Intravenous phytonadione administered orally in reducing warfarin-related coagulopathy.

INTRODUCTION: The cost of phytonadione tablets has increased markedly and is significantly higher than the intravenous formulation. The intravenous formulation given orally is a potential alternative but has not been directly evaluated in comparison to the commercially available tablet. The objective of this study was to evaluate the efficacy of phytonadione intravenous solution given orally compared to commercially available phytonadione tablets for reversal of coagulopathy related to warfarin. METHODS: We conducted a retrospective, observational study of adult patients who received phytonadione tablets and the IV formulation orally for warfarin-related coagulopathy. The international normalized ratio (INR) was measured before and after phytonadione administration. The primary outcome was INR <1.5 at 24 h after phytonadione administration. RESULTS: From January 1, 2015 to August 1, 2018 a total of 200 patients were identified. In total, 58% (n = 116) patients received IV phytonadione solution given orally and 42% (n = 84) patients received the tablets. The primary outcome of INR <1.5 at 24 h was not significantly different between groups (p = 0.321). DISCUSSION: The IV phytonadione solution given by mouth and the tablet formulation performed similarly.

Anatomical and genotype-specific mechanosensory responses in Drosophila melanogaster larvae.

Afferent neurons commonly exhibit a somatotopic arrangement in the central nervous system that organizes spatially discrete sensory input. We are interested in how that spatial input gets integrated into motor commands. With resources for screening genes and neural circuits, and given that the cells and ion channels that transduce tactile stimuli in Drosophila larvae are remarkably well-characterized, larval mechanosensation is an ideal system for investigating how specific behaviors emerge from localized sensory input. We observed that crawling larvae are more reactive to a 20mN tactile stimulus on the head than on the tail or abdomen. Behavioral responses that were evoked by the stimuli also depended on where the stimulus was delivered. Differences in relative sensitivity were observed in different genotypes, e.g., a null white mutant and hypomorphic smn mutant are significantly more reactive to tail touches than Canton-S larvae. Responses were inhibited by silencing chemical transmission in a combination of multidendritic and chordotonal neurons, but not by inhibiting any specific subset of neurons. Extracellular recordings from segmental nerves revealed that sensory-evoked responses exhibit spike-timing dependence at the neural circuit level. Tactile stimuli reduced endogenous firing frequency and increased bursting periods when applied during periods of motor activity. The same stimulus initiated bursts of activity when applied during inactive periods. Together, these data depict the spatial and temporal complexity of mechanosensation as it applies to action selection, and provide a foundation for addressing how neural circuits in the CNS adjust their activity to afferent input.