Asociación entre los niveles séricos de vitamina D y marcadores inflamatorios en pacientes en hemodiálisis / Association between vitamin D serum levels and inflammatory markers in patients on hemodialysis

Resumen Introducción: La relación entre 25-OH-vitamina D y el sistema inmune en pacientes con enfermedad renal crónica es objeto de atención. Objetivos: Evaluar la prevalencia de la deficiencia de vitamina D en pacientes en hemodiálisis e investigar la asociación entre la vitamina D y proteína C reactiva ultrasensible (PCRus), índice neutrófilo/linfocito (INL) e índice plaqueta/linfocito (IPL). Método: Estudio transversal de 80 pacientes en hemodiálisis, divididos en dos grupos: un nivel sérico de 25-OH-vitamina D < 20 ng/mL se consideró como deficiencia de vitamina D y ≥ 20 ng/mL, como normal. Con el análisis de correlación de Spearman se definió la relación entre los parámetros. Resultados: 40 % de los pacientes presentó deficiencia de vitamina D. Hubo diferencias significativas entre los grupos en PCRus (p = 0.047), INL (p = 0.039), IPL (p = 0.042) y tratamiento con análogos de vitamina D (p = 0.022). La vitamina D tuvo una correlación negativa significativa con PCRus (p = 0.026), INL (p = 0.013) e IPL (p = 0.022). Conclusiones: La deficiencia de vitamina D fue de 40 %. Los niveles de PCRus, INL e IPL fueron significativamente más altos ante deficiencia de vitamina D. Se encontró correlación inversa significativa entre vitamina D y PCRus, INL e IPL.

Abstract Introduction: The relationship between 25-OH-vitamin D and the immune system in patients with chronic kidney disease is a subject of attention. Objectives: To assess the prevalence of vitamin D deficiency in patients on hemodialysis and to investigate the association between vitamin D, ultra-sensitive C-reactive protein (US-CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Method: Cross-sectional study of 80 patients on hemodialysis, divided into two groups: a serum 25-OH-vitamin D level < 20 ng/mL was considered to be vitamin D deficiency and a serum level ≥ 20 ng/mL was regarded as normal. The relationship between the parameters was defined with Spearman’s correlation analysis. Results: 40 % of the patients had vitamin D deficiency. There were significant differences between groups in US-CRP (p = 0.047), NLR (p = 0.039), PLR (p = 0.042) and treatment with vitamin D analogues (p = 0.022). Vitamin D had a significant negative correlation with US-CRP (p = 0.026), NLR (p = 0.013) and PLR (p = 0.022). Conclusions: The prevalence of vitamin D deficiency was 40 %. The values of US-CRP, NLR and PLR were significantly higher in the presence of vitamin D deficiency. A significant inverse correlation was found between vitamin D levels and US-CRP, NLR and PLR.

Does periodontitis affect mean platelet volume(MPV) and plateletcrit (PCT) levels in healthy adults?

SUMMARY OBJECTIVE Periodontitis may stimulate infectious and immune response and cause the development of atherogenesis, coronary heart disease, and myocardial infarction. The aim of this study was to compare the plateletcrit (PCT) and mean platelet volume (MPV) levels derived from complete blood count (CBC) tests in patients suffering from stage 3 periodontitis with those of healthy individuals without periodontal disease. METHODS The study included 57 patients (28 females and 29 males) with Stage 3 Periodontitis and 57 volunteering individuals (31 females and 26 males) who were periodontally healthy. The age of study participants ranged from 18 to 50 years. Their periodontal condition was investigated with probing depth (PD), clinical attachment level, bleeding on probing, and plaque index. Leukocyte (WBC) and erythrocyte count (RBC), hemoglobin (Hb) and hematocrit (HCT) levels, mean corpuscular volume (MCV) and red cell distribution width (RDW), thrombocyte count, mean platelet volume (MPV), plateletcrit (PCT ), and neutrophil and lymphocyte counts were evaluated based on the CBC test results of the study participants. RESULTS PCT, WBC, Neutrophil, and MPV values were found to be significantly higher in the periodontitis group (p<0.05). There were no significant differences in RBC counts, Hb, HCT, MCV, RDW, and platelet and lymphocyte counts between the two study groups (p>0.05). CONCLUSIONS PCT and MPV levels may be a more useful marker to determine an increased thrombotic state and inflammatory response in periodontal diseases.

RESUMO OBJETIVO A periodontite pode estimular a resposta infecciosa e imunitária e causar o desenvolvimento da aterogênese, doença coronária e infarto do miocárdio. O objetivo deste estudo foi comparar os níveis de plaquetócrito (PCT) e de volume médio de plaquetas (VMP) derivados dos testes de hemograma completo (CBC) em doentes que sofrem de periodontite de fase 3 com os de indivíduos saudáveis, sem doença periodontal. MÉTODOS O estudo incluiu 57 doentes (28 mulheres e 29 homens) com periodontite de fase 3 e 57 voluntários (31 mulheres e 26 homens) que eram periodontalmente saudáveis. A idade dos participantes do estudo variou de 18 a 50 anos. A condição periodontal dos participantes do estudo foi investigada com profundidade de sonda (PD), nível de ligação clínica, hemorragia na sonda e índice de placas. Contagem de leucócitos (WBC) e eritrócitos (RBC), níveis de hemoglobina (Hb) e hematócrito (HCT), volume corpuscular médio (VCM) e largura de distribuição das células vermelhas (RDW), contagem de trombócitos, volume plaquetário médio (MPV), plaquetócrito (PCT) e contagem de neutrófilos e linfócitos foram avaliados com base nos resultados do teste CBC dos participantes do estudo. RESULTADO Verificou-se que os valores de PCT, WBC, neutrófilos e MPV eram significativamente mais elevados no grupo da periodontite (p<0,05). Não houve diferenças significativas nas contagens de glóbulos vermelhos, Hb, HCT, MCV, RDW; nem nas contagens de plaquetas e linfócitos entre os dois grupos estudados (p>0, 05). CONCLUSÃO Os níveis de PCT e MPV podem ser um marcador mais útil para determinar um estado trombótico aumentado e a resposta inflamatória em doenças periodontais.

Association of platelet to lymphocyte and neutrophil to lymphocyte ratios with in-hospital mortality in patients with type A acute aortic dissection

Abstract Objective: To evaluate the relationship between neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) with in-hospital mortality in type A acute aortic dissection (AAD). Methods: A total of 96 patients who presented to the emergency department between January 2013 and June 2018 with a diagnosis of type A AAD were enrolled in this study. White blood cell count subtypes such as NLR and PLR were calculated at the time of admission. The end point was in-hospital mortality. Results: Of the 96 type A AAD patients included in this analysis, 17 patients (17.7%) died during hospitalization. NLR and PLR were significantly elevated in patients with type A AAD (P<0.001 and <0.001, respectively). Based on the receiver operating characteristic curve, the best NLR cut-off value to predict in-hospital mortality was 9.74, with 70.6% sensitivity and 76.8% specificity, whereas the best PLR cut-off value was 195.8, with 76.5% sensitivity and 78.1% specificity. Conclusion: Admission NLR and PLR levels were important risk factors and independently associated with in-hospital mortality of type A AAD patients.

Platelet-to-lymphocyte ratio (PLR) and Plateletcrit (PCT) in young patients with morbid obesity

SUMMARY OBJECTIVE To compare the complete blood counts, namely the plateletcrit (PCT) and Platelet-To-Lymphocyte Ratio (PLR) of healthy subjects and those with morbid obesity in the young population. METHODS We included 45 patients with morbid obesity (body mass index -BMI - greater than or equal to 45 kg/m2) and 45 healthy subjects (BMI less than or equal to 25 kg/m2) in our study. Blood samples were obtained from the participants following a 12-hour fasting period. Then we evaluated the levels of hemoglobin (Hb), hematocrit (HCT), red cell distribution width (RDW), mean platelet volume (MPV), white blood cell (WBC), PLR, platelet counts, and PCT in the complete blood count. RESULTS The morbid obesity group had significantly higher platelet counts and PCT values (p<0.001), and PLR values (p=0.033). The value of WBC was also higher in the obese group (p=0.001). MPV was lower in the obesity group but not statistically significant (p=0.815). No significant difference was found between hemoglobin and hematocrit values in these groups; but RDW valuewere higher and statistically significant in the obese group (p=0.001). CONCLUSION PLR or PCT may be more useful as a marker in determining an increased thrombotic state and inflammatory response in morbid obesity.

RESUMO OBJETIVO Comparar as contagens sanguíneas completas, nomeadamente o plateletcrit (PCT) e a razão plaquetas/linfócitos (PPL) de indivíduos saudáveis com aqueles que têm obesidade mórbida na população jovem. MÉTODOS Incluímos 45 pacientes com obesidade mórbida (índice de massa corporal superior a 45 kg/m2) e 45 indivíduos saudáveis (índice de massa corporal inferior a 25 kg/m2) em nosso estudo. Foram obtidas amostras de sangue dos participantes após um período de jejum de 12 horas. Depois, avaliamos os níveis de hemoglobina, hematócrito, largura de distribuição dos glóbulos vermelhos, volume médio de plaquetas, glóbulos brancos, razão plaquetas/linfócitos, contagem de plaquetas e plateletcrit no hemograma completo. RESULTADOS O grupo de obesidade mórbida teve contagens plaquetárias e valores plateletcrit significativamente mais elevados (p<0, 001), e valores razão plaquetas/linfócitos (p=0, 033). O valor dos glóbulos brancos também foi maior no grupo obeso (p=0, 001). O volume médio dos plateletes foi inferior no grupo da obesidade, mas não estatisticamente significativo (p=0, 815). Não foi encontrada diferença significativa entre os valores de hemoglobina e hematócrito nesses grupos, mas os valores da largura de distribuição dos glóbulos vermelhos foram mais elevados no grupo obeso e estatisticamente significativos (p=0, 001). CONCLUSÃO Relação plaquetas-linfócitos e valores de plateletcrit podem ser mais úteis como marcadores na determinação de um estado trombótico aumentado e da resposta inflamatória na obesidade mórbida.

Hematological and morphometric differences of blood cells from rheas, Rhea americana (Struthioniformes: Rheidae) on two conservation farms / Diferenças hematológicas e morfométricas de células sanguineas de emas, Rhea americana (Struthioniformes: Rheidae) em dois criatórios conservacionistas

Abstract Today, blood tests are an indispensable tool in avian medicine. This study aimed to describe and compare hematological and morphometric data of erythrocytes, leukocytes and thrombocytes of rhea, Rhea americana. To do so, 58 rheas of both sexes on two farms, one in Cachoeiro do Itapemirim, Espírito Santo (ES), and the other in São Carlos, São Paulo (SP), were selected. Blood samples were taken and their RBC counts, PCV and Hb levels were determined and used in hematimetric index calculations. The total and differentiated leukocyte counts and the TPP and fibrinogen serum levels were also obtained. The results from the two farms analyzed were compared by means of the t test. There were differences in the parameters of the erythrocyte series between the two flocks because of a process of hypochromic macrocytic anemia observed among the rheas in ES. The values for the erythrocyte series and indexes were: RBC, 2.81 ± 0.15 x106/μl; PCV, 44.20 ± 2.86%; Hb, 12.12 ± 0.74 g/dL; MCV, 15.75 ± 0.89 fL; MCH, 43.18 ± 1.82 pg; and MCHC, 27.44 ± 0.80 g/dL. The values for the leukocyte series were: WBC, 12,072 ± 4116 /μL; heterophils, 64.10 ± 9.90%; eosinophils, 2.05 ± 2.06%; monocytes, 6.40 ± 2.99%; lymphocytes, 26.93 ± 9.62%; and basophils, 0.52 ± 1.27%. These can all be suggested as references for rheas reared in Brazil. Statistical differences were observed in erythrocyte length measurements, which were higher in the rheas in SP than in those in ES. Regarding width, the heterophils, lymphocytes and monocytes of the birds in ES were statistically greater than those of the birds in SP. It was concluded that rheas may exhibit morphometric alterations to blood cells and differences in blood elements according to the type of management to which they are subjected.

Resumo Atualmente exames de sangue são ferramentas indispensáveis na medicina aviária. Este estudo teve como objetivo descrever e comparar valores hematológicos e morfométricos de eritrócitos, leucócitos e trombócitos de emas, Rhea americana. Para isso, foram selecionadas 58 emas de ambos os sexos de dois criatórios, um em Cachoeiro do Itapemirim, Espírito Santo (ES) e o outro em São Carlos, São Paulo (SP). Amostras de sangue foram coletadas e realizadas a hematimetria, Hto e dosagem de Hb que foram utilizados nos cálculos dos índices hematimétricos. Também foram efetuadas as contagens total e diferencial de leucócitos, além da dosagem de proteínas total e do fibrinogênio séricos. Os resultados referentes às duas propriedades analisadas foram comparados pelo Teste t. Ocorreram diferenças nos parâmetros da série vermelha entre as aves dos dois criatórios devido a um processo de anemia macrocítica hipocrômica observado nas emas do ES. Os valores para a série vermelha e índices hematimétricos como: hematimetria, 2,81±0,15 x106/μl; Hto, 44,20±2,86%; Hb, 12,12±0,74 g/dL; VCM, 15,75±0,89 fL; HCM, 43,18±1,82 pg; CHCM, 27,44±0,80, além dos valores da série branca como: leucometria total, 12.072±4.116/μL, heterofilo, 64,10±9,90%, eosinófilo, 2,05±2,06%, monócito, 6,40±2,99%, linfócito, 26,93±9,62%, basófilo, 0,52±1,27% foram sugeridos como os de referência para as emas criadas no Brasil. Diferenças estatísticas foram observadas no comprimento de eritrócitos, o qual estava maior nas emas de SP do que aquelas do ES. Em relação à largura, os heterófilos, linfócitos e monócitos das aves do ES foram estatisticamente maior do que aquelas das aves de SP. Concluiu-se que emas podem apresentar alterações morfométricas de células sanguíneas e diferenças nos elementos do sangue de acordo com o tipo de manejo a que são submetidos.

Mean platelet volume is decreased in adults with active lupus disease / O volume plaquetário médio está reduzido em adultos com lúpus ativo

ABSTRACT Background: Only a few biomarkers are available for assessing disease activity in systemic lupus erythematosus (SLE). Mean platelet volume (MPV) has been recently studied as an inflammatory biomarker. It is currently unclear whether MPV may also play a role as a biomarker of disease activity in adult patients with SLE. Objective: We investigated the association between MPV and disease activity in adult patients with SLE. Methods: In this retrospective study, we compared two groups of adult patients divided according to disease activity (36 per group). Subjects were age- and gender-matched. Results: MPV was significantly decreased with respect to those of inactive patients (7.16 ± 1.39 vs. 8.16 ± 1.50, p = 0.005). At a cutoff level of 8.32 fL, MPV has a sensitivity of 86% and a specificity of 41% for the detection of disease activity. A modest positive correlation was found between MPV and albumin (r = 0.407, p = 0.001), which in turn is inversely associated with disease activity. Conclusions: In summary, MPV is decreased in adult patients with active lupus disease, and positively correlated with albumin, another biomarker of disease activity. Prospective studies are needed to evaluate the prognostic value of this biomarker.

RESUMO Antecedentes: Existem poucos biomarcadores disponíveis para avaliar a atividade da doença no lúpus eritematoso sistêmico (LES). O volume plaquetário médio (VPM) foi recentemente estudado como um biomarcador inflamatório. Atualmente não está claro se o VPM também pode desempenhar um papel como um biomarcador da atividade da doença em pacientes adultos com LES. Objetivo: Investigou-se a associação entre o VPM e a atividade da doença em pacientes adultos com LES. Métodos: Neste estudo retrospectivo, compararam-se dois grupos de pacientes adultos divididos de acordo com a atividade da doença (36 por grupo). Os indivíduos foram pareados por idade e gênero. Resultados: O VPM esteve significativamente diminuído nos pacientes com doença ativa em comparação com os níveis em pacientes com doença inativa (7,16 ± 1,39 versus 8,16 ± 1,50, p = 0,005). Em um nível de corte de 8,32 fL, o VPM tem uma sensibilidade de 86% e uma especificidade de 41% para a detecção da atividade da doença. Encontrou-se uma correlação positiva modesta entre o VPM e a albumina (r = 0,407, p = 0,001), que por sua vez está inversamente associada à atividade da doença. Conclusões: Em resumo, o VPM está diminuído em pacientes adultos com lúpus ativo e positivamente correlacionado com a albumina, outro biomarcador da atividade da doença. São necessários estudos prospectivos para avaliar o valor prognóstico desse biomarcador.

Current Pathological and Laboratory Considerations in the Diagnosis of Disseminated Intravascular Coagulation

Systemically sustained thrombin generation in vivo is the hallmark of disseminated intravascular coagulation (DIC). Typically, this is in response to a progressing disease state that is associated with significant cellular injury. The etiology could be infectious or noninfectious, with the main pathophysiological mechanisms involving cross-activation among coagulation, innate immunity, and inflammatory responses. This leads to consumption of both pro- and anticoagulant factors as well as endothelial dysfunction and disrupted homeostasis at the blood vessel wall interface. In addition to the release of tissue plasminogen activator (tPA) and soluble thrombomodulin (sTM) following cellular activation and damage, respectively, there is the release of damage-associated molecular patterns (DAMPs) such as extracellular histones and cell-free DNA. Extracellular histones are increasingly recognized as significantly pathogenic in critical illnesses through direct cell toxicity, the promotion of thrombin generation, and the induction of neutrophil extracellular trap (NET) formation. Clinically, high circulating levels of histones and histone–DNA complexes are associated with multiorgan failure, DIC, and adverse patient outcomes. Their measurements as well as that of other DAMPs and molecular markers of thrombin generation are not yet applicable in the routine diagnostic laboratory. To provide a practical diagnostic tool for acute DIC, a composite scoring system using rapidly available coagulation tests is recommended by the International Society on Thrombosis and Haemostasis. Its usefulness and limitations are discussed alongside the advances and unanswered questions in DIC pathogenesis.

Magnetization-tagged MRI is a simple method for predicting liver fibrosis

BACKGROUND/AIMS: To assess the usefulness of magnetization-tagged magnetic resonance imaging (MRI) in quantifying cardiac-induced liver motion and deformation in order to predict liver fibrosis. METHODS: This retrospective study included 85 patients who underwent liver MRI including magnetization-tagged sequences from April 2010 to August 2010. Tagged images were acquired in three coronal and three sagittal planes encompassing both the liver and heart. A Gabor filter bank was used to measure the maximum value of displacement (MaxDisp) and the maximum and minimum values of principal strains (MaxP1 and MinP2, respectively). Patients were divided into three groups (no fibrosis, mild-to-moderate fibrosis, and significant fibrosis) based on their aspartate-aminotransferase-to-platelet ratio index (APRI) score. Group comparisons were made using ANOVA tests. RESULTS: The patients were divided into three groups according to APRI scores: no fibrosis (≤0.5; n=41), moderate fibrosis (0.5-1.5; n=23), and significant fibrosis (>1.5; n=21). The values of MaxDisp were 2.9±0.9 (mean±SD), 2.3±0.7, and 2.1±0.6 in the no fibrosis, moderate fibrosis, and significant fibrosis groups, respectively (P<0.001); the corresponding values of MaxP1 were 0.05±0.2, 0.04±0.02, and 0.03±0.01, respectively (P=0.002), while those of MinP2 were -0.07±0.02, -0.05±0.02, and -0.04±0.01, respectively (P<0.001). CONCLUSIONS: Tagged MRI to quantify cardiac-induced liver motion can be easily incorporated in routine liver MRI and may represent a helpful complementary tool in the diagnosis of early liver fibrosis.

Platelet-Rich Fibrin Lysate Can Ameliorate Dysfunction of Chronically UVA-Irradiated Human Dermal Fibroblasts

To determine whether platelet-rich fibrin lysate (PRF-L) could restore the function of chronically ultraviolet-A (UVA)-irradiated human dermal fibroblasts (HDFs), we isolated and sub-cultured HDFs from six different human foreskins. HDFs were divided into two groups: those that received chronic UVA irradiation (total dosages of 10 J cm-2) and those that were not irradiated. We compared the proliferation rates, collagen deposition, and migration rates between the groups and between chronically UVA-irradiated HDFs in control and PRF-L-treated media. Our experiment showed that chronic UVA irradiation significantly decreased (p<0.05) the proliferation rates, migration rates, and collagen deposition of HDFs, compared to controls. Compared to control media, chronically UVA-irradiated HDFs in 50% PRF-L had significantly increased proliferation rates, migration rates, and collagen deposition (p<0.05), and the migration rates and collagen deposition of chronically UVA-irradiated HDFs in 50% PRF-L were equal to those of normal fibroblasts. Based on this experiment, we concluded that PRF-L is a good candidate material for treating UVA-induced photoaging of skin, although the best method for its clinical application remains to be determined.

Hematological, morphological and morphometric characteristics of blood cells from rhea, Rhea Americana (Struthioniformes: Rheidae): a standard for Brazilian birds / Características hematológicas, morfológicas e morfométricas de células sanguíneas de emas, Rhea americana (Struthioniformes: Rheidae): um padrão para aves brasileiras

Abstract Blood exams are an indispensable tool in bird medicine. This study aimed at describing values and aspects of rheas' hematology, Rhea americana, as well as analyzing the morphology and morphometry of all blood cells. Fifty eight adult rheas of both sexes from two farms, one in Cachoeiro de Itapemirim, Espírito Santo State and the other in São Carlos, São Paulo State, were selected. Blood samples were taken and RBC count, PCV and Hb levels measured and used in hematimetric indexes calculations. The total and differentiated leukocyte counts, as well as the TPP and fibrinogen were determined. Erythrocytes, leukocytes and thrombocytes were identified and characterized morphologically. The values for the red series and hematimetric indexes were: RBC (2.81±0.15×106/μL), PCV (44.20±2.86%), Hb (12.12±0.74 g/dL), MCV (15.75±0.89 fL), MCH (43.18±1.82 pg), MCHC (27.44±0.80 g/dL); the values of white series were: WBC (12.072±4116/μL), heterophils (64.10±9.90%), eosinophils (2.05±2.06%), monocytes (6.40±2.99%), lymphocytes (26.93±9.62%), basophils (0.52±1.27%). One may conclude that on average, rheas' blood cells are larger than those of other birds, but these cells in smears cannot be differentiated only by their size. Besides rheas' leukocytes have different components and coloring as in other bird species, however, there are no components or staining aspects unique to the species.

Resumo Exames de sangue são uma ferramenta indispensável na medicina de aves. Este estudo teve como objetivo descrever valores e aspectos da hematologia de emas, Rhea americana, bem como analisar a morfologia e morfometria de todas as células sanguíneas. Cinquenta e oito emas adultas de ambos os sexos de dois criatórios, um em Cachoeiro do Itapemirim, ES e o outro em São Carlos, SP foram selecionadas. Amostras de sangue foram coletadas e CTH, Ht e níveis de Hb foram mensurados e usados para o cálculo dos índices hematimétricos. A contagem total e diferencial de leucócitos, assim como, PPT e fibrinogênio foram determinados. Eritrócitos, leucócitos e trombócitos foram identificados e caracterizados morfologicamente. Os valores para série vermelha e índices hematimétricos foram: CTH (2,81±0,15×106/μL), Ht (44,20±2,86%), Hb (12,12±0,74 g/dL), VCM (15,75±0,89 fL), HCM (43,18±1,82 pg), CHCM (27,44±0,80 g/dL); os valores da série branca foram: CTL (12,072±4116/μL), heterófilos (64,10±9,90%), eosinófilos (2,05±2,06%), monócitos (6,40±2,99%), linfócitos (26,93±9,62%), basófilos (0,52±1,27%). Pode-se concluir que, na média, células sanguíneas de emas são maiores que as de outras aves, porém, não é possível diferenciar estas células em esfregaços somente pelo seu tamanho. Além disso, leucócitos de emas possuem diferentes componentes e coloração como acontece em outras espécies de aves, no entanto, não há nenhum componente ou aspectos tintoriais exclusivo para a espécie.

Avaliação do perfil de mediadores séricos e proteínas intraplaquetárias em relação à plaquetopenia em pacientes infectados pelo vírus dengue / Evaluation of serum mediators profile and intraplatelet proteins in respect to thrombocytopenia in patients infected with dengue virus

Plaquetas são fragmentos celulares derivados dos megacariócitos, que desempenham papel na hemostasia, coagulação, angiogênese, inflamação e resposta imune. Na infecção humana pelo Vírus Dengue (DENV), plaquetas constituem uma das populações celulares mais afetadas devido à plaquetopenia e disfunção plaquetária. O objetivo deste trabalho foi investigar a influência de citocinas, quimiocina e fatores de crescimento séricos e de proteínas intraplaquetárias relacionadas à angiogênese, coagulação, regulação da matriz extracelular e inflamação na plaquetopenia de pacientes infectados pelo DENV. Para tal, realizamos: (i) estudo populacional de pacientes e obtenção de soro e plaquetas em 2013, (ii) ensaios multiplex de micrarranjo líquido para quantificação dos níveis séricos de citocinas, quimiocina e fatores de crescimento e (iii) ensaio de determinação do perfil de expressão 55 proteínas intraplaquetárias. Quarenta e três pacientes DENV foram confirmados, com predominância do DENV-4. Independente da forma clínica, pacientes DENV apresentaram níveis séricos elevados de IL-10, TNF-alfa, CXCL8/IL-8, mas não de IL-1beta e IFN-gama quando comparados aos controles sadios. Análises estatísticas demonstraram que níveis de IL-10 e IFN-gama apresentaram correlação, respectivamente inversa e direta com a contagem de plaquetas. Ainda, IL-10 diretamente com leucócitos e linfócitos e TNF-alfa com linfócitos. Vinte e cinco proteínas intraplaquetárias foram quantificadas, mas apenas cinco delas, PDGF-AA, TGF-beta1, HGF, IGFBP-1 e Angiopoetina-1, apresentaram correlação direta com a contagem de plaquetas nos pacientes DENV. A quantificação sérica de PDGF e VEGF demostrou que ambos estavam diminuídos no grupo DENV mais trombocitopênico...

Platelets are cell fragments derived from megakaryocytes, which play a role in hemostasis, coagulation, angiogenesis, inflammation and immune response. In human infection with dengue virus (DENV), platelets are one of the most affected cell populations due to thrombocytopeniaand platelet dysfunction. The objective of this study was to investigate the influence of serum cytokines, chemokines, intraplatelet growth factors and proteins related to angiogenesis, coagulation, regulation of extracellular matrix and inflammation in thrombocytopenia of patientsinfected with DENV. For this purpose, we conducted: (i) population study of patients and obtaining their serum and platelets in 2013, (ii) liquid microarray multiplex assays for quantitationof serum levels of cytokines, chemokine, and growth factors, and (iii) assay for determiningexpression profile of 55 intraplapletelet proteins. Forty-three DENV patients were confirmed, with a predominance of DENV-4. Regardless of type of DENV, levels of IL-10, TNF-alfa, CXCL8 /IL-8, but not IL-1beta and IFN-gama were higher on serum of patients compared to healthy individuals. Statistical analyses showed that levels of IL-10 and IFN-gama presented correlation, respectively, inverse and direct with platelet count. Furthermore, IL-10 was directly correlated with leukocytes, lymphocytes, TNF-alfa and with lymphocytes. Twenty-five intraplatelet proteins were quantified, but only five of them, PDGF-AA, TGF-beta1, HGF, angiopoietin-1 and IGFBP-1 weredirectly correlated with platelet count in DENV patients. Both levels of PDGF and VEGF were decreased in group of DENV thrombocytopenic...

Association Between High Platelet Indices and Proteinuria in Patients With Hypertension

BACKGROUND: We aimed to determine the association between platelet indices including plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW), and proteinuria associated with hypertension (HT) as well as the relative power of each to predict proteinuria. METHODS: The study included 223 patients (68 men and 155 women) with primary HT. PCT, MPV, PDW, and proteinuria levels were measured. The patients were divided into two groups according to proteinuria status based on 24-hr urinary protein excretion: proteinuria (+) group (15 men and 40 women) and proteinuria (-) group (53 men and 115 women). RESULTS: The mean and SD of platelet count, PDW, PCT, and MPV were 278.8+/-49.6x10(9)/L, 13.5+/-1.8%, 0.31+/-0.07%, and 11.3+/-2.6 fL, respectively. The mean platelet count, PCT, MPV, and PDW were significantly higher in the proteinuria (+) group than in the proteinuria (-) group (P<0.05); there were no significant differences in the other blood parameters between the two groups. The platelet count, PCT, MPV, and PDW were independent risk factors predictive of proteinuria according to a stepwise regression analysis of PDW, PCT, and MPV. PCT was the strongest independent predictor of proteinuria. CONCLUSIONS: The platelet indices PCT, PDW, and MPV were significantly higher in patients with proteinuria than in those without it. Among these three indices, PCT was the strongest predictor of proteinuria.

Prognostic Significance of Initial Platelet Counts and Fibrinogen Level in Advanced Non-Small Cell Lung Cancer

Thrombocytosis and coagulation systems activation are commonly associated with disease progression and are suggested poor prognostic factors in patients with malignancies. This study aimed to investigate the prevalence and prognostic significance of thrombocytosis and elevated fibrinogen levels in patients with advanced non-small cell lung cancer (NSCLC). Initial platelet counts and fibrinogen levels were reviewed in 854 patients with histologically proven NSCLC. Thrombocytosis was defined as platelet counts > 450 x 10(9)/L. A serum fibrinogen level > 4.5 g/L was considered high. At the time of diagnosis, initial platelet counts and serum fibrinogen levels were evaluated before treatment. Clinicopathologic data including histological type, tumor, node, metastasis (TNM) stage, performance status, treatment method, and survival time were evaluated. Initial thrombocytosis was found in 6.9% of patients, and elevated fibrinogen levels were found in 55.1% of patients. Patients with thrombocytosis had a significantly poorer prognosis than patients with normal platelet counts (P < 0.001). In multivariate survival analysis, thrombocytosis was an independent prognostic factor (P < 0.001). An elevated serum fibrinogen level was associated with poor prognosis (P < 0.001). In conclusion, initial thrombocytosis and a high fibrinogen level are independent factors for predicting poor prognosis in patients with advanced NSCLC.

White Blood Cell, Hemoglobin and Platelet Distribution Width as Short-Term Prognostic Markers in Patients with Acute Myocardial Infarction

The aim of this study was to assess the prognostic value of combined use of white blood cell (WBC), hemoglobin (Hb), and platelet distribution width (PDW) in patients with acute myocardial infarction (AMI). This study included 1,332 consecutive patients with AMI. Patients were categorized into complete blood cell (CBC) group 0 (n=346, 26.0%), 1 (n=622, 46.7%), 2 (n=324, 24.3%), and 3 (n=40, 3.0%) according to the sum of the value defined by the cut-off levels of WBC (1, > or =14.5x10(3)/microL; 0, or =12.7 g/dL), and PDW (1, > or =51.2%; 0: or =2 (odds ratio, 3.604; 95% confidence interval, 1.040-14.484, P=0.043) was an independent predictor for in-hospital death. The prognostic impact of the combined use of CBC markers remained significant over 12 months. In conclusions, combination of WBC, Hb, and PDW, a cheap and simple hematologic marker, is useful in early risk stratification of patients with AMI.

Changes in Plasma Levels of Natural Anticoagulants in Disseminated Intravascular Coagulation: High Prognostic Value of Antithrombin and Protein C in Patients with Underlying Sepsis or Severe Infection

BACKGROUND: Dysfunctional natural anticoagulant systems enhance intravascular fibrin for mation in disseminated intravascular coagulation (DIC), and plasma levels of natural anti coagulants can be used in the diagnosis and prognosis of DIC. Herein, the diagnostic value of 4 natural anticoagulants was assessed, and the prognostic value of antithrombin and protein C were validated in a large population. METHODS: Part 1 study included 126 patients with clinically suspected DIC and estimated plasma levels of 4 candidate anticoagulant proteins: antithrombin, protein C, protein S, and protein Z. Part 2 comprised 1,846 patients, in whom plasma antithrombin and protein C levels were compared with other well-known DIC markers according to the underlying dis eases. The 28-day mortality rate was used to assess prognostic outcome. RESULTS: Antithrombin and protein C showed higher areas under the ROC curve than pro tein S and protein Z. In part 2 of the study, antithrombin and protein C levels significantly correlated with DIC score, suggesting that these factors are good indicators of DIC severity. Antithrombin and protein C showed significant prognostic power in Kaplan-Meier analyses. In patients with sepsis/severe infection, antithrombin and protein C showed higher hazard ratios than D-dimer. Platelet count showed the highest hazard ratio in patients with hemato logic malignancy. In patients with liver disease, the hazard ratio for antithrombin levels was significantly high. CONCLUSIONS: Decreased plasma anticoagulant levels reflect florid consumption of the phys iologic defense system against DIC-induced hypercoagulation. Plasma antithrombin and protein C levels are powerful prognostic markers of DIC, especially in patients with sepsis/severe infection.

Mean Platelet Volume and Vitamin D Level

BACKGROUND: Vitamin D deficiency and a high mean platelet volume (MPV) are related to cardiovascular disease. We investigated whether vitamin D deficiency is associated with high MPV. METHODS: This study included 434 patients without chronic disease who were not taking vitamin D or calcium supplements. Vitamin D was measured by chemiluminescent microparticle immunoassay on the Architect-I2000 system (Abbott Diagnostics, USA), and MPV was measured on the Cell-Dyn Ruby analyzer (Abbott Diagnostics). Patients were divided into Groups 1 (138 [men/women, 46/92]), 2 (148 [men/women, 54/94]), and 3 (148 [men/women, 50/98]) according to vitamin D levels of 20 ng/mL, respectively. RESULTS: The vitamin D level in Group 1 (7.7+/-1.9 ng/mL) was lower than that in Group 2 (15.1+/-1.6 ng/mL, P<0.001) and Group 3 (25.6+/-6.3 ng/mL, P<0.001). The MPV in Group 3 (7.5+/-1.0 fL) was lower than that in Group 1 (8.1+/-1.1 fL, P<0.001) and Group 2 (7.9+/-1.0 fL, P=0.009). Linear regression analysis showed that low levels of vitamin D (beta=-0.109, P=0.019) was independently associated with increased MPV. CONCLUSIONS: There was a strong association between a low vitamin D level and a high MPV; therefore, vitamin D deficiency may be associated with increased MPV.

The Sysmex XN-2000 Hematology Autoanalyzer Provides a Highly Accurate Platelet Count than the Former Sysmex XE-2100 System Based on Comparison with the CD41/CD61 Immunoplatelet Reference Method of Flow Cytometry

No abstract available.

Isolated biomolecules of pharmacological interest in hemostasis from Cerastes cerastes venom

Biomolecules from Cerastes cerastes venom have been purified and characterized. Two phospholipases isolated from Cerastes cerastes venom share 51% of homology. CC2-PLA2 exhibits antiplatelet activity that blocks coagulation. CCSV-MPase, a non-hemorrhagic Zn2+-metalloproteinase, significantly reduced the plasmatic fibrinogen level and hydrolyzes only its Bβ chain. Serine proteinases such as RP34, afaâcytin and CC3-SPase hydrolyze the fibrinogen and are respectively α, αβ and αβ fibrinogenases. In deficient human plasma, afaâcytin replaces the missing factors VIII and IX, and activates purified human factor X into factor Xa. It releases serotonin from platelets and directly aggregates human (but not rabbit) blood platelets. RP34 proteinase also had no effect on both human and rabbit blood platelet aggregation. CC3-SPase revealed a pro-coagulant activity. However, the insolubility of the obtained clot indicates that CC3-SPase does not activate factor XIII. In addition, CC3-SPase clotting activity was carried out with human plasmas from volunteer patients deficient in clotting factors. Results showed that CC3-SPase shortens clotting time of plasma deficient in factors II and VII but with weaker clotting than normal plasma. The clotting time of plasma deficient in factor II is similar to that obtained with normal plasma; suggesting that CC3-SPase is able to replace both factors IIa and VII in the coagulation cascade and thus could be involved in the blood clotting process via an extrinsic pathway. These results imply that CC3-SPase and afaâcytin could repair hemostatic abnormalities and may replace some factors missing in pathological deficiency. Afaâcytin also exhibits α fibrinase property similar to a plasmin-like proteinase. Despite its thrombin-like characteristics, afaâcytin is not inhibited by plasmatic thrombin inhibitors. The procoagulant properties of afaâcytin might have potential clinical applications.