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

Study of Gluon versus Quark Fragmentation in Υ→ggγ\Upsilon\to gg\gamma and e+e−→qqˉγe^{+}e^{-}\to q\bar{q}\gamma Events at \sqrt{s}=10 GeV

Using data collected with the CLEO II detector at the Cornell Electron Storage Ring, we determine the ratio R(chrg) for the mean charged multiplicity observed in Upsilon(1S)->gggamma events, to the mean charged multiplicity observed in e+e- -> qqbar gamma events. We find R(chrg)=1.04+/-0.02+/-0.05 for jet-jet masses less than 7 GeV.Comment: 15 pages, postscript file also available through http://w4.lns.cornell.edu/public/CLN

Limits on the production of scalar leptoquarks from Z (0) decays at LEP

A search has been made for pairs and for single production of scalar leptoquarks of the first and second generations using a data sample of 392000 Z0 decays from the DELPHI detector at LEP 1. No signal was found and limits on the leptoquark mass, production cross section and branching ratio were set. A mass limit at 95% confidence level of 45.5 GeV/c2 was obtained for leptoquark pair production. The search for the production of a single leptoquark probed the mass region above this limit and its results exclude first and second generation leptoquarks D0 with masses below 65 GeV/c2 and 73 GeV/c2 respectively, at 95% confidence level, assuming that the D0lq Yukawa coupling alpha(lambda) is equal to the electromagnetic one. An upper limit is also given on the coupling alpha(lambda) as a function of the leptoquark mass m(D0)

A proton tagging detector for the NA48 experiment

Prototype test results are reported from the NA48 KS tagging system. Thin scintillator foils were arranged as two staircases intersecting in space. A geometric alignment to 0.4 mrad, a light yield of 300–400 photoelectrons and a time resolution of 70–90 ps with conventional TDCs were achieved. A FADC system operating at 450 megasamples/s performed at 50 ps intrinsic time resolution. Overlapping pulses could be resolved down to 7 ns

Two new species of Apistogramma Regan (Teleostei: Cichlidae) from the rio Trombetas, Pará State, Brazil

Apistogramma angayuara is described from the rio Trombetas close to the cachoeira Vira Mundo where it is found in association with rapids. It is assigned to the A. pertensis species group, distinguished by the following characters in combination: three prominent stripes composed of dark spots along the sides of the abdomen, 2 vs. 3 postlachrymal infraorbital pores, 5 vs. 4 dentary pores, low dorsal fin in adult males, and presence of a caudal spot. It is the smallest species of Apistogramma reported so far, with the largest male 24.7 mm SL and the largest female 22.7 mm SL, and the first cichlid species found with a significant proportion of rhizopods in the stomach content. Apistogramma salpinction is described from lentic habitats at the margin of road BR-163, circa 70 km from Cachoeira Porteira village, in a swamp most probably connected to the igarapé Caxipacoré. It is compared to members of the Apistogramma cacatuoides group with which it shares prolonged anterior dorsal fin lappets and marginal caudal fin streamers in adult males. It is distinguished from all other species of Apistogramma by the color pattern which includes a lateral band and abdominal stripes that become darker and have much lighter interspaces on the caudal peduncle, and a caudal spot that is divided into elongated blotches continuing the lateral band and upper two abdominal stripes, respectively