Fresh blood for transfusion in adults with beta thalassaemia.

BACKGROUND: Patients with beta-thalassaemia major require life-long blood transfusion with the aim of achieving normal growth and development whilst minimising iron overload. A pre-transfusion Hb between 9.5 and 10 g/dL is thought to achieve this balance. UK consensus is that fresh blood (less than 14 days) is better at maintaining this target pre-transfusion Hb but there is no firm stipulation in place and no robust evidence supporting this. METHODS: After introduction of a universal fresh blood policy for adult beta-thalassaemics in 2010, we reviewed locally transfused adult patients to determine if there was any significant difference in pre-transfusion Hb using fresh blood. Nine adult thalassaemic patients were analysed for two consecutive 6-month periods in 2009 and 2010 (periods 1 and 2). RESULTS: Mean pre-transfusion Hb was significantly higher by an average of 0.5 g/dL in period 2 than period 1 (P < 0.05). The average unit age was 18 vs 9.5 days for periods 1 and 2 respectively (P < 0.05). There were no significant differences in potential confounders such as transfusion volume (P = 0.06), number of units transfused, ferritin or transfusion interval. DISCUSSION: Use of fresh blood produced significantly higher pre-transfusion Hb, giving credence to UK consensus. Lesser volumes of fresh blood appeared to achieve the target pre-transfusion Hb, which may translate to reduced iron overload and chelation costs. Whether the assumption that the use of blood less than 7 days old in these patients would result in greater benefit requires further study.

A record of recent change in terrestrial sedimentation in a coral-reef environment, La Parguera, Puerto Rico: a response to coastal development?

Increased sediment flux to the coastal ocean due to coastal development is considered a major threat to the viability of coral reefs. A change in the nature of sediment supply and storage has been identified in a variety of coastal settings, particularly in response to European colonization, but sedimentation around reefs has received less attention. This research examines the sedimentary record adjacent to a coastal village that has experienced considerable land-use change over the last few decades. Sediment cores were analyzed to characterize composition and sediment accumulation rates. Sedimentation rates decreased seaward across the shelf from 0.85 cm y(-1) in a nearshore bay to 0.19 cm y(-1) in a fore-reef setting. Data reflected a significant (up to 2x) increase over the last approximately 80 years in terrestrial sediment accumulating in the back-reef setting, suggesting greater terrestrial sediment flux to the area. Reef health has declined, and increased turbidity is believed to be an important impact, particularly when combined with additional stressors.

Akt and Erk signal transduction pathways are early markers of differentiation in dominant and subordinate ovarian follicles in cattle.

Dominant follicles are those that continue to develop and have the potential to ovulate while subordinate follicles regress. Characteristics of dominant follicles include a larger diameter, higher intrafollicular estradiol, and lower IGF-binding protein (IGFBP)-4 concentrations compared with other cohort follicles. Follicle development is regulated by endocrine hormones that act via intracellular signaling pathways. Here, we show the differences in Akt, Erk, c-Jun N-terminal protein kinase, and p-38 signaling pathways between dominant and subordinate follicles at the dominance stage of the follicle wave. However, earlier in the follicle wave (dominant follicle selection), there were only differences in the levels of Akt and Erk signal transduction proteins among dominant and subordinate follicles. Using this profile of Akt and Erk protein expression in granulosa and theca cells of selected dominant follicles compared with subordinate follicles, we suggest a predictive model to identify future dominant and subordinate follicles from the pool of otherwise similar cohort follicles at the time of follicle wave emergence. We conclude that the Erk and Akt signal transduction pathways are important for dominant follicle selection and development and, furthermore, that the observed differences in these pathways mark the future dominant follicle from subordinate follicles before differences in follicular diameter, follicular fluid estradiol, and IGFBP-4 concentrations are apparent.

HEPTEST: a suitable method for monitoring heparin during pregnancy.

Methods of monitoring heparin in pregnancy are problematic. The aim of this study was to assess the plasma HEPTEST as a rapid and reliable test for heparin monitoring in pregnancy. HEPTEST, activated partial thromboplastin time (APTT) and chromogenic anti-Xa assays were performed on individual heparin-spiked plasma samples from two groups: normal non-pregnant women (n = 6) and normal pregnant women during the third trimester (n = 6). Heparin activity curves were established in plasma from both groups for low (< 0.3 IU/ml), intermediate (0.3-0.7 IU/ml) and high (> 0.7 IU/ml) heparin concentrations and validated by comparison with the anti-Xa chromogenic assay. Both the APTT and HEPTEST demonstrated good correlation with anti-Xa levels across all heparin concentrations in both plasma groups (r range = 0.879-0.945). In comparison with the APTT, the HEPTEST showed better correlation with anti-Xa levels at low concentrations of heparin (r values 0.933 vs. 0.772, respectively). For both the APTT and HEPTEST there were significant differences between the clotting times in pregnant and non-pregnant plasma at a number of heparin concentrations. This data supports the plasma HEPTEST as an acceptable alternative to the chromogenic anti-Xa assay for monitoring heparin thromboprophylaxis in pregnancy.

Splenic regrowth in sickle cell anaemia following hypertransfusion.

We describe five adult patients with sickle cell anaemia (SS) who developed clinical, radiological and histological evidence of splenic regrowth while receiving regular blood transfusions. Five patients, all homozygous SS, range 23-34 years, were commenced on hypertransfusion therapy. Three patients were transfused because of severe recurrent vaso-occlusive crises, one for chronic sickle lung and one in an attempt to prevent deterioration of renal function. The mean duration of hypertransfusion prior to documentation of splenic regrowth was 52 months (range 12-97 months). Two patients developed significant hypersplenism. One patient had clinically-apparent splenomegaly and four patients had splenomegaly documented on ultrasound. Splenic regrowth in hypertransfused adults with sickle cell anaemia is not infrequent and may have important clinical implications.

Antithrombotic properties of dermatan sulphate (MF 701) in haemodialysis for chronic renal failure.

The therapeutic potential of the glycosaminoglycan (GAG), dermatan sulphate (DS), as an antithrombotic agent in humans has yet to be established. We have performed dose ranging studies of DS to determine its effectiveness as an antithrombotic agent in patients (n = 6-8) undergoing haemodialysis for chronic renal failure. In an initial study, Study 1, i.v. bolus doses of 2-4 mg/kg and 5-6 mg/kg DS were given to patients dialysing with polyacrylonitrile hollow fibre (PAN HF) membranes. In a second crossover study, Study 2, performed using cuprophane hollow fibre (CHF) membranes, i.v. bolus doses of 3 mg/kg and 6 mg/kg DS were compared to a standard unfractionated heparin (UFH) regime that has been shown previously to inhibit fibrin formation. Further infusion studies, Study 3 and Study 4 evaluated the antithrombotic efficacy of an i.v. DS bolus of 3 mg/kg plus an i.v. infusion of DS 0.6 mg kg-1 h-1 and a DS bolus of 5 mg/kg plus an infusion of 1 mg kg-1 h-1 over 5 h, respectively. These studies were compared to standard UFH regimes in a randomised crossover design. Plasma levels of fibrinopeptide A (FPA) and thrombin-antithrombin (TAT) were used as markers of fibrin formation and thrombin generation during dialysis using both membranes. The changes in DS concentration following administration of the different doses were similar in Studies 1 and 2. However, the effectiveness of DS as an anticoagulant appeared to depend markedly on the different dialyser types used in the two studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Dose finding study of a low molecular weight heparin, Innohep, in haemodialysis.

A pilot investigation was performed with Innohep, a low molecular weight (LMWH) preparation (peak maximum molecular mass 3,000-6,000), to determine possible dose regimens for patients undergoing regular maintenance haemodialysis for chronic renal failure. Results from this study suggested that suppression of macroscopic clot formation and fibrinopeptide A (FPA), a marker of fibrin formation, could be achieved following bolus injections rather than bolus injections and an infusion. On the basis of these preliminary findings, a randomised crossover study was performed in eight patients undergoing regular maintenance haemodialysis for 5-7 h to determine the effective antithrombotic dose of this LMWH. Single i.v. bolus doses of 1,250 AFXa u, 2,500 AFXa u and 5,000 AFXa u (n = 7-8) were compared to an UFH regime of 5,000 iu + 1,500 iu/h. Excessive clot formation in the dialyser bubble trap, necessitating additional UFH to enable completion of a prolonged (up to 7 h) dialysis, was observed in all patients on the 1,250 AFXa u dose (mean duration of dialysis prior to UFH, 3 h) but in a single patient only receiving the other LMWH doses. A dose-related response in the AFXa activity, measured by chromogenic substrate (CS) assay was seen in the three LMWH groups, with levels declining significantly (p less than 0.05) from 1-7 h. This contrasted with the constant levels maintained during dialysis with UFH. FPA levels were significantly elevated after 2 h following the 1,250 AFXa u bolus and after 4 h following the 2,500 AFXa u bolus. There was no significant difference in FPA levels between the 5,000 AFXa u bolus and UFH.(ABSTRACT TRUNCATED AT 250 WORDS)

At the core. A system measures the level of employee commitment to its core values.

Corporate culture has been described as the shared values that drive employee satisfaction and enhance employee commitment to the organization. Therefore system leaders must know the strength of their corporate culture. Sisters of St. Francis Health Services, Inc. (SFHS), wanted to measure whether it had a strong corporate culture based on its stated values. Executives, managers, and physicians completed surveys that assessed employee job satisfaction, commitment to the organization, and perceived strength of the system's culture. The survey achieved a 68 percent response rate. SFHS learned that it had a strong culture based on tradition and that special and unique core corporate values define "systemness" throughout its different facilities. Although each facility serves significantly different functions, leaders throughout the system make everyday decisions using the same core corporate values.

Radioimmunoassay of buprenorphine in urine: studies in patients and in a drug clinic.

A radioimmunoassay kit (DPC buprenorphine double antibody) was evaluated with clinical samples and samples from a drug clinic. Urine samples were collected over a 2-day period from 5 hospital in-patients receiving sublingual buprenorphine, 400 to 2000 micrograms/day, for the relief of chronic pain. Samples were measured before and after enzymatic hydrolysis. Urine buprenorphine concentrations were measurable at all doses studied (minimum value 5.6 ng/mL) and were greater with larger doses. The increase in concentration after hydrolysis averaged 49% and was similar for all doses studied. The authors conclude that the method has extensive cross-reactivity with glucuronides of buprenorphine and its metabolites and that samples may be analyzed without prior hydrolysis. The prevalence of buprenorphine use in 97 patients attending a drug clinic was also studied. Sixty (62%) had measurable urinary buprenorphine concentrations of 1 ng/mL or more by direct assay. The buprenorphine users were significantly younger and reported significantly greater use of opiates than nonusers.