bluuebunny/crossref_metadata_2025 huggingface dataset:
Hemolytic uremic syndrome/thrombotic thrombocytopenic purpura: Outcome with plasma exchange
Authors: Roberts Andrew W. , Gillett E. Ann , Fleming Simon J.
Published: February 2007

A retrospective analysis was made of 14 consecutive adults with hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP) who were treated with plasma exchange (PE). In six patients the disease was primary, whilst in eight HUS/TTP was considered secondary to an associated condition. Thirteen patients had renal involvement, six had central nervous system symptoms or signs, three had fever, and one had myocardial damage.

Twelve patients (86%) recovered. Four of these relapsed, but responded to further treatment. Two patients failed to respond and died. Hematological response occurred rapidly in survivors: throrobocytopenia resolved after a median of four exchanges, and hemolysis after a median of six. Four patients had a complete recovery, seven had residual mild end organ damage, and one had severe renal impairment.

PE was an effective treatment for both primary and secondary HUS/TTP. The platelet count proved to be the earliest indicator of clinical outcome. Continuing follow‐up of survivors is required because of the risk of relapse and the high incidence of end organ damage.
Zidovudine removal during plasma exchange
Authors: Fauvelle F. , Leon A. , Petitjean O. , Guillevin L.
Published: February 2007

Pharmacokinetics of zidovudine (azidothymidine, AZT) were investigated after oral administration (300 mg every 8 hours) in a human immunodeficiency virus seropositive patient who was also treated with plasma exchange (60 ml/kg). Plasma AZT concentrations were measured using high performance liquid chromatography assay. Plasma exchange clearances reached 1–3.8% of the total clearance. The fraction of AZT removed from separated plasma accounted for only 1% of the administered dose. The contribution of plasma exchange to the elimination of AZT appears to be negligible. Solely on the basis of AZT pharmacokinetic data, no particular dose adjustment appears to be necessary in patients treated with multiple plasma exchanges.
Sickle cell anemia: Pathophysiology, management, and prospects for the future
Authors: Steinberg Martin H.
Published: February 2007

Sickle cell anemia is present in about 1 in 600 Black Americans at birth. It claims the life of many infants, causes pain and suffering in adults, and usually culminates in premature death. We currently understand a great deal about this disease on a molecular, cellular, and clinical basis. The results of years of research are slowly being translated to innovative therapies and improvements in patient care. In this paper I review the pathophysiology of this disorder, highlight the currently available treatment, and discuss new forms of therapy that promise a more direct approach to avoiding the many complications of sickle cell anemia.
Writing, reviewing, and presenting an abstract
Authors: Strauss Ronald G.
Published: February 2007

Abstracts afford an opportunity to report data at professional meetings and, when published, in the literature. Accordingly, they should be prepared with great care. When writing an abstract, anticipate questions the reviewer will ask when judging it and provide complete answers. The presentation of an abstract should follow similar thought processes. State why a problem or question is important, how you addressed it, what you found, and how your findings can be applied to the issue at hand. Slides and text should provide coordinated visual and auditory input, respectively, to ensure complete comprehension.
A discrepancy between the instantaneous and the overall collection efficiency of the fenwal CS3000 for peripheral blood stem cell apheresis
Authors: Haylock David N. , Canty Ann , Thorp Dawn , Dyson Pamela G. , Juttner Christopher A. , Bikto L.
Published: February 2007

The collection efficiency (CE) of the Fenwall CS3000 continuous flow blood cell separator in the apheresis of peripheral blood stem cells during haemopoietic recovery following myelosuppressive chemotherapy was analysed. Ninety‐three aphereses were performed in 19 patients using procedure 3 on the Fenwal CS3000. The overall CE was calculated from the pre‐apheresis cell counts and the stated blood volume processed. Instantaneous CE was calculated from cell counts in the inlet and return lines. The overall mononuclear cell and granulocyte‐macrophage colony forming unit CE were 64.0% and 55.8%, respectively, significantly lower than the instantaneous CEs of 94.5% and 95.4%, respectively (P = 0.0001, t test, for both comparisons). Three factors unrelated to machine performance contributed to the lower overall CE despite a high instantaneous CE: (I) A fall in the patient's mononuclear cell counts during apheresis leading to an overestimation of the cells available for collection, (2) dilution of blood by anti‐coagulant, and (3) the operational dead space of the Fenwal CS3000. The overall CE corrected for these 3 factors approximated the instantaneous CE closely. Thus there is little room for further enhancement of machine performance because the Fenwal CS3000 is already operating with a very high instantaneous CE. To achieve major improvement in the yield of peripheral blood stem cell harvests, more effective mobilization protocols and better timing of apheresis are required. © 1992 Wiley‐Liss, Inc.
Collection of blood mononuclear cells by leukapheresis for transplantation in a yucatan miniature swine model
Authors: Smith Douglas M. , Stribley Judith A. , Lieberman Robert P. , Sharp John G.
Published: February 2007

A large animal model is needed to evaluate new apheresis technologies. These technologies include novel methods of harvesting the blood mononuclear cell population which contains the hematopoietic stem cells needed to restore hematopoiesis in recipients of hematopoietically lethal therapy and the use of cytokines to provide a safe and predictable method of manipulating these circulating hematopoietic stem cells. We describe the methods used to collect mononuclear cells by leukapheresis from Yucatan miniature swine. These animals are of sufficient size to tolerate the procedures and have many physiologic and hematologic similarities to man. They are of good temperament and are easily trained. Long‐term venous access was obtained using single lumen silicone rubber catheters placed in the inferior vena cava. The animals were apheresed while fully awake using a Haemonetics Model V50 machine and a modified lymphocyte collection protocol. The procedure was highly efficient for the collection of mononuclear cells and a 10 pass procedure yielded a product which contained 19.7 × 109 mononuclear cells, 10.7 × 109 granulocytes, and 17 ml of erythrocytes in a volume of approximately 100 ml. This product can be cryopreserved and used for subsequent transplantation. The content of four apheresis procedures provides hematopoietic reconstitution of lethally irradiated swine on a time scale equivalent to transplantation of optimal numbers of bone marrow cells. © 1992 Wiley‐Liss, Inc.
Apheresis for severe malaria complicated by cerebral malaria, acute respiratory distress syndrome, acute renal failure, and disseminated intravascular coagulation
Authors: Lercari Giuseppe , Paganini Giorgio , Malfanti Libera , Rolla Davide , Machi Anna Maria , Rizzo Fortunato , Cannella Giuseppe , Valbonesi Mauro
Published: February 2007

Malaria has become a very uncommon disease in Italy. Recently a variety of circumstances, such as travel to tropical countries as well as immigration from Asia and Africa, have combined to increase the number of malaria cases recorded annually. In this report we describe the use of red cell exchange transfusion and plasma exchange in the treatment of a patient with hyperparasitemic malaria (51% erythrocytes or more parasitized). When first observed the patient was in shock and had signs of cerebral malaria, disseminated intravascular coagulation, and acute respiratory distress syndrome, which in the following 2 days were complicated by acute renal failure. After mefloquine therapy combined with 3 red blood cell exchanges, 2 plasma exchanges, and 10 dialysis sessions over 14 days, the patient recovered completely. This case of severe malaria with multiple complications, treated with mefloquine in conjunction with both exchange transfusion and plasmapheresis, had a successful outcome and lends further support to the possible beneficial role of exchange transfusion in complicated malaria. © 1992 Wiley‐Liss, Inc.
Peripheral blood stem cell mobilization by cytokines
Authors: Ahmed Tauseef , Wuest David , Ciavarella David
Published: February 2007

Hematopoietic stem cells circulate in the peripheral blood. These cells can be collected by apheresis techniques either in the unperturbed state, after mobilization following the administration of cytokines like G‐CSF or GM‐CSF, or during the phase of early blood count recovery following chemotherapy‐induced myelosuppression. The number of cells collected following mobilization is greater than that obtained after apheresis in the unperturbed state. There are, however, qualitative differences between unperturbed and mobilized cells. Chemotherapy related mobilization can be potentially dangerous in that severe myelosuppression necessary to achieve mobilization can have serious consequences. There are no controlled studies that evaluate the relative merits of each method of collection. Regardless of the techniques employed peripheral blood stem cells can reliably accelerate hematologic recovery after potentially myeloblative therapy and provide an alternative to bone marrow support. © 1992 Wiley‐Liss, Inc.
Basic principles of immunology (immune response) for hemapheresis practitioners
Authors: Sigmon Janice M.
Published: February 2007

Advances in medical knowledge and technology have identified the essential elements involved in the human immune system, their relationships and interactions, and offer more advanced concepts in the design, function, and maintenance of immune response. Immune response begins with the earliest progenitor cell and transfers its legacy of protection through white blood cells and the complement system. A basic understanding of immunology is essential to the hemapheresis practitioner as new treatment regimens requiring hemapheresis interventions develop. © 1992 Wiley‐Liss, Inc.
Evaluation of elutriated single donor platelets collected and stored in a closed system
Authors: Elias M. K. , Blom N. , Rijskamp L. , Weggemans M. , Halie M. R. , Das P. C. , Sibinga C. Th. Smit
Published: February 2007

Single donor platelets (SDPC) were collected by the elutriation technique in a closed‐system integrated with large storage containers. Seven runs of SDPC were stored in a 1.5 liter polyvinyl‐chloride trimellitate (PVC‐TOTM) storage container, making the ratio of platelet concentrate volume to container volume 1:4.5. An equal volume of pooled multiple donor platelet concentrates (MDPC) was stored in parallel under the same conditions. All haematological data were comparable for both products, except for the degree of leukocyte contamination (5‐fold increase in the pool). Under these conditions, the functional, morphological, and metabolic characteristics of elutriated platelets throughout 7‐day storage were superior to those of pooled platelets. Although the platelet count was not significantly different in both types of concentrates, the mean pH of pooled MDPC fell to 6.0 on day 5 of storage. Leukocytes were shown to contribute to this pH fall. The extent of cell damage, however, as evidenced by LDH leakage (42.7 LDH units/1011 platelets/day by differential centrifugation, compared to 5.3 units by elutriation) could not be explained solely on the basis of the leukocyte effect. This indicated that the processing method itself influences the platelet quality. By increasing the surface/volume ratio of SDPC, the initial pH of 7.1 was well maintained throughout storage, platelet metabolic rate was slowed, and the function and ultrastructure improved significantly. © 1992 Wiley‐Liss, Inc.
Selective removal of cholesterol by plasmapheresis and the progression of atherosclerosis
Authors: Nomura Hideaki , Malcheskyy Paul S. , Goldcamp James B. , Yamashita Masato , Werynski Andrzej , Nosé Yukihiko
Published: February 2007

There is a strong correlation of plasma cholesterol levels with the risk of coronary heart diseases as shown by epidemiologic studies. This study was undertaken to evaluate the effect of plasma cholesterol lowering on the progression of atherosclerosis in the homozygous Watanabe heritable hyperlipidemic (WHHL) rabbit. The effect of cholesterol lowering, which was accomplished by thermofiltration (on‐line plasma separation with plasma filtration at 39°C) was evaluated by comparison between treated and untreated control groups. Thermofiltration reduced significantly the mean plasma level of total cholesterol (284 vs. 655 mg/dl, P = 0.0005) and the percent aortic area occupied by atherosclerotic plaque (15.0 vs. 44.2%, P = 0.0003). The total lipid and cholesterol contents in the aortas in the treated group were also significantly lower than those in the control group. Microscopically, thickness measurements of the lesions showed that the mean thickness of the fibrous cap and the ratio of the thickness of the intima to that of the media were smaller for the treated group than the control group. This study demonstrated the slowing or stopping of the progression of atherosclerosis by lowering the plasma total cholesterol level in WHHL rabbits. © 1992 Wiley‐Liss, Inc.
Folinic acid does not mobilize hemopoietic progenitors following repeated consolidation chemotherapy for acute leukemia
Authors: Teshima Takanori , Harada Mine , Takamatsu Yasushi , Inaba Shoichi , Kondo Seiji , Akashi Koichi , Okamura Takashi , Niho Yoshiyuki
Published: February 2007

Folinic acid (FA) has been reported to expand the pool of peripheral blood stem cells (PBSC) after chemotherapy. We evaluated the efficacy of FA for harvesting PBSC following cytotoxic chemotherapy in 4 patients with acute leukemia. After achieving a complete remission (CR), 3 courses of chemotherapy for a consolidation of the CR were administered to the patients. Two successive cycles of leukapheresis were performed during the recovery phase from consolidation chemotherapy, which consisted of an intermediate dose of cytosine arabinoside. For the second cycle of leukapheresis. FA was administered intravenously at a dose of 50 mg/day following consolidation. The yields of either mononuclear cells or burst‐forming units‐erythroid (BFU‐E) were not affected by FA administration. In contrast, the yields of colony‐forming units‐granulocyte/macrophage (CFU‐GM) were significantly decreased in all patients compared to the CFU‐GM yields after the first cycle of leukapheresis (P = 0.032). Thus FA is considered not to be effective in expanding the peripheral blood progenitor pool when given in a fashion different from the original report. © 1992 Wiley‐Liss, Inc.
Treatment of babesiosis by red blood cell exchange in an HIV‐positive, splenectomized patient
Authors: Machtinger Larry , Telford Sam R. , Inducil Chat , Klapper Ellen , Pepkowitz Samuel H. , Goldfinger Dennis
Published: February 2007

Babesiosis is a malaria‐like parasitic disease causing subclinical or mild illness in most cases. Splenectomized patients, however, may experience a more severe course. Although generally responsive to antibiotic therapy, several cases of severe babesiosis refractory to appropriate antibiotic therapy have been reported to respond promptly and dramatically to red blood cell (RBC) exchange transfusion. Although the role of HIV coinfection in babesiosis is uncertain, two previously reported cases raise a concern that it may predispose to a more severe clinical course. We report a third case of severe babesiosis in an HIV‐positive splenectomized man, following travel to an endemic area. Antibiotic therapy, though initially effective, ultimately failed to prevent severe disease. RBC exchange transfusion resulted in prompt clinical improvement, which has been sustained during 26 months of follow‐up. Although the patient has since developed various sequelae of HIV infection, including disseminated Kaposi's sarcoma, CMV retinitis, and enteritis, there has been no recurrence of observable parasitemia. In severe babesiosis, RBC exchange transfusion, combined with appropriate antibiotic therapy, appears to be a rapidly effective therapeutic modality which can induce sustained remissions. © 1993 Wiley‐Liss, Inc.
Summary of results of 1991 ASFA apheresis survey
Authors: Malchesky Paul S. , Skibinski Christine I.
Published: February 2007

As part of gathering data for its Networking Directory, the Registry/Directory Committee of the American Society for Apheresis solicited data on the types of apheresis procedures performed, equipment used, and diseases treated in the year 1991. In this voluntary solicitation of the 266 centers responding, 94% were from the United States. For those centers reporting exact numbers of procedures performed out of all institutions doing the procedures 48, 221 therapeutic and 330,702 donor procedures were reported. The dominant type of equipment being used is the centrifugal type.

For therapeutic procedures plasma exchange is the most prevalent procedure and for donor procedures it is plateletpheresis. For therapeutics, Guillain‐Barre syndrome was the most prevalent disease treated by plasmapheresis and leukemias by cytapheresis. The survey methodology proved to be valuable in gathering the data on a voluntary basis. With subsequent surveys and refinement of its methodology the apheresis practices in the United States could be assessed quantitatively to provide information on the number and types of procedures being carried out. Such information is required to assess the impact of apheresis technology on health care, to project trends, and to review the cost impact of this technology. © 1993 Wiley‐Liss, Inc.
HIV infection in hemophilia
Authors: Levine Peter H.
Published: February 2007

This report reviews the natural history of hemophilia and the development of concentrates as the preferred form of treatment and discusses the nature of immune defect in persons with hemophilia. It examines the risk of hepatitis and effect of HIV infection on treatment protocols, and it surveys the status of the safety of modern concentrates and what we have to look forward to in the future. © 1993 Wiley‐Liss, Inc.
HIV—science, politics, and policy: What have we learned?
Authors: Gebbie Kristine
Published: February 2007

A review of where we are as a society after 10 years into the HIV epidemic: how this information will influence public policy over the next 10 years and what factors will influence policy. © 1993 Wiley‐Liss, Inc.
Prolonged circulation of activated platelets following plasmapheresis
Authors: Wun Theodore , Paglieroni Teresa , Holland Paul
Published: February 2007

The extent and duration of in vivo platelet activation were determined in 12 volunteer donors undergoing automated plasmapheresis. Expression of P‐selectin, activated GpIIb/IIIa, and platelet microparticle formation were measured by flow cytometry on peripheral blood samples obtained immediately before and after plasmapheresis and at 24 hour intervals thereafter for up to 3 days. Although no adverse effects were noted in any donor, immediately after apheresis 3 87% of circulating platelets expressed P‐selectin: by 48 hours. 0.5 50% expressed P‐selectin; and by 72 hours, all donors studied had fewer than 5% P‐selectin expression on circulating platelets. Results were similar for the expression of the activated conformation of GpIIb/IIIa. There was a positive correlation with in vitro P‐selectin expression in response to ADP in the pre‐apheresis sample and the number of platelet microparticles detected in the donor following plasmapheresis. In addition, the percent expression of P‐selectin and activated GpIIb/IIIa in response to ADP was reproducible in each individual studied on five separate occasions (CV ≤ 8%). Platelets activated during plasmapheresis using an automated device may circulate for at least 48 hours, and pre‐plasmapheresis response of platelets to the agonist ADP correlated with platelet microparticle formation post‐plasmapheresis. © 1994 Wiley‐Liss, Inc.
Durable remissions following prolonged plasma exchange in thrombotic thrombocytopenic purpura
Authors: Dawson R. Ben , Brown James A. , Mahalati Kathy , Sapsiri Suchada , Pearlman Steve , Gulden Diane , Bilenki Lois , Wenk Robert E.
Published: February 2007

We evaluated the efficacy of prolonged plasma exchange (PEX) for attaining durable remissions in thrombotic thrombocytopenic purpura (TTP). A recent review using steroids or PEX in initial management showed an 80% response rate but produced a relapse rate of 67‐84%. Records of 50 patients starting PEX treatment for TTP/HUS were reviewed to identify and select those whose course of treatment had ended over 1 year earlier, whether or not the result was satisfactory. Records were evaluated for outcome, especially remission associated with treatment by “prolonged” plasma exchange. “Prolonged” was defined as continuing PEX beyond the stage where a normal platelet count was attained and until evidence of hemolysis was “minimal or at least compensated.” If disease activity as judged by the criteria of hemolysis became accelerated or resumed, PEX was increased by volume of FFP (e.g., from 3 to 4 L) or rate (from less than daily to daily). Of 50 consecutive patients treated by PEX for TTP/HUS there were 40 cases after which at least one year had passed since the end of treatment. These 40 patients were evaluated for the results of treatment by PEX. Eight failed to achieve remission, dying in hospital within 1 month of admission. Twenty‐eight achieved remission, sustained for 1 year or more in all. These are the reasons for our enthusiasm about this report. Four achieved remission lasting less than 1 year. Splenectomy was performed to obtain a sustained remission in one patient following administration of three 2 mg doses of vincristine and two relapses. The second was discharged with an adequate platelet count, but had ongoing hemolytic anemia and had to be retreated as an early relapse. The third, a mitomycin‐induced TTP, had an early relapse which responded to additional PEX. The fourth was a late relapse. Our response rate of 80% is not higher than that of recent reviews. However, the relapse rate of 9% with prolonged plasma exchange is three times better than the average relapse rate of 27% from the 20 previous reports in the literature over the same period (Onundarson et al., Arch Int Med 152:761–766, 1992). We attribute this benefit to a strategy of continuing to perform plasma exchange on a tapering, alternating day schedule until disease activity is minimal as defined by criteria of hemolysis. Since relapses are often as devastating as the original episode, the treatment plan described is recommended.
Manual plasmapheresis in the treatment of guillain‐barré syndrome
Authors: De Zoysa Nandrani S. , Jayaweera K. K. D. G. , Vaithianathan Thiru
Published: February 2007

We report on 41 patients with Guillain‐Barré Syndrome (GBS) with disability grade 4 and 5 who were treated with manual plasma exchange (PE). Approximately 20‐40 ml/kg body weight of plasma was removed with each manual PE; 63% of patients needed one PE, 24% needed two, 10% needed three, and 2% needed four plasma exchanges. Normal saline, human serum albumin (NSA) and fresh frozen plasma were used in varying proportions as replacement solutions. Ninety‐one percent of the patients resumed walking with very little assistance ranging from 4 to 56 days with an average of 25 days from the commencement of the first PE. Manual PE in our series was effective and safe as the reported experience of automated apheresis and less volume of plasma was exchanged in our patients undergoing manual PE when compared to those treated in other studies employing automated PE.
Plasma exchange for preeclampsia: III. Immediate peripartal utilization for selected patients with hellp syndrome
Authors: Martin James N. , Perry Kenneth G. , Roberts William E. , Files Joe C. , Norman Patricia F. , Morrison John C. , Blake Pamela G.
Published: February 2007

OBJECTIVE: To explore the potential efficacy of plasma exchange as an ancillary interventive therapeutic tool immediately before or after delivery in the patient with severe preeclampsia/eclampsia and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. STUDY DESIGN: Two gravidas with complicated severe preeclampsia/eclampsia/HELLP syndrome were treated emergently in the immediate peripartal period with single‐volume plasma exchange and fresh frozen plasma fluid replacement using the IBM 2997 Cell Separator. RESULTS: Despite multiple platelet unit infusions, one primigravida in active labor at 5 cm cervical dilatation and 39 weeks' gestation remained at a platelet count of 14,000/μL and began to ooze from her gums. A second primigravida remained obtunded, oliguric, and thrombocytopenic with epistaxis and hematuria following cesarean delivery and platelet transfusions. A single expedited 3‐liter plasma exchange procedure reversed the rapidly deteriorating clinical situation for each patient and accelerated recovery from HELLP syndrome. Both patients and progeny suffered no permanent sequelae. CONCLUSION: Based on our experience, we believe that the therapeutic modality of plasma exchange with fresh frozen plasma can be employed effectively for the pregnant patient with severe atypical HELLP syndrome that progressively worsens during labor or the early puerperium despite the use of conventional transfusion therapy.
Preoperative autologous donation: Surgery clinic staff knowledge/attitudes
Authors: Randels M. J. , Ferguson K. , Strauss R. G. , Daniels M. , Stehling L. , Toy P.
Published: February 2007

Preoperative autologous blood donation (PABD) is both under‐ and overused. Although the decision to order PABD lies with the surgeon, it is quite likely that other surgery clinic personnel influence patient acceptance and enrollment into PABD programs. Accordingly, we measured knowledge, attitudes, and the referral practice of clinic personnel pertaining to PABD. We administered a questionnaire to 102 nurses and 33 clerks working in surgery clinics at three university medical centers‐one center in an area with a high incidence of AIDS and two centers in areas of low incidence of AIDS. Knowledge of PABD was poor when assessed by six questions. Only 6% each of nurses and clerks answered all questions correctly; 55% of nurses and 54% clerks missed three or more of the six questions. Surprisingly, no differences (P > .05) in knowledge deficits were noted when personnel from high and low AIDS areas were compared‐indicating an overall need for education about PABD. In general, attitudes about PABD were positive, as most respondents (63%) gave favorable answers. Clinic personnel from the high AIDS area had even more favorable attitudes (P = .02). Because of these favorable attitudes, it seems likely that educational programs dealing with PABD would be readily accepted by clinic personnel. Greater knowledge should enhance the effectiveness of clinic staff in identifying, counseling, and referring eligible patients for this service.
Sequential transplants using mobilized peripheral blood progenitor cells
Authors: Ghalie Richard , Richman Carol M. , Bender James G. , McLeod Bruce C. , Lee Wanda , Czyzewski Ann , Manson Sharon , Cobleigh Melody A. , Reed Susan , Pierre Ron , George Selma , Kaizer Herbert
Published: February 2007

Modest success has been achieved with the use of high‐dose cytotoxic therapy and bone marrow transplantation in solid tumors. Patient outcome can potentially be improved with further intensification of the therapy. The rapid hematologic recovery achieved with mobilized peripheral blood progenitor cells (PBPC) may reduce the toxicity of transplantation enabling the use of sequential courses of myeloablative therapy. We report on 42 patients with solid tumors enrolled in a tandem transplant protocol involving the use of PBPC mobilized with cyclophosphamide (4 g/m2), etoposide (1 g/m2), and granulocyte‐colony‐stimulating factor (G‐CSF: 10 μg/kg/day). This regimen significantly increased the number of circulating progenitor cells; only 1‐2 aphereses were sufficient to collect 2.5 × 108/kg mononuclear cells, our goal for each transplant course. The median number of circulating colony‐forming units (CFU) and CD34+ cells obtained for each transplant course were 70.3 × 104/kg and 11.7 × 106/kg, respectively. There was a significant correlation between the numbers of CD34+ cells and CFU measured in the apheresis product (r = 0.49, P = .003). The first transplant regimen given to 38 patients consisted of thiotepa, carboplatin, and cyclophosphamide. The second transplant regimen given to 29 patients consisted of busulfan and etoposide. Hematologic recovery was comparable after each of the two transplant courses. The median time to neutrophil recovery over 0.5 × 109/L and to platelet transfusion independence was 9 and 8 days, respectively. There was no difference in engraftment rates after transplant with PBPC only (n = 28 courses) compared to transplant with PBPC plus bone marrow (n = 39 courses). There was a significant correlation between hematologic recovery after transplant and the number of CD34+ cells present in the PBPC. In conclusion, 1) PBPC are significantly mobilized with this combination chemotherapy and G‐CSF, 2) mobilized PBPC result in rapid engraftment after myeloablative therapy, 3) hematologic recovery rates are comparable after sequential PBPC transplants, 4) PBPC alone are sufficient for long‐term engraftment, and 5) rapid engraftment after PBPC transplant enables the use of a second course of myeloablative therapy within a short interval of time.
Plasmapheresis combined with interferon: An effective therapy for multiple sclerosis
Authors: Medenica Rajko D. , Mukerjee Sonjoy , Alonso Kenneth , Lazovic Gavrilo , Huschart Teresa
Published: February 2007

The rationale for the use of interferon (IFN) in the treatment of multiple sclerosis (MS) is based on its recognized antiviral and immunomodulating actions. The pathogenesis of MS is believed to be due to an immunologic response in a genetically predisposed individual, localized within the central nervous system white matter, and triggered by exposure to an environmental agent such as a virus. Based on our personal experience we find that the efficacy of IFN therapy is hampered in MS patients by the presence of an interferon inhibitor factor (IIF) in the patients' sera which we have isolated and characterized. When plasmapheresis (PP) was done on 24 MS patients with intermittent 3‐day administration of IFN‐a and human leukocyte IFN, marked increase of IFN in 18 patients and modest increase in three patients correlated with clinical improvement. Three clinical nonresponders showed no increase in IFN levels following therapy. The ability to remove IIF and lymphokine inhibitor factor (LIF) by PP may explain the successful treatment of our patients. We describe the evaluation of helper T cells, suppressor T cells, HLADR antigen, natural killer cells, and monocyte/macrophage cell populations by flow cytometry before and after PP. A significant increase in these immune‐competent cells correlated with marked improvement in Kurtzke disability status scale in 13 patients, while eight stabilized. Patients showing progression of the disease either showed decrease or no change in these parameters after therapy. Encouraging results from this pilot study suggest that PP combined with immunomodulatory regimens of IFN may be an effective therapy for MS.
Plasma separation for artificial liver support
Authors: Lepage Elaine B. , Lane Robert , McKay Dan , Rozga Jacek , Demetriou Achilles A.
Published: February 2007

A bioartificial liver (BAL) support system, using plasma separation, has been developed to support acute liver failure patients. This study examined 14 consecutive BAL treatments in nine patients with severe acute liver failure. We report methods to achieve and manage plasma separation for an extended period of time. The mean duration of a BAL treatment was 435 minutes, with 26–59 liters of blood processed. Ionized hypocalcemia resulting in muscle twitching was a side effect of the therapy. Ionized calcium levels decreased significantly (P lt; .02) after BAL treatment; however, total calcium levels increased (P lt; .05). No significant changes were noted in heart rate, electrocardiogram [Q—T (Q—Tc) interval], blood pressure, prothrombin time, partial thromboplastin time, hematocrit, platelet count and serum phosphorous, magnesium, glucose, and pH. Plasma fibrinogen levels decreased significantly (P lt; .002). Ionized hypocalcemia due to the chelating effect of sodium citrate was controlled by calcium chloride administration, adjustment of blood separation rates, and reduction of the blood‐to‐citrate ratio. This report demonstrates that intensive, large‐volume plasma separation for long periods of time can be achieved safely in critically ill patients without serious adverse effects.
Clinical perspectives of platelet transfusions: Defining the optimal dose
Authors: Strauss Ronald G.
Published: February 2007

To halt bleeding in patients with severe thrombocytopenia due to bone marrow failure, it is desirable to achieve a post‐transfusion blood platelet count of 40 × 109/L by platelet transfusions. Based on calculations of corrected count increments, each 1 × 1011 platelets transfused will increase the blood platelet count approximately 10 × 109/L per each square meter of patient body surface area. Thus, the post‐transfusion blood platelet count will be approximately 20 × 109/L following transfusion of 3 × 1011 platelets to a 5 foot, 8 inch patient weighing 170 pounds (2.0 m2), who is bleeding because of a pre‐transfusion platelet count of 5 × 109/L. The post‐transfusion platelet count likely will be even lower in sick patients (sepsis, amphotericin B plus antibiotic therapy, splenomegaly, graft‐vs.‐host disease, etc.) or if platelets are lost from the unit by leukofiltration before transfusion. Although a dose of 3 × 1011 platelets is acceptable, in a regulatory sense for product quality, it is inadequate to control bleeding in most thrombocytopenic adult patients. Adjusting dose for body size, bleeding patients with pre‐transfusion blood platelet of <10 × 109/L and weighing >120 pounds should receive approximately 6 × 1011 platelets, those weighing 30 to 120 pounds should receive 3 × 1011 platelets, and infants weighing <30 pounds (15 kg) should receive 5–10 ml/kg of platelet concentrate.
Blood center perspective: Defining the ideal platelet concentrate
Authors: Axelrod Frederick B. , Ooley Patrick W.
Published: February 2007

During the past two decades, an increased demand for platelets has challenged blood collection centers to produce a safe and readily available supply. Defining the ideal platelet for transfusion is a process that cannot be decided by a single entity. Collection centers are only one member of a partnership which involves the donor, transfusion service, hospital administration, clinicians, and patients. Regulatory definitions exist to help guide collection centers to the minimum acceptable criteria for the production of platelets, but in reality, the standard by which clinicians judge the efficacy of the product is most important.
T‐cell responses in photoimmune therapy
Authors: Heald Peter W. , Kim Hong Yong , Perez Maritza , Edelson Richard L. , Berger Carole L.
Published: February 2007

The extracorporeal inactivation of a lymphocyte rich buffy coat suspension with ultraviolet A light and 8 methoxypsoralen can lead to dramatic clinical improvements following reinfusion of the damaged cells. This therapy is reviewed in the context of the disease it is most commonly used for: cutaneous lymphoma. Studies with cutaneous lymphoma patients have shown an active immune response against purified tumor cells. In addition a mouse model for an impact of therapy on a T‐cell lymphoma has demonstrated results that parallel those from clinical studies in humans. The impact of photoimmune therapy on in vivo and in vitro T‐cell responses to cutaneous lymphoma is discussed.
Influence of type of exchange fluid on survival in therapeutic apheresis for thrombotic thrombocytopenic purpura
Authors: Owens Michael R. , Sweeney Joseph D. , Tahhan Raymond H. , Fortkolt Peter
Published: February 2007

Thrombotic thrombocytopenic purpura (TTP) is a potentially lethal disease that may respond favorably to plasma infusion or therapeutic plasma exchange (TPE) with frozen plasma (FP) as the exchange fluid. Frozen plasma from which the cryo‐precipitated fraction has been removed (cryopoor plasma, CP) has reportedly been useful in refractory cases in which a response to FP is not being observed. We report a retrospective analysis of all cases of TTP treated by TPE with either FP (1985–1989) or CP (1989–1993) as exchange fluid at a large tertiary care hospital between the years 1985 and 1993. A severity score index was compiled for each patient using the platelet count, mental status, hematocrit, and renal function at the time of diagnosis. Nineteen patients were treated with FP (group I) and 18 patients with CP (group 2). Groups did not differ in age, gender, race, hematologic parameters, or severity scores. Patients treated with CP, however, had more plasma exchanges (14 ± 10 vs. 12 ± 8, respectively) and more fluid exchanged than these treated with FP (50 L ± 36 vs. 37 L ± 40, respectively). Survival was 72% in the CP group and 47% in the FP group.

Although a survival advantage for the use of CP as exchange fluid in the treatment of TTP is suggested by our observations, the retrospective nature of the study, lack of randomization, and sequential rather than concurrent use of FP and CP indicates caution in interpretation. The data do indicate, however, that use of CP is acceptable as the initial exchange fluid in TTP.
Physician coverage of therapeutic apheresis
Authors: Woll Judith E.
Published: February 2007

A “snapshot” survey of physician coverage for evaluation and supervision of therapeutic apheresis procedures shows significant variation in current clinical practice between 39 blood center‐ and 41 non‐blood center‐based programs. Whereas 56% of blood center‐based programs usually require physician's “in person” evaluation of the patient, 86% of non‐blood center programs do (P< .005). Similarly, non‐blood center‐based programs were more likely to have physicians on the premises to supervise first and subsequent procedures and to bill separately for medical coverage. These differences were unrelated to location of the procedure (in hospital, blood bank, outpatient department, or other), the size of the program, or any information provided on adverse reactions.
Efficacy and safety of plateletpheresis by donors with low‐normal platelet counts
Authors: Rogers R. L. , Johnson H. , Ludwig G. , Winegarden D. , Randels M. J. , Strauss R. G.
Published: February 2007

Our practice is to defer donors with blood platelet (PLT) counts of <180 × 109/L because PLT yields are low, when compared to PLT units collected from donors with higher counts. In an attempt to minimize deferral, we determined whether 33 donors, who repeatedly demonstrated low‐normal PLT counts (150–180 × 109/L) on multiple occasions during the prestudy period, might safely donate satisfactory apheresis PLT units simply by extending the apheresis collection time by 20 min (men) and 40 min (women). Repeat plateletpheresis procedures were scheduled at ≥28‐day intervals. The mean PLT yield (N = 92) was 5.8 × 1011 with 97% of units containing ≥4.0 × 109 PLTs. Although donors entered the study only after they had repeatedly exhibited predonation PLT counts of <180 × 109/L, PLT counts were not always below this level at the time of study collections. However, analyzing only donations with true predonation PLT counts of <180 × 109/L (N = 35), the mean PLT yield was excellent—5.4 × 1011 with 97% of units containing ≥4.0 × 1011 PLTs. The average fall in donor blood PLT counts (pre‐ vs. postdonation) was 36%, with only ten of 99 postdonation counts being <100 × 109/L; the lowest was 69 × 109/L. Thus, extending the apheresis collection time permitted donors who in the past were routinely deferred because of low PLT counts to safely donate satisfactory PLT units.
Timescales and Phenomenology of Mechanically Stimulated Glasses: a Review
Authors: D'Amore Alberto , Grassia Luigi , Acierno Domenico
Published: February 2007

The principal features of the volumetric as well as the viscoelastic response of mechanically stimulated glasses can be summarized as follows: i) the time‐aging time shift factors contract upon increasing the probe stress (i.e. the stress apparently modifies the volume recovery kinetics), ii) the volume recovery baseline remains unaltered (i.e. the underlying structure of the stimulated glass remains unchanged) iii) yielding scales linearly with the logarithmic of the strain rate. Here we present a review of the above features with aid of a series of numerically simulated results concerning the responses of glassy polycarbonate. Simulations are obtained coupling a modified KAHR equation with the constitutive law for linear viscoelasticity within the domain of the reduced time. It will be shown that by using a minimum of experimental (PVT and linear viscoelastic) data inputs even the subtle intricacies can be predicted. Furthermore a new class of results concerning the stress‐strain behaviour of glassy polymers is presented that never appeared before.
Preparation and Properties of Nanostructured Rubber Composites with Montmorillonite
Authors: Cataldo Franco
Published: February 2007

Montmorillonite exfoliated nanoclay was prepared by treating montmorillonite with an alkyalmmonium salt. It has been characterized by FT‐IR spectroscopy and thermal analysis (TGA‐DTA). The nanoclay composites, in which the rubber matrix was introduced by mixing solutions of the elastomer with the organically modified clay was then compounded with carbon black filler at 2.5, 5, 10, 15 phr loading level of nanoclay. The sulfur cured rubber samples were tested against a reference compound not filled with the nanoclay. Rheometrical and scorch measurements have shown that the nanoclay increases the curing speed and reduces the scorch safety. A very high reinforcement and stiffening effect due to the nanoclay was observed especially at 5 and 10 phr nanoclay filling level and especially at low extension modulus which can be increased up to 40% its original level than in the reference compound. An anisotropic behavior has been recorded in the stress‐strain curve: for instance the 50% modulus was found >20% higher when measured parallel to the alignment of the exfoliated nanoclay lamellae in comparison to the modulus perpendicular to the lamellae orientation. The compounds with nanoclay show no adverse effects in tensile strength and in tear resistance, in De Mattia crack initiation and in abrasion resistance. Nanoclay reduces also the hysteresis and heat build up of the rubber compounds.
Effect of Morphology on the Relaxation Processes and Mechanical Properties in Polyimide/Silica Hybrids
Authors: Ragosta Giuseppe , Musto Pellegrino , Abbate Mario , Russo Pietro , Scarinzi Gennaro
Published: February 2007

Polyimide/silica hybrids were produced by a sol‐gel process and were examined in terms of their morphology, dynamic‐mechanical properties and mechanical performances. Two types of morphology were obtained by tailoring the composition of the precursor solution mixture, i.e. phase‐ separated or co‐continuous systems. These morphologies were found to exhibit considerably different properties. In particular, co‐continuous nanocomposite systems were found much more effective in suppressing molecular relaxation processes than micron sized particulate hybrids. The latter systems, on the other hand, exhibited enhanced ductility and fracture toughness
Innovative Poly(Butylene Terephthalate) Based Nanocomposites: a Preliminary Investigation
Authors: Acierno D. , Amendola E. , Callegaro G. , Napolitano G.
Published: February 2007

A polymer‐clay nanocomposite based on Poly(butyleneterephthalate) (PBT) and an innovative organoclay has been synthesized via intercalation of Bis(hydroxyethyl terephthalate) (BHET) in Na‐Montmorillonite layers. Chemical and physical properties of this nanocomposite have been studied in comparison to other PBT/nanocomposites based on two commercial organoclay: Cloisite 25A and Somasif MEE. Nanocomposites have been prepared via melt compounding using a twin‐screw extruder, with extrusion rate of 150 rpm. Samples were characterized by using wide‐angle X‐ray diffraction, TEM, thermal and mechanical analysis.
Characterization of hdpe/ha Composites Treated with Titanate and Zirconate Coupling Agents
Authors: Carmen Albano , Rosestela Perera , Arquímedes Karam , Gema González , Nohemy Domínguez , Yanixia Sánchez , Luís Brito Juaquín
Published: February 2007

The development of new materials for bone substitution has been of great interest for the scientific community in the last years. High‐density polyethylene (HDPE) and hydroxyapatite (HA) composites have been used in biomedical applications without any inflammatory response. However, the differences in nature of both materials have motivated the use of coupling agents to improve their interfacial interactions. In this work, the effects of adding three different commercial coupling agents (NZ12, Lica01, Lica12) to high‐density polyethylene (HDPE)/hydroxyapatite (HA) composites were studied. Composites containing 20 parts per hundred (phr) of HA previously treated with the already mentioned coupling agents were characterized by mechanical tests and their morphologies were analyzed afterwards. Composites with 0.3 and 0.5 wt% of NZ12 unfolded an increase in their Young's modulus and tensile strength, as a consequence of an improved dispersion of the filler into the polymeric matrix. Analysis of the samples by XPS showed that the zirconate coupling agent interacted more with the HA, as reflected in the lower binding energies of the corresponding oxygen atoms, which agrees with their better performance from the mechanical point of view.
Influence of Electrical, Chemical and Morphological Properties of Inorganic/Organic Interface on Light Emitting Devices Performance
Authors: Vacca Paolo , Petrosino Mario , Chierchia Rosa , Guerra Alfredo , Minarini Carla , Rubino Alfredo
Published: February 2007

studies on the influence of chemical and physical treatments on the properties of indium–tin oxide (ITO) thin films are reported. The ITO films are utilized as transparent anodes of organic light‐emitting diodes (OLEDs) incorporating poly(9,9‐dihexyl‐9H‐fluorene‐2,7‐diyl) (PF6) as the hole transporter material and 8‐hydroxyquinoline aluminum salt (Alq3) as emitter material. Chemical (HCl, piranha solutions), thermal (vacuum annealing), physical treatments (oxygen plasma, UV ozone) and combined treatments are studied. First, ITO layers with different treatments are characterized by using four point probe method, contact angle measurement, X‐Ray diffraction (XRD), surface profilometer, scanning electron microscopy (SEM), UV‐Vis‐IR transmittance. Later, electrical and optical properties of OLEDs with treated ITO as anode are extensively investigated.
Chemiluminescence ‐ A Novel Method in the Research of Degradation of Paper. I. The Effect of Light on Stacked Sheets of Paper
Authors: Matisová‐Rychlá Lyda , Bukovský Vladimír , Rychlý Jozef , Pleteníková Martina
Published: February 2007

Statistical scission of cellulose macromolecules leading to the negative changes in mechanical properties of the paper has been quantified on irradiated stacks of newsprint papers. Attention has been paid to comparison of changes occurring in respective sheets of the stack. The correlation of the results of non‐isothermal chemiluminescence method from which the rate constant of paper oxidation has been determined for 105 °C with the changes of carbonyl groups concentration, pH and double folds has been outlined.