-
Critical Care (London, England) May 2023Cytokine adsorption using the CytoSorb® adsorber has been proposed in various clinical settings including sepsis, ARDS, hyperinflammatory syndromes, cardiac surgery or... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Cytokine adsorption using the CytoSorb® adsorber has been proposed in various clinical settings including sepsis, ARDS, hyperinflammatory syndromes, cardiac surgery or recovery after cardiac arrest. The aim of this analysis is to provide evidence for the efficacy of the CytoSorb® adsorber with regard to mortality in various settings.
METHODS
We searched PubMed, Cochrane Library database and the database provided by Cytosorbents™ (01.1.2010-29.5.2022). We considered randomized controlled trials and observational studies with control groups. The longest reported mortality was defined as the primary endpoint. We computed risk ratios and 95%-confidence intervals and used DerSimonian and Lairds random effects model. We analysed all studies combined and divided them into the subgroups: sepsis, cardiopulmonary bypass surgery (CPB), other severe illness, SARS-CoV-2 infection and recovery from cardiac arrest. The meta-analysis was registered in advance (PROSPERO: CRD42022290334).
RESULTS
Of an initial 1295 publications, 34 studies were found eligible, including 1297 patients treated with CytoSorb® and 1314 controls. Cytosorb® intervention did not lower mortality (RR [95%-CI]: all studies 1.07 [0.88; 1.31], sepsis 0.98 [0.74; 1.31], CPB surgery 0.91 [0.64; 1.29], severe illness 0.95 [0.59; 1.55], SARS-CoV-2 1.58 [0.50; 4.94]). In patients with cardiac arrest, we found a significant survival advantage of the untreated controls (1.22 [1.02; 1.46]). We did not find significant differences in ICU length of stay, lactate levels, or IL-6 levels after treatment. Of the eligible 34 studies only 12 were randomized controlled trials. All observational studies showed moderate to serious risk of bias.
INTERPRETATION
To date, there is no evidence for a positive effect of the CytoSorb® adsorber on mortality across a variety of diagnoses that justifies its widespread use in intensive care medicine.
Topics: Cytokines; Adsorption; Thoracic Surgery; Cardiopulmonary Bypass; Postoperative Complications
PubMed: 37259160
DOI: 10.1186/s13054-023-04492-9 -
Journal of Clinical Apheresis Jun 2016The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing... (Review)
Review
Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue.
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the Committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Seventh Edition of the JCA Special Issue continues to maintain this methodology and rigor to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Seventh Edition, like its predecessor, has consistently applied the category and grading system definitions in the fact sheets. The general layout and concept of a fact sheet that was used since the fourth edition has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. The Seventh Edition discusses 87 fact sheets (14 new fact sheets since the Sixth Edition) for therapeutic apheresis diseases and medical conditions, with 179 indications, which are separately graded and categorized within the listed fact sheets. Several diseases that are Category IV which have been described in detail in previous editions and do not have significant new evidence since the last publication are summarized in a separate table. The Seventh Edition of the JCA Special Issue serves as a key resource that guides the utilization of therapeutic apheresis in the treatment of human disease. J. Clin. Apheresis 31:149-162, 2016. © 2016 Wiley Periodicals, Inc.
Topics: Blood Component Removal; Evidence-Based Medicine; Humans; Practice Guidelines as Topic; Societies, Medical
PubMed: 27322218
DOI: 10.1002/jca.21470 -
Critical Care (London, England) Jul 2023The oXiris is a novel filter for continuous renal replacement therapy (CRRT) featuring an adsorption coating to adsorb endotoxins and remove inflammatory mediators.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The oXiris is a novel filter for continuous renal replacement therapy (CRRT) featuring an adsorption coating to adsorb endotoxins and remove inflammatory mediators. Given that no consensus has been reached on its potential benefits in treating sepsis, a meta-analysis was conducted to assess its impact on the clinical outcomes of this patient population.
METHODS
Eleven databases were retrieved to find relevant observational studies and randomized controlled trials. The Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool were used to assess the quality of the included studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) process was employed to assess the certainty of evidence. The 28-day mortality was the primary outcome. Secondary outcomes were 7-, 14-, and 90-day mortality, length of intensive care unit (ICU) and hospital stay, ICU and hospital mortality, norepinephrine (NE) dose, interleukin-6 (IL-6) and lactate levels, and Sequential Organ Failure Assessment (SOFA) score.
RESULTS
The meta-analysis, pooling data from 14 studies, involving 695 patients, showed significant reductions in 28-day mortality [odds ratio (OR) 0.53; 95% confidence interval (CI) 0.36-0.77, p = 0.001] and length of ICU stay [weighted mean difference (WMD) - 1.91; 95% CI - 2.56 to - 1.26, p < 0.001)] in patients with sepsis using the oXiris filter compared to other filters. Besides, the SOFA score, NE dose, IL-6 and lactate levels, and 7- and 14-day mortalities were lower in the oXiris group. However, the 90-day mortality, ICU and hospital mortality, and length of hospital stay were comparable. The quality assessment of the ten observational studies indicated intermediate to high quality (average Newcastle-Ottawa score: 7.8). However, all four randomized controlled trials (RCTs) had an unclear risk of bias. The evidence for all outcomes had a low or very low level of certainty because the original study design was mainly observational studies and the RCTs included had an unclear risk of bias and a small sample size.
CONCLUSION
The treatment with the oXiris filter during CRRT in sepsis patients may be associated with lower 28-, 7-, and 14-day mortalities, lactate levels, SOFA score, NE dose, and shorter length of ICU stay. However, due to the low or very low quality of evidence, the effectiveness of oXiris filters was still uncertain. Besides, no significant difference was observed for the 90-day mortality, ICU and hospital mortality, and length of hospital stay.
Topics: Humans; Continuous Renal Replacement Therapy; Interleukin-6; Adsorption; Sepsis; Lactates
PubMed: 37424026
DOI: 10.1186/s13054-023-04555-x -
The Science of the Total Environment Mar 2022Among numerous methods developed in purification and separation industries, the adsorption process has received considerable attention due to its inexpensive, facile,... (Review)
Review
Among numerous methods developed in purification and separation industries, the adsorption process has received considerable attention due to its inexpensive, facile, and eco-friendly nature. The importance of the adsorption process causes extraordinary endeavors for modeling the adsorption isotherms during the years; thus, myriads of research have been conducted and many reviews have been published. In this paper, we have attempted to gather the most widely used adsorption isotherms and their related definitions, along with examples of correlated work of the recent decade. In the present review, 37 adsorption isotherms with about 400 references have been collected from the research published in the period of 2010-2020. The adsorption isotherms utilized are alphabetically organized for ease of access. The parameters of each isotherm, as well as the applicable definitions, are presented in the table, in addition to being discussed in the text. Another table is provided for the practical use of researchers, featuring the usage of the related isotherms in peer-reviewed studies.
Topics: Adsorption; Thermodynamics
PubMed: 34748826
DOI: 10.1016/j.scitotenv.2021.151334 -
Iranian Journal of Public Health Jan 2023Selenium (Se) is an essential element playing a vital role in the metabolism of organisms. Se can generally be discharged in the potable water through natural and... (Review)
Review
BACKGROUND
Selenium (Se) is an essential element playing a vital role in the metabolism of organisms. Se can generally be discharged in the potable water through natural and anthropogenic activities. Both excess and shortage of Se can cause significant adverse health effects in humans. Excess values of se may toxicity, leading to selenosis and alkali disease in humans and grazing animals, respectively.
METHODS
A review search was systematically carried out from the databases Embase, PubMed/MEDLINE, Scopus, PubMed Central (PMC), Google Scholar, as well as medRxiv by using the following keywords: "waste water", "bioremediation", "selenium removal", "adsorption", and "drinking water". This study provides a review of the recent literature covering the period between 2011 and 2021. After screening the full text of the articles, 27 papers were enrolled. This study reviews the reported techniques for Se removal from water and wastewater, including adsorption, biological treatment, microbial reduction, bioreactors, fungal bioreactor, algal treatment, phytoremediation, and photocatalysis.
RESULTS
Biological and bioremediation techniques, such as microbial reduction, biotransformation, and fluidized bed reactor have removal efficiency about 100%. The highest Se concentration of 15-7600 μg/L was achieved in ground waters in Ethiopia and the lowest level of 0.07 μg/L in Finland.
CONCLUSION
The combination of biological treatment with chemical or physical technologies is envisaged to optimize se elimination and to ensure ecological protection and human health safety.
PubMed: 36824240
DOI: 10.18502/ijph.v52i1.11667 -
The Science of the Total Environment Feb 2022The contamination of natural resources by hexavalent chromium (Cr(VI)) originating from natural and anthropogenic activities is a serious environmental concern. Although... (Review)
Review
The contamination of natural resources by hexavalent chromium (Cr(VI)) originating from natural and anthropogenic activities is a serious environmental concern. Although many articles on chromium remediation have been published, a comprehensive understanding of the mechanisms involved in remediation with different sorbents is not yet available. In this systematic review, the performance and applicability of several adsorptive materials for Cr(VI) removal from aqueous media are discussed, along with a detailed analysis of the mechanisms involved. Statistical analysis is applied to compare the efficacies of different adsorbents, while a similar approach is used to determine the effects of sorbent properties and experimental conditions on the adsorption capacity. A detailed analysis of the factors involved in fixed-bed column studies is also presented. A suitable desorption approach to the regeneration of the spent adsorbent and its adsorption performance in reuse is also examined. Among the different sorbents, nanoparticles and mineral-doped biochar were found to be the most effective sorbents, while the adsorption was higher at low pH (~4.0) than that at intermediate pH (6-8). Contrary to our expectation, adsorption was high for sorbents with low specific surface areas, suggesting that the adsorption of Cr(VI) is largely influenced by the chemical properties of the sorbents. The optimum adsorption in fixed-bed column systems is obtained at a lower Cr(VI) ion concentration, a lower influent flow rate, and a higher bed height. Since most of the studies reviewed herein were merely experimental and utilized ideal conditions with the presence of a single contaminant, i.e. Cr(VI) in water, further studies on adsorption dynamics with the presence of other interfering ions are suggested. This review is promising for the further development of Cr(VI) removal strategies and closes the research gaps pertaining to their challenges.
Topics: Adsorption; Anthropogenic Effects; Chromium; Hydrogen-Ion Concentration; Kinetics; Water; Water Pollutants, Chemical
PubMed: 34871684
DOI: 10.1016/j.scitotenv.2021.152055 -
Environmental Monitoring and Assessment May 2023Antimony (Sb) has been classified as a high-priority contaminant in the environment. Sb contamination resulting from the use of antimony-containing compounds in industry... (Review)
Review
Antimony (Sb) has been classified as a high-priority contaminant in the environment. Sb contamination resulting from the use of antimony-containing compounds in industry necessitates the development of efficient methods to remove it from water and wastewater. Adsorption is a highly efficient and reliable method for pollutants removal owing to its availability, recyclability, and low cost. Recently, carbonaceous materials and their applications for the removal of Sb from the aqueous matrices have received special attention worldwide. Herein, this review systematically summarizes the occurrence and exposure of Sb in the environment and on human health, respectively. Different carbon-based adsorbents have been classified for the adsorptive removal of Sb and their adsorption characteristics have been delineated. Recent development in the adsorption performance of the adsorbent materials for improving the Sb removal from the aqueous medium has been outlined. Further, to develop an understanding of the effect of different parameters like pH, competitive ions, and dissolved ions for Sb adsorption and subsequent removal have been discussed. A retrospective analysis of literature was conducted to present the adsorption behavior and underlying mechanisms involved in the removal of Sb using various adsorbents. Moreover, this study has identified emerging research gaps and emphasized the need for developing modified/engineered carbonaceous adsorbents to enhance Sb adsorption from various aqueous matrices.
Topics: Humans; Water; Wastewater; Antimony; Carbon; Retrospective Studies; Water Pollutants, Chemical; Environmental Monitoring; Adsorption
PubMed: 37248306
DOI: 10.1007/s10661-023-11322-6 -
Journal of Hazardous Materials Jun 2022Organic phosphorus flame retardants (OPFRs), as a new type of emerging contaminant, have drawn great attention over the last few years, due to their wide distribution in... (Review)
Review
Organic phosphorus flame retardants (OPFRs), as a new type of emerging contaminant, have drawn great attention over the last few years, due to their wide distribution in aquatic environments and potential toxicities to humans and living beings. Various treatment methods have been reported to remove OPFRs from water or wastewater. In this review, the performances and mechanisms for OPFRs removal with different methods including adsorption, oxidation, reduction and biological techniques are overviewed and discussed. Each technique possesses its advantage and limitation, which is compared in the paper. The degradation pathways of typical OPFRs pollutants, such as Cl-OPFRs, alkyl OPFRs and aryl OPFRs, are also reviewed and compared. The degradation of those OPFRs depends heavily upon their structures and properties. Furthermore, the implications and future perspectives in such area are discussed. The review may help identify the research priorities for OPFRs remediation and understand the fate of OPFRs during the treatment processes.
Topics: Environmental Pollutants; Flame Retardants; Humans; Organophosphates; Phosphorus; Water
PubMed: 35217347
DOI: 10.1016/j.jhazmat.2022.128517 -
The Science of the Total Environment Feb 2023Microplastics (<5 mm) (MPs) are widely distributed throughout the world, and their accumulation and migration in the environment have caused health and safety concerns.... (Review)
Review
Microplastics (<5 mm) (MPs) are widely distributed throughout the world, and their accumulation and migration in the environment have caused health and safety concerns. Currently, most of the reviewed literatures mainly focus on the distribution in various environmental media, adsorption mechanisms with different pollutants, and characterization of MPs. Therefore, the present review mainly highlights the characterization techniques of MPs and the underlying mechanisms of their combination with conventional coexisting substances (heavy metals, organic pollutants, and nutrients). We observed that massive MP pollution has been found in many areas, especially in Africa, Asia, India, South Africa, North America and Europe. The separation methods of MPs in different environmental media are basically similar, including sampling, pre-treatment, flotation, filtration and digestion. The combination of multiple characterization technologies can more precisely identify the shape, abundance, colour, and particle size of MPs. Notably, although recent reports have confirmed that MPs can act as carriers of heavy metals and carry them into organisms to cause harm, MPs have different adsorption and desorption characteristics for various heavy metals. The adsorption capacity of organic pollutants onto MPs is closely related to their hydrophobicity, specific surface area and functional group characteristics. The relative abundance of MPs in sediments and lakes had a significantly positive correlation with the mass concentration of total nitrogen in lake water, but this finding still needs to be further verified. Based on current research, we suggest that future MP research should focus on characterization technology, environmental migration, ecological effects, health risks and degradation methods.
Topics: Microplastics; Plastics; Environmental Pollutants; Water Pollutants, Chemical; Metals, Heavy; South Africa
PubMed: 36423843
DOI: 10.1016/j.scitotenv.2022.160151 -
Journal of the Royal Army Medical Corps Dec 2015Coupled plasma filtration and adsorption (CPFA) has been used in the treatment of severe sepsis with the intention of removing the proinflammatory and anti-inflammatory... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Coupled plasma filtration and adsorption (CPFA) has been used in the treatment of severe sepsis with the intention of removing the proinflammatory and anti-inflammatory mediators from the systemic circulation. It is believed that this interrupts and moderates the septic cascade, but there is uncertainty about the benefits of this therapy.
METHODS
A systematic review and meta-analysis were performed to estimate the effects of CPFA on mortality in severe sepsis. The Cochrane CENTRAL Register of Controlled Trials, CINAHL, EMBASE, MEDLINE-EBSCO-Host, MEDLINE and ProQuest, were searched from 1997 to 2013. Randomised controlled trials, prospective cohort studies and retrospective cohort studies were included using the Centre for Reviews and Dissemination (CRD) framework. Data were abstracted using standard pro forma, and studies independently reviewed by two authors to confirm inclusion criteria. Quality of studies and risk of bias were assessed using the Grading of Recommendations, Assessment, Development and Evaluation Working Group (GRADE) and Critical Appraisal Skills (CASP) criteria, respectively. Meta-analysis was performed using Review Manager (RevMan V.5.1) software. The primary outcome was 28-day mortality. Secondary outcomes were mediator adsorption (picograms/mL), mean arterial BP (mm Hg) and oxygenation ratio.
RESULTS
17 studies met the inclusion criteria (n=441 patients, 242 CPFA). 14 studies reported the primary outcome of 28-day mortality. There were 88 deaths in CPFA patients versus 118 in those receiving haemofiltration: OR 0.34 (95% CI 0.24 to 0.13). Point estimates of effect on the secondary outcomes of mean arterial pressure and oxygen ratio favoured CPFA. Studies were small and heterogenous.
CONCLUSIONS
Evidence for CPFA in severe sepsis is sparse, of poor quality and further research is required, however, this meta-analysis noted improvements in survival rates of those patients treated with CPFA.
Topics: Hemofiltration; Humans; Sepsis
PubMed: 26621809
DOI: 10.1136/jramc-2015-000552