Myocardial infarction with non-obstructive coronary arteries in young women presenting with ST-segment elevation myocardial infarction: a case series

Introduction. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is an increasingly recognised entity, with comparable mortality to myocardial infarction with obstructive coronary artery disease (CAD).Case presentation. We present the cases of two young females presenting to hospital with ST-segment elevation myocardial infarction without obstructive CAD. Common to both cases was the acute onset of chest pain with no prior cardiac history, minimal cardiac risk factors, and the use of hormone-based contraception. The first patient had an ostially occluded left anterior descending artery (LAD). Flow was restored with balloon inflation and the administration of tirofiban. However, no underlying obstructive CAD was identified, which was confirmed with repeat angiography and optical coherence tomography. The cause was later attributable to plaque erosion, after learning the results of a normal thrombophilia screening. The second patient had ST-segment resolution on arrival to the catheter lab, and on angiography, she had TIMI II flow down the LAD due to significant thrombus burden. Similarly, balloon inflation and tirofiban were administered to improve flow, and non-obstructive CAD was confirmed with repeat angiography and OCT 48 hours later. As with patient 1, this patient too had normal thrombophilia screening results. Both patients were discharged with dual-antiplatelet therapy and secondary prevention, and were advisedagainst hormone-based contraception.Discussion. Patients with MINOCA tend to be younger, with a higher female-to-male preponderance. Multiple causes have been identified, highlighting the importance of following a diagnostic algorithm. This will enable correct treatment, which may differ from that for patients with obstructive coronary disease, thus improving prognosis

Campylobacter jejuni PflB is required for motility and colonisation of the chicken gastrointestinal tract.

Campylobacter jejuni is the leading cause of foodborne bacterial gastroenteritis worldwide. Although the mechanisms by which C. jejuni causes disease are not completely understood, the presence of functional flagella appears to be required for colonisation of the gastrointestinal tract of humans and animals. Therefore much attention has been given to understanding the synthesis and role of flagella in C. jejuni. In this study we report insights into the function of PflB that is essential for Campylobacter motility. We have explored the function of this gene by constructing deletion mutants in C. jejuni strains NCTC11168 and M1, in the genes cj0390 and CJM1_0368, respectively. The mutants were non-motile yet assembled flagella that appeared structurally identical to the wild type. Furthermore the protein is required for C. jejuni colonisation of caeca in a two-week old chicken colonisation model.This work was supported by the Department for Environment, Food and Rural Affairs (Defra) Senior Fellowship awarded to D.J.M.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.micpath.2015.09.01

Reciprocal regulation of airway rejection by the inducible gas-forming enzymes heme oxygenase and nitric oxide synthase

Obliterative bronchiolitis (OB) develops insidiously in nearly half of all lung transplant recipients. Although typically preceded by a CD8+ T cell–rich lymphocytic bronchitis, it remains unresponsive to conventional immunosuppression. Using an airflow permissive model to study the role of gases flowing over the transplanted airway, it is shown that prolonged inhalation of sublethal doses of carbon monoxide (CO), but not nitric oxide (NO), obliterate the appearance of the obstructive airway lesion. Induction of the enzyme responsible for the synthesis of CO, heme oxygenase (Hmox) 1, increased carboxyhemoglobin levels and suppressed lymphocytic bronchitis and airway luminal occlusion after transplantation. In contrast, zinc protoporphyrin IX, a competitive inhibitor of Hmox, increased airway luminal occlusion. Compared with wild-type allografts, expression of inducible NO synthase (iNOS), which promotes the influx of cytoeffector leukocytes and airway graft rejection, was strikingly reduced by either enhanced expression of Hmox-1 or exogenous CO. Hmox-1/CO decreased nuclear factor (NF)-κB binding activity to the iNOS promoter region and iNOS expression. Inhibition of soluble guanylate cyclase did not interfere with the ability of CO to suppress OB, implicating a cyclic guanosine 3′,5′-monophosphate–independent mechanism through which CO suppresses NF-κB, iNOS transcription, and OB. Prolonged CO inhalation represents a new immunosuppresive strategy to prevent OB