bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Practice of Continuous Palliative Sedation in Elderly Patients: A Nationwide Explorative Study Among Dutch Nursing Home Physicians
Authors: van Deijck Rogier H.P.D. , Krijnsen Petrus J.C. , Hasselaar Jeroen G.J. , Verhagen Stans C.A.H.H.V.M. , Vissers Kris C.P. , Koopmans Raymond T.C.M. 
Published: August 2010

OBJECTIVES: To study the practice of continuous palliative sedation (CPS) by Dutch nursing home physicians in 2007.DESIGN: A structured retrospective questionnaire.SETTING: Nationwide nursing home physician study in the Netherlands.PARTICIPANTS: One thousand two hundred fifty‐four nursing home physicians received a questionnaire concerning their last case of CPS in 2007; 54% (n=675) responded.MEASUREMENTS: Characteristics of CPS and requests for euthanasia were measured.RESULTS: Three hundred sixteen patients were described. The majority had cancer or dementia. The most‐reported refractory symptoms were pain (52%), anxiety (44%), exhaustion (44%), dyspnea (40%), delirium (24%), loss of dignity (18%), and existential distress (16%). In 98% of cases, CPS was aimed at symptom relief. Of patients with cancer, 17% had previously requested euthanasia. The mean starting dose of midazolam was 31 mg every 24 hours (range 0–240 mg/24 h), and the mean end dose was 48 mg every 24 hours (range 0–480 mg/24 h).CONCLUSION: In addition to physical symptoms, anxiety, exhaustion, loss of dignity, and existential distress are often mentioned as refractory symptoms in the decision to start CPS by nursing home physicians. Furthermore, close to one in five patients with cancer had made a previous request for euthanasia. The dosage range of midazolam in this study fits the recommendations of the Dutch national guideline on palliative sedation, although international studies show smaller dosage ranges. Finally, prospective research about the acceptability and assessment of nonphysical symptoms as indications for CPS is recommended.
Mitochondrial dysfunction of platelets stored in first‐ and second‐generation containers is, in part, associated with elevated carbon dioxide levels
Authors: Skripchenko Andrey , Myrup Andrew , Thompson‐Montgomery Dedeene , Awatefe Helen , Wagner Stephen J. 
Published: August 2010

BACKGROUND: The gas permeability of platelet (PLT) storage bags influences the retention of in vitro PLT parameters during storage. The aim of this study was to evaluate mitochondrial function of PLTs stored in first‐ and second‐generation bags with different gas permeabilities.STUDY DESIGN AND METHODS: Identical whole blood–derived PLT concentrates were stored in second‐generation CLX (Pall Corp.) and first‐generation PL146 (Baxter Healthcare Corp.) bags (n = 12). PLTs were assayed for standard in vitro PLT assays as well as for mitochondrial membrane potential (MMP), accumulation of reactive oxygen species, Annexin V binding, mitochondrial mass, and activity of mitochondrial reduction power on Days 1, 4, 5, 6, and 7. Results were analyzed by paired t test and by multiple regression analysis.RESULTS: With PLTs stored in PL146 bags that underwent large pH declines, there was greater superoxide production, greater peroxide accumulation, and greater mitochondrial membrane depolarization. Superoxide anion generation was correlated with higher levels of carbon dioxide (p = 0.0001) and lower oxygen levels (p = 0.0064; multiple regression R2 = 0.9204). Changes in MMP were correlated with higher levels of carbon dioxide (p = 0.0288) and PLT activation (p = 0.0178; multiple regression R2 = 0.9511).CONCLUSION: Prolonged periods of elevated carbon dioxide levels, potentially coupled with other factors, is associated with PLT mitochondria dysfunction and poor pH control during storage.
An unusual febrile nonhemolytic reaction occurred after transfusion in a thalassemia major patient with asymptomatic Plasmodium falciparum infection
Authors: Boschetti Carla , Cappellini Maria D. , Colombi Mariangela , Villa Antonietta , Grande Romualdo , Vercellati Cristina , Radaelli Franca , Caspani Luisa , Zanella Alberto 
Published: August 2010

BACKGROUND: Febrile nonhemolytic transfusion reactions occur in 0.12% of transfusions, usually during transfusion or within 4 to 6 hours after transfusion and are not medically dangerous.CASE REPORT: A patient with thalassemia from Togo with asymptomatic malaria in which the infection became clinically manifest only after blood transfusion, mimicking a febrile nonhemolytic transfusion reaction, is presented. Thirty‐two hours after transfusion of 2 O D− red blood cell (RBC) units, the patient (phenotype A2 D+) developed fever and multiorgan failure and was admitted to the intensive care unit. Direct and indirect antiglobulin tests were negative on posttransfusion samples. Blood cultures and infectious diseases testing were negative. No malaria parasites were found at thick blood smear microscopic examination on Days 1 and 2 and the malaria rapid diagnostic test gave inconsistent results. Plasmodium total antibodies were detected in the serum at high levels. On Day 5, routine microscopic examination of blood smear revealed the presence of parasites in a very small number of RBCs. This finding was almost simultaneous to the availability of polymerase chain reaction testing results that were positive for P. falciparum. The sequential agglutination with anti‐A antiserum allowed patient's and donors' RBCs to be separated and revealed that the parasitized cells were almost exclusively those of donors (14.4% vs. 0.029%). Malaria infection in implicated donors was excluded.CONCLUSION: In this patient with thalassemia with asymptomatic malaria, the infusion of two normal RBC units provided a favorable environment for a rapid parasite replication leading to a dramatic acute malaria attack.
Risk factors and outcome associated with hypomagnesemia in massive transfusion
Authors: Ho Kwok M. , Leonard Anton 
Published: August 2010

BACKGROUND: Electrolyte disturbances are common in patients with critical bleeding requiring massive transfusion. The risk factors and outcome associated with the occurrence of hypomagnesemia in massive transfusion remain uncertain.STUDY DESIGN AND METHODS: A cohort of 353 consecutive patients who required massive transfusion, defined as 10 or more units of allogeneic red blood cells or whole blood transfusion within 24 hours, between 2002 and 2008 in a quaternary health care center in Western Australia was considered. Logistic regression was used to identify risk factors and outcome associated with hypomagnesemia during massive transfusion (<0.7 mmol/L or 1.7 mg/dL).RESULTS: Of the 353 patients requiring massive transfusion during the study period, 298 patients (84%) had serum magnesium concentrations available for analysis. Hypomagnesemia was common (172 patients, 58%), and the mean magnesium concentration was 0.68 mmol/L (1.65 mg/dL; standard deviation, 0.15 mmol/L) in these patients. The risk factors for hypomagnesemia were hypocalcemia (odds ratio [OR], 1.67 per 0.1 mmol/L decrement; 95% confidence interval [CI], 1.36‐2.01; p = 0.001) and hypofibrinogenemia (OR, 1.05 per 0.1 g/L decrement; 95% CI, 1.01‐1.09; p = 0.009). The lowest serum magnesium concentrations were associated with the lowest ionized calcium concentrations (Spearman correlation coefficient, 0.377; p = 0.001). Both magnesium concentrations (OR, 0.91 per 0.1 mmol/L increment; 95% CI 0.31‐2.69; p = 0.863) and the interaction term between magnesium and calcium concentrations were not associated with an increased risk of mortality after adjusting for other covariates.CONCLUSIONS: Hypomagnesemia was common and associated with hypocalcemia in massive transfusion, but serum magnesium concentrations had no independent effect or interactive effect with hypocalcemia on mortality of patients requiring massive transfusion.
RhD variant caused by an in‐frame triplet duplication in the RHD gene
Authors: Pereira Janet C. , Rodrigues Maria J. , Tilley Louise , Poole Joyce , Chabert Teresa , Ribeiro Maria L. 
Published: August 2010

BACKGROUND: The RHD gene is highly polymorphic and a large number of D variants have already been detected. Several mechanisms are involved in the origin of D variants. In‐frame deletions, resulting in a single‐amino‐acid deletion, have been described associated with RhD and RhCE variants. No in‐frame duplications and/or insertions have been reported in the RH genes to date.STUDY DESIGN AND METHODS: Blood samples from a Brazilian blood donor and his sister were serologically tested with routine anti‐D reagents and anti‐D panels (ALBAclone advanced partial D typing kit, Alba Bioscience Limited; and D‐Screen, Diagast), followed by molecular biology techniques, RHD polymerase chain reaction with sequence‐specific priming and sequencing.RESULTS: Samples tested negative with routine immunoglobulin M (IgM) anti‐D reagents and positive with IgG anti‐D, which detect weak D cells. The pattern of results with anti‐D panels did not correspond to any described before. A 3‐bp in‐frame duplication within Exon 1 (c.75_77dupTCT), resulting in the duplication of leucine 26 (p.Leu26dup), was identified in the two samples.CONCLUSION: We report the first RhD variant associated with a 3‐bp in‐frame duplication in the RHD gene, predicted to be located within the RhD protein transmembrane domain that might be expected to result in a weak‐D–like phenotype, concordant with serologic findings.
Quality management in the transfusion service: case studies in process improvement
Authors: Goodnough Lawrence T. , Viele Maurene , Fontaine Magali , Chua Lee , Ferrer Zenaida , Jurado Christine , Quach Peter , Dunlap Marsha , Arber Daniel A. 
Published: August 2010

BACKGROUND: Laboratory‐based quality improvement (QI) initiatives can improve clinical outcomes and patient safety.STUDY DESIGN AND METHODS: We present three cases of QI that impact processes from the transfusion service (TS) laboratory to the patient's bedside.RESULTS: Case 1 was event discovery reporting (EDR). We were able to reduce our biologic product deviation reports from 41 (17%) of 238 EDRs to only 19 (7%) of 272 (p < 0.01) EDRs after implementation of a QI workflow process. Case 2 was antibody evaluation before elective surgery. We implemented process improvement strategies: 1) surgical safety checklist with confirmation of type‐and‐screen completion and antibody evaluation before patients can proceed to surgery; 2) specimen retention policy of 30 days to allow advance testing; and 3) daily review to identify specimens needed on day of surgery. After intervention, only 7 (0.3%) of 2298 patients required antibody evaluation on day of surgery, compared to 65 (0.75%) of 8656 patients (p < 0.01) before intervention. Case 3 was wrong blood in tube (WBIT). We have a two‐specimen requirement for blood type verification before transfusion. To determine whether trauma patients should be exempted, we reviewed WBIT errors. Six WBIT errors were from the emergency department (an error rate of 1:400) and nine WBIT specimens were institution‐wide. Three patients were transfused after correction of the WBIT error. Based on this analysis, our institution agreed that no clinical units shall be exempted from our policy.CONCLUSION: Successful QI in the TS improves processes that promote efficiency, effectiveness, and patient safety.
Neonatal alloimmune neutropenia due to immunoglobulin G antibodies against human neutrophil antigen‐5a
Authors: Porcelijn Leendert , Abbink Floor , Terraneo Loes , Hoogen Laura Onderwater‐vd , Huiskes Elly , de Haas Masja 
Published: August 2010

BACKGROUND: Neonatal alloimmune‐mediated neutropenia (NAIN) due to maternal alloantibodies directed against one of the human neutrophil antigens (HNAs) can cause severe infections. NAIN has been described as caused by antibodies against HNA‐1a, ‐b, ‐c, ‐2a, ‐3a, or ‐4a, but not by antibodies against HNA‐5a.RESULTS: Blood from a 3‐week‐old newborn and from his parents was sent to our laboratory because of suspicion of NAIN. Granulocyte‐specific antibodies were present in the maternal antiserum and reactive with the paternal granulocytes. The specificity of the maternal alloantibodies was shown to be anti‐HNA‐5a by the monoclonal antibody immobilization of granulocyte antigens assay. The mother was genotyped HNA‐5a negative, and the father was genotyped homozygous HNA‐5a positive.CONCLUSION: We identified a first case of NAIN due to maternal alloantibodies against HNA‐5a.
Thrombopoietin to replace megakaryocyte‐derived growth factor: impact on stem and progenitor cells during ex vivo expansion of CD34+ cells mobilized in peripheral blood
Authors: Duchez Pascale , Chevaleyre Jean , Vlaski Marija , Dazey Bernard , Bijou Fontanet , Lafarge Xavier , Milpied Noël , Boiron Jean‐Michel , Ivanovic Zoran 
Published: August 2010

BACKGROUND: The first protocol of ex vivo expansion that enabled almost total abrogation of postmyeloablative chemotherapy neutropenia was based on a three‐cytokine cocktail (stem cell factor [SCF], granulocyte–colony‐stimulating factor [G‐CSF], pegylated‐megakaryocyte growth and development factor [PEG‐MGDF]) in a serum‐free medium. Since the clinical‐grade molecule MGDF is no longer available on the market, we evaluated its substitution by thrombopoietin (TPO).STUDY DESIGN AND METHODS: CD34+ cells of myeloma patients were expanded for 10 days in serum‐free cultures with SCF, G‐CSF, or MGDF (100 ng/mL) or with TPO (2.5, 10, 20, 50, and 100 ng/mL) instead of MGDF. Day 10 amplifications of total nucleated cells, CD34+ cells, committed progenitors (CFCs), the capacity of engraftment of NOD/SCID mice (SCID repopulating cells [SRCs]), and the immunophenotype of cells in expansion product (CD13, CD14, CD33, CD41, CD61) were analyzed.RESULTS: TPO in doses of 2.5 and 10 ng/mL exhibits an effect comparable to that of MGDF (100 ng/mL) on total, CD34+, and CFCs amplification. Compared to MGDF, TPO (starting at 10 ng/mL) enhances two‐ to threefold the percentage of megakaryocyte lineage cells (CD41+ and CD61+). Finally, TPO maintains or even enhances (depending on dose) SRC activity.CONCLUSIONS: The use of TPO instead of MGDF in our protocol is feasible without any negative effect on progenitor cell expansion. Furthermore, applied in dose of 10 or 100 ng/mL it could enhance both the stem cell activity and the percentage of megakaryocyte lineage cells in expansion product.
Red blood cell microparticles show altered inflammatory chemokine binding and release ligand upon interaction with platelets
Authors: Xiong Zeyu , Cavaretta John , Qu Lirong , Stolz Donna Beer , Triulzi Darrell , Lee Janet S. 
Published: August 2010

BACKGROUND: Storage of red blood cells (RBCs) under standard blood bank conditions results in reduced structural integrity leading to membrane budding and release of microparticles. Microparticles express the blood group Duffy antigen known to bind multiple inflammatory chemokines, but the functional chemokine binding properties of microparticles are not known.STUDY DESIGN AND METHODS: We determined whether storage‐induced microparticles show inflammatory chemokine binding through the expression of the Duffy antigen, comparing the binding properties to intact RBCs, and assessed microparticle interactions with platelets (PLTs) that release chemokines upon activation.RESULTS: Intact RBCs retained similar equilibrium dissociation constants for CCL2 (Kd = 7.4 ± 0.9 nmol/L), CXCL8 (Kd = 7.9 ± 1.0 nmol/L), and CXCL1 (Kd = 4.4 ± 1.0 nmol/L) throughout storage. In contrast, microparticles increased in relative counts with storage, showed higher percentages of surface phosphatidylserine, and demonstrated impaired Duffy‐dependent chemokine binding affinity with wider variability in dissociation constant for CXCL1(Kd = 362 ± 328 nmol/L; range, 0.6‐2000 nmol/L). The altered chemokine binding affinity of RBC microparticles was associated with a propensity to release ligand upon incubation with PLTs. Relative quantification of microparticles, based on criteria of glycophorin A expression and size, underestimated particle numbers with functional chemokine binding, suggesting that glycophorin A–negative particles and nanoparticles contribute to overall chemokine binding capacity.CONCLUSION: Microparticle burden in transfusates, as determined by functional chemokine binding, is considerable. Altered membrane properties of RBC microparticles enhance PLT interactions to increase inflammatory chemokine bioavailability in vitro.
Perspectives of potential donors on cord blood and cord blood cryopreservation: a survey of highly educated, pregnant Korean women receiving active prenatal care
Authors: Shin Sue , Yoon Jong Hyun , Lee Hye Ryun , Kim Byoung Jae , Roh Eun Youn 
Published: August 2010

BACKGROUND: The aim of the study was to investigate the knowledge of cord blood (CB) and attitudes toward CB banking among high‐potential donors (i.e., well‐educated pregnant Koreans) because their voluntary donation is indispensable to the success of unrelated CB transplantation.STUDY DESIGN AND METHODS: Questionnaires examining perspectives on CB were distributed to and completed by 1001 women attending a maternity education program from April to October 2008; 863 women answered that they had heard of CB. We analyzed the 863 questionnaires to identify the sources of information, the plan for CB, the reasons for decisions, beliefs about the potential uses of CB, and knowledge about current therapeutic uses.RESULTS: Most subjects received information from promotional materials distributed by CB banks and the media; however, minimal information was obtained from obstetricians. More than 90% of women who planned to donate cited “altruism,” and 75.0% of the “private preservation” group indicated that a desire to “safeguard for the future” was the reason for their decision. The probability of autologous CB transplantation (p = 0.001) and current usefulness were significantly overestimated in the private preservation group (p = 0.02). In addition, 56% of subjects underestimated the probability of identifying a matched CB in the public bank, and the overall rate of correct answers about current usefulness was 57.4%.CONCLUSIONS: A considerable portion of educated pregnant Korean women has more than minimal knowledge of CB, but the levels of knowledge regarding the potency of the public bank and the current usefulness and limitations of CB are generally low; in addition, obstetricians play insignificant roles in disseminating knowledge. Providing accurate and detailed information to pregnant women not only via brochures and the media and/or Internet but also by obstetricians would encourage CB donation.
Sleep Disordered Breathing and Arrhythmia Burden in Pacemaker Recipients
Authors: PADELETTI MARGHERITA , VIGNINI SIMONE , RICCIARDI GIUSEPPE , PIERAGNOLI PAOLO , ZACÀ VALERIO , EMDIN MICHELE , FUMAGALLI STEFANO , JELIC SANJA 
Published: August 2010

Background: Sleep disordered breathing (SDB), a common condition among patients with permanent pacemaker (PM), is associated with greater incidence of cardiac arrhythmias. Scarce availability of sleep laboratories and the high costs of nocturnal‐attended polysomnography limit the routine screening of patients with PM for SDB. We investigated whether a novel PM that utilizes variations in transthoracic impedance to record the fluctuations in breathing pattern and minute ventilation could be used to screen patients for SDB.
Methods: Twenty patients who underwent dual‐chamber PM implantation were studied. The Talent 3 DR PM (SORIN Group Italy S.r.l., Milan, Italy) calculates apnea‐hypopnea index (AHI) by computing minute ventilation signal derived from transthoracic impedance measurements. Within a month after PM implantation, an in‐home respiratory monitoring was performed to evaluate the accuracy of PM‐derived AHI. Patients were followed for mean ± standard deviation, 487 ± 166 days. The PM was checked at each follow‐up visit to retrieve the information about recurrent arrhythmias.
Results: Eleven patients were diagnosed with SDB by an in‐home respiratory monitoring. An AHI derived from an in‐home respiratory monitoring was similar to pacemaker‐derived AHI (27 ± 14 vs 16 ± 13 events/hour, P = 0.15). The cumulative incidence of cardiac arrhythmias, including atrial fibrillation, extrasystolic beats, sustained and nonsustained ventricular tachycardia, and supraventricular tachycardia was similar in patients with and without SDB.
Conclusion: SDB is highly prevalent in patients with permanent pacemaker. Screening for SDB with Talent 3 DR PM may facilitate diagnosis and treatment of SDB. (PACE 2010; 33:1462–1466)
Off‐Label Use of Drug‐Eluting versus Bare Metal Stents: A Lesion‐Specific Systematic Review of Long‐Term Outcomes
Authors: BEOHAR NIRAT , MEYERS SHERIDAN N. , ERDOGAN ATA , HARINSTEIN MATTHEW E. , PIEPER KAREN , GAGNON STEPHANIE , DAVIDSON CHARLES J. 
Published: August 2010

Objective: The purpose of this systematic review was to evaluate differences in lesion‐specific outcomes with the “off‐label” use of drug‐eluting stents (DES) versus bare metal stents (BMS).
Methods: MEDLINE, PubMed, the Cochrane databases, and other Web were searched for studies evaluating off‐label use of DES and BMS with the same characteristics. Of 1,258 abstracts or manuscripts reviewed, 112 studies were included (total N = 23,438). Studies were excluded if patients received both types of stent or no stent; lesion type was unknown; lesion‐specific outcomes for ≥6 months were unavailable; or <25 patients were enrolled.
Results: Overall mortality at 6–12 months was approximately 3% for BMS and DES for off‐label use. Increase in mortality was greater from 6–12 months to 2 years with BMS than with DES (3.3%–9.1%; 2.8%–4.1%); however, rates were similar at 3 years (BMS: 18.8%; DES:15.3%). Myocardial Infarction rates were similar for both types at 6–12 months (BMS: 6.5%; DES: 6.0%). Overall rates of stent thrombosis were 1.8% and 1.7% for BMS and DES, respectively. Similar or slightly lower rates of stent thrombosis were seen for most lesion types, except higher rates for small vessels for BMS (5.2%) and true bifurcation for DES (3.3%). Rates of target lesion revascularization (TLR) were 7.5% for BMS and 19.6% for DES at 6–12 months. At 2‐years TLR remained lower than DES. When the combined group was compared to registry data alone, similar values were seen.
Conclusions: Rates of mortality, myocardial infarction (MI), and stent thrombosis were similar in patients receiving BMS or DES, while TLR rates were lower in DES patients. (J Interven Cardiol 2010;23:528–545)