Anticoagulant treatment at a specialized outpatient anticoagulant therapy unit, a descriptive study

BACKGROUND: The indications for continuous oral anticoagulant treatment, the target interval and the procedures for withdrawing treatment have changed in the last 10 years. METHODS: Patients on continuous oral anticoagulant treatment at the Outpatient Anticoagulant Clinic at Umeå University Hospital in 2002 were included in a descriptive study (n = 900). 263 of those had a mechanical heart valve prosthesis. Only patient records for patients with other indications than mechanical heart valve prosthesis were examined. 582 of those records were found. In the 55 remaining patients some clinical information was retrieved from the computerised warfarin dosage database. These latter, more unsure clinical data, are presented separately. Anticoagulant treatment was discontinued if lack of proper indication or presence of too high risk for hemorrhagic complications were found. RESULTS: The prevalence of continuous oral anticoagulant treatment in the uptake area was 0.65%. The most common target interval was INR 2.1–3.0, but patients with a mechanical heart valve prosthesis were often treated more aggressively, i.e. with a higher INR target interval. Of the patients on continuous treatment, 26.6% of the INR values were outside 2.0–3.0. The most common reasons for oral anticoagulant treatment were atrial fibrillation or mechanical heart valve prosthesis, in contrast to earlier findings in studies of our population in 1987 and 1990. We found 90 patients (10.0%) without proper indication for oral anticoagulant treatment or too high risk, and their treatment was discontinued. CONCLUSION: In patients on oral anticoagulant therapy, re-evaluation of indications and risks resulted in a substantial number of treatment withdrawals. There have been major changes in treatment indications during the last decade, possibly due to rapid development of knowledge in the field of thrombosis risk factors. Treatment should be re-considered once a year

Efficient implementation of the Gutzwiller variational method

We present a self-consistent numerical approach to solve the Gutzwiller variational problem for general multi-band models with arbitrary on-site interaction. The proposed method generalizes and improves the procedure derived by Deng et al., Phys. Rev. B. 79 075114 (2009), overcoming the restriction to density-density interaction without increasing the complexity of the computational algorithm. Our approach drastically reduces the problem of the high-dimensional Gutzwiller minimization by mapping it to a minimization only in the variational density matrix, in the spirit of the Levy and Lieb formulation of DFT. For fixed density the Gutzwiller renormalization matrix is determined as a fixpoint of a proper functional, whose evaluation only requires ground-state calculations of matrices defined in the Gutzwiller variational space. Furthermore, the proposed method is able to account for the symmetries of the variational function in a controlled way, reducing the number of variational parameters. After a detailed description of the method we present calculations for multi-band Hubbard models with full (rotationally invariant) Hund's rule on-site interaction. Our analysis shows that the numerical algorithm is very efficient, stable and easy to implement. For these reasons this method is particularly suitable for first principle studies -- e.g., in combination with DFT -- of many complex real materials, where the full intra-atomic interaction is important to obtain correct results.Comment: 19 pages, 7 figure

On the superconvergence of Galerkin methods for hyperbolic IBVP

Finite element Galerkin methods for periodic first order hyperbolic equations exhibit superconvergence on uniform grids at the nodes, i.e., there is an error estimate 0(h(sup 2r)) instead of the expected approximation order 0(h(sup r)). It will be shown that no matter how the approximating subspace S(sup h) is chosen, the superconvergence property is lost if there are characteristics leaving the domain. The implications of this result when constructing compact implicit difference schemes is also discussed

The Dynamical Mean Field Theory phase space extension and critical properties of the finite temperature Mott transition

We consider the finite temperature metal-insulator transition in the half filled paramagnetic Hubbard model on the infinite dimensional Bethe lattice. A new method for calculating the Dynamical Mean Field Theory fixpoint surface in the phase diagram is presented and shown to be free from the convergence problems of standard forward recursion. The fixpoint equation is then analyzed using dynamical systems methods. On the fixpoint surface the eigenspectra of its Jacobian is used to characterize the hysteresis boundaries of the first order transition line and its second order critical end point. The critical point is shown to be a cusp catastrophe in the parameter space, opening a pitchfork bifurcation along the first order transition line, while the hysteresis boundaries are shown to be saddle-node bifurcations of two merging fixpoints. Using Landau theory the properties of the critical end point is determined and related to the critical eigenmode of the Jacobian. Our findings provide new insights into basic properties of this intensively studied transition.Comment: 11 pages, 12 figures, 1 tabl

The Dynamical Mean Field Theory phase space extension and critical properties of the finite temperature Mott transition

We consider the finite temperature metal-insulator transition in the half filled paramagnetic Hubbard model on the infinite dimensional Bethe lattice. A new method for calculating the Dynamical Mean Field Theory fixpoint surface in the phase diagram is presented and shown to be free from the convergence problems of standard forward recursion. The fixpoint equation is then analyzed using dynamical systems methods. On the fixpoint surface the eigenspectra of its Jacobian is used to characterize the hysteresis boundaries of the first order transition line and its second order critical end point. The critical point is shown to be a cusp catastrophe in the parameter space, opening a pitchfork bifurcation along the first order transition line, while the hysteresis boundaries are shown to be saddle-node bifurcations of two merging fixpoints. Using Landau theory the properties of the critical end point is determined and related to the critical eigenmode of the Jacobian. Our findings provide new insights into basic properties of this intensively studied transition.Comment: 11 pages, 12 figures, 1 tabl

Testis dosimetry in individual patients by combining a small-scale dosimetry model and pharmacokinetic modeling-application of (111)In-Ibritumomab Tiuxetan (Zevalin(®)).

A heterogeneous distribution of radionuclides emitting low-energy electrons in the testicles may result in a significant difference between an absorbed dose to the radiosensitive spermatogonia and the mean absorbed dose to the whole testis. This study focused on absorbed dose distribution in patients at a finer scale than normally available in clinical dosimetry, which was accomplished by combining a small-scale dosimetry model with patient pharmacokinetic data. The activity in the testes was measured and blood sampling was performed for patients that underwent pre-therapy imaging with (111)In-Zevalin(®). Using compartment modeling, testicular activity was separated into two components: vascular and extravascular. The uncertainty of absorbed dose due to geometry variations between testicles was explored by an assumed activity micro-distribution and by varying the radius of the interstitial tubule. Results showed that the absorbed dose to germ cells might be strongly dependent on the location of the radioactive source, and may exceed the absorbed dose to the whole testis by as much as a factor of two. Small-scale dosimetry combined with compartmental analysis of clinical data proved useful for gauging tissue dosimetry and interpreting how intrinsic geometric variation influences the absorbed dose

Real-life efficacy of pregabalin for the treatment of peripheral neuropathic pain in daily clinical practice in Denmark:the NEP-TUNE study

OBJECTIVE: The aim of this study was to provide evidence regarding the real-life efficacy of pregabalin in the treatment of peripheral neuropathic pain (NeP) in Denmark. METHODS: In this prospective, observational, noninterventional study, pregabalin (Lyrica(®)) was prescribed following usual clinical practice. Compared with baseline, the primary study end points after 3 months of observation were changes in 1) the average level of pain during the past week, 2) the worst level of pain during the past week, and 3) the least level of pain during the past week. The Wilcoxon signed-rank test was used to perform paired analyses, and a multivariate regression analysis investigated factors driving change in pain. RESULTS: A total of 86 of the 128 patients included were regarded as efficacy evaluable (those completing 3 months of pregabalin treatment). Patients (59 years) were long-time sufferers of peripheral NeP, and 38% of them had comorbidities. The majority had previously been treated with tricyclic antidepressants or gabapentin. The average dose of pregabalin was 81.5 mg/d at baseline and 240 mg/d after 3 months. A clinically and statistically significant improvement of 2.2 points in the average level of pain intensity was found after 3 months. The higher the pain intensity at baseline, the higher was the reduction of the pain score. Positive results were also found for pain-related sleep interference, patients’ global impression of change, quality of life, and work and productivity impairment. Twenty-one patients reported 28 adverse events. CONCLUSION: This real-life study indicates that for some patients (two-thirds), addition of pregabalin for peripheral NeP helps to reduce their pain intensity significantly

Preclinical evaluation of (111)In-DTPA-INCA-X anti-Ku70/Ku80 monoclonal antibody in prostate cancer.

The aim of this investigation was to assess the Ku70/Ku80 complex as a potential target for antibody imaging of prostate cancer. We evaluated the in vivo and ex vivo tumor targeting and biodistribution of the (111)In-labeled human internalizing antibody, INCA-X ((111)In-DTPA-INCA-X antibody), in NMRI-nude mice bearing human PC-3, PC-3M-Lu2 or DU145 xenografts. DTPA-conjugated, non-labeled antibody was pre-administered at different time-points followed by a single intravenous injection of (111)In-DTPA-INCA-X. At 48, 72 and 96 h post-injection, tissues were harvested, and the antibody distribution was determined by measuring radioactivity. Preclinical SPECT/CT imaging of mice with and without the predose was performed at 48 hours post-injection of labeled DTPA-INCA-X. Biodistribution of the labeled antibody showed enriched activity in tumor, spleen and liver. Animals pre-administered with DTPA-INCA-X showed increased tumor uptake and blood content of (111)In-DTPA-INCA-X with reduced splenic and liver uptake. The in vitro and in vivo data presented show that the (111)In-labeled INCA-X antibody is internalized into prostate cancer cells and by pre-administering non-labeled DTPA-INCA-X, we were able to significantly reduce the off target binding and increase the (111)In-DTPA-INCA-X mAb uptake in PC-3, PC-3M-Lu2 and DU145 xenografts. The results are encouraging and identifying the Ku70/Ku80 antigen as a target is worth further investigation for functional imaging of prostate cancer

Consistent pattern between physical activity measures and chronic pain levels: the Tromsø Study 2015-2016

Epidemiological literature on the relationship between physical activity and chronic pain is scarce and inconsistent. Hence, our aim was to assess the relationship applying comprehensive methodology, including self-reported and accelerometer measures of physical activity and different severity levels of chronic pain. We used data from the Tromsø Study (2015-2016). All residents in the municipality, aged 40 years and older were invited to participate (n=32,591, 51% women). A total of 21,083 (53% women) reported on questionnaires. Additionally, 6,778 participants (54% women) were invited to wear accelerometers (6,125 with complete measurements). Our exposure measures were self-reported leisure time physical activity, exercise frequency, duration and intensity and two accelerometer-measures (steps per day and minutes of moderate to vigorous physical activity per day). Outcome measurements were chronic pain and moderate-to-severe chronic pain. We used Poisson regression to estimate chronic pain prevalence and prevalence ratios for each physical activity measure, with adjustments for sex, age, education level, smoking history, and occupational physical activity. Our main analyses showed an inverse dose-response relationships between all physical activity measures and both severity measures of chronic pain, except that the dose-response relationship with exercise duration was only found for moderate-to-severe pain. All findings were stronger for the moderate-to-severe pain outcomes than for chronic pain. Robustness analyses gave similar results as the main analyses. We conclude that an inverse dose-response association between physical activity and chronic pain is consistent across measures. To summarize, higher levels of physical activity is associated with less chronic pain and moderate-to-severe chronic pain

Retirement age and disability status as pathways to later-life cognitive impairment: Evidence from the Norwegian HUNT Study linked with Norwegian population registers

Background Research shows that retirement age is associated with later-life cognition but has not sufficiently distinguished between retirement pathways. We examined how retirement age was associated with later-life dementia and mild cognitive impairment (MCI) for people who retired via the disability pathway (received a disability pension prior to old-age pension eligibility) and those who retired via the standard pathway. Methods The study sample comprised 7210 participants from the Norwegian Trøndelag Health Study (HUNT4 70+, 2017–2019) who had worked for at least one year in 1967–2019, worked until age 55+, and retired before HUNT4. Dementia and MCI were clinically assessed in HUNT4 70+ when participants were aged 69–85 years. Historical data on participants' retirement age and pathway were retrieved from population registers. We used multinomial regression to assess the dementia/MCI risk for women and men retiring via the disability pathway, or early (<67 years), on-time (age 67, old-age pension eligibility) or late (age 68+) via the standard pathway. Results In our study sample, 9.5% had dementia, 35.3% had MCI, and 28.1% retired via the disability pathway. The disability retirement group had an elevated risk of dementia compared to the on-time standard retirement group (relative risk ratio [RRR]: 1.64, 95% CI 1.14–2.37 for women, 1.70, 95% CI 1.17–2.48 for men). MCI risk was lower among men who retired late versus on-time (RRR, 0.76, 95% CI 0.61–0.95). Conclusion Disability retirees should be monitored more closely, and preventive policies should be considered to minimize the dementia risk observed among this group of retirees.publishedVersio