Коагулопатія як фактор ризику венозних тромбозів та емболій у хворих з гострими неварикозними гастродуоденальними кровотечами

The aim of the works: risk evaluation of venous thromboembolism in patients with acute nonvariceal gastrointestinal bleeding.Materials and Methods. Treatment results of 246 with acute nonvariceal gastrointestinal bleeding was carried out. Gastroduodenoscopy had been performed aiming to recognize source of bleeding and risk of rebleeding in accordance with J. Forrest classification as well. Duodenal peptic ulcer disease was recognized as main source of bleeding in 83.7 % of patients. Endoscopic haemostasis had performed in patients with ongoing bleeding and high risk of its recurrence: Forrest 1А (2.5 %), Forrest 1В (12.8 %) and Forrest 2А (10.3 %), Forrest 2В (19.4 %), respectively. Ten patients died (mortality – 4.1 %) but no one from ongoing bleeding. Acute cardiopulmonary insufficiency as the main cause of death was recognized. Proximal deep vein thrombosis was revealed in 2 patients and in 4 cases – pulmonary thromboembolism. Coagulation status was evaluated in accordance with local protocol.Results and Discussion. In 70.3 % of patients coagulation tests were in the normal limits, whereas hypercoagulation and hypocoagulation were recognized in 25.3 % and 4.4 % of cases, respectively. Hypercoagulation was recognized when shortening of clotting time, prothrombin time and elevated concentration of D-dimers were revealed. High risk of VTE according with Caprini score was calculated. Main VTE – risk factors were recognized: prolonged bed rest – more than 72 hours, age 61–74 years, previous VTE, central vein catheterization.Conclusions. Hypercoagulation in patients with acute nonvariceal gastrointestinal bleeding combined with other factors constituteshigh risk of VTE.Цель работы: исследовать риск ВТЭ у больных с острыми желудочно-кишечными кровотечениями неварикозного генеза.Материалы и методы. Проведен анализ результатов лечения 246 больных с острыми желудочно-кишечными кровотечениями неварикозного генеза. Всем больным с целью диагностики источника кровотечения выполняли фиброгастродуоденоскопию (ФГДС) для поиска источника геморрагии и оценки риска ее рецидива по классификации J. Forrest. Установлено, что в 83,7 % больных источником геморрагии была язва двенадцатиперстной кишки. Комбинированный инъекционно-коагуляционный гемостаз применяли в случаях продолжающейся геморрагии и стигматах нестабильного гемостаза – Forrest 1А (2,5 %), Forrest 1В (12,8 %) и Forrest 2А (10,3 %), Forrest 2В (19,4 %), в соответствии. Умерли 10 больных с острыми желудочно-кишечными кровотечениями (ОЖКК) (общая летальность – 4,1 %) ни один – от продолжающегося кровотечения. Причиной летального исхода во всех случаях признано сердечно-легочную недостаточность. В 2 умерших во время аутопсии обнаружено проксимальный флеботромбоз, у 4 – тромбоз и эмболию сегментарных ветвей легочной артерии. Состояние системы гемостаза оценивали по показателям стандартной коагулограммы.Результаты исследований и их обсуждение. Проведенное исследование не обнаружыло патологических отклонений в коагуляционных тестах в 70,3 % больных с ОЖКК, гиперкоагуляции – в 25,3 %, гипокоагуляцию – в 4,4 % пациентов. О повышенном потенциале крови к свертыванию свидетельствовали: уменьшение времени свертывания крови, протромбинового времени, повышенный уровень растворимых комплексов мономерных фибринов (РКМФ). Все больные ОЖКК, в которых констатировано лабораторные признаки гиперкоагуляции, имели высокий риск ВТЭ по общепризнанной шкале J. Caprini. Факторами, которые обусловили максимальный риск ВТЭ, были: постельный режим более 72 ч, возраст 61–74 года, венозные тромбозы в анамнезе, катетеризация центральных вен. Таким образом, гиперкоагуляция у больных с острыми неварикозными гастродуоденальными кровотечениями при сочетании с другими факторами составляет высокий риск возникновения венозных тромбозов и эмболии.Мета роботи: дослідити ризик ВТЕ у хворих із гострими шлунково-кишковими кровотечами неварикозного генезу.Матеріали і методи. Проведено аналіз результатів лікування 246 хворих із гострими шлунково-кишковими кровотечами неварикозного генезу. Усім хворим з метою діагностики джерела кровотечі виконували фіброгастродуоденоскопію (ФГДС) для пошуку джерела геморагії та оцінки ризику її рецидиву за класифікацією J. Forrest. Встановлено, що у 83,7 % хворих джерелом геморагії була пептична виразка дванадцятипалої кишки. Комбінований ін’єкційно-коагуляційний гемостаз застосовували у випадках триваючої геморагії та стигматах нестабільного гемостазу – Forrest 1А (2,5 %), Forrest 1В (12,8 %) та Forrest 2А (10,3 %), Forrest 2В (19,4 %), відповідно. Померли 10 хворих із ГШКК (загальна летальність – 4,1 %), жоден – від триваючої кровотечі. Причиною летального результату в усіх випадках визнано серцево-легеневу недостатність. У 2 померлих під час автопсії виявлено проксимальний флеботромбоз, у 4 – тромбоз та емболію сегментарних гілок легеневої артерії. Стан системи гемостазу оцінювали за показниками стандартної коагулограми.Результати досліджень та їх обговорення. Проведене дослідження не виявило патологічних відхилень у коагуляційних тестах у 70,3 % хворих з ГШКК, гіперкоагуляцію – у 25,3 %, гіпокоагуляцію – у 4,4 % пацієнтів. Про підвищений потенціал крові до зсідання свідчили вкорочення часу зсідання крові, протромбінового часу, підвищений рівень розчинних комплексів фібрину мономерів (РКМФ). Усі хворі на ГШКК, в яких констатовано лабораторні ознаки гіперкоагуляції, мали високий ризик ВТЕ за загальновизнаною шкалою J. Caprini. Факторами, що зумовили максимальний ризик ВТЕ, були: ліжковий режим більше 72 год, вік 61–74 роки, венозні тромбози в анамнезі, катетеризація центральних вен. Таким чином, гіперкоагуляція у хворих з гострими неварикозними гастродуоденальними кровотечами при поєднанні з іншими факторами становить високий ризик виникнення венозних тромбозів та емболій

Nambu-Goldstone Dark Matter and Cosmic Ray Electron and Positron Excess

We propose a model of dark matter identified with a pseudo-Nambu-Goldstone boson in the dynamical supersymmetry breaking sector in a gauge mediation scenario. The dark matter particles annihilate via a below-threshold narrow resonance into a pair of R-axions each of which subsequently decays into a pair of light leptons. The Breit-Wigner enhancement explains the excess electron and positron fluxes reported in the recent cosmic ray experiments PAMELA, ATIC and PPB-BETS without postulating an overdensity in halo, and the limit on anti-proton flux from PAMELA is naturally evaded.Comment: 3 figure

Dirac gaugino as leptophilic dark matter

We investigate the leptophilic properties of Dirac gauginos in an R--symmetric N=2 supersymmetric model with extended gauge and Higgs sectors. The annihilation of Dirac gauginos to leptons requires no chirality flip in the final states so that it is not suppressed as in the Majorana case. This implies that it can be sizable enough to explain the positron excess observed by the PAMELA experiment with moderate or no boost factors. When squark masses are heavy, the annihilation of Dirac gauginos to hadrons is controlled by their Higgsino fraction and is driven by the $hZ$ and $W^+W^-$ final states. Moreover, at variance with the Majorana case, Dirac gauginos with a non-vanishing higgsino fraction can also have a vector coupling with the $Z$ gauge boson leading to a sizable spin--independent scattering cross section off nuclei. Saturating the current antiproton limit, we show that Dirac gauginos can leave a signal in direct detection experiments at the level of the sensitivity of dark matter searches at present and in the near future.Comment: 24 pages, 10 figures, typos corrected, final version published on JCA

PAMELA, DAMA, INTEGRAL and Signatures of Metastable Excited WIMPs

Models of dark matter with ~ GeV scale force mediators provide attractive explanations of many high energy anomalies, including PAMELA, ATIC, and the WMAP haze. At the same time, by exploiting the ~ MeV scale excited states that are automatically present in such theories, these models naturally explain the DAMA/LIBRA and INTEGRAL signals through the inelastic dark matter (iDM) and exciting dark matter (XDM) scenarios, respectively. Interestingly, with only weak kinetic mixing to hypercharge to mediate decays, the lifetime of excited states with delta < 2 m_e is longer than the age of the universe. The fractional relic abundance of these excited states depends on the temperature of kinetic decoupling, but can be appreciable. There could easily be other mechanisms for rapid decay, but the consequences of such long-lived states are intriguing. We find that CDMS constrains the fractional relic population of ~100 keV states to be <~ 10^-2, for a 1 TeV WIMP with sigma_n = 10^-40 cm^2. Upcoming searches at CDMS, as well as xenon, silicon, and argon targets, can push this limit significantly lower. We also consider the possibility that the DAMA excitation occurs from a metastable state into the XDM state, which decays via e+e- emission, which allows lighter states to explain the INTEGRAL signal due to the small kinetic energies required. Such models yield dramatic signals from down-scattering, with spectra peaking at high energies, sometimes as high as ~1 MeV, well outside the usual search windows. Such signals would be visible at future Ar and Si experiments, and may be visible at Ge and Xe experiments. We also consider other XDM models involving ~ 500 keV metastable states, and find they can allow lighter WIMPs to explain INTEGRAL as well.Comment: 22 pages, 7 figure

ATIC and PAMELA Results on Cosmic e^\pm Excesses and Neutrino Masses

Recently the ATIC and PAMELA collaborations released their results which show the abundant e^\pm excess in cosmic rays well above the background, but not for the \bar{p}. Their data if interpreted as the dark matter particles' annihilation imply that the new physics with the dark matter is closely related to the lepton sector. In this paper we study the possible connection of the new physics responsible for the cosmic e^\pm excesses to the neutrino mass generation. We consider a class of models and do the detailed numerical calculations. We find that these models can natually account for the ATIC and PAMELA e^\pm and \bar{p} data and at the same time generate the small neutrino masses.Comment: 7 pages, 5 figures. Published version with minor corrections and more reference

R-parity preserving super-WIMP decays

We point out that when the decay of one electroweak scale super-WIMP state to another occurs at second order in a super-weak coupling constant, this can naturally lead to decay lifetimes that are much larger than the age of the Universe, and create observable consequences for the indirect detection of dark matter. We demonstrate this in a supersymmetric model with Dirac neutrinos, where the right-handed scalar neutrinos are the lightest and next-to-lightest supersymmetric partners. We show that this model produces a super-WIMP decay rate scaling as m_nu^4/(weak scale)^3, and may significantly enhance the fraction of energetic electrons and positrons over anti-protons in the decay products. Such a signature is consistent with the observations recently reported by the PAMELA experiment.Comment: 14 pages, v3 JHEP versio

Dark Matter Model Selection and the ATIC/PPB-BETS anomaly

We argue that we may be able to sort out dark matter models in which electrons are generated through the annihilation and/or decay of dark matter, by using a fact that the initial energy spectrum is reflected in the cosmic-ray electron flux observed at the Earth even after propagation through the galactic magnetic field. To illustrate our idea we focus on three representative initial spectra: (i)monochromatic (ii)flat and (iii)double-peak ones. We find that those three cases result in significantly different energy spectra, which may be probed by the Fermi satellite in operation or an up-coming cosmic-ray detector such as CALET.Comment: 19 pages, 8 figure

Two component dark matter

We explain the PAMELA positron excess and the PPB-BETS/ATIC e+ + e- data using a simple two component dark matter model (2DM). The two particle species in the dark matter sector are assumed to be in thermal equilibrium in the early universe. While one particle is stable and is the present day dark matter, the second one is metastable and decays after the universe is 10^-8 s old. In this model it is simple to accommodate the large boost factors required to explain the PAMELA positron excess without the need for large spikes in the local dark matter density. We provide the constraints on the parameters of the model and comment on possible signals at future colliders.Comment: 6 pages, 2 figures, discussion clarified and extende

Scalar Multiplet Dark Matter

We perform a systematic study of the phenomenology associated to models where the dark matter consists in the neutral component of a scalar SU(2)_L n-uplet, up to n=7. If one includes only the pure gauge induced annihilation cross-sections it is known that such particles provide good dark matter candidates, leading to the observed dark matter relic abundance for a particular value of their mass around the TeV scale. We show that these values actually become ranges of values -which we determine- if one takes into account the annihilations induced by the various scalar couplings appearing in these models. This leads to predictions for both direct and indirect detection signatures as a function of the dark matter mass within these ranges. Both can be largely enhanced by the quartic coupling contributions. We also explain how, if one adds right-handed neutrinos to the scalar doublet case, the results of this analysis allow to have altogether a viable dark matter candidate, successful generation of neutrino masses, and leptogenesis in a particularly minimal way with all new physics at the TeV scale.Comment: 43 pages, 20 figure