Hong M.,Agency for Science, Technology and Research Singapore |
Hong M.,National University of Singapore |
Sandalova E.,Agency for Science, Technology and Research Singapore |
Low D.,Agency for Science, Technology and Research Singapore |
And 11 more authors.
Nature Communications | Year: 2015
The newborn immune system is characterized by an impaired Th1-associated immune response. Hepatitis B virus (HBV) transmitted from infected mothers to newborns is thought to exploit the newbornsâ (tm) immune system immaturity by inducing a state of immune tolerance that facilitates HBV persistence. Contrary to this hypothesis, we demonstrate here that HBV exposure in utero triggers a state of trained immunity, characterized by innate immune cell maturation and Th1 development, which in turn enhances the ability of cord blood immune cells to respond to bacterial infection in vitro. These training effects are associated with an alteration of the cytokine environment characterized by low IL-10 and, in most cases, high IL-12p40 and IFN-Î± 2. Our data uncover a potentially symbiotic relationship between HBV and its natural host, and highlight the plasticity of the fetal immune system following viral exposure in utero. © 2015 Macmillan Publishers Limited. All rights reserved.
Grassetto A.,UOC Anestesia e Rianimazione |
Fullin G.,UOC Anestesia e Rianimazione |
Cerri G.,UOC Ostetricia e Ginecologia |
Simioni P.,University of Padua |
And 2 more authors.
Blood Coagulation and Fibrinolysis | Year: 2014
Haemoperitoneum due to ruptured extrauterine pregnancy is a complication that may occur in the first trimester of pregnancy, but massive haemorrhage with severe shock is rare. When severe bleeding does occur, timely diagnosis and rapid haemostatic treatment are vital. We present the case of a 37-year-old woman with severe bleeding and shock due to ruptured extrauterine pregnancy.Management of the patient consisted of emergency laparotomy, red blood cell transfusion and targeted haemostatic therapy guided by rotational thromboelastometry using the fibrin-based clotting (FIBTEM) assay, (activation with tissue factor with addition of the platelet inhibitor cytochalasin D). As severe hypofibrinogenaemia was apparent, indicated by a FIBTEM maximum clot firmness (MCF) that was not measurable (i.e.<2mm) and a plasma fibrinogen level of 0.17g/l, the patient was treated with 4g fibrinogen concentrate. Tranexamic acid (1g) was also administered.Rapid restoration of haemostasis was indicated by the improvement of thromboelastometric parameters (FIBTEM MCF 16mm) and, later, laboratory coagulation tests (plasma fibrinogen 2.75g/l), along with cessation of bleeding. No fresh frozen plasma (FFP) was administered. Surgery was successfully completed, and the patient was subsequently discharged 5 days after admission with no further complications. Haemorrhage in extrauterine pregnancy is commonly managed using autologous blood transfusion (via cell salvage) and homologous plasma transfusion. In this case of severe bleeding and shock due to ruptured extrauterine pregnancy, thromboelastometry- guided administration of fibrinogen concentrate enabled rapid restoration of haemostasis, complete avoidance of FFP transfusion and resulted in a successful outcome. © 2014 Wolters Kluwer Health.
Pepe F.,UOC Ostetricia e Ginecologia |
Fauzia M.,UOC Ostetricia e Ginecologia |
Di Grazia F.,UOC Ostetricia e Ginecologia |
Giunta M.,UOC Ostetricia e Ginecologia |
And 2 more authors.
Giornale Italiano di Ostetricia e Ginecologia | Year: 2012
Errors in medicine cause serious complications and about 20-25% are due to cognitive errors. It means that physicians have sufficient clinical data, but they are unable to perform a correct analysis for medical decisions. Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both intuitive, experiential, affective system (system I) and/or analytical, deliberative system (system II), processing system. The process of decision making requires integrations of benefits and harms and in this context the individual difference may be important in subjective judgments of disease prevalence and " thresholds" at which physicians act. With this aim it is relevant developing skills concerning human communication between physician and patient, quality of anamnesis/physical examination, request and interpretation of laboratory exams and collaborative work according to flow-chart and EBM. The goal is the acquisition of correct data with the optimization of the "thresholds" at which physicians act. The knowledge and consciousness of cognitive errors may reduce cognitive errors with targeted interventions during academic study and routine work. © 2013 Copyright, CIC Edizioni Internazionali, Roma.
PubMed | Agency for Science, Technology and Research Singapore, UO Immunoematologia e Medicina Trasfusionale, National University of Singapore and UOC Ostetricia e Ginecologia
Type: | Journal: Nature communications | Year: 2015
The newborn immune system is characterized by an impaired Th1-associated immune response. Hepatitis B virus (HBV) transmitted from infected mothers to newborns is thought to exploit the newborns immune system immaturity by inducing a state of immune tolerance that facilitates HBV persistence. Contrary to this hypothesis, we demonstrate here that HBV exposure in utero triggers a state of trained immunity, characterized by innate immune cell maturation and Th1 development, which in turn enhances the ability of cord blood immune cells to respond to bacterial infection in vitro. These training effects are associated with an alteration of the cytokine environment characterized by low IL-10 and, in most cases, high IL-12p40 and IFN-2. Our data uncover a potentially symbiotic relationship between HBV and its natural host, and highlight the plasticity of the fetal immune system following viral exposure in utero.
Recurrent endometrial adenocarcinoma subcutaneous level near scar laparotomy sole recovery site of disease [Recidiva di adenocarcinoma endometriale a livello sottocutaneo in prossimità della cicatrice laparotomica come unico sito di ripresa della malattia]
Bertoldi A.,U.O.C. Ostetricia e Ginecologia |
Salimbeni A.,Ospedale Civile P. Colombo
Giornale Italiano di Ostetricia e Ginecologia | Year: 2011
Endometrial cancer is the most common gynecologic cancer worldwide and is the eighth leading cause of death among women. The clinical case we observed during our professional activities cover the case of a woman of 73 years, Caucasian, with endometrial adenocarcinoma (G2). The patient underwent the diagnostic tests necessary for the staging of the disease, that showed that the tumor was confined to the uterus, there was no metastatic repetition. The patient underwent total extrafascial hysterectomy, bilateral annessiectomia, peritoneal washing, omental biopsy, and subdiaphragmatic bilateral biopsies. The final histological examination confirmed that the tumor corresponded to endometrial adenocarcinoma that extends to the outer half of myometrium (stage IC sec. Figo). Subsequently,recommended to the oncologists, the patient underwent external pelvic radiotherapy for 5 weeks. About a year and a half after surgery, during an inspection, physical examination one feels a mass in the anterior abdominal wall, in the left paramedian, close to the laparotomy scar in the subcutaneous tissue. The lesion was excised, the histological examination showed that it was a metastatic repetition in the subcutaneous of the primitive cancer. Surgery is the first choice treatment for endometrial cancer. In literature is still debated whether the lymph node excision, lymph nodes and pelvic-aortic lumbar, is in itself a clinical benefit. Surely the lymph node dissection is necessary in patients with lymph suspicious on CT or MRI. Certainly with regard to our case and others reported in the literature, we believe that the metastasis of the abdominal wall may have no correlation with lymph node dissection. Any correlation to lymphatic spread of blood-repeating or "seeding" of cells during the operation can not be superseded by the narrowness of the series. © Copyright 2011, CIC Edizioni Internazionali.