Although several effects of electromagnetic fields (EMFs) on articular cartilage have been reported in recent studies, the use of EMFs to treat osteoarthritis remains a matter of debate. In an in vitro study, human chondrocytes harvested from osteoarthritic knee joints were released from their surrounding matrix and transferred in defined concentration into a 3D matrix (type-I collagen gel). The cultivation, performed under standard conditions, lasted up to 14 days. During this time, treatment groups were continuously exposed to either sinusoid or pulsed electromagnetic fields (PEMFs). The PEMFs revealed the following characteristics: maximum magnetic flux density of 2 mT, frequency of the bursts of 16.7 Hz with each burst consisting of 20 pulses. Similarly, the sinusoid EMFs also induced a maximum flux density of 2 mT with a frequency of 50 Hz. Control groups consisting of equal number of samples were not exposed to EMF. Immunohistological examinations of formalin-fixed, paraffin-embedded samples revealed positive staining for type-II collagen and proteoglycans in the immediate pericellular region with no differences between the two different treatment groups and the control groups. With increasing cultivation time, both type-II collagen and aggrecan gene expression declined, but no significant differences in gene expression were found between the treatment and control groups. In conclusion, using our in vitro setting, we were unable to detect any effects of pulsed and sinusoidal magnetic fields on human adult osteoarthritic chondrocytes.

Venous thromboembolism (VTE) is a common and serious complication in patients with cancer; treatment guidelines recommend extended therapy of ≥6 months with low-molecular-weight heparin (LMWH) for treatment and prevention of recurrent VTE (rVTE) in this population. This post hoc analysis used data from the CLOT study—a phase III, randomized, open-label, controlled study (N = 676)—to compare the efficacy and safety of dalteparin, a LMWH, versus vitamin K antagonist (VKA) for prevention of rVTE in patients with cancer and renal impairment (creatinine clearance <60 ml/min). Overall, 162/676 (24 %) patients had renal impairment at baseline. Patients received subcutaneous dalteparin 200 IU/kg once daily during month 1, followed by 150 IU/kg once daily for months 2–6; or VKA once daily for 6 months, with initial overlapping subcutaneous dalteparin 200 IU/kg once daily for ≥5 days until international normalized ratio was 2.0–3.0 for 2 consecutive days. Endpoints included the rates of rVTE (primary) and bleeding events. Overall, fewer dalteparin-treated patients (2/74 [2.7 %]) experienced ≥1 adjudicated symptomatic rVTE compared with VKA-treated patients (15/88 [17.0 %]; hazard ratio = 0.15 [95 % confidence interval 0.03–0.65]; p = 0.01). Bleeding event rates for both treatments were similar (p = 0.47). In summary, compared with VKA, dalteparin significantly reduced risk of rVTE in patients with cancer and renal impairment (p = 0.01) while exhibiting a comparable safety profile. This analysis supports dosing patients with renal impairment in accordance with patients with normal renal function; however, anti-Xa monitoring could be considered to further support safety in selected patients, particularly those with very severe renal impairment.

We document the severe burns sustained by three patients with epilepsy who suffered seizures while showering. On the basis of the circumstances of these accidents, we suggest preventative measures to help other patients with epilepsy avoid similar burn injuries. Patient data collected from January 1987 to May 2004 by the Burn Unit of the Department of Plastic Surgery, University of Aachen, Germany, were reviewed. Three patients with epileptic disorders were found who suffered severe burn injuries caused by seizures that occurred while showering. Scald location and depth was assessed. Three patients (two women, one man) sustained extensive scald injuries after epileptic seizures while showering. Burn extent ranged from 20% to 35% TBSA. Scalds primarily affected the trunk, legs, arms, and buttocks. Two of the three patients used showers with levers for controlling water temperature. Safety devices for limiting water temperature were absent. All patients used shower cubicles. Patients with epilepsy may sustain serious burns, typically affecting the trunk, legs, arms, and buttocks, when a seizure occurs while showering. We suggest that individuals with epilepsy use showers designed with pirouetting taps, rather than levers, to regulate water temperature. Pirouetting taps are less likely to be shifted out of position during a seizure. We also recommend that epileptic patients have safety devices installed in their water heaters that limit maximum water temperature. Such safety devices prevent scald injury. And, finally, we suggest that people with comparable disorders generally avoid using shower cubicles. Instead, showers with curtains should be used, which may allow occupants to escape from dangerously hot shower water more easily.

In patients with active cancer and acute venous thromboembolism (VTE), the low-molecular-weight-heparin (LMWH) dalteparin is more effective than vitamin K antagonist (VKA) in reducing the risk of recurrent venous thromboembolism (rVTE) without increasing the risk of bleeding. However, the relative benefit of LMWH versus VKA in patients with active cancer at high or low risk of rVTE and bleeding is unclear. This post hoc analysis used data from the CLOT study to explore the efficacy and safety of LMWH versus VKA in preventing recurrent thrombosis in high- and low-risk patients with active cancer. High-risk patients were defined by metastatic disease and/or antineoplastic treatment at baseline; low-risk patients presented with neither. Among high-risk patients, rVTE occurred in 25/318 (8%) (LMWH) versus 53/314 (17%) (VKA) (hazard ratio, 0.44; p = 0.001). No significant difference was detected in the rate of major or any bleeding. The 6-month mortality rate was 40% (LMWH) versus 41% (VKA). In low-risk patients, 2/20 (10%) (LMWH) had rVTE versus 0/24 (0%) (VKA) (hazard ratio, not estimable; p = 0.998). No significant difference was detected in the rate of major or any bleeding. The 6-month mortality rate was 20% (LMWH) versus 29% (VKA). In patients with cancer-associated thrombosis at high risk of rVTE and bleeding, the LMWH dalteparin was more effective than VKA in reducing the risk of rVTE without increasing the risk of bleeding. No difference in rate of rVTE or bleeding was observed between LMWH and VKA among low-risk patients.

Patient obesity appears to directly correspond to the amount of phenprocoumon required during initiation of therapy. The CYP2C9 genotype was not shown to influence the necessary therapeutic dosage.