Autologous serum eye drops improve tear production, both lachrymal flow and stability tests and conjunctival impression cytology with transfer in dry eye disease.

BACKGROUND: Autologous serum eye drops, produced by separation of liquid and cellular components of the patient's blood, contain biological nutrients present in natural tears. The aim of this study was to analyse changes in conjunctival impression cytology with transfer and both lachrymal stability and flow tests in patients with dry eye disease after treatment with autologous serum eye drops. MATERIALS AND METHODS: Conjunctival impression cytology and lachrymal flow and stability tests, namely Schirmer's and tear break-up time, were prospectively studied in patients with dry eye disease before and 1 month after treatment with autologous serum eye drops. RESULTS: Twenty-four patients (23 women, mean age 53.8±12.6 years) were included in the study. Ten patients (41.7%) had moderate and six (25.0%) had severe dry eye disease. Five patients had rheumatoid arthritis. After treatment, the number and density of conjunctival goblet cells, their size, the size of their nuclei and the nucleus/cytoplasm ratio increased significantly (202.3±107.5 vs 210.1±100.9 cells/mm2, p<0.01). Seven of ten patients with grade 3 or 4 metaplasia had an improvement in the degree of metaplasia. Both Schirmer's test and tear break-up time improved significantly in this subgroup of patients. In the multivariate study, the increase in conjunctival goblet cells was associated with the number of goblet cells and the size of the cytoplasm at baseline. No adverse reactions were noted. DISCUSSION: Treatment with autologous serum eye drops for 1 month was well tolerated and improved tear production, lachrymal flow and stability tests and conjunctival impression cytology with transfer, increasing the density of the goblet cells.

Polymorphisms in Receptors Involved in Opsonic and Nonopsonic Phagocytosis, and Correlation with Risk of Infection in Oncohematology Patients.

High-risk hematological malignancies are a privileged setting for infection by opportunistic microbes, with invasive mycosis being one of the most serious complications. Recently, genetic background has emerged as an unanticipated risk factor. For this reason, polymorphisms for genes encoding archetypal receptors involved in the opsonic and nonopsonic clearance of microbes, pentraxin-3 (PTX3) and Dectin-1, respectively, were studied and correlated with the risk of infection. Fungal, bacterial, and viral infections were registered for a group of 198 patients with high-risk hematological malignancies. Polymorphisms for the pentraxin-3 gene (PTX3) showed a significant association with the risk of fungal infection by Candida spp. and, especially, by Aspergillus spp. This link remained even for patients undergoing antifungal prophylaxis, thus demonstrating the clinical relevance of PTX3 in the defense against fungi. CLEC7A polymorphisms did not show any definite correlation with the risk of invasive mycosis, nor did they influence the expression of Dectin-1 isoforms generated by alternative splicing. The PTX3 mRNA expression level was significantly lower in samples from healthy volunteers who showed these polymorphisms, although no differences were observed in the extents of induction elicited by bacterial lipopolysaccharide and heat-killed Candidaalbicans, thus suggesting that the expression of PTX3 at the start of infection may influence the clinical outcome. PTX3 mRNA expression can be a good biomarker to establish proper antifungal prophylaxis in immunodepressed patients.

Safety and efficacy of splenectomy in over 65-yrs-old patients with immune thrombocytopenia.

AIM: Few studies specifically focus on elderly splenectomized immune thrombocytopenia (ITP) patients. Older patients with ITP and excellent health are often excluded from surgery splenectomy. We aimed to compare the safety and efficacy of splenectomy in elderly and non-elderly ITP patients and to examine the effect of age on therapeutic response. MATERIAL AND METHODS: We carried out a retrospective analysis of a series of 218 patients who had undergone splenectomy for ITP. We compared the data from the elderly group (≥65 yrs, 57 patients) with the young group (<65 yrs, 162 patients). RESULTS: Surgical technique (laparoscopy or open laparotomy splenectomy) was comparable between the two age groups. The adjusted risk of major bleeding following splenectomy for elderly patients was three times that for young patients (OR 3.05, 95% CI: 1.44-6.52). The median duration of postoperative hospital stay was longer for elderly than for young patients (8 d vs. 4 d, P < 0.001). However, we identified a subgroup of elderly ITP patients, those aged between 65 and 70 yrs who had undergone laparoscopic splenectomy, with a low risk of postoperative complications. Of the 218 patients, 89% achieved a favorable response to splenectomy. A favorable response was significantly less common in elderly than in young people (79% vs. 92%, P = 0.005). However, we observed an acceptable long-term control of ITP in the elderly group, in which the probability of maintaining response for 14 yrs after splenectomy was 56%. CONCLUSIONS: Patients aged ≥65 yrs experienced negative effects on safety and efficacy outcomes of splenectomy for ITP, but further studies are needed to identify predictors of postsplenectomy outcomes in this group.

[Effect of persistent microvascular obstruction on post-infarction ventricular remodeling following intracoronary bone-marrow cell transplantation: a contrast-enhanced cardiac magnetic resonance study]. / Impacto de la obstrucción microvascular persistente en el remodelado ventricular postinfarto tras el implante intracoronario de células mononucleadas de médula ósea: un estudio de cardiorresonancia con contraste.

INTRODUCTION AND OBJECTIVES: Late contrast-enhanced cardiac magnetic resonance (CMR) enables areas of persistent microvascular obstruction (PMO) to be detected early after acute myocardial infarction. Our aim was to evaluate the impact of PMO on subsequent ventricular remodeling in a cohort of patients with acute ST-elevation myocardial infarction (STEMI) who underwent intracoronary autologous bone-marrow mononuclear cell (ABMMC) transplantation. METHODS: In total, 14 patients underwent intracoronary transplantation of 66+/-39 x 10(6) ABMMCs 8+/-2 days following successful revascularization of a STEMI (i.e., TIMI flow grade 3 in the affected artery). Serial CMR studies with gadolinium-DTPA enhancement were performed at baseline and 10 months after infarction. Left ventricular volume and ejection fraction, regional contractility and the infarct size were measured and the presence of PMO (defined as hypoenhanced areas within the infarcted zone) was investigated. RESULTS: Overall, PMO was detected in five of the 14 patients (36%). Those with PMO tended to have a larger infarct size, larger ventricular volumes, and poorer regional and global left ventricular systolic function in baseline studies than those without PMO. At follow-up, there were significant associations between PMO and an increase in end-diastolic volume (25+/-24 mL vs. -2+/-19 mL; P=.037), the absence of an increase in end-diastolic parietal thickness (P=.027), and a smaller reduction in the number of akinetic or dyskinetic segments. CONCLUSIONS: The detection of PMO by CMR early after successful revascularization of a STEMI in patients who underwent intracoronary ABMMC transplantation was associated with adverse left ventricular remodeling.

Impacto de la obstrucción microvascular persistente en el remodelado ventricular postinfarto tras el implante intracoronario de células mononucleadas de médula ósea: un estudio de cardiorresonancia con contraste / Effect of Persistent Microvascular Obstruction on Post-Infarction Ventricular Remodeling Following Intracoronary Bone-Marrow Cell Transplantation: a Contrast-Enhanced Cardiac Magnetic Resonance Study

Introducción y objetivos. La cardiorresonancia magnéticacon realce tardío de contraste (RMc) permite la detecciónprecoz de obstrucción microvascular persistente(OMP) tras un infarto. Hemos analizado el impacto de laOMP en el remodelado ventricular de una cohorte de pacientes con infarto agudo de miocardio con ST elevado(IAMSTE) que recibieron implante intracoronario de células mononucleadas de médula ósea autóloga (CMMOA).Métodos. Catorce pacientes recibieron infusión intracoronaria de 66 ± 39 millones de CMMOA a los 8 ± 2 días de un IAMSTE revascularizado con éxito (flujo TIMI 3 epicárdico). Se realizaron estudios seriados de RMc con gadolinio- DTPA (basal y a los 10 meses del infarto), con análisis de volúmenes y fracción de eyección ventricular izquierda, motilidad regional, tamaño del infarto y presenciade OMP (definida como un área con ausencia de señalen el seno del infarto).Resultados. Se detectó OMP en 5 (36%) de los 14 pacientes,junto con una tendencia en el estudio basal a presentar un mayor tamaño del infarto, mayores volúmenes y peor función sistólica general y regional de ventrículo izquierdo respecto a aquellos sin OMP. En el seguimiento, la presencia de OMP se relacionó significativamente con un incremento en el volumen telediastólico (25 ± 24 frente a –2 ± 19 ml; p = 0,037), ausencia de incremento en el grosor telediastólico parietal (p = 0,027) y una menor reducciónen el número de segmentos acinéticos o discinéticos.Conclusiones. La OMP evaluada precozmente medianteRMc tras un IAMSTE revascularizado con éxito seasocia con un remodelado ventricular izquierdo adversoen pacientes sometidos a implante intracoronario de CMMOA

Introduction and objectives. Late contrast-enhancedcardiac magnetic resonance (CMR) enables areas ofpersistent microvascular obstruction (PMO) to bedetected early after acute myocardial infarction. Our aimwas to evaluate the impact of PMO on subsequentventricular remodeling in a cohort of patients with acuteST-elevation myocardial infarction (STEMI) whounderwent intracoronary autologous bone-marrowmononuclear cell (ABMMC) transplantation.Methods. In total, 14 patients underwent intracoronarytransplantation of 66±39 × 106 ABMMCs 8±2 daysfollowing successful revascularization of a STEMI (i.e.,TIMI flow grade 3 in the affected artery). Serial CMRstudies with gadolinium-DTPA enhancement wereperformed at baseline and 10 months after infarction. Left ventricular volume and ejection fraction, regionalcontractility and the infarct size were measured and thepresence of PMO (defined as hypoenhanced areas withinthe infarcted zone) was investigated.Results. Overall, PMO was detected in five of the 14patients (36%). Those with PMO tended to have a largerinfarct size, larger ventricular volumes, and poorer regional and global left ventricular systolic function in baseline studies than those without PMO. At follow-up, there were significant associations between PMO and an increase in end-diastolic volume (25±24 mL vs. –2±19 mL; P=.037), the absence of an increase in end-diastolic parietal thickness (P=.027), and a smaller reduction in the number of akinetic or dyskinetic segments.Conclusions. The detection of PMO by CMR earlyafter successful revascularization of a STEMI in patientswho underwent intracoronary ABMMC transplantationwas associated with adverse left ventricular remodeling