bluuebunny/crossref_metadata_2025_split huggingface dataset:
P56 Platelet Screening by Bactalert Prior to Issue ‐ Limited Sensitivity Revealed by Residual Rate of Contamination in Outdated Screened Units.
Authors: Doherty C. , Foley M. , Salami A. , Cadden E. , Coakley P. , Murphy W. G. 
Published: September 2006

Introduction and Methods  Since November 2004 we have tested all platelets for bacterial contamination prior to release. Platelets are stored for a minimum of 12 h at 22 oC after manufacture, and a 7.5–10 ml sample is then inoculated into an aerobic BacTAlert bottle, and a similar volume into an anaerobic bottle. (For the first 10 months an 8 mL inoculum in aerobic culture only was used.) All units stored to expiry are retested using a 10 mL aerobic sample and a 10 mL anaerobic sample on BacTAlert. Confirmed positive is a positive result on BacTAlert, a positive subculture from the BacTAlert bottle, and a further culture of the same species from the platelet unit, or for pools, from the pool or from one other component from the donations used in the pool. False positive is a positive signal from the bottle, but no organism detected on subculture, Gram stain, and re‐culture of the unit. Unconfirmed positive is a positive subculture or Gram stain from the bottle but no residual material available for culture, or all residual material negative on culture. Since November 2005 we have extended the shelf life of Gambro Trima apheresis platelets on the basis of a retest at day 4; platelets still in stock on day 4 of storage have a repeat aerobic and anaerobic culture performed, and are returned to stock with a extra two days of shelf life.Results  In total 30,751 platelet units have been screened prior to issue. There were 12 confirmed and 16 non‐confirmed positives on the initial test, for a total positive rate of 0.09%. 13/9213 (0.14%) were from apheresis collections; 15/21538 (0.07%) were from pools of four buffy coats after 22oC overnight hold of the whole blood units (95% confidence interval for the difference in positive rate = 0.0%–0.2%, i.e. statistically significantly different). 5651/30,751 expired unused and were retested: there were 12 positives ‐ five confirmed and seven non‐confirmed, for a total positive rate of 0.21% (12/5651). This is not statistically significantly different from the initial test rate (95% confidence interval for the difference is −0.003–0.000). All day four tests for extending shelf life (n = 1293) were negative. There were 14 isolates of coagulase negative staphylococci, 11 of P acnes, three of bacillus spp, and two of diphtheroids among the 40 positive units.Conclusions  Screening platelets for bacteria prior to issue using relatively large sample volumes to increase detection rates has a limited sensitivity in the order of 50%.Apheresis platelets are more likely to be contaminated after collection than platelets manufactured from pooled buffy coats made from whole blood units stored overnight at 22oC.Using a day four retest for extending platelet shelf life is a practicable approach to the problem of low initial sensitivity of bacterial screening.
P59 Involvement of CD9 in Erythroid Progenitor Cell Apoptosis
Authors: Webster K. , Green C. A. , Singleton B. K. , Daniels G. L. 
Published: September 2006

Introduction  The study of erythroid progenitor cell proliferation and differentiation in vitro is essential if we are to achieve our goal of producing therapeutic quantities of red cells by cell culture. The mechanisms of cell regulation need to be appreciated and a cell culture environment developed for optimal cell renewal and growth. Changes in cell surface molecules and understanding of their function form an important part of the study together with knowledge about the genes involved in the erythropoietic process, including those genes involved in apoptosis. CD9, a member of the tetraspanin super family, is reportedly involved in tumour progression and metastasis and has been implicated in apoptosis of cancer cells.Methods  Apoptosis was induced in erythroid progenitor cells by depriving the cultures of erythropoietin (EPO). CD34+ cells were isolated from the peripheral blood of adults and cultured for 5 days in serum free medium with IL‐3 (1 ng mL−1), SCF (10 ng mL−1) and EPO (3 IU mL−1). On day 6 the culture was divided and half the cells deprived of EPO; both cultures were analysed on day 8. Total RNA was extracted and run on Affymetrix microarray chips to compare the mRNA profile of the apoptotic and control cells.Results  One gene that was consistently upregulated in the apoptotic cells was CD9. This result was confirmed by real‐time PCR. Immunofluorescent staining and confocal microscopy revealed that CD9 protein expression changed during apoptosis from low level expression within the cell membrane to a much higher level, which was cytoplasmic as well as membranous. To determine whether this CD9 upregulation was an initiator of apoptosis or a consequence, CD34+ cells were cultured with anti‐CD9 (ALB6) antibody added to the culture medium. Ligation of CD9 by anti‐CD9 did not change the apototic profile of the cultures.Conclusion  It can be concluded that although CD9, by itself, is not an initiator of apoptosis in erythroid progenitor cells it is obviously an important target in the subsequent apoptotic pathway. Continued research into CD9 and other mechanisms of apoptosis may allow manipulation of cells in culture with a possible extension of their life span and increase in the number of cells produced.
P08 Role of a National Cell Salvage Co‐ordinator
Authors: Grainger H. , Jones J. , Benton A. 
Published: September 2006

Background  Management of the supply of allogeneic red cells is an important issue in the UK due to the unquantifiable risk of transmission of vCJD( Llewellyn CA et al.Lancet. 2004; 363: 417–421) The Health Circular, Better Blood Transfusion ‐ The Appropriate use of Blood, instructed hospitals to address the ‘appropriate use of autologous transfusion’. Historically various methods of cell salvage have been used sporadically, driven only by the occasional enthusiastic clinician. Increased awareness of potential threats to the blood supply as well as the benefit for patients of autologous blood, have prompted a more focused approach to cell salvage development. In Wales this has been addressed by the establishment of a structured programme under the direction of a dedicated cell salvage co‐ordinator.Approach  Initial discussions with trusts highlighted common themes and the following needs were identified: (i) Practical information on how to set up a cell salvage programme; (ii) Training; and (iii) National data to support appropriate use of cell salvageA ‘toolkit’ was developed and subsequently a coordinator appointed to take forward the initiative. A strategy was developed following a review of current practice.• Establish a plan of action within each Trust• Undertake training of key personnel and raise awareness of all staff• Develop and facilitate competency assessments for all trainees and existing staff• Produce National policies, protocols and SOP's to promote standard practice• Establish a National databaseConclusion  1. All hospitals in Wales now undertake cell salvage and there is increasing use in Obstetrics following the published NICE guidelines2. A National database is being established3. Training package, including a resource folder for staff available for use4. National policies under development.
P09 Intra‐operative Cell Salvage in Abdominal Aortic Aneurysm Repair in the South West Region
Authors: Birchall J. ,   on behalf of the South West Regional Blood Transfusion Committee
Published: September 2006

Background  The Department of Health circular, Better Blood Transfusion two requires hospitals to avoid unnecessary use of donor blood and to explore effective alternatives. The National Blood Conservation Strategy 2004 recommends that intra‐operative cell salvage (IOCS) should be considered for surgical patients where the anticipated blood loss exceeds 1000 mL. The Southwest Regional Blood Transfusion Committee selected abdominal aortic aneurysm (AAA) repair to audit the use of IOCS within the region. The aims were to identify the percentage of cases where IOCS is used and determine the reasons why IOCS is not used.Method  All Trusts/hospitals in the region were invited to participate. A simple proforma was completed by theatre staff on each AAA repair for a 3 month period from November 2005 to February 2006. Co‐ordinators at each Trust/hospital returned these to the NBS Clinical Audit department for analysis.Results  A total of 14 NHS Trusts/hospitals took part and only 1 eligible Trust/hospital declined to participate. All Trusts/hospitals used IOCS and in 6/14 (43%) this was used in all cases. There were 127 cases of AAA repair during the audit period and IOCS was used in 100 (79%) and not used in 27 (21%). Most cases (69%) were performed as elective procedures and in 85% IOCS was used. Emergency surgery was associated with a lower incidence of IOCS although this was still high at 72%. The most common reason for not using IOCS was lack of trained staff and this was not out of hours related. This accounted for 15 out of the 27 cases where IOCS was not used and in two Trusts/hospitals occurred in 50% or more of all cases. In the 100 cases when IOCS was used 124 units of donor red cells were transfused (average 1.24 units, range 1–15 units). In the 27 cases where IOCS was not used 102 units of donor red cells were transfused (average 3.8 units, range 1–30 units). In the 15 cases when lack of trained staff prevented IOCS, 93 donor units were transfused (average 6.2 units).Conclusions  All Trusts/hospitals who participated have access to cell salvage machines. IOCS was used in 79% of all cases which compares favourably with 43% of cases reported nationally by the Vascular Society of Great Britain and Ireland 2004. Trained staff must be available for IOCS to be a valuable resource both from a clinical governance and cost‐effective perspective.
Seed longevity and dormancy of four summer annual grass weeds in turf
Authors: MASIN R , ZUIN MC , OTTO S , ZANIN G 
Published: September 2006

Summary Digitaria sanguinalis, Eleusine indica, Setaria glauca and S. viridis are troublesome summer annual weeds in turf. For taking rational decisions on the necessity for the level and type of weed management, it is important to know when weeds are ready to emerge (dormancy status) and also how long weed seeds can survive in the soil. Seeds of these four species were buried 4.0–4.5 cm deep in steel mesh net bags placed under permanent turf and periodically exhumed for 3 years to evaluate viability and determine the dormancy/non‐dormancy cycle. D. sanguinalis, S. glauca and S. viridis showed the typical dormancy cycle of summer annual species, and their seed viability declined completely after 3 years of burial. In contrast, E. indica demonstrated unusual behaviour, with long persistence and no dormancy.
Assessing the opportunity for site‐specific management ofAvena sterilisin winter barley fields in Spain
Authors: RUIZ D , ESCRIBANO C , FERNÁNDEZ‐QUINTANILLA C 
Published: September 2006

SummaryThe abundance ofAvena sterilisin dryland barley fields was studied in four Spanish provinces. During two growing seasons, differential geopositioning system (DGPS)‐geo‐referencedA. sterilisinfestations were obtained in 31 fields. The majority of the infestations were concentrated in few large but irregularly shaped patches, with a higher number of smaller and more regular patches accounting for a small proportion of the infestation. A multitude of very small and irregular patches completed the inventory. The implications of this spatial structure were studied. Site‐specific adjusted‐dose herbicide application offered 61–74% potential herbicide savings. However, given the low levels of infestation and the low economic returns obtained in most of the provinces, the most profitable strategy was generally no herbicide application. Site‐specific treatments were advantageous only in high‐returns systems. Because few large patches provided the majority of the infestation, zone‐specific treatments would be advisable, until such time that weed detection and site‐specific application technologies become more efficient.
L/I‐11 Simultaneous adult‐to‐adult (A/A) split liver transplants
Authors: Panaro F. , Andorno E. , Ravazzoni F. , Di Domenico S. , Ghinolfi D. , Miggino M. , Morelli N. , Bottino G. , Casaccia M. , Valente U. 
Published: September 2006

Introduction:  Split liver transplants (SLTs) and living related liver transplants (LRLTs) were developed to increase the number of available organs for adult recipients. We review our experience in performing both the split procedure and the 2‐graft transplant at the same division.Patients and methods:  From 1997 to 2005, we performed 96 in situ SLTs (82 adult donor‐to‐pediatric recipient [A/P] and 14 adult‐to‐adult [A/A]). We used 9 right grafts (SV‐VIII) and 5 left grafts (SI‐IV) for the A/A group. Two of these grafts were procured from a single donor and transplanted into 2 recipients by our team. The in situ SL procedure was performed in the emergency department OR and the 2 transplants in our dedicated ORs.Results:  The splitting procedure required 110 minutes with a blood loss of 350 ml. The entire procedure (from procurement to last transplant) took 18 hours to be completed. Donor: 17 yrs, 170 cm,78 kg, ICU stay 2 days, SLV 1341 gr (right 737 gr, left 604 gr). Recipients: see below.The overall survival rate of the A/A group was 66% for right grafts (median follow‐up, 46 months) and 80% for left grafts (median follow‐up, 62 months). The recipients with the same donor are still alive with normal LFTs at 47 months posttransplant.Conclusion:  A “simultaneous” transplant of 2 liver grafts at the same center may increase graft quality and improve organ survival. Conversely, it requires excellent technical facilities and organizational skills. This approach has the potential to decrease mortality on the adult waiting list, to optimize LT timing with outcome improvement, and to decrease the need for LRLDs.

Left Graft Recipient
Right Graft Recipient

Graft weight (gr)
600
580

Age (yrs)
51
53

Diagnosis
HCV+ALCOHOL
HCV+HBV+HDV+ALCOHOL

Status/MELD
2B/13
3/14

Weight (kg)
56
57

GRWR (%)
1.07
0.98

Blood transfusions (units)
11
6

Length (h)
6h36min
9h30min

Discharge (POD)
23
58*

Liver volume after 2 mos
1515 ml
1522 ml

*comorbidity: renal failure requiring hemodialysis.
*Chi‐squared p = .046 comparing Clavien 0/I vs. II/III/IV.
L/I‐12 Living donor hepatectomies: program experience and lessons learned
Authors: Tan H.P. , Marsh J. , Tom K. , Thai N. , Shaw‐Stiffel T. , Lopez R. , Boig L. , Caponi T. , Starzl T. , Marcos A. 
Published: September 2006

Introduction:  Living donor hepatectomies are technically challenging and we continue to modify our techniques to decrease morbidities.Patients and methods:  We present our program experience with 114 living donor hepatectomies (95 right lobes, 3 left lobes, 16 left lateral segments) from 3/4/03 to 2/28/06 at the Starzl Transplantation Institute. A total of 208 potential donors were screened, resulting in 114 (54%) living donor hepatectomies and living donor liver transplants (98 adults, 16 pediatric recipients).Results:  In all, 94 potential donors (46%) were declined for the following reasons: fatty livers (43), availability of a deceased donor liver (15), small liver volume (12), workup (6), biopsy consistent with fibrosis (4), polycystic liver disease (3), cardiovascular contraindications (2), mental illnesses (2), hepatitis B (2), and hepatic vascular/biliary anomalies (2). There was no donor mortality and the donor morbidity rate was 8.8%. Three (2.6%) donors had bile leak from cut liver edges with JP removed by 3 weeks (all managed conservatively). Other morbidities included 1 unit pRBC transfusion (2), pneumonia (1), incisional hernia (1), prolonged LFTs (1), deep venous thrombosis (1), and narcotic pscyhosis (1). The mean donor hospital stay was 7 days. Blood loss did not correlate with liver volume but correlated with technique of liver parenchymal dissection. With technique modifications (combination of Tissue Link, Erbe HELIX hydro‐jet, endovascuar GIA stapler, and CUSA) during the last 70 right lobe hepatectomies, the mean estimated blood loss has dropped to about 250 mL, with no blood transfusion. Operative time for liver parenchymal dissection has also dropped from about 200 minutes to 90 minutes.Discussion:  With intraoperative technical experience and refinements, previous surgical contraindications are decreasing. A higher percentage of potential living liver donors screened are allowed to donate, with decreasing morbidities.
L/I‐2 Living related liver transplants: preliminary report on an initial experience in Italy
Authors: Gruttadauria S. , Mandala’ L. , Cintorino D. , Biondo D. , Panarello G. , Verzaro R. , Spada M. , Marsh J.W. , Marcos A. , Gridelli B. 
Published: September 2006

Introduction:  Living related liver transplantation has become the treatment for many liver diseases. We present our initial analysis on 42 cases of adult‐to‐adult living related liver transplants (ALRLTs) performed in a single institution in Italy.Materials and methods:  From January 2002 to February 2006, we performed 42 ALRLTs. The donors (age 18 to 53) all had genetic or emotional relationships; they were all ABO‐identical or ABO‐compatible. Recipients (age 18 to 68) suffered from cirrhosis secondary to viral etiology (n=13), hepatocellular carcinoma on viral cirrhosis (n=21), cystic fibrosis (n=2), primary biliary cirrhosis (n=2), hepatocellular carcinoma on nonviral cirrhosis (n=2), alcoholic cirrhosis (n=1), and metastatic carcinoid to the liver (n=1). Donor liver resection resulted in 40 right hepatectomies and 2 left hepatectomies. Graft body weight ratio was always above 1%; graft implantation was performed with the piggyback technique, and in 32 cases with the use of venovenous bypass.Results:  There was no donor mortality; 4 donors had biliary complications. The actuarial recipient survival rate at 3 years was 89.25% and the graft survival rate was 82.69%. Graft loss occurred in 7 patients: 5 patients underwent retransplants (4 because of hepatic artery thrombosis, 1 because of graft dysfunction), and 2 patients had 1 episode of acute cellular rejection.Conclusion:  ALRLTs represent a resource to face the organ shortage in a region where the deceased donor donation rate is 7.2 donors per year per million.
L/I‐3 Biliary complications in adult‐to‐adult living donor right lobe liver transplants
Authors: Cotterell A. , Fisher R. , Maluf D. , Stravitz R. , Sterling R. , Luketic V. , Sanyal A. , Shiffman M. , Posner M. 
Published: September 2006

Introduction:  Biliary complications are a major cause of morbidity after living donor right lobe liver transplantation. The purpose of this study was to compare the incidence of biliary complications after Roux‐en‐Y vs. duct‐to‐duct reconstruction in adult‐to‐adult right lobe liver transplantation.Patients and methods:  This study reports on 75 patients who underwent 77 right lobe liver transplants. During the initial experience beginning in June 1998, a Roux limb was used routinely for biliary reconstruction. Since September 2000 a duct‐to‐duct biliary anastomosis was performed if technically feasible.Results:  Of 49 procedures involving Roux‐en‐Y reconstruction, 15 patients (30.6%) experienced 18 biliary complications, including 7 cases of biliary anastomotic strictures, 3 cut surface leaks requiring intervention, 1 anastomotic leak, 1 anastomotic obstruction, and 1 excluded segmental duct. In addition, 5 patients experienced episodes of cholangitis unrelated to strictures. Of the 47 patients with Roux‐en‐Y reconstruction, 32 are alive a mean of 75 months posttransplant. Of 28 patients with duct‐to‐duct reconstruction, 8 (28.6%) experienced 9 biliary complications including 5 anastomotic strictures (3 of which required operative intervention), 2 anastomotic leaks, 1 cut surface leak requiring intervention, and 1 excluded segmental duct. Twenty‐four of 28 patients with duct‐to‐duct reconstruction are alive a mean of 39 months posttransplant.Conclusion:  The incidence of biliary complications after right lobe living donor liver transplantation is about 30% regardless of the method used for biliary reconstruction. A duct‐to‐duct biliary anastomosis is an acceptable alternative to Roux‐en‐Y reconstruction if technically feasible.
L/I‐7 Comparison of HCV outcomes in recipients of expanded‐criteria, living donor, and standard liver grafts
Authors: Kinkhabwala M. , Mayerfield A. , Kin C. , Renz J. , Gaglio P. , Emond J. , Brown R. 
Published: September 2006

Introduction:  Living donor (LD) and expanded‐criteria donor (ECD) livers are important sources of organ transplants in some regions. Hepatitis C virus (HCV) remains the most common reason for end‐stage liver disease in the United States. It is unclear whether ECD and LD grafts are associated with poorer outcomes in hepatitis C recipients, as compared with non‐ECD (standard [STD]) MELD‐allocated livers. The aim of this retrospective study was to compare long‐term hepatitis C recurrence rates and outcomes in recipients of ECD, LD, and STD grafts.Methods:  The cohort of patients analyzed comprised all adult hepatitis C transplant recipients between 1/1/01 and 11/1/04 (minimum follow‐up, 1 year). Recipients not surviving the immediate perioperative period (90 days) were excluded. Censored events were defined by disease‐free graft survival. Disease recurrence was defined by histologically confirmed hepatitis C and at least stage II fibrosis. ECDs were identified according to accepted criteria (e.g., age, steatosis, ischemia, donation after cardiac death, abnormal biopsy).Results:  In all, 120 patients formed the study cohort, with 79 ECD, 27 LD, and 14 STD grafts. The mean recipient MELD was 19.8 overall (range, 6 to 43), 20.1 (ECD), 14.1 (LD), and 24.7 (STD). The mean time to censored event was 709 days overall, 631 (ECD), 884 (STD), and 846 (LD). The 2‐year disease‐free survival rate was 44% (ECD), 55.6% (LD), and 70.7% (STD), by Kaplan‐Meier analysis. Comparison of the curves indicated a significant difference between ECD and STD recipients, but no difference between ECD and LD recipients.Conclusions:  Recipients with hepatitis C who received ECD grafts had poorer outcomes in our experience, as compared with those receiving STD grafts. LD grafts, which can be viewed as a subset of ECD grafts, also had poorer outcomes than STD whole grafts, but this difference was not statistically significant.
L/I‐8 Adult living donor liver transplants: biliary morbidity
Authors: Giacomoni A. , Lauteri A. , Slim A. , Mangoni I. , Aseni P. , Pirotta V. , Mariani A. , De Carlis L. 
Published: September 2006

Introduction:  Biliary problems are very common complications in adult living donor liver transplants (ALDLTs), with a reported negative incidence of 22% to 64%.Patients and methods:  From March 2001 through February 2006, we performed 27 ALDLTs, grafting segments V‐VIII without the middle hepatic vein. Biliary anatomy was investigated using intraoperative cholangiography in the first 5 patients and with magnetic resonance cholangiography alone in the remaining 22. In 15 patients, we found a single right biliary duct (55.55%) and in 12 we found multiple biliary ducts (44.45%). We performed single biliary anastomoses in 20 patients (74.07%) and multiple anastomoses in the remaining 7 (25.93%).Results:  With a mean follow‐up of 675 days (range, 8 to 1,804 days), patient and graft survival rates were 85% and 74%. The following biliary complications were observed: 4 biliary leaks from the cut surface, 3 anastomotic leaks, 6 late anastomotic strictures, and 1 early kinking of the choledochus.These 14 biliary complications (51.85%) occurred in 11 patients (40.74%).Conclusion:  Biliary complications affected our series of ALDLTs at a high percentage, but none of the grafts transplanted was lost due to biliary problems. Magnetic resonance cholangiography seems to be a reliable instrument to investigate biliary anatomy.Multiple biliary reconstructions are strongly associated with a high risk of complications.