In patients with acute myocardial infarction undergoing reperfusion therapy to restore blood flow through blocked arteries, simultaneous inhibition of platelet P2Y12 receptors with the current standard of care neither completely prevents recurrent thrombosis nor provides satisfactory protection against reperfusion injury. Additionally, these antiplatelet drugs increase the risk of bleeding. To devise a different strategy, we engineered and optimized the apyrase activity of human nucleoside triphosphate diphosphohydrolase-3 (CD39L3) to enhance scavenging of extracellular adenosine diphosphate, a predominant ligand of P2Y12 receptors. The resulting recombinant protein, APT102, exhibited greater than four times higher adenosine diphosphatase activity and a 50 times longer plasma half-life than did native apyrase. Treatment with APT102 before coronary fibrinolysis with intravenous recombinant human tissue-type plasminogen activator in conscious dogs completely prevented thrombotic reocclusion and significantly decreased infarction size by 81% without increasing bleeding time. In contrast, clopidogrel did not prevent coronary reocclusion and increased bleeding time. In a murine model of myocardial reperfusion injury caused by transient coronary artery occlusion, APT102 also decreased infarct size by 51%, whereas clopidogrel was not effective. These preclinical data suggest that APT102 should be tested for its ability to safely and effectively maximize the benefits of myocardial reperfusion therapy in patients with arterial thrombosis.
Twenty nine term newborns were studied at a Regional Hospital in Southern Chile to test the prophylactic value of antibiotics in infants undergoing blood exchange procedures by umbilical catheterlsm. Patients were asigned into two different groups, with or without antibiotic prophylaxis respectively. Complete blood counts and blood cultures were done in the third day after the procedure on both groups. There were 5 positive blood cultures among 15 newborns receiving antibiotics and 5 among 14 newborns managed without drugs. In retrospect and because no clinical nor hemathological evidence of infection was found in those patients, positive blood cultures were considered contaminated. It is concluded that in our experience the prophylactic use of antibiotics in term newborns undergoing umbilical catheterism is not useful in the prevention of secondary infections. (
Please watch the video below depicting the performance of an exchange transfusion. Think first, then answer the question below.After watching the accompanying video, what is your opinion about the time out performed? a) It was suboptimal. Not all the recommended elements of time out were included. b) It was ideal. All the recommended elements of time out were included. c) It could have been better. Some of the recommended elements of time out were included. d) It was poor. None of the recommended elements of time out were included. Figure. Click here to view the video. (Reproduced with permission of Akshaya Vachharajani, MD, and The Saigh Foundation
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