The treatment effect of rivaroxaban on clot characteristics in patients who present acutely with first time deep vein thrombosis.

BACKGROUND: The acute vascular disease deep vein thrombosis (DVT) requires oral anticoagulants to prevent progression. Monitoring therapeutic efficacy of direct oral anticoagulants (DOAC), including rivaroxaban, is problematic as no reliable test is available. Advances in rheometry have led to the development of a functional coagulation biomarker using Gel Point (GP) analysis which assesses clot structure formation. The biomarker measures incipient clot formation time (TGP) and quantifies fibrin clot structure in terms of fractal dimension (df). OBJECTIVE: This study aimed to investigate clot structure formation in first time DVT and the effect of rivaroxaban treatment. METHODS: This prospective observational cohort study measured the GP and standard laboratory markers at three sample points: pre-treatment and at 20 and 60 days following 15 mg BD and 20 mg OD rivaroxaban respectively. RESULTS: Forty DVT patients (mean age 64 years [SD±14.8]; 23 males, 17 female) were recruited. The results show that DVT vs non-DVT patients did not have a significantly different GP profile (df: 1.72±0.06 vs 1.70±0.06 and TGP: 267±68 sec vs 262±73 sec) with both within the defined healthy index. In addition, rivaroxaban therapy increased TGP to 392 s (±135 s) after 20 days, and subsequently increased to 395 s (±194 s) at 60 days but did not significantly increase df (from 1.69±0.05 to 1.71±0.06). CONCLUSIONS: The results indicate in this cohort of DVT patients there was no underlying hypercoagulable effect as determined by gel point analysis. Furthermore, the anticoagulant effect of rivaroxaban prolonged clotting, suggesting a protective effect against clot formation, without significantly reducing clot microstructural properties.

Examination of alumina ceramic components from total hip arthroplasties.

Materials analysis has been conducted on retrieved Mittelmeier-Autophor ceramic components from total hip arthroplasties, correlating articulating surface wear morphology with clinical reasons for failure. Plastically deformed, agglomerated wear debris (30-60 microns) has been identified on femoral head articulation wear surfaces, displaying exaggerated wear, especially during the initiation stage. Such surfaces were associated with clinical failures involving displacement of the acetabular cup and perforation of the cortex by the femoral stem. It is thought that this wear debris may play an important role in the promotion of the 'avalanche' wear mechanism, as it is adherent and thus difficult to remove from the wear interface.

A study of cells in the mammary secretions of sows.

The morphology and some of the in vitro functional properties of the cells in the mammary secretions of sows have been examined. A mean cell yield of 1 x 10(7) cells/ml was obtained from sow colostrum but during the first week post-partum the yield decreased approximately 10 fold. The polymorphonuclear leucocyte was the predominant cell type in colostrum and milk and was associated with varying proportions of lymphocytes, macrophages and epithelial cells. The phagocytes of sow milk ingested heat-killed yeast, although the phagocytic index for milk macrophages was low compared with autologous neutrophils and alveolar macrophages. Milk whey provided an effective opsonising medium for yeast ingestion. Intra-mammary immunisation of sows with ovalbumin induced antigen-reactive lymphocytes in both peripheral blood and milk.

Effectiveness of frontalis feedback training in producing general body relaxation.

Although it is common for EMG frontalis feedback to be used to train general relaxation, there is a growing literature that challenges its use. This experiment explored whether successful frontalis EMG training produces concomitant covariation of autonomic nervous system indicators of decreased arousal and tension for highly anxious subjects. Twenty-four subjects were divided into groups receiving either frontalis feedback training, motivated constant-tone control, or motivated self-relaxation control procedures. Analysis showed that feedback training led to significantly lower frontalis levels, but similar effects were not found for heart rate, skin conductance levels, or respiration rate. The results suggest that even successful EMG frontalis feedback is not accompanied by anticipated reduction in related physiological descriptors. The use of frontalis tension level as an index of general tension is also discussed.

Treatment of Tietze's syndrome pain through paced respiration.

A paced respiration methodology and self-control procedure was developed to reduce respiratory irregularities associated with disabling Tietze's syndrome pain. A 46-year-old disabled male patient who was diagnosed as having Tietze's syndrome and coronary heart disease was trained in respiratory control during five training sessions. Treatment was directed at producing normal respiratory activity and reducing involuntary deep inspirations. Training led to within- and between-sessions reductions in respiratory irregularity and pain frequency, and to increases in self-reported activity levels. Two- and 5-month follow-up sessions showed that improvements were maintained but at an attenuated level. Possible respiration biofeedback or self-monitoring treatments of this syndrome are also discussed.