To evaluate factor XII deficiency in women with primary and secondary recurrent abortion.
Prospective case–control study.
University hospital.
Sixty-seven women with primary and 33 women with ...secondary recurrent abortion of unexplained nature and 49 healthy controls with no history of thrombotic disease or adverse pregnancy outcomes.
Plasma factor XII activity, activated protein C resistance, factor V Leiden mutation analysis, protein C, protein S, antithrombin III, karyotyping, and anticardiolipin antibodies.
Ten of 67 women with primary recurrent abortion (14.9%) and 4 of 33 women (12.1%) with secondary recurrent abortion had reduced factor XII activity (<60%). These results are highly significant in the former group and showed a tendency toward significance in the latter group. All controls had normal factor XII activity.
Factor XII deficiency is strongly associated with primary recurrent abortion, and women with secondary recurrent abortion show a tendency toward factor XII deficiency.
Low molecular weight heparin in hemodialysis and hemofiltration patients. Low molecular weight (LMW)-heparin was used as the sole anticoagulant during hemodialysis and hemofiltration in a pilot study ...on 32 patients. A LMW-heparin dose corresponding to 50% of the patients usual unfractionated, standard (UF)-heparin dose was found to produce comparable plasma heparin levels (anti-FXa-activity). No thrombosis of the extracorporal system and no bleeding complications occurred at this LMW-heparin dose. In contrast to UF-heparin, LMW-heparin produced only slight increases in PTT and thrombin time in all patients. Lipoprotein lipase was stimulated only marginally by LMW-heparin, with a correspondingly reduced release of free fatty acids. Both heparin species caused similar elevations in factor VIII and fibrin monomers, thus excluding a difference in coagulation activation. On the basis of these results, long-term studies have been started at four nephrology centers. To date, 26 patients have been treated with LMW-heparin for 6 months. A LMW-heparin dose was used that produced plasma anti-FXa-activity of 0.5 to 0.9 U/ml (initial dose: 30 to 40; dose/hr: 8 to 15 anti-FXa-units/kg body wt). PTT and thrombin time were only increased by 5sec on average. Surprisingly, the elevated pre-dialysis levels of factor VIII and fibrin monomers decreased during this 6-month period. Bleeding complications did not occur and thrombotic complications were not observed when the anti-FXa levels were above 0.5 U/ml. LMW-heparin, therefore, appears to be a good alternative to UF-heparin for dialysis patients and may present less risk of bleeding because of its reduced effect on PTT, thrombin time, and thrombocytes.
To diagnose von Willebrand disease (vWD) and to monitor drug efficacy, several tests have been established that are not, however, focused on the platelet adhesion properties of von Willebrand factor ...(vWF). The new platelet retention test Homburg (RTH) is characterized by a nonthrombogenic filter that retains platelets from blood when it is pressed through this filter. It was the aim of this study to examine the capability of this test to monitor the adhesive properties of vWF after its substitution in vWD or its release by desmopressin infusion. The RTH demonstrated a striking sensitivity for vWF after its release from endogenous storage sites or its supplementation in vivo as well as in vitro, whereas it did not detect an inhibition of platelet aggregability due to aspirin. Desmopressin infusions led to an immediate and highly significant increase of RTH platelet retention, followed by a gradual decline to initial values during the next 4 hours. The transfusion of a vWF concentrate also resulted in RTH data that demonstrated different kinetics than established parameters such as vWF:antigen, vWF:RiCoF, or the PFA-100 in vitro bleeding analysis. Additional in vitro experiments confirmed the correlation of RTH values with vWF concentrations. In conclusion, the RTH may be efficient to complement presently used measures to monitor vWD therapy with desmopressin or vWF concentrates.
Comparison of low molecular weight heparin to standard heparin in hemodialysis/hemofiltration. Low molecular weight (LMW) heparin has been compared to standard unfractionated (UF) heparin in ...hemodialysis/hemofiltration in a 12 month, randomized study. Seventy patients with end-stage chronic renal failure starting dialysis treatment were randomly assigned to one of two groups treated with either LMW or UF heparin. The LMW and UF heparin doses used produced similar plasma anti-FXa levels, and comparable antithrombotic effectiveness was observed in the two groups as reflected in similar incidences of thrombus formation in the extracorporeal circulation: 1.59% and 1.33% for LMW and UF heparin, respectively. No bleeding complications were seen with either heparin, but significantly (P < 0.05) fewer erythryocyte concentrates were needed in the LMW heparin patients. Mean factor VIII activities had risen significantly (P < 0.001) after 12 months in the UF heparin group, whereas they were unchanged in the LMW heparin group. A significant (P < 0.05) increase in plasma triglycerides was observed in the UF heparin group which was attributable to six (18.8%) of the patients in this group. Triglyceride concentrations remained relatively constant in the LMW heparin group. Post-heparin lipolytic activity, and in particular hepatic lipase activity, was not stimulated to the same extent in the LMW heparin-treated patients as compared to the UF heparin group. We conclude that LMW heparin is a suitable alternative to standard UF heparin for anticoagulation in hemodialysis/hemofiltration therapy. It may offer potential advantages with regard to a lower requirement for erythrocyte concentrates and less derangement of certain metabolic parameters, such as factor VIII, triglycerides and plasma lipase activity.
The factor XII gene from factor XII-deficient patients was screened for mutations at the genomic level. In patients negative for cross-reacting material, a T to C transition 224 bp upstream of exon 3 ...was identified (exon 3-224 (T --> C)) that creates an additional TaqI restriction site in intron B. This mutation is located within a putative hormone responsive element and within a B box promoter of an Alu repeat of the Sb0 family. The TaqI site is associated with a G to C transversion upstream of the transcription initiation site (exon 1-8 (G --> C)). We discuss the possible roles of these elements in factor XII gene regulation.
Mit der Verwirklichung der deutschen Einheit hat sich auch die Kulturpolitik verändert - sowohl konzeptionell wie instrumentell. Dieser Transformationsprozess wäre jedoch zu kurz gedacht, wenn man ...sie nur auf die unmittelbaren Folgen der deutschen Einheit beziehen würde. Man muss auch in Rechnung stellen, dass er sich im Rahmen eines nicht nur europäischen, sondern globalen gesellschaftlichen Wandels ereignet.Das »Jahrbuch für Kulturpolitik 2015/16« enthält die Beiträge des 8. Kulturpolitischen Bundeskongresses 2015 »Kultur.Macht.Einheit?«, auf welchem u.a. Monika Grütters, Wolfgang Thierse, Norbert Lammert und Michael Schindhelm referierten. Zusätzliche Fachartikel erschließen diesen umfangreichen Kontext und verbreitern die Perspektive auf das Phänomen kulturpolitischer Transformation.
With the realisation of German unity, cultural policies have also changed - conceptually as well as instrumentally. It would be too short-sighted, however, if one were to frame this transformation as ...the direct result of German unity. It is also necessary to take into account that it occures in the context of a not only European but also global social shift. The "2015 Yearbook for Cultural Politics" contains the contributions from the eighth Federal Congress for Cultural Politics, entitled "Kultur.Macht.Einheit?" ("Culture.Power.Unity?"), which featured presentations be figures such as Monika Grütters, Wolfgang Thierse, Norbert Lammert, and Tim Renner. Additional articles extrapolate on this extensive field and broaden the range of perspectives on the phenomenon of transformation.
Mit der Verwirklichung der deutschen Einheit hat sich auch die Kulturpolitik verändert – sowohl konzeptionell wie instrumentell. Dieser Transformationsprozess wäre jedoch zu kurz gedacht, wenn man sie nur auf die unmittelbaren Folgen der deutschen Einheit beziehen würde. Man muss auch in Rechnung stellen, dass er sich im Rahmen eines nicht nur europäischen, sondern globalen gesellschaftlichen Wandels ereignet. Das »Jahrbuch für Kulturpolitik 2015/16« enthält die Beiträge des 8. Kulturpolitischen Bundeskongresses 2015 »Kultur.Macht.Einheit?«, auf welchem u.a. Monika Grütters, Wolfgang Thierse, Norbert Lammert und Michael Schindhelm referierten. Zusätzliche Fachartikel erschließen diesen umfangreichen Kontext und verbreitern die Perspektive auf das Phänomen kulturpolitischer Transformation.
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