Intraoperatively administered hydroxyethyl starch could be a risk indicator for postoperative acute kidney injury (AKI) in vascular surgical patients.In a single-center retrospective cohort analysis, ...we assessed the impact of hydroxyethyl starch and other risk indicators on AKI and mortality in 1095 patients undergoing elective open abdominal aneurysm repair (AAA-OR) or endovascular aortic repair (EVAR). We established logistic regression models to determine the effect of various risk indicators, including hydroxyethyl starch, on AKI, as well as Cox proportional hazard models to assess the effect on mortality.The use of intravenous hydroxyethyl starch was not associated with an increased risk of AKI or mortality. Patients undergoing EVAR were less likely to develop AKI (4% vs 18%). Multivariate risk indicators associated for AKI included suprarenal or pararenal aortic cross-clamp odds ratio (OR), 4.44; 95% confidence interval (95% CI), 2.538-7.784; P < .001 and procedure length (OR, 1.005; 95% CI, 1.003-1.007; P < .001), and favored EVAR (OR, 0.351; 95% CI, 0.118-0.654; P < .01). Main multivariate risk indicators associated with mortality included patients needing an urgent procedure hazard ratio (HR), 2.294; 95% CI, 1.541-3.413; P < .001, those with suprarenal or pararenal aortic cross-clamp (HR, 1.756; 95% CI, 1.247-2.472; P < .01), and patients undergoing EVAR (HR, 1.654; 95% CI, 1.292-2.118; P < .001).We found neither a benefit nor a negative effect of hydroxyethyl starch on the risk of AKI or mortality. Instead, other variables and comorbidities were found to be relevant for the development of postoperative AKI and survival. Nevertheless, clinicians should be aware of the high risk of postoperative AKI, particularly among those undergoing AAA-OR procedures.
The optimum duration of anticoagulant therapy after an episode of deep venous thrombosis (DVT) is controversial. Contributing to the controversy is uncertainty about whether residual venous ...thrombosis, as assessed by repeated ultrasonography over time, increases the risk for recurrent thromboembolism.
To determine the risk for recurrent thromboembolism in patients who have persistent residual thrombosis compared with patients who have early vein recanalization.
Prospective cohort study.
A university hospital in Padua, Italy.
313 consecutive symptomatic outpatients with proximal DVT who received conventional short-term anticoagulation.
Ultrasonographic assessment of the common femoral and popliteal veins was performed 3 months after acute DVT in all patients and at 6, 12, 24, and 36 months in patients found to have residual venous thrombosis. Veins were considered recanalized if they were 2.0 mm or less in diameter on a single test or 3.0 mm or less in diameter on two consecutive tests. Recurrent thromboembolism was assessed during a 6-year period.
The cumulative incidence of normal results on ultrasonography was 38.8% at 6 months, 58.1% at 12 months, 69.3% at 24 months, and 73.8% at 36 months. Of 58 recurrent episodes, 41 occurred while the patient had residual thrombosis. The hazard ratio for recurrent thromboembolism was 2.4 (95% CI, 1.3 to 4.4; P = 0.004) for patients with persistent residual thrombosis versus those with early vein recanalization.
Residual venous thrombosis is an important risk factor for recurrent thromboembolism. Ultrasonographic assessment of residual venous thrombosis may help clinicians modify the duration of anticoagulation in patients with DVT.
Summary
The pandemic from the SARS-CoV‑2 virus is currently challenging healthcare systems all over the world. Maintaining appropriate staffing and resources in healthcare facilities is essential to ...guarantee a safe working environment for healthcare personnel and safe patient care. Extracorporeal membrane oxygenation (ECMO) represents a valuable therapeutic option in patients with severe heart or lung failure. Although only a limited proportion of COVID-19 patients develop respiratory or circulatory failure that is refractory to conventional treatment, it is of utmost importance to clearly define criteria for the use of ECMO in this steadily growing patient population. The ECMO working group of the Medical University of Vienna has established the following recommendations for ECMO support in COVID-19 patients.
Since the earliest reports on catalytic benzene hydrogenation, 1,3‐cyclohexadiene and cyclohexene have been proposed as key intermediates. However, the former has never been obtained with remarkable ...selectivity. Herein, we report the first partial hydrogenation of benzene towards 1,3‐cyclohexadiene under mild conditions in a catalytic biphasic system consisting of Ru@Pt nanoparticles (NPs) in ionic liquid (IL). The tandem reduction of Ru(COD)(2‐methylallyl)2 (COD=1,5‐cyclooctadiene) followed by decomposition of Pt2(dba)3 (dba=dibenzylideneacetone) in 1‐n‐butyl‐3‐methylimidazolium hexafluorophosphate (BMI⋅PF6) IL under hydrogen affords core–shell Ru@Pt NPs of 2.9±0.2 nm. The hydrogenation of benzene (60 °C, 6 bar of H2) dissolved in n‐heptane by these bimetallic NPs in BMI⋅PF6 affords 1,3‐cyclohexadiene with an unprecedented 21 % selectivity at 5 % benzene conversion. Conversely, almost no 1,3‐cyclohexadiene was observed when using monometallic Pt0 or Ru0 NPs under the same reaction conditions and benzene conversions. This study reveals that the selectivity is related to synergetic effects of the bimetallic composition of the catalyst material as well as to the performance under biphasic reaction conditions. It is proposed that colloidal metal catalysts in ILs and under multiphase conditions (“dynamic asymmetric mixtures”) can operate far from the thermodynamic equilibrium akin to chemically active membranes.
Thermodynamically unfavored: The first partial hydrogenation of benzene to 1,3‐cyclohexadiene in a catalytic biphasic system (a “chemically active membrane‐like”) composed of Ru@Pt nanoparticles in ionic liquid is reported.
The results of a prospective cohort study on the long term clinical course of acute deep vein thrombosis is presented. Symptomatic deep vein thrombosis of the arm carries a low risk of recurrent ...thromboembolism, with post-thrombotic sequelae occurring in almost one fourth of patients within the first two years that are related to residual thrombosis and the extent of the initial thrombosis.
In patients who have symptomatic deep venous thrombosis, the long-term risk for recurrent venous thromboembolism and the incidence and severity of post-thrombotic sequelae have not been well ...documented.
To determine the clinical course of patients during the 8 years after their first episode of symptomatic deep venous thrombosis.
Prospective cohort study.
University outpatient thrombosis clinic.
355 consecutive patients with a first episode of symptomatic deep venous thrombosis.
Recurrent venous thromboembolism, the post-thrombotic syndrome, and death. Potential risk factors for these outcomes were also evaluated.
The cumulative incidence of recurrent venous thromboembolism was 17.5% after 2 years of follow-up (95% CI, 13.6% to 22.2%), 24.6% after 5 years (CI, 19.6% to 29.7%), and 30.3% after 8 years (CI, 23.6% to 37.0%). The presence of cancer and of impaired coagulation inhibition increased the risk for recurrent venous thromboembolism (hazard ratios, 1.72 CI, 1.31 to 2.25 and 1.44 CI, 1.02 to 2.01, respectively). In contrast, surgery and recent trauma or fracture were associated with a decreased risk for recurrent venous thromboembolism (hazard ratios, 0.36 CI, 0.21 to 0.62 and 0.51 CI, 0.32 to 0.87, respectively). The cumulative incidence of the post-thrombotic syndrome was 22.8% after 2 years (CI, 18.0% to 27.5%), 28.0% after 5 years (CI, 22.7% to 33.3%), and 29.1% after 8 years (CI, 23.4% to 34.7%). The development of ipsilateral recurrent deep venous thrombosis was strongly associated with the risk for the post-thrombotic syndrome (hazard ratio, 6.4; CI, 3.1 to 13.3). Survival after 8 years was 70.2% (CI, 64.7% to 75.6%). The presence of cancer increased the risk for death (hazard ratio, 8.1; CI, 3.6 to 18.1).
Patients with symptomatic deep venous thrombosis, especially those without transient risk factors for deep venous thrombosis, have a high risk for recurrent venous thromboembolism that persists for many years. The post-thrombotic syndrome occurs in almost one third of these patients and is strongly related to ipsilateral recurrent deep venous thrombosis. These findings challenge the widely adopted use of short-course anticoagulation therapy in patients with symptomatic deep venous thrombosis.
There is no consensus on the efficacy of the antithrombotic drugs available for patients with intermittent claudication.
A Medline and manual search was used to identify relevant publications. ...Uncontrolled or retrospective studies, double reports or trials without clinical outcomes were excluded. Included studies were graded as level 1 (randomised and double- or assessor-blind), level 2 (open randomised), or level 3 (non-randomised comparative). Mortality, cerebro- or cardiovascular events, amputations, arterial occlusions or number of revascularization procedures performed in the lower limbs, pain-free and total walking distance, ankle brachial index and calf blood flow, were the main outcomes considered. When feasible, end of treatment results, either continuous or binary, were combined with appropriate statistical methods.
Mortality was significantly decreased by ticlopidine compared to placebo (common odds ratio 0.68, 95% C.I., 0.49 - 0.95); clopidogrel decreased vascular events in comparison to aspirin (odds ratio 0.76, 95% C.I., 0.63 - 0.92) in level 1 studies. Arterial occlusions and the number of revascularization procedures performed were statistically significantly decreased by aspirin and ticlopidine, respectively. A small but statistically significant improvement in pain-free walking distance was determined by picotamide, indobufen, low molecular weight heparins, sulodexide and defibrotide, in small studies.
Clopidogrel and ticlopidine do reduce clinically important events in patients with intermittent claudication and could be added to the primary medical treatment of these patients. The use of aspirin in these patients cannot be based on direct evidence, but only on analogy with coronary and cerebral atherosclerosis, where it has documented efficacy. Other antithrombotic drugs were not properly evaluated in patients with intermittent claudication.
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