Evaluation of outcomes with apixaban use for venous thromboembolism in hospitalized patients with end-stage renal disease receiving renal replacement therapy.

While direct oral anticoagulants (DOACs) received expanded labeling for use in atrial fibrillation (AF) for end-stage renal disease (ESRD) based on pharmacokinetic trials, little data exist regarding the use of DOACs for venous thromboembolism (VTE) in ESRD patients requiring renal replacement therapy (RRT). This retrospective, descriptive cohort study evaluated adult patients with a diagnosis of ESRD on RRT and with a VTE diagnosis receiving apixaban therapy prior to or during admission. The primary outcome was to identify major bleeding events within 72 h of last apixaban dose administration. Secondary outcomes included new VTE while on apixaban, appropriateness of anticoagulation regimen with regards to FDA labeled dosing and frequency, anticoagulation regimen adjustments, and factor Xa inhibitor-specific anti-Xa levels if available. A total of 68 patients met criteria for inclusion in the final analysis. Major bleeding events occurred in 13.2% of patients receiving apixaban within the last 72 h. Recurrent thrombosis occurred in 7.4% of patients. The use of apixaban for VTE in patients with ESRD on RRT led to a higher risk of bleeding compared to that of landmark trials. Therefore, apixaban use should occur following shared decision making especially if there is no contraindication to warfarin.

Comparison of antimicrobial utilization metrics: Food for thought for an antimicrobial stewardship programme.

Given the overuse of antimicrobials and increasing antimicrobial resistance, the World Health Organization and Centers for Disease Control and Prevention recommend antimicrobial stewardship programmes to measure and assess the use of antimicrobials. Several antimicrobial use metrics have been described, including days of therapy, defined daily doses and standardized antimicrobial administration ratio. Understanding these metrics, including the advantages and disadvantages, can help antimicrobial stewardship programmes to monitor antimicrobial use at their institution, and assess the impact of antimicrobial stewardship efforts. This review discusses the three commonly used antimicrobial use metrics, their pros and cons, and how antimicrobial stewardship programmes can use these metrics to help assess the use of antimicrobials.

Efficacy evaluation and mechanical study of short- and long-term antithrombotic therapy for Kawasaki disease.

BACKGROUND: Antithrombotic therapy was commonly applied in treating Kawasaki disease (KD) children; however, the effects and mechanisms of different plans were not fully elucidated. In this study, we aimed to evaluate different antithrombotic drugs. METHODS: Eighty-two children diagnosed with KD in Hebei Children's Hospital from January 2017 to January 2020 were recruited. For cohort study, KD children were divided into a series of groups according to whether they were complicated with coronary artery lesions (CAL), drug therapy plan, and the presence of liver damage. The thromboelastogram (TEG) indexes [clotting time (R), clot formation time (K), clot formation angle (α), maximum amplitude of the clot (MA), arachidonic acid (AA), and adenosine diphosphate (ADP)] were employed to evaluate the relationship between disease state and drug treatment efficacy. Meanwhile, children were divided into different therapy groups according to their degree of CAL, the treatment efficiency was evaluated by TEG indexes, and the bleeding ratio was recorded. In addition, the warfarin metabolic gene was detected to explain the changes of coagulation parameters in children treated with warfarin. RESULTS: The R value and coagulation index (CoI) were significantly lower (P<0.05) and MA value was significantly higher (P<0.05) in CAL group than those in non-coronary artery lesion (NCAL) group. There were significant individual differences in platelet inhibition between aspirin and dipyridamole groups. The AA% in aspirin group was 64% [95% confidence interval (CI): 49% to 74.3%] and the ADP% was 28.5% (95% CI: 26.2% to 37.2%) in dipyridamole group, and were significantly between groups. Warfarin and aspirin had a synergistic effect in anticoagulation. Warfarin metabolic gene detection was shown to be helpful for adjusting warfarin treatment dose, and shortening the initial attainment time of standard international normalized ratio (INR) index. The R value was significantly higher (P<0.05) in the liver injury group than that in the control group. CONCLUSIONS: KD Children complicated with CAL presented a hypercoagulable state, and the CAL was predictable with the R value. Warfarin metabolic gene detection and TEG can effectively evaluate and guide short- and long-term antithrombotic therapy in KD children.

Decoy receptor 3 expression during the menstrual cycle and pregnancy, and regulation by sex steroids in endometrial cells in vitro.

BACKGROUND: Decoy receptor 3 (DcR3) is a soluble receptor belonging to the tumor necrosis factor receptor superfamily and can inhibit Fas ligand-induced apoptosis. DcR3 is related to carcinogenesis, but is found in human gestational tissues, where the function is uncertain. We aimed to determine DcR3 expression and regulation in endometrial cells in vitro, and throughout the menstrual cycle and pregnancy in vivo. METHODS: Serum DcR3 levels were measured at various stages of the menstrual cycle (n = 40 women) and pregnancy (n = 20). DcR3 transcript and protein levels were analyzed in RL95-2 endometrial cells after treatment with estradiol (E(2)) (+/- anti-estrogen) and/or progesterone (+/- anti-progesterone). Finally, DcR3 protein and transcript were examined in decidua and chorionic villi from normal (n = 14) and anembryonic (n = 14) pregnancies. RESULTS: We identified a trend towards cyclic changes of serum DcR3 levels in the normal menstrual cycle, peaking at the mid-luteal phase, and relatively lower, more stable serum levels throughout normal gestation. DcR3 protein levels were higher in decidua than chorionic villi in normal pregnancy (P = 0.001), and levels in decidua were significantly lower in anembryonic than in normal pregnancies (P = 0.034). Physiologic concentrations of E(2) and/or progesterone stimulated DcR3 transcripts in RL95-2 endometrial cells. CONCLUSIONS: This study suggested that DcR3 expression varies during the menstrual cycle and is regulated by sex steroid hormones in vitro in endometrial cells. Human gestational tissues showed a differential production of DcR3, and decidual DcR3 protein was lower in anembryonic than normal pregnancies, suggesting an active role of DcR3 in the regulation of successful pregnancies.

Precision dose measurement of 125I seed in solid water through SPECT/CT detecting.

PURPOSE: The aim of the study is to study the feasibility of gamma-ray-detection-based precision dose measurement of 125I seed brachytherapy in solid water. MATERIALS AND METHODS: Seven group 125I seeds with different activities were put into a hole in the center of solid water individually. Each group had ten seeds, and the seed activity ranged from 1.48 × 107 Bq to 3.7 × 107 Bq. Single-photon emission computed tomography/computed tomography (SPECT/CT) was used to scan the seeds perpendicular to the long axis of the seed, with a slice thickness of 3.75 mm. The radioactive count values (x) of the radioactive concentration around the seeds were collected at a distance of 1-15 mm from the center of the seeds, while the corresponding doses (Y) (Gy) were calculated. SPSS 18.0 was used to analyze the relationship between the count value and the dose. RESULTS: With the same seed activity, the count values became smaller according to the distance from the center of the seeds. The count values at the same point had an increasing trend according to the activity. This is similar to the doses calculated at the same point. There was an exponential relationship between the dose around the 125I seeds, and the radioactive count value detected by SPECT/CT. Correlative curves between the dose and radioactive count value detected by SPECT/CT of different-activity 125I seeds were fitted. The formulas of the dose and radioactive count with different seed activity were in the form of Y = b0 (b1)x. The constant b0 ranged from 1.48 to 3.93, according to the seed activity, while b1 was 1.006 for every seed's activity. CONCLUSION: The count value around the 125I seed can be detected accurately by SPECT/CT, and then can be quantified. This study provided useful experiment data for the precision measurement of 125I seed implantation. Radiation detection-based dose measurement may become a new noninvasive technology for the dynamic dosimetry verification method after brachytherapy.