The epidemiology of venous thromboembolism Heit, John A.; Spencer, Frederick A.; White, Richard H.
Journal of thrombosis and thrombolysis,
2016/1, Letnik:
41, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Venous thromboembolism (VTE) is categorized by the U.S. Surgeon General as a major public health problem. VTE is relatively common and associated with reduced survival and substantial health-care ...costs, and recurs frequently. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and VTE risk factors, including increasing patient age and obesity, hospitalization for surgery or acute illness, nursing-home confinement, active cancer, trauma or fracture, immobility or leg paresis, superficial vein thrombosis, and, in women, pregnancy and puerperium, oral contraception, and hormone therapy. Although independent VTE risk factors and predictors of VTE recurrence have been identified, and effective primary and secondary prophylaxis is available, the occurrence of VTE seems to be relatively constant, or even increasing.
Context:
It is unclear whether endoscopic transsphenoidal surgery (ETSS) or microsurgical transsphenoidal surgery (MTS) is a superior surgical approach for pituitary adenomas.
Objective:
The ...objective of the study was to compare the outcome of surgery with ETSS and MTS by experienced pituitary surgeons using criteria of remission using current consensus criteria for acromegaly.
Design and Setting:
This was a retrospective review of prospectively recorded outcomes. The study was conducted at a tertiary referral center.
Patients, Interventions, and Outcome Measures:
Remission was defined as a normal IGF-I level and either suppressed GH less than 0.4 ng/mL during an oral glucose tolerance test or random GH less than 1.0 ng/mL. The Youden indices were calculated to determine the optimal cutoffs for using immediate postoperative GH levels to predict the results of later testing for remission.
Results:
Preoperative demographics and tumor characteristics were not significantly different between patients undergoing ETSS (72 patients) or MTS (41 patients). Overall, postoperative remission was achieved in 20 of 23 microadenomas (87%) and 59 of 90 macroadenomas (66%). Remission rates and perioperative complications were not significantly different between ETSS and MTS groups, except for self-reported sinusitis and alterations in taste or smell, which were significantly higher in patients treated with ETSS. Preoperative variables predicting remission in multivariate analysis included GH less than 45 ng/mL odds ratio (OR) 6.4, P = .010) and Knosp score of 0–2 (OR 6.8, P < .001). Postoperative in-hospital GH less than 1.15 ng/mL provided the best predictor of remission (OR 7.7, P < .001; sensitivity of 73%, specificity of 85%) defined by follow-up testing.
Conclusions:
Outcomes of transsphenoidal surgery for acromegaly by experienced pituitary surgeons do not differ between endoscopic and microscopic techniques. Regardless of the mode of resection, patients with high preoperative GH levels and Knosp scores are less likely to achieve remission. An immediate postoperative GH level of less than 1.15 ng/mL provides the best immediate predictor of remission, but long-term outcomes are indicated.
More than 41 000 water bodies are listed as impaired by the US Environmental Protection Agency under the Clean Water Act. Implementation and enforcement of regulations designed to address these ...impairments can be costly, raising questions about the value of the public benefits derived from improved surface water quality. Here, we assess the recreational value of changes in water quality using freely available geotagged photographs, taken by members of the public, as a proxy for recreational visits to lakes. We found that improved water clarity is associated with increased numbers of visits to lakes and that lake users were willing to incur greater costs to visit clearer lakes. Lake users were willing to travel 56 minutes farther (equivalent to US$22 in travel costs) for every one-meter increase in water clarity in Minnesota and Iowa lakes, when controlling for other lake attributes. Our approach demonstrates the potential for social-media data to inform social-ecological research, including assessment of the recreational benefits of improvements in water quality.
Context:
Despite the growing application of endoscopic transsphenoidal surgery (ETSS), outcomes for GH adenomas are not clearly defined.
Objective:
We reviewed our experience with ETSS with specific ...interest in remission rates using the 2010 consensus criteria, predictors of remission, and associated complications.
Design and Setting:
This was a retrospective single institution study.
Patients, Interventions, and Outcome Measures:
Sixty acromegalic patients who underwent ETSS were identified. Remission was defined as a normal IGF-I and either a suppressed GH less than 0.4 ng/ml during an oral glucose tolerance test or a random GH less than 1.0 ng/ml.
Results:
Remission was achieved in all 14 microadenomas and 28 of 46 macroadenomas (61%). Tumor size, age, gender, and history of prior surgery were not predictive on multivariant analysis. In hospital postoperative morning GH levels less than 2.5 ng/ml provided the best prediction of remission (P < 0.001). Preoperative variables predictive of remission included Knosp score (P = 0.017), IGF-I (P = 0.030), and GH (P = 0.042) levels. New endocrinopathy consisted of diabetes insipidus in 5%, adrenal insufficiency in 5.4%, and new hypogonadism in 29% of men and 17% of women. However, 41% of hypogonadal men had normal postoperative testosterone levels and 83% of amenorrheic women regained menses. The most common complaints after surgery were sinonasal (36 of 60, 60%) resolving in all but two.
Conclusions:
ETSS for GH adenomas is associated with high rates of remission and a low incidence of new endocrinopathy. Despite the panoramic views offered by the endoscope, invasive tumors continue to have lower rates of remission.
An update of the 2010 published ESUR recommendations of MRI of the sonographically indeterminate adnexal mass integrating functional techniques is provided. An algorithmic approach using sagittal T2 ...and a set of transaxial T1 and T2WI allows categorization of adnexal masses in one of the following three types according to its predominant signal characteristics. T1 'bright' masses due to fat or blood content can be simply and effectively determined using a combination of T1W, T2W and FST1W imaging. When there is concern for a solid component within such a mass, it requires additional assessment as for a complex cystic or cystic-solid mass. For low T2 solid adnexal masses, DWI is now recommended. Such masses with low DWI signal on high b value image (e.g. > b 1000 s/mm
2
) can be regarded as benign. Any other solid adnexal mass, displaying intermediate or high DWI signal, requires further assessment by contrast-enhanced (CE)T1W imaging, ideally with DCE MR, where a type 3 curve is highly predictive of malignancy. For complex cystic or cystic-solid masses, both DWI and CET1W—preferably DCE MRI—is recommended. Characteristic enhancement curves of solid components can discriminate between lesions that are highly likely malignant and highly likely benign.
Key Points
•
MRI is a useful complementary imaging technique for assessing sonographically indeterminate masses.
•
Categorization allows confident diagnosis in the majority of adnexal masses.
•
Type 3 contrast enhancement curve is a strong indicator of malignancy.
•
In sonographically indeterminate masses, complementary MRI assists in triaging patient management.
Abstract Beneficial effects of CO 2 on photosynthetic organisms will be a key driver of ecosystem change under ocean acidification. Predicting the responses of macroalgal species to ocean ...acidification is complex, but we demonstrate that the response of assemblages to elevated CO 2 are correlated with inorganic carbon physiology. We assessed abundance patterns and a proxy for CO 2 :HCO 3 − use (δ 13 C values) of macroalgae along a gradient of CO 2 at a volcanic seep, and examined how shifts in species abundance at other Mediterranean seeps are related to macroalgal inorganic carbon physiology. Five macroalgal species capable of using both HCO 3 − and CO 2 had greater CO 2 use as concentrations increased. These species (and one unable to use HCO 3 − ) increased in abundance with elevated CO 2 whereas obligate calcifying species, and non-calcareous macroalgae whose CO 2 use did not increase consistently with concentration, declined in abundance. Physiological groupings provide a mechanistic understanding that will aid us in determining which species will benefit from ocean acidification and why.
The future of Blue Carbon science Macreadie, Peter I; Anton, Andrea; Raven, John A ...
Nature communications,
09/2019, Letnik:
10, Številka:
1
Journal Article
Recenzirano
Odprti dostop
The term Blue Carbon (BC) was first coined a decade ago to describe the disproportionately large contribution of coastal vegetated ecosystems to global carbon sequestration. The role of BC in climate ...change mitigation and adaptation has now reached international prominence. To help prioritise future research, we assembled leading experts in the field to agree upon the top-ten pending questions in BC science. Understanding how climate change affects carbon accumulation in mature BC ecosystems and during their restoration was a high priority. Controversial questions included the role of carbonate and macroalgae in BC cycling, and the degree to which greenhouse gases are released following disturbance of BC ecosystems. Scientists seek improved precision of the extent of BC ecosystems; techniques to determine BC provenance; understanding of the factors that influence sequestration in BC ecosystems, with the corresponding value of BC; and the management actions that are effective in enhancing this value. Overall this overview provides a comprehensive road map for the coming decades on future research in BC science.
The object of this study was to compare surgical outcomes and complications in a contemporaneous series of patients undergoing either microscopic or endoscopic transsphenoidal surgery for ...nonfunctioning pituitary macroadenomas without imaging evidence of cavernous sinus invasion.
This is a retrospective analysis of a prospectively collected database from a single institution. Data were collected from patients whose surgery had occurred in the period from June 2010 to January 2013. Patients who underwent microscopic or endoscopic surgery for Knosp Grade 0, 1, or 2 nonfunctioning pituitary macroadenomas were included in the study. Patients who had clinically secreting or Knosp Grade 3 or 4 tumors and patients who were undergoing revision surgery were excluded from analysis. Eligible patient records were analyzed for outcomes and complications. Statistical analyses were performed on tumor volume, intraoperative factors, postoperative complications, and degree of resection on 1-year postoperative MRI. The results were used to compare the outcomes after microscopic and endoscopic approaches.
Forty-three patients underwent microscopic transsphenoidal surgery, and 56 underwent endoscopic transsphenoidal surgery. There were no statistical differences in the intraoperative extent of resection or endocrinological complications. There were significantly more intraoperative CSF leaks in the endoscopic group (58% vs 16%); however, there was no difference in the incidence of postoperative CSF rhinorrhea (12% microscopic vs 7% endoscopic). Length of hospitalization was significantly shorter in patients undergoing an endoscopic approach (3.0 days vs 2.4 days). Two-month follow-up imaging was available in 95% of patients, and 75% of patients had 1-year follow-up imaging. At 2 months postprocedure, there was no evidence of residual tumor in 79% (31 of 39) and 85% (47 of 55) of patients in the microscopic and endoscopic groups, respectively. At 1 year postprocedure, 83% (25 of 30) of patients in the microscopic group had no evidence of residual tumor and 82% (36 of 44) of those in the endoscopic group had no evidence of residual tumor.
The microscopic and endoscopic techniques provide similar outcomes in the surgical treatment of Knosp Grades 0-2 nonfunctioning pituitary macroadenomas.
– Objective: Despite a marked improvement in oral health of Australian children over the last 30 years, severe early childhood caries (S‐ECC) affects up to 17% of 2‐ to 3‐year‐old children with ...some requiring hospitalization and invasive treatment. This provided a compelling rationale to develop and test an oral health promotion programme which aimed to reduce this unnecessary suffering. The purpose of this study was to test the efficacy of an oral health promotion programme for the parents of infants, starting during the pregnancy, using a randomized controlled trial.
Methods: A programme was developed around the provision of anticipatory guidance to nulliparous women (women expecting their first child) in Adelaide. Mothers in the test group received oral health promotion information during pregnancy, and later when the child reached 6 and 12 months of age. After the second round of information the test group mothers were randomized again. The information was reinforced in one of the test subgroups through a telephone consultation. There was no contact with mothers in the control group after enrolment. At the age of 20 ± 2.5 months all test and control group children were examined by a dentist. The case definition of an incidence of S‐ECC was one or more upper incisor teeth being carious at the level of a cavitated or noncavitated lesion. The differences in S‐ECC incidence between the test and control groups, and the test subgroups were analysed.
Results: Of 649 women enroled in the programme (test group 327, control group 322), 441 had their child examined at follow‐up. The incidence of S‐ECC in the test group was 1.7% and in the control group 9.6% (P < 0.001).
Conclusion: An oral health promotion programme based on repeated rounds of anticipatory guidance initiated during the mother’s pregnancy was successful in reducing the incidence of S‐ECC in these very young children.
General Considerations...e70 Risk Assessment Using Clinical Parameters...e71 Advanced Testing: Resting and Stress Noninvasive Testing...e72 Resting Imaging to Assess Cardiac Structure and Function: ...Recommendations...e72 Stress Testing and Advanced Imaging in Patients With Known SIHD Who Require Noninvasive Testing for Risk Assessment: Recommendations...e74 Risk Assessment in Patients Able to Exercise...e74 Risk Assessment in Patients Unable to Exercise...e74 Risk Assessment Regardless of Patients' Ability to Exercise...e74 Exercise ECG...e75 Exercise Echocardiography and Exercise Nuclear MPI...e76 Dobutamine Stress Echocardiography and Pharmacological Stress Nuclear MPI...e77 Pharmacological Stress CMR Imaging...e77 Special Patient Group: Risk Assessment in Patients Who Have an Uninterpretable ECG Because of LBBB or Ventricular Pacing...e77 Prognostic Accuracy of Anatomic Testing to Assess Risk in Patients With Known CAD...e78 Coronary CT Angiography...e78 Coronary Angiography...e78 Coronary Angiography as an Initial Testing Strategy to Assess Risk: Recommendations...e78 Coronary Angiography to Assess Risk After Initial Workup With Noninvasive Testing: Recommendations...e78 Treatment...e80 Definition of Successful Treatment...e80 General Approach to Therapy...e82 Factors That Should Not Influence Treatment Decisions...e83 Assessing Patients' Quality of Life...e84 Patient Education: Recommendations...e84 Guideline-Directed Medical Therapy...e86 Risk Factor Modification: Recommendations...e86 Lipid Management...e86 Blood Pressure Management...e88 Diabetes Management...e89 Physical Activity...e91 Weight Management...e92 Smoking Cessation Counseling...e92 Management of Psychological Factors...e93 Alcohol Consumption...e94 Avoiding Exposure to Air Pollution...e94 Additional Medical Therapy to Prevent MI and Death: Recommendations...e95 Antiplatelet Therapy...e95 Beta-Blocker Therapy...e96 Renin-Angiotensin-Aldosterone Blocker Therapy...e97 Influenza Vaccination...e98 Additional Therapy to Reduce Risk of MI and Death...e99 Medical Therapy for Relief of Symptoms...e100 Use of Anti-ischemic Medications: Recommendations...e100 Alternative Therapies for Relief of Symptoms in Patients With Refractory Angina: Recommendations...e104 Enhanced External Counterpulsation...e104 Spinal Cord Stimulation...e105 Acupuncture...e105 CAD Revascularization...e106 Heart Team Approach to Revascularization Decisions: Recommendations...e106 Revascularization to Improve Survival: Recommendations...e108 Revascularization to Improve Symptoms: Recommendations...e109 CABG Versus Contemporaneous Medical Therapy...e109 PCI Versus Medical Therapy...e110 CABG Versus PCI...e110 CABG Versus Balloon Angioplasty or BMS...e110 CABG Versus DES...e111 Left Main CAD...e111 CABG or PCI Versus Medical Therapy for Left Main CAD...e111 Studies Comparing PCI Versus CABG for Left Main CAD...e111 Revascularization Considerations for Left Main CAD...e112 Proximal LAD Artery Disease...e112 Clinical Factors That May Influence the Choice of Revascularization...e113 Completeness of Revascularization...e113 LV Systolic Dysfunction...e113 Previous CABG...e113 Unstable Angina/Non-ST-Elevation Myocardial Infarction...e113 DAPT Compliance and Stent Thrombosis: Recommendation...e113 Transmyocardial Revascularization...e114 Hybrid Coronary Revascularization: Recommendations...e114 Special Considerations...e114 Women...e115 Older Adults...e115 Diabetes Mellitus...e116 Obesity...e117 Chronic Kidney Disease...e118 HIV Infection and SIHD...e118 Autoimmune Disorders...e119 Socioeconomic Factors...e119 Special Occupations...e119 Patient Follow-Up: Monitoring of Symptoms and Antianginal Therapy...e119 Clinical Evaluation, Echocardiography During Routine, Periodic Follow-Up: Recommendations...e120 Follow-Up of Patients With SIHD...e121 Focused Follow-Up Visit: Frequency...e121 Focused Follow-Up Visit: Interval History and Coexisting Conditions...e121 Focused Follow-Up Visit: Physical Examination...e122 Focused Follow-Up Visit: Resting 12-Lead ECG...e122 Focused Follow-Up Visit: Laboratory Examination...e122 Noninvasive Testing in Known SIHD...e122 Follow-Up Noninvasive Testing in Patients With Known SIHD:
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