Reversal of dabigatran by intraosseous or intravenous idarucizumab in a porcine polytrauma model.

BACKGROUND: Idarucizumab is licensed to reverse dabigatran in life-threatening haemorrhage. Establishment of venous access can be challenging, and the intraosseous (IO) route is a potentially life-saving alternative. In this study, we compared the efficacy and safety of IO or intravenous (i.v.) idarucizumab for dabigatran reversal in a porcine polytrauma model. METHODS: Male pigs (n=21) received oral dabigatran etexilate (30 mg kg-1 bid) for 3 days. On the 4th day, animals received dabigatran infusion and were randomised 1:1:1 to receive IO saline (control), i.v. idarucizumab (60 mg kg-1), or IO idarucizumab (60 mg kg-1), or animals were included in a sham group (n=7). Study treatment was administered after polytrauma and the animals were monitored for 240 min, or until death. Coagulation status was monitored by thromboelastometry, thromboelastography, and thrombin measurements. RESULTS: Total blood loss was lowest in sham animals [521 (52) ml, P<0.01 vs all other groups], and comparable in the two idarucizumab groups [IO: 1085 (102) ml vs i.v.: 1142 (125) ml], and highest in the control group [4065 (557) ml, P<0.001 vs all other groups]. Survival to 240 min was 100% in the sham group and both idarucizumab groups, and 14% in the control group. IO and i.v. idarucizumab promptly normalised global coagulation assays and thrombin generation. Thromboelastography showed a strong correlation between dabigatran concentrations and R-time (R2=0.90 and 0.89) in idarucizumab-treated animals. CONCLUSIONS: Intravenous and intraosseous idarucizumab were comparable for reversing dabigatran in a porcine trauma model. Dabigatran reversal could be monitored using fully automated thromboelastography.

Half-metallic silicon nanowires: first-principles calculations.

From first-principles calculations, we predict that specific transition metal (TM) atom-adsorbed silicon nanowires have a half-metallic ground state. They are insulators for one spin direction, but show metallic properties for the opposite spin direction. At high coverage of TM atoms, ferromagnetic silicon nanowires become metallic for both spin directions with high magnetic moment and may have also significant spin polarization at the Fermi level. The spin-dependent electronic properties can be engineered by changing the type of adsorbed TM atoms, as well as the diameter of the nanowire. Present results are not only of scientific interest, but also can initiate new research on spintronic applications of silicon nanowires.

Comparison of two different viscosupplements in knee osteoarthritis -- a pilot study.

A pilot study was designed to investigate the efficacy of two different hyaluronic acid preparations combined to physical therapy in patients with knee osteoarthritis in terms of reduction in pain and disability and muscle strengthening. Thirty-seven patients with symptomatic osteoarthritis of the knees were randomly assigned into three groups. First group received a lower molecular weight hyaluronic acid plus physical therapy, second group received a higher molecular weight hyaluronic acid plus physical therapy, and the third group received physical therapy alone. The isokinetic knee muscle strengths and index of severity for osteoarthritis of the knee scores were evaluated at baseline, at the end of treatment (3 weeks) and at 3 months of follow up. At both short-term (3 weeks) and long-term (3 months) evaluations, index of severity for osteoarthritis of the knee scores were reduced in all three groups, while there was no significant muscle strengthening.

Overview of 321 patients with idiopathic thrombocytopenic purpura. Retrospective analysis of the clinical features and response to therapy.

In this retrospective study, we evaluated the clinical features and the effects of various treatment modalities on the clinical course in patients diagnosed with idiopathic thrombocytopenic purpura (ITP) at our center between 1984-2000. We retrospectively examined the medical records of 321 (229 females, 92 males) ITP patients. One hundred and seventy-one (53.3%) patients were lost to follow-up. When evaluating the clinical features, all 321 patients were included; however, when the response to treatment modalities was evaluated only 150 patients followed up regularly were considered. The median age of the patients on initial diagnosis was 34 years (range: 14-78). At initial diagnosis, 235 (73.2%) patients had signs of bleeding. Of patients diagnosed with ITP initially, six later turned out to have systemic lupus erythematosus (SLE) and two myelodysplastic syndrome (MDS). The median follow-up of 150 patients followed up regularly was 30 months (range: 4-396). One hundred and thirty-seven of these subjects had an indication for treatment and 94.2% of them were administered either standard or high-dose steroids as the first-line therapy. Complete remission (CR) was defined as any platelet count >100,000/mm(3) lasting for 3 months or longer without treatment. CR was achieved in 51.9% of the patients given steroids as the initial therapy. During a median follow-up of 33 months, relapse occurred in 58.2% of these patients, and after a median follow-up of 11 months the rest of them were still in remission. Ninety-eight patients followed up regularly were administered second-line therapies. CR was obtained in 44.4% of the patients who used steroids as second-line therapy. Within a median follow-up of 15 months, 20.8% of these patients relapsed. Splenectomy was performed in 76 patients and CR was obtained in 68.4% of the regularly followed up patients. Relapse occurred within a median of 96 months in 15.4% of the patients who had CR. Kaplan-Meier curves showed that the duration of CR obtained by splenectomy was significantly higher than that obtained by steroids (p<0.001). The 10-year disease-free survivals in patients who used steroids and who underwent splenectomy were, respectively, 13% and 58%. In our adult ITP patients, steroids induced nearly similar rates of CR both as first-and second-line therapies. Splenectomy seems to be effective in patients unresponsive to steroids. The duration of CR obtained by splenectomy is significantly longer when compared with the duration of CR obtained by steroid therapy.

Functional outcome in stroke patients with atrial fibrillation.

OBJECTIVES: To identify the prevalence of atrial fibrillation (AF) in a sample of stroke patients and to evaluate the impact of AF on patient clinical characteristics and functional outcome. DESIGN: A retrospective case-comparison study. SETTING: University-affiliated rehabilitation centers. PARTICIPANTS: One hundred ninety-six of 231 consecutive stroke patients admitted to inpatient rehabilitation units were evaluated during the rehabilitation period. MAIN OUTCOME MEASURES: Characteristics of cerebral lesions, patient demographic features, disease duration, length of hospital stay (LOS), risk factors for stroke, and functional status at admission and at discharge were assessed and compared in patients with and without AF. Functional Independence Measure (FIM) and Adapted Patient Evaluation Conference System (APECS) were used to evaluate functional status. RESULTS: AF was diagnosed in 41 (20.1%) patients. Patients who had AF were more likely to have ischemic cerebral lesions. There were no significant differences between the AF and non-AF groups with regard to mean age, LOS, and disease duration. Ischemic and valvular heart disease were more common in patients with AF. Based on FIM and APECS scores, both initial and discharge disability were more severe in patients with AF. In a multivariate model, AF was a negative prognostic factor for functional outcome in stroke patients. CONCLUSION: AF is not only associated with increased risk of stroke, but also with markedly greater disability in stroke patients. Factors such as size and type of cerebral lesions, stroke severity, comorbid conditions, and impact of AF on systemic and cerebral circulation can influence stroke recovery.

Effects of intrathecal baclofen on chronic spinal cord injury pain.

The pain of 16 patients with spasticity secondary to spinal cord injury was assessed prior to intrathecal baclofen pump implantation and again 6 and 12 months postoperatively. Chronic pain was delineated into neurogenic and musculoskeletal components, noting changes in nature, quality, and severity of pain (visual analogue scale) and use of analgesic medications. Twelve of 16 patients had chronic pain preoperatively and were included in the study. Six patients had neurogenic pain, three had musculoskeletal pain, and three had both pain components. Postoperatively, at both 6- and 12-month intervals, seven patients with neurogenic pain (78%) demonstrated no significant change in pain severity, while in five patients (83%) musculoskeletal pain decreased significantly. Two patients with neurogenic pain (22%) demonstrated an increase in pain severity at both 6- and 12-month intervals. This study suggests that intrathecal baclofen reduces chronic musculoskeletal pain associated with spasticity but does not decrease chronic neurogenic spinal cord injury pain.

Persistent peripheral nerve pathologies in patients with electric burns.

Clinical and electrodiagnostic evaluations were performed in 25 patients with electric burns who were injured 2 to 13 years before the study. Abnormal motor nerve conduct findings were detected in 12 of the patients. In nine patients, abnormalities were observed in more than one nerve. There was a positive relation noted between age and nerve lesions. Weakness was the most prominent clinical finding.

Heterogenous glycogen storage disease in one family.

Three brothers, aged 17, 14 and 4 ye presented. Deficiency of glucose-6-phosphatase was associated with deficiency of acid maltase in one and debranching enzyme in the other. Enzyme analyses could not be performed in the youngest sibling.

Polycythemia vera associated with Ushers's symdrome.

A 50-year-old man with Usher's syndrome, progressive retinitis pigmentosa, and congenital sensoneural deafness developed polycythemia vera. Usher's syndrome was associated with a variety of congenital herediatry disorders but there was no evidence to support more than a chance association between Usher's syndrome and polycythemia vera.