Hemostasis in patients with severe von Willebrand disease improves after normal platelet transfusion and normalizes with further correction of the plasma defect

BACKGROUND: A defective hemostatic effect of plasma concentrate infusion in patients with severe von Willebrand disease (vWD) has been ascribed to the absence of platelet von Willebrand factor (vWF) STUDY DESIGN AND METHODS: The role of platelet vWF in hemostasis of severe vWD was investigated. A plateletpheresis unit (4-5 × 10(11) platelets) from a normal compatible donor was transfused before any cryoprecipitate infusion to three type 3 vWD patients and to one patient with severe type 1 vWD with low levels of platelet vWF who required replacement therapy for bleeding episodes. Autologous platelets were transfused to one of the patients with type 3 vWD. RESULTS: Partial corrections of bleeding times (14-17 min vs. baseline>30 min) were observed in all patients after the transfusion of normal platelets. During cryoprecipitate infusion, bleeding times were normalized (<6 min), and bleeding episodes stopped when plasma levels of vWF activity ranged from 14 to 18 U per dL. Platelet interactions with the subendothelium increased in parallel with the correction of bleeding times. These results indicate that if approximately 20 percent of the total number of platelets have normal vWF antigen and if plasma vWF levels are at least 14 U per dL, then bleeding times will normalize and mucosal hemorrhages will stop. Transfusion of autologous platelets in one patient with type 3 vWD did not modify bleeding times or platelet adhesion on the subendothelium. CONCLUSION: The hemostatic effect of normal platelets in type 3 vWD seems to be related to the platelet vWF in the transfused platelets.     

Gender Classification by Means of Online Uppercase Handwriting: A Text-Dependent Allographic Approach

This paper presents a gender-classification schema based on online handwriting. Using samples acquired with a digital tablet that captures the dynamics of the writing, it classifies the writer as a male or a female. The method proposed is allographic, regarding strokes as the structural units of handwriting. Strokes performed while the writing device is not exerting any pressure on the writing surface, pen-up (in-air) strokes, are also taken into account. The method is also text-dependent meaning that training and testing is done with exactly the same text. Text-dependency allows classification be performed with very small amounts of text. Experimentation, performed with samples from the BiosecurID database, yields results that fall in the range of the classification averages expected from human judges. With only four repetitions of a single uppercase word, the average rate of well-classified writers is 68 %; with sixteen words, the rate rises to an average of 72.6 %. Statistical analysis reveals that the aforementioned rates are highly significant. In order to explore the classification potential of the pen-up strokes, these are also considered. Although in this case, results are not conclusive, and an outstanding average of 74 % of well-classified writers is obtained when information from pen-up strokes is combined with information from pen-down ones.     

Bone mineral density and bone fracture in male patients receiving long-term suppressive levothyroxine treatment for differentiated thyroid carcinoma

Studies on the effect of exogenous subclinical thyrotoxicosis on bone mineral density (BMD) in male patients treated with suppressive doses of levothyroxine for differentiated thyroid carcinoma (DTC) are not conclusive. In order to evaluate BMD (in femoral neck, lumbar spine, and distal radius) and bone fractures in men under long-term suppressive treatment with levothyroxine for DTC, we conducted a cross-sectional, retrospective study in 33 Caucasian men (mean?±?SD age: 56?±?14?years) under treatment for DTC. The control group comprised 33 healthy age- and body mass index-matched male volunteers. BMD was assessed by dual-energy X-ray absorptiometry (DXA). Bone turnover biomarkers (calcium, phosphate, alkaline phosphatase, PTH, vitamin D, urinary calcium, and N-Telopeptide/creatinine index) and testosterone were determined. Previous bone fractures were evaluated with a questionnaire and X-ray images of thoracic and lumbar vertebrae. Patients were treated for a mean duration of 15?±?5?years. No differences were found between patients and controls in bone turnover biomarkers or areal BMD, T-scores or Z-scores in all sites evaluated. No earlier fractures or pain episodes were registered in either group and the incidence of asymptomatic vertebral fractures did not differ significantly between patient (18.8%) and control groups (16.7%), (P?=?0.9). In conclusion, long-term suppressive treatment with levothyroxine in men with DTC does not appear to exert deleterious effects on bone mineral density or increase the prevalence of fracture.     

The BC genotype of the VNTR polymorphism of platelet glycoprotein Ibalpha is overrepresented in patients with recurrent stroke regardless of aspirin therapy

BACKGROUND: The contribution of genetic factors to aspirin treatment failure (ATF) for secondary prevention is not settled in patients with ischemic stroke. METHODS: We assessed the polymorphisms VNTR (A, B, C, D) of glycoprotein (GP) Ibalpha, 807C/T of GP Ia/IIa, and Pl(A1/A2) of GP IIb/IIIa, and the 5-year incidence of major recurrent events in 82 stroke patients with no major sources of cardioembolism (mean age 70, SD 9.0 years; female gender 23%). Using a structured interview, all participants confirmed good compliance with aspirin (100-300 mg/day) for secondary prevention. Demographics and atherothrombotic risk factors assessed included diabetes, hypertension, dyslipemia, smoking, and coronary heart disease. RESULTS: Thirty-one stroke patients had one recurrent stroke or myocardial infarction within 33 (7-48) months of aspirin onset, while 51 patients demonstrated an uneventful clinical course. Female gender (p < 0.05), diabetes (p < 0.05), dyslipemia (p < 0.05), and the BC genotype of VNTR (25.8 vs. 7.8%, p < 0.05) were more prevalent in patients in whom aspirin failed to prevent clinical events than in those in whom it did not. The BC genotype of VNTR was the only factor that remained associated with ATF in an age-, sex-, and risk factor-adjusted logistic regression analysis (OR 9.6, 95% CI 1.5-61.0). CONCLUSION: The BC genotype of the VNTR polymorphism of GP Ibalpha is an independent predictor of recurrent events in stroke patients treated with aspirin. This finding suggests that high shear-induced platelet activation mediated by GP Ibalpha and von Willebrand factor is an important contributor to ATF in the stroke population.     

Improving the role of nursing in the treatment of depression in primary care in Spain

PURPOSE. We describe a multicomponent program for the systematic evaluation and treatment of depression in primary care. CONCLUSION. Primary‐care nurses trained in clinical and therapeutic aspects of depression play a central role in care management, patient education, treatment adherence, and clinical monitoring. PRACTICE IMPLICATIONS. Diverse interventions, including organizational changes and the enhancement of the role of nurses, have been effective in improving depression outcomes in primary‐care settings.