A retrospective study on the risk factors for bleeding events in warfarin therapy, focusing on renal function.

PURPOSE: The anticoagulant effect of warfarin used to treat stroke has been shown to vary with the concomitant use of medications and comorbidity. Concomitant use of antithrombotic drugs and underlying chronic kidney disease (CKD) represent risk factors for bleeding events. We conducted a comprehensive investigation of the background characteristics and concomitant use of drugs to identify the risk factors for warfarin-related bleeding, focusing on renal function. METHODS: The study population consisted of patients prescribed warfarin at the Tokyo Women's Medical University Hospital. A retrospective review of the patient data, including bleeding events, bleeding sites, the patient's background, concomitant use of drugs, and laboratory data was carried out, and the incidence of bleeding events was compared in patient groups stratified according to CKD stage and antithrombotic drug use. Multivariate logistic regression analysis was performed to determine the risk factors for warfarin-related bleeding. RESULTS: Of the 3,831 patients included in the study, the incidence of warfarin-related bleeding was 3.0 events per 100 patient-years. The multivariate logistic regression analysis identified age > 65 years, body mass index (BMI), alanine aminotransferase (ALT), estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2, prothrombin time-international normalized ratio (PT-INR), and concomitant use of antithrombotic drugs as risk factors for warfarin-related bleeding. CONCLUSIONS: The present analyses identified age > 65 years, BMI, ALT, eGFR <30 mL/min/1.73 m2, PT-INR, and concomitant use of antithrombotic drugs as independent risk factors for warfarin-related bleeding. We should pay attention to the risk factors associated with warfarin-related bleeding when prescribing warfarin in patients with renal impairment.

On the switching dynamics of epitaxial ferroelectric CeO2-HfO2 thin film capacitors.

Epitaxial layers of ferroelectric orthorhombic HfO2 are frequently investigated as model systems for industrially more relevant polycrystalline films. The recent success in stabilizing the orthorhombic phase in the solid-solution cerium oxide - hafnium oxide system allows detailed investigations of external influences during fabrication. This report analyzes the ferroelectric properties of two thin film capacitors, which were post-deposition annealed in N2 and O2 atmospheres to achieve the orthorhombic phase after room temperature deposition. The samples, which exhibit very similar constituent phase, appear identical in conventional polarization-field hysteresis measurements. However, a significant switching speed difference is observed in pristine devices. Continued field cycling reduces the difference. Deeper analysis of switching transients based on the Nucleation Limited Switching model suggests that the O2 heat treatment atmosphere results in an altered oxygen vacancy profile, which is reverted during ferroelectric cycling.

Evaluation of macular abnormalities in Stargardt's disease using optical coherence tomography and scanning laser ophthalmoscope microperimetry.

BACKGROUND: The purpose of this study is to evaluate the diagnostic value of optical coherence tomography (Stratus OCT) and scanning laser ophthalmoscope (SLO) microperimetry in patients with Stargardt's disease (STGD), and the correlation between macular morphology and visual function in these patients. METHODS: Twenty-two patients with STGD (mean age 44 years, range 11 to 71 years) and 20 age-matched healthy control subjects were included in the study. OCT imaging was performed using six radial line scans manually centered on the fovea. SLO microperimetry was used to assess central scotoma and fixation behavior in patients with STGD. RESULTS: Mean best corrected Snellen visual acuity (BCVA) was 20/80, range 20/25 to 20/300 (log MAR 0.6, range 0.1 to 1.2) in the STGD group and 20/20 (log MAR 0.0) in the control group. Foveal thickness was significantly reduced in patients with STGD (119.0 +/- 19.6 microm) compared to controls (210.7 +/- 19.6 microm, P < 0.0001). A significant correlation between foveal thickness and BCVA was observed within the STGD group (R(2) = 0.62, P < 0.0001). Photoreceptor loss in the macular area and a corresponding central scotoma were observed in all STGD patients. CONCLUSIONS: OCT findings, particularly reduced foveomacular thickness and photoreceptor loss in the macular area may be useful in the diagnosis of STGD. Furthermore, a strong correlation between foveal thickness and visual function was observed in our patients. Assessment of central visual function using SLO microperimetry provides additional useful information, important in the management of STGD.

[A case of follicular lymphoma derived from the conjunctiva].

BACKGROUND: Follicular lymphoma, derived from ocular adnexa as defined by World Health Organization Classification of neoplastic diseases of the hematopoietic and lymphoid tissues, is quite rare in Japan. CASE: A 65-year-old woman visited our clinic for treatment of a conjunctival tumor in the left eye. FINDINGS: Incisional biopsy revealed that the lesion was a lymphoma with well-defined follicles, and it was L 26(CD20) and BCL-2 positive immunohistochemically. Flow cytometric analysis showed that more than 70% of the cells were double positive for CD10 and CD20. Southern blot hybridization demonstrated gene rearrangement bands in the immunoglobulin gene JH region. The chromosome had a translocation t(14, 18) (q32, q21). Systemic evaluation detected no other lymphoma. CONCLUSION: The lesion was a follicular lymphoma derived from conjunctival tissue. Additional examinations such as flow cytometric analysis, gene analysis, and chromosome examination were useful for differential diagnosis of marginal zone B cell lymphoma of mucosa associated lymphoid tissue type and benign reactive lymphoid hyperplasia.