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Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries. Br J Surg 2024; 111:znad370. [PMID: 38029386 PMCID: PMC10771257 DOI: 10.1093/bjs/znad370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. METHODS The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. RESULTS A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). CONCLUSION Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).
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The association between iron deficiency and outcomes: a secondary analysis of the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial. Anaesthesia 2023; 78:320-329. [PMID: 36477695 PMCID: PMC10107684 DOI: 10.1111/anae.15926] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Abstract
In the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial, the use of intravenous iron did not reduce the need for blood transfusion or reduce patient complications or length of hospital stay. As part of the trial protocol, serum was collected at randomisation and on the day of surgery. These samples were analysed in a central laboratory for markers of iron deficiency. We performed a secondary analysis to explore the potential interactions between pre-operative markers of iron deficiency and intervention status on the trial outcome measures. Absolute iron deficiency was defined as ferritin <30 μg.l-1 ; functional iron deficiency as ferritin 30-100 μg.l-1 or transferrin saturation < 20%; and the remainder as non-iron deficient. Interactions were estimated using generalised linear models that included different subgroup indicators of baseline iron status. Co-primary endpoints were blood transfusion or death and number of blood transfusions, from randomisation to 30 days postoperatively. Secondary endpoints included peri-operative change in haemoglobin, postoperative complications and length of hospital stay. Most patients had iron deficiency (369/452 [82%]) at randomisation; one-third had absolute iron deficiency (144/452 [32%]) and half had functional iron deficiency (225/452 [50%]). The change in pre-operative haemoglobin with intravenous iron compared with placebo was greatest in patients with absolute iron deficiency, mean difference 8.9 g.l-1 , 95%CI 5.3-12.5; moderate in functional iron deficiency, mean difference 2.8 g.l-1 , 95%CI -0.1 to 5.7; and with little change seen in those patients who were non-iron deficient. Subgroup analyses did not suggest that intravenous iron compared with placebo reduced the likelihood of death or blood transfusion at 30 days differentially across subgroups according to baseline ferritin (p = 0.33 for interaction), transferrin saturation (p = 0.13) or in combination (p = 0.45), or for the number of blood transfusions (p = 0.06, 0.29, and 0.39, respectively). There was no beneficial effect of the use of intravenous iron compared with placebo, regardless of the metrics to diagnose iron deficiency, on postoperative complications or length of hospital stay.
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An analytic network process model to prioritize supply chain risks in green residential megaprojects. OPERATIONS MANAGEMENT RESEARCH 2022. [PMCID: PMC9216306 DOI: 10.1007/s12063-022-00288-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Megaprojects and specifically ‘green’ construction of residential megaprojects can contain significant risks of failure. To design proper risk mitigation strategies, after identifying key risk factors, the next step is to conduct assessments that would facilitate the process of risk element prioritization. Risk assessment comprises the establishment of factor interrelation and discerning the indicators of importance. This research proposes a novel version of an integrated prioritization method and analyzes twelve all-inclusive key supply chain oriented risk factors identified in a previous study. Through a comprehensive literature review three criteria, impact, probability, and manageability are selected. Also, a fourth criterion namely influence rate is included in the model, based on the driving powers that can also be derived from the Interpretive Structural Modeling’s (ISM) assessment. Fundamentally, the calculations hinge on the Analytic Network Process (ANP) method which provides an assessment of the alternatives’ weights based on pairwise comparisons concerning the criteria specified. To enhance the accuracy of the perceptive judgments of the expert panelists, a bell-shaped fuzzy function is used to convert the verbal statements to crisp values. In addition, Row Sensitivity Analysis is administered to check the stability of the results and provide predictive scenarios. To validate the model, a case study, located in Iran, was conducted, where an expert panel consisting of four individuals made the pair-wise comparisons through an ANP questionnaire. Results indicate priority and sensitivity of the alternatives concerning criteria, for the case under study.
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Wastewater-based epidemiology in hazard forecasting and early-warning systems for global health risks. ENVIRONMENT INTERNATIONAL 2022; 161:107143. [PMID: 35176575 PMCID: PMC8842583 DOI: 10.1016/j.envint.2022.107143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 05/17/2023]
Abstract
With the advent of the SARS-CoV-2 pandemic, Wastewater-Based Epidemiology (WBE) has been applied to track community infection in cities worldwide and has proven succesful as an early warning system for identification of hotspots and changingprevalence of infections (both symptomatic and asymptomatic) at a city or sub-city level. Wastewater is only one of environmental compartments that requires consideration. In this manuscript, we have critically evaluated the knowledge-base and preparedness for building early warning systems in a rapidly urbanising world, with particular attention to Africa, which experiences rapid population growth and urbanisation. We have proposed a Digital Urban Environment Fingerprinting Platform (DUEF) - a new approach in hazard forecasting and early-warning systems for global health risks and an extension to the existing concept of smart cities. The urban environment (especially wastewater) contains a complex mixture of substances including toxic chemicals, infectious biological agents and human excretion products. DUEF assumes that these specific endo- and exogenous residues, anonymously pooled by communities' wastewater, are indicative of community-wide exposure and the resulting effects. DUEF postulates that the measurement of the substances continuously and anonymously pooled by the receiving environment (sewage, surface water, soils and air), can provide near real-time dynamic information about the quantity and type of physical, biological or chemical stressors to which the surveyed systems are exposed, and can create a risk profile on the potential effects of these exposures. Successful development and utilisation of a DUEF globally requires a tiered approach including: Stage I: network building, capacity building, stakeholder engagement as well as a conceptual model, followed by Stage II: DUEF development, Stage III: implementation, and Stage IV: management and utilization. We have identified four key pillars required for the establishment of a DUEF framework: (1) Environmental fingerprints, (2) Socioeconomic fingerprints, (3) Statistics and modelling and (4) Information systems. This manuscript critically evaluates the current knowledge base within each pillar and provides recommendations for further developments with an aim of laying grounds for successful development of global DUEF platforms.
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Results of the phase II TRAXAR study: A randomized phase II trial of axitinib and TRC105 (TRAX) versus axitinib (AX) alone in patients with advanced or metastatic renal cell carcinoma (mRCC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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P2.13-39 A Phase Ib Trial of the HSP90 Inhibitor AUY922 in Combination with Pemetrexed in Metastatic Non-Squamous, Non-Small Cell Lung Cancer Patients. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Primary Thromboprophylaxis with Heparins for Arteriovenous Fistula Failure in Pediatric Patients. J Vasc Access 2018. [DOI: 10.1177/112972980700800404] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background To reduce the incidence of early arteriovenous fistula failure (AVF) due to thrombosis in pediatric hemodialysis (HD) patients, a primary thromboprophylaxis (PTP) protocol was initiated at author's institution in June 2005. The goal of this study is to report author's experience with this protocol one year later. Methods and Results 19 AVFs (14 patients, Historical group) and 8 AVFs (7 patients, PTP group) were created prior to and after initiation of PTP respectively. PTP consisted of unfractionated heparin (5–10 units/kg/hr) infusion postoperatively, followed by subcutaneous low molecular weigh heparin (LMWH) until AVF was matured. LMWH dosing was “Prophylactic” (0.5 mg/kg/d, anti-factor Xa levels: peak 0.25–0.5 and trough < 0.3 units/mL) and “Therapeutic” (1 mg/kg/d, anti-factor Xa level: peak 0.5-1 and trough < 0.5 units/mL) based on thrombosis predisposition. In Historical group, 12 AVFs did not receive thromboprophylaxis (No-treatment group), 5 received 81 mg aspirin/day (Aspirin group), and 2 received LMWH. In No-treatment group 10/12 AVFs failed: 9 thromboses and 1 stenosis. In Aspirin group 1/5 AVFs failed due to thrombosis. In PTP group 1/8 AVFs failed due to stenosis; the first 2 AVFs developed hematoma prompting a reduction in LMWH dose and monitoring trough anti-factor Xa levels, one AVF required thrombectomy after LMWH was transiently held. The incidence of thrombosis was less in PTP group (12.5%) when comparing to No-treatment group (83%) (p < 0.05). Conclusion PTP is a feasible option to prevent early thrombosis at AVF. Close clinical and laboratory monitoring including trough anti-factor Xa levels is required to adjust optimum anticoagulation. Larger studies are needed to clarify safety and efficacy of our PTP protocol.
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[Nephrogenic syndrome of inappropriate antidiuresis: Early diagnosis avoids severe hyponatremia complications]. Arch Pediatr 2017; 24:630-633. [PMID: 28583780 DOI: 10.1016/j.arcped.2017.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/10/2017] [Accepted: 04/19/2017] [Indexed: 11/18/2022]
Abstract
AIM Nephrogenic syndrome of inappropriate antidiuresis (NSIAD) is a rare disease characterized by a kidney disability to dilute urine and, as a result, severe recurrent hyponatremia. Due to wide variability in clinical expression, the diagnosis still remains a challenge for clinicians. We report our experience of a case in which NSIAD was diagnosed early. We also stress the importance of early diagnosis and treatment, which protects an infant with NSAID from severe hyponatremia. BACKGROUND A 1-month-old boy was referred to our hospital for persistent hyponatremia and intense vomiting. He was born full term after a normal pregnancy with a normal birth weight. The parents were healthy, nonconsanguineous, of Moroccan origin. They already had healthy twin girls. The physical examination was normal upon admission with no signs of dehydration and normal weight gain since birth. Plasma sodium was very low (125mmol/L) associated with low plasma urea (5mg/dL), osmolality (258 mOsm/kg) and low natriuresis (59mmol/L). These laboratory results suggested inappropriate antidiuretic hormone secretion (SIAD) and the infant was consequently treated with oral urea (he was already receiving sodium supplements that were later stopped). Due to exclusive breastfeeding, water restriction was impossible. Further biological investigation revealed undetectable plasma arginine vasopressin (AVP), suggesting the diagnosis of NSIAD. This was confirmed by genetic sequencing of the AVP receptor (AVPR2), demonstrating the presence of an R137C mutation. CONCLUSIONS We herein report a case of a genetic fluid balance disorder due to an activating mutation of AVPR2. NSIAD is an X-linked disease, first described in 2005 by Feldman et al., which involved severe recurrent hyponatremia. The very early diagnosis (at 7 weeks of life) and appropriate treatment with urea prevented seizures and cerebral damage due to severe recurrent hyponatremia. Clinicians should consider the diagnosis of NSIAD in infants with recurrent hyponatremia with hemodilution and low AVP serum level. Genetic analysis of the AVPR2 sequence on the X chromosome will confirm the diagnosis and, given the wide variability of clinical expression, sequencing of the family members should be done.
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Cost and Efficiency of Multisite Palliative Radiation Therapy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A phase 1b dose-escalation study of TRC105 (endoglin antibody) in combination with axitinib in patients with metastatic renal cell carcinoma (mRCC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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TRAXAR study: a randomized phase 2 trial of axitinib and TRC105 versus axitinib alone in patients with advanced or metastatic renal cell carcinoma (mRCC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gesund und Fit im Kreis Olpe – Evaluation eines präventiven Ernährungs- und Bewegungskonzeptes für Kinder in Förderschulen. DAS GESUNDHEITSWESEN 2016. [DOI: 10.1055/s-0036-1578899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Can Stereotactic Ablative Radiation Therapy (SABR) Improve Patient Selection for Lung Cancer Surgery and Reduce Perioperative Mortality? Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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MRE-Netzwerk Kreis Olpe als beispielhaftes Projekt für die stationäre Versorgung im ländlichen Raum. DAS GESUNDHEITSWESEN 2015. [DOI: 10.1055/s-0035-1546912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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A Novel Technique for the Management of Reccurent Malignant Pericardial Effusions. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv053.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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The exclusion problem in seasonally forced epidemiological systems. J Theor Biol 2014; 367:49-60. [PMID: 25437346 DOI: 10.1016/j.jtbi.2014.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 10/11/2014] [Accepted: 11/13/2014] [Indexed: 11/24/2022]
Abstract
The pathogen exclusion problem is the problem of finding control measures that will exclude a pathogen from an ecological system or, if the system is already disease-free, maintain it in that state. To solve this problem we work within a holistic control theory framework which is consistent with conventional theory for simple systems (where there is no external forcing and constant controls) and seamlessly generalises to complex systems that are subject to multiple component seasonal forcing and targeted variable controls. We develop, customise and integrate a range of numerical and algebraic procedures that provide a coherent methodology powerful enough to solve the exclusion problem in the general case. An important aspect of our solution procedure is its two-stage structure which reveals the epidemiological consequences of the controls used for exclusion. This information augments technical and economic considerations in the design of an acceptable exclusion strategy. Our methodology is used in two examples to show how time-varying controls can exploit the interference and reinforcement created by the external and internal lag structure and encourage the system to 'take over' some of the exclusion effort. On-off control switching, resonant amplification, optimality and controllability are important issues that emerge in the discussion.
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A biological comparison of tarnished plant bug (Hemiptera: Miridae) populations from Mississippi's major agricultural regions. ENVIRONMENTAL ENTOMOLOGY 2014; 43:782-786. [PMID: 24690673 DOI: 10.1603/en13169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A laboratory experiment was performed to compare fitness parameters of the tarnished plant bug, Lygus lineolaris (Palisot de Beauvois), populations collected from the Hills and Delta regions of Mississippi. Each population was split into two cohorts to be reared on cotton or artificial diet to make comparisons of food source and region of collection. Each population was maintained separately and allowed to mate. Nymphal survivorship from the F1 generation of each population from each region and food source was compared. Parameters measured included development times to fourth instar, fifth instar and adult, total nymphal survivorship, fecundity, and fertility. Populations collected from the Delta region and reared on cotton developed significantly faster at all life stages than other populations. Tarnished plant bugs from the Hills reared on cotton developed significantly slower than other populations, except those from the Hills reared on artificial diet. Populations reared on diet had significantly higher survivorship than those reared on cotton. Tarnished plant bug populations from the Delta region laid significantly more eggs per female per day than those from the Hills region. Populations reared on cotton also laid significantly more eggs per female per day than those reared on diet. Populations collected in the Delta region laid significantly more viable eggs per female per day than those from the Hills region. Tarnished plant bugs reared on cotton produced significantly more nymphs per female per day than those reared on diet. These data indicate there are differences in several fitness parameters between tarnished plant bug populations from the Hills and Delta regions of Mississippi.
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P-208 * DETERMINING OPTIMAL FLUID AND AIR LEAK CUT-OFF VALUES FOR CHEST DRAIN MANAGEMENT. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gesund und Fit im Kreis Olpe – Dritte Evaluation eines präventiven Ernährungs- und Bewegungskonzeptes für Kinder in Kindertageseinrichtungen und Grundschulen. DAS GESUNDHEITSWESEN 2014. [DOI: 10.1055/s-0034-1371632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Analysis of Incidence and Risk Factors for Polyomavirus Infection after Lung Transplant. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
Objective Acute heart failure syndrome (AHFS) is a major cause of hospitalisation and imparts a substantial burden on patients and healthcare systems. Tools to define risk of AHFS hospitalisation are lacking. Methods A prospective cohort study (n=628) of patients with stable chronic heart failure (CHF) secondary to left ventricular systolic dysfunction was used to derive an AHFS prediction model which was then assessed in a prospectively recruited validation cohort (n=462). Results Within the derivation cohort, 44 (7%) patients were hospitalised as a result of AHFS during 1 year of follow-up. Predictors of AHFS hospitalisation included furosemide equivalent dose, the presence of type 2 diabetes mellitus, AHFS hospitalisation within the previous year and pulmonary congestion on chest radiograph, all assessed at baseline. A multivariable model containing these four variables exhibited good calibration (Hosmer–Lemeshow p=0.38) and discrimination (C-statistic 0.77; 95% CI 0.71 to 0.84). Using a 2.5% risk cut-off for predicted AHFS, the model defined 38.5% of patients as low risk, with negative predictive value of 99.1%; this low risk cohort exhibited <1% excess all-cause mortality per annum when compared with contemporaneous actuarial data. Within the validation cohort, an identically applied model derived comparable performance parameters (C-statistic 0.81 (95% CI 0.74 to 0.87), Hosmer–Lemeshow p=0.15, negative predictive value 100%). Conclusions A prospectively derived and validated model using simply obtained clinical data can identify patients with CHF at low risk of hospitalisation due to AHFS in the year following assessment. This may guide the design of future strategies allocating resources to the management of CHF.
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keiner angegeben. Mol Immunol 2013. [DOI: 10.1016/j.molimm.2013.05.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Denosumab and giant cell tumour of bone-a review and future management considerations. ACTA ACUST UNITED AC 2013; 20:e442-7. [PMID: 24155640 DOI: 10.3747/co.20.1497] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Giant cell tumour of bone (gctb) is one type of giant-cell-rich bone lesion characterized by the presence of numerous multinucleated osteoclast-type giant cells. Giant cells are known to express rankl (receptor activator of nuclear factor κB ligand) and are responsible for the aggressive osteolytic nature of the tumour. No available treatment option is definitively effective in curing this disease, especially in surgically unsalvageable cases. In recent years, several studies of denosumab in patients with advanced or unresectable gctb have shown objective changes in tumour composition, reduced bony destruction, and clinical benefit. Denosumab is a fully human monoclonal antibody that targets and binds with high affinity and specificity to rankl. Several large phase iii studies have shown that denosumab is more effective than bisphosphonates in reducing skeletal morbidity arising from a wide range of tumours and that it can delay bone metastasis. The relevant articles are reviewed here. The controversies related to the future use of denosumab in the treatment of gctb are discussed.
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Assessment of the purity of isolated cell populations for lineage-specific chimerism monitoring post haematopoietic stem cell transplantation. ACTA ACUST UNITED AC 2013; 82:269-75. [DOI: 10.1111/tan.12172] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 05/31/2013] [Accepted: 07/02/2013] [Indexed: 11/30/2022]
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010 QUANTIFYING THE ASSOCIATION BETWEEN MORTALITY AND CHANGE IN ACE INHIBITOR AND β-BLOCKER DOSE IN PATIENTS WITH CHRONIC HEART FAILURE: A PROSPECTIVE COHORT STUDY. BRITISH HEART JOURNAL 2013. [DOI: 10.1136/heartjnl-2013-304019.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gesund und Fit im Kreis Olpe - Zweite Evaluation eines präventiven Ernährungs- und Bewegungskonzeptes für Kinder in Kindertageseinrichtungen und Grundschulen. DAS GESUNDHEITSWESEN 2013. [DOI: 10.1055/s-0033-1337579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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High contrast x-ray speckle from atomic-scale order in liquids and glasses. PHYSICAL REVIEW LETTERS 2012; 109:185502. [PMID: 23215295 DOI: 10.1103/physrevlett.109.185502] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 06/14/2012] [Indexed: 05/20/2023]
Abstract
The availability of ultrafast pulses of coherent hard x rays from the Linac Coherent Light Source opens new opportunities for studies of atomic-scale dynamics in amorphous materials. Here, we show that single ultrafast coherent x-ray pulses can be used to observe the speckle contrast in the high-angle diffraction from liquid Ga and glassy Ni(2)Pd(2)P and B(2)O(3). We determine the thresholds above which the x-ray pulses disturb the atomic arrangements. Furthermore, high contrast speckle is observed in scattering patterns from the glasses integrated over many pulses, demonstrating that the source and optics are sufficiently stable for x-ray photon correlation spectroscopy studies of dynamics over a wide range of time scales.
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Adjunctive Use of Ezogabine/Retigabine with Either Traditional Sodium Channel Blocker or Non-Sodium Channel Blocker Antiepileptic Drugs: Evaluation of Safety and Tolerability (P06.098). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gesund und Fit im Alter im Kreis Olpe - Symposium über gesunde Ernährung im Alter und Bewegungsprogramm „Fit für 100“ als Start für neues Handlungskonzept. DAS GESUNDHEITSWESEN 2012. [DOI: 10.1055/s-0032-1307343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Calculating Reach of Evidence-Based Weight Loss and Memory Improvement Interventions Among Older Adults Attending Arkansas Senior Centers, 2008-2011. Prev Chronic Dis 2012. [DOI: 10.5888/pcd9.110141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Important differences in management policies for children with end-stage renal disease in the Netherlands and Belgium--report from the RICH-Q study. Nephrol Dial Transplant 2011; 27:1984-92. [DOI: 10.1093/ndt/gfr570] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Is measuring the wavelengths for transcutaneous bilirubin meter sufficient to detect instrument malfunction? Clin Biochem 2011. [DOI: 10.1016/j.clinbiochem.2011.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Metastatic potential and prognosis of mucinous adenocarcinoma of the endometrium. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Endovascular Repair of an Acute, Mycotic, Ascending Aortic Pseudoaneurysm. Eur J Vasc Endovasc Surg 2011; 41:488-91. [DOI: 10.1016/j.ejvs.2010.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 12/13/2010] [Indexed: 11/15/2022]
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Gesund und Fit im Kreis Olpe - Erste Evaluation eines präventiven Ernährungs- und Bewegungskonzeptes für Kinder in Kindertageseinrichtungen und Grundschulen. DAS GESUNDHEITSWESEN 2011. [DOI: 10.1055/s-0031-1274451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Transplantation tolerance induced by neonatal injection of semi-allogeneic spleen cells is associated with a pathological syndrome caused by T helper type 2 (Th2) differentiation of donor-specific CD4(+) T lymphocytes. We have shown previously that this Th2-biased response is inhibited by host CD8(+) T cells. Herein, we demonstrate that upon neonatal immunization with (A/J × BALB/c)F(1) spleen cells, BALB/c mice expand a population of CD8(+) T cells expressing both CD25 and forkhead box P3 (FoxP3) markers. In this setting, CD8(+) CD25(+) T cells predominantly produce interferon (IFN)-γ and interleukin (IL)-10 and are efficient in controlling IL-4, IL-5 and IL-13 production by donor-specific CD4(+) T cells in vitro. CD8(+) FoxP3(-) T cells are single producers of IFN-γ or IL-10, whereas CD8(+) FoxP3(+) T cells are double producers of IFN-γ and IL-10. We further demonstrate that IFN-γ and IL-10 are two major cytokines produced by CD8(+) T cells involved in the in vivo regulation of Th2-type pathology. In this setting, we conclude that neonatal alloimmunization induces the expansion of several regulatory CD8(+) T cells which may control Th2 activities via IFN-γ and IL-10.
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Using the simultaneous protocol to study equivalence class formation: the facilitating effects of nodal number and size of previously established equivalence classes. J Exp Anal Behav 2010; 67:367-89. [PMID: 16812847 PMCID: PMC1284613 DOI: 10.1901/jeab.1997.67-367] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Depressive relapse during lithium treatment associated with increased serum thyroid-stimulating hormone: results from two placebo-controlled bipolar I maintenance studies. Acta Psychiatr Scand 2009; 120:10-3. [PMID: 19183414 DOI: 10.1111/j.1600-0447.2008.01343.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the relationship between depressive relapse and change in thyroid function in an exploratory post hoc analysis from a controlled maintenance evaluation of bipolar I disorder. METHOD Mean thyroid-stimulating hormone (TSH) and outcome data were pooled from two 18-month, double-blind, placebo-controlled, maintenance studies of lamotrigine and lithium monotherapy. A post hoc analysis of 109 subjects (n = 55 lamotrigine, n = 32 lithium, n = 22 placebo) with serum TSH values at screening and either week 52 (+/-14 days) or study drop-out was conducted. RESULTS Lithium-treated subjects who required an intervention for a depressive episode had a significantly higher adjusted mean TSH level (4.4 microIU/ml) compared with lithium-treated subjects who did not require intervention for a depressive episode (2.4 microIU/ml). CONCLUSION Lithium-related changes in thyroid function are clinically relevant and should be carefully monitored in the maintenance phase of bipolar disorder to maximize mood stability and minimize the risk of subsyndromal or syndromal depressive relapse.
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Superficial myofibroblastoma of the lower female genital tract: first case report of a pregnant patient. J OBSTET GYNAECOL 2009; 28:657-8. [PMID: 19003678 DOI: 10.1080/01443610802421668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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471: Utility of Basiliximab Induction at Mid-Term Follow-Up. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Viral bioinformatics. MODERN GENOME ANNOTATION 2008. [PMCID: PMC7121286 DOI: 10.1007/978-3-211-75123-7_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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[Pediatric nephrology from the fetal kidney to the kidney graft]. REVUE MEDICALE DE BRUXELLES 2008; 29:S25-S31. [PMID: 18497217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The department of pediatric uro-nephrology was created in 1977 in Brugmann hospital. Since then, various sectors have been developed including: hemodialysis and peritoneal dialysis, kidney transplantation, urological and genital surgery, antenatal screening and rapid management of uronephropathies, treatment of voiding dysfunction and neurogenic bladder, management of tubular and glomerular diseases. The progress in genetics, medical imaging, obstetrics, neonatology and surgery has allowed us to take care of our young patients within a multidisciplinary framework. The most original contributions of the department are related to the performance of combined liver-kidney transplantation in primary hyperoxaluria, to the determination of the natural history of several congenital anomalies of the kidney and urinary tract, to the assessment of the role of genetic mutations on tubular and glomerular diseases, to the usefulness of radioisotopic tracers in the measurement of renal function in infants, and to the study of experimental tolerance of allografts. The transition of young renal patients from pediatric to adult care is actually well organized due to our 30 years experience and the excellent collaboration with the adult nephrologists.
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Identification and functional characterization of a polymorphic oestrogen response element in the human coagulation factor IX gene promoter. Br J Haematol 2007; 140:241-9. [DOI: 10.1111/j.1365-2141.2007.06912.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Primary thromboprophylaxis with heparins for arteriovenous fistula failure in pediatric patients. J Vasc Access 2007; 8:235-244. [PMID: 18161668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND To reduce the incidence of early arteriovenous fistula failure (AVF) due to thrombosis in pediatric hemodialysis (HD) patients, a primary thromboprophylaxis (PTP) protocol was initiated at author's institution in June 2005. The goal of this study is to report author's experience with this protocol one year later. METHODS AND RESULTS 19 AVFs (14 patients, Historical group) and 8 AVFs (7 patients, PTP group) were created prior to and after initiation of PTP respectively. PTP consisted of unfractionated heparin (5-10 units/kg/hr) infusion postoperatively, followed by subcutaneous low molecular weigh heparin (LMWH) until AVF was matured. LMWH dosing was 'Prophylactic' (0.5 mg/kg/d, anti-factor Xa levels: peak 0.25-0.5 and trough < 0.3 units/mL) and 'Therapeutic' (1 mg/kg/d, anti-factor Xa level: peak 0.5-1 and trough < 0.5 units/mL) based on thrombosis predisposition. In Historical group, 12 AVFs did not receive thromboprophylaxis (No-treatment group), 5 received 81 mg aspirin/day (Aspirin group), and 2 received LMWH. In No-treatment group 10/12 AVFs failed: 9 thromboses and 1 stenosis. In Aspirin group 1/5 AVFs failed due to thrombosis. In PTP group 1/8 AVFs failed due to stenosis; the first 2 AVFs developed hematoma prompting a reduction in LMWH dose and monitoring trough anti-factor Xa levels, one AVF required thrombectomy after LMWH was transiently held. The incidence of thrombosis was less in PTP group (12.5%) when comparing to No-treatment group (83%) (p < 0.05). CONCLUSION PTP is a feasible option to prevent early thrombosis at AVF. Close clinical and laboratory monitoring including trough anti-factor Xa levels is required to adjust optimum anticoagulation. Larger studies are needed to clarify safety and efficacy of our PTP protocol.
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Abstract
Intense femtosecond laser excitation can produce transient states of matter that would otherwise be inaccessible to laboratory investigation. At high excitation densities, the interatomic forces that bind solids and determine many of their properties can be substantially altered. Here, we present the detailed mapping of the carrier density-dependent interatomic potential of bismuth approaching a solid-solid phase transition. Our experiments combine stroboscopic techniques that use a high-brightness linear electron accelerator-based x-ray source with pulse-by-pulse timing reconstruction for femtosecond resolution, allowing quantitative characterization of the interatomic potential energy surface of the highly excited solid.
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Cross-protective immunity can account for the alternating epidemic pattern of dengue virus serotypes circulating in Bangkok. Proc Natl Acad Sci U S A 2006; 103:14234-9. [PMID: 16966609 PMCID: PMC1599940 DOI: 10.1073/pnas.0602768103] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Indexed: 12/16/2022] Open
Abstract
Dengue virus, the causative agent of dengue fever and its more serious manifestation dengue hemorrhagic fever, is widespread throughout tropical and subtropical regions. The virus exists as four distinct serotypes, all of which have cocirculated in Bangkok for several decades with epidemic outbreaks occurring every 8-10 years. We analyze time-series data of monthly infection incidence, revealing a distinctive pattern with epidemics of serotypes 1, 2, and 3 occurring at approximately the same time and an isolated epidemic of serotype 4 occurring in the intervening years. Phylogenetic analysis of virus samples collected over the same period shows that clade replacement events are linked to the epidemic cycle and indicates that there is an interserotypic immune reaction. Using an epidemic model with stochastic seasonal forcing showing 8- to 10-year epidemic oscillations, we demonstrate that moderate cross-protective immunity gives rise to persistent out-of-phase oscillations similar to those observed in the data, but that strong or weak cross-protection or cross-enhancement only produces in-phase patterns. This behavior suggests that the epidemic pattern observed in Bangkok is the result of cross-protective immunity and may be significantly altered by changes in the interserotypic immune reaction.
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Survivorship patterns of a large nationwide cohort of elderly veterans with colorectal cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.13525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13525 Background: Administrative databases are not designed to permit cancer researchers to readily follow patients from the period pre-diagnosis through initial curative intent treatment, adjuvant therapy, post-treatment follow-up, to either death or loss to follow-up. One major hurdle to cancer research using such databases has been the lack of data such as stage at diagnosis, and histopathologic type and grade. A second major hurdle is that many patients use more than one system of care, in this instance, Department of Veterans Affairs (VA) and Medicare-reimbursed care. These dual users would be inaccurately represented in the analysis if only one source of data were analyzed. Methods: A retrospective analysis of 13 years of nationwide Medicare and VA inpatient and institutional outpatient data beginning with the three years pre-diagnosis (1986–1990) through a minimum of five years post-diagnosis (1994–1998) was conducted. Death data were available through June 2005. Data were also extracted from tumor registry files, Computerized Patient Record System Files, and paper medical records at each VA. The population studied included all VA patients diagnosed with colorectal cancer and surgically treated for cure during the five-year period 1989–1993, who were Medicare-eligible at diagnosis, and survived the index admission. Results: Of the 6612 patients treated with curative intent during the five-year period, 4924 (74%) could be staged. Of these, 4551 (92%) were deemed eligible for the study. Of the eligible patients, 77% were diagnosed with colon cancer and 23 percent with rectal cancer. The majority (89%) had adenocarcinoma. The histopathologic grade was moderately differentiated for 54% and well differentiated for 19%. As of June 2005, 77% had died. Including all stages (0- IV), the average survival in months after treatment was 86 (median=61). Survivorship differed significantly by stage at diagnosis (p < .001). Conclusions: This rich database provides a wealth of data for subgroup analyses of survivorship, recurrence patterns, and health services utilization patterns within and across systems of care. Identifying predictors of survivorship within subgroups of this population is currently under way [Table: see text]
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