bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Safety and Efficacy of Programmable Implantable Insulin Delivery Systems
Authors: Olsen C.L. , Liu G. , Iravani M. , Nguyen S. , Khourdadjian K. , Turner D.S. , Waxman K. , Selam J-L. , Charles M.A.
Published: April 2018

Objectives

Since only short-term studies of continuous intraperitoneal insulin infusion (CIPII) therapy using implantable programmable insulin delivery systems have been performed to show this method of diabetes therapy to be safe and efficacious, we have performed long-term studies to assess its safety and efficacy.

Research design and methods

For 78 patient-years of follow-up, we have longitudinally studied the incidence of diabetic ketoacidosis and severe hypoglycemia in 25 type 1 diabetic patients treated with CIPII. We also compared, cross-sectionally, the long-term safety and efficacy of CIPII to intensive subcutaneous insulin therapy using intermittent injections or continuous subcutaneous insulin infusion. Finally, we examined the relationship between glycated hemoglobin levels and the standard deviation of daily blood glucose excursion.

Results

Cross-sectional analysis revealed similar degrees of metabolic control accompanied by significantly decreased rates of both ketoacidosis (0.013 events/patient/year) and severe hypoglycemia (0.05 events/patient/year) during CIPII compared to intermittent injections and continuous subcutaneous insulin infusion therapy. A four-fold decrease in the rate of severe hypoglycemia was observed during longitudinal comparison of pre- and post-implantation complication rates. A relationship was also shown between decreased levels of mean glycated hemoglobin and the standard deviation of blood glucose excursions during CIPII therapy.

Conclusions

Our data demonstrate that long-term therapy with CIPII is as effective as other methods in achieving near-normal levels of glycated hemoglobin, which in CIPII is associated with a decreased standard deviation of blood glucose excursions. Further, CIPII using implantable programmable insulin delivery systems is the safest method described for intensive insulin therapy in home blood glucose monitoring type 1 diabetic patients.
Survival after PBSC Transplantation and Comparison of Engraftment Speed with Autologous and Allogeneic Marrow Transplantation: Results of a Multicenter Study
Authors: Iacone A. , Pierelli L. , Quaglietta A.M. , Nicolucci A. , Menichella G. , Di Bartolomeo P. , De Laurenzi A. , Fioritoni G. , Indovina A. , Leone G. , Majolino I. , Montuoro A. , Di Marzio A. , Torlontano G.
Published: April 2018

We have analyzed the results of a multicenter study on peripheral blood stem cell transplantation (PBSCT) performed on 55 patients suffering from various neoplastic diseases. After myeloablative therapy, they received a mediam of 6.8x108/kg MNC and 11.4x104/kg CFU-GM harvested by a median of 9 apheresis after mobilization with chemotherapy alone. As of date, 34 of the 55 patients are alive and 28 of them are in continuous complete remission after a follow-up of 30 months. The probability of survival was related to the disease status at transplant, CR/PR vs. PD (p= 0.0001) and the bone marrow involvement, BM-vs. BM+ (P=0.009). Furthermore, a comparative study on speed of engraftment and clinical management was conducted on the 55 PBSCT patients as well as on 41 autoBMT and 52 alloBMT patients. Days to reach WBC> 1.0x109/L, PMN> 0.5x109/L and PLT> 50x109/L was 12/14/33 for PBSCT, 17/20/23 for ABMT and 15/16.5/18 for BMT, respectively. Days with fever >38° C, systemic antibiotic therapy and length of hospitalization was 3/12/36 for PBSCT, 5/18.5/42 for ABMT and 9/25/46 for BMT respectively.
PBSC Collection after High Dose Chemotherapy Followed by G-CSF in Patients with Malignancies: Analysis of Results regarding Factors Affecting the Yield of Hemopoietic Progenitors
Authors: Olivieri A. , Offidani M. , Ciniero L. , Poloni A. , Tedeschi A. , Refe M.C. , Strusi A.S. , Leoni P.
Published: April 2018

High-dose non ablative chemotherapy followed by growth factors efficiently mobilizes and amplifies Pheripheral Blood stem Cells (PBSC). Cytofluorimetric PBSC monitoring reduces the number of leukapheresis needed to collect sufficient amounts of progenitors to restore hemopoiesis after myeloablative therapy. Twenty-eight patients, affected by lymphoproliferative disorders, were primed with non myeloablative chemotherapy followed by G-CSF 5 μg/kg/die subcutaneously, until leukapheresis. A total number of 90 leukaphereses was performed (median: 3 per patient) using blood cell separator CS 3000 Plus Baxter; we collected 1±0.8 x 108/kg mononuclear cells (MNC), 6±9 x 104/kg CFU-GM and 4±5 x 106 CD34+ cells for each procedure. The statistical analysis showed that the number of progenitors collected was dependent on the age, number and type of previous chemotherapies and interval between the last chemotherapy and the priming; the type of priming, type and status of disease, sex, and bone marrow involvement were not significant. Duration of neutropenia after megachemotherapy was very short; in two cases platelet support was necessary and only two patients needed hospitalization. Our experience shows that high-dose non ablative chemotherapy followed by G-CSF is safe and yields large amounts of PBSC; several factors influence the quality of collections mainly regarding age and the previous treatment.
Peripheral Blood Stem Cell Transplantation: Critical Review
Authors: Hénon P.R.
Published: April 2018

Autologous blood stem cell transplantations have been increasingly performed worldwide for almost ten years in place of autologous bone marrow transplantation and even of allogenic bone marrow transplantation. Several crucial issues were the subjects of impassioned controversies. Some of them are now satisfactorily answered while others still remain unresolved. First, it is now possible to conclude today that peripheral blood stem cells (PBSC) are undoubtedly capable of restoring short term hematopoiesis when reinfused after myeloablative therapy as well and even more rapidly than bone marrow stem cells, provided that they have been previously collected in sufficient amounts. On the opposite, it is still impossible to firmly prove that their very immature CD34+ cell subset, although in vitro functionally and phenotypically almost identical to their marrow counterpart, is actually responsible for sustained long term hematopoietic recovery, even if it is likely that these cells play a key role.

Most of the time, using chemotherapy alone or a combination of chemotherapy and cytokine(s), mobilizing regimens allow collection of appropriate yields of PBSC with only a small number of apheresis cycles, provided that a sufficient number of residual stem cells remains to be stimulated, when, on the contrary, collection in steady-state is time-consuming and does not provide further accelerated post transplant hematopoietic recovery.

It was initially hypothesized that PBSC could have a lower likelihood of tumoral contamination compared with bone marrow. In fact, biological as well as clinical data are discordant and probably depend largely on the type of disease, its evolutive history and its way of dissemination. Furthermore, the respective impact on the development of further relapse of graft contamination and of residual tumor cells into patient remains to be determined.

Finally, although it has often been claimed that the cost of mobilization, collection and cryopreservation of PBSC would be much higher than the cost of bone marrow harvesting, it is now possible to assert that the whole ABSCT procedure, including this preliminary phase, as well as the post-transplant period, allows an indisputable saving compared with ABMT.

These advantages are already sufficient reasons “per se” to propose ABSCT in place of ABMT or alloBMT in many indications even if their clinical benefit, in terms of disease-outcome, remains to be prospectively explored.
Peripheral Blood Stem Cell (PBSC) Mobilization and Transplantation (PSCT) in Patients with Malignant Lymphomas and Solid Tumors
Authors: Richel D.J. , Van Der Wall E. , Slaper J. , Van Der Schoot E. , Rodenhuis S.
Published: April 2018

Peripheral blood stem cells can reconstitute bone marrow function after high-dose chemo-Zradiotherapy. We describe 44 patients related with a three-day course of chemotherapy, for hematopoietic stem cell mobilization, consisting of cyclophosphamide or ifosfamide and etoposide (malignant lymphoma and germ cell tumor) or a one-day course of 5-fluorouracil, epirubi-cin and cyclophosphamide (breast cancer), followed by the administration of recombinant human granulocyte colony-stimulating factor (G-CSF).

Maximum numbers peripheral blood stem cells (PBSC) were recruited on day 9-10 of the G-CSF administration. The total number of PBSC cells harvested with median 3.6 leukaphereses was 46 x 104/kg (7.5-136) CFU-GM or 8 x 106/kg (0.7-25.0)CD34+ cells for patients with solid tumors and 26 (4.5-258) CFU-GM's or 6.1 (1-0-39.2) CD34+ cells for patients with malignant lymphomas. Thirty-five patients with malignant lymphomas or solid tumours received high-dose chemotherapy followed by bone marrow and PBSC infusion (n=8) or PBSC cell infusion alone (n=27). The recovery of granulocytes, platelets and reticulocytes after peripheral stem cell transplantation (-PSCT) in addition to or instead of bone marrow, was markedly accelerated compared with the infusion of BM alone. The accelerated haemopoietic recovery was associated with a reduction in platelet and red blood cell transfusion, reduction in fever periods and earlier discharge from hospital. PSCT is an important alternative to autologous bone marrow transplantation (ABMT). This transplantation technique may also allows application of multiple-cycle intensive chemotherapy.
In Vitro Expansion of CD34+ Cells Mobilized with Chemotherapy and G-CSF
Authors: Teofili L. , Iovino M.S. , Di Mario A. , La Barbera E. Ortu , Pierelli L. , Bussa S. , Rumi C. , Menichella G. , Leone G.
Published: April 2018

Hemopoietic CD34+ progenitors were isolated by immunomagnetic method from normal bone marrow (BM) or from peripheral blood (PB) of patients with non-Hodgkin's lymphoma treated with chemotherapy and granulocyte colony-stimulating factor (GCSF). Aliquots were seeded in longterm cultures (LTC) on bone marrow-derived stromal layers; non-adherent and adherent clonogenic content of the cultures was assayed weekly. The final recovery and the clonogenic efficiency of the CD34+ cells were sligthly higher in PB samples than in BM controls. In long term cultures PB cells sustained hemopoiesis as much as BM cells; at week 3 and 4 PB total mononuclear cells and CD34+ cells showed a non-adherent cell recovery higher than the respective BM controls. Furthermore, PB CD34+ cells were expanded in liquid culture in the presence of granulocyte-macrophage colony-stimulating factor (GM-CSF) or G-CSF alone or combined with interleukin 3 (IL3), stem cell factor (SCF), interleukin 1 (IL 1), interleukin 6 (IL6). The combination of GM-CSF, IL3, SCF, IL 1 and IL6 produced the maximum increase of both mononuclear cells (30-fold) and granulocyte-macrophage colony forming units (CFU-GM) (4.6-fold) after 7 days of cultures; yet after 14 days a strong decrease of the CFU-GM occurred. These data suggest that G-CSF following chemotherapy mobilizes both early and committed hemopoietic progenitors.
Autologous Bone Marrow Purging with Lak Cells
Authors: Giuliodori L. , Moretti L. , Stramigioli S. , Luchetti F. , Annibali G.M. , Baldi A.
Published: April 2018

In this study we will demonstrate that LAK cells, in vitro, can lyse hematologic neoplastic cells with a minor toxicity of the staminal autologous marrow cells. In fact, after bone marrow and LAK co-culture at a ratio of 1/1 for 8 hours, the inhibition on the GEMM colonies resulted to be 20% less compared to the untreated marrow. These data make LAK an inviting agent for marrow purging in autologous bone marrow transplantation.
Gene Therapy and Apheresis
Authors: Servida P. , Bordignon C.
Published: April 2018

Gene therapy is becoming a real therapeutic chance in some genetic disorders. The first candidates to this approach are genetic diseases which involve hematopoiesis, because of the facility for the collection and the manipulation of hematopoietic progenitors.

Apheresis techniques, which are able to collect a great number of mononuclear cells from peripheral blood, are ideal for obtaining a large number of cells which can be transfected.

Future uses of gene therapy techniques could be: the treatment of hematopoietic genetic disorders, procedures of gene marking, and the manipulation of normal hematopoietic cells with the objective of increasing their resistance to myelotoxic drugs.
Donors Thrombocytapheresis with Last Generation Cell Separators
Authors: Valbonesi M. , Frisoni R. , Florio G. , Ruzzenenti M.R. , Carlier P.
Published: April 2018

An exciting, fast moving and promising field remains the use of plasma-free synthetic medium for platelet storage (10, 11), that along with the potential for getting more plasma for therapeutic needs, might also improve the quality of stored platelets. Addition of acetate to solution, may be the way to obtain these results. An astonishing fact is that citrate remains the only anticoagulant for platelet collection, and remains as well the only real cause of donor disconfort during thrombocytapheresis.
Evaluation of Platelet Concentrates with the New Dideco Blood Cell Separator: Excel
Authors: Schooneman F.
Published: April 2018

The Excel Cell Separator produced by Dideco represents a good compromise between automation and Platelet efficiency. Platelet activation is a phenomenon that we can find with the concentrates of all cell separators. Although, the complement activation of Excel is extremely lower in comparison with the same data obtained using all the other cell separators, the 5-day storage is acceptable. It will be important to research the bacteriological controls. Like the pH of the platelet bags, because in certain cases it was too low. For the future it will be interesting to study the possibility to predict the quantity of platelets collected having a system that is adaptable with the donor parameters.
Plateletpheresis during Plasma Collection
Authors: Rubertelli M. , Marafioti F. , Mazzon C. , Rossetti G. , Gosetti G. , Gottardi P. , Antolini M. , Ceschini N. , Boccagni P.
Published: April 2018

New systems for collection of platelet concentrate (PC) and platelet poor plasma (PPP) are presently available. The aim of our work was to test the possibility of preparing PC routinely from normal plasma donors in a minimum amount of time and, at the same time, providing a second product that can be used as source-plasma or fresh-frozen plasma. Over a 3 year period (from 1990 to 1992) we performed 3503 procedures using 2 Haemonetics PCS machines (1236 procedures) and 3 Autopheresis-C (2267 procedures). With the PC produced we were able to satisfy all the requests coming from the hospitals of our region. The platelet yield was 1.95x10″ with PCS and 3.2x10″ with Auto-C in a PC volume of 150 and 200 ml respectively; collection times were quite similar (56 and 63 min). The results show that plasma-plateletpheresis is an efficient and competitive system. Regarding platelet yield, the best results were obtained with the Auto-C.
Experience of Computer-Aided Management of Hemapheresis Unit
Authors: Scarpato N. , Falco C. , Nappi G. , Formisano S.
Published: April 2018

Several programs are available for blood banks management but none of them is particularly made for hemapheresis.

We studied a data base application able to manage any aspect of hemapheresis unit activity. The programming general criteria were:

1) easiness of use even for people without any previous experience in using Personal Computers;

2) maximum saving time in operating;

3) easily modifiable system in reply to problems or new needs;

4) automatic checks in order to have the highest automation together with the smallest error risk;

5) quick view on state of activity and on material consumption;

6) simplification of donor recruitment.

After a three year long experience, we describe our program structure in order to give a basis for the development of a standardized management system which is useful for different needs and open to future applications of blood cell separators.
Organization and Technical Problems of LDL-apheresis
Authors: Scarpato N. , Falco C. , Nappi G. , Formisano S.
Published: April 2018

The Authors consider problems related to technique and organization of LDL-Apher-esis with respect to some particular aspects. They evaluate:

a) Technical complexity of procedures both in devices to use and in staff preparation;

b) Length of treatment which conditions the other fields of activity;

c) Problems in management treatments periodicity;

d) Usually high cost of this kind of procedures;

e) Problems related to vascular accesses;

f) Problems related to pediatric patients, both for their low weight and vascular accesses;

g) Management of cardiovascular complications;

h) Difficulties in evaluation of regression of vascular lesions.

Finally, it is particularly difficult the management of psychological aspects related to somatic symptoms of the disease and to the acceptance of treatment.
Plasma Exchange: The Cost/benefit Ratio and the Critical Revision of Indications
Authors: Valbonesi M. , Florio G. , Lercari G. , Carlier P. , Ruzzenenti M.R. , Frisoni R.
Published: April 2018

The number of conditions that can benefit from Plasma-Exchange (PE) continues to grow. We have recently added to the list the Cyclosporin-A induced hypertrygliceridemia and myoglobinuric acute renal insufficiency.

Such as any therapeutic measure for PE, four evolutive phases can be recognized: the discovery and research, the confirmation of indications, the routine applications and the decline, when new more powerful tools are offered by culture or technology. We have participated in the first three phases during the last 20 years.

Not necessarily all experiences were favourable. Nonetheless, we feel that, for the time being, a hemapheresis unit is an absolute necessity for a medium - sized hospital even if only therapeutic procedures are carried out. The phase four, decline of interest and applications, cannot be foreseen. Finally the ability of PE to shorten substantially the length of hospital stays along with the ease with which procedure can be performed on ambulatory patients, substantiate a favourable cost/benefit ratio for this therapeutic modality.
Complications of Plasma-exchange
Authors: Belloni M. , Alghisi A. , Scremin L.
Published: April 2018

Complications in apheresis affect on the average 40% of treated patients and 10-14% of the procedures. The mortality rate is 1/500 treated patients.

The utilization of more complex techniques, central catheters, plasma infusion and even more the superimposition of different factors increase the incidence and gravity of side effects. Very influent are also the underlying pathologies and the clinical conditions; particularly at risk are patients with TTP/HUS and GBS.

However, PE represents a relatively safe therapy in which prevention of complications requires a particularly diligent personnel and a careful evaluation of indications.
Immunoregulation of Autoimmune Disorders: The Role of Intravenous Immunoglobulins
Authors: Luzi G. , Ferrara R.
Published: April 2018

Modified and intact immunoglobulin preparations are available for therapeutic use. The administration of intravenous immunoglobulins (IVI G) gave positive results in Primary Immunodeficiency Syndromes (PIS) (prophylaxis of viral and bacterial diseases), in treatment of secondary immunodeficiencies (hematologic malignancies, bone marrow transplantation), and in some infections. Adverse reactions have been reported during IVIG infusions, but they are rarely serious and do not represent limiting conditions for a short or long term therapy. After the original observation in thrombocytopenic purpura, IVIG have been used as immune modulators in various autoimmune related disorders. Various mechanisms of action are proposed: blockade and down regulation of phagocytic function via Fc receptor, regulation of idiotype-anti idiotype network, suppression of idiotype synthesis, T-B cell interference towards antigen presentation, increase in suppressor lymphocytes, IVIG-cytokine interaction.
Current Concepts of Platelet Physiopathology
Authors: Cerletti C. , De Gaetano G.
Published: April 2018

The genesis of the modern concept of platelet physiopathology can be traced historically to many individuals and developments, including the pioneering work of Giulio Bizzozero over 100 years ago. Much knowledge has since been gained to the point that we can now define many of the elements of the platelet function in relation to the hemostatic process in terms of their molecular biology. This presentation will attempt to synthesize a simple, understandable, yet global perspective of platelet function and of its participation to the pathogenesis of arterial thrombosis. Focus will be placed on the crucial importance of cell-cell interaction. A symbolic representation of platelet plug formation using simple mathematical figures like the line, point, and triangle is helpful. The line represents the vascular system with intact endothelial cell linings. The irritation/disruption of vascular endothelium can be viewed as a point on the line representative of a localized event. From this initial (often small) stimulus, amplification occurs rapidly to produce an appropriate cellular and humoral response, represented by a triangle. Each component (vessel wall, platelets, leukocytes, coagulation and fibrinolysis systems) of this complicated response has biological characteristics which localize and amplify subsequent reactions to the site of primary injury until bleeding is arrested and the wound is healed or arterial thrombosis progresses to vascular occlusion.
Biocompatibility in Hemapheresis: Blood Coagulation
Authors: Bizzi B. , Foddai M.L.
Published: April 2018

Hemapheresis may influence the coagulation system with effects of activation and dilution. Dilution can lead to reduced levels of platelets, fibrinogen and antithrombin III. Activation initially causes increased clotting activity, but the consumption of the activated factors generally induces a subsequent phase of hypocoagulability. In the donor, apheresis diminishes platelet count and function, as well as the levels of many other clotting factors. Depletion of fibrinogen and antithrombin III are less transient than others because their rates of synthesis are lower. In spite of the wide variety in hemapheretic procedures, all of them (or at least, those that are the most commonly used) are associated with similar activation phenomena, that appear to be mediated by the formation of a fibrinogen layer on the artificial surfaces of the circuitry.
Quality Assurance in Hemapheresis: Quality of Fresh Frozen Plasma
Authors: Baldini G.M. , Silvestri M.G.
Published: April 2018

The Authors analyse how established criteria for quality assurance of FFP may be applied to apheresis plasma produced for fractionation into derivatives.
Autotransfusion Program: Integrated Use of Different Techniques
Authors: Mercuriali F. , Inghilleri G. , Biffi E. , Vinci A. , Colotti M.T. , Scalamogna R.
Published: April 2018

A successful autologous program should enroll all appropriate patients, conserve homologous blood and minimise the exposure to the risks of donor blood.

A program of autotransfusion and proper use of blood has been implemented since 1980 with the objectives to include all eligible patients and to transfuse autologous blood only. The following strategies were adopted: critical review of transfusion indications; control of overtransfusion; avoidance of waste; systematic and integrated use of all autotransfusion techniques currently available.

Results in 1992 in elective surgery: 98% enrolment, 75% blood conservation. Exposure to homologous blood was completely avoided in 53% of the cases.
Predeposit Hemodilution and Intra- and Postoperative Blood Salvage in the Orthopaedic Surgery of Brain Damaged Children
Authors: Zanolli F.A. , Scremin A. , Negri M.G. , Braga A. , Majoni A. , Novello A. , Valenti S. , Dal Zotto I.
Published: April 2018

The advantages of autologous transfusion are nowaday well known. It appears so very important to enlarge to the greatest number of kinds of pathologies, trying to overcome all possible problems and studying every counterindication.

In this study, through a strict collaboration among orthopaedics, anhaestesia, transfusion medicine, neurological and pediatric specialists, we studied a peculiar protocol, suitable for enlarging the autologous techniques to brain damaged children and, after a regular application lasted globally for about two years, we did an evaluation of the results.
Plasma Predeposit: The Role of Productive Plasmapheresis
Authors: Bassi A. , Borghi B. , Brillante C. , Mattioli R.
Published: April 2018

At the Rizzoli Orthopaedic Institute, as part of our autotransfusion program, we have recently had the possibility to introduce plasma predeposit by means of productive plasmapheresis in patients undergoing major orthopaedic surgery, in which bleeding more than 50-60% of circulating blood mass was expected and so a greater quantity of plasma compared to red blood cells was considered necessary. Red cells and fresh frozen plasma predeposits and perioperative blood recovery was sufficient to cover transfusional needs. In our opinion, plasma predepositing by plasmapheresis is indicated in patients with anaemia, cardiopathy and/or vasculopathy, minute constitution.
The Organization of the Autotransfusion-perioperative Blood Salvage at San Martino Hospital
Authors: Carlier P. , Ferrari G.M. , Florio G. , Fella M. , Ruzzenenti M.R. , Frisoni R. , Valbonesi M.
Published: April 2018

Autologous transfusion is playing an important role in modern transfusion medicine. At San Martino hospital we use a combination of manual and mechanical techniques in order to improve autotransfusion procedures, control the hypertransfusion and avoid waste.

Our autotransfusion program has determined a 55% reduction in the red cell concentrates used (from 42,000 in 1985 down to 19,400 in 1992). Proper training, cultural improvements and new applications on autotransfusion procedures will permit a better use of blood with less transfusion related complications, until a suitable substitute for blood will be available.
Erythroplateletapheresis: A New Strategy in the Global Apheresis Program
Authors: Menichella G. , Ciarli M. , Serafini R. , Pierelli L. , Vittori M. , Hortencio M. , Rossi P.L. , Fagiolo E. , Leone G.
Published: April 2018

Blood donation allowed by cell separators can offer higher performance and higher yield to guarantee better quality and pureness of collected products. New systems for the collection of platelet concentrate (PC) and packed red blood cells (PRBC) are currently available. The aim of our work was to test the possibility of preparing PC routinely from normal apheresis donors in a minimum amount of time while providing a second product. Over a 3-month period we performed 40 procedures using the Hemonetics MCS3P blood cell separator and the Dideco Excel. The mean values of platelet yield were 2.8 x 1011 (range 1.4-4.1) with the MCS3P and 3.49 x 1011 (range 2.9-3.9) with the Excel, in a plasma volume of 240 ml and 215 ml respectively; the PRBC units were added with SAG-Mannitol allowing a storage time of 42 days. Collection times were 71’ and 48’ respectively. Donor tolerance was analogous to phateletapheresis or plasmapheresis.
Multicomponent Collection: The Experience of Regione Lazio
Authors: Girelli G. , De Fabritiis P. , Menichella G. , Serafini R. , Foddai M.L. , Di Carlo M. , D'Angiolino A. , Migliaccio M.
Published: April 2018

Five blood banks of Regione Lazio implemented a multicomponent collection program using apheresis technology. The automated collection of blood components included: red blood cell concentrate and fresh plasma (RBCP), plasma and platelet concentrate (P-PLT), red blood cell and platelet concentrates (RBC-PLT). 334 voluntary blood donors and 30 patients - as autologous donors- were involved. Apheresis collection of RBCP, P - PU, RBC - PLT yielded a standardized product (adequate volume, low residual leucocyte counts, adeguate hematocrit, low platelet contamination) was well tolerated by donors, was performed without technical problems. We conclude that multicomponent collection is a new feasible alternative to conventional whole blood collection.
Cost of Production and Convenience of Multicomponent Procedures
Authors: Belloni M. , Lunghi M. , Sandini A. , Radossi P. , Bettini M.C. , Soli M. , Zampieri L. , Alghisi A.
Published: April 2018

Multicomponent procedures have recently undergone remarkable development. For this reason the Scientific Committee of the National Congress in Trieste, during the session “Toward the global apheresis”, thought it opportune to execute an analysis of their cost, in order to evaluate an eventual real economic convenience of same. Of course this evaluation can only be in general terms, since we must consider both plasmaproduction costs, determined by organization, costs of materials and methods of equipment acquisition, along with agreements made with the plasma transformation industries, which vary from country to country.
Comparison of Different Ldl-Apheresis Techniques
Authors: Stefanutti C. , Di Giacomo S. , Vivenzio A.
Published: April 2018

LDL-apheresis is an extracorporeal technique which removes all apo B100-containing lipoproteins (VLDL, LDL, Lp(a)) from plasma, in patients whith homozygous, and double heterozygous, familial hypercholesterolemia (FH). One of the most significant technical characteristics of LDL-apheresis is the selectivity in the removal of atherogenic lipoproteins, namely LDLs, which has been improved in the most recently developed techniques. The oldest system for therapeutic plasmapheresis in the treatment of severe hyperlipoproteinemias, is plasma-exchange, where all plasma components are unselectively removed. More recently, the systems (dextransulphate cellulose LDL-apheresis [DSC/LDL-A], heparin induced LDL precipitation-apheresis [HELP/LDL-A], immunoadsorption LDL-apheresis [IMA/LDL-A], direct adsorption of lipids [DALI]) have permitted a selective removal of LDL and of other apo B100-containing lipoproteins. The higher selectivity, thus the higher efficacy and safety, has also allowed the treatment of high risk patients with severe cardiovascular conditions, and pediatric patients. Therefore, it is currently possible to begin treatment with LDL-apheresis, even at a very early age. The most recent system for LDL-apheresis (DALI: Direct Adsorption of Lipids) even permits the removal of LDL from whole blood, without previous cell/plasma separation. This system is promising for further progress in the technology related to LDL-apheresis.
Therapeutical Apheresis: Cost Analysis
Authors: Russo G.E. , Leopardi N. , Vitaliano E.
Published: April 2018

The constant technological advancement implies the definition of new diagnostic and therapeutic strategies that are in contrast with present requirements to reduce health costs. As far as apheretic therapy is concerned cost analysis should be carried out on a variable series: prevention, method efficacy, selection of one method rather than another, patient's social and working recovery, disablement, reduction in hospitalization and drugs. So, if on one hand we find ourselves facing therapeutical technology the cost of which is well defined, on the other an accurate “therapeutic prescription” is lacking in this sector, such as: choice of method, number of treatments, percentage of plasma exchange, distance between each treatment and number of cycles. The techniques on the market are: plasma-exchange by means of centrifugation or plasmaftitration, the double cascade selective method, various selective techniques of immunoabsorption and finally photopheresis. Each of these methods has different applications, potentialities and costs. The selective methods of immunoabsorption are the most expensive, while the double filtration cascade is the most economical and versatile, since it can be used in many pathologies with very encouraging results, although all its active processes are not yet well defined.
The Role of Hemapheresis in Autotransfusion
Authors: Fornasari P.M. , Cenacchi A. , Fogli M. , Bassi A. , Poluzzi V.
Published: April 2018

Hemapheresis is a commonly used technique for single donor procedures of cell and/or plasma collection. In our blood center a new protocol was carried out to study the application of Hemonetics MCS3p to autotransfusion. PES and TAE protocols were applied: 40 patients for ‘each branch and 40 as controls completed the protocol. In the TAE protocol, 2 units of red cell concentrate were collected at day 0, in the PES protocol 300 ml of plasma were added, while in the control group 400 ml of whole blood were collected. Complete blood cell count, clotting parameters, and the EPO level were tested. The two protocols (TAE and PES) prove effective and safe: no significant change was shown for the clotting time and factors, other hematological and plasma values were controlled:; the endogenous EPO doubles its value 24-h after the procedure and the difference compared to controls is highly significant.
Autotransfusion in Major Orthopedic Surgery: Postoperative Evaluation
Authors: Borghi B. , Pignotti E. , Famelli G. , Baroncini S.
Published: April 2018

The aim of this prospective study was to assess the postoperative progress of autotransfused patients (predonated blood + intra and postoperative blood salvage) in major orthopedic surgery.

Patients

1,785 consecutively treated patients (1,198 females, 587 males), mean aged 62± 11 years, basal Hb 13.4± 1,4 g/dl.

Surgery

Total hip arthroplasty (THA, 1,229 pts), THA after the removal of internal fixation devices (RFD+THA THA 18), total knee arthroplasty (TKA 263 pts), hip revision (HR) (cup+stem THR 197, cupR 53, stemR 16 pts) and knee revision (KR 9 pts).

Results

Homologous tranfusions were carried out in 130 patients (7.3%). The need to use homologous transfusions was significantly associated to the female sex (8.5% vs 4.7%, p=0.0049), older age (67.8 vs 62.1 years; p=0.0001), lower baseline Hb (12.3 vs 13.5g/dl p=0.0001), use of Calcium Heparin (CaHe) for antithromboembolic prophylaxis (CaHe 18% vs low molecular weight heparin 7.8% vs Indobufen 5% p=0.0001), lower number of predeposits (zero 62.5% vs one 16.2% vs two 5.2% vs three 6.4% vs four 5.5%, p=0.0001), type of surgery (THR 16.2% vs cupR 11.3% vs RPS+THA 11.1% vs stemR 6.2% vs THA 6.1% vs TKA 5.7% vs KR 0%, p=0.0001), presence of coexisting diseases like coronary heart disease (15.7% vs 6.2%, p=0.0001), and nephropathy (18.7 vs 7.1%, p=0.031), higher ASA (ASA4 18.7% vs ASA3 10.1% vs ASA2 6.6% vs ASA1 0%, p=0.0001). Postoperative hospitalization was significantly shorter in patients only autotransfused (12.3 vs 16.5 days, p=0.0001). The result confirms the central role of the anesthesiologist in the application of blood saving techniques.
Quality Assurance of Platelet Concentrates Used in Routine Practice
Authors: Rebulla P. , Greppi N. , Marangoni F. , Riccardi D. , Sirchia G.
Published: April 2018

Quality assurance of platelet concentrates should include regular determinations on sampled units of platelet concentrate volume, platelet count, pH value and an indicator of maintenance of platelet discoid shape. In regard to the latter, recent investigations suggest that the visual assessment of platelet swirling may provide meaningful and reproducible information with limited staff training and efforts. Other laboratory assays provide useful data that may prove beneficial particulary when new procedures and products are examined.

In addition to laboratory tests, it is of utmost importance to regularly monitor the effectiveness of platelet support therapy at clinical level. This can be done using a number of indicators including the proportion of patients who show febrile, allergic and septic reactions, who become and remain refractory to random-donor platelet support, who develop and/or die of hemorrhage not prevented or corrected by platelet support.
Immune Mechanisms of Platelet Refractoriness
Authors: Fischetti F. , Tedesco F.
Published: April 2018

Multiple platelet transfusions may prove ineffective in approximately 40% of patients treated for bone marrow aplasia. This condition is known as platelet refractoriness and is diagnosed by evaluating the corrected count increment following platelet transfusion. Immune factors still represent an important cause of platelet refractoriness and, among these, HLA alloimmunization plays the most relevant pathogenetic role. Less important are other specific and non-specific antigens, that can be detected on platelet surface. Several assays have been developed to reveal anti-platelet antibodies, which include the lymphocyte cytotoxicity test, the platelet immunofluorescence assay and the mixed passive hemagglutination assay. It is now clear that leukocytes contaminating the platelet concentrates represent the main cause of HLA alloimmunization which can be prevented by leukocyte depletion to less than 5 × 106 cells per unit. Transfusion of HLA-matched platelets in alloimmunized platelets may be quite effective, but it can also be fairly expensive considering the large number of donors to be typed for HLA in order to find HLA compatible platelets. A more practical approach would be to select the platelet concentrates on the basis of the negative crossmatch.
Cosmetic Surgery in Iran: Sociodemographic Characteristics of Cosmetic Surgery Patients in a Large Clinical Sample in Tehran
Authors: Kalantar Hormozi Abdoljalil , Maleki Simin , Rahimi Abolfazl , Manafi Ali , Amirizad Seyed Javad
Published: April 2018

Sociodemographic characteristics of cosmetic surgery patients are less studied in developing countries. Examining sociodemographic characteristics of cosmetic surgery patients in clinical settings can help surgeons identify their potential patients and highlights marketing opportunities for medical institutions. We conducted this study to determine the sociodemographic details of a large clinical sample from Tehran, Iran. The aim of this study was to present the demographic characteristics of Iranian patients undergoing cosmetic procedures. Tehran was selected from Iran as its most populated city and center of most medical facilities. The present study aimed to examine the sociodemographic characteristics of a large clinical sample (N = 744 patients; 900 cosmetic procedures) who underwent cosmetic surgery in Tehran, Iran. These surgeries were performed by 3 well-known plastic surgeons in Tehran. Sociodemographic details were gathered using patient’s cases and phone interview. A previously published questionnaire with modification was used. Findings suggest that most of the patients (90.7%) are women. Rhinoplasty (61.3%), facial fat injection (6.7%), blepharoplasty (6.3%), facelift (4.0%), and breast augmentation (3.8%) were the top 5 cosmetic procedures in the present sample. Approximately half of the sample (49.6%) was single, and most of married patients (80%) had children. A large number of patients (37.2%) were between 30 and 39 years old. In addition, a considerable proportion of the sample reported university education and being currently employed. This is the first study to document sociodemographic details in a large clinical sample from Iran as an understudied setting. We used insights from evolutionary psychology to explain the large sex differences in the number of cosmetic surgeries. In addition, we compared the findings with existing evidence from the United States and Saudi Arabia. Limitations and future directions are also discussed.
Perspectives on Providing And Receiving Preventive Health Care From Primary Care Providers and Their Patients With Mental Illnesses
Authors: Stumbo Scott P. , Yarborough Bobbi Jo H. , Yarborough Micah T. , Green Carla A.
Published: April 2018

Purpose:

Individuals with mental illnesses have higher morbidity rates and reduced life expectancy compared to the general population. Understanding how patients and providers perceive the need for prevention, as well as the barriers and beliefs that may contribute to insufficient care, are important for improving service delivery tailored to this population.

Design:

Cross-sectional; mixed methods.

Setting:

An integrated health system and a network of federally qualified health centers and safety net clinics.

Participants:

Interviews (n = 30) and surveys (n = 249) with primary care providers. Interviews (n = 158) and surveys (n = 160) with patients diagnosed with schizophrenia, bipolar, anxiety, or major depressive disorders.

Measures:

Semi-structured interviews and surveys.

Analysis:

Thematic analysis for qualitative data; frequencies for quantitative data.

Results:

More than half (n = 131, 53%) of clinicians believed patients with mental illnesses care less about preventive care than the general population, yet 88% (n = 139) of patients reported interest in improving health. Most providers (n = 216, 88%) lacked confidence that patients with mental illnesses would follow preventive recommendations; 82% (n = 129) of patients reported they would try to change lifestyles if their doctor recommended. Clinicians explained that their perception of patients’ chaotic lives and lack of interest in preventive care contributed to their fatalistic attitudes on care delivery to this population. Clinicians and patients agreed on substantial need for additional support for behavior changes. Clinicians reported providing informational support by keeping messages simple; patients reported a desire for more detailed information on reasons to complete preventive care. Patients also detailed the need for assistive and tangible support to manage behavioral health changes.

Conclusions:

Our results suggest a few clinical changes could help patients complete preventive care recommendations and improve health behaviors: improving clinician–patient collaboration on realistic goal setting, increasing visit time or utilizing behavioral health consultants that bridge primary and specialty mental health care, and increasing educational and tangible patient support services.
From gatekeepers to GONGOs
Authors: McGaughey Fiona
Published: April 2018

Despite growing awareness of the importance of the role of Non-Governmental Organisations (NGOs) in monitoring international human rights law, there is as yet little analysis of the heterogeneous nature of NGOs and of the relationships between NGOs engaging with the United Nations (UN). This socio-legal analysis was drawn from 26 interviews with key stakeholders across the UN, Governments and NGOs. The article analyses, problematises and maps the NGO role, presenting a taxonomy with six categories of NGOs engaging with UN human rights bodies - international facilitative, gatekeeper, imperialist, domestic self-sufficient, domestic dependent and Governmental Non-governmental Organisations (GONGOs). It also considers the role of National Human Rights Institutions in engaging with the UN, vis-à-vis the NGO role. A preferred NGO model of engagement according to those in the UN receiving NGO reports is presented. The article concludes that NGOs play a pragmatic role in addressing limitations of the UN human rights system, and a normative role in contributing to global democratisation and governance.
Modeling and dynamic analysis of accessory drive systems with integrated starter generator for micro-hybrid vehicles
Authors: Feng Xiao , Shangguan Wen-Bin , Deng Jianxiang , Jing Xingjian
Published: April 2018

Belt-driven integrated starter generator system is a hybrid transmission that resembles the conventional serpentine belt-driven system. The system contains an integrated starter generator that performs a “start-stop” function on the engine. A two-pulley tensioner mechanism is attached to the integrated starter generator to maintain belt tension. The objectives of this paper are to develop modeling and calculation methods for estimating the performances of the belt-driven integrated starter generator system and to investigate the influence of damping of the two-pulley tensioner on vibration and shock. A systematic modeling and analysis method is proposed. The modeling method for the two-pulley tensioner is distinguished from any existing studies, which are generic for modeling the tensioner in belt-driven integrated starter generator systems with different layouts. A typical belt-driven integrated starter generator system is presented and a model is established to predict the dynamic response of rotational vibrations of pulleys, tensioner motions, and tension fluctuations. A parametric analysis is conducted to evaluate the two-pulley tensioner parameters with respect to their impact on the performances of the belt-driven integrated starter generator system.
Impediments to Effective Altruism: The Role of Subjective Preferences in Charitable Giving
Authors: Berman Jonathan Z. , Barasch Alixandra , Levine Emma E. , Small Deborah A.
Published: April 2018

Charity could do the most good if every dollar donated went to causes that produced the greatest welfare gains. In line with this proposition, the effective-altruism movement seeks to provide individuals with information regarding the effectiveness of charities in hopes that they will contribute to organizations that maximize the social return of their donation. In this research, we investigated the extent to which presenting effectiveness information leads people to choose more effective charities. We found that even when effectiveness information is made easily comparable across options, it has a limited impact on choice. Specifically, people frequently choose less effective charity options when those options represent more subjectively preferred causes. In contrast to making a personal donation decision, outcome metrics are used to a much greater extent when choosing financial investments and when allocating aid resources as an agent of an organization. Implications for effective altruism are discussed.
Expanding conceptions of liberation: Holding Marxisms with liberation psychology
Authors: Malherbe Nick
Published: April 2018

By considering how psychologists are able to hold (that is, support distinctive ontologies) Liberation Psychology (LP) with Marxisms, this article interrogates psychological approaches to liberation in two ways. First, against the foundations of LP and Marxisms, as well as attempts to formulate psychological Marxisms and Marxist psychologies, the paper examines how holding LP with Marxisms facilitates a necessarily expansive, innovative, and democratic conception of liberation. Second, by exploring matters related to history, epistemology, reflexivity, and the State, a theoretical holding of this kind is shown to permit psychologists nuanced ways of engaging complex psychosocial phenomena in their work. It is concluded that by holding LP with Marxisms, psychologists employ a sensitivity towards a local–global nexus of interlocking liberation struggles, while taking seriously matters of power, space, time, identity, violence, and freedom.