Global Registry of Acute Coronary Events (GRACE) risk score and redbloodcelldistributionwidth (RDW) content can both independently predict major adverse cardiac events (MACEs) in patients with acute coronary syndrome (ACS). We investigated the combined predictive value of RDW and GRACE risk score for cardiovascular events in patients with ACS undergo- ing percutaneous coronary intervention (PCI) for the first time. We enrolled 480 ACS patients. During a median follow-up time of 37.2 months, 70 (14.58%) patients experienced MACEs. Patients were divided into tertiles according to the baseline RDW content (11.30–12.90, 13.00–13.50, 13.60–16.40). GRACE score was positively correlated with RDW content. Multivariate Cox analysis showed that both GRACE score and RDW content were indepen- dent predictors of MACEs (hazard ratio 1.039; 95% confidence interval [CI] 1.024–1.055; p < 0.001; 1.699; 1.294–2.232; p < 0.001; respectively). Furthermore, Kaplan–Meier analysis demonstrated that the risk of MACEs increased with increasing RDW content (p < 0.001). For GRACE score alone, the area under the receiver operating characteristic (ROC) curve for MACEs was 0.749 (95% CI: 0.707–0.787). The area under the ROC curve for MACEs increased to 0.805 (0.766–0.839, p = 0.034) after adding RDW content. The incremental pre- dictive value of combining RDW content and GRACE risk score was significantly improved, also shown by the net reclassification improvement (NRI = 0.352, p < 0.001) and integrated discrimination improvement (IDI = 0.023, p = 0.002). Combining the predictive value of RDW and GRACE risk score yielded a more accurate predictive value for long-term cardiovascular events in ACS patients who underwent PCI as compared to each measure alone.
A backward model was used and only the final variables retained in the model are presented. In the admission RDW model, the following variables were tested: age, sex, atrial fibrillation (yes/no), LVEF, peripheral edema (yes/no), interstitial edema on chest X-ray (yes/no), pleural effusion on chest X-ray (yes/no), urea, creatinine, sodium, potassium, hemoglobin, hematocrit, albumin, total protein, iron, ferritin, transferrin saturation, and NT-pro BNP/100 (admission values were used unless stated otherwise). In the discharge RDW model, the following variables were tested: age, sex, atrial fibrillation (yes/no), LVEF, peripheral edema (yes/no), interstitial edema on chest X-ray (yes/no), pleural effusion on chest X-ray (yes/no), admission RDW, urea, creatinine, sodium, potassium, hemoglobin, hematocrit, albumin, total protein, iron, ferritin, transferrin saturation, and NT-pro BNP/100 (discharge values were used whenever available). In the DRDW model, the following variables were tested: age, sex, atrial fibrillation (yes/no), LVEF, peripheral edema (yes/no), interstitial edema on chest X-ray (yes/no), pleural effusion on chest X-ray (yes/no), admission and last RDW, urea, creatinine, sodium, potassium, hemoglobin, hematocrit, albumin, total protein, iron, ferritin, transferrin saturation, and NT-pro BNP/100 (adjusted delta values were used whenever available). Bold, significant value (P 0.05). D ¼ adjusted delta (discharge–admission/ admission). NT-pro BNP ¼ N-terminal pro brain natriuretic peptide, OR¼ odds ratio, RDW ¼ redbloodcelldistributionwidth.
RDW is known to be elevated in states of ineffective redcell production and increased redcell destruction, which are a common feature in a variety of infectious and inflammatory con- ditions [1, 10, 11]. An association between increasing RDW and elevated levels of acute phase reactants including erythrocyte sedimentation rate, high sensitivity C-reactive protein, and in- terleukin-6 has been demonstrated in adults, suggesting that RDW may be elevated in the set- ting of acute inflammatory states secondary to rapid redbloodcell destruction or blunted erythropoiesis [5, 7, 10, 11]. However, prior studies have revealed that increased RDW remains predictive of outcomes after controlling for known inflammatory markers, indicating that in- flammation alone cannot entirely explain the pathophysiologic processes leading to RDW ele- vation in critical illness [2, 5, 7]. In our study, patients with the highest RDW were more likely to present with infection, sepsis, and shock. Although this implies a causative role for inflam- mation to increase RDW, we lacked specific measures to determine the extent to which inflam- mation modified the association of RDW with LOS or mortality in our patients. A key point, however, is that RDW is most likely to be a marker of an underlying pathophysiological process (i.e., inflammation, impaired erythropoiesis, or bone marrow dysfunction) rather than itself being a cause of adverse clinical outcomes.
24. Li DZ, Chen QJ, Sun HP, Zeng R, Zeng Z, Gao XM, et al. Mean platelet volume to platelet count ratio predicts in-hospital complications and long-term mortality in type A acute aortic dissection. Blood Coagul Fibrinolysis. 2016;27(6):653-9. doi:10.1097/MBC.0000000000000449. 5. Hountis PG, Plestis KA. Strategies in the management of extensive
Background: Redcelldistributionwidth (RDW), a classical parameter used in the differential diagnosis of anemia, has recently been recognized as a marker of chronic inflammation and high levels of oxidative stress (OS). Fanconi anemia (FA) is a genetic disorder associated to redox imbalance and dysfunctional response to OS. Clinically, it is characterized by progressive bone marrow failure, which remains the primary cause of morbidity and mortality. Macrocytosis and increased fetal hemoglobin, two indicators of bone marrow stress erythropoiesis, are generally the first hematological manifestations to appear in FA. However, the significance of RDW and its possible relation to stress erythropoiesis have never been explored in FA. In the present study we analyzed routine complete blood counts from 34 FA patients and evaluated RDW, correlating with the hematological parameters most consistently associated with the FA phenotype.
Carotid plaque and carotid IMT are strongly related to risk of cerebral infarction.[20,21] One study of hypertensive patients proposed an association between RDW and presence of ca- rotid plaques and higher IMT–CCA, but did not adjust the results for smoking or MCV. Our results suggest that RDW levels are associated with IMT–CCA after extensive risk factor adjustments, but not with presence of plaque or IMT in the bifurcation. Arterial thickening may therefore constitute one link between RDW and stroke. Studies have suggested that IMT in the bifurcation and presence of plaque are predominantly associated with blood lipids, smoking, and ischemic heart disease, whereas IMT–CCA is more related to hypertension. [43,44] We could not find a strong relationship between blood pressure and RDW. However, prevalence of smoking was much higher in subjects with high RDW, which could increase IMT–CCA in this group.
In the second methodology adopted, we used the intensity proﬁles obtained from the Z-project to assess the CFL thickness. Figure 7a, b show the superposition of the projection image and the intensity proﬁle obtained for channels 12 and 11, respec- tively. As it is easily observed, the projection for the channel with larger flow rate (12) is very homogeneous suggesting a similar distribution of cells along the channel width. For channel 11, however, there is a lateral peak close to the outer wall corre- sponding to the CFL. Several thresholds of intensity were considered to determine the limit of the CFL. The ﬁnal CFL thickness would then correspond to the distance from the channel inner wall to the y-position where the intensity reaches the deﬁned threshold (expressed as % of variation of intensity between the maximum value and the average value within the centre of the bulk cell region). Table 2 shows the comparison between the CFL measured directly in the image using the visual inspection procedure (Fig. 7b, dashed line) and the CFL determined using the intensity proﬁle considering different values for the threshold (100, 90, 80, 70, 60 and 50%), where 100% corre- sponds to the Dx40 solution flowing without cells.
(Pompei et al., 2005). Redblood cells have been proposed as a prototypical cellular system regarding drug mediated plasma membrane effects (Li et al., 1999). Different techniques have demonstrated that therapeutic drugs can modify the structure and morphology of these cells (Nwafor and Coakley, 1986; Scheiman and Elta, 1990; Li et al., 1999; Shacter and Weitzman, 2002; Suwalsky et al., 2003; Hubner et al., 2005; Santos et al., 2005; Zhang et al., 2005). The morphometric analysis (area, shape and volume measurements) has been used to evaluate the alterations induced by natural products and synthetic drugs on membrane of redblood cells (Oliveira et al., 2002; Moreno et al., 2004).
In order to supply oxygen to the brain, RBCs must deform as they pass through the narrow pores of capillaries. However, RBC deformability reportedly decreases when Ab adheres to RBC . Thus, the interaction of Ab with RBC may decrease blood flow, impair oxygen delivery to the brain and contribute to brain hypoxia . These processes are implicated in the pathogenesis of AD. In support of these notions, a relationship between blood (plasma) Ab and AD was observed in Down syndrome patients, among whom those with elevated Ab levels in plasma were reported to have a greater risk of developing AD . Additional research (e.g., measurement of Ab levels in RBCs of AD patients) would be necessary to confirm these hypotheses.
Results from Goldsmith and his colleagues (see Goldsmith et al. 16 for review) regarding the flow behavior of RBCs in glass capillaries have provided the most insight into several microrheological phenomena occurring in highly concentrated RBC suspensions. However, their research employed transparent ghost cell suspensions to avoid light absorption by hemoglobin, which strongly influences the mechanical properties of RBC membranes. By removing hemoglobin, the membrane mechanical properties might have been altered appreciably, consequently changing the rheological behavior 17–20 . In addition, conventional microscopy illuminates the entire flow region, providing high background noise from out-of-focus emitted light and thereby degrading flow measurements 21,22 . Hence, more accurate measurements in concentrated RBC suspensions are required to gain further insight into complex microhemodynamic phenomena.
Despite the evidence accumulated, the immunomodulatory mechanism of the blood transfusion remains insufficiently elucidated [30,31]. The most acknowledge view is that allogenic leukocytes (and leukocyte-derived soluble mediators) present in the RBC preparations are the cell type responsible for the immunomodulatory effect of blood transfusion, namely immunosuppression [50,51]. However clinical trials of leukoreduction have shown conflicting results [52,53]. Thus, the likely possibility that RBC could mediate the TRIM effect could not be ruled out [54,55]. Indeed, experimental and clinical studies point to RBC as the cell type responsible for the immunosuppressive activity of blood transfusions in vivo . Recent studies by Baumgartner and colleagues suggest that the transfusion related immunosuppression could be in part mediated by RBC by inducing a population of regulatory T cells . Another study from the same group, points to RBC as capable to potentiate pro-inflammatory cytokine response from peripheral blood mononuclear cells, partially explaining the immune activation seen clinically after blood transfusion . Moreover, erythrocyte chemokine scavenging was shown to be involved in RBC transfusion-related lung inflammation . In other studies, arginine depletion by the RBC enzyme arginase has been suggested as a novel mechanism for transfusion associated immunosuppression [59,60]. Finally, a role for RBC storage conditions and the RBC aging to the side effects of blood transfusions has also been suggested [61,62]. Indeed, several authors have suggested that transfusion of RBC units that have been stored for longer periods of time may not be as beneficial as transfusion of RBC units stored for shorter periods of time in terms of immunomodulation and inflammatory complications, due to time-dependent cellular lesions in the blood components, namely in the RBC.
so highly correlated with hyperglycemia, since total hemoglobin glycosylation does not reflect only hyperglycemia (Adams et al., 2009; Chan et al., 2014), which is in agreement with our data. In addition, diabetogenic conditions, such as those presented here and those found in the literature (Koga et al., 2007; Miyashita et al., 2007; Wakabayashi, 2012) do not show the expected changes in hemoglobin glycosylation. Our data on the lack of significant changes elicited by diet on plasma protein glycosylation do not agree with the common occurrence of increased glycosylated proteins in plasma of humans and rodents alike under already settled metabolic syndrome or its associated pathologies (Gornik & Lauc, 2008). The probable differences lie in the fact that in our model of initial stages of metabolic syndrome, the pathologic markers have not been yet developed fully, as we have previously found (Ferrer-Lorente et al., 2005). It must be also taken into account that metabolic syndrome-induced modifications on plasma proteins (Marliss et al., 2006; Welle et al., 1992) and RBC (Cohen, Franco & Joiner, 2004; Manodori & Kuypers, 2002) increase their cell turnover rates which compounds the problem and makes more difficult the comparisons unless the data maintain their homology.
A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, rowsiness may be a symptom while dilated pupils may be a sign. Diabetic retinopathy typically has no symptoms during the early stages. Unfortunately, when symptoms become noticeable the condition is often at an advanced stage. Sometimes the only detectable symptom is a sudden and complete loss of vision. The only way patients with diabetes can protect themselves is attend every eye examination their doctor tells them to go to. Based on the research done by the Professors Tapp RJ, Shaw JE, Harper CA et al it is identified that patient can be prevented from the loss of vision if Diabetic Retinopathy is detected earlier. The blood vessel in the retina bulges called microneurysms causes the vessel width to vary (when the vessel bulges) compare to the other vessels or the other eye of the human. This symptom will be taken as earlier sign for the Diabetic Retinopathy and sometimes burst in the blood vessels causes tiny blood spots (hemorrhages) in the retina. Therefore the methods are proposed below to measure the blood vessel width more accurately to identify diabetic Retinopathy earlier.
This retrospective study evaluated 153 patients treated in the Hemocentro Regional de Uberaba (HRU)/Fundac¸ão Hemom- inas or Hospital de Clínicas da Universidade Federal do Triângulo Mineiro from 2006 to 2014, who had been trans- fused with at least three RBC bags on different occasions. Sixty-eight (44.44%) had onco-hematological diseases (acute leukemia, multiple myeloma, myelodysplastic syndrome), 64 (41.83%) had hemoglobinopathies (sickle cell anemia and tha- lassemia) and 21 (13.73%) had CRF.
Background. Trauma—a serious injury to the body caused by violence or an accident—is a major global health problem. Every year, injuries caused by traffic collisions, falls, blows, and other traumatic events kill more than 5 million people (9% of annual global deaths). Indeed, for people between the ages of 5 and 44 years, injuries are among the top three causes of death in many countries. Trauma sometimes kills people through physical damage to the brain and other internal organs, but hemorrhage (serious uncontrolled bleeding) is responsible for 30%–40% of trauma-related deaths. Consequently, early trauma care focuses on minimizing hemorrhage (for example, by using compression to stop bleeding) and on restoring blood circulation after blood loss (health-care professionals refer to this as resuscitation). Redbloodcell (RBC) transfusion is often used for the management of patients with trauma who are bleeding; other resuscitation products include isotonic saline and solutions of human blood proteins.
Remarks: This is the first redescription of this species from outside its type locality in Curaçao. (Netherlands Antilles, southern Caribbean). The species is nearly indistinguishable from Mycale (Aegogropila) escarlatei Hajdu et al.,1995 in the field, which has also been collected in the reefs of Maceió. Obvious crustose mycalids with neat ectosomal reticulations were relatively common in Maceió reefs. Of fourteen collected specimens, six turned out to be M. (N.) diversisigmata (also from Mirante da Sereia, ca. 09° 33’ 56’’ S - 035º 38’ 42’’ W; and Guaxuma, ca. 09º 35’ 26’’ S - 035º 39’ 55’’ W), seven were M. (A.) escarlatei (red), and one is an unidentified M. (Naviculina) (dull-yellow). M. (N.) diversisigmata, which had its distribution range expanded from the single locality record in Curaçao, at about 12º 16’ N - 069º 07’ W to 09º 40’ S. Toxas and sigmas IV were reported by Van Soest (1984) to be rare in the type material. They were not found in all specimens studied here, and the sigmas IV observed in MNRJ 4721 were rather smaller than those of the type material. This is suggestive that additional Caribbean material should be studied to better characterize variability in that area, thus permitting sounder assignment of Brazilian putative conspecific populations.
Melatonin is the hormone synthesized dur- ing the dark phase by the pineal gland and is responsible for the transduction of the envi- ronmental illumination of several physiologi- cal events that change diurnally in vertebrates (9), arthropods (10), higher plants (11), and dinoflagellates (12). The dependence of ma- laria infection on daylight is clear from the fact that changes in the host photoperiod also change the timing of the parasite cell cycle (13).
Preparation of RBC suspensions containing alcohols Whole blood was diluted 1:200 in a viscous medium containing alcohol at various concentrations for ektacytometry. Methanol, ethanol, propanol and butanol were added to a 6% solution of high-molecular weight polyvinylpyralidone (PVP, 360 kDa) prepared in isotonic-phosphate buffered saline (PBS, pH = 7.4) at concentrations presented in Table 1; these concentrations were selected based on preliminary studies. The viscosities of the PVP solutions were measured at 37°C following the addition of alcohols using a Wells-Brookfield cone-plate rotational viscometer. The viscosity of the PVP solution was 23.0 mPa·s without added alcohol but was slightly increased by the addition of ethanol, propanol and butanol, with the increase being a function of both alcohol molecular size and concentration; no change of viscosity was observed with methanol at any concentration (Table 1). Measured viscosity values were used to calculate the rotational speed (i.e., shear rate) of the ektacytometer that are needed to achieve a given SS.
Blood flow in microcirculation is crucial for the normal function of tissues and organs. Detailed study of blood cells flowing in microvessels and microchannels is essential to provide a better under- standing on the blood rheological properties and disorders in microcirculation [1–9]. One of the most reliable ways to measure velocity fields in microcirculation is using Eulerian methods, such as the conventional micro-Particle Image Velocimetry (PIV) [10–17] or the confocal micro-PIV [1, 5, 8, 9]. By using these Eulerian methods, the most common methodology to calculate the velocity fields is a statistical technique known as cross-correlation. For high concentration of particles, that is, the interrogation window contains at least three particles, the micro-PIV technique is the best suitable methodology to study blood flow phenomena in microcirculation. However, most of in vivo mea- surements contain physiological fluids with high concentrations of blood cells and as a result the amount of tracer particles captured within the fluid is often very low . If the number of particles or cells within the interrogation area is small (less than three), it is recommended to measure the displacements of each individual object by tracking them in a Lagrangian way . This kind of PIV mode (low-image-density PIV) is often referred to as particle tracking velocimetry (PTV) [5, 14, 15]. The main advantage of this method is the ability to obtain detailed quantitative information on the motion of particles and cells flowing within a working fluid with high hematocrits (Hcts) close to