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Spiegel E, Spence AR, Czuzoj-Shulman N, Abenhaim HA. Pregnancy outcomes after thyroid cancer. J Perinat Med 2019; 47:710-716. [PMID: 31323010 DOI: 10.1515/jpm-2019-0039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 06/21/2019] [Indexed: 12/16/2022]
Abstract
Background Thyroid cancer is one of the most common cancers in women of reproductive age. Our purpose was to evaluate the association between thyroid cancer and maternal and neonatal outcomes of pregnancy. Methods We conducted a retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) database from the US. A cohort consisting of women who delivered between 1999 and 2014 was created. Multivariate logistic regression, controlling for baseline maternal characteristics, was used to compare pregnancy complications and neonatal outcomes of pregnant women with thyroid cancer [International Classification of Diseases, ninth edition (ICD-9) code 193] diagnosed before or during pregnancy with those of the obstetric population without thyroid cancer. Results The study included 14,513,587 pregnant women, of which 581 women had a diagnosis of thyroid cancer (4/100,000). During the observation period, there was an upward trend in the prevalence of thyroid cancer among pregnant women, though not statistically significant (P = 0.147). Women with thyroid cancer were more likely to be Caucasian, belong to a higher income quartile, have private insurance, to be discharged from an urban teaching hospital and to have pre-gestational hypertension. Women with thyroid cancer had a greater chance of delivering vaginally, requiring transfusion of blood and developing venous thromboembolism (VTE). Neonates of mothers with thyroid cancer were not found to be at increased risk for the adverse neonatal outcomes examined, specifically, congenital malformations, intrauterine growth restriction, fetal death and preterm labor. Conclusion Pregnancies complicated by thyroid cancer have higher incidences of VTE and need for transfusions, with comparable overall newborn outcomes.
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Affiliation(s)
- Efrat Spiegel
- Jewish General Hospital, McGill University, Obstetrics and Gynecology, Montreal, Canada
| | - Andrea R Spence
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
| | - Nicholas Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
| | - Haim Arie Abenhaim
- Jewish General Hospital, McGill University, Obstetrics and Gynecology, Montreal, Canada.,Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
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2
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Juratli MA, Menyaev YA, Sarimollaoglu M, Melerzanov AV, Nedosekin DA, Culp WC, Suen JY, Galanzha EI, Zharov VP. Noninvasive label-free detection of circulating white and red blood clots in deep vessels with a focused photoacoustic probe. BIOMEDICAL OPTICS EXPRESS 2018; 9:5667-5677. [PMID: 30460154 PMCID: PMC6238938 DOI: 10.1364/boe.9.005667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/24/2018] [Accepted: 10/04/2018] [Indexed: 05/03/2023]
Abstract
Blood clotting is a serious clinical complication of many medical procedures and disorders including surgery, catheterization, transplantation, extracorporeal circuits, infections, and cancer. This complication leads to high patient morbidity and mortality due to clot-induced pulmonary embolism, stroke, and in some cases heart attack. Despite the clear medical significance, little progress has been made in developing the methods for detection of circulating blood clots (CBCs), also called emboli. We recently demonstrated the application of in vivo photoacoustic (PA) flow cytometry (PAFC) with unfocused ultrasound transducers for detection of CBCs in small vessels in a mouse model. In the current study, we extend applicability of PAFC for detection of CBCs in relatively large (1.5-2 mm) and deep (up to 5-6 mm) blood vessels in rat and rabbit models using a high pulse rate 1064 nm laser and focused ultrasound transducer with a central hole for an optic fiber. Employing phantoms and chemical activation of clotting, we demonstrated PA identification of white, red, and mixed CBCs producing negative, positive, and mixed PA contrast in blood background, respectively. We confirmed that PAFC can detect both red and white CBCs induced by microsurgical procedures, such as a needle or catheter insertion, as well as stroke modeled by injection of artificial clots. Our results show great potential for a PAFC diagnostic platform with a wearable PA fiber probe for diagnosis of thrombosis and embolism in vivo that is impossible with existing techniques.
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Affiliation(s)
- Mazen A Juratli
- Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, 60323, Germany
| | - Yulian A Menyaev
- Arkansas Nanomedicine Center, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Mustafa Sarimollaoglu
- Arkansas Nanomedicine Center, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | | | - Dmitry A Nedosekin
- Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, 60323, Germany
| | - William C Culp
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - James Y Suen
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Ekaterina I Galanzha
- Arkansas Nanomedicine Center, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
- Laboratory of Biomedical Photoacoustics, Saratov State University, 83, Astrakhanskaya St., Saratov, 410012, Russia
| | - Vladimir P Zharov
- Arkansas Nanomedicine Center, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
- Laboratory of Biomedical Photoacoustics, Saratov State University, 83, Astrakhanskaya St., Saratov, 410012, Russia
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3
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Le Mao R, Tromeur C, Bazire A, Gouillou M, Guegan M, Lacut K, Delluc A, Mottier D, Leroyer C, Couturaud F. Risk of recurrent venous thromboembolism in COPD patients: results from a prospective cohort study. Eur Respir J 2017; 50:50/1/1700094. [PMID: 28751412 DOI: 10.1183/13993003.00094-2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/10/2017] [Indexed: 12/28/2022]
Abstract
We aimed to assess the risk of recurrent venous thromboembolism (VTE) in patients with chronic obstructive pulmonary disease (COPD) following cessation of anticoagulation therapy.In a prospective cohort of 1468 patients with a documented episode of VTE, followed for up to 5 years after cessation of anticoagulation therapy, the diagnosis of COPD was confirmed in 136. The main outcome was recurrent VTE. The secondary outcome was overall mortality. Univariate and multivariate analyses were performed to identify the risk factors of recurrence.Of the 1468 patients included, recurrent VTE was observed in 306 (34 with COPD and 272 without) during a median follow-up period of 36.5 months. The incidence rate of recurrent VTE was 9.1% (95% CI 6.5-12.8) for COPD patients and 7.0% (95% CI 6.2-7.9) for non-COPD patients. COPD was not associated with an increased risk of VTE recurrence on univariate or multivariate analyses (hazard ratio: 1.0 (95% CI 0.7-1.4)). The risk of death, adjusted for demographic and clinical characteristics, showed no increase in COPD patients, as compared to non-COPD patients.In patients with COPD who had an acute episode of VTE, the risk of recurrent VTE was not any higher than that in non-COPD patients.
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Affiliation(s)
- Raphael Le Mao
- Dept de Médecine Interne et Pneumologie, Hôpital La Cavale Blanche, Brest, France.,EA3878, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université Européenne de Bretagne, Brest, France
| | - Cécile Tromeur
- Dept de Médecine Interne et Pneumologie, Hôpital La Cavale Blanche, Brest, France.,EA3878, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université Européenne de Bretagne, Brest, France
| | - Amélie Bazire
- Dept de Médecine Interne et Pneumologie, Hôpital La Cavale Blanche, Brest, France
| | - Maelenn Gouillou
- Centre d'Investigation Clinique CIC-ISERM1412, Hôpital La Cavale Blanche, Brest, France
| | - Marie Guegan
- EA3878, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université Européenne de Bretagne, Brest, France.,Centre d'Investigation Clinique CIC-ISERM1412, Hôpital La Cavale Blanche, Brest, France
| | - Karine Lacut
- EA3878, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université Européenne de Bretagne, Brest, France.,Centre d'Investigation Clinique CIC-ISERM1412, Hôpital La Cavale Blanche, Brest, France
| | - Aurélien Delluc
- Dept de Médecine Interne et Pneumologie, Hôpital La Cavale Blanche, Brest, France.,EA3878, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université Européenne de Bretagne, Brest, France
| | - Dominique Mottier
- EA3878, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université Européenne de Bretagne, Brest, France.,Centre d'Investigation Clinique CIC-ISERM1412, Hôpital La Cavale Blanche, Brest, France
| | - Christophe Leroyer
- Dept de Médecine Interne et Pneumologie, Hôpital La Cavale Blanche, Brest, France.,EA3878, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université Européenne de Bretagne, Brest, France
| | - Francis Couturaud
- Dept de Médecine Interne et Pneumologie, Hôpital La Cavale Blanche, Brest, France .,EA3878, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université Européenne de Bretagne, Brest, France.,Centre d'Investigation Clinique CIC-ISERM1412, Hôpital La Cavale Blanche, Brest, France
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4
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Wang R, Liu R, Zhao L, Xu D, Hu L. Influence of type 2 diabetes mellitus on Khorana venous thromboembolism risk in colorectal cancer patients. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:503-509. [PMID: 28593781 DOI: 10.17235/reed.2017.4322/2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Many studies have documented the association between venous thromboembolism (VTE) and colorectal cancer (CRC). The Khorana model is a VTE risk assessment model for predicting cancer-associated thrombosis. Type 2 diabetes (T2DM) has also been reported to increase the risk of VTE. PURPOSE The aim of this study was to investigate the influence of T2DM on Khorana VTE risk in CRC patients and to explore the relationship between Khorana VTE category and CRC clinicopathological factors. METHODS This analysis included 615 CRC patients (205 with T2DM). Fibrinogen and D-dimer levels were compared within each group. A comparison was made of the proportion of patients in different Khorana VTE risk categories in CRC patients with and without T2DM. The association between Khorana VTE risk category and clinicopathological factors among all the CRC patients was evaluated. RESULTS Fibrinogen levels of CRC patients with T2DM were significantly higher than those of non-diabetes patients (4.13 ± 1.06 vs 3.94 ± 0.98, p < 0.001). A higher proportion of CRC patients with T2DM were in the Khorana intermediate-to-high risk category (H = 4.749, p = 0.029). Female sex, diabetes, colon location (compared with rectum), larger tumor size, advanced pT stage and pN stage were correlated with the intermediate-to-high Khorana VTE risk category, with odd ratios (95% confidence intervals [CI]) of 1.537 (1.064-2.220), 1.499 (1.027-2.186), 2.313 (1.588-3.370), 2.284 (1.542-3.383), 4.429 (2.088-9.396) and 1.822 (1.230-2.698), respectively. CONCLUSION T2DM increases Khorana VTE risk in CRC patients. Female sex, diabetes, colon location, large tumor size and poor stage are associated with the intermediate-to-high Khorana VTE risk category.
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Affiliation(s)
- Ruyao Wang
- Graduate School, Tianjin Medical University, People's Republic of China
| | - Rui Liu
- Department of Clinical Laboratory, Tianjin Union Medical Center, People's Republic of China
| | - Lijie Zhao
- Department of Clinical Laboratory, Tianjin Union Medical Center, People's Republic of China
| | | | - Liling Hu
- Department of Clinical Laboratory, Tianjin Union Medical Center, People's Republic of China
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5
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van der Boom T, Klein Hesselink EN, Kooistra HAM, Meijer K, van der Horst-Schrivers ANA, Lefrandt JD, Links TP. Risk factors for venous thromboembolism in patients treated for differentiated thyroid carcinoma. Endocr Relat Cancer 2017; 24:267-273. [PMID: 28476911 DOI: 10.1530/erc-17-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/03/2017] [Indexed: 11/08/2022]
Abstract
Although cancer in general is a strong risk factor for developing venous thromboembolism (VTE), the risk factors for venous thromboembolic events in patients with differentiated thyroid carcinoma (DTC) have never been assessed. This is remarkable, as several parts of the treatment comprise a hypercoagulable state that could in subgroups of DTC patients lead to an increased risk of VTE. The aim of this study was to assess which risk factors could cause DTC patients to develop VTE. We performed a nested case-control study, involving cases of DTC patients treated between 1980 and 2014 with confirmed VTE after diagnosis of DTC. Controls were defined as DTC patients without VTE. In all subjects, we collected information about thyroid cancer characteristics, treatment characteristics, traditional risk factors for VTE and additional clinical data, and we performed univariable and multivariable regression analyses. We included 28 cases and 56 controls matched for age at DTC diagnosis, sex and date of DTC diagnosis. In the univariable regression analysis, histology, distant metastases, DTC risk classification, recent surgery and other active malignancy were associated with VTE. In the multivariable analysis, distant metastases (odds ratio 7.9) and recent surgery (odds ratio 6.1) were independently associated with VTE. In conclusion, surgery and presence of distant metastases are independent risk factors for developing VTE in DTC patients. The risk factors identified in this study could be considered when making decisions regarding thromboprophylaxis for patients with thyroid cancer.
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Affiliation(s)
- Trynke van der Boom
- Department of Vascular MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen,the Netherlands
| | - Esther N Klein Hesselink
- Department of Vascular MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen,the Netherlands
| | - Hilde A M Kooistra
- Department of HematologyUniversity of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Karina Meijer
- Department of HematologyUniversity of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Joop D Lefrandt
- Department of Vascular MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Thera P Links
- Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen,the Netherlands
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6
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Fialho A, Fialho A, Schenone A, Thota P, McCullough A, Shen B. Association between small intestinal bacterial overgrowth and deep vein thrombosis. Gastroenterol Rep (Oxf) 2016; 4:299-303. [PMID: 27044499 PMCID: PMC5193062 DOI: 10.1093/gastro/gow004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/13/2016] [Indexed: 01/02/2023] Open
Abstract
Objective: Small intestinal bacterial overgrowth (SIBO) has been associated with several diseases. The association between SIBO and deep vein thrombosis (DVT) has not been investigated. This study was aimed to investigate the frequency and risk factors for the development of DVT in patients tested for SIBO. Methods: All 321 eligible patients were included from the Cleveland Clinic Gastrointestinal Motility Lab databank from January 2008 to January 2014. Patients who were evaluated with glucose hydrogen/methane breath test as well as Doppler ultrasonography for suspected DVT were included. Patients with catheter-related DVT were excluded. The primary outcomes were the frequency and risk factors (including SIBO) for DVT in this patient population. Results: Of the 321-case cohort, 144 patients (44.9%) tested positive for SIBO, and 53 (16.5%) had ultrasonographic findings of DVT. SIBO evaluation before the evaluation of DVT occurred in 201 patients (median time from the breath test to ultrasonography: 27 months; interquartile range [IQR]: 11.0–45.0 months), and SIBO evaluation after evaluation for DVT occurred in 120 patients (median time from ultrasonography to the breath test: 30 months; IQR: 11.8–54.3 months). In the univariate analysis, DVT was associated with family history of thromboembolic events (35.8% vs 16.0%, P=0.001), chronic kidney diseases (CKD; 26.4% vs 13.4%, P=0.019) and the presence of SIBO (69.8% vs 39.9%, P<0.001). In the multivariate analysis, family history of thromboembolic events (odds ratio [OR]: 3.39; 95% confidence interval [CI]: 1.67–6.87; P<0.001), CKD (OR: 2.23; 95%CI: 1.04–4.74; P = 0.037), and the presence of SIBO (OR: 3.27; 95% CI: 1.70–6.32; P < 0.001) remained independently associated with DVT. Conclusion: SIBO was found to be associated with DVT. The nature of this association warrants further investigation.
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Affiliation(s)
- Andre Fialho
- Department of Internal Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA and
| | - Andrea Fialho
- Department of Internal Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA and
| | - Aldo Schenone
- Department of Internal Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA and
| | - Prashanthi Thota
- Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Arthur McCullough
- Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bo Shen
- Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, Cleveland, OH, USA
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