St Thomas' Hospital

About: St Thomas' Hospital is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Pregnancy. The organization has 12105 authors who have published 15596 publications receiving 624309 citations. The organization is also known as: St Thomas's Hospital & St. Thomas's.

A practical guideline for the haematological management of major haemorrhage.

Abstract: The aim of this guideline is to provide recommendations for the haematological management of major haemorrhage in any clinical situation, with practical guidance for Clinical Haematologists and laboratory staff on the content and delivery of major bleeding protocols, including the use of blood components and transfusion alternatives. Management of major haemorrhage in any setting requires a multidisciplinary approach. There have been advances in techniques for resuscitation as well as surgical, radiological and endoscopy interventions, to control bleeding alongside critical care support, but these are beyond the scope of this document. These updated guidelines are based on new studies, which have provoked reassessment of the principles of managing major haemorrhage in all clinical situations, and which mandate much closer working between hospital blood banks and emergency departments to provide timely transfusion support for patients with major bleeding. Alongside changes in the use of blood component therapy, the importance of antifibrinolytics has been demonstrated in the study by the Clinical Randomization of Antifibrinolytics in Significant Haemorrhage (CRASH-2) collaborators (2010). The recognition that tranexamic acid (TA) benefited not only those with massive haemorrhage but also the larger number of patients with, or at risk of, significant haemorrhage (i.e. not only those fulfilling the criteria for massive bleeding) has led to an expansion of our guidelines from massive to major haemorrhage so that we can include this group. Methods

Targeting the Receptor for Advanced Glycation Endproducts (RAGE): A Medicinal Chemistry Perspective

Abstract: The receptor for advanced glycation endproducts (RAGE) is an ubiquitous, transmembrane, immunoglobulin-like receptor that exists in multiple isoforms and binds to a diverse range of endogenous extracellular ligands and intracellular effectors. Ligand binding at the extracellular domain of RAGE initiates a complex intracellular signaling cascade, resulting in the production of reactive oxygen species (ROS), immunoinflammatory effects, cellular proliferation, or apoptosis with concomitant upregulation of RAGE itself. To date, research has mainly focused on the correlation between RAGE activity and pathological conditions, such as cancer, diabetes, cardiovascular diseases, and neurodegeneration. Because RAGE plays a role in many pathological disorders, it has become an attractive target for the development of inhibitors at the extracellular and intracellular domains. This review describes the role of endogenous RAGE ligands/effectors in normo- and pathophysiological processes, summarizes the current status o...

The clinical spectrum of autoimmune congenital heart block

Abstract: Autoimmune congenital heart block is more likely to occur in the babies of women with rheumatic diseases, particularly women seropositive for anti-Ro or anti-La autoantibodies. Here, the authors provide advice for the management of these women and their babies in juxtaposition to a systematic assessment of the epidemiology and classification of the disease.

Anti-prothrombin (aPT) and anti-phosphatidylserine/prothrombin (aPS/PT) antibodies and the risk of thrombosis in the antiphospholipid syndrome. A systematic review.

Abstract: Antibodies to prothrombin are detected by directly coating prothrombin on irradiated ELISA plates (aPT) or by using the phosphatidylserine/prothrombin complex as antigen (aPS/PT). Although these antibodies have both been associated with antiphospholipid syndrome (APS) and a correlation between the two assays have been reported, it seems that aPT and aPS/PT belong to different populations of autoantibodies. It was our objective to systematically review the available evidence on aPT and aPS/PT antibodies and the risk of thrombosis in APS. Medline-reports published between 1988 and 2013 investigating aPT and aPS/PT as a risk factor for thrombosis were included. Whenever possible, antibody isotype(s) and site of thrombosis were analysed. This systematic review is based on available data from more than 7,000 patients and controls from 38 studies analysing aPT and 10 aPS/PT. Antibodies to prothrombin (both aPT and aPS/PT) increased the risk of thrombosis (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.72–3.5). aPS/PT seemed to represent a stronger risk factor for thrombosis, both arterial and/or venous than aPT (OR 5.11; 95%CI 4.2–6.3 and OR 1.82; 95%CI 1.44–2.75, respectively). In conclusion, routine measurement of aPS/PT (but not aPT) might be useful in establishing the thrombotic risk of patients with previous thrombosis and/or systemic lupus erythematosus. Their inclusion as laboratory criteria for the APS should be indisputably further explored.

Inpatient vs. outpatient pain management: results of a randomised controlled trial

Abstract: Inpatient and outpatient cognitive behavioural pain management programmers for mixed chronic pain patients were compared Patients were randomly allocated to the 4 week inpatient programme or to the 8 half day per week outpatient programme, or to a waiting list control group Staff, teaching materials, and setting were the same for the two treatment groups Patients were assessed pre-treatment, and at 1 month after discharge, and treated patients also at 6 months and 1 year after discharge, by assessors blind to treatment group; assessments included physical, functional and psychological measures, and medication use In total, 121 mixed chronic pain patients (mean age 50 years; mean chronicity 81 years) were included in the study, following medical examination to ensure that no further medical treatment was appropriate There was no change in the control group; inpatients and outpatients, comparable before treatment, both made significant improvements in physical performance and psychological function, and reduced medication use Inpatients made greater gains, and maintained them better at 1 year; they also used less health care than outpatients There were no outstanding predictors of improvement other than treatment group