Colloid Osmotic Pressure Research Articles

Point-of-Care Ultrasound Abnormalities in Late-Onset Severe Preeclampsia: Prevalence and Association With Serum Albumin and Brain Natriuretic Peptide

(Anesth Analg. 2019;128(6):1208–1216) Care providers frequently use point-of-care ultrasound (POCUS) on pregnant women diagnosed with preeclampsia to prevent serious afflictions such as cerebral complications or cardiorespiratory failure. Present-day ultrasound research has found a number of indicators for pulmonary interstitial syndrome (PIS) and a higher optic nerve sheath diameter (ONSD), the latter of which could indicate elevated intracranial pressure. As of now, irregular laboratory markers of oncotic pressure and cardiac dysfunction have inconclusive clinical applications; many experts posit that reduced serum albumin level is a contributor to excessive brain fluid and brain swelling. These investigators examined patients with preeclampsia to determine how PIS, ONSD, brain natriuretic peptide (BNP), and serum albumin level contribute to cardiac dysfunction. They also aimed to study the comparison of information acquired from a POCUS examination to information recorded with traditional clinical methods.

Discriminating transudates and exudates in dogs with pleural effusion: diagnostic utility of simplified Light’s criteria compared with traditional veterinary classification

ObjectivesTo determine whether the simplified Light’s criteria (ie, pleural effusion lactate dehydrogenase concentration and serum total protein) can identify the pathophysiology of pleural effusion formation in dogs, and to assess...

Fatty Acid Oxidation and Mitochondrial Morphology Changes as Key Modulators of the Affinity for ADP in Rat Heart Mitochondria.

Fatty acids are the main respiratory substrates important for cardiac function, and their oxidation is altered during various chronic disorders. We investigated the mechanism of fatty acid–oxidation-induced changes and their relations with mitochondrial morphology and ADP/ATP carrier conformation on the kinetics of the regulation of mitochondrial respiration in rat skinned cardiac fibers. Saturated and unsaturated, activated and not activated, long and medium chain, fatty acids similarly decreased the apparent KmADP. Addition of 5% dextran T-70 to mimic the oncotic pressure of the cellular cytoplasm markedly increased the low apparent KmADP value of mitochondria in cardiac fibers respiring on palmitoyl-l-carnitine or octanoyl-l-carnitine, but did not affect the high apparent KmADP of mitochondria respiring on pyruvate and malate. Electron microscopy revealed that palmitoyl-l-carnitine oxidation-induced changes in the mitochondrial ultrastructure (preventable by dextran) are similar to those induced by carboxyatractyloside. Our data suggest that a fatty acid oxidation-induced conformational change of the adenosine diphosphate (ADP)/adenosine triphosphate (ATP) carrier (M-state to C-state, condensed to orthodox mitochondria) may affect the oxidative phosphorylation affinity for ADP.

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.

Physical and Rheological Characteristics of Hydroxypropyl, Acid‐Thinned Tapioca Starch‐Based Plasma Expander for Blood Volume Replacement

AbstractPlasma expander (PE) is fluid administered to instantly restore intravascular volume after massive blood loss. PEs can be prepared from various types of polymers such as dextran, albumin, and starch derivatives. This study investigates an alternative source of starch for PEs, that is, hydroxypropyl, acid‐thinned tapioca starch (HPS). HPS is dissolved in 0.9% sodium chloride solution at different concentrations (2%, 4%, 6%, 8%, and 10%). The physical and rheological properties (turbidity, pH, colloid osmotic pressure (COP), and viscosity) and storage stability are compared with 6% of hydroxyethyl starch (6% HES 130/0.4). It clearly demonstrates that turbidity, COP, and viscosity of HPS‐based PE increase when the concentration of HPS increases. The pH of the HPS‐based PE is higher than that of the 6% HES 130/0.4. The viscosity of 6% HPS‐based PE is close to 6% HES 130/0.4 that shows a Newtonian fluid behavior. The COP of 8% HPS‐based PE is similar to 6% HES 130/0.4. After storing for 4 weeks, the viscosity of each concentration is of similar value compared to Day 1. Using a hydroxypropyl tapioca starch as PE has more advantages than HES‐based PE, HPS can be prepared more economically and safely, on a commercial scale, than HES.

Marathoners' Breathing Pattern Protects Against Lung Injury by Mechanical Ventilation: An Ex Vivo Study Using Rabbit Lungs.

Breathing during a marathon is often empirically conducted in a so-called "2:2 breathing rhythm," which is based on a four-phase cycle, consisting of the 1st and 2nd inspiratory and the 1st and 2nd expiratory phases. We developed a prototype ventilator that can perform intermittent positive pressure ventilation, mimicking the breathing cycle of the 2:2 breathing rhythm. This mode of ventilation was named the marathoners' breathing rhythm ventilation (MBV). We hypothesized that MBV may have a lung protective effect. We examined the effects of the MBV on the pulmonary pre-edema model in isolated perfused rabbit lungs. The pulmonary pre-edema state was induced using bloodless perfusate with low colloid osmotic pressure. The 14 isolated rabbit lung preparations were randomly divided into the conventional mechanical ventilation (CMV) group and MBV group, (both had an inspiratory/expiratory ratio of 1/1). In the CMV group, seven rabbit lungs were ventilated using the Harvard Ventilator 683 with a tidal volume (TV) of 8 mL/kg, a respiratory rate (RR) of 30 cycles/min, and a positive end-expiratory pressure (PEEP) of 2 cmH2O for 60 min. In the MBV group, seven rabbit lungs were ventilated using the prototype ventilator with a TV of 6 mL/kg, an RR of 30 cycles/min, and a PEEP of 4 cmH2O (first step) and 2 cmH2O (second step) for 60 min. The time allocation of the MBV for one cycle was 0.3 s for each of the 1st and 2nd inspiratory and expiratory phases with 0.2 s of intermittent resting between each phase. Peak airway pressure and lung wet-to-dry ratio after 60 min of ventilation were lower in the MBV group than in the CMV group. MBV was considered to have a lung-protective effect compared to CMV.

Differential diagnosis and treatment of edema of lower extremities

The article gives a definition, classification and mechanisms for the development of edema (increased hydrostatic pressure, increased capillary permeability, decreased colloidal osmotic pressure). The main diseases accompanied by edematous syndrome are considered, diagnostic search algorithms are given. The clinic and treatment of edema of the lower extremities due to lymphatic and venous insufficiency are separately discussed. The data of a clinical study of the effectiveness of drugs based on diosmin and hesperidin in the treatment of chronic venous insufficiency are presented.

Evaluation of Methotrexate Clearance in Adult and Pediatric Patients with Hypoalbuminemia

Introduction: Methotrexate (MTX) is a weak acid that is approximately 50% bound to serum albumin. Although data are limited, recent publications have shown higher MTX concentrations in patients with low albumin levels. It has been proposed that hypoalbuminemia alters MTX clearance through two distinct mechanisms: 1) increased formation of intracellular MTX polyglutamates, and 2) development of third-space fluid collections in the absence of appropriate colloidal osmotic pressure. The purpose of our study was to evaluate the effect of albumin on MTX clearance in cancer patients. Methods: This single center, retrospective analysis included hospitalized adult and pediatric patients receiving high-dose MTX therapy (≥ 1 g/m2). The study was approved by the local IRB. Adult patients' records were reviewed from January 2015 to December 2018, and pediatric patients' records were reviewed from August 2016 to December 2018. Patients were included in the study more than once if they had a repeat but separate hospital encounter. The primary outcome measure was the average time to MTX clearance in patients with normal (3.5 g/dL to 5 g/dL) versus low (< 3.5 g/dL) serum albumin levels. MTX clearance was defined as the first recorded time that the level was ≤ 0.1 μM/L. Secondary outcomes included MTX levels at 24, 48, and 72 hours; rate of delayed clearance; rate of toxicities; hospital length of stay; and other factors that contribute to delayed clearance. Group comparisons for continuous data were made using Student's t-test or Mann-Whitney U test. Chi-square or Fisher's exact test was used for categorical data. To evaluate the relationship between time to MTX clearance and toxicities, Cox proportional hazards models were used. Analyses were conducted separately for pediatric and adult patients. P values < 0.05 were considered statistically significant. Results: Of 510 encounters initially screened, 204 adult patient encounters and 106 pediatric patient encounters were included. Among the adults and pediatric patients, 52% and 23% had hypoalbuminemia, respectively. In both cohorts, baseline characteristics were largely similar between the groups (Table 1). The most common cancer diagnosis among adults was lymphoma (60%). High-dose MTX ± rituximab (58%) and HyperCVAD (39%) were the most common protocols used in the adult population. The majority of pediatric patients had leukemia (55%). Results are shown in Table 2. Adult outcomes: MTX clearance was prolonged in patients with hypoalbuminemia when compared to those with normal albumin levels (108 hours vs 78.7 hours; p=0.0012) with a significantly higher percentage of the former group experiencing delayed clearance (42.8% vs 24.2%; p=0.00077). Mean length of stay was longer among hypoalbuminemic patients (17.6 days vs 8.7 days; p=0.0001). There were no statistically significant differences in rate of toxicities (Table 3). However, there was a trend towards an increased rate of grades 3-4 hepatitis among patients with low albumin levels (28.6% vs 15.8%; p=0.073). Further analysis utilizing a Cox proportional hazards model revealed that a shorter infusion time (HR 0.4, 95% CI 0.22-0.75) had a protective effect on MTX clearance. Conversely, MTX doses of 1-2.9 g/m2 (HR 3.26, 95% CI 1.52-6.97) were associated with delayed excretion of MTX. Age (HR 0.94, 95% CI 0.83-1.06), hypoalbuminemia (HR 0.94, 95% CI 0.49-1.79) and a MTX dose of 3-5.9 g/m2 (HR 1.57, 95% CI 0.64-3.88) were not significant predictors of delayed clearance. Pediatric outcomes: There was no statistically significant difference between the two groups with regard to mean time to MTX clearance. Overall mean length of stay was 7.6 days in the low albumin group and 4.4 days in the normal albumin group (p<0.00001). There were no differences in mean MTX levels at 24, 48, or 72 hours. As seen in Table 3, hypoalbuminemic patients had an increased rate of hepatitis (58.3% vs 47.9%; p= 0.017). Using the Cox analysis, the most significant predictors of delayed MTX clearance were serum creatinine and age. Conclusion: Adult patients with hypoalbuminemia had prolonged MTX excretion but this observation did not translate into an increased rate of toxicities. No difference in clearance time was detected between the two pediatric groups. To our knowledge, this is the largest study to demonstrate that high-dose MTX in combination with aggressive supportive care can be safely administered to patients with low albumin levels. Disclosures No relevant conflicts of interest to declare.

Effect of Coagulation Factor Concentrates on Markers of Endothelial Cell Damage in Experimental Hemorrhagic Shock.

Plasma-based resuscitation showed protective effects on the endothelial glycocalyx compared with crystalloid resuscitation. There is paucity of data regarding the effect of coagulation factor concentrates (CFC) on the glycocalyx in hemorrhagic shock (HS). We hypothesized that colloid-based resuscitation supplemented with CFCs offers a therapeutic value to treat endothelial damage following HS. Eighty-four rats were subjected to pressure-controlled (mean arterial pressure (MAP) 30-35 mm Hg) and lab-guided (targeted cutoff: lactate >2.2. mmol/L and base deficit > 5.5 mmol/L) HS. Animals were resuscitated with fresh frozen plasma (FFP), human albumin (HA) or Ringer's lactate (RL) and RL or HA supplemented with fibrinogen concentrate (FC) or prothrombin complex concentrate (PCC). Serum epinephrine and the following markers of endothelial damage were assessed at baseline and at the end-of-observation (120 min after shock was terminated): syndecan-1, heparan sulfate, and soluble vascular endothelial growth factor receptor 1 (sVEGFR 1). Resuscitation with FFP had no effect on sVEGFR1 compared with crystalloid-based resuscitation (FFP: 19.3 ng/mL vs. RL: 15.9 ng/mL; RL+FC: 19.7 ng/mL; RL+PCC: 18.9 ng/mL; n.s.). At the end-of-observation, syndecan-1 was similar among all groups. Interestingly, HA+FC treated animals displayed the highest syndecan-1 concentration (12.07 ng/mL). Resuscitation with FFP restored heparan sulfate back to baseline (baseline: 36 ng/mL vs. end-of-observation: 36 ng/mL). The current study revealed that plasma-based resuscitation normalized circulating heparan sulfate but not syndecan-1. Co-administration of CFC had no further effect on glycocalyx shedding suggesting a lack of its therapeutic potential. VExperimental in vivo study.

Using Dramatization to Teach Starling Forces in the Microcirculation to First-Year Medical Students.

The clinical importance, prevalence, and multiple etiologies of tissue edema make it a critical part of medical education. Given the multiple physiological parameters that must be simultaneously considered to determine fluid movement, it is important that a deeper understanding of the microcirculation and fluid shifts is achieved in preclinical education. We describe an innovative teaching methodology using dramatization to interactively teach Starling forces to first-year medical students. Prior to the dramatization, students were given an introduction to Starling forces. They also completed a brief knowledge quiz on the topic before and after the activity. The classroom walls were marked with signs representing the intravascular space, extravascular or interstitium, and lymphatics compartments. Students were invited to act out or mimic the fluid shifts within capillaries as the values for hydrostatic and colloid osmotic pressures for the intravascular and interstitial spaces were presented. The goal was for each student to decide which compartment he/she would move to as fluid according to Starling force values and/or clinical scenarios. A significant improvement between pre- and postactivity quiz performance (45.4% ± 25.1% and 77.5% ± 14.1%, respectively) was observed (n = 26, p < .001, t test). In a postactivity survey, 85% of students reported the activity to be an effective way of learning. Our data indicate that this dramatization approach is effective in complementing passive learning in traditional lectures. Furthermore, this type of dynamic activity brings joy to the classroom and breaks the monotony of lecturing.

Effect of two different colloid priming strategies in infants weighing less than 5 kg undergoing on-pump cardiac surgeries.

Our aim was toexplore the effect of two different priming strategies (artificial colloid only vs. artificial colloid combined with human serum albumin) on the prognosis of children weighing less than 5 kg undergoing on-pump congenital heart disease (CHD) surgery. A total of 65 children weighing less than 5 kg who underwent on-pump CHD surgery in our hospital from September 2016 to December 2017 were enrolled in this study. The children were randomly divided into two groups: artificial colloid priming group (AC group, n=33) and artificial colloid combined albumin priming group (ACA group, n=32). The primary clinical endpoint was the peri-CPB colloid osmotic pressure (COP). Secondary clinical endpoints included perioperative blood product and hemostatic drug consumption, postoperative renal function, coagulation function, postoperative renal function, and postoperative recovery parameters. COP values were not significant in the priming system as well as peri-CPB time points between the two groups (P>.05). Platelet consumption in the AC group was significantly lower than that in the ACA group (P<.05). There were no significant differences in the use of other blood products and hemostatic drugs as well as perioperative coagulation parameters between the two groups (P>.05). Postoperative length of stay in the AC group was significantly lower than that in the ACA group (P<.05). There were no significant differences in mortality, postoperative mechanical ventilation time, ICU time, and perioperative adverse events (including postoperative AKI) occurrences between the two groups (P>.05). In the on-pump cardiac surgeries of patients weighing less than 5 kg, total colloidal priming would not affect peri-CPB COP values, postoperative coagulation function, and blood products consumption. Total artificial colloidal priming strategy is feasible in low-weight patients.

P4547Serum biochemical determinants of peripheral congestion assessed by bioimpedance vector analysis in acute heart failure

Abstract Background The pathophysiology of peripheral congestion is poorly investigated in patients with acute heart failure (AHF). Purpose This study evaluated the relative contribution of serum colloid osmotic pressure (COP), relative plasma volume status (PVS), biomarkers of renal function, electrolytes, haemoglobin, and brain natriuretic peptide (BNP) in peripheral fluid overload using bioimpedance vector analysis (BIVA). Methods We retrospectively analysed data from 485 patients with AHF. Hydration status was evaluated by semiquantitative and quantitative approach using BIVA (R/Xc graph) and Hydration Index (HI), respectively. COP was calculated from albumin and total protein concentration, while relative PVS was calculated from validated equations. Results Congestion assessed by BIVA was observed in 304 (63%) patients and classified as mild (30%), moderate (42%), and severe (28%). On univariate analysis, HI was inversely correlated with COP (P&lt;0.01), glomerular filtration rate (P&lt;0.01), and haemoglobin (P&lt;0.01), while positive correlations were found for relative PVS (P&lt;0.05), BNP (P&lt;0.01), and blood urea nitrogen (BUN; P&lt;0.01). On stepwise multivariate analysis, COP explained 12% of the total variability, while BUN, PVS, haemoglobin, and BNP added a further 6%, 4%, 2%, and 1%, respectively, to the final explanatory model. Conclusions COP was the major determinant of the presence and entity of peripheral congestion assessed by BIVA. BUN, PVS, haemoglobin, and BNP revealed reduced influence on congestion as compared with COP. Routine laboratory testing could be useful in peripheral fluid accumulation. Future studies should evaluate the relationship between COP and pharmacological target therapies for the fluid management of AHF patients. Acknowledgement/Funding None

Impact of Cytokine Adsorption Treatment in Liver Failure

Sepsis causes life-threatening organ dysfunction and is the leading cause of morbidity and mortality in critically ill patients worldwide. Mortality rate of sepsis is close to 30% to 50% despite better understanding of the pathophysiology of sepsis, and advances in antimicrobial therapy, resuscitation strategies, and mechanical ventilation.Liver failure is characterized by accumulation of potentially toxic substances in the systemic circulation of the patient. Toxic effects of these molecules can induce cellular injuries leading to multiorgan dysfunction. Hydrophobic unconjugated bilirubin and bile acids, hydrophilic conjugated bilirubin, and ammonium are the main toxins accumulated in liver failure.We carried out cytokine adsorbtion (CytoSorb) procedure with continuous venovenous hemodialysis in 12-hour sessions. The biochemical values of the patients before and after the use of the filter were recorded. The parameters compared were as follows: total bilirubin, direct bilirubin, C-reactive protein, leukocyte, neutrophil, alanine aminotransferase, aspartate aminotransferase, creatinine, colloid oncotic pressure, ammonia, gamma-glutamyl transferase, alkaline phosphatase, procalcitonin, hematocrit, hemoglobin, pH, albumin, international normalized ratio, fibrinogen, lactate dehydrogenase, platelet, temperature, changes in vasoactive medication requirement, temperature.According to these results, cytokine adsorption systems can be considered as an option to lower bilirubin levels in cases of liver failure. Its inability to lower ammonia level is considered a disadvantage compared with other bilirubin-lowering methods. Although further studies are needed to compare different methods, cytokine adsorption systems may be considered in treatment planning as it contributes to the treatment of sepsis and hyperbilirubinemia in liver failure patients with sepsis.

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.&#x0D; 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 &lt; 0.01) and between COP and TP (r= +0.54; P &lt; 0.01) .&#x0D; A strong negative correlation was also found between COP and the degree of edema (r = _ 0.55; p &lt;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 &lt; 0.05) and no correlation at all was found between edema and TP (r= - 0.19; P &gt; 0.05).&#x0D; 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.

Ultrafiltration-profiled hemodialysis to reduce dialysis-related cardiovascular stress: Study protocol for a randomized controlled trial

Rapid fluid removal (ultrafiltration, UF) is associated with higher cardiovascular morbidity and mortality among individuals receiving maintenance hemodialysis (HD). Fluid removal rates that exceed vascular refill rates can result in hemodynamic instability, end-organ damage to the heart, kidneys, gut and brain, among other organs, and patient symptoms. There are no known evidence-based HD treatment strategies to reduce harm from higher UF rates. Ultrafiltration profiling, the practice of varying UF rates to maximize fluid removal during periods of greatest hydration and plasma oncotic pressure, has been proposed as an HD treatment intervention that may reduce UF rate-related complications. This study is a randomized 4-phase cross-over trial in which participants are successively alternated between study arms with intervening washout periods, and treatment order is randomized. After 4-week screening and 6-week baseline periods, participants are randomized to HD with conventional UF or HD with UF profiling for a period of 3 weeks followed by a 1-week washout period before crossing over. Participants cross into conventional UF and UF profiling phases twice (2 phases per arm). The primary outcomes of interest are intradialytic hypotension (nadir intradialytic systolic blood pressure <90 mmHg), pre-to post-HD change in troponin T (expressed as a percentage), change in left ventricular global longitudinal strain (an echocardiographic measure of left ventricular systolic function), and development of intradialytic left ventricular stunning (worsening of contractile function in ≥2 segments). This study will determine the impact of UF profiling on UF rate-related cardiovascular complications in prevalent, maintenance HD patients.

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 KERY is 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.

Protectively Decellularized Porcine Cornea versus Human Donor Cornea for Lamellar Transplantation

AbstractDecellularization can reduce the immune barrier of xenotransplantation, but tissue swelling‐caused structural and functional damage remains unsolved, including corneal transparency loss after decellularization. Here, a protective decellularization strategy is developed for the preparation of decellularized porcine cornea (DPC), in which corneas are treated by detergent and endonuclease in the protective medium with 50 mmHg colloid osmotic pressure. A nonrandomized open‐label trial is conducted to evaluate the clinical outcome of lamellar transplantation with DPC versus human donor cornea (HDC) as grafts. Through the protective corneal decellularization, major xenoantigen DNA and α‐gal are efficiently removed, while corneal original structural and transparency characteristics are preserved. Among the 23 patients with DPC transplantation for 12 months, 22 grafts survive without ulcer recurrence or immune rejection, 1 graft demonstrate melting. Compared with HDC grafts, DPC grafts showed early suture loosing, but no complication is observed with timely removal. The epithelial regeneration rate, graft transparency restoration, best‐corrected visual acuity improvement, and mechanical properties achieve equivalent levels compared with that of HDC grafts. Collectively, the results suggest that the porcine cornea through protective decellularization may provide an effective “off‐the‐shelf” substitute of globally‐shortened human donor tissue for lamellar transplantation.

The Strategies of Organization of the Fish Plasma Proteome: with and without Albumin

Various principles of organization of the blood plasma proteome are considered using the example of teleost fishes, whose lower members have albumin, while the higher members have lost it. Albumin, which creates the colloid osmotic pressure of blood plasma and is involved in lipid transport and other functions, is compared to the multifunctional potential of high-density lipoproteins (HDL), which dominate in the blood of bony fishes and probably compensate for the lack of albumin in higher Teleostei. The elements of the structural organization and functions of two proteins, that is, albumin and apolipoprotein A (as a part of HDL) that are dominant in the blood of fish, the features of the plasma proteome in marine and freshwater fishes, and the hypothesis of the evolution of the plasma proteome and a special strategy of osmoregulation in Teleostei (with the involvement of serum HDL and without albumin) are considered. Two strategies of organization of the fish blood plasma proteome are noted: on the branch that led to Teleostei an expansion of the size–compositional range of lipoproteins and an increase in the role of HDL in metabolic processes occurred; on the branch that led to Mammalia a separation of the lipid transport and osmoregulation functions occurred between lipid and albumin and an increase in the albumin content in the blood plasma.

HYPOALBUMINEMIA AS A RISK FACTOR OF PREECLAMPSIA- ECLAMPSIA IN HIGH RISK PREGNANCY

Objective: Preeclampsia-eclampsia (PE) has a worldwide incidence of 5–10%, accounting for 18% of maternal deaths.In PE albuminemia is diminished by increased capillary permeability secondary to endothelial damage and proteinuria. Reduction of colloid osmotic pressure (PCO) produces interstitial edema and a decreasing blood volume, stimulating the renin-angiotensin-aldosterone system. AIM:Was to determine if hypoalbuminemia is PE cause in a population of high risk pregnant women attended in a Gestational Hypertension Unit of the San Carlos Clinical Hospital (Madrid, Spain) and in the High Obstetric Risk Unit of the Hospital de Clinics Dr. Manuel Quintela (Montevideo, Uruguay). Design and method: Retrospective, observational, descriptive-analytical study. Pregnant women with chronic or gestational hypertension were included at the 32th week of gestation. The PCO and the Briones Index (IB: PCO / mean arterial pressure) were calculated Results: 193 pregnant women were included. 25.4% had PE, 3.6% developed HELLP. A single case of eclampsia was recorded. The demographic variables are described in Table 1. Hypoalbuminemia (plasmatic albumin < 3 g/dl) was observed in 13 patients (11 developed PE). We found that a value of albuminemia <3.3 g/dl had a RR 1.8 (95% CI:1.01–3.2, p = 0.036) for the development of PE in the analysis of multivariate regression adjustment binary logistics. These pregnant women had children with a lower birth weight, (−319 gr, p < 0.004) and a lower gestational age at birth (36.7 ± 3 vs 38 ± 2.4;p < 0.002). Patients that developed PE had lower PCO than the group without PE, (19.05mmHg vs 20.33mmHg, p < 0.004), and lower IB (0.10 ± 0.02 vs 0.12 ± 0.02; p = 0.000). This index had a better predictive capacity than albumin 0.74 (95% CI 0.64–0.81) vs 0.64 (95% CI:0.53–0.74) p = 0.044. Conclusions: There is a high incidence of PE, as expected in high-risk patients. Albuminemia <3.3 g/dl is associated with a higher risk of PE, lower birth weight and lower gestational age. The PCO and the Briones Index are very valid for the quantitative assessment of capillary leakage.

Hydroxyethyl starches in equine medicine.

To review and discuss the use of hydroxyethyl starches (HES) in equine veterinary medicine, and to provide recommendations for its use. Veterinary and human peer-reviewed medical literature including scientific reviews, meta-analyses, and original research articles. Increasing evidences on adverse effects after HES use and decreasing support for beneficial effects with regards to volume expansion and colloid osmotic pressure (COP) support in critically ill subjects have led to a recent guideline to limit the use of HES in critically ill people. The rationale for HES use in horses is mainly extrapolated from human medicine, and very limited studies in horses are available. There is limited evidence suggesting a superiority of volume expansion effects of HES over crystalloids. The potential for HES to increase and maintain COP is well supported, but there is no evidence that maintaining or increasing plasma COP influences outcome, tissue edema formation, or rates of complications that potentially relate to edema formation. HES induce dose-dependent changes in coagulopathic parameters, but there is no evidence that HES causes clinical coagulopathies. Insufficient data are available on other adverse effects such as acute kidney injury, or mortality in horses. The use of HES should be restricted in septic patients, but may still have some use in cases of hemorrhagic shock resuscitation, hypoalbuminemia, or perioperative fluid replacement. The evidence supporting the use of HES in horses is weak due to lack of species-specific investigations. Acknowledging species differences, the use of HES should be judicious, yet with some recognition of its benefits in particular cases. More research is necessary to improve knowledge on use of HES in horses and to establish better future recommendations.