Thromboprophylaxis in atrial fibrillation: correct interpretation and effective use of CHA2DS2-VASc and HAS-BLED scores

Thromboprophylaxis is one of the most important aspects of atrial fibrillation (AF) management as irregular atrial contractions foster formation of blood clots that may result in ischemic stroke. Strokes caused by AF are relatively large and often lead to death or sever disability, but they may be avoided with appropriate anticoagulation therapy. Unfortunately, the risk factors for stroke overlap with risk factors for bleeding, creating a genuine challenge for clinicians seeking to strike a balance in preventing these two types of complications. This is why risk assessment scores CHA2DS2-VASc and HAS-BLED have been developed. While their role to optimize the anticoagulation therapy was confirmed in multiple studies, the misinterpretation of the criteria within these scores and their inappropriate application can result in suboptimal treatment and needlessly expose patients to the risk of stroke, hemorrhage, or both. This review aims to present appropriate interpretation of CHA2DS2-VASc and HAS-BLED scores and discuss how anticoagulation therapy of AF patients should be guided by those two scores

High variation among clinical studies in the assessment of physical function after knee replacement: a systematic review

PurposeThe purpose of this study was to summarise the current use of outcome measures for the assessment of physical function after knee joint replacement.MethodsA systematic approach following the PRISMA guidelines was used. Literature search was performed on MEDLINE database via PubMed and on Epistemonikos. Clinical trials (level of evidence I-II) on knee joint replacement reporting data on the 'physical function' domain published between January 2017 and June 2022 were included. Descriptive statistics were used to summarise the evidence.ResultsIn the 181 articles that met the inclusion criteria, 49 different outcome measurements were used to evaluate clinical outcomes after knee joint replacement. The most frequently adopted patient-reported outcome measures (PROMs) were the Knee Society Score (KSS) (78 studies; 43.1%), the Western Ontario and McMaster Universities (WOMAC) Arthritis Index (62 studies; 34.3%), the Oxford Knee Score (OKS) (51 studies; 28.2%) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) (36 studies; 20%). The most frequently used performance-based outcome measures (PBOMs) were the Timed-Up-and-Go (TUG) test (30 studies; 16.6%) and the 6-min-walk test (6MWT) (21 studies; 11.6%). Among impairment-based outcome measures (IBOMs), range of motion (ROM) was the most used (74 studies; 40.9%).ConclusionThere is considerable variation among clinical studies regarding the assessment of the physical function of patients after knee joint replacement. PROMs were found to be the most commonly adopted outcome measures; however, no single PROM was used in more than half of the papers analysed

Respiratory disorders and neonatal outcomes of triplet pregnancies – our ten year experience

Objective. To compare respiratory disorders (respiratory distress syndrome, requirement for respiratory support, development of chronic lung disease), duration of hospitalization and other neonatal outcomes between newborns born from triplet pregnancies over a ten year period. Methods. A retrospective analysis of 34 triplet pregnancies delivered between 2006 and 2015 in one perinatal tertiary centre. Ninety-nine newborns from these pregnancies were divided into 2 groups: one consisted of 56 neonates (19 sets of triplets) born between 2006 and 2011 and the second contained 43 neonates delivered from 15 triplet pregnancies between 2012 and 2015. Results. There were no differences in the incidence of respiratory distress syndrome and chronic lung disease between group I and group II. In both groups, a similar amount of patients required respiratory support. We did not notice any significant differences in the type of ventilation (mechanical ventilation or nasal continuous positive airway pressure -nCPAP), duration of ventilation, length of hospitalization or the incidence of complications of prematurity, such as 3rd or 4th grade intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) stage > 2, between both groups. Conclusion. Despite important progress in perinatal care and wide use of advanced technologies in neonatal intensive care there has been no significant improvement in neonatal outcomes of triplets during the past 10 years. Multiple pregnancies still remain a risk factor for respiratory disorders and other neonatal complications in prematurely delivered newborns

Thromboprophylaxis in atrial fibrillation: correct interpretation and effective use of CHA2DS2-VASc and HAS-BLED scores

Thromboprophylaxis is one of the most important aspects of atrial fibrillation (AF) management as irregular atrial contractions foster formation of blood clots that may result in ischemic stroke. Strokes caused by AF are relatively large and often lead to death or sever disability, but they may be avoided with appropriate anticoagulation therapy. Unfortunately, the risk factors for stroke overlap with risk factors for bleeding, creating a genuine challenge for clinicians seeking to strike a balance in preventing these two types of complications. This is why risk assessment scores CHA2DS2-VASc and HAS-BLED have been developed. While their role to optimize the anticoagulation therapy was confirmed in multiple studies, the misinterpretation of the criteria within these scores and their inappropriate application can result in suboptimal treatment and needlessly expose patients to the risk of stroke, hemorrhage, or both. This review aims to present appropriate interpretation of CHA2DS2-VASc and HAS-BLED scores and discuss how anticoagulation therapy of AF patients should be guided by those two scores

Distance of the cervical part of the internal carotid artery from the selected anatomical structures in the parapharyngeal space and its relation to patient characteristics

Anomalies of the internal carotid artery (ICA) can increase the risk of haemorrhage during common surgical procedures. The aim of this literature review was to summarize the current state of knowledge on the course of the internal carotid artery in the parapharyngeal space, including the impact of the patient characteristics on the distances between the artery and other anatomical structures, as well as symptoms accompanying the aberrations. Pathologies related to the course of ICA in the parapharyngeal space are common (10%-60% in the general population and up to 84.4% in the elderly). In women, the distances in the oropharynx area are shorter than in men. Although the number of morphological studies is growing, providing more information on this topic, the identified studies differ in the methods and results. Knowledge on the variability in the course of ICA can help identify patients at high risk for the ICA trauma during pharyngeal procedures

Carbon ion self-sputtering attained by sublimation of hot graphite target and controlled by pulse injection of a neon-helium gas mixture

The operation of graphite targets with an increased temperature (HT - hot target) is studied for the case of gas injection magnetron sputtering (GIMS) of: 1) diamond-like carbon (DLC), and 2) carbon-silicon carbide (C-SiC) films. A purposely-thinned graphite target with a reduced thermal conductivity is applied for DLC deposition, extending its high temperature sputtering range up to 1636 degrees C. For the purpose of C-SiC synthesis four sockets with a silicon carbide powder are designed within graphite target. In this approach, the C-SiC target surface can be heated up to 1443 degrees C due to a greater energy input from impulse plasma, in the range 322-932 J. The HT sputtering is energy-controlled by a pulsed injection of a neon-helium gas mixture. High-energy Ne+ and He+ ions extend the length of pulsed GIMS discharge due to the self-sputtering effect observed during the deposition of DLC and C-SiC films. These conditions result in an almost 5-fold increase in the film growth rate (up to 185 nm/min) with respect to the operation with a cold target, which is due to the assisting vapour sublimation from custom-designed graphite-based targets. The temperature boosted HT GIMS discharge, proves to be an efficient tool for reaching relatively high (similar to 35 %) sp(3)-hybridized C content in both carbon-based materials. It also allows for tailoring the energy bandgap of DLC-based optical structure, in the range from 1.7 to 2.75 eV, due to the formation of the (C-C) and (C-O) bonds. Higher content of silicon oxide (SiO2-x) and silicon carbide (SiC) phases (15 - 23 %) in the case of C-SiC films results in hardness increase from 21.8 to 30.1 GPa.Funding Agencies|National Science Centre of Poland [2018/31/B/ST8/00635]; National Science Centre of Poland under PRELUDIUM project [2017/27/N/ST8/00454]; Warsaw University of Technology within the Excellence Initiative: Research University [1820/151/Z09/2021]; Swedish Research Council VR [2018-03957]; Swedish Energy Agency [51201-1]</p

The Patellostabilometer: A New Device for Quantification of Mediolateral Patella Displacement

Mediolateral patella displacement is of interest for diagnostics and clinically relevant research questions. Apart from manual testing, no standardized method is currently available. Proper quantification of patella mobility is necessary to better understand pathologies at the patellofemoral joint. Patella mobility was assessed in 25 healthy individuals using a Patellostabilometer, a new prototype instrument for quantification of the mediolateral patella displacement. The participants underwent measurements of the mediolateral displacement three times using the Patellostabilometer. A maximal force of 10 N was applied for patella movement. Additionally, leg length and circumference of the knee, upper- and lower-leg were measured. Lateral patella displacement of 18.27 ± 3.76 mm (range 15.85–20.64 mm, interquartile range (IQR) of 4.79) was measured. The medial patella displacement showed 24.47 ± 6.59 mm (range 19.29–29.76 mm, IQR of 10.47). The test–retest measurement error was 2.32 ± 1.76 mm (IQR of 2.38 mm), with five outliers. There was greater test–retest variability between the measurements of the medial displacement compared to the lateral one. The test–retest variability reached 7% of the patella displacement. Other parameters provided no significant correlations. Based on the natural patellofemoral mobility, a precise and clinically relevant quantification of patella mobility is allowed