Comparison of biocompatibility in polysulfone dialysis membranes with different sterilization.

INTRODUCTION: Polysulfone (PSf) membrane has been widely used for hemodialysis. A few studies have been reported in which a method of sterilization may affect biocompatibility. In this study, the comparison was made between two PSf membranes in order to evaluate the effect of sterilization from the biocompatibility point of view. METHODS: We investigated the biocompatibility of the following two dialyzers, that is, APS-11SA (Asahi Kasei medical Co., Tokyo, Japan), sterilized by gamma-ray irradiation, and RENAK PS-1.0 (Kawasumi laboratories, Tokyo, Japan), sterilized by autoclave. Heparin of 40 units/mL was put in a syringe, and test blood was collected from healthy volunteers. Then, the dialyzer and blood circuit were filled with the test blood. Subsequently, the blood was circulated by a roller pump at the rate of 200 mL/min. We measured the platelet counts, CD41 and CD42b platelet surface markers, beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4) at 30, 120, and 240 minutes, respectively. FINDINGS: The platelet counts at 30, 120, and 240 minutes decreased significantly from the initiation of blood circulation in both dialyzers. The average beta-TG and PF4 increased from 61.3 ± 22.1 and 17.0 ± 6.4 ng/mL to 680.7 ± 217.1 and 550.7 ± 116.7 ng/mL with APS-11SA and to 454.3 ± 85.6 and 402.0 ± 58.0 ng/mL with RENAK PS-1.0, respectively. The average expression of CD41 and CD42b in APS-11SA and RENAK PS-1.0 was similar. DISCUSSION: There are some reports that the gamma-ray irradiation changes the membrane structure of the PSf membrane, crosslinking the polyvinylpyrrolidone (PVP), a hydrophilic agent, on to the membrane. On the other hand, excess amount of PVP may have been eluted during the rinsing procedure in RENAK PS-1.0 because it was sterilized with autoclave. Because both these factors influenced on our results, APS-11SA and RENAK PS-1.0 dialyzers showed excellent blood compatibility.

[Ruptured Aneurysm of the Sinus of Valsalva Accompanied with a Bicuspid Aortic Valve in an Elderly Man;Report of a Case].

The combination of ruptured aneurysm of the sinus of Valsalva and a bicuspid aortic valve is very rare in an elderly person. A 71-year-old man with ruptured aneurysm of the sinus of Valsalva and a bicuspid aortic valve had undergone an operation. He was admitted to his other hospital because of heart failure. He was transferred to our hospital to undergo treatment for ruptured aneurysm of sinus of Valsalva. At our hospital, echocardiography findings showed ruptured aneurysm of the sinus of Valsalva, a ventricular septal defect (VSD), and severe aortic regurgitation with moderate stenosis of the bicuspid aortic valve. An aneurysm originating from the anterior sinus of Valsalva had ruptured into the right ventricular outflow tract. The ruptured aneurysm and VSD were repaired by patch closure through the right ventricular outflow tract. Additionally, the aneurysm of the sinus of Valsalva was repaired with direct closure through aortotomy. The insufficient bicuspid aortic valve was replaced with a bioprosthetic valve. After the operation, heart failure improved promptly, and he was making satisfactory progress in his recovery.

Comparison of Diagnostic Accuracy between Pulse Volume Recording Parameters and Exercise-Ankle-Brachial Pressure Index in Patients with Ankle-Brachial Pressure Index above 0.9.

Objective: The objective of this study was to clarify whether or not pulse volume recoding (PVR) parameters have screening capability equivalent to ankle-brachial pressure index after walking (Ex-ABI) for patients with 0.91 or higher ABI. Patients and Methods: The subjects were 87 patients (147 limbs) with symptoms of lower extremities with 0.91 or higher ABI. In all patients, upstroke time (UT), percentage of mean artery pressure (%MAP) of PVR and Ex-ABI were measured, and computed tomographic angiography (CTA) was concomitantly performed. Results: Area under the curve (AUC) of receiver operating characteristics (ROC) curves of Ex-ABI, %MAP, and UT were 0.90, 0.70, and 0.81, respectively. A significant difference was noted in AUC between Ex-ABI and %MAP (p <0.001). When the cut-off values were set at %MAP ≥45% and UT ≥180 msec, the accuracies of %MAP and UT were markedly lower than that of Ex-ABI. When the cut-off values were corrected to the values determined from the ROC curves (%MAP ≥41, UT ≥164 msec), the diagnostic accuracy of UT increased markedly. Conclusion: In patients with 0.91 or higher ABI, screening capability of PVR parameters was markedly lower than that of Ex-ABI, but UT has screening capability close to that of Ex-ABI when the cut-off value is corrected downward.

Utility of Exercise-Induced Zero TBI Sign in Patients on Maintenance Hemodialysis.

It is uncertain whether exercise-induced zero toe brachial index sign (e-ZETS) is beneficial to prevent advanced perfusion disturbance in maintenance hemodialysis (HD) patients. In HD patients, we compared the clinical findings and prognoses among 22 toes in a resting zero toe brachial index sign (r-ZETS) group, 22 toes in an e-ZETS group, and 63 toes in a non-e-ZETS group. The hemodynamics of the lower extremities in the e-ZETS group is intermediate between the r-ZETS and non-e-ZETS groups. As the result of a 36-month follow- up observation, the r-ZETS avoidance rate was significantly lower in the e-ZETS group (63.6%; P <0.001) than the non-e-ZETS group (98.4%), showing that it was difficult to avoid advanced perfusion disturbance. The e-ZETS in HD patients may appear before r-ZETS, being beneficial as a predictor for advanced perfusion disturbance. (This is a translation of J Jpn Coll Angiol 2015; 55: 125-129.).

Exercise-ankle brachial pressure index with one-minute treadmill walking in patients on maintenance hemodialysis.

BACKGROUND: The ankle-brachial pressure index (ABI) is widely used as a standard screening method for arterial occlusive lesion above the knee. However, the sensitivity of ABI is low in hemodialysis (HD) patients. Exercise stress (Ex-ABI) may reduce the false negative results. PATIENTS AND METHODS: After measuring resting ABI and toe-brachial pressure index (TBI), ankle pressure and ABI immediately after walking (Post-AP, Post-ABI) were measured using one-minute treadmill walking in 52 lower limbs of 26 HD patients. The definition of peripheral arterial occlusive disease (PAD) required an ABI value of less than 0.90, TBI value of less than 0.60, and decrease of more than 15% of the Post-ABI value and 20 mmHg of Post-AP in Ex-ABI. Computed tomographic angiography (CTA) was performed in 32 lower limbs of 16 HD patients. PAD is defined as presence of stenosis of more than 75% in the case of lesions from an iliac artery to knee on CTA. RESULTS: The accuracy of Ex-ABI (Sensitivity, 85.7%; Specificity, 77.7%) was higher than those of ABI (Sensitivity, 42.9%; Specificity, 83.3%) or TBI (Sensitivity, 78.6%; Specificity, 61.1%). CONCLUSION: Ex-ABI with one-minute treadmill walking is the most useful tool for the screening of arterial occlusive lesions above the knee in maintenance HD patients.

Robustness of the oxygen uptake efficiency slope to exercise intensity in patients with coronary artery disease.

Oxygen uptake efficiency slope (OUES) and ventilatory efficiency (VE/VCO2 slope) are widely used as submaximal measurements of cardiopulmonary exercise testing as the evaluator or prognosticator of cardiac diseases. However, very few studies have compared the effects of submaximal exercise on these measurements. A total of 58 patients with coronary artery disease underwent maximal cardiopulmonary exercise testing on a treadmill. We compared the values obtained from the first 75% (VE/VCO2 slope75 and OUES75) and 90% (VE/VCO2 slope90 and OUES90) of the exercise period with the entire duration (VE/ VCO2 slope100 and OUES100). Although OUES100, OUES90 and OUES75 were virtually identical, submaximal calculations of VE/VCO2 slope underestimated the measurements. The Bland-Altman method revealed that submaximal measurements of OUES agreed very well with maximal OUES (limits of agreement -5.0% to +6.0% for OUES90, and -11.5% to +12.9% for OUES75). However, the submaximal calculations of VE/ VCO2 slope showed rather poor agreement with the maximal calculations (limit of agreement -11.8% to +3.1% for VE/VCO2 slope90, and -20.8% to +5.3%% for VE/VCO2 slope75). These results revealed that both the OUES and the VE/VCO2 slopes are not overly influenced by exercise.

Concentrations of hepatocyte growth factor, basic fibroblast growth factor, and vascular endothelial growth factor in pericardial fluid and plasma.

Some angiogenic factors, including hepatocyte growth factor (HGF), basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF), have been reported to promote angiogenesis and improve myocardial perfusion in experimental models of ischemic heart disease. These factors are produced in various tissues, including myocardium. We measured the concentrations of HGF, bFGF, and VEGF by enzyme-linked immunosorbent assay in plasma and in pericardial fluid sampled during open heart surgery (12 patients with ischemic heart disease and 17 with nonischemic heart disease). HGF levels were significantly higher in plasma than in pericardial fluid (12.0 +/- 1.8 versus 0.26 +/- 0.04 ng/mL, P < 0.0001). On the other hand, bFGF levels were significantly higher in pericardial fluid than in plasma (243.5 +/- 50.9 versus 49.6 +/- 7.8 pg/mL, P = 0.009). VEGF levels were not significantly different between pericardial fluid and plasma (47.2 +/- 17.6 versus 24.5 +/- 3.6 pg/mL, P = 0.23). Concentrations of angiogenic factors in pericardial fluid and in plasma were not significantly different between patients with ischemic and nonischemic heart disease. These results suggest that the production, secretion, and kinetics of HGF, bFGF, and VEGF are different. These angiogenic factors may have different pathophysiologic roles.

Endothelin-1 concentrations in pericardial fluid are more elevated in patients with ischemic heart disease than in patients with nonischemic heart disease.

There is epidemiologic evidence that the prognosis of patients with nonischemic heart failure is better than that for patients with ischemic heart failure. In addition, studies have revealed that patients with ischemic heart failure show a poorer response to medical therapy. However, the pathophysiologic difference between ischemic and nonischemic heart disease is unclear. To clarify this point, we measured atrial natriuretic peptide, brain natriuretic peptide, angiotensin II, endothelin (ET)-1. interleukin-1beta interleukin-6. tumor necrosis factor (TNF)-alpha soluble TNF receptor I, and soluble TNF receptor II concentrations in plasma and pericardial fluid in patients with ischemic or nonischemic heart disease undergoing cardiac surgery. The pericardial ET-1 concentration in patients with ischemic heart disease was statistically greater than that in patients with nonischemic heart disease (about 1.5-fold), although no difference was found in the plasma ET-1 concentration. These findings suggest that the production and secretion of ET-1 from the myocardium in patients with ischemic heart disease are augmented to a greater extent than in patients with nonischemic heart disease. This result may lead to a greater understanding of the pathophysiology of ischemic heart disease.