T cell differentiation in chronic infection and cancer: functional adaptation or exhaustion?

Chronic viral infections and malignant tumours induce T cells that have a reduced ability to secrete effector cytokines and have upregulated expression of the inhibitory receptor PD1 (programmed cell death protein 1). These features have so far been considered to mark terminally differentiated 'exhausted' T cells. However, several recent clinical and experimental observations indicate that phenotypically exhausted T cells can still mediate a crucial level of pathogen or tumour control. In this Opinion article, we propose that the exhausted phenotype results from a differentiation process in which T cells stably adjust their effector capacity to the needs of chronic infection. We argue that this phenotype is optimized to cause minimal tissue damage while still mediating a critical level of pathogen control. In contrast to the presently held view of functional exhaustion, this new concept better reflects the pathophysiology and clinical manifestations of persisting infections, and it provides a rationale for emerging therapies that enhance T cell activity in chronic infection and cancer by blocking inhibitory receptors.

Effect of neighborhood and plot size on experiments with multiple-harvest oleraceous crops

The objective of this work was to determine the efficiency of the Papadakis method on the quality evaluation of experiments with multiple-harvest oleraceous crops, and on the estimate of the covariate and the ideal plot size. Data from nine uniformity trials (five with bean pod, two with zucchini, and two with sweet pepper) and from one experiment with treatments (with sweet pepper) were used. Through the uniformity trials, the best way to calculate the covariate was defined and the optimal plot size was calculated. In the experiment with treatments, analyses of variance and covariance were performed, in which the covariate was calculated by the Papadakis method, and experimental precision was evaluated based on four statistics. The use of analysis of covariance with the covariate obtained by the Papadakis method increases the quality of experiments with multiple-harvest oleraceous crops and allows the use of smaller plot sizes. The best covariate is the one that considers a neighboring plot of each side of the reference plot.

Angiotensin converting enzyme inhibitor induced angio-oedema: a review of the pathophysiology and risk factors.

Angio-oedema (AE) is a known adverse effect of angiotensin converting enzyme inhibitor (ACE-I) therapy. Over the past several decades, evidence of failure to diagnose this important and potentially fatal reaction is commonly found in the literature. Because this reaction is often seen first in the primary care setting, a review was undertaken to analyse and document the keys to both diagnostic criteria as well as to investigate potential risk factors for ACE-I AE occurrence. A general review of published literature was conducted through Medline, EMBASE, and the Cochrane Database, targeting ACE-I-related AE pathomechanism, diagnosis, epidemiology, risk factors, and clinical decision making and treatment. The incidence and severity of AE appears to be on the rise and there is evidence of considerable delay in diagnosis contributing to significant morbidity and mortality for patients. The mechanism of AE due to ACE-I drugs is not fully understood, but some genomic and metabolomic information has been correlated. Additional epidemiologic data and clinical treatment outcome predictors have been evaluated, creating a basis for future work on the development of clinical prediction tools to aid in risk identification and diagnostic differentiation. Accurate recognition of AE by the primary care provider is essential to limit the rising morbidity associated with ACE-I treatment-related AE. Research findings on the phenotypic indicators relevant to this group of patients as well as basic research into the pathomechanism of AE are available, and should be used in the construction of better risk analysis and clinical diagnostic tools for ACE-I AE.

Developmental critical period in genetic redox dysregulation: animal and human studies in schizophrenia

Converging evidence favors an abnormal susceptibility to oxidative stress in schizophrenia. Decreased levels of glutathione (GSH), the major cellular antioxidant and redox regulator, was observed in cerebrospinal-fluid and prefrontal cortex of patients. Importantly, abnormal GSH synthesis of genetic origin was observed: Two case-control studies showed an association with a GAG trinucleotide repeat (TNR) polymorphism in the GSH key synthesizing enzyme glutamate-cysteine-ligase (GCL) catalytic subunit (GCLC) gene. The most common TNR genotype 7/7 was more frequent in controls, whereas the rarest TNR genotype 8/8 was three times more frequent in patients. The disease associated genotypes (35% of patients) correlated with decreased GCLC protein, GCL activity and GSH content. Similar GSH system anomalies were observed in early psychosis patients. Such redox dysregulation combined with environmental stressors at specific developmental stages could underlie structural and functional connectivity anomalies. In pharmacological and knock-out (KO) models, GSH deficit induces anomalies analogous to those reported in patients. (a) morphology: spine density and GABA-parvalbumine immunoreactivity (PV-I) were decreased in anterior cingulate cortex. KO mice showed delayed cortical PV-I at PD10. This effect is exacerbated in mice with increased DA from PD5-10. KO mice exhibit cortical impairment in myelin and perineuronal net known to modulate PV connectivity. (b) physiology: In cultured neurons, NMDA response are depressed by D2 activation. In hippocampus, NMDA-dependent synaptic plasticity is impaired and kainate induced g-oscillations are reduced in parallel to PV-I. (c) cognition: low GSH models show increased sensitivity to stress, hyperactivity, abnormal object recognition, olfactory integration and social behavior. In a clinical study, GSH precursor N-acetyl cysteine (NAC) as add on therapy, improves the negative symptoms and decreases the side effects of antipsychotics. In an auditory oddball paradigm, NAC improves the mismatched negativity, an evoked potential related to pre-attention and to NMDA receptors function. In summary, clinical and experimental evidence converge to demonstrate that a genetically induced dysregulation of GSH synthesis combined with environmental insults in early development represent a major risk factor contributing to the development of schizophrenia

Investigation of discrete imaging models and iterative image reconstruction in differential X-ray phase-contrast tomography.

Differential X-ray phase-contrast tomography (DPCT) refers to a class of promising methods for reconstructing the X-ray refractive index distribution of materials that present weak X-ray absorption contrast. The tomographic projection data in DPCT, from which an estimate of the refractive index distribution is reconstructed, correspond to one-dimensional (1D) derivatives of the two-dimensional (2D) Radon transform of the refractive index distribution. There is an important need for the development of iterative image reconstruction methods for DPCT that can yield useful images from few-view projection data, thereby mitigating the long data-acquisition times and large radiation doses associated with use of analytic reconstruction methods. In this work, we analyze the numerical and statistical properties of two classes of discrete imaging models that form the basis for iterative image reconstruction in DPCT. We also investigate the use of one of the models with a modern image reconstruction algorithm for performing few-view image reconstruction of a tissue specimen.

On Modelling, System Identification and Control of Servo-Systems with a Flexible Load

The present study was done with two different servo-systems. In the first system, a servo-hydraulic system was identified and then controlled by a fuzzy gainscheduling controller. The second servo-system, an electro-magnetic linear motor in suppressing the mechanical vibration and position tracking of a reference model are studied by using a neural network and an adaptive backstepping controller respectively. Followings are some descriptions of research methods. Electro Hydraulic Servo Systems (EHSS) are commonly used in industry. These kinds of systems are nonlinearin nature and their dynamic equations have several unknown parameters.System identification is a prerequisite to analysis of a dynamic system. One of the most promising novel evolutionary algorithms is the Differential Evolution (DE) for solving global optimization problems. In the study, the DE algorithm is proposed for handling nonlinear constraint functionswith boundary limits of variables to find the best parameters of a servo-hydraulic system with flexible load. The DE guarantees fast speed convergence and accurate solutions regardless the initial conditions of parameters. The control of hydraulic servo-systems has been the focus ofintense research over the past decades. These kinds of systems are nonlinear in nature and generally difficult to control. Since changing system parameters using the same gains will cause overshoot or even loss of system stability. The highly non-linear behaviour of these devices makes them ideal subjects for applying different types of sophisticated controllers. The study is concerned with a second order model reference to positioning control of a flexible load servo-hydraulic system using fuzzy gainscheduling. In the present research, to compensate the lack of dampingin a hydraulic system, an acceleration feedback was used. To compare the results, a pcontroller with feed-forward acceleration and different gains in extension and retraction is used. The design procedure for the controller and experimental results are discussed. The results suggest that using the fuzzy gain-scheduling controller decrease the error of position reference tracking. The second part of research was done on a PermanentMagnet Linear Synchronous Motor (PMLSM). In this study, a recurrent neural network compensator for suppressing mechanical vibration in PMLSM with a flexible load is studied. The linear motor is controlled by a conventional PI velocity controller, and the vibration of the flexible mechanism is suppressed by using a hybrid recurrent neural network. The differential evolution strategy and Kalman filter method are used to avoid the local minimum problem, and estimate the states of system respectively. The proposed control method is firstly designed by using non-linear simulation model built in Matlab Simulink and then implemented in practical test rig. The proposed method works satisfactorily and suppresses the vibration successfully. In the last part of research, a nonlinear load control method is developed and implemented for a PMLSM with a flexible load. The purpose of the controller is to track a flexible load to the desired position reference as fast as possible and without awkward oscillation. The control method is based on an adaptive backstepping algorithm whose stability is ensured by the Lyapunov stability theorem. The states of the system needed in the controller are estimated by using the Kalman filter. The proposed controller is implemented and tested in a linear motor test drive and responses are presented.

Essays on Innovativeness and its Evaluation in Small and Medium-sized Enterprises

Tutkimus koostuu neljästä artikkelista, jotka käsittelevät suomalaisten pienten ja keskisuurten teollisuusyritysten (PKT-yritysten) innovatiivisuutta, sen attribuutteja (ominaispiirteitä) sekä indikaattoreita. Tutkimuksessa tarkastellaan sekä kirjallisuudessa esitettyjä että PKT-johtajien ja PKT-yritystenkehityshankkeiden rahoituspäätöksiin osallistuvien yritystutkijoiden haastatteluissa esittämiä innovatiivisuuden määritelmiä. Innovatiivisuusindikaattoreista tarkastellaan PKT-yritysten kehittämishankkeille sovellettavia rahoitus- ja arviointikriteerejä sekä yritysten ulkopuolisten rahoittajien että PKT-johtajien näkökulmasta. Erityistä huomiota kohdistetaan sovellettuihin laadullisiin ja ei-numeerisiin innovatiivisuuden arviointikriteereihin. Sekä kirjallisuudessa että kymmenen yritystutkijan ja kuuden esimerkkiyrityksen johtajan haastatteluissa innovaation uutuus yhdistetään innovatiivisuuteen. Muita tärkeitä innovatiivisuuteen liitettyjä ominaisuuksia olivat markkinat, muista yrityksistä erottuminen ja yksilöiden luovuus. Ihmisläheiset ja yksilöihin liittyvät näkökulmat korostuvat yritystutkijoiden ja PKT-johtajien innovatiivisuuden määritelmissä, kun taas kirjallisuudessa annetaan enemmän painoa ympäristölle, tuotteille ja markkinoille. Yritystutkijat pitivät yritykseen ja sen johtajaan liittyviä tekijöitä tärkeinä rahoitettavien kehittämishankkeiden panosten arviointikriteereinä. Tuotteiden kaupallinen menestys oli rahoittajan kannalta tärkein tulostekijä. Tarkastelluissa esimerkkiyrityksissä kehityshankkeista päättäminen ja hankkeiden arviointi on toisaalta intuitiivista ja saattaa olla tiedostamatontakin, koska yritysten kehittämistoiminta on vähäistä. Pienyritysten johtajat korostavat arvioinnissa rahallisiamittareita, vaikka sekä numeerisia että laadullisia kriteereitä sovelletaan. Todennäköisin syy tälle on pienyritysten rajalliset taloudelliset voimavarat. Toinen mahdollinen syy rahoituksellisten tekijöiden painottamiseen on, että tämän päivän ihannejohtaja ymmärretään analyyttiseksi ja mm.rahavirtoja valvovaksi. Kuitenkin innovatiiviset yritysjohtajat pitävät innovaatioiden luomista yhtenä elämän hauskoista puolista. Innovatiiviset esimerkkiyritykset ovat tulevaisuuteen ja kasvuun suuntautuneita strategisella tasolla. Operationaalisella tasolla ne tuottavat keksintöjä ja innovaatioita. Patentteja tarkastelluilla yrityksillä on kuitenkin vähän. Sekä innovatiiviset että vähemmän innovatiiviset esimerkkiyritykset ovat voimakkaasti asiakassuuntautuneita ja erikoistuneita tiettyihin tuotteisiin ja asiakkaisiin. Asiakkaiden tarpeita tyydytetään kehittämällä niitä vastaavia tuotteita. Tästä johtuu, että valtaosa yritysten kehittämistoiminnasta kohdistuu tuotteisiin tai tuotantoon.

Correlations of glycogen synthase and phosphorylase activities with glycogen concentration in human muscle biopsies. Evidence for a double-feedback mechanism regulating glycogen synthesis and breakdown.

The purpose of this study was to verify in man the relationships of muscle glycogen synthase and phosphorylase activities with glycogen concentration that were reported in animal studies. The upper level of glycogen concentration in muscle is known to be tightly controlled, and glycogen concentration was reported to have an inhibitory effect on synthase activity and a stimulatory effect on phosphorylase activity. Glycogen synthase and phosphorylase activity and glycogen concentration were measured in muscle biopsies in a group of nine normal subjects after stimulating an increase of their muscle glycogen concentration through either an intravenous glucose-insulin infusion to stimulate glycogen synthesis, or an Intralipid (Vitrum, Stockholm, Sweden) infusion in the basal state to inhibit glycogen mobilization by favoring lipid oxidation at the expense of glucose oxidation. Phosphorylase activity increased from 71.3 +/- 21.0 to 152.8 +/- 20.0 nmol/min/mg protein (P < .005) after the glucose-insulin infusion. Phosphorylase activity was positively correlated with glycogen concentration (P = .005 and P = .0001) after the glucose-insulin and Intralipid infusions, respectively. Insulin-stimulated glycogen synthase activity was significantly negatively correlated with glycogen concentration at the end of the Intralipid infusion (P < .005). In conclusion, by demonstrating a negative correlation of glycogen concentration with glycogen synthase and a positive correlation with phosphorylase, this study might confirm in man the double-feedback mechanism by which changes in glycogen concentration regulate glycogen synthase and phosphorylase activities. It suggests that this mechanism might play an important role in the regulation of glucose storage.

Acting, predicting and intervening in a socio-hydrological world

This paper asks a simple question: if humans and their actions co-evolve with hydrological systems (Sivapalan et al., 2012), what is the role of hydrological scientists, who are also humans, within this system? To put it more directly, as traditionally there is a supposed separation of scientists and society, can we maintain this separation as socio-hydrologists studying a socio-hydrological world? This paper argues that we cannot, using four linked sections. The first section draws directly upon the concern of science-technology studies to make a case to the (socio-hydrological) community that we need to be sensitive to constructivist accounts of science in general and socio-hydrology in particular. I review three positions taken by such accounts and apply them to hydrological science, supported with specific examples: (a) the ways in which scientific activities frame socio-hydrological research, such that at least some of the knowledge that we obtain is constructed by precisely what we do; (b) the need to attend to how socio-hydrological knowledge is used in decision-making, as evidence suggests that hydrological knowledge does not flow simply from science into policy; and (c) the observation that those who do not normally label themselves as socio-hydrologists may actually have a profound knowledge of socio-hydrology. The second section provides an empirical basis for considering these three issues by detailing the history of the practice of roughness parameterisation, using parameters like Manning's n, in hydrological and hydraulic models for flood inundation mapping. This history sustains the third section that is a more general consideration of one type of socio-hydrological practice: predictive modelling. I show that as part of a socio-hydrological analysis, hydrological prediction needs to be thought through much more carefully: not only because hydrological prediction exists to help inform decisions that are made about water management; but also because those predictions contain assumptions, the predictions are only correct in so far as those assumptions hold, and for those assumptions to hold, the socio-hydrological system (i.e. the world) has to be shaped so as to include them. Here, I add to the ``normal'' view that ideally our models should represent the world around us, to argue that for our models (and hence our predictions) to be valid, we have to make the world look like our models. Decisions over how the world is modelled may transform the world as much as they represent the world. Thus, socio-hydrological modelling has to become a socially accountable process such that the world is transformed, through the implications of modelling, in a fair and just manner. This leads into the final section of the paper where I consider how socio-hydrological research may be made more socially accountable, in a way that is both sensitive to the constructivist critique (Sect. 1), but which retains the contribution that hydrologists might make to socio-hydrological studies. This includes (1) working with conflict and controversy in hydrological science, rather than trying to eliminate them; (2) using hydrological events to avoid becoming locked into our own frames of explanation and prediction; (3) being empirical and experimental but in a socio-hydrological sense; and (4) co-producing socio-hydrological predictions. I will show how this might be done through a project that specifically developed predictive models for making interventions in river catchments to increase high river flow attenuation. Therein, I found myself becoming detached from my normal disciplinary networks and attached to the co-production of a predictive hydrological model with communities normally excluded from the practice of hydrological science.

The potential impact of new effervescent alendronate formulation on compliance and persistence in osteoporosis treatment.

Osteoporotic fractures are a public health problem and their incidence and subsequent economic and social costs are expected to rise in the next future. Different drugs have been developed to reduce osteoporosis and the risk of osteoporotic fractures, and among them, antiresorptive agents, and in particular oral alendronate, are the most widely utilized. However, one of the most common problems with antiresorptive drugs is poor adherence to treatment, which is associated with a high fracture incidence and with an increase in hospitalization costs. One of the main reasons of poor adherence to these treatments is the occurrence of adverse events, mainly at gastrointestinal (GI) level, including dyspepsia, dysphagia, and esophageal ulcers. In light of these considerations the aim of this paper is to perform a literature review to show the pathophysiologic bases of GI alendronate-induced adverse events and how new bisphosphonate formulations like effervescent alendronate can improve compliance and persistence to treatment and decrease the fracture rate incidence in osteoporotic patients.

The importance of sonographer experience and machine quality with regards to the role of musculoskeletal ultrasound in routine care of rheumatoid arthritis patients.

OBJECTIVES: Regarding recent progress, musculoskeletal ultrasound (US) will probably soon be integrated in standard care of patient with rheumatoid arthritis (RA). However, in daily care, quality of US machines and level of experience of sonographers are varied. We conducted a study to assess reproducibility and feasibility of an US scoring for RA, including US devices of different quality and rheumatologist with various levels of expertise in US as it would be in daily care. METHODS: The Swiss Sonography in Arthritis and Rheumatism (SONAR) group has developed a semi-quantitative score using OMERACT criteria for synovitis and erosion in RA. The score was taught to 108 rheumatologists trained in US. One year after the last workshop, 19 rheumatologists participated in the study. Scans were performed on 6 US machines ranging from low to high quality, each with a different patient. Weighted kappa was calculated for each pair of readers. RESULTS: Overall, the agreement was fair to moderate. Quality of device, experience of the sonographers and practice of the score before the study improved substantially the agreement. Agreement assessed on higher quality machine, among sonographers with good experience in US increased to substantial (median kappa for B-mode and Doppler: 0.64 and 0.41 for erosion). CONCLUSIONS: This study demonstrated feasibility and reproducibility of the Swiss US SONAR score for RA. Our results confirmed importance of the quality of US machine and the training of sonographers for the implementation of US scoring in the routine daily care of RA.

Selluradan leijutus ja hallinta ilmakuivaimessa

Diplomityön tavoitteena oli tutkia selluradan leijutusta sekä hallintaa kapealla ja täysleveällä selluradalla ilmakuivaimessa. Työn sisältö on jaettu neljään osaan teoriaan, numeeriseen virtauslaskentaan, kokeelliseen osuuteen ja johtopäätöksiin. Työn alussa kiinnitettiin huomiota ilmakuivaimen ja selluradan rakenteeseen, selluradan lujuusominaisuuksiin ja niiden testaamiseen laboratorio-oloissa. Teoria osuudessa tarkasteltiin selluradan leijutusteoriaa ja siihen liittyvää virtaustekniikkaa. Leijutusta kuvattiin mekaniikasta tutun vapaakappalekuvan muodossa. Vapaakappalekuva auttaa ymmärtämään sellurataan vaikuttavia voimia ja niiden aiheuttajia. Numeerisessa virtauslaskennassa rakennettiin Fluent -virtauslaskentamalli. Malli kuvaa leijutussuuttimen alusta 0,2 metrin pituista pätkää. Laskennassa simuloitiin selluradan lei-jutusta 2, 5 ja 7 mm etäisyyksillä. Tuloksia tarkasteltiin paine- ja nopeusjakaumien muodossa. Kokeellisessa osuudessa tehtiin mittauksia yksittäisellä ylä- ja alasuuttimella sekä suutinpaketilla. Yksittäisistä suuttimista mitattiin ilmasuihkujen ulostulokulmaa, suuttimensisäistä painejakaumaa ja selluradan pintaan vaikuttavaa staattista painetta suuttimen pituuden funktiona. Suutinpaketilla tutkittiin ilmasuihkujen ja tasomaisen levyn välistä vuorovaikutusta. Ylä- ja alasuuttimen välissä leijutettiin levyä, josta mitattiin ilmasuihkujen aiheuttama z-suuntainen voima ja leijutuskorkeus. Työn lopussa arvioitiin teorian, numeerisen virtauslaskennan ja kokeellisen osuuden tuloksia. Näiden pohjalta tehtiin teknisiä parannusehdotuksia ilmakuivaimen toiminnan tehostamiseksi ja selluradan hallinnan parantamiseksi kapealla ja täysleveällä selluradalla.

Evolution and perspective of the temperate fruit crops in São Paulo state, Brazil

This work was carried out to show the current situation of the temperate fruit crops in São Paulo state, Brazil, with an emphasis on grapes, peaches, apples, plums, nectarines and pears crops. Current economic data of crops, major growing regions, main cultivars produced, as well as the new technologies generated by research are presented. Regarding the grape crop, a decrease in the national production as well as in the major growing states was observed. The main grapes growing centers in São Paulo state are presented, highlighting its peculiarities regarding cultivars, cultural crop management and current researches. A trend has been observed toward increasing Niagara Rosada grape growing area rather than the fine table grape cultivars. It was also observed the adoption of cultural practices, aiming to increase productivity, to improve the fruits quality and to reduce manpower necessity. In terms of stone fruits, peaches are the most widely cultivated in São Paulo state, followed by plums and nectarines. Both for stone fruits crop and for apples and pears crops, statistics and comments are presented on the crops evolution as well as the current researches results and the requirements of these fruit crops in São Paulo state, Brazil.

Application of the N-alkane molecular alloys to thermally protected containers for catering

A thermally controlled transport device was designed and tested. As hot food needs to be transported at temperatures between 60 and 70ºC in order to avoid contamination by microorganisms, the use of Molecular Alloy Phase Change Materials (MAPCM) can lead to improvements in this field of application. A heat transfer numerical simulation of the box used for transporting the food was conducted. Despite obvious simplifications, a good agreement between numerical simulation and experimental results was obtained. Furthermore, we compared our experimental results with those from other experiments related to the transport of hot food. Here, pizza is taken as the example, and it is shown that delivering time can be increased three-fold.

Assessment of subjective and hemodynamic tolerance of different high- and low-flux dialysis membranes in patients undergoing chronic intermittent hemodialysis: a randomized controlled trial.

Clinical experience and experimental data suggest that intradialytic hemodynamic profiles could be influenced by the characteristics of the dialysis membranes. Even within the worldwide used polysulfone family, intolerance to specific membranes was occasionally evoked. The aim of this study was to compare hemodynamically some of the commonly used polysulfone dialyzers in Switzerland. We performed an open-label, randomized, cross-over trial, including 25 hemodialysis patients. Four polysulfone dialyzers, A (Revaclear high-flux, Gambro, Stockholm, Sweden), B (Helixone high-flux, Fresenius), C (Xevonta high-flux, BBraun, Melsungen, Germany), and D (Helixone low-flux, Fresenius, Bad Homburg vor der Höhe, Germany), were compared. The hemodynamic profile was assessed and patients were asked to provide tolerance feedback. The mean score (±SD) subjectively assigned to dialysis quality on a 1-10 scale was A 8.4 ± 1.3, B 8.6 ± 1.3, C 8.5 ± 1.6, D 8.5 ± 1.5. Kt/V was A 1.58 ± 0.30, B 1.67 ± 0.33, C 1.62 ± 0.32, D 1.45 ± 0.31. The low- compared with the high-flux membranes, correlated to higher systolic (128.1 ± 13.1 vs. 125.6 ± 12.1 mmHg, P < 0.01) and diastolic (76.8 ± 8.7 vs. 75.3 ± 9.0 mmHg; P < 0.05) pressures, higher peripheral resistance (1.44 ± 0.19 vs. 1.40 ± 0.18 s × mmHg/mL; P < 0.05) and lower cardiac output (3.76 ± 0.62 vs. 3.82 ± 0.59 L/min; P < 0.05). Hypotension events (decrease in systolic blood pressure by >20 mmHg) were 70 with A, 87 with B, 73 with C, and 75 with D (P < 0.01 B vs. A, 0.05 B vs. C and 0.07 B vs. D). The low-flux membrane correlated to higher blood pressure levels compared with the high-flux ones. The Helixone high-flux membrane ensured the best efficiency. Unfortunately, the very same dialyzer correlated to a higher incidence of hypotensive episodes.