Development of a silicone hollow fiber membrane oxygenator for ECMO application

A new silicone hollow fiber membrane oxygenator for extracorporeal membrane oxygenation (ECMO) was developed using an ultrathin silicone hollow fiber, with a 300 microm outer diameter and a wall thickness of 50 microm. The hollow fibers were mechanically cross-wound on the flow distributor to achieve equal distribution of blood flow without changing the fiber shape. The housing, made of silicone coated acryl, was 236 mm long with an inner diameter of 60 mm. The surface area was 1.0 m2 for prototype 211, and 1.1 m2 for prototype 209. The silicone fiber length was 150 mm, and the silicone membrane packing density was 43% for prototype 211 and 36% for prototype 209. Prototype 211 has a priming volume of 208 ml, and prototype 209 has a priming volume of 228 ml. The prototype 211 oxygenator demonstrates a gas transfer rate of 120 +/- 5 ml/min (mean +/- SD) for O2 and 67 +/- 12 ml/min for CO2 under 2 L of blood flow and 4 L of O2 gas flow. Prototype 209 produced the same values. The blood side pressure drop was low compared with the silicone sheet oxygenator (Avecor, 1500ECMO). These results showed that this new oxygenator for ECMO had efficiency similar to the silicone sheet oxygenator that has a 50% larger surface area. These results suggest that the new generation oxygenator using an ultrathin silicone hollow fiber possesses sufficient gas transfer performance for long-term extracorporeal lung support.     

Use of in vitro models of haemofiltration and haemodiafiltration to estimate dosage regimens for critically ill patients prescribed cefpirome

Membrane oxygenators have now gained wide acceptance. A new hollow-fibre membrane oxygenator, the Dideco D903 Avant 1.7, with an optimized membrane surface (1.7 m2) and a wavy blood flow pattern, was tested for gas transfer and blood path resistance in a standardized setting with surviving animals. Three calves (mean body weight 63.29 +/- 2.9 kg) were connected to cardiopulmonary bypass by jugular venous and carotid arterial cannulation, classic roller pump and the Dideco D903 oxygenator with a mean flow rate of 53 +/- 0.1 ml/kg/min for 6 h. After this time, the animals were weaned from the CPB and thereafter from the ventilator. After 7 days, the animals were killed electively. Blood gas analysis was performed before bypass, after mixing (10 min) and then hourly for the 6 h of perfusion. Further samples were taken 30 min (spontaneous breathing) and 60 min after bypass (extubated). Physiological blood gas values could be maintained throughout perfusion in all animals. Mean arterial oxygen saturation varied between 99.3% and 99.7% for the arterial side of the oxygenator compared to 64.6% and 71% for the venous side. The highest mean pressure drop through the oxygenator was 54 mmHg. Postbypass blood gas analysis showed physiological values and no evidence of major lung trauma or pulmonary oedema in relation to the 6 h perfusion. The hollow-fibre membrane oxygenator, Dideco D903, offers excellent gas exchange capabilities and a low pressure drop under experimental conditions, despite reduced membrane surface area. The post mortem examination did not show any deleterious lesion.     

Membrane versus bubble oxygenator in hyperthermic regional perfusion: a prospective randomized clinical study

In a prospective randomized clinical study a routinely used bubble oxygenator (Bentley-5) was compared with a hollow fiber membrane oxygenator (D 701 Masterflo 34) during hyperthermic isolated extremity perfusion. This was done to find out whether there were differences between the two oxygenators in hemolysis, cellular damage, oxygenation and temperature achieved during extremity perfusion. In 30 perfusions blood samples were obtained at defined times: plasma hemoglobin (Hb), serum lactate dehydrogenase (s-LDH), number of erythrocytes, mean corpuscular volume (MCV), hemoglobin and bilirubin were determined for hemolysis, leukocyte count (neutrophils, lymphocytes, monocytes) and platelets as a check for cellular damage, and PO2, PCO2, O2 saturation and pH to define blood oxygenation and CO2 elimination. Maximal increase in temperature after 30 min and perfusion time until maximum tissue temperature were also recorded. The membrane oxygenator yielded better results from the aspect of hemolysis: s-LDH and plasma Hb were significantly different (p < 0.001). Cellular damage was less with the membrane oxygenator: platelet differences were significant (p < 0.01). Oxygenation and hyperthermia were obtained more quickly and were better controllable in membrane oxygenator. Further advantages for the patient were the smaller volume of blood needed for priming in a membrane oxygenator (750 vs. 1,200 ml) and improved safety resulting from a 'closed' perfusion system. On the basis of the clinical prospective randomized trial conducted, we conclude that membrane oxygenators must be adopted as the new standard in isolated hyperthermic extremity perfusion.     

Reusable tubular membrane oxygenator for isolated organ hemoperfusion

A reusable tubular membrane oxygenator is described for hypotraumatic hemoperfusion of isolated organs in physiological studies. The constructed oxygenator was of approximately 0.24-m2 effective surface area and contained 450 silicone rubber capillaries of 0.51-mm nominal ID, 34.9 cm long, fixed by conical-shaped, plastic blood headers at manifolds made from Dow-Corning MDX-4-4210 silicone elastomer. During ex vivo hemoperfusions in dogs at inlet hemoglobin saturations near 67%, oxygen transfer rates of the oxygenator increased serially, from 16.6 +/- 1.7 ml/min per m2 (mean +/- SD) at blood flows of 100 ml/min to 34.1 +/- 3.8 ml/min per m2 at flows of 500 ml/min. The oxygenator was thromboresistant and of much loss priming blood volume and wall compliance than the nonresuable Travenol membrane oxygenator of 0.26-m2 effective surface area. The tubular oxygenator was easily cleaned and reassembled, with reproducible oxygen transfer rates. It should prove useful for hemoperfusion studies in organs of moderate size, such as the isolated canine kidney, stomach, and pancreas.     

Assay of DNA content and estrogen receptor status in human breast cancer

IVOX was named as an acronym for intravascular oxygenator. The device does not need a blood pomp like an extracorporeal membrane oxygenator (ECMO), and performs intracorporeal gas exchange to be a small elongated, hollow fiber membrane oxygenator designed to lie within the subject's venae cavae so that circulating venous blood can flow freely over and around the external surfaces of the hollow fibers. The amount of gas exchange in IVOX is less than ECMO, however, the equipment is simple and there is no effect to hemodynamics and body temperature. IVOX has been utilized in the management of 165 clinical trials patients in 31 international critical care centers. Currently the gas transfer rate by means of the IVOX device constitutes 1/4 to 1/3 the total metabolic requirement of adult acute respiratory failure patients. Therefore, intentional hypoventilation to limit airway pressures (mild permissive hypercapnia) is recommended to improve CO2 removal with increasing mixed venous CO2 concentrations. In the future, improvements of design, function, and methods of utilization of IVOX device are expected to increase the amount of gas exchange and to enlarge the indications for its use.     

Development of a membrane oxygenator for ECMO using a novel fine silicone hollow fiber

One of the limitations of conventional silicone hollow fiber oxygenators compared with microporous membrane oxygenators is poor gas permeability. However, the silicone hollow fiber is free from plasma leakage, which is the major life limiting factor of the microporous membrane oxygenator. It has been difficult to fabricate a fine, thin hollow fiber for reduction of resistance to gas permeability because of the poor mechanical strength of conventional silicone materials. The authors developed a novel silicone material with sufficient mechanical strength, and a fine silicone hollow fiber with a diameter of 30 microns and wall thickness of 50 microns, which is approximately half that of a conventional silicone hollow fiber. Using this newly developed silicone hollow fiber, the authors developed a compact extracapillary flow membrane oxygenator. The oxygenator consists of fine silicone hollow fibers inserted in a housing made of polycarbonate. The housing is a cylindrical case, 20 cm long and 55 mm in inside diameter. The hollow fibers are cross-wound. The surface area of the membrane is 2.0 m2, and priming volume is 230 ml. Gas transfer performance of the newly developed oxygenator was evaluated by in vitro experiments. Oxygen and carbon dioxide transfer rates were 195 ml/min and 165 ml/min, at a blood flow rate 3 L/min. The novel silicone membrane oxygenator developed in this study can be used for extended duration in such applications as extracorporeal membrane oxygenation.     

Phospholipid dynamics and function in cell membrane of blood cells. With reference to mode of action of certain amphiphilic drugs

An asymmetric modification of the cell membrane lipid bilayer of erythrocytes by means of exogenous phospholipase (PL) treatment or of phospholipid addition induced an echinocyte- or stomatocyte-type shape change of the cells. Such membrane shape change was demonstrated to be due to asymmetric swelling or shrinkage of the lipid bilayer halves, from the simultaneous determination of the change or intra-bilayer transfer of the phospholipid molecules. In the collagen-induced activation of blood platelets, the importance of PLA2 activation as the initial reaction of the signaling system was demonstrated, and the regulatory effects of the membrane fluidity change on the enzyme activation were also shown. In the antigen-induced activation of peritoneal mast cells, a pathway through the PLD activation appeared to be more important. Phosphatidic acid produced from the membrane phospholipids through the PLD activation was shown to act as an intracellular mediator to stimulate the PLA2 activation. Various amphiphilic drugs, including benzylisoquinoline alkaloids such as cepharanthine, were shown to inhibit the platelet activation and the mechanism was studied. The anti-platelet activity appeared to be mainly due to inhibition of the PLA2 activation.     

Emboli from an extraluminal blood flow hollow fiber oxygenator with and without an arterial filter during cardiopulmonary bypass in a pig model

The effect of an arterial filter on visceral emboli was quantified with autologous indium-111 labeled platelets (INPLT) during cardiopulmonary bypass (CPB) in Yorkshire pigs. Biodistribution of INPLT was determined in 12 control pigs (30-35 kg, unoperated control [n = 6] and sham operated control [n = 6]). CPB was carried out with (n = 6) and without (n = 6) an arterial filter in 12 pigs at a flow rate of 2.5-3.5 L/min. Platelets labeled with In-111 tropolone (650-780 microCi) were injected intravenously 24 hr before CPB. All pigs were systemically heparinized (activated coagulation time > 400 sec); CPB was instituted with a roller pump, an extraluminal blood flow oxygenator (Bentley Univox, 1.8 m2), and an arterial filter (0.25 m2) and continued for 3 hr. Platelet kinetics, pooling, and counts were monitored by a Geiger probe and a Coulter counter. The thrombi in the oxygenator and arterial filter and emboli in viscera and brain were imaged with a gamma camera and measured with an ion chamber and gamma counter. Percentage of INPLT (mean +/- SD) in organs, tissues, and components of the circuit in four groups of pigs was calculated. Flow cytometry with antibodies to CD61 (GPIIIa) and CD62P (GMP-140: control) of porcine platelets was carried out with blood samples taken before, during, and after CPB for estimation of circulating platelet aggregates and platelet microparticles. Pulmonary, renal, cardiac, and cerebral emboli in pigs undergoing CPB with and without a filter were similar (p < 0.1). The amount of filter adherent thrombi was small (0.04 +/- 0.01%); oxygenator adherent thrombus in both groups was similar (p < 0.1). Emboli were found in the cerebral medulla, hippocampus, and posterior cerebral cortex in both groups. During CPB, the arterial filter functioned minimally as a trap for platelet thrombi detached from the oxygenator and circulating emboli. Flow cytometry of blood demonstrated the shift of equilibria from single platelets to platelet aggregates and microparticles during CPB and their gradual reversal to single platelets after CPB; the loosely adherent emboli disaggregated and further shifted these equilibria to single platelets and smaller aggregates, probably through the action of endogenous nitric oxide and prostacyclin. The emboli were trapped in organs and tissues and microparticles were sequestered by the reticuloendothelial system.     

An adiabatic multiple spin-echo pulse sequence: removal of systematic errors due to pulse imperfections and off-resonance effects

Poly(2-methacryloyloxyethyl phosphorylcholine) (pMPC) was grafted onto the surface of a silicon rubber (SR) membrane (pMPC-SR) by plasma induced grafted copolymerization (PIP). Argon plasma was used to activate the SR surfaces. Determination was also made of the influences of grafted copolymerization reaction time, reaction temperature, and monomer concentration on polymerization yield. The surface properties of SR were characterized by ATR-FTIR, ESCA, and SEM. In those analyses the ATR-FTIR spectra indicated that the pMPC grafted onto the SR surface at 1720 and 3300 cm(-1). The elemental composition and different carbon bindings on the surface of the SR were examined by ESCA. An increasing P1s/C1s value g was obtained in the grafted polymerization yield with a concentration of 0.05-0.5M of MPC in the isolated ethanol solution. The surface morphologies of pMPC-SR differed more than those of control and Ar plasma treated surfaces. The difference could have been caused by the homogeneous graft polymerization of pMPC onto the SR membrane. In the biological analyses, protein adsorption on pMPC-SR surfaces was reduced. The reduced level increased with an increase in the pMPC grafted amount. The epithelial cell attachment and growth onto these samples were suppressed. The blood compatibility for a series of pMPC-SR surfaces was examined by platelet adhesion. Blood platelet morphologies in contact with the high ratio of pMPC-SR surfaces were maintained, meaning that in this case the release reaction for platelets never occurred. Consequently, the high amount of pMPC-SR surface had excellent blood compatibility, further suggesting that prevention of adhesion, activation of platelets, and adsorption of blood protein could be achieved.     

A new blood compatible and permselective hollow fiber membrane for hemodialysis

The authors have prepared a blood compatible and highly permselective hemodialysis membrane composed of polyether segmented nylon. This block copolymer was synthesized by polycondensation of bis-3-aminopropyl-poly(tetramethylene oxide) (PTMO) and poly(imino-1,3-bismethyl-cyclohexyl-iminoisophtharoyl) (NyBl) prepolymer obtained by polycondensation of 1,3-bis(aminomethyl)cyclohexane (B) and isophthalic acid (I). The molecular weight (MW) calculated from the number of end-groups was 16,000-21,000. In vitro blood compatibility was evaluated in terms of platelet adhesion onto the surface. PTMO-NyBl surfaces showed excellent platelet adhesion preventing properties. The PTMO-NyBl hollow fiber membrane was obtained by a dry-wet spinning process. The membranes had higher permeability coefficients for macromolecules ranging from MW 10,000 to 20,000 than polysulfone hollow fiber membrane (PS membrane), and had acceptably low albumin permeability for use as a dialysis membrane. The ex vivo blood compatibilities of PTMO-NyBl membrane and PS membrane were investigated by extracorporeal circulation in a pig model. The PTMO-NyBl membrane gave excellent results when assessing hemodialysis leukopenia, oxidative burst, and free platelet count decrease.     

Nitric oxide prevents human platelet adhesion to fiber membranes in whole blood

During cardiopulmonary bypass or long-term extracorporeal life support, foreign surface induced platelet deposition in the oxygenator causes deterioration of gas exchange. In this study, the authors evaluated the effectiveness of nitric oxide (NO) in reducing the adhesion of platelets in whole blood to the surface of hollow fiber membranes. For this purpose, a test chamber was designed consisting of a gas exchanger with ten mitsubishi multi-layered composite hollow fibers (MHF: 257 mm OD; 203 mm ID; 70 mm length) and a polypropylene tube (16 mm OD; 100 mm length). Pure N2 (control) or nitric oxide (NO) (100 ppm, 200 ppm in N2) were delivered into the test chamber previously filled with 13 ml human whole blood. Platelet counts and platelet factor 4 (PF4), as a measure of platelet activation, were measured before and after either 1 or 2 hr of testing, and fibers were observed under scanning electron microscopic study (SEM) after each experiment. In the control and 100 ppm NO groups, platelet counts decreased and the level of PF4 increased during the 1 hr period. In the 200 ppm NO group, almost no platelet deposition could be observed on the surface of fibers under SEM. In conclusion, NO flow through hollow fiber membranes can markedly reduce platelet adhesion. Additional quantitative studies should define the optimal concentration for this effect and determine if this finding could improve oxygenator function, especially under conditions of long-term support.     

Experimental research on delayed responses in cochlear microphonics records in guinea pigs

The stability (with respect to encapsulated carboxyfluorescein release) of liposomes made from various fluorocarbon 1,2-or 1,3-di-O-alkylglycerophosphocholines (ether-connected) and their membrane permeability have been investigated in buffer and in human serum. Membranes and liposomes, whether formulated with fluorocarbon/fluorocarbon or mixed fluorocarbon/hydrocarbon, 1,2- or 1,3-di-O-alkylglycerophospholipids, display lower permeability coefficients and are able to retain more efficiently encapsulated CF, even when incubated in human serum, than any of their conventional counterparts. These fluorinated liposomes are as stable as the first generation of liposomes formulated with their fluorocarbon ester-connected 1,2-di-O-acylglycerophosphocholine analogs. These results further confirm that a fluorinated intramembranar layer reduces the permeability of membranes (more significantly when they are in a fluid state), protects them from the destabilizing effects of serum components and increases even the stability of the fluorinated liposomes whose membranes are in the gel state when incubated in human serum. The impact of the modular structure of the fluorinated phospholipids (number of fluorocarbon chains, ether vs. ester bond, 1,2- vs. 1,3-isomer, etc...) and structure/permeability/ stability relationships are also presented.     

Pancreatic diabetes in Japan

Islets of Langerhans surrounded by a semipermeable membrane to prevent an immune response by the host immunosystem is a potential way of treating type I diabetes mellitus. In this study, poly(vinyl alcohol) (PVA) tubular membranes with added polyethylene glycol to create pores in the skin layer were prepared to improve their diffusion property. In a static incubation study, islets cultured in the PVA tubular membranes still demonstrated their function of secreting insulin after 30 days. When the tubular PVA bioartificial pancreas was perifused in a small chamber with RPMI-1640 medium containing glucose at concentrations of 5.6-16.6 mmol/L, insulin release began to increase without delay. Therefore, such a membrane is an alternative potential material for a bioartificial pancreas. In addition, a mathematical mass transfer model of insulin release was developed and compared with the perifusion data. It was shown that satisfactory kinetics could be achieved with a PVA membrane. However, the model showed that the insulin output of islets cultured in the PVA tubular membrane must be increased to improve the performance significantly. These findings suggest that a bioartificial pancreas using a PVA membrane is a promising material, but the technique for seeding islets in the chamber requires further modification.     

Application of asymmetric TPX membranes to transdermal delivery of nitroglycerin

In this study, asymmetric poly(4-methyl-1-pentene) (TPX) membranes, fabricated by the dry/wet inversion method, were applied to transdermal delivery of nitroglycerin (NTG), a drug for treating angina pectoris. The flux of NTG through the TPX membrane was measured in vitro by a Franz cell. The results indicate that the NTG flux through asymmetric TPX membranes is strongly dependent on the membrane structure, which can be varied by adding nonsolvents in the casting solution. By adding different kinds of nonsolvents and adjusting the added amounts, membranes with different NTG release rates can be fabricated. It was also found that, with suitable drug formula, the NTG dissolution rate of a prototype TPX patch is comparable to that of a commercial patch, Transderm-Nitro. In addition, the data of NTG flux through a composite of TPX membrane and pig skin are also presented.     

Highly fluorinated amphiphiles and colloidal systems, and their applications in the biomedical field. A contribution

Fluorocarbons and fluorocarbon moieties are uniquely characterized by very strong intramolecular bonds and very weak intermolecular interactions. This results in a combination of exceptional thermal, chemical and biological inertness, low surface tension, high fluidity, excellent spreading characteristics, low solubility in water, and high gas dissolving capacities, which are the basis for innovative applications in the biomedical field. Perfluoroalkyl chains are larger and more rigid than their hydrogenated counterparts. They are considerably more hydrophobic, and are lipophobic as well. A large variety of well-defined, modular fluorinated surfactants whose polar head groups consist of polyols, sugars, sugar phosphates, amino acids, amine oxides, phosphocholine, phosphatidylcholine, etc, has recently been synthesized. Fluorinated surfactants are significantly more surface active than their hydrocarbon counterparts, both in terms of effectiveness and of efficiency. Despite this, they are less hemolytic and less detergent. Fluorosurfactants appear unable to extract membrane proteins. Fluorinated chains confer to surfactants a powerful driving force for collecting and organizing at interfaces. As compared to non-fluorinated analogs, fluorosurfactants have also a much stronger capacity to self-aggregate into discrete molecular assemblies when dispersed in water and other solvents. Even very short, single-chain fluorinated amphiphiles can form highly stable, heat-sterilizable vesicles, without the need for supplementary associative interactions. Sturdy microtubules were obtained from non-chiral, non-hydrogen bonding single-chain fluorosurfactants. Fluorinated amphiphiles can be used to engineer a variety of colloidal systems and manipulate their morphology, structure and properties. Stable fluorinated films, membranes and vesicles can also be prepared from combinations of standard surfactants with fluorocarbon/hydrocarbon diblock molecules. In bilayer membranes made from fluorinated amphiphiles the fluorinated tails segregate to form an internal teflon-like hydrophobic and lipophobic film that increases the stability of the membrane and reduces its permeability. This fluorinated film can also influence the behavior of fluorinated vesicles in a biological milieu. For example, it can affect the in vivo recognition and fate of particles, or the enzymatic hydrolysis of phospholipid components. Major applications of fluorocarbons currently in advanced clinical trials include injectable emulsions for delivering oxygen to tissues at risk of hypoxia; a neat fluorocarbon for treatment of acute respiratory failure by liquid ventilation; and gaseous fluorocarbon-stabilized microbubbles for use as contrast agents for ultrasound imaging. Fluorosurfactants also allow the preparation of a range of stable direct and reverse emulsions, microemulsions, multiple emulsions, and gels, some of which may include fluorocarbon and hydrocarbon and aqueous phases simultaneously. Highly fluorinated systems have potential for the delivery of drugs, prodrugs, vaccines, genes, markers, contrast agents and other materials.     

Antioxidant status and alpha1-antiproteinase activity in subarachnoid hemorrhage patients

Grafting of polyethylene glycol chains onto cellulosic membrane can be expected to reduce the interaction between blood (plasma protein and cells) and the membrane surface. Alkylether carboxylic acid (PEG acid) grafted high flux cellulosic membranes for hemodialysis, in which the polyethylene glycol chain bears an alkyl group at one side and a carboxyl group at the other side, have been developed and evaluated. PEG acid-grafted high flux cellulosic membranes with various grafting amounts have been compared with respect to platelet adhesion, the contact phase of blood coagulation, and complement activation in vitro. A new method of quantitating platelet adhesion on hollow-fiber membrane surfaces has been developed, which is based on the determination of lactate dehydrogenase (LDH) activity after lysis of the adhered platelets. PEG acid-grafted high flux cellulosic membranes showed reduced platelet adhesion and complement activation effects in grafting amounts of 200 ppm or higher without detecting adverse effects up to grafting amounts of 850 ppm. The platelet adhesion of a PEG acid-grafted cellulosic membrane depends on both the flux and grafting amounts of the membrane. It is concluded that the grafting of PEG acid onto a cellulosic membrane improves its biocompatibility as evaluated in terms of platelet adhesion, complement activation, and thrombogenicity.     

Morphologic parameters of blood platelets and dysmorphic erythrocyturia in chronic glomerulonephritis]

Dysmorphic erythrocyturia is known as an attribute of glomerular bleeding. During chronic glomerulonephritis the morphological changes of blood platelets were also observed. The subject of our study was to indicate if the common mechanism leading to blood platelets polymorphology and dysmorphic erythrocytes origination in chronic glomerulonephritis is possible. We estimate the count of blood platelets (PLT), mean platelets volume (MPV), platelet distribution weight (PDW) and platelets crit (PCT) in peripheral blood of 46 patients with chronic glomerulonephritis with dysmorphic erythrocyturia (26 with renal sufficiency and 20 with renal insufficiency) and 32 healthy volunteers. The dysmorphic erythrocyturic erythrocytes were examined in first morning urine. We have not demonstrated the correlation of changes in blood platelets morphology with percent dysmorphic erythrocytes in urine. The results of our investigations do not confirm exactly the common mechanism of the morphological changes which were observed. Minimal changes of the blood platelets parameters may be the results of changes in structure of phospholipids platelets membrane as well as less activation of platelets membrane receptors-GP Ia/IIb and GP Ic/IIa.     

Effect of methylene chain length in phospholipid moiety on blood compatibility of phospholipid polymers

To investigate the effects of the methylene chain length between the phospholipid polar group and the backbone on blood compatibility of a phospholipid polymer, copolymers of omega-methacryloyloxyalkyl phosphorylcholine (MAPC) with n-butyl methacrylate (BMA) were synthesized. The methylene chains were ethylene (n = 2), tetramethylene (n = 4), and hexamethylene (n = 6). Every MAPC copolymer with an MAPC mole fraction in the range of 0.1-0.3 was soluble in ethanol but only swelled in water, and the equilibrium water fraction of the water-swollen MAPC copolymer membrane decreased with the length of the methylene chain. When a rabbit platelet-rich plasma was applied on the MAPC copolymer surface with an 0.1 MAPC mol fraction for 180 min, the number of adhered platelets depended on the length of the methylene chain in the MAPC moiety of the copolymer. The amount of phospholipid adsorbed on the MAPC copolymer from human plasma was larger than that on hydrophobic poly(BMA) and increased with the length of the methylene chain in the MAPC moiety. That is, the reduction of platelet adhesion corresponded to the increase in the amount of phospholipid adsorbed on the MAPC copolymer.     

Effects of blood flow pulse frequency on mass transfer efficiency of a commercial hollow fibre oxygenator

The clinical advantages achievable through pulsatile blood perfusion during cardio-pulmonary bypass have recently suggested the design of new pulsatile systems for extracorporeal circulation. Still it is not clear whether current commercial membrane oxygenators could be adopted with such systems, since their behaviour with pulsatile perfusion has not been satisfactorily documented yet. In a previous paper, we assessed that pulsatile perfusion of a widely used hollow fibre oxygenator (Sorin Monolyth) at 60 bpm provides more time-consistent oxygen transfer than steady perfusion. The present work is aimed to evaluate how the pulse frequency influences the gas transfer performance of the same device. The oxygenator was subjected to in vitro trials using a roller pump with pulsatile module (Stockert Instrumente) to generate pulsed flow. Four different pulse frequencies (45, 60, 75 and 90 bpm) were investigated at a fixed blood flow rate (4.0 l/min). The experiments lasting six hours were carried out using bovine blood with inlet conditions according to AAMI standards requirements. Blood samples were withdrawn every hour and O2 and CO2 transfer rates were evaluated. The experimental findings confirm that with pulsatile blood flow no time decay take place during prolonged perfusion. Moreover, when pulse frequency increases, transition levels occur for both O2 and CO2. Over these thresholds gas transfer rates display significant increases (p < 0.05), though of little magnitude (up to 2.5% for oxygen over 60 bpm; up to 3.7% for carbon dioxide over 75 bpm).     

Membrane microviscosity and human platelet function

An increased sensitivity to epinephrine-induced aggregation has been observed both in platelets obtained from patients with type IIa hyperlipoproteinemia and in normal platelets following incubation with cholesterol-rich lecithin dispersions. We have reported previously that the membrane fraction of platelets is enriched with cholesterol relative to phospholipid under each of these conditions. To further explore the effect of cholesterol on platelet membranes, we have examined the fluidity (microviscosity) of whole platelets and platelet subcellular fractions using a hydrophobic fluorescent probe, 1,6-diphenyl-1,3,5-hexatriene (DPH), under conditions in which the cholesterol-to-phospholipid mole ratio (C/PL) of platelets was varied by incubation with various cholesterol-lecithin sonicated dispersions. The C/PL of platelets directly influenced the rotational diffusion of DPH, as indicated by changes in fluorescence polarization. This was reflected in an increase in microviscosity at 37 degrees C (ETA37) from 2.84 P in normal platelets to 4.06 P in platelets with a 118% increase in C/PL. Conversely, platelets with a 43% decrease in C/PL had a 13% decrease in eta37. A strong correlation (r = 0.94) existed between C/PL and eta37 throughout this entire range. However, C/PL had no effect on the excited-state fluorescence lifetime of DPH. Both C/PL and eta37 were lower in isolated platelet membranes than in the platelet granule fraction. When platelets were incubated for 20 h with cholesterol-rich dispersions, there was an increase in C/PL and eta37 in both the membrane and granule fractions. However, this occurred more rapidly in membranes so that, at 5 h (a time when an increased sensitivity of whole platelets to epinephrine is evident), membrane C/PL had increased 55% and eta37 had increased 42%, whereas granule C/PL and eta37 had changed minimally. Cholesterol-rich platelets and subcellular fractions had a lower fusion (or flow) activation energy for viscosity (deltaE), reflecting a higher degree of order, and the converse was true in cholesterol-poor platelets. Moreover, a strong negative correlation existed between the percent change in deltaE and the percent change in eta37 induced either by cholesterol incorporation or depletion. These data demonstrate that cholesterol influences the fluidity and the degree of order within the hydrophobic core of platelet membranes. Changes induced in these physical properties by an excess of cholesterol relative to phospholipid may underlie the abnormal reception or transmission of the aggregation stimulus in cholesterol-rich platelets.