Introduction: A substantial proportion of critically ill patients require central venous catheterization, with infection being the most significant complication. Catheter-related infections may increase ICU length of stay, morbidity, and mortality. This study aimed to identify factors contributing to these infections. Methods: This retrospective observational study included 1985 central venous and hemodialysis catheters meeting predefined inclusion criteria. Catheters were classified by insertion site as femoral, internal jugular, or subclavian. Catheter-related infections were assessed as percentages and as incidence per 1000 catheter-days. Infection risks were compared using relative risk (RR) with 95% confidence intervals (CI). Results: Catheter-related infection occurred in 309 catheters (15.6%). Infection rates did not differ significantly by insertion site when analyzed as percentages (femoral 16.7%, internal jugular 15.3%, subclavian 13.6%; p = 0.474). However, incidence analysis accounting for dwell time showed a higher infection incidence in femoral catheters (13.9 per 1000 catheter-days). Compared with subclavian catheters, femoral catheters had a significantly increased infection risk (RR 1.56; 95% CI 1.07–2.28). Conclusion: Central venous catheter-related infections are more frequent in femoral sites in a time-dependent manner. Early replacement of femoral catheters is important to reduce infection risk. In clinical practice, prevention strategies should consider not only the insertion site but also expected duration of use, frequency of access, catheter type, patient characteristics, and infection control measures
Objective: This study aims to comprehensively analyze the global scientific literature on machine perfusion (MP) using bibliometric methods, to identify publication trends, influential authors and journals, thematic evolution, research focuses, and emerging topics. Methods: A bibliometric analysis of MP research in transplantation was performed using the Web of Science Core Collection database (1982–2024). Bibliometrix (R package) was utilized to evaluate publication outputs, citation dynamics, and thematic clustering. Results: A total of 1,145 publications were identified, showing rapid growth after 2000, peaking between 2022 and 2024. The USA, UK, and Netherlands were the most productive countries. Leading investigators included Ploeg RJ, Watson CJE, Friend PJ. Keyword and thematic analyses highlighted central focuses on organ preservation, delayed graft function, ischemia-reperfusion injury, and donation after circulatory death. Normothermic machine perfusion (NMP) appeared more frequently than hypothermic machine perfusion (HMP) (65 vs 50 occurrences), while oxygenated hypothermic perfusion emerged as a recent trend. Conclusion: Thematic patterns indicate an evolution in MP research from early preservation studies toward dynamic perfusion strategies, organ-specific applications, and ex-vivo organ assessment. The literature reflects ongoing heterogeneity in perfusion protocols and reporting practices. Future research should prioritize standardized reporting, multicenter validation of viability indicators, and international harmonization of perfusion protocols.
Efficient removal of middle-to-large molecules, such as α 1 -microglobulin (α 1 -MG, 33 kDa), is essential for mitigating long-term complications in patients undergoing hemodiafiltration (HDF). However, objective evaluation of diafilter performance requires standardized laboratory systems that can reproduce clinical transport characteristics while monitoring albumin leakage. This study established an in vitro experimental system utilizing recombinant α 1 -MG to evaluate post-dilution on-line HDF. Two configurations were compared: Circuit#1, featuring an auxiliary pump at the blood outlet, and Circuit#2, where the pump was removed to optimize flow regulation. Results demonstrated that Circuit#1 significantly deviated from clinical benchmarks due to internal pressure accumulation. Conversely, Circuit#2 successfully mirrored clinical trends, showing a strong positive correlation between α 1 -MG removal and albumin leakage. Observed clearances in Circuit#2 were slightly higher than clinical averages, likely due to the smaller molecular weight of the recombinant solute (31 vs. 33 kDa), reduced circulation volume, and the absence of α 1 in vitro -MG-IgA dimer binding complexes. This validated model provides a robust and reliable platform for the standardized assessment and development of next-generation blood purification devices.
Background: Spinal cord injury (SCI) triggers oxidative stress, inflammation, and progressive neurodegeneration. Methods: Here, we developed a dual-therapy composite hydrogel that integrates niraparib-loaded chitosan nanoparticles (NICNPs) and adipose-derived stromal cells (ASCs) into a calcium alginate scaffold for sustained drug release and cell delivery. Results: NICNPs demonstrated comparable encapsulation efficiencies across formulations (44.97% ± 7.23%, 41.54% ± 4.70%, and 44.67% ± 8.81% for 1%, 3%, and 5% loading, respectively), with biphasic sustained drug release over 168 h. All hydrogels supported ASC viability; under oxidative stress, NICNP hydrogels significantly improved cell survival compared with ASC-only hydrogels. In vitro, NICNP–ASC constructs markedly reduced LPS-induced cytokines (TNF-α, IL-6, and IL-1β). In vivo, in a rat SCI model, NICNP–ASC hydrogels significantly reduced lesion volume and enhanced gray and white matter preservation compared to other formulations and the control group. Alginate hydrogel incorporating ASCs and niraparib-loaded chitosan nanoparticles at 5% w/w drug loading (HY–ASC–NICNPs-5) demonstrated maximal efficacy, showing robust parenchymal bridging, dense myelin preservation, and angiogenesis. Behavioral recovery improved significantly, with BBB scores highest in HY–ASC–NICNPs-5 at both 4 and 8 weeks. ELISA confirmed elevated neurotrophic factors and antioxidant enzymes alongside reduced inflammatory cytokines in NICNP–ASC groups, particularly in the 5% formulation. Conclusion: Overall, these dual-functional hydrogel systems created a pro-regenerative microenvironment, attenuated secondary injury cascades, and restored hindlimb motor function.
Objective: In this study, the efficacy and safety of HA60 hemoadsorption in pediatric sepsis/septic shock and multiple organ dysfunction were evaluated. Methods: Eight patients who underwent HA60 hemoperfusion were analyzed. In addition to standard sepsis treatment, all patients received a single 6-h session with the HA60 filter. Along with the vasoactive inotropic score (VIS), CRP, IL-6, PCT, ferritin, lactate, AST, ALT, LDH, and bilirubin levels were evaluated at 0, 24, 48, and 72 h. Results: The median age was 44.5 months, and 62.5% of the patients were male; 75% had underlying heart disease, all patients received invasive mechanical ventilation and CRRT, and 62.5% required ECMO. Following HA60, a significant decrease in CRP was observed up to 72 h (from 224.7 to 113.4 mg/dL; p < 0.001), together with significant reductions in IL-6, PCT, and ferritin; IL-6 decreased by 71.7%, PCT by 79.7, and ferritin by 70.6% (all p < 0.001). Lactate levels decreased from 3.5 to 2.4 mmol/L ( p < 0.001), and significant reductions were detected in AST, ALT, and LDH levels ( p < 0.001). A decrease in VIS was observed between the pre-filter and 72 h (from 55 to 45; p = 0.034), and no procedure-related adverse events or hemodynamic instability were observed. Conclusion: In our study, HA60 hemoadsorption was associated with reductions in inflammatory markers, improvements in organ function parameters, and a decrease in vasoactive inotropic scores in critically ill children with septic shock. These findings are preliminary; prospective controlled studies are needed to establish the efficacy and optimal use of HA60 in pediatric septic shock.
