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Highlights from the article: Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions - Part I: Review of Anticoagulation Agents and Clinical Considerations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe In 2012, the Society of Interventional Radiology (SIR) published its first consensus practice guidelines regarding the periprocedural management of coagulation status for percutaneous image-guided interventions [1], which was subsequently revised in 2013 with a discussion of newer anticoagulant agents [2]. Nevertheless, the interventionalist is encouraged to ask the patient about the use of nontraditional treatments and consult with a pharmacist on their potential implications in patient care given their propensity for drug-drug interactions. For example, it would be incorrect to interpret an INR of 3 in a patient with CLD as representing a significant increase in bleeding risk: as a result of the decrease in production of procoagulant and natural anticoagulant factors, the plasma of the patient with CLD actually has the same amount of thrombin generation as the plasma of a normal patient [87]. 32 S. Endres, A. Shufelt, N. Bogduk, The risks of continuing or discontinuing anticoagulants for patients undergoing common interventional pain procedures, Pain Med, 18, 2017, 403-409Endres S, Shufelt A, Bogduk N. The risks of continuing or discontinuing anticoagulants for patients undergoing common interventional pain procedures.

Rationale and Objectives: To evaluate different techniques for reducing hemorrhagic complications in coagulopathic patients with elevated international normalized ratio having an image-guided percutaneous invasive procedure; techniques included systemic transfusion of fresh frozen plasma (FFP), local injection of FFP, percutaneous injection of gelatin sponge, and percutaneous placements of angiographic coils.Materials and Methods: Retrospective review of 232 consecutive patients with known coagulopathy undergoing image-guided minimally invasive procedures were selected. Ninety-one patients had local FFP injected, 40 patients underwent local synthetic gelatin injection, 16 patients had percutaneous coil embolization, and 85 patients received systemic FFP. The number of bleeds, complications related to bleeds, and systemic complications were recorded. A 30 cc threshold was used to delineate significant bleeding.Results: No patients experienced clinically significant or insignificant bleeding with local FFP injection (P value <.05). Other local hemostatic methods (Gelfoam, systemic FFP, and coil embolization) were associated with higher levels of bleeding (12.5%, 17.1%, 37.5%, respectively) and complications (7.5%, 31.4%, 37.5%, respectively). Systemic FFP infusion was associated with respiratory, infectious, and mortal complications.Conclusions: Local injection of blood products provides a safe and efficacious hemostatic agent to reduce the incidence of postprocedural bleeding. The technique is associated with lower rates of bleeding and systemic complications when compared to other local and systemic techniques. Further randomized prospective studies with a larger patient cohort need to be performed to corroborate these initial findings. [ABSTRACT FROM AUTHOR]

This review article is designed as an introductory reference to the clinical management of trauma patients by interventional radiologists. The article is geared toward the radiology nurse participating in the care of these patients alongside the interventionalist to provide a framework to understand the process of working up, treating, and managing trauma patients using minimally invasive techniques. Special emphasis is placed on the preoperative and postprocedural care issues that are relevant specifically to nursing staff as they relate interventional radiology. A sample case is provided at the end to further emphasize key points discussed in the article. [ABSTRACT FROM AUTHOR]

Preprocedural evaluation of patients in an interventional radiology (IR) clinic is a complex synthesis of physical examination and imaging findings, and as IR transitions to an independent clinical specialty, such evaluations will become an increasingly critical component of a successful IR practice and quality patient care. Prior research suggests that preprocedural evaluations increased patient's perceived quality of care and may improve procedural technical success rates. Appropriate documentation of a preprocedural evaluation in the medical record is also paramount for an interventional radiologist to add value and function as an effective member of a larger IR service and multidisciplinary health care team. The purpose of this study is to examine the quality of radiology resident notes for patients seen in an outpatient IR clinic at a single academic medical center before and after the adoption of clinic note template with reminders to include platelet count, international normalized ratio, glomerular filtration rate, and plan for periprocedural coagulation status. Before adoption of the template, platelet count, international normalized ratio, glomerular filtration rate and an appropriate plan for periprocedural coagulation status were documented in 72%, 82%, 42%, and 33% of patients, respectively. After adoption of the template, appropriate documentation of platelet count, international normalized ratio, and glomerular filtration rate increased to 96%, and appropriate plan for periprocedural coagulation status was documented in 83% of patients. Patient evaluation and clinical documentation skills may not be adequately practiced during radiology residency, and tools such as templates may help increase documentation quality by radiology residents. [ABSTRACT FROM AUTHOR]

Abstract: The geochemical characteristics of continental crust are present in nearly all arc magmas. These characteristics may reflect a specific source process, such as fluid fluxing, common to both arc magmas and the continental crust, and/or may reflect the incorporation of continental crust into arc magmas either at source via subducted sediment, or via contamination during differentiation. Resolving the relative mass contributions of juvenile, mantle-derived material, versus that derived from pre-existing crust of the upper plate, and providing these estimates on an element-by-element basis, is important because: (1) we want to constrain crustal growth rates; (2) we want to quantitatively track element cycling at convergent margins; and (3) we want to determine the origin of economically important elements and compounds. Traditional geochemical approaches for determining the contributions of various components to arc magmas are particularly successful when applied on a comparative basis. Studies of suites from multiple magmatic systems along arcs, for which differentiation effects can be individually constrained, can be used to extrapolate to potential source compositions. In the Lesser Antilles Arc, for example, differentiation trends from individual volcanoes are consistent with open-system evolution. However, such trends do not project back to a common primitive magma composition, suggesting that differentiation modifies magmas that were derived from distinct mantle sources. We propose that such approaches should now be complemented by petrographically constrained mineral-scale isotope and trace element analysis to unravel the contributing components to arc magmas. This innovative approach can: (1) better constrain true end-member compositions by returning wider ranges in geochemical compositions among constituent minerals than is found in whole rocks; (2) better determine magmatic evolution processes from core–rim isotopic or trace element profiles from the phases contained in magmas; and (3) constrain rates of differentiation by applying diffusion-controlled timescales to element profiles. An example from Nguaruhoe Volcano, New Zealand, underscores the importance of such a microsampling approach, showing that mineral isotopic compositions encompass wide ranges, that whole-rock isotopic compositions are consequently simply element-weighted averages of the heterogeneous crystal cargo, and that open-system evolution is proved by core–rim variations in Sr isotope ratios. Nguaruhoe is just one of many systems examined through microanalytical approaches. The overwhelming conclusion of these studies is that crystal cargoes are not truly phenocrystic, but are inherited from various sources. The implication of this realization is that the interpretation of whole-rock isotopic data, including the currently popular U-series, needs careful evaluation in the context of petrographic observations. [Copyright &y& Elsevier]

Highlights from the article: Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions - Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe Part II of the consensus guidelines updates the recommendations for the periprocedural management of thrombotic and bleeding risks in patients who require image-guided interventions ( B Appendices A and B b , available online on the article's Supplemental Material page at www.jvir.org). Other retrospective reviews on thoracentesis suggest similar results: 17 bleeding-related complications after thoracentesis in 9,320 patients (0.18%), all of which occurred in patients with platelet counts > 50 × 10 SP 9 sp /L [53]; and no bleeding complications after thoracentesis in 32 patients with an INR > 3.0 [77]. Observational studies on liver biopsy [38], [74], [82], [83] support the threshold of a platelet count > 50 × 10 SP 9 sp /L. In a study of 291 consecutive patients who underwent a liver biopsy [74], a 3.4% incidence of clinically significant bleeding was noted among 175 patients with mild thrombocytopenia (platelet counts 50-99 × 10 SP 9 sp /L), and this was not different from the bleeding incidence in patients with normal platelet counts [74].

We present whole rock 187 Os/ 188 Os data for the most mafic lavas along the Lesser Antilles arc (MgO = 5–17 wt.%) and for the subducting basalt and sediments. 187 Os/ 188 Os ratios vary from 0.127 to 0.202 in the arc lavas. Inverse correlations between 187 Os/ 188 Os and Os concentrations and between 187 Os/ 188 Os and indices of differentiation such as MgO suggests that assimilation, rather than source variation, is responsible for the range of Os isotopic variation observed. 87 Sr/ 86 Sr, La/Sm and Sr/Th are also modified by assimilation since they all correlate with 187 Os/ 188 Os. The assimilant is inferred to have a MORB-like 87 Sr/ 86 Sr with high Sr (>700 ppm), low light on middle and heavy rare earth elements (L/M-HREE; La/Sm ∼2.5) and 187 Os/ 188 Os > 0.2. Such compositional features are likely to correspond to a plagioclase-rich early-arc cumulate. Given that assimilation affects lavas that were last stored at more than 5 kbar, assimilation must occur in the middle-lower crust. Only a high MgO picrite from Grenada escaped obvious assimilation (MgO = 17% wt.%) and could reflect mantle source composition. It has a very radiogenic 87 Sr/ 86 Sr (0.705) but a 187 Os/ 188 Os ratio that overlaps the mantle range (0.127). 187 Os/ 188 Os and 87 Sr/ 88 Sr ratios of the sediments and an altered basalt from the subducting slab vary from 0.18 to 3.52 and 0.708 to 0.714. We therefore suggest that, unlike Sr, no Os from the slab was transferred to the parental magmas. Os may be either retained in the mantle wedge or even returned to the deep mantle in the subducting slab. [ABSTRACT FROM AUTHOR]