New peritoneal dialysis solutions

Summary: Current peritoneal dialysis solutions are not biocompatible, particularly in respect to low pH, high osmolality and use of lactate. In addition, glucose is not an ideal osmotic agent. Recent advances in the formulation of peritoneal dialysis fluids aim to provide a more physiological environment to preserve membrane integrity. the effects of pH and lactate have been overcome by the use of bicarbonate based solutions whilst icodextrin (glucose polymers) often prolonged ultrafiltration in spite of being isomotic to uraemic plasma. Future formulations will see a combination of osmotic agents (including amino acids) and bicarbonate to achieve a more biocompatible solution whilst still meeting the ultrafiltration needs of the patients. Additives (glycosaminoglycans, procysteine) may protect the peritoneum from free radical injury.     

异种角膜片层间植入的组织相容性及形态学研究

采用层间囊袋分离法在２８只兔眼角膜上行角膜层间植入术，植片由人尸体角膜制成，最后进行观察并取得结果的２３只，术后观察３个月，角膜保持透明，形态学的主要特点是植片内角膜细胞缺如，内皮细胞形态结构未见明显影响，提示人眼角膜植片与兔眼角膜具有较好的组织相容性，为非人类角膜材料的应用提供了初步的经验与依据。     

Experimental Study on Allogenic Decalcified Bone Matrix as Carrier for Bone Tissue Engineering

The biocompatibility and osteogenic activity of allogenic decalcified bone matrix (DBM) used as a carrier for bone tissue engineering were studied. Following the method described by Urist, allogenic DBM was made. In vitro, DBM and bone marrow stromal cell (BMSC) from rab-bits were co-cultured for 3-7 days and subjected to HE staining, and a series of histomorphological observations were performed under phase-contrast microscopy and scanning electron microscopy (SEM). In vivo the mixture of DBM/BMSC co-cultured for 3 days was planted into one side of muscules sacrospinalis of rabbits, and the DBM without BMSC was planted into other side as con-trol. Specimens were collected at postoperative week 1, 2 and 4, and subjected to HE staining, and observed under SEM. The results showed during culture in vitro, the BMSCs adherent to the wall of DBM grew, proliferated and had secretive activity. The in vivo experiment revealed that BMSCs and undifferentiated mesenchymal cells in the perivascular region invaded gradually and proliferated together in DBM/BMSC group, and colony-forming units of chondrocytes were found. Osteoblasts,trabecular bone and medullary cavity appeared. The inflammatory reaction around muscles almost disappeared at the second weeks. In pure DBM group, the similar changes appeared from the sur-face of the DBM to center, and the volume of total regenerate bones was less than the DBM/BMSC group at the same time. The results indicated that the mixture of DBM and BMSC had good bio-compatibility and ectopic induced osteogentic activty.     

改良消蚀法制备脱细胞真皮基质微粒及其生物相容性评价

目的:利用改良消蚀法制备一种新型脱细胞真皮基质(Acellular dermal matrix,ADM)微粒,并对其相容性加以评价,为组织工程微粒皮肤的制备奠定研究基础。方法:应用机械法切除猪真皮乳头层,结合消蚀法和冻融法除去网状真皮中的所有细胞制备成ADM,将ADM搅碎成颗粒状,对其做细胞毒性实验和皮下埋藏实验检验其相容性。结果:该方法制备的ADM微粒韧性好,细胞去除完全,胶原三维稍松散但结构完整,无基底膜和乳头层。细胞毒性实验显示其基本无毒性,成纤维细胞在ADM微粒上增殖良好,皮下埋藏试验未见明显排异反应,ADM微粒能诱导血管和成纤维细胞长入。结论:用改良消蚀法制备的ADM微粒抗原性低、相容性好,可以作为组织工程微粒皮肤的支架和填充材料。     

Biocompatibility pattern of a bicarbonate/lactate-buffered peritoneal dialysis fluid in APD: a prospective, randomized study.

BACKGROUND: In chronic ambulatory peritoneal dialysis, bicarbonate-buffered fluids, with their neutral pH and less advanced glycosylation end-products (AGE) and glucose degradation products (GDP), have better biocompatibility than conventional peritoneal dialysis (PD) solutions. That difference may be more beneficial in automated peritoneal dialysis (APD), due to its more frequent exchanges and longer contact times with fresh dialysate. We performed a prospective, randomized study in APD patients to compare the biocompatibility of conventional and bicarbonate/lactate-buffered PD fluids. METHODS: We randomized 14 APD patients to have APD with either conventional or bicarbonate/lactate-based fluids. After 6 months, both groups changed to the other solution. The overall observation period was 12 months. After 1 and 5 months and again after 7 and 11 months, phagocytotic and respiratory burst capacities of effluent peritoneal macrophages were determined. Plasma interleukin (IL)-6 and C-reactive protein (CRP) as well as effluent IL-6, CRP, transforming growth factor (TGF)-beta 1, AGE and CA125 concentrations were measured. Inflow pain was quantified using a patient questionnaire. RESULTS: Respiratory burst capacity remained unchanged and phagocytotic activity increased significantly during APD (P<0.001) with the bicarbonate/lactate fluid. Effluent IL-6 release was significantly lower than with the lactate fluid (P<0.05). While in the effluent TGF-beta 1 was unaffected, AGE concentration was lower after bicarbonate/lactate treatment (P<0.05). Effluent CA125 concentration, an indicator of mesothelial cell integrity, was higher (P<0.05) in neutral effluents. Finally, patients' inflow pain diminished (P = 0.05) when using the neutral fluid. CONCLUSIONS: The use of a neutral PD fluid in APD improved patients' inflow pain as well as biocompatibility parameters reflecting enhanced phagocytotic activity of peritoneal macrophages, reduced constitutive inflammatory stimulation (IL-6), reduced AGE accumulation in the peritoneal cavity and better preservation of the mesothelial cell integrity. From the biocompatibility point of view, a neutral fluid with low GDP content can be recommended as the primary choice for APD.     

Endotoxin transfer through dialysis membranes: small- versus large-pore membranes.

In this in-vivo study, dialysate and serum endotoxin was evaluated before and after haemodialysis with small-pore (PS400) and large-pore (PS600) polysulphone dialysers, and before and after haemodiafiltration with the PS600 filter. The source of the endotoxin was the presence in dialysate of Pseudomonads at a concentration of 10(3)-10(4) CFU/ml. Endotoxin was measured by a modified chromogenic limulus amoebocyte lysate (LAL) assay. In spite of dialysate endotoxin concentrations greater than 100 pg/ml, no changes in pre- versus posttreatment LAL reactivity were observed in PS400 dialysis and PS600 haemodiafiltration. In contrast, PS600 haemodialysis was related to an increase in serum LAL reactivity from 1.3 +/- 1.5 to 3.8 +/- 2.0 pg/ml (n = 15, P less than 0.01), and five patients (33.3%) showed a post-dialysis value in excess of 5 pg/ml. Our data are consistent with the absence of in-vivo endotoxin transfer during haemodialysis with small-pore dialyser membranes, and during haemodiafiltration with membranes with larger pores. An increase in LAL reactivity during haemodialysis with membranes with larger pores is, however, present, presumably due to the occurrence of backdiffusion/filtration with that specific strategy.     

Cell-associated adhesion molecules as early markers of bioincompatibility

BACKGROUND.: Transient nature of adhesive interactions occurring during cellmargination is mainly dependent on expression of selectins whichare shed by activated cells. This shedding in the circulationmay play an important role as anti-inflammatory mediator. Haemodialysisis also associated with P-selectin (CD62P)/sialyl-Lewisx (CD15s)interactions which mediate platelet-leukocyte coaggregation.We further investigated the mechanisms underlying leukocytemargination during haemodialysis. METHODS.: CD15s, CD11b and CD61 expression on circulating leukocytes frompatients dialysed on synthetic membranes (modified polyacrylonitrile(SPAN), polysulphone (PS), and polyacrylonitrile (AN69) wasassessed by cytofluorometry in a prospective crossover trial.We measured plasma levels C3a/C3a desArg, soluble CD62P, andCD62E molecules obtained from patients and healthy individuals. RESULTS.: Expression of CD11b and CD15s was upregulated on neutrophilsfrom patients dialysed with SPAN and PS membranes during thedialysis session. A significant negative correlation was foundbetween the expression of CD11b or CD15s molecules and neutrophilcounts as well as between CD15s expression and monocyte countsduring haemodialysis. As assessed by CD61 expression on leukocytes,we observed that platelets bound significantly onto both neutrophilsand monocytes during dialysis with both membranes. A significantpositive correlation was found between the expression of CD11bmolecules and the percentage of CD61 ⁺ monocytes counts duringSPAN and PS dialysis. We found a significant increase of solubleCD62P in plasma samples obtained from haemodialysed patientsbefore the dialysis session as compared to the levels detectedin plasma from healthy individuals. CONCLUSIONS.: This study documents a major role of CD15s, CD11b, CD61, CD62Pmolecules in the transient leukocytes activation and marginationduring haemodialysis on synthetic membranes despite their lowcomplement-activating properties.     

纳米锰锌铁氧体的生物相容性研究

目的：研究用于肿瘤磁流体热疗的自制纳米级Mn-Zn铁氧体(Mn0.5Zn0.5Fe2O4)的生物相容性。方法：溴化—3(4，5—二甲基噻唑基—2)—2，5—二苯基四唑(MTT)实验评价其体外细胞毒性；溶血试验评价其有无溶血作用：小鼠腹腔注射其无菌生理盐水混悬液以测定其LD50及最大耐受量(MTD)；微核试验评价其有无致畸、致突变作用等。结果：MTT显示该材料对L-929细胞毒性为0～1级；无溶血作用；昆明小鼠腹腔注射该材料混悬液1ml．在极限浓度时的LD50测不出，MTD值达到6g／ks；微核实验结果表明无致畸致突变作用。结论：该材料是一种具有良好生物相容性的材料，应用于肿瘤热疗具有广阔前景。     

Hydrogels in endovascular embolization. II. Clinical use of spherical particles

In this study we report the results of clinical experiments, obtained with spherical particles made from poly(2-hydroxyethyl methacrylate) used in the embolization of arteriovenous anastomoses, in the suppression of pulmonary haemorrhage and haemoptysis and in the occlusion of some other arteries. So far we have used these particles in the treatment of 187 patients. It must be stressed that the advantage of spherical particles consists in the simplicity of their introduction into the blood vessel through a catheter, while in the blood vessel itself the particle swells in blood still more, when compared with the particle size in saline. This results in an immediate and permanent haemostatic effect. No revascularization occurs.     

血管内皮生长因子受体在鼠横纹肌的表达与羟基磷灰石/碳纳米管复合材料毒性研究

目的 从观察鼠骨骼肌组织形态学改变和VEGF表达的角度研究CNTs/HAP纳微米复合材料对鼠骨骼肌的细胞毒性。方法 将CNTs/HAP纳米复合材料植入实验鼠臀大肌。按不同时间取材，做组织学观察和RT-PCR分析。结果 1d、3d显微镜下观察，炎细胞和淋巴细胞浸润伴轻度水肿、间质疏松；5d、7d显微镜下观察血管壁增厚，单核巨噬细胞和纤维组织增生，少量肌纤维出现变性，VEGF表达呈上升趋势；14天显微镜下观察周围组织间质血管扩张，仅有少量炎细胞浸润，水肿不明显，VEGF表达呈下降趋势。结论 CNTs/HAP对鼠骨骼肌细胞无毒性，有利于血管的再生，具有良好的生物相容性。