In vitro evaluation of platelet concentrates, prepared from pooled buffy coats, stored for 8 days after filtration

BACKGROUND: Posttransfusion complications can be prevented by pretransfusion removal of donor white cells from platelet concentrate. The filtration used for this removal seems to have little effect on platelet function and activation, but more information is needed on its effect on function during subsequent long-term storage of concentrate. STUDY DESIGN AND METHODS: The effect of prestorage filtration of buffy coat-prepared platelet concentrates (PCs) on platelet function, metabolism, and activation was investigated. A pool of three PCs, each made of four buffy coats, was split into three equal volumes; two were filtered over two different filters and the third served as a control. Variables monitored immediately after filtration and during the subsequent 8-day storage period at 22 degrees C included aggregation upon stimulation with collagen and/or ADP, platelet adhesion capacity to collagen and fibrinogen in flowing blood, nucleotide content of and nucleobase release by the platelets, expression of activation-dependent antigens, and beta-thromboglobulin release by the platelets. RESULTS: No differences were observed between the PCs filtered over two different filters and the nonfiltered control PCs immediately after filtration and during storage, except for a selective removal (20%) of beta-thromboglobulin by one filter. CONCLUSION: PCs prepared from a pool of four buffy coats can be filtered and subsequently stored for 8 days (starting +/− 24 hours after whole blood collection) without detriment to platelet function, metabolism, or activation.     

A POST-MARKETING SURVEILLANCE STUDY OF ®VOLTAROL 75 mg SR IN THE PRIMARY CARE SETTING

SUMMARY A total of 7438 patients suffering from a wide variety of painful conditions was included in the final analysis of a post-marketing surveillance (PMS) study monitoring the use of Voltarol 75 mg SR in a primary care setting. Follow-up data were collected at visits conducted one, four and 12 months after the initial consultation. Improvement of symptoms was the most common reason for discontinuation of treatment (47% of patients who discontinued). Adverse events led to the withdrawal of 18% of patients overall. The rate of serious gastrointestinal complications was low (0.4%) and deleterious hepatic or renal effects were not apparent. There were significantly more events experienced by female patients and there was a significant effect of age on severe gastrointestinal events. In this PMS study Voltarol 75 mg SR was used successfully once or twice daily without any unexpected adverse effects in a manner consistent with current recommendations for the use of non-steroidal anti-inflammatory drugs.     

Influence of physical activity on the health-related quality of life of young adults with and without autism spectrum disorder

Background: Health-related quality of life constructs has been used to understand the multiple dimensions (i.e., physical health, psychological, environment and social relationships) that affect a person’s health status. In order to improve health-related quality of life for young adults, it is important to understand the factors that influence each dimension. The purpose of this paper was to examine the influence of the presence of autism spectrum disorder and physical activity on the multiple domains of health-related quality of life for young adults.

Methods: Three-hundred and twenty participants, including young adults with ASD, completed a questionnaire about their physical activity and health-related quality of life.

Results: Five multiple regressions revealed that the presence of autism spectrum disorder significantly predicted overall health-related quality of life, the physical health domain, psychological domain, and the environment domain. Additionally, physical activity significantly predicted each domain and overall health-related quality of life regardless of the presence of autism spectrum disorder.

Conclusion: Practitioners should recognize the limitations that individuals with autism spectrum disorder may experience regarding their health-related quality of life, and utilize physical activity as a tool for improving health-related quality of life.

• Implications for Rehabilitation

• In order to address an individual’s overall health, practitioners must consider multiple dimensions of health-related quality of life.

• Autism spectrum disorders influence how people perceive multiple dimensions of their health.

• Physical activity is a tool for improving perceptions of the multiple dimensions of health for individuals with and without autism spectrum disorders.

     

Mass administration of azithromycin and Streptococcus pneumoniae carriage: cross-sectional surveys in the Gambia

Objective

To evaluate the effect of repeated mass drug administration (MDA) of azithromycin in the Gambia on the nasopharyngeal carriage of Streptococcus pneumoniae and on the emergence of antibiotic-resistant strains.

Methods

This study involved villages that participated in a cluster randomized trial comparing the effect of one versus three azithromycin MDA rounds on the prevalence of trachoma. Only villages in which most children received 7-valent pneumococcal conjugate vaccine were included. Three cross-sectional surveys were performed in two villages that received three annual MDA rounds: the first immediately before the third MDA round and the second and third, 1 and 6 months, respectively, after the third MDA round. The third survey also covered six villages that had received one MDA round 30 months previously. Pneumococcal carriage was assessed using nasopharyngeal swabs and azithromycin resistance was detected using the Etest.

Findings

The prevalence of pneumococcal carriage decreased from 43.4% to 19.2% between the first and second surveys (P < 0.001) but rebounded by the third survey (45.8%; P = 0.591). Being a carrier at the first survey was a risk factor for being a carrier at the second (odds ratio: 3.71; P <  0.001). At the third survey, the prevalence of carriage was similar after one and three MDA rounds (50.3% versus 45.8%, respectively; P = 0.170), as was the prevalence of azithromycin resistance (0.3% versus 0.9%, respectively; P = 0.340).

Conclusion

Three azithromycin MDA rounds did not increase the prevalence of nasopharyngeal carriage of azithromycin-resistant S. pneumoniae strains compared with one round.     

Intra-arterial Ultra Low Iodine CT Angiography of Renal Transplant Arteries

Purpose

This study was designed to evaluate the technical feasibility and the image quality of intra-arterial 320-row CT angiography (ia-CTA) in the detection of transplant renal artery stenosis (TRAS) using a very low dose of contrast agent.

Methods

Evaluation of ia-CTA using a 4F catheter in ten patients with impaired renal transplant function and suspected TRAS. Average amount of contrast agent applied was 10 ± 3.7 ml standard deviation (SD). Patient serum creatinine levels had been monitored for 72 h. TRAS was detected and graded (1: less than 20 %; 2: 20–49 %; 3: 50–74 %; 4: 75–99 %; 5: total occlusion) and presence of kinking was recorded. Attenuation and vessel delineation were parameters for image quality analysis of the renal arterial supply, divided into four segments. Subjective image quality.

Results

Ia-CTA of the renal transplant was technically successful in all patients, revealing relevant stenoses in 7 of 10 patients. Serum creatinine levels before and after ia-CTA were 2.71 ± 1.46 and 2.56 ± 1.39 mg/dl, respectively. None of the patients developed signs of contrast-induced nephropathy within 72 h. Subjective image quality was excellent in all four segments, rated by two separate readers. No segment was found to be nondiagnostic. Mean attenuation values in the arterial segments ranged between 754 and 987 Hounsfield units.

Conclusions

Wide detector ia-CTA for the diagnosis of TRAS is feasible using very low doses of contrast agent and results in high image quality.     

Radiologische „report turnaround times“ und Untersuchungszeitpunkte bei Patienten auf Intensivstationen

Aims

The radiological examinations performed in intensive care units (ICUs) were analyzed for the purpose of internal quality control. Data included the type of examination performed, the time of day the examination was performed and the differences in radiologist report turnaround times.

Material and methods

A retrospective analysis of the radiology information system (RIS) database of all radiological examinations performed in the ICU of a large German hospital from 2009 through 2011 was carried out. The search retrieved 75,169 examinations performed in ICU patients which were included in the analysis. The records were analyzed for type of radiological examination performed, i.e. conventional X-ray, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), angiography and nuclear medicine examinations, time of day the examination was performed and the interval between examination and time of reporting and release of the final report.

Results

Cross-modality it took on average 52 min until a report was written and approximately 7 h before the final report was released. Turnaround times were shortest for ultrasound, conventional X-ray and CT. Over the 3-year observation period there was an overall tendency toward shorter turnaround times whereby improvement in time until reporting was most marked for conventional X-ray, MRI and ultrasound (reduction of 24, 17, and 15 min, respectively). The time until release of the final report improved most markedly for CT, conventional X-ray and angiography (improvement of approximately 6.67, 5.08 and 0.78 h, respectively).

Conclusions

During the 3-year observation period a reduction in turnaround times for reporting results and release of finalized reports could be observed, despite an increase in the total number of cases.     

MR guidance and thermometry of percutaneous laser disc decompression in open MRI: an initial clinical investigation

Objectives

To assess the feasibility, safety and efficacy of real-time MR guidance and thermometry of percutaneous laser disc decompression (PLDD).

Methods

Twenty-four discs in 22 patients with chronic low-back and radicular pain were treated by PLDD using open 1.0-T magnetic-resonance imaging (MRI). A fluoroscopic proton-density-weighted turbo spin-echo (PDw TSE) sequence was used to position the laser fibre. Non-spoiled gradient-echo (GRE) sequences were employed for real-time thermal monitoring based on proton resonance frequency (PRF). Radicular pain was assessed over 6 months with a numerical rating scale (NRS).

Results

PLDD was technically successful in all cases, with adequate image quality for laser positioning. The PRF-based real-time temperature monitoring was found to be feasible in practice. After 6 months, 21 % reported complete remission of radicular pain, 63 % at least great pain relief and 74 % at least mild relief. We found a significant decrease in the NRS score between the pre-intervention and the 6-month follow-up assessment (P?<?0.001). No major complications occurred; the single adverse event recorded, moderate motor impairment, resolved.

Conclusions

Real-time MR guidance and PRF-based thermometry of PLDD in the lumbar spine under open 1.0-T MRI appears feasible, safe and effective and may pave the way to more precise operating procedures.

Key Points

? Percutaneous laser disc decompression (PLDD) is increasingly used instead of conventional surgery. ? Open 1.0-T MRI with temperature mapping seems technically successful in monitoring PLDD. ? Pain relief was at least ‘great’ in 64?% of patients. ? No major complications occurred. ? Open 1.0-T MRI appears a safe and effective option for patient-tailored PLDD.     

Percutaneous ablation of lymph node metastases using CT-guided high-dose-rate brachytherapy

Objective:

To assess the technical feasibility, safety and clinical outcome of CT-guided high-dose-rate brachytherapy (CT-HDRBT) for achieving local tumour control (LTC) in isolated lymph node metastases.

Methods:

From January 2008 to December 2011, 10 patients (six males and four females) with isolated nodal metastases were treated with CT-HDRBT. Five lymph node metastases were para-aortic, three were at the liver hilum, one at the coeliac trunk and one was a left iliac nodal metastasis. The mean lesion diameter was 36.5 mm (range 12.0–67.0 mm). Patients were followed up by either contrast-enhanced CT or MRI 6 weeks and then every 3 months after the end of treatment. The primary end point was LTC. Secondary end points included primary technical effectiveness rate, adverse events and progression-free survival.

Results:

The first follow-up examination after 6 weeks revealed complete coverage of all nodal metastases treated. There was no peri-interventional mortality or major complications. The mean follow-up period was 13.2 months (range 4–20 months). 2 out of 10 patients (20%) showed local tumour progression 9 and 10 months after ablation. 5 out of 10 patients (50%) showed systemic tumour progression. The mean progression-free interval was 9.2 months (range 2–20 months).

Conclusion:

CT-HDRBT is a safe and effective technique for minimally invasive ablation of nodal metastases.

Advances in knowledge:

CT-HDRBT of lymph node metastases is feasible and safe. CT-HDRBT might be a viable therapeutic alternative to obtain LTC in selected patients with isolated lymph node metastases.Metastatic spread to lymph nodes is a common event in the course of many thoracic and abdominal malignancies and has considerable clinical implications [1]. The management of metastatic disease is complex, and treatment modalities reported in the literature are heterogeneous, depending largely on the localisation of metastatic nodes as well as the patient’s performance status and treatment history. Hence, the optimal management for patients with isolated lymph node metastasis has not yet been established.Although the results of several studies suggest a potential benefit to the cytoreduction of isolated nodal disease among patients with ovarian, hepatocellular, renal or colorectal carcinoma, data on the role of repeated surgical resection of confined lymph node metastases are limited, and response rates of nodal metastases to chemotherapy are inconsistent [2–7].Over the past decades, interventional oncology has expanded its role, and minimally invasive tumour ablation techniques have become a cornerstone in the multimodal treatment of oncological patients. The clinical success of thermal ablation techniques, such as radiofrequency ablation (RFA), has generated a large body of literature on the treatment of liver and lung tumours, while data on its use for the treatment of lymph node metastases remain scarce. CT-guided high-dose-rate brachytherapy (CT-HDRBT) is a radio-ablative technique that was established about 10 years ago to overcome the limitations of thermal ablative techniques [8]. Features such as high accuracy in dose distribution and applicability regardless of tumour diameter and location have contributed to the attractiveness of this technique. In recent years, several studies have reported encouraging results for the treatment of lung and liver tumours as well as extrahepatic and extrapulmonary malignancies [9–12]. The purpose of the present study is to report the results of CT-HDRBT for achieving local tumour control (LTC) in the treatment of isolated lymph node metastases.     

Using Community-Based Participatory Mixed Methods Research to Understand Preconception Health in African American Communities of Arizona

The article discusses Arizona’s strategic implementation and evaluation of the first time motherhood initiative grant (FTMI) to understand preconception health among African American men and women in Arizona. Longitudinal focus groups assessed whether African American men and women in the targeted areas comprehended and recalled the messages related to preconception health. Matched pre and posttests assessed community members’ knowledge of preconception as well as physicians’ perceptions on preconception health and care. Focus-group data were transcribed and coded by independent coders to conduct content analyses. Inter-rater reliability and agreement among coders, bivariate and multivariate statistics were conducted for quantitative matched pre and posttests data using SAS v9.2 (SAS Institute, Cary, NC). The social marketing campaign had limited impact in recall and comprehension of the preconception health message among African American men and women. Data from focus groups revealed that African American men and women perceived preconception health to be vital. And results from the pretest and posttests of community-based presentations, further supported this finding. Evidence from Grand Round presentations indicated that practitioners and health care providers had diverging views on preconception health. Use of community-based participatory mixed methods research can facilitate better understanding of the efficacy of strategic interventions such as FTMI and can provide valuable information on preconception health. Cost limitations often prohibit extensive evaluation of social marketing campaigns, hence, evaluators and researchers should assess the feasibility of conducting an efficacy study versus an effectiveness study in evaluating social marketing campaigns.