bluuebunny/crossref_metadata_2025 huggingface dataset:
Isokinetic Leg Muscle Strength in Older Americans and Its Relationship to a Standardized Walk Test: Data from the National Health and Nutrition Examination Survey 1999–2000
Authors: Ostchega Yechiam , Dillon Charles F. , Lindle Rosemary , Carroll Margaret , Hurley Ben F.
Published: May 2004

Objectives: To describe isokinetic knee extensor muscle strength in older U.S. men and women by age and race/ethnicity and to ascertain its relationship to a standard, timed walking‐speed test.

Setting: The U.S. National Health and Nutrition Examination Survey (NHANES) 1999–2000.

Design: A cross‐sectional nationally representative health examination survey.

Participants: All surveyed persons aged 50 and older (N=1,499) who performed muscle strength and timed walk examinations in the NHANES mobile examination center.

Measurements: Concentric peak torque (strength) of the knee extensors at 1.05 rads/ s−1 velocity and a 6‐m walk timed in seconds.

Results: Knee extensor strength was inversely associated with age (P<.01), and women had less knee extensor muscle strength than men (P<.01). After adjustment for standing height, no significant difference in muscle strength was found across the three race/ethnicity groups (Mexican Americans, non‐Hispanic blacks, and non‐Hispanic whites) for men or women. After adjustment for age, race/ethnicity, weight, and height, increasing knee extensor strength was associated with significant increases in meters walked per second (P<.01).

Conclusion: Knee extensor muscle strength is affected by age and sex but not by race/ethnicity and it is significantly associated with timed walk.
Effects of the Balanced Budget Act on Medicare Home Health Utilization
Authors: Zhu Carolyn Wei
Published: May 2004

This article examines the effects of the Balanced Budget Act of 1997 on Medicare home healthcare utilization by older adults in different income groups. Data are drawn from a sample of functionally limited Medicare‐eligible elderly respondents (N=2,749) from the Medical Expenditures Panel Survey. Results from multivariate analyses revealed that, although policies succeeded in curbing home health expenditures for all income groups, the reduction was heavily concentrated among the poorest respondents. Between 1997 and 1998, Medicare home health expenditures decreased by $1,404 in lower income respondents, four times as much as the reduction in expenditures in middle‐income respondents ($352) and more than twice the reduction in high‐income respondents ($567). These findings raise important questions about whether the decrease in expenditures will result in increased incidence of adverse effects or less satisfaction with care of vulnerable individuals.
Recognition of Late‐Life Depression in Home Care: Accuracy of the Outcome and Assessment Information Set
Authors: Brown Ellen L. , Bruce Martha L. , McAvay Gail J. , Raue Patrick J. , Lachs Mark S. , Nassisi Pamela
Published: May 2004

This study evaluated the accuracy of home care nurses' ratings of the Outcome and Assessment Information Set (OASIS) depression items. The accuracy of home care nurses' depression assessments was studied by comparing nurse ratings of OASIS depression items with a research diagnostic assessment based on the Structured Clinical Interview for Axis I Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). The setting for this study was a nonprofit, Medicare‐certified, voluntary home healthcare agency. Sixty‐four home care nurses assessed 220 patients aged 65 and older with the OASIS upon admission. Of the 220 patients, using standard SCID criteria, 35 cases of major or minor depression were identified. The home care nurses accurately documented the presence of depression in 13 of 35 cases (sensitivity=37.1%; positive predictive value=0.56). Of the 220 patients, 185 had no SCID‐identified major or minor depression. The nurses agreed on the absence of depression in 175 of 185 cases (specificity=94.6%; negative predictive value=88.8%). This study indicates that home care nurses often do not accurately rate OASIS depression items for older adult patients.
Disciplinary Split: A Threat to Geriatrics Interdisciplinary Team Training
Authors: Reuben David B. , Levy‐Storms Lené , Yee Misty N. , Lee Ming , Cole Kenneth , Waite Martha , Nichols Linda , Frank Janet C.
Published: May 2004

In 1995, the John A. Hartford Foundation launched an initiative to strengthen geriatric interdisciplinary team training (GITT) for advanced practice nursing and masters‐level social work students and residents in internal medicine and family practice. As part of the national evaluation of the initiative, case‐study and cross‐case designs were employed using quantitative and qualitative data to examine the influence of cultures, regulations, and attitudes of individual disciplines on interdisciplinary training efforts at the first eight GITT programs.

This evaluation found that attitudinal and cultural traditions of the different health professions faculty and students (disciplinary split) remain as important obstacles to creating an optimal interdisciplinary team–training experience. In general, physician trainees participated least enthusiastically in GITT. In part, this lower level of enthusiasm may have been the result of inconsistent medicine faculty support of the program. At all but one program, physician trainees also had shorter GITT training experiences than other disciplines. In addition, the disparity in level of training by discipline of GITT participants may have contributed to attitudinal barriers to interdisciplinary training. Discipline‐specific regulatory and accreditation barriers also impede interdisciplinary training. Nevertheless, GITT experiences at some clinical sites, especially home visits, appeared to promote interdisciplinary training.

Some barriers to creating and implementing GITT programs may be best approached at the level of accrediting agencies and certifying organizations. Others will require local and national efforts of leaders in the different disciplines to model and support good team care.
Adult Immunization in University‐Based Primary Care and Specialty Practices
Authors: Daniels Nicholas A. , Nguyen Tung T. , Gildengorin Ginny , Pérez‐Stable Eliseo J.
Published: May 2004

The purpose of this study was to assess vaccination status of adults in primary and specialty care practices in a retrospective review of medical records from 1997 to 2000 at one university medical center. Eligible patients were aged 50 and older and had two or more visits to primary and specialty care practices (N=14,556). Outcomes were receipt of pneumococcal vaccine once, tetanus booster within 10 years, and influenza vaccine in 2 of the 3 years. Vaccination rates for patients aged 65 and older were 59% for pneumococcal, 51% for tetanus, and 32% for influenza. Asians, Latinos, and African Americans were more likely than whites to have received influenza, pneumococcal, or tetanus vaccinations. Patients seen in primary care (41%) or in both primary care and specialty practices (42%) were more likely to receive adequate vaccination than those in specialty practices (17%) (P<.001). For pneumococcal vaccinations, relative to patients receiving specialty care only, patients receiving primary care only had an adjusted odds ratios (OR) of 6.6 (95% confidence interval (CI)=5.6–7.7) and patients in both primary care and specialty care had an OR of 7.2 (95% CI=6.2–8.3). For influenza, the corresponding ORs were 3.9 and 4.8, respectively, and for tetanus, 4.6 and 5.2. Patients who received care only from specialty practices were less likely than those with some primary care to receive adequate adult vaccinations. With the exception of Russian immigrants, the study did not find that racial and ethnic minorities had lower rates of vaccination than whites.
An immediate hemolytic reaction induced by repeated administration of oxaliplatin
Authors: Chen Vivien M.Y. , Thrift Karen M. , Morel‐Kopp Marie‐Christine , Jackson David , Ward Christopher M. , Flower Robert L.
Published: May 2004

BACKGROUND:  Platinum‐based chemotherapy agents have been associated with potentially fatal acute immune‐mediated hemolytic anemia. The target antigen, cause of the positive direct antiglobulin test (DAT) and mechanism of hemolysis have been the subject of controversy.

CASE REPORT:  We report a patient who developed a DAT‐positive hemolytic episode after a red cell (RBC) transfusion was delivered during the infusion of her 17th cycle of oxaliplatin. Standard pretransfusion testing was uncomplicated; however, after infusion, the serum was no longer compatible with the transfused units and a strong (4+) panreactive IgG antibody was detected.

RESULTS:  The patient's serum from 10 days after the episode, only when therapeutic concentrations of oxaliplatin were added, reacted with all RBCs tested using the indirect antiglobulin test (IAT) (3+). The effect was retained with a purified IgG fraction and almost eliminated with IgG‐depleted serum. Immunoprecipitation analysis revealed a band with the molecular weight of the Band 3 anion channel only in the presence of the patient's serum and oxaliplatin.

CONCLUSION:  Our investigations indicated that oxaliplatin interacted with both an IgG antibody and a RBC membrane epitope probably located on the Band 3 anion channel.
Decreased platelet aggregation of platelet concentrate during storage recovers in the body after transfusion
Authors: Miyaji Ryosuke , Sakai Michio , Urano Hajime , Nakata Koichi , Sakamoto Hisahi , Shirahata Akira
Published: May 2004

BACKGROUND:  Previous reports have shown that storage decrease the ability of PLTs to aggregate in the form of PLT concentrate (PC). Nevertheless, there are few reports that have studied the PLT function in blood samples obtained from recipients after PLT transfusion. In this study, this issue was addressed by examining the ability of PLTs to aggregate after being transfused into the blood stream.

STUDY DESIGN AND METHODS:  PC was transfused to the patients with extremely low PLT counts resulting from chemotherapy. The maximum extent of PLT aggregation and size of the aggregates were compared between PLT in stored PC before transfusion with the PLT‐rich plasma (PRP) from the recipients after transfusion and with PRP from patients with moderate decrease in PLT counts after chemotherapy.

RESULTS:  The maximum extent of PLT aggregation was significantly higher in PRP collected from the patients after transfusion compared to the extent obtained before transfusion. There were no significant differences in the maximum extents of PLT aggregation between the PRP collected from the recipients after PC transfusion and, in the same patients, when PLT counts were moderately low.

CONCLUSION:  These results suggest that the observed decreased in PLT aggregation after storage can improve in the body after transfusion, and transfused PLTs have similar aggregation ability compared to the PLTs derived from the patient.
Efficacy and safety of phlebotomy to reduce transfusional iron overload in adult, long‐term survivors of acute leukemia
Authors: Franchini Massimo , Gandini Giorgio , Veneri Dino , De Matteis Giovanna , Federici Francesca , Solero Pietro , Aprili Giuseppe
Published: May 2004

BACKGROUND:  Transfusional iron overload is a frequent finding in long‐term survivors of acute leukemia (AL). Only a few studies have reported the results of iron depletion therapy in this category of patients.

STUDY DESIGN AND METHODS:  Between January 1996 and July 2003, 26 consecutive adult patients who achieved complete remission of AL and developed transfusional iron overload underwent a weekly phlebotomy program at our transfusion center. Serum ferritin levels and transferrin saturation were monitored during the iron depletion therapy and the follow‐up period. These AL patients were also checked for the presence of 12 hereditary hemochromatosis (HH) gene mutations.

RESULTS:  After a mean follow‐up of 57.8 months, therapeutic phlebotomy (mean number of units collected, 36.6) was effective in reducing mean ferritin concentration and transferrin saturation from 1726.9 to 93.0 mg per L and from 54.7 to 23.3 percent, respectively. The presence of a HH gene mutation did not influence initial iron status or response to treatment. The phlebotomy program was well tolerated and no adverse events were recorded during or after collection. In three cases the time between phlebotomies was increased because of patient's poor compliance or low Hb levels.

CONCLUSION:  Our study shows that phlebotomies are a safe and effective method for reducing iron over‐load in multiply transfused long‐term AL survivors with secondary hemochromatosis.
Significant numbers of apheresis‐derived group O platelet units have “high‐titer” anti‐A/A,B: implications for transfusion policy
Authors: Josephson C.D. , Mullis N.C. , Van Demark C. , Hillyer C.D.
Published: May 2004

Transfusion of group O single‐donor apheresis PLTs (SDP) to group A recipients has resulted in intravascular hemolysis and mortality. Owing to low availability of type‐specific SDPs, transfusion services sometimes issue ABO‐mismatched PLTs. After observing two cases of acute hemolysis following infusion of O SDPs to group A patients, where both recipient eluates revealed anti‐A specificity, a prospective study to determine the prevalence of “high‐titer” anti‐A/A,B in group O SDPs was commenced.

One hundred group O SDP samples were tested. Titers of at least 64 and/or 256 from either buffered (generally reflective of IgM antibodies) or anti‐IgG gel cards, respectively, were considered critically high. Twenty‐eight and 39 percent of samples revealed critically high anti‐A/A,B IgM and IgG titers, respectively. IgM titers were at 1:64 (18%), 128 (6%), and 256 (4%), whereas IgG titers were at 1:256 (28%), 512 (7%), 1024 (2%), and 2048 (2%).

The prevalence of critical anti‐A/A,B titers in group O SDPs is relatively high. Thus, the risk of minor side ABO mismatch and potential intravascular hemolysis during group O SDP transfusion to group A recipients may be significant. Based on these data, a policy was instituted to test anti‐A/A,B titers in O SDPs prior to “out‐of‐group” transfusion.
Transfusion‐transmitted hepatitis E caused by apparently indigenous hepatitis E virus strain in Hokkaido, Japan
Authors: Matsubayashi Keiji , Nagaoka Yasuhiro , Sakata Hidekatsu , Sato Shinichiro , Fukai Kanji , Kato Toshiaki , Takahashi Kazuaki , Mishiro Shunji , Imai Mitsunobu , Takeda Naokazu , Ikeda Hisami
Published: May 2004

BACKGROUND:  In industrialized countries, sporadic cases of hepatitis E have been reported in individuals who have never been in an endemic area. Hepatitis E virus (HEV) infection commonly occurs via the fecal‐oral route but a potential risk of transfusion transmission route has been suggested.

STUDY DESIGN AND METHODS:  A 67‐year‐old Japanese male patient who had never been abroad received a transfusion of blood from 23 voluntary donors and developed acute hepatitis with unknown etiology after transfusion. His blood samples were tested for viral markers of hepatitis viruses.

RESULTS:  HAV, HBV, HCV, CMV, and EBV were ruled out as causative agents in this case. The patient's blood sample in the acute phase contained HEV RNA as well as IgM and IgG anti‐HEV. HEV RNA was also detected in one of the FFP units transfused. The donor had no history of traveling abroad and had a normal ALT level at the time of donation. The PCR products from the patient and the donor showed complete identity for two distinct regions of HEV within open reading frame 1.

CONCLUSION:  The patient was infected with HEV via transfused blood from a volunteer donor. A potential risk of posttransfusion hepatitis E should be considered even in nonendemic countries.
Collection of white blood cell‐reduced plasma by apheresis
Authors: Vrielink Hans , Van Der Meer Pieter F.
Published: May 2004

BACKGROUND:  WBC reduction of cellular blood components has been introduced in many countries. Owing to concerns of residual WBCs in plasma, a new method to collect WBC‐reduced plasma by apheresis was studied.

STUDY DESIGN AND METHODS:  An apheresis machine (PCS2, Haemonetics) was used, in combination with the “high‐separation” core (HSC) bowl, a redesigned version of the blow‐molded (BM) bowl. With the BM bowl collections as control group, various software settings were investigated applying the HSC bowl. The optimized program was validated for routine application. Results are expressed as means ± SD.

RESULTS:  Plasma collected in the control group with the BM bowl (n = 25) had a volume of 622 ± 7 mL and contained 5.3 ± 4.6 × 106 WBCs per L, 11 ± 5 × 109 PLTs per L, and 0.063 ± 0.051 × 109 RBCs per L. The collection efficiency was 17.8 ± 2.8 mL per minute, and the total procedure time was 36.1 ± 6.3 minutes. The HSC bowl produced plasma that had a volume of 623 ± 9 mL and contained 0.01 ± 0.02 × 106 WBCs per L, 2 ± 2 × 109 PLTs per L, and 0.00040 ± 0.0016 × 109 RBCs per L (n = 134, all p < 0.001). The collection efficiency was 15.8 ± 2.2 mL per minute, and the collection time was 40.3 ± 6.3 minutes (both p < 0.001).

CONCLUSION:  The HSC bowl with the new software reliably produces WBC‐reduced apheresis plasma, with a slight elongation of the procedure time.
RH locus contraction in a novel Dc‐/D‐‐ genotype resulting from separate genetic recombination events
Authors: Huang C.‐H. , Peng J. , Chen H.C. , Chen Y.X. , Lin D.‐T. , Lin S.W‐S. , Reid M.E. , Powell V.I.
Published: May 2004

BACKGROUND:  The rare phenotypes Dc‐ and D‐‐ lack the expression of E/e and CcEe antigens, respectively; their cotransmission in a single family has not been reported.

STUDY DESIGN AND METHODS:  Six members of a Chinese family with two exhibiting the Dc‐ phenotype were studied using standard serologic methods. Rh genotypes were analyzed by Southern blot, and RH loci, by exon PCR. Rh transcripts were characterized by gene‐specific RT‐PCR and sequencing.

RESULTS:  Although Rh typing detected two members as Dc‐ homozygotes, RFLP analysis and exon PCR showed them to be Dc‐ heterozygotes with a partial deletion of RHCE. cDNA sequencing showed the expression in the family of normal RHD and RHCe as well as hybrid transcripts, RHD(1‐9)/RHCE(10) and RHCE(1‐3)/RHD(4‐10). Thus, the Dc‐ members had the genotype of Dc‐/ D‐‐ and expressed both hybrid genes that were inherited from their parents, respectively.

DISCUSSION:  This is the first demonstration in a family that the Dc‐ and D‐‐ complexes neither are linked with a normal RHD or RHCE gene. The segregation of these two different hybrid genes with single break points sug‐gests their independent genetic origin and provides molecular insights into the dynamic nature of genomic rearrangements leading to RH locus contraction.
Effect of thrombopoietin alone and a combination of cytochalasin B and ethylene glycol bis(β‐aminoethyl ether) N,N′‐tetraacetic acid‐AM on the survival and function of autologous baboon platelets stored at 4°C for as long as 5 days
Authors: Valeri C. Robert , Ragno Gina , Marks Peter W. , Kuter David J. , Rosenberg Robert D. , Stossel Thomas P.
Published: May 2004

BACKGROUND:  PLTs stored at 22°C have the potential for bacterial contamination, a problem that could be reduced by 4°C storage. Nevertheless, PLTs stored at 4°C exhibit a significantly reduced life span. This study was performed to determine whether treatment of PLTs with thrombopoietin or cytochalasin B plus ethylene glycol bis(β‐aminoethyl ether) N,N′‐tetraacetic acid (EGTA)‐AM could prevent exponential loss of PLTs stored at 4°C.

STUDY DESIGN AND METHODS:  Autologous baboon PLTs were stored at 22 or 4°C. The 4°C stored PLTs were treated with 1.5 ng per mL thrombopoietin, with 1 µmol per L cytochalasin B, and 80 µmol per L EGTA‐AM (cyto‐EGTA) or not treated and labeled with 111In‐oxine to study their in vivo recovery and life span. PLT function was assessed by correction of an aspirin‐induced prolonged bleeding time. Aggregation responses and morphology were also assessed.

RESULTS:  PLTs stored at 22°C had normal in vivo recovery and linear survival. PLTs stored at 4°C, whether or not they were treated with thrombopoietin, had normal recovery and exponential survival. Aggregation of cyto‐EGTA‐treated PLTs was similar for PLTs stored at 4°C and fresh PLTs, but decreased in PLTs stored at 22°C for 5 days. The addition of cyto‐EGTA to PLTs before 4°C storage inhibited morphologic changes that occurred in PLTs stored at 22°C and cold‐induced PLT clumping, but did not prevent exponential disappearance of the PLTs.

CONCLUSION:  Addition of thrombopoietin or cyto‐chalasin B and EGTA‐AM to PLTs before 4°C storage did not prevent exponential loss of PLTs.
Analysis of ABO discrepancies occurring in 35 French hospitals
Authors: Chiaroni J. , Legrand D. , Dettori I. , Ferrera V.
Published: May 2004

BACKGROUND:  The risk of immunohemolytic reaction owing to ABO‐mismatched mistransfusion is 100 to 1000 times higher than the risk of viral infection. Like analysis of incident reports, evaluation of near‐miss events can provide useful insight into hazardous situations for mis‐matched blood transfusion. The aim of this prospective study was to assess the incidence and root causes of all ABO discrepancies, detected by a central hematology laboratory, in blood samples referred from 35 district hospitals.

STUDY DESIGN AND METHODS:  ABO discrepancies were detected by comparing either two current blood specimens or a current and historical specimen collected over a 5‐year study period. Discrepancies were investi‐gated by retyping new samples, checking sample identifi‐cation, and reviewing previous hospital records.

RESULTS:  A total of 118 ABO discrepancies were discovered in a series of 407,769 tests carried out during the study period. The incidence of ABO discrepancies was 1 per 3,400. This figure was 10 times higher than the incidence of ABO‐mismatched transfusions. Most of these ABO discrepancies were due to phlebotomy errors, that is, collection from wrong patient. The second most common cause involved clerical errors during patient registration or identification.

CONCLUSION:  ABO discrepancies can result from errors made not only by the medical staff during phlebotomy but also to by the clerical staff during registration and identification. These findings emphasize the need to standardize data transmission between health care personnel.
Photochemical inactivation of selected viruses and bacteria in platelet concentrates using riboflavin and light
Authors: Ruane Patrick H. , Edrich Richard , Gampp Deanna , Keil Shawn D. , Leonard R. Lynne , Goodrich Raymond P.
Published: May 2004

BACKGROUND:  A medical device is being developed for the reduction of pathogens in PLT concentrates (PCs). The device uses broadband UV light and the compound riboflavin (vitamin B2).

STUDY DESIGN AND METHODS:  Pathogens were added to single‐donor PLTs. After treatment, the infectivity of each pathogen was measured using established biologic assays. In vitro PLT performance was evaluated after treatment and after 5 days of storage using a panel of 10 in‐vitro cell quality assays.

RESULTS:   In studies with viral pathogens, the Pathogen Reduction Technology (PRT) system provided average log reduction factors of 4.46 ± 0.39 for intracellular HIV, 5.93 ± 0.20 for cells associated HIV, and 5.19 ± 0.50 for West Nile virus. For the nonenveloped porcine parvovirus, a reduction factor greater than 5.0 log was observed. Staphylococcus epidermidis and Escherichia coli bacteria were also tested with observed reduction factors to the limits of detection of 4.0 log or greater. PLT cell quality was adequately maintained after treatment and during storage. Although P‐selectin expression, glucose consumption, and lactate production increased relative to controls, this was not beyond accepted levels. The pH of treated PCs also decreased slightly relative to control PLTs on Days 1 and 5.

CONCLUSION:  The data indicate that the device successfully reduced the number of selected pathogens in PCs. Despite the fact that significant differences exist between treated and control in‐vitro variables, it is speculated that the clinical effectiveness of both products will not be significantly different, based on comparison to historical data for products in routine clinical use today.
Anemia and its treatment and outcomes in persons infected with human immunodeficiency virus
Authors: Buskin Susan E. , Sullivan Patrick S.
Published: May 2004

BACKGROUND:  Anemia is a common comorbidity with HIV. Before the highly active antiretroviral therapy (HAART) era, anemia was found to be associated with decreased survival. This study examined the prevalence of anemia since HAART's availability and the associations between anemia treatments and survival.

STUDY DESIGN AND METHODS:  Anemia prevalence in a cohort of HIV‐infected persons was described. In a smaller cohort of HIV‐infected anemic patients, survival was modeled with a time‐dependent proportional hazards regression model adjusting for CD4+ T‐lymphocyte count, plasma HIV RNA concentration load, hemoglobin (Hb) level, and other factors.

RESULTS:  Anemia (Hb level < 10.5 g/dL, or physician diagnosis) decreased from 13 to 5 percent (p < 0.05) in 1996 through 2001. Anemia prevalence was highest (24‐35%) and did not decrease among patients with CD4 count less than 100 cells per mL. In total, 216 severely anemic HIV‐infected individuals (mean Hb level, 8.1 g/dL) followed for a median of 13 months had a 37‐percent mortality rate. Of these, 22 percent were untreated (13% mortality rate), 42 percent received transfusion alone (52% mortality), 12 percent received epoetin alfa alone (19% mortality), and 24 percent received both (47% mortality). Transfusion was associated with a threefold excess mortality risk, but epoetin alfa prescription was not associated with mortality.

CONCLUSION:  The prevalence of anemia decreased in the HAART era, and transfusion was positively associated with risk of death, suggesting limiting use of transfusions in nonemergency situations.
Persistence of cefotetan on red blood cells
Authors: Davenport Robertson D. , Judd W. John , Dake Louann R.
Published: May 2004

BACKGROUND:  Cefotetan can cause severe immune hemolytic anemia that may persist long after the drug is discontinued. To study the binding of cefotetan to RBCs, patients who received cefotetan were followed and tested for the presence of antibody to cefotetan.

STUDY DESIGN AND METHODS:  Patients receiving cefotetan were identified from pharmacy and nursing records. Blood samples obtained for routine hematology tests were analyzed. Cefotetan binding to patients’ RBCs was tested using a previously characterized high‐titer anticefotetan serum by gel technique. To determine the minimum amount of drug necessary for binding to occur, RBCs were incubated with serial dilutions of cefotetan at pH 7.4.

RESULTS:  Sixty patients receiving 1 to 25 g IV (median, 2 g) of cefotetan were followed for 1 to 123 days (median, 18 days). All were initially positive, for cefotetan on RBCs. Positivity persisted for up to 98 days after the last dose of drug. Fifteen patients became negative during follow‐up. The first negative sample occurred at Day 30 to 123. Using the midpoint between the last positive and first negative to estimate of the duration of positivity, we estimate that cefotetan remains RBC‐bound for 16.5 to 92 days (median, 67.5 days). During the follow‐up period, five patients developed anticefotetan detectable in the serum. Twenty patients receiving other cephalosporin antibiotics showed no specific reactivity of their RBCs with anticefotetan. In vitro studies showed a minimum necessary drug concentration of 1 µmol/L at physiologic pH, which was not significantly altered by RBC pretreatment with ficin, sialydase, or DTT.

CONCLUSIONS:  Cefotetan is tightly bound to RBCs after intravenous administration and remains detectable for weeks after the last dose. Antibodies to cefotetan may occur in about 8 percent of patients receiving the drug. The minimum necessary concentration for RBC binding is low compared to an estimated plasma concentration of 240 µmol/L from a single IV dose of 1 g.
Incidence and specificity of HLA antibodies in multitransfused patients with acquired aplastic anemia
Authors: Laundy G.J. , Bradley B.A. , Rees B.M. , Younie M. , Hows J.M.
Published: May 2004

BACKGROUND:  This study aimed to establish the prevalence and characteristics of anti‐HLA in antibody acquired aplastic anemia patients following cessation of antithymocyte globulin therapy and to characterize antibody in terms of epitope specificity.

STUDY DESIGN AND METHODS:  One hundred and fifty multitransfused, untransplanted patients from eight European centers were investigated by serologic methods.

RESULTS:  Sixty‐two percent were antibody positive. Eighteen HLA‐Class‐I‐specific antibodies (15 IgG, 3 IgM) were identified in 13 patients; 13 antibodies were specific for HLA‐A epitopes and 5 for HLA‐B. Epitope analysis identified significant correlation between serum reactivity and amino acid substitutions associated with HLA‐Class‐I epitopes. An excess of antibodies to HLA‐A1‐associated cross‐reactive groups was identified. There was no significant difference in antibody frequency in patients taking cyclosporine compared to those who were not.

CONCLUSION:  Data suggested a contribution from B cell memory of alloantigens introduced during pregnancy. In some cases, antibody production continued many years after the last transfusion, and although the target varied between individual patients, the antibody to HLA was focused on a few specific Class I epitopes, the majority of which mapped to the HLA‐A molecule.
Posttransfusion 24‐hour recovery and subsequent survival of allogeneic red blood cells in the bloodstream of newborn infants
Authors: Strauss Ronald G. , Mock Donald M. , Widness John A. , Johnson Karen , Cress Gretchen , Schmidt Robert L.
Published: May 2004

BACKGROUND:  The feasibility, efficacy, and safety of transfusing stored allogeneic RBCs has been demon‐strated for small‐volume transfusions given to infants. We measured the posttransfusion recovery and intravascular survival of allogeneic RBCs stored up to 42 days to further elucidate their efficacy.

STUDY DESIGN AND METHODS:  Preterm infants were transfused with 1.0 mL of biotinylated RBCs plus 15 mL per kg of unlabeled allogeneic RBCs. Posttran‐sfusion infant blood samples obtained at 10 minutes, and at 1, 2, 4, 7, 10, 14, and 21 days were used to determine the 24‐hour posttransfusion recovery (PTR24), mean potential life span (MPL), and time to disappearance of 50 percent of biotinylated RBCs (T50).

RESULTS:  No significant differences were found between allogeneic RBCs stored 1 to 21 days versus 22 to 42 days for PTR24, MPL, or T50, indicating comparable posttransfusion circulation, regardless of storage age. Although MPL and T50 values in infants using biotinylated RBCs were short, compared to those expected using chromium‐labeled RBCs in adults, they agreed with results reported by others using biotinylated RBCs.

CONCLUSIONS:  Satisfactory posttransfusion RBC recovery and survival, measured with biotinylated RBCs, support earlier clinical trials that established the efficacy and safety of stored allogeneic RBCs for small‐volume transfusions given to infants. The relatively short MPL and T50 values in some infants may underestimate true survival due to ongoing erythropoiesis and infant growth with commensurate increase in blood volume during the time of RBC survival studies. Because values in infants differ from those expected using chromium‐labeled RBCs in adults, and the number of posttransfusion determinations was few, additional studies are needed to define the mechanisms involved.
Blood transfusion rates in the care of acute trauma
Authors: Como John J. , Dutton Richard P. , Scalea Thomas M. , Edelman Bennett B. , Hess John R.
Published: May 2004

BACKGROUND:  Ten to 15 percent of all RBCs are used in the care of injury. Understanding patterns of RBC use is important. Routine resource allocation, planning for mass casualty situations, designing research, and optimizing triage all can be usefully informed.

STUDY DESIGN AND METHODS:  Blood Bank and Trauma Registry records were linked to produce a transfused blood product list for each patient directly admitted from the scene of injury to a large Level 1 trauma center in calendar year 2000. Categorical associations between demographic data, Injury Severity Score, transfused products, and outcome were sought. Special attention was paid to the groups receiving uncross‐matched RBCs and more than 10 units of RBCs.

RESULTS:  Eight percent (479/5645) of acute trauma patients received RBCs, using 5219 units and sustaining an overall mortality of 27 percent. Sixty‐two percent of RBCs were given in the first 24 hours of care. Three percent of patients (147 injured) received more than 10 units and received 71 percent of all RBCs given. Mortality in this cohort was 39 percent. Ninety percent of the patients who received more than 10 units of RBCs received plasma, and 71 percent received PLTs.

CONCLUSIONS:  A small number of patients receives most of the blood products used in the treatment of injury. Transfusion of more than 10 units of RBCs identifies a subgroup where most patients received plasma and PLTs to treat actual or anticipated dilutional coagulopathy. There is no clear threshold beyond which blood use is futile.
West Nile virus in plasma is highly sensitive to methylene blue–light treatment
Authors: Mohr Harald , Knüver‐Hopf Joseph , Gravemann Ute , Redecker‐Klein Anette , Müller Thomas H.
Published: May 2004

BACKGROUND: The epidemic of West Nile virus (WNV) in the US resulted in cases of transfusion‐transmitted WNV. Effective pathogen reduction methods could have removed this infectious agent from the blood supply We have evaluated the efficacy of photodynamic treatment of fresh frozen plasma (FFP) with methylene blue (MB), a decontamination method applied in several European countries.

STUDY DESIGN AND METHODS: FFP units (300 ml each) were spiked with WNV. MB was added, and the units were illuminated with white or monochromatic yellow light. WNV infectivity was determined by bioassay. WNV‐RNA was quantitated by real‐time PCR. The inactivation of WNV was investigated under standard and under suboptimal conditions, respectively. In addition, rechallenge experiments with multiple addition of WNV at maximal load (approx. 105 CFU/ml) and repeated illumination without replenishing MB were performed.

RESULTS: Complete inactivation of WNV was achieved by MB (0.8‐1 mmol/l) and illumination with white light (30,000‐45,000 Lux) within 2 min. White yellow light 20‐40 J/cm2(2.5‐5 min) were sufficient for inactivation by 5.75 log10‐steps. The rechallenge experiments revealed the substantial reserve capacity of the procedure to inactivate WNV. Quantitative PCR indicated that the viral RNA was rapidly destroyed.

CONCLUSION: All experimental data demonstrate the enormous potency of phototreatment with MB to inactivate WNV in plasma.
Predonation water ingestion attenuates negative reactions to blood donation
Authors: Hanson Sarah A. , France Christopher R.
Published: May 2004

BACKGROUND:  Novice blood donors are at increased risk for unpleasant blood donation‐related symptoms (e.g., dizziness, weakness, and lightheadedness), and the experience of such symptoms can contribute to a decreased likelihood of repeat donation. Recent laboratory studies suggest that water ingestion produces hemodynamic effects that may be sufficient to reduce risk of syncope and related reactions during blood donation.

STUDY DESIGN AND METHODS:  Male and female volunteers were randomly assigned to ingest either 500 or 0 mL of water 30 minutes before donating blood for the first time. In addition, bioimpedance analysis was used to assess predonation chronic hydration levels in all donors. Immediately after donation, participants completed the Blood Donation Reactions Inventory to assess subjective experience of negative physiologic reactions.

RESULTS:  Analysis of Blood Donation Reactions Inventory scores revealed that predonation water ingestion was associated with a 47‐percent reduction of total donation‐related symptoms (F [1,79]= 11.81, p = 0.001). Chronic hydration status was not related to reported reactions.

CONCLUSION:  Novice blood donors responded positively to predonation water consumption, and they were able to consume 500 mL in less than 5 minutes. Results of the present study suggests that predonation water ingestion may be a simple and cost‐effective strategy to enhance the donation experience and possibly increase donor retention.
A multivariate analysis of the outcome of endodontic treatment
Authors: Ørstavik Dag , Qvist Vibeke , Stoltze Kaj
Published: May 2004

In the present study, multivariate analyses were performed on clinical and treatment variables that may influence the outcome of endodontic treatment. Data collected in a previous clinical‐radiographic follow‐up study were used. Of 810 treated, 675 roots in 498 teeth were followed for 6 months to 4 yr. Of these, 192 (the CAP group) had pre‐existing, chronic apical periodontitis and 483 (the NAP group) had not. Root canal treatment followed a standard procedure with one of three sealers chosen at random. Demographic, clinical and radiographic variables were recorded at the start of, and during treatment. The periapical index (PAI) score was used to record the outcome of treatment, and applied in two different endpoint modes (END1 and END2) as the dependent variable for multivariate statistical analyses using logistic regression and the general model. The modes reflected increasing PAI scores (END1) and conventional success/failure assessment (END2). Dropouts were largely similar to the cases followed up. A total of 10 preoperative and peroperative variables were found to be significantly associated with treatment outcome by the multivariate analyses of either the total material or the NAP or CAP subgroups. Several of these were not significant in univariate analyses (e.g. the effect of sealer). Conventional success/failure analyses (END2) identified fewer of the influential variables and had low explanatory power, whereas PAI scores on an ordinal scale (END1) were most sensitive in identifying variables of influence on the treatment outcome.
Comparison of bonding efficacy of an all‐in‐one adhesive with a self‐etching primer system
Authors: Abo Tomoko , Uno Shigeru , Sano Hidehiko
Published: May 2004

The aim of this study was to compare the bonding efficacy of an all‐in‐one adhesive with that of a self‐etching primer system by measuring microleakage after thermocycling and the microtensile bond strength (μTBS) to enamel and dentin. Circular class V cavities along cement–enamel junctions were prepared in 20 extracted human premolars. Each 10 teeth were bonded with either AD Bond (AD) or Clearfil SE Bond (SE), and filled with a resin composite (Charisma). After thermocycling and staining with 0.5% basic fuchsin, the microleakage at the coronal and apical walls was evaluated using longitudinal sections. In addition 20 premolars were used to measure μTBS at 24 h after bonding for these adhesives to enamel and dentin that corresponded to the coronal and apical walls of the class V cavities. AD showed more microleakage than SE in the coronal walls, but there was less microleakage in the apical walls and no difference in apical leakage between the two adhesives. μTBS (SD) in MPa to enamel and dentin were 25.2 (7.3) and 68.3 (9.4) for AD, and 35.8 (7.4) and 76.4 (7.8) for SE, respectively. AD gave a lower μTBS to enamel than did SE. The results suggested that the poor adaptation at the coronal wall in AD might be caused by the lower bond strength to enamel.
In vitro cell death induced by irradiation and chemicals relevant for dental applications; dose–response and potentiation effects
Authors: Roll Ellen Bruzell , Dahl Jon E. , Runningen Gry , Morisbak Else
Published: May 2004

Resin‐based dental materials polymerized using blue light are frequently used in dental practice and may come in contact with the oral mucosa. Remnants from oral hygiene product ingredients, such as sodium lauryl sulfate (SLS), add to the chemical exposure of the mucosa. The aim of the present in vitro study was to elucidate the cytotoxic effects in terms of apoptosis and necrosis after exposures to combinations of an adhesive (0.5% and 0.6%), SLS (concentration range 0.0025%‐0.0075%), and irradiation from a dental curing lamp (radiant exposure of 8 J cm−2). The test system chosen was rat submandibular salivary gland acinar cells, and the cytotoxic effects were measured by fluorescence microscopy and flow cytometry methods. Cytotoxicity was observed as a result of irradiation. The most pronounced cytotoxic effects were seen in cells exposed to a combination of adhesive and SLS compared with those exposed to either agent alone. Necrosis was the dominating form of cell death for all exposures, except for the highest concentration of SLS. Apoptosis was dose‐dependent on SLS in the rat submandibular acinar cells. Cytotoxic considerations of dental materials should include contributions from irradiation and other chemicals that might be present in the oral cavity.
Morphometric analysis of the mandible in growing rats with different masticatory functional demands: adaptation to an upper posterior bite block
Authors: Mavropoulos Anestis , Bresin Andrea , Kiliaridis Stavros
Published: May 2004

Functional appliances displace the mandible forward and/or downward, causing a stretching of the orofacial soft tissues, muscles included. The resulting forces are directly or indirectly transmitted to the underlying dento‐skeletal tissues. The hypothesis underlying the present investigation was that the insertion of a bite‐opening appliance influences the lateral morphology of the rat mandible during growth, and that, moreover, this influence depends on the masticatory functional demands. One‐hundred and four 4‐wk‐old male albino rats were divided into two groups, fed a hard and soft diet, respectively. After 2 wk, half of the animals in each experimental group were fitted with upper posterior blocks, and 4 wk later they were killed. Their left hemi‐mandibles were transilluminated, photographed under magnification, and digitized on screen. A total of 170 points were used to draw the lateral outline of the mandible. In addition to the inhibitory effect on the height of the dento‐alveolar process, the upper bite block resulted in significant changes in the condyle inclination, the length of the coronoid process, and the occlusal plane inclination. Masticatory functional demands influenced this adaptation in an additive way. The results raise the question of whether orthodontic treatment with posterior bite blocks might have different effects on the mandible, depending on the characteristics of the orofacial soft tissues.
Effect of xylitol on mutans streptococci and lactic acid formation in saliva and plaque from adolescents and young adults with fixed orthodontic appliances
Authors: Stecksén‐Blicks Christina , Holgerson Pernilla Lif , Olsson Martin , Bylund Britt , Sjöström Inger , Sköld‐Larsson Kerstin , Kalfas Sotos , Twetman Svante
Published: May 2004

This study aimed to investigate two dose regimens of xylitol‐containing tablets on the ecology of dental plaque and saliva during treatment with fixed orthodontic appliances. The study group comprised 56 healthy patients (mean age 15.8 yr) randomly assigned into the following groups: A, (n = 23) two xylitol tablets two times a day (1.7 g xylitol d−1) for 18 wk; B, (n = 23) two tablets four times per day (3.4 g xylitol d−1) for 18 wk; and C, (n = 10) no tablets. The levels of mutans streptococci (ms) were enumerated in plaque and saliva and the proportion of xylitol‐sensitive (XS) strains in saliva was determined by autoradiography with [14C]‐xylitol at baseline and at 6, 12, and 18 wk. The lactic acid formation rate was assessed enzymatically in sucrose‐challenged plaque suspensions. A drop in salivary ms levels was found in Group A after 6 wk but not after 12 or 18 wk. The proportion of XS ms was decreased after 6 wk in groups A and B and remained so during the experimental period. The lactic acid formation rates decreased slightly (≈ 10%) in the two xylitol groups compared with baseline. In conclusion, our results showed that although an alteration of ms strains was demonstrated following a regular daily low‐dose intake of xylitol, the long‐term total ms counts in plaque and saliva as well as plaque acidogenicity remained unchanged.
Histochemical examination of periodontal junctional epithelium in p21/p27 double knockout mice
Authors: Watanabe Keiko , Petro Benjamin J. , Sevandal Maureen , Anshuman Soni , Jovanovic Aleksandra , Tyner Angela L.
Published: May 2004

The periodontal junctional epithelium (JE) is maintained in a steady state through a dynamic process that balances proliferation and exfoliation of epithelial cells. However, mechanisms that regulate JE are not well understood. To better understand how proliferation of the JE is controlled in healthy gingiva, we have studied functional roles of the CDK (cyclin dependent kinase) inhibitors p21 and p27 in JE using knockout mouse model systems. Image analysis of the dentogingival junction in p21 or p27 single knockout mice as well as p21/p27 double knockout mice (dKO) was performed. The analysis revealed enlarged JE in p21/p27 dKO mice due to an increase in the area of the epithelium and associated connective tissue ‘islands’. Immunohistochemistry was performed for p21, p27, cyclin D1, and proliferating cell nuclear antigen (PCNA). The highest levels of PCNA‐positive cells were detected in the p21/p27 dKO mice, reflecting increased cell turnover. Lower levels of cyclin D1 were detected in the JE of p21/p27 knockout mice, suggesting that p21 and p27 regulate stability of cyclin D1 in oral epithelium. These data suggest that p21 and p27 have a critical role in controlling epithelial cell proliferation in the JE and thus function to maintain the JE at a normal size.
White spot lesions around brackets: in vitro detection by laser fluorescence
Authors: Staudt Christine Bettina , Lussi Adrian , Jacquet Jean , Kiliaridis Stavros
Published: May 2004

Demineralization around orthodontic brackets is one of the side‐effects of orthodontic treatment. However, simple methods for its early detection, quantification and monitoring are lacking. Therefore, the aim of this investigation was to evaluate red laser‐light induced fluorescence for measurement of demineralization around brackets in vitro, and whether an interference by the brackets should be expected. The site of measurement was standardized on 30 extracted human molars with natural demineralization on smooth surfaces. Fluorescence was measured (Diagnodent) on prebonded, etched, bonded with stainless steel brackets, and debonded enamel. We found no statistically significant difference in fluorescence after etching. After bonding, the fluorescence decreased by a median value of 0.5 compared to the prebonded and etched enamel. After debonding, the fluorescence increased by a median value of 0.5 and 1 compared with the prebonded and bonded conditions, respectively. The lack of agreement between prebonded and bonded enamel values (limits +12.4/−12.6) was possibly due to the difficulty in finding the same spot without the bracket (coefficient of repeatability = 9.1–10.8). In vitro, demineralization around brackets can be measured by laser fluorescence, but clinical studies are necessary.