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1.
Chirurgia (Bucur) ; 115(1): 39-49, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32155398

RESUMEN

Introduction: The inflammatory response plays a critical role in carcinogenesis. There are recent scores based on the systemic inflammatory response, such as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), which have been shown to have prognostic value in cancer patients. These scores allow the identification of patients who will have poor response to treatment and poor survival. The aim of this study is to evaluate the prognostic role of NLR, PLR, LMR and PNI in terms of long-term survival in patients with colorectal cancer, operated in emergency. Material and Methods: We included 391 patients admitted and operated for complicated colorectal cancer in the Surgery II clinic of the Clinical Emergency County Hospital Sf. Ap. Andrei - from Galati, between 2008-2017. We analyzed the paraclinical factors of systemic inflammation NLR, PLR, MRL and PNI. As prognostic factors, survival curves were analyzed. Results: The high values of NLR and PLR increased the risk of death (HR = 7.581, 95% CI = (6.358,9.039), p value = 0.000000, respectively HR = 1.043, 95% CI = (1.039, 1.047), p value = 0.000000), and the increased values of LMR and PNI led to the decrease of this risk (HR = 0.069, 95% CI = (0.054.0.090), p value = 0.000000, respectively HR = 0.758, 95 % CI = (0.730.0.788), p value = 0.000000). In the multivariate regression analysis, the increase of PLR resulted in an increase in the risk of death (HR = 1.024, 95% CI = (1.019.1.029), p value = 0.000000), and for the LMR and PNI, a reduction of the risk of death (HR = 0.353, 95% CI = (0.248.0.504), p value = 0.000000, respectively HR = 0.852, 95% CI = (0.822.0.883), p value = 0.000000). Conclusions: The univariate analysis showed that NLR and PLR are risk factors, and LMR and PNI are protective factors in terms of survival. The multivariate analysis revealed that PLR is an independent risk factor, and LMR and PNI were independent protection factors.


Asunto(s)
Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/mortalidad , Inflamación/sangre , Recuento de Leucocitos , Recuento de Plaquetas , Biomarcadores/sangre , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Urgencias Médicas , Humanos , Pronóstico
2.
3.
Medicine (Baltimore) ; 99(7): e19096, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049816

RESUMEN

INTRODUCTION: The assessment of bone marrow thrombopoietic activity in patients with thrombocytopenia is necessary to achieve an accurate diagnosis and administer effective treatment. We evaluated the discriminatory power of the immature platelet fraction (IPF) in differentiating hyperdestructive/consumptive thrombocytopenia from hypoproductive thrombocytopenia and its potential use as a predictive marker for platelet recovery. METHODS: In this observational study, platelet indices, including IPF, were measured in 105 healthy individuals, 27 patients with hyperdestructive/consumptive thrombocytopenia (all with immune thrombocytopenic purpura [ITP]), and 35 patients with hypoproductive thrombocytopenia (5 with aplastic anemia and 30 with cancer who were undergoing chemotherapy) using a Sysmex XN-3000 hematology analyzer. RESULTS: The platelet distribution width, mean platelet volume, platelet large cell ratio, IPF, and absolute immature platelet count (AIPC) were significantly higher in the hyperdestructive/consumptive thrombocytopenia group than in the hypoproductive thrombocytopenia group (P < .001). The IPF showed the highest difference between the two patient groups (200%). Receiver operating characteristics analysis that showed the IPF had the largest area under the curve among all the platelet indices analyzed; its cut-off value was 2.3%. The IPF decreased 3 to 4 days in advance of platelet count elevation in patients with ITP, whereas the delta AIPC increased 3 days in advance. Furthermore, the IPF and delta AIPC increased 5.5 days and 8.5 days, respectively, before platelet counts increased up to 130.0 × 10/L in cancer patients receiving chemotherapy. CONCLUSION: These data demonstrated that the IPF and delta AIPC are both excellent indicators of the etiology of thrombocytopenia and predictive markers for platelet recovery.


Asunto(s)
Anemia Aplásica/diagnóstico , Volúmen Plaquetario Medio , Recuento de Plaquetas , Púrpura Trombocitopénica Idiopática/diagnóstico , Adulto , Anciano , Anemia Aplásica/sangre , Anemia Aplásica/complicaciones , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Valor Predictivo de las Pruebas , Púrpura Trombocitopénica Idiopática/sangre , Curva ROC
4.
J Photochem Photobiol B ; 204: 111782, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32062389

RESUMEN

BACKGROUND: Ultraviolet (UV) fluorescent lamp (FL) was applied in mainstream riboflavin photochemical method (RPM) to inactivate pathogens in blood components. Low UV irradiance emitted by UV-FL resulted in more time to achieve effective inactivation. MATERIALS AND METHODS: A novel light emitting diode (LED) UV illumination with adjustable irradiance was developed by us. Two strains of drug-resistant bacteria (DRB), pan-drug resistant Acinetobacter baumannii (PDRAB) and methicillin-resistant Staphylococcus aureus (MRSA) were cultured and used for evaluating the inactivation effectiveness of RPM using UV-LED or UV-FL against DRB in plasma or platelets. Three plasma factors and four platelet parameters were measured after treatments. RESULTS: There was a linear relationship between UV-LED irradiance and electric current, the minimum UV irradiance was 24 mW/cm2, and the maximum was 258 mW/cm2. At the same UV dose of 15 J/cm2, inactivation effectiveness of UV-LED with 258 mW/cm2 against PDRAB in plasma or platelets were comparable to that of UV-FL with 16 mW/cm2, both above 98%. UV-FL treatment required 10-15 min, but UV-LED only required 1-2 min. However, MRSA showed a resistance to UV-LED (inactivation effectiveness was around 40%) compared with UV-FL (inactivation effectiveness was above 98%). The retention of fibrinogen, factor V, factor VII in plasma and platelet counts in platelets with UV-LED treatment were significantly higher than UV-FL at the same UV dose. CONCLUSION: The treatment of RPM using UV-LED with high UV irradiance was able to dramatically shorten inactivation time against PDRAB in plasma or platelets and improve retention of blood components compared with UV-FL.


Asunto(s)
Proteínas Sanguíneas/metabolismo , Riboflavina/química , Rayos Ultravioleta , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/efectos de la radiación , Plaquetas/citología , Plaquetas/efectos de los fármacos , Plaquetas/efectos de la radiación , Farmacorresistencia Bacteriana/efectos de los fármacos , Factor V/metabolismo , Fibrinógeno/metabolismo , Humanos , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/efectos de la radiación , Recuento de Plaquetas , Riboflavina/farmacología
5.
Int Heart J ; 61(1): 89-95, 2020 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-31956149

RESUMEN

Thrombocytopenia is a frequent complication in patients requiring intra-aortic balloon pumping (IABP) counterpulsation. However, its prognostic impact has not been fully addressed. The objective of this study is to evaluate the impact of the change in the platelet number during IABP use on the prognosis after device removal.This is a retrospective observational study. Patients in the intensive cardiac care unit at three Juntendo University hospitals who underwent percutaneous implantation of IABP with or without veno-arterial extracorporeal membrane oxygenation (V-A ECMO), since 2012-2016, were enrolled in the study (n = 439). Patients who died during mechanical circulatory support (n = 47) were excluded. We evaluated the prognostic impact of the ratio of platelet reduction from the baseline (% PLT reduction) during IABP use on cardiovascular mortality after device removal.The median and the range of follow-up period were 298 days and 0-1,869 days, respectively. Unadjusted Kaplan-Meier analysis demonstrated that patients with a higher % PLT reduction had higher cardiovascular (CV) mortality. An adjusted Cox proportional hazard analysis demonstrated that a 10% higher % PLT reduction was associated with higher cardiovascular (CV) mortality (Hazard ratio: 1.3, 95% Confidence interval: 1.1-1.6, P < 0.001). Moreover, % PLT reduction and the maximum C-reactive protein (CRP) level during IABP use were positively correlated (r = 0.326, P < 0.001).The reduced number of platelets during IABP use was associated with an increased risk of CV mortality.


Asunto(s)
Remoción de Dispositivos/efectos adversos , Oxigenación por Membrana Extracorpórea/métodos , Contrapulsador Intraaórtico/efectos adversos , Anciano , Anciano de 80 o más Años , Remoción de Dispositivos/mortalidad , Oxigenación por Membrana Extracorpórea/mortalidad , Femenino , Humanos , Unidades de Cuidados Intensivos , Contrapulsador Intraaórtico/mortalidad , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento
6.
Ann Hematol ; 99(3): 451-457, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31932901

RESUMEN

The objective of this cohort study was to examine the association between platelet counts upon acute hospitalization and mortality. The study included all adults in North and Central Denmark Regions with a first acute admission to an internal medicine unit during 2006-2012, categorized by first platelet count within +/-24 hours of admission. We assessed the association between platelet count and in-hospital, 30-day, 90-day, and 365-day mortality using age- and sex-adjusted Cox models. We also stratified analyses by presence/absence of comorbidity and performed additional analyses restricted to patients with a primary discharge diagnosis of cardiovascular disease or infection. Among the 274,148 study patients, the 1-year mortality was 12.6%. The association between platelet count and mortality took the form of an asymmetric U-shaped curve. For 30-day mortality, hazard ratios (HRs) were 5.24 (95% CI: 4.60-5.97) for platelet count < 50 × 109/L and 2.50 (95% CI: 2.33-2.69) for platelet count ≥ 500 × 109/L, compared with a normal platelet count (150-400 × 109/L). A slightly increased risk of mortality was observed for platelet counts < 200 × 109/L and ≥ 250 × 109/L. A similar pattern was observed for 30-day, 90-day, and 365-day mortality and in all subgroups except patients with a primary discharge diagnosis of infection. In this case, patients with a platelet count between 150 × 109/L and 199 × 109/L had the lowest mortality. Platelet counts in adults upon acute hospital admission to internal medicine units, including counts within the normal range, are a predictor of mortality.


Asunto(s)
Mortalidad Hospitalaria , Admisión del Paciente , Sistema de Registros , Anciano , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Factores de Riesgo , Tasa de Supervivencia
7.
An Bras Dermatol ; 95(1): 40-45, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31889591

RESUMEN

BACKGROUND: Psoriasis is a chronic immune-mediated inflammatory skin disease that is associated with cardiovascular comorbidities. OBJECTIVES: The objective of this retrospective study is to assess the C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio as inflammatory markers in patients with psoriasis and to search for a relationship between these parameters and psoriasis severity, as defined by the psoriasis area and severity index. METHODS: There were 94 patients with psoriasis and 118 healthy controls enrolled in the study. The C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio values of two groups were retrospectively evaluated. RESULTS: Statistically significant differences were observed in terms of C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio between the patient and control groups (p=0.001, p=0.003, p=0.038, and p=0.007, respectively). Positive correlations were found between the psoriasis area and severity index and the values of C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio (r: 0.381; p<0.01, r: 0.203; p<0.05, r: 0.268; p<0.01, r: 0.374; p<0.01, r: 0.294; p<0.01, respectively). STUDY LIMITATIONS: The small sample size and the retrospective design of the study are limitations. CONCLUSION: Elevated C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio were significantly associated with psoriasis. A positive correlation between C-reactive protein and monocyte-to-high-density-lipoprotein ratio leads to the suggestion that monocyte-to-high-density-lipoprotein ratio might be a reliable parameter in psoriasis during the follow-up. The relationship between the diasease and inflammatory parameters might provide early detection of cardiovascular morbidities in psoriasis patients.


Asunto(s)
Plaquetas , Proteína C-Reactiva/análisis , Lipoproteínas HDL/sangre , Linfocitos , Monocitos , Neutrófilos , Psoriasis/sangre , Adulto , Análisis de Varianza , Biomarcadores/sangre , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/etiología , Estudios de Casos y Controles , Femenino , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Psoriasis/complicaciones , Valores de Referencia , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Adulto Joven
8.
J Zoo Wildl Med ; 50(4): 1021-1025, 2020 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31926541

RESUMEN

Hematology and serum biochemistry profiles are used to evaluate the health status of animals ongoing rehabilitation. The aim of this project was to develop blood and biochemistry ranges for harbor seal pups (Phoca vitulina) after rehabilitation; thus, 22 different blood parameters in 60 animals were tested before release. The second goal was to test for differences due to sex, stranding location, body condition at admission, and presence or absence of umbilical cord. The alanine aminotransferase, ALT (or glutamate pyruvate transaminase, GPT), (ALT-GPT) differed significantly (P bq = 0.00851) between sexes. Lower leukocyte counts and higher liver enzyme values were the most remarkable findings when comparing the results of this study to other published data. This is the first study to report blood reference ranges for harbor seal pups in the Dutch Wadden Sea after rehabilitation.


Asunto(s)
Recuento de Eritrocitos/veterinaria , Hematócrito/veterinaria , Recuento de Leucocitos/veterinaria , Phoca/sangre , Recuento de Plaquetas/veterinaria , Alanina Transaminasa/sangre , Fosfatasa Alcalina/sangre , Animales , Glucemia , Nitrógeno de la Urea Sanguínea , Creatinina , Femenino , Hemoglobinas , Masculino
9.
Lakartidningen ; 1172020 01 23.
Artículo en Sueco | MEDLINE | ID: mdl-31990364

RESUMEN

A program for care of women with immune thrombocytopenic purpura (ITP) with the recommendation to avoid treatment if platelets were >20 × 109/l during pregnancy, with the target level 100 × 109/l at delivery, was introduced. Treatment should be given with intravenous immunoglobulin (IVIG) or corticosteroids. Out of 75 pregnancies with ITP, 39 percent were treated and the treatment period was shorter with IVIG. Blood loss at delivery was similar as the reference population. Epidural analgesia was given in only 17 percent of the vaginal deliveries. Twenty-three percent of the infants had platelet counts less than 50 × 109/l during the first days after birth. If the women had prior neonatal trombocytopenia 63 percent got a child with thrombocytopenia and 40 percent of those with platelets <20 × 109/l during pregnancy had a child with thrombocytopenia. Multidisciplinary care of pregnant women with ITP including obstetricians, hematologists and neonatologists is recommended.


Asunto(s)
Complicaciones Hematológicas del Embarazo , Púrpura Trombocitopénica Idiopática , Niño , Femenino , Humanos , Inmunoglobulinas Intravenosas , Recuento de Plaquetas , Embarazo , Complicaciones Hematológicas del Embarazo/terapia , Púrpura Trombocitopénica Idiopática/terapia
10.
Medicine (Baltimore) ; 99(2): e18727, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914089

RESUMEN

The current study aimed to analyze the clinical characteristics of severe fever with thrombocytopenia syndrome (SFTS) and to explore the risk factors of critical patients. From 2016 to 2018, we collected the hospitalized diagnosed cases with SFTS in Jinan infectious disease hospital of Shandong University and analyzed by the descriptive epidemiological method. According to the prognosis, they were divided into general group and severe group. The epidemiological characteristics, clinical features, and laboratory indexes of these 2 groups of patients were compared and analyzed at the first visit. The risk factors related to the severity of the disease were analyzed by univariate Logistic regression. In total, 189 cases of SFTS were treated during the period and 33 deaths occurred in the severe group, with the fatality rate of 17.46%. The patients' age (χ = 8.864, P < .01), ALT (Z = -2.304, P = .03), AST (Z = -3.361, P < .01), GLU (t = -4.115, P < .01), CK (Z = -3.964, P < .01), CK-MB (Z = -2.225, P = .03), LDH (Z = -3.655, P < .01), α-HBDH (Z = -2.040, P = .04), APTT (t = -3.355, P < .01), BUN (Z = -2.040, P = .04), Cr (Z = -3.071, P = .01), and D-dimer (Z = -2.026, P = .04) in the severe group were higher than that in the normal group, but the blood platelet (PLT) counts were significantly lower (Z = -2.778, P < .01) than that in the normal group. With the neuropsychiatric symptoms (OR = 24.083, 95% CI = 6.064-95.642), skin bleeding point (OR = 30.000, 95% CI = 6.936-129.764), multiple organ dysfunction (OR = 34.048, 95% CI = 7.740-149.782), past medical history (OR = 3.792, 95% CI = 1.284-11.200), and fasting glucose elevation (OR = 1.359, 95% CI = 1.106-1.668) could predict the severity of the SFTS. In summary, the abnormality of the laboratory index, the special clinical manifestations, and the past medical history of SFTS patients were the important basis for judging the patient's serious condition.


Asunto(s)
Fiebre/epidemiología , Fiebre/fisiopatología , Trombocitopenia/epidemiología , Trombocitopenia/fisiopatología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Glucemia , Comorbilidad , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/epidemiología , Recuento de Plaquetas , Pronóstico , Factores de Riesgo , Estaciones del Año , Índice de Severidad de la Enfermedad , Trombocitopenia/mortalidad , Adulto Joven
11.
BMC Infect Dis ; 20(1): 71, 2020 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-31969117

RESUMEN

BACKGROUND: Whipple's disease (WD) is a rare multisystem infectious disorder that is caused by the actinomycete Tropheryma whipplei. It presents with joint pain followed by abdominal pain, diarrhea, malabsorption and finally failure to thrive. Diagnosis requires tissue sampling and histology with periodic acid-Schiff [PAS] staining. Thrombocytopenia associated with endocarditis associated with WD has been reported twice. CASE PRESENTATION: A 56 year old Caucasian male presented with years of steroid treated joint pain and recent onset diarrhea, weight loss and abdominal pain. Ultimately he was found to have a platelet count of 4000 with concomitant endocarditis and embolic stroke. Small bowel biopsy confirmed the diagnosis of WD approximately 1 year after his first visit. His platelets improved with antibiotic treatment but he eventually expired 16 months after his initial consult and 5 months after his definitive diagnosis. CONCLUSION: WD can remain undiagnosed and untreated until late in the course of the illness. A high index of suspicion is recognized as necessary for early diagnosis to begin treatment. Critical thrombocytopenia associated with endocarditis is a rare and potentially poor prognostic sign in late stage Whipple's disease.


Asunto(s)
Endocarditis Bacteriana/etiología , Trombocitopenia/etiología , Enfermedad de Whipple/complicaciones , Antibacterianos/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Humanos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Trombocitopenia/tratamiento farmacológico , Tropheryma/patogenicidad , Enfermedad de Whipple/diagnóstico
12.
Int J Sports Med ; 41(1): 12-20, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31747702

RESUMEN

In view of the growing amount of (intense) training in competitive sports, quick recovery plays a superior role in performance restoration. The aim of the present study was to compare the effects of active versus passive recovery during high-intensity interval training (HIIT) and sprint interval training (SIT) protocols on acute alterations of circulating blood cells. Twelve male triathletes/cyclists performed 1) a HIIT consisting of 4×4 min intervals, 2) a SIT consisting of 4×30s intervals, separated by either active or passive recovery. Blood samples were collected immediately before and at 0', 30', 60' and 180' (minutes) post-exercise. Outcomes comprised leukocytes, lymphocytes, neutrophils, mixed cell count, platelets, cellular inflammation markers (neutrophil/lymphocyte-ratio (NLR), platelet/lymphocyte-ratio (PLR)), and the systemic immune-inflammation index (SII). In view of HIIT, passive recovery attenuated the changes in lymphocytes and neutrophils compared to active recovery. In view of SIT, active recovery attenuated the increase in leukocytes, lymphocytes and absolute mixed cell count compared to passive recovery. Both protocols, independent of recovery, significantly increased NLR, PLR and SII up to 3h of recovery compared to pre-exercise values. The mode of recovery influences short-term alterations in the circulating fraction of leukocytes, lymphocytes, neutrophils and the mixed cell count, which might be associated with different hormonal and metabolic stress responses due to the mode of recovery.


Asunto(s)
Recuento de Células Sanguíneas , Entrenamiento de Intervalos de Alta Intensidad/métodos , Homeostasis/fisiología , Inflamación/sangre , Esfuerzo Físico/fisiología , Adulto , Biomarcadores/sangre , Recuento de Eritrocitos , Humanos , Recuento de Leucocitos , Recuento de Linfocitos , Masculino , Neutrófilos/metabolismo , Recuento de Plaquetas , Adulto Joven
13.
Int J Radiat Biol ; 96(1): 145-154, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31021662

RESUMEN

Purpose: Rapid depletion of white blood cells, platelets, and reticulocytes are hallmarks of hematopoietic injury of acute radiation syndrome (H-ARS) and, if left untreated, can lead to severe health consequences including death. While the granulocyte colony stimulating factors (G-CSF) filgrastim (Neupogen®), pegfilgrastim (Neulasta®), and sargramostim (Leukine®) are approved to increase survival in patients exposed to a myelosuppressive dose of radiation, no medical countermeasure is currently available for treatment of the thrombocytopenia that also results following radiation exposure. Romiplostim (Nplate®), a thrombopoietin receptor agonist, is the first FDA-approved thrombopoiesis-stimulating protein for the treatment of low platelet (PLT) counts in adults with chronic immune thrombocytopenia. Herein, we present the results of an analysis in mice of romiplostim as a medical countermeasure to improve survival and PLT recovery following acute radiation.Materials and methods: Male and female C57BL/6J mice (11 - 12 weeks of age, n = 21/sex/group) were total body irradiated (TBI) with 6.8 Gy X-rays that reduces 30-day survival to 30% (LD70/30). Vehicle, romiplostim, and/or pegfilgrastim were administered subcutaneously beginning 24 h after TBI for 1-5 days. Evaluation parameters included 30-day survival, pharmacokinetics, and hematology.Results: Full or maximal efficacy with an ∼40% increase in survival was achieved after a single 30 µg/kg dose of romiplostim. No further survival benefit was seen with higher (100 µg/kg) or more frequent dosing (3 or 5 once daily doses at 30 µg/kg) of romiplostim or combined treatment with pegfilgrastim. Pharmacodynamic analysis revealed that the platelet nadir was not as low and recovery was faster in the irradiated mice treated with romiplostim when compared with irradiated control animals (Day 8 versus 10 nadir; Day 22 versus 29 recovery to near baseline). Platelet volume also increased more rapidly after romiplostim injection. Kinetic profiles of other hematology parameters were similar between TBI romiplostim-treated and control mice. Peak serum levels of romiplostim in TBI mice occurred 4 - 24 h (Tmax) after injection with a t1/2 of ∼24 h. Cmax values were at ∼6 ng/ml after 30 µg/kg ± TBI and ∼200 ng/ml after 300 µg/kg. A 10-fold higher romiplostim dose increased the AUClast values by ∼35-fold.Conclusion: A single injection of romiplostim administered 24 h after TBI is a promising radiation medical countermeasure that dramatically increased survival, with or without pegfilgrastim, and hastened PLT recovery in mice.


Asunto(s)
Plaquetas/efectos de los fármacos , Plaquetas/efectos de la radiación , Contramedidas Médicas , Proteínas Recombinantes de Fusión/farmacología , Trombopoyetina/farmacología , Animales , Plaquetas/citología , Relación Dosis-Respuesta a Droga , Interacciones de Drogas , Femenino , Filgrastim/farmacología , Masculino , Ratones , Ratones Endogámicos C57BL , Recuento de Plaquetas , Polietilenglicoles/farmacología , Receptores Fc , Proteínas Recombinantes de Fusión/farmacocinética , Análisis de Supervivencia , Trombopoyetina/farmacocinética , Rayos X/efectos adversos
14.
J Matern Fetal Neonatal Med ; 33(1): 1-4, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29804488

RESUMEN

Objective: To demonstrate the utility of dexamethasone, used according to the criteria of the attending physician, in patients with HELLP syndrome.Methods: This cross-sectional study was conducted in patients with HELLP syndrome and was based on the daily, real-life management of HELLP syndrome. Patients who received dexamethasone had it administered immediately after giving birth at a dosage of 8 mg every 8 hours for 72 hours, for a total of 72 mg. The analysis was conducted between patients who received corticosteroids and those who did not, with complete or partial HELLP.Results: There were 97 women who suffered complications from HELLP syndrome, there were 43 (44.3%) received dexamethasone. The groups were comparable except for the initial platelet count because this was the criterion used to divide the groups. In addition, the group without corticosteroids comprised more patients with partial HELLP. The platelet count shows that on the third day was similar in both groups, following a difference of more than 40,000 at the beginning of the study. The average platelet increase was 27,448 in the group without corticosteroids and 88,408 in the corticosteroid group; p = .001.Conclusions: This study demonstrates that the administration of postpartum dexamethasone at a dosage of 8 mg every 8 hours for 72 hours in HELLP syndrome is associated with a significant increase in platelet count.


Asunto(s)
Dexametasona/uso terapéutico , Síndrome HELLP/tratamiento farmacológico , Adulto , Plaquetas/efectos de los fármacos , Plaquetas/patología , Bolivia/epidemiología , Estudios Transversales , Dexametasona/administración & dosificación , Esquema de Medicación , Femenino , Síndrome HELLP/epidemiología , Humanos , Recuento de Plaquetas , Atención Posnatal/métodos , Periodo Posparto/sangre , Periodo Posparto/efectos de los fármacos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Embarazo , Resultado del Tratamiento , Adulto Joven
15.
Medicine (Baltimore) ; 98(49): e18038, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31804310

RESUMEN

In the absence of liver biopsy and transient elastography (TE), aspartate aminotransferase to platelet ratio (APRI), fibrosis-4 score (FIB-4), and gammaglutamyl transpeptidase to platelet ratio (GPR) are simple and inexpensive methods for the detection of liver fibrosis. AIMS: We compared the performance of APRI, FIB-4, and GPR scores against TE in predicting the presence of liver fibrosis and cirrhosis, determined the optimal cut-off values for fibrosis and cirrhosis prediction, and reviewed the need for further TE assessment in resource-limited areas in China. METHODS: TE and basic laboratory tests were performed in 2014 consecutive patients with chronic hepatitis B (CHB), and then compared to APRI, FIB-4, and GPR. RESULTS: For the detection of significant fibrosis, the areas under the receiver operating characteristic (AUROC) curves for APRI, FIB-4, and GPR were 0.83, 0.75, and 0.77, respectively. For the detection of cirrhosis, the AUROC curves for APRI, FIB-4, and GPR were 0.90, 0.84, and 0.84, respectively. The cutoff of APRI was 0.35, with 78% sensitivity and 63% negative predictive value (NPV), to exclude significant fibrosis (F ≥ 2). At an APRI of 0.6, results showed a 94% specificity, 100% positive predictive value (PPV) and 7.9 positive likelihood ratio (PLR) in detecting significant fibrosis. Thus, patients with an APRI of <0.35 or >0.6 demonstrated correct prediction of liver fibrosis. These results translated to 1250 out of the 2014 patients avoiding the need for TE with a diagnostic accuracy of >80%. CONCLUSIONS: The APRI score accurately assessed fibrosis and reduced the need for TE in almost two-thirds of Chinese patients with CHB.


Asunto(s)
Aspartato Aminotransferasas/sangre , Hepatitis B Crónica/sangre , Hepatitis B Crónica/complicaciones , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/etiología , Adulto , Biomarcadores , China , Diagnóstico por Imagen de Elasticidad/métodos , Femenino , Hepatitis B Crónica/patología , Humanos , Cirrosis Hepática/sangre , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Pobreza , Curva ROC , Estudios Retrospectivos , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , gamma-Glutamiltransferasa/sangre
16.
PLoS Negl Trop Dis ; 13(12): e0007817, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31805088

RESUMEN

BACKGROUND: Hepatic dysfunction and coagulopathy are common in acute dengue illness. We analyzed the trajectories of the above parameters in the survivors and fatal patients in the outbreak in Tainan, 2015. METHODS: A retrospective study was conducted using data from a tertiary hospital between January and December 2015. Multilevel modeling (MLM) was used to identify the changes in aminotransferase (AST), alanine aminotransferase (ALT), activated partial thromboplastin time (aPTT), and platelet counts from Day 0 to Day 7 of the onset of dengue infection. The machine-learning algorithm was used by purity measure assumption to calculate the accuracy of serum transaminases and coagulation variables to discriminate between the fatal and survival groups. RESULTS: There were 4,069 dengue patients, of which 0.9% died in one week after illness onset (i.e., early mortality). Case fatality rate was the highest for those aged ≥70 years. Both AST and ALT values of the fatal group were significantly higher than those of the survivor group from Day 3 (AST median, 624 U/L vs. 60 U/L, p < 0.001; ALT median, 116 U/L vs. 29 U/L, p = 0.01) of illness onset and peaked on Day 6 (AST median, 9805 U/L vs. 90 U/L, p < 0.001; ALT median, 1504 U/L vs. 49 U/L, p < 0.001). AST ≥ 203 U/L, ALT ≥ 55 U/L, AST2/ALT criteria ≥337.35, or AST/platelet count ratio index (APRI) ≥ 19.18 on Day 3 of dengue infection had a high true positive rate, 90%, 78%, 100%, or 100%, respectively, of early mortality. The platelet counts of the fatal group declined significantly than those of the survivor group since Day 3 of illness onset (median, 19 x103/µl vs. 91 x103/µl, p < 0.01), and aPTT values of the fatal group significantly prolonged longer since Day 5 (median, 68.7 seconds vs. 40.1 seconds, p < 0.001). CONCLUSIONS: AST, ALT, and platelet counts should be monitored closely from Day 0 to Day 3 of dengue infection, and aPTT be followed up on Day 5 of infection to identify the individuals at risk for early mortality.


Asunto(s)
Pruebas de Coagulación Sanguínea/métodos , Dengue/diagnóstico , Dengue/mortalidad , Pruebas de Función Hepática/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Niño , Preescolar , Dengue/epidemiología , Dengue/patología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Tiempo de Tromboplastina Parcial , Recuento de Plaquetas , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Taiwán/epidemiología , Centros de Atención Terciaria , Adulto Joven
17.
Rinsho Ketsueki ; 60(11): 1525-1531, 2019.
Artículo en Japonés | MEDLINE | ID: mdl-31839629

RESUMEN

Thrombocytopenia is a relatively common complication in pregnancy, with a reported frequency of 7%-11%. The causes of this condition are diverse, although the most common etiology is gestational thrombocytopenia (GT) (70%-80%), followed by HELLP syndrome and immune thrombocytopenia (ITP). To investigate the clinical features of thrombocytopenia during pregnancy, we conducted a retrospective analysis of 69 women at our center with 91 pregnancies in which the platelet count was below 100×109/l. There were 38 cases in women with a prior diagnosis of thrombocytopenic diseases such as ITP or an inherited platelet disorder. In the remaining 53 cases, a diagnosis could be made only after delivery. We analyzed the disease course, maternal and perinatal characteristics, platelet count fluctuations, and pregnancy outcomes. The final diagnosis was GT in 38, ITP in 14, and other causes in 1. To distinguish between GT and ITP is not always feasible and can sometimes only be performed based on postpartum changes in the platelet count. In pregnant women with thrombocytopenia, careful follow-up of platelet count fluctuations after delivery is crucial to distinguish ITP from GT.


Asunto(s)
Complicaciones Hematológicas del Embarazo , Trombocitopenia , Femenino , Humanos , Recuento de Plaquetas , Embarazo , Estudios Retrospectivos
18.
Anticancer Res ; 39(12): 6923-6929, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31810963

RESUMEN

BACKGROUND/AIM: The platelet-to-lymphocyte ratio (PLR) has recently been suggested as a new predictor of the prognosis in several carcinoma types. However, the clinical impact remains controversial in patients with ampullary carcinoma. Thus, the aim of this study was to investigate other useful biomarkers for identifying poor prognosis in patients with ampullary carcinoma. PATIENTS AND METHODS: Forty-one patients with ampullary carcinoma underwent pancreaticoduodenectomy (PD) with curative resection between April 2000 and April 2017. Various clinicopathological findings of the patients and their tumors were evaluated as potential prognostic factors which might enable better stratification of prognosis. RESULTS: Platelet-to-lymphocyte ratio, as well as other markers, was found to be a prognostic factor in patients with ampullary carcinoma. The 2-year disease-free survival percentage was significantly higher in the group with low PLR than in the high PLR group (70.2% vs. 28.6%; p=0.005). Combinational analysis of the PLR and conventional TMs enabled us to stratify prognosis of the patients more clearly than by each marker alone. CONCLUSION: PLR was a useful prognostic factor for patients with ampullary cancer. The combination of preoperative PLR and conventional TMs markers may be powerful predictive factors for postoperative prognosis in patients with ampullary carcinoma following PD.


Asunto(s)
Ampolla Hepatopancreática/patología , Carcinoma Ductal Pancreático/sangre , Carcinoma Ductal Pancreático/cirugía , Neoplasias Pancreáticas/sangre , Neoplasias Pancreáticas/cirugía , Anciano , Ampolla Hepatopancreática/cirugía , Biomarcadores de Tumor/sangre , Femenino , Humanos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Pancreaticoduodenectomía , Recuento de Plaquetas , Pronóstico , Análisis de Supervivencia , Resultado del Tratamiento
19.
Orv Hetil ; 160(51): 2012-2020, 2019 Dec.
Artículo en Húngaro | MEDLINE | ID: mdl-31838859

RESUMEN

Introduction: Thrombocytosis and type 2 diabetes have negative effect on the survival of tumor patients. Previously, their joint effect has not been studied in breast cancer. Aim: The aim of our retrospective study was to investigate the occurrence and effects of thrombocytosis and/or type 2 diabetes in breast cancer patients who attended the 2nd Department of Internal Medicine or the 1st Department of Surgery, Semmelweis University, between 2014 and 2017. Laboratory and anamnestic data were compared at the time of tumor diagnosis between diabetic and non-diabetic groups. Survival analysis was performed to study the effects of thrombocytosis and/or type 2 diabetes. Method: 274 study participants were followed until 31 December 2018, or until their last appearance at the University, or until their death. Results: 5% of the patients had elevated platelet counts (over 400 G/L), and 52 were diabetics. Diabetics were significantly older (non-diabetics: 56.8 ± 13.8 years, diabetics: 67.8 ± 11.0 years, p<0.0001). Triple negative subtype (p = 0.0366), and T1 stage (50%) were present more often in non-diabetics. Stage T2 was more common in diabetic patients (51.9%). Type 2 diabetes was associated with a shorter survival time (p = 0.0032). Thrombocytosis did not affect patient survival. Conclusion: At the diagnosis of breast cancer, existing type 2 diabetes is associated with a more severe clinicopathological stage and shorter survival. We recommend that during routine diabetes controls, women should be made aware of the importance of mammography screening. Moreover, diabetes should be considered as a risk factor; after 30 years of age, diabetics should be screened at least every two years. Orv Hetil. 2019; 160(51): 2012-2020.


Asunto(s)
Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/mortalidad , Diabetes Mellitus Tipo 2/complicaciones , Síndromes Paraneoplásicos/complicaciones , Trombocitosis/complicaciones , Adulto , Neoplasias de la Mama/patología , Diabetes Mellitus Tipo 2/mortalidad , Femenino , Humanos , Recuento de Plaquetas , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Tasa de Supervivencia , Trombocitosis/epidemiología , Trombocitosis/mortalidad
20.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 27(6): 1949-1954, 2019 Dec.
Artículo en Chino | MEDLINE | ID: mdl-31839065

RESUMEN

OBJECTIVE: To investigate the changes of mean platelet volume (MPV), platelet distribution width (PDW) and platelet associated antibodies (PAIg) in children with acute immune thrombocytopenic purpura (aITP), and to explore the diagnostic value of MPV, PDW, PAIg and their combination for megakaryocyte dysmaturity in aITP children. METHODS: Plt count, MPV and PDW of 36 aITP children were measured by using Sysmex XN automatic blood cell analyzer, and 33 children with acquired thrombocytopenic purpura (ATP) without megakaryocyte dysmaturity. The expression of PAIg was detected by flow cytometry, and the number and classification of megakaryocytes in the bone marrow were performed by marrow cytology. The diagnostic significances of MPV, PDW, PAIg and their combination as well as the sensitivity and specificity for megakaryocytes dysmaturity in aITP were assessed through calculating the area under ROC curve (AUC), after determining the influence of each parameters on the megakaryocyte dysmaturity by Logistic regression. RESULTS: MPV, PDW and PAIg of aITP children were significantly higher than those of the ATP children (P<0.05), while the Plt count and number of thromocytogenic megakaryocytes per area (1.5 cm×3 cm) were less than those of the controls (P<0.05). Count of RBC and WBC, percentages of neutrophil granulocytes and lymphocydes in aITP were similar to those in the controls(P>0.05). The results of Logistic regression showed that Plt count, MPV, PDW and PAIg were the factors influencing megakaryocyte dysmaturity in aITP children, and the regression model has a high statistical significance (χ2=65.491,P=0.001) and r square (R2=0.713). The AUC of the combined detection of Plt count, MPV, PDW and PAIg was 0.863, which was much higher than that of Plt count, MPV, PDW, PAIg individually or in pairs. The sensitivity and specificity of the combined detection were 79.167% and 89.697%, which were higher than those of Plt count, MPV, PDW, PAIg individually or in pairs. CONCLUSION: The diagnostic significance of MPV and PDW for megakaryocyte dysmaturity in aITP are insufficient, but the diagnostic efficacy can be improved by combined examination with PAIg.


Asunto(s)
Volúmen Plaquetario Medio , Púrpura Trombocitopénica Idiopática , Anticuerpos , Plaquetas , Niño , Humanos , Megacariocitos , Recuento de Plaquetas , Púrpura Trombocitopénica Idiopática/diagnóstico
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