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https://www.readbyqxmd.com/read/29332223/long-term-efficacy-of-partial-splenic-embolization-for-the-treatment-of-steroid-resistant-chronic-immune-thrombocytopenia
#1
Emi Togasaki, Naomi Shimizu, Yuhei Nagao, Chika Kawajiri-Manako, Ryoh Shimizu, Nagisa Oshima-Hasegawa, Tomoya Muto, Shokichi Tsukamoto, Shio Mitsukawa, Yusuke Takeda, Naoya Mimura, Chikako Ohwada, Masahiro Takeuchi, Emiko Sakaida, Tohru Iseki, Hideyuki Yoshitomi, Masayuki Ohtsuka, Masaru Miyazaki, Chiaki Nakaseko
Thrombopoietin-receptor agonists have been recently introduced for a second-line treatment of immune thrombocytopenia (ITP). Splenectomy has tended to be avoided because of its complications, but the response rate of splenectomy is 60-80% and it has still been considered for steroid-refractory ITP. We performed partial splenic embolization (PSE) as an alternative to splenectomy. Between 1988 and 2013, 91 patients with steroid-resistant ITP underwent PSE at our hospital, and we retrospectively analyzed the efficacy and long-term outcomes of PSE...
January 13, 2018: Annals of Hematology
https://www.readbyqxmd.com/read/29317351/a-new-physiological-model-for-studying-the-effect-of-chest-compression-and-ventilation-during-cardiopulmonary-resuscitation-the-thiel-cadaver
#2
Emmanuel Charbonney, Stéphane Delisle, Dominique Savary, Gilles Bronchti, Marceau Rigollot, Adrien Drouet, Bilal Badat, Paul Ouellet, Patrice Gosselin, Alain Mercat, Laurent Brochard, Jean-Christophe M Richard
BACKGROUND: Studying ventilation and intrathoracic pressure (ITP) induced by chest compressions (CC) during Cardio Pulmonary Resuscitation is challenging and important aspects such as airway closure have been mostly ignored. We hypothesized that Thiel Embalmed Cadavers could constitute an appropriate model. METHODS: We assessed respiratory mechanics and ITP during CC in 11 cadavers, and we compared it to measurements obtained in 9 out-of-hospital cardiac arrest patients and to predicted values from a bench model...
January 6, 2018: Resuscitation
https://www.readbyqxmd.com/read/29288170/atorvastatin-enhances-bone-marrow-endothelial-cell-function-in-corticosteroid-resistant-immune-thrombocytopenia-patients
#3
Yuan Kong, Xie-Na Cao, Xiao-Hui Zhang, Min-Min Shi, Yue-Yun Lai, Yu Wang, Lan-Ping Xu, Ying-Jun Chang, Xiao-Jun Huang
The pathogenesis of corticosteroid-resistant immune thrombocytopenia (ITP), a clinically challenging condition in which patients exhibit either no response to corticosteroids or are corticosteroid-dependent, remains poorly understood. Murine studies suggest that bone marrow (BM) endothelial progenitor cells (EPCs) play a crucial role in regulating megakaryocytopoiesis. However, little is known regarding the number and function of BM EPCs or how to improve impaired BM EPCs in corticosteroid-resistant ITP patients...
December 29, 2017: Blood
https://www.readbyqxmd.com/read/29203584/fc-independent-immune-thrombocytopenia-via-mechanomolecular-signaling-in-platelets
#4
M Edward Quach, Matthew A Dragovich, Wenchun Chen, Anum K Syed, Wenpeng Cao, Xin Liang, Wei Deng, Simon F De Meyer, Guangheng Zhu, Jun Peng, Heyu Ni, Carolyn M Bennett, Ming Hou, Jerry Ware, Hans Deckmyn, X Frank Zhang, Renhao Li
Immune thrombocytopenia (ITP) is a prevalent autoimmune disease characterized by autoantibody-induced platelet clearance. Some ITP patients are refractory to standard immunosuppressive treatments such as intravenous immunoglobulin (IVIG). These patients often have autoantibodies targeting the ligand-binding domain (LBD) of glycoprotein (GP)Ibα, a major subunit of the platelet mechanoreceptor complex GPIb-IX. However, the molecular mechanism of this Fc-independent platelet clearance is not clear. Here, we report that many anti-LBD monoclonal antibodies such as 6B4, but not AK2, activated GPIb-IX in a shear-dependent manner and induced IVIG-resistant platelet clearance in mice...
December 4, 2017: Blood
https://www.readbyqxmd.com/read/29188168/igg4-related-pancreatitis-and-immune-thrombocytopenia-a-case-report-and-literature-review
#5
Claire Sakiyama, Stephen Sullivan
A patient with a prior diagnosis of IgG4-related autoimmune pancreatitis (AIP) presented four years later with severe prednisone resistant immune thrombocytopenia (ITP). Her case is reported and the scant literature of the very unusual possible association of IgG4-related AIP and ITP is reviewed. It is suggested that investigation for IgG4-related disease be part of the work-up of ITP.
September 28, 2017: Curēus
https://www.readbyqxmd.com/read/29044634/rituximab-for-the-treatment-of-type-b-insulin-resistance-syndrome-a-case-report-and-review-of-the-literature
#6
Ken Iseri, Masayuki Iyoda, Yasuto Shikida, Takako Inokuchi, Tomoki Morikawa, Noriko Hara, Tsutomu Hirano, Takanori Shibata
BACKGROUND: Type B insulin resistance syndrome is a rare disease characterized by refractory transient hyperglycaemia and severe insulin resistance associated with circulating anti-insulin receptor antibodies. A standardized treatment regimen for type B insulin resistance syndrome has yet to be established. CASE REPORT: We report the case of a 64-year-old man undergoing haemodialysis for antineutrophil cytoplasmic antibody-associated vasculitis and diabetic nephropathy, who developed rapid onset of hyperglycaemia (glycated albumin 52...
October 16, 2017: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/28820609/cardio-pulmonary-interactions-physiologic-basis-and-clinical-applications
#7
Michael R Pinsky
The hemodynamic effects of ventilation can be grouped into three concepts: 1) spontaneous ventilation is exercise; 2) changes in lung volume alter autonomic tone, pulmonary vascular resistance, and can compress the heart in the cardiac fossa; 3) spontaneous inspiratory efforts decrease intrathoracic pressure (ITP) increasing venous return and impeding left ventricular (LV) ejection; whereas positive pressure ventilation decreases venous return and unloads LV ejection. Spontaneous inspiratory efforts may induce acute LV failure and cardiogenic pulmonary edema...
August 18, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28596654/is-there-a-relationship-between-cxcr4-gene-expression-and-prognosis-of-immune-thrombocytopenia-in-children
#8
Sajedeh Saeidi, Javad Mohammadi-Asl, Mohammad Ali Jalali Far, Ali Amin Asnafi, Firouzeh Dehuri, Yousef Tavakolifar, Najmaldin Saki
Immune thrombocytopenia (ITP) is a common autoimmune disorder characterized by decreased platelet count (thrombocytopenia) and bleeding symptoms due to production of autoantibodies against platelets. Chemokines are molecules inducing chemotaxis and play an important role in megakaryopoiesis, including CXCR4 chemokine receptor. CXCR4 is expressed on cells of megakaryocytic series, especially platelets, and triggers several mechanisms in these cells. The purpose of this study was to evaluate the pattern of CXCR4 gene changes upon diagnosis and after treatment and its comparison with laboratory findings in peripheral blood samples from newly diagnosed ITP patients...
June 2017: Indian Journal of Hematology & Blood Transfusion
https://www.readbyqxmd.com/read/28566594/the-effective-treatment-with-cyclosporine-of-a-ulcerative-colitis-patient-with-concurrent-idiopathic-thrombocytopenic-purpura-who-subsequently-developed-spontaneous-pneumomediastinum
#9
Tsutomu Iwasa, Kazuhiko Nakamura, Eikichi Ihara, Akira Aso, Tetsuhide Ito
Although extraintestinal manifestations of inflammatory bowel diseases are not uncommon, few reports have described concurrent idiopathic thrombocytopenic purpura (ITP). Spontaneous pneumomediastinum is also a rare complication of ulcerative colitis (UC). This report describes the case of a 14-year-old boy who experienced recurrent ulcerative colitis 3 months after temporary improvement following treatment with prednisolone (20 mg/day) and granulocyte/monocyte adsorption apheresis. His platelet counts decreased, suggesting ITP...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28142109/cytokine-changes-in-response-to-tpo-receptor-agonist-treatment-in-primary-immune-thrombocytopenia
#10
Ming-Ming Qu, Xue-Na Liu, Xin-Guang Liu, Qi Feng, Yang Liu, Xu Zhang, Shuang Liu, Lei Zhang, Guo-Sheng Li, Yuan-Yuan Zhu, Ming-Yun Lv, Jun Peng, Ming Hou
Thrombopoietin receptor agonists (TPO-RAs) have been clinically used in primary immune thrombocytopenia (ITP) with favorable outcomes, while their effect on cytokine regulation in ITP remains unknown. In the present study, plasma and mRNA expression levels of interleukin (IL)-2, interferon gamma (IFN-γ), IL-4, IL-17A, and transforming growth factor-β1 (TGF-β1) were determined by ELISA and real-time quantitative PCR in 26 corticosteroid-resistant/relapsed ITP patients receiving eltrombopag or rhTPO therapy and 15 healthy controls (HCs)...
April 2017: Cytokine
https://www.readbyqxmd.com/read/28071659/acg-clinical-guideline-treatment-of-helicobacter-pylori-infection
#11
William D Chey, Grigorios I Leontiadis, Colin W Howden, Steven F Moss
Helicobacter pylori (H. pylori) infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. H. pylori may also have a role in uninvestigated and functional dyspepsia, ulcer risk in patients taking low-dose aspirin or starting therapy with a non-steroidal anti-inflammatory medication, unexplained iron deficiency anemia, and idiopathic thrombocytopenic purpura. While choosing a treatment regimen for H. pylori, patients should be asked about previous antibiotic exposure and this information should be incorporated into the decision-making process...
February 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/27876239/case-reports-of-idiopathic-thrombocytopenia-unresponsive-to-first-line-therapies-treated-with-traditional-herbal-medicines-based-on-syndrome-differentiation
#12
Juno Yang, Beom-Joon Lee, Jun-Hwan Lee
The objective of our study is to present two cases showing the effects of traditional Korean herbal medicines based on traditional Korean medicine (TKM) for the treatment of immune thrombocytopenic purpura (ITP). One patient showed no response to treatment with steroids and an immunosuppressive agent. Moreover, liver toxicity and side effects of steroids were evident. However, after he ceased conventional treatment and started to take an herbal medicine, his liver function normalized and the steroid side effects resolved...
January 2017: Explore: the Journal of Science and Healing
https://www.readbyqxmd.com/read/27766635/procoagulant-profile-in-patients-with-immune-thrombocytopenia
#13
María T Álvarez-Román, Ihosvany Fernández-Bello, Víctor Jiménez-Yuste, Mónica Martín-Salces, Elena G Arias-Salgado, María I Rivas Pollmar, Raúl Justo Sanz, Nora V Butta
Despite their low platelet count some immune thrombocytopenia (ITP) patients seldom bleed, indicating the presence of factors to compensate thrombocytopenia. Moreover, ITP patients may have an increased risk for thrombosis. These facts suggest the presence of procoagulant mechanisms that have not been clarified yet. The aim of this study was to identify these possible factors. Moreover, the utility of rotational thromboelastometry (ROTEM(®) ) to test haemostasis in these patients was also evaluated. Patients with ITP presented a procoagulant profile due to an increased amount of platelet- and red cell-microparticles, an increased resistance to protein C and the formation of a clot more resistant to fibrinolysis due to augmented levels of plasminogen activator inhibitor-1, which might reflect an endothelial damage/activation in ITP patients...
December 2016: British Journal of Haematology
https://www.readbyqxmd.com/read/27377010/worsening-hypoxemia-in-the-face-of-increasing-peep-a-case-of-large-pulmonary-embolism-in-the-setting-of-intracardiac-shunt
#14
Glen T Granati, Getu Teressa
BACKGROUND Patent foramen ovale (PFO) are common, normally resulting in a left-to-right shunt or no net shunting. Pulmonary embolism (PE) can cause sustained increased pulmonary vascular resistance (PVR) and right atrial pressure. Increasing positive end-expiratory pressure (PEEP) improves oxygenation at the expense of increasing intrathoracic pressures (ITP). Airway pressure release ventilation (APRV) decreases shunt fraction, improves ventilation/perfusion (V/Q) matching, increases cardiac output, and decreases right atrial pressure by facilitating low airway pressure...
July 5, 2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27313917/nocardia-transvalensis-disseminated-infection-in-an-immunocompromised-patient-with-idiopathic-thrombocytopenic-purpura
#15
Jorge García-Méndez, Erika M Carrillo-Casas, Andrea Rangel-Cordero, Margarita Leyva-Leyva, Juan Xicohtencatl-Cortes, Roberto Arenas, Rigoberto Hernández-Castro
Nocardia transvalensis complex includes a wide range of microorganisms with specific antimicrobial resistance patterns. N. transvalensis is an unusual Nocardia species. However, it must be differentiated due to its natural resistance to aminoglycosides while other Nocardia species are susceptible. The present report describes a Nocardia species involved in an uncommon clinical case of a patient with idiopathic thrombocytopenic purpura and pulmonary nocardiosis. Microbiological and molecular techniques based on the sequencing of the 16S rRNA gene allowed diagnosis of Nocardia transvalensis sensu stricto...
2016: Case Reports in Infectious Diseases
https://www.readbyqxmd.com/read/27281793/thrombopoietin-receptor-agonists-shift-the-balance-of-fc%C3%AE-receptors-toward-inhibitory-receptor-iib-on-monocytes-in-itp
#16
Xin-Guang Liu, Shuang Liu, Qi Feng, Xue-Na Liu, Guo-Sheng Li, Zi Sheng, Peng Chen, Yang Liu, Yu Wei, Xiao-Yuan Dong, Ping Qin, Chengjiang Gao, Chunhong Ma, Lei Zhang, Ming Hou, Jun Peng
Elevated expression of the activating Fcγ receptor (FcγR) I and FcγRIIa together with decreased expression of the inhibitory FcγRIIb are involved in the pathogenesis of primary immune thrombocytopenia (ITP). Thrombopoietin receptor agonists (TPO-RAs) have been used clinically for the management of ITP; however, little is known about the effect of TPO-RAs on FcγR modulation in ITP. In this prospective study, we measured the alteration in monocyte FcγR expression from 21 corticosteroid-resistant/relapsed patients with chronic ITP receiving eltrombopag therapy...
August 11, 2016: Blood
https://www.readbyqxmd.com/read/27258931/effects-of-the-multidrug-resistance-1-gene-on-drug-resistance-in-primary-immune-thrombocytopenia
#17
Wenjie Liu, Huiyuan Li, Donglei Zhang, Mingen Lv, Yang Li, Yating Hao, Yunfei Chen, Xiaofan Liu, Feng Xue, Lei Zhang, Renchi Yang
Primary immune thrombocytopenia (ITP) is an autoimmune disorder that is characterized by low platelet count. Glucocorticoids (GCs) resistance is a great challenge in the treatment of ITP. P-glycoprotein (P-gp) is a widely studied protein, which is associated with drug resistance. However, in ITP, the functional activity and immune regulation mechanism of P-gp remain uncertain. In this study, we evaluated the expression and functional activity of P-gp in different lymphocyte subsets, explored the correlation between P-gp function and GCs resistance and investigated the role of P-gp in ITP pathogenesis...
November 2016: Autoimmunity
https://www.readbyqxmd.com/read/27158433/life-threatening-autoimmune-hemolytic-anemia-and-idhiopatic-thrombocytopenic-purpura-successful-selective-splenic-artery-embolization
#18
Matteo Molica, Fulvio Massaro, Giorgia Annechini, Erminia Baldacci, Gianna Maria D'Elia, Riccardo Rosati, Silvia Maria Trisolini, Paola Volpicelli, Robin Foà, Saveria Capria
Selective splenic artery embolization (SSAE) is a nonsurgical intervention characterized by the transcatheter occlusion of the splenic artery and/or its branch vessels using metallic coils or other embolic devices. It has been applied for the management of splenic trauma, hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia and splenic hemangioma. We hereby describe a case of a patient affected by idiopathic thrombocytopenic purpura (ITP) and warm auto-immune hemolytic anemia (AIHA) both resistant to immunosuppressive and biological therapies, not eligible for a surgical intervention because of her critical conditions...
2016: Mediterranean Journal of Hematology and Infectious Diseases
https://www.readbyqxmd.com/read/27077774/relationship-between-expression-of-glucocorticoid-receptor-isoforms-and-glucocorticoid-resistance-in-immune-thrombocytopenia
#19
Yan Liang, Meng Meng Song, Shi Yan Liu, Liang Liang Ma
BACKGROUND: Glucocorticoids (GCs) play an important role in the treatment of several hematological malignancies, such as immune thrombocytopenia (ITP). The glucocorticoid receptor (GR) mediates the effects of GCs. Five isoforms of GR mRNA were described: GRα, GRβ, GRγ, GRP, and GRA. GR levels are regulated by alternative splicing of GR mRNA. Several studies demonstrated that a lower GR expression was associated with poor GC response. PURPOSE: This study investigated the expression of GR isoforms and the relationship between GC resistance in ITP...
August 2016: Hematology (Amsterdam, Netherlands)
https://www.readbyqxmd.com/read/26740892/seasonal-association-of-immune-thrombocytopenia-in-adults
#20
Anıl Tombak, Burcu Boztepe, Naci Tiftik, Melda Cömert, Ozan Salim, Kaniye Aydın, Emel Gürkan, Orhan Kemal Yücel, Güray Saydam, Mehmet Ali Sungur
BACKGROUND: Immune thrombocytopenia (ITP) is an autoimmune disorder. It is characterized by thrombocytopenia due to thrombocyte destruction mediated by autoantibodies; however, cytotoxic and defective regulatory T-lymphocytes play an important role in its pathogenesis. While childhood ITP is usually acute, self-limiting and generally seasonal in nature, ITP in adults is usually chronic; its relation with seasons has not been studied. AIMS: We investigated whether months and/or seasons have triggering roles in adults with ITP...
October 2015: Balkan Medical Journal
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