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Mathews R, Hinds MT, Nguyen KP. Venous thromboembolism: diagnostic advances and unaddressed challenges in management. Curr Opin Hematol 2024; 31:122-129. [PMID: 38359323 DOI: 10.1097/moh.0000000000000809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE OF REVIEW This review summarizes recent advances in developing targeted diagnostics for venous thromboembolism (VTE) and unaddressed knowledge gaps in patient management. Without addressing these critical data needs, the morbidity in VTE patients will persist. RECENT FINDINGS Recent studies investigating plasma protein profiles in VTE patients have identified key diagnostic targets to address the currently unmet need for low-cost, confirmatory, point-of-care VTE diagnostics. These studies and a growing body of evidence from animal model studies have revealed the importance of inflammatory and vascular pathology in driving VTE, which are currently unaddressed targets for VTE therapy. To enhance the translation of preclinical animal studies, clinical quantification of thrombus burden and comparative component analyses between modeled VTE and clinical VTE are necessary. SUMMARY Lead candidates from protein profiling of VTE patients' plasma offer a promising outlook in developing low cost, confirmatory, point-of-care testing for VTE. Additionally, addressing the critical knowledge gap of quantitatively measuring clinical thrombi will allow for an array of benefits in VTE management and informing the translatability of experimental therapeutics.
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Affiliation(s)
- Rick Mathews
- Department of Biomedical Engineering, Oregon Health and Science University
| | - Monica T Hinds
- Department of Biomedical Engineering, Oregon Health and Science University
| | - Khanh P Nguyen
- Department of Biomedical Engineering, Oregon Health and Science University
- Research & Development Service, VA Portland Healthcare System
- Division of Vascular Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
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Clerici B, Pontisso E, Aloise C, Peroni B, Perricone R, Pisetta C, Scavone M, Birocchi S, Podda GM. Thrombosis and Bleeding in Patients with Vaccine-Induced Immune Thrombotic Thrombocytopenia: A Systematic Review of Published Cases. Thromb Haemost 2024; 124:423-431. [PMID: 38109906 DOI: 10.1055/s-0043-1777134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a highly prothrombotic reaction to COVID-19 (coronavirus disease 2019) adenoviral vector vaccines. Its distinct bleeding and thrombotic patterns compared with other platelet consumptive disorders remain unclear. METHODS We performed a systematic review of the literature (PubMed and Embase) up to July 31, 2022, including case reports and case series providing nonaggregate data of VITT patients. Accurate VITT diagnosis required fulfillment of the following criteria: (1) endorsement by the authors, (2) consistent vaccine type and timing, (3) presence of thrombocytopenia and thrombosis, (4) detection of anti-platelet factor 4 antibodies. Data are presented as frequencies with 95% confidence intervals (CIs) calculated with the exact binomial method. RESULTS We retrieved 143 eligible studies, describing 366 patients. Of 647 thrombotic events, 53% (95% CI: 49-56) were venous thromboses at unusual sites and 30% (95% CI: 27-34) were cerebral venous sinus thromboses (CVSTs). The ratio of venous-to-arterial events was 4.1. Thromboses in most sites were associated with at least another thrombotic event, with the exception of CVST and CNS arterial thrombosis (isolated in 49 and 39% of cases, respectively). Bleeding occurred in 36% (95% CI: 31-41) of patients; 68% (95% CI: 59-75) of bleeding events were intracranial hemorrhages (ICHs). Overall mortality was 24% (95% CI: 19-29), and 77% (95% CI: 58-90) in patients with isolated CVST complicated by ICH. CONCLUSION VITT displays a venous-to-arterial thrombosis ratio comparable to heparin-induced thrombocytopenia. However, VITT is characterized by a higher prevalence of CVST and ICH, which contribute to the increased bleeding frequency and mortality.
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Affiliation(s)
- Bianca Clerici
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Eleonora Pontisso
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Chiara Aloise
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Benedetta Peroni
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Rosaria Perricone
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Chiara Pisetta
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Mariangela Scavone
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Simone Birocchi
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Gian Marco Podda
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
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Broccard SP, Edwards MA, Brennan ER, Spaulding AC, DeLeon MF, Mishra N, Casler JD, Colibaseanu DT. Room for Improvement: The Impact of Guideline-Recommended Extended Thromboprophylaxis in Patients Undergoing Abdominal Surgery for Colorectal and Anal Cancer at a Tertiary Referral Center. Dis Colon Rectum 2024; 67:714-722. [PMID: 38335005 DOI: 10.1097/dcr.0000000000003158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Venous thromboembolism occurs in approximately 2% of patients undergoing abdominal and pelvic surgery for cancers of the colon, rectum, and anus and is considered preventable. The American Society of Colon and Rectal Surgeons recommends extended prophylaxis in high-risk patients, but there is low adherence to the guidelines. OBJECTIVE This study aims to analyze the impact of venous thromboembolism risk-guided prophylaxis in patients undergoing elective abdominal and pelvic surgeries for colorectal and anal cancers from 2016 to 2021. DESIGN This was a retrospective analysis. SETTING The study was conducted at a multisite tertiary referral academic health care system. PATIENTS Patients who underwent elective abdominal or pelvic surgery for colon, rectal, or anal cancer. MAIN OUTCOME MEASURES Receipt of Caprini-guided venous thromboembolism prophylaxis, 90-day postoperative rate of deep vein thrombosis, pulmonary embolism, venous thromboembolism, and bleeding events. RESULTS A total of 3504 patients underwent elective operations, of whom 2224 (63%) received appropriate thromboprophylaxis in the inpatient setting. In the postdischarged cohort of 2769 patients, only 2% received appropriate thromboprophylaxis and no thromboembolic events were observed. In the group receiving inappropriate thromboprophylaxis, at 90 days postdischarge, the deep vein thrombosis, pulmonary embolism, and venous thromboembolism rates were 0.60%, 0.40%, and 0.88%, respectively. Postoperative bleeding was not different between the 2 groups. LIMITATIONS Limitations to our study include its retrospective nature, use of aggregated electronic medical records, and single health care system experience. CONCLUSION Most patients in our health care system undergoing abdominal or pelvic surgery for cancers of the colon, rectum, and anus were discharged without appropriate Caprini-guided venous thromboembolism prophylaxis. Risk-guided prophylaxis was associated with decreased rates of inhospital and postdischarge venous thromboembolism without increased bleeding complications. See Video Abstract . MARGEN DE MEJORA EL IMPACTO DE LA TROMBOPROFILAXIS RECOMENDADA POR LAS DIRECTRICES EN PACIENTES SOMETIDOS A CIRUGA ABDOMINAL POR CNCER COLORRECTAL Y ANAL EN UN CENTRO DE REFERENCIA TERCIARIO ANTECEDENTES:El tromboembolismo venoso ocurre en aproximadamente el 2% de los pacientes sometidos a cirugía abdominal y pélvica por cánceres de colon, recto y ano, y se considera prevenible. La Sociedad Estadounidense de Cirujanos de Colon y Recto recomienda una profilaxis prolongada en pacientes de alto riesgo, pero el cumplimiento de las directrices es bajo.OBJETIVO:Este estudio tiene como objetivo analizar el impacto de la profilaxis guiada por el riesgo de tromboembolismo venoso (TEV) en pacientes sometidos a cirugías abdominales y pélvicas electivas por cáncer colorrectal y anal entre 2016 y 2021.DISEÑO:Este fue un análisis retrospectivo.AJUSTE:El estudio se llevó a cabo en un sistema de salud académico de referencia terciaria de múltiples sitios.PACIENTES:Pacientes sometidos a cirugía abdominal o pélvica electiva por cáncer de colon, recto o ano.PRINCIPALES MEDIDAS DE RESULTADO:Recepción de profilaxis de tromboembolismo venoso guiada por Caprini, tasa postoperatoria de 90 días de trombosis venosa profunda, embolia pulmonar, tromboembolismo venoso y eventos de sangrado.RESULTADOS:Un total de 3.504 pacientes se sometieron a operaciones electivas, de los cuales 2.224 (63%) recibieron tromboprofilaxis adecuada en el ámbito hospitalario. En el cohorte de 2.769 pacientes después del alta, solo el 2% recibió tromboprofilaxis adecuada en la que no se observaron eventos tromboembólicos. En el grupo que recibió tromboprofilaxis inadecuada, a los 90 días después del alta, las tasas de trombosis venosa profunda, embolia pulmonar y tromboembolia venosa fueron del 0,60%, 0,40% y 0,88%, respectivamente. El sangrado posoperatorio no fue diferente entre los dos grupos.LIMITACIONES:Las limitaciones de nuestro estudio incluyen su naturaleza retrospectiva, el uso de registros médicos electrónicos agregados y la experiencia de un solo sistema de atención médica.CONCLUSIÓN:La mayoría de los pacientes en nuestro sistema de salud sometidos a cirugía abdominal o pélvica por cánceres de colon, recto y ano fueron dados de alta sin una profilaxis adecuada de TEV guiada por Caprini. La profilaxis guiada por el riesgo se asoció con menores tasas de tromboembolismo venoso hospitalario y dado de alta sin un aumento de las complicaciones de sangrado. (Traducción-Dr. Aurian Garcia Gonzalez ).
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Affiliation(s)
| | - Michael A Edwards
- Division of Advanced GI and Bariatric Surgery, Mayo Clinic, Jacksonville, Florida
| | - Emily R Brennan
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center, Mayo Clinic, Jacksonville, Florida
| | - Aaron C Spaulding
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center, Mayo Clinic, Jacksonville, Florida
| | - Michelle F DeLeon
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida
| | - Nitin Mishra
- Division of Colon and Rectal Surgery, Mayo Clinic, Phoenix, Arizona
| | - John D Casler
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona
| | - Dorin T Colibaseanu
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center, Mayo Clinic, Jacksonville, Florida
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida
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Zhang L, Yu R, Chen K, Zhang Y, Li Q, Chen Y. Enhancing deep vein thrombosis prediction in patients with coronavirus disease 2019 using improved machine learning model. Comput Biol Med 2024; 173:108294. [PMID: 38537565 DOI: 10.1016/j.compbiomed.2024.108294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/21/2024] [Accepted: 03/12/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Deep vein thrombosis (DVT) is a significant complication in coronavirus disease 2019 patients, arising from coagulation issues in the deep venous system. Among 424 scheduled patients, 202 developed DVT (47.64%). DVT increases hospitalization risk, and complications, and impacts prognosis. Accurate prognostication and timely intervention are crucial to prevent DVT progression and improve patient outcomes. METHODS This study introduces an effective DVT prediction model, named bSES-AC-RUN-FKNN, which integrates fuzzy k-nearest neighbor (FKNN) with enhanced Runge-Kutta optimizer (RUN). Recognizing the insufficient effectiveness of RUN in local search capability and its convergence accuracy, spherical evolutionary search (SES) and differential evolution-inspired knowledge adaptive crossover (AC) are incorporated, termed SES-AC-RUN, to enhance its optimization capability. RESULTS Based on the benchmark set by CEC 2017 and comparative analyses with several peers, it is evident that SES-AC-RUN significantly enhances search performance compared to traditional RUN, even standing comparably against leading championship algorithms. The proposed bSES-AC-RUN-FKNN model was applied to predict a dataset comprising 424 cases of DVT patients, totaling 7208 records. Remarkably, the model demonstrates outstanding accuracy, reaching 91.02%, alongside commendable sensitivity at 91.07%. CONCLUSIONS The bSES-AC-RUN-FKNN emerges as a robust and efficient predictive tool, significantly enhancing the accuracy of DVT prediction. This model can be used to manage the risk of thrombosis in the care of COVID-19 patients. Nursing staff can combine the model's predictions with clinical judgment to formulate comprehensive treatment approaches.
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Affiliation(s)
- Lufang Zhang
- The First Clinical College, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Renyue Yu
- Cardiac Care Unit, Sir RUN RUN Shaw Hospital, Hangzhou, 310000, China.
| | - Keya Chen
- The First Clinical College, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Ying Zhang
- Wenzhou Medical University School of Nursing, 325000, Wenzhou, 325000, China; Cixi Biomedical Research Institute, Wenzhou Medical University, Cixi, 315300, China.
| | - Qiang Li
- School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China.
| | - Yu Chen
- Nursing Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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Liu F, Duan M, Fu H, Wang T. The efficacy and safety of perioperative glucocorticoid for total knee arthroplasty: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:144. [PMID: 38622510 PMCID: PMC11017604 DOI: 10.1186/s12871-024-02530-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 04/08/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND An increasing number of individuals undergo total knee arthroplasty (TKA), which can result in pain, limited motor function and adverse complications such as infection, nausea and vomiting. Glucocorticoids have been shown anti-inflammatory and antiemetic effects, but can also elevate blood glucose levels and increase the risk of wound infection. Thus, it is essential to investigate the efficacy and safety of glucocorticoid usage in TKA. METHOD A comprehensive systematic search of PubMed, Medline, EMBASE, Cochrane databases, to identify relevant randomized controlled trials (RCTs) of glucocorticoid application in TKA. The primary outcomes assessed were the postoperative pain assessment. Secondary outcomes included the range of motion in knee joint, levels of inflammatory cytokines, adverse complications, and the length of hospital stay. RESULTS Thirty-six randomized controlled trials were included in the final analysis. The glucocorticoid group exhibited significant reduction in the resting VAS scores on postoperative days 1, 2 (POD1, 2)and postoperative 3 months (POM3), as well as decreased morphine consumption on POD1 and increased range of motion (ROM) in knee joint on POD1, 3. Additionally, the glucocorticoid group exhibited decreased levels of postoperative inflammatory cytokines and the incidence of PONV along with a shorter length of hospital stay. The blood glucose concentration was significantly increased in the glucocorticoid group on POD1 compared with the control group. While the blood glucose on POD2 and occurrence of postoperative adverse complications were similar between two groups including wound infection and venous thrombosis. The periarticular injection analgesia (PIA) group demonstrated lower VAS scores on POD2 comparing to the systemic administration (SA) group according to two studies. However, there was no significant difference of the resting VAS on POD1 and POD2 between PIA and SA group across all studies. CONCLUSION Perioperative glucocorticoids treatment in TKA significantly reduced short-term pain score and opioid-use which was probably not patient relevant. The application of glucocorticoids in TKA implied a beneficial trend in analgesic, anti-inflammatory, and antiemetic effects, as well as improved range of motion and shortened hospital stay. While it will not increase the risk of continued high glucose, postoperative wound infection and venous thrombosis.
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Affiliation(s)
- Fangyan Liu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Mei Duan
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Huiqun Fu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.
- National Clinical Research Center for Geriatric Diseases, Beijing, China.
- Beijing Institute for Brain Disorders, Beijing, China.
- Center for Sleep and Consciousness Disorders, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.
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Taieb D, Moyon Q, Lhote R, Annesi-Maesano I, Haroche J, Cervera R, Amoura Z, Cohen Aubart F. Phenotypes in antiphospholipid syndrome: A hierarchical cluster analysis based on two independent databases. J Autoimmun 2024; 144:103173. [PMID: 38330544 DOI: 10.1016/j.jaut.2024.103173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/24/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Antiphospholipid syndrome (APS) is a rare autoimmune disease characterized by thromboses at various sites and obstetric events associated with the persistent presence of antiphospholipid antibodies. The identification of clinical phenotypes in APS patients is a clinical need. In this study, we aimed to determine the clinical phenotypes of APS patients through an unsupervised analysis of two well-characterized cohorts of APS patients. PATIENTS AND METHODS APS phenotypes were defined by an ascending hierarchical cluster analysis to identify preferential associations between 18 types of organ involvement and clinical characteristics. This analysis was performed on an initial multi-center cohort of 1000 patients, with validation in a replication cohort of 435 patients. RESULTS The hierarchical analysis identified three APS phenotypes in both the initial and replication cohorts: an obstetric phenotype (n = 259 and n = 74 patients, respectively), a venous thrombosis phenotype, accounting for the largest number of patients (n = 461 and n = 297 patients, respectively), and a skin-central nervous system-heart phenotype (n = 280 and n = 64 patients, respectively). The clinical characteristics of the patients differed significantly between the three phenotypes, but there was no difference in antiphospholipid antibody profile between the groups. CONCLUSIONS We identified three phenotypes of APS defined based on preferential associations of organ involvements and differences in presentation. These observations may help clinicians to detect organ involvement and to manage treatment.
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Affiliation(s)
- Dov Taieb
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, 75013, Paris, France.
| | - Quentin Moyon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Raphael Lhote
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Isabella Annesi-Maesano
- Institut Debrest D'Epidémiologie et de Santé Publique, UMR UA11, Université de Montpellier et INSERM 34090-Montpellier, Service des Maladies Allergiques et Respiratoires, CHU, Montpellier, France
| | - Julien Haroche
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Member of ERN-ReCONNET/RITA, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Zahir Amoura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Fleur Cohen Aubart
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, 75013, Paris, France
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Michelson KA, Rees CA, Florin TA, Bachur RG. Emergency Department Volume and Delayed Diagnosis of Serious Pediatric Conditions. JAMA Pediatr 2024; 178:362-368. [PMID: 38345811 PMCID: PMC10862268 DOI: 10.1001/jamapediatrics.2023.6672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024]
Abstract
Importance Diagnostic delays are common in the emergency department (ED) and may predispose to worse outcomes. Objective To evaluate the association of annual pediatric volume in the ED with delayed diagnosis. Design, Setting, and Participants This retrospective cohort study included all children younger than 18 years treated at 954 EDs in 8 states with a first-time diagnosis of any of 23 acute, serious conditions: bacterial meningitis, compartment syndrome, complicated pneumonia, craniospinal abscess, deep neck infection, ectopic pregnancy, encephalitis, intussusception, Kawasaki disease, mastoiditis, myocarditis, necrotizing fasciitis, nontraumatic intracranial hemorrhage, orbital cellulitis, osteomyelitis, ovarian torsion, pulmonary embolism, pyloric stenosis, septic arthritis, sinus venous thrombosis, slipped capital femoral epiphysis, stroke, or testicular torsion. Patients were identified using the Healthcare Cost and Utilization Project State ED and Inpatient Databases. Data were collected from January 2015 to December 2019, and data were analyzed from July to December 2023. Exposure Annual volume of children at the first ED visited. Main Outcomes and Measures Possible delayed diagnosis, defined as a patient with an ED discharge within 7 days prior to diagnosis. A secondary outcome was condition-specific complications. Rates of possible delayed diagnosis and complications were determined. The association of volume with delayed diagnosis across conditions was evaluated using conditional logistic regression matching on condition, age, and medical complexity. Condition-specific volume-delay associations were tested using hierarchical logistic models with log volume as the exposure, adjusting for age, sex, payer, medical complexity, and hospital urbanicity. The association of delayed diagnosis with complications by condition was then examined using logistic regressions. Results Of 58 998 included children, 37 211 (63.1%) were male, and the mean (SD) age was 7.1 (5.8) years. A total of 6709 (11.4%) had a complex chronic condition. Delayed diagnosis occurred in 9296 (15.8%; 95% CI, 15.5-16.1). Each 2-fold increase in annual pediatric volume was associated with a 26.7% (95% CI, 22.5-30.7) decrease in possible delayed diagnosis. For 21 of 23 conditions (all except ectopic pregnancy and sinus venous thrombosis), there were decreased rates of possible delayed diagnosis with increasing ED volume. Condition-specific complications were 11.2% (95% CI, 3.1-20.0) more likely among patients with a possible delayed diagnosis compared with those without. Conclusions and Relevance EDs with fewer pediatric encounters had more possible delayed diagnoses across 23 serious conditions. Tools to support timely diagnosis in low-volume EDs are needed.
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Affiliation(s)
- Kenneth A. Michelson
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Todd A. Florin
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard G. Bachur
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
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Zhao H, Sengupta SK, Sisley JM, Haddadin O, Pfeifer H, Ortega-Loayza AG. Deep Vein Thrombosis and Healing Outcomes in Patients With Pyoderma Gangrenosum. JAMA Dermatol 2024; 160:472-474. [PMID: 38353971 PMCID: PMC10867771 DOI: 10.1001/jamadermatol.2023.6066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/11/2023] [Indexed: 02/17/2024]
Abstract
This single-center prospective case-control study assessed the association between deep vein thrombosis and healing outcomes in patients with pyoderma gangrenosum.
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Affiliation(s)
- Hannah Zhao
- School of Medicine, Oregon Health & Science University, Portland
| | | | | | - Olivia Haddadin
- School of Medicine, Oregon Health & Science University, Portland
| | - Hailey Pfeifer
- School of Medicine, Oregon Health & Science University, Portland
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Hur JY, Choi N, Choi JH, Kim J, Won YW. Risk of thrombosis, hemorrhage and leukemic transformation in patients with myeloproliferative neoplasms: A nationwide longitudinal cohort study. Thromb Res 2024; 236:209-219. [PMID: 38461615 DOI: 10.1016/j.thromres.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION There are few large-scale, population-based studies detailing the risks of thrombosis, hemorrhage, leukemic transformation in patients with myeloproliferative neoplasms (MPNs), including essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF). METHODS We performed a nationwide longitudinal cohort study using the Korean National Health Insurance System (NHIS) database. MPN patients (n = 11,991) and their 1:4 age- and sex-matched controls (n = 47,964) were enrolled. The risk of thrombosis, hemorrhage, leukemic transformation was estimated using a Cox proportional hazards regression, and stratified analyses were performed for related factors. RESULTS During a median of 7.8 years of follow-up, 30.1 % of MPN patients (3614/11,991) and 19.0 % of the matched controls (9141/47,964) developed arterial thrombosis, 11.6 % of MPN patients (1397/11,991) and 6.4 % of the matched controls (3099/47,964) developed venous thrombosis and 18.7 % of MPN patients (2251/11,991) and 12.1 % of the matched controls (5836/47,964) developed hemorrhage. 4.9 % of MPN patients (597/11,991) and 0.1 % of matched controls (50/47,964) developed leukemia. The overall risk of developing thrombosis, hemorrhage, leukemic transformation was higher in MPN patients (adjusted hazard ratio [aHR] 1.695, 95 % confidence interval [CI]: 1.629-1.765 for arterial thrombosis, aHR 1.963, 95 % CI: 1.838-2.096 for venous thrombosis, and aHR 1.714, 95 % CI: 1.630-1.802 for hemorrhage) than in the controls. Patients with MPNs had a 10-year cumulative incidence of leukemic transformation of 6.2 %. CONCLUSION The patients with MPNs have a higher risk of thrombosis, hemorrhage, and leukemic transformation than matched controls. Strategies are warranted to reduce the risk of thrombosis, hemorrhage, and leukemic transformation in MPN patients.
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Affiliation(s)
- Joon Young Hur
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Republic of Korea
| | - Nayeon Choi
- Biostatistics Lab, Medical Research Collaborating Center, Industry-University Cooperation Foundation, Hanyang University, Seoul, Republic of Korea
| | - Jung Hye Choi
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Republic of Korea
| | - Jiyeong Kim
- Biostatistics Lab, Medical Research Collaborating Center, Industry-University Cooperation Foundation, Hanyang University, Seoul, Republic of Korea; Department of Pre-Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Young-Woong Won
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Republic of Korea.
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10
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Carrion AN, Allison TA, Samuel S. Is a minimum duration of 5 days of unfractionated heparin infusion necessary before transition to oral anticoagulation in cerebral venous thrombosis? a retrospective chart review. J Thromb Thrombolysis 2024; 57:691-698. [PMID: 38418744 DOI: 10.1007/s11239-024-02950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 03/02/2024]
Abstract
In managing cerebral venous sinus thrombosis (CVT), the standard approach has been administering parenteral anticoagulation for at least five days, despite limited supporting evidence. This study aimed to determine the optimal duration of parenteral anticoagulation for CVT patients and its potential impact on their functional outcomes upon discharge. This retrospective observational cohort study was conducted across multiple healthcare centers and included adult CVT patients who received varying durations of parenteral anticoagulation: less than 5 days (n = 25) or 5 days or more (n = 16). The primary focus was on the duration of acute anticoagulation treatment, with secondary endpoints including hospital stay length and functional outcomes. The study found that a shorter duration of anticoagulation treatment (< 5 days) was linked to more favorable outcomes, as measured by the modified Rankin Scale (mRS) (68% vs. 25%, RR = 0.37, CI 0.15-0.90, p = 0.007). However, regression analysis showed non statistically significant associations for all variables except gender. Female patients were significantly more likely to receive a shorter duration of anticoagulation (Odds Ratio: 2.6, 95% CI: 2.2-3.1, P-Value: <0.001). These findings suggest a potential connection between shorter anticoagulation duration (< 5 days) and improved CVT patient outcomes, as indicated by their mRS scores at discharge. The observed relationship between female gender and shorter anticoagulation duration warrants further exploration. Nevertheless, caution is necessary when interpreting these findings due to the small sample size and specific patient characteristics. Further research in a larger and more diverse cohort is essential to validate these results and understand their implications fully.
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Affiliation(s)
- Ariel N Carrion
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin Street, Houston, TX, 77030, USA
| | - Teresa A Allison
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin Street, Houston, TX, 77030, USA
| | - Sophie Samuel
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin Street, Houston, TX, 77030, USA.
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11
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Vlazny DT, Houghton DE. Impact of vascular medicine specialists on inpatient utilization and management of inferior vena cava filters. Vasc Med 2024; 29:123-124. [PMID: 38334043 DOI: 10.1177/1358863x231224326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
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12
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Su W, Liang X, Lu H, Zhang J, Fang JY. Concurrent Arterial and Venous Thromboses in Ulcerative Colitis: A Complex Case of Multiorgan Involvement. Dig Dis Sci 2024; 69:1076-1077. [PMID: 38376786 DOI: 10.1007/s10620-024-08268-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Wenyu Su
- Department of Gastroenterology and Hepatology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
- State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, No.145 Middle Shandong Road, Shanghai, China
| | - Xiao Liang
- Department of Gastroenterology and Hepatology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
- State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, No.145 Middle Shandong Road, Shanghai, China
| | - Hong Lu
- Department of Gastroenterology and Hepatology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
- State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, No.145 Middle Shandong Road, Shanghai, China
| | - Jin Zhang
- Department of Radiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Jing-Yuan Fang
- Department of Gastroenterology and Hepatology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China.
- State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, No.145 Middle Shandong Road, Shanghai, China.
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Flynn C, Baldassarra J, Hamidi A. Enoxaparin is safe for the treatment of venous thromboembolisms in patients with renal dysfunction: A retrospective cohort study. Thromb Res 2024; 236:127-129. [PMID: 38430903 DOI: 10.1016/j.thromres.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/04/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Connor Flynn
- Department of Pharmacy, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, USA.
| | - Julie Baldassarra
- Department of Pharmacy, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, USA.
| | - Arzo Hamidi
- Department of Pharmacy, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, USA.
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Thurin NH, Grelaud A, Grolleau A, Bernard MA, Bignon E, Blin P, Lassalle R, Droz-Perroteau C. Design and validation of algorithms to identify venous thromboembolism in the French National Healthcare Database. Pharmacoepidemiol Drug Saf 2024; 33:e5781. [PMID: 38527971 DOI: 10.1002/pds.5781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 01/23/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE This paper aims to introduce an algorithm designed to identify Venous Thromboembolism (VTE) in the French National Healthcare Database (SNDS) and to estimate its positive predictive value. METHODS A case-identifying algorithm was designed using SNDS inpatient and outpatient encounters, including hospital stays with discharge diagnoses, imaging procedures and drugs dispensed, of French patients aged at least 18 years old to whom baricitinib or Tumor Necrosis Factor Inhibitors (TNFi) were dispensed between September 1, 2017, and December 31, 2018. An intra-database validation study was then conducted, drawing 150 cases identified as VTE by the algorithm and requesting four vascular specialists to assess them. Patient profiles used to conduct the case adjudication were reconstituted from de-identified pooled and formatted SNDS data (i.e., reconstituted electronic health records-rEHR) with a 6-month look-back period prior to the supposed VTE onset and a 12-month follow-up period after. The positive predictive value (PPV) with its 95% confidence interval (95% CI) was calculated as the number of expert-confirmed VTE divided by the number of algorithm-identified VTE. The PPV and its 95% CI were then recomputed among the same patient set initially drawn, once the VTE-identifying algorithm was updated based on expert recommendation. RESULTS For the 150 patients identified with the first VTE-identifying algorithm, the adjudication committee confirmed 92 cases, resulting in a PPV of 61% (95% CI = [54-69]). The final VTE-identifying algorithm including expert suggestions showed a PPV of 92% (95% CI = [86-98]) with a total of 87 algorithm-identified cases, including 80 retrieved from the 92 confirmed by experts. CONCLUSION The identification of VTE in the SNDS is possible with a good PPV.
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Affiliation(s)
- Nicolas H Thurin
- Bordeaux PharmacoEpi, INSERM CIC-P 1401, University of Bordeaux, Bordeaux, France
| | - Angela Grelaud
- Bordeaux PharmacoEpi, INSERM CIC-P 1401, University of Bordeaux, Bordeaux, France
| | - Adeline Grolleau
- Bordeaux PharmacoEpi, INSERM CIC-P 1401, University of Bordeaux, Bordeaux, France
| | - Marie-Agnès Bernard
- Bordeaux PharmacoEpi, INSERM CIC-P 1401, University of Bordeaux, Bordeaux, France
| | - Emmanuelle Bignon
- Bordeaux PharmacoEpi, INSERM CIC-P 1401, University of Bordeaux, Bordeaux, France
| | - Patrick Blin
- Bordeaux PharmacoEpi, INSERM CIC-P 1401, University of Bordeaux, Bordeaux, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC-P 1401, University of Bordeaux, Bordeaux, France
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Gonzalez CA, Van Rysselberghe NL, Maschhoff C, Gardner MJ. Outcomes of Patients with Preoperative Thrombocytosis After Hip Fracture Surgery. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00014. [PMID: 38595218 PMCID: PMC11003512 DOI: 10.5435/jaaosglobal-d-23-00159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/13/2023] [Accepted: 01/30/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Low platelet counts have clinically relevant effects on patient outcomes after hip fracture surgery; however, the relationship between abnormally high platelet counts and postoperative outcomes in this population is unknown. METHODS The ACS-NSQIP database was queried for patients who underwent hip fracture surgery between 2015 and 2019. Outcomes were compared between patients with normal platelet counts (150,000 to 450,000/μL) and thrombocytosis (>450,000/μL). RESULTS Eighty-six thousand three hundred eleven hip fracture patients were identified, of which 1067 (1.2%) had preoperative thrombocytosis. Compared with patients with normal platelet counts, patients with preoperative thrombocytosis had increased rates of 30-day mortality (6.4% vs 4.5%, P = 0.004; OR 1.15 [95% CI 0.88 to 1.50], P = 0.322) as well as increased rates and odds of readmission (11.4% vs 7.8%, P < 0.001; OR 1.35 [95% CI 1.10 to 1.65], P = 0.004) and venous thromboembolic events (3.2% vs 1.7%, P < 0.001; OR 1.88 [95% CI 1.31 to 2.71], P < 0.001). CONCLUSIONS Hip fracture patients with preoperative thrombocytosis had increased rates of early mortality as well as increased odds of venous thromboembolic events and readmission. A patient with thrombocytosis may benefit from close postoperative surveillance and careful follow-up. Future prospective studies are needed to verify causation and investigate how to mitigate adverse outcomes in hip fracture patients with preoperative thrombocytosis.
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Affiliation(s)
- Christian A. Gonzalez
- From the Reno School of Medicine, University of Nevada, Reno, NV (Dr. Gonzalez); the Department of Orthopaedic Surgery, Stanford University, Stanford, CA (Dr. Rysselberghe and Dr. Gardner); and the University of Illinois College of Medicine, Chicago, IL (Dr. Maschhoff)
| | - Noelle L. Van Rysselberghe
- From the Reno School of Medicine, University of Nevada, Reno, NV (Dr. Gonzalez); the Department of Orthopaedic Surgery, Stanford University, Stanford, CA (Dr. Rysselberghe and Dr. Gardner); and the University of Illinois College of Medicine, Chicago, IL (Dr. Maschhoff)
| | - Clayton Maschhoff
- From the Reno School of Medicine, University of Nevada, Reno, NV (Dr. Gonzalez); the Department of Orthopaedic Surgery, Stanford University, Stanford, CA (Dr. Rysselberghe and Dr. Gardner); and the University of Illinois College of Medicine, Chicago, IL (Dr. Maschhoff)
| | - Michael J. Gardner
- From the Reno School of Medicine, University of Nevada, Reno, NV (Dr. Gonzalez); the Department of Orthopaedic Surgery, Stanford University, Stanford, CA (Dr. Rysselberghe and Dr. Gardner); and the University of Illinois College of Medicine, Chicago, IL (Dr. Maschhoff)
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16
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Essouma M, Nkeck JR, Noubiap JJ. Epidemiology of thromboembolic events in children and adolescents with antiphospholipid syndrome: A systematic review with meta-analysis. Reumatol Clin (Engl Ed) 2024; 20:155-161. [PMID: 38494306 DOI: 10.1016/j.reumae.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/09/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND AIM This was a systematic review and meta-analysis of the prevalence of thromboembolic events in children and adolescents with antiphospholipid syndrome (APS). METHODS We searched PubMed, EMBASE and Web of Science to select relevant articles published between 1 January 2000 and 27 February 2022. We used the random-effects meta-analysis to estimate pooled point prevalence rates of thromboembolic events in studies with a minimum sample size of 30. RESULTS We included five studies reporting data of 336 children and adolescents with primary APS and secondary APS (SAPS). Pooled point prevalence rates of initial general thrombosis, arterial thrombosis, venous thrombosis and stroke in individuals with seropositive APS were 98.2% (95% confidence interval [CI] 87.5-100), 27.6% (95% CI 21.4-34.2), 51.1% (95% CI 38.2-63.9) and 13.4% 95% CI (6.3-22.7), respectively. Pooled point prevalence rates of initial arterial and venous thromboses in children and adolescents with SAPS were 45.7% (95% CI 21.1-71.6) and 29.2% (95% CI 14.8-46), respectively. CONCLUSION Arterio-venous thromboembolism is highly frequent in children and adolescents with SAPS. More studies using thrombotic and non-thrombotic APS classification criteria are warranted to better assess the frequency and predictors of thromboembolism in age- and ancestry-diverse pediatric populations affected by different types of APS.
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Affiliation(s)
- Mickael Essouma
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Yaoundé, Cameroon.
| | - Jan Rene Nkeck
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon; Regional Hospital Centre, Ebolowa, Cameroon
| | - Jean Jacques Noubiap
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, United States
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Febra C, Saraiva J, Vaz F, Macedo J, Al-Hroub HM, Semreen MH, Maio R, Gil V, Soares N, Penque D. Acute venous thromboembolism plasma and red blood cell metabolomic profiling reveals potential new early diagnostic biomarkers: observational clinical study. J Transl Med 2024; 22:200. [PMID: 38402378 PMCID: PMC10894498 DOI: 10.1186/s12967-024-04883-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/10/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a leading cause of cardiovascular mortality. The diagnosis of acute VTE is based on complex imaging exams due to the lack of biomarkers. Recent multi-omics based research has contributed to the development of novel biomarkers in cardiovascular diseases. Our aim was to determine whether patients with acute VTE have differences in the metabolomic profile compared to non-acute VTE. METHODS This observational trial included 62 patients with clinical suspicion of acute deep vein thrombosis or pulmonary embolism, admitted to the emergency room. There were 50 patients diagnosed with acute VTE and 12 with non-acute VTE conditions and no significant differences were found between the two groups for clinical and demographic characteristics. Metabolomics assays identified and quantified a final number of 91 metabolites in plasma and 55 metabolites in red blood cells (RBCs). Plasma from acute VTE patients expressed tendency to a specific metabolomic signature, with univariate analyses revealing 23 significantly different molecules between acute VTE patients and controls (p < 0.05). The most relevant metabolic pathway with the strongest impact on the acute VTE phenotype was D-glutamine and D-glutamate (p = 0.001, false discovery rate = 0.06). RBCs revealed a specific metabolomic signature in patients with a confirmed diagnosis of DVT or PE that distinguished them from other acutely diseased patients, represented by 20 significantly higher metabolites and four lower metabolites. Three of those metabolites revealed high performant ROC curves, including adenosine 3',5'-diphosphate (AUC 0.983), glutathione (AUC 0.923), and adenine (AUC 0.91). Overall, the metabolic pathway most impacting to the differences observed in the RBCs was the purine metabolism (p = 0.000354, false discovery rate = 0.68). CONCLUSIONS Our findings show that metabolite differences exist between acute VTE and nonacute VTE patients admitted to the ER in the early phases. Three potential biomarkers obtained from RBCs showed high performance for acute VTE diagnosis. Further studies should investigate accessible laboratory methods for the future daily practice usefulness of these metabolites for the early diagnosis of acute VTE in the ER.
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Affiliation(s)
- Cláudia Febra
- Department of Intensive Care, Hospital da Luz Lisboa, Lisbon, Portugal.
- Faculty of Medicine, University of Porto, Porto, Portugal.
- Human Genetics Department, Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA), Lisbon, Portugal.
| | - Joana Saraiva
- Human Genetics Department, Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA), Lisbon, Portugal
- Center for Toxicogenomics and Human Health (ToxOmics), NOVA Medical School-FCM, UNL, Lisbon, Portugal
- NOVA School of Science and Technology, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Fátima Vaz
- Human Genetics Department, Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA), Lisbon, Portugal
- Center for Toxicogenomics and Human Health (ToxOmics), NOVA Medical School-FCM, UNL, Lisbon, Portugal
| | - João Macedo
- NOVA School of Science and Technology, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Hamza Mohammad Al-Hroub
- Department of Medical Chemistry, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohammad Harb Semreen
- Department of Medical Chemistry, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Rui Maio
- Department of General Surgery, Hospital da Luz Lisboa, Lisbon, Portugal
| | - Vitor Gil
- Faculty of Medicine, University of Porto, Porto, Portugal
- Center of Cardiovascular Risk and Thrombosis, Hospital da Luz Torres de Lisboa, Lisbon, Portugal
| | - Nelson Soares
- Human Genetics Department, Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA), Lisbon, Portugal.
- NOVA School of Science and Technology, Universidade Nova de Lisboa, Lisbon, Portugal.
- Department of Medical Chemistry, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates.
| | - Deborah Penque
- Human Genetics Department, Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA), Lisbon, Portugal.
- Center for Toxicogenomics and Human Health (ToxOmics), NOVA Medical School-FCM, UNL, Lisbon, Portugal.
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Patarroyo Aponte MM. When Bad and Worse Collide: Venous Thromboembolic Disease and Pulmonary Hypertension. Am J Cardiol 2024; 213:164-165. [PMID: 38199843 DOI: 10.1016/j.amjcard.2023.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Maria M Patarroyo Aponte
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, The University of Texas Health Science Center-Houston/Memorial Hermann Hospital-Texas Medical Center, Houston, Texas.
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Plante MM, Wolf EB, Chirila RM. What are the management considerations for venous thromboembolic events in patients with cirrhosis? Cleve Clin J Med 2024; 91:86-88. [PMID: 38307607 DOI: 10.3949/ccjm.91a.23045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Affiliation(s)
- Marie M Plante
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Emily B Wolf
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
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Lemoine CP, Yang S, Brandt KA, Carra S, Superina RA. A History of Umbilical Vein Catheterization Does Not Preclude Children from a Successful Meso-Rex Bypass. Eur J Pediatr Surg 2024; 34:28-35. [PMID: 37487509 DOI: 10.1055/s-0043-1771225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Umbilical vein catheterization (UVC) can cause portal venous thrombosis, leading to the development of extrahepatic portal venous obstruction (EHPVO) and portal hypertension (PHT). The feasibility of the Meso-Rex bypass (MRB) for the treatment of EHPVO in patients with a history of UVC has been questioned. We compared the feasibility of performing an MRB in patients with or without a history of previous UVC. METHODS A retrospective review of patients with EHPVO and known UVC status explored for a possible MRB at our institution was performed (1997-2022). Patients were categorized in two groups: with (UVC(+)) or without (UVC(-)) a history of UVC for comparison. A p-value less than 0.05 was considered significant. RESULTS One hundred and eighty-seven patients were included (n = 57 in UVC(+); n = 130 in UVC(-)). Patients in the UVC group were significantly younger at surgery and the incidence of prematurity was higher. Other risk factors for the development of EHPVO were similar between the groups, but only history of UVC could predict the ability to receive MRB (odds ratio [OR]: 7.4 [3.5-15.4]; p < 0.001). The success rate of MRB was significantly higher in patients with no history of UVC (28/57 [49.1%] in UVC(+) vs. 114/130 [87.7%] in UVC(-); p < 0.001). However, MRB patency at discharge (25/28 [89.3%] in UVC(+) vs. 106/114 [94.7%] in UVC(-); p = 0.3) was equally high in both groups. CONCLUSION Our results indicate that a history of UVC is not a contraindication to MRB. Half of the patients were able to successfully receive an MRB. Patients with symptomatic PHT from EHPVO should not be excluded from consideration for MRB based on UVC history.
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Affiliation(s)
- Caroline P Lemoine
- Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Stephanie Yang
- Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Katherine A Brandt
- Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Sydney Carra
- Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Riccardo A Superina
- Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
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Zhang C, Calderon E, Chang YH, Lu P, Durant AM, Villa EL, Katariya NN, Jadlowiec C, Reddy KS, Moss A, Mathur AK. Portal vein thrombosis and donation after cardiac death liver transplantation: Pre-perfusion data implications for the perfusion era. Am J Surg 2024; 228:301-304. [PMID: 37777377 DOI: 10.1016/j.amjsurg.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Chi Zhang
- Transplant Center, Mayo Clinic Arizona, Phoenix, AZ, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester, MN, USA
| | | | - Yu-Hui Chang
- Quantitative Health Sciences, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Patricia Lu
- Transplant Center, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Adri M Durant
- Transplant Center, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | | | | | - Kunam S Reddy
- Transplant Center, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Adyr Moss
- Transplant Center, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Amit K Mathur
- Transplant Center, Mayo Clinic Arizona, Phoenix, AZ, USA.
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Farhat K, Farhat N, Bruyère PJ, Seghaye MC. Vena cava inferior thrombosis diagnosed 12 years after interventional atrial septum defect closure in an infant. Acta Cardiol 2024; 79:70-71. [PMID: 36803388 DOI: 10.1080/00015385.2023.2177372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/24/2023] [Accepted: 02/01/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Khaldoun Farhat
- Department of Pediatric Cardiology, University Hospital Liège, Liège, Belgium
| | - Nesrine Farhat
- Department of Pediatric Cardiology, University Hospital Liège, Liège, Belgium
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Ken-Dror G, Sharma P. ABO blood group associated with cerebral venous thrombosis after Oxford-AstraZeneca COVID-19 vaccination: a case-control study. J R Soc Med 2024; 117:69-76. [PMID: 38086410 PMCID: PMC10949869 DOI: 10.1177/01410768231214341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/29/2023] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES To determine whether blood group influences development of cerebral venous thrombosis (CVT) after administration of the coronavirus disease 2019 (COVID-19) AstraZeneca ChAdOx1-S vaccine. DESIGN A case-control study. Univariate and multivariate logistic regression was used to determine the association between blood type and COVID-19 vaccination status. SETTING Vaccinated and unvaccinated patients recruited from the international Bio-Repository to Establish the Aetiology of Sinovenous Thrombosis study and the Cerebral Venous Sinus Thrombosis With Thrombocytopenia Syndrome Study Group. PARTICIPANTS All patients were of European descent and age and sex matched. Cases (n = 82) were patients ≥18 years old who suffered a CVT within 28 days of a first dose of ChAdOx1-S vaccine. Controls (n = 441) were unvaccinated CVT patients ≥18 years old. All patients were of European descent. MAIN OUTCOME MEASURES Frequency of blood type and ABO allele distribution by vaccination status. RESULTS Blood group O was found to be more prevalent among CVT patients with vaccine-induced thrombotic thrombocytopenia (VITT-CVT) after ChAdOx1-S vaccination compared with unvaccinated CVT cases (43% vs. 17%, respectively, p < 0.001). Blood group A was less prevalent, though still high, in the vaccinated group compared with the unvaccinated group (47% vs. 71%, respectively, p < 0.001). No significant differences were observed in the VITT-CVT non-ChAdOx1-S vaccine group and unvaccinated pre-COVID-19 CVT group for blood group. CONCLUSIONS Blood group O is more prevalent among patients with VITT-CVT after ChAdOx1-S vaccination compared with unvaccinated cases, independent of well-established CVT risk factors. A larger dataset may be able to determine whether those of blood groups B and/or AB may be safely vaccinated with the low cost, readily available and easily transported ChAdOx1-S rather than adopting a complete ban.
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Affiliation(s)
- Gie Ken-Dror
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London TW20 0EX, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London TW20 0EX, UK
- Department of Clinical Neurology, Imperial College Healthcare NHS Trust, London W6 8RF, UK
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Ye M, Yu X, Yuan Y, He M, Zhuang J, Xiong S, Li J, Wang Y, Li C, Xiong X, Deng H. Design a dual-response two-photon fluorescent probe for simultaneous imaging of mitochondrial viscosity and peroxynitrite in a thrombosis model. Anal Chim Acta 2024; 1287:342088. [PMID: 38182381 DOI: 10.1016/j.aca.2023.342088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Venous thromboembolism is a sudden cardiovascular disease that can lead to death, and its pathologic development is closely related to vascular viscosity and inflammation. However, direct evidence from in vivo is really scarce. The key limitation is that the combined probes cannot detect multiple markers simultaneously, which may lead to unreliable results. Therefore, to develop a single probe that can simultaneously monitor the variations of viscosity in the vascular microenvironment as well as inflammation level during venous thrombosis. RESULTS A dual-responsive two-photon fluorescent probe, Cou-ONOO, was designed and synthesized. Cou-ONOO provides a visualization tool for monitoring the viscosity of the vascular as well as the inflammatory marker ONOO‾ during thromboembolism via dual-channel simultaneous imaging. As a single probe that can recognize dual targets, Cou-ONOO effectively avoids the problems from unreliable results caused by complex synthesis and differences in intracellular localization, diffusion, and metabolism of different dyes as using combinatorial probes. Using Cou-ONOO, simultaneous imaging the variations of viscosity and ONOO‾at the cellular and tissue levels was successfully performed. In addition, Cou-ONOO also successfully visualized and tracked the viscosity of the vascular microenvironment and ONOO‾ during venous embolism in mice. SIGNIFICANCE Experimental results show that both viscosity and inflammation are abnormally overexpressed in the microenvironment at the thrombus site during venous thrombosis. An intuitive visualization tool to elucidate the variations of viscosity as well as inflammation level in the vascular microenvironment during thrombosis was provided, which will facilitate a better clinical understanding of the pathological process of thrombosis.
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Affiliation(s)
- Miantai Ye
- Department of Vascular Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China; Key Laboratory of Analytical Chemistry of the State Ethnic Affairs Commission, College of Chemistry and Material Science, South-central Minzu University, Wuhan, 430074, China
| | - Xiaohui Yu
- Department of Vascular Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yan Yuan
- Department of Vascular Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Meng He
- Key Laboratory of Analytical Chemistry of the State Ethnic Affairs Commission, College of Chemistry and Material Science, South-central Minzu University, Wuhan, 430074, China
| | - Junli Zhuang
- Department of Vascular Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Sizheng Xiong
- Department of Vascular Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jie Li
- Department of Vascular Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yanying Wang
- Key Laboratory of Analytical Chemistry of the State Ethnic Affairs Commission, College of Chemistry and Material Science, South-central Minzu University, Wuhan, 430074, China
| | - Chunya Li
- Key Laboratory of Analytical Chemistry of the State Ethnic Affairs Commission, College of Chemistry and Material Science, South-central Minzu University, Wuhan, 430074, China.
| | - Xiaoxing Xiong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Hongping Deng
- Department of Vascular Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Li T, Zhang Y, Cheng X, Jia L, Tian Y, He J, He M, Chen L, Hao P, Xiao Y, Peng L, Chong W, Hai Y, You C, Fang F. Association between postoperative changes in natremia and outcomes in patients undergoing elective craniotomy. Neurosurg Rev 2024; 47:69. [PMID: 38270672 DOI: 10.1007/s10143-024-02287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/27/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
Postoperative dysnatremias, characterized by imbalances in serum sodium levels, have been linked to increased resource utilization and mortality in surgical and intensive care patients. The management of dysnatremias may involve medical interventions based on changes in sodium levels. In this study, we aimed to investigate the impact of postoperative changes in natremia on outcomes specifically in patients undergoing craniotomy.We conducted a retrospective analysis of patient records from the Department of Neurosurgery at West China Hospital, Sichuan University, covering the period from January 2011 to March 2021. We compared the highest and lowest sodium values in the first 14 postoperative days with the baseline values to define four categories for analysis: no change < 5 mmol/L; decrease > 5 mmol/L; increase > 5 mmol/L; both increase and decrease > 5 mmol/L. The primary outcome measure was 30-day mortality.A total of 12,713 patients were included in the study, and the overall postoperative mortality rate at 30 days was 2.1% (264 patients). The increase in sodium levels carried a particularly high risk, with a tenfold increase (OR 10.21; 95% CI 7.25-14.39) compared to patients with minimal or no change. Decreases in sodium levels were associated with an increase in mortality (OR 1.60; 95% CI 1.11-2.23).Moreover, the study revealed that postoperative sodium decrease was correlated with various complications, such as deep venous thrombosis, pneumonia, intracranial infection, urinary infection, seizures, myocardial infarction, and prolonged hospital length of stay. On the other hand, postoperative sodium increases were associated with acute kidney injury, deep venous thrombosis, pneumonia, intracranial infection, urinary infection, surgical site infection, seizures, myocardial infarction, and prolonged hospital length of stay.Changes in postoperative sodium levels were associated with increased complications, prolonged length of hospital stay, and 30-day mortality. Moreover, the severity of sodium change values correlated with higher mortality rates.
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Affiliation(s)
- Tiangui Li
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- Department of Neurosurgery, The First People's Hospital of Longquanyi District Chengdu, Sichuan, China
| | - Yu Zhang
- Center for Evidence-Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Xin Cheng
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Lu Jia
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Yixing Tian
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Jialing He
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Miao He
- Department of Anesthesia, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Lvlin Chen
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Pengfei Hao
- Center for Evidence-Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yangchun Xiao
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Liyuan Peng
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Gu Y, Han F, Xue M, Wang M, Huang Y. The benefits and risks of menopause hormone therapy for the cardiovascular system in postmenopausal women: a systematic review and meta-analysis. BMC Womens Health 2024; 24:60. [PMID: 38263123 PMCID: PMC10804786 DOI: 10.1186/s12905-023-02788-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Menopause hormone therapy (MHT), as an effective method to alleviate the menopause-related symptoms of women, its benefits, risks, and potential influencing factors for the cardiovascular system of postmenopausal women are not very clear. OBJECTIVES To evaluate cardiovascular benefits and risks of MHT in postmenopausal women, and analyze the underlying factors that affect both. SEARCH STRATEGY The EMBASE, MEDLINE, and CENTRAL databases were searched from 1975 to July 2022. SELECTION CRITERIA Randomized Clinical Trials (RCTs) that met pre-specified inclusion criteria were included. DATA COLLECTION AND ANALYSIS Two reviewers extracted data independently. A meta-analysis of random effects was used to analyze data. MAIN RESULTS This systematic review identified 33 RCTs using MHT involving 44,639 postmenopausal women with a mean age of 60.3 (range 48 to 72 years). There was no significant difference between MHT and placebo (or no treatment) in all-cause death (RR = 0.96, 95%CI 0.85 to 1.09, I2 = 14%) and cardiovascular events (RR = 0.97, 95%CI 0.82 to 1.14, I2 = 38%) in the overall population of postmenopausal women. However, MHT would increase the risk of stroke (RR = 1.23, 95%CI 1.08 to 1.41,I2 = 0%) and venous thromboembolism (RR = 1.86, 95%CI 1.39 to 2.50, I2 = 24%). Compared with placebo, MHT could improve flow-mediated arterial dilation (FMD) (SMD = 1.46, 95%CI 0.86 to 2.07, I2 = 90%), but it did not improve nitroglycerin-mediated arterial dilation (NMD) (SMD = 0.27, 95%CI - 0.08 to 0.62, I2 = 76%). Compared with women started MHT more than 10 years after menopause, women started MHT within 10 years after menopause had lower frequency of all-cause death (P = 0.02) and cardiovascular events (P = 0.002), and more significant improvement in FMD (P = 0.0003). Compared to mono-estrogen therapy, the combination therapy of estrogen and progesterone would not alter the outcomes of endpoint event. (all-cause death P = 0.52, cardiovascular events P = 0.90, stroke P = 0.85, venous thromboembolism P = 0.33, FMD P = 0.46, NMD P = 0.27). CONCLUSIONS MHT improves flow-mediated arterial dilation (FMD) but fails to lower the risk of all-cause death and cardiovascular events, and increases the risk of stroke and venous thrombosis in postmenopausal women. Early acceptance of MHT not only reduces the risk of all-cause death and cardiovascular events but also further improves FMD, although the risk of stroke and venous thrombosis is not reduced. There is no difference in the outcome of cardiovascular system endpoints between mono-estrogen therapy and combination therapy of estrogen and progesterone.
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Affiliation(s)
- Yimeng Gu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Fangfang Han
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Mei Xue
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Miyuan Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuxiao Huang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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Qin X, Gao X, Yang Y, Ou S, Luo J, Wei H, Jiang Q. Developing a risk assessment tool for cancer-related venous thrombosis in China: a modified Delphi-analytic hierarchy process study. BMC Cancer 2024; 24:120. [PMID: 38263026 PMCID: PMC10807161 DOI: 10.1186/s12885-024-11877-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/13/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE To develop a Risk Assessment Tool for Cancer-related Venous Thrombosis in China. METHODS A modified two-round Delphi method was employed to establish consensus within a field to reach an agreement via a questionnaire or by interviewing a multidisciplinary panel of experts by collecting their feedback to inform the next round, exchanging their knowledge, experience, and opinions anonymously, and resolving uncertainties. Furthermore, The AHP (Analytic Hierarchy Process) was used to determine the final quality indicators' relative importance. RESULTS The expert's positive coefficient was 85.19% in the first round and 82.61% in the second round, with authoritative coefficients of 0.89 and 0.92 in the respective surveys. The P-value of Kendall's W test was all less than 0.001 for each round, and the W-value for concordance at the end of the two rounds was 0.115. The final Risk Assessment Tool for Cancer-related Venous Thrombosis consisted of three domains, ten subdomains, and 39 indicators, with patient factors weighing 0.1976, disease factors weighing 0.4905, and therapeutic factors weighing 0.3119. CONCLUSION The tool is significantly valid and reliable with a strong authority and coordination degree, and it can be used to assess the risk of cancer-related VTE and initiate appropriate thrombophylactic interventions in China.
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Affiliation(s)
- Xiaoli Qin
- Department of Pharmacy, The Third People's Hospital of Chengdu, 610031, Chengdu, Sichuan, P.R. China
- School of Pharmacy, Chengdu Medical College, 610500, Chengdu, Sichuan, P.R. China
| | - Xiurong Gao
- School of Pharmacy, Chengdu Medical College, 610500, Chengdu, Sichuan, P.R. China
| | - Yujie Yang
- Department of Pharmacy, The Third People's Hospital of Chengdu, 610031, Chengdu, Sichuan, P.R. China
| | - Shunlong Ou
- Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, 610041, Chengdu, Sichuan, P.R. China
| | - Jing Luo
- Department of Pharmacy, The Second People's Hospital of Yibin, 644000, Yibin, Sichuan, P.R. China
| | - Hua Wei
- Department of Pharmacy, Chengdu Second People's Hospital, 610011, Chengdu, Sichuan, P.R. China
| | - Qian Jiang
- Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, 610041, Chengdu, Sichuan, P.R. China.
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Balcar L, Mrekva A, Scheiner B, Pomej K, Meischl T, Mandorfer M, Reiberger T, Trauner M, Tamandl D, Pinter M. Management of varices but not anticoagulation is associated with improved outcome in patients with HCC and macrovascular tumour invasion. Cancer Imaging 2024; 24:9. [PMID: 38217049 PMCID: PMC10787425 DOI: 10.1186/s40644-024-00657-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND & AIMS The value of bleeding prophylaxis and anticoagulation in patients with hepatocellular carcinoma (HCC) and macrovascular tumour invasion (MVI) is unclear. We evaluated the impact of anticoagulation on thrombosis progression, bleeding events, and overall mortality, and assessed the efficacy of adequate management of varices as recommended for patients with cirrhosis. METHODS HCC patients with MVI who had Child-Turcotte-Pugh A-B7 were included between Q4/2002 and Q2/2022. Localization of the tumour thrombus and changes at 3-6 months were evaluated by two radiologists. Univariable and multivariable logistic/Cox regression analyses included time-dependent variables (i.e., anticoagulation, systemic therapy, non-selective beta blocker treatment). RESULTS Of 124 patients included (male: n = 110, 89%), MVI involved the main portal vein in 47 patients (38%), and 49 individuals (40%) had additional non-tumorous thrombus apposition. Fifty of 80 patients (63%) with available endoscopy had varices. Twenty-four individuals (19%) received therapeutic anticoagulation and 94 patients (76%) were treated with effective systemic therapies. The use of therapeutic anticoagulation did not significantly affect the course of the malignant thrombosis at 3-6 months. Systemic therapy (aHR: 0.26 [95%CI: 0.16-0.40]) but not anticoagulation was independently associated with reduced all-cause mortality. In patients with known variceal status, adequate management of varices was independently associated with reduced risk of variceal bleeding (aHR: 0.12 [95%CI: 0.02-0.71]). In the whole cohort, non-selective beta blockers were independently associated with reduced risk of variceal bleeding or death from any cause (aHR: 0.69 [95%CI: 0.50-0.96]). CONCLUSION Adequate bleeding prophylaxis and systemic anti-tumour therapy but not anticoagulation were associated with improved outcomes in patients with HCC and MVI.
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Affiliation(s)
- Lorenz Balcar
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
- Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Arpad Mrekva
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
- Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Katharina Pomej
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
- Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Tobias Meischl
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
- Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
- 3rd Medical Department (Hematology & Oncology), Hanusch Krankenhaus, Vienna, Austria
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Dietmar Tamandl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Matthias Pinter
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
- Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria.
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Malek AM, Wilson DA, Turan TN, Mateus J, Lackland DT, Hunt KJ. Hypertensive Disorders of Pregnancy and Pre-Pregnancy Hypertension with Subsequent Incident Venous Thromboembolic Events. Int J Environ Res Public Health 2024; 21:89. [PMID: 38248552 PMCID: PMC10815509 DOI: 10.3390/ijerph21010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
Hypertensive disorders of pregnancy (HDP) and pre-pregnancy hypertension contribute to maternal morbidity and mortality. We examined the association of HDP and pre-pregnancy hypertension with subsequent venous thromboembolic (VTE) events. The retrospective cohort study included 444,859 women with ≥1 live, singleton birth in South Carolina (2004-2016). Hospital and emergency department visit and death certificate data defined incident VTE, HDP, and pre-pregnancy hypertension. Birth certificate data also defined the exposures. Adjusted Cox proportional hazards methods modeled VTE events risk. Of the cohort, 2.6% of women had pre-pregnancy hypertension, 5.8% had HDP, 2.8% had both pre-pregnancy hypertension and HDP (both conditions), and 88.8% had neither condition. The risk of incident VTE events within one year of delivery was higher in women with HDP (hazard ratio [HR] = 1.62, 95% confidence interval [CI]: 1.15-2.29) and both conditions (HR = 2.32, 95% CI: 1.60-3.35) compared to those with neither condition as was the risk within five years for women with HDP (HR = 1.35, 95% CI: 1.13-1.60) and for women with both conditions (HR = 1.82, 95% CI: 1.50-2.20). One- and five-year risks did not differ in women with pre-pregnancy hypertension compared to women with neither condition. Compared to non-Hispanic White (NHW) women with neither condition, the incident VTE event risk was elevated within five years of delivery for NHW (HR = 1.29, 95% CI: 1.02-1.63; HR = 1.59, 95% CI: 1.16-2.17) and non-Hispanic Black (NHB; HR = 1.51, 95% CI: 1.16-2.96; HR = 2.08, 95% CI: 1.62-2.66) women with HDP and with both conditions, respectively, and for NHB women with pre-pregnancy hypertension (HR = 1.50, 95% CI: 1.09-2.07). VTE event risk was highest in women with HDP, and the event rates were higher in NHB women than in NHW women in the same exposure group.
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Affiliation(s)
- Angela M. Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Dulaney A. Wilson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Tanya N. Turan
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Julio Mateus
- Atrium Health, Department of Obstetrics & Gynecology, Maternal-Fetal Medicine Division, Charlotte, NC 28204, USA
| | - Daniel T. Lackland
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kelly J. Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
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30
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Zhang L. Better with poorly performing fibrin(ogen). Blood 2024; 143:95-97. [PMID: 38206639 PMCID: PMC10797544 DOI: 10.1182/blood.2023022668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Li Zhang
- University of Maryland School of Medicine
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Wang X, Zhou R, Gao D. Thrombosis of acute superior mesenteric artery in a patient with breast cancer receiving toremifene therapy: a case report and literature review. BMC Womens Health 2024; 24:20. [PMID: 38172886 PMCID: PMC10765882 DOI: 10.1186/s12905-023-02855-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
It is widely recognized that cancer itself is related to increased risk of thromembolism. Venous thromboembolism is relatively common in breast cancer patients, but arterial thrombosis, especially acute superior mesenteric artery thrombosis (SMAT) associated with chemotherapy or endocrinotherapy, rarely occurs in breast cancer patients. There were few reports about acute SMAT in cancer patients who underwent chemotherapy, but no reports of acute SMAT caused by endocrine-therapy. We reported a 54-year-old patient with acute SMAT during toremifene treatment after breast cancer surgery. She underwent 4 cycles chemotherapy of TC regimen, then accepted toremifen endocrinotherapy because of positive estrogen receptor. She suffered from acute SMAT after 2 months toremifen treatment. Therefore, we consider that this case of acute SMAT may be a rare adverse event of toremifen. In view of the high risk and rarity of acute SMAT caused by toremifene, we suggest that except for venous thrombosis, arterial thrombosis in special position (ATSP) should be kept in mind during use of toremifene. Once a thrombotic event occurs, toremifene should be stopped immediately.
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Affiliation(s)
- Ximei Wang
- Department of General Surgery, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, China
| | - Runhe Zhou
- Department of General Surgery, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, China
| | - Dezong Gao
- Department of General Surgery, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, China.
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Christensen JM, Ahn L, Meulendijks MZ, Iskhakov D, Wong F, Winograd J, Valerio IL, Cetrulo CL, Helliwell LA, Eberlin KR. Technical Variables in Lower Extremity Free Flap Reconstruction. J Reconstr Microsurg 2024; 40:78-86. [PMID: 37040875 DOI: 10.1055/a-2071-3250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND Lower extremity free flap failure rates are higher than in other areas of the body. While prior studies assessed the effect of intraoperative technical variables, these generally investigated individual variables and did not examine relationships between the many individual technical decisions made during free tissue reconstruction. Our purpose was to investigate the effect of variation in intraoperative microsurgical techniques on flap outcomes in a diverse cohort of patients requiring lower extremity free flap coverage. METHODS Consecutive patients undergoing free flap reconstruction of the lower extremity at two level 1 trauma centers from January 2002 to January 2020 were identified using Current Procedural Terminology codes, followed by a review of medical records. Information regarding demographics and comorbidities, indications, intraoperative technical details, and complications was collected. Outcomes of interest included an unplanned return to the operating room, arterial thrombosis, venous thrombosis, partial flap failure, and total flap failure. Bivariate analysis was performed. RESULTS In total, 410 patients underwent 420 free tissue transfers. The median follow-up time was 17 months (interquartile ranges: 8.0-37). Total flap failure occurred in 4.9% (n = 20), partial flap failure in 5.9% (n = 24), and unplanned reoperation in 9.0% (n = 37), with arterial thrombosis in 3.2% (n = 13) and venous thrombosis in 5.4% (n = 22). Overall complications were significantly associated with recipient artery choice, with arteries other than PT and AT/DP having a higher rate (p = 0.033), and with arterial revisions (p = 0.010). Total flap failure was also associated with revision of the arterial anastomosis (p = 0.035), and partial flap failure was associated with recipient artery choice (p = 0.032). CONCLUSION Many interoperative options and techniques are available when performing microvascular lower extremity reconstruction that leads to equally high success rates. However, the use of arterial inflow outside of the posterior tibial and anterior tibial arteries leads to a higher overall complication rate and partial flap failure rate. Intraoperative revision of the arterial anastomosis portends poorly for ultimate flap survival.
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Affiliation(s)
- Joani M Christensen
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Leah Ahn
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mara Z Meulendijks
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Iskhakov
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frankie Wong
- Harvard Plastic Surgery Residency Training Program, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Winograd
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ian L Valerio
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Curtis L Cetrulo
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lydia A Helliwell
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kyle R Eberlin
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Marongiu F, Ruberto MF, Marongiu S, Mameli A, Barcellona D. Do we need more guidance on thrombophilia testing? Challenges and special considerations. Expert Rev Hematol 2024; 17:27-37. [PMID: 38228491 DOI: 10.1080/17474086.2024.2306821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/15/2024] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Thrombophilia testing (TT) is a laboratory procedure designed to detect the risk factors involved in the pathogenesis of vascular occlusions. The role of TT is also controversial because it has a limited impact on the choice and duration of antithrombotic treatments. AREAS COVERED We reviewed, by examining MEDLINE up to October 2023. Accepted and not accepted thrombophilia markers are discussed along with the appropriateness or not of prescribing TT in several conditions such as: provoked and unprovoked venous thromboembolism (VTE), women who are planning a pregnancy whose relatives had VTE or have a hereditary thrombophilia, before assumption of estro-progestins, after multiple pregnant loss, arterial thrombosis, retinal vein occlusion, and splanchnic vein thrombosis. EXPERT OPINION TT is not essential in the management of VTE, but it may be useful for limiting adverse events in case of thrombophilia. We expose our criticism of items afforded by other guidelines by presenting our opinion based on both the scientific evidence and clinical practice. We also deal with common mistakes in prescribing and interpretations of TT hoping to purpose an educational approach on this topic. Finally, we emphasize the creation of the expert in hemostasis and thrombosis who should be present in every hospital.
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Affiliation(s)
- Francesco Marongiu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Haemostasis and Thrombosis Unit, Azienda Ospedaliera Universitaria of Cagliari, Cagliari, Italy
| | - Maria Filomena Ruberto
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Silvia Marongiu
- Internal Medicine department, SS Trinità Hospital, ASL, Cagliari, Italy
| | - Antonella Mameli
- Haemostasis and Thrombosis Unit, Azienda Ospedaliera Universitaria of Cagliari, Cagliari, Italy
| | - Doris Barcellona
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Haemostasis and Thrombosis Unit, Azienda Ospedaliera Universitaria of Cagliari, Cagliari, Italy
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Goodwin TM, White CC, Wetzler A, Cincere BA. Paralabral Cyst of the Hip Causing Deep Vein Thrombosis Treated with Arthroscopic Decompression and Labral Repair. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202401000-00010. [PMID: 38265245 PMCID: PMC10807876 DOI: 10.5435/jaaosglobal-d-23-00178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/12/2023] [Indexed: 01/25/2024]
Abstract
In the setting of femoroacetabular impingement of the hip joint, paralabral cysts are well-documented sequelae. These cysts are typically associated with labral tears caused by CAM and/or pincer-type bony lesions. Synovial fluid extravasation through a tear in the labrum, similar to a popliteus cyst, leads to formation of a capsular-based cyst that is usually self-limiting. Few documented cases of these cysts causing compression of nearby neurovascular structures exist. There are several studies documenting arthroscopic decompression of these cysts, but none reporting compression of the femoral vein by a paralabral cyst resulting in deep vein thrombosis. We present the case of a large anterior paralabral cyst causing compression of the right femoral vein in a patient presenting with deep vein thrombosis and hip pain. Treatment consisted of arthroscopic decompression, followed by definitive aspiration by interventional radiology after labral repair and bipolar hip osteoplasty. The purpose of this case report was to document this rare presentation and offer learning points from our experience.
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Affiliation(s)
- Tyler M. Goodwin
- From the University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, TN (Dr. Goodwin, Dr. White, and Dr. Cincere), and the Lewis Katz School of Medicine at Temple University (Mr. Wetzler), Philadelphia, PA
| | - Charles Cody White
- From the University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, TN (Dr. Goodwin, Dr. White, and Dr. Cincere), and the Lewis Katz School of Medicine at Temple University (Mr. Wetzler), Philadelphia, PA
| | - Austin Wetzler
- From the University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, TN (Dr. Goodwin, Dr. White, and Dr. Cincere), and the Lewis Katz School of Medicine at Temple University (Mr. Wetzler), Philadelphia, PA
| | - Brandon A. Cincere
- From the University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, TN (Dr. Goodwin, Dr. White, and Dr. Cincere), and the Lewis Katz School of Medicine at Temple University (Mr. Wetzler), Philadelphia, PA
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Lippi G, Mattiuzzi C, Favaloro EJ. Recent monthly mortality for pulmonary embolism in the US. Thromb Res 2024; 233:99-100. [PMID: 38035648 DOI: 10.1016/j.thromres.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, School of Medicine, University of Verona, Verona, Italy.
| | - Camilla Mattiuzzi
- Medical Direction, Rovereto Hospital, Service of Clinical Governance and Medical Direction, Provincial Agency for Social and Sanitary Services (APSS), Trento, Italy
| | - Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia; School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia; School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
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Fu H, Hou D, Xu R, You Q, Li H, Yang Q, Wang H, Gao J, Bai D. Risk prediction models for deep venous thrombosis in patients with acute stroke: A systematic review and meta-analysis. Int J Nurs Stud 2024; 149:104623. [PMID: 37944356 DOI: 10.1016/j.ijnurstu.2023.104623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The number of risk prediction models for deep venous thrombosis (DVT) in patients with acute stroke is increasing, while the quality and applicability of these models in clinical practice and future research remain unknown. OBJECTIVE To systematically review published studies on risk prediction models for DVT in patients with acute stroke. DESIGN Systematic review and meta-analysis of observational studies. METHODS China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), SinoMed, PubMed, Web of Science, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Embase were searched from inception to November 7, 2022. Data from selected studies were extracted, including study design, data source, outcome definition, sample size, predictors, model development and performance. The Prediction Model Risk of Bias Assessment Tool (PROBAST) checklist was used to assess the risk of bias and applicability. RESULTS A total of 940 studies were retrieved, and after the selection process, nine prediction models from nine studies were included in this review. All studies utilized logistic regression to establish DVT risk prediction models. The incidence of DVT in patients with acute stroke ranged from 0.4 % to 28 %. The most frequently used predictors were D-dimer and age. The reported area under the curve (AUC) ranged from 0.70 to 0.912. All studies were found to have a high risk of bias, primarily due to inappropriate data sources and poor reporting of the analysis domain. The pooled AUC value of the five validated models was 0.76 (95 % confidence interval: 0.70-0.81), indicating a fair level of discrimination. CONCLUSION Although the included studies reported a certain level of discrimination in the prediction models of DVT in patients with acute stroke, all of them were found to have a high risk of bias according to the PROBAST checklist. Future studies should focus on developing new models with larger samples, rigorous study designs, and multicenter external validation. REGISTRATION The protocol for this study is registered with PROSPERO (registration number: CRD42022370287).
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Affiliation(s)
- Han Fu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongjiang Hou
- College of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ran Xu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qian You
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hang Li
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qing Yang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hao Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Gao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Dingxi Bai
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Tsunemitsu A, Tsutsumi T, Inokuma S, Imanaka Y. Effects of hospitalist co-management for hip fractures. J Orthop Sci 2024; 29:278-285. [PMID: 36443140 DOI: 10.1016/j.jos.2022.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/29/2022] [Accepted: 11/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early surgery is recommended for patients with hip fractures. Average time to surgery in Japan is 3.8 days. Such delay could be caused by the burden of preoperative assessment and management of geriatric comorbidities upon orthopedic surgeons. Hospitalist co-management has potential benefits in comprehensive perioperative care that could positively affect time to surgery in patients with hip fractures. We compare clinical outcomes of patients with hip fractures managed by orthopedic surgeon-led care (conventional group) vs. those of patients with hip fractures managed by hospitalist co-management. METHODS In this single-center retrospective cohort study, time to surgery was assessed with interrupted time series analyses. Whole length of hospital stay, length of hospital stay after surgery, complications during hospitalization, 30-day readmission, initiation of osteoporosis treatment and adherence to guidelines for deep vein thrombosis prophylaxis were also evaluated with Chi-square or Fisher's exact tests. RESULTS The conventional group comprised 332 patients and the co-management group 418 patients. Interrupted time series analyses revealed an immediate reduction of time to surgery by 1.2 days (95%CI, -1.9 to -0.4, P = 0.003) with the start of co-management. Whole length of hospital stay and length of hospital stay after surgery tended to be shorter, but without statistical significance. Intermediate to severe complications and 30-day readmission were not significantly different between the groups. In the co-management group, the rate of initiation of osteoporosis treatment (46.4% vs. 6.3%, P < 0.001) and adherence rate to guidelines for deep vein thrombosis prophylaxis (99.3% vs. 88%, P < 0.001) were significantly higher than those in the conventional group. CONCLUSIONS Hospitalist co-management for elderly patients with hip fractures led to significantly shorter time to surgery than conventional orthopedic surgeon-led care, and had advantages in other clinical indicators.
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Affiliation(s)
- Ayako Tsunemitsu
- Department of General Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan; Department of Healthcare Economics and Quality Management, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto 606-8501, Japan.
| | - Takahiko Tsutsumi
- Department of General Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan; Department of Healthcare Economics and Quality Management, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto 606-8501, Japan
| | - Sakiko Inokuma
- Department of General Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto 606-8501, Japan
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Tavares IR, Caffaro RA, Portugal MF, Ribeiro CM, da Silva VS, Krupa E, Nikolovski S, de Britto KF, Gomes Pereira Petisco AC, Miranda MC, Gomes de Souza Santos S, da Silva Dourado M, Siqueira PV, Siddiqui F, Fareed J, Ramacciotti E. Biomarkers Profile in Provoked Versus Unprovoked Deep Venous Thrombosis. Clin Appl Thromb Hemost 2024; 30:10760296241238211. [PMID: 38566607 PMCID: PMC10989034 DOI: 10.1177/10760296241238211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/12/2024] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), represents a substantial healthcare challenge. Provoked and unprovoked DVT cases carry distinct risks and treatment considerations. Recognizing the limitations of this classification, molecular markers may enhance diagnostic precision and guide anticoagulation therapy duration relying on patient history and risk factors. This preliminary, open-label, prospective cohort study was conducted including 15 patients (10 provoked DVT and 5 unprovoked DVT) and a control group of healthy plasmatic subjects. Plasma levels of 9 biomarkers were measured at diagnosis (baseline, day 0, and D0) and after 30 days (day 30-D30). Patient demographics, clinical data, and biomarker concentrations were analyzed. Serum concentrations of D-dimer, von Willebrand factor, C-reactive protein, and Anti-Xa were elevated in DVT groups at D0 compared to controls. No significant differences were observed between the provoked and unprovoked groups on the day of diagnosis and 30 days later. Over 30 days, the provoked group exhibited significant biomarker changes related to temporal assessment. No significant differences were noted in the biomarker profile between provoked and unprovoked DVT groups. This study is indicative of the concept of individualized thrombosis assessment and subsequent treatment for VTE. Larger cohorts are warranted to validate these findings and further define the most appropriate use of the molecular markers.
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Affiliation(s)
- Isabela Rodrigues Tavares
- Department of Vascular Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
- Dante Pazzanese Cardiology Institute, São Paulo, SP, Brazil
| | - Roberto Augusto Caffaro
- Department of Vascular Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
| | | | | | | | - Emily Krupa
- Pathology Department, Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
| | - Srdjan Nikolovski
- Pathology Department, Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
| | - Karen Falcão de Britto
- Department of Vascular Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
| | | | | | | | | | | | - Fakiha Siddiqui
- Pathology Department, Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
- Program in Health Sciences. UCAM - Universidad Católica San Antonio de Murcia, Guadalupe, Murcia, Spain
| | - Jawed Fareed
- Pathology Department, Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
| | - Eduardo Ramacciotti
- Science Valley Research Institute, Santo André, São Paulo, Brazil
- Pathology Department, Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
- Department of Cardiovascular Medicine, Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo André, São Paulo, Brazil
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Ding Y, Han B, Yuan B, Nie M, Liu R, Zhao M, Wang H. Occurrence rates and risk factors of in-hospital venous thromboembolism, major bleeding, and death in patients receiving fondaparinux after orthopedic surgery or trauma surgery. Ir J Med Sci 2023; 192:2973-2979. [PMID: 36787027 PMCID: PMC10692026 DOI: 10.1007/s11845-023-03289-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023]
Abstract
AIM Fondaparinux is a synthetic anticoagulant that inhibits thrombosis by suppressing factor Xa. The efficacy of fondaparinux for orthopedic surgeries has been revealed by several foreign studies; however, relevant evidence in Chinese patients is lacking. This study intended to investigate the occurrence rate and risk factors of in-hospital venous thromboembolism (VTE), major bleeding, and death in patients receiving fondaparinux after orthopedic surgery or trauma surgery. METHODS Totally, 1258 patients who received fondaparinux after orthopedic surgery or trauma surgery were retrospectively enrolled. Meanwhile, in-hospital VTE, major bleeding, and death were obtained for assessment. Besides, adverse events were recorded. RESULTS The occurrence rates of in-hospital VTE, major bleeding, and death were 2.5%, 21.8%, and 0.0%, respectively. The multivariate logistic regression analysis revealed that only age (> 60 years vs. ≤ 60 years) (odd ratios (OR) = 3.380, P = 0.013) was independently correlated with increased risk of in-hospital VTE. Additionally, osteoarthritis diagnosis (OR = 3.826, P < 0.001), femoral head necrosis diagnosis (OR = 1.809, P = 0.034), hip replacement (vs. internal fracture fixation) (OR = 2.199, P = 0.007), knee replacement (vs. internal fracture fixation) (OR = 2.781, P = 0.002), and serum creatinine (abnormal vs. normal) (OR = 1.677, P = 0.012) were independently linked to a higher risk of in-hospital major bleeding. Moreover, the common adverse events included pain (56.6%), wound bleeding (23.0%), increased drainage (5.2%), etc. CONCLUSION: Fondaparinux realizes low occurrence rates of in-hospital VTE and major bleeding with tolerable adverse events in patients receiving orthopedic surgery or trauma surgery.
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Affiliation(s)
- Ya Ding
- Department of Orthopedics, Anhui Spinal Deformities Clinical Medical Research Center, Fuyang People's Hospital, No. 501 Sanqing Road, Fuyang, Anhui, 236000, China
| | - Bowen Han
- Department of Orthopedics, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453000, China
| | - Bin Yuan
- Department of Orthopedics, Xinyi People's Hospital, Xuzhou, 221400, China
| | - Mingjun Nie
- Department of Orthopedics, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Renyang Liu
- Department of Orthopedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Ming Zhao
- Department of Traumatology, The Affiliated Taian City Central Hospital of Qingdao University, Taian, 271000, China
| | - Hongliang Wang
- Department of Orthopedics, Anhui Spinal Deformities Clinical Medical Research Center, Fuyang People's Hospital, No. 501 Sanqing Road, Fuyang, Anhui, 236000, China.
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Li J, Li Z, Zhu Y, Peng H, Du Z, Ru S, Wang W. Bisphenol S remodels red blood cell membrane lipids by altering plasma lipid levels, causing the risk of venous thrombosis in SD rats and zebrafish embryos. Environ Int 2023; 182:108331. [PMID: 37995390 DOI: 10.1016/j.envint.2023.108331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
Bisphenol S (BPS) is a raw material that is used extensively in various manufacturing processes but possesses a high detection rate in human red blood cells (RBCs). Accordingly, BPS is a potential toxicant in disturbing the function of RBCs and causing RBC-related diseases. To date, the effects and mechanisms of BPS-induced RBC-related diseases have not been elucidated. Here, using different models, including rats, zebrafish embryos and RBCs, the underlying mechanism of RBC-related diseases induced by BPS was explored. The accumulation of BPS in tissue was colon > kidney > liver > plasma > testicle > heart > brain in SD rats orally administered BPS (10 and 50 mg/kg bw/day) for 32 days, which was similar in both 10 mg/kg bw/day and 50 mg/kg bw/day group. Rats given BPS orally developed hyperlipidemia and increased RBC membrane cholesterol, as well as changes in RBC morphology and function. Moreover, BPS at the concentrations measured in rats plasma caused oxidative stress and phosphatidylserine exposure in vitro RBCs. These combined factors led to RBC aggregation in blood and an increasing in the number of RBCs in the blood vessels of the liver in rats. The dynamic visual observation of RBCs in vein vessels of zebrafish embryos exposed to BPS at 0, 1, 10 and 100 μg/L further found that the flow of RBCs in the tail vein is slow or even immobile, posing the risk of venous thrombosis. The present study provides new insight into the links between environmental pollutants and venous thrombosis.
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Affiliation(s)
- Jiali Li
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, China
| | - Ze Li
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, China
| | - Yaxuan Zhu
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, China
| | - Hongyuan Peng
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, China
| | - Zehui Du
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, China
| | - Shaoguo Ru
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, China.
| | - Weiwei Wang
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, China.
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Barr J, Pascarella L, Pappas TN. Richard Nixon's Left Knee and Its Impact on American History. Am Surg 2023; 89:5559-5564. [PMID: 36867122 DOI: 10.1177/00031348231161769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Richard Nixon injured his left knee in a limousine door while campaigning in North Carolina in 1960, resulting in septic arthritis that required a multi-day admission to Walter Reed Hospital. Still ill for the first presidential debate that fall, Nixon lost the contest based more on his appearance than his performance. Partly as a result of this debate, he was defeated by John F. Kennedy in the general election. Because of his leg wound, Nixon developed chronic DVTs in that limb, including a severe thrombus in 1974 that embolized to his lung, required surgery, and prevented him from testifying at the Watergate Trial. Episodes like this one highlight the value of studying the health of famous figures, where even the most minor injuries have the potential to influence world history.
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Affiliation(s)
- Justin Barr
- Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - Luigi Pascarella
- Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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Sharma S, Rizwi K, Prasad SN, Meena A. Systemic arterial to pulmonary arterial shunt masquerading as acute pulmonary embolism. BMJ Case Rep 2023; 16:e256008. [PMID: 38050385 PMCID: PMC10693879 DOI: 10.1136/bcr-2023-256008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Affiliation(s)
- Srishti Sharma
- Radiodiagnosis, All India Institute of Medical Sciences - Patna, Patna, Bihar, India
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kashif Rizwi
- Radiodiagnosis, All India Institute of Medical Sciences - Patna, Patna, Bihar, India
| | - Surya Nandan Prasad
- Radiodiagnosis, All India Institute of Medical Sciences - Patna, Patna, Bihar, India
| | - Anamika Meena
- Radiodiagnosis, All India Institute of Medical Sciences - Patna, Patna, Bihar, India
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Hoang TT, Do HD, Do HT, Nguyen CN, Alward WLM. Bilateral Blood Reflux Into Schlemm Canals Caused by a Unilateral Dural Sinus Arteriovenous Fistula in a Patient With Cerebral Venous Thrombosis. J Neuroophthalmol 2023; 43:e288-e290. [PMID: 34924532 DOI: 10.1097/wno.0000000000001419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tung Thanh Hoang
- Department of Ophthalmology (TTH, HDD), Hanoi Medical University, Hanoi, Vietnam; Ophthalmology Unit (TTH, HDD, HTD), Hanoi Medical University Hospital, Hanoi, Vietnam; Save Sight Institute (TTH), The University of Sydney School of Medicine, Sydney, Australia ; Radiology Center (CNN), Hanoi Medical University Hospital, Hanoi,Vietnam; and Department of Ophthalmology and Visual Sciences (WLMA), University of Iowa Carver College of Medicine, Iowa City, Iowa
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Jarragh A, AlAwadhi K, Shammasi A, Alloughani E, Alzamel A, Maqseed M, Lari A. Splint versus no splint after ankle fracture fixation; Results from the multi-centre post-operative ankle splint trial (PAST). Injury 2023; 54:111084. [PMID: 37832217 DOI: 10.1016/j.injury.2023.111084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/07/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND There is considerable variation in the rehabilitation of ankle fractures. Ankle fractures treated surgically are often immobilized or splinted in the early post-operative period, despite the lack of robust evidence supporting this intervention. Thus, this randomized controlled trial aims to investigate the anecdote that splinting reduces pain and oedema. METHODS A prospective multi-centre randomized controlled trial was performed in three trauma centres. Eligible patients were over 18 years of age that have sustained an isolated unilateral ankle fracture requiring surgical intervention. Patients were randomized to two groups receiving either; a plaster of Paris posterior back-slab or compressive bandage dressing. The post-operative rehabilitation protocol was standardized across both groups. Baseline demographics and fracture characteristics and classifications were analysed. Primary outcomes included; oedema measured by the figure-of-eight-20 technique and pain at multiple time points. Secondary outcomes included; the American Orthopaedic Foot and Ankle Society (AOFAS) score, satisfaction, unplanned emergency room (ER) visits and complications. RESULTS A total of 104 comparable participants were included; 54 in the non-splint group and 50 in the splint group. There was no significance difference in ankle oedema, ankle oedema compared to contralateral ankle and pain scores between the two groups (P = 0.56, P = 0.25, P = 0.39 respectively). Patient satisfaction was higher in the early postoperative period in the non-splint group (P = 0.016). The AOFAS score was not significantly different across any time point (P = 0.534). In the splint group, there was a 46% rate of splint-related complaints and complications. Unplanned ER visits occurred in 46% of the splint group and 7.4% of the non-splint group (P < 0.001). There were 2 wound infections, 1 non-union and 1 deep vein thrombosis in the splint group. There was 1 wound infection and 1 deep vein thrombosis in the no-splint group (P = 0.481) CONCLUSION: The routine use of a splint does not add any perceivable benefit to the postoperative course of an ankle fracture fixation, particularly in the reduction of oedema and postoperative pain. Another key finding is that the absence of a splint does not appear to result in higher complication rates, instead leads to higher unplanned ER visits and lower early satisfaction rates.
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Affiliation(s)
- Ali Jarragh
- Department of Orthopedic Surgery, Kuwait University, Kuwait
| | - Khaled AlAwadhi
- Department of Orthopedic Surgery, AlFarwaniya Hospital, Kuwait
| | - Ahmad Shammasi
- Department of Orthopedic Surgery, Jaber Al Ahmed Hospital, Kuwait
| | - Eisa Alloughani
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait
| | - Abdullah Alzamel
- Department of Orthopedic Surgery, Jaber Al Ahmed Hospital, Kuwait
| | - Mohammed Maqseed
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait
| | - Ali Lari
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait.
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Yang J, He QF, Fan BR, Jin YH. Inferior vena cava filter misplacement caused by the special anatomy of inferior vena cava: A case report. Asian J Surg 2023; 46:5874-5876. [PMID: 37679201 DOI: 10.1016/j.asjsur.2023.08.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023] Open
Affiliation(s)
- Jian Yang
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Qi-Fan He
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Bao-Rui Fan
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Yong-Hai Jin
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
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Griffin MM, Engel A, Mehta-Lee SS, Nusbaum J, Golpanian M, Izmirly P, Belmont HM, Buyon JP. Risk Assessment Model for Postpartum Venous Thromboembolism Prevention in Patients with Systemic Lupus Erythematosus. Am J Perinatol 2023; 40:1732-1737. [PMID: 37494484 DOI: 10.1055/s-0043-1771049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE This article assesses the application of the Royal College of Obstetricians and Gynaecologists (RCOG) venous thromboembolism (VTE) risk model on a cohort of postpartum patients with a history of systemic lupus erythematosus (SLE). STUDY DESIGN This is a secondary analysis of an ongoing patient registry of women with SLE from 2016 to 2022. There were 49 SLE patients with 55 pregnancies using the Definitions of Remission in SLE (DORIS) criteria to determine SLE disease activity. RCOG risk assessment model scoring was calculated for each patient prior to and after delivery. The primary outcome was the qualification of "active SLE" by standard rheumatologic criteria and assessment of recommendations for VTE prophylaxis based on RCOG VTE risk assessment scoring. Data were analyzed using Fisher's exact test, chi-square test, and Mann-Whitney U test with significance defined as p < 0.05. RESULTS In the study cohort, 34 pregnancies (61.8%) were in DORIS remission at delivery. Twenty-one pregnancies (38.2%) were not and scored 3 points on the RCOG VTE risk model. Of these pregnancies, only 19% (n = 4) were recommended for VTE prophylaxis by the obstetrical provider despite RCOG score ≥3. Only 35.7% (n = 5) of pregnancies in DORIS remission, but with 3 points for non-SLE-related VTE risk factors (n = 14), were recommended for VTE prophylaxis. Of the 20 pregnancies in remission with an RCOG score < 3 after assessing all risk factors, 15% (n = 3) were nevertheless recommended for VTE prophylaxis. No patients had a postpartum VTE regardless of therapy. CONCLUSION These data reveal a need to improve upon providing postpartum VTE prophylaxis to SLE patients not in remission while also recognizing a diagnosis of SLE alone should not equate with active disease. Moreover, SLE patients in remission may still warrant VTE prophylaxis if other non-SLE-related risk factors are present. KEY POINTS · Those with SLE are at increased risk for VTE postpartum.. · VTE prophylaxis should be instituted when clinically appropriate.. · Caution should be exercised in broadly assigning disease activity for SLE diagnosis only.. · This study supports VTE prophylaxis use in postpartum patients with SLE..
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Affiliation(s)
- Myah M Griffin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, New York, New York
| | - Alexis Engel
- Department of Rheumatology, NYU Langone Health/New York University Grossman School of Medicine, New York, New York
| | - Shilpi S Mehta-Lee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, New York, New York
| | - Julie Nusbaum
- Department of Rheumatology, NYU Langone Health/New York University Grossman School of Medicine, New York, New York
| | - Michael Golpanian
- Department of Rheumatology, NYU Langone Health/New York University Grossman School of Medicine, New York, New York
| | - Peter Izmirly
- Department of Rheumatology, NYU Langone Health/New York University Grossman School of Medicine, New York, New York
| | - H Michael Belmont
- Department of Rheumatology, NYU Langone Health/New York University Grossman School of Medicine, New York, New York
| | - Jill P Buyon
- Department of Rheumatology, NYU Langone Health/New York University Grossman School of Medicine, New York, New York
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Deng Y, Wang B, Liu H, Meng Y, Rong X, Wu T, Chen H, Hong Y. A Novel Intraoperative Posture-Adjustment Apparatus for Correction of Cervical Lordosis in Anterior Cervical Surgery. Orthop Surg 2023; 15:3162-3173. [PMID: 37866365 PMCID: PMC10694009 DOI: 10.1111/os.13917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVE Cervical alignment is a crucial factor related to the success of anterior cervical surgical procedures. In patients with severe spinal cord compression, a traditional neck pillow (TNP) may not adequately correct cervical position during surgery. Therefore, the aim of this study was to introduce this innovative intraoperative posture-adjustment apparatus (IPAA), and explored its clinical and radiological results in cervical angle correction against TNP in patients who had undergone anterior cervical surgery. METHODS The clinical and radiological data of 86 patients who underwent anterior cervical surgery with a minimum follow-up period of 1 year were retrospectively reviewed. Of these, 58 patients underwent IPAA, whereas 28 underwent TNP. Radiological parameters such as the degree of C2-C7 lordosis (CL), functional spinal unit angle (FSUA), C7 slope (C7S), fusion rate, and adjacent segment disease (ASD) were recorded and compared between the groups. Clinical outcomes including the Japanese Orthopaedic Association (JOA), neck disability index (NDI), visual analogue scale (VAS) for neck and arm were recorded. Complications such as kyphosis, dysphagia, Braden Scale score, revision surgery, hematoma, cerebrospinal fluid leakage, wound infection, and deep venous thrombosis were also recorded. The independent t-test or Mann-Whitney U test was used to compare continuous data, and categorical variables were assessed using the Pearson's chi-square test or Fisher's exact test. RESULTS Compared with the pre-operative data, the post-operative CL, FSUA, and C7S were significantly increased in both groups. CL, FSUA, and C7S in the IPAA group (14.44 ± 4.94°, 7.36 ± 2.91°, 16.54 ± 4.63°) were significantly higher than those in the TNP group (7.17 ± 8.19°, 4.99 ± 5.36°, 14.19 ± 4.48°; P < 0.05). Although there were no significant differences between the groups in terms of VAS arm and JOA scores, the post-operative and final follow-up NDI and VAS neck scores in the IPAA group were significantly lower than those in the TNP group (p < 0.05). At the last follow-up, the TNP group had significantly more kyphotic patients than the IPAA group (2 vs. 0, p = 0,041). There was no significant difference between the groups in terms of fusion rate, ASD, or complications such as dysphagia, Braden's Scale score, revision surgery, hematoma, cerebrospinal fluid leakage, wound infection, or deep venous thrombosis. CONCLUSION IPAA was shown to be more effective than TNP in adjusting cervical alignment (CL, FSUA, and C7S). These findings suggest that IPAA could be used as an alternative way to TNP in neck setting and cervical alignment adjustment and IPAA could potentially improve clinical outcomes after anterior cervical surgery.
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Affiliation(s)
- Yifei Deng
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Beiyu Wang
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Hao Liu
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Yang Meng
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Xin Rong
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Tingkui Wu
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Hao Chen
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Ying Hong
- Department of Anesthesiology, West China HospitalSichuan UniversityChengduChina
- Department of Operation Room, West China HospitalSichuan UniversityChengduChina
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Tsujisaka Y, Yamashita Y, Morimoto T, Takase T, Hiramori S, Kim K, Oi M, Akao M, Kobayashi Y, Chen PM, Murata K, Tsuyuki Y, Nishimoto Y, Sakamoto J, Togi K, Mabuchi H, Takabayashi K, Kato T, Ono K, Kimura T. Application of the RIETE score to identify low-risk patients with pulmonary embolism: From the COMMAND VTE Registry. Thromb Res 2023; 232:35-42. [PMID: 37922657 DOI: 10.1016/j.thromres.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/18/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The RIETE score could be specifically useful for identification of low-risk pulmonary embolism (PE) patients for home treatment. However, the external validation of the RIETE score has been limited. METHODS The COMMAND VTE Registry is a multicenter registry enrolling consecutive patients with acute symptomatic venous thromboembolism (VTE). The current study population consisted of 1479 patients with acute PE, who were divided into 2 groups; RIETE scores of 0 (N = 260) and ≥ 1 (N = 1219). RESULTS The cumulative 10-day and 30-day incidences of a composite endpoint of all-cause death, recurrent PE, or major bleeding were lower in patients with the RIETE score of 0 than in those with the RIETE score of ≥1 (10-day: 0.4 % vs. 6.7 %, P < 0.001, and 30-day: 0.4 % vs. 10.0 %, P < 0.001). The area under the receiver-operating characteristic curve (AUC) in the RIETE score for the 10-day composite endpoint showed numerically better predictive ability than that in the sPESI score (0.77 vs. 0.73, P = 0.07), and the AUC in the RIETE score for the 30-day composite endpoint showed significantly better predictive ability than that in the sPESI score (0.77 vs. 0.71, P = 0.003). CONCLUSIONS The RIETE score was well validated in the current large real-world registry. The RIETE score of 0 could identify patients with reasonably low risks of the 10-day and 30-day composite endpoint of all-cause death, recurrent PE, or major bleeding.
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Affiliation(s)
- Yuta Tsujisaka
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toru Takase
- Department of Cardiology, Kinki University Hospital, Osaka, Japan
| | - Seiichi Hiramori
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Maki Oi
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yohei Kobayashi
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Po-Min Chen
- Department of Cardiology, Osaka Saiseikai Noe Hospital, Osaka, Japan
| | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Yoshiaki Tsuyuki
- Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
| | - Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Jiro Sakamoto
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Kiyonori Togi
- Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan
| | - Hiroshi Mabuchi
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | | | - Takao Kato
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
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Gu H, Li M, Xie H, Yang F, Wang Z, Sheng L. Correlation between Serum MMP-2/-16 Levels and Inflammation in Patients with Deep Vein Thrombosis. Clin Lab 2023; 69. [PMID: 38084687 DOI: 10.7754/clin.lab.2023.230611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND The aim of the study was to clarify the correlation between serum MMP-2/-16 and inflammation in patients with deep venous thrombosis (DVT). METHODS Sixty DVT patients and 60 healthy people who underwent health examinations were collected. Serum MMP-2/-16, IL-6/-8, and TNF-α were determined by ELISA. MMP-2/-16 protein levels were detected by western blot, and IL-6/-8 and TNF-α by RT-qPCR. Correlation analysis was performed on MMP-2/-16xdd, IL-6/-8, and TNF-α in DVT patients. RESULTS MMP-2/-16, IL-6/-8, and TNF-α in DVT patients after treatment were lower than before treatment. Serum IL-6/-8 and TNF-α levels in DVT patients were both positively correlated with MMP-2/-16 levels. CONCLUSIONS MMP-2/-16 and inflammatory factors are related to DVT development, and IL-6/-8 and TNF-α are positively correlated with MMP-2/-16.
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Dymm B, Wiggins W, Smith VL, El Husseini N, Pawar S, Feng W. Teaching NeuroImage: Diffuse Midline Glioma Mimicking Edema in Cerebral Venous Thrombosis. Neurology 2023; 101:e1945-e1947. [PMID: 37652698 PMCID: PMC10663001 DOI: 10.1212/wnl.0000000000207822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/10/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Braydon Dymm
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC.
| | - Walter Wiggins
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
| | - Vanessa L Smith
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
| | - Nada El Husseini
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
| | - Swaroop Pawar
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
| | - Wuwei Feng
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
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