Monitoring prohemostatic treatment in bleeding patients

Acutely bleeding patients are commonly found in the trauma and major surgery scenarios. They require prompt and effective treatment to restore an adequate hemostatic pattern, to avoid serious and sometimes life-threatening complications.Different prohemostatic treatments are available, including allogeneic blood derivatives (fresh frozen plasma, platelet concentrates, and cryoprecipitates), prothrombin complex concentrates, specific coagulation factors (fibrinogen, recombinant factor XIII, recombinant activated factor VII), and drugs (protamine for patients under heparin treatment, desmopressin, antifibrinolytics).For decades, prohemostatic treatment of the acutely bleeding patient was based on empirical strategies and clinical judgment, both in terms of a correct diagnosis of the mechanism(s) leading to bleeding, and of an assessment of the effects of the treatment. This empirical strategy may lead to excessive or unnecessary use of allogeneic blood products, as well as to an incorrect, inefficacious, or even dangerous treatment. Different monitoring devices are nowadays available for guiding the diagnostic and therapeutic decision-making process in an acutely bleeding patient. This review addresses the available tools for monitoring prohemostatic treatment of the bleeding patient, with a specific respect for point-of-care tests (thromboelastography, thromboelastometry, platelet function tests, and heparin monitoring systems) at the light of the existing evidence

Quantum Gravity - Testing Time for Theories

The extreme smallness of both the Planck length, on the one side, and the ratio of the gravitational to the electrical forces between, say, two electrons, on the other side has led to a widespread belief that the realm of quantum gravity is beyond terrestrial experiments. A series of classical and quantum arguments are put forward to dispel this view. It is concluded that whereas the smallness of the Planck length and the ratio of gravitational to electrical forces, does play its own essential role in nature, it does not make quantum gravity a science where humans cannot venture to probe her secrets. In particular attention is drawn to the latest neutron and atomic interferometry experiments, and to gravity wave interferometers. The latter, as Giovanni Amelino-Camelia argues [Nature 398, 216 (1999)], can be treated as probes of space-time fuzziness down to Planck length for certain quantum-gravity models

Comment on "Gravitationally Induced Neutrino-Oscillation Phases"

We critically examine the recent claim (gr-qc/9603008) of a ``new effect'' of gravitationally induced quantum mechanical phases in neutrino oscillations. A straightforward exercise in the Schwarzschild coordinates appropriate to a spherically symmetric non-rotating star shows that, although there is a general relativistic effect of the star's gravity on neutrino oscillations, it is not of the form claimed, and is too small to be measured.Comment: Plain LaTeX, 7 pages, no figure

Piecewise Parabolic Method on a Local Stencil for Magnetized Supersonic Turbulence Simulation

Stable, accurate, divergence-free simulation of magnetized supersonic turbulence is a severe test of numerical MHD schemes and has been surprisingly difficult to achieve due to the range of flow conditions present. Here we present a new, higher order-accurate, low dissipation numerical method which requires no additional dissipation or local "fixes" for stable execution. We describe PPML, a local stencil variant of the popular PPM algorithm for solving the equations of compressible ideal magnetohydrodynamics. The principal difference between PPML and PPM is that cell interface states are evolved rather that reconstructed at every timestep, resulting in a compact stencil. Interface states are evolved using Riemann invariants containing all transverse derivative information. The conservation laws are updated in an unsplit fashion, making the scheme fully multidimensional. Divergence-free evolution of the magnetic field is maintained using the higher order-accurate constrained transport technique of Gardiner and Stone. The accuracy and stability of the scheme is documented against a bank of standard test problems drawn from the literature. The method is applied to numerical simulation of supersonic MHD turbulence, which is important for many problems in astrophysics, including star formation in dark molecular clouds. PPML accurately reproduces in three-dimensions a transition to turbulence in highly compressible isothermal gas in a molecular cloud model. The low dissipation and wide spectral bandwidth of this method make it an ideal candidate for direct turbulence simulations.Comment: 28 pages, 18 figure

Effect of preoperative P2Y12 and thrombin platelet receptor inhibition on bleeding after cardiac surgery

BACKGROUND: Drugs that act on the platelet P2Y12 receptor are responsible for postoperative bleeding in cardiac surgery. However, protease-activated receptor (PAR) that reacts to thrombin stimulation might still be active in patients treated with P2Y12 inhibitors. Preoperative platelet function testing could possibly guide the timing of surgery. We investigated the association between P2Y12 receptor and PAR inhibition and bleeding after cardiac surgery. METHODS: A retrospective cohort study of 361 patients undergoing cardiac surgery and treated with P2Y12 anti-platelet agents was undertaken. All patients received a preoperative multiplate electrode aggregometry testing of platelet P2Y12 receptor activity (ADPtest) and PAR reactivity with thrombin receptor-activating peptide (TRAP) stimulation. ADPtest and TRAPtest data measured before surgery were analysed for association with postoperative bleeding (ml per 12 h) and severe postoperative bleeding. RESULTS: Both the ADPtest and the TRAPtest were significantly (P=0.001) associated with postoperative bleeding. A threshold of 22 U for the ADPtest yielded a negative predictive value (NPV) of 94% and a positive predictive value (PPV) of 20%, and a threshold of 75 U for the TRAPtest yielded an NPV of 95% and a PPV of 23%. In the subgroup of patients with ADPtest <22 U, TRAPtest ≥75 U was not associated with severe bleeding (NPV of 100% and PPV of 37%). CONCLUSIONS: In patients taking P2Y12 receptor inhibitors, residual platelet reactivity to thrombin stimulation limits the risk of severe postoperative bleeding

Some Remarks on the Neutrino Oscillation Phase in a Gravitational Field

The weak gravitational field expansion method to account for the gravitationally induced neutrino oscillation effect is critically examined. It is shown that the splitting of the neutrino phase into a ``kinematic'' and a ``gravitational'' phase is not always possible because the relativistic factor modifies the particle interference phase splitting condition in a gravitational field.Comment: 4 pages, no figure

Local and global gravity

Our long experience with Newtonian potentials has inured us to the view that gravity only produces local effects. In this paper we challenge this quite deeply ingrained notion and explicitly identify some intrinsically global gravitational effects. In particular we show that the global cosmological Hubble flow can actually modify the motions of stars and gas within individual galaxies, and even do so in a way which can apparently eliminate the need for galactic dark matter. Also we show that a classical light wave acquires an observable, global, path dependent phase in traversing a gravitational field. Both of these effects serve to underscore the intrinsic difference between non-relativistic and relativistic gravity.Comment: LaTeX, 20 pages plus three figures in two postscript files. To appear in a special issue of Foundations of Physics honoring Professor Lawrence Horwitz on the occasion of his 65th birthday; A. van der Merwe and S. Raby, Editors, Plenum Publishing Company, N.Y., 199

Does Quantum Mechanics Clash with the Equivalence Principle - and Does it Matter?

With an eye on developing a quantum theory of gravity, many physicists have recently searched for quantum challenges to the equivalence principle of general relativity. However, as historians and philosophers of science are well aware, the principle of equivalence is not so clear. When clarified, we think quantum tests of the equivalence principle won't yield much. The problem is that the clash/not-clash is either already evident or guaranteed not to exist. Nonetheless, this work does help teach us what it means for a theory to be geometric.Comment: 12 page

Importance of spinal deformity index in risk evaluation of VCF (vertebral compression fractures) in obese subjects: prospective study.

Introduction Obesity and osteoporosis share many features and recent studies have identified many similarities suggesting common pathophysiological mechanisms. Obesity is associated with a higher risk of non-traumatic fractures despite bone mineral density (BMD) being normal or even increased. Materials and methods 54 obese subjects were analyzed (51 ± 16 years, 10 males, 44 females). Spinal deformity index (SDI) is a semi-quantitative method that may be a surrogate index of bone microarchitecture. SDI index was higher in patients than in controls. In 87.5 % of patients and 10 % of controls we found morphometric vertebral fractures, despite a DEXA Tscore not diagnostic of osteoporosis. Conclusion The objective of this study was to assess in obese patients levels of 25OH vitamin D, parathyroid hormone, serum and urinary calcium (Ca) and phosphorus (P), BMD, and SDI. 87.5 % of the obese subjects present nontraumatic vertebral fractures and reduced bone quality as measured by SDI

New Relativistic Effects in the Dynamics of Nonlinear Hydrodynamical Waves

In Newtonian and relativistic hydrodynamics the Riemann problem consists of calculating the evolution of a fluid which is initially characterized by two states having different values of uniform rest-mass density, pressure and velocity. When the fluid is allowed to relax, one of three possible wave-patterns is produced, corresponding to the propagation in opposite directions of two nonlinear hydrodynamical waves. New effects emerge in a special relativistic Riemann problem when velocities tangential to the initial discontinuity surface are present. We show that a smooth transition from one wave-pattern to another can be produced by varying the initial tangential velocities while otherwise maintaining the initial states unmodified. These special relativistic effects are produced by the coupling through the relativistic Lorentz factors and do not have a Newtonian counterpart.Comment: 4 pages, 5 figure