Anti-PF4 antibodies after SARS-CoV-2 vaccines: Long term follow-up

Introduction A subgroup of anti-platelet factor 4 (PF4) antibodies can activate platelets via Fcgamma RIIA and cause thrombotic and thrombocytopenic diseases such as heparin-induced thrombocytopenia and vaccine-induced immune thrombotic thrombocytopenia (VITT). Nonpathological anti-PF4 antibodies are detected in 1-7 % of healthy blood donors and in 2-8 % of SARS-CoV-2 vaccinated individuals. In this study, we investigated the long-term course of anti- PF4 antibodies detected after the first SARS-CoV-2 vaccination in healthy subjects and in patients with VITT. Method Five healthy subjects (all female, median age (range): 40 years (29-62) ) who had anti-PF4 antibodies after the first vaccination with ChadOx1 nCov19 (Vaxzevria, AstraZeneca-Oxford) were included. None of the subjects developed VITT. Blood samples were collected as part of a longitudinal study (TuSeRe:exact) evaluating the immune response to SARS-CoV-2 vaccines among employees of an University Hospital. In addition, data from 4 patients with VITT (3 female, median age (range): 44 years (22 -62 years)) were included for long-term follow-up of anti-PF4 antibodies. Anti-PF4/heparin antibodies were measured using a commercially available ELISA assay (Zymutest HIA IgG, Hyphen BioMed, France). Platelet activation was tested with a modified heparin- induced platelet aggregation assay (HIPA). Results In the non-VITT group, the median (range) OD for IgG anti-PF4/heparin antibodies was 0.69 (0.60-1.83) after the first vaccination. Blood samples were available up to 16 months after the first vaccination (range: 5-16 months). Anti-PF4 antibody levels decreased in all subjects despite further vaccination. However, antibody levels returned to pre-vaccination levels in only one subject. In one subject who had received two doses of ChadOx1 nCov19, anti-PF4 antibodies remained above OD 1.0 at the last follow-up. All samples were negative in the modified HIPA assay. Patients with VITT received mRNA-based vaccine as second vaccination against SARS CoV2. No significant drop in platelet count or new thromboembolic complication was observed. Conclusion Nonpathological anti-PF4 antibodies can be detected even several months after the first vaccination. The clinical significance of these antibodies in case of subsequent exposure to a vector vaccine or heparin is not yet clear. Furthermore, subsequent vaccination seems safe in VITT patietns.

EXITrun - A Lecture as a Virtual Educational Escape Game

Using gamification approaches in Higher Education is an appropriate way to increase student's engagement especially during the time of the COVID-19 pandemic. Escape Games which could be either used as physical experience of a group in a room, or - more virtually - as several puzzles that need to be solved with the target to solve one overarching mystery, are well known tools that can be used in an educational environment as well. However, despite of existing frameworks and manifold examples it remains difficult to set up a Virtual Educational Escape Game (VEEG) with the proven positive effect on successful learning. This study presents some factors that support successful learning when using a VEEG and compares cost-benefitratios for manually versus automatically run VEEGs.

Assessment of interhospital transfers of acute surgical patients within an NHS trust

Acute surgical services at our trust were moved from two sites to a single site, due to CoVID-19. This project was inspired by cases of transfer whereby significant time delays resulted in poorer patient clinical outcome. Aim(s): To assess The times and delays in The transfer of an acute surgical patient at Site A to Site B for either continuing or definitive surgical intervention To assess The risks to patient safety and patient outcomes resulting from transfer To assess whether NCEpoD guidance for urgent surgery were adhered to Methods: * Total transfers were audited over a three month period. The following parameters were recorded: Patient demographics Time patient referred to On call surgical team at Site A Time patient seen by On call surgical team at Site A Times to diagnosis and subsequent decision to transfer Time patient reached Site B Any procedure or operation or higher lever treatment The patient received Length of stay Any complications noted during inpatient stay Results: Total cases of transfer 188 No. cases that went for CEpoD 78 No. of cases for procedures of any sort 99 Complications post/during procedure 37 Deaths 7 Average time from decision to transfer until arrival time at 11:11 Site B Average decision to transfer until procedure time 46:54 Conclusion(s): Interhospital transfer must focus On maintaining optimal Health and outcomes for The patient. A guideline and framework for safe transfers must be implemented and adhered to strictly.

Clinical and serological follow up of VITT patients treated with heparin and alternative anticoagulation

Background: Vaccine induced thrombotic thrombocytopenia (VITT) is a rare but severe complication following vaccination with ChAdOx1 nCoV-19. Antibodies directed against platelet factor 4 (PF4) are thought to be responsible for platelet activation and subsequent thromboembolic events in these patients. Because of the similarities between heparin-induced thrombocytopenia (HIT) and VITT heparin was avoided but the risk of thrombosis in VITT upon heparin administration remains unclear. Aim(s): To assess the impact of heparin used as initial anticoagulants to treat VITT. Method(s): We prospectively analyzed follow up data from 4 patients with confirmed VITT patients (3 women and 1 men;median age, 44 years [range, 22-62 years]). ELISA and functional VITT testing was performed at each time point. Result(s): The patients' clinical symptoms started between days 4 and 17 after first vaccination with ChAdOx1 nCoV-19. All patients presented with thrombocytopenia and thromboembolic events (amaurosis fugax and peripheral thrombosis and venous sinus thrombosis). The follow-up duration ranged between 8 weeks and 9 months. No additional thromboembolic event or disease progression occured in any patient. A recovery in platelet count was monitored in all four patients within 10 days after starting treatment (heparin or alternative anticoagulation combined with IVIG). In both patients who were treated with heparin, anti-PF4 antibodies were not detectable after 3 and 19 weeks respectively. All 4 patients received mRNA-based vaccine as second vaccination against SARS CoV2. No significant drop in platelet count or new thromboembolic complication was observed. Conclusion(s): In the treatment of VITT, early beginning of anticoagulation with close follow-up of the platelet count and thrombosis signs seem to be more important than the choice of anticoagulant. Subsequent vaccination with an mRNA vaccine appears to be safe in VITT patients.

ULTRASOUND GUIDED INJECTIONS of HYADD4 for KNEE OSTEOARTHRITIS IMPROVES PAIN and FUNCTIONAL OUTCOMES at 3 and 6 MONTHS WITHOUT CHANGES in SYNOVIAL FLUID VOLUMES

Background: Prior studies have demonstrated improved accuracy and efficacy when Intra-articular (IA) therapeutics are injected using ultrasound (US) guidance. There is also growing evidence that many patients with knee oste-oarthritis (OA) exhibit a pro-infammatory catabolic synovial fuid (SF) profile. However, it is not known if temporary clinical improvement in pain and function after IA Hyaluronic acid (HA) injections is associated with changes in SF volumes. Objectives: The purpose of this study was to determine if IA HA injections delivered using US directed needle visualization with an external pneumatic compression device would result in improved clinical outcomes for knee OA at 3 and 6 months, and if this was associated with a reduction in the amount of knee synovial fuid (SF) measured on US. Methods: 49 eligible subjects with symptomatic Knee OA, BMI < 40 and KL radiographic rating of II or III OA were consented for this open label prospective IRB approved Investigator Initiated SF OA biomarker study (HS 3179, NCT 04093232). All standing radiographs were reviewed by a fellowship-trained MSK radiologist. 36 subjects had adequate aspirated SF volumes of > 500 mcl for biomarker analysis and therefore were eligible to receive two IA injections of HYADD4, 24 mg/3ml (Fidia Farmaceutici S.p.A. Italy) 7 days apart by a MSK US certifed Rheumatologist. An external pneumatic compression device and US visualized needle insertion ensured injections were delivered into the intra-syn-ovial space. Despite COVID-19 restrictions, 34 patients (17 women and 17 men) between 35 and 78 years of age returned for 3 month evaluations and 30 had evaluations at 6 months. The following clinical variables were measured: Western Ontario and McMaster Universities Index (WOMAC) total scores, Visual Analog Pain Scale (VAS, 0-10), PCS scores on the SF-36 health survey questionnaires (physical function/bodily pain and general health), 6-min-ute walking distance in meters (6 MWD), and measured SF depth before and after an external pneumatic compression device was infated to 100 mmHg to facilitate aspiration by increasing available SF volumes under positive presure. The SF depth was measured on the recorded US image (GE logiq e) as the largest anechoic region selected for aspiration on either the lateral (n= 30) or medial (n=4) compartment. SF and simultaneous peripheral blood samples were centrifuged and cryopreserved at-80 o C within 45 minutes of aspiration for future analysis. Statistical differences between baseline values compared to those levels at 3 and 6 months were determined using a paired ANOVA test with p <0.05 signifcance. Results: Improvements over baseline values were observed at 3 and 6 months respectively, after IA HA injections in WOMAC (40%, 40%), VAS (45%, 51%) and PCS (15%, 18%) all p< 0.0001. The 6 WWD improved by 7 % at 3 months (p< 0.007) but was not statistically improved at 6 months. US measured SF depth at baseline was 3.2 ± 2.2 mm before infation and 6.4 + 3.7 mm after infation of the pneumatic external compressioin device but statistical differences in SF depth were not observed at 3 and 6 months. Conclusion: Despite improvements in WOMAC, VAS scores, and PCS scores on the SF 36 at 3 and 6 months after US guided knee injections with an HA product, a statistically signifcant reduction in the amount of US measured SF was not observed. The 6 MWD improved at 3 months but was not statistically different from the baseline distance by 6 months. IA injections using US needle visualization confrmed that the product was delivered into the synovial space with 100 % accuracy which might have resulted in improved efficacy results in this study compared to prior IA HA studies injected without US or using different HA products. In the future, we hope SF biomarkers may identify which individual OA patients will likely achieve the greatest beneft with IA HA injections and to determine if this is associated with a reduction in catabolic pro-infammatory proteins.

TRAJECTORIES OF PERCEIVED SUSCEPTIBILITY TO COVID-19 OVER A YEAR: THE COVID-19 & CHRONIC CONDITIONS (C3) STUDY

BACKGROUND: The U.S. public health response to COVID-19 has been widely criticized as having downplayed the potential implications COVID-19 could have on one's personal health. Despite the unprecedented threat of COVID-19, many individuals still believed that it was not at all likely that they would become infected. We examined: (1) the yearlong trend of adults' perceived susceptibility to COVID-19, (2) whether distinct trajectories emerged, and (3) whether the trajectories differed by participant sociodemographic characteristics. METHODS: Participants from Chicago were recruited from one of five ongoing NIH-funded studies managed by our research team. Data was collected at five timepoints, where participants were asked about their susceptibility to COVID-19, in addition to their socio-demographic and health-related data. We identified groups of individuals following similar progressions of perceived susceptibility to COVID-19 and classified them into trajectory groups using the traj command in Stata. Associations between participant characteristics and their trajectory group were examined in bivariate analyses. Additionally, a multivariable Poisson model was used to estimate relative risks of following a certain trajectory. RESULTS: Nearly two-thirds (62.2%) of participants perceived themselves to be highly susceptible to COVID-19 from the onset of the pandemic ('early responders') and sustained this over a year, 29.0% eventually perceived themselves to be highly susceptible ('late responders'), and 8.8% maintained a low likelihood of susceptibility throughout the pandemic ('non-responders'). In multivariate analyses, compared to White participants, Latinx participants were significantly more likely to be non-responders and report low likelihood of perceived susceptibility (RR: 3.46;95% CI: 1.19, 10.1), as were Black participants (RR: 5.49;95% CI: 2.19, 13.8). CONCLUSIONS: A year into the COVID-19 pandemic, 1 out of 11 participants persistently did not think they might be susceptible and potentially infected. Future studies are needed to understand reasons why certain individuals, particularly those of racial/ethnic minorities, did not perceive themselves at risk for infection.

Validation of MyCog: A Self-Administered Rapid Detection Tool for Cognitive Impairment in Everyday Clinical Settings

Objective: To present initial validity evidence for MyCog. Background: Cognitive Impairment (CI) affects more than 16 million people, with dementia or severe cognitive decline projected to increase significantly by 2050. MyCog is a brief, standardized iPad-based, self-administered cognitive screening assessment designed for use in diverse clinical settings, among older adults or any patient with a recognized cognitive concern. It will address the need for sensitive measures of CI feasible for use in primary care settings. Design/Methods: Participants were recruited from an ongoing cognitive aging study conducted in academic internal medicine clinic and community health centers. CI was determined based on either a chart diagnosis of dementia or mild cognitive impairment (MCI), or by normative performance on a comprehensive cognitive battery within the prior 18 months. The MyCog assessments, Dimensional Change Card Sort (DCCS) and Picture Sequence Memory (PSM), measure executive function, cognitive flexibility, and episodic memory. We evaluated the efficacy of MyCog as a detection tool using sensitivity, specificity, and receiver operator characteristic (ROC) curves. Results: Of the 80 participants administered the MyCog assessment, 31 were classified as CI. In the sub-sample of participants who expressed concern about their cognition (n = 52), PSM and DCCS demonstrated exceptional ability in detecting CI (the area under the ROC curve, or AUC, = 0.92), with an average administration time of 12 minutes. When only including the first of two PSM trials along with DCCS, time was reduced on an average to <7 minutes, with little change in AUC (0.90). Conclusions: Preliminary validity evidence supports the use of MyCog as a self-administered cognitive screening battery. Given the COVID-19 pandemic, it is important to provide physicians and clinical staff access to well-designed cognitive assessments that can be selfadministered. We are currently validating MyCog in MCI clinical populations, and our next steps include a clinical trial with modified clinic workflows.

Impact of COVID-19 on the Capacity to Self-Manage Health and Chronic Conditions

Background: At the outbreak of the pandemic in Chicago, there were disruptions in daily life, communication and delivery of healthcare services. Our objective was to investigate mental well-being, lifestyle behaviors, self-management capacity and healthcare utilization during the early months of the COVID-19 pandemic among older adults with one or multiple chronic conditions. Methods: Telephone interviews were conducted as part of the ongoing COVID-19 & Chronic Conditions (C3) study between March and May 2020. Participants were recruited from local academic and safety net clinics and participated in existing research studies prepandemic. Self-report items assessed perceived stress due to coronavirus, self-management capacity and healthcare utilization. Validated measures assessed well-being, alcohol consumption, physical activity and self-efficacy. Results: The average age of participants (N=565) was 62.4, most were female (61.4%), and over half (n=310) were non-White or Latinx. One in five (20.7%) participants were stressed about the coronavirus most or all the time. Almost a quarter (22.3%) engaged in hazardous drinking and 79.7% reported insufficient physical activity. Nearly one in four participants (23.7%) avoided seeking medical care due to worry about COVID-19. In multivariable analyses, women reported more stress than men. Greater COVID-19 related stress and low health activation were associated with less physical activity, lower self-efficacy, greater difficulty managing health/medications and more avoidance of medical care. Conclusion: Consequences of COVID-19 on the mental wellbeing, lifestyle and ability of adults with chronic conditions to manage health were apparent in the initial months of the pandemic. As the C3 study is ongoing, it will be possible to examine pre- and postpandemic factors over time to understand the influence of the pandemic on the overall health trajectories of older adults.

Intranasal administration of BReC-CoV-2 COVID-19 vaccine protects K18-hACE2 mice against lethal SARS-CoV-2 challenge.

SARS-CoV-2 is a viral respiratory pathogen responsible for the current global pandemic and the disease that causes COVID-19. All current WHO approved COVID-19 vaccines are administered through the muscular route. We have developed a prototype two-dose vaccine (BReC-CoV-2) by combining the Receptor Binding Domain (RBD) antigen, via conjugation to Diphtheria toxoid (EcoCRM®). The vaccine is adjuvanted with Bacterial Enzymatic Combinatorial Chemistry (BECC), BECC470. Intranasal (IN) administration of BreC-CoV-2 in K18-hACE2 mice induced a strong systemic and localized immune response in the respiratory tissues which provided protection against the Washington strain of SARS-CoV-2. Protection provided after IN administration of BReC-CoV-2 was associated with decreased viral RNA copies in the lung, robust RBD IgA titers in the lung and nasal wash, and induction of broadly neutralizing antibodies in the serum. We also observed that BReC-CoV-2 vaccination administered using an intramuscular (IM) prime and IN boost protected mice from a lethal challenge dose of the Delta variant of SARS-CoV-2. IN administration of BReC-CoV-2 provided better protection than IM only administration to mice against lethal challenge dose of SARS-CoV-2. These data suggest that the IN route of vaccination induces localized immune responses that can better protect against SARS-CoV-2 than the IM route in the upper respiratory tract.

Differential Effects of Bridge Program Participation on Perceived Belonging and Peer Support for STEM Degree Seekers during the COVID-19 Pandemic

This NSF S-STEM Grantee poster examines the impact of participation in the Rice Emerging Scholars Program (RESP), Rice University's comprehensive undergraduate science, technology, engineering, and mathematics (STEM) summer bridge program, on student perceptions of university belongingness within the context of the COVID-19 pandemic. Within a quasi-experimental design, the researchers examined whether RESP participants experienced different levels of belongingness utilizing two measures: The Psychological Sense of School Membership Scale, as well as a measure of perceived peer support. Additionally, the researchers examined whether family income impacted students, regardless of RESP program participation. Finally, researchers examined whether family income moderated the relationship between belongingness outcomes and program participation. Results did not support the hypotheses;there were no significant relationships found between RESP participation and sense of school membership (r = -.02, p >.05), RESP participation and perceived peer support (r =.05, p >.05), family income and sense of school membership (r = -.05, p >.05), or family income and perceived peer support (r = -.06, p >.05), nor was evidence found for family income moderating the relationship between belongingness outcomes and RESP participation. Implications for future work in this area are discussed. © American Society for Engineering Education, 2021

Wine market segmentation by age generations in the Western US: expectations after the COVID-19 pandemic

Purpose The purpose of this paper is to investigate if differences exist between the four wine-consuming generations in wine purchasing behavior, the desirability of wine attributes when making a purchase decision and information sources used. It examines if generational market segmentation is an actionable and valuable strategy for the wine industry. Generation Z, Millennials, Generation X and Baby-Boomers are the four generations examined. This research also investigates if the generations behaved differently concerning wine consumption during the COVID-19 pandemic. Further, expectations concerning future wine purchasing behavior are examined. Design/methodology/approach An online survey was conducted between April 29, 2020 and May 7, 2020, with a sample size of 944 consumers from Western US States (California, Washington, Idaho, Oregon and Nevada). One-way analysis of variance technique and Chi-square tests were used to examine differences. Findings Segmentation by generation is appropriate when creating products, pricing, determining channels of distribution and creating messaging for a specific wine brand. The COVID-19 pandemic caused channel shifting that is expected to continue after the pandemic. Originality/value This is the second academic paper that examines differences in wine purchasing behavior between generations including Generation Z and the only study that examines the purchasing behavior changes and expectations for the future by generation concerning the COVID-19 pandemic. Research limitations/implications A national survey should be conducted to confirm that the results from the sample that was mostly from California and neighboring states reflect the national wine consumer in the USA. Practical implications The research identifies the products, prices, channels of distribution and messaging that are appropriate to target each generation.

Influence of study design on effects of mask wearing on fMRI BOLD contrast and systemic physiology - A comment on Law et al. (2021).

In a study by Law and colleagues recently published in Neuroimage, the authors reported that wearing a surgical mask during an fMRI scan leads to a statistically significant subject-specific change (30%) in the baseline BOLD level in gray matter, although the response to a sensory-motor task was unaffected. An average increase in end-tidal CO2 of 7.4% was found when wearing a mask, despite little support in the literature for major effects of mask wearing on blood gas levels. We comment on these findings, point out a several relevant limitations of the study design and provide alternative interpretations of these data.

Hands-On Laboratory Experience Using Adhesives for Remote Learning of Polymer Chemistry

Teaching chemistry without access to a traditional laboratory space is an ongoing challenge that has become especially relevant because of the SARS-CoV-2 pandemic. While several remote learning options exist for covering general chemistry concepts (including kitchen-based experiments, online modules, and virtual reality), few options provide opportunities for hands-on learning about the chemistry of synthetic polymer materials. Here, we offer remote learning modules that use household adhesives as a platform for teaching polymer chemistry outside of the laboratory. These modules are designed for students who have taken at least one semester of organic chemistry and have varied hands-on time commitments, ranging from 2 to 10 total hours each. Concepts covered include polymer synthesis, intermolecular interactions, thermomechanical properties, structure–function relationships, and molecular design. The experiments described in these modules also give students a chance to practice research-relevant skills such as searching for primary literature sources, fabricating test samples, explaining unexpected experimental results, and revising experimental procedures to improve methodologies. Ultimately, these modules provide educators with an additional tool for teaching experimental chemistry outside of the laboratory.

Interplay of Antibody and Cytokine Production Reveals CXCL13 as a Potential Novel Biomarker of Lethal SARS-CoV-2 Infection.

The SARS-CoV-2 pandemic is impacting the global population. This study was designed to assess the interplay of antibodies with the cytokine response in SARS-CoV-2 patients. We demonstrate that significant levels of anti-SARS-CoV-2 antibody to receptor binding domain (RBD), nucleocapsid, and spike S1 subunit of SARS-CoV-2 develop over the first 10 to 20 days of infection. The majority of patients produced antibodies against all three antigens (219/255 SARS-CoV-2+ patient specimens, 86%), suggesting a broad response to viral proteins. Antibody levels to SARS-CoV-2 antigens were different based on patient mortality, sex, blood type, and age. Analyses of these findings may help explain variation in immunity between these populations. To better understand the systemic immune response, we analyzed the levels of 20 cytokines by SARS-CoV-2 patients throughout infection. Cytokine analysis of SARS-CoV-2+ patients exhibited increases in proinflammatory markers (interleukin 6 [IL-6], IL-8, IL-18, and gamma interferon [IFN-γ]) and chemotactic markers (IP-10 and eotaxin) relative to healthy individuals. Patients who succumbed to infection produced decreased IL-2, IL-4, IL-12, RANTES, tumor necrosis factor alpha (TNF-α), GRO-α, and MIP-1α relative to patients who survived infection. We also observed that the chemokine CXCL13 was particularly elevated in patients who succumbed to infection. CXCL13 is involved in B cell activation, germinal center development, and antibody maturation, and we observed that CXCL13 levels in blood trended with anti-SARS-CoV-2 antibody levels. Furthermore, patients who succumbed to infection produced high CXCL13 and had a higher ratio of nucleocapsid to RBD antibodies. This study provides insights into SARS-CoV-2 immunity implicating the magnitude and specificity of response in relation to patient outcomes.IMPORTANCE The SARS-CoV-2 pandemic is continuing to impact the global population, and knowledge of the immune response to COVID-19 is still developing. This study assesses the interplay of different parts of the immune system during COVID-19 disease. We demonstrate that COVID-19 patients produce antibodies to three proteins of the COVID-19 virus (SARS-CoV-2) and identify many other immunological proteins that are involved during infection. The data suggest that one of these proteins (CXCL13) may be a novel biomarker for severe COVID-19 that can be readily measured in blood. This information combined with our broad-scale analysis of immune activity during COVID-19 provides new information on the immunological response throughout the course of disease and identifies a novel potential marker for assessing disease severity.

Using proteomics analyses to gain insight into protein adsorption on oxygenator membranes leading to better haemocompatibility

OBJECTIVES: Extracorporeal membrane oxygenation is of crucial importance for the treatment of acute or chronic lung diseases and gains even more significance with the increasing prevalence of Covid-19. In recent years, some modifications of the gas exchange membranes have been made which led to improvements in gas exchange properties and hemocompatibility, but a long-term solution is still not within reach. Blood contact with the membranes and tubes leads to activation of the coagulation, complement system and to inflammatory reactions. The competitive plasma protein adsorption within the first minutes mainly determines the reaction against the material and thus the fate of the oxygenators. Therefore, we aimed at investigating the time- and flowdependent plasma protein adsorption on oxygenator membranes to better understand the complex interactions on the surface. METHODS: Miniature oxygenator devices were built from PVC tubes and polycarbonate connectors. Heparin-coated and uncoated hollow fibre membranes were rolled to fit into the miniature devices. The circuit with tubes and miniature oxygenators was filled with human plasma and pumped through the heated circuit for 1 minute up to 6 hours (roller pumps). Afterwards, haemocompatibility parameters according to ISO10993-4 were examined and the oxygenator membranes used were washed and proteins desorbed. The resulting protein solutions were analysed by mass spectrometry. RESULTS: Protein adsorption started immediately after contact with blood. From the identified proteins, clusters were created which show a similar expression over time. This allows to analyse specifically when which proteins of certain pathways bind on the surface. Further mass spectrometric analyses are ongoing and will be analysed shortly. DISCUSSION: Identification of the time-dependent protein adsorption and -exchange on the surface will provide us with the necessary knowledge to predict beneficial protein compositions over adverse ones for haemocompatibility. Further experiments will then reveal if the new surface modifications are suitable for long-term use of oxygenators. CONCLUSIONS: Manufacturing of new surface modifications after analysing the protein adsorption data will pave the way towards longer use of oxygenators, maybe even for long-term use as part of implantable devices.