Activity

The peak thrombin, velocity-index and area under the curve were calculated. Microparticles contribute to the different parameters in samples with increased thrombin generation as follows 50 ± 19% for peak thrombin, 58 ± 24% for velocity-index and 35 ± 13% for area under the curve. Microparticles did not contribute to thrombin generation in plasma samples with normal thrombin generation. Microparticles play a significant role in coagulation and contribute largely to increased thrombin generation in plasma; however, microparticles do not contribute to coagulation in the plasma of participants with normal thrombin generation.Previously, we reported that a direct thrombin inhibitor melagatran paradoxically increased thrombin generation in human plasma in the presence of thrombomodulin. The aim of this study is to test the hypothesis that melagatran may exert a deleterious effect on tissue-type plasminogen activator (t-PA)-induced fibrinolysis via enhancement of thrombin generation and subsequent activation of thrombin-activatable fibrinolysis inhibitor (TAFI) and factor XIII (FXIII). Clot formation in human plasma containing t-PA and thrombomodulin was induced by tissue factor. The absorbance at 405 nm was measured to obtain clot lysis time. Effects of melagatran and a factor Xa inhibitor edoxaban on clot lysis time were determined. In the presence of thrombomodulin, melagatran significantly prolonged clot lysis time, but edoxaban shortened it. In the absence of thrombomodulin, melagatran did not inhibit fibrinolysis. Prolongation of clot lysis time by melagatran was reversed by activated protein C (which suppressed thrombin generation increased by melagatran) and a TAFIa inhibitor. Melagatran significantly suppressed plasmin generation, while edoxaban significantly increased it. However, both melagatran and edoxaban suppressed FXIII activation. In the clot formed in the presence of melagatran and edoxaban, the fibrin fibre was thin compared with control, showing no clear difference in the clot structures between melagatran and edoxaban. These results indicated that melagatran, not edoxaban, prolonged clot lysis time through the paradoxical enhancement of thrombin generation, and subsequent TAFI activation and inhibition of plasmin generation. Neither FXIII activation nor change in fibrin clot structure contributed to the inhibition of fibrinolysis by melagatran.Saphenous vein graft (SVG) percutaneous coronary interventions (PCIs) are procedures with potential complications such as distal embolization, slow or no-reflow phenomenon. Platelets are the main factors in development of thrombus and no-reflow phenomenon. There have been multiple studies that identified the association between plateletcrit (PCT) and cardiovascular outcomes. The aim of the study was to investigate whether PCT can predict the development of no-reflow in patients with non-ST elevation myocardial infarction (NSTEMI) undergoing PCI for SVG disease. A total of 181 patients who underwent PCI for SVG disease with NSTEMI were included retrospectively. Platelet indices on admission were recorded. Patients were divided into two groups according to the development of no-reflow during the procedure no-reflow (n = 32; 18%) and normal reflow (n = 149; 82%). PCT and platelet count were higher in the no-reflow group (0.254 vs. 0.224, P = 0.020; 265.4 vs. 233, P = 0.011, respectively). The PCT cut-off value for predicting no-reflow was calculated as 0.230 by ROC curve analysis with 68.8% sensitivity and 51.0% specificity. Multivariate logistic regression analysis showed that PCT was an independent predictor of no-reflow (odds ratio 5.091, confidence interval 1.356-19.116, P = 0.016). PCT may be useful in identifying patients at risk for developing no-reflow in patient with NSTEMI undergoing SVG PCI.Coronavirus disease 2019 (COVID-19) is a new medical challenge for all individuals, especially for those with underlying disorders, such as congenital bleeding disorders (CBDs). Therefore, the pandemic might significantly change the behaviour of patients with CBDs and results in some challenges. In the present study, we assessed the main challenges of COVID-19 infection to patients with CBDs. Data were collected from medical files and interviews of patients with CBDs who had COVID-19 infection. Follow-ups were performed on patients who had active severe acute respiratory syndrome coronavirus 2 infection between April and October 2020. All patients were interviewed by an expert in order to collect the pertinent data. Some questions were about patients’ preventive behaviors and feelings prior to infection, and some were about the consequences of infection on patients’ replacement therapy and bleeding management. Among 25 patients, infection and death of loved ones (n 7, 28%), and their own (n 5, 20%) or family members’ (n 1, 4%) infection, and the resulting economic burden (n 2, 8%) were main concerns. Six patients experienced depression during the pandemic. The pandemic caused all severely affected patients but one (n 11, 92%) to abandon replacement therapy. However, two received on-demand therapy after exacerbation of their bleeding. Only one (25%) of four patients on prophylaxis received in-home therapy, whereas the others (75%) abandoned prophylaxis. It seems that COVID-19 infection has great consequences on the lives of patients with CBDs, causing some to take dangerous actions, such as abandonment of their treatment. Healthcare systems, and healthcare providers, should have an appropriate strategy for management of patients with CBDs that prevents infection and provides timely replacement therapy.

Late seroma related to breast silicone implants is a rare complication. Interest for its characterization has grown after its association with the recently described breast implant-associated anaplastic large cell lymphoma. The differential diagnosis includes infectious diseases, mechanical and traumatic causes, tumors, postpartum seroma, and inflammatory, allergic, or idiopathic causes.Sarcoidosis has been associated with breast silicone implants over the last decades, but it has never been reported as a cause of breast effusion. CDDP We describe a rare presentation of sarcoidosis as a late breast implant seroma simulating the clinical features and radiologic findings of breast implant-associated anaplastic large cell lymphoma and highlight that sarcoidosis can be suspected by the presence of nonnecrotizing epithelioid granulomas in the cytology, with a characteristic inverted ratio of CD4/CD8 T cells.The aims of this article are to review the current evidence about sarcoidosis related to silicone implants and breast cancer, provide a new alternative in the differential diagnosis of late seroma, and advise the scientific community how early implant removal can improve the disease.