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Liu Z.-J.,Enders Research Building | Bussel J.B.,New York Presbyterian Hospital | Lakkaraja M.,New York Presbyterian Hospital | Ferrer-Marin F.,Enders Research Building | And 5 more authors.
Blood | Year: 2015

Incompatibility of the human platelet antigen-1 (HPA-1) system is the most common cause of fetal/neonatal alloimmune thrombocytopenia (F/NAIT) and is thought to be mediated by accelerated clearance of antibody-opsonized fetal platelets. We evaluated the effect of maternal sera containing anti-HPA-1a antibodies (F/NAIT sera) on in vitro megakaryopoiesis. Compared with control maternal sera, 14 out of 17 F/NAIT sera significantly reduced megakaryocyte (MK) number. This finding was associated with increased apoptosis and cell death of early MKs/MK progenitors, but normal maturation and differentiation of surviving MKs. An analysis of platelet counts in infants born to mothers following antenatal intravenous immunoglobulin (IVIG) ± prednisone therapy demonstrated a significant and moderately strong correlation between the MK growth in cultures and the infants' platelet counts at birth. These findings suggest that maternal anti-HPA-1a antibodies can suppress fetal megakaryopoiesis by inducing early cell death and that this influences the neonatal platelet count. Thus, the ability of maternal antibodies to suppress MK growth is a potential predictive factor for the fetal response to maternal IVIG therapy. © 2015 by The American Society of Hematology.

Manzano-Fernandez S.,Instituto Murciano Of Investigacion Biosanitaria | Manzano-Fernandez S.,University of Murcia | Sanchez-Martinez M.,Instituto Murciano Of Investigacion Biosanitaria | Flores-Blanco P.J.,Instituto Murciano Of Investigacion Biosanitaria | And 10 more authors.
American Journal of Cardiology | Year: 2016

Risk assessment plays a major role in the management of acute coronary syndrome. The aim was to compare the performance of the Global Registry of Acute Coronary Events (GRACE) and the Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the American College of Cardiology/American Heart Asociation guidelines (CRUSADE) risk scores to predict in-hospital mortality and major bleeding (MB) in 1,587 consecutive patients with acute coronary syndrome. In-hospital deaths and bleeding complications were prospectively collected. Bleeding complications were defined according to CRUSADE and Bleeding Academic Research Consortium (BARC) criteria. During the hospitalization, 71 patients (4.5%) died, 37 patients (2.3%) had BARC MB and 34 patients (2.1%) had CRUSADE MB. Receiver operating characteristic curves analyses showed GRACE risk score has better discrimination capacity than CRUSADE risk score for both, mortality (0.86 vs 0.79; p = 0.018) and BARC MB (0.80 vs 0.73; p = 0.028), but similar for CRUSADE MB (0.79 vs 0.79; p = 0.921). Both scores had low discrimination for predicting MB in the elderly (>75 years) and patients with atrial fibrillation, whereas CRUSADE risk score was especially poor for predicting MB in patients with <60 ml/min/1.73 m2 or those treated with new antiplatelets. Reclassification analyses showed GRACE risk score was associated with a significant improvement in the predictive accuracy of CRUSADE risk score for predicting mortality (net reclassification improvement: 22.5%; p <0.001) and MB (net reclassification improvement: 17.6%; p = 0.033) but not for CRUSADE MB. In conclusion, GRACE risk score has a better predictive performance for predicting both in-hospital mortality and BARC MB. In light of these findings, we propose the GRACE score as a single score to predict these in-hospital complications. © 2016 Elsevier Inc. All rights reserved.

Alvarez C.,University Pompeu Fabra | Andreu M.,University Pompeu Fabra | Castells A.,University of Barcelona | Quintero E.,Hospital Universitario Of Canarias | And 36 more authors.
Gastrointestinal Endoscopy | Year: 2013

Background: Serrated cancers account for 10% to 20% of all colorectal cancers (CRC) and more than 30% of interval cancers. The presence of proximal serrated polyps and large (≥10 mm) serrated polyps (LSP) has been correlated with colorectal neoplasia. Objective: To evaluate the prevalence of serrated polyps and their association with synchronous advanced neoplasia in a cohort of average-risk population and to assess the efficacy of one-time colonoscopy and a biennial fecal immunochemical test for reducing CRC-related mortality. This study focused on the sample of 5059 individuals belonging to the colonoscopy arm. Design: Multicenter, randomized, controlled trial. Setting: The ColonPrev study, a population-based, multicenter, nationwide, randomized, controlled trial. Patients: A total of 5059 asymptomatic men and women aged 50 to 69 years. Intervention: Colonoscopy. Main Outcome Measurements: Prevalence of serrated polyps and their association with synchronous advanced neoplasia. Results: Advanced neoplasia was detected in 520 individuals (10.3%) (CRC was detected in 27 [0.5%] and advanced adenomas in 493 [9.7%]). Serrated polyps were found in 1054 individuals (20.8%). A total of 329 individuals (6.5%) had proximal serrated polyps, and 90 (1.8%) had LSPs. Proximal serrated polyps or LSPs were associated with male sex (odds ratio [OR] 2.08, 95% confidence interval [CI], 1.76-4.45 and OR 1.65, 95% CI, 1.31-2.07, respectively). Also, LSPs were associated with advanced neoplasia (OR 2.49, 95% CI, 1.47-4.198), regardless of their proximal (OR 4.15, 95% CI, 1.69-10.15) or distal (OR 2.61, 95% CI, 1.48-4.58) locations. When we analyzed subtypes of serrated polyps, proximal hyperplasic polyps were related to advanced neoplasia (OR 1.61, 95% CI, 1.13-2.28), although no correlation with the location of the advanced neoplasia was observed. Limitations: Pathology criteria for the diagnosis of serrated polyps were not centrally reviewed. The morphology of the hyperplasic polyps (protruded or flat) was not recorded. Finally, because of the characteristics of a population-based study carried out in average-risk patients, the proportion of patients with CRC was relatively small. Conclusion: LSPs, but not proximal serrated polyps, are associated with the presence of synchronous advanced neoplasia. Further studies are needed to determine the risk of proximal hyperplastic polyps.

Sanchez-Navarro J.P.,University of Murcia | Sanchez-Navarro J.P.,Instituto Murciano Of Investigacion Biosanitaria | Maldonado E.F.,University of Malaga | Martinez-Selva J.M.,University of Murcia | And 2 more authors.
Psychophysiology | Year: 2012

We studied the changes in salivary alpha-amylase (sAA) and other psychophysiological indices (heart rate, skin conductance, and corrugator supercilii activity) elicited by sustained exposure to affective pictures. Thirty-nine subjects viewed five blocks of pictures depicting mutilations, human attack, neutral scenes, sport/adventure, and erotica. Each block comprised 12 pictures of the same content. Saliva samples were collected before and after each block of pictures. The results showed that mutilation pictures promoted the greatest increase in sAA activity and output, as well as greater corrugator supercilii activity than pleasant pictures. Skin conductance response did not differ among high arousal picture contents. Changes in sAA varied with the affective valence but not with the arousal ratings of the pictures. Our results point to sAA as an index directly related to the unpleasantness elicited by sustained exposure to affective stimuli. © 2012 Society for Psychophysiological Research.

Cruzado J.,Instituto Murciano Of Investigacion Biosanitaria | Sanchez F.I.,University of Murcia | Abellan J.M.,University of Murcia | Perez-Riquelme F.,Instituto Murciano Of Investigacion Biosanitaria | Carballo F.,University of Murcia
Best Practice and Research: Clinical Gastroenterology | Year: 2013

Because of its incidence and mortality colorectal cancer represents a serious public health issue in industrial countries. In order to reduce its social impact a number of screening strategies have been implemented, which allow an early diagnosis and treatment. These basically include faecal tests and studies that directly explore the colon and rectum. No strategy, whether alone or combined, has proven definitively more effective than the rest, but any such strategy is better than no screening at all. Selecting the most efficient strategy for inclusion in a population-wide program is an uncertain choice. Here we review the evidence available on the various economic evaluations, and conclude that no single method has been clearly identified as most cost-effective; further research in this setting is needed once common economic evaluation standards are established in order to alleviate the methodological heterogeneity prevailing in study results. © 2013 Elsevier Ltd. All rights reserved.

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