Characterization of reactions after exclusive transfusion of white cell- reduced cellular blood components

BACKGROUND: Potential adverse effects of white cells (WBCs) within transfused cellular blood components include febrile nonhemolytic transfusion reactions (FNHTRs), alloimmunization, transmission of infectious diseases, transfusion-related acute lung injury, and immunomodulation. Although exclusive use of WBC-reduced components to prevent alloimmunization and cytomegalovirus transmission has been studied, the use of these components to avert FNHTR has not been examined. STUDY DESIGN AND METHODS: Transfusion reactions (FNHTRs, allergic reactions, and others) were characterized in recipients of 12,277 WBC-reduced single-donor apheresis platelets (SDAPs) and/or red cells (RBCs). Medical and laboratory evaluations for possible infectious and immunologic (alloimmunization) causes of each reaction were undertaken, and the benefit of further modification of components for the prevention of subsequent reactions was also evaluated. RESULTS: Transfusion reactions occurred after 481 (3.92%) of 12,277 transfusions. Allergic reactions occurred more commonly after transfusion of SDAPs (3.69%) than of RBCs (0.51%). Conversely, FNHTRs occurred more commonly after transfusion of RBCs (2.15%) than of SDAPs (1.58%). HLA antibodies were present in a posttransfusion sample from 27 (10.6%) of 255 patients; bacterial contamination was a possible cause of only 2 (0.42%) of 481 reactions. In patients with recurrent FNHTRs, further WBC reduction in components did not wholly prevent further FNHTRs. CONCLUSION: The incidence of FNHTRs and alloimmunization after exclusive transfusion of WBC-reduced RBCs and SDAPs was low. Further WBC reduction in components transfused to patients with a history of recurrent FNHTRs does not completely prevent subsequent reactions.     

供体鼠龄对急性心肌梗死骨髓间充质干细胞移植后血管发生的影响

目的:干细胞移植后可以通过改善梗死区域血管新生而发挥改善心功能的作用。实验观察不同鼠龄骨髓间充质干细胞移植后的效果,拟验证其对急性心肌梗死动物血管发生的影响。方法:实验于2006-02/2007-05在福建省高血压研究所完成。①实验材料:清洁级SD大鼠由上海实验动物公司提供。选用2周龄雄性SD大鼠作为幼年鼠骨髓间充质干细胞来源,选用1年龄雄性SD大鼠作为老年鼠骨髓间充质干细胞来源。实验过程中对动物处置符合动物伦理学标准。②实验方法:密度梯度离心法和贴壁筛选法获得SD大鼠骨髓间充质干细胞,观察老年与幼年大鼠骨髓间充质干细胞的凋亡情况。体外模拟梗死心肌缺血、缺氧条件,制备大鼠心肌梗死模型。将造模后大鼠随机分为3组:对照组(n=8)不进行干细胞移植,只在梗死心肌周围注入等量的生理盐水。老年鼠移植组(n=8)梗死心肌周围分4点注入同种异体老年鼠骨髓间充质干细胞,幼年鼠移植组(n=8)梗死心肌周围分4点注入同种异体幼年鼠骨髓间充质干细胞。③实验评估:干细胞移植4周后,采用Ⅷ因子免疫组织化学观察各组间血管密度的差别。结果:24只大鼠均进入结果分析。在缺血、缺氧条件下,幼年鼠骨髓间充质干细胞的抗凋亡能力强于老年鼠(P<0.05)。Ⅷ因子免疫组织化学检测显示,两移植组梗死区域均有新生血管生成,幼鼠移植组血管密度高于老年鼠移植组(P<0.05),老年鼠移植组高于对照组(P<0.05)。结论:供体年龄在一定程度上影响急性心肌梗死骨髓间充质干细胞移植后血管的发生。     

Posterior Interosseous Artery Flap for Hand Defects

Background

Reconstruction of soft tissue defects in the hand need an early, single stage and well vascularised cover to achieve the best functional result. Usually a full thickness graft is required since vital structures like tendons, bones and joints are exposed and often there is need for secondary reconstruction.

Methods

We managed 12 cases of complex defects over the hand in the last 2 years with the posterior interosseous artery flap.

Results

In 5 cases the defect was due to blast injury and in 4 because of crush injury. Males predominated in the ratio of 5:1. The defect was most often in the 1^st web space and the largest flap was 11×8 cm. In all but one case the donor site was covered by split skin graft, which settled well. 2 patients had superficial flap necrosis needing debridement and skin graft.

Conclusion

Flap based on reverse flow in the posterior interosseous artery is a versatile and reliable source for full thickness cover of complex soft tissue defects in the hand.Key Words: Soft tissue defect of hand, Posterior interosseous artery flap     

Positional cloning of a gene involved in hereditary multiple exostoses

Hereditary multiple exostosis (EXT) is an autosomal dominant condition mainly characterized by the presence of multiple exostoses on the long bones. These exostoses are benign cartilaginous tumors (enchondromata). Three different EXT loci on chromosomes 8q (EXT1), 11p (EXT2) and 19p (EXT3) have been reported, and recently the EXT1 gene was identified by positional cloning. To isolate the EXT2 gene, we constructed a contig of yeast artificial chromosomes (YAC) and P1 clones covering the complete EXT2 candidate region on chromosome 11p11-p12. One of the transcribed sequences isolated from this region corresponds to a novel gene with homology to the EXT1 gene, and harbours inactivating mutations in different patients with hereditary multiple exostoses. This indicates that this gene is the EXT2 gene. EXT2 has an open reading frame encoding 718 amino acids with an overall homology of 30.9% with EXT1, suggesting that a family of related genes might be responsible for the development of EXT.      

Peripheral and central sites of action for the non-selective cannabinoid agonist WIN 55,212-2 in a rat model of post-operative pain

Background and purpose:

Activation of cannabinoid (CB) receptors decreases nociceptive transmission in inflammatory or neuropathic pain states. However, the effects of CB receptor agonists in post-operative pain remain to be investigated. Here, we characterized the anti-allodynic effects of WIN 55,212-2 (WIN) in a rat model of post-operative pain.

Experimental approach:

WIN 55,212-2 was characterized in radioligand binding and in vitro functional assays at rat and human CB₁ and CB₂ receptors. Analgesic activity and site(s) of action of WIN were assessed in the skin incision-induced post-operative pain model in rats; receptor specificity was investigated using selective CB₁ and CB₂ receptor antagonists.

Key results:

WIN 55,212-2 exhibited non-selective affinity and agonist efficacy at human and rat CB₁ versus CB₂ receptors. Systemic administration of WIN decreased injury-induced mechanical allodynia and these effects were reversed by pretreatment with a CB₁ receptor antagonist, but not with a CB₂ receptor antagonist, given by systemic, intrathecal and supraspinal routes. In addition, peripheral administration of both CB₁ and CB₂ antagonists blocked systemic WIN-induced analgesic activity.

Conclusions and implications:

Both CB₁ and CB₂ receptors were involved in the peripheral anti-allodynic effect of systemic WIN in a pre-clinical model of post-operative pain. In contrast, the centrally mediated anti-allodynic activity of systemic WIN is mostly due to the activation of CB₁ but not CB₂ receptors at both the spinal cord and brain levels. However, the increased potency of WIN following i.c.v. administration suggests that its main site of action is at CB₁ receptors in the brain.British Journal of Pharmacology (2009) 157, 645–655; doi:10.1111/j.1476-5381.2009.00184.x; published online 3 April 2009     

Another Example of Anti-Jsa

The fourth example of anti-Js^a probably stimulated by blood transfusion is described. Thirty-four of 244 Negroid bloods were Js(a+). All 103 Caucasians and three Indian blood samples were Js(a–).     

Second Example of Hemolytic Disease of the Newborn Caused by Anti-Jkb

Mild hemolytic disease developed in the second child of a woman who gave no history of transfusions. The antibody was identified as anti-Jk^b. The antiglobulin method gave the strongest reactions but the antibody also agglutinated test cells in saline at room temperature and at 37 C. No difficulty was encountered in determining the presence of the Jk^b antigen in cord blood erythrocytes.