Univariate analysis of continuous variables among cirrhotics waiting for LT, with and without visceral aneurysms.

<p>Univariate analysis of continuous variables among cirrhotics waiting for LT, with and without visceral aneurysms.</p

Univariate analysis of categorical variables among cirrhotics waiting for LT with and without visceral aneurysms.

<p>Univariate analysis of categorical variables among cirrhotics waiting for LT with and without visceral aneurysms.</p

Univariate analysis of continuous variables (just before LT) of transplanted patients, according to the presence of post-LT visceral aneurysms.

<p>Univariate analysis of continuous variables (just before LT) of transplanted patients, according to the presence of post-LT visceral aneurysms.</p

Risk of pre-LT aneurisms among cirrhotics waiting fort LT transplant.

<p>Results of a multivariate logistic regression.</p

Image_1_Use of Laser Assisted Optical Rotational Cell Analyzer (LoRRca MaxSis) in the Diagnosis of RBC Membrane Disorders, Enzyme Defects, and Congenital Dyserythropoietic Anemias: A Monocentric Study on 202 Patients.TIF

<p>Chronic hemolytic anemias are a group of heterogeneous diseases mainly due to abnormalities of red cell (RBC) membrane and metabolism. The more common RBC membrane disorders, classified on the basis of blood smear morphology, are hereditary spherocytosis (HS), elliptocytosis, and hereditary stomatocytoses (HSt). Among RBC enzymopathies, the most frequent is pyruvate kinase (PK) deficiency, followed by glucose-6-phosphate isomerase, pyrimidine 5′ nucleotidase P5′N, and other rare enzymes defects. Because of the rarity and heterogeneity of these diseases, diagnosis may be often challenging despite the availability of a variety of laboratory tests. The ektacytometer laser-assisted optical rotational cell analyser (LoRRca MaxSis), able to assess the RBC deformability in osmotic gradient conditions (Osmoscan analysis), is a useful diagnostic tool for RBC membrane disorders and in particular for the identification of hereditary stomatocytosis. Few data are so far available in other hemolytic anemias. We evaluated the diagnostic power of LoRRca MaxSis in a large series of 140 patients affected by RBC membrane disorders, 37 by enzymopathies, and 16 by congenital diserythropoietic anemia type II. Moreover, nine patients with paroxysmal nocturnal hemoglobinuria (PNH) were also investigated. All the hereditary spherocytoses, regardless the biochemical defect, showed altered Osmoscan curves, with a decreased Elongation Index (EI) max and right shifted Omin; hereditary elliptocytosis (HE) displayed a trapezoidal curve and decreased EImax. Dehydrated hereditary stomatocytosis (DHSt) caused by PIEZO1 mutations was characterized by left-shifted curve, whereas KCNN4 mutations were associated with a normal curve. Congenital diserythropoietic anemia type II and RBC enzymopathies had Osmoscan curve within the normal range except for glucosephosphate isomerase (GPI) deficient cases who displayed an enlarged curve associated with significantly increased Ohyper, offering a new diagnostic tool for this rare enzyme defect. The Osmoscan analysis performed by LoRRca MaxSis represents a useful and feasible first step screening test for specialized centers involved in the diagnosis of hemolytic anemias. However, the results should be interpreted by caution because different factors (i.e., splenectomy or coexistent diseases) may interfere with the analysis; additional tests or molecular investigations are therefore needed to confirm the diagnosis.</p

Assessment of Fibrinolysis in Sepsis Patients with Urokinase Modified Thromboelastography

<div><p>Introduction</p><p>Impairment of fibrinolysis during sepsis is associated with worse outcome. Early identification of this condition could be of interest. The aim of this study was to evaluate whether a modified point-of-care viscoelastic hemostatic assay can detect sepsis-induced impairment of fibrinolysis and to correlate impaired fibrinolysis with morbidity and mortality.</p><p>Methods</p><p>This single center observational prospective pilot study was performed in an adult Intensive Care Unit (ICU) of a tertiary academic hospital. Forty consecutive patients admitted to the ICU with severe sepsis or septic shock were included. Forty healthy individuals served as controls. We modified conventional kaolin activated thromboelastography (TEG) adding urokinase to improve assessment of fibrinolysis in real time (UK-TEG). TEG, UK-TEG, plasminogen activator inhibitor (PAI)-1, thrombin-activatable fibrinolysis inhibitor (TAFI), d-dimer, DIC scores and morbidity (rated with the SOFA score) were measured upon ICU admission. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) of mortality at ICU discharge.</p><p>Results</p><p>UK-TEG revealed a greater impairment of fibrinolysis in sepsis patients compared to healthy individuals confirmed by PAI-1. TAFI was not different between sepsis patients and healthy individuals. 18/40 sepsis patients had fibrinolysis impaired according to UK-TEG and showed higher SOFA score (8 (6–13) vs 5 (4–7), p = 0.03), higher mortality (39% vs 5%, p = 0.01) and greater markers of cellular damage (lactate levels, LDH and bilirubin). Mortality at ICU discharge was predicted by the degree of fibrinolysis impairment measured by UK-TEG Ly30 (%) parameter (OR 0.95, 95% CI 0.93–0.98, p = 0.003).</p><p>Conclusions</p><p>Sepsis-induced impairment of fibrinolysis detected at UK-TEG was associated with increased markers of cellular damage, morbidity and mortality.</p></div

Additional file 2: of Characterizing human lung tissue microbiota and its relationship to epidemiological and clinical features

Supplementary Figures S1 through S5. (PDF 630 kb

Distribution of MA and Ly30 measured by TEG and UK-TEG in healthy individuals and sepsis patients.

<p>Column scatter-plot for TEG_MA (Panel A), UK-TEG_MA (Panel B), TEG_Ly30 (Panel C) and UK-TEG_Ly30 (Panel D) in healthy individuals (circles) and sepsis patients (squares). Filled squares represent sepsis patients with SOFA score ≤ 10 (lower severity of disease), clear squares represent sepsis patients with SOFA score > 10 (higher severity of disease). Horizontal lines represent median (25^th- 75^th). * p<0.05, *** p<0.001, p value from Mann-Whitney test. TEG_MA, MA measured by TEG, UK-TEG_MA, MA measured by UK-TEG, TEG_Ly30, Ly30 measured by TEG, UK-TEG_Ly30, Ly30 measured by UK-TEG.</p

Clinical characteristics of 494 adult recipients who underwent primary liver transplantation, 1983–2009.

<p>Clinical characteristics of 494 adult recipients who underwent primary liver transplantation, 1983–2009.</p

Observed (Obs) and expected (Exp) cases of de-novo tumors, Standardized Incidence Ratios (SIR), and 95% Confidence Intervals (95% CI) among 494 adult recipients who underwent primary liver transplantation, 1983–2009, by gender. Reference: pool of Italian cancer registries.

<p>Observed (Obs) and expected (Exp) cases of de-novo tumors, Standardized Incidence Ratios (SIR), and 95% Confidence Intervals (95% CI) among 494 adult recipients who underwent primary liver transplantation, 1983–2009, by gender. Reference: pool of Italian cancer registries.</p