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Yadav M, Maiwal R, Kumar Br V, Tripathi G, Sharma N, Sharma N, Bindal V, Mathew B, Pandey S, Singh SP, Tevathia HV, Maras JS, Sarin SK. Comparative metabolome analysis reveals higher potential of haemoperfusion adsorption in providing favourable outcome in ACLF patients. Liver Int 2024; 44:1189-1201. [PMID: 38358068 DOI: 10.1111/liv.15858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 01/02/2024] [Accepted: 01/21/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND AIMS Acute-on-chronic liver failure (ACLF) is a serious illness associated with altered metabolome, organ failure and high mortality. Need for therapies to improve the metabolic milieu and support liver regeneration are urgently needed. METHODS We investigated the ability of haemoperfusion adsorption (HA) and therapeutic plasma exchange (TPE) in improving the metabolic profile and survival in ACLF patients. Altogether, 45 ACLF patients were randomized into three groups: standard medical therapy (SMT), HA and TPE groups. Plasma metabolomics was performed at baseline, post-HA and TPE sessions on days 7 and 14 using high-resolution mass spectrometry. RESULTS The baseline clinical/metabolic profiles of study groups were comparable. We identified 477 metabolites. Of these, 256 metabolites were significantly altered post 7 days of HA therapy (p < .05, FC > 1.5) and significantly reduced metabolites linked to purine (12 metabolites), tryptophan (7 metabolites), primary bile acid (6 metabolites) and arginine-proline metabolism (6 metabolites) and microbial metabolism respectively (p < .05). Metabolites linked to taurine-hypotaurine and histidine metabolism were reduced and temporal increase in metabolites linked to phenylalanine and tryptophan metabolism was observed post-TPE therapy (p < .05). Finally, weighted metabolite correlation network analysis (WMCNA) along with inter/intragroup analysis confirmed significant reduction in inflammatory (tryptophan, arachidonic acid and bile acid metabolism) and secondary energy metabolic pathways post-HA therapy compared to TPE and SMT (p < .05). Higher baseline plasma level of 11-deoxycorticosterone (C03205; AUROC > 0.90, HR > 3.2) correlated with severity (r2 > 0.5, p < .05) and mortality (log-rank-p < .05). Notably, 51 of the 64 metabolite signatures (ACLF non-survivor) were reversed post-HA treatment compared to TPE and SMT(p < .05). CONCLUSION HA more potentially (~80%) improves plasma milieu compared to TPE and SMT. High baseline plasma 11-deoxycorticosterone level correlates with early mortality in ACLF patients.
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Affiliation(s)
- Manisha Yadav
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rakhi Maiwal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vinay Kumar Br
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Gaurav Tripathi
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Neha Sharma
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nupur Sharma
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vasundhra Bindal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Babu Mathew
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Sushmita Pandey
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Satender Pal Singh
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Jaswinder Singh Maras
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Duan M, Yang B, Cheng X, Shen F, Lu X, Wang F. Two cases of diquat poisoning in adolescent children. Ital J Pediatr 2024; 50:80. [PMID: 38644498 PMCID: PMC11034119 DOI: 10.1186/s13052-024-01640-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/04/2024] [Indexed: 04/23/2024] Open
Abstract
Diquat (DQ) is among the most widely used herbicides, and its intake can cause severe systemic toxicity that manifests rapidly. The resultant symptoms can cause the dysfunction of a range of tissues and organs,. As there is no specific antidote for diquat poisoning and the efficacy of extant treatments is suboptimal, physicians must acquire a more comprehensive understanding of the most effective approaches to managing affected patients. Relative few studies have been published to date focused on diquat poisoning in pediatric patients. In this report, we compare two similar cases of juvenile diquat poisoning with dynamic changes in clinical manifestations, laboratory values, and imaging results. For the first time, the difference in whether to perform blood flow perfusion and the time difference of initiation of hemoperfusion had a clear clinical difference in the subsequent effects of diquat poisoning in children with diquat poisoning. Limited evidence is available regarding the efficacy of early hemoperfusion for diquat poisoning; however, the differences in clinical outcomes articulated here highlight the benefits of early and timely hemoperfusion therapy in the treatment of DQ toxicity in children, in conjunction with primary supportive care in the management of DQ poisoning in children.
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Affiliation(s)
- Mengtao Duan
- The Second Clinical Medical College of Lanzhou University, 199 Donggang West Road, Chengguan District, 730030, Lanzhou City, Gansu Province, China
| | - Baowang Yang
- Lanzhou University Second Hospital , No.82 Cuiyingmen, Linxia Road, Chengguan District, 730030, Lanzhou City, Gansu Province, China
| | - Xiaohang Cheng
- The Second Clinical Medical College of Lanzhou University, 199 Donggang West Road, Chengguan District, 730030, Lanzhou City, Gansu Province, China
| | - Fuhui Shen
- The Second Clinical Medical College of Lanzhou University, 199 Donggang West Road, Chengguan District, 730030, Lanzhou City, Gansu Province, China
| | - Xia Lu
- The Second Clinical Medical College of Lanzhou University, 199 Donggang West Road, Chengguan District, 730030, Lanzhou City, Gansu Province, China
| | - Fan Wang
- Lanzhou University Second Hospital , No.82 Cuiyingmen, Linxia Road, Chengguan District, 730030, Lanzhou City, Gansu Province, China.
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Wang J, Cheng C, Sun S, Zhao W, Zhao C. Metal-organic framework-based adsorbents for blood purification: progress, challenges, and prospects. J Mater Chem B 2024; 12:3594-3613. [PMID: 38506127 DOI: 10.1039/d3tb03047d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Blood purification, such as hemodialysis (HD), plasma exchange (PE), and hemoperfusion (HP), is widely applied in patients with organ failure (such as kidney and liver failure). Among them, HP mainly relies on porous adsorbents to efficiently adsorb accumulated metabolic wastes and toxins, thus improving purification efficiency. Metal-organic frameworks (MOFs), with a high porosity, large surface area, high loading capacity, and tailorable topology, are emerging as some of the most promising materials for HP. Compared with non-metal framework counterparts, the self-built metal centers of MOFs feature the intrinsic advantages of coordination with toxin molecules. However, research on MOFs in blood purification is insufficient, particularly in contrast to materials applied in other biomedical applications. Thus, to broaden this area, this review first discusses the essential characteristics, potential mechanisms, and structure-function relationship between MOFs and toxin adsorption based on porosity, topology, ligand functionalization, metal centers, and toxin types. Moreover, the stability, utilization safety, and hemocompatibility of MOFs are illustrated for adsorbent selection. The current development and progress in MOF composites for HD, HP, and extracorporeal membrane oxygenation (ECMO) are also summarized to highlight their practicability. Finally, we propose future opportunities and challenges from materials design and manufacture to the computational prediction of MOFs in blood purification. It is anticipated that our review will expand the interest of researchers for more impact in this area.
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Affiliation(s)
- Jiemin Wang
- College of Biomedical Engineering, Sichuan University, Chengdu, 610064, China
| | - Chong Cheng
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China.
| | - Shudong Sun
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China.
| | - Weifeng Zhao
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China.
| | - Changsheng Zhao
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China.
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Votrico V, Grilli M, Gerini U, Berlot G. Hemoperfusion with high-affinity polyethylene microbeads (Seraph-100 ®) for the removal of pathogens in chronic critically ill patients: Clinical experience. Int J Artif Organs 2024; 47:115-117. [PMID: 38182550 DOI: 10.1177/03913988231221405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
Critically ill septic patients present variable clinical trajectories, with some succumbing to hyperinflammatory responses while others develop a chronic critical illness, characterized by a prolonged low-grade inflammation, muscle atrophy, and mechanical ventilation dependency and often develop secondary infections often caused by from low-virulence microorganisms or reactivated latent viruses. The Seraph-100® hemoperfusion cartridge takes advantage from heparin-coated ultra-high molecular weight polyethylene microbeads mimicking pathogen-binding cell receptors and can adsorb both pathogens and damage-associated molecular patterns released by injured tissues. We describe two chronic critically ill patients who developed secondary viral bloodstream infections successfully treated with this device.
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Affiliation(s)
- Valentina Votrico
- Department of Nephrology and Dialysis, University of Verona, Verona, Veneto, Italy
| | - Matteo Grilli
- Department of Emergency Medicine, University of Trieste, Trieste, Friuli-Venezia Giulia, Italy
| | - Ugo Gerini
- Department of Nephrology, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Friuli-Venezia Giulia, Italy
| | - Giorgio Berlot
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Friuli-Venezia Giulia, Italy
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Wang P, Lin LY, Lu YQ. Mid-to-late stage diquat accumulation in the central nervous system: A severe case of oral poisoning. Am J Emerg Med 2024; 75:198.e1-198.e5. [PMID: 37925304 DOI: 10.1016/j.ajem.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 11/06/2023] Open
Abstract
A 54-year-old woman in good health was admitted to our hospital with diquat poisoning. The patient drank an unknown dose of diquat, and acute kidney injury developed early. However, there were no obvious pulmonary abnormalities and no signs of central nervous system toxicity in the early stage. The woman underwent active treatment, which resulted in a significant decrease in blood diquat levels, but her lung condition progressively worsened and neurological symptoms developed. Fortunately, the patient survived after intensive hemoperfusion combined with continuous renal replacement therapy (CRRT), intracranial pressure reduction, and anti-infective treatment. This case report highlights the importance of being aware of the development of delayed pulmonary symptoms and neurologic complications when caring for patients poisoned with diquat, even in those with low diquat blood concentrations. Interestingly, we also detected the concentration of diquat in the cerebrospinal fluid (CSF) of patients with diquat poisoning, and found that the rate of decrease of diquat concentration in the CSF was considerably slower than that in the blood.Notably, a specific correlation was observed between the concentration of diquat in the CSF, rather than in the blood, and both the intracranial pressure (ICP) and the severity of cerebral edema in this patient.
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Affiliation(s)
- Ping Wang
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China; Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou, China
| | - Li-Ying Lin
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China; Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou, China
| | - Yuan-Qiang Lu
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China; Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou, China.
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Cutuli SL, Carelli S, Cascarano L, Cicconi S, Silvestri D, Cicetti M, Vallecoccia MS, Pintaudi G, Tanzarella ES, Grieco DL, Antonelli M, De Pascale G. Clinical implications of endotoxin activity and Polymyxin-B hemoperfusion in critically ill patients with septic cardiomyopathy: A single-center, retrospective, observational study. Artif Organs 2023; 47:1865-1873. [PMID: 37737449 DOI: 10.1111/aor.14645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND To explore the association between endotoxin activity (EA) and septic cardiomyopathy (SCM), the relationship between endotoxin removal by Polymyxin-B hemoperfusion (PMX-HP) and recovery from SCM (R-SCM), and the correlation between R-SCM and the 28-day mortality in septic patients admitted to the intensive care unit (ICU). METHODS Observational study that included patients admitted to two ICUs of a tertiary university hospital between April 2011 and December 2019, who received PMX-HP for sepsis/septic shock. The SCM and R-SCM were assessed by transthoracic echocardiography. RESULTS Among 148 patients, SCM was diagnosed in 60 (46%) of them and had no relationship with median EA (SCM group: 0.73; no-SCM group: 0.66, p = 0.48). Recovery from SCM was observed in 24 patients (49%) and was independently associated with the PMX-HP (OR 4.19, 95%CI [1.22, 14.3]; p = 0.02) and the SAPS2 II score (OR 0.94, 95%CI [0.9, 0.98]; p = 0.006). In the SCM group, the 28-day mortality was 60% and was independently predicted by R-SCM (OR 0.02, 95%CI [0.001, 0.3] p = 0.005) and SAPS II score (OR 1.11, 95%CI [1.01, 1.23] p = 0.037). CONCLUSIONS In septic patients, EA was not associated with SCM. However, endotoxin removal by Polymyxin-B hemoperfusion was associated with recovery from cardiomyopathy, which was a predictor of lower 28-day mortality.
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Affiliation(s)
- Salvatore Lucio Cutuli
- Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simone Carelli
- Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Cascarano
- Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sandra Cicconi
- Department of Anesthesiology and Intensive Care Medicine, Infermi Hospital, Rimini, Italy
| | - Davide Silvestri
- Department of Anesthesiology and Intensive Care Medicine, S. Luca Hospital, Lucca, Italy
| | - Marta Cicetti
- Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Gabriele Pintaudi
- Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eloisa Sofia Tanzarella
- Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Luca Grieco
- Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Antonelli
- Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro De Pascale
- Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
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Liang C, Cui S, Geng L. Hemoperfusion combined with methylene blue in treating methemoglobinemia caused by emamectin benzoate + indoxacarb poisoning: A case report and literature review. Asian J Surg 2023; 46:5899-5900. [PMID: 37730503 DOI: 10.1016/j.asjsur.2023.08.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Chaoyue Liang
- Department of Critical Care Medicine, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, 014000, China
| | - Shaohua Cui
- Department of Critical Care Medicine, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, 014000, China
| | - Lixia Geng
- Department of Critical Care Medicine, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, 014000, China.
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Imai E, Kaneko S, Hoshimoto A, Hisada R, Harano M, Anno E, Hagiwara S, Ozaki S, Torii H, Tsukamoto Y. Short term-efficacy and tolerability of Rheocarna, a novel direct hemoperfusion adsorptive column, for chronic limb-threatening ischemia in dialysis patients: A single-center case series. Ther Apher Dial 2023; 27:1010-1016. [PMID: 37605563 DOI: 10.1111/1744-9987.14049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/22/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION With population aging and lifestyle changes, the number of patients with chronic limb-threatening ischemia (CLTI) is increasing, and refractory or recurrent lesions are more common, especially in chronic dialysis patients. In March 2021, a new type of adsorptive cellulose bead column immobilized with dextran sulfate and L-tryptophan for direct hemoperfusion (DHP) was approved by Japan's medical insurance system as a treatment for CLTI. METHODS We retrospectively analyzed 17 cases of CLTI in dialysis patients treated with DHP using the novel column (Rheocarna) (DHP-R) at our hospital from May 2021 to October 2022. The short-term of efficacy of DHP-R was judged qualitatively by the foot care team every 2 weeks based on the assessment of skin color, warmth, ulcer epithelialization or shrinkage of the ulcer area, and foot pain. The final judgment of efficacy was made after the final DHP-R session. RESULTS The median age of patients was 66 years, the median dialysis duration was 10 years, 15 cases (88%) were male, and 15 cases (88%) had diabetes. The median total number of sessions was eight. In comparing the groups in which DHP-R was effective and ineffective, there was no significant difference in any factors including patient background data (i.e., age, diabetes, low-density lipoprotein cholesterol, hemoglobin, dialysis duration, etc.), type of anticoagulants, and presence of episodes of blood pressure drop or circuit clotting during session. Three cases with symptomatic hypotension during the session and two cases with circuit clotting that did not improve with increased heparin dose all resolved immediately after changing the anticoagulant from heparin to nafamostat mesylate (NM). CONCLUSION Identification of patients' characteristics in which DHP-R is favorable and some reliable index that allow a rapid decision to continue DHP-R are needed. In addition, validating whether the use of NM as anticoagulant affects the efficacy of DHP-R for CTLI treatment remains a challenge to resolve.
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Affiliation(s)
- Eri Imai
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Shuzo Kaneko
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Ainori Hoshimoto
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Rina Hisada
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Makiko Harano
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Emi Anno
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - So Hagiwara
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Shunsuke Ozaki
- Department of Cardiology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Hiroko Torii
- Department of Plastic surgery, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Yusuke Tsukamoto
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
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Hayanga JWA. Reply to Supady et al. Comment on: Extracorporeal hemoadsorption in critically ill COVID-19 patients on VV ECMO: the CytoSorb therapy in COVID-19 (CTC) registry. Crit Care 2023; 27:421. [PMID: 37919758 PMCID: PMC10621176 DOI: 10.1186/s13054-023-04678-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023] Open
Affiliation(s)
- J W Awori Hayanga
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA.
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Pisarev VM, Rey SI, Kulabukhov VV, Popov AY. If EAA Test Versus LAL Test is Always Clinically Better and Whether Any Test Always Relates to the Therapeutic Value of Hemoperfusion in Septic Shock Patients? Shock 2023; 60:725-726. [PMID: 37549019 DOI: 10.1097/shk.0000000000002201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
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Forin E, Lorenzoni G, Ferrer R, De Cal M, Zanella M, Marchionna N, Gregori D, Forfori F, Lorenzin A, Danzi V, Ronco C, De Rosa S. Endotoxin removal therapy with Polymyxin B immobilized fiber column: a single center experience from EUPHAS2 registry. Sci Rep 2023; 13:17600. [PMID: 37845296 PMCID: PMC10579294 DOI: 10.1038/s41598-023-44850-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023] Open
Abstract
Although the precise clinical indication for initiation of PMX-HA is widely debated in the literature, a proper patient selection and timing of treatment delivery might play a critical role in the clinical course of a specific subphenotype of septic shock (endotoxic shock). In light of this view, since 2019, we have introduced in our clinical practice a diagnostic-therapeutic flowchart to select patients that can benefit the most from the treatment proposed. In addition, we reported in this study our experience of PMX-HA in a cohort of critically ill patients admitted to our intensive care unit (ICU). We analyzed a single centre, retrospective, observational web-based database (extracted from the EUPHAS2 registry) of critically ill patients admitted to the ICU between January 2016 and May 2021 who were affected by endotoxic shock. Patients were divided according to the diagnostic-therapeutic flowchart in two groups: Pre-Flowchart (Pre-F) and Post-Flowchart (Post-F). From January 2016 to May 2021, 61 patients were treated with PMX-HA out of 531 patients diagnosed with septic shock and of these, fifty patients (82%) developed AKI during their ICU stay. The most common source of infection was secondary peritonitis (36%), followed by community-acquired pneumonia (29%). Fifty-five (90%) out of 61 patients received a second PMX-HA treatment, with a statistically significant difference between the two groups (78% of the Pre-F vs. 100% of the Post-F group, p = 0.005). In both groups, between T0 and T120, the Endotoxin Activity Assay (EAA) decreased, while the SOFA score, mean arterial pressure (MAP), and Vasoactive Inotropic Score (VIS) improved with no statistically significant difference. Furthermore, when performing a propensity score matching analysis to compare mortality between the two groups, statistically significant lower ICU and 90-day mortalities were observed in the Post-F group [p = 0.016]. Although in this experienced centre data registry, PMX-HA was associated with organ function recovery, hemodynamic improvement, and current EAA level reduction in critically ill patients with endotoxic shock. Following propensity score-matched analysis, ICU mortality and 90-day mortalities were lower in the diagnostic-therapeutic flowchart group when considering two temporal groups based on strict patient selection criteria and timing to achieve PMX. Further Randomised Control Trials focused on centre selection, adequate training and a flowchart of action when assessing extracorporeal blood purification use should be performed.
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Affiliation(s)
- Edoardo Forin
- International Renal Research Institute of Vicenza Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
- Department of Anesthesiology and Intensive Care, San Bortolo Hospital, Vicenza, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Ricard Ferrer
- Shock, Organ Dysfunction, and Resuscitation Research Group (SODIR), Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain
- Intensive Care Department, Hospital Universitari Vall d́'Hebron, Barcelona, Spain
| | - Massimo De Cal
- International Renal Research Institute of Vicenza Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Nicola Marchionna
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, The University of Pisa, Pisa, Italy
| | - Anna Lorenzin
- International Renal Research Institute of Vicenza Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Vinicio Danzi
- Department of Anesthesiology and Intensive Care, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Silvia De Rosa
- International Renal Research Institute of Vicenza Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy.
- Department of Anesthesiology and Intensive Care, San Bortolo Hospital, Vicenza, Italy.
- Centre for Medical Sciences - CISMed, University of Trento, Via S. Maria Maddalena 1, 38122, Trento, Italy.
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12
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Fang X, Xu Z, Dai Q, Zhang A. [Numerical Study on the Process of Human Brain Cooling Treated by Hemoperfusion Mild Hypothermia]. Zhongguo Yi Liao Qi Xie Za Zhi 2023; 47:391-395. [PMID: 37580288 DOI: 10.3969/j.issn.1671-7104.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Mild hypothermia, as a common means of intraoperative nerve protection, has been used in clinical practice. Compared with the traditional methods such as freezing helmet and nasopharyngeal cooling, hypothermic blood perfusion is considered to be a promising treatment for mild hypothermia, but it lacks experimental and theoretical verification of its cooling effect. In this study, the commercial finite element simulation software COMSOL combined the Pennes equation with the cerebrovascular network model to construct a new simplified human brain model, which was further used to simulate the cooling process of cerebral hypothermic blood perfusion. When the hypothermic blood perfusion was 33 ℃, the human brain could enter the mild hypothermic state within 4 minutes. By comparing with helmet cooling, the feasibility and efficiency of the blood perfusion scheme were verified. By comparing with the calculation results based on Pennes equation, the rationality of the model constructed in this study were verified. This model can non-intrusively predict the changes of brain temperature during surgery, and provide a reference for the setting of treatment parameters such as blood temperature, so as to provide personalized realization of safer and more effective mild hypothermia neuro protection.
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Affiliation(s)
- Xin Fang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030
| | - Zihang Xu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030
| | - Qizheng Dai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030
| | - Aili Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030
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13
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Osawa I, Goto T, Kudo D, Hayakawa M, Yamakawa K, Kushimoto S, Foster DM, Kellum JA, Doi K. Targeted therapy using polymyxin B hemadsorption in patients with sepsis: a post-hoc analysis of the JSEPTIC-DIC study and the EUPHRATES trial. Crit Care 2023; 27:245. [PMID: 37344804 PMCID: PMC10286480 DOI: 10.1186/s13054-023-04533-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Polymyxin B hemadsorption (PMX-HA) reduces blood endotoxin levels, but characteristics of patients with sepsis likely to benefit from PMX-HA are not well known. We sought to identify patient subgroups likely to benefit from PMX-HA. METHODS We retrospectively identified 1911 patients with sepsis from a retrospective observational study in Japan (the JSEPTIC-DIC study) and 286 patients with endotoxemic septic shock from a randomized controlled trial in North America that restricted patients to those with high endotoxin activity (the EUPHRATES trial). We applied the machine learning-based causal forest model to the JSEPTIC-DIC cohort to investigate heterogeneity in treatment effects of PMX-HA on 28-day survival after adjusting for potential confounders and ascertain the best criteria for PMX-HA use. The derived criteria for targeted therapy by PMX-HA were validated using the EUPHRATES trial cohort. RESULTS The causal forest model revealed heterogeneity in treatment effects of PMX-HA. Since patients having higher treatment effects were more likely to have severe coagulopathy and hyperlactatemia, we identified the potential treatment targets of PMX-HA as patients with PT-INR > 1.4 or lactate > 3 mmol/L. In the EUPHRATES trial cohort, PMX-HA use on the targeted subpopulation (75% of all patients) was significantly associated with higher 28-day survival (PMX-HA vs. control, 68% vs. 52%; treatment effect of PMX-HA, + 16% [95% CI + 2.2% to + 30%], p = 0.02). CONCLUSIONS Abnormal coagulation and hyperlactatemia in septic patients with high endotoxin activity appear to be helpful to identify patients who may benefit most from PMX-HA. Our findings will inform enrollment criteria for future interventional trials targeting patients with coagulopathy and hyperlactatemia.
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Affiliation(s)
- Itsuki Osawa
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- TXP Medical Co. Ltd., Tokyo, Japan
| | - Daisuke Kudo
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, Hokkaido, Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | | | - John A Kellum
- Spectral Medical, Toronto, ON, Canada
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan.
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14
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Ferrari F, Manera M, D'Auria L, De Rosa S, Ronco C. Hemoperfusion in Poisoning and Drug Overdose. Contrib Nephrol 2023; 200:218-241. [PMID: 37311422 DOI: 10.1159/000526730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Hemoperfusion (HP) is an extracorporeal blood purification therapy that is used to remove poisons or drugs from the body. This chapter provides a brief overview of the technical aspects and the potential indications and limitations of HP, with the focus being on the use of HP for acute poisoning cases reported from January 1, 2000, to April 30, 2022.
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Affiliation(s)
- Fiorenza Ferrari
- Intensive Care Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Miriam Manera
- Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Pavia, Italy
| | - Luigi D'Auria
- Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Pavia, Italy
| | - Silvia De Rosa
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
- Intensive Care Unit, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
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15
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Abraham P, Monard C, Lamblin A, Schneider A, Rimmelé T. Hemoperfusion in Burns. Contrib Nephrol 2023; 200:160-168. [PMID: 37290418 DOI: 10.1159/000527709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/23/2022] [Indexed: 06/10/2023]
Abstract
Patients with severe thermal injury require urgent specialized care in burn units. These units assure good coordination of a bundle of care including fluid resuscitation, nutritional support, respiratory care, surgical care and wound care, infection prevention, and rehabilitation. When severely injured, burn patients present a systemic inflammatory response syndrome, associated with a dysregulated immune homeostasis. This complex host response exposes patients to prolonged hospitalization with suppressed immune function, increased susceptibility to secondary infections, longer organ support, and increased mortality. To date, several strategies, such as hemoperfusion techniques, have been developed to mitigate immune activation. We propose herein a review of the immune response to burn injury and the rationale and potential applications of extracorporeal blood purification techniques such as hemoperfusion for burn patients' management.
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Affiliation(s)
- Paul Abraham
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Céline Monard
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- EA 7426, PI3 (Pathophysiology of Injury‑Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
| | - Antoine Lamblin
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Antoine Schneider
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thomas Rimmelé
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,
- EA 7426, PI3 (Pathophysiology of Injury‑Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France,
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16
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Danguilan RA. Hemoperfusion in Leptospirosis. Contrib Nephrol 2023; 200:252-261. [PMID: 37263231 DOI: 10.1159/000527571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/23/2022] [Indexed: 06/03/2023]
Abstract
Leptospirosis is the most common zoonosis frequently seen in the tropics and subtropics especially during the rainy season when humans wade in floods contaminated by the urine of infected rats in urban areas. Aside from direct toxicity of the leptospires, the role of an exuberant immune response to the pathogen leading to secondary organ damage has been recognized. Thus, our treatment protocol for patients with severe leptospirosis characterized by renal failure, acute liver injury, and lung hemorrhage now includes a short course of methylprednisolone and intravenous cyclophosphamide. In some patients, however, hemodynamic collapse and acute respiratory distress syndrome ensue, which may be due to the release of cytokines resulting from the dysregulated immune response. Blood purification in the form of hemoperfusion (HP) with neutral macroporous resin-adsorbing beads adsorbs cytokines and other inflammatory mediators leading to cardiovascular stability and stabilization of endothelial membranes. HP may be considered part of a multiorgan system therapeutic approach in diseases with reversible multiorgan failure that can lead to an improvement in patient survival.
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Affiliation(s)
- Romina A Danguilan
- Department of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Philippines
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17
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Ronco C. Combined Hemoperfusion-Hemodialysis in End-Stage Renal Disease Patients. Contrib Nephrol 2023; 200:118-122. [PMID: 37263230 DOI: 10.1159/000527953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 06/03/2023]
Abstract
Despite advances in dialysis technology, a high level of morbidity and mortality is still present in end-stage renal disease patients undergoing maintenance dialysis. This has been in great part correlated with accumulation of uremic toxins that cannot be adequately removed by classic dialysis membranes and techniques. Improvements have been made in enhancing both membrane permeability and convection rates as in the case for expanded hemodialysis (HD) and hemodiafiltration, but these techniques still present limitations or cannot be performed due to technical reasons. Considering the abovementioned limitations of current dialysis techniques, the additional use of adsorption as a solute removal mechanism may represent an interesting option. Recent studies have underlined the significant improvement in the levels of medium-large retention solutes and toxin-related symptoms using a combination of hemoperfusion with HD at least in a session per week. These studies need further confirmation, but they may represent the doorway to further improve patient's outcome in maintenance dialysis.
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Affiliation(s)
- Claudio Ronco
- International Renal Research Institute of Vicenza, IRRIV Foundation, Vicenza, Italy
- Department of Nephrology, St. Bortolo Hospital, ULSS8 Berica, Vicenza, Italy
- Department of Medicine, University of Padova, Padova, Italy
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18
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Abraham P, Mendes V, Kirsch M, Schneider A. Hemoperfusion in Cardiac Surgery and ECMO. Contrib Nephrol 2023; 200:180-191. [PMID: 37263244 DOI: 10.1159/000527338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/23/2022] [Indexed: 06/03/2023]
Abstract
Extracorporeal circulation (ECC) such as cardiopulmonary bypass or extracorporeal membrane oxygenation (ECMO) may induce a complex activation of the immune system. To date, strategies to mitigate this activation have failed to translate into meaningful improvement of clinical outcomes. Hemoperfusion is a blood purification technique, which relies on mass separation by a solid agent (hemoadsorption). It can be performed by adding a cartridge filled with adsorptive sorbent in the extracorporeal circuit. These devices have the theoretical advantage to enable the removal of excess pro- and anti-inflammatory molecules. Several studies have demonstrated the feasibility and safety of hemoperfusion during cardiac surgery. They have suggested that the procedure could decrease cytokine levels in situations where they were elevated. However, further studies are required to determine the clinical indications, timing, and duration of hemoperfusion during cardiac surgery. Although a similar rationale can apply to hemoperfusion in ECMO, available data in this situation are even more limited and results are conflicting. In this chapter, we discuss the rationale for hemoperfusion with ECC, how to practically do it, and the current level of evidence supporting this therapy.
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Affiliation(s)
- Paul Abraham
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Vitor Mendes
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Antoine Schneider
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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19
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Bidar F, Abrard S, Lamblin A, Rimmelé T. Hemoperfusion: Indications, Dose, Prescription. Contrib Nephrol 2023; 200:88-97. [PMID: 37263188 DOI: 10.1159/000529294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/23/2023] [Indexed: 06/03/2023]
Abstract
Recent advances in the development of sorbent materials have enabled the development of hemoperfusion (HP). However, HP dose and prescription are not standardized and there is no consensus in clinical practice guidelines. Adequate prescription and modality are of utmost importance to ensure HP effectiveness. Although the main indication of CytoSorb®, HA330/380, polymyxin B, and Seraph® is sepsis, these devices may be beneficial in many other situations such as liver failure, rhabdomyolysis, pancreatitis, cardiopulmonary bypass, extensive burns, and trauma or to ensure antiplatelet therapy drug removal. They can be applied as stand-alone therapies or combined with renal replacement therapy. The usual prescribed blood flow varies between 100 and 700 mL/min. CytoSorb® sessions usually last 24 h and may be repeated up to 7 days, whereas HA330/380, polymyxin B, and Seraph® sessions usually last between 2 and 4 h and are repeated up to 3 days. Current clinical data are lacking to establish the optimal operating conditions of HP and studies focusing on defining the optimal timing, dose, and duration of these therapies could help define future clinical applications.
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Affiliation(s)
- Frank Bidar
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
- EA 7426, Pathophysiology of Injury-Induced Immunosuppression, Hospices Civils de Lyon-Biomérieux-University Claude Bernard Lyon 1, Lyon, France
| | - Stanislas Abrard
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
- MitoVasc Institut, INSERM 1083 - CNRS 6015, University of Angers, Angers, France
| | - Antoine Lamblin
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Thomas Rimmelé
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
- EA 7426, Pathophysiology of Injury-Induced Immunosuppression, Hospices Civils de Lyon-Biomérieux-University Claude Bernard Lyon 1, Lyon, France
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20
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Eldridge JC, Wan YI, Prowle JR. Hemoperfusion in Trauma. Contrib Nephrol 2023; 200:169-179. [PMID: 37263242 DOI: 10.1159/000527570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/23/2022] [Indexed: 06/03/2023]
Abstract
Major trauma care has seen significant improvements in early mortality, reflecting improvements in prehospital techniques for hemorrhage control and speed of access to specialized trauma centers. However, many patients then go on to die in the intensive care unit (ICU), and improvements in immediate trauma care are presenting intensivists with greater numbers of severely injured patients who might previously have died shortly after injury. It is theorized that, despite initial survival, these patients deteriorate due to massive release of damage associated molecular patterns (DAMPs) after traumatic and ischemic tissue injury. These trigger a vicious cycle of overactive pro- and anti-inflammatory pathways, leading to organ dysfunction and immunoparesis. Extracorporeal hemoperfusion, with its ability to adsorb both DAMPs and inflammatory mediators from the bloodstream, has the potential to break this cycle and could, in theory, then prevent early death or organ dysfunction in the ICU. However, currently, there has been little research around the indications for, and efficacy of, this therapy in the setting of polytrauma. Here we outline potential molecular targets, summarize existing exploratory studies, and suggest areas for future research required to establish the benefits of hemoperfusion as an adjunct therapy in major polytrauma.
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Affiliation(s)
- Jack C Eldridge
- Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, UK
- Critical Care and Perioperative Medicine Research Group (CCPMG), Faculty of Medicine and Dentistry, Queen Mary University, London, UK
| | - Yize I Wan
- Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, UK
- Critical Care and Perioperative Medicine Research Group (CCPMG), Faculty of Medicine and Dentistry, Queen Mary University, London, UK
| | - John R Prowle
- Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, UK
- Critical Care and Perioperative Medicine Research Group (CCPMG), Faculty of Medicine and Dentistry, Queen Mary University, London, UK
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21
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Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the global emergency outbreak disease that devastatingly affected world public health and the economy. The pathogenesis of severe SARS-CoV-2 infection in humans has been linked to a strong immunological response that leads to a hyperinflammatory state, or "cytokine storm," which is a sepsis-like state resulting in capillary leakage, microvascular and macrovascular thrombosis, and multiple organ destruction. In recent years, there have been several case series and few randomized controlled trials studying the effectiveness and risk of various hemoperfusion techniques in the context of severe SARS-CoV-2 infection including HA330, CytoSorb, Polymyxin, oXiris, and Seraph 100 cartridges. Because inconsistencies exist between studies, there is currently no consensus regarding the use of hemoperfusion in patients with SARS-CoV-2 infection. Further well-designed research is needed to validate its potential clinical benefits and identify the timing and characteristics of patients who might benefit the most.
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Affiliation(s)
- Tanat Lertussavavivat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
- The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Academy of Science, Royal Society of Thailand, Bangkok, Thailand
- Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
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22
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Griveas I. Effectiveness of hemoperfusion (HP) in hemodialysis (HD) patients with Covid-19 infection. Transfus Apher Sci 2022; 61:103589. [PMID: 36376212 PMCID: PMC9616508 DOI: 10.1016/j.transci.2022.103589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction The aims of this study are to observe the clinical course of all patients affected by infection with SARS-CoV-2 undergoing HD focusing on the impact of HP. Methods Patients were divided into Group A: HD sessions with HP and Group B: patients without HP. We registered all the data regarding patients’ clinical course. Results 13 patients have been enrolled in group A. 9 patients were discharged from the hospital after 43 days (range: 35–56). 30 days was the mean hospitalization stay for the deceased. We did not observe any side effects with HP cartridges. 9 patients did not receive HP during their hospitalization. For those who represented as symptomatic, 8 out of 9 patients died after 6 days of hospitalization (range: 1–14), 2 of them in ICU. Conclusion HP seems to be a helpful, safe and quite efficient tool in the battle against Covid-19 in HD patients.
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Affiliation(s)
- Ioannis Griveas
- Nephrology Department, Army Share Fund Hospital of Athens, 417 NIMTS, Greece.
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23
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Lou XH, Zhang BW, Ma XC. [A case of acute poisoning with thiamethoxam]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:779-782. [PMID: 36348562 DOI: 10.3760/cma.j.cn121094-20211013-00499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Thiamethoxam belongs to the second generation of neonicotinoid insecticides, and case of acute poisoning with thiamethoxam had never reported in China. This paper reviewed a case of oral poisoning with thiamethoxam pesticides, the patient suffered vomiting, generalized convulsions, confusion, and decreased oxygen saturation. After treated with gastric lavage, ventilator support, and the use of propofol, midazolam, sodium phenobarbital, and sodium valproate, the convulsions could not be controlled. Untill treated with penehyclidine hydrochloride and hemoperfusion combined with hemofiltration, the patient finally recovered and was discharged from the hospital. We suggest that the main treatments for acute severe thiamethoxam poisoning are decontamination and symptomatic support, pentoxifylline hydrochloride and hemoperfusion combined with hemofiltration may improve the patients' prognosis.
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Affiliation(s)
- X H Lou
- Department of Emergency, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, China
| | - B W Zhang
- Department of Emergency, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, China
| | - X C Ma
- Department of Emergency, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, China
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24
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Sun CC, Jian TZ, Yu GC, Li YQ, Jian XD, Kan BT. [A case of acute fish gallbladder poisoning with multiple organ dysfunction]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:700-702. [PMID: 36229219 DOI: 10.3760/cma.j.cn121094-20210520-00260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Fish bile poisoning may damage human liver and kidney, causing degeneration and necrosis. Can also damage brain cells and heart muscle, resulting in nervous system and cardiovascular system lesions. This paper reports a case of a patient who developed multiple organ dysfunction syndrome (MODS) after oral administration of fish bile with Xiexin folk prescription for eye disease. In January 2020, he went to the poisoning and occupational diseases department of the emergency department of Qilu hospital. After receiving hemoperfusion, continuous renal replacement therapy (CRRT) and symptomatic support treatment, the patient was improved and discharged. CRRT combined with HP is one of the rapid and effective methods for the treatment of acute fish bile poisoning.
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Affiliation(s)
- C C Sun
- Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - T Z Jian
- Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - G C Yu
- Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Y Q Li
- Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - X D Jian
- Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - B T Kan
- Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
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25
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Lu ZX, Li X, He YP, Fang CT, Song YX, Wang J. [An investigation of a food poisoning incident caused by Amanita fuliginea]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:607-609. [PMID: 36052592 DOI: 10.3760/cma.j.cn121094-20210420-00222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Mistakenly picking and eating poisonous mushrooms can cause acute poisoning. In August 2020, Qingdao Hospital of Traditional Chinese Medicine handled a poisonous mushroom poisoning incident, conducted epidemiological investigation on all poisoned patients, collected suspicious food, clinical manifestations, clinical test results and treatment conditions, and identified the mushrooms as Amanita fuliginea poisoning after morphological identification. In this incident, 6 people ate grey goose paste, of which 4 were sick with a incubation period of 6~12 h. The clinical manifestations were gastrointestinal symptoms such as nausea, vomiting and diarrhea, liver and kidney damage. After symptomatic support treatment, hemoperfusion or continuous hemofiltration treatment, the patients were cured and discharged. It is suggested to strengthen the popular science education on poisonous mushroom poisoning and improve the ability of identification and clinical treatment of poisonous mushrooms in grass-roots medical institutions.
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Affiliation(s)
- Z X Lu
- Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser Hospital) , Qingdao 266033, China
| | - X Li
- Qingdao Eighth People's Hospital, Qingdao 266100, China
| | - Y P He
- Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser Hospital) , Qingdao 266033, China
| | - C T Fang
- Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser Hospital) , Qingdao 266033, China
| | - Y X Song
- Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser Hospital) , Qingdao 266033, China
| | - J Wang
- Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser Hospital) , Qingdao 266033, China
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Saetang P, Samransamruajkit R, Singjam K, Deekajorndech T. Polymyxin B Hemoperfusion in Pediatric Septic Shock: Single-Center Observational Case Series. Pediatr Crit Care Med 2022; 23:e386-e391. [PMID: 35687100 PMCID: PMC9345520 DOI: 10.1097/pcc.0000000000002969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the use of direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) as adjunctive therapy during pediatric patients with septic shock. DESIGN Prospective observational study. SETTING Nine-bed PICUs at university referral hospital. PATIENTS Children (30 d to 15 yr) with septic shock and Pediatric Logistic Organ Dysfunction (PELOD)-2 score greater than or equal to 10 or Pediatric Risk of Mortality (PRISM) 3 score greater than or equal to 15, who were also receiving at least one inotrope. INTERVENTION Patients received 2-4 hour treatment with PMX-DHP 20R column on 2 consecutive days. MEASUREMENTS AND MAIN RESULTS We enrolled six children aged 21-167 months old (median, 99-mo old), with a body weight of 10-50 kg (median, 28 kg). All six patients had both PELOD-2 greater than or equal to 10 and PRISM-3 greater than or equal to 15, required invasive mechanical ventilation, and received standard treatment for septic shock before enrollment. We observed significant improvement in PELOD-2 score from baseline to 72 hours after the start of PMX-DHP (mean [95% CI] from 14.3 [12.2-16.5] to 6.0 [0.3-11.7]; p = 0.006). The vasoactive inotropic score (VIS) and lactate concentration also significantly decreased from baseline to 72 hours (VIS, 60 mmol/L [25-95 mmol/L] to 4.0 mmol/L [44.1-12 mmol/L]; p = 0.003; lactate, 2.4 mmol/L [1.0-3.8 mmol/L] to 1.0 mmol/L [0.5-1.5 mmol/L]; p = 0.01). Five of six patients survived. There was no device-related adverse event in these patients. CONCLUSIONS In this case series of treatment with PMX-DHP as adjunctive therapy in children with refractory septic shock and high baseline severity, we have shown that patient recruitment is feasible. We have also found that clinical hemodynamic and severity of illness scores at 72 hours may be potential end points for testing in future randomized controlled trials.
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Affiliation(s)
- Patcharin Saetang
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rujipat Samransamruajkit
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kanokwan Singjam
- Division of Pediatric Critical Care, Pediatric Intensive Care Unit, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Tawatchai Deekajorndech
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Wardoyo EY, Sari AP, Djojo AY, Sarwono J, Mokoagow MI, Darnindro N, Nasarudin J, Epriliawati M, Manurung A, Iskandar M, Wibisana KA, Widyastuti AAA, Mardiyah R. Hemoperfusion as an Adjuvant Therapy in Maintenance Hemodialysis Patients with Severe COVID-19: A Single Centre Experience. Acta Med Indones 2022; 54:444-450. [PMID: 36156468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Mortality rate among maintenance hemodialysis (HD) patients with COVID-19 is alarmingly high. In Fatmawati General Hospital, most of HD patients with COVID-19 presented with acute respiratory distress syndrome (ARDS). Hemoperfusion (HP) is a blood purification therapy used to remove cytokines and inflammatory mediators to prevent ARDS worsening and organ failure. We report 6 cases of COVID-19 in maintenance HD patients. HP and HD were performed in two consecutive days when patient developed early ARDS as indicated by inflammatory markers elevation. HP and HD were conducted by using resin-containing cartridge and high-flux dialyzer, respectively, for 4 hours. Improvements in CRP levels, PaO2/FiO2 ratios, and chest X-rays were observed after 2 sessions of HP in most of our patients. Based on our clinical experience, the timing of HP delivery is critical and should be undertaken in the early phase of ARDS, but larger studies are still needed.
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Affiliation(s)
- Elizabeth Yasmine Wardoyo
- Division of Renal Hypertension, Department of Internal Medicine, Fatmawati Hospital, Jakarta, Indonesia.
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Ohashi K, Ito R, Koda R, Iino N, Takada T. Serum cytokine changes induced by direct hemoperfusion with polymyxin B-immobilized fiber in patients with acute respiratory failure. Respir Investig 2022; 60:585-594. [PMID: 35525835 DOI: 10.1016/j.resinv.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Polymyxin B-immobilized Fiber therapy (PMX-DHP) may improve the prognosis of patients with rapidly progressive interstitial lung diseases (ILDs). However, the mechanisms by which PMX-DHP ameliorates oxygenation are unclear. The present study aimed to clarify the changes in serum cytokine concentrations during PMX-DHP with steroid pulse therapy. METHODS Patients with acute respiratory failure (ARF) and rapidly progressive ILDs, acute exacerbation of idiopathic pulmonary fibrosis (IPF), or acute respiratory distress syndrome (ARDS), and treated with PMX-DHP were assessed, including patients with IPF. The serum concentrations of 38 cytokines were compared between the ARF and IPF groups before treatment. In the ARF group, cytokine levels were compared before, immediately after PMX-DHP, and the day after termination of steroid pulse therapy. RESULTS Fourteen ARF and eight IPF patients were enrolled. A comparison of the cytokine levels before treatment initiation revealed that EGF, GRO, IL-10, MDC, IL-12p70, IL-15, sCD40L, IL-7, IP-10, MCP-1, and MIP-1β were significantly different between the two groups. In the ARF group treated with PMX-DHP, the concentrations of MDC, IP-10, and TNF-α continuously decreased during treatment (P < 0.01). Further, the cytokine levels of GRO, IL-10, IL-1Ra, IL-5, IL-6, and MCP-1 decreased after the entire treatment period, with no change observed during the steroid-only period (P < 0.01, except GRO and MCP-1). Although PMX-DHP significantly reduced eotaxin and GM-CSF serum levels (P < 0.01 and P < 0.05), these levels did not change after treatment. CONCLUSIONS PMX-DHP combined with steroid pulse therapy might reduce GRO, IL-10, IL-1Ra, IL-5, IL-6, and MCP-1 levels in ARF, contributing to better oxygenation in the disorder.
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Affiliation(s)
- Kazumasa Ohashi
- Department of Respiratory Medicine, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-uonuma, Niigata, Japan
| | - Ryo Ito
- Department of Respiratory Medicine, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-uonuma, Niigata, Japan
| | - Ryo Koda
- Department of Nephrology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-uonuma, Niigata, Japan
| | - Noriaki Iino
- Department of Nephrology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-uonuma, Niigata, Japan
| | - Toshinori Takada
- Department of Respiratory Medicine, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-uonuma, Niigata, Japan.
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29
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Li M, Wang X, Gong G, Tang Y, Zhang Y, Guo J, Liao X, Shi B. Natural polyphenol-based nanoengineering of collagen-constructed hemoperfusion adsorbent for the excretion of heavy metals. J Hazard Mater 2022; 428:128145. [PMID: 35007965 DOI: 10.1016/j.jhazmat.2021.128145] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
Designing a hemoperfusion adsorbent for the excretion therapy of toxic heavy metals still remains a great challenge due to the biosafety risks of non-biological materials and the desired highly efficient removal capacity. Herein, inspired from the homeostasis mechanism of plants, natural polyphenols are integrated with collagen matrix to construct a polyphenol-functionalized collagen-based artificial liver (PAL) for heavy metals excretion and free radicals scavenging therapy. PAL presents high adsorption capacities for Cu2+, Pb2+, and UO22+ ions, up to 76.98 μmol g-1, 106.70 μmol g-1, and 252.48 μmol g-1, respectively. Remarkably, PAL possesses a high binding affinity for UO22+, Pb2+, and Cu2+ ions even in the complex serum environment with the presence of biologically-relevant ions (e.g., Mg2+, Ca2+ ions). Low hemolysis ratio (1.77%), high cell viability (> 85%), high plasma recalcification time (17.4 min), and low protein adsorption (1.02 μmol g-1) indicate outstanding biocompatibility of this material. This natural polyphenol/collagen-based fully bio-derived hemoperfusion adsorbent provides a novel and potentially applicable strategy for constructing a hemoperfusion adsorbent for heavy metal ions excretion therapy with efficiency and biosafety.
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Affiliation(s)
- Meifeng Li
- Department of Biomass Chemistry and Engineering, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Xiaoling Wang
- Department of Biomass Chemistry and Engineering, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan 610065, China; BMI Center for Biomass Materials and Nanointerfaces, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Guidong Gong
- Department of Biomass Chemistry and Engineering, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan 610065, China; BMI Center for Biomass Materials and Nanointerfaces, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Yi Tang
- Department of Biomass Chemistry and Engineering, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Yaoyao Zhang
- Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Junling Guo
- Department of Biomass Chemistry and Engineering, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan 610065, China; BMI Center for Biomass Materials and Nanointerfaces, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan 610065, China; State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, Sichuan 610065, China; National Engineering Research Center of Clean Technology in Leather Industry, Sichuan University, Chengdu, Sichuan 610065, China.
| | - Xuepin Liao
- Department of Biomass Chemistry and Engineering, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan 610065, China; BMI Center for Biomass Materials and Nanointerfaces, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan 610065, China; National Engineering Research Center of Clean Technology in Leather Industry, Sichuan University, Chengdu, Sichuan 610065, China.
| | - Bi Shi
- Department of Biomass Chemistry and Engineering, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan 610065, China; BMI Center for Biomass Materials and Nanointerfaces, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan 610065, China; State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, Sichuan 610065, China; National Engineering Research Center of Clean Technology in Leather Industry, Sichuan University, Chengdu, Sichuan 610065, China
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Zhang MH, Wei N, Tian XX, Zhao SZ, Li LH, Wang BL. [Analysis of risk factors for hemorrhage in patients with acute poisoning treated with hemoperfusion]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:208-212. [PMID: 35439864 DOI: 10.3760/cma.j.cn121094-20210107-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To explore the clinical characterist ics and risk factors of hemorrhage complicated by hemoperfusion therapy in patients with acute poisoning. Methods: In January 2021, the clinical data of 196 patients with acute poisoning who received hemoperfusion therapy in the Second Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2020 were analyzed, and the patients were divided into bleeding group and non-bleeding group according to whether the patients were complicated with bleeding. Multivariate logistic regression was used to analyze the independent risk factors for hemorrhage in patients treated with hemoperfusion. Results: A total of 21 patients in the bleeding group and 175 patients in the non-bleeding group were included. There was no significant difference in general data such as gender, age, and body mass index between the two groups (P>0.05) . Organophosphorus pesticides (χ(2)= 4.56, P=0.030) , HA230 perfusion device (χ(2)=4.12, P=0.042) , platelet count (t=-2.33, P=0.009) and activated partial thromboplastin time (t=14.53, P<0.001) at 2 h of perfusion were the influencing factors of hemorrhage in patients with acute poisoning treated with hemoperfusion. Among them, organophosphorus pesticides, 2 h perfusion activated partial thromboplastin time ≥35 s and other factors were independent risk factors forcomplicated bleeding (P<0.05) . Conclusion: Patients with acute poisoning, especially organophosphorus pesticide poisoning, are at greater risk of bleeding during hemoperfusion therapy. Monitoring of changes in activated partial thromboplastin time should be strengthened and the dose of anticoagulants should be adjusted in time to reduce the risk of bleeding.
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Affiliation(s)
- M H Zhang
- Department of Emergency, the Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710038, China
| | - N Wei
- Department of Emergency, the Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710038, China
| | - X X Tian
- Department of Emergency, the Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710038, China
| | - S Z Zhao
- Department of Emergency, the Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710038, China
| | - L H Li
- Department of Emergency, the Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710038, China
| | - B L Wang
- Department of Emergency, the Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710038, China
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Giordano G, Alessandri F, Pugliese F. Hemoperfusion during veno-venous ECMO in severe COVID-19 with IL-6 elevation. Cytokine 2022; 152:155813. [PMID: 35123303 PMCID: PMC8806024 DOI: 10.1016/j.cyto.2022.155813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Giovanni Giordano
- Department of Anesthesia and Intensive Care Medicine, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Francesco Alessandri
- Department of Anesthesia and Intensive Care Medicine, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Francesco Pugliese
- Department of Anesthesia and Intensive Care Medicine, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
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Mu YH, Li XL, Pang L. [A case of paralytic intestinal obstruction caused by nifedipine poisoning]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2021; 39:952-953. [PMID: 35164430 DOI: 10.3760/cma.j.cn121094-20210129-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Nifedipine is a typical dihydropyridine calcium antagonist, and large doses of intake can cause poisoning. This article retrospectively analyzed the clinical data of a patient with nifedipine poisoning complicated with paralytic intestinal obstruction admitted to the First Affiliated Hospital of Jilin University in October 2020. When the patient was admitted to the hospital, the symptoms of poisoning were decreased blood pressure and shock, followed by severe paralytic intestinal obstruction. Finally, after active hemoperfusion combined with hemofiltration and symptomatic supportive treatment, the patient's condition improved and was discharged. There was no discomfort in the follow-up 2 months later.
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Affiliation(s)
- Y H Mu
- Department of Emergency, The First Hospital of Jilin University, Changchun 130021, China
| | - X L Li
- Department of Emergency, The First Hospital of Jilin University, Changchun 130021, China
| | - L Pang
- Department of Emergency, The First Hospital of Jilin University, Changchun 130021, China
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Mrosak J, Banasiak K, Edelheit B, Lapin C, Tory H, Collins MS. Polymyxin-B Hemoperfusion as a Novel Treatment for Rapidly Progressive Interstitial Lung Disease in a Pediatric Patient Diagnosed With Anti-MDA5 Juvenile Dermatomyositis. J Clin Rheumatol 2021; 27:S480-S484. [PMID: 31743264 DOI: 10.1097/rhu.0000000000001191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ishikura K, Katayama K, Hara A, Kotani H, Suzuki K, Kaneko T, Dohi K, Imai H. A case of acute bromvalerylurea intoxication that was successfully treated with direct hemoperfusion. CEN Case Rep 2021; 11:269-272. [PMID: 34817846 DOI: 10.1007/s13730-021-00666-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022] Open
Abstract
Bromvalerylurea is included in over-the-counter analgesics and is known to cause chronic bromism. Patients can also present acute intoxication because of suicide attempts. The treatment consists of drug cessation and intravenous drip with furosemide. Few reports have described the efficacy of blood purification therapy in a critical case. We report a 21-year-old Japanese woman who was admitted to our hospital in an unconscious state after she had taken 388 tablets of NARON ACE. She was intubated and high flow continuous hemodiafiltration was initiated because her blood pressure remained low, despite continuous intravenous drip infusion. To remove unknown drugs, direct hemoperfusion was performed twice. NARON ACE contains bromvalerylurea, ibuprofen, ethenzamide, and anhydrous caffeine; only the amount of bromvalerylurea was thought to exceed a lethal dose. The plasma concentrations of bromvalerylurea on the first, second, third, and fourth days were 118.9, 45.1, 30.2, and 12.6 μg/mL, respectively. Her level of consciousness improved on the third day and she was extubated. She became stable and was transferred to the psychiatric department to continue medication on day 14. Her clinical course improved, and she was discharged on day 89. In a potentially fatal case, direct hemoperfusion combined with intravenous drip should be considered.
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Affiliation(s)
- Ken Ishikura
- Department of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu, Japan.
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Kan Katayama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akiko Hara
- Department of Forensic Medicine and Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hirokazu Kotani
- Department of Forensic Medicine and Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kei Suzuki
- Department of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Tadashi Kaneko
- Department of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroshi Imai
- Department of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu, Japan
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Mousavi‐Roknabadi RS, Haddad F, Fazlzadeh A, Kheirabadi D, Dehghan H, Rezaeisadrabadi M. Investigation of plasma exchange and hemoperfusion effects and complications for the treatment of patients with severe COVID-19 (SARS-CoV-2) disease: A systematic scoping review. J Med Virol 2021; 93:5742-5755. [PMID: 34228355 PMCID: PMC8427024 DOI: 10.1002/jmv.27182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/21/2021] [Accepted: 07/01/2021] [Indexed: 01/08/2023]
Abstract
Some previous studies suggested that the plasma exchange (PE) and hemoperfusion (HP) played a cardinal role in the treatment of severe coronavirus disease 2019 (COVID-19) cases by diminishing the cytokine storm. This study aimed to assess the effects of PE and HP on cytokine storms in patients with severe COVID-19 through a systematic scoping review. Four Electronic databases (Medline [accessed from PubMed], Scopus, Science Direct, and Cochrane library) were searched systematically on February 2, 2021, using MESH terms and related keywords in the English language. Considering the titles and abstracts, unrelated studies were excluded. The full texts of the remained studies were evaluated by authors, independently. Then, their findings were assessed and reported. A total of 755 articles were obtained within the first step of searching, and 518 remained after removing the duplications. Through the title and abstract screening, 438 were removed. Of the rest, 59 papers were excluded. Finally, after reading the full text of the remained articles, 21 were included in data extraction. Most of the previously reported evidence were case reports and case series. Findings were summarized in two categories. The first category encompassed nine studies regarding HP and continuous renal replacement therapy, and the second category included twelve studies about PE. The results revealed that HP and PE within the cytokine storm phase would be beneficial with a high probability in the treatment of severely ill COVID-19 patients. Highlights Some studies showed that plasma exchange (PE) and hemoperfusion (HP) played an important role in the treatment of patients with severe COVID-19 disease. The results of this systematic scoping review revealed that HP and PE within the cytokine storm phase would be beneficial with a high probability in the treatment of severely ill COVID-19 patients.
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Affiliation(s)
- Razieh Sadat Mousavi‐Roknabadi
- Department of Emergency Medicine, School of MedicineShiraz University of Medical SciencesShirazIran
- Emergency Medicine Research CenterShiraz University of Medical SciencesShirazIran
| | - Fatemeh Haddad
- Department of Medical PhysiologyShiraz University of Medical SciencesShirazIran
| | - Aylar Fazlzadeh
- Department of Internal MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Dorna Kheirabadi
- Department of Anesthesiology and Critical Care, School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Hamidreza Dehghan
- Department of Biostatistics, Research Center for Health Technology Assessment and Medical Informatics, School of Public HealthShahid Sadoughi University of Medical SciencesYazdIran
| | - Mohammad Rezaeisadrabadi
- Department of Anesthesiology and Critical Care, School of MedicineIsfahan University of Medical SciencesIsfahanIran
- Resident of Gastroenterology and Liver Disease SubspecialtyIsfahan University of Medical SciencesIsfahanIran
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Jang JH, Jang HJ, Kim HK, Park JH, Kim HJ, Jo KM, Heo W, Kim SH, No TH, Lee JH. Acute respiratory distress syndrome caused by carbon monoxide poisoning and inhalation injury recovered after extracorporeal membrane oxygenation along with direct hemoperfusion with polymyxin B-immobilized fiber column: a case report. J Med Case Rep 2021; 15:456. [PMID: 34521457 PMCID: PMC8439957 DOI: 10.1186/s13256-021-03023-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 07/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Inhalation injury from smoke or chemical products and carbon monoxide poisoning are major causes of death in burn patients from fire accidents. Respiratory tract injuries from inhalation injury and carbon monoxide poisoning can lead to acute respiratory distress syndrome and cytokine storm syndrome. In the case of acute respiratory failure needing mechanical ventilation accompanied by cytokine storm, mortality is high and immediate adequate treatment at the emergency department is very important. CASE PRESENTATION This report describes a case of acute respiratory distress syndrome and cytokine storm followed by carbon monoxide poisoning in a 34-year-old Korean male patient who was in a house fire, and was successfully treated by extracorporeal membrane oxygenation and direct hemoperfusion with polymyxin B-immobilized fiber column at emergency department. CONCLUSIONS To prevent mortality in acute respiratory distress syndrome with cytokine storm from inhalation injury and to promote a better prognosis, we suggest that early implication of extracorporeal membranous oxygenation along with direct hemoperfusion with polymyxin B-immobilized fiber column even at the emergency department should be considered.
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Affiliation(s)
- Ji Hoon Jang
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 135-710, Korea
| | - Hang Jea Jang
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 135-710, Korea
| | - Hyun-Kuk Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 135-710, Korea
| | - Jin Han Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 135-710, Korea
| | - Hyo-Jung Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 135-710, Korea
| | - Kyeong Min Jo
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 135-710, Korea
| | - Woon Heo
- Department of Thoracic and Cardiovascular surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Se Hun Kim
- Department of Anesthesiology and Pain medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Tae-Hoon No
- Department of Internal Medicine, Seoul ST. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae Ha Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 135-710, Korea.
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Kanjo A, Molnar Z, Zádori N, Gede N, Erőss B, Szakó L, Kiss T, Márton Z, Malbrain MLNG, Szuldrzynski K, Szrama J, Kusza K, Kogelmann K, Hegyi P. Dosing of Extracorporeal Cytokine Removal In Septic Shock (DECRISS): protocol of a prospective, randomised, adaptive, multicentre clinical trial. BMJ Open 2021; 11:e050464. [PMID: 34446497 PMCID: PMC8395301 DOI: 10.1136/bmjopen-2021-050464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Sepsis and septic shock have mortality rates between 20% and 50%. In sepsis, the immune response becomes dysregulated, which leads to an imbalance between proinflammatory and anti-inflammatory mediators. When standard therapeutic measures fail to improve patients' condition, additional therapeutic alternatives are applied to reduce morbidity and mortality. One of the most recent alternatives is extracorporeal cytokine adsorption with a device called CytoSorb. This study aims to compare the efficacy of standard medical therapy and continuous extracorporeal cytokine removal with CytoSorb therapy in patients with early refractory septic shock. Furthermore, we compare the dosing of CytoSorb adsorber device changed every 12 or 24 hours. METHODS AND ANALYSIS It is a prospective, randomised, controlled, open-label, international, multicentre, phase III study. Patients fulfilling the inclusion criteria will be randomly assigned to receive standard medical therapy (group A) or-in addition to standard treatment-CytoSorb therapy. CytoSorb treatment will be continuous and last for at least 24 hours, CytoSorb adsorber device will be changed every 12 (group B) or 24 hours (group C). Our primary outcome is shock reversal (no further need or a reduced (≤10% of the maximum dose) vasopressor requirement for 3 hours) and time to shock reversal (number of hours elapsed from the start of the treatment to shock reversal).Based on sample size calculation, 135 patients (1:1:1) will need to be enrolled in the study. A predefined interim analysis will be performed after reaching 50% of the planned sample size, therefore, the corrected level of significance (p value) will be 0.0294. ETHICS AND DISSEMINATION Ethics approval was obtained from the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (OGYÉI/65049/2020). Results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04742764; Pre-results.
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Affiliation(s)
- Anna Kanjo
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Heim Pál National Paediatric Institute, Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Zsolt Molnar
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
- Chair and Department of Anaesthesiology and Intensive Therapy and Pain Treatment, Poznan University for Medical Sciences, Poznan, Poland
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Noémi Zádori
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Department of Anaesthesiology and Intensive Care, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Lajos Szakó
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Tamás Kiss
- Department of Anaesthesiology and Intensive Care, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Márton
- 1st Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Manu L N G Malbrain
- International Fluid Academy, Lovenjoel, Belgium
- Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Medical Department, CMO, AZ Jan Palfijn Hospital, Ghent, Belgium
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Konstanty Szuldrzynski
- Department of Anaesthesiology and Intensive Care, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
- Chair of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Szrama
- Chair and Department of Anaesthesiology and Intensive Therapy and Pain Treatment, Poznan University for Medical Sciences, Poznan, Poland
| | - Krzysztof Kusza
- Chair and Department of Anaesthesiology and Intensive Therapy and Pain Treatment, Poznan University for Medical Sciences, Poznan, Poland
| | - Klaus Kogelmann
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Emden, Emden, Germany
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Tyagi A, Ng YW, Tamtaji M, Abidi IH, Li J, Rehman F, Hossain MD, Cai Y, Liu Z, Galligan PR, Luo S, Zhang K, Luo Z. Elimination of Uremic Toxins by Functionalized Graphene-Based Composite Beads for Direct Hemoperfusion. ACS Appl Mater Interfaces 2021; 13:5955-5965. [PMID: 33497185 DOI: 10.1021/acsami.0c19536] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Conventional absorbents for hemoperfusions suffer from low efficiency and slow absorption with numerous side effects. In this research, we developed cellulose acetate (CA) functionalized graphene oxide (GO) beads (∼1.5-2 mm) that can be used for direct hemoperfusion, aiming at the treatment of kidney dysfunction. The CA-functionalized GO bead facilitates adsorption of toxins with high biocompatibility and high-efficiency of hemoperfusion while maintaining high retention for red blood cell, white blood cells, and platelets. Our in vitro results show that the toxin concentration for creatinine reduced from 0.21 to 0.12 μM (p < 0.005), uric acid from 0.31 to 0.15 mM (p < 0.005), and bilirubin from 0.36 to 0.09 mM (p < 0.005), restoring to normal levels within 2 h. Our in vivo study on rats (Sprague-Dawley, n = 30) showed that the concentration for creatinine reduced from 83.23 to 54.87 μmol L-1 (p < 0.0001) and uric acid from 93.4 to 54.14 μmol L-1 (p < 0.0001), restoring to normal levels within 30 min. Results from molecular dynamics (MD) simulations using free-energy calculations reveal that the presence of CA on GO increases the surface area for adsorption and enhances penetration of toxins in the binding cavities because of the increased electrostatic and van der Waals force (vdW) interactions. These results provide critical insight to fabricate graphene-based beads for hemoperfusion and to have the potential for the treatment of blood-related disease.
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Affiliation(s)
- Abhishek Tyagi
- State Key Laboratory of Precision Electronic Manufacturing Technology and Equipment, School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, China
- Department of Chemical and Biological Engineering, William Mong Institute of Nano Science and Technology, and Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Yik Wong Ng
- Department of Chemical and Biological Engineering, William Mong Institute of Nano Science and Technology, and Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Mohsen Tamtaji
- Department of Chemical and Biological Engineering, William Mong Institute of Nano Science and Technology, and Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Irfan Haider Abidi
- Department of Chemical and Biological Engineering, William Mong Institute of Nano Science and Technology, and Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Jingwei Li
- Department of Chemical and Biological Engineering, William Mong Institute of Nano Science and Technology, and Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Faisal Rehman
- Department of Chemical and Biological Engineering, William Mong Institute of Nano Science and Technology, and Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Md Delowar Hossain
- Department of Chemical and Biological Engineering, William Mong Institute of Nano Science and Technology, and Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Yuting Cai
- Department of Chemical and Biological Engineering, William Mong Institute of Nano Science and Technology, and Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Zhenjing Liu
- Department of Chemical and Biological Engineering, William Mong Institute of Nano Science and Technology, and Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Patrick Ryan Galligan
- Department of Chemical and Biological Engineering, William Mong Institute of Nano Science and Technology, and Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Shaojuan Luo
- Department of Chemical and Biological Engineering, William Mong Institute of Nano Science and Technology, and Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
- School of Chemical Engineering and Light Industry, Guangdong University of Technology, Guangzhou 510006, China
| | - Kai Zhang
- State Key Laboratory of Precision Electronic Manufacturing Technology and Equipment, School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, China
| | - Zhengtang Luo
- Department of Chemical and Biological Engineering, William Mong Institute of Nano Science and Technology, and Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
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Affiliation(s)
- Edward G Clark
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada.
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Lauralyn McIntyre
- Division of Critical Care, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Ron Wald
- Division of Nephrology, St Michael's Hospital and Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gregory L Hundemer
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
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Iannaccone G, Scacciavillani R, Del Buono MG, Camilli M, Ronco C, Lavie CJ, Abbate A, Crea F, Massetti M, Aspromonte N. Weathering the Cytokine Storm in COVID-19: Therapeutic Implications. Cardiorenal Med 2020; 10:277-287. [PMID: 32599589 PMCID: PMC7360507 DOI: 10.1159/000509483] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) recently emerged in Wuhan, Hubei-China, as responsible for the coronavirus disease 2019 (COVID-19) and then spread rapidly worldwide. While most individuals remain asymptomatic or develop only mild symptoms, approximately 5% develop severe forms of COVID-19 characterized by acute respiratory distress syndrome (ARDS) and multiple-organ failure (MOF) that usually require intensive-care support and often yield a poor prognosis. SUMMARY The pathophysiology of COVID-19 is far from being completely understood, and the lack of effective treatments leads to a sense of urgency to develop new therapeutic strategies based on pathophysiological assumptions. The exaggerated cytokine release in response to viral infection, a condition known as cytokine release syndrome (CRS) or cytokine storm, is emerging as the mechanism leading to ARDS and MOF in COVID-19, thus endorsing the hypothesis that properly timed anti-inflammatory therapeutic strategies could improve patients' clinical outcomes and prognosis. Key Messages: The objective of this article is to explore and comment on the potential role of the promising immunomodulatory therapies using pharmacological and nonpharmacological approaches to overcome the dysregulated proinflammatory response in COVID-19.
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Affiliation(s)
- Giulia Iannaccone
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Roberto Scacciavillani
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Giuseppe Del Buono
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimiliano Camilli
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Claudio Ronco
- Department of Medicine, University of Padova, Padua, Italy
- Department of Nephrology, Dialysis and Kidney Transplant, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Antonio Abbate
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nadia Aspromonte
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
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Abstract
Sepsis can cause septic shock, multiple organ dysfunction and even death. The combination of different blood purification would be the certain trend in the treatment of sepsis.This study was to evaluate the clinical effects of hemoperfusion (HP) combined with pulse high volume hemofiltration (PHVHF) on septic shock.Thirty cases were involved in this study and were randomly divided into two groups: HP and PHVHF group (n = 15) and CVVH (continuous veno-venous hemofiltration) group (n = 15). Acute physiology and chronic health evaluation (APACHE) II scores, sequential organ failure assessment (SOFA) scores as well as biochemical changes were measured before and after the treatment. The levels of IL-6, IL-10, and TNF-α in plasma were assessed by ELISA before and after treatment for 2 and 24 h. The norepinephrine doses were also analyzed. The 28-day mortalities in both groups were also compared.In both groups, body temperature (BT), respiratory rate (RR), white blood cells (WBC), C-reactive protein (CRP), Procalcitonin (PCT), lactic acid, serum creatinine, APACHE II scores and SOFA scores decreased after hemofiltration (P < .05). The HP&PHVHF group was superior to the CVVH group in CRP, APACHE II score (P < .01), and heart rate (HR), WBC, PCT, SOFA (P < .05). The doses of norepinephrine were also decreased after treatment (P < .01), with more reduction in the HP&PHVHF group (P < .05). After 24 h of treatment, the levels of IL-6, IL-10, and TNF-α decreased in both groups (P < .05), and the decrease was more significant in HP&PHVHF group (P < .05). In combined group, after 2 h of hemoperfison, there was a significant reduction in these inflammatory factors (P < .01). Combined therapy group's mortality was 26.7%, while CVVH group's was 40%.HP combined with PHVHF has a significant effect on septic shock and can be an important therapy for septic shock.
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Affiliation(s)
- Laping Chu
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi
| | - Guangyao Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Yafen Yu
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi
| | - Xiaoyan Bao
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi
| | - Hongyi Wei
- Department of Intensive Care Unit, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, China
| | - Minhong Hu
- Department of Intensive Care Unit, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, China
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Sun X, Chen X, Lu J, Tao Y, Zhang L, Dong L. Extracorporeal treatment in children with acute severe poisoning. Medicine (Baltimore) 2019; 98:e18086. [PMID: 31764843 PMCID: PMC6882618 DOI: 10.1097/md.0000000000018086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/06/2019] [Accepted: 10/23/2019] [Indexed: 02/01/2023] Open
Abstract
Acute poisoning in children is a clinical emergency. Prompt and effective treatment is critical for life-threatening poisoning. Extracorporeal treatment (ECTR) is a practical option for enhancing the elimination of poisons.We conducted a retrospective observational study on 338 children with severe acute poisoning who received ECTR during hospitalization from January 2010 to December 2017. The poisonous substances, utilization of ECTR, adverse reactions to ECTR, and outcomes were recorded.The top 3 poisoning categories, in order of frequency, were found to be pesticides (57.99%), biotoxins (25.15%), and pharmaceuticals (14.20%). Paraquat (35.21%), an organic heterocyclic herbicide with high toxicity to humans, was the most common toxic substance. The main modalities of ECTR use were hemoperfusion (50.59%) and therapeutic plasma exchange (42.60%), followed by continuous renal replacement therapy (4.44%) and hemodialysis (1.18%). There were also 4 patients (1.18%) with a combination of ECTR performed. Adverse events of ECTR included errhysis and hematomas around the catheter exit site, oral cavity bleeding, allergic reactions, hypothermia, hypotension, and blood coagulation. The adverse reactions were mostly mild to moderate and were manageable. During the study period, there were 295 patients (87.28%) who were cured, 9 (2.66%) who experienced some improvement, and 34 (10.06%) who died.ECTR modalities were found to be clinically effective approaches to the treatment of poisoning by pesticides, biotoxins, and pharmaceuticals, indicating they are important modalities in toxicology and treatment, and are well tolerated by children.
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Affiliation(s)
- Xiaomei Sun
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiuying Chen
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Lu
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuhong Tao
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lijuan Zhang
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liqun Dong
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Lin G, Yuan L, Peng X, Long J, Wang C, Bai L, Lu X, Dong J, Liu Y, Wang Y, Qiu Z. Clinical characteristics and treatment of thallium poisoning in patients with delayed admission in China. Medicine (Baltimore) 2019; 98:e16471. [PMID: 31335706 PMCID: PMC6708863 DOI: 10.1097/md.0000000000016471] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Thallium is highly toxic and its effects are cumulative. The clinical symptoms of thallium poisoning are non-specific, thereby delaying admission and treatment. This study aimed to summarize the clinical features and treatment experience of patients with delayed admission who experience thallium poisoning.We conducted a retrospective descriptive analysis of patients in our hospital from 2008 to 2018 who had thallium poisoning and experienced a delay in hospital admission. The time from symptom onset to admission was assessed. The patients were divided into 3 groups and descriptive analyses of their clinical characteristics, including basic patient information, symptoms, laboratory test results, examination findings, treatment methods, outcomes, and follow-up information, were conducted.A total of 34 patients with thallium poisoning were included: 8 were admitted to the hospital early or with mild delay, 9 had a moderate delay, and 17 had a severely delayed admission. The time from illness onset to admission was 13 (interquartile range, 7.5-26) days. Some patients with delayed admission had significant symptoms associated with central nervous system damage, and changes in magnetic resonance images and electroencephalograms were also noted. After admission, all patients received Prussian blue treatment, and some patients with relatively high blood concentration received blood purification treatments. Following treatment, the blood and urine thallium concentrations of all patients decreased significantly, and their symptoms were alleviated.Our results show that delayed patient admission in cases of thallium poisoning is associated with greater risk of central nervous system damage. Use of Prussian blue combined with blood purification treatments might improve patients' conditions.
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Affiliation(s)
- Guodong Lin
- Poisoning Treatment Department, Affiliated Hospital Academy of Military Medical Sciences, Beijing
| | - Luo Yuan
- State Key Laboratory of Toxicology and Medical Countermeasures, Institutes of Pharmacology and Toxicology, Academy of Military Medical Sciences, People's Republic of China
| | - Xiaobo Peng
- Poisoning Treatment Department, Affiliated Hospital Academy of Military Medical Sciences, Beijing
| | - Jianhai Long
- State Key Laboratory of Toxicology and Medical Countermeasures, Institutes of Pharmacology and Toxicology, Academy of Military Medical Sciences, People's Republic of China
| | - Chunyan Wang
- Poisoning Treatment Department, Affiliated Hospital Academy of Military Medical Sciences, Beijing
| | - Lili Bai
- Poisoning Treatment Department, Affiliated Hospital Academy of Military Medical Sciences, Beijing
| | - Xiaoxia Lu
- Poisoning Treatment Department, Affiliated Hospital Academy of Military Medical Sciences, Beijing
| | - Jianguang Dong
- Poisoning Treatment Department, Affiliated Hospital Academy of Military Medical Sciences, Beijing
| | - Yanqing Liu
- Poisoning Treatment Department, Affiliated Hospital Academy of Military Medical Sciences, Beijing
| | - Yongan Wang
- State Key Laboratory of Toxicology and Medical Countermeasures, Institutes of Pharmacology and Toxicology, Academy of Military Medical Sciences, People's Republic of China
| | - Zewu Qiu
- Poisoning Treatment Department, Affiliated Hospital Academy of Military Medical Sciences, Beijing
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Abstract
Following on from previous studies on dermal inflammation in the isolated perfused bovine udder, a new in vitro model of the isolated haemoperfused bovine uterus was established for studies on acute inflammatory reactions (for example, eicosanoid synthesis and regulation of cyclooxygenase-1 [COX-1] and COX-2) caused by ischaemia-reperfusion (I-R) injury. The organs and blood used in this study were obtained from a slaughterhouse. Within 2 hours of slaughter, uterine perfusion was re-established, by using a mixture of homologous blood and Tyrode solution (4:1). After equilibration, several deposits of arachidonic acid (5 mg and 0.1 mg) and arachidonylethanolamide (0.1 mg) were injected into the myometrial tissue. Tissue biopsies were taken from treated and untreated areas at 180 and 300 minutes after the onset of haemoperfusion, for measuring prostaglandin E(2) (PGE(2)) levels. In addition, the regulation of COX-1 and COX-2 mRNA was investigated by using the reverse transcriptase-polymerase chain reaction. Eicosanoid levels were determined by using an enzyme immunoassay (ELISA). Because both an increase in PGE(2) concentration and up-regulation of COX mRNA were observed, the inhibitory effects of dexamethasone, added to the perfusion medium, were studied. Dexamethasone caused a significant decrease in tissue PGE(2) production, but did not induce down-regulation of COX-2 mRNA. In conclusion, the isolated haemoperfused bovine uterus was introduced as an in vitro model of acute inflammation, induced by I-R injury. The suitability of the model for investigating anti-inflammatory substances was demonstrated. Use of the isolated haemoperfused bovine uterus in pharmacological research and drug screening may contribute to reducing the number of animals used for testing.
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Affiliation(s)
- Michael Braun
- Department of Pharmacology, Toxicology and Pharmacy, School of Veterinary Medicine, Buenteweg 17, 30559 Hannover, Germany.
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45
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Affiliation(s)
- James C Hurley
- Department of Rural Health, University of Melbourne Medical School, Melbourne, Australia
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46
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Hashimoto M, Murata K, Kagawa Y, Kawai K, Sakamoto T, Naito A, Murakami K, Katsura Y, Omura Y, Masuzawa T, Takeno A, Takamatsu J, Yoshimura M, Takeda Y. [A Case of Curative Surgery after Infection Control Surgery for Peritonitis Due to Perforation of Rectal Cancer]. Gan To Kagaku Ryoho 2019; 46:564-566. [PMID: 30914615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 70s man was admitted to another hospital with a complaint of abdominal pain, and was diagnosed with a gastrointestinal perforation based on the presence of free air in the abdominal cavity on computed tomography. The patient was transferred to our hospital in shock and underwent emergency surgery. Operative findings showed a perforation of the rectosigmoid colon and rectal cancer at the anal side of the perforation site. As his general condition was unstable due to septic shock, only the segments of the colon including the perforation site and rectal cancer were resected for source control. The abdominal wall was kept open, and intraperitoneal contamination was managed with an open management method using negative pressure wound therapy. Systemictreatments for septicshoc k were performed in the intensive care unit with a vasopressor and polymyxin-B hemoperfusion. The general condition became stable with intensive care by postoperative day 3. We performed additional lymph node dissection and one-step rectal sigmoidoscopic anastomosis on postoperative day 4. The pathological results confirmed pT4aN1M0, pStage Ⅲa disease. Although the course was complicated by postoperative pneumonia, the patient was discharged on postoperative day 28. We experienced a case in which curative resection with radical lymph node dissection and one-step anastomosis were performed after infection and source control with open abdomen management.
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47
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Affiliation(s)
- Didier Payen
- UMR Inserm 1160, Université Paris 7 Denis-Diderot, Paris Cité Sorbone, France.
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48
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Guo X, Zhong CG, Zhang YF, Liu F, He J, Lin H, Guo MQ. In Vitro Evaluation of Hemoperfusion for Chlorpyrifos Poisoning. Biomed Environ Sci 2018; 31:922-926. [PMID: 30636666 DOI: 10.3967/bes2018.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Xiang Guo
- XiangYa School of Public Health, Central South University, Changsha 410078, Hunan, China; Shenzhen Prevention and Treatment Center for Occupational Disease, Shenzhen 518020, Guangdong, China
| | - Cai Gao Zhong
- XiangYa School of Public Health, Central South University, Changsha 410078, Hunan, China
| | - Yan Fang Zhang
- Shenzhen Prevention and Treatment Center for Occupational Disease, Shenzhen 518020, Guangdong, China
| | - Fen Liu
- Shenzhen Prevention and Treatment Center for Occupational Disease, Shenzhen 518020, Guangdong, China
| | - Jian He
- Shenzhen Prevention and Treatment Center for Occupational Disease, Shenzhen 518020, Guangdong, China
| | - Hui Lin
- Shenzhen Prevention and Treatment Center for Occupational Disease, Shenzhen 518020, Guangdong, China
| | - Mei Qiong Guo
- Shenzhen Prevention and Treatment Center for Occupational Disease, Shenzhen 518020, Guangdong, China
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Klein DJ, Foster D, Walker PM, Bagshaw SM, Mekonnen H, Antonelli M. Polymyxin B hemoperfusion in endotoxemic septic shock patients without extreme endotoxemia: a post hoc analysis of the EUPHRATES trial. Intensive Care Med 2018; 44:2205-2212. [PMID: 30470853 PMCID: PMC6280819 DOI: 10.1007/s00134-018-5463-7] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/12/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE The EUPHRATES trial examined the impact of polymyxin B hemoperfusion (PMX) on mortality in patients with septic shock and endotoxemia, defined as EAA ≥ 0.60. No difference was found in 28-day all-cause mortality. However, the trial showed that in some patients with septic shock the burden of endotoxin activity was extreme (EAA ≥ 0.9). In a post hoc analysis, we evaluated the impact of PMX use in patients with septic shock and endotoxin activity measured between 0.6-0.89. METHODS Post-hoc analysis of the EUPHRATES trial for the 194 patients with EAA ≥ 0.6-0.89 who completed two treatments (PMX or sham). The primary end point was mortality at 28 days adjusted for APACHE II score and baseline mean arterial pressure (MAP). Additional end points included changes in MAP, cumulative vasopressor index (CVI), median EAA reduction, ventilator-free days (VFD), dialysis-free days (DFD) and hospital length of stay. Subpopulations analyzed were site and type of infection and those with norepinephrine dose > 0.1 mcg/kg/min at baseline. RESULTS At 28 days, 23 patients of 88 (26.1%) in the PMX group died versus 39 of 106 (36.8%) in the sham group [risk difference 10.7%, OR 0.52, 95% CI (0.27, 0.99), P = 0.047]. When unadjusted for baseline variables, P = 0.11. The 28-day survival time in the PMX group was longer than for the sham group [HR 0.56 (95% CI 0.33, 0.95) P = 0.03]. PMX treatment compared with sham showed greater change in MAP [median (IQR) 8 mmHg (- 0.5, 19.5) vs. 4 mmHg (- 4.0, 11) P = 0.04] and VFD [median (IQR) 20 days (0.5, 23.5) vs. 6 days (0, 20), P = 0.004]. There were no significant differences in other end points. There was a significant difference in mortality in PMX-treated patients with no bacterial growth on culture [PMX, 6/30 (20%) vs. sham, 13/31 (41.9%), P = 0.005]. The median EAA change in the population was - 12.9% (range: increase 49.2%-reduction 86.3%). The mortality in the above median EAA change group was PMX: 6/38 (15.7%) vs. sham 15/49 (30.6%), P = 0.08. CONCLUSIONS These hypothesis-generating results, based on an exploratory post hoc analysis of the EUPHRATES trial, suggest measurable responses in patients with septic shock and an EAA ≥ 0.6 to 0.89 on changes in mean arterial pressure, ventilator-free days and mortality. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT01046669. Funding Spectral Medical Incorporated.
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Affiliation(s)
- D J Klein
- Department of Critical Care, St. Michael's Hospital, University of Toronto, 4-054c Donnelly Wing, Toronto, ON, M5B1W8, Canada.
| | - D Foster
- Spectral Medical Inc, Toronto, Canada
| | | | - S M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - H Mekonnen
- AMAREX Clinical Research, Germantown, MD, USA
| | - M Antonelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Universitá Cattolica del Sacro Cuore, Rome, Italy
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50
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Liu S, Xu L, Ma J, Huang R, Lin T, Li Z, Liang H, Li S, Li R, Zhang L, Tao Y, Li Z, Chen Y, Ye Z, Zhang B, Wang W, Xiao H, Liang X, Shi W. High-volume continuous venovenous hemodiafiltration plus resin hemoperfusion improves severe metformin-associated toxicity. J Diabetes Investig 2018; 9:975-978. [PMID: 28980449 PMCID: PMC6031495 DOI: 10.1111/jdi.12757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 12/19/2022] Open
Abstract
We present the case of a 42-year-old female patient who attempted suicide by taking approximately 100 tablets of metformin (500 mg). Laboratory tests revealed severe lactic acidosis with lactate levels of 24 mmol/L and pH of 7.09. The patient was treated with high-volume continuous venovenous hemodiafiltration (CVVH) and resin-sorbent hemoperfusion. Metformin concentrations were measured by high-performance liquid chromatography during CVVH and hemoperfusion treatment. Before extracorporeal treatment, the plasma metformin concentration was 208.5 mg/L. After CVVH treatment for 24 h, the plasma metformin concentration had decreased to 13.9 mg/L. Resin-based sorbent hemoperfusion plus CVVH treatment had reduced the metformin plasma concentration by 61.8% after 3 h. After 7 days, the patient's laboratory tests and clinical syndrome were improved, and she was discharged from hospital. We provide evidence that CVVH plus hemoperfusion is effective in eliminating metformins and metabolic products.
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Affiliation(s)
- Shuangxin Liu
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Lixia Xu
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Jianchao Ma
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Renwei Huang
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Ting Lin
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Zhuo Li
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Huabang Liang
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Sijia Li
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Ruizhao Li
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Li Zhang
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Yiming Tao
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Zhilian Li
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Yuanhan Chen
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Zhiming Ye
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Bin Zhang
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Wenjian Wang
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Houqing Xiao
- Dongguan City Five People's HospitalDongguanGuangdongChina
| | - Xinling Liang
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Wei Shi
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
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