Evolution of blood donation patterns in a hospital-based blood centre over a seven-year period: implications for donor recruitment and retention.

OBJECTIVE: The aim of this study is to investigate the effect of a public appeal to encourage voluntary blood donation by comparing the pattern of blood donations in 2000 and 2007. METHODS: A retrospective analysis of blood donation records was conducted at the University Hospital of the West Indies (UHWI) Blood Collection Centre from April to December of 2000 and 2007. Data were analysed to identify any significant changes in donation patterns and donor profiles. RESULTS: The total number of blood donor records reviewed was 3194 in 2000 and 2634 in 2007 representing 69.0% and 72.3% of the total blood donations, respectively. Autologous donations accounted for 1% in 2000 and 2.2% in 2007; however, there was no corresponding change in voluntary donations (3.4% in 2000 and 3.2% in 2007). Despite a reduction in the number of first-time donors (1539 in 2000 and 1115 in 2007), the percentage of units discarded for the presence of a marker of transfusion transmission infection (TTI) increased, being 6.5% in 2000 and 7.4% in 2007. Human T-lymphotropic virus (HTLV) was the most common infectious marker in 2000 (3.4% of donors) whereas reactive Venereal Disease Research Laboratory (VDRL) predominated in 2007 (3.6% of donors). CONCLUSION: The per capita donations (0.99% in 2000 and 0.88% in 2007) failed to meet the World Health Organization (WHO) recommendation for an adequate blood supply of 1-3%. Despite a national effort to improve voluntary donations, the positive changes in the pattern of blood donation over a period of seven years were limited to a decrease in the proportion of first-time donors and an increase in blood donors with one to four previous donations.

Cholelithiasis on imaging--an analysis of clinical presentations by age and gender in a Jamaican population.

OBJECTIVE: This study is a descriptive analysis of the clinical presentations in which cholelithiasis was diagnosed on imaging over a five-year period at the University Hospital of the West Indies, Jamaica and how the clinical presentation varied with age and gender. METHOD: A retrospective review was done of all cases of cholelithiasis recorded in the reports of the Radiology section during the period January 1, 2002 to December 31, 2006. Patients' age and gender were noted. Each case was assigned to one of four clinical categories based on the clinical scenario at the time of referral for imaging: Acute abdomen-Incidental: (not referable to the biliary tract); Acute abdomen-Biliary (biliary colic/acute cholecystitis); Non-acute-Incidental: (not referable to the biliary tract) and Non-acute-Biliary (suspected cholelithiasis). The data were analyzed using post-hoc cross-tabulations, ANOVA, and post-hoc Tukey-tests. RESULTS: Three hundred and forty-four females and 137 males were diagnosed with cholelithiasis with the mean age at diagnosis being 49 and 50 years respectively. Females were diagnosed with cholelithiasis at higher rates in the context of acute abdominal symptoms both referable and unrelated to the biliary tract, while males were diagnosed at higher rates as an incidental finding in a non-acute presentation. There was no significant difference between the genders in the rate of diagnosis of cholelithiasis when this was suspected clinically in the non-acute setting. CONCLUSION: More females were diagnosed with cholelithiasis. There was no gender-related difference in the mean age at which cholelithiasis was diagnosed. There were statistically significant differences between the genders in the rates at which cholelithiasis was identified in different clinical scenarios.

Chronic myeloid leukaemia at the University Hospital of the West Indies: a 17-year review.

OBJECTIVE: To determine the presenting features and evolution of patients diagnosed with chronic myeloid leukaemia between 1983 and 1999 at the University Hospital of the West Indies. METHODS: Forty-one records were retrospectively analyzed for the patients' demographics, reasons for referral, clinical features, laboratory investigations and the time to blast transformation and death. RESULTS: Seventy-one per cent were males and 29% were females. The male to female ratio was 2.4:1. The median age at presentation was 37 years (range 14-81 years). Seventy-eight per cent of the patients presented in the chronic phase. Weight loss and splenomegaly were the most frequent presenting features being seen in 54 and 83 per cent respectively. The median survival was 36 months. CONCLUSION: In this study, the clinical features and evolution were comparable to existing data. Improved accrual and routine Philadelphia chromosome testing would provide a more accurate reflection of the status of CML in our population.

Ultrasound and white blood cell counts in suspected acute appendicitis.

The use of radiological studies as diagnostic tools in patients with suspected acute appendicitis has increased recently. In this setting, abdominal ultrasonography is viewed as a possible means of avoiding unnecessary surgery. This retrospective study of patients who underwent laparotomy for suspected acute appendicitis was undertaken to determine the sensitivity and specificity of ultrasound in diagnosing acute appendicitis and the frequency of leucocytosis in patients in whom the diagnosis was confirmed by histology. The ultrasound and surgery registers were reviewed to identify 254 referrals for abdominal ultrasound between January 2001 and December 2002 because of a clinical suspicion of acute appendicitis. Of these cases, 223 did not proceed to surgery. The study sample comprised 31 patients who had appendectomies after abdominal ultrasonography. The ultrasound reports, pathological diagnoses and white blood cell counts of these patients were obtained and formed the basis for the analysis. A histological diagnosis was available for 30 cases, in 17 of whom appendicitis was confirmed In these patients, positive ultrasound and leucocytosis were present in five (29%) and nine (53%) respectively. Ultrasound showed 92% specificity and 29% sensitivity for the pre-operative diagnosis of appendicitis. The positive predictive value of ultrasonography (83%) was higher than that of leucocytosis (69%). The sensitivity and specificity of ultrasound and leucocytosis in this study indicate limited utility as preoperative diagnostic tools.

Ultrasound and white blood cell counts in suspected acute appendicitis / Ultrasonido y conteo de glóbulos blancos en casos de sospecha de apendicitis aguda

The use of radiological studies as diagnostic tools in patients with suspected acute appendicitis has increased recently. In this setting, abdominal ultrasonography is viewed as a possible means of avoiding unnecessary surgery. This retrospective study of patients who underwent laparotomy for suspected acute appendicitis was undertaken to determine the sensitivity and specificity of ultrasound in diagnosing acute appendicitis and the frequency of leucocytosis in patients in whom the diagnosis was confirmed by histology. The ultrasound and surgery registers were reviewed to identify 254 referrals for abdominal ultrasound between January 2001 and December 2002 because of a clinical suspicion of acute appendicitis. Of these cases, 223 did not proceed to surgery. The study sample comprised 31 patients who had appendectomies after abdominal ultrasonography. The ultrasound reports, pathological diagnoses and white blood cell counts of these patients were obtained and formed the basis for the analysis. A histological diagnosis was available for 30 cases, in 17 of whom appendicitis was confirmed In these patients, positive ultrasound and leucocytosis were present in five (29) and nine (53) respectively. Ultrasound showed 92specificity and 29sensitivity for the pre-operative diagnosis of appendicitis. The positive predictive value of ultrasonography (83) was higher than that of leucocytosis (69). The sensitivity and specificity of ultrasound and leucocytosis in this study indicate limited utility as preoperative diagnostic tools.

El uso de estudios radiológicos como herramientas de diagnóstico en los pacientes con sospecha de apendicitis aguda ha aumentado recientemente. En este escenario, la ultrasonografía abdominal se ve como un posible medio de evitar una cirugía innecesaria. Este estudio retrospectivo de pacientes sometidos a laparotomía por sospecha de apendicitis aguda, fue realizado a fin de determinar la sensibilidad y especificidad del ultrasonido a la hora de diagnosticar la apendicitis aguda así como la frecuencia de leucocitos, en pacientes en quienes el diagnóstico fue confirmado mediante histología. Se revisaron las historias de ultrasonido y cirugía con el propósito de identificar 254 remisiones para la realización de ultrasonido abdominal entre enero de 2001 y diciembre de 2002, debido a una sospecha clínica de apendicitis aguda. De estos casos, 223 no pasaron a cirugía. La muestra del estudio abarcó 31 pacientes a los que se les realizaron apendicectomías tras del ultrasonido abdominal. Se obtuvieron los reportes de los ultrasonidos, los diagnósticos patológicos y los conteos de glóbulos blancos de estos pacientes. Estos reportes constituyeron la base del análisis. Se tuvo a disposición un diagnóstico histológico en 30 casos, en 17 de los cuales se confirmó apendicitis. En estos pacientes, el ultrasonido resultó positivo en cinco casos (29%) y la leucocitosis estuvo presente en nueve (53%). El ultrasonido arrojó un 92% de especificidad y 29% de sensibilidad para el diagnóstico preoperativo de la apendicitis. El valor predictivo positivo de la ultrasonografía (83%) fue mayor que el de la leucocitosis (69%). En este estudio, la sensibilidad y especificidad del ultrasonido y la leucocitosis, indican una limitada utilidad tanto del ultrasonido como del conteo de glóbulos blancos como instrumentos preoperativos de diagnóstico.

The inhibition of neutrophil-endothelial cell adhesion by hyaluronan independent of CD44.

OBJECTIVE: To study the effect of hyaluronan on cell adhesion and recruitment both in vitro and in vivo, since hyaluronan both inhibits restenosis and is anti-inflammatory. When administered to animals undergoing angioplasty the recruitment of cells into the restenotic plaque is inhibited, as well as into inflammatory lesions. The recent discovery that ICAM-1 binds hyaluronan and exhibits the B(X(7))B HA binding motif, led us also to investigate whether cell adhesion could be modulated by hyaluronan. MATERIALS AND METHODS: Human neutrophils were adhered to human umbilical vein (HUVEC) or Ea.hy.926 HUVEC cells stimulated with phorbol myristate acetate (PMA) or tumour necrosis factor (TNFalpha). Neutrophil binding in vivo utilized FMLP-stimulated hamster cheek pouch post-capillary venules. RESULTS: Hyaluronan inhibited human neutrophil adhesion to both PMA and TNFalpha-stimulated HUVEC. Ea.hy.926 human immortal HUVECs expressed ICAM-1 in response to TNFalpha and PMA. E-selectin was also upregulated by 6 h with TNFalpha but not significantly with PMA. TNFalpha induced CD44 expression within 4 h, but PMA not significantly up to 6 h. However, specific binding of [125I]hyaluronan to Ea.hy.926 cells was increased by PMA-stimulation at 4 h. Neutrophil adhesion to PMA-stimulated Ea.hy.926 HUVECs was inhibited in a concentration dependent fashion by both anti-ICAM-1 and hyaluronan (1 ng/ml-10 microg/ml) at 4 h. At 1 mg/ml adhesion was stimulated by hyaluronan. Hyaluronan had no effect on neutrophil adhesion to resting Ea.hy.926 cells. Hyaluronan (25 mg/kg, i.v.) inhibited cell adhesion to FMLP-stimulated post capillary venules of the hamster cheek pouch, whilst leaving cell rolling unaffected. CONCLUSIONS: These results show that hyaluronan, at concentrations below those where intra-molecular associations occur, binds selectively to stimulated endothelial cells and inhibits neutrophil adhesion in vitro and in vivo via a mechanism which may involve molecules other than CD44, such as ICAM-1.

The role of the matrix metalloproteinases during in vitro vessel formation.

Matrix metalloproteinases (MMPs) constitute a large family of extracellular matrix degrading proteases implicated in a number of physiological and pathological processes, including angiogenesis. However, the relative importance of the individual MMPs in vessel formation is poorly understood. Using the three-dimensional rat aortic model, the role of the MMPs in angiogenesis in vitro was investigated both by the use of synthetic MMP inhibitors, and by a study of the expression of nine MMPs and three of their endogenous inhibitors (the TIMPs) during vessel formation. Inhibition of microvessel growth in this model by the MMP inhibitor Marimastat demonstrated the requirement of the MMPs for angiogenesis in both collagen and fibrin matrices (half-maximal inhibition at 5 and 80 nM, respectively). The profile of MMP expression was seen to be modified by both matrix composition and exogenous growth factors. For example, whilst the gelatinase MMP-2 and stromelysin MMP-3 were present at high levels in fibrin culture, the stromelysin MMP-11 and membrane-type-1-MMP were more highly expressed during vessel formation in collagen. The angiogenic basic fibroblast growth factor (bFGF) upregulated the expression of the gelatinases (MMP-2 and MMP-9), the stromelysins (MMP-3, MMP-10 and MMP-11) and the interstitial collagenase MMP-13, whereas vascular endothelial growth factor (VEGF) led to a marked increase in expression of MMP-2 only. Together, the environment-dependent upregulation in expression of a number of MMPs during angiogenesis, and the total inhibition of vessel growth observed at nanomolar concentrations of synthetic MMP inhibitors, suggests a major collective role of these enzymes in angiogenesis, and provides a basis for further development of MMP inhibitors for anti-angiogenic therapy.

Human cutaneous fatty acid-binding protein induces metastasis by up-regulating the expression of vascular endothelial growth factor gene in rat Rama 37 model cells.

Human cutaneous fatty acid-binding protein (C-FABP) gene is capable of inducing the metastatic phenotype when overexpressed in nonmetastatic rat Rama 37 cells. However, the mechanism of how it induces metastasis is not clear. Northern and slot blot analyses revealed that expression of the endogenous vascular endothelial growth factor (VEGF) gene was increased by 3.8-5.2-fold in the C-FABP-transfected cells (pSV-CFABP-R37) and in their metastatic sublines (e.g., Met-1) when compared with that in the nonmetastatic control transfectant pSV-R37 cells generated by transfection of only plasmid DNA. Higher levels of VEGF immunoreactive protein were also secreted from the malignant C-FABP-expressing cells. Reverse transcription-PCR detected two VEGF transcript isoforms, VEGF(164) and VEGF(188), in both the nonmetastatic control transfectant pSV-R37 cells and the malignant metastatic Met-1 cells. Chick chorioallantoic membrane assays showed that the conditioned medium of the control pSV-R37 cells possessed only very weak angiogenic activity, whereas conditioned media from the metastatic C-FABP transfectants and their sublines were strongly angiogenic and could be inhibited by antibodies to VEGF. Transfection of VEGF(164) cDNA in an expression vector into nonmetastatic Rama 37 cells produced a cell clone (R37-VEGF-2) that expressed high levels of VEGF. Inoculation of R37-VEGF-2 cells into syngeneic Wistar Furth rats produced metastases in a significant number (Fisher's exact test, P < 0.01) of animals (18 of 31 animals), whereas the control, vector alone-transfected R37-PSV cells produced no metastases (0 of 30 animals). Immunocytochemical methods demonstrated a strong positive staining for VEGF and an increased microvessel density in the primary tumors produced from PSV-VEGF-2 cells in comparison with tumors produced from control transfectants. Immunocytochemical staining for factor VIII detected a 3.5-fold increase in microvessel density of the primary tumors produced by PSV-VEGF-2 cells when compared with that of the primary tumors developed from the control pSV-R37 cells. Therefore, we suggest that overexpression of the C-FABP gene in the original transfectants induces metastasis through up-regulation of expression of the VEGF gene in this rat Rama 37 model system, and thus VEGF may play a crucial role in this particular metastatic cascade.

Clear cell sarcoma of soft parts. A case report and review of the literature.

The case of a 25-year-old woman with recurring and metastasizing clear cell sarcoma of soft parts (CCS) is presented. The clinical setting and pathological appearance were in agreement with the original cases described. This report serves to highlight the clinico-pathological features of this rare and aggressive malignancy with specific reference to prognostic markers and treatment.

Clear cell sarcoma of soft parts. A case report and review of the literature

The case of a 25-year-old woman with recurring and metastasizing clear cell sarcoma of soft parts (CCS) is presented. The clinical setting and pathological appearance were in agreement with the original cases described. This report serves to highlight the clinico-pathological features of this rare and aggressive malignancy with specific reference to prognostic markers and treatment.

Angiogenesis assays using chick chorioallantoic membrane.

The study of the angiogenic process and the search for novel therapeutic agents to inhibit, or stimulate, angiogenesis has employed a wide range of in vivo 'angiogenesis' assays (reviewed in 1-3). These differ greatly in their difficulty, quantitative nature, rapidity, and cost. The classical in vivo models include the rabbit ear chamber, hamster cheek pouch, dorsal skin chamber, dorsal skin and air-sac model, anterior chamber/iris and avascular corneal pocket assay, and the chick embryo chorioallantoic membrane (CAM) assay. More recent methods involve the implantation of preloaded Matrigel or alginate plugs, or collagen or poly vinyl sponges (1). Largely owing to its simplicity and low cost, the CAM is the most widely used in vivo model for the study of both angiogenesis and antiangiogenesis (1,4).

Rat Aortic Ring : 3D Model of Angiogenesis In Vitro.

Angiogenesis is a necessary component of normal tissue repair, tumor growth and dissemination, and a wide variety of other inflammatory and pathological processes as well, including diabetic retinopathy, rheumatoid arthritis, and psoriasis. Consequently, the last two decades have seen extensive research into the regulation of neovascularization, particularly in tumors. Partly due to the emphasis on tumor angiogenesis, much of this effort has been devoted to the detection and characterization of angiogenic growth factors and inhibitory molecules. Thus assays have commonly been developed to measure the amount of vascular growth in vivo, or the modulation of endothelial cell (EC) proliferation, or migration in simple 2D culture systems (1).

Retrospective audit of blood donation at a hospital-based blood centre. Implications for blood product supply and safety.

An audit of blood donation at the University Hospital of the West Indies (UHWI) was performed between January 1995 and December 1998. During these four years, 21,733 persons attended the blood collection centre and 6711 (30.8%) were rejected as donors. Females accounted for 3,054 (45.6%) of rejected donors while 3,647 (54.4%) were males. Females were rejected primarily because of low haemoglobin levels, while rejection of males was most frequently attributed to symptoms of the common cold and recent drug use. One hundred and two rejected donors (1.5%) admitted to recent treatment for a sexually transmitted disease, and 138 (2.0%) presented within 16 weeks of a prior donation. Of 15,022 units donated, altruistic voluntary donations accounted for 307 (2%) and 53 (0.3%) were autologous donations. Seven hundred and four units (4.6%) were discarded because of positivity on initial testing for a marker of transmissible infection. Overall prevalence for markers of infection was 2.5% for HTLV-1, 0.9% for Hepatitis B and 0.4% for HIV I/II. Donations at the University Hospital of the West Indies (UHWI) collection centre contributed 15.8% of the national blood supply for the period under study.

Oscillations and long-lasting correlations in a model of the lateral geniculate nucleus and visual cortex.

We have previously developed a model of the corticogeniculate system to explore cortically induced synchronization of lateral geniculate nucleus (LGN) neurons. Our model was based on the experiments of Sillito et al. Recently Brody discovered that the LGN events found by Sillito et al. correlate over a much longer period of time than expected from the stimulus-driven responses and proposed a cortically induced slow covariation in LGN cell membrane potentials to account for this phenomenon. We have examined the data from our model, and we found, to our surprise, that the model shows the same long-term correlation. The model's behavior was the result of a previously unsuspected oscillatory effect, not a slow covariation. The oscillations were in the same frequency range as the well-known spindle oscillations of the thalamocortical system. In the model, the strength of feedback inhibition from the cortex and the presence of low-threshold calcium channels in LGN cells were important. We also found that by making the oscillations more pronounced, we could get a better fit to the experimental data.

In vitro and in vivo production of vascular endothelial growth factor by chronic lymphocytic leukemia cells.

Expansion of primary solid tumors and their malignant dissemination are angiogenesis-dependent. Vascular endothelial growth factor (VEGF) is the key factor playing a pivotal role in solid tumor-induced angiogenesis. Recent studies indicate that angiogenesis may also be involved in the pathogenesis of certain hemic malignancies, including B-cell chronic lymphocytic leukemia (B-CLL). Mechanisms underlying angiogenesis in B-CLL and the role of VEGF in this process are incompletely understood. In this study, it was examined whether angiogenically functional VEGF is produced by B-CLL cells. Immunohistochemical staining with antibodies against VEGF and CD34, an endothelial cell marker, demonstrated the presence of VEGF protein and abundant blood vessels in infiltrated lymphoreticular tissues. Low levels of VEGF were detected by ELISA in the culture media of unstimulated cells; this was enhanced up to 7-fold by hypoxic stimulation. SDS-PAGE and Western blot analysis of the concentrated culture media showed 2 isoforms of VEGF protein with molecular weights of 28 and 42 kd, respectively. RNA hybridization showed that these cells expressed VEGF mRNA. Reverse transcription-polymerase chain reaction, combined with nucleotide sequence analysis, revealed that the predominantly expressed isoforms were VEGF121 and VEGF165. Moreover, (3)H-thymidine incorporation and an in vivo angiogenic assay demonstrated that the VEGF produced by CLL cells can induce angiogenesis by stimulating endothelial cell proliferation. In conclusion, this study shows that B-CLL cells produce VEGF and demonstrates the angiogenic effects of this growth factor, which may be relevant for the tissue phase of the disease.

Critical thinking in graduate medical education: A role for concept mapping assessment?

CONTEXT: Tools to assess the evolving conceptual framework of physicians-in-training are limited, despite their critical importance to physicians' evolving clinical expertise. Concept mapping assessment (CMA) enables teachers to view students' organization of their knowledge at various points in training. OBJECTIVE: To assess whether CMA reflects expected differences and changes in the conceptual framework of resident physicians, whether concept maps can be scored reliably, and how well CMA scores relate to the results of standard in-training examination. DESIGN, SETTING, AND PARTICIPANTS: A group of 21 resident physicians (9 first-year and 12 second- and third-year residents) from a university-based pediatric training program underwent concept map training, drew a preinstruction concept map about seizures, completed an education course on seizures, and then drew a postinstruction map. Maps were scored independently by 3 raters using a standardized method. The study was conducted in May and June 1999. MAIN OUTCOME MEASURES: Preinstruction map total scores and subscores in 4 categories compared with postinstruction map scores; map scores of second- and third-year residents compared with first-year residents; and interrater correlation of map scores. RESULTS: Total CMA scores increased after instruction from a mean (SD) preinstruction map score of 429 (119) to a mean postinstruction map score of 516 (196) (P =.03). Second- and third-year residents scored significantly higher than first-year residents before instruction (mean [SD] score of 472 [116] vs 371 [102], respectively; P =.04), but not after instruction (mean [SD] scores, 561 [203] vs 456 [179], respectively; P =.16). Second- and third-year residents had greater preinstruction map complexity as measured by cross-link score (P =.01) than first-year residents. The CMA score had a weak to no correlation with the American Board of Pediatrics In-training Examination score (r = 0.10-0.54). Interrater correlation of map scoring ranged from weak to moderate for the preinstruction map (r = 0.51-0.69) and moderate to strong for the postinstruction map (r = 0.74-0.88). CONCLUSIONS: Our data provide preliminary evidence that concept mapping assessment reflects expected differences and change in the conceptual framework of resident physicians. Concept mapping assessment and standardized testing may measure different cognitive domains. JAMA. 2000;284:1105-1110

Retrospective audit of blood donation at a Hospital-based blood centre: Implications for blood product supply and safety

An audit of blood donation at the University Hospital of the West Indies (UHWI) was performed between January 1995 and December 1998. During these four years, 21,733 persons attended the blood collection centre and 6,711 (30.8 percent) were rejected as donors. Females accounted for 3, 054 (45.6 percent) of rejected donors while 3,647 (54.4 percent) were males. Females were rejected primarily because of low haemoglobin levels, while rejection was most frequently attributed to symptoms of the common cold and recent drug use. One hunderd and two rejected donors (1.5 percent) admitted to recent treatment of a sexually transmitted disease, and 138 (2.0 percent) presented within 16 weeks of a prior donation. Of 15,022 units donated, altruistic voluntary donations accounted for 307 (2 percent) and 53 (0.3 percent) were autologous donations. Seven hundred and four units (4.6 percent) were discarded because of positivity on initial testing for a marker of transmissible infection. Overall prevalence for markers of infection was 2.5 eprcent for HTLV-1, 0.9 percent for Hepatitis B and 0.4 percent for HIV I/II. Donations at the University Hospital of the West Indies (UHWI) collection centre contributed 15.8 percent of the national blood supply for the period under study.

Prevalence of risk factors in breast cancer patients at the University Hospital of the West Indies.

The records of one hundred and twenty consecutive patients diagnosed with carcinoma of the breast were examined between July 1996 and June 1999 in order to estimate the prevalence of established risk factors for this disease. Early menarche was present in 5.5% of patients, while 36 subjects (30%) were nulliparous and 6 (5%) had a first live birth after age 30 years. Four subjects had a previous biopsy with histological features of atypical hyperplasia. Fifteen subjects (12.5%) had one or more affected first degree relatives. Fifty-four per cent of subjects possessed none of the risk factors examined in this study while 36% had a single risk factor and 10% possessed two risk factors. There was no significant clustering of risk factors in the group of patients aged thirty-five years or less. Larger studies should be encouraged to identify the risk factors which operate in our population and the degree to which published predictive variables are applicable.