Current status of additive solutions for platelets

The storage of platelets in additive solution (PAS) had lagged behind red cell concentrates, especially in North America. The partial or complete removal of anticoagulated plasma and storage of platelet concentrates in AS presents many advantages. The PAS can be formulated to optimize aerobic metabolism or decrease platelet activation, thus abrogating the platelet storage lesion and potentially improving in vivo viability. Plasma removal has been shown to reduce allergic reactions and the plasma harvested could contribute to the available plasma pool for transfusion or fractionation. PAS coupled to pathogen reduction technology results in a platelet product of equivalent hemostatic efficacy to conventionally stored platelets. Given the above, the likely future direction of platelet storage will be in new generation designer PAS with an extended shelf life and a superior safety profile to plasma stored platelets. J. Clin. Apheresis, 2012. © 2012 Wiley Periodicals, Inc.

Adjudicating bleeding events in a platelet dose study: impact on outcome results and challenges

BACKGROUND

In the SToP platelet dose study, the World Health Organization (WHO) bleeding grade was assigned using adjudication. This study describes the challenges associated with adjudicating bleeding events and compares the adjudicated and bedside results for bleeding grade.

STUDY DESIGN AND METHODS

To categorize bleeding, the following information was provided to adjudicators: daily bleeding assessments, interventions to stop or control bleeding, daily blood counts, and transfused blood components. Each daily assessment was sent to two adjudicators who independently assigned a grade and anatomic site of bleeding. Discordant cases where disagreement occurred were sent to a third adjudicator and subsequently to a fourth or fifth adjudicator in an attempt to reach agreement. Disagreement after five adjudicators was resolved by consensus. The final adjudicated grade was compared with the grade of bleeding assigned at the bedside by study personnel.

RESULTS

A total of 1150 case report forms were adjudicated. Disagreement on grade of bleeding was common: 31.2% after the first two adjudicators, 4.0% after the third adjudicator, 0.7% after four, and 0.05% after five. Disagreement on anatomic site was less but still occurred in 17% of cases after two adjudicators. The frequency of bleeding (≥ Grade 2) based on adjudication was higher than bedside grading (standard-dose arm, 47.5% vs. 34.4%; low-dose arm, 50.0% vs. 43.1%).

CONCLUSION

The frequency of WHO bleeding varies depending on the method used to assign grade. Adjudication to assign bleeding grade resulted in significant disagreement when two adjudicators were used.

Stored red blood cell supernatant facilitates thrombin generation

BACKGROUND

Observational studies have reported that patients transfused with red blood cells (RBCs) have a worse clinical outcome than untransfused patients and that storage age of RBCs at the time of transfusion may be an independent predictor of this adverse clinical outcome.

STUDY DESIGN AND METHODS

Eight RBC concentrates in additive solution were studied over an 8-week storage period. The RBC supernatant was ultracentrifuged to concentrate microvesicles (RCMVs). RCMVs were studied by flow cytometry to identify phosphatidylserine (PS)-expressing RCMVs and in a thromboelastograph (TEG) using a modified assay to detect a thrombin facilitation effect.

RESULTS

For all products, the percentage of RCMVs that exhibited PS expression on Day 1 was 50 ± 13%, which increased with storage, and on Day 31 was 90 ± 4%. After 31 days, four of the eight products showed a thrombin facilitation effect as evidenced by a shortening of the TEG reaction (R) time of 1.3 ± 1.1 minutes, which persisted to Day 41. Data are the mean ± 1 SD. This TEG R shortening effect was neutralized by annexin V. No such effect was observed on, or before, Day 21.

CONCLUSIONS

Some stored RBCs release RCMVs, which express PS and are capable of facilitating thrombin generation in vitro. This provides a possible mechanism by which stored RBCs could promote adverse thrombotic or inflammatory effects.

Young students' use of the Internet for mental health information and support

It is recognized that young people experience difficulties in accessing mainstream mental health services particularly because of the stigma that remains associated with mental health problems. One potential solution is to use the many websites available offering information and support for mental health problems, such support and information could be offered by Psychiatric Nurses. However, young peoples' usage and views on using the Internet for this purpose has yet to be examined. This quantitative descriptive study aimed to elicit the views of 922 University students, aged between 18 and 24 years, on using the Internet for mental health information and support. Data were collected using a 30-item self-designed questionnaire and analysed using descriptive statistics. The findings indicated that 72.4% of participants used the Internet several times a day. In addition, 30.8% had previously searched for mental health information online, predominantly on depression. While it was found that 68% of participants indicated that they would use the Internet for mental health support if they needed to, 79.4% would still prefer face to face support. It is concluded that young people are willing to use the Internet for mental health information and that it represents a viable source of support for this age group.

Transfusion-transmitted babesiosis in Rhode Island

BACKGROUND

Babesiosis is caused by an intraerythrocytic protozoan transmitted by ticks. Blood transfusion is another mode of transmission.

STUDY DESIGN AND METHODS

This was a retrospective study based on babesiosis cases reported to the Rhode Island Department of Health between 1999 and 2007. Additional cases were also identified.

RESULTS

Twenty-one cases of transfusion-transmitted babesiosis (TTB) were identified from 1999 through 2007. From 2005 through 2007, the incidence approached one case per 9000 units of blood transfused. One of 21 (5%) TTB cases was diagnosed in July, in sharp contrast to 65 of 152 (43%) of the total babesiosis cases diagnosed during July in Rhode Island. Many cases were identified when a complete blood count with a differential was routinely requested and parasites were noted by laboratory technologists. Most patients with TTB had underlying conditions known to predispose to symptomatic infection.

CONCLUSION

Blood transfusion is an important mode of Babesia transmission. The current screening method of omitting donors with a history of babesiosis may be effective in preventing some, but not all, cases of TTB and current processing of blood products does not eradicate this parasite. Thus, a better screening test is needed. Alternatively, pathogen reduction technology could be utilized to prevent this mode of transmission.

Estimation of effective and functional cortical connectivity from neuroelectric and hemodynamic recordings

In this paper, different linear and nonlinear methodologies for the estimation of cortical connectivity from neuroelectric and hemodynamic measurements are reviewed and applied on common data set in order to highlight similarities and differences in the results. Different effective and functional connectivity methods were applied to motor and cognitive data sets, including structural equation modeling (SEM), directed transfer function (DTF), partial directed coherence (PDC), and direct directed transfer function (dDTF). Comparisons were made between the results in order to understand if, for a same dataset, effective and functional connectivity estimators can return the same cortical connectivity patterns. An application of a nonlinear method [phase synchronization index (PSI)] to similar executed and imagined movements was also reviewed. Connectivity patterns estimated with the use of the neuroelectric information and of the information from the multimodal integration of neuroelectric and hemodynamic data were also compared. Results suggests that the estimation of the cortical connectivity patterns performed with the linear methods (SEM, DTF, PDC, dDTF) or with the nonlinear method (PSI) on movement related potentials returned similar cortical networks. Differences in cortical connectivity were noted between the patterns estimated with the use of multimodal integration and those estimated by using only the neuroelectric data.

The suitability of hemolyzed specimens for compatibility testing using automated technology

BACKGROUND

Blood banks have historically rejected hemolyzed specimens for ABO type and antibody screen based on concerns of artifactual interference with test performance or the detection of incompatibility. Samples from emergency departments (EDs) are commonly discarded due to hemolysis or mislabeling.

STUDY DESIGN AND METHODS

This study investigated whether hemolysis produced via experimental mechanical stress has a threshold for introducing discrepancy in ABO-Rh typing and antibody screening using an automated gel testing system (ProVue, Ortho-Clinical Diagnostics, Inc.).

RESULTS

Twenty-three samples from healthy subjects were shown to have threshold supernatant hemoglobin (Hb) levels producing discrepancy in the results for both ABO reverse type and antibody screen at 75 and 125 mg per dL, respectively. Above these levels of Hb, both tests became uninterpretable and reported as "no result determined." Twenty of 31 positive antibody screens became uninterpretable after experimental hemolysis without any threshold supernatant Hb being evident, likely explained by the duration of specimen storage before experimental hemolysis. No false-positive or false-negative samples were observed in the antibody screen of the hemolyzed specimens.

CONCLUSIONS

Properly collected hemolyzed specimens present an opportunity for ABO-Rh forward typing, and a significant proportion of such specimens give valid (concordant) results for reverse type and antibody screen. Our data, although device-specific, are adequate to suggest that sample discard and recollection due to hemolysis in blood bank specimens should be reconsidered with potential benefits for patient safety and efficiency.

In vitro evaluation of prestorage pools consisting of mixed A and O platelet concentrates

BACKGROUND

Current FDA regulations allow the prestorage pooling of whole blood-derived platelet concentrates (PCs) of identical ABO type in a recently cleared platelet (PLT) pooling bag (Acrodose, Pall Medical). It is unclear how ABO-mixed PC pools would store if pooled before storage.

STUDY DESIGN AND METHODS

Pools consisting of ABO-identical PLTs and mixed A and O PLTs in varying proportions were evaluated on Days 1, 5, and 7 of storage with measures of the PLT storage lesion, lymphocyte activation, and activation of the complement and coagulation system. Data were analyzed by analysis of variance.

RESULTS

Pools did not differ on Day 7 in pH (p = 0.63), hypotonic shock response (p = 0.25), extent of shape change (p = 0.26), morphology score (p = 0.18), or white cell count (p = 0.79), but surface P-selectin expression was more evident in the ABO-mixed pools (p = 0.02). Small microscopic clumps of PLTs were observed in all pools, but were more prominent in the ABO-mixed pools (p < 0.01). PLT counts, however, did not differ between pools (p = 0.93), indicating that only a small proportion of PLTs were clumped. Surface A-antigen expression was proportional to the number of A PCs in each pool and did not vary between study days. Anti-A(1) titers were either unchanged or decreased by one dilution. Complement and coagulation activation markers did not differ between pools.

CONCLUSION

Pooling A and O PCs is associated with evidence of increased microscopic PLT clumping and activation, but these differences are not exacerbated with 7-day storage. Other major measures of PLT quality do not differ, and there was no evidence of a mixed lymphocyte reaction.

Improved estimation of human cortical activity and connectivity with the multimodal integration of neuroelectric and hemodynamic data

In the last decade, the possibility to noninvasively estimate cortical activity and connectivity has been highlighted by the application of the techniques known as high resolution EEG. These techniques include a subject's multi-compartment head model (scalp, skull, dura mater, cortex) constructed from individual magnetic resonance images, multi-dipole source model, and regularized linear inverse source estimates of cortical current density. More recently, it has proved as the use of information from the hemodynamic responses of the cortical areas as revealed by block-designed (strength of activated voxels) fMRI improves dramatically the estimates of cortical activity and connectivity. Here, we present some applications of such estimation in two set of high resolution EEG and fMRI data, related to the motor (finger tapping) and cognitive (Stroop) tasks. We observed that the proposed technology was able to unveil the direction of the information flow between the cortical regions of interest.

Storage of platelet-rich plasma-derived platelet concentrate pools in plasma and additive solution

BACKGROUND

Prestorage pooling of platelet (PLT)-rich plasma (PRP)-derived PLT concentrates (PCs) and storage in either plasma (PS) or an additive solution (AS) is logistically feasible and would result in a product similar to buffy-coat or apheresis PLTs.

STUDY DESIGN AND METHODS

On Day 0, PS PRP PCs were pooled with a sterile connecting device into a new 1.3-L storage container (ELX, PALL Medical). AS-PCs were prepared by addition of a new low-pH glucose-containing AS to the PLT sediment. AS-PCs were pooled into a 1.3-L ELX bag containing four tablets of NaHCO3. PC pools were sampled on Days 1, 5, and 7.

RESULTS

PS pools containing 5 units had a mean PLT yield similar to the AS pools (39 x 10(10) +/- 3 x 10(10) vs. 37 x 10(10) +/- 6 x 10(10); p = 0.25). All pools had WBC counts of less than 1 x 10(6). pH and HCO3 decreased in PS pools with storage, but either increased or remained constant in the AS pools. On Day 7, no differences were seen in morphology score or extent of shape change. Hypotonic shock response was better preserved in the plasma pools (71 +/- 12% vs. 56 +/- 13%, p < 0.01); however, surface P-selectin was expressed less in the AS pools (6 +/- 4% vs. 18 +/- 10%, p < 0.01).

CONCLUSION

Manufacture and storage of PRP-PCs in pools either in plasma or in a glucose-containing AS in this new container are feasible, and there is good preservation of PLT quality to Day 7.

Estrous cycle characterisation and artificial insemination using frozen–thawed spermatozoa in the bottlenose dolphin (Tursiops truncatus)

The reproductive endocrinology of the bottlenose dolphin,Tursiops truncatus,was characterized to facilitate the development of artificial insemination using cryopreserved spermatozoa. Specific objectives were: (i) to determine the excretory dynamics of urinary luteinizing hormone (LH) and ovarian steroid metabolites during the estrous cycle; (ii) to evaluate the effect of an exogenously administered synthetic progesterone analog (altrenogest) on reproductive hormone excretion; (iii) to correlate follicular growth and ovulation (as determined by transabdominal ultrasound) to urinary LH and ovarian steroid metabolites; (iv) examine thein vivofertilisation capacity of cryopreserved semen, and (v) to develop an intrauterine insemination technique. Based on urinary endocrine monitoring of natural estrous cycles (2 consecutive cycles) and nine post altrenogest cycles in ten females, estrous cycles were found to be 36 days long and comprised of an 8 day and 19 day follicular and luteal phase, respectively. Peak estrogen conjugates (EC; 5.4 ± 3.8 ng/mg creatinine (Cr)) occurred 8 h prior to the LH surge (70.9 ± 115.7 ng/mg Cr). The time of ovulation, as determined by ultrasonography, occurred 32.1 ± 8.9 h and 24.3 ± 7.0 h after the onset of the LH surge and LH peak, respectively. Mean preovulatory follicular diameter and circumference were 2.1 ± 0.5 cm and 6.5 ± 1.5 cm, respectively. Of the 27 estrous synchronisation attempts, 13 resulted in an ovulatory cycle, with ovulation occurring 21 days post-altrenogest treatment. Intrauterine (4 of 5) and intracornual (1 of 3) inseminations conducted across eight estrous cycles resulted in five pregnancies (63%), one pregnancy resulted from the use of liquid stored semen, whereas four were achieved using cryopreserved semen. These data provide new information on female bottlenose dolphin reproductive physiology, and demonstrate that the combination of endocrine monitoring and serial ultrasonography contributed to successful AI using liquid-stored and cryopreserved semen.

Estimation of the cortical functional connectivity with the multimodal integration of high-resolution EEG and fMRI data by directed transfer function

Nowadays, several types of brain imaging device are available to provide images of the functional activity of the cerebral cortex based on hemodynamic, metabolic, or electromagnetic measurements. However, static images of brain regions activated during particular tasks do not convey the information of how these regions communicate with each other. In this study, advanced methods for the estimation of cortical connectivity from combined high-resolution electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) data are presented. These methods include a subject's multicompartment head model (scalp, skull, dura mater, cortex) constructed from individual magnetic resonance images, multidipole source model, and regularized linear inverse source estimates of cortical current density. Determination of the priors in the resolution of the linear inverse problem was performed with the use of information from the hemodynamic responses of the cortical areas as revealed by block-designed (strength of activated voxels) fMRI. We estimate functional cortical connectivity by computing the directed transfer function (DTF) on the estimated cortical current density waveforms in regions of interest (ROIs) on the modeled cortical mantle. The proposed method was able to unveil the direction of the information flow between the cortical regions of interest, as it is directional in nature. Furthermore, this method allows to detect changes in the time course of information flow between cortical regions in different frequency bands. The reliability of these techniques was further demonstrated by elaboration of high-resolution EEG and fMRI signals collected during visually triggered finger movements in four healthy subjects. Connectivity patterns estimated for this task reveal an involvement of right parietal and bilateral premotor and prefrontal cortical areas. This cortical region involvement resembles that revealed in previous studies where visually triggered finger movements were analyzed with the use of separate EEG or fMRI measurements.

Theoretical and finite-element investigation of the mechanical response of spinodal structures

In recent years there have been major advances in our understanding of the mechanisms of phase separation in polymer and copolymer blends, to the extent that good control of phase-separated morphology is a real possibility. Many groups are studying the computational simulation of polymer phase separation. In the light of this, we are exploring methods which will give insight into the mechanical response of multiphase polymers. We present preliminary results from a process which allows the production of a two-dimensional finite-element mesh from the contouring of simulated composition data. We examine the stretching of two-phase structures obtained from a simulation of linear Cahn-Hilliard spinodal phase separation. In the simulations, we assume one phase to be hard, and the other soft, such that the shear modulus ratio G is large (>or= 10(3)). We indicate the effect of varying composition on the material modulus and on the distribution of strains through the stretched material. We also examine in some detail the symmetric structures obtained at 50% composition, in which both phases are at a percolation threshold. Inspired by simulation results for the deformation of these structures, we construct a "scaling" theory, which reproduces the main features of the deformation. Of particular interest is the emergence of a lengthscale, below which the deformation is non-affine. This length is proportional to G(1/4), and hence is still quite small for all reasonable values of this ratio. The same theory predicts that the effective composite modulus scales also as G(1/4), , which is supported by the simulations.