Pooling, room temperature, and extended storage time increase the release of adult‐specific biologic response modifiers in platelet concentrates: a hidden transfusion risk for neonates?

BACKGROUND: Adult donor platelets (PLTs) are frequently transfused to prevent or stop bleeding in neonates with thrombocytopenia. There is evidence for PLT transfusion-related morbidity and mortality, leading to the hypothesis on immunomodulatory effects of transfusing adult PLTs into neonates. Candidate factors are biologic response modifiers (BRMs) that are expressed at higher rates in adult than in neonatal PLTs. This study investigated whether storage conditions or preparation methods impact on the release of those differentially expressed BRMs. STUDY DESIGN AND METHODS: Pooled PLT concentrates (PCs) and apheresis PCs (APCs) were stored under agitation for up to 7 days at room temperature (RT) or at 2 to 8 degrees C. The BRMs CCL5/RANTES, TGF beta 1, TSP1, and DKK1 were measured in PCs' supernatant, lysate, and corresponding plasma. PLT function was assessed by light transmission aggregometry. RESULTS: Concerning the preparation method, higher concentrations of DKK1 were found in pooled PCs compared to APCs. In supernatants, the concentrations of CCL5, TGF beta 1, TSP1, and DKK1 significantly increased, both over standard (≤ 4 days) and over extended storage times (7 days). Each of the four BRMs showed an up to twofold increase in concentration after storage at RT compared to cold storage (CS). There was no difference in the aggregation capacity. CONCLUSION: This analysis shows that the release of adult-specific BRMs during storage is lowest in short- and CS APCs. Our study points to strategies for reducing the exposure of sick neonates to BRMs that can be specifically associated to PLT transfusion-related morbidity

A clinical radiological score for femoral head grafts - Establishment of the Tabea FK score to ensure the quality of human femoral head grafts

Einleitung: Die Transplantation humaner Femurköpfe (FK) ist ein etabliertes Verfahren in der knöchernen Defektrekonstruktion bei orthopädischen und unfallchirurgischen Eingriffen, wobei eine standardisierte morphologische Qualitätsbewertung des Femurkopfgewebes bisher kaum erfolgt. Material und Methoden: Bei 105 Patienten wurde der jeweilige FK im Rahmen einer Hüft-TEP standardisiert entnommen. Anhand klinischer und radiologischer Kriterien (Vorhandensein von Zysten, Nekrosen, Verkalkungen, Deformitäten und Osteoporose) wurde der FK mittels des Tabea-FK-Scores in drei Kategorien (beste/mittlere/schlechte Qualität) eingeteilt. Hiernach erfolgte eine zweite, makroskopische Einteilung der Qualität des in drei Schichten aufgesägten FK. Dieser „Makro-Score“ diente als Goldstandard. Ergänzend wurden eine periphere quantitative Computertomographie (pQCT) sowie histologische Untersuchungen durchgeführt. Die Übereinstimmung des Tabea-FK-Scores sowie der Ergebnisse der ergänzenden Untersuchungen mit dem Makro-Score wurde mittels Sensitivitäten und Spezifitäten beurteilt. Ergebnisse: Bei 91/105 Patienten (Alter: 68,4 ± 9,9 Jahre, n = 60 Frauen, n = 31 Männer) wurden die explantierten FK in die Studie eingeschlossen. Die Übereinstimmung zwischen dem primären Tabea-FK-Score und dem Makro-Score in Bezug auf die Unterscheidung mittlere/beste sowie schlechte/mittlere Qualität ist als gut einzustufen (Sensitivität 77 % sowie 81 % und Spezifität 76 % sowie 84 %). Die Übereinstimmung des histologischen Befundes mit dem Makro-Score war insgesamt etwas schlechter und wies in Bezug auf die Unterscheidung mittlere/beste sowie schlechte/mittlere Qualität eine Sensitivität von 85 % sowie 54 % und eine Spezifität von 66 % sowie 97 % auf. Der pQCT-Score wies lediglich bei der Unterscheidung mittlere/beste Qualität eine zufriedenstellende Sensitivität (82 %) auf, während diese bei der Unterscheidung schlechte/mittlere Qualität sowie schlechte/mittlere + beste Qualität <10 % betrug. Diskussion: Die gute Übereinstimmung zwischen primärem Tabea-FK-Score und makroskopischer Zweitbewertung unterstreicht die Fähigkeiten langjährig operativ tätiger Orthopäden, die Qualität der Knochenspongiosa bereits anhand des Röntgenbildes und des intraoperativen Befundes korrekt einzustufen. Insofern kann die Einführung des Tabea-FK-Scores in die Routineabläufe von Knochenbanken als Qualitätssicherungsmaßnahme empfohlen werden.Introduction: Transplantation of cancellous tissue from human femoral heads (FK) is an established method in the reconstruction of bony defects in orthopedic and trauma surgery. Standardized rating systems with respect to the morphological quality of this tissue are not available. Materials and methods: In 91/105 patients who had been a regular, clinically-indicated surgery (arthroplasty of the hip joint) the respective femoral head (FK) was taken under standardized conditions. Using a checklist defined clinical and radiological criteria of FK are judged in terms of their quality (cysts, necrosis, calcification, deformities, osteoporosis) and divided by the Tabea FK score into three classes (best/middle/poor quality). This was followed by a blinded repeated scoring, now as macroscopic assessment of three sawed layers from the same femoral head. The femoral heads are examined by peripheral quantitative computed tomography (pQCT) and a standardized histological examination of the bony tissue. We evaluated the accordance of the Tabea FK score with complementary assessments by calculation of sensitivity and specificity. Results: Femoral heads from 91/105 patients (ages: 68.4 ± 9.9 , n = 60 women, n = 31 men) were explanted and included in the study. The correlation between the primary radiologic clinical score (Tabea FK score) and the macroscopic second review of the sawn FK with respect to middle/best and poor/middle quality was classified as good (sensitivity 77% and 81%, respectively; specificity 76% and 84%, respectively). The correlation of histology and macroscopic second review was worse and in relation to discrimination of middle/best and poor/middle quality had a sensitivity of 85% and 54%, respectively, and a specificity of 66% and 97%, respectively. The pQCT showed a sensitivity of 82% only in discrimination of middle/best, while sensitivity in discrimination of poor/middle and poor/middle + best, respectively, was <10%. Discussion: The corresponding correlation between the primary and the second clinical score was evaluated as good. This emphasizes the long-standing skills of operationally active orthopedic surgeons to classify the quality of cancellous bone correctly already on the basis of X‑ray images and intraoperative findings. In this respect, the introduction of the Tabea FK score as a quality assurance tool in the routines of bone banks can be recommended

Risk Factors for Cerebral Aneurysm Rupture in Mongolia

Purpose!#!Identification of country-specific demographic, medical, lifestyle, and geoenvironmental risk factors for cerebral aneurysm rupture in the developing Asian country of Mongolia. First-time estimation of the crude national incidence of aneurysmal subarachnoid hemorrhage (aSAH).!##!Methods!#!A retrospective analysis of all intracranial digital subtraction angiographies (DSA) acquired in Mongolia during the 2‑year period 2016-2017 (1714 examinations) was performed. During this period, DSA was used as primary diagnostic imaging modality for acute severe neurological symptoms in the sole hospital nationwide dedicated to neurological patients. The catchment area of the hospital included the whole country. Patients with incidental and ruptured aneurysms were reviewed with respect to their medical history and living conditions. The data was used to install a Mongolian aneurysm registry.!##!Results!#!The estimated annual crude incidence of cerebral aneurysm rupture was 6.71 for the country of Mongolia and 14.53 per 100,000 persons for the capital region of Ulaanbaatar. Risk factors common in developed countries also applied for the Mongolian population: A medical history of hypertension, smoking or the presence of multiple aneurysms led to a higher relative risk of rupture. In contrast, female gender was not associated with a higher risk in this national cohort. Males pursuing a traditional nomadic living may exhibit a specifically high risk of rupture.!##!Conclusion!#!Disease management of over 200 individuals/year with aSAH constitutes a socioeconomic burden in Mongolia. Efforts to raise awareness of the risk factors hypertension and smoking among the Mongolian population are desirable. Measures to improve the nationwide availability of modern neurovascular treatment options are currently under consideration

Consistently dated Atlantic sediment cores over the last 40 thousand years

Abstract: Rapid changes in ocean circulation and climate have been observed in marine-sediment and ice cores over the last glacial period and deglaciation, highlighting the non-linear character of the climate system and underlining the possibility of rapid climate shifts in response to anthropogenic greenhouse gas forcing. To date, these rapid changes in climate and ocean circulation are still not fully explained. One obstacle hindering progress in our understanding of the interactions between past ocean circulation and climate changes is the difficulty of accurately dating marine cores. Here, we present a set of 92 marine sediment cores from the Atlantic Ocean for which we have established age-depth models that are consistent with the Greenland GICC05 ice core chronology, and computed the associated dating uncertainties, using a new deposition modeling technique. This is the first set of consistently dated marine sediment cores enabling paleoclimate scientists to evaluate leads/lags between circulation and climate changes over vast regions of the Atlantic Ocean. Moreover, this data set is of direct use in paleoclimate modeling studies

Consistently dated Atlantic sediment cores over the last 40 thousand years

Rapid changes in ocean circulation and climate have been observed in marine-sediment and ice cores over the last glacial period and deglaciation, highlighting the non-linear character of the climate system and underlining the possibility of rapid climate shifts in response to anthropogenic greenhouse gas forcing. To date, these rapid changes in climate and ocean circulation are still not fully explained. One obstacle hindering progress in our understanding of the interactions between past ocean circulation and climate changes is the difficulty of accurately dating marine cores. Here, we present a set of 92 marine sediment cores from the Atlantic Ocean for which we have established age-depth models that are consistent with the Greenland GICC05 ice core chronology, and computed the associated dating uncertainties, using a new deposition modeling technique. This is the first set of consistently dated marine sediment cores enabling paleoclimate scientists to evaluate leads/lags between circulation and climate changes over vast regions of the Atlantic Ocean. Moreover, this data set is of direct use in paleoclimate modeling studies

Consistently dated Atlantic sediment cores over the last 40 thousand years.

Rapid changes in ocean circulation and climate have been observed in marine-sediment and ice cores over the last glacial period and deglaciation, highlighting the non-linear character of the climate system and underlining the possibility of rapid climate shifts in response to anthropogenic greenhouse gas forcing. To date, these rapid changes in climate and ocean circulation are still not fully explained. One obstacle hindering progress in our understanding of the interactions between past ocean circulation and climate changes is the difficulty of accurately dating marine cores. Here, we present a set of 92 marine sediment cores from the Atlantic Ocean for which we have established age-depth models that are consistent with the Greenland GICC05 ice core chronology, and computed the associated dating uncertainties, using a new deposition modeling technique. This is the first set of consistently dated marine sediment cores enabling paleoclimate scientists to evaluate leads/lags between circulation and climate changes over vast regions of the Atlantic Ocean. Moreover, this data set is of direct use in paleoclimate modeling studies

Consistently dated Atlantic sediment cores over the last 40 thousand years

Rapid changes in ocean circulation and climate have been observed in marine-sediment and ice cores over the last glacial period and deglaciation, highlighting the non-linear character of the climate system and underlining the possibility of rapid climate shifts in response to anthropogenic greenhouse gas forcing. To date, these rapid changes in climate and ocean circulation are still not fully explained. One obstacle hindering progress in our understanding of the interactions between past ocean circulation and climate changes is the difficulty of accurately dating marine cores. Here, we present a set of 92 marine sediment cores from the Atlantic Ocean for which we have established age-depth models that are consistent with the Greenland GICC05 ice core chronology, and computed the associated dating uncertainties, using a new deposition modeling technique. This is the first set of consistently dated marine sediment cores enabling paleoclimate scientists to evaluate leads/lags between circulation and climate changes over vast regions of the Atlantic Ocean. Moreover, this data set is of direct use in paleoclimate modeling studies