Transfusion of fresh whole blood stored (4 degrees C) for short period fails to improve platelet aggregation on extracellular matrix and clinical hemostasis after cardiopulmonary bypass

It has recently been shown that the hemostatic effect of 1 unit of fresh whole blood is equivalent to the effect of 8 to 10 platelet units. This study was designed to evaluate the effect of short periods of cold (4 degrees C) storage on the hemostatic effect of fresh whole blood transfusion in 36 patients immediately after cardiopulmonary bypass. Twelve patients (group A) received unrefrigerated fresh whole blood, 12 (group B) received fresh whole blood after 5 hours' storage at 4 degrees C, and 12 (group C) after 24 hours' storage at 4 degrees C. For evaluation of platelet function, a method with an extracellular matrix and an electron microscope was used. The platelet function was graded from 1 to 4, with grade 4 being normal aggregation. Postoperatively, group A patients bled less than groups B and C (267 +/- 42 versus 397 +/- 72 and 601 +/- 172 ml/24 hr, respectively, p less than 0.001) and therefore received fewer blood units (1.4 +/- 0.5 versus 2 +/- 0.9 and 3 +/- 1.4, respectively, p less than 0.01). Five patients of group A (42%) reached grade A aggregation after transfusion of unstored fresh whole blood, compared with two (17%) of group B and none (0%) of group C (p less than 0.01). Posttransfusion platelet count and mean platelet volume were not significantly different in the three groups. We conclude that storage at 4 degrees C, even for a short period of 5 hours, diminishes the hemostatic effect of fresh whole blood by decreasing platelet aggregability.     

A Typology of ICU Patients and Families from the Clinician Perspective: Toward Improving Communication

This paper presents an exploratory case study of clinician–patient communications in a specific clinical environment. It describes how intensive care unit (ICU) clinicians’ technical and social categorizations of patients and families shape the flow of communication in these acute care settings. Drawing on evidence from a year-long ethnographic study of four ICUs, we develop a typology of patients and families as viewed by the clinicians who care for them. Each type, or category, of patient is associated with differing communication strategies, with compliant patients and families engaged in greater depth. In an era that prioritizes patient engagement through communication for all patients, our findings suggest that ICU teams need to develop new strategies for engaging and communicating with not just compliant patients and families, but those who are difficult as well. We discuss innovative methods for developing such strategies.     

Sentinel Lymph Node Biopsy in Pregnant Women with Breast Cancer

Background

Sentinel lymph node biopsy (SNB) in pregnant women with breast cancer is uncommonly pursued given concern for fetal harm. This study evaluated efficacy and safety outcomes in pregnant breast cancer patients undergoing SNB.

Methods

Patients who underwent SNB while pregnant were identified from a retrospective parent cohort of women diagnosed with breast cancer during pregnancy. Chart review was performed to tabulate patient/tumor characteristics, method/outcome of SNB, and short-term maternal/fetal outcomes.

Results

Within a cohort of 81, 47 clinically node-negative patients had surgery while pregnant: 25 (53.2 %) SNB, 20 (42.6 %) upfront axillary lymph node dissection, and 2 (4.3 %) no lymph node surgery. Of SNB patients, 8, 9, and 8 had SNB in the first, second, and third trimesters, respectively. 99 m-Technetium (99-Tc) alone was used in 16 patients, methylene blue dye alone in 7 patients, and 2 patients had unknown mapping method. Mapping was successful in all patients. There were no SNB-associated complications. At a median of 2.5 years from diagnosis, there was one locoregional recurrence, one new primary contralateral tumor, three distant recurrences, and one breast cancer death. Among patients who underwent SNB, there were 25 liveborn infants, of whom 24 were healthy, and 1 had cleft palate (in the setting of other maternal risk factors).

Conclusions

SNB in pregnant breast cancer patients appears to be safe and accurate using either methylene blue or 99-Tc. This is one of the largest reported experiences of SNB during pregnancy; however, numbers remain limited. SNB rates in this cohort were lower than in non-pregnant breast cancer patients.     

NF-kappaB regulates the response of embryonic cells to heat shock.

NF-kappaB was shown previously to regulate apoptotic cell death processes in various experimental systems. However, its role in controlling teratogen-induced cell death has not been established yet. Therefore, the objective of the present study was to explore the involvement of the p65 subunit of NF-kappaB in the response of mouse embryonic fibroblasts (MEFs) to heat shock, using p65 knockout (p65-/-) cells. Indeed, we found p65-/- MEFs to be more susceptible to the exposure to heat shock, as compared with wild-type (WT) MEFs, as they demonstrated a more prominent decrease in cell survival and proliferation as well as the appearance of cells undergoing apoptotic cell death. These heat-shock-induced effects were preceded by a decrease in p65 expression in WT cells, which was accompanied by a decrease in IkappaBalpha expression in WT MEFs, while disappearing completely in p65-/- MEFs and accordingly, by an increase in p-IkappaBalpha expression in both cell lines, which was found to be more prominent in p65-/- MEFs. Interestingly, the heat shock-induced decrease in p65 expression was accompanied by an increase in HSP70 expression in both cell lines. However, it was again found to be more prominent in p65-/- MEFs. Taken together, our results suggest a protective role for the p65 subunit of NF-kappaB in mechanisms underlying the response of embryonic cells to heat shock.     

Cellular functions related to metastasis differing between low- and high-malignancy variants of AKR lymphoma.

Two AKR lymphoma variants of low (LM) and high (HM) malignancy were characterized for cell properties important for metastatic capacity. Previous data suggested that these murine lymphoma variants differed in the late phase of metastasis. In the present study we attempted to determine more accurately the stage in which they differ. The HM cells attached less efficiently than the LM ones to both endothelial cells (5 times) and extracellular matrix (twice), possibly indicating a more efficient extravasation capacity of the HM cells. The level of heparinase was low in the two variant cells. Attachment to liver sections was, however, more efficient with the HM than with the LM cells.     

Concordance of three measures of cocaine use in an arrestee population: hair, urine, and self-report.

This article reports on the comparison of self-reported cocaine use with urinalysis outcomes and radioimmunoassay of hair samples for cocaine. The data is based on a voluntary sample of approximately 300 arrestees, tested and interviewed anonymously. The study reports high rates of request compliance for both urine and hair samples, and affirms a relatively high degree of underreporting of cocaine use. Radioimmunoassay of hair appears to detect considerably larger degrees of cocaine use than are detected by urinalysis. The differential rates of detection between hair and urine are less dramatic in subjects who appear to be high rate users.     

Immunostimulation increases the resistance of mouse embryos to the teratogenic effect of diabetes mellitus

Summary The present work was aimed to assess the possible effect of stimulation of the maternal immune system on the teratogenic potential of diabetes mellitus. ICR female mice were immunized with splenocytes of male rats 3 weeks before the beginning of mating and were injected with 240 mg/kg streptozocin (STZ) 10 days after immunization. Females with blood glucose levels over 27.8 mmol/l and HbA_{1 c} levels over 6 standard deviations (SD) above the mean of intact animals were used for teratological studies. The rate of malformed fetuses, resorptions and fetal weights were evaluated for animals killed on day 19 of pregnancy using routine teratological methods. Also, phenotyping of spleen cells of these females was performed by fluorescein activated cell sorter analysis. Two main effects possibly due to immunostimulation of ICR females were observed: 1) immunostimulated females had significantly fewer litters with malformed fetuses than non-immunized females: only 4 litters out of 22 (18 %) compared to 10 out of 16 (63 %). Correspondingly, the incidence of malformed fetuses was also decreased: 2.1 compared to 8.9 %; 2) a significant increase in the pregnancy rate in immunized diabetic ICR mice: 69 % as compared to 44 % in non-immunized diabetic females. Also, immunostimulation resulted in a visible increase in spleen cellularity and a certain increase in the number of cells with mature T-cell and macrophage surface markers. These results strongly suggest that immunostimulation increases the tolerance of ICR females to the teratogenic effect of STZ-induced diabetes. [Diabetologia (1997) 40: 635–640] Received: 23 December 1996 and in revised form: 4 March 1997     

Soluble Galactose Content of Selected Baby Food Cereals and Juices

To provide information necessary for managing the diets of infants with galactosemia, the amount of galactose, in its unconjugated monomeric form, was quantified via capillary gas chromatography/mass spectrometry in selected baby food cereals and juices. Apple and orange baby fruit juices had the highest galactose content, typically over 2 mg/100 g of juice. Pear and white grape juices contained less than 1.5 mg/100 g of juice. Of the cereals tested, rice, oatmeal, high protein (containing soy, wheat, and either oat or corn), and mixed (containing oat, wheat, corn, and rice and/or barley) contained less than 1 mg galactose/100 g cereal; some contained no detectable galactose. However, these cereals commercially supplemented with fruit contained elevated levels of galactose, in some cases over threefold.