Anticoagulation with Bivalirudin during Deep Hypothermic Circulatory Arrest in a Patient with Heparin-Induced Thrombocytopenia

Heparin-induced thrombocytopenia is a well-recognized complication of anticoagulation with heparin. We present the case of a patient with recent heparin-induced thrombocytopenia who subsequently needed surgery on an emergency basis for acute type A aortic dissection. This article reports the successful use of bivalirudin, a direct thrombin inhibitor, as an alternative to heparin throughout cardiopulmonary bypass and deep hypothermic circulatory arrest. We contend that bivalirudin is a safe alternative to heparin when performing surgery for aortic dissection and should be considered as an option for use in patients who present with heparin-induced thrombocytopenia.     

Disturbed Interplay Between Mid- and High-Level Vision in ASD? Evidence from a Contour Identification Task with Everyday Objects

Atypical visual processing in children with autism spectrum disorder (ASD) does not seem to reside in an isolated processing component, such as global or local processing. We therefore developed a paradigm that requires the interaction between different processes—an identification task with Gaborized object outlines—and applied this to two age groups of 6-to-10 and 10-to-14 year old children with and without ASD. Event history analyses demonstrated an identification disadvantage in the ASD group, which remained quite stable during the temporal unfolding of the outline. The typically developing group particularly outperformed the ASD group when more complex contours were shown. Together, our results suggest that the interplay between local and global processes and between bottom-up and top-down processes is disturbed in ASD.     

Concomitant use of oral anticoagulants in patients with advanced prostate cancer receiving apalutamide: A post-hoc analysis of TITAN and SPARTAN studies

Apalutamide, an androgen receptor signaling inhibitor, in combination with androgen-deprivation therapy (ADT), is approved for treatment of patients with nonmetastatic castration-resistant prostate cancer and metastatic castration-sensitive prostate cancer, based on the data from the phase 3 SPARTAN and TITAN studies respectively. Apalutamide is an inducer of cytochrome P450 enzymes and P-glycoprotein, which are involved in the metabolism of oral anticoagulants (OACs) and may thus have potential drug-drug interactions when co-administered with OACs. Concomitant use of certain OACs such as apixaban, rivaroxaban, edoxaban, dabigatran, and warfarin was allowed in the SPARTAN and TITAN studies. A post-hoc analysis was conducted to evaluate the incidence of treatment-emergent thrombotic and embolic adverse events (AEs) in patients receiving concomitant OACs with apalutamide + ADT or placebo + ADT in both the studies. Anticoagulants were identified by WHO Drug Anatomical Therapeutic Chemical level 4 classifications. Thrombotic and embolic AEs were coded using the Medical Dictionary for Regulatory Activities Version 22.1. Data were analyzed from patients receiving concurrent OACs among all treated patients in SPARTAN (apalutamide + ADT: 95/803 [11.8%]; placebo + ADT: 48/398 [12.1%]) and TITAN (apalutamide + ADT: 31/524 [5.9%]; placebo + ADT: 28/527 [5.3%]). No consequential differences were observed in the occurrence of thrombotic and embolic events between apalutamide + ADT and placebo + ADT groups receiving concomitant OACs in SPARTAN (11.6% vs 12.5%) or TITAN (19.4% vs 21.4%). Grade 3/4 thrombotic and embolic AEs observed in patients receiving concomitant OACs with apalutamide + ADT or placebo + ADT were 6 (6.3%) vs 5 (10.4%) in SPARTAN and 3 (9.7%) vs 1 (3.6%) in TITAN. This analysis suggests that when necessary, concomitant OACs can be used with apalutamide with appropriate monitoring.     

TEMPO-oxidised nanocellulose hydrogels and self-standing films derived from bacterial cellulose nanopaper

Hydrogels derived from TEMPO-oxidised cellulose nanofibrils (TOCNs) are not robust and inherently water unstable if the TOCNs are not crosslinked or coated with a water-swellable polymer. Furthermore, the manufacturing of self-standing TOCN films is still a challenge due to the small TOCN diameter and the viscosifying effect of TOCNs. Here, we report the TEMPO-mediated oxidation of bacterial cellulose (BC) nanopaper as a route to produce robust and water stable TOCN hydrogels without the need of additional additives or crosslinking steps. Pristine BC pellicle was first press-dried into a dried and well-consolidated BC nanopaper, followed by TEMPO-oxidation at various NaClO concentrations. The oxidation reaction introduced carboxylate moieties onto the exposed BC nanofibrils within the nanopaper network structure. This then led to the expansion and swelling of the nanopaper into a hydrogel. A swelling ratio of up to 100 times the original thickness of the BC nanopaper was observed upon TEMPO-oxidation. The water retention value of the TEMPO-oxidised BC hydrogels was also found to increase with increasing carboxylate content. These TEMPO-oxidised BC hydrogels were found to be robust and water-stable, even under prolonged (>1 month) magnetic stirring in water. We further showed that high grammage self-standing TOCN films (100 g m⁻²) can be fabricated as simple as press-drying these water stable TEMPO-oxidised BC hydrogels without the need of vacuum-assisted filtration or slow-drying, which is typically the rate-limiting step in the manufacturing of TOCN films.

TEMPO-mediated oxidation of well-consolidated bacterial cellulose (BC) nanopaper derived from pristine BC pellicle as a route to produce robust and water stable nanocellulose hydrogels.