Procoagulant factors and the risk of myocardial infarction in young women

Abstract:  Objectives:  We investigated whether elevated levels of factor VIII, IX and XI is associated with myocardial infarction (MI) in young women. In addition, we studied ABO blood group, von Willebrand factor (VWF) and C-reactive protein (CRP). Methods and results:  We compared 200 women with MI before age 49 years with 626 controls from a population-based case–control study. Mean levels of factor VIII activity (VIII), von Willebrand factor antigen (VWF), factor IX activity (IX) were higher in patients (133, 134 and 132 IU/dL) than in controls (111, 107 and 120 IU/dL, respectively). Mean levels of factor XI (XI) were equal in patients (114 IU/dL) and controls (113 IU/dL). The odds ratio (OR) for MI for blood group non-O vs. O was 1.6 [95% confidence interval (CI) 1.1–2.3]. The OR adjusted for age, index year and area of residence for the highest quartile >150 IU/dL of factor VIII was 2.7 (95% CI 1.6–4.6), of VWF 4.7 (95% CI 2.3–9.7), of factor IX 2.6 (95% CI 1.3–5.4) and of factor XI 0.9 (95% CI 0.5–1.4), all compared with the lowest quartile <100 IU/dL. Conclusions:  Non-O blood group, high VWF, factor VIII and factor IX levels are associated with an increased risk of MI in young women, while high factor XI levels are not.     

Antigen-positive platelet transfusion in neonatal alloimmune thrombocytopenia (NAIT)

Neonatal alloimmune thrombocytopenia (NAIT) is a fetomaternal incompatibility most commonly induced by maternal anti-HPA-1a, IgG alloantibodies against a polymorphic epitope of the glycoprotein IIb/IIIa complex in approximately 97.5% of white patients. Current guidelines recommend transfusion of immunologically compatible platelets to prevent cerebral hemorrhage, the most severe complication in affected newborns. Such platelet concentrates, however, are often not readily available. In a retrospective analysis in German and Canadian centers, 27 newborns with NAIT were identified who received platelets from random donors. Unexpectedly, 24 of 27 newborns showed an increase above a threshold of 40 x 10(9) platelets per liter, with moderate (n = 8) or significant (n = 16) platelet count increments (more than 80 x 10(9)/L). We conclude that transfusion of platelet concentrates from random donors is an appropriate strategy in the management of unexpected, severe NAIT predominantly in first pregnancies, pending the availability of compatible platelets.     

Apolipoprotein E4 and tau allele frequencies among Choctaw Indians

Apolipoprotein genotyping and tau haplotyping were carried out on a series of cases with dementia and controls from the Choctaw Nation of Oklahoma. Both the Apolipoprotein E4 allele frequency and the tau H2 haplotype frequency were low in the Choctaw compared with Caucasians and there was the possibility that the association between dementia and the E4 allele was weaker than in Caucasians.     

Diagnosis of progressive supranuclear palsy: can measurement of tau forms help?

Recently, a new assay for the differential diagnosis of progressive supranuclear palsy (PSP) was proposed. It was shown that the ratio of 33/55 kDa tau forms in cerebrospinal fluid (CSF) was specifically reduced in PSP CSF. We aimed to reproduce these results, but were not able to detect the tau forms in CSF. We demonstrate that i) CSF total tau levels are too low to be detected by the published protocol, and ii) the described 33 and 55 kDa bands are likely the heavy and light chains of IgG used in the assay. We conclude that more sensitive techniques are needed to measure tau forms in CSF.     

Applicability of two brief evidence-based interventions to improve sleep quality in inpatient mental health care

The present study explored the applicability of two brief evidence-based interventions to improve sleep quality in inpatient psychiatry. The study involved three comparable admission wards of a psychiatric hospital. Stimulus control was introduced at the first ward, and music-assisted relaxation at the second. At the third ward, no intervention was introduced. A mixed-method study was employed. We found that nurses share the opinion that both interventions can be applied, but patients are hard to motivate. They perceived the lack of available time, busyness at the ward, and the lack of cooperation of patients as the main obstacles. The perception of a successful implementation is correlated with the perception of gained attention for sleep problems, the perception of increased care options, and the impression of effectiveness. Qualitative data showed that the effectiveness of the interventions was compromised by operational issues, commitment issues, adaptation to contextual limitations, and conflicting individual beliefs. We concluded that music-assisted relaxation is applicable in inpatient psychiatry. The application of stimulus control met with insurmountable operational issues. The nursing team is a very important factor for the implementation of evidence-based interventions at ward level. The lack of a shared urge for change and responsibility for continuity are important factors contributing to failure.     

Expression of IL-17A in human atherosclerotic lesions is associated with increased inflammation and plaque vulnerability

A chronic (auto)immune response is the critical mechanism in atherosclerosis. Interleukin-17A is a pivotal effector cytokine, which modulates immune cell trafficking and initiates inflammation in (auto)immune and infectious diseases. However, expression of IL-17A in the context of human atherosclerosis has hardly been explored. Carotid artery plaques were collected from 79 patients undergoing endarterectomy. Patients were grouped according to their symptomatic status (TIA, stroke), plaque morphology and medication. Quantitative RT-PCR was used to analyze tissue inflammation and immunohistochemistry to assess cellular source of IL-17A expression and lesion morphology. Carotid plaques from patients with ischemic symptoms were characterized by a highly activated inflammatory milieu including accumulation of T cells (p = 0.04) and expression of IL-6 and VCAM1 (p = 0.02, 0.01). Expression of IL-17A and its positive regulators IL-21 and IL-23 was present in atherosclerotic lesions, significantly upregulated in atheromas of symptomatic patients (p = 0.005, 0.004, 0.03), and expression of IL-17A and IL-21 showed a strong correlation (p = 0.002, r = 0.52). The cellular sources of lesional IL-17A expression are T cells, macrophages, B cells and plasma cells. Vulnerable/ruptured (complicated) plaques were significantly associated with IL-17A expression levels (p = 0.003). In addition, IL-17A showed a marked negative correlation with the potent anti-inflammatory/atheroprotective cytokine IL-10 (p = 0.0006, r = −0.46). Furthermore, treatment with a HMG-CoA reductase inhibitor or acetylsalicylic acid showed reduced levels of IL-21, IL-23 and VCAM1 (all p < 0.05), but did not influence IL-17A. The association of IL-17A with ischemic symptoms and vulnerable plaque characteristics suggests that the pro-inflammatory cytokine IL-17A may contribute to atherosclerosis und plaque instability.