Obstetric Thromboprophylaxis: The Swedish Guidelines

Obstetric thromboprophylaxis is difficult. Since 10 years Swedish obstetricians have used a combined risk estimation model and recommendations concerning to whom, at what dose, when, and for how long thromboprophylaxis is to be administrated based on a weighted risk score. In this paper we describe the background and validation of the Swedish guidelines for obstetric thromboprophylaxis in women with moderate-high risk of VTE, that is, at similar or higher risk as the antepartum risk among women with history of thrombosis. The risk score is based on major risk factors (i.e., 5-fold increased risk of thromboembolism). We present data on the efficacy of the model, the cost-effectiveness, and the lifestyle advice that is given. We believe that the Swedish guidelines for obstetric thromboprophylaxis aid clinicians in providing women at increased risk of VTE with effective and appropriate thromboprophylaxis, thus avoiding both over- and under-treatment

Assessment of Left Atrial Deformation and Function by 2-Dimensional Speckle Tracking Echocardiography in Healthy Dogs and Dogs With Myxomatous Mitral Valve Disease

open7noBackground: The assessment of left atrial (LA) function by 2-dimensional speckle tracking echocardiography (STE) holds important clinical implications in human medicine. Few similar data are available in dogs. Objectives: To assess LA function by STE in dogs with and without myxomatous mitral valve disease (MMVD), analyzing LA areas, systolic function, and strain. Animals: One hundred and fifty dogs were divided according to the American College of Veterinary Internal Medicine classification of heart failure: 23 dogs in class A, 52 in class B1, 36 in class B2, and 39 in class C + D. Methods: Prospective observational study. Conventional morphologic and Doppler variables, LA areas, and STE-based LA strain analysis were performed in all dogs and results were compared among groups. Correlation analysis was carried out between LA STE variables and other echocardiographic variables. Results: Variability study showed good reproducibility for all the tested variables (coefficient of variation <16%). Left atrial areas, fractional area change, peak atrial longitudinal strain (PALS), peak atrial contraction strain, and contraction strain index (CSI) differed significantly between groups B2 and C + D and all the other groups (overall P < .001), whereas only PALS differed between groups B1 and A (P = .01). Left atrial areas increased with progression of the disease, whereas LA functional parameters decreased. Only CSI increased nonsignificantly from group A to group B1 and then progressively decreased. Thirty-one significant correlations (P < .001, r > .3) were found between conventional left heart echocardiographic variables and LA areas and strain variables. Conclusions and Clinical Importance: Left atrial STE analysis provides useful information on atrial function in the dog, highlighting a progressive decline in atrial function with worsening of MMVD.openBaron Toaldo, M; Romito, G.; Guglielmini, C.; Diana, A.; Pelle, N.G.; Contiero, B.; Cipone, M.Baron Toaldo, M; Romito, G.; Guglielmini, C.; Diana, A.; Pelle, N.G.; Contiero, B.; Cipone, M

Prognostic value of echocardiographic indices of left atrial morphology and function in dogs with myxomatous mitral valve disease

Background: The prognostic relevance of left atrial (LA) morphological and functional variables, including those derived from speckle tracking echocardiography (STE), has been little investigated in veterinary medicine. Objectives: To assess the prognostic value of several echocardiographic variables, with a focus on LA morphological and functional variables in dogs with myxomatous mitral valve disease (MMVD). Animals: One-hundred and fifteen dogs of different breeds with MMVD. Methods: Prospective cohort study. Conventional morphologic and echo-Doppler variables, LA areas and volumes, and STE-based LA strain analysis were performed in all dogs. A survival analysis was performed to test for the best echocardiographic predictors of cardiac-related death. Results: Most of the tested variables, including all LA STE-derived variables were univariate predictors of cardiac death in Cox proportional hazard analysis. Because of strong correlation between many variables, only left atrium to aorta ratio (LA/Ao > 1.7), mitral valve E wave velocity (MV E vel > 1.3 m/s), LA maximal volume (LAVmax > 3.53 mL/kg), peak atrial longitudinal strain (PALS < 30%), and contraction strain index (CSI per 1% increase) were entered in the univariate analysis, and all were predictors of cardiac death. However, only the MV E vel (hazard ratio [HR], 4.45; confidence interval [CI], 1.76-11.24; P <.001) and LAVmax (HR, 2.32; CI, 1.10-4.89; P =.024) remained statistically significant in the multivariable analysis. Conclusions and Clinical Importance: The assessment of LA dimension and function provides useful prognostic information in dogs with MMVD. Considering all the LA variables, LAVmax appears the strongest predictor of cardiac death, being superior to LA/Ao and STE-derived variables

Retrospective evaluation of the ST segment electrocardiographic features in 180 healthy dogs

Objectives Normal features of the ST segment are poorly characterised in dogs. This study aimed to describe ST segment characteristics in a population of healthy dogs. Materials and Methods Medical records were reviewed to identify healthy dogs that underwent an electrocardiogram. Several ST segment qualitative parameters were evaluated: presence/absence of deviation, type of deviation (depression/elevation) and morphological patterns of depression (horizontal, downsloping, upsloping and sagging) and elevation (horizontal, concave and convex). Moreover, the amplitude of ST segment depression/elevation was measured. The potential effect of sex, bodyweight, age and somatotype on the presence/absence of ST segment deviation was evaluated through binary logistic regression. Results One hundred and eighty dogs were enrolled. The deviation was evident in 43 of 180 dogs (23.9%), among which 36 showed depression and seven showed elevation. The median depression amplitude was 0.1 (range 0.05 to 0.3) mV. The mean elevation amplitude was 0.136 +/- 0.055 mV. Concerning depression morphology, the horizontal pattern was overrepresented, followed by the downsloping and upsloping ones. Concerning elevation morphology, all dogs showed a concave pattern. No meaningful effect of sex, bodyweight, age and somatotype on the presence/absence of ST segment deviation was documented. Clinical Significance Normal features of canine ST segment were described and made available for clinical use

The effect of sea‐level rise on estuary filling in scaled landscape experiments

When sea-level rise slowed down in the middle Holocene, fluvial and coastal sediments filled the newly created accommodation, whilst others remained largely unfilled because of limited sediment supply. In view of current and future rapid sea-level rise, the question arises how estuarine systems will adapt and whether the land-level rise may keep up. Besides geological data and conceptual models of large-scale and long-term estuary filling, little is known about the filling process during sea-level rise on the decadal-to-centennial time scale that is relevant for society. This study focusses on how sea-level rise affects the morphological and hydrodynamic development of filling estuaries. To this end, scaled laboratory experiments were conducted in a tilting flume facility that creates bidirectional tidal currents and develops entire estuaries. A net importing estuary with sand, mud and vegetation was formed that was subjected to linear sea-level rise. Findings show less of the imported sand was deposited landward following sea-level rise than in an experiment without sea-level rise. The bay-head delta and the flood-tidal delta retained nearly enough sediment to keep up with sea-level rise, whilst the tidal embayment in between drowned except for the highest vegetated bars. Sea-level rise also reduced vegetation survival and sprouting potential, as prolonged inundation increased mortality, negating the potential eco-engineering effect. This resulted in lower vegetation coverage with sea-level rise than under constant sea level. These findings suggest that sea-level rise may cause natural systems to drown even if nearly sufficient sediment is available to fill the newly created accommodation, particularly in areas further away from the fluvial and marine sediment sources. Finally, depending on the sea-level rise rate, the flood-tidal delta may show back-stepping like fluvial deltas, but in the reverse direction towards the sea

Time-dependent cyclic behavior of reinforced concrete bridge columns under chlorides-induced corrosion and rebars buckling

This study presents the results of a refined numerical investigation meant at understanding the time-dependent cyclic behavior of reinforced concrete (RC) bridge columns under chlorides-induced corrosion. The chloride ingress in the cross-section of the bridge column is simulated, taking into account the effects of temperature, humidity, aging, and corrosion-induced cover cracking. Once the partial differential equations governing such multiphysics problem are solved through the finite-element method, the loss of reinforcement steel bars cross-section is calculated based on the estimated corrosion current density. The nonlinear cyclic response of the RC bridge column under corrosion is, thus, determined by discretizing its cross-sections into several unidirectional fibers. In particular, the nonlinear modeling of the corroded longitudinal rebars exploits a novel proposal for the estimation of the ultimate strain in tension and also accounts for buckling under compression. A parametric numerical study is finally conducted for a real case study to unfold the role of corrosion pattern and buckling mode of the longitudinal rebars on the time variation of capacity and ductility of RC bridge columns