Nightmare: Simultaneous Subacute Stent Thrombosis of Different New-Generation Drug-Eluting Stents in Multiple Coronary Arteries.

UNLABELLED: Simultaneous stent thrombosis (ST) of first-generation drug-eluting stents (DES) has been rarely reported and could lead to high morbidity and mortality. However, to date there was no literature discussing simultaneous ST of different new-generation DESs in multiple coronary arteries. Herein, we report a 60-year-old male suffering from acute myocardial infarction complicated with cardiogenic shock. He had percutaneous coronary intervention (PCI) performed approximately 7 days prior to admission at a local teaching hospital, with different DES devices implanted over the left anterior descending and the left circumflex artery. Emergency coronary angiography revealed simultaneous subacute ST over both vessels. After PCI, there was a gradual improvement in both cardiogenic shock and acute pulmonary edema. High dose clopidogrel (150 mg) was used initially, which was later shifted to ticagrelor. Genetic testing of CYP2C19*2 G681A polymorphism revealed heterozygous genotype and platelet function testing showed substantial inhibition after a medication change. This rare case should remind physicians that new-generation DES thrombosis in multiple vessels is still a possible complication of PCI, and checking genetic and/or platelet function testing might be indicated in these high risk patients. The use of a new antiplatelet drug was also strongly suggested to avoid possible clopidogrel resistance. KEY WORDS: Clopidogrel resistance; Drug-eluting stents; Genetic testing; Platelet function; Stent thrombosis.

A comparative study on the flow experience in web-based and text-based interaction environments.

The purpose of this study was to explore a substantial phenomenon related to flow experiences (immersion) in text-based interaction systems. Most previous research emphasizes the effects of challenge/skill, focused attention, telepresence, web characteristics, and systems' interface design on users' flow experiences in online environments. However, text-based interaction systems without telepresence features and web characteristics still seem to create opportunities for flow experience. To explore this phenomenon, this study incorporates subject involvement and interpersonal interaction as critical antecedents into the model of flow experience, as well as considers the existence of telepresence. Results reveal that subject involvement, interpersonal interaction, and interactivity speed are critical to focused attention, which enhances users' immersion. With regard to the effect of telepresence, the perceived attractiveness of the interface is a significant facilitator determining users' immersion in web-based, rather than in text-based, interaction environments. Interactivity speed is unrelated to immersion in both web-based and text-based interaction environments. The influence of interpersonal involvement is diminished in web-based interaction environments. The implications and limitations of this study are discussed.