Blood purification
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Clinical Trial Controlled Clinical Trial
Effect of polymyxin B-immobilized fiber on blood metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 levels in acute respiratory distress syndrome patients.
Metalloproteinase (MMP)-9 plays a role in the pathogenesis of acute respiratory distress syndrome (ARDS). Polymyxin B-immobilized fiber (PMX-F) treatment improves circulatory disturbance and oxygenation in ARDS patients. We aimed to assess whether PMX-F treatment alters the blood MMP-9 and tissue inhibitor of MMP (TIMP)-1 levels in ARDS patients. ⋯ These data suggest that MMP-9 and TIMP-1 may play a role in the pathogenesis of ARDS and that PMX-F treatment ameliorated increased MMP-9 and TIMP-1 levels in ARDS patients.
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Comparative Study Clinical Trial
Kinetics and dose of daily hemofiltration.
Daily hemofiltration (D-HF) is a new treatment modality that shows unique solute removal characteristics and possibly provides high quality of life for patients with end-stage renal disease. We evaluated solute removal characteristics of D-HF for 5 patients by kinetic modeling analysis. Five patients treated with normal 4-hour x 3 times/week hemodialysis (HD) were switched to D-HF (2-hour x 6 times/week). ⋯ The model also predicted that the 7 times/week D-HF should not increase the pretreatment concentration of UN, expecting even much lower beta(2)-MG concentration after switching from normal HD to D-HF. D-HF is superior to normal HD for removing larger solutes but may increase the TAC of small solutes. A 7-day treatment (7 times/week) D-HF may improve the solute removal capacity of small solutes.
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Clinical Trial
Regional citrate anticoagulation in critically ill patients treated with plasma filtration and adsorption.
In high-risk bleeding conditions conventional systemic anticoagulation with heparin is a contraindication to renal replacement therapy. We evaluate the feasibility and safety of regional citrate anticoagulation in high-risk bleeding conditions during coupled plasma filtration adsorption (CPFA). ⋯ These suits demonstrate the feasibility and safety of regional citrate anticoagulation in severely burned and polytrauma septic patients treated by CPFA.
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To evaluate the outcome of patients who require continuous renal replacement therapy (CRRT) following cardiac surgery. ⋯ Renal impairment is relatively common after cardiac surgery. The mortality of patients who required CRRT after cardiac surgery was 43.5% and was particularly influenced by the type of surgery.
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While brain-dead organ donors represent the majority of the organ donor pool, it appears that graft survival is adversely affected by brain death itself. Brain death has been shown to cause severe disturbances in the hormonal, hemodynamic and immunological homeostasis, which could in part be responsible for the inferior outcome of organs originating from brain-dead donors compared to living donors. Hemodynamic effects of brain death lead to a wide fluctuation in mean perfusion pressures, blood flow to the organs and systemic oxygen consumption, altering regional perfusion. ⋯ Hence, we hypothesize that nonspecific downregulation of this inflammatory response by hemoadsorption could potentially lead to improved donor organ and allograft function. As a 'proof of concept' we tested the ability of a novel hemoadsorbent to remove S100B in vitro using two human glioblastoma cell lines. Our results indicate a >80% reduction in S100B after 2 h of circulation with the sorbent.