Effect of the molecular adsorbent recirculating system and Prometheus devices on systemic haemodynamics and vasoactive agents in patients with acute-on-chronic alcoholic liver failure

INTRODUCTION: Patients with acute-on-chronic liver failure show an aggravated hyperdynamic circulation. We evaluated, in a controlled manner, potential changes in systemic haemodynamics induced by the molecular adsorbent recirculating system (MARS) and the Prometheus system liver detoxification devices in a group of patients with acute-on-chronic liver failure. METHODS: Eighteen patients (51.2 ± 2.3 years old; Child–Pugh score, 12.5 ± 0.2; Maddrey score, 63.1 ± 5.0; hepatic venous pressure gradient, 17.6 ± 0.9 mmHg) with biopsy-proven alcoholic cirrhosis and superimposed alcoholic hepatitis were either treated with standard medical therapy (SMT) combined with MARS (n = 6) or Prometheus (n = 6) or were treated with SMT alone (n = 6) on three consecutive days (6 hours/session). Liver tests, systemic haemodynamics and vasoactive substances were determined before and after each session. RESULTS: Groups were comparable for baseline haemodynamics and levels of vasoactive substances. Both MARS and Prometheus decreased serum bilirubin levels (P < 0.005 versus SMT), the Prometheus device being more effective than MARS (P = 0.002). Only MARS showed significant improvement in the mean arterial pressure (Δchange, +9 ± 2.4 mmHg versus -0.3 ± 2.4 mmHg with Prometheus and -5.2 ± 2.1 mmHg with SMT, P < 0.05) and in the systemic vascular resistance index (Δchange, +131.5 ± 46.2 dyne.s/cm(5)/m(2 )versus -92.8 ± 85.2 dyne.s/cm(5)/m(2)with Prometheus and -30.7 ± 32.5 dyne.s/cm(5)/m(2 )with SMT; P < 0.05), while the cardiac index and central filling remained constant. This circulatory improvement in the MARS group was paralleled by a decrease in plasma renin activity (P < 0.05), aldosterone (P < 0.03), norepinephrine (P < 0.05), vasopressin (P = 0.005) and nitrate/nitrite levels (P < 0.02). CONCLUSION: The MARS device, and not the Prometheus device, significantly attenuates the hyperdynamic circulation in acute-on-chronic liver failure, presumably by a difference in removal rate of certain vasoactive substances. These findings suggest conspicuous conceptual differences among the albumin dialysis devices

Multicentre evaluation of the Boehringer Mannheim / Hitachi 911 Analysis System

The analytical performance and practicability of the Boehringer Mannheim (BM)/mtaci 91 analysis system have been assessed in a multicentre evaluation, which involved six laboratories from European countries. Analytes commonly used in classical clinical chemistry were tested in a core programme, which mainlyfollowed lhe ECCLS guidelines. In addition, a satellite programme covered other analytes, such as proteins, drugs and urine analytes. In total, the study comprised more than 100 000 data items collected over a three-month period. The evaluation was supported with 'Computer Aided Evaluation' (CAEv) and telecommunications. Acceptance criteria for the results were established at the beginning ofthe study. Nearly all ofthe analytes met the imprecision limits.' within-run imprecision (as CVs) was 2l/ofor enzyme and substrate assays, l%for ISE methods and 5l/o for immunoassays; between-day imprecision was 3l/ofor enzyme and substrate assays, 2o//o for ISE methods and 10% for immunoassays

Multicentre evaluation of the Boehringer Mannheim/Hitachi 917 analysis system

The new selective access analysis system BM/Hitachi 917 was evaluated in an international multicentre study, mainly according to the ECCLS protocol for the evaluation of analysers in clinical chemistry. Forty-three different analytes, covering 56 different methods enzymes, substrates, electrolytes, specific proteins, drugs and urine applications were tested in seven European clinical chemistry laboratories. Additionally, the practicability of the BM/ Hitachi 917 was tested according to a standardized questionnaire. Within-run CVs (median of 3 days) for enzymes, substrates and electrolytes were <2% except for creatine-kinase MB isoform and lipase at low concentration. For proteins, drugs and urine analytes the within-run CVs were < 4% except for digoxin and albumin in urine. Between-day median CVs were generally < 3% for enzymes, substrates and electrolytes, and < 6% for proteins, drugs and urine analytes, except for lipase, creatine kinase and MB isoform, D-dimer, glycosylated haemoglobin, rheumatoid factors, digoxin, digitoxin, theophylline and albumin in urine in some materials. Linearity was found according to the test specifications or better and there were no relevant effects seen in drift and carry-over testing. The interference results clearly show that also for the BM/Hitachi 917 interference exists sometimes, as could be expected because of the chemistries applied. It is a situation that can be found in equivalent analysers as well. The accuracy is acceptable regarding a 95–105% recovery in standard reference material, with the exception of the creatinine Jaffé method. Most of the 160 method comparisons showed acceptable agreement according to our criteria: enzymes, substrates, urine analytes deviation of slope ± 5%, electrolytes ± 3%, and proteins and drugs ± 10%. The assessment of practicability for 14 groups of attributes resulted in a grading of one–three scores better for the BM/Hitachi 917 than the present laboratory situation. In conclusion, the results of the study showed good analytical performance and confirmed the usefulness of the system as a consolidated workstation in medium-sized to large clinical chemistry laboratories

Effect of non-glucose sugars and haematocrit on glucose measurements with Roche Accu-Chek Performa glucose strips

status: publishe

Inhibition of Acetylcholine Esterase and Choline Esterase by Benzethonium Chloride and Avoidance of the Benzethonium Chloride Carry-Over Inhibitory Effect

Peer Reviewe

THE IMPACT OF RIVER BED SEDIMENTATION ON THE SUNDARBANS MANGROVE FOREST (BANGLADESH) WITH ITS EXCEPTIONAL ECOLOGICAL VALUE

The present contribution focuses on challenges for conservation efforts of the Sundarbans mangrove forest in Bangladesh, which is a World Heritage Site. Current threats to its ecology may affect the forest's diminishing population of Royal Bengal Tigers. Moreover, the vegetation and wildlife are under threat because of significantly increasing concentrations of salt in the water. The effect of dredging in the Passur River is insignificant in terms of the so-called Outstanding Universal Value of the forest because the measured Environmental Risk Index is relatively low. The toxicity level is to be 29%. The salinity levels of the Sundarbans vary from 54,025 dS/m to 69,152 dS/m for south western rivers, which is some 50% higher than the typical salinity value of 43,320 dS/m. This has a strongly negative effect on the soil, agriculture, fisheries, flora, and wildlife; all this is detrimental for the Outstanding Universal Value of the Sundarbans. Examination of the current physical, chemical, and biological processes that pay a role in the Sundarbans natural setup and ecosystem indicates that it is under significant environmental stress