To cite this article: Undas A, Plicner D, Stępień E, Drwiła R, Sadowski J. Altered fibrin clot structure in patients with advanced coronary artery disease: a role of C-reactive protein, lipoprotein(a) and homocysteine. J Thromb Haemost 2007; 5: 1988-90. Evidence for a role of fibrin clot structure/function in coronary artery disease (CAD) is scarce [1]. Factors that determine unfavorable fibrin clot properties in CAD patients are poorly understood. We have demonstrated that C-reactive protein (CRP) [2], lipoprotein(a) [Lp(a)] [3] and total homocysteine (tHcy) [4] are associated with decreased clot permeability and susceptibility to lysis. However, these findings are derived from small studies in patients aged < 60 years with a variable extent of CAD. The aim of the current study was to evaluate fibrin clot properties in middle-aged and elderly patients with advanced CAD.We studied 133 patients with angiographically proven CAD ( ‡ 70% stenosis), who qualified for elective coronary artery bypass grafting surgery. Exclusion criteria were: any acute illness; cancer; hepatic or renal dysfunction; anticoagulant therapy; acute coronary syndrome within the previous 6 weeks; or previous venous thromboembolism. Medications were administered in unchanged doses for at least 2 weeks. Apparently healthy, age-and sex-matched individuals (n = 100) served as controls.Fibrinogen and high-sensitivity CRP were measured by nephelometry (Dade Behring, Marburg, Germany). Fasting plasma tHcy levels were measured using the IMX System (Abbott Diagnostics, Wiesbaden, Germany). Serum Lp(a) levels were determined by ELISA (Biopool, Umea, Sweden).Fibrin clot permeability, expressed as a permeation coefficient (K s ), which indicates the pore size, was determined as described [5]. Clot lysis times were determined using a turbidity assay with slight modifications. Citrated plasma was diluted with the Tris buffer, containing 20 mmol L -1 CaCl 2 , 1 U mL -1 human thrombin (Sigma) and 1 lg mL -1 recombinant tissue plasminogen activator, rtPA (Boerhinger Ingelheim, Ingelheim, Germany). The time required for a 50% decrease in clot turbidity (t 50% ) was determined [6]. Assembly kinetics were monitored at 405 nm. The intra-assay and interassay coefficients of variation for all the measures were 4-7%.Clots from CAD patients with fibrinogen within the reference range were fixed, further processed by dehydration and photographed digitally in six different areas with a Hitachi S-4700 scanning electron microscopy (SEM) [5].Data are given as mean ± SD or median (interquartile range). Inter-group comparisons were performed using the Mann-Whitney U-test and correlations were assessed by the SpearmanÕs rank-correlation coefficient. Multiple linear regression analysis was used to determine predictors of K s and lysis times. A value of P < 0.05 was considered significant.The CAD group consisted of 133 patients (94 male, 39 female), aged 62 (59-67) years, including 53 (40%) smokers and 28 (21%) diabetics. Seventy-eight (59%) of the patients had previous MI; ...

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BackgroundThe incidence of hypothermia is difficult to evaluate, and the data concerning the morbidity and mortality rates do not seem to fully represent the problem. The aim of the study was to estimate the actual prevalence of accidental hypothermia in Poland, as well as the methods of diagnosis and management procedures used in emergency rooms (ERs).MethodsA specially designed questionnaire, consisting of 14 questions, was mailed to all the 223 emergency rooms (ER) in Poland. The questions concerned the incidence, methods of diagnosis and risk factors, as well as the rewarming methods used and available measurement instruments.ResultsThe analysis involved data from 42 ERs providing emergency healthcare for the population of 5 305 000. The prevalence of accidental hypothermia may have been 5.05 cases per 100.000 residents per year. Among the 268 cases listed 25% were diagnosed with codes T68, T69 or X31, and in 75% hypothermia was neither included nor assigned a code in the final diagnosis. The most frequent cause of hypothermia was exposure to cold air alongside ethanol abuse (68%). Peripheral temperature was measured in 57%, core temperature measurement was taken in 29% of the patients. Peripheral temperature was measured most often at the axilla, while core temperature measurement was predominantly taken rectally. Mild hypothermia was diagnosed in 75.5% of the patients, moderate (32-28°C) in 16.5%, while severe hypothermia (less than 28°C) in 8% of the cases. Cardiopulmonary resuscitation was carried out in 7.5% of the patients. The treatment involved mainly warmed intravenous fluids (83.5%) and active external rewarming measures (70%). In no case was extracorporeal rewarming put to use.ConclusionsThe actual incidence of accidental hypothermia in Polish emergency departments may exceed up to four times the official data. Core temperature is taken only in one third of the patients, the treatment of hypothermic patients is rarely conducted in intensive care wards and extracorporeal rewarming techniques are not used. It may be expected that personnel education and the development of management procedures will brighten the prognosis and increase the survival rate in accidental hypothermia.

Hypothermic patients may be rewarmed using passive or active techniques. In case of severe accidental hypothermia (temperature<28°C) and stage III/IV according to the Swiss Staging System, standard methods might not be effective and aggressive treatment is needed. Extracorporeal membrane oxygenation (ECMO) has proved to be both effective and safe in such cases. The Department of Anesthesiology and Intensive Care, John Paul II Hospital, Cracow, Poland, established the Severe Accidental Hypothermia Center, which provides 24 h on-call to consult and accept patients who need ECMO implantation for profound hypothermia rewarming. Our center is so far the only one in Poland and can accept patients from south-east Poland. Most importantly, it collaborates with all prehospital medical services, namely, with 115 Ambulances, Polish Medical Air Rescue, Mountain Rescue Services, and all 28 Emergency Departments in the area. Severe Accidental Hypothermia Center is a solution for advanced treatment of patients with accidental hypothermia requiring ECMO implantation.

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Bleeding is the most frequent complication related to implantation of a mechanical cardiac assist device. 1 Recombinant activated factor VII (NovoSeven; Novo Nordisk, Bagsvaerd, Denmark) was developed as a prohemostatic agent. We report the successful use of recombinant activated factor VII to control bleeding abnormalities in a patient with a left ventricular assist device (LVAD).

BackgroundMicrobiological diagnosis of sepsis relies primarily on blood culture data. This study compares four diagnostic methods, i.e. those developed by us: nested, multiplex, qPCR (qPCR) and FISH with commercial methods: SeptiFast (Roche) (SF) and BacT/ALERT® 3D blood culture system (bioMérieux). Blood samples were derived from adult patients with clinical symptoms of sepsis, according to SIRS criteria, hospitalized in the Intensive Care Unit.ResultsUsing qPCR, FISH, SF, and culture, microbial presence was found in 71.8%, 29.6%, 25.3%, and 36.6% of samples, respectively. It was demonstrated that qPCR was significantly more likely to detect microorganisms than the remaining methods; qPCR confirmed the results obtained with the SF kit in all cases wherein bacteria were detected with simultaneous confirmation of Gram-typing. All data collected through the FISH method were corroborated by qPCR.ConclusionsThe qPCR and FISH methods described in this study may constitute alternatives to blood culture and to the few existing commercial molecular assays since they enable the detection of the majority of microbial species, and the qPCR method allows their identification in a higher number of samples than the SF test. FISH made it possible to show the presence of microbes in a blood sample even before its culture.

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