Microplastic fibers influence Ag toxicity and bioaccumulation in Eisenia andrei but not in Enchytraeus crypticus.

Microplastic fibers (MF) are released from synthetic textiles during washing and end up in the wastewater. Similarly, silver nanoparticles (AgNP), incorporated in textiles as antimicrobial agents, are released in washing machines, also reaching the wastewater treatment plants. Therefore, both MF and AgNP co-exist in the environment and enter the soil compartment mainly via the application of biosolids. Yet, the combined effect of MF and AgNP has not been studied. Here, we assessed the effects of polyester MF on the toxicity of AgNP and AgNO3 to the earthworm Eisenia andrei and the enchytraeid Enchytraeus crypticus. The organisms were exposed to a range of concentration of AgNP (32, 100, 320, 1000, 3200 mg Ag/kg) and AgNO3 (12.8, 32, 80, 200, 500 mg Ag/kg) in LUFA 2.2 soil in the absence or presence of MF (0.01% DW). Reproduction tests were conducted and the toxicity outcomes compared between soils with and without MF. The exposure to MF caused a decrease in the number of juveniles and changed the biochemical composition of earthworms. Moreover, the presence of MF increased the toxicity of AgNP to earthworm reproduction (EC50 = 165 mg Ag/kg) when compared to AgNP exposure alone (EC50 = 450 mg Ag/kg), but did not alter the toxicity of AgNO3 (EC50 = 40 mg Ag/kg). For enchytraeids, no significant difference in Ag toxicity could be detected when MF was added to the soil for both AgNP and AgNO3. Overall, Ag bioaccumulation was not affected by MF, except for a decrease in earthworm body concentration at the highest Ag soil concentration (3200 mg Ag/kg). Our results suggest that the presence of MF in the soil compartment may be a cause of concern, and that the joint exposure to Ag may be deleterious depending on the Ag form, organism, and endpoint. The present work provides the first evidence that a realistic MF concentration in soil lowers AgNP concentration necessary to provoke reproductive impairment in earthworms. The influence of MF on the risk assessment of AgNP should be considered.

3D-Printed Magnetic Stirring Cages for Semidispersive Extraction of Bisphenols from Water Using Polymer Micro- and Nanofibers.

A magnetic stirring device allowing semidispersive solid phase extraction of eight bisphenols (A, AF, AP, C, BP, G, M, and Z) from river waters using polymer nano- and microfibers followed by HPLC with spectrophotometric detection has been developed and applied. About 50 mg of fibers was placed in a round, cage-like housing consisting of two identical 3D printed pieces that were locked together by a magnetic stirring bar. Magnetic stirring action of the cage devices enabled highly efficient interaction of the fibers housed inside with the aqueous samples and analyte transfer without risking fiber compaction and/or damaging. Polypropylene was found to be the best-suited filament material for the cage 3D printing, and polycaprolactone fibers appeared the most efficient sorbent out of eight tested polymers. Experimental design revealed that analytes extraction from 100 mL aqueous samples was completed within 50 min and stripping in methanol required less than 35 min. Cage housing enabled simple and robust handling of the fibrous sorbent that could be used repeatedly up to at least 5 times. Procedural repeatability was less than 5% RSD, and limits of detection and quantitation were 0.1-2.1 and 0.4-7.0 µg L-1, respectively. Analyte recoveries at 50 µg L-1 level ranged from 87.1% to 106.5% in the analysis of two spiked river and two lake waters.

Poly-ε-caprolactone Nanofibrous Polymers: A Simple Alternative to Restricted Access Media for Extraction of Small Molecules from Biological Matrixes.

Poly-ε-caprolactone nanofibrous polymer has been used as an alternative to restricted access media for extraction of protein-containing biological samples and direct transfer in the chromatographic system. Three commercial cartridges differing in length and internal diameter have been manually packed with the composite material prepared from poly-ε-caprolactone nanofibers coated on poly-ε-caprolactone microfibrous scaffold and connected to the column-switching chromatographic system. Bovine milk and human serum (25 µL) spiked with a mixture of methyl-, ethyl-, propyl-, and butylparaben in a concentration range of 1-100 µg mL-1 were online extracted using the cartridge-containing fibers. Then, 5 and 20% (v/v) aqueous methanol was applied as the washing mobile phase. While the ballast protein macromolecules were quantitatively eluted from the nano/microfibrous composite sorbent, the parabens were retained. After the mobile phase was switched to a stronger one, these compounds were then eluted from the extraction sorbent, directed in the analytical column, and finally separated. An extraction efficiency of 86-101% for all parabens achieved using the optimum-sized cartridge and a repeatability of the extraction procedure of 0.06-1.95% RSD were obtained.

[Antibiotic-induced organ dysfunction in intensive care patients].

The aim of this review is to point out the dark side of antibiotic treatment in critically ill patients. Although antibiotics are crucial for survival of patients with infection, the risk of organ dysfunction potentiated by them cannot be overlooked. Antibiotic classes and their influence on organ dysfunction and the development of bacterial resistance are discussed in the text. The risk of mitochondrial dysfunction is mentioned as well.

Polycaprolactone nanofibers functionalized with a dopamine coating for on-line solid phase extraction of bisphenols, betablockers, nonsteroidal drugs, and phenolic acids.

Polycaprolactone composite nanofibers coated with a polydopamine layer are introduced as a new type of absorption material for on-line solid phase extraction (SPE) in chromatographic system. A hybrid technology combining the electrospinning and melt blowing was used for the preparation of 3D-structured microfiber/nanofibrous polycaprolactone composite. The dopamine coating was then applied to functionalize the micro/nanofibers. Polydopamine-coated polycaprolactone fibers were tested as an extraction phase in on-line SPE prior to HPLC separation and UV detection. Four groups of biologically active substances including bisphenols (Bisphenol S, Bisphenol AF, Bisphenol A, Bisphenol C, Bisphenol AP, Bisphenol Z, Bisphenol BP, and Bisphenol M), betablockers (Timolol, Metoprolol, Labetalol, and Propranolol), nonsteroidal antiphlogistic drugs (Salicylic acid, Ketoprofen, Naproxen, Indomethacin, Diclofenac, Ibuprophen, and Meclofenamic acid), and phenolic acids (Chlorogenic acid, Caffeic acid, Sinapic acid, m-Coumaric acid, Benzoic acid, and Cinnamic acid) were used as the model analytes. Neat and coated fibers were compared and applied as sorbents for the on-line extraction set-up. Both materials produced good extraction potential for the determination of bisphenols and nonsteroidal drugs in model biological and environmental samples including river water, human urine, and blood serum. However, the polydopamine layer significantly increased the extraction efficiency of polar drugs. Typical repeatability of on-line extraction procedure on polydopamine coated fibers was in the range 0.12-4.11% for bisphenols, 0.55-1.41% for antiphlogistic drugs, 0.59-2.52% for phenolic acids, and 1.01-1.65% for betablockers. Graphical abstract Schematic representation of polycaprolactone composite nanofibers coated with a polydopamine layer as an advanced absorption material for on-line solid phase extraction in chromatography.

Molecular differences in susceptibility of the kidney to sepsis-induced kidney injury.

BACKGROUND: Septic acute kidney injury affects 40-50% of all septic patients. Molecular differences between septic patients with and without acute kidney injury (AKI) are only poorly understood. Here, we investigated gene expression changes that differentiated the subjects who developed septic AKI from those who did not and coupled this approach with traditional parameters of renal physiology. METHODS: In 15 anesthetized, mechanically ventilated and instrumented pigs, progressive sepsis was induced either by peritonitis or by continuous intravenous infusion of Pseudomonas aeruginosa. Animals received standard intensive care including goal-directed hemodynamic management. Analyses were performed on kidneys from sham operated animals, septic pigs without AKI, and pigs with septic AKI. Before, and at 12, 18 and 22 h of progressive sepsis, systemic and renal hemodynamics, cortex microcirculation and plasma IL-6 and TNF-α were measured. At 22 h whole kidney expression of pre-selected genes was analyzed by quantitative Real Time PCR. RESULTS: Animals with septic AKI had systemic hemodynamic phenotype (normo- or hyperdynamic) comparable with non-AKI subjects, but demonstrated higher plasma levels of cytokines, an increase in renal vascular resistance and early fall in cortical microcirculatory blood flow. The genes whose expression discriminated septic AKI from non-AKI included Toll like receptor 4 (up-regulated 2.7-fold, P = 0.04); Cyclooxygenase-2 (up-regulated 14.6-fold, P = 0.01), Angiotensin II Receptor (up-regulated 8.1-fold, P = 0.01), Caspase 3 (up-regulated 5.1-fold, P = 0.02), Peroxisome Proliferator-Activated Receptor Gamma, Coactivator 1 Alpha (down-regulated 2-fold, P = 0.02). CONCLUSIONS: In this preliminary experimental study, kidney gene expression was profoundly different in animals that developed septic AKI as opposed to septic animals that did not. The biological functions of the genes differentially expressed support a role of inflammatory overstimulation coupled with metabolic and apoptotic molecular responses in early septic AKI. Cyclooxygenase-2 and angiotensin type 2 receptor-dependent downstream mechanisms appear fruitful targets for future mechanistic research.

Space GlucoseControl system for blood glucose control in intensive care patients--a European multicentre observational study.

BACKGROUND: Glycaemia control (GC) remains an important therapeutic goal in critically ill patients. The enhanced Model Predictive Control (eMPC) algorithm, which models the behaviour of blood glucose (BG) and insulin sensitivity in individual ICU patients with variable blood samples, is an effective, clinically proven computer based protocol successfully tested at multiple institutions on medical and surgical patients with different nutritional protocols. eMPC has been integrated into the B.Braun Space GlucoseControl system (SGC), which allows direct data communication between pumps and microprocessor. The present study was undertaken to assess the clinical performance and safety of the SGC for glycaemia control in critically ill patients under routine conditions in different ICU settings and with various nutritional protocols. METHODS: The study endpoints were the percentage of time the BG was within the target range 4.4 - 8.3 mmol.l(-1), the frequency of hypoglycaemic episodes, adherence to the advice of the SGC and BG measurement intervals. BG was monitored, and insulin was given as a continuous infusion according to the advice of the SGC. Nutritional management (enteral, parenteral or both) was carried out at the discretion of each centre. RESULTS: 17 centres from 9 European countries included a total of 508 patients, the median study time was 2.9 (1.9-6.1) days. The median (IQR) time-in-target was 83.0 (68.7-93.1) % of time with the mean proposed measurement interval 2.0 ± 0.5 hours. 99.6% of the SGC advices on insulin infusion rate were accepted by the user. Only 4 episodes (0.01% of all BG measurements) of severe hypoglycaemia <2.2 mmol.l(-1) in 4 patients occurred (0.8%; 95% CI 0.02-1.6%). CONCLUSION: Under routine conditions and under different nutritional protocols the Space GlucoseControl system with integrated eMPC algorithm has exhibited its suitability for glycaemia control in critically ill patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT01523665.

[International guidelines for management of severe sepsis and septic shock 2012 - comment]. / Mezinárodní doporucení pro lécbu tezké sepse a septického soku 2012 - komentovaný výber.

Sepsis is one of the leading and grossly under recognized cause of death in the world. If not recognized early and treated promptly, sepsis leads to septic shock, multiorgan failure and death. This article summarizes recently updated international guidelines for management of severe sepsis and septic shock.

Advanced nanofibrous sorbents for the extraction of pollutants from river water and protein-containing matrices.

The extraction efficiencies of thirty types of fibers produced by meltblown, alternating current electrospinning, and meltblown-co-electrospinning technologies were tested as advanced sorbents for on-line solid-phase extraction in a high-performance liquid chromatography system have been tested and compared with a commercial C18 sorbent. The properties of each fiber, which were often depended on the production process, and their applicability were demonstrated with the extraction of the model analytes nitrophenols and chlorophenols from various matrices including river water and to purify complex matrix human serum and bovine serum albumin from macromolecular ballast. Polycaprolactone fibers outperformed other polymers and were selected for subsequent modifications including (i) incorporation of hybrid carbon nanoparticles, i.e., graphene, activated carbon, and carbon black into the polymer prior to fiber fabrication, and (ii) surface modification by dip coating with polyhydroxy modifiers including graphene oxide, tannin, dopamine, hesperidin, and heparin. These novel fibrous sorbents were comparable to commercial C18 sorbent and provided excellent analyte recoveries of 70-112% even from the protein-containing matrices.

Effects of clinically relevant acute hypercapnic and metabolic acidosis on the cardiovascular system: an experimental porcine study.

INTRODUCTION: Hypercapnic acidosis (HCA) that accompanies lung-protective ventilation may be considered permissive (a tolerable side effect), or it may be therapeutic by itself. Cardiovascular effects may contribute to, or limit, the potential therapeutic impact of HCA; therefore, a complex physiological study was performed in healthy pigs to evaluate the systemic and organ-specific circulatory effects of HCA, and to compare them with those of metabolic (eucapnic) acidosis (MAC). METHODS: In anesthetized, mechanically ventilated and instrumented pigs, HCA was induced by increasing the inspired fraction of CO2 (n = 8) and MAC (n = 8) by the infusion of HCl, to reach an arterial plasma pH of 7.1. In the control group (n = 8), the normal plasma pH was maintained throughout the experiment. Hemodynamic parameters, including regional organ hemodynamics, blood gases, and electrocardiograms, were measured in vivo. Subsequently, isometric contractions and membrane potentials were recorded in vitro in the right ventricular trabeculae. RESULTS: HCA affected both the pulmonary (increase in mean pulmonary arterial pressure (MPAP) and pulmonary vascular resistance (PVR)) and systemic (increase in mean arterial pressure (MAP), decrease in systemic vascular resistance (SVR)) circulations. Although the renal perfusion remained unaffected by any type of acidosis, HCA increased carotid, portal, and, hence, total liver blood flow. MAC influenced the pulmonary circulation only (increase in MPAP and PVR). Both MAC and HCA reduced the stroke volume, which was compensated for by an increase in heart rate to maintain (MAC), or even increase (HCA), the cardiac output. The right ventricular stroke work per minute was increased by both MAC and HCA; however, the left ventricular stroke work was increased by HCA only. In vitro, the trabeculae from the control pigs and pigs with acidosis showed similar contraction force and action-potential duration (APD). Perfusion with an acidic solution decreased the contraction force, whereas APD was not influenced. CONCLUSIONS: MAC preferentially affects the pulmonary circulation, whereas HCA affects the pulmonary, systemic, and regional circulations. The cardiac contractile function was reduced, but the cardiac output was maintained (MAC), or even increased (HCA). The increased ventricular stroke work per minute revealed an increased work demand placed by acidosis on the heart.

Comparing adsorption performance of microfibers and nanofibers with commercial molecularly imprinted polymers and restricted access media for extraction of bisphenols from milk coupled with liquid chromatography.

Advanced solid phase extraction (SPE) fibrous sorbents including polyethylene, polypropylene poly (hydroxybutyrate), and polyamide 6 nanofibers, polycaprolactone microfibers/nanofibers, polycaprolactone microfibers/polyvinylidene difluoride nanofibers, and poly (hydroxybutyrate) microfibers/polypropylene microfibers composites, as well as commercial molecularly imprinted polymers and restricted access media sorbent were compared in terms of bisphenols extraction from milk and their clean-up efficiency. Three on-line SPE-HPLC methods were completely validated for the extraction and detection of bisphenols A, AF, C, A diglycidyl ether, and F diglycidyl ether in bovine milk. Polycaprolactone composite nanofibers compared favorably to restricted access media, enabled excellent clean-up of bisphenols from the proteinaceous matrix, and yielded recoveries 98.0-124.5% and 93.0-115.0%, respectively, with RSD less than 10%. Total analysis time including on-line SPE step lasted only 12 min, which represents a significant reduction in time compared with previously reported as well as official European Union and AOAC methods defined for the determination of bisphenols in various matrices.

Small nanofibrous disks for preconcentration of environmental contaminants followed by direct in-vial elution and chromatographic determination.

A novel method for the extraction of river water contaminants as model analytes of ranging polarities, including bisphenols A, C, S, Z, fenoxycarb, kadethrin, and deltamethrin, using small compact fibrous disks has been developed and validated. Polymer nanofibers and microfibers prepared from poly(3-hydroxybutyrate), polypropylene, polyurethane, polyacrylonitrile, poly(lactic acid), and polycaprolactone doped with graphene were evaluated in terms of extraction efficiency, selectivity, and stability in organic solutions. Our novel extraction procedure comprised preconcentration of analytes from 150 mL river water to 1 mL of eluent using a compact nanofibrous disk freely vortexed in the sample. Small nanofibrous disks with a diameter of 10 mm were cut from a compact and mechanically stable 1-2 mm thick micro/nanofibrous sheet. After 60 min extraction in a magnetically stirred sample located in a beaker, the disk was removed from the liquid and washed with water. Then, the disk was inserted into a 1.5 mL HPLC vial and extracted with 1.0 ml methanol upon short intensive shaking. Our approach avoided the undesired problems related to the manual handling typical of "classical" SPE procedure since the extraction was carried out directly in the HPLC vial. No sample evaporation, reconstitution, or pipetting was required. The nanofibrous disk is affordable, needs no support or holder, and its use avoids creation of plastic waste originating from disposable materials. Recovery of compounds from the disks was 47.2-141.4% depending on the type of polymer used and the relative standard deviations calculated from 5 extractions ranged from 6.1 to 11.8% for poly(3-hydroxybutyrate), 6.3-14.8% for polyurethane, and 1.7-16.2% for polycaprolactone doped with graphene. A small enrichment factor was obtained for polar bisphenol S using all sorbents. A higher preconcentration reaching up to 40-fold was achieved for lipophilic compounds such as deltamethrin when using poly(3-hydroxybutyrate) and graphene-doped polycaprolactone.

The Combination of Hydrogels with 3D Fibrous Scaffolds Based on Electrospinning and Meltblown Technology.

This study presents the advantages of combining three-dimensional biodegradable scaffolds with the injection bioprinting of hydrogels. This combination takes advantage of the synergic effect of the properties of the various components, namely the very favorable mechanical and structural properties of fiber scaffolds fabricated from polycaprolactone and the targeted injection of a hydrogel cell suspension with a high degree of hydrophilicity. These properties exert a very positive impact in terms of promoting inner cell proliferation and the ability to create compact tissue. The scaffolds were composed of a mixture of microfibers produced via meltblown technology that ensured both an optimal three-dimensional porous structure and sufficient mechanical properties, and electrospun nanofibers that allowed for good cell adhesion. The scaffolds were suitable for combination with injection bioprinting thanks to their mechanical properties, i.e., only one nanofibrous scaffold became deformed during the injection process. A computer numerical-control manipulator featuring a heated printhead that allowed for the exact dosing of the hydrogel cell suspension into the scaffolds was used for the injection bioprinting. The hyaluronan hydrogel created a favorable hydrophilic ambiance following the filling of the fiber structure. Preliminary in vitro testing proved the high potential of this combination with respect to the field of bone tissue engineering. The ideal structural and mechanical properties of the tested material allowed osteoblasts to proliferate into the inner structure of the sample. Further, the tests demonstrated the significant contribution of printed hydrogel-cell suspension to the cell proliferation rate. Thus, the study led to the identification of a suitable hydrogel for osteoblasts.

The Potential for the Direct and Alternating Current-Driven Electrospinning of Polyamides.

The paper provides a description of the potential for the direct current- and alternating current-driven electrospinning of various linear aliphatic polyamides (PA). Sets with increasing concentrations of selected PAs were dissolved in a mixture of formic acid and dichloromethane at a weight ratio of 1:1 and spun using a bar electrode applying direct and alternating high voltage. The solubility and spinnability of the polyamides were investigated and scanning electron microscopy (SEM) images were acquired of the resulting nanofiber layers. The various defects of the spun fibers and their diameters were detected and subsequently measured. Moreover, the dynamic viscosity and conductivity were also subjected to detailed investigation. The most suitable concentrations for each of the PAs were determined according to previous findings, and the solutions were spun using a NanospiderTM device at the larger scale. The fiber diameters of these samples were also measured. Finally, the surface energy of the fiber layers produced by the NanospiderTM device was measured aimed at selecting a suitable PA for a particular application.

The Injection Molding of Biodegradable Polydioxanone-A Study of the Dependence of the Structural and Mechanical Properties on Thermal Processing Conditions.

Recent years have observed a significant increase in the use of degradable materials in medicine due to their minimal impact on the patient and broad range of applicability. The biodegradable polymer Polydioxanone (PDO) provides a good example of the use of such one polymer that can represent the aforementioned medical materials in the field of medicine, due to its high level of biocompatibility and interesting mechanical properties. PDO is used to produce absorbable medical devices such as sutures and stents, and is also suitable for the fabrication of certain orthopedic implants. Polydioxanone can be processed using the injection molding method due to its thermoplastic nature; this method allows for the precise and easily-controllable production of medical materials without the need for toxic additives. A number of small commercial polymer implants have recently been introduced onto the market based on this processing method. It is important to note that, to date, no relevant information on the molding of PDO is available either for the scientific or the general public, and no study has been published that describes the potential of the injection molding of PDO. Hence, we present our research on the basic technological and material parameters that allow for the processing of PDO using the laboratory microinjection molding method. In addition to determining the basic parameters of the process, the research also focused on the study of the structural and mechanical properties of samples based on the thermal conditions during processing. A technological frame work was successfully determined for the processing of PDO via the microinjection molding approach that allows for the production of samples with the required homogeneity, shape stability and surface quality in a laboratory scale. The research revealed that PDO is a polymer with a major share of crystalline phases, and that it is sensitive to the annealing temperature profile in the mold, which has the potential to impact the final crystalline structure, the fracture morphology and the mechanical properties.

Nanofibrous Online Solid-Phase Extraction Coupled with Liquid Chromatography for the Determination of Neonicotinoid Pesticides in River Waters.

Polymeric nano- and microfibers were tested as potential sorbents for the extraction of five neonicotinoids from natural waters. Nanofibrous mats were prepared from polycaprolactone, polyvinylidene fluoride, polystyrene, polyamide 6, polyacrylonitrile, and polyimide, as well as microfibers of polyethylene, a polycaprolactone nano- and microfiber conjugate, and polycaprolactone microfibers combined with polyvinylidene fluoride nanofibers. Polyimide nanofibers were selected as the most suitable sorbent for these analytes and the matrix. A Lab-In-Syringe system enabled automated preconcentration via online SPE of large sample volumes at low pressure with analyte separation by HPLC. Several mat layers were housed in a solvent filter holder integrated into the injection loop of an HPLC system. After loading 2 mL sample on the sorbent, the mobile phase eluted the retained analytes onto the chromatographic column. Extraction efficiencies of 68.8-83.4% were achieved. Large preconcentration factors ranging from 70 to 82 allowed reaching LOD and LOQ values of 0.4 to 1.7 and 1.2 to 5.5 µg·L-1, respectively. Analyte recoveries from spiked river waters ranged from 53.8% to 113.3% at the 5 µg·L-1 level and from 62.8% to 119.8% at the 20 µg·L-1 level. The developed methodology proved suitable for the determination of thiamethoxam, clothianidin, imidacloprid, and thiacloprid, whereas matrix peak overlapping inhibited quantification of acetamiprid.

Modeling sepsis, with a special focus on large animal models of porcine peritonitis and bacteremia.

Infectious diseases, which often result in deadly sepsis or septic shock, represent a major global health problem. For understanding the pathophysiology of sepsis and developing new treatment strategies, reliable and clinically relevant animal models of the disease are necessary. In this review, two large animal (porcine) models of sepsis induced by either peritonitis or bacteremia are introduced and their strong and weak points are discussed in the context of clinical relevance and other animal models of sepsis, with a special focus on cardiovascular and immune systems, experimental design, and monitoring. Especially for testing new therapeutic strategies, the large animal (porcine) models represent a more clinically relevant alternative to small animal models, and the findings obtained in small animal (transgenic) models should be verified in these clinically relevant large animal models before translation to the clinical level.

The safety and efficacy of a new anticoagulation strategy using selective in-circuit blood cooling during haemofiltration--an experimental study.

BACKGROUND: Selective in-circuit blood cooling was recently shown to be an effective anticoagulation strategy during short-term haemofiltration. The aim of this study was to examine the safety of this novel method and circuit life. METHODS: Fourteen pigs were randomly assigned to receive continuous haemofiltration with anticoagulation achieved either by selective cooling of an extracorporeal circuit (ECC) (COOL; n = 8) or through systemic heparinization (HEPARIN; n = 6). Before (T0) as well as 1 (TP1) and 6 h (TP6) after starting the procedure the following parameters were assessed: animal status, variables reflecting haemostasis, oxidative stress, inflammation and function of blood elements. RESULTS: All animals remained haemodynamically stable with unchanged body core temperature and routine biochemistry. Regional ECC blood cooling did not alter clinically relevant markers of haemostasis, namely activated partial thromboplastin and prothrombin times, thrombin-antithrombin complexes, von Willebrand factor and plasminogen activator inhibitor-1. Platelet aggregability, serum levels of free haemoglobin, leukocyte count, oxidative burst and blastic transformation of T-lymphocytes were all found to be stable over the treatment period in both groups. ECC blood cooling affected neither plasma malondialdehyde concentrations (a surrogate marker of oxidative stress) nor plasma levels of cytokines (tumour necrosis factor-α, interleukin-6 and -10). While the patency of all circuits treated with systemic heparin was well maintained within the pre-selected period of 24 h, the median filter lifespan in the COOL group was 17 h. CONCLUSION: Utilizing clinically relevant markers, selective in-circuit blood cooling was demonstrated to be a safe and feasible means of achieving regional anticoagulation in healthy pigs. The long-term safety issues warrant further evaluation.

Pharmacokinetic evaluation of voriconazole treatment in critically ill patients undergoing continuous venovenous hemofiltration.

INTRODUCTION: Voriconazole represents an essential part of antimicrobial therapy in critically ill patients. The aim of this study was to exclude a significant alteration in voriconazole pharmacokinetics in critically ill patients undergoing continuous venovenous hemofiltration (CVVH). METHODS: Six patients dependent on CVVH with evidence of an invasive mycotic infection treated with intravenous voriconazole at the standard dosing regimen were investigated. The total serum concentration of voriconazole in arterial blood and the concentration in ultrafiltrate were measured by reverse-phase high-performance liquid chromatography with ultraviolet detection. The authors profiled a 5-point pharmacokinetic concentration-time curve during the 12-hour standard maintenance dosing interval and derived the basic pharmacokinetic parameters. RESULTS: The serum voriconazole concentration did not decrease <1.0 mg/L at any time point, and the mean was 4.3 ± 2.6 mg/L and the median (range) 3.6 (9.0) mg/L. The sieving coefficient of the drug did not exceed 0.30 in any patient (0.22 ± 0.08). The mean serum AUC0-12, the mean total clearance, and the mean clearance via CVVH were 53.52 ± 29.97 mg·h/L [the median (range) of 57.74 (62.34) mg·h/L], 0.11 ± 0.07 L·h-1·kg-1, and 0.007 ± 0.003 L·h-1·kg-1, respectively. The clearance by the CVVH method ranged from 4% to 20% of the total drug clearance. The disposition of voriconazole was not compromised. The mean elimination half-life was 27.58 ± 35.82 hours [the median of 13.10 (92.21) hours], and the mean distribution volume value was 3.28 ± 3.10 L/kg [the median of 2.01 (8.10) L/kg]. Marked variability in serum concentrations, elimination half-life, distribution volume, and total clearance was seen. Half of the patients showed some drug accumulation. CONCLUSIONS: The clearance of voriconazole by CVVH is not clinically significant. In view of this finding, voriconazole dose adjustment in patients undergoing the standard method of CVVH is not required. However, the observed potential for an unpredictable voriconazole accumulation suggests the usefulness for monitoring its levels in critically ill patients.

Searching for mechanisms that matter in early septic acute kidney injury: an experimental study.

INTRODUCTION: In almost half of all sepsis patients, acute kidney injury (AKI) develops. However, the pathobiologic differences between sepsis patients with and without AKI are only poorly understood. We used a unique opportunity to examine dynamic inflammatory, renal hemodynamic, and microvascular changes in two clinically relevant large-animal models of sepsis. Our aim was to assess variability in renal responses to sepsis and to identify both hemodynamic and nonhemodynamic mechanisms discriminating individuals with AKI from those in whom AKI did not develop. METHODS: Thirty-six pigs were anesthetized, mechanically ventilated, and instrumented. After a recovery period, progressive sepsis was induced either by peritonitis (n = 13) or by continuous intravenous infusion of live Pseudomonas aeruginosa (n = 15). Eight sham operated-on animals served as time-matched controls. All animals received standard intensive care unit (ICU) care, including goal-directed hemodynamic management. Before, and at 12, 18, and 22 hours of sepsis, systemic and renal (ultrasound flow probe) hemodynamics, renal cortex microcirculation (laser Doppler), inflammation (interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), oxidative stress (thiobarbituric acid reactive species (TBARS), nitrite/nitrate concentrations (NOx), and renal oxygen kinetics and energy metabolism were measured. RESULTS: In 14 (50%) pigs, AKI developed (62% in peritonitis, 40% in bacteria infusion model). Fecal peritonitis resulted in hyperdynamic circulation, whereas continuous bacteria infusion was associated with normodynamic hemodynamics. Despite insults of equal magnitude, comparable systemic hemodynamic response, and uniform supportive treatment, only those pigs with AKI exhibited a progressive increase in renal vascular resistance. This intrarenal vasoconstriction occurred predominantly in the live-bacteria infusion model. In contrast to AKI-free animals, the development of septic AKI was preceded by early and remarkable inflammatory response (TNF-α, IL-6) and oxidative stress (TBARS). CONCLUSIONS: The observed variability in susceptibility to septic AKI in our models replicates that of human disease. Early abnormal host response accompanied by subsequent uncoupling between systemic and renal vascular resistance appear to be major determinants in the early phase of porcine septic AKI. Nonuniform and model-related renal hemodynamic responses that are unpredictable from systemic changes should be taken into consideration when evaluating hemodynamic therapeutic interventions in septic AKI.