An examination and appreciation of the dimensions of locus of control in psychosis: issues and relationships between constructs and measurement.

Internal locus of control is associated with better psychological outcomes in comparison with external locus of control. Individuals experiencing a psychotic episode have a more external orientation, an externalizing bias for negative events and associations between paranoid delusions and external locus of control. The concept of multidimensional locus of control as measured by the Multidimensional Health Locus of Control (MHLC) scale may provide important information about the nature and course of psychotic symptoms. This narrative review explored the relationship between the orientation of locus of control and psychosis. Few studies have used the scale in samples with people experiencing psychotic symptoms and so there is limited evidence about the psychometric properties of the MHLC scale within this client group, although the findings from studies that have explored the properties of this tool in other groups suggest it could be a valuable instrument for use in psychosis. Further research is required to determine both the relationship between locus of control and psychosis in terms of therapeutic factors and outcome, and also the veracity of the MHLC scale as an instrument of choice in this group.

The effect of overnight storage of leukapheresis stem cell products on cell viability, recovery, and cost.

The cost of harvesting, processing, and freezing multiple peripheral blood stem cell (PBSC) products could easily exceed that of bone marrow harvest. To reduce costs while maintaining product viability, we examined the effect of overnight storage on PBSC products. Sixteen consecutive leukapheresis samples from 12 patients were examined prospectively. Each initial leukapheresis product was stored overnight on ice (median temperature 15 degrees C) after adding an equal amount of M199 culture medium containing heparin. After overnight storage, the product was combined with the next day PBSC harvest if required and processed/frozen per protocols. Parameters measured before and after storage include cell count and differential, viability, bacterial cultures, and colony-forming unit (CFU) assays. The results show that the median cell concentration during storage was 7.12 x 10(7)/ml and the median length of storage was 20 h. After storage, the median viability and nucleated cell recovery were 100% and 99.5%, respectively. In addition, 98% recovery of CFU-GM was achieved. No clotting or bacterial contamination was detected. All 12 patients studied engrafted promptly. In addition, 124 similarly treated patients were retrospectively analyzed. Of these, 48% required > or = 2 large-volume leukaphereses to achieve the target cell dose. As a result of overnight storage, 150 final products, instead of 224, were processed and cryopreserved. This difference is equivalent to 33% cost savings. Again, all patients were transplanted and engrafted successfully. In conclusion, overnight storage and pooling of two consecutive PBSC products are safe, reduce cost, and allow for optimum laboratory staffing.

Measurement of absolute concentration and viability of CD34+ cells in cord blood and cord blood products using fluorescent beads and cyanine nucleic acid dyes.

Conventional flow cytometric methods for CD34+ cell counting may be affected by the high number of nucleated red blood cells or nonviable cells in cord blood and its products. We developed a simple flow cytometric no-wash procedure that avoids these shortcomings because it provides absolute CD34+ cell counts and assesses cell viability. Samples were incubated with phycoerythrin (PE)-labeled anti-CD34 (Becton Dickinson Immunocytometry Systems [BD], San Jose, CA) and peridinin chlorophyll protein (PerCP)-labeled anti-CD45 (BD) in bead-containing TRUCOUNT tubes (BD). After red cell lysis with a fixative-free reagent, the impermeant nucleic acid dye YO-PRO-1 (Molecular Probes, Eugene, OR) was added and samples were analyzed on a single-laser FACSCalibur (BD). A comparison with the ProCOUNT progenitor cell assay (BD) in 57 samples revealed excellent correlation of results (r = 0.98, intercept -0.2 cells/microl, slope 1.01). Precision studies conveyed coefficients of variation of 6.4 and 8.9% at concentrations of 35 and 16 CD34+ cells/microl, respectively. In untreated and leukocyte-enriched cord blood 4.5+/-3.8% of CD34+ cells were stained by YO-PRO-1, representing apoptotic or necrotic cells. In post-thawing cryopreserved samples this number increased to 10.4+/-5.5%. Isotype controls showed very low blank values of viable cells (0.1+/-0.4 cells/microl, maximum 2.4) and seemed unnecessary. We found no washing-related alteration of results in 35 samples, indicating that the method may also be performed with cell washing. Replacing YO-PRO-1 with TO-PRO-3 facilitated four-color analysis of subpopulations of viable CD34+ cells on a FACSCalibur equipped with a second (diode) laser. We found the proposed method to be a rapid, efficient, and flexible procedure that improved validity of CD34+ cell counts.

Increased frequency of autoaggression syndrome associated with autologous stem cell transplantation in breast cancer patients.

In our BMT Unit, we have observed a high frequency of skin rash associated with fever and other clinical findings during engraftment of autologous BM and/or PBSC. Thirty patients with breast cancer and 12 patients with Hodgkin's or non-Hodgkin's lymphoma, treated with the same regimen, were analyzed retrospectively or prospectively to characterize the clinical syndrome, its frequency, and its clinical course, as well as to define the factors affecting its incidence. In patients developing skin rash, the median and range for time to onset of skin rash and for time to increase in WBC after reinfusion of stem cells were identical (8 days, range 5-13) and did not differ significantly (P = 0.533). Twenty-three patients (55%) had skin rash, 18 patients had fever. Other, less frequent manifestations include platelet transfusion refractoriness (PTR), diarrhea, diffuse alveolar hemorrhage, and autoimmune thrombocytopenia or hemolytic anemia. A higher proportion of breast cancer patients developed the syndrome in comparison to lymphoma patients (67% vs 25%, P = 0.051). Acute GVHD grade I-II was established histologically in six patients with the syndrome. Comparison of the incidence of the syndrome by different variables using Fisher's exact test revealed significance for disease category (P = 0.02) and number of previous treatment regimens (P = 0.002) as predictive factors for developing the autoaggression syndrome. In other words, patients with breast cancer and those with only one previous treatment regimen were more likely to develop the syndrome. This study suggests that an autoaggression GVHD-like syndrome accompanies the early phase of autologous engraftment and that a higher frequency of the syndrome might be seen in breast cancer patients undergoing high-dose chemotherapy and autologous stem cell transplantation.

A modified harvest technique for cord blood hematopoietic stem cells.

Human umbilical cord blood is an excellent source of hematopoietic stem cells for research and bone marrow transplantation. We have developed a modified technique which effectively flushes and collects placental derived stem cells. Catheters were inserted into the umbilical artery and vein. Using this sterile and closed system technique, 10 saline diluted cord blood harvests had hematocrits of 16% to 25%, total mononuclear cell counts of 1.17 to 34.4 x 10(8) and volumes of 105-245 ml. The averaged extrapolated colony forming units from five cord blood harvests were as follows: CFU-GM 5.2 x 10(5) (9.96 x 10(4) to 1.24 x 10(6)), BFU-E 8.82 x 10(5) (2.40 x 10(4) to 1.61 x 10(6)) and CFU-GEMM 1.37 x 10(5) (7.33 x 10(3) to 3.18 x 10(5)). This quick technique avoids needle exposure and collects a significant volume of stem cells.

Ramps or stairs: the choice using physiological and biomechanic criteria.

A study using eight subjects compared the O(2) consumption, heart rate and maximum knee joint angles when climbing stairs or ramps ranging in slope from 10 degrees to 30 degrees . It was found that the physiological cost of stairs is always less than a ramp of equal slope and that stairs with a 6 in riser were usually better than those with a 4 in riser. The values of the flexion at the knee joint were compared with a theoretical analysis by Shinno and found to differ considerably.