The controversy of managing calf vein thrombosis Masuda, Elna M., MD; Kistner, Robert L., MD; Musikasinthorn, Chayanin, MD ...
Journal of vascular surgery,
02/2012, Letnik:
55, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Background Controversy persists as to whether all calf vein thrombi should be treated with anticoagulation or observed with duplex surveillance. We performed a systematic review of the literature to ...assess whether data could support either approach, followed by examination of its natural history by stratifying results according to early clot propagation, pulmonary emboli (PE), recurrence, and postthrombotic syndrome (PTS). Methods A total of 1513 articles were reviewed that were published from January 1975 to August 2010 using computerized database searches of PubMed, Cochrane Controlled Trials Register, and extensive cross-references. English-language studies specifically examining calf deep vein thrombosis (C-DVT) defined as axial and/or muscular veins of the calf, not involving the popliteal vein, were included. Papers were independently reviewed by two investigators (E.M., F.L.) and quality graded based on nine methodologic standards reporting on four outcome parameters. Results Of the 1513 citations reviewed, 31 relevant papers meeting predefined criteria were found: six randomized controlled trials (RCT) and 25 observational cohort studies or case series. There was a single RCT directly comparing anticoagulation with no anticoagulation with compression and duplex surveillance, and they found no difference in propagation, PE, or bleeding in a low-risk population. Based on two studies of moderately strong methodology, C-DVT propagation was reduced with anticoagulation. When treatment was unassigned, moderately strong evidence suggested that about 15% propagate to the popliteal vein or higher. However, based on nonrandomized data but with moderate to high quality (level A and B studies), propagation to popliteal or higher was 8% in those with no anticoagulation treated with surveillance only. Propagation involving adjacent calf veins but remaining in the calf occured in up to one-half of all those who propagate. Major bleeding was an intended endpoint in three RCTs and was reported as 0% to 6%, with a trend toward lower bleeding risk in more recent studies. PE during surveillance in studies with unassigned treatment was strikingly lower than the historical reports of PE recorded at presentation, emphasizing the distinction that must be made between the two entities. Recurrence in C-DVT is lower than thigh DVT, and data suggest that in low-risk groups with transient risk factors, 6 weeks of anticoagulation may be sufficient, as opposed to 12 weeks. Studies of PTS reported that patients with C-DVT had fewer symptoms than their thigh DVT counterparts. Approximately one out of 10 showed symptoms of CEAP Class 4 to 6; however, C5 or C6 with healed or active ulceration were not commonly encountered. Conclusions No study of strong methodology could be found to resolve the controversy of optimal treatment of C-DVT. Given the risks of propagation, PE, and recurrence, the option of doing nothing should be considered unacceptable. In the absence of strong evidence to support anticoagulation over imaging surveillance with selective anticoagulation, either method of managing calf DVT must remain as current acceptable standards.
We report the search for a nonstandard force by measuring the Casimir forces in the 0.48-6.5 microm range. By comparing the data and the theory of the Casimir force, we have obtained constraints for ...the parameter alpha of the Yukawa-type deviations from Newtonian gravity. The obtained limits are more stringent than previous limits in the 1.0-2.9 microm range. Furthermore, we have obtained lower limits for the fundamental scale M* for gauged baryon number in the bulk. In particular, for six extra dimensions, the limits on M* are stringent in the range 6.5x10(-6)<rho<2.5x10(-4).
Objective
To assess if repeated intramuscular injections of nerve growth factor into the temporalis and masseter muscles increase mechanical sensitivity and entropy scores. Furthermore, to ...investigate if increased mechanical sensitivity would lead to increased prevalence of referred pain in the studied individuals. Finally, if increased muscle sensitization would lead to an increase in number of headache days during the experimental period.
Methods
The present double-blind, randomized placebo-controlled study recruited 16 healthy participants who were injected with nerve growth-factor, on 2 days, into the masseter and temporalis muscles and isotonic saline on the contralateral side. Mechanical sensitivity was assessed at seven different time-points (total of 21 days) by application of three different forces to 15 different sites of both muscles. Participants were asked after each force application if they experienced referred pain and were asked to keep a headache diary during the experimental period.
Results
In summary, a) repeated intramuscular injections of nerve-growth-factor caused an increase in mechanical sensitivity for the masseter but not the temporalis muscle, and an increase in entropy scores when compared to the isotonic saline side. b) Both referred pain frequency and number of headache days were not increased following nerve-growth-factor injections.
Conclusions
These findings support the idea that mechanical sensitization in the masseter and temporalis muscles differs following injections of nerve growth factor. Furthermore, referred pain and headache frequency do not seem to be related to nerve growth factor sensitization in this model. These findings support the idea that in healthy individuals referred pain may be an epiphenomenon of the muscle in response to noxious input.
Only a handful of bird species are known to use foraging tools in the wild. Amongst them, the New Caledonian crow (Corvus moneduloides) stands out with its sophisticated tool-making skills. Despite ...considerable speculation, the evolutionary origins of this species' remarkable tool behaviour remain largely unknown, not least because no naturally tool-using congeners have yet been identified that would enable informative comparisons. Here we show that another tropical corvid, the 'Alalā (C. hawaiiensis; Hawaiian crow), is a highly dexterous tool user. Although the 'Alalā became extinct in the wild in the early 2000s, and currently survives only in captivity, at least two lines of evidence suggest that tool use is part of the species' natural behavioural repertoire: juveniles develop functional tool use without training, or social input from adults; and proficient tool use is a species-wide capacity. 'Alalā and New Caledonian crows evolved in similar environments on remote tropical islands, yet are only distantly related, suggesting that their technical abilities arose convergently. This supports the idea that avian foraging tool use is facilitated by ecological conditions typical of islands, such as reduced competition for embedded prey and low predation risk. Our discovery creates exciting opportunities for comparative research on multiple tool-using and non-tool-using corvid species. Such work will in turn pave the way for replicated cross-taxonomic comparisons with the primate lineage, enabling valuable insights into the evolutionary origins of tool-using behaviour.
The aim of this study was to determine whether mef(C) and mph(G), originally found on the transferable multi‐drug plasmid pAQU1 from Photobacterium damselae subsp. damselae isolated from seawater of ...a fish farm, are responsible for conferring macrolide resistance. Since these genes are localized head‐to‐tail on pAQU1 and only four nucleotides exist between them, the single‐ and combination‐effect of these genes was examined. When mph(G) alone was introduced to Escherichia coli, the minimum inhibitory concentrations (MICs) against erythromycin, clarithromycin and azithromycin increased, whereas introduction of mef(C) alone did not influence macrolide susceptibility. Introduction of both mef(C) and mph(G) dramatically increased the MICs to the same three macrolides, i.e. >512 μg ml−1, >512 μg ml−1 and 128 μg ml−1 respectively. These results suggest that the macrolide phosphotransferase encoded by mph(G) is essential for macrolide resistance, while the efflux pump encoded by mef(C) is required for high‐level macrolide resistance. The tandem‐pair arrangements of the mef(C) and mph(G) genes were conserved on plasmids ranging in size from 240 to 350 kb of the 22 erythromycin‐resistant strains belonging to Vibrio and Photobacterium obtained from the fish farm. Sixteen of 22 plasmids ranged in size from 300 to 350 kb. This is the first report of novel macrolide resistance genes originating from a marine bacterium.
Significance and Impact of the Study
In this study, mef(C) and mph(G) were found to be novel macrolide‐resistance genes, and this is the first report of macrolide‐resistance genes originating from a marine bacterium. These genes may be responsible for previously reported cases of the emergence of erythromycin‐resistant bacteria in aquaculture sites by an unknown mechanism. The introduction of the tandem arrangement of the mef(C) and mph(G) genes in Escherichia coli increased the MICs to erythromycin, clarithromycin and azithromycin, suggesting a novel mechanism conferring high‐level macrolide resistance via combined expression of the efflux pump and macrolide phosphotransferase.
Significance and Impact of the Study: In this study, mef(C) and mph(G) were found to be novel macrolide‐resistance genes, and this is the first report of macrolide‐resistance genes originating from a marine bacterium. These genes may be responsible for previously reported cases of the emergence of erythromycin‐resistant bacteria in aquaculture sites by an unknown mechanism. The introduction of the tandem arrangement of the mef(C) and mph(G) genes in Escherichia coli increased the MICs to erythromycin, clarithromycin and azithromycin, suggesting a novel mechanism conferring high‐level macrolide resistance via combined expression of the efflux pump and macrolide phosphotransferase.
The second-generation anticoagulant rodenticide brodifacoum is an effective tool for the eradication of invasive rodents from islands and fenced sanctuaries, for biodiversity restoration. However, ...broadcast application of brodifacoum bait on islands may expose non-target wildlife in coastal marine environments to brodifacoum, with subsequent secondary exposure risk for humans if such marine wildlife is harvested for consumption. We report a case study of monitoring selected marine species following aerial application of brodifacoum bait in August 2011 to eradicate Norway rats (Rattus norvegicus) from Ulva Island, New Zealand. Residual concentrations of brodifacoum were detected in 3 of 10 species of coastal fish or shellfish sampled 43–176d after bait application commenced. Residual brodifacoum concentrations were found in liver, but not muscle tissue, of 2 of 24 samples of blue cod (0.026 and 0.092µg/g; Parapercis colias) captured live then euthanized for tissue sampling. Residual brodifacoum concentrations were also found in whole-body samples of 4 of 24 mussels (range=0.001–0.022µg/g, n=4; Mytilus edulis) and 4 of 24 limpets (range=0.001–0.016µg/g, n=4; Cellana ornata). Measured residue concentrations in all three species were assessed as unlikely to have eventually caused mortality of the sampled individuals. We also conducted a literature review and determined that in eleven previous accounts of residue examination of coastal marine species following aerial applications of brodifacoum bait, including our results from Ulva Island, the overall rate of residue detection was 5.6% for marine invertebrates (11 of 196 samples tested) and 3.1% for fish (2 of 65 samples tested). Furthermore, our results from Ulva Island are the first known detection of brodifacoum residue in fish liver following an aerial application of brodifacoum bait. Although our findings confirm the potential for coastal marine wildlife to be exposed to brodifacoum following island rodent eradications using aerial bait application, the risk of mortality to exposed individual fish or shellfish appears very low. There is also a very low risk of adverse effects on humans that consume fish or shellfish containing residual concentrations in the ranges reported here. Furthermore, any brodifacoum residues that occur in marine wildlife decline to below detectable concentrations over a period of weeks. Thus potential human exposure to brodifacoum through consumption of marine wildlife containing residual brodifacoum could be minimized by defining ‘no take’ periods for harvest following bait application and regular monitoring to confirm the absence of detectable residues in relevant marine wildlife.
•Samples of edible marine species were analysed for brodifacoum residue.•Some blue cod, limpets, and mussels had detectable residue.•Where detected in blue cod, residue was present in liver but not muscle.•Measured residues present a low risk of secondary poisoning to human consumers.
Resveratrol has various attractive bioactivities, such as prevention of cancer, neurodegenerative disorders, and obesity-related diseases. Therefore, identifying its direct binding proteins is ...expected to discover druggable targets. Sirtuin 1 and phosphodiesterases have so far been found as the direct molecular targets of resveratrol. We herein identified 11 novel resveratrol-binding proteins, including the DEAD (Asp-Glu-Ala-Asp) box helicase 5 (DDX5, also known as p68), using resveratrol-immobilized beads. Treatment with resveratrol induced degradation of DDX5 in prostate cancer cells. Depletion of DDX5 caused apoptosis by inhibiting mammalian target of rapamycin complex 1 (mTORC1) signaling. Moreover, knockdown of DDX5 attenuated the inhibitory activities of resveratrol against mTORC1 signaling and cancer cell growth. These data show that resveratrol directly targets DDX5 and induces cancer cell death by inhibiting the mTORC1 pathway.
Purpose
The aim of this study is to reveal the vascular branching variation in SFC (splenic flexure cancer) patients using the preoperative three-dimensional computed tomography angiography with ...colonography (3D-CTAC).
Methods
We retrospectively analyzed patients with SFC who underwent preoperative 3D-CTAC between January 2014 and December 2019.
Results
Among 1256 colorectal cancer (CRC) patients, 96 (7.6%) manifested SFC. The arterial branching from the superior mesenteric artery (SMA) was classified into five patterns, as follows: (type 1A) the left branch of middle colic artery (LMCA) diverged from middle colic artery (MCA) (
N
= 47, 49.0%); (2A) the LMCA diverged from the MCA and the accessory middle colic artery (AMCA) (
N
= 26, 27.1%); (3A) the LMCA independently diverged from the SMA (
N
= 16, 16.7%); (4A) the LMCA independently diverged from the SMA and AMCA (
N
= 3, 3.1%); (5A) only the AMCA and the LMCA was absent (
N
= 4, 4.1%). Venous drainage was classified into four patterns, as follows: (type 1V) the SFV flows into the inferior mesenteric vein (IMV) then back to the splenic vein (
N
= 50, 52.1%); (2V) the SFV flows into the IMV then back to the superior mesenteric vein (SMV) (
N
= 19, 19.8%); (type 3V) the SFV independently flows into the splenic vein (
N
= 3, 3.1%); (type 4V) the SFV is absent (
N
= 24, 25.0%).
Conclusion
3D-CTAC could reveal accurate preoperative tumor localization and vascular branching. These classifications should be helpful in performing accurate complete mesocolic excision and central vessel ligation for SFC.
In this paper, we propose a low-power area-efficient redundant flip-flop for soft errors, called DICE-ACFF. Its structure is based on the reliable DICE (Dual Interlocked storage CEll) and the ...low-power ACFF (Adaptive-Coupling Flip-Flop). It achieves lower power at lower data-activity. We designed DICE-FF and DICE-ACFF using 65 nm conventional bulk and thin-BOX FD-SOI (Silicon on Thin-BOX, SOTB) processes. Its area is twice as large as the conventional DFF. As for power dissipation, DICE ACFF achieves lower power than the conventional DFF below 20% data activity. When data activity is 0%, its power is half of the DFF. As for soft error rates DICE ACFFs are 1.5x better than conventional DICE FFs based on circuit-level simulations to estimate critical charge. No SEU is observed on the DICE ACFF by α-particle and neutron irradiations on the bulk and SOTB chips. From neutron irradiation results, the soft error rate of the DFF of the SOTB chip is 1/15 compared with that of the bulk chip.
Objectives Patients with critical limb ischemia (CLI) have poor overall and limb prognosis. Although nutritional status influences overall prognosis, and the Geriatric Nutritional Risk Index (GNRI) ...is a widely used, simple and well established nutritional status screening method, the association between the GNRI and the overall and limb prognosis of patients with CLI following endovascular therapy (EVT) has not been explored. Methods Clinical outcomes were retrospectively evaluated in 473 consecutive patients (74 ± 10 years; 59% male) with CLI who underwent EVT. The GNRI on admission was calculated as follows: 14.89 × albumin (g/dL) + 41.7 × (body weight/ideal body weight). Cox proportional hazard analysis was performed to explore the independent association between the GNRI and mortality and major amputation. Results Patients (53% ambulatory, 38% wheelchair bound, and 9% bedridden) were divided into two groups based on the median GNRI: the higher group (GNRI ≥ 91.2, n = 237) and the lower group (GNRI < 91.2, n = 236). Median follow up duration after EVT was 11.3 months. Three years after EVT, the survival rate (74% in the higher GNRI, and 48% in the lower GNRI, respectively), and limb salvage rate (92% in the higher GNRI, and 84% in the lower GNRI) were significantly lower in the lower GNRI group. GNRI (hazard ratio HR, 1.03; 95% confidence interval CI, 1.01–1.05), along with being wheelchair bound (HR, 1.87; 95% CI 1.17–2.97; vs. ambulatory status), being bedridden (HR, 3.10; 95% CI, 1.63–2.97; vs. ambulatory status), being on hemodialysis (HR, 2.33; 95% CI, 1.49–3.64), and having chronic heart failure (HR, 2.22; 95% CI, 1.44–3.43) were the independent predictors of mortality. The GNRI (HR, 1.04; 95% CI, 1.01–1.07), being bedridden (HR, 4.15; 95% CI, 1.67–10.3; vs. ambulatory status), isolated below knee disease (HR, 2.49; 95% CI, 1.30–4.77), and hemodialysis (HR, 2.44; 95% CI, 1.23–4.85) were independently associated with major amputation. Conclusions The GNRI on admission was independently associated with mortality and major amputation after EVT in patients with CLI.
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