to the therapy.

scholarly journals Effects of Plasma Exchange and Heparin Concentration on the Serotonin Release Assay in Heparin-Induced Thrombocytopenia

2017 ◽  
Vol 2 (3) ◽  
pp. 380-385 ◽  
Author(s):  
Benjamin F. Tillman ◽  
Anton Matafonov ◽  
Adam J. Kingeter ◽  
Ashish S. Shah ◽  
David Gailani
Keyword(s):  
Plasma Exchange ◽  
Serotonin Release ◽  
Heparin Induced Thrombocytopenia ◽  
Heparin Concentration ◽  
Release Assay

Safety and Efficacy of Regional Citrate Anticoagulation during Plasma Adsorption Plus Plasma Exchange Therapy for Patients with Acute-on-Chronic Liver Failure: A Pilot Study

2019 ◽  
Vol 48 (3) ◽  
pp. 223-232 ◽  
Author(s):  
Yuanji Ma ◽  
Fang Chen ◽  
Yan Xu ◽  
Ming Wang ◽  
Taoyou Zhou ◽  
...  
Keyword(s):  
Pilot Study ◽  
Liver Failure ◽  
Plasma Exchange ◽  
Chronic Liver ◽  
Regional Citrate Anticoagulation ◽  
Chronic Liver Failure ◽  
Safety And Efficacy ◽  
Citrate Anticoagulation ◽  
Citrate Accumulation ◽  
Heparin Anticoagulation

Background: Patients with acute-on-chronic liver failure (ACLF) might be at risk for citrate accumulation during plasma adsorption plus plasma exchange (PE) therapy with regional citrate anticoagulation (RCA). Objectives: To assess the safety and efficacy of RCA during double plasma molecular adsorption system (DPMAS) plus PE therapy for patients with ACLF. Method: A prospective nonrandomized controlled pilot study was conducted at West China Hospital of Sichuan University. Patients with ACLF were enrolled to heparin anticoagulation (HA) group and RCA group. Serial blood samples were taken. Patients were followed up for 3 months. Results: Twenty-four patients with 94 sessions of HA and 28 patients with 106 sessions of RCA were enrolled. RCA method did not affect the therapeutic efficacy, the function of extracorporeal circulation, and the prognosis of these patients. The occurrences of citrate accumulation in RCA group were 0.0, 67.0, 100.0, 34.0, and 0.0% before DPMAS therapy, at the end of DPMAS therapy, immediately after PE therapy, 2 h after PE therapy, and the next morning, while that in HA group were 0.0, 0.0, 100.0, 7.4, and 0.0%, respectively. The occurrences of citrate accumulation at the end of DPMAS therapy and at 2 h after PE therapy in RCA group were much higher than that in HA group (67.0 vs. 0.0%, p = 0.000; 34.0 vs. 7.4%, p = 0.000, respectively). Although the trend of citrate accumulation in RCA group was much more obvious than that in HA group during and after DPMAS plus PE therapy (p = 0.000), the values on the next morning were similar between the 2 groups (p > 0.05). The main alteration of acid–base status was metabolic alkalosis with no difference between the 2 groups. Conclusions: RCA might be safe and effective in patients with ACLF receiving plasma adsorption plus PE therapy. RCA method might offer an alternative anticoagulation method for them.

scholarly journals Dietary interventions as a neuroprotective therapy for the delay of the onset of cognitive decline in older adults: Evaluation of the evidence

2017 ◽  
Vol 7 (10) ◽  
pp. 743 ◽  
Author(s):  
Debra Krause ◽  
Peter Roupas
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Systematic Reviews ◽  
Critical Evaluation ◽  
Current Evidence ◽  
Blood Levels ◽  
Omega 3 ◽  
Dietary Interventions ◽  
Neuroprotective Therapy ◽  
The Individual

Background: The relationship between nutrition and cognitive functioning is unclear, especially in elderly populations as many elderly people with cognitive impairment have low blood levels of some nutrients even in the absence of malnourishment. The objective of this review was to assess the evidence from systematic reviews of human studies on the effectiveness of dietary interventions as monotherapies in delaying the onset of cognitive decline in older adults.Scope and approach: Evidence-based methodologies were used to gather and assess the highest levels of evidence that evaluated the effects of administration of any dose of the individual dietary interventions as neuroprotective agents for any duration. The search strategy was designed to identify systematic reviews and meta-analyses published from 1990 to December 2015. There were no language restrictions as part of the inclusion criteria.Key Findings and Conclusions: This review provides the current state of knowledge from systematic reviews on the effects on cognition of acetyl-L-carnitine, alpha-lipoic acid, choline, inositol compounds, omega-3 polyunsaturated fatty acids, and polyphenols, which are all commonly studied nutrients for neurocognitive effects. A critical evaluation of the current evidence from systematic reviews indicated that there are no clinically-relevant effects from supplementation with these nutrients on delaying the onset of cognitive decline in older adults. Keywords: diet, cognition, Alzheimer’s disease, dementia, nutrient

scholarly journals Sex-dependent modulation of treatment response

2004 ◽  
Vol 6 (1) ◽  
pp. 39-51 ◽  
Keyword(s):  
Treatment Response ◽  
Psychotropic Medication ◽  
Individual Characteristic ◽  
Tissue Response ◽  
Sexual Differences ◽  
Blood Levels ◽  
Clinical Interventions ◽  
The Individual

The response to a psychotropic medication reflects characteristics of both the medication and the substrate, ie, the individual receiving the medication. Sex is an individual characteristic that influences all elements of the pharmacokinetic process - absorption, distribution, metabolism, and elimination. The effects of sex on these components of the pharmacokinetic process often counterbalance one another to yield minimal or varying sexual differences in blood levels achieved. However, sex also appears to influence pharmacodynamics, the tissue response to a given level of medication. Consideration by the practitioner of sex as a possible contributing factor to treatment nonresponse will enhance the efficacy and precision of clinical interventions.

Enhancement by hypophysectomy of insulin effect on extrahepatic galactose transfer

1961 ◽  
Vol 200 (6) ◽  
pp. 1311-1314 ◽  
Author(s):  
Norio Kokka ◽  
Leslie L. Bennett
Keyword(s):  
Blood Glucose Concentration ◽  
Equilibrium Concentration ◽  
Distribution Volume ◽  
Blood Levels ◽  
Volume Distribution ◽  
Insulin Effect ◽  
Hypophysectomized Rats ◽  
Prior Administration ◽  
Insulin Hypersensitivity ◽  
Normal Controls

Fasted, normal, and hypophysectomized rats were eviscerated and nephrectomized under light pentobarbital anesthesia. Glucose was infused intravenously at rates that maintained a nearly constant blood glucose concentration. Single injections of galactose were given that produced an equilibrium concentration at 60 min of 247 ± 30 mg%. The galactose level was not significantly different at 90 min. Thus insulin could be administered at 60 min and the 60–90 min blood galactose change used as an index of insulin action. The extrahepatic uptake of galactose in hypophysectomized rats was demonstrated to be hypersensitive to insulin by two criteria: a) significant decreases in blood galactose concentration of hypophysectomized rats were produced by 0.01 unit of insulin/kg, a dose that had no effect on normal rats; b) after 0.02 unit of insulin/kg, changes in blood levels of galactose were greater in hypophysectomized rats than in their normal controls. Hypophysectomy did not alter galactose distribution volume. In neither normal nor hypophysectomized rats did prior administration of growth hormone alter either volume distribution of galactose or insulin hypersensitivity.

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