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However, in cardiac surgery using the heart\u2013lung machine with direct retransfusion of suction blood, activated blood may re\u2010enter the circulation without filtration and may trigger a cascade reaction leading to systemic inflammation and thrombosis. We therefore set out to evaluate the inflammatory potential of untreated and pyrogen\u2010impregnated cotton\u2010based surgical invasive medical devices. After incubation of the swabs with whole blood or PBMC, the cell\u2010free supernatant was investigated for IL1\u03b2 and IL6. While the reaction of human whole blood toward cotton swabs could not be influenced by any sterilization technique, dry heat and gamma\u2010irradiation were able to diminish the inflammatory reaction of PBMC toward the material and the used pyrogens. In conclusion, using PBMC in direct contact to cotton we are the first to establish a suitable test method for quantification of the pyrogenic\/inflammatory activity of this material. The unaltered reaction of whole blood, however, suggests a crosstalk of cells and plasma proteins in the inflammation activation that is not prevented by sterilization of the swabs. This new<jats:italic>in vitro<\/jats:italic>testing methodology may help to better display the clinical situation during development of new materials. \u00a9 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1877\u20131888, 2019.<\/jats:p>","DOI":"10.1002\/jbm.b.34280","type":"journal-article","created":{"date-parts":[[2018,11,23]],"date-time":"2018-11-23T08:59:02Z","timestamp":1542963542000},"page":"1877-1888","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Inflammatory potential of cotton\u2010based surgically invasive devices: Implications for cardiac surgery"],"prefix":"10.1002","volume":"107","author":[{"given":"Stefan","family":"Trunk","sequence":"first","affiliation":[{"name":"Clinical Research Laboratory, Department of Thoracic Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University Tuebingen 72076 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pia","family":"M\u00fcllerbader","sequence":"additional","affiliation":[{"name":"Clinical Research Laboratory, Department of Thoracic Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University Tuebingen 72076 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrike","family":"Hennig","sequence":"additional","affiliation":[{"name":"Clinical Research Laboratory, Department of Thoracic Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University Tuebingen 72076 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Abel","sequence":"additional","affiliation":[{"name":"Clinical Regulatory Affairs Lohmann &amp; Rauscher GmbH &amp;Co KG Neuwied Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette","family":"Koggel","sequence":"additional","affiliation":[{"name":"Clinical Regulatory Affairs Lohmann &amp; Rauscher GmbH &amp;Co KG Neuwied Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Stang","sequence":"additional","affiliation":[{"name":"Clinical Research Laboratory, Department of Thoracic Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University Tuebingen 72076 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yvonne","family":"Altreuter","sequence":"additional","affiliation":[{"name":"Clinical Research Laboratory, Department of Thoracic Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University Tuebingen 72076 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Volker","family":"Steger","sequence":"additional","affiliation":[{"name":"Clinical Research Laboratory, Department of Thoracic Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University Tuebingen 72076 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Schlensak","sequence":"additional","affiliation":[{"name":"Clinical Research Laboratory, Department of Thoracic Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University Tuebingen 72076 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans P.","family":"Wendel","sequence":"additional","affiliation":[{"name":"Clinical Research Laboratory, Department of Thoracic Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University Tuebingen 72076 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Stoppelkamp","sequence":"additional","affiliation":[{"name":"Clinical Research Laboratory, Department of Thoracic Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University Tuebingen 72076 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,11,22]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"DIN EN ISO 10993","author":"e.V. 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