Application Of Blood Purification Research Articles

Risk Factors for Post-Operative Multi-Drug-Resistant Organism Bacterial Infection in Patients With Stanford Acute Type A Aortic Dissection.

Background: To explore the risk factors for multi-drug-resistant organism (MDRO) infection in patients with Stanford acute type A aortic dissection (ATAAD). We conducted a retrospective cohort study using the data of post-operative patients with ATAAD in our hospital. Patients and Methods: This study included 82 post-operative patients with ATAAD in the past decade. They were divided into a MDRO group (n = 31) and a non-MDRO group (n = 51) according to whether they had acquired multi-drug-resistant (MDR) bacterial infection. Multivariable logistic regression was used to analyze the risk factors for MDR infections in patients with ATAAD. Results: The incidence of multi-drug-resistant bacterial infection was 37.80%. Seventeen factors, including hospital stay (p = 0.007), utilization of third-generation cephalosporins (p = 0.0068), antibiotic species of exposure (p = 0.0002), leukocyte-depleted red blood cell suspension dosage (p < 0.0001), fresh frozen plasma dosage (p < 0.0001), application of blood purification (p = 0.0493), and the total antibiotic days of exposure (p = 0.0001) diverged between the two groups (all p < 0.05). The logistic regression analysis revealed that the utilization of third-generation cephalosporins (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.01-5.33; p = 0.0478), antibiotic species of exposure (OR, 5.76; 95% CI, 1.45-22.83; p = 0.0128), leukocyte-depleted red blood cell suspension dosage (OR, 12.43; 95% CI, 2.71-57.07; p = 0.0012), and fresh frozen plasma dosage (OR, 5.05; 95% CI, 1.18-21.56; p = 0.0286) were independent variables for MDRO infections. Among the 23 drug-resistant bacteria detected, Acinetobacter baumannii was the main pathogen. Conclusions: Our study shows that the utilization of third-generation cephalosporins, antibiotic species of exposure, leukocyte-depleted red blood cell suspension dosage, and fresh frozen plasma dosage were independent risk factors for post-operative multi-drug-resistant infection in patients with ATAAD. Acinetobacter baumannii occupied the largest share of resistant bacteria that induce infection in post-operative patients with ATAAD.

Clinical application of blood purification in polymyositis/dermatomyositis.

We investigated the clinical efficacy and safety of blood purification technology in patients with polymyositis/dermatomyositis. In a study of 22 patients, 10 cases received blood purification treatment (5 cases received plasma exchange, 5 cases received plasma HA280 immunoadsorption), and 12 cases served as the control group. A 3-month follow-up was conducted to compare the clinical manifestations and laboratory examination. Symptoms and signs of patients in treatment group were significantly improved, and the hormone usage was lower than the control group. For patients with normal creatine kinase level and ferritin level below three times the upper limit of normal, there was a positive correlation between their N/L values and MDAAT scores. The results of this study suggest that blood purification therapy, including plasma HA280 immunoadsorption and plasma exchange, is an effective and safe treatment for patients with polymyositis/dermatomyositis, offering assistance in reducing hormone usage in the long-term.

Application of blood purification based on a new type of nanofiber membrane in critically ill patients and comparative analysis of its nursing methods

Blood purification technology is one of the main treatment methods to prolong the life of severe patients. The traditional blood purification membrane materials have the disadvantages of non-selective adsorption, single pore size and low permeability, and need to develop new and efficient blood purification membrane materials. To explore the application of a new type of nanofiber membrane in blood purification of critically ill patients and compare and analyze its nursing methods. When the experimental subjects are performing blood purification, a new nanofiber membrane material is used in the purification machine. The control group adopted conventional nursing methods, while the experimental group adopted targeted nursing methods based on the nursing methods of the control group. After intervention, the eight indicators of quality of life in the experimental group were significantly improved (P < 0.05), for example, the score of physiological function was increased from 41.042 ± 7.625 to 54.236 ± 2.544, and the energy status was increased from 46.094 ± 7.192 to 59.768 ± 4.241. The physiological and biochemical indexes of both groups tend to be normal, but the experimental group is more obvious. The patients in the experimental group were more satisfied with the nursing services provided in the process. The new blood purification method of nanofiber membrane can overcome the shortcomings of traditional purification and remove toxic small and medium-sized molecules to the maximum extent.

MOFs-alginate/polyacrylic acid/poly (ethylene imine) heparin-mimicking beads as a novel hemoadsorbent for bilirubin removal in vitro and vivo models

Metal–organic frameworks (MOFs) have a potential application in blood purification, but their microcrystalline nature has hampered their industrial application. Here, novel MOFs-polymer beads based on UiO, sodium alginate, polyacrylic acid, and poly (ethylene imine) were prepared and applied as a whole blood hemoadsorbent for the first time. The amidation among polymers immobilized UiO66-NH2 into the network of the optimal product (SAP-3), and the NH2 of UiO66-NH2 significantly increased the removal rate (70 % within 5 min) of SAP-3 on bilirubin. The adsorption of SAP-3 on bilirubin mainly obeyed the pseudo-second-order kinetic, Langmuir isotherm and Thomas models with a maximum adsorption capacity (qm) of 63.97 mg·g−1. Experimental and density functional theory simulation results show that bilirubin was mainly adsorbed by UiO66-NH2via electrostatic force, hydrogen bonding, and π-π interactions. Notably, the adsorption in vivo show that the total bilirubin removal rate in the whole blood of the rabbit model was up to 42 % after 1 h of adsorption. Given its excellent stability, cytotoxicity, and hemocompatibility, SAP-3 has a great potential in hemoperfusion therapy. This study proposes an effective strategy for settling the powder property of MOFs and could provide experimental and theoretical references for application of MOFs in blood purification.

Clinical Analysis of Early Application of Blood Purification in the Treatment of Acute Severe Poisoning

Clinical Analysis of Early Application of Blood Purification in the Treatment of Acute Severe Poisoning

Fabrication of a novel nitrogen-containing porous carbon adsorbent for protein-bound uremic toxins removal

Protein-bound uremic toxins (PBUTs), the presence of which in the blood is an important risk factor for the progression of chronic kidney disease (CKD), have not been cleared efficiently via traditional hemodialysis methods until now. In this study, biosafe and efficient nitrogen-containing porous carbon adsorbent (NPCA) beads for the clearance of PBUTs were prepared from porous acrylonitrile/divinylbenzene cross-linked copolymer beads followed by pyrolysis. The resulting NPCA beads were characterized via SEM, XPS and nitrogen adsorption/desorption tests. The results demonstrated that the NPCA beads possessed a mesoporous/microporous hierarchical structure with rich nitrogen functional groups on their surfaces and realized efficient PBUTs adsorption in human plasma. More importantly, the efficacy of PBUTs removal was substantially higher than those of commercial adsorbents that are commonly used in clinical uremia treatments. The NPCA beads also exhibited satisfactory removal efficacy towards middle-molecular-weight uremic toxins. The PBUTs removal mechanism of the NPCA beads is ascribed to effective competition between nitrogen-containing NPCA and proteins for PBUT binding. According to hemocompatibility assays, the NPCA beads possessed satisfactory in vitro hemocompatibility. This nitrogen-containing porous carbon adsorbent is an attractive and promising material for blood purification applications in the treatment of clinical uremia.

血液净化在多发性骨髓瘤肾病中的应用

血液净化在多发性骨髓瘤肾病中的应用

Clinical application of blood purification in treatment of severe adenovirus pneumonia

To study the role of blood purification in the treatment of severe adenovirus pneumonia. A total of 57 children with severe adenovirus pneumonia who underwent mechanical ventilation from February to June, 2019, were enrolled. According to whether blood purification was performed, they were divided into a purification group with 22 children and a conventional group with 35 children. Related clinical indices were collected, including duration of fever, duration of mechanical ventilation, length of stay in the intensive care unit (ICU), and mortality rate. The purification group was analyzed in terms of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) before blood purification and at 48 hours after blood purification, as well as stroke volume variation (SVV), thoracic fluid content (TFC), arterial partial pressure of oxygen/fraction of inhaled oxygen (P/F) value, and partial pressure of carbon dioxide (PCO2) before blood purification and at 6, 12, 24, and 48 hours after blood purification. Compared with the conventional group, the purification group had significantly shorter duration of fever, duration of mechanical ventilation, and length of stay in the ICU (P<0.05), and there was no significant difference in the mortality rate between the two groups (P>0.05). The purification group had significant reductions in IL-6 and TNF-α after blood purification, (P<0.05) and significant reductions in SVV and TFC at 12, 24, and 48 hours after blood purification (P<0.01), as well as a significant increase in P/F value and a significant reduction in PCO2 at 6, 12, 24, and 48 hours after blood purification (P<0.01). Blood purification as an auxiliary therapy can effectively improve the clinical symptoms of children with severe adenovirus pneumonia, and is thus an option for the treatment of severe adenovirus pneumonia in children.

A zwitterionic polymer/PES membrane for enhanced antifouling performance and promoting hemocompatibility

Although zwitterionic polymers exhibit outstanding non-fouling property and biocompatibility, their poor solubility in organic solvents limits their practical applications. In this work, an amphiphilic zwitterionic polymer whose core is made of PES matrix was designed via addition and quaternization, which exhibited excellent solubility in various organic solvents and good compatibility with PES. Its incorporation into the PES matrix by direct blending endowed the resulting membrane with excellent hydrophilicity and high water flux (243.4 L m−2 h−1), which was amplified about 2 times that of the pure PES membrane (125.0 L m−2 h−1), and the flux recover ratio was as high as 93.8%. Especially, the hemocompatibility of membranes determined by the protein adsorption, platelet adhesion, hemolysis ratio, plasma recalcification time, complement activation and whole blood clotting time tests confirmed that the PES/PES-zwitterionic membrane possessed excellent anticoagulation effect, mainly due to the gathering of zwitterions on membrane surface. Meanwhile, the low surface roughness of membrane also played an important role in hemocompatibility. The mutiphysical-chemical properties of the membrane allow it to function with synergy between permeability and hemocompatibility for further blood purification applications. We expect this methodology for construction of an enhanced and promoted hemocompatibility by chemical design will shed light on the material design. And this facile approach may have great potential in fabrication of blood purification membrane in large scale.

Preparation of Nitrogen-Doped Mesoporous Carbon for the Efficient Removal of Bilirubin in Hemoperfusion.

The development of bilirubin adsorbent with high selectivity, brilliant adsorption ability, and biocompatibility is still a considerable challenge. In this study, a copolymer-templated nitrogen-doped mesoporous carbon (CTNC) has been prepared via a simple carbonization procedure of well-defined polyacrylonitrile-block-poly(n-butyl acrylate) (PAN-b-PBA) block copolymer precursors. The structure and morphology were characterized by transmission electron microsphere (TEM), adsorption-desorption isotherms, and X-ray photoelectron spectroscopy (XPS). Owing to its high specific area, hierarchical open-porous structure, and the introduction of nitrogen atoms in graphitic sp2 network, the adsorbent CTNC exhibited high removal efficiency toward bilirubin and bile acid from human plasma. The removal rate of bilirubin was more than 50.7% with a minimal loss of albumin. Meanwhile, exceeding 95% of bile acid was eliminated. The effect of albumin on the adsorption kinetic of bilirubin was identified. The result indicated that the adsorption rate of BSA-bonded bilirubin experienced a decline than that of free bilirubin, but the adsorption capacity was still up to 39.8 mg/g within 2 h. Moreover, the effect of porosity and nitrogen contents on bilirubin adsorption ability and blood compatibility were systematically investigated. The material with lower nitrogen content showed only a negligible hemolysis activity. Therefore, the nitrogen-doped mesoporous carbon developed in this work has potential application in blood purification for the efficient removal of bilirubin.

Improving the clearance of protein-bound uremic toxins using cationic liposomes as an adsorbent in dialysate

Anionic and protein-bound uremic toxins, represented by indoxyl sulfate (IS), may be associated with cardiovascular outcomes and the progression of chronic kidney disease in cases of injured kidney function and are not easily cleared by traditional dialysis therapy. We fabricated cationic liposomes that were modified with polyethyleneimine (PEI), octadecylamine (Oct), and hexadecyl trimethyl ammonium bromide (CTAB), and evaluated the effects on the clearance of the representative protein-bound uremic toxins (PBUTs). The binding rate was obtained by ultrafiltration and in vitro dialysis was performed in a Rapid Equilibrium Dialysis (RED) device to assay the clearing efficiency of the dialysate supported by three types of cationic liposomes. The cationic liposomes showed a higher binding rate with IS (1.24–1.38 fold higher) and p-cresol (1.07–1.09 fold higher) than in the unmodified plain liposomes. The dialysate supported by cationic liposomes also exhibited better clearing efficiency for IS (PEI-20: 57.65 ± 1.74 %; Oct-5: 62.80 ± 0.69 %; CTAB-10: 66.54 ± 0.91 %; p < 0.05) and p-cresol (PEI-20: 67.05 ± 3.09 %; Oct-5: 79.26 ± 0.43 %; CTAB-5: 68.45 ± 1.72 %; p < 0.05) than for phosphate buffer saline (IS: 29.70 ± 2.38 %; p-cresol: 33.59 ± 3.44 %) or dialysate supported by bovine serum albumin (IS: 50.00 ± 4.01 %; p-cresol: 53.06 ± 0.97 %). In conclusion, cationic liposomes are efficient in the clearance of anionic PBUTs, and these modified liposomes suggest a potential application in blood purification.

Application of blood purification in acute lymphoblastic leukemia pediatric patients with hypermethotrexemia accompanied with acute kidney injury

Objective To investigate the efficacy of blood purification for acute lymphoblastic leukemia pediatric patients with high-dose methotrexate(MTX)-induced hypermethotrexemia and acute kidney injury (AKI). Methods The clinical data of 50 acute lymphoblastic leukemia pediatric patients with hypermethotrexemia (the 45th hour MTX blood concentration >20 μmol/L) and AKI who were admitted to Beijing Children's Hospital Capital Medical University from May 2010 to August 2018 were collected. After the treatment of blood purification, the declining rate of MTX concentration, the incidence of drug-related side effects and the clinical transition were analyzed retrospectively. Results The median MTX blood concentration at the 45th hour after high-dose MTX chemotherapy was 31.5 μmol/L (20.0-80.3 μmol/L). After blood purification treatment, 48 patients (96%) survived, 1 patient (2%) died, and 1 patient (2%) gave up treatment. It costed 10.0 days (7.0-15.0 days) to decline the MTX concentration to the normal level by using blood purification. The median time of purification was 32.5 hours (2.0-168.0 hours), and the days of dialysis were 3.0 days (1.0-9.0 days). The AKI occurred in approximately 96% (48/50) of patients, which was the main side effect. The time of declining the high MTX concentration to the normal was positively correlated with the increase times of serum creatinine (r = 0.371, P = 0.009) and urea nitrogen (r = 0.486, P = 0.001), and the value of the alanine aminotransferase (r = 0.364, P = 0.010) and gamma glutamyl transpeptidase (r = 0.344, P = 0.010), and the days of dialysis (r = 0.532, P < 0.01), but there was no relationship with the 45th hour MTX blood concentration (r=0.110, P = 0.248). The reduction of MTX blood concentration from the 45th hour to the 69th hour after high-dose MTX chemotherapy was negatively correlated with the increase times of urea nitrogen (r = -0.336, P = 0.009) and serum creatinine (r = -0.260, P = 0.035). Conclusion When the MTX blood concentration of patients with hypermethotrexemia and AKI couldn't be declined to the normal level by using high-dose leucovorin, hydration and alkalization, and without the effective detoxification drug (carboxypeptidase G2), they should be offered blood purification, especially continuous renal replacement therapy as soon as possible, which can reduce the blood concentration of MTX quickly and decrease the incidence of side effects effectively. Key words: Leukemia, lymphoblastic, acute; Methotrexate; Blood purification

Preparation of chitosan/SiO2-loaded graphene composite beads for efficient removal of bilirubin

Porous nanocomposite materials possess enhanced adsorption properties, but uniformly dispersing nanofillers in polymer matrices is still a challenging technical difficulty. In this study, modification through loading with SiO2 successfully improved the dispersibility of graphene in chitosan suspensions. By employing a phase-inversion method, cross-linked chitosan/SiO2-loaded graphene (CS/graphene-SiO2) composite beads were prepared. The resulting CS/graphene-SiO2 beads were characterized by scanning electron microscopy and Raman spectroscopy, which clearly showed that graphene was well-dispersed in the chitosan matrix. Adsorption results demonstrated that CS/graphene-SiO2 beads possessed much better adsorption capacity for bilirubin (77.87%) compared to pure chitosan (CS) beads (22.47%), mainly due to the synergistic effect between the hydrophobic forces of graphene and the electrostatic interactions provided by the amino groups of CS. The adsorption of bilirubin was found to match a monolayer model, as well as a pseudo-first-order kinetic model. The mechanical strength of composite beads was significantly improved as compared to CS beads, due to the incorporation of graphene. The effects on hemolytic activity and the components of blood were negligible, which indicate an excellent compatibility of the obtained composite beads with blood. Overall, the proposed CS/graphene-SiO2 beads as an efficient adsorbent for bilirubin have high potential in blood purification applications.

Nanofibrous composite hemodiafiltration membrane: A facile approach towards tuning the barrier layer for enhanced performance

In order to develop advanced hemodiafiltration membrane with favorable biocompatibility and efficient dialysis performance, novel thin film nanofibrous composite (TFNC) ultrafiltration (UF) membranes consisting of sulfonated poly(vinyl alcohol) (s-PVA) blended PVA hydrogel barrier layer and electrospun polyacrlonitrile (PAN) nanofibrous supporting layer were designed and fabricated by combining electrospinning and conventional surface coating techniques. The mesh sizes of hydrogel network of s-PVA/PVA barrier layer could be tuned by varying the blending content of s-PVA. The optimized s-PVA/PVA TFNC UF membrane (S-P-TFNC-1-3) possessed high pure water flux up to 380 L m−2 h−1 bar−1 with high bovine serum albumin (BSA) rejection (>90%). Besides, the introduction of s-PVA into the hydrogel barrier layer endowed the TFNC membranes with enhanced hydrophilicity, antifouling property and biocompatibility (decreased protein adsorption, prolonged clotting time, suppressed platelet adhesion, lower hemolysis ratio and more benefits for cell proliferation) due to the presence of sulfonic groups. The dialysis simulation experiment results of S-P-TFNC-1-3 showed that 84.2% of urea and 60.9% of lysozyme were cleaned and over 95% of BSA was retained after 4 h dialysis process. Especially, the removal of middle-molecule uremic toxin was more efficient than conventional hemodialysis membranes reported so far, and high retention of big proteins was achieved simultaneously. This work exposes a window of opportunity for modified PVA TFNC membranes in blood purification applications.

Preparation of chitosan/amino multiwalled carbon nanotubes nanocomposite beads for bilirubin adsorption in hemoperfusion.

Chitosan-carbon nanotube composite beads combines the advantages of chitosan in forming a stable biocompatible framework and carbon nanotube that provide nanometer effects (high strength and high specific surface area etc.). In this study, chitosan/amino multiwalled carbon nanotubes (CS/AMWCNT) composite beads was prepared by phase-inversion method, in which CS and AMWCNT was crosslinked by ethylene glycol diglycidyl ether (EGDE). The CS/AMWCNT nanocomposite beads produced has been characterized by BET, SEM, TGA, and Raman spectroscopy which exhibited enhanced thermal stability due to the incorporation of AMWCNT. Mechanical test results showed that mechanical strength of the CS/AMWCNT composite beads was significantly enhanced when comparing to unmodified chitosan beads, the breakage percentage decreased from 34.1% to 0.67%. The adsorption capacity for bilirubin was measured in PBS and BSA solutions, and the CS/AMWCNT composite beads with 5 wt% AMWCNT showed much higher adsorption capacity (12.7 mg/g in PBS and 7.6 mg/g in BSA) to bilirubin than chitosan beads (8.5 mg/g in PBS and 4.2 mg/g in BSA). Our nanocomposite beads with excellent hemocompatibility has a high potential application in blood purification as an efficient adsorbent for bilirubin. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 96-103, 2018.

Graphene Oxide Nanocomposite Incorporated Poly(ether imide) Mixed Matrix Membranes for in Vitro Evaluation of Its Efficacy in Blood Purification Applications

Hemodialysis is one of the most commonly used treatments for patients suffering from irrecoverable kidney damage. In our present work, we investigate poly(ether imide) (PEI) mixed matrix membranes (MMMs) as a potential candidate for hemodialysis applications due to their efficient clearance and high biocompatibility. Graphene oxide (GO) was synthesized by the modified Hummers’ method and was then confirmed by X-ray diffraction spectroscopy, Fourier transform infrared spectroscopy, Raman spectroscopy, and high-resolution transmission electron microscopy. The GO-polyvinylpyrrolidone nanocomposite incorporated PEI MMMs were fabricated by a semiautomatic casting unit using the nonsolvent induced phase separation technique. The effect of the nanocomposite loading ratio was evaluated by water content, ultrafiltration rate, and porosity, which were all found to increase as the nanocomposite content increased. Cross-sectional and top surface morphology was visualized using scanning electron microscopy and atomic ...

The clinical application of pulse indicator continuous cardiac output monitoring in early fluid resuscitation for patients with severe acute pancreatitis

To evaluate the therapeutic effect of early fluid resuscitation under the guidance of pulse indicator continuous cardiac output (PiCCO) on patients with severe acute pancreatitis (SAP). Clinical data of 18 SAP patients (research group), who had undergone fluid resuscitation under the guidance of PiCCO in the Department of Critical Care Medicine of the Second Affiliated Hospital of Anhui Medical University from October 2011 to October 2013, were analyzed prospectively. At the same time, clinical data of 25 cases (control group) that had undergone fluid resuscitation without the guidance of PiCCO from January 2009 to September 2011 were collected retrospectively. The volume of fluid and clinical data were compared between two groups. During the first 6 hours, 0-24 hours, 24-48 hours, and 0-72 hours after intensive care unit (ICU) admission, the research group received larger volume of fluid than that of the control group (2 133 ± 1 593 mL vs. 1 024 ± 421 mL, t=3.337, P=0.002; 5 960 ± 2 951 mL vs. 3 767 ± 854 mL, t=3.531, P=0.001; 4 709 ± 1 508 mL vs. 3 863 ± 1 122 mL, t=2.112, P=0.031; 14 601 ± 5 095 mL vs. 11 409 ± 2 667 mL, t=2.673, P=0.007). Compared with the control group, the incidence of application of blood purification was lowered [5.56% (1/18) vs. 44.00% (11/25), χ² = 7.688, P=0.006], the duration of the systemic inflammatory response syndrome (SIRS) was shortened (3.54 ± 2.44 days vs. 5.62 ± 3.62 days, t=2.113, P=0.041), acute physiology and chronic health II (APACHEII) score was significantly declined at 24 hours after admission (11 ± 4 vs. 14 ± 5, t=2.104, P=0.042), the blood lactic acid was decreased more significantly after 72 hours (3.10 ± 0.55 mmol/L vs. 2.40 ± 1.12 mmol/L, t=2.442, P=0.019), and the length of ICU stay was shortened (10 ± 9 days vs. 20 ± 10 days, t=3.371, P=0.002) in research group. But there was no significant difference in the percentage of the use of vasoactive drugs [16.67% (3/18) vs. 24.00% (6/25), χ² =0.340, P=0.560], the incidence of invasive mechanical ventilation [50.00% (9/18) vs. 52.00% (13/25), χ² = 0.017, P=0.897], 72-hour urea nitrogen changes (-0.33 ± 4.71 mmol/L vs. -0.09 ± 5.37 mmol/L, t=0.152, P=0.880), and the percentage of abdominal infection[16.67% (3/18) vs. 16.00% (4/25), χ² = 0.003, P=0.953] between research group and control group. The mortality in research group was lower than that in control group [5.56% (1/18) vs. 20.00% (5/25)] without statistical difference (χ² = 1.819, P=0.178). According to the 2012 Atlanta classification, patients were re-evaluated after 48 hours fluid resuscitation. Six patients in research group developed moderately severe acute pancreatitis, and the incidence was significantly higher than that in control group [33.33% (6/18) vs. 8.00% (2/25), χ² = 4.435, P=0.034]. The time of mean PiCCO installation was 4.5 days in 18 cases of the research group, and no related complications occurred. The PiCCO device may be a useful adjunct for fluid resuscitation monitoring in patients with SAP within 72 hours. Early fluid resuscitation under the guidance of PiCCO may be helpful in improving tissue perfusion, reducing the application of blood purification, as well as shortening length of ICU stay. This program did not increase the risk of invasive mechanical ventilation, and no obvious change in mortality rate was observed.

Clinical application of blood purification (artificial liver) in treatment of acute liver failure in children

To investigate the clinical application, indication, timing and prognosis of blood purification (artificial liver, BP) in treatment of acute liver failure in children. Artificial liver was used to treat 30 cases of pediatric acute liver failure (PALF), who were hospitalized in pediatric intensive care unit of Bayi Children's Hospital Affiliated to Beijing Military Command General Hospital, during March 2010 to July 2013. Simple plasma exchange (PE) mode was used for PALF without complications, while PE combined with continuous veno-venous hemodiafiltration (CVVHDF) mode was used for PALF with cerebral edema and/or hepatorenal syndrome and/or serious abnormality of electrolyte and acid-base balance. Sixteen cases survived and restored hepatic function, with a survival rate of 53.3%. Single PE therapy could significantly decrease total bilirubin (TBIL) from (293.96 ± 214.52) µmol/L to (155.64 ± 140.97) µmol/L (P = 0.033), increase prothrombin time activity (PTA) from (34.50 ± 18.34) % to (60.50 ± 33.97) % (P = 0.013), while it did not significantly influence ammonia from (156.43 ± 67.23) µmol/L to (124.03 ± 62.58) µmol/L (P = 0.156) and alanine transarninase (ALT) from (752.53 ± 1 291.84) U/L to (132.00 ± 98.57) U/L (P = 0.066). PE + CVVHDF therapy could significantly ameliorate TBIL from (326.90 ± 233.85) µmol/L to (157.53 ± 125.31) µmol/L (P = 0.033), ALT from (1 476.64 ± 1 728.18) U/L to (169.38 ± 207.18) U/L (P = 0.019), ammonia from (215.83 ± 83.92) µmol/L to (141.25 ± 63.09) µmol/L (P = 0.022) and PTA from (36.68 ± 23.13)% to (71.75 ± 50.50) % (P = 0.044). Prothrombin time (PT) from (29.71 ± 17.75)s to (16.27 ± 6.38)s (P = 0.008) , ALT from (1 574.11 ± 1 775.96) U/L to (145.81 ± 113.89 ) U/L (P = 0.003) , TBIL from (233.16 ± 219.70) µmol/L to (75.19 ± 86.07) µmol/L (P = 0.012) , ammonia from (182.75 ± 90.07) µmol/L to (101.81 ± 37.14) µmol/L (P = 0.002) and PTA from (38.38 ± 20.39)% to (83.13 ± 41.68)% (P = 0.001) in survived cases significantly ameliorated after BP therapy. TBIL from (394.04 ± 192.80) µmol/L to (249.34 ± 113.97) µmol/L (P = 0.023) in died cases declined significantly after BP therapy, while alteration of PT, ALT, ammonia , and PTA had no statistical significance (P > 0.10) after BP therapy. PE + CVVHDF therapy could significantly ameliorate not only TBIL and PTA but also ammonia and ALT compared with single PE therapy. The decline of only an index like TBIL or ALT after BP therapy could not improve the prognosis. The inconsistency between serum bilirubin and ALT levels was an important factor that suggested poor prognosis of ALF, and it might increase survival rate to use BP therapy before that inconsistency emerged.

Route to hemocompatible polyethersulfone membranes via surface aminolysis and heparinization

Polyethersulfone (PES) membranes with improved hemocompatibility were prepared via solid–liquid interface aminolysis and heparinization. Reactive amino groups were generated by immersing solid PES membranes in proper diamine solution. Heparin was covalent immobilized on the surface via amide bond. The feasibility of surface aminolysis for the introduction of amino groups and the effectiveness for further heparin immobilization were confirmed by surface group analysis. The effect of aminolysis time on surface amino group concentration and bulk mechanical properties was investigated. The surface amino group concentration determined the amount and bioactivity of immobilized heparin chains. SEM images suggested that both the aminolysis and heparinization reaction had little effect on the surface morphology of PES membranes. Contact angle measurement, surface charge analysis, protein and platelet adsorption/adhesion experiment were applied to study the surface properties. The results showed that the heparinized PES membranes displayed enhanced hydrophilicity and hemocompatibility, indicating potential application in blood purification and other blood contacting fields.

Application of blood purification to prevent distant organ dysfunction in AKI

Application of blood purification to prevent distant organ dysfunction in AKI