Vitamin K Antagonist Reversal for Urgent Surgery Using 4-Factor Prothrombin Complex Concentrates: A Randomized Clinical Trial.

Importance: Millions of people take vitamin K antagonists (VKAs). Some people who need urgent surgical procedures require rapid VKA reversal to prevent excessive intraoperative bleeding.

Objective: To evaluate the hemostatic noninferiority of an investigational 4-factor prothrombin complex concentrate (4F-PCC) to a control 4F-PCC for rapid VKA reversal before urgent surgery.

Novel approach to treating a coronavirus disease 2019-positive patient with a complex arch and descending aneurysm and dissection for whom open surgery was prohibitive.

Ascending aortic and arch aneurysms are a challenging group of pathologies for surgeons. These typically require a complex open repair, including hypothermic circulatory arrest, and carry a high perioperative risk. The outcomes have been best when performed in centers with significant experience and expertise.

GORE TAG conformable thoracic stent graft for the treatment of descending aortic pathologies.

Endovascular repair of the descending thoracic aorta has gained widespread acceptance as a primary treatment modality for thoracic aortic disease due to its minimally invasive approach and improved survival rates. GORE TAG Conformable Thoracic Stent Graft was designed for descending thoracic aortic aneurysms, penetrating ulcers, aortic transections and type B aortic dissections, which are accepted indications for endovascular therapy. The aim of this review is to summarize the clinical literature, focusing mainly on the publications that came from manufacturer's pre-market and post-market studies.

Early Detection of Deep Venous Thrombosis in Trauma Patients.

Background This study was performed to determine whether trauma patients are at an increased risk of developing deep venous thrombosis (DVT) within the first 48 hours of hospitalization. Materials and methods A retrospective review was performed using a prospectively maintained database of patients admitted to a trauma center during a five-year time period. Patients hospitalized for greater than 48 hours who received a screening venous duplex for DVT were included in the study.

Survival after endovascular therapy in patients with ruptured thoracic aortic diseases: Results from the Global Registry for Endovascular Aortic Treatment Registry.

Objective: The Global Registry for Endovascular Aortic Treatment is a prospective observational multicenter cohort registry of all Gore aortic endografts for a variety of aortic pathologies. The purpose of this study was to evaluate the outcome of the Conformable GORE TAG Thoracic Endoprosthesis and GORE TAG Thoracic Endoprosthesis devices for ruptured thoracic aortic syndromes.

Methods: Between December 2010 and October 2016, a total of 5018 patients were enrolled from 114 international sites in this registry.

Balloon angioplasty for symptomatic inferior vena cava aneurysm.

Aneurysms of the inferior vena cava (IVC) are uncommon. Symptomatic patients usually present with thrombosis and venous obstruction. Classification is based on location and the presence or absence of congenital IVC interruption.

Astronomy. ASASSN-15lh: A highly super-luminous supernova.

We report the discovery of ASASSN-15lh (SN 2015L), which we interpret as the most luminous supernova yet found. At redshift z = 0.2326, ASASSN-15lh reached an absolute magnitude of Mu ,AB = -23.

[Effect of low intensive helium-neon laser on superoxide-producing and methemoglobin-restoring activity of cytochrome b558III of red cell membranes in experiment].

It is established that low-energy He-Ne laser without changes from the side of NADPH-dependent superoxide-producing activity of b558III cytochrome isolated from erythrocytic membranes (EM) promotes b558III activity decrease in EM. The level of metHb-restoring activity increases during irradiation by He-Ne laser. The form of optical spectrum of b558III cytochrome absorption in the visible spectrum area does not undergo essential changes after laser irradiation while optical spectral index (A412/A530) is reduced a little.

A journey in reversing practice patterns: a multidisciplinary experience in implementing DOQI guidelines for vascular access.

Background: The National Kidney Foundation has established detailed guidelines due to increasing morbidity and costs related to haemodialysis vascular access in the end-stage renal disease population.

Methods: A quality assurance multidisciplinary committee was formed to implement the Dialysis Outcome Quality Initiative (DOQI) guidelines in September, 1999. Beginning January 2000, a 'Save the Vein Programme' was implemented and native fistulae became the angioaccess of first choice for new patients.

[Regulating effect of gamma-aminobutyric acid and pyrrolidone-2 on endogenous blood metalloproteins with anti- and pro-oxidant activity in hypoxia].

Various stages of hypokinesia are marked by specific changes in the level and activity of endogenous metalloproteins with anti- (MAA) and prooxidant action (MPA). In particular, the level of MPA [cytochromes b5 and b558 (III + IV) and suprol] decreases in all stages (except for the level of cytochrome b5 exceeding that in the free control on the 15th and 30th day of hypokinesia). The superoxide production activity of suprol always exceeds that in the control, while the activity of cytochrome b558 (III) exceeds that in the control only on the 30th day of experiment.

In-stent restenosis after carotid angioplasty-stenting: incidence and management.

Purpose: Carotid angioplasty-stenting (CAS) has been advocated as an alternative to carotid endarterectomy (CEA) in patients with restenotic lesions after prior CEA, primary stenoses with significant medical comorbidities, and radiation-induced stenoses. The incidence of restenosis after CAS and its management remains ill defined. We evaluated the incidence and management of in-stent restenosis after CAS.

Increasing use of autogenous fistulas: selection of dialysis access sites by duplex scanning and transposition of forearm veins.

Although the autogenous radiocephalic fistula is considered to be the ideal access for hemodialysis, significant changes in the demographics of patients undergoing angioaccess have occurred since its initial description in the 1960s. Patients presenting for initial access evaluation in contemporary practice are less likely to have arteries and veins suitable for autogenous fistula (AF) formation in the classic location. Physical examination of the upper extremity alone may be inadequate for selection of arteries and veins that will mature into a functioning AF.

Dermal tissue fibrosis in patients with chronic venous insufficiency is associated with increased transforming growth factor-beta1 gene expression and protein production.

Purpose: Pathologic dermal degeneration in patients with chronic venous insufficiency (CVI) is characterized by aberrant tissue remodeling that results in stasis dermatitis, tissue fibrosis, and ulcer formation. The cytochemical processes that regulate these events are unclear. Because transforming growth factor-beta(1) (TGF-beta(1)) is a known fibrogenic cytokine, we hypothesized that the increased production of TGF-beta(1) would be associated with CVI disease progression.

Mandibular subluxation for distal internal carotid exposure: technical considerations.

Purpose: Carotid endarterectomy (CEA) has become one of the most commonly performed vascular procedures, because of the beneficial outcome it has when compared with medical therapy alone and because of the anatomic accessibility of the artery. In cases of distal carotid occlusive disease, high cervical carotid bifurcation, and some reoperative cases, access to the distal internal carotid artery may limit surgical exposure and increase the incidence of cranial nerve palsies. Mandibular subluxation (MS) is recommended to provide additional space in a critically small operative field.

Aortic reconstruction in the HIV infected patient.

Major vascular reconstruction using prosthetic implantation is uncommon in the HIV infected patient. We describe a 52-year-old man with HIV infection and HIV-induced thrombocytopenia, who underwent successful aorto-bifemoral bypass for lower extremity ischemic symptoms. Postoperative progressive thrombocytopenia and subsequent hemorrhage were successfully treated with intravenous steroid replacement, platelet transfusion, alpha-globulin administration and expectant management.

Thalidomide inhibits TNF response and increases survival following endotoxin injection in rats.

Sepsis is a leading cause of death following major trauma and complicated abdominal surgery. Tumor necrosis factor-alpha (TNF) is believed to be a central mediator in the inflammatory response syndrome. Numerous methods of blunting the TNF response in sepsis have been attempted with suggestion of increased survival and decreased organ injury.

[Cytochrome b-558 from blood serum and erythrocyte membranes. Isolation, purification, and brief characteristics].

Four types of water-soluble cytochromes b-558 (cyt. b-558) have been isolated and purified from blood serum (cyt. b-558 (I), cyt.

A comparison of survival at different degrees of hemorrhagic shock in germ-free and germ-bearing rats.

We have previously reported superior survival after one level of hemorrhagic shock in germ-free (GF) rats compared with germ-bearing (GB) rats. The objective of this study was to determine the effect of the GF state on survival at different degrees of hemorrhagic shock. GF and GB rats were bled to a mean arterial blood pressure of 30 mmHg.

Comparative efficacy of topical hemostatic agents in a rat kidney model.

The efficacies of four topical hemostatic agents were compared in a rat model employing a standardized renal injury. The materials used to effect hemostasis were oxidized cellulose, microfibrillar collagen powder, positively charged modified collagen, and single donor heterologous fibrin glue. Animals that were treated only with surgical gauze served as controls.

[The intracellular pH of the peripheral blood lymphocytes in cattle during the development of leukemia].

The intracellular pH distribution of peripheral cattle lymphocytes has been studied in normal state and at six stages of the development of bovine leukosis by the dye microfluorimetry of single cells. It has been shown that the increase of mean intracellular pH value occurs as well some distribution parameters, such as pH range and asymmetry change during the disease process. Probable reasons responsible for the observed modification of the distribution pattern are discussed.