bluuebunny/crossref_metadata_2025 huggingface dataset:
Mini-Suffering State Examination: Suffering and Survival of End-of-Life Cancer Patients in a Hospice Setting
Authors: Adunsky Abraham , Zvi Aminoff Bechor , Arad Marina , Bercovitch Michaela
Published: December 2007

The objective of this study was to evaluate suffering of end-of-life cancer patients during their final hospice stay and the possible interrelations with survival. A cohort of consecutive patients hospitalized in an inpatient cancer hospice of a tertiary hospital was used for this study. Patients were evaluated upon admission and once weekly by the Mini-Suffering State Examination (MSSE). The distribution of patients for each MSSE score group, changes in MSSE scores (total and for each item of scale), and MSSE interrelation with clinical parameters associated with patients' condition during hospitalization were studied. In addition, the interrelation of MSSE score and survival was examined. Documentation of a high suffering level by the MSSE scale helps in identifying end-of-life cancer patients expected to benefit from enrollment in a hospice setting, provides quantitative information about various symptom dimensions, and may improve medical management and facilitate communication between these patients and caregivers.
Identification of Quality Indicators of End-of-Life Cancer Care From Medical Chart Review Using a Modified Delphi Method in Japan
Authors: Miyashita Mitsunori , Nakamura Asumi , Morita Tatsuya , Bito Seiji
Published: December 2007

End-of life care is one of the principle components of cancer care. Measurement of the quality of care provided for end-of-life cancer patients is an important issue. The aim of this study was to identify the quality indicators (QIs) for end-of-life cancer care for Japanese patients using a medical chart review. A modified Delphi method for the development of QIs was adopted. Seventeen multi-professional specialists participated by rating the appropriateness and feasibility of potential QIs. Thirty QIs for end-of-life cancer care were ultimately identified within 4 domains: (1) symptom control, (2) decision-making and preference of care, (3) family care, and (4) psychosocial and spiritual concerns. These QIs will be useful for monitoring and evaluating end-of-life care for Japanese cancer patients. The QIs are feasible for use in any clinical setting and cover a comprehensive area in accordance with the World Health Organization's (WHO) definition of palliative care including physical, psychosocial, and spiritual concerns.
Confronting Death: Perceptions of a Good Death in Adults With Lung Cancer
Authors: Hughes Travonia , Schumacher Mitzi , Jacobs-Lawson Joy M. , Arnold Susanne
Published: December 2007

Investigations regarding patients' concerns about death have focused on the importance of autonomy, resolution of concerns, family relationships, and religiosity, and relied on data from physicians, nurses, family members, and healthy older adults. Few studies have focused on patients with diseases that have short-term survival rates. This study examined lung cancer patients' perceptions of a good death. One hundred lung cancer patients answered open-ended questions about what a good death was and completed measures assessing coping, spirituality, religious coping, and life satisfaction. Content analysis revealed 4 themes describing a good death: (a) during sleep, (b) pain-free, (c) peaceful, and (d) quick. These findings have implications for those caring for terminally ill patients as the 4 themes differ from those derived from studies of more heterogeneous patients, their families, and health care providers.
A UK Perspective on Worldwide Inadequacies in Palliative Care Training: A Short Postgraduate Course Is Proposed
Authors: Charlton Rodger , Currie Andy
Published: December 2007

A chronological literature review illustrates how undergraduate and postgraduate education and training in the care of the dying and bereaved is inadequate worldwide. This is despite the foundation of the modern hospice movement in the United Kingdom in 1967 and its wider dissemination as a specialty in 1985. This situation has implications for those doctors working in both primary and secondary care, and this paper describes a 3-day course which has been successfully run in the West Midlands, UK, since 1997 for family physicians in training. A pre-course survey of 250, with a response rate of 54%, in 2003 revealed that 100% of respondents felt that they needed further training, and 51.5% said that they had had no previous training in palliative care.
Monitoring of Functional Plasminogen in the Blood of Patients on Fibrinolytics
Authors: Stief Thomas W. , Richter Anette , Maisch Bernhard , Renz Harald
Published: December 2007

There are no reliable data on functional plasminogen in the blood of patients receiving fibrinolytic treatment. Here, artifactual in vitro changes of functional plasminogen were prevented by arginine stabilization blood samples of myocardial infarction patients: 12 received 36.4 mg reteplase in bolus, and 1 patient received 100 mg tissue plasminogen activator in continuous infusion. Arginine (1.5 M, 1.3 mL, pH 8.7) was used to stabilize 2.6 mL ethylenediaminetetraacetic acid-blood. The arginine-stabilized plasma was analyzed with a functional oxidative assay for plasminogen. Functional plasminogen decreased within 2 minutes of reteplase treatment by about 40% and by about 80% after 60 minutes. Lowest plasminogen concentrations were found in plasmas with highest plasmin activities. Chloramine oxidation of purified Glu-plasminogen increased its activation by urokinase up to 3-fold. Arginine stabilization allows reliable determinations of functional plasminogen in the blood of patients receiving fibrinolytics, enabling the rapid diagnosis of prothrombotic plasminogen consumption. The present findings support the profibrinolytic action of chloramines.
Recurrent Abortions in Asian Indians: No Role of Factor V Leiden Hong Kong/Cambridge Mutation and MTHFR Polymorphism
Authors: Biswas Arijit , Choudhry Priya , Mittal Anuradha , Meena Arvind , Ranjan Ravi , Choudhry V.P. , Saxena Renu
Published: December 2007

Recurrent fetal loss is a frequent health problem. Data accumulated over the past few years have suggested a possible correlation between thrombophilia and fetal loss. Although a clear association has been established between fetal loss and certain thrombophilic states, such as antiphospholipid antibody syndromes, antithrombin deficiency, and combined defects, reports on the prevalence of inherited prothrombotic defects such as factor V Leiden mutation and methylene tetrahydrofolate reductase C677T polymorphism in fetal loss are contradictory. The prevalence of these 2 mutations in Asian Indians with recurrent fetal loss has not yet been studied. In light of this, the present study looked at the prevalence of these mutations in 85 patients with spontaneous recurrent abortion and 31 controls. The authors did not find any significant role of these mutations in the development of recurrent abortion.
Further Insight Into the Heparin-Releasable and Glycosylphosphatidylinositol-Lipid— Anchored Forms of Tissue Factor Pathway Inhibitor
Authors: Ellery Paul E.R. , Hardy Kathy , Oostryck Robert , Adams Murray J.
Published: December 2007

The release of tissue factor pathway inhibitor (TFPI) from human umbilical vein endothelial cells (HUVECs) was investigated using heparin and phospholipase C. The experiment included incubating HUVECs with 0, 1, or 10 U/mL heparin diluted in Dulbecco Modified Eagle's Medium plus 5% fetal calf serum for 1 or 24 hours. A statistically significant increase in TFPI activity levels was seen at 1 hour, but not at 24 hours. A 20-fold increase in the release of TFPI after phospholipase C treatment of HUVECs was demonstrated, confirming that it is glycosylphosphatidylinositol-lipid (GPI) anchored. Sequential treatment of HUVECs with phospholipase C and heparin was performed, and a trend was observed where GPI-anchored TFPI levels were increased after 1 hour of pretreatment with heparin but were decreased after 24 hours. Serum is a requirement for the heparin-dependent release of TFPI from HUVECs. Heparin pretreatment of HUVECs may affect levels of GPI anchored TFPI in a time and dose-dependent manner.
Heparin-Induced Thrombocytopenia Complicating Hemodialysis
Authors: Barginear M.F. , Donahue L. , Allen S.L. , Budman D.R. , Bradley T. , Bhaskaran M. , Shapira I.
Published: December 2007

Hemodialysis complicated by heparin-induced thrombocytopenia (HIT) is a rare event requiring anticoagulation with direct-thrombin inhibitors. Contaminant calcific uremic arteriolopathy (calciphylaxis) further complicates this situation due to the possibility that warfarin anticoagulation may exacerbate skin necrosis. The authors report a patient with renal failure and calciphylaxis who developed HIT after starting hemodialysis. She was successfully treated with Argatroban.
Pleiotropic Effects of Heparin and Heparinoids in Peritoneal Dialysis
Authors: Gozdzikiewicz Joanna , Borawski Jacek , Mysliwiec Michal
Published: December 2007

Unfractionated heparin, low-molecular-weight heparins, and sulodexide belong to the family of glycosaminoglycans. Recent studies report on properties other than anticoagulant activities of these medications. They include modulation of cell growth and proliferation via actions on numerous growth factors affecting the immune system and matrix molecules production and degradation. Long-term peritoneal dialysis remarkably influences peritoneal cavity homeostasis by mechanisms mediated by growth factors. They initiate progression of pathological processes and further account for morphological and functional alterations of the peritoneal membrane. The best-recognized pathologies in peritoneal cavity under these conditions encompass inflammation, fibrosis, and vasculopathy, often leading to fatal encapsulating peritoneal sclerosis. Intraperitoneal heparin and its derivatives, by their pleiotropic actions, may influence these crucial processes and improve the peritoneal dialysis technique survival in a complex and so far understudied way. These issues, novel medical approaches, and their likely mechanisms have been reviewed.
Ocular Vascular Thrombotic Events: Central Retinal Vein and Central Retinal Artery Occlusions
Authors: Glueck Charles J. , Ping Wang  , Hutchins Robert , Petersen Michael R. , Golnik Karl
Published: December 2007

We prospectively assessed associations of thrombophilia— hypofibrinolysis with central retinal vein occlusion (CRVO) (40 patients) and central retinal artery occlusion (CRAO) (9 patients). We used polymerase chain reaction measures for thrombophilia (factor V Leiden, prothrombin, C677T MTHFR, platelet glycoprotein PlA1/A2) and hypofibrinolysis (plasminogen activator inhibitor-1 4G4G). Serologic thrombophilia measures included protein C, protein S (total and free) and antithrombin III, homocysteine, lupus anticoagulant, anticardiolipin antibodies IgG-IgM, and factors VIII and XI. Serologic hypofibrinolysis measures included Lp(a) and plasminogen activator inhibitor activity. For comparison with 40 CRVO and 9 CRAO patients, 80 and 45 race—gender matched controls were studied. The factor V mutation was more common in CRVO (3/40, 8%) than controls (0/79, 0%), P = .036, as was high (>150%) factor VIII (12/40, 30%) versus (4/77, 5%), P = .0002. Low antithrombin III (<80%) was more common in CRVO (5/39, 13%) than in controls (2/73, 3%), P = .049. Homocysteine was high (≥13.5 µmol/L) in 5/39 (13%) CRVO patients versus 2/78 controls (3%), P = .04. Three of 9 CRAO patients (33%) had low (<73%) protein C versus 2/37 controls (5%), P = .044. Two of 9 CRAO patients (22%) had high (≥13.5 µmol/L) homocysteine versus 0/42 controls (0%), P =. 028. Four of 9 CRAO patients had the lupus anticoagulant (44%) versus 4/33 (12%) controls ( P = .050). CRVO is associated with familial thrombophilia (factor V Leiden, factor VIII, low antithrombin III, homocysteinemia), and CRAO is associated with familial and acquired thrombophilia (low protein C, homocysteinemia, lupus anticoagulant), providing avenues for thromboprophylaxis, and triggering family screening.
The Effect of Plasminogen Activator Inhibitor-1 −675 4G/5G Polymorphism on PAI-1 Gene Expression and Adipocyte Differentiation
Authors: Ozel Demiralp Duygu , Aktas Huseyin , Akar Nejat
Published: December 2007

Obesity is a complex, multifactorial chronic disease frequently associated with cardiovascular risks, hypertriglyceridemia, low high-density lipoprotein-cholesterol, high blood pressure, and the insulin resistance that appears to be central to the pathogenesis of Type II diabetes. Plasminogen activator inhibitor-1 expression induced in differentiating adipose tissue, but its role in adipogenesis and obesity is poorly understood. Circulating plasminogen activator inhibitor-1 levels are elevated at an early stage of impaired glucose tolerance, resulting in diabetes and metabolic syndrome. Plasminogen activator inhibitor-1 levels are also significantly elevated in the plasma of obese individuals and in adipose tissues of obese mice and humans. Some investigators proposed that the −675 4G/5G polymorphism in plasminogen activator inhibitor-1 promoter caused overexpression of this gene and predisposed carriers to obesity. In this study, we investigated the role of −675 4G/5G polymorphism in plasminogen activator inhibitor-1 promoter in the expression of this gene and the contribution of plasminogen activator inhibitor-1 to adipogenesis. Using a dualluciferase promoter assay, we determined that the −675 4G/5G polymorphism contributes significantly to overexpression of plasminogen activator inhibitor-1 in the course of adipogenesis. The antidiabetic agents troglitazone and ciglitazone inhibited reporter gene expression driven by wild-type and −675 4G/5G mutant promoter, as well as the expression of endogenous plasminogen activator inhibitor-1, indicating that suppression of plasminogen activator inhibitor-1 expression may contribute to antidiabetic effects of these agents. The results indicate that absence of plasminogen activator inhibitor-1 in adipocytes may protect the cells against insulin resistance by promoting glucose uptake and adipocyte differentiation via a decrease in the peroxisome proliferator activated receptor-gamma expression that modulates the adipocyte differentiation.
Adipokines, Linking Adipocytes and Vascular Function in Hemodialyzed Patients, May Also Be Possibly Related to CD146, a Novel Adhesion Molecule
Authors: Malyszko J. , Malyszko J.S. , Kozminski P. , Pawlak K. , Mysliwiec M.
Published: December 2007

Possible correlations between adiponectin, leptin, CD146, a novel adhesion molecule localized at the endothelial junction, and other markers of endothelial cell injury, von Willebrand factor, thrombomodulin, vascular cell adhesion molecule, and intracellular adhesion molecule, and markers of inflammation, tumor necrosis factor-α, interleukin-6, and high-sensitivity C-reactive protein in nondiabetic hemodialyzed patients with and without coronary artery disease were studied. Markers of endothelial dysfunction were elevated in hemodialyzed patients, predominantly with coronary artery disease. In multivariate analysis, kinetic urea modeling and plasminogen activator inhibitor-1 remained the only positive predictors of adiponectin. In multivariate analysis, predictors of leptin were triglycerides, tissue plasminogen activator, CD146, and coronary artery disease. In multivariate analysis, predictors of CD146 were age, hemoglobin, and adiponectin. Elevated adiponectin correlated to CD146 may be the expression of a counterregulatory response aimed at mitigating the consequences in endothelial damage and increased cardiovascular risk in renal failure. The data provide further support for a link between adipocytokines, endothelial dysfunction, cardiovascular risk, and renal failure.
The Role of Plasminogen Activator Inhibitor-1 Polymorphism, Factor-V-Leiden, and Prothrombin-20210 Mutations in Pulmonary Thromboembolism
Authors: Oguzulgen I. Kivilcim , Demirtas Senay , Erkekol Ferda Oner , Ekim Numan , Demir Nalan , Numanoglu Numan , Ozel Duygu , Ulu Arzu , Akar Nejat
Published: December 2007

Polymorphism in plasminogen activator inhibitor-1 gene is suggested to be associated with an increased risk of venous thromboembolism. The aim of this study was to investigate the association of plasminogen activator inhibitor-1 gene polymorphism and its coexistence with factor-V-Leiden and prothrombin-20210 mutations in pulmonary thromboembolism. The authors investigated plasminogen activator inhibitor-1 4G/5G polymorphism, factor-V-Leiden, and prothrombin-20210 mutations in 143 pulmonary thromboembolism patients and 181 controls. Plasminogen activator inhibitor-1 4G/4G, 4G/5G, and 5G/5G gene polymorphisms and prothrombin-20210 mutations were not different between cases and controls. Factor-V-Leiden mutation was present in 21.0% and 7.7% of the cases and controls, respectively, P = .001. Neither different plasminogen activator inhibitor-1 genotypes and 4G allele nor coexistence of the allele with factor-V-Leiden or prothrombin-20210 was associated with the risk of recurrence. As a result, plasminogen activator inhibitor-1 gene polymorphism or its concomitant presence with mentioned mutations was not found to be associated with increased risk for pulmonary thromboembolism or recurrent disease in this study.
The Effect of ABO Blood Group on von Willebrand Response to Exercise
Authors: Ribeiro Jerri L. , Salton Gabriele D. , Bandinelli Eliane , Oliveira Alvaro R. , Roisenberg Israel
Published: December 2007

Individuals of O blood group have significantly lower plasma levels of either Factor VIII (FVIII) or the von Willebrand factor (vWF). Conversely, there is accumulating evidence that elevated FVIII—vWF levels may represent an important risk factor for ischemic heart and venous thromboembolic disease. In this study, individuals exercised for 20 minutes at 10% below the first ventilatory threshold (aerobic threshold), which corresponds to 48% of maximum oxygen uptake. People with non-O blood group show higher resting and postexercise vWF levels compared with those of O blood group, as evidenced by a lower maximal heart rate. The groups were compared using the ANOVA one-way test, and a P < 0.05 was considered statistically significant. These results could change the way in which exercise training is designed for both healthy and sick individuals because O group individuals could have a more thrombogenic response to exercise.
Platelet Adhesion Testing May Predict Early Hemodialysis Arteriovenous Graft and Fistula Failure in End-Stage Renal Disease Patients
Authors: ElChoufani Samer E. , Bolin Paul , Waien Saiqua , Christiano Cynthia R. , Holbert Donald , Bode Arthur P.
Published: December 2007

Vascular access thrombosis (VAT) is the most morbid and costly complication in end-stage renal disease (ESRD) patients. Although hypercoagulability is a major risk factor for VAT, in most patients, the cause of hypercoagulability cannot be identified despite clinical suspicion. In this study, platelet hyperreactivity was investigated for a possible role in the hypercoagulability of ESRD and VAT in 42 patients with arteriovenous (AV) grafts or fistulas. Platelet adhesion, platelet aggregation, and the history of VAT were assessed. The statistics included a nonparametric 2-factor ANOVA, a Mann-Whitney analysis, and a Kaplan-Meier analysis of hemodialysis angioaccess survival to examine platelet hyperadhesiveness as a predictor of access survival. The study showed a significant correlation between increased platelet adhesiveness and shortened survival of the primary hemodialysis angioaccess. Collagen-induced platelet aggregation reflected a significantly higher response in those with shortened access survival. These findings may have significant clinical implications for risk assessment and prevention of VAT.
Platelet Aggregation and Activation in Thalassemia Major Patients in Indonesia
Authors: Setiabudy Rahajuningsih , Wahidiyat Pustika Amalia , Setiawan Lyana
Published: December 2007

Thromboembolic events and hypercoagulable state have been reported in patients with thalassemia. As platelets play an important role in the pathogenesis of thrombosis, the authors aimed to find the pattern of changes in platelet count, function and activation, and evidence of coagulation activation in patients with thalassemia major in Indonesia. A total of 31 patients with splenectomized and 35 patients with nonsplenectomized thalassemia major were enrolled in this study. Platelet count, platelet aggregation, β-thromboglobulin, and D-dimer levels were measured. All measured parameters were significantly higher in splenectomized than in nonsplenectomized patients. β-thromboglobulin level was increased, but D-dimer level was within normal range. The authors concluded that there was an increase in platelet activation in patients with β-thalassemia major. Platelet activation was higher in splenectomized than in nonsplenectomized patients.
The Importance of Thrombotic Risk Factors in the Development of Idiopathic Sudden Hearing Loss
Authors: Yildiz Zuleyha , Ulu Arzu , Incesulu Armagan , Ozkaptan Yalcin , Akar Nejat
Published: December 2007

Impaired cochlear blood circulation has been suggested to cause sudden hearing loss. In this study, the role of factor V 1691 G-A (FV 1691 G-A), prothrombin 20210 G-A (PT 20210 G-A), methylene tetrahydrofolate reductase 677 C-T (MTHFR 677 C-T), factor V 4070 A-G (FV 4070 A-G), endothelial cell protein C receptor (EPCR) gene 23-bp insertion, and plasminogen activator inhibitor-1 (PAI-1) 4G/5G mutation was assessed. Fifty-three patients with idiopathic sudden sensorineural hearing loss and 80 individuals comprising the control group were included in this study. The frequency for FV 1691 A was 6.2% in the patient group and 3.7% in the control group, PT 20210 G-A was 1.2% in the patient group and 1.9% in the control group, and FV 4070 A-G was 7.5% in the patient group and 11.3% in the control group. The frequency of MTHFR 677 C-T was significantly higher in the patient group than in the control group, with a P value of .03. PAI-1-675 4G/5G polymorphism was found to be 71.2% and 69.8%, in the control group and the patient group, respectively. The EPCR 23-bp insertion was 0% in the control group and was found in 3 patients (3.7%), which needs further study.
Factor V Leiden, Prothrombin G20210A, and Protein C Mutation Frequency in Turkish Venous Thrombosis Patients
Authors: Altinisik Julide , Ates Omer , Ulutin Turgut , Cengiz Mujgan , Buyru Nur
Published: December 2007

Several inherited polymorphisms are associated with risk of venous thrombosis, including mutation at codon 506 of the factor V gene, mutation at position 20210 of the prothrombin gene, and mutations in the protein C gene. In this study, genotyping for factor V, prothrombin, and protein C mutations was performed in 50 patients and 25 control subjects by polymerase chain reaction—based analysis. The prevalence of factor V and prothrombin mutations was not significantly different from that in the general population. Nine of the patients had heterozygous protein C mutation. There was a high prevalence of the mutated protein C allele in the pulmonary emboli group (42.8%). Protein C mutation incidence was higher in the pulmonary emboli group than in the deep vein thrombosis (8.33%) and cerebral vein thrombosis (16.1%) groups. These results indicate that patients with protein C deficiency have a greater risk of thrombosis than patients with factor V or prothrombin G20210A mutation.
Aspirin-Resistance Frequency: A Prospective Study in 280 Healthy Turkish Volunteers
Authors: Akay O. Meltem , Canturk Zerrin , Akin Enver , Bal Cengiz , Gulbas Zafer
Published: December 2007

This study reports the frequency of aspirin resistance and its correlation with clinical and biochemical parameters among 280 healthy Turkish volunteers (179 men, 101 women) who were taking 100 mg of aspirin 7 days or more. Aspirin resistance was detected by optical platelet aggregometry, using adenosine diphosphate and arachidonic acid, and defined as a mean aggregation of 64% or more with 5µM adenosine diphosphate and a mean aggregation of 20% or more with 0.5-mg/mL arachidonic acid. Of the study population, 27.5% (26 women [25.5 %] and 51 men [28.5 %]) were aspirin resistant. The current findings indicate that aspirin resistance is an important and real laboratory diagnosis given its frequency of 27.5% in the study population. These results of this large trial evaluating the frequency of aspirin resistance in healthy subjects indicate that aspirin resistance should be diagnosed so that individuals with no response can receive alternative or additional antiplatelet therapy.
Activated Protein C Resistance and Factor V Leiden in Mexico
Authors: Majluf-Cruz Abraham , Moreno-Hernández Manuel , Ruiz-de-Chávez-Ochoa Adriana , Monroy-García Rosario , Majluf-Cruz Karim , Guardado-Mendoza Rodolfo , Molina-Ávila Irma , Isordia-Salas Irma , Corona-de la Peña Norma , Vargas-Vorackova Florencia , Vela-Ojeda Jorge , García-Chávez Jaime
Published: December 2007

A common cause of hereditary thrombophilia is activated protein C resistance (APCR), and most cases result from factor V Leiden mutation. An APCR phenotype without association with factor V Leiden has been described. This transversal, observational, nonrandomized study evaluated these 2 phenomena in healthy indigenous and mestizo Mexican subjects (n = 4345), including 600 Mexican natives. No indigenous subjects had APCR, but 82 mestizo subjects did. After retesting, 50 subjects had a negative test. The remaining 32 subjects had factor V Leiden, giving a 0.85% prevalence of factor V Leiden in the mestizo Mexican population. Only 31% of APCR carriers had factor V Leiden. These results show a very low prevalence of APCR and factor V Leiden in Mexico. Except for factor V Leiden, there are no other mutations in the factor V gene responsible for the APCR phenotype. Acquired APCR is nearly twice as prevalent as the inherited variant.
Kallikrein Activates Prothrombin
Authors: Stief Thomas W.
Published: December 2007

Kallikrein is a multitalented enzyme in hemostasis and inflammation. Normally, kallikrein is formed in intrinsic hemostasis and activates factor XII. A total of 10 µL of 0 to 100 µg/mL human plasma kallikrein in 6% human albumin—PBS were incubated with 90 µL 111.1 µg/mL prothrombin in 6% human albumin in absence and presence of 23 mM Ca++. After 0 to 64 minutes (37°C), 100 µL of 2.5 M arginine, pH 9, were added. Fifty microliters of 0.72 mM HD-CHG-Ala-Arg-pNA in 1.36 M arginine were added and increase in absorbance at 405 nm was determined. Within 8 minutes (37°C), 1 µg/mL kallikrein, ie, 2.5% of the normal plasmatic prekallikrein concentration, generates approximately 3 mIU/mL thrombin in absence and 27 mIU/mL thrombin in presence of Ca++. Kallikrein can directly activate prothrombin; there is a shortcut in the intrinsic hemostasis system that generates catalytic amounts of thrombin without following the known intrinsic clotting pathway.
The Impact of an Aging Population on the Diagnosis of Pulmonary Embolism: Comparison of Young and Elderly Patients
Authors: Castelli Robert , Bergamaschini Luigi , Sailis Patrizia , Pantaleo Giuseppe , Porro Fernando
Published: December 2007

The influence of age on predisposing factors, diagnostic tests, and clinical presentation of pulmonary embolism was evaluated in 582 subjects with suspected pulmonary embolism (180 aged <65 years; 402 aged ≥65 years) consecutively enrolled at the Emergency Department. Pulmonary embolism was confirmed in 40% of patients, 75% of those were aged >65 years. Age was directly related to the diagnosis, and the observed probability was higher than the expected probability in the 70 to 79 year subgroup. Score at the Cumulative Illness Rating Scale significantly increased as a function of both age and pulmonary embolism. Dyspnea, syncope, jugular distension, and history of previous venous thromboembolism were more frequently observed in elderly patients. In-hospital mortality rate among the elderly and younger patients was 2% and 0.2%, respectively. The authors conclude that age ≥65 years and high comorbidity are risk factors for pulmonary embolism.
Use of Recombinant Activated Factor VII to Arrest Uncontrolled Bleeding: A Case Series
Authors: Alsayegh Faisal , Fakeir Aisha , Alhumood Salah , Abdumalek Kefaya , Matar Hatem , Samaul Isaac , Nampoory Narayanan , Kabalawi Housam , Mousa Shaker A.
Published: December 2007

A retrospective analysis is described to assess the effects of using recombinant activated factor VII to control bleeding in a series of patients who had failed to respond to conventional hemostatic measures. In all, 18 patients (aged 16-65 years) with a range of conditions resulting in bleeding refractory to conventional methods of control were treated with recombinant activated factor VII (60-120 μg/kg; 1-4 doses). The effects of recombinant activated factor VII on bleeding were noted together with the patients’ transfusion requirements and hematological parameters. Administration of recombinant activated factor VII successfully stopped bleeding in 17 of the 18 patients. Therapy with recombinant activated factor VII significantly decreased transfusion requirements for packed red blood cells, fresh frozen plasma, platelets, and cryoprecipitate compared with pretreatment values along with significant improvement in hemostasis. In various serious bleeding situations, treatment with recombinant activated factor VII may effectively arrest bleeding, which has remained refractory to conventional methods of control.
Further Removal of Factor V Related Antigen From Bovine Thrombin by Utilizing a Membrane-Filtration Step
Authors: Terrab Abdel , Pawlak Dan , Spaay Pat , Hoppensteadt Debra , Fareed Jawed
Published: December 2007

Topical bovine thrombin is commonly used during surgery to maintain hemostasis and is rarely associated with abnormalities in hemostasis, including coagulopathies and bleeding. Coagulopathies may be related to the formation of cross-reactive antibodies to bovine factor V. Effectiveness of a new filtration step to remove factor V/Va from bovine thrombin was evaluated. A highly sensitive and specific Western blot capable of detecting minute amounts of factor V/Va and/or its fragments was developed. Samples were evaluated for bovine factor V related antigens using the Western blot method and a competitive enzyme-linked immunosorbent assay. Factor Va light chain fragment levels were detectable in crude thrombin and chromatographically purified thrombin but not in chromatographically purified and virally filtered preparations. Therefore, inclusion of the viral-filtration step during purification of thrombin is effective in reducing factor V or its fragments to undetectable levels, thus enhancing product purity.
Evolution of Prenatal Diagnostic Techniques From Phenotypic Diagnosis to Gene Arrays: Its Likely Impact on Prenatal Diagnosis of Hemophilia
Authors: Ghosh Kanjaksha , Shetty Shrimati , Tulsiani Mukesh
Published: December 2007

Prenatal diagnostic techniques in hemophilia have evolved through the early sex-determination techniques of offering a nonspecific diagnosis in case of a male fetus through the various mutation screening techniques to the more recent gene array techniques. Each of these techniques has specific advantages and disadvantages. The sampling techniques have evolved simultaneously to suit the requirements of each technique and also the different gestation periods. The DNA-based testing methods provide a range of aberrations detected with different levels of genomic resolution. The more recent gene array analysis is poised to have substantial impact on prenatal diagnosis of hemophilia not only in studying the highly heterogeneous mutations but may also be useful in studying the effect of various ameliorating or epistatic genetic mutations/ polymorphisms simultaneously, providing a wide range of options to the prenatal diagnosis experts, the genetic counselors, and the couples opting for prenatal diagnosis.
Factor VIII Gene Haplotypes and Linkage Disequilibrium for the Indirect Genetic Analysis of Hemophilia A in India
Authors: Singh Monica , Singh Puneetpal
Published: December 2007

Genomic consequences of factor VIII gene haplotypes for the indirect genetic analysis of haemophilia A has not been done in India hitherto. Consequently, BclI/intron18, HindIII/intron 19, and XbaI/intron 22 restriction sites were investigated in 159 individuals from 42 families with hemophilia A. The frequencies of haplotype II, IV, VI, that is, BclI (+)- HindIII (−)- XbaI (+), BclI (+) HindIII (+)- XbaI (−), and BclI (−)- HindIII (−)- XbaI (+) were 0.312, 0.198, and 0.164 respectively. The high heterogeneity of haplotype II highlighted its potential for indirect genetic diagnosis of factor VIII. Analysis revealed strong but incomplete linkage disequilibrium (D′ = 0.76, 0.68, and 0.51) between BclI/ HindIII, HindIII/ XbaI, and BclI/ XbaI, respectively. The overall cumulative polymorphism information content (PIC) of these three markers increased from 0.36 to 0.80. Escalation of PIC up to 80% in the present study suggests that haplotyping of factor VIII gene determines better prognosis in the direction of indirect genetic analysis of hemophilia A.
Is There Any Effect of Tumor Burden on Hemostatic Parameters in Cancer Patients? A Case—Control Study of Hemostatic Abnormalities and Anticardiolipin Antibodies in Solid Tumors
Authors: Turna Hande , Ozguroglu Mustafa , Bolayirli Murat , Orhanoglu Timur , Balci Huriye
Published: December 2007

Hemostatic complications are one of the leading causes of mortality in cancer patients. In the present study, we assessed the hemostatic parameters and anticardiolipin antibodies in patients with solid tumors (n = 104) and healthy controls (n = 25) and also find out whether the abnormalities in these hemostatic parameters vary related to tumor burden. Prothrombin time, activated partial thromboplastine time, D-dimer, and fibrinogen as hemostatic parameters were determined by photo-optometric clot detection system, and serum anticardiolipin levels were measured by enzyme-linked immunosorbent assay. The plasma levels of fibrinogen, D-dimer, and serum anticardiolipin IgM levels in cancer patients were significantly higher compared with those in controls ( P < .001, P = .001, and P = .01, respectively). Only fibrinogen levels were significantly higher in metastatic group than nonmetastatic group ( P < .001 ). Hemostatic abnormalities that are detected in asymptomatic cancer patients may not give any clue about tumor burden or stage of the cancer patients.
Management of Uremic Patients With Heparin-Induced Thrombocytopenia Requiring Hemodialysis
Authors: Matsuo Takefumi , Wanaka Keiko
Published: December 2007

Medical records of 122 patients with suspected heparin-induced thrombocytopenia on dialysis were reviewed. Method of dialysis in heparin-induced thrombocytopenia patients with bleeding from various causes (including surgical interventions) and how to cope with blood access occlusion induced by heparin-induced thrombocytopenia were studied. Of 122 patients, 17 who met the criteria of >30% thrombocytopenia, clots in the extracorporeal circulation, positive for heparin/PF4 complex antibodies, and improvement from heparin-induced thrombocytopenia with the use of an alternative anticoagulant or another strategy for heparin-induced thrombocytopenia were chosen. Argatroban was uneventfully introduced in 12 patients having neither bleeding nor blood access failure. In all, 2 of 5 patients were treated with peritoneal dialysis. The others requiring a regional anticoagulant were given nafamostat mesilate. Argatroban as an alternative provides effectively anticoagulation in patients with heparin-induced thrombocytopenia on dialysis. In patients with heparin-induced thrombocytopenia with bleeding and its associated risk, nafamostat mesilate was an alternative. Peritoneal dialysis also was applied in cases of blood access failure due to heparin-induced thrombocytopenia.
PIA1/A2 Polymorphism of the Platelet Glycoprotein Receptor IIb/IIIIa and Its Correlation to Cerebrovascular Diseases: An Appraisal
Authors: Wiwanitkit Viroj
Published: December 2007

Platelet glycoprotein (GP) IIb/IIIa is a membrane receptor for fibrinogen and von Willebrand factor. There is considerable controversy regarding the clinical role of the GP IIb/IIIa PIA1/A2 as a risk factor of cerebrovascular diseases. Here, the author performs a summative analysis on the recent previous reports on the GP IIb/IIIa PIA1/A2 and its correlation to cerebrovascular diseases. The metanalysis was performed to assess the correlation between the pattern of GP IIb/IIIa PIA1/A2 polymorphism and cerebrovascular diseases. From available 4 case-control studies, 553 patients and 1059 controls are evaluated. From overall risk estimation, the subjects with PIA2 alleles have 1.18 times higher risk to develop cerebrovascular diseases. According to this analysis, the author proposes that the pattern of GP IIb/IIIa PIA1/A2 polymorphism does not represent a useful marker of increased risk for cerebrovascular diseases. The lack of association between pattern of GP IIb/IIIa PIA1/A2 polymorphism and ethnicity can also be showed in this study.
The QIO Program, Home Health, and the National Acute Care Hospitalization Priority
Authors: Essey Marian
Published: December 2007

The Centers for Medicare & Medicaid Services (CMS), previously the Health Care Financing Administration (HCFA), an agency of the U.S. Department of Health and Human Services, has been committed to improving the quality of care to Medicare beneficiaries since the inception of the Medicare Program. This commitment is evident in the Quality Improvement Organization (QIO) Program. In 2003, the QIOs worked to promote public reporting and the Home Health Compare Web site and improving the performance on publicly reported quality measures. Beginning in 2005, the QIO work in home health expanded to include adult immunizations, telehealth, and organizational culture. Currently, the QIOs primarily focuses efforts on the home health national-priority topic of reducing avoidable hospitalizations as measured by the publicly reported measure of acute care hospitalization or ACH. The focus on reducing avoidable hospitalizations became heightened with the yearlong Home Health Quality Improvement National Campaign, which began in January 2007.
Improvement in the Management of Oral Medications: Collaborative Approaches
Authors: Kerns Bonnie , Atkinson Wayne , Niewenhous Susan S.
Published: December 2007

This article describes two collaborative approaches that have proven to be effective in improving oral medication management in the home care setting. The first approach to be discussed is one that began with the introduction of best practice tools and supporting resources through the Quality Medication Administration Project collaborative. A case study highlights the experience of a home health care agency in the implementation of the Q-MAP tools and resources. The second approach describes a pharmacist's perspective of a patient-centered medication therapy program that promotes direct collaboration between home health agencies and qualified pharmacists. This article developed by a team of authors provides approaches and application examples to present a broad picture of the initiative.
Fall Risk Assessment & Prevention in Home Care
Authors: Krulish Linda H. , Anemaet Wendy K.
Published: December 2007

Falls happen. Fortunately, there are usually no serious consequences in the general population. However, when looking at the microcosm of the older person, falls frequently occur and are often life changing. In the home care world, where the majority of patients are either older and/or infirmed, falls are even more frequent and result in serious consequences to patients and their families. Although the impact of falls on patients is well documented, the impact of falls on home health providers is more indirect and deserves discussion.
How Do We Know It's Working? Effective Intervention Monitoring
Authors: Higgins Caroline (Carol)
Published: December 2007

Home health agencies across the United States have been exploring techniques to reduce acute care hospitalizations. Many are promoting change in staff behaviors to implement best practice interventions. The frequently overlooked component of this change process is monitoring to ensure the interventions are being implemented and the changes are leading to improvements. In this article, the components of balanced intervention monitoring, including process and outcome, are provided with examples and rationale.
Data Management in Home Care: Using Data to Drive Acute Care Hospitalizations
Authors: Hunt Sean
Published: December 2007

Data analysis and quality improvement activities in the home health industry are essential to achieving and maintaining the level of quality expected for each and every patient. Medicare-certified home health agencies have access to a wide variety of patient data and other quality indicators, which can form the foundation for proactive process improvement. This article provides a brief review of the available home health data, followed by two agency case studies demonstrating radically different approaches to using available data to improve their patient outcomes, including reducing avoidable hospitalizations.
Patient Emergency Planning & Teletriage: The ACH Reduction Connection
Authors: Sanderson Sandy , Anderson Donna , Dugan Laura
Published: December 2007

Patient-centered emergency planning is a multifaceted process that begins with the completion of an acute care hospitalization (ACH) risk assessment that provides for the identification of patients at risk for rehospitalization. Once a patient is identified as high risk, an emergency plan of care must then be collaboratively developed based on the findings from the assessment, followed by the effective triage of incoming calls from patients/caregivers. This article discusses the fundamentals of this triad: ACH risk assessment, emergency planning, and teletriage. The experiences of two home care agencies in two different states of the United States that have implemented these interventions is also shared.
Language, Meaning, and Social Cognition
Authors: Holtgraves Thomas M. , Kashima Yoshihisa
Published: December 2007

Social cognition is meant to examine the process of meaningful social interaction. Despite the central involvement of language in this process, language has not received the focal attention that it deserves. Conceptualizing meaningful social interaction as the process of construction and exchange of meaning, the authors argue that language can be productively construed as a semiotic tool, a tool for meaning making and exchange, and that language use can produce unintended consequences in its users. First, the article shows a particular instance of language use to be a collaborative process that influences the representation of meaning in the speaker, the listener, and the collective that includes both the speaker and listener. It then argues that language use and social cognition may have reciprocal effects in the long run and may have significant implications for generating and maintaining cultural differences in social cognition.
Conceptualizing the Participation of Managers in Career-Focused Learning and Development: A Framework
Authors: Carbery Ronan , Garavan Thomas N.
Published: December 2007

Protean, boundaryless, authentic, and portfolio careers increasingly challenge managers to be proactive and self-regulated. Managers are expected to manage their careers, develop employability, and continually learn. This article proposes a conceptual framework to explain manager participation in career-focused learning and development. It proposes that participation by managers in career-focused learning and development should be understood in terms of the relationship between individual agency and context. The authors suggest three levels to their framework and identify ensuing implications for research and practice.
Integrative Literature Review: Emotional Intelligence in the K-12 Curriculum and its Relationship to American Workplace Needs: A Literature Review
Authors: Opengart Rose
Published: December 2007

The purpose of this article is to review the content of existing social— emotional learning programs in the American K-12 curriculum and the relationship between the school-based programs and the needs of the American workplace. Social and emotional learning (SEL) programs were examined for their content and compared to research on critical emotional intelligence skills for the workplace. Emotional intelligence literature was reviewed, as was the SEL literature. The two literatures were compared to identify gaps so that practitioners of human resource development have a basis on which to consider important areas for training programs in emotional intelligence.
Who or What Creates? A Conceptual Framework for Social Creativity
Authors: Watson Elizabeth
Published: December 2007

Creativity is increasingly understood as a social phenomenon, especially in organizational contexts. This article offers a conceptual framework for social creativity that integrates perspectives from published literature. The foundational questions that structured the literature review are twofold. First, because both individuals and entities, such as teams, can be agents of creativity, who or what creates? Second, through what sites of action or contexts does creative engagement by individuals, groups, and organizations occur? An integrative review of the literature reveals that the engagement occurs in individuals, in individuals interacting, in group work, and in complex multilevel systems.

A concept map is used to represent the literature in this domain. This is then discussed with reference to the representative authors in each of the identified sectors. A set of names for the outcomes of the creative process is suggested, including individually generated creative outcomes, socially influenced creative outcomes, socially constructed creative outcomes, and socially generated creative outcomes.
Identification of somatic JAK1 mutations in patients with acute myeloid leukemia
Authors: Xiang Zhifu , Zhao Yu , Mitaksov Vesselin , Fremont Daved H. , Kasai Yumi , Molitoris AnnaLynn , Ries Rhonda E. , Miner Tracie L. , McLellan Michael D. , DiPersio John F. , Link Daniel C. , Payton Jacqueline E. , Graubert Timothy A. , Watson Mark , Shannon William , Heath Sharon E. , Nagarajan Rakesh , Mardis Elaine R. , Wilson Richard K. , Ley Timothy J. , Tomasson Michael H.
Published: December 2007

Somatic mutations in JAK2 are frequently found in myeloproliferative diseases, and gain-of-function JAK3 alleles have been identified in M7 acute myeloid leukemia (AML), but a role for JAK1 in AML has not been described. We screened the entire coding region of JAK1 by total exonic resequencing of bone marrow DNA samples from 94 patients with de novo AML. We identified 2 novel somatic mutations in highly conserved residues of the JAK1 gene (T478S, V623A), in 2 separate patients and confirmed these by resequencing germ line DNA samples from the same patients. Overexpression of mutant JAK1 did not transform primary murine cells in standard assays, but compared with wild-type JAK1, JAK1T478S, and JAK1V623A expression was associated with increased STAT1 activation in response to type I interferon and activation of multiple downstream signaling pathways. This is the first report to demonstrate somatic JAK1 mutations in AML and suggests that JAK1 mutations may function as disease-modifying mutations in AML pathogenesis.