Recurrent early filter clotting during continuous veno-venous hemodialysis with regional citrate anticoagulation is linked to systemic thrombin generation and heparin induced thrombocytopenia type II: a retrospective analysis

OBJECTIVE: Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) is widely used and leads to an excellent clottingfree filter survival. Despite strict adherence to protocols, in some cases recurrent early filter-clotting occurs. The aim of this observational study was to evaluate the underlying causes and the efficacy of interventions in patients with early recurrent filter-clotting during RCA. METHODS: In a retrospective analysis of a cohort of 1183 patients treated with RCA-CRRT we detected 12 patients with early filter-clotting unrelated to protocol violation or any obvious technical or medical reason. RESULTS: All patients were systemically anticoagulated with low molecular weight or unfractionated heparin for at least 24h before initiation of Continuous Veno-Venous Hemodialysis with RCA (RCA-CVVHD). During RCA, all postfilter ionized calcium concentrations were in the target range (mean 0.33±0.05 mmol/L). At the time of the first clotting event, thrombocyte counts were 168±66/ nL. After the clotting events, the systemic anticoagulation was switched to argatroban in all patients. With systemic anticoagulation using argatroban filter lifetime of RCA-CVVHD increased significantly (p<0.001) and clotting-events decreased from 0.61 to 0.10 per 24h. All patients were tested for HIT and 5/12 (42%) had a positive test for hep-PF4-antibodies. Application of argatroban significantly reduced early filter-clotting both in HIT-positive patients as well as in HIT-negative patients. At the time of the first clotting event, no patient had clinical signs of thrombosis or thromboembolism. However, during follow up a thromboembolic event occurred in three patients. CONCLUSION: In patients with recurrent early filter-clotting despite strict adherence to the citrate protocol undetected HIT or other causes of thrombin activation may be present. Therefore, patients with recurrent early filter clotting in RCA-CVVHD should be screened for HIT or other conditions that may activate thrombin. A significant improvement of filter run-time can be achieved by systemic administration of a thrombin inhibitor both in patients with and without HIT

Further Search for the Two-Photon Production of the Glueball Candidate fJ(2220)f_{J}(2220)

The CLEOII detector at the Cornell e+ e- storage ring CESR has been used to search for the two-photon production of the $f_J(2220)$ decaying into pi+ pi-. No evidence for a signal is found in data corresponding to an integrated luminosity of 4.77/fb and a 95% CL upper limit on $\Gamma_{two-photon} * BR{pi+ pi-}$ of 2.5 eV is set. If this result is combined with the BES Collaboration's measurement of $f_J(2220) -> pi+ pi-$ in radiative $J/\psi$ decay, a 95% CL lower limit on the stickiness of the $f_J(2220)$ of 73 is obtained. If the recent CLEO result for \Gamma_{two-photon} * BR{\K_S K_S} is combined with the present result, the stickiness of the $f_J(2220)$ is found to be larger than 102 at the 95% CL. These results for the stickiness (the ratio of the probabilities for two-gluon coupling and two-photon coupling) provide further support for a substantial neutral parton content in the $f_J(2220)$.Comment: 8 pages, postscript file also available through http://w4.lns.cornell.edu/public/CLN

Determination of the Michel Parameters and the tau Neutrino Helicity in tau Decay

Using the CLEO II detector at the $e^+e^-$ storage ring CESR, we have determined the Michel parameters $\rho$, $\xi$, and $\delta$ in $\tau^\mp \to l^\mp\nu\bar{\nu}$ decay as well as the tau neutrino helicity parameter $h_{\nu_\tau}$ in $\tau^\mp \to \pi^\mp\pi^0\nu$ decay. From a data sample of $3.02\times 10^6$ tau pairs produced at $\sqrt{s}=10.6 GeV$, using events of the topology $e^+e^- \to \tau^+\tau^- \to (l^\pm\nu\bar{\nu}) (\pi^\mp\pi^0\nu)$ and $e^+e^- \to \tau^+\tau^- \to (\pi^\pm\pi^0\bar{\nu}) (\pi^\mp\pi^0\nu)$, and the determined sign of $h_{\nu_\tau}$, the combined result of the three samples is: $\rho = 0.747\pm 0.010\pm 0.006$, $\xi = 1.007\pm 0.040\pm 0.015$, $\xi\delta = 0.745\pm 0.026\pm 0.009$, and $h_{\nu_\tau} = -0.995\pm 0.010\pm 0.003$. The results are in agreement with the Standard Model V-A interaction.Comment: 18 page postscript file, postscript file also available through http://w4.lns.cornell.edu/public/CLN

Search for the Decay τ−→4pi−3π+(π0)ντ\tau^{-}\to 4pi^{-}3\pi^{+}(\pi^{0})\nu_{\tau}

We have searched for the decay of the tau lepton into seven charged particles and zero or one pi0. The data used in the search were collected with the CLEO II detector at the Cornell Electron Storage Ring (CESR) and correspond to an integrated luminosity of 4.61 fb^(-1). No evidence for a signal is found. Assuming all the charged particles are pions, we set an upper limit on the branching fraction, B(tau- -> 4pi- 3pi+ (pi0) nu_tau) < 2.4 x 10^(-6) at the 90% confidence level. This limit represents a significant improvement over the previous limit.Comment: 9 page postscript file, postscript file also available through http://w4.lns.cornell.edu/public/CLN

Measurement of the Branching Ratios for the Decays of Ds+→ηπ+,η′π+,ηρ+D_{s}^{+}\to \eta\pi^{+}, \eta^{'}\pi^{+}, \eta\rho^{+}, and eta′ρ+eta^{'}\rho^{+}

Using a data sample with integrated luminosity of about 3.9 fb^{-1} collected in e+ e- annihilation with the CLEO-II detector at the Cornell Electron Storage Ring, we have measured the branching ratios for the decay modes Ds -> (eta, eta') pi and Ds -> (eta, eta') rho relative to Ds -> phi pi. These decay modes are among the most common hadronic decays of the Ds's and can be related by factorization to the semileptonic decays Ds -> (eta,eta') l nu. The results obtained are compared with previous CLEO results and with the branching ratios measured for the related semileptonic decays. We also report results on the Cabibbo-suppressed decays of the D+ to the same final states.Comment: 18 page postscript file, postscript file also available through http://w4.lns.cornell.edu/public/CLN

Measurement of Br(D0→K−π+)Br(D^{0}\to K^{-}\pi^{+}) using Partila Reconstruction of Bˉ→D∗+Xℓ−νˉ\bar{B}\to D^{*+}X\ell^{-}\bar{\nu}

We present a measurement of the absolute branching fraction for $D^0 -> K^- pi^+$ using the reconstruction of the decay chain $Bbar -> D^{*+} X l^- nubar$, $D^{*+} -> D^0 pi^+$ where only the lepton and the low-momentum pion from the $D^{*+}$ are detected. With data collected by the CLEO II detector at the Cornell Electron Storage Ring, we have determined $Br(D^0 -> K^- pi^+)= [3.81 +- 0.15(stat.) +- 0.16(syst.)]$.Comment: 10 page postscript file, postscript file also available through http://w4.lns.cornell.edu/public/CLN

Tau Neutrino Helicity from h±h^{\pm} Energy Correlations

We report a measurement of the magnitude of the tau neutrino helicity from tau-pair events taken with the CLEO detector at the CESR electron-positron storage ring. Events in which each tau undergoes the decay tau -> h nu, with h a charged pion or kaon, are analyzed for energy correlations between the daughter hadrons, yielding |xi| = 2*|h_nu| = 1.03 +/- 0.06 +/- 0.04, with the first error statistical and the second systematic.Comment: 11 pages, postscript file also available through http://w4.lns.cornell.edu/public/CLN

Investigation of Semileptonic BB Meson Decay to P-Wave Charm Mesons

We have studied semileptonic $B$ meson decays with a P-wave charm meson in the final state using 3.29 x 10^6 B\bar{B} events collected by the CLEO~II detector at the Cornell Electron-positron Storage Ring. We find a value for the exclusive semileptonic product branching fraction: Br(B^- -> D_1^0 l^- \bar{\nu}) x Br(D_1^0 -> D^{*+}\pi^-) = (0.373 \pm 0.085 \pm 0.052 \pm 0.024)% and an upper limit for Br(B^- -> D_2^{*0} l^- \bar{\nu}) x Br(D_2^{*0} -> D^{*+}\pi^-) < 0.16%$ (90% C.L.). These results indicate that at least 20% of the total B^- semileptonic rate is unaccounted for by the observed exclusive decays, B^- -> D^0 l^- \bar{\nu}, B^- -> D^{*0} l^- \bar{\nu}, B^- -> D_1^0 l^- \bar{\nu}, and B^- -> D_2^{*0} l^- \bar{\nu}.Comment: 10 page postscript file, postscript file also available through http://w4.lns.cornell.edu/public/CLN

Flavor-Specific Inclusive B Decays to Charm

We have measured the branching fractions for B -> D_bar X, B -> D X, and B -> D_bar X \ell^+ \nu, where ``B'' is an average over B^0 and B^+, ``D'' is a sum over D^0 and D^+, and``D_bar'' is a sum over D^0_bar and D^-. From these results and some previously measured branching fractions, we obtain Br(b -> c c_bar s) = (21.9 $\pm$ 3.7)%, Br(b -> s g) K^- \pi^+) = (3.69 $\pm$ 0.20)%. Implications for the ``B semileptonic decay problem'' (measured branching fraction being below theoretical expectations) are discussed. The increase in the value of Br(b -> c c_bar s) due to $B -> D X$ eliminates 40% of the discrepancy.Comment: 12 page postscript file, postscript file also available through http://w4.lns.cornell.edu/public/CLN

Limit on the Two-Photon Production of the Glueball Candidate fJ(2220)f_{J}(2220) at CLEO

We use the CLEO detector at the Cornell electron-positron storage ring, CESR, to search for the two-photon production of the glueball candidate f_J(2220) in its decay to K_s K_s. We present a restrictive upper limit on the product of the two-photon partial width and the K_s K_s branching fraction. We use this limit to calculate a lower limit on the stickiness, which is a measure of the two-gluon coupling relative to the two-photon coupling. This limit on stickiness indicates that the f_J(2220) has substantial glueball content.Comment: 9 page postscript file, postscript file also available through http://w4.lns.cornell.edu/public/CLN