A feasibility evaluation of an automated bloodcomponent collection system platelets and red cells

BACKGROUND: The purpose of these studies was to evaluate the functional properties of blood components collected with an automated collection system. STUDY DESIGN AND METHODS: Single-donor platelets (n = 44) and packed red cell (RBC) units (n = 10) were collected. In vitro and in vivo assays were used to assess the function of single-donor platelet components stored for 5 days and of packed RBC units after storage for 42 days at 4 degrees C. RESULTS: Adverse events observed in the 44 study subjects were minor. The mean 24-hour recovery value for the packed RBC units stored for 42 days was 83.6 +/- 5.4 percent, with a mean percentage of hemolysis on Day 42 at 0.46 +/- 0.19 percent. The 25 patients receiving platelet components achieved a mean corrected count increment of 15.1 +/- 10.4 x 10(3). All platelet concentrates had less than 1 x 10(6) total white cells. CONCLUSION: Both in vitro and in vivo testing for the packed RBCs collected and stored for 42 days met the standards for both hemolysis and percentage of 51Cr 24-hour RBC recovery. The in vitro results and transfusion data on white cell-reduced platelet components transfused to thrombocytopenic patients were comparable to those on available platelet components.     

Quality and clinical response to transfusion of prestorage white cell-reduced apheresis platelets prepared by use of an in-line white cell-reduction system

BACKGROUND: This study evaluated the quality and clinical effectiveness of white cell (WBC)-reduced apheresis platelets collected by the use of a new technology, fluidized particle-bed separation. STUDY DESIGN AND METHODS: In phase 1, six suitable donors underwent two separate plateletpheresis procedures on one occasion, each separated by less than 10 minutes. In random order, a control unit was collected with the COBE Spectra and a test unit with the Spectra Leukocyte-Reduction System (LRS). The quality of apheresis platelet components was assessed by an in vitro test panel, and residual WBCs were counted by Nageotte chamber and flow cytometric methods. For the in vivo studies, the test and control units were randomly labeled with either 51Cr or 111In at the end of storage and transfused simultaneously to the donor. Samples were taken for calculation of platelet survival and recovery. In phase II, 109 thrombocytopenic patients were given platelets collected by use of the Spectra LRS. RESULTS: Test platelets had significantly fewer residual WBCs (median 7.6 x 10(4)) than control platelets (median 3.9 x 10(5)), with equivalent in vitro function values. Test and control platelets had similar recovery and survival. Transfused platelets collected by use of the LRS achieved a mean 1-hour corrected-count increment of 19.3. CONCLUSION: The LRS collects platelet components with significantly lower WBC contamination without adverse effects on the function or in vivo survival of the platelets.     

温心胶囊对慢性心功能不全大鼠心功能和心肌基质金属蛋白酶组织抑制物-1表达的研究

研究温心胶囊对慢性心功能不全(CCI)大鼠心功能和心肌基质金属蛋白酶组织抑制物-1(TIMP—1)表达的影响,探讨TIMP—1在CCI发病中的作用及该胶囊防治CCI心肌重塑的作用机理。采用皮下注射异丙肾上腺素(ISO)法制备CCI模型,随机分为模型组、阳性药对照组、温心胶囊低、高剂量组,每组12只;另设空白组12只。各组相应处理6周后,检测血流动力学、胶原表达、心肌TIMP-1表达变化。结果：温心胶囊能提高CCI大鼠dp／dtmin、dp／dtmax和LVSP水平。降低LVEDP水平;减低心脏重量指数,改善胶原改建;提高下调的TIMP-1表达。结论：温心胶囊能明显改善CCI大鼠心肌收缩和舒张功能,抑制细胞外基质重塑,可能与其上调TIMP-1蛋白表达有关。     

复方斑蝥注射液对人肝癌细胞SMMC-7721的生长抑制作用

目的:探讨复方斑蝥注射液(Compound Cantharis Injection,CCI)对人肝癌细胞SMMC-7721生长抑制作用.方法:分别用用MTT法和细胞生长曲线研究CCI对人肝癌细胞SMMC-7721增殖的抑制作用.结果:与阴性对照组比较,CCI在2mg/ml、4mg/ml、8mg/ml、16mg/ml剂量时对肝癌SMMC-7721细胞的生长抑制率分别为11.63%、20.54%、38.11%、62.44% (P<0.05);平均半数抑制浓度(IC50)为11.29mg/ml.生长曲线结果显示:CCI对肝癌细胞的抑制作用且呈明显的量效和时效关系.结论:CCI能显著抑制人肝癌细胞SMMC-7721生长,具有一定的剂量依赖性.     

Prognostic utility of a geriatric nutritional risk index in combination with a comorbidity index in elderly patients with diffuse large B cell lymphoma

Reflecting the increasing risk in elderly patients with diffuse large B cell lymphoma (DLBCL), prognostic predictors other than the International Prognostic Index have attracted more attention. This study presents the first analysis of the prognostic utility of the Geriatric Nutritional Risk Index (GNRI) in combination with the Charlson Comorbidity Index (CCI) for overall survival (OS) in elderly DLBCL patients. A multicentre retrospective was conducted on a cohort of 451 patients (≥65 years). The GNRI and CCI were independent predictors in a multivariate Cox proportional hazard model. There was a nonlinear correlation between the GNRI and OS in a Cox model with restricted cubic spline. Multivariate receiver operating characteristic curves showed a significant improvement in prediction accuracy when the GNRI was added to CCI. Adding the GNRI to CCI yielded a significant category‐free net reclassification improvement (0·556; 95% CI: 0·378–0·736, P < 0·001) and integrated discrimination improvement (0·094; 95% CI: 0·067–0·122, P < 0·001). The decision curve analysis demonstrated the clinical net benefit associated with the adoption of the GNRI. The GNRI was not only a predictor of OS but also remarkably improved the prognosis prediction accuracy when incorporated with the CCI, having the ability to stratify the prognosis of elderly DLBCL patients.     

Association between a cannabinoid receptor gene (CNR1) polymorphism and cannabinoid-induced alterations of the auditory event-related P300 potential

The biochemical sequelae that follow traumatic brain injury (TBI) are numerous and affect many different brain functions at different points of time as the secondary cascades progress. The complexity of the resulting pathophysiology is such that a singular therapeutic intervention may not provide adequate benefit and a combination of drugs targeting different pathways may be needed. Two of the most widely studied injury mechanisms are oxidative stress and inflammation. Numerous studies have suggested that pharmacological agents targeting either of these pathways may produce an improvement in histological and functional outcome measures. We hypothesized that combining melatonin, a potent antioxidant, with minocycline, a bacteriostatic agent that also inhibit microglia, would provide better neuroprotection than either agent used alone. To test this hypothesis, we subjected anesthetized adult male rats to a 1.5mm controlled cortical impact and administered melatonin or vehicle in the acute post-injury period followed by daily minocycline or vehicle injections beginning the following day in a 2×2 study design. The animals were allowed to recover for 5 days before undergoing Morris water maze (MWM) testing to assess cognitive functioning following injury. There was no significant difference in MWM performance between the vehicle, melatonin, minocycline, or combination treatments. Following sacrifice and histological examination for neuroprotection, we did not observe a significant difference between the groups in the amount of cortical tissue that was spared nor was there a significant difference in [(3)H]-PK11195 binding, a marker for activated microglia. These results suggest that neither drug has therapeutic efficacy, however dosing and/or administration issues may have played a role.     

Airway stenting: Applications and practice management considerations

BACKGROUND: Airway stenting is a procedure that is performed increasingly often, and the availability of metallic stents placed by flexible bronchoscopy may have contributed to the increased usage. These procedures have an impact on the required physician skill set and practice management. We review the indications for airway stenting, and how the requirement of combined therapies and technical aspects of central airway stenting pertain to practice management. PROCEDURE: We compared several reimbursement scenarios for managing stent placement using the Centers for Medicare and Medicaid Services relative value units (RVUs) and average reimbursement amounts. We also compared the reimbursement to other commonly performed activities performed by pulmonary and critical care physicians. An analysis of Medicare facility outpatient and inpatient payment for procedures using silicone and metallic stents was also conducted. RESULTS: Professional reimbursement is identical regardless of stent type, method of insertion, and anesthesia administered. The net facility reimbursement largely depends on stent costs. The RVUs alone are a poor comparator for the reimbursement of therapeutic bronchoscopy because of Correct Coding Initiatives edits. Considering the time necessary for performing advanced therapeutic bronchoscopy, the professional fees are not attractive. The net facility reimbursement largely depends on stent costs. CONCLUSION: The placement of airway stents is not reimbursed at competitive rates and may even lead to a net loss for the facility. The practice management benefits of central airway therapy are probably best obtained by a multidisciplinary airway team with an established cost center structure.     

Post-ICU mechanical ventilation at 23 long-term care hospitals: a multicenter outcomes study

STUDY OBJECTIVES: This multicenter study was undertaken to characterize the population of ventilator-dependent patients admitted to long-term care hospitals (LTCHs) with weaning programs, and to report treatments, complications, weaning outcome, discharge disposition, and survival in these patients. DESIGN: Observational study with concurrent data collection. SETTING: Twenty-three LTCHs in the United States. PATIENTS: Consecutive ventilator-dependent patients admitted over a 1-year period: March 1, 2002, to February 28, 2003. RESULTS: A total of 1,419 patients were enrolled in the Ventilation Outcomes Study. Median age of patients was 71.8 years (range, 18 to 97.7 years). Patients averaged 6.9 procedures and treatments during the LTCH hospitalization; median length of stay was 40 days (range, 1 to 365 days). Seven of the 10 most frequent complications treated at the LTCH were infections; congestive heart failure and diabetes mellitus were the most common comorbidities requiring treatment. Outcomes of weaning attempts, scored at LTCH discharge, were 54.1% weaned, 20.9% ventilator dependent, and 25.0% deceased. Median time to wean (n = 766) was 15 days (range, 7 to 30 days). Discharge disposition included 28.8% to home, 49.2% to rehabilitation and extended-care facilities, and 19.5% to short-stay acute hospitals. Nearly one third of patients were known to be alive 12 months after admission to the LTCH. CONCLUSIONS: Patients admitted to LTCHs for weaning attempts were elderly, with acute-on-chronic diseases, and continued to require considerable medical interventions and treatments. The frequency and type of complications were not surprising following prolonged and aggressive ICU interventions. In the continuum of critical care medicine, more than half of ventilator-dependent survivors of catastrophic illness transferred from the ICU were successfully weaned from prolonged mechanical ventilation in the setting of an LTCH.     

Neuroprotective effects of acetyl-L-carnitine on neuropathic pain and apoptosis: a role for the nicotinic receptor

Several pathologies related to nervous tissue alterations are characterized by a chronic pain syndrome defined by persistent or paroxysmal pain independent or dependent on a stimulus. Pathophysiological mechanisms related to neuropathic disease are associated with mitochondrial dysfunctions that lead to an activation of the apoptotic cascade. In a model of peripheral neuropathy obtained by the loose ligation of the rat sciatic nerve, acetyl-L-Carnitine (ALCAR; 100 mg/kg intraperitoneally [i.p.] twice daily for 14 days) was able to reduce hyperalgesia and apoptosis. In the present study, different mechanisms for the analgesic and the antineuropathic effect of ALCAR are described. The muscarinic blocker atropine (5 mg/kg i.p.) injected simultaneously with ALCAR did not antagonize the ALCAR antihyperalgesic effect on the paw-pressure test but significantly reduced the analgesic effect of ALCAR. Conversely, the antineuropathic effect of ALCAR was prevented by cotreatment with the nicotinic antagonist mecamylamine (2 mg/kg i.p. twice daily for 14 days). A pharmacological silencing of the nicotinic receptors significantly reduced the X-linked inhibitor of apoptosis protein-related protective effect of ALCAR on the apoptosis induced by ligation of the sciatic nerve. Taken together, these data highlight the relevance of nicotinic modulation in neuropathy treatment.