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Nakane S, Matsuo H, Nakatsuji Y. Immunological and therapeutic insights in autoimmune autonomic ganglionopathy: What is the position of apheresis in immunotherapy? Transfus Apher Sci 2024; 63:103967. [PMID: 38959810 DOI: 10.1016/j.transci.2024.103967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Autoimmune autonomic ganglionopathy (AAG) is characterized by various autonomic and extra-autonomic symptoms and is caused by autoantibodies against nicotinic acetylcholine receptors present in the autonomic ganglia (ganglionic acetylcholine receptor, gAChR), requiring immediate and aggressive intervention to prevent the exacerbation of symptoms. However, there is currently no internationally accepted standard of care for the immunotherapy of AAG, including apheresis. Although the rationale for the use of plasma exchange (PLEX) in AAG is strong, whereby pathogenic gAChR antibodies are removed, its overall impact on patient outcomes is not well-established. Based on previous case reports and small case series studies, we provide a comprehensive overview of the challenges and uncertainties surrounding the use of PLEX for the management of AAG and provide current practice recommendations to guide treatment decisions.
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Affiliation(s)
- Shunya Nakane
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan.
| | - Hidenori Matsuo
- Department of Neurology, National Hospital Organization Nagasaki Kawatana Medical Center, Nagasaki, Japan
| | - Yuji Nakatsuji
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
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2
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Liu J, Lu X, Shu G, Li K, Zheng S, Kong X, Li T, Yang J. The facile method developed for preparing polyvinylidene fluoride plasma separation membrane via macromolecular interaction. Chin J Chem Eng 2022. [DOI: 10.1016/j.cjche.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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3
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Hu Y, Yang H, Fu S, Wu J. Therapeutic Plasma Exchange: For Cancer Patients. Cancer Manag Res 2022; 14:411-425. [PMID: 35140519 PMCID: PMC8818550 DOI: 10.2147/cmar.s340472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/25/2021] [Indexed: 11/23/2022] Open
Abstract
Therapeutic plasma exchange is used as a trial method for the treatment of cancer patients. Therapeutic plasma exchange uses in vitro technology to remove pathogenic factors in the plasma, returning the replacement and remaining components to the patient to facilitate cure. In the effort to explore new methods of cancer treatment, the introduction of therapeutic plasma exchange brings new hope for cancer treatment; however, the current evidence supporting therapeutic plasma exchange is controversial, and most of the evidence comes from observational studies, lacking large prospective randomized trials. Therefore, this review attempts to focus on the main indications of therapeutic plasma exchange for the treatment of tumors and their complications, including hematological tumors (multiple myeloma cast nephropathy and hyperviscosity syndrome), nervous system tumors (myasthenia gravis associated with thymoma, paraneoplastic neurological syndrome, Lambert–Eaton myasthenia syndrome, and anti-N-methyl-D-aspartate receptor encephalitis), overdose of chemotherapy drugs. In addition, the issues of side-effects and safety in the use of therapeutic plasma exchange are also discussed. However, well-designed prospective trials are needed to better define the role of therapeutic plasma exchange in cancer.
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Affiliation(s)
- Yuru Hu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Hanshan Yang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Shaozhi Fu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Jingbo Wu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Correspondence: Jingbo Wu; Shaozhi Fu, Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China, Tel +8613980257136, Email ;
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Kim P, Kim H, Oh H, Kang JS, Lee S, Park K. Influence of Solute Size on Membrane Fouling during Polysaccharide Enrichment Using Dense Polymeric UF Membrane: Measurements and Mechanisms. MEMBRANES 2022; 12:membranes12020142. [PMID: 35207064 PMCID: PMC8878232 DOI: 10.3390/membranes12020142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 02/05/2023]
Abstract
Fouling mechanisms associated with membrane-based polysaccharide enrichment were determined using a dense ultrafiltration (UF) membrane. Dextran with different molecular weights (MWs) was used as a surrogate for polysaccharides. The influence of dextran MW on fouling mechanisms was quantified using the Hermia model. Flux data obtained with different dextran MWs and filtration cycles were plotted to quantify the more appropriate fouling mechanisms among complete pore blocking, standard pore blocking, intermediate pore blocking, and cake filtration. For 100,000 Da dextran, all four mechanisms contributed to the initial fouling. As the filtration progressed, the dominant fouling mechanism appeared to be cake filtration with a regression coefficient (R2) of approximately 0.9519. For 10,000 Da, the R2 value for cake filtration was about 0.8767 in the initial filtration. Then, the R2 value gradually decreased as the filtration progressed. For 6000 Da, the R2 values of the four mechanisms were very low in the initial filtration. However, as the filtration progressed, the R2 value for cake filtration reached 0.9057. These results clearly show that the fouling mechanism of dense UF membranes during polysaccharide enrichment can be quantified. In addition, it was confirmed that the dominant fouling mechanism can change with the size of the polysaccharide and the duration of filtration.
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Affiliation(s)
- Pooreum Kim
- Graduate School of Water Resources, Sungkyunkwan University, Suwon 16419, Korea; (P.K.); (J.-s.K.)
| | - Hyungsoo Kim
- Graduate School of Water Resources, Sungkyunkwan University, Suwon 16419, Korea; (P.K.); (J.-s.K.)
- Correspondence: (H.K.); (S.L.); (K.P.); Tel.: +82-31-290-7520 (H.K.); +82-32-290-7542 (S.L.); +82-31-290-7647 (K.P.)
| | - Heekyong Oh
- School of Environmental Engineering, University of Seoul, Seoul 02504, Korea;
| | - Joon-seok Kang
- Graduate School of Water Resources, Sungkyunkwan University, Suwon 16419, Korea; (P.K.); (J.-s.K.)
| | - Sangyoup Lee
- Graduate School of Water Resources, Sungkyunkwan University, Suwon 16419, Korea; (P.K.); (J.-s.K.)
- Correspondence: (H.K.); (S.L.); (K.P.); Tel.: +82-31-290-7520 (H.K.); +82-32-290-7542 (S.L.); +82-31-290-7647 (K.P.)
| | - Kitae Park
- Graduate School of Water Resources, Sungkyunkwan University, Suwon 16419, Korea; (P.K.); (J.-s.K.)
- Correspondence: (H.K.); (S.L.); (K.P.); Tel.: +82-31-290-7520 (H.K.); +82-32-290-7542 (S.L.); +82-31-290-7647 (K.P.)
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Abstract
Liver failure in the context of acute (ALF) and acute on chronic liver failure (ACLF) is associated with high mortality in the absence of a liver transplant. For decades, therapeutic plasma exchange (TPE) is performed for the management of immune-mediated diseases. TPE has emerged as an attractive extracorporeal blood purification technique in patients with ALF and ACLF. The basic premise of using TPE is to remove the toxic substances which would allow recovery of native liver functions by facilitating liver regeneration. In recent years, encouraging data have emerged, suggesting the benefits of TPE in patients with liver failure. TPE has emerged as an attractive liver support device for the failing liver until liver transplantation or clinical recovery. The data in patients with ALF suggest routine use of high-volume TPE, while the data for such a strategy are less robust for patients with ACLF.
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Affiliation(s)
- Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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6
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Structure design and performance study on filtration-adsorption bifunctional blood purification membrane. J Memb Sci 2021. [DOI: 10.1016/j.memsci.2021.119535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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7
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Sikorska W, Milner-Krawczyk M, Wasyłeczko M, Wojciechowski C, Chwojnowski A. Biodegradation Process of PSF-PUR Blend Hollow Fiber Membranes Using Escherichia coli Bacteria-Evaluation of Changes in Properties and Porosity. Polymers (Basel) 2021; 13:polym13081311. [PMID: 33923596 PMCID: PMC8073714 DOI: 10.3390/polym13081311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 01/13/2023] Open
Abstract
This work was focused on biodegradation with Escherichia coli bacteria studies of PSF-PUR blend semipermeable hollow fiber membranes that possibly can undergo a partial degradation process. Hollow fiber membranes were obtained from polysulfone (PSF) and polyurethane (PUR) containing ester bonds in the polymer chain in various weight ratios using two solvents: N,N-Dimethylmethanamide (DMF) or N-Methylpyrrolidone (NMP). The membranes that underwent the biodegradation process were tested for changes in the ultrafiltration coefficient (UFC), retention and cut-off point. Moreover, the membranes were subjected to scanning electron microscopy (SEM), MeMoExplorerTM Software and Fourier-transform infrared spectroscopy (FT-IR) analysis. The influence of E. coli and its metabolites has been proven by the increase in UFC after biodegradation and changes in the selectivity and porosity of individual membranes after the biodegradation process.
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Affiliation(s)
- Wioleta Sikorska
- Nałęcz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4 Str., 02-109 Warsaw, Poland; (M.W.); (C.W.); (A.C.)
- Correspondence:
| | | | - Monika Wasyłeczko
- Nałęcz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4 Str., 02-109 Warsaw, Poland; (M.W.); (C.W.); (A.C.)
| | - Cezary Wojciechowski
- Nałęcz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4 Str., 02-109 Warsaw, Poland; (M.W.); (C.W.); (A.C.)
| | - Andrzej Chwojnowski
- Nałęcz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4 Str., 02-109 Warsaw, Poland; (M.W.); (C.W.); (A.C.)
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Jouve T, Marlu R, Naciri Bennani H, Noble J, Chevallier E, Motte L, Imerzoukene F, Malvezzi P, Rostaing L. Fibrinogen reconstitution after therapeutic apheresis: Comparison of double-filtration plasmapheresis, plasma exchange, and immunoadsorption. J Clin Apher 2021; 36:574-583. [PMID: 33783856 DOI: 10.1002/jca.21895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/05/2021] [Accepted: 03/14/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Fibrinogen reconstitution after therapeutic apheresis has been poorly studied. Apheresis modalities, for example, plasma exchange (PE), double-filtration plasmapheresis (DFPP), or selective immunoadsorption (IA), may have different impacts. METHODS We retrospectively investigated therapeutic apheresis sessions performed at our center across four modalities (PE, DFPP, and IA with or without plasma filtration). Fibrinogen levels were assessed at the beginning and end of each apheresis session, and immediately before the subsequent session. We adjusted measurements on hematocrit values to account for hemoconcentration. RESULTS Between January 10, 2016 and March 2, 2020, we included 90 patients for a total of 754 apheresis sessions (PE: 35; DFPP: 351; IA only: 109; IA + plasma filtration: 259). Each patient received a median of five sessions (1Q 3; 3Q 9); median plasma volume treated was 5.5 L (1Q 4.3 L; 3Q 7.0 L). Within a session, DFPP and PE induced a significantly greater depletion of fibrinogen than both IA modalities, even after adjustment for the treated plasma volume. Median fibrinogen reconstitution was 0.8 (0.4-1.2) g/L (median time between sessions: 38 hours). In multivariate analysis, fibrinogen reconstitution was significantly associated with intersession time (+0.66 g/L/log-hour P < .001), apheresis modality (ANOVA; P < .001), initial fibrinogen concentration (+0.15 g/L per gram of fibrinogen; P < .001), and the last fibrinogen concentration from the previous apheresis session (-0.14 g/L per gram of fibrinogen; P < .001). In a model that considered hemoconcentration, the results were unchanged. CONCLUSIONS We demonstrate that fibrinogen reconstitution was highly variable between patients and apheresis sessions. Apheresis modalities had a significant impact on fibrinogen reconstitution, regardless of hemoconcentration.
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Affiliation(s)
- Thomas Jouve
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France.,Faculty of Health, Grenoble Alpes University, Grenoble, France
| | - Raphaël Marlu
- Faculty of Health, Grenoble Alpes University, Grenoble, France.,Hemostasis Laboratory, Grenoble University Hospital, Grenoble, France
| | - Hamza Naciri Bennani
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France
| | - Johan Noble
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France
| | - Eloi Chevallier
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France
| | - Lionel Motte
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France
| | - Farida Imerzoukene
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France
| | - Paolo Malvezzi
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France
| | - Lionel Rostaing
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France.,Faculty of Health, Grenoble Alpes University, Grenoble, France
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Naciri Bennani H, Noble J, Chevallier E, Terrec F, Motte L, Giroux-Lathuile C, Bugnazet M, Imerzoukene F, Janbon B, Malvezzi P, Rostaing L, Jouve T. Isoagglutinin removal by plasma centrifugation or filtration (single or double): A prospective study in a single center. J Clin Apher 2020; 36:149-160. [PMID: 33230824 DOI: 10.1002/jca.21857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/27/2020] [Accepted: 11/11/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION ABO-incompatible (ABOi) kidney transplantation, a well-established procedure, has good long-term results provided pretransplant desensitization that includes immunosuppression and apheresis. OBJECTIVE To compare, within the first pretransplant apheresis session given to 29 ABOi kidney-transplant candidates, the effect on isoagglutinin titers (both IgG and IgM isotypes) of three modalities: centrifugation therapeutic plasmapheresis (cTP; n = 10), filtration TP (fTP; n = 9), and double-filtration plasmapheresis (DFPP; n = 10). RESULTS The three groups were comparable according to baseline demographics. Treated plasma volumes were similar across the three groups, that is, 4111 ± 403 mL (cTP), 3861 ± 282 mL (fTP), and 3699 ± 820 mL (DFPP): that is, 54 ± 7, 53 ± 7, and 53 ± 10 mL/kg respectively. One session of centrifugation or filtration TP reduced IgG anti-A/anti-B isoagglutinin titer by ~4, whereas one DFPP session reduced it by ~2. One session of cTP reduced IgM anti-A isoagglutinin titer by a little less than 4, whereas fTP and DFPP sessions reduced it by ~3. There were no statistical differences across the three groups regarding isoagglutinin rebound (IgG and IgM). However, isoagglutinin IgG rebound was >4 dilutions for anti-B titers compared with ~2 dilutions for anti-A titers. The median decreases in IgG level were -3.9 g/L (DFPP), -5.9 g/L (cTP), and - 6.06 g/L (fTP) (p = ns). Median fibrinogen depletions were ~ 60% (fTP), 64% (DFPP), and 76% (cTP). CONCLUSIONS Isoagglutinin depletions within the first apheresis session were similar across cTP, fTP, and DFPP: this was numerically lower for DFPP.
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Affiliation(s)
- Hamza Naciri Bennani
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Johan Noble
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Eloi Chevallier
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Florian Terrec
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Lionel Motte
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | | | - Mathilde Bugnazet
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Farida Imerzoukene
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Bénédicte Janbon
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Paolo Malvezzi
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Lionel Rostaing
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Thomas Jouve
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
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Guan Y, Zhang K, Xu F, Guo R, Fang A, Sun B, Meng X, Liu Y, Bai M. An integrated platform for fibrinogen quantification on a microfluidic paper-based analytical device. LAB ON A CHIP 2020; 20:2724-2734. [PMID: 32588856 DOI: 10.1039/d0lc00439a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Fibrinogen (FIB) plays a key role in blood coagulation and thrombosis and its concentration in blood can directly reflect health conditions, thus efficient detection of FIB would benefit the treatments of certain diseases such as liver and heart diseases. However, there is a lack of sensitive, simple, rapid and cheap FIB detection device currently, in lieu of expensive and sophisticated approaches in laboratories. Here, we propose a novel plasma separation and FIB detection platform based on a microfluidic paper-based analytical device (μPAD). It is the first time that dielectrophoretic (DEP) force is combined with capillary force on paper for plasma separation, and the separation efficiency of plasma reaches about 95%, ensuring reliable downstream FIB detection, for which we also propose a new method called the resistance-fibrinogen detection (RFD) method. It not only avoids the use of large-scale instruments for detection, but also possesses high precision and simplicity. The method is found to be reliable in FIB detection for various concentrations ranging from 127.0 to 508.0 mg dL-1. Moreover, the results obtained from the proposed μPAD show an excellent agreement (R2 = 0.9985) with those obtained from an automatic coagulation analyzer with natural human blood samples. Overall, the proposed platform provides a low-cost and reliable approach for FIB detection, especially for clinical use in resource-limited areas.
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Affiliation(s)
- Yanfang Guan
- College of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
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Lien CC, Chen PJ, Venault A, Tang SH, Fu Y, Dizon GV, Aimar P, Chang Y. A zwitterionic interpenetrating network for improving the blood compatibility of polypropylene membranes applied to leukodepletion. J Memb Sci 2019. [DOI: 10.1016/j.memsci.2019.04.056] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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