Chronic stress and temporalis muscle activity in TMD patients and controls during sleep: a pilot study in females

Clinical Oral Investigations - The aim of this study was to assess the correlation between chronic stress and temporalis muscle activity during four nights. Forty-four female subjects were...     

Off-label-dosing of non-vitamin K-dependent oral antagonists in AF patients before and after stroke: results of the prospective multicenter Berlin Atrial Fibrillation Registry

Aims

We aimed to analyze prevalence and predictors of NOAC off-label under-dosing in AF patients before and after the index stroke.

Methods

The post hoc analysis included 1080 patients of the investigator-initiated, multicenter prospective Berlin Atrial Fibrillation Registry, designed to analyze medical stroke prevention in AF patients after acute ischemic stroke.

Results

At stroke onset, an off-label daily dose was prescribed in 61 (25.5%) of 239 NOAC patients with known AF and CHA₂DS₂-VASc score ≥ 1, of which 52 (21.8%) patients were under-dosed. Under-dosing was associated with age ≥ 80 years in patients on rivaroxaban [OR 2.90, 95% CI 1.05–7.9, P = 0.04; n = 29] or apixaban [OR 3.24, 95% CI 1.04–10.1, P = 0.04; n = 22]. At hospital discharge after the index stroke, NOAC off-label dose on admission was continued in 30 (49.2%) of 61 patients. Overall, 79 (13.7%) of 708 patients prescribed a NOAC at hospital discharge received an off-label dose, of whom 75 (10.6%) patients were under-dosed. Rivaroxaban under-dosing at discharge was associated with age ≥ 80 years [OR 3.49, 95% CI 1.24–9.84, P = 0.02; n = 19]; apixaban under-dosing with body weight ≤ 60 kg [OR 0.06, 95% CI 0.01–0.47, P < 0.01; n = 56], CHA₂DS₂-VASc score [OR per point 1.47, 95% CI 1.08–2.00, P = 0.01], and HAS-BLED score [OR per point 1.91, 95% CI 1.28–2.84, P < 0.01].

Conclusion

At stroke onset, off-label dosing was present in one out of four, and under-dosing in one out of five NOAC patients. Under-dosing of rivaroxaban or apixaban was related to old age. In-hospital treatment after stroke reduced off-label NOAC dosing, but one out of ten NOAC patients was under-dosed at discharge.

Clinical trial registration

NCT02306824.

     

Determination of heparin-induced IgG antibody in heparin-induced thrombocytopenia type II

BACKGROUND: Heparin-induced thrombocytopenia is a relatively uncommon but severe side-effect of heparin therapy. Heparin-induced IgG antibody has been elucidated to be the main isotype and the most pathogenic antibody in the pathophysiology. As affected patients are at high risk of developing thrombotic events, confirmation of the clinical diagnosis and avoidance of heparin re-exposure are important and desirable. MATERIALS AND METHODS: In the present study, heparin-induced IgG was measured by the binding of neoantigens, which were prepared by incubating FITC-heparin with platelet factor 4 present in normal serum. The cross-reactivities of heparin-induced IgG with low-molecular-weight heparin and danaparoid were analysed by competitive binding. RESULTS: A total of 81 clinically suspected heparin-induced thrombocytopenia type II patients were analysed. Thirty-seven of 38 heparin-induced thrombocytopenia type II patients, in whom thromboembolism was confirmed by objective methods, had elevated relative fluorescence intensity ratios (patient normal control) and 36 had positive heparin-induced platelet activation results. The prevalence of heparin-induced IgG in heparin-induced thrombocytopenia type II patients was 97.4%. Positive heparin-induced IgG results were: 0/319 healthy volunteers, 0/38 other thrombo-cytopenia and 2/56 heparin/low-molecular-weight heparin-receiving patients without thrombocytopenia, 2/41 hyperbilirubinaemic patients and 2/50 hyperlipidaemic patients. A small amount of cross-reaction assays showed similar results as obtained in heparin-induced platelet activation. CONCLUSION: Our results suggest that a very high frequency of heparin-induced IgG in heparin-induced thrombocytopenia type II patients can be detected using a novel antigen assay. The rapid determination of pathogenic heparin-induced IgG may be a useful tool for the rapid diagnosis of heparin-induced thrombocytopenia type II that could facilitate further management of the patients.     

Application of information technology in orthodontics. 6. Knowledge based systems in orthodontics

The increase of quality and efficiency in orthodontic treatment is characterized by the development of knowledge based consultations systems. These systems support the dentist to optimate treatment planing. Basis configuration and technical background of those systems are presented.     

The effectiveness of labetalol in treating postoperative hypertension

During the postanesthesia recovery period, surgical patients often exhibit an increased arterial blood pressure. Although these transient increases in blood pressure are usually benign, significant morbidity and mortality may result from complications of postoperative hypertension. The purpose of this study was twofold: to determine the frequency of postoperative hypertension in one particular recovery room, and to determine the efficacy of labetalol as an antihypertensive drug in this setting. This study included both a retrospective and prospective component. The retrospective portion involved review of 465 records of patients admitted to the recovery room at a large, private eastern medical college. Nearly 20% of patients admitted were found to have blood pressures in the range of our study's criteria for hypertension. Records were also reviewed for types of therapeutic interventions used to treat hypertension and determinations of their success or failure. The prospective portion of the study evaluated treatment protocols for postoperative hypertension with graduated intravenous injections of labetalol in 30 patients. Blood pressure was effectively controlled with an average of 25 minutes for all patients and remained effective for 24 hours postoperatively.     

Membranes from acrylonitrile-based polymers for selective cultivation of human keratinocytes

A cell carrier made from synthetic material supporting selective growth of keratinocytes is a promising approach to avoid the phenomenon of fibroblast overgrowth during in vitro culture of skin substitutes. Therefore, we investigated polymer membranes made of polyacrylonitrile and copolymers of acrylonitrile and N-vinylpyrrolidone (NVP) for their ability to support selectively the growth of keratinocytes. It was found that a copolymer with an NVP-content of 30% (NVP30) supports growth of human keratinocyte cell line (HaCaT) cells and inhibits fibroblast growth under serum-containing conditions. Cell proliferation of HaCaT cells was measured over 14 days. If both cell types were cultured under serum-free conditions for initial adhesion over 6 h on these NVP30 polymers, they adhered to the same extent. Long-term experiments over 7 days were performed as a coculture of both cell types showing that HaCaT cells had a growth advantage that seems to be related to the paracrine activity of contaminating fibroblasts. As a result, confluent layers of HaCaT cells were obtained with small numbers of remaining fibroblasts. The new poly [acrylonitrile-co(NVP) membranes seem to be a promising culture system for the production of epidermal transplants.     

Application of information technology in orthodontics. 3. Practical method for computer aided measurements of orthodontic models

A practical method for computer aided measurements of orthodontic models is introduced here. Measurements values are taken by using in incremental donor with the traditional slide rule. Advantages of this method lead to a higher efficiency of model measurements.     

Combination of intensity-based image registration with 3D simulation in radiation therapy

Modern techniques of radiotherapy like intensity modulated radiation therapy (IMRT) make it possible to deliver high dose to tumors of different irregular shapes at the same time sparing surrounding healthy tissue. However, internal tumor motion makes precise calculation of the delivered dose distribution challenging. This makes analysis of tumor motion necessary. One way to describe target motion is using image registration. Many registration methods have already been developed previously. However, most of them belong either to geometric approaches or to intensity approaches. Methods which take account of anatomical information and results of intensity matching can greatly improve the results of image registration. Based on this idea, a combined method of image registration followed by 3D modeling and simulation was introduced in this project. Experiments were carried out for five patients 4DCT lung datasets. In the 3D simulation, models obtained from images of end-exhalation were deformed to the state of end-inhalation. Diaphragm motions were around -25 mm in the cranial-caudal (CC) direction. To verify the quality of our new method, displacements of landmarks were calculated and compared with measurements in the CT images. Improvement of accuracy after simulations has been shown compared to the results obtained only by intensity-based image registration. The average improvement was 0.97 mm. The average Euclidean error of the combined method was around 3.77 mm. Unrealistic motions such as curl-shaped deformations in the results of image registration were corrected. The combined method required less than 30 min. Our method provides information about the deformation of the target volume, which we need for dose optimization and target definition in our planning system.