Resistance to activated protein C in a patient with multiple myocardial infarctions and stroke--a case report

A case of a 49-year-old female with a history of two myocardial infarctions (MI) and ischaemic stroke is presented. The patient was admitted to the hospital due to a third acute MI. Laboratory investigations revealed resistance to activated protein C due to factor V Leiden mutation. Diagnosis and treatment of patients with this condition are discussed.     

Favorable four‐yr outcome after renal transplantation in a patient with complement factor H antibody and CFHR1/CFHR3 gene mutation‐associated HUS

aHUS is a clinical challenge for successful renal transplantation. Case report: A 14‐yr‐old girl lost her kidneys at the age of 7, due to CFH antibodies and CFH‐related protein (CFHR1/CFHR3) homozygous deletion‐associated aHUS. CFH, CFI, and MCP gene mutations were excluded. The patient was a candidate for renal transplantation despite persistent presence of CFH antibodies (up to 539 AU/mL). Treatment with MMF, IVIG, and repeated PF (n = 8) was introduced while being placed on urgent waiting list. Three years after aHUS onset, the patient underwent the deceased donor renal transplantation “under cover” of PF, as PF was performed directly prior to surgery and, then, PFs were repeated up to overall 14 sessions. Quadruple immunosuppression (basiliximab + tacrolimus + MMF + prednisolone) was used. Moderate symptoms of aHUS (hemolysis, low platelets, and low C3) were present within first seven days post‐transplant and then normalized with PF therapy. The patient remained stable during four yr of further follow‐up after transplantation. Conclusion: Specific pre‐ and post‐transplant management allowed successful renal transplantation in a CFH antibody‐positive patient.     

Development and initial evaluation of an instrument to assess physiotherapists’ clinical reasoning focused on clients’ behavior change

Background and Aim: A systematically developed and evaluated instrument is needed to support investigations of physiotherapists’ clinical reasoning integrated with the process of clients’ behavior change. This study’s aim was to develop an instrument to assess physiotherapy students’ and physiotherapists’ clinical reasoning focused on clients’ activity-related behavior and behavior change, and initiate its evaluation, including feasibility and content validity. Methods: The study was conducted in three phases: 1) determination of instrument structure and item generation, based on a model, guidelines for assessing clinical reasoning, and existing measures; 2) cognitive interviews with five physiotherapy students to evaluate item understanding and feasibility; and 3) a Delphi process with 18 experts to evaluate content relevance. Results: Phase 1 resulted in an instrument with four domains: Physiotherapist; Input from client; Functional behavioral analysis; and Strategies for behavior change. The instrument consists of case scenarios followed by items in which key features are identified, prioritized, or interpreted. Phase 2 resulted in revisions of problems and approval of feasibility. Phase 3 demonstrated high level of consensus regarding the instrument’s content relevance. Conclusions: This feasible and content-validated instrument shows potential for use in investigations of physiotherapy students’ and physiotherapists’ clinical reasoning, however continued development and testing are needed.     

Neurodegenerative Genes Polymorphisms of the -491A/T APOE,the -877T/C APP and the Risk of Primary Open-angle Glaucoma in the Polish Population

Background: Glaucoma is characterized by optic neuropathy of the retinal ganglion cell. It may be possible that β-amyloid (Aβ) and apolipoprotein E (APOE), the main proteins of the pathogenesis of AD, play a role in glaucoma development. The aim of this study was to evaluate a relationship between the APP and APOE gene polymorphisms and the risk of primary open-angle glaucoma (POAG) occurrence.

Materials and methods: The study consisted of 183 patients with POAG and 209 healthy subjects. Genomic DNA was extracted from peripheral blood. Analysis of the gene polymorphisms was performed using PCR-RFLP.

Results: We found a statistically significant increase of the -491?T allele frequency (p?=?0.02; OR?=?1.48; 95% CI?=?1.06–2.08) of APOE in POAG compared to healthy controls. There were no differences in the genotype and allele distributions and odds ratios of the APP polymorphism between patients and controls group. We also found an association between APOE polymorphic variant and retinal nerve fiber layer (RNFL). There was a statistically significant difference in the APOE gene A/T genotype frequency in the early POAG stage and middle-advanced POAG stage in comparison to the advanced POAG stage (p?=?0.04; OR?=?3.38; 95% CI?=?1.04–10.97).

Conclusions: The -491?T allele of APOE polymorphism may be associated with a risk of POAG occurrence in the Polish population.     

Effect of cobalt addition on the corrosion behavior of near equiatomic NiTi shape memory alloy in normal saline solution: electrochemical and XPS studies

The electrochemical and corrosion (uniform and localized) behavior of a binary Ni₅₂Ti₄₈ shape memory alloy (SMA) and two ternary Ni₅₂Ti_48−xCo_x (x = 1.5 and 4.0 wt%) SMAs were studied. Measurements were conducted in 0.9% NaCl solution at 37 °C employing various electrochemical methods. These include: linear polarization resistance (LPR), linear sweep voltammetry (LSV), chronoamperometry and dynamic electrochemical impedance spectroscopy (DEIS). Such measurements were complemented with scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) analysis. Results revealed that the addition of alloyed Co to NiTi significantly reduced the uniform corrosion rate of the studied SMA and greatly enhanced its pitting corrosion resistance. XPS measurements evidenced high stability of the passive layer and limited adsorption of chloride ions. Additionally, it was found that the passive layer remained primarily composed of titanium oxides. Microstructure changes accompanying the addition of Co were also used to account for its role in improving the corrosion resistance of these materials.

The electrochemical and corrosion (uniform and localized) behavior of a binary Ni₅₂Ti₄₈ shape memory alloy (SMA) and two ternary Ni₅₂Ti_48−xCo_x (x = 1.5 and 4.0 wt%) SMAs were studied.     

Effect of Asthma Call-back Survey methodology changes on work-related asthma estimates, 19 states, 2007–2012

Objective: Asthma Call-back Survey methodology has been changed recently, as a new sampling design, weights calculation (2011–2012), and revised work-related asthma (WRA) section (2012) were implemented. To assess the effect of these changes on the WRA and possible WRA estimates among ever-employed adults with current asthma, we analyzed 2007–2012 data for 37?505 ever-employed adults (≥18 years) collected from 19 US states (representing an estimated 10 million adults each year). Methods: Using data from landline telephone (LLP) households, we calculated estimates applying poststratification weights (2007–2010) and “raking” weights (2011–2012). Also, using data from LLP/cellular telephone (CP) households combined, we calculated estimates applying “raking” weights (2012). Results: Based on LLP household data, the WRA estimates ranged from 7.8% to 9.7% during 2007–2010, was 9.1% in 2011 and 15.4% in 2012. Possible WRA estimates ranged from 35.1% to 38.1% during 2007–2010, was 38.1% in 2011 and 39.8% in 2012. Using the 2012 LLP/CP household data, the WRA and possible WRA estimates were 15.4% and 38.9%, respectively. Conclusions: Implementation of “raking” weights did not substantially change the WRA or possible WRA estimates among ever-employed adults with current asthma. The WRA and possible WRA estimates based on LLP and LLP/CP samples in 2012 were comparable, as CP users are younger and less likely to have WRA. The substantial upward shift in the 2012 WRA estimates likely was associated with the revision to the WRA section.     

Analysis of efficacy and safety of multiple intravenous infusion of anti-tumor necrosis factor-alpha monoclonal antibody (Remicade) combined with methotrexate compared with sodium aurothiomalate and intramuscular depot methylprednisolone in rheumatoid arthritis

The objective of the paper was compare the effects and tolerability of combined therapy of multiple intravenous infusions of anti-tumour necrosis factor-alfa (TNF-alfa) monoclonal antibody (Remicade) with methotrexate versus treatment with sodium aurothiomalate and intramuscular depot methylprednisolone in rheumatoid arthritis (RA). We investigate also the interval necessary to obtain the improvement in both treatment groups. 36 patients commencing intramuscular sodium aurothiomalate therapy with intramuscular depot methylprednisolone acetate at weeks 0, 4, 8 and 12 in addition to chrysotherapy were compared in retrospective analysis with 32 patients starting with multiple intravenous infusions of infliximab, anti-TNF-alfa monoclonal antibody (Remicade) and methotrexate at a stable dose. Patients were assessed by composite clinical score (DAS 28) and C-reactive protein during 22 weeks of therapy. At week 2 and 6 a significantly greater percentage of infliximab-treated than gold-treated RA patients achieved improvement in each clinical measurement of disease activity. At 22 week of treatment moderate and good response according to EULAR criteria was achieved in 91% of infliximab-treated patients and 58% gold treated patients (p < 0.001). Adverse events were more frequently observed in infliximab-treated patients, but only gold-treated patients discontinued treatment because adverse events (2 patients due to proteinuria, 2 patients due to mucocutaneous changes and one patient due to leucopenia). The higher percentage of adverse events in infliximab-treated patients was caused mainly by the occurrence of infusion reactions (23 reactions out of 160 infusions); most of them were mild (somnolentia and headache) and transient. Viral infections (including herpes simplex and zoster) were more common in patients treated with infliximab and methotrexate. Combination therapy of infliximab and methotrexate is more effective in reducing clinical and biochemical disease activity than gold with methylprednisolone treatment in RA patients during 22 weeks of treatment, especially in the first 6 weeks.