The accumulation of amyloid β protein (Aβ) in the brain reflects cognitive impairment in Alzheimer's disease. We hypothesized that the rapid removal of Aβ from the blood by an extracorporeal system may act as a peripheral Aβ sink from the brain. The present study aimed to determine the optimal materials and modality for Aβ removal by hemodialyzers. In a batch analysis, hollow-fiber fragments of polysulfone (PSf) and polymethyl methacrylate (PMMA) showed greater removal efficiency of Aβ than did other materials, such as cellulose-triacetates and ethylene-vinyl alcohol copolymer (PSf:PMMA at 30 min, 98.6 ± 2.4 %:97.8 ± 0.4 % for Aβ1-40 and 96.6 ± 0.3 %:99.0 ± 1.0 % for Aβ1-42). In a modality study, the Aβ solution was applied to PSf dialyzers and circulated in the dialysis and Air-filled adsorption-mode (i.e., the outer space of the hollow fibers was filled with air) or phosphate-buffered saline (PBS)-filled adsorption modes. The Aβ1-40 removal efficiency of the pre/post dialyzer in the Air-filled adsorption-mode was the highest (62.4 ± 12.6 %, p = 0.007). In a flow rate study in the Air-filled adsorption-mode, 200 mL/min showed the highest Aβ1-40 reduction rate of pool solution (97.3 ± 0.8 % at 15 min) compared with 20 mL/min (p = 0.00001) and 50 mL/min (p = 0.00382). PMMA dialyzers showed similar high reduction rates. Thus, the optimal modality for Aβ removal was the adsorption-mode with PSf or PMMA hollow fibers at around 50 mL/min flow rate, which seems to be suitable for clinical use.
Acute kidney injury associated with cardiopulmonary bypass(AKI-CPB)can occur because of cardiopulmonary complications. The renal toxicity of plasma-free hemoglobin(PF-Hb)is presented as one of the factors. Since January 2014, our hospital measured the PF-Hb in cardiopulmonary bypasses(CPB)and we introduced a method that administers haptoglobin (Hp)agents as an indicator of PF-Hb values. We selected 129 patients, having a body weight ≦20kg, who received treatment at our hospital between January 2012 and December 2015, and they received CPB because of congenital heart disease. This comparative study includes 57 patients who were administered 25mL of the Hp drug when the blood concentration container held red waste or hemolytic urine(group A) .The remaining 72 patients were administered 25mL of the Hp drug when PF-Hb values in the range of 0.03-0.05g/dL and 50mL when the PF-Hb value was ≧0.05g/dL(group B) .The study analyzed Hp drug-dose amounts, post-operative hemolytic urine occurrences, Acute Kidney Injury Network(AKIN)stage classifications, post-operative acute kidney injury(AKI)incidences, and liver function evaluations.
Acute kidney injury (AKI) is a common complication of prolonged cardiopulmonary bypass (CPB) performed during cardiac surgery. There are several known risk factors associated with AKI perioperatively. However, there is little knowledge about CPB and its complications in children with congenital heart disease (CHD) undergoing cardiac surgery. This study aims to identify and analyze the risk factors associated with perioperative AKI due to CPB performed in patients with CHD.The study includes 217 patients with CHD who underwent surgery and CPD at Mie University Hospital. The participants had a bodyweight of 20kg or less;they were classified into two groups:the non-AKI group consisting of 150 cases, and the AKI group containing 67 cases. The risk factors were identified and analyzed.The body surface area (BSA) of each patient (OR 0.461, 95%C.I. 0.317-0.732;p=0.008) , time duration of CPB (OR 1.546, , the maximum level of PF-Hb (OR 2.142, 95%C.I. 1.276-3.998;p=0.011) , and the minimum DO2 value (OR 0.659, 95%C.I. 0.518-0.802;p=0.032) were detected as independent risk factors for the perioperative AKI.
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