Anti-citrullinated protein antibodies (ACPA) have been shown to cause platelet activation in vitro, through the low-affinity immunoglobulin G (IgG) receptor (FcγRIIa) on platelets. Platelet ...activation via engagement of FcγRIIa results in proteolytic cleavage and shedding of platelet specific glycoprotein VI (GPVI) which can be detected in the plasma as soluble GPVI (sGPVI). We hypothesized that plasma levels of sGPVI would be increased among patients with seropositive RA as a consequence of antibody-induced platelet activation and GPVI shedding.
Samples from 84 patients with RA (65 seropositive and 19 seronegative) and 67 healthy controls were collected prospectively and analysed for sGPVI using a standardised ELISA.
Patients with seropositive RA had significantly higher levels of sGPVI compared to seronegative RA and controls. Median (IQR) sGPVI levels were 4.2 ng/ml (3.2, 8.0) in seropositve RA, 2.2 ng/ml (1.5, 3.5) in seronegative RA and 2.2 ng/ml (1.6, 3.4) in controls (p<0.0001). sGPVI levels correlated with ACPA titres (r = 0.32, p = 0.0026) and with RF titres (r = 0.48, p<0.0001).
Plasma sGPVI, a specific marker of platelet activation is increased among patients with seropositive RA.
No midwifery-led units existed in Ireland before 2004. The aim of this study was to compare midwife-led (MLU) versus consultant-led (CLU) care for healthy, pregnant women without risk factors for ...labour and delivery.
An unblinded, pragmatic randomised trial was designed, funded by the Health Service Executive (Dublin North-East). Following ethical approval, all women booking prior to 24 weeks of pregnancy at two maternity hospitals with 1,300-3,200 births annually in Ireland were assessed for trial eligibility.1,653 consenting women were centrally randomised on a 2:1 ratio to MLU or CLU care, (1101:552). 'Intention-to-treat' analysis was used to compare 9 key neonatal and maternal outcomes.
No statistically significant difference was found between MLU and CLU in the seven key outcomes: caesarean birth (163 14.8% vs 84 15.2%; relative risk (RR) 0.97 95% CI 0.76 to 1.24), induction (248 22.5% vs 138 25.0%; RR 0.90 0.75 to 1.08), episiotomy (126 11.4% vs 68 12.3%; RR 0.93 0.70 to 1.23), instrumental birth (139 12.6% vs 79 14.3%; RR 0.88 0.68 to 1.14), Apgar scores < 8 (10 0.9% vs 9 1.6%; RR 0.56 0.23 to 1.36), postpartum haemorrhage (144 13.1% vs 75 13.6%; RR 0.96 0.74 to 1.25); breastfeeding initiation (616 55.9% vs 317 57.4%; RR 0.97 0.89 to 1.06). MLU women were significantly less likely to have continuous electronic fetal monitoring (397 36.1% vs 313 56.7%; RR 0.64 0.57 to 0.71), or augmentation of labour (436 39.6% vs 314 56.9%; RR 0.50 0.40 to 0.61).
Midwife-led care, as practised in this study, is as safe as consultant-led care and is associated with less intervention during labour and delivery.
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