Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients

Background Patients with acute medical illnesses are at prolonged risk for venous thrombosis. However, the appropriate duration of thromboprophylaxis remains unknown. Methods Patients who were hospitalized for acute medical illnesses were randomly assigned to receive subcutaneous enoxaparin (at a dose of 40 mg once daily) for 10±4 days plus oral betrixaban placebo for 35 to 42 days or subcutaneous enoxaparin placebo for 10±4 days plus oral betrixaban (at a dose of 80 mg once daily) for 35 to 42 days. We performed sequential analyses in three prespecified, progressively inclusive cohorts: patients with an elevated d-dimer level (cohort 1), patients with an elevated d-dimer level or an age of at least 75 years (cohort 2), and all the enrolled patients (overall population cohort). The statistical analysis plan specified that if the between-group difference in any analysis in this sequence was not significant, the other analyses would be considered exploratory. The primary efficacy outcome was a composite of asymptomatic proximal deep-vein thrombosis and symptomatic venous thromboembolism. The principal safety outcome was major bleeding. Results A total of 7513 patients underwent randomization. In cohort 1, the primary efficacy outcome occurred in 6.9% of patients receiving betrixaban and 8.5% receiving enoxaparin (relative risk in the betrixaban group, 0.81; 95% confidence interval [CI], 0.65 to 1.00; P=0.054). The rates were 5.6% and 7.1%, respectively (relative risk, 0.80; 95% CI, 0.66 to 0.98; P=0.03) in cohort 2 and 5.3% and 7.0% (relative risk, 0.76; 95% CI, 0.63 to 0.92; P=0.006) in the overall population. (The last two analyses were considered to be exploratory owing to the result in cohort 1.) In the overall population, major bleeding occurred in 0.7% of the betrixaban group and 0.6% of the enoxaparin group (relative risk, 1.19; 95% CI, 0.67 to 2.12; P=0.55). Conclusions Among acutely ill medical patients with an elevated d-dimer level, there was no significant difference between extended-duration betrixaban and a standard regimen of enoxaparin in the prespecified primary efficacy outcome. However, prespecified exploratory analyses provided evidence suggesting a benefit for betrixaban in the two larger cohorts. (Funded by Portola Pharmaceuticals; APEX ClinicalTrials.gov number, NCT01583218. opens in new tab.

Mathematical model for determination of consumed energy during the flat hot rolling of steel plates

In this work a mathematical model for estimation and optimization of the required consumption energy for the flat plate rolling of the group of Grade 0003 steel is presented. A design of experiments was performed. The key geometrical parameters namely, the thickness, the programmed plate width and the length are considered as independent parameters, in two levels of variation. The relation between these variables to the consumed rolling energy as a dependent changeable is described through the derived model of the plan matrix. A great number of data, collected in a four-year period were selected, filtered and processed statistically. Based on the model, graphs were obtained showing the dependence of the consumed rolling energy from the slab thickness and the programmed plate width and length. The results show that energy savings of about 11 percent can be achieved by operating the mill under optimal conditions

Motivation and elite performance : an exploratory investigation with Bulgarian athletes

A sample of 98 Bulgarian top athletes (35 females and 63 males): canoeists, biathletes, figure skaters, boxers, tennis players and skiers, were investigated to explore the motivation of elite sport athletes and to determine the effects of motivation on performance. Participants' athletic performances in national and international events over 2 years (September 1990 to November 1992) was documented. Participants also completed the Bulgarian version of the Sport Motivation Scale (Brière, Vallerand, Blais, & Pelletier, in press; Pelletier, Fortier, Vallerand, Tuson, Brière, & Blais, International Journal of Sport Psychology, 1995). The SMS, which is based on the tenets of Self-Determination Theory (Deci & Ryan, Nebraska Symposium on Motivation, Vol. 38, pp.237-288, 1991), assesses: intrinsic motivation, self-determined extrinsic motivation, non-self-determined extrinsic motivation, and amotivation. Results indicated that, in comparison with less successful athletes, title and medal holders displayed higher levels of non-self-determined extrinsic motivation and higher levels of amotivation. With respect to gender, the motivation of female athletes was more strongly characterized by intrinsic motivation. Results are discussed in light of Self-Determination Theory and the cultural context which prevailed in Bulgaria at the time of the investigation. It was found that non-self determined types of motivation (for example gaining medals) were more prominent among the best performing athletes, and female athletes displayed higher levels of intrinsic motivation (such as performing to the best of their ability) than their male counterparts. It is concluded that these results highlight the role of motivation in elite sport performance

PRIMARY SJOGREN'S SYNDROME ANDOFDISEASE BASEDOV (FAMILY CASE)

Bstract. Case report of two sislers with primary Sjttgren’s syndrome combined with Basedow’s disease is described. Immunological studies revealed HLA-DR3 antigen which reliably more often is found in pts with above autoimmunic diseases. Some clinical peculiarities of the process of SjOgrcn’s syndrome stipulated by genetic and exogenous factors

Pleuropulmonary blastoma in children and adolescents: The EXPeRT/PARTNER diagnostic and therapeutic recommendations

Pleuropulmonary blastoma (PPB) is a rare cancer occurring mainly during early childhood and often associated with germline DICER1 mutations. It is classified by the macroscopic appearance into three interrelated clinico-pathologic entities on a developmental continuum. Complete tumor resection is a main prognostic factor and can be performed at diagnosis or after neoadjuvant treatment that includes chemotherapy and in some cases radiotherapy. Optimal modalities of neo- or adjuvant treatments can be challenging taking into account potential long-term toxicities in this young population. This paper presents the recommendations for diagnosis and treatment of children and adolescents with PPB elaborated by the European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT) within the European Union-funded project PARTNER (Paediatric Rare Tumours Network - European Registry)