Advanced Therapeutic Options in Acute Heart Failure
Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler in Heart Failure, 2023
In patients who fail maximal diuretic therapy, ultrafiltration is an option that functions similarly to dialysis, as it removes isotonic fluid from blood. A nephrology consult is warranted when considering ultrafiltration. Data supporting ultrafiltration over diuresis is limited, with two major trials, UNLOAD and CARRESS-HF, having conflicting outcomes. UNLOAD studied 200 patients admitted for ADHF and randomized subjects to ultrafiltration or diuretic therapy. The ultrafiltration group had greater weight and fluid loss after 48 hours without a change in dyspnea compared with the diuretic group. In addition, this group had lower rehospitalization rates at 90 days, but no change in mortality.6 Despite these promising results, this study had major design flaws, as low doses of diuretics were utilized, limiting reproducibility. Moreover, it did not specify the degree of renal dysfunction, unlike the CARRESS-HF trial. In the latter trial, 188 patients with decompensated heart failure and worsening cardiorenal syndrome, defined by an increase of creatinine >0.3 mg/dL, were randomly assigned to ultrafiltration or tailored diuretic therapy for a goal of 3–5L of daily urine output. CARRESS-HF failed to achieve its primary outcome of weight loss. Furthermore, the ultrafiltration group had worse renal function and higher rates of adverse events, including renal failure, heart failure, anemia, thrombocytopenia, and infection, than the diuretic therapy.7 Thus, utilizing ultrafiltration for ADHF carries a class IIb recommendation according to the ACC/AHA.3
Manufacture of Glycerine from Natural Fats and Oils
Eric Jungermann, Norman O.V. Sonntag in Glycerine, 2018
Modern developments in reverse osmosis, ultrafiltration, or biotechnology will have important impacts on the glycerine process industry. Reverse osmosis has potential for concentration or desalination of glycerol solutions, while ultrafiltration has the ability to separate fats or other high-molecular-weight contaminants. The field of biotechnology may find ways to alter the nature of the fats and oils which provide glycerol, or find new ways to manufacture glycerol from natural materials. Supercritical fluid (SCF) or other extraction methods can be utilized to remove contaminants which are resistant to normal refining techniques [17,18]. Only time will show the impact these emerging technologies will have on the unit operations now employed in glycerine treatment or recovery.
Lymphedema: Physical and medical therapy
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
In addition to MLD, CDT incorporates the application of external compression in the initial management of lymphedema via repetitively applied short-stretch (or low-stretch) bandages and padding material. Consequently, a multilayered compartment is created that applies pressure during muscular contraction that enhances lymphatic contractility and flow (Figure 63.2). Additionally, a reduction in the pathological increased ultrafiltration ultimately improves fluid reabsorption. Variable pressure can be created by inserting different-strength foam pads in order to selectively apply pressure in more dysfunctional regions. During intensive reduction periods, the wraps are placed after MLD and are donned constantly, except for during bathing. Note that traditional long-stretch (or high-stretch) elastic bandages are not utilized. With daily intensive phase I CDT, limb volume reduction will ultimately reach a nadir. Consequently, the maintenance phase of therapy begins where the patient is fitted with an elastic or inelastic compression garment to use during waking hours. Some patients will need nocturnal compression as well. Compression garments must be properly fitted and ideally replaced every 3–6 months.
A review on the current literature regarding the value of exosome miRNAs in various diseases
Published in Annals of Medicine, 2023
Senjie Li, Dongqing Lv, Hong Yang, Yan Lu, Yongping Jia
Common methods for isolating exosomes include ultracentrifugation, ultrafiltration, immuno-affinity purification and microfluidic-based isolation techniques [29]. The most classical extraction method, ultracentrifugation, is low-cost and suitable for the study and analysis of large sample numbers. However, the operation procedure is complicated and the extraction concentration is low. Thus, it is mainly used for analysing a small number of samples. Ultrafiltration is used for screening molecules based on their molecular weight, size, density and function. It has the advantages of high speed and purification concentration. However, some impure proteins remain in samples. Regarding new separation methods, immuno-affinity purification and microfluidics-based isolation both have high efficiency and good purification. However, because new technologies require specific reagents and instruments, they are not currently widely available and are primarily used for research on essential molecules and proteins [30]. In addition to the above methods, size exclusion chromatography (SEC) and precipitation are also used for exosome isolation [31]. Still, regardless of how they are isolated, exosomes must either be studied as soon as possible or stored in a refrigerator at −80 °C to ensure that the components are not degraded.
Role of abnormal energy metabolism in the progression of chronic kidney disease and drug intervention
Published in Renal Failure, 2022
Xuyan Liu, Huasheng Du, Yan Sun, Leping Shao
Renal hyperfiltration is an early characteristic of DKD [40]. Hyperglycemia causes afferent arteriolar dilatation by releasing vasoactive mediators [41], increasing RBF, and thereby increasing salt and fluid filtration by the kidneys. Ultrafiltration increases the transport load and energy consumption of renal tubules, which increases the consumption of oxygen [42]. Studies have demonstrated that a significant decrease in oxygen tension was detected in the renal cortex in a type 1 diabetes mellitus rat model [43]. Increased oxidative stress is also responsible for the increased oxygen consumption [2]. Mitochondrial dysfunction caused by various reasons is an important reason for the increase of ROS [44]. Excessive ROS will be neutralized by reducing substances in the body, such as nitric oxide (NO), which is also a suppressor of mitochondrial respiration. The depletion of NO may stimulate mitochondrial respiration and increase oxygen consumption, resulting in tissue hypoxia [45].
Hydrogen sulfide poisoning in forensic pathology and toxicology: mechanism and metabolites quantification analysis
Published in Critical Reviews in Toxicology, 2022
Jiaxin Zhang, Longda Ma, Yu Liu, Xin Tong, Yiwu Zhou
Thiosulfate, which is always used in preclinical, clinical, or forensic trial samples, is usually quantified in plasma and urine in bioanalytical practice. Several pieces of the literature showed its stability under different circumstances. Experiment by Jin (Jin et al. 2020) showed that thiosulfate in whole blood gradually decreased at 4 °C, and approximately 13% were lost after 96 h. Subsequently, the author proposed a new method for delaying degradation–ultrafiltration. Ultrafiltration was used to reduce the macromolecules such as proteins, and the thiosulfate degradation was less than 10% in blood samples with ultrafiltration after 96 h using a liquid chromatograph-mass spectrometer (LC/MS). In addition to blood, the storage of thiosulfate in urine was proved to exist for weeks at 4 °C and for months at −20 °C (Cole and Evrovski 1997).
Related Knowledge Centers
- Membrane Technology
- Fick'S Laws of Diffusion
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- Solution
- Separation Process
- Protein
- Microfiltration
- Membrane Gas Separation
- Absorption
- Diffusion