Dental management considerations for the patient with an acquired coagulopathy. Part 1: Coagulopathies from systemic disease

Current teaching suggests that many patients are at risk for prolonged bleeding during and following invasive dental procedures, due to an acquired coagulopathy from systemic disease and/or from medications. However, treatment standards for these patients often are the result of long-standing dogma with little or no scientific basis. The medical history is critical for the identification of patients potentially at risk for prolonged bleeding from dental treatment. Some time-honoured laboratory tests have little or no use in community dental practice. Loss of functioning hepatic, renal, or bone marrow tissue predisposes to acquired coagulopathies through different mechanisms, but the relationship to oral haemostasis is poorly understood. Given the lack of established, science-based standards, proper dental management requires an understanding of certain principles of pathophysiology for these medical conditions and a few standard laboratory tests. Making changes in anticoagulant drug regimens are often unwarranted and/or expensive, and can put patients at far greater risk for morbidity and mortality than the unlikely outcome of postoperative bleeding. It should be recognised that prolonged bleeding is a rare event following invasive dental procedures, and therefore the vast majority of patients with suspected acquired coagulopathies are best managed in the community practice setting

Static platelet adhesion, flow cytometry and serum TXB2 levels for monitoring platelet inhibiting treatment with ASA and clopidogrel in coronary artery disease: a randomised cross-over study

<p>Abstract</p> <p>Background</p> <p>Despite the use of anti-platelet agents such as acetylsalicylic acid (ASA) and clopidogrel in coronary heart disease, some patients continue to suffer from atherothrombosis. This has stimulated development of platelet function assays to monitor treatment effects. However, it is still not recommended to change treatment based on results from platelet function assays. This study aimed to evaluate the capacity of a static platelet adhesion assay to detect platelet inhibiting effects of ASA and clopidogrel. The adhesion assay measures several aspects of platelet adhesion simultaneously, which increases the probability of finding conditions sensitive for anti-platelet treatment.</p> <p>Methods</p> <p>With a randomised cross-over design we evaluated the anti-platelet effects of ASA combined with clopidogrel as well as monotherapy with either drug alone in 29 patients with a recent acute coronary syndrome. Also, 29 matched healthy controls were included to evaluate intra-individual variability over time. Platelet function was measured by flow cytometry, serum thromboxane B₂(TXB₂)-levels and by static platelet adhesion to different protein surfaces. The results were subjected to Principal Component Analysis followed by ANOVA, t-tests and linear regression analysis.</p> <p>Results</p> <p>The majority of platelet adhesion measures were reproducible in controls over time denoting that the assay can monitor platelet activity. Adenosine 5'-diphosphate (ADP)-induced platelet adhesion decreased significantly upon treatment with clopidogrel compared to ASA. Flow cytometric measurements showed the same pattern (r²= 0.49). In opposite, TXB₂-levels decreased with ASA compared to clopidogrel. Serum TXB₂and ADP-induced platelet activation could both be regarded as direct measures of the pharmacodynamic effects of ASA and clopidogrel respectively. Indirect pharmacodynamic measures such as adhesion to albumin induced by various soluble activators as well as SFLLRN-induced activation measured by flow cytometry were lower for clopidogrel compared to ASA. Furthermore, adhesion to collagen was lower for ASA and clopidogrel combined compared with either drug alone.</p> <p>Conclusion</p> <p>The indirect pharmacodynamic measures of the effects of ASA and clopidogrel might be used together with ADP-induced activation and serum TXB₂for evaluation of anti-platelet treatment. This should be further evaluated in future clinical studies where screening opportunities with the adhesion assay will be optimised towards increased sensitivity to anti-platelet treatment.</p

Description and applications of a 3D mathematical model for horizontal anode baking furnaces

In aluminum industry, carbon anodes are consumed continuously during alumina reduction in the electrolysis cells. Anodes are made of calcined coke, butt, and recycled anode particles and pitch as the binder. Green anodes are baked in large furnaces where they attain specific properties in terms of density, mechanical strength, and electrical conductivity. Baking is an important and costly step in carbon anode production. The proper operation of the furnace provides the required anode quality. Mathematical modeling allows the prediction of the heating profile of anodes during baking. Taking into account all the relevant phenomena, a 3D transient mathematical model was developed to simulate the different stages of the baking process in the furnace. The predictions give a detailed view of the furnace operation and performance. In this article, the 3D model is described, and the results on the impact of various parameters on furnace behavior are presented

A dynamic process model for predicting the performance of horizontal anode baking furnaces

Anode manufacturing is an important step during the production of primary aluminum, and baking is the costliest stage of the anode manufacturing process. The industrial challenge resides in obtaining a good anode quality while keeping the energy consumption, environmental emissions, and cost to minimum. A dynamic process model has been developed for horizontal anode baking furnaces. It covers all important phenomena such as fuel combustion, generation and combustion of volatiles (tar, methane, and hydrogen), air infiltration, and heat losses to the atmosphere and the foundation. The model was built using two coupled sub-models of the flue and the pit and was validated using the plant data. It simulates the dynamic behavior of the furnace and gives a prediction of its operation and performance. In this article, the modelling approach will be described, and the results of a number of case studies will be presented

Does PACS improve diagnostic accuracy in chest radiograph interpretations in clinical practice?

10.1016/j.ejrad.2010.08.043European Journal of Radiology811173-177EJRA

Do clinicians read our reports? Integrating the radiology information system with the electronic patient record: Experiences from the first 2 years

10.1007/s00330-008-1098-3European Radiology19131-36EURA