Saline Dilution Research Articles

Strategic Co-Location in a Hybrid Process Involving Desalination and Pressure Retarded Osmosis (PRO).

This paper focuses on a Hybrid Process that uses feed salinity dilution and osmotic power recovery from Pressure Retarded Osmosis (PRO) to achieve higher overall water recovery. This reduces the energy consumption and capital costs of conventional seawater desalination and water reuse processes. The Hybrid Process increases the amount of water recovered from the current 66.7% for conventional seawater desalination and water reuse processes to a potential 80% through the use of reclaimed water brine as an impaired water source. A reduction of up to 23% in energy consumption is projected via the Hybrid Process. The attractiveness is amplified by potential capital cost savings ranging from 8.7%–20% compared to conventional designs of seawater desalination plants. A decision matrix in the form of a customizable scorecard is introduced for evaluating a Hybrid Process based on the importance of land space, capital costs, energy consumption and membrane fouling. This study provides a new perspective, looking at processes not as individual systems but as a whole utilizing strategic co-location to unlock the synergies available in the water-energy nexus for more sustainable desalination.

Fibrinogen concentrate and cryoprecipitate but not fresh frozen plasma correct low fibrinogen concentrations following in vitro haemodilution

IntroductionFibrinogen deficiency often develops during massive bleeding due to e.g. fluid resuscitation with colloid plasma expanders like hydroxyethyl starch. This study investigates the haemostatic effect of various sources of fibrinogen: fibrinogen concentrates (Haemocomplettan® (FC 1), CSL Behring and Clottagen® (FC 2), LFB Biomedicaments), fresh frozen plasma (FFP), and Cryoprecipitate (CP). MethodsWhole blood samples provided by healthy individuals (n=8) were diluted 1:1 with HES or 0.9% isotonic saline as control. Various sources of fibrinogen was added to the HES diluted samples in concentrations equivalent to giving a 70kg male either no correction, 2grams of FC 1 or FC 2, 4grams of FC 1 or FC 2, 15ml/kg of FFP, 2 packs of CP or 4 packs of CP. Haemostatic effect was assessed by thromboelastometry initiated by tissue factor, with maximum clot firmness (MCF) as the primary endpoint. In addition thrombin generation was assessed for each intervention ResultsHES dilution reduced MCF significantly more than isotonic saline. High dose FC 1, 2 and CP corrected the MCF so that it did not differ significantly from the isotonic saline dilution group. Thrombin generation following isotonic saline and HES dilution was comparable and not decreased compared to whole blood. Fibrinogen concentrates supplementation did not increase thrombin generation whereas CP and FFP both increased thrombin generation ConclusionFibrinogen concentrates investigated dose dependently and equally corrected the MCF and caused no increase in thrombin generation. Cryoprecipitate also corrected the MCF, but also increased thrombin generation. FFP failed to improve MCF, but increased thrombin generation.

Electrical Properties of Silicon-Based Nanogap Electrodes for Label-Free Biomolecular Detection

The electrical properties of 6-, 33- and 89-nm gap structures were systematically studied to evaluate the feasibility of these structures to be used in biomolecular sensing devices. The fabrication and morphological characterization of these structures were previously reported. In this report, we electrically probed the presence of nanogap through current measurement. The effects of electrolytes to the capacitance profiles of these structures were systematically studied with air, water and various dilution of phosphate buffer saline. Increment in capacitance was found with the increment in electrolyte concentration. Improvement in current flow, capacitance, permittivity, and conductivity were observed with the smaller size nanogaps, suggesting their applications in low power consuming devices. Since nanogap-based dielectric biosensing devices needs to be operated with low level of current to avoid biomolecular damage, these structures should have potential applications in dielectric-based biomolecular detection using a low cost dielectric analyzer.

Blood as active colloid system: Study of blood sedimentation upon dilution of saline

Dependence of dynamics of blood sedimentation upon successive dilution of blood with saline solution in vitro was studied basing on the application of the principles of the system of technical vision. Oscillatory nature of the process of sedimentation of boundary between blood cells and plasma dependent on the degree of blood dilution with saline was found rate changes. The correlation between ESR (erythrocyte sedimentation rate) and the concentration of saline was determined.

Practical utility of thermodilution versus doppler ultrasound to measure hemodialysis blood access flow.

The current clinical guidelines recommend indirect access blood flow (Qa) measurement as one of the most important components in vascular access maintenance programs. The best-know methods are doppler ultrasound (DU) and saline dilution method. This study evaluates the efficiency of Qa measurement with thermodilution method (TD) in comparison with the DU. Transversal study in 64 patients in hemodialysis (41 men); mean age 59.9 years with 54 AVFs and 10 PTFE. Qa reference value was obtained with DU in brachial artery (AVFs) or at the zone of arterial puncture (AVGs). Bland-Altman and interclass correlation coefficient (ICC) were used to study accuracy. Mean values obtained with DU-Qa were 1426 ± 753 mL/min AVFs and 1186 ± 789 mL/min AVGs. The mean Qa with TD was 1372 ± 770 AVFs (bias 54.6; ICC 0.923) and 1176 ± 758 AVGs (bias 10.2; ICC 0.992). In the subgroup of 28 patients with radiocephalic latero-terminal AVFs the DU-Qa was 1232 ± 767 mL/min. The Qa was in radial artery 942 (ICC 0.805); radial-ulnar artery 1103 (ICC 0.973); cephalic vein 788 (ICC 0.772) and TD 1026 (ICC 0.971). We detected 5 cases of significant stenosis. After endovascular treatment the Kt was 79 liters (61; p=0.043) and TD-Qa 895 mL/min (663; p=0.043). TD represents a good indirect method of Qa measurement. In the subgroup of patients with radiocephalic AVFs, Qa measurements in the radial and ulnar artery are more accurate. Therefore, in this situation the TD method obtained an excellent correlation in comparison to brachial artery.

Thermodilution versus Saline Dilution Method for Vascular Access Blood Flow Measurement in High-Flux and On-Line Hemodiafiltration

Purpose Access blood flow (Qa) measurements are one of the most important components in vascular access monitoring programs, even though these indirect methods have only been validated with high-flux hemodialysis (HF; pump flow [Qb] 300 mL/min). This study was to assess the utility from thermodilution (BTM) with respect to the saline dilution method (SDM) in HF and on-line hemodiafiltration (OL-HDF) with routinely prescribed parameters in comparison with validation conditions. Methods Three consecutive sessions were assessed in 31 hemodialysis patients (27AVF). The Bland-Altman method and Lin's concordance coefficient (ρc) were used to study accuracy and precision. We used the student t test for the analysis of Qa-value in the different subgroups. Results In HF-hemodialysis 1 (Qb 300 mL/min), Qa was 1109 ± 541 mL/min SDMa and 1213 ± 639 mL/min BTM (P=.993a; bias 103.7 mL/min and ρc 0.78). In HF-hemodialysis 2 (Qb 420 mL/min) Qa 1071 ± 578 mL/min SDM (P=1.0a; -38.2 mL/min and 0.96) and 1216 ± 667 mL/min BTM (P=.992a; 127.3 mL/min and 0.70). In OL-HDF hemodialysis 3 (Qb 420 mL/min) Qa 1071 ± 510 mL/min SDM (P=1.0a; -48.4 mL/min and 0.96) and 1219 ± 580 mL/min BTM (P=.977a; 99.2 mL/min and 0.75). Statistically significant differences were only obtained in patients aged ≥ 65 years old (P=.016) and peripheral vascular disease (P=.007). Conclusions Our results demonstrate how the saline dilution method was more accurate than thermodilution in the HF and OL-HDF modalities with routinely prescribed parameters. Finally, in this study, advanced age (>65 years old) and peripheral vascular disease were associated with a significantly lower Qa-value.

Identifying Hemodialysis Catheter Recirculation Using Effective Ionic Dialysance

Vascular catheter use for dialysis remains highly prevalent, however, it is frequently adversely affected by access recirculation (AR). We previously reported the utility of effective ionic dialysance (EID)/blood flow rate (Qb) ratio in identifying significant (>5%) AR in arteriovenous (AV) fistulas (Mohan et al ASAIO J 56:427-433, 2010). We present data from 58 patients, receiving hemodialysis via venous catheters (85% tunneled cuffed catheters) who underwent intermittent monitoring for AR with the saline dilution technique (Transonic HD02 monitor) and had EID and Qb measurements from Diascan biosensor in the Gambro Phoenix dialysis machine available. Among the 193 hemodialysis sessions studied, 74 instances of significant access recirculation (sAR) were identified. A higher incidence of sAR occurred with temporary catheters and catheters in the femoral vein. We report a significant correlation between the EID/Qb ratio and AR in addition to demonstrating the predictive utility of the ratio for identifying dysfunction catheters with sAR (area under the receiver operator characteristic curve of 0.86 with a sensitivity of 79% and a specificity of 76% at an EID/Qb ratio of ≤ 0.60). Our data demonstrate the utility of the EID/Qb ratio as an indicator of sAR in dialysis catheters albeit at a different threshold than that seen with AV fistulae.

Thermodilution versus saline dilution method for vascular access blood flow measurement in high-flux and on-line hemodiafiltration

Access blood flow (Qa) measurements are one of the most important components in vascular access monitoring programs, even though these indirect methods have only been validated with high-flux hemodialysis (HF; pump flow [Qb] 300 mL/min). This study was to assess the utility from thermodilution (BTM) with respect to the saline dilution method (SDM) in HF and on-line hemodiafiltration (OL-HDF) with routinely prescribed parameters in comparison with validation conditions. Three consecutive sessions were assessed in 31 hemodialysis patients (27AVF). The Bland-Altman method and Lin's concordance coefficient (ρc) were used to study accuracy and precision. We used the student t test for the analysis of Qa-value in the different subgroups. In HF-hemodialysis 1 (Qb 300 mL/min), Qa was 1109 ± 541 mL/min SDM(a) and 1213 ± 639 mL/min BTM (P=.993(a); bias 103.7 mL/min and ρc 0.78). In HF-hemodialysis 2 (Qb 420 mL/min) Qa 1071 ± 578 mL/min SDM (P=1.0(a); -38.2 mL/min and 0.96) and 1216 ± 667 mL/min BTM (P=.992(a); 127.3 mL/min and 0.70). In OL-HDF hemodialysis 3 (Qb 420 mL/min) Qa 1071 ± 510 mL/min SDM (P=1.0(a); -48.4 mL/min and 0.96) and 1219 ± 580 mL/min BTM (P=.977(a); 99.2 mL/min and 0.75). Statistically significant differences were only obtained in patients aged ≥ 65 years old (P=.016) and peripheral vascular disease (P=.007). Our results demonstrate how the saline dilution method was more accurate than thermodilution in the HF and OL-HDF modalities with routinely prescribed parameters. Finally, in this study, advanced age (>65 years old) and peripheral vascular disease were associated with a significantly lower Qa-value.

Assessment of soil salinization risks under irrigation with brackish water in semiarid Tunisia

The salinity problem is becoming increasingly widespread in arid countries. In semiarid Tunisia about 50% of the irrigated land is considered as highly sensitive to salinization. To avoid the risk of salinization, it is important to control the soil salinity and keep it below plant salinity tolerance thresholds. The objective of the present study was to provide farmers and rural development offices with a tool and methodology for predicting, monitoring of soil salinity for a better agronomical strategy. The experiments were carried out in the highly complex and heterogeneous semiarid Kalâat Landalous irrigated district of Tunisia. The field and laboratory measurements of soil and water properties were conducted in 1989 and 2006 at different observation scales (2900ha, 1400ha, 5200m long transect, and soil profiles). Seventeen years of reclamation of a saline and waterlogged soil led to the reduction of average electrical conductivity of the soil saturated paste extract (ECe), measured at 5 soil depths (from 0 to 2m) below the plant salt tolerance threshold and the dilution of groundwater salinity from 18.3 to 6.6dSm−1. The variation in soil salt storage (ΔMss=Mss2006−Mss1989) in the vadose zone was negative, equal to about −145×103ton (≈−50tonha−1). During the same period, the salt balance (Siw–Sdw) estimated from the input dissolved salt brought by irrigation water (Siw) and output salts exported by the drainage network (Sdw) was equal to −685×106kg and the Sdw was 945×106kg. Under irrigation and efficient drainage, the soil salinization could be considered as a reversible process. At the transect scale, the high clay content and the exchangeable sodium percentage was negatively correlated to saturated hydraulic conductivity. The textural stratification, observed at soil profile scale, favors accumulation of salt in the soil. Based on the findings related to the multiscale assessment of soil salinity and groundwater properties, soil salinization factors were identified and a soil salinization risk map (SRU) was elaborated. The shallow groundwater constitutes the main risk of soil salinization. This map can be used by both land planners and farmers to make appropriate decisions related to crop production, and soil and water management.

The Impact of Hematocrit on Fibrin Clot Formation Assessed by Rotational Thromboelastometry

Rotational thromboelastometry (ROTEM®)-based FIBTEM is used perioperatively to assess the extent of fibrin polymerization in whole blood. In FIBTEM, cytochalasin D eliminates the contribution of platelets to whole blood clotting, but changing levels in fibrin(ogen) and erythrocytes may differently affect clot formation. Because dynamic changes of hematocrit are not reflected in plasma fibrinogen measurements, we hypothesized that the lack of erythrocytes in isolated plasma measurements would affect the relationship between the Clauss method and whole blood-based FIBTEM during cardiac surgery. Therefore, in the current study we investigated the influence of perioperative hematocrit changes on FIBTEM and fibrinogen measurements. Blood samples were collected from 6 consenting healthy volunteers. FIBTEM tests were run before and after serial in vitro dilutions of whole blood with saline or autologous plasma (5:1, 2:1, and 1:1 v/v). We then evaluated the relationship between FIBTEM-maximal clot firmness (MCF) and the Clauss fibrinogen method in relation to hematocrit values before and after cardiac surgery. Pearson correlation coefficients were determined between laboratory test results and ROTEM variables. Upon in vitro hematocrit reduction, FIBTEM-MCF was progressively decreased depending on the extent of saline dilution, but it was increased by 31% after 1:1 volume replacement with autologous plasma (P < 0.05). In samples from cardiac patients (150 measurements in 50 patients), the overall correlation coefficient between FIBTEM-MCF and plasma fibrinogen was 0.80 (P < 0.001). In hemodiluted blood samples (during surgery or at intensive care unit), FIBTEM-MCF 10 mm corresponded to plasma fibrinogen levels of 200 mg/dL. In the subgroup analysis (n = 50 each), according to hematocrit levels (<25%, ≥25% to 30%, ≥30%), plasma fibrinogen levels of 200 mg/dL corresponded to 11 mm, 10 mm, and 8 mm of FIBTEM-MCF, respectively. The correlation between FIBTEM-MCF and plasma fibrinogen was higher at lower hematocrit (<25%) than at higher hematocrit (>30%) (r = 0.88 and 0.67, respectively). Perioperative changes in hematocrit affect the correlation between plasma fibrinogen levels and FIBTEM-MCF values. The higher correlation between FIBTEM-MCF and plasma fibrinogen with lower hematocrit (<25%) indicates that FIBTEM is a practical method to determine the need for fibrinogen replacement in bleeding patients who typically develop perioperative anemia.

Comparison of a bronchoscopic microsample probe with bronchoalveolar lavage to measure cytokine levels in critically ill patients

The use of bronchoalveolar lavage (BAL) to investigate inflammatory lung disease in the critically ill may not be tolerated in hypoxic patients. Furthermore, soluble protein analysis of BAL fluid suffers from inaccuracies related to saline dilution. The bronchoscopic microsample (BMS) probe allows absolute cytokine levels in epithelial lining fluid (ELF) to be measured directly without lavage [1]. We compared cytokine levels from ELF obtained by the BMS probe with those from BAL, to verify its utility in critical illness.

Intravenous Fluids Cause Systemic Bias in a Conductivity-Based Point-of-Care Hematocrit Meter

Point-of-care (POC) devices measuring hematocrit rely on determination of electrical conductivity of whole blood. We hypothesized that some frequently administered IV fluids independently alter blood conductivity and confound hematocrit determination. Whole human blood was diluted to predetermined hematocrit values with normal saline, lactated Ringer solution, hetastarch, or plasma. Electrical conductivity and hematocrit (i-STAT® and spun methods) were measured at each dilution. In separate experiments, the effects of propofol and heparin were noted on these variables. Greater dilution significantly increased conductivity irrespective of diluent type. The magnitude of the conductivity slopes increased in order for plasma, hetastarch, lactated Ringer solution, and normal saline dilution. Moreover, each slope varied from every other slope (all P < 0.0001), and 94.2% of hematocrit values measured by i-STAT (n = 211 of 224) were less than those for the spun method. Dilution with plasma, normal saline, lactated Ringer solution, and hetastarch caused bias (Bland-Altman limits of agreement) of -2.7% (-6.9/1.4), -4.6% (-7.3/-2.0), -4.8% (-7.8/-1.7), and -2.0% (-5.6/1.9), respectively. The Cohen κ agreement values (5th-95th confidence interval) for a transfusion trigger of 30% were 0.90 (all values, 0.85-0.95), 0.25 (hematocrit <30%, 0.02-0.48), and 0.21 (hematocrit 18%-30%, 0.01-0.42). Clinically relevant concentrations of propofol and heparin had minimal effects on electrical conductivity or hematocrit determination. Dilution of blood with frequently used IV solutions affects whole blood conductivity determinations and thereby decreases hematocrits measured by a POC device relying on this method as compared with spun hematocrit. Conductivity-based hematocrit POC devices should be cautiously interpreted when hemodilution is present.

Enzyme-Linked Immunosorbent Assay for Okadaic Acid: Investigation of Analytical Conditions and Sample Matrix on Assay Performance

Abstract Okadaic acid (OA) is a lipophilic marine biotoxin. In this study, OA was coupled with the carrier proteins keyhole limpet hemocyanin and bovine serum albumin as immunity and detection antigens by an active ester method. The polyclonal antibody against OA was prepared successfully, an indirect competitive ELISA (ciELISA) developed for the detection of OA in shellfish, and the reactive conditions of ciELISA optimized. The LOD (15% inhibition concentration) for the microwell plates was 1.28±0.38 ng/mL, corresponding to 12.8±3.8 ng/g. Two extraction methods were used to remove shellfish matrix interference with high recovery of spiked samples, and the methanol extraction of shellfish mussel was analyzed after dilution in phosphate-buffered saline. For validation of the optimized ciELISA, spiked and natural samples were analyzed by ciELISA, and HPLC with fluorescence detection. The correlation of linear regression equation was y=1.0064x–10.234, and the correlation coefficient was 0.9347. From the results of the comparative study, the established ciELISA assay using polyclonal antibody against OA could be used in preliminary screening of suspicious shellfish samples.

Enzyme-Linked Immunosorbent Assay for Okadaic Acid: Investigation of Analytical Conditions and Sample Matrix on Assay Performance

Okadaic acid (OA) is a lipophilic marine biotoxin. In this study, OA was coupled with the carrier proteins keyhole limpet hemocyanin and bovine serum albumin as immunity and detection antigens by an active ester method. The polyclonal antibody against OA was prepared successfully, an indirect competitive ELISA (ciELISA) developed for the detection of OA in shellfish, and the reactive conditions of ciELISA optimized. The LOD (15% inhibition concentration) for the microwell plates was 1.28 +/- 0.38 ng/mL, corresponding to 12.8 +/- 3.8 ng/g. Two extraction methods were used to remove shellfish matrix interference with high recovery of spiked samples, and the methanol extraction of shellfish mussel was analyzed after dilution in phosphate-buffered saline. For validation of the optimized ciELISA, spiked and natural samples were analyzed by ciELISA, and HPLC with fluorescence detection. The correlation of linear regression equation was y = 1.0064x - 10.234, and the correlation coefficient was 0.9347. From the results of the comparative study, the established ciELISA assay using polyclonal antibody against OA could be used in preliminary screening of suspicious shellfish samples.

Subcutaneous Injection of Normal Saline Prevents Cutaneous Complications of Ethanol Sclerotherapy for Superficial Vascular Lesions: An Experimental Study

Percutaneous sclerotherapy is an effective therapeutic option for the treatment of venous malformations. Absolute ethanol is used as a sclerotic agent because of its effectiveness but is often avoided for treatment of superficial lesions because of the possible risk of cutaneous necrosis. A preclinical experimental study was performed to validate whether the cytotoxic effects of ethanol on surrounding healthy tissues could be diminished with prophylactic subcutaneous injection of normal saline above the vascular lesion immediately after intraluminal injection of ethanol by dilution. The effect of normal saline dilution on cytotoxicity of ethanol to the main cells of the skin (fibroblasts and keratinocytes) were assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide colorimetric assay. Effects of subcutaneous injection of normal saline immediately after intraluminal ethanol injection were assessed in a newly developed animal experimental model using the rabbit auricular vein. Cytotoxic effects of ethanol were decreased by saline dilution in vitro. Subcutaneous injection of normal saline after intraluminal injection of ethanol prevented the cutaneous ulceration observed in all cases without subcutaneous injection of normal saline in our animal model. Subcutaneous injection of normal saline appears effective for preventing cutaneous complications after ethanol sclerotherapy for superficial vascular lesions.

Microarray-detected changes in gene expression in gills of green crabs ( Carcinus maenas) upon dilution of environmental salinity

The interaction between environmental salinity and gene expression was studied in gills of the euryhaline green shore crab Carcinus maenas. A 4462-feature oligonucleotide microarray was used to analyze changes in transcript abundance in posterior ion-transporting gills at 8 time periods following transfer of animals from 32 to 10 or 15 ppt salinity. Transcripts encoding Na +/K +-ATPase α-subunit and cytoplasmic carbonic anhydrase were upregulated with significant changes between 6 and 24 h post-transfer. Other transport proteins showing similar transcriptional upregulation were an organic cation transporter, a sodium/glucose cotransporter, an endomembrane protein associated with regulating plasma membrane protein composition, and a voltage-gated calcium channel. Transport proteins showing little transcriptional response included Na +/H + exchanger, Na +/K +/2Cl − cotransporter, and V-type H +-ATPase B subunit, all of which have been implicated in osmoregulatory ion transport across crustacean gill. Interestingly, there was little affect of salinity dilution on transcriptional expression of stress proteins, suggesting that salinity acclimation is part of normal physiology for C. maenas. Expression of transcripts encoding a variety of mitochondrial proteins was significantly upregulated between 4 days and 7 days post-transfer, consistent with the proliferation of mitochondria-rich cells previously observed at this time.

Practical Utility of On-Line Clearance and Blood Temperature Monitors as Noninvasive Techniques to Measure Hemodialysis Blood Access Flow

Background/Aims: Access blood flow (Qa) measurements are recommended by the current guidelines as one of the most important components in vascular access maintenance programs. This study evaluates the efficiency of Qa measurement with on-line conductivity (OLC-Qa) and blood temperature monitoring (BTM-Qa) in comparison with the gold standard saline dilution method (SDM-Qa). Subjects and Methods: 50 long-term hemodialysis patients (42 arteriovenous fistulas/8 arteriovenous grafts) were studied. Bland-Altman and Lin’s coefficient (ρ_c) were used to study accuracy and precision. Results: Mean values were 1,021.7 ± 502.4 ml/min SDM-Qa, 832.8 ± 574.3 ml/min OLC-Qa (p = 0.007) and 1,094.9 ± 491.9 ml/min with BTM-Qa (p = NS). Biases and ρ_c obtained were –188.8 ml/min (ρ_c 0.58) OLC-Qa and 73.2 ml/min (ρ_c 0.89) BTM-Qa. The limits of agreement (bias ± 1.96 SD) obtained were from –1,119 to 741.3 ml/min (OLC-Qa) and –350.6 to 497.2 ml/min (BTM-Qa). Conclusions: BTM-Qa and OLC-Qa are valid noninvasive and practical methods to estimate Qa, although BTM-Qa was more accurate and had better concordance than OLC-Qa compared with SDM-Qa.

Our strategy in complication management of augmentation mammaplasty with polyacrylamide hydrogel injection in 235 patients

Polyacrylamide hydrogel (PAAG) was once widely used in breast augmentation in China. Although it had been banned for augmentation mammaplasty in 2006, a large number of patients whose breasts were augmented with the gel injection have continued to seek medical advice because of its complications. The clinical management of these complications has never been standardised. The data of a total of 235 patients with complications following PAAG-injected breast augmentation have been summarised and the types and causations analysed. Magnetic resonance imaging (MRI) was undertaken in 228 patients with palpable masses, breast pain or tenderness, asymmetry or deformity and functional or psychological problems to eliminate neoplasm, infection and to delineate the diseases. The surgical gel evacuation via periareolar incisions was performed for all patients and immediate silicone breast prostheses were implanted in 108 patients and were delayed in 28 cases by 6 months. Most patients (214/235) of the group were satisfied with the treatment, and symptoms disappeared after removal of the gel. The gel distribution and involved tissue were well defined and neoplasm was ruled out by MRI. Postoperative MRI in 68 patients revealed that no obvious PAAG remaining. In either immediate or delayed reconstructive patients with silicone breast implants, good breast contour presented. A diagnosis and management strategy for these complications is proposed. In conclusion, the breast masses, pain and deformity are major complications after PAAG-injected breast augmentation. Psychological problems should be paid attention to. MRI is a sensitive and accurate method for diagnosis and treatment evaluation. Surgical removal of injected gel is the preferred method for complication management. The implantation of silicone prostheses for breast contour restoration after PAAG evacuation is effective for patients under strict selection. Our strategy for treating PAAG-related complications proved useful.

Effective Ionic Dialysance/Blood Flow Rate Ratio: An Indicator of Access Recirculation in Arteriovenous Fistulae

Effective ionic dialysance (EID) is an online measure of hemodialysis (HD) effective urea clearance that is calculated using changes in dialysate sodium conductivity. Effective ionic dialysance is blood flow (Q(b)) dependent. The presence of significant (> or =5%) access recirculation (sAR) during dialysis lowers EID at a given Q(b), thereby lowering EID/Q(b). We propose using EID/Q(b) as a useful chairside tool for detection of sAR in arteriovenous fistulae (AVF). Data were collected from 47 patients with AVF (72% men, mean age 49 +/- 11.8 years, duration on dialysis 3.78 +/- 3.4 years, duration of fistula use 3.35 +/- 3.42 years) dialyzed with an high-efficiency dialyzer with a mass transfer area coefficient (KoA) of 1714 ml/min. Effective ionic dialysance were measured at regular intervals by the Gambro Phoenix dialysis system during treatments. The access recirculation (AR) and access blood flow (Q(a)) were measured using the reference standard saline dilution technique (Transonic HD-02 monitor). Among the 323 HD sessions where Q(b), EID, AR, and Q(a) were available, we identified 17 instances of sAR. The performance of EID/Q(b) as indicator of sAR was assessed by a receiver operator characteristic (ROC) curve (Stata version 10.1). The area under the ROC curve was 0.935 (95% confidence interval 0.869-1.000), which demonstrated a sensitivity of 76.5% and specificity of 96.4% at an EID/Q(b) < or =50% with a positive likelihood ratio of 21, negative likelihood ratio of 0.24, positive predictive value of 54.2%, and negative predictive value of 98.7%. We found similar test performance in patients who received HD with dialyzers with smaller surface areas and lower KoAs. The high specificity of EID/Q(b) makes it an excellent yet simple and early chairside indicator of AVF recirculation.

Mini buffy coat photopheresis for children and critically ill patients with extracorporeal photopheresis contraindications

Conventional extracorporeal photopheresis (ECP) has proven efficacy for the treatment of several diseases but is limited to patients with sufficient body weight. A novel simplified mini buffy coat ECP technique that allows treatment of small children and patients with apheresis contraindications has been developed. White blood cell (WBC)-rich buffy coat fractions were prepared from 5 to 8 mL/kg whole blood in a closed system, diluted, and ultraviolet A (UVA)-irradiated after addition of 8-methoxypsoralen (8-MOP). Apoptosis and cell death were analyzed by annexin V and 7-aminoactinomycin staining. Lymphocyte proliferation was measured after CD3/CD28 and phytohemagglutinin (PHA) stimulation. Autologous residual blood and UVA-irradiated buffy coat were returned to the patients. Fifty-six mini buffy coat ECP procedures were applied to three children with acute steroid-refractory skin graft-versus-host disease and apheresis contraindications. Mean whole blood and buffy coat volumes were 166 (+/-61.8) and 8 (+/-1.6) mL, respectively, and resulted in a hematocrit of 2.2% (+/-0.4) after saline dilution (median +/- SD). UVA irradiation of 8-MOP buffy coat preparations resulted in significant induction of WBC apoptosis at 48-72 hours (p <or= 0.006). WBC proliferation was significantly inhibited both after CD3/CD28 stimulation and after PHA stimulation when compared to controls (p <or= 0.001). No clinical or laboratory side effects were observed during mini ECP procedures and the three patients responded to the therapy. Mini buffy coat ECP induces apoptosis and lymphocyte proliferation inhibition, both of which occur after standard ECP. This study proposes that mini buffy coat ECP be used as a simple and inexpensive alternative to classical ECP in children and adult patients with apheresis contraindications.