Cryosupernatant and solvent detergent fresh-frozen plasma (Octaplas) usage at a single centre in acute thrombotic thrombocytopenic purpura

BACKGROUND

Thrombotic thrombocytopenic purpura (TTP) is an acute, life-threatening disorder and plasma exchange (PEX) remains the mainstay of treatment.

METHODS

We reviewed 50 acute TTP episodes to establish the efficacy and safety of cryosupernatant (CPP) and Octaplas.

RESULTS

Twelve episodes used CPP only and 15 episodes started with CPP and changed to Octaplas. Once Octaplas had been used, it was continued on further admissions. Cryosupernatant was used exclusively in 24% and Octaplas exclusively in 42% of all episodes. The number of citrate reactions and allergic (plasma) reactions were halved in those receiving only Octaplas compared with cryosupernatant. There were 22 line infections and in approximately 70% of cases the infection was associated with a reduction in platelet count. In all 50 episodes, the only documented thrombosis was a superficial non-central vein. In episodes receiving only cryosupernatant or Octaplas, there was no significant difference in the median number of PEX to remission, 7.0 (interquartile range, IQR 5-8.8) and 8.0 (IQR 6.5-22), respectively. Baseline viral screen in all episodes was negative after discharge following an acute episode.

CONCLUSION

There was no difference in number of PEX to remission with cryosupernatant and solvent/detergent fresh-frozen plasma (Octaplas). However, allergic/urticarial and citrate reactions were more common with cryosupernatant. There was no documented viral transmission with either product.

The effects of training in nonaversive behavior management on the attitudes and understanding of direct care staff

Recent developments in behavior therapy for persons with developmental disabilities and behavior disorders emphasize positive treatment designs that focus on understanding the causes of behavior, teaching functional alternatives, and enhancing the quality of daily experiences, rather than simple contingency management. There is little information on how well direct care staff can support these nonaversive strategies. This study examined the effects of training in traditional (positive) behavior management versus nonaversive principles on the understanding and attitudes of direct care staff. Overall, nonprofessional level staff receiving the nonaversive training showed increased sophistication in understanding the range of possible causes of behavior and were able to generate treatment suggestions based on skill development and environmental change. The effectiveness of staff in implementing state-of-the-art behavior therapy procedures is likely to be an important component of the continued success of behavior therapy, especially in residential settings, both institutional and community-based.

A Phase Ib open label, randomized, safety study of SANGUINATE™ in patients with sickle cell anemia

Background

Treatment of sickle cell anemia is a challenging task and despite the well understood genetic and biochemical pathway of sickle hemoglobin, current therapy continues to be limited to the symptomatic treatment of pain, supplemental oxygen, antibiotics, red blood cell transfusions and hydroxyurea. SANGUINATE is a carbon monoxide releasing molecule and oxygen transfer agent under clinical development for the treatment of sickle cell anemia and comorbidities.

Methods

An open-label randomized Phase Ib study was performed in adult sickle cell anemia patients. Two dose levels of SANGUINATE were compared to hydroxyurea in 24 homozygotes for Hb SS. Twelve subjects received either a low dose (160 mg/kg) of SANGUINATE or 15 mg/kg hydroxyurea. Another 12 subjects received either a high dose (320 mg/kg) of SANGUINATE or 15 mg/kg hydroxyurea. The primary endpoint was the safety of SANGUINATE versus hydroxyurea in sickle cell anemia patients. Secondary endpoints included determination of the plasma pharmacokinetics and assessment of hematologic measurements.

Results

Musculoskeletal related adverse events were the most common. Transient troponin I levels increased in three patients, one of whom had an increase in tricuspid regurgitant velocity; however, no clinical signs were noted. Following an assessment of vital signs, tricuspid regurgitant velocity, electrocardiogram, serum biochemistry, hematology, urinalysis, and analysis of reported adverse events, SANGUINATE was found to be safe in stable sickle cell anemia patients.

Conclusions

The clinical trial met its primary objective of demonstrating an acceptable safety profile for SANGUINATE in patients with sickle cell anemia. This trial established the safety of SANGUINATE at both dose levels and permitted its advance to Phase II trials.

A Phase I study to determine safety, pharmacokinetics, and pharmacodynamics of ANF-RHO™, a novel PEGylated granulocyte colony-stimulating factor, in healthy volunteers

Patients receiving pegfilgrastim (Neulasta®) for the treatment of neutropenia can experience bone pain following the injections required to achieve effective neutrophil levels. The safety, pharmacokinetic (PK), and pharmacodynamic (PD) profiles of ANF-RHO™, a novel pegylated granulocyte colony stimulating factor, were assessed in a randomized, controlled, double-blind Phase 1 clinical study in healthy volunteers. Subjects received a single subcutaneous dose of ANF-RHO over a range of 6 doses (5-50 μg/kg), placebo (saline), or the recommended clinical dose of pegfilgrastim administered at the labeled fixed 6 mg dosage (equivalent to 80-100 μg/kg). The primary outcome measure was safety and tolerability. Secondary outcomes included PK and PD effects on absolute neutrophil count (ANC) and number of CD34+ progenitor cells. Severity of bone pain was also assessed. In healthy volunteers, ANF-RHO was administered at ascending doses up to 50 μg/kg without significant adverse effects; appeared to be better (5 to 30 μg/kg) or equally well (50 μg/kg) tolerated, and had lower mean bone pain scores as compared to pegfilgrastim. ANF-RHO achieved CD34+ and ANC numbers at significantly lower doses, and had a significantly longer circulating half-life than pegfilgrastim. These results suggest that ANF-RHO can be provided less frequently, at a lower dose, and with fewer side effects. ANF-RHO had unique, prolonged PK/PD attributes as compared to marketed pegfilgrastim, suggesting that it may provide an improved clinical benefit in further clinical studies in patients with chemotherapy-induced or chronic idiopathic neutropenia.

Quadrupole transition strength in the (74)Ni nucleus and core polarization effects in the neutron-rich Ni isotopes

The reduced transition probability B(E2;0(+)→2(+)) has been measured for the neutron-rich nucleus (74)Ni in an intermediate energy Coulomb excitation experiment performed at the National Superconducting Cyclotron Laboratory at Michigan State University. The obtained B(E2;0(+)→2(+))=642(-226)(+216)  e(2) fm(4) value defines a trend which is unexpectedly small if referred to (70)Ni and to a previous indirect determination of the transition strength in (74)Ni. This indicates a reduced polarization of the Z=28 core by the valence neutrons. Calculations in the pfgd model space reproduce well the experimental result indicating that the B(E2) strength predominantly corresponds to neutron excitations. The ratio of the neutron and proton multipole matrix elements supports such an interpretation.

Computerized Braille Production: A Producer's Viewpoint

Describes the computerized braille production system installed in the Royal N.S. W. Institute for Deaf and Blind Children. Over 500 original volumes of braille have been produced. The system has been upgraded to twice its original capacity and the staff increased to ten persons. The benefits and the disadvantages of the computerized approach are described.