Filtration Rate Plasma Research Articles

Clinical use of plasmafiltration coupled with adsorption

Coupled plasma filtration adsorption is an extracorporeal therapy that combines plasma separation and adsorption of inflammatory mediators and toxins, followed by hemofiltration to control volume overload and removal of small and medium-sized water-soluble mediators. Although it is not new, there are still doubts about its clinical role. Evidence indicates that the coupled plasma filtration adsorption is highly efficient in removing inflammatory molecules in sepsis. So far it has not been shown to reduce mortality, but it is possible to achieve a better hemodynamic benefit over convective therapies. On the other hand, the absorptive component makes it possible to purify larger mediators associated with causes of non-septic acute kidney injury, such as myoglobin, toxins associated with liver failure and others, allowing that coupled plasma filtration adsorption indications to be expanded to various clinical settings with a high inflammatory component, particularly when it is required to manage several organ dysfunctions simultaneously.

An inquiry into the treatment of sepsis using plasma exchange therapy: A systematic review and meta-analysis.

Sepsis is a potentially lethal condition that occurs when the body's response to infection damages tissue and organs. The production of inflammatory mediators typically assists in defending the body against infection; however, an overreaction to inflammation can cause coagulation problems, vascular endothelial damage, and organ hypoperfusion. Blood purification methods, such as plasmapheresis, can effectively remove inflammatory mediators from plasma. The purpose of this meta-analysis was to explore the efficacy of plasma exchange for sepsis treatment as noted in recent studies. The authors searched the Pubmed (Medline), Cochrane Central Register of Controlled Trials (The Cochrane Library), Embase (Ovid), and Scopus databases and included controlled clinical studies that compared plasmapheresis or plasma filtration with conventional treatment in patients with severe sepsis. The Newcastle-Ottawa Scale literature quality assessment tool was used to assess the risk of bias. The primary study outcome was all-cause mortality. The random effects model was adopted for conducting the meta-analysis. Among the 1013 records found, the study included 5 trials, all of which carried a low risk of bias. The use of plasmapheresis was associated with a longer stay in the intensive care unit (odds ratio [OR], 0.85, 95% confidence interval [CI], 0.39-1.32, heterogeneity [I2 ]=0%), a significant reduction in all-cause mortality (OR, 0.54, 95% CI, 0.33-0.89, I2 =70%), and reduced mortality (OR, 0.29, 95% CI, 0.13-0.67, I2 =0%) in adults; the results for children differed from this (OR, 0.79, 95% CI, 0.36-1.72, I2 =89%). Four trials reported no adverse events; one trial reported an adverse event related to plasma exchange, including an instance of hypotension in one patient. Plasmapheresis appeared to be an effective treatment for patients suffering from sepsis. A large number of additional randomised controlled trials are needed to confirm this finding.

Difficulties of differential diagnosis of polyneuropathy developed after Gam-COVID-Vac vaccination on the background of combined infectious pathology (clinical case)

The clinical case describes the difficulties of differential diagnosis of polyneuropathy that developed after Gam-Covid-Vac vaccination on the background of combined infectious pathology (HIV infection, tick-borne borreliosis, COVID-19) in a young woman. It is shown that various infectious and non-infectious diseases with similar clinical symptoms (peripheral nervous system affliction) occurring simultaneously in one patient can significantly affect each other’s course and complicate the establishment of the true cause of polyneuropathy. It should be noted that in this example, the establishment of a final diagnosis was carried out collectively, by consensus, and was based on the effectiveness of etiotropic (antibacterial) treatment, which in fact was an ex juvantibus therapy option, which made it possible to establish the most probable etiology of polyneuropathy – tick-borne borreliosis. In turn, HIV infection and possibly vaccination, according to the authors, could cause immunosuppression, which affected the degree of dissemination of Borrelia burgdorferi. It is also likely that the insufficient immune response in combination with the cascade plasma filtration session affected the initial dubious results of the serological tests, which further complicated the diagnosis.

Liver Support Devices: Bridge to Transplant or Recovery

Liver failure, whether acute or acute on chronic, is a devastating disease with a very high mortality and morbidity. The recent therapeutic advances, especially liver transplant, have given reason for optimism to the ever-rising population affected by this disease. However, scarcity of organs and lack of resources make this an option that only few can afford. The hunt for an artificial device to assist or replace the functions of the liver has been on the rise since the past 40 years. These devices are classified into artificial and bioartificial liver (BAL) assist devices. Artificial liver devices such as molecular adsorbent recirculating system, Prometheus, single-pass albumin dialysis, and selective plasma filtration therapy are mostly aimed at taking over the blood purification systems of the liver. BAL-assisted devices incorporate hepatic cell lines to obtain a more comprehensive coverage of the complex functions of the liver. These include extracorporeal liver assist device, modular extracorporeal liver support, HepatAssist, and Amsterdam Medical Centre-BAL. Development of an ideal liver assist device has been difficult due to the complexity of the functions of the organ. The initial studies on these devices are promising but inconclusive. Therapeutic plasma exchange seems to have a very favorable profile in the treatment of these patients and has been successfully used in a large number of patients. To arrive at a more definitive conclusion of the usefulness of these devices in the management of liver failure, large randomized multicentric studies with more objective end points need to be carried out. A literature review was performed using PubMed and library searches to collect the recent studies in this regard. This review aims to provide a myopic view of the advances that have been made in the development and usefulness of these liver assist devices.

CSF Dynamics: Implications for Hydrocephalus and Glymphatic Clearance.

Beyond its neuroprotective role, CSF functions to rid the brain of toxic waste products through glymphatic clearance. Disturbances in the circulation of CSF and glymphatic exchange are common among those experiencing HCP syndrome, which often results from SAH. Normally, the secretion of CSF follows a two-step process, including filtration of plasma followed by the introduction of ions, bicarbonate, and water. Arachnoid granulations are the main site of CSF absorption, although there are other influencing factors that affect this process. The pathway through which CSF is through to flow is from its site of secretion, at the choroid plexus, to its site of absorption. However, the CSF flow dynamics are influenced by the cardiovascular system and interactions between CSF and CNS anatomy. One, two, and three-dimensional models are currently methods researchers use to predict and describe CSF flow, both under normal and pathological conditions. They are, however, not without their limitations. "Rest-of-body" models, which consider whole-body compartments, may be more effective for understanding the disruption to CSF flow due to hemorrhages and hydrocephalus. Specifically, SAH is thought to prevent CSF flow into the basal cistern and paravascular spaces. It is also more subject to backflow, caused by the presence of coagulation cascade products. In regard to the fluid dynamics of CSF, scar tissue, red blood cells, and protein content resulting from SAH may contribute to increased viscosity, decreased vessel diameter, and increased vessel resistance. Outside of its direct influence on CSF flow, SAH may result in one or both forms of hydrocephalus, including noncommunicating (obstructive) and communicating (nonobstructive) HCP. Imaging modalities such as PC-MRI, Time-SLIP, and CFD model, a mathematical model relying on PC-MRI data, are commonly used to better understand CSF flow. While PC-MRI utilizes phase shift data to ultimately determine CSF speed and flow, Time-SLIP compares signals generated by CSF to background signals to characterizes complex fluid dynamics. Currently, there are gaps in sufficient CSF flow models and imaging modalities. A prospective area of study includes generation of models that consider "rest-of-body" compartments and elements like arterial pulse waves, respiratory waves, posture, and jugular venous posture. Going forward, imaging modalities should work to focus more on patients in nature in order to appropriately assess how CSF flow is disrupted in SAH and HCP.

Potential of Garlic Filtrate as An Alternative Anticoagulant for Whole Blood Samples

Synthetic anticoagulants such as heparin, citric, and ethylenediaminetetraacetic acid (EDTA) are commonly used to prevent blood clots. In contrast, its widespread use in clinical laboratories is still constrained by price, its toxic nature, and its short shelf life. Therefore, an alternative material that is relatively cheap, non-toxic, and easy to obtain and process in a ready-to-use form is needed. Garlic contains allicin and ajoene, which are anti-platelet and anti-thrombogenic. This study’s aim is to explore the potential of garlic filtrate as an alternative anticoagulant. Blood from 16 individuals was used and separated into four groups: non-anticoagulant, 50 μL/mL garlic filtrate, 100 μL/mL garlic filtrate, and 150 μL/mL heparin, for a total of 64 treatments. The Lee and White method showed that non-anticoagulated blood had normal clotting times (mean 8 minutes and 56 seconds), whereas heparin plasma and garlic filtrate plasma had longer clotting times (more than 20 minutes); and this is statistically different based on the ANOVA test with a significance value (p) of 0.000 < 0.05. On spectrophotometric measurements, the levels of calcium ions in heparinized plasma and serum were 8.66 mg/dL and 8.52 mg/dL, respectively, while in garlic plasma filtrate of 50 μL/mL and 100 μL/mL were 4.13 mg/dL and 3.58 mg/dL, respectively; this is also statistically different based on the ANOVA test with a significance value of 0.000 < 0.05. The differences indicate that garlic filtrate can extend clotting time and reduce calcium ions therefore it is worth reviewing as an alternative anticoagulant.

Coupled plasma filtration adsorption for the treatment of sepsis or septic shock: a systematic review and meta-analysis

BackgroundThe effect of coupled plasma filtration adsorption (CPFA) for the treatment of sepsis or septic shock is controversial. A systematic review and meta-analysis was performed to evaluate the impact of CPFA on all-cause mortality in patients with sepsis or septic shock.MethodsWe searched the PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) and cohort studies from inception to the 1st of May 2022. We included studies involving patients (˃ 14 years) with sepsis or septic shock. All authors reported our primary outcome of all-cause mortality (hospital mortality, 28-day mortality or 30-day mortality). Results were expressed as odds ratio (OR) with accompanying 95% confidence interval (CI).ResultsSix studies including 537 patients were included. The primary outcome of this meta-analysis showed that the all-cause mortality was about 54.2% (119/243 in the CPFA group and 172/294 in the control group). There was no statistically significant difference in the all-cause mortality between two groups (odds ratio [OR] = 0.75; 95% CI 0.53 to 1.06; P = 0.11; Chi2 = 14.04; I2 = 64%).ConclusionsThe treatment of CPFA failed to decrease all-cause mortality of sepsis or septic shock patients. Further large-scale randomized controlled trials (RCTs) evaluating the ability of this therapy to improve clinical outcomes are still required to confirm these results.

Selective endocytosis controls slit diaphragm maintenance and dynamics in Drosophila nephrocytes.

The kidneys generate about 180 l of primary urine per day by filtration of plasma. An essential part of the filtration barrier is the slit diaphragm, a multiprotein complex containing nephrin as major component. Filter dysfunction typically manifests with proteinuria and mutations in endocytosis regulating genes were discovered as causes of proteinuria. However, it is unclear how endocytosis regulates the slit diaphragm and how the filtration barrier is maintained without either protein leakage or filter clogging. Here, we study nephrin dynamics in podocyte-like nephrocytes of Drosophila and show that selective endocytosis either by dynamin- or flotillin-mediated pathways regulates a stable yet highly dynamic architecture. Short-term manipulation of endocytic functions indicates that dynamin-mediated endocytosis of ectopic nephrin restricts slit diaphragm formation spatially while flotillin-mediated turnover of nephrin within the slit diaphragm is needed to maintain filter permeability by shedding of molecules bound to nephrin in endosomes. Since slit diaphragms cannot be studied in vitro and are poorly accessible in mouse models, this is the first analysis of their dynamics within the slit diaphragm multiprotein complex. Identification of the mechanisms of slit diaphragm maintenance will help to develop novel therapies for proteinuric renal diseases that are frequently limited to symptomatic treatment.

Numerical study of the effect of hemodynamic variables on LDL concentration through the single layer of the Left Anterior Descending coronary artery (LAD) under the heart pulse.

Heart attack is one of the most common causes of death in the world. Coronary artery disease is the most recognized cause of heart attack whose onset and progression have been attributed to low-density lipoprotein (LDL) passing through the wall of the artery. In this paper, hemodynamic variables as well as the concentration of LDL through the coronary porous artery at the Left Anterior Descending coronary artery (LAD), and its first diagonal branch (D1) under the heart motion investigated using computational simulation. The geometry that has been studied in this paper is the first bifurcation of Left Anterior Descending (LAD) that has been placed on a perimeter of hypothetical sphere representative of the heart geometry. Sinusoidal variations of sphere radii, simulated pulsating movement of the heart. Blood has been considered as a Newtonian and incompressible flow with pulsatile flow rate and real physiological profile. The plasma filtration boundary condition used over the walls in order to simulate the concentration of LDL to a one-layer artery wall. Variations in the concentration of LDL on the artery wall and its relation to oscillation on shear stress on the artery wall under different conditions are presented. Moreover, the effects of the pulsating inlet flow and dynamic movement of the artery are explored. The results declared that minimum shear stress and maximum LDL concentration take place at the bifurcation and on the myocardial wall which is in complete agreement with clinical studies. Furthermore, it has been shown that the heart pulse has a slight effect on the average time of concentration (0.1% increase); however, by analyzing all time steps, one could observe that the maximum concentration rises in some time steps; where this increases the possibility of LDL presence and helps them diffuse inside the artery wall.

Application of Extracorporeal Apheresis in Treatment of COVID-19: a Rapid Review.

Spread of a novel coronavirus infection in 2019 caused by SARS-CoV-2 virus has become a real threat to public health all around the world. The new pandemic required the mobilization of all resources for effective treatment of COVID-19 patients. Extracorporeal apheresis methods were suggested as an addition to the therapy of severe COVID-19 patients, especially when there is a threat of cytokine storm. Cytokine storm has a complex and not fully understood mechanism, and it can result in the multiple organ failure syndrome, associated with high mortality. The main cytokines that play the key role in the cytokine storm are IL-6, IL-10, and TNF-alpha. Removal of the target pro-inflammatory cytokines from the bloodstream can be beneficial in reducing the risk of complications as well as the mortality rate. We describe and compare different methods of extracorporeal apheresis: hemoadsorption, selective plasma filtration, and plasma exchange therapy in the context of their potential use in COVID-19 treatment.

An Extracorporeal Plasma Filtration Column with Specific Binding to Dengue Virions

Introduction: Dengue infection is a significant public health concern that no specific treatment is available. Extracorporeal plasmapheresis or plasma filtration is a treatment option for severe cases with complications. However, the commercial adsorption devices mainly contained size-exclusive porous beads to adsorb the plasma proteins nonselectively. Methods: We developed a 1:50 simulated circuit for dengue virus-specific adsorption using a flavivirus-specific (4G2) antibody entrapped into the alginate bead. Results: The reduction ratios of the viral titer after 3 h of continuous run were 63.00 ± 1.21%, and 93.97 ± 1.27% measured by reverse transcription qPCR, and plaque titration, respectively. No specific adsorption was observed with Enterovirus A71 or Escherichia coli bacteria. Conclusion: This study is a proof-of-concept for the potential use of a dengue virus-specific adsorption column in the 1:50 simulated circuit. The system could be applied to various clinical platforms by substituting target-specific antibodies.

Pathogenetic Approach to Early Preeclampsia and the Feasibility of Pregnancy Prolongation

Aim. To evaluate the efficacy of cascade plasma filtration (CPF) for the correction of lipid profile and biochemical markers (sFlt-1, PIGF, sFlt-1/PIGF) in pregnant women with early preeclampsia. Materials and Methods. A prospective controlled study of 23 CPF procedures was conducted in 11 pregnant women with early preeclampsia at gestational ages 22 to 31 weeks. The evolution of clinical manifestations of preeclampsia (BP, urine output, and proteinuria), laboratory biochemical parameters (protein/creatinine ratio, lipid profile), blood coagulation tests, and thromboelastometry (ROTEM) were assessed. In addition, the effect of CPF on the level of preeclampsia markers (sFlt-1, PIGF, sFlt-1/PIGF-ratio) as predictors of endothelial aggression was analyzed. The efficacy of extracorporeal therapy was evaluated based on the duration of pregnancy prolongation. Results. The use of CPF as an adjunct for the treatment of early preeclampsia had a positive effect on the lipid profile by reducing cholesterol and LDL, which helped to decrease atherogenic aggression on the vascular endothelium. In addition, the extracorporeal therapy promoted reduction of the anti-angiogenic effect of sFlt-1, which was confirmed by a significant decrease in the sFlt-1/PIGF ratio from 515 [347; 750] to 378 [285; 557] (P = 0.013). The period of prolongation of pregnancy was longer in the main group (with CPF) and was 19 [5; 26] days, whereas in the comparison group (without CPF) it was 3 [1; 4] days (P < 0.001). All newborns were discharged from the hospital in a stable condition. The paper is supplemented with a clinical observation of the effective use of CPF in early preeclampsia. Conclusion. The use of cascade plasma filtration in the treatment of early preeclampsia to prolong pregnancy could be a promising approach.

Fluidic system with movable layers for all-in-one assay of cell-free DNA in blood

Detection of circulating cell-free DNA (cfDNA) requires multiple processes, including plasma separation, cfDNA isolation, and high-sensitivity detection. However, implementing such processes in a single system in a simple and effective manner is nontrivial. Here, we present a fluidic system for the isolation and detection of cfDNA from whole blood performed in a fully automated and effective manner. The system utilizes vertically mobile top and rotational bottom parts with multiple disposable chambers for sequential processes. The key components for plasma filtration are a sedimentation chamber that enables the dextran-enhanced sedimentation of red blood cells and a plunger chamber with a porous filter and a check valve. cfDNA in the plasma is captured by silica-coated magnetic beads in the plunger chamber, washed via the motion of the top and bottom parts, and then detected by real-time on-chip polymerase chain reaction. We vary several parameters, including the plunger speed, dextran concentration, and hematocrit concentration, to optimize the time and efficiency of the assay. The total assay time is 1.5 h with a detection limit of 42 ag/mL for a sample volume of 1.5 mL. Plasma and cfDNA recoveries are 53% and 28%, respectively. Our system is a useful tool for all-in-one assays in liquid biopsies of cancers and other diseases detectable by cfDNA.

Increased intrarenal post-glomerular blood flow is a key condition for the development of calcineurin inhibitor-induced renal tubular acidosis in kidney transplant recipients.

Hyperchloremic metabolic acidosis (HCMA) from renal tubular acidosis (RTA) is common in kidney transplant (KT) recipients. Calcineurin inhibitors (CNIs) are a potential cause of RTA, and whether HCMA is a determinant of poor graft prognosis is controversial. The subjects were living-donor KT recipients (LDKTRs, n=47) and matched donors (n=43). All cases of rejection, extrarenal causes, and respiratory disorders were excluded. HCMA was defined as having a [Na+]-[Cl- ] value of ≤34 or starting alkalization. We determined the potential causes of HCMA in LDKTRs at 3 months (m) and 1 year (y) post-KT. We examined renal hemodynamic parameters in 26 LDKTRs at 1 y post-KT: namely, glomerular filtration rate (GFR), renal plasma flow (RPF), filtration fraction (FF; GFR/RPF) and pre-/post-glomerular vascular resistance (pre-/postVR). The HCMA incidence in the 3-m post-KT LDKTR group was higher than that of the donors (51.0%vs. 6.9%, p<0.001, adjusted odds ratio: 6.7-15.7). Among adjusted factors, the most dominant HCMA contributor was low hemoglobin concentration (Hb≤12g/dl). Compared to non-HCMA cases, HCMA patients had low FF and low post-VR (p=0.008, 0.003, respectively) suggesting increased intrarenal post-glomerular blood flow. The high pathological score of alternative arteriolar hyalinosis (aah) ≥2 was a significant HCMA risk. The tacrolimus trough level was not high in HCMA but was significantly high in HCMA in the low post-VR setting (p=0.002). Among LDKTRs, low hemoglobin level is an important contributor to the manifestation of HCMA in the induction period, and increased intrarenal post-glomerular blood flow is a key condition for the development of CNI-induced RTA.

Determination of unbound piperaquine in human plasma by ultra-high performance liquid chromatography tandem mass spectrometry

Piperaquine (PQ) is an antimalarial drug that is highly protein-bound. Variation in plasma protein contents may affect the pharmacokinetic (PK) exposure of unbound drug, leading to alteration of clinical outcomes. All published methods for determination of PQ in human plasma measure the total PQ including both bound and unbound PQ to plasma proteins. There is no published method for unbound PQ determination. Here we report an ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) method for determination of PQ in human plasma filtrate prepared by filtering human plasma through Millipore Microcon® centrifugal filters (10k NMWL). The filter cup had to be treated with 5% benzalkonium chloride to reduce non-specific binding to the filter devices before filtration of plasma samples. Multiple reactions monitoring (MRM) of the ion pairs m/z 535/288 for PQ and m/z 541/294 for the internal standard (IS) was selected for quantification. When electrospray ionization (ESI+) was used, paradoxical matrix effect was observed despite the structure similarity of the deuterated IS: Ion suppression for PQ versus ion enhancement for the PQ-d6, even though they were closely eluted: 0.62 min versus 0.61 min. Separation was achieved on Evo C18 column (50 × 2.1 mm, 1.7 μm, Phenomenex Inc.) eluted with 10 mM NH4OH and MeCN. When atmospheric pressure chemical ionization in positive mode (APCI+) was used for ion source, matrix effect diminished. Separation was achieved on a PFP column (30 × 2.1 mm, 1.7 μm, Waters, Corp.) eluted with aqueous 20 mM ammonium formate 0.14% trifluoroacetic acid (A) and methanol-acetonitrile (4:1, v/v) containing 0.1% trifluoroacetic acid (B) at 0.8 mL/min flow rate in a gradient mode: 30–30–80–80–30–30%B (0–0.1–1.0–1.40–1.41–1.50 min). The retention time was 0.67 min for both PQ and the IS. The method was validated with a linear calibration range from 20 to 5,000 pg/mL and applied to clinical samples.

Results of Coupled Plasma Filtration Adsorption (CPFA) Treatment Applied to Critical COVID-19 Patients in Intensive Care Unit

Objective: The novel coronavirus, called SARS-CoV-2, causes COVID-19 disease and began a pandemic on a global scale. Uncontrolled cytokine production is observed especially in COVID-19 cases with severe progression and this situation is thought to be one of the causes of more severe disease progression and increased mortality.&#x0D; In our study, we aimed to assess the efficacy of Coupled Plasma Filtration Adsorption (CPFA) treatment in situations with severe disease progression like sepsis, septic shock and multiple organ failure, considered to be secondary to cytokine storm, in COVID-19 disease.&#x0D; Methods: Our study retrospectively screened data from 20 patients admitted to our intensive care unit and administered CPFA. CPFA was administered as 10 hours each session and 2 sessions with 12 hours interval.&#x0D; Results: After our CPFA treatment, there were statistically significant ameliorations in clinical and laboratory findings like SOFA scores, mainly, Horowitz values, fever and IL-6 values.&#x0D; Conclusion: The CPFA treatment removes the uncontrolled production of harmful cytokines/chemokines and toxic substances from the blood and shows promise in the treatment of the cytokine storm that develops in COVID-19 disease.

Two-phase binding of drug in a three-layered arterial wall following stent implantation

The present study explores the distribution and the binding of drug eluted from an embedded drug-eluting stent (DES), having struts of the circular cross-section. The arterial tissue is composed of three distinct layers, namely, the intima, the media and the adventitia, with varying diffusivity, and at the interfaces between different layers, a jump condition is imposed. The transport of free drug is modelled by the convection–diffusion-reaction process while the binding of drug is modelled by a nonlinear saturable reversible chemical reaction only. This model incorporates two types of binding mechanisms, namely, the specific binding caused by the interaction of drug and receptors, and the non-specific binding due to the gripping of drug in the extracellular medium (ECM). Furthermore, a constant as well as time-dependent release kinetics have been considered. All the governing equations along with suitable initial, boundary and jump interface conditions in cylindrical polar coordinate system are solved successfully by using the finite difference method. In this study, several clinical key factors like the degree of strut embedment, inter-strut distance (ISD), release mechanism are examined thoroughly. The study reveals that the inclusion of different layers along with jump interface conditions has a remarkable impact on stent-based delivery. Simulated results predict that a higher concentration profile for free drug and rapid saturation of binding sites take place for a half-embedded stent as compared to a quarterly and well-apposed stent. An intriguing feature is to be noted that the inter-strut distance through which the transmural plasma filtration takes place, plays a pivotal role in the distribution and retention of drug in the therapeutic domain considered. Furthermore, the steady-state simulation predicts the influence of strut dimension on the distributions of all drug forms.

Model selection and curative effect judgment criteria for artificial liver in the treatment of liver failure

Artificial liver is one of the effective methods to treat liver failure. Patients with liver failure are critically ill and have great individualized differences. Therefore, the specific program for the treatment of liver failure with artificial liver should be individualized. The commonly used non-biological artificial liver models include simple plasmapheresis, double filtration plasmapheresis, plasma filtration with dialysis, double plasma molecular adsorption system, molecular absorbent recirculating system, hemodiafiltration, continuous venovenous hemodiafiltration, hybrid, etc. The curative effect should be properly judged from patient's symptoms, laboratory test indicators, survival rate and other aspects after artificial liver therapy.

Study of the Impact of Leucocyte Reduction on the Coagulation Factors in Fresh Frozen Plasma

Introduction:Plasma transfusion is required to arrest or prevent bleeding, for various congenital and acquired cases of coagulopathies such as inherited factor deficiencies, disseminated intravascular coagulation, liver disease, post major trauma, etc. Leukocyte reduced blood components are indicated to prevent the febrile nonhemolytic transfusion reactions, Human Leukocyte Antigen (HLA) alloimmunization, transmission of infections such as cytomegalovirus (CMV), and adverse transfusion reactions due to storage lesion. In the present study, the effect of plasma filtration on eight coagulation factors viz. fibrinogen, factors II, V, VII, VIII, IX, X and XI has been studied.Materials and Methods:The plasma separated from the whole blood donation from each of 25 donors was separated into two aliquots. Group-1 included unfiltered fresh frozen plasma; group-2 included fresh frozen plasma which was subjected to pre-storage leukocytereductionbyfiltration.ThelevelsofthecoagulationfactorsFibrinogen,II,V, VII, VIII, IX, X, XI were estimated in each sample in both the groups.Results:There was no statistically significant difference in the levels of any of the coagulation factors included in this study, between the unfiltered and the leukocyte reduced plasma. Group O positive individuals were found to have higher levels of all the coagulation factors. Conclusion:Filtration of plasma has no effect on the coagulation factors. This is the first study where the effect of plasma filtration on eight coagulation factors has been studied. Blood group O positive individuals were found to have higher levels of all the eight coagulation factors.

Biomedical simulations of nanoparticles drug delivery to blood hemodynamics in diseased organs: Synovitis problem

PurposeSynovial fluid is an ultra-viscous plasma filtration that lubricates joint movement. During acute accidents or a cartilage repair surgical intervention, blood is introduced into the joint and mixed with variable amounts of synovial fluid. The hypothesis of this study was that mixing the blood with the synovial fluid, forming a mixture of them, can change the rheological properties of the blood and the mechanical properties of the stenosis formed. Design/methodology/approachIn this work we have presented a theoretical study to a mixture of synovial and blood nanofluid with heat distribution, concentration and volume fraction effects through concentric tube when the outer tube contain stenosis. Two models of synovial fluid that depend on viscosity are debated, in model I the viscosity depend exponentially on the concentration while model II shear tensor is considered as a function of concentration. The mathematical model has been studied in cylindrical coordinates. The solution of mathematical model was also obtained numerically using finite difference method after using a domain transformation to transform the variable cross-section of the concentric tube to a uniform cross section. We approaches to the synovial fluid improves the velocity of blood in the areas of atherosclerosis due to the nature of synovial fluid, which has less friction forces. Also, the velocity of mixture blood and synovial for model I is higher than that for model II. Realistic implicationsThis problem with synovial lining is called synovitis. Originality/valueTo the authors’ information, no such research has been performed in the literature.