Aim:The role of platelet-derived microparticles (PDMPs) in the crosstalk between coagulopathy and inflammation in critically ill patients remains unclear. The aim of this cohort observational study was to investigate the associations between the PDMP levels and hospital mortality or disseminated intravascular coagulopathy (DIC). Methods: This study included 119 patients who were admitted to the ICU. The PDMP levels were measured using an enzyme-linked immunosorbent assay three times a week, for a total of 372 samples. We calculated the maximum (max) PDMP value, max PDMP/platelet (PDMP/Plts) ratio (converted to the PDMP levels per 10 4 platelets) and nadir platelet count during the ICU stay. Baseline patient data and scores, including the Japanese Association for Acute Medicine (JAAM) DIC score, were collected, and potential predictors were analyzed for possible associations with hospital mortality. Results: The max PDMP/Plts ratio was significantly different comparing the survivors (n 98: median, 2.54) and non-survivors (n 21: median 17.59; p 0.001). There was a weak but statistically significant negative correlation between the max PDMP level and nadir platelet count (r 0.332, p 0.001). The max PDMP level and max PDMP/Plts ratio were higher in the DIC group (81.48 and 9.27, respectively) than in the non-DIC group (34.88 and 2.35, p 0.001 and p 0.001, respectively). The max PDMP/Plts ratio was the only variable found to be independently associated with hospital mortality according to a multivariate logistic regression analysis. Conclusions: PDMPs are involved in the development of DIC but are not related to hospital mortality. There is a good association between the PDMP/Plts ratio and hospital mortality and/or DIC in critically ill patients.

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Purkinje fibers are an essential element of the conduction system that provides for coordinated ventricular contraction of the heart. Although classic studies established structure and electrical activities of Purkinje fibers, an integrated understanding of the Purkinje-ventricular interconnection within the working heart remains to be had. In this review article we will briefly overview the gross anatomy and cytological characteristics of Purkinje fibers and their transition to the ventricular muscle, and we will discuss functional and morphological aspects of the Purkinje-ventricular interconnection from the perspectives of electrophysiology, distribution of gap junctions, and intracellular Ca 2+ ([Ca 2+ ] i ) dynamics. Furthermore, the potential usefulness of the recently developed optical voltagemapping and in situ real-time confocal [Ca 2+ ] i imaging techniques is discussed as an integrated approach to the pathophysiological investigation of the Purkinje-ventricular interconnection in the heart.