A prospective comparison of three argatroban treatment regimens during hemodialysis in end-stage renal disease

A prospective comparison of three argatroban treatment regimens during hemodialysis in end-stage renal disease.BackgroundWe prospectively evaluated 3 treatment regimens of argatroban, a direct thrombin inhibitor, for providing adequate, safe anticoagulation in patients with end-stage renal disease (ESRD) during hemodialysis.MethodsIn this randomized, 3-way crossover study, ESRD patients underwent hemodialysis sessions of 3- or 4-hour duration using high-flux membranes and each of 3 argatroban treatment regimens (A: 250-μg/kg bolus, with an additional 250-μg/kg bolus allowed; B: 250-μg/kg bolus followed by 2-μg/kg/min infusion; C: steady-state, 2-μg/kg/min infusion initiated 4 hours before dialysis). Pharmacodynamic effects including activated clotting times (ACTs); hemodialysis efficacy including single-pool Kt/V, urea reduction ratio (URR), and circuit flow; and safety through a 3-day follow-up were monitored. Argatroban pharmacokinetic parameters including dialytic clearance were evaluated during regimen C.ResultsThirteen patients completed 38 hemodialysis sessions (1 patient withdrew consent after 2 sessions). Mean ± SD ACTs increased from 131 ± 14 seconds at baseline to 153 ± 24, 200 ± 30, and 197 ± 33 seconds, respectively, after 60 minutes of hemodialysis using regimens A, B, and C. Across regimens, mean Kt/Vs (1.5–1.6) and URRs (70%-73%) were comparable. No dialyzer was changed; 1 session was shortened 15 minutes because of circuit clot formation. Systemic argatroban clearance increased ∼20% during hemodialysis, without clinically significantly affecting ACTs. Upon argatroban discontinuation, ACTs and plasma argatroban decreased concurrently (elimination half-life, 35 ± 6 min). No thrombosis, bleeding, serious adverse events, or clinically significant changes in vital signs or routine laboratory measures occurred.ConclusionArgatroban, administered by each treatment regimen, provides safe, adequate anticoagulation to enable successful hemodialysis in ESRD patients. Argatroban dialytic clearance by high-flux membranes is clinically insignificant

Understanding Novel Superconductors with Ab Initio Calculations

This chapter gives an overview of the progress in the field of computational superconductivity. Following the MgB2 discovery (2001), there has been an impressive acceleration in the development of methods based on Density Functional Theory to compute the critical temperature and other physical properties of actual superconductors from first-principles. State-of-the-art ab-initio methods have reached predictive accuracy for conventional (phonon-mediated) superconductors, and substantial progress is being made also for unconventional superconductors. The aim of this chapter is to give an overview of the existing computational methods for superconductivity, and present selected examples of material discoveries that exemplify the main advancements.Comment: 38 pages, 10 figures, Contribution to Springer Handbook of Materials Modellin

A 24-month evaluation of amalgam and resin-based composite restorations:Findings from The National Dental Practice-Based Research Network

BACKGROUND: Knowing which factors influence restoration longevity can help clinicians make sound treatment decisions. The authors analyzed data from the National Dental Practice-Based Research Network to identify predictors of early failures of amalgam and resin-based composite (RBC) restorations. METHODS: This prospective cohort study gathered information from clinicians and offices participating in the network. Clinicians completed a baseline data collection form at the time of restoration placement, and annually thereafter. Data collected included patient factors, practice factors, and dentist factors, and were analyzed using mixed-model logistic regression. RESULTS: A total of 226 practitioners followed 6,218 direct restorations in 3,855 patients; 386 restorations failed (6.6 percent) during the mean follow-up period of 23.7 (SD 8.8) months. The number of tooth surfaces restored at baseline predicted subsequent restoration failure; large restorations were over 4 times more likely to fail. Material was not significantly associated with longevity; neither was tooth type. Patient age was highly associated with failure (p<0.0001). The failure rate for children was 5 percent, compared to 12 percent in persons 65 years old or older. Dentist gender and practice workload were significantly associated with restoration longevity. CONCLUSIONS: In this prospective cohort study, these factors significantly predicted an increased failure rate for amalgam and RBC restorations: older patient age and a higher number of surfaces restored at baseline, with other key baseline variables taken into account. Material choice was not significantly predictive in these early results. CLINICAL IMPLICATIONS: Understanding risk factors for early restoration failure may lead to more-effective patient care

A Review of Equation-of-State Models for Inertial Confinement Fusion Materials

International audienceMaterial equation-of-state (EOS) models, generally providing the pressure and internal energy for a given density and temperature, are required to close the equations of hydrodynamics. As a result they are an essential piece of physics used to simulate inertial confinement fusion (ICF) implosions. Historically, EOS models based on different physical/chemical pictures of matter have been developed for ICF relevant materials such as the deuterium (D2) or deuterium-tritium (DT) fuel, as well as candidate ablator materials such as polystyrene (CH), glow-discharge polymer (GDP), beryllium (Be), carbon (C), and boron carbide (B4C). The accuracy of these EOS models can directly affect the reliability of ICF target design and understanding, as shock timing and material compressibility are essentially determined by what EOS models are used in ICF simulations. Systematic comparisons of current EOS models, benchmarking with experiments, not only help us to understand what the model differences are and why they occur, but also to identify the state-of-the-art EOS models for ICF target designers to use. For this purpose, the first Equation-of-State Workshop, supported by the US Department of Energy’s ICF program, was held at the Laboratory for Laser Energetics (LLE), University of Rochester on 31 May - 2nd June, 2017. This paper presents a detailed review on the findings from this workshop: (1) 5-10% model-model variations exist throughout the relevant parameter space, and can be much larger in regions where ionization and dissociation are occurring, (2) the D2 EOS is particularly uncertain, with no single model able to match the available experimental data, and this drives similar uncertainties in the CH EOS, and (3) new experimental capabilities such as Hugoniot measurements around 100 Mbar and high-quality temperature measurements are essential to reducing EOS uncertainty