The international normalized ratio overestimates coagulopathy in patients after major hepatectomy

Abstract BACKGROUND: The International Normalized Ratio (INR) is commonly used to guide therapy after hepatectomy. We hypothesized that the use of thrombelastography (TEG) would demonstrate a decreased incidence of hypocoagulability in this patient population. METHODS: Seventy-eight patients were prospectively enrolled before undergoing hepatectomy. INR, TEG, and coagulation factors were drawn before incision, postoperatively, and on postoperative days 1, 3, and 5. RESULTS: Patients demonstrated an elevated INR at all postoperative time points. However, TEG demonstrated a decreased R value postoperatively, with subsequent normalization. Other TEG measurements were equivalent to preoperative values. All procoagulant factors save factor VIII decreased postoperatively, with a simultaneous decrease in protein C. CONCLUSIONS: TEG demonstrated a brief hypercoagulable state after major hepatectomy, with coagulation subsequently normalizing. The INR significantly overestimates hypocoagulability after hepatectomy and these data call into question current practices using the INR to guide therapy in this patient population. Ó 2014 Elsevier Inc. All rights reserved. Partial hepatectomy remains the treatment of choice for a wide range of both benign and malignant diseases of the liver. Following major hepatectomy, derangement of hepatic synthetic function has been well characterized, including impaired synthesis of serum clotting factors and regulatory proteins

Sample-size dependence of the ground-state energy in a one-dimensional localization problem

We study the sample-size dependence of the ground-state energy in a one-dimensional localization problem, based on a supersymmetric quantum mechanical Hamiltonian with random Gaussian potential. We determine, in the form of bounds, the precise form of this dependence and show that the disorder-average ground-state energy decreases with an increase of the size $R$ of the sample as a stretched-exponential function, $\exp( - R^{z})$, where the characteristic exponent $z$ depends merely on the nature of correlations in the random potential. In the particular case where the potential is distributed as a Gaussian white noise we prove that $z = 1/3$. We also predict the value of $z$ in the general case of Gaussian random potentials with correlations.Comment: 30 pages and 4 figures (not included). The figures are available upon reques

Evidence of Final-State Suppression of High-p_T Hadrons in Au + Au Collisions Using d + Au Measurements at RHIC

Transverse momentum spectra of charged hadrons with ${p_{T} <}$ 6 GeV/c have been measured near mid-rapidity (0.2 $< \eta <$ 1.4) by the PHOBOS experiment at RHIC in Au + Au and d + Au collisions at ${\sqrt{s_{_{NN}}} = \rm {200 GeV}}$. The spectra for different collision centralities are compared to ${p + \bar{p}}$ collisions at the same energy. The resulting nuclear modification factor for central Au + Au collisions shows evidence of strong suppression of charged hadrons in the high-$p_{T}$ region (${>2}$ GeV/c). In contrast, the d + Au nuclear modification factor exhibits no suppression of the high-$p_{T}$ yields. These measurements suggest a large energy loss of the high-$p_{T}$ particles in the highly interacting medium created in the central Au + Au collisions. The lack of suppression in d + Au collisions suggests that it is unlikely that initial state effects can explain the suppression in the central Au + Au collisions.Comment: 3 pages, 4 figures, International Europhysics Conference on High Energy Physics EPS (July 17th-23rd 2003) in Aachen, German

Identified particles in Au+Au collisions at sqrt{s_NN} = 200 GeV

The yields of identified particles have been measured at RHIC for Au+Au collisions at sqrt{s_NN} = 200 GeV using the PHOBOS spectrometer. The ratios of antiparticle to particle yields near mid-rapidity are presented. The first measurements of the invariant yields of charged pions, kaons and protons at very low transverse momenta are also shown.Comment: 4 pages, 4 figures, Contribution to Quark Matter 2002, Nantes, France, July 200

Universal Behavior of Charged Particle Production in Heavy Ion Collisions

The PHOBOS experiment at RHIC has measured the multiplicity of primary charged particles as a function of centrality and pseudorapidity in Au+Au collisions at sqrt(s_NN) = 19.6, 130 and 200 GeV. Two kinds of universal behavior are observed in charged particle production in heavy ion collisions. The first is that forward particle production, over a range of energies, follows a universal limiting curve with a non-trivial centrality dependence. The second arises from comparisons with pp/pbar-p and e+e- data. N_tot/(N_part/2) in nuclear collisions at high energy scales with sqrt(s) in a similar way as N_tot in e+e- collisions and has a very weak centrality dependence. This feature may be related to a reduction in the leading particle effect due to the multiple collisions suffered per participant in heavy ion collisions.Comment: 4 Pages, 5 Figures, contributed to the Proceedings of Quark Matter 2002, Nantes, France, 18-24 July 200

Recent Results from PHOBOS at RHIC

The PHOBOS experiment at RHIC has recorded measurements for Au-Au collisions spanning nucleon-nucleon center-of-mass energies from 19.6 GeV to 200 GeV. Global observables such as elliptic flow and charged particle multiplicity provide important constraints on model predictions that characterize the state of matter produced in these collisions. The nearly 4 pi acceptance of the PHOBOS experiment provides excellent coverage for complete flow and multiplicity measurements. Results including beam energy and centrality dependencies are presented and compared to elementary systems.Comment: 4 pages, 4 figures, proceedings from PANIC02 in Osaka, Japa

Global Observations from PHOBOS

Particle production in Au+Au collisions has been measured in the PHOBOS experiment at RHIC for a range of collision energies. Three empirical observations have emerged from this dataset which require theoretical examination. First, there is clear evidence of limiting fragmentation. Namely, particle production in central Au+Au collisions, when expressed as $dN/d\eta'$ ($\eta' \equiv \eta-y_{beam}$), becomes energy independent at high energy for a broad region of $\eta'$ around $\eta'=0$. This energy-independent region grows with energy, allowing only a limited region (if any) of longitudinal boost-invariance. Second, there is a striking similarity between particle production in e+e- and Au+Au collisions (scaled by the number of participating nucleon pairs). Both the total number of produced particles and the longitudinal distribution of produced particles are approximately the same in e+e- and in scaled Au+Au. This observation was not predicted and has not been explained. Finally, particle production has been found to scale approximately with the number of participating nucleon pairs for $N_{part}>65$. This scaling occurs both for the total multiplicity and for high \pT particles (3 <\pT< 4.5 GeV/c).Comment: QM2002 plenary talk, 10 pages, 11 figure

Tomato: a crop species amenable to improvement by cellular and molecular methods

Tomato is a crop plant with a relatively small DNA content per haploid genome and a well developed genetics. Plant regeneration from explants and protoplasts is feasable which led to the development of efficient transformation procedures. In view of the current data, the isolation of useful mutants at the cellular level probably will be of limited value in the genetic improvement of tomato. Protoplast fusion may lead to novel combinations of organelle and nuclear DNA (cybrids), whereas this technique also provides a means of introducing genetic information from alien species into tomato. Important developments have come from molecular approaches. Following the construction of an RFLP map, these RFLP markers can be used in tomato to tag quantitative traits bred in from related species. Both RFLP's and transposons are in the process of being used to clone desired genes for which no gene products are known. Cloned genes can be introduced and potentially improve specific properties of tomato especially those controlled by single genes. Recent results suggest that, in principle, phenotypic mutants can be created for cloned and characterized genes and will prove their value in further improving the cultivated tomato.