Characterization of a Precocious New Lesion Distal to a Stent Site by Atherectomy

A 58-year-old woman presented with a new rapidly progressive lesion distal to a stent. This lesion was treated with atherectomy through the stem in order to characterize it pathologically. The aggressive proliferative response discovered suggested that this unusually distal lesion was produced by the trauma of her previous angioplasty .     

Relation between power spectrum time course during ventricular fibrillation and electromechanical dissociation. Effects of coronary perfusion and nifedipine

To relate the evolution of ventricular fibrillation (VF) tothe haemodynamic recovery after cardioversion, we characterizedthe differences in the ECG power spectrum (PS) time course,among different types of VF: under control conditions, withprevious administration of nifedipine and on cardiopulmonarybypass (CPB). In the first few seconds VF showed a PS with anarrow peak between 8 and 15 Hz and its higher harmonics, suggestingsome organization and regularity. In the following 40 seconds,the arrhythmia accelerated slightly, maintaining an organizedspectrum. Afterwards, the PS became slow and irregular, losingits initial characteristics after 60 seconds. Conversely, VFon CPB maintained its organized PS, over a prolonged period.Previous administration of 0.32,0.64 mg kg^–l of nifedipinemaintained the initial characteristics of the PS for 90 and150 seconds. Similar results were obtained with previous autonomicblockade. In another group of dogs, defibrillation was performedafter successive periods of VF, to study electromechanical dissociation(EMD). In all control dogs, EMD was observed after 90 secondsof VF. Pretreatment with nifedipine postponed EMD until 120–150seconds and was not observed in dogs on CPB. The PS time courseduring seems a reliable method of analyzing and quantifyingthe different types of VF. It could be related with the onsetof EMD, reflecting the metabolic alterations that happen duringVF. Nifedipine could delay the ischaemic effects during VF andincrease the possibility of successful cardiac resuscitation.     

The development and validation of a new coeliac disease quality of life survey (CD‐QOL)

Aliment Pharmacol Ther 31 , 666–675

Summary

Background Previous studies on coeliac disease (CD)‐related quality of life (QOL) have been limited by their use of a ‘generic’ rather than coeliac disease‐specific assessment instruments. Aim To develop and psychometrically validate a new coeliac disease‐specific instrument, the CD‐QOL. Methods Through a series of focus groups, we elicited items from patients that related to the specific nature of their disease and its impact on their basic needs. Through expert review, cognitive debriefing with patients and pilot testing, a scale was developed, refined and administered to 387 patients on a gluten‐free diet from both community‐based support groups and a tertiary care referral centre. Finally, a formal validation study was conducted to assess the psychometric properties of the CD‐QOL. Results The final CD‐QOL has 20 items across four clinically relevant subscales (Limitations, Dysphoria, Health Concerns, and Inadequate Treatment). The CD‐QOL has high internal consistency, reliability, and psychometric validation indicates both convergent and discriminate validity. Conclusions The CD‐QOL is a reliable and valid measure of coeliac disease related QOL. As a new disease‐specific instrument, it is likely to be a useful tool for evaluating patients with this disorder.     

Evidence that α2-antiplasmin becomes covalently ligated to plasma fibrinogen in the circulation: a new role for plasma factor XIII in fibrinolysis regulation

Summary.  Background : Plasma alpha₂-antiplasmin (α₂AP) is a rapid and effective inhibitor of the fibrinolytic enzyme plasmin. Congenital α₂AP deficiency results in a severe hemorrhagic disorder due to accelerated fibrinolysis. It is well established that in the presence of thrombin-activated factor XIII (FXIIIa), α₂AP becomes covalently ligated to the distal α chains of fibrin or fibrinogen at lysine 303 (two potential sites per molecule). Some time ago we showed that α₂AP is covalently linked to plasma fibrinogen . That singular observation led to our hypothesis that native plasma factor XIII (FXIII), which is known to catalyze covalent cross-linking of fibrinogen in the presence of calcium ions, can also incorporate α₂AP into fibrinogen in the circulation. Results and Conclusions : We now provide evidence that FXIII incorporates I¹²⁵-labelled α₂AP into the Aα-chain sites on fibrinogen or fibrin. We also measured the content of α₂AP in isolated plasma fibrinogen fractions by ELISA and found that substantial amounts were present (1.2–1.8 moles per mole fibrinogen). We propose that α₂AP becomes ligated to fibrinogen while in the circulation through the action of FXIII, and that its immediate presence in plasma fibrinogen contributes to regulation of in vivo fibrinolysis.