Manejo de la trombastenia de Glanzmann durante el embarazo: reporte de un caso y revisión de la literatura / Management of Glanzmann's thrombasthenia during pregnancy: a case report and literature review

Resumen Objetivo: Reportar el caso de una paciente con trombastenia de Glanzmann que recibe manejo con transfusión de plaquetas con factor VII activado y realizar una revisión de la literatura referente al tratamiento y el pronóstico de esta patología durante la gestación. Método: Se presenta el caso de una paciente de 27 años con trombastenia de Glanzmann y embarazo de 33 semanas, con cesárea al término sin complicaciones. Se realizó una búsqueda en las bases de datos Medline vía PubMed, Lilacs, SciELO y ScienceDirect; se incluyeron reportes de caso, series de casos y revisiones bibliográficas hasta 2021. Resultados: Se encontraron 21 artículos, con 23 casos reportados. Los embarazos se presentaron entre la tercera y la cuarta décadas de la vida, siendo la mayoría pacientes con anticuerpos frente a antígenos plaquetarios (43,4% de los casos). El principal manejo fue con transfusión plaquetaria. Conclusiones: La trombastenia de Glanzmann durante el embarazo es infrecuente y se asocia a eventos hemorrágicos. La presencia de anticuerpos frente a antígenos plaquetarios condiciona el manejo con mayor riesgo de complicaciones perinatales. No tiene un enfoque terapéutico unificado, siendo el de elección la transfusión de plaquetas y como segunda línea el factor VII activado.

Abstract Objective: To report the case of a patient with Glanzmann's thrombasthenia who receives management with platelet transfusion with activated factor VII and a literature review regarding the treatment and prognosis of this pathology during pregnancy. Method: We present the case of a 27 year old patient with Glanzmann's thrombasthenia and a 33-week pregnancy, with a cesarean section at term without complications. Medline databases were searched via PubMed, Lilacs, SciELO and ScienceDirect; case reports, case series and bibliographic reviews were included until 2021. Results: A total of 21 articles were found, with 23 reported cases; the pregnancies occurred between the third and fourth decades of life, the majority being patients with anti-platelet antigen antibodies in 43.4% of the cases. The main management was with platelet transfusion. Conclusions: Glanzmann's thrombasthenia during pregnancy is rare and is associated with hemorrhagic events. The presence of anti-platelet antigen antibodies conditions management with a higher risk of perinatal complications. It does not have a unified therapeutic approach, with platelet transfusion being the management of choice and activated factor VII as second line.

High-power laser for periodontal surgery in a patient with glanzmann thrombasthenia / Laser de alta potência para cirurgia periodontal em paciente com trombastenia de glanzmann

Background: Glanzmann thrombasthenia (GT) is a rare autosomal recessive disorder characterized by platelet function impairment. Considering that the oral cavity is highly vascularized and performing some local hemostatic maneuvers may be difficult, GT patients are at high risk for hemorrhage related to invasive oral procedures. This study aimed to present an alternative method for periodontal surgery in a young GT patient. Case Report: A 15-year-old female GT patient with a recent history of excessive bleeding following dental surgeries was referred to a public dental center, presenting gingival hyperplasia. The procedure was performed using a high-power laser (HPL), and except for local anesthesia with epinephrine, no further hemostatic agent was necessary. Conclusion: According to the case, the HPL seems to be an efficient tool for preventing perioperative bleeding in GT patients submitted to minor oral surgeries(AU)

Introdução: A trombastenia de Glanzmann (TG) é uma doença autossômica recessiva rara caracterizada por comprometimento da função plaquetária. Tendo em vista que a cavidade oral é altamente vascularizada e a realização de algumas manobras hemostáticas locais pode ser difícil, pacientes com TG apresentam alto risco de hemorragia relacionada a procedimentos orais invasivos. Este artigo teve como objetivo apresentar uma técnica alternativa para cirurgia periodontal em um paciente jovem com TG. Relato de Caso: Paciente com TG, sexo feminino, 15 anos, com história recente de sangramento excessivo relacionado a cirurgias odontológicas prévias, foi encaminhada a um centro odontológico público apresentando hiperplasia gengival. O procedimento de remoção foi realizado com laser de alta potência e, com exceção da anestesia local com epinefrina, nenhum outro agente hemostático foi necessário. Conclusão: De acordo com o caso, o laser de alta potência parece ser uma ferramenta eficiente na prevenção de sangramento perioperatório em pacientes com TG submetidos a pequenas cirurgias orais(AU)

Concurrencia entre el síndrome de Guillain-Barré y púrpura trombocitopénica inmune posiblemente inducidos por COVID-19 prolongado / Concurrence between Guillain-Barré syndrome and immune thrombocytopenic purpura possibly induced by long COVID-19

RESUMEN Durante la infección aguda por el SARVS-CoV-2 se produce una desregulación del sistema inmune que puede durar hasta ocho meses después de controlado el cuadro agudo. Esto, sumado a otros factores, posiblemente este asociado con un aumento del riesgo de aparición y concurrencia de enfermedades autoinmunes. La aparición simultanea del síndrome de Guillain-Barré (SGB) y púrpura trombocitopénica (PTI) se ha reportado poco en la literatura, y el SGB raramente se asocia con otra enfermedad autoinmune. Presentamos el caso de un varón que luego de un mes de tener un cuadro agudo de COVID-19 moderado, presentó concurrentemente SGB y PTI con respuesta adecuada al tratamiento.

ABSTRACT During acute SARS-CoV-2 infection, there is persistent deregulation of the immune system that can last up to 8 months after the acute condition is controlled. This, added to other factors, is possibly associated with an increased risk of the appearance and concurrence of autoimmune diseases. The simultaneous occurrence of GBS and ITP has been rarely reported in the literature, and GBS is rarely associated with another autoimmune disease. We present the case of a man who, one month after his recovery from acute moderate COVID-19, presented concurrent GBS and ITP with an adequate response to treatment.

Dialysis-related thrombocytopenia: a case report / Plaquetopenia relacionada à hemodiálise: relato de caso

Abstract Thrombocytopenia is frequently observed in hemodialysis patients, and its correct investigation and control remain a challenge. It is estimated that during the hemodialysis session there is a drop of up to 15% in the platelet count, with recovery after the end of treatment. This reduction in platelets is due to platelet adhesion and complement activation, regardless of the membrane material. Several studies with platelet surface markers demonstrate increased platelet activation and aggregation secondary to exposure to cardiopulmonary bypass. This case report describes a patient on hemodialysis who developed severe thrombocytopenia during hospitalization. Investigation and exclusion of the most common causes were carried out: heparin-related thrombocytopenia, adverse drug reaction, hypersplenism, and hematological diseases. Afterwards, the possibility of hemodialysis-related thrombocytopenia was raised, since the fall was accentuated during the sessions with partial recovery after the dialyzer change. Attention to the sterilization method and dialyzer reuse must be considered for correction. In the current case, reusing the dialyzer minimized the drop in platelet counts associated with hemodialysis.

Resumo Plaquetopenia é frequentemente observada em pacientes em hemodiálise, e sua correta investigação e controle permanecem um desafio. Estima-se que, durante a sessão de hemodiálise, ocorra queda de até 15% da contagem de plaquetas, com recuperação após o término do tratamento. Essa queda de plaquetas é decorrente de adesão plaquetária e ativação do complemento, independentemente do material da membrana. Vários estudos com marcadores de superfície plaquetária demonstram aumento da ativação e agregação plaquetária secundários à exposição à circulação extracorpórea. Este relato de caso mostra um paciente dialítico que evoluiu com plaquetopenia severa durante internação. Realizada investigação e exclusão de causas mais comuns: plaquetopenia relacionada à heparina, reação adversa a medicamentos, hiperesplenismo e doenças hematológicas, foi então aventada a possibilidade de plaquetopenia relacionada à hemodiálise após observação de que a queda se acentuava durante as sessões de hemodiálise com recuperação parcial após. Mudança do dialisador, atenção ao método de esterilização e realização do reuso devem ser consideradas para correção. No presente caso, a utilização do reuso minimizou a plaquetopenia associada a hemodiálise.

Role of platelets aggregation in the process of ductus arteriosus closure of newborn pups / 中华危重病急救医学

Objective:To investigate the role of platelets aggregation in the developing process of ductus arteriosus closure of newborn pups, and the effect of platelet membrane glycoprotein Ⅱb-Ⅲa (GPⅡb-Ⅲa) receptor antagonist (tirofiban).Methods:Four 24-month-old Beagle bitches were selected and numbered 1, 2, 3, and 4 respectively, and their pups were removed by cesarean section in two batches 1-2 days before the expected date of delivery. Bitches 1 and 2 were the first batch. Eighteen newborn pups were removed after cesarean section as the control group. They were divided into three subgroups: 1-hour subgroup, 4-hour subgroup, and 12-hour subgroup according to postnatal time point, with 6 pups in each subgroup. The newborn pups were injected with normal saline 10 mL/kg via jugular vein immediately after birth. Bitches 3 and 4 were the second batch. Nineteen newborn pups were removed by cesarean section as tirofiban group. They were also divided into three subgroups: 1-hour subgroup ( n = 6), 4-hour subgroup ( n = 6), and 12-hour subgroup ( n = 7) according to the postnatal time point. The newborn pups were injected with tirofiban hydrochloride injection 10 mL/kg (10 mL injection including 2.5 mg of tirofiban) via jugular vein immediately after birth. The diameter of ductus arteriosus was measured by echocardiography. Ductus arteriosus was removed by surgical dissection and divided into two parts. Western blotting and immunohistochemistry were used to detect the expression of platelet membrane GPⅡb-Ⅲa, respectively. Results:In the control group, 1 newborn pup died at 0.5 hour after birth in the 1-hour subgroup. The experiment was completed by 19 in the tirofiban group. Ductus arteriosus of all pups were not closed in 1-hour subgroups of the two groups, and there was no significant difference in the diameter of ductus arteriosus between the control group and the tirofiban group (mm: 1.72±0.08 vs. 1.70±0.11, P > 0.05). Ductus arteriosus of 1 newborn pup in 4-hour subgroup of the control group was closed, but the ductus arteriosus of all the newborn pups in 4-hour subgroup of the tirofiban group were not closed. The diameter of ductus arteriosus of the tirofiban group was significantly larger than that of the control group (mm: 1.52±0.15 vs. 0.95±0.48, P < 0.05). Ductus arteriosus of all pups were closed in 12-hour subgroup of the control group, but the ductus arteriosus of 2 pups of the tirofiban group were still not closed, with the diameter of ductus arteriosus of 1.0 mm and 1.1 mm, respectively. Western blotting showed that at 1-hour, 4-hour and 12-hour after birth, the expression of platelet membrane GPⅡb-Ⅲa was gradually increased in ductus arteriosus of newborn pups of the two groups. The expression of GPⅡb-Ⅲa in 1-hour subgroup of the tirofiban group was significantly lower than that in the control group (GPⅡb-Ⅲa/β-actin: 0.67±0.07 vs. 0.84±0.16, P < 0.05). The expression of GPⅡb-Ⅲa in 4-hour and 12-hour subgroups of the tirofiban group were slightly lower than those in the control group (GPⅡb-Ⅲa/β-action: 0.85±0.12 vs. 0.95±0.11 in 4-hour subgroup, 1.04±0.16 vs. 1.09±0.17 in 12-hour subgroup, both P > 0.05). Immunohistochemistry showed that the change trend of platelet membrane GPⅡb-Ⅲa in ductus arteriosus of newborn pups in both groups was similar to the results of Western blotting. Conclusions:The ductus arteriosus of newborn pups begin to close 1-4 hours after birth, and all closed at 12 hours after birth. The expression of platelet membrane GPⅡb-Ⅲa in ductus arteriosus increase gradually after birth, and the platelet aggregation may participate in and promote ductus arteriosus closure to some extent. Tirofiban, a platelet membrane GPⅡb-Ⅲa receptor antagonist, may delay ductus arteriosus closure of newborn pups to some extent by inhibiting platelet aggregation.

Effect of allogeneic platelet transfusion on migration and invasion of human lung cancer A549 cells and its mechanism of action / 中国肿瘤生物治疗杂志

@#[Abstract] Objective: To observe the effect of allogeneic platelets transfusion on the invasion and metastasis of human lung cancer A549 cells, and to preliminarily explore its mechanism of action. Methods: Eighty-nine patients with advanced lung cancer, who had received platelet transfusion in the Chemotherapy Department of Fourth Hospital of Hebei Medical University between January 2017 and December 2018, were enrolled in this study. The study cells were randomized into Ctrl group (A549 cells co-incubated with culture medium), Before group, and After group (A549 cells co-incubated with plasma Before and After platelet transfusion, respectively). The migration and invasion of A549 cells co-cultured with plasma before and after platelet transfection were detected by Scratch and Transwell experiments. The expression of MMPs, TIMPs and epithelial-mesenchymal transition (EMT) related proteins E-cadherin, N-cadherin and Vimentin, as well as vascular endothelial growth factor (VEGF) and its receptor 2 (VEGFR2) were detected by Western blotting (WB) method. Results: The scratch healing ability of A549 cells in After group was significantly higher than that of Ctrl group and Before group [(73.67±2.60)% vs (58.33±2.33)%, (35.33±2.03) %; P<0.01, vs Ctrl group; P<0.05, vs Before group], and there was also a significant difference between Before group and Ctrl group (P<0.05). The results of cell migration experiment showed that the number of transmembrane cells in After group was significantly higher than that in Ctrl group and Before group [(69.67±7.84) vs (18±2.08) and (39.33±2.03), all P<0.01]. The cell invasion experiment showed that the number of transmembrane cells in After group was significantly higher than that in Ctrl group and Before group [(59.34±3.46) vs (18.34±1.56) and (37.58±2.79), all P<0.01]. When A549 cells were co-incubated with plasma before and after platelet transfusion for 48 h, it was found that the expressions of MMP9 and MMP2 were increased (P<0.05), while their inhibitors TIMP1 and TIMP2 were decreased (P<0.01); the expressions of EMT-related proteins N-cadherin and Vimentin were increased (P<0.05), but E-cadherin was decreased (P<0.01); the expressions of angiogenesis related proteins VEGF and VEGFR2 were increased (P<0.05). Conclusion: Alloplatelets transfusion can promote the invasion and metastasis of lung cancer A549 cells, which may be realized by regulation of the expressions of EMT, metallomatrix protease and vascular growth factor-related proteins.

Scaffolds for dental pulp regeneration and revascularization / 中国组织工程研究

BACKGROUND: Rapid development in tissue engineering research and technology makes dental pulp regeneration and revascularization possible. The interactions of stem cells, scaffolds and signaling factors in tissue engineering are particularly important. Whether stem cells can proliferate, differentiate and develop dental pulp-like tissue greatly depends on the choice of scaffolds OBJECTIVE: To review the widely studied and effective scaffold materials and two methods of scaffold preparation and analyze their applications in dental pulp reconstruction and their revascularization ability. METHODS: The first author searched PubMed, Wanfang and CNKI databases using a computer for relevant articles published between January 1, 2019 and September 30, 2019 with the search terms “pulp regeneration, pulp revascularization, scaffold” in English, and “pulp regeneration, pulp revascularization, revascularization, scaffold” in Chinese. A total of 421 English articles and 181 Chinese articles were retrieved. Finally, 61 articles were reviewed. RESULTS AND CONCLUSION: Platelet-derived scaffolds, extracellular-matrix-derived scaffolds, and self-assembling peptide take effect in pulp regeneration and revascularization. Composite materials combining natural and synthetic materials prepared by hydrogel and nanomaterial techniques exhibited advantages in cell proliferation, differentiation, migration, adherence, anti-inflammation, and factor delivery. The modified composite materials have a strong ability to promote vascularization. With the development of scaffold design and preparation technology based on hydrogels and nanomaterials, problems regarding insufficient scaffold source and unstable clinical effect will be solved in the future.

Síndrome de Bernard-Soulier / Bernard-Soulier síndrome

Resumen: El síndrome de Bernard-Soulier ocupa el séptimo lugar entre los trastornos de la coagulación más comunes y es una enfermedad poco frecuente de carácter genético, que se distingue por disfunción o ausencia del complejo plaquetario glicoproteína Ib-IX-V, que es el principal receptor del factor de von Willebrand, importante en la adhesión plaquetaria al subendotelio. Su incidencia puede llegar a ser de más de un caso por millón porque a menudo es mal diagnosticado si el paciente no manifiesta los datos clínicos típicos o si no hay resultados de laboratorio concluyentes. Los pacientes manifiestan macrotrombocitopenia con recuentos de plaquetas variables, además de prolongación del tiempo de coagulación. A la fecha se han descrito más de 100 mutaciones relacionadas con los componentes del complejo plaquetario, la manifestación de la enfermedad puede llegar a ser muy heterogénea incluso en pacientes que tengan una mutación idéntica.

Abstract: The Bernard-Soulier syndrome ranked seventh among the most common coagulation disorders; it is a rare genetic disease, characterized by dysfunction or absence of the glycoprotein Ib-IX-V platelet complex, which is the main receptor of von Willebrand factor, important in platelet adhesion to the subendothelium. Its incidence can be more than 1 per 1 million because it is often misdiagnosed if the patient does not present with the typical clinic or if there are no conclusive laboratory results. The syndrome presents macrothrombocytopenia with variable platelet counts as well as prolongation of the coagulation time. To date, more than 100 mutations related to the components of the platelet complex have been described, the presentation of the disease can become very heterogeneous even in patients who have an identical mutation.

Trombastenia de Glanzmann: conceptos clave de la enfermedad / Glanzmann thrombasthenia: key concepts of the disease

La trombastenia de Glanzmann (TG), es un trastorno autosómico recesivo en el cual hay una reducción grave o ausencia de la agregación plaquetaria. Se debe a las alteraciones cualitativas o cuantitativas de la integrina α IIb o de integrina β 3, codificados por los genes ITGA2B e ITGB3 y relacionadas con la glicoproteína IIb/IIIa, que intervienen en la activación plaquetaria. La mayor incidencia de TG ha sido reportada en la población judía-iraquí, pero también se ha presentado en Israel, Jordania, Arabia saudita, Italia y, en menor número, en familias gitanas y pakistaníes. A pesar de ser poco frecuente, este trastorno se debe sospechar en casos de trastornos hemorrágicos graves espontáneos o inducidos por traumatismos, que varían desde hemorragias gastrointestinales y mucocutáneas, como epistaxis y hemorragias gingivales recurrentes de difícil manejo, las cuales son potencialmente mortales y en más del 75 por ciento de los casos requieren transfusión sanguínea o plaquetaria. Para realizar la confirmación del diagnóstico, los hallazgos de laboratorio se caracterizan por tiempos de sangrado prolongados, retracción del coágulo disminuida y respuestas anormales de agregación plaquetaria a estímulos fisiológicos. Aunque, actualmente no existe una cura para la enfermedad, el tratamiento adecuado con transfusiones plaquetarias y en caso de refractariedad, el uso del factor VIIa, permiten un buen pronóstico para los pacientes. Aún queda mucho por estudiar en estos casos debido a esto se están realizando nuevos estudios para la posibilidad de otros tratamientos, entre ellos la terapia génica plaquetaria(AU)

Glanzmann's thrombasthenia (GT) is an autosomal recessive disorder in which there is a severe reduction or absence of platelet aggregation. It is due to the qualitative or quantitative alterations of integrin #945; IIb or integrin #946; 3, encoded by the ITGA2B and ITGB3 genes and related to glycoprotein IIb / IIIa, which intervene in platelet activation. The highest incidence of GT has been reported in the Jewish-Iraqi population, but it has also been reported in Israel, Jordan, Saudi Arabia, Italy, and in smaller numbers in Gypsy and Pakistani families. Despite being uncommon, this disorder should be suspected in cases of severe spontaneous or trauma-induced bleeding disorders, ranging from gastrointestinal and mucocutaneous hemorrhages such as epistaxis and recurrent, difficult to manage gingival hemorrhages, which are potentially fatal and more than 75 percent of cases require blood or platelet transfusion. To confirm the diagnosis, the laboratory findings are characterized by prolonged bleeding times, decreased clot retraction and abnormal platelet aggregation responses to physiological stimuli. Although there is currently no cure for the disease, adequate treatments with platelet transfusions and in case of refractoriness, the use of factor VIIa, allow a good prognosis for patients. There is still much to study in these cases, because of this, new studies are being conducted for the possibility of other treatments, including platelet gene therapy(AU)

Sex-divided reference intervals for mean platelet volume, platelet large cell ratio and plateletcrit using the Sysmex XN-10 automated haematology analyzer in a UK population

ABSTRACT Background: This study aimed to define the sex-divided reference intervals for platelet indices (mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (P-LCR) and plateletcrit (PCT)) on the Sysmex XN-10. Methods: A total of 2376 samples were assayed for full blood count on the Sysmex XN-10 haematology analyzer. After removing the outliers, reference intervals were calculated using the mean ± 2SD. The P value 0.05 was adopted to denote statistical significance. Results: There was a statistical significance (α = 0.05) between sex-divided reference intervals for MPV (p = 0.007), P-LCR (p = 0.015) and PCT (p < 0.001), thus separate reference intervals were calculated for these indices, with orientation to the sex-divisions as follows: MPV, 9.1-13.0 fL [males] and 9.2-12.8 fL [females]; P-LCR, 17.6-47.0% [males] and 17.8-47.8% [females]; and PCT, 0.16-0.35% [males] and 0.18-0.37% [females]. No significance was found between sex-divided reference intervals for the PDW (p = 0.838), therefore a reference interval for total individuals was calculated for this platelet measurement as 9.3-17.3 fL. Conclusion: This study showed comparable reference intervals, using the Sysmex XN-10, with the previous literature. It determined the need to define sex-specific reference intervals for the MPV, P-LCR and PCT, but not for the PDW. These reference intervals will allow for low and high values to be facilitated in order to do further research and guide platelet disorder management.

Retrospective Analysis of Patterns of Donor Deferral among Blood Donors in a Tertiary Care Hospital

Introduction: Blood transfusion saves millions of lives.Donors undergo certain stringent selection criteria to ensuresafe and quality blood and blood products. During such processit is likely that donors may get deferred either temporarily orpermanently. Deferral leads to precious loss of donors andblood units. Morever rates and reasons of deferral vary fromregion to region. The aim of the study was to analyse rates andreasons of donor deferral in our hospital.Material and Methods: It is a retrospective study done overa period of 6 years from January 2012 to December 2017.Details of donors who were deferred either temporarily orpermanently during the study period was collected from thedonor registry.Results: Out of the 15,807 donors who registered for blooddonation during study period, 971 donors were deferreddue to several reasons both temporarily and permanently.Total deferral rate of 6% as comparable to other studies inliterature.Conclusion: Knowledge about rates and reasons of donordeferral may guide medical personnel to focus on donorscreening. Proper follow up measures can be carried out incase of temporarily deferred donors to bring them back todonor pool.

Platelet count response to Helicobacter pylori eradication for idiopathic thrombocytopenic purpura in northeastern Brazil

Abstract Background: Several studies have demonstrated that platelet counts in Helicobacter pylori-positive patients with chronic idiopathic thrombocytopenic purpura improved significantly after successful eradication of the infection. However, depending of the geographical region of the study the results have been highly divergent. Objective: The purpose of this study was to evaluate the effect of H. pylori eradication therapy on platelet count in a cohort of chronic idiopathic thrombocytopenic purpura patients from northeastern Brazil. Method: H. pylori status was determined in 28 chronic idiopathic thrombocytopenic purpura patients using the rapid urease test and histology. H. pylori-positive patients received standard triple therapy for one week. The effect of the eradication therapy was evaluated using the 13C-urea breath test two to three months after treatment. Results: The prevalence of H. pylori infection was similar to that found in the general population. Twenty-two patients (78.5%) were H. pylori-positive. Fifteen were treated, 13 (86%) of whom successfully. At six months, 4/13 (30%) displayed increased platelet counts, which remained throughout follow-up (12 months). Platelet response was not associated to mean baseline platelet count, duration of chronic idiopathic thrombocytopenic purpura, gender, age, previous use of medication, or splenectomy. Conclusions: H. pylori eradication therapy showed relatively low platelet recovery rates, comparable with previous studies from southeastern Brazil. The effect of H. pylori eradication on platelet counts remained after one year of follow-up suggesting that treating H. pylori infection might be worthwhile in a subset of chronic idiopathic thrombocytopenic purpura patients.

The clinical application study of platelet to lymphocyte ratio in type 2 diabetes-induced renal impairment in elderly patients / 中华老年医学杂志

Objective To explore the relationship between platelet to lymphocyte ratio(PLR) and the severity of renal impairment in elderly patients with type 2 diabetes mellitus (T2DM) Methods Two hundred elderly T2DM patients treated in our department of endocrinology from January 2017 to January 2018 included 100 cases with diabetic nephropathy(DN group)and 100 without nephropathy(control DM group),and 100 individuals undergoing physical healthy examination during the same period(normal control group)were retrospectively enrolled.DN group included 50 early,27 medium and 23 end stage patients.Albumin to globulin ratio (A/G),hemoglobin A1c (HbA1c),urea nitrogen (BUN),serum creatinine (Scr),estimated glomerular filtration rate (eGFR),24-hour urine protein quantification (24h-UTP),neutrophil-lymphocyte ratio (NLR),plateletlymphocyte ratio(PLR),etc.were collected and compared among DN group,control DM group and normal control group.Binary Logistic regression analyses were performed to predict whether elderly patients with T2DM progress to DN.Correlations between PLR and HbA1c were analyzed using Spearman correlation coefficient.Results The BMI,waist circumference,waist-hip ratio,systolic blood pressure,disease duration,A/G,Scr,BUN,eGFR,24 h-UTP,interleukin 6 (IL-6),hypersensitive C-reactive protein(hs-CRP),PLR,and NLR showed statistically significant differences among three groups(all P ＜ 0.05).The differences in A/G,Scr,BUN,eGFR,24h-UTP,hs-CRP,PLR,and NLR between early,medium and end phases of DN were statistically significant (all P ＜ 0.05).The predictors for the progression to diabetic nephropathy were the levels of A/G(OR:1.12,95％CI:0.89-1.65),Scr(OR:200.34,95％CI:65.28-412.36),BUN(OR:10.26,95％CI:8.34-16.94),eGFR (OR:85.37,95 ％ CI:78.31-103.57),24h-UTP (OR:187.32,95 ％ CI:142.92-1523.49),PLR (OR:81.51,95％CI:78.45-132.68),NLR(OR:1.20,95％CI:1.07-3.57),IL-6(OR:4.25,95％CI:3.76-9.31),and hs-CRP (OR:3.41,95％ CI:2.35-10.51) in T2DM patients.There were significant correlations of PLR with A/G,Scr,BUN,eGFR,24 UTP,NLR,IL-6,and hs-CRP (r =-0.338,0.469,0.521,-0.457,0.463,0.642,0.297,0.448,all P＜0.05).Conclusions PLR,which is inexpensive and easy to measure,can predict the risk of progressing to DN in elderly T2DM patients and may evaluate their renal function,and is worth extending in clinical practice.

Platelet Distribution Width on Admission Predicts In-Stent Restenosis in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus Treated with Percutaneous Coronary Intervention / 中华医学杂志(英文版)

<p><b>Background</b>It is known that there is a definite association between platelet distribution width (PDW) and poor prognosis in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM). However, there are no data available regarding the prognostic significance of PDW for in-stent restenosis (ISR) in patients with CAD and T2DM. We aimed to determine the value of PDW on admission that predicted ISR in patients with CAD and T2DM.</p><p><b>Methods</b>Between January 2012 and December 2013, a total of 5232 consecutive patients diagnosed with CAD and T2DM undergoing percutaneous coronary intervention were admitted. Three years of retrospective follow-up was undertaken. A total of 438 patients with second angiography operations were included. ISR was defined as ≥50% luminal stenosis of the stent or peri-stent segments. Continuous data were presented as the mean ± standard deviation or median (P, P) and were compared by one-way analysis of variance or Kruskal-Wallis H-test. Categorical variables were presented as percentages and were compared by Chi-square test or Fisher's exact test. The association between PDW and ISR was calculated by logistic regression analysis. A two-sided value of P < 0.05 was considered statistically significant. Statistical analyses were performed by SPSS version 22.0 for windows.</p><p><b>Results</b>Fifty-nine patients with ISR, accounting for 13.5% of the total, were included. ISR was significantly more frequent in patients with higher PDW quartiles compared with lower quartiles. We observed that PDW had a strong relationship with mean platelet volume (r = 0.647, 95% confidence interval [CI]: 0.535-0.750, P < 0.0001). The receiver-operating characteristic curves showed that the PDW cutoff value for predicting ISR rate was 13.65 fl with sensitivity of 59.3% and specificity of 72.4% (area under curve [AUC] = 0.701, 95% CI: 0.625-0.777, P < 0.001). Multivariate analysis showed that the risk of ISR increased approximately 30% when PDW increased one unit (odds ratio [OR]: 1.289, 95% CI: 1.110-1.498, P = 0.001). Patients with higher PDW, defined as more than 13.65 fl, had a 4-fold higher risk of ISR compared with lower PDW (OR: 4.241, 95% CI: 1.879-9.572, P = 0.001). Furthermore, when patients were divided by PDW quartiles values, PDW was able to predict ISR (Q2: OR = 0.762, 95% CI: 0.189-3.062, P = 0.762; Q3: OR = 2.782, 95% CI: 0.865-8.954, P = 0.086; and Q4: OR = 3.849, 95% CI: 1.225-12.097, P = 0.021, respectively; P for trend <0.0001).</p><p><b>Conclusion</b>PDW is an independent predictor of ISR in patients with CAD and T2DM.</p>

Mechanism of inhibition of platelet activation by tanshinone type ⅡA though G protein signal pathway / 国际检验医学杂志

Objective To discuss the mechanism of inhibition of platelet activation by tanshinone type ⅡA(TanⅡA) through G protein signal pathway.Methods Methylthiazolyldiphenyl-tetrazolium bromide(MTT) test was used to determine the optimum effective concentration and optimal time of thrombin and TanⅡA on platelet.Northern blot and Western blot were used to detect the transcription and expression levels of G protein and related signal molecules,including protease activated receptors(PARs),P2Y1 and P2Y12 receptors,α2A-adrenergic receptor and thromboxane A2(TXA2) receptor,in control group,thrombin treated group and TanⅡA treated group,and the platelet aggregation rate was also detected.Results Platelet aggregation rate,and the transcription and expression levels of G protein and related molecules in thrombin treated group were higher than control group(P<0.05).The transcription and expression levels of G protein and related molecules in different concentrations of TanⅡA treated groups were lower than thrombin treated group(P<0.05).Conclusion TanⅡA could inhibit the activation of platelet by inhibiting the transcription and expression of G protein and the related molecules.

The influence of coagulation dysfunction to the prognosis in the critically ill patients of emergency room / 中华急诊医学杂志

Objective This research investigated the coagulation of critically ill patients for predicting the prognosis of 28 day in a university hospital emergency room.Methods A prospective investigation was done in the emergency room of Beijing Chao-Yang Hospital,Capital Medical University from June 2015 to May 2016,and 28-day mortality was recorded.Whole blood cell analysis,blood gas analysis and clotting test were done and repeated after patients in hospital.Results A total of 1 992 patients were enrolled,and divided into two groups:survival (n =1 522) and dead (n =470).No significant difference of age,gender,body mass index and disease composition were found between the two groups (P ＞0.05).APACHE Ⅱ of the survival and dead groups were (12.11 ±4.12) and (21.15 ± 5.55) respectively.D-dimer and platelet account of the dead group were M (Qr) 265 (0,718) μg/L and (208.16±89.87) × 109/L-1 respectively,significant differences were found between the two groups (P ＜ 0.05).Coagulation was found deteriorated progressively in the dead group,whereas improved in the survival group.The risk factors of poor prognosis,which were the increased APACHE Ⅱ and D-dimer,were detected by Logistic analysis and ROC curve,especially the D-dimer.Conclusions Coagulation abnormalities were found in the critically ill patients of emergency room.The increasing of D-dimer is one of the risk factors of poor prognosis.

Water soluble tomato concentrate regulates platelet function via the mitogen-activated protein kinase pathway

Tomato extract has been shown to exert antiplatelet activity in vitro and to change platelet function ex vivo, but with limitations. In this study, antiplatelet activity of water soluble tomato concentrate (Fruitflow I) and dry water soluble tomato concentrate (Fruitflow II) was investigated using rat platelets. Aggregation was induced by collagen and adenosine diphosphate and granule-secretion, [Ca2+]i, thromboxane B2, cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) levels were examined. The activation of integrin αIIbβ3 and phosphorylation of signaling molecules, including mitogen-activated protein kinase (MAPK) and PI3K/Akt, were investigated by flow cytometry and immunoblotting, respectively. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) were examined. Moreover, in vivo thrombus weight was tested by an arteriovenous shunt model. Fruitflow I and Fruitflow II significantly inhibited agonist induced platelet aggregation, adenosine triphosphate and serotonin release, [Ca2+]i, and thromboxane B2 concentration, while having no effect on cAMP and cGMP levels. Integrin αIIbβ3 activation was also significantly decreased. Moreover, both concentrates reduced phosphorylation of MAPK pathway factors such as ERK, JNK, P38, and PI3K/Akt. In vivo thrombus formation was also inhibited. Taken together, these concentrates have the potential for ethnomedicinal applications to prevent cardiovascular ailments and can be used as functional foods.

The platelet indices in pediatric patients with acute appendicitis.

Background: The diagnosis of Acute Appendicitis (AA) remains a problem in pediatric population. It has been suggested that Mean Platelet Volume (MPV) is lower in the patients with AA. The purpose of this study was to investigate the diagnostic value of platelet indices in pediatric AA cases. Methods: A retrospective case-controlled study was designed: 224 subjects were included in this study. All patients had been operated on in division of pediatric surgery at the Kars Government Hospital with the preliminary diagnosis of AA. 204 and 20 of these patients were pathologically diagnosed as AA (group 1) and normal appendix vermiformis (group 2), respectively. Platelet indices had been studied in the biochemistry laboratory of the hospital, before the surgery. Results: In group 1, platelet count, mean platelet volume, plateletcrit and platelet distribution width were 305 ± 94x103/μL; 7.37 ± 0.90 fL; 0,220 ± 0.057 % and 16.3 ± 0.5%, respectively. In group 2, platelet count, mean platelet volume, plateletcrit and platelet distribution width were 283 ± 85 103/μL; 7.60 ± 1.24 fL; 0.208 ± 0.045 % and 16.4 ± 0.7%, respectively. There was no statistically significant difference between the groups studied with regard to platelet indices (P>0.05). Conclusions: Our study showed that platelet indices have no diagnostic value in the diagnosis of AA at pediatric age group.

Changes in platelet parameters and their influential factors in cirrhotic patients with hepatocellular carcinoma / 临床肝胆病杂志

Objective To analyze the changes in platelet parameters and their influential factors in cirrhotic patients with hepatocellular car-cinoma (HCC).Methods The clinical data of 602 cirrhotic patients with HCC who were admitted to the First Hospital of Jilin University from January 201 1 to December 2012,as well as 200 cirrhotic patients hospitalized during the same period,were collected.Statistical analy-sis was performed using SPSS 19.0.Normally distributed continuous data were expressed as mean ± standard deviation;comparison be-tween two groups was made by t test,and comparison between multiple groups was made by analysis of variance.Non-normally distributed data were expressed as median and interquartile range (P25 -P75 );comparison between groups was made by rank sum test.Results Com-pared with the cirrhotic group,the HCC group had significantly higher platelet count (PLT)and plateletcrit (PCT)(t=5.019,P=0.000;t=5.017,P=0.000)and a significantly lower mean platelet volume (MPV)/PLT (t=5.877,P=0.000);there were no significant differences in MPV and platelet distribution width between the two groups (t=-0.942,P=0.347;t=-1.040,P=0.298).The receiv-er operating characteristic (ROC)analysis showed that the area under the ROC curve was 0.636 for PLT,0.633 for PCT,and 0.639 for MPV/PLT in the diagnosis of HCC in cirrhotic patients.Decreases in PLT and PCT were closely related to hepatitis C virus (HCV)infec-tion.Patients with Child-Pugh class A cirrhosis had significantly higher PLT and PCT than those with Child-Pugh class B and C cirrhosis (P<0.01);patients with a maximum tumor diameter of≥5 cm had significantly higher PLT and PCT than those with maximum tumor di-ameters of2-5 cm and≤2 cm (P<0.01).Patients with Child-Pugh class A cirrhosis had a significantly lower MPV/PLT than those with Child-Pugh class B and C cirrhosis (P<0.01);patients with a maximum tumor diameter of≥5 cm had a significantly lower MPV/PLT than those with maximum tumor diameters of2-5 cm and≤2 cm (P<0.01).Conclusion PLT,PCT,and MPV/PLT can be used in the auxiliary diagnosis of HCC in cirrhotic patients,which are related to HCV,Child-Pugh classification,and tumor size.

Experimental research on distribution of 125 I labeled recombinant fusion protein dTMP-GH in mice / 局解手术学杂志

Objective To assess the distribution of recombinant fusion protein dTMP-GH in mice and to determine whether it is of tar-geted distribution characteristics. Methods A laboratory scale preparation of dTMP-GH recombinant fusion protein was obtained. Protein dT-MP-GH was labeled with radioactive 125 I,then mice were sacrificed at 5 min,15 min,30 min,1 h,2 h,4 h,8 h,12 h,24 h after tail vein injec-tion of 125 I-dTMP-GH at a dose of 100 μg/kg,and the organs and tissues ( heart,liver,spleen,kidney,bone and thyroid) were collected for radioactive counting. Results Preparation of purified ( >98%) dTMP-G was obtained. 125 I labeling rate was 71. 53%,radiochemical purity was 96. 53%,and specific activity was 0. 22 MBq/μl. 30 min after tail vein injection of 125 I labeled dTMP-GH,radioactivity accounted for 10% of the total injected in femoral,and metabolism was carried via liver and kidney over time. Conclusion Fusion protein mainly distribu-ted in bone marrow via tail vein injection in mice,which expressed that dTMP-GH has the characteristics of selective distribution in bone mar-row tissue.