37 research outputs found
The role of tissue factor in coagulation imbalance in patients with liver cirrhosis
No full textIntroduction: Cirrhosis is characterized by significant perturbations of the coagulation mechanism. Tissue factor (TF) is the main activator molecule of the coagulation cascade. The main mode of TF activation is through its expression by microvesicles, establishing them as an important research focus in multiple prothrombotic syndromes. Therefore, their study may provide valuable insights into the hypercoagulability of cirrhosis and possible mechanisms by which it contributes to disease progression. Our study aimed to assess TF levels and activity of TF-expressing microvesicles in the plasma of cirrhotic patients and correlate them with disease severity. Materials & Methods: We prospectively enrolled 82 patients [11 with cirrhosis and hepatocellular cancer (group 1), 50 with cirrhosis (group 2) and 21 controls (group 3)]. Extensive workup for disease staging and exclusion criteria was undertaken. Exclusion criteria included thrombophilia, any history of thrombosis, recent hospitalisation, ongoing infection or excessive alcohol intake, cancer, haematological diseases and use of anticoagulant, antiplatelet or contraceptive drugs. Plasma tissue factor antigen concentration (TFag) and tissue factor-expressing plasma microvesicles (MV-TF) activity were assessed. Results: TFag median values were 71.2 [56.8-81.9], 59.7 [47.1-66.6] and 43.9 [29.4-47.9] pg/ml in the cirrhosis with HCC (group 1), cirrhosis without HCC (group 2) and control (group 3) groups, respectively. There was a statistically significant difference between groups 1 and 3 (p<0.001) and groups 2 and 3 (p<0.001), while group 1 had higher values than group 2 without statistical significance (p=0.133). MV-TF showed median values of 4.03 [3.35-4.92], 3.22 [2.44-4.09] and 2.17 [1.49-3.05] pg/ml in groups 1, 2 and 3 respectively. There was a statistically significant difference between groups 1 and 3 (p<0.001) and groups 2 and 3 (p=0.003), while group 1 had higher values than group 2 without statistical significance (p=0.088). In Group 2, the patients’ Child-Pugh (CP) stage was A in 56%, B in 26% and C in 18% of cases, while 50% of the patients had decompensated cirrhosis (DeCi). MV-TF activity significantly correlated with decompensated cirrhosis (p=0.005) and higher CP stage (p=0.011). Finally, MV-TF activity significantly correlated with 12-month mortality (p=0.021).Conclusions: MV-TF activity is elevated in patients with cirrhosis, showing a significant correlation with disease severity. The fact that all patients had stable disease indicates that these dynamics are intrinsic to cirrhosis and independent of acute complications. MV-TF may play an essential role in the procoagulant imbalance of liver cirrhosis and their contribution in disease progression should be studied further.Εισαγωγή: Η κίρρωση του ήπατος χαρακτηρίζεται από σημαντικές διαταραχές του μηχανισμού πήξης. Ο ιστικός παράγοντας (TF) είναι το κύριο μόριο ενεργοποιητής του καταρράκτη της πήξης. Ο κύριος τρόπος ενεργοποίησης του TF είναι μέσω της έκφρασής του από μικροκυστίδια, καθιστώντας τα ως σημαντικό αντικείμενο έρευνας σε πολλές θρομβωτικές παθήσεις. Ως εκ τούτου, η μελέτη τους μπορεί να προσφέρει πολύτιμες γνώσεις σχετικά με την υπερπηκτικότητα που παρατηρείται στην κίρρωση και τους πιθανούς μηχανισμούς με τους οποίους ενδέχεται να συμβάλλει στην εξέλιξη της νόσου. Η μελέτη μας είχε ως στόχο να αξιολογήσει τα επίπεδα TF και τη δραστηριότητα των μικροκυστιδίων που εκφράζουν TF στο πλάσμα των ασθενών με κίρρωση του ήπατος και την πιθανή συσχέτιση τους με τη βαρύτητα της νόσου. Υλικά & Μέθοδοι: Στη μελέτη εντάχθηκαν προοπτικά 82 ασθενείς [11 με κίρρωση και ηπατοκυτταρικό καρκίνο (ομάδα 1), 50 με κίρρωση (ομάδα 2) και 21 μάρτυρες (ομάδα 3)]. Τα κριτήρια αποκλεισμού περιλάμβαναν θρομβοφιλία, ιστορικό θρόμβωσης, πρόσφατη νοσηλεία, ενεργό λοίμωξη ή κατάχρηση αλκοόλ, καρκίνο, αιματολογικές ασθένειες και χρήση αντιπηκτικών, αντιαιμοπεταλιακών ή αντισυλληπτικών φαρμάκων. Αξιολογήθηκαν η συγκέντρωση του αντιγόνου του TF στο πλάσμα (TFag) και η δραστηριότητα των μικροκυστιδίων πλάσματος που εκφράζουν τον TF (MV-TF). Αποτελέσματα: Οι διάμεσες τιμές TFag ήταν 71.2 [56.8-81.9], 59.7 [47.1-66.6] και 43.9 [29.4-47.9] pg/ml στους ασθενείς με κίρρωση και ηπατοκυτταρικό καρκίνο (ομάδα 1), με κίρρωση (ομάδα 2) και στην ομάδα ελέγχου (ομάδα 3), αντίστοιχα. Υπήρχε στατιστικά σημαντική διαφορά μεταξύ των ομάδων 1 και 3 (p<0.001) και των ομάδων 2 και 3 (p<0.001), ενώ η ομάδα 1 είχε υψηλότερες τιμές από την ομάδα 2 χωρίς στατιστικά σημαντική διαφορά (p=0.133). Η δραστηριότητα των MV-TF εμφάνισε διάμεσες τιμές 4.03 [3.35-4.92], 3.22 [2.44-4.09] και 2.17 [1.49-3.05] pg/ml στις ομάδες 1, 2 και 3 αντίστοιχα. Υπήρχε στατιστικά σημαντική διαφορά μεταξύ των ομάδων 1 και 3 (p<0.001) και των ομάδων 2 και 3 (p=0.003), ενώ η ομάδα 1 είχε υψηλότερες τιμές από την ομάδα 2 χωρίς στατιστική σημαντικότητα (p=0.088). Στην Ομάδα 2, το στάδιο Child-Pugh (CP) των ασθενών ήταν Α στο 56%, Β στο 26% και C στο 18% των περιπτώσεων, ενώ το 50% των ασθενών είχε μη-αντιρροπούμενη κίρρωση. Η δραστηριότητα MV-TF συσχετίστηκε σημαντικά με την παρουσία μη-αντιρροπούμενης κίρρωσης (p=0.005) και υψηλότερο στάδιο CP (p=0.011). Τέλος, η δραστηριότητα MV-TF συσχετίστηκε σημαντικά με τη θνητότητα 12 μηνών (p=0.021). Συμπεράσματα: Η δραστηριότητα των MV-TF είναι αυξημένη σε ασθενείς με κίρρωση, δείχνοντας σημαντική συσχέτιση με τη βαρύτητα της νόσου. Το γεγονός ότι όλοι οι ασθενείς είχαν σταθερή νόσο δείχνει ότι αυτές οι δυναμικές είναι εγγενείς στην κίρρωση και ανεξάρτητες από οξείες επιπλοκές. Τα MV-TF ενδέχεται να παίζουν σημαντικό ρόλο στην προθρομβωτική ανισορροπία της κίρρωσης και η συμβολή τους στην εξέλιξη της νόσου θα πρέπει να μελετηθεί περαιτέρω
An intentional approach to risk management processes and methods and the impact of the recent financial crisis.
No full textPurpose In a first stage this research attempt to explored the phenomenon of financial crisis and the risk management procedures and methods of the banking industry. Secondly the author attempts to examine the risk management differences and similarities, in four different countries.
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Design/methodology/approach The conducted research comprises, four (4) case studies, interviews and the creation of descriptive statistics as a complementary element for a more comprehensive understanding
Findings no significant changes occur regarding the risk management framework of credit and market risk after the financial crisis period. Although, the crisis expose significant gaps of the econometric models that are currently perform in the Banking industry. Furthermore, the differences reveal the gap between developed and emerge countries
An intentional approach to risk management processes and methods and the impact of the recent financial crisis.
No full textPurpose In a first stage this research attempt to explored the phenomenon of financial crisis and the risk management procedures and methods of the banking industry. Secondly the author attempts to examine the risk management differences and similarities, in four different countries.
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Design/methodology/approach The conducted research comprises, four (4) case studies, interviews and the creation of descriptive statistics as a complementary element for a more comprehensive understanding
Findings no significant changes occur regarding the risk management framework of credit and market risk after the financial crisis period. Although, the crisis expose significant gaps of the econometric models that are currently perform in the Banking industry. Furthermore, the differences reveal the gap between developed and emerge countries
From temporal processing to developmental language disorders: Mind the gap
No full textThe 'rapid temporal processing' and the 'temporal sampling framework' hypotheses have been proposed to account for the deficits in language and literacy development seen in specific language impairment and dyslexia. This paper reviews these hypotheses and concludes that the proposed causal chains between the presumed auditory processing deficits and the observed behavioural manifestation of the disorders are vague and not well established empirically. Several problems and limitations are identified. Most data concern correlations between distantly related tasks, and there is considerable heterogeneity and variability in performance as well as concerns about reliability and validity. Little attention is paid to the distinction between ostensibly perceptual and metalinguistic tasks or between implicit and explicit modes of performance, yet measures are assumed to be pure indicators of underlying processes or representations. The possibility that diagnostic categories do not refer to causally and behaviourally homogeneous groups needs to be taken seriously, taking into account genetic and neurodevelopmental studies to construct multiple-risk models. To make progress in the field, cognitive models of each task must be specified, including performance domains that are predicted to be deficient versus intact, testing multiple indicators of latent constructs and demonstrating construct reliability and validity. © 2013 The Author(s) Published by the Royal Society. All rights reserved
Conflict monitoring or multi-tasking? Tracking within-task performance in single-item and multi-item Stroop tasks
No full textCognitive control is applied in situations that require overriding a habitual and automatic response. The conflict monitoring hypothesis and the Expected Value of Control (EVC) theory as its extension posit a control system responsible for detecting conflicting occasions and adapting to them dynamically within a task. Here we evaluate this prediction in two versions of one of the most popular tasks in cognitive control, namely the Stroop task. We hypothesized that nearby-items interference combines with task interference in the multi-item version effectively turning it into a multi-task that may challenge cognitive control. Adopting an alternative methodology tracking within-task performance, we compared the classical multi-item version of the Stroop task and its single-item counterpart in adults and children. The results revealed a within-task performance decline only in the multi-item version of the task, in both incongruent and neutral conditions, modulated by the presumed maturity of the control system. These findings suggest capacity constraints in control implementation and allocation under conditions requiring parallel execution of multiple cognitive tasks. Task complexity and demands seem to modulate effects on performance. We discuss implications for cognitive control as well as substantial concerns regarding the calculation and use of indices of interference based on the commonly used multi-item version of the Stroop task. © 2022 The Author
Post-COVID-19 and Irritable Bowel Syndrome: A Literature Review
No full textThe emergence of post-COVID-19 syndrome (PCS), a complex and multifactorial condition that follows the acute COVID-19 infection, has raised serious concerns within the global medical community. Concurrently, Irritable Bowel Syndrome (IBS), a widespread chronic gastrointestinal (GI) dysfunction, is considered to be one of the most common disorders of gut–brain interaction (DGBI) that significantly affects the quality of life and social functioning of patients. PCS presents a wide range of symptoms and GI manifestations, including IBS. This review aims to analyze the GI involvement and the prolonged symptoms of COVID-19 infection as part of PCS, in order to explore the potential development of post-infection IBS (PI-IBS) in COVID-19 patients. Irritating factors such as enteric infection, psychosocial conditions, food antigens, and antibiotics may lead to abnormalities in the physiological function of the GI system and could be involved in the development of PI-IBS. Through the presentation of the pathophysiological mechanisms and epidemiological studies that assessed the prevalence of IBS as part of PCS, we attempted to provide a better understanding of the long-term consequences of COVID-19 and the pathogenesis of PI-IBS. Even though PI-IBS is becoming a global challenge, there are only a few studies about it and therefore limited knowledge. Currently, the majority of the existing treatment options are referred to non-COVID-19-associated DGBIs. Forthcoming studies may shed light on the mechanisms of PI-IBS that could be targeted for treatment development
Greek Physicians' Perceptions on Generic Drugs in the Era of Austerity
No full textproperly cited. Purpose. To assess the beliefs and preferences of Greek physicians, regarding generic drugs, in the years of financial crisis. Setting. Multicentered, nationwide survey. Material and Methods. A custom questionnaire based on former similar studies was developed and administered to Greek physicians. The variable "perception on generics" was constructed after an exploratory study and the instrument was validated by conventional and Rasch analysis methods. 22 items formed 5 subscales that constructed the variable in question. Results. 908 physicians successfully participated in the study (response rate: 80%). Mean total scores to the instrument were 60.63 ± 12.12 for men and significantly less (58.24 ± 11.73) for women (p = 0.04). Greek physicians were not persuaded on the potential economic gain (45.79 ± 10.53); moreover they identified that Greek authorities cannot address the increased pharmacovigilance mandates. Physicians working in Athens and those working in surgical units demonstrated significantly worse scores than their colleagues from the rest of Greece and those working in Internal Medicine wards (p = 0.03). Conclusion. Our results suggest an overall poor acceptance of the national initiative on generic drugs by Greek physicians. This trial is registered with Clinicaltrials.gov identifier: NCT01855802
