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Doyun?ParkEmail author William?Southern Manuela?Calvo Margarita?Kushnir Clemencia?Solorzano Mark?Sinnet Henny?H.?Billett 《Journal of general internal medicine》2016,31(2):182-187
BACKGROUND
Low molecular weight heparins (LMWHs) have been cautiously used in patients with chronic kidney disease (CKD) due to fear of accumulation. Dalteparin, however, has shown minimal tendency to accumulate in patients with CKD and may be safe to use in this patient population.OBJECTIVE
We compared the incidence of clinically significant bleeding in patients with CKD receiving therapeutic doses of dalteparin to that of patients with CKD receiving therapeutic doses of UFH.DESIGN
This was a retrospective cohort study.SUBJECTS
Inpatients with CKD (GFR?<?60 ml/min) who were treated with therapeutic dalteparin or UFH were included in the studyMAIN MEASURES
Primary outcome was major bleeding within 10 days of anticoagulation, identified by ICD-9 code and confirmed by chart review. Demographic characteristics, laboratory values, comorbidities, prior bleeding history and inpatient medications were extracted for each admission from the electronic medical record. Logistic regression models were created to examine the association between choice of anticoagulant and bleeding rates, after adjustment for demographic and clinical characteristics.KEY RESULTS
Dalteparin-treated patients were significantly less likely to experience a major bleed than patients treated with UFH (1.14 % vs. 3.49 %, p?<?0.001). The reduced likelihood of bleeding associated with dalteparin treatment remained significant after adjustment for patient characteristics (HR 0.39, 95 % CI: 0.21–0.70, p?<?0.0001). A stratified analysis for subgroups with GFR< 30 mL/min and with GFR between 30 and 60 mL/min showed that dalteparin was still associated with lower odds of bleeding compared to treatment with unfractionated heparin, but the difference was nonsignificant for GFR< 30 (HR 0.35, 95 % CI: 0.11–1.15), even after adjustment (OR 0.37, 95 % CI: 0.11–1.22).CONCLUSION
In patients with CKD, treatment with therapeutic dose dalteparin was associated with lower rates of bleeding than treatment with unfractionated heparin. For patients with severe CKD (GFR< 30), dalteparin was shown to be at least as safe as unfractionated heparin.115.
Maira Diaz Maria Jose Sanchez-Barrena Juana Maria Gonzalez-Rubio Lesia Rodriguez Daniel Fernandez Regina Antoni Cristina Yunta Borja Belda-Palazon Miguel Gonzalez-Guzman Marta Peirats-Llobet Margarita Menendez Jasminka Boskovic Jose A. Marquez Pedro L. Rodriguez Armando Albert 《Proceedings of the National Academy of Sciences of the United States of America》2016,113(3):E396-E405
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Blas Couto Alejo Salles Lucas Sede?o Margarita Peradejordi Pablo Barttfeld Andrés Canales-Johnson Yamil Vidal Dos Santos David Huepe Tristán Bekinschtein Mariano Sigman Roberto Favaloro Facundo Manes Agustin Ibanez 《Social cognitive and affective neuroscience》2014,9(9):1253-1260
Recent advances in neuroscience have provided new insights into the understanding of heart–brain interaction and communication. Cardiac information to the brain relies on two pathways, terminating in the insular cortex (IC) and anterior cingulate cortex (ACC), along with the somatosensory cortex (S1-S2). Interoception relying on these neuroanatomical pathways has been shown to modulate social cognition. We report the case study of C.S., a patient with an ‘external heart’ (an extracorporeal left-univentricular cardiac assist device, LVAD). The patient was assessed with neural/behavioral measures of cardiac interoception complemented by neuropsychological and social cognition measures. The patient’s performance on the interoception task (heartbeat detection) seemed to be guided by signals from the artificial LVAD, which provides a somatosensory beat rather than by his endogenous heart. Cortical activity (HEP, heartbeat-evoked potential) was found decreased in comparison with normal volunteers, particularly during interoceptive states. The patient accurately performed several cognitive tasks, except for interoception-related social cognition domains (empathy, theory of mind and decision making). This evidence suggests an imbalance in the patient’s cardiac interoceptive pathways that enhances sensation driven by the artificial pump over that from the cardiac vagal-IC/ACC pathway. A patient with two hearts, one endogenous and one artificial, presents a unique opportunity to explore models of interoception and heart–brain interaction. 相似文献
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Incidence of human papillomavirus‐related oropharyngeal cancer and outcomes after chemoradiation in a population of heavy smokers 下载免费PDF全文
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Stephanie Habersaat Ayala Borghini Jennifer Nessi Margarita Forcada‐Guex Carole Müller‐Nix Blaise Pierrehumbert François Ansermet 《Journal of traumatic stress》2014,27(4):488-491
Preterm infants experience intense stress during the perinatal period because they endure painful and intense medical procedures. Repeated activation of the hypothalamic–pituitary–adrenal (HPA) axis during this period may have long‐term effects on subsequent cortisol regulation. A premature delivery may also be intensely stressful for the parents, and they may develop symptoms of posttraumatic stress disorder (PTSD). Usable saliva samples were collected (4 times per day over 2 days, in the morning at awakening, at midday, in the afternoon, and in the evening before going to bed) to assess the diurnal cortisol regulation from 46 preterm infants when the infants were 12 months of corrected age (~ 14 months after birth). Mothers reported their level of PTSD symptoms. The results showed an interaction between perinatal stress and maternal traumatic stress on the diurnal cortisol slope of preterm infants (R2 = .32). This suggests that the HPA axis of preterm infants exposed to high perinatal stress may be more sensitive to subsequent environmental stress. 相似文献