Thrombophilia and direct thrombin inhibitor lepirudin clinical and monitoring aspects

Thrombophilia (TF) predisposes both to venous and arterial thrombosis at a young age. TF may also impact the thrombosis or stenosis of hemodialysis (HD) vascular access in patients with end-stage renal disease (ESRD). When involved in severe thrombosis TF may associate with inappropriate response to anticoagulation. Lepirudin, a potent direct thrombin inhibitor (DTI), indicated for heparin-induced thrombocytopenia-related thrombosis, could offer a treatment alternative in TF. Monitoring of narrow-ranged lepirudin demands new insights also in laboratory. The above issues constitute the targets in this thesis. We evaluated the prevalence of TF in patients with ESRD and its impact upon thrombosis- or stenosis-free survival of the vascular access. Altogether 237 ESRD patients were prospectively screened for TF and thrombogenic risk factors prior to HD access surgery in 2002-2004 (mean follow-up of 3.6 years). TF was evident in 43 (18%) of the ESRD patients, more often in males (23 vs. 9%, p=0.009). Known gene mutations of FV Leiden and FII G20210A occurred in 4%. Vascular access sufficiently matured in 226 (95%). The 1-year thrombosis- and stenosis-free access survival was 72%. Female gender (hazards ratio, HR, 2.5; 95% CI 1.6-3.9) and TF (HR 1.9, 95% CI 1.1-3.3) were independent risk factors for the shortened thrombosis- and stenosis-free survival. Additionally, TF or thrombogenic background was found in relatively young patients having severe thrombosis either in hepatic veins (Budd-Chiari syndrome, BCS, one patient) or inoperable critical limb ischemia (CLI, six patients). Lepirudin was evaluated in an off-label setting in the severe thrombosis after inefficacious traditional anticoagulation without other treatment options except severe invasive procedures, such as lower extremity amputation. Lepirudin treatments were repeatedly monitored clinically and with laboratory assessments (e.g. activated partial thromboplastin time, APTT). Our preliminary studies with lepirudin in thrombotic calamities appeared safe, and no bleeds occurred. An effective DTI lepirudin calmed thrombosis as all patients gradually recovered. Only one limb amputation was performed 3 years later during the follow-up (mean 4 years). Furthermore, we aimed to overcome the limitations of APTT and confounding effects of warfarin (INR of 1.5-3.9) and lupus anticoagulant (LA). Lepirudin responses were assessed in vitro by five specific laboratory methods. Ecarin chromogenic assay (ECA) or anti-Factor IIa (anti-FIIa) correlated precisely (r=0.99) with each other and with spiked lepirudin in all plasma pools: normal, warfarin, and LA-containing plasma. In contrast, in the presence of warfarin and LA both APTT and prothrombinase-induced clotting time (PiCT®) were limited by non-linear and imprecise dose responses. As a global coagulation test APTT is useful in parallel to the precise chromogenic methods ECA or Anti-FIIa in challenging clinical situations. Lepirudin treatment requires multidisciplinary approach to ensure appropriate patient selection, interpretation of laboratory monitoring, and treatment safety. TF seemed to be associated with complicated thrombotic events, in venous (BCS), arterial (CLI), and vascular access systems. TF screening should be aimed to patients with repeated access complications or prior unprovoked thromboembolic events. Lepirudin inhibits free and clot-bound thrombin which heparin fails to inhibit. Lepirudin seems to offer a potent and safe option for treatment of severe thrombosis. Multi-centered randomized trials are necessary to assess the possible management of complicated thrombotic events with DTIs like lepirudin and seek prevention options against access complications.

Silva Fennica Vol. 23, 1989.

Julkaistu Silva Fennica Vol. 23(4) -numeron liitteenä.

Changing Paradigms in Biblical Criticism : 2 Kings 22:1 23:30 in the Flux of Discourses

The subject and methodology of biblical scholarship has expanded immense-ly during the last few decades. The traditional text-, literary-, source- and form-critical approaches, labeled historical-critical scholarship , have faced the challenge of social sciences. Various new literary, synchronic readings, sometimes characterized with the vague term postmodernism, have in turn challenged historicalcritical, and social-scientific approaches. Widened limits and diverging methodologies have caused a sense of crisis in biblical criticism. This metatheoretical thesis attempts to bridge the gap between philosophical discussion about the basis of biblical criticism and practical academic biblical scholarship. The study attempts to trace those epistemological changes that have produced the wealth of methods and results within biblical criticism. The account of the cult reform of King Josiah of Judah as reported in 2 Kings 22:1 23:30 serves as the case study because of its importance for critical study of the Hebrew Bible. Various scholarly approaches embracing 2 Kings 22:1 23:30 are experimentally arranged around four methodological positions: text, author, reader, and context. The heuristic model is a tentative application of Oliver Jahraus s model of four paradigms in literary theory. The study argues for six theses: 1) Our knowledge of the world is con-structed, fallible and theory-laden. 2) Methodological plurality is the neces-sary result of changes in epistemology and culture in general. 3) Oliver Jahraus s four methodological positions in regard to literature are also an applicable model within biblical criticism to comprehend the methodological plurality embracing the study of the Hebrew Bible. 4) Underlying the methodological discourse embracing biblical criticism is the epistemological ten-sion between the natural sciences and the humanities. 5) Biblical scholars should reconsider and analyze in detail concepts such as author and editor to overcome the dichotomy between the Göttingen and Cross schools. 6) To say something about the historicity of 2 Kings 22:1 23:30 one must bring together disparate elements from various disciplines and, finally, admit that though it may be possible to draw some permanent results, our conclusions often remain provisional.

Synthesis based on cyclohexadienes .23. Total synthesis of 5-epi-pupukean-2-one

A new strategy for the construction of the isotwistane skeleton is reported from easily available cyclohexadienes which involves stereoselective alkylation of a bicyclooctenone derivative and a decarboxylative 5-exo-trig radical cyclisation as the key steps in the total synthesis of 5-epi-pupukean-2-one.

Conformational Diversity in Contryphans from Conus Venom: cis-trans Isomerisation and Aromatic/Proline Interactions in the 23-Membered Ring of a 7-Residue Peptide Disulfide Loop

Conformational diversity or shapeshifting in cyclic peptide natural products can, in principle, confer a single molecular entity with the property of binding to multiple receptors. Conformational equilibria have been probed in the contryphans, which are peptides derived from Conus venom possessing a 23-membered cyclic disulfide moiety. The natural sequences derived from Conus inscriptus, GCV(D)LYPWC* (In936) and Conus loroisii, GCP(D)WDPWC* (Lo959) differ in the number of proline residues within the macrocyclic ring. Structural characterisation of distinct conformational states arising from cis-trans equilibria about Xxx-Pro bonds is reported. Isomerisation about the C2-P3 bond is observed in the case of Lo959 and about the Y5-P6 bond in In936. Evidence is presented for as many as four distinct species in the case of the synthetic analogue V3P In936. The Tyr-Pro-Trp segment in In936 is characterised by distinct sidechain orientations as a consequence of aromatic/proline interactions as evidenced by specific sidechain-sidechain nuclear Overhauser effects and ring current shifted proton chemical shifts. Molecular dynamics simulations suggest that Tyr5 and Trp7 sidechain conformations are correlated and depend on the geometry of the Xxx-Pro bond. Thermodynamic parameters are derived for the cis trans equilibrium for In936. Studies on synthetic analogues provide insights into the role of sequence effects in modulating isomerisation about Xxx-Pro bonds.

Prudentia Iuris, 1990, n° 23 (número completo)

Contenido: Doctor Santiago de Estrada / Alfredo Di Pietro – Jornadas sobre “La reforma del Estado”: Las alternativas de financiamiento del mercado de capitales / Joaquín R. Ledesma – Una reflexión sobre la ley de reforma del Estado / Carlos Raúl Sanz – Las privatizaciones / Juan Carlos Cassagne – La concesión de obra pública / Rodolfo Barra – Constitucionalidad de las privatizaciones / Néstor Pedro Sagüés – Aspectos laborales de la ley 23.696 / Hugo R. Carcavallo – Estado nacional y bien común / José Giménez Rébora – Atribuciones, conducta y control de los funcionarios públicos en la época hispánica / Julio R. Lascano – Notas acerca de las relaciones Iglesia-Estado / Néstor Daniel Villa – Interdictos y acciones populares en Roma/ Fernando M. Zamora – Ciencias políticas: Ortega y la “sociedad de naciones” / Enrique Aguilar -- Documentos

Letras, 1990-1991, nº 23-24 (número completo)

Contenido: Un pequeño gran gigante. Más notas acerca de la hipérbole de lo corporal en la obra de Rabelais / Susana G. Artal – Una lectura de los cuatro cuartetos de T. S. Eliot (segunda parte) / Inés de Cassagne – Los estudios lingüísticos con base computacional / María Amalia García Jurado – Bucolismo en una carta de Sidonio Apolinar / Raúl Lavalle – La seducción estética de la barbarie como poesía de lo original originario / María Rosa Lojo – La elegía a María Blanchard / Lía Noemí Uriarte Rebaudi – Nota – Reseñas bibliográficas

南海北部湾23/25太阳区块海底工程地质调查与评价

<正> 本项成果,是承包美国太阳东方勘探公司任务而完成的。在系统分析总结了南海西部石油公司“南海—503工程地质取芯船”在南海北部湾23/25太阳区块所进行的测深、侧扫声纳、地震声学剖面测量,及4口孔深40米的工程地质浅钻土柱等材料的基础上,详细阐述了

[Discurso do Deputado Antunes de Oliveira : Sessão Conjunta do Congresso Nacional de 23 de novembro de 1978]

Afirma ser favorável à Proposta de Emenda Constitucional n. 14/78 do Senador Cattete Pinheiro, que estabelece representação política para o Distrito Federal. Compara a situação de Brasília com a de Washington, capital dos Estados Unidos.