Disección coronaria espontánea / Spontaneous coronary artery dissection

Resumen La disección coronaria espontánea es la separación de capas de la pared de una arteria coronaria epicárdica secundaria a hemorragia intramural, con o sin desgarro de la íntima, no asociada con aterosclerosis, traumatismo o iatrogenia. Esta enfermedad ha emergido como causa de síndrome coronario agudo e infarto agudo de miocardio en personas jóvenes, principalmente mujeres, cuya prevalencia de factores de riesgo cardiovasculares es menor en comparación con el síndrome coronario agudo por aterosclerosis. Su diagnóstico se hace con síntomas clínicos, exclusión de causas secundarias, arteriografía coronaria y a veces, con la ayuda de imágenes intra o extravasculares. En la mayoría de los casos el manejo es conservador, con algunas excepciones en donde se requiere intervención percutánea o quirúrgica. Se presenta el caso de un paciente masculino de mediana edad con disección coronaria espontánea, quien se presentó con un infarto agudo de miocardio con elevación del segmento ST.

Abstract Spontaneous coronary dissection is the separation of layers of the wall of an epicardial coronary artery secondary to intramural bleeding, with or without tear of the intima, not associated with atherosclerosis, trauma or iatrogenia. This condition has emerged as a cause of acute coronary syndrome and acute myocardial infarction in young people, occurring mainly in women, whose prevalence of cardiovascular risk factors is lower compared to acute coronary syndrome due to atherosclerosis. Diagnosis is made with clinical symptoms, exclusion of secondary causes, coronary arteriography and, in some cases, the help of intra- or extravascular images is required. In most cases the management is conservative, with some exceptions where percutaneous or surgical intervention is required. We present the case of a middle-aged male with spontaneous coronary dissection, who presents with an acute myocardial infarction with ST segment elevation.

Evolution and Analysis of Hapkit: An Open-Source Haptic Device for Educational Applications.

We present the design, evolution and analysis of "Hapkit," a low-cost, open-source kinesthetic haptic device for use in educational applications. Hapkit was developed in 2013 based on the design of the Stanford Haptic Paddle, with the goal of decreasing cost and increasing accessibility for educational applications, including online teaching, K-12 school use, and college dynamic systems and control courses. In order to develop Hapkit for these purposes, we tested a variety of transmission, actuation, and structural materials. Hapkit 3.0, the latest version, uses a capstan drive, inexpensive DC motor, and 3-D printed structural materials. A frequency-domain system identification method was used to characterize Hapkit dynamics across the various designs. This method was validated using a first principles parameter measurement and a transient response analysis. This characterization shows that Hapkit 3.0 has lower damping and Coulomb friction than previous designs. We also performed a user study demonstrating that Hapkit 3.0 improves discrimination of virtual stiffness compared to previous designs. The design evolution of Hapkit resulted in a low-cost, high-performance device appropriate for open-source dissemination and educational applications.

Multifaceted Role of BTLA in the Control of CD8+ T-cell Fate after Antigen Encounter.

Purpose: Adoptive T-cell therapy using autologous tumor-infiltrating lymphocytes (TIL) has shown an overall clinical response rate 40%-50% in metastatic melanoma patients. BTLA (B-and-T lymphocyte associated) expression on transferred CD8+ TILs was associated with better clinical outcome. The suppressive function of the ITIM and ITSM motifs of BTLA is well described. Here, we sought to determine the functional characteristics of the CD8+BTLA+TIL subset and define the contribution of the Grb2 motif of BTLA in T-cell costimulation.Experimental Design: We determined the functional role and downstream signal of BTLA in both human CD8+ TILs and mouse CD8+ T cells. Functional assays were used including single-cell analysis, reverse-phase protein array (RPPA), antigen-specific vaccination models with adoptively transferred TCR-transgenic T cells as well as patient-derived xenograft (PDX) model using immunodeficient NOD-scid IL2Rgammanull (NSG) tumor-bearing mice treated with autologous TILs.Results: CD8+BTLA- TILs could not control tumor growth in vivo as well as their BTLA+ counterpart and antigen-specific CD8+BTLA- T cells had impaired recall response to a vaccine. However, CD8+BTLA+ TILs displayed improved survival following the killing of a tumor target and heightened "serial killing" capacity. Using mutants of BTLA signaling motifs, we uncovered a costimulatory function mediated by Grb2 through enhancing the secretion of IL-2 and the activation of Src after TCR stimulation.Conclusions: Our data portrays BTLA as a molecule with the singular ability to provide both costimulatory and coinhibitory signals to activated CD8+ T cells, resulting in extended survival, improved tumor control, and the development of a functional recall response. Clin Cancer Res; 23(20); 6151-64. ©2017 AACR.

Can use of positive religious coping predict greater distress? An examination of Army soldiers on deployment.

Although positive religious coping is generally viewed as an adaptive, functional coping pattern, some studies have actually found positive religious coping to be associated with more distress in military populations. In the current study, we examined the role of positive religious coping on distress across 2 time points. Participants in this study were 192 Army soldiers (men = 90.4%) who were stationed in Iraq for a 1-year deployment in 2005. Using structural equation modeling, we conducted a cross-lag analysis of positive religious coping and distress. Results indicated that greater use of positive religious coping significantly predicted greater distress 1 month later, whereas distress at T1 did not predict positive religious coping 1 month later. Combat exposure was also a significant predictor of distress 1 month later. Implications of these results include the need to inquire about clients' use of religious coping and whether such coping methods are having the desired effect for them. (PsycINFO Database Record