Impact of dual antiplatelet therapy on thrombus architecture in patients with acute myocardial infarction

Mit dem raschen Aufsteigen der Koronaren Herzerkrankung zur Hauptursache für Mortalität und Morbidität weltweit ist ein tiefgreifendes Verstehen und kontinuierliche Verbesserung der Therapiestrategien der zugrundliegenden Ursachen zur Voraussetzung und Aufgabe für Forscher und Kliniker auf der ganzen Welt geworden. Die aktuelle Standardbehandlung für Patienten vor oder nach PCI ist eine duale antiaggregatorische Therapie mit ASS und einem Thrombozytenaggregationshemmer entweder aus der Thienopyridin-Gruppe (Clopidogrel, Prasugrel, Ticlopidin) oder mit einem nicht-Thienopyridin Derivat wie Ticagrelor oder Cangrelor. In dieser Studie wurde der Fokus auf die zwei Hauptrepräsentanten der Thienopyridin-Gruppe, Clopidogrel und Prasugrel gelegt. Basierend auf der Hypothese dass Prasugrel im Vergleich zu Clopidogrel nicht nur die Größe intrakoronarer Thromben reduziert, sondern auch ihre Komposition und somit die Thrombusarchitektur beeinflusst, war das Ziel dieser Studie diese Charakteristiken von intrakoronaren Thromben in einer Kohorte von STEMI-Patienten zu analysieren und zu vergleichen. Für die Studie wurden insgesamt 102 Patienten, die sich einer PCI und Thrombektomie unterzogen, rekrutiert. 51 Patienten dieser Kohorte erhielten ein Clopidogrel-, die andere Hälfte ein Prasugrel- Loading. Die Loading-Dosis war ASS 500 mg + Clopidogrel 600 mg oder ASS 500 mg + Prasugrel 60 mg entsprechend Standardklinikroutine. Die aspirierten Thromben dieser zwei Gruppen wurden im Anschluss mittels Immunhistologie weiter untersucht. Um einen differenzierten Überblick über die Thrombenkomposition zu erhalten, wurden die histologischen Schnitte neben der Standard HE-Färbung mit einer Auswahl an molekularen Biomarkern (CD14, CD42b, CD68, CD105, MIF, Grem1, TGFß) gefärbt. Die Ergebnisse wurden dann zwischen den zwei Gruppen verglichen und in Relation zu den klinischen Befunden und Patienten-Charakteristika gesetzt. Der größte signifikante Unterschied zwischen den zwei Gruppen zeigte sich hinsichtlich des Fibringehalts. Die intrakoronaren Thromben der Patienten, die mit Clopidogrel behandelt worden waren, zeigten häufiger einen Fibrinanteil von über 50% der ausgewerteten Region im Vergleich zur Prasugrel Gruppe. Angesichts der klinischen Parameter, Risikofaktoren und weiteren Patientenmerkmale zeigten sich keine wesentlichen Unterschiede zwischen den zwei Gruppen, sodass diese Parameter als potenzielle Einflussfaktoren ausgeschlossen werden können. Wir konnten auch einen Trend zu einer erhöhten CD14 Prävalenz in der Clopidogrel Gruppe aufweisen. Wenn auch nicht signifikant erhöht, so spricht dieser Trend doch für eine gesteigerte inflammatorische Reaktion mit erhöhter Beteiligung von Monozyten und Makrophagen in der Clopidogrel-Gruppe. Die übrigen Biomarker zeigten keine signifikanten Unterschiede zwischen den zwei Behandlungsarmen in Bezug auf ihre Expression. Somit konnten wir zeigen, dass ein Kausalzusammenhang zwischen Prasugrel-Loading und geringerem Fibringehalt in intrakoronaren Thromben von STEMI-Patienten besteht und dass die Art der antithrombozytären Behandlung mit Prasugrel oder Clopidogrel einen direkten Einfluss auf die Thrombusarchitektur hat

Little SAC River Watershed: Bacterial Source Tracking Analysis

Agricultural and Food Policy, Environmental Economics and Policy,

A Study of Faunal Consumption at the Gallinazo Group Site, Northern Coast of Peru

This thesis is an investigation into consumption patterns at the Gallinazo Group archaeological site, from the Early Intermediate Period (200 B.C. to 800 A.D.), on the Peruvian north coast. Faunal samples were recovered from two different but contemporaneous contexts: a civic-ceremonial platform mound and an Architectural Compound in a residential sector. The main objectives were: 1) create a faunal database for the site; 2) assess the nature of faunal resources consumed in these two different contexts; and 3) contribute to the zooarchaeological literature on the use of consumption patterns to reconstruct aspects of ancient complex societies. For each specimen collected, the species, element, state of fusion, and length were recorded. Differences suggest that the nature of consumption activities varied in both areas of the site. Occupants were exploiting a range of ecological habitats and practiced camelid husbandry, suggesting that increased control and exploitation of their environment was connected to state-emergence

The skeletal carbonate contribution to mixed terrigenous-carbonate sediments on the temperate northeastern Northland continental shelf, New Zealand

The northeastern Northland continental shelf (NNCS) includes the coastal, shelf and uppermost slope seafloor out to depths of 210 m and over a distance of 150 km between North Cape and Ngurauru Bay slightly north of Whangarei. The nature of the surficial sediments covering NNCS is poorly known and this study uses archived and recently collected samples to begin to address this situation, with special attention to the nature and distribution of the skeletal carbonate fraction. The sediments are mainly neither carbonate-dominated as occurs in the Three Kings area immediately to the north, nor overwhelmingly terrigenous in nature as typifies more southern shelf sectors. Instead, mixed terrigenous-carbonate deposits prevail in an often patchwork mosaic distribution of facies. Carbonate content is often highest nearshore and in bays and harbours (50-80%), and generally decreases into deeper water (few-50%). The NNCS sediments are almost completely dominated by sand-sized components (60-90%) comprising gravelly sand, sand, muddy sand and gravelly muddy sand textures. A sedimentary facies model is developed for the NNCS identifying five different facies. Facies 1 is siliciclastic quartzofeldspathic sand with minor bivalve contributions, occurring only in the northern sector. Subfacies 1a (quartz>feldspar) occurs at inner- to mid-shelf depths and is mainly derived from reworked Quaternary Karioitahi Group sand deposits and/or podzolisation and reworking of local soils. Subfacies 1b (feldspar>quartz) occurs in mid- to outer-shelf depths and is derived from the erosion of a combination of the Quaternary sand deposits (Katioitahi Group), Mesozoic basement rocks and Northland volcanic and sedimentary rocks. Facies 2 comprises mixed barnacle-siliciclastic gravel and sand at inner-shelf to uppermost slope depths in the northern sector and includes submarine basaltic and type 1 sedimentary rock fragments derived from Mesozoic basement rocks and the Tangihua Complex of the Northland Allochthon. Facies 3 consists of mixed calcareous red algae and bivalve-siliciclastic gravel and sand at inner- to mid-shelf depths in the southern sector and involves a mix of relict and modern skeletal material and sedimentary rock fragments type 2 sourced from Tertiary deposits. Facies 4 is mixed foraminiferal-siliciclastic sand and mud and occurs only in the very southern sector in two subfacies. Subfacies 4a, a mixed benthic foraminiferal-siliciclastic sand, occurs in mid-shelf depths and comprises plagioclase dominated siliciclastic material sourced from Mesozoic basement rocks. Subfacies 4b, a mixed planktic foraminiferal-siliciclastic sand and mud, occurs in mid- to outer-shelf depths and comprises rock fragments derived from Tertiary deposits which could also be a local source of the reworked planktic foraminifera at these depths. Facies 5 consists of mixed bryozoan-siliciclastic sand at mid-shelf depths and in scattered locations across the NNCS associated with rocky outcrops for bryozoan attachment. Siliciclastic material comprises plagioclase sand sourced from reworking of Mesozoic basement rocks, and sedimentary rock fragments type 2 sourced from Tertiary sediments. The NNCS sedimentary facies model is compared with other temperate carbonate shelf models and carbonate-rich North Island shelf sectors, including Hauraki Gulf, Three Kings platform, north Kaipara continental margin and Wanganui shelf, which serves to both test and expand scenarios of cool-water carbonate sedimentation established for New Zealand. Overall, the mixed terrigenous-carbonate material on the NNCS comprises an often mosaic facies distribution with the skeletal fraction dominated by bivalve and barnacle fragments and a mixture of relict and modern material. These characteristics reflect several environmental controls, including (a) diversified substrate types (rock, shell, sand, mud); (b) variable supply and dispersal routes of terrigenous material linked to positions of hinterland estuaries/harbours and rocky versus sandy coastlines; (c) scattered and discrete areas of primary carbonate generation (the “carbonate factories”) and the subsequent selective transportation of skeletal grains; (d) local effects of nutrient-rich upwelling; and (e) the variable mix of relict and modern sediment associated with the post-glacial rise of sea level since about 20 ka

Adequate Access to Contraception and Sexual and Reproductive Health (SRH) Information Post-Abortion: A Case Study from Nepal

This qualitative, exploratory study examined the post-abortion experiences of Nepali women, and access and uptake of safe abortion services; unsafe abortion; post-abortion contraception; and sexual and reproductive health information. Analysis revealed themes relating to women’s abortion seeking decision-making processes and barriers to high quality safe abortion services and family planning counselling. Findings emphasised the interconnectivity of sexual and reproductive health and rights; gender discrimination, reproductive coercion; education; poverty; geographical isolation; spousal separation; and women’s empowerment

Smoke Signals: An Investigation of the Effects of Eco-stoves on Community and the Environment

The use of solid biomass fuels and the implementation of eco-stoves to mitigate its harmful effects has become a popular topic in discussions on global development. An article published on use of traditional fuels in The New Yorker reports, “A map of the world\u27s poor is easy to make…just follow the smoke.” Eco-stoves are now being constructed in impoverished communities around the world as an alternative to traditional stove models as a means to improve health and overall quality of life. Global Brigades, a sustainable development NGO, has been working in communities in rural Honduras to construct an eco-stove model called an Estufa Justa. This article pertains to a research project designed to evaluate household satisfaction with this new stove model, the stove\u27s efficiency, and the effect that installing these stoves has had on community dynamic. The methodology included a combination of qualitative and quantitative methods. Using the data obtained from this study, it can be concluded that the Global Brigades model is more efficient and has a higher satisfaction rate among users compared to the traditional fogón models currently in use and that the installation of stoves has had a positive impact on community dynamic

Sexual and reproductive health communication among Sudanese and Eritrean women: an exploratory study from Brisbane, Australia

This exploratory study piloted in Brisbane, Australia, reports on findings from in-depth focus-group discussions conducted with Sudanese and Eritrean women in Brisbane. We investigated and documented their experiences and knowledge of sexual and reproductive health and contraception, and explored their views on sexuality and relationships education within the family environment of minority ethnic communities in Australia. Underpinned by a qualitative psychosocial framework, the study also involved key-informant interviews with health and multicultural not-for-profit sector professionals. Through the knowledge and experiences shared by the participants, the key themes of cultural insensitivity, exclusion and poor communication within the family were highlighted by participants as determining factors in the achievement of sexual and reproductive health and good quality sex and relationships education. Participants proposed recommendations for how minority ethnic communities in Australia can more effectively support and communicate within the family environment to increase their own and their children's knowledge and understanding

Living it : children, young people, justice

Our main aim in editing this issue has been to create a space for those who had contact with the justice system as young people to share their experiences and reflections.This issue represents an attempt to shift power and control a bit from the professionals who usually edit these types of things, to people who have lived it

Commissioning of self-management support for people with long-term conditions: an exploration of commissioning aspirations and processes

Objectives: To explore how self-management support (SMS) is considered and conceptualised by Clinical Commissioning Groups (CCGs) and whether this is reflected in strategic planning and commissioning. SMS is an essential element of long-term condition (LTC) management and CCGs are responsible for commissioning services that are coordinated, integrated and link into patient's everyday lives. This focus provides a good test and exemplar for how commissioners communicate with their local population to find out what they need.Design: A multisite, quasi-ethnographic exploration of 9 CCGs.Setting: National Health Service (NHS) CCGs in southern England, representing varied socioeconomic status, practice sizes and rural and urban areas.Data collection/analysis: Content analysis of CCG forward plans for mention of SMS. Semistructured interviews with commissioners (n=10) explored understanding of SMS and analysed thematically. The practice of commissioning explored through the observations of Service User Researchers (n=5) attending Governing Body meetings (n=10, 30?hours).Results: Observations illuminate the relative absence of SMS and gateways to active engagement with patient and public voices. Content analysis of plans point to tensions between local aspirations and those identified by NHS England for empowering patients by enhancing SMS services (‘person-centred’, whole systems). Interview data highlight disparities in the process of translating the forward plans into practice. Commissioners reference SMS as a priority yet details of local initiatives are notably absent with austerity (cost-containment) and nationally measured biomedical outcomes taking precedence.Conclusions: Commissioners conceptualise locally sensitive SMS as a means to improve health and reduce service use, but structural and financial constraints result in prioritisation of nationally driven outcome measures and payments relating to biomedical targets. Ultimately, there is little evidence of local needs driving SMS in CCGs. CCGs need to focus more on early strategic planning of lay involvement to provide an avenue for genuine engagement, so that support can be provided for communities and individuals in a way people will engage with.<br/

Little SAC River Watershed: Bacterial Source Tracking Analysis

Data collected from November 2003 to October 2004 at two sites on the Little Sac River show that the whole body contact water quality criteria was not met during this period. The year was divided in four periods: winter, spring, summer, and fall. Averages and geometric means were above the 200 colonies/100 ml for any of the winter, summer, and fall periods at both sites.This material is based upon work supported by the Environmental Protection Agency, region VII through a grant entitled “DNA Source Tracking of Fecal E. Coli in the Little Sac River, Missouri,” (grant X7-98740401-0). Any opinions, findings, conclusions or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the U.S. Environmental Protection Agency