三维显微定量超声在乙型肝炎肝硬化患者病情评价中的应用

目的初步评估三维显微定量超声对于乙型肝炎肝硬化及肝功能失代偿的诊断价值。 方法收集2016年1月至2017年12月青海省第四人民医院住院患者共270例，分为慢性乙型肝炎（CHB）组（102例）、代偿期肝硬化（LC）组（84例）和失代偿期LC组（84例）。入组患者均行三维显微定量超声检查、二维剪切波弹性成像检查及肝功能、血常规等检查。计算患者的天门冬氨酸氨基转移酶和血小板比率指数（APRI）评分。比较3组患者间三维显微定量超声、二维剪切波弹性成像（2D-SWE）和APRI评分差异。评价三维显微定量超声、2D-SWE和APRI评分指标对于LC以及LC相关肝功能失代偿的预测价值、灵敏度和特异度。 结果3组患者三维显微定量超声和肝脏硬度差异均有统计学意义（F = 313.52、173.36，P均< 0.001）。三维显微定量超声预测LC的受试者操作曲线下面积为0.925（95%CI：0.885～0.965，P < 0.001），取三维显微定量超声临界值为11.5分，其诊断LC的敏感度和特异度分别为85.7%和90.2%；三维显微定量超声预测LC相关肝功能失代偿的受试者操作曲线下面积为0.850（95%CI：0.795～0.905、P < 0.001），取三维显微定量超声临界值为16.5分，其诊断肝功能失代偿的敏感度和特异度分别为60.7%和89.3%。 结论本研究建立了基于三维显微超声技术的定量诊断标准，该标准可用于LC及失代偿LC的辅助诊断。     

失代偿期肝硬化患者发生感染性休克影响因素

目的探讨失代偿期肝硬化患者发生感染性休克的影响因素。 方法收集内蒙古自治区人民医院感染科2013年3月至2018年2月收治的96例失代偿期肝硬化感染性休克患者，就其性别、年龄、住院时间、感染部位、病原微生物、基础疾病、白蛋白（ALB）、C-反应蛋白（CRP）、降钙素原（PCT）和临床转归等与同期未发生感染性休克的失代偿期肝硬化患者进行回顾性对比分析。 结果入组的96例患者中肺部感染居首位，占46.8%（45/96），其次为腹腔感染[32.4%（31/96）]。96例患者中培养分离出病原菌者21例（21.9%）共23株，其中革兰阴性杆菌为78.3%（18/23），革兰阳性球菌为21.7%（5/23）。发生感染性休克患者的年龄、糖尿病、住院时间、ALB、CRP和PCT等与同期未发生感染性休克的肝硬化患者差异均有统计学意义（χ² = 27.324、P < 0.001，χ² = 16.146，P < 0.001，χ² = 30.007、P < 0.001，χ² = 26.984、P < 0.001，χ² = 88.821、P < 0.001，χ² = 96.028、P < 0.001）。96例失代偿期肝硬化患者感染性休克病死率为39.6%，显著高于未发生感染性休克的肝硬化患者（8.5%），差异具有统计学意义（χ² = 77.070，P < 0.001）。 结论失代偿期肝硬化感染性休克患者的病死率较高，与患者年龄、病原微生物、感染部位、糖尿病病史、住院时间相关；ALB、CRP和PCT为失代偿期肝硬化患者发生感染性休克的早期敏感检测指标。     

肝硬化失代偿期低钠血症相关因素分析及护理

目的 探讨肝硬化失代偿期发生低钠血症的相关因素及护理措施。方法 从护理的角度对96例肝硬化失代偿期低钠血症患者的临床资料进行由顾性分析。结果 96例肝硬化患者失代偿期低钠血症的诱发因素主要为摄入不足与排出过多、利尿剂使用不当、长期低钠饮食和多次放腹水。不同程度低钠血症患者肝性脑病、肝肾综合征的发生率及预后比较．差异有显著性意义（P〈0．05。P〈0．01）。结论 临床护理工作中需密切注意肝硬化失代偿期低钠血症的各项相关因素。根据不同原因进行心理护理和饮食指导．加强治疗中用药观察和护理．预防肝性脑病和肝肾综合征的发生。     

经门静脉自体骨髓细胞回输治疗失代偿期肝硬化42例疗效分析

目的观察经门静脉自体骨髓细胞回输治疗失代偿期肝硬化患者的效果及安全性。方法回顾分析42例接受经门静脉输液港途径回输自体骨髓细胞治疗的失代偿期肝硬化患者的临床资料。比较患者术前、术后连续3个月血清丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、清蛋白(ALB)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及临床症状、腹部体征改善情况。结果除1例患者术后因肝性脑病加重死亡外,其余患者自体骨髓细胞回输术后1个月及3个月的ALT、TBIL、ALB、PT、APTT均较术前改善,差异有统计学意义(P0.05)。自体骨髓细胞回输术后3个月,患者乏力好转30例,食欲改善32例,腹胀减轻29例,腹腔积液减少25例。未发现严重不良反应及并发症。结论经门静脉自体骨髓细胞回输治疗失代偿期肝硬化患者疗效确切、安全性好。     

拉米夫定和(或)阿德福韦酯治疗失代偿期乙型肝炎肝硬化3年疗效观察

目的 观察拉米夫定和(或)阿德福韦酯治疗失代偿期乙型肝炎肝硬化3年疗效.方法 收集乙型肝炎肝硬化失代偿期患者68例,分为抗病毒治疗组和对照组,观察入组患者的临床症状、体征、生化指标、HBV DNA和Child-Pugh分级等变化情况.结果 随访治疗中,治疗组6个月后ALT、ALB和HBV DNA水平均较对照组有明显改善,12个月后TBil和Child-Pugh评分较对照组有明显改善,差异具有统计学意义(P<0.05);治疗组和对照组36个月生存率分别为62.5%和36.1%,差异具有统计学意义(P< 0.05);36个月后治疗组和对照组肝细胞癌发生率分别为3.1%和8.3%,差异无统计学意义.结论 拉米夫定和(或)阿德福韦酯治疗失代偿期乙型肝炎肝硬化,能够改善患者肝功能,延缓疾病进展,提高生存率.     

乙肝后肝硬化失代偿期患者抗病毒治疗的疗效与经济学研究

目的：对乙肝后肝硬化失代偿期患者分别采用抗病毒治疗和一般护肝治疗,观察两组患者的临床疗效及经济学效益差异。方法选择我院接诊的155例乙肝后肝硬化失代偿期患者,其中98例患者采用抗病毒治疗（实验组）,57例患者仅采用一般护肝治疗（对照组）。疗程结束后,观察两组患者的临床疗效,同时进行经济成本与效果分析。结果实验组患者死亡5例,对照组患者死亡18例,占总死亡率的78.2%。且临床疗效实验组患者明显优于对照（P＜0.05）;经济成本与效果分析,实验组患者经济成本明显低于对照组（P＜0.05）。结论采用抗病毒药物治疗乙肝后肝硬化失代偿期患者疗效好、费用低,是治疗乙肝后肝硬化失代偿期患者的重要治疗手段。     

肝硬化失代偿期并发肠梗阻患者生存质量及影响因素分析

目的了解肝硬化失代偿期并发肠梗阻患者的生存质量,并分析其影响因素,为临床干预提供依据。方法回顾性收集2018年8月—2019年8月在湖北医药学院附属人民医院收治的39例肝硬化失代偿期并发肠梗阻患者的病例资料,设为观察组,其中男性25例,女性14例,年龄(52.34±2.64)岁,年龄范围39~64岁。采取单纯随机抽样中的随机数字表法,抽取同期42例硬化失代偿期未并发肠梗阻患者的病例资料设为对照组,其中男性30例,女性12例,年龄(51.34±3.45)岁,年龄范围37~68岁。分别对两组患者采用慢性肝病患者生存质量量表——慢性肝病问卷进行调查,比较两组患者的腹部症状、疲劳、全身症状、活动、情感、焦虑各维度得分及生存质量总分,并对影响因素进行分析,其中,正态分布的计量资料采用均数±标准差(Mean±SD)表示,两组间比较采用t检验。计数资料采用χ2检验。生存质量影响因素采用多元线性回归分析。结果观察组患者的腹部症状、疲劳、全身症状、活动、情感、焦虑得分以及总分得分分别为(5.58±1.79)、(4.23±1.74)、(4.93±1.39)、(5.36±1.36)、(4.74±1.05)、(4.26±1.25)、(31.06±6.53)分,对照组得分分别为(6.27±1.12)、(5.47±1.26)、(6.14±0.78)、(5.88±0.93)、(5.45±0.82)、(4.96±0.94)、(33.79±4.01)分,观察组得分均低于对照组,两组间的比较差异均具有统计学意义(P<0.05);多元线性回归结果显示,病程,肝功能Child-Pugh分级,腹痛、腹胀、乏力等不适症状,营养状况,性别,年龄,医疗费用支付方式,家庭人均月收入,焦虑是其影响因素。结论肝硬化失代偿期并发肠梗阻患者的生存质量低于肝硬化失代偿期未并发肠梗阻患者,其影响因素有疾病相关因素,也有非疾病相关因素,医务人员应根据患者情况,给予患者针对性的干预,尽可能改善患者的生存质量。     

乙型肝炎失代偿期肝硬化患者肠道菌群特征

目的观察乙型肝炎失代偿期肝硬化患者肠道菌群特征。 方法收集首都医科大学附属北京地坛医院收治的符合入排标准的乙型肝炎失代偿期肝硬化患者及健康者粪便标本共82例，其中乙型肝炎失代偿期肝硬化且不合并其他感染者41例和健康对照者41例。所有标本均进行细菌16S rDNA高通量测序，并用Qiime软件、R软件以及LEfSe软件分析菌群构成、丰度和差异性等特征，同时分析两组研究对象肝硬化生态失调比值的差异。 结果乙型肝炎失代偿期肝硬化组患者粪便菌群丰度及多样性较健康对照组显著降低，Weighted Unifrac的Beta多样性分析显示两组研究对象肠道菌群结构差异有统计学意义（P = 0.004）。门水平方面，乙型肝炎失代偿期肝硬化组患者厚壁菌门丰度较健康对照组显著降低（Z =－2.57、P = 0.045）。属水平方面，乙型肝炎失代偿期肝硬化患者组链球菌属、梭杆菌属、韦荣球菌属和嗜血杆菌属丰度较健康对照组显著增加（P均< 0.05）；毛螺菌属、Dorea、Dialister、Subdoligranulum丰度较健康对照组显著降低（P均< 0.05）。使用LEfSe软件比较两组人群菌群差异及其功能，发现两组间具有显著差异的菌群生物学指标有乳杆菌目、梭菌目毛螺菌科及瘤胃菌科（LDA > 4）。 结论乙型肝炎失代偿期肝硬化且不合并感染者的肠道菌群多样性显著降低、厚壁菌门相对丰度显著降低，存在显著的肠道菌群失衡，但菌群失衡程度较轻，涉及显著变化的菌属较少。     

严重烧伤后液体复苏及早期救治的进展

烧伤休克是严重烧伤后最早期出现的影响病情发展与救治效果的全身性复杂性病理生理过程与临床综合征。临床过程可分为3期：代偿期、失代偿隐匿期(亦可称为失代偿前期)和失代偿显性期。国内外学者一致认为，严重烧伤患者能否平稳渡过烧伤休克期，对救治成功率有重要影响。伤后早期治疗对预后的影响非常大，英国Stone和Pape将此期称为“gold time。     

替比夫定治疗乙型肝炎肝硬化失代偿期患者80例临床疗效观察

核苷(酸)类抗病毒药物治疗可以提高乙型肝炎肝硬化患者的生存率,甚至使部分患者暂不需要进行肝移植[1].替比夫定(ldt)是一种合成的胸腺嘧啶核苷类似物,抗病毒作用强,并可选择性地抑制hbv dna聚合酶的活性,实验及临床研究均证实其是一种特异而高效的抗hbv药物[2].然而,有关替比夫定(ldt)对乙型肝炎肝硬化尤其是失代偿期肝硬化患者的疗效在肝功能改善、病毒抑制以及症状缓解等方面的资料并不多.本研究观察了替比夫定治疗乙型肝炎失代偿期肝硬化患者的临床疗效,现报道如下.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.