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Buchanan IA, Lin M, Donoho DA, Patel A, Ding L, Amar AP, Giannotta SL, Mack WJ, Attenello F. Predictors of Venous Thromboembolism After Nonemergent Craniotomy: A Nationwide Readmission Database Analysis. World Neurosurg 2018; 122:e1102-e1110. [PMID: 30465948 DOI: 10.1016/j.wneu.2018.10.237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is responsible for many hospital readmissions each year, particularly among postsurgical cohorts. Because early and indiscriminate VTE prophylaxis carries catastrophic consequences in postcraniotomy cohorts, identifying factors associated with a high risk for thromboembolic complications is important for guiding postoperative management. OBJECTIVE To determine VTE incidence in patients undergoing nonemergent craniotomy and to evaluate for factors that predict 30-day and 90-day readmission with VTE. METHODS The 2010-2014 cohorts of the Nationwide Readmissions Database were used to generate a large heterogeneous craniotomy sample. RESULTS There were 89,450 nonemergent craniotomies that met inclusion criteria. Within 30 days, 1513 patients (1.69%) were readmitted with VTE diagnoses; among them, 678 (44.8%) had a diagnosis of deep vein thrombosis alone, 450 (29.7%) had pulmonary embolism alone, and 385 (25.4%) had both. The corresponding 30-day deep vein thrombosis and pulmonary embolism incidences were 1.19% and 0.93%, respectively. In multivariate analysis, several factors were significantly associated with VTE readmission, namely, craniotomy for tumor, corticosteroids, advanced age, greater length of stay, and discharge to institutional care. CONCLUSIONS Craniotomies for tumor, corticosteroids, advanced age, prolonged length of stay, and discharge to institutional care are significant predictors of VTE readmission. The implication of steroids, coupled with their ubiquity in neurosurgery, makes them a potentially modifiable risk factor and a prime target for VTE reduction in craniotomy cohorts. Furthermore, the fact that dose is proportional to VTE risk in the literature suggests that careful consideration should be given toward decreasing regimens in situations in which use of a lower dose might prove equally sufficient.
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Affiliation(s)
- Ian A Buchanan
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
| | - Michelle Lin
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Daniel A Donoho
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Arati Patel
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Li Ding
- Departments of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Arun P Amar
- Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Steven L Giannotta
- Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - William J Mack
- Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Frank Attenello
- Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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202
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Swan D, Rocci A, Bradbury C, Thachil J. Venous thromboembolism in multiple myeloma - choice of prophylaxis, role of direct oral anticoagulants and special considerations. Br J Haematol 2018; 183:538-556. [DOI: 10.1111/bjh.15684] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/18/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Dawn Swan
- Department of Haematology; University Hospital Galway; Galway Republic of Ireland
| | - Alberto Rocci
- Department of Haematology; Manchester University Hospitals NHS Foundation Trust; Manchester United Kingdom
- Faculty of Biology, Medicine and Health; School of Medical Science; Division of Cancer Science; University of Manchester; Manchester United Kingdom
| | - Charlotte Bradbury
- Cellular and Molecular Medicine; University of Bristol; Bristol United Kingdom
- Bristol Haematology and Oncology Centre; University Hospitals Bristol NHS Foundation Trust; Bristol United Kingdom
| | - Jecko Thachil
- Department of Haematology; Manchester University Hospitals NHS Foundation Trust; Manchester United Kingdom
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203
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Sundbøll J, Darvalics B, Horváth-Puhó E, Adelborg K, Laugesen K, Schmidt M, Henderson VW, Sørensen HT. Preadmission use of glucocorticoids and risk of cardiovascular events in patients with ischemic stroke. J Thromb Haemost 2018; 16:2175-2183. [PMID: 30179297 DOI: 10.1111/jth.14283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Indexed: 01/30/2023]
Abstract
Essentials The risk of thrombosis among ischemic stroke patients using glucocorticoids is unknown. We examined the risk of thrombosis in 98 487 ischemic stroke patients, by glucocorticoid use. Myocardial infarction and venous thromboembolism risk was increased in glucocorticoid users. Hemorrhagic stroke risk was lower and recurrent ischemic stroke the same in glucocorticoid users. SUMMARY: Background Glucocorticoid users have a high mortality rate following stroke, but the underlying clinical pathways are poorly understood. Objectives To examine the risk of cardiovascular events among ischemic stroke patients using glucocorticoids. Methods We conducted a nationwide population-based cohort study by using medical registries in Denmark. We identified all patients hospitalized with a first-time ischemic stroke (2004-2013). We categorized glucocorticoid use into current use (last prescription redemption ≤ 90 days before admission), former use, and non-use. With non-users as reference, we studied the risks of recurrent ischemic stroke, hemorrhagic stroke, myocardial infarction and venous thromboembolism associated with glucocorticoid use. Comorbidity and comedication-adjusted 1-year hazard ratios (aHRs) with 95% confidence intervals (CIs) were computed on the basis of Cox regression analysis. Results We identified 98 487 patients with a first-time (index) ischemic stroke. After the index stroke, the 1-year cumulative incidence of recurrent ischemic stroke was 16.4% among current glucocorticoid users, whereas risks were lower for hemorrhagic stroke (0.46%), myocardial infarction (1.35%), and venous thromboembolism (0.98%). Among current glucocorticoid users, aHRs were increased for myocardial infarction (1.32, 95% CI 0.98-1.76) and venous thromboembolism (1.39, 95% CI 0.99-1.94), whereas the risk of hemorrhagic stroke was reduced (aHR 0.60, 95% CI 0.38-0.93). There was no association with recurrent ischemic stroke (aHR 1.01, 95% CI 0.94-1.09). Conclusions During the first year after ischemic stroke, current glucocorticoid use was associated with moderately increased risks of myocardial infarction and venous thromboembolism, and a lower risk of hemorrhagic stroke, whereas the risk of recurrent ischemic stroke was not affected.
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Affiliation(s)
- J Sundbøll
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - B Darvalics
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - E Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - K Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - K Laugesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - M Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
| | - V W Henderson
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Departments of Health Research and Policy (Epidemiology) and Neurology and Neurological Sciences, Stanford, CA, USA
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA, USA
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204
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Song T, Li X, Liu Y, Zhang X. Prevalence and risk factors of deep venous thrombosis in patients with longitudinally extensive transverse myelitis: one center data from China. BMC Neurol 2018; 18:179. [PMID: 30376813 PMCID: PMC6206719 DOI: 10.1186/s12883-018-1178-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/16/2018] [Indexed: 12/28/2022] Open
Abstract
Objective Deep venous thrombosis (DVT) is a severe complication in longitudinally extensive transverse myelitis (LETM) patients. It may interfere with LETM treatment and delay the recovery of the spinal dysfunction. However, there is less data about the prevalence and risk factors of DVT in patients with LETM. We analyzed data retrospectively to ascertain the prevalence of DVT and the clinical risk factors for DVT. Methods Clinical data on 255 LETM patients were collected from medical records. All patients were performed color Doppler ultrasound(US) to screen DVT in both lower extremities when admitted. Clinical characteristics of LETM patients with DVT were compared with those without DVT using corresponding statistical methods. Multivariate logistic regression was performed to identify risk factors related to DVT. Results DVT were found in 11.8% patients with LETM. Univariate analysis showed that age, muscle force and elevated baseline D-dimer were risk factors for DVT. After multivariate logistic regression, age, dyslipidemia, segments of lesions, and elevated baseline D-dimer remained significant independent risk factors. Conclusions DVT is common in patients with LETM and related to patient’s age, dyslipidemia, segments of lesions, and elevated baseline D-dimer. Early recognition of DVT and thrombosis prophylaxis are appropriate in patients with LETM.
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Affiliation(s)
- Tian Song
- Neuroinfection and Neuroimmunology Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 6 TiantanXili, Dongcheng District, Beijing, 100050, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 6 TiantanXili, Dongcheng District, Beijing, 100050, People's Republic of China
| | - Xindi Li
- Neuroinfection and Neuroimmunology Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 6 TiantanXili, Dongcheng District, Beijing, 100050, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 6 TiantanXili, Dongcheng District, Beijing, 100050, People's Republic of China
| | - Yonghong Liu
- Department of Neurology, Beijing Rehabilitation Hospital, Capital Medical University,Xixiazhuang, Shijingshan District, Beijing, 100050, People's Republic of China
| | - Xinghu Zhang
- Neuroinfection and Neuroimmunology Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 6 TiantanXili, Dongcheng District, Beijing, 100050, People's Republic of China. .,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 6 TiantanXili, Dongcheng District, Beijing, 100050, People's Republic of China.
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205
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Ahmed O, Geraldes R, DeLuca GC, Palace J. Multiple sclerosis and the risk of systemic venous thrombosis: A systematic review. Mult Scler Relat Disord 2018; 27:424-430. [PMID: 30642566 DOI: 10.1016/j.msard.2018.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/13/2018] [Accepted: 10/13/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Omnya Ahmed
- Rheumatology department, Royal Berkshire NHS Foundation Trust, Reading, UK.
| | - Ruth Geraldes
- Neuropathology Department, Oxford University Hospitals, Oxford, UK; Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
| | - Gabriele C DeLuca
- Neuropathology Department, Oxford University Hospitals, Oxford, UK; Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
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206
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Imanishi J, Iseri M, Motoki M, Yoshikawa S, Sone N, Honjo T, Kamemura K, Kaihotsu K, Iwahashi M. An Unusual Case of Inferior Vena Cava Thrombosis in a Healthy Male Bodybuilder. Intern Med 2018; 57:2517-2521. [PMID: 29709932 PMCID: PMC6172542 DOI: 10.2169/internalmedicine.0377-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Inferior vena cava (IVC) thrombosis is very rare, particularly in the absence of an apparent congenital caval abnormality or hypercoagulable state. We herein report an unusual case of a healthy and active 62-year-old male bodybuilder with a mass-like IVC thrombus. We placed an IVC filter and began treatment with rivaroxaban. The patient recovered successfully, and the IVC thrombus completely disappeared three months later. This case suggested that extrinsic compression of IVC by a tightened weightlifting belt around the abdomen is a triggering factor of IVC thrombosis, and rivaroxaban, a new oral anticoagulant, may be a useful option for treatment.
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Affiliation(s)
- Junichi Imanishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, Japan
| | - Michiko Iseri
- Department of Clinical Laboratory, Shinko Hospital, Japan
| | | | - Sachiko Yoshikawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, Japan
| | - Naohiko Sone
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, Japan
| | - Tomoyuki Honjo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, Japan
| | - Kohei Kamemura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, Japan
| | - Kenji Kaihotsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, Japan
| | - Masanori Iwahashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, Japan
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207
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Temraz S, Tamim H, Mailhac A, Taher A. Could sodium imbalances predispose to postoperative venous thromboembolism? An analysis of the NSQIP database. Thromb J 2018; 16:11. [PMID: 29988709 PMCID: PMC6029156 DOI: 10.1186/s12959-018-0165-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/01/2018] [Indexed: 12/16/2022] Open
Abstract
Background Hyponatremia is common among patients with pulmonary embolism, while hypernatremia increases the risk of venous thromboembolism (VTE). Our objective was to evaluate the association between sodium imbalances and the incidence of VTE and other selected perioperative outcomes. Methods We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and identified 1,108,704 patients undergoing major surgery from 2008 to 2012. We evaluated 30-day perioperative outcomes, including mortality and cardiac, respiratory, neurological, urinary, wound, and VTE outcomes. Multivariate logistic regressions were used to estimate the odds of 30-day perioperative outcomes. Results Compared with the normal sodium group, in which VTE occurred in 1.0% of patients, 1.8% of patients in the hyponatremia group (unadjusted odds ratio (OR) 1.84) and 2.4% of patients in the hypernatremia group (unadjusted OR 2.49) experienced VTE. Crude mortality was 1.3% in the normal sodium group, 4.9% in the hyponatremia group (unadjusted OR 3.93) and 8.4% in the hypernatremia group (unadjusted OR 7.01). Crude composite morbidity was 7.1% for the normal sodium group, 16.7% for the hyponatremia group (unadjusted OR 2.63) and 20.6% for the hypernatremia group (unadjusted OR 3.43). After adjusting for potential confounders, hyponatremia and hypernatremia remained significantly and independently associated with an increased risk of VTE (adjusted OR 1.43 and 1.56, respectively), mortality (adjusted OR 1.39 and 1.39, respectively) and composite morbidity (adjusted OR 2.15 and 3.34, respectively). Conclusions Pre-operative hyponatremia and hypernatremia are potential prognostic markers for perioperative 30-day morbidity, mortality and VTE.
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Affiliation(s)
- Sally Temraz
- 1Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh 110 72020, Beirut, Lebanon
| | - Hani Tamim
- 1Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh 110 72020, Beirut, Lebanon
| | - Aurelie Mailhac
- 2Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Taher
- 1Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh 110 72020, Beirut, Lebanon
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208
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Nonaka D, Takase H, Machii M, Ohno K. Effect of combined therapy with catheter-directed thrombolysis and factor Xa inhibitor for inferior vena cava thrombosis: A case report. Medicine (Baltimore) 2018; 97:e11221. [PMID: 29995753 PMCID: PMC6076200 DOI: 10.1097/md.0000000000011221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Inferior vena cava (IVC) thrombosis is an under-recognized entity that is associated with a mortality rate approaching twice that of lower extremity deep venous thrombosis (DVT). Thrombolytic therapy not only results in greater lysis, but also results in higher complication rates than anticoagulation alone. Catheter-directed thrombolysis (CDT), which is effective in accomplishing local resolution whilst reducing bleeding complications, has been established as an alternative treatment for patients with extensive DVT. PATIENT CONCERNS We report the case of a 70-year-old man who was admitted due to warmness, pain, and swelling in his left leg and a feeling of gait disturbance. DIAGNOSES Contrast-enhanced computed tomography and venous ultrasonography revealed a pulmonary embolism and extensive DVT spreading to the IVC. INTERVENTIONS First, the patient was treated with fondaparinux. Since this was inadequate, he underwent CDT using a Fountain infusion catheter. Then, CDT was switched to direct oral anticoagulant (DOAC) treatment. OUTCOMES Both CDT and subsequent DOAC treatments dramatically improved the DVT. His subjective symptoms have disappeared, and no recurrence of thrombosis has been identified. LESSONS The present case showed the therapeutic effect of CDT, which preceded DOAC treatment, on an extensive DVT.
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209
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Facteurs de risque de maladie thromboembolique dans les myopathies inflammatoires : résultats d’une étude rétrospective multicentrique sur 203 patients. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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210
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Iida T, Ikeya K, Kato M, Abe J, Yamamoto M, Watanabe F, Sugimoto K, Hanai H. Adsorptive Depletion of Myeloid Lineage Leucocytes as Remission Induction Therapy in Patients with Ulcerative Colitis after Failure of First-Line Medications: Results from a Three-Year Real World, Clinical Practice. Digestion 2018; 96:119-126. [PMID: 28796990 DOI: 10.1159/000479502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/17/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS In patients with active ulcerative colitis (UC), pharmacologics, although initially effective in most patients, are associated with refractoriness, loss of response or unfavourable side effects as additional morbidity factors. Depletion of myeloid lineage leucocytes like the CD14(+)CD16(+) monocyte phenotype, which is a major source of tumour necrosis factor-α, by granulocyte/monocyte apheresis (GMA) if effective, is also known to be free from side effects. METHODS In clinical practice setting, 77 consecutive patients with moderate to severe UC, who failed to respond to first-line medications received GMA with the Adacolumn as remission induction therapy. Patients who achieved remission were followed for 3 years. RESULTS Among the 77 patients, 46.8% were corticosteroids-naïve, 26% corticosteroid-dependent and 27.3% corticosteroid-refractory. The overall clinical remission rate was 79.2%, and the overall mucosal healing (MH) rate according to the Mayo endoscopic subscore ≤1 was 58.5%. MH rates in corticosteroid-naïve, corticosteroid-dependent and corticosteroid-refractory subgroups were 70.8, 56.3, and 38.5%, respectively. The 3-year sustained clinical remission rates in corticosteroid-naïve, corticosteroid-dependent and corticosteroid-refractory subgroups were 83.3, 68.8, and 23.1%, respectively. CONCLUSION Corticosteroid-naïve patients appeared to benefit the most from the Adacolumn GMA, and attain a favourable long-term clinical course. Accordingly, GMA should be a first-line therapy in this clinical setting.
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Affiliation(s)
- Takayuki Iida
- Centre for Gastroenterology and Inflammatory Bowel Disease Research, Hamamatsu South Hospital, Hamamatsu, Japan
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211
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Boonpheng B, Ungprasert P. Risk of venous thromboembolism in patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2018; 35:109-114. [PMID: 32476889 DOI: 10.36141/svdld.v35i2.6213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/31/2017] [Indexed: 01/11/2023]
Abstract
Background: Recent studies have suggested that patients with idiopathic pulmonary fibrosis (IPF) may have a higher risk of venous thromboembolism (VTE) compared to general population even though the results were inconsistent. Objective: To investigate the risk of VTE among patients with IPF. Methods: Comprehensive literature review using MEDLINE and EMBASE database were performed to identify studies that compared the risk of VTE among patients with IPF to general population. Effect estimates from each study were combined together using random effect model, generic inverse variance method of DerSimonian and Laird. Results: Out of 510 retrieved articles, 5 studies met the inclusion criteria and were included in the meta-analysis. A significant risk of VTE in patients with IPF was observed with the pooled risk ratio of 2.11 (95% confidence interval, 1.28-3.48). The heterogeneity was moderate with I2 of 64%. Conclusion: An approximately 2-fold increased risk of VTE among patients with IPF was observed in this meta-analysis. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 109-114).
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Affiliation(s)
- Boonphiphop Boonpheng
- Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Patompong Ungprasert
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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212
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Erben Y, Miller SM, Sumpio BJ, Dillon BJ, Lee AI, Blume P, Sumpio BE, Mena-Hurtado C. Acute Limb Ischemia in an 8-Year-Old Patient: A Case Report. Ann Vasc Surg 2018; 51:327.e1-327.e8. [PMID: 29655809 DOI: 10.1016/j.avsg.2018.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
We report the case of an 8-year-old patient with a history of nephrotic syndrome, who presented to the emergency department with right foot pain. The patient's mother described intermittent pain that woke her son from sleep and was accompanied by the foot turning purple and becoming cold to touch. Physical examination revealed capillary refill of over 10 seconds in the right and less than 2 seconds in the left foot. Ankle-brachial indices (ABIs) were 0.0 on the right and 0.96 on the left. The patient was admitted and started on therapeutic intravenous heparin. After consultation with his parents, right lower extremity angiography and thrombolysis was performed over 2 days. He subsequently underwent fasciotomy and amputation of the tip of all 5 toes. Eighteen months later, there is no leg length discrepancy, he is walking with foot inserts and has normal ABIs bilaterally.
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Affiliation(s)
- Young Erben
- Section of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT.
| | - Samuel M Miller
- Warren Alpert Medical School at Brown University, Providence, RI
| | - Brandon J Sumpio
- Section of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT
| | - Brian J Dillon
- Section of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Alfred I Lee
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Peter Blume
- Department of Orthopedic Surgery and Anesthesia, Yale University School of Medicine, New Haven, CT; Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Bauer E Sumpio
- Section of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT
| | - Carlos Mena-Hurtado
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
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213
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Sarlos P, Szemes K, Hegyi P, Garami A, Szabo I, Illes A, Solymar M, Petervari E, Vincze A, Par G, Bajor J, Czimmer J, Huszar O, Varju P, Farkas N. Steroid but not Biological Therapy Elevates the risk of Venous Thromboembolic Events in Inflammatory Bowel Disease: A Meta-Analysis. J Crohns Colitis 2018; 12:489-498. [PMID: 29220427 DOI: 10.1093/ecco-jcc/jjx162] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease [IBD] is associated with a 1.5- to 3-fold increased risk of venous thromboembolism [VTE] events. The aim of this study was to determine the risk of VTE in IBD as a complication of systemic corticosteroids and anti-tumour necrosis factor alpha [TNFα] therapies. METHODS A systematic review and meta-analysis was conducted, which conforms to the Preferred Reporting Items for Systematic Reviews and Meta-analyses [PRISMA] statement. PubMed, EMBASE, Cochrane Library and Web of Science were searched for English-language studies published from inception inclusive of 15 April 2017. The population-intervention-comparison-outcome [PICO] format and statistically the random-effects and fixed-effect models were used to compare VTE risk during steroid and anti-TNFα treatment. Quality of the included studies was assessed using the Newcastle-Ottawa scale. The PROSPERO registration number is 42017070084. RESULTS We identified 817 records, of which eight observational studies, involving 58518 IBD patients, were eligible for quantitative synthesis. In total, 3260 thromboembolic events occurred. Systemic corticosteroids were associated with a significantly higher rate of VTE complication in IBD patients as compared to IBD patients without steroid medication (odds ratio [OR]: 2.202; 95% confidence interval [CI]: 1.698-2.856, p < 0.001). In contrast, treatment with anti-TNFα agents resulted in a 5-fold decreased risk of VTE compared to steroid medication [OR: 0.267; 95% CI: 0.106-0.674, p = 0.005]. CONCLUSION VTE risk should be carefully assessed and considered when deciding between anti-TNFα and steroids in the management of severe flare-ups. Thromboprophylaxis guidelines should be followed, no matter the therapy choice.
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Affiliation(s)
- Patricia Sarlos
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary.,Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Kata Szemes
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Peter Hegyi
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary.,Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,Hungarian Academy of Sciences-University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary
| | - Andras Garami
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Imre Szabo
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Anita Illes
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Margit Solymar
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Erika Petervari
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Aron Vincze
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Gabriella Par
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Judit Bajor
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Jozsef Czimmer
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Orsolya Huszar
- First Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Peter Varju
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Institute of Bioanalysis, University of Pécs, Pécs, Hungary
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214
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Sung PH, Chiang HJ, Yang YH, Chiang JY, Chen CJ, Yip HK, Lee MS. Nationwide study on the risk of unprovoked venous thromboembolism in non-traumatic osteonecrosis of femoral head. INTERNATIONAL ORTHOPAEDICS 2018. [PMID: 29541810 DOI: 10.1007/s00264-018-3866-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Endothelial dysfunction is a risk factor for osteonecrosis of femoral head (ONFH) and venous thromboembolism (VTE) [defined as deep venous thrombosis (DVT) or pulmonary embolism (PE)]. However, the risk of unprovoked VTE in non-traumatic ONFH patients remains unclear. METHODS We investigated the relationship between ONFH and VTE using Taiwan National Health Insurance Research Database (NHIRD). Between 1997 and 2010, a total of 1514 non-traumatic ONFH patients were identified from 1,000,000 general populations after excluding initially concomitant diagnoses of DVT and PE, and subjects undergoing lower limb surgery within one year since enrollment. The comparison group (n = 15,140) without ONFH was set up by matching study cohort with age, gender, income and urbanization in a 1:10 ratio. Subjects diagnosed with VTE within one year after surgery were also excluded. RESULTS The patients with non-traumatic ONFH had significantly higher frequency of unprovoked VTE, including DVT, than general population (1.19 vs. 0.5%, p < 0.0007), whereas the frequency of PE was similar between these two groups (p = 0.4922). The cumulative incidence of VTE and DVT was also remarkably higher in the ONFH than non-ONFH group (all p < 0.001). After adjusting for age, gender, medications and comorbidities with multivariate analysis, the ONFH patients had a 2.3-fold increase in risk of DVT compared with non-ONFH counterparts (95% CI 1.28 to 4.13, p = 0.0053). Apart from ONFH, age > 65 years and hypertension were also identified as risk factors for DVT occurrence. CONCLUSIONS The incidence and risk of unprovoked VTE were significantly increased in the non-traumatic ONFH population.
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Affiliation(s)
- Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist, Kaohsiung city, 83301, Taiwan, Republic of China
| | - Hsin-Ju Chiang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Chung Shan Medical University School of Medicine, Taichung, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Jen Chen
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist, Kaohsiung city, 83301, Taiwan, Republic of China. .,Institute for Translational Research in Biomedicine, Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. .,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan. .,Department of Nursing, Asia University, Taichung, Taiwan.
| | - Mel S Lee
- Department of Orthopedics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist, Kaohsiung city, 83301, Taiwan, Republic of China.
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215
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Thromboembolism with Janus Kinase (JAK) Inhibitors for Rheumatoid Arthritis: How Real is the Risk? Drug Saf 2018; 41:645-653. [DOI: 10.1007/s40264-018-0651-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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216
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Horstman H, Gruhl J, Smith L, Ganti AK, Shonka NA. Safety of long-term anticoagulation in patients with brain metastases. Med Oncol 2018; 35:43. [DOI: 10.1007/s12032-018-1101-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/23/2018] [Indexed: 11/29/2022]
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217
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Wu Y, Sun Y, Wei X, Zhang L, Han T, Zhao Z, Zhou J, Jing Z. Relationship between serum cortisol level and degree of false lumen thrombosis in patients with uncomplicated type B aortic dissection. Sci Rep 2018; 8:1215. [PMID: 29352180 PMCID: PMC5775319 DOI: 10.1038/s41598-018-19691-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/08/2018] [Indexed: 12/01/2022] Open
Abstract
Partial thrombosis of the false lumen in uncomplicated type B aortic dissection (uTBAD) is associated with an increased late mortality risk. Whether the serum cortisol level can affect false lumen thrombosis in patients with uTBAD has not been well characterized. This study was performed on 87 patients with uTBAD. A curve-fitting method was used to analyze the relationship between serum cortisol and partial thrombosis of false lumen. Univariate and multivariate logistic regression analyses were used to identify false lumen partial thrombosis–associated serum cortisol. Curve-fitting’s result revealed a characteristic U shape, and 14.0 µg/dL was considered as the cutoff point for serum cortisol. The results of univariate and multivariate logistic regression analyses suggested that when trisecting the serum cortisol level into three parts, the low and high levels of serum cortisol could significantly affect the occurrence of false lumen partial thrombosis compared with the middle level. The odds ratio value of the low and high levels of serum cortisol was 6.12 and 4.65, respectively, in the univariate analysis, and 24.32 and 3.93, respectively, in the multivariate analysis. Low or high levels of serum cortisol might influence the natural result of uTBAD through affecting the false lumen thrombosis.
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Affiliation(s)
- Yani Wu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.,Department of Breast and Thyroid Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yudong Sun
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Xiaolong Wei
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Tonglei Han
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Zhiqing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.
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218
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Branchford BR, Carpenter SL. The Role of Inflammation in Venous Thromboembolism. Front Pediatr 2018; 6:142. [PMID: 29876337 PMCID: PMC5974100 DOI: 10.3389/fped.2018.00142] [Citation(s) in RCA: 220] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/27/2018] [Indexed: 12/12/2022] Open
Abstract
Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT), and pulmonary embolism (PE), is becoming increasingly recognized as a cause of morbidity and mortality in pediatrics, particularly among hospitalized children. Furthermore, evidence is accumulating that suggests the inflammatory response may be a cause, as well as consequence, of VTE, but current anticoagulation treatment regimens are not designed to inhibit inflammation. In fact, many established clinical VTE risk factors such as surgery, obesity, cystic fibrosis, sepsis, systemic infection, cancer, inflammatory bowel disease, and lupus likely modulate thrombosis through inflammatory mediators. Unlike other traumatic mechanisms of thrombosis involving vascular transection and subsequent exposure of subendothelial collagen and other procoagulant extracellular matrix materials, inflammation of the vessel wall may initiate thrombosis on an intact vein. Activation of endothelial cells, platelets, and leukocytes with subsequent formation of microparticles can trigger the coagulation system through the induction of tissue factor (TF). Identification of biomarkers to evaluate VTE risk could be of great use to the clinician caring for a patient with inflammatory disease to guide decisions regarding the risk:benefit ratio of various types of potential thromboprophylaxis strategies, or suggest a role for anti-inflammatory therapy. Unfortunately, no such validated inflammatory scoring system yet exists, though research in this area is ongoing. Elevation of C-reactive protein, IL-6, IL-8, and TNF-alpha during a response to systemic inflammation have been associated with increased VTE risk. Consequent platelet activation enhances the prothrombotic state, leading to VTE development, particularly in patients with other risk factors, most notably central venous catheters.
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Affiliation(s)
- Brian R Branchford
- University of Colorado Hemophilia and Thrombosis Center, Pediatric Hematology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Shannon L Carpenter
- Kansas City Regional Hemophilia Treatment Center, Pediatric Hematology, UMKC School of Medicine and Children's Mercy Hospital, Kansas, CO, United States
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219
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Ungprasert P, Wijarnpreecha K, Thongprayoon C. Risk of venous thromboembolism in patients with bullous pemphigoid: A systematic review and meta-analysis. Indian J Dermatol Venereol Leprol 2018; 84:22-26. [DOI: 10.4103/ijdvl.ijdvl_827_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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220
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Pedersen AB, Ehrenstein V, Szépligeti SK, Sørensen HT. Excess risk of venous thromboembolism in hip fracture patients and the prognostic impact of comorbidity. Osteoporos Int 2017; 28:3421-3430. [PMID: 28871320 DOI: 10.1007/s00198-017-4213-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 08/25/2017] [Indexed: 12/21/2022]
Abstract
UNLABELLED Hip fracture patients were at increased excess risk of venous thromboembolism (VTE) up to 1 year following hip fracture. During the first year, interaction between hip fracture and comorbidity was observed among patients with severe and very severe comorbidity. INTRODUCTION We compared the risk of VTE in hip fracture patients with that in the general population. We also examined whether and to what extent the association between hip fracture and VTE varied by comorbidity level. METHODS Nationwide cohort study based on Danish health registries, 1995-2015. We identified hip fracture patients (n = 110,563) and sampled a comparison cohort without hip fracture from the general population (n = 552,774). Comorbidity was assessed using the Charlson comorbidity index. We calculated attributable fraction, as the proportion of the VTE rate, among persons exposed to both hip fracture and comorbidity, attributed to exposure interaction. RESULTS The cumulative incidences of VTE were 0.73% within 30 days and 0.83% within 31-365 days among hip fracture patients, and 0.05 and 0.43% in the general population. Adjusted hazard ratios (HRs) of VTE among hip fracture patients were 17.29 [95% confidence interval (CI) 14.74-20.28] during the first 30 days and 2.13 (95% CI 1.95-2.32) during 31-365 days following hip fracture. The relative risks of VTE were 1.03 (95% CI 0.96-1.11) and 1.11 (95% CI 1.00-1.23) after 1-5 years and 6-10 years. During the first 30 days and 31-365 days, 14%/28% of VTE rates and 5%/4% of VTE rates were attributable to the interaction between hip fracture and severe/very severe comorbidity, respectively. Mortality risks within 30 days of VTE were 29.4% in hip fracture and 11.0% in general population cohorts. CONCLUSIONS Hip fracture patients were at increased excess risk of VTE up to 1 year following their fracture. During the first year, interaction between hip fracture and comorbidity was observed among patients with severe and very severe comorbidity.
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Affiliation(s)
- A B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - V Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - S K Szépligeti
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
- Department of Health Research & Policy (Epidemiology), Stanford University, Stanford, CA, USA
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221
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Carretón E, Morchón R, Montoya-Alonso JA. Cardiopulmonary and inflammatory biomarkers in heartworm disease. Parasit Vectors 2017; 10:534. [PMID: 29143665 PMCID: PMC5688449 DOI: 10.1186/s13071-017-2448-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In heartworm disease, several biomarkers of cardiopulmonary injury and inflammatory activity have been studied during the recent years. D-dimer is a fibrin degradation product present after a clot is degraded, which has been reported to provide support for the diagnosis of pulmonary thromboembolism in heartworm disease. Furthermore, concentrations increment with increased disease severity and during the adulticide treatment. This increase in concentration has proved to be valuable. Cardiac biomarkers troponin I, myoglobin and NT-proBNP demonstrated presence of myocardial injury and heart failure, especially in chronic infections, which in some cases, slightly improve after the adulticide treatment. An acute phase response in dogs with Dirofilaria immitis, characterized by variations of acute phase proteins (APP), has been reported, indicating inflammatory processes that could contribute to disease progression. Among them, C-reactive protein (CRP) increases according to the severity of the disease; and a strong correlation between pulmonary hypertension and CRP has been observed. In cats, little work has been done to ascertain the utility of these biomarkers in feline heartworm; the only published study in D. immitis–seropositive cats reported significantly higher concentrations in positive APP serum amyloid A, haptoglobin and ceruloplasmin.
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Affiliation(s)
- Elena Carretón
- Faculty of Veterinary Medicine, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Trasmontaña s/n, 35413-Arucas, Las Palmas, Spain.
| | - Rodrigo Morchón
- Laboratory of Parasitology, Faculty of Pharmacy, Institute of Biomedical Research of Salamanca(IBSAL), University of Salamanca, Salamanca, Spain
| | - José Alberto Montoya-Alonso
- Faculty of Veterinary Medicine, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Trasmontaña s/n, 35413-Arucas, Las Palmas, Spain
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222
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Yoon WK, Kim YW, Suh SIL, Choi R, Lee SG, Hyun C. Evaluation of cardiopulmonary and inflammatory markers in dogs with heartworm infection during treatment with the 2014 American Heartworm Society recommended treatment protocol. Parasit Vectors 2017; 10:535. [PMID: 29143684 PMCID: PMC5688508 DOI: 10.1186/s13071-017-2427-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Heartworm disease in dogs is a life-threatening parasitic disease. Although adulticide treatment with melarsomine has been proven to be the most effective, complications associated with adulticide treatment are major concerns for clinicians. Methods This study evaluated the change in levels of D-dimer, interleukin-6, C-reactive protein and cardiac troponin I in 12 dogs with different severities of heartworm infection treated by the American Heartworm Society (AHS) recommended protocol during the treatment period. The serum levels of several markers were measured on the day of diagnosis (T-60), before the initiation of melarsomine therapy (T0), 1 day after the first injection (T1), 1 week after the first injection (T7), 1 month after the first injection (T30), 1 day after the second injection (T31), 1 day after the third injection (T32), 1 week after the third injection (T39), 1 month after the third injection (T62), 2 months after the third injection (T92), 3 months after the third injection (T122), and 6 months after the third injection (T182). Results The serum levels of these markers were significantly different at the test time point after melarsomine treatment and also differed significantly according to the stage of heartworm disease in the dogs. Conclusion This study found that monitoring of inflammatory and hemostatic markers in dogs with heartworm disease being treated with melarsomine might be beneficial in predicting the clinical outcomes and complications associated with melarsomine treatment.
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Affiliation(s)
- Won-Kyoung Yoon
- Section of Small Animal Internal Medicine, College of Veterinary Medicine, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea
| | - Ye-Won Kim
- Section of Small Animal Internal Medicine, College of Veterinary Medicine, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea
| | - Sang-I L Suh
- Section of Small Animal Internal Medicine, College of Veterinary Medicine, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea
| | - Ran Choi
- Section of Small Animal Internal Medicine, College of Veterinary Medicine, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea
| | - Seung-Gon Lee
- Section of Small Animal Internal Medicine, College of Veterinary Medicine, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea
| | - Changbaig Hyun
- Section of Small Animal Internal Medicine, College of Veterinary Medicine, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea.
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Smit J, López-Cortés LE, Thomsen RW, Schønheyder HC, Nielsen H, Frøslev T, Rodríguez-Bãno J, Søgaard M. Statin Use and Risk of Community-Acquired Staphylococcus aureus Bacteremia: A Population-Based Case-Control Study. Mayo Clin Proc 2017; 92:1469-1478. [PMID: 28982483 DOI: 10.1016/j.mayocp.2017.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/17/2017] [Accepted: 07/19/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To ascertain whether persons treated with statins experience a decreased risk of community-acquired Staphylococcus aureus bacteremia (CA-SAB) as compared with nonusers. PATIENTS AND METHODS Using population-based medical registries, we conducted a case-control study including all adults with first-time CA-SAB and population controls matched on age, sex, and residence in Northern Denmark from January 1, 2000, through December 31, 2011. Statin users were categorized as current users (new or long-term use), former users, and nonusers. We used conditional logistic regression to compute odds ratios (ORs) for CA-SAB according to statin exposure, overall and stratified by intensity (<20, 20-39, ≥40 mg/d) and duration of use (<365, 365-1094, ≥1095 days). RESULTS We identified 2638 patients with first-time CA-SAB and 26,379 matched population controls. Compared with nonusers, current statin users experienced markedly decreased risk of CA-SAB (adjusted OR, 0.73; 95% CI, 0.63-0.84). The adjusted OR was 0.96 (95% CI, 0.60-1.51) for new users, 0.71 (95% CI, 0.62-0.82) for long-term users, and 1.12 (95% CI, 0.94-1.32) for former users as compared with nonusers. The CA-SAB risk decreased with increasing intensity of statin use; thus, compared with nonusers, the adjusted OR was 0.84 (95% CI, 0.68-1.04) for current users with daily dosages of less than 20 mg/d, 0.71 (95% CI, 0.58-0.87) for 20 to 39 mg/d, and 0.63 (95% CI, 0.49-0.81) for 40 mg/d or more. Conversely, we observed no differences in the risk of CA-SAB with successive increases in the duration of statin use. CONCLUSION Statin use was associated with a decreased risk of CA-SAB, particularly in long-term users.
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Affiliation(s)
- Jesper Smit
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBiS), Hospitales Universitarios Virgen Macarena y Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik C Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesús Rodríguez-Bãno
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBiS), Hospitales Universitarios Virgen Macarena y Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Mette Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University Hospital, Aalborg, Denmark
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Safety Considerations with the Use of Corticosteroids and Biologic Therapies in Mild-to-Moderate Ulcerative Colitis. Inflamm Bowel Dis 2017; 23:1689-1701. [PMID: 28906290 DOI: 10.1097/mib.0000000000001261] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The risk of corticosteroid-associated adverse events can limit the use of systemic corticosteroids. Oral, topically acting, second-generation corticosteroids that deliver drug to the site of inflammation, and biologic therapies, are effective treatment alternatives. The aim of this review was to evaluate the safety and tolerability of topically acting corticosteroids and biologic therapies versus oral systemic corticosteroids for ulcerative colitis (UC). METHODS The PubMed database was searched for clinical and observational trials, systematic reviews, and case reports/series published between January 1950 and September 30, 2016. Search terms used included "corticosteroids," "beclomethasone dipropionate," "budesonide," "infliximab," "adalimumab," "golimumab," and "vedolizumab" in combination with "ulcerative colitis" or "inflammatory bowel disease." RESULTS A total of 582 studies were identified from PubMed searches. Only 1 direct comparative trial for oral topically acting corticosteroids and systemic corticosteroids was available, and no comparative trials versus biologic therapies were identified. In patients with mild-to-moderate UC, short-term (4-8 wk) oral beclomethasone dipropionate or oral budesonide multimatrix system demonstrated safety profiles comparable with placebo with few corticosteroid-related adverse events reported. Based on long-term data in patients with moderate-to-severe UC, biologics have a generally tolerable adverse event profile, although infections, infusion reactions, and autoimmune disorders were frequently reported. CONCLUSIONS Second-generation corticosteroids, beclomethasone dipropionate and budesonide multimatrix system, exhibited a favorable safety profile in patients with mild-to-moderate UC. For biologics, which are only indicated in moderate-to-severe UC, additional studies are needed to further ascertain the benefit to risk profile of these agents in patients with mild-to-moderate disease (see Video Abstract, Supplemental Digital Content, http://links.lww.com/IBD/B653).
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Abstract
Venous thromboembolism (VTE) has a wide range of clinical presentations. Deep venous thrombosis may occur in upper or lower extremities or in visceral veins. Extremity deep venous thrombosis usually manifests with unilateral painful swelling in the limb, while visceral deep venous thrombosis manifestations vary on the basis of the involved organ. Pulmonary embolism classically manifests with sudden pleuritic chest pain and unexplained dyspnea. Superficial thrombophlebitis usually presents with acute inflammation around a palpable thrombosed superficial vein. Risk factors of VTE are either inherited or acquired. The inherited causes of VTE tend to be familial and more common in younger patients. The common acquired risk factors of VTE include previous history of venous thrombosis, immobilization, recent surgery or trauma, malignancy, and pregnancy. Identifying high-risk patients for VTE based on these risk factors is the cornerstone to provide the prophylactic treatment to prevent thrombotic events.
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226
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Iwasaku M, Shinzawa M, Tanaka S, Kimachi K, Kawakami K. Clinical characteristics of adrenal crisis in adult population with and without predisposing chronic adrenal insufficiency: a retrospective cohort study. BMC Endocr Disord 2017; 17:58. [PMID: 28893233 PMCID: PMC5594557 DOI: 10.1186/s12902-017-0208-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 09/05/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Adrenal crisis (AC) occurs in various clinical conditions but previous epidemiological studies in AC are limited to chronic adrenal insufficiency (AI) and sepsis. The aim of this study was to investigate characteristics of AC patients, including predisposing diseases and to describe candidate risk factors for AC such as comorbidities and glucocorticoid (GC) therapy. METHODS We conducted a retrospective cohort study using a claims database on 7.4 million patients from 145 acute care hospitals between January 1, 2003 and April 30, 2014. We identified AC patients who met the following criteria: 1) disease name with ICD-10 corresponded with AI; 2) therapeutic GC administration (hydrocortisone equivalent dose ≥100 mg/day); 3) admission; and 4) age ≥18 years. RESULTS We identified 504 patients with AC (median age, 71 years; interquartile range, 59 to 80; 50.6% male). As predisposing conditions, primary AI and central AI accounted for 23 (4.6%) and 136 patients (27.0%), respectively. In the remaining AC patients (68.5%), comorbidities such as cancer, autoimmune diseases, and renal failure were frequent. The most frequent indication for hospitalization was AC (16.3%), followed by pituitary disease (14.7%), cancer (14.7%), AI-related clinical symptoms (11.5%), and infection (11.1%). Admission under oral GC treatment was reported in 104 patients (20.6%). Twenty-six patients were admitted within 14 days after GC cessation (5.2%). CONCLUSIONS These findings present an overview of patients with AC in general practice settings, clarifying that predisposing factors for AC were complicated and that patients other than those with chronic AI were older and had more comorbid conditions than those with primary and central AI.
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Affiliation(s)
- Masahiro Iwasaku
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Maki Shinzawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Kimihiko Kimachi
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
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227
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Fraisse C, Nouvier M, Lainez S, Nesme P, Ernesto S, Devouassoux G. [Pulmonary embolism as a presentation of nephrotic syndrome]. Rev Mal Respir 2017; 34:765-769. [PMID: 28844809 DOI: 10.1016/j.rmr.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 12/13/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nephrotic syndrome (NS) in adults is defined by proteinuria>3g/24h or 50mg/kg/d, hypoproteinemia<60g/24h and hypoalbuminemia<30g/L. The final diagnosis is guided by the histopathology evidence when a renal biopsy is possible. The consequences of NS are multiple: high blood pressure, undernutrition, infections and a hypercoagulable state. OBSERVATION We report the case of a patient presenting with thromboembolic disease, occurring in the absence of other thromboembolic risk factors, which revealed NS with spontaneously favorable evolution. CONCLUSION Thromboembolic disease in NS is frequent but underestimated and may remain underdiagnosed. Thorough investigation - including serum protein levels and testing for proteinuria - are essential in thromboembolism, as is excluding cancer or another cause. The treatment of thromboembolic disease in NS is based on anticoagulation for as long as the NS persists. There is no consensus about primary prophylaxis but an albumin level below 20g/L should be considered as a risk factor of thrombosis and prophylactic anticoagulation should be started.
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Affiliation(s)
- C Fraisse
- Service de pneumologie, bâtiment I, hôpital de la Croix-Rousse, groupement hospitalier nord, hospices civils de Lyon et université Claude-Bernard Lyon 1, 103, grande-rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - M Nouvier
- Service de néphrologie hôpital Lyon sud, groupement hospitalier sud, hospices civils de Lyon et université Claude-Bernard Lyon 1, France
| | - S Lainez
- Service de pneumologie, bâtiment I, hôpital de la Croix-Rousse, groupement hospitalier nord, hospices civils de Lyon et université Claude-Bernard Lyon 1, 103, grande-rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - P Nesme
- Service de pneumologie, bâtiment I, hôpital de la Croix-Rousse, groupement hospitalier nord, hospices civils de Lyon et université Claude-Bernard Lyon 1, 103, grande-rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - S Ernesto
- Service de pneumologie, bâtiment I, hôpital de la Croix-Rousse, groupement hospitalier nord, hospices civils de Lyon et université Claude-Bernard Lyon 1, 103, grande-rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - G Devouassoux
- Service de pneumologie, bâtiment I, hôpital de la Croix-Rousse, groupement hospitalier nord, hospices civils de Lyon et université Claude-Bernard Lyon 1, 103, grande-rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
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228
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Venous thromboembolism in patients with pemphigus: A cohort study. J Am Acad Dermatol 2017; 77:256-260. [DOI: 10.1016/j.jaad.2017.01.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 01/01/2023]
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229
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Moulis G, Lapeyre-Mestre M, Adoue D, Sailler L. Épidémiologie et pharmacoépidémiologie du purpura thrombopénique immunologique. Rev Med Interne 2017; 38:444-449. [DOI: 10.1016/j.revmed.2016.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/04/2016] [Accepted: 12/22/2016] [Indexed: 02/06/2023]
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230
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Watanabe T, Oku K, Amengual O, Hisada R, Ohmura K, Nakagawa I, Shida H, Bohgaki T, Horita T, Yasuda S, Atsumi T. Effects of statins on thrombosis development in patients with systemic lupus erythematosus and antiphospholipid antibodies. Lupus 2017; 27:225-234. [DOI: 10.1177/0961203317716787] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- T Watanabe
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Oku
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - O Amengual
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - R Hisada
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Ohmura
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - I Nakagawa
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Shida
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Bohgaki
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Horita
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - S Yasuda
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Atsumi
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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231
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Ahlehoff O, Wu JJ, Raunsø J, Kristensen SL, Khalid U, Kofoed K, Gislason G. Cutaneous lupus erythematosus and the risk of deep venous thrombosis and pulmonary embolism: A Danish nationwide cohort study. Lupus 2017; 26:1435-1439. [DOI: 10.1177/0961203317716306] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Venous thromboembolism (VTE) is a major public health concern. Lupus erythematosus (LE) is a chronic autoimmune disease ranging from localized cutaneous disease (CLE) to systemic involvement (SLE). Patients with SLE have an increased risk of venous thromboembolism (VTE), but little is known about the CLE-related risk of VTE. Methods To evaluate the risk of VTE in patients with SLE and CLE as compared to the general population, a retrospective cohort study was conducted. Incidence rates and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox regression models were used to evaluate and compare the risk of VTE. Registries of hospitalizations, outpatient visits, and prescription drug use were studied to determine the risk of VTE in patients with CLE and SLE and the general population between 1997 and 2011. Results A total of 3234 patients with CLE and 3627 patients with SLE were identified and compared to 5,590,070 individuals in the reference population. The incidence rates per 1000 year of VTE were higher in patients with LE, i.e. 1.20, 3.06, and 5.24 for the reference population, CLE, and SLE, respectively. In adjusted models, both CLE (HR 1.39; 95% CI 1.10–1.78) and SLE (HR 3.32; 95% CI 2.73–4.03) were associated with a statistically significant increased risk of VTE, compared to the reference population. Conclusion In this nationwide study, both CLE and SLE were significant risk factors for VTE. The results add to our understanding of comorbidities in patients with LE, and call for further studies and increased awareness of thromboembolic complications in patients with CLE.
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Affiliation(s)
- O Ahlehoff
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - J J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - J Raunsø
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - S L Kristensen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - U Khalid
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - K Kofoed
- Department of Dermatology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - G Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
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Abstract
OBJECTIVES Glucocorticoid (GC) use is widespread and associated with many adverse effects. Thus, it is important to ascertain GC utilisation patterns. In this study, we examined the annual prevalence of prescription users and amount of use of systemic GCs. DESIGN Population-wide prevalence study. SETTING The primary healthcare and hospital sectors in Denmark from 1999 to 2015. RESULTS Approximately 3% of the Danish population redeemed at least one prescription for a systemic GC annually between 1999 and 2015, with annual prevalence remaining constant over the period. However, after adjusting for age and sex, we observed a decrease in annual prevalence from 1999 to 2015, with a prevalence ratio of 0.92 (95% CI 0.91 to 0.92). Annual prevalence was highest among the elderly (7.0%-8.2% among persons 65-79 years of age and 8.4%-10% among persons 80+ years of age). Prednisolone was the most frequently redeemed systemic GC, with annual prevalence increasing from 1.4% to 2.1% during the 1999-2015 period. The amount of systemic GCs provided to the hospital sector increased from 2.3 defined daily doses (DDD)/1000 inhabitants/day in 1999 to 3.5 DDD/1000 inhabitants/day in 2015, while the amount provided to the primary healthcare sector remained constant in the range of 10-11 DDD/1000 inhabitants/day. CONCLUSION We found a high prevalence of systemic GC use of 3% with a remarkably high prevalence in elderly of up to 10%, wherefore continued awareness of its effects is mandated.
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Affiliation(s)
- Kristina Laugesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Irene Petersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Primary Care and Population Health, University College London, London, UK
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233
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Transcatheter aortic valve implantation in patients on corticosteroid therapy. Heart Vessels 2017; 32:1236-1243. [DOI: 10.1007/s00380-017-0996-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
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234
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Ungprasert P, Crowson CS, Matteson EL. Epidemiology and clinical characteristics of sarcoidosis: an update from a population-based cohort study from Olmsted County, Minnesota. Reumatismo 2017; 69:16-22. [PMID: 28535617 PMCID: PMC5521258 DOI: 10.4081/reumatismo.2017.965] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/27/2017] [Accepted: 03/30/2017] [Indexed: 12/22/2022] Open
Abstract
Information about the epidemiology, clinical manifestations and comorbidities of sarcoidosis among Caucasians is relatively scarce. This review focuses primarily on the data from a recently published Caucasianpredominant population-based cohort from Olmsted County, Minnesota. Overall, the incidence rate was 10.0 per 100,000 population, which suggested that sarcoidosis is less common in Caucasians than in Blacks, but is more common in Caucasians than in Asians. Intrathoracic involvement was seen in the vast majority of patients, but less than half have respiratory symptoms. The most common extra-thoracic manifestations were skin rash followed by arthralgia, ophthalmologic involvement, hepatic involvement, splenomegaly, renal involvement, neurological involvement, extra-thoracic lymphadenopathy, exocrine gland involvement, upper respiratory tract involvement and cardiac involvement. Compared to sex and age-matched subjects, patients with sarcoidosis suffer from increased rates of cardiovascular disease, venous thromboembolism and hospitalized infection.
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Affiliation(s)
- P Ungprasert
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
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235
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Tirosh A, Lodish M, Lyssikatos C, Belyavskaya E, Feelders RA, Stratakis CA. Coagulation Profile in Patients with Different Etiologies for Cushing Syndrome: A Prospective Observational Study. Horm Metab Res 2017; 49:365-371. [PMID: 28226363 PMCID: PMC6533628 DOI: 10.1055/s-0043-100113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Previous studies reported a higher prevalence of venous-thromboembolic events among patients with Cushing disease (CD) compared to those with ACTH-independent Cushing syndrome (CS) from adrenal sources. The objective of the current study was to evaluate the coagulation profile of patients with CS from different etiologies. A prospective observational study was conducted at a clinical research center. The study included adult patients admitted for evaluation of suspected CS (n=85), that were divided into 3 groups: CD (n=22), ACTH-independent CS from an adrenal tumor/hyperplasia (adrenal CS, n=21), and a control group consisting of subjects with negative screening for CS (rule-out CS, n=42). Coagulation profiles were drawn before and 8.5±4.3 months after surgery (trans-sphenoidal or adrenalectomy, n=18), and included fibrinogen, Factor VIII (FVIII), von Willebrand factor antigen (vWF:Ag), plasminogen activator inhibitor-1 (PAI-1), antithrombin III (ATIII), Protein C (PC), Protein S (PS), α2-antiplasmin (α2AP), and aPTT measurements. Patients with CD had higher baseline mean cortisol levels, ATIII activity and vWF:Ag levels compared with adrenal CS. Differences in ATIII activity and vWF:Ag levels remained even after controlling for BMI, and ATIII after also controlling for 24-h urinary free cortisol collections. Our study showed for the first time the differences in coagulation profiles between various etiologies of CS. We assume that the higher cortisol burden among CD patients may explain the differences found in the coagulation profile as well as the higher risk for VTE compared with primary adrenal CS patients.
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Affiliation(s)
- Amit Tirosh
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Sackler Faculty of medicine, Tel Aviv University, Israel
| | - Maya Lodish
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Charalampos Lyssikatos
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Elena Belyavskaya
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Richard A. Feelders
- Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Constantine A. Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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236
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Venous thrombosis in patients with giant cell arteritis: Features and outcomes in a cohort study. Joint Bone Spine 2017; 84:323-326. [DOI: 10.1016/j.jbspin.2016.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/27/2016] [Indexed: 11/22/2022]
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237
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Tandon R, Baughman RP, Stanley J, Khan AA. The link between chronic thromboembolic pulmonary hypertension and sarcoidosis: association or visual masquerade? SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:352-355. [PMID: 32476868 DOI: 10.36141/svdld.v34i4.5852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 08/10/2017] [Indexed: 11/02/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) and sarcoidosis are recognized causes of pulmonary hypertension according to the World Health Organization classification scheme. This case series describes seven patients with sarcoidosis with a mean age of 61 who developed pulmonary hypertension. They were found to have CTEPH, diagnosed by either CT pulmonary angiography or a lung ventilation perfusion scan. They all underwent confirmatory right heart catheterization showing elevated mean pulmonary artery pressures (mean of 42 mmHg - normal less than 25 mmHg). Sarcoidosis has been previously shown to be associated with increased rates of venous thromboembolic disease. In these cases, patients with sarcoidosis later developed CTEPH and this may be another mechanism in which sarcoidosis can lead to pulmonary hypertension. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 352-355).
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Affiliation(s)
| | | | | | - Ali A Khan
- Rush University Medical Center, Pulmonary and Critical Care, Chicago, IL, USA
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238
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Waljee AK, Rogers MAM, Lin P, Singal AG, Stein JD, Marks RM, Ayanian JZ, Nallamothu BK. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ 2017; 357:j1415. [PMID: 28404617 PMCID: PMC6284230 DOI: 10.1136/bmj.j1415] [Citation(s) in RCA: 449] [Impact Index Per Article: 64.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective To determine the frequency of prescriptions for short term use of oral corticosteroids, and adverse events (sepsis, venous thromboembolism, fractures) associated with their use.Design Retrospective cohort study and self controlled case series.Setting Nationwide dataset of private insurance claims.Participants Adults aged 18 to 64 years who were continuously enrolled from 2012 to 2014.Main outcome measures Rates of short term use of oral corticosteroids defined as less than 30 days duration. Incidence rates of adverse events in corticosteroid users and non-users. Incidence rate ratios for adverse events within 30 day and 31-90 day risk periods after drug initiation.Results Of 1 548 945 adults, 327 452 (21.1%) received at least one outpatient prescription for short term use of oral corticosteroids over the three year period. Use was more frequent among older patients, women, and white adults, with significant regional variation (all P<0.001). The most common indications for use were upper respiratory tract infections, spinal conditions, and allergies. Prescriptions were provided by a diverse range of specialties. Within 30 days of drug initiation, there was an increase in rates of sepsis (incidence rate ratio 5.30, 95% confidence interval 3.80 to 7.41), venous thromboembolism (3.33, 2.78 to 3.99), and fracture (1.87, 1.69 to 2.07), which diminished over the subsequent 31-90 days. The increased risk persisted at prednisone equivalent doses of less than 20 mg/day (incidence rate ratio 4.02 for sepsis, 3.61 for venous thromboembolism, and 1.83 for fracture; all P<0.001).Conclusion One in five American adults in a commercially insured plan were given prescriptions for short term use of oral corticosteroids during a three year period, with an associated increased risk of adverse events.
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Affiliation(s)
- Akbar K Waljee
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
- University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- University of Michigan Medical School, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Ann Arbor, MI, USA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI, USA
| | - Mary A M Rogers
- University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI, USA
- University of Michigan Medical School, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI, USA
| | - Paul Lin
- University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joshua D Stein
- University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- University of Michigan Medical School, Department of Ophthalmology and Visual Science, Ann Arbor, MI, USA
- University of Michigan School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Rory M Marks
- University of Michigan Medical School, Department of Internal Medicine, Division of Rheumatology, Ann Arbor, MI, USA
| | - John Z Ayanian
- University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- University of Michigan Medical School, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI, USA
- University of Michigan School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Brahmajee K Nallamothu
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
- University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI, USA
- University of Michigan Medical School, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
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239
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Broersen LHA, Horváth-Puhó E, Pereira AM, Erichsen R, Dekkers OM, Sørensen HT. Corticosteroid use and mortality risk in patients with perforated colonic diverticular disease: a population-based cohort study. BMJ Open Gastroenterol 2017; 4:e000136. [PMID: 28461904 PMCID: PMC5387955 DOI: 10.1136/bmjgast-2017-000136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 01/05/2023] Open
Abstract
Background Corticosteroids are a potential risk factor for mortality in patients with perforated diverticular disease, due to blinding of disease severity, hampered wound healing or adrenal insufficiency. We examined mortality in corticosteroid users and non-users among patients with perforated diverticular disease. Methods A cohort study based on medical databases including all patients ≥18 years in Denmark (source population 5 289 261 inhabitants) admitted to a hospital with incident perforated diverticular disease between 2005 and 2013. 7-day, 1-month, 3-month and 1-year mortality risks in corticosteroid users and non-users were calculated using the Kaplan–Meier method, and compared with Cox proportional hazard regression adjusted for age, sex and comorbidities. Results The study included 4640 patients with perforated diverticular disease. Of these, 3743 (80.7%) had not used corticosteroids in the year before admission and 725 (15.6%) had been exposed to systemic corticosteroid treatment. The remaining 172 patients had been exposed to either inhaled or intestinal acting corticosteroid therapy. Mortality risk in non-users was 4.4% after 7 days and 15.6% after 1 year. This risk was doubled for corticosteroid users who filled their last prescription during the 90 days before admission, with mortality risks ranging from 14.2% after 7 days to 47.6% after 1 year. 1-year mortality risk was even higher for corticosteroid users with a first filled prescription ≤90 days before admission: 52.5%. Conclusions Corticosteroid use was associated with clearly increased mortality risk after perforated diverticular disease. Thus, use of corticosteroids should be regarded as an important clinical prognostic factor for mortality in patients with this condition.
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Affiliation(s)
- L H A Broersen
- Division of Endocrinology, Department of Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - E Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - A M Pereira
- Division of Endocrinology, Department of Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - R Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - O M Dekkers
- Division of Endocrinology, Department of Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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240
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Ogawa Y, Yanagisawa K, Souri M, Mihara M, Naito C, Takizawa M, Ishizaki T, Mitsui T, Handa H, Osaki T, Nojima Y, Ichinose A. Successful Management of a Patient with Autoimmune Hemorrhaphilia due to Anti-Factor XIII/13 Antibodies Complicated by Pulmonary Thromboembolism. Acta Haematol 2017; 137:141-147. [PMID: 28380473 DOI: 10.1159/000455938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022]
Abstract
Autoimmune hemophilia-like disease (hemorrhaphilia) due to anti-factor XIII (FXIII) antibodies (AH13) is a very rare, life-threatening bleeding disorder. A 77-year-old woman developed macrohematuria and a right renal pelvic hematoma. The coagulation times were not prolonged, but FXIII activity and antigen levels were severely and moderately reduced to 9 and 29% of normal values, respectively. Accordingly, the FXIII-specific activity turned out to be low. FXIII inhibitor and anti-FXIII-A subunit autoantibodies were detected by a 1:1 crossmixing test and immunoblot and immunochromatographic assays. She was therefore diagnosed with "definite AH13" and treated with plasma-derived FXIII concentrates to arrest the hemorrhage. In addition to a highly compressed inferior vena cava by a huge renal pelvic hematoma, deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) were identified by systemic computed tomography. The patient was immediately started on anticoagulation therapy with low-dose heparin. Emboli disappeared quickly, probably because under-crosslinked thrombi caused by severe FXIII deficiency are vulnerable to fibrinolysis. After about 1.5 years, anti-FXIII-A subunit autoantibodies still remained despite the use of rituximab, steroid pulse therapy, oral prednisolone, and oral cyclophosphamide treatments. In conclusion, an extremely rare AH13 case complicated by DVT and PE was successfully managed by balancing anticoagulation therapy with hemostatic therapy.
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Affiliation(s)
- Yoshiyuki Ogawa
- Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
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241
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Nørgaard M, Ehrenstein V, Vandenbroucke JP. Confounding in observational studies based on large health care databases: problems and potential solutions - a primer for the clinician. Clin Epidemiol 2017; 9:185-193. [PMID: 28405173 PMCID: PMC5378455 DOI: 10.2147/clep.s129879] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Population-based health care databases are a valuable tool for observational studies as they reflect daily medical practice for large and representative populations. A constant challenge in observational designs is, however, to rule out confounding, and the value of these databases for a given study question accordingly depends on completeness and validity of the information on confounding factors. In this article, we describe the types of potential confounding factors typically lacking in large health care databases and suggest strategies for confounding control when data on important confounders are unavailable. Using Danish health care databases as examples, we present the use of proxy measures for important confounders and the use of external adjustment. We also briefly discuss the potential value of active comparators, high-dimensional propensity scores, self-controlled designs, pseudorandomization, and the use of positive or negative controls.
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Affiliation(s)
- Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan P Vandenbroucke
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands; Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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242
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Aleva FE, Voets LW, Simons SO, de Mast Q, van der Ven AJ, Heijdra YF. Prevalence and Localization of Pulmonary Embolism in Unexplained Acute Exacerbations of COPD. Chest 2017; 151:544-554. [DOI: 10.1016/j.chest.2016.07.034] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/04/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022] Open
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243
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Takayasu S, Murasawa S, Yamagata S, Kageyama K, Nigawara T, Watanuki Y, Kimura D, Tsushima T, Sakamoto Y, Hakamada K, Terui K, Daimon M. Acute mesenteric ischemia and hepatic infarction after treatment of ectopic Cushing's syndrome. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM160144. [PMID: 28480039 PMCID: PMC5413775 DOI: 10.1530/edm-16-0144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 02/01/2017] [Indexed: 12/04/2022] Open
Abstract
Summary Patients with Cushing’s syndrome and excess exogenous glucocorticoids have an increased risk for venous thromboembolism, as well as arterial thrombi. The patients are at high risk of thromboembolic events, especially during active disease and even in cases of remission and after surgery in Cushing’s syndrome and withdrawal state in glucocorticoid users. We present a case of Cushing’s syndrome caused by adrenocorticotropic hormone-secreting lung carcinoid tumor. Our patient developed acute mesenteric ischemia after video-assisted thoracoscopic surgery despite administration of sufficient glucocorticoid and thromboprophylaxis in the perioperative period. In addition, our patient developed hepatic infarction after surgical resection of the intestine. Then, the patient was supported by total parenteral nutrition. Our case report highlights the risk of microthrombi, which occurred in our patient after treatment of ectopic Cushing’s syndrome. Guidelines on thromboprophylaxis and/or antiplatelet therapy for Cushing’s syndrome are acutely needed. Learning points:
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ken Terui
- Departments of Endocrinology and Metabolism
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244
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Strehl C, van der Goes MC, Bijlsma JW, Jacobs JWG, Buttgereit F. Glucocorticoid-targeted therapies for the treatment of rheumatoid arthritis. Expert Opin Investig Drugs 2017; 26:187-195. [DOI: 10.1080/13543784.2017.1276562] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Cindy Strehl
- Department of Rheumatology and Clinical Immunology, Charité – University Medicine Berlin, Berlin, Germany
- German Rheumatism Research Centre (DRFZ), Berlin, Germany
| | - Marlies C. van der Goes
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes W.J. Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes W. G. Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité – University Medicine Berlin, Berlin, Germany
- German Rheumatism Research Centre (DRFZ), Berlin, Germany
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245
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James J, Shiji PV, Radhakrishnan C. Cerebral Venous Thrombosis after Intravenous Immunoglobulin Therapy in Immune Thrombocytopenic Purpura. Indian J Crit Care Med 2017; 21:869-871. [PMID: 29307971 PMCID: PMC5752799 DOI: 10.4103/ijccm.ijccm_308_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A common misconception is that immune thrombocytopenic purpura (ITP) causes only bleeding diathesis. From this case vignette of a young male with ITP who had cerebral venous thrombosis, we highlight the importance of considering venous thrombosis in such patients when they present with focal cerebral signs.
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Affiliation(s)
- Joe James
- Department of Internal Medicine, Government Medical College, Kozhikode, Kerala, India
| | - P V Shiji
- Department of Internal Medicine, Government Medical College, Kozhikode, Kerala, India
| | - Chandni Radhakrishnan
- Department of Internal Medicine, Government Medical College, Kozhikode, Kerala, India
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246
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Unizony S, Lu N, Tomasson G, Zhang Y, Merkel PA, Stone JH, Antonio Aviña‐Zubieta J, Choi HK. Temporal Trends of Venous Thromboembolism Risk Before and After Diagnosis of Giant Cell Arteritis. Arthritis Rheumatol 2016; 69:176-184. [DOI: 10.1002/art.39847] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/16/2016] [Indexed: 12/28/2022]
Affiliation(s)
| | - Na Lu
- Massachusetts General Hospital, Harvard Medical School, and Boston University School of MedicineBoston
| | - Gunnar Tomasson
- Boston University School of Medicine, Boston, Massachusetts, and University of IcelandReykjavik Iceland
| | - Yuqing Zhang
- Boston University School of MedicineBoston Massachusetts
| | | | - John H. Stone
- Massachusetts General Hospital, Harvard Medical SchoolBoston
| | | | - Hyon K. Choi
- Massachusetts General Hospital, Harvard Medical School, and Boston University School of MedicineBoston
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247
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Schneiderman M, Czuzoj-Shulman N, Spence AR, Abenhaim HA. Maternal and neonatal outcomes of pregnancies in women with Addison's disease: a population-based cohort study on 7.7 million births. BJOG 2016; 124:1772-1779. [PMID: 27981742 DOI: 10.1111/1471-0528.14448] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess if pregnancies among women with Addison's disease (AD) are at higher risk of adverse maternal and neonatal outcomes. DESIGN Population-based retrospective cohort study. SETTING/POPULATION All births in the United States' Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2011. METHODS Baseline characteristics were compared between women with AD and those without, and prevalence over time was measured. Logistic regression was used to estimate the effect of AD on maternal and neonatal outcomes by calculating the crude and adjusted odds ratios (OR) and corresponding 95% confidence intervals (95% CI). RESULTS We calculated a prevalence of AD in pregnancy of 5.5/100 000, increasing from 5.6 to 9.6/100 000 (P = 0.0001) over the 9-year study period. Compared with women without AD, women with AD were more likely to deliver preterm (OR 1.50, 95% CI 1.16-1.95), deliver by caesarean section (OR 1.32, 95% CI 1.08-1.61), have impaired wound healing (OR 4.28, 95% CI 2.55-7.18), develop infections (OR 2.44, 95% CI 1.66-3.58) and develop thromboembolism (OR 5.21, 95% CI 2.15-12.63), require transfusions (OR 6.69, 95% CI 4.69-9.54), and have prolonged postpartum hospital admissions (OR 5.71, 95% CI 4.37-7.47). Maternal mortality was significantly higher than in the comparison group (OR 22.30, 95% CI 6.82-72.96). Congenital anomalies (OR 3.62, 95% CI 2.05-6.39) and small-for-gestational age infants (OR 1.78, 95% CI 1.15-2.75) were more likely in these pregnancies. CONCLUSIONS Addison's disease significantly increases the risk of severe adverse maternal and neonatal outcomes, so pregnant women with AD are best managed in tertiary-care centres. TWEETABLE ABSTRACT Pregnancies complicated by Addison's disease have an increased risk of adverse maternal and neonatal outcomes.
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Affiliation(s)
- M Schneiderman
- Department of Obstetrics and Gynaecology, Jewish General Hospital, Montreal, QC, Canada
| | - N Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
| | - A R Spence
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
| | - H A Abenhaim
- Department of Obstetrics and Gynaecology, Jewish General Hospital, Montreal, QC, Canada.,Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
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248
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Bartko J, Schoergenhofer C, Schwameis M, Buchtele N, Wojta J, Schabbauer G, Stiebellehner L, Jilma B. Dexamethasone inhibits endotoxin-induced coagulopathy in human lungs. J Thromb Haemost 2016; 14:2471-2477. [PMID: 27622544 PMCID: PMC5298044 DOI: 10.1111/jth.13504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/26/2016] [Indexed: 12/17/2022]
Abstract
Essentials Glucocorticoids are associated with an increased risk of thrombosis. Healthy volunteers received dexamethasone or placebo in an endotoxin lung instillation model. Dexamethasone suppressed thrombin generation in bronchoalveolar lavage. Glucocorticoids inhibit endotoxin induced pulmonary coagulopathy. SUMMARY Background Activation of local and systemic coagulation is a common finding in patients with pneumonia. There is evidence that glucocorticoids have procoagulant activity in the circulation, particularly in the context of inflammation. The effects of glucocorticoids on local pulmonary coagulation have not yet been investigated. Objective To use a human model of lung inflammation based on the local instillation of endotoxin in order to investigate whether glucocorticoids alter pulmonary coagulation. Methods Twenty-four healthy volunteers were randomized to receive either dexamethasone or placebo in a double-blind trial. Endotoxin was instilled via bronchoscope into right or left lung segments, followed by saline into the contralateral site. Six hours later, a bilateral bronchoalveolar lavage (BAL) was performed and coagulation parameters were measured. Results Endotoxin induced activation of coagulation in the bronchoalveolar compartment: the level of prothrombin fragment 1 + 2 (F1 + 2 ) was increased three-fold (248 pmol L-1 , 95% confidence interval [CI] 43-454 versus 743 pmol L-1 , 95% CI 437-1050) and the level of thrombin-antithrombin complex (TATc) was increased by ~ 50% (31 μg L-1 , 95% CI 18-45 versus 49 μg L-1 , 95% CI 36-61) as compared with saline-challenged segments. Dexamethasone reduced F1 + 2 (284 pmol L-1 , 95% CI 34-534) and TATc (9 μg L-1 , 95% CI 0.7-17) levels almost to those measured in BAL fluid from the saline-instilled segments in the placebo group. Dexamethasone even profoundly reduced F1 + 2 levels (80%) in saline-instilled lung segments (50 pmol L-1 , 95% CI 12-87). In contrast, dexamethasone had no effect on systemic F1 + 2 levels. Conclusions Dexamethasone inhibits endotoxin-induced coagulopathy in lungs. This trial is the first to provide insights into the effects of glucocorticoids on pulmonary coagulation in response to endotoxin.
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Affiliation(s)
- J. Bartko
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - C. Schoergenhofer
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - M. Schwameis
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - N. Buchtele
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - J. Wojta
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - G. Schabbauer
- Institute of Physiology, Center for Physiology and PharmacologyMedical University of ViennaViennaAustria
| | - L. Stiebellehner
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - B. Jilma
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
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249
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Crous-Bou M, Harrington LB, Kabrhel C. Environmental and Genetic Risk Factors Associated with Venous Thromboembolism. Semin Thromb Hemost 2016; 42:808-820. [PMID: 27764878 DOI: 10.1055/s-0036-1592333] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Venous thromboembolism (VTE) includes deep vein thrombosis and pulmonary embolism, and a combination of environmental and genetic risk factors contributes to VTE risk. Within environmental risk factors, some are provoking (e.g., cancer, surgery, trauma or fracture, immobilization, pregnancy and the postpartum period, long-distance travel, hospitalization, catheterization, and acute infection) and others are nonprovoking (e.g., age, sex, race/ethnicity, body mass index and obesity, oral contraceptive or hormone therapy use, corticosteroid use, statin use, diet, physical activity, sedentary time, and air pollution). Additionally, VTE has a strong genetic basis, with approximately 50 to 60% of the variance in VTE incidence attributed to genetic effects. Some genetic susceptibility variants that contribute to risk have been identified in candidate genes, mostly related to the clotting system and responsible for inherited hypercoagulable states (e.g., factor V Leiden, prothrombin, fibrinogen gamma, or blood group non-O). Other susceptibility single-nucleotide polymorphisms have been identified from genome-wide association studies, such as the two new loci in TSPAN15 (rs78707713) and SCL44A2 (rs2288904) genes. Risk factors are not always associated with VTE in isolation; however, and an understanding of how environmental and genetic factors interact may provide insight into the pathophysiology of VTE, possibly identifying opportunities for targeted prevention and treatment.
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Affiliation(s)
- Marta Crous-Bou
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura B Harrington
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Christopher Kabrhel
- Department of Emergency Medicine, Center for Vascular Emergencies, Massachusetts General Hospital, Boston, Massachusetts
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250
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Ungprasert P, Crowson CS, Matteson EL. Association of Sarcoidosis With Increased Risk of VTE: A Population-Based Study, 1976 to 2013. Chest 2016; 151:425-430. [PMID: 27687848 DOI: 10.1016/j.chest.2016.09.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/04/2016] [Accepted: 09/09/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The goal of this study was to investigate the risk of VTE among patients with sarcoidosis. METHODS A cohort of 345 incident cases of sarcoidosis and 345 sex- and age-matched comparator subjects in Olmsted County, Minnesota, from 1976 to 2013 were identified from the comprehensive medical record linkage system. Medical records were reviewed for DVT and pulmonary embolism (PE). The cumulative incidence was estimated, adjusted for the competing risk of death. Cox proportional hazards models were used to compare the rate of development of these events between patients with sarcoidosis and the nonsarcoidosis comparison cohort. RESULTS The prevalence of VTE, DVT, and PE prior to the index date was not significantly different between case and comparator subjects. The risk of incident VTE adjusted for age, sex, and calendar year was significantly higher among patients with sarcoidosis (hazard ratio [HR], 3.04 [95% CI, 1.47-6.29]). Significantly elevated risk was observed in both subtypes of VTE, with an HR of 3.14 (95% CI, 1.32-7.48) for DVT and an HR of 4.29 (95% CI, 1.21-15.23) for PE. A sensitivity analysis including only VTE events that occurred at least 6 months after the index date adjusted for age, sex, and calendar year revealed somewhat lower HRs: VTE, 2.73 (95% CI, 1.30-5.72); DVT, 3.00 (95% CI, 1.25-7.20); and PE, 3.58 (95% CI, 0.98-13.03). CONCLUSIONS An increased risk of VTE among patients with sarcoidosis was observed in this population-based cohort.
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Affiliation(s)
- Patompong Ungprasert
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN
| | - Eric L Matteson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Science Research, Mayo Clinic, Rochester, MN
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