Evaluation of bleeding symptoms and laboratory parameters related to bleeding in sisters of patients with hemophilia A and B.

INTRODUCTION: Our purpose was to determine the bleeding risk of obligate and potential carriers, highlight the prophylactic applications before interventions for families and physicians. METHOD: Forty-six sisters who had at least one family member with hemophilia A or B were included. Laboratory parameters were tested.Bleeding tendency interrogated by a detailed questionnaire.The results were compared with 43 healthy female controls. RESULTS: Mean factor activity levels were significantly lower in sisters than control subjects (p = 0,004). Bleeding score was higher in sisters than controls (p = 0.001). Prolonged bleeding after minor injury was significantly higher in the sisters than control subjects (p = 0.008). Requiring further treatment due to prolonged bleeding after tooth extraction was significantly higher in sisters (p = 0.001). Sisters had postpartum hemorrhage lasting longer than 6 weeks than controls (p = 0.025). Menstrual period lasted longer in the sisters than controls (p < 0.001). Spontaneous epistaxis, oral and gingival bleeding were more frequently observed in sisters whose factor activity levels were 60 % or below (p = 0.014 and p = 0.047, respectively). There was no statistically significant difference between the severity of hemophilia in the affected family member and the factor levels in the sisters (p = 0.398).Spontaneous epistaxis has found to be significantly associated with the hemophilia severity in the family (p = 0.004). CONCLUSION: Clotting factor levels were found to be lower in the sisters and associated with spontaneous epistaxis, oral and gingival bleeding.Also, regardless of clotting factor levels, sisters significantly experienced more bleeding problems.Our study demonstrated the importance of taking precautions for prolonged bleeding in cases where medical interventions are inevitable in these patients.

Contact mechanics between the human finger and a touchscreen under electroadhesion.

The understanding and control of human skin contact against technological substrates is the key aspect behind the design of several electromechanical devices. Among these, surface haptic displays that modulate the friction between the human finger and touch surface are emerging as user interfaces. One such modulation can be achieved by applying an alternating voltage to the conducting layer of a capacitive touchscreen to control electroadhesion between its surface and the finger pad. However, the nature of the contact interactions between the fingertip and the touchscreen under electroadhesion and the effects of confined material properties, such as layering and inelastic deformation of the stratum corneum, on the friction force are not completely understood yet. Here, we use a mean field theory based on multiscale contact mechanics to investigate the effect of electroadhesion on sliding friction and the dependency of the finger-touchscreen interaction on the applied voltage and other physical parameters. We present experimental results on how the friction between a finger and a touchscreen depends on the electrostatic attraction between them. The proposed model is successfully validated against full-scale (but computationally demanding) contact mechanics simulations and the experimental data. Our study shows that electroadhesion causes an increase in the real contact area at the microscopic level, leading to an increase in the electrovibrating tangential frictional force. We find that it should be possible to further augment the friction force, and thus the human tactile sensing, by using a thinner insulating film on the touchscreen than used in current devices.

Electroadhesion with application to touchscreens.

There is growing interest in touchscreens displaying tactile feedback due to their tremendous potential in consumer electronics. In these systems, the friction between the user's fingerpad and the surface of the touchscreen is modulated to display tactile effects. One of the promising techniques used in this regard is electrostatic actuation. If, for example, an alternating voltage is applied to the conductive layer of a surface capacitive touchscreen, an attractive electrostatic force is generated between the finger and the surface, which results in an increase in frictional forces acting on the finger moving on the surface. By altering the amplitude, frequency, and waveform of this signal, a rich set of tactile effects can be generated on the touchscreen. Despite the ease of implementation and its powerful effect on our tactile sensation, the contact mechanics leading to an increase in friction due to electroadhesion has not been fully understood yet. In this paper, we present experimental results for how the friction between a finger and a touchscreen depends on the electrostatic attraction and the applied normal pressure. The dependency of the finger-touchscreen interaction on the applied voltage and on several other parameters is also investigated using a mean field theory based on multiscale contact mechanics. We present detailed theoretical analysis of how the area of real contact and the friction force depend on contact parameters, and show that it is possible to further augment the friction force, and hence the tactile feedback displayed to the user by carefully choosing those parameters.

The Incidence and Predictive Factors in the Development of Acute Hepatitis in Patients with Leukemia.

INTRODUCTION: Liver involvement is common in hematological malignancies, but the incidence and pattern of liver injury vary among the different types. The aims of our study were to determine the incidence and clinical course of acute hepatitis and the important factors for its development in patients with leukemia after chemotherapy. MATERIALS AND METHODS: All patients with the diagnosis of leukemia who were treated at the Department of Hematology between January 2008 and January 2013 were included in the study. A detailed medical history, clinical and laboratory findings, treatment modalities, complications, and clinical course were recorded retrospectively. RESULTS: A total of 124 patients (64 females) with the diagnosis of leukemia were included in the study. The mean age was 45.2 years (16-89 years) and mean follow-up time was 29.7 months (0.25-192 months). A total of 43 (34.6%) patients had acute hepatitis after chemotherapy. Pattern of liver injury was hepatocellular in 31 patients, cholestasis in 2, and mix in 10 patients. Age (p = 0.001), hepatitis B surface antigen (HBsAg, p = 0.007), acute leukemia (p < 0.001), positive blood culture (p = 0.004), the amount of transfused red blood cell (p = 0.001), and amount of transfused platelets (p = 0.002) were significantly different under univariate analysis between the acute hepatitis group and the nonacute hepatitis group. Under multivariate analysis, only acute lymphoblastic leukemia (ALL) was identified as independent predictive factor for development of acute hepatitis after starting chemotherapy. CONCLUSION: Acute and self-limited hepatitis develops in the substantial proportion of patients with leukemia. The most important factor for development of acute hepatitis is the type of leukemia.How to cite this article: Kaya M, Akdogan R, Uçmak F, Ayyildiz MO, Karakus A, Kaplan MA. The Incidence and Predictive Factors in the Development of Acute Hepatitis in Patients with Leukemia. Euroasian J Hepato-Gastroenterol 2018;8(1):31-37.

Efficacy of CLARA in recurrent/refractory acute myeloid leukaemia patients unresponsive to FLAG chemotherapy.

We hereby report our multicentre, retrospective experience with CLARA in patients with fludarabine/cytarabine/G-CSF (FLAG) refractory AML. The study included all consecutive R/R AML patients, who received CLARA salvage during October 2010-October 2015 period. All patients were unresponsive to FLAG salvage chemotherapy regimen and did not undergo previous allo-HCT. A total of 40 patients were included. Following CLARA 5 (12.5%) patients experienced induction mortality and 10 (25%) patients achieved CR. 25 (62.5%) patients were unresponsive to CLARA. 7 (17.5%) out of 10 patients in CR received allo-HCT. Median overall survival of patients who achieved CR after CLARA was 24.5 months (8.5-54.5) and 3 months (2.5-5), in patients who underwent and didn't allo-HCT, respectively. Our results indicate that CLARA may be good alternative even in FLAG refractory AML patients and can be used as a bridge to allo-HCT, who have a suitable donor and able to tolerate the procedure.

Effect of normal compression on the shear modulus of soft tissue in rheological measurements.

While the effect of normal compression on the measured shear material properties of viscoelastic solids has been already acknowledged in rheological studies in the literature, to our knowledge, no systematic study has been conducted to investigate this effect in detail to date. In this study, we perform two sets of experiments to investigate the effect of normal strain and strain rate on the dynamic shear moduli of bovine liver. First, we apply normal compressive strain to the cylindrical bovine samples up to 20% at loading rates of v=0.000625, 0.00625, 0.0625, 0.315, 0.625 mm/s. Second, we perform torsional shear loading experiments, in the frequency range of ω=0.1-10 Hz, under varying amounts of compressive pre-strain (ε=1%, 2.5%, 5%, 7.5%, 10%, 12.5%, 15%, 17.5% and 20%) applied at the quasi-static loading rate of v=0.000625 mm/s. The results of the experiments show that the shear moduli of bovine liver increase with compressive pre-strain. A hyper-viscoelastic constitutive model is developed and fit to the experimental data to estimate the true shear moduli of bovine liver for zero pre-compression. With respect to this reference value, the mean relative error in the measurement of shear moduli of bovine liver varies between 0.2% and 243.1% for the compressive pre-strain varying from ε=1% to 20%. The dynamic shear modulus of bovine liver for compressive pre-strain values higher than ε>2.5% are found to be statistically different than the true shear moduli estimated for zero compressive strain (p<0.05).

Effect of solution and post-mortem time on mechanical and histological properties of liver during cold preservation.

BACKGROUND: In liver transplantation, the donor and recipient are in different locations most of the time, and longer preservation periods are inevitable. Hence, the choice of the preservation solution and the duration of the preservation period are critical for the success of the transplant surgery. OBJECTIVE: In this study, we examine the mechanical and histological properties of the bovine liver tissue stored in Lactated Ringer's (control), HTK and UW solutions as a function of preservation period. METHODS: The mechanical experiments are conducted with a shear rheometer on cylindrical tissue samples extracted from 3 bovine livers and the change in viscoelastic material properties of the bovine liver is characterized using the fractional derivative Kelvin-Voigt Model. Also, the histological examinations are performed on the same liver samples under a light microscope. RESULTS: The results show that the preservation solution and period have a significant effect on the mechanical and histological properties of the liver tissue. The storage and loss shear moduli, the number of the apoptotic cells, the collagen accumulation, and the sinusoidal dilatation increase, and the glycogen deposition decreases as the preservation period is longer. CONCLUSIONS: Based on the statistical analyses, we observe that the liver tissue is preserved well in all three solutions for up to 11 h. After then, UW solution provides a better preservation up to 29 h. However, for preservation periods longer than 29 h, HTK is a more effective preservation solution based on the least amount of change in mechanical properties. On the other hand, the highest correlation between the mechanical and histological properties is observed for the liver samples preserved in UW solution.

Correlation between the mechanical and histological properties of liver tissue.

In order to gain further insight into the mechanisms of tissue damage during the progression of liver diseases as well as the liver preservation for transplantation, an improved understanding of the relation between the mechanical and histological properties of liver is necessary. We suggest that this relation can only be established truly if the changes in the states of those properties are investigated dynamically as a function of post mortem time. In this regard, we first perform mechanical characterization experiments on three bovine livers to investigate the changes in gross mechanical properties (stiffness, viscosity, and fracture toughness) for the preservation periods of 5, 11, 17, 29, 41 and 53h after harvesting. Then, the histological examination is performed on the samples taken from the same livers to investigate the changes in apoptotic cell count, collagen accumulation, sinusoidal dilatation, and glycogen deposition as a function of the same preservation periods. Finally, the correlation between the mechanical and histological properties is investigated via the Spearman's Rank-Order Correlation method. The results of our study show that stiffness, viscosity, and fracture toughness of bovine liver increase as the preservation period is increased. These macroscopic changes are very strongly correlated with the increase in collagen accumulation and decrease in deposited glycogen level at the microscopic level. Also, we observe that the largest changes in mechanical and histological properties occur after the first 11-17h of preservation.

Idiopathic thrombocytopenic purpura associated with splenic tuberculosis: case report.

Tuberculosis is still one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. Splenic tuberculosis is a rare form of extrapulmonary tuberculosis. There are limited numbers of cases in which immune thrombocytopenia is associated with splenic tuberculosis. We report a case of immune thrombocytopenic purpura due to splenic tuberculosis. Our case was a 58-year-old female with headache, gum bleeding, redness in legs, and ecchymoses on the arms for 10 days. On admission to hospital, laboratory tests were as follows: platelet count 6.000/mmc (150 000-450 000), haemoglobin: 12 g/dl, WBC: 8000/mm3, erythrocyte sedimentation rate: 58 mm/h and C-reactive protein was in normal ranges. After standard laboratory tests, the patient was diagnosed with idiopathic thrombocytopenic purpura. The patient presented abdominal lymphadenopathies and spleen in normal size in radiological examinations. Diagnostic laparotomy and splenectomy and lymph node excision was performed and splenic tuberculosis was detected in pathologic and microbiologic examination. The patient was successfully treated with apheresis platelets suspension, intravenous immunoglobulin and antituberculous therapy. In conclusion, splenic tuberculosis should be suspected in patients who have fever, abdominal lymphadenopathies and immune thrombocytopenic purpura. Histopathological examination is still an ideal method to confirm the diagnosis, suitably aided by microbiological examination.