Peri-procedural bridging with low molecular weight heparin in patients receiving warfarin for venous thromboembolism: a pediatric experience

INTRODUCTION

The incidence of venous thromboembolism (VTE) in children appears to be increasing, and warfarin remains one of the few standard anticoagulants used for secondary VTE prevention. When invasive procedures are required in adults with high TE risk who are receiving warfarin, low-molecular weight heparin (LMWH) bridging is recommended, based mainly upon observational evidence; in children, no such studies have been published. We sought to determine the risks of recurrent TE (both VTE and arterial TE [ATE]) and major bleeding with peri-procedural LMWH bridging in children receiving warfarin for VTE.

METHODS

Children (age≤21years of age at the time of bridge) receiving warfarin for VTE and undergoing a standardized clinical care protocol for peri-procedural LMWH bridging were enrolled and followed in an institution-based prospective inception cohort study at Children's Hospital Colorado between March 2006 and February 2012. Outcomes were assessed at 30days post-procedure, and followed International Society on Thrombosis and Haemostasis guidelines.

RESULTS

Seventeen children comprised the cohort, with a total of 23 bridging episodes. Median age at bridging episode was 17.5years (range, 12 to 21years). In 22% of bridging episodes, indication was for major surgery. Median duration of LMWH administration prior to procedure was 6days (range, 4-10days); median duration off anticoagulation peri-procedurally was 1.5days (range: 1-2days). The risks of major bleeding, recurrent VTE, and ATE at 30days post-procedure were 4.3% (1/23), 0% and 0%, respectively.

CONCLUSIONS

This study provides important preliminary data on safety and efficacy of perioperative LMWH bridging for adolescent VTE patients receiving warfarin. Larger collaborative pediatric studies are warranted to substantiate these findings and to investigate prognostic factors of bleeding and recurrent TE in this setting.

Diet creates metabolic niches in the "immature gut" that shape microbial communities

Although diet composition has been implicated as a major factor in the etiology of various gastrointestinal diseases, conclusive evidence remains elusive. This is particularly true in diseases such as necrotizing enterocolitis where breast milk as opposed to commercial formula appears to confer a "protective effect" to the "immature gut." Yet the mechanism by which this occurs continues to remain speculative. In the present study we hypothesize that the basic chemical composition of diet fundamentally selects for specific intestinal microbiota which may help explain disparate disease outcome and therapeutic direction. Complimentary animal and human studies were conducted on young piglets (21 d.)(n = 8) (IACUC protocols 08070 and 08015) and premature infants (adjusted gestational age 34-36 weeks) (n = 11) (IRB Protocol 15895A). In each study, cecal or stool contents from two groups (Breast milk-fed (BF) vs. Formula-fed (FF)) were analyzed by gas chromatography/mass spectrometry (GC/MS) and comprehensive metabolic profiles generated and compared. Concurrently, bacterial community structure was assayed and respective representative microbiota of the groups determined by 16S rRNA gene amplicon pyrosequencing. Statistical modeling and analysis was done using SIMCA-P+ and R software. GC/MS metabolomics identified clear differences between BF and FF groups in the intestinal environment of piglets and humans. Sugars, amino-sugars, fatty acids, especially unsaturated fatty acids, and sterols were identified as being among the most important metabolites for distinguishing between BF and FF groups. Joint analysis of microbiota and metabolomics pinpointed specific sets of metabolites (p < 0.05) associated with the dominant bacterial taxa. The chemical composition of diet appears to have a significant role in defining the microbiota of the immature gut. Tandem analysis of intestinal microbial and metabolic profiles is potentially a powerful tool leading to better understanding of the role of diet in disease perhaps even leading to specific strategies to alter microbial behavior to improve clinical outcome.

Differential expression of IGF1, IGFR1 and IGFBP3 in mandibular condylar cartilage between male and female rats applied with malocclusion

This study was designed to investigate the expression differences of insulin-like growth factor-1 (IGF1), IGF type 1 receptor (IGFR1) and IGF-binding protein-3 (IGFBP3) in mandibular condylar cartilage between male and female rats with experimentally created malocclusion. A total of 40 male and 40 female rats were used, and malocclusion was created by moving the first molars mesially and the third molars distally in the experimental group. Animals were killed at the end of the second and fourth weeks. Haematoxylin and eosin (HE) staining was performed to monitor the changes in cartilage morphology and thickness. Immunohistochemistry and real-time PCR were used to detect the expression of IGF1, IGFR1 and IGFBP3. Osteoarthritis (OA)-like changes were observed in the experimental groups, with 2-week females showing larger OA-like regions than 2-week males (P < 0·05). Compared to their age- and sex-matched controls, both 2- and 4-week males in the experimental groups displayed increased cartilage thickness in the posterior regions (P < 0·05). Compared to their age- and sex-matched controls, the expression of IGF1 was lower in 2-week female group (P < 0·05), but higher in 4-week female, 2- and 4-week male experimental groups (P < 0.05). Similarly, the expression of IGFR1 was lower in 2-week female experimental group (P < 0.05), but higher in 2-week male experimental group (P < 0.05). The higher expression of IGFBP3 was observed in 2-week female, 2- and 4-week male experimental groups (P < 0·05). These results indicate that condylar cartilage from male and female rats respond differently to the malocclusion in early stage of OA, with more serious degeneration in females.

Retrieving quasi-phase-matching structure with discrete layer-peeling method

An approach to reconstruct a quasi-phase-matching grating by using a discrete layer-peeling algorithm is presented. Experimentally measured output spectra of Šolc-type filters, based on uniform and chirped QPM structures, are used in the discrete layer-peeling algorithm. The reconstructed QPM structures are in agreement with the exact structures used in the experiment and the method is verified to be accurate and efficient in quality inspection on quasi-phase-matching grating.

Comparison of Two At-home Whitening Products of Similar Peroxide Concentration and Different Delivery Methods

Purpose

This study compared the whitening efficacy, side effects, and patients' preferences/perceptions of two whitening systems of similar peroxide concentration but different formulation and delivery methods.

Methods

The tooth color change of 24 participants was measured using a shade guide (BSG) and a spectrophotometer (ES). Color difference was calculated: ΔE* = [(ΔL*)2 + (Δa*)2 + (Δb*)2]1/2. One whitening treatment was randomly applied to the right or left maxillary anterior teeth and the other was applied to the contralateral teeth, at-home with 35% carbamide peroxide in a tray (TW) or with 14% hydrogen peroxide in strips (WS). The tooth color was evaluated at baseline, 15 and 30 days (15 days postwhitening). Participants rated their tooth and soft tissue sensitivity (1–10 scale) and completed a questionnaire on their preferences. Results were analyzed by repeated measurement regression analysis/Tukey and Mann-Whitney (p&lt;0.05).

Results

At 15 days, the teeth treated with TW and WS presented ΔE* = 7 and 6, respectively (ΔBSG=3 for both), and at 30 days, they presented ΔE* = 7.5 and 6.5, respectively (ΔBSG=3 for both). There was no significant difference in tooth and soft tissue sensitivity between treatments. No participant reported tooth and gingival sensitivity at the postwhitening appointment. Of the participants, 83% preferred the TW over WS.

Conclusion

Both ΔE* and ΔBSG showed no significant difference in tooth color change between TW and SW at either time point. By the end of the study no participants reported tooth and gingival sensitivity. Participants preferred TW over SW.

Search for dark matter and large extra dimensions in pp collisions yielding a photon and missing transverse energy

Results are presented from a search for new physics in the final state containing a photon (γ) and missing transverse energy (E[combininb /](T)). The data correspond to an integrated luminosity of 5.0 fb(-1) collected in pp collisions at √[s]=7 TeV by the CMS experiment. The observed event yield agrees with standard-model expectations for the γ+E[combininb /](T) events. Using models for the production of dark-matter particles (χ), we set 90% confidence level (C.L.) upper limits of 13.6-15.4 fb on χ production in the γ+E[combininb /](T) state. These provide the most sensitive upper limits for spin-dependent χ-nucleon scattering for χ masses (M(χ)) between 1 and 100 GeV. For spin-independent contributions, the present limits are extended to M(χ)<3.5 GeV. For models with 3-6 large extra dimensions, our data exclude extra-dimensional Planck scales between 1.64 and 1.73 TeV at 95% C.L.

Observation of a new Ξb baryon

The observation of a new b baryon via its strong decay into Ξ(b)(-) π(+) (plus charge conjugates) is reported. The measurement uses a data sample of pp collisions at sqrt[s] = 7 TeV collected by the CMS experiment at the LHC, corresponding to an integrated luminosity of 5.3 fb(-1). The known Ξ(b)(-) baryon is reconstructed via the decay chain Ξ(b)(-) → J/ψΞ(-) → μ(+) μ(-) Λ(0) π(-), with Λ(0) → pπ(-). A peak is observed in the distribution of the difference between the mass of the Ξ(b)(-) π(+) system and the sum of the masses of the Ξ(b)(-) and π(+), with a significance exceeding 5 standard deviations. The mass difference of the peak is 14.84 ± 0.74(stat) ± 0.28(syst) MeV. The new state most likely corresponds to the J(P) = 3/2(+) companion of the Ξ(b).

Measurements of the mass and width of the η(c) using the decay ψ(3686)→γη(c)

The mass and width of the lowest-lying S-wave spin singlet charmonium state, the η(c), are measured using a data sample of 1.06×10(8) ψ(3686) decays collected with the BESIII detector at the BEPCII storage ring. We use a model that incorporates full interference between the signal reaction, ψ(3686)→γη(c), and a nonresonant radiative background to describe the line shape of the η(c) successfully. We measure the η(c) mass to be 2984.3±0.6±0.6 MeV/c(2) and the total width to be 32.0±1.2±1.0 MeV, where the first errors are statistical and the second are systematic.

Normal and diseased personal eye modeling using age-appropriate lens parameters

Personalized eye modeling of normal and diseased eye conditions is attractive due to the recent availability of detailed ocular measurements in clinic environments and the promise of its medical and industrial applications. In the customized modeling, the optical properties of the crystalline lens including the gradient refractive index, the lens bio-geometry and orientation are typically assigned with average lens parameters from literature since typically they are not clinically available. Although, through the optical optimization by assigning lens parameters as variables, the clinical measured wavefront aberration can be achieved, the optimized lens biometry and orientation often end up at edges of the statistical distribution. Without an effective validation of these models today, the fidelity of the final lens (and therefore the model) remains questionable. To develop a more reliable customized model without detailed lens information, we incorporate age-appropriate lens parameters as the initial condition of optical optimization. A biconic lens optimization was first performed to provide a correct lens profile for accurate lower order aberration and then followed by the wavefront optimization. Clinical subjects were selected from all ages with both normal and diseased corneal and refractive conditions. 19 ammetropic eyes ( + 4D to -11D), and 16 keratoconus eyes (mild to moderate with cylinder 0.25 to 6D) were modeled. Age- and gender-corrected refractive index was evaluated. Final models attained the lens shapes comparable to the statistical distribution in their age.

First observation of η(1405) decays into f(0)(980)π0

The decays J/ψ → γ π+ π- π0 and J/ψ → γ π0 π0 π0 are analyzed using a sample of 225×10(6) J/ψ events collected with the BESIII detector. The decay of η(1405) → f(0)(980)π0 with a large isospin violation is observed for the first time. The width of the f(0)(980) observed in the dipion mass spectra is anomalously narrower than the world average. Decay rates for three-pion decays of the η' are also measured precisely.

Differential expression of microRNAs during allograft rejection

MicrorRNA are small noncoding RNA molecules that regulate the posttranscriptional expression of target genes. In addition to being involved in many biologic processes, microRNAs are important regulators in innate and adaptive immune responses. Distinct sets of expressed microRNAs are found in different cell types and tissues and aberrant expression of microRNAs is associated with many disease states. MicroRNA expression was examined in a model of heterotopic heart transplantation by microarray analyses and a unique profile was detected in rejecting allogeneic transplants (BALB/c → C57BL/6) as compared to syngeneic transplants (C57BL/6 → C57BL/6). The microRNA miR-182 was significantly increased in rejecting cardiac allografts and in mononuclear cells that infiltrate the grafts. Forkhead box (FOX) proteins are a family of important transcription factors and FOXO1 is a target of miR-182. As miR-182 increases after transplant, there is a concomitant posttranscriptional decrease in FOXO1 expression in heart allografts that is localized to both the cardiomyocytes and CD3(+) T cells. The microRNA miR-182 is significantly increased in both peripheral blood mononuclear cells and plasma during graft rejection suggesting potential as a biomarker of graft status. Our results identify microRNAs that may regulate alloimmune responses and graft outcomes.

Observation of electron-antineutrino disappearance at Daya Bay

The Daya Bay Reactor Neutrino Experiment has measured a nonzero value for the neutrino mixing angle θ(13) with a significance of 5.2 standard deviations. Antineutrinos from six 2.9 GWth reactors were detected in six antineutrino detectors deployed in two near (flux-weighted baseline 470 m and 576 m) and one far (1648 m) underground experimental halls. With a 43,000 ton-GWth-day live-time exposure in 55 days, 10,416 (80,376) electron-antineutrino candidates were detected at the far hall (near halls). The ratio of the observed to expected number of antineutrinos at the far hall is R=0.940±0.011(stat.)±0.004(syst.). A rate-only analysis finds sin(2)2θ(13)=0.092±0.016(stat.)±0.005(syst.) in a three-neutrino framework.