Training response to high-intensity interval training in a 42-year-old man with chronic spinal cord injury

Objective: To review the outcome of 12 weeks of periodized, high-intensity interval training (HIT) in a man with chronic traumatic spinal cord injury (SCI).

Methods: A 42-year-old man (180?cm tall, 68.4?kg and 32.0% Fat) with a C8/T1 motor complete SCI took part in 12 weeks of 3 days per week arm crank ergometry (ACE) interval training. Training consisted of a combination of HIT that included three times 5 min at ～70% Peak Power (W_Peak) and 5 min recovery (HIT₅); four times 2.5 min at ～85% W_Peak and 5 min recovery (HIT_2.5); ten times 1 min at ～110% W_Peak and 2 min recovery (HIT₁). Heart rate (HR) zones were set as <75% HR_Peak (Z1), 75–89% (Z2), and 90+% (Z3) and used to monitor overall training efficacy.

Results: Thirty-six sessions that included 8 HIT5, 10 HIT2.5, and 5 HIT1 sessions were completed. W_Peak and VO_{2 Peak} improved about 45% and 52%, respectively, by week 6, without further improvement at week 12, HR TRIMP scores and power in training sessions trended upward over the 12-week program.

Conclusions: Twelve weeks of HIT resulted in a large increase in peak aerobic power, as well as submaximal endurance performance in our participant. The early plateau in maximal testing supports the use of submaximal training assessment important in the long-term training monitoring for SCI.     

Protracted bleeding after hirudin anticoagulation for cardiac surgery in a patient with HIT II and chronic renal failure

Heparin-induced thrombocytopenia type II (HIT II) requires alternative anticoagulation. Hirudin has been effectively used in patients with HIT II scheduled for cardiac surgery. However, bleeding complications were observed in patients with renal impairment. In vitro hemodialysis (HD) has been questioned over its efficacy in eliminating hirudin. Another approach to stop bleeding is the application of recombinant factor VIIa (rFVIIa). We report on a patient with HIT II and chronic renal failure who suffered from severe hirudin-induced bleeding after cardiac surgery who was safely treated with a combined approach of surgical hemostasis, substitution of blood products, HD, and rFVIIa to stop finally bleeding.     

The costs of heparin‐induced thrombocytopenia: a patient‐based cost of illness analysis

Summary. Background and objectives: Due to the complexity of heparin‐induced thrombocytopenia (HIT), currently available cost analyses are rough estimates. The objectives of this study were quantification of costs involved in HIT and identification of main cost drivers based on a patient‐oriented approach. Methods: Patients diagnosed with HIT (1995–2004, University‐hospital Greifswald, Germany) based on a positive functional assay (HIPA test) were retrieved from the laboratory records and scored (4T‐score) by two medical experts using the patient file. For cost of illness analysis, predefined HIT‐relevant cost parameters (medication costs, prolonged in‐hospital stay, diagnostic and therapeutic interventions, laboratory tests, blood transfusions) were retrieved from the patient files. The data were analysed by linear regression estimates with the log of costs and a gamma regression model. Mean length of stay data of non‐HIT patients were obtained from the German Federal Statistical Office, adjusted for patient characteristics, comorbidities and year of treatment. Hospital costs were provided by the controlling department. Results and conclusions: One hundred and thirty HIT cases with a 4T‐score ≥4 and a positive HIPA test were analyzed. Mean additional costs of a HIT case were 9008 €. The main cost drivers were prolonged in‐hospital stay (70.3%) and costs of alternative anticoagulants (19.7%). HIT was more costly in surgical patients compared with medical patients and in patients with thrombosis. Early start of alternative anticoagulation did not increase HIT costs despite the high medication costs indicating prevention of costly complications. An HIT cost calculator is provided, allowing online calculation of HIT costs based on local cost structures and different currencies.     

Systemic lupus erythematosus and systemic sclerosis: All roads lead to platelets

Systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are two phenotypically distincts inflammatory systemic diseases. However, SLE and SSc share pathogenic features such as interferon signature, loss of tolerance against self-nuclear antigens and increased tissue damage such as fibrosis. Recently, platelets have emerged as a major actor in immunity including auto-immune diseases. Both SLE and SSc are characterized by strong platelet system activation, which is likely to be both the witness and culprit in their pathogenesis. Platelet activation pathways are multiple and sometimes redundant. They include immune complexes, Toll-like receptors activation, antiphospholipid antibodies and ischemia-reperfusion associated with Raynaud phenomenon. Once activated, platelet promote immune dysregulation by priming interferon production by immune cells, providing CD40L supporting B lymphocyte functions and providing a source of autoantigens. Platelets are actively implicated in SLE and SSc end-organ damage such as cardiovascular and renal disease and in the promotion of tissue fibrosis. Finally, after understanding the main pathogenic implications of platelet activation in both diseases, we discuss potential therapeutics targeting platelets.     

Laboratory testing of anticoagulants: the present and the future

This review provides an update on laboratory testing and monitoring for existing and emerging anticoagulants, starting with an overview of haemostasis and the routine coagulation tests currently employed within most haemostasis laboratories, including the prothrombin time (PT)/international normalised ratio (INR) and the activated partial thromboplastin time (APTT). Current anticoagulant therapy and laboratory monitoring is then discussed in terms of benefits and limitations, followed by a similar brief discussion of the new and emerging anticoagulants. The main focus, however, is laboratory testing related to vitamin K antagonists, heparin, lepirudin and the new agents dabigatran etexilate and rivaroxaban. Although the newer agents do not require laboratory monitoring, laboratory testing will occasionally be required, and pathology laboratories should become proactive in developing appropriate strategies. The tests most likely to fulfill this role are the ecarin clotting time (or chromogenic alternatives), and the chromogenic anti-Xa assay. Nevertheless, the dilute Russell viper venom time (dRVVT) assay may provide another alternative, and existing routine tests are also likely to be utilised for the foreseeable future, potentially also for laboratory testing of the new anticoagulants, albeit perhaps in modified form.     

The Impact of Health Information Technology Adoption by Outpatient Facilities on Pregnancy Outcomes

Objective

Examine whether health information technology (HIT) at nonhospital facilities (NHFs) improves health outcomes and decreases resource use at hospitals within the same heath care network, and whether the impact of HIT varies as providers gain experience using the technologies.

Data Sources

Administrative claims data on 491,832 births in Pennsylvania during 1998–2004 from the Pennsylvania Health Care Cost Containment Council and HIT applications data from the Dorenfest Institute.

Study Design

Fixed-effects regression analysis of the impact of HIT at NHFs on adverse birth outcomes and resource use.

Principal Findings

Greater use of clinical HIT applications by NHFs is associated with reduced incidence of obstetric trauma and preventable complications, as well as longer lengths of stay. In addition, the beneficial effects of HIT increase the longer that technologies have been in use. However, we find no consistent evidence on whether or how nonclinical HIT in NHFs affects either resource use or health outcomes.

Conclusions

Clinical HIT applications at NHFs may reduce the likelihood of adverse birth outcomes, particularly after physicians and staff gain experience using the technologies.     

A common standard is inappropriate for determining the potency of ultra low molecular weight heparins such as semuloparin and bemiparin

Introduction

Lower low-molecular-weight heparins are being developed to improve on the safety and efficacy of antithrombotic therapy. Semuloparin and bemiparin are two depolymerized heparins produced by distinct manufacturing processes. The objective of this investigation was to determine whether a common standard could be used to define their potency.

Materials and Methods

Activities were compared using typical clinical coagulation assays and pharmacological assays required for potency assessment.

Results

The activity of semuloparin and bemiparin was comparable in FXa-based assays (anti-FXa, Heptest). However, bemiparin produced a stronger effect in the aPTT, ACT and anti-thrombin assays. Assessment of the parallelism of the concentration-response curves indicated that bemiparin and semuloparin are not equivalent in terms of anti-FIIa activity. Bemiparin had a stronger inhibitory effect on thrombin induced platelet aggregation, and a stronger interaction with HIT antibodies.

Conclusions

These data demonstrate that depolymerized heparins can exhibit a range of biologic activities making them unique agents. Pharmacopoeial parameters such as anti-IIa and anti-Xa potency and molecular weight are insufficient to characterize such agents.     

正压阀仅用生理盐水预防静脉导管堵塞作封管处理的可行性

目的观测PosiSite正压阀在静脉管腔内静脉压力条件下仅用生理盐水作封管操作时效果的可能影响,并评价其可行性。方法以硅胶管为模拟血管;以容器装红墨水作为模拟血源;用硅胶管作为模拟血管,用静脉留置针作模拟试验,观察PosiSite正压阀在静脉压力条件下仅用生理盐水作封管操作时的模拟血液回流情况。结果封管后血液回流情况：25cmH2O：0mm。结论 PosiSite正压阀仅用生理盐水封管来预防静脉导管堵塞是合适的,从而避免了使用肝素可能诱发的严重并发症。     

Pregnancy-related venous thromboembolism: risk and the effect of thromboprophylaxis

Venous thromboembolism (VTE) is a leading cause of maternal mortality and morbidity during pregnancy in developed countries. The incidence of VTE per pregnancy-year increases about 4-fold during pregnancy and at least 14-fold during the puerperium. Risk factors include a personal history of VTE, presence of inherited or acquired thrombophilia, a family history of VTE and general medical conditions, such as immobilisation, overweight, varicose veins, some haematological diseases and inflammatory disorders. VTE is considered potentially preventable with the prophylactic administration of anticoagulants, but there are no high quality randomized clinical trials that compared different strategies of thromboprophylaxis in pregnant women. Balancing the absolute risk of VTE against the risks of exposure to anticoagulants, this review provides advice regarding which women may benefit from thromboprophylaxis during and after pregnancy.