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

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

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

Implications of the Fermi-LAT diffuse gamma-ray measurements on annihilating or decaying Dark Matter

We analyze the recently published Fermi-LAT diffuse gamma-ray measurements in the context of leptonically annihilating or decaying dark matter (DM) with the aim to explain simultaneously the isotropic diffuse gamma-ray and the PAMELA, Fermi and HESS (PFH) anomalous $e^\pm$ data. Five different DM annihilation/decay channels $2e$, $2\mu$, $2\tau$, $4e$, or $4\mu$ (the latter two via an intermediate light particle $\phi$) are generated with PYTHIA. We calculate both the Galactic and extragalactic prompt and inverse Compton (IC) contributions to the resulting gamma-ray spectra. To find the Galactic IC spectra we use the interstellar radiation field model from the latest release of GALPROP. For the extragalactic signal we show that the amplitude of the prompt gamma-emission is very sensitive to the assumed model for the extragalactic background light. For our Galaxy we use the Einasto, NFW and Isothermal DM density profiles and include the effects of DM substructure assuming a simple subhalo model. Our calculations show that for the annihilating DM the extragalactic gamma-ray signal can dominate only if rather extreme power-law concentration-mass relation $C(M)$ is used, while more realistic $C(M)$ relations make the extragalactic component comparable or subdominant to the Galactic signal. For the decaying DM the Galactic signal always exceeds the extragalactic one. In the case of annihilating DM the PFH favored parameters can be ruled out only if power-law $C(M)$ relation is assumed. For DM decaying into $2\mu$ or $4\mu$ the PFH favored DM parameters are not in conflict with the Fermi gamma-ray data. We find that, due to the (almost) featureless Galactic IC spectrum and the DM halo substructure, annihilating DM may give a good simultaneous fit to the isotropic diffuse gamma-ray and to the PFH $e^\pm$ data without being in clear conflict with the other Fermi-LAT gamma-ray measurements.Comment: Accepted for publication in JCAP, added missing references, new Figs. 9 \& 10, 35 page

The Leptonic Higgs as a Messenger of Dark Matter

We propose that the leptonic cosmic ray signals seen by PAMELA and ATIC result from the annihilation or decay of dark matter particles via states of a leptonic Higgs doublet to $\tau$ leptons, linking cosmic ray signals of dark matter to LHC signals of the Higgs sector. The states of the leptonic Higgs doublet are lighter than about 200 GeV, yielding large $\bar{\tau} \tau$ and $\bar{\tau} \tau \bar{\tau} \tau$ event rates at the LHC. Simple models are given for the dark matter particle and its interactions with the leptonic Higgs, for cosmic ray signals arising from both annihilations and decays in the galactic halo. For the case of annihilations, cosmic photon and neutrino signals are on the verge of discovery.Comment: 34 pages, 9 figures, minor typos corrected, references adde

Gravitational reheating in quintessential inflation

We provide a detailed study of gravitational reheating in quintessential inflation generalizing previous analyses only available for the standard case when inflation is followed by an era dominated by the energy density of radiation. Quintessential inflation assumes a common origin for inflation and the dark energy of the Universe. In this scenario reheating can occur through gravitational particle production during the inflation-kination transition. We calculate numerically the amount of the radiation energy density, and determine the temperature $T_*$ at which radiation starts dominating over kination. The value of $T_*$ is controlled by the Hubble parameter $H_0$ during inflation and the transition time $\Delta t$, scaling as $H_0^2 [\ln(1/H_0\Delta t)]^{3/4}$ for $H_0 \Delta t \ll1$ and $H_0^2 (H_0 \Delta t)^{-c}$ for $H_0\Delta t \gg 1$. The model-dependent parameter $c$ is found to be around 0.5 in two different parametrizations for the transition between inflation and kination.Comment: 12 pages, 5 figure