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Liu Y, Huang T, Yap NA, Lim K, Ju LA. Harnessing the power of bioprinting for the development of next-generation models of thrombosis. Bioact Mater 2024; 42:328-344. [PMID: 39295733 PMCID: PMC11408160 DOI: 10.1016/j.bioactmat.2024.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 08/07/2024] [Accepted: 08/29/2024] [Indexed: 09/21/2024] Open
Abstract
Thrombosis, a leading cause of cardiovascular morbidity and mortality, involves the formation of blood clots within blood vessels. Current animal models and in vitro systems have limitations in recapitulating the complex human vasculature and hemodynamic conditions, limiting the research in understanding the mechanisms of thrombosis. Bioprinting has emerged as a promising approach to construct biomimetic vascular models that closely mimic the structural and mechanical properties of native blood vessels. This review discusses the key considerations for designing bioprinted vascular conduits for thrombosis studies, including the incorporation of key structural, biochemical and mechanical features, the selection of appropriate biomaterials and cell sources, and the challenges and future directions in the field. The advancements in bioprinting techniques, such as multi-material bioprinting and microfluidic integration, have enabled the development of physiologically relevant models of thrombosis. The future of bioprinted models of thrombosis lies in the integration of patient-specific data, real-time monitoring technologies, and advanced microfluidic platforms, paving the way for personalized medicine and targeted interventions. As the field of bioprinting continues to evolve, these advanced vascular models are expected to play an increasingly important role in unraveling the complexities of thrombosis and improving patient outcomes. The continued advancements in bioprinting technologies and the collaboration between researchers from various disciplines hold great promise for revolutionizing the field of thrombosis research.
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Affiliation(s)
- Yanyan Liu
- School of Biomedical Engineering, The University of Sydney, Darlington, NSW, 2008, Australia
| | - Tao Huang
- School of Biomedical Engineering, The University of Sydney, Darlington, NSW, 2008, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Nicole Alexis Yap
- School of Biomedical Engineering, The University of Sydney, Darlington, NSW, 2008, Australia
| | - Khoon Lim
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
- School of Medical Sciences, The University of Sydney, Darlington, NSW 2008, Australia
- The University of Sydney Nano Institute (Sydney Nano), The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Lining Arnold Ju
- School of Biomedical Engineering, The University of Sydney, Darlington, NSW, 2008, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
- The University of Sydney Nano Institute (Sydney Nano), The University of Sydney, Camperdown, NSW, 2006, Australia
- Heart Research Institute, Camperdown, Newtown, NSW 2042, Australia
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2
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Ghandour S, Jain VK, Gupta A. Choosing ankle tourniquets in foot and ankle surgery: Beyond postoperative pain considerations. World J Orthop 2024; 15:828-830. [PMID: 39318490 PMCID: PMC11417627 DOI: 10.5312/wjo.v15.i9.828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 08/07/2024] [Accepted: 08/09/2024] [Indexed: 09/12/2024] Open
Abstract
This editorial critically explores the use of ankle vs thigh tourniquets in foot and ankle surgery based on a recent study that found no significant difference in postoperative pain between the two placement techniques. Despite these findings, we argue for the preferential use of ankle tourniquets, highlighting their potential benefits in reducing venous blood stasis and minimizing soft tissue injury. This approach underscores the importance of considering long-term patient outcomes and vascular health beyond immediate postoperative pain. By integrating study findings with broader clinical considerations, we hereby advocate for a nuanced approach to tourniquet use that prioritizes patient safety and long-term recovery in conjunction with immediate postoperative pain.
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Affiliation(s)
- Samir Ghandour
- The Faculty of Medicine and Biomedical Sciences, The University of Balamand, Beirut 1100, Lebanon
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, Delhi 110001, India
| | - Ashim Gupta
- Department of Orthopaedics and Regenerative Medicine, Future Biologics, Lawrenceville, GA 30043, United States
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Aldiabat M, Alhuneafat L, Al Ta'ani O, Altarawneh S, Aleyadeh W, Almuzamil T, Butt A, Alahmad M, Madi MY, Alsabbagh K, Ayoub M, Kilani Y, Alsakarneh S, Jaber F, Alhamdani A. Inflammatory bowel disease and pulmonary embolism: a nationwide perspective. Eur J Gastroenterol Hepatol 2024:00042737-990000000-00405. [PMID: 39292971 DOI: 10.1097/meg.0000000000002851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
OBJECTIVE To examine the characteristics and outcomes of patients with inflammatory bowel disease (IBD) hospitalized with pulmonary embolism (PE). METHODS This cross-sectional observational study analyzed data from the 2016 to 2019 National Inpatient Sample to investigate hospitalizations for PE in the USA, stratified by the presence or absence of IBD. Adult patients were selected using the International Classification of Diseases, Tenth Revision codes for PE, Crohn's disease, and ulcerative colitis. Data on patient demographics, comorbidities, and hospital characteristics were collected. Statistical analysis included univariable and multivariable logistic regression using Stata/BE 17.0, focusing on in-hospital mortality and complications in PE patients with and without IBD. Adjusted odds ratios (aOR) and their corresponding 95% confidence intervals (CI) were calculated when appropriate. RESULTS PE/IBD group was younger (mean age 58.3 vs. 62.7 years; P < 0.001), had a higher proportion of white patients (81.2% vs. 70.9%; P < 0.001), and had a greater prevalence of chronic liver disease (7.54% vs. 6.02%; P = 0.002) when compared to PE/non-IBD patients. The PE/IBD group had lower prevalence rates of coronary artery disease, congestive heart failure, obesity, chronic obstructive pulmonary disease, hypertension, and diabetes. Regarding primary outcomes, there was no significant difference in in-hospital mortality between the two groups (aOR, 0.92; 95% CI, 0.77-1.09; P = 0.355). However, the IBD/PE group had a higher risk of acute kidney injury, sepsis, septic shock, cardiac arrhythmias, and deep vein thrombosis. As for secondary outcomes, PE/IBD patients had more extended hospital stays and higher healthcare costs compared with PE/non-IBD patients. CONCLUSION Hospitalized PE patients with IBD differ demographically and have a different comorbidity profile compared to those without IBD. PE/IBD patients demonstrate greater use of healthcare resources and elevated risk of hospitalization adverse events than PE/non-IBD patients, highlighting the necessity for individualized management approaches in this population.
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Affiliation(s)
- Mohammad Aldiabat
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Laith Alhuneafat
- Department of Cardiovascular Disease, University of Minnesota, Minneapolis, MN
| | - Omar Al Ta'ani
- Department of Medicine, Allegheny Health Network, Pittsburgh
| | - Saba Altarawneh
- Division of Gastroenterology, Department of Medicine,The Wright Center for Graduate Medical Education, Scranton, PA
| | - Wesam Aleyadeh
- Department of Medicine, Akron General Hospital, Akron, Ohio
| | | | - Ali Butt
- Department of Medicine, Allegheny Health Network, Pittsburgh
| | - Majd Alahmad
- Department of Medicine, University of Missouri-Columbia, Columbia, Missouri
| | - Mahmoud Y Madi
- Division of Gastroenterology, Department of Medicine, SSM Health Saint Louis University Hospital, St. Louis, Missouri
| | | | - Malek Ayoub
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Yassine Kilani
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medicine, Bronx, New York
| | - Saqr Alsakarneh
- Department of Medicine, University of Missouri Kansas City, Kansas City, Missouri and
| | - Fouad Jaber
- Department of Medicine, University of Missouri Kansas City, Kansas City, Missouri and
| | - Adee Alhamdani
- Division of Cardiology, Department of Medicine, Marshall University, Huntington, West Virginia, USA
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4
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Xie Y, Huang Y, Stevenson HCS, Yin L, Zhang K, Islam ZH, Marcum WA, Johnston C, Hoyt N, Kent EW, Wang B, Hossack JA. Sonothrombolysis Using Microfluidically Produced Microbubbles in a Murine Model of Deep Vein Thrombosis. Ann Biomed Eng 2024:10.1007/s10439-024-03609-7. [PMID: 39249170 DOI: 10.1007/s10439-024-03609-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/19/2024] [Indexed: 09/10/2024]
Abstract
The need for safe and effective methods to manage deep vein thrombosis (DVT), given the risks associated with anticoagulants and thrombolytic agents, motivated research into innovative approaches to resolve blood clots. In response to this challenge, sonothrombolysis is being explored as a technique that combines microbubbles, ultrasound, and thrombolytic agents to facilitate the aggressive dissolution of thrombi. Prior studies have indicated that relatively large microbubbles accelerate the dissolution process, either in an in vitro or an arterial model. However, sonothrombolysis using large microbubbles must be evaluated in venous thromboembolism diseases, where blood flow velocity is not comparable. In this study, the efficacy of sonothrombolysis was validated in a murine model of pre-existing DVT. During therapy, microfluidically produced microbubbles of 18 μm diameter and recombinant tissue plasminogen activator (rt-PA) were administered through a tail vein catheter for 30 min, while ultrasound was applied to the abdominal region of the mice. Three-dimensional ultrasound scans were performed before and after therapy for quantification. The residual volume of the thrombi was 20% in animals post sonothrombolysis versus 52% without therapy ( p = 0.012 < 0.05 ), indicating a significant reduction in DVT volume. Histological analysis of tissue sections confirmed a reduction in DVT volume post-therapy. Therefore, large microbubbles generated from a microfluidic device show promise in ultrasound-assisted therapy to address concerns related to venous thromboembolism.
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Affiliation(s)
- Yanjun Xie
- Department of Biomedical Engineering, University of Virginia, 415 Lane Road, Charlottesville, VA, 22908, USA
| | - Yi Huang
- Department of Biomedical Engineering, University of Virginia, 415 Lane Road, Charlottesville, VA, 22908, USA
| | - Hugo C S Stevenson
- Department of Biomedical Engineering, University of Virginia, 415 Lane Road, Charlottesville, VA, 22908, USA
| | - Li Yin
- Department of Surgery, School of Medicine, University of Virginia, 409 Lane Rd MR4, Charlottesville, VA, 22908, USA
- Feinberg School of Medicine, Northwestern University, 300 E. Superior St. Tarry Building, Chicago, IL, 60611, USA
| | - Kaijie Zhang
- Department of Surgery, School of Medicine, University of Virginia, 409 Lane Rd MR4, Charlottesville, VA, 22908, USA
- Feinberg School of Medicine, Northwestern University, 300 E. Superior St. Tarry Building, Chicago, IL, 60611, USA
| | - Zain Husain Islam
- Department of Surgery, School of Medicine, University of Virginia, 409 Lane Rd MR4, Charlottesville, VA, 22908, USA
| | - William Aaron Marcum
- Department of Surgery, School of Medicine, University of Virginia, 409 Lane Rd MR4, Charlottesville, VA, 22908, USA
| | - Campbell Johnston
- Department of Surgery, School of Medicine, University of Virginia, 409 Lane Rd MR4, Charlottesville, VA, 22908, USA
| | - Nicholas Hoyt
- Department of Surgery, School of Medicine, University of Virginia, 409 Lane Rd MR4, Charlottesville, VA, 22908, USA
| | - Eric William Kent
- Department of Surgery, School of Medicine, University of Virginia, 409 Lane Rd MR4, Charlottesville, VA, 22908, USA
| | - Bowen Wang
- Department of Surgery, School of Medicine, University of Virginia, 409 Lane Rd MR4, Charlottesville, VA, 22908, USA
- Feinberg School of Medicine, Northwestern University, 300 E. Superior St. Tarry Building, Chicago, IL, 60611, USA
| | - John A Hossack
- Department of Biomedical Engineering, University of Virginia, 415 Lane Road, Charlottesville, VA, 22908, USA.
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Zhan J, Wang D, Luo C, Bi H. Umbilical Vascular Thromboembolism: High-Risk Factors, Diagnosis, Management, and Pregnancy Outcomes: A Scoping Review. Ther Clin Risk Manag 2024; 20:597-610. [PMID: 39263225 PMCID: PMC11389714 DOI: 10.2147/tcrm.s478593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 09/01/2024] [Indexed: 09/13/2024] Open
Abstract
Umbilical vascular thromboembolism is a rare condition that can lead to serious consequences such as fetal hypoxia, fetal growth restriction, and even stillbirth. However, there is currently a lack of research on the pathology, pathogenesis, clinical management, and prognosis of this condition. Therefore, the purpose of this article is to analyze this condition's high-risk factors, clinical characteristics, pregnancy management, and discuss its corresponding pregnancy outcomes. Databases such as PubMed are searched using the relevant keywords of umbilical vascular thromboembolism in worldwide. And related information is analyzed such as maternal risk factors, fetal risk factors, umbilical cord and placental risk factors, and pregnancy outcomes. The literature search yields 113 articles, 64 of which meet the inclusion criteria for umbilical vascular thromboembolism. There are 4 retrospective cohort studies and 8 case series, the rest are all case reports. A total of 262 cases of umbilical vascular thromboembolism are found. The most common maternal complications and fetal related risk factors are diabetes (25 cases, 9.5%) and stillbirths (106 cases, 40.5%), respectively. Among these 262 cases, 98 (37.4%) cases are found by prenatal ultrasound to have umbilical vascular thromboembolism and the fetus is in a viable state with complete clinical information. In addition, considering the effectiveness and safety of low molecular weight heparin in thromboembolic conditions, twenty-four patients of umbilical artery thromboembolism attempted to use low molecular weight heparin during observation. Maternal diabetes was the highest risk factor for this condition. When umbilical artery thromboembolism occurs, the incidence of stillbirth increases. Premature patients with this condition can continue their pregnancy under close external monitoring. However, due to the small sample size, further research is needed.
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Affiliation(s)
- Jun Zhan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Dingding Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Chuanxiang Luo
- Department of Clinical Medicine, Medical College, Qingdao University, Qingdao, People's Republic of China
| | - Haiyan Bi
- Office for Medical and Health Service, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
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Da Rocha Ribas PA, Da Rocha Ribas JÁ, Mialski Fontana R. Thrombotic Events in a Patient With Acute Toxoplasmosis. Cureus 2024; 16:e69797. [PMID: 39308842 PMCID: PMC11414767 DOI: 10.7759/cureus.69797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2024] [Indexed: 09/25/2024] Open
Abstract
The etiology of venous thromboembolism is multifactorial, with causes being classified as either provoked or unprovoked, making it difficult to attribute a single factor as the cause of the thromboembolic event in most cases. The relationship between inflammation and thrombotic phenomena is well established. Here, we describe the uncommon occurrence of thromboses in a previously healthy patient with acute toxoplasmosis. The patient initially presented with fatigue, abdominal pain, fever and dyspnea. The diagnosis was confirmed through toxoplasmosis serology in a set of admission laboratory tests, and further imaging studies revealed the presence of pulmonary embolism and portal vein thrombosis. The patient was treated with anticoagulants and sulfamethoxazole-trimethoprim, showing improvement in the following days. This case highlights the importance of considering infectious diseases, such as toxoplasmosis, in the differential diagnosis of thrombosis, even in previously healthy individuals. To our knowledge, this is the second reported case of this association in Brazil.
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Affiliation(s)
| | | | - Rafael Mialski Fontana
- Infectious Disease Service, Clinical Hospital Complex of the Federal University of Paraná, Curitiba, BRA
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Zheng B, Chen J, Xu Y, Wu W, Zhu Y, Cai W, Lin W, Shi C. Poly (β-amino esters)/Mobil Composition of Matter 41-mediated delivery of siIL-1β alleviates deep vein thrombosis in rat hind limbs. J Biomater Appl 2024:8853282241280376. [PMID: 39213651 DOI: 10.1177/08853282241280376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Introduction: Deep vein thrombosis (DVT) is a major cause of cardiovascular disease-related deaths worldwide and is considered a thrombotic inflammatory disorder. IL-1β, as a key promoter of venous thrombus inflammation, is a potential target for DVT treatment. Constructing a nanocarrier system for intracellular delivery of siIL-1β to silence IL-1β may be an effective strategy for alleviating DVT. Methods: ELISA was used to detect the expression levels of IL-1β and t-PA in the serum of DVT patients and healthy individuals. In vitro, HUVEC cells were treated with IL-1β, and changes in VWF and t-PA expression levels were assessed. PBAE/MCM-41@siIL-1β (PM@siIL-1β) nano-complexes were synthesized, the characterization and biocompatibility of PM@siIL-1β were evaluated. A rat hind limb DVT model was established, and PM@siIL-1β was used to treat DVT rats. Morphology of the inferior vena cava, endothelial cell count, IL-1β, vWF, and t-PA levels, as well as changes in the p38 MAPK and NF-κB pathways, were examined in the different groups. Results: IL-1β and t-PA were highly expressed in DVT patients, and IL-1β treatment induced a decrease in VWF levels and an increase in t-PA levels in HUVEC cells. The synthesized PM@siIL-1β exhibited spherical shape, good stability, high encapsulation efficiency, and high drug loading capacity, with excellent biocompatibility. In the DVT model rats, the inferior vena cava was filled with blood clots, endothelial cells increased, IL-1β and VWF levels significantly increased, while t-PA levels were significantly downregulated. Treatment with PM@siIL-1β resulted in reduced thrombus formation, decreased endothelial cell count, and reversal of IL-1β, VWF, and t-PA levels. Furthermore, PM@siIL-1β treatment significantly inhibited p38 phosphorylation and upregulation of NF-κB expression in the DVT model group. Conclusion: IL-1β can be considered a therapeutic target for suppressing DVT inflammation. The synthesized PM@siIL-1β achieved efficient delivery and gene silencing of siIL-1β, demonstrating good therapeutic effects on rat hind limb DVT, including anti-thrombotic and anti-inflammatory effects, potentially mediated through the p38 MAPK and NF-κB pathways.
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Affiliation(s)
- Bingru Zheng
- Department of Interventional Vascular Surgery, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinjie Chen
- Department of Nephrology, Rui'an Third People's Hospital, Wenzhou, China
| | - Yizhou Xu
- Department of Interventional Vascular Surgery, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wanrui Wu
- Department of Interventional Vascular Surgery, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Zhu
- Department of Interventional Vascular Surgery, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei Cai
- Department of Interventional Vascular Surgery, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weili Lin
- Department of Ultrasound Imaging, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Changsheng Shi
- Department of Interventional Vascular Surgery, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Dumitrescu G, Antovic J, Soutari N, Gran C, Antovic A, Al-Abani K, Grip J, Rooyackers O, Taxiarchis A. The role of complement and extracellular vesicles in the development of pulmonary embolism in severe COVID-19 cases. PLoS One 2024; 19:e0309112. [PMID: 39178205 PMCID: PMC11343408 DOI: 10.1371/journal.pone.0309112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/05/2024] [Indexed: 08/25/2024] Open
Abstract
Complement and extracellular vesicles (EVs) association with thrombogenic tendencies is acknowledged, but limited evidence exists for their link to COVID-19 venous thromboembolism. This study aims to examine the relationship between pulmonary embolism and the expression of complement and other proteins related to thrombogenesis in severe Covid-19 patients. We included prospectively 207 severe COVID-19 patients and retrospectively screened for pulmonary embolism (PE). This analysis comprises 20 confirmed PE cases and 20 matched patients without PE. Blood samples taken at the admission in the intensive care unit were analyzed for complement using ELISA. EVs derived from neutrophils, endothelium, or platelets, as well carrying complement or tissue factor were analyzed using flow cytometry. Complement levels were markedly elevated, with a notable increase in C3a and Terminal Complement Complex. The most prevalent EV population was identified as tissue factor (TF)-carrying EVs which peaked in patients with PE during ICU days 4-9. However, for both the complement and analyzed EV populations, no statistically significant differences were found between the patients who developed pulmonary embolism and those who did not. In conclusion, complement factors and EVs expressing tissue factor, along with EVs derived from endothelial cells and platelets, are elevated in severe COVID-19 patients, regardless of the presence of pulmonary embolism. However, the involvement of complement and procoagulant EVs in peripheral plasma in the development of pulmonary embolism is still unclear and requires further investigation.
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Affiliation(s)
- Gabriel Dumitrescu
- Division of Anaesthesia and Intensive Care, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, and Perioperative and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Jovan Antovic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Nida Soutari
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Gran
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Aleksandra Antovic
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, and Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Kais Al-Abani
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonathan Grip
- Division of Anaesthesia and Intensive Care, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, and Perioperative and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Olav Rooyackers
- Division of Anaesthesia and Intensive Care, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, and Perioperative and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Apostolos Taxiarchis
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
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9
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Zhang W, Paudel D, Shi R, Yang J, Liu J, Jia Y. Pulmonary embolism incidence among patient admitted under psychiatry department: a case-control study. Front Psychiatry 2024; 15:1449963. [PMID: 39220184 PMCID: PMC11362096 DOI: 10.3389/fpsyt.2024.1449963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024] Open
Abstract
Background Pulmonary embolism (PE) is a serious and potentially life-threatening condition that requires prompt diagnosis and treatment. Identifying risk factors and diagnostic markers can aid in the early detection and management of this condition. Methods This case-control study examined 10,077 patients admitted to Shenzhen Kangning Hospital's psychiatry facility in 2020. Among these, 65 patients were diagnosed with PE, including 50 new cases. After survival sampling for controls and age-and-gender matching, the study included 41 new PE cases and 41 age-and-gender-matched controls. Data on demographics, comorbidities, and medication use were extracted from electronic records. Conditional logistic regression analyses were performed to determine the association between each predictor and PE risk. Additionally, the sensitivity and specificity of the d-dimer diagnostic tool were assessed. Results In univariable conditional logistic regression, active alcoholism was associated with a higher PE risk (OR=3.675, 95% CI 1.02-13.14, P=0.046). A history of physical restraint (OR=4.33, 95% CI 1.24-15.21, P=0.022) and chemical restraint (OR 4.67, 95% CI 1.34-16.24, p=0.015) also increased PE risk, as did benzodiazepine use (OR=3.33, 95% CI 1.34-8.30, P=0.010). Conversely, psychotropic medication before admission was associated with a lower risk of PE (OR=0.07, 95% CI 0.01-0.59, P=0.013). Stepwise multivariable forward conditional regression identified two subsets of psychiatric patients at higher risk of PE: new psychiatric cases without medication at admission who were chemically restrained, and cases without medication at admission who were started on antipsychotics and benzodiazepines. The d-dimer diagnostic tool, with an optimal threshold of 570 ng/ml determined by the Youden index (J statistic of 0.6098), showed a sensitivity of 73.17% and specificity of 87.80% for detecting PE, with an AUC of 0.833 (95% CI: 0.735-0.906). Conclusion Our findings suggest that a history of restraint, alcoholism, and the use of antipsychotics and benzodiazepines are important predictors of PE in psychiatric inpatients. Conversely, psychotropic medications at admission may be linked to a lower PE risk. The d-dimer diagnostic tool shows good value for screening PE in psychiatric inpatients. These predictors and diagnostic markers could help clinicians identify high-risk patients and implement appropriate prevention strategies.
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Affiliation(s)
- Wanling Zhang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Dhirendra Paudel
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Rui Shi
- Chongqing Mental Health Center, Chongqing, China
| | - Junwei Yang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Jingwen Liu
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
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10
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Gooderham MJ, de Bruin-Weller M, Weidinger S, Cork MJ, Eichenfield LF, Simpson EL, Tsianakas A, Kerkmann U, Feeney C, Romero W. Practical Management of the JAK1 Inhibitor Abrocitinib for Atopic Dermatitis in Clinical Practice: Special Safety Considerations. Dermatol Ther (Heidelb) 2024; 14:2285-2296. [PMID: 38954384 PMCID: PMC11333678 DOI: 10.1007/s13555-024-01200-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024] Open
Abstract
Abrocitinib, an oral, once-daily, Janus kinase (JAK) 1-selective inhibitor, is approved for the treatment of adults and adolescents with moderate-to-severe atopic dermatitis (AD). Abrocitinib has shown rapid and sustained efficacy in phase 3 trials and a consistent, manageable safety profile in long-term studies. Rapid itch relief and skin clearance are more likely to be achieved with a 200-mg daily dose of abrocitinib than with dupilumab. All oral JAK inhibitors are associated with adverse events of special interest and laboratory changes, and initial risk assessment and follow-up monitoring are important. Appropriate selection of patients and adequate monitoring are key for the safe use of JAK inhibitors. Here, we review the practical use of abrocitinib and discuss characteristics of patients who are candidates for abrocitinib therapy. In general, abrocitinib may be used in all appropriate patients with moderate-to-severe AD in need of systemic therapy, provided there are no contraindications, e.g., in patients with active serious systemic infections and those with severe hepatic impairment, as well as pregnant or breastfeeding women. For patients aged ≥ 65 years, current long-time or past long-time smokers, and those with risk factors for venous thromboembolism, major adverse cardiovascular events, or malignancies, a meticulous benefit-risk assessment is recommended, and it is advised to start with the 100-mg dose, when abrocitinib is the selected treatment option.
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Affiliation(s)
- Melinda J Gooderham
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Queen's University, Kingston, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
| | | | | | - Michael J Cork
- Sheffield Dermatology Research, University of Sheffield, Sheffield, UK
- Sheffield Children's Hospital, Sheffield, UK
| | - Lawrence F Eichenfield
- University of California San Diego and Rady Children's Hospital San Diego, San Diego, CA, USA
| | | | | | | | - Claire Feeney
- Pfizer Ltd, Walton Oaks, Dorking Road, Tadworth, Surrey, KT20 7NS, UK.
| | - William Romero
- Pfizer Ltd, Walton Oaks, Dorking Road, Tadworth, Surrey, KT20 7NS, UK
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11
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Masand VH, Al-Hussain S, Alzahrani AY, Al-Mutairi AA, Sultan Alqahtani A, Samad A, Alafeefy AM, Jawarkar RD, Zaki MEA. Unveiling dynamics of nitrogen content and selected nitrogen heterocycles in thrombin inhibitors: a ceteris paribus approach. Expert Opin Drug Discov 2024; 19:991-1009. [PMID: 38898679 DOI: 10.1080/17460441.2024.2368743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Despite the progress in comprehending molecular design principles and biochemical processes associated with thrombin inhibition, there is a crucial need to optimize efforts and curtail the recurrence of synthesis-testing cycles. Nitrogen and N-heterocycles are key features of many anti-thrombin drugs. Hence, a pragmatic analysis of nitrogen and N-heterocycles in thrombin inhibitors is important throughout the drug discovery pipeline. In the present work, the authors present an analysis with a specific focus on understanding the occurrence and distribution of nitrogen and selected N-heterocycles in the realm of thrombin inhibitors. RESEARCH DESIGN AND METHODS A dataset comprising 4359 thrombin inhibitors is used to scrutinize various categories of nitrogen atoms such as ring, non-ring, aromatic, and non-aromatic. In addition, selected aromatic and aliphatic N-heterocycles have been analyzed. RESULTS The analysis indicates that ~62% of thrombin inhibitors possess five or fewer nitrogen atoms. Substituted N-heterocycles have a high occurrence, like pyrrolidine (23.24%), pyridine (20.56%), piperidine (16.10%), thiazole (9.61%), imidazole (7.36%), etc. in thrombin inhibitors. CONCLUSIONS The majority of active thrombin inhibitors contain nitrogen atoms close to 5 and a combination of N-heterocycles like pyrrolidine, pyridine, piperidine, etc. This analysis provides crucial insights to optimize the transformation of lead compounds into potential anti-thrombin inhibitors.
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Affiliation(s)
- Vijay H Masand
- Department of Chemistry, Vidya Bharati Mahavidyalaya, Amravati, India
| | - Sami Al-Hussain
- Department of Chemistry, College of Science, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Abdullah Y Alzahrani
- Department of Chemistry, Faculty of Science and Arts, King Khalid University, Mohail Asser, Saudi Arabia
| | - Aamal A Al-Mutairi
- Department of Chemistry, College of Science, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Arwa Sultan Alqahtani
- Department of Chemistry, College of Science, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Abdul Samad
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Tishk International University, Erbil, Iraq
| | - Ahmed M Alafeefy
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Universiti Teknologi MARA [UiTM], Bandar Puncak Alam, Selangor, Malaysia
| | - Rahul D Jawarkar
- Department of Medicinal Chemistry and Drug Discovery, Dr Rajendra Gode Institute of Pharmacy, Amravati, India
| | - Magdi E A Zaki
- Department of Chemistry, College of Science, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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12
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Choinski KN, Smolock CJ, Phair JP. The Top 100 Most-Cited Articles in Venous Disease and Management. Ann Vasc Surg 2024:S0890-5096(24)00413-8. [PMID: 39009118 DOI: 10.1016/j.avsg.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Advancements in the management of venous disease have been documented in scientific literature. We performed a bibliometric analysis using citations as an indication of impact to analyze the most influential articles on venous disease and treatment. METHODS A retrospective search of the Web of Science database was conducted in May 2023. Key search terms were queried to generate relevant articles. Articles were ranked on total number of citations and average number of citations per year. Metrics analyzed included top journals, impact factor, journal discipline, institution and country of publication, author degree and gender, number of publications per year, level of evidence, and article topic area. RESULTS The top 100 articles on venous disease were published between 1994 and 2020, with a total of 102,856 citations, average 1,028 citations/article, and mean of 70 citations/year. The most popular article was "Incidence of thrombotic complications of in critically ill Intensive Care Unit patients with COVID-19" with 3,482 citations in total. The most popular journals were New England Journal of Medicine (22 articles), Lancet (14 articles), and CHEST (13 articles), pertaining to management of deep venous thrombosis (DVT). The Journal of Vascular surgery had 2 influential articles, focused on management of chronic venous disease. Many articles were published in the United States (52), Canada (38), and Netherlands (25). Prolific authors were predominantly male (96%) and 59% were MDs versus 29% combined MD/PhD and 12% PhDs. Popular venous articles included guidelines/standards for DVT management (12%), epidemiology of venous thromboembolism (12%), and anticoagulation for DVT (12%). Specific venous thromboembolism risk factors within popular literature included prothrombotic genes, malignancy, pregnancy, trauma, and COVID-19. Articles on surgical interventions included inferior vena cava filter placement, catheter-directed thrombolysis, and risks of femoral and subclavian vein catheterization. Venous stenting and mechanical thrombectomy were not within the top articles. CONCLUSIONS Top-cited articles on venous disease emphasized management of DVT, followed by chronic venous disease, through the collaboration of multiple medical and surgical specialties. The largest number of citations in recent DVT literature was driven by COVID-19 complications.
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Affiliation(s)
- Krystina N Choinski
- Division of Vascular and Endovascular Surgery, Mount Sinai Health System, New York, NY
| | - Christopher J Smolock
- Division of Vascular and Endovascular Surgery, Mount Sinai Health System, New York, NY
| | - John P Phair
- Division of Vascular and Endovascular Surgery, Mount Sinai Health System, New York, NY.
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Liu KT, Wang PW, Hsieh HY, Pan HC, Chin HJ, Lin CW, Huang YJ, Liao YC, Tsai YC, Liu SR, Su IC, Song YF, Yin GC, Wu KC, Chuang EY, Fan YJR, Yu J. Site-specific thrombus formation: advancements in photothrombosis-on-a-chip technology. LAB ON A CHIP 2024; 24:3422-3433. [PMID: 38860416 DOI: 10.1039/d4lc00216d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Thrombosis, characterized by blood clot formation within vessels, poses a significant medical challenge. Despite extensive research, the development of effective thrombosis therapies is hindered by substantial costs, lengthy development times, and high failure rates in medication commercialization. Conventional pre-clinical models often oversimplify cardiovascular disease, leading to a disparity between experimental results and human physiological responses. In response, we have engineered a photothrombosis-on-a-chip system. This microfluidic model integrates human endothelium, human whole blood, and blood flow dynamics and employs the photothrombotic method. It enables precise, site-specific thrombus induction through controlled laser irradiation, effectively mimicking both normal and thrombotic physiological conditions on a single chip. Additionally, the system allows for the fine-tuning of thrombus occlusion levels via laser parameter adjustments, offering a flexible thrombus model with varying degrees of obstruction. Additionally, the formation and progression of thrombosis noted on the chip closely resemble the thrombotic conditions observed in mice in previous studies. In the experiments, we perfused recalcified whole blood with Rose Bengal into an endothelialized microchannel and initiated photothrombosis using green laser irradiation. Various imaging methods verified the model's ability to precisely control thrombus formation and occlusion levels. The effectiveness of clinical drugs, including heparin and rt-PA, was assessed, confirming the chip's potential in drug screening applications. In summary, the photothrombosis-on-a-chip system significantly advances human thrombosis modeling. Its precise control over thrombus formation, flexibility in the thrombus severity levels, and capability to simulate dual physiological states on a single platform make it an invaluable tool for targeted drug testing, furthering the development of organ-on-a-chip drug screening techniques.
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Affiliation(s)
- Kuan-Ting Liu
- Department of Chemical Engineering, National Taiwan University, Taipei 10617, Taiwan.
| | - Pai-Wen Wang
- Institute of Applied Mechanics, National Taiwan University, Taipei 10617, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Han-Yun Hsieh
- Department of Biochemical and Molecular Medical Science, National Dong Hwa University, Hualien 97401, Taiwan
| | - Han-Chi Pan
- National Laboratory Animal Center, National Applied Research Laboratories, Taipei 115021, Taiwan
| | - Hsian-Jean Chin
- National Laboratory Animal Center, National Applied Research Laboratories, Taipei 115021, Taiwan
| | - Che-Wei Lin
- School of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
| | - Yu-Jen Huang
- Department of Chemical Engineering, National Taiwan University, Taipei 10617, Taiwan.
| | - Yung-Chieh Liao
- Department of Chemical Engineering, National Taiwan University, Taipei 10617, Taiwan.
| | - Ya-Chun Tsai
- Institute of Applied Mechanics, National Taiwan University, Taipei 10617, Taiwan
| | - Shang-Ru Liu
- Institute of Applied Mechanics, National Taiwan University, Taipei 10617, Taiwan
| | - I-Chang Su
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Department of Neurosurgery, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, 23561, Taiwan
| | - Yen-Fang Song
- National Synchrotron Radiation Research Center, Hsinchu 300092, Taiwan
| | - Gung-Chian Yin
- National Synchrotron Radiation Research Center, Hsinchu 300092, Taiwan
| | - Kuang-Chong Wu
- Institute of Applied Mechanics, National Taiwan University, Taipei 10617, Taiwan
| | - Er-Yuan Chuang
- School of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
| | - Yu-Jui Ray Fan
- School of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
| | - Jiashing Yu
- Department of Chemical Engineering, National Taiwan University, Taipei 10617, Taiwan.
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14
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Ventrapragada K, Wright A, Tahir S, Tartaglia L, Ganti L. Traumatic Pulmonary Embolism. Cureus 2024; 16:e64614. [PMID: 39156300 PMCID: PMC11328824 DOI: 10.7759/cureus.64614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 07/11/2024] [Indexed: 08/20/2024] Open
Abstract
Pulmonary embolism (PE) is a life-threatening illness caused by a blood clot obstructing a pulmonary artery, resulting in decreased blood supply to the lungs. PE is a high-stakes diagnosis with considerable morbidity and death if left untreated. This case emphasizes the increased risk of PE associated with trauma and stresses the importance of this differential diagnosis in patients who report dyspnea following physical trauma. Understanding the risk factors and processes that contribute to PE in trauma patients is critical for accurate diagnosis and treatment.
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Affiliation(s)
| | - Alexis Wright
- Medical School, Lewis Katz School of Medicine, Temple University, Philadelphia, USA
| | - Sana Tahir
- Medicine, Orlando College of Osteopathic Medicine, Winter Garden, USA
| | - Lisa Tartaglia
- Specialty Care, Orlando College of Osteopathic Medicine, Winter Garden, USA
| | - Latha Ganti
- Emergency Medicine and Neurology, University of Central Florida, Orlando, USA
- Research, Orlando College of Osteopathic Medicine, Winter Garden, USA
- Medical Sciences, The Warren Alpert Medical School of Brown University, Providence, USA
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15
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Wang G, Wu BF, Zhao WJ, Hu WP, Wang JY, Gao HZ. C-reactive protein is a predictor for lower-extremity deep venous thrombosis in patients with primary intracerebral hemorrhage. Eur J Med Res 2024; 29:311. [PMID: 38845036 PMCID: PMC11157878 DOI: 10.1186/s40001-024-01842-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/13/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE Our study aimed to determine whether there exists an association between low-grade systemic inflammation, as measured by serum C-reactive protein (CRP), and the risk of lower-extremity deep venous thrombosis (LEDVT) in patients with primary intracerebral hemorrhage (ICH). METHODS This observational study was retrospectively conducted on patients with primary ICH who were presented to two tertiary medical centers between January 2021 and August 2022. The primary outcome was detecting LEDVT occurrence within 14 days from the onset of the acute ICH episode. Weighted logistic regression and restricted cubic spline models were employed to estimate the association between CRP and LEDVT following 1:1 propensity score matching (PSM). RESULTS Of the 538 patients with primary ICH who met the inclusion criteria, 76 (14.13%) experienced LEDVT. Based on the cut-off levels of CRP measured upon admission from the receiver operating characteristic (ROC) curve, patients with primary ICH were categorized into two groups: (i) CRP < 1.59 mg/L and (ii) CRP ≥ 1.59 mg/L. After 1:1 PSM, the LEDVT events occurred in 24.6% of patients with CRP ≥ 1.59 mg/L and 4.1% of patients with CRP < 1.59 mg/L (P < 0.001). ROC curve revealed the area under the ROC curve of 0.717 [95% confidence interval (CI) 0.669-0.761, P < 0.001] for CRP to predict LEDVT with a sensitivity of 85.71% and specificity of 56.29%. After adjusting for all confounding variables, the occurrence of LEDVT in ICH patients with higher CRP levels (≥ 1.59 mg/L) was 10.8 times higher compared to those with lower CRP levels (95% CI 4.5-25.8, P < 0.001). A nonlinear association was observed between CRP and an increased risk of LEDVT in the fully adjusted model (P for overall < 0.001, P for nonlinear = 0.001). The subgroup results indicated a consistent positive link between CRP and LEDVT events following primary ICH. CONCLUSIONS Higher initial CRP levels (CRP as a dichotomized variable) in patients with primary ICH are significantly associated with an increased risk of LEDVT and may help identify high-risk patients with LEDVT. Clinicians should be vigilant to enable early and effective intervention in patients at high risk of LEDVT.
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Affiliation(s)
- Gang Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, China
- Key Lab of Neurology of Gansu Province, Lanzhou, China
| | - Bao-Fang Wu
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Wen-Jun Zhao
- Department of Health Management Center, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Wei-Peng Hu
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Jia-Yin Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China.
| | - Hong-Zhi Gao
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China.
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16
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Elashmawy A, Gold L. Upper Extremity Deep Vein Thrombosis in the Setting of Ductal Carcinoma In Situ: A Case Report. Cureus 2024; 16:e61805. [PMID: 38975418 PMCID: PMC11227265 DOI: 10.7759/cureus.61805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Deep vein thrombosis (DVT) is a type of venous thromboembolism that usually involves a clot formation in the deep veins of the lower extremities. Its formation is linked to Virchow's Triad which factors in venous stasis, endothelial damage, and hypercoagulability. Venous stasis is the primary factor contributing to the development of DVT and it refers to varicosity, external pressure placed on the extremity, or immobilization due to bed rest or long flights. Clinical presentation of DVT depends on the extent and location of the thrombus with common signs including localized swelling, pain, warmth, and edema. The Wells criteria are typically applied to assess the likelihood of thrombus formation alongside D-dimer assay, ultrasound, or CT imaging. As previously mentioned, these mostly occur in the lower extremities. However, upper extremity DVT has been noted and has been linked to inherited issues with coagulation and autoimmune disorders. This report will discuss a case of left-arm DVT in a patient who underwent bilateral mastectomy with sentinel node biopsy for a diagnosis of ductal carcinoma in situ in the left breast.
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Affiliation(s)
- Ahmed Elashmawy
- Surgery, Wayne State University School of Medicine, Detroit, USA
| | - Linsey Gold
- Surgery, Wayne State University School of Medicine, Detroit, USA
- Surgery, Oakland University William Beaumont School of Medicine, Rochester, USA
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17
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Riccio A, Shilling AM. Unique Medical Considerations for the Athlete Undergoing Anesthesia. Anesthesiol Clin 2024; 42:185-201. [PMID: 38705670 DOI: 10.1016/j.anclin.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Athletes are among a unique group such that they may possess a serious underlying pathologic condition that may often go unnoticed given their high caliber of physical fitness. However, several considerations should be investigated, especially in the perioperative period, in order to minimize morbidity and mortality. Namely, cardiac pathologic condition can result in sudden death, and pulmonary pathologic condition may affect airway and respiratory management. Moreover, patients undergoing orthopedic surgery are at the highest risk for venous thromboembolism. Regardless of the condition, it is crucial to be vigilant and explore the unique medical considerations for the athlete undergoing anesthesia.
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Affiliation(s)
| | - Ashley M Shilling
- Department of Anesthesiology, University of Virginia Health System, MDPO Box 800710, Charlottesville VA 22908, USA.
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18
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Feng L, Xie Z, Zhou X, Yang Y, Liang Z, Hou C, Liu L, Zhang D. Diagnostic value of fibrinogen in lower extremity deep vein thrombosis caused by rib fracture: A retrospective study. Phlebology 2024:2683555241258274. [PMID: 38822566 DOI: 10.1177/02683555241258274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
Objectives: To investigate the diagnostic value of fibrinogen (FIB) in patients with rib fractures complicated by lower extremity deep venous thrombosis (DVT).Methods: Analyzing data from 493 patients at Shijiazhuang Third Hospital, FIB levels at 24, 48, and 72 h post-injury were compared between DVT and non-DVT groups.Results: DVT group had elevated FIB levels at all times (p < .001). FIB at 24 h showed highest AUC, particularly in patients with BMI <28.Conclusion: In conclusion, measuring FIB at 24 h post-injury enhances DVT detection in rib fracture patients, with potential BMI-related variations.
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Affiliation(s)
- Lei Feng
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, China
| | - Zexin Xie
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, China
| | - Xuetao Zhou
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, China
| | - Yang Yang
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, China
| | - Zheng Liang
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, China
| | - Chunjuan Hou
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, China
| | - Lili Liu
- Department of Cardiology, The Third Hospital of Shijiazhuang, Shijiazhuang, China
| | - Dongsheng Zhang
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, China
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19
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Mongelli M, Lorusso D, Zanagnolo V, Pignata S, Colombo N, Cormio G. Venous Thromboembolism Prophylaxis in Gynecologic Oncology: A MITO-MaNGO Survey. Diagnostics (Basel) 2024; 14:1159. [PMID: 38893685 PMCID: PMC11172117 DOI: 10.3390/diagnostics14111159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Cancer-associated thrombosis is the second leading cause of death in cancer patients, and its incidence has been increasing in recent years. This survey was aimed at gathering information regarding the management of thromboembolic prophylaxis within the MITO (Multicenter Italian Trials in Ovarian Cancer)-MaNGO (Mario Negri Gynecologic Oncology) groups. We designed a self-administered, multiple-choice online questionnaire available only for MITO-MaNGO members for one month, starting in May 2022 and ending in June 2022. We processed one response form per center, and 50 responses were analyzed, with most of the respondents (78%) over 40 years old. We found that 82% of them consider thromboembolic prophylaxis in gynecologic oncology to be relevant. In 82% of the centers, a standardized protocol on venous thromboembolism (VTE) prophylaxis is used, which is applied to both patients undergoing surgery and those undergoing chemotherapy. In the remaining 18% of centers, prophylaxis is used exclusively for patients undergoing chemotherapy treatment. Prophylaxis of patients undergoing surgery and chemotherapy treatment is managed in most cases by the surgeon (72%) and oncologist (76%), respectively. Only 26% of respondents use a thromboembolic risk assessment scale, and of these, those used are the Caprini Score (6%), Khorana Score (6%), and Wells Score (2%). The respondents have good knowledge of low-molecular-weight heparin (90%) and average knowledge of dicumarolics (40%), direct oral anticoagulants (DOACs) (68%), and antiplatelet agents (40%). The results of our survey indicate that there is a good awareness of thromboembolic prophylaxis in gynecologic oncology. Nevertheless, it is used less in outpatients than in patients undergoing surgery. Moreover, the thromboembolic risk assessment scores are barely used.
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Affiliation(s)
- Michele Mongelli
- Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 00168 Rome, Italy
| | - Vanna Zanagnolo
- Department of Gynecologic Oncology, Istituto Europeo di Oncologia, 20141 Milan, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Fondazione G. Pascale, 80131 Naples, Italy
| | - Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 20139 Milan, Italy
- School of Medicine and Surgery, University of Milan-Bicocca, 20126 Milan, Italy
| | - Gennaro Cormio
- S.S.D. Ginecologia Oncologica Clinicizzata, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
- Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, 70124 Bari, Italy
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20
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Ramanujam RK, Garyfallogiannis K, Litvinov RI, Bassani JL, Weisel JW, Purohit PK, Tutwiler V. Mechanics and microstructure of blood plasma clots in shear driven rupture. SOFT MATTER 2024; 20:4184-4196. [PMID: 38686609 PMCID: PMC11135145 DOI: 10.1039/d4sm00042k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
Intravascular blood clots are subject to hydrodynamic shear and other forces that cause clot deformation and rupture (embolization). A portion of the ruptured clot can block blood flow in downstream vessels. The mechanical stability of blood clots is determined primarily by the 3D polymeric fibrin network that forms a gel. Previous studies have primarily focused on the rupture of blood plasma clots under tensile loading (Mode I), our current study investigates the rupture of fibrin induced by shear loading (Mode II), dominating under physiological conditions induced by blood flow. Using experimental and theoretical approaches, we show that fracture toughness, i.e. the critical energy release rate, is relatively independent of the type of loading and is therefore a fundamental property of the gel. Ultrastructural studies and finite element simulations demonstrate that cracks propagate perpendicular to the direction of maximum stretch at the crack tip. These observations indicate that locally, the mechanism of rupture is predominantly tensile. Knowledge gained from this study will aid in the development of methods for prediction/prevention of thrombotic embolization.
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Affiliation(s)
- Ranjini K Ramanujam
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA.
| | | | - Rustem I Litvinov
- Department of Cell and Developmental Biology, University of Pennsylvania, Philadelphia, PA, USA
| | - John L Bassani
- Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, PA, USA
| | - John W Weisel
- Department of Cell and Developmental Biology, University of Pennsylvania, Philadelphia, PA, USA
| | - Prashant K Purohit
- Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, PA, USA
| | - Valerie Tutwiler
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA.
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21
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Piech P, Haratym M, Borowski B, Węgłowski R, Staśkiewicz G. Beyond the fractures: A comprehensive Comparative analysis of Affordable and Accessible laboratory parameters and their coefficients for prediction and Swift confirmation of pulmonary embolism in high-risk orthopedic patients. Pract Lab Med 2024; 40:e00397. [PMID: 38737854 PMCID: PMC11088337 DOI: 10.1016/j.plabm.2024.e00397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024] Open
Abstract
Background Pulmonary embolism (PE) poses a significant challenge in diagnosis and treatment, particularly in high-risk patient populations such as those hospitalized for orthopedic reasons. This study explores the predictive and diagnostic potential of laboratory parameters in identifying PE among orthopedic patients. Objectives The purpose of this study was to determine whether selected (inexpensive and readily available) laboratory parameters and their coefficients can be used to diagnose pulmonary embolism and whether they are applicable in predicting its occurrence. Material and methods Selected laboratory parameters were determined twice in 276 hospitalized orthopedic patients with suspected PE: PLT, MPV, NEU, LYM, D-dimer, troponin I, age-adjusted D-dimer and their coefficients. Depending on the angio-CT results, patients were divided into groups. Selected popular laboratory coefficients were calculated and statistically analyzed. Optimal cutoff points were determined for the above laboratory tests and ROC curves were plotted. Results D-dimer/troponin I [p = 0.008], D-dimer [p = 0.001], age-adjusted D-dimer [p = 0.007], NLR/D-dimer [p = 0.005] and PLR [p = 0.021] are statistically significant predictors of PE. D-dimer/troponin I [p < 0.001], troponin I [p = 0.005] and age-adjusted D-dimer [p = 0.001] correlated with the diagnosis of PE after the onset of clinical symptoms. Conclusions In the context of orthopedic patients, cost-effective laboratory parameters, particularly the D-dimer/troponin I ratio and age-adjusted D-dimer, exhibit considerable potential in predicting and diagnosing PE. These findings suggest that combining readily available laboratory tests with clinical observation can offer a viable and cost-effective diagnostic alternative, especially in resource-constrained settings. Further studies with larger and diverse patient populations are recommended to validate these results.
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Affiliation(s)
- Piotr Piech
- Department of Normal, Clinical and Imaging Anatomy, Medical University of Lublin, Poland
- Department of Orthopedics and Traumatology, Medical University of Lublin, Poland
| | - Mateusz Haratym
- Research Group of Normal, Clinical and Imaging Anatomy, Medical University of Lublin, Poland
| | - Bartosz Borowski
- Research Group of Normal, Clinical and Imaging Anatomy, Medical University of Lublin, Poland
| | - Robert Węgłowski
- Department of Normal, Clinical and Imaging Anatomy, Medical University of Lublin, Poland
| | - Grzegorz Staśkiewicz
- Department of Normal, Clinical and Imaging Anatomy, Medical University of Lublin, Poland
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22
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Nguyen HT, Vu MP, Nguyen TTM, Nguyen TT, Kieu TVO, Duong HY, Pham PT, Hoang TH. Association of the neutrophil-to-lymphocyte ratio with the occurrence of venous thromboembolism and arterial thrombosis. J Int Med Res 2024; 52:3000605241240999. [PMID: 38606734 PMCID: PMC11015807 DOI: 10.1177/03000605241240999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/04/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE This study aimed to assess the association of the neutrophil-to-lymphocyte ratio (NLR) with the occurrence of venous thromboembolism (VTE) and arterial thrombosis (AT). METHODS This was a retrospective cross-sectional study including 585 medical records obtained from all consecutive patients who were suspected of having thrombosis. RESULTS The AT group had a higher neutrophil count and NLR and a lower lymphocyte count than the non-thrombosis group. Receiver operating characteristic curve analysis showed the ability of the NLR to predict the presence of AT. The cut-off value for the NLR was 4.44. No distinction was found in the NLR between the VTE and non-thrombosis groups. Regression analysis showed that a high NLR was an independent factor related to the presence of AT. Patients with an NLR ≥ 4.44 had a higher risk of AT than those with an NLR < 4.44 (odds ratio = 2.015, 95% confidence interval: 1.180-3.443). CONCLUSION A high NLR may be considered a predictive factor for the occurrence of AT, but an association with the presence of VTE was not found.
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Affiliation(s)
- Ha Thanh Nguyen
- Department of Hematology, Hanoi Medical University, Hanoi, Vietnam
| | - Minh Phuong Vu
- Department of Hematology, Hanoi Medical University, Hanoi, Vietnam
- Hematology and Blood Transfusion Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Thi Tuyet Mai Nguyen
- Department of Hematology, Hanoi Medical University, Hanoi, Vietnam
- Hematology and Blood Transfusion Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Tuan Tung Nguyen
- Hematology and Blood Transfusion Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Thi Van Oanh Kieu
- Hematology and Blood Transfusion Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Hai Yen Duong
- Hematology and Blood Transfusion Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Phuong Thao Pham
- Department of Hematology, Hanoi Medical University, Hanoi, Vietnam
- Hematology and Blood Transfusion Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Thi Hue Hoang
- Department of Hematology, Hanoi Medical University, Hanoi, Vietnam
- Hematology and Blood Transfusion Center, Bach Mai Hospital, Hanoi, Vietnam
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Leonard J, Kepplinger D, Espina V, Gillevet P, Ke Y, Birukov KG, Doctor A, Hoemann CD. Whole blood coagulation in an ex vivo thrombus is sufficient to induce clot neutrophils to adopt a myeloid-derived suppressor cell signature and shed soluble Lox-1. J Thromb Haemost 2024; 22:1031-1045. [PMID: 38135253 DOI: 10.1016/j.jtha.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Blood clots are living tissues that release inflammatory mediators including IL-8/CXCL8 and MCP-1/CCL2. A deeper understanding of blood clots is needed to develop new therapies for prothrombotic disease states and regenerative medicine. OBJECTIVES To identify a common transcriptional shift in cultured blood clot leukocytes. METHODS Differential gene expression of whole blood and cultured clots (4 hours at 37 °C) was assessed by RNA sequencing (RNAseq), reverse transcriptase-polymerase chain reaction, proteomics, and histology (23 diverse healthy human donors). Cultured clot serum bioactivity was tested in endothelial barrier functional assays. RESULTS All cultured clots developed a polymorphonuclear myeloid-derived suppressor cell (PMN-MDSC) signature, including up-regulation of OLR1 (mRNA encoding lectin-like oxidized low-density lipoprotein receptor 1 [Lox-1]), IL-8/CXCL8, CXCL2, CCL2, IL10, IL1A, SPP1, TREM1, and DUSP4/MKP. Lipopolysaccharide enhanced PMN-MDSC gene expression and specifically induced a type II interferon response with IL-6 production. Lox-1 was specifically expressed by cultured clot CD15+ neutrophils. Cultured clot neutrophils, but not activated platelets, shed copious amounts of soluble Lox-1 (sLox-1) with a donor-dependent amplitude. sLox-1 shedding was enhanced by phorbol ester and suppressed by heparin and by beta-glycerol phosphate, a phosphatase inhibitor. Cultured clot serum significantly enhanced endothelial cell monolayer barrier function, consistent with a proresolving bioactivity. CONCLUSION This study suggests that PMN-MDSC activation is part of the innate immune response to coagulation which may have a protective role in inflammation. The cultured blood clot is an innovative thrombus model that can be used to study both sterile and nonsterile inflammatory states and could be used as a personalized medicine tool for drug screening.
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Affiliation(s)
- Julia Leonard
- Department of Bioengineering, Institute of Biomedical Engineering, George Mason University, Manassas, Virginia, USA
| | - David Kepplinger
- Department of Statistics, George Mason University, Fairfax, Virginia, USA
| | - Virginia Espina
- Department of Systems Biology, George Mason University, Fairfax, Virginia, USA
| | - Pat Gillevet
- Department of Biology, George Mason University, Fairfax, Virginia, USA
| | - Yunbo Ke
- Department of Anesthesiology, School of Medicine, University of Maryland at Baltimore, Baltimore, Maryland, USA
| | - Konstantin G Birukov
- Department of Anesthesiology, School of Medicine, University of Maryland at Baltimore, Baltimore, Maryland, USA
| | - Allan Doctor
- Departments of Pediatrics & Bioengineering and Center for Blood Oxygen Transport and Hemostasis, School of Medicine, University of Maryland at Baltimore, Baltimore, Maryland, USA
| | - Caroline D Hoemann
- Department of Bioengineering, Institute of Biomedical Engineering, George Mason University, Manassas, Virginia, USA.
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24
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Wenzel AN, Marrache M, Schmerler J, Kinney J, Khanuja HS, Hegde V. Impact of Postoperative COVID-19 Infection Status on Outcomes in Elective Primary Total Joint Arthroplasty. J Arthroplasty 2024; 39:871-877. [PMID: 37852450 DOI: 10.1016/j.arth.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Although Coronavirus disease 2019 (COVID-19) infection causes major morbidity and mortality, it is unclear what the impact of postoperative COVID-19 infection is on 30-day outcomes after total joint arthroplasty (TJA). METHODS There were 2,340 patients who underwent TJA in 2021, identified using the National Surgical Quality Improvement Program database, with 925 total hip arthroplasty (THA) patients (39.5%) and 1,415 total knee arthroplasty (TKA) patients (60.5%), overall. Propensity score matching was implemented using patient demographics and preoperative medical conditions to compare outcomes for postoperative COVID-19-positive and COVID-19-negative patients who underwent TKA or THA. RESULTS Postoperative COVID-19-positive THA patients were found to have a significantly increased risk of pneumonia (odds ratio [OR] 42.57), sepsis (OR 12.77), readmission (OR 12.06), non-home discharge (OR 3.78), and longer length of stay (hazard ratio 1.62). Postoperative COVID-19-positive TKA patients had an increased risk of 30-day mortality (OR 14.17), superficial infection (OR 3.17), pneumonia (OR 34.68), unplanned intubation (OR 18.31), ventilator use for more than 48 hours (OR 18.31), pulmonary embolism (OR 11.98), urinary tract infection (OR 5.16), myocardial infarction (OR 16.02), deep vein thrombosis (OR 4.69), non-home discharge (OR 1.79), reoperation (OR 3.17), readmission (OR 9.61), and longer length of stay (hazard ratio 1.49). CONCLUSIONS Patients who contracted COVID-19 within 30 days after TJA were at increased risk of mortalities, medical complications, readmissions, reoperations, and non-home discharges. It is important for orthopedic surgeons to understand these adverse outcomes to better counsel patients and mitigate these risks, particularly in higher risk populations.
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Affiliation(s)
- Alyssa N Wenzel
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Majd Marrache
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica Schmerler
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason Kinney
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vishal Hegde
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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25
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Thind T, Heye T, Henson C, Reif R, Jensen HK, Kalkwarf KJ, Bhavaraju A, Robertson R, Jenkins A. Weight-Based Dosing for Low-Molecular-Weight Heparin (Enoxaparin) Administration to Achieve Optimal VTE Prophylaxis in Trauma Patients. Am Surg 2024:31348241241620. [PMID: 38518208 DOI: 10.1177/00031348241241620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Patients admitted after traumatic injuries are at high risk for developing venous thromboembolism (VTE). Low-molecular-weight heparin (LMWH) is commonly used to prevent VTE in this patient population; however, the optimal dosing strategy has yet to be determined. To address this question, a fixed-dosing strategy of LMWH was compared to a weight-based dosing strategy of LMWH for VTE prophylaxis. METHODS A retrospective, pre-post implementation cohort study compared a fixed vs a weight-based dosing strategy of LMWH for VTE prophylaxis. Patients admitted to our level 1 trauma center were included if they had an estimated glomerular filtration rate >30 mL/min/1.73 m2, received at least 3 doses of LMWH, and had an appropriately drawn anti-Xa level on their initial dosing regimen. Patients in the pre-cohort received 30 mg LMWH subcutaneously twice daily as the initial dosing regimen. Patients in the post-cohort received .5 mg/kg (max 60 mg) LMWH subcutaneously every 12 h as the initial dosing regimen. A goal anti-Xa of .2-.4 IU/mL was targeted for prophylaxis. RESULTS There were 817 patients in the fixed-dosing group (FDG) and 874 patients in the weight-based dosing group (WBDG). In the FDG, 42.8% of the patients achieved the goal initial anti-Xa level, with 54.1% and 3.1% reaching sub- and supratherapeutic doses, respectively. In the WBDG, 66.5% of patients reached goal initial anti-Xa levels, with 23.5% and 10.1% at sub- and supratherapeutic levels. The distribution of dose ranges was significantly different between the dosing strategies (P-value <.001). There was no difference in the number of patients who received blood products (39.1% vs 41.7%. P-value = .299). CONCLUSIONS In our study, weight-based dosing of LMWH yielded a significantly higher proportion of patients who achieved goal prophylactic anti-Xa levels than fixed-dosing of LMWH. Larger-scale studies are needed to assess the risk of VTE events and bleeding with these dosing strategies.
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Affiliation(s)
- Tarendeep Thind
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Thomas Heye
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Curran Henson
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rebecca Reif
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hanna K Jensen
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kyle J Kalkwarf
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Avi Bhavaraju
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ronald Robertson
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Allison Jenkins
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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26
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Zhang Y, Zhang Z, Li H, Chu C, Liang G, Fan N, Wei R, Zhang T, Li L, Wang B, Li X. Increased miR-6132 promotes deep vein thrombosis formation by downregulating FOXP3 expression. Front Cardiovasc Med 2024; 11:1356286. [PMID: 38572308 PMCID: PMC10987872 DOI: 10.3389/fcvm.2024.1356286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
Background Deep vein thrombosis (DVT) is associated with aberrant gene expression that is a common peripheral vascular disease. Here, we aimed to elucidate that the epigenetic modification of forkhead box protein 3 (FOXP3) at the post-transcriptional level, which might be the key trigger leading to the down-regulation of FOXP3 expression in DVT. Methods In order to explore the relationship between microRNAs (miRNAs) and FOXP3, mRNA and microRNA microarray analysis were performed. Dual luciferase reporter assay was used to verify the upstream miRNAs of FOXP3. Quantitative real-time polymerase chain reaction, flow cytometry and Western blot were used to detect the relative expression of miR-6132 and FOXP3. Additionally, DVT models were established to investigate the role of miR-6132 by Murine Doppler Ultrasound and Hematoxylin-Eosin staining. Results Microarray and flow cytometry results showed that the FOXP3 expression was decreased while miR-6132 level was increased substantially in DVT, and there was significant negative correlation between miR-6132 and FOXP3. Moreover, we discovered that overexpressed miR-6132 reduced FOXP3 expression and aggravated DVT formation, while miR-6132 knockdown increased FOXP3 expression and alleviated DVT formation. Dual luciferase reporter assay validated the direct binding of miR-6132 to FOXP3. Conclusion Collectively, our data elucidate a new avenue through which up-regulated miR-6132 contributes to the formation and progression of DVT by inhibiting FOXP3 expression.
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Affiliation(s)
- Yunhong Zhang
- Innovative Institute of Chinese Medicine and Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Zhen Zhang
- Innovative Institute of Chinese Medicine and Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Haoyang Li
- International Business School, Tianjin Foreign Studies University, Tianjin, China
| | - Chu Chu
- Innovative Institute of Chinese Medicine and Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Gang Liang
- Department of Peripheral Vascular Disease, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Nannan Fan
- Innovative Institute of Chinese Medicine and Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Ran Wei
- Innovative Institute of Chinese Medicine and Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
- School of Clinical and Basic Medical Sciences, Shandong First Medical University& Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - Tingting Zhang
- Innovative Institute of Chinese Medicine and Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Lihua Li
- Innovative Institute of Chinese Medicine and Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
- School of Clinical and Basic Medical Sciences, Shandong First Medical University& Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - Bin Wang
- Department of Peripheral Vascular Disease, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Xia Li
- Innovative Institute of Chinese Medicine and Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
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Sun M, Liu C, Liu J, Wen J, Hao T, Chen D, Shen Y. A microthrombus-driven fixed-point cleaved nanosystem for preventing post-thrombolysis recurrence via inhibiting ferroptosis. J Control Release 2024; 367:587-603. [PMID: 38309306 DOI: 10.1016/j.jconrel.2024.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/05/2024]
Abstract
Thrombus-induced cardiovascular diseases threaten human health. Current treatment strategies often rely on urokinase plasminogen activator (uPA) for its efficacy, yet it has such limiting factors as short half-life, lack of thrombus targeting, and systemic side effects leading to unintended bleeding. In addition, thrombolytic interventions can trigger inflammation-induced damage at thrombus sites, which affects endothelial function. To address these challenges, Fer-1/uPA@pep-CREKA-Lipo (Fu@pep-CLipo) has been developed. This system achieves precise and efficient thrombolysis while enhancing the thrombus microenvironment and mitigating ischemia-reperfusion injury, with exceptional thrombus targeting ability via the strong affinity of the Cys-Arg-Glu-Lys-Ala (CREKA) peptide for fibrin. The Cys-Nle-TPRSFL-DSPE (pep) could respond to the thrombus microenvironment and fixed-point cleavage. The uPA component linked to the liposome surface is strategically cleaved upon exposure to abundant thrombin at thrombus sites. Importantly, the inclusion of Fer-1 within Fu@pep-CLipo contributes to reactive oxygen species (ROS) scavenging and significantly improves the thrombus microenvironment. This innovative approach not only achieves highly efficient and precise thrombolysis but also positively influences the expression of eNOS protein while suppressing inflammatory factors like TNF-α and IL-6. This dual action contributes to improved thrombus inflammatory microenvironment and mitigated ischemia-reperfusion injury.
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Affiliation(s)
- Mengjuan Sun
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, 639 Long Mian Da Dao, Nanjing 211198, China; Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 639 Long Mian Da Dao, Nanjing 211198, China
| | - Chang Liu
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, 639 Long Mian Da Dao, Nanjing 211198, China; Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 639 Long Mian Da Dao, Nanjing 211198, China
| | - Ji Liu
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, 639 Long Mian Da Dao, Nanjing 211198, China; Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 639 Long Mian Da Dao, Nanjing 211198, China
| | - Jing Wen
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, 639 Long Mian Da Dao, Nanjing 211198, China; Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 639 Long Mian Da Dao, Nanjing 211198, China
| | - Tianjiao Hao
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, 639 Long Mian Da Dao, Nanjing 211198, China; Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 639 Long Mian Da Dao, Nanjing 211198, China
| | - Daquan Chen
- School of Pharmacy, Yantai University, 30 Qingquan Road, Yantai 264005, China
| | - Yan Shen
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, 639 Long Mian Da Dao, Nanjing 211198, China; Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 639 Long Mian Da Dao, Nanjing 211198, China.
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28
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Arnold MJ. Thromboembolic Disease. Prim Care 2024; 51:65-82. [PMID: 38278574 DOI: 10.1016/j.pop.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Venous thromboembolism (VTE) encompasses deep vein thrombosis and pulmonary embolism, both of which can present on a spectrum from subtle symptoms to life- and limb-threatening emergencies. Some risk factors for VTE overlap cardiovascular risk factors and statin therapy can somewhat reduce the VTE risk. When presentations are not life-threatening, clinical prediction scores using the Well's criteria are best used to determine diagnostic testing. The mainstay of VTE treatment is anticoagulant therapy, although life- and limb-threatening presentations can also require thrombolytic therapy.
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Affiliation(s)
- Michael J Arnold
- Department of Family Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 40814, USA.
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Yazdi H, Eslami A, Torkaman A, Elahifar O, Kasaeian A, Alimoghadam S, Alimoghadam R, Abolghasemian M. Aspirin is as effective as low molecular weight heparins in preventing symptomatic venous thromboembolism following arthroscopic anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2024; 25:154. [PMID: 38373950 PMCID: PMC10875785 DOI: 10.1186/s12891-024-07282-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE The optimal agent for thromboprophylaxis following arthroscopic anterior cruciate ligament reconstruction (ACLR) remains unclear, particularly in patients with a low baseline risk for venous thromboembolism (VTE). This retrospective cohort study aims to compare the effectiveness and safety of aspirin versus low molecular weight heparins (LMWHs) in this specific patient population. METHODS We analyzed data from patients who underwent ACLR between March 2016 and March 2021, focusing on those with a low risk for VTE. High-risk individuals, identified by factors such as cardiac disease, pulmonary disease, diabetes mellitus, previous VTE, inflammatory bowel disease, active cancer, and a BMI > 40, were excluded (n = 33). Our approach included a thorough review of medical charts, surgical reports, and pre-operative assessments, complemented by telephone follow-up conducted over a 3-month period by a single investigator. We assessed the incidence of symptomatic VTE, including deep vein thrombosis and pulmonary thromboembolism, as the primary outcome. The secondary outcomes included to complications related to the surgery and thromboprophylaxis. Statistical analysis included descriptive statistics, univariate logistic regression models, and calculations of incidence rates. RESULT In our study, 761 patients (761 knees) were included, with 458 (60.18%) receiving aspirin and 303 (39.82%) receiving LMWH. The two groups showed no significant differences in demographic factors except for age. The incidence of VTE was reported at 1.31% (10 individuals). Specifically, five patients in the aspirin group (1.09%) and five patients in the LMWH group (1.65%) developed a symptomatic VTE event (p = 0.53). Additionally, the two groups did not significantly differ in terms of other complications, such as hemarthrosis or surgical site infection (p > 0.05). Logistic regression analysis revealed no statistically significant difference in VTE risk between the two groups. CONCLUSION This study, focusing on isolated ACLR in patients with a low baseline risk for venous thromboembolism, demonstrated that aspirin is equally effective as low molecular weight heparins for VTE prophylaxis following this surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hamidreza Yazdi
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Arvin Eslami
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran.
| | - Ali Torkaman
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Omid Elahifar
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Digestive Diseases Research Center, Digestive Diseases Research Institute; Research Center for Chronic Inflammatory Diseases; Clinical Research Development Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaya Alimoghadam
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Rojina Alimoghadam
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Abolghasemian
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran.
- University of Alberta, Alberta, Canada.
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30
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Roberts SH, Zaghloul MS, Ismail U, Rowe RA, Engel C, Meade R, Elizondo-Benedetto S, Genin GM, Zayed MA. In Vivo Porcine Model of Acute Iliocaval Deep Vein Thrombosis. J Endovasc Ther 2024:15266028241231513. [PMID: 38357736 DOI: 10.1177/15266028241231513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
CLINICAL IMPACT The study establishes a rapid, technically straightforward, and reproducible porcine large animal model for acute iliocaval deep vein thrombosis (DVT). The procedure can be performed with basic endovascular skillsets. With its procedural efficiency and consistency, the platform is promising for comparative in vivo testing of venous thrombectomy devices in a living host, and for future verification and validation studies to determine efficacy of novel thrombectomy devices relative to predicates.
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Affiliation(s)
- Sophia H Roberts
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardiovascular Research Innovation in Surgery and Engineering Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Mohamed S Zaghloul
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardiovascular Research Innovation in Surgery and Engineering Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | | | - Connor Engel
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardiovascular Research Innovation in Surgery and Engineering Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Rodrigo Meade
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardiovascular Research Innovation in Surgery and Engineering Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Santiago Elizondo-Benedetto
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardiovascular Research Innovation in Surgery and Engineering Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Guy M Genin
- Cardiovascular Research Innovation in Surgery and Engineering Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Caeli Vascular, Inc., St. Louis, MO, USA
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO, USA
- NSF Science and Technology Center for Engineering Mechanobiology, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Mohamed A Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardiovascular Research Innovation in Surgery and Engineering Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Caeli Vascular, Inc., St. Louis, MO, USA
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO, USA
- Division of Molecular Cell Biology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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31
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Bordeanu-Diaconescu EM, Grosu-Bularda A, Frunza A, Grama S, Andrei MC, Neagu TP, Hariga CS, Lascar I. Venous Thromboembolism in Burn Patients: A 5-Year Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:258. [PMID: 38399545 PMCID: PMC10889946 DOI: 10.3390/medicina60020258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Burn patients manifest all components of Virchow's triad, amplifying the concern for venous thromboembolism (VTE). Routine prophylaxis for VTE remains a subject of debate, with the central concern being the occurrence of associated adverse events. Materials and Methods: We conducted a five-year retrospective study on burn patients admitted to our burn center. Demographic data, comorbidities, burn lesions characteristics, surgical interventions, anticoagulant medication, the need for transfusions, the presence of a central venous catheter, length of stay, complications, and mortality were recorded. Results: Of the overall number of patients (494), 2.63% (13 patients) developed venous thromboembolic complications documented through paraclinical investigations. In 70% of cases, thrombosis occurred in a limb with central venous catether (CVC). Every patient with VTE had a Caprini score above 8, with a mean score of 12 points in our study group. Conclusions: Considering each patient's particularities and burn injury characteristics, individualized approaches may be necessary to optimize thromboprophylaxis effectiveness. We suggest routinely using the Caprini Risk Assessment Model in burn patients. We recommend the administration of pharmacologic thromboprophylaxis in all patients and careful monitoring of patients with Caprini scores above 8, due to the increased risk of VTE. Additionally, ongoing research in this field may provide insights into new strategies for managing thrombotic risk in burn patients.
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Affiliation(s)
- Eliza-Maria Bordeanu-Diaconescu
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.)
- Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania (I.L.)
| | - Andreea Grosu-Bularda
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.)
- Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania (I.L.)
| | - Adrian Frunza
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.)
- Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania (I.L.)
| | - Sabina Grama
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.)
| | - Mihaela-Cristina Andrei
- Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania (I.L.)
| | - Tiberiu Paul Neagu
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.)
- Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania (I.L.)
| | - Cristian-Sorin Hariga
- Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania (I.L.)
| | - Ioan Lascar
- Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania (I.L.)
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32
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Lin S, Alepuz A, Tritsch T, Schwartz G. Deep Vein Thrombosis Prophylaxis in Orthopedic Surgery. Cureus 2024; 16:e53726. [PMID: 38455781 PMCID: PMC10919879 DOI: 10.7759/cureus.53726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Deep vein thrombosis (DVT) is a complex and multifactorial process arising from a variety of factors, including recent surgical procedures, traumatic events, and periods of prolonged immobility. The extended period of stasis post-orthopedic surgery places patients at a notably high risk of developing DVT, and DVT-related pulmonary embolism (PE) ranks as the third most common cause of death in orthopedic surgery patients. This review examines the multifaceted risk factors contributing to the development of DVT in orthopedic patients. Additionally, it addresses the importance of DVT prophylaxis in orthopedic settings, the efficacy and safety of various prophylactic methods encompassing both mechanical and pharmacological approaches, and the economic dimensions of DVT prophylaxis, including scrutiny of cost-effectiveness and the exploration of strategies for optimization.
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Affiliation(s)
- Shu Lin
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Adrian Alepuz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Tara Tritsch
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Gary Schwartz
- Orthopedic Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
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33
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Pimentel-Esparza JA, Rios-Gomez M, Cervantes-Nieto JA, Fuentes Mendoza JA. Massive Pulmonary Embolism Related to a Patient With Heart Failure Secondary to Stress Cardiomyopathy: A Case Report. Cureus 2024; 16:e52985. [PMID: 38406044 PMCID: PMC10894014 DOI: 10.7759/cureus.52985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Venous thromboembolism (VTE) is a common disease, which includes deep venous thrombosis (DVT) and pulmonary embolism (PE). It is the third most common cardiovascular disorder, affecting predominantly the male elderly population. Stress cardiomyopathy (SC) is a transitorily cardiovascular condition produced after an emotional or physical trigger, and it features signs and symptoms of acute coronary syndrome. Its pathophysiological mechanisms remain unclear, and SC has also been related to critical complications such as heart failure, arrhythmias, left ventricular outflow obstruction, and thromboembolic events. This case report highlights the association of PE and SC that might play a pathophysiological role.
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Affiliation(s)
| | - Mariana Rios-Gomez
- Department of Internal Medicine, Petróleos Mexicanos (PEMEX) Regional Hospital Salamanca, Salamanca, MEX
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34
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Viudes-Sarrión N, Aleixandre-Carrera F, Beltrá P, Ortega FJ, Molina-Payá FJ, Velasco E, Delicado-Miralles M. Blood flow effects of percutaneous peripheral nerve stimulation. A blinded, randomized clinical trial. Eur J Clin Invest 2024; 54:e14091. [PMID: 37675595 DOI: 10.1111/eci.14091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The vasculature function is mainly regulated by the autonomic nervous system. Importantly, the sensory-motor nervous system also innervates peripheral vessels and has the capacity to modulate vascular tone. Here we investigated the effects of electrical stimulation of a mixed nerve trunk on blood flow in deep arteries and muscle perfusion. Our hypothesis is that stimulation of a mixed nerve can modify blood flow. METHODS Twenty-nine healthy participants were included into a randomized-crossover and blinded clinical trial. Each subject received a placebo and two percutaneous peripheral nerve stimulation (pPNS) protocols on the median nerve: Pain Threshold continuous Low Frequency (PT-cLF) and Sensory Threshold burst High Frequency (ST-bHF). Blood flow was then assessed bilaterally using Power Doppler Ultrasonography at the main arteries of the arm, and blood perfusion at the forearm muscles. Afterwards, blood flow was quantified using a semi-automatized software, freely shared here. RESULTS Placebo, consisting in needle insertion, produced an immediate and generalized reduction on peak systolic velocity in all arteries. Although nerve stimulation produced mainly no effects, some significant differences were found: both protocols increased the relative perfusion area of the forearm muscles, the ST-bHF protocol prevented the reduction in peak systolic velocity and TAMEAN of the radial artery produced by the control protocol and PT-cLF produced a TAMEAN reduction of the ulnar artery. CONCLUSIONS Therefore, the arterial blood flow in the arm is mainly impervious to the electrical stimulation of the median nerve, composed by autonomic and sensory-motor axons, although it produces mild modifications in the forearm muscles perfusion.
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Affiliation(s)
- Nuria Viudes-Sarrión
- Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Human Movement Biomechanics Research Group, Deptartment of Movement Sciences, KU Leuven, Leuven, Belgium
- Neuroscience in Physiotherapy (NiP), Independent Research Group, Elche, Spain
| | - Fernando Aleixandre-Carrera
- Neuroscience in Physiotherapy (NiP), Independent Research Group, Elche, Spain
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
| | - Patricia Beltrá
- Neuroscience in Physiotherapy (NiP), Independent Research Group, Elche, Spain
- Physical Therapy Department, Valencia University, Valencia, Spain
| | - Francisco Javier Ortega
- Physical therapy and advanced rehabilitation clinic RehAv Elche, Elche, Spain
- Physical Therapy Department, Health Sciences Faculty, CEU-Cardenal Herrera University, CEU Universities, Elche, Spain
| | - Francisco Javier Molina-Payá
- Physical Therapy Department, Health Sciences Faculty, CEU-Cardenal Herrera University, CEU Universities, Elche, Spain
| | - Enrique Velasco
- Neuroscience in Physiotherapy (NiP), Independent Research Group, Elche, Spain
- Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven; VIB-KU Leuven Center for Brain & Disease Research, Leuven, Belgium
| | - Miguel Delicado-Miralles
- Neuroscience in Physiotherapy (NiP), Independent Research Group, Elche, Spain
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
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35
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Chaudhry WAR, Ahmad BA, Waqas MS, Khan JR, Khan MHUH, Khiyam U, Malik J. Altitude-Related Venous Thrombosis With Heart Disease: An Updated Review. Curr Probl Cardiol 2024; 49:102018. [PMID: 37544620 DOI: 10.1016/j.cpcardiol.2023.102018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
Altitude-related venous thrombosis (ARVT) is a condition of growing concern among individuals engaged in high-altitude travel and activities. This updated review explores the epidemiology, pathophysiological mechanisms, clinical presentations, and management of ARVT based on a thematic analysis and synthesis of the existing literature. ARVT's multifactorial etiology involves the interplay of hypobaric hypoxia and endothelial dysfunction, creating a procoagulant state and increasing the risk of thrombosis. Common clinical manifestations include pain, swelling, and redness in the extremities, necessitating accurate and timely diagnosis, particularly in remote settings. Thromboprophylaxis during high-altitude travel and activities plays a crucial role in reducing the risk of ARVT, while anticoagulation remains the mainstay of management. Further research is needed to optimize preventive and treatment strategies, enhancing patient outcomes and safety in high-altitude environments.
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Affiliation(s)
| | - Binish Ayub Ahmad
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | | | | | | | - Umer Khiyam
- Department of Medicine, Peshawar Medical College, Peshawar, Pakistan
| | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan.
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36
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Dhaliwal G, Patrone MV, Bickston SJ. Venous Thromboembolism in Patients with Inflammatory Bowel Disease. J Clin Med 2023; 13:251. [PMID: 38202258 PMCID: PMC10780135 DOI: 10.3390/jcm13010251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/16/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Patients diagnosed with inflammatory bowel disease (IBD), which encompasses Crohn's disease and ulcerative colitis, experience chronic inflammation of the gastrointestinal tract. Those with IBD face a higher risk of developing venous thromboembolism (VTE) compared to individuals without IBD. This escalated risk is associated with various factors, some modifiable and others non-modifiable, with disease activity being the primary concern. Interestingly, Janus Kinase inhibitors approved for the treatment of IBD may be associated with an increased risk of VTE but only in patients that have other underlying risk factors leading to an overall increased VTE risk. Several recognized medical societies have recommended the use of VTE prophylaxis for hospitalized individuals with IBD. The association between VTE and IBD and the need for pharmacologic prophylaxis remains under-recognized. Increased awareness of this complication can hopefully protect patients from a potentially deadly complication.
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Affiliation(s)
- Galvin Dhaliwal
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA 23219, USA; (M.V.P.); (S.J.B.)
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37
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Shih NC, Yeh LT, Wang BY, Wang YH, Yang SF, Yeh CB. Dose-response association of benzodiazepine use and development of deep vein thrombosis. Psychiatry Res 2023; 330:115553. [PMID: 37924771 DOI: 10.1016/j.psychres.2023.115553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/06/2023]
Abstract
Benzodiazepines have sedative effects that cause reduced activity in users and may increase the risk of deep vein thrombosis. However, few studies have examined this potential risk of benzodiazepine use. This study examined the association between benzodiazepine use and the risk of deep vein thrombosis (DVT) in adults in Taiwan using a longitudinal health insurance database. The study population included 12,546 individuals with DVT and 50,184 matched controls. Results showed that benzodiazepine use was associated with an increased risk of DVT occurrence (adjusted odds ratio [aOR]: 1.66; 95 % CI, 1.54-1.79; P <0.001), with a dose-response relationship. Patients with a higher defined daily dose had a higher risk of DVT, with ORs of 1.65-, 2.09-, and 2.16-fold higher for those with an average benzodiazepine dose of <0.5, 0.5-0.9, or ≥1 (DDD/day), respectively, compared to nonbenzodiazepine users. Stratification by age, sex, and follow-up duration yielded similar results. This study highlights the need to evaluate the association and benefits of benzodiazepine prescription to decrease the risk of DVT development.
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Affiliation(s)
- Nai-Chen Shih
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Liang-Tsai Yeh
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Anesthesiology, Changhua Christian Hospital, Changhua, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Bo-Yuan Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Hsun Wang
- Center for Health Data Science, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Chao-Bin Yeh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
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38
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Constantinescu AE, Bull CJ, Goudswaard LJ, Zheng J, Elsworth B, Timpson NJ, Moore SF, Hers I, Vincent EE. A phenome-wide approach to identify causal risk factors for deep vein thrombosis. BMC Med Genomics 2023; 16:284. [PMID: 37951941 PMCID: PMC10640748 DOI: 10.1186/s12920-023-01710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023] Open
Abstract
Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein. DVT can lead to a venous thromboembolism (VTE), the combined term for DVT and pulmonary embolism, a leading cause of death and disability worldwide. Despite the prevalence and associated morbidity of DVT, the underlying causes are not well understood. Our aim was to leverage publicly available genetic summary association statistics to identify causal risk factors for DVT. We conducted a Mendelian randomization phenome-wide association study (MR-PheWAS) using genetic summary association statistics for 973 exposures and DVT (6,767 cases and 330,392 controls in UK Biobank). There was evidence for a causal effect of 57 exposures on DVT risk, including previously reported risk factors (e.g. body mass index-BMI and height) and novel risk factors (e.g. hyperthyroidism and varicose veins). As the majority of identified risk factors were adiposity-related, we explored the molecular link with DVT by undertaking a two-sample MR mediation analysis of BMI-associated circulating proteins on DVT risk. Our results indicate that circulating neurogenic locus notch homolog protein 1 (NOTCH1), inhibin beta C chain (INHBC) and plasminogen activator inhibitor 1 (PAI-1) influence DVT risk, with PAI-1 mediating the BMI-DVT relationship. Using a phenome-wide approach, we provide putative causal evidence that hyperthyroidism, varicose veins and BMI enhance the risk of DVT. Furthermore, the circulating protein PAI-1 has a causal role in DVT aetiology and is involved in mediating the BMI-DVT relationship.
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Affiliation(s)
- Andrei-Emil Constantinescu
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK.
- Bristol Medical School, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK.
- School of Translational Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK.
| | - Caroline J Bull
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- School of Translational Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- Health Data Research UK. Registered Office, 215 Euston Road, London, NW1 2BE, UK
| | - Lucy J Goudswaard
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Jie Zheng
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Benjamin Elsworth
- Our Future Health Ltd. Registered office: 2 New Bailey, 6 Stanley Street, Manchester, M3 5GS, UK
| | - Nicholas J Timpson
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Samantha F Moore
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
- UKRI Medical Research Council, Swindon, UK
| | - Ingeborg Hers
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Emma E Vincent
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- School of Translational Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
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39
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Bakhsh E. The Benefits and Imperative of Venous Thromboembolism Risk Screening for Hospitalized Patients: A Systematic Review. J Clin Med 2023; 12:7009. [PMID: 38002623 PMCID: PMC10672497 DOI: 10.3390/jcm12227009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Venous thromboembolism (VTE) is a major preventable condition in hospitalized patients globally. This systematic review evaluates the effectiveness and clinical significance of venous thromboembolism (VTE) risk-screening protocols in preventing VTE events among hospitalized patients. Databases, including PubMed, Embase and Cochrane, were searched without date limits for studies comparing outcomes between hospitalized patients who did and did not receive VTE risk screening using standard tools. Twelve studies, enrolling over 139,420 patients, were included. Study quality was assessed using the ROBVIS tool. The results were summarized narratively. The findings show significant benefits of using VTE risk screening versus usual care across various outcomes. Using recommended tools, like Caprini, Padua and IMPROVE, allowed for the accurate identification of high-risk patients who benefited most from prevention. Formal screening was linked to much lower VTE rates, shorter hospital stays, fewer deaths and better use of preventive strategies matched to estimated clot risk. This review calls for the widespread adoption of VTE risk screening as an important safety step for at-risk hospital patients. More high-quality comparative research is needed to validate screening tools in different settings and populations. In summary, VTE risk screening is essential for healthcare systems to reduce life-threatening VTE events and improve patient outcomes through properly targeted preventive methods.
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Affiliation(s)
- Ebtisam Bakhsh
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
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40
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Muscat-Baron L, Borg AL, Attard LM, Gatt A, Riva N. Cancer-Associated Abdominal Vein Thrombosis. Cancers (Basel) 2023; 15:5293. [PMID: 37958466 PMCID: PMC10649304 DOI: 10.3390/cancers15215293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Cancer is associated with an increased risk of developing venous thromboembolism, due to its direct influence on the three pillars of Virchow's triad (e.g., compression on the blood vessels by the tumour, blood vessels invasion, and cytokine release), together with the effect of exogenous factors (such as chemotherapy, radiotherapy, surgery). In cancer patients, the risk of thrombosis at unusual sites, such as splanchnic, ovarian and renal vein thrombosis, is also increased. Abdominal vein thromboses are frequently incidental findings on abdominal imaging performed as part of the diagnostic/staging workup or the follow-up care of malignancies. There is little evidence on the management of unusual site venous thromboembolism in cancer patients since there are only a few specific recommendations; thus, the management follows the general principles of the treatment of cancer-associated deep vein thrombosis and pulmonary embolism. This narrative review summarises the latest evidence on cancer-associated abdominal vein thrombosis, i.e., thrombosis of the splanchnic, ovarian and renal veins.
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Affiliation(s)
- Lorna Muscat-Baron
- Medical School, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta; (L.M.-B.); (A.L.B.); (L.M.A.)
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
| | - Amber Leigh Borg
- Medical School, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta; (L.M.-B.); (A.L.B.); (L.M.A.)
| | - Laura Maria Attard
- Medical School, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta; (L.M.-B.); (A.L.B.); (L.M.A.)
| | - Alex Gatt
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
| | - Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
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41
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Patel H, Pundkar A, Shrivastava S, Chandanwale R, Jaiswal AM. A Comprehensive Review on Platelet-Rich Plasma Activation: A Key Player in Accelerating Skin Wound Healing. Cureus 2023; 15:e48943. [PMID: 38106716 PMCID: PMC10725573 DOI: 10.7759/cureus.48943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
Platelet-rich plasma (PRP) activation is emerging as a promising and multifaceted tool for accelerating skin wound healing. This review extensively examines PRP's role in wound healing, focusing on its composition, mechanisms of action, activation methods, and clinical applications. PRP's potential to enhance both chronic and acute wound healing and its applications in cosmetic and aesthetic procedures are explored. Furthermore, this review investigates safety concerns, including adverse reactions, infection risks, and long-term safety implications. Looking to the future, emerging technologies, combination therapies, personalized medicine approaches, and regulatory developments are discussed, pointing towards an important and transformative era in wound healing and regenerative medicine. With its wide-ranging implications for healthcare, PRP activation has the potential to become a ubiquitous and essential therapeutic option, improving patient outcomes and reducing healthcare costs.
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Affiliation(s)
- Hardik Patel
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Aditya Pundkar
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sandeep Shrivastava
- Orthopedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Rohan Chandanwale
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ankit M Jaiswal
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Cuartas-Vélez C, Middelkamp HHT, van der Meer AD, van den Berg A, Bosschaart N. Tracking the dynamics of thrombus formation in a blood vessel-on-chip with visible-light optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2023; 14:5642-5655. [PMID: 38021142 PMCID: PMC10659801 DOI: 10.1364/boe.500434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/31/2023] [Accepted: 09/03/2023] [Indexed: 12/01/2023]
Abstract
Thrombus formation is a physiological response to damage in a blood vessel that relies on a complex interplay of platelets, coagulation factors, immune cells, and the vessel wall. The dynamics of thrombus formation are essential for a deeper understanding of many disease processes, like bleeding, wound healing, and thrombosis. However, monitoring thrombus formation is challenging due to the limited imaging options available to analyze flowing blood. In this work, we use a visible-light optical coherence tomography (vis-OCT) system to monitor the dynamic process of the formation of thrombi in a microfluidic blood vessel-on-chip (VoC) device. Inside the VoC, thrombi form in a channel lined with a monolayer of endothelial cells and perfused by human whole blood. We show that the correlation of the vis-OCT signal can be utilized as a marker for thrombus formation. By thresholding the correlation during thrombus formation, we track and quantify the growth of the thrombi over time. We validate our results with fluorescence microscopic imaging of fibrin and platelet markers at the end of the blood perfusion assay. In conclusion, we demonstrate that the correlation of the vis-OCT signal can be used to visualize both the spatial and temporal behavior of the thrombus formation in flowing human whole blood.
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Affiliation(s)
- Carlos Cuartas-Vélez
- Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Heleen H. T. Middelkamp
- BIOS/Lab on a Chip, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
| | - Andries D. van der Meer
- Applied Stem Cell Technologies, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Albert van den Berg
- BIOS/Lab on a Chip, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
| | - Nienke Bosschaart
- Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
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Ding C, Guo C, Du D, Gong X, Yuan Y. Association between diabetes and venous thromboembolism: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e35329. [PMID: 37861548 PMCID: PMC10589568 DOI: 10.1097/md.0000000000035329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/31/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) plays a vital role in the development of cardiovascular disease. However, its association with venous thromboembolism (VTE) remains unclear, for the published study results are conflicting. We performed a meta-analysis of published cohort studies and case-control studies to assess the role of DM in the formation and prognosis of VTE. METHODS PubMed and EMBASE databases were searched for articles from the database's establishment until September 15, 2022. Of the 15,754 publications retrieved, 50 studies were identified that met the selection criteria. The New castle-Ottawa Scale was used to evaluate the quality of the literature. Pooled odds ratios (ORs) and 95% confidence intervals were calculated using fixed- or random-effect models. RESULTS We combined OR using a random-effects or fixed-effects model: patients with DM had an increased risk of VTE (OR 1.27, 95% confidence interval [CI]: 1.15-1.41), which still showed a partial association in studies adjusted by confounding factors (OR 1.20, 95% CI: 1.07-1.35). DM was not significantly associated with VTE when analyzed in studies adjusted by body mass index (OR 1.04, 95% CI: 0.94-1.15). VTE patients with DM had a higher risk of short-term and long-term mortality than those without DM (OR 1.58 [95% CI: 1.26-1.99] for long-term mortality and OR 1.20 [95% CI: 1.19-1.21] for short-term mortality). CONCLUSION There was no significant association between DM and VTE risk, and body mass index may be a significant confounding factor between DM and VTE risk. However, DM can still lead to an increased risk of long-term and short-term mortality in patients with VTE.
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Affiliation(s)
- Chaowei Ding
- Department of Respiratory and Critical Care Medicine, Xiamen Humanity Hospital Fujian Medical University, Xiamen, Fujian, China
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Chang Guo
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Dan Du
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xiaowei Gong
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yadong Yuan
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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Huang Y, Gao S, Li T, Zhang B, Du J, Qian Y, Xing Y, Zhou T, Shi M, Huang J, Lian Y. Characteristics and risk factors for advanced lung cancer with pulmonary embolism: A cross-sectional, case-control study. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:1048-1057. [PMID: 37675831 PMCID: PMC10543065 DOI: 10.1111/crj.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/24/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES Pulmonary embolism (PE) is a life-threatening complication that can occur in patients with lung cancer. In this study, we aimed to identify risk factors and examine the clinical characteristics of advanced lung cancer patients with PE. METHODS We conducted a retrospective review of patients admitted to our two hospitals between January 2020 and June 2022. The case group consisted of patients with lung cancer and PE, and a closely matched control group was included to identify risk factors. Statistical analysis was conducted using R language. RESULTS A total of 4957 patients were reviewed, and 162 patients (comprising 54 cases and 108 controls) were included in this study. The prevalence of lung cancer with PE in the study population was 1.08%. The majority of patients were male, and the most common histological subtype was adenocarcinoma (67%), followed by squamous cell carcinoma, small cell carcinoma, and poorly differentiated non-small cell lung cancer. The majority of patients had a high performance status (PS) score, with 50% experiencing respiratory failure (mainly hypoxia) and 33% with deep vein thrombosis (DVT). Forty-eight percent of patients were diagnosed with concurrent PE. Further analysis showed that PE was an independent predictor of poor survival, and a PS score of >1 was an independent risk factor for PE in patients with lung cancer. CONCLUSION Our study provides valuable insights into the epidemiology and prognosis of PE in lung cancer patients and suggests that a poor ECOG PS, which has not been previously reported, is an independent risk factor for PE.
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Affiliation(s)
- Yongkang Huang
- Department of Respiratory and Critical Care MedicineThe Second Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Shiyuan Gao
- Department of Respiratory and Critical Care MedicineThe Second Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Ting Li
- Department of Respiratory and Critical Care MedicineThe Second Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Beilei Zhang
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Juan Du
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Yajuan Qian
- Department of Respiratory and Critical Care MedicineThe Second Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Yufei Xing
- Department of Respiratory and Critical Care MedicineThe Second Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Tong Zhou
- Department of Respiratory and Critical Care MedicineThe Second Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Minhua Shi
- Department of Respiratory and Critical Care MedicineThe Second Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Jian‐an Huang
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Yixin Lian
- Department of Respiratory and Critical Care MedicineThe Second Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
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Heye T, Thind T, Jenkins A, Reif R, Jensen HK, Sexton K, Kalkwarf K, Bhavaraju A. Weight-Based Dosing for Venous Thromboembolism Prophylaxis in Spinal Trauma Patients Appears Safe. J Surg Res 2023; 290:209-214. [PMID: 37285702 PMCID: PMC11362993 DOI: 10.1016/j.jss.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a substantial cause of morbidity and mortality in trauma patients. VTE prophylaxis (VTEP) initiation is often delayed in certain patients due to the perceived risk of bleeding complications. Our VTEP guideline was changed from fixed-dosing to a weight-based dosing strategy using enoxaparin in June 2019. We investigated the rate of postoperative bleeding complications with a weight-based and a standard dosing protocol in traumatic spine injury patients requiring surgical stabilization. METHODS A retrospective pre-post cohort study using an institutional trauma database was conducted, comparing bleeding complications between fixed and weight-based VTEP protocols. Patients undergoing surgical stabilization of a spine injury were included. The preintervention cohort received fixed-dose thromboprophylaxis (30 mg twice daily or 40 mg daily); the postcohort received weight-based thromboprophylaxis (0.5 mg/kg q12 h with anti-factor Xa monitoring). All patients received VTEP 24-48 h after surgery. International Classification of Diseases codes were used to identify bleeding complications. RESULTS There were 68 patients in the pregroup and 68 in the postgroup with comparable demographics. Incidence of bleeding complications in the pre- and postgroups were 2.94% and 0% respectively. CONCLUSIONS VTEP initiated 24-48 h after surgical stabilization of a spine fracture using a weight-based dosing strategy and has a similar rate of bleeding complications as a standard dose protocol. Our study is limited by the low overall incidence of bleeding complications and small sample size. These findings could be validated by a larger multicenter trial.
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Affiliation(s)
- Thomas Heye
- University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas
| | - Tarendeep Thind
- University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas
| | - Allison Jenkins
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rebecca Reif
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Hanna K Jensen
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kevin Sexton
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Biomedical Informatics, UAMS College of Medicine, Little Rock, Arkansas; Department of Health Policy and Management, UAMS Fay. W. Boozman College of Public Health, Little Rock, Arkansas; Division of Pharmaceutical Evaluation & Policy, Department of Pharmacy Practice, UAMS College of Pharmacy, Little Rock, Arkansas
| | - Kyle Kalkwarf
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Avi Bhavaraju
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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Sun B, Cheng X, Zhang M, Shi Q, Zhao X, Wang X, Zhang Y. Dynamic observation of circRNA and mRNA profiles in a rat model of deep vein thrombosis. Exp Ther Med 2023; 26:467. [PMID: 37664678 PMCID: PMC10469585 DOI: 10.3892/etm.2023.12166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/20/2023] [Indexed: 09/05/2023] Open
Abstract
The goal of the present study was to identify different transcriptome expression profiles involved in the pathogenesis of deep vein thrombosis (DVT), and to illustrate the diagnostic and therapeutic potential of circular RNAs (circRNAs) and mRNAs in DVT progression. A Sprague-Dawley rat model of DVT was successfully established through the stenosis method and samples were sequenced at four time points (1, 6 and 12 h, and 3 days after ligation) to observe the dynamic changes in circRNAs and mRNAs during DVT progression. RNA sequencing was used to analyze the circRNA and mRNA expression profiles, and associated functions and pathways, in the blood of DVT rats at the four time points. In addition, Short Time Series Expression Miner (STEM) analysis was performed to explore temporal gene expression. Differential expression of 1,680, 4,018, 3,724, and 3,036 circRNAs, and 400, 1,176, 373, and 573 mRNAs was observed in the 1, 6 and 12 h, and 3-day groups, respectively, compared with the sham group (fold change >2.0 or <-2.0, P<0.05). Functional enrichment analysis indicated that differentially expressed mRNAs were associated with the following terms: Immune response, cell activation, blood stasis facilitated organelle, extracellular membrane-bounded organelle, and blood microparticle, oxygen transporter activity. STEM analysis indicated that the expression of 366 circRNAs in circRNA profile 45 and 270 mRNAs in mRNA profile 45 was consistent with thrombus progression. Enrichment analysis was performed on mRNA profile 45. The main Gene Ontology annotations were chromosome segregation, mitotic sister chromatid segregation, cell cycle process, and ligand-dependent nuclear receptor transcription coactivator activity. Pathway enrichment analysis identified the platelet-associated pathway, immune-associated pathway, and inflammation-relation pathway. According to the enriched platelet-associated pathways, four mRNAs and ten candidate circRNAs were selected for reverse transcription-quantitative PCR verification. The expression of nine of the ten circRNAs and all four mRNAs was consistent with the sequencing results. In summary, differentially expressed circRNAs and mRNAs are dynamically involved in DVT development. Dysregulated transcriptome profiles and the corresponding functions and pathways may provide mechanistic insights into DVT diagnosis and treatment.
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Affiliation(s)
- Baolan Sun
- Department of Laboratory, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Xi Cheng
- Department of Gynecology and Obstetrics, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Mu Zhang
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Qin Shi
- Department of Gynecology and Obstetrics, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Xinxin Zhao
- Department of Gynecology and Obstetrics, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Xudong Wang
- Department of Laboratory, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Yuquan Zhang
- Department of Gynecology and Obstetrics, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
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Swamy S, Ueland T, Hansen JB, Snir O, Brækkan SK. Plasma levels of P-selectin and future risk of incident venous thromboembolism. J Thromb Haemost 2023; 21:2451-2460. [PMID: 37182696 DOI: 10.1016/j.jtha.2023.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND P-selectin levels are elevated following acute deep vein thrombosis and reported to predict recurrent venous thromboembolism (VTE) and cancer-associated VTE. Yet, it is unknown whether plasma P-selectin levels are associated with incident VTE. OBJECTIVES We aimed to investigate the association between plasma P-selectin levels and risk of future incident VTE. METHODS We performed a nested case-control study in 415 patients with VTE and 843 age- and sex-matched controls derived from the general population (Tromsø IV Study). Plasma P-selectin levels were measured using enzyme-linked immunosorbent assay. Logistic regression models were used to estimate odds ratios (ORs) for VTE across quartiles of plasma P-selectin level. Sex-stratified analysis was also performed. RESULTS Plasma P-selectin levels were higher in men (41.4 ng/mL) than in women (38.7 ng/mL, p = .0046). We found no association between plasma P-selectin levels and risk of VTE in the overall analyses. However, sex-stratified analyses revealed that women with P-selectin levels in the highest quartile (>44.3 ng/mL) had higher risk of VTE (OR, 1.63; 95% CI, 1.01-2.64) than women with P-selectin levels in the lowest quartile (≤29.9 ng/mL). In contrast, higher levels of P-selectin were apparently associated with lower risk of VTE in men (OR for highest vs lowest quartile of P-selectin, 0.69; 95% CI, 0.42-1.15). The observed associations were stronger when the time between blood sampling and VTE was shorter. CONCLUSION Elevated levels of plasma P-selectin were associated with increased risk of VTE in women but not in men, suggesting a differential impact of sex on the association between P-selectin and VTE risk.
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Affiliation(s)
- Samantha Swamy
- Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.
| | - Thor Ueland
- Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway; Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - John-Bjarne Hansen
- Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Omri Snir
- Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Sigrid K Brækkan
- Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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Sanders KE, Holevinski S, Zhang X, Cotton BA, Cardenas JC. Soluble endothelial protein C receptor is an independent predictor of venous thromboembolism after severe injury: Secondary analysis of a prospective cohort study. Surgery 2023; 174:376-381. [PMID: 37270299 PMCID: PMC10578199 DOI: 10.1016/j.surg.2023.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/18/2023] [Accepted: 04/27/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Venous thromboembolism is a leading cause of morbidity after trauma. Endothelial cells are essential regulators of coagulation. Although endothelial cell dysregulation is widely reported after trauma, the link between endothelial injury and venous thromboembolism has not been reported. METHODS We conducted a secondary analysis of the Pragmatic Randomized Optimal Platelets and Plasma Ratios study. Deaths from hemorrhage or within 24 hours were excluded. Venous thromboembolism was diagnosed by duplex ultrasound or chest computed tomography. Endothelial markers soluble endothelial protein c receptor, thrombomodulin, and syndecan-1 were measured in plasma by enzyme-linked immunosorbent assay and compared over the first 72 hours from admission using the Mann-Whitney test. Multivariable logistic regression assessed the adjusted effects of endothelial markers on venous thromboembolism risk. RESULTS Of 575 patients enrolled, 86 developed venous thromboembolism (15%). The median time to venous thromboembolism was 6 days ([Q1, Q3], [4, 13]). No differences were identified in demographics or injury severity. Soluble endothelial protein c receptor, thrombomodulin, and syndecan-1 showed significant increases over time among patients who developed venous thromboembolism compared to those who did not. Using the last available values, patients were stratified into high and low-soluble endothelial protein c receptor, thrombomodulin, and syndecan-1 groups. Multivariable analyses revealed an independent association between elevated soluble endothelial protein c receptor and venous thromboembolism risk (odds ratio 1.63; 95% confidence interval 1.01, 2.63; P = .04). Cox proportional hazards modeling demonstrated a strong yet nonsignificant trend between elevated soluble endothelial protein c receptor and time to venous thromboembolism. CONCLUSION Plasma markers of endothelial injury, particularly soluble endothelial protein c receptor, are strongly associated with trauma-related venous thromboembolism. Therapeutics targeting endothelial function could mitigate the incidence of venous thromboembolism after trauma.
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Affiliation(s)
- Kelly E Sanders
- Department of Surgery, Division of Acute Care Surgery, The University of Texas Health Science Center and the McGovern School of Medicine, and the Center for Translational Injury Research, Houston, TX.
| | - Sarah Holevinski
- Department of Surgery, Division of Acute Care Surgery, The University of Texas Health Science Center and the McGovern School of Medicine, and the Center for Translational Injury Research, Houston, TX
| | - Xu Zhang
- Center for Clinical and Translational Sciences, The University of Texas Health Science Center, Houston, TX
| | - Bryan A Cotton
- Department of Surgery, Division of Acute Care Surgery, The University of Texas Health Science Center and the McGovern School of Medicine, and the Center for Translational Injury Research, Houston, TX; The Red Duke Texas Trauma Institute at Memorial Hermann Hospital, Houston, TX
| | - Jessica C Cardenas
- Department of Surgery, Division of Acute Care Surgery, The University of Texas Health Science Center and the McGovern School of Medicine, and the Center for Translational Injury Research, Houston, TX. https://twitter.com/JCCardenas52
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Lo Faro V, Johansson T, Höglund J, Hadizadeh F, Johansson Å. Polygenic risk scores and risk stratification in deep vein thrombosis. Thromb Res 2023; 228:151-162. [PMID: 37331118 DOI: 10.1016/j.thromres.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/18/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Deep vein thrombosis (DVT) is a complex disease, where 60 % of risk is due to genetic factors, such as the Factor V Leiden (FVL) variant. DVT is either asymptomatic or manifests with unspecific symptoms and, if left untreated, DVT leads to severe complications. The impact is dramatic and currently, there is still a research gap in DVT prevention. We characterized the genetic contribution and stratified individuals based on genetic makeup to evaluate if it favorably impacts risk prediction. METHODS In the UK Biobank (UKB), we performed gene-based association tests using exome sequencing data, as well as a genome-wide association study. We also constructed polygenic risk scores (PRS) in a subset of the cohort (Number of cases = 8231; Number of controls = 276,360) and calculated the impact on the prediction capacity of the PRS in a non-overlapping part of the cohort (Number of cases = 4342; Number of controls = 142,822). We generated additional PRSs that excluded the known causative variants. RESULTS We discovered and replicated a novel common variant (rs11604583) near the region where are located the TRIM51 and LRRC55 genes and identified a novel rare variant (rs187725533) located near the CREB3L1 gene, associated with 2.5-fold higher risk of DVT. In one of the PRS models constructed, the top decile of risk is associated with 3.4-fold increased risk, an effect that is 2.3-fold when excluding FVL carriers. In the top PRS decile, the cumulative risk of DVT at the age of 80 years is 10 % for FVL carriers, contraposed to 5 % for non-carriers. The population attributable fractions of having a high polygenic risk on the rate of DVT was estimated to be around 20 % in our cohort. CONCLUSION Individuals with a high polygenic risk of DVT, and not only carriers of well-studied variants such as FVL, may benefit from prevention strategies.
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Affiliation(s)
- Valeria Lo Faro
- Department of Immunology, Genetics and Pathology, Genomics and Neurobiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
| | - Therese Johansson
- Department of Immunology, Genetics and Pathology, Genomics and Neurobiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden; Centre for Women's Mental Health during the Reproductive Lifespan - Womher, Uppsala University, Uppsala, Sweden
| | - Julia Höglund
- Department of Immunology, Genetics and Pathology, Genomics and Neurobiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Fatemeh Hadizadeh
- Department of Immunology, Genetics and Pathology, Genomics and Neurobiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Åsa Johansson
- Department of Immunology, Genetics and Pathology, Genomics and Neurobiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
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50
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Feng L, Xie Z, Zhou X, Hou C, Liang Z, Lu H, Liu L, Zhang D. Diagnostic value of D-dimer for lower extremity deep venous thrombosis caused by rib fracture: a retrospective study. J Orthop Surg Res 2023; 18:515. [PMID: 37475021 PMCID: PMC10357766 DOI: 10.1186/s13018-023-03997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the role of D-dimer in the diagnosis of lower extremity deep venous thrombosis (DVT) in patients with rib fractures. METHOD Retrospective analysis was conducted on the clinical data of 499 patients with rib fractures who were admitted to the Third Hospital of Shijiazhuang between October 2020 and September 2021. These patients were divided into the DVT and the non-DVT groups. D-dimer levels were compared between the two groups at 24, 48, and 72 h after the injury. Receiver operating characteristic curves were utilized to evaluate the diagnostic efficacy of dynamically monitoring changes in D-dimer for DVT. RESULTS The D-dimer levels in the DVT group were significantly higher than those in the non-DVT group at 24, 48, and 72 h after the injury. The area under the curve values for predicting DVT based on D-dimer level at 24, 48, and 72 h after injury in patients with rib fractures were 0.788, 0.605, and 0.568, respectively. CONCLUSION Detecting D-dimer levels 24 h after the injury can enhance diagnostic efficacy and sensitivity for DVT, thereby reducing the rate of missed diagnoses, which is of great clinical value.
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Affiliation(s)
- Lei Feng
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, 050011, Hebei, China
| | - Zexin Xie
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, 050011, Hebei, China
| | - Xuetao Zhou
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, 050011, Hebei, China
| | - Chunjuan Hou
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, 050011, Hebei, China
| | - Zheng Liang
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, 050011, Hebei, China
| | - Huiqing Lu
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, 050011, Hebei, China
| | - Lili Liu
- Department of Cardiology, The Third Hospital of Shijiazhuang, Shijiazhuang, China
| | - Dongsheng Zhang
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, 050011, Hebei, China.
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