Effect of time windows in LSTM networks for EEG-based BCIs.

People with impaired motor function could be helped by an effective brain-computer interface (BCI) based on a real-time electroencephalogram (EEG) and artificial intelligence algorithms. However, current methodologies for interpreting patient instructions from an EEG are not accurate enough to be completely safe in a real-world situation , where a poor decision would place their physical integrity at risk, such as when traveling in an electric wheelchair in a city. For various reasons, such as the low signal-to-noise ratio of portable EEGs or the effects of signal contamination (disturbances due to user movement, temporal variation of the features of EEG signals, etc.), a long short-term memory network (LSTM) (a type of recurrent neural network) that is able to learn data flow patterns from EEG signals could improve the classification of the actions taken by the user. In this paper, the effectiveness of using an LSTM with a low-cost wireless EEG device in real time is tested, and the time window that maximizes its classification accuracy is studied. The goal is to be able to implement it in the BCI of a smart wheelchair with a simple coded command protocol, such as opening or closing the eyes, which could be executed by patients with reduced mobility. Results show a higher resolution of the LSTM with an accuracy range between 77.61 and 92.14% compared to traditional classifiers (59.71%), and an optimal time window of around 7 s for the task done by users in this work. In addition, tests in real-life contexts show that a trade-off between accuracy and response times is necessary to ensure detection.

A New PLV-Spatial Filtering to Improve the Classification Performance in BCI Systems.

OBJECTIVE: The performance of an EEG-based brain-computer interface (BCI) system is highly dependent on signal preprocessing. This manuscript presents a filtering method to improve the feature classification algorithms typically used in BCI. METHODS: A graph Laplacian quadratic form using the Phase Locking Value (PLV) is applied to generate a new filtered signal in the preprocessing stage. RESULTS: The accuracy of the classification algorithms improved significantly (up to 27.18% in the BCI Competition IV dataset, and up to 42.56% with records made with an Emotiv EPOC+). In addition, the proposed filtering algorithm has similar or better results when compared with the Filter Bank Common Spatial Pattern (FBCSP), which has disadvantages in a multiclass classification. CONCLUSION: This paper shows how our PLV-based filtering between EEG channels could improve the performance of a BCI.

Parsonage-Turner posterior a vacunación antirrábica por mordedura de murciélago: comunicación de un caso / Parsonage-Turner after rabies vaccination due to bat bite: case report

Introducción:Paciente adulto masculino que consulta por mordedura de murciélago. Se realiza aplicación de vacuna antirrábica y toxoide tetánico, tras lo cual presenta alteraciones motoras, sensitivas y dolor de difícil manejo en el miembro superior derecho. Siendo un reto diagnóstico de manera inicial, posterior a estudios electrofisiológicos se consideró un síndrome de Parsonage-Turner. Este caso es relevante por la asociación de vacuna antirrábica no descrita en antecedentes de inmunización en revisiones previas.Caso clínico:Se le realizaron varias pruebas diagnósticas e imágenes como ecografías, resonancia magnética y estudios electrofisiológicos los cuales confirmaron el diagnóstico de neuritis braquial (síndrome de Parsonage-Turner). El paciente recibió intervenciones quirúrgicas con fascitomías y neurólisis, además de múltiples manejos farmacológicos para dolor, incluyendo opioides fuertes, neuromoduladores, antidepresivos y medicamentos por bomba intratecal, con disminución solo del 50 % de los síntomas de dolor y afectación a su calidad de vida.Conclusión:El caso nos muestra cómo el síndrome de Parsonage-Turner, una enfermedad neurológica con etiología desconocida, se puede cronificar en un síndrome doloroso al no tener un diagnóstico temprano o someter al paciente procedimientos no indicados. Este síndrome debe considerarse en la atención de urgencias y consulta externa por sus consecuencias a largo plazo y el difícil manejo de los síntomas crónicos. Hay una relación causal reportada en la literatura con el toxoide tetánico, pero este se aplicó previo a los síntomas; no hay referencias de inicio de síntomas posterior a la vacuna antirrábica, lo cual puede generar a futuro, una relación causal si se encontraran nuevos casos.(AU)

Introduction:Adult male patient who suffers a bat bite, after which rabies vaccine and tetanus toxoid are administered; later, he presents on the right upper limb severe motor, sensory and pain disorders. Initially a diagnostic challenge, after electrophysiological studies, Parsonage-Turner syndrome was considered. This case is relevant since the association between rabies vaccine and this syndrome has not been described.Clinical case:Several diagnostic tests and images were performed, including ultrasound, magnetic resonance and electrophysiological studies, which confirmed the diagnosis of brachial neuritis (Parsonage-Turner syndrome). Even though the patient received surgical interventions with fasciotomies and neurolysis as well as multiple pharmacological pain management with strong opioids, neuromodulators, antidepressants and intrathecal pump medications, there was a 50 % decrease in pain symptoms and an impairment of their quality of life.Conclusion:The case shows a Parsonage-Turner syndrome, a neurological disease with unknown etiology, with difficult diagnosis which can lead to chronic pain syndrome or unnecessary surgical procedures. This syndrome should be considered in emergency care and outpatient care due to its long-term consequences and the difficult management of chronic symptoms. There is a causal relationship reported in the literature with tetanus toxoid, but it was applied prior to symptoms; there are no reports of onset of symptoms after the rabies vaccine, which may generate a causal relationship in the future if new cases are found.(AU)

Surface-enhanced raman spectroscopy: A non invasive alternative procedure for early detection in childhood asthma biomarkers in saliva.

The early detection of bronchial inflammation in asthma, through a non-invasive, simple method and under a subclinical state, could lead to a more effective control of this condition. The aim of this study was to identify biomarkers of bronchial inflammation in the saliva of children with asthma through immunoassay and Surface Enhanced Raman Spectroscopy (SERS). We conducted an analytical cross-sectional study in 44 children ages 6-12; the diagnosis of asthma was made according to Global Initiative for Asthma (GINA) standards. The children's saliva was analyzed by immunoassay for the quantification of 37 cytokines, as well as SERS analysis in a confocal Raman microscope at 785 nm. We found a significant association between bronchial obstruction and IL-8 (p = 0.004), IL-10 (p = 0.008) and sCD163 (p = 0.003). The Raman spectra showed significant amplification in the region of 760 to 1750 cm-1. The Principal Component Analysis and Linear Discriminant Analysis (PCA-LDA) method has a sensitivity of 85%, specificity of 82% and an accuracy of 84% for the diagnosis of asthma. These results demonstrate the presence of a subclinical inflammatory state, suggestive of bronchial remodeling in the population studied. The SERS method is a potential tool for identifying bronchial inflammation and its endotype, allowing for a highly sensitive and specific diagnosis.

Charge distribution from SKPM images.

Inferring the surface charge distribution from experimental Kelvin probe microscopy measurements is usually a hard task. Although several approximations have been proposed in order to estimate the effect of these charges, the real inverse problem has not been addressed so far. In this paper, we propose a fast and intuitive method based on Fast Fourier Transform algorithms that allows the surface charge distribution to be obtained directly from the experimental Kelvin voltage measurements. With this method, quantitative physical information such as the total charge and charge position is accessible even in complex charge distributions such as highly insulating polymer surfaces. Moreover, one of the strongest points is that sub-tip resolution is achieved, and therefore the usually unknown charge size can be estimated.

Bioremoval of arsenic (V) from aqueous solutions by chemically modified fungal biomass.

The biosorption of arsenic (V) on nine chemically modified biomasses (with iron oxide coated) of mycelia fungi: Aspergillus flavus III, IV and V, Aspergillus fumigatus I-II, Paecilomyces sp., Cladosporium sp., Mucor sp-1 and 2 was studied in this work. This study provides evidence that the biomasses of the fungi A. flavus, IV, III and V, Paecilomyces sp., and A. fumigatus I were very efficient at removing 1 mg/L of the metal in solution, using atomic absorption spectroscopy (AAS), achieving the following percentage of removals: 97.1, 92.3, 90.3, 89.0, and 83.4%, respectively. The results of adsorption were obtained at pH 6.0, 30 °C after 24 h of incubation, with 1 g/100 mL of fungal biomass. These results suggest the excellent potential of almost all isolated strains for bioremediation and removal of metals from contaminated sites.

Urinary Clara Cell Protein in Kidney Transplant Patients: A Preliminary Study.

OBJECTIVE: The aim of this exploratory study was to analyze the urinary excretion of Clara cell protein (CC16), a new marker of proximal tubular dysfunction (PTD), in kidney transplantation (KT). MATERIALS AND METHODS: Urinary concentrations of CC16, ß2-microglobulin (ß2m), and N-acetyl-glucosaminidase (NAG) were measured in 50 KT patients (72% men; mean age 50.4 ± 12.4 years; diabetes in 24%; duration of KT 4.3 ± 3.1 years) and 10 healthy controls (6 men; mean age 33.6 ± 13.4 years). RESULTS: Urinary levels of ß2m, NAG, and CC16 were significantly higher in KT patients than in controls: ß2m: 0.77 (interquartile range [IQ] 0.22 to 4.62) g/g vs 0.069 (IQ 0.05 to 0.10) g/g; NAG: 3.16 (IQ 2.09 to 5.33) U/g vs 1.73 (IQ 1.25 to 2.07) U/g; CC16: 26.01 (IQ 8.62 to 123.3) g/g vs 2.51 (IQ 0.83 to 7.18) g/g (P < .001). Elevated levels of ß2m, NAG, and CC16 were found in 81%, 28%, and 71% of KT patients, respectively. Urinary levels of ß2m, NAG, and CC16 significantly increase as glomerular filtration rate (GFR) decreases. Interestingly, in patients with GFR >60 mL/min, we still found high levels of ß2m, NAG, and CC16 in 77%, 13%, and 52%, respectively. Diabetic subjects had significant higher levels of the 3 markers compared with nondiabetic subjects, without differences in albumin excretion or GFR. CC16 showed a positive correlation with urinary albumin (r = 0.42, P < .001), NAG (r = 0.352, P < .05), and ß2m (r = 0.75, P < .001). CONCLUSION: PTD is highly prevalent in KT patients. This is the first study that analyzes CC16 in KT patients, showing that the urinary excretion of this protein is significantly increased in this population. Further studies are needed to examine the clinical value of CC16 in KT patients.

Coracoid bone block fixation with cortical buttons: An alternative to screw fixation?

BACKGROUND: The purpose of this study was to evaluate suture button fixation in a bone block (Bristow and Latarjet) procedure. We hypothesize that (1) cortical button fixation will allow predictable and reproducible bone union and (2) minimize the complications reported with screw fixation. MATERIALS AND METHODS: Seventy patients (mean age, 27 years) underwent an arthroscopic bone block procedure with a guided surgical approach and suture button fixation for recurrent anterior shoulder instability. There were two groups of patients: 35 Bristow procedures (group A) and 35 Latarjet procedures (group B). Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging at 2 weeks and 6 months, respectively. RESULTS: The coracoid graft was positioned below the equator in 93% and strictly tangential to the glenoid surface in 94% of the cases. Bone healing was observed in 83% of the cases (58/70) with 74% bone union in group A and 91% in group B. Neurologic and hardware complications, classically reported with screw fixation, were not observed with this novel fixation method. CONCLUSIONS: (1) Suture button fixation can be an alternative to screw fixation, obtaining bone block union, (2) in the lying position (Latarjet) bone healing was better than in the standing position (Bristow), and (3) complications classically reported with screw fixation were not observed. LEVEL OF EVIDENCE: Level IV.

Production of Cost-Effective Mesoporous Materials from Prawn Shell Hydrocarbonization.

In this work, prawn shell was studied as raw material for the production of mesoporous adsorbents via hydrocarbonization, studying the effect of temperature and time on the process reactivity and final characteristics of the hydrochars. By suitable characterization technique analyses (N2 adsorption at 77 K, SEM observation, ultimate analysis, surface composition), the materials were examined. It was found that in both cases mesoporous materials with low values of S BET due to the presence of CaCO3 on the material structure. In order to provide a potential application for these materials, the adsorption behaviour of hydrochars (HCs) as well as that of pristine prawn shells and ashes from prawn shell combustion was studied for the first time with the model compound p-nitrophenol (PNP). The results indicated that HC treatment was beneficial and enhanced adsorption performance, especially at high values of equilibrium concentration, attaining adsorption capacities up to 1.6 mg g(-1).

Adaptive pharmacokinetic and pharmacodynamic modelling to predict propofol effect using BIS-guided anesthesia.

BACKGROUND AND OBJECTIVE: Propofol is widely used for hypnosis induction and maintenance of general anesthesia. Its effect can be assessed using the bispectral index (BIS). Many automatic infusion systems are based in pharmacokinetics (PK) and pharmacodynamics (PD) models to predict the response of the patient to the drug. However, all these models do not take into account intra and inter-patient variability. An adjusted intraoperative drug administration allows faster recovery and provides post-operative side-effect mitigation METHODS: BIS evolution and surgery-recorded propofol infusion data of a group of 60 adult patients (30 males/30 females) with ASA I/II physical status were used to test a real time PK/PD compartmental model. This new algorithm tunes three model parameters (ce50, γ and ke0), minimizing a performance function online. RESULTS: The error in the BIS signal predicted by the real time PK/PD model was smaller than the error measured with fixed parameter equations. This model shows that ce50, γ and ke0 change with time and patients, given a mean (95% confidence interval) of 3.89 (3.52-4.26)mg/l, 4.63 (4.13-5.13) and 0.36 (0.31-0.4)min(-1), respectively. CONCLUSIONS: The real time PK/PD model proposed provides a closer description of the patient real state at each sample time. This allows for greater control of the drug infusion, and thus the quantity of drug administered can be titrated to achieve the desired effect for the desired duration, and reduce unnecessary waste or post-operative effects.

Potential role for mucosal IgA in modulating Haemonchus contortus adult worm infection in sheep.

Haemonchus contortus (H. contortus) is a haematophagous parasite which causes important economic losses in small ruminants. On the island of Gran Canaria, two sheep breeds coexist which differ in their susceptibility to the infection with H. contortus; the resistant Canaria Hair Breed (CHB) sheep and the susceptible Canaria Sheep (CS) breed. The major target of resistance mechanisms in CHB sheep are directed to the adult parasite stage, reducing the worm burden, and decreased length and fecundity of surviving worms. Mucosal IgA (mIgA) has been shown to be an important regulator of immunity in Haemonchus and Teladorsagia infections; through correlations with larval stages where such mechanisms as antibody-dependent cell cytotoxicity and enzyme inhibition may mediate resistance. Here for the first time, we demonstrate a significant negative correlation between mIgA and adult worm length and fecundity only in the resistant CHB sheep. In contrast, and as reported in other sheep breeds, mIgA was only negatively correlated against the larval stage in the more susceptible CS breed. This study suggests mIgA may play a role in resistance to both larval and adult stages.

Immunity to Haemonchus contortus and Vaccine Development.

Sheep are capable of developing protective immunity to Haemonchus contortus through repeated exposure to this parasite, although this immune protection is the result of a complex interaction among age, gender, physiological status, pregnancy, lactation, nutrition and innate and adaptive immunity in the host animal. There are multiple effectors of the protective immune response, which differ depending on the developmental stage of the parasite being targeted, and our understanding of the effector mechanisms has developed considerably in the 2000s. The rational design of vaccines based on 'natural' or 'exposed' antigens depends on an understanding of this exposure-induced immunity. However, the most effective current vaccines rely on protection via the induction of high circulating antibody levels to 'hidden' gut antigens of H. contortus. The success of this latter strategy has resulted in the launch of a vaccine, which is based on extracts of the parasite's gut, to aid in the control of Haemonchus in Australia. The development of recombinant subunit vaccines based on the components of the successful native vaccine has not yet been achieved and most of the recent successes with recombinant subunit vaccines have focussed on antigens unrelated to the gut antigens. The future integration of an understanding of the immunobiology of this parasite with advances in antigen identification, expression (or synthesis) and presentation is likely to be pivotal to the further development of these recombinant subunit vaccines. Recent progress in each of the components underpinning this integrated approach is summarized in this review.

[Thromboelastometric profile of unwashed shed blood after primary knee arthroplasty]. / Évaluation du profil thromboélastométrique du sang épanché après arthroplastie primaire du genou.

INTRODUCTION: Knee arthroplasty causes significant blood loss. Different blood-saving measures exist like retransfusion of unwashed salvaged blood. Some studies question the quality of this blood and in particular its ability to clot. These studies use "static" coagulation tests reflecting only partially the reality, unlike viscoelastic methods. The main objective of this study was to evaluate the salvaged blood thromboelastometric profile using ROTEM® system and to compare these results with patient venous blood. MATERIALS AND METHODS: We performed an observational, prospective, single-center study conducted over 3 months in 2013. Agreement of local ethical committee and patient consent were obtained beforehand. All adult patients who underwent a primary total knee arthroplasty were included. A thromboelastometric profile and standard laboratory tests (hemoglobin, platelets count, PT, aPTT, fibrinogen) were performed in the same time on patient venous blood and on unwashed salvaged blood in the PACU. RESULTS: Twenty patients were included. The median duration of surgery was 93 minutes. Thirteen patients (65%) received tranexamic acid during procedure. The median volume of shed blood was 225 mL. Two patients (10%) received a reinfusion. Analysis of shed blood showed a major deficiency of clotting factor in standard biology (PT<10%) and an absence of clot formation in thromboelastometric test (In-tem®, Ex-tem®, Fib-tem® or Ap-tem®). Compared to venous blood, shed blood had significantly lower hemoglobin levels: 8.8 vs 13.5 g/dL (P<0.0001). Allogenic transfusion concerned 5% of patients. DISCUSSION: In this work, we confirmed that shed blood was naturally uncoagulable probably due to a multifactorial mechanism involving a major clot factor deficiency and an activation of fibrinolysis.

Application of active electrode compensation to perform continuous voltage-clamp recordings with sharp microelectrodes.

OBJECTIVE: Electrophysiological recordings of single neurons in brain tissues are very common in neuroscience. Glass microelectrodes filled with an electrolyte are used to impale the cell membrane in order to record the membrane potential or to inject current. Their high resistance induces a high voltage drop when passing current and it is essential to correct the voltage measurements. In particular, for voltage clamping, the traditional alternatives are two-electrode voltage-clamp technique or discontinuous single electrode voltage-clamp (dSEVC). Nevertheless, it is generally difficult to impale two electrodes in a same neuron and the switching frequency is limited to low frequencies in the case of dSEVC. We present a novel fully computer-implemented alternative to perform continuous voltage-clamp recordings with a single sharp-electrode. APPROACH: To reach such voltage-clamp recordings, we combine an active electrode compensation algorithm (AEC) with a digital controller (AECVC). MAIN RESULTS: We applied two types of control-systems: a linear controller (proportional plus integrative controller) and a model-based controller (optimal control). We compared the performance of the two methods to dSEVC using a dynamic model cell and experiments in brain slices. SIGNIFICANCE: The AECVC method provides an entirely digital method to perform continuous recording and smooth switching between voltage-clamp, current clamp or dynamic-clamp configurations without introducing artifacts.

Selective vitamin D receptor activation as anti-inflammatory target in chronic kidney disease.

Paricalcitol, a selective vitamin D receptor (VDR) activator used for treatment of secondary hyperparathyroidism in chronic kidney disease (CKD), has been associated with survival advantages, suggesting that this drug, beyond its ability to suppress parathyroid hormone, may have additional beneficial actions. In this prospective, nonrandomised, open-label, proof-of-concept study, we evaluated the hypothesis that selective vitamin D receptor activation with paricalcitol is an effective target to modulate inflammation in CKD patients. Eight patients with an estimated glomerular filtration rate between 15 and 44 mL/min/1.73 m(2) and an intact parathyroid hormone (PTH) level higher than 110 pg/mL received oral paricalcitol (1 µg/48 hours) as therapy for secondary hyperparathyroidism. Nine patients matched by age, sex, and stage of CKD, but a PTH level <110 pg/mL, were enrolled as a control group. Our results show that five months of paricalcitol administration were associated with a reduction in serum concentrations of hs-CRP (13.9%, P < 0.01), TNF-α (11.9%, P = 0.01), and IL-6 (7%, P < 0.05), with a nonsignificant increase of IL-10 by 16%. In addition, mRNA expression levels of the TNFα and IL-6 genes in peripheral blood mononuclear cells decreased significantly by 30.8% (P = 0.01) and 35.4% (P = 0.01), respectively. In conclusion, selective VDR activation is an effective target to modulate inflammation in CKD.

Immunopathological study of parasitic cholangitis in cetaceans.

This paper describes the immunophenotype of cellular inflammatory infiltrates in chronic cholangitis in six common dolphins (Delphinus delphis), four striped dolphins (Stenella coeruleoalba), three Atlantic spotted dolphins (Stenella frontalis) and one pygmy sperm whale (Kogia Breviceps) found stranded along the coasts of the Canary Islands (Spain). A panel of 5 antibodies previously tested in dolphins (anti-CD3, -IgG, -MHC class II, -S100 protein and -lysozyme) were used. The present work also reports cross reactivity with dolphin antigens of two antibodies not used to date in dolphins (anti-mouse iNOS and anti-mouse Foxp3). The most common type of cholangitis found was chronic granulomatous cholangitis, associated with the presence of the parasite Campula spp., or its eggs in bile ducts. The cellular composition of the hepatic inflammatory infiltrate associated to chronic parasitic cholangitis was closely similar to that found in the cortex of control lymph nodes, including the presence of S100(+) and MHC class II(+) dendritic-like cells in lymphoid follicles and interfollicular areas. Only occasional macrophages expressed iNOS, whereas Foxp3(+) lymphocytes were not found in any of the lesions described in the different types of cholangitis.

Relationship between inflammation and microalbuminuria in prehypertension.

Inflammation is a pathogenic factor for target-organ damage (TOD) in hypertension. This study examined the relationship between inflammatory parameters and urinary albumin excretion (UAE) in prehypertension. A total of 65 prehypertensive subjects (blood pressure (BP) 120-139/80-89 mm Hg) and 26 healthy volunteers with BP <120/80 mm Hg were included. High-sensitivity C-reactive protein (hs-CRP), and serum and urinary tumor necrosis factor-α (TNF-α) were measured as inflammatory markers. Prehypertensive individuals had higher levels of inflammatory parameters and UAE than healthy subjects. Analyses carried out in prehypertensive participants showed that BP was similar between individuals with normoalbuminuria or microalbuminuria (MAB) (UAE between 30 and 299 mg per day). However, serum hs-CRP and urinary TNF-α excretion were higher in prehypertensives with MAB. Multiple regression analysis showed that systolic blood pressure (r=0.29, P<0.01), hs-CRP (r=0.20, P<0.001), and urinary TNF-α (r=0.69, P<0.001) were independently correlated with UAE (adjusted R(2)=0.73, P<0.001). Finally, logistic regression analysis performed in the prehypertensive group with the absence or presence of MAB as the dependent variable demonstrated that hs-CRP (3.92 (1.45-10.58), P=0.007) and urinary TNF-α (1.69 (1.20-2.37), P=0.002) were independent risk factors for the presence of MAB. Inflammatory parameters are significantly and independently associated with UAE in prehypertensive subjects, suggesting that inflammation may be a pathogenic factor for the early vascular or TOD in these individuals.

Platelet function normalization after a prasugrel loading-dose: time-dependent effect of platelet supplementation.

BACKGROUND: Hemostatic benefits of platelet transfusions in thienopyridine-treated acute coronary syndrome (ACS) patients may be compromised by residual metabolite in circulation. OBJECTIVES: To estimate the earliest time after a prasugrel loading-dose when added platelets are no longer inhibited by prasugrel's active metabolite. METHODS: Baseline platelet reactivity of healthy subjects (n=25, 30 ± 5 years, 68% male) on ASA 325 mg was tested using maximum platelet aggregation (MPA, ADP 20 µm) and VerifyNow(®) P2Y12 and was followed by a 60 mg prasugrel loading-dose. At 2, 6, 12 and 24 h post-dose, fresh concentrated platelets from untreated donors were added ex-vivo to subjects' blood, raising platelet counts by 0% (control), 40%, 60% and 80%. To estimate the earliest time when prasugrel's active metabolite's inhibitory effect on the added platelets ceases, platelet function in supplemented samples was compared across time-points to identify the time when effect of supplementation on platelet function stabilized (i.e. the increase in platelet reactivity was statistically similar to that at the next time-point). RESULTS: Supplemented samples showed concentration-dependent increases in platelet reactivity vs. respective controls by both MPA and VerifyNow(®) at all assessment time-points. For each supplementation level, platelet reactivity showed a sharp increase from 2 to 6 h but was stable (P=NS) between 6 and 12 h. CONCLUSIONS: The earliest measured time when supplemented platelets were not inhibited by circulating active metabolite of prasugrel was 6 h after a prasugrel loading-dose. These findings may have important implications for prasugrel-treated ACS patients requiring platelet transfusions during surgery.