Two one-dimensional compounds composed of a 1:1 ratio of Mn(III) salen-type complex and Ni(II) oximato moiety with different counter anions, PF(6)(-) and BPh(4)(-), were synthesized: [Mn(3,5-Cl(2)saltmen)Ni(pao)(2)(phen)]PF(6) (1) and [Mn(5-Clsaltmen)Ni(pao)(2)(phen)]BPh(4) (2), where 3,5-Cl(2)saltmen(2-) = N,N'-(1,1,2,2-tetramethylethylene)bis(3,5-dichlorosalicylideneiminate); 5-Clsaltmen(2-) = N,N'-(1,1,2,2-tetramethylethylene)bis(5-chlorosalicylideneiminate); pao(-) = pyridine-2-aldoximate; and phen = 1,10-phenanthroline. Single-crystal X-ray diffraction study was carried out for both compounds. In 1 and 2, the chain topology is very similar forming an alternating linear chain with a [-Mn(III)-ON-Ni(II)-NO-] repeating motif (where -ON- is the oximate bridge). The use of a bulky counteranion, such as BPh(4)(-), located between the chains in 2 rather than PF(6)(-) in 1, successfully led to the magnetic isolation of the chains in 2. This minimization of the interchain interactions allows the study of the intrinsic magnetic properties of the chains present in 1 and 2. While 1 and 2 possess, as expected, very similar paramagnetic properties above 15 K, their ground state is antiferromagnetic below 9.4 K and paramagnetic down to 1.8 K, respectively. Nevertheless, both compounds exhibit a magnet-type behavior at temperatures below 6 K. While for 2, the observed magnetism is well explained by a Single-Chain Magnet (SCM) behavior, the magnet properties for 1 are induced by the presence in the material of SCM building units that order antiferromagnetically. By controlling both intra- and interchain magnetic interactions in this new [Mn(III)Ni(II)] SCM system, a remarkable AF phase with a magnet-type behavior has been stabilized in relation with the intrinsic SCM properties of the chains present in 1. This result suggests that the simultaneous enhancement of both intrachain (J) and interchain (J') magnetic interactions (with keeping J >> J'), independently of the presence of AF phase might be an efficient route to design high temperature SCM-based magnets.

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To cite this article: Furukawa S, Nogami K, Ogiwara K, Yada K, Minami H, Shima M. Systematic monitoring of hemostatic management in hemophilia A patients with inhibitor in the perioperative period using rotational thromboelastometry. J Thromb Haemost 2015; 13: 1279-84.Summary. Background: The management of hemophilia A (HA) patients with inhibitors on bypassing therapy remains challenging. In particular, the monitoring of treatment is restricted by the limited reliability and lack of standardization of currently available methods to evaluate the physiological effects of various hemostatic agents. Accurate monitoring of these patients is particularly important in surgical situations. The recently developed comprehensive coagulation assays, including rotational thromboelastometry (ROTEM), may be useful in these circumstances. Objective: We have attempted to establish a systematic monitoring protocol using ROTEM (NATEM triggered by CaCl 2 ) to evaluate the choice and effectiveness of different bypassing agents in the perioperative period. Methods and Results: The hemostatic effects of recombinant factor VIIa (rFVIIa) and activated prothrombin complex concentrates (aPCC) were determined using a three-step procedure (spike, preoperative and perioperative) in eight patients with HA inhibitor admitted for elective surgery and assessed for individually tailored therapy. The ROTEM parameters demonstrated similar improvement to approximately normal levels at each stage after treatment with rFVIIa. Results in the presence of aPCC showed a marked improvement in the spike data, although this appeared to be different from those in the preoperative and perioperative assessments. The information derived from the spike and preoperative findings provided a useful guide for establishing an effective dose of therapeutic material, and facilitated good hemostatic control during and after surgery in all cases. Conclusion:The findings suggest that this systematic analysis using ROTEM could provide a promising strategy for the use of bypassing therapy in HA patients with inhibitor.

Summary In emicizumab prophylaxis, the concomitant therapy using bypassing agents (BPAs) is required for breakthrough bleeding and invasive procedures with attention to thrombotic complications. To predict coagulant effects of BPAs in emicizumab‐treated patients with haemophilia A (PwHA) with inhibitor (PwHAwI), blood samples from emicizumab‐treated PwHAwI (n = 8) and PwHA without inhibitor (n = 2) in phase 1/2 and HAVEN 1 study, spiked with activated prothrombin complex concentrates (aPCC) or recombinant factor VIIa (rFVIIa) ex vivo, and blood samples from emicizumab‐treated PwHAwI‐receiving BPAs were analysed by Ca2+‐triggered rotational thromboelastometry (ROTEM) and ellagic acid/tissue factor‐triggered clot waveform analysis (CWA). Spiked aPCC, corresponded to 10–100 U/kg, markedly shortened ROTEM parameters beyond the normal range, while spiked rFVIIa, corresponded to 90–270 μg/kg, shortened them within near‐normal range. Each of the spiked BPA‐improved adjusted maximum coagulation velocity of CWA to within or near the normal range. In blood samples at post‐infusion of aPCC (44–73 U/kg) or rFVIIa (79–93 μg/kg), the parameters of both assays improved to approximately the normal range. Taken together, ex vivo results of spiking tests in ROTEM and CWA, except aPCC spiking test in ROTEM, were relatively consistent with in vivo ones, and could usefully predict the coagulant effects of concomitant bypassing therapy for emicizumab‐treated PwHAwI.

Most individuals suffering from essential hyperhidrosis lack overt psychopathology. While some patients subjectively describe symptoms of anxiety, mild depression and social isolation, these complaints appear often to be in reaction to or superimposed upon an organic disease process and not the primary cause of their condition.

Platelet storage pool disease (SPD) is a platelet function disorder characterized by a reduction in the number or content of α-granules, dense granules, or both, and is diagnosed by specialized tests. Patients with SPD often present with prolonged bleeding time (BT), but the sensitivity and reproducibility of this test have limitations, often resulting in false negatives. It has recently been reported that an automated microchip flow-chamber system (T-TAS(®)) is useful in the assessment of anti-platelet therapy, and could have potential as a screening test for SPD. We examined the utility of T-TAS in three individuals from one family diagnosed with δ-SPD. The propositus had a mildly prolonged BT, and the standard tests for platelet function were close to the normal range. Whole blood samples were anti-coagulated with hirudin and applied to T-TAS microchips coated with collagen (PL-chips) at shear rates of 1000 and 2000 s(-1). Platelet thrombus formation (PTF) was monitored with a pressure sensor. Markedly depressed PTF was observed in all cases at both shear rates. These findings indicate that T-TAS is highly sensitive to the defect in these patients with SPD, and may represent a good candidate screening test for a wide range of platelet function disorders.

A 27‐year‐old woman with panic disorder taking 20 mg olanzapine daily for 4 months was admitted to Mito Kyodo General Hospital, Mito, Ibaraki, Japan, because of disturbed consciousness with fever, hyperglycemia, hyperosmolarity and elevated creatine phosphokinase. She was diagnosed with a hyperosmolar hyperglycemic state and neuroleptic malignant syndrome. Brain magnetic resonance imaging showed transiently restricted diffusion in the splenium of the corpus callosum, with a high signal intensity on diffusion‐weighted imaging. The neurological abnormalities disappeared along with improvement of metabolic derangements, and the follow‐up magnetic resonance imaging carried out on the 26th day of admission showed complete resolution of the lesions in the splenium of the corpus callosum. These clinical and radiological features are highly suggestive of clinically mild encephalitis/encephalopathy with a reversible splenial lesion. The first case of mild encephalitis/encephalopathy with a reversible splenial lesion caused by olanzapine‐induced hyperosmolar hyperglycemic state and neuroleptic malignant syndrome is reported.

HLA-DR were calculated, resulting in 0 to 6 MM. Patients with primary graft failure were excluded from statistical analysis. Results: Survival analysis revealed a statistically significant impact of HLA-DR MM on survival. 5-year survival in patients without HLA-DR MM (nϭ9) was 100%, in patients with one HLA-DR MM (nϭ102) 82% and 75% in patients with two HLA-DR MM (nϭ104; log rank 1MM vs. 2MM pϭ0.05). Freedom from cardiac allograft vasculopathy after 5 years was 89% in HLA-DR identical recipients (nϭ9), 61% in patients with one HLA-DR MM (nϭ93) and 54% in patients with two HLA-DR MM (nϭ92). Conventional matching with 6 missmatches over the 3 major HLA loci revealed a trend towards a higher relative risk for adverse outcome in patients with increased MM. Conclusion: HLA-DR matching had a significant impact on survival after HTx in our centre. In our efforts to achieve the best comparative use of scarce donor organs the inclusion of HLA-DR matching into allocation policies might improve long-term outcome after HTx.