Achievement of goal anti-Xa activity with weight-based enoxaparin dosing for venous thromboembolism prophylaxis in trauma patients

STUDY OBJECTIVE

The purpose of this study was to evaluate the utility of routine anti-Xa peak monitoring for trauma patients initiated on weight-based enoxaparin for venous thromboembolism (VTE) prophylaxis and identify patient populations where monitoring is necessary.

DESIGN

Retrospective study.

SETTING

Augusta University (AU) Medical Center in Augusta, Georgia, a level 1 trauma center.

PATIENTS

Adult patients admitted to the trauma surgery service requiring chemical VTE prophylaxis.

INTERVENTION

At least three consecutive doses of enoxaparin 0.5 mg/kg subcutaneously every 12 hour for VTE prophylaxis prior to an anti-Xa peak as the initial chemical VTE prophylaxis strategy.

MEASUREMENTS

The primary end point was the percentage of patients who achieved goal anti-Xa peak of 0.2-0.6 unit/ml. The incidence of newly diagnosed VTE and clinically significant bleeding were assessed as secondary end points.

MAIN RESULTS

From January 1, 2018, through February 28, 2019, 300 patients met inclusion criteria. Anti-Xa peaks were within goal in 91% of all patients, 7.7% were below goal, and 1.3% were above goal. For patients who did not meet the goal, dose adjustments were made in 70.4% of patients. New levels were obtained in 73.7% of those patients, and all repeat levels was within goal. Clinically significant bleeding occurred in 5.3% of patients. Newly diagnosed VTE occurred in 1.7% of patients.

CONCLUSIONS

The use of initial weight-based enoxaparin dosing in trauma patients routinely achieved the prespecified target anti-Xa goal. In conclusion, anti-Xa levels are not necessary for routine monitoring of weight-based enoxaparin for VTE prophylaxis in trauma patients. Incidence of clinically significant bleeding and newly diagnosed VTE were similar to previous studies.

Health-related quality of life in women after colposcopy: results from a longitudinal patient survey

BACKGROUND

Information concerning the health-related quality-of-life (HRQoL) consequences of colposcopy is limited, particularly over time. In a longitudinal study, we investigated women's HRQoL at 4, 8 and 12 months post colposcopy and the factors associated with this.

METHODS

Women attending colposcopy at two large hospitals affiliated with the national screening programme in Ireland were invited to complete questionnaires at 4, 8 and 12 months post colposcopy. HRQoL was measured using the EQ-5D-3L and compared across a range of socio-demographic, clinical and attitudinal variables. A mixed-effects logistic multivariable model was employed to investigate associations between these variables and low HRQoL.

RESULTS

Of 584 women initially recruited, 429, 343 and 303 completed questionnaires at 4, 8 and 12 months, respectively. The mean overall HRQoL score for the sample across all time points was 0.90 (SD 0.16). Approximately 18% of women experienced low HRQoL at each of the three time points. In multivariable testing, over the entire 12-month follow-up period, non-Irish nationals (OR 8.99, 95% CI 2.35-34.43) and women with high-grade referral cytology (OR 2.78, 95% CI 1.08-7.13) were at higher odds of low HRQoL. Women who were past (OR 0.20, 95% CI 0.07-0.58) or never (OR 0.42, 95% CI 0.16-1.12) smokers were at lower odds of low HRQoL than current smokers. As women's satisfaction with their healthcare increased their odds of experiencing low HRQoL fell (OR per unit increase 0.51, 95% CI 0.34-0.75).

CONCLUSIONS

Women's HRQoL did not change over the 12 months post colposcopy, but some subgroups of women were at higher risk of experiencing low HRQoL. These subgroups may benefit from additional support.

Nonfuel Antineutrino Contributions in the High Flux Isotope Reactor

Reactor neutrino experiments have seen major improvements in precision in recent years. With the experimental uncertainties becoming lower than those from theory, carefully considering all sources of ν ¯ e is important when making theoretical predictions. One source of ν ¯ e that is often neglected arises from the irradiation of the nonfuel materials in reactors. The ν ¯ e rates and energies from these sources vary widely based on the reactor type, configuration, and sampling stage during the reactor cycle and have to be carefully considered for each experiment independently. In this article, we present a formalism for selecting the possible ν ¯ e sources arising from the neutron captures on reactor and target materials. We apply this formalism to the High Flux Isotope Reactor (HFIR) at Oak Ridge National Laboratory, the ν ¯ e source for the the Precision Reactor Oscillation and Spectrum Measurement (PROSPECT) experiment. Overall, we observe that the nonfuel ν ¯ e contributions from HFIR to PROSPECT amount to 1% above the inverse beta decay threshold with a maximum contribution of 9% in the 1.8-2.0 MeV range. Nonfuel contributions can be particularly high for research reactors like HFIR because of the choice of structural and reflector material in addition to the intentional irradiation of target material for isotope production. We show that typical commercial pressurized water reactors fueled with low-enriched uranium will have significantly smaller nonfuel ν ¯ e contribution.

VIP interneurons in mouse primary visual cortex selectively enhance responses to weak but specific stimuli

Vasoactive intestinal peptide-expressing (VIP) interneurons in the cortex regulate feedback inhibition of pyramidal neurons through suppression of somatostatin-expressing (SST) interneurons and, reciprocally, SST neurons inhibit VIP neurons. Although VIP neuron activity in the primary visual cortex (V1) of mouse is highly correlated with locomotion, the relevance of locomotion-related VIP neuron activity to visual coding is not known. Here we show that VIP neurons in mouse V1 respond strongly to low contrast front-to-back motion that is congruent with self-motion during locomotion but are suppressed by other directions and contrasts. VIP and SST neurons have complementary contrast tuning. Layer 2/3 contains a substantially larger population of low contrast preferring pyramidal neurons than deeper layers, and layer 2/3 (but not deeper layer) pyramidal neurons show bias for front-to-back motion specifically at low contrast. Network modeling indicates that VIP-SST mutual antagonism regulates the gain of the cortex to achieve sensitivity to specific weak stimuli without compromising network stability.

CT findings in dogs with gastric malposition: 6 cases (2016-2019)

OBJECTIVES

To describe the computed tomographic (CT) findings of gastric malposition in a group of dogs with suspected chronic gastric instability.

MATERIALS AND METHODS

A multicentre retrospective study of CT studies of dogs with abnormal gastric position in the absence of clinical signs referable to gastric dilatation and volvulus.

RESULTS

Gastric malposition was identified in six dogs as either an incidental finding or in dogs with histories of chronic and intermittent gastroenteropathy. Gastric malposition was similar in all six cases; the pyloric canal was positioned in the left cranial abdomen in close proximity to the cardia and the pyloric antrum was found either to the left or ventral to the fundus.

CLINICAL SIGNIFICANCE

Recognition of gastric malposition as an incidental or chronic finding may prevent unnecessary emergency intervention on patients presenting for unrelated conditions.

Association of glycaemic variables with trabecular bone score in post-menopausal women with type 2 diabetes mellitus

AIM

To determine the relationship between bone microarchitecture, as measured by trabecular bone score, and advanced glycation end-product accumulation, as assessed by skin autofluorescence.

METHODS

This was a cross-sectional study. Participants were 64 post-menopausal women with type 2 diabetes and 175 post-menopausal women without diabetes. Trabecular bone score and skin autofluorescence data were obtained at time of bone density measurement.

RESULTS

Trabecular bone score and skin autofluorescence were inversely correlated in women with type 2 diabetes (r = -0.34, P = 0.006); no correlation was seen in post-menopausal women without diabetes (r = -0.029, P = 0.707). After adjustment, neither skin autofluorescence nor a diagnosis of diabetes were associated with trabecular bone score, but HbA_1c and waist circumference were independently associated with trabecular bone score.

CONCLUSION

Skin autofluorescence did not predict trabecular bone score. In contrast, glycaemia, as reflected by HbA_1c , and visceral adiposity, as reflected by waist circumference, were independently associated with trabecular bone score.

Improved Constraints on Sterile Neutrino Mixing from Disappearance Searches in the MINOS, MINOS+, Daya Bay, and Bugey-3 Experiments

Searches for electron antineutrino, muon neutrino, and muon antineutrino disappearance driven by sterile neutrino mixing have been carried out by the Daya Bay and MINOS+ collaborations. This Letter presents the combined results of these searches, along with exclusion results from the Bugey-3 reactor experiment, framed in a minimally extended four-neutrino scenario. Significantly improved constraints on the θ_{μe} mixing angle are derived that constitute the most constraining limits to date over five orders of magnitude in the mass-squared splitting Δm_{41}^{2}, excluding the 90% C.L. sterile-neutrino parameter space allowed by the LSND and MiniBooNE observations at 90% CL_{s} for Δm_{41}^{2}<13  eV^{2}. Furthermore, the LSND and MiniBooNE 99% C.L. allowed regions are excluded at 99% CL_{s} for Δm_{41}^{2}<1.6 eV^{2}.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

'Zero Leprosy' and other endgame strategies: Rhetoric vs. realism in public health campaigns

For over half a century, many public health campaigns related to infectious disease have focused on disease 'eradication,' rather than 'control' or 'management.' In this article, I will focus on the example of a recent global leprosy (Hansen's Disease) control campaign, Triple Zero. Drawing on examples from other public health initiatives, this article explores how the language of 'zero disease' or 'endgame strategies' is appealing to certain audiences but how it can also be misleading and have unexpected and unintended consequences. Depending on the specific characteristics of the disease, the disease vectors, and the circumstances of transmission, 'zero' disease is rarely an achievable goal. In addition, when a disease is said to reach 'zero,' it is important to consider the possible implications for people with social, physical, or emotional sequeläe from the disease and who still may require follow-up treatment and care.

Aberration-free multi-plane imaging of neural activity from the mammalian brain using a fast-switching liquid crystal spatial light modulator

We report a novel two-photon fluorescence microscope based on a fast-switching liquid crystal spatial light modulator and a pair of galvo-resonant scanners for large-scale recording of neural activity from the mammalian brain. The spatial light modulator is used to achieve fast switching between different imaging planes in multi-plane imaging and correct for intrinsic optical aberrations associated with this imaging scheme. The utilized imaging technique is capable of monitoring the neural activity from large populations of neurons with known coordinates spread across different layers of the neocortex in awake and behaving mice, regardless of the fluorescent labeling strategy. During each imaging session, all visual stimulus driven somatic activity could be recorded in the same behavior state. We observed heterogeneous response to different types of visual stimuli from ∼ 3,300 excitatory neurons reaching from layer II/III to V of the striate cortex.

Tuna robotics: A high-frequency experimental platform exploring the performance space of swimming fishes

Tuna and related scombrid fishes are high-performance swimmers that often operate at high frequencies, especially during behaviors such as escaping from predators or catching prey. This contrasts with most fish-like robotic systems that typically operate at low frequencies (< 2 hertz). To explore the high-frequency fish swimming performance space, we designed and tested a new platform based on yellowfin tuna (Thunnus albacares) and Atlantic mackerel (Scomber scombrus). Body kinematics, speed, and power were measured at increasing tail beat frequencies to quantify swimming performance and to study flow fields generated by the tail. Experimental analyses of freely swimming tuna and mackerel allow comparison with the tuna-like robotic system. The Tunabot (255 millimeters long) can achieve a maximum tail beat frequency of 15 hertz, which corresponds to a swimming speed of 4.0 body lengths per second. Comparison of midline kinematics between scombrid fish and the Tunabot shows good agreement over a wide range of frequencies, with the biggest discrepancy occurring at the caudal fin, primarily due to the rigid propulsor used in the robotic model. As frequency increases, cost of transport (COT) follows a fish-like U-shaped response with a minimum at ~1.6 body lengths per second. The Tunabot has a range of ~9.1 kilometers if it swims at 0.4 meter per second or ~4.2 kilometers at 1.0 meter per second, assuming a 10-watt-hour battery pack. These results highlight the capabilities of high-frequency biological swimming and lay the foundation to explore a fish-like performance space for bio-inspired underwater vehicles.

C-35 Clinical Diagnosis of Behavioral Variant Frontotemporal Dementia with Underlying Primary Age-Related Tauopathy

Objective

Primary age-related tauopathy (PART) is a neuropathologic entity characterized by neurofibrillary tangles in medial temporal regions comparable to Alzheimer’s disease (AD), but with few or no amyloid plaques. A definitive clinical phenotype for PART has not been determined. Some studies report milder deficits and a longer course compared with AD. In the National Alzheimer’s Coordinating Center database, the most common clinical diagnosis of PART cases classified as dementia is AD, though primary progressive aphasia/behavioral-variant frontotemporal dementia (bvFTD) is also common. We describe 3 patients diagnosed with bvFTD later found to have PART to further describe possible PART phenotypes.

Method

Charts of 3 autopsy-proven PART cases clinically diagnosed as bvFTD by consensus conference were reviewed. All patients (A, B, C) were male and presented with behavioral changes. Only B was APOE4+. Neuroimaging was mostly unremarkable (ventriculomegaly in patient C).

Results

All subjects presented with anosognosia, fatigue, and behavioral changes, 1 (A) with pronounced apathy and 2 (B, C) with disinhibition, impulsivity, and mood swings. Onset was early 70’s for A & C, and 50’s for B. Patients B & C had gradual onset/course (~20 years) with initial subtle executive (EF) dysfunction and intact memory. Patient A had a 6-year course and initial deficits in EF and memory.

Conclusion

This review underscores the varied presentation and clinical course of PART, including presence of early behavioral changes. Slower progression as previously reported was seen in 2 of 3 patients. Future research is warranted to better characterize the entire spectrum of clinical presentations in subjects with PART neuropathology.