Clinical outcomes and plasma clot permeability and lysability in patients with venous thromboembolism on rivaroxaban : a cohort study

Denser fibrin structure and impaired fibrinolysis reported in patients following venous thromboembolism (VTE) can predict recurrent VTE after cessation of anticoagulation. The aim of the study was to investigate whether the properties of fibrin clot may be useful in predicting adverse events in patients with VTE receiving rivaroxaban. In 132 patients with VTE treated with rivaroxaban for 8 weeks or longer, we determined plasma clot permeability ($K_{s}$) and clot lysis time (CLT) in blood samples collected 2 to 28 hours after rivaroxaban intake (20 mg/d). The primary endpoint was a composite of major and clinically relevant nonmajor bleeding, while the secondary endpoint was recurrent symptomatic VTE. During a median follow‑up of 32 months, the annual rates of primary and secondary endpoints were 3.6% and 2.7%, respectively. There were no differences in $K_{s}$ and CLT between individuals who experienced the primary endpoint and the remainder. Patients with recurrent VTE had lower baseline $K_{s}$ (-26.7%) and prolonged CLT (+20.8%) on rivaroxaban, without differences in rivaroxaban concentrations at the time of blood collection. After adjustment for confounding factors, $K_{s}$ was the only predictor of VTE recurrence on rivaroxaban (odds ratio, 0.23; 95% CI, 0.06-0.94). Our study suggests that $K_{s}$ assessed on rivaroxaban may provide prognostic information about the risk of recurrent VTE in anticoagulated patients

Anthropometric profile of pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a single center one-year follow-up study

Introduction: Hematopoietic stem cell transplantation (HSCT) is an aggressive form of therapy which leads to malnutri­tion requiring nutritional support. The aim of our study was to evaluate if the growth of children is affected by HSCT and what the relevant factors are. Methods: We analyzed changes in anthropometric measures of 79 pediatric patients who underwent allogeneic HSCT. Nutritional status was assessed based on weight and height measurements collected prior to HSCT and within 12 months post-transplantation. Body weight and height were referred to the age of patients using available z-score calculators. Results: Compared to the first measurement, the weight-for-age and height-for-age z-scores were significantly reduced in all following measurements within a 1-year follow-up. The most severe weight loss occurred on the last day of hospitalization related to HSCT, while the height gain declined progressively after HSCT. The presence of acute graft versus host disease (GvHD) and the use of a total body irradiation-based regimen were found to be risk factors for a severe slowdown of weight gain, while acute GvHD of the gastrointestinal tract, chronic GvHD and the use of parenteral nutri­tion were risk factors for a decline in height gain. Conclusions: Patients treated with allogeneic HSCT demonstrate a reduction in the pace of growth. HSCT recipients complicated by GvHD require prolonged and close weight and height monitorin

Genetic Profile and Clinical Implications of Hepatoblastoma and Neuroblastoma Coexistence in a Child

The aim of the following case report is to provide a description of the coexistence of two independent tumors in a child. A 9-month-old male was referred to Department of Pediatric Oncology and Hematology with hepatic tumor present on ultrasound imaging and symptoms of enlarged abdominal circumference. Physical examination revealed a palpable epigastric mass and the imaging techniques showed a tumor of the left hepatic lobe measuring 11 × 6.5 × 8.9 cm with pancreas infiltration, distant metastases in both lungs and abnormal lesion in the left adrenal gland. Basing on histopathological examination, after a core-needle biopsy, hepatoblastoma (HBL) (mixed epithelial-mesenchymal subtype) was diagnosed. The α-fetoprotein level was 112 993 ng/ml. Elevated values of normetanephrine, 3-methoxytyramine as well as neuron-specific enolase were observed. Due to the clinical picture and diagnosis, the patient was qualified to preoperative chemotherapy according to the SIOPEL-3 protocol, followed by SIOPEL-4 protocol for the high-risk patients. After undergoing preoperative chemotherapy, imaging tests revealed regression of hepatic tumor and no focal pulmonary masses, while regression of adrenal gland mass was not completed. The patient was qualified for left hemihepatectomy with left adrenalectomy. Histopathological examination of liver specimen confirmed the HBL diagnosis. However, in left adrenal gland and paraaortic lymph nodes the residual neuroblastoma (NBL) cells were detected. Whole exome sequencing (WES) was utilized to identify disease-associated germline mutations. WES revealed a novel germline insertion variant in TWIST1 (p.Gly86dup), along with the potentially pathogenic non-synonymous variants in NF1 (p.Val2511Ile), RAF1 (p.Leu445Arg), and WHSC1 (p.Ser4Asn) genes. Currently, 6 months after completion of treatment according to the SIOPEL-4 protocol, the patient is in good general condition, without any signs, and symptoms of relapse of both neoplasms. The coexistence of two different primary childhood malignancies is rarely seen. So far, only one case of synchronous HBL and NBL has been reported. However, for the first time therapeutic process was successful. A specific signature of rare germline mutations can be proposed as a predisposing factor to synchronous HBL and NBL occurrence

Evaluation of Lower Limb Muscle Electromyographic Activity during 400 m Indoor Sprinting among Elite Female Athletes: A Cross-Sectional Study

The purpose of this cross-sectional study was to analyze changes in normalized surface electromyography (sEMG) signals for the gastrocnemius medialis, biceps femoris, gluteus maximus, tibialis anterior, and vastus lateralis muscles occurring during a 400 m indoor sprint between subsequent curved sections of the track. Ten well-trained female sprinters (age: 21 ± 4 years; body mass: 47 ± 5 kg; body height: 161 ± 7 cm; 400 m personal best: 52.4 ± 1.1 s) performed an all-out 400 m indoor sprint. Normalized sEMG signals were recorded bilaterally from the selected lower limb muscles. The two-way ANOVA (curve × side) revealed no statistically significant interaction. However, the main effect analysis showed that normalized sEMG signals significantly increased in subsequent curves run for all the studied muscles: gastrocnemius medialis (p = 0.003), biceps femoris (p < 0.0001), gluteus maximus (p = 0.044), tibialis anterior (p = 0.001), and vastus lateralis (p = 0.023), but differences between limbs were significant only for the gastrocnemius medialis (p = 0.012). The results suggest that the normalized sEMG signals for the lower limb muscles increased in successive curves during the 400 m indoor sprint. Moreover, the gastrocnemius medialis of the inner leg is highly activated while running curves; therefore, it should be properly prepared for high demands, and attention should be paid to the possibility of the occurrence of a negative adaptation, such as asymmetries