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Background: Haemoperfusion (HP) is an innovative extracorporeal therapy that utilizes special cartridges to filter the blood, effectively removing pro-inflammatory cytokines, toxins, and pathogens in COVID-19 patients. This retrospective cohort study aimed to assess the clinical benefits of HP for severe COVID-19 cases using Shapley values for machine learning models. Methods: The research involved 578 inpatients (≥ 20 years old) admitted to Baqiyatallah hospital (Tehran, Iran). The control group (359 patients) received standard treatment, including high doses of corticosteroids (a single 500 mg methylprednisolone pulse, followed by 250 mg for 2 days), categorized as regimen (I). On the other hand, the HP group (219 patients) received regimen II, consisting of the same corticosteroid treatment (regimen I) along with haemoperfusion using Cytosorb H300. The frequency of haemoperfusion sessions varied based on the type of lung involvement determined by chest CT scans. In addition, the value function v defines the Shapley value of the i th feature for the query point x , where the input matrix features represent individual characteristics, drugs, and history and clinical conditions of the patient. Results: Our data showed a favorable clinical response in the HP group compared to the control group. Notably, one-to-three sessions of HP using the CytoSorb® 300 cartridge led to reduced ventilation requirements and mortality rates in severe COVID-19 patients. Shapley values were calculated to evaluate the contribution of haemoperfusion among other factors, such as side effects, medications, and individual characteristics, to COVID-19 patient outcomes. In addition, there is a significant difference between the two groups among the treatments and medications used remdesivir, adalimumab, tocilizumab, favipiravir, Interferon beta-1a, enoxaparin prophylaxis, enoxaparin full dose, heparin prophylaxis, and heparin full dose (P < 0.05). It seems that haemoperfusion has a positive impact on the reduction of inflammation markers and renal functional such as ferritin and creatinine, respectively, as well as d-dimer and WBC levels in the HP group were significantly lower than the control group. Conclusion: The findings indicated that haemoperfusion played a crucial role in predicting patient survival, making it a significant feature in classifying patients' prognoses. [ABSTRACT FROM AUTHOR]

Abstract Background Endotoxin adsorption is a promising but controversial therapy in severe, refractory septic shock and conflicting results exist on the effective capacity of available devices to reduce circulating endotoxin and inflammatory cytokine levels. Methods Multiarm, randomized, controlled trial in two Swiss intensive care units, with a 1:1:1 randomization of patients suffering severe, refractory septic shock with high levels of endotoxemia, defined as an endotoxin activity ≥ 0.6, a vasopressor dependency index ≥ 3, volume resuscitation of at least 30 ml/kg/24 h and at least single organ failure, to a haemoadsorption (Toraymyxin), an enhanced adsorption haemofiltration (oXiris) or a control intervention. Primary endpoint was the difference in endotoxin activity at 72-h post-intervention to baseline. In addition, inflammatory cytokine, vasopressor dependency index and SOFA-Score dynamics over the initial 72 h were assessed inter alia. Results In the 30, out of 437 screened, randomized patients (10 Standard of care, 10 oXiris, 10 Toraymyxin), endotoxin reduction at 72-h post-intervention-start did not differ among interventions (Standard of Care: 12 [1–42]%, oXiris: 21 [10–51]%, Toraymyxin: 23 [10–36]%, p = 0.82). Furthermore, no difference between groups could be observed neither for reduction of inflammatory cytokine levels (p = 0.58), nor for vasopressor weaning (p = 0.95) or reversal of organ injury (p = 0.22). Conclusions In a highly endotoxemic, severe, refractory septic shock population neither the Toraymyxin adsorber nor the oXiris membrane could show a reduction in circulating endotoxin or cytokine levels over standard of care. Trial registration ClinicalTrials.gov. NCT01948778. Registered August 30, 2013. https://clinicaltrials.gov/study/NCT01948778

Background: Endotoxin adsorption is a promising but controversial therapy in severe, refractory septic shock and conflicting results exist on the effective capacity of available devices to reduce circulating endotoxin and inflammatory cytokine levels. Methods: Multiarm, randomized, controlled trial in two Swiss intensive care units, with a 1:1:1 randomization of patients suffering severe, refractory septic shock with high levels of endotoxemia, defined as an endotoxin activity ≥ 0.6, a vasopressor dependency index ≥ 3, volume resuscitation of at least 30 ml/kg/24 h and at least single organ failure, to a haemoadsorption (Toraymyxin), an enhanced adsorption haemofiltration (oXiris) or a control intervention. Primary endpoint was the difference in endotoxin activity at 72-h post-intervention to baseline. In addition, inflammatory cytokine, vasopressor dependency index and SOFA-Score dynamics over the initial 72 h were assessed inter alia. Results: In the 30, out of 437 screened, randomized patients (10 Standard of care, 10 oXiris, 10 Toraymyxin), endotoxin reduction at 72-h post-intervention-start did not differ among interventions (Standard of Care: 12 [1–42]%, oXiris: 21 [10–51]%, Toraymyxin: 23 [10–36]%, p = 0.82). Furthermore, no difference between groups could be observed neither for reduction of inflammatory cytokine levels (p = 0.58), nor for vasopressor weaning (p = 0.95) or reversal of organ injury (p = 0.22). Conclusions: In a highly endotoxemic, severe, refractory septic shock population neither the Toraymyxin adsorber nor the oXiris membrane could show a reduction in circulating endotoxin or cytokine levels over standard of care. Trial registration ClinicalTrials.gov. NCT01948778. Registered August 30, 2013. https://clinicaltrials.gov/study/NCT01948778 [ABSTRACT FROM AUTHOR]

Introduction: Paraquat poisoning has the highest mortality rate, as high as, 50%-90% due to multiorgan failure, inspite of early interventions by symptomatic medications in the best intensive care settings.The high degree of acute inflammation was found in the subjects of paraquat poisoning with multiorgan failure. There are no specific antidotes at present for the paraquat poison. Aim: To know the role of corticosteroid as a life-saving drug in paraquat poisoning. Materials and Methods: This prospective cohort study was conducted in the Department of Internal Medicine at KR Hospital, Mysuru, Karnataka, India. The duration of the study was eight months, from August 2022 to March 2023. A total of 108 subjects suffering from paraquat poisoning and were divided into two arms, arm one constitutes 70 (64.8%) subjects, they were given 1 gm of methylprednisolone, intravenously for five days with haemoperfusion. The arm two constitutes 38 (35.2%) subjects, they were treated with symptomatic drugs with haemoperfusion. Both the groups were followed-up during the hospital stay, to look for the outcome. The Chi-square test was applied to assess the association between two variables. The data was analysed using Statistical Package for Social Sciences (SPSS) version 25.0 (IBM Chicago). Results: The present study was done on 108 subjects, 43 (39.81%) were females and 65 (60.18%) were males. The majority of subjects showed high level of acute inflammatory mediators with multiorgan dysfunction. The subjects on corticosteroids (i.v. methylprednisolone) with haemoperfusion showed low mortality 12 (17.14%) and high survival rate 58 (82.85%) (p-value=0.001) as compared to the subjects on symptomatic treatment with haemoperfusion, with mortality of 36 (94.73%) (p-value=0.01). Conclusion: The early administration of high doses of corticosteroids in subjects with paraquat poisoning had been shown to provide tangible and measurable mortality benefits as compared to the symptomatic medications.

Introduction: Paraquat poisoning has the highest mortality rate, as high as, 50%-90% due to multiorgan failure, inspite of early interventions by symptomatic medications in the best intensive care settings. The high degree of acute inflammation was found in the subjects of paraquat poisoning with multiorgan failure. There are no specific antidotes at present for the paraquat poison. Aim: To know the role of corticosteroid as a life-saving drug in paraquat poisoning. Materials and Methods: This prospective cohort study was conducted in the Department of Internal Medicine at KR Hospital, Mysuru, Karnataka, India. The duration of the study was eight months, from August 2022 to March 2023. A total of 108 subjects suffering from paraquat poisoning and were divided into two arms, arm one constitutes 70 (64.8%) subjects, they were given 1 gm of methylprednisolone, intravenously for five days with haemoperfusion. The arm two constitutes 38 (35.2%) subjects, they were treated with symptomatic drugs with haemoperfusion. Both the groups were followed-up during the hospital stay, to look for the outcome. The Chi-square test was applied to assess the association between two variables. The data was analysed using Statistical Package for Social Sciences (SPSS) version 25.0 (IBM Chicago). Results: The present study was done on 108 subjects, 43 (39.81%) were females and 65 (60.18%) were males. The majority of subjects showed high level of acute inflammatory mediators with multiorgan dysfunction. The subjects on corticosteroids (i.v. methylprednisolone) with haemoperfusion showed low mortality 12 (17.14%) and high survival rate 58 (82.85%) (p-value=0.001) as compared to the subjects on symptomatic treatment with haemoperfusion, with mortality of 36 (94.73%) (p-value=0.01). Conclusion: The early administration of high doses of corticosteroids in subjects with paraquat poisoning had been shown to provide tangible and measurable mortality benefits as compared to the symptomatic medications. [ABSTRACT FROM AUTHOR]

Abstract Background This study investigated the efficacy of the integrated blood purification mode of early haemoperfusion (HP) combined with continuous venovenous haemodiafiltration (CVVHDF) in children with severe viral encephalitis, and evaluated the correlation of cerebrospinal fluid (CSF) neopterin (NPT) levels with prognosis. Methods The records of children with viral encephalitis who received blood purification treatment in the authors’ hospital from September 2019 to February 2022 were retrospectively analysed. According to the blood purification treatment mode, they were divided into the experimental group (HP + CVVHDF, 18 cases), control group A (CVVHDF only, 14 cases), and control group B (16 children with mild viral encephalitis who did not receive blood purification treatment). The correlation between the clinical features, severity of the disease and the extent of lesions on brain magnetic resonance imaging (MRI) and the CSF NPT levels was analysed. Results The experimental group and control group A were comparable with respect to age, gender and hospital course (P > 0.05). There was no significant difference in speech and swallowing functions between the two groups after treatment (P > 0.05) and no significant difference in 7 and 14-day mortality (P > 0.05). The CSF NPT levels in the experimental group before treatment were significantly higher compared with control group B (P

Background: This study investigated the efficacy of the integrated blood purification mode of early haemoperfusion (HP) combined with continuous venovenous haemodiafiltration (CVVHDF) in children with severe viral encephalitis, and evaluated the correlation of cerebrospinal fluid (CSF) neopterin (NPT) levels with prognosis. Methods: The records of children with viral encephalitis who received blood purification treatment in the authors' hospital from September 2019 to February 2022 were retrospectively analysed. According to the blood purification treatment mode, they were divided into the experimental group (HP + CVVHDF, 18 cases), control group A (CVVHDF only, 14 cases), and control group B (16 children with mild viral encephalitis who did not receive blood purification treatment). The correlation between the clinical features, severity of the disease and the extent of lesions on brain magnetic resonance imaging (MRI) and the CSF NPT levels was analysed. Results: The experimental group and control group A were comparable with respect to age, gender and hospital course (P > 0.05). There was no significant difference in speech and swallowing functions between the two groups after treatment (P > 0.05) and no significant difference in 7 and 14-day mortality (P > 0.05). The CSF NPT levels in the experimental group before treatment were significantly higher compared with control group B (P < 0.05). The extent of brain MRI lesions correlated positively with CSF NPT levels (P < 0.05). In the experimental group (14 cases), the serum NPT levels decreased after treatment, whereas the CSF NPT levels increased after treatment, and the differences were statistically significant (P < 0.05). Dysphagia and motor dysfunction correlated positively with CSF NPT levels (P < 0.05). Conclusion: Early HP combined with CVVHDF in the treatment of severe viral encephalitis in children may be a better approach than CVVHDF only for improving prognosis. Higher CSF NPT levels indicated the likelihood of a more severe brain injury and a greater possibility of residual neurological dysfunction. [ABSTRACT FROM AUTHOR]

It remains a formidable challenge to construct high-performance haemoperfusion adsorbents with fast adsorption kinetic and high adsorption capacity for efficiently removing bilirubin from human blood. In this work, we report a facile yet efficient strategy to manufacture lysine-modified macroporous cellulose/carbon nanotube microspheres (LMCMs) by surfactant micelles swelling strategy followed by modification with lysine. The macroporous structure not only provides wide channels for fast mass transfer, but also shortens the diffusion path into meso/micropores, increasing the accessibility of mesopores and micropores. Experimental results reveal that LMCMs can remove bilirubin with fast adsorption kinetic (> 90% of its equilibrium uptake within 2 h) and high adsorption capacity of 338.14 mg/g. More importantly, the adsorbent can remove about 79% of bilirubin in rabbit serum, and the bilirubin concentration in rabbit serum decreases from 213.36 to 45.78 mg/L within 2 h, indicating a very appealing application prospect. [ABSTRACT FROM AUTHOR]

Abstract Although improving, the mortality from septic shock still remains high despite increased international awareness. As a consequence, much effort has focused on alternative treatment strategies in an effort to improve outcomes. The application of blood purification therapies to improve immune homeostasis has been suggested as one such method, but these approaches, such as high-volume continuous haemofiltration or cytokine and/or endotoxin removal, have enjoyed little success to date. More recently, the use of sorbent technologies has attracted much attention. These adsorbers are highly effective at removing inflammatory mediators, in particular, cytokines, from the bloodstream. This narrative review is the executive summary of meetings held throughout the 6th International Fluid Academy Days in Antwerp, Belgium (Nov 23–25, 2017), focusing on the current understanding regarding the use of such adsorbers in humans with septic shock. We followed a modified Delphi approach involving a combination of evidence appraisal together with expert opinion in order to achieve recommendations for practice and, importantly, future research.

Abstract Cytokine release syndrome (CRS) is known to be associated with severe coronavirus disease 2019 (COVID‐19). Multiple anti‐inflammatory therapies such as tocilizumab, corticosteroids, intravenous immunoglobulin (IVIG), and haemoadsorption or haemoperfusion have been used to combat this life‐threatening condition. However, immunocompromised hosts are often omitted from research studies, and knowledge on the clinical efficacy of these therapies in immunocompromised patients is therefore limited. We report two cases of immunocompromised patients with severe COVID‐19‐related CRS requiring mechanical ventilation who were treated with multimodality treatment consisting of tocilizumab, IVIG, and haemoperfusion. Within 48 h, both patients showed clinical improvement with PaO2:FiO2 ratio and haemodynamic stability. Both survived to discharge. There were no adverse events following these therapies. In conclusion, combined therapeutic modalities, possibly tailored to individual inflammatory profiles, are promising treatment for severe COVID‐19 infection in the immunocompromised host. Timely administration of adjunctive therapies that alleviate overwhelming inflammation may provide the best outcome.

Cytokine release syndrome (CRS) is known to be associated with severe coronavirus disease 2019 (COVID‐19). Multiple anti‐inflammatory therapies such as tocilizumab, corticosteroids, intravenous immunoglobulin (IVIG), and haemoadsorption or haemoperfusion have been used to combat this life‐threatening condition. However, immunocompromised hosts are often omitted from research studies, and knowledge on the clinical efficacy of these therapies in immunocompromised patients is therefore limited. We report two cases of immunocompromised patients with severe COVID‐19‐related CRS requiring mechanical ventilation who were treated with multimodality treatment consisting of tocilizumab, IVIG, and haemoperfusion. Within 48 h, both patients showed clinical improvement with PaO2:FiO2 ratio and haemodynamic stability. Both survived to discharge. There were no adverse events following these therapies. In conclusion, combined therapeutic modalities, possibly tailored to individual inflammatory profiles, are promising treatment for severe COVID‐19 infection in the immunocompromised host. Timely administration of adjunctive therapies that alleviate overwhelming inflammation may provide the best outcome. [ABSTRACT FROM AUTHOR]

Mortality and morbidity rates among critically ill septic patients having acute kidney injury (AKI) are very high, considering the total number of deaths after their admission. Inappropriate selection of the type of continuous renal replacement therapy and inadequate therapy become the immediate causes of these issues. Dialysis is a commonly used treatment intended to prolong the life of AKI patients. Dialysis membranes, which are the core of dialysis treatment, must be properly selected to ensure fair treatment to the patients. The accumulation of certain types of molecules must be dealt with using the right membrane. Whether it is low-flux, high-flux, or adsorptive type, the dialysis membrane should be chosen depending on the condition of the patients. The selection of dialysis membranes should also be based on their effect on the treatment outcomes and well-being. All these options are needed to serve the patients of different clinical settings. The use of dialysis membranes is not restricted to conventional haemodialysis, but rather they can be employed in haemoperfusion, haemofiltration, haemodiafiltration, or a combination of any two of them. This review focuses in-depth on different types of dialysis membranes, their characteristics, and approaches in addressing the issues encountered in patients having AKI with sepsis and/or multiorgan failure in intensive care units.

Rapid reduction of plasma triglycerides (TG) is believed to improve the outcome of pancreatitis in the context of hypertriglyceridaemia (HTG)-induced acute pancreatitis (HTG-AP). Previous studies have suggested that haemoperfusion (HP) with the Jafron cartridge series could be effective for reducing TG concentrations in patients with HTG-AP. However, the clearance capacity (CC) for TG removal has not been reported. This case series reports on data from three patients with HTG-AP who underwent HP with HA230 or HA330 cartridges. Blood samples were collected from both before and after the cartridge circuit every 30 min and the CC was calculated. Twelve pairs of blood samples were collected for each type of HP cartridge. The mean ± SD CC of the HA230 cartridge for TG removal in this case series was 0.009781 ± 1.117235 ml/min (95% confidence interval [CI], -0.7000762, 0.7196384 ml). The mean ± SD CC of the HA330 cartridge for TG removal in this case series was 0.344914 ± 1.412183 ml/min (95% CI, -0.5523448, 1.2421721 ml). Based on the findings of this small case series, special caution is advised when considering the use of the HA230 and HA330 cartridges for reducing blood TG concentration pending further conclusive evidence from larger studies., Competing Interests: Declaration of conflicting interestThe authors declare that there are no conflicts of interest.

Acute paraquat poisoning (APP) is a serious public health problem with a high mortali- ty rate and there is no specific antidote for APP in clinical. Early haemoperfusion (HP) treatment is effective in APP rescue. In this study, we compared the influence of routine HP and continuous HP on the survival rate and the treatment of pulmonary fibrosis in mild and moderate APP patients. Eighty-two cases of mild and moderate APP patients who were admitted to our hospital from January of 2017 to December of 2018 were selected. All patients were randomly divided into a routine haemoperfusion (HP) group (n = 40) and a continuous haemoperfusion (CHP) group (n = 42). Compared with the HP group, the 28-day survival rate of mild and moderate APP patients was elevated in the CHP group. Blood N-terminal procollagen Ш propeptide (PIIINP) levels in APP patients were positively related with paraquat (PQ) concentration (r = 0.309, P = 0.000). There were statistically significant differences in the levels of PIIINP, Collage TypeIV (CIV), transforming growth factor-beta 1 (TGF-β1), malondialdehyde (MDA), superoxide dismutase (SOD) activity and sequential organ failure assessment (SOFA) score between the two groups both on the third and seventh days after treatment, and the treatment effect of the CHP group on pulmonary fibrosis in APP patients was better than that of the HP group. In conclusion, CHP treatment had a significant therapeutic effect on mild and moderate APP patients, which could effectively improve the survival rate and relieve pulmonary fibrosis. [ABSTRACT FROM AUTHOR]

Background: Recent innovations in biomaterials technology have led to the development of innovative sorbents adopted as adsorbing devices in the field of extracorporeal blood purification therapies. As removal mechanism, adsorption allows to remove specific molecules, selectively binding them to sorbent materials. In addition to the material properties, a quintessential aspect influencing device properties is blood flow distribution within the sorbent particles. Objectives: In order to adequately characterize the potential adsorbing properties for an effective blood purification therapy, an in vitro study assessing the fluid dynamics inside 3 new cartridges, HA130, HA230 and HA330 (Jafron, Zhuhai City, -China) was conducted through CT imaging technique. -Methods: The cartridges were placed in vertical position in the CT -gantry. Dye solution was circulated through the cartridges at 250 mL/min, longitudinal sections, 0.5 cm thick, were recorded for 60 s. Furthermore, an in vitro test was conducted to build pressure drop profiles. Blood was circulated at a different flow rate, 100–400 mL/min, step 50 mL/min. Pre and post cartridges pressures were acquired and pressure drop calculated. Results: Sequential images demonstrated an excellent distribution of the flow inside the cartridges. Average flow velocity was 0.37 cm/s for the 3 cartridges. HA130 had a homogeneous flow profile along the entire length of the device; HA230 and HA330 showed minimal differences between central and peripheral regions. Pressure drop profiles resulted linear, increasing proportionally with blood flow rate and packing density. Conclusions: We may conclude that the structural and functional design of the studied cartridges is adequate for haemoperfusion with no channelling phenomena. This ensures maximum and optimal utilization of the sorbent contained in the devices. [ABSTRACT FROM AUTHOR]

Haemodialysis (HD) patients present more morbidity and mortality risk in coronavirus disease 2019 (COVID-19). In patients who may develop severe symptoms, the process called 'viral sepsis' seems to be a crucial mechanism. In those cases, the HD procedure provides an excellent tool to explore the benefit of some extracorporeal therapies. We reported the outcome of four HD patients with severe COVID-19 treated with Seraph®100 haemoperfusion (HP) device. Three of the four cases presented a good clinical response after HP. In conclusion, the treatment with Seraph®100 device may be a simultaneous treatment to improve HD patients with severe acute respiratory syndrome coronavirus 2. [ABSTRACT FROM AUTHOR]

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The review is devoted to analysis of the use of carbon sorbents for medicinal purposes in China and description of some innovative technologies in this field in Ukraine. The review underlines the presence of common roots of sorption therapy development in these two countries determined by pioneer works of Prof. T.M.S. Chang, created to the concept of artificial cells. High level of works of Chinese scientists on sorption purification of blood and combined extracorporeal methods has been mentioned. At the same time, by author's opinion, two other methods of sorption therapy, namely enterosorption and sorption therapy of wounds and burns, has not been properly developed in China. In the review, there are also described the essential results of Ukrainian scientists in the field of blood purification from protein-bound toxins and other harmful compounds what is important for treatment of many serious human pathologies, and also the important data on the use of oral sorbents and dressings from activated carbon materials, which could be considered as a useful addition to achievements of Chinese scientists in the field of the development and use of sorbents for medicinal purposes. [ABSTRACT FROM AUTHOR]

Abstract: A novel composite-derived activated carbon spheres, i.e., carbon nanotubes/phenolic-resin-derived activated carbon spheres (CNTs/P-ACSs) were prepared by carbonizing and activating spheres of CNTs/phenolic-resin. The activated carbon spheres produced have excellent mechanical strength, high-mesoporous volume and efficient adsorption to middle molecular weight toxins. The breakage force and adsorption capacity of 30% CNTs doped composite spheres are both several times of that of P-ACSs and commercial macroporous resin, showing great potential to be efficient haemoadsorbent for the removal of middle molecular weight toxins in haemoperfusion. [Copyright &y& Elsevier]

Background and objective: Acute exacerbations of interstitial pneumonias (IP) can occasionally occur, and have an extremely poor prognosis. Recently, direct haemoperfusion with a polymyxin B immobilized fibre column (PMX-DHP) was shown to have a beneficial effect in acute exacerbations of IPF. However, little is known about the efficacy of PMX-DHP in acute exacerbations of other IP. This study investigated the effectiveness and safety of PMX-DHP in acute exacerbations of IP. Methods: The study subjects consisted of five patients with an acute exacerbation of IP, including three with IPF, one with idiopathic interstitial pneumonia (IIP) with atypical radiological findings of IPF, and one with myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-related IP. The patients were treated with two courses of 3–12 h each of PMX-DHP, concurrently with corticosteroids alone or plus cyclophosphamide. Results: After two courses of PMX-DHP, the PaO2/fraction of inspired oxygen (FiO2) (P/F) ratio increased rapidly from an average of 93 to 260 mm Hg, and there was radiological improvement in all patients. However, one patient treated for 3 h each time eventually died of respiratory failure, and two patients treated for 6 h each time died from respiratory infections. The other two patients were treated for 12 h each time, and the therapeutic effects lasted longer, with both surviving longer than 48 days. No adverse effects were detected apart from thrombocytopaenia. Conclusion: PMX-DHP therapy was safe and effective in improving oxygenation in acute exacerbations of IPs, either with corticosteroids alone or plus cyclophosphamide, and may be beneficial for the treatment of this condition. [ABSTRACT FROM AUTHOR]

Abstract: The adsorption properties of two representative uraemic toxins (i.e., creatinine and vitamin B12) on CNTs were studied compared with two commercial haemoadsorbents (i.e., activated carbon and macroporous resin). Results show that it takes only 15 and 10min for CR and VB12 to achieve the adsorption equilibrium on CNTs. The adsorption amount of VB12 on CNTs reaches 47.18mg/g, which is 5.5 and 10.8 times of that of macroporous resin and activated carbon, respectively. Pore structure analyses indicate that the high adsorption efficiency should be attributed to the higher ratio of mesopores and macropores and the higher pore volume of CNTs. All of the results imply the great potential applications of CNTs in haemoperfusion. [Copyright &y& Elsevier]

Although there have been descriptive, uncontrolled clinical reports of removal of tablet debris by gastric lavage, there have been no clinical studies that have demonstrated that this has any impact on outcome in patients with tricyclic antidepressant (TCA) poisoning. There is also the possibility that lavage may increase drug absorption by pushing tablets into the small intestine. Furthermore, gastric lavage in patients with TCA poisoning may induce hypoxia and a tachycardia potentially increasing the risk of severe complications such as arrhythmias and convulsions. In view of the paucity of evidence that gastric lavage removes a significant amount of drug and the risk of complications associated with the procedure, the routine use of gastric lavage in the management of patients with TCA poisoning is not appropriate. Volunteer studies have shown generally that activated charcoal is more likely to reduce drug absorption if it is administered within 1 hour of drug ingestion. In the one volunteer study that looked at later administration of activated charcoal, there was a 37% decrease in plasma concentration associated with administration of activated charcoal at 2 hours post-ingestion. There have been no clinical studies that enable an estimate of the effect of activated charcoal administration on outcome in the management of patients with TCA poisoning. Volunteer studies have shown that multiple-dose activated charcoal increases the elimination of therapeutic doses of amitriptyline and nortriptyline, but not of doxepin or imipramine; however, these studies cannot be directly extrapolated to the management of patients with TCA poisoning. There have been no well designed controlled studies that have assessed the impact of multiple-dose activated charcoal in the management of patients with TCA poisoning. Because of the large volume of distribution of TCAs, it would not be expected that their elimination would be significantly increased by multiple-dose activated charcoal. Haemoperfusion, haemodialysis and the combination of these procedures do not result in significant removal of TCAs and are not recommended in the management of patients with TCA poisoning. [ABSTRACT FROM AUTHOR]

This study was to observe the paraquat (PQ) reduction rate after haemoperfusion (HP) on the groups of a relatively large number: 50 survivors out of 105 patients with acute PQ poisoning. We started off by measuring the clearance of haemodialysis (HD) and HP for the PQ in vitro. At the blood flow of 250 mL/min, the PQ clearance was greater in HP than in HD during the first 90 minutes: 215 versus 175 mL/min at 30 minutes, 213 versus 201 mL/min at 60 minutes, and 199 versus 179 mL/min at 90 minutes. The clearance in HP decreased rapidly after two hours. By the end of the dialysis, however, the final concentration in container decreased to 5.7 μg/mL in HD and 1.5 μg/mL in HP, which implied that although HD was cleared more effectively during the later stages, the overall elimination was greater in HP. Following this preliminary investigation, we performed HP on all the patients in order to assess the extracorporeal elimination. One hundred and five patients who had swallowed one to three mouthfuls of PQ (24.5% w/v) solution were subjected to the in vivo study. The reduction rate of PQ was checked out by measuring the PQ concentration in plasma before and after four hours of HP. Seeing the reduction rate was significantly higher in the survivors group than in the nonsurvivors group (80.3 ± 19.9 versus 67.2 ± 19.2%, P <0.01), we concluded that adequate HP appears to be an indispensable treatment for patients with acute PQ poisoning. [ABSTRACT FROM AUTHOR]

Mortality and morbidity rates among critically ill septic patients having acute kidney injury (AKI) are very high, considering the total number of deaths after their admission. Inappropriate selection of the type of continuous renal replacement therapy and inadequate therapy become the immediate causes of these issues. Dialysis is a commonly used treatment intended to prolong the life of AKI patients. Dialysis membranes, which are the core of dialysis treatment, must be properly selected to ensure fair treatment to the patients. The accumulation of certain types of molecules must be dealt with using the right membrane. Whether it is low-flux, high-flux, or adsorptive type, the dialysis membrane should be chosen depending on the condition of the patients. The selection of dialysis membranes should also be based on their effect on the treatment outcomes and well-being. All these options are needed to serve the patients of different clinical settings. The use of dialysis membranes is not restricted to conventional haemodialysis, but rather they can be employed in haemoperfusion, haemofiltration, haemodiafiltration, or a combination of any two of them. This review focuses in-depth on different types of dialysis membranes, their characteristics, and approaches in addressing the issues encountered in patients having AKI with sepsis and/or multiorgan failure in intensive care units.

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Copyright of Klinische Wochenschrift is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Six patients were admitted after erroneous massive intake of levothyroxine (70-1200 mg over an interval of 2-12 days). All patients developed classical symptoms of thyrotoxicosis within 3 days of the first dose; five patients presented grade II-III coma and one became stuporous (days 7-10). Two patients developed left ventricular failure and three had arrhythmias (days 8-11). Total thyroid hormone levels in serum on admission ranged 935-7728 nmol/l for T4 (TT4) and 23-399 nmol/l for T3 (TT3). All patients received treatment with hydrocortisone and Propranolol. Propylthiouracil was also given in 3 cases. Extractive techniques (charcoal haemoperfusion and/or plasmapheresis) were initiated 8-14 days after the first dose of L-T4. The plasma disappearance rate (K) of TT4 with plasmapheresis was 30 times higher, on average, than under standard medical treatment (M). Also, K of TT4 under haemoperfusion was about five times higher than K under M. K changes for TT3 were higher under haemoperfusion than under plasmapheresis. Furthermore, extractive procedures shortened the average half life of TT4, (from 106.5 +/- 44.6 to 59.7 +/- 20.2 h, p less than 0.05). [ABSTRACT FROM AUTHOR]

The in vitro measurement of adsorption isotherms and intraparticle diffusivities for three types of activated carbon and four exogenous and endogenous toxins is described. Complications due to the chemical breakdown of creatinine and paracetamol in the presence of activated carbon are discussed. Three methods are compared for the estimation of intraparticle diffusivity from the kinetic data. The simplest method is also used to reinterpret literature data comparing diffusivity values using plasma or HSA solution as opposed to buffer as the solvent. The adsorption isotherms and intraparticle diffusivities comprise the fundamental data used to validate the mass transfer model of a haemoperfusion column developed in Part 2. [ABSTRACT FROM AUTHOR]

The relative influences of the normalised adsorption, mass transfer and hydrodynamic parameters on the performance of haemoperfusion columns are quantified using a lumped parameter, mass transfer model, validated in vitro. The effects of patient pharmacokinetics and protein binding are then investigated using the model. In addition, the solution of the distributed parameter model of an adsorber column, at small times, is used to emphasise the role of the external diffusion resistance in determining column performance for both free and protein bound toxins. This rationale facilitates a logical comparison between haemoperfusion and haemodialysis on the basis of the controlling mass transfer mechanisms in each technique. [ABSTRACT FROM AUTHOR]

To evaluate the influence of haemoperfusion on haemodynamics, complement system, leucocyte and thrombocyte concentration, a controlled study was performed in three groups of five dogs each. During the first 30 min of haemoperfusion with columns containing cellulose-coated activated charcoal, a significant decrease of mean aortic pressure, cardiac output and stroke volume was observed, while heart rate and total systemic resistance decreased. A comparable phenomenon, although to a much lesser extent, was observed during perfusion using columns containing polystyrene resin. Perfusion with columns containing cellulose-coated activated charcoal caused a significant decrease in total haemolytic complement, indicating activation of the complement system. A significant decrease in the leucocyte and thrombocyte concentration due to sequestration of granulocytes and thrombocytes in the columns was observed during the first 30 min of perfusion in both groups. Pulmonary leucostasis, without decrease of arterial oxygen tension, occurred during perfusion with columns containing cellulose-coated activated charcoal. Both the simultaneous occurrence and the transient character of the haemodynamic changes, complement activation and sequestration of granulocytes and thrombocytes in the perfusion column suggest a relationship between these various changes. The results stress the importance of close monitoring of the haemodynamic parameters of the intoxicated patient, particularly during the early phase of haemoperfusion. [ABSTRACT FROM AUTHOR]

The efficacy of intermittent charcoal haemoperfusion in combination with forced diuresis and Prussian Blue therapy was evaluated in three cases of thallium poisoning. At a blood flow of 300 ml/min the average blood clearance values obtained with haemoperfusion were 72 ± 11 ml/min (mean±SD) at a starting blood concentration above 2 mg/l and 120 ± 23 ml/min (mean ± SD) below this blood level. As a result of the combined intensive treatment, the thallium half-lives in blood observed during the period monitored were only 25-41 h. Removal of thallium by haemoperfusion is faster per unit of time than simultaneous excretion by forced diuresis. When forced diuresis was combined with intermittent (4-20 h intervals) haemoperfusion therapy, the total elimination by each technique was about equivalent over the period of combined treatment. Saturation of the Adsorba 300 C columns occurred during treatment. As a result, the clearance obtained did decrease to half the initial value in 2-3 h. As this decrease in efficacy is related to the blood concentration, haemoperfusion is more efficient at lower blood concentrations. This is in contradistinction to forced diuresis, of which the excretion is proportional to the blood concentration. [ABSTRACT FROM AUTHOR]

The influence of haemoperfusion on some immunological parameters was investigated in a pilot study involving two groups of three patients each. In columns containing cellulose-coated activated charcoal or polystyrene resin a temporary reduction of the total white cell number, particularly involving the segmented and band neutrophils, was demonstrated. Cellulose-coated activated charcoal and, to a lesser extent, polystyrene resin induced activation of the complement system using C3d as a parameter. An appreciable decrease of immunoglobulin or complement levels could not be demonstrated in either column. [ABSTRACT FROM AUTHOR]

Five patients who were severely poisoned with hypnotic drugs, paracetamol, or theophylline were treated by charcoal haemoperfusion. The device contained 160 g of activated carbon beads with a polyester coating. Four patients made a significant improvement; one subsequently died from a cerebral haemorrhage which had occurred prior to haemoperfusion. Platelet losses were minimal and no fibrinolysis was observed. No significant biochemical abnormality occurred as a result of haemoperfusion, although one patient, who presented with hypocalcaemia, required intravenous calcium throughout the procedure. [ABSTRACT FROM AUTHOR]

The influence of haemoperfusion on blood-coagulation and cellular constituents of the blood was studied in three groups of patients. In four patients haemoperfusion was performed using a column containing acrylic-hydrogel coated activated charcoal (Haemocol), in five patients with a column containing uncoated XAD-4 nonionic polystyrene resin (Amberlite) and in five patients with a column containing cellulose coated activated charcoal (Gambro Adsorba 300 C). Perfusion was performed during 4 h with a flow of 300 ml/min. Before the start, 2 h after the start, at the end and 2 h after the end of the perfusion the haemoglobin concentration, haematocrit, leucocyte number, differential white cell count, thrombocyte number and heparin concentration were measured. Before the start and 2 h after the end prothrombin time, thrombin time, partial thromboplastin time, reptilase time, fibrinogen, prothrombin, factors V, VII, X, antithrombin III, bleeding time (Ivy), ethanol gelation test, fibrin split products and plasminogen were measured. The following conclusions can be drawn: haemoperfusion per se causes haemodilution; polystyrene resin causes in some patients a temporary reduction of the leucocyte number during haemoperfusion; polystyrene resin causes a significant reduction of thrombocyte number compared to coated activated charcoal; polystyrene resin and to a lesser extent acrylic-hydrogel-coated activated charcoal causes in some patients a prolongation of bleeding time probably by inducing alteration of thrombocyte function caused by release; polystyrene resin and probably also acrylic-hydrogel-coated activated charcoal causes an increased fibrinolytic activity without signs of disseminated intravascular coagulation. [ABSTRACT FROM AUTHOR]

Fifteen patients who were severely poisoned with either hypnotic drugs or salicylate were treated by charcoal haemoperfusion. The device contained 100 g of activated charcoal immobilised by fixation to a polyester film. Two patients showed no response and eventually died. The remainder showed marked lightening of coma and recovered uneventfully. Complications of platelet loss and, in one patient, fibrinolysis were observed, but these had no serious consequences. No significant biochemical disturbances occurred with the exception of one patient who presented with hypocalcaemia and required intravenous calcium throughout the treatment. Drug clearance values were comparable with those obtained with columns containing 300 g of acrylic polymer coated charcoal. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Toxicology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Toxicology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Toxicology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archiv für Toxikologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)