Summary
Background
Post‐thrombotic syndrome (PTS) is the most frequent complication of deep vein thrombosis (DVT). Its diagnosis is based on clinical characteristics. However, symptoms and signs of ...PTS are non‐specific, and could result from concomitant primary venous insufficiency (PVI) rather than DVT. This could bias evaluation of PTS.
Methods
Using data from the REVERSE multicenter study, we assessed risk factors for PTS in patients with a first unprovoked unilateral proximal DVT 5–7 months earlier who were free of clinically significant PVI (defined as absence of moderate or severe venous ectasia in the contralateral leg).
Results
Among the 328 patients considered, the prevalence of PTS was 27.1%. Obesity (odds ratio OR 2.6 95% confidence interval (CI) 1.5–4.7), mild contralateral venous ectasia (OR 2.2 95% CI 1.1–4.3), poor International Normalized Ratio (INR) control (OR per additional 1% of time with INR < 2 during anticoagulant treatment of 1.018 95% CI 1.003–1.034) and the presence of residual venous obstruction on ultrasound (OR 2.1 95% CI 1.1–3.7) significantly increased the risk for PTS in multivariable analyses. When we restricted our analysis to patients without any signs, even mild, of contralateral venous insufficiency (n = 244), the prevalence of PTS decreased slightly to 24.6%. Only obesity remained an independent predictor of PTS (OR 2.6 95% CI 1.3–5.0). Poor INR control and residual venous obstruction also increased the risk, but the results were no longer statistically significant (OR 1.017 95% CI 0.999–1.035 and OR 1.7 95% CI 0.9–3.3, respectively).
Conclusions
After a first unprovoked proximal DVT, obese patients and patients with even mild PVI constitute a group at increased risk of developing PTS for whom particular attention should be paid with respect to PTS prevention. Careful monitoring of anticoagulant treatment may prevent PTS.
The introduction of computed tomography pulmonary angiography (CTPA) has led to an increase in the incidence of pulmonary embolism (PE) diagnosis. However, the case fatality rate is lower and the ...mortality rates of PE have remained unchanged, suggesting a lower severity of illness. Specifically, the multiple‐detector CTPA increased the rate of subsegmental filling defect reported in patients with suspected PE. Whether these filling defects reported on CTPA would correlate with true subsegmental PE (SSPE) on pulmonary angiography or are actually artifacts is unknown. The inter‐observer agreement for SSPE diagnosis among radiologists with varied levels of experience is low (κ of 0.38; 95% CI, 0.0–0.89). Furthermore, the clinical importance of a symptomatic SSPE diagnosed by CTPA is unclear. SSPE are frequent on pulmonary angiography in patients with a low probability ventilation‐perfusion (V/Q) scan for suspected PE. Several prospective management cohort studies have demonstrated that patients with low or intermediate V/Q scan results can be safely managed without anticoagulation by combining the scan results with the pretest probability (PTP) of PE and compression ultrasonography. Although clinical equipoise exists, the majority of patients diagnosed with SSPE on CTPA are currently treated with anticoagulant therapy. Only a small number of patients with SSPE diagnosed by CTPA and without DVT who did not receive anticoagulation treatment have been reported in the literature. None of these patients suffered recurrent symptomatic VTE (PE or DVT) during the 3‐month follow‐up period (0%; 95% CI, 0–7.4%), suggesting that SSPE might be clinically unimportant. These conclusions are only hypothesis generating and need to be confirmed in prospective clinical management studies before changing clinical practice.
Introduction: The incidence of venous thromboembolism (VTE) in patients with multiple myeloma (MM) treated with thalidomide‐ and lenalidomide‐based regimens is high. Recent observational studies have ...suggested that thromboprophylaxis might be efficacious in decreasing the risk of VTE in this population. Purpose: To determine the absolute rates of VTE with and without different thromboprophylactic agents in patients with newly diagnosed or previously treated MM receiving thalidomide‐ or lenalidomide‐based regimens. Results: Patients with newly diagnosed MM treated with thalidomide in combination with dexamethasone have a VTE risk of 4.1 (95% CI, 2.8–5.9) per 100 patient‐cycles. Therapeutic doses of anticoagulants seem to provide the largest absolute risk reduction of VTE. The rate of VTE in patients with previously treated MM receiving thalidomide in combination with dexamethasone is 0.8 (95% CI, 0.1–2.1) per 100 patient‐months. A combination of lenalidomide and dexamethasone is associated with of risk of VTE of 0.8 (95% CI, 0.07–2.0) per 100 patient‐cycles and 0.7 (95% CI, 0.4–0.9) per 100 patient‐cycles in patients with newly diagnosed and previously treated MM, respectively. Similarly, the rates of VTE in patients also receiving thromboprophylaxis with aspirin were 0.9 (95% CI, 0.5–1.5) and 0.6 (95% CI, 0.01–2.1), respectively. Conclusion: Patients with newly diagnosed or previously treated MM receiving thalidomide‐ or lenalidomide‐based regimens in combination with dexamethasone are at high risk of VTE. The benefit of various types of thromboprophylaxis is difficult to quantify in patients with MM receiving immunomodulatory therapy, especially in those receiving lenalidomide‐based therapy or who have previously treated MM. Randomized controlled trials are needed to address this important clinical need.
Although fetal fluids, amnion (AM) and allantois (AL), have been studied at the end of pregnancy in the bitch, little is known about their composition during gestation. The aim of this study was to ...characterize and compare the biochemical parameters of fetal fluids collected from healthy pregnant bitches in mid pregnancy. Fetal fluids were collected from 26 pregnant bitches between 35 and 62 days from ovulation based on ultrasonography. A total of 149 samples were analyzed; 94 samples of known origin (61 a.m. and 33 AL) from 17 dams, which included 17 paired samples (AM and AL from the same fetus; 34 samples), and 55 of unknown origin from nine dams. Reference ranges were formulated for 22 biochemical parameters in AM and AL based on the samples of known origin (n = 94). All parameters (creatinine, albumin, GGT and urea) significantly different between AM and AL were included (by mixed model ANOVA) in the analysis and an algorithm to predict the origin of the fluid was developed (by logistic regression). Overall, of the 94 samples, 79 samples (84%) were correctly identified by the algorithm. For the 33 allantois samples, and for the 61 amnion samples, 23 (69.7%) and 56 (91.8%) were correctly identified by the algorithm, respectively. Based on the algorithm, 31 of the unknown samples (58%) were classified as amnion and 22 samples (42%), as allantois fluid. For all the unknown samples, the average certainty was 86% (compared to 81% for the samples whose fluid type was known), showing the degree of precision of the classification.
•Established biochemical reference ranges for fetal fluids in the pregnant bitch.•Determination of significant parameters that differentiate between amniotic and allantoic fluids.•Algorithm developed for predicting the origin of the fetal fluids.
This book investigates several classes of partial differential equations of real time variable and complex spatial variables, including the heat, Laplace, wave, telegraph, Burgers, ...Black–Merton–Scholes, Schrödinger and Korteweg–de Vries equations. The complexification of the spatial variable is done by two different methods. The first method is that of complexifying the spatial variable in the corresponding semigroups of operators. In this case, the solutions are studied within the context of the theory of semigroups of linear operators. It is also interesting to observe that these solutions preserve some geometric properties of the boundary function, like the univalence, starlikeness, convexity and spirallikeness. The second method is that of complexifying the spatial variable directly in the corresponding evolution equation from the real case. More precisely, the real spatial variable is replaced by a complex spatial variable in the corresponding evolution equation and then analytic and non-analytic solutions are sought.
Thromboprophylaxis for patients with non-surgical isolated lower-limb trauma requiring immobilization is a matter of debate. Our aim was to develop and validate a clinical risk- stratification model ...based on Trauma, Immobilization and Patients' characteristics (the TIP score).
The TIP score criteria and the cut-off were selected by a consensus of international experts (n = 27) using the Delphi method. Retrospective validation was performed in a population-based case-control study (MEGA study). The potential score's impact in anticoagulant treatment was assessed in a prospective single-center observational cohort study.
After four successive rounds, 30 items constituting the TIP score were selected: thirteen items for trauma, three for immobilization and 14 for patient characteristics were selected, each rated on a scale of 1 to 3. In the validation database, the TIP score had an AUC of 0·77 (95% CI 0.70 to 0.85). Using the cut-off proposed by the experts (≥5) and assuming a prevalence of 1·8%, the TIP scores had a sensitivity, specificity and negative predictive values of 89·9%, 30·7% and 99·4% respectively. In the prospective cohort, 84·2% (165/196) of all the patients concerned who presented at the emergency department had a low VTE risk not requiring thromboprophylaxis according to their TIP scores. The 3-month rate of symptomatic VTE was 1/196 95% CI 0.1-2.8 this patient was in the sub-group TIP score ≥5.
For patients with non-surgical lower-limb trauma and orthopedic immobilization, the TIP score allows an individual VTE risk-assessment and shows promising results in guiding thromboprophylaxis.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract This paper investigates the separation property in binary phase-segregation processes modelled by Cahn-Hilliard type equations with constant mobility, singular entropy densities and ...different particle interactions. Under general assumptions on the entropy potential, we prove the strict separation property in both two and three-space dimensions. Namely, in 2D, we notably extend the minimal assumptions on the potential adopted so far in the literature, by only requiring a mild growth condition of its first derivative near the singular points $\pm 1$ , without any pointwise additional assumption on its second derivative. For all cases, we provide a compact proof using De Giorgi’s iterations. In 3D, we also extend the validity of the asymptotic strict separation property to the case of fractional Cahn-Hilliard equation, as well as show the validity of the separation when the initial datum is close to an ‘energy minimizer’. Our framework offers insights into statistical factors like particle interactions, entropy choices and correlations governing separation, with broad applicability.
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