Variability in response to clopidogrel: where is the threshold for 'low response'?: reply

We appreciate to read Dr Komócsís comments toour article entitled ‘Low response to clopidogrel is associatedwith cardiovascular outcome after coronary stent implantation’. He critically remarked the mortality rate in our study. Indeed,we found an all-cause mortality of 5.2% within 3 months (cardiovascularmortality: 3.9%). However, it is worthy to note that we investigatedan unselected patient collective with moderate- to     

Akuter thrombembolischer ST-Hebungs-Infarkt bei einem Patienten mit essenzieller Thrombozytose

A 48-year-old man presented with acute chest pain and a greatly increased platelet count. Emergency coronary angiographc revealed thrombotic occlusion of the right coronary artery. Coronary angioplasty and stenting were successfully combined with intracoronary abciximab administration. Due to inadequate postinterventional platelet inhibition an intensified dual antiplatelet therapy with acetylsalicylic acid (ASS) and clopidogrel was applied to prevent stent thrombosis. Due to the thrombo-embolic complication and a platelet count over 1 million/µl a cytoreductive treatment with hydroxyurea was initiated.     

Two-tone suppression by a saturating feedback model of the cochlear partition.

A model of a small strip of cochlear partition was computer simulated. The model is composed of two elements, approximations to the transfer functions of an inner hair cell (IHC) and an outer hair cell (OHC), respectively. The IHC element was insensitive to DC stimulation. Input was one or two sinusoids. One sinusoid, at the characteristic frequency (CF), was multiplied by the gain of the 'cochlear amplifier'. A second sinusoid, representing a tone with much lower frequency, was not affected by the amplifier gain. This gain was determined by the OHC transfer function. In one form of the model ('fixed-gain'), this gain was set at a fixed number determined from the furthest point reached on the OHC transfer function. This form of the model produced very realistic single-tone responses as well as showing 'two-tone suppression': that is, the IHC DC response produced by CF stimulation was reduced when the lower-frequency sinusoid, at suitable intensities, was added to the stimulus. When a DC component was added to the two-tone stimulus, the magnitude of this two-tone suppression was enhanced. In the second form of the model ('variable-gain'), the cochlear-amplifier gain varied throughout the stimulus cycle. Its value was re-calculated at each instant, determined by the point on the OHC transfer function current at that particular instant. This form of the model showed two-tone suppression only when a DC component was added to the two-tone stimulus.