HIT: treatment easier, prevention harder

In this issue of Blood, Krauel and colleagues identify two potential off-label treatments(rivaroxaban, dabigatran) for heparin-induced thrombocytopenia (HIT),and also outline aHIT prevention strategy through disrupting PF4/heparin complexes with low-sulfated heparin; the former approach will be easy to implement, the latter much harder—but potentially more worthwhile     

How to perform and interpret capillaroscopy

The essence of capillaroscopy is to examine, noninvasively and safely the morphology of nailfold dermal papillary capillaries using a magnification system (microscopical lenses). Capillaroscopy may be performed with lenses with low (×20) and with high magnification (×200 up to ×600). The video-capillaroscope consists of an optical/digital probe which is moved to the finger of the patient and allows direct contact with the nailfold. Through qualitative assessment a normal capillaroscopy can be distinguished from a pathognomonic abnormal one due most frequently to systemic sclerosis (SSc). This pattern recognition relies on evaluating the morphology of the capillaries, their density (number) and dimensions ‘at sight’ of the capillaries and their architecture. In SSc three progressive capillaroscopic patterns have been described (‘early’, ‘active’ and ‘late’). Quantitative assessment (quantitation of certain characteristics and semi-quantitative scoring) of the capillaroscopic pictures may also be performed. Qualitative and semi-quantitative assessments are used to predict SSc clinical complications. In other connective tissue diseases (CTDs) prospective clinical studies resulting in indices which can predict future clinical complications have not been published, as yet.     

How to interpret plain radiographs in clinical practice

In this article I will consider the basic principles of requesting, acquiring, interpreting and reporting plain radiographs of joints, including assessment of the distribution of joint abnormalities, and specific pathological changes that may occur in bone, cartilage and soft tissues. I will then move on to a more specific discussion of the major arthropathies and the role of radiographs in the diagnosis and assessment in each condition as well as reviewing the combined abnormalities that may be visible on radiographs and how these relate to underlying pathological processes.     

How to interpret right ventricular remodeling in athletes

Long-lasting athletic training induces an overload on the heart that leads to structural, functional, and electrical adaptive changes known as the “athlete's heart.” The amount of this heart remodeling has been traditionally considered balanced between the left and the right heart chambers. However, during intense exercise, the right heart is exposed to a disproportional afterload and wall stress which over a long period of time could lead to more pronounced exercise-induced changes. Highly trained athletes, especially those involved in endurance sport disciplines, can develop marked right ventricular (RV) remodeling that could raise the suspicion of an underlying RV pathology including arrhythmogenic cardiomyopathy (ACM). The distinction between physiological and pathological RV remodeling is essential as ACM is a common cause of sudden cardiac death in athletes, and high-intensity exercise training has demonstrated to accelerate its phenotypic expression and worsen its prognosis. The distinction between physiological and pathological RV remodeling is essential since ACM is a common cause of sudden cardiac death in athletes, and high-intensity exercise training has demonstrated to accelerate the phenotypic expression and worsen the prognosis. This article outlines the physiological adaptation of the RV to acute exercise, the subsequent physiological structural and functional changes induced by athletic training and provides useful tips of how to differentiate between physiological RV remodeling and a cardiomyopathy phenotype.     

Using life-histories to predict and interpret variability in yolk hormones

Variation in yolk hormones is assumed to provide the plasticity necessary for mothers to individually optimize reproductive decisions via changes in offspring phenotype, the benefit being to maximise fitness. However, rather than routinely expecting adaptive variation within all species, the pattern and magnitude of yolk hormone deposition should theoretically relate to variation in life-histories. Here we present data on intra-clutch variation in yolk corticosterone in three species along a developmental continuum (European starling (Sturnus vulgaris): fully altricial; black guillemot (Cepphus grylle): semi-precocial; common eider (Somateria mollissima): fully precocial) to examine how and why variation in life-histories might relate to the evolution of variation in yolk steroids. Starlings and guillemots showed a significant increase in yolk corticosterone across the laying sequence; however, we found no pattern within eider clutches. Moreover, starlings showed the largest difference (94.6%) in yolk corticosterone between first- and last-laid eggs, whereas guillemots showed a moderate difference (58.9%). Despite these general species-specific patterns, individuals showed marked variation in the intra-clutch patterns of yolk corticosterone within each species indicating potential differences in intra-clutch flexibility among females. It is well documented that exposure to elevated yolk glucocorticoids reduces offspring quality at birth/hatching in many taxa and it has therefore been proposed that elevated yolk levels may modulate offspring competition and/or facilitate brood reduction under harsh conditions in birds. Our data suggests that intra-clutch variation in yolk corticosterone has the potential to act as an adaptive maternal effect in species where modulation of competition between nest-bound offspring would benefit mothers (starlings and guillemots). However, in precocial species where mothers would not benefit from a modulation of offspring quality, intra-clutch variation in yolk hormones may play little or no adaptive role. While future phylogenetically-controlled studies will be helpful in examining questions of adaptive mechanisms once more data on yolk corticosterone becomes available, our results nonetheless suggest that research on the evolutionary role of yolk hormones can benefit by a priori incorporating species-specific life-history-driven hypotheses.