bluuebunny/crossref_metadata_2025 huggingface dataset:
Report on the Eleventh International Society of Blood Transfusion Platelet Genotyping and Serology Workshop
Authors: Goldman M. , Trudel E. , Richard L.
Published: December 2004

Background and Objectives The aims of the Eleventh International Workshop were to evaluate proficiency in platelet genotyping and antibody detection, to equip laboratories to perform Gov antigen system genotyping and antibody detection, and to evaluate the laboratory and clinical approach to cases of neonatal alloimmune thrombocytopenia (NAIT).

Materials and Methods There were 34 participating laboratories from 22 countries on five continents. Participating laboratories were provided with 10 DNA samples, 15 unknown sera, and three monoclonal antibodies for titration, as well as primer pairs and a protocol for Gov genotyping and Gov antibody screening. They were also provided with a questionnaire on investigation and clinical management of patients with NAIT.

Results Thirty‐three participants reported human platelet antigen (HPA)‐1, ‐2, ‐3 and ‐5 genotyping results, 25 reported HPA‐4 typing results, 17 reported HPA‐6 typing results and 24 reported Gov typing results. For HPA‐1–6 genotyping, 23 laboratories were concordant with a majority vote for all allotypes tested, five laboratories reported one deviation, three laboratories reported two deviations and one laboratory reported three deviations. For Gov genotyping, six deviations occurred in three of the 24 laboratories reporting results. Antibody detection was 90% concordant for anti‐HPA‐1a, anti‐HPA‐5a and anti‐HPA‐5b detection. Anti‐HPA‐2b and anti‐Gova were detected by 20 and 14 out of 33 laboratories, respectively. Approaches to the clinical management of NAIT vary widely, especially for mothers with a history of a previous infant with mild NAIT.

Conclusions The overall error rate for HPA‐1–6 genotyping decreased from 2·7% in the tenth workshop to 0·8% in the eleventh workshop. The majority of laboratories were able to perform Gov genotyping, although the error rate was 7·5%. Detection of common clinically significant antibodies was good, although detection of the much rarer HPA‐2b was problematic. There was considerable progress in the detection of anti‐Gova. The lack of consensus over treatment of NAIT demonstrates uncertainty over optimal management of these patients.
Cost‐effectiveness of solvent/detergent‐treated fresh‐frozen plasma
Authors: Riedler G. F. , Haycox A. R. , Duggan A. K. , Dakin H. A.
Published: December 2004

Background and Objectives Although transfusion‐transmitted infections are rare, non‐infectious complications occur relatively frequently. Solvent/detergent‐treated fresh‐frozen plasma (SD‐FFP) has been shown to reduce the frequency of both types of complication, although previous economic evaluations failed to consider non‐infective events and subsequently underestimated the benefits of SD‐FFP.

Materials and Methods A time‐series analytical model was used to estimate the incremental cost/life year saved for SD‐FFP compared with untreated FFP, having controlled for post‐transfusion mortality and patient age. Various infective and non‐infective transfusion‐related complications were considered.

Results The discounted cost/life year saved for SD‐FFP use in the UK was £22 728 [95% confidence interval (95% CI): £22 604–22 853] for neonates and £98 465 (95% CI: £97 924–99 005) for patients aged 70. The cost‐effectiveness ratio was below £50 000/life year saved for patients ≤ 48 years of age, and below £30 000/life year saved for those ≤ 21 years of age. In transfusion recipients with no significant morbidity, the cost‐effectiveness ratio was £12 335 for neonates and £61 692 for 70‐year olds. The most important driver of cost‐effectiveness was transfusion‐related acute lung injury (TRALI), on account of its relatively high incidence and mortality rate.

Conclusions Previous analyses greatly underestimated the cost‐effectiveness of SD‐FFP. Inclusion of non‐infectious complications suggests that SD‐FFP is cost‐effective in patients ≤ 48 years of age and in older patients with good clinical prognosis, which may justify the wider use of this technology.
Batches of intravenous immunoglobulin associated with adverse reactions in recipients contain atypically high anti‐Rh D activity
Authors: Thorpe S. J. , Fox B. J. , Dolman C. D. , Lawrence J. , Thorpe R.
Published: December 2004

Background and Objectives The presence of anti‐Rh D in intravenous immunoglobulin (IVIG) products has been claimed to be associated with adverse reactions in recipients. There is currently no regulatory specification to control the level of anti‐D in IVIG products and it is unclear what this should be. Two reports of haemolysis occurring in recipients of IVIG manufactured from US plasma provided a rare opportunity to investigate whether high anti‐D levels could have induced the haemolysis.

Materials and Methods We developed a direct microtitre plate haemagglutination method suitable for screening IVIG products and starting plasma pools for haemagglutinating activity.

Results Of 101 batches of IVIG tested, six were found to contain specific anti‐D. Four of these batches had anti‐D titres ranging from 64 to 256 (including the two batches each associated with a report of haemolysis) and could be linked, in each case, to a starting plasma pool also positive for anti‐D.

Conclusions  Our results show that IVIG products can contain appreciable anti‐D levels. To avoid potential problems in recipients, we propose an anti‐D titre of 8 as the maximum permissible limit of anti‐D in IVIG products for batch acceptance and release. The availability of a reference preparation is essential for control of this proposed requirement.
Flash electroretinography in standing horses using the DTL™ microfiber electrode
Authors: Komáromy András M. , Andrew Stacy E. , Sapp Harold L. , Brooks Dennis E. , Dawson William W.
Published: December 2004

PurposeThe goal of our study was the evaluation of a practical method for the recording of flash electroretinograms (ERGs) in sedated, standing horses with the DTL™ microfiber electrode.

MethodsThe horses were sedated intravenously with detomidine hydrochloride (0.015 mg/kg). The pupil was dilated and the auriculopalpebral nerve was blocked. The ERGs were recorded with the active electrode on the cornea (DTL™), the reference electrode near the lateral canthus, and the ground electrode over the occipital bone. The light intensities of the white strobe light were 0.03 cd·s/m2(scotopic) and 3 cd·s/m2(scotopic and photopic). Photopic and scotopic single flash and flicker responses to Ganzfeld stimulation were recorded. During the 20‐min dark adaptation period the retina was stimulated every 5 min with the 0.03 cd·s/m2single flash.

ResultsThe median b‐wave amplitudes and implicit times were 38 µV and 33 ms (photopic cone‐dominated response), 43 µV and 63 ms (5‐min dark adaptation), 72 µV and 89 ms (10 min), 147 µV and 103 ms (15 min), 188 µV and 109 ms (20 min, 0.03 cd·s/m2, rod response), and 186 µV and 77 ms (20 min, 3 cd·s/m2, maximal combined rod‐cone response). A steady increase in amplitude and implicit time was noted during dark adaptation. No oscillatory potentials could be isolated.

ConclusionsThe use of detomidine hydrochloride sedation and the DTL™ microfiber electrode allowed the recording of good quality ERGs. This protocol should permit the detection of functional problems in the retina without the risk involved with general anesthesia.
Inhibition of collagenase breakdown of equine corneas by tetanus antitoxin, equine serum and acetylcysteine
Authors: Haffner John C. , Fecteau Kellie A. , Eiler Hugo
Published: December 2004

Objective To determine whether tetanus antitoxin, equine serum, and acetylcysteine, which are currently used in the treatment of equine corneal ulcer, inhibit the digestion of equine corneal collagen when exposed to collagenase in vitro.

Animals studied Corneas from 40 adult horses.

Procedures Sections of equine corneas were incubated with saline, a solution of bacterial collagenase in saline, bacterial collagenase in saline plus equine tetanus antitoxin, bacterial collagenase in saline plus equine serum, or bacterial collagenase in saline plus acetylcysteine. Each one of the collagenase inhibitors was tested at different concentrations. The degree of corneal collagen digestion was determined by concentrations of hydroxyproline released into the incubation media and/or by weight loss of the cornea.

Results Corneas exposed to collagenase released a significant (0.05 level) large amount of hydroxyproline (43.1 ± 2.3 µg/mL/100 mg cornea/5 h) and decreased cornea weight by up to 89%. Blood serum (200 µL/mL), purified albumin or globulin fractions of serum, tetanus antitoxin (120 units/mL), and acetylcysteine (20 mg/mL) when used at the highest concentrations blocked collagenase digestive activity by approximately 50%. Dilution of inhibitors decreased corneal protection and linearly increased corneal weight loss. Purified equine serum albumin and globulin fractions were equally effective in protecting corneas.

Conclusions This experiment indicates that tetanus antitoxin, serum and acetylcysteine equally protected corneas from collagenase digestion, in vitro. However, a clinical trial is needed to establish relative therapeutic value.
A Spatiotemporal Model for Mexico City Ozone Levels
Authors: Huerta Gabriel , Sansó Bruno , Stroud Jonathan R.
Published: December 2004

We consider hourly readings of concentrations of ozone over Mexico City and propose a model for spatial as well as temporal interpolation and prediction. The model is based on a time-varying regression of the observed readings on air temperature. Such a regression requires interpolated values of temperature at locations and times where readings are not available. These are obtained from a time-varying spatiotemporal model that is coupled to the model for the ozone readings. Two location-dependent harmonic components are added to account for the main periodicities that ozone presents during a given day and that are not explained through the covariate. The model incorporates spatial covariance structure for the observations and the parameters that define the harmonic components. Using the dynamic linear model framework, we show how to compute smoothed means and predictive values for ozone. We illustrate the methodology on data from September 1997.
Bayesian Analysis of Directed Graphs Data with Applications to Social Networks
Authors: Gill Paramjit S. , Swartz Tim B.
Published: December 2004

A fully Bayesian analysis of directed graphs, with particular emphasis on applica- tions in social networks, is explored. The model is capable of incorporating the effects of covariates, within and between block ties and multiple responses. Inference is straightforward by using software that is based on Markov chain Monte Carlo methods. Examples are provided which highlight the variety of data sets that can be entertained and the ease with which they can be analysed.
P108The importance of studying the ductus venosus for predicting acidosis at birth in pregnancies with absent or reversed end‐diastolic (ARED) velocity flow in the umbilical arteries
Authors: Francisco R. P. V. , Yamamoto R. M. , Sakamoto K. , Miyadahira S. , Zugaib M.
Published: December 2004

Background

A study of the relation between methods for assessment of fetal well‐being and birth weight.

Methods

A prospective study was conducted to assess the fetal well‐being in 61 singleton pregnancies with ARED. The results of these methods were compared with the occurrence of umbilical artery pH at birth < 7.20 and < 7.15. All data were analyzed and compared using logistic regression.

Conclusion

The pulsatility index for veins in the ductus venosus is the most important predictor for acidosis at birth. Once the ductus venosus pi is known, it is possible to estimate the probability of fetal acidosis in pregnancies with AREDV.
P140A case of an old age postmenopausal woman with a giant myoma uteri
Authors: Kavak Z. N. , Başgül A.
Published: December 2004

Background

Since leiomyomas are estrogen dependent, the occurrence of myoma uteri in in a large size, in late postmenopausal years is unusual and should be evaluated carefully for underlying malignancy. We report here, a case of an old age postmenopausal woman with a giant myoma uteri. Ultrasonographic features, clinical presentation, differential diagnosis and treatment modalities of this rare case are presented and discussed.

Case

74‐year‐old woman gravida 4 para 4 was referred to our clinic with the complaint of genital bleeding and pelvic discomfort. On her gynecologic examination a pelvic mass was discovered. Detailed sonographic examination of her showed solid uterine tumor, measuring 10 × 12 × 10 cm in diameter in fundo corporal portion of the uterus. It has got typical whorled appareance with increased echogenicity compared with the uterus. Irregular sonolucent areas were seen within the tumor and thought as a possible myoma uteri with cystic degeneration. Endometrial lining was distorted and 4 mm in size. Endometrial biopsy revealed no evidence of malignancy. Since a tumor with such a size in a postmenopausal woman should be encouraged for early surgery. Surgery was performed and total abdominal histerectomy with bilateral salphingooopherectomy was performed. Laparatomy revealed a solid tumor on the uterine corpus and histologically was diagnosed as leimyoma of uteri. Postoperative follow up of her was uneventful and hormone replacement therapy was given.
P85Pulsatility index in the umbilical artery Doppler studies for predicting birth weight in pregnancies with absent or reversed end‐diastolic velocity flow (ARED) in the umbilical arteries
Authors: Francisco R. P. V. , Yamamoto R. M. , Miyadahira S. , Zugaib M.
Published: December 2004

Background

A study of the relation between methods for assessment of fetal well‐being and birth weight.

Methods

A prospective study was conducted to assess the fetal well‐being in 30 singleton pregnancies with ARED. The results of these methods were compared with the occurrence of birth weight above 1000 g. All data were analyzed and compared using logistic regression.

Conclusion

Higher values for the pulsatility index in the umbilical arteries reflect the gravity of placental lesions and the probability of occurrence of a very low birth weight.
Swedish school nurses’ view of school health care utilization, causes and management of recurrent headaches among school children
Authors: Larsson Bo , Zaluha Myron
Published: December 2004

The present survey was addressed to a representative, nationwide sample of Swedish school nurses and 174 (69%) responded. They were asked about their views on: (i) the most usual problems for students that prompt attendance at school nurses’ offices; (ii) the causes and management of school children's headaches and (iii) the school nurses’ own education with respect to headaches. Headaches were reported to be one of the most common problems among adolescents visiting the school nurses’ offices and tension‐type headaches were regarded as a more serious school health problem, compared with migraine. Various stressors such as family and peer problems were regarded as important causes of recurrent headaches. In addition, the school nurses mentioned too little physical activity, sleep problems and poor eating habits as related factors, in particular among students with tension‐type headaches. Common management approaches used by the school nurses were to provide information about headaches or supportive discussion, recommend follow‐up visits, perform vision tests and refer students to a school physician. About one‐fifth to one‐third of the school nurses often gave analgesic medication to students because of headaches, most commonly used were paracetamol followed by various NSAIDs. Most of the school nurses regarded relaxation training as an ‘‘effective or very effective’’ treatment for both migraine and tension‐type headaches, whereas palliative and prophylactic drug treatments were seen as more effective for migraine. It is suggested that school nurses, who often provide the first line of treatment for school children and adolescents with recurrent headaches, also should administer a cost‐effective treatment such as relaxation training in school settings, where many of the headache episodes occur. However, school nurses also need to be properly trained to ensure quality in delivering such treatment approaches.
Fibromyalgia patients’ own experiences of video self‐interpretation: A phenomenological‐hermeneutic study
Authors: Horwitz Eva Bojner , Theorell Töres , Anderberg Ulla Maria
Published: December 2004

Fibromyalgia syndrome (FMS) is a disorder with musculoskeletal pain as well as many other psychological and physical symptoms. Up‐to‐date treatment strategies for this disorder often have only limited effects. In order to develop more effective and adequate treatment tools, a phenomenological‐hermeneutic study inspired by Paul Ricoeur was used. FMS patients viewed themselves on videotapes. After the video sessions the FMS patients were interviewed about thoughts that were triggered when they saw themselves on videotape. Video interpretation in combination with interviews facilitated a communication and understanding between the patient and therapist about the patients’ body and self‐image. The results showed that with the help of video interpretation, the patients’ body and self‐awareness could be improved, which in turn may help therapists to find better treatment tools for a more directed and individually adapted treatment. This is of importance as this method can be useful to FMS patients for early identification of maladaptive movement patterns and for a better integration their body and self‐image. By allowing the FMS patients to interpret themselves from videotape, the FMS patients become more aware of both body and self‐signals, which make it easier for the clinician/therapist to know where to start to work with each patients’ specific rehabilitation programme.
The measurement properties of the Swedish version of the assessment of communication and interaction skills*
Authors: Kjellberg Anette , Haglund Lena , Forsyth Kirsty , Kielhofner Gary
Published: December 2004

The purpose of this study was to validate the Swedish translation of the Assessment of Communication and Interaction Skills (ACIS‐S) and its applicability in Sweden. The ACIS is an observational rating scale designed to capture, in detail, a person's social interactional ability, while he/she is participating in meaningful occupations. Eighteen occupational therapists trained in administering the ACIS‐S, completed 157 ACIS‐S assessments of 67 subjects with psychosocial and learning disabilities. Many‐faceted Rasch analysis was used to analyse the data. The results supported internal, construct and person response validity of the ACIS‐S, and rater validity and reliability. The scale effectively categorized subjects according to the levels of communication and interaction ability.
The meaning of being in ethically difficult care situations in paediatric care as narrated by female Registered Nurses
Authors: Sørlie Venke , Jansson Lilian , Norberg Astrid
Published: December 2004

Studies among physicians and nurses in paediatric care reveal experiences of loneliness and lack of open dialogue. The aim of this study was to illuminate the meaning of female Registered Nurses’ lived experience of being in ethically difficult care situations in paediatric care. Twenty female Registered Nurses who had experienced being in ethically difficult care situations in paediatric care were interviewed as part of a comprehensive investigation into the narratives of male and female nurses and physicians about being in such situations. The transcribed interview texts were subjected to phenomenological‐hermeneutic interpretation. The results showed that nurses appreciated social confirmation from their colleagues, patients and parents very much. This was a conditioned confirmation that was given when they performed the tasks expected from them. The nurses, however, felt that something was missing. They missed self‐confirmation from their conscience. This gave them an identity problem. They were regarded as good care providers but at the same time, their conscience reminded them of not taking care of all the ‘uninteresting’ patients. This may be understood asethics of memorywhere their conscience ‘set them a test’. The emotional pain nurses felt was about remembering the children they overlooked, about bad conscience and lack ofself‐confirmation. Nurses felt lonely because of the lack of open dialogue about ethically difficulties, for example, between colleagues and about their feeling that the wrong things were prioritized in the clinics. In this study, problems arose when nurses complied with the unspoken rules and routines without discussing the ethical challenges in their caring culture. The rules and the routines of the caring culture represented structural barriers for creating open dialogue and an ethically justifiable practice, calledinauthentic existence,blindness related to our own inauthentic understanding, which focuses on the routines, rules, theories and systems.
Family carers of ICU survivors: A survey of the burden they experience
Authors: Foster Michelle , Chaboyer Wendy
Published: December 2004

Intensive care unit (ICU) survivors may experience deterioration in their quality of life for months following their return home, with families assuming a caregiving role. The aim of this study was to measure the burden associated with caring for a family member who had been critically ill. The study also sought to describe the relationship between three factors (filial obligation, social support, self‐efficacy) and caregiver burden. Seventy‐one family carers, 51 females (72%) and 20 (28%) males of long‐term intensive care patients completed a mailed survey, after signing an informed consent form. Although the vast majority of the caregivers were providing substantial number of hours of care each week, they scored lower than the midpoint on all caregiver burden inventory subscales. Filial obligation was found to be positively associated with caregiver burden; however, there was no association between social support, self‐efficacy and caregiver burden. Male caregivers experienced significantly more burden than female caregivers. The findings suggest that an understanding of the factors that impact on caregiver burden of families of ICU survivors is only beginning to emerge.
Standardized qualitative evaluation of scar tissue properties in an animal wound healing model
Authors: Hollander Dirk A. , Erli Hans J. , Theisen Alf , Falk Stephan , Kreck Thomas , Müller Stefan
Published: December 2004

There is a great need to establish reproducible methods for evaluative studies of wound treatment and wound healing. Validation of the healing process through optical techniques, as well as histologic and immunohistochemical methodologies, have been improved and to some extent have become well‐established assays. Data relating to biomechanical properties, e.g., evaluation of the tensile strength of scar tissue that forms in experimental wound treatment strategies, are less widely available. We chose the domestic pig as an animal model in which to examine epidermal wound healing. We implanted specially made chambers that served to isolate the wounds and prevent epidermal migration from the edges. We performed histologic and immunohistochemical analyses as well as evaluation of biomechanical qualities of scar tissue using laser tensiometry. Pig skin is well suited for wound healing studies, and wound creation, implantation of the chambers, and the regular changing of dressings could all be carried out in the operating theater. In addition to established macroscopic evaluation and microscopic documentation, the need for objective biomechanical assessment of scar tissue by measuring tensile strength has been met using laser tensiometry. By optimizing methods for measuring tensile strength, it is possible to evaluate the biomechanical quality of scar tissue formed following different courses of wound treatment, as well as histologic assessment. (WOUND REP REG 2003;11:150–157)
THE CLINICAL EPIDEMIOLOGY OF CARDIOVASCULAR DISEASES IN CHRONIC KIDNEY DISEASE: Clinical Epidemiology of Cardiac Disease in Renal Transplant Recipients
Authors: Rigatto Claudio
Published: December 2004

Cardiovascular disease (CVD) is the major cause of death among renal transplant recipients (RTRs), accounting for 17–50% of deaths. Both cardiomyopathy (congestive heart failure [CHF] and left ventricular hypertrophy [LVH]) and ischemic heart disease (IHD) are important complications of renal transplantation, although the morbid impact of cardiomyopathy has been overlooked until recently. Echocardiographic disorders and clinical CHF occur far more frequently in RTRs than in the general population, suggesting that renal transplantation may be a state of accelerated heart failure. In contrast, the incidence of IHD in RTRs is similar to that in the Framingham cohort. Age, diabetes, and gender remain important markers of risk for both disorders. Smoking, hyperlipidemia, and hypertension appear to be the major reversible risk factors for IHD, while anemia and hypertension are major reversible risk factors for cardiomyopathy. Definitive evidence on optimal intervention is lacking. Clinical trials are needed to define optimum targets for treatment of these risk factors, especially hypertension and anemia.
Extracorporeal Monocyte Granulocytapheresis was Effective for a Patient of Erythema Nodosum Concomitant withUlcerative Colitis
Authors: Fukunaga Ken , Sawada Koji , Fukuda Yoshihiro , Matoba Yoshika , Natsuaki Masaru , Ohnishi Kunio , Fukui Shin , Satomi Masamichi , Shimoyama Takashi
Published: December 2004

Abstract:  We report an erythema nodosum (EN) patient whose condition becameapparent during the clinical course of ulcerative colitis (UC).The patient relapsed frequently in spite of taking a high dose adrenocorticalsteroid during his morbidity period of UC. Monocyte‐granulocytapheresis(M‐GCAP) was combined with 5‐aminosalicylic acid 2250 mg/dayperoral and once a day of steroid enema. Monocyte‐granulocytapheresiswas performed once a week for 5 weeks, and succeeded in inducingclinical remission for both UC and EN. The immunological and clinical connectionsbetween UC and EN have never been fully elucidated. In this case,because the symptoms of UC and EN revealed parallel improvementafter his inflammatory reaction had been brought under control by combining M‐GCAP therapy, we hypothesize that theonset of EN appeared as a result of the patient's long‐term,treatment‐resistant immuno‐disturbance, which first appeared as symptomsof UC. Immunomodulative effects induced by M‐GCAP might help tocontrol other chronic non‐specific inflammations not concerned withtargeted organ(s).
Plasmapheresis in Immune Hematology: Review of Clinical OutcomeData with Respect to Evidence‐Based Medicine and Clinical Experience
Authors: Von Baeyer Hans
Published: December 2004

The objective of this paper is to assess the role of plasmapheresisin immune hematology by reviewing published clinical outcome dataand narrative review articles. This information will be used todefine evidence levels for appraisal of the efficacy and rank ofplasmapheresis among other management options. This evidence‐basedstrategy conforms to the concepts of the American Society of Hematology(ASH), as put forward in 1996 in the context of immune thrombocytopenia(ITP) treatment. The term ‘experimental’ is usedto describe indications where the only scientific evidence of theefficacy of plasmapheresis consists of pathophysiological reasoningand empiric clinical findings. We reviewed the availableliterature on the use of plasmapheresis in autoimmune hemolyticanemia (AIHA), hemolytic disease of the newborn (HDN), autoimmunethrombocytopenic purpura (AITP), heparin‐induced thrombocytopeniatype II (HIT II), post‐transfusion purpura (PTP), refractorinessto platelet transfusion (RPT), coagulation factor inhibitor (CFI)and catastrophic antiphospholipid syndrome (CAS). Plasmapheresiscompletes the spectrum of management options as it eliminates physicallycirculating free antibodies involved in the pathogenesis of theseimmune hematological syndromes. Because of the paucity of data,evidence levels had to be defined based on the findings of uncontrolledcase series and the opinions of independent experts. In many cases, randomizedclinical trials were not feasible because the syndromes are so rare.When defined as an ‘experimental indication’,plasmapheresis has a firm scientific basis, but larger scale clinicalexperience with the method is still lacking. In these cases, thedetection and monitoring of symptomatic disease‐related circulatingfree antibodies or immune complexes is a mandatory prerequisitefor the use of plasmapheresis. The therapeutic benefit of plasmapheresisis substantiated by the level V of evidence of its efficacy in treatmentof HDN, HIV‐associated AITP, induction of tolerance in CFI and inCAS. The goal of future studies should be to establish a firmerbase of scientific evidence for indications classified as experimentalby setting up case series large enough for proper assessment ofplasmapheresis alone or combination with other treatment measures. Thisgoal can only be achieved through multiinstitutional cooperation.
Adsorption Column for Myasthenia Gravis Treatment: MedisorbaMG‐50
Authors: Nakaji Shuhei , Hayashi Nobuyuki
Published: December 2004

Abstract:  Adsorption column Medisorba MG‐50 (Kuraray MedicalInc.) for the treatment of myasthenia gravis (MG) is introduced.The adsorbent in this column is composed of cellulose beads as carriermaterial and covalent‐bound synthetic peptide as a ligand that hasa specific affinity to the pathogenic anti‐acetylcholine receptorantibody of MG. The amino acid sequence of the peptide is modifiedfrom the segment of alpha 183–200 of the torpedo acetylcholine receptor(AChR) protein, and the segment is the acetylcholine binding siteon AChR and the target site of anti‐AChR antibody. The adsorbentshowed specific adsorption characteristics to the anti‐ACHR antibody(blocking antibody) in vitro. Clinically, MG‐50 is used in plasma‐perfusiontherapy, and it is recognized that MG‐50 specificallyreduces blocking antibody titer and improves MG symptoms. MG‐50is approved in Japan.
Superlite Plasma Collection System
Authors: Yamazaki Sohachi
Published: December 2004

Abstract:  The Japanese Ministry of Health, Labor and Welfare launched anational initiative to become plasma self‐sufficient by reducingreliance on imported plasma products and increasing plasma collectionsto enable plasma‐derived pharmaceuticals, including albumin, globulin,and Factor VIII products to use plasma collected within Japan. Inorder to realize this goal, plasma collections from volunteer donorsmust increase to about 1.5 million litres of plasma per year (1) or about 50% more than what theJapan Red Cross currently collects. A mobile device, such as theSuperlite system, will make it easier and more efficient for Japan’ssole blood collection agency, the Japan Red Cross, to add plasmacollection to mobile blood drives. Haemonetics Corporation (Braintree,MA, USA) has combined many years of apheresis experience with up‐to‐datetechnology to create the Superlite Plasma Collection System (PCS)for the Japan Red Cross. This new device, which is expected to greatlycontribute to the Red Cross's national source plasma collectionprogram, is even smaller than the Ultralite PCS and offers severaladvanced features and benefits.

Light, compact, and very portable, the Superlite has a Japaneselanguage friendly user interface that continually displays collectionstatus, including time remaining in the collection procedure. The device features a protocol that limits extra‐corporealblood volume for low‐weight donors; a program used in conjunction with a reduced volume disposable bowl. Superlite, designedfor use in both fixed‐site and mobile applications, combines the portable ease‐of‐use of the Ultralite with the collection process calculation abilities of the CCS to provide a state‐of‐the‐art collection device that will help define the future of Japan plasma collection.
Peptide Based Adsorbers for Therapeutic Immunoadsorption
Authors: Rönspeck Wolfgang , Brinckmann Roland , Egner Ralf , Gebauer Frank , Winkler Dirk , Jekow Petra , Wallukat Gerd , Müller Johannes , Kunze Rudolf
Published: December 2004

Abstract:  Peptides as ligands for immunoadsorption exhibit several potentialadvantages over native proteins. Two newly developed adsorbers arebased on peptides covalently coupled to sepharose CL‐4B. Globaffinis capable of binding immunoglobulins independent from their antigenspecificity and thus, applicable in transplant recipients and severalantibody mediated autoimmune diseases. Among others, the most importantdisorders suitable for the treatment with Globaffin are rheumatoidarthritis, systemic lupus erythematosus, and acute renal transplant rejection.Coraffin is a specific adsorber using two linear peptide ligandsmimicking epitopes of the β1‐adrenergic receptor,that bind corresponding autoantibodies from patients suffering fromidiopathic dilated cardiomyopathy. Specific immunoadsorption hasbeen shown to be beneficial for patients with dilated cardiomyopathy.Coraffin can be used as a new therapeutic option for these patients, who get only limited benefit from medicaltherapy. Both adsorbers may be combined with all approved apheresis control devices available.
Extracorporal Low‐density Lipoprotein Elimination by Immunoadsorption
Authors: Ritter M.M. , Parhofer K.G.
Published: December 2004

Abstract: Low‐density lipoprotein (LDL) apheresis has proven its therapeutic usefulness in patients who suffer from coronary heart disease but cannot achieve LDL cholesterol concentrations defined by the National Cholesterol Education Program guidelines. Immunoadsorption was the first commercially available apheresis technique. It is based on affinity chromatography. As with other apheresis techniques, immunoadsorption has specific advantages and disadvantages. These have to be taken into account when selecting an apheresis technique for the individual patient.
Long‐term Effect of Low‐density Lipoprotein Apheresis in Patients with Heterozygous Familial Hypercholesterolemia
Authors: Higashikata Toshinori , Mabuchi Hiroshi
Published: December 2004

Abstract:  Clinical efficacy and safety of the therapeutic tool which directly removes LDL particles from circulation (LDL apheresis) have already been established in the treatment for refractory hypercholesterolemia in patients with familial hypercholesterolemia (FH). Two clinical studies with event‐based assessment have demonstrated remarkably beneficial outcomes of long‐term LDL apheresis using dextran sulfate cellulose columns plus adjunctive cholesterol‐lowering drug therapy in the prevention of cardiovascular events in heterozygous FH with coronary artery disease. The results of several studies with angiographic and ultrasound‐based assessment indicate a possible role for LDL apheresis in restructuring and stabilization of atherosclerotic lesions.

These clinical improvements caused by LDL apheresis in heterozygous FH support the efficacy and importance of aggressive cholesterol‐lowering therapy for secondary prevention of atherosclerotic cardiovascular disease in hypercholesterolemic patients.
The Effect of Apheresis on Adhesion Molecules
Authors: Motohashi Kazuko , Yamane Shingo
Published: December 2004

Abstract:  The adhesion molecules on the leukocytes and the endothelial cells mediate interaction between their cells. The plasma levels of soluble adhesion molecules increase in patients with ischemic heart disease, atherosclerotic aortic disease. Hypercholesterolemia is one of risk factors for atherosclerosis, and it is considered that the expression of adhesion molecules in endothelial cells is related to the development of atherosclerosis. Low‐density lipoprotein (LDL) apheresis has been applied to patients with hypercholesterolemia. LDL apheresis may have an effect on adhesion molecules in patients with hypercholesterolemia.
The Sequential Organ Failure Assessment Score as a Useful Predictor for Estimating the Prognosis of Systemic Inflammatory Response Syndrome Patients Being Treated with Extracorporeal Blood Purification
Authors: Kikuchi Hiroshi , Maruyama Hiroki , Omori Saori , Kazama Junichiro J. , Gejyo Fumitake
Published: December 2004

Abstract:  Systemic inflammatory response syndrome (SIRS) is a major cause of morbidity and mortality in critically ill patients. Extracorporeal blood purification procedures are becoming important for treating these patients. However, the cost of these procedures is high. Therefore, a prognostic marker would be helpful. To establish the reliability of the Sequential Organ Failure Assessment (SOFA) score as a prognostic indicator, we evaluated daily changes in the SOFA score of 40 SIRS patients who needed blood purification procedures such as continuous renal replacement therapy (CRRT), endotoxin adsorption, bilirubin adsorption, and/or plasma exchange. Twenty patients survived and 20 died. Although the baseline scores of the two groups (survivors and non‐survivors) did not differ, both the maximum value of the SOFA score and the ΔSOFA score (the difference between the maximum SOFA and baseline SOFA scores) were significantly higher in the non‐survivor group. The mortality rate among patients with a maximum SOFA score greater than or equal to 18 or a ΔSOFA score greater than or equal to 3 was higher than for the rest of the patients. The changes in the SOFA score correlated well with the outcomes of the SIRS patients. The maximum SOFA score and the ΔSOFA score are therefore likely to be useful prognostic markers.
A Case of Advanced Primary Biliary Cirrhosis Treated with Granulocyte and Monocyte Apheresis1
Authors: Takegoshi Kunio , Tohyama Tatsuhiko , Okada Eikichi
Published: December 2004

Abstract:  Generally, the most effective treatment for advanced primary biliary cirrhosis (PBC) is liver transplantation, but adjunct therapies are needed. We report here a first case of advanced PBC treated with a new immunotherapy, granulocyte and monocyte apheresis (GCAP). A column (Adacolumn, Japan Immunoresearch Laboratory Takasaki, Japan) was filled with cellulose acetate beads to selectively adsorb granulocytes and monocytes/macrophages. A 49‐year‐old woman was diagnosed with PBC in 1987. In June 2001, steroid pulse therapy and adjuvant fresh frozen plasma was given for moderate jaundice but without success. In July, as total bilirubin rapidly increased, treatment with GCAP was started and succeeded in suppressing the rapid deterioration of total bilirubin (value changes after each of four applications: 15.4→14.0, 27.2→25.1, 25.8→24.0, 25.7→23.7 mg/dL) and improving prothrombin time (16.4→14.5 s). Although GCAP therapy did not prevent a fatal outcome, it suppressed rapid deterioration of jaundice and increased quality of life for a month.
A pH‐Dependent Auto‐agglutinin with Anti‐P Specificity
Authors: Judd W. J.
Published: December 2004

An agglutinin with apparent anti‐P specificity, reactive only at pH values below 6.0, was found in the plasma of a healthy female blood donor. It is postulated that this agglutinin recognizes latent receptors revealed by structural alterations to red blood cell membranes which occur in an acid environment.
Hydroxyethyl Starch as an Experimental Adjunct to Leukocyte Separation by Centrifugal Means: Review of Safety and Efficacy
Authors: Mishler J. M.
Published: December 2004

A total of 1,921 leukapheresis procedures have been performed on 532 normal and CIVIL donors at six research institutions, for the purpose of supporting granulocytopenic leukemia patients during infectious episodes. The addition of HES alone or in combination with either etiocholanolone or dexamethasone, resulted in a significant increase in the numbers of leukocytes (granulocytes) harvested by continuous and noncontinuous flow centrifugation. Normal donors participating in these programs were monitored prior to and immediately following each procedure by standard laboratory methods which revealed no serious or abnormal changes occurring as a result of the procedure in those undergoing single or multiple donations with these agents. CIVIL donors tolerated the addition of only HES well, as evidenced by the lack of toxic reactions in three donors undergoing 101 to 121 procedures.
Fatal Pulmonary Hypersensitivity Reaction to HL‐A Incompatible Blood Transfusion:
Authors: Wolf C. F. W. , Canale V. C.
Published: December 2004

A girl with Thalassemia major reacted to a transfusion of packed red blood cells with increasing respiratory distress until death 12/1/2 hours later. Chills and fever were followed by dry cough, dyspnea, and pulmonary edema. The recipient had lymphocytotoxic antibodies specific for donor leukocyte antigens HL‐A11 and possibly W14. At autopsy, the lungs showed pulmonary edema with extensive nonspecific acute alveolar injury. Similar cases in the literature are reviewed.
The Use of Frozen Blood in Neonatal Exchange Transfusion
Authors: Umlas J. , Gootblatt S.
Published: December 2004

Because of inability to quickly locate donors to provide fresh heparinized blood, seven exchange transfusions were performed on four newborns with hemolytic disease due to Rhesus incompatibility using previously frozen erythrocytes suspended in albumin or heparinized, decitrated fresh frozen plasma. Platelets were added to one unit of previously frozen erythrocytes because of severe thrombocytopenia in one patient following an earlier exchange transfusion. The hematologic and bilirubin removing responses were comparable to those seen with fresh heparinized whole blood. Using this method, the safest red blood cells available, namely the mother's, can be drawn and frozen early in gestation for subsequent exchange transfusion.
Anti‐A1 in the Plasma of Platelet Concentrates Causing a Hemolytic Reaction
Authors: Zoes C. , Dube V. E. , Miller H.J. , Vye M. V.
Published: December 2004

A patient with acute leukemia who typed as AintB received 10 packs of platelets of group 0. Subsequent transfusion of A1B blood resulted in a hemolytic transfusion reaction. Anti‐A1 was detected in the serum and on the red blood cells of a post‐transfusion sample. This anti‐A1 reacted with the transfused A1B red blood cells and other A1 cells, but not with the patient's pretransfusion red blood cells. The plasma of the transfused platelet concentrates had a high titer of immune anti‐A.
In Vivo Stability of Cryoprecipitate Fibrinogen
Authors: Sherman L. A.
Published: December 2004

Because of its lower hepatitis risk, cryoprecipitate has been advocated as a substitute for commercial fibrinogen. Previous literature on cryofibrinogen has demonstrated a short blood t t 1/2. rendering it unsuitable for therapeutic/ use. The in vivo clearance of 131I‐cryoprecipitate was compared with that of 125I‐standard fibrinogen. A small amount of cryoprecipitate was rapidly cleared and apparently was cryofibrinogen. However, the bulk of the cryoprecipitate was cleared with a normal half life, as was cryoprecipitate that was in 10‐bag pools. The data indicated cryoprecipitate was an effective in vivo form of fibrinogen and thus the preferred fibrinogen source because of its combining normal t 1/2 with single donor procurement.
Factors Affecting the Efficiency of Filtration Leukapheresis
Authors: Katz A. J. , Houx J. , Morse E. E.
Published: December 2004

Continuous flow filtration leukapheresis was performed on normal volunteer donors with and without intravenous administration of dexamethasone. Although granulocyte counts were increased in steroid treated donors and almost 20 per cent more cells were presented to the filters, the final yield of granulocytes was slightly decreased and the efficiency of collection during a two‐ to three‐hour leukapheresis was statistically significantly decreased.
Decreased Accumulation of Phthalate Plasticizer during Storage of Blood as Packed Cells
Authors: Miripol J. E. , Stern I. J.
Published: December 2004

Accumulation of phthalate plasticizer (di‐(2‐ethylhexyl) phthalate, DEHP) was markedly reduced in blood stored as packed cells rather than as whole blood. After the first week, the accumulation rate in whole blood was essentially linear, but in packed cells DEHP accumulation was lower, and reached a plateau. At three weeks whole blood contained about three times more DEHP than did packed cells. Smaller amounts of plasma and restricted diffusion probably limited DEHP accumulation in packed cell preparations.
Chemical Analysis of a 30‐Year‐Old Bottle of Lyophilized Plasma
Authors: Fu P. , Yhre B. M.
Published: December 2004

The biochemical constituents of a 30‐year‐old sealed bottle of lyophilized plasma were analyzed. The results in this communication show that the process of lyophilization and storage has not seemed to cause any great changes in plasma components, including hormones, enzymes, and proteins.
How donors and nondonors view people who do not give blood
Authors: Rados David L.
Published: December 2004

Ninety Australian college students, both donors and nondonors, were asked why they felt other people did not give blood. Donors tended to stress fears, possible ill‐effects, and the inconvenience of giving blood. Nondonors tended to dismiss most reasons, although more than half of them agreed with Fear of Being Pricked with a Neddle, Never Been Asked to Give, and Inconvenience such as Loss of Time.
Tn‐polyagglutinability of red blood cells and acquired A‐like specificity
Authors: Kourteva B. T. , Manolova V. R. , Mitova D. K.
Published: December 2004

A woman whose red blood cells are polyagglutinable due to Tn‐activation is reported. The true blood group of the patient is B but her cells have an acquired A‐like specificity. The importance of the lectins, especially of Salvia sclarae extract, for the identification of Tn‐ polyagglutinability is demonstrated. The possibilities of A‐like specificity of Tn‐activated group B red blood cells is discussed.
Genetic independence of the Lutheran and Diego blood group loci
Authors: Buchanan Donald I. , Makelki Dianne , Marsh Shirley , Gangopadhyay Kamalesh C.
Published: December 2004

The Diego locus had been shown to be genetically distinct from the loci for all the established blood group systems save that for Lutheran. This gap has now been filled, after 21 years, by studies of a Cree Indian family which demonstrates that Diego is separate also from the Lutheran locus.
An elapsed time‐temperature monitor for blood storage
Authors: Harris G. E. , Cloud S. , Myhre B. A.
Published: December 2004

Blood should not be allowed to exceed 10 C while being stored or transported. However, one cannot test the internal temperature of a unit of blood without contaminating it. Most blood banks have established an arbitrary time limit beyond which a blood unit cannot be kept out of the refrigerator. This method is ineffective if blood is stored in a satellite refrigerator, since the blood may be moved in and out of the refrigerator and the blood bank personnel will be unaware of it. An elapsed time indicator is described which employs a small condenser (E‐Cell‐Plessey Electronics) charged with a known amount of electricity. If the device is removed from the refrigerator, it begins to discharge at a known rate. The amount of time subsequently can be determined by the loss of charge. The prototype of this instrument has been found to be quite accurate and small (2“× 2” × 1“). It would be rather inexpensive if made in considerable numbers.