Summary
The diagnosis of disseminated intravascular coagulation (DIC) should encompass both clinical and laboratory information. The International Society for Thrombosis and Haemostasis (ISTH) DIC ...scoring system provides objective measurement of DIC. Where DIC is present the scoring system correlates with key clinical observations and outcomes. It is important to repeat the tests to monitor the dynamically changing scenario based on laboratory results and clinical observations. The cornerstone of the treatment of DIC is treatment of the underlying condition. Transfusion of platelets or plasma (components) in patients with DIC should not primarily be based on laboratory results and should in general be reserved for patients who present with bleeding. In patients with DIC and bleeding or at high risk of bleeding (e.g. postoperative patients or patients due to undergo an invasive procedure) and a platelet count of <50 × 109/l transfusion of platelets should be considered. In non‐bleeding patients with DIC, prophylactic platelet transfusion is not given unless it is perceived that there is a high risk of bleeding. In bleeding patients with DIC and prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), administration of fresh frozen plasma (FFP) may be useful. It should not be instituted based on laboratory tests alone but should be considered in those with active bleeding and in those requiring an invasive procedure. There is no evidence that infusion of plasma stimulates the ongoing activation of coagulation. If transfusion of FFP is not possible in patients with bleeding because of fluid overload, consider using factor concentrates such as prothrombin complex concentrate, recognising that these will only partially correct the defect because they contain only selected factors, whereas in DIC there is a global deficiency of coagulation factors. Severe hypofibrinogenaemia (<1 g/l) that persists despite FFP replacement may be treated with fibrinogen concentrate or cryoprecipitate. In cases of DIC where thrombosis predominates, such as arterial or venous thromboembolism, severe purpura fulminans associated with acral ischemia or vascular skin infarction, therapeutic doses of heparin should be considered. In these patients where there is perceived to be a co‐existing high risk of bleeding there may be benefits in using continuous infusion unfractionated heparin (UFH) due to its short half‐life and reversibility. Weight adjusted doses (e.g. 10 μ/kg/h) may be used without the intention of prolonging the APTT ratio to 1·5–2·5 times the control. Monitoring the APTT in these cases may be complicated and clinical observation for signs of bleeding is important. In critically ill, non‐bleeding patients with DIC, prophylaxis for venous thromboembolism with prophylactic doses of heparin or low molecular weight heparin is recommended. Consider treating patients with severe sepsis and DIC with recombinant human activated protein C (continuous infusion, 24 μg/kg/h for 4 d). Patients at high risk of bleeding should not be given recombinant human activated protein C. Current manufacturers guidance advises against using this product in patients with platelet counts of <30 × 109/l. In the event of invasive procedures, administration of recombinant human activated protein C should be discontinued shortly before the intervention (elimination half‐life ≈20 min) and may be resumed a few hours later, dependent on the clinical situation. In the absence of further prospective evidence from randomised controlled trials confirming a beneficial effect of antithrombin concentrate on clinically relevant endpoints in patients with DIC and not receiving heparin, administration of antithrombin cannot be recommended. In general, patients with DIC should not be treated with antifibrinolytic agents. Patients with DIC that is characterised by a primary hyperfibrinolytic state and who present with severe bleeding could be treated with lysine analogues, such as tranexamic acid (e.g. 1 g every 8 h).
On 15 January 2022, at around 04:00 UTC, the submarine volcano Hunga Tonga‐Hunga Ha'apai explosively erupted. We examine data from 10 Pacific Ocean geomagnetic observatories and process the data ...using both high pass filters and cross‐wavelet analyses to enable evaluating the time‐frequency characteristics of the magnetic signals across the Pacific region. At the Western Samoa observatory (API), magnetic signals of 3–8 min period, and visible in both vertical and horizontal fields, arrived at ∼04:44 UTC. The observatories at Chichijima Island (CBI) and Easter Island (IPM) both had local magnetic signatures concurrent with the eruption's water wave arrival and period ranges from, respectively, 13–93 and 5–100+ min. At CBI and IPM, the magnetic signal may be due to both the eruption's tsunami water wave and atmospheric/ionospheric sources. Our results suggest that the magnetic signatures from the eruption are identifiable and may be further separated in future studies.
Plain Language Summary
On 15 January 2022, at around 04:00 UTC, the submarine volcano Hunga Tonga‐Hunga Ha'apai erupted in a violent explosion. Previous studies have identified magnetic signals from earthquake‐created tsunamis, however, no such studies have identified marine magnetic signals from eruption‐created tsunamis. Identifying magnetic signals from different aspects of a submarine eruption can lead to a better understanding of the eruption's mechanisms, as well as potentially improve warning systems for the tsunami created by the eruption. Toward this aim, we examine data from 10 Pacific Ocean geomagnetic observatories. We processed the data using mathematical methods that enable examining the different wave components of the timeseries. We find magnetic signals likely caused by the eruption at three different Pacific island observatories (API‐ Western Samoa, CBI‐ Chichijima Island, and IPM‐ Easter Island).
Key Points
Magnetic signals of 3–8 min period, and visible in both horizontal and vertical field components, arrived at Western Samoa (API)
Both Chichijima Island (CBI) and Easter Island (IPM) had local magnetic signatures concurrent with the eruption's water wave arrival
The magnetic signals at CBI and IPM may be due to both the eruption's tsunami water wave and atmospheric/ionospheric waves
Unlike conventional functional MR imaging where external sensory/cognitive paradigms are needed to specifically activate different regions of the brain, resting functional connectivity MR imaging ...acquires images in the absence of cognitive demands (a resting condition) and detects brain regions, which are highly temporally correlated. Therefore, resting functional MR imaging is highly suited for the study of brain functional development in pediatric subjects. This study aimed to determine the temporal and spatial patterns of rfc in healthy pediatric subjects between 2 weeks and 2 years of age.
Rfc studies were performed on 85 children: 38 neonates (2-4 weeks of age), 26 one-year-olds, and 21 two-year-olds. All subjects were imaged while asleep; no sedation was used. Six regions of interest were chosen, including the primary motor, sensory, and visual cortices in each hemisphere. Mean signal intensity of each region of interest was used to perform correlation analysis pixel by pixel throughout the entire brain, identifying regions with high temporal correlation.
Functional connectivity was observed in all subjects in the sensorimotor and visual areas. The percent brain volume exhibiting rfc and the strength of rfc continued to increase from 2 weeks to 2 years. The growth trajectories of the percent brain volume of rfc appeared to differ between the sensorimotor and visual areas, whereas the z-score was similar. The percent brain volume of rfc in the sensorimotor area was significantly larger than that in the visual area for subjects 2 weeks of age (P = .008) and 1-year-olds (P = .017) but not for the 2-year-olds.
These findings suggest that rfc in the sensorimotor precedes that in the visual area from 2 weeks to 1 year but becomes comparable at 2 years. In contrast, the comparable z-score values between the sensorimotor and visual areas for all age groups suggest a disassociation between percent brain volume and the strength of cortical rfc.
This study evaluates the association between Internal Addiction (IA) and psychiatric co-morbidity in the literature.
Meta-analyses were conducted on cross-sectional, case-control and cohort studies ...which examined the relationship between IA and psychiatric co-morbidity. Selected studies were extracted from major online databases. The inclusion criteria are as follows: 1) studies conducted on human subjects; 2) IA and psychiatric co-morbidity were assessed by standardised questionnaires; and 3) availability of adequate information to calculate the effect size. Random-effects models were used to calculate the aggregate prevalence and the pooled odds ratios (OR).
Eight studies comprising 1641 patients suffering from IA and 11210 controls were included. Our analyses demonstrated a significant and positive association between IA and alcohol abuse (OR = 3.05, 95% CI = 2.14-4.37, z = 6.12, P < 0.001), attention deficit and hyperactivity (OR = 2.85, 95% CI = 2.15-3.77, z = 7.27, P < 0.001), depression (OR = 2.77, 95% CI = 2.04-3.75, z = 6.55, P < 0.001) and anxiety (OR = 2.70, 95% CI = 1.46-4.97, z = 3.18, P = 0.001).
IA is significantly associated with alcohol abuse, attention deficit and hyperactivity, depression and anxiety.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A new class of 'soft' particles, micelles, is detected electrochemically
'nano-impacts' for the first time. Short, sharp bursts of current are used to indicate the electrical contact of a single CTAB ...(cetyltrimethylammonium bromide) micelle with an electrode
the oxidation of the bromide content. The variation in CTAB concentration for such 'nano-impact' experiments shows that a significant number of 'spikes' are observed above the CMC (critical micelle concentration) and this is attributed to the formation of micelles. A comparison with dynamic light scattering is also reported.
Abstract
Background
The impact of SARS-CoV-2 variants of concern (VOCs) on disease severity is unclear. In this retrospective study, we compared the outcomes of patients infected with B.1.1.7, ...B.1.351, and B.1.617.2 with wild-type strains from early 2020.
Methods
National surveillance data from January to May 2021 were obtained and outcomes in relation to VOCs were explored. Detailed patient-level data from all patients with VOC infection admitted to our center between December 2020 and May 2021 were analyzed. Clinical outcomes were compared with a cohort of 846 patients admitted from January to April 2020.
Results
A total of 829 patients in Singapore in the study period were infected with these 3 VOCs. After adjusting for age and sex, B.1.617.2 was associated with higher odds of oxygen requirement, intensive care unit admission, or death (adjusted odds ratio aOR, 4.90; 95% confidence interval CI: 1.43-30.78). Of these patients, 157 were admitted to our center. After adjusting for age, sex, comorbidities, and vaccination, the aOR for pneumonia with B.1.617.2 was 1.88 (95% CI: .95-3.76) compared with wild-type. These differences were not seen with B.1.1.7 and B.1.351. Vaccination status was associated with decreased severity. B.1.617.2 was associated with significantly lower polymerase chain reaction cycle threshold (Ct) values and longer duration of Ct value ≤30 (median duration 18 days for B.1.617.2, 13 days for wild-type).
Conclusions
B.1.617.2 was associated with increased severity of illness, and with lower Ct values and longer viral shedding. These findings provide impetus for the rapid implementation of vaccination programs.
In this retrospective cohort study we found an association between infection with B.1.617.2 (Delta) and increased disease severity. B.1.617.2 was also associated with higher viral loads and prolonged duration of viral shedding. Vaccination remained protective.
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