Anticoagulation in the cardiac patient: A concise review

Anticoagulation has multiple roles in the treatment of cardiovascular disease, including in management of acute myocardial infarction, during percutaneous coronary intervention, as stroke prophylaxis in patients with atrial arrhythmias, and in patients with mechanical heart valves. Clinical anticoagulation choices in the aforementioned diseases vary widely, due to conflicting data to support established agents and the rapid evolution of evidence‐based practice that parallels more widespread use of novel oral anticoagulants. This review concisely summarizes evidence‐based guidelines for anticoagulant use in cardiovascular disease, and highlights new data specific to direct oral anticoagulants.     

The impact of stenosis and translation on spinal cord injuries in traumatic cervical facet dislocations

BACKGROUND CONTEXT

Although facet dislocations account for only 6% of cervical trauma, the consequences are often devastating. Cervical facet dislocations are associated with a disproportionate amount of spinal cord injuries; however, neurologic examination of patients is often difficult, as patients commonly present with reduced levels of consciousness. There are limited studies that have investigated the impact of spinal canal diameter and translation on neurologic injury following facet dislocations.

Decreased efficacy of UV inactivation of Staphylococcus aureus after multiple exposure and growth cycles

UV disinfection is a relatively simple and cost-efficient disinfection method, especially for in-home greywater treatment. In this study, a bench scale experiment was performed using a LED collimated UV-C beam with a peak wavelength of 256?nm to determine if potentially pathogenic bacteria such as Staphylococcus aureus may become enriched in a semi-recirculating greywater system with UV as the sole disinfection step. A statistically significant (P?<?0.001) decreasing trend in UV-C efficacy was observed between the 1st and 6th UV exposure-growth cycles of S. aureus (ATCC 25923), resulting in a 1.5 decrease in log₁₀ removal (P?<?0.00000) by the 5th iteration. An eleven-point dose-response curve of the 7th iteration of S. aureus was estimated and compared to the dose-response curve of the original strain; due to a longer apparent shoulder period and a decay constant of lesser degree, the dose required for a 4-log reduction of the enriched S. aureus was estimated to be ～1.9 times greater (22.0?mJ?cm^?2 versus 11.8?mJ?cm^?2). However, experimental results with S. epidermidis (ATCC 12228) and two wild strains, S. aureus and S. warneri, exhibited no trend of increased resistance. UV doses exceeding 20?mJ?cm^?2 are generally sufficient in achieving a 4-log reduction of bacteria in drinking water systems; however, the results exhibited in this study suggest that when recirculation is involved, there may be a need for UV doses exceeding what is necessary for a 4-log reduction to suppress the enrichment of strains which could pose a public health risk.     

Patterns of relapse after successful completion of initial therapy in primary central nervous system lymphoma: a case series

Journal of Neuro-Oncology - Primary central nervous system lymphoma (PCNSL) is a subtype of non-Hodgkin’s lymphoma that involves the brain, spinal cord, or leptomeninges, without evidence of...     

The impact of patient characteristics on enzalutamide pharmacokinetics and how this relates to treatment toxicity and efficacy in metastatic prostate cancer patients

The aim of the study is to investigate the influence of patient characteristics, age and body mass index (BMI), on pharmacokinetics of enzalutamide, and to study the relationships between drug exposure and enzalutamide efficacy and toxicity, in mCRPC patients. Data were collected in a longitudinal cohort study (ANDROPS) and a prospective observational study (ILUMINATE), both in mCRPC patients treated with enzalutamide. To investigate the influence of age and BMI on exposure, enzalutamide and N-desmethylenzalutamide levels were compared by ANOVA. To investigate the relation of exposure versus time to progression (TTP), the sum plasma levels were divided into quartiles and compared by Kaplan–Meier analysis. To assess the relation of exposure with fatigue, plasma levels in patients experiencing fatigue vs. no fatigue were compared by and independent t test. Data of 68 mCRPC patients were included for analysis. Plasma levels were not different for age or BMI. No difference in TTP between both studies was observed (383 days (95% CI 287–859), and 567 days (95% CI 351–NR), p = 0.36). Kaplan–Meier analysis of quartiles of sum levels showed no difference for TTP. Fatigue was reported by 22 patients, no difference in sum plasma levels was observed between patients with and without fatigue. We observed that age and BMI did not influence systemic exposure in patients treated with enzalutamide. No relation of exposure with efficacy or fatigue was observed. Further research using enzalutamide at a lower dose is needed to understand the relation of enzalutamide exposure and fatigue.