Association of pharmacologic thromboprophylaxis with clinically relevant bleeding and hospital-acquired anemia in medical inpatients: the risk stratification for hospital-acquired venous thromboembolism in medical patients study

Contexte : La thromboprophylaxie pharmacologique (pTPX) pourrait augmenter le risque de saignements cliniquement significatif (CRB) et d'anémie acquise à l'hôpital (HAA) chez les personnes âgées hospitalisées atteintes de multiples pathologies. Nous avons évalué l'association entre l'utilisation de pTPX et le CRB ainsi que l'HAA. Méthode : Nous avons utilisé des données issues d'une étude de cohorte prospective menée dans trois hôpitaux universitaires suisses. Les adultes admis dans des services de médecine interne sans anticoagulation thérapeutique ont été inclus. L'utilisation de pTPX a été enregistrée pendant l'hospitalisation. Les mesures principales étaient les CRB et l'HAA durant l’hospitalisation. Nous avons calculé les taux d'incidence selon le statut de pTPX. Nous avons évalué l'association entre pTPX et CRB en utilisant une analyse de survie, ajusté pour le score de risque hémorragique du Registre international de prévention médicale des thromboembolies veineuses (IMPROVE-BRS). Nous avons également évalué l’association entre le pTPX et l'HAA en utilisant une régression logistique, ajustée pour l'infection, la durée du séjour et le score IMPROVE-BRS. Résultats : Parmi 1305 participant·e·s (âge moyen, 63,7 ans ; 44% de femmes, 90% à faible risque de saignement), 809 (62%) ont reçu une pTPX. L'incidence du CRB était de 2,4 pour 1000 patient·e-jours et n'était pas significativement plus élevée chez les personnes ayant reçu pTPX que chez celles qui ne l'avaient pas reçu. Nous n'avons trouvé aucune association statistiquement significative entre pTPX et CRB. L'HAA était fréquente (20,2%) et plus élevée chez les personnes ayant reçu pTPX que chez celles qui ne l'avaient pas reçu (23,2% contre 15,3%). L'incidence de l'HAA était de 21,2 pour 1000 patient·e-jours et ne différait pas significativement entre les individus ayant reçu pTPX et ceux qui ne l'avaient pas reçu. Nous avons trouvé une association entre pTPX et HAA (rapport de cotes ajusté, 1,4 ; IC à 95 %, 1,0-2,1). Conclusion : Notre étude confirme la sécurité de la pTPX concernant le CRB chez les personnes admises en médecine interne à faible risque de saignement. L'administration de pTPX était associée à l'HAA, et des études supplémentaires sont nécessaires pour explorer cette constatation. En attendant, il est recommandé d’appliquer les lignes directrices cliniques qui recommandent d'administrer une pTPX aux personnes présentant un risque accru de maladie thromboembolique veineuse, à condition qu'elles présentent un faible risque de saignement. -- Background: Pharmacologic thromboprophylaxis (pTPX) might exacerbate the risk of clinically relevant bleeding (CRB) and hospital-acquired anemia (HAA) in older multi- morbid inpatients. Objectives: We aimed to evaluate the association of pTPX use with CRB and HAA. Methods: We used data from a prospective cohort study conducted in 3 Swiss university hospitals. Adult patients admitted to internal medicine wards with no therapeutic anticoagulation were included. pTPX use was ascertained during hospitalization. Outcomes were in-hospital CRB and HAA. We calculated incidence rates by status of pTPX. We assessed the association of pTPX with CRB using survival analysis and with HAA using logistic regression, adjusted for infection, length of stay, and the Interna- tional Medical Prevention Registry on Venous Thromboembolism bleeding risk score. Results: Among 1305 patients (mean age, 63.7 years; 44% women, 90% at low risk of bleeding), 809 (62%) received pTPX. The incidence of CRB was 2.4 per 1000 patient- days and was not significantly higher in patients with pTPX than in those without. We found no significant association between pTPX and CRB. HAA was frequent (20.2%) and higher in patients with pTPX than in those without (23.2% vs 15.3%). The incidence of HAA was 21.2 per 1000 patient-days and did not significantly differ be- tween patients with pTPX and those without. We found an association between pTPX and HAA (adjusted odds ratio, 1.4; 95% CI, 1.0-2.1). Conclusion: Our study confirmed the safety of pTPX in medical inpatients at low risk of bleeding but identified an association between pTPX and HAA. Adherence to guidelines that recommend administering pTPX to medical inpatients at increased venous thromboembolism risk and low bleeding risk is necessary

Apontamentos para a História de Guimarães. Relatório sobre o abastecimento de água da cidade de Guimarães. VIIª Parte.

21 (3-4) Jan.-Mar. 1904, p. 138-167

Poly(di(ω-alkylphenyl)stannane)s

Poly(di(ω-alkylphenyl)stannane)s, [Sn(C n H2n Ph)2] m with n=2-4, and a copolymer of di(3-propylphenyl)stannane and dibutylstannane of weight-average molar masses of 2-8·104g/mol were synthesized by dehydropolymerization of stannanes of the composition H2SnR2 using Wilkinson's catalyst [RhCl(PPh3)3]. At least two methylene groups were required as spacers between the phenyl group and the tin atom for polymerization to occur. The polystannanes were characterized by, among other techniques, 1H, 13C and 119Sn NMR spectroscopy, thermal analysis and X-ray diffraction. The polymers featured properties different from those of the corresponding poly(dialkylstannane)s. Specifically, the [Sn(C n H2n Ph)2] m family displayed glass transitions at remarkably low temperatures, down to ca. −50°C, and a lower value for a copolymer (−68°C). Polymers [Sn(CnH2nPh)2]m with n=2 and 3 and a copolymer at room temperature were of a gel-like concistence, which enabled facile orientation with shear forces. Finally, the temperature-dependent electrical conductivity was determined for poly(di(3-propylphenyl)stannane), which followed the law of typical semiconductors, with an activation energy for conduction of 0.12e

Large and interacting effects of temperature and nutrient addition on stratified microbial ecosystems in a small, replicated, and liquid-dominated Winogradsky column approach

Aquatic ecosystems are often stratified, with cyanobacteria in oxic layers and phototrophic sulfur bacteria in anoxic zones. Changes in stratification caused by the global environmental change are an ongoing concern. Increasing understanding of how such aerobic and anaerobic microbial communities, and associated abiotic conditions, respond to multifarious environmental changes is an important endeavor in microbial ecology. Insights can come from observational and experimental studies of naturally occurring stratified aquatic ecosystems, theoretical models of ecological processes, and experimental studies of replicated microbial communities in the laboratory. Here, we demonstrate a laboratory-based approach with small, replicated, and liquid-dominated Winogradsky columns, with distinct oxic/anoxic strata in a highly replicable manner. Our objective was to apply simultaneous global change scenarios (temperature, nutrient addition) on this micro-ecosystem to report how the microbial communities (full-length 16S rRNA gene seq.) and the abiotic conditions (O2 , H2 S, TOC) of the oxic/anoxic layer responded to these environmental changes. The composition of the strongly stratified microbial communities was greatly affected by temperature and by the interaction of temperature and nutrient addition, demonstrating the need of investigating global change treatments simultaneously. Especially phototrophic sulfur bacteria dominated the water column at higher temperatures and may indicate the presence of alternative stable states. We show that the establishment of such a micro-ecosystem has the potential to test global change scenarios in stratified eutrophic limnic systems. Keywords: anaerobes; cyanobacteria; global change; oxygen; phototrophic sulfur bacteri

De Pampilhosa au granite : observations géologiques en voyage par la ligne Coimbra - Sta. Comba Dão - Guarda - frontière espagnole

Relato sucinto das duas viagens de comboio que P. Choffat efectuou no princípio do séc. XX ao Maciço Hespérico, provavelmente para reconhecimento da geologia regional, com observações geológicas egeográficas e ainda sobre a sua vegetação, agricultura e arquitectura

Sexual behaviour in Drosophila is irreversibly programmed during a critical period

AbstractSexual differentiation in Drosophila is controlled by a short cascade of regulatory genes, the expression pattern of which determines all aspects of maleness and femaleness, including complex behaviours displayed by males and females [1–3]. One sex-determining gene is transformer (tra), the activity of which is needed for female development. Flies with a female karyotype (XX) but which are mutant for tra develop and behave as males. In such flies, a female phenotype can be restored by a transgene that carries the female-specific cDNA of tra under the control of a heat-shock promoter. This transgene, called hs[trafem], also transforms XY animals into sterile females [4]. When we raised these XX and XY ‘females’ at 25°C, however, they displayed vigorous male courtship while at the same time, as a result of their female pheromone pattern, they were attractive to males. Intriguingly, their male courtship behaviour was indiscriminately directed towards both females and males. When we forced expression of tra by heat shock, applied during a limited period around puparium formation, male behaviour was abolished and replaced by female behaviour. We conclude that sexual behaviour is irreversibly programmed during a critical period as a result of the activity or inactivity of a single control gene

Effect of Pre-Hospital Intubation in Patients with Severe Traumatic Brain Injury on Outcome: A Prospective Cohort Study.

Secondary injuries are associated with bad outcomes in the case of severe traumatic brain injury (sTBI). Patients with a Glasgow Coma Scale (GCS) < 9 should undergo pre-hospital intubation (PHI). There is controversy about whether PHI is beneficial. The aim of this study was to estimate the effect of PHI in patients after sTBI. A multicenter, prospective cohort study was performed in Switzerland, including 832 adults with sTBI. Outcomes were death and impaired consciousness at 14 days. Associations between risk factors and outcomes were assessed with univariate and multivariate Cox models for survival, and univariate and multivariate regression models for impaired consciousness. Potential risk factors were age, GCS on scene, pupil reaction, Injury Severity Score (ISS), PHI, oxygen administration, and type of admission to trauma center. Age, GCS on scene < 9, abnormal pupil reaction and ISS ≥ 25 were associated with mortality. GCS < 9 and ISS ≥ 25 were correlated with impaired consciousness. PHI was overall not associated with short-term mortality and consciousness. However, there was a significative interaction with PHI and major trauma. PHI improves outcome from patients with sTBI and an ISS ≥ 25

Risk Assessment Models for Venous Thromboembolism in Medical Inpatients.

IMPORTANCE Thromboprophylaxis is recommended for medical inpatients at risk of venous thromboembolism (VTE). Risk assessment models (RAMs) have been developed to stratify VTE risk, but a prospective head-to-head comparison of validated RAMs is lacking. OBJECTIVES To prospectively validate an easy-to-use RAM, the simplified Geneva score, and compare its prognostic performance with previously validated RAMs. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted from June 18, 2020, to January 4, 2022, with a 90-day follow-up. A total of 4205 consecutive adults admitted to the general internal medicine departments of 3 Swiss university hospitals for hospitalization for more than 24 hours due to acute illness were screened for eligibility; 1352 without therapeutic anticoagulation were included. EXPOSURES At admission, items of 4 RAMs (ie, the simplified and original Geneva score, the Padua score, and the IMPROVE [International Medical Prevention Registry on Venous Thromboembolism] score) were collected. Patients were stratified into high and low VTE risk groups according to each RAM. MAIN OUTCOMES AND MEASURES Symptomatic VTE within 90 days. RESULTS Of 1352 medical inpatients (median age, 67 years [IQR, 54-77 years]; 762 men [55.4%]), 28 (2.1%) experienced VTE. Based on the simplified Geneva score, 854 patients (63.2%) were classified as high risk, with a 90-day VTE risk of 2.6% (n = 22; 95% CI, 1.7%-3.9%), and 498 patients (36.8%) were classified as low risk, with a 90-day VTE risk of 1.2% (n = 6; 95% CI, 0.6%-2.6%). Sensitivity of the simplified Geneva score was 78.6% (95% CI, 60.5%-89.8%) and specificity was 37.2% (95% CI, 34.6%-39.8%); the positive likelihood ratio of the simplified Geneva score was 1.25 (95% CI, 1.03-1.52) and the negative likelihood ratio was 0.58 (95% CI, 0.28-1.18). In head-to-head comparisons, sensitivity was highest for the original Geneva score (82.1%; 95% CI, 64.4%-92.1%), while specificity was highest for the IMPROVE score (70.4%; 95% CI, 67.9%-72.8%). After adjusting the VTE risk for thromboprophylaxis use and site, there was no significant difference between the high-risk and low-risk groups based on the simplified Geneva score (subhazard ratio, 2.04 [95% CI, 0.83-5.05]; P = .12) and other RAMs. Discriminative performance was poor for all RAMs, with an area under the receiver operating characteristic curve ranging from 53.8% (95% CI, 51.1%-56.5%) for the original Geneva score to 58.1% (95% CI, 55.4%-60.7%) for the simplified Geneva score. CONCLUSIONS AND RELEVANCE This head-to-head comparison of validated RAMs found suboptimal accuracy and prognostic performance of the simplified Geneva score and other RAMs to predict hospital-acquired VTE in medical inpatients. Clinical usefulness of existing RAMs is questionable, highlighting the need for more accurate VTE prediction strategies