Low levels of ADAMTS-13 with high anti-ADAMTS-13 antibodies during remission of immune-mediated thrombotic thrombocytopenic purpura highly predict for disease relapse: A multi-institutional study.

Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a life-threatening immune-mediated thrombotic microangiopathy. Daily therapeutic plasma exchange (TPE) and the optimized use of rituximab have strikingly improved the outcome of this disease, however the rate of disease recurrence remains high. Specific predictors of relapse in patients in remission can be relevant for an optimal patient management. In this study, we aimed to identify predictive variables of disease relapse in a multicenter cohort of 74 out of 153 iTTP patients. They were tested at different time points during remission for the levels of ADAMTS-13 activity and autoantibody, and did not receive pre-emptive treatment for ADAMTS-13 activity deficiency during remission. The results showed that the association of ADAMTS13 activity ≤20% with a high anti-ADAMTS-13 titer at remission, and the time to response to first line treatment ≥13 days, were independent predictive factors of disease relapse. In addition, the use of rituximab in patients with exacerbation or refractoriness to TPE was significantly associated with reduced relapse rate. By Cox regression analysis, patients with ADAMTS-13 activity ≤20% plus anti-ADAMTS13 antibody titer ≥15 U/mL at remission had an increased risk of relapse (HR 1.98, CI 95% 1.087-3.614; P < .02). These findings may help to outline more personalized therapeutic strategies in order to provide faster and sustained responses to first-line iTTP treatment and prevent relapses in these patients.

New approach in vaginal prolapse repair: mini-invasive surgery associated with application of platelet-rich fibrin.

INTRODUCTION AND HYPOTHESIS: Platelet-rich fibrin (PRF) matrix is an autologous leukocyte and PRF biomaterial. PRF is a fibrin matrix polymerized in a tetramolecular structure with the incorporation of platelets, leukocytes, cytokines, and circulating stem cells. The three-dimensional structure of PRF is optimal for migration of endothelial cells and fibroblasts. It permits rapid angiogenesis and easier remodeling of fibrin in a more resistant connective matrix. In vaginal surgery, PRF may act as a graft material with better healing and better functional outcome. METHODS: We performed a prospective observational study on ten consecutive women requiring surgery for prolapse recurrence (stage II or higher). These women had high risks for recurrence, erosion with graft materials, and intraoperative and postoperative complications with traditional pelvic reconstructive surgical procedures. ICS score and P-QoL Questionnaire results were assessed preoperatively and postoperatively. Surgery consisted of anterior, posterior, or apical repair plus PRF. Follow-up was performed at 1, 6, 12, 18, and 24 months. RESULTS: Anatomically, the success rate was 80%. Prolapse symptoms improved by 100%. Sexual activity increased by 20% without dyspareunia. The surgical time was satisfactory (mean, 38.5 min). There were no intraoperative or postoperative complications. CONCLUSIONS: The use of PRF for site-specific prolapse repair is associated with a good functional outcome because of the healing and mechanical properties of PRF.