Calcification and fibrointimal proliferation are associated with advanced complicated atherosclerosis in large arteries but may also occur in smaller vessels, resulting in ischaemic tissue necrosis. This study investigates whether the mechanisms of calcification and intimal fibrosis are similar in vessels of different sizes. The localization of osteopontin (OPN), matrix Gla protein (MGP), thrombospondin‐1 (TSP‐1), and cartilage oligomeric matrix protein (COMP) was investigated in three types of human vascular lesions: atherosclerosis, chronic vascular rejection (CVR) in renal allografts, and calcific uraemic arteriolopathy (calciphylaxis). These lesions were chosen as they affect different sized blood vessels and they exhibit a fibroproliferative intimal reaction, with or without calcification, resulting in luminal obliteration and ischaemic complications. OPN, MGP, TSP‐1, and COMP were not detected in normal blood vessels. However, OPN and MGP were expressed at sites of calcification within atherosclerotic lesions and in microvessels in calciphylaxis, suggesting that calcification in different sized vessels may occur by a common mechanism. These proteins were not detected in areas of fibrointimal proliferation. In contrast, TSP‐1 was localized primarily within the fibrous tissue of atherosclerotic lesions and was also expressed in the expanded fibrous intima of arteries showing CVR. COMP was localized primarily within the fibrous tissue under the lipid core of the majority of advanced atherosclerotic lesions. TSP‐1 and COMP were also detected in areas of microcalcification in atherosclerotic lesions and TSP‐1 was detected adjacent to areas of calcification in calciphylaxis. However, neither TSP‐1 nor COMP was localized to calcific foci within these lesions. The localization of OPN, MGP, TSP‐1, and COMP to pathological, but not normal arterial intima supports a pathogenetic role for these proteins in the development of vascular fibrosis and calcification. Modulation of their production and activity may offer a novel approach to the therapy of a number of vascular diseases. Copyright © 2001 John Wiley & Sons, Ltd.

Attitudes of nursing staff to the autopsyWe assessed the views of hospital nurses on the autopsy, using a questionnaire which was distributed by hand to all quali®ed nurses working at Manchester Royal In®rmary during a 48-h period. We found that many respondents (43%) had had occasion to discuss autopsy with relatives, and the majority (90%) would like to learn more about counselling the bereaved. Few (15%) clearly understood the legal distinction between coroners' and hospital autopsies. Almost all (97%) thought the main reason for autopsy was determination of the cause of death, and only 12% supported a role in clinical audit. More respondents saw bene®ts for doctors rather than for nurses, and only 56% perceived a bene®t for relatives. In general, nursing staff have a more positive view of the autopsy than we anticipated, and we would advocate making more information about the bene®ts of autopsy available to nurses.

Attitudes of nursing staff to the autopsyWe assessed the views of hospital nurses on the autopsy, using a questionnaire which was distributed by hand to all quali®ed nurses working at Manchester Royal In®rmary during a 48-h period. We found that many respondents (43%) had had occasion to discuss autopsy with relatives, and the majority (90%) would like to learn more about counselling the bereaved. Few (15%) clearly understood the legal distinction between coroners' and hospital autopsies. Almost all (97%) thought the main reason for autopsy was determination of the cause of death, and only 12% supported a role in clinical audit. More respondents saw bene®ts for doctors rather than for nurses, and only 56% perceived a bene®t for relatives. In general, nursing staff have a more positive view of the autopsy than we anticipated, and we would advocate making more information about the bene®ts of autopsy available to nurses.