Haematological factors in the management of adult epistaxis: systematic review.

BACKGROUND: The management of epistaxis requires an understanding of haematological factors that may complicate its treatment. This systematic review includes six distinct reviews examining the evidence supporting epistaxis-specific management strategies relating to warfarin, direct oral anticoagulants, heparin, antiplatelet agents, tranexamic acid and transfusion. METHOD: A systematic review of the literature was performed using a standardised methodology and search strategy. RESULTS: Limited numbers of articles were identified in each systematic review, with level 1 evidence only regarding the use of tranexamic acid. No studies met the inclusion criteria within the heparin, direct oral anticoagulants or transfusion systematic reviews. Many studies were limited by small sample sizes and significant risk of bias. CONCLUSION: The management of major bleeding and transfusion practice is well documented in national guidance from multiple sources. The guidelines include advice on anticoagulants, antiplatelet agents and tranexamic acid. In the absence of more specific evidence, these guidelines should be applied in the management of epistaxis.

Determining the haemodynamic significance of arterial stenosis: the relationship between CT angiography, computational fluid dynamics, and non-invasive fractional flow reserve.

Coronary artery disease causes significant morbidity and mortality worldwide. Invasive coronary angiography (ICA) is currently the reference standard investigation. Fractional flow reserve (FFR) complements traditional ICA by providing extra information on blood flow, which has convincingly led to better patient management and improved cost-effectiveness. Computed tomography coronary angiography (CTCA) is suitable for the investigation of chest pain, especially in the low- and intermediate-risk groups. FFR generated using CT data (producing FFRCT) may improve the positive predictive value of CTCA. The basic science of FFRCT is like a "black box" to most imaging professionals. A fundamental principle is that good quality CTCA is likely to make any post-processing easier and more reliable. Both diagnostic and observational studies have suggested that the accuracy and the short-term outcome of using FFRCT are both comparable with FFR in ICA. More multidisciplinary research with further refined diagnostic and longer-term observational studies will hopefully pinpoint the role of FFRCT in existing clinical pathways.

Asymmetries observed in Saturn's magnetopause geometry.

For over 10 years, the Cassini spacecraft has patrolled Saturn's magnetosphere and observed its magnetopause boundary over a wide range of prevailing solar wind and interior plasma conditions. We now have data that enable us to resolve a significant dawn-dusk asymmetry and find that the magnetosphere extends farther from the planet on the dawnside of the planet by 7 ± 1%. In addition, an opposing dawn-dusk asymmetry in the suprathermal plasma pressure adjacent to the magnetopause has been observed. This probably acts to reduce the size asymmetry and may explain the discrepancy between the degree of asymmetry found here and a similar asymmetry found by Kivelson and Jia (2014) using MHD simulations. Finally, these observations sample a wide range of season, allowing the "intrinsic" polar flattening (14 ± 1%) caused by the magnetodisc to be separated from the seasonally induced north-south asymmetry in the magnetopause shape found theoretically (5 ± 1% when the planet's magnetic dipole is tilted away from the Sun by 10-17°).

Internally driven large-scale changes in the size of Saturn's magnetosphere.

Saturn's magnetic field acts as an obstacle to solar wind flow, deflecting plasma around the planet and forming a cavity known as the magnetosphere. The magnetopause defines the boundary between the planetary and solar dominated regimes, and so is strongly influenced by the variable nature of pressure sources both outside and within. Following from Pilkington et al. (2014), crossings of the magnetopause are identified using 7 years of magnetic field and particle data from the Cassini spacecraft and providing unprecedented spatial coverage of the magnetopause boundary. These observations reveal a dynamical interaction where, in addition to the external influence of the solar wind dynamic pressure, internal drivers, and hot plasma dynamics in particular can take almost complete control of the system's dayside shape and size, essentially defying the solar wind conditions. The magnetopause can move by up to 10-15 planetary radii at constant solar wind dynamic pressure, corresponding to relatively "plasma-loaded" or "plasma-depleted" states, defined in terms of the internal suprathermal plasma pressure.

Ultrasonic treatment of Cryptosporidium oocysts.

The effect of 20 kHz ultrasound on the viability of Cryptosporidium oocysts was investigated. More than 90% of the dispersed Cryptosporidium oocysts could be deactivated in about 1.5 min of continuous sonication. In order to apply this technique to large quantities of contaminated water, quantitative filtration and redispersion of Cryptosporidium oocysts were investigated and found to be easily achievable. The estimated cost of sonication showed that the ultrasound treatment of Cryptosporidium oocysts contaminated water could be a very effective means of "deactivating" Cryptosporidium oocysts.

Suicidality patterns and sexual orientation-related factors among lesbian, gay, and bisexual youths.

Three hundred fifty lesbian, gay, and bisexual youths aged 14 to 21 years were questioned about suicidal thoughts and behaviors, families' reactions to youths' sexual orientation, and suicidality among relatives and friends. Results confirmed an association between sexual orientation and suicidality. Nearly half (42%) had sometimes or often thought of suicide; one third (33%) reported at least one suicide attempt. Many related suicidal ideation and suicide attempts to their sexual orientation. Most attempts followed awareness of same-sex feelings and preceded disclosure of sexual orientation to others. One quarter said a family member had made a suicide attempt, and nearly three quarters said a close friend had attempted suicide.

Lesbian, gay, and bisexual youth and their families: disclosure of sexual orientation and its consequences.

Lesbian, gay, and bisexual youngsters, aged 14-21 and living at home, were studied for patterns of disclosure of sexual orientation to families. Three-quarters had told at least one parent, more often the mother than the father. Those who had disclosed were generally more open about their sexual orientation than those who had not, and few of the nondisclosed expected parental acceptance. Those who had disclosed reported verbal and physical abuse by family members, and acknowledged more suicidality than those who had not "come out" to their families.

Effect of prolonged modified fasting in obese persons on in vitro markers of immunity: lymphocyte function and serum effects on normal neutrophils.

The effects of nutritional manipulation on immune function have been extensively studied in animals, but few studies have examined dietary restriction in humans. Obese patients enrolled in a protein-sparing, calorically restricted diet were monitored over a 3-month period with in vitro examination of mitogen- and antigen-induced lymphocyte blastogenesis. The sera from these patients were evaluated for effects on neutrophil chemotaxis, phagocytosis and microbial killing. Significant changes in body weight, triglycerides and glucose occurred during the diet, and most patients exhibited urinary ketosis. The diet was associated with increased blastogenesis in unstimulated cultures and in varicella and candida antigen-stimulated cultures, but blastogenesis was unchanged for phytohemagglutinin, concanavalin A, SK-SD and histoplasma. In assays of serum effects on neutrophil function, patients with urinary ketosis had depression of chemotaxis and microbial killing but not phagocytosis when compared to baseline or nonketotic patients. This study indicates that long-term caloric restriction is associated with significant effects on in vitro lymphocyte stimulation and with significant serum effects on normal neutrophil function.

Effects of ribavirin on neutrophil function.

Ribavirin, a broad spectrum antiviral agent, has been shown to exhibit immunosuppressive activity. This property has raised concerns during clinical trials because candidates for antiviral therapy are those who may develop secondary bacterial infection. We therefore investigated a number of parameters of neutrophil function after the in vitro addition of various concentrations of ribavirin. At pharmacologic concentrations (1.25-7.5 micrograms/mL), percent killing of phagocytized bacteria was increased as measured by an acridine orange fluorochrome microassay, significantly higher at a concentration of 5 micrograms/mL (p less than .02). There was no concomitant adverse effect on adherence, random migration, chemotaxis, opsonization or phagocytosis. The present data indicate that ribavirin has no acute suppressive effect on granulocyte function and may even enhance bacterial killing capabilities for treated patients.

Functional capacity of marginated and bone marrow reserve granulocytes.

Marginated and bone marrow reserve granulocytes were obtained from young healthy volunteers after subcutaneous administration of aqueous epinephrine (0.4 ml/m2) or intravenous administration of hydrocortisone sodium succinate (250 mg), respectively. These leukocytes were compared with circulating granulocytes for the ability to adhere to surfaces, migrate in a random fashion, respond to chemoattractants, interact with autologous serum opsonins, and phagocytize and kill five common bacterial pathogens. As contrasted with circulating neutrophils, marginated cells had enhanced phagocytic and killing capacity for some pathogens, whereas adherence, random migration, chemotaxis, and chemiluminescence for the two cell populations were equivalent. Bone marrow reserve cells demonstrated increased activity for three functional mechanisms; chemotaxis for these cells averaged 21% higher than that for circulating cells, and phagocytosis was 32% higher, with 6 to 17% greater killing of the five bacterial species studied. All of these differences were statistically significant (P less than 0.05). Random migration and interaction with serum opsonins were unchanged in bone marrow granulocytes. These enhanced functional properties of neutrophils which are outside of the circulating pool may represent important host defense mechanisms during episodes of bacterial infection.