Impact of an oral anticoagulation self-monitoring and self-management program in patients with mechanical heart valve prosthesis

Objective: To analyze impact of implementation of an oral anticoagulation self-monitoring and self-management program among patients with mechanical valve prosthesis. Materials & methods: Observational and retrospective study performed in Hospital Moises Broggi, Barcelona, Spain. The program started on June 2019. The study compared 6-month period before and after the implementation of the program. Results: The study included 44 patients. There was a numerical increase of time in therapeutic range from 53.6 ± 21.3% to 57.1 ± 15.7% (p = 0.30). Proportion of patients with international normalized ratio (INR) >5 significantly decreased from 3.9 to 2.0% (p = 0.04). No significant differences were observed in thromboembolic or bleeding complications. Visits to emergency department decreased from (29.5 to 22.7%; p = 0.41). Conclusion: Oral anticoagulation self-monitoring and self-management program seems an appropriate approach that could provide additional benefits in selected patients with mechanical valve prosthesis.

Sperm telomere length in motile sperm selection techniques: A qFISH approach

Several studies have associated telomere shortening with alterations in reproductive function. The objective of the present study was to determine telomere length (TL) in spermatozoa selected by either density-gradient centrifugation (DGC) or swim-up. The analysis of TL was performed using quantitative fluorescent in situ hybridisation (qFISH) using PNA probes in combination with a chromatin decompaction protocol in sperm cells. Results of TL were 24.64 ± 5.00 Kb and 24.95 ± 4.60 Kb before and after DGC, respectively, and 19.59 ± 8.02 Kb and 20.22 ± 5.18 Kb before and after swim-up respectively. Sperm selected by DGC or swim-up did not show any significant differences in TL as compared to nonselected sperm (p > .05). Negative correlations between TL and sperm motility (r = -.308; p = .049) and concentration (r = -.353; p = .028) were found. Furthermore, exposure of sperm to increasing concentrations of hydrogen peroxide during incubation resulted in a reduction in TL. These data indicate that oxidative stress may be one of the main factors involved in the reduction of TL in sperm. Preliminary clinical results from patients included in this study indicate that TL was shorter in spermatozoa from couples who never achieved a pregnancy compared to couples who did achieve at least one natural pregnancy (p < .05); however, the clinical utility of this biomarker still needs to be confirmed in further studies.

Effect of electrical and mechanical stunning on bleeding, instrumental properties and sensory meat quality in rabbits

Different voltage and frequency (T-1=49V, 250Hz; T-2=130V, 172Hz; T-3=22V, 833Hz) combinations of electrical stunning and cervical dislocation (T-4) were studied in 101 commercial rabbits in an industrial abattoir. Electrical stunning accelerated the early muscular acidification, providing lower pH-45 and pH-2h values on Longissimus dorsi and Biceps femoris and higher pH-24h on Biceps femoris than cervical dislocation (P<0.02). Furthermore, meat from rabbits stunned with electrical methods showed more redness (a* with mean values 1.17-1.30 vs. 0.66, P<0.02), although this cannot be associated to low exsanguination levels because electrical methods tend to produce even higher bleeding percentage than mechanical stunning (P=0.063). Haematin content in muscle, water-holding capacity and cooking losses were similar in all treatments. Shear force did not change because of the stunning methods, but the members of experienced panel found the meat coming from electrical stunning T-1 (with intermediate voltages and frequencies) tougher and less juicy than the meat obtained with other electrical applications or with cervical dislocation (P<0.05).

Evaluation of 5 versus 10 granulocyteaphaeresis sessions in steroid-dependent ulcerative colitis: A pilot, prospective, multicenter, randomized study

AIM: To evaluate the efficacy of 5 compared to 10 granulocyteaphaeresis sessions in patients with active steroid-dependent ulcerative colitis.

METHODS: In this pilot, prospective, multicenter randomized trial, 20 patients with moderately active steroid-dependent ulcerative colitis were randomized to 5 or 10 granulocyteaphaeresis sessions. The primary objective was clinical remission at wk 17. Secondary measures included endoscopic remission and steroid consumption.

RESULTS: Nine patients were randomized to 5 granulocyteaphaeresis sessions (group 1) and 11 patients to 10 granulocyteaphaeresis sessions (group 2). At wk 17, 37.5% of patients in group 1 and 45.45% of patients in group 2 were in clinical remission. Clinical remission was accompanied by endoscopic remission in all cases. Eighty-six percent of patients achieving remission were steroid-free at wk 17. Daily steroid requirements were significantly lower in group 2. Eighty-nine per cent of patients remained in remission during a one year follow-up. One serious adverse event, not related to the study therapy, was reported.

CONCLUSION: Granulocyteaphaeresis is safe and effective for the treatment of steroid-dependent ulcerative colitis. In this population, increasing the number of aphaeresis sessions is not associated with higher remission rates, but affords a significant steroid-sparing effect.

Adsorptive granulocyte/monocyte apheresis for the treatment of refractory rheumatoid arthritis: an open pilot multicentre trial

OBJECTIVE

To assess the efficacy and safety of adsorptive granulocyte and monocyte apheresis (GCAP) in patients with refractory rheumatoid arthritis (RA).

METHODS

Patients with active and refractory RA were treated with weekly GCAP sessions using a column filled with acetate beads (Adacolumn) over five consecutive weeks. Clinical assessments and response to therapy were analysed at weeks 5, 7, 12 and 20 in an open multicentre trial. The primary outcome measure of clinical response was 20% improvement in the American College of Rheumatology criteria (ACR20) at week 20. EULAR (European League Against Rheumatism) response criteria, based on the disease activity score for 28 joints (DAS28) and disability using the Health Assessment Questionnaire (HAQ), were also assessed.

RESULTS

Of 27 patients, 81.5% were women with mean disease duration of 14.4 yr. The mean number of previous disease-modifying antirheumatic drugs (DMARDs) was 3.7, and 48.1% of patients had previously failed on biologicals. On an intention-to-treat basis, 40.7% of patients achieved an ACR20 and 44.4% a therapeutic EULAR response at week 20. These percentages were 50 and 54.5% in 22 patients who completed the trial. In the 10 completers who had previously failed on biologicals, an ACR response was achieved in four patients (ACR20, two; ACR50, one; ACR70, one). A significant decrease was recorded in different ACR response components, including the tender joint and swollen joint counts, pain score and patient and physician global disease assessments, as well as the DAS28 index; most of them improved after week 5. ESR and CRP, but not the HAQ score, had decreased significantly at week 20. The treatment was well tolerated and only one serious adverse event related to the study procedure was documented (sepsis due to a catheter infection).

CONCLUSIONS

GCAP treatment led to significant clinical improvement in a subset of patients with RA who had failed to respond to DMARDs or biologicals. Further large, placebo-controlled studies are warranted to fully assess the therapeutic value of GCAP for refractory RA.

Quantitative assessment of gait deviation: contribution to the objective measurement of disability

Three biomechanical parameters based on force plate measurements were defined as indicators of gait deviation. Symmetry was specified as the relative difference in stance time and vertical impulse loading between both feet, constancy as the mean S.D. of the force curves for one subject under a specified gait condition and discrepancy as the average difference between the individual gait pattern and the expected force curves, normalised by the value of the S.D. in a control group. One hundred and forty four patients with osteoarthritis (OA) of the lower extremity and 144 control subjects were studied. There were 45 patients with OA of the hip, 54 of the knee and 45 of the ankle and their function was determined using the Harris Hip score, the hospital for special surgery knee score and the Mazur ankle score, respectively. The temporal asymmetry indicator was more sensitive to unilateral joint affliction, whereas the discrepancy indicators were sensitive to the presence of OA. Both correlated with the patient's function as measured by the relevant clinical score. A significant increase of gait discrepancy was detected in the arthritis group when patients were asked to walk at faster speeds; whilst walking barefoot led to an unexpected reduction of intra-subject kinetic variability. Our results confirm the validity and usefulness of the gait deviation concept in patients with OA.

Design and test of neural networks and statistical classifiers in computer-aided movement analysis: a case study on gait analysis

OBJECTIVE: To describe the methods for designing and testing diagnostic systems in movement analysis and to verify the clinical usefulness of neural networks and statistical classifiers in a case study. DESIGN: Connectionist and statistical models trained and tested with measured data. BACKGROUND: A basic need in rehabilitation and related fields is to efficiently manage the vast information obtained from a movement analysis laboratory. Many studies have dealt with the interpretation of measured variables in order to correlate objective descriptors to the presence and/or severity of specific neuromusculoskeletal disorders or their consequences. This traditional analytical approach has been complemented in the last decade by new non-linear classification tools called neural networks. METHODS: A gait analysis study on 148 lower limb arthrosis patients and 88 age-matched control subjects. Pathological and healthy gait patterns obtained from force plates wer discriminated by means of multilayer perceptrons and statistical classifiers. RESULTS: Ten input features were enough to train a multilayer perceptron with six hidden neurons. The discrimination rate of the neural net was 80% after cross-validation, significantly higher (P<0.05) than the performance of a Bayes quadratic classifier (about 75%). A great variance due to a small cross-validation set could be demonstrated. CONCLUSIONS: Strict statistical requirements must be observed for designing a neural network. Although these models attain a better performance than conventional statistical approaches, the benefits they bring are sometimes not sufficient to justify their use. Furthermore, clinicians routinely involved in critical decisions may not consider such diagnostic systems reliable enough.

Application of fuzzy logic techniques for the qualitative interpretation of preferences in a collective questionnaire for users of wheelchairs

Active participation of users in the evaluation of technical aids is essential, since they are part of the interface with the system and constitute a fundamental source of design criteria. In this study, 88 active users of wheelchairs were interviewed by means of a written questionnaire about their opinion concerning the adaptation of his/her wheelchair to the office workplace. A conceptual framework was introduced linking objective measurements of the user-wheelchair interface to the subjective preferences expressed by the user. Discriminant analysis was used in order to select and quantify the importance of the most significant factors influencing the user's opinions. Fuzzy logic was introduced for the qualitative interpretation of the relationship between those significant factors, based on an inductive algorithm for generating fuzzy rules. Fuzzy logic enables a person to model the uncertainty within the subjective formulation of knowledge or opinions. From the results, a mismatch between actual performance of conventional wheelchairs and requirements of office work became evident. The proposed methods make it possible to determine reliable rules explaining subjective preferences; thus, they provide a flexible means of interpreting user questionnaires and obtaining new design criteria.

Microbial degradation of poly-beta-hydroxyalkanoates

The search for new materials that are not hazardous to the environment has become a major issue in our society, engaged as it is in the attainment of sustainable development. Poly-beta-hydroxyalkanoates (PHA), produced exclusively by prokaryotes, can be used as thermoplastics and are fully biodegradable and innocuous to the environment. Biodegradability testing has quantified the capacity of microorganisms to degrade such new chemical compounds, particularly polyhydroxyalkanoates. Standardized tests may also discover new microorganisms and environmental conditions that accelerate biodegradation. We evaluate various techniques used to assess the biodegradability of PHA, and which may also be applied to test other kinds of polymers.

Abnormal chromatin clumping in leucocytes: a clue to a new subtype of myelodysplastic syndrome

We report 6 patients with myelodysplastic syndrome, all of whom showed a bizarre nuclear anomaly within the neutrophils that was characterized by extensive clumping of chromatin into large blocks separated by clear zones, generally associated with a lack of segmentation. Anaemia, thrombocytopenia, variable leucocyte counts with leucoerythroblastic picture, marrow hypercellularity with granulocytic hyperplasia and moderate dysplastic changes in erythroblastic and megakaryocytic lines were present at diagnosis. 2 patients had normal karyotypes and a 3 showed a deletion of chromosome 14. 5 out of 6 patients had pneumonia at diagnosis. The median survival was short (5 months) and haemorrhagic complications were the cause of death in 4 patients. The clinical features and the evolution of these and other reported cases suggest that the presence of abnormal chromatin clumping in leucocytes might be a clue to a new subtype of myelodysplastic syndrome.

[Erythroid colonies derived from BFU-E from the bone marrow in a patient with type I congenital dyserythropoietic anemia]

The findings of in vitro culture of bone-marrow BFU-E from a patient with type I dyserythropoietic anaemia are reported, scarce data being seemingly available in the literature. The number of BFU-E in the culture was increased four-fold with respect to the normal values. The morphologic study of the colonies showed in all cases varying number of erythroblasts with internuclear bridges (5-20%). Upon ultrastructural examination of the colonies, a great number of erythroblasts exhibited morphologic alterations, spongy chromatin and internuclear bridges being commonest. These findings suggest that an alteration of the progenitor erythroid cells exists in type I dyserythropoietic anaemia, whereas the morphological defects appreciated show great variation in the progeny of each BFU-E.

Circulating erythroid and megakaryocytic progenitors in polycythaemia vera and essential thrombocythaemia

We studied the behaviour in culture of erythroid and megakaryocyte progenitor cells (BFU-E, CFU-MK) obtained from peripheral blood (PB) in 38 patients: 15 with essential thrombocythaemia, 3 with reactive thrombocytosis, 16 with polycythaemia vera and 4 with secondary polyglobulia. Clonal erythroid growth without added erythropoietin was observed in all patients with polycythaemia vera and in 5 out of 15 with essential thrombocythaemia, but in none of the patients with reactive thrombocytosis or secondary polyglobulia or in controls. When the CFU-MK were cultured without phytohaemagglutinin-stimulated medium (PHA-LCM), all patients with essential thrombocythaemia and 7 out of 16 with polycythaemia vera showed circulating CFU-MK but none of those with reactive thrombocytosis or secondary polyglobulia or controls did so. This study indicates that the growth in vitro of megakaryocytic and erythroid progenitors from such a readily available source as peripheral blood can be valuable in the diagnosis of certain borderline cases of thrombocytosis or erythrocytosis.

[Pseudohemopathy caused by rhabdomyosarcoma]

A 26-year-old male with a primary rhabdomyosarcoma of maxillary sinus is reported. The tumor was initially mistaken for an anaplastic Ki-1 positive anaplastic lymphoma in the histological preparation, owing to its high indifferentiation degree. After a smear study it was categorized as IEA, and chemotherapy of CHOP type was started; after two courses, local telecobalt therapy was given. After this was completed, the disease showed a progression, involving the bone marrow and resulting in clinical and cytological features consistent with acute leukemia. At that time we saw the patient for the first time. He is presently in complete remission after having started polychemotherapy of CVADIC type. After a commentary on the major study steps that led to the diagnosis, the crucial role of electron microscopy and, particularly, immunocytology for the correct identification of anaplastic tumors is emphasized.

Acute nonlymphocytic leukemia (M7 subtype) with erythrocytic internalization

A case of acute nonlymphocytic leukemia of megakaryocytic lineage or M7 with a conspicuous phenomenon of erythrocytic internalization present in nearly 3% of the leukemic megakaryocytic precursors (LMP) is reported. The phagocytosis was detected at light microscopy and ultrastructural levels. The erythrocyte might have reached the interior of the LMP through cytoplasmic vacuoles that are connected with the extracellular space and that can be considered rudimentary equivalents of the demarcation membrane system (DMS). Erythrocytic internalization is not a specific feature of the mononuclear phagocytic system and can be misleading in the classification of undifferentiated blast cells.

Acquired refractory anaemia with excess of blasts of promegakaryoblastic type

A case of acquired refractory anaemia with excess of blasts (RAEB) of the promegakaryoblastic type is described. The promegakaryoblastic origin was demonstrated by means of ultrastructural cytochemistry (platelet peroxidase) and immunological methods. The blasts were also 5'-Nucleotidase positive. After a stable course over 2.5 years the patient died from hematological failure, his marrow demonstrating a high degree of fibrosis.

Platelet peroxidase of circulating thrombocytes in acquired refractory anaemias

The platelet peroxidase (PPO) content of circulating thrombocytes was determined in 10 healthy controls and in 18 cases of acquired refractory anaemia (2 with refractory anaemia, 4 with sideroblastic refractory anaemia, 8 with refractory anaemia with excess of blasts, 3 with refractory anaemia in transformation and 1 with chronic myelomonocytic leukaemia). The thrombocytes of the controls were invariably PPO-positive. No peroxidase deficiency was found in the 4 patients with sideroblastic refractory anaemia. Of the remaining 14 cases PPO-positive and PPO-negative thrombocytes coexisted in 8. Only in 1 case of refractory anaemia with excess of blasts were circulating platelet peroxidase-positive micromegakaryocytes demonstrated. PPO deficiency seems to be an important dysthrombopoietic feature detectable only at an ultrastructural level.

Acute myelomonocytic leukaemia with abnormal eosinophils and inversion of chromosome 16

We report a further case of a recently recognized variety of acute myelomonocytic leukaemia (M4 subtype) with bone marrow eosinophilia and inversion of chromosome 16. The eosinophils showed a distinctly abnormal morphology, cytochemical staining and ultrastructure.

Cytochemical detection of erythroblastic enzymes in acquired dyserythropoiesis

We have studied the amount and intracellular distribution of erythroblastic alkaline and acid phosphatase, nonspecific esterase, and N-acetyl-beta-glucosaminidase in 50 patients with acquired dyserythropoiesis. 19 morphologically normal bone marrow smears served as controls. Alkaline phosphatase was found in all controls (mean 9.4% of erythroblasts). The percentage of positive erythroblasts in pathological conditions varied greatly from absence to over 70%. Acid phosphatase and N-acetyl-beta-glucosaminidase were positive in pernicious anaemia and in acute erythremic myelosis. Nonspecific esterase was only detected in a case of erythremic myelosis. This case also showed a faint metachromasia with the dye azure A.