Thromboembolic and major bleeding events in relation to perioperative bridging of vitamin K antagonists in 649 fast-track total hip and knee arthroplasties

Background — The benefit of preoperative bridging in surgical patients with continuous anticoagulant therapy is debatable, and drawing of meaningful conclusions may have been limited by mixed procedures with different thromboembolic and bleeding risks in most published studies. Patients and methods — This was an observational cohort treatment study in consecutive primary unilateral total hip and knee arthroplasty patients between January 2010 and November 2013 in 8 Danish fast-track departments. Data were collected prospectively on preoperative comorbidity and anticoagulants in patients with preoperative vitamin K antagonist (VKA) treatment. We performed 30-day follow-up on in-hospital complications and re-admissions through the Danish National Patient Registry and patient records. Results — Of 13,375 procedures, 649 (4.7%) were in VKA patients with a mean age of 73 (SD 9) years and a median length of stay of 3 days (IQR: 2–4). Preoperative bridging was used in 430 (67%), while 215 (33%) were paused. Of 4 arterial thromboembolic events (ATEs) (0.6%), 2 were in paused patients and 2 were in bridged patients (p = 0.6). Of 3 venous thromboembolic events (VTEs) (0.5%), 2 were in paused patients and 1 was in a bridged patient (p = 0.3). Of 8 major bleedings (MBs) (1.2%), 1 was in a paused patient and 7 were in bridged patients (p = 0.3), 5 of whom received therapeutic bridging. Similar results were found in a propensity-matched cohort. Interpretation — In contrast to recent studies in mixed surgical procedures, no statistically significant differences in ATE, VTE, or MB were found between preoperative bridging and pausation of VKA patients. However, the higher number of thromboembolic events in paused patients and the higher number of major bleedings in bridged patients warrant more extensive investigation

Broadband Relaxation-Optimized Polarization Transfer in Magnetic Resonance

Many applications of magnetic resonance are limited by rapid loss of spin coherence caused by large transverse relaxation rates. In nuclear magnetic resonance (NMR) of large proteins, increased relaxation losses lead to poor sensitivity of experiments and increased measurement time. In this paper we develop broadband relaxation optimized pulse sequences (BB-CROP) which approach fundamental limits of coherence transfer efficiency in the presence of very general relaxation mechanisms that include cross-correlated relaxation. These broadband transfer schemes use new techniques of chemical shift refocusing (STAR echoes) that are tailored to specific trajectories of coupled spin evolution. We present simulations and experimental data indicating significant enhancement in the sensitivity of multi-dimensional NMR experiments of large molecules by use of these methods

Space capsule Patent

Manned space capsule configuration for orbital flight and atmospheric reentr

Does BMI influence hospital stay and morbidity after fast-track hip and knee arthroplasty?

BACKGROUND AND PURPOSE: Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality in such patients who were operated with the fast-track methodology and compared the levels with those in patients with normal BMI. PATIENTS AND METHODS: This was a prospective observational study involving 13,730 procedures (7,194 THA and 6,536 TKA operations) performed in a standardized fast-track setting. Complete 90-day follow-up was achieved using national registries and review of medical records. Patients were grouped according to BMI as being underweight, of normal weight, overweight, obese, very obese, and morbidly obese. RESULTS: Median length of stay (LOS) was 2 (IQR: 2–3) days in all BMI groups. 30-day re-admission rates were around 6% for both THA (6.1%) and TKA (5.9%), without any statistically significant differences between BMI groups in univariate analysis (p > 0.4), but there was a trend of a protective effect of overweight for both THA (p = 0.1) and TKA (p = 0.06). 90-day re-admission rates increased to 8.6% for THA and 8.3% for TKA, which was similar among BMI groups, but there was a trend of lower rates in overweight and obese TKA patients (p = 0.08 and p = 0.06, respectively). When we adjusted for preoperative comorbidity, high BMI in THA patients (very obese and morbidly obese patients only) was associated with a LOS of >4 days (p = 0.001), but not with re-admission. No such relationship existed for TKA. INTERPRETATION: A fast-track setting resulted in similar length of hospital stay and re-admission rates regardless of BMI, except for very obese and morbidly obese THA patients