bluuebunny/crossref_metadata_2025_split huggingface dataset:
Protein a immunoadsorption treatment in hematology: An overview
Authors: Howe Robert B. , Christie Douglas J. 
Published: February 2007

AbstractStaphylococcal protein A efficiently binds immunoglobulins and circulating immune complexes (CIC) and provides an effective medium to remove immunoglobulins and CICs from plasma while sparing albumin and most coagulation proteins. Although it activates the complement system its clinical use abrogates the need for plasma expanders necessitated by plasma exchange. Despite anecdotal reports of utility in several hematologic syndromes, publications of clinical trials are available only for autoimmune thrombocytopenic purpura (AITP) and refractoriness to platelet transfusions (RFT) associated with alloimmunization. In the former situation Snyder et al. (Blood 79:2237–2245, 1992) reported on 72 patients with AITP all of whom had failed at least two previous therapies including splenectomy in 68%. Forty‐six percent achieved improved platelet counts following treatment. The response was durable (8–26 mo) in all but 10%. Spleen‐intact patients could not be differentiated from those who had been splenectomized. Both responders and nonresponders showed significant decreases in CIC and platelet‐directed immunoglobulin (PDIG), but responders achieved near‐normal levels. The beneficial response of these factors, particularly in spleen‐intact patients, warrants a prospective study. In our studies at the University of Minnesota twelve patients with thrombocytopenia secondary to bone marrow failure who were refractory to platelet transfusion were treated with protein A immunoadsorption. Ten had demonstrable antiplatelet Abs (Anti‐HLA, HPA, ABO). Seven of 12 demonstrated improved platelet counts and post‐transfusion corrected count increments after treatment. This was associated with decreased platelet utilization and clinical bleeding. A prospective controlled clinical trial is justified. © 1994 Wiley‐Liss, Inc.
Synchronization of plasma exchange and cyclophosphamide in severe and refractory autoimmune hemolytic anemia
Authors: Silva Victor A. , Seder Richard H. , Weintraub Lewis R. 
Published: February 2007

AbstractTwo cases of severe autoimmune hemolytic anemia (AIHA) that failed multiple treatment modalities obtained complete and long‐lasting remissions with a combination of three one volume plasma exchange (PE) on succeeding days followed 6 hours later on the 3rd day by cyclophosphamide (cyc) 750 mg/m2 IV, and cyc/prednisone (pred) qd tapering to either no therapy or minimal therapy over a 6 month period. Both cases remain without evidence of AIHA after 43 and 19 months follow‐up. Possible non‐exclusive mechanisms that explain this favorable outcome are enhanced cytotoxic effect of cyc on proliferating lymphocytes participating in the antibody rebound phenomena, suppression of B lymphocytes with daily cyc/pred, and/or formation of anti‐idiotype antibodies.We present two cases of severe and refractory AIHA, one warm and the other cold, that obtained complete and long‐lasting responses to a synchronized therapy of three daily one volume PE followed 6 hours later by cyc 750 mg/m2 IV and low doses of daily cyc and pred. In both cases the auto‐antibodies virtually disappeared. In one case, red cell allo‐antibodies disappeared as well.
Effects on donors of repeated leukocyte losses during plateletpheresis
Authors: Strauss Ronald G. 
Published: February 2007

AbstractAll blood components collected by automated cytapheresis contain donor leukocytes. The possibility that repeated cytapheresis donation might lead to clinically important leukocyte losses and immunodeficiency has been a longstanding concern. Although convincing data do not exist to substantiate this concern, it is common practice to limit the number of annual cytapheresis donations per donor and to monitor donors for developing lymphocytopenia. Clinically significant immunodeficiency is unlikely to occur unless donors lose >1 × 1011 lymphocytes within a few weeks period of time or unless donor lymphocyte counts fall persistently to <0.5 × 109/L. Each plateletpheresis procedure, when performed using modern cell separators that are designed to produce a relatively “pure” platelet concentrate, leads to the loss of 1.0 × 106 to 5.0 × 107 leukocytes. Thus, automated plateletpheresis as performed in 1994 is extremely unlikely to cause clinically significant lymphocyte depletion and consequent immunodeficiency.
Effects on recipients of exposure to allogeneic donor leukocytes
Authors: Dzik Walter H. 
Published: February 2007

AbstractBlood transfusion recipients are exposed to allogeneic donor leukocytes at the time of transfusion. Exposure to allogeneic donor leukocytes has been linked to a variety of complications of transfusion including primary HLA alloimmunization and platelet refractoriness, febrile nonhemolytic transfusion reactions, transmission of leukotropic viruses, transfusion‐associated graft versus host disease, and transfusion‐induced immune suppression. The development of high‐performance leukodepletion blood filters and of low‐leukocyte plateletapheresis machines has provided the technology to reduce recipient exposure to allogeneic donor leukocytes. This article provides a brief review of current information on the utility and shortcomings of these technologies for the prevention of leukocyte‐mediated transfusion complications.
Plasma exchange for preeclampsia: II. Unsuccessful antepartum utilization for severe preeclampsia with or without hellp syndrome
Authors: Martin James N. , Perry Kenneth G. , Roberts William E. , Norman Patricia F. , Files Joe C. , Blake Pamela G. , Morrison John C. , Wiser Winfred L. 
Published: February 2007

AbstractOBJECTIVE: To explore the efficacy of plasmapheresis/plasma exchange as the primary therapy to arrest and reverse the progression of severe preeclampsia with or without HELLP syndrome in order to postpone delivery and improve perinatal outcome in very preterm pregnancies. STUDY DESIGN: In this case series of patients managed over a 4‐year period from 1984 to 1987, seven gravidas with severe preterm preeclampsia underwent 1‐2 plasmaphereses/plasma exchange procedures using the IBM 2997 Cell Separator with continuous electronic fetal heart rate monitoring (n = 7 patients) and central cardiovascular monitoring (n = 3 patients). RESULTS: The seven patients (one with HELLP syndrome, six without HELLP) presented between 24 and 30 weeks gestation and, despite plasmapheresis/plasma exchange, the severity of each study subject's preeclampsia persisted without clinically significant improvement. Maternal‐fetal deterioration required cesarean delivery in all cases within 48 (in four patients within <36) hours of therapy. No clinically significant adverse effect of plasma exchange therapy was recorded during cardiovascular and laboratory monitoring; two fetuses developed repetitive late decelerations during exchange despite adequate maternal fluid preload. The only patient with HELLP syndrome developed eclampsia as her third plasma exchange within 25 hours was being initiated. Significant problems with fluid retention and displacement (variable amounts of pulmonary edema, pleural effusions, large volume ascites) were encountered in all patients. Four neonates died (24‐27 weeks/438‐820 g) and three survived intact (740, 950, and 1,280 g). One mother (case 5) developed end‐stage renal disease 21 months postpartum. CONCLUSIONS: The application of plasmapheresis/plasma exchange therapy as described in order to prolong very preterm pregnancies in the undelivered patient with severe preeclampsia/eclampsia with or without HELLP syndrome did not produced encouraging results. Patients in general were exposed to additional medical and surgical risk without a corresponding improvement in perinatal outcome.
Treatment of severe cardiac allograft rejection with extracorporeal photochemotherapy
Authors: Wieland M. , Thiede V. L. , Strauss R. G. , Piette W. W. , Kapelanski D. P. , Landas S. K. , Hunsicker L. G. , Vance S. J. , Randels M. J. 
Published: February 2007

AbstractTwo patients were treated with photopheresis for marked cardiac allograft rejection with hemodynamic compromise that had become unresponsive to standard therapy. Multiple episodes of rejection had occurred, and initial response to standard therapy was favorable. However, progressive deterioration was documented by serial endomyocardial biopsies, fever, congestive heart failure, and abnormal cardiac catheterization findings. In the absence of retransplantation, death seemed imminent. Photopheresis was begun. Both patients received oral 8‐methoxypsoralen and ⩾5 × 109 mononuclear cells were collected, treated with ultraviolet light A for 1.5 hours, and were reinfused. One procedure was performed weekly X4 and then monthly X5. Responses were striking with rapid loss of fever, improvement in exercise tolerance, normalization of cardiac hemodynamics, and improvement in endomyocardial biopsies. Although our experience with these two patients is anecdotal, photopheresis merits further study as treatment for severe cardiac allograft rejection.
Pyrogen reactions to human serum albumin during plasma exchange
Authors: Pool Mark , McLeod Bruce C. 
Published: February 2007

AbstractReactions to human serum albumin (HSA) in therapeutic plasma exchange (TPE) are rare. Nevertheless, older literature describes possible adverse effects, including specific immune responses to albumin or other proteins, and reactions due to contaminating organisms or pyrogen. During an eight day period three patients in our unit had unusual reactions after infusion of 1.5–2 L of HSA. Patient 1 had trembling that persisted for 20 min. Patient 2 had shaking for 40 min despite calcium gluconate infusion, and fever to 100.8° F. Patient 3 had severe rigors that subsided after 90 min when meperidine was finally given, and fever to 103.5°F. Record reviews revealed that all three patients had received HSA from the same lot, and that only one other TPE patient had received HSA from that lot. Neither our pharmacy nor the manufacturer was aware of other reactions associated with that lot. Material from a bottle only partially infused to patient 3 was negative in culture and was negative for pyrogen when retested by the manufacturer. Nevertheless, because patients 1 and 2 had each had multiple previous uneventful TPEs and because all three patients tolerated subsequent TPEs without incident when another brand of HSA was used, we conclude that these patients had pyrogen reactions to the implicated HSA lot. This experience illustrates the value of cluster recognition in arousing suspicion of unusual reactions to HSA and the value of recorded lot numbers in pursuing such suspicions. Apheresis personnel should be aware of the potential for pyrogen reactions with HSA and should record lot numbers of all fluids infused during TPE.
International Forum. Evaluation of the single needle procedure in plateletpheresis with the fresenius as 104 blood cell separator
Authors: Moog Rainer , Müller Norbert 
Published: February 2007

AbstractThe aim of the present study was to evaluate the single needle (SN) procedure for plateletpheresis with the AS 104 blood cell separator. One hundred fifty‐seven platelet collections with different protocols were carried out and analysed with respect to platelet yield, separation efficiency, leukocyte contamination, anticoagulant infused, and donation time. SN plateletpheresis resulted in a mean platelet yield of 2.6–3.1 × 1011 with separation efficiencies of 49.2–57.4%. The mean leukocyte contamination ranged from 2.8 to 40.5 × 106.Parameters of product quality were investigated in 14 platelet concentrates (PC). Determination of glucose, lactate, lactate dehydrogenase (LDH), and morphology score showed good quality of the PC.
Immunomodulatory effects of donor lymphocyte infusions following allogeneic bone marrow transplantation
Authors: Soiffer Robert J. , Alyea Edwin P. , Ritz Jerome 
Published: February 2007

AbstractRecently, donor lymphocyte infusions have been successfully used to treat patients with CML who have relapsed following allogeneic bone marrow transplantation (BMT). Responses can be achieved in more than 60–70% of patients with stable phase CML without the need for the additional high dose cytotoxic chemotherapy that would accompany a second transplant procedure. The clinical and molecular remissions induced by this approach are a clear demonstration of graft‐versus‐leukemia (GVL) activity. Although undoubtedly donor lymphocyte infusions are safer than a second BMT, they are associated with toxicities stemming from graft‐versus‐host disease (GVHD) and pancytopenia. In this review, the immunomodulatory mechanisms underlying the GVL activity of donor allogeneic lymphocytes infusions are presented. Unresolved issues regarding lymphocyte administration are discussed as well as potential ways to limit complications due to GVHD and pancytopenia. New potential applications of this immunotherapeutic approach for treatment of infectious disease and non‐hematologic malignancies will be presented.
Meta‐analysis of clinical studies of the efficacy of plasma exchange in the treatment of chronic progressive multiple sclerosis
Authors: Vamvakas Eleftherios C. , Pineda Alvaro A. , Weinshenker Brian G. 
Published: February 2007

AbstractTo examine the hypothesis that addition of therapeutic plasma exchange (TPEX) to an immunosuppressive drug regimen increases that regimen's efficacy to halt the progression of chronic progressive multiple sclerosis (CPMS). METHODS: The literature was searched for prospective controlled clinical trials evaluating the efficacy of TPEX in CPMS. Six studies were eligible for meta‐analysis. Their results were combined, using Cochran's and Peto's methods. Three outcome measures were studied: 1) the change in Kurtzke's disability status scale (DSS) scores, 2) the relative odds of neurologic decline by 1 or more DSS grades, and 3) the relative odds of neurologic improvement by 1 or more DSS grades, in the treatment versus the comparison group of patients. Reported results of neurologic evaluations at 6, 12, 24, and 36 months of follow‐up were analyzed separately. RESULTS: TPEX significantly (P lt; .05) reduced the proportion of patients who experienced neurologic decline (by 1 or more DSS grades) at 12 months of follow‐up (relative odds of decline = 0.441, 95% confidence interval = 0.210–0.929). CONCLUSIONS: There is a need for further clinical research into the possibility of a beneficial effect of TPEX in patients with CPMS likely to experience neurologic decline over the ensuring 12 months. Targeting treatment to a particular subgroup of CPMS patients may be necessary for TPEX to prove effective.
Intensive blood and plasma exchange for treatment of coagulopathy in meningococcemia
Authors: Churchwell Kevin B. , McManus Michael L. , Kent Patricia , Gorlin Jed , Galacki Dolores , Humphreys Donald , Kevy Sherwin V. 
Published: February 2007

AbstractEight pediatric patients with fulminant meningococcemia, purpura, and disseminated intravascular coagulation who by multiple prognostic scoring systems were anticipated to have a poor outcome underwent intensive plasma exchange (IPE) or whole blood exchange (WBE) in addition to standard medical therapy. IPE/WBE was initiated shortly after admission with a mixture of both fresh frozen plasma and cryoprecipitate as the replacement solution. All IPE procedures were performed using a continuous flow system and a red cell prime. The mean fibrinogen level increased from 62 to 192 mg/dl, the prothrombin time (PT) decreased from a mean of 32.4 seconds to 15.1 seconds, and the mean activated partial thromboplastin time (APTT) decreased from 89.5 seconds to 40.1 seconds following completion of the initial IPE/WBE. There was a corresponding improvement in all coagulation factor levels but only slight improvement in antithrombin III (ATIII) and protein C levels. Seven of eight patients survived (87.5%) their initial presentation with the sole early death attributed to meningitis with cerebral edema. Mean fluid balance after the procedure was + 10.8 ± 5.87 cc/kg. There were no significant bleeding or cardiovascular complications during the procedure. There was no clinical or radiographic evidence of fluid overload after the procedure.This experience demonstrates that IPE/WBE may be conducted safely in critically ill, unstable pediatric patients and is effective in rapidly improving coagulopathy without fluid overload.
Modifications to increase accuracy and consistency of anticoagulant delivery using the fenwal CS3000 plus
Authors: Burgstaler E. A. , Pineda A. A. , Geissler U. C. 
Published: February 2007

AbstractConsistent and accurate delivery of anticoagulant (AC) with the Fenwal CS3000 Plus has been difficult to maintain. We have modified and evaluated methods to deliver AC more accurately and consistently at a 11:1 ratio on the Fenwal CS 3000 Plus. Two modifications (shortened AC tubing, shortened AC tubing with modified drip chamber) and two unmodified methods (unmodified right‐hand string, unmodified double string) were compared (n = 20 platelet apheresis procedures each), resulting in average AC ratios of 11.4 ± 0.5, 11.2 ± 0.4, 11.6 ± 1.3, and 12.1 ± 0.7:1, respectively. There was a significantly higher incidence of ratios within ±10% of 11:1 using the modified methods, 90% and 100%, versus the unmodified methods, 50% and 55%, respectively. Comparison of 36 plateletapheresis (each) using 15‐, 30‐, and 90‐minute intervals in AC drip rate monitoring revealed no significant difference. However, the 30‐minute interval had a better ratio, 11,4 ± 1.0 versus 11.6 ± 0.8 or 11.7 ± 1.1, and higher frequency of 11 ± 10%:1 at 81% versus 75% and 72% and was more practical to use than 15‐minute interval; the 90‐minute interval did require adjustments in 8% of the procedures. The use of a spring scale versus AC bag graduations (n = 75 plateletapheresis) to measure AC volume was significantly superior in measuring volume (343 ± 64 versus 373 ± 72 ml), ratio (11.2 ± 1.5 versus 10.2 ± 1.6), and ratios 11 ± 10%:1 (71% versus 52%). For more accurate and consistent AC delivery with the Fenwal CS 3000 Plus, we recommend three courses of action: 1) Shorten the AC line and modify the AC drip chamber, 2) use a 30‐minute interval to monitor AC drip rate and adjust only if off by more than 3 drops/15 sec, 3) use a spring scale rather than AC bag graduations to obtain more accurate measurement of AC volume used.
Masticatory motor patterns in ungulates: a quantitative assessment of jaw‐muscle coordination in goats, alpacas and horses
Authors: Williams Susan H. , Vinyard Christopher J. , Wall Christine E. , Hylander William L. 
Published: February 2007

AbstractWe investigated patterns of jaw‐muscle coordination during rhythmic mastication in three species of ungulates displaying the marked transverse jaw movements typical of many large mammalian herbivores. In order to quantify consistent motor patterns during chewing, electromyograms were recorded from the superficial masseter, deep masseter, posterior temporalis and medial pterygoid muscles of goats, alpacas and horses. Timing differences between muscle pairs were evaluated in the context of an evolutionary model of jaw‐muscle function. In this model, the closing and food reduction phases of mastication are primarily controlled by two distinct muscle groups, triplet I (balancing‐side superficial masseter and medial pterygoid and working‐side posterior temporalis) and triplet II (working‐side superficial masseter and medial pterygoid and balancing‐side posterior temporalis), and the asynchronous activity of the working‐ and balancing‐side deep masseters. The three species differ in the extent to which the jaw muscles are coordinated as triplet I and triplet II. Alpacas, and to a lesser extent, goats, exhibit the triplet pattern whereas horses do not. In contrast, all three species show marked asynchrony of the working‐side and balancing‐side deep masseters, with jaw closing initiated by the working‐side muscle and the balancing‐side muscle firing much later during closing. However, goats differ from alpacas and horses in the timing of the balancing‐side deep masseter relative to the triplet II muscles. This study highlights interspecific differences in the coordination of jaw muscles to influence transverse jaw movements and the production of bite force in herbivorous ungulates. J. Exp. Zool. 307A:226–240, 2007. © 2007. Wiley‐Liss, Inc.
The circulatory system in Mysidacea—Implications for the phylogenetic position of Lophogastrida and Mysida (Malacostraca, Crustacea)
Authors: Wirkner Christian S. , Richter Stefan 
Published: February 2007

AbstractThe morphology of the circulatory organs in Mysida and Lophogastrida (traditionally combined as Mysidacea) is revisited investigating species so far unstudied. In addition to classical morphological methods, a newly developed combination of corrosion casting with micro computer tomography (MicroCT) and computer aided 3D reconstructions is used. Lophogastrida and Mysida show a highly developed arterial system. The tubular heart extends through the greater part of the thorax and is connected with the ventral vessel via an unpaired descending artery. It is suggested that a distinct ostia pattern supports the monophyly of Mysidacea. The cardiac artery system is more complex in Lophogastrida than in Mysida, consisting of up to 10 pairs of arteries that supply the viscera. In both taxa, an anterior and posterior aorta leads off the heart. In the anterior part of the cephalothorax the anterior aorta forms dilations into which muscles are internalized; these structures are called myoarterial formations. One of these myoarterial formations can also be found in all the other peracarid taxa but not in other Malacostraca. J Morphol., 2007. © 2007 Wiley‐Liss, Inc.
Dating Quaternary volcanism and incision by the River Tigris at Diyarbakır, southeast Turkey
Authors: Bridgland David R. , Demi̇r Tuncer , Seyrek Ali̇ , Pringle Malcolm , Westaway Rob , Beck Anthony R. , Rowbotham George , Yurtmen Sema 
Published: February 2007

AbstractNew high‐precision Ar‐Ar dating of basalt underlying the city of Diyarbakır, southeast Turkey, constrains the Quaternary incision history of the River Tigris, strengthening the pre‐existing chronology based on magnetostratigraphy and K‐Ar dates. The basalt, which overlies Tigris terrace gravel 70 m above the river, is part of the Karacadağ shield volcano complex centred ca. 60 km to the southwest. The reverse‐magnetised Diyarbakır basalt, one of relatively few flow units to reach the Tigris valley axis, has been dated to 1196 ± 19 ka (±2σ). Two lower terraces have been recognised in the Diyarbakır area, 46 and 32 m above the present river, with at least one other further downstream. From this evidence the rate of Middle‐Late Pleistocene incision by the Tigris can be estimated; it probably reached ca. 0.07 mm a−1, reflecting the characteristic global increase in uplift rates observed at that time. Copyright © 2007 John Wiley & Sons, Ltd.