Measurement and mobilisation of localised oedema in haemodialysis.

BACKGROUND: The presence of localised oedema can make measurement and removal of excess fluid in haemodialysis challenging. OBJECTIVES: To evaluate (i) the effectiveness of intermittent pneumatic compression and neuromuscular electrical stimulation at mobilising oedema and (ii) the impact of localised fluid on bioimpedance measured fluid status. DESIGN: A single centre, cross-over study design. Participants were monitored weekly during mid-week dialysis sessions. Four sessions with each of the interventions and no interventions, with washout periods between, were included. PARTICIPANTS: Six participants with lower limb oedema and established on haemodialysis for at least 3 months. MEASUREMENTS: The effectiveness of mobilising oedema and improving haemodynamic stability was assessed by: reduction in ankle circumference; ultrafiltration volume achieved; blood pressure changes; participant symptoms and achievement of target weight. The impact of localised fluid on bioimpedance measurements was assessed by comparing measurements across affected tissue with measurements avoiding the site of oedema. RESULTS: There were no differences in ultrafiltration volumes, achievement of target weight, participant symptoms or reductions in ankle circumference and systolic blood pressure between intermittent pneumatic compression and neuromuscular electrical stimulation sessions compared to control sessions. Measurements of fluid overload with bioimpedance were 1.7 and 1.8 L higher when measuring across oedematous tissue compared to non-oedematous tissue. CONCLUSIONS: We were unable to demonstrate improved mobilisation of fluid in the participant's lower limb, though there was a low number of study participants and notable interindividual variation observed. Bioimpedance offers potential for monitoring fluid management in individuals with lower limb oedema but specific protocols are necessary.

Recent Approaches to the Manufacturing of Biomimetic Multi-Phasic Scaffolds for Osteochondral Regeneration.

Cartilage lesions of the knee are common disorders affecting people of all ages; as the lesion progresses, it extends to the underlying subchondral bone and an osteochondral defect appears. Osteochondral (OC) tissue compromises soft cartilage over hard subchondral bone with a calcified cartilage interface between these two tissues. Osteochondral defects can be caused by numerous factors such as trauma and arthritis. Tissue engineering offers the possibility of a sustainable and effective treatment against osteochondral defects, where the damaged tissue is replaced with a long-lasting bio-manufactured replacement tissue. This review evaluates both bi-phasic and multi-phasic scaffold-based approaches of osteochondral tissue regeneration, highlighting the importance of having an interface layer between the bone and cartilage layer. The significance of a biomimetic approach is also evidenced and shown to be more effective than the more homogenous design approach to osteochondral scaffold design. Recent scaffold materials and manufacturing techniques are reviewed as well as the current clinical progress with osteochondral regeneration scaffolds.