The Lazarus effect of very high-dose intravenous anakinra in severe non-familial CNS-HLH

Abstract Background Opioid prescribing for a range of health issues is increasing globally. The risk of fatal and non-fatal overdose is increased among people prescribed strong opioids: in high doses in the context of polypharmacy (the use of multiple medications at the same time), especially with other sedatives; and among people with multiple morbidities including cardiorespiratory, hepatic and renal conditions. This study described and quantified the prescribing of strong opioids, comorbidities and other overdose risk factors among those prescribed strong opioids, and factors associated with high/very high opioid dosage in a regional health authority in Scotland as part of a wider service improvement exercise. Methods Participating practices ran searches to identify patients prescribed strong opioids and their characteristics, polypharmacy, and other overdose risk factors. Data were anonymised before being analysed at practice and patient-level. Morphine Equivalent Doses were calculated for patients based on drug/dose information and classed as Low/Medium/High/Very High. Descriptive statistics were generated on the strong opioid patient population and overdose risk factors. The relationship between the prescribing of strong opioids and practice/patient-level factors was investigated using linear and logistic regression models. Results Eighty-five percent (46/54) of GP practices participated. 12.4% (42,382/341,240) of individuals in participating practices were prescribed opioids and, of these, one third (14,079/42,382) were prescribed strong opioids. The most common comorbidities and overdose risk factors among strong opioid recipients were pain (67.2%), cardiovascular disease (43.2%), and mental health problems (39.3%). There was a positive significant relationship between level of social deprivation among practice caseload and level of strong opioid prescribing (p < 0.001). People prescribed strong opioids tended to be older (mean 59.7 years) and female (8638, 61.4%) and, among a subset of patients, age, gender and opioid drug class were significantly associated with prescribing of High/Very High doses. Conclusions Our findings have identified a large population at potential risk of prescription opioid overdose. There is a need to explore pragmatic models of tailored interventions which may reduce the risk of overdose within this group and clinical practice may need to be tightened to minimise overdose risk for individuals prescribed high dose opioids.

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Tandem high-dose chemotherapy with thiotepa and busulfan–melphalan and autologous stem cell transplantation in very high-risk neuroblastoma patients

Bone Marrow Transplantation ◽

10.1038/bmt.2015.264 ◽

2015 ◽

Vol 51 (2) ◽

pp. 227-231 ◽

Cited By ~ 20

Author(s):

C Pasqualini ◽

C Dufour ◽

G Goma ◽

M-A Raquin ◽

V Lapierre ◽

...

Keyword(s):

Stem Cell ◽

High Risk ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Autologous Stem Cell Transplantation ◽

High Dose Chemotherapy ◽

High Dose ◽

Very High

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Formation of Oxide Layers by High Dose Implantation into Silicon

MRS Proceedings ◽

10.1557/proc-27-275 ◽

1983 ◽

Vol 27 ◽

Cited By ~ 4

Author(s):

S.S. Gill ◽

I. H. Wilson

Keyword(s):

Oxide Layer ◽

Single Crystal Silicon ◽

High Dose ◽

Surface Oxide Layer ◽

Crystal Silicon ◽

Implantation Energy ◽

Oxygen Ions ◽

Oxygen Profile ◽

Dose Levels ◽

Very High

ABSTRACTSingle crystal silicon was implanted with 80, 120, 160 and 240 keV oxygen ions. Rutherford backscattering (RBS) analysis was used to obtain the implanted oxygen profile and the oxygen to silicon ratio in the implanted layer for doses in the range 1016 to 1.5 × 1018 O2+ cm−2 for room temperature implants. The depth and the thickness of the buried oxide layer has been measured as a function of implantation energy and oxygen dose. Chemical formation of stoichiometric SiO2 was confirmed by infra-red (IR) spectroscopy. Both RBS and IR indicate that once a surface oxide layer is formed for very high dose levels, the layer thickness decreases with increasing implanted dose beyond a critical dose level.

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A Successful Venous Thromboprophylaxis in a Patient with Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT): a case report of the first reported case in Thailand

10.21203/rs.3.rs-702766/v1 ◽

2021 ◽

Author(s):

Archrob Khuhapinant ◽

Tarinee Rungjirajittranon ◽

Bundarika Suwanawiboon ◽

Yingyong Chinthammitr ◽

Theera Ruchutrakool

Keyword(s):

Asian Population ◽

High Dose ◽

Severe Thrombocytopenia ◽

Imaging Studies ◽

Fatal Complication ◽

Platelet Factor ◽

High Dose Dexamethasone ◽

Prophylactic Dose ◽

Spontaneous Platelet Aggregation ◽

Very High

Abstract BackgroundVaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but fatal complication of Coronavirus Disease 2019 vaccine. Many reports of VITT have mostly been in the Caucasian population. Here, we present first reported case from an oriental population.Case presentationA 26-year-old female who had severe headache and severe thrombocytopenia 8 days after administration of the ChAdOx1 nCoV-19 vaccine developed by AstraZeneca. Although no thrombosis was demonstrated by imaging studies, she had very highly elevated d-dimer level during hospitalization. Serology for antibody against platelet factor 4 was positive on several days with very high optical density readings. Furthermore, we found the antibody could induce spontaneous platelet aggregation without the presence of heparin. We decided to treat her with intravenous immunoglobulin, high-dose dexamethasone, and a prophylactic dose of apixaban. She improved rapidly and was discharged from the hospital 6 days after admission. Neither thrombocytopenia nor thrombosis was subsequently detected at three weeks follow-up.ConclusionsDespite lower rate of thrombosis, VITT can present in Asian population. Early detection and prompt treatment of VITT can improve patients’ clinical outcome. Thromboprophylaxis of non-heparin anticoagulants also results in prevention of clot formation.

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Very-High-Dose Phenobarbital for Childhood Refractory Status Epilepticus

Pediatric Neurology ◽

10.1016/j.pediatrneurol.2005.06.014 ◽

2006 ◽

Vol 34 (1) ◽

pp. 63-65 ◽

Cited By ~ 27

Author(s):

Wai Kin Lee ◽

Kam Tim Liu ◽

Betty Wan Yin Young

Keyword(s):

Status Epilepticus ◽

Refractory Status Epilepticus ◽

High Dose ◽

Refractory Status ◽

Very High

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Evaluation of Soil S Pools under 23 Years of Maize Monoculture

Agronomy ◽

10.3390/agronomy11122376 ◽

2021 ◽

Vol 11 (12) ◽

pp. 2376

Author(s):

Pavel Suran ◽

Martin Kulhánek ◽

Jiří Balík ◽

Jindřich Černý ◽

Ondřej Sedlář

Keyword(s):

High Dose ◽

The Czech Republic ◽

S Uptake ◽

Biomass Yields ◽

Entire Experiment ◽

Initial Content ◽

Phosphorus And Potassium ◽

Very High ◽

Sulfur Nutrition

Sulfur nutrition is a critical part of proper crop growth and development. In our study, biomass yields (BY) and S uptake were investigated on long-term maize monoculture on haplic luvisol soil during the 23 years of this trial, as well as changes in water extractable (Sw), adsorbed (Sads), mineral (Sav), and pseudo-total S (St) fractions. Treatments used in this study are: (1) Control (Cont); (2) ammonium sulfate (AS); (3) urea and ammonium nitrate (UAN); (4) UAN + phosphorus and potassium (UAN + PK); (5) UAN + phosphorus, magnesium, sulfur (UAN + PMgS); and (6) Fallow. Recently, the Mehlich 3 method started to be used in the Czech Republic to determine content of plant available S. Using this method, it was found that the content of S extracted by Mehlich 3 (SM3) closely correlates to Sav in both topsoil and subsoil (r = 0.958 in 1997 and 0.990 in 2019, both at p < 0.001). We also found that, on average, during the entire experiment, all treatments had increased yields over Cont (135–147%) and increased S uptake (291, 192, 180, and 246% of Cont for AS, UAN, UAN + PK, and UAN + PMgS, respectively). Examining the changes from 1997 to 2019 in topsoil (0–30 cm depth), we discovered a decrease of S content in Sw, Sads, Sav, and St fractions on all treatments to an average of 34.6%, 65.8%, 42.2%, and 78.6% of their initial values. The exception was AS treatment, which doubled its initial content in mineral fractions and maintained the same levels of St, and which we attribute to the very high dose of S on this treatment (142 kg ha−1 year−1). Using the simple balance method, AS and UAN + PMgS treatments lost 142.2 and 95.3 kg S ha−1 year−1 to other sinks, except plant uptake, from the entire soil profile (0–60 cm) during 23 years of experiment. Other treatments also show significant losses with the exception of Fallow. Given these results, it is clear that content of sulfur in soil is generally decreasing and attention should be paid mainly towards minimizing of its losses.

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Back to the Future: Very High-Energy Electrons (VHEEs) and Their Potential Application in Radiation Therapy

Cancers ◽

10.3390/cancers13194942 ◽

2021 ◽

Vol 13 (19) ◽

pp. 4942

Author(s):

Maria Grazia Ronga ◽

Marco Cavallone ◽

Annalisa Patriarca ◽

Amelia Maia Leite ◽

Pierre Loap ◽

...

Keyword(s):

Radiation Therapy ◽

Current Knowledge ◽

High Energy ◽

High Dose Rate ◽

Point Of View ◽

High Dose ◽

Dose Rates ◽

High Energy Electrons ◽

Very High Energy ◽

Very High

The development of innovative approaches that would reduce the sensitivity of healthy tissues to irradiation while maintaining the efficacy of the treatment on the tumor is of crucial importance for the progress of the efficacy of radiotherapy. Recent methodological developments and innovations, such as scanned beams, ultra-high dose rates, and very high-energy electrons, which may be simultaneously available on new accelerators, would allow for possible radiobiological advantages of very short pulses of ultra-high dose rate (FLASH) therapy for radiation therapy to be considered. In particular, very high-energy electron (VHEE) radiotherapy, in the energy range of 100 to 250 MeV, first proposed in the 2000s, would be particularly interesting both from a ballistic and biological point of view for the establishment of this new type of irradiation technique. In this review, we examine and summarize the current knowledge on VHEE radiotherapy and provide a synthesis of the studies that have been published on various experimental and simulation works. We will also consider the potential for VHEE therapy to be translated into clinical contexts.

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