bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Aspirin Attenuate the Effect of Angiotensin‐Converting Enzyme Inhibitors on Health Outcomes of Very Old Patients with Heart Failure?
Authors: L Lapane Kate , L Hume Anne , M Barbour Marilyn , Lipsitz Lewis A. 
Published: March 2003

OBJECTIVES: Concomitant ischemic heart disease (IHD) is common in older individuals with heart failure (HF). We estimated the effect of aspirin use on the rate of mortality, morbidity, and decline in physical functioning in nursing home residents with HF taking angiotensin‐converting enzyme (ACE) inhibitors.DESIGN: We conducted a retrospective cohort study using a nursing home database linking resident information collected via the Minimum Data Set (MDS) with drug utilization data.SETTING: Nursing homes in four states (1992–1995).PARTICIPANTS: Of 49,779 residents with HF admitted to these homes, 12,703 residents were taking an ACE inhibitor; 2,046 of these took aspirin.MEASUREMENTS: Medicare enrollment files provided the date of death, and we used the Part A Medicare files to identify hospital admissions. The activity of daily living scale from repeat MDS assessments allowed us to evaluate decline in physical function. Cox proportional hazards models provided adjusted estimates of the aspirin effect, with nonusers as the reference group.RESULTS: The overall mortality rate, hospitalization rate, and rate of decline in physical function of aspirin users were not different from those of nonusers (e.g., hospitalization rate ratio = 0.99, 95% confidence interval = 0.92–1.07). This effect did not vary by presence of concomitant IHD or by dose or type of ACE inhibitor.CONCLUSION: In a cohort of older HF residents receiving ACE inhibitors in nursing homes, we found that treatment with aspirin did not appear to affect outcomes negatively.
Unrecognized Tuberculosis in a Nursing Home Causing Death with Spread of Tuberculosis to the Community
Authors: Ijaz Kashef , Dillaha Jennifer A. , Yang Zhenhua , Cave M. Donald , Bates Joseph H. 
Published: March 2003

OBJECTIVES: To determine the reason for an increase in tuberculin skin test (TST) conversion in employees in a nursing home and to determine the source case responsible for spread of tuberculosis (TB) in two nursing homes and a hospital in a rural part of Arkansas using molecular and traditional epidemiological methods.DESIGN: TB contact investigation of residents and employees of two nursing homes and a hospital.SETTING: Two nursing homes and a hospital in rural part of Arkansas.PARTICIPANTS: One hundred fifty‐seven employees and 117 residents of two nursing homes and 211 employees of a hospital in rural part of ArkansasMEASUREMENTS: Tuberculin skin test.RESULTS: Analysis of room and work assignments of residents and employees who converted their TSTs in Nursing Home A showed that residents and employees in the same wing as the suspect source case were significantly more likely to have converted their TST than residents and employees in other wings (P = .01). A nurse from the local hospital where the suspected source case had been sent developed a tuberculous cervical abscess, and one employee in Nursing Home A developed pulmonary TB. A visitor to Nursing Home A was diagnosed with culture‐positive pulmonary TB 2 years later. Genotyping of the Mycobacterium tuberculosis isolates from the four secondary cases showed identical patterns.CONCLUSION: Molecular and traditional epidemiological studies revealed an outbreak of TB that began in a nursing home and spread to a second nursing home, a local hospital, and the community.
Translating Clinical Research into Practice: A Randomized Controlled Trial of Exercise and Incontinence Care with Nursing Home Residents
Authors: Schnelle John F. , Alessi Cathy A. , Simmons Sandra F. , Al‐Samarrai Nahla R. , Beck John C. , Ouslander Joseph G. 
Published: March 2003

OBJECTIVES: To examine clinical outcomes and describe the staffing requirements of an incontinence and exercise intervention.DESIGN: Randomized controlled trial with blinded assessments of outcomes at three points over 8 months.SETTING: Four nursing homes.PARTICIPANTS: Two hundred fifty‐six incontinent residents.INTERVENTION: Research staff provided the intervention, which integrated incontinence care and exercise every 2 hours from 8:00 a.m. to 4:00 p.m. 5 days a week.MEASUREMENTS: Average and maximum distance walked or wheeled, level of assistance required to stand, maximum pounds lifted by arms, fecal and urinary incontinence frequency, and time required to implement intervention.RESULTS: Intervention residents maintained or improved performance whereas the control group's performance declined on 14 of 15 outcome measures. Repeated measures analysis of variance group‐by‐time significance levels ranged from P < .0001 to .05. The mean time required to implement the intervention each time care was provided was 20.7 ± 7.2 minutes. We estimate that a work assignment of approximately five residents to one aide would be necessary to provide this intervention.CONCLUSIONS: The incontinence care and exercise intervention resulted in significant improvement for most residents, and most who could be reliably interviewed expressed a preference for such care. Fundamental changes in the staffing of most nursing homes will be necessary to translate efficacious clinical interventions into everyday practice.
Factors Associated With Falls in Older Patients With Diffuse Polyneuropathy
Authors: Richardson James K. 
Published: March 2003

OBJECTIVES: To identify clinical factors associated with falls by older persons with polyneuropathy (PN).DESIGN: A cross‐sectional study of 82 subjects aged 50 to 85 with clinical and electrodiagnostic evidence of PN.SETTING: Electrodiagnostic and biomechanical research laboratories.PARTICIPANTS: Patients referred to the electrodiagnostic laboratory.MEASUREMENTS: History and physical examination, including semiquantitative methods of peripheral nerve function, and clinical balance testing. Falls were defined by retrospective self‐report over a 2‐year period.RESULTS: Forty (48.8%), 28 (34.1%), and 18 (22.0%) subjects reported a history of at least one fall, multiple falls, and injurious falls, respectively. Factors associated with single and multiple falls were similar, so only results for multiple and injurious falls are reported. Bivariate analysis showed that an increased body mass index (BMI) and more severe PN (as determined by the Michigan Diabetes Neuropathy Score) were associated with both fall categories. Men reporting falls also demonstrated a decreased unipedal stance time. Age, sex, nerve conduction study parameters, Romberg testing, medications, and comorbidities were not consistently associated with either fall category. Logistic regression demonstrated that multiple and injurious falls were associated with an increased BMI and more severe PN, controlling for age, sex, medications, and comorbidities (pseudo R2 = 0.458 and 0.484, respectively).CONCLUSIONS: Although previous work has demonstrated that all older persons with PN are at increased risk for falls, patients with increased BMI and more severe PN are at particularly high risk and should be targeted for intervention.
Anti‐EnaFS detected in the serum of an MiVII homozygote
Authors: Laird‐Fryer B. , Moulds J. J. , Dahr W. , Min Y. O. , Chandanayingyong D. 
Published: March 2003

Anti‐EnaFS was detected in the serum of a Caucasian woman, K.T., during her third pregnancy. She had not been transfused. At delivery, the infant's red cells (RBCs) had a negative direct antiglobulin test. The antibody was inhibited by isolated MN sialoglycoprotein (SGP). Unlike other En(a—) cells, K.T.'s EnaFS‐negative RBCs were found to demonstrate normal sialic acid levels, and an MN SGP exhibiting normal sodium dodecylsulphate electrophoretic mobility and periodic acid‐Schiff staining intensity. K.T., whose parents were consanguineous, appears to be the first known MiVII homozygote. In a three‐generation family study, MiVII was shown to travel with MS.The Anek receptor of K.T.'s RBCs was found to be located on the trypsin‐resistant and V8 protease‐sensitive portion of the MN SGP (residues 40 to 57), whereas the Anek receptor of MiVI RBCs was shown to be associated with their abnormal Ss SGP. K.T.'s MN SGP appears to exhibit an amino acid sequence alteration in the region of the EnaFS determinant, which is located within the residues 46 to 56 of the normal MN SGP. These findings suggest that the MiVII and EnaFS receptors are the products of allelic genes.
Characterization of the neutrophil molecules identified by quinine‐ dependent antibodies from two patients
Authors: Stroncek D. F. , Herr G. P. , Maguire R. B. , Eiber G. , Clement L. T. 
Published: March 2003

BACKGROUND: Two patients with episodic pancytopenia and renal failure associated with quinine (Qn) ingestion were previously found to have Qn‐ dependent antibodies that reacted with red cells, platelets, and neutrophils. The purpose of these studies was to characterize the neutrophil antigens recognized by Qn‐dependent antibodies from these two patients.STUDY DESIGN AND METHODS: The neutrophil molecules recognized by the Qn‐dependent antibodies in the sera from the two patients were analyzed by immunoprecipitation using 125I‐labeled neutrophils. Neutrophils from 13 different donors were tested.RESULTS: The Qn‐dependent antibodies from Patient 1 immunoprecipitated a 60‐kDa molecule on neutrophils from seven donors and an 85‐kDa molecule on neutrophils from three donors. The Qn‐dependent antibodies from Patient 2 reacted with a 32‐kDa molecule on neutrophils from 5 donors, a 60‐kDa molecule on neutrophils from 9 donors, and an 85‐kDa molecule on neutrophils from 10 donors. Neutrophil‐specific antigen NB1 is also located on a 60‐kDa glycoprotein (GP). While the antibody in serum from Patient 1 did not show specificity for NB1, the antibody from Patient 2 detected the 60‐kDa molecule on NB1‐positive neutrophils from 9 of 11 donors tested and did not detect the 60‐kDa molecule on NB1‐negative neutrophils from 2 donors. In a monoclonal antibody immobilization of granulocyte antigens assay, the Qn‐dependent antibody from both patients reacted with the 60‐kDa molecule carrying NB1. The Qn‐ dependent antibody from a third patient, Patient 3, was previously found to react with an 85‐kDa GP and the 60‐kDa NB1 GP. To determine if the Qn‐dependent antibodies from Patients 2 and 3 recognized the same 85‐kDa GP, neutrophils were treated with serum from Patient 3 plus Qn to remove the 85‐kDa GP. Then, serum from Patient 2 plus Qn no longer immunoprecipitated the 85‐kDa GP.CONCLUSION: The antigens recognized by Qn‐dependent neutrophil antibodies were located on molecules of 85, 60, and 32 kDa. Qn‐dependent antibodies from two patients reacted with the same 85‐kDa GP and those from three patients reacted with the same 60‐kDa GP. The 60‐kDa molecule recognized by the Qn‐dependent antibodies carried the NB1 antigen.
Evaluation of platelet concentrates stored for 5 days with reduced plasma volume
Authors: Holme S. , Heaton W.A. , Moroff G. 
Published: March 2003

BACKGROUND: Currently, platelet concentrates (PCs) are stored in a suspending plasma volume of 45 to 65 mL. Previous studies using second‐ generation containers indicated that PCs stored for 5 days at volumes less than 30 mL have reduced in vivo percentage recoveries as compared to PCs stored at volumes of 50 mL or more.STUDY DESIGN AND METHODS: This study has evaluated the effect of PC plasma volume on the maintenance of in vivo and in vitro platelet properties following 5 days of storage, with the purpose of establishing the minimum plasma volume in the range of 30 to 50 mL. Twenty paired studies were performed in which identical populations of platelets from the same donor (obtained by double manual apheresis) were stored in a normal volume (55‐60 mL, control) and reduced volume (30‐50 mL, test) of plasma. Comparison of in vivo viability between test and control PCs was performed after random radiolabeling of 1 unit with 51Cr and of the other with 111In, with simultaneous transfusion and with calculation of percentage recovery and the area below the survival curve (integral) as measures of viability.RESULTS: When test unit volumes were > or = 35 mL, essentially identical platelet survival curves and in vitro results were obtained for test and control. The integral and the percentage recovery for the test units were (mean, 95% confidence interval) 98.7 (96.3‐101.0) and 99.0 percent (94.7‐103.3) of those values in the control units, respectively. Test units with volume < or = 34 mL demonstrated reduced in vivo viability with integral and percentage recovery of 81.1 (68.9‐93.3) and 80.4 (69.3‐91.5), respectively, as compared to the control units. This loss was associated with increased metabolic activity (lactate production), which may suggest platelet activation due to the increased surface‐to‐PC volume ratio.CONCLUSION: These results show that the storage volume of PCs may be reduced from 50 to 60 mL to 35 to 40 mL without any significant decrease in in vivo or in vitro platelet quality.
In vitro production of interleukin‐1 receptor antagonist in IgG‐ mediated red cell incompatibility
Authors: Davenport R.D. , Burdick M.D. , Strieter R.M. , Kunkel S.L. 
Published: March 2003

Background: Recently, proinflammatory cytokines including interleukin 1 (IL‐1) have been implicated in the pathophysiology of immune‐mediated hemolysis. Little is known, however, about the mechanisms by which inflammatory events in these reactions may be downregulated. IL‐1 receptor antagonist (IL‐1ra) inhibits the actions of IL‐1 by competition for cellular receptors, and thus it may regulate the biologic actions of IL‐1 during immune‐mediated hemolysis. The production of IL‐1ra by peripheral blood mononuclear cells (PBMNCs) in response to IgG‐coated red cells in vitro was investigated.Study Design and Methods: Fresh PBMNCs were obtained by density gradient separation of heparinized whole blood. PBMNCs were cultured in the presence of anti‐D‐coated, Rh‐positive red cells or uncoated Rh‐ negative red cells under nonadherent conditions. IL‐1ra concentrations in the culture media were measured by enzyme‐linked immunosorbent assay. IL‐1ra and IL‐1β gene expression was assessed by Northern blot analysis of PBMNC mRNA.Results: IL‐1ra production was evident 4 hours after stimulation with IgG‐coated red cells and increased progressively over 24 hours. Gene expression of IL‐1ra was first detected at 2 hours, lagging behind that of IL‐1β. IL‐1ra gene expression was not inhibited by neutralizing polyclonal antibodies to IL‐1. Immunocytochemical staining to determine the cellular source localized IL‐1ra production to monocytes engaged in erythrophagocytosis. IL‐1ra production was inhibited by dexamethasone (10−7 M).Conclusion: These results suggest that IL‐1ra production may partly account for the variable pathophysiologic events seen in IgG‐ mediated autoimmune hemolysis and hemolytic transfusion reactions. Steroid treatment may also downregulate anti‐inflammatory cytokine production in immune hemolysis.
Laboratory diagnosis of heparin‐associated thrombocytopenia and comparison of platelet aggregation test, heparin‐induced platelet activation test, and platelet factor 4/heparin enzyme‐linked immunosorbent assay
Authors: Greinacher A. , Amiral J. , Dummel V. , Vissac A. , Kiefel V. , Mueller‐Eckhardt C. 
Published: March 2003

BACKGROUND: As clinical diagnosis of heparin‐associated thrombocytopenia (HAT) is often difficult, confirmation by sensitive laboratory assays is desirable.STUDY DESIGN AND METHODS: The sensitivity of the heparin‐induced platelet activation (HIPA) test and the platelet aggregation test (PAT) was prospectively compared by using the sera of 209 patients with the putative diagnosis of HAT. Both assays were performed concomitantly with platelets of the same four donors using a different combination of donors from day to day. Further, all sera were assessed with a platelet factor 4 (PF4)/heparin enzyme‐linked immunosorbent assay (ELISA).RESULTS: Positive results were obtained with 33 percent of sera in the PF4/heparin ELISA, with 33.5 percent of sera in the HIPA test, and with 11.5 percent of sera in the PAT. The PF4/heparin ELISA and the HIPA test showed no difference in sensitivity (p = 0.27 by McNemar's test) and were more sensitive than PAT (p < 10(‐8) by McNemar's test). However, they recognized different patient cohorts. Nine HIPA‐indeterminate and 12 HIPA‐negative sera were positive in the PF4/heparin ELISA. Eight of the nine indeterminate sera caused platelet activation with high heparin concentrations in the HIPA test. Eleven of the 12 negative sera contained no IgG, but 9 contained IgM and 2 contained IgA HAT antibodies. Four sera that were indeterminate in the PF4/heparin ELISA and 18 sera that were negative were positive in the HIPA test. None of the sera that were positive in the PAT was missed in the HIPA test, but two of those were negative in the PF4/heparin ELISA. All sera were assessed with four low‐molecular‐weight heparins and a low‐molecular‐ weight heparinoid in the HIPA test with platelets from the same four donors. Low‐molecular‐weight heparin caused platelet activation with positive sera in 98 percent of tests, and the heparinoid did so in 10 percent; in a further 12.8 percent, crossreactivity to the low‐ molecular‐weight heparinoid could not be excluded.CONCLUSION: The majority of HAT antibodies react with a PF4/heparin complex, but there is strong evidence that other antigens are involved in some patients. The HIPA test and the PF4/heparin ELISA are sensitive for diagnosing HAT, and they complement one another.
Circannual variation in lymphocyte subsets, revisited
Authors: Paglieroni T.G. , Holland P.V. 
Published: March 2003

Background: Circadian and circannual variations in lymphocyte subsets, especially CD8+ T‐lymphocytes, have been reported. This study focuses on CD4+ T‐lymphocyte seasonal variation over a 6‐year 8‐month period.Study Design and Methods: Lymphocyte subsets were quantitated monthly for four healthy individuals from 1986 through 1992 as part of a flow cytometry quality‐control program.Results: In general, there were no significant seasonal changes in the total number of white cells or in total lymphocyte counts. The absolute numbers of CD4+ T‐lymphocytes were lowest in summer when the CD8+ T‐lymphocytes were highest. Mean CD4+ T‐lymphocyte counts were 846, 967, 618, and 695 per microL for Subjects 1 through 4, respectively, in winter and 432, 670, 355, and 766 per microL, respectively, in summer. Two healthy subjects had CD4+ T‐lymphocyte counts lower than 300 per microL on one or more occasions during the study period. In three of the four subjects, the percentage of B‐lymphocytes in winter was almost double that in summer. In one of the four subjects, no circannual rhythm was observed in these lymphocyte subpopulations.Conclusion: The seasonal variation in CD4+ T‐ lymphocyte counts demonstrated in three healthy individuals over almost 7 years is again of interest in light of renewed consideration of using surrogate tests, such as CD4+ T‐lymphocyte counts, to screen for AIDS‐ like diseases that may be in the blood supply.
Lack of alloimmunization to D antigen in D‐negative immunosuppressed liver transplant recipients
Authors: Casanueva M. , Valdes M.D. , Ribera M.C. 
Published: March 2003

BACKGROUND: Orthotopic liver transplantation (OLT) sometimes requires large amounts of blood. An adequate supply of Rh‐negative blood for Rh‐ negative patients is not always available.STUDY DESIGN AND METHODS: Seventeen Rh‐negative patients, out of 327 receiving OLT in this hospital, received from 5 to 41 units of Rh‐positive red cells during surgery. Each of the 17 patients was followed for 7 weeks to 70 months after OLT for detection of unexpected antibodies. Cyclosporin A and prednisone, azathioprine, and adjunctive rabbit antilymphocyte globulin or monoclonal OKT3 antibody were used to prevent graft rejection.RESULTS: Evidence of immunization, either to D or to antigens in the rest of the red cell antigen systems, did not appear in any patients.CONCLUSION: It is hypothesized that cyclosporin A affects the immune humoral response, inhibiting lymphocyte activation and the primary immune response; consequently, Rh‐positive blood may be transfused to Rh‐negative OLT recipients so treated with little or no risk of alloimmunization.
The risk of alloimmunization to c (Rh4) in R1R1 patients who present with anti‐E
Authors: SHIREY R.S. , EDWARDS R.E. , NESS P.M. 
Published: March 2003

BACKGROUND: Because the Rh antigens E (Rh3) and c (Rh4) are relatively immunogenic, it has been suggested that R1R1 (E‐, c‐) patients who present with anti‐E alone receive prophylactic c‐ (Rh: −4) red cell transfusions.STUDY DESIGN AND METHODS: To determine the utility of this approach, the transfusion records of 100 consecutive R1R1 patients with anti‐E identified over a 6‐year period were reviewed.RESULTS: Thirty‐two (32%) had anti‐c concurrent with anti‐E. Twenty‐seven of the 68 patients who presented with anti‐E alone received random (i.e., not typed for c [Rh4]) red cell transfusions. Five (18.5%) of the 27 subsequently developed anti‐c 13 to 193 days (mean, 50) after transfusion of 2 to 14 (mean, 8) red cell units. None of the five had clinical evidence of hemolysis that could be attributed to a delayed hemolytic transfusion reaction. Twenty‐two (81.5%) of the 27 failed to develop anti‐c even after transfusion of 1 to 41 (mean, 9; median, 7) red cell units.CONCLUSION: The overall rate of immunization to c (Rh4) antigen in R1R1 patients with anti‐E was 37 percent. Production of anti‐ c following transfusion to R1R1 patients with anti‐E occurred in 18.5 percent of the cases in this series, which could have been avoided by the prophylactic use of R1R1 (E‐, c‐) blood for transfusion. The prophylactic use of c‐ (Rh: −4) blood in this patient population may be justified by the high immunization rate and the potential risk of delayed hemolytic transfusion reaction.
Flow cytometric analysis in platelet crossmatching using a platelet suspension immunofluorescence test
Authors: Skogen B. , Christiansen D. , Husebekk A. 
Published: March 2003

BACKGROUND: The sensitivity of flow cytometric measurement of platelet antibodies in a crossmatch technique was investigated.STUDY DESIGN AND METHODS: The corrected count increment after platelet transfusion was compared with the fluorescence ratio determined by flow cytometric measurement.RESULTS: When crossmatching was performed before transfusion(s) in alloimmunized patients, a fluorescence ratio < or = 1.7 was associated with satisfactory responses (corrected count increment > or = 7.5), and the predictive values for negative and positive crossmatch results were 94 and 87 percent, respectively. Analysis of antigen preservation during platelet storage with antibodies to HLA alpha‐chain, HLA‐B27, HPA‐1a, and HPA‐3a showed that platelets can be stored, refrigerated, for up to 4 weeks without significant loss of HLA class I and HPA‐1a. There was a slight but continuous loss of HPA‐3a upon storage.CONCLUSION: Flow cytometric measurement of fluorescence in the platelet suspension immunofluorescence test can be used for platelet crossmatching, with sensitivity and predictive values comparable to those of previously described techniques and with the advantage of automation.