On formation of padder syndrome

Edematous syndrome is most common among patients of older age groups and indicates pathology on the part of such organ systems as cardiovascular, genitourinary, musculoskeletal, lymphatic, endocrine. The causes of edema are diverse, and the tactics of further management due to incorrect justification can lead to serious consequences.The purpose of this study. To study the prevalence and differential diagnostic features of edematous syndrome based on the analysis of current scientific publications containing information on this topic.Results. The development of edematous syndrome is caused by a number of factors, the main of which are: hydrodynamic factor, osmotic factor, oncotic pressure, membranogenic factor. Despite the fact that edematous syndrome is associated with many diseases, it has specific differential diagnostic signs for each pathology.Conclusions. Edema is a visible objective symptom and is a root cause factor of various diseases, such as glomerulonephritis, thrombophlebitis, filariasis, cirrhosis, chronic heart failure, shock, allergic, inflammatory conditions and many others. However, with the help of specific clinical features of the symptoms of this syndrome, it is possible to make a differential diagnosis and determine the underlying disease that led to the formation of edematous syndrome.

Pump-Free Microfluidic Hemofiltration Device

Hemofiltration removes water and small molecules from the blood via nanoporous filtering membranes. This paper discusses a pump-free hemofiltration device driven by the pressure difference between the artery and the vein. In the design of the filtering device, oncotic pressure needs to be taken into consideration. Transmembrane pressure (TMP) determines the amount and direction of hemofiltration, which is calculated by subtracting the oncotic pressure from the blood pressure. Blood pressure decreases as the channels progress from the inlet to the outlet, while oncotic pressure increases slightly since no protein is removed from the blood to the filtrate in hemofiltration. When TMP is negative, the filtrate returns to the blood, i.e., backfiltration takes place. A small region of the device with negative TMP would thus result in a small amount of or even zero filtrates. First, we investigated this phenomenon using in vitro experiments. We then designed a hemofiltration system taking backfiltration into consideration. We divided the device into two parts. In the first part, the device has channels for the blood and filtrate with a nanoporous membrane. In the second part, the device does not have channels for filtration. This design ensures TMP is always positive in the first part and prevents backfiltration. The concept was verified using in vitro experiments and ex vivo experiments in beagle dogs. Given the simplicity of the device without pumps or electrical components, the proposed pump-free hemofiltration device may prove useful for either implantable or wearable hemofiltration.

Albumin Infusion in Critically Ill COVID-19 Patients: Hemodilution and Anticoagulation

Hypercoagulation is one of the major risk factors for ICU treatment, mechanical ventilation, and death in critically ill patients infected with SARS-CoV-2. At the same time, hypoalbuminemia is one risk factor in such patients, independent of age and comorbidities. Especially in patients with severe SARS-CoV-2-infection, albumin infusion may be essential to improve hemodynamics and to reduce the plasma level of the main marker of thromboembolism, namely, the D-dimer plasma level, as suggested by a recent report. Albumin is responsible for 80% of the oncotic pressure in the vessels. This is necessary to keep enough water within the systemic circulatory system and for the maintenance of sufficient blood pressure, as well as for sufficient blood supply for vital organs like the brain, lungs, heart, and kidney. The liver reacts to a decrease in oncotic pressure with an increase in albumin synthesis. This is normally possible through the use of amino acids from the proteins introduced with the nutrients reaching the portal blood. If these are not sufficiently provided with the diet, amino acids are delivered to the liver from muscular proteins by systemic circulation. The liver is also the source of coagulation proteins, such as fibrinogen, fibronectin, and most of the v WF VIII, which are physiological components of the extracellular matrix of the vessel wall. While albumin is the main negative acute-phase protein, fibrinogen, fibronectin, and v WF VIII are positive acute-phase proteins. Acute illnesses cause the activation of defense mechanisms (acute-phase reaction) that may lead to an increase of fibrinolysis and an increase of plasma level of fibrinogen breakdown products, mainly fibrin and D-dimer. The measurement of the plasma level of the D-dimer has been used as a marker for venous thromboembolism, where a fourfold increase of the D-dimer plasma level was used as a negative prognostic marker in critically ill SARS-CoV-2 hospitalized patients. Increased fibrinolysis can take place in ischemic peripheral sites, where the mentioned coagulation proteins can become part of the provisional clot (e.g., in the lungs). Although critically ill SARS-CoV-2-infected patients are considered septic shock patients, albumin infusions have not been considered for hemodynamic resuscitation and as anticoagulants. The role of coagulation factors as provisional components of the extracellular matrix in case of generalized peripheral ischemia due to hypoalbuminemia and hypovolemia is discussed in this review.

A case of preeclampsia developed massive ascites after delivery

Preeclampsia causes various presentations by increased endothelial permeability and microvascular damages. Maternal ascites related severe preeclampsia is generally explained by increased capillary permeability due to endothelial cell dysfunction and reduced intravascular oncotic pressure. Here we report a patient with postpartum massive ascites associated with preeclampsia.

Microvascular Fluid Exchange: Implications of the Revised Starling Model for Resuscitation of Dengue Shock Syndrome

Dengue is the most common mosquito-borne viral infection in the world. The most feared complication is a poorly understood vasculopathy that occurs in only a small minority of symptomatic individuals, especially children and young adults, but can result in potentially fatal dengue shock syndrome (DSS). Based mainly on expert opinion, WHO management guidelines for DSS recommend prompt infusion of a crystalloid fluid bolus followed by a tapering crystalloid fluid regimen, supplemented if necessary by boluses of synthetic colloid solutions. However, following publication of a number of major trials undertaken in other, primarily adult, critical care scenarios, use of both synthetic colloid solutions and of fluid boluses for volume expansion have become controversial. Synthetic colloids tend to be used for severe DSS cases in order to boost intravascular oncotic pressure, based on the classic Starling hypothesis in which opposing hydrostatic and oncotic forces determine fluid flow across the microvascular barrier. However, the revised Starling model emphasizes the critical contribution of the endothelial glycocalyx layer (EGL), indicating that it is the effective oncotic pressure gradient across the EGL not endothelial cells per se that opposes filtration. Based on several novel concepts that are integral to the revised Starling model, we review the clinical features of DSS and discuss a number of implications that are relevant for fluid management. We also highlight the need for context-specific clinical trials that address crucially important questions around the management of DSS.

Effect of Albumin Addition to Cardiopulmonary Bypass Prime on Outcomes in Children Undergoing Open-Heart Surgery (EACPO Study)—A Randomized Controlled Trial

Background: There is a paucity of literature regarding the association of high oncotic priming solutions for pediatric cardiopulmonary bypass (CPB) and outcomes, and no consensus exists regarding the composition of optimal CPB priming solution. This study aimed to examine the impact of high oncotic pressure priming by the addition of 20% human albumin on outcomes. Methods: Double-blinded, randomized controlled study was done in the pediatric cardiac intensive care unit of a tertiary care hospital. Consecutive children with congenital heart diseases admitted for open-heart surgery were randomized into two groups, where the study group received an additional 20% albumin to conventional blood prime before CPB initiation. Results: We enrolled 39 children in the high oncotic prime (added albumin) group and 37 children in the conventional prime group. In the first 24-hour postoperative period, children in the albumin group had significantly lower occurrence of hypotension (28.2% vs 54%, P = .02), requirement of fluid boluses (25.6% vs 54%, P = .006), and lactate clearance time (6 vs 9 hours, P < .001). Albumin group also had significantly higher platelet count (×103/µL) at 24 hours (112 vs 91, P = .02). There was no significant difference in intra-CPB hemodynamic parameters and incidence of acute kidney injury. In subgroup analysis based on risk category, significantly decreased intensive care unit stay (4 vs 5 days, P = .04) and hospital stay (5 vs 7 days, P = .002) were found in the albumin group in low-risk category. Conclusion: High oncotic pressure CPB prime using albumin addition might be beneficial over conventional blood prime, and our study does provide a rationale for further studies.

Twenty-one Reasons Affirming Starling’s Law on the Capillary-interstitial Fluid Transfer Wrong and the Correct Replacement is the Hydrodynamic of the Porous Orifice (G) Tube

Many reasons why Starling’s law wrong and the correct replacement is the hydrodynamic of porous orifice (G) tube exist. Starling’s hypothesis is based on Poiseuille’s work in which the hydrostatic pressure causes filtration. The oncotic pressure force of plasma proteins causes re-absorption. Starling’s law is wrong on both forces. The capillary has a pre-capillary sphincter and pores that allow the passage of plasma proteins. This makes the capillary a porous orifice (G) tube with different hydrodynamic; side pressure causes suction not filtration. The pores nullify the oncotic force in vivo. There is evidence to show that the osmotic chemical composition of various body fluids is identical to plasma proteins. The interstitial fluid (ISF) space has a negative pressure of -7 cm water. Evidence on Albumin versus Saline for fluid resuscitation shows no significant difference. This affirms that the oncotic force does not exist in vivo that partly prove Starling’s law wrong. Inadequacy in explaining the capillary–ISF transfer, has previously called for reconsideration of Starling’s hypothesis. Physics and physiological research demonstrate that pressure does not cause filtration across the wall of G tube, it causes suction. In G tube negative side pressure gradient causing suction maximum near the inlet and turns positive maximum near the exit causing filtration. Physiological study completed the evidence that Starling’s law is wrong as the capillary works as G tube not Poiseuille’s tube. Both absorption and filtration are autonomous functions of G tube thus fit to replace Starling’s law. The clinical significance is discussed.

The Correct Replacement for the Wrong Starling’s law is the Hydrodynamic of the Porous Orifice (G) Tube: The Complete Physics and physiological Evidence with Clinical Relevance and Significance

Introduction and objective: To report the complete evidence that Starling’s law is wrong and the correct replacement is the hydrodynamic of the G tube. New physiological evidence is provided with clinical relevance and significance. Material and methods: The physics proof is based on G tube hydrodynamic. Physiological proof is based on study of the hind limb of sheep: running plasma and later saline through the artery compared to that through the vein as regards the formation of oedema. The clinical significance is based on 2 studies one prospective and a 23 case series on volumetric over load shocks (VOS). Results: Hydrodynamic of G tube showed that proximal, akin to arterial, pressure induces suction “absorption” not “filtration”. In Poiseuille’s tube side pressure is all positive causing filtration based on which Starling proposed his hypothesis, The physiological evidence proves that the capillary works as G tube not Poiseuille’s tube: Oedema occurred when fluids are run through the vein but not through the artery. There was no difference using saline or plasma proteins. The wrong Starling’s law dictates the faulty rules on fluid therapy inducing VOS and causing ARDS. Conclusion: Hydrodynamic of the G tube challenges the role attributed to arterial pressure as filtration force in Starling’s law. A literature review shows that oncotic pressure does not work either. The new hydrodynamic of G tube is proposed to replace Starling’s law which is wrong on both forces. The physiological proof and relevance to clinical importance on the pathogenesis of clinical syndromes are discussed.

Colloid Oncotic Pressure in Children with Nephrotic Syndrome

To evaluate the correlation between plasma protein concentration and colloid oncotic pressure (COP) and their influence on clinical symptom of edema, we studied 30 children with nephrotic syndrome (NS). Total plasma protein concentration (TP), albumm, globulin and COP were measured in all patients in edema forming state (EF) and m steady state phase (SS), except for COP, only 16 samples in SS phase. COP TP plasma albumin and globulin contents in EF group were 8. 7 ± 2. 7 mmHg, 4.07 '± 0.68 g/dl; 2.57 ± 0.50 g/dl and 1.51 ± 0.32 g/dl, respectively. In SS group these figures rose significantly to 16.7 ± 3.9 mmHg for COP; 5. 70 ± 0.99 g/dl for TP; 3.46 ± 0.52 g!dl and 2.06 ± 0.56 g/dl for plasma albumin and globulin, respectively. We also found the high correlation both between COP and albumin content (r= +0.58; p < 0.01) and between COP and TP (r= +0.54; P < 0.01) . A strong negative correlation was also found between COP and the degree of edema (r = _ 0.55; p <0.01). On the other hand a very low grade correlation was noticed between plasma albumin content and the degree of edema (r= - 0.26; P < 0.05) and no correlation at all was found between edema and TP (r= - 0.19; P > 0.05). We conclude that COP has the highest correlation with plasma protein concentration and the degree of edema, and can be used as a diagnostic tool. It is even more sensitive and simple compared with the TP or albumin content determination.

Changes of the erythrocyte phenotype and blood biochemistry in dairy calves during the first ten weeks of age

BackgroundBovine erythrocytes undergo important changes in their morphology and chemical composition during the first weeks of age, which must be understood to accurately interpret hematology results in calves. The objectives of this prospective cohort study were to describe physiological changes of calf erythrocytes and to investigate mechanisms potentially causing these changes.MethodsBlood samples from 30 clinically healthy dairy calves were obtained from birth to the tenth week of age in weekly intervals. Hematological and plasma biochemical parameters as well as the mineral electrolyte content of erythrocytes were determined and followed over time. The changes of parameters characterizing the erythrocyte phenotype over time were compared to the changes of plasma and erythrocyte biochemical parameters and possible associations were investigated using correlation and stepwise regression analyses.ResultsAlthough the erythrocyte mean corpuscular volume (MCV) declined from 43.6 ± 3.7 fL to 35.6 ± 3.2 fL between the first and seventh week, the red blood cell count (RBC) increased from 7.2 ± 1.1 × 1012/L to 9.3 ± 1.0 × 1012/L until the fifth week of age. The blood hemoglobin (Hb) concentration increased from 0.96 ± 0.16 g/L to 1.16 ± 0.11 g/L in the first three weeks of age and remained at this level until the end of the study. Changes in MCV were accompanied by a decline of the erythrocyte potassium content (KERY) from 91.9 ± 13.5 to 24.6 ± 7.2 mmol/L and a concomitant increase of the erythrocyte sodium content from 45.0 ± 32.0 to 102.7 ± 26.5 mmol/L. MCV was found to be associated with KERY, the primary determinant of the intra-erythrocyte osmotic pressure from the sixth week of age and with blood hemoglobin, the primary determinant of the intra-erythrocyte oncotic pressure from the eighth week of age, when KERY, blood Hb and MCV already had reached or approached normal levels of adult cattle. The plasma iron concentration was not found to be associated to any of the studied hematological parameters.ConclusionA volume reduction of 20% in bovine neonatal erythrocytes is a physiological change occurring during the first weeks of age and is neither associated with sideropenia nor with anemia in healthy calves. The mechanism driving the observed erythrocyte volume change could not be identified. Results of the correlation and regression analyses indicate that changes in intra-erythrocyte osmotic or oncotic pressure are improbable underlying causes. Results reported here show that KERYis an unreliable indicator for the K homeostasis of the intracellular space in neonatal calves and that a decrease in MCV in early life per-se is an unreliable indicator for the development of microcytic anemia.