Antithrombin and hypercoagulability in sepsis: insights from thrombelastography?

Antithrombin (AT) has been used for over 25 years to successfully treat disseminated intravascular coagulation (DIC). A four-day AT therapy in patients with DIC in the KyberSept trial has been related to a clear survival benefit in patients not receiving concomitant heparin. Gonano and coworkers performed thrombelastography (TEG) measurements in patients with severe sepsis and clearly showed hypercoagulability, as defined by five TEG parameters, compared to healthy controls. In the AT group they found a trend towards normalization of TEG parameters after treatment, although this did not reach statistical significance. This first clinical evaluation of hypercoagulability during AT treatment could not provide evidence for an attenuation of coagulopathy, an effect that might be due to high inter-individual variability

Region and volume dependencies in spectral linewidth assessed by 1H 2D chemical shift imaging in the monkey brain at 7T

High magnetic fields increase the sensitivity and spectral dispersion in MR spectroscopy. In contrast, spectral peaks are broadened in vivo at higher field strength due to stronger susceptibility-induced effects. Strategies to minimize the spectral linewidth are therefore of critical importance. In the present study, 1H 2D chemical shift imaging (CSI) at short echo time was performed in the macaque monkey brain at 7 T. Dependencies of spectral linewidth on the CSI voxel size were determined by data reconstruction at different spatial resolution. An overall linewidth narrowing at increased spatial resolution is shown and regional differences are demonstrated

High Prevalence of Obesity and Female Gender Among Patients With Concomitant Tibialis Posterior Tendonitis and Plantar Fasciitis.

UNLABELLED: The link between increased body weight and hindfoot complaints is largely based on correlation to single foot pathology. We retrospectively reviewed 6879 patients with tibialis posterior tendonitis (TPT), plantar fasciitis (PF), or both. Among patients with either TPT or PF, 1 in 11 (9%) had both. We then compared age, gender, and body mass index among these groups. Patients with both diagnoses were neither statistically older nor more obese than patients with single diagnoses. However, they were statistically more female. Given the overall high prevalence of obesity in the study population, we feel these data support the link between obesity and multiple foot pathology. LEVELS OF EVIDENCE: Prognostic, Level IV: Case series

3D wedge filling and 2D random-bond wetting

Fluids adsorbed in 3D wedges are shown to exhibit two types of continuous interfacial unbinding corresponding to critical and tricritical filling respectively. Analytic solution of an effective interfacial model based on the transfer-matrix formalism allows us to obtain the asymptotic probability distribution functions for the interfacial height when criticality and tricriticality are approached. Generalised random walk arguments show that, for systems with short-ranged forces, the critical singularities at these transitions are related to 2D complete and critical wetting with random bond disorder respectively.Comment: 7 pages, 3 figures, accepted for publication in Europhysics Letter

Prothrombin complex concentrate in surgical patients: retrospective evaluation of vitamin K antagonist reversal and treatment of severe bleeding

Introduction Prothrombin complex concentrates are recommended for rapid reversal of vitamin K anticoagulants. As they normalize levels of vitamin K dependent clotting factors and re-establish hemostasis, they may also be used as adjunctive therapy in patients with major bleeding. The aim of this study was to retrospectively evaluate the efficacy of prothrombin complex concentrates in the surgical setting. Methods The case notes of 50 patients requiring urgent oral anticoagulation reversal (n = 12) or with severe perioperative coagulopathic bleeding (n = 38) who received an infusion of prothrombin complex concentrate (Beriplex P/N(R) 500) at the surgical department of the University of Munich Hospital, Germany were retrospectively reviewed. Efficacy of prothrombin complex concentrate application was evaluated using the Quick test, reported as an international normalized ratio, hemodynamic measurements and requirement for blood products. Safety assessments included whole blood hemoglobin levels and specific parameters of organ dysfunction. Results Baseline characteristics were comparable, except that mean baseline international normalized ratio and hemoglobin levels were significantly higher (P < 0.01) in anticoagulation reversal than in bleeding patients. In anticoagulation reversal, the international normalized ratio was significantly reduced (from 2.8 +/- 0.2 at baseline to 1.5 +/- 0.1, P < 0.001) after one prothrombin complex concentrate infusion (median dose 1500 IU; lower quartile 1,000, upper quartile 2,000). No major bleeding was observed during surgery after prothrombin complex concentrate administration. Only one patient received platelets and red blood cell transfusion after prothrombin complex concentrate administration. In bleeding patients, infusion of prothrombin complex concentrate (median dose 2,000 IU; lower quartile 2,000, upper quartile 3,000) significantly reduced the INR from 1.7 +/- 0.1 at baseline to 1.4 +/- 0.1 (P < 0.001). This decrease was unrelated to fresh frozen plasma or vitamin K administration. Bleeding stopped after prothrombin complex concentrate administration in 4/11 (36%) patients with surgical bleeding and 26/ 27 (96%) patients with diffuse bleeding. Hemoglobin levels increased significantly from baseline in bleeding patients (P < 0.05) and mean arterial pressure stabilized (P < 0.05). No thrombotic events or changes in organ function were reported in any patient. Conclusions Prothrombin complex concentrate application effectively reduced international normalized ratios in anticoagulation reversal, allowing surgical procedures and interventions without major bleeding. In bleeding patients, the improvement in coagulation after prothrombin complex concentrate administration was judged to be clinically significant

What do emulsification failure and Bose-Einstein condensation have in common?

Ideal bosons and classical ring polymers formed via self-assembly, are known to have the same partition function, and so analogous phase transitions. In ring polymers, the analogue of Bose-Einstein condensation occurs when a ring polymer of macroscopic size appears. We show that a transition of the same general form occurs within a whole class of systems with self-assembly, and illustrate it with the emulsification failure of a microemulsion phase of water, oil and surfactant. As with Bose-Einstein condensation, the transition occurs even in the absence of interactions.Comment: 7 pages, 1 figure, typeset with EUROTeX, uses epsfi

Derivation of a Non-Local Interfacial Hamiltonian for Short-Ranged Wetting II: General Diagrammatic Structure

In our first paper, we showed how a non-local effective Hamiltionian for short-ranged wetting may be derived from an underlying Landau-Ginzburg-Wilson model. Here, we combine the Green's function method with standard perturbation theory to determine the general diagrammatic form of the binding potential functional beyond the double-parabola approximation for the Landau-Ginzburg-Wilson bulk potential. The main influence of cubic and quartic interactions is simply to alter the coefficients of the double parabola-like zig-zag diagrams and also to introduce curvature and tube-interaction corrections (also represented diagrammatically), which are of minor importance. Non-locality generates effective long-ranged many-body interfacial interactions due to the reflection of tube-like fluctuations from the wall. Alternative wall boundary conditions (with a surface field and enhancement) and the diagrammatic description of tricritical wetting are also discussed.Comment: (14 pages, 2 figures) Submitted J. Phys. Condens. Matte