bluuebunny/crossref_metadata_2025 huggingface dataset:
Troubling dimensions of heart transplantation
Authors: Shildrick M , McKeever P , Abbey S , Poole J , Ross H
Published: May 2009

Heart transplantation is now the accepted therapy for end-stage heart failure that is resistant to medical treatment. Families of deceased donors routinely are urged to view the heart as a “gift of life” that will enable the donor to live on by extending and sustaining the life of a stranger. In contrast, heart recipients are encouraged to view the organ mechanistically—as a new pump that was rendered a spare, reusable part when a generous stranger died. Psychosocial and psychoanalytic research, anecdotal evidence and first-person accounts indicate that after transplant, many recipients experience unexpected changes or distress that cannot be understood adequately using biomedical explanatory models alone. In this paper it is argued that phenomenological philosophy offers a promising way to frame an ongoing empirical study that asks recipients to reflect on what it is like to incorporate the heart of another person. Merleau-Ponty and others have posited that any change to the body inevitably transforms the self. Hence, it is argued in this paper that replacing failing hearts with functioning hearts from deceased persons must be considered much more than a complex technical procedure. Acknowledging the disturbances to embodiment and personal identity associated with transplantation may explain adverse outcomes that heretofore have been inexplicable. Ultimately, a phenomenological understanding could lead to improvements in the consent process, preoperative teaching and follow-up care.
Comparison of Thinopyrum intermedium derivatives carrying barley yellow dwarf virus resistance in wheat
Authors: Ayala-Navarrete L. , Tourton E. , Mechanicos A. A. , Larkin P. J.
Published: May 2009

Resistance to both barley yellow dwarf virus (BYDV) and cereal yellow dwarf virus (CYDV) has been demonstrated in wheat genetic stocks with Thinopyrum intermedium chromatin. A number of resistance-bearing translocations have been reported on chromosome arm 7DL from two independent Th. intermedium sources; one source is the addition line L1 and the other is the spontaneous substitution line P29. Another source of resistance in wheat cytogenetic stocks is available as a 2Ai(2D) substitution line. We used a set of 38 molecular markers and the available deletion stocks to compare the size of the 7DL translocations more comprehensively than has been done previously. We also compared the efficacy of BYDV resistance of the various genetic stocks both before and after transfer to a common genetic background. TC14 was confirmed as carrying the smallest translocation, replacing about 20% of the distal end of 7DL. TC5 and TC10 had 90% of the chromosome arm replaced by Th. intermedium chromatin; the proximal 10% corresponded to wheat chromatin. YW642 appeared to have the whole 7DL replaced by Th. intermedium chromatin, as confirmed by the co-dominant marker cfd68 mapping on the bin nearest the centromere. Translocation line P961341 had bins 3, 7, and 8 replaced by Th. intermedium chromatin, making this the second smallest translocation with BYDV and CYDV resistance. The translocation sizes reported here differ from some of the previous estimates. The translocated Th. intermedium segments appeared to be bigger than the replaced wheat 7DL fragments. All the resistances derived from the L1 and P29 group 7 chromosomes and the 2Ai#2 chromosome were effective in reducing the number of infected plants and the mean virus titre, regardless of the background. Some evidence is discussed suggesting the long arm of the Th. intermedium group 7 chromosome 7Ai#1 carries two resistances, the distal Bdv2 and a proximal second gene.
3D modelling of ice-covered flows in the vicinity of a deep hole in the East Channel of the Mackenzie Delta, N.W.T.
Authors: Inkratas Chris , Gharabaghi Bahram , Beltaos Spyros , Krishnappan Bommanna
Published: May 2009

The discovery of vast quantities of hydrocarbons during exploration of the Mackenzie Delta has led to the detection of numerous anomalous deep holes in various delta channels in the past four decades. The proposed pipeline crossing from the Mackenzie Delta to northern Alberta has renewed interest in studying the stability of these deep holes. The main goal of this research project was to study ice-covered flow velocity and bed shear stress distributions using a previously calibrated computational fluid dynamics (CFD) model for a 30 m deep hole in the East Channel of the Mackenzie Delta to provide an initial assessment of its stability. In this study, a previously developed 3D CFD model using the FLUENT code with the renormalization group theory (RNG) k-ε turbulence closure model with nonequilibrium wall functions was adapted to represent ice-covered flow conditions for the study reach. The numerical model was applied to simulate four flow conditions (500, 720, and 1000 m3/s along with a moving ice cover during a flow rate of 720 m3/s). Results indicated that a single vortex was formed near the inner bend above the hole and deposition may be a key process occurring during ice-covered flow conditions.
Chlorine and UV disinfection of ampicillin-resistant and trimethoprim-resistant Escherichia coliA paper submitted to the Journal of Environmental Engineering and Science.
Authors: Templeton Michael R. , Oddy Francine , Leung Wing-kit , Rogers Michael
Published: May 2009

This bench-scale study investigated whether strains of Escherichia coli that are resistant to two common types of antibiotics, ampicillin and trimethoprim, possess increased resistance to two common disinfectants in water and wastewater treatment, free chlorine and ultraviolet disinfection, relative to an antibiotic-sensitive strain of E. coli isolated from sewage sludge. Trimethoprim-resistant E. coli was slightly more resistant to chlorine than the antibiotic-sensitive isolate and the ampicillin-resistant E. coli under the study conditions (95% confidence), however this difference would not be important under normal chlorination conditions applied in practice. There were no statistically significant differences between the ultraviolet dose-response profiles of the antibiotic-resistant and antibiotic-sensitive E. coli strains over the ultraviolet dose range tested.
Étude de la résistance aux β-lactamines et des marqueurs moléculaires chez 157 souches d’Haemophilus influenzae isolées chez l’enfant à Tunis
Authors: Oueslati S. , Smaoui H. , Joubert G. , Dabernat H. , Kechrid A.
Published: May 2009

The aim of this study was to precise the capsular type of Haemophilus influenzae , to determine its susceptibility to β-lactam agents, and to search for an eventual clonality between the clinical strains of the pathogen. Polymerase chain reaction was carried out to confirm the capsular type and to determine the β-lactamase type. Minimum inhibitory concentrations (MICs) of β-lactam agents for H. influenzae were determined by the agar dilution method on Haemophilus test medium, and the strains were analyzed by pulsed-field gel electrophoresis after SmaI restriction. Among 157 strains of H. influenzae studied, 12.1% was of serotype b. Sixty-seven strains (42.7%) were resistant to amoxicillin, among which 51 were resistant through production of TEM-type β-lactamase while 16 showed high MICs for amoxicillin, amoxicillin + clavulanic acid, and cefuroxim, which suggested a resistance by modification of penicillin-binding proteins. Among the latter strains, five were producing TEM-type β-lactamase. Cefotaxim, cefixim, and cefpodoxim had low MICs in all cases. The pulsed-field gel electrophoresis revealed 110 pulsotypes. All H. influenzae strains, including noncapsulated strains and serotype-b encapsulated strains, had a high level of heterogeneity, with diversity indices of respectively 0.67 and 0.94.
Design and testing of real-time PCR primers for the quantification ofMethanoculleus,Methanosarcina,Methanothermobacter, and a group of uncultured methanogens
Authors: Franke-Whittle Ingrid H. , Goberna Marta , Insam Heribert
Published: May 2009

In this study, 16S rRNA gene primers were designed to complement the suite of already available PCR primers for the detection of different methanogens involved in biogas production through anaerobic digestion by SYBR Green real-time PCR. Primers designed for use in TaqMan real-time PCR for the organisms Methanosaeta , Methanosarcina , and Methanoculleus have been described previously; however, we found that (i) the Methanoculleus primers were not specific to members of the genus and that (ii) the Methanosarcina primers did not work specifically with SYBR Green real-time PCR. Thus, we designed new primers for these and other methanogens, and we optimized SYBR Green real-time PCR assays. Primers were tested by end-point and real-time PCR, and they were found to work specifically and sensitively. Application of these primers will allow the detection and quantification of Methanoculleus, Methanosarcina, Methanothermobacter , and a group of yet uncultured archaea from anaerobic habitats.
Activity of spores and extracellular proteins from six Cry+strains and a Cry–strain ofBacillus thuringiensissubsp.kurstakiagainst the western spruce budworm,Choristoneura occidentalis(Lepidoptera: Tortricidae)
Authors: Kalmykova Galina , Burtseva Ljudmila , Milne Ross , van Frankenhuyzen Kees
Published: May 2009

We characterized insecticidal activity of previously untested strains of Bacillus thuringiensis kurstaki belonging to two crystal serovars (K-1 and K-73) against the western spruce budworm ( Choristoneura occidentalis Freeman 1967). By testing various components, we demonstrated that spores play a critical role in the pathogenesis of each strain. Spore-free crystals caused low mortality and purified spores were generally not toxic. The addition of spores to purified protoxin increased toxicity several hundred-fold, regardless of the parental strain from which the spores or protoxins were derived. The crystal and spore components did not account for full insecticidal activity of whole sporulated cultures owing to the toxicity of soluble proteins that are secreted during cell growth. We observed a marked difference in toxicity of secreted proteins between the K-1 and K-73 type strains, with the K-1 preparations causing much higher mortality, mass reduction, and inhibition of pupation. There was a consistent correlation between relative toxicity of secreted protein preparations and the presence and quantity of the Vip3A protein, suggesting that this protein contributes to the virulence of B. thuringiensis subsp. kurstaki in western spruce budworm larvae. However, other virulence factors have to be invoked to explain the synergizing effect of spores from both K-1 and K-73 strains on Cry protein toxicity.
Pseudomonas fluorescens ompW: plasmid localization and requirement for naphthalene uptake
Authors: Neher Tracy M. , Lueking Donald R.
Published: May 2009

Suppressive subtractive hybridization has been utilized to generate a cDNA library of genes differentially expressed in naphthalene grown cells of Pseudomonas fluorescens . The library was devoid of genes known to be associated with naphthalene catabolism, but was enriched in genes related to cellular uptake and efflux systems. The gene for OmpW, which was present in the cDNA library and has been proposed to encode a porin for the transport of hydrophobic molecules, was isolated, cloned, and sequenced. This gene was shown to be exclusively localized on a large catabolic plasmid possessed by the organism, and its specific mutation resulted in the loss of the organism’s ability to grow on naphthalene and several other polycyclic aromatic hydrocarbons. It is proposed that a primary response by P. fluorescens to the presence of naphthalene is the elevation of the cellular mechanism(s) required for its assimilation. The presence of genes related to the uptake and efflux mechanisms present following suppressive subtractive hybridization supports this proposal.
CHANGE MANAGEMENT AND SOFTWARE REUSE SUPPORTIVE 'GENETIC INFORMATION SYSTEM DEVELOPMENT AND MAINTENANCE' MODEL
Authors: MANCHANDA SANJEEV , SINGH S. B. , DAVE MAYANK
Published: May 2009

The aim of the present research work is to develop an information system development process and a model for the development of new generation information systems. New age information systems are those information systems that are capable of fulfilling the demand of highly dynamic information requirements derived from the competitive environments of business organizations and support controlling the complexity involved in their maintenance and software configuration management. Present research work analyzes the theoretical, financial, technical and practical problems related to the information system development, maintenance and change management to propose an appropriate system development process and a model for the development as well as maintenance of information systems with maximum software reuse. The proposed system development process and model provide inherent support to the business organizations in having total control over information system development, maintenance and software configuration management.
PROCEDURES AND ALGORITHMS FOR CONTINUOUS INTEGRATION IN AN AGILE SPECIFICATION ENVIRONMENT
Authors: LÓPEZ-NORES MARTÍN , PAZOS-ARIAS JOSÉ J. , GARCÍA-DUQUE JORGE , BLANCO-FERNÁNDEZ YOLANDA , DÍAZ-REDONDO REBECA P. , FERNÁNDEZ-VILAS ANA , GIL-SOLLA ALBERTO , RAMOS-CABRER MANUEL
Published: May 2009

One of the main ideas of agile development is to perform continuous integration, in order to detect and resolve conflicts among several modular units of a system as soon as possible. Whereas this feature is well catered for at the level of programming source code, the support available in formal specification environments is still rather unsatisfactory: it is possible to analyze the composition of several modular units automatically, but no assistance is given to help modify them in case of problems. Instead, the stakeholders who build the specifications are forced to attempt manual changes until reaching the desired functionality, in a process that is far from being intuitive. In response to that, this paper presents procedures and algorithms that automate the whole process of doing integration analyses and generating revisions to solve the diagnosed problems. These mechanisms serve to complete an agile specification environment presented in a previous paper, which was designed around the principle of facilitating the creative efforts of the stakeholders.
BI-LEGENDRIAN STRUCTURES AND PARACONTACT GEOMETRY
Authors: CAPPELLETTI MONTANO BENIAMINO
Published: May 2009

We study the interplays between paracontact geometry and the theory of bi-Legendrian manifolds. We interpret the bi-Legendrian connection of a bi-Legendrian manifold M as the paracontact connection of a canonical paracontact structure induced on M and then we discuss many consequences of that result both for bi-Legendrian and for paracontact manifolds, as a classification of paracontact metric structures. Finally new classes of examples of paracontact manifolds are presented.
Training-induced changes in structural and mechanical properties of the patellar tendon are related to muscle hypertrophy but not to strength gains
Authors: Seynnes O. R. , Erskine R. M. , Maganaris C. N. , Longo S. , Simoneau E. M. , Grosset J. F. , Narici M. V.
Published: May 2009

To obtain a better understanding of the adaptations of human tendon to chronic overloading, we examined the relationships between these adaptations and the changes in muscle structure and function. Fifteen healthy male subjects (20 ± 2 yr) underwent 9 wk of knee extension resistance training. Patellar tendon stiffness and modulus were assessed with ultrasonography, and cross-sectional area (CSA) was determined along the entire length of the tendon by using magnetic resonance imaging. In the quadriceps muscles, architecture and volume measurements were combined to obtain physiological CSA (PCSA), and maximal isometric force was recorded. Following training, muscle force and PCSA increased by 31% ( P < 0.0001) and 7% ( P < 0.01), respectively. Tendon CSA increased regionally at 20–30%, 60%, and 90–100% of tendon length (5–6%; P < 0.05), and tendon stiffness and modulus increased by 24% ( P < 0.001) and 20% ( P < 0.01), respectively. Although none of the tendon adaptations were related to strength gains, we observed a positive correlation between the increase in quadriceps PCSA and the increases in tendon stiffness ( r = 0.68; P < 0.01) and modulus ( r = 0.75; P < 0.01). Unexpectedly, the increase in muscle PCSA was inversely related to the distal and the mean increases in tendon CSA (in both cases, r = −0.64; P < 0.05). These data suggest that, following short-term resistance training, changes in tendon mechanical and material properties are more closely related to the overall loading history and that tendon hypertrophy is driven by other mechanisms than those eliciting tendon stiffening.
Nachweis und Nebenwirkungen von Isoantikörpern in intravenös applizierbaren Immunglobulinpräparaten
Authors: Strobel E. , Wüllenweber J. , Peters J.
Published: May 2009

Hintergrund: Intravenös verabreichbare Immunglobuhnpräparate enthalten nicht nur die in der Regel deklarierten Antikörper gegen pathogene Mikroorganismen, sondern auch andere Antikörper der Blutspender, z. B. gegen erythrozytäre Antigene. Material und Methodik: In unserer Untersuchung wurden 14 Präparate von 7 Herstellern (insgesamt 40 Chargen) auf das Vorhandensein von Isoantikörpern und irregulären Blutgruppenantikörpern untersucht. Um die Ablesbarkeit zu verbessern, setzten wir die Gel-Zentrifugations-Technik (ID-Microtyping-System®, Fa. Diamed, Bensheim, Deutschland) ein. Ergebnisse: Die höchsten Isoantikörpertiter betrugen (bei 8 Chargen) 1:32 oder 1:64 in der Liss-Coombs-Phase. Irreguläre Antikörper wurden in 5 Präparaten (höchster Titer 1:8) gefunden. Schlußfolgerungen: Die in den Präparaten enthaltenen Isoantikörper können blutgruppenserologische Untersuchungen beeinflussen. Am Beispiel eines Neugeborenen weisen wir auf die potentielle Gefahr von Fehlinterpretationen hin, wenn nach Immunglobulingabe ein positiver direkter Coombs-Test gefunden wird. Wir halten es daher für sinnvoll, bei Kindern und Erwachsenen 1. den direkten Coombs-Test vor einer Immunglobulintherapie durchzuführen und 2. das Eluat nicht nur mit einem Panel von 0-Erythrozyten, sondern gegebenenfalls auch mit A- bzw. B-Zellen zu untersuchen.
Protein Synthesis in Specific Tissues during Sepsis
Authors: Planas M. , Schwartz S. , García-Arumí E. , Andreu A. , Farriol M. , López J.
Published: May 2009

Background: The hypothesis that fractional protein synthesis rates (Ks) are tissue-specific and bidirectional during sepsis was tested in an animal model. Material and Methods: Ks in liver, triceps muscle, and diaphragm were measured in septic (n = 27) and control rats (n = 26). Sepsis was induced by a reproducible model established in our laboratory (intraperitoneal injection of sterile NaOH 0.75 N at 0.075 ml/l00 g of body weight). Ks were measured using the flooding-dose method in tissue obtained from the diaphragm, liver, and from the triceps muscle. Results: In hepatic and diaphragmatic tissue, Ks were significantly higher in the septic animals (Ks: 112.2 ± 8 and 5.4 ± 1.9, respectively) than in control animals (Ks: 78.5 ± 13 and 2.9 ± 1.7, respectively). In the triceps, Ks were significantly lower in septic animals (Ks: 2.9 ± 1.4) than in control animals (Ks: 5 ± 1.8). Conclusion: The results suggest that in septic animals the rate of protein synthesis is enhanced in tissues of priority, such as the liver, and varies in response to differences in muscle activity.
Erfahrungen mit Anti-Rhesus-D-Therapie bei vorbehandelten Patienten mit idiopathischer Thrombozytopenie
Authors: Pfeilstöcker M. , Waldner R. , Reisner R. , Heinz R. , Pittermann E.
Published: May 2009

Ziel: Die Effizienz von Anti-Rhesus-D[Anti-Rh(D)]-spezifischem IgG bei massiv vorbehandelten Patienten mit idiopathischer thrombozytopenischer Purpura (ITP) wurde untersucht. Design: Retrospektive Einzelfallanalyse. Rahmen: Klinisch-hämatologische Abteilung. Patienten: 6 konsekutive Patienten mit therapierefraktärer ITP. Interventionen: 5 Patienten erhielten einen Zyklus Anti-Rh(D) in Dosierungen zwischen 1200 und 6000 µg, bei einem Patienten wurden 2 Zyklen appliziert. Kurz-und Langzeittherapieeffekt sowie Nebeneffekte wurden untersucht. Ergebnisse: Patienten nach Splenektomie und/oder immunsuppressiver Therapie zeigten kΕin Ansprechen, 2 Patienten sprachen kurzzeitig an, bei einer weiteren Patientin konnte eine Dauerremission erzielt werden. Patienten mit Therapieerfolg zeigten einen geringen Hämoglobinabfall als Zeichen milder Hämolyse. Andere Nebenwirkungen wurden nicht beobachtet. Schlußfolgerungen: Unsere Daten zeigen, daß eine Therapie mit Anti-Rh(D) sicher und nebenwirkungsarm ist. Bei unseren Patienten konnte keine klare Dosis-Wirkungs-Beziehung festgestellt werden. Nach unseren Erkenntnissen können nur Patienten mit Plättchensequestration in die Milz auf die Therapie ansprechen.
Benefits of Early Postoperative Enteral Feeding in Cancer Patients
Authors: Braga M. , Vignali A. , Gianotti L. , Cestari A. , Profili M. , Di Carlo V.
Published: May 2009

Objective: To evaluate the effect of the early postoperative administration of an enriched enteral diet in cancer patients. Design: Randomised controlled study. Setting: Surgical intensive care unit of a university hospital. Patients: 77 consecutive patients undergoing curative surgery for gastric or pancreatic cancer. Interventions: Patients were randomised into 3 groups to receive: a standard enteral formula (n = 24); the same formula enriched with arginine, RNA, and omega-3 fatty acids (n = 26); isonitrogen isocaloric total parenteral nutrition (n = 27). Enteral nutrition was started within 12 h following surgery. Infusion rate was progressively increased reaching the full regimen on postoperative day (POD) 4. On admission and on POD 1 and 8, the following measurements were performed: serum level of total iron-binding capacity, albumin, prealbumin, retinol-binding protein (RBP), and cholinesterase. Delayed hypersensitivity response (DHR), IgG, IgM, IgA, lymphocyte subsets, and monocyte phagocytosis ability were also evaluated. Bioelectrical impedance analysis was performed preoperatively and on POD 2, 7, and 11. The rate and severity of postoperative infections and the length of hospital stay were evaluated. Results: In all patients, a significant drop of nutritional and immunologic parameters was observed on POD 1. A significant increase of prealbumin (p < 0.02), RBP (p < 0.005), monocyte phagocytosis ability (p < 0.001), and DHR (p < 0.005) was found on POD 8 only in the group fed with the enriched diet. A significant reduction of severity of postoperative infections and length of postoperative stay was found in the group with the enriched diet compared to the other groups. Conclusions: These data are suggestive of an improvement of the nutritional and immunologic status and clinical outcome in cancer patients who receive an enriched enteral diet in the early postoperative course.
Durchflußzytofluorometrischer Nachweis von erythrozytären Antigenen und Antikörpern. Technische Aspekte und neue klinische Anwendungen
Authors: Fischer K. , Wester S. , Grundmann A. , Poschmann A.
Published: May 2009

Hintergrund: Die in der Immunhämatologie seit vielen Jahren bewährten Häm-agglutinationsmethoden haben auch einige Nachteile: Manuelle Abarbeitung und subjektive Interpretation der Reaktionsergebnisse erlauben keine exakte quantitative Bestimmung von erythrozytären Antikörpern oder Oberflächenantigenen. Die Durchflußzytofluorometrie überwindet diese Beschränkungen, weil sie eine große Zahl von Einzelzellen mit empfindlichen reproduzierbaren und objektiven Methoden auswerten kann. Material und Methoden: Gewaschene Erythrozyten von Blutspendern und Patienten wurden nativ und nach Behandlung mit Enzymen oder Pneumokokkenantigenen untersucht, wobei entweder monoklonale Rh-Antikörper, humanes IgG-Immunglo-bulin, FITC-markiertes Antihuman-IgG oder FITC-Anti-T-Lektin eingesetzt wurden. Die Fluoreszenzintensität der einzelnen Erythrozyten wurde im Durchflußzyto-meter Cytoron Absolute® der Firma Ortho bestimmt. Ergebnisse: Wir ermittelten die optimalen Reaktionsbedingungen und erhoben die Normalwerte von 50 Blutspendern. Die Fluoreszenzintensität der unbehandelten Erythrozyten erwies sich als sehr konstant und konnte daher zur Justierung des Instruments verwendet werden. Neben experimentellen Befunden, bei denen Erythrozyten in vitro mit Pneumokokkenantigenen oder Enzymen (Sialidase, Protease) behandelt wurden, werden auch Ergebnisse von Patienten mit chronischer HBV-Infektion und Wärmeautoantikörperanämie sowie akuter Pankreatitis mitgeteilt. Für die statistische Analyse und graphische Darstellung der Ergebnisse wurde ein spezielles EDV-Programm entwickelt, das die gleichzeitige Darstellung von Befunden aus unterschiedlichen Experimenten oder verschiedenen Untersuchungs-zeiten erlaubt. Dies ist besonders für Langzeituntersuchungen bei quantitativen Bestimmungen von Antigenen oder Antikörpern von Bedeutung. Schlußfolgerung: Der durchflußzytofluorometrische Nachweis von erythrozytären Antigenen und Antikörpern ist eine schnelle, einfache und gut reproduzierbare Methode. Möglicherweise können mit ihr neue Erkenntnisse über die zur Zeit schlecht definierten infektionsassoziierten hämolytischen Anämien gewonnen werden.
Der posttransfusionelle Thrombozytenanstieg: Beobachtungen an einem hämatologisch-onkologischen Patientengut
Authors: Böck M. , Muggenthaler K.H. , Schmidt U. , Heim M.U. , Mempel W.
Published: May 2009

Ziel: Ziel der vorliegenden Untersuchung war die Bestätigung bereits bekannter sowie die Evaluierung neuer, bisher nicht beschriebener klinischer Bedingungen und präparatespezifischer Eigenschaften mit Einfluβ auf das posttransfusionelle Thrombozyteninkrement. Design: In einer retrospektiven Analyse wurde an 400 Einzelspender-Thrombozyten-transfusionen der Einfluβ von patienten- und präparatespezifischen Einfluβgröβen auf das posttransfusionelle Inkrement erfaβt. Die statistische Auswertung erfolgte mittels Varianzanalyse mit gemischten Effekten, wobei eine Irrtumswahrscheinlich-keit von 0,05 zugrunde gelegt wurde. Rahmen: Hämatologisch-onkologische Universitätsklinik. Patienten: 46 Patienten (24 männlich, 22 weiblich; Alter 17-80 Jahre). Intervention: Einzelspender-Thrombozytentransfusionen. Ergebnisse: Als klinische Parameter mit staíistisch gesichertem negativem Einfluβ auf das posttransfusionelle Inkrement konnten die bereits bekannten Effekte Spleno-megalie, Körpertemperatur und Knochenmarktransplantation verifiziert werden. Darüber hinaus lieβen sich weitere negative Einfluβgröβen wie Hepatomegalie oder die Applikation von Antibiotika nachweisen. Bei den präparatespezifischen Parametern zeigte sich, daβ sowohl die Leukozytenkontamination der Konzentrate als auch die prätransfusionelle Lagerungsdauer das posttransfusionelle Inkrement reduzieren. Schluβfolgerung: Während die klinischen Parameter wie Splenomegalie oder Körpertemperatur nur schwer beeinfluβbar sind, ist dies bei den präparatespezifischen Einfluβgröβen leichter möglich. Daher sollte bei der Auswahl der Konzentrate besonderer Wert auf eine geringe Leukozytenkontamination sowie eine kurze Lagerungsdauer gelegt werden.
IgG-Subklassenverteilung in IVIG-Produkten: Ermittlung der Reproduzierbarkeit einer Methode der IgG-Subklassenbestimmung
Authors: Kotitschke R. , Lang H. , Page M.
Published: May 2009

Hintergrund: Von der Sektion «Plasmatische Blutbestandteile» der DGTI wurde ein Ringversuch mit humanen Immunglobulinen zur intravenösen Anwendung (IVIG) und einem NIBSC-Serum, mit der Bezeichnung 67/98C, durchgeführt, da die IVIG-Monographie der Europäischen Pharmacopoeia (EP) keine Angaben zur IgG-Subklassenverteilung enthält. Ziel der Ringstudie der DGTI-Arbeitsgruppe war 1) die Bestimmung der IgG-Subklassenverteilung in IVIGs mit einer einheitlichen Methode und 2) die Bestimmung der IgG-Subklassenverteilung in dem Serum mit der Codierung 67/98C des NIBSC und zu prüfen, ob die NIBSC-Präparation mit dem Code 67/98C als Referenzserum zur IgG-Subklassenbestimmung geeignet ist. Material und Methodik: An dem Ringversuch nahmen zehn Labors aus Europa teil. Die Bestimmung der IgG-Subklassen erfolgte mit der radialen Immundiffusion (RID). Ergebnis: Der Ringversuch ergab gut übereinstimmende Ergebnisse für die teilneh-menden Labors und zeigte deutliche Unterschiede der IgG-Subklassenzusammen-setzung für die IVIGs auf. Die Reproduzierbarkeit der RID-Methode ergab Variationskoeffizienten (VK) von ca. 10%. Schluβfolgerung: Das NIBSC-Serum 67/98C ist als Referenzserum zur IgG-Subklassenbestimmung in Seren und IVIGs geeignet.
Praktische Ansätze und Erfahrungen in der Kryokonservierung von Humanerythrozyten mit Glycerol
Authors: Walther W. , Henning U.
Published: May 2009

We present a new method for deglycerolizing cryopreserved autologous blood. With the Cell-Saver (Hemonetics) the thawed blood units are processed directly in the operation theatre by the anesthetist. The quality of the so prepared blood is examined. As to the removal of glycerol, free hemoglobin, leukocytes, and potassium a quality is achieved that compares to the standard procedure. Further we investigated the posttransfusion period of our patients. There was no impairment in renal function and coagulation. No difference was seen in the need of allogeneic blood transfusion compared to the patients that received liquid stored autologous blood. We conclude that processing and washing of cryopreserved autologous blood with the Cell-Saver is feasible and safe.
Durchflußzytometrische Untersuchungen zur Verträglichkeit von Thrombozytentransfusionen
Authors: Dittmann J. , Lynen R. , Humpe A. , Riggert J. , Legler T. , Neumeyer H. , Köhler M.
Published: May 2009

We developed a flow cytometric crossmatch (FC-CM) for the selection of compatible donors for thrombocytopenic patients and compared its predictive value for a successful platelet transfusion in a prospective study to LCT. In case of alloimmunization, FC-CM detects bound IgG on lymphocytes and/or platelets after incubation with patient’s serum. Based on the posttransfusion increment in 122 transfusions, the specifity was 81% for LCT and 96% for FC-CM (platelet gate). In conclusion, the FACS-CM is a rapid and useful assay for donor selection in cases of alloimmunized patients with lymphocytotoxic and/or platelet-specific antibodies.
Diagnostic of the Lupus Anticoagulant with the Tissue Thromboplastin Inhibition (TTI) Test in Different Dilutions
Authors: Bensmann K. , Brauer P. , Garritsen H. , Reh H. , Schmitz-Linneweber B. , Sibrowski W.
Published: May 2009

Unter Lupus-Antikoagulans (LA) faβt man Antikörper gegen verschiedene gerinnungsaktive Phospholipide zusammen. Da sie in vitro zu verlängerten Gerinnungszeiten führen, in vivo jedoch gehäuft mit Thrombosen einhergehen, kommt ihnen bei der Indikationsstellung zur Hämotherapie, unter anderem präoperativ, differentialdiagnostische Bedeutung zu. Wir screenten 46 Patienten mit systemischem Lupus erythematodes (SLE) auf Vor-liegen eines LA. Hierbei wurden unter anderem Plasmatauschversuche auf Basis der Kaolin Clotting Time und TTI-Tests mit verschiedenen Thromboplastinverdün-nungen durchgeführt. In Ergänzung zu dem in der Originalarbeit von Schleider und Mitarbeitern beschriebenen Vorgehen verwendeten wir neben der Standardverdünnung von 2% im TTI-Test eine zweite Verdünnungsstufe von 0,2%. Die TTI-Modi-fikation mit 0,2%iger Thromboplastverdünnung zeigte mit 17,4% LA-positiver Patienten (n = 8) eine signifikant höhere LA-Sensitivität als die 2%ige Standardverdünnung mit nur 4,3% LA-positiver Patienten (n=2) (p < 0,05) und empfiehlt sich daher für die Diagnostik. Als Ursache vermuten wir eine verminderte Neutralisierung «schwacher LAs» aufgrund der geringeren Thromboplastinkonzentration im Testansatz.
Präparation von Thrombospondin aus Thrombozytenkonzentraten
Authors: Bassus S. , Huang S. , Seifried E. , Kirchmaier C.M.
Published: May 2009

Thrombospondin (TSP), a 420-kDa glycoprotein found in human platelet alpha gra-nula, is thought to play an important role in platelet haemostatic function. The aim of this study was to develop a rapid method to isolate TSP for functional and structural studies. For preparation we used two PRPs, each unit containing 2.6 ×1010 platelets. Washed platelets were stimulated with thrombin (1.5 U/ml), protease activity was inhibited by hirudin (5 U/ml) and DIFP (1 mM). Cellular fragments and micro-somes were separated by centrifugation (700g, 5min; 48,000g, 30min). The clear protein solution was further purified by HiTrap Heparin affinity chromatography and a following MonoQ ion exchange chromatography using a NaCl gradient (0-2 M) on an FPLC System. 800 µg/U TSP were isolated within a total separation time of 60min. Purity of the isolated fraction was proved by SDS PAGE showing no additional proteins. TSP-binding studies are now made feasible without long-term planning and set-up. This method may be a helpful tool for further characterisation of platelet TSP receptor.
The Intraoperative Application of Aprotinin Reduces Blood Loss and the Requirement for Heterologous Blood Transfusion during Lung Surgery
Authors: Kätzel R. , Bolomsky-Kahl E. , Wiedemann B. , Brethner L. , Voigt B.
Published: May 2009

In einer randomisierten, plazebokontrollierten Doppelblindstudie mit zweimal 12 männlichen Patienten, die wegen Bronchialkarzinom operiert werden muβten, wur-de intraoperativ Aprotinin (Antagosan®; Behringwerke AG, Marburg, Germany) in hoher Dosierung eingesetzt (präoperativer Bolus: 2 Mill. KIE; 0,5 Mill. KIE/h als Infusion bis lh nach Operationsende). Die Behandlung mit Aprotinin führte zu einer signifikanten Verminderung des intraoperativen Blutverlustes (Aprotinin-gruppe: 324,25 ± 158,83ml; Plazebogruppe: 855,50 ± 562,60ml; p < 0,02) und des postoperativen Drainagevolumens (Aprotiningruppe: 402,10 ± 236,34ml; Plazebogruppe: 843,50 ± 562,60ml; p < 0,02). Der Bedarf an Erythrozytenkonserven wurde durch die Aprotiningabe drastisch gesenkt [Aprotiningruppe: 1 Erythrozytenkon-zentrat (EK)/12 Patienten; Plazebogruppe: 16 EKs/12 Patienten; p < 0,02]. In einer Gegenüberstellung der ärztlichen Leistungen und der Sachkosten wurde ermittelt, daβ beim Vergleich Aprotininanwendung/Fremdbluteinsparung Kosten-neutralität besteht. Die intraoperative Aprotininapplikation scheint auch in der Thoraxchirurgie ohne extrakorporale Zirkulation ein geeignetes Verfahren zu sein, um den Blutverlust und den Fremdblutbedarf zu senken.
RIBA Performance in the Routine Diagnostic of HCV
Authors: da Silva Cardoso M. , Koerner K. , Epple S. , Dengler T. , Kerowgan M. , Kubanek B.
Published: May 2009

Der DRK-BSD BaWü testet seit 1993 alle anti-HCV-ELISA-positiven Blutspenden (0,4%) mit RIBAII. RIBA-II-positive Spender werden von weiteren Blutspenden ausgeschlossen. Die Rate an RIBA-II-positiven Blutspendern ist innerhalb von 2 Jahren von 0,085% auf 0,016% zurückgegangen. Mit Hilfe der RT/PCR wurde gezeigt, daß 90% der RIBA-II-positiven Spender HCV-RNA-positiv sind. Dagegen wurde bei keinem der RIBA-II-negativen Spender HCV-RNA gefunden. Lediglich bei 11 % der RIBA-II-fraglichen Spender konnte HCV-RNA nachgewiesen werden. Diese Daten zeigen, daß Blutspender nur nach einem positiven HCV-Bestätigungstest benachrichtigt werden sollten, um das Risiko einer falschen Diagnose zu verringern. Auch Lookback-Untersuchungen sollten nur nach diesen Kriterien durchgeführt werden.
Mobilization and Collection of Allogeneic and Autologous Peripheral Blood Progenitor Cells for Transplantation
Authors: Wiesneth M. , Schreiner T. , Frickhofen N. , Friedrich W. , Müller S. , Kubanek B.
Published: May 2009

Bei 10 Patienten mit Non-Hodgkin-Lymphomen wurden nach Chemotherapie und 5µg G-CSF/kg Körpergewicht und Tag insgesamt 28 Blutstammzellapheresen durchgeführt. Im Vergleich hierzu erfolgten bei 8 Normalpersonen mit täglich 5 bzw. 10 µg G-CSF/kg am Tag 5 und 6 insgesamt 16 Apheresen. Bei den Patienten und den Spendern mit 10 µg G-CSF kam es zu einer adäquaten Mobilisation von CD34+ Zellen im peripheren Blut (xxx > 200/µl). Die Apheresedauer betrug im Mittel 175 (143-201) min mit einem Separations-volumen von 8,9 (6,9-11,1) Liter Blut. Die Transplantat-Sollzahlen von 5 × 108 mononukleären Zellen (MNC), 5 × 106 CD34+ Zellen und 1 × 105 CFU-GM/kg konnten bei Patienten nach Chemotherapie und 5 µg G-CSF wie auch bei Spendern mit der höheren Dosis von 10 µg G-CSF durch < 2 Standardapheresen erreicht wer-den. Die Konditionierung mit 10 µg G-CSF/kg führte jedoch zu Nebenwirkungen, so daβ Alternativen wie die In-vitro Expansion zur Präparation von allogenen Blutstammzellen zur Transplantation angestrebt werden sollten.
Der Stellenwert der gemischten Lymphozytenkultur für die verwandte und unverwandte Knochenmarktransplantation
Authors: Lattermann A. , Hundertmark R. , Mueller-Eckhardt G.
Published: May 2009

With the growing development and routine use of high-resolution DNA typing techniques for HLA class II alleles the importance of mixed lymphocyte cultures (MLC) with respect to bone marrow transplantation is under controversial discussion. Therefore, results of MLC assays performed for donor/recipient pairs were analysed in comparison to the degree of histocompatibility as determined by prospective serological and retrospective DNA typing. Three different groups were evaluated for MLC data: (A) siblings sharing two parental haplotypes, (B) related donors sharing one haplotype, with 1-3 MM on the second haplotype, (C) phenotypically identical unrelated donors. In group A, all MLCs were negative. In contrast, 55 out of 59 MLCs in group B and 30 out of 41 in group C were positive. In group C, 11 MLCs were positive despite phenotypic class I and DRB 1 compatibility. We conclude from our results that, at present, MLC is not mandatory for genotypically HLA-identical siblings while for donor/recipient pairs of groups B and C MLC should be carried out even in cases of phenotypical compatibility for class I and DRB 1 alleles.
Präparation und Transfusion von positiv selektionierten CD34-positiven peripheren Blutstammzellen
Authors: Höcker P. , Friedl J. , Kurz M. , Dossenbach-Glaninger A. , Kahls P. , Greinix H. , Kührer I. , Gerhartl K. , Wagner A.
Published: May 2009

Great amounts of haematopoietic stem cells can be collected after conditioning with growth factors and myelosuppressive treatment. With the immunadsorption technique (Ceprate SC®) CD34+ cells can be purified and concentrated with an overall loss of about 20^40%. Retransfusion of CD34+ purified cells resulted in a rapid and sustained engraftment after myeloablative treatment. Thus CD34+ selection by immunadsorption offers the opportunity to purify stem cells concentrates from platelets, red cells and granulocytes and to minimize DMSO toxicity.
Aspekte zur Hämokompatibilität im Rahmen einer Thrombozytapherese mit dem Blutzellseparator Fresenius AS 104
Authors: Seyfert U.T. , Kaiser M. , Wenzel E.
Published: May 2009

New cell separators must allow to obtain poor leucocyte, high-quality platelet concentrates with good therapeutical efficacy. Elevated thrombin-antithrombin III levels after apheresis with the cell separator AS 104 (Fresenius, Germany) gave a hint of an activation of coagulation, but prothrombin-thrombin generation (Fl+2) or fibrinogen-fibrin conversion and consecutive fibrinolysis is not involved. Haem-apheresis with Fresenius AS 104 is safe. Adverse effects were not observed.
Polymerstruktur und Thrombogenität
Authors: Seyfert U.T. , Peters C. , Perkins S. , Kümmel M. , Wenzel E.
Published: May 2009

Haemoincompatibility induced by contact with artificial materials is a major obstacle to further development of artificial organs and accounts for much of morbidity in circumstances when the blood is circulated through an extracorporeal system or when a catheter is placed. Material’s testing was performed using different models, and a score system (0-60 score points) was developed. Our models can characterize ex vivo haemocompatibility of different polymers. Flow characteristics and preanalytical effects (e.g. anticoagulants) may not be neglected.
Life-Threatening or Organ-Impairing Henoch-Schönlein Purpura: Plasmapheresis May Save Lives and Limit Organ Damage
Authors: Donghi Davide , Schanz Urs , Sahrbacher Ulrike , Recher Mike , Trüeb Ralph M. , Müllhaupt Beat , French Lars E. , Hafner Jürg
Published: May 2009

Adult-onset Henoch-Schönlein purpura (HSP) tends to become chronic-relapsing, yet rarely leads to organ impairment, e.g. due to chronic glomerulonephritis. Bed rest, compression and nonsteroidal anti-inflammatory drugs are usually sufficient to control the active phases. We report 2 cases of adult HSP with an unusually severe evolution. One patient required intensive-care treatment for hypovolemic shock caused by hemorrhagic pancolitis; the other had progressive and extremely extensive vasculitic leg ulcers. Both were refractory to common immunosuppression with systemic corticosteroids (oral and pulse) and additive steroid-sparing immunosuppressive drugs. Only after the introduction of plasmapheresis did both patients show a dramatic improvement in the disease, with rapid and almost complete healing. Plasmapheresis is a rarely used therapeutic tool in the treatment of severe HSP, but the growing literature on its highly beneficial effect underlines its potential usefulness.
How Accurate is Serologic Testing of Plasma Pools for Hepatitis B Virus Surface Antigen, anti-Human Immunodeficiency Virus 1 and 2, and anti-Hepatitis C Virus?
Authors: Rabenau H. , Schütz R. , Berger A. , Doerr H.W. , Weber B.
Published: May 2009

Objective: The European pharmacopeia prescribes that, during the manufacture of blood derivates, the first homogeneous pool of plasma (for example, after removal of cryoprecipitate) must be tested for hepatitis B virus surface antigen (HBsAg), for hepatitis C virus (HCV) antibodies and for human immunodeficiency virus (HIV) antibodies using test methods of suitable sensitivity and specificity, in order to reduce the residual risk of infection originating from blood products. The present study was performed to verify if commercially available immunoassays, which are licensed for the screening of single serum and plasma samples, are suitable for the determination of HBsAg, anti-HCV, and anti-HIV in plasma pools. Design: Plasma pools originating from different countries were spiked with HBsAg- and anti-HCV-positive standards (National Institut für Biological Standards, Hertfordshire, UK) and anti-HIV-positive serum. For the determination of HBsAg with and without immune complex dissociation (ICD), anti-HCV and anti-HIV antibodies the Abbott (Delkenheim, Germany) IMx system was used. Results: In contrast to the testing for anti-HIV and anti-HCV, the detection of HBsAg (0.125 IU/ml detection limit) was influenced by the presence of anti-HBs in plasma pools. Statistically significant differences could be observed between anti-HBs-positive plasma pools and anti-HBs-negative serum samples spiked with HBsAg. The kinetics of HBsAg-anti-HBs complex formation showed that in a plasma pool with a high anti-HBs (329.4 IU/ml) concentration HBsAg was not detectable after 5 h of incubation. After ICD, HBsAg was still detectable in the pool with high anti-HBs content. Anti-HIV antibodies could be detected up to a dilution of 1/480,000, anti-HCV up to a dilution of 1/80, both in a spiked negative serum. Overall, the divergences between spiked plasma and serum were relatively low for anti-HCV and anti-HIV detection. Conclusions: The Abbott IMx assay permits a highly sensitive detection of HBsAg (after ICD or immediately after thawing of anti-HBs-positive plasma pools), anti-HCV, and anti-HIV in plasma pools. However, in case of a contamination with donations originating from individuals with acute HBV, HIV, or HCV infection or with a poor humoral immune response, serologic testing for HBsAg, anti-HIV, and anti-HCV may fail to detect potentially infectious plasma pools.
Vergleich einer standardisierten Ernährungslösung (ZPE-Glukose/Elektrolyte®) mit einer üblichen Ernährung im Intensivbereich
Authors: Gottardis M. , Hackl J.M. , Hasibeder W. , Putensen Ch. , Knapp D.
Published: May 2009

Ziel: Vergleich einer standardisierten Ernährungslösung mit einer selbst-gemischten Infusionstherapie bei Intensivpatienten einer chirurgischen Intensivstation; Untersuchung der standardisierten Ernährungstherapie auf Praktikabilität und Effizienz. Design: Prospektive randomisierte Studie. Rahmen: Chirurgisch-traumatologische Intensivstation einer Universitätsklinik. Patienten: Chirurgisch-traumatologische Patienten, die länger als 6 Tage auf der Intensivstation lagen. Interventionen: Gabe einer standardisierten Ernährungslösung im Ein-Liter-System (ZPE-GE) bzw. Gabe einer herkömmlichen, selbstgemischten Infusionslösung (hER). Bestim-mung von Stoffwechselparametern und Serum- bzw. Harnelektrolyten, zusätzlich Bestimmung von Blut- und Harnglukose, Harnstoffproduktionsrate, Triglyzeriden. Ergebnisse: Die beiden Patientengruppen waren sowohl in ihren physiologischen Daten als auch in der Schwere der Erkrankung miteinander vergleichbar, Komplikationen und Unverträglichkeiten konnten unter den angegebenen Regimen nicht beobachtet werden. Die Energie- (durchschnittlich 1202 kcal/Tag in der Gruppe hER versus 1331 kcal/Tag in der Gruppe ZPE-GE) und Substratzufuhren (Glukose: 228 versus 252 g/Tag; Aminosäuren: 56 versus 64 g/Tag) sind als ausge-glichen zu betrachten, es konnten keine Stoffwechselentgleisungen beobachtet werden. Die Elektrolytzufuhr (Natrium: 56 mmol/Tag in der Gruppe hER versus 92 mmol/Tag in der Gruppe ZPE-GE; Kalium: 65 versus 68 mmol/Tag; Phosphat: 15 versus 19 mmol/Tag) scheint in der Vollperiode nicht ganz optimal zu sein. Schlussfolgerungen: Die standardisierte Lösung scheint gegenüber den herkömmlichen Mischungen Vorteile zu haben: Sie erleichtert das Handling im Intensiv- und Postoperativbereich und verbessert Genauigkeit, Zeitersparnis und hygienische Bedingungen beim Umgang mit diesen Lösungen. Eine Infusionsmenge von 2000 ml (300 g Glukose und 100 g Aminosäuren) dieser Lösung erscheint als ausreichend, bei höherer Zufuhr könnte die Kohlenhydrat- und Aminosäurenzufuhr zu hoch liegen. Auch bei der Elektrolytzufuhr ist eine Begrenzung auf 2000 ml (120 mmol Natrium) angezeigt. Der Natriumanteil könnte auf 50 mmol/l reduziert werden, um ein entsprechendes Natriumloading zu verhindern, bei der Phosphatzufuhr ware eine Erhöhung auf 12 mmol/l empfehlenswert. Die Lösung kann zur standardisierten parenteralen Ernährung bei einem Großteil (ca. 80%) der postoperativen und posttraumatischen Patienten herangezogen werden, nur bei Extremsituationen müssen weiterhin die Einzelkomponenten (Glukose, Aminosäuren, Fette und Elektrolyte) speziell zusammengemischt werden, um metabolische Komplikationen zu verhindern.