Patient ABO blood type is a major predictor of a positive DAT following a transfusion reaction.

BACKGROUND: A direct antiglobulin test (DAT) checks for antibody or complement on the surface of RBCs and is often done following a transfusion reaction. While passive anti-A and anti-B antibodies are known to cause positive DATs, the extent this occurs following transfusion is unknown. STUDY DESIGN AND METHODS: DAT results, ABO type, eluate information, and blood product information were recorded on 1097 transfusion reactions at a large academic hospital over 8 years. The effect of patient blood type, product type, and plasma compatibility of blood product transfused on DAT results were determined. Statistical significance was determined using Chi-squared testing. RESULTS: Patient ABO blood type was a strong predictor of a positive DAT, with type O patients having 6.7% positive rate and non-O patients having a positive rate of 20.6% (p < .0001). Plasma compatibility of the product was a strong predictor of a positive DAT, with plasma compatible transfusions having a 9.4% positive rate while plasma incompatible transfusions were positive 44% of the time (p < .0001). Elution studies found that anti-A/B antibodies were the most common antibody identified. Platelets were more likely to be associated with a positive DAT when compared with RBC transfusions (p < .05). CONCLUSIONS: These results demonstrate the patient ABO type and plasma incompatibility are strong predictors of positive DAT results following a transfusion reaction. Anti-A and anti-B antibodies are estimated to account for about 50% of positive DATs in this study.

SARS-CoV-2 antibody changes in patients receiving COVID-19 convalescent plasma from normal and vaccinated donors.

Vaccination has been shown to stimulate remarkably high antibody levels in donors who have recovered from COVID-19. Our objective was to measure patient antibody levels before and after transfusion with COVID-19 Convalescent Plasma (CCP) and compare the antibody levels following transfusion of CCP from vaccinated and nonvaccinated donors. Plasma samples before and after transfusion were obtained from 25 recipients of CCP and COVID-19 antibody levels measured. Factors that effect changes in antibody levels were examined. In the 21 patients who received CCP from nonvaccinated donors, modest increases in antibody levels were observed. Patients who received two units were more likely to seroconvert than those receiving just one unit. The strongest predictor of changes in patient antibody level was the CCP dose, calculated by the unit volume multiplied by the donor antibody level. Using patient plasma volume and donor antibody level, the post-transfusion antibody level could be predicted with reasonable accuracy(R2> 0.90). In contrast, the 4 patients who received CCP from vaccinated donors all had dramatic increases in antibody levels following transfusion of a single unit. In this subset of recipients, antibody levels observed after transfusion of CCP were comparable to those seen in donors who had fully recovered from COVID-19. If available, CCP from vaccinated donors with very high antibody levels should be used. One unit of CCP from vaccinated donors increases patient antibody levels much more than 1 or 2 units of CCP from unvaccinated donors.

Hemolytic disease of the fetus and newborn in the sensitizing pregnancy where anti-D was incorrectly identified as RhIG.

BACKGROUND: Hemolytic disease of the fetus and newborn (HDFN) is a potentially fatal complication in Rh-incompatible pregnancies and rarely occurs in the sensitizing pregnancy. Distinguishing RhIG from true anti-D identified is challenging. A case of severe HDFN in which a sample drawn at 28 weeks showed anti-D antibody (3+ strength) attributed to RhIG is described. RBC antibody testing early in pregnancy was negative. At birth, the infant was severely anemic and maternal anti-D titer was 1:256. This case represents a clinically significant anti-D in the sensitizing pregnancy that was missed due to confusion with RhIG. METHODS: To determine if agglutination strength could be helpful, a retrospective chart-review using both electronic and paper medical records was performed on 348 samples identified as RhIG and 52 true anti-D samples. The agglutination strength of antibody was recorded for each sample. RESULTS: For RhIG, there was an even distribution between the weak to moderate agglutination strength (w+, 1+, and 2+) results (35%, 26%, and 33%, respectively) and just 6% had a 3+ strength. Agglutination strength in patients with high titer (≥1:16) anti-D showed they often (44.4%) have 1+ or 2+ agglutination reactivity. CONCLUSIONS: These results show that agglutination strength alone does not provide reliable evidence to distinguish RhIG from high titer anti-D antibodies. We recommend that in cases where there is any uncertainty about whether the anti-D reactivity is due to RhIG, titers should be performed to rule out clinically significant anti-D antibody.

Exponential increase in neutralizing and spike specific antibodies following vaccination of COVID-19 convalescent plasma donors.

BACKGROUND: With the recent approval of COVID-19 vaccines, recovered COVID-19 subjects who are vaccinated may be ideal candidates to donate COVID-19 convalescent plasma (CCP). CASE SERIES: Eleven recovered COVID-19 patients were screened to donate CCP. All had molecularly confirmed COVID-19, and all but one were antibody positive by chemiluminescence immunoassay (DiaSorin) prior to vaccination. All were tested again for antibodies 11-21 days after they were vaccinated (Pfizer/Moderna). All showed dramatic increases (~50-fold) in spike-specific antibody levels and had at least a 20-fold increase in the IC50 neutralizing antibody titer based on plaque reduction neutralization testing (PRNT). The spike-specific antibody levels following vaccination were significantly higher than those seen in any non-vaccinated COVID-19 subjects tested to date at our facility. CONCLUSION: Spike-specific and neutralizing antibodies demonstrated dramatic increases following a single vaccination after COVID-19 infection, which significantly exceeded values seen with COVID-19 infection alone. Recovered COVID-19 subjects who are vaccinated may make ideal candidates for CCP donation.

ABO-incompatible platelets are associated with increased transfusion reaction rates.

BACKGROUND: ABO compatibility can affect platelet transfusion safety and efficacy, and ABO-incompatible (ABOi) platelets likely increases the risks of transfusion reactions though the magnitude of this risk is unclear. STUDY DESIGN AND METHODS: Data collected on all platelet transfusions administered over 36+ months were classified based on patient and product ABO blood group type and merged with a data set that included all transfusion reactions reported during that period. The transfusion reaction rates among various subsets was calculated. RESULTS: In patients greater than 1 year of age, the transfusion reaction rate in the ABO-compatible (ABO-identical) platelet group was 1.0%, while the ABOi platelet group had an elevated reaction rate of 1.7%. The increased reaction rate for ABOi platelets held true even if the analysis were limited to Centers for Disease Control and Prevention/National Healthcare Safety Network qualifying reactions or just allergic or febrile nonhemolytic reactions. The increased reaction rate with ABOi platelets was independent of unit age. Surprisingly, major-incompatible transfusions (A/B antigen incompatible) had the highest rate of reactions, at 2.0%. During the study period, three acute hemolytic reactions were reported out of 2522 plasma-incompatible platelet transfusions (0.12%). CONCLUSIONS: Our results find that compatible platelet transfusions have the lowest rate of transfusion reactions. While hemolytic reactions were observed with plasma-incompatible transfusions, the rate was low. Transfusion of ABO antigen-incompatible platelets had the highest rate of transfusion reactions and resulted in a transfusion reaction rate 1.5 to 2 times that of ABO compatible transfusions.

Treatment of pediatric spasticity, including children with cerebral palsy, with Botox (onabotulinumtoxinA): Development, insights, and impact.

Spasticity is a velocity-dependent increase in muscle tone that has a negative effect on quality of life and hinders the ability of others to provide care. In children, most cases are caused by cerebral palsy. Traditionally, many children are treated with surgery, sometimes performed before their limbs had grown sufficiently to permit long-term success. Nonsurgical treatment comprises oral pharmacological options, but their efficacy is limited and side effects such as drowsiness and decreased short-term memory are common; nerve block procedures can cause painful dysesthesias and muscle scarring. OnabotulinumtoxinA was first approved for the treatment of pediatric lower limb spasticity in Europe in the 1990s and is now licensed for use in pediatric patients in over 80 countries worldwide, based on a large body of clinical evidence demonstrating its efficacy and safety. In 2019 the U.S. Food and Drug Administration approved onabotulinumtoxinA for the treatment of pediatric patients with upper or lower limb spasticity. This approval represents 3 decades of work to refine the dose, measurements, patient selection, and muscle selection. The availability of onabotulinumtoxinA as a treatment for pediatric spasticity can have a substantial impact on a patient's quality of life. The use of onabotulinumtoxinA in combination with orthoses and occupational/physical therapy can postpone corrective surgery until growth is nearly complete and minimize the number of corrective surgeries.

Thermal Conductivity of Nanoporous Materials: Where Is the Limit?

Nowadays, our society is facing problems related to energy availability. Owing to the energy savings that insulators provide, the search for effective insulating materials is a focus of interest. Since the current insulators do not meet the increasingly strict requirements, developing materials with a greater insulating capacity is needed. Until now, several nanoporous materials have been considered as superinsulators achieving thermal conductivities below that of the air 26 mW/(m K), like nanocellular PMMA/TPU, silica aerogels, and polyurethane aerogels reaching 24.8, 10, and 12 mW/(m K), respectively. In the search for the minimum thermal conductivity, still undiscovered, the first step is understanding heat transfer in nanoporous materials. The main features leading to superinsulation are low density, nanopores, and solid interruptions hindering the phonon transfer. The second crucial condition is obtaining reliable thermal conductivity measurement techniques. This review summarizes these techniques, and data in the literature regarding the structure and thermal conductivity of two nanoporous materials, nanocellular polymers and aerogels. The key conclusion of this analysis specifies that only steady-state methods provide a reliable value for thermal conductivity of superinsulators. Finally, a theoretical discussion is performed providing a detailed background to further explore the lower limit of superinsulation to develop more efficient materials.

Optical Properties of Polyisocyanurate-Polyurethane Aerogels: Study of the Scattering Mechanisms.

Highly transparent polyisocyanurate-polyurethane (PUR-PIR) aerogels were synthesized, and their optical properties were studied in detail. After determining the density and structural parameters of the manufactured materials, we analyzed their optical transmittance. It was demonstrated that the catalyst content used to produce the aerogels can be employed to tune the internal structure and optical properties. The results show that the employment of lower catalyst amounts leads to smaller particles forming the aerogel and concomitantly to higher transmittances, which reach values of 85% (650 nm) due to aerogel particles acting as scattering centers. Thus, it was found that the lower this size, the higher the transmittance. The effect of the sample thickness on the transmittance was studied through the Beer-Lambert law. Finally, the scattering mechanisms involved in the light attenuation were systematically evaluated by measuring a wide range of light wavelengths and determining the transition between Rayleigh and Mie scattering when the particles were larger. Therefore, the optical properties of polyurethane aerogels were studied for the first time, opening a wide range of applications in building and energy sectors such as glazing windows.

Cyclic Gas Dissolution Foaming as an Approach for Simultaneously Reducing Cell Size and Relative Density in Nanocellular PMMA.

A new approach to produce nanocellular polymers combining small cell sizes with low relative densities is presented herein. This production method, based on gas dissolution foaming, consists of performing a double saturation and foaming cycle. Thus, nanocellular polymethylmethacrylate (PMMA) has been produced through a first saturation at different saturation conditions (6, 10, and 20 MPa and -32 °C), at constant foaming conditions (60 °C for 1 min). Then, the nanocellular PMMAs obtained from the previous step were again saturated at different saturation conditions, 10 MPa 24 °C, 31 MPa 24 °C, 35 MPa 22 °C, and 6 MPa -15 °C and foamed at different temperatures (40, 80 and 100 °C) for 1 min. This new approach allows the cells created in the first saturation and foaming cycle to further grow in the second cycle. This fact permits producing nanocellular polymethylmethacrylate sheets combining, for the first time in the literature, cell sizes of 24 nm with relative densities of 0.3.

Analysis of the Foaming Window for Thermoplastic Polyurethane with Different Hard Segment Contents.

A series of thermoplastic polyurethanes (TPUs) with different amounts of hard segments (HS) (40, 50 and 60 wt.%) are synthesized by a pre-polymer method. These synthesized TPUs are characterized by Shore hardness, gel permeation chromatography (GPC), differential scanning calorimetry (DSC), wide angle X-ray diffraction (WAXD), dynamic mechanical thermal analysis (DMTA), and rheology. Then, these materials are foamed by a one-step gas dissolution foaming process and the processing window that allows producing homogeneous foams is analyzed. The effect of foaming temperature from 140 to 180 °C on the cellular structure and on density is evaluated, fixing a saturation pressure of 20 MPa and a saturation time of 1 h. Among the TPUs studied, only that with 50 wt.% HS allows obtaining a stable foam, whose better features are reached after foaming at 170 °C. Finally, the foaming of TPU with 50 wt.% HS is optimized by varying the saturation pressure from 10 to 25 MPa at 170 °C. The optimum saturation and foaming conditions are 25 MPa and 170 °C for 1 h, which gives foams with the lowest relative density of 0.74, the smallest average cell size of 4 µm, and the higher cell nucleation density of 8.0 × 109 nuclei/cm3. As a final conclusion of this investigation, the TPU with 50 wt.% HS is the only one that can be foamed under the saturation and foaming conditions used in this study. TPU foams containing 50 wt.% HS with a cell size below 15 microns and porosity of 1.4-18.6% can be obtained using foaming temperatures from 140 to 180 °C, saturation pressure of 20 MPa, and saturation time of 1 h. Varying the saturation pressure from 10 to 25 MPa and fixing the foaming temperature of 170 °C and saturation pressure of 1 h results in TPU foams with a cell size of below 37 microns and porosity of 1.7-21.2%.

Nanocellular Polymers: The Challenge of Creating Cells in the Nanoscale.

The evolution of technology means that increasingly better materials are needed. It is well known that as a result of their interesting properties, nanocellular polymers perform better than microcellular ones. For this reason, the investigation on nanocellular materials is nowadays a very topical issue. In this paper, the different approaches for the production of these materials in our laboratory are explained, and results obtained by using polymethylmethacrylate (PMMA) are shown. Homogeneous nucleation has been studied by using raw PMMA, while two different systems were used for heterogeneous nucleation; adding nanoparticles to the system and using nanostructured polymers as solid precursors for foaming. The effects of the different parameters of the production process (gas dissolution foaming process) have been evaluated for all systems being possible to establish a comparison between the materials produced by different approaches. Moreover, the limitations and future work to optimise the materials produced are also discussed.

Low Density Nanocellular Polymers Based on PMMA Produced by Gas Dissolution Foaming: Fabrication and Cellular Structure Characterization.

This paper describes the processing conditions needed to produce low density nanocellular polymers based on polymethylmethacrylate (PMMA) with relative densities between 0.45 and 0.25, cell sizes between 200 and 250 nm and cell densities higher than 1014 cells/cm³. To produce these nanocellular polymers, the foaming parameters of the gas dissolution foaming technique using CO2 as blowing agent have been optimized. Taking into account previous works, the amount of CO2 uptake was maintained constant (31% by weight) for all the materials. Foaming parameters were modified between 40 °C and 110 °C for the foaming temperature and from 1 to 5 min for the foaming time. Foaming temperatures in the range of 80 to 100 °C and foaming times of 2 min allow for production of nanocellular polymers with relative densities as low as 0.25. Cellular structure has been studied in-depth to obtain the processing-cellular structure relationship. In addition, it has been proved that the glass transition temperature depends on the cellular structure. This effect is associated with a confinement of the polymer in the cell walls, and is one of the key reasons for the improved properties of nanocellular polymers.

Vivencias espirituales del adulto mayor en un hospital de día de la red almenara, en Lima, Perú / Spiritual experiences of the elderly in a day hospital of the almenara network, in Lima, Peru

Objetivo: analizar vivencias espirituales del adulto mayor en un Hospital de Día de la Red Almenara, en Lima. Introducción: las vivencias son experiencias que viven los adultos mayores, surgen de su interior y forman parte de su carácter, la espiritualidad basada en creencias y valores se caracteriza por la relación con el yo, con el otro, con la naturaleza y con la vida. Material y métodos: investigación cualitativa, descriptiva comprensiva, realizada con 10 adultos mayores, el muestreo fue definido por saturación de discursos. La técnica fue la entrevista a profundidad con una guía de entrevista semi estructurada, aplicada en dos sesiones, respetándose los principios bioéticos. Resultados: se identificaron tres categorías generales: re-creando las concepciones de la espiritualidad; la espiritualidad en la práctica de valores y la espiritualidad desde la religio-sidad del adulto mayor. Discusión: la primera categoría define el acercamiento a Dios a través de la oración y la religión, considerada una necesidad básica y humana para promover la calidad de vida. La segunda categoría, se refiere a la práctica de valores que es trascendente y se refleja principalmente en el amor y la solidaridad. La tercera categoría, señala que la espiritualidad brinda la oportunidad de estar en paz con uno mismo y con los demás. Conclusiones: las vivencias espirituales de los adultos mayores indican que ellos desean vivir mejor, usando lo que le resta de vida de la mejor manera posible. Por ello, se apoyan en la religiosidad y la práctica de valores para conservar la paz espiritual logrando así, un envejecimiento favorable.