Elucidation of a mechanism of cell lysis by chorhexidine : a biophysical approach

Chlorhexidine is an effective antiseptic used widely in disinfecting products (hand soap), oral products (mouthwash), and is known to have potential applications in the textile industry. Chlorhexidine has been studied extensively through a biological and biochemical lens, showing evidence that it attacks the semipermeable membrane in bacterial cells. Although extremely lethal to bacterial cells, the present understanding of the exact mode of action of chlorhexidine is incomplete. A biophysical approach has been taken to investigate the potential location of chlorhexidine in the lipid bilayer. Deuterium nuclear magnetic resonance was used to characterize the molecular arrangement of mixed phospholipid/drug formulations. Powder spectra were analyzed using the de-Pake-ing technique, a method capable of extracting both the orientation distribution and the anisotropy distribution functions simultaneously. The results from samples of protonated phospholipids mixed with deuterium-labelled chlorhexidine are compared to those from samples of deuterated phospholipids and protonated chlorhexidine to determine its location in the lipid bilayer. A series of neutron scattering experiments were also conducted to study the biophysical interaction of chlorhexidine with a model phospholipid membrane of DMPC, a common saturated lipid found in bacterial cell membranes. The results found the hexamethylene linker to be located at the depth of the glycerol/phosphate region of the lipid bilayer. As drug concentration was increased in samples, a dramatic decrease in bilayer thickness was observed. Differential scanning calorimetry experiments have revealed a depression of the DMPC bilayer gel-to-lamellar phase transition temperature with an increasing drug concentration. The enthalpy of the transition remained the same for all drug concentrations, indicating a strictly drug/headgroup interaction, thus supporting the proposed location of chlorhexidine. In combination, these results lead to the hypothesis that the drug is folded approximately in half on its hexamethylene linker, with the hydrophobic linker at the depth of the glycerol/phosphate region of the lipid bilayer and the hydrophilic chlorophenyl groups located at the lipid headgroup. This arrangement seems to suggest that the drug molecule acts as a wedge to disrupt the bilayer. In vivo, this should make the cell membrane leaky, which is in agreement with a wide range of bacteriological observations.

Crystal Structures and Spectral Aspects of Mixed Ligand Transition Metal Chelates Derived from Aldehyde based ONS Donor Thiosemicarbazones

Thiosemicarbazones have emerged as an important class of ligands over a period of time, for a variety of reasons, such as variable donor properties, structural diversity and biological applications. Interesting as the coordination chemistry may be, the driving force for the study of these ligands has undoubtedly been their biological properties and the majority of the 3000 or so publications on thiosemicarbazones since 2000 have alluded to this feature. Thiosemicarbazones with potential donor atoms in their structural skeleton fascinate coordination chemists with their versatile chelating behavior. The thiosemicarbazones of aromatic aldehydes and ketones form stable chelates with transition metal cations by utilizing both their sulfur and azomethine nitrogen as donor atoms. They have been shown to possess a diverse range of biological activities including anticancer, antitumor, antibacterial, antiviral, antimalarial and antifungal properties owing to their ability to diffuse through the semipermeable membrane of the cell lines. The enhanced effect may be attributed to the increased lipophilicity of the metal complexes compared to the ligand alone.

Synthese C-glycosidischer und N-methylierter Glycosylaminosäuren für den Aufbau von Mimetika tumorassoziierter MUC1-Glycopeptidantigene unter Verwendung mikrostrukturierter Reaktoren

Zur Synthese hydrolysestabiler MUC1-Antitumorvakzine wurde im Rahmen dieser Arbeit zunächst ein Verfahren zur effizienten N Methylierung von Fmoc-Aminosäuren entwickelt. Die Synthese erfolgte in einer zweistufigen Umsetzung über Oxazolidinone unter Verwendung eines Tube-in-Tube-Durchflussreaktors mit einer semipermeablen Membran aus Teflon® AF 2400. In diesem Tube-in-Tube-Reaktor wurde in der ersten Stufe das Modellsubstrat Fmoc-Alanin bereits nach 2 h annähernd quantitativ in das entsprechende Oxazolidinon umgesetzt. In der zweiten Stufe wurde mit TFA erstmals eine Flüssigkeit durch eine solche Membran des Tube-in-Tube-Reaktors eingeleitet und lieferte innerhalb einer Stunde zahlreiche aliphatische, aromatische und funktionalisierte N-Methylaminosäuren in hohen Ausbeuten.rnDes Weiteren wurden erstmals sensible Glycosylaminosäuren, darunter auch TN Antigen-Strukturen, N-methyliert. Sie dienen als Bausteine für die Synthese von MUC1-Antitumorvakzinen. Neben Fmoc-N-Methyl-TN-Threonin konnten die Fmoc-geschützten N-Methyl-TN-Serin, N-Methyl-Sialyl-TN-Threonin sowie zwei N-Methyl-C Glycosylaminosäuren und in guten Ausbeuten erhalten werden. Anschließend wurde das N methylierte TN-Threonin gezielt in die tandem repeat-Sequenz des MUC1 in einer Festphasenpeptidsynthese eingebaut. Um einen direkten Vergleich bezüglich der N Methylierung im MUC1-Glycopeptide und dem darauf folgenden Einfluss auf die Tumorselektivität der resultierenden Vakzine erhalten zu können, wurde zudem ein Referenzpeptid aufgebaut. Zur Vollendung der Vakzinsynthese erfolgte die Konjugation beider Glycopeptidantigene an die jeweiligen BSA- und TTox-Proteine. rnEin alternativer Zugang zu hydrolysestabilen Glycopeptidbausteinen wurde im letzten Teil der Arbeit über die Synthese von α C Glycosylaminosäuren erarbeitet. Der entwickelte Syntheseweg basiert auf einer Ugi-Vier-Komponenten-Reaktion aus Aldehyd, Amin, Nitril und Carbonsäure. Als benötigte Aldehydkomponenten wurden ein einfaches Galactose- sowie ein Galactosamin-Derivat verwendet. Zum Aufbau des C-glycosidischen Grundgerüsts wurde eine Mikrowellen-unterstützte C-Allylierungsvariante im Durchfluss realisiert. Die Galactose- und Galactosaminaldehyde wurden danach mit chirale Glycosylaminen umgesetzt.

Critical review of coupled flux formulations for clay membranes based on nonequilibrium thermodynamics

Extensive research conducted over the past several decades has indicated that semipermeable membrane behavior (i.e., the ability of a porous medium to restrict the passage of solutes) may have a significant influence on solute migration through a wide variety of clay-rich soils, including both natural clay formations (aquitards, aquicludes) and engineered clay barriers (e.g., landfill liners and vertical cutoff walls). Restricted solute migration through clay membranes generally has been described using coupled flux formulations based on nonequilibrium (irreversible) thermodynamics. However, these formulations have differed depending on the assumptions inherent in the theoretical development, resulting in some confusion regarding the applicability of the formulations. Accordingly, a critical review of coupled flux formulations for liquid, current, and solutes through a semipermeable clay membrane under isothermal conditions is undertaken with the goals of explicitly resolving differences among the formulations and illustrating the significance of the differences from theoretical and practical perspectives. Formulations based on single-solute systems (i.e., uncharged solute), single-salt systems, and general systems containing multiple cations or anions are presented. Also, expressions relating the phenomenological coefficients in the coupled flux equations to relevant soil properties (e.g., hydraulic conductivity and effective diffusion coefficient) are summarized for each system. A major difference in the formulations is shown to exist depending on whether counter diffusion or salt diffusion is assumed. This difference between counter and salt diffusion is shown to affect the interpretation of values for the effective diffusion coefficient in a clay membrane based on previously published experimental data. Solute transport theories based on both counter and salt diffusion then are used to re-evaluate previously published column test data for the same clay membrane. The results indicate that, despite the theoretical inconsistency between the counter-diffusion assumption and the salt-diffusion conditions of the experiments, the predictive ability of solute transport theory based on the assumption of counter diffusion is not significantly different from that based on the assumption of salt diffusion, provided that the input parameters used in each theory are derived under the same assumption inherent in the theory. Nonetheless, salt-diffusion theory is fundamentally correct and, therefore, is more appropriate for problems involving salt diffusion in clay membranes. Finally, the fact that solute diffusion cannot occur in an ideal or perfect membrane is not explicitly captured in any of the theoretical expressions for total solute flux in clay membranes, but rather is generally accounted for via inclusion of an effective porosity, n(e), or a restrictive tortuosity factor, tau(r), in the formulation of Fick's first law for diffusion. Both n(e) and tau(r) have been correlated as a linear function of membrane efficiency. This linear correlation is supported theoretically by pore-scale modeling of solid-liquid interactions, but experimental support is limited. Additional data are needed to bolster the validity of the linear correlation for clay membranes. Copyright 2012 Elsevier B.V. All rights reserved.

Critical Review of Coupled Flux Formulations for Clay Membranes Based on Nonequilibrium Thermodynamics

Extensive research conducted over the past several decades has indicated that semipermeable membrane behavior (i.e., the ability of a porous medium to restrict the passage of solutes) may have a significant influence on solute migration through a wide variety of clay-rich soils, including both natural clay formations (aquitards, aquicludes) and engineered clay barriers (e.g., landfill liners and vertical cutoff walls). Restricted solute migration through clay membranes generally has been described using coupled flux formulations based on nonequilibrium (irreversible) thermodynamics. However, these formulations have differed depending on the assumptions inherent in the theoretical development, resulting in some confusion regarding the applicability of the formulations. Accordingly, a critical review of coupled flux formulations for liquid, current, and solutes through a semipermeable clay membrane under isothermal conditions is undertaken with the goals of explicitly resolving differences among the formulations and illustrating the significance of the differences from theoretical and practical perspectives. Formulations based on single-solute systems (i.e., uncharged solute), single-salt systems, and general systems containing multiple cations or anions are presented. Also, expressions relating the phenomenological coefficients in the coupled flux equations to relevant soil properties (e.g., hydraulic conductivity and effective diffusion coefficient) are summarized for each system. A major difference in the formulations is shown to exist depending on whether counter diffusion or salt diffusion is assumed. This difference between counter and salt diffusion is shown to affect the interpretation of values for the effective diffusion coefficient in a clay membrane based on previously published experimental data. Solute transport theories based on both counter and salt diffusion then are used to re-evaluate previously published column test data for the same clay membrane. The results indicate that, despite the theoretical inconsistency between the counter-diffusion assumption and the salt-diffusion conditions of the experiments, the predictive ability of solute transport theory based on the assumption of counter diffusion is not significantly different from that based on the assumption of salt diffusion, provided that the input parameters used in each theory are derived under the same assumption inherent in the theory. Nonetheless, salt-diffusion theory is fundamentally correct and, therefore, is more appropriate for problems involving salt diffusion in clay membranes. Finally, the fact that solute diffusion cannot occur in an ideal or perfect membrane is not explicitly captured in any of the theoretical expressions for total solute flux in clay membranes, but rather is generally accounted for via inclusion of an effective porosity, ne, or a restrictive tortuosity factor, tr, in the formulation of Fick's first law for diffusion. Both ne and tr have been correlated as a linear function of membrane efficiency. This linear correlation is supported theoretically by pore-scale modeling of solid-liquid interactions, but experimental support is limited. Additional data are needed to bolster the validity of the linear correlation for clay membranes.

Multimode Analysis of Nanoscale Biomolecular Interactions

Biomolecular interactions, including protein-protein, protein-DNA, and protein-ligand interactions, are of special importance in all biological systems. These interactions may occer during the loading of biomolecules to interfaces, the translocation of biomolecules through transmembrane protein pores, and the movement of biomolecules in a crowded intracellular environment. The molecular interaction of a protein with its binding partners is crucial in fundamental biological processes such as electron transfer, intracellular signal transmission and regulation, neuroprotective mechanisms, and regulation of DNA topology. In this dissertation, a customized surface plasmon resonance (SPR) has been optimized and new theoretical and label free experimental methods with related analytical calculations have been developed for the analysis of biomolecular interactions. Human neuroglobin (hNgb) and cytochrome c from equine heart (Cyt c) proteins have been used to optimize the customized SPR instrument. The obtained Kd value (~13 µM), from SPR results, for Cyt c-hNgb molecular interactions is in general agreement with a previously published result. The SPR results also confirmed no significant impact of the internal disulfide bridge between Cys 46 and Cys 55 on hNgb binding to Cyt c. Using SPR, E. coli topoisomerase I enzyme turnover during plasmid DNA relaxation was found to be enhanced in the presence of Mg2+. In addition, a new theoretical approach of analyzing biphasic SPR data has been introduced based on analytical solutions of the biphasic rate equations. In order to develop a new label free method to quantitatively study protein-protein interactions, quartz nanopipettes were chemically modified. The derived Kd (~20 µM) value for the Cyt c-hNgb complex formations matched very well with SPR measurements (Kd ~16 µM). The finite element numerical simulation results were similar to the nanopipette experimental results. These results demonstrate that nanopipettes can potentially be used as a new class of a label-free analytical method to quantitatively characterize protein-protein interactions in attoliter sensing volumes, based on a charge sensing mechanism. Moreover, the molecule-based selective nature of hydrophobic and nanometer sized carbon nanotube (CNT) pores was observed. This result might be helpful to understand the selective nature of cellular transport through transmembrane protein pores.

Bacterial cellulose membrane as flexible substrate for organic light emitting devices

Bacterial cellulose (BC) membranes produced by gram-negative, acetic acid bacteria (Gluconacetobacter xylinus), were used as flexible substrates for the fabrication of Organic Light Emitting Diodes (OLED). In order to achieve the necessary conductive properties indium tin oxide (ITO) thin films were deposited onto the membrane at room temperature using radio frequency (r.f) magnetron sputtering with an r.f. power of 30 W, at pressure of 8 mPa in Ar atmosphere without any subsequent thermal treatment. Visible light transmittance of about 40% was observed. Resistivity, mobility and carrier concentration of deposited ITO films were 4.90 x 10(-4) Ohm cm, 8.08 cm(2)/V-s and -1.5 x 10(21) cm(-3), respectively, comparable with commercial ITO substrates. In order to demonstrate the feasibility of devices based on BC membranes three OLEDs with different substrates were produced: a reference one with commercial ITO on glass, a second one with a SiO(2) thin film interlayer between the BC membrane and the ITO layer and a third one just with ITO deposited directly on the BC membrane. The observed OLED luminance ratio was: 1; 0.5; 0.25 respectively, with 2400 cd/m(2) as the value for the reference OLED. These preliminary results show clearly that the functionalized biopolymer, biodegradable, biocompatible bacterial cellulose membranes can be successfully used as substrate in flexible organic optoelectronic devices. (C) 2008 Elsevier B.V. All rights reserved.

New sensing platforms based on nanoscopic devices for probing protein-membrane interactions

A novel nanosized and addressable sensing platform based on membrane coated plasmonic particles for detection of protein adsorption using dark field scattering spectroscopy of single particles has been established. To this end, a detailed analysis of the deposition of gold nanorods on differently functionalized substrates is performed in relation to various factors (such as the pH, ionic strength, concentration of colloidal suspension, incubation time) in order to find the optimal conditions for obtaining a homogenous distribution of particles at the desired surface number density. The possibility of successfully draping lipid bilayers over the gold particles immobilized on glass substrates depends on the careful adjustment of parameters such as membrane curvature and adhesion properties and is demonstrated with complementary techniques such as phase imaging AFM, fluorescence microscopy (including FRAP) and single particle spectroscopy. The functionality and sensitivity of the proposed sensing platform is unequivocally certified by the resonance shifts of the plasmonic particles that were individually interrogated with single particle spectroscopy upon the adsorption of streptavidin to biotinylated lipid membranes. This new detection approach that employs particles as nanoscopic reporters for biomolecular interactions insures a highly localized sensitivity that offers the possibility to screen lateral inhomogeneities of native membranes. As an alternative to the 2D array of gold nanorods, short range ordered arrays of nanoholes in optically transparent gold films or regular arrays of truncated tetrahedron shaped particles are built by means of colloidal nanolithography on transparent substrates. Technical issues mainly related to the optimization of the mask deposition conditions are successfully addressed such that extended areas of homogenously nanostructured gold surfaces are achieved. Adsorption of the proteins annexin A1 and prothrombin on multicomponent lipid membranes as well as the hydrolytic activity of the phospholipase PLA2 were investigated with classical techniques such as AFM, ellipsometry and fluorescence microscopy. At first, the issues of lateral phase separation in membranes of various lipid compositions and the dependency of the domains configuration (sizes and shapes) on the membrane content are addressed. It is shown that the tendency for phase segregation of gel and fluid phase lipid mixtures is accentuated in the presence of divalent calcium ions for membranes containing anionic lipids as compared to neutral bilayers. Annexin A1 adsorbs preferentially and irreversibly on preformed phosphatidylserine (PS) enriched lipid domains but, dependent on the PS content of the bilayer, the protein itself may induce clustering of the anionic lipids into areas with high binding affinity. Corroborated evidence from AFM and fluorescence experiments confirm the hypothesis of a specifically increased hydrolytic activity of PLA2 on the highly curved regions of membranes due to a facilitated access of lipase to the cleavage sites of the lipids. The influence of the nanoscale gold surface topography on the adhesion of lipid vesicles is unambiguously demonstrated and this reveals, at least in part, an answer for the controversial question existent in the literature about the behavior of lipid vesicles interacting with bare gold substrates. The possibility of formation monolayers of lipid vesicles on chemically untreated gold substrates decorated with gold nanorods opens new perspectives for biosensing applications that involve the radiative decay engineering of the plasmonic particles.

Development of a Composite ion-exchange membrane for PDMS-based microfluidic devices

The purpose of this research is to investigate potential methods to produce an ion-exchange membrane that can be integrated directly into a polydimethylsiloxane Lab-on-a-Chip or Micro-Total-Analysis-System. The majority of microfluidic membranes are based on creating microporous structures, because it allows flexibility in the choice of material such that it can match the material of the microfluidic chip. This cohesion between the material of the microfluidic chip and membrane is an important feature to prevent bonding difficulties which can lead to leaking and other practical problems. However, of the materials commonly used to manufacture microfluidic chips, there are none that provide the ion-exchange capability. The DuPont product Nafion{TM} is chosen as the ion-exchange membrane, a copolymer with high conductivity and selectivity to cations and suitable for many applications such as electrolysis of water and the chlor-alkali process. The use of such an ion-exchange membrane in microfluidics could have multiple advantages, but there is no reversible/irreversible bonding that occurs between PDMS and Nafion{TM}. In this project multiple methods of physical entrapment of the ion-exchange material inside a film of PDMS are attempted. Through the use of the inherent properties of PDMS, very inexpensive sugar granulate can be used to make an inexpensive membrane mould which does not interfere with the PDMS crosslinking process. After dissolving away this sacrificial mould material, Nafion{TM} is solidified in the irregular granulate holes. Nafion{TM} in this membrane is confined in the irregular shape of the PDMS openings. The outer structure of the membrane is all PDMS and can be attached easily and securely to any PDMS-based microfluidic device through reversible or irreversible PDMS/PDMS bonding. Through impedance measurement, the effectiveness of these integrated membranes are compared against plain Nafion{TM} films in simple sodium chloride solutions.

Sterilization of Medical Devices by Ethylene Oxide, Determination of the Dissipation of Residues, and Use of Green Fluorescent Protein as an Indicator of Process Control

Ethylene oxide (EO) is used to sterilize Oxygenator and Tubing applied to heart surgery. Residual levels of EO and its derivatives, ethylene chlorohydrin (ECH) and ethylene glycol (EG), may be hazardous to the patients. Therefore, it must be removed by the aeration process. This study aimed to estimate the minimum aeration time for these devices to attain safe limits for use (avoiding excessive aeration time) and to evaluate the Green Fluorescent Protein (GFP) as a biosensor capable of best indicating the distribution and penetration of EO gas throughout the sterilization chamber. Sterilization cycles of 2, 4, and 8 h were monitored by Bacillus atrophaeus ATCC 9372 as a biological indicator (131) and by the GFP. Residual levels of EO, ECH, and EG were determined by gas chromatography (GC), and the residual dissipation was studied. Safe limits were reached right after the sterilization process for Oxygenator and after 204 h of aeration for Tubing. In the 2 h cycle, the GFP concentration decreased from 4.8 (+/- 3.2)% to 7.5 (+/- 2.5)%. For the 4 h cycle, the GFP concentration decreased from 17.4 (+/- 3.0)% to 21.5 (+/- 6.8)%, and in the 8 h cycle, it decreased from 22.5 (+/- 3.2)% to 23.9 (+/- 3.9)%. This finding showed the potentiality for GFP applications as an EO biosensor. (C) 2009 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 9113: 626-630, 2009

Cucurbit[6]uril/PVC-based semipermeable membranes as electrode modifiers for electrochemical investigation of insoluble substrates

We have described here a new kind of membrane material which acts as an ionic conductor on the surface of modified electrodes. Using these membranes it is possible to assemble highly efficient modified electrodes for electrochemical investigation of insoluble substrates. These materials can easily replace carbon paste electrodes and Nafion (R) for this purpose with a series of advantages. (C) 2009 Elsevier B.V. All rights reserved.

Membrane selectivity versus sensor response in hydrogenated amorphous silicon CHEMFETs using a semi-empirical model

Toxic amides, such as acrylamide, are potentially harmful to Human health, so there is great interest in the fabrication of compact and economical devices to measure their concentration in food products and effluents. The CHEmically Modified Field Effect Transistor (CHEMFET) based onamorphous silicon technology is a candidate for this type of application due to its low fabrication cost. In this article we have used a semi-empirical modelof the device to predict its performance in a solution of interfering ions. The actual semiconductor unit of the sensor was fabricated by the PECVD technique in the top gate configuration. The CHEMFET simulation was performed based on the experimental current voltage curves of the semiconductor unit and on an empirical model of the polymeric membrane. Results presented here are useful for selection and design of CHEMFET membranes and provide an idea of the limitations of the amorphous CHEMFET device. In addition to the economical advantage, the small size of this prototype means it is appropriate for in situ operation and integration in a sensor array.

Saloplastic membranes as green devices for soft tissue regeneration

Implantable devices must exhibit mechanical properties similar to native tissues to promote appropriate cellular behavior and regeneration. Herein, we report a new membrane manufacture method based on the synthesis of polyelectrolyte complexes (PECs) that exhibit saloplasticity, i.e. variable physical-chemistry using salt as a plasticizer. This is a Green Chemistry approach, as PECs generate structures that are stabilized solely by reversible electrostatic interactions, avoiding the use of harmful crosslinkers completely. Furthermore, natural polyelectrolytes - chitosan and alginate - were used. Upon mixing them, membranes were obtained by drying the PECs at 37ºC, yielding compact PECs without resorting to organicsolvents. The plasticizing effect of salt after synthesis was shown by measuring tensile mechanical properties, which were lower when samples were immersed in high ionic strength solutions.Salt was also used during membrane synthesis in different quan- tities (0 M, 0.15 M and 0.5 M in NaCl) yielding structures with no significant differences in morphology and degradation (around 15% after 3 months in lysozyme). However, swelling was higher (about 10x) when synthesized in the presence of salt. In vitro cell studies using L929 fibroblasts showed that cells adhered and proliferated preferentially in membranes fabricated in the presence of salt (i.e. the membranes with lower tensile strength). Structures with physical-chemical properties controlled with precision open a path to tissue engineering strategies depending on fine tuning mechanical properties and cellular adhesion simply by changing ionic strength during membrane manufacture

Cardiopulmonary support and extracorporeal membrane oxygenation for cardiac assist.

BACKGROUND: Use of cardiopulmonary bypass for emergency resuscitation is not new. In fact, John Gibbon proposed this concept for the treatment of severe pulmonary embolism in 1937. Significant progress has been made since, and two main concepts for cardiac assist based on cardiopulmonary bypass have emerged: cardiopulmonary support (CPS) and extracorporeal membrane oxygenation (ECMO). The objective of this review is to summarize the state of the art in these two technologies. METHODS: Configuration of CPS is now fairly standard. A mobile cart with relatively large wheels allowing for easy transportation carries a centrifugal pump, a back-up battery with a charger, an oxygen cylinder, and a small heating system. Percutaneous cannulation, pump-driven venous return, rapid availability, and transportability are the main characteristics of a CPS system. Cardiocirculatory arrest is a major predictor of mortality despite the use of CPS. In contrast, CPS appears to be a powerful tool for patients in cardiogenic shock before cardiocirculatory arrest, requiring some type of therapeutic procedures, especially repair of anatomically correctable problems or bridging to other mechanical circulatory support systems such as ventricular assist devices. CPS is in general not suitable for long-term applications because of the small-bore cannulas, resulting in significant pressure gradients and eventually hemolysis. RESULTS: In contrast, ECMO can be designed for longer-term circulatory support. This requires large-bore cannulas and specifically designed oxygenators. The latter are either plasma leakage resistent (true membranes) or relatively thrombo-resistant (heparin coated). Both technologies require oxygenator changeovers although the main reason for this is different (clotting for the former, plasma leakage for the latter). Likewise, the tubing within a roller pump has to be displaced and centrifugal pump heads have to be replaced over time. ECMO is certainly the first choice for a circulatory support system in the neonatal and pediatric age groups, where the other assist systems are too bulky. ECMO is also indicated for patients improving on CPS. Septic conditions are, in general, considered as contraindications for ECMO. CONCLUSIONS: Ease of availability and moderate cost of cardiopulmonary bypass-based cardiac support technologies have to be balanced against the significant immobilization of human resources, which is required to make them successful.

Assistances ventriculaires gauches dans le choc cardiogène et l'insuffisance cardiaque terminate [Left ventricular assist devices in cardiogenic shock and chronic refractory heart failure].

Decompensated heart failure, either acute (cardiogenic shock) or chronic (terminal heart failure) may become refractory to conventional therapy, then requiring mechanical assistance of the failing heart to improve hemodynamics. In the acute setting, aortic balloon counterpulsation is used as first line therapy. In case of failure, other techniques include the extracorporal membrane oxygenator or a percutaneous left ventricular assist device, such as the TandemHeart or the Impella. In chronic heart failure, long-term left ventricular assist devices can be surgically implanted. The continuous flow devices give here the best results. The aim of the present review article is to present with some details the various methods of mechanical left ventricle assistance to which the intensivist may be confronted in his daily practice.