Coagulation Alteration and Deep Vein Thrombosis in Brain Tumor Patients During the Perioperative Period.

PubMed

Guo, Xiaopeng; Zhang, Fa; Wu, Yue; Gao, Lu; Wang, Qiang; Wang, Zihao; Feng, Chenzhe; Yang, Yi; Xing, Bing; Xu, Zhiqin

2018-06-01

To explore coagulation function in patients with brain tumors before and after craniotomy and tumor resection and to analyze its correlation with deep vein thrombosis (DVT). This study enrolled 133 consecutive patients with brain tumors. Coagulation evaluation and limb venous ultrasonography were performed before and after surgery. Clinical characteristics and dynamic changes in coagulation parameters were recorded, and their correlations with DVT were analyzed. The incidence of postoperative DVT in patients with brain tumors was 10.5%. The average age of patients with DVT was older compared with patients without DVT (63.21 ± 11.21 years vs. 50.24 ± 11.95 years, P < 0.001), and the incidence of hepatitis B (21% vs. 4%, P = 0.035) was higher in patients with DVT compared with patients without DVT. D-dimer and fibrinogen were the most variable parameters during the perioperative period. In patients with DVT, D-dimer levels displayed a "zigzagging-rise" trend and were significantly higher than levels in patients without DVT. Platelet levels displayed a "first-descend-then-rise" trend and were significantly lower in patients with DVT on the second and third postoperative days. In patients with brain tumors, D-dimer and fibrinogen were elevated postoperatively, manifesting as hypercoagulability. Postoperative DVT was correlated with aging and hepatitis B. A "zigzagging-rise" trend of D-dimer and a "sharp-descent" trend of platelets in the early postoperative period might predict DVT in patients with brain tumors. Copyright © 2018 Elsevier Inc. All rights reserved.

Deep Venous Thrombosis: An Interventionalist's Approach

PubMed Central

Jenkins, J. Stephen; Michael, Paul

2014-01-01

Background Deep venous thrombosis (DVT) of the lower extremity has traditionally been anatomically categorized into proximal DVT (thrombosis involving the popliteal vein and above) and distal DVT (isolated calf vein thrombosis). Proximal DVT involving the common femoral and/or iliac veins, referred to as iliofemoral DVT (IFDVT), represents a disease process with a worse prognosis and higher risk for poor clinical outcomes compared to proximal DVT not involving the common femoral or iliac draining veins. Methods This review discusses therapeutic options for treatment of lower extremity IFDVT, including adjuvant anticoagulation and catheter-based invasive therapies; literature supporting current acute interventional techniques; and the recommendations from the recently published American Heart Association guidelines. Results Patients with IFDVT represent an opportune subset of patients for acute interventional management with currently available techniques. This subset of patients with proximal DVT has a worse prognosis, is less well studied, and benefits more from acute intervention compared to patients with proximal DVT or distal DVT. Conclusion Invasive catheter-based therapies that remove thrombus and correct venous outflow obstructions improve outcomes and morbidity in patients with IFDVT. Future trials that address IFDVT specifically will improve our understanding and the proper management of this higher-risk subset of patients with DVT. PMID:25598728

Emergency Department Management of Suspected Calf-Vein Deep Venous Thrombosis: A Diagnostic Algorithm

PubMed Central

Kitchen, Levi; Lawrence, Matthew; Speicher, Matthew; Frumkin, Kenneth

2016-01-01

Introduction Unilateral leg swelling with suspicion of deep venous thrombosis (DVT) is a common emergency department (ED) presentation. Proximal DVT (thrombus in the popliteal or femoral veins) can usually be diagnosed and treated at the initial ED encounter. When proximal DVT has been ruled out, isolated calf-vein deep venous thrombosis (IC-DVT) often remains a consideration. The current standard for the diagnosis of IC-DVT is whole-leg vascular duplex ultrasonography (WLUS), a test that is unavailable in many hospitals outside normal business hours. When WLUS is not available from the ED, recommendations for managing suspected IC-DVT vary. The objectives of the study is to use current evidence and recommendations to (1) propose a diagnostic algorithm for IC-DVT when definitive testing (WLUS) is unavailable; and (2) summarize the controversy surrounding IC-DVT treatment. Discussion The Figure combines D-dimer testing with serial CUS or a single deferred FLUS for the diagnosis of IC-DVT. Such an algorithm has the potential to safely direct the management of suspected IC-DVT when definitive testing is unavailable. Whether or not to treat diagnosed IC-DVT remains widely debated and awaiting further evidence. Conclusion When IC-DVT is not ruled out in the ED, the suggested algorithm, although not prospectively validated by a controlled study, offers an approach to diagnosis that is consistent with current data and recommendations. When IC-DVT is diagnosed, current references suggest that a decision between anticoagulation and continued follow-up outpatient testing can be based on shared decision-making. The risks of proximal progression and life-threatening embolization should be balanced against the generally more benign natural history of such thrombi, and an individual patient’s risk factors for both thrombus propagation and complications of anticoagulation. PMID:27429688

Emergency Department Management of Suspected Calf-Vein Deep Venous Thrombosis: A Diagnostic Algorithm.

PubMed

Kitchen, Levi; Lawrence, Matthew; Speicher, Matthew; Frumkin, Kenneth

2016-07-01

Unilateral leg swelling with suspicion of deep venous thrombosis (DVT) is a common emergency department (ED) presentation. Proximal DVT (thrombus in the popliteal or femoral veins) can usually be diagnosed and treated at the initial ED encounter. When proximal DVT has been ruled out, isolated calf-vein deep venous thrombosis (IC-DVT) often remains a consideration. The current standard for the diagnosis of IC-DVT is whole-leg vascular duplex ultrasonography (WLUS), a test that is unavailable in many hospitals outside normal business hours. When WLUS is not available from the ED, recommendations for managing suspected IC-DVT vary. The objectives of the study is to use current evidence and recommendations to (1) propose a diagnostic algorithm for IC-DVT when definitive testing (WLUS) is unavailable; and (2) summarize the controversy surrounding IC-DVT treatment. The Figure combines D-dimer testing with serial CUS or a single deferred FLUS for the diagnosis of IC-DVT. Such an algorithm has the potential to safely direct the management of suspected IC-DVT when definitive testing is unavailable. Whether or not to treat diagnosed IC-DVT remains widely debated and awaiting further evidence. When IC-DVT is not ruled out in the ED, the suggested algorithm, although not prospectively validated by a controlled study, offers an approach to diagnosis that is consistent with current data and recommendations. When IC-DVT is diagnosed, current references suggest that a decision between anticoagulation and continued follow-up outpatient testing can be based on shared decision-making. The risks of proximal progression and life-threatening embolization should be balanced against the generally more benign natural history of such thrombi, and an individual patient's risk factors for both thrombus propagation and complications of anticoagulation.

[Clinical features of hospitalized patients with deep venous thrombosis].

PubMed

Sun, M L; Feng, Y P; Huang, J; Wang, Y

2017-12-01

Objective: To increase the consciousness of incident deep venous thrombosis (DVT) in hospitalized patients. Methods: This is a retrospective study of hospitalized patients with DVT in Beijing Shijitan Hospital from 2007 to 2016. Clinical features of DVT patients who were admitted with no DVT were summarized. The demographic and epidemiological characteristics, involved site of veins, department of patients and risk factors were discussed. Results: A total of 5 063 patients were complicated with DVT from 305 922 inpatients who were without DVT at the admission during past 10 years. Among them, 54.36% (2 752/5 063) were men. The age of the patients was (74.1±15.9) years old (range 1-103 years) with 37.78% of them in 80 to 89 age group. The incidence of DVT in the hospital was 1.65%. It increased yearly during the past decade (from 0.50% to 2.74%), and increased with age in patients from 1 to 99 years old (7.32% in 90-99 age group). Totally, 5 204 veins were involved in the patients. Most thrombosis involved inferior vena cava system (96.54%,5 024/5 204), especially deep veins of lower extremity (83.78%,4 360/5 204), some involved portal veins (8.61%,448/5 204) and a little was found in superior venae cava (3.46%, 180/5 204). More DVT patients were in department of internal medicine than those in department of surgery (2.95% vs 0.97%, P< 0.01). ICU had the highest rate of DVT among the hospital departments (9.75%). No DVT occurred in department of newborn. Risk factors of DVT were inflammatory diseases (71.54%), age over 75 years old (67.25%), and heart diseases (58.98%). Conclusion: Sensitivity of detection on DVT should be emphasized in hospitalized patients with DVT risk, especially at the department with high incident of DVT.

Management of Venous Thromboembolisms: Part I. The Consensus for Deep Vein Thrombosis

PubMed Central

Wang, Kang-Ling; Chu, Pao-Hsien; Lee, Cheng-Han; Pai, Pei-Ying; Lin, Pao-Yen; Shyu, Kou-Gi; Chang, Wei-Tien; Chiu, Kuan-Ming; Huang, Chien-Lung; Lee, Chung-Yi; Lin, Yen-Hung; Wang, Chun-Chieh; Yen, Hsueh-Wei; Yin, Wei-Hsian; Yeh, Hung-I; Chiang, Chern-En; Lin, Shing-Jong; Yeh, San-Jou

2016-01-01

Deep vein thrombosis (DVT) is a potentially catastrophic condition because thrombosis, left untreated, can result in detrimental pulmonary embolism. Yet in the absence of thrombosis, anticoagulation increases the risk of bleeding. In the existing literature, knowledge about the epidemiology of DVT is primarily based on investigations among Caucasian populations. There has been little information available about the epidemiology of DVT in Taiwan, and it is generally believed that DVT is less common in Asian patients than in Caucasian patients. However, DVT is a multifactorial disease that represents the interaction between genetic and environmental factors, and the majority of patients with incident DVT have either inherited thrombophilia or acquired risk factors. Furthermore, DVT is often overlooked. Although symptomatic DVT commonly presents with lower extremity pain, swelling and tenderness, diagnosing DVT is a clinical challenge for physicians. Such a diagnosis of DVT requires a timely systematic assessment, including the use of the Wells score and a D-dimer test to exclude low-risk patients, and imaging modalities to confirm DVT. Compression ultrasound with high sensitivity and specificity is the front-line imaging modality in the diagnostic process for patients with suspected DVT in addition to conventional invasive contrast venography. Most patients require anticoagulation therapy, which typically consists of parenteral heparin bridged to a vitamin K antagonist, with variable duration. The development of non-vitamin K oral anticoagulants has revolutionized the landscape of venous thromboembolism treatment, with 4 agents available,including rivaroxaban, dabigatran, apixaban, and edoxaban. Presently, all 4 drugs have finished their large phase III clinical trial programs and come to the clinical uses in North America and Europe. It is encouraging to note that the published data to date regarding Asian patients indicates that such new therapies are safe and efficacious. Ultimately, our efforts to improve outcomes in patients with DVT rely on the awareness in the scientific and medical community regarding the importance of DVT. PMID:27122927

Impact of sickle cell trait on the thrombotic risk associated with non-O blood groups in northern Nigeria.

PubMed

Ahmed, Sagir G; Kagu, Modu B; Ibrahim, Umma A; Bukar, Audu A

2015-10-01

The non-O blood group is an established risk factor for deep vein thrombosis (DVT), while controversy surrounds the role of sickle cell trait (SCT) as a risk factor for DVT. We hypothesised that if SCT is a risk factor for DVT, individuals with non-O blood groups and SCT (Hb AS) would have a higher risk of DVT than their counterparts with non-O blood groups and normal haemoglobin phenotype (Hb AA). We retrospectively analysed the prevalence of SCT and non-O blood groups among 148 DVT patients with control subjects in order to determine the role of SCT as a risk factor for DVT and its impact on the risk of DVT among patients with non-O blood groups. In comparison with control subjects, DVT patients had significantly higher prevalences of SCT (35.1% vs 27.7%, p=0.04) and non-O blood groups (68.9% vs 45.9%, p=0.02). The odds ratios for DVT due to SCT, non-O blood groups with normal Hb phenotype (Hb AA) and non-O blood groups with SCT (Hb AS) were 1.3, 2.4 and 3.5, respectively. These results suggest that SCT by itself is a weak risk factor for DVT but it has the potential of escalating the DVT risk among patients with non-O blood groups. The combined effects of elevated clotting factors (non-O group effect) and increased clotting factor activation (SCT effect) were responsible for the escalated DVT risk among patients with co-inheritance of non-O blood groups and SCT. Co-inheritance of SCT and non-O blood group is, therefore, an important mixed risk factor for DVT. This should be taken into account when assessing DVT risk profiles of patients in Africa and other parts of the world where the SCT is prevalent.

Global upper ocean heat storage response to radiative forcing from changing solar irradiance and increasing greenhouse gas/aerosol concentrations

NASA Astrophysics Data System (ADS)

White, Warren B.; Cayan, Daniel R.; Lean, Judith

1998-09-01

We constructed gridded fields of diabatic heat storage changes in the upper ocean from 20°S to 60°N from historical temperature profiles collected from 1955 to 1996. We filtered these 42 year records for periods of 8 to 15 years and 15 to 30 years, producing depth-weighted vertical average temperature (DVT) changes from the sea surface to the top of the main pycnocline. Basin and global averages of these DVT changes reveal decadal and interdecadal variability in phase across the Indian, Pacific, Atlantic, and Global Oceans, each significantly correlated with changing surface solar radiative forcing at a lag of 0+/-2 years. Decadal and interdecadal changes in global average DVT are 0.06°+/-0.01°K and 0.04°K+/-0.01°K, respectively, the same as those expected from consideration of the Stefan-Boltzmann radiation balance (i.e., 0.3°K per Wm-2) in response to 0.1% changes in surface solar radiative forcing of 0.2 Wm-2 and 0.15 Wm-2, respectively. Global spatial patterns of DVT changes are similar to temperature changes simulated in coupled ocean-atmosphere models, suggesting that natural modes of Earth's variability are phase-locked to the solar irradiance cycle. A trend in global average DVT of 0.15°K over this 42 year record cannot be explained by changing surface solar radiative forcing. But when we consider the 0.5 Wm-2 increase in surface radiative forcing estimated from the increase in atmospheric greenhouse gas and aerosol (GGA) concentrations over this period [Intergovernmental Panel on Climate Change, 1995], the Stefan-Boltzmann radiation balance yields this observed change. Moreover, the sum of solar and GGA surface radiative forcing can explain the relatively sharp increase in global and basin average DVT in the late 1970's.

[Meta-analysis on randomized trials comparing the results of low-molecular weight heparins to those of fractioned heparins in the prevention of deep venous thrombosis].

PubMed

Daures, J P; Schved, J F; Momas, I; Gril, J C; Azoulay, P; Gremy, F

1989-01-01

The main reason for using low molecular weight heparin (LMWH) is its capacity to keep the antithrombotic effect of standard non-fractioned heparin (NFH) while reducing its hemorrhagic power. Various studies comparing LMWH to NFH gave contradictory results, so we carried out a meta-analysis of randomized trials comparing these two treatments in prevention of deep-vein thrombosis (DVT) (and in prevention of deep-vein thrombosis or pulmonary embolism). From a selection of ten trials we could not show any significant difference in the DVT rates, as well as for the whole of surgical indications as for the subgroups of abdominal and orthopedic surgery. The weighted global difference between the DVT rates is so low that, in spite of the use of meta-analysis, the power is clearly insufficient. The hemorrhagic risk is not statistically reduced as well for the whole of surgical indications as for the subgroups.

Risk factors for deep venous thrombosis in women with ovarian cancer

PubMed Central

Ebina, Yasuhiko; Uchiyama, Mihoko; Imafuku, Hitomi; Suzuki, Kaho; Miyahara, Yoshiya; Yamada, Hideto

2018-01-01

Abstract We aim to clarify the incidence of deep venous thrombosis (DVT) before treatment in women with ovarian cancer and identify risk factors for DVT. In this prospective study, 110 women underwent venous ultrasonography before cancer treatment and D-dimer levels were measured. We investigated factors predicting DVT by logistic regression. DVT was detected in 25 of 110 women (22.7%) and pulmonary thromboembolism was coexisted in 2 women (1.8%). A total of 21 women (84.4%) with DVT were asymptomatic. D-dimer levels in women with DVT (median, 10.9; range, <0.5–98.2 μg/mL) were significantly higher than those in women without DVT (2.0; <0.5–60.8 μg/mL; P < .01). When 10.9 μg/mL was used as a cutoff value for D-dimer levels to predict DVT, specificity, sensitivity, and positive and negative predictive values were 92.9%, 52.0%, 68.4%, and 86.8%, respectively. The multivariate analysis demonstrated that D-dimer level (odds ratio [OR], 19.7; 95% confidence interval [CI], 5.89–76.76) and clear cell histology (OR, 7.1; 95% CI, 2.12–25.67) were independent factors predicting DVT. Asymptomatic DVT occurred with great frequency before treatment in patients with ovarian cancer. High D-dimer level and clear cell pathology is associated with a higher DVT risk. PMID:29879062

The hidden risk of deep vein thrombosis--the need for risk factor assessment: case reviews.

PubMed

Race, Tara Kay; Collier, Paul E

2007-01-01

Deep vein thrombosis (DVT) is a very serious, potentially fatal, and very preventable medical condition. It is important for all patients admitted to the hospital to be screened for the risk of developing a DVT. This could be easily accomplished by performing a risk factor assessment-screening tool on all patients. It is also important to educate the medical and nursing staff on the fact that all patients are at risk for developing DVT, not just surgical patients who are often believed to be at the highest risk of DVT. The implementation of the risk factor assessment could potentially save lives and reduce the hospital costs of treating and managing the complications of DVT and venous thromboembolic disease. The cases chosen for review in this article will demonstrate many risk factors that often go overlooked in nonsurgical patients. The implementation of a risk factor assessment tool could potentially aid in the recognition and appropriate prophylaxis of those patients who are at extremely high risk for DVT. Without appropriate recognition of the risk for DVT, patients may be placed at risk for DVT and the potentially fatal and/or debilitating complications associated with the development of DVT.

Monocytes, neutrophils, and platelets cooperate to initiate and propagate venous thrombosis in mice in vivo.

PubMed

von Brühl, Marie-Luise; Stark, Konstantin; Steinhart, Alexander; Chandraratne, Sue; Konrad, Ildiko; Lorenz, Michael; Khandoga, Alexander; Tirniceriu, Anca; Coletti, Raffaele; Köllnberger, Maria; Byrne, Robert A; Laitinen, Iina; Walch, Axel; Brill, Alexander; Pfeiler, Susanne; Manukyan, Davit; Braun, Siegmund; Lange, Philipp; Riegger, Julia; Ware, Jerry; Eckart, Annekathrin; Haidari, Selgai; Rudelius, Martina; Schulz, Christian; Echtler, Katrin; Brinkmann, Volker; Schwaiger, Markus; Preissner, Klaus T; Wagner, Denisa D; Mackman, Nigel; Engelmann, Bernd; Massberg, Steffen

2012-04-09

Deep vein thrombosis (DVT) is a major cause of cardiovascular death. The sequence of events that promote DVT remains obscure, largely as a result of the lack of an appropriate rodent model. We describe a novel mouse model of DVT which reproduces a frequent trigger and resembles the time course, histological features, and clinical presentation of DVT in humans. We demonstrate by intravital two-photon and epifluorescence microscopy that blood monocytes and neutrophils crawling along and adhering to the venous endothelium provide the initiating stimulus for DVT development. Using conditional mutants and bone marrow chimeras, we show that intravascular activation of the extrinsic pathway of coagulation via tissue factor (TF) derived from myeloid leukocytes causes the extensive intraluminal fibrin formation characteristic of DVT. We demonstrate that thrombus-resident neutrophils are indispensable for subsequent DVT propagation by binding factor XII (FXII) and by supporting its activation through the release of neutrophil extracellular traps (NETs). Correspondingly, neutropenia, genetic ablation of FXII, or disintegration of NETs each confers protection against DVT amplification. Platelets associate with innate immune cells via glycoprotein Ibα and contribute to DVT progression by promoting leukocyte recruitment and stimulating neutrophil-dependent coagulation. Hence, we identified a cross talk between monocytes, neutrophils, and platelets responsible for the initiation and amplification of DVT and for inducing its unique clinical features.

Monocytes, neutrophils, and platelets cooperate to initiate and propagate venous thrombosis in mice in vivo

PubMed Central

von Brühl, Marie-Luise; Stark, Konstantin; Steinhart, Alexander; Chandraratne, Sue; Konrad, Ildiko; Lorenz, Michael; Khandoga, Alexander; Tirniceriu, Anca; Coletti, Raffaele; Köllnberger, Maria; Byrne, Robert A.; Laitinen, Iina; Walch, Axel; Brill, Alexander; Pfeiler, Susanne; Manukyan, Davit; Braun, Siegmund; Lange, Philipp; Riegger, Julia; Ware, Jerry; Eckart, Annekathrin; Haidari, Selgai; Rudelius, Martina; Schulz, Christian; Echtler, Katrin; Brinkmann, Volker; Schwaiger, Markus; Preissner, Klaus T.; Wagner, Denisa D.; Mackman, Nigel; Engelmann, Bernd

2012-01-01

Deep vein thrombosis (DVT) is a major cause of cardiovascular death. The sequence of events that promote DVT remains obscure, largely as a result of the lack of an appropriate rodent model. We describe a novel mouse model of DVT which reproduces a frequent trigger and resembles the time course, histological features, and clinical presentation of DVT in humans. We demonstrate by intravital two-photon and epifluorescence microscopy that blood monocytes and neutrophils crawling along and adhering to the venous endothelium provide the initiating stimulus for DVT development. Using conditional mutants and bone marrow chimeras, we show that intravascular activation of the extrinsic pathway of coagulation via tissue factor (TF) derived from myeloid leukocytes causes the extensive intraluminal fibrin formation characteristic of DVT. We demonstrate that thrombus-resident neutrophils are indispensable for subsequent DVT propagation by binding factor XII (FXII) and by supporting its activation through the release of neutrophil extracellular traps (NETs). Correspondingly, neutropenia, genetic ablation of FXII, or disintegration of NETs each confers protection against DVT amplification. Platelets associate with innate immune cells via glycoprotein Ibα and contribute to DVT progression by promoting leukocyte recruitment and stimulating neutrophil-dependent coagulation. Hence, we identified a cross talk between monocytes, neutrophils, and platelets responsible for the initiation and amplification of DVT and for inducing its unique clinical features. PMID:22451716

Deep venous thrombosis associated with corporate air travel.

PubMed

Dimberg, L A; Mundt, K A; Sulsky, S I; Liese, B H

2001-01-01

Deep venous thrombosis (DVT) is commonly seen among bedridden and postoperative patients. Its association with travel may also make DVT an occupational health risk to otherwise healthy business travelers. We estimated the incidence of and risk factors for DVT among 8,189 World Bank employees and a subset of 4,951 international business travelers. Occurrence of DVT between 1995 and 1998 was determined using 1) medical insurance claims; 2) Workers' Compensation claims; and 3) intra-office E-mail solicitation followed by interview. For each insurance claim case, 10 controls were randomly selected from among World Bank employees insured during the same month and year as the case's claim was filed, and case-control analyses were performed to identify potential predictors or risk factors for DVT. Thirty individuals filed claims for DVT of the legs (annual incidence rate: 0.9 per 1,000 employees); three of these claims were filed within 30 days after a travel mission. Two employees reported DVT as a Workers' Compensation injury, and five staff with verified DVT participated in interviews. After controlling for age and gender, no association with any travel-related covariate was seen. Results of analyses considering all thrombophlebitis and thromboembolism followed the same pattern. The average annual incidence of DVT occurring within 30 days of mission among traveling staff ranged from 0.10 per 1,000 to 0.25 per 1,000 travelers, depending on the case-finding method. No association between DVT and travel was observed after adjustment for gender and age. These results, however, are preliminary, and due to the rarity of DVT, based on small numbers.

Active Ankle Movements Prevent Formation of Lower-Extremity Deep Venous Thrombosis After Orthopedic Surgery

PubMed Central

Li, Ye; Guan, Xiang-Hong; Wang, Rui; Li, Bin; Ning, Bo; Su, Wei; Sun, Tao; Li, Hong-Yan

2016-01-01

Background The aim of this study was to assess the preventive value of active ankle movements in the formation of lower-extremity deep venous thrombosis (DVT), attempting to develop a new method for rehabilitation nursing after orthopedic surgery. Material/Methods We randomly assigned 193 patients undergoing orthopedic surgery in the lower limbs into a case group (n=96) and a control group (n=97). The control group received routine nursing while the case group performed active ankle movements in addition to receiving routine nursing. Maximum venous outflow (MVO), maximum venous capacity (MVC), and blood rheology were measured and the incidence of DVT was recorded. Results On the 11th and 14th days of the experiment, the case group had significantly higher MVO and MVC than the control group (all P<0.05). The whole-blood viscosity at high shear rate and the plasma viscosity were significantly lower in the case group than in the control group on the 14th day (both P<0.05). During the experiment, a significantly higher overall DVT incidence was recorded in the control group (8 with asymptomatic DVT) compared with the case group (1 with asymptomatic DVT) (P=0.034). During follow-up, the case group presented a significantly lower DVT incidence (1 with symptomatic DVT and 4 with asymptomatic DVT) than in the control group (5 with symptomatic DVT and 10 with asymptomatic DVT) (P=0.031). Conclusions Through increasing MVO and MVC and reducing blood rheology, active ankle movements may prevent the formation of lower-extremity DVT after orthopedic surgery. PMID:27600467

Research and Deployment a Hospital Open Software Platform for e-Health on the Grid System at VAST/IAMI

NASA Astrophysics Data System (ADS)

van Tuyet, Dao; Tuan, Ngo Anh; van Lang, Tran

Grid computing has been an increasing topic in recent years. It attracts the attention of many scientists from many fields. As a result, many Grid systems have been built for serving people's demands. At present, many tools for developing the Grid systems such as Globus, gLite, Unicore still developed incessantly. Especially, gLite - the Grid Middleware - was developed by the Europe Community scientific in recent years. Constant growth of Grid technology opened the way for new opportunities in term of information and data exchange in a secure and collaborative context. These new opportunities can be exploited to offer physicians new telemedicine services in order to improve their collaborative capacities. Our platform gives physicians an easy method to use telemedicine environment to manage and share patient's information (such as electronic medical record, images formatted DICOM) between remote locations. This paper presents the Grid Infrastructure based on gLite; some main components of gLite; the challenge scenario in which new applications can be developed to improve collaborative work between scientists; the process of deploying Hospital Open software Platform for E-health (HOPE) on the Grid.

iBIOMES Lite: Summarizing Biomolecular Simulation Data in Limited Settings

PubMed Central

2015-01-01

As the amount of data generated by biomolecular simulations dramatically increases, new tools need to be developed to help manage this data at the individual investigator or small research group level. In this paper, we introduce iBIOMES Lite, a lightweight tool for biomolecular simulation data indexing and summarization. The main goal of iBIOMES Lite is to provide a simple interface to summarize computational experiments in a setting where the user might have limited privileges and limited access to IT resources. A command-line interface allows the user to summarize, publish, and search local simulation data sets. Published data sets are accessible via static hypertext markup language (HTML) pages that summarize the simulation protocols and also display data analysis graphically. The publication process is customized via extensible markup language (XML) descriptors while the HTML summary template is customized through extensible stylesheet language (XSL). iBIOMES Lite was tested on different platforms and at several national computing centers using various data sets generated through classical and quantum molecular dynamics, quantum chemistry, and QM/MM. The associated parsers currently support AMBER, GROMACS, Gaussian, and NWChem data set publication. The code is available at https://github.com/jcvthibault/ibiomes. PMID:24830957

Deep vein thrombosis: diagnosis and treatment.

PubMed

Bonner, Lynda; Johnson, Jacqueline

2014-01-28

This article aims to give nurses an insight into proximal deep vein thrombosis (DVT). DVT is relatively common and is associated with significant morbidity and mortality. Complications such as post-thrombotic syndrome, venous leg ulcers, recurrent venous thromboembolism (VTE) - pulmonary embolism (PE) or DVT - and pulmonary hypertension can develop following DVT diagnosis. There is also a risk that a large PE could prove fatal. While VTE prevention is a clinical priority, nurses should also have appropriate skills and knowledge to care for patients with suspected DVT. Nurses need to be aware of the signs and symptoms of DVT, common diagnostic tests, pharmacological and mechanical treatments, and the follow-up investigations patients should be offered.

In too deep: understanding, detecting and managing DVT.

PubMed

Meetoo, Danny

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious health and social care problem of the developed world, affecting 1 in 1000 adults every year, and with an annual financial overhead of approximately £640 million. The nature of DVT means that often the condition can go unrecognized until the thrombus becomes an embolus. The pathogenesis of DVT continues to be based on Virchow's triad, which attributes VTE to 'hypercoagulability', 'stasis' and 'intimal injury'. The diagnosis of DVT is often the result of a number of tests performed either sequentially or in combination before mechanical and/or chemical treatment is embarked on. Creating public awareness of DVT and PE is the best way to prevent this condition. Nurses are in an ideal position to discuss the importance of lifestyle changes and other related measures to prevent DVT.

Deep vein thrombosis in the disabled pediatric population.

PubMed

Radecki, R T; Gaebler-Spira, D

1994-03-01

The incidence of deep vein thrombosis (DVT) in the disabled pediatric population has rarely been studied. The purpose of our retrospective study was to define the incidence in patients younger than 18 years of age who were in a rehabilitation center. We reviewed the charts of 532 children admitted to the center from 1983 through 1987, and found a 2.2% overall incidence of DVT. The largest group of children under 18 of age with documented or suspected DVT was the group with spinal cord injuries (SCI). There were 87 SCI children, 67 of whom were between the ages of 15 and 18. Of the 67, 7 (10%) had DVT: 1 of the 20 SCI children under age 15 had DVT. There were single cases of DVT documented in children with: meningoencephalitis, arteriovenous malformation, closed head injuries, and Guillian-Barré syndrome. We studied the risk involved in treating DVT with heparin and formulated recommendations based on our findings.

Diagnosis of DVT

PubMed Central

Jaeschke, Roman; Stevens, Scott M.; Goodacre, Steven; Wells, Philip S.; Stevenson, Matthew D.; Kearon, Clive; Schunemann, Holger J.; Crowther, Mark; Pauker, Stephen G.; Makdissi, Regina; Guyatt, Gordon H.

2012-01-01

Background: Objective testing for DVT is crucial because clinical assessment alone is unreliable and the consequences of misdiagnosis are serious. This guideline focuses on the identification of optimal strategies for the diagnosis of DVT in ambulatory adults. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Results: We suggest that clinical assessment of pretest probability of DVT, rather than performing the same tests in all patients, should guide the diagnostic process for a first lower extremity DVT (Grade 2B). In patients with a low pretest probability of first lower extremity DVT, we recommend initial testing with D-dimer or ultrasound (US) of the proximal veins over no diagnostic testing (Grade 1B), venography (Grade 1B), or whole-leg US (Grade 2B). In patients with moderate pretest probability, we recommend initial testing with a highly sensitive D-dimer, proximal compression US, or whole-leg US rather than no testing (Grade 1B) or venography (Grade 1B). In patients with a high pretest probability, we recommend proximal compression or whole-leg US over no testing (Grade 1B) or venography (Grade 1B). Conclusions: Favored strategies for diagnosis of first DVT combine use of pretest probability assessment, D-dimer, and US. There is lower-quality evidence available to guide diagnosis of recurrent DVT, upper extremity DVT, and DVT during pregnancy. PMID:22315267

Timing of deep vein thrombosis formation after aneurysmal subarachnoid hemorrhage

PubMed Central

Liang, Conrad W.; Su, Kimmy; Liu, Jesse J.; Dogan, Aclan; Hinson, Holly E.

2015-01-01

OBJECT Deep vein thrombosis (DVT) is a common complication of aneurysmal subarachnoid hemorrhage (aSAH). The time period of greatest risk for developing DVT after aSAH is not currently known. aSAH induces a prothrombotic state, which may contribute to DVT formation. Using repeated ultrasound screening, the hypothesis that patients would be at greatest risk for developing DVT in the subacute post-rupture period was tested. METHODS One hundred ninety-eight patients with aSAH admitted to the Oregon Health & Science University Neurosciences Intensive Care Unit between April 2008 and March 2012 were included in a retrospective analysis. Ultrasound screening was performed every 5.2 ± 3.3 days between admission and discharge. The chi-square test was used to compare DVT incidence during different time periods of interest. Patient baseline characteristics as well as stroke severity and hospital complications were evaluated in univariate and multivariate analyses. RESULTS Forty-two (21%) of 198 patients were diagnosed with DVT, and 3 (2%) of 198 patients were symptomatic. Twenty-nine (69%) of the 42 cases of DVT were first detected between Days 3 and 14, compared with 3 cases (7%) detected between Days 0 and 3 and 10 cases (24%) detected after Day 14 (p < 0.05). The postrupture 5-day window of highest risk for DVT development was between Days 5 and 9 (40%, p < 0.05). In the multivariate analysis, length of hospital stay and use of mechanical prophylaxis alone were significantly associated with DVT formation. CONCLUSIONS DVT formation most commonly occurs in the first 2 weeks following aSAH, with detection in this cohort peaking between Days 5 and 9. Chemoprophylaxis is associated with a significantly lower incidence of DVT. PMID:26162047

Incidence of Postoperative Deep Venous Thrombosis Is Higher among Cardiac and Vascular Surgery Patients as Compared with General Surgery Patients.

PubMed

Aziz, Faisal; Patel, Mayank; Ortenzi, Gail; Reed, Amy B

2015-01-01

Unlike general surgery patients, most of vascular and cardiac surgery patients receive therapeutic anticoagulation during operations. The purpose of this study was to report the incidence of deep venous thrombosis (DVT) among cardiac and vascular surgery patients, compared with general surgery. The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent surgical procedures from 2005 to 2010. Patients who developed DVT within 30 days of an operation were identified. The incidence of DVT was compared among vascular, general, and cardiac surgery patients. Risk factors for developing postoperative DVT were identified and compared among these patients. Of total 2,669,772 patients underwent surgical operations in the period between 2005 and 2010. Of all the patients, 18,670 patients (0.69%) developed DVT. The incidence of DVT among different surgical specialties was cardiac surgery (2%), vascular surgery (0.99%), and general surgery (0.66%). The odds ratio for developing DVT was 1.5 for vascular surgery patients and 3 for cardiac surgery patients, when compared with general surgery patients (P < 0.001). The odds ratio for developing DVT after cardiac surgery was 2, when compared with vascular surgery (P < 0.001). The incidence of DVT is higher among vascular and cardiac surgery patients as compared with that of general surgery patients. Intraoperative anticoagulation does not prevent the occurrence of DVT in the postoperative period. These patients should receive DVT prophylaxis in the perioperative period, similar to other surgical patients according to evidence-based guidelines. Copyright © 2015 Elsevier Inc. All rights reserved.

PAI-1 4G/5G and MTHFR C677T polymorphisms increased the accuracy of two prediction scores for the risk of acute lower extremity deep vein thrombosis.

PubMed

Pop, Tudor Radu; Vesa, Ştefan Cristian; Trifa, Adrian Pavel; Crişan, Sorin; Buzoianu, Anca Dana

2014-01-01

This study investigates the accuracy of two scores in predicting the risk of acute lower extremity deep vein thrombosis. The study included 170 patients [85 (50%) women and 85 (50%) men] who were diagnosed with acute lower extremity deep vein thrombosis (DVT) with duplex ultrasonography. Median age was 62 (52.75; 72) years. The control group consisted of 166 subjects [96 (57.8%) women and 70 (42.2%) men], without DVT, matched for age (± one year) to those in the group with DVT. The patients and controls were selected from those admitted to the internal medicine, cardiology and geriatrics wards within the Municipal Hospital of Cluj-Napoca, Romania, between October 2009 and June 2011. Clinical, demographic and lab data were recorded for each patient. For each patient we calculated the prior risk of DVT using two prediction scores: Caprini and Padua. According to the Padua score only 93 (54.7%) patients with DVT had been at high risk of developing DVT, while 48 (28.9%) of controls were at high risk of developing DVT. When Padua score included PAI-1 4G/5G and MTHFR C677T polymorphisms, the sensitivity increased at 71.7%. Using the Caprini score, we determined that 147 (86.4%) patients with DVT had been at high risk of developing DVT, while 103 (62%) controls were at high risk of developing DVT. A Caprini score higher than 5 was the strongest predictor of acute lower extremity DVT risk. The Caprini prediction score was more sensitive than the Padua score in assessing the high risk of DVT in medical patients. PAI-1 4G/5G and MTHFR C677T polymorphisms increased the sensitivity of Padua score.

Primary venous insufficiency increases risk of deep vein thrombosis.

PubMed

Shaydakov, Maxim E; Comerota, Anthony J; Lurie, Fedor

2016-04-01

Varicose veins have been recognized as a risk factor for deep vein thrombosis (DVT). However, venous reflux has not carried the same correlation. This study evaluated the association between primary valvular reflux and DVT. We performed a nested case-control study with enrollment of outpatients presenting to the vascular laboratory with signs and symptoms of DVT. All patients had a complete bilateral venous duplex examination evaluating for DVT and superficial and deep venous valvular reflux. Eighty-seven patients with confirmed DVT on venous duplex were selected for the study group. The control group was randomly selected from the same cohort in a 4:1 ratio matched by age and gender (n = 348). Groups were compared for the prevalence of deep and superficial reflux. DVT outpatients were 4.7-times more likely to have primary valvular reflux than symptomatic controls (65.5% vs 29.0%; 95% confidence interval [CI], 2.8-7.7; P < .000001). Deep reflux was 2.1-times more prevalent (36.8% vs 21.6%; odds ratio, 2.12; 95% CI, 1.28-3.51; P = .005) and superficial reflux was 4.6-times more prevalent (43.7% vs 14.4%; odds ratio, 4.62; 95% CI, 2.75-7.77; P < .0000001) in DVT patients than in controls. DVT patients were also 2.1-times more likely to have combined deep and superficial reflux than non-DVT patients (13.8% vs 6.6%, 95% CI, 1.08-4.75; P = .044). The prevalence of primary valvular reflux in patients with DVT is significantly higher than expected. Reflux may be considered as a novel risk factor for DVT. Two-thirds of patients with DVT have pre-existent primary chronic venous disease, which is likely to contribute to post-thrombotic morbidity. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Clinical features and risk factor analysis for lower extremity deep venous thrombosis in Chinese neurosurgical patients

PubMed Central

Guo, Fuyou; Shashikiran, Tagilapalli; Chen, Xi; Yang, Lei; Liu, Xianzhi; Song, Laijun

2015-01-01

Background: Deep venous thrombosis (DVT) contributes significantly to the morbidity and mortality of neurosurgical patients; however, no data regarding lower extremity DVT in postoperative Chinese neurosurgical patients have been reported. Materials and Methods: From January 2012 to December 2013, 196 patients without preoperative DVT who underwent neurosurgical operations were evaluated by color Doppler ultrasonography and D-dimer level measurements on the 3rd, 7th, and 14th days after surgery. Follow-up clinical data were recorded to determine the incidence of lower extremity DVT in postoperative neurosurgical patients and to analyze related clinical features. First, a single factor analysis, Chi-square test, was used to select statistically significant factors. Then, a multivariate analysis, binary logistic regression analysis, was used to determine risk factors for lower extremity DVT in postoperative neurosurgical patients. Results: Lower extremity DVT occurred in 61 patients, and the incidence of DVT was 31.1% in the enrolled Chinese neurosurgical patients. The common symptoms of DVT were limb swelling and lower extremity pain as well as increased soft tissue tension. The common sites of venous involvement were the calf muscle and peroneal and posterior tibial veins. The single factor analysis showed statistically significant differences in DVT risk factors, including age, hypertension, smoking status, operation time, a bedridden or paralyzed state, the presence of a tumor, postoperative dehydration, and glucocorticoid treatment, between the two groups (P < 0.05). The binary logistic regression analysis showed that an age greater than 50 years, hypertension, a bedridden or paralyzed state, the presence of a tumor, and postoperative dehydration were risk factors for lower extremity DVT in postoperative neurosurgical patients. Conclusions: Lower extremity DVT was a common complication following craniotomy in the enrolled Chinese neurosurgical patients. Multiple factors were identified as predictive of DVT in neurosurgical patients, including the presence of a tumor, an age greater than 50 years, hypertension, and immobility. PMID:26752303

Deep venous thrombosis in elderly patients as a surgical emergency at King Abdulaziz University Hospital, Jeddah, Saudi Arabia

PubMed Central

Alanazi, Reham Muqbil; Alanazi, Ashjan Aqeel; Alenezi, Ibtihaj Qaseem; Alsulobi, Anwar Matar; Almutairy, Abdulrhman Fahad; Ali, Wafaa Mohamed Bakr; Alanazi, Mohammed Abdullah; Alkhidhr, Mohammed Abdullah; Elfetoh, Nagah Mohamed Abo; Ali, Abdalla Mohamed Bakr

2017-01-01

Background Deep venous thrombosis (DVT) is a condition that occurs frequently among surgical, as well as acutely ill hospitalized medical patients, and is responsible for significant morbidity and mortality in hospitalized patients. Risk factors include older age, surgery and immobilization (as with bed rest, orthopedic casts, and sitting on long flights. Objective This study was conducted to identify the frequency and factors associated with occurrence of DVT among elderly patients referred to King Abdulaziz University (KAU) Hospital, Jeddah, Kingdom of Saudi Arabia. Methods The current study is a hospital based cross sectional study. The emergency, inpatients and outpatients’ departments at KAU hospital were reviewed. We studied all the referred elderly subjects during the study period. All elderly patients (540) referred to or admitted to the hospital departments and who were clinically suspected to have DVT and subjected to Doppler examination were included in the study. Data were analyzed using descriptive statistics and Chi square test. Results Based on the results of Doppler examination, DVT was detected in 97 (18.0%) of the studied elderly population. There were no significant differences in gender between patients who developed DVT and those who were negative by Doppler examination (p=0.018). Other comorbidities as diabetes, IHD and hypertension were significantly associated with the occurrence of DVT among the participants (p=0.05, 0.05 and 0.04 respectively). Furthermore, the other investigated factors such as being bed ridden, cancer, orthopedic cast and previous DVT were not significantly associated with the development of DVT among the studied elderly patients (p=0.42, 0.16, 0.45 and 0.75 respectively). Conclusion DVT has high prevalence in Jeddah; KSA. Thrombophilia screening should be regular for elderly patients with diabetes, hypertension and bed-ridden patients with recurrent DVT or patients with other risk factors. Knowing the most common risk factors and their significance in developing DVT is essential for early detection of DVT to prevent unwanted complications for elderlies. PMID:29403615

Prevention of DVT after orthopaedic surgery: the A-V Impulse System.

PubMed

Turnbull, Betty

Deep vein thrombosis (DVT) is a major health problem, which affects 1 in 1000 people in the general population each year. It may be asymptomatic or cause swelling and pain, and can lead to potentially fatal complications. Immobilisation following bone surgery significantly increases the risk of DVT, and prevention is a salient goal for nursing. This article reviews the pathogenesis of DVT, and therapeutic venous thromboembolic prophylaxis in the prevention of DVT following orthopaedic surgery. Best nursing practice is outlined from management of the Arteriovenous (A-V) Impulse System(R), the advent of which has had a positive impact on the incidence of DVT following orthopaedic surgery but requires further research to substantiate its effectiveness and determine patient acceptability.

[Practical Use of Doppler Ultrasonography of the Cardiovascular System and Clinical Laboratory Tests for the Management of Pulmonary Embolism].

PubMed

Mizukami, Naoko

2015-08-01

Acute or chronic pulmonary embolism (PE) is a serious disease, and the risk of mortality is increased if untreated. In 90% of cases the embolus source is deep vein thrombosis (DVT) of the lower limbs or pelvic cavity. Therefore, it is necessary to recognize these as venous thromboembolism (VTE) which includes both DVT and PE. I suggest that Doppler ultrasonography of cardiovascular and clinical laboratory tests provide very valuable medical support for the management of VTE. Specifically, in the early diagnosis of VTE and the prevention of fatal PE, Doppler ultrasonography (cardiac and vascular) can provide very useful information. On the other hand, blood coagulation and thrombophilia tests are important to determine the risk of VTE and evaluate the effect of anticoagulant therapy on VTE. In this paper, I explain the main points of each examination of VTE by describing representative cases. I also show the results on investigating cases in our hospital involving diseases related to VTE and the onset site of DVT. In addition, I introduce how we convey the results of analysis to the clinical side.

Magnetic resonance direct thrombus imaging of the evolution of acute deep vein thrombosis of the leg.

PubMed

Westerbeek, R E; Van Rooden, C J; Tan, M; Van Gils, A P G; Kok, S; De Bats, M J; De Roos, A; Huisman, M V

2008-07-01

Accurate diagnosis of acute recurrent deep vein thrombosis (DVT) is relevant to avoid improper diagnosis and unnecessary life-long anticoagulant treatment. Compression ultrasound has high accuracy for a first episode of DVT, but is often unreliable in suspected recurrent disease. Magnetic resonance direct thrombus imaging (MR DTI) has been shown to accurately detect acute DVT. The purpose of this prospective study was to determine the MR signal change during 6 months follow-up in patients with acute DVT. This study was a prospective study of 43 consecutive patients with a first episode of acute DVT demonstrated by compression ultrasound. All patients underwent MR DTI. Follow-up was performed with MR-DTI and compression ultrasound at 3 and 6 months respectively. All data were coded, stored and assessed by two blinded observers. MR direct thrombus imaging identified acute DVT in 41 of 43 patients (sensitivity 95%). There was no abnormal MR-signal in controls, or in the contralateral extremity of patients with DVT (specificity 100%). In none of the 39 patients available at 6 months follow-up was the abnormal MR-signal at the initial acute DVT observed, whereas in 12 of these patients (30.8%) compression ultrasound was still abnormal. Magnetic resonance direct thrombus imaging normalizes over a period of 6 months in all patients with diagnosed DVT, while compression ultrasound remains abnormal in a third of these patients. MR-DTI may potentially allow for accurate detection in patients with acute suspected recurrent DVT, and this should be studied prospectively.

Inflammation Modulates Murine Venous Thrombosis Resolution In Vivo: Assessment by Multimodal Fluorescence Molecular Imaging

PubMed Central

Ripplinger, Crystal M.; Kessinger, Chase W.; Li, Chunqiang; Kim, Jin Won; McCarthy, Jason R.; Weissleder, Ralph; Henke, Peter K.; Lin, Charles P.; Jaffer, Farouc A.

2012-01-01

Objective Assessment of thrombus inflammation in vivo could provide new insights into deep vein thrombosis (DVT) resolution. Here we develop and evaluate two integrated fluorescence molecular-structural imaging strategies to quantify DVT-related inflammation and architecture, and to assess the effect of thrombus inflammation on subsequent DVT resolution in vivo. Methods and Results Murine DVT were created with topical 5% FeCl3 application to thigh or jugular veins (n=35). On day 3, mice received macrophage and matrix metalloproteinase (MMP) activity fluorescence imaging agents. On day 4, integrated assessment of DVT inflammation and architecture was performed using confocal fluorescence intravital microscopy (IVM). Day 4 analyses showed robust relationships among in vivo thrombus macrophages, MMP activity, and FITC-dextran deposition (r>0.70, p<0.01). In a serial two-timepoint study, mice with DVT underwent IVM at day 4 and at day 6. Analyses revealed that the intensity of thrombus inflammation at day 4 predicted the magnitude of DVT resolution at day 6 (p<0.05). In a second approach, noninvasive fluorescence molecular tomography-computed tomography (FMT-CT) was employed, and detected macrophages within jugular DVT (p<0.05 vs. sham-controls). Conclusions Integrated fluorescence molecular-structural imaging demonstrates that the DVT-induced inflammatory response can be readily assessed in vivo, and can inform the magnitude of thrombus resolution. PMID:22995524

Is real-time elastography helpful to differentiate acute from subacute deep venous thrombosis? A preliminary study.

PubMed

Aslan, Ahmet; Barutca, Hakan; Ayaz, Ercan; Aslan, Mine; Kocaaslan, Cemal; Inan, Ibrahim; Sahin, Sinan; Yıkılmaz, Ali

2018-02-01

To detect and characterize changes in stiffness of thrombus in patients with acute and subacute deep venous thrombosis (DVT) by using real-time elastography (RTE). Fifty-eight patients with acute or subacute DVT were prospectively evaluated by B-mode sonography (US), color Doppler US (CDUS), and RTE. Two radiologists evaluated the thrombus echogenicity, compressibility, and recanalization of the affected vein, and thrombus stiffness in consensus. The thrombi were classified into 3 groups as soft, intermediate, and hard on RTE images. The final study group consisted of 30 patients with acute DVT, among whom 10 were women (33%), and 19 patients with subacute DVT, among whom 6 were women (32%). The presence of hypoechoic thrombus, incompressible vein, and absence of recanalization on US and CDUS were significantly associated with acute DVT (P < .001 for all variables). The differences in elasticity pattern of the thrombi between acute and subacute DVT were not significant (P = .202). Venous thrombus hardens with age; however, elastography pattern on RTE, in its present form, may not be able to differentiate acute DVT from subacute DVT. © 2017 Wiley Periodicals, Inc.

Association of deep venous thrombosis with calf vein diameter in acute hemorrhagic stroke.

PubMed

Ogata, Toshiyasu; Yasaka, Masahiro; Wakugawa, Yoshiyuki; Kitazono, Takanari; Okada, Yasushi

2013-10-01

We investigated the association between the development of deep venous thrombosis (DVT) and calf vein diameter in patients with acute hemorrhagic stroke. We measured the maximum diameter of paralytic side posttibial veins (PTVs) and peroneal veins (PVs) in 49 patients with intracerebral hemorrhage on admission and at 2 weeks after stroke onset by ultrasonography. We also examined for the presence or absence of DVT, and then analyzed the association of DVT with the maximum vein diameter. At 2 weeks after stroke, DVTs were detected in PTVs in 7 patients and in PVs in 6 patients. The maximum calf vein diameters at 2 weeks were significantly greater in patients with DVT compared with those without DVT (PTV, P = .033; PV, P = .015). Although calf vein diameter at admission did not influence the future incidence of DVT in patients with intracerebral hemorrhage, the presence of DVT was associated with calf vein dilatation. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Estimated effect of an integrated approach to suspected deep venous thrombosis using limited-compression ultrasound.

PubMed

Poley, Rachel A; Newbigging, Joseph L; Sivilotti, Marco L A

2014-09-01

Deep vein thrombosis (DVT) is both common and serious, yet the desire to never miss the diagnosis, coupled with the low specificity of D-dimer testing, results in high imaging rates, return visits, and empirical anticoagulation. The objective of this study was to evaluate a new approach incorporating bedside limited-compression ultrasound (LC US) by emergency physicians (EPs) into the workup strategy for DVT. This was a cross-sectional observational study of emergency department (ED) patients with suspected DVT. Patients on anticoagulants; those with chronic DVT, leg cast, or amputation; or when the results of comprehensive imaging were already known were excluded. All patients were treated in the usual fashion based on the protocol in use at the center, including comprehensive imaging based on the modified Wells score and serum D-dimer testing. Seventeen physicians were trained and performed LC US in all subjects. The authors identified a priori an alternate workup strategy in which DVT would be ruled out in "DVT unlikely" (Wells score < 2) patients if the LC US was negative and in "DVT likely" (Wells score ≥ 2) patients if both the LC US and the D-dimer were negative. The criterion standard was based on comprehensive imaging interpreted by radiologists blinded to LC US findings and by structured medical record review at 6 months in patients without comprehensive imaging. A total of 227 patients were enrolled (47% DVT likely), of whom 24 had DVT. The LC US was positive in 27 cases (21 actually DVT positive), indeterminate in 28 (one DVT positive), and negative in 172 (two DVT positive). Of 130 patients deemed DVT negative by the new strategy, one had confirmed DVT (miss rate = 0.8%; 95% confidence interval [CI] = 0.1% to 4.0%), but this patient had been misclassified by the treating physician as low risk by Wells criteria. The stand-alone sensitivity and specificity of LC US were 91% (95% CI = 70% to 98%) and 97% (95% CI = 92% to 99%), respectively. Incorporating LC US into the diagnostic approach would have reduced the rate of comprehensive imaging from 70% to 43%, D-dimer testing from 100% to 33%, and the mean time to diagnostic certainty by 5.0 hours and avoided 24 (11%) return visits for imaging and 10 (4.4%) cases of unnecessary anticoagulation. In 19% of cases, the treating and scanning physician disagreed whether the patient was DVT likely or DVT unlikely based on Wells score (κ = 0.62; 95% CI = 0.48 to 0.77). Limited-compression US holds promise as one component of the diagnostic approach to DVT, but should not be used as a stand-alone test due to imperfect sensitivity. Tradeoffs in diagnostic efficiency for the sake of perfect sensitivity remain a difficult issue collectively in emergency medicine (EM), but need to be scrutinized carefully in light of the costs of overinvestigation, delays in diagnosis, and risks of empirical anticoagulation. © 2014 by the Society for Academic Emergency Medicine.

Management of Chronic Deep Vein Thrombosis in Women.

PubMed

Hardman, Rulon L

2018-03-01

Chronic deep vein thrombosis (DVT) affects hundreds of thousands of women in the United States. Chronic DVT can lead to pain, edema, venous ulcers, and varicosities. While there are limited data regarding the management of chronic DVT, several interventional radiology groups aggressively treat chronic DVT to aid patient symptom resolution. Recanalization of occluded veins and venous stenting re-establishes deep vein flow and decreases venous hypertension.

Thrombolytic therapeutic effect monitoring based on functional near-infrared spectroscopy

NASA Astrophysics Data System (ADS)

Pan, Boan; Wang, Pengbo; Li, Yaoxian; Gao, Yuan; Li, Ting

2017-02-01

Deep vein thrombosis (DVT) is of serious mortality and morbidity, which often happens in inpatients and especially with the postoperative population [1]. The golden standard to diagnose DVT is venography, which relies on complicated imaging modalities requiring to be injected in a vein below the clot invasively and ionizing procedures that employing xray imaging to show where and how the DVT blocks. The near-infrared spectroscopy (NIRS) is recently found to be an intriguing and potential method detecting DVT in clinics. It has been reported recently that employing NIRS to diagnose DVT. Arteriosclerosis obliterans (ASO), local extremities manifestations of systemic atherosclerosis, usually cause thrombosis and the reduction of distal blood flow. Thrombolytic therapy is to use exogenous activator to activate the dissolution system, which can dissolve intracoronary thrombus. Here we attempt to monitor the DVT and ASO patients during the whole procedure of thrombolytic treatment, then compare the data with those DVT and ASO patients did not take treatments and normal population. 8 DVT and 9 ASO patients and 12 normal subjects were recruited to take the measurements of concentration variation of oxy- and deoxy-hemoglobins (Δ[HbO2] and Δ[Hb]) by NIRS-based thrombosis monitor. Thereinto, 5 DVT and 6 ASO patients has taken the thrombolytic treatment, and the data for the periods before treatment, during treatment, and after treatment were extracted for analysis. We found that Δ[HbO2] fluctuates and even decreases in DVT and ASO patients. After the thrombolytic therapy, Δ[HbO2] increases about 45% and converge to the curves of normal subjects. And the Δ[Hb] emerges the similar trends, except for the rising trend in the beginning and the downtrend after thrombolytic therapy. The findings indicated NIRS has big potential in clinical monitoring of DVT and ASO patients and offering reliable and quantitative evaluation of thrombolytic therapy outcomes.

"Tap and twist": preventing deep vein thrombosis in neuroscience patients through foot and ankle range-of-motion exercises.

PubMed

Palamone, Janet; Brunovsky, Susan; Groth, Matt; Morris, Linda; Kwasny, Mary

2011-12-01

Neurosurgical patients tend to have the highest rate of deep vein thrombosis (DVT) rate among other postsurgical patients. The methods and timing of DVT prevention and treatment continue to be debated among neurointensivists. The greatest opportunity to intervene is early during the stay in the intensive care unit. There are many factors, however, that can make this the most neglected time for aggressive prevention measures. For large university teaching hospitals, the target of the University Health System Consortium is to achieve an average DVT rate at or below half that of previous reported rates. The current recommendations are effective only if there is compliance with these measures during the majority of the patients' hospitalization. Our hypothesis states that without changing any of the current measures to prevent DVT, a structured program of foot and ankle range-of-motion (ROM) exercises will decrease the incidence of DVT in the neuroscience intensive care patient population. This quasi-experimental study was a quality improvement project examining 315 individuals over the age of 18 years, who were admitted to the neurospine intensive care unit and who received a new program of foot exercises as a method of DVT prevention. Data for the outcome measures were derived from bedside measurement of lower extremity doppler, the percentage of time the exercises were performed, patient history, and standard DVT prevention measures. Overall, there was no difference in DVT rates for those receiving the foot ROM intervention during the study period in 2008-2009 compared with the usual nursing practice for the previous year. However, during the study period, those who developed DVT had a significantly lower compliance rate with the ROM exercises (38.7%) than did those who did not develop DVT (58.4%; p < .001). Therefore, foot and ankle ROM exercises may have a promising role in reducing the incidence of DVT in neuroscience intensive care patients when there is diligent performance of the exercises.

The effect of prothrombotic blood abnormalities on risk of deep vein thrombosis in users of hormone replacement therapy: a prospective case-control study.

PubMed

Douketis, Jim D; Julian, Jim A; Crowther, Mark A; Kearon, Clive; Bates, Shannon M; Barone, Marisa; Piovella, Franco; Middeldorp, Saskia; Prandoni, Paolo; Johnston, Marilyn; Costantini, Lorrie; Ginsberg, Jeffrey S

2011-01-01

Few studies have assessed the effect of prothrombotic blood abnormalities on the risk of deep vein thrombosis (DVT) with hormone replacement therapy (HRT). We studied postmenopausal women with suspected DVT in whom HRT use and prothrombotic blood abnormalities were sought. Cases had unprovoked DVT and controls had no DVT and without DVT risk factors. The risk of DVT was determined in women with and without prothrombotic abnormalities. A total of 510 postmenopausal women with suspected DVT were assessed; 57 cases and 283 controls were identified. Compared to HRT, nonusers without the factor V Leiden mutation, the risk of DVT was increased in estrogen-progestin HRT users (odds ratio [OR], 3.2; 95% confidence interval [CI]: 1.2-8.6) and in nonusers with the factor V Leiden mutation (OR, 5.3; 1.9-15.4) and appears multiplied in users of estrogen-progestin HRT with the factor V Leiden mutation (OR, 17.1; 3.7-78). Compared to HRT, nonusers with normal factor VIII, the risk of DVT was increased in estrogen-progestin HRT users with normal factor VIII (OR, 2.8; 1.0-7.9) and in HRT nonusers with the highest factor VIII quartile (OR, 6.0; 2.1-17), and appears to be multiplied in women who are users of estrogen-progestin HRT with the highest factor VIII quartile (OR, 17.0; 3.6-80). In postmenopausal women who are estrogen-progestin HRT users, the presence of the factor V Leiden mutation or an elevated factor VIII level appears to have a multiplicative effect on their overall risk of DVT, increasing it 17-fold compared to women without these blood abnormalities who are HRT nonusers.

Correlation of missed doses of enoxaparin with increased incidence of deep vein thrombosis in trauma and general surgery patients.

PubMed

Louis, Scott G; Sato, Misa; Geraci, Travis; Anderson, Ross; Cho, S David; Van, Philbert Y; Barton, Jeffrey S; Riha, Gordon M; Underwood, Samantha; Differding, Jerome; Watters, Jennifer M; Schreiber, Martin A

2014-04-01

Enoxaparin sodium is widely used for deep vein thrombosis (DVT) prophylaxis, yet DVT rates remain high in the trauma and general surgery populations. Missed doses during hospitalization are common. To determine if missed doses of enoxaparin correlate with DVT formation. Data were prospectively collected among 202 trauma and general surgery patients admitted to a level I trauma center. Deep vein thrombosis screening was performed using a rigorous standardized protocol. The overall incidence of DVT was 15.8%. In total, 58.9% of patients missed at least 1 dose of enoxaparin. The DVTs occurred in 23.5% of patients who missed at least 1 dose and in 4.8% of patients who did not (P < .01). On univariate analysis, the need for mechanical ventilation (71.8% vs 44.1%), the performance of more than 1 operation (59.3% vs 40.0%), and male sex (75% vs 56%) were associated with DVT formation (P < .05 for all). A bivariate logistic regression was then performed, which revealed age 50 years or older and interrupted enoxaparin therapy as the only independent risk factors for DVT formation. The DVT rate did not differ between trauma and general surgery populations or in patients receiving once-daily vs twice-daily dosing regimens. Interrupted enoxaparin therapy and age 50 years or older are associated with DVT formation among trauma and general surgery patients. Missed doses occur commonly and are the only identified risk factor for DVT that can be ameliorated by physicians. Efforts to minimize interrupted enoxaparin prophylaxis in patients at risk for DVT should be optimized.

Deep venous thrombosis among diabetic patients in King Abdulaziz University (KAU) Hospital, Jeddah, Kingdom of Saudi Arabia.

PubMed

Alotaibi, Hanan Khalid; Abo El-Fetoh, Nagah Mohamed; MenwerAlanazi, Aseel; Alanazi, Omar Ayed; Alanazi, Abdullah Barghash; Alhowaish, Mohammed Ali; Alzahrani, Hussam Saeed Busays; Alshammari, Mashael Abdullah; ALrashidi, Rawan Fulayyih; Alblowi, Thikra Mohammed; Alqahtani, Sarah Jemal; Almaashi, Fatin Salem

2017-09-01

Deep venous thrombosis (DVT) is a major cause of morbidity and mortality among hospitalized patients worldwide and, simultaneously, the most preventable. Studies revealed several risk factors of deep venous thrombosis in hospitalized patients. to identify frequency and factors associated with occurrence of deep venous thrombosis among diabetic patients referred to King Abdulaziz University (KAU) Hospital, Jeddah, Kingdom of Saudi Arabia. This cross-sectional hospital-based study was conducted from June to December, 2016. All diabetic patients referred to the hospital departments and who were suspected to have deep venous thrombosis (DVT) and subjected to Doppler examination were included in the study. A questionnaire was designed to obtain data about deep venous thrombosis frequency among participants and factors associated with the development of deep venous thrombosis among them. Data was collected through face to face interviews with patients included in the study. We used SPSS version 16 for data analysis through descriptive statistics and Chi-square test. DVT was detected in 14.7 % of the examined patients. There were significant and positive associations between age and DVT (X 2 =10.13, p=0.03) and between ischemic heart disease and DVT (X 2 =1.628, p=0.043) with the development of deep venous thrombosis among the studied patients. On the other hand, gender, other comorbidities, history of previous DVT, being bed ridden and using orthopedic casting were not significantly associated with the occurrence of deep venous thrombosis among the participants. DVT development rate among the participants was 14.7 %. Aging was significantly associated with DVT occurrence. Most of the studied factors and comorbidities had no significant role in DVT development among participants and only ischemic heart disease was significantly associated with DVT development.

Validation of the Oudega diagnostic decision rule for diagnosing deep vein thrombosis in frail older out-of-hospital patients.

PubMed

Schouten, Henrike J; Koek, Huiberdina L; Oudega, Ruud; van Delden, Johannes J M; Moons, Karel G M; Geersing, Geert-Jan

2015-02-01

We aimed to validate the Oudega diagnostic decision rule-which was developed and validated among younger aged primary care patients-to rule-out deep vein thrombosis (DVT) in frail older outpatients. In older patients (>60 years, either community dwelling or residing in nursing homes) with clinically suspected DVT, physicians recorded the score on the Oudega rule and d-dimer test. DVT was confirmed with a composite reference standard including ultrasonography examination and 3-month follow-up. The proportion of patients with a very low probability of DVT according to the Oudega rule (efficiency), and the proportion of patients with symptomatic venous thromboembolism during 3 months follow-up within this 'very low risk' group (failure rate) was calculated. DVT occurred in 164 (47%) of the 348 study participants (mean age 81 years, 85% residing in nursing homes). The probability of DVT was very low in 69 patients (Oudega score ≤3 points plus a normal d-dimer test; efficiency 20%) of whom four had non-fatal DVT (failure rate 5.8%; 2.3-14%). With a simple revised version of the Oudega rule for older suspected patients, 43 patients had a low risk of DVT (12% of the total population) of whom only one had DVT (failure rate 2.3%; 0.4-12%). In older suspected patients, application of the original Oudega rule to exclude DVT resulted in a higher failure rate as compared to previous studies. A revised and simplified Oudega strategy specifically developed for elderly suspected patients resulted in a lower failure rate though at the expense of a lower efficiency. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

TRIPOLI-4® - MCNP5 ITER A-lite neutronic model benchmarking

NASA Astrophysics Data System (ADS)

Jaboulay, J.-C.; Cayla, P.-Y.; Fausser, C.; Lee, Y.-K.; Trama, J.-C.; Li-Puma, A.

2014-06-01

The aim of this paper is to present the capability of TRIPOLI-4®, the CEA Monte Carlo code, to model a large-scale fusion reactor with complex neutron source and geometry. In the past, numerous benchmarks were conducted for TRIPOLI-4® assessment on fusion applications. Experiments (KANT, OKTAVIAN, FNG) analysis and numerical benchmarks (between TRIPOLI-4® and MCNP5) on the HCLL DEMO2007 and ITER models were carried out successively. In this previous ITER benchmark, nevertheless, only the neutron wall loading was analyzed, its main purpose was to present MCAM (the FDS Team CAD import tool) extension for TRIPOLI-4®. Starting from this work a more extended benchmark has been performed about the estimation of neutron flux, nuclear heating in the shielding blankets and tritium production rate in the European TBMs (HCLL and HCPB) and it is presented in this paper. The methodology to build the TRIPOLI-4® A-lite model is based on MCAM and the MCNP A-lite model (version 4.1). Simplified TBMs (from KIT) have been integrated in the equatorial-port. Comparisons of neutron wall loading, flux, nuclear heating and tritium production rate show a good agreement between the two codes. Discrepancies are mainly included in the Monte Carlo codes statistical error.

Noninvasive diagnosis and therapeutic effect evaluation of deep vein thrombosis in clinics by near-infrared spectroscopy

NASA Astrophysics Data System (ADS)

Li, Ting; Sun, Yunlong; Chen, Xiao; Zhao, Yue; Ren, Rongrong

2015-01-01

Deep vein thrombosis (DVT) has become a severe disease with a rising incidence rate. The conventional diagnosis relies on complicated imaging modalities that may also involve invasive contrast agent injection and ionizing procedures (e.g., venography). Noninvasive near-infrared spectroscopy (NIRS) methods have been explored which required the DVT patients to follow some exercise protocols. Here, we attempt to use portable NIRS under patients' natural state for DVT diagnosis. Nine DVT patients and seven healthy subjects participated in NIRS measurements of concentration of oxy- and deoxy-hemoglobins (Δ[HbO2] and Δ[Hb]) relative to data on a tissue mimicking phantom at six particular sites of calves. It was found that Δ[HbO2] is significantly lower in DVT patients than healthy ones, whereas Δ[Hb] is distinctly higher. Moreover, after thrombolytic therapy, both Δ[HbO2] and Δ[Hb] in DVT calves assume a gradual convergence to the curves of healthy ones. This reveals the potential of NIRS for the noninvasive, continuous, and straightforward monitoring/therapeutic effect evaluation of DVT in clinics with appropriate bedside monitoring capability.

D-dimer as an applicable test for detection of posttraumatic deep vein thrombosis in lower limb fracture.

PubMed

Bakhshi, Hooman; Alavi-Moghaddam, Mostafa; Wu, Karin C; Imami, Mohammad; Banasiri, Mohammad

2012-06-01

Measuring the plasma levels of D-dimer is an accurate and easy modality to detect deep vein thrombosis (DVT) in nontraumatic settings. However, the diagnostic reliability of D-dimer assays in detecting posttraumatic DVT among patients with lower limb fracture undergoing orthopedic surgery is not validated. In this study, 141 patients with lower limb fracture admitted through the emergency department and undergoing orthopedic surgery were enrolled. Postoperative venous blood samples for D-dimer assay were taken on the 1st, 7th, and 28th postoperative days. Color Doppler sonography examination of both lower limbs was performed at the same time as a standard test. Eight out of the 141 patients (6%) had acute DVT based on Color Doppler sonography. Mean D-dimer was 2160 ng/mL in DVT positive patients and 864 in DVT negative patients. D-dimer levels greater than 1000 ng/mL were 100% sensitive and 71% specific for detecting postoperative DVT. D-dimer assay is a useful and sensitive test for detecting posttraumatic DVT.

Identification of intraluminal thrombus by ultrasonography in emergency department patients with acute deep venous thrombosis.

PubMed

Mehta, Ninfa; Schecter, Joshua; Stone, Michael

2012-05-01

Traditionally, the diagnosis of deep venous thrombosis (DVT) using duplex ultrasonography (DU) has relied on the absence of venous compressibility. Visualization of an intraluminal thrombus is considered an uncommon finding. The purpose of this study is to determine the frequency of intraluminal thrombus in emergency department (ED) patients diagnosed with acute DVT. Retrospective chart review of adult ED patients with DU examinations demonstrating acute DVT. Patients with chronic DVT or patients in whom DU did not demonstrate DVT were excluded from data analysis. Study reports and ultrasound images were reviewed and analyzed for the presence of intraluminal thrombus. There were 189 patients who met inclusion criteria, of which 160 (85%) were found to have intraluminal thrombus. Intraluminal thrombi are present in the majority of patients in our ED in whom acute DVT is identified by DU. Copyright © 2012 Elsevier Inc. All rights reserved.

Deep venous thrombosis after saphenous endovenous radiofrequency ablation: is it predictable?

PubMed

Jacobs, Chad E; Pinzon, Maria Mora; Orozco, Jennifer; Hunt, Peter J B; Rivera, Aksim; McCarthy, Walter J

2014-04-01

Endovenous radiofrequency ablation (RFA) is a safe and effective treatment for varicose veins caused by saphenous reflux. Deep venous thrombosis (DVT) is a known complication of this procedure. The purpose of this study is to describe the frequency of DVT after RFA and the associated predisposing factors. A retrospective analysis was performed using prospectively collected data from December 2008 to December 2011; a total of 277 consecutive office-based RFA procedures were performed at a single institution using the VNUS ClosureFast catheter (VNUS Medical Technologies, San Jose, CA). Duplex ultrasonography scans were completed 2 weeks postprocedure in all patients. Risk factors assessed for the development of DVT included: great versus small saphenous vein (SSV) treated, right versus left side treated, number of radiofrequency cycles used, hypercoagulable state, history of DVT, tobacco use, medications (i.e., oral contraceptives, aspirin, warfarin, and clopidogrel), and vein diameter at the junction of the superficial and deep systems. Seventy-two percent of the patients were women, 56% were treated on the right side, and 86% were performed on the great saphenous vein (GSV). The mean age was 54 ± 14 years (range: 23-88 years). Three percent of patients had a preprocedure diagnosis of hypercoagulable state, and 8% had a history of previous DVT. On postprocedural ultrasound, thrombus protrusion into the deep system without occlusion (endovenous heat-induced thrombosis) was present in 11 patients (4%). DVT, as defined by thrombus protrusion with complete occlusion of the femoral or popliteal vein, was identified in 2 patients (0.7%). Previous DVT was the only factor associated with postprocedural DVT (P = 0.018). Although not statistically significant, there was a trend toward a higher risk of DVT in SSV-treated patients. Factors associated with endovascular heat-induced thrombosis alone were male sex (P = 0.02), SSV treatment (P = 0.05), aspirin use (P = 0.008), and factor V Leiden deficiency (P = 0.01). The use of RFA to treat patients with symptoms caused by saphenous reflux involves a small but definite risk of DVT. This study shows that the risk of post-RFA DVT is greater in patients with previous DVT, with a trend toward an increased risk in patients having treatment of the SSV. Periprocedural anticoagulation may be considered in this subset to reduce the risk of DVT after RFA. Thrombus protrusion without DVT was found to be more likely in patients with hypercoagulability, male sex, SSV treatment, and aspirin use. Additional prospective studies are required to analyze these and other factors that may predict thrombotic events after endovenous RFA. Copyright © 2014 Elsevier Inc. All rights reserved.

Fluid management with a simplified conservative protocol for the acute respiratory distress syndrome*.

PubMed

Grissom, Colin K; Hirshberg, Eliotte L; Dickerson, Justin B; Brown, Samuel M; Lanspa, Michael J; Liu, Kathleen D; Schoenfeld, David; Tidswell, Mark; Hite, R Duncan; Rock, Peter; Miller, Russell R; Morris, Alan H

2015-02-01

In the Fluid and Catheter Treatment Trial (FACTT) of the National Institutes of Health Acute Respiratory Distress Syndrome Network, a conservative fluid protocol (FACTT Conservative) resulted in a lower cumulative fluid balance and better outcomes than a liberal fluid protocol (FACTT Liberal). Subsequent Acute Respiratory Distress Syndrome Network studies used a simplified conservative fluid protocol (FACTT Lite). The objective of this study was to compare the performance of FACTT Lite, FACTT Conservative, and FACTT Liberal protocols. Retrospective comparison of FACTT Lite, FACTT Conservative, and FACTT Liberal. Primary outcome was cumulative fluid balance over 7 days. Secondary outcomes were 60-day adjusted mortality and ventilator-free days through day 28. Safety outcomes were prevalence of acute kidney injury and new shock. ICUs of Acute Respiratory Distress Syndrome Network participating hospitals. Five hundred three subjects managed with FACTT Conservative, 497 subjects managed with FACTT Liberal, and 1,124 subjects managed with FACTT Lite. Fluid management by protocol. Cumulative fluid balance was 1,918 ± 323 mL in FACTT Lite, -136 ± 491 mL in FACTT Conservative, and 6,992 ± 502 mL in FACTT Liberal (p < 0.001). Mortality was not different between groups (24% in FACTT Lite, 25% in FACTT Conservative and Liberal, p = 0.84). Ventilator-free days in FACTT Lite (14.9 ± 0.3) were equivalent to FACTT Conservative (14.6 ± 0.5) (p = 0.61) and greater than in FACTT Liberal (12.1 ± 0.5, p < 0.001 vs Lite). Acute kidney injury prevalence was 58% in FACTT Lite and 57% in FACTT Conservative (p = 0.72). Prevalence of new shock in FACTT Lite (9%) was lower than in FACTT Conservative (13%) (p = 0.007 vs Lite) and similar to FACTT Liberal (11%) (p = 0.18 vs Lite). FACTT Lite had a greater cumulative fluid balance than FACTT Conservative but had equivalent clinical and safety outcomes. FACTT Lite is an alternative to FACTT Conservative for fluid management in Acute Respiratory Distress Syndrome.

A cost-analysis model for anticoagulant treatment in the hospital setting.

PubMed

Mody, Samir H; Huynh, Lynn; Zhuo, Daisy Y; Tran, Kevin N; Lefebvre, Patrick; Bookhart, Brahim

2014-07-01

Rivaroxaban is the first oral factor Xa inhibitor approved in the US to reduce the risk of stroke and blood clots among people with non-valvular atrial fibrillation, treat deep vein thrombosis (DVT), treat pulmonary embolism (PE), reduce the risk of recurrence of DVT and PE, and prevent DVT and PE after knee or hip replacement surgery. The objective of this study was to evaluate the costs from a hospital perspective of treating patients with rivaroxaban vs other anticoagulant agents across these five populations. An economic model was developed using treatment regimens from the ROCKET-AF, EINSTEIN-DVT and PE, and RECORD1-3 randomized clinical trials. The distribution of hospital admissions used in the model across the different populations was derived from the 2010 Healthcare Cost and Utilization Project database. The model compared total costs of anticoagulant treatment, monitoring, inpatient stay, and administration for patients receiving rivaroxaban vs other anticoagulant agents. The length of inpatient stay (LOS) was determined from the literature. Across all populations, rivaroxaban was associated with an overall mean cost savings of $1520 per patient. The largest cost savings associated with rivaroxaban was observed in patients with DVT or PE ($6205 and $2742 per patient, respectively). The main driver of the cost savings resulted from the reduction in LOS associated with rivaroxaban, contributing to ∼90% of the total savings. Furthermore, the overall mean anticoagulant treatment cost was lower for rivaroxaban vs the reference groups. The distribution of patients across indications used in the model may not be generalizable to all hospitals, where practice patterns may vary, and average LOS cost may not reflect the actual reimbursements that hospitals received. From a hospital perspective, the use of rivaroxaban may be associated with cost savings when compared to other anticoagulant treatments due to lower drug cost and shorter LOS associated with rivaroxaban.

Blood Clots That Kill: Preventing DVT | NIH MedlinePlus the Magazine

MedlinePlus

... please turn Javascript on. Feature: Deep Vein Thrombosis Blood Clots That Kill: Preventing DVT Past Issues / Spring 2011 ... Contents Deep vein thrombosis, or DVT, is a blood clot that forms in a vein deep in the ...

Incidence of deep vein thrombosis and pulmonary embolism after Achilles tendon rupture.

PubMed

Patel, Arush; Ogawa, Brent; Charlton, Timothy; Thordarson, David

2012-01-01

The use of venous thromboembolism prophylaxis after an Achilles rupture is controversial. The rates of reported deep vein thrombosis (DVT) range from 6.3% to 34%. There is no agreement regarding prophylactic therapy after an Achilles tendon rupture. We determined the overall risk of DVT and pulmonary embolism (PE) after an Achilles tendon rupture and identified potential risk factors including surgery. We retrospectively reviewed a large healthcare management organization database and identified 1172 patients who had Achilles tendon ruptures. None of the patients routinely received anticoagulation. Patients were stratified into surgical versus nonsurgical group, age older than 40 years, history of congestive heart failure, previous history of DVT or PE, and BMI greater than 30. A patient was considered to have symptomatic DVT or PE related to the Achilles tendon rupture if diagnosed within 3 months from the injury or surgery. We used a multivariable analysis to identify risk factors. The overall rates for DVT and PE after Achilles tendon ruptures were 0.43% and 0.34%, respectively. Age older than 40 years, congestive heart failure, history of DVT or PE, obesity, and whether a patient had surgery did not predict occurrence of DVT or PE. We found the overall incidence of symptomatic DVT and PE to be low after an Achilles tendon rupture and believe routine use of anticoagulation might be unwarranted.

[Ultrasound examination for lower extremity deep vein thrombosis].

PubMed

Toyota, Kosaku

2014-09-01

Surgery is known to be a major risk factor of vein thrombosis. Progression from lower extremity deep vein thrombosis (DVT) to pulmonary embolism can lead to catastrophic outcome, although the incidence ratio is low. The ability to rule in or rule out DVT is becoming essential for anesthesiologists. Non-invasive technique of ultrasonography is a sensitive and specific tool for the assessment of lower extremity DVT. This article introduces the basics and practical methods of ultrasound examination for lower extremity DVT.

Acquired activated protein C resistance associated with anti-protein S antibody as a strong risk factor for DVT in non-SLE patients.

PubMed

Nojima, Junzo; Kuratsune, Hirohiko; Suehisa, Etsuji; Kawasaki, Tomio; Machii, Takashi; Kitani, Teruo; Iwatani, Yoshinori; Kanakura, Yuzuru

2002-11-01

Anti-phospholipid (aPL) antibodies (Abs) are well known to be associated with thromboembolic events in patients with systemic lupus erythematosus (SLE). However, the clinical relevance of a PL Abs in patients without SLE (non-SLE) who have venous thromboembolism remains unclear. We evaluated 143 non-SLE patients with a first episode of clinically suspected deep vein thrombosis (DVT) by using objective tests for diagnosing DVT and laboratory tests including the activated protein C resistance (APC-R) test, the factor V Leiden test, and various aPL Abs. The prevalence of acquired APC-R, in which case there was no factor V Leiden mutation, was significantly higher in patients with DVT (15/58 cases, 25.9%, p < 0.0001) than in those without DVT (3/80 cases, 3.7%), and confirmed that acquired APC-R was a strong risk factor for DVT (odds ratio [OR], 8.95; 95% confidence intervals [CI], 2.45-32.7; p < 0.001). Multivariate logistic analysis revealed that the presence of LA, aCL, anti-beta2-glycoprotein I, anti-prothrombin and anti-protein C Abs was not reliable as a risk factor for DVT in non-SLE patients, and that the presence of anti-protein S Abs was the most significant risk factor for DVT (OR, 5.88; 95% CI, 1.96-17.7; p < 0.002). Furthermore, the presence of anti-protein S Abs was strongly associated with acquired APC-R (OR, 57.8; 95% CI, 8.53-391; p < 0.0001). These results suggest that acquired APC-R may reflect functional interference by anti-protein S Abs of the protein C pathway, which action may represent an important mechanism for the development DVT in non-SLE patients.

Deep Vein Thrombosis in Patients with Severe Motor and Intellectual Disabilities, Especially Diagnosis and Prevention of Recurrence for Chronic Thrombosis—Serial Changes of Sonography and D-Dimer

PubMed Central

Kanaoka, Yasushi; Murata, Yoshio; Yamasaki, Masami; Takesue, Hiroko; Matsumoto, Nobuo; Sumimoto, Ryo; Ohgi, Shigetsugu

2015-01-01

Most patients with severe motor and intellectual disabilities (SMID) have restricted mobility capability and have been bedridden for long periods because of paralysis of the extremities caused by abnormal muscular tonicity due to cerebral palsy and developmental disabilities. Such patients are associated with a high risk of complications like deep vein thrombosis (DVT). Here, we report twelve patients (42.9%) with DVT among 28 patients with SMID during prolonged bed rest. However, we did not detect thrombosis in the soleal veins, finding it mostly in the femoral and common femoral veins. We applied anticoagulant therapy (warfarin), and carefully followed up the cases with DVT, regulating the warfarin dosage at prothrombin time-international normalized ratio (PT-INR) values around two to prevent recurrence of chronic thrombosis. Regarding laboratory data for the coagulation system, there were no cases above 5 µg/ml for the D-dimer and there were significant differences between the DVT and non-DVT groups in the D-dimer levels. The plasma levels of D-dimer in patients with DVT diminished to less than 1.0 µg/ml after warfarin treatment. Concerning sudden death (4.2%) in patients with SMID, we have to be very careful of the possibility of pulmonary thromboembolism due to DVT. Therefore, we should consider the particularity of the underdeveloped vascular system from underlying diseases for the evaluation of DVT. A detailed study of DVT as a vascular complication is very important for the smooth medical care of SMID, and serial assessment of compression Doppler ultrasonography of the lower extremities, as a noninvasive examination and measurement of D-dimer, is very helpful. (This article is a translation of Jpn J Phlebol 2014; 25: 34–42.) PMID:26730253

Altered plasma levels of cytokines, soluble adhesion molecules and matrix metalloproteases in venous thrombosis.

PubMed

Mosevoll, Knut Anders; Lindås, Roald; Tvedt, Tor Henrik Anderson; Bruserud, Øystein; Reikvam, Håkon

2015-07-01

Recent studies have emphasized the importance of the inflammatory response mediated by monocyte and neutrophil activation in deep venous thrombosis (DVT); we therefore investigated whether this response was reflected in the plasma profile of inflammatory mediators in patients with suspected DVT. We included a group of 169 consecutive patients admitted to hospital from the primary health care service with suspected lower limb DVT. Plasma levels of 43 mediators were examined for a cohort of 89 consecutive patients and 20 healthy controls by Luminex multiplex analyses, i.e. 13 interleukins, 3 immunomodulatory cytokines, 8 chemokines, 8 growth factors, 3 adhesion molecules and 8 matrix metalloproteases. Selected mediators were analyzed for a second cohort of 80 consecutive patients. Thirty-five of 169 (21%) of referred patients were diagnosed with DVT. Only P-selectin (p<0.0001), vascular cell adhesion protein 1 (VCAM-1, p=0.0009), matrix metalloprotease 8 (MMP-8, p=0.0151) and hepatocyte growth factor (HGF, p=0.0415) differed significantly when comparing patients with and without DVT. When comparing DVT patients with healthy controls we observed significant differences for several mediators, where P-selectin (p=0.0009), VCAM-1 (p<0.0001), all the MMPs (all p<0.0014) and HGF (p<0.0001) showed the strongest significant differences. Unsupervised hierarchical clustering analyses based on biomarkers showing differences between patients with and without DVT could be used to identify patient subsets that differed significantly in DVT frequency. Plasma biomarker profiling of selected soluble mediators can be used to identify subsets among patients with suspected lower limb thrombosis that differ significantly in their frequencies of DVT. Copyright © 2015 Elsevier Ltd. All rights reserved.

Incidence and risk factors for preoperative deep venous thrombosis in 314 consecutive patients undergoing surgery for spinal metastasis.

PubMed

Zacharia, Brad E; Kahn, Sweena; Bander, Evan D; Cederquist, Gustav Y; Cope, William P; McLaughlin, Lily; Hijazi, Alexa; Reiner, Anne S; Laufer, Ilya; Bilsky, Mark

2017-08-01

OBJECTIVE The authors of this study aimed to identify the incidence of and risk factors for preoperative deep venous thrombosis (DVT) in patients undergoing surgical treatment for spinal metastases. METHODS Univariate analysis of patient age, sex, ethnicity, laboratory values, comorbidities, preoperative ambulatory status, histopathological classification, spinal level, and surgical details was performed. Factors significantly associated with DVT univariately were entered into a multivariate logistic regression model. RESULTS The authors identified 314 patients, of whom 232 (73.9%) were screened preoperatively for a DVT. Of those screened, 22 (9.48%) were diagnosed with a DVT. The screened patients were older (median 62 vs 55 years, p = 0.0008), but otherwise similar in baseline characteristics. Nonambulatory status, previous history of DVT, lower partial thromboplastin time, and lower hemoglobin level were statistically significant and independent factors associated with positive results of screening for a DVT. Results of screening were positive in only 6.4% of ambulatory patients in contrast to 24.4% of nonambulatory patients, yielding an odds ratio of 4.73 (95% CI 1.88-11.90). All of the patients who had positive screening results underwent preoperative placement of an inferior vena cava filter. CONCLUSIONS Patients requiring surgery for spinal metastases represent a population with unique risks for venous thromboembolism. This study showed a 9.48% incidence of DVT in patients screened preoperatively. The highest rates of preoperative DVT were identified in nonambulatory patients, who were found to have a 4-fold increase in the likelihood of harboring a DVT. Understanding the preoperative thrombotic status may provide an opportunity for early intervention and risk stratification in this critically ill population.

Statins, inflammation and deep vein thrombosis: a systematic review

PubMed Central

Rodriguez, April L.; Wojcik, Brandon M.; Wrobleski, Shirley K.; Myers, Daniel D.; Wakefield, Thomas W.

2012-01-01

Venous thromboembolism (VTE) includes both deep vein thrombosis (DVT) and pulmonary embolism. The 2009 JUPITER trial showed a significant decrease in DVT in non-hyperlipidemic patients, with elevated C-reactive protein (CRP) levels, treated with rosuvastatin. The effects of statins on thrombosis are unclear, prompting this literature review. A literature search was performed (1950 to February 2011) with MEDLINE, EMBASE, and PUBMED databases including the following keywords: “statins”, “hydroxymethylglutaryl-CoA reductase inhibitors”, “VTE”, “PE”, “DVT”, and either “anti-coagulation” or “inflammation”. Editorials, reviews, case reports, meta-analysis and duplicates were excluded. Inflammatory biomarkers of DVT, include interleukin (IL)-6, CRP, IL-8, and monocyte chemotactic protein 1 (MCP-1). Statin therapy reduces IL-6 expression of CRP and MCP-1, usually elevated in VTE. Reduction of IL-6 induced MCP-1 has been linked to vein wall fibrosis, promoting post thrombotic syndrome (PTS) and recurrent DVT in patients. Also, our review suggests that the anti-thrombotic effects are likely exhibited through the anti-inflammatory properties of statins. This work supports that statin therapy has the ability to decrease the incidence and recurrence of VTE and the potential to decrease PTS. This is mainly due to the anti-inflammatory effects of statins and may explain why normolipidemic patients, with elevated CRP, appear to have the greatest reduction in VTE. Given their low risk of bleeding, statins have the potential to serve as a safe adjunctive pharmacological therapy to current treatments in select patients with VTE, however further investigations into this concept are needed and essential. PMID:22278047

Assessment of 30-day mortality and complication rates associated with extended deep vein thrombosis prophylaxis following hip fracture surgery.

PubMed

Durand, Wesley M; Goodman, Avi D; Johnson, Joey P; Daniels, Alan H

2018-06-01

DVT is a common complication following lower extremity surgery, occurring in up to 60% of patients undergoing hip fracture surgery without postoperative anticoagulation. The risk of fatal PE continues well-beyond two weeks postoperatively, thus extended DVT prophylaxis beyond 14 days may be warranted. This investigation sought to examine the association between prescription of extended DVT prophylaxis and 30-day postoperative complications following hip fracture surgery. This study utilized the ACS NSQIP Hip Fracture Procedure Targeted dataset, a newly available set of patient variables for 2016. The outcome measures were death, occurrence of any postoperative complication, complication subtype, readmission or reoperation within 30-days postoperatively, and length of stay. The primary independent variable was medical DVT prophylaxis continued 28-days postoperatively ("extended DVT prophylaxis"). The control group contains both patients receiving no prophylaxis and those receiving short-duration prophylaxis. Multivariate stepwise logistic regression was employed to control for potential demographic, comorbidity, and procedural/medical confounding factors. In total, 7533 surgically treated hip fracture patients treated in 2016 were analyzed. Overall, 57.8% of patients (n = 4354) were prescribed extended DVT prophylaxis. On bivariate analysis, prescription of extended DVT prophylaxis was associated with significantly lower incidence of death (7.7% without vs. 2.7% with, p < 0.0001) and stroke/CVA (1.4% vs. 0.6%, p = 0.0016). In multivariate analysis, prescription of extended DVT prophylaxis was significantly associated with lower odds of death (OR 0.33, p < 0.0001), stroke/CVA (OR 0.44, p = 0.0010), and acute kidney injury (AKI) (OR 0.31, p = 0.0010). This retrospective cohort study of the 2016 ACS NSQIP found that hip fracture surgery patients prescribed ≥28 days of postoperative DVT prophylaxis exhibited 67% lower odds of death and significantly lower rates of AKI and stroke/CVA as compared to those prescribed short-duration prophylaxis. Given the retrospective and uncontrolled nature of this analysis, these results should be interpreted with caution, and additional prospective randomized controlled trials examining the association between extended DVT prophylaxis and postoperative outcomes are warranted. If these observations accurately reflect real-world experience, these data suggest that ≥28 days of DVT prophylaxis following hip fracture surgery should be strongly considered for patients without explicit contraindications. Copyright © 2018 Elsevier Ltd. All rights reserved.

Inpatient resource use and cost burden of deep vein thrombosis and pulmonary embolism in the United States.

PubMed

LaMori, Joyce C; Shoheiber, Omar; Mody, Samir H; Bookhart, Brahim K

2015-01-01

Venous thromboembolism (VTE), which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE), is associated with significant morbidity and mortality. VTE frequently leads to hospitalization and represents a considerable economic burden to the US health care system. However, little information exists on the duration of hospitalization and associated charges among patients with an admitting or primary diagnosis of DVT or PE. This study assessed the charges associated with hospitalization length of stay in patients with DVT or PE discharged from US hospitals in 2011. Using data from the Nationwide Inpatient Sample of the Healthcare Utilization Project database, this analysis examined hospital length of stay and associated charges in patients with DVT or PE discharged from US hospitals in 2011. Both initial and subsequent hospitalizations were analyzed. DVT was responsible for fewer hospitalizations than PE. In 2011, among 330,044 patients with VTE discharged from US hospitals, 143,417 had DVT and 186,627 had PE. Mean length of stay for patients with DVT was 4.7 days (median, 3.9 days) compared with 5.1 days (median, 4.5 days) for patients with PE. For initial hospitalizations, the mean (SE) charge amounted to $30,051 ($246) for DVT compared with $37,006 ($214) for PE. Older patients with PE incurred greater hospital charges than younger ones, and for both DVT and PE patients, women incurred greater charges than men. Of 31,463 patients admitted to the hospital with PE, 4.0% had a subsequent admission, which was more costly than the initial admission. Many patients with both DVT and PE were discharged to specialist nursing facilities, indicating continuing posthospitalization charges. Hospital stays for DVT and PE represent a substantial cost burden to the US health care system. Health care systems have the potential to reduce the clinical and economic burden of VTE by ensuring that evidence-based, guideline-recommended anticoagulation therapy is adhered to by patients with an initial VTE. Appropriate anticoagulant therapy and continuity of care in these patients may reduce the incidence and frequency of hospital readmissions and VTE-related morbidity and mortality and have a potential effect on health care resources. Copyright © 2015. Published by Elsevier Inc.

TES L2 Lite Standard Products

Atmospheric Science Data Center

2015-07-21

L2 Lite Standard Products The TES Lite products are intended to simplify TES data usage including data /model and data/data comparisons. This product can be used for science analysis ... PGE corrected a date range issue in the originally delivered standard output.  An updated set of  TES L2 Lite standard products was ...

Characterization of central venous catheter-associated deep venous thrombosis in infants.

PubMed

Gray, Brian W; Gonzalez, Raquel; Warrier, Kavita S; Stephens, Lauren A; Drongowski, Robert A; Pipe, Steven W; Mychaliska, George B

2012-06-01

Deep venous thrombosis (DVT) is a frequent complication in infants with central venous catheters (CVCs). We performed this study to identify risk factors and risk-reduction strategies of CVC-associated DVT in infants. Infants younger than 1 year who had a CVC placed at our center from 2005 to 2009 were reviewed. Patients with ultrasonically diagnosed DVT were compared to those without radiographic evidence. Of 333 patients, 47% (155/333) had femoral, 33% (111/333) had jugular, and 19% (64/333) had subclavian CVCs. Deep venous thromboses occurred in 18% (60/333) of patients. Sixty percent (36/60) of DVTs were in femoral veins. Femoral CVCs were associated with greater DVT rates (27%; 42/155) than jugular (11%; 12/111) or subclavian CVCs (9%; 6/64; P < .01). There was a 16% DVT rate in those with saphenofemoral Broviac CVCs vs 83% (20/24) in those with percutaneous femoral lines (P < .01). Multilumen CVCs had higher DVT rates than did single-lumen CVCs (54% vs 6%, P < .01), and mean catheter days before DVT diagnosis was shorter for percutaneous lines than Broviacs (13 ± 17 days vs 30 ± 37 days, P = .02). Patients with +DVT had longer length of stay (86 ± 88 days vs 48 ± 48 days, P < .01) and higher percentage of intensive care unit admission (82% vs 70%, P = .02). Deep venous thrombosis reduction strategies in infants with CVCs include avoiding percutaneous femoral and multilumen CVCs, screening percutaneous lines, and early catheter removal. Copyright © 2012 Elsevier Inc. All rights reserved.

Tissue factor expressed by circulating cancer cell-derived microparticles drastically increases the incidence of deep vein thrombosis in mice

PubMed Central

Thomas, G. M.; Brill, A.; Mezouar, S.; Crescence, L.; Gallant, M.; Dubois, C.; Wagner, D. D.

2015-01-01

Background The risk of thrombotic complications such as deep vein thrombosis (DVT) during tumor development is well known. Tumors release into circulation procoagulant microparticles (MPs) that can participate in thrombus formation following vessel injury. The importance of this MP tissue factor (TF) in the initiation of cancer-associated DVT remains uncertain. Objective To address how pancreatic cancer MPs promote DVT in vivo. Methods We combined a DVT mouse model where thrombosis is induced by flow restriction of the inferior vena cava with one of subcutaneous pancreatic cancer in C57BL/6J mice. We infused high and low TF tumor MPs to determine the importance of TF in experimental cancer-associated DVT. Results Both tumor-bearing mice and mice infused with tumor MPs submitted to 3 hours of partial flow restriction developed an occlusive thrombus; fewer than a third of the control mice did. We observed that MPs adhered to neutrophil extracellular traps (NETs), functionally important players during DVT, whereas neither P-selectin nor GPIb were required for the MP recruitment in DVT. The thrombotic phenotype induced by MP infusion was suppressed by hirudin suggesting the importance of thrombin generation. TF carried by tumor MPs was essential to promote DVT as mice infused with low TF tumor MPs had less thrombosis than mice infused with high TF tumor MPs. Conclusions TF expressed on tumor MPs contributes to the increased incidence of cancer-associated venous thrombosis in mice in vivo. These MPs may adhere to NETs formed at the site of thrombosis. PMID:25955268

Tissue factor expressed by circulating cancer cell-derived microparticles drastically increases the incidence of deep vein thrombosis in mice.

PubMed

Thomas, G M; Brill, A; Mezouar, S; Crescence, L; Gallant, M; Dubois, C; Wagner, D D

2015-07-01

The risk of thrombotic complications such as deep vein thrombosis (DVT) during tumor development is well known. Tumors release into the circulation procoagulant microparticles (MPs) that can participate in thrombus formation following vessel injury. The importance of this MP tissue factor (TF) in the initiation of cancer-associated DVT remains uncertain. To investigate how pancreatic cancer MPs promote DVT in vivo. We combined a DVT mouse model in which thrombosis is induced by flow restriction in the inferior vena cava with one of subcutaneous pancreatic cancer in C57BL/6J mice. We infused high-TF and low-TF tumor MPs to determine the importance of TF in experimental cancer-associated DVT. Both tumor-bearing mice and mice infused with tumor MPs subjected to 3 h of partial flow restriction developed an occlusive thrombus; fewer than one-third of the control mice did. We observed that MPs adhered to neutrophil extracellular traps (NETs), which are functionally important players during DVT, whereas neither P-selectin nor glycoprotein Ib were required for MP recruitment in DVT. The thrombotic phenotype induced by MP infusion was suppressed by hirudin, suggesting the importance of thrombin generation. TF carried by tumor MPs was essential to promote DVT, as mice infused with low-TF tumor MPs had less thrombosis than mice infused with high-TF tumor MPs. TF expressed on tumor MPs contributes to the increased incidence of cancer-associated venous thrombosis in mice in vivo. These MPs may adhere to NETs formed at the site of thrombosis. © 2015 International Society on Thrombosis and Haemostasis.

Role of blood transfusion product type and amount in deep vein thrombosis after cardiac surgery.

PubMed

Ghazi, Lama; Schwann, Thomas A; Engoren, Milo C; Habib, Robert H

2015-12-01

Postoperative deep vein thrombosis (DVT) is associated with significant morbidity. Even with maximal thromboprophylaxis, postoperative DVT is present in 10% of cardiac surgery patients, and is linked to receiving transfusion. We hypothesized that the incidence of DVT varies with the transfused blood product type, and increases with transfusion dose. 139/1070 cardiac surgery patients have DVT despite maximal chemo and mechanical prophylaxis. DVTs were detected via serial perioperative duplex venous scans (DVS). Red blood cells (RBC), platelets (PLT), plasma (FFP) and cryoprecipitate transfusion data were collected. Transfusion was used in 506(47%) patients: RBC [468(44%); 4.0 ± 4.2u]; FFP [155(14.5%); 3.5 ± 2.3 u]; PLT [185(17.3%); 2.2 ± 1.3 u] and Cryoprecipitate [51(4.8%); 1.3 ± 0.6 u]. Isolated RBC transfusion accounted for 92.6% patients receiving one product, and their DVT rate was increased considerably compared to no transfusion (16.7% versus 7.3%; P<0.001). Incidence of DVT increased substantially for multiple product transfusions; particularly when both RBC and FFP are used (25%-40%). Relative to no RBC (n=602), multivariate logistic regression analysis identified a significant RBC-DVT dose dependent relation (P<0.001) with: 1-3 RBC units [n=285, AOR=1.95(1.23-3.07), adjusted odds ratio (95% confidence interval)]; 4-6 units [n=117; AOR=1.65(0.86-3.20)]; and ≥ 7 RBC units [n=66; 3.19(1.52-6.70)]. This relation also increased according to an RBC∗FFP interaction term [AOR=1.87(1.11-3.22); P=0.022]. RBC transfusion is associated with increased risk of DVT after cardiac surgery in a dose-dependent fashion that is exacerbated when accompanied with FFP. Postoperative screening diagnostic DVS are warranted in this transfused, high risk for DVT population to facilitate timely therapeutic intervention. Copyright © 2015 Elsevier Ltd. All rights reserved.

Toll-like receptor 9 gene expression in the post-thrombotic syndrome, residual thrombosis and recurrent deep venous thrombosis: A case-control study.

PubMed

Cheung, Y Whitney; Bouman, Annemieke C; Castoldi, Elisabetta; Wielders, Simone J; Spronk, Henri M H; Ten Cate, Hugo; Ten Cate-Hoek, Arina J; Ten Wolde, Marije

2016-04-01

Animal models suggest that toll-like receptor 9 (TLR9) promotes thrombus resolution after acute deep venous thrombosis (DVT). We hypothesized that TLR9 expression is lower in patients with post-thrombotic syndrome (PTS) and investigated the role of TLR9 in residual thrombosis (RT) and recurrence. Patients with a history of DVT with PTS (cases, n=30) and without PTS after minimal 24 months follow-up (controls, n=30) were selected. Healthy individuals (HI, n=29) without DVT were included as reference. TLR9 mRNA expression in leukocytes was determined by qPCR and normalized to the housekeeping succinate dehydrogenase subunit A gene using the ΔCt method. Sub analyses were performed to explore the TLR9 expression in patients with and without RT and multiple DVT episodes. The median TLR9 expression was 0.45 (interquartile range 0.31 to 0.93), 0.39 (0.25 to 0.69) and 0.62 (0.32 to 0.75) in cases, controls and HI respectively (p=0.61). The median TLR9 expression was 0.39 (0.26 to 0.51) in patients with RT compared to 0.55 (0.30 to 0.86, p=0.13) in those without. The median TLR9 expression was significantly lower in patients who had one DVT compared to patients with recurrent DVT, 0.37 (0.23 to 0.63) versus 0.55 (0.43 to 0.96) respectively (p<0.01). No significant difference in TLR9 expression was found between cases, controls and HI. However TLR9 expression seems lower in individuals with DVT and RT, albeit not significant. Interestingly, TLR9 might play a role in recurrent DVT, as the TLR9 expression was significantly higher in patients with recurrent DVT. Copyright © 2016 Elsevier Ltd. All rights reserved.

Accuracy of screening compression ultrasonography and clinical examination for the diagnosis of deep vein thrombosis after total hip or knee arthroplasty

PubMed Central

Robinson, K. Sue; Anderson, David R.; Gross, Michael; Petrie, David; Leighton, Ross; Stanish, William; Alexander, David; Mitchell, Michael; Mason, William; Flemming, Bruce; Fairhurst-Vaughan, Marlene; Gent, Michael

1998-01-01

Objective To determine whether compression ultrasonography or clinical examination should be considered as screening tests for the diagnosis of deep vein thrombosis (DVT) after total hip or knee arthroplasty in patients receiving warfarin prophylaxis postoperatively. Design A prospective cohort study. Setting A single tertiary care orthopedic centre. Patients One hundred and eleven patients who underwent elective total hip or knee arthroplasty were enrolled. Postoperatively the warfarin dose was adjusted daily to maintain the international normalized ratio between 1.8 and 2.5. Eighty-six patients successfully completed the study protocol. Intervention Before they were discharged from hospital, patients were assessed for DVT by clinical examination, bilateral compression ultrasonography of the proximal venous system and bilateral contrast venography. Results DVT was found in 29 patients (34%; 95% confidence interval [CI] 24% to 45%), and 6 patients (7%; 95% CI 3% to 15%) had proximal DVT. DVT developed in 18 (40%) of 45 patients who underwent total knee arthroplasty and in 11 (27%) of 41 patients who underwent total hip arthroplasty. The sensitivity of compression ultrasonography for the diagnosis of proximal DVT was 83% (95% CI 36% to 99%) and the specificity was 98% (95% CI 91% to 99%). The positive predictive value of compression ultrasonography was 71%. In contrast, clinical examination for DVT had a sensitivity of 11% (95% CI 2% to 28%) and a positive predictive value of 25%. Conclusions DVT is a common complication after total hip or knee arthroplasty. Compression ultrasonography appears to be a relatively accurate noninvasive test for diagnosing postoperative proximal DVT. In contrast, clinical examination is a very insensitive test. Whether routine use of screening compression ultrasonography will reduce the morbidity of venous thromboembolism after joint arthroplasty requires confirmation in a prospective trial involving long-term follow-up of patients. PMID:9793503

Enhanced lysis and accelerated establishment of viscoelastic properties of fibrin clots are associated with pulmonary embolism.

PubMed

Martinez, Marissa R; Cuker, Adam; Mills, Angela M; Crichlow, Amanda; Lightfoot, Richard T; Chernysh, Irina N; Nagaswami, Chandrasekaran; Weisel, John W; Ischiropoulos, Harry

2014-03-01

The factors that contribute to pulmonary embolism (PE), a potentially fatal complication of deep vein thrombosis (DVT), remain poorly understood. Whereas fibrin clot structure and functional properties have been implicated in the pathology of venous thromboembolism and the risk for cardiovascular complications, their significance in PE remains uncertain. Therefore, we systematically compared and quantified clot formation and lysis time, plasminogen levels, viscoelastic properties, activated factor XIII cross-linking, and fibrin clot structure in isolated DVT and PE subjects. Clots made from plasma of PE subjects showed faster clot lysis times with no differences in lag time, rate of clot formation, or maximum absorbance of turbidity compared with DVT. Differences in lysis times were not due to alterations in plasminogen levels. Compared with DVT, clots derived from PE subjects showed accelerated establishment of viscoelastic properties, documented by a decrease in lag time and an increase in the rate of viscoelastic property formation. The rate and extent of fibrin cross-linking by activated factor XIII were similar between clots from DVT and PE subjects. Electron microscopy revealed that plasma fibrin clots from PE subjects exhibited lower fiber density compared with those from DVT subjects. These data suggest that clot structure and functional properties differ between DVT and PE subjects and provide insights into mechanisms that may regulate embolization.

Enhanced lysis and accelerated establishment of viscoelastic properties of fibrin clots are associated with pulmonary embolism

PubMed Central

Martinez, Marissa R.; Cuker, Adam; Mills, Angela M.; Crichlow, Amanda; Lightfoot, Richard T.; Chernysh, Irina N.; Nagaswami, Chandrasekaran; Weisel, John W.

2014-01-01

The factors that contribute to pulmonary embolism (PE), a potentially fatal complication of deep vein thrombosis (DVT), remain poorly understood. Whereas fibrin clot structure and functional properties have been implicated in the pathology of venous thromboembolism and the risk for cardiovascular complications, their significance in PE remains uncertain. Therefore, we systematically compared and quantified clot formation and lysis time, plasminogen levels, viscoelastic properties, activated factor XIII cross-linking, and fibrin clot structure in isolated DVT and PE subjects. Clots made from plasma of PE subjects showed faster clot lysis times with no differences in lag time, rate of clot formation, or maximum absorbance of turbidity compared with DVT. Differences in lysis times were not due to alterations in plasminogen levels. Compared with DVT, clots derived from PE subjects showed accelerated establishment of viscoelastic properties, documented by a decrease in lag time and an increase in the rate of viscoelastic property formation. The rate and extent of fibrin cross-linking by activated factor XIII were similar between clots from DVT and PE subjects. Electron microscopy revealed that plasma fibrin clots from PE subjects exhibited lower fiber density compared with those from DVT subjects. These data suggest that clot structure and functional properties differ between DVT and PE subjects and provide insights into mechanisms that may regulate embolization. PMID:24414255

Vena cava filters and thrombolytic therapeutic monitoring based on functional near-infrared spectroscopy for deep vein thrombosis

NASA Astrophysics Data System (ADS)

Pan, Boan; Liu, Weichao; Fang, Xiang; Zhao, Ke; Li, Ting

2018-02-01

Deep vein thrombosis (DVT), happening in inpatients usually and especially with the postoperative population, is a serious disease characterized by an increased incidence. The venography is the golden standard to diagnose DVT. However, it involves invasive contrast agent injection and give patients physical and mental pressure. Functional nearinfrared spectroscopy (fNIRS) has been reported recently to diagnose DVT. Thrombolytic therapy activates the dissolution system with an exogenous activator that dissolves coronary thrombosis. The vena cava filter is a medical filter used for the treatment of thrombosis and the prevention of pulmonary embolism. Here we attempt to use portable NIRS for the DVT monitoring in the whole process of vena cava filter implantation and thrombolytic treatment, and contrast the patients of untreated, vena cava filter implantation and thrombolytic treatment. 19 DVT patients and 12 normal subjects were recruited. Thereinto, 7 patients have taken vena cava filter implantation, and 6 patients have taken the thrombolytic treatment. It was found that deoxyhemoglobins (Δ[Hb]) fluctuates and even increases in DVT. After vena cava filter implantation, Δ[Hb] increases first, then decreases. However, it emerges the rising trend and converge to the curves of normal subjects in thrombolytic treatment. The oxyhemoglobins (Δ[HbO2]) emerges opposite trend in most paradigms. The findings reveal the potential of fNIRS for monitoring DVT and therapeutic effect evaluation of thrombolysis and vena cava filters.

Prevalence of Factor V Genetic Variants Associated With Indian APCR Contributing to Thrombotic Risk.

PubMed

Sharma, Amit; Bhakuni, Teena; Biswas, Arijit; Ranjan, Ravi; Kumar, Ravi; Kishore, Kamal; Mahapatra, Manoranjan; Jairajpuri, Mohamad Aman; Saxena, Renu

2017-09-01

Phenotypic resistance to activated protein C (APC) is a complex mechanism associated with increased thrombosis risk. Activated protein C resistance (APCR) is mainly influenced by FV Leiden mutation, and various other single nucleotide polymorphisms (SNPs) in FV gene are known to be associated with APCR. The aim of present study was to investigate the incidence and assess possible mechanisms of APCR in Indian patients with deep vein thrombosis (DVT). Three hundred and ten Doppler-proven patients with DVT were screened for APCR, and 50 APCR positive patients and 50 controls were typed for FV Leiden , Hong Kong, Cambridge, HR2 haplotype, Glu666Asp, Ala485Lys, and Liverpool using either polymerase chain reaction (PCR)-restriction fragment length polymorphism or allele specific PCR. FV Leiden was commonest cause of APCR (50%) in Indian patients with DVT being statistically significant ( P = .001) compared to controls. FV Liverpool, FV Glu666Asp and FV Ala485Lys were studied for the first time in Indian population. FV Liverpool, FV Glu666Asp, Hong Kong, and Cambridge were found to be absent. High frequency of Ala485Lys in patients shows that it might be a risk factor contributing to APCR in Indian patients with DVT. HR2 haplotype was not associated with APCR; however, presence of homozygous HR2 haplotype in patients only indicates the role it might play in Indian APCR population. In conclusion, contribution of FV Leiden causing APCR in Indian population is not as strong as previously reported in Western countries. The presence of other SNPs observed in the present study requires such studies on larger sample size to understand the molecular basis of defect.

Patients with inferior vena cava thrombosis frequently present with lower back pain and bilateral lower-extremity deep vein thrombosis.

PubMed

Kraft, Christiane; Hecking, Carola; Schwonberg, Jan; Schindewolf, Marc; Lindhoff-Last, Edelgard; Linnemann, Birgit

2013-07-01

Inferior vena cava (IVC) thrombosis is rare, and data about the clinical presentation of patients are scarce. Therefore, we reviewed all cases of IVC thrombosis consecutively registered in the MAISTHRO (MAin-ISar-THROmbosis) database and described patients’ characteristics in terms of their clinical presentations in the acute setting of IVC thrombosis. From the MAISTHRO registry, which enrolled 1470 consecutive patients with documented histories of venous thromboembolism, we identified 60 patients (0,4 %; females 60 %) with IVC thrombosis and 888 patients (60.4 %; females 55 %) with isolated lower-extremity deep vein thrombosis (LE-DVT). The median age at the time of IVC thrombosis manifestation was 36.5 years (9 to 83). IVC thrombosis was the initial VTE event in 47 patients (78 %). In the majority of cases, IVC thrombosis extended to the lower-extremity veins, and both lower extremities were affected in 17 cases (28 %). The initial clinical symptom of IVC thrombosis was lower back or abdominal pain which preceded typical symptoms of LE-DVT in 29 (48 %) patients. Symptomatic pulmonary embolism was more frequently observed in IVC thrombosis patients when compared to a sex- and age-matched subgroup of LE-DVT patients, although the difference was not significant (27 % vs. 12 %; p = 0.064). Malignant disease was the only established VTE risk factor with a higher prevalence among IVC thrombosis patients than patients with isolated LE-DVT (27 % vs. 9 %; p = 0.015). Congenital IVC anomalies were identified in another eight IVC thrombosis patients (13 %). IVC thrombosis should be considered a differential diagnosis for inexplicable lower back or abdominal pain especially in young patients. Malignant disease and congenital IVC anomalies seem to be predisposing factors for thrombosis involving the inferior vena cava.

Ionospheric Observations During a Geomagnetic Storm from LITES on the ISS

NASA Astrophysics Data System (ADS)

Finn, S. C.; Stephan, A. W.; Cook, T.; Budzien, S. A.; Chakrabarti, S.; Erickson, P. J.; Geddes, G.

2017-12-01

The Limb-Imaging Ionospheric and Thermospheric Extreme-Ultraviolet Spectrograph (LITES) is an extreme-ultraviolet imaging spectrograph that launched in February 2017 and was installed on the International Space Station (ISS). LITES is limb-viewing ( 150 - 350 km tangent altitude) and measures airglow emissions from 60 - 140 nm with 0.2° angular and 1 nm spectral resolutions. We present early LITES results of observations during a G2 geomagnetic storm in April 2017. In addition to LITES data, we will show complementary ground-based incoherent scatter radar (ISR) observations from Millstone Hill during this storm. The combination of LITES EUV space-based observations with the ground-based radio data is an example of the capability of campaign-style measurements of the ionosphere-thermosphere system using multiwavelength ground- and space-based instruments.

M2Lite: An Open-source, Light-weight, Pluggable and Fast Proteome Discoverer MSF to mzIdentML Tool.

PubMed

Aiyetan, Paul; Zhang, Bai; Chen, Lily; Zhang, Zhen; Zhang, Hui

2014-04-28

Proteome Discoverer is one of many tools used for protein database search and peptide to spectrum assignment in mass spectrometry-based proteomics. However, the inadequacy of conversion tools makes it challenging to compare and integrate its results to those of other analytical tools. Here we present M2Lite, an open-source, light-weight, easily pluggable and fast conversion tool. M2Lite converts proteome discoverer derived MSF files to the proteomics community defined standard - the mzIdentML file format. M2Lite's source code is available as open-source at https://bitbucket.org/paiyetan/m2lite/src and its compiled binaries and documentation can be freely downloaded at https://bitbucket.org/paiyetan/m2lite/downloads.

Prospective evaluation of a screening protocol to exclude deep vein thrombosis on the basis of a combination of quantitative D-dimer testing and pretest clinical probability score.

PubMed

Yamaki, Takashi; Nozaki, Motohiro; Sakurai, Hiroyuki; Takeuchi, Masaki; Soejima, Kazutaka; Kono, Taro

2005-11-01

Clinical signs and symptoms such as swelling, pain, and redness are unreliable markers of deep vein thrombosis (DVT). Because of this venous duplex scanning (VDS) has been heavily used in DVT detection. The purpose of this study was to determine if a combination of D-dimer testing and pretest clinical score could reduce the use of VDS in symptomatic patients with suspected DVT. One hundred seventy-four consecutive patients with suspected DVT were prospectively evaluated using pretest clinical probability (PCP) score and D-dimer testing before VDS. After calculating clinical probability scores developed by Wells and associates, patients were divided into low risk (or=3 points) PCP. One hundred fifty-eight patients were enrolled. The prevalence of DVT in this study was 37%. Thirty-eight patients (24%) were classified as low risk, 64 (41%) as moderate risk, and 56 (35%) as high risk PCP. DVT was identified in only one patient (2.6%) with low risk PCP. In contrast, DVT was found in 22 (34%) with moderate risk, and 35 (63%) with high risk PCP. In the high and moderate risk PCP groups, positive scan patients had a markedly higher value of D-dimer assay than negative scan patients (p=0.0001 and p=0.0057, respectively). In the low risk PCP patients, D-dimer testing provided 100% sensitivity, 46% specificity, 4.8% positive predictive value, and 100% negative predictive value in the diagnosis of DVT. Similarly, in the moderate risk PCP, the D-dimer testing showed 100% sensitivity, 45% specificity, 49% positive predictive value, and 100% negative predictive value. In the high risk group, D-dimer testing achieved 100% sensitivity, 57% specificity, 80% positive predictive value, and 100% negative predictive value in the diagnosis of DVT. These results suggested that 36 of 158 patients who had a non-high PCP (low and moderate PCP) and a normal D-dimer concentration were considered to have no additional investigation, so VDS could have been reduced by 23% (36/158). A combination of D-dimer testing and clinical probability score may be effective in avoiding unnecessary VDS in suspected symptomatic DVT in the low and moderate PCP patients. The need for VDS could be reduced by 23% despite a relatively high prevalence of DVT.

Association of Methylenetetrahydrofolate Reductase C677T Polymorphism with Hyperhomocysteinemia and Deep Vein Thrombosis in the Iranian Population.

PubMed

Ghaznavi, Habib; Soheili, Zahra; Samiei, Shahram; Soltanpour, Mohammad Soleiman

2015-12-01

Deep venous thrombosis (DVT) is a common but elusive condition characterized by a high morbidity and mortality rate. The aim of the present study was to investigate the correlation between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism with plasma total homocysteine (tHcy) levels and DVT risk in an Iranian population. Our study population consisted of 67 patients with a diagnosis of DVT and 67 healthy subjects as controls. Genotyping of MTHFR C677T polymorphism was performed by the polymerase chain reaction technique combined with restriction enzyme fragment length polymorphism (PCR-RFLP) and measurement of tHcy levels was done by enzyme immunoassay method. Plasma tHcy levels were significantly higher in DVT patients than controls (18.09±7.6 vs. 10.5±4.3, P=0.001). Also, plasma tHcy levels were significantly higher in MTHFR 677TT genotypes compared to 677CC genotypes in both DVT patients (P=0.016) and controls (P=0.03). Neither heterozygote nor homozygote genotypes of MTHFR C677T polymorphism was significantly correlated with DVT (P>0.05). The distribution of MTHFR C677T genotypes was similar between men and women in both DVT patients and controls (P>0.05). Moreover, the frequency of mutant 677T allele did not differ significantly between the two groups (28.3% vs. 21.6%, P=0.15). Based on this study, we propose that hyperhomocysteinemia but not homozygosity for MTHFR C677T polymorphism is a significant risk factor for DVT in the Iranian population. Also, MTHFR 677TT genotype is a determinant of elevated plasma tHcy levels.

The Incidence of Deep Vein Thrombosis in Asian Patients With Chronic Obstructive Pulmonary Disease.

PubMed

Chen, Chung-Yu; Liao, Kuang-Ming

2015-11-01

Most studies have focused on the prevalence of deep vein thrombosis (DVT) and pulmonary embolism in patients with chronic obstructive pulmonary disease (COPD) and acute exacerbation in Caucasian populations. DVT is supposedly less likely to occur among Asians than Caucasians, and the primary purpose of this study was to determine the actual incidence of DVT in patients with COPD in Asian populations.We enrolled patients over the age of 40 with a diagnosis of COPD (International Classification of Diseases, Ninth Revision [ICD-9]: 490-492, 496; A-code: A323 and A325) between 1998 and 2008. The index date was the date of first-time COPD diagnosis. We excluded the patients who had been diagnosed with COPD and DVT (The International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]: 453.8) before index date. The control group was frequency-matched according to age (3-year stratum), sex, and the year of admission, at a 2:1 ratio. Patients were followed from index date to when either a diagnosis of DVT was made, death occurred, December 31, 2009 was reached, or when the patients withdrew from the National Health Insurance program.The overall incidence rate of DVT was 18.78 per 10,000 person-years in patients with COPD, and the adjusted hazard ration of DVT in patients with COPD was 1.38 (95% confidence interval 1.06-1.80), which was greater than patients without COPD after adjusting for age, sex, atrial fibrillation, hypertension, diabetes, hyperlipidemia, cerebrovascular accident, congestive heart failure, lower leg fracture or surgery, and cancer.Asian patients with COPD had a higher incidence of DVT than non-COPD patients.

Traumatic brain injury is associated with the development of deep vein thrombosis independent of pharmacological prophylaxis.

PubMed

Reiff, Donald A; Haricharan, Ramanath N; Bullington, Nathan M; Griffin, Russell L; McGwin, Gerald; Rue, Loring W

2009-05-01

Deep venous thrombosis (DVT) is common among trauma patients. If left untreated it may result in lethal pulmonary thromboembolism. Previous studies have suggested that intracranial hemorrhage serves as an independent risk factor for the development of DVT. These studies were not able to exclude anticoagulation therapy as a confounding variable in their analysis. Our objective was to determine the association of traumatic brain injury (TBI) to the formation of DVT irrespective of the use of anticoagulation therapy. All patients admitted to an academic level I Trauma Center between 2000 and 2007 with blunt or penetrating injuries were selected for inclusion in this study. Patients who died or who were discharged within 24 hours of admission were excluded in the analysis. TBI was defined as any intraparenchymal hemorrhage or extra-axial intracranial bleeding identified on radiographic imaging or both. Anticoagulation therapy was defined as the uninterrupted use of either subcutaneous lovenox or heparin. Risk ratios and 95% confidence intervals compared the risk of DVT among patients with and without TBI according to the initiation of anticoagulation therapy (no therapy, <24 hours, 24-48 hours, and >48 hours) adjusted for age, gender, race, injury severity, mechanism of injury, spinal injury, and lower extremity fracture. Irrespective of the time of initiation of pharmacologic prophylaxis, TBI is independently associated with the formation of DVT. A threefold to fourfold increased risk of DVT formation is consistent across all prophylaxis groups among patients with TBI. The incidence of DVT among injured patients with TBI is significantly higher than those patients without head injury independent of anticoagulation therapy. Rigorous surveillance to detect DVT among trauma patients with TBI should be undertaken and where appropriate alternate means for pulmonary thromboembolism prevention used.

Risk of Deep vein thrombosis in neurosurgery: State of the art on prophylaxis protocols and best clinical practices.

PubMed

Ganau, Mario; Prisco, Lara; Cebula, Helene; Todeschi, Julien; Abid, Houssem; Ligarotti, Gianfranco; Pop, Raoul; Proust, Francois; Chibbaro, Salvatore

2017-11-01

To analytically discuss some protocols in Deep vein thrombosis (DVT)/pulmonary Embolism (PE) prophylaxis currently use in Neurosurgical Departments around the world. Analysis of the prophylaxis protocols in the English literature: An analytical and narrative review of literature concerning DVT prophylaxis protocols in Neurosurgery have been conducted by a PubMed search (back to 1978). 80 abstracts were reviewed, and 74 articles were extracted. The majority of DVT seems to develop within the first week after a neurosurgical procedure, and a linear correlation between the duration of surgery and DVT occurrence has been highlighted. The incidence of DVT seems greater for cranial (7.7%) than spinal procedures (1.5%). Although intermittent pneumatic compression (IPC) devices provided adequate reduction of DVT/PE in some cranial and combined cranial/spinal series, low-dose subcutaneous unfractionated heparin (UFH) or low molecular-weight heparin (LMWH) further reduced the incidence, not always of DVT, but of PE. Nevertheless, low-dose heparin-based prophylaxis in cranial and spinal series risks minor and major postoperative haemorrhages: 2-4% in cranial series, 3.4% minor and 3.4% major haemorrhages in combined cranial/spinal series, and a 0.7% incidence of major/minor haemorrhages in spinal series. This analysis showed that currently most of the articles are represented by case series and case reports. As long as clear guidelines will not be defined and universally applied to this diverse group of patients, any prophylaxis for DVT and PE should be tailored to the individual patient with cautious assessment of benefits versus risks. Copyright © 2017 Elsevier Ltd. All rights reserved.

Deep venous thrombosis among disaster shelter inhabitants following the March 2011 earthquake and tsunami in Japan: a descriptive study.

PubMed

Shibata, M; Hanzawa, K; Ueda, S; Yambe, T

2014-05-01

A retrospective analysis of data collected during subject screening following Japan's March 2011 earthquake and tsunami was performed. We aimed to determine the incidence of deep venous thrombosis (DVT) among screened subjects and to identify risk factors associated with the development of DVT as independent variables. Calf ultrasonography was undertaken in 269 subjects living in 21 shelters in Miyagi prefecture during the one-month period immediately following the March 2011 disaster. Information regarding the health and risk factors of subjects was collected by questionnaire and assessment of physical signs. Of the 269 evacuees screened, 65 (24%) met the criteria for calf DVT. We found lower limb trauma, reduced frequency of urination and sleeping in a vehicle to be independent positive predictors of DVT. Evacuees had an increased risk of developing DVT, associated with tsunami-related lower limb injury, immobility and dehydration.

Catheter-Directed Thrombolysis of Acute Deep Vein Thrombosis in the Lower Extremity of a Child with Interrupted Inferior Vena Cava

DOE Office of Scientific and Technical Information (OSTI.GOV)

Oguzkurt, Levent, E-mail: loguzkurt@yahoo.com; Ozkan, Ugur; Tercan, Fahri

2007-04-15

We present the case of a 14-year-old girl who developed acute deep vein thrombosis (DVT) in her right lower extremity. Laboratory testing revealed protein S deficiency, and the patient's father also had this abnormality with a history of lower extremity DVT. Manual thromboaspiration followed by catheter-directed thrombolysis resulted in total clearance of all thrombi. Computed tomography and later venography revealed an interrupted inferior vena cava. Catheter-directed thrombolysis is an established treatment for adults with acute DVT. To the best of our knowledge, this report is the first to describe catheter-directed thrombolysis in a pediatric patient with lower extremity DVT. Ourmore » results suggest that catheter-directed thrombolysis is safe and effective for use in selected older children and adolescents with acute DVT in the lower extremity.« less

The unlikely presence of deep vein thrombosis in a patient with low pretest probability and a negative D-dimer: a case report.

PubMed

Ramsey, Shaun C; Flaherty, Patrick M

2015-06-01

Deep vein thrombosis (DVT) is commonly encountered in the emergency department. Clinical models, such as the Wells criteria, allow physicians to estimate the probability of DVT in a patient. Current literature suggests a low pretest probability combined with a negative D-dimer laboratory study rules out DVT approximately 99% of the time. This case discusses a 37-year-old male patient who had a low pretest probability and a negative D-dimer, but was found to have a DVT on Doppler ultrasound. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The astute emergency physician must not discount clinical suspicion in order to decide when radiographic imaging is warranted for a possible venous thromboembolism. New adjuncts, such as bedside ultrasonography, can also be implemented to further risk stratify patients, potentially decreasing morbidity and mortality associated with DVT. Copyright © 2015 Elsevier Inc. All rights reserved.

Role of Color Flow Ultrasound in Detection of Deep Venous Thrombosis

ERIC Educational Resources Information Center

Mohammed, Shelan Hakeem; AL-Najjar, Salwa A.

2016-01-01

Background: Deep vein thrombosis (DVT) of lower limbs is one of the most causes for the majority of death caused by pulmonary embolism. Many medical and surgical disorders are complicated by DVT. Most venous thrombi are clinically silent. B-mode and color Doppler imaging is needed for early diagnosis of DVT to prevent complications and squeal of…

Venous Thromboembolism Within Professional American Sport Leagues.

PubMed

Bishop, Meghan; Astolfi, Matthew; Padegimas, Eric; DeLuca, Peter; Hammoud, Sommer

2017-12-01

Numerous reports have described players in professional American sports leagues who have been sidelined with a deep vein thrombosis (DVT) or a pulmonary embolism (PE), but little is known about the clinical implications of these events in professional athletes. To conduct a retrospective review of injury reports from the National Hockey League (NHL), Major League Baseball (MLB), the National Basketball Association (NBA), and the National Football League (NFL) to take a closer look at the incidence of DVT/PE, current treatment approaches, and estimated time to return to play in professional athletes. Descriptive epidemiology study. An online search of all team injury and media reports of DVT/PE in NHL, MLB, NBA, and NFL players available for public record was conducted by use of Google, PubMed, and SPORTDiscus. Searches were conducted using the professional team name combined with blood clot , pulmonary embolism , and deep vein thrombosis . A total of 55 venous thromboembolism (VTE) events were identified from 1999 through 2016 (NHL, n = 22; MLB, n = 16; NFL, n = 12; NBA, n = 5). Nineteen athletes were reported to have an upper extremity DVT, 15 had a lower extremity DVT, 15 had a PE, and 6 had DVT with PE. Six athletes sustained more than 1 VTE. The mean age at time of VTE was 29.3 years (range, 19-42 years). Mean (±SD) time lost from play was 6.7 ± 4.9 months (range, 3 days to career end). Seven athletes did not return to play. Players with upper extremity DVT had a faster return to play (mean ± SD, 4.3 ± 2.7 months) than those with lower extremity DVT (5.9 ± 3.8 months), PE (10.8 ± 6.8 months), or DVT with PE (8.2 ± 2.6 months) ( F = 5.69, P = .002). No significant difference was found regarding time of return to play between sports. VTE in professional athletes led to an average of 6.7 months lost from play. The majority of athletes were able to return to play after a period of anticoagulation or surgery. Those with an upper extremity DVT returned to play faster than those with other types of VTE. Further study is needed to look into modifiable risk factors for these events and to establish treatment and return-to-play guidelines to ensure the safety of these athletes.

Short-Term Anticoagulant Therapy and Thrombus Location Are Independent Risk Factors for Delayed Recanalization of Deep Vein Thrombosis.

PubMed

Zhang, Chuanlin; Fu, Qining; Zhao, Yu; Mu, Shaoyu; Liu, Liping

2016-01-21

Prompt recanalization of the vein containing the thrombus is an important goal during the initial treatment of DVT, and risk factors for delayed recanalization in patients with deep vein thrombosis (DVT) in the lower extremities need to be determined. A total of 174 patients with DVT in lower extremities were recruited from June 2014 to March 2015 at our hospital. Duplex ultrasound scanning was conducted for all patients at 1 and 6 months after baseline evaluation. We divided the patients into recanalization and non-recanalization groups and analyzed risk factors for delayed recanalization. The univariate analysis revealed that an oral anticoagulant time of less than 3 months and venous thrombus location were risk factors for delayed recanalization (P<0.01). However, age, gender, hypertension, diabetes, pulmonary embolism, incidence factors, the use of catheter-directed thrombolytic (CDT) drugs, and inferior vena cava filter (IVCF) implantation had no influence on the incidence of delayed recanalization in patients with DVT (P>0.05). The multivariate analysis showed that patients with an anticoagulant time of less than 3 months had a lower incidence of recanalization than those with an anticoagulant time of more than 3 months (OR=2.358, P<0.05). The risk of delayed recanalization in patients with proximal DVT was 7 times higher than that in patients with distal DVT. Duration of anticoagulant treatment of less than 3 months and venous thrombus location are independent risk factors for delayed recanalization of DVT in the lower extremities.

Vein wall re-endothelialization after deep vein thrombosis is improved with low-molecular-weight heparin.

PubMed

Moaveni, Daria K; Lynch, Erin M; Luke, Cathy; Sood, Vikram; Upchurch, Gilbert R; Wakefield, Thomas W; Henke, Peter K

2008-03-01

Vein wall endothelial turnover after stasis deep vein thrombosis (DVT) has not been well characterized. The purpose of this study was to quantify re-endothelialization after DVT and determine if low-molecular-weight heparin (LMWH) therapy affects this process. Stasis DVT was generated in the rat by inferior vena cava ligation, with harvest at 1, 4, and 14 days. Immunohistologic quantification of vascular smooth muscle cells and luminal endothelialization was estimated by positive staining for alpha-smooth muscle actin and von Willebrand factor, respectively. In separate experiments, rats were treated either before or after DVT with subcutaneous LMWH (3 mg/kg daily) until harvesting at 4 and 14 days. The inferior vena cava was processed for histologic analysis or was processed for organ culture after the thrombus was gently removed. The vein wall was stimulated in vitro with interleukin-1beta (1 ng/mL), and the supernatant was processed at 48 hours for nitric oxide. Cells were processed by real-time polymerase chain reaction for endothelial nitric oxide synthase, inducible nitric oxide synthase, cyclooxygenase-1 and -2, and thrombomodulin at 4 and 14 days, and collagen I and III at 14 days. Comparisons were done with analysis of variance or t test. A P < .05 was significant. Thrombus size peaked at 4 days, whereas luminal re-endothelialization increased over time (1 day, 11% +/- 2%; 4 days, 23% +/- 4%; 14 days, 64% +/- 7% (+) von Willebrand factor staining; P < .01, n = 3 to 4, compared with non-DVT control). Similarly, vascular smooth muscle cell staining was lowest at day 1 and gradually returned to baseline by 14 days. Both before and after DVT, LMWH significantly increased luminal re-endothelialization, without a difference in thrombus size at 4 days, but no significant difference was noted at 14 days despite smaller thrombi with LMWH treatment. Pretreatment with LMWH was associated with increased vascular smooth muscle cell area and recovery of certain inducible endothelial specific genes. No significant difference in nitric oxide levels in the supernatant was found at 4 days. At 14 days, type III collagen was significantly elevated with LMWH treatment. Venous re-endothelialization occurs progressively as the DVT resolves and can be accelerated with LMWH treatment, although this effect appears limited to the early time frame. These findings may have clinical relevance for LMWH timing and treatment compared with mechanical forms of therapy. How the vein wall endothelium responds after deep vein thrombosis (DVT) has not been well documented owing to limited human specimens. This report shows that low-molecular-weight heparin accelerates or protects the endothelium and preserves medial smooth muscle cell integrity after DVT, but that this effect is limited to a relatively early time period. Although most DVT prophylaxis is pharmacologic (a heparin agent), use of nonpharmacologic measures is also common. The use of heparin prophylaxis, compared with after DVT treatment, and the acceleration of post-DVT re-endothelialization require clinical correlation.

Risk of deep venous thrombosis (DVT) in bedridden or wheelchair-bound multiple sclerosis patients: a prospective study.

PubMed

Arpaia, G; Bavera, P M; Caputo, D; Mendozzi, L; Cavarretta, R; Agus, G B; Milani, M; Ippolito, E; Cimminiello, C

2010-04-01

Multiple sclerosis (MS) often causes progressive loss of mobility, leading to limb paralysis. Venous and lymphatic stasis is a risk condition for venous thromboembolism (VTE). There is, however, no data on the frequency of VTE complicating the progression of MS. The aim of this study was to assess the frequency of deep vein thrombosis (DVT) in patients with late-stage MS attending a neurology center for rehabilitation. A total of 132 patients with MS were enrolled, 87 women and 45 men, mean age 58+/-11 years. The disease had started on average 18.7 years before; patients reported 9.6 hours bedridden per day or 14.3 hours wheelchair-bound. Only 25 patients reported a residual ability to walk alone or with help. Lower limb edema was present in 113 patients, bilateral in 41 cases. At admission all patients underwent extended compression ultrasonography. Their plasma D-dimer levels were measured. No antithrombotic prophylaxis was given. DVT was found in 58 patients (43.9%); 32 had a history of VTE. Forty of these patients (69%) had chronic lower limb edema, in 19 cases bilateral. D-dimer levels in the DVT patients were significantly higher than in patients without DVT (553+/-678 vs. 261+/-152 ng/mL, p=0.0112, Mann-Whitney Test). Nearly half the DVT patients (26, 45%) had high D-dimer levels (701+/-684 ng/mL). Of the 74 patients without DVT, 48 had normal D-dimer (193.37+/-67.28 ng/mL) and 26 high (387.61+/-187.42 ng/mL). The frequency of DVT in late-stage MS may be over 40%. The long history of the disease means the onset of each episode cannot be established with certainty. A number of patients with positive CUS findings had negative D-dimer values, suggesting a VTE event in the past. However, the level of DVT risk in this series should lead physicians to consider the systematic application of long-term preventive measures. (c) 2009 Elsevier Ltd. All rights reserved.

Experimental evaluation of job provenance in ATLAS environment

NASA Astrophysics Data System (ADS)

Křenek, A.; Sitera, J.; Chudoba, J.; Dvořák, F.; Filipovič, J.; Kmuníček, J.; Matyska, L.; Mulaš, M.; Ruda, M.; Šustr, Z.; Campana, S.; Molinari, E.; Rebatto, D.

2008-07-01

Grid middleware stacks, including gLite, matured into the state of being able to process up to millions of jobs per day. Logging and Bookkeeping, the gLite job-tracking service, keeps pace with this rate; however, it is not designed to provide a long-term archive of information on executed jobs. ATLAS — representative of a large user community — addresses this issue with its own job catalogue (ProdDB). Development of such a customized service, not easily reusable, took considerable effort which is not affordable by smaller communities. On the contrary, Job Provenance (JP), a generic gLite service designed for long-term archiving of information on executed jobs focusing on scalability, extensibility, uniform data view, and configurability, allows more specialized catalogues to be easily built. We present the first results of an experimental JP deployment for the ATLAS production infrastructure where a JP installation was fed with a part of ATLAS jobs, and also stress tested with real production data. The main outcome of this work is a demonstration that JP can complement large-scale application-specific job catalogue services, while serving a similar purpose where there are none available.

The role of molecular imaging in diagnosis of deep vein thrombosis

PubMed Central

Houshmand, Sina; Salavati, Ali; Hess, Søren; Ravina, Mudalsha; Alavi, Abass

2014-01-01

Venous thromboembolism (VTE) mostly presenting as deep venous thrombosis (DVT) and pulmonary embolism (PE) affects up to 600,000 individuals in United States each year. Clinical symptoms of VTE are nonspecific and sometimes misleading. Additionally, side effects of available treatment plans for DVT are significant. Therefore, medical imaging plays a crucial role in proper diagnosis and avoidance from over/under diagnosis, which exposes the patient to risk. In addition to conventional structural imaging modalities, such as ultrasonography and computed tomography, molecular imaging with different tracers have been studied for diagnosis of DVT. In this review we will discuss currently available and newly evolving targets and tracers for detection of DVT using molecular imaging methods. PMID:25143860

Adaptive traffic signal control system (ACS-Lite) for Wolf Road, Albany, New York.

DOT National Transportation Integrated Search

2014-10-01

Adaptive Control Software Lite (ACS : - : Lite) is a : traffic : signal timing optimization system that : dynamically adjusts : traffic : signal timing : s : to meet current traffic demands. : The purpose of this : research project : was : to : deplo...

A comparative approach to deep vein thrombosis risk assessment.

PubMed

Hums, Wendy; Blostein, Paul

2006-01-01

Trauma patients are at risk for developing DVT/PE. The Bronson Trauma Model incorporates a DVT scoring system into the daily routine for all injured patients admitted to the Trauma Care Unit. Dr Paul Blostein added the DVT Risk Assessment spreadsheet to his personal digital assistant and made it available to other members of the team to allow calculation of a patient's DVT risk percentage during daily multidisciplinary rounds in the Trauma Care Unit. The Trauma Program has found the incorporation of the scoring systems into the trauma registry to be a value-added component of our performance improvement process. Bronson's unique model of trauma care, where patients are admitted and discharged from the same room, combined with today's technology of wireless laptops and personal digital assistants, promotes a progressive approach to DVT/PE prophylaxis and performance improvement. Our trauma follow-up program has proven to be effective in reintegrating patients back into the trauma system to optimize their functional status and improve their outcome.

Deep venous thrombophlebitis: detection with 4-hour versus 24-hour platelet scintigraphy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Seabold, J.E.; Conrad, G.R.; Ponto, J.A.

Thirty-one nonheparinized patients with suspected deep venous thrombophlebitis (DVT) underwent contrast venography and indium-111 platelet scintigraphy (In-111 PS). Venography permitted identification of acute DVT in 12 of 31 cases (39%). One additional patient was considered to have acute DVT despite nonconclusive venography results. In-111 PS results were positive at 4 hours in nine of 13 cases (69%) and at 24 hours in 12 of 13 cases (92%). Two of four patients with false-negative 4-hour In-111 PS studies had received warfarin. Thus, the sensitivity of 4-hour In-111 PS in patients not receiving anticoagulants was 82%. Venography results were negative for acutemore » DVT in 18 cases, and 4-hour In-111 PS studies were negative or equivocal in each. In-111 PS is an alternative to contrast venography for detecting acute DVT. If 4-hour In-111 PS results are positive, anticoagulation can be initiated. Delayed images are necessary if the 4-hour images are negative or equivocal.« less

Effect of rivaroxaban on preventing deep vein thrombosis in aged diabetics with femoral neck fractures after hip replacement

PubMed Central

Jiang, Xin; Sun, Yan-Shan

2017-01-01

The present study estimates the effect of rivaroxaban on preventing deep vein thrombosis (DVT) in aged diabetics with femoral neck fractures after hip replacement. Our study consisted of 236 aged diabetics with femoral neck fractures, which were divided into the rivaroxaban and control groups. Reaction time (R time), clot formation time (K time), α angle (α), maximum amplitude (MA), clot elasticity (G) and coagulation index (CI), prothrombin time (PT) and activated partial thromboplastin time (APTT) were measured. DVT was diagnosed by color duplex Doppler ultrasound (CDDU). The risk factors of DVT were analysed by logistic regression analysis. Compared with the control group, in the rivaroxaban group, R time and K time were extended and α, MA and G decreased 1 day before operation. One day after operation, the rivaroxaban group had less PT and APPT and lower incidence of DVT than the control group. In the two groups, preoperative and postoperative PT and APPT significantly differed. Body mass index (BMI) ≥25, abnormal coagulation indicators, use of cemented femoral hip prosthesis, high haemoglobin content and non-ankle pump exercise after operation were the risk factors for DVT. Rivaroxaban could prevent DVT in aged diabetics with femoral neck fractures after hip replacement. PMID:28442600

Magnetic resonance direct thrombus imaging differentiates acute recurrent ipsilateral deep vein thrombosis from residual thrombosis.

PubMed

Tan, Melanie; Mol, Gerben C; van Rooden, Cornelis J; Klok, Frederikus A; Westerbeek, Robin E; Iglesias Del Sol, Antonio; van de Ree, Marcel A; de Roos, Albert; Huisman, Menno V

2014-07-24

Accurate diagnostic assessment of suspected ipsilateral recurrent deep vein thrombosis (DVT) is a major clinical challenge because differentiating between acute recurrent thrombosis and residual thrombosis is difficult with compression ultrasonography (CUS). We evaluated noninvasive magnetic resonance direct thrombus imaging (MRDTI) in a prospective study of 39 patients with symptomatic recurrent ipsilateral DVT (incompressibility of a different proximal venous segment than at the prior DVT) and 42 asymptomatic patients with at least 6-month-old chronic residual thrombi and normal D-dimer levels. All patients were subjected to MRDTI. MRDTI images were judged by 2 independent radiologists blinded for the presence of acute DVT and a third in case of disagreement. The sensitivity, specificity, and interobserver reliability of MRDTI were determined. MRDTI demonstrated acute recurrent ipsilateral DVT in 37 of 39 patients and was normal in all 42 patients without symptomatic recurrent disease for a sensitivity of 95% (95% CI, 83% to 99%) and a specificity of 100% (95% CI, 92% to 100%). Interobserver agreement was excellent (κ = 0.98). MRDTI images were adequate for interpretation in 95% of the cases. MRDTI is a sensitive and reproducible method for distinguishing acute ipsilateral recurrent DVT from 6-month-old chronic residual thrombi in the leg veins. © 2014 by The American Society of Hematology.

Congenital abnormalities of the inferior vena cava presenting clinically in adolescent males.

PubMed

Halparin, Jessica; Monagle, Paul; Newall, Fiona

2015-04-01

Congenital anatomic abnormality of the inferior vena cava (IVC) is an important risk factor for the development of spontaneous proximal lower extremity deep vein thrombosis (DVT) in young adults. The incidence of DVT associated with congenital IVC anomalies in paediatric populations has not been described, and the implications of IVC anomalies for treatment and outcomes of DVT are unknown. This study reports a series of five adolescent males with spontaneous lower extremity DVTs and underlying congenital IVC abnormalities. Cases were identified by searching the institutional database of patients treated with anticoagulation for venous thromboembolism at a tertiary children's hospital. The demographics, clinical presentations, imaging findings, treatment courses, and outcomes are described. All cases occurred in males, and accounted for approximately twenty percent of adolescent males presenting with DVT. IVC abnormality is likely an under-recognized risk factor for DVT in this age group, and detailed vascular imaging should be pursued in adolescents with spontaneous proximal lower extremity DVT when initial ultrasonography does not delineate the proximal clot extent. Management requires individual risk-benefit assessment in the context of providing developmentally appropriate care. Further research is required to establish long-term outcomes and determine optimal treatment strategies. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Quality of care and safety indicators in anticoagulated patients with non-valvular auricular fibrillation and deep venous thromboembolic disease].

PubMed

Ignacio, E; Mira, J J; Campos, F J; López de Sá, E; Lorenzo, A; Caballero, F

To identify and prioritise indicators to assess the quality of care and safety of patients with non-valvular auricular fibrillation (NVAF) and deep vein thrombosis (DVT) treated with anticoagulants. Using the consensus conference technique, a group of professionals and clinical experts, the determining factors of the NVAF and DVT care process were identified, in order to define the quality and safety criteria. A proposal was made for indicators of quality and safety that were prioritised, taking into account a series of pre-established attributes. The selected indicators were classified into indicators of context, safety, action, and outcomes of the intervention in the patient. A set of 114 health care and safety quality indicators were identified, of which 35 were prioritised: 15 for NVAF and 20 for DVT. About half (49%) of the indicators (40% for NVAF and 55% for DVT) applied to patient safety, and 26% (33% for NVAF and 20% for DVT) to the outcomes of interventions in the patient. The present work presents a set of agreed indicators by a group of expert professionals that can contribute to the improvement of the quality of care of patients with NVAF and DVT treated with anticoagulants. Copyright © 2018 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Airline chair-rest deconditioning: induction of immobilisation thromboemboli?

PubMed

Greenleaf, John E; Rehrer, Nancy J; Mohler, Stanley R; Quach, David T; Evans, David G

2004-01-01

Air passenger miles will likely double by year 2020. The altered and restrictive environment in an airliner cabin can influence haematological homeostasis in passengers and crew. Flight-related deep venous thromboemboli (DVT) have been associated with at least 577 deaths on 42 of 120 airlines from 1977 to 1984 (25 deaths/million departures), whereas many such cases go unreported. However, there are four major factors that could influence formation of possible flight-induced DVT: sleeping accommodations (via sitting immobilisation); travellers' medical history (via tissue injury); cabin environmental factors (via lower partial pressure of oxygen and lower relative humidity); and the more encompassing chair-rest deconditioning (C-RD) syndrome. There is ample evidence that recent injury and surgery (especially in deconditioned hospitalised patients) facilitate thrombophlebitis and formation of DVT that may be exacerbated by the immobilisation of prolonged air travel. In the healthy flying population, immobilisation factors associated with prolonged (>5 hours) C-RD such as total body dehydration, hypovolaemia and increased blood viscosity, and reduced venous blood flow (pooling) in the legs may facilitate formation of DVT. However, data from at least four case-controlled epidemiological studies did not confirm a direct causative relationship between air travel and DVT, but factors such as a history of vascular thromboemboli, venous insufficiency, chronic heart failure, obesity, immobile standing position, more than three pregnancies, infectious disease, long-distance travel, muscular trauma and violent physical effort were significantly more frequent in DVT patients than in controls. Thus, there is no clear, direct evidence yet that prolonged sitting in airliner seats, or prolonged experimental chair-rest or bed-rest deconditioning treatments cause DVT in healthy people.

Economic evaluation of different screening alternatives for patients with clinically suspected acute deep vein thrombosis.

PubMed

Bogavac-Stanojević, Natasa; Dopsaj, Violeta; Jelić-Ivanović, Zorana; Lakić, Dragana; Vasić, Dragan; Petrova, Guenka

2013-01-01

We examined the cost-effectiveness of the three different D-dimer measurements in the screening of DVT in models with and without calculation of pre-test probability (PTP) score. Moreover, we calculated the minimal cost in DVT detection. In the group of 192 patients with clinically suspected acute DVT, we examined the three different D-dimer measurements (Innovance D-dimer, Hemosil D-dimer HS and Vidas D-dimer Exclusion II) in combination with and without PTP assessment. The diagnostic alternative employing Vidas D-dimer Exclusion II assay without and with PTP calculation gave lower incremental cost-effectiveness ratio (ICER) than the alternative employing Hemosil D-dimer HS assay (0.187 Euros vs. 0.998 Euros per one additional DVT positive patient selected for CUS in model without PTP assessment and 0.450 vs. 0.753 Euros per one DVT positive patient selected for CUS in model with PTP assessment). According to sensitivity analysis, the Hemosil D-dimer HS assay was the most cost effective alternative when one patient was admitted to the vascular ambulance per day. Vidas D-dimer Exclusion II assay was the most cost effective alternative when more than one patient were admitted to the vascular ambulance per day. Cost minimisation analysis indicated that selection of patients according to PTP score followed by D-dimer analysis decreases the cost of DVT diagnosis. ICER analysis enables laboratories to choose optimal laboratory tests according to number of patients admitted to laboratory. Results support the feasibility of using PTP scoring and D-dimer measurement before CUS examination in DVT screening.

Airline chair-rest deconditioning: induction of immobilisation thromboemboli?

NASA Technical Reports Server (NTRS)

Greenleaf, John E.; Rehrer, Nancy J.; Mohler, Stanley R.; Quach, David T.; Evans, David G.

2004-01-01

Air passenger miles will likely double by year 2020. The altered and restrictive environment in an airliner cabin can influence haematological homeostasis in passengers and crew. Flight-related deep venous thromboemboli (DVT) have been associated with at least 577 deaths on 42 of 120 airlines from 1977 to 1984 (25 deaths/million departures), whereas many such cases go unreported. However, there are four major factors that could influence formation of possible flight-induced DVT: sleeping accommodations (via sitting immobilisation); travellers' medical history (via tissue injury); cabin environmental factors (via lower partial pressure of oxygen and lower relative humidity); and the more encompassing chair-rest deconditioning (C-RD) syndrome. There is ample evidence that recent injury and surgery (especially in deconditioned hospitalised patients) facilitate thrombophlebitis and formation of DVT that may be exacerbated by the immobilisation of prolonged air travel.In the healthy flying population, immobilisation factors associated with prolonged (>5 hours) C-RD such as total body dehydration, hypovolaemia and increased blood viscosity, and reduced venous blood flow (pooling) in the legs may facilitate formation of DVT. However, data from at least four case-controlled epidemiological studies did not confirm a direct causative relationship between air travel and DVT, but factors such as a history of vascular thromboemboli, venous insufficiency, chronic heart failure, obesity, immobile standing position, more than three pregnancies, infectious disease, long-distance travel, muscular trauma and violent physical effort were significantly more frequent in DVT patients than in controls. Thus, there is no clear, direct evidence yet that prolonged sitting in airliner seats, or prolonged experimental chair-rest or bed-rest deconditioning treatments cause DVT in healthy people.

Short-Term Anticoagulant Therapy and Thrombus Location Are Independent Risk Factors for Delayed Recanalization of Deep Vein Thrombosis

PubMed Central

Zhang, Chuanlin; Fu, Qining; Zhao, Yu; Mu, Shaoyu; Liu, Liping

2016-01-01

Background Prompt recanalization of the vein containing the thrombus is an important goal during the initial treatment of DVT, and risk factors for delayed recanalization in patients with deep vein thrombosis (DVT) in the lower extremities need to be determined. Material/Methods A total of 174 patients with DVT in lower extremities were recruited from June 2014 to March 2015 at our hospital. Duplex ultrasound scanning was conducted for all patients at 1 and 6 months after baseline evaluation. We divided the patients into recanalization and non-recanalization groups and analyzed risk factors for delayed recanalization. Results The univariate analysis revealed that an oral anticoagulant time of less than 3 months and venous thrombus location were risk factors for delayed recanalization (P<0.01). However, age, gender, hypertension, diabetes, pulmonary embolism, incidence factors, the use of catheter-directed thrombolytic (CDT) drugs, and inferior vena cava filter (IVCF) implantation had no influence on the incidence of delayed recanalization in patients with DVT (P>0.05). The multivariate analysis showed that patients with an anticoagulant time of less than 3 months had a lower incidence of recanalization than those with an anticoagulant time of more than 3 months (OR=2.358, P<0.05). The risk of delayed recanalization in patients with proximal DVT was 7 times higher than that in patients with distal DVT. Conclusions Duration of anticoagulant treatment of less than 3 months and venous thrombus location are independent risk factors for delayed recanalization of DVT in the lower extremities. PMID:26790571

Neutrophil extracellular traps promote deep vein thrombosis in mice

PubMed Central

Brill, A.; Fuchs, T.A.; Savchenko, A.S.; Thomas, G.M.; Martinod, K.; De Meyer, S.F.; Bhandari, A.A.; Wagner, D.D.

2011-01-01

Summary Background Upon activation, neutrophils can release nuclear material known as neutrophil extracellular traps (NETs), which were initially described as a part of antimicrobial defense. Extracellular chromatin was recently reported to be pro-thrombotic in vitro and to accumulate in plasma and thrombi of baboons with experimental deep vein thrombosis (DVT). Objective To explore the source and role of extracellular chromatin in DVT. Methods We used an established murine model of DVT induced by flow restriction (stenosis) in the inferior vena cava (IVC). Results We demonstrate that the levels of extracellular DNA increase in plasma after 6 h IVC stenosis, compared to sham-operated mice. Immunohistochemical staining revealed the presence of Gr-1-positive neutrophils in both red (RBC-rich) and white (platelet-rich) parts of thrombi. Citrullinated histone H3 (CitH3), an element of NETs’ structure, was present only in the red part of thrombi and was frequently associated with the Gr-1 antigen. Immunofluorescent staining of thrombi showed proximity of extracellular CitH3 and von Willebrand factor (VWF), a platelet adhesion molecule crucial for thrombus development in this model. Infusion of Deoxyribonuclease 1 (DNase 1) protected mice from DVT after 6 h and also 48 h IVC stenosis. Infusion of an unfractionated mixture of calf thymus histones increased plasma VWF and promoted DVT early after stenosis application. Conclusions Extracellular chromatin, likely originating from neutrophils, is a structural part of a venous thrombus and both the DNA scaffold and histones appear to contribute to the pathogenesis of DVT in mice. NETs may provide new targets for DVT drug development. PMID:22044575

Effect of Compression Devices on Preventing Deep Vein Thrombosis Among Adult Trauma Patients: A Systematic Review.

PubMed

Ibrahim, Mona; Ahmed, Azza; Mohamed, Warda Yousef; El-Sayed Abu Abduo, Somaya

2015-01-01

Trauma is the leading cause of death in Americans up to 44 years old each year. Deep vein thrombosis (DVT) is a significant condition occurring in trauma, and prophylaxis is essential to the appropriate management of trauma patients. The incidence of DVT varies in trauma patients, depending on patients' risk factors, modality of prophylaxis, and methods of detection. However, compression devices and arteriovenous (A-V) foot pumps prophylaxis are recommended in trauma patients, but the efficacy and optimal use of it is not well documented in the literature. The aim of this study was to review the literature on the effect of compression devices in preventing DVT among adult trauma patients. We searched through PubMed, CINAHL, and Cochrane Central Register of Controlled Trials for eligible studies published from 1990 until June 2014. Reviewers identified all randomized controlled trials that satisfied the study criteria, and the quality of included studies was assessed by Cochrane risk of bias tool. Five randomized controlled trials were included with a total of 1072 patients. Sequential compression devices significantly reduced the incidence of DVT in trauma patients. Also, foot pumps were more effective in reducing incidence of DVT compared with sequential compression devices. Sequential compression devices and foot pumps reduced the incidence of DVT in trauma patients. However, the evidence is limited to a small sample size and did not take into account other confounding variables that may affect the incidence of DVT in trauma patients. Future randomized controlled trials with larger probability samples to investigate the optimal use of mechanical prophylaxis in trauma patients are needed.

Contralateral Deep Vein Thrombosis after Iliac Vein Stent Placement in Patients with May-Thurner Syndrome.

PubMed

Le, Trong Binh; Lee, Taeg Ki; Park, Keun-Myoung; Jeon, Yong Sun; Hong, Kee Chun; Cho, Soon Gu

2018-04-25

To investigate the incidence and potential causes of contralateral deep vein thrombosis (DVT) after common iliac vein (CIV) stent placement in patients with May-Thurner syndrome (MTS). Data of 111 patients (women: 73%) who had CIV stent implantation for symptomatic MTS at a single center were retrospectively analyzed. Mean patient age was 63.1 ± 15.2 years. Median follow-up was 36 months (range, 1-142 months). Stent location was determined by venogram and classified as extended to the inferior vena cava (IVC), covered the confluence, or confined to the iliac vein. Potential causes of contralateral DVT were presumed based on venographic findings. The relationship between stent location and contralateral DVT was analyzed. Ten patients (9%, men/women: 4/6) exhibited contralateral DVT at a median timing of 40 months (range, 6-98 months). Median age was 69 years (range, 42-85 years). Median follow-up was 73.5 months (range, 20-134 months). Potential causes were venous intimal hyperplasia (VIH) (n = 7), "jailing" (n = 2), and indeterminate (n = 1). All patients with VIH had previous CIV stents overextended to the IVC. Overextension of CIV stent was associated with contralateral DVT (P < .001). The primary patency rate of the contralateral CIV stent was 70% at 20 months. Contralateral DVT after CIV stent implantation has a relatively high incidence and often occurs late during follow-up. Overextension of the CIV stent to the IVC is associated with development of contralateral DVT, and VIH should be considered a potential cause. Copyright © 2018 SIR. Published by Elsevier Inc. All rights reserved.

Prospective study of natural history of deep vein thrombosis: early predictors of poor late outcomes.

PubMed

van Rij, André M; Hill, Gerry; Krysa, Jo; Dutton, Samantha; Dickson, Riordon; Christie, Ross; Smillie, Judi; Jiang, Ping; Solomon, Clive

2013-10-01

A proportion of patients with deep vein thrombosis (DVT) will develop postthrombotic syndrome (PTS). Currently, the only clearly identified risk factors for developing PTS are recurrent ipsilateral DVT and extensive proximal disease. The aim of the study was to assess the natural history of DVT and identify early predictors of poor clinical outcome at 5 years. Patients with suspected acute DVT in the lower limb were assessed prospectively. All patients with a confirmed DVT were asked to participate in this study. Within 7-10 days after diagnosis of DVT, patients underwent a further review, involving clinical, ultrasound, and air plethysmography assessment of both lower limbs. Patients were reassessed at regular intervals for 5 years. One hundred twenty-two limbs in 114 patients were included in this study. Thrombus regression occurred in two phases, with a rapid regression between 10 days and 3 months, and a more gradual regression thereafter. Reflux developed as thrombus regression occurred. Segmental reflux progressed to axial deep reflux and continued to deteriorate in a significant proportion of patients with iliofemoral-popliteal-calf DVT throughout the 5-year study period. Similarly, venous filling index became progressively more abnormal, in this group, over the course of the study. Four risk factors for PTS were identified as best predictors: extensive clot load on presentation; <50% clot regression at 6 months; venous filling index >2.5 mL/sec; and abnormal outflow rate (<0.6). Patients with three or more of these risk factors had a significant risk of developing PTS with sensitivity 100%, specificity 83%, and positive predictive value 67%. Patients scoring 2 or less did not have PTS at 5 years with a negative predictive value of 100%. This is the first study to show that venous assessment at 6 months post-DVT can predict PTS at 5 years. Those who will not develop PTS can be reassured of this at 6 months. Copyright © 2013 Elsevier Inc. All rights reserved.

Web Thermo Tables (WTT) - Lite Edition

National Institute of Standards and Technology Data Gateway

SRD 202 NIST/TRC Web Thermo Tables (WTT) - Lite Edition (Online Subscription)   WTT - Lite Edition, a Web version of the TRC Thermodynamic Tables, represents a collection of critically evaluated thermodynamic property data for 150 commonly-used (primarily organic) pure compounds.

Venous Thromboembolism Within Professional American Sport Leagues

PubMed Central

Bishop, Meghan; Astolfi, Matthew; Padegimas, Eric; DeLuca, Peter; Hammoud, Sommer

2017-01-01

Background: Numerous reports have described players in professional American sports leagues who have been sidelined with a deep vein thrombosis (DVT) or a pulmonary embolism (PE), but little is known about the clinical implications of these events in professional athletes. Purpose: To conduct a retrospective review of injury reports from the National Hockey League (NHL), Major League Baseball (MLB), the National Basketball Association (NBA), and the National Football League (NFL) to take a closer look at the incidence of DVT/PE, current treatment approaches, and estimated time to return to play in professional athletes. Study Design: Descriptive epidemiology study. Methods: An online search of all team injury and media reports of DVT/PE in NHL, MLB, NBA, and NFL players available for public record was conducted by use of Google, PubMed, and SPORTDiscus. Searches were conducted using the professional team name combined with blood clot, pulmonary embolism, and deep vein thrombosis. Results: A total of 55 venous thromboembolism (VTE) events were identified from 1999 through 2016 (NHL, n = 22; MLB, n = 16; NFL, n = 12; NBA, n = 5). Nineteen athletes were reported to have an upper extremity DVT, 15 had a lower extremity DVT, 15 had a PE, and 6 had DVT with PE. Six athletes sustained more than 1 VTE. The mean age at time of VTE was 29.3 years (range, 19-42 years). Mean (±SD) time lost from play was 6.7 ± 4.9 months (range, 3 days to career end). Seven athletes did not return to play. Players with upper extremity DVT had a faster return to play (mean ± SD, 4.3 ± 2.7 months) than those with lower extremity DVT (5.9 ± 3.8 months), PE (10.8 ± 6.8 months), or DVT with PE (8.2 ± 2.6 months) (F = 5.69, P = .002). No significant difference was found regarding time of return to play between sports. Conclusion: VTE in professional athletes led to an average of 6.7 months lost from play. The majority of athletes were able to return to play after a period of anticoagulation or surgery. Those with an upper extremity DVT returned to play faster than those with other types of VTE. Further study is needed to look into modifiable risk factors for these events and to establish treatment and return-to-play guidelines to ensure the safety of these athletes. PMID:29318176

Implementing AORN recommended practices for prevention of deep vein thrombosis.

PubMed

Van Wicklin, Sharon A

2011-11-01

One to two people per 1,000 are affected by deep vein thrombosis (DVT) or pulmonary embolism in the United States each year. AORN published its new "Recommended practices for prevention of deep vein thrombosis" to guide perioperative RNs in establishing organization-wide protocols for DVT prevention. Strategies for successful implementation of the recommended practices include taking a multidisciplinary approach to protocol development, providing education and guidance for performing preoperative patient assessments and administering DVT prophylaxis, and having appropriate resources and the facility's policy and procedure for DVT prevention readily available in the practice setting. Hospital and ambulatory patient scenarios have been included as examples of appropriate execution of the recommended practices. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Validation of a literature-based adherence score to Mediterranean diet: the MEDI-LITE score.

PubMed

Sofi, Francesco; Dinu, Monica; Pagliai, Giuditta; Marcucci, Rossella; Casini, Alessandro

2017-09-01

Numerous studies have demonstrated a relationship between adherence to Mediterranean diet and prevention of chronic degenerative diseases. The aim of this study was to validate a novel instrument to measure adherence to Mediterranean diet based on the literature (the MEDI-LITE score). Two-hundred-and-four clinically healthy subjects completed both the MEDI-LITE score and the validated MedDietScore (MDS). Significant positive correlation between the MEDI-LITE and the MDS scores was found in the study population (R = .70; p < .0001). Furthermore, statistically significant positive correlations were found for all the nine different food groups. According to the receiver operating characteristic (ROC) curve analysis, MEDI-LITE evidenced a significant discriminative capacity between adherents and non-adherents to the Mediterranean diet pattern (optimal cut-off point = 8.50; sensitivity = 96%; specificity = 38%). In conclusion, our findings show that the MEDI-LITE score well correlate with MDS in both global score and in most of the items related to the specific food categories.

Prevalence of deep vein thrombosis and pulmonary embolism in patients with superficial vein thrombosis: a systematic review and meta-analysis.

PubMed

Di Minno, M N D; Ambrosino, P; Ambrosini, F; Tremoli, E; Di Minno, G; Dentali, F

2016-05-01

Essentials The association of superficial vein thrombosis (SVT) with venous thromboembolism (VTE) is variable. We performed a meta-analysis to assess the prevalence of concomitant VTE in patients with SVT. Deep vein thrombosis was found in 18.1%, and pulmonary embolism in 6.9%, of SVT patients. Screening for VTE may be worthy in some SVT patients to plan adequate anticoagulant treatment. Background Some studies have suggested that patients with superficial vein thrombosis (SVT) have a non-negligible risk of concomitant deep vein thrombosis (DVT) or pulmonary embolism (PE) at the time of SVT diagnosis. Unfortunately, the available data on this association are widely variable. Objectives To perform a systematic review and meta-analysis of the literature in order to evaluate the prevalence of concomitant DVT/PE in patients with SVT of the lower limbs. Methods Studies reporting on the presence of DVT/PE in SVT patients were systematically searched for in the PubMed, Web of Science, Scopus and EMBASE databases. The weighted mean prevalence (WMP) of DVT and PE was calculated by use of the random effect model. Results Twenty-one studies (4358 patients) evaluated the prevalence of DVT and 11 studies (2484 patients) evaluated the prevalence of PE in patients with SVT. The WMP of DVT at SVT diagnosis was 18.1% (95%CI: 13.9%, 23.3%) and the WMP of PE was 6.9% (95%CI: 3.9%, 11.8%). Heterogeneity among the studies was substantial. Selection of studies including outpatients only gave similar results (WMP of DVT, 18.2%, 95% CI 12.2-26.3%; and WMP of PE, 8.2%, 95% CI 3.3-18.9%). Younger age, female gender, recent trauma and pregnancy were inversely associated with the presence of DVT/PE in SVT patients. Conclusions The results of our large meta-analysis suggest that the prevalence of DVT and PE in patients presenting with SVT is not negligible. Screening for a major thromboembolic event may be worthwhile in some SVT patients, in order to allow adequate anticoagulant treatment to be planned. Other high-quality studies are warranted to confirm our findings. © 2016 International Society on Thrombosis and Haemostasis.

Qualitative Slow Blood Flow in Lower Extremity Deep Veins on Doppler Sonography: Quantitative Assessment and Preliminary Evaluation of Correlation With Subsequent Deep Venous Thrombosis Development in a Tertiary Care Oncology Center.

PubMed

Jensen, Corey T; Chahin, Antoun; Amin, Veral D; Khalaf, Ahmed M; Elsayes, Khaled M; Wagner-Bartak, Nicolaus; Zhao, Bo; Zhou, Shouhao; Bedi, Deepak G

2017-09-01

To determine whether the qualitative sonographic appearance of slow deep venous flow in the lower extremities correlates with quantitative slow flow and an increased risk of deep venous thrombosis (DVT) in oncology patients. In this Institutional Review Board-approved retrospective study, we reviewed lower extremity venous Doppler sonographic examinations of 975 consecutive patients: 482 with slow flow and 493 with normal flow. The subjective slow venous flow and absence of initial DVT were confirmed by 2 radiologists. Peak velocities were recorded at 3 levels. Each patient was followed for DVT development. The associations between DVT and the presence of slow venous flow were examined by the Fisher exact test; a 2-sample t test was used for peak velocity and DVT group comparisons. The optimal cutoff peak velocity for correlation with the radiologists' perceived slow flow was determined by the Youden index. Deep venous thrombosis development in the slow-flow group (21 of 482 [4.36%]) was almost doubled compared with patients who had normal flow (11 of 493 [2.23%]; P = .0456). Measured peak venous velocities were lower in the slow-venous flow group (P < .001). Patients with subsequent DVT did not have a significant difference in venous velocities compared with their respective patient groups. The sum of 3 venous level velocities resulted in the best cutoff for dichotomizing groups into normal versus slow venous flow. Qualitative slow venous flow in the lower extremities on Doppler sonography accurately correlates with quantitatively slower flow, and this preliminary evaluation suggests an associated mildly increased rate of subsequent DVT development in oncology patients. © 2017 by the American Institute of Ultrasound in Medicine.

Prophylaxis against Deep Venous Thrombosis in Patients Hospitalized in Surgical Wards in One of the Hospitals in Iran: Based on the American College of Chest Physician's Protocol.

PubMed

Shohani, Masoumeh; Mansouri, Akram; Norozi, Siros; Parizad, Naser; Azami, Milad

2018-01-01

There is not enough studies to determine the frequency of using the prophylaxis against deep venous thrombosis (DVT) based on the American College of Chest Physician's (ACCP) guidelines in Iran. Thus, providing such statistics is essential to improve thromboprophylaxis in hospital. The present study aimed to determine the frequency of using the prophylaxis against DVT based on ACCP guidelines in patients hospitalized in surgical wards in one of teaching hospital in Ilam, Iran. In a cross-sectional, the samples were selected among medical records of patients who were hospitalized and underwent surgery in surgical wards of the hospital from April 2012 to September 2013. Type of prophylaxis was determined based on ACCP guidelines. After reviewing inclusion and exclusion criteria, patients' data were extracted from medical records based on required variables. In reviewing 169 qualified samples, 46.2% (78 patients) were women. Of these, 132 patients were at risk of DVT and needed prophylaxis, only 39 patients (29.5%) received prophylaxis. Thromboprophylaxis based on ACCP guidelines had been fully implemented only in 30 cases (22.7%) of patients with the risk of DVT.. The highest thromboprophylaxis was in the intensive care unit (46.6%) and neurosurgery (37.5%), and the least rate was in urology (0%). As the results of this study, there are differences between clinical practice and the ACCP guidelines recommendation in prophylaxis against DVT. Thromboprophylaxis has not been implemented based on ACCP guidelines in more than 75% of patients with the risk of DVT. Thus, new strategies are needed to implement thromboprophylaxis against DVT in Iranian hospitals.

Survey of methods used to determine if a patient has a deep vein thrombosis: An exploratory research report.

PubMed

Heick, John D; Farris, James W

2017-09-01

The use of evidence-based practice (EBP) is encouraged in the physical therapy profession, but integrating evidence into practice can be difficult for clinicians because of lack of time and other constraints. To survey physical therapy clinical instructors and determine the methods they use for screening for deep vein thrombosis (DVT), a type of venous thromboembolism (VTE) in the lower extremities. Exploratory survey. Twelve survey questions written specifically for this study were sent to a convenience sample of clinical instructors associated with seven universities across 43 states. Eight hundred fifty clinical instructors (22.4% response rate) completed the survey. Of those who responded, 80.5% were taught to use Homans sign to screen for a possible DVT in their entry-level education and 67.9% continued to use Homans sign in clinical practice. Regardless of post-graduate education, respondents were more likely to choose Homans sign than a clinical decision rule (CDR) to screen for a suspected DVT. Additionally, nearly two-thirds of respondents failed to correctly identify one or more of the major risk factors for developing a DVT/VTE. The response rate was 22.4% and therefore may not fully represent the population of physical therapy clinical instructors in the United States. Results from this exploratory survey indicated that approximately two-thirds of physical therapy clinical instructors used outdated DVT/VTE screening methods that they were taught in their entry-level education and nearly two-thirds did not identify the major risk factors associated with DVT/VTE. These results suggest that change is necessary in physical therapy education, clinical practice, and continuing professional development to ensure a more evidenced-based identification of DVT and VTE.

A novel method of adverse event detection can accurately identify venous thromboembolisms (VTEs) from narrative electronic health record data

PubMed Central

Rochefort, Christian M; Verma, Aman D; Eguale, Tewodros; Lee, Todd C; Buckeridge, David L

2015-01-01

Background Venous thromboembolisms (VTEs), which include deep vein thrombosis (DVT) and pulmonary embolism (PE), are associated with significant mortality, morbidity, and cost in hospitalized patients. To evaluate the success of preventive measures, accurate and efficient methods for monitoring VTE rates are needed. Therefore, we sought to determine the accuracy of statistical natural language processing (NLP) for identifying DVT and PE from electronic health record data. Methods We randomly sampled 2000 narrative radiology reports from patients with a suspected DVT/PE in Montreal (Canada) between 2008 and 2012. We manually identified DVT/PE within each report, which served as our reference standard. Using a bag-of-words approach, we trained 10 alternative support vector machine (SVM) models predicting DVT, and 10 predicting PE. SVM training and testing was performed with nested 10-fold cross-validation, and the average accuracy of each model was measured and compared. Results On manual review, 324 (16.2%) reports were DVT-positive and 154 (7.7%) were PE-positive. The best DVT model achieved an average sensitivity of 0.80 (95% CI 0.76 to 0.85), specificity of 0.98 (98% CI 0.97 to 0.99), positive predictive value (PPV) of 0.89 (95% CI 0.85 to 0.93), and an area under the curve (AUC) of 0.98 (95% CI 0.97 to 0.99). The best PE model achieved sensitivity of 0.79 (95% CI 0.73 to 0.85), specificity of 0.99 (95% CI 0.98 to 0.99), PPV of 0.84 (95% CI 0.75 to 0.92), and AUC of 0.99 (95% CI 0.98 to 1.00). Conclusions Statistical NLP can accurately identify VTE from narrative radiology reports. PMID:25332356

Use of US in the evaluation of patients with symptoms of deep venous thrombosis of the lower extremities.

PubMed

Useche, Juan N; de Castro, Alfredo M Fernández; Galvis, Germán E; Mantilla, Rodolfo A; Ariza, Alvaro

2008-10-01

Deep venous thrombosis (DVT) is a major health problem and is estimated to have an incidence of 600,000 cases per year. Clinical signs and symptoms of DVT are unreliable. If clinical signs alone were used to diagnose DVT, 42% of patients would receive unnecessary anticoagulation therapy. Most patients evaluated with ultrasonography (US) do not have DVT. The key to making a precise diagnosis is recognizing the characteristics of various diseases on US images. The anatomic approach is the most useful strategy for characterizing the spectrum of pathologic conditions seen in patients with symptoms that simulate DVT. The inferior extremity can be divided into four regions-inguinal, thigh, popliteal, and lower leg-with the rough limits defined for each as they are examined at US. The differential diagnoses affecting the lower extremities include infectious, neoplastic, traumatic, inflammatory, vascular, and miscellaneous entities. Some pathologic conditions seen in the inguinal region are adenopathies, lymphangitis, soft-tissue tumors, hematomas, adductor tendonitis, and hernias. In the thigh, cellulitis, myositis, abscess, benign and malignant tumors, and sports-related lesions are seen. In the popliteal region, cellulitis, arthritis, benign and malignant masses, muscle contusions, ruptured popliteal cysts, and thrombophlebitis are seen. And in the lower leg, cellulitis, lipomas, tennis leg, superficial thrombophlebitis, tendonitis, and soft-tissue hydrostatic edema secondary to cardiac and renal failure can simulate DVT. (c) RSNA, 2008.

[Effect of bone cement application on the incidence of deep vein thrombosis in major joint arthroplasties].

PubMed

Aslan, Ahmet; Ağar, Emre; Aydoğan, Nevres Hürriyet; Atay, Tolga; Baydar, Metin Lütfi; Kırdemir, Vecihi; Ozden, Ahmet

2011-12-01

In this study, we have investigated whether the application of bone cement has an effect on the frequency of deep vein thrombosis (DVT) in major joint arthroplasties (MJA). A total of 95 MJA cases meeting the inclusion criteria of this study between January 2004 and January 2005 were divided into cemented and cementless groups. For prophylaxis, all patients were given low molecular weight heparin (LMWH). The patients were scanned for DVT preoperatively and on the postoperative 12(th) day by color Doppler ultrasonography. In hip arthroplasties, in knee arthroplasties and in general, DVT was seen more frequently in cemented group, however, there was no statistically significant difference between groups in the frequency of DVT (p=0.549, p=0.749 and p=0.462, respectively). Also, there was no significant difference between the results of the different LMWH groups (p=0.616). The results of this study shows that bone cement application in MJAs such as hip or knee arthroplasties has no significant effect on the frequency of DVT.

Observational cohort study of pediatric inpatients with central venous catheters at "intermediate risk" of thrombosis and eligible for anticoagulant prophylaxis.

PubMed

Harney, Kathy M; McCabe, Margaret; Branowicki, Patricia; Kalish, Leslie A; Neufeld, Ellis J

2010-01-01

The risk of deep vein thrombosis (DVT) among hospitalized children is rising.The optimal approach to DVT prophylaxis in children is unclear. This study set out to ascertain the prevalence of DVT among pediatric inpatients who neither have contraindications to nor absolute indications for prophylactic therapy. A prospective surveillance of at-risk children plus a retrospective chart review were conducted. Patients were considered to be at risk after the first 2 days of their admission. Of 1,637 patients reviewed, 198 patients met criteria; among these, 84% did not receive prophylaxis. Of 2,354 observed days at risk for nonprophylaxed patients (including days at risk prior to initiating prophylaxis among prophlyaxed patients), there were 9 DVT events, for a rate 3.82/1,000 days observed. A total of 31 patients received prophylaxis. Three of these patients experienced a DVT. One patient had a bleeding event, hematuria. These results describe patients who may be eligible for prophylaxis and should be screened for further risk factors.

Endovascular Thrombolysis Using Monteplase for Non-chronic Deep Venous Thrombosis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yamagami, Takuji, E-mail: yamagami@koto.kpu-m.ac.jp; Yoshimatsu, Rika, E-mail: rika442@koto.kpu-m.ac.jp; Tanaka, Osamu, E-mail: otanaka@koto.kpu-m.ac.jp

This study was designed to evaluate the usefulness of endovascular thrombolysis using monteplase for deep venous thrombosis (DVT). Between December 2005 and October 2009, at our institution nine endovascular thrombolysis treatments with monteplase were performed for symptomatic DVT in eight patients (6 women, 2 men; mean age, 56 (range, 15-80) years). In all, systemic anticoagulation administered by the peripheral intravenous route with heparin and/or thrombolysis with urokinase followed by anticoagulation with orally administered warfarin had been performed, and subsequently six endovascular treatments without monteplase were administered. However, DVT persisted, and endovascular treatments with monteplase were tried. In six (67%) ofmore » the nine procedures, DVT completely or almost completely disappeared after endovascular thrombolysis with monteplase. Mean dose of monteplase used was 2,170,000 IU. There was only one procedure-related complication. In one patient, just after thrombolysis with monteplase, bleeding at the puncture site and gingival bleeding occurred. Bleeding was stopped by manual astriction only. Endovascular thrombolysis with monteplase may be an effective treatment for DVT, even in cases resistant to traditional systemic anticoagulation and thrombolysis and endovascular procedures without monteplase.« less

Room Temperature Operable Autonomously Moving Bio-Microrobot Powered by Insect Dorsal Vessel Tissue

PubMed Central

Akiyama, Yoshitake; Hoshino, Takayuki; Iwabuchi, Kikuo; Morishima, Keisuke

2012-01-01

Living muscle tissues and cells have been attracting attention as potential actuator candidates. In particular, insect dorsal vessel tissue (DVT) seems to be well suited for a bio-actuator since it is capable of contracting autonomously and the tissue itself and its cells are more environmentally robust under culturing conditions compared with mammalian tissues and cells. Here we demonstrate an autonomously moving polypod microrobot (PMR) powered by DVT excised from an inchworm. We fabricated a prototype of the PMR by assembling a whole DVT onto an inverted two-row micropillar array. The prototype moved autonomously at a velocity of 3.5×10−2 µm/s, and the contracting force of the whole DVT was calculated as 20 µN. Based on the results obtained by the prototype, we then designed and fabricated an actual PMR. We were able to increase the velocity significantly for the actual PMR which could move autonomously at a velocity of 3.5 µm/s. These results indicate that insect DVT has sufficient potential as the driving force for a bio-microrobot that can be utilized in microspaces. PMID:22808004

Alternative Fuels Data Center: Electric Vehicle Infrastructure Projection

Science.gov Websites

Tool (EVI-Pro) Lite Electric Vehicle Infrastructure Projection Tool (EVI-Pro) Lite to someone by E-mail Share Alternative Fuels Data Center: Electric Vehicle Infrastructure Projection Tool (EVI -Pro) Lite on Facebook Tweet about Alternative Fuels Data Center: Electric Vehicle Infrastructure

Improved recombinant Api m 1- and Ves v 5-based IgE testing to dissect bee and yellow jacket allergy and their correlation with the severity of the sting reaction.

PubMed

Šelb, J; Kogovšek, R; Šilar, M; Košnik, M; Korošec, P

2016-04-01

No study has assessed the diagnostic sensitivity of rApi m 1 and rVes v 5 on Immulite testing system. To compare the diagnostic sensitivity of commercially available venom recombinant allergens between the currently available immunoassays [ImmunoCAP (CAP) and Immulite (LITE)] and establish their correlation with the severity of the sting reaction. This study evaluated 95 bee venom and 110 yellow jacket venom-allergic subjects. We measured the levels of sIgE to rApi m 1, rVes v 5 (LITE and CAP), rApi m 2 (LITE), rVes v 1 (CAP) and total IgE (CAP). Forty-nine healthy subjects served as controls. The diagnostic sensitivity of rApi m 1 and rVes v 5 was significantly higher with the LITE than with the CAP system (71% vs. 88% and 82% vs. 93%). The specificity of both assays for both allergens was between 94% and 98%. Twenty-nine patients that tested negative for rApi m 1 or rVes v 5 with CAP were positive with LITE, but none of the patients that tested negative with LITE were positive with CAP. The positive values of rApi m 1 and rVes v 5 were on average 2.7 and 2.3 times higher, with the LITE than with the CAP system. The combination of rApi m 1 and rApi m 2 (LITE) and the combination of rVes v 5 (LITE) and rVes v 1 (CAP) almost matched the sensitivity of native venoms (95% and 97%, respectively), whereas the diagnostic sensitivity of the combination of rVes v 5 and rVes v 1 (CAP) did not reach the sensitivity of rVes v 5 (LITE) alone (90% vs. 93%). IgE levels to venom recombinants and total IgE did not correlate with the severity of sting reaction. The use of rApi m 1 and rVes v 5 with the LITE system significantly enhanced diagnostic utility of venom recombinants and should improve the dissection of bee and yellow jacket venom allergy. © 2015 John Wiley & Sons Ltd.

Investigation of Propulsion System Requirements for Spartan Lite

NASA Technical Reports Server (NTRS)

Urban, Mike; Gruner, Timothy; Morrissey, James; Sneiderman, Gary

1998-01-01

This paper discusses the (chemical or electric) propulsion system requirements necessary to increase the Spartan Lite science mission lifetime to over a year. Spartan Lite is an extremely low-cost (less than 10 M) spacecraft bus being developed at the NASA Goddard Space Flight Center to accommodate sounding rocket class (40 W, 45 kg, 35 cm dia by 1 m length) payloads. While Spartan Lite is compatible with expendable launch vehicles, most missions are expected to be tertiary payloads deployed by. the Space Shuttle. To achieve a one year or longer mission life from typical Shuttle orbits, some form of propulsion system is required. Chemical propulsion systems (characterized by high thrust impulsive maneuvers) and electrical propulsion systems (characterized by low-thrust long duration maneuvers and the additional requirement for electrical power) are discussed. The performance of the Spartan Lite attitude control system in the presence of large disturbance torques is evaluated using the Trectops(Tm) dynamic simulator. This paper discusses the performance goals and resource constraints for candidate Spartan Lite propulsion systems and uses them to specify quantitative requirements against which the systems are evaluated.

Accuracy evaluation of five blood glucose monitoring systems obtained from the pharmacy: a European multicenter study with 453 subjects.

PubMed

Tack, Cornelius; Pohlmeier, Harald; Behnke, Thomas; Schmid, Volkmar; Grenningloh, Marco; Forst, Thomas; Pfützner, Andreas

2012-04-01

This multicenter study was conducted to evaluate the performance of five recently introduced blood glucose (BG) monitoring (BGM) devices under daily routine conditions in comparison with the YSI (Yellow Springs, OH) 2300 Stat Plus glucose analyzer. Five hundred one diabetes patients with experience in self-monitoring of BG were randomized to use three of five different BGM devices (FreeStyle Lite® [Abbott Diabetes Care Inc., Alameda, CA], FreeStyle Freedom Lite [Abbott Diabetes Care], OneTouch® UltraEasy® [LifeScan Inc., Milpitas, CA], Accu-Chek® Aviva [Roche Diagnostics, Mannheim, Germany], and Contour® [Bayer Vital GmbH, Leverkusen, Germany]) in a daily routine setting. All devices and strips were purchased from local regular distribution sources (pharmacies, four strip lots per device). The patients performed the finger prick and the glucose measurement on their own. In parallel, a healthcare professional performed the glucose assessment with the reference method (YSI 2300 Stat Plus). The primary objective was the comparison of the mean absolute relative differences (MARD). Secondary objectives were compliance with the International Organization for Standardization (ISO) accuracy criteria under these routine conditions and Clarke and Parkes Error Grid analyses. MARD ranged from 4.9% (FreeStyle Lite) to 9.7% (OneTouch UltraEasy). The ISO 15197:2003 requirements were fulfilled by the FreeStyle Lite (98.8%), FreeStyle Freedom Lite (97.5%), and Accu-Chek Aviva (97.0%), but not by the Contour (92.4%) and OneTouch UltraEasy (91.1%). The number of values in Zone A of the Clarke Error Grid analysis was highest for the FreeStyle Lite (98.8%) and lowest for the OneTouch Ultra Easy (90.4%). FreeStyle Lite, FreeStyle Freedom Lite, and Accu-Chek Aviva performed very well in this study with devices and strips purchased through regular distribution channels, with the FreeStyle Lite achieving the lowest MARD in this investigation.

Accuracy Evaluation of Five Blood Glucose Monitoring Systems Obtained from the Pharmacy: A European Multicenter Study with 453 Subjects

PubMed Central

Tack, Cornelius; Pohlmeier, Harald; Behnke, Thomas; Schmid, Volkmar; Grenningloh, Marco; Forst, Thomas

2012-01-01

Abstract Background This multicenter study was conducted to evaluate the performance of five recently introduced blood glucose (BG) monitoring (BGM) devices under daily routine conditions in comparison with the YSI (Yellow Springs, OH) 2300 Stat Plus glucose analyzer. Methods Five hundred one diabetes patients with experience in self-monitoring of BG were randomized to use three of five different BGM devices (FreeStyle Lite® [Abbott Diabetes Care Inc., Alameda, CA], FreeStyle Freedom Lite [Abbott Diabetes Care], OneTouch® UltraEasy® [LifeScan Inc., Milpitas, CA], Accu-Chek® Aviva [Roche Diagnostics, Mannheim, Germany], and Contour® [Bayer Vital GmbH, Leverkusen, Germany]) in a daily routine setting. All devices and strips were purchased from local regular distribution sources (pharmacies, four strip lots per device). The patients performed the finger prick and the glucose measurement on their own. In parallel, a healthcare professional performed the glucose assessment with the reference method (YSI 2300 Stat Plus). The primary objective was the comparison of the mean absolute relative differences (MARD). Secondary objectives were compliance with the International Organization for Standardization (ISO) accuracy criteria under these routine conditions and Clarke and Parkes Error Grid analyses. Results MARD ranged from 4.9% (FreeStyle Lite) to 9.7% (OneTouch UltraEasy). The ISO 15197:2003 requirements were fulfilled by the FreeStyle Lite (98.8%), FreeStyle Freedom Lite (97.5%), and Accu-Chek Aviva (97.0%), but not by the Contour (92.4%) and OneTouch UltraEasy (91.1%). The number of values in Zone A of the Clarke Error Grid analysis was highest for the FreeStyle Lite (98.8%) and lowest for the OneTouch Ultra Easy (90.4%). Conclusions FreeStyle Lite, FreeStyle Freedom Lite, and Accu-Chek Aviva performed very well in this study with devices and strips purchased through regular distribution channels, with the FreeStyle Lite achieving the lowest MARD in this investigation. PMID:22176154

Genome-Wide Expression Analysis Suggests Hypoxia-Triggered Hyper-Coagulation Leading to Venous Thrombosis at High Altitude.

PubMed

Jha, Prabhash Kumar; Sahu, Anita; Prabhakar, Amit; Tyagi, Tarun; Chatterjee, Tathagata; Arvind, Prathima; Nair, Jiny; Gupta, Neha; Kumari, Babita; Nair, Velu; Bajaj, Nitin; Shanker, Jayashree; Sharma, Manish; Kumar, Bhuvnesh; Ashraf, Mohammad Zahid

2018-06-04

Venous thromboembolism (VTE), a multi-factorial disease, is the third most common cardiovascular disease. Established genetic and acquired risk factors are responsible for the onset of VTE. High altitude (HA) also poses as an additional risk factor, predisposing individuals to VTE; however, its molecular mechanism remains elusive. This study aimed to identify genes/pathways associated with the pathophysiology of deep vein thrombosis (DVT) at HA. Gene expression profiling of DVT patients, who developed the disease, either at sea level or at HA-DVT locations, resulted in differential expression of 378 and 875 genes, respectively. Gene expression profiles were subjected to bioinformatic analysis, followed by technical and biological validation of selected genes using quantitative reverse transcription-polymerase chain reaction. Both gene ontology and pathway analysis showed enrichment of genes involved in haemostasis and platelet activation in HA-DVT patients with the most relevant pathway being 'response to hypoxia'. Thus, given the environmental condition the differential expression of hypoxia-responsive genes (angiogenin, ribonuclease, RNase A family, 5; early growth response 1; lamin A; matrix metallopeptidase 14 [membrane-inserted]; neurofibromin 1; PDZ and LIM domain 1; procollagen-lysine 1, 2-oxoglutarate 5-dioxygenase 1; solute carrier family 6 [neurotransmitter transporter, serotonin], member 4; solute carrier family 9 [sodium/hydrogen exchanger], member 1; and TEK tyrosine kinase, endothelial) in HA-DVT could be a determining factor to understand the pathophysiology of DVT at HA. Schattauer GmbH Stuttgart.

Outcomes of catheter-directed treatment of lower extremity deep vein thrombosis of patients presenting to a tertiary care hospital.

PubMed

Sundar, Gaurav; Keshava, Shyamkumar N; Moses, Vinu; Chiramel, George K; Ahmed, Munawwar; Mammen, Suraj; Aggarwal, Sunil; Stephen, Edwin

2016-01-01

Lower extremity deep vein thrombosis (DVT) is a common illness with an annual incidence of 1 per 1000 adults. The major long-term complication of DVT is post-thrombotic syndrome (PTS) which occurs in up to 60% of patients within 2 years of an episode of DVT. We aim to evaluate the outcomes of catheter-directed treatment (CDT) for symptomatic acute or subacute lower extremity DVT. A retrospective 12-year study was conducted on the outcomes of CDT on 54 consecutive patients who presented with acute or subacute lower extremity DVT to our hospital. Descriptive summary statistics and the Chi-square test were used to measure the outcomes of CDT. Grade 3 thrombolysis was achieved in 25 (46.3%) patients, grade 2 thrombolysis in 25 (46.3%) patients, and grade 1 thrombolysis in 4 (7.4%) patients. Significant recanalization (grade 2 or 3 thrombolysis) was possible in 50 (92.6%) patients. There was no statistically significant difference in the percentage of significant recanalization that could be achieved between patients who underwent CDT before and after 10 days. There was no significant difference between the thrombolysis achieved between urokinase and r-tPA. PTS was seen in 33% of the patients. Major complications were seen in 5.5% of the patients. CDT is a safe and effective therapeutic technique in patients with acute and subacute lower extremity DVT, if appropriate patient selection is made.

Association between thrombophilia and the post-thrombotic syndrome: a systematic review and meta-analysis.

PubMed

Rabinovich, A; Cohen, J M; Prandoni, P; Kahn, S R

2014-01-01

The postthrombotic syndrome (PTS) is a frequent chronic complication of deep vein thrombosis (DVT), occurring in 20-40% of patients. Identifying risk factors for PTS may be useful to provide patients with prognostic information and target prevention strategies. To conduct a systematic review to assess whether, among patients with DVT, inherited and acquired thrombophilias are associated with a risk of PTS. We searched the electronic databases PubMed, EMBASE, Scopus, and Web of Science for studies published from 1990 to 2013 that assessed any thrombophilia in adult DVT patients and its association with the development of PTS. We calculated odds ratios and 95% confidence intervals for PTS according to the presence of thrombophilia. Meta-analysis was performed using the random-effects model. Sixteen studies were included: 13 assessed factor V Leiden (FVL), 10 assessed prothrombin mutation, five assessed protein S and C deficiencies, three assessed antithrombin deficiency, four assessed elevated FVIII levels, and six assessed antiphospholipid antibodies. None of the meta-analyses identified any thrombophilia to be predictive of PTS. Both FVL and prothrombin mutation appeared protective among studies including patients with both first and recurrent DVT and studies in which more than 50% of patients had an unprovoked DVT. Our meta-analysis did not demonstrate a significant association between any of the thrombophilias assessed and the risk of PTS in DVT patients. Other biomarkers in the pathophysiological pathway may be more predictive of PTS. © 2013 International Society on Thrombosis and Haemostasis.

Study on relationships among deep vein thrombosis, homocysteine & related B group vitamins.

PubMed

Ekim, Meral; Ekim, Hasan; Yilmaz, Yunus Keser; Kulah, Bahadir; Polat, M Fevzi; Gocmen, A Yesim

2015-01-01

Hyperhomocysteinemia has been considered as a potential risk factor for deep venous thrombosis (DVT) but it is still controversy. We aimed to evaluate the prevalence of hyperhomocysteinemia in patients with DVT. Our second objective was to document the prevalence of folate, Vitamin B6, and Vitamin B12 level in this patient population. Sixty patients with DVT aged from 23 to 84 years, were assessed regarding demographic characteristics, serum levels of homocysteine, folate, vitamin B12, and vitamin B6. The diagnosis of DVT was based upon Wells scoring system and serum D-dimer level and confirmed by deep venous Doppler ultrasonography of the lower limbs. Mean serum homocysteine levels were found significantly higher in patients over the age of 40 years (10.81±4.26 µmol/L vs 9.13±3.23 µmol/L). Of all the patients, 9 patients had homocysteine level above the 15µmol/L, 26 had folic acid level below 3 ng/ml, one had vitamin B12 level below 150 pmol/L, and two had vitamin B6 level below 30 nmol/L. In the hyperhomocysteinemic group, five patients had low folic acid level, one had low vitamin B12 level, and two had low vitamin B6 level. Hyperhomocysteinemia, in women older than 40 years, may be a risk factor for DVT. Folic acid deficiency may also influence serum homocysteine concentrations. Folate therapy may be offered to the patients with DVT. However further studies are required to clarify the underlying molecular mechanisms.

Red blood cell transfusion and increased length of storage are not associated with deep vein thrombosis in medical and surgical critically ill patients: a prospective observational cohort study

PubMed Central

2011-01-01

Introduction With prolonged storage times, cell membranes of red blood cells (RBCs) undergo morphologic and biochemical changes, termed 'RBC storage lesions'. Storage lesions may promote inflammation and thrombophilia when transfused. In trauma patients, RBC transfusion was an independent risk factor for deep vein thrombosis (DVT), specifically when RBC units were stored > 21 days or when 5 or more units were transfused. The objective of this study was to determine if RBC transfusions or RBC storage age predicts incident DVT in medical or surgical intensive care unit (ICU) patients. Methods Using a database which prospectively enrolled 261 patients over the course of 1 year with an ICU stay of at least 3 days, we analyzed DVT and RBC transfusions using Cox proportional hazards regression. Transfusions were analyzed with 4 thresholds, and storage age using 3 thresholds. DVTs were identified by twice-weekly proximal leg ultrasounds. Multivariable analyses were adjusted for 4 significant DVT predictors in this population (venous thrombosis history, chronic dialysis, platelet transfusion and inotropes). Results Of 261 patients, 126 (48.3%) had at least 1 RBC transfusion; 46.8% of those transfused had ≥ 5 units in ICU. Patients receiving RBCs were older (68.8 vs 64.1 years), more likely to be female (47.0 vs 30.7), sicker (APACHEII 26.8 vs 24.4), and more likely to be surgical (21.4 vs 8.9) (P < 0.05). The total number of RBCs per patient was 1-64, mean was 6.3 (SD 7.5), median was 4 (IQR 2,8). In univariate analyses, there was no association between DVT and RBC exposure (1 day earlier, 3 days earlier, 7 days earlier, or ever) or RBC storage (≤ 7 or > 7 days, ≤ 14 or > 14 days, ≤ 21 or > 21 days). Among patients transfused, no multivariable analyses showed that RBC transfusion or storage age predicted DVT. Trends were counter to the hypothesis (e.g., RBC storage for ≤ 7 days suggested a higher DVT risk compared to > 7 days (HR 5.3; 95% CI 1.3-22.1). Conclusions We were unable to detect any association between RBC transfusions or prolonged red cell storage and increased risk of DVT in medical or surgical ICU patients. Alternate explanations include a lack of sufficient events or patients' interaction, between patient groups, a mixing of red cell storage times creating differential effects on DVT risk, and unmeasured confounders. PMID:22044745

SR-90107 (Sanofi-Synthélabo).

PubMed

Liu, F; Bagley, W P; Carroll, R C

2000-09-01

SR-90107 is a synthetic pentasaccharide heparinoid Factor Xa antagonist and thrombokinase inhibitor in joint development by Sanofi-Synthelabo (formerly Sanofi) and Organon as a potential treatment and prophylaxis for deep vein thrombosis (DVT) and symptomatic pulmonary embolism following hip or knee surgery and as a potential treatment for coronary artery diseases [330073,359231]. The compound is in phase III clinical trials for the prevention of DVT and pulmonary embolism; phase III trials for the treatment of DVT and pulmonary embolism were expected to start in the first quarter of 2000 and phase IIb trials in cardiology indications are also underway. NDAs are planned to be submitted in Europe and the US in the third quarter of 2000 for the prevention of DVT and symptomatic pulmonary embolism, in 2002 for the treatment of DVT and pulmonary embolism and in 2004 for the treatment of coronary artery diseases [359231]. DVT AND PULMONARY EMBOLISM: The compound had entered phase III clinical trials by December 1998 for the prevention of thrombosis [320585]. By February 2000, four phase III trials in the prevention of DVT and pulmonary embolism following orthopaedic surgery were underway: the European PENTHIFRA trial, which involves 1707 patients with hip fracture; the US PENTATHLON trial, which involves 2200 patients undergoing hip replacements; the European EPHESUS trial, which involves 2200 patients undergoing hip replacements; and the US PENTAMAKS trial, which involves 1000 patients undergoing major knee surgery [359231]. Clinical data from these trials are expected to be available by June 2000 [359793]. By February 2000, preparations were also being made for two phase III trials of SR-90107 for the treatment of DVT and pulmonary embolism, both expected to be initiated in the first quarter of 2000; the MATISSE DVT trial, a double-blind trial of SR-90107 versus enoxaparin sodium in 2200 patients; and the MATISSE PE trial, an open study of SR-90107 versus unfractionated heparin in 2200 patients [359231]. CORONARY ARTERY DISEASES: By February 2000, SR-90107 was also under development for unstable angina, percutaneous transluminal coronary angioplasty, and acute myocardial infarction. At this time, the phase IIb PENTALYSE trial in thrombolyzed acute myocardial infarction patients had been completed, demonstrating a good safety/efficacy ratio, and the phase IIb PENTUA trial in unstable angina was ongoing [359231]. In October 1999, Merrill Lynch forecast sales of EUR 180 million in 2003, planning a review of this figure once clinical data were available [346209]. Also in October 1999, Lehman Brothers predicted that the product had a 70% chance of reaching the market with potential peak sales of US 700 million dollars in 2008 [346267].

REopt Lite Web Tool

DOE Office of Scientific and Technical Information (OSTI.GOV)

NREL developed a free, publicly available web version of the REopt (TM) renewable energy integration and optimization platform called REopt Lite. REopt Lite recommends the optimal size and dispatch strategy for grid-connected photovoltaics (PV) and battery storage at a site. It also allows users to explore how PV and storage can increase a site's resiliency during a grid outage.

Deep Vein Thrombosis in Patients with Severe Motor and Intellectual Disabilities

PubMed Central

2013-01-01

Most patients with severe motor and intellectual disabilities (SMID) have restricted mobility capability and have been bedridden for long periods because of paralysis of the extremities caused by abnormal muscular tonicity due to cerebral palsy and developmental disabilities, and such patients are associated with a high risk for the complications of deep vein thrombosis (DVT). Here, we report 8 patients (34.8%) with DVT among 23 patients with SMID during prolonged bed rest. However, we did not detect thrombosis in the soleal veins, finding it mostly in the superficial femoral and common femoral veins. Regarding laboratory data for the coagulation system, there were no cases with D-dimer above 5 µg/ml. Concerning sudden death in patients with SMID, we have to be very careful of the possibility of pulmonary thromboembolism due to DVT. Therefore, we should consider the particularities of an underdeveloped vascular system from underlying diseases for the evaluation of DVT in patients with SMID. A detailed study of DVT as a vascular complication is very important for smooth medical care of SMID and compression Doppler ultrasonography of the lower extremities, as noninvasive examination, is very helpful. (*English translation of Jpn J Phlebol 2012; 23: 17-24) PMID:24386017

Customizing our approach in deep vein thrombosis and pulmonary embolism treatment: overview of our clinical experience.

PubMed

Turpie, A G

1999-08-01

Until recently, the management of established deep vein thrombosis (DVT) and pulmonary embolism remained largely unchanged and unchallenged. Treatment comprised an initial intravenous bolus of unfractionated heparin (UFH), followed by dose-adjusted intravenous UFH for 5-7 days, and oral warfarin for three months. UFH is traditionally administered in hospital, and monitoring and dose adjustment remain essential features of both UFH and warfarin treatment, making therapy both costly and inconvenient. Recent clinical trials have shown that subcutaneous UFH, or low-molecular-weight heparins (LMWHs), administered subcutaneously at a weight-adjusted fixed dose, are at least as effective as standard UFH given intravenously in the treatment of DVT. The feasibility of initial treatment of DVT at home in selected patients, with associated cost-savings and improved convenience have also been demonstrated with LMWHs. Clinical trials are currently investigating the potential value of LMWHs in the treatment of pulmonary embolism and as an alternative to warfarin in secondary prevention of DVT. The role of newer anticoagulants, such as recombinant hirudin, in initial treatment of DVT, and of thrombolysis in the management of pulmonary embolism remain to be defined.

Recent Status of SIM Lite Astrometric Observatory Mission: Flight Engineering Risk Reduction Activities

NASA Technical Reports Server (NTRS)

Goullioud, Renaud; Dekens, Frank; Nemati, Bijan; An, Xin; Carson, Johnathan

2010-01-01

The SIM Lite Astrometric Observatory is a mission concept for a space-borne instrument to perform micro-arc-second narrow-angle astrometry to search 60 to 100 nearby stars for Earth-like planets, and to perform global astrometry for a broad astrophysics program. The instrument consists of two Michelson stellar interferometers and a telescope. The first interferometer chops between the target star and a set of reference stars. The second interferometer monitors the attitude of the instrument in the direction of the target star. The telescope monitors the attitude of the instrument in the other two directions. The main enabling technology development for the mission was completed during phases A & B. The project is currently implementing the developed technology onto flight-ready engineering models. These key engineering tasks will significantly reduce the implementation risks during the flight phases C & D of the mission. The main optical interferometer components, including the astrometric beam combiner, the fine steering optical mechanism, the path-length-control and modulation optical mechanisms, focal-plane camera electronics and cooling heat pipe, are currently under development. Main assemblies are built to meet flight requirements and will be subjected to flight qualification level environmental testing (random vibration and thermal cycling) and performance testing. This paper summarizes recent progress in engineering risk reduction activities.

Remote Sensing of the Upper Atmosphere and the Ionosphere in the Extreme and Far Ultraviolet: Results from the LITES Experiment aboard the IS

NASA Astrophysics Data System (ADS)

Finn, S. C.; Chakrabarti, S.; Stephan, A. W.; Geddes, G.; Budzien, S. A.; Cook, T.; Aryal, S.; Martel, J.; Galkin, I. A.; Erickson, P. J.

2017-12-01

The Limb-Imaging Ionospheric and Thermospheric Extreme-ultraviolet Spectrograph (LITES) was launched as part of the Space Test Program Houston #5 (STP-H5) payload aboard a commercial resupply flight on February 19, 2017 and was subsequently installed on the International Space Station (ISS). LITES is an imaging spectrograph that spans the 60 - 140 nm wavelength range at 1 nm spectral resolution and samples tangent altitudes 150 - 350 km with 0.2° angular resolution. LITES, in combination with the GPS Radio Occultation and Ultraviolet Photometry - Colocated (GROUP-C) experiment, which includes a GPS receiver and a nadir viewing 135.6 nm photometer, jointly collect new information on the thermosphere and the ionosphere using simultaneous UV and radio emissions. LITES, which uses standard stars to perform in-flight calibration, observes altitude profiles of day and night airglow emissions that are being used to infer thermospheric and ionospheric density profiles. Furthermore, due to the inclination of the ISS, LITES has also observed auroral spectrum and their altitude and spatial variations. Finally, geomagnetic storm effects on its UV emissions can be used to remotely sense their effects on the upper atmospheric morphology. These ISS observations,which are complement to the upcoming ICON and GOLD NASA missions, are focused on ionosphere-atmosphere coupling and global-scale atmospheric response to space weather observed from higher altitudes . We will present an overview of the LITES instrument, some early results from the first few months of operations. We will also summarize the advantages in calibration and validation activities that are possible through space-based LITES, GROUP-C and stellar measurements and simultaneous ground-based optical and radar observations.

Method and apparatus for an insulating glazing unit and compliant seal for an insulating glazing unit

DOEpatents

Francis, IV, William H.; Freebury, Gregg E.; Beidleman, Neal J.; Hulse, Michael

2016-05-03

A Vacuum Insulating Glazing Unit (VIGU) comprises two or more glass lites (panes) spaced apart from one another and hermetically bonded to an edge seal assembly therebetween. The resulting cavity between the lites is evacuated to create at least one insulating vacuum cavity within which are disposed a plurality of stand-off members to maintain separation between the lites. The edge seal assembly is preferably compliant in the longitudinal (i.e., edgewise) direction to allow longitudinal relative motion between the two lites (e.g., from thermal expansion). The longitudinal compliance may be obtained by imprinting a three-dimensional pattern into the edge seal material. The edge seal assembly is preferably bonded to the lites with a first bond portion that is hermetic and a second bond portion that is load-resistant. Methods for producing VIGUs and/or compliant edge seal assemblies and VIGU and edge seal apparatus are disclosed.

Extra-adrenal pheochromocytoma: an unusual cause of deep vein thrombosis.

PubMed

Stevenson, Susan; Ramani, Vijay; Nasim, Akhtar

2005-09-01

We report a case of extra-adrenal pheochromocytoma within the organ of Zuckerkandl that presented initially with a left iliofemoral deep venous thrombosis (DVT). At the time of presentation, the DVT was thought to be idiopathic as no underlying cause was detected. Subsequently, because of a series of medical events, the patient was further investigated. This led to a diagnosis of extra-adrenal pheochromocytoma. We discuss the management of patients presenting with DVT, the nature of pheochromocytoma within the organ of Zuckerkandl, and problems relating to its diagnosis.

Residual vein thrombosis and serial D-dimer for the long-term management of patients with deep venous thrombosis.

PubMed

Prandoni, Paolo; Vedovetto, Valentina; Ciammaichella, Maurizio; Bucherini, Eugenio; Corradini, Sara; Enea, Iolanda; Cosmi, Benilde; Mumoli, Nicola; Visonà, Adriana; Barillari, Giovanni; Bova, Carlo; Quintavalla, Roberto; Zanatta, Nello; Pedrini, Simona; Villalta, Sabina; Camporese, Giuseppe; Testa, Sofie; Parisi, Roberto; Becattini, Cecilia; Cuppini, Stefano; Pengo, Vittorio; Palareti, Gualtiero

2017-06-01

The optimal long-term strategy for preventing recurrent venous thromboembolism (VTE) in patients with deep-vein thrombosis (DVT) is uncertain. In 620 consecutive outpatients with a first proximal DVT who had completed at least three months of anticoagulation (unprovoked in 483, associated with minor risk factors in 137), the ultrasound presence of residual vein thrombosis (RVT) was assessed and defined as an incompressibility of at least 4mm. In 517 patients without RVT and with negative D-dimer, anticoagulation was stopped and D-dimer was repeated after one and three months. Anticoagulation was resumed in 63 of the 72 patients in whom D-dimer reverted to positivity. During a mean follow-up of three years, recurrent VTE developed in 40 (7.7%) of the 517 patients, leading to an annual rate of 3.6% (95% CI, 2.6 to 4.9): 4.1% (95% CI, 2.9 to 5.7) in individuals with unprovoked DVT, and 2.2% (95% CI, 1.1 to 4.5) in those with DVT associated with minor risk factors. Of the 233 males with unprovoked DVT, 17 (7.3%) developed events in the first year of follow-up. Major bleeding complications occurred in 8 patients while on anticoagulation, leading to an annual rate of 1.2% (95% CI, 0.6 to 2.4). Discontinuing anticoagulation in patients with a first episode of proximal DVT based on the assessment of RVT and serial D-dimer leads to an overall annual rate of recurrent VTE lower than 5.0%, which is the rate deemed as acceptable by the Subcommittee on Control of Anticoagulation of the ISTH. However, in males with unprovoked DVT there is room for further improving the long-term strategy of VTE prevention. (ClinicalTrials.gov number, NCT01285661). Copyright © 2017 Elsevier Ltd. All rights reserved.

Goal directed enoxaparin dosing provides superior chemoprophylaxis against deep vein thrombosis.

PubMed

Kopelman, Tammy R; Walters, Jarvis W; Bogert, James N; Basharat, Usmaan; Pieri, Paola G; Davis, Karole M; Quan, Asia N; Vail, Sydney J; Pressman, Melissa A

2017-05-01

Optimal enoxaparin dosing for deep venous thrombosis (DVT) prophylaxis remains elusive. Prior research demonstrated that trauma patients at increased risk for DVT based upon Greenfield's risk assessment profile (RAP) have DVT rates of 10.8% despite prophylaxis. The aim of this study was to determine if goal directed prophylactic enoxaparin dosing to achieve anti-Xa levels of 0.3-0.5IU/ml would decrease DVT rates without increased complications. Retrospective review of trauma patients having received prophylactic enoxaparin and appropriately timed anti-Xa levels was performed. Dosage was adjusted to maintain an anti-Xa level of 0.3-0.5IU/ml. RAP was determined on each patient. A score of ≥5 was considered high risk for DVT. Sub-analysis was performed on patients who received duplex examinations subsequent to initiation of enoxaparin therapy to determine the incidence of DVT. 306 patients met inclusion criteria. Goal anti-Xa levels were met initially in only 46% of patients despite dosing of >40mg twice daily in 81% of patients; however, with titration, goal anti-Xa levels were achieved in an additional 109 patients (36%). An average enoxaparin dosage of 0.55mg/kg twice daily was required for adequacy. Bleeding complications were identified in five patients (1.6%) with three requiring intervention. There were no documented episodes of HIT. Subsequent duplex data was available in 197 patients with 90% having a RAP score >5. Overall, five DVTs (2.5%) were identified and all occurred in the high-risk group. All patients were asymptomatic at the time of diagnosis. An increased anti-Xa range of 0.3-0.5IU/ml was attainable but frequently required titration of enoxaparin dosage. This produced a lower rate of DVT than previously published without increased complications. Copyright © 2016 Elsevier Ltd. All rights reserved.

Differentiation of deep venous thrombosis from femoral vein mixing artifact on routine abdominopelvic CT.

PubMed

Doshi, Ankur M; Hoffman, David; Kierans, Andrea S; Ream, Justin M; Rosenkrantz, Andrew B

2015-10-01

The objective of this study is to assess the performance of qualitative and quantitative imaging features for the differentiation of deep venous thrombosis (DVT) from mixing artifact on routine portal venous phase abdominopelvic CT. This retrospective study included 40 adult patients with a femoral vein filling defect on portal venous phase CT and a Duplex ultrasound (n = 36) or catheter venogram (n = 4) to confirm presence or absence of DVT. Two radiologists (R1, R2) assessed the femoral veins for various qualitative and quantitative features. 60% of patients were confirmed to have DVT and 40% had mixing artifact. Features with significantly greater frequency in DVT than mixing artifact (all p ≤ 0.006) were central location (R1 90% vs. 28%; R2 96% vs. 31%), sharp margin (R1 83% vs. 28%; R2 96% vs. 31%), venous expansion (R1 48% vs. 6%, R2 56% vs. 6%), and venous wall enhancement (R1 62% vs. 0%; R2 48% vs. 0%). DVT exhibited significantly lower mean attenuation than mixing artifact (R1 42.1 ± 20.2 vs. 57.1 ± 23.6 HU; R2 43.6 ± 19.4 vs. 58.8 ± 23.4 HU, p ≤ 0.031) and a significantly larger difference in vein diameter compared to the contralateral vein (R1 0.4 ± 0.4 vs. 0.1 ± 0.2 cm; R2 0.3 ± 0.4 vs. 0.0 ± 0.1 cm, p ≤ 0.026). At multivariable analysis, central location and sharp margin were significant independent predictors of DVT for both readers (p ≤ 0.013). Awareness of these qualitative and quantitative imaging features may improve radiologists' confidence for differentiating femoral vein DVT and mixing artifact on routine portal venous phase CT. However, given overlap with mixing artifact, larger studies remain warranted.

Biological risk factors for deep vein trombosis.

PubMed

Vayá, Amparo; Mira, Yolanda; Martínez, Marcial; Villa, Piedad; Ferrando, Fernando; Estellés, Amparo; Corella, Dolores; Aznar, Justo

2002-01-01

Hypercoagulable states due either to inherited or acquired thrombotic risk factors are only present in approximately half of cases of DVT, but the causes in the other half, remain unknown. The importance of biological risk factors such as hyperlipidemia, hypofibrinolysis and hemorheological alterations in the pathogenesis of DVT has not been well established. In order to ascertain whether the above mentioned biological factors are associated with DVT and could constitute independent risk factors, we carried out a case-control study in 109 first DVT patients in whom inherited or acquired thrombophilic risk factors had been ruled out and 121 healthy controls age (42+/-15 years) and sex matched. From all the biological variables analyzed (cholesterol, triglycerides, glucose, fibrinogen, erythrocyte aggregation, hematocrit, plasma viscosity and PAI-1) only fibrinogen concentration reached a statistically significant difference on the comparison of means (290+/-73 mg/dl in cases vs 268+/-58 mg/dl in controls, p<0.05). After this continuous variables were dichotomized according to our reference values, the percentage of cases with cholesterolemia >220 mg/dl, hematocrit >45% and fibrinogen >300 mg/dl was higher in cases than in controls: 38% vs 22%; p<0.01; 43% vs 27%; p<0.05; 36% vs 23%; p<0.05, respectively. The percentage of cases with PAI-1 values >30 ng/ml, 37% vs 25% was borderline significant; p=0.055. Multivariate logistic regression analysis showed that cholesterolemia >220 mg/dl and fibrinogen >300 mg/dl constitute independent predictors of venous thrombotic risk. The adjusted OR's were 2.03 (95% CI; 1.12-3.70) for cholesterolemia and 1.94 (95% CI; 1.07-3.55) for fibrinogen. When these two variables combined DVT risk rose about fourfold (3.96; p<0.05). Our results suggest that hypercholesterolemia and hyperfibrinogenemia should be added to the list of known DVT risk factors and we recommend adopting measures to decrease these variables in the population with a high risk of DVT.

A novel method of adverse event detection can accurately identify venous thromboembolisms (VTEs) from narrative electronic health record data.

PubMed

Rochefort, Christian M; Verma, Aman D; Eguale, Tewodros; Lee, Todd C; Buckeridge, David L

2015-01-01

Venous thromboembolisms (VTEs), which include deep vein thrombosis (DVT) and pulmonary embolism (PE), are associated with significant mortality, morbidity, and cost in hospitalized patients. To evaluate the success of preventive measures, accurate and efficient methods for monitoring VTE rates are needed. Therefore, we sought to determine the accuracy of statistical natural language processing (NLP) for identifying DVT and PE from electronic health record data. We randomly sampled 2000 narrative radiology reports from patients with a suspected DVT/PE in Montreal (Canada) between 2008 and 2012. We manually identified DVT/PE within each report, which served as our reference standard. Using a bag-of-words approach, we trained 10 alternative support vector machine (SVM) models predicting DVT, and 10 predicting PE. SVM training and testing was performed with nested 10-fold cross-validation, and the average accuracy of each model was measured and compared. On manual review, 324 (16.2%) reports were DVT-positive and 154 (7.7%) were PE-positive. The best DVT model achieved an average sensitivity of 0.80 (95% CI 0.76 to 0.85), specificity of 0.98 (98% CI 0.97 to 0.99), positive predictive value (PPV) of 0.89 (95% CI 0.85 to 0.93), and an area under the curve (AUC) of 0.98 (95% CI 0.97 to 0.99). The best PE model achieved sensitivity of 0.79 (95% CI 0.73 to 0.85), specificity of 0.99 (95% CI 0.98 to 0.99), PPV of 0.84 (95% CI 0.75 to 0.92), and AUC of 0.99 (95% CI 0.98 to 1.00). Statistical NLP can accurately identify VTE from narrative radiology reports. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Deep Vein Thrombosis After Complex Posterior Spine Surgery: Does Staged Surgery Make a Difference?

PubMed

Edwards, Charles C; Lessing, Noah L; Ford, Lisa; Edwards, Charles C

Retrospective review of a prospectively collected database. To assess the incidence of deep vein thrombosis (DVT) associated with single- versus multistage posterior-only complex spinal surgeries. Dividing the physiologic burden of spinal deformity surgery into multiple stages has been suggested as a potential means of reducing perioperative complications. DVT is a worrisome complication owing to its potential to lead to pulmonary embolism. Whether or not staging affects DVT incidence in this population is unknown. Consecutive patients undergoing either single- or multistage posterior complex spinal surgeries over a 12-year period at a single institution were eligible. All patients received lower extremity venous duplex ultrasonographic (US) examinations 2 to 4 days postoperatively in the single-stage group and 2 to 4 days postoperatively after each stage in the multistage group. Multivariate logistic regression was used to assess the independent contribution of staging to developing a DVT. A total of 107 consecutive patients were enrolled-26 underwent multistage surgery and 81 underwent single-stage surgery. The single-stage group was older (63 years vs. 45 years; p < .01) and had a higher Charlson comorbidity index (2.25 ± 1.27 vs. 1.23 ± 1.58; p < .01). More multistage patients had positive US tests than single-stage patients (5 of 26 vs. 6 of 81; 19% vs. 7%; p = .13). Adjusting for all the above-mentioned covariates, a multistage surgery was 8.17 (95% CI 0.35-250.6) times more likely to yield a DVT than a single-stage surgery. Patients who undergo multistage posterior complex spine surgery are at a high risk for developing a DVT compared to those who undergo single-stage procedures. The difference in DVT incidence may be understated as the multistage group had a lower pre- and intraoperative risk profile with a younger age, lower medical comorbidities, and less per-stage blood loss. Copyright © 2017 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Longitudinal Ionospheric Variability Observed by LITES on the ISS

NASA Astrophysics Data System (ADS)

Stephan, A. W.; Finn, S. C.; Cook, T.; Geddes, G.; Chakrabarti, S.; Budzien, S. A.

2017-12-01

The Limb-Imaging Ionospheric and Thermospheric Extreme-Ultraviolet Spectrograph (LITES) is an imaging spectrograph designed to measure altitude profiles (150-350 km) of extreme- and far-ultraviolet airglow emissions that originate from photochemical processes in the ionosphere and thermosphere. During the daytime, LITES observes the bright O+ 83.4 nm emission from which the ionospheric profile can be inferred. At night, recombination emissions at 91.1 and 135.6 nm provide a direct measure of the electron content along the line of sight. LITES was launched and installed on the International Space Station (ISS) in late February 2017 where it has been operating along with the highly complementary GPS Radio Occultation and Ultraviolet Photometry - Colocated (GROUP-C) experiment. We will present some of the first observations from LITES in April 2017 that show longitudinal patterns in ionospheric density and the daily variability in those patterns. LITES vertical imaging from a vantage point near 410 km enables a particularly unique perspective on the altitude of the ionospheric peak density at night that can complement and inform other ground- and space-based measurements, and track the longitude-altitude variability that is reflective of changes in equatorial electrodynamics.

Usability and Acceptance of the Librarian Infobutton Tailoring Environment: An Open Access Online Knowledge Capture, Management, and Configuration Tool for OpenInfobutton.

PubMed

Jing, Xia; Cimino, James J; Del Fiol, Guilherme

2015-11-30

The Librarian Infobutton Tailoring Environment (LITE) is a Web-based knowledge capture, management, and configuration tool with which users can build profiles used by OpenInfobutton, an open source infobutton manager, to provide electronic health record users with context-relevant links to online knowledge resources. We conducted a multipart evaluation study to explore users' attitudes and acceptance of LITE and to guide future development. The evaluation consisted of an initial online survey to all LITE users, followed by an observational study of a subset of users in which evaluators' sessions were recorded while they conducted assigned tasks. The observational study was followed by administration of a modified System Usability Scale (SUS) survey. Fourteen users responded to the survey and indicated good acceptance of LITE with feedback that was mostly positive. Six users participated in the observational study, demonstrating average task completion time of less than 6 minutes and an average SUS score of 72, which is considered good compared with other SUS scores. LITE can be used to fulfill its designated tasks quickly and successfully. Evaluators proposed suggestions for improvements in LITE functionality and user interface.

Traveller's thrombosis: a review of deep vein thrombosis associated with travel. The Air Transport Medicine Committee, Aerospace Medical Association.

PubMed

Bagshaw, M

2001-09-01

There is an increasing suspicion among the travelling public and the international media of an association between the occurrence of deep venous thrombosis (DVT) and air travel. It was noted by the UK House of Lords Select Committee on Science and Technology that up to 20% of the total population may have some degree of increased clotting tendency. It follows that some air travellers are at risk of developing DVT when, or soon after, travelling. There have been no epidemiological studies published which show a statistically significant increase in cases of DVT when travelling in the absence of pre-existing risk factors. The literature was reviewed. Current evidence indicates that any association between symptomatic DVT and travel by air is weak, and the incidence is less than the impression given by recent media publicity.

Prevalence of factor V leiden, MTHFR C677T and MTHFR A1298C polymorphisms in patients with deep vein thrombosis in Central Iran.

PubMed

Ehsani, Majid; Imani, Aida; Moravveji, Alireza

2018-05-31

Deep vein thrombosis (DVT) is a common disease, especially among elderly patients, which is associated with high costs of treatment and high rates of recurrence. The risk factors for venous thrombosis are primarily related to hypercoagulability, which can be genetic or acquired, or because of immobilization and venous stasis. Among relevant genetic markers are a number of common polymorphisms and mutations in the genes coding for Factor V leiden and methylenetetrahydrofolate reductase. Differential associations of these polymorphisms have been reported in different populations with DVT due to ethnic variations. However, no study has been reported with respect to these polymorphisms in DVT in Iran. Thus, the aim of the present study is to determine the prevalence of FVL, MTHFR C677T and MTHFR A1298C gene polymorphisms in patients with DVT in central Iran. In the present cross-sectional study, a total of 100 patients with first and recurrent episodes of DVT and age less than 70 years were recruited during 2016-2017. Blood sample was collected from the recruited patients and FVL mutation was screened using ARMS-PCR method, MTHFR C677T and MTHFR A1298C mutations were screened using PCR-RFLP method. The results revealed that MTHFR A1298C gene polymorphism in both homozygote and heterozygote form was found to be most frequent i.e. 77% among cases, followed by MTHFR C677T (67%) and FVL (17%). The study highlights the importance of screening of these genetic markers among patients with DVT in this region.

Skater Tara Lipinski Speaks Out About DVT | NIH MedlinePlus the Magazine

MedlinePlus

... don’t exercise or who are sick and bedridden.” I just never thought that a teenager—especially ... DVT is not just a condition of the elderly. It can strike anyone in any physical condition ...

Risk of deep venous thrombosis in elective neurosurgical procedures: a prospective, Doppler ultrasound-based study in children 12 years of age or younger.

PubMed

Scherer, Andrea G; White, Ian K; Shaikh, Kashif A; Smith, Jodi L; Ackerman, Laurie L; Fulkerson, Daniel H

2017-07-01

OBJECTIVE The risk of venous thromboembolism (VTE) from deep venous thrombosis (DVT) is significant in neurosurgical patients. VTE is considered a leading cause of preventable hospital deaths and preventing DVT is a closely monitored quality metric, often tied to accreditation, hospital ratings, and reimbursement. Adult protocols include prophylaxis with anticoagulant medications. Children's hospitals may adopt adult protocols, although the incidence of DVT and the risk or efficacy of treatment is not well defined. The incidence of DVT in children is likely less than in adults, although there is very little prospectively collected information. Most consider the risk of DVT to be extremely low in children 12 years of age or younger. However, this consideration is based on tradition and retrospective reviews of trauma databases. In this study, the authors prospectively evaluated pediatric patients undergoing a variety of elective neurosurgical procedures and performed Doppler ultrasound studies before and after surgery. METHODS A total of 100 patients were prospectively enrolled in this study. All of the patients were between the ages of 1 month and 12 years and were undergoing elective neurosurgical procedures. The 91 patients who completed the protocol received a bilateral lower-extremity Doppler ultrasound examination within 48 hours prior to surgery. Patients did not receive either medical or mechanical DVT prophylaxis during or after surgery. The ultrasound examination was repeated within 72 hours after surgery. An independent, board-certified radiologist evaluated all sonograms. We prospectively collected data, including potential risk factors, details of surgery, and details of the clinical course. All patients were followed clinically for at least 1 year. RESULTS There was no clinical or ultrasound evidence of DVT or VTE in any of the 91 patients. There was no clinical evidence of VTE in the 9 patients who did not complete the protocol. CONCLUSIONS In this prospective study, no DVTs were found in 91 patients evaluated by ultrasound and 9 patients followed clinically. While the study is underpowered to give a definitive incidence, the data suggest that the risk of DVT and VTE is very low in children undergoing elective neurosurgical procedures. Prophylactic protocols designed for adults may not apply to pediatric patients. Clinical trial registration no.: NCT02037607 (clinicaltrials.gov).

9 CFR 317.356 - Nutrient content claims for “light” or “lite.”

Code of Federal Regulations, 2014 CFR

2014-01-01

... âlite.â 317.356 Section 317.356 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE... Labeling § 317.356 Nutrient content claims for “light” or “lite.” (a) General requirements. A claim using... claims in § 317.313; and (3) The product for which the claim is made is labeled in accordance with § 317...

9 CFR 317.356 - Nutrient content claims for “light” or “lite.”

Code of Federal Regulations, 2013 CFR

2013-01-01

... âlite.â 317.356 Section 317.356 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE... Labeling § 317.356 Nutrient content claims for “light” or “lite.” (a) General requirements. A claim using... claims in § 317.313; and (3) The product for which the claim is made is labeled in accordance with § 317...

9 CFR 317.356 - Nutrient content claims for “light” or “lite.”

Code of Federal Regulations, 2011 CFR

2011-01-01

... âlite.â 317.356 Section 317.356 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE... Labeling § 317.356 Nutrient content claims for “light” or “lite.” (a) General requirements. A claim using... claims in § 317.313; and (3) The product for which the claim is made is labeled in accordance with § 317...

9 CFR 317.356 - Nutrient content claims for “light” or “lite.”

Code of Federal Regulations, 2012 CFR

2012-01-01

... âlite.â 317.356 Section 317.356 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE... Labeling § 317.356 Nutrient content claims for “light” or “lite.” (a) General requirements. A claim using... claims in § 317.313; and (3) The product for which the claim is made is labeled in accordance with § 317...

Nephrotic syndrome presenting as deep vein thrombosis or pulmonary embolism.

PubMed

Ambler, Bill; Irvine, Sharon; Selvarajah, Vik; Isles, Chris

2008-04-01

A patient presenting with a swollen left leg and pleuritic chest pain was shown to have deep vein thrombosis (DVT) by Doppler studies. He was anticoagulated but required two further admissions with swelling of both legs before a diagnosis of nephrotic syndrome was considered and confirmed. Renal biopsy showed that this was caused by membranous nephropathy. Two audits were subsequently conducted. The first was of diagnostic discharge codes for nephrotic syndrome and venous thromboembolism in south west Scotland (population 147,000) from 1997 to 2006. A diagnosis of nephrotic syndrome was confirmed in 32 patients, four (12.5%) of whom (including the index case) had presented with DVT (two) or pulmonary embolus (PE) (two). A second audit of 98 consecutive patients with Doppler-positive lower limb DVT presenting to A&E in Dumfries from July 2005 to July 2006 showed that the urine had been tested for protein in one case only. Although nephrotic syndrome remains an uncommon cause of DVT or PE, it is complicated by venous thromboembolism sufficiently frequently for the diagnosis to be considered in all patients with DVT or PE, for whom the take-home message should simply be-Don't forget to dip the urine or ignore a low serum albumin.

Efficacy of prophylactic inferior vena caval filters in prevention of pulmonary embolism in the absence of deep venous thrombosis.

PubMed

Davies, Mark G; Hart, Joseph P; El-Sayed, Hosam F

2016-01-01

There is an increasing use of inferior vena caval filters (IVCFs) as prophylactic activity in the absence of a deep venous thrombosis (DVT) to prevent pulmonary embolism (PE) in high-risk patients. These devices are effective in preventing PE in the presence of lower extremity DVT, when anticoagulation is contraindicated or has failed. An electronic databases search of MEDLINE, PubMed, The Cochrane Library, and Google Scholar for relevant articles listed between January 2000 and December 2014 was performed. The review was confined to patients without a history of previous venous thromboembolism and no evidence of changes on venous duplex imaging suggestive of previous DVT. At present, the use of prophylactic IVCF is predominantly in the trauma, orthopedic, and bariatric surgical populations. Currently, no class I studies exist to support insertion of an IVCF in a patient without an established DVT or PE. However, there is a body of class II and class III evidence that would support the use of IVCFs in certain "high-risk" patients who do not have a documented DVT or the occurrence of a PE. Widespread use of prophylactic IVCFs is not supported by evidence and should be discouraged. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Thrombophilia in Klinefelter Syndrome With Deep Venous Thrombosis, Pulmonary Embolism, and Mesenteric Artery Thrombosis on Testosterone Therapy: A Pilot Study.

PubMed

Glueck, Charles J; Jetty, Vybhav; Goldenberg, Naila; Shah, Parth; Wang, Ping

2017-11-01

We compared thrombophilia and hypofibrinolysis in 6 men with Klinefelter syndrome (KS), without previously known familial thrombophilia, who had sustained deep venous thrombosis (DVT)-pulmonary emboli (PE) or mesenteric artery thrombosis on testosterone replacement therapy (TRT). After the diagnosis of KS, TRT had been started in the 6 men at ages 11, 12, 13, 13, 19, and 48 years. After starting TRT, DVT-PE or mesenteric artery thrombosis was developed in 6 months, 1, 11, 11, 12, and 49 years. Of the 6 men, 4 had high (>150%) factor VIII (177%, 192%, 263%, and 293%), 3 had high (>150%) factor XI (165%, 181%, and 193%), 1 was heterozygous for the factor V Leiden mutation, and 1 was heterozygous for the G20210A prothrombin gene mutation. None of the 6 men had a precipitating event before their DVT-PE. We speculate that the previously known increased rate of DVT-PE and other thrombi in KS reflects an interaction between prothrombotic, long-term TRT with previously undiagnosed familial thrombophilia. Thrombophilia screening in men with KS before starting TRT would identify a cohort at increased risk for subsequent DVT-PE, providing an optimally informed estimate of the risk/benefit ratio of TRT.

Venous duplex and pathologic differences in thrombus characteristics between de novo deep vein thrombi and endovenous heat-induced thrombi.

PubMed

Santin, Brian J; Lohr, Joanne M; Panke, Thomas W; Neville, Patrick M; Felinski, Melissa M; Kuhn, Brian A; Recht, Matthew H; Muck, Patrick E

2015-04-01

Superficial venous reflux disease has been treated with endovenous ablation techniques for more than 15 years. Thrombi discovered in the postoperative period are referred to as endovenous heat-induced thrombi (EHIT). In spite of the few studies of the ultrasound differentiation between EHIT and deep vein thrombi (DVT), there remains a paucity of literature regarding the evaluation of ultrasound examination and pathologic differentiation. Six Yorkshire cross swine underwent femoral vein thrombosis by suture ligation or endovenous radiofrequency ablation. At 1 week after the procedure, each femoral vein was imaged by color Duplex ultrasound and sent for histologic interpretation for differentiation between EHIT and DVT. Five blinded vascular surgery faculty, two vascular surgery fellows, and three vascular surgery residents reviewed the ultrasound images. Thrombi associated with radiofrequency ablation demonstrated a greater degree of hypercellular response, fibroblastic reaction, and edema (3.42 vs 2.92; 3.75 vs 2.42; 2.83 vs 1.33). Specimens harvested from the iatrogenic-induced DVT swine demonstrated a more prolific response to trichrome staining (3.42 vs 2.67). Evidence of revascularization was found in all of the EHIT specimens but in 33% of DVT specimens. On the basis of histologic findings, the pathologist predicted correct modality 92% of the time. Subgroup analysis comparing paired specimens from each swine failed to demonstrate any marked pathologic differences. Recorded ultrasound images from EHIT and DVT samples were reviewed by fellows, residents, and vascular surgery staff to determine whether clot was stationary or free-floating (n = 111; 93%), evidence of retracted or adherent vein (n = 105; 88%), and absence of color flow (n = 102; 85%). The degree of occlusion (partial vs total) and degree of distention of a visualized vein were least likely to be agreed on by reviewers (n = 95; 79% each, respectively). In subgroup (DVT vs EHIT) analyses, the percentage agreement was greatest among vascular surgery fellows (89% and 92%) compared with residents (82% and 79%) and faculty (78% and 77%). It is possible to differentiate the thrombus origin on pathologic examination but not clinically on ultrasound. Wide variability exists for ultrasound diagnosis of EHIT and de novo DVT. Care must be taken in evaluating post-treatment duplex scans to not assign diagnosis of EHIT when DVT may well be present and extending into the deep venous system. The modulation of collagen production in the treatment of DVT may be helpful in preventing vascular dysfunction and reducing the post-thrombotic changes. Further studies on injury after radiofrequency ablation and laser ablation are needed. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

SSUSI-Lite: a far-ultraviolet hyper-spectral imager for space weather remote sensing

NASA Astrophysics Data System (ADS)

Ogorzalek, Bernard; Osterman, Steven; Carlsson, Uno; Grey, Matthew; Hicks, John; Hourani, Ramsey; Kerem, Samuel; Marcotte, Kathryn; Parker, Charles; Paxton, Larry J.

2015-09-01

SSUSI-Lite is a far-ultraviolet (115-180nm) hyperspectral imager for monitoring space weather. The SSUSI and GUVI sensors, its predecessors, have demonstrated their value as space weather monitors. SSUSI-Lite is a refresh of the Special Sensor Ultraviolet Spectrographic Imager (SSUSI) design that has flown on the Defense Meteorological Satellite Program (DMSP) spacecraft F16 through F19. The refresh updates the 25-year-old design and insures that the next generation of SSUSI/GUVI sensors can be accommodated on any number of potential platforms. SSUSI-Lite maintains the same optical layout as SSUSI, includes updates to key functional elements, and reduces the sensor volume, mass, and power requirements. SSUSI-Lite contains an improved scanner design that results in precise mirror pointing and allows for variable scan profiles. The detector electronics have been redesigned to employ all digital pulse processing. The largest decrease in volume, mass, and power has been obtained by consolidating all control and power electronics into one data processing unit.

In-Flight Thermal Performance of the Lidar In-Space Technology Experiment

NASA Technical Reports Server (NTRS)

Roettker, William

1995-01-01

The Lidar In-Space Technology Experiment (LITE) was developed at NASA s Langley Research Center to explore the applications of lidar operated from an orbital platform. As a technology demonstration experiment, LITE was developed to gain experience designing and building future operational orbiting lidar systems. Since LITE was the first lidar system to be flown in space, an important objective was to validate instrument design principles in such areas as thermal control, laser performance, instrument alignment and control, and autonomous operations. Thermal and structural analysis models of the instrument were developed during the design process to predict the behavior of the instrument during its mission. In order to validate those mathematical models, extensive engineering data was recorded during all phases of LITE's mission. This inflight engineering data was compared with preflight predictions and, when required, adjustments to the thermal and structural models were made to more accurately match the instrument s actual behavior. The results of this process for the thermal analysis and design of LITE are presented in this paper.

LITE microscopy: Tilted light-sheet excitation of model organisms offers high resolution and low photobleaching

PubMed Central

Gerbich, Therese M.; Rana, Kishan; Suzuki, Aussie; Schaefer, Kristina N.; Heppert, Jennifer K.; Boothby, Thomas C.; Allbritton, Nancy L.; Gladfelter, Amy S.; Maddox, Amy S.

2018-01-01

Fluorescence microscopy is a powerful approach for studying subcellular dynamics at high spatiotemporal resolution; however, conventional fluorescence microscopy techniques are light-intensive and introduce unnecessary photodamage. Light-sheet fluorescence microscopy (LSFM) mitigates these problems by selectively illuminating the focal plane of the detection objective by using orthogonal excitation. Orthogonal excitation requires geometries that physically limit the detection objective numerical aperture (NA), thereby limiting both light-gathering efficiency (brightness) and native spatial resolution. We present a novel live-cell LSFM method, lateral interference tilted excitation (LITE), in which a tilted light sheet illuminates the detection objective focal plane without a sterically limiting illumination scheme. LITE is thus compatible with any detection objective, including oil immersion, without an upper NA limit. LITE combines the low photodamage of LSFM with high resolution, high brightness, and coverslip-based objectives. We demonstrate the utility of LITE for imaging animal, fungal, and plant model organisms over many hours at high spatiotemporal resolution. PMID:29490939

Prevention of edema, flight microangiopathy and venous thrombosis in long flights with elastic stockings. A randomized trial: The LONFLIT 4 Concorde Edema-SSL Study.

PubMed

Belcaro, Gianni; Cesarone, Maria Rosaria; Shah, Sandeep S G; Nicolaides, Andrew N; Geroulakos, George; Ippolito, Edmondo; Winford, Michelle; Lennox, Andrew; Pellegrini, Luciano; Brandolini, Rossella; Myers, Kenneth A; Simeone, Emilio; Bavera, Peter; Dugall, Mark; Di Renzo, Andrea; Moia, Marco

2002-01-01

The LONFLIT1/2 studies have established that in high-risk subjects after long (> 10 hours) flights the incidence of deep venous thrombosis (DVT) is between 4% and 6%. The LONFLIT4 study has been planned to evaluate the control of edema and DVT in low-medium-risk subjects. The aim of this study was to evaluate edema and its control with specific flight stockings, in long-haul flights. In the first part of the study 400 subjects at low-medium risk for DVT were contacted; 28 were excluded for several nonmedical problems; 372 were randomized into 2 groups to evaluate prophylaxis with stockings in 7-8-hour flights; the control group had no prophylaxis. Below-knee, Scholl, Flight Socks, producing 14-17 mm Hg of pressure at the ankle, were used in the treatment group. The occurrence of DVT was evaluated with high-resolution ultrasound scanning (femoral, popliteal, and tibial veins). Edema was assessed with a composite score based on parametric and nonparametric measurements. Part II: In this part of the study 285 subjects at low-medium risk for DVT were included and randomized into 2 groups to evaluate edema prophylaxis in 11-12-hour flights; the controls had no prophylaxis while the prevention group had below-knee, Scholl, Flight Socks (comparable to part I). Part 1: DVT evaluation. Of the 184 included subjects in the stockings group and 188 in the control group, 358 (96.2%) completed the study. Dropouts were due to compliance or connection problems. Age/sex distributions were comparable in the groups. Stockings Group: of 179 subjects (mean age 49; SD 7; M:F = 101:78), none had DVT or superficial thromboses. of 179 subjects (mean age 48.4; SD 7.3; M:F = 98:81), 4 (2.2%) had a DVT. There were also 2 superficial thromboses. In total, 3.35% (6) subjects had a thrombotic event. The difference (p<0.002) is significant. Intention-to-treat analysis detects 15 failures in the control group (9 lost + 6 thromboses) out of 188 subjects (7.9%) versus 5 subjects (2.7%) in the stockings group (p <0.05). All thrombotic events were observed in passengers sitting in nonaisle seats. The tolerability of the stockings was very good and there were no complaints or side effects. Thrombotic events were asymptomatic. No difference was observed in the distribution of events between men and women. The 3 women who had a thrombotic event were taking low-dose, oral contraceptives. Edema evaluation: The level of edema at inclusion was comparable in the 2 groups. After the flight there was a score of 6.7 (3.1) in controls; in the stockings group the score was 2.9 times lower (p<0.05). The control of edema with stockings was clear considering both parametric (circumference, volume) and nonparametric (analogue scale lines) data. Part II: DVT evaluation. Of the 285 included subjects, 271 (95%) completed the study. Dropouts were due to low compliance or connection problems. Age/sex distributions were comparable in the groups. Stockings Group: of 142 subjects (mean age 48; SD 8; M:F = 89:53), none had DVT or superficial thromboses. of 143 subjects (mean age 47; SD 8; M:F = 87:56), 3 had a popliteal DVT and 3 a superficial thrombosis. In total, 4.2% (6) subjects had a thrombotic event. The difference (p<0.02) between groups is significant. Intention-to-treat analysis detects 14 failures in the control group (8 lost + 6 thromboses = 9.7%) versus 6 (all lost = 4.2% in the stockings group) (p<0.05). Four of 6 events (3 DVT + 1 SVT) were observed in non-aisle seats. The tolerability of the stockings was very good. No difference was observed in the distribution of events between men and women. Edema evaluation: The level of edema at inclusion was comparable in the 2 groups. After the flight there was a score of 8.08 (2.9) in controls while in the stockings group the score was 2.56 (1.5) (p < 0.005). In conclusion. Scholl Flight Socks are very effective in controlling edema. Also this type of compression is effective in significantly reducing the incidence of DVT and thrombotic events in low-medium-risk subjects, in long-haul flights. Considering these observations, Flight Socks are effective in controlling edema and in reducing the incidence of DVT in low-medium-risk subjects, in long-haul flights (7-11 hours).

An Integrated Fuel Depletion Calculator for Fuel Cycle Options Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schneider, Erich; Scopatz, Anthony

2016-04-25

Bright-lite is a reactor modeling software developed at the University of Texas Austin to expand upon the work done with the Bright [1] reactor modeling software. Originally, bright-lite was designed to function as a standalone reactor modeling software. However, this aim was refocused t couple bright-lite with the Cyclus fuel cycle simulator [2] to make it a module for the fuel cycle simulator.

Aladin Lite: Lightweight sky atlas for browsers

NASA Astrophysics Data System (ADS)

Boch, Thomas

2014-02-01

Aladin Lite is a lightweight version of the Aladin tool, running in the browser and geared towards simple visualization of a sky region. It allows visualization of image surveys (JPEG multi-resolution HEALPix all-sky surveys) and permits superimposing tabular (VOTable) and footprints (STC-S) data. Aladin Lite is powered by HTML5 canvas technology and is easily embeddable on any web page and can also be controlled through a Javacript API.

Living Near Major Traffic Roads and Risk of Deep Vein Thrombosis

PubMed Central

Baccarelli, Andrea; Martinelli, Ida; Pegoraro, Valeria; Melly, Steven; Grillo, Paolo; Zanobetti, Antonella; Hou, Lifang; Bertazzi, Pier Alberto; Mannucci, Pier Mannuccio; Schwartz, Joel

2010-01-01

Background Particulate air pollution has been consistently linked to increased risk of arterial cardiovascular disease. Few data on air pollution exposure and risk of venous thrombosis are available. We investigated whether living near major traffic roads increases the risk of deep vein thrombosis (DVT), using distance from roads as a proxy for traffic exposure. Methods and Results Between 1995-2005, we examined 663 patients with DVT of the lower limbs and 859 age-matched controls from cities with population>15,000 inhabitants in Lombardia Region, Italy. We assessed distance from residential addresses to the nearest major traffic road using geographic information system methodology. The risk of DVT was estimated from logistic regression models adjusting for multiple clinical and environmental covariates. The risk of DVT was increased (Odds Ratio [OR]=1.33; 95% CI 1.03-1.71; p=0.03 in age-adjusted models; OR=1.47; 95%CI 1.10-1.96; p=0.008 in models adjusted for multiple covariates) for subjects living near a major traffic road (3 meters, 10th centile of the distance distribution) compared to those living farther away (reference distance of 245 meters, 90th centile). The increase in DVT risk was approximately linear over the observed distance range (from 718 to 0 meters), and was not modified after adjusting for background levels of particulate matter (OR=1.47; 95%CI 1.11-1.96; p=0.008 for 10th vs. 90th distance centile in models adjusting for area levels of particulate matter <10 μm in aerodynamic diameter [PM10] in the year before diagnosis). Conclusions Living near major traffic roads is associated with increased risk of DVT. PMID:19506111

Four Thrombotic Events Over 5 Years, Two Pulmonary Emboli and Two Deep Venous Thrombosis, When Testosterone-HCG Therapy Was Continued Despite Concurrent Anticoagulation in a 55-Year-Old Man With Lupus Anticoagulant.

PubMed

Glueck, Charles J; Lee, Kevin; Prince, Marloe; Jetty, Vybhav; Shah, Parth; Wang, Ping

2016-01-01

When exogenous testosterone or treatments to elevate testosterone (human chorionic gonadotropin [HCG] or Clomid) are prescribed for men who have antecedent thrombophilia, deep venous thrombosis and pulmonary embolism often occur and may recur despite adequate anticoagulation if testosterone therapy is continued. A 55-year-old white male was referred to us because of 4 thrombotic events, 3 despite adequate anticoagulation over a 5-year period. We assessed interactions between thrombophilia, exogenous testosterone therapy, and recurrent thrombosis. In 2009, despite low-normal serum testosterone 334 ng/dL (lower normal limit [LNL] 300 ng/dL), he was given testosterone (TT) cypionate (50 mg/week) and human chorionic gonadotropin (HCG; 500 units/week) for presumed hypogonadism. Ten months later, with supranormal serum T (1385 ng/dL, upper normal limit [UNL] 827 ng/dL) and estradiol (E2) 45 pg/mL (UNL 41 pg/mL), he had a pulmonary embolus (PE) and was then anticoagulated for 2 years (enoxaparin, then warfarin). Four years later, on TT-HCG, he had his first deep venous thrombosis (DVT). TT was stopped and HCG continued; he was anticoagulated (enoxaparin, then warfarin, then apixaban, then fondaparinux). One year after his first DVT, on HCG, still on fondaparinux, he had a second DVT (5/315), was anticoagulated (enoxaparin + warfarin), with a Greenfield filter placed, but 8 days later had a second PE. Thrombophilia testing revealed the lupus anticoagulant. After stopping HCG, and maintained on warfarin, he has been free of further DVT-PE for 9 months. When DVT-PE occur on TT or HCG, in the presence of thrombophilia, TT-HCG should be stopped, lest DVT-PE reoccur despite concurrent anticoagulation.

Prophylactic Placement of an Inferior Vena Cava Filter During Aspiration Thrombectomy for Acute Deep Venous Thrombosis of the Lower Extremity.

PubMed

Kwon, Se Hwan; Park, So Hyun; Oh, Joo Hyeong; Song, Myung Gyu; Seo, Tae-Seok

2016-05-01

To evaluate the effect of an inferior vena cava (IVC) filter during aspiration thrombectomy for acute deep vein thrombosis (DVT) in the lower extremity. From July 2004 to December 2013, a retrospective analysis of 106 patients with acute DVT was performed. All patients received an IVC filter and were treated initially with aspiration thrombectomy. Among the 106 patients, DVT extension into the IVC was noted in 27 but was not evident in 79. We evaluated the presence of trapped thrombi in the filters after the procedure. The sizes of the trapped thrombi were classified into 2 grades based on the ratio of the maximum transverse length of the trapped thrombus to the diameter of the IVC (Grades I [≤ 50%] and II [> 50%]). A trapped thrombus in the filter was detected in 46 (43%) of 106 patients on final venograms. The sizes of the trapped thrombi were grade I in 12 (26.1%) patients and grade II in 34 (73.9%). Among the 27 patients with DVT extension into the IVC, 20 (74.1%) showed a trapped thrombus in the filter, 75% (15 of 20) of which were grade II. Among the 79 patients without DVT extension into the IVC, 26 (32.9%) showed a trapped thrombus in the IVC filter, 73% (19 of 26) of which were grade II. Thrombus migration occurred frequently during aspiration thrombectomy of patients with acute DVT in the lower extremity. However, further studies are needed to establish a standard protocol for the prophylactic placement of an IVC filter during aspiration thrombectomy. © The Author(s) 2016.

Disulfide HMGB1 derived from platelets coordinates venous thrombosis in mice

PubMed Central

Philippi, Vanessa; Stockhausen, Sven; Busse, Johanna; Antonelli, Antonella; Miller, Meike; Schubert, Irene; Hoseinpour, Parandis; Chandraratne, Sue; von Brühl, Marie-Luise; Gaertner, Florian; Lorenz, Michael; Agresti, Alessandra; Coletti, Raffaele; Antoine, Daniel J.; Heermann, Ralf; Jung, Kirsten; Reese, Sven; Laitinen, Iina; Schwaiger, Markus; Walch, Axel; Sperandio, Markus; Nawroth, Peter P.; Reinhardt, Christoph; Jäckel, Sven; Bianchi, Marco E.; Massberg, Steffen

2016-01-01

Deep venous thrombosis (DVT) is one of the most common cardiovascular diseases, but its pathophysiology remains incompletely understood. Although sterile inflammation has recently been shown to boost coagulation during DVT, the underlying molecular mechanisms are not fully resolved, which could potentially identify new anti-inflammatory approaches to prophylaxis and therapy of DVT. Using a mouse model of venous thrombosis induced by flow reduction in the vena cava inferior, we identified blood-derived high-mobility group box 1 protein (HMGB1), a prototypical mediator of sterile inflammation, to be a master regulator of the prothrombotic cascade involving platelets and myeloid leukocytes fostering occlusive DVT formation. Transfer of platelets into Hmgb1−/− chimeras showed that this cell type is the major source of HMGB1, exposing reduced HMGB1 on their surface upon activation thereby enhancing the recruitment of monocytes. Activated leukocytes in turn support oxidation of HMGB1 unleashing its prothrombotic activity and promoting platelet aggregation. This potentiates the amount of HMGB1 and further nurtures the accumulation and activation of monocytes through receptor for advanced glycation end products (RAGE) and Toll-like receptor 2, leading to local delivery of monocyte-derived tissue factor and cytokines. Moreover, disulfide HMGB1 facilitates formation of prothrombotic neutrophil extracellular traps (NETs) mediated by RAGE, exposing additional HMGB1 on their extracellular DNA strands. Eventually, a vicious circle of coagulation and inflammation is set in motion leading to obstructive DVT formation. Therefore, platelet-derived disulfide HMGB1 is a central mediator of the sterile inflammatory process in venous thrombosis and could be an attractive target for an anti-inflammatory approach for DVT prophylaxis. PMID:27574188

Value of platelet indices in identifying complete resolution of thrombus in deep venous thrombosis patients.

PubMed

Sevuk, Utkan; Altindag, Rojhat; Bahadir, Mehmet Veysi; Ay, Nurettin; Demirtas, Ertan; Ayaz, Fırat

2015-03-01

We aimed to evaluate whether mean platelet volume (MPV) and platelet distribution width (PDW) are helpful to identify complete thrombus resolution (CTR) after acute deep venous thrombosis (DVT). Patients who had first-time episode of acute proximal DVT were included in this retrospective study. 100 patients with DVT were divided into two groups according to absence (group 1; n = 68) or presence (group 2; n = 32) of CTR on doppler ultrasonography at month 6. There were no significant difference in admission MPV and PDW levels between group 1 and group 2. MPV (p = 0.03) and PDW (p < 0.001) levels at month 6 were significantly higher in group 1 than in group 2. CTR showed a moderate negative correlation with PDW at month 6 (ρ = -0.47) and a weak negative correlation with MPV at month 6 (ρ = -0.26). Logistic regression analysis showed that PDW (OR, 2.2; p = 0.004) at month 6 was an independent risk factor for the presence of residual venous thrombosis in DVT patients. Receiver operating characteristics analysis revealed that a 8.4 % decrease in admission MPV at month 6 provided 62 % sensitivity and 62 % specificity (AUC: 0.64) and a 15.4 % decrease in admission PDW at month 6 provided 87 % sensitivity and 94 % specificity (AUC: 0.89) for prediction of CTR in DVT patients. Percent change in admission MPV and PDW levels at month 6 may be used to identify the patients with CTR after a first episode of acute proximal DVT.

[How to provide practical treatment for ambulatory patients with deep venous thrombosis].

PubMed

Achkar, A; Samama, M M

1999-02-01

Much interest has been focused on low molecular weight heparins (LMWH), light weight fragments of standard heparin, for the management of deep vein thrombosis (DVT) without pulmonary embolism (PE). LMWHs offer several advantages: predictable anticoagulant activity, better bioavailability, longer half-life, better patient and caretaker comfort, safety and efficacy at least comparable to continuous intravenous heparin. Ambulatory treatment is quite attractive and a large number of patients with DVT are now being managed as outpatients. There are however certain precautions which must be taken to avoid unsatisfactory anticoagulation and subsequent consequences which have nevertheless been shown to be exceptional in well-designed and well-conducted trials excluding patients with high risk for hemorrhage and based on attentive medical control. The purpose of this review is to propose clear and simple protocols for everyday practice aimed at a global diagnostic and therapeutic management of venous thromboembolism. The review of the literature draws attention to the need for confirmation of the clinical suspicion of DVT, practical application of the anticoagulant treatment, and the importance of the etiology search in order to avoid missing a congenital or acquired state of thrombophilia or an occult cancer revealed by DVT. Half of all cases of thrombosis are caused by these two etiologies. In addition, with the development of noninvasive methods for diagnosing DVT, the efficacy of clear therapeutic regimens and the simplification of coagulation tests warrant outpatient management in many cases of DVT in compliance with certain rules of good clinical practice: confirmation of the diagnosis and regular treatment controls. An essential element is the close collaboration between the patient, the physician, the nursing staff, the laboratory and the pharmacist.

Comparing the impact of supine and leg elevation positions during coronary artery bypass graft on deep vein thrombosis occurrence: a randomized clinical trial study.

PubMed

Ayatollahzade-Isfahani, Farah; Pashang, Mina; Omran, Abbas Salehi; Saadat, Soheil; Shirani, Shapour; Fathollahi, Mahmood Sheikh

2013-06-01

Deep vein thrombosis (DVT) is a common preoperative complication that occurs in patients who undergoing coronary artery bypass grafting surgery (CABG). Early ambulation, elastic stockings, intermittent pneumatic compression, and leg elevation, before and after surgery, are among preventative interventions. The goal of the study was to compare the effect of supine position with that of leg elevation on the occurrence of DVT during CABG and after, until ambulation. Between October, 2008, and May, 2011, a total of 185 eligible CABG patients admitted to the Cardiac Surgery Unit were randomly assigned to groups designated as the supine group (n = 92) or the leg-elevation group (n = 93). Of this total, 92 patients were assigned to the supine group and 93 to the leg-elevation group. Doppler ultrasonography of the superficial and deep veins in the lower extremities was performed for each patient before and after surgery. Logistic regression analysis was conducted to investigate the possible independent factors associated with DVT. DVT was detected in 25 (13.5%) patients: 17 (18.4%) patients in the supine position group and 8 (8.6%) in the leg-elevation group (P value = .065). After adjustment for confounding factors there was no effect of position on the presence of DVT (P = .126).Clots were often localized in legs ipsilateral to the saphenous vein harvest. The authors conclude that a positive, albeit not statistically significant, trend was evident toward higher incidence of silent DVT in supine position during and after CABG in comparison with leg elevation. Future studies with larger sample sizes are required to confirm this result. Copyright © 2013 Society for Vascular Nursing, Inc. Published by Mosby, Inc. All rights reserved.

Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with organophosphate intoxication: a nationwide prospective cohort study.

PubMed

Lim, Yun-Ping; Lin, Cheng-Li; Hung, Dong-Zong; Ma, Wei-Chih; Lin, Yen-Ning; Kao, Chia-Hung

2015-01-01

Organophosphate (OP) poisoning is a critical cause of morbidity and mortality worldwide. We conducted a nationwide longitudinal cohort study to investigate the development of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) among patients admitted with OP intoxication.We identified patients with OP intoxication by using the Taiwan National Health Insurance Research Database and enrolled 9223 patients who were hospitalized for OP intoxication between 2000 and 2011. OP intoxication was diagnosed based on a clinical assessment and serum acetylcholinesterase levels at the time of hospital admission. Each patient in the OP intoxication cohort was randomly frequency matched with 4 patients without OP intoxication based on their age, sex, and index year (36,892 patients as control cohort), and all patients were observed from the index date until the appearance of a DVT or a PTE event, or until December 31, 2011. We analyzed the risks of DVT and PTE by using Cox proportional hazards regression models that included the demographic variables of sex, age, and comorbidities (eg, hypertension, diabetes, cerebral vascular disease, heart failure, all cancer types, and lower leg fracture or surgery).The results revealed a significantly increased risk of developing DVT among patients with OP poisoning (adjusted hazard ratio [HR] = 1.55; 95% confidence interval [CI] = 1.03-2.34) but not PTE (adjusted HR = 1.44; 95% CI = 0.83-2.52). Among the patients without comorbidities, the OP poisoning patients compared with controls had a higher adjusted HR of 2.12 (95% CI = 1.21-3.71) for DVT.The results of this nationwide cohort study indicate that the risk of developing DVT is markedly higher in patients with OP intoxication compared with that of the general population.

Increased Risk of Deep Vein Thrombosis and Pulmonary Thromboembolism in Patients With Organophosphate Intoxication

PubMed Central

Lim, Yun-Ping; Lin, Cheng-Li; Hung, Dong-Zong; Ma, Wei-Chih; Lin, Yen-Ning; Kao, Chia-Hung

2015-01-01

Abstract Organophosphate (OP) poisoning is a critical cause of morbidity and mortality worldwide. We conducted a nationwide longitudinal cohort study to investigate the development of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) among patients admitted with OP intoxication. We identified patients with OP intoxication by using the Taiwan National Health Insurance Research Database and enrolled 9223 patients who were hospitalized for OP intoxication between 2000 and 2011. OP intoxication was diagnosed based on a clinical assessment and serum acetylcholinesterase levels at the time of hospital admission. Each patient in the OP intoxication cohort was randomly frequency matched with 4 patients without OP intoxication based on their age, sex, and index year (36,892 patients as control cohort), and all patients were observed from the index date until the appearance of a DVT or a PTE event, or until December 31, 2011. We analyzed the risks of DVT and PTE by using Cox proportional hazards regression models that included the demographic variables of sex, age, and comorbidities (eg, hypertension, diabetes, cerebral vascular disease, heart failure, all cancer types, and lower leg fracture or surgery). The results revealed a significantly increased risk of developing DVT among patients with OP poisoning (adjusted hazard ratio [HR] = 1.55; 95% confidence interval [CI] = 1.03–2.34) but not PTE (adjusted HR = 1.44; 95% CI = 0.83–2.52). Among the patients without comorbidities, the OP poisoning patients compared with controls had a higher adjusted HR of 2.12 (95% CI = 1.21–3.71) for DVT. The results of this nationwide cohort study indicate that the risk of developing DVT is markedly higher in patients with OP intoxication compared with that of the general population. PMID:25569651

Role of IVC Filters in Endovenous Therapy for Deep Venous Thrombosis: The FILTER-PEVI (Filter Implantation to Lower Thromboembolic Risk in Percutaneous Endovenous Intervention) Trial

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sharifi, Mohsen, E-mail: seyedmohsensharifi@yahoo.com; Bay, Curt; Skrocki, Laura

Objectives: The purpose of this study was to evaluate the necessity of and recommend indications for inferior vena cava (IVC) filter implantation during percutaneous endovenous intervention (PEVI) for deep venous thrombosis (DVT).BackgroundPEVI has emerged as a powerful tool in the management of acute proximal DVT. Instrumentation of extensive fresh thrombus is potentially associated with iatrogenic pulmonary embolism (PE). The true frequency of this complication has not been studied in a randomized fashion. We evaluated IVC filter implantation during PEVI for DVT. Methods: A total of 141 patients with symptomatic proximal DVT undergoing PEVI for symptomatic DVT were randomized to receivemore » an IVC filter (70 patients) or no filter (71 patients; control group). The anticoagulation and PEVI regimen were similar between the two groups. Patients with development of symptoms suggestive of PE underwent objective testing for PE. Results: PE developed in 1 of the 14 symptomatic patients in the filter group and 8 of the 22 patients in the control group (P = 0.048). There was no mortality in any group. Three patients (4.2%) in the control group had transient hemodynamic instability necessitating resuscitory efforts. Predictors of iatrogenic PE were found to be PE at admission; involvement of two or more adjacent venous segments with acute thrombus; inflammatory form of DVT (severe erythema, edema, pain, and induration); and vein diameter of {>=}7 mm with preserved architecture. Conclusions: IVC filter implantation during PEVI reduces the risk of iatrogenic PE by eightfold without a mortality benefit. A selective approach may be exercised in filter implantation during PEVI.« less

Plasminogen activator inhibitor-1 4G/5G genotype and residual venous occlusion following acute unprovoked deep vein thrombosis of the lower limb: A prospective cohort study.

PubMed

Giurgea, Georgiana-Aura; Brunner-Ziegler, Sophie; Jilma, Bernd; Sunder-Plassmann, Raute; Koppensteiner, Renate; Gremmel, Thomas

2017-05-01

A recent study suggested that the plasminogen activator inhibitor (PAI)-1 4G/5G genotype may play a role in the resolution of deep vein thrombosis (DVT) after surgery. In the present study, we investigated the association between PAI-1 4G/5G genotype and the persistence of venous occlusion after acute idiopathic DVT of the lower limb. The PAI-1 4G/5G genotype was determined by real-Time PCR in 43 patients with unprovoked DVT of the lower limb. Residual venous occlusion was assessed by duplex sonography 1, 3, 6, 12 and 24months after the acute event. The PAI-1 Activity was determined by ELISA. Ten patients (23%) were homozygous for 4G (4G/4G), 27 patients (63%) were heterozygous 4G/5G and 6 patients (14%) were homozygous for 5G (5G/5G). Residual venous occlusion (RVO) was found in 77%, 65%, 58%, 56% and 37% of the overall study population, at 1, 3, 6, 12 and 24months after acute DVT, respectively. The presence of residual venous occlusion at 1, 3, 6, 12 and 24months after acute unprovoked DVT did not differ significantly between genotypes, but age was associated with RVO. Plasma levels of PAI-1 activity correlated with body mass index but was not associated with genotypes in our study. The PAI-1 4G/5G genotype was not a relevant predictor of persistent residual venous occlusion after idiopathic DVT, which however was associated with age. Copyright © 2017 Elsevier Ltd. All rights reserved.

An analysis of deep vein thrombosis in burn patients (Part 1): Comparison of D-dimer and Doppler ultrasound as screening tools.

PubMed

Ahuja, Rajeev B; Bansal, Priya; Pradhan, Gaurav S; Subberwal, Manju

2016-12-01

The high prevalence of deep vein thrombosis (DVT) reported in prospective studies and the unreliability of clinical diagnosis mandates prospective screening for DVT in burn patients. Our study seeks to compare D-dimer and Doppler ultrasound (DUS) in search for a practical, inexpensive and a reliable screening tool. One hundred burn patients (inclusion criteria: 30-60% TBSA burn, >18 years of age, admitted within 48h of burn) were computer randomized into two equal groups. The study (prophylaxis) group received low molecular weight heparin (LMWH) (0.5mg/kg, twice daily-max 60mg/day) from day one, till discharge. Screening D-dimer assays and DUS of the lower extremities were performed on all 100 patients on day five, and then weekly, till discharge. Signs and symptoms simulating DVT (pain, swelling, redness, warmth, positive Homans' and Moses' sign) were present in majority of patients with lower limb burns. 43/50 patients (86%) in the control group and 38/50 patients (76%) in the study (prophylaxis) group had positive D-dimer values (>0.5μg/ml) on the 5th post-burn day. D-dimer was positive in all the four patients identified with DVT. However, only 4/100 patients enrolled in the study demonstrated DVT on DUS. Thus, the specificity of the D-dimer assay was only 20% with a positive predictive value of 5%. Absolute D-dimer values were found to have no correlation to the extent of burns. We conclude that D-dimer is not a useful screening tool for DVT in burns contrary to its accepted value in general trauma and medical patients. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Efficacy in Deep Vein Thrombosis Prevention With Extended Mechanical Compression Device Therapy and Prophylactic Aspirin Following Total Knee Arthroplasty: A Randomized Control Trial.

PubMed

Snyder, Mark A; Sympson, Alexandra N; Scheuerman, Christina M; Gregg, Justin L; Hussain, Lala R

2017-05-01

Aspirin at 325 mg twice daily is now included as a nationally approved venous thromboembolism (VTE) prophylaxis protocol for low-risk total knee arthroplasty (TKA) patients. The purpose of this study is to examine whether there is a difference in deep vein thrombosis (DVT) occurrence after a limited tourniquet TKA using aspirin-based prophylaxis with or without extended use of mechanical compression device (MCD) therapy. One hundred limited tourniquet TKA patients, whose DVT risk was managed with aspirin 325 mg twice daily for 3 weeks, were randomized to either using an MCD during hospitalization only or extended use at home up to 6 weeks postoperatively. Lower extremity duplex venous ultrasonography (LEDVU) was completed on the second postoperative day, 14 days postoperatively, and at 3 months postoperatively to confirm the absence of DVT after treatment. The DVT rate for the postdischarge MCD therapy group was 0% and 23.1% for the inpatient MCD group (P < .001). All DVTs resolved by 3 months postoperatively. Patient satisfaction was 9.56 (±0.82) for postdischarge MCD patients vs 8.50 (±1.46) for inpatient MCD patients (P < .001). Limited tourniquet TKA patients who were mobilized early, managed with aspirin for 3 weeks postoperatively, and on MCD therapy for up to 6 weeks postoperatively experienced superior DVT prophylaxis than patients receiving MCD therapy only as an inpatient (P < .05). The 0% incidence of nonsymptomatic DVTs prevented by aspirin and extended-use MCD further validates this type of prophylaxis in low DVT risk TKA patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Flood Runoff in Relation to Water Vapor Transport by Atmospheric Rivers Over the Western United States, 1949-2015

NASA Astrophysics Data System (ADS)

Konrad, Christopher P.; Dettinger, Michael D.

2017-11-01

Atmospheric rivers (ARs) have a significant role in generating floods across the western United States. We analyze daily streamflow for water years 1949 to 2015 from 5,477 gages in relation to water vapor transport by ARs using a 6 h chronology resolved to 2.5° latitude and longitude. The probability that an AR will generate 50 mm/d of runoff in a river on the Pacific Coast increases from 12% when daily mean water vapor transport, DVT, is greater than 300 kg m-1 s-1 to 54% when DVT > 600 kg m-1 s-1. Extreme runoff, represented by the 99th quantile of daily values, doubles from 80 mm/d at DVT = 300 kg m-1 s-1 to 160 mm/d at DVT = 500 kg m-1 s-1. Forecasts and predictions of water vapor transport by atmospheric rivers can support flood risk assessment and estimates of future flood frequencies and magnitude in the western United States.

Clinical risk factors to predict deep venous thrombosis post-endovenous laser ablation of saphenous veins.

PubMed

Chi, Y-W; Woods, T C

2014-04-01

Endovenous laser ablation of saphenous veins is an alternative in treating symptomatic varicose veins. Deep venous thrombosis (DVT) has been reported in up to 7.7% of patients undergoing such procedure. We sought to establish clinical risk factors that predict DVT post-endovenous laser ablation. Patients who underwent endovenous laser ablation were prospectively followed. Clinical data and post-interventional duplex ultrasound were analysed. A P value <0.05 was accepted as representing a significant difference. From 2007 to 2008, 360 consecutive patients were followed. Nineteen DVTs were found on follow-up ultrasound. Eighteen cases involved either the saphenofemoral or saphenopopliteal junctions; only one case involved the deep venous system. Age >66 (P = 0.007), female gender (P = 0.048) and prior history of superficial thrombophlebitis (SVT) (P = 0.002) were associated with increased risk of DVT postprocedure. Age >66, female gender and history of SVT were significant predictors of DVT post-endovenous laser ablation of saphenous veins.

Development of a guideline for treatment of deep and superficial venous thrombosis in the emergency department.

PubMed

Tosone, Nancy C; Costanzo, Cindy

2012-01-01

Patients with DVT, aged 45.64 years, often present to the ED, with an annual cost of $1.5-$3.2 billion per year. This paper describes the process used to implement an evidence-based guideline on deep venous thrombosis (DVT) for the emergency department (ED). Specific aims were to (a) conduct an organizational assessment of DVT treatment practices; (b) compare organizational results with evidence-based treatment guidelines; (c) develop recommendations for the treatment of DVT for ED discharge; and (d) conduct an interdisciplinary evaluation of the evidence-based guideline. A retrospective review of 149 records of adults in an urban Midwestern ED in 2010 was undertaken. Differences in provider practices were identified. A guideline was developed that included clinical management, social/financial concerns, patient education, anticoagulation monitoring, and outpatient follow-up. Implementation and evaluation were accomplished through electronic and paper communication, medical record monitoring, and patient call back. Evaluation also included simulation exercises with an interdisciplinary team.

Medical Treatment for Postthrombotic Syndrome

PubMed Central

Palacios, Federico Silva; Rathbun, Suman Wasan

2017-01-01

Deep vein thrombosis (DVT) is a prevalent disease. About 20 to 30% of patients with DVT will develop postthrombotic syndrome (PTS) within months after the initial diagnosis of DVT. There is no gold standard for diagnosis of PTS, but clinical signs include pitting edema, hyperpigmentation, phlebectatic crown, venous eczema, and varicose veins. Several scoring systems have been developed for diagnostic evaluation. Conservative treatment includes compression therapy, medications, lifestyle modification, and exercise. Compression therapy, the mainstay and most proven noninvasive therapy for patients with PTS, can be prescribed as compression stockings, bandaging, adjustable compression wrap devices, and intermittent pneumatic compression. Medications may be used to both prevent and treat PTS and include anticoagulation, anti-inflammatories, vasoactive drugs, antibiotics, and diuretics. Exercise, weight loss, smoking cessation, and leg elevation are also recommended. Areas of further research include the duration, compliance, and strength of compression stockings in the prevention of PTS after DVT; the use of intermittent compression devices; the optimal medical anticoagulant regimen after endovascular therapy; and the role of newer anticoagulants as anti-inflammatory agents. PMID:28265131

Length of stay and economic consequences with rivaroxaban vs enoxaparin/vitamin K antagonist in patients with DVT and PE: findings from the North American EINSTEIN clinical trial program.

PubMed

Bookhart, Brahim K; Haskell, Lloyd; Bamber, Luke; Wang, Maria; Schein, Jeff; Mody, Samir H

2014-10-01

Venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [(PE]) represents a substantial economic burden to the healthcare system. Using data from the randomized EINSTEIN DVT and PE trials, this North American sub-group analysis investigated the potential of rivaroxaban to reduce the length of initial hospitalization in patients with acute symptomatic DVT or PE. A post-hoc analysis of hospitalization and length-of-stay (LOS) data was conducted in the North American sub-set of patients from the randomized, open-label EINSTEIN trial program. Patients received either rivaroxaban (15 mg twice daily for 3 weeks followed by 20 mg once daily; n = 405) or dose-adjusted subcutaneous enoxaparin overlapping with (guideline-recommended 'bridging' therapy) and followed by a vitamin K antagonist (VKA) (international normalized ratio = 2.0-3.0; n = 401). The open-label study design allowed for the comparison of LOS between treatment arms under conditions reflecting normal clinical practice. LOS was evaluated using investigator records of dates of admission and discharge. Analyses were carried out in the intention-to-treat population using parametric tests. Costs were applied to the LOS based on weighted mean cost per day for DVT and PE diagnoses obtained from the Healthcare Cost and Utilization Project dataset. Of 382 patients hospitalized, 321 (84%), had acute symptomatic PE; few DVT patients required hospitalization. Similar rates of VTE patients were hospitalized in the rivaroxaban and enoxaparin/VKA treatment groups, 189/405 (47%) and 193/401 (48%), respectively. In hospitalized VTE patients, rivaroxaban treatment produced a 1.6-day mean reduction in LOS (median = 1 day) compared with enoxaparin/VKA (mean = 4.5 vs 6.1; median = 3 vs 4), translating to total costs that were $3419 lower in rivaroxaban-treated patients. In hospitalized North American patients with VTE, treatment with rivaroxaban produced a statistically significant reduction in LOS. When treating DVT and PE patients, clinicians should consider newer anti-coagulants with less complex treatment regimens.

Digital volume tomography in the diagnosis of periodontal defects: an in vitro study on native pig and human mandibles.

PubMed

Mengel, Reiner; Candir, Muhsin; Shiratori, Kiyoshi; Flores-de-Jacoby, Lavin

2005-05-01

The aim of this study of native pig and human mandibles was to investigate the accuracy and quality of the representation of periodontal defects by intraoral radiography (IR), panoramic radiography (PR), computed tomography (CT), and digital volume tomography (DVT) in comparison with histologic specimens. Following the standardized preparation of periodontal defects (14 dehiscences, fenestrations, 2- to 3-walled intrabony defects, respectively; Class I, II, and III furcation involvement) in six pig and seven human mandibles, IR, PR, CT, and DVT were performed. The histologic specimens were produced by cutting blocks with the individual defects out of the mandibles, embedding them in acrylic, and producing sagittal and axial microsections. The intrabony defects were measured using appropriate software on the digitized IR and PR images programs. The histologic sections were measured by reflecting stereomicroscopy. The statistical comparison between the measurements of the radiographic images and those of the histologic specimens was performed with Pearson's correlation coefficient. The quality of the radiographic images was determined through the subjective perception and detectability of the intrabony defects by five independent observers. All intrabony defects could be measured in three planes in the CT and DVT scans. Comparison with the histologic specimens yielded a mean deviation of 0.16 +/- 0.10 mm for the CT scans and 0.19 +/- 0.11 mm for the DVT scans. On the IR and PR images, the defects could be detected only in the mesio-distal and craniocaudal planes. In comparison with the histologic specimens, the IR images revealed a mean deviation of 0.33 +/- 0.18 mm and the PR images a mean deviation of 1.07 +/- 0.62 mm. The quality rating of the radiographic images was highest for the DVT scans. Overall, the CT and DVT scans displayed only a slight deviation in the extent of the periodontal defects in comparison with the histologic specimens. Both radiographic imaging techniques permitted imaging of anatomic osseous structures in three planes, true to scale, and without overlay or distortion. The DVT scans showed the best imaging quality.

Digital volume tomography in the diagnosis of peri-implant defects: an in vitro study on native pig mandibles.

PubMed

Mengel, Reiner; Kruse, Björn; Flores-de-Jacoby, Lavin

2006-07-01

The aim of this study of native pig mandibles was to investigate the accuracy and quality of the representation of peri-implant defects by intraoral radiography (IR), panoramic radiography (PR), computer tomography (CT), and digital volume tomography (DVT). The examination was carried out on 19 native pig mandibles. In the toothless sections of the mandibles, one or two implants were inserted. Following the standardized preparation of peri-implant defects (11 each of dehiscences, fenestrations, and 2- to 3-walled intrabony defects), IR, PR, CT, and DVT were performed. The peri-implant defects were measured using appropriate software on the digitized IR and PR image programs. As a control method, the peri-implant bone defects were measured directly using a reflecting stereomicroscope with measuring ocular. The statistical comparison between the measurements of the radiographic scans and those of the direct readings of the peri-implant defects was performed with Pearson's correlation coefficient. The quality of the radiographic scans was determined through the subjective perception and detectability of the peri-implant defects by five independent observers. In the DVT and CT scans, it was possible to measure all the bone defects in three planes. Comparison with the direct peri-implant defect measurements yielded a mean deviation of 0.17+/-0.11 mm for the DVT scans and 0.18+/-0.12 mm for the CT scans. On the IR and PR images, the defects could be detected only in the mesio-distal and cranio-caudal planes. In comparison with the direct measurements of the peri-implant defects, the IR images revealed a mean deviation of 0.34+/-0.30 mm, and the PR images revealed a mean deviation of 0.41+/-0.35 mm. The quality rating of the radiographic images was highest for the DVT scans. Overall, the CT and DVT scans displayed only a slight deviation in the extent of the peri-implant defects. Both radiographic imaging techniques permitted imaging of peri-implant defects in three planes, true to scale, and without overlay or distortion. The DVT scans showed the best imaging quality.

The Pulmonary Thromboembolism as a Risk of Surgical Treatments and the Role of Anticoagulant Prophylaxiss

PubMed Central

Cukic, Vesna

2014-01-01

Objective: Our objective is to show the number of patients with postoperative pulmonary thromboembolism (PPTE) treated in Intensive care unit of Clinic for pulmonary diseases an TB “Podhrastovi” in three-year period : from June 1, 2011 - June 1, 2014 and to indicate the importance of various surgical operations in the development of pulmonary thromboembolism (PTE). Material and methods: This is the retrospective study which shows the number of patients with PPTE treated in Intensive care unit of Clinic for pulmonary diseases an TB “Podhrastovi” in three-year period : from 01.06.2011.-01.06.2014. It represents the number of these patients, per cent of patients with PPTE of total patients with PTE, age and sex of patients, type of surgery, period expressed in days from surgery to diagnosis of PTE, presence of deep venous thrombosis (DVT) of lower extremities, massiveness of PPTE e.g. level of pulmonary artery with embolus. Results: In three-year period 232 patients with PTE were treated in Intensive care unit of Clinic “Podhrastovi”. 60 of them or 25.86% were patients with 24 males or 40% middle-aged 58.5 years, and 36 females or 60% middle-aged 56.3 years. PPTE developed in 15 patients with abdominal, 11 with urologic, 8 with gynecologic, 15 with orthopedic, 4 with cardiologic, 2 with vascular, 3 with neurosurgical, 1 with glandular and 1 with orl operations. The average period from operation to diagnosis of PPTE was 10.5 days for women, and 13.8 days for men. Only two patients had acute DVT after operation (one man and one woman), and five had amnesias of previous DVT or PTE. The level or the site of pulmonary embolus was different from segmental to main branches of pulmonary artery. Conclusion: Different surgical operations are the big risk factor for the development of PTE. There is great significance of anticoagulant prophylaxis before surgery even in patients with no anamnesis of previous DVT or PTE. PMID:25568626

Does tranexamic acid increase the risk of thromboembolism after bilateral simultaneous total knee arthroplasties in Asian Population?

PubMed

Kim, Young-Hoo; Park, Jang-Won; Kim, Jun-Shik; Seo, Dong-Hyuk

2018-01-01

To ascertain whether tranexamic acid reduces the blood loss and transfusion rate and volumes; increase the prevalence of deep vein thrombosis (DVT); and investigate factors associated with DVT in patients undergoing primary bilateral total knee arthroplasties (TKAs) without use of chemical thromboprophylaxis. There were 874 patients (1748 knees) in the control group who did not receive tranexamic acid and 871 patients (1742 knees) in the study group who received tranexamic acid. Mechanical compression device was applied without any chemical thromboprophylaxis. Transfusion rates and volumes were recorded. DVT was diagnosed using both sonogram and venogram at 7 or 8 day post-operatively. Intra- and post-operative blood loss and transfusion volumes were significantly lower in the tranexamic acid group. The prevalence of DVT was 14% (245 of 1748 knees) in the control group and 18% (314 of 1742 knees) in the tranexamic acid group. Pre- and post-operative perfusion lung scans revealed no evidence of PE in any patients in either group. Coagulation or thrombophilic data or molecular genetic testing was not significantly different between the two groups. The use of tranexamic acid reduces the volume of blood transfusion and does not increase the prevalence of DVT or PE in the patients who did not receive routine chemical thromboprophylaxis after primary bilateral simultaneous sequential TKAs in Asian patients.

Deep vein thrombosis in an athletic military cadet.

PubMed

Fink, Michael L; Stoneman, Paul D

2006-09-01

Resident's case problem. A 21-year-old healthy athletic male military cadet with complaint of worsening diffuse left knee pain was evaluated 4 days after onset. The knee pain began 2 hours after completing a long car trip, worsened over the subsequent 3 days, and became almost unbearable during the return trip. The patient reported constant pain, limited knee motion, and difficulty ambulating. In addition, he was unable to perform physical military training or attend academic classes due to the severe left knee pain. Past medical history revealed a mild left lateral calf strain 21/2 weeks prior, which completely resolved within 24 hours of onset. Our physical examination led us to either monoarticular arthritis, pseudothrombophlebitis (ruptured Baker's cyst), or a lower leg deep vein thrombosis (DVT) as the cause of knee pain. Diagnostic imaging of this patient revealed a left superficial femoral vein thrombosis and popliteal DVT, with bilateral pulmonary emboli (PE). A systematic differential diagnosis was undertaken to rule out a potentially fatal DVT diagnosis as the cause of knee pain, despite minimal DVT risk factors. The physical therapist in a direct-access setting must ensure timely evaluation and referral of a suspected DVT, even when patient demographics cause the practitioner to question the likelihood of this diagnosis. The physical examination findings, clinical suspicion, and established clinical prediction rules can accurately dictate the appropriate referral action necessary.

SIM Lite Astrometric Observatory progress report

NASA Astrophysics Data System (ADS)

Marr, James C., IV; Shao, Michael; Goullioud, Renaud

2010-07-01

The SIM Lite Astrometric Observatory (aka SIM Lite), a micro-arcsecond astrometry space mission, has been developed in response to NASA's indefinite deferral of the SIM PlanetQuest mission. The SIM Lite mission, while significantly more affordable than the SIM PlanetQuest mission concept, still addresses the full breadth of SIM science envisioned by two previous National Research Council (NRC) Astrophysics Decadal Surveys at the most stringent "Goal" level of astrometric measurement performance envisioned in those surveys. Over the past two years, the project has completed the conceptual design of the SIM Lite mission using only the completed SIM technology; published a 250 page book describing the science and mission design (available at the SIM website: http://sim.jpl.nasa.gov); been subject to an independent cost and technical readiness assessment by the Aerospace Corporation; and submitted a number of information responses to the NRC Astro2010 Decadal Survey. The project also conducted an exoplanet-finding capability double blind study that clearly demonstrated the ability of the mission to survey 60 to 100 nearby sun-like dwarf stars for terrestrial, habitable zone planets in complex planetary systems. Additionally, the project has continued Engineering Risk Reduction activities by building brassboard (form, fit & function to flight) version of key instrument elements and subjecting them to flight qualification environmental and performance testing. This paper summarizes the progress over the last two years and the current state of the SIM Lite project.

9 CFR 317.356 - Nutrient content claims for “light” or “lite.”

Code of Federal Regulations, 2010 CFR

2010-01-01

..., a low fat meal”); and (B) The accompanying statement is no less than one-half the type size of the... products, except meal-type products as defined in § 317.313(l) and main-dish products as defined in § 317... its calories from fat, its fat content is reduced by 50 percent or more per reference amount...

9 CFR 381.456 - Nutrient content claims for “light” or “lite.”

Code of Federal Regulations, 2010 CFR

2010-01-01

..., a low fat meal”); and (B) The accompanying statement is no less than one-half the type size of the... products, except meal-type products as defined in § 381.413(l) and main-dish products as defined in § 381... its calories from fat, its fat content is reduced by 50 percent or more per reference amount...

Seeing the LITE

NASA Astrophysics Data System (ADS)

Brecher, K.

2000-12-01

We are developing a number of eyes-on experiments, lecture demonstrations and Web based JAVA applets about light, optics, color and visual perception as part of `Project LITE - Light Inquiry Through Experiments'. These are intended for incorporation into introductory level university science courses in astronomy, physics and other disciplines. In this presentation, several of the new LITE demonstrations applicable to large astronomy and physics classes will be shown. One demonstration involves novel materials to display Rayleigh scattering (blue skies, red sunsets and interstellar reddening - NOT redshift!) - including polarization effects. Others employ incandescent bulbs, LED's and laser pointers to illustrate fluorescence, diffraction and other physical and quantum optics phenomena. Still other demonstrations utilize transparent plastic moire overlays as well as computer animated moire patterns to show a variety of astronomical and physical phenomena. We will also display some of our applets posted at the Project LITE Web site (http://www.bu.edu/smec/lite) as well as the associated kit of optical materials we have developed for use by individual students in their own homes or dormitory rooms. This work was supported in part by NSF grant # DUE-9950551.

IBE-Lite: a lightweight identity-based cryptography for body sensor networks.

PubMed

Tan, Chiu C; Wang, Haodong; Zhong, Sheng; Li, Qun

2009-11-01

A body sensor network (BSN) is a network of sensors deployed on a person's body for health care monitoring. Since the sensors collect personal medical data, security and privacy are important components in a BSN. In this paper, we developed IBE-Lite, a lightweight identity-based encryption suitable for sensors in a BSN. We present protocols based on IBE-Lite that balance security and privacy with accessibility and perform evaluation using experiments conducted on commercially available sensors.

LiteBIRD

NASA Astrophysics Data System (ADS)

Ishino, Hirokazu

2016-07-01

We present LiteBIRD, a satellite project dedicated for the detection of the CMB B-mode polarization. The purpose of LiteBIRD is to measure the tensor-to-scalar ratio r with a precision of σr < 0.001 to test large-single-field slow-roll inflation models by scanning all the sky area for three years at the sun-earth L2 with the sensitivity of 3.2μKṡarcmin. We report an overview and the status of the project, including the ongoing detector and systematic studies.

Batch Proving and Proof Scripting in PVS

NASA Technical Reports Server (NTRS)

Munoz, Cesar A.

2007-01-01

The batch execution modes of PVS are powerful, but highly technical, features of the system that are mostly accessible to expert users. This paper presents a PVS tool, called ProofLite, that extends the theorem prover interface with a batch proving utility and a proof scripting notation. ProofLite enables a semi-literate proving style where specification and proof scripts reside in the same file. The goal of ProofLite is to provide batch proving and proof scripting capabilities to regular, non-expert, users of PVS.

Project LITE Spectroscopy

NASA Astrophysics Data System (ADS)

Weeks, E.; Brecher, K.; Carr, P.; Garik, P.

2003-12-01

Spectroscopy is one of the most important tools used by astronomers to disentangle information about the universe. However, it is one of the most challenging subjects in undergraduate astronomy courses. Among the most difficult concepts for students to master are Kirchhoff's laws, blackbody radiation, the Stefan-Boltzmann law, Wien's law, the nature and causes of emission and absorption lines, and the relation of spectra to the underlying astronomical and physical processes producing them. Students often seem baffled by the connection between a spectrum seen visually as a color band and the same spectrum plotted graphically as intensity versus wavelength or frequency. Project LITE (Light Inquiry Through Experiments) is a software, curriculum, and materials development project at Boston University. As part of the project, we are currently developing a suite of spectroscopic tools for astronomy education. We are also assessing their effectiveness in improving conceptual understanding of spectroscopic phenomena by astronomy students at the undergraduate level. The spectroscopy component of Project LITE includes take-home laboratory materials and experiments, which are integrated with web-based software. We have also developed a novel quantitative handheld binocular spectrometer (patent pending). Here we present an overview of the Project LITE homelab kits and curriculum, the Spectrum Explorer, and the Project LITE spectrometer. The homelab experiments and the Spectrum Explorer have been tested with students in a non-science majors introductory astronomy course as well as in a School of Education course for prospective elementary school science teachers. We present preliminary results of pre- and post-instruction surveys of student understanding of various spectral properties of light both from students who used the homelab activities and the Spectrum Explorer and those who did not. The Spectrum Explorer (along with many other applets about both the physical and perceptual nature of light) can be found at the Project LITE web site http://lite.bu.edu. Project LITE is supported by Grant #DUE-0125992 from the National Science Foundation Division of Undergraduate Education. E. W. is supported by a NASA Graduate Student Research Fellowship, NASA Grant number NGT5-50482.

Ultrasonographic findings of the various diseases presenting as calf pain.

PubMed

Lee, Sun Joo; Kim, Ok Hwa; Choo, Hye Jung; Park, Jun Ho; Park, Yeong-Mi; Jeong, Hae Woong; Lee, Sung Moon; Cho, Kil Ho; Choi, Jung-Ah; Jacobson, Jon A

2016-01-01

There are various causes of calf pain. The differential diagnoses affecting the lower leg include cystic lesions, trauma-related lesions, infection or inflammation, vascular lesions, neoplasms, and miscellaneous entities. Ultrasound (US) provide detailed anatomical information of the calf structures, and it offers the ability to confirm, other calf abnormalities, particularly when deep vein thrombosis (DVT) is ruled out. The purpose of this article is to review the causes of a painful calf presenting as DVT and incidental findings found as part of the work-up of DVT, and to provide a broad overview of US findings and clinical features of these pathologies. Copyright © 2015 Elsevier Inc. All rights reserved.

Deep vein thrombosis and the oestrogen content in oral contraceptives. An epidemiological analysis.

PubMed

Kierkegaard, A

1985-01-01

Epidemiological studies have pointed to a correlation between the oestrogen content of oral contraceptives and the risk of deep vein thrombosis (DVT). The correlation has been strongest in studies which partially consisted of adverse drug reaction reports to the Swedish Adverse Drug Reaction Advisory Committee (SADRAC). The present study analyzes the epidemiological basis of the adverse drug reaction reports on DVT in women on oral contraceptives to SADRAC. It verifies the reported correlation between the oestrogen content of the pills and the risk of DVT but it also demonstrates that this correlation probably was secondary to differences in the diagnostic standard of DVT, to differences in reporting policies to SADRAC and to an age difference between women on low-oestrogen-pills and those on high-oestrogen pills and is thus due to bias. It is concluded that adverse drug reaction reporting on oral contraceptives has been very unreliable, for which reason it cannot support any epidemiological conclusion concerning the relative thrombogenicity of high-oestrogen pills compared with that of low-oestrogen pills.

[Clinical analysis of patients with lower extremity deep venous thrombosis complicated with inferior vena cava thrombus].

PubMed

Dong, Dian-ning; Wu, Xue-jun; Zhang, Shi-yi; Zhong, Zhen-yue; Jin, Xing

2013-06-04

To explore the clinical profiles of patients with lower extremity deep venous thrombosis (DVT) complicated with inferior vena cava (IVC) thrombus and summarize their clinical diagnostic and therapeutic experiences. The clinical characteristics, diagnosis and treatment of 20 hospitalized patients with DVT complicated with inferior vena cava thrombus were analyzed retrospectively. All of them were of proximal DVT. There were phlegmasia cerulea dolens (n = 3), pulmonary embolism (n = 3) and completely occlusion of IVC (n = 5). Clinical manifestations were severe. Retrievable inferior vena cava filter (IVCF) was implanted for 17 cases. Catheter-directed thrombolysis (CDT) through ipsilateral popliteal vein was applied for 7 cases and systemic thrombolysis therapy for 8 cases. The effective rate of thrombolysis for fresh IVC thrombus was 100%. Among 5 cases with Cockett Syndrome, 3 cases underwent balloon dilatation angioplasty and endovascular stenting of iliac vein. And 17 IVCFs were retrieved successfully within 3 weeks. IVC thrombus disappeared completely in 15 cases. Systemic or local thrombolysis with protective IVCF is a safe and effective therapy for nonocclusive IVC thrombus in DVT. And CDT is recommended for symptomatic occlusive IVC thrombus.

ZOOM Lite: next-generation sequencing data mapping and visualization software

PubMed Central

Zhang, Zefeng; Lin, Hao; Ma, Bin

2010-01-01

High-throughput next-generation sequencing technologies pose increasing demands on the efficiency, accuracy and usability of data analysis software. In this article, we present ZOOM Lite, a software for efficient reads mapping and result visualization. With a kernel capable of mapping tens of millions of Illumina or AB SOLiD sequencing reads efficiently and accurately, and an intuitive graphical user interface, ZOOM Lite integrates reads mapping and result visualization into a easy to use pipeline on desktop PC. The software handles both single-end and paired-end reads, and can output both the unique mapping result or the top N mapping results for each read. Additionally, the software takes a variety of input file formats and outputs to several commonly used result formats. The software is freely available at http://bioinfor.com/zoom/lite/. PMID:20530531

MODELING MULTI-WAVELENGTH STELLAR ASTROMETRY. I. SIM LITE OBSERVATIONS OF INTERACTING BINARIES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Coughlin, Jeffrey L.; Harrison, Thomas E.; Gelino, Dawn M.

Interacting binaries (IBs) consist of a secondary star that fills or is very close to filling its Roche lobe, resulting in accretion onto the primary star, which is often, but not always, a compact object. In many cases, the primary star, secondary star, and the accretion disk can all be significant sources of luminosity. SIM Lite will only measure the photocenter of an astrometric target, and thus determining the true astrometric orbits of such systems will be difficult. We have modified the Eclipsing Light Curve code to allow us to model the flux-weighted reflex motions of IBs, in a codemore » we call REFLUX. This code gives us sufficient flexibility to investigate nearly every configuration of IB. We find that SIM Lite will be able to determine astrometric orbits for all sufficiently bright IBs where the primary or secondary star dominates the luminosity. For systems where there are multiple components that comprise the spectrum in the optical bandpass accessible to SIM Lite, we find it is possible to obtain absolute masses for both components, although multi-wavelength photometry will be required to disentangle the multiple components. In all cases, SIM Lite will at least yield accurate inclinations and provide valuable information that will allow us to begin to understand the complex evolution of mass-transferring binaries. It is critical that SIM Lite maintains a multi-wavelength capability to allow for the proper deconvolution of the astrometric orbits in multi-component systems.« less

[Cost-effectiveness of the deep vein thrombosis diagnosis process in primary care].

PubMed

Fuentes Camps, Eva; Luis del Val García, José; Bellmunt Montoya, Sergi; Hmimina Hmimina, Sara; Gómez Jabalera, Efren; Muñoz Pérez, Miguel Ángel

2016-04-01

To analyse the cost effectiveness of the application of diagnostic algorithms in patients with a first episode of suspected deep vein thrombosis (DVT) in Primary Care compared with systematic referral to specialised centres. Observational, cross-sectional, analytical study. Patients from hospital emergency rooms referred from Primary Care to complete clinical evaluation and diagnosis. A total of 138 patients with symptoms of a first episode of DVT were recruited; 22 were excluded (no Primary Care report, symptoms for more than 30 days, anticoagulant treatment, and previous DVT). Of the 116 patients finally included, 61% women and the mean age was 71 years. Variables from the Wells and Oudega clinical probability scales, D-dimer (portable and hospital), Doppler ultrasound, and direct costs generated by the three algorithms analysed: all patients were referred systematically, referral according to Wells and Oudega scale. DVT was confirmed in 18.9%. The two clinical probability scales showed a sensitivity of 100% (95% CI: 85.1 to 100) and a specificity of about 40%. With the application of the scales, one third of all referrals to hospital emergency rooms could have been avoided (P<.001). The diagnostic cost could have been reduced by € 8,620 according to Oudega and € 9,741 according to Wells, per 100 patients visited. The application of diagnostic algorithms when a DVT is suspected could lead to better diagnostic management by physicians, and a more cost effective process. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Lessons from French National Guidelines on the treatment of venous thrombosis and central venous catheter thrombosis in cancer patients.

PubMed

Farge, Dominique; Durant, Cecile; Villiers, Stéphane; Long, Anne; Mahr, Alfred; Marty, Michel; Debourdeau, Philippe

2010-04-01

Increased prevalence of Venous thromboembolism (VTE), as defined by deep-vein thrombosis (DVT), central venous catheter (CVC) related thrombosis or pulmonary embolism (PE) in cancer patients has become a major therapeutic issue. Considering the epidemiology and each national recommendations on the treatment of VTE in cancer patients, we analysed guidelines implementation in clinical practice. Thrombosis is the second-leading cause of death in cancer patients and cancer is a major risk factor of VTE, due to activation of coagulation, use of long-term CVC, the thrombogenic effects of chemotherapy and anti-angiogenic drugs. Three pivotal trials (CANTHANOX, LITE and CLOT) and several meta-analysis led to recommend the long term (3 to 6 months) use of LMWH during for treating VTE in cancer patients with a high level of evidence. The Italian Association of Medical Oncology (AIOM), the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), the French "Institut National du Cancer" (INCa), the European Society of Medical Oncology (ESMO) and the American College of Chest Physicians (ACCCP) have published specific guidelines for health care providers regarding the prevention and treatment of cancer-associated VTE. Critical appraisal of these guidelines, difficulties in implementation of prophylaxis regimen, tolerance and cost effectiveness of long term use of LMWH may account for large heterogenity in daily clinical practice. Homogenization of these guidelines in international consensus using an adapted independent methodological approach followed by educational and active implementation strategies at each national level would be very valuable to improve the care of VTE in cancer patients.

Duplex Ultrasonography Has Limited Utility in Detection of Postoperative DVT After Primary Total Joint Arthroplasty.

PubMed

Vira, Shaleen; Ramme, Austin J; Alaia, Michael J; Steiger, David; Vigdorchik, Jonathan M; Jaffe, Frederick

2016-07-01

Duplex ultrasound is routinely used to evaluate suspected deep venous thrombosis after total joint arthroplasty. When there is a clinical suspicion for a pulmonary embolism, a chest angiogram (chest CTA) is concomitantly obtained. Two questions were addressed: First, for the population of patients who receive duplex ultrasound after total joint arthroplasty, what is the rate of positive results? Second, for these patients, how many of these also undergo chest CTA for clinical suspicion of pulmonary embolus and how many of these tests are positive? Furthermore, what is the correlation between duplex ultrasound results and chest CTA results? A retrospective chart review was conducted of total joint replacement patients in 2011 at a single institution. Inclusion criteria were adult patients who underwent a postoperative duplex ultrasonography for clinical suspicion of deep venous thrombosis (DVT). Demographic data, result of duplex scan, clinical indications for obtaining the duplex scan, and DVT prophylaxis used were recorded. Additionally, if a chest CTA was obtained for clinical suspicion for pulmonary embolus, results and clinical indication for obtaining the test were recorded. The rate of positive results for duplex ultrasonography and chest CTA was computed and correlated based on clinical indications. Two hundred ninety-five patients underwent duplex ultrasonography of which only 0.7% were positive for a DVT. One hundred three patients underwent a chest CTA for clinical suspicion of a pulmonary embolism (PE) of which 26 revealed a pulmonary embolus, none of which had a positive duplex ultrasound. Postoperative duplex scans have a low rate of positive results. A substantial number of patients with negative duplex results subsequently underwent chest CTA for clinical suspicion for which a pulmonary embolus was found, presumably resulting from a DVT despite negative duplex ultrasound result. A negative duplex ultrasonography should not rule out the presence of a DVT which can embolize to the lungs and thus should not preclude further workup when clinical suspicion exists for a pulmonary embolus.

Epidemiological trends of deep venous thrombosis in HIV-infected subjects (1997-2013): A nationwide population-based study in Spain.

PubMed

Alvaro-Meca, Alejandro; Ryan, Pablo; Martínez-Larrull, Esther; Micheloud, Dariela; Berenguer, Juan; Resino, Salvador

2018-02-01

Chronic infections may be a triggering factor as well as a risk factor of deep venous thrombosis (DVT). The purpose of this study was to analyze the epidemiological trends of hospital admissions related to DVT in human immunodeficiency virus (HIV)-infected patients during the combination antiretroviral therapy (cART) era, in relation to hepatitis C virus (HCV) serological status. We performed a retrospective study using the Spanish Minimum Basic Data Set. We selected HIV-infected subjects over 15years old with a hospital admission and DVT diagnosis (ICD-9-CM codes: 453.4x and 453.8x) between 1997 and 2013. Patients were classified according to HCV serology. We estimated the incidence (events per 100,000 patient-years) in four calendar periods (1997-1999, 2000-2003, 2004-2007, and 2008-2013). Overall, the incidence of DVT-related hospitalizations had a significant upward trend in all HIV-infected patients (P<0.001), with significant differences between 1997-1999 and 2008-2013 [49.5 vs. 88.1 (P<0.001)]. Moreover, the incidence was higher in HIV-monoinfected patients than in HIV/HCV-coinfected patients during the entire follow-up (P<0.001). However, the incidence had a significant downward trend in HIV-monoinfected patients (P=0.002) and a significant upward trend in HIV/HCV-coinfected patients (P<0.001). Specifically, the incidence of DVT-related hospitalizations in HIV-monoinfected patients significantly decreased from 1997-1999 to 2008-2013 [142.7 vs. 103.1 (P=0.006)], whereas in HIV/HCV-coinfected patients, the incidence increased from 8.4 (1997-1999) to 70.7 (2008-2013) (P<0.001). Our findings suggest that DVT is an emerging health problem among HIV-infected patients, with increasing incidence during the first 17years after the introduction of cART, particularly in HIV/HCV-coinfected patients. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Rutosides for prevention of post-thrombotic syndrome.

PubMed

Morling, Joanne R; Yeoh, Su Ern; Kolbach, Dinanda N

2015-09-16

Post-thrombotic syndrome (PTS) is a long-term complication of deep venous thrombosis (DVT) that is characterised by pain, swelling, and skin changes in the affected limb. One in three patients with DVT will develop post-thrombotic sequelae within five years. The current standard care for the prevention of PTS following DVT is elastic compression stockings. Rutosides are a group of compounds derived from horse chestnut (Aesculus hippocastanum), a traditional herbal remedy for treating oedema formation in chronic venous insufficiency (CVI). However, it is not known whether rutosides are effective and safe in the prevention of post-thrombotic syndrome. This is an update of the review first published in 2013. To determine the effectiveness and safety of rutosides for prevention of PTS in patients with DVT, compared to placebo, no intervention, or reference medication. For this update the Cochrane Vascular Group Trials Search Co-ordinator searched the Specialised Register (last searched September 2015) and the Cochrane Register of Studies (CRS) ((CENTRAL) 2015, Issue 8). Clinical trials databases were searched for details of ongoing and unpublished studies. We planned to include trials of rutosides versus any alternative (placebo, no intervention, or reference medication) in the prevention of PTS in patients with DVT. Two review authors independently assessed studies for inclusion and intended to extract information from the trials. No studies were identified comparing rutosides versus any alternative in the prevention of PTS. As there were no studies identified in this review there is currently insufficient evidence to determine the effectiveness and safety of rutosides for prevention of PTS in patients with DVT. Some studies suggest that rutosides may provide short-term relief of PTS symptoms. However, there is nothing published on their use as a preventative therapy for PTS. High quality randomised controlled trials of rutoside versus any alternative are required to build the evidence base in this area.

Indications, applications, and outcomes of inferior vena cava filters for venous thromboembolism in Japanese patients.

PubMed

Yamashita, Yugo; Unoki, Takashi; Takagi, Daisuke; Hamatani, Yasuhiro; Ishii, Mitsuru; Iguchi, Moritake; Ogawa, Hisashi; Masunaga, Nobutoyo; Wada, Hiromichi; Hasegawa, Koji; Abe, Mitsuru; Akao, Masaharu

2016-07-01

A recent multicenter registry study of venous thromboembolism (VTE) patients in Japan demonstrated a high prevalence of inferior vena cava (IVC) filter placement. However, data regarding indications, applications, and outcomes of IVC filters in Japanese patients are quite limited. This study was an observational, single-center, retrospective cohort study of all consecutive patients with acute VTE treated between March 2006 and February 2014. Data extracted included patient demographics, indications, applications, and complications of IVC filters, as well as VTE recurrence and death. A total of 257 consecutive patients were analyzed. Seventy-eight patients (30 %) received IVC filters. The proportions of IVC filter placement were 26 % for deep-vein thrombosis (DVT) alone, 10 % for pulmonary embolism (PE) alone, and 46 % for both DVT and PE. There was no significant difference in patient demographics between the IVC filter group and no-IVC filter group. Stated indications for filter placement were 24 cases (30 %) of DVT in intrapelvic veins, 16 cases (20 %) of DVT in proximal veins, and 11 cases (14 %) of contraindication to anticoagulant therapy. In the IVC filter group, cases of class I indication (guidelines: JCS 75:1258-1281, 2009) numbered only 6 (8 %). Many of the retrievable IVC filters were not removed and placed permanently and the retrieval rate was 42 %. We found complications of IVC filters in 8 cases (10 %). IVC filter placement was significantly associated with a better survival rate and a higher incidence of DVT recurrence during a mean observation period of 541 days. Our research suggests the frequent use of IVC filters for VTE treatment, combined with a low retrieval rate. Most of the stated indications of IVC filter placement for VTE in Japanese patients were cases of DVT in intrapelvic veins or proximal veins, not cases of contraindication to anticoagulant therapy.

Efficacy of Lower-Extremity Venous Thrombolysis in the Setting of Congenital Absence or Atresia of the Inferior Vena Cava

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ganguli, Suvranu, E-mail: sganguli@partners.org; Kalva, Sanjeeva; Oklu, Rahmi

Purpose: A rare but described risk factor for deep venous thrombosis (DVT), predominately in the young, is congenital agenesis or atresia of the inferior vena cava (IVC). The optimal management for DVT in this subset of patients is unknown. We evaluated the efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) followed by systemic anticoagulation in the treatment of acute lower-extremity DVT in the setting of congenital IVC agenesis or atresia. Materials and Methods: Between November of 2005 and May of 2010, six patients (three women [average age 21 years]) were referred to our department with acute lower-extremity DVT and subsequently found tomore » have IVC agenesis or atresia on magnetic resonance imaging. A standardized technique for PCDT (the Angiojet Rheolytic Thrombectomy System followed by the EKOS Microsonic Accelerated Thrombolysis System) was used for all subjects. Successful thrombolysis was followed by systemic heparinization with transition to Coumadin or low molecular-weight heparin and compression stockings. Subjects were followed-up at 1, 3, and then every 6 months after the procedure with clinical assessment and bilateral lower-extremity venous ultrasound. Results: All PCDT procedures were technically successful. No venous stenting or angioplasty was performed. The average thrombolysis time was 28.6 h (range 12-72). Two patients experienced heparin-induced thrombocytopenia, and one patient developed a self-limited knee hemarthrosis, No patients were lost to follow-up. The average length of follow-up was 25.8 {+-} 20.2 months (range 3.8-54.8). No incidence of recurrent DVT was identified. There were no manifestations of postthrombotic syndrome. Conclusions: PCDT followed by systemic anticoagulation and the use of compression stockings appears to be safe and effective in relatively long-term follow-up treatment of patients who present with acute DVT and IVC agenesis or atresia.« less

Imaging Thromboembolism with Fibrin-Avid 99mTc-Peptide: Evaluation in Swine

PubMed Central

Aruva, Mohan R.; Daviau, Judy; Sharma, Shubh S.; Thakur, Mathew L.

2006-01-01

A pentapeptide, Gly-Pro-Arg-Pro-Pro, with high affinity for α-chain-fibrin was labeled with 99mTc (99mTc-TP850) and evaluated in swine to image experimental venous thromboembolism (deep vein thrombosis [DVT]) and pulmonary embolism (PE). Methods Scatchard analysis was performed to determine fibrin affinity for TP850 and the number of binding sites (receptors) per milligram of fibrin. DVT was induced in the left jugular vein and PE was induced by introducing a preformed autologous blood clot into the right atrium using a 7-French introducer sheath inserted into the right jugular vein. 99mTc-TP850 was injected at 4, 24, 48, 72, 96, or 120 h later. Animals were imaged for up to 4 h after injection, heparinized, and sacrificed. Lungs were extirpated, radiographed, and imaged, and the PE was removed. Other tissues, including blood and normal lungs, were harvested and, concomitantly, 99mTc was counted for determination of target-to-tissue ratios and the percentage injected dose per gram of tissue. Results The affinity for human fibrin was 10−9 mol/L and there were >1015 receptors per milligram of fibrin. DVT and PE were visualized for up to 4 h after injection with high DVT/blood (7.9–22.6), DVT/muscle (31.1–89.4), PE/blood (1–155), and PE/lung (0.8–245) ratios. Thereafter, the PEs fragmented spontaneously below the spatial resolution of the γ-camera and, despite the high associated radioactivity, could not be localized in vivo. The fragmented clots were detectable by scintigraphy on excised lungs and provided excellent concordance with radiograms. Conclusion 99mTc-TP850 with its modest affinity (10−9 mol/L), rapid blood clearance, and high DVT and PE uptake is a promising agent for imaging vascular thrombosis. PMID:16391200

Rivaroxaban for the treatment of symptomatic deep-vein thrombosis and pulmonary embolism in Chinese patients: a subgroup analysis of the EINSTEIN DVT and PE studies.

PubMed

Wang, Yuqi; Wang, Chen; Chen, Zhong; Zhang, Jiwei; Liu, Zhihong; Jin, Bi; Ying, Kejing; Liu, Changwei; Shao, Yuxia; Jing, Zhicheng; Meng, Isabelle Ling; Prins, Martin H; Pap, Akos F; Müller, Katharina; Lensing, Anthonie Wa

2013-12-16

The worldwide EINSTEIN DVT and EINSTEIN PE studies randomized 8282 patients with acute symptomatic deep-vein thrombosis (DVT) and/or pulmonary embolism (PE) and, for the first time in trials in this setting, included patients in China. This analysis evaluates the results of these studies in this subgroup of patients. A total of 439 Chinese patients who had acute symptomatic DVT (n=211), or PE with or without DVT (n=228), were randomized to receive rivaroxaban (15 mg twice daily for 21 days, followed by 20 mg once daily) or standard therapy of enoxaparin overlapping with and followed by an adjusted-dose vitamin K antagonist, for 3, 6, or 12 months. The primary efficacy outcome was symptomatic recurrent venous thromboembolism. The principal safety outcome was major or non-major clinically relevant bleeding. The primary efficacy outcome occurred in seven (3.2%) of the 220 patients in the rivaroxaban group and in seven (3.2%) of the 219 patients in the standard-therapy group (hazard ratio, 1.04; 95% confidence interval 0.36-3.0; p=0.94). The principal safety outcome occurred in 13 (5.9%) patients in the rivaroxaban group and in 20 (9.2%) patients in the standard-therapy group (hazard ratio, 0.63; 95% confidence interval 0.31-1.26; p=0.19). Major bleeding was observed in no patients in the rivaroxaban group and in five (2.3%) patients in the standard-therapy group. In fragile patients (defined as age >75 years, creatinine clearance <50 mL/min, and/or body weight ≤50 kg), the principal safety outcome occurred in four (8.9%) of the 45 patients who received rivaroxaban compared with seven (15.2%) of the 46 patients who received standard therapy. In Chinese patients with acute symptomatic DVT and/or PE, rivaroxaban was as efficacious as enoxaparin followed by vitamin K antagonist therapy, with a similar safety profile. The relative efficacy and safety of rivaroxaban compared with enoxaparin/vitamin K antagonist were consistent with that found in the rest of the world. EINSTEIN PE, ClinicalTrials.gov NCT00439777; EINSTEIN DVT, ClinicalTrials.gov NCT00440193.

Impact of operative time on early joint infection and deep vein thrombosis in primary total hip arthroplasty.

PubMed

Wills, B W; Sheppard, E D; Smith, W R; Staggers, J R; Li, P; Shah, A; Lee, S R; Naranje, S M

2018-03-22

Infections and deep vein thrombosis (DVT) after total hip arthroplasty (THA) are challenging problems for both the patient and surgeon. Previous studies have identified numerous risk factors for infections and DVT after THA but have often been limited by sample size. We aimed to evaluate the effect of operative time on early postoperative infection as well as DVT rates following THA. We hypothesized that an increase in operative time would result in increased odds of acquiring an infection as well as a DVT. We conducted a retrospective analysis of prospectively collected data using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2015 for all patients undergoing primary THA. Associations between operative time and infection or DVT were evaluated with multivariable logistic regressions controlling for demographics and several known risks factors for infection. Three different types of infections were evaluated: (1) superficial surgical site infection (SSI), an infection involving the skin or subcutaneous tissue, (2) deep SSI, an infection involving the muscle or fascial layers beneath the subcutaneous tissue, and (3) organ/space infection, an infection involving any part of the anatomy manipulated during surgery other than the incisional components. In total, 103,044 patients who underwent THA were included in our study. Our results suggested a significant association between superficial SSIs and operative time. Specifically, the adjusted odds of suffering a superficial SSI increased by 6% (CI=1.04-1.08, p<0.0001) for every 10-minute increase of operative time. When using dichotomized operative time (<90minutes or >90minutes), the adjusted odds of suffering a superficial SSI was 56% higher for patients with prolonged operative time (CI=1.05-2.32, p=0.0277). The adjusted odds of suffering a deep SSI increased by 7% for every 10-minute increase in operative time (CI=1.01-1.14, p=0.0335). No significant associations were detected between organ/space infection, wound dehiscence, or DVT and operative time either as continuous or as dichotomized. Prolonged operative times (>90min) are associated with increased rates of superficial SSIs, but not deep SSIs, organ/space infections, wound dehiscence, or DVT. III. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Cost-Effectiveness of Dabigatran Compared to Vitamin-K Antagonists for the Treatment of Deep Venous Thrombosis in the Netherlands Using Real-World Data.

PubMed

van Leent, Merlijn W J; Stevanović, Jelena; Jansman, Frank G; Beinema, Maarten J; Brouwers, Jacobus R B J; Postma, Maarten J

2015-01-01

Vitamin-K antagonists (VKAs) present an effective anticoagulant treatment in deep venous thrombosis (DVT). However, the use of VKAs is limited because of the risk of bleeding and the necessity of frequent and long-term laboratory monitoring. Therefore, new oral anticoagulant drugs (NOACs) such as dabigatran, with lower rates of (major) intracranial bleeding compared to VKAs and not requiring monitoring, may be considered. To estimate resource utilization and costs of patients treated with the VKAs acenocoumarol and phenprocoumon, for the indication DVT. Furthermore, a formal cost-effectiveness analysis of dabigatran compared to VKAs for DVT treatment was performed, using these estimates. A retrospective observational study design in the thrombotic service of a teaching hospital (Deventer, The Netherlands) was applied to estimate real-world resource utilization and costs of VKA monitoring. A pooled analysis of data from RE-COVER and RE-COVER II on DVT was used to reflect the probabilities for events in the cost-effectiveness model. Dutch costs, utilities and specific data on coagulation monitoring levels were incorporated in the model. Next to the base case analysis, univariate probabilistic sensitivity and scenario analyses were performed. Real-world resource utilization in the thrombotic service of patients treated with VKA for the indication of DVT consisted of 12.3 measurements of the international normalized ratio (INR), with corresponding INR monitoring costs of €138 for a standardized treatment period of 180 days. In the base case, dabigatran treatment compared to VKAs in a cohort of 1,000 DVT patients resulted in savings of €18,900 (95% uncertainty interval (UI) -95,832, 151,162) and 41 (95% UI -18, 97) quality-adjusted life-years (QALYs) gained calculated from societal perspective. The probability that dabigatran is cost-effective at a conservative willingness-to pay threshold of €20,000 per QALY was 99%. Sensitivity and scenario analyses also indicated cost savings or cost-effectiveness below this same threshold. Total INR monitoring costs per patient were estimated at minimally €138. Inserting these real-world data into a cost-effectiveness analysis for patients diagnosed with DVT, dabigatran appeared to be a cost-saving alternative to VKAs in the Netherlands in the base case. Cost savings or favorable cost-effectiveness were robust in sensitivity and scenario analyses. Our results warrant confirmation in other settings and locations.

Thromboelastogram-guided enoxaparin dosing does not confer protection from deep venous thrombosis: a randomized controlled pilot trial.

PubMed

Louis, Scott G; Van, Philbert Y; Riha, Gordon M; Barton, Jeffrey S; Kunio, Nicholas R; Underwood, Samantha J; Differding, Jerome A; Rick, Elizabeth; Ginzburg, Enrique; Schreiber, Martin A

2014-04-01

The incidence of deep venous thrombosis (DVT) remains high in general surgery and trauma patients despite widespread prophylaxis with enoxaparin. A recent study demonstrated decreased incidence of DVT if patients on enoxaparin had a change in R time (ΔR) of greater than 1 minute when heparinase-activated thromboelastography (TEG) was compared with normal TEG. We hypothesized that using ΔR-guided dosing would result in decreased DVT rates. A prospective, randomized controlled trial was performed at a Level 1 trauma center. Both trauma and general surgery patients were included. Upon enrollment, demographic data including age, sex, body mass index, and Acute Physiology and Chronic Health Evaluation II score were obtained. Enrolled patients were randomized to standard (30 mg twice a day) or TEG-guided dosing. Dose-adjusted patients underwent daily enoxaparin titration to achieve an ΔR of 1 minute to 2 minutes. Venous thromboembolism screening was performed per institutional protocol. Antithrombin III (AT-III) and anti-Xa levels were drawn at peak enoxaparin concentrations. A total of 87 patients were enrolled. There was no difference in demographic data between the groups. No pulmonary emboli were identified. The control group had a DVT rate of 16%, while the experimental group had a rate of 14% (p = nonsignificant). The experimental group's median enoxaparin dosage, 50 mg twice a day, was significantly higher than that of the control (p < 0.01). TEG ΔR was not different between the control and experimental groups. Beginning at Day 3, anti-Xa levels were higher in the experimental group (p < 0.05). There was no difference in AT-III activity between the two groups; 67% of the patients demonstrated AT-III deficiency. TEG adjusted enoxaparin dosing led to significant increases in anti-Xa activity, which did not correlate with a decreased DVT rate. Failure to reduce the DVT rate and increase ΔR despite increased dosing and increased anti-Xa activity is consistent with the high rate of AT-III deficiency detected in this study cohort. These data suggest that the future of DVT prevention may not lie in the optimization of low molecular weight heparin therapy but rather in compounds that increase antithrombin directly or operate independently of the AT-III pathway. Therapeutic study, level III.

Automation and hypermedia technology applications

NASA Technical Reports Server (NTRS)

Jupin, Joseph H.; Ng, Edward W.; James, Mark L.

1993-01-01

This paper represents a progress report on HyLite (Hypermedia Library technology): a research and development activity to produce a versatile system as part of NASA's technology thrusts in automation, information sciences, and communications. HyLite can be used as a system or tool to facilitate the creation and maintenance of large distributed electronic libraries. The contents of such a library may be software components, hardware parts or designs, scientific data sets or databases, configuration management information, etc. Proliferation of computer use has made the diversity and quantity of information too large for any single user to sort, process, and utilize effectively. In response to this information deluge, we have created HyLite to enable the user to process relevant information into a more efficient organization for presentation, retrieval, and readability. To accomplish this end, we have incorporated various AI techniques into the HyLite hypermedia engine to facilitate parameters and properties of the system. The proposed techniques include intelligent searching tools for the libraries, intelligent retrievals, and navigational assistance based on user histories. HyLite itself is based on an earlier project, the Encyclopedia of Software Components (ESC) which used hypermedia to facilitate and encourage software reuse.

Computational Model of Heat Transfer on the ISS

NASA Technical Reports Server (NTRS)

Torian, John G.; Rischar, Michael L.

2008-01-01

SCRAM Lite (SCRAM signifies Station Compact Radiator Analysis Model) is a computer program for analyzing convective and radiative heat-transfer and heat-rejection performance of coolant loops and radiators, respectively, in the active thermal-control systems of the International Space Station (ISS). SCRAM Lite is a derivative of prior versions of SCRAM but is more robust. SCRAM Lite computes thermal operating characteristics of active heat-transport and heat-rejection subsystems for the major ISS configurations from Flight 5A through completion of assembly. The program performs integrated analysis of both internal and external coolant loops of the various ISS modules and of an external active thermal control system, which includes radiators and the coolant loops that transfer heat to the radiators. The SCRAM Lite run time is of the order of one minute per day of mission time. The overall objective of the SCRAM Lite simulation is to process input profiles of equipment-rack, crew-metabolic, and other heat loads to determine flow rates, coolant supply temperatures, and available radiator heat-rejection capabilities. Analyses are performed for timelines of activities, orbital parameters, and attitudes for mission times ranging from a few hours to several months.

LiteBIRD: mission overview and design tradeoffs

NASA Astrophysics Data System (ADS)

Matsumura, T.; Akiba, Y.; Borrill, J.; Chinone, Y.; Dobbs, M.; Fuke, H.; Hasegawa, M.; Hattori, K.; Hattori, M.; Hazumi, M.; Holzapfel, W.; Hori, Y.; Inatani, J.; Inoue, M.; Inoue, Y.; Ishidoshiro, K.; Ishino, H.; Ishitsuka, H.; Karatsu, K.; Kashima, S.; Katayama, N.; Kawano, I.; Kibayashi, A.; Kibe, Y.; Kimura, K.; Kimura, N.; Komatsu, E.; Kozu, M.; Koga, K.; Lee, A.; Matsuhara, H.; Mima, S.; Mitsuda, K.; Mizukami, K.; Morii, H.; Morishima, T.; Nagai, M.; Nagata, R.; Nakamura, S.; Naruse, M.; Namikawa, T.; Natsume, K.; Nishibori, T.; Nishijo, K.; Nishino, H.; Noda, A.; Noguchi, T.; Ogawa, H.; Oguri, S.; Ohta, I. S.; Okada, N.; Otani, C.; Richards, P.; Sakai, S.; Sato, N.; Sato, Y.; Segawa, Y.; Sekimoto, Y.; Shinozaki, K.; Sugita, H.; Suzuki, A.; Suzuki, T.; Tajima, O.; Takada, S.; Takakura, S.; Takei, Y.; Tomaru, T.; Uzawa, Y.; Wada, T.; Watanabe, H.; Yamada, Y.; Yamaguchi, H.; Yamasaki, N.; Yoshida, M.; Yoshida, T.; Yotsumoto, K.

2014-08-01

We present the mission design of LiteBIRD, a next generation satellite for the study of B-mode polarization and inflation from cosmic microwave background radiation (CMB) detection. The science goal of LiteBIRD is to measure the CMB polarization with the sensitivity of δr = 0:001, and this allows testing the major single-field slow-roll inflation models experimentally. The LiteBIRD instrumental design is purely driven to achieve this goal. At the earlier stage of the mission design, several key instrumental specifications, e.g. observing band, optical system, scan strategy, and orbit, need to be defined in order to process the rest of the detailed design. We have gone through the feasibility studies for these items in order to understand the tradeoffs between the requirements from the science goal and the compatibilities with a satellite bus system. We describe the overview of LiteBIRD and discuss the tradeoffs among the choices of scientific instrumental specifications and strategies. The first round of feasibility studies will be completed by the end of year 2014 to be ready for the mission definition review and the target launch date is in early 2020s.

Ultrasonographic findings in dual kidney transplantation.

PubMed

Impedovo, Stefano Vittorio; Martino, Pasquale; Palazzo, Silvano; Ditonno, Pasquale; Tedeschi, Michele; Palumbo, Fabrizio; Tafa, Ardit; Matera, Matteo; Selvaggi, Francesco Paolo; Battaglia, Michele

2012-12-01

Organ shortage has led to using grafts from expanded criteria donors (ECD). Double kidney transplantation is an accepted strategy to increase the donor pool, using organs from an ECD which are not acceptable for single kidney transplantation (SKT). Aim of this retrospective study was to analyse the role of colour Doppler ultrasound (CDUS) in the diagnosis of major surgical complications in DKT, performed with unilateral or bilateral placement. From 2000 to 2011 we performed 54 DKT. Unilateral placement of both kidneys was done in 26 patients and bilateral DKT in 28, through two separate Gibson incisions (18) or one midline incision (10). Each patient underwent at least 3 CDUS before hospital discharge. The main surgical complications, discovered initially thanks to ultrasound (US), were hydronephrosis from ureteral obstruction, lymphocele and deep venous thrombosis (DVT). Mean follow-up was 42.7 months. Good postoperative renalfunction was demonstrated in 25 patients (46.3%), while delayed graft function occurred in 29 (53.7%). US showed ureteral obstruction requiring surgery in 5 unilateral DKT while no patient subjected to bilateral DKT developed severe hydronephrosis. Lymphoocele, surgically drained, was demonstrated in 6 bilateral DKT with a midline incision, 2 bilateral DKT with two separate incisions and 3 unilateral DKT. CDUS also enabled diagnosis of 2 cases of DVT in ipsilateral DKTs. CDUS provides useful information in patients with DKT, allowing the detection of clinically unsuspected unilateral diseases. US study of our patients demonstrated that unilateral DKTs are more susceptible to the development of DVT and ureteral stricture, while the incidence of voluminous lymphocele is more frequent in bilateral DKT through a single midline incision. In this scenario, all patients undergoing DKT should be carefully monitored by US after surgery.

PCoD Lite - Using an Interim PCoD Protocol to Assess the Effects of Disturbance Associated with US Navy Exercises on Marine Mammal Populations

DTIC Science & Technology

2014-09-30

1 DISTRIBUTION STATEMENT A. Approved for public release; distribution is unlimited. PCoD Lite - Using an Interim PCoD Protocol to Assess...Skookum Tom Road Friday Harbor, WA, USA phone: 1-360-370-5493 email: jw@smrullc.com Award Number: N000141410406 http://www.smrumarine.com/ pcod ...DATE 30 SEP 2014 2. REPORT TYPE 3. DATES COVERED 00-00-2014 to 00-00-2014 4. TITLE AND SUBTITLE PCoD Lite - Using an Interim PCoD Protocol to

The Lyman Imaging Telescope Experiment (LITE)

NASA Technical Reports Server (NTRS)

Siegmund, O. H. W.

1997-01-01

The scientific aim of the LITE mission is to carry out the first set of very high spatial resolution (0.2 arc sec), wide field of view (10 arc minute), pointed astronomical observations in several narrow wavelength bands in the far ultraviolet region of the spectrum (900-1600 A). Two wavelength regions in the far UV were chosen to be of prime scientific importance for the LITE mission: 1030A and 1240A. It was therefore decided to design and test novel, narrow band, high reflectance multilayer filters for these observations.

REopt Lite Web Tool Evaluates Photovoltaics and Battery Storage

DOE Office of Scientific and Technical Information (OSTI.GOV)

Building on the success of the REopt renewable energy integration and optimization platform, NREL has developed a free, publicly available web version of REopt called REopt Lite. REopt Lite evaluates the economics of grid-connected photovoltaics (PV) and battery storage at a site. It allows building owners to identify the system sizes and battery dispatch strategy that minimize their life cycle cost of energy. This web tool also estimates the amount of time a PV and storage system can sustain the site's critical load during a grid outage.

76 FR 14400 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-16

... determine the public's knowledge of DVT, its common symptoms, and risk factors. Although over 60% of... not identify common risk factors for DVT such as sitting for a long period of time (e.g., during air... pills; or getting older; and certain groups could not identify risk factors that specifically applied to...

Power Reactant Storage Assembly (PRSA) (Space Shuttle). PRSA hydrogen and oxygen DVT tank refurbishment

NASA Technical Reports Server (NTRS)

1993-01-01

The Power Reactant Storage Assembly (PRSA) liquid hydrogen Development Verification Test (H2 DVT) tank assembly (Beech Aircraft Corporation P/N 15548-0116-1, S/N 07399000SHT0001) and liquid oxygen (O2) DVT tank assembly (Beech Aircraft Corporation P/N 15548-0115-1, S/N 07399000SXT0001) were refurbished by Ball Electro-Optics and Cryogenics Division to provide NASA JSC, Propulsion and Power Division, the capability of performing engineering tests. The refurbishments incorporated the latest flight configuration hardware and avionics changes necessary to make the tanks function like flight articles. This final report summarizes these refurbishment activities. Also included are up-to-date records of the pressure time and cycle histories.

PopED lite: An optimal design software for preclinical pharmacokinetic and pharmacodynamic studies.

PubMed

Aoki, Yasunori; Sundqvist, Monika; Hooker, Andrew C; Gennemark, Peter

2016-04-01

Optimal experimental design approaches are seldom used in preclinical drug discovery. The objective is to develop an optimal design software tool specifically designed for preclinical applications in order to increase the efficiency of drug discovery in vivo studies. Several realistic experimental design case studies were collected and many preclinical experimental teams were consulted to determine the design goal of the software tool. The tool obtains an optimized experimental design by solving a constrained optimization problem, where each experimental design is evaluated using some function of the Fisher Information Matrix. The software was implemented in C++ using the Qt framework to assure a responsive user-software interaction through a rich graphical user interface, and at the same time, achieving the desired computational speed. In addition, a discrete global optimization algorithm was developed and implemented. The software design goals were simplicity, speed and intuition. Based on these design goals, we have developed the publicly available software PopED lite (http://www.bluetree.me/PopED_lite). Optimization computation was on average, over 14 test problems, 30 times faster in PopED lite compared to an already existing optimal design software tool. PopED lite is now used in real drug discovery projects and a few of these case studies are presented in this paper. PopED lite is designed to be simple, fast and intuitive. Simple, to give many users access to basic optimal design calculations. Fast, to fit a short design-execution cycle and allow interactive experimental design (test one design, discuss proposed design, test another design, etc). Intuitive, so that the input to and output from the software tool can easily be understood by users without knowledge of the theory of optimal design. In this way, PopED lite is highly useful in practice and complements existing tools. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

RepeatsDB-lite: a web server for unit annotation of tandem repeat proteins.

PubMed

Hirsh, Layla; Paladin, Lisanna; Piovesan, Damiano; Tosatto, Silvio C E

2018-05-09

RepeatsDB-lite (http://protein.bio.unipd.it/repeatsdb-lite) is a web server for the prediction of repetitive structural elements and units in tandem repeat (TR) proteins. TRs are a widespread but poorly annotated class of non-globular proteins carrying heterogeneous functions. RepeatsDB-lite extends the prediction to all TR types and strongly improves the performance both in terms of computational time and accuracy over previous methods, with precision above 95% for solenoid structures. The algorithm exploits an improved TR unit library derived from the RepeatsDB database to perform an iterative structural search and assignment. The web interface provides tools for analyzing the evolutionary relationships between units and manually refine the prediction by changing unit positions and protein classification. An all-against-all structure-based sequence similarity matrix is calculated and visualized in real-time for every user edit. Reviewed predictions can be submitted to RepeatsDB for review and inclusion.

Patient-reported quality of life in a randomized placebo-controlled trial of naltrexone/bupropion for obesity.

PubMed

Kolotkin, R L; Chen, S; Klassen, P; Gilder, K; Greenway, F L

2015-10-01

Weight loss is associated with improved quality of life in some, but not all, weight loss trials. We evaluated changes at 56 weeks in quality of life, measured by the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire, in a pooled analysis of patient-level data from four randomized controlled Phase 3 studies of naltrexone/bupropion (NB32 or Contrave®). The total number of subjects was 3362 (NB32 = 2043; placebo = 1319; mean body mass index = 36.3 kg m(2); mean age = 46). Improvements in IWQOL-Lite Total Score were greater in subjects treated with NB32 (11.9 points [SE 0.3]) vs. placebo (8.2 points [SE 0.3]; P < 0.001), corresponding to weight reductions of 7.0% (SE 0.2) and 2.3% (SE 0.2), respectively. Greater improvements were also observed for NB32 vs. placebo on all five subscale scores of the IWQOL-Lite. Fifty per cent of NB32-treated subjects achieved clinically meaningful improvements in IWQOL-Lite Total Score vs. 32.3% of placebo-treated subjects (odds ratio, 95% confidence interval; 2.09, 1.79-2.44). Subjects losing the most weight (≥ 15% of baseline weight) experienced the greatest improvement in IWQOL-Lite Total Score (19.3 points [SE 0.7] for NB32 and 18.7 points [SE 1.3] for placebo; P = 0.624). Improved quality of life was associated with weight reduction and was achieved in more subjects treated with NB32 than placebo. © 2015 World Obesity.

Long-term treatment of deep-vein thrombosis with low-molecular-weight heparin: an update of the evidence.

PubMed

Hull, Russell D; Townshend, Grace

2013-07-01

This article reviews updated evidence-based knowledge on long-term treatment of deep-vein thrombosis (DVT) with low-molecular-weight heparin (LMWH) or vitamin K antagonists (VKAs). Eleven trials were identified comparing the two treatments in a broad spectrum of patients with DVT and with >100 study participants. Four comparative trials were identified in patients with cancer and DVT (in whom anticoagulation treatment is more complex and bleeding complications more frequent). In the 11 trials in broad patient populations, LMWHs were as effective as VKAs in preventing recurrent venous thromboembolism (VTE), and there were no consistent differences in the incidence of bleeding complications during long-term treatment. In patients with cancer, VTE recurrence was significantly reduced with LMWH versus VKA in two studies, while major bleeding complications did not differ between groups in any of the four trials. Current evidence-based European and American guidelines recommend LMWH over VKA for the long-term treatment of DVT in patients with cancer. LMWH and VKA are recommended over the new oral anticoagulant drugs, for which there are limited data on use in long-term treatment. Post-thrombotic syndrome (PTS), a common complication of DVT, causes considerable morbidity. Long-term use of tinzaparin reduced the risk of PTS compared with VKA in one trial, and a meta-analysis of nine studies in total demonstrated a consistently favourable effect of LMWHs versus VKA on PTS-related outcomes. Given the limited treatment options available for PTS, this suggests that LMWHs provide a useful therapeutic option in any patient particularly at risk of developing PTS.

OC-15 - Risk factors for cancer development after idiopathic venous thromboembolism.

PubMed

Cosmi, B; Legnani, C; Ghirarduzzi, A; De Micheli, V; Pengo, V; Testa, S; Poli, D; Antonucci, E; Prisco, D; Tripodi, A; Prandoni, P; Palareti, G

2016-04-01

Idiopathic venous thromboembolism (VTE) is associated with the risk of cancer but the risk factors for cancer development in such patients are still uncertain. To assess risk factors for the development of cancer after a standard course of anticoagulation in patients with first episode of idiopathic VTE. Subjects were enrolled in the three large prospective multicentre studies: PROLONG (NEJM 2006) PROLONG II (Blood 2010) and DULCIS (Blood 2014). Women whose index event was hormone related were excluded from the analysis. The development of cancer was recorded during a 2-year follow-up. 1,805 patients were enrolled (M/F: 510/453), mean age: 62, median: 67; range:18-87 years). Cancer developed in 55 patients (3% ; 1.7% pt-years) of whom 15 (2.0%; 1.1% pt-years) had PE with or without DVT and 40 (3.8%; 2.1% pt-years) had DVT without PE (p=0.03). The development of cancer was associated with DVT without PE (HR:1.8; 95% CI: 1.1-3.3) and age >65 (HR: 2.5; 95%: 1.3-4.9). Among patients with DVT, with or without PE, the development of cancer was associated with the presence of residual vein obstruction>4mm (RVO) at compression ultrasound (HR: 1.8, 95% CI: 1.1-3.3) and age>65 (HR: 2.8; 95% CI: 1.3-6.2). Age>65 years, DVT without PE and the presence of RVO are significantly associated with the risk of developing cancer after a first episode of idiopathic VTE over a two-year follow-up. © 2016 Elsevier Ltd. All rights reserved.

Preventive effect of electrical acupoint stimulation on lower-limb thrombosis: a prospective study of elderly patients after malignant gastrointestinal tumor surgery.

PubMed

Hou, Li L; Yao, Li W; Niu, Qian M; Xu, L; Yu, Qiu H; Sun, Wen Q; Yin, Pei-Hao; Li, Qi

2013-01-01

Lower deep venous thrombosis (DVT) is one of the major complications of patients with tumors or patients undergoing major surgery. Electrical acupoint stimulation, an established technique of traditional Chinese medicine (TCM), can be well combined with Western medicine to reduce the incidence of postoperative DVT, especially in elderly patients. The objectives of this study were to assess the efficiency of electrical acupoint stimulation in the prevention of postsurgery DVT in elderly patients with gastrointestinal malignant tumors and to validate an effective and safe nursing approach that integrates TCM and Western medicine. A total of 120 patients (none aged <60 years) who underwent malignant gastrointestinal tumor surgery between July 2005 and May 2007 were randomly divided into 3 groups: routine nursing group (group C1), graduated compression stockings group (group C2), and electrical acupoint stimulation group (group T). Hemorheological parameters (blood viscosity, etc) were measured and compared before and after surgery. Compared with groups C1 and C2, group T showed a significant difference in blood viscosity and blood flow velocity (P < .05). However, there were no statistical differences among groups C1, C2, and T in other hemorheological parameters. By speeding up the blood flow in patients' lower limbs, electrical acupoint stimulation showed a great potential to prevent symptomless DVT in elderly patients after malignant gastrointestinal tumor surgery. Western medical care combined with TCM can reduce the occurrence of lower DVT in elderly patients suffering from gastrointestinal cancer. This approach may help nurses to plan effective care for elderly patients.

Chemical Thromboprophylaxis Is Not Necessary to Reduce Risk of Thromboembolism With Tranexamic Acid After Total Hip Arthroplasty.

PubMed

Kim, Young-Hoo; Park, Jang-Won; Kim, Jun-Shik

2017-02-01

The major concern with the use of tranexamic acid is that it may promote a hypercoagulable state and increase the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE), particularly when chemical thromboprophylaxis is not used. The objective of this study was to ascertain whether tranexamic acid reduces blood loss and transfusion amounts and increases the prevalence of DVT and PE in the patients undergoing primary cementless total hip arthroplasty (THA) without the use of routine chemical thromboprophylaxis. There were 480 patients (582 hips) in the control group who did not receive tranexamic acid and 487 patients (584 hips) in the study group who received tranexamic acid. Mechanical compression device was applied without any chemical thromboprophylaxis. Transfusion rates and volumes were recorded. DVT was diagnosed using both sonogram and venogram at 7 or 8 days postoperatively. All patients had pre- and postoperative perfusion lung scanning to defect pulmonary embolism (PE). Intraoperative (614 vs 389 mL) and postoperative blood loss (515 vs 329 mL) and transfusion volumes (3 units vs 1.5 units) were significantly lower (P < .001) in the tranexamic acid group. The prevalence of DVT was 15% (87 of 582 hips) in the control group and 18% (105 of 584 hips) in the tranexamic acid group. No fatal PE occurred in either group. The use of tranexamic acid reduces the volume of blood transfusion and does not increase the prevalence of DVT or PE in the patients who did not receive routine chemical thromboprophylaxis after primary cementless THA. Copyright © 2016 Elsevier Inc. All rights reserved.

The profile and frequency of known risk factors or comorbidities for deep vein thrombosis in an urban district hospital in KwaZulu-Natal

PubMed Central

Awolesi, Damilola; Cassimjee, Mohammed H.

2016-01-01

Background Although deep vein thrombosis (DVT) is a preventable disease, it increases the morbidity and mortality in hospitalised, patients, resulting in considerable economic health impact. The identification and primary prevention of risk factors using risk assessment and stratification with subsequent anti-thrombotic prophylaxis in moderate- to severe-risk categories is the most rational means of reducing morbidity and mortality. Aim and setting The aim of the study was to describe the profile and frequency of known risk factors or comorbidities of hospitalised medical patients with ultrasound-diagnosed DVT in an urban district hospital in KwaZulu-Natal. Methods A retrospective review of clinical notes of all medical patients (age ≥ 13 years) admitted to the hospital with ultrasound-diagnosed DVT between July and December 2013. Results The median age was 40 years (interquartile range 32–60 years) and female preponderance was 72.84%. HIV and tuberculosis emerged as the prevalent risk factors, accounting for 51.85% and 35.80%, respectively. Other risk factors observed were recent hospitalisation (34.57%), smoking (25.93%), previous DVT (19.75%) and congestive cardiac failure (18.52%). Conclusion DVT in our study occurred predominantly in young female patients unlike previous studies where patients were generally older. Furthermore, HIV and tuberculosis were the two most common known risk factors or comorbidities observed. Clinicians should have a heightened awareness of venous thromboembolism in patients with either condition or where both conditions occur together and appropriate thromboprophylaxis should be administered. PMID:29568604

A Meta-Analysis of the Educational Effectiveness of Three-Dimensional Visualization Technologies in Teaching Anatomy

ERIC Educational Resources Information Center

Yammine, Kaissar; Violato, Claudio

2015-01-01

Many medical graduates are deficient in anatomy knowledge and perhaps below the standards for safe medical practice. Three-dimensional visualization technology (3DVT) has been advanced as a promising tool to enhance anatomy knowledge. The purpose of this review is to conduct a meta-analysis of the effectiveness of 3DVT in teaching and learning…

Incidence of deep vein thrombosis is increased with 30 mg twice daily dosing of enoxaparin compared with 40 mg daily.

PubMed

Riha, Gordon M; Van, Philbert Y; Differding, Jerome A; Schreiber, Martin A

2012-05-01

The purpose of this study was to analyze whether 2 standard dosing regimens of enoxaparin (30 mg twice daily vs 40 mg once daily) would result in different deep vein thrombosis (DVT) rates and anti-factor Xa activity (anti-Xa) in surgical patients. Patients who required enoxaparin for prophylaxis were followed prospectively. Demographics were recorded. Patients underwent standardized duplex screening. Peak anti-Xa levels were drawn on 4 consecutive days. Sixty-three patients were followed up (28 patients on 30 mg twice daily, 35 patients on 40 mg once daily). There was no significant difference in demographics between groups. Twenty-five percent of patients on 30 mg twice daily developed a DVT, whereas 2.9% of patients on 40 mg once daily developed a DVT. Patients on 30 mg twice daily had significantly lower anti-Xa levels. The incidence of DVT is increased in surgical patients who receive 30 mg twice daily dosing of enoxaparin compared with 40 mg daily. Dosing of 40 mg once daily results in significantly higher peak anti-Xa levels compared with 30 mg twice daily. Copyright © 2012 Elsevier Inc. All rights reserved.

A case of huge colon carcinoma and right renal angiomyolipoma accompanied by proximal deep venous thrombosis, pulmonary embolism and tumor thrombus in the renal vein.

PubMed

Ban, Daisuke; Yamamoto, Seiichiro; Kuno, Hirofumi; Fujimoto, Hiroyuki; Fujita, Shin; Akasu, Takayuki; Moriya, Yoshihiro

2008-10-01

A preoperative inferior vena cava (IVC) filter is reported to be effective in surgical cases with proximal deep venous thrombosis (DVT) or in which pulmonary embolism (PE) has already developed, and considered to be at high risk of developing secondary fatal PE during or after surgery. However, guidelines for using an IVC filter have yet to be established. The patient in the present report had two huge tumors, ascending colon cancer and renal angiomyolipoma, which occupied the entire right half of the abdomen, coexisting PE, DVT and tumor thrombus in the right renal vein. Secondary PE is fatal in the perioperative period, therefore, the vena cava filters were preoperatively inserted into the supra- and the infrarenal IVC. We successfully removed the tumors without complications. The patient is alive without tumor recurrence and PE or recurrent DVT 1 year and 6 months after surgery. The coexistence of two huge abdominal tumors as potential causes of PE and DVT is extremely rare, and we could have safely undergone the operation, using two vena cava filters in the supra- and infrarenal IVC.

Procedure Training Aid for the SH-3D/H Normal Start Checklist.

DTIC Science & Technology

1982-02-01

1 Engine .... START Pupoe: To make a Normal Start of No. 1 engine. :4 14. Action Pilot/Copilot verify lite -off by noting rapid rise in T5 and Nq and...Nf increasinq 15. Note Normal starts are characterized by 7 0-75D0 T5 in I seconds after lite -off 16. If T5 is incrasinn too rapidlyv or appears to...Pumps 206 NORMAL START CHECKLIST ITEM NO. 23. No. I Ergine ... TART 14. Action Pilot/Copilot verify lite -off by noting ra ’pid rise in and Ng and Nf

A Multi-Attribute-Utility-Theory Model that Minimizes Interview-Data Requirements: A Consolidation of Space Launch Decisions.

DTIC Science & Technology

1994-12-01

satel~ lites on th" .gruunu" U, .U,- orbit affects the priority given to a new launch. Table 3.9 Launch Priorities Level Level Title Description 0.00 No...value of a satellite’s mission(s) relative to the misston(s) of other sate• lites As such the rating given may reflect an endre class of satellites for...Expected Remaining Lifetime 0 Years Assign a number between 0 and I that best describes the utility of a sate; lite ’,th Vh,,V- ,ta .=.... ,. A at these

Aerosol and cloud sensing with the Lidar In-space Technology Experiment (LITE)

NASA Technical Reports Server (NTRS)

Winker, D. M.; McCormick, M. P.

1994-01-01

The Lidar In-space Technology Experiment (LITE) is a multi-wavelength backscatter lidar developed by NASA Langley Research Center to fly on the Space Shuttle. The LITE instrument is built around a three-wavelength ND:YAG laser and a 1-meter diameter telescope. The laser operates at 10 Hz and produces about 500 mJ per pulse at 1064 nm and 532 nm, and 150 mJ per pulse at 355 nm. The objective of the LITE program is to develop the engineering processes required for space lidar and to demonstrate applications of space-based lidar to remote sensing of the atmosphere. The LITE instrument was designed to study a wide range of cloud and aerosol phenomena. To this end, a comprehensive program of scientific investigations has been planned for the upcoming mission. Simulations of on-orbit performance show the instrument has sufficient sensitivity to detect even thin cirrus on a single-shot basis. Signal averaging provides the capability of measuring the height and structure of the planetary boundary layer, aerosols in the free troposphere, the stratospheric aerosol layer, and density profiles to an altitude of 40 km. The instrument has successfully completed a ground-test phase and is scheduled to fly on the Space Shuttle Discovery for a 9-day mission in September 1994.

Discos de acreción circumplanares: Modelo de Co-acreción

NASA Astrophysics Data System (ADS)

Parisi, M. G.; de Elía, G.

Los discos de acreción circumplanetarios precursores de los satélites regulares de los planetas gigantes, se pueden formar por cuatro mecanismos (Pollack y otros, 1991, In Uranus, Bergtralh, Miner y Mattews, Eds., p. 469, Univ. de Arizona Press, Tucson). En este trabajo estudiamos uno de tales mecanismos: el Modelo de Co-acreción. En dicho modelo, el disco circumplanetario se forma a partir de las colisiones mutuas entre planetesimales dentro de la esfera de Hill del planeta durante el proceso de formación planetaria. Realizamos un modelo semi-analítico para calcular la masa del disco y compararla con la masa requerida para formar los satélites regulares de los planetas gigantes. Hemos obtenido una cota superior para la masa del disco que resulta inferior a la masa de los satélites más grandes de los planetas gigantes. En principio, estos resultados permitirían descartar el modelo de co-acreción como uno de los procesos que podrían dar lugar a la formación de los satélites regulares. Estos resultados permiten obtener restricciones en el escenario de formación planetaria y en los mecanismos de formación de sistemas de satélites.

Early diagnosis of iliofemoral DVT in pregnancy in the emergency department.

PubMed

van Zyl Smit, Nellis; Govind, Abha; Sharma, Devesh

2012-06-12

The case of a 26-year-old woman who was 23 weeks pregnant is described; the patient presented, on a weekend, to the emergency department (ED) with left groin pain. There were few clinical signs of deep venous thrombosis (DVT) but ED ultrasound (US) showed a left external iliac vein thrombus. This is a new technique in the ED. Not only does this case show the importance of using this technique in the ED, but it also shows the importance of correct training in how to examine for thrombus in the external iliac vein in the pregnant patient. The patient was admitted to the hospital and started on low-molecular-weight heparin. A formal radiology department US performed the next week confirmed the diagnosis of DVT.

[The diagnostic scores for deep venous thrombosis].

PubMed

Junod, A

2015-08-26

Seven diagnostic scores for the deep venous thrombosis (DVT) of lower limbs are analyzed and compared. Two features make this exer- cise difficult: the problem of distal DVT and of their proximal extension and the status of patients, whether out- or in-patients. The most popular score is the Wells score (1997), modi- fied in 2003. It includes one subjective ele- ment based on clinical judgment. The Primary Care score 12005), less known, has similar pro- perties, but uses only objective data. The pre- sent trend is to associate clinical scores with the dosage of D-Dimers to rule out with a good sensitivity the probability of TVP. For the upper limb DVT, the Constans score (2008) is available, which can also be coupled with D-Dimers testing (Kleinjan).

Spinal Epidural Hematoma After Thrombolysis for Deep Vein Thrombosis with Subsequent Pulmonary Thromboembolism: A Case Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Han, Young-Min, E-mail: ymhan@chonbuk.ac.kr; Kwak, Ho-Sung; Jin, Gong-Young

2006-06-15

A 38-year-old male was initially admitted for left leg swelling. He was diagnosed as having deep vein thrombosis (DVT) in the left leg and a pulmonary thromboembolism by contrast-enhanced chest computed tomography (CT) with delayed lower extremity CT. The DVT was treated by thrombolysis and a venous stent. Four hours later, he complained of severe back pain and a sensation of separation of his body and lower extremities; he experienced paraplegia early in the morning of the following day. Magnetic resonance imaging showed a spinal epidural hematoma between T11 and L2, which decompressed following surgery. We, therefore, report a casemore » of a spinal epidural hematoma after thrombolysis in a case of DVT with a pulmonary thromboembolism.« less

Thromboprophylaxis for trauma patients.

PubMed

Barrera, Luis M; Perel, Pablo; Ker, Katharine; Cirocchi, Roberto; Farinella, Eriberto; Morales Uribe, Carlos Hernando

2013-03-28

Trauma is a leading causes of death and disability in young people. Venous thromboembolism (VTE) is a principal cause of death. Trauma patients are at high risk of deep vein thrombosis (DVT). The incidence varies according to the method used to measure the DVT and the location of the thrombosis. Due to prolonged rest and coagulation abnormalities, trauma patients are at increased risk of thrombus formation. Thromboprohylaxis, either mechanical or pharmacological, may decrease mortality and morbidity in trauma patients who survive beyond the first day in hospital, by decreasing the risk of VTE in this population.A previous systematic review did not find evidence of effectiveness for either pharmacological or mechanical interventions. However, this systematic review was conducted 10 years ago and most of the included studies were of poor quality. Since then new trials have been conducted. Although current guidelines recommend the use of thromboprophylaxis in trauma patients, there has not been a comprehensive and updated systematic review since the one published. To assess the effects of thromboprophylaxis in trauma patients on mortality and incidence of deep vein thrombosis and pulmonary embolism. To compare the effects of different thromboprophylaxis interventions and their effects according to the type of trauma. We searched The Cochrane Injuries Group Specialised Register (searched April 30 2009), Cochrane Central Register of Controlled Trials 2009, issue 2 (The Cochrane Library), MEDLINE (Ovid) 1950 to April (week 3) 2009, EMBASE (Ovid) 1980 to (week 17) April 2009, PubMed (searched 29 April 2009), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED) (1970 to April 2009), ISI Web of Science: Conference Proceedings Citation Index-Science (CPCI-S) (1990 to April 2009). Randomized controlled clinical trials involving people of any age with major trauma defined by one or more of the following criteria: physiological: penetrating or blunt trauma with more than two organs and unstable vital signs, anatomical: people with an Injury Severity Score (ISS) higher than 9, mechanism: people who are involved in a 'high energy' event with a risk for severe injury despite stable or normal vital signs. We excluded trials that only recruited outpatients, trials that recruited people with hip fractures only, or people with acute spinal injuries. Four authors, in pairs (LB and CM, EF and RC), independently examined the titles and the abstracts, extracted data, assessed the risk of bias of the trials and analysed the data. PP resolved any disagreement between the authors. Sixteen studies were included (n=3005). Four trials compared the effect of any type (mechanical and/or pharmacological) of prophylaxis versus no prophylaxis. Prophylaxis reduced the risk of DVT in people with trauma (RR 0.52; 95% CI 0.32 to 0.84). Mechanical prophylaxis reduced the risk of DVT (RR = 0.43; 95% CI 0.25 to 0.73). Pharmacological prophylaxis was more effective than mechanical methods at reducing the risk of DVT (RR 0.48; 95% CI 0.25 to 0.95). LMWH appeared to reduce the risk of DVT compared to UH (RR 0.68; 95% CI 0.50 to 0.94). People who received both mechanical and pharmacological prophylaxis had a lower risk of DVT (RR 0.34; 95% CI 0.19 to 0.60) We did not find evidence that thromboprophylaxis reduces mortality or PE in any of the comparisons assessed. However, we found some evidence that thromboprophylaxis prevents DVT. Although the strength of the evidence was not high, taking into account existing information from other related conditions such as surgery, we recommend the use of any DVT prophylactic method for people with severe trauma.

Measurement of thrombus resolution using three-dimensional ultrasound assessment of deep vein thrombosis volume.

PubMed

Zhao, Limin; Prior, Steven J; Kampmann, Meghan; Sorkin, John D; Caldwell, Kevin; Braganza, Melita; McEvoy, Sue; Lal, Brajesh K

2014-04-01

Current imaging techniques are limited in their ability to quantify thrombus burden, progression, resolution, and organization over time in patients with acute deep vein thrombosis (DVT). These assessments are critical measures of therapeutic success when thrombolytic or thrombectomy treatment protocols are utilized for DVT. We evaluated the reliability of a new, commercially available method of acquiring and analyzing three-dimensional (3D) ultrasound images of DVTs that measures thrombus volume and echogenicity. We studied 25 consecutive hospital in-patients (18 male, seven female; age range, 37-87 years) with a first episode of acute DVT. Treatment decisions were not influenced by the study protocol. Scanning was performed independently by two sonographers, then the first sonographer repeated the scan. A combination of routine imaging in grayscale, color-flow, and power-Doppler modes (2D transducer) along with volumetric imaging (3D transducer) was performed. Patients underwent imaging at baseline and on one or more follow-up days 7, 14, 21 and 30. Image-processing software loaded on the ultrasound machine was used to obtain thrombus volume and echogenicity measurements. Thrombus volume was reliably determined by our protocol. The median volume of thrombus at baseline was 0.4 cm(3). Mean inter- and intraobserver differences in volume measurements were 0.006 ± 0.26 cm(3) and -0.12 ± 0.29 cm(3) (mean ± standard deviation). Thrombus resolved over time at a rate of -0.042 ± 0.01 cm(3)/day (P < .003). The median echogenicity of thrombus at baseline expressed as the grayscale median value was 59. There was a trend for thrombus organization (measured as echogenicity) to increase with time, +0.36 ± 0.23 grayscale median units/day (P < .13). Adjustment for the use of anticoagulation, gender of subject, or location of DVT in the upper vs lower extremity did not alter the relationship between time and volume or time and echogenicity. We describe a 3D imaging protocol that reliably measures thrombus volume and echogenicity over time. The method is convenient and can be utilized in routine clinical practice. Acute DVT was associated with a reduction in thrombus size and trend for increased echogenicity over 1 month. This protocol will be of increasing value as our appreciation for the deleterious effects of residual thrombus after DVT increases and our utilization of aggressive thrombus removal treatments for acute DVT increases. Copyright © 2014 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Results from a Year of Column CO2 Measurements over Paris France using Harris GreenLITE™

NASA Astrophysics Data System (ADS)

Dobler, J. T.; Zaccheo, T. S.; Blume, N.; Broquet, G.; Ramonet, M.; Staufer, J.; Vogel, F. R.

2016-12-01

In 2013 Harris Corporation and Atmospheric and Environmental Research developed the GreenLITE™ system under a cooperative agreement with the Department of Energy, National Energy Technology Laboratory, to monitor geologic carbon storage sites on the square km scale. Since that time the system has expanded to enable coverage of areas >25 km2, and was deployed over the city of Paris, France, in November 2015. The system consists of two scanning continuous wave laser absorption spectroscopy instruments and a number of reflectors arranged to provide a number of overlapping 2-5 km chords across the 25 km2 area. The system was deployed as a demonstration for the 21st Conference of Parties (COP21), and has since been extended to a full year experiment. Operating GreenLITE for a full year will allow evaluations of seasonalvariability and enable ingestion of these measurements into inversion model frameworks to estimate the city'semissions. High resolution emissions models currently function on scales of 1-4 km2 and use in situ instrumentation located outside of the urban environment for the inversions due to challenges related to high spatio-temporal variability within the complex urban environment. GreenLITE measurements, on the other hand, provide integrated measurements on spatial and temporal scales that are more suitable for these models.This presentation will review the GreenLITE measurement approach and discuss results of the GreenLITE demonstration, including: comparisons with well calibrated Picarro and ThermoFisher in situ instruments located in or near the GreenLITE footprint, comparisons with high resolution model results, and recent steps toward using the GreenLITE data directly in the inversion models.

Project LITE - Light Inquiry Through Experiments

NASA Astrophysics Data System (ADS)

Brecher, K.

2004-12-01

Hands-on, inquiry-based, constructivist activity offers students a powerful way to explore, uncover and ultimately gain a feel for the nature of science. In order to make practicable a more genuine approach to learning astronomy, we have undertaken the development of hands-on (and eyes-on) materials that can be used in introductory undergraduate astronomy courses. These materials focus on light and optics. Over the past several years as part of Project LITE (Light Inquiry Through Experiments), we have developed a kit of optical materials that is integrated with a set of Java applets. The combined kit and software allows students to do actual experiments concerning geometrical optics, fluorescence, phosphorescence, polarization and other topics by making use of the photons that are emitted by their computer screens. We have also developed a suite of over 100 Flash applets that allow students to directly explore many aspects of visual perception. A major effort of the project concerns spectroscopy, since it is arguably the most important tool used by astronomers to disentangle the nature of the universe. It is also one of the most challenging subjects to teach in undergraduate astronomy courses. The spectroscopy component of Project LITE includes take-home laboratory materials and experiments that are integrated with web-based software. We have also developed a novel quantitative handheld binocular spectrometer (patent pending). Our major spectroscopic software is called the Spectrum Explorer (SPEX). It allows students to create, manipulate and explore all types of spectra including blackbody, power law, emission and absorption. We are now extending the SPEX capabilities to help students gain easy access to the astronomical spectra included in the NVO databases. All of the Project LITE software can be found http://lite.bu.edu. Project LITE is supported by Grant #DUE-0125992 from the NSF Division of Undergraduate Education.

The Diagnostic Value of 3-Dimensional Sampling Perfection With Application Optimized Contrasts Using Different Flip Angle Evolutions (SPACE) MRI in Evaluating Lower Extremity Deep Venous Thrombus.

PubMed

Wu, Gang; Xie, Ruyi; Zhang, Xiaoli; Morelli, John; Yan, Xu; Zhu, Xiaolei; Li, Xiaoming

2017-12-01

The aim of this study was to evaluate the diagnostic performance of noncontrast magnetic resonance imaging utilizing sampling perfection with application optimized contrasts using different flip angle evolutions (SPACE) in detecting deep venous thrombus (DVT) of the lower extremity and evaluating clot burden. This prospective study was approved by the institutional review board. Ninety-four consecutive patients (42 men, 52 women; age range, 14-87 years; average age, 52.7 years) suspected of lower extremity DVT underwent ultrasound (US) and SPACE. The venous visualization score for SPACE was determined by 2 radiologists independently according to a 4-point scale (1-4, poor to excellent). The sensitivity and specificity of SPACE in detecting DVT were calculated based on segment, limb, and patient, with US serving as the reference standard. The clot burden for each segment was scored (0-3, patent to entire segment occlusion). The clot burden score obtained with SPACE was compared with US using a Wilcoxon test based on region, limb, and patient. Interobserver agreement in assessing DVT (absent, nonocclusive, or occlusive) with SPACE was determined by calculating Cohen kappa coefficients. The mean venous visualization score for SPACE was 3.82 ± 0.50 for reader 1 and 3.81 ± 0.50 for reader 2. For reader 1, sensitivity/specificity values of SPACE in detecting DVT were 96.53%/99.90% (segment), 95.24%/99.04% (limb), and 95.89%/95.24% (patient). For reader 2, corresponding values were 97.20%/99.90%, 96.39%/99.05%, and 97.22%/95.45%. The clot burden assessed with SPACE was not significantly different from US (P > 0.05 for region, limb, patient). Interobserver agreement of SPACE in assessing thrombosis was excellent (kappa = 0.894 ± 0.014). Non-contrast-enhanced 3-dimensional SPACE magnetic resonance imaging is highly accurate in detecting lower extremity DVT and reliable in the evaluation of clot burden. SPACE could serve as an important alternative for patients in whom US cannot be performed.

Lidar In-space Technology Experiment (LITE) Electronics Overview

NASA Technical Reports Server (NTRS)

Blythe, Michael P.; Couch, Richard H.; Rowland, Carroll W.; Kitchen, Wayne L.; Regan, Curtis P.; Koch, Michael R.; Antill, Charles W.; Stevens, William T.; Rollins, Courtney H.; Kist, Edward H.

1992-01-01

The LITE electronics system consists of the following seven subsystems: Laser Transmitter Module (LTM), Boresight Assembly (BA), Aft-Optics Electronics (AOE), Digital Data Handling Unit (DDHU), Engineering Data System (EDS), Instrument Controller (IC), and the Ground Support Equipment (GSE). Each of these subsystems is discussed.

Grid enablement of OpenGeospatial Web Services: the G-OWS Working Group

NASA Astrophysics Data System (ADS)

Mazzetti, Paolo

2010-05-01

In last decades two main paradigms for resource sharing emerged and reached maturity: the Web and the Grid. They both demonstrate suitable for building Distributed Computing Infrastructures (DCIs) supporting the coordinated sharing of resources (i.e. data, information, services, etc) on the Internet. Grid and Web DCIs have much in common as a result of their underlying Internet technology (protocols, models and specifications). However, being based on different requirements and architectural approaches, they show some differences as well. The Web's "major goal was to be a shared information space through which people and machines could communicate" [Berners-Lee 1996]. The success of the Web, and its consequent pervasiveness, made it appealing for building specialized systems like the Spatial Data Infrastructures (SDIs). In this systems the introduction of Web-based geo-information technologies enables specialized services for geospatial data sharing and processing. The Grid was born to achieve "flexible, secure, coordinated resource sharing among dynamic collections of individuals, institutions, and resources" [Foster 2001]. It specifically focuses on large-scale resource sharing, innovative applications, and, in some cases, high-performance orientation. In the Earth and Space Sciences (ESS) the most part of handled information is geo-referred (geo-information) since spatial and temporal meta-information is of primary importance in many application domains: Earth Sciences, Disasters Management, Environmental Sciences, etc. On the other hand, in several application areas there is the need of running complex models which require the large processing and storage capabilities that the Grids are able to provide. Therefore the integration of geo-information and Grid technologies might be a valuable approach in order to enable advanced ESS applications. Currently both geo-information and Grid technologies have reached a high level of maturity, allowing to build such an integration on existing solutions. More specifically, the Open Geospatial Consortium (OGC) Web Services (OWS) specifications play a fundamental role in geospatial information sharing (e.g. in INSPIRE Implementing Rules, GEOSS architecture, GMES Services, etc.). On the Grid side, the gLite middleware, developed in the European EGEE (Enabling Grids for E-sciencE) Projects, is widely spread in Europe and beyond, proving its high scalability and it is one of the middleware chosen for the future European Grid Infrastructure (EGI) initiative. Therefore the convergence between OWS and gLite technologies would be desirable for a seamless access to the Grid capabilities through OWS-compliant systems. Anyway, to achieve this harmonization there are some obstacles to overcome. Firstly, a semantics mismatch must be addressed: gLite handle low-level (e.g. close to the machine) concepts like "file", "data", "instruments", "job", etc., while geo-information services handle higher-level (closer to the human) concepts like "coverage", "observation", "measurement", "model", etc. Secondly, an architectural mismatch must be addressed: OWS implements a Web Service-Oriented-Architecture which is stateless, synchronous and with no embedded security (which is demanded to other specs), while gLite implements the Grid paradigm in an architecture which is stateful, asynchronous (even not fully event-based) and with strong embedded security (based on the VO paradigm). In recent years many initiatives and projects have worked out possible approaches for implementing Grid-enabled OWSs. Just to mention some: (i) in 2007 the OGC has signed a Memorandum of Understanding with the Open Grid Forum, "a community of users, developers, and vendors leading the global standardization effort for grid computing."; (ii) the OGC identified "WPS Profiles - Conflation; and Grid processing" as one of the tasks in the Geo Processing Workflow theme of the OWS Phase 6 (OWS-6); (iii) several national, European and international projects investigated different aspects of this integration, developing demonstrators and Proof-of-Concepts; In this context, "gLite enablement of OpenGeospatial Web Services" (G-OWS) is an initiative started in 2008 by the European CYCLOPS, GENESI-DR, and DORII Projects Consortia in order to collect/coordinate experiences on the enablement of OWS on top of the gLite middleware [GOWS]. Currently G-OWS counts ten member organizations from Europe and beyond, and four European Projects involved. It broadened its scope to the development of Spatial Data and Information Infrastructures (SDI and SII) based on the Grid/Cloud capacity in order to enable Earth Science applications and tools. Its operational objectives are the following: i) to contribute to the OGC-OGF initiative; ii) to release a reference implementation as standard gLite APIs (under the gLite software license); iii) to release a reference model (including procedures and guidelines) for OWS Grid-ification, as far as gLite is concerned; iv) to foster and promote the formation of consortiums for participation to projects/initiatives aimed at building Grid-enabled SDIs To achieve this objectives G-OWS bases its activities on two main guiding principles: a) the adoption of a service-oriented architecture based on the information modelling approach, and b) standardization as a means of achieving interoperability (i.e. adoption of standards from ISO TC211, OGC OWS, OGF). In the first year of activity G-OWS has designed a general architectural framework stemming from the FP6 CYCLOPS studies and enriched by the outcomes of other projects and initiatives involved (i.e. FP7 GENESI-DR, FP7 DORII, AIST GeoGrid, etc.). Some proof-of-concepts have been developed to demonstrate the flexibility and scalability of such architectural framework. The G-OWS WG developed implementations of gLite-enabled Web Coverage Service (WCS) and Web Processing Service (WPS), and an implementation of a Shibboleth authentication for gLite-enabled OWS in order to evaluate the possible integration of Web and Grid security models. The presentation will aim to communicate the G-OWS organization, activities, future plans and means to involve the ESSI community. References [Berners-Lee 1996] T. Berners-Lee, "WWW: Past, present, and future". IEEE Computer, 29(10), Oct. 1996, pp. 69-77. [Foster 2001] I. Foster, C. Kesselman and S. Tuecke, "The Anatomy of the Grid. The International Journal ofHigh Performance Computing Applications", 15(3):200-222, Fall 2001 [GOWS] G-OWS WG, https://www.g-ows.org/, accessed: 15 January 2010

RGLite, an interface between ROOT and gLite—proof on the grid

NASA Astrophysics Data System (ADS)

Malzacher, P.; Manafov, A.; Schwarz, K.

2008-07-01

Using the gLitePROOF package it is possible to perform PROOF-based distributed data analysis on the gLite Grid. The LHC experiments managed to run globally distributed Monte Carlo productions on the Grid, now the development of tools for data analysis is in the foreground. To grant access interfaces must be provided. The ROOT/PROOF framework is used as a starting point. Using abstract ROOT classes (TGrid, ...) interfaces can be implemented, via which Grid access from ROOT can be accomplished. A concrete implementation exists for the ALICE Grid environment AliEn. Within the D-Grid project an interface to the common Grid middleware of all LHC experiments, gLite, has been created. Therefore it is possible to query Grid File Catalogues from ROOT for the location of the data to be analysed. Grid jobs can be submitted into a gLite based Grid. The status of the jobs can be asked for, and their results can be obtained.

Accelerating the use of molecular modeling in the high school classroom with VMD Lite.

PubMed

Lundquist, Karl; Herndon, Conner; Harty, Tyson H; Gumbart, James C

2016-01-01

It is often difficult for students to develop an intuition about molecular processes, which occur in a realm far different from day-to-day life. For example, thermal fluctuations take on hurricane-like proportions at the molecular scale. Students need a way to visualize realistic depictions of molecular processes to appreciate them. To this end, we have developed a simplified graphical interface to the widely used molecular visualization and analysis tool Visual Molecular Dynamics (VMD) called VMD lite. We demonstrate the use of VMD lite through a module on diffusion and the hydrophobic effect as they relate to membrane formation. Trajectories from molecular dynamics simulations, which students can interact with freely, illustrate the dynamical behavior of lipid molecules and water. VMD lite was tested by ∼70 students with overall positive reception. Remaining deficiencies in conceptual understanding were noted, however, and the module has been revised in response. © 2016 The International Union of Biochemistry and Molecular Biology.

ARCIMBOLDO_LITE: single-workstation implementation and use.

PubMed

Sammito, Massimo; Millán, Claudia; Frieske, Dawid; Rodríguez-Freire, Eloy; Borges, Rafael J; Usón, Isabel

2015-09-01

ARCIMBOLDO solves the phase problem at resolutions of around 2 Å or better through massive combination of small fragments and density modification. For complex structures, this imposes a need for a powerful grid where calculations can be distributed, but for structures with up to 200 amino acids in the asymmetric unit a single workstation may suffice. The use and performance of the single-workstation implementation, ARCIMBOLDO_LITE, on a pool of test structures with 40-120 amino acids and resolutions between 0.54 and 2.2 Å is described. Inbuilt polyalanine helices and iron cofactors are used as search fragments. ARCIMBOLDO_BORGES can also run on a single workstation to solve structures in this test set using precomputed libraries of local folds. The results of this study have been incorporated into an automated, resolution- and hardware-dependent parameterization. ARCIMBOLDO has been thoroughly rewritten and three binaries are now available: ARCIMBOLDO_LITE, ARCIMBOLDO_SHREDDER and ARCIMBOLDO_BORGES. The programs and libraries can be downloaded from http://chango.ibmb.csic.es/ARCIMBOLDO_LITE.

A systematic review of ultrasound-accelerated catheter-directed thrombolysis in the treatment of deep vein thrombosis.

PubMed

Shi, Yadong; Shi, Wanyin; Chen, Liang; Gu, Jianping

2018-04-01

To review the clinical evidence for ultrasound-accelerated catheter-directed thrombolysis (UACDT) using the EKOS system in the treatment of deep vein thrombosis (DVT) in terms of case selection, procedural outcomes, clinical outcomes and safety outcomes. A systematic literature search strategy was used to identify the use of the EKOS system in the treatment of DVT using the following electronic databases: MEDLINE, EMBASE, the Cochrane databases and the Web of Science. The references in the relevant literature were also screened. Our literature search identified a total of 16 unique clinical studies. Twelve of the sixteen studies were retrospective case series studies. To date, only one randomised controlled trial (RCT) is available. Overall, UACDT using the EKOS system was performed 548 times in 512 patients. Among all cases, 77-100% achieved substantial lysis (> 50%) based on the different definitions of the individual studies. This treatment modality appears to be safe, as there were no reported procedure-related pulmonary embolisms (PE) and only one procedure-related death was reported. Bleeding events were reported in 14 of the 16 studies, and 3.9% (20/512) of the cases of bleeding were considered major. During the follow-up, post-thrombotic syndrome was observed in 17.1% (20/117) of cases. UACDT using the EKOS system is an effective, safe and promising treatment modality for DVT, but the existing clinical evidence is inadequate to make UACDT using the EKOS system the first-line choice for DVT. Additional prospective large-sample RCTs with long-term follow-ups are warranted to define the role of UACDT using the EKOS system in the treatment of DVT.

Deep venous thrombosis: The valve cusp hypoxia thesis and its incompatibility with modern orthodoxy.

PubMed

Malone, P Colm; Agutter, Paul S

2016-01-01

The valve cusp hypoxia thesis (VCHT) of the aetiology of deep venous thrombosis (DVT) was adumbrated in this journal in 1977 and fully articulated in 2008, the original hypothesis having been strongly corroborated by experiments published in 1981 and 1984. It presents a unitary account of the pathogenesis of venous thrombosis and embolism that is rooted in the pathophysiological tradition of Hunter, Virchow, Lister, Welch and Aschoff, a tradition traceable back to Harvey. In this paper we summarise the thesis in its mature form, consider its compatibility with recent advances in the DVT field, and ask why it has not yet been assimilated into the mainstream literature, which during the past half century has been dominated by a haematology-orientated 'consensus model'. We identify and discuss seven ways in which the VCHT is incompatible with these mainstream beliefs about the aetiology of venous thrombosis, drawing attention to: (1) the spurious nature of 'Virchow's triad'; (2) the crucial differences between 'venous thrombus' and 'clot'; the facts that (3) venous thrombi form in the valve pockets (VVPs), (4) DVT is not a primarily haematological condition, (5) the so-called 'thrombophilias' are not thrombogenic per se; (6) the conflict between the single unitary aetiology of DVT and the tacit assumption that the condition is 'multicausal'; (7) the inability of anticoagulants to prevent the initiation of venous thrombogenesis, though they do prevent the growth of thrombi to clinically significant size. In discussing point (7), we show that the VCHT indicates new approaches to mechanical prophylaxis against DVT. These approaches are then formulated as experimentally testable hypotheses, and we suggest methods for testing them preclinically using animal trials. Copyright © 2015 Elsevier Ltd. All rights reserved.

A new D-dimer cutoff in bedridden hospitalized elderly patients.

PubMed

Granziera, Serena; Rechichi, Alfonsina; De Rui, Marina; De Carlo, Paola; Bertozzo, Giulia; Marigo, Lucia; Nante, Giovanni; Manzato, Enzo

2013-03-01

Asymptomatic deep vein thrombosis (DVT) and pulmonary embolism are leading causes of morbidity following the hospitalization of elderly people. The diagnosis of DVT is supported by the D-dimer laboratory assay. The concentration of D-dimer increases in patients with DVT, but may be high in other conditions too (i.e. cancer, infections and inflammation). Old age coincides with a physiological increase in D-dimer values, and that is why D-dimer assay in the elderly is characteristically highly sensitive but scarcely specific. The aim of our study was to explore the reliability of different D-dimer cutoffs for the diagnosis of asymptomatic DVT in a population of bedridden hospitalized elderly patients. We studied 199 patients who were a mean 86.3 ± 6.7 years old. All participants underwent lower limb Doppler ultrasound (DUS) and D-dimer venous blood sampling on admission. In our cohort, the usual cutoff proved highly sensitive (100%), but its specificity was very poor (20.1%). To find a higher cutoff that could improve the method's specificity, we analyzed our data using a receiver operating characteristic curve analysis. The resulting D-dimer cutoff of 492 μg/l enabled us to retain the same sensitivity while improving the test's specificity to 39.1%, with a consequent improvement in its positive predictive value and accuracy. In addition to improving the method's reliability, this result may be helpful in clinical practice, in both medical wards and nursing homes. By adopting a cutoff of 492 μg/l, clinicians could significantly increase the proportion of older patients in whom DVT can be safely ruled out, reducing referrals for DUS and administration of heparin, with consequent clinical, practical and economic advantages.

Outcomes after Deep Vein Thrombosis and Pulmonary Embolism in the Community: The Worcester Venous Thromboembolism Study

PubMed Central

Spencer, Frederick A.; Gore, Joel M.; Lessard, Darleen; Douketis, James D.; Emery, Cathy; Goldberg, Robert J.

2009-01-01

Background Despite advances in the management of deep vein thrombosis (DVT) and pulmonary embolism (PE), there are relatively few contemporary data describing and comparing outcomes in patients with these common conditions from a more generalizable community-based perspective. The purpose of this study was to measure and compare clinical characteristics and outcomes of patients with validated symptomatic PE and isolated DVT in a New England community. Methods The medical records of residents from the Worcester (MA) area with ICD-9 codes consistent with possible venous thromboembolism (VTE) during 1999, 2001, and 2003 were independently validated and reviewed by trained abstractors. Results Patients presenting with PE or isolated DVT experienced similar rates of subsequent PE, overall venous thromboembolism (VTE), and major bleeding during 3-year follow-up (5.9% vs. 5.1%, 15% vs. 17.9%, 15.6% vs. 12.4%, respectively). Mortality was significantly increased at 1-month follow-up in patients initially presenting with PE (13.0% vs. 5.4%) - this difference persisted at 3 years (35.3% vs. 29.6%). Patients whose course was complicated by major bleeding were more likely to suffer recurrent VTE or to die at 3 years than those without these complications. Conclusions Patients presenting with PE had similar rates of subsequent PE or recurrent VTE as patients with isolated DVT. However, rates of recurrent VTE and major bleeding following DVT and PE remain unacceptably high in the community setting. Efforts remain needed to identify patients most at risk for VTE-associated complications and development of better anticoagulation strategies conducive to long-term use in the community setting. PMID:18299499

Rutosides for prevention of post-thrombotic syndrome.

PubMed

Morling, Joanne R; Yeoh, Su Ern; Kolbach, Dinanda N

2013-04-30

Post-thrombotic syndrome (PTS) is a long-term complication of deep venous thrombosis (DVT) that is characterised by pain, swelling, and skin changes in the affected limb. One in three patients with DVT will develop post-thrombotic sequelae within five years. The current standard care for the prevention of PTS following DVT is elastic compression stockings. Rutosides are a group of compounds derived from horse chestnut (Aesculus hippocastanum), a traditional herbal remedy for treating oedema formation in chronic venous insufficiency (CVI). However, it is not known whether rutosides are effective and safe in the prevention of post-thrombotic syndrome. To determine the effectiveness and safety of rutosides for prevention of PTS in patients with DVT, compared to placebo, no intervention, or reference medication. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched October 2012) and CENTRAL (2012, Issue 9). Clinical trials databases were searched for details of ongoing and unpublished studies. We planned to include trials of rutosides versus any alternative (placebo, no intervention, or reference medication) in the prevention of PTS in patients with DVT. Two authors independently assessed studies for inclusion and intended to extract information from the trials. No studies were identified comparing rutosides versus any alternative in the prevention of PTS. As there were no studies identified in this review it is not possible to support the use of rutosides in the prevention of PTS. Some studies suggest that rutosides may provide short-term relief of PTS symptoms. However, there is nothing published on their use as a preventative therapy for PTS. High quality randomised controlled trials of rutoside versus any alternative are required to build the evidence base in this area.

Venous Thromboembolism After Removal of Retrievable Inferior Vena Cava Filters

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yamagami, Takuji, E-mail: yamagami@koto.kpu-m.ac.jp; Tanaka, Osamu; Yoshimatsu, Rika

The purpose of this study was to examine the incidence of new or recurrent venous thromboembolism (VTE) after retrieval of inferior vena cava (IVC) filters and risk factors associated with such recurrence. Between March 2001 and September 2008, at our institution, implanted retrievable vena cava filters were retrieved in 76 patients. The incidence of new or recurrent VTE after retrieval was reviewed and numerous variables were analyzed to assess risk factors for redevelopment of VTE after filter retrieval. In 5 (6.6%) of the 76 patients, redevelopment or worsening of VTE was seen after retrieval of the filter. Three patients (4.0%)more » had recurrent deep venous thrombosis (DVT) in the lower extremities and 2 (2.6%) had development of pulmonary embolism, resulting in death. Although there was no significant difference in the incidence of new or recurrent VTE related to any risk factor investigated, a tendency for development of VTE after filter retrieval was higher in patients in whom DVT in the lower extremities had been so severe during filter implantation that interventional radiological therapies in addition to traditional anticoagulation therapies were required (40% in patients with recurrent VTE vs. 23% in those without VTE; p = 0.5866 according to Fisher's exact probability test) and in patients in whom DVT remained at the time of filter retrieval (60% in patients with recurrent VTE vs. 37% in those without VTE; p = 0.3637). In conclusion, new or recurrent VTE was rare after retrieval of IVC filters but was most likely to occur in patients who had severe DVT during filter implantation and/or in patients with a DVT that remained at the time of filter retrieval. We must point out that the fatality rate from PE after filter removal was high (2.6%).« less

Comparison of empirical estimate of clinical pretest probability with the Wells score for diagnosis of deep vein thrombosis.

PubMed

Wang, Bo; Lin, Yin; Pan, Fu-shun; Yao, Chen; Zheng, Zi-Yu; Cai, Dan; Xu, Xiang-dong

2013-01-01

Wells score has been validated for estimation of pretest probability in patients with suspected deep vein thrombosis (DVT). In clinical practice, many clinicians prefer to use empirical estimation rather than Wells score. However, which method is better to increase the accuracy of clinical evaluation is not well understood. Our present study compared empirical estimation of pretest probability with the Wells score to investigate the efficiency of empirical estimation in the diagnostic process of DVT. Five hundred and fifty-five patients were enrolled in this study. One hundred and fifty patients were assigned to examine the interobserver agreement for Wells score between emergency and vascular clinicians. The other 405 patients were assigned to evaluate the pretest probability of DVT on the basis of the empirical estimation and Wells score, respectively, and plasma D-dimer levels were then determined in the low-risk patients. All patients underwent venous duplex scans and had a 45-day follow up. Weighted Cohen's κ value for interobserver agreement between emergency and vascular clinicians of the Wells score was 0.836. Compared with Wells score evaluation, empirical assessment increased the sensitivity, specificity, Youden's index, positive likelihood ratio, and positive and negative predictive values, but decreased negative likelihood ratio. In addition, the appropriate D-dimer cutoff value based on Wells score was 175 μg/l and 108 patients were excluded. Empirical assessment increased the appropriate D-dimer cutoff point to 225 μg/l and 162 patients were ruled out. Our findings indicated that empirical estimation not only improves D-dimer assay efficiency for exclusion of DVT but also increases clinical judgement accuracy in the diagnosis of DVT.

Airline Chair-rest Deconditioning: Induction of Immobilization Thromboemboli?

NASA Technical Reports Server (NTRS)

Greenleaf, J. E.; Rehrer, N. J.; Mohler, S. R.; Quach, D. T.; Evans, D. G.; Dalton, Bonnie P. (Technical Monitor)

2002-01-01

Air passenger miles will likely double by year 2020. The altered and restrictive environment in an airliner cabin can influence hematological homeostasis in passengers and crew. Flight-related deep various thromboemboli (DVT) have been associated with at least 577 deaths on 42 of 120 airlines from 1977 to 1984 (25 deaths/million departures), whereas many such cases go unreported. However, there are four major factors that could influence formation of possible flight-induced DVT: sleeping accomodations (via sitting immobilization), travelers' medical history (via tissue injury), cabin environmental factors (via lower partial pressure of oxygen and lower relative humidity), and the more encompassing chair-rest deconditioning (C-RD) syndrome. There is ample evidence that recent injury and surgery (especially in deconditioned hospitalized patients) facilitate thrombophlebitis and formation of DVT that may be exacerbated by the immobilization of prolonged air travel. In the healthy flying population immobilization factors associated with prolonged (> 5 hr) C-RID such as total body dehydration, hypovolemia and increased blood viscosity, and reduced various blood flow (pooling) in the legs may facilitate formation of DVT. However, data from at least four case-controlled epidemiological studies did not confirm a direct causative relationship between air travel and DART, but factors such as history of vascular thromboemboli, various insufficiency, chronic heart failure, obesity, immobile standing position, more than 3 pregnancies, infectious disease, long-distance travel, muscular trauma and violent physical effort were significantly more frequent in DVT patients than in controls. Thus, there is no clear, direct evidence yet that prolonged sitting in airliner seats, or prolonged experimental chair-rest- or bed- rest-deconditioning treatments cause deep various thromboemboli in healthy people.

Common iliac vein stenosis and risk of symptomatic pulmonary embolism: an inverse correlation.

PubMed

Chan, Keith T; Popat, Rita A; Sze, Daniel Y; Kuo, William T; Kothary, Nishita; Louie, John D; Hovsepian, David M; Hwang, Gloria L; Hofmann, Lawrence V

2011-02-01

To test the hypothesis that a common iliac vein (CIV) stenosis may impair embolization of a large deep venous thrombosis (DVT) to the lungs, decreasing the incidence of a symptomatic pulmonary embolism (PE). Between January 2002 and August 2007, 75 patients diagnosed with unilateral DVT were included in a single-institution case-control study. Minimum CIV diameters were measured 1 cm below the inferior vena cava (IVC) bifurcation on computed tomography (CT) images. A significant stenosis in the CIV ipsilateral to the DVT was defined as having either a diameter 4 mm or less or a greater than 70% reduction in lumen diameter. A symptomatic PE was defined as having symptoms and imaging findings consistent with a PE. The odds of symptomatic PE versus CIV stenosis were assessed using logistic regression models. The associations between thrombus location, stenosis, and symptomatic PE were assessed using a stratified analysis. Of 75 subjects, 49 (65%) presented with symptomatic PE. There were 17 (23%) subjects with a venous lumen 4 mm or less and 12 (16%) subjects with a greater than 70% stenosis. CIV stenosis of 4 mm or less resulted in a decreased odds of a symptomatic PE compared with a lumen greater than 4 mm (odds ratio [OR] 0.17, P = .011), whereas a greater than 70% stenosis increased the odds of DVT involving the CIV (OR 7.1, P = .047). Among patients with unilateral DVT, those with an ipsilateral CIV lumen of 4 mm or less have an 83% lower risk of developing symptomatic PE compared with patients with a CIV lumen greater than 4 mm. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

Statins improve the resolution of established murine venous thrombosis: reductions in thrombus burden and vein wall scarring.

PubMed

Kessinger, Chase W; Kim, Jin Won; Henke, Peter K; Thompson, Brian; McCarthy, Jason R; Hara, Tetsuya; Sillesen, Martin; Margey, Ronan J P; Libby, Peter; Weissleder, Ralph; Lin, Charles P; Jaffer, Farouc A

2015-01-01

Despite anticoagulation therapy, up to one-half of patients with deep vein thrombosis (DVT) will develop the post-thrombotic syndrome (PTS). Improving the long-term outcome of DVT patients at risk for PTS will therefore require new approaches. Here we investigate the effects of statins--lipid-lowering agents with anti-thrombotic and anti-inflammatory properties--in decreasing thrombus burden and decreasing vein wall injury, mediators of PTS, in established murine stasis and non-stasis chemical-induced venous thrombosis (N = 282 mice). Treatment of mice with daily atorvastatin or rosuvastatin significantly reduced stasis venous thrombus burden by 25% without affecting lipid levels, blood coagulation parameters, or blood cell counts. Statin-driven reductions in VT burden (thrombus mass for stasis thrombi, intravital microscopy thrombus area for non-stasis thrombi) compared similarly to the therapeutic anticoagulant effects of low molecular weight heparin. Blood from statin-treated mice showed significant reductions in platelet aggregation and clot stability. Statins additionally reduced thrombus plasminogen activator inhibitor-1 (PAI-1), tissue factor, neutrophils, myeloperoxidase, neutrophil extracellular traps (NETs), and macrophages, and these effects were most notable in the earlier timepoints after DVT formation. In addition, statins reduced DVT-induced vein wall scarring by 50% durably up to day 21 in stasis VT, as shown by polarized light microscopy of picrosirius red-stained vein wall collagen. The overall results demonstrate that statins improve VT resolution via profibrinolytic, anticoagulant, antiplatelet, and anti-vein wall scarring effects. Statins may therefore offer a new pharmacotherapeutic approach to improve DVT resolution and to reduce the post-thrombotic syndrome, particularly in subjects who are ineligible for anticoagulation therapy.

Combined MR direct thrombus imaging and non-contrast magnetic resonance venography reveal the evolution of deep vein thrombosis: a feasibility study.

PubMed

Mendichovszky, I A; Priest, A N; Bowden, D J; Hunter, S; Joubert, I; Hilborne, S; Graves, M J; Baglin, T; Lomas, D J

2017-06-01

Lower limb deep venous thrombosis (DVT) is a common condition with high morbidity and mortality. The aim of the study was to investigate the temporal evolution of the acute thrombus by magnetic resonance imaging (MRI) and its relationship to venous recanalization in patients with recurrent DVTs. Thirteen patients with newly diagnosed lower limb DVTs underwent MRI with non-contrast MR venography (NC-MRV) and MR direct thrombus imaging (MR-DTI), an inversion-recovery water-selective fast gradient-echo acquisition. Imaging was performed within 7 days of the acute thrombotic event, then at 3 and 6 months. By 3 months from the thrombotic event a third of the thrombi had resolved and by 6 months about half of the cases had resolved on the basis of vein recanalisation using NC-MRV. On the initial MR-DTI acute thrombus was clearly depicted by hyperintense signal, while the remaining thrombi were predominantly low signal at 3 and 6 months. Some residual thrombi contained small and fragmented persisting hyperintense areas at 3 months, clearing almost completely by 6 months. Our study suggests that synergistic venous assessment with combined NC-MRV and MR-DTI is able to distinguish acute venous thrombosis from the established (old) or evolving DVT detected by ultrasound. • MRI can distinguish between acute and evolving or chronic lower limb DVT • Two advanced MRI techniques can follow the evolution of lower limb DVT • MRI could be used to avoid an incorrect diagnosis of recurrent DVT • MRI could help avoid the risks and complications of lifelong anticoagulation therapy.

[Deep venous thrombosis of the upper limb in a violin player: The "bow syndrome"].

PubMed

Sanson, H; Gautier, V; Stansal, A; Sfeir, D; Franceschi, C; Priollet, P

2016-12-01

Exercise-induced thrombosis is a rare cause of deep venous thrombosis (DVT) of the upper limb and usually affects young subjects without comorbid conditions. The diagnosis may be challenging. A 23-year-old female right-handed French teacher and amateur violin player presented with edema of the root of the right arm associated with erythrocyanosis of the extremity and collateral circulation of the shoulder. History taking revealed oral contraception and recent change in violin playing habits. D-dimers were negative. A second duplex-Doppler was required before visualization of a DVT in the right subclavian vein. The patient was given low-molecular-weight heparin alone, followed by rivaroxaban. The outcome was very favorable at 48h. The patient was seen at 4 months and had not had a recurrent episode. The diagnosis of DVT of the upper limb is basically clinical. There is a clinical probability score for the introduction of anticoagulation even if the duplex-Doppler fails to visualize DVT, a situation that can occur due to the clavicular superposition in this region. Exercise-induced DVT should be suspected in patients with minimally intense but repeated exercise (hyper-abduction), e.g. as here playing the violin. Anticoagulation is the treatment of choice. The role for surgery and pharmacomechanical strategies remains to be defined. Exercise-induced thrombosis (Paget-Schroetter syndrome) should be suspected in young patients free of any comorbidity who develop a thrombosis of the upper limb. Studies comparing different therapeutic options would be useful to achieve more homogeneous management practices despite the heterogeneous clinical presentations. Copyright © 2016. Published by Elsevier Masson SAS.

Statins Improve the Resolution of Established Murine Venous Thrombosis: Reductions in Thrombus Burden and Vein Wall Scarring

PubMed Central

Kessinger, Chase W.; Kim, Jin Won; Henke, Peter K.; Thompson, Brian; McCarthy, Jason R.; Hara, Tetsuya; Sillesen, Martin; Margey, Ronan J. P.; Libby, Peter; Weissleder, Ralph; Lin, Charles P.; Jaffer, Farouc A.

2015-01-01

Despite anticoagulation therapy, up to one-half of patients with deep vein thrombosis (DVT) will develop the post-thrombotic syndrome (PTS). Improving the long-term outcome of DVT patients at risk for PTS will therefore require new approaches. Here we investigate the effects of statins—lipid-lowering agents with anti-thrombotic and anti-inflammatory properties—in decreasing thrombus burden and decreasing vein wall injury, mediators of PTS, in established murine stasis and non-stasis chemical-induced venous thrombosis (N = 282 mice). Treatment of mice with daily atorvastatin or rosuvastatin significantly reduced stasis venous thrombus burden by 25% without affecting lipid levels, blood coagulation parameters, or blood cell counts. Statin-driven reductions in VT burden (thrombus mass for stasis thrombi, intravital microscopy thrombus area for non-stasis thrombi) compared similarly to the therapeutic anticoagulant effects of low molecular weight heparin. Blood from statin-treated mice showed significant reductions in platelet aggregation and clot stability. Statins additionally reduced thrombus plasminogen activator inhibitor-1 (PAI-1), tissue factor, neutrophils, myeloperoxidase, neutrophil extracellular traps (NETs), and macrophages, and these effects were most notable in the earlier timepoints after DVT formation. In addition, statins reduced DVT-induced vein wall scarring by 50% durably up to day 21 in stasis VT, as shown by polarized light microscopy of picrosirius red-stained vein wall collagen. The overall results demonstrate that statins improve VT resolution via profibrinolytic, anticoagulant, antiplatelet, and anti-vein wall scarring effects. Statins may therefore offer a new pharmacotherapeutic approach to improve DVT resolution and to reduce the post-thrombotic syndrome, particularly in subjects who are ineligible for anticoagulation therapy. PMID:25680183

[Survey of nurses about compression therapy of acute deep venous thrombosis. Field study in Saxony-Anhalt].

PubMed

Thieme, Dorothea; Langer, Gero; Behrens, Johann

2010-03-01

In clinical practice, the compression therapy is an established method for the treatment of acute deep vein thrombosis (DVT). The aim of this study was to clarify the extent to which current guidelines and results of studies done in the field for the treatment of acute DVT--particularly compression therapy--are implemented in clinical practice. All hospitals in Saxony-Anhalt using primary diagnosis and therapy for DVT (n = 34) were informed about a survey in 2007 and the nursing staff of angiology and internistical wards in these hospitals was asked to take part. The collection of data was done with the help of a questionnaire that had been designed and tested for its validity in a specialised hospital. 510 questionnaires were distributed. The response rate of questionnaires was 69 percent. 79 percent of the nursing staff of internistical wards in Saxony-Anhalt and 94 percent of the nursing staff of angiology wards said that patients with acute DVT have initially received a compression bandage. Significant deficits were visible in transferring the knowledge of evidence-based medicine and nursing regarding techniques of compression bandage. The recommended Fischer-Bandage was only put on in exceptional cases in internistical wards (3 percent) and Angiology (2 percent). Compression stockings were not a suitable method into the treatment of acute deep vein thrombosis of Angiology. 21 percent of the nursing staff of internistical wards said that they have initially applied compression stockings. The treatment of acute DVT is important in clinical practice. The compression bandage should be effectively put on the leg. The quality of care and long-term compliance of the patients could be increased this way, leading to prevention of post thrombotic syndrome (PTS) and reduction the duration of patients stay in the clinics.

Home therapy for deep vein thrombosis and pulmonary embolism in cancer patients.

PubMed

Siragusa, S; Arcara, C; Malato, A; Anastasio, R; Valerio, M R; Fulfaro, F; Lo Coco, L; Grimaudo, S; Bajardi, G; Abbadessa, V; Gebbia, N

2005-05-01

Outpatient treatment of deep vein thrombosis (DVT) has become a common practice in uncomplicated patients. Few data are still present in patients with comorbidity (such as cancer) or concomitant symptomatic pulmonary embolism. Cancer patients with DVT are often excluded from home treatment because they have a higher risk of both bleeding and recurrent DVT. We tested the feasibility and safety of the Home Treatment (HT) program for acute DVT a PE in cancer patients. Patients were treated as outpatients unless they required admission for other medical problems, were actively bleeding or had pain that requires parenteral narcotics. Outpatient treatment was with low molecular weight heparin (LMWH) followed by warfarin or with LMWH alone. An educational program for patients was implemented. Two-hundred and seven patients with cancer were evaluated, 36 (17.4%) of whom had metastatic disease. Treatment with LMWH and warfarin was prescribed to 106 (51.2%) and LMWH alone to 102 (48.8%). One hundred and twenty-seven patients (61.3%) were entirely treated at home. There were no differences between patients treated at home and hospitalized patients with regard to gender, mean age, site of cancer, presence of metastases, and treatment. After 6 months, recurrent thrombo-embolism occurred in 8.7% of patients treated at home and in 5.6% of hospitalized patients (P=0.58); major bleeding in 2.0% and 1.5%, respectively (P=0.06). Twenty-seven patients (33%) in the hospitalized, and 33 (26%) in the home-treatment group, died after a follow-up of 6 months. These results indicate that, regarding cancer patients with acute DVT and/or PE, there is no difference between hospitalised and home-treated patients in terms of major outcomes.

Postoperative Venous Thromboembolism in Patients Undergoing Endovenous Laser and Radiofrequency Ablation of the Saphenous Vein

PubMed Central

Hirokawa, Masayuki; Yamamoto, Takashi

2016-01-01

Objective: Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) are safe and effective treatments for varicose veins caused by saphenous reflux. Deep venous thrombosis (DVT) and endovenous heat-induced thrombosis (EHIT) are known complications of these procedures. The purpose of this article is to investigate the incidence of postoperative DVT and EHIT in patients undergoing EVLA and RFA. Methods: The patients were assessed by clinical examination and venous duplex ultrasonography before operation and at 24–72 hours, 1 month, and 1 year follow-up after operation. Endovenous ablation (EVA) had been treated for 1026 limbs (835 patients) using an RFA; 1174 limbs (954 patients) using a 1470-nm wavelength diode laser with radial two-ring fiber (1470R); and 6118 limbs (5513 patients) using a 980-nm wavelength diode laser with bare-tip fiber (980B). Results: DVT was detected in 3 legs (0.3%) of RFA, 5 legs (0.4%) of 1470R, and 27 legs (0.4%) of 980B. One patient in three symptomatic DVT treated with 980B developed asymptomatic pulmonary embolus. In all, 31 of the 35 DVTs were confined to the calf veins. The incidence of EHIT classes 2 and 3 was 2.7% following RFA procedure, 6.7% after 1470R, and 7.5% after 980B. Conclusion: The incidence of EHIT following EVA was low, especially the RFA procedure. EHIT resolves within 2–4 weeks in most patients. DVT rates after EVA were compared with those published for saphenous vein stripping. (This is a translation of J Jpn Coll Angiol 2015; 55: 153–161.) PMID:28018495

Multimodal ultrasonographic assessment of leiomyosarcoma of the femoral vein in a patient misdiagnosed as having deep vein thrombosis: A case report.

PubMed

Zhang, Mei; Yan, Feng; Huang, Bin; Wu, Zhoupeng; Wen, Xiaorong

2017-11-01

Primary leiomyosarcoma (LMS) of the vein is a rare tumor that arises from the smooth muscle cells of the vessel wall and has an extremely poor prognosis. This tumor can occur in vessels such as the inferior vena cava, great saphenous vein, femoral vein, iliac vein, popliteal vein, and renal vein; the inferior vena cava is the most common site. LMS of the femoral vein can result in edema and pain in the lower extremity; therefore, it is not easy to be differentiated from deep vein thrombosis (DVT). Moreover, virtually no studies have described the ultrasonographic features of LMS of the vein in detail. We present a case of a 55-year-old woman with LMS of the left femoral vein that was misdiagnosed as having deep vein thrombosis (DVT) on initial ultrasonographic examination. The patient began to experience edema and pain in her left leg seven months previously. She was diagnosed as having DVT on initial ultrasonographic examination, but the DVT treatment that she had received for 7 months failed to improve the status of her left lower limb. She subsequently underwent re-examination by means of a multimodal ultrasonographic imaging approach (regular B-mode imaging, color Doppler imaging, pulsed-wave Doppler imaging, contrast-enhanced ultrasonography), which confirmed a diagnosis of LMS. This patient was treated successfully with surgery. This case demonstrates that use of multiple ultrasonographic imaging techniques can be helpful to diagnose LMS accurately. Detection of vasculature in a dilated vein filled with a heterogeneous hypoechoic substance on ultrasonography is a sign of a tumor. The pitfall of misdiagnosing this tumor as DVT is a useful reminder.

Multimodal ultrasonographic assessment of leiomyosarcoma of the femoral vein in a patient misdiagnosed as having deep vein thrombosis

PubMed Central

Zhang, Mei; Yan, Feng; Huang, Bin; Wu, Zhoupeng; Wen, Xiaorong

2017-01-01

Abstract Rationale: Primary leiomyosarcoma (LMS) of the vein is a rare tumor that arises from the smooth muscle cells of the vessel wall and has an extremely poor prognosis. This tumor can occur in vessels such as the inferior vena cava, great saphenous vein, femoral vein, iliac vein, popliteal vein, and renal vein; the inferior vena cava is the most common site. LMS of the femoral vein can result in edema and pain in the lower extremity; therefore, it is not easy to be differentiated from deep vein thrombosis (DVT). Moreover, virtually no studies have described the ultrasonographic features of LMS of the vein in detail. Patient concerns: We present a case of a 55-year-old woman with LMS of the left femoral vein that was misdiagnosed as having deep vein thrombosis (DVT) on initial ultrasonographic examination. The patient began to experience edema and pain in her left leg seven months previously. She was diagnosed as having DVT on initial ultrasonographic examination, but the DVT treatment that she had received for 7 months failed to improve the status of her left lower limb. Diagnoses: She subsequently underwent re-examination by means of a multimodal ultrasonographic imaging approach (regular B-mode imaging, color Doppler imaging, pulsed-wave Doppler imaging, contrast-enhanced ultrasonography), which confirmed a diagnosis of LMS. Interventions: This patient was treated successfully with surgery. Outcomes: This case demonstrates that use of multiple ultrasonographic imaging techniques can be helpful to diagnose LMS accurately. Detection of vasculature in a dilated vein filled with a heterogeneous hypoechoic substance on ultrasonography is a sign of a tumor. Lessons: The pitfall of misdiagnosing this tumor as DVT is a useful reminder. PMID:29145269

Screening and prevention of venous thromboembolism in critically ill patients: a decision analysis and economic evaluation.

PubMed

Sud, Sachin; Mittmann, Nicole; Cook, Deborah J; Geerts, William; Chan, Brian; Dodek, Peter; Gould, Michael K; Guyatt, Gordon; Arabi, Yaseen; Fowler, Robert A

2011-12-01

Venous thromboembolism is difficult to diagnose in critically ill patients and may increase morbidity and mortality. To evaluate the cost-effectiveness of strategies to reduce morbidity from venous thromboembolism in critically ill patients. A Markov decision analytic model to compare weekly compression ultrasound screening (screening) plus investigation for clinically suspected deep vein thrombosis (DVT) (case finding) versus case finding alone; and a hypothetical program to increase adherence to DVT prevention. Probabilities were derived from a systematic review of venous thromboembolism in medical-surgical intensive care unit patients. Costs (in 2010 $US) were obtained from hospitals in Canada, Australia, and the United States, and the medical literature. Analyses were conducted from a societal perspective over a lifetime horizon. Outcomes included costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios. In the base case, the rate of proximal DVT was 85 per 1,000 patients. Screening resulted in three fewer pulmonary emboli than case-finding alone but also two additional bleeding episodes, and cost $223,801 per QALY gained. In sensitivity analyses, screening cost less than $50,000 per QALY only if the probability of proximal DVT increased from a baseline of 8.5-16%. By comparison, increasing adherence to appropriate pharmacologic thromboprophylaxis by 10% resulted in 16 fewer DVTs, one fewer pulmonary emboli, and one additional heparin-induced thrombocytopenia and bleeding event, and cost $27,953 per QALY gained. Programs achieving increased adherence to best-practice venous thromboembolism prevention were cost-effective over a wide range of program costs and were robust in probabilistic sensitivity analyses. Appropriate prophylaxis provides better value in terms of costs and health gains than routine screening for DVT. Resources should be targeted at optimizing thromboprophylaxis.

Optical designing of LiteBIRD

NASA Astrophysics Data System (ADS)

Sugai, Hajime; Kashima, Shingo; Kimura, Kimihiro; Matsumura, Tomotake; Inoue, Masanori; Ito, Makoto; Nishibori, Toshiyuki; Sekimoto, Yutaro; Ishino, Hirokazu; Sakurai, Yuki; Imada, Hiroaki; Fujii, Takenori

2016-07-01

LiteBIRD aims to detect the footprint of the primordial gravitational wave on the Cosmic Microwave Background (CMB) in a form of polarization pattern called B mode. In order to separate CMB from the Galactic emission, our measurements cover 35 GHz to 450 GHz. The LiteBIRD optics consists of two telescopes: a crossed Dragone type for lower frequencies, which provides a compact configuration with a wide field of view, and a refractor type for higher frequencies. The whole optical system is cooled down to around 5 K to minimize the thermal emission. We use two kinds of approaches of designing calculations as well as the experimental confirmation particularly for the lower frequency telescope.

Systems Engineering and Application of System Performance Modeling in SIM Lite Mission

NASA Technical Reports Server (NTRS)

Moshir, Mehrdad; Murphy, David W.; Milman, Mark H.; Meier, David L.

2010-01-01

The SIM Lite Astrometric Observatory will be the first space-based Michelson interferometer operating in the visible wavelength, with the ability to perform ultra-high precision astrometric measurements on distant celestial objects. SIM Lite data will address in a fundamental way questions such as characterization of Earth-mass planets around nearby stars. To accomplish these goals it is necessary to rely on a model-based systems engineering approach - much more so than most other space missions. This paper will describe in further detail the components of this end-to-end performance model, called "SIM-sim", and show how it has helped the systems engineering process.

Simultaneous acute deep vein thrombosis and acute brucellosis. A case report.

PubMed

Salihi, Salih; Andaç, Şeyda; Kalender, Mehmet; Yıldırım, Onur; İmre, Ayfer

2016-06-01

Brucellosis is a zoonotic disease common in developing countries. Vascular complications, including arterial and venous, associated with Brucella infection have rarely been reported. A case of deep venous thrombosis (DVT) developing after a diagnosis of acute brucellosis in a young milkman is presented. A 26-year-old man presented with pain in the right leg. The patient's medical history included a diagnosis of brucellosis in our hospital where he had presented with complaints of weakness and fever. Peripheral venous Doppler ultrasound showed DVT, and the patient was treated with anticoagulants. The patient was discharged with warfarin therapy and anti-brucellosis treatment. Although rare, some infectious agents may cause vascular pathologies. Patients presenting with symptoms of DVT or similar vascular pathologies should be assessed for infectious agents, particularly in those coming from Brucella-endemic areas.

Mechanical design of a lidar system for space applications - LITE

NASA Technical Reports Server (NTRS)

Crockett, Sharon K.

1990-01-01

The Lidar In-Space Technology Experiment (LITE) is a Shuttle experiment that will demonstrate the first use of a lidar system in space. Its design process must take into account not only the system design but also the unique design requirements for spaceborne experiment.

Effect of Traumatic Brain Injury Among U.S. Servicemembers with Amputation

DTIC Science & Technology

2013-01-01

than servicemembers without TBI (Table 6). For individ- ual complications, servicemembers with TBI had three times the odds of developing cellulitis ...number of other injuries; and (4) more postinjury complications, especially cellulitis , infection due to a device, or DVT and/or PE. Frequency of... Cellulitis Infection/Inflammation Due to Device Nonhealing Wound Pneumonia DVT and/or PE Bacterial Infection Anemia Phantom Limb Syndrome Amputation Residual

Differences of wells scores accuracy, caprini scores and padua scores in deep vein thrombosis diagnosis

NASA Astrophysics Data System (ADS)

Gatot, D.; Mardia, A. I.

2018-03-01

Deep Vein Thrombosis (DVT) is the venous thrombus in lower limbs. Diagnosis is by using venography or ultrasound compression. However, these examinations are not available yet in some health facilities. Therefore many scoring systems are developed for the diagnosis of DVT. The scoring method is practical and safe to use in addition to efficacy, and effectiveness in terms of treatment and costs. The existing scoring systems are wells, caprini and padua score. There have been many studies comparing the accuracy of this score but not in Medan. Therefore, we are interested in comparative research of wells, capriniand padua score in Medan.An observational, analytical, case-control study was conducted to perform diagnostic tests on the wells, caprini and padua score to predict the risk of DVT. The study was at H. Adam Malik Hospital in Medan.From a total of 72 subjects, 39 people (54.2%) are men and the mean age are 53.14 years. Wells score, caprini score and padua score has a sensitivity of 80.6%; 61.1%, 50% respectively; specificity of 80.65; 66.7%; 75% respectively, and accuracy of 87.5%; 64.3%; 65.7% respectively.Wells score has better sensitivity, specificity and accuracy than caprini and padua score in diagnosing DVT.

An Unusual Endovascular Therapeutic Approach for a Rare Case of May-Thurner Syndrome.

PubMed

DaSilva-DeAbreu, Adrian; Masha, Luke; Peerbhai, Shareez

2017-03-06

BACKGROUND The etiology of deep venous thrombosis (DVT) may pose a significant diagnostic challenge because truly reversible causes of DVT are rare. In this regard, known pelvic anatomic abnormalities such as aortic and iliac aneurysms should be seriously considered as a complicating factor in patients presenting with acute DVT so as not to miss a potentially curable etiology of May-Thurner syndrome (MTS). CASE REPORT We report the case of a 69-year-old man with a known abdominal aortic aneurysm and bilateral iliac artery aneurysms who presented with an acute DVT. A computed tomography scan of the abdomen and pelvis showed increased dilation of his aneurysmal disease with new resultant compression of the left iliac vein representing acquired MTS. The patient underwent endovascular aneurysm repair of the infra-renal abdominal aortic aneurysm and right common iliac artery aneurysm with a Gore Excluder endoprosthesis in lieu of venous stenting, with resolution of symptoms. CONCLUSIONS Infra-renal aortic and iliac aneurysms causing MTS are extremely rare, and patients at risk for MTS through these mechanisms do not fit the classical demographics associated with this syndrome. Furthermore, this is the first case described in which MTS was treated by addressing the aneurysm through an endoprosthetic approach instead of venous stenting, which is the conventional intervention for MTS.

[Usefulness of clinical prediction rules for ruling out deep vein thrombosis in a hospital emergency department].

PubMed

Rosa-Jiménez, Francisco; Rosa-Jiménez, Ascensión; Lozano-Rodríguez, Aquiles; Santoro-Martínez, María Del Carmen; Duro-López, María Del Carmen; Carreras-Álvarez de Cienfuegos, Amelia

2015-01-01

To compare the efficacy of the most familiar clinical prediction rules in combination with D-dimer testing to rule out a diagnosis of deep vein thrombosis (DVT) in a hospital emergency department. Retrospective cross-sectional analysis of the case records of all patients attending a hospital emergency department with suspected lower-limb DVT between 1998 and 2002. Ten clinical prediction scores were calculated and D-dimer levels were available for all patients. The gold standard was ultrasound diagnosis of DVT by an independent radiologist who was blinded to clinical records. For each prediction rule, we analyzed the effectiveness of the prediction strategy defined by "low clinical probability and negative D-dimer level" against the ultrasound diagnosis. A total of 861 case records were reviewed and 577 cases were selected; the mean (SD) age was 66.7 (14.2) years. DVT was diagnosed in 145 patients (25.1%). Only the Wells clinical prediction rule and 4 other models had a false negative rate under 2%. The Wells criteria and the score published by Johanning and colleagues identified higher percentages of cases (15.6% and 11.6%, respectively). This study shows that several clinical prediction rules can be safely used in the emergency department, although none of them have proven more effective than the Wells criteria.

Idraparinux sodium: SANORG 34006, SR 34006.

PubMed

2004-01-01

Idraparinux sodium [SANORG 34006, SR 34006], a synthetic, anti Xa pentasaccharide and analogue of SR 32701 and fondaparinux sodium, was in development with Sanofi (now Sanofi-Synthélabo) and Organon (Akzo Nobel) in Europe and the USA (now Sanofi-Synthélabo alone). It may have potential in the treatment and secondary prevention of thrombosis, especially deep-vein thrombosis (DVT). Because of the long duration of action of idraparinux sodium, it may be suitable for once-weekly administration. In January 2004, Sanofi-Synthélabo announced it was to acquire, before the end of the first quarter 2004, all the rights of Organon relating to idraparinux sodium, subject to approval of the regulatory authorities. Sanofi-Synthélabo is to make payments to Organon based on future sales. Idraparinux sodium has completed phase IIb development with the PERSIST study and it is in phase III clinical trials. In June 2003, Organon announced the initiation of pivotal phase III studies as a once-weekly treatment of DVT and pulmonary embolism (PE), and for the prevention of stroke in patients with atrial fibrillation. The AMADEUS study will focus on patients with atrial fibrillation while the Van Gogh PE, Van Gogh DVT and the Van Gogh extension (EXT) will focus on patients with DVT or PE.

Sniffing Out Efficacy: Sniffy Lite, a Virtual Animal Lab

ERIC Educational Resources Information Center

Venneman, Sandy S.; Knowles, Laura, Ruth

2005-01-01

We investigated the benefits of using a virtual laboratory, Sniffy Lite CD-ROM (Alloway, Wilson, Graham, & Krames, 2000), as a supplemental teaching tool to present schedules of reinforcement in operant conditioning. Our results suggest that using the virtual laboratory significantly enhanced understanding. Students who used the virtual laboratory…

A Case for More Multiple Scattering Lidar from Space: Analysis of Four LITE Pulses Returned from a Marine Stratocumulus Deck

NASA Technical Reports Server (NTRS)

Davis, Anthony B.; Winker, David M.

2011-01-01

Outline: (1) Signal Physics for Multiple-Scattering Cloud Lidar, (2) SNR Estimation (3) Cloud Property Retrievals (3a) several techniques (3b) application to Lidar-In-space Technology Experiment (LITE) data (3c) relation to O2 A-band

Lite-therm Design Manual. Second Edition.

ERIC Educational Resources Information Center

Environmental Systems Corp., Atlanta, GA.

Occupant comfort in glass facade buildings is the problem for which a solution is suggested. Optimum comfort is obtained by intercepting radiant heat before it enters the room. Through a combination of luminaires, induction boxes, and louvers, a "Lite-Therm System" is presented which integrates lighting, heating, and cooling systems into the…

Advanced network planning for bus rapid transit : the "Quickway" model as a modal alternative to "Light Rail Lite"

DOT National Transportation Integrated Search

2008-02-01

Transit planning in the United States has tended toward viewing BRT as an analogue to light rail transit, with similar operating patterns. This model, referred to as Light Rail Lite, is compared to international best practices, which have often...

Lidar In-space Technology Experiment: Overview and early results

NASA Technical Reports Server (NTRS)

McCormick, M. Patrick

1995-01-01

The September 1994 Shuttle flight of the Lidar In-space Technology Experiment (LITE) brought to fruition 10 years of effort at NASA's Langley Research Center where it was built. Being the first flight of a spaceborne lidar to measure atmospheric constituents and parameters and surface properties, it culminates the efforts of many worldwide over the last 20 years to usher in this new remote sensing technique from space. This paper will describe the LITE instrument, the in-orbit performance, and initial results. In addition, the global correlative measurements program will be outlined which involved 60 groups in 20 countries who made various simultaneous ground-based or aircraft measurements as LITE flew overhead.

A vascular laboratory protocol for improving and managing after-hours suspected acute deep venous thrombosis.

PubMed

Martin, Angela H; Eckert, George; Lemmon, Gary W; Sawchuk, Alan; Dalsing, Michael C

2014-04-01

This study reviews the clinical and workforce impact of a suggested protocol designed for the management of suspected acute deep venous thrombosis (DVT) in patients seen after standard vascular laboratory business hours. The protocol included the use of Wells score, D-dimer and a single dose of therapeutic anticoagulant to defer venous duplex ultrasound (VDU) testing until routine business hours unless contraindicated. Information was collected on medical history, physical exam and the timing of any diagnostic studies and treatment provided. Over 15% of studies done after-hours were deemed unnecessary by our protocol and in every individual the results were negative for an acute DVT. There were no adverse events from a one-time dose of anticoagulant. Limiting emergency VDU coverage to evaluate for acute DVT based on a management protocol can eliminate unnecessary after-hours VDU testing without having a negative impact on patient care.

Deep Vein Thrombosis and True Crural Aneurysm: Misdiagnosis or Causal Relation?

PubMed

Floros, Nikolaos; Antoniou, Zoi; Papadakis, Marios

2016-04-01

True crural artery aneurysm is a rare clinical entity. Crural artery aneurysms are most frequently seen in men in their sixth decade without major cardiopulmonary diseases and are often associated with injury, superinfection, or vasculitis. We report the case of a 44-year-old man with a history of idiopathic deep vein thrombosis (DVT) as the first manifestation of a true crural artery aneurysm. To our knowledge, DVT is very rarely related with true crural artery aneurysms, with only 3 cases reported in the current literature. Open surgical repair is the most common management, with ligation as a second option in emergencies such as rupture. The related literature is discussed. We conclude that crural aneurysms should be considered in differential diagnosis of popliteal DVT in adults. True crural aneurysms need vigilance and a more systematical approach to provide physicians the means to the best medical care. Copyright © 2016 Elsevier Inc. All rights reserved.

The Futility of PLC Lite

ERIC Educational Resources Information Center

DuFour, Rick; Reeves, Douglas

2016-01-01

Although many schools around the world have claimed to embrace the Professional Learning Community process, it would be more accurate to describe the current state of affairs in many schools as PLC Lite. Educators rename their traditional faculty or department meetings as PLC meetings, engage in book studies that result in no action, or devote…

Job submission and management through web services: the experience with the CREAM service

NASA Astrophysics Data System (ADS)

Aiftimiei, C.; Andreetto, P.; Bertocco, S.; Fina, S. D.; Ronco, S. D.; Dorigo, A.; Gianelle, A.; Marzolla, M.; Mazzucato, M.; Sgaravatto, M.; Verlato, M.; Zangrando, L.; Corvo, M.; Miccio, V.; Sciaba, A.; Cesini, D.; Dongiovanni, D.; Grandi, C.

2008-07-01

Modern Grid middleware is built around components providing basic functionality, such as data storage, authentication, security, job management, resource monitoring and reservation. In this paper we describe the Computing Resource Execution and Management (CREAM) service. CREAM provides a Web service-based job execution and management capability for Grid systems; in particular, it is being used within the gLite middleware. CREAM exposes a Web service interface allowing conforming clients to submit and manage computational jobs to a Local Resource Management System. We developed a special component, called ICE (Interface to CREAM Environment) to integrate CREAM in gLite. ICE transfers job submissions and cancellations from the Workload Management System, allowing users to manage CREAM jobs from the gLite User Interface. This paper describes some recent studies aimed at assessing the performance and reliability of CREAM and ICE; those tests have been performed as part of the acceptance tests for integration of CREAM and ICE in gLite. We also discuss recent work towards enhancing CREAM with a BES and JSDL compliant interface.

An Ultra-faint Galaxy Candidate Discovered in Early Data from the Magellanic Satellites Survey

NASA Astrophysics Data System (ADS)

Drlica-Wagner, A.; Bechtol, K.; Allam, S.; Tucker, D. L.; Gruendl, R. A.; Johnson, M. D.; Walker, A. R.; James, D. J.; Nidever, D. L.; Olsen, K. A. G.; Wechsler, R. H.; Cioni, M. R. L.; Conn, B. C.; Kuehn, K.; Li, T. S.; Mao, Y.-Y.; Martin, N. F.; Neilsen, E.; Noel, N. E. D.; Pieres, A.; Simon, J. D.; Stringfellow, G. S.; van der Marel, R. P.; Yanny, B.

2016-12-01

We report a new ultra-faint stellar system found in Dark Energy Camera data from the first observing run of the Magellanic Satellites Survey (MagLiteS). MagLiteS J0644-5953 (Pictor II or Pic II) is a low surface brightness (μ ={28.5}-1+1 {mag} {arcsec}{}-2 within its half-light radius) resolved overdensity of old and metal-poor stars located at a heliocentric distance of {45}-4+5 {kpc}. The physical size ({r}1/2={46}-11+15 {pc} ) and low luminosity ({M}V=-{3.2}-0.5+0.4 {mag} ) of this satellite are consistent with the locus of spectroscopically confirmed ultra-faint galaxies. MagLiteS J0644-5953 (Pic II) is located {11.3}-0.9+3.1 {kpc} from the Large Magellanic Cloud (LMC), and comparisons with simulation results in the literature suggest that this satellite was likely accreted with the LMC. The close proximity of MagLiteS J0644-5953 (Pic II) to the LMC also makes it the most likely ultra-faint galaxy candidate to still be gravitationally bound to the LMC.

Ultra-long Duration Balloon Mission Concept Study: EXIST-LITE Hard X-ray Imaging Survey

NASA Technical Reports Server (NTRS)

2003-01-01

We carried out a mission concept Study for an ultra-long duration balloon (ULDB) mission to conduct a high-sensitivity hard x-ray (approx. 20-600 keV) imaging sky survey. The EXIST-LITE concept has been developed, and critical detector technologies for realistic fabrication of very large area Cd-Zn-Te imaging detector arrays are now much better understood. A ULDB mission such as EXIST-LITE is now even more attractive as a testbed for the full Energetic X-ray Imaging Survey Telescope (EXIST) mission, recommended by the Decadal Survey, and now included in the NASA Roadmap and Strategic Plan as one of the 'Einstein Probes'. In this (overdue!) Final Report we provide a brief update for the science opportunities possible with a ULDB mission such as EXIST-LITE and relate these to upcoming missions (INTErnational Gamma-Ray Astrophysics Laboratory (INTEGRAL) and Swift) as well as the ultimate very high sensitivity sky survey mission EXIST. We then review the progress made over this investigation in Detector/Telescope design concept, Gondola and Mission design concept, and Data Handling/Analysis.

Astrophysics with Microarcsecond Accuracy Astrometry

NASA Technical Reports Server (NTRS)

Unwin, Stephen C.

2008-01-01

Space-based astrometry promises to provide a powerful new tool for astrophysics. At a precision level of a few microarcsonds, a wide range of phenomena are opened up for study. In this paper we discuss the capabilities of the SIM Lite mission, the first space-based long-baseline optical interferometer, which will deliver parallaxes to 4 microarcsec. A companion paper in this volume will cover the development and operation of this instrument. At the level that SIM Lite will reach, better than 1 microarcsec in a single measurement, planets as small as one Earth can be detected around many dozen of the nearest stars. Not only can planet masses be definitely measured, but also the full orbital parameters determined, allowing study of system stability in multiple planet systems. This capability to survey our nearby stellar neighbors for terrestrial planets will be a unique contribution to our understanding of the local universe. SIM Lite will be able to tackle a wide range of interesting problems in stellar and Galactic astrophysics. By tracing the motions of stars in dwarf spheroidal galaxies orbiting our Milky Way, SIM Lite will probe the shape of the galactic potential history of the formation of the galaxy, and the nature of dark matter. Because it is flexibly scheduled, the instrument can dwell on faint targets, maintaining its full accuracy on objects as faint as V=19. This paper is a brief survey of the diverse problems in modern astrophysics that SIM Lite will be able to address.

Habitat-Lite: A GSC case study based on free text terms for environmental metadata

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kyrpides, Nikos; Hirschman, Lynette; Clark, Cheryl

2008-04-01

There is an urgent need to capture metadata on the rapidly growing number of genomic, metagenomic and related sequences, such as 16S ribosomal genes. This need is a major focus within the Genomic Standards Consortium (GSC), and Habitat is a key metadata descriptor in the proposed 'Minimum Information about a Genome Sequence' (MIGS) specification. The goal of the work described here is to provide a light-weight, easy-to-use (small) set of terms ('Habitat-Lite') that captures high-level information about habitat while preserving a mapping to the recently launched Environment Ontology (EnvO). Our motivation for building Habitat-Lite is to meet the needs ofmore » multiple users, such as annotators curating these data, database providers hosting the data, and biologists and bioinformaticians alike who need to search and employ such data in comparative analyses. Here, we report a case study based on semi-automated identification of terms from GenBank and GOLD. We estimate that the terms in the initial version of Habitat-Lite would provide useful labels for over 60% of the kinds of information found in the GenBank isolation-source field, and around 85% of the terms in the GOLD habitat field. We present a revised version of Habitat-Lite and invite the community's feedback on its further development in order to provide a minimum list of terms to capture high-level habitat information and to provide classification bins needed for future studies.« less

Inferior Vena Cava Filters to Prevent Pulmonary Embolism: Systematic Review and Meta-Analysis.

PubMed

Bikdeli, Behnood; Chatterjee, Saurav; Desai, Nihar R; Kirtane, Ajay J; Desai, Mayur M; Bracken, Michael B; Spencer, Frederick A; Monreal, Manuel; Goldhaber, Samuel Z; Krumholz, Harlan M

2017-09-26

Inferior vena cava (IVC) filters are widely used for prevention of pulmonary embolism (PE). However, uncertainty persists about their efficacy and safety. The authors conducted a systematic review and meta-analysis of the published reports on the efficacy and safety of IVC filters. The authors searched PubMed, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov through October 3, 2016, for randomized controlled trials (RCTs) or prospective controlled observational studies of IVC filters versus none in patients at risk of PE. Inverse variance fixed-effects models with odds ratio (OR) as the effect measure were used for primary analyses. Main outcomes included subsequent PE, PE-related mortality, all-cause mortality, and subsequent deep vein thrombosis (DVT). The authors' search retrieved 1,986 studies, of which 11 met criteria for inclusion (6 RCTs and 5 prospective observational studies). Quality of evidence for RCTs was low to moderate. Overall, patients receiving IVC filters had lower risk for subsequent PE (OR: 0.50; 95% confidence interval [CI]: 0.33 to 0.75); increased risk for DVT (OR: 1.70; 95% CI: 1.17 to 2.48); nonsignificantly lower PE-related mortality (OR: 0.51; 95% CI: 0.25 to 1.05); and no change in all-cause mortality (OR: 0.91; 95% CI: 0.70 to 1.19). Limiting the results to RCTs showed similar results. Findings were substantively similar across a wide range of sensitivity analyses. Very few prospective controlled studies, with limited quality of evidence, exist regarding the efficacy and safety of IVC filters. Overall, filters appear to reduce the risk of subsequent PE, increase the risk for DVT, and have no significant effect on overall mortality. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

What is in your cup of tea? DNA Verity Test to characterize black and green commercial teas

PubMed Central

Comparone, Maria; Di Maio, Antonietta; Del Guacchio, Emanuele; Menale, Bruno; Troisi, Jacopo; Aliberti, Francesco

2017-01-01

In this study, we used several molecular techniques to develop a fast and reliable protocol (DNA Verity Test, DVT) for the characterization and confirmation of the species or taxa present in herbal infusions. As a model plant for this protocol, Camellia sinensis, a traditional tea plant, was selected due to the following reasons: its historical popularity as a (healthy) beverage, its high selling value, the importation of barely recognizable raw product (i.e., crushed), and the scarcity of studies concerning adulterants or contamination. The DNA Verity Test includes both the sequencing of DNA barcoding markers and genotyping of labeled-PCR DNA barcoding fragments for each sample analyzed. This protocol (DVT) was successively applied to verify the authenticity of 32 commercial teas (simple or admixture), and the main results can be summarized as follows: (1) the DVT protocol is suitable to detect adulteration in tea matrices (contaminations or absence of certified ingredients), and the method can be exported for the study of other similar systems; (2) based on the BLAST analysis of the sequences of rbcL+matK±rps7-trnV(GAC) chloroplast markers, C. sinensis can be taxonomically characterized; (3) rps7-trnV(GAC) can be employed to discriminate C. sinensis from C. pubicosta; (4) ITS2 is not an ideal DNA barcode for tea samples, reflecting potential incomplete lineage sorting and hybridization/introgression phenomena in C. sinensis taxa; (5) the genotyping approach is an easy, inexpensive and rapid pre-screening method to detect anomalies in the tea templates using the trnH(GUG)-psbA barcoding marker; (6) two herbal companies provided no authentic products with a contaminant or without some of the listed ingredients; and (7) the leaf matrices present in some teabags could be constituted using an admixture of different C. sinensis haplotypes and/or allied species (C. pubicosta). PMID:28542606

Traditional Chinese and western medicine for the prevention of deep venous thrombosis after lower extremity orthopedic surgery: a meta-analysis of randomized controlled trials.

PubMed

Zhu, Shibai; Song, Yi; Chen, Xi; Qian, Wenwei

2018-04-10

Chinese herbal medicine has traditionally been considered to promote blood circulation to remove obstruction in the channels and clear pathogenic heat to drain dampness effects. We conducted this meta-analysis to evaluate its benefits for the prevention of deep venous thrombosis (DVT) after lower extremity orthopedic surgery. Relevant, published studies were identified using the following keywords: lower extremity orthopedic surgery, arthroplasty, joint replacement, fracture, traditional Chinese and western medicine, Chinese herbal medicine, deep venous thrombosis (DVT), and Venous thromboembolism (VTE). The following databases were used to identify the literature consisting of RCTs with a date of search of 31 May 2017: PubMed, Cochrane Library, Web of knowledge, the Chinese National Knowledge Infrastructure Database, the Chongqing VIP Database, the Chinese Biomedical Database, and the Wanfang Database (including three English and four Chinese databases). All relevant data were collected from studies meeting the inclusion criteria. The outcome variables were the incidence rate of DVT, activated partial thromboplastin time (APTT), prothrombin time (PT), and D-dimer; subcutaneous hematoma; and other reported outcomes. RevMan5.2. software was adopted for the meta-analysis. A total of 20 published studies (1862 cases) met the inclusion criteria. The experimental group, 910 patients (48.87%), received the Chinese herbal medicine or traditional Chinese and western medicine for prevention of DVT; the control group, 952 patients (51.13%), received the standard western treatment. The meta-analysis showed that traditional Chinese and western medicine therapy reduced the incidence rates of DVT significantly when compared with controls (risk ratio [RR] = 0.40; 95% CI, 0.30 to 0.54; P < 0.00001), and the D-dimer was lower in the experimental group (P = 0.01). Besides, the incidence rate of subcutaneous hematoma was lower in the experimental group (P < 0.0001). However, no significant difference was found in the PT (P = 0.98) and APTT (P = 0.75) in two groups. No serious adverse events were reported. Traditional Chinese and western medicine therapy may be a safe, effective prevention modality for DVT after lower extremity orthopedic surgery. Further rigorously designed, randomized trials are warranted.

Improvements in health-related quality of life with liraglutide 3.0 mg compared with placebo in weight management.

PubMed

Kolotkin, R L; Fujioka, K; Wolden, M L; Brett, J H; Bjorner, J B

2016-08-01

Obesity has a negative impact on health-related quality of life (HRQoL). The SCALE Obesity and Prediabetes study investigated the effect of liraglutide 3.0 mg, as adjunct to diet and exercise, on HRQoL in patients with obesity [body mass index (BMI) ≥ 30 kg m(-2) ] or overweight (BMI ≥ 27 kg m(-2) ) with comorbidity. Participants were advised on a 500 kcal d(-1) deficit diet and a 150-min week(-1) exercise programme and were randomised 2:1 to once-daily subcutaneous liraglutide 3.0 mg or placebo. HRQoL was assessed using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) and Short-Form 36 (SF-36) v2 health questionnaires. Individuals on liraglutide 3.0 mg (n = 2046) had significantly greater improvements in IWQOL-Lite total score (10.6 ± 13.3) vs. placebo (n = 1020) (7.7 ± 12.8) and SF-36 physical (PCS) and mental (MCS) component summary scores (PCS, 3.6 ± 6.8; MCS, 0.2 ± 8.1) vs. placebo (PCS, 2.2 ± 7.7; MCS, -0.9 ± 9.1). The estimated treatment differences were IWQOL-Lite total score 3.1 (95% CI: 2.2; 4.0), P < 0.0001; SF-36 PCS 1.7 (95% CI: 1.2; 2.2), P < 0.0001 and MCS 0.9 (95% CI: 0.3; 1.5), P = 0.003. All subscales of the IWQOL-Lite and SF-36 were significantly improved with liraglutide 3.0 mg vs. placebo. More patients on liraglutide 3.0 mg experienced meaningful improvement on the IWQOL-Lite total (P < 0.0001) and the SF-36 PCS (P < 0.0001) scores. © 2016 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of International Association for the Study of Obesity (IASO).

Physicomechanical evaluation of polypropylene, polyester, and polytetrafluoroethylene meshes for inguinal hernia repair.

PubMed

Deeken, Corey R; Abdo, Michael S; Frisella, Margaret M; Matthews, Brent D

2011-01-01

For meshes to be used effectively for hernia repair, it is imperative that engineers and surgeons standardize the terminology and techniques related to physicomechanical evaluation of these materials. The objectives of this study were to propose standard techniques, perform physicomechanical testing, and classify materials commonly used for inguinal hernia repair. Nine meshes were evaluated: 4 polypropylene, 1 polyester, 1 polytetrafluoroethylene, and 3 partially absorbable. Physical properties were determined through image analysis, laser micrometry, and density measurements. Biomechanical properties were determined through suture retention, tear resistance, uniaxial, and ball burst testing with specimens tested in 2 different orientations. A 1-way ANOVA with Tukey's post-test or a t-test were performed, with p < 0.05. Significant differences were observed due to both mesh type and orientation. Areas of interstices ranged from 0.33 ± 0.01 mm² for ProLite (Atrium Medical Corp) and C-QUR Lite (Atrium Medical Corp) Large to 4.10 ± 0.06 mm² for ULTRAPRO (Ethicon), and filament diameters ranged from 99.00 ±8.1 μm for ProLite Ultra (Atrium Medical Corp) and C-QUR Lite Small to 338.8 ± 3.7 μm for Parietex Flat Sheet TEC (Covidien). These structural characteristics influenced biomechanical properties such as tear resistance and tensile strength. ProLite Ultra, C-QUR Lite Small, ULTRAPRO and INFINIT (WL Gore & Associates) did not resist tearing as effectively as the others. All meshes exhibited supraphysiologic burst strengths except INFINIT and ULTRAPRO. Significant differences exist between the physicomechanical properties of polypropylene, polyester, polytetrafluoroethylene, and partially absorbable mesh prostheses commonly used for inguinal hernia repair. Orientation of the mesh was also shown to be critical for the success of meshes, particularly those demonstrating anisotropy. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

The diagnostic accuracy of magnetic resonance venography in the detection of deep venous thrombosis: a systematic review and meta-analysis.

PubMed

Abdalla, G; Fawzi Matuk, R; Venugopal, V; Verde, F; Magnuson, T H; Schweitzer, M A; Steele, K E

2015-08-01

To search the literature for further evidence for the use of magnetic resonance venography (MRV) in the detection of suspected DVT and to re-evaluate the accuracy of MRV in the detection of suspected deep vein thrombosis (DVT). PubMed, EMBASE, Scopus, Cochrane, and Web of Science were searched. Study quality and the risk of bias were evaluated using the QUADAS 2. A random effects meta-analysis including subgroup and sensitivity analyses were performed. The search resulted in 23 observational studies all from academic centres. Sixteen articles were included in the meta-analysis. The summary estimates for MRV as a diagnostic non-invasive tool revealed a sensitivity of 93% (95% confidence interval [CI]: 89% to 95%) and specificity of 96% (95% CI: 94% to 97%). The heterogeneity of the studies was high. Inconsistency (I2) for sensitivity and specificity was 80.7% and 77.9%, respectively. Further studies investigating the use of MRV in the detection of suspected DVT did not offer further evidence to support the replacement of ultrasound with MRV as the first-line investigation. However, MRV may offer an alternative tool in the detection/diagnosis of DVT for whom ultrasound is inadequate or not feasible (such as in the obese patient). Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

DKA, CVL and DVT. Increased risk of deep venous thrombosis in children with diabetic ketoacidosis and femoral central venous lines.

PubMed

Davis, J; Surendran, T; Thompson, S; Corkey, C

2007-01-01

Incidence of type 1 diabetes mellitus is continuing to rise in children. The presentation of diabetic ketoacidosis (DKA) in children with newly diagnosed diabetes is significantly higher in those less than 5 years old. Critically ill patients admitted to Paediatric Intensive Care Units (PICU), would have a central venous line (CVL) inserted as part of their ongoing management. There are associations linking with the development of deep venous thrombosis (DVT) in DKA/CVL patients. An 18-month-old boy presented with a short history of polydypsia, polyuria and weight loss. The initial blood sugar was 27.0 mmol/L and a venous blood gas showed severe metabolic acidosis. He was diagnosed and treated for DKA. He was transferred to the regional PICU for further management. There, a central venous line (CVL) was inserted in his left femoral vein. This was removed on Day 4. Subsequently, he developed a swelling on his left leg, with significant discrepancy in leg circumference. Doppler ultrasound confirmed a deep venous thrombosis. Conclusion Diabetes has a propensity for hypercoagulability and DKA promotes a prothrombotic state. Retrospective studies have shown younger patients with DKA and a femoral CVL are at higher risk of developing DVT. A central femoral line should avoided in such patients. DVT prophylaxis and Doppler follow up should also be considered.

Thromboembolic Risk of Endovascular Intervention for Lower Extremity Deep Venous Thrombosis.

PubMed

Lindsey, Philip; Echeverria, Angela; Poi, Mun J; Matos, Jesus; Bechara, Carlos F; Cheung, Mathew; Lin, Peter H

2018-05-01

This study evaluated the risk of thromboembolism during endovascular interventions in patients with symptomatic lower extremity deep vein thrombosis (DVT) METHODS: Clinical records of all patients who underwent endovascular interventions for symptomatic lower extremity DVT from 2001 to 2017 were retrospectively analyzed using a prospectively maintained database. Only patients who received an inferior vena cava (IVC) filter were included in the analysis. Trapped intrafilter thrombus was assessed for procedure-related thromboembolism. Clinical outcomes of thrombus management and thromboembolism risk were analyzed. A total 172 patients (mean age 57.4 years, 98 females) who underwent 174 endovascular DVT interventions were included in the analysis. Treatment strategies included thrombolytic therapy (64%), mechanical thrombectomy (n = 86%), pharmacomechanical thrombolysis (51%), balloon angioplasty (98%), and stent placement (28%). Thrombectomy device used included AngioJet (56%), Trellis (19%), and Aspire (11%). Trapped IVC filter thrombus was identified in 58 patients (38%) based on the IVC venogram. No patient developed clinically evident pulmonary embolism (PE). IVC filter retrieval was performed in 98 patients (56%, mean 11.8 months after implantation). Multivariate analysis showed that iliac vein occlusion (P = 0.04) was predictive for procedure-related thromboembolism. Iliac vein thrombotic occlusion is associated with an increased thromboembolic risk in DVT intervention. Retrievable IVC filter should be considered when performing percutaneous thrombectomy in patients with iliac venous occlusion to prevent PE. Copyright © 2017 Elsevier Inc. All rights reserved.

Epidemiology, Risk Factors, and In-Hospital Mortality of Venous Thromboembolism in Liver Cirrhosis: A Single-Center Retrospective Observational Study

PubMed Central

Zhang, Xintong; Qi, Xingshun; De Stefano, Valerio; Hou, Feifei; Ning, Zheng; Zhao, Jiancheng; Peng, Ying; Li, Jing; Deng, Han; Li, Hongyu; Guo, Xiaozhong

2016-01-01

Background Risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), may be increased in liver cirrhosis. We conducted a single-center study to explore the epidemiology, risk factors, and in-hospital mortality of VTE in Chinese patients with liver cirrhosis. Material/Methods All patients with liver cirrhosis who were consecutively admitted to our hospital between January 2011 and December 2013 were retrospectively included. Results Of 2006 patients with liver cirrhosis included, 9 patients were diagnosed with or developed VTE during hospitalization, including 5 patients with a previous history of DVT, 1 patient with either a previous history of DVT or new onset of PE, and 3 patients with new onset of VTE (PE, n=1; DVT, n=2). Risk factors for VTE included a significantly higher proportion of hypertension and significantly higher red blood cells, hemoglobin, alanine aminotransferase, aspartate aminotransferase, prothrombin time (PT), international normalized ratio (INR), D-dimer, and Child-Pugh scores. The in-hospital mortality was significantly higher in patients with VTE than those without VTE (33.3% [3/9] versus 3.4% [67/1997], P<0.001). Conclusions VTE was observed in 0.4% of patients with liver cirrhosis during hospitalization and it significantly increased the in-hospital mortality. Elevated PT/INR aggravated the risk of VTE. PMID:27009380

Quantity of residual thrombus after successful catheter-directed thrombolysis for iliofemoral deep venous thrombosis correlates with recurrence.

PubMed

Aziz, F; Comerota, A J

2012-08-01

Iliofemoral deep venous thrombosis (IFDVT) is an independent risk factor for recurrent DVT. It has been observed that recurrent DVT correlates with residual thrombus. This study evaluates whether risk of recurrence is related to the amount of residual thrombus following catheter-directed thrombolysis (CDT) for IFDVT. Patients who underwent CDT for IFDVT had their degree of lysis quantified by a reader blind to the patients' long-term clinical outcome. Patients were classified into two groups, ≥50% and <50% residual thrombus. Recurrence was defined as a symptomatic presentation with image verification of new or additional thrombus. A total of 75 patients underwent CDT for IFDVT. Median follow-up was 35.9 months. Sixty-eight patients (91%) had no evidence of recurrence and seven (9%) developed recurrence. Of the patients who had ≥50% (mean 80%) residual thrombus, 50% (4/8) experienced recurrence, but in those with <50% (mean 35%) residual thrombus, only 5% (3/67) had recurrent DVT (P = 0.0014). The burden of residual thrombus at completion of CDT correlates with the risk of DVT recurrence. Patients having CDT for IFDVT had a lower risk of recurrence than expected. Successful clearing of acute clot in IFDVT patients significantly reduces the recurrence risk compared to patients with a large residual thrombus burden. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Deep vein thrombus formation induced by flow reduction in mice is determined by venous side branches.

PubMed

Brandt, Moritz; Schönfelder, Tanja; Schwenk, Melanie; Becker, Christian; Jäckel, Sven; Reinhardt, Christoph; Stark, Konstantin; Massberg, Steffen; Münzel, Thomas; von Brühl, Marie-Luise; Wenzel, Philip

2014-01-01

Interaction between vascular wall abnormalities, inflammatory leukocytes, platelets, coagulation factors and hemorheology in the pathogenesis of deep vein thrombosis (DVT) is incompletely understood, requiring well defined animal models of human disease. We subjected male C57BL/6 mice to ligation of the inferior vena cava (IVC) as a flow reduction model to induce DVT. Thrombus size and weight were analyzed macroscopically and sonographically by B-mode, pulse wave (pw) Doppler and power Doppler imaging (PDI) using high frequency ultrasound. Thrombus size varied substantially between individual procedures and mice, irrespective of the flow reduction achieved by the ligature. Interestingly, PDI accurately predicted thrombus size in a very robust fashion (r2 = 0.9734, p < 0.0001). Distance of the insertion of side branches from the ligature significantly determines thrombus weight (r2 = 0.5597, p < 0.0001) and length (r2 = 0.5441, p < 0.0001) in the IVC, regardless of the flow measured by pw-Doppler with distances <1.5 mm drastically impairing thrombus formation. Occlusion of side branches prior to ligation of IVC did not increase thrombus size, probably due to patent side branches inaccessible to surgery. Venous side branches influence thrombus size in experimental DVT and might therefore prevent thrombus formation. This renders vessel anatomy and hemorheology important determinants in mouse models of DVT, which should be controlled for.

Use of the LITEE Lorn Manufacturing Case Study in a Senior Chemical Engineering Unit Operations Laboratory

ERIC Educational Resources Information Center

Abraham, Nithin Susan; Abulencia, James Patrick

2011-01-01

This study focuses on the effectiveness of incorporating the Laboratory for Innovative Technology and Engineering Education (LITEE) Lorn Manufacturing case into a senior level chemical engineering unit operations course at Manhattan College. The purpose of using the case study is to demonstrate the relevance of ethics to chemical engineering…

NREL's EVI-Pro Lite Tool Paves the Way for Future Electric Vehicle

Science.gov Websites

Electric Vehicle Infrastructure Planning NREL's EVI-Pro Lite Tool Paves the Way for Future Electric Vehicle electric vehicle charging station To assist state and local governments anticipating this type of growth in simplified version of the Electric Vehicle Infrastructure Projection Tool (EVI-Pro) model. Combining a sleek

Project LITE: Light Inquiry Through Experiments

NASA Astrophysics Data System (ADS)

Brecher, Kenneth

2007-06-01

"Project LITE: Light Inquiry Through Experiments" is a science education project aimed at developing interactive hands-on and eyes-on curriculum, software and materials about light and optics. These are being developed for use in undergraduate astronomy courses, but they can also be used to advantage in physics, chemistry, Earth science and psychology courses throughout the K-12 and undergraduate curriculum.

Mecânica celeste.

NASA Astrophysics Data System (ADS)

de Luca, N.; Ferraz-Mello, S.

Contents: Os princípios da mec@OSC@@CCF@anica celeste. O problema de 2-corpos. O sistema de equações canônicas. A teoria das perturbações. O movimento de um satélite artifical. A teoria lunar e o movimento de outros satélites naturais. A teoria planetária. Procedimentos numéricos.

NPS Cubesat Launcher-Lite Sequencer

DTIC Science & Technology

2009-06-01

AND SUBTITLE NPS Cubesat Launcher-Lite Sequencer 6. AUTHOR(S) Harris, Anthony D. 5. FUNDING NUMBERS RSPXL 7. PERFORMING ORGANIZATION NAME(S) AND...ADDRESS(ES) Naval Postgraduate School Monterey, CA 93943-5000 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING /MONITORING AGENCY...international nanosatellite manufacturers. On April 28, 2009, Indian Space Research Organization launched 8 nanosatellites on the Polar Satellite Launch

Web service module for access to g-Lite

NASA Astrophysics Data System (ADS)

Goranova, R.; Goranov, G.

2012-10-01

G-Lite is a lightweight grid middleware for grid computing installed on all clusters of the European Grid Infrastructure (EGI). The middleware is partially service-oriented and does not provide well-defined Web services for job management. The existing Web services in the environment cannot be directly used by grid users for building service compositions in the EGI. In this article we present a module of well-defined Web services for job management in the EGI. We describe the architecture of the module and the design of the developed Web services. The presented Web services are composable and can participate in service compositions (workflows). An example of usage of the module with tools for service compositions in g-Lite is shown.

Lidar In-Space Technology Experiment (LITE) - NASA's first in-space lidar system for atmospheric research

NASA Technical Reports Server (NTRS)

Couch, Richard H.; Rowland, Carroll W.; Ellis, K. Scott; Blythe, Michael P.; Regan, Curtis P.; Koch, Michael R.; Antill, Charles W.; Kitchen, Wayne L.; Cox, John W.; Delorme, Joseph F.

1991-01-01

Engineering aspects are presented of the design, fabrication, integration, and operation of the Lidar In-Space Technology Experiment (LITE) for flight aboard the Space Shuttle in mid-1993. The LITE system is being developed by NASA/Langley Research Center and will be used to detect stratospheric and tropospheric aerosols, probe the planetary boundary layer, measure cloud top heights, and measure atmospheric temperature and density in the 10- to 40-km range. The system consists of a nominal telescope receiver 1 meter in diameter, a three-color Nd:YAG laser transmitter, and the system electronics. The system makes extensive use of Space Shuttle resources for electrical power, thermal control, and command and data handling.

Rationale and design of three observational, prospective cohort studies including biobanking to evaluate and improve diagnostics, management strategies and risk stratification in venous thromboembolism: the VTEval Project

PubMed Central

Frank, Bernd; Ariza, Liana; Lamparter, Heidrun; Grossmann, Vera; Prochaska, Jürgen H; Ullmann, Alexander; Kindler, Florentina; Weisser, Gerhard; Walter, Ulrich; Lackner, Karl J; Espinola-Klein, Christine; Münzel, Thomas; Konstantinides, Stavros V; Wild, Philipp S

2015-01-01

Introduction Venous thromboembolism (VTE) with its two manifestations deep vein thrombosis (DVT) and pulmonary embolism (PE) is a major public health problem. The VTEval Project aims to investigate numerous research questions on diagnosis, clinical management, treatment and prognosis of VTE, which have remained uncertain to date. Methods and analysis The VTEval Project consists of three observational, prospective cohort studies on VTE comprising cohorts of individuals with a clinical suspicion of acute PE (with or without DVT), with a clinical suspicion of acute DVT (without symptomatic PE) and with an incidental diagnosis of VTE (PE or DVT). The VTEval Project expects to enrol a total of approximately 2000 individuals with subsequent active and passive follow-up investigations over a time period of 5 years per participant. Time points for active follow-up investigations are at months 3, 6, 12, 24 and 36 after diagnosis (depending on the disease cohort); passive follow-up investigations via registry offices and the cancer registry are performed 48 and 60 months after diagnosis for all participants. Primary short-term outcome is defined by overall mortality (PE-related death and all other causes of death), primary long-term outcome by symptomatic VTE (PE-related death, recurrence of non-fatal PE or DVT). The VTEval Project includes three ‘all-comer’ studies and involves the standardised acquisition of high-quality data, covering the systematic assessment of VTE including symptoms, risk profile, psychosocial, environmental and lifestyle factors as well as clinical and subclinical disease, and it builds up a large state-of-the-art biorepository containing various materials from serial blood samplings. Ethics and dissemination The VTEval Project has been approved by the local data safety commissioner and the responsible ethics committee (reference no. 837.320.12 (8421-F)). Trial results will be published in peer-reviewed journals and presented at national and international scientific meetings. Trial registration number NCT02156401. PMID:26133379

Causes of distal volcano-tectonic seismicity inferred from hydrothermal modeling

NASA Astrophysics Data System (ADS)

Coulon, C. A.; Hsieh, P. A.; White, R.; Lowenstern, J. B.; Ingebritsen, S. E.

2017-10-01

Distal volcano-tectonic (dVT) seismicity typically precedes eruption at long-dormant volcanoes by days to years. Precursory dVT seismicity may reflect magma-induced fluid-pressure pulses that intersect critically stressed faults. We explored this hypothesis using an open-source magmatic-hydrothermal code that simulates multiphase fluid and heat transport over the temperature range 0 to 1200 °C. We calculated fluid-pressure changes caused by a small (0.04 km3) intrusion and explored the effects of flow geometry (channelized vs. radial flow), magma devolatilization rates (0-15 kg/s), and intrusion depths (5 and 7.5 km, above and below the brittle-ductile transition). Magma and host-rock permeabilities were key controlling parameters and we tested a wide range of permeability (k) and permeability anisotropies (kh/kv), including k constant, k(z), k(T), and k(z, T, P) distributions, examining a total of 1600 realizations to explore the relevant parameter space. Propagation of potentially causal pressure changes (ΔP ≥ 0.1 bars) to the mean dVT location (6 km lateral distance, 6 km depth) was favored by channelized fluid flow, high devolatilization rates, and permeabilities similar to those found in geothermal reservoirs (k 10- 16 to 10- 13 m2). For channelized flow, magma-induced thermal pressurization alone can generate cases of Δ P ≥ 0.1 bars for all permeabilities in the range 10- 16 to 10- 13 m2, whereas in radial flow regimes thermal pressurization causes Δ P < 0.1 bars for all permeabilities. Changes in distal fluid pressure occurred before proximal pressure changes given modest anisotropies (kh/kv 10-100). Invoking k(z,T,P) and high, sustained devolatilization rates caused large dynamic fluctuations in k and P in the near-magma environment but had little effect on pressure changes at the distal dVT location. Intrusion below the brittle-ductile transition damps but does not prevent pressure transmission to the dVT site.

Costs of hospital visits among patients with deep vein thrombosis treated with rivaroxaban and LMWH/warfarin.

PubMed

Merli, Geno J; Hollander, Judd E; Lefebvre, Patrick; Laliberté, François; Raut, Monika K; Germain, Guillaume; Bookhart, Brahim; Pollack, Charles V

2016-01-01

For many years, the standard of care for patients diagnosed with deep vein thrombosis (DVT) has been low-molecular-weight heparin (LMWH) bridging to an oral Vitamin-K antagonist (VKA). The availability of new non-VKA oral anticoagulants (NOAC) agents as monotherapy may reduce the likelihood of hospitalization for DVT patients. To compare hospital visit costs of DVT patients treated with rivaroxaban and LMWH/warfarin. A retrospective claim analysis was conducted using the MarketScan Hospital Drug Database for care provided between January 2011 and December 2013. Adult patients using rivaroxaban or LMWH/warfarin with a primary diagnosis of DVT during the first day of a hospital visit were identified (i.e., index hospital visit). Based on propensity-score methods, historical LMWH/warfarin patients (i.e., patients who received LMWH/warfarin before the approval of rivaroxaban) were matched 4:1 to rivaroxaban patients. The hospital-visit cost difference between these groups was evaluated for the index hospital visit, as well as for total hospital-visit costs (i.e., including index and subsequent hospital visit costs). All rivaroxaban users (n = 134) in the database were well-matched with four LMWH/warfarin users (n = 536). The mean hospital-visit costs were $5257 for the rivaroxaban cohort and $6764 in the matched-cohort of patients using LMWH/warfarin. The $1508 cost difference was statistically significant between cohorts (95% CI = [-$2296; -$580]; p-value = 0.002). Total hospital-visit costs were lower for rivaroxaban compared to LMWH/warfarin users within 1, 2, 3, and 6 months after index visit (significantly lower within 1 and 3 months, p-values <0.05) LIMITATIONS: Limitations were inherent to administrative-claims data, completeness of baseline characteristics, adjustments restricted to observational factors, and lastly the sample size of the rivaroxaban cohort. The availability of rivaroxaban significantly reduced the costs of hospital visits in patients with DVT treated with rivaroxaban compared to LMWH/warfarin.

Thrombus Burden of Deep Vein Thrombosis and Its Association with Thromboprophylaxis and D-Dimer Measurement: Insights from the APEX Trial.

PubMed

Chi, Gerald; Goldhaber, Samuel Z; Hull, Russell D; Hernandez, Adrian F; Kerneis, Mathieu; Al Khalfan, Fahad; Cohen, Alexander T; Harrington, Robert A; Gibson, C Michael

2017-12-01

Background The aim of this study was to evaluate the effect of betrixaban on the occurrence of deep vein thrombosis (DVT) and also the extent of thrombus and to assess the association of baseline D-dimer with subsequent thrombus burden. Methods In the APEX trial (ClinicalTrials.gov: NCT01583218), 7,513 acutely ill hospitalized medical patients were randomly assigned to extended-duration betrixaban (35–42 days) or enoxaparin (10 ± 4 days). D-dimer concentration was measured at baseline, and mandatory lower-extremity compression ultrasonography (CUS) was performed at 35 to 42 days. The thrombus burden of DVT was assessed by the number of non-compressible vascular segments in six target proximal veins and compared between treatment groups and D-dimer categories (≥2 × upper limit of normal [ULN] versus <2 × ULN). Results Compared with enoxaparin, extended-duration betrixaban reduced the DVT risk at 35 to 42 days (any-dose: relative risk [RR] = 0.76 [95% confidence interval: 0.61–0.94]; p = 0.013; full-dose: RR = 0.70 [0.55–0.90]; p = 0.005). Patients who received betrixaban were more likely to have a lower thrombus burden (p = 0.012 for any-dose and p = 0.001 for full-dose). Elevated D-dimer at baseline was independently associated with a 2.12-fold increased risk of developing DVT (p < 0.001). A greater thrombus burden was also observed in those with D-dimer ≥ 2 × ULN compared with <2 × ULN (p < 0.0001). Conclusion Extended-duration betrixaban reduced the number of venous segments with thrombosis at 35 to 42 days compared with enoxaparin. A positive D-dimer was associated with a greater extent of thrombus burden among acutely ill medical patients who developed DVT despite receiving thromboprophylaxis.

Incidence and Outcomes of Inferior Vena Cava Filter Thrombus during Catheter-directed Thrombolysis for Proximal Deep Venous Thrombosis.

PubMed

Jiang, Jianguang; Tu, Jianfei; Jia, Zhongzhi; Chen, Jiezhong; Cao, Haitao; Meng, Qingli; Fuller, Tyler A; Tian, Feng

2017-01-01

The aim of the study was to retrospectively evaluate the incidence and outcomes of inferior vena cava (IVC) filter thrombus during catheter-directed thrombolysis (CDT) for acute proximal deep venous thrombosis (DVT). From October 2006 to June 2015, patients diagnosed with acute proximal DVT and received CDT after a retrievable IVC filter was placed were included. The incidence, treatment, and outcomes of IVC filter thrombus during CDT were recorded and analyzed. A total of 189 patients (91 women, 98 men; mean age, 57.6 ± 9.8 years; range, 24-85 years) were included in this study. Among the 189 cases, the DVTs involved popliteal iliofemoral veins in 54 patients, iliofemoral veins in 113 patients, and iliac veins in 22 patients, of which 18 patients had thrombus extended into the IVC. Of the 189 patients, a total of 8 (4.2%, 8 of 189) patients were identified with IVC filter thrombus during CDT. The IVC filter thrombus was detected on a median of 2 days (range, 2-4 days) of CDT therapy, including small-size (n = 6) and large-size (n = 2) filter thrombus. Of the 8 patients, CDTs were performed with a mean 7.6 ± 1.1 days (range, 6-11 days) after the presence of symptoms for the treatment of proximal DVT, and all the IVC filter thrombi were lysed during CDT for the proximal DVT. All the IVC filters were removed successfully with a mean of 12.8 ± 0.93 days from placement. There were no procedure- or thrombolysis-related major complications, and no symptomatic pulmonary embolism breakthrough was seen in any of the patients after the filter placement. IVC filter thrombus during CDT for the acute proximal DVT is uncommon, and all of them did not need any additional treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Shifting from inpatient to outpatient treatment of deep vein thrombosis in a tertiary care center: a cost-minimization analysis.

PubMed

Boucher, Michel; Rodger, Marc; Johnson, Jeffrey A; Tierney, Mike

2003-03-01

To compare the cost of contemporary outpatient and historical inpatient management of proximal lower limb deep vein thrombosis (DVT) in adults. Prospective, observational study with historical inpatient cases as controls. Ambulatory thrombosis clinic of a tertiary care teaching center in Canada. Forty-nine inpatients with DVT from a previous study in 1996 at the same institution who would have been eligible for outpatient therapy if this option had been available, and 51 consecutive patients referred to the ambulatory thrombosis clinic for treatment of DVT between March 2000 and January 2001. The 49 inpatients received unfractionated heparin, and the 51 outpatients received low-molecular-weight heparin (LMWH). A cost-minimization analysis restricted to the hospital perspective was conducted. This design was justified based on the clinical equivalence of the two treatment strategies. All direct hospital costs for treating the 51 consecutive outpatients with LMWH were measured. These data were compared with the cost of treating the inpatients with unfractionated heparin. The analysis horizon was limited to 7 days, based on the duration of hospitalization and length of heparin therapy for DVT before conversion to oral warfarin. The mean cost (in Canadian dollars) per outpatient case was 248 Canadian dollars (95% confidence interval 216-280 Canadian dollars) and was significantly different from the mean cost/inpatient case of 2826 Canadian dollars (adjusted for the difference in fiscal years) (p<0.0005). A breakdown of the outpatient cost showed that nursing time contributed to 51% of the cost, monitoring laboratory tests 5%, drugs 2%, and other costs (diagnostic laboratory tests and medical imaging) 42%. Converting from inpatient to outpatient treatment of proximal DVT was associated with a significant cost savings for our institution. Accordingly, it is financially advantageous for hospitals to offer this service as it reduces direct costs and does not appear to compromise patient care.

Determining the magnitude of surveillance bias in the assessment of lower extremity deep venous thrombosis: A prospective observational study of two centers.

PubMed

Shackford, Steven R; Cipolle, Mark D; Badiee, Jayraan; Mosby, Danielle L; Knudson, M Margaret; Lewis, Paul R; McDonald, Victoria S; Olson, Erik J; Thompson, Kimberly A; Van Gent, Jan-Michael; Zander, Ashley L

2016-05-01

Venous thromboembolism (VTE) remains a significant cause of morbidity and mortality in trauma. Controversy exists regarding the use of lower extremity duplex ultrasound screening and surveillance (LEDUS). Advocates cite earlier diagnosis and treatment of deep venous thrombosis (DVT) to prevent clot propagation and pulmonary embolism (PE). Opponents argue that LEDUS identifies more DVT (surveillance bias) but does not reduce the incidence of PE. We sought to determine the magnitude of surveillance bias associated with LEDUS and test the hypothesis that LEDUS does not decrease the incidence of PE after injury. We compared data from two Level 1 trauma centers: Scripps Mercy Hospital, which used serial LEDUS, and Christiana Care Health System, which used LEDUS only for symptomatic patients. Beginning in 2013, both centers prospectively collected data on demographics, injury severity, and VTE risk for patients admitted for more than 48 hours. Both centers used mechanical and pharmacologic prophylaxis based on VTE risk assessment. Scripps Mercy treated 772 patients and Christiana Care treated 454 patients with similar injury severity and VTE risk. The incidence of PE was 0.4% at both centers. The odds of a DVT diagnosis were 5.3 times higher (odds ratio, 5.3; 95% confidence interval, 2.5-12.9; p < 0.0001) for patients admitted to Scripps Mercy than for patients admitted to Christiana Care. Of the 80 patients who developed DVT, PE, or both, 99% received prophylaxis before the event. Among those who received pharmacologic prophylaxis, the VTE rates between the two centers were not statistically significantly different (Scripps Mercy, 11% vs. Christiana Care, 3%; p = 0.06). The odds of a diagnosis of DVT are increased significantly when a program of LEDUS is used in trauma patients. Neither pharmacologic prophylaxis nor mechanical prophylaxis is completely effective in preventing VTE in trauma patients. VTE should not be considered a "never event" in this cohort. Prognostic/epidemiologic study, level III; therapeutic study, level III.

DVT Management and Outcome Trends, 2001 to 2014.

PubMed

Morillo, Raquel; Jiménez, David; Aibar, Miguel Ángel; Mastroiacovo, Daniela; Wells, Philip S; Sampériz, Ángel; Saraiva de Sousa, Marta; Muriel, Alfonso; Yusen, Roger D; Monreal, Manuel

2016-08-01

A comprehensive evaluation of temporal trends in the treatment of patients who have DVT may assist with identification of modifiable factors that contribute to short-term outcomes. We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies among 26,695 adults with DVT enrolled in the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2014. We also examined temporal trends in risk-adjusted rates of all-cause, pulmonary embolism-related, and bleeding-related death to 30 days after diagnosis. The mean length of hospital stay decreased from 9.0 days in 2001 to 2005 to 7.6 days in 2010 to 2014 (P < .01). For initial DVT treatment, the use of low-molecular-weight heparin decreased from 98% to 90% (P < .01). Direct oral anticoagulants use increased from 0.5% in 2010 to 13.4% in 2014 (P < .001). Risk-adjusted rates of 30-day all-cause mortality decreased from 3.9% in 2001 to 2005 to 2.7% in 2010 to 2014 (adjusted rate ratio per year, 0.84; 95% CI, 0.74-0.96; P < .01). VTE-related mortality showed a nonstatistically significant downward trend (adjusted rate ratio per year, 0.70; 95% CI, 0.44-1.10; P = .13), whereas 30-day bleeding-related mortality significantly decreased from 0.5% in 2001 to 2005 to 0.1% in 2010-2014 (adjusted rate ratio per year, 0.55; 95% CI, 0.40-0.77; P < .01). This international registry-based temporal analysis identified reductions in length of stay for adults hospitalized for DVT. The study also found a decreasing trend in adjusted rates of all-cause and bleeding-related mortality. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Thromboelastography as a Better Indicator of Postinjury Hypercoagulable State Than Prothrombin Time or Activated Partial Thromboplastin Time

DTIC Science & Technology

2009-08-01

trauma 53 Yes 9 Acute desaturation and lung consolidation Abbreviation: DVT, deep venous thrombosis. a All patients were men. All had pulmonary embolism. J Trauma. Author manuscript; available in PMC 2012 August 09. ...pulmonary embolism indicated that our current prophylaxis regimen could be improved. Keywords deep vein thrombosis; pulmonary embolism...important to accurately evaluate an injured patient’s hemostatic status to assess the need for and efficacy of deep vein thrombosis (DVT) prophylaxis

Examining the Association Between Body Mass Index and Weight Related Quality of Life in Black and White Women

PubMed Central

Ard, Jamy D.; Beasley, T. Mark; Fernandez, Jose R.; Howard, Virginia J.; Kolotkin, Ronnete L.; Crosby, Ross D.; Affuso, Olivia

2017-01-01

Obesity not only increases risk for morbidity/mortality, but also impacts the quality of life of obese individuals. In the United States, black women have the highest prevalence of obesity of any other group with approximately 80% of black women over age 20 having a body mass index (BMI) ≥25 kg/m2. We aimed to examine the association between BMI and quality of life in this high risk population compared to this association in white women, using the Impact of Weight on Quality of Life (IWQOL)-Lite questionnaire. Data from 172 black women (mean BMI= 35.7; age=40.5) and 171 white women (mean BMI= 35.5; age=40.4) were collected between 2000 and 2010 analyzed in 2010. The mean IWQOL-Lite total score was 81.6 for black women compared to 66.9 for white women, a statistically significant difference. Hierarchical linear regression models revealed a significant BMI-by-race interaction indicating that the relationship between BMI and IWQOL-Lite score was moderated by race. Our findings suggest notable differences in weight-related quality of life in black and white women. At similar BMIs, black women consistently reported better quality of life than white women on all IWQOL-Lite subscales. The greatest difference in IWQOL-Lite scores between black and white women was seen in the self-esteem subscale. Additional research is needed to understand how to incorporate the weight perspectives of black women into weight management messages and interventions. PMID:28286583

Oxygen generation by combined electrolysis and fuel-cell technology: clinical use in COPD patients requiring long time oxygen therapy.

PubMed

Hirche, T O; Born, T; Jungblut, S; Sczepanski, B; Kenn, K; Köhnlein, T; Hirche, H; Wagner, T O

2008-10-27

Oxy-Gen lite, a recently developed combined electrolysis and fuel cell technology, de-novo generates oxygen with high purity for medical use from distilled water and room air. However, its use in patients with chronic respiratory failure has never been evaluated. To test the clinical applicability and safety of Oxy-Gen lite technology, we enrolled 32 COPD patients with chronic hypoxemia and long-term oxygen therapy (LTOT) in a controlled, randomized, multicenter clinical trial. Standard continuous oxygen therapy with a maximal flow rate of 2 L/min was tested against pulsatile oxygen delivery by Oxy-Gen lite. Oxygen saturation at seated-rest was recorded over 30 min and used as a primary read-out parameter. Oxygen saturation was also recorded during mild physical strain (speaking out loud) or overnight's sleep. Both methods of oxygen supply established oxygen saturations within the normal range (i.e., upper plateau of the sigmoid oxyhaemoglobin dissociation curve) compared to breathing room air (p<0.0001). Mean oxygen saturation under standard continuous oxygen flow or Oxy-Gen lite technology during rest, physical strain or sleep proved statistically equivalent (95%CI<2.5% of reference saturation). The use of Oxy-Gen lite in COPD patients with hypoxemia and LTOT

Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review

PubMed Central

Petraglia, Federica; Ramazzina, Ileana; Costantino, Cosimo

2017-01-01

Summary Background: Plantar fasciitis (PF) is reported in different sports mainly in running and soccer athletes. Purpose of this study is to conduct a systematic review of published literature concerning the diagnosis and treatment of PF in both recreational and élite athletes. The review was conducted and reported in accordance with the PRISMA statement. Methods: The following electronic databases were searched: PubMed, Cochrane Library and Scopus. As far as PF diagnosis, we investigated the electronic databases from January 2006 to June 2016, whereas in considering treatments all data in literature were investigated. Results: For both diagnosis and treatment, 17 studies matched inclusion criteria. The results have highlighted that the most frequently used diagnostic techniques were Ultrasonography and Magnetic Resonance Imaging. Conventional, complementary, and alternative treatment approaches were assessed. Conclusions: In reviewing literature, we were unable to find any specific diagnostic algorithm for PF in athletes, due to the fact that no different diagnostic strategies were used for athletes and non-athletes. As for treatment, a few literature data are available and it makes difficult to suggest practice guidelines. Specific studies are necessary to define the best treatment algorithm for both recreational and élite athletes. Level of evidence: Ib. PMID:28717618

EMI datalib - joining the best of ARC and gLite data libraries

NASA Astrophysics Data System (ADS)

Nilsen, J. K.; Cameron, D.; Devresse, A.; Molnar, Zs; Nagy, Zs; Salichos, M.

2012-12-01

To manage data in the grid, with its jungle of protocols and enormous amount of data in different storage solutions, it is important to have a strong, versatile and reliable data management library. While there are several data management tools and libraries available, they all have different strengths and weaknesses, and it can be hard to decide which tool to use for which purpose. EMI is a collaboration between the European middleware providers aiming to take the best out of each middleware to create one consolidated, all-purpose grid middleware. When EMI started there were two main tools for managing data - gLite had lcg util and the GFAL library, ARC had the ARC data tools and libarcdata2. While different in design and purpose, they both have the same goal; to manage data in the grid. The design of the new EMI datalib was ready by the end of 2011, and a first prototype is now implemented and going through a thorough testing phase. This presentation will give the latest results of the consolidated library together with an overview of the design, test plan and roadmap of EMI datalib.

TES/Aura L2 Ammonia (NH3) Lite Nadir V6 (TL2NH3LN)

Atmospheric Science Data Center

2017-07-20

TES/Aura L2 Ammonia (NH3) Lite Nadir (TL2NH3LN) News:  TES News ... Level:  L2 Instrument:  TES/Aura L2 Ammonia Spatial Coverage:  5.3 km nadir Spatial ... OPeNDAP Access:  OPeNDAP Parameters:  Ammonia Order Data:  Earthdata Search:   Order Data ...

Implementation of Case Studies in an Introduction to Engineering Course for "LITEE National Dissemination Grant Competition"

ERIC Educational Resources Information Center

Le, Qiang

2012-01-01

This paper discusses the year 2008 and the 2009 results of implementing the Laboratory for Innovative Technology and Engineering Education (LITEE) case studies in an engineering class at Hampton University (HU), a HBCU. Questionnaires were administered at the conclusion of the experiment. The goal of this research is to investigate the relevance…

Educational Leadership in Teaching Excellence: The University of Guelph EnLITE Program

ERIC Educational Resources Information Center

Buchholz, Andrea; Wolstenholme, Janet

2014-01-01

Educational Leadership in Teaching Excellence (EnLITE) is a one-year program (Sept to Aug) at the University of Guelph. It is designed to engage mid-career faculty in the theory, practice and scholarship of teaching and learning, and to establish and support a faculty community of practice which provides mentorship and leadership in teaching and…

MobiDB-lite: fast and highly specific consensus prediction of intrinsic disorder in proteins.

PubMed

Necci, Marco; Piovesan, Damiano; Dosztányi, Zsuzsanna; Tosatto, Silvio C E

2017-05-01

Intrinsic disorder (ID) is established as an important feature of protein sequences. Its use in proteome annotation is however hampered by the availability of many methods with similar performance at the single residue level, which have mostly not been optimized to predict long ID regions of size comparable to domains. Here, we have focused on providing a single consensus-based prediction, MobiDB-lite, optimized for highly specific (i.e. few false positive) predictions of long disorder. The method uses eight different predictors to derive a consensus which is then filtered for spurious short predictions. Consensus prediction is shown to outperform the single methods when annotating long ID regions. MobiDB-lite can be useful in large-scale annotation scenarios and has indeed already been integrated in the MobiDB, DisProt and InterPro databases. MobiDB-lite is available as part of the MobiDB database from URL: http://mobidb.bio.unipd.it/. An executable can be downloaded from URL: http://protein.bio.unipd.it/mobidblite/. silvio.tosatto@unipd.it. Supplementary data are available at Bioinformatics online. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

An ultra-faint galaxy candidate discovered in early data from the Magellanic Satellites Survey

DOE PAGES

Drlica-Wagner, A.; Bechtol, Keith; Allam, S.; ...

2016-11-30

Here, we report a new ultra-faint stellar system found in Dark Energy Camera data from the first observing run of the Magellanic Satellites Survey (MagLiteS). MagLiteS J0644–5953 (Pictor II or Pic II) is a low surface brightness (more » $$\\mu ={28.5}_{-1}^{+1}\\,\\mathrm{mag}\\,\\,\\mathrm{arcsec}{}^{-2}$$ within its half-light radius) resolved overdensity of old and metal-poor stars located at a heliocentric distance of $${45}_{-4}^{+5}\\,\\mathrm{kpc}$$. The physical size ($${r}_{1/2}={46}_{-11}^{+15}\\,\\mathrm{pc}\\,$$) and low luminosity ($${M}_{V}=-{3.2}_{-0.5}^{+0.4}\\,\\mathrm{mag}\\,$$) of this satellite are consistent with the locus of spectroscopically confirmed ultra-faint galaxies. MagLiteS J0644–5953 (Pic II) is located $${11.3}_{-0.9}^{+3.1}\\,\\mathrm{kpc}\\,$$ from the Large Magellanic Cloud (LMC), and comparisons with simulation results in the literature suggest that this satellite was likely accreted with the LMC. The close proximity of MagLiteS J0644–5953 (Pic II) to the LMC also makes it the most likely ultra-faint galaxy candidate to still be gravitationally bound to the LMC.« less

A Comparative Evaluation of EPR and OxyLite Oximetry Using a Random Sampling of pO2 in a Murine Tumor

PubMed Central

Vikram, Deepti S.; Bratasz, Anna; Ahmad, Rizwan; Kuppusamy, Periannan

2015-01-01

Methods currently available for the measurement of oxygen concentrations (oximetry) in viable tissues differ widely from each other in their methodological basis and applicability. The goal of this study was to compare two novel methods, particulate-based electron paramagnetic resonance (EPR) and OxyLite oximetry, in an experimental tumor model. EPR oximetry uses implantable paramagnetic particulates, whereas OxyLite uses fluorescent probes affixed on a fiber-optic cable. C3H mice were transplanted with radiation-induced fibrosarcoma (RIF-1) tumors in their hind limbs. Lithium phthalocyanine (LiPc) microcrystals were used as EPR probes. The pO2 measurements were taken from random locations at a depth of ~3 mm within the tumor either immediately or 48 h after implantation of LiPc. Both methods revealed significant hypoxia in the tumor. However, there were striking differences between the EPR and OxyLite readings. The differences were attributed to the volume of tissue under examination and the effect of needle invasion at the site of measurement. This study recognizes the unique benefits of EPR oximetry in terms of robustness, repeatability and minimal invasiveness. PMID:17705635

An ultra-faint galaxy candidate discovered in early data from the Magellanic Satellites Survey

DOE Office of Scientific and Technical Information (OSTI.GOV)

Drlica-Wagner, A.; Bechtol, Keith; Allam, S.

Here, we report a new ultra-faint stellar system found in Dark Energy Camera data from the first observing run of the Magellanic Satellites Survey (MagLiteS). MagLiteS J0644–5953 (Pictor II or Pic II) is a low surface brightness (more » $$\\mu ={28.5}_{-1}^{+1}\\,\\mathrm{mag}\\,\\,\\mathrm{arcsec}{}^{-2}$$ within its half-light radius) resolved overdensity of old and metal-poor stars located at a heliocentric distance of $${45}_{-4}^{+5}\\,\\mathrm{kpc}$$. The physical size ($${r}_{1/2}={46}_{-11}^{+15}\\,\\mathrm{pc}\\,$$) and low luminosity ($${M}_{V}=-{3.2}_{-0.5}^{+0.4}\\,\\mathrm{mag}\\,$$) of this satellite are consistent with the locus of spectroscopically confirmed ultra-faint galaxies. MagLiteS J0644–5953 (Pic II) is located $${11.3}_{-0.9}^{+3.1}\\,\\mathrm{kpc}\\,$$ from the Large Magellanic Cloud (LMC), and comparisons with simulation results in the literature suggest that this satellite was likely accreted with the LMC. The close proximity of MagLiteS J0644–5953 (Pic II) to the LMC also makes it the most likely ultra-faint galaxy candidate to still be gravitationally bound to the LMC.« less

A Security Architecture for Grid-enabling OGC Web Services

NASA Astrophysics Data System (ADS)

Angelini, Valerio; Petronzio, Luca

2010-05-01

In the proposed presentation we describe an architectural solution for enabling a secure access to Grids and possibly other large scale on-demand processing infrastructures through OGC (Open Geospatial Consortium) Web Services (OWS). This work has been carried out in the context of the security thread of the G-OWS Working Group. G-OWS (gLite enablement of OGC Web Services) is an international open initiative started in 2008 by the European CYCLOPS , GENESI-DR, and DORII Project Consortia in order to collect/coordinate experiences in the enablement of OWS's on top of the gLite Grid middleware. G-OWS investigates the problem of the development of Spatial Data and Information Infrastructures (SDI and SII) based on the Grid/Cloud capacity in order to enable Earth Science applications and tools. Concerning security issues, the integration of OWS compliant infrastructures and gLite Grids needs to address relevant challenges, due to their respective design principles. In fact OWS's are part of a Web based architecture that demands security aspects to other specifications, whereas the gLite middleware implements the Grid paradigm with a strong security model (the gLite Grid Security Infrastructure: GSI). In our work we propose a Security Architectural Framework allowing the seamless use of Grid-enabled OGC Web Services through the federation of existing security systems (mostly web based) with the gLite GSI. This is made possible mediating between different security realms, whose mutual trust is established in advance during the deployment of the system itself. Our architecture is composed of three different security tiers: the user's security system, a specific G-OWS security system, and the gLite Grid Security Infrastructure. Applying the separation-of-concerns principle, each of these tiers is responsible for controlling the access to a well-defined resource set, respectively: the user's organization resources, the geospatial resources and services, and the Grid resources. While the gLite middleware is tied to a consolidated security approach based on X.509 certificates, our system is able to support different kinds of user's security infrastructures. Our central component, the G-OWS Security Framework, is based on the OASIS WS-Trust specifications and on the OGC GeoRM architectural framework. This allows to satisfy advanced requirements such as the enforcement of specific geospatial policies and complex secure web service chained requests. The typical use case is represented by a scientist belonging to a given organization who issues a request to a G-OWS Grid-enabled Web Service. The system initially asks the user to authenticate to his/her organization's security system and, after verification of the user's security credentials, it translates the user's digital identity into a G-OWS identity. This identity is linked to a set of attributes describing the user's access rights to the G-OWS services and resources. Inside the G-OWS Security system, access restrictions are applied making use of the enhanced Geospatial capabilities specified by the OGC GeoXACML. If the required action needs to make use of the Grid environment the system checks if the user is entitled to access a Grid infrastructure. In that case his/her identity is translated to a temporary Grid security token using the Short Lived Credential Services (IGTF Standard). In our case, for the specific gLite Grid infrastructure, some information (VOMS Attributes) is plugged into the Grid Security Token to grant the access to the user's Virtual Organization Grid resources. The resulting token is used to submit the request to the Grid and also by the various gLite middleware elements to verify the user's grants. Basing on the presented framework, the G-OWS Security Working Group developed a prototype, enabling the execution of OGC Web Services on the EGEE Production Grid through the federation with a Shibboleth based security infrastructure. Future plans aim to integrate other Web authentication services such as OpenID, Kerberos and WS-Federation.

Hypercoagulability in athletes.

PubMed

Meyering, Christopher; Howard, Thomas

2004-04-01

Risk factors for thromboembolism are well known, and athletes are placed under conditions that can result in exposure to several of these risk factors, which include travel, trauma, immobilization, hemoconcentration, and polycythemia. Presence of a genetic hypercoagulable disorder adds additional risk. Overall management is no different than in nonathletes. Thrombolysis is strongly recommended for upper extremity deep venous thrombosis (DVT) coupled with surgical decompression of obstructive structures if indicated. Thrombolytic therapy does not appear to be necessary for treatment of lower extremity DVT. Prevention of DVT with travel can be achieved through general techniques such as leg exercises, hydration, and loose fitting clothes. Aspirin before travel shows some benefits of protection, but individuals at higher risk may need low molecular weight heparin. Athletes should be screened during preparticipation physicals for thromboembolic risk. Individuals on anticoagulation therapy should not participate in collision or contact sports. Return to play with gradual increase in intensity is recommended with careful monitoring for recurrent venous thromboembolism and management of post-thrombotic symptoms.

Diagnosis and management of deep venous thrombosis and pulmonary embolism in neonates and children.

PubMed

Monagle, Paul

2012-10-01

Neonates and children represent a specific population that can suffer from deep venous thrombosis (DVT) and pulmonary embolism (PE). In considering how the diagnosis and management of DVT/PE in neonates and children differs from adults, one has to consider the fundamental differences in the general characteristics of the patient population, the specific differences in the disease entity, the differences in sensitivity or specificity of diagnostic strategies and risk/benefit profile of therapeutic options available, and then finally the practical applications of therapies, using an evidence-based approach. This review will articulate the key differences in the patient population, disease entity, diagnostic strategies, and drug therapies that must be understood to apply a rigorous evidence-based approach to diagnosis and management of DVT and PE in neonates and children. Finally, there will be a brief discussion of the latest American College of Chest Physician guidelines for antithrombotic treatment in neonates and children. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

[Effectiveness of intermittent pneumatic compression (IPC) on thrombosis prophylaxis: a systematic literature review].

PubMed

Rohrer, Ottilia; Eicher, Manuela

2006-06-01

Despite changes in patient demographics and short-ened length of hospital stay deep vein thrombosis (DVT) remains a major health care problem which may lead to a variety of other high risk complications. Current treatment guidelines focus on preventive measures. Beside drug therapy, physical measures executed by nursing professionals exist, the outcomes of which are discussed controversially. Based on 25 studies that were found in MEDLINE and the Cochrane library, this systematic literature review identifies the effectiveness of intermittent pneumatic compression (IPC) on thrombosis prophylaxis. In almost all medical settings IPC contributes to a significant reduction of the incidence of DVT. At the same time, IPC has minimal negative side effects and is also cost effective. Correct application of IPC and patient compliance are essential to achieve its effectiveness. An increased awareness within the healthcare team in identifying the risk for and implementing measures against DVT is needed. Guidelines need to be developed in order to improve the effectiveness of thrombosis prophylaxis with the implementation of IPC.

Hidden costs associated with venous thromboembolism: impact of lost productivity on employers and employees.

PubMed

Page, Robert L; Ghushchyan, Vahram; Gifford, Brian; Read, Richard Allen; Raut, Monika; Bookhart, Brahim K; Naim, Ahmad B; Damaraju, C V; Nair, Kavita V

2014-09-01

To determine productivity loss and indirect costs with deep vein thrombosis (DVT) and pulmonary embolism (PE). Medical and pharmacy claims with short-term disability (STD) and long-term disability (LTD) claims from 2007 to 2010 were analyzed from the Integrated Benefits Institute's Health and Productivity Benchmarking (IBI-HPB) database (STD and LTD claims) and IMS LifeLink™ data (medical and pharmacy claims), which were indirectly linked using a weighting approach matching from IBI-HPB patients' demographic distribution. A total of 5442 DVT and 6199 PE claims were identified. Employees with DVT lost 57 STD and 440 LTD days per disability incident. The average per claim productivity loss from STD and LTD was $7414 and $58181, respectively. Employees with PE lost 56 STD and 364 LTD days per disability incident. The average per claim productivity loss from STD and LTD was $7605 and $48,751, respectively. Deep vein thrombosis and PE impose substantial economic burdens.

Catheter-directed Thrombolysis with Argatroban and tPA for Massive Iliac and Femoropopliteal Vein Thrombosis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sharifi, Mohsen, E-mail: seyedmohsensharifi@yahoo.com; Bay, Curt; Nowroozi, Sasan

2013-12-15

Purpose: Catheter-directed thrombolysis (CDT) is a highly effective approach in the treatment of deep venous thrombosis (DVT). There are no data on the primary use of CDT with argatroban and tissue plasminogen activator (tPA) in patients without heparin-induced thrombocytopenia (HIT). The aim of this study was to evaluate the efficacy and safety of the combined administration of argatroban and tPA during CDT for massive DVT in patients without HIT. Methods: Thirty-three patients with massive symptomatic iliac and femoropopliteal DVT underwent CDT with tPA and argatroban within 28 {+-} 6 h of presentation. The dose of tPA was 0.75-1 mg/h throughmore » the infusion port and that of argatroban at 0.3-1 {mu}g/kg/min through the side port of the sheath. The patients were evaluated for the efficacy and safety of CDT and recurrent symptomatic venous thromboembolism (VTE) at a mean follow-up of 22 months. Results: There was no bleeding or iatrogenic pulmonary embolism with the CDT regimen we used. Grade III lysis (complete resolution of thrombus on venography) was achieved in 30 patients (91 %). In 3 patients with additional inferior vena cava filter thrombosis, further thrombectomy of the filter was required. No patient developed recurrent VTE. Conclusion: Concomitant administration of argatroban and tPA is a highly safe and effective regimen for CDT for massive DVT.« less

Seismic Forecasting of Eruptions at Dormant StratoVolcanoes

NASA Astrophysics Data System (ADS)

White, R. A.

2015-12-01

Seismic monitoring data provide important constraints on tracking magmatic ascent and eruption. Based on direct experience with over 25 and review of over 10 additional eruption sequences at 24 volcanoes, we have identified 4 phases of precursory seismicity. 1) Deep (>20 km) low frequency (DLF) earthquakes occur near the base of the crust as magma rises toward crustal reservoirs. This seismicity is the most difficult to observe, owing to generally small magnitudes (M<2.5) the significant depth. 2) Distal volcano-tectonic (DVT) earthquakes occur on tectonic faults from a 2 to 30+ km distance laterally from (not beneath) the eventual eruption site as magma intrudes into and rises out of upper crustal reservoirs to depths of 2-3 km. A survey of 111 eruptions of 83 previously dormant volcanoes, (including all eruptions of VEI >4 since 1955) shows they were all preceded by significant DVT seismicity, usually felt. This DVT seismicity is easily observed owing to magnitudes generally reaching M>3.5. The cumulative DVT energy correlates to the intruding magma volume. 3) Low frequency (LF) earthquakes, LF tremor and contained explosions occur as magma interacts with the shallow hydrothermal system (<2 km depth), while the distal seismicity dies off.4) Shortly after this, repetitive self-similar proximal seismicity may occur and may dominate the seismic records as magma rises to the surface. We present some examples of this seismic progression to demonstrate that data from a single short-period vertical station are often sufficient to forecast eruption onsets.

A Cross‐Study Analysis Evaluating the Effects of Food on the Pharmacokinetics of Rivaroxaban in Clinical Studies

PubMed Central

Peters, Gary; Haskell, Lloyd; Patel, Purve; Nandy, Partha; Moore, Kenneth Todd

2017-01-01

Abstract US prescribing guidelines recommend that 15‐ and 20‐mg doses of rivaroxaban be administered with food for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) and for reduction in the risk of recurrence of DVT and PE. In addition, the US prescribing guidelines recommend these doses be administered with an evening meal to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AF). The purpose of this model‐based cross‐study comparison was to examine the impact of food, with regard to both meal timing and content, on the pharmacokinetics (PK) of rivaroxaban, using data collected during its clinical development. Results of this analysis showed that a PK model built from pooled data in the AF population (for whom rivaroxaban was administered with an evening meal) and in the DVT population (for whom rivaroxaban was administered with a morning meal) can describe both data sets well. Furthermore, the PK model built from data in the AF population alone can adequately predict the PK profile of the DVT population and vice versa. This cross‐study analysis also confirmed the findings from previous clinical pharmacology studies, which showed that meal content does not have a clinically relevant impact on the PK of rivaroxaban at 20 mg. Therefore, although the administration of rivaroxaban with food is necessary for maintaining high bioavailability, neither meal timing nor meal content appears to affect the PK of rivaroxaban. PMID:28679020

[Identifying clinical risk factors in recurrent idiopathic deep venous thrombosis].

PubMed

Del Río Solá, M Lourdes; González Fajardo, José Antonio; Vaquero Puerta, Carlos

2016-03-18

Oral anticoagulant therapy for more than 6 months in patients with an episode of idiopathic thromboembolic disease is controversial. The objective was to determine predictive clinical signs that identify patients at increased risk of thromboembolic recurrence after stopping anticoagulant therapy for 6 months after an episode of idiopathic deep vein thrombosis (DVT). A prospective study which included 306 consecutive patients with a first episode of idiopathic DVT from June 2012 to June 2014. Predictor variables of recurrent thromboembolic disease and episodes of recurrence during follow-up of the patients (28.42 months) were collected. We performed a multivariate analysis to analyze possible predictors (P<.20) and an analysis of Kaplan-Meier to establish mean recurrence-free survival. We identified 91 episodes of residual vein thrombosis on follow-up of the patients (37.5% men and 20.3% women) (OR 1.84; 95% CI 1.25-2.71). In the Cox regression analysis stratified by gender, variables showed significant presence of hyperechoic thrombus (P=.001) in males, and persistence of residual thrombus in women (P=.046). The mean recurrence-free survival was shorter in both groups. The presence of echogenic thrombus in men and the existence of residual DVT in women were 2 clinical signs associated with increased risk of thromboembolic recurrence after stopping anticoagulant therapy for 6 months after an episode of idiopathic DVT in our study. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Absent Inferior Vena Cava Leading to Recurrent Lower Extremity Deep Vein Thrombosis in a United States Marine.

PubMed

Kim, Sang; Kunkel, Scott; Browske, Kristin

2018-01-01

Anomalies of the inferior vena cava (AIVC) are rare but well-recognized anatomic abnormalities that can lead to clinically significant deep vein thrombosis (DVT) in a subset of otherwise healthy patients. This report illustrates an uncommon congenital anomaly that military clinicians should consider when evaluating unprovoked DVT in young patients. Single case report and literature review. We describe a case of a 24-yr-old United States Marine who presented with abdominal pain for 2 wk. After conservative therapy failed, a contrast-enhanced abdominal computed tomography (CT) scan was performed. The CT scan revealed an absent inferior vena cava with evidence of right venous thrombophlebitis. We include four contrast-enhanced helical CT scans that illustrate this phenomenon. Due to the lack of available studies and data, we do not know the relative risk of DVT in patients with AIVC. However, the literature review suggests that there is a pro-thrombogenic effect of this congenital anomaly. Clinicians should include AIVC in their differential when treating young, otherwise healthy patients with unprovoked DVT. This population is much more likely to have an AIVC than the general population. In addition to thrombophilia markers, a contrast-enhanced CT scan should be considered as part of the initial workup. Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Septic knee-induced deep venous thrombosis in a young adult.

PubMed

Backes, Jeffrey; Taylor, Benjamin C; Clayton, Matthew D

2010-10-11

This article describes a case of a 26-year-old man presenting with left knee pain of 1 week's duration, fever, and acute onset of shortness of breath the day of admission. An arthrocentesis of the knee joint was grossly positive for methicillin-resistant Staphylococcus aureus. A left lower extremity venous duplex showed thrombosis of the superficial femoral, popliteal, posterior tibial, peroneal, and gastrocnemius veins. Pulmonary computed tomography-angiography was positive for acute pulmonary emboli. Initial management consisted of anticoagulation, intravenous antibiotics, and 2 arthroscopic irrigation and debridement procedures. After a normal transesophageal echocardiogram, a diagnosis of septic knee-induced deep venous thrombosis (DVT) of the left lower leg with subsequent septic pulmonary emboli was established. The patient was discharged to a long-term care facility for a 6-week monitored course of intravenous antibiotics. His DVT and pulmonary emboli were managed successfully with oral warfarin. Two months after his initial presentation, the patient returned with acute worsening knee pain. A knee arthrocentesis was unremarkable; however, radiographic imaging revealed fulminant osteomyelitis of the distal femur. He has since undergone open arthrotomy with excisional irrigation and debridement and is on a chronic oral antibiotic regimen. Sparse pediatric literature has shown an association between musculoskeletal sepsis and thrombosis. Only 1 case of septic knee-induced DVT exists in the adult literature, and it was not associated with pulmonary emboli. Our case provides evidence that DVT must be considered by the treating physician as a possible and devastating complication of septic arthritis. Copyright 2010, SLACK Incorporated.

The development and validation of a shorter version of the Canadian Health Care Evaluation Project Questionnaire (CANHELP Lite): a novel tool to measure patient and family satisfaction with end-of-life care.

PubMed

Heyland, Daren K; Jiang, Xuran; Day, Andrew G; Cohen, S Robin

2013-08-01

The recently developed Canadian Health Care Evaluation Project (CANHELP) questionnaire, which can be used to assess both patient and family satisfaction with end-of-life care, takes 40-60 minutes to complete. The length of the interview may limit its uptake and clinical utility; a shorter version would make its use more feasible. The purpose of this study was to develop and validate a shorter version of the CANHELP questionnaire. Data were collected using a cross-sectional survey of patients with advanced medical diseases and their family members. Participants completed the long version of CANHELP, a global rating of satisfaction with care (GRS), the FAMCARE scale (family members only), and a quality-of-life (QOL) questionnaire. We reduced the items on the long version based on their relationship to the GRS, the frequency of missing data, the distribution of responses, the redundancy of the items, and focus groups with frontline users. With the remaining items, we assessed internal consistency using Cronbach's alpha, and evaluated construct validity by describing the correlation of the new CANHELP Lite with the full version of CANHELP, GRS, FAMCARE, and the QOL questionnaire scores. A total of 363 patients and 193 family members participated in this study. The patient version was reduced from 37 items to 20 items and the caregiver version was reduced from 38 items to 21 items. Cronbach's alphas ranged from 0.68 to 0.93 for all domains of both the patient and caregiver questionnaires. We observed a high degree of correlation between CANHELP Lite domains and overall scores and the same domains and overall scores for the full version of CANHELP. In addition, we observed moderate to strong correlation between the CANHELP Lite overall satisfaction scores and the GRS questions. There was moderate correlation between the overall family member CANHELP Lite score and overall FAMCARE score (r = 0.45) and this was similar to the correlation between the full version of CANHELP and FAMCARE scores (r = 0.41). CANHELP Lite correlated more strongly with the QOL subscale on health care than the other QOL subscales. The CANHELP Lite questionnaire is a valid and internally consistent instrument to measure satisfaction with end-of-life care. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Active Ankle Movement May Prevent Deep Vein Thrombosis in Patients Undergoing Lower Limb Surgery.

PubMed

Wang, Zhe; Chen, Qian; Ye, Mao; Shi, Guang-Hui; Zhang, Bo

2016-04-01

Our aim is to investigate the effect of active ankle movement to prevent deep vein thrombosis (DVT) in patients who received lower limb surgery, and to provide a theory of evidence for rehabilitation nursing of patients after orthopedic surgery. Between January 2012 and December 2013, a total of 174 patients were randomized as case group (n = 96) and control group (n = 78). Case group received routine nursing and active ankle movement (30 times/min, 1-7 days after surgery), while control group only received routine nursing. The symptoms and signs of DVT were in real-time observation during the experiment. Thigh and crus circumference, maximum venous outflow (MVO), maximum venous capacity (MVC), and MVO ratio (MVO ratio = MVO/MVC) in the two groups were measured 1-7 days after surgery. Six-month follow-up study was also conducted to observe the occurrence of DVT. Our study revealed that thigh circumference in the case group decreased compared with the control group in 5-7 days (fifth day: 39.98 ± 3.25 vs. 41.01 ± 3.38, P = 0.043; sixth day: 38.21 ± 3.81 vs. 39.49 ± 3.79, P = 0.029; seventh day: 37.13 ± 3.15 vs. 38.76 ± 3.31, P = 0.001), and crus circumference in the case group also decreased compared with the control group in 5-7 days (fifth day: 26.35 ± 2.11 vs. 27.01 ± 2.19, P = 0.045; sixth day: 25.99 ± 2.31 vs. 26.88 ± 3.12, P = 0.032; seventh day: 25.56 ± 1.99 vs. 26.38 ± 2.89, P = 0.028). MVO and MVC in the case group increased compared with the control group 7 days after surgery (MVO: 15.01 ± 2.56 vs. 14.12 ± 2.56, P = 0.024; MVC: 10.18 ± 3.15 vs. 8.91 ± 2.78, P = 0.006). Significant difference in the incidence of thrombus and DVT were found between the case group and the control group 1-7 days after surgery (thrombus: 1.0% and 7.7%, P = 0.027; DVT: 7.6% and 18.4%, P = 0.032). Our result manifested that active ankle movement can relieve the swelling of patients after lower limb surgery, and improve the MVO and MVC of patients to prevent formation of DVT after lower limb surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Acute deep vein thrombosis and endovascular techniques: It is time for a new aggiornamento!

PubMed

Pernès, J-M; Auguste, M; Kovarski, S; Borie, H; Renaudin, J-M; Coppe, G

2012-10-01

The stated aims of treating acute deep vein thrombosis (DVT) are to prevent a pulmonary embolism, stop the clot from spreading, reduce the risk of a recurrence; they are less concerned with the late morbidity associated with post-thrombotic syndrome (PTS). In accordance with the French (Afssaps, 2009) and North American (ACCP, 2008) recommendations, anticoagulants (LMWH, heparin, AVK) form the cornerstone for treating DVT. These treatments appear to be far less effective in preventing post-thrombotic syndrome (PTS), associated with venous hypertension, residual occlusion, and with reflux caused by valve incompetence. Given that, the new aim is to optimise the prevention of PTS, the ACCP guidelines, unlike those of Afssaps, "suggest" for selected patients suffering from acute iliofemoral DVT, the use of both classic anticoagulants, and in situ percutaneous administration of thrombolytic drugs (recommendation grade 2B) and simultaneous correction of any underlying anatomical anomalies using angioplasty and stenting (recommendation 2C). Contemporary endovascular methods, referred to collectively as "facilitated" thrombolysis, combine low doses of rtPa or Urokinase administered locally, and the removal of the clot using various mechanical, rotating, rheolytic systems, or using ultrasound. The results of non-randomised, heterogeneous studies objectivised a lysis rate of 80%, a 50% lower risk of haemorrhage complications compared with systemic thrombolysis (<4%), and a clear reduction in treatment time (one-shot methods possible for procedures lasting less than 2 hours). This data ties in with the modern "open vein" concept which underpins the hope of an improvement in the late prognosis of acute DVT, through the removal of a clot, thereby improving permeability and valve integrity; this hypothesis is supported by the results at 24 months of a randomised CaVent objectifying absolute risk reduction of 15% in the thrombolysis in situ. The current randomised study (ATTRACT trial) comparing the combination of "facilitated thrombolysis" in addition to the usual treatment with the traditional treatment alone for acute iliofemoral DVT, the statistical power of which has been established (600 patients) to authenticate a reduction by a third in the number of PTS (CaVent trial, showing a 15% reduction rate of 24 months PTS in the thrombolysed group results expected in 2016), might, if the results are positive, lead to a profound change in the paradigms for the treatment of acute iliofemoral DVT. Copyright © 2012 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

A portable digital microphotography unit for rapid documentation of periungual nailfold capillary changes in autoimmune connective tissue diseases.

PubMed

Sontheimer, Richard D

2004-03-01

While employing a DermLite dermoscopy unit to assess pigment pattern networks in melanocytic skin lesions, it was observed that this compact, portable dermoscopy unit can also be used to quickly detect nailfold capillary changes when entertaining a diagnosis of autoimmune connective tissue diseases (CTD) such as dermatomyositis (DM), scleroderma/systemic sclerosis (SSc), or systemic lupus erythematosus. Aware that the suppliers of the DermLite dermoscopy unit also market a portable digital microphotography unit based on the DermLite optical principles for efficiently documenting cutaneous pigment network patterns, we investigated whether this unit (DermLite Foto flash unit attached to a Nikon Coolpix digital camera) might be used to photographically document nailfold capillary changes in patients with autoimmune CTD. A DermLite Foto flash unit attached to a Nikon Coolpix digital camera was used in a controlled observational study to obtain digital photographs of nailfold capillaries in a small sequential sample of patients with autoimmune CTD attending a rheumatic skin disease subspecialty clinic in an academic department of dermatology. The digital microphotography system proved to be highly useful in documenting the nailfold vascular changes observed in a small sample of patients with DM. We observed that the nailfold capillary changes seen in patients with clinically amyopathic DM were qualitatively and quantitatively similar to those seen in patients with classical DM. Digital microphotography systems designed for examining pigmented skin lesions can be used easily to document nailfold capillary changes often observed in DM and SSc. Nailfold capillary changes documented in this manner appear to be indistinguishable in clinically amyopathic DM and classical DM.

The LiteBIRD Satellite Mission: Sub-Kelvin Instrument

NASA Astrophysics Data System (ADS)

Suzuki, A.; Ade, P. A. R.; Akiba, Y.; Alonso, D.; Arnold, K.; Aumont, J.; Baccigalupi, C.; Barron, D.; Basak, S.; Beckman, S.; Borrill, J.; Boulanger, F.; Bucher, M.; Calabrese, E.; Chinone, Y.; Cho, S.; Crill, B.; Cukierman, A.; Curtis, D. W.; de Haan, T.; Dobbs, M.; Dominjon, A.; Dotani, T.; Duband, L.; Ducout, A.; Dunkley, J.; Duval, J. M.; Elleflot, T.; Eriksen, H. K.; Errard, J.; Fischer, J.; Fujino, T.; Funaki, T.; Fuskeland, U.; Ganga, K.; Goeckner-Wald, N.; Grain, J.; Halverson, N. W.; Hamada, T.; Hasebe, T.; Hasegawa, M.; Hattori, K.; Hattori, M.; Hayes, L.; Hazumi, M.; Hidehira, N.; Hill, C. A.; Hilton, G.; Hubmayr, J.; Ichiki, K.; Iida, T.; Imada, H.; Inoue, M.; Inoue, Y.; Irwin, K. D.; Ishino, H.; Jeong, O.; Kanai, H.; Kaneko, D.; Kashima, S.; Katayama, N.; Kawasaki, T.; Kernasovskiy, S. A.; Keskitalo, R.; Kibayashi, A.; Kida, Y.; Kimura, K.; Kisner, T.; Kohri, K.; Komatsu, E.; Komatsu, K.; Kuo, C. L.; Kurinsky, N. A.; Kusaka, A.; Lazarian, A.; Lee, A. T.; Li, D.; Linder, E.; Maffei, B.; Mangilli, A.; Maki, M.; Matsumura, T.; Matsuura, S.; Meilhan, D.; Mima, S.; Minami, Y.; Mitsuda, K.; Montier, L.; Nagai, M.; Nagasaki, T.; Nagata, R.; Nakajima, M.; Nakamura, S.; Namikawa, T.; Naruse, M.; Nishino, H.; Nitta, T.; Noguchi, T.; Ogawa, H.; Oguri, S.; Okada, N.; Okamoto, A.; Okamura, T.; Otani, C.; Patanchon, G.; Pisano, G.; Rebeiz, G.; Remazeilles, M.; Richards, P. L.; Sakai, S.; Sakurai, Y.; Sato, Y.; Sato, N.; Sawada, M.; Segawa, Y.; Sekimoto, Y.; Seljak, U.; Sherwin, B. D.; Shimizu, T.; Shinozaki, K.; Stompor, R.; Sugai, H.; Sugita, H.; Suzuki, J.; Tajima, O.; Takada, S.; Takaku, R.; Takakura, S.; Takatori, S.; Tanabe, D.; Taylor, E.; Thompson, K. L.; Thorne, B.; Tomaru, T.; Tomida, T.; Tomita, N.; Tristram, M.; Tucker, C.; Turin, P.; Tsujimoto, M.; Uozumi, S.; Utsunomiya, S.; Uzawa, Y.; Vansyngel, F.; Wehus, I. K.; Westbrook, B.; Willer, M.; Whitehorn, N.; Yamada, Y.; Yamamoto, R.; Yamasaki, N.; Yamashita, T.; Yoshida, M.

2018-05-01

Inflation is the leading theory of the first instant of the universe. Inflation, which postulates that the universe underwent a period of rapid expansion an instant after its birth, provides convincing explanation for cosmological observations. Recent advancements in detector technology have opened opportunities to explore primordial gravitational waves generated by the inflation through "B-mode" (divergent-free) polarization pattern embedded in the cosmic microwave background anisotropies. If detected, these signals would provide strong evidence for inflation, point to the correct model for inflation, and open a window to physics at ultra-high energies. LiteBIRD is a satellite mission with a goal of detecting degree-and-larger-angular-scale B-mode polarization. LiteBIRD will observe at the second Lagrange point with a 400 mm diameter telescope and 2622 detectors. It will survey the entire sky with 15 frequency bands from 40 to 400 GHz to measure and subtract foregrounds. The US LiteBIRD team is proposing to deliver sub-Kelvin instruments that include detectors and readout electronics. A lenslet-coupled sinuous antenna array will cover low-frequency bands (40-235 GHz) with four frequency arrangements of trichroic pixels. An orthomode-transducer-coupled corrugated horn array will cover high-frequency bands (280-402 GHz) with three types of single frequency detectors. The detectors will be made with transition edge sensor (TES) bolometers cooled to a 100 milli-Kelvin base temperature by an adiabatic demagnetization refrigerator. The TES bolometers will be read out using digital frequency multiplexing with Superconducting QUantum Interference Device (SQUID) amplifiers. Up to 78 bolometers will be multiplexed with a single SQUID amplifier. We report on the sub-Kelvin instrument design and ongoing developments for the LiteBIRD mission.

Comparação de modelos para o cálculo de perturbações orbitais devidas à maré terrestre

NASA Astrophysics Data System (ADS)

Vieira Pinto, J.; Vilhena de Moraes, R.

2003-08-01

Aplicações recentes de satélites artificiais com finalidades geodinâmicas requerem órbitas determinadas com bastante precisão. Em particular marés terrestres influenciam o potencial terrestre causando perturbações adicionais no movimento de satélites artificiais, as quais tem sido medidas por diversos processos. A atração exercida pela lua e pelo sol sobre a terra produz deslocamentos elásticos em seu interior e uma protuberância em sua superfície. O resultado é uma pequena variação na distribuição da massa na terra, consequentemente no geopotencial. As perturbações nos elementos orbitais de satélites artificiais terrestres devidas a maré terrestre podem ser estudadas a partir das equações de Lagrange, considerando-se um conveniente potencial. Por outro lado, como tem sido feito pelo IERS, as mudanças induzidas pela maré terrestre no geopotencial podem ser convenientemente modeladas como variações nos coeficientes Cnm e Snm do geopotencial. As duas teorias ainda não foram comparados para um mesmo satélite. Neste trabalho são apresentadas e comparadas as variações de longo período e seculares nas perturbações orbitais devidas à maré terrestre, calculadas por um modelo simples, o de Kozai, e pelo modelo do IERS. Resultados preliminares mostram, para os satélites SCD2 e CBERS1, e para a Lua em movimento elíptico e precessionando, as perturbações seculares no argumento do perigeu e na longitude do nodo ascendente.

A nurse-led ambulatory care pathway for patients with deep venous thrombosis in an acute teaching hospital.

PubMed

Deagle, Jennifer; Allen, James; Mani, Raj

2005-06-01

This article describes the management of deep vein thrombosis (DVT) using an ambulatory nurse-led pathway and the compression technique using duplex ultrasound. This pathway permits the management of the "walking wounded" as well as other patients at varying risks of having DVT and in so doing has changed the approach toward the management of this common clinical event. The success of the described pathway is attributed to the development of low molecular weight heparin and the reliability of diagnostics.

Oral direct thrombin inhibitors or oral factor Xa inhibitors for the treatment of deep vein thrombosis.

PubMed

Robertson, Lindsay; Kesteven, Patrick; McCaslin, James E

2015-06-30

Deep vein thrombosis (DVT) is a condition in which a clot forms in the deep veins, most commonly of the leg. It occurs in approximately 1 in 1,000 people. If left untreated, the clot can travel up to the lungs and cause a potentially life-threatening pulmonary embolism (PE). Previously, a DVT was treated with the anticoagulants heparin and vitamin K antagonists. However, two forms of novel oral anticoagulants (NOACs) have been developed: oral direct thrombin inhibitors (DTI) and oral factor Xa inhibitors. The new drugs have characteristics that may be favourable over conventional treatment, including oral administration, a predictable effect, lack of frequent monitoring or re-dosing and few known drug interactions. To date, no Cochrane review has measured the effectiveness and safety of these drugs in the treatment of DVT. To assess the effectiveness of oral DTIs and oral factor Xa inhibitors for the treatment of DVT. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched January 2015) and the Cochrane Register of Studies (last searched January 2015). We searched clinical trials databases for details of ongoing or unpublished studies and the reference lists of relevant articles retrieved by electronic searches for additional citations. We included randomised controlled trials in which people with a DVT confirmed by standard imaging techniques, were allocated to receive an oral DTI or an oral factor Xa inhibitor for the treatment of DVT. Two review authors (LR, JM) independently extracted the data and assessed the risk of bias in the trials. Any disagreements were resolved by discussion with the third review author (PK). We performed meta-analyses when we considered heterogeneity low. The two primary outcomes were recurrent VTE and PE. Other outcomes included all-cause mortality and major bleeding. We calculated all outcomes using an odds ratio (OR) with a 95% confidence interval (CI). We included 11 randomised controlled trials of 27,945 participants. Three studies tested oral DTIs (two dabigatran and one ximelagatran), while eight tested oral factor Xa inhibitors (four rivaroxaban, two apixaban and two edoxaban). We deemed all included studies to be of high methodological quality and low risk of bias. The quality of the evidence was graded as high as the outcomes were direct and effect estimates were consistent and precise, as reflected in the narrow CIs around the ORs. Meta-analysis of three studies (7596 participants) comparing oral DTIs with standard anticoagulation groups showed no difference in the rate of recurrent VTE (OR 1.09; 95% CI 0.80 to 1.49), recurrent DVT (OR 1.08; 95% CI 0.74 to 1.58), fatal PE (OR 1.00; 95% CI 0.27 to 3.70), non-fatal PE (OR 1.12; 95% CI 0.66 to 1.90) or all-cause mortality (OR 0.82; 95% CI 0.60 to 1.13). However, oral DTIs were associated with reduced bleeding (OR 0.68; 95% CI 0.47 to 0.98). Meta-analysis of eight studies (16,356 participants) comparing oral factor Xa inhibitors with standard anticoagulation demonstrated a similar rate of recurrent VTE between the two treatments (OR 0.89; 95% CI 0.73 to 1.07). Oral factor Xa inhibitors were associated with a lower rate of recurrent DVT (OR 0.75; 95% CI 0.57 to 0.98). However, this was a weak association, heavily dependent on one study. The rate of fatal (OR 1.20; 95% CI 0.71 to 2.03), non-fatal PE (OR 0.94; 95% CI 0.68 to 1.28) and all-cause mortality (OR 0.90; 95% CI 0.65 to 1.23) was similar between the two treatment groups. Oral factor Xa inhibitors were also associated with reduced bleeding (OR 0.57; 95% CI 0.43 to 0.76). None of the included studies measured post-thrombotic syndrome or health-related quality of life. NOACs such as DTIs and factor Xa inhibitors may be an effective and safe alternative to conventional anticoagulation treatment for acute DVT.

Linking Investigations in Trauma and Emergency Services (LITES)

DTIC Science & Technology

2017-10-01

observational cohort that will have a limited data set from trauma registry data and electronic health records. Specific Aim one is to characterize the...epidemiology of moderate and severe physical injury in the U.S. and across the LITES network and investigate regional variations of presenting...observational cohort that will have a limited data set from trauma registry data and electronic health records. Specific Aim one is to characterize the

An Overview of GNSS Remote Sensing

DTIC Science & Technology

2014-08-27

dedicated space missions and develop- ments of new algorithms and innovative methodologies. Atmospheric sounding is a new area of GNSS applications based on...the analysis of radio signals from GNSS satel - lites, which are refracted as they pass through the atmos- phere and can give information on its...under a full COSMIC constellation. The L-band radio signals broadcast by the GNSS satel - lites are affected by both the ionospheric and tropospheric

Engaging Élitism: The Mediating Effect of Work Engagement on Affective Commitment and Quit Intentions in Two Australian University Groups

ERIC Educational Resources Information Center

Ferrer, Justine L.; Morris, Leanne

2013-01-01

Some universities rely on their élitism as one mechanism to attract and retain talented faculty. This paper examines two groups of élite and non-élite universities and the mediating effect that work engagement has on affective commitment and intention to quit. Findings indicate partial support for the mediating effect of work engagement in the…

The Implementation of Satellite Attitude Control System Software Using Object Oriented Design

NASA Technical Reports Server (NTRS)

Reid, W. Mark; Hansell, William; Phillips, Tom; Anderson, Mark O.; Drury, Derek

1998-01-01

NASA established the Small Explorer (SNMX) program in 1988 to provide frequent opportunities for highly focused and relatively inexpensive space science missions. The SMEX program has produced five satellites, three of which have been successfully launched. The remaining two spacecraft are scheduled for launch within the coming year. NASA has recently developed a prototype for the next generation Small Explorer spacecraft (SMEX-Lite). This paper describes the object-oriented design (OOD) of the SMEX-Lite Attitude Control System (ACS) software. The SMEX-Lite ACS is three-axis controlled and is capable of performing sub-arc-minute pointing. This paper first describes high level requirements governing the SMEX-Lite ACS software architecture. Next, the context in which the software resides is explained. The paper describes the principles of encapsulation, inheritance, and polymorphism with respect to the implementation of an ACS software system. This paper will also discuss the design of several ACS software components. Specifically, object-oriented designs are presented for sensor data processing, attitude determination, attitude control, and failure detection. Finally, this paper will address the establishment of the ACS Foundation Class (AFC) Library. The AFC is a large software repository, requiring a minimal amount of code modifications to produce ACS software for future projects.

LiteNet: Lightweight Neural Network for Detecting Arrhythmias at Resource-Constrained Mobile Devices.

PubMed

He, Ziyang; Zhang, Xiaoqing; Cao, Yangjie; Liu, Zhi; Zhang, Bo; Wang, Xiaoyan

2018-04-17

By running applications and services closer to the user, edge processing provides many advantages, such as short response time and reduced network traffic. Deep-learning based algorithms provide significantly better performances than traditional algorithms in many fields but demand more resources, such as higher computational power and more memory. Hence, designing deep learning algorithms that are more suitable for resource-constrained mobile devices is vital. In this paper, we build a lightweight neural network, termed LiteNet which uses a deep learning algorithm design to diagnose arrhythmias, as an example to show how we design deep learning schemes for resource-constrained mobile devices. Compare to other deep learning models with an equivalent accuracy, LiteNet has several advantages. It requires less memory, incurs lower computational cost, and is more feasible for deployment on resource-constrained mobile devices. It can be trained faster than other neural network algorithms and requires less communication across different processing units during distributed training. It uses filters of heterogeneous size in a convolutional layer, which contributes to the generation of various feature maps. The algorithm was tested using the MIT-BIH electrocardiogram (ECG) arrhythmia database; the results showed that LiteNet outperforms comparable schemes in diagnosing arrhythmias, and in its feasibility for use at the mobile devices.

Astronomy LITE Demonstrations

NASA Astrophysics Data System (ADS)

Brecher, Kenneth

2006-12-01

Project LITE (Light Inquiry Through Experiments) is a materials, software, and curriculum development project. It focuses on light, optics, color and visual perception. According to two recent surveys of college astronomy faculty members, these are among the topics most often included in the large introductory astronomy courses. The project has aimed largely at the design and implementation of hands-on experiences for students. However, it has also included the development of lecture demonstrations that employ novel light sources and materials. In this presentation, we will show some of our new lecture demonstrations concerning geometrical and physical optics, fluorescence, phosphorescence and polarization. We have developed over 200 Flash and Java applets that can be used either by teachers in lecture settings or by students at home. They are all posted on the web at http://lite.bu.edu. For either purpose they can be downloaded directly to the user's computer or run off line. In lecture demonstrations, some of these applets can be used to control the light emitted by video projectors to produce physical effects in materials (e.g. fluorescence). Other applets can be used, for example, to demonstrate that the human percept of color does not have a simple relationship with the physical frequency of the stimulating source of light. Project LITE is supported by Grant #DUE-0125992 from the NSF Division of Undergraduate Education.

LiteNet: Lightweight Neural Network for Detecting Arrhythmias at Resource-Constrained Mobile Devices

PubMed Central

Zhang, Xiaoqing; Cao, Yangjie; Liu, Zhi; Zhang, Bo; Wang, Xiaoyan

2018-01-01

By running applications and services closer to the user, edge processing provides many advantages, such as short response time and reduced network traffic. Deep-learning based algorithms provide significantly better performances than traditional algorithms in many fields but demand more resources, such as higher computational power and more memory. Hence, designing deep learning algorithms that are more suitable for resource-constrained mobile devices is vital. In this paper, we build a lightweight neural network, termed LiteNet which uses a deep learning algorithm design to diagnose arrhythmias, as an example to show how we design deep learning schemes for resource-constrained mobile devices. Compare to other deep learning models with an equivalent accuracy, LiteNet has several advantages. It requires less memory, incurs lower computational cost, and is more feasible for deployment on resource-constrained mobile devices. It can be trained faster than other neural network algorithms and requires less communication across different processing units during distributed training. It uses filters of heterogeneous size in a convolutional layer, which contributes to the generation of various feature maps. The algorithm was tested using the MIT-BIH electrocardiogram (ECG) arrhythmia database; the results showed that LiteNet outperforms comparable schemes in diagnosing arrhythmias, and in its feasibility for use at the mobile devices. PMID:29673171

SSUSI-lite: next generation far-ultraviolet sensor for characterizing geospace

NASA Astrophysics Data System (ADS)

Paxton, Larry J.; Hicks, John E.; Grey, Matthew P.; Parker, Charles W.; Hourani, Ramsay S.; Marcotte, Kathryn M.; Carlsson, Uno P.; Kerem, Samuel; Osterman, Steven N.; Maas, Bryan J.; Ogorzalek, Bernard S.

2016-10-01

SSUSI-Lite is an update of an existing sensor, SSUSI. The current generation of Defense Meteorological Satellite Program (DMSP) satellites (Block 5D3) includes a hyperspectral, cross-tracking imaging spectrograph known as the Special Sensor Ultraviolet Spectrographic Imager (SSUSI). SSUSI has been part of the DMSP program since 1990. SSUSI is designed to provide space weather information such as: auroral imagery, ionospheric electron density profiles, and neutral density composition changes. The sensors that are flying today (see http://ssusi.jhuapl.edu) were designed in 1990 - 1992. There have been some significant improvements in flight hardware since then. The SSUSI-Lite instrument is more capable than SSUSI yet consumes ½ the power and is ½ the mass. The total package count (and as a consequence, integration cost and difficulty) was reduced from 7 to 2. The scan mechanism was redesigned and tested and is a factor of 10 better. SSUSI-Lite can be flown as a hosted payload or a rideshare - it only needs about 10 watts and weighs under 10 kg. We will show results from tests of an interesting intensified position sensitive anode pulse counting detector system. We use this approach because the SSUSI sensor operates in the far ultraviolet - from about 110 to 180 nm or 0.11 to 0.18 microns.

Causes of distal volcano-tectonic seismicity inferred from hydrothermal modeling

USGS Publications Warehouse

Coulon, Cecile A.; Hsieh, Paul A.; White, Randall A.; Lowenstern, Jacob B.; Ingebritsen, Steven E.

2017-01-01

Distal volcano-tectonic (dVT) seismicity typically precedes eruption at long-dormant volcanoes by days to years. Precursory dVT seismicity may reflect magma-induced fluid-pressure pulses that intersect critically stressed faults. We explored this hypothesis using an open-source magmatic-hydrothermal code that simulates multiphase fluid and heat transport over the temperature range 0 to 1200 °C. We calculated fluid-pressure changes caused by a small (0.04 km3) intrusion and explored the effects of flow geometry (channelized vs. radial flow), magma devolatilization rates (0–15 kg/s), and intrusion depths (5 and 7.5 km, above and below the brittle-ductile transition). Magma and host-rock permeabilities were key controlling parameters and we tested a wide range of permeability (k) and permeability anisotropies (kh/kv), including k constant, k(z), k(T), and k(z, T, P) distributions, examining a total of ~ 1600 realizations to explore the relevant parameter space. Propagation of potentially causal pressure changes (ΔP ≥ 0.1 bars) to the mean dVT location (6 km lateral distance, 6 km depth) was favored by channelized fluid flow, high devolatilization rates, and permeabilities similar to those found in geothermal reservoirs (k ~ 10− 16 to 10− 13 m2). For channelized flow, magma-induced thermal pressurization alone can generate cases of ∆ P ≥ 0.1 bars for all permeabilities in the range 10− 16 to 10− 13 m2, whereas in radial flow regimes thermal pressurization causes ∆ P < 0.1 bars for all permeabilities. Changes in distal fluid pressure occurred before proximal pressure changes given modest anisotropies (kh/kv ~ 10–100). Invoking k(z,T,P) and high, sustained devolatilization rates caused large dynamic fluctuations in k and P in the near-magma environment but had little effect on pressure changes at the distal dVT location. Intrusion below the brittle-ductile transition damps but does not prevent pressure transmission to the dVT site.

Rationale and design of three observational, prospective cohort studies including biobanking to evaluate and improve diagnostics, management strategies and risk stratification in venous thromboembolism: the VTEval Project.

PubMed

Frank, Bernd; Ariza, Liana; Lamparter, Heidrun; Grossmann, Vera; Prochaska, Jürgen H; Ullmann, Alexander; Kindler, Florentina; Weisser, Gerhard; Walter, Ulrich; Lackner, Karl J; Espinola-Klein, Christine; Münzel, Thomas; Konstantinides, Stavros V; Wild, Philipp S

2015-07-01

Venous thromboembolism (VTE) with its two manifestations deep vein thrombosis (DVT) and pulmonary embolism (PE) is a major public health problem. The VTEval Project aims to investigate numerous research questions on diagnosis, clinical management, treatment and prognosis of VTE, which have remained uncertain to date. The VTEval Project consists of three observational, prospective cohort studies on VTE comprising cohorts of individuals with a clinical suspicion of acute PE (with or without DVT), with a clinical suspicion of acute DVT (without symptomatic PE) and with an incidental diagnosis of VTE (PE or DVT). The VTEval Project expects to enrol a total of approximately 2000 individuals with subsequent active and passive follow-up investigations over a time period of 5 years per participant. Time points for active follow-up investigations are at months 3, 6, 12, 24 and 36 after diagnosis (depending on the disease cohort); passive follow-up investigations via registry offices and the cancer registry are performed 48 and 60 months after diagnosis for all participants. Primary short-term outcome is defined by overall mortality (PE-related death and all other causes of death), primary long-term outcome by symptomatic VTE (PE-related death, recurrence of non-fatal PE or DVT). The VTEval Project includes three 'all-comer' studies and involves the standardised acquisition of high-quality data, covering the systematic assessment of VTE including symptoms, risk profile, psychosocial, environmental and lifestyle factors as well as clinical and subclinical disease, and it builds up a large state-of-the-art biorepository containing various materials from serial blood samplings. The VTEval Project has been approved by the local data safety commissioner and the responsible ethics committee (reference no. 837.320.12 (8421-F)). Trial results will be published in peer-reviewed journals and presented at national and international scientific meetings. NCT02156401. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Nadroparin or fondaparinux versus no thromboprophylaxis in patients immobilised in a below-knee plaster cast (PROTECT): A randomised controlled trial.

PubMed

Bruntink, Marlieke M; Groutars, Yannick M E; Schipper, Inger B; Breederveld, Roelf S; Tuinebreijer, Wim E; Derksen, Robert J

2017-04-01

The immobilisation of the lower leg is associated with deep vein thrombosis (DVT). However, thromboprophylaxis in patients with a below-knee plaster cast remains controversial. We examined the efficacy and safety of nadroparin and fondaparinux to ascertain the need for thromboprophylaxis in these patients. PROTECT was a randomised, controlled, single-blind, multicentre study that enrolled adults with an ankle or foot fracture who required immobilisation for a minimum of four weeks. The patients were randomly assigned (1:1:1) to a control group (no thromboprophylaxis) or to one of the intervention groups: daily subcutaneous self-injection of either nadroparin (2850 IE anti-Xa=0.3ml) or fondaparinux (2.5mg=0.5ml). A venous duplex sonography was performed after the removal of the cast or earlier if thrombosis was suspected. The primary outcome was the relative risk of developing DVT in the control group compared with that in both intervention groups. This trial is registered at ClinicalTrials.gov, number NCT00881088. Between April 2009 and December 2015, 467 patients were enrolled and assigned to either the nadroparin group (n=154), the fondaparinux group (n=157), or the control group (n=156). A total of 273 patients (92, 92, and 94 patients, respectively) were analysed. The incidence of DVT in the nadroparin group was 2/92 (2.2%) compared with 11/94 (11.7%) in the control group, with a relative risk of 5.4 (95% CI 1.2-23.6; p=0.011). The incidence of DVT in the fondaparinux group was 1/92 (1.1%), yielding a relative risk of 10.8 (95% CI 1.4-80.7; p=0.003) compared with that in the control group. No major complications occurred in any group. Thromboprophylaxis with nadroparin or fondaparinux significantly reduces the risk of DVT in patients with an ankle or foot fracture who were treated in a below-knee cast without any major adverse events. Copyright © 2017 Elsevier Ltd. All rights reserved.

What Is the Safety and Efficacy of Chemical Venous Thromboembolism Prophylaxis Following Vestibular Schwannoma Surgery?

PubMed

Casazza, Geoffrey C; Bowers, Christian A; MacDonald, Joel D; Couldwell, William T; Shelton, Clough; Gurgel, Richard K

2018-02-01

The benefit of routine chemical prophylaxis use for venous thromboembolism (VTE) prevention in skull base surgery is controversial. Chemical prophylaxis can prevent undue morbidity and mortality, however there are risks for hemorrhagic complications. Retrospective case-control. A retrospective chart review of patients who underwent surgery for vestibular schwannoma from 2011 to 2016 was performed. Patients were divided by receipt of chemical VTE prophylaxis. Number of VTEs and hemorrhagic complications (intracranial hemorrhage, abdominal hematoma, and postauricular hematoma) were recorded. One hundred twenty-six patients were identified, 55 received chemical prophylaxis, and 71 did not. All the patients received mechanical prophylaxis. Two patients developed a deep vein thrombosis (DVT) and one patient developed a pulmonary embolism (PE). All patients who developed a DVT or PE received chemical prophylaxis. There was no difference in DVT (p = 0.1886) or PE (p = 0.4365) between those who received chemical prophylaxis and those who did not. Five patients developed a hemorrhagic complication, two intracranial hemorrhage, three abdominal hematoma, and zero postauricular hematoma. All five patients with a complication received chemical prophylaxis (p = 0.00142). The relative risk of a hemorrhagic complication was 14.14 (95% CI = 0.7987-250.4307; p = 0.0778). There was a significant difference between the number of hemorrhagic complications but not between numbers of DVT or PE. Mechanical and chemical prophylaxis may lower the risk of VTE but in our series, hemorrhagic complications were observed. These measures should be used selectively in conjunction with early ambulation.

A case report: a young waiter with Paget-Schroetter syndrome.

PubMed

Drakos, Nicholas; Gausche-Hill, Marianne

2013-03-01

Paget-Schroetter syndrome (PSS) is a rare presentation of primary axillary subclavian vein thrombosis that classically occurs in young men with a degree of underlying thoracic outlet syndrome after a period of upper extremity exertion. The primary complication of PSS is post-thrombotic syndrome, a result of chronic venous hypertension. To educate Emergency Physicians on this condition to potentiate timely diagnosis and appropriate disposition. A 29-year-old right-handed restaurant waiter presented with 3 days of non-painful, gradual-onset right upper extremity swelling with normal vital signs. The patient's history was otherwise notable for subjective fevers and a right forearm abrasion. Upon examination, the right upper extremity was neurovascularly intact and remarkable for uniform edema and erythema extending distally from the level of the mid-humerus. The primary differential diagnoses were deep venous thrombosis (DVT) vs. soft tissue infection. Venous phase contrast computed tomography did not reveal evidence of underlying soft tissue infection and was inconclusive regarding a DVT. Ultrasound demonstrated a right subclavian vein DVT. The patient was admitted and underwent thrombolysis, venolysis, and first rib resection and initiation of warfarin. PSS is a rare presentation of upper-extremity DVT occurring classically in patients without commonly recognized pro-thrombotic risk factors. PSS carries the potential of significant morbidity in the form of post-thrombotic syndrome and pulmonary embolism. Current literature suggests that optimal outcomes are achieved when treatment is initiated within 6 weeks of onset. The treatment paradigm calls for thrombolysis and, frequently, a first rib resection. Copyright © 2013 Elsevier Inc. All rights reserved.

Relationship between development of post-thrombotic syndrome and serial ultrasound, D-dimer, and factor VIII activity after a first deep venous thrombosis.

PubMed

Roberts, Lara N; Patel, Raj K; Goss, David E; Chitongo, Paradzai; Bonner, Lynda; Arya, Roopen

2016-01-01

The aim of this study was to evaluate the relationship of post-thrombotic syndrome (PTS) with residual vein thrombosis, deep venous reflux (DVT), D-dimer, and factor VIII (FVIII) after a first deep venous thrombosis (DVT). There were 133 participants with objectively confirmed DVT, of whom 114 were observed for 6 months after completion of anticoagulation. Ultrasound, D-dimer, and FVIII evaluations were undertaken at 6 weeks after completion of anticoagulation and at the end of follow-up. PTS was considered present in those with a score of ≥5 on the Villalta scale at either assessment. The cumulative incidence of PTS was 51.8%, with median duration of follow-up of 11 months. Median D-dimer and FVIII in those with PTS were significantly higher at both time points compared with those without. Similarly, residual vein thrombosis and deep venous reflux were more prevalent in those with PTS at both study assessments. On multivariable analysis, only FVIII at end of study remained significantly associated with PTS with an odds ratio of 2.83 (95% confidence interval, 1.09-7.42; P = .034). Ultrasound markers and D-dimer were not significantly associated with PTS after adjustment for age, body mass index, Charlson Index ≥1, and proximal extent of DVT. FVIII activity at end of follow-up was independently associated with PTS, suggesting underlying activation of coagulation. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

High Speed PC Based Data Acquisition and Instrumentation for Measurement of Simulated Low Earth Orbit Thermally Induced Disturbances

NASA Technical Reports Server (NTRS)

Sills, Joel W., Jr.; Griffin, Thomas J. (Technical Monitor)

2001-01-01

The Hubble Space Telescope (HST) Disturbance Verification Test (DVT) was conducted to characterize responses of the Observatory's new set of rigid solar array's (SA3) to thermally induced 'creak' or stiction releases. The data acquired in the DVT were used in verification of the HST Pointing Control System on-orbit performance, post-Servicing Mission 3B (SM3B). The test simulated the on-orbit environment on a deployed SA3 flight wing. Instrumentation for this test required pretest simulations in order to select the correct sensitivities. Vacuum compatible, highly accurate accelerometers and force gages were used for this test. The complexity of the test, as well as a short planning schedule, required a data acquisition system that was easy to configure, highly flexible, and extremely robust. A PC Windows oriented data acquisition system meets these requirements, allowing the test engineers to minimize the time required to plan and perform complex environmental test. The SA3 DVT provided a direct practical and complex demonstration of the versatility that PC based data acquisition systems provide. Two PC based data acquisition systems were assembled to acquire, process, distribute, and provide real time processing for several types of transducers used in the SA3 DVT. A high sample rate digital tape recorder was used to archive the sensor signals. The two systems provided multi-channel hardware and software architecture and were selected based on the test requirements. How these systems acquire and processes multiple data rates from different transducer types is discussed, along with the system hardware and software architecture.

Effects of forced deep breathing on blood flow velocity in the femoral vein: Developing a new physical prophylaxis for deep vein thrombosis in patients with plaster cast immobilization of the lower limb.

PubMed

Nakanishi, Keisuke; Takahira, Naonobu; Sakamoto, Miki; Yamaoka-Tojo, Minako; Katagiri, Masato; Kitagawa, Jun

2018-02-01

Patients with plaster cast immobilization of the lower limb have an estimated symptomatic venous thromboembolism rate of 5.5%. However, there is currently no practical physical prophylaxis for deep-vein thrombosis (DVT). The objective of this study was to examine the effects of forced deep breathing on peak blood velocity in the superficial femoral vein (PBVFV), which is a surrogate measure of the efficacy of thromboprophylaxis against DVT, in patients with plaster cast immobilization of the lower limb. Nine young males and 18 elderly males were recruited. We immobilized the right lower limb of each subject with a plaster splint and measured PBVFV during forced deep breathing in supine and sitting positions. In all subjects, PBVFV during forced deep breathing in both positions was significantly higher than at rest. There was no significant difference in the PBVFV change ratio for three breathing rates in the sitting position for the young subjects (15breaths/min: 415%, 5breaths/min: 475%, 3breaths/min: 483%), whereas that for the elderly subjects at 3breaths/min (449%) was significantly higher than that at 15breaths/min (284%). Forced deep breathing significantly increased PBVFV in patients with plaster cast immobilization of the lower limb in both supine and sitting positions. Testing the efficacy and adherence in clinical contexts, and following up with the incidence rate of DVT in future studies, is necessary for the development of a new physical prophylaxis for DVT. Copyright © 2017 Elsevier Ltd. All rights reserved.

Endovascular Treatment of Veno-Occlusive Behcet's Disease

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tekbas, Guven, E-mail: drgtekbas@gmail.com; Oguzkurt, Levent, E-mail: loguzkurt@yahoo.com; Gur, Serkan, E-mail: mserkangur@yahoo.com

Purpose: To retrospectively evaluate the outcome of endovascular treatments for patients with chronic veno-occlusive disease in different vascular beds secondary to Behcet's disease (BD). There are few case reports on the subject, and this is the largest study to date. Materials and Methods: From January 2001 through October 2009, chronic venous occlusions were treated in 10 patients (all male [age range 18-76 years]) with BD using percutaneous transluminal angioplasty and/or stent placement. All patients were symptomatic and had chronic iliofemoral deep venous thrombosis (DVT; n = 5), central venous occlusion (n = 3), or Budd-Chiari syndrome (BCS; n = 2).more » All patients met criteria of the International Study Group on Behcet's Disease. Results: Two of five patients with DVT had unsuccessful recanalization attempts. Three patients had successful recanalization with stent placement. All three veins were occluded within 1 month with unsuccessful reinterventions. Three patients with chronic central venous occlusion had successful recanalization with percutaneous transluminal angioplasty (n = 1) and stent placement (n = 2). Two patients had reocclusion with successful reintervention. Two BCS patients had successful treatment with stent placements. Overall technical success was 69%, and no procedural complications were encountered. None of the patients with chronic DVT had patent veins; however, all patients with central venous occlusion or BCS had patent veins on color Doppler ultrasonography at follow-up ranging from 3 to 48 months after intervention. Conclusion: Endovenous treatment for chronic iliofemoral DVT due to BD had a poor outcome. However, long-term outcome after endovenous treatment for upper-extremity central venous occlusion and BCS syndrome was good.« less

A novel approach for assessing the progression of deep venous thrombosis by area of venous thrombus in ultrasonic elastography.

PubMed

Wang, Chao; Wang, Lei; Zhang, Yuhui; Chen, Ming

2014-04-01

Exact age determination of deep venous thrombosis (DVT) is important for an appropriate treatment. The purpose of this present study is to assess the age of acute DVT with the area of venous thrombi in elasticity imaging during the thrombosis procession. The thrombus area is obtained from a specially designed program. It was applied to clot specimens induced in human great saphenous (n = 15) at selected time points following the initiation of thrombosis. The relative mean proportion of blood clots was 50.01% ± 12.44% at day 1; 69.94% ± 8.19% at day 3; 81.93% ± 6.15% at day 6; and 92.37% ± 4.06% at day 9. The results indicated that the thrombus area increased significantly over time, while the normalized strain values inside the thrombus changed only a little. The pathological analyses also showed the same results. Therefore, we conclude that the area of venous thrombi in elasticity imaging may be a novel function for acute DVT staging.

[Outpatient management of patients with deep vein thrombosis and cancer: a study of safety, cost and budget impact].

PubMed

Jara Palomares, Luis; Caballero Eraso, Candela; Elías Hernández, Teresa; Ferrer Galván, Marta; Márquez Peláez, Sergio; Cayuela, Aurelio; Alfaro, María José; Barrot Cortés, Emilia; Otero Candelera, Remedios

2012-04-07

This is a safety and cost comparison study with an analysis of budgetary impact of ambulatory management of patients with cancer and deep vein thrombosis (DVT) compared with hospital management. Prospective observational study of patients with known malignancy and diagnosed with DVT from 2003 to 2007. The outcome variables were mortality, relapse and bleeding in one month. We conducted an economic analysis to evaluate the comparative cost of ambulatory patients. Three hundred and seventeen patients, 55 (17%) had cancer. The mean age of patients was 63 ± 11 years. There were 2 hemorrhagic events, 2 recurrences and 6 deaths in one month of follow-up. Of all patients, only 7 (13,7%) required hospitalization. All but one deaths were due to progression of the underlying disease. Economic analysis concluded that outpatient management is 6 times less expensive than hospital management, which would imply a cost reduction of 85%. Specialized outpatient treatment of cancer patients with DVT is safe and could save significant financial resources. Copyright © 2011 Elsevier España, S.L. All rights reserved.

Density conversion factor determined using a cone-beam computed tomography unit NewTom QR-DVT 9000.

PubMed

Lagravère, M O; Fang, Y; Carey, J; Toogood, R W; Packota, G V; Major, P W

2006-11-01

The purpose of this study was to determine a conversion coefficient for Hounsfield Units (HU) to material density (g cm(-3)) obtained from cone-beam computed tomography (CBCT-NewTom QR-DVT 9000) data. Six cylindrical models of materials with different densities were made and scanned using the NewTom QR-DVT 9000 Volume Scanner. The raw data were converted into DICOM format and analysed using Merge eFilm and AMIRA to determine the HU of different areas of the models. There was no significant difference (P = 0.846) between the HU given by each piece of software. A linear regression was performed using the density, rho (g cm(-3)), as the dependent variable in terms of the HU (H). The regression equation obtained was rho = 0.002H-0.381 with an R2 value of 0.986. The standard error of the estimation is 27.104 HU in the case of the Hounsfield Units and 0.064 g cm(-3) in the case of density. CBCT provides an effective option for determination of material density expressed as Hounsfield Units.

Fatigue Rated Fastener Systems

DTIC Science & Technology

1985-11-01

programme part also .how. that the »tatement "the higher th«. load traust.,, the shorter the tallgu. lite could not b. confirmed for all Joints. It might...realistic fatigue loading: the lite improvement mechanisms are more marked in these Joints than in .-.-* luad transfer/low secondary bending Joints...7050-T76 PRIMER REAM HI-LOK TEST SERIES NOT CLEARANCE 10-30 34432 11832 GH3 JRFS-A") COLD WORK VRFS -B) INTERFERENCE 15-35 >16773 >16044

Scientific investigations planned for the Lidar in-Space Technology Experiment (LITE)

NASA Technical Reports Server (NTRS)

Mccormick, M. P.; Winker, D. M.; Browell, E. V.; Coakley, J. A.; Gardner, C. S.; Hoff, R. M.; Kent, G. S.; Melfi, S. H.; Menzies, R. T.; Platt, C. M. R.

1993-01-01

The Lidar In-Space Technology Experiment (LITE) is being developed by NASA/Langley Research Center for a series of flights on the space shuttle beginning in 1994. Employing a three-wavelength Nd:YAG laser and a 1-m-diameter telescope, the system is a test-bed for the development of technology required for future operational spaceborne lidars. The system has been designed to observe clouds, tropospheric and stratospheric aerosols, characteristics of the planetary boundary layer, and stratospheric density and temperature perturbations with much greater resolution than is available from current orbiting sensors. In addition to providing unique datasets on these phenomena, the data obtained will be useful in improving retrieval algorithms currently in use. Observations of clouds and the planetary boundary layer will aid in the development of global climate model (GCM) parameterizations. This article briefly describes the LITE program and discusses the types of scientific investigations planned for the first flight.

Using CREAM and CEMonitor for job submission and management in the gLite middleware

NASA Astrophysics Data System (ADS)

Aiftimiei, C.; Andreetto, P.; Bertocco, S.; Dalla Fina, S.; Dorigo, A.; Frizziero, E.; Gianelle, A.; Marzolla, M.; Mazzucato, M.; Mendez Lorenzo, P.; Miccio, V.; Sgaravatto, M.; Traldi, S.; Zangrando, L.

2010-04-01

In this paper we describe the use of CREAM and CEMonitor services for job submission and management within the gLite Grid middleware. Both CREAM and CEMonitor address one of the most fundamental operations of a Grid middleware, that is job submission and management. Specifically, CREAM is a job management service used for submitting, managing and monitoring computational jobs. CEMonitor is an event notification framework, which can be coupled with CREAM to provide the users with asynchronous job status change notifications. Both components have been integrated in the gLite Workload Management System by means of ICE (Interface to CREAM Environment). These software components have been released for production in the EGEE Grid infrastructure and, for what concerns the CEMonitor service, also in the OSG Grid. In this paper we report the current status of these services, the achieved results, and the issues that still have to be addressed.

Sistema Planeta-Satélite. Simulación orbital y potenciales gravitatorios

NASA Astrophysics Data System (ADS)

Medina, C.; Carrillo, M.

Se presenta un programa (desarrollado en Quick Basic 4.5) que simula, en tres dimensiones, el movimiento orbital de un satélite (o luna) alrededor de un planeta, al tiempo que calcula y grafica, en un plano, el potencial gravitatorio del sistema en función de la distancia al planeta. Para la simulación orbital, se emplea la matriz de transformación entre el sistema del planeta y el plano orbital. Para el cálculo y graficación del potencial se aplica un desarrollo en serie hasta el segundo orden, que da cuenta del efecto de achatamiento de los polos, en caso de que éste exista. Las longitudes de los ejes del planeta, la masa de éste y del satélite, sus tamaños aparentes, y los parámetros orbitales son introducidos por el usuario.

In vitro metabolism studies of desoxy-methyltestosterone (DMT) and its five analogues, and in vivo metabolism of desoxy-vinyltestosterone (DVT) in horses.

PubMed

Kwok, Wai Him; Kwok, Karen Y; Leung, David K K; Leung, Gary N W; Wong, Colton H F; Wong, Jenny K Y; Wan, Terence S M

2015-08-01

The positive findings of norbolethone in 2002 and tetrahydrogestrinone in 2003 in human athlete samples confirmed that designer steroids were indeed being abused in human sports. In 2005, an addition to the family of designer steroids called 'Madol' [also known as desoxy-methyltestosterone (DMT)] was seized by government officials at the US-Canadian border. Two years later, a positive finding of DMT was reported in a mixed martial arts athlete's sample. It is not uncommon that doping agents used in human sports would likewise be abused in equine sports. Designer steroids would, therefore, pose a similar threat to the horseracing and equestrian communities. This paper describes the in vitro metabolism studies of DMT and five of its structural analogues with different substituents at the 17α position (RH, ethyl, vinyl, ethynyl and 2 H 3 -methyl). In addition, the in vivo metabolism of desoxy-vinyltestosterone (DVT) in horses will be presented. The in vitro studies revealed that the metabolic pathways of DMT and its analogues occurred predominantly in the A-ring by way of a combination of enone formation, hydroxylation and reduction. Additional biotransformation involving hydroxylation of the 17α-alkyl group was also observed for DMT and some of its analogues. The oral administration experiment revealed that DVT was extensively metabolised and the parent drug was not detected in urine. Two in vivo metabolites, derived respectively from (1) hydroxylation of the A-ring and (2) di-hydroxylation together with A-ring double-bond reduction, could be detected in urine up to a maximum of 46 h after administration. Another in vivo metabolite, derived from hydroxylation of the A-ring with additional double-bond reduction and di-hydroxylation of the 17α-vinyl group, could be detected in urine up to a maximum of 70 h post-administration. All in vivo metabolites were excreted mainly as glucuronides and were also detected in the in vitro studies. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

A low-power, high-efficiency Ka-band TWTA

NASA Astrophysics Data System (ADS)

Curren, Arthur N.; Dayton, James A., Jr.; Palmer, Raymond W.; Force, Dale A.; Tamashiro, Rodney N.; Wilson, John F.; Dombro, Louis; Harvey, Wayne L.

1992-03-01

NASA has developed a new class of Ka-band TWT amplifiers (TWTAs) which achieve their high efficiency/low power performance goals by means of an advanced dynamic velocity taper (DVT). The DVT is characterized by a continuous, nonlinear reduction in helix pitch from its initial synchronous value in the output section of the TWT to near the end of the helix. Another efficiency-maximizing feature is the inclusion of a multistage depressed collector employing oxygen-free, high-conductivity Cu electrodes treated for secondary electron emission suppression by means of ion bombardment. An efficiency of 43 percent is expected to be reached.

A NATO Guide for Assessing Deployability for Military Personnel with Medical Conditions (Guide OTAN d’evaluation de l’aptitude medicale a la projection du personnel militaire)

DTIC Science & Technology

2014-06-01

Pulmonary Embolism (PE) / Deep Venous Thrombosis (DVT) 3-9 3.2.16.3 Venous Insufficiency 3-9 3.2.17 Vision/Ophthalmology 3-9 3.2.17.1 Refractive Surgery...Thoracic Aortic Aneurysms 3-63 3.3.16.2 History of Pulmonary Embolism (PE) or Deep Venous Thrombosis 3-65 (DVT) 3.3.16.3 Venous Insufficiency 3-67...Drugs OCD Obsessive-Compulsive Disorder PASI Psoriasis Area and Severity Index PE Pulmonary Embolism PEF Peak Expiratory Flow PHA Periodic

Deep vein thrombosis following prolonged kneeling: a case report.

PubMed

van Beeck, J Looringh; Versfeld, K; Ehrlich, R

2014-06-01

This report describes a fibreglass mould maker in the yacht building industry who developed a deep vein thrombosis (DVT) after 6 weeks of working in a kneeling position. We propose that his prolonged kneeling combined with constrictive knee pad straps caused vascular compression, precipitating his DVT. A hypercoagulability diathesis was suspected but not confirmed. Operator and employer education, modified work practices and strapless knee pads are suggested as possible preventive measures. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Appropriate use of D-dimer testing can minimize over-utilization of venous duplex ultrasound in a contemporary high-volume hospital.

PubMed

Mousa, Albeir Y; Broce, Mike; Gill, Gurpreet; Kali, Maher; Yacoub, Michael; AbuRahma, Ali F

2015-02-01

The sensitivity of d-dimer (DD) in detecting deep venous thrombosis (DVT) is remarkably high; however, many institutions send patients immediately for a venous duplex ultrasound (VDU). This study was designed to examine the appropriate utilization of DD and VDU in a high-volume hospital. A retrospective study was conducted on consecutive patients who presented to a high-volume emergency department (ED) with lower extremity limb swelling/pain over a 30-day period, who were sent for VDU during an evaluation for DVT. VDU data were merged with electronic DD laboratory results. The enzyme-linked immunosorbent assay method was used to provide DD values and thresholds. Values above 0.60 mg/fibrinogen equivalent unit (FEU) were considered abnormal. We reviewed the medical records of 517 ED patients in the month of June 2013. After applying the Wells criteria, 157 patients (30.4%) were excluded because of a history of DVT or pulmonary embolism, having been screened for shortness of breath, or sent for surveillance-leaving 360 for analysis. The average age was 59.3 ± 16.5 years with more women (210, 58.3%) and the majority reported limb pain or swelling (73.9%). DD was performed on 51 patients with an average value of 3.6 ± 5.4 mg/FEU, of which 43 (84.3%) were positive. DD identified all positive and negative DVT patients (100% sensitivity and negative predictive value), but also included 40 false positives (16.7% specificity). On the other hand, 309 patients were sent directly to VDU without DD; of those, 43 (13.9%) were positive for DVT. However, 266 (86.1%) patients were negative for DVT by VDU without DD and these were deemed improper by our current study protocol. Potential charge savings were calculated as VDU for all (360 × $1000 = $360,000), DD for all (360 × $145 = $52,200), and VDU for both true and false positives (estimated to be about 25% of the cases; 90 × $1000 = $90,000); this equals a charge savings of $217,800 and would avoid unnecessary VDUs. Based on the results of our study, we suggest that the DD test be utilized during the initial work-up for patients with limb swelling/pain in the emergency room. Appropriate utilization of DD, as well as other clinical criteria, may limit the over-utilization and added cost of VDU, without a negative impact on patient care. The results of DD tests should be utilized to limit the number of patients sent for VDU to only those patients with a positive DD or other significant underlying concerns. Copyright © 2015 Elsevier Inc. All rights reserved.

xEMU Lite Development Plan

NASA Technical Reports Server (NTRS)

Rodriggs, Liana

2017-01-01

Since 2012, the Advanced EVA Development team has been maturing the design for an exploration suit (xEMU) capable of supporting Deep Space Gateway missions with the goal of demonstrating the core system architecture (xEMU Lite) on ISS by the mid-2020s. This presentation will provide a high-level status on progress made since the 2016 EVA Workshop, an overview of the xEMU architecture, and a summary of new development milestones and decision points between now and 2024.

The Selection Process of U.S. Army Recruiters.

DTIC Science & Technology

1986-06-06

lite ana nas orobablv caused a hioh orooortion to list iob security as one ot their inain considerations when lookina for a future orofession. This...34 not they previously felt satisfied with the military as a way of lite . Almost all of those who like beino recruiters wrt a future assion- ment within... Vrf -onal. presented to the newlv selected recruiter) by the chain of command. Similartv, it seems imperative to counter the onooino and mainlv neoative

Comparison of Direct Oral Anticoagulants and Warfarin in the Treatment of Deep Venous Thrombosis in the Chronic Phase.

PubMed

Wakakura, Shingo; Hara, Fumihiko; Fujino, Tadashi; Hamai, Asami; Ohara, Hiroshi; Kabuki, Takayuki; Harada, Masahiko; Ikeda, Takanori

2018-01-27

We assessed the efficacy and safety of direct oral anticoagulants (DOACs) for the treatment of deep venous thrombosis (DVT) in the chronic phase through comparison with conventional warfarin therapy.A total of 807 consecutive patients who were diagnosed with having DVT in the chronic phase were included (484 patients to warfarin therapy and 323 patients to DOAC therapy). The condition of leg veins was assessed 3 to 6 months after starting the therapies by ultrasound examination. Major bleeding and mortality during the therapies were followed-up.There was no significant difference between the two groups in the thrombosis improvement rate (DOAC group: 91.2% versus warfarin group: 88.9%). There was no significant difference between the two groups in major bleeding (DOAC group: 1.8% versus warfarin group: 1.8%). In patients with active cancer, the DOAC group had a borderline higher thrombosis improvement rate than the warfarin group (92.1% versus 80.0%, P = 0.05). The proportion of major bleeding in the patients with active cancer was slightly higher in the warfarin group than in the DOAC group (4.3% versus 2.8%; P = 0.71). Active cancer was not an independent risk factor for major bleeding and recurrence in the DOAC group (OR 2.68, 95% CI 0.51-14.1; P = 0.24 and OR 0.65, 95% CI 0.20-2.07; P = 0.47).In treatment using oral anticoagulants for DVT in the chronic phase, DOACs exhibited equal efficacy and safety as warfarin did. Particularly DOACs appear to be an attractive therapeutic option for cancer-associated DVT in chronic phase, with relatively low anticipated rates of recurrence and major bleeding.

An Unusual Endovascular Therapeutic Approach for a Rare Case of May-Thurner Syndrome

PubMed Central

DaSilva-DeAbreu, Adrian; Masha, Luke; Peerbhai, Shareez

2017-01-01

Patient: Male, 69 Final Diagnosis: May-Thurner syndrome secondary to left common iliac artery aneurysm Symptoms: Left lower extremity edema • left lower extremity erythema • left lower extremity pain Medication: — Clinical Procedure: Endovascular aneurysm repair (EVAR) of the infra-renal abdominal aorta aneurysm and right common iliac artery aneurysm Specialty: Cardiology Objective: Unknown ethiology Background: The etiology of deep venous thrombosis (DVT) may pose a significant diagnostic challenge because truly reversible causes of DVT are rare. In this regard, known pelvic anatomic abnormalities such as aortic and iliac aneurysms should be seriously considered as a complicating factor in patients presenting with acute DVT so as not to miss a potentially curable etiology of May-Thurner syndrome (MTS). Case Report: We report the case of a 69-year-old man with a known abdominal aortic aneurysm and bilateral iliac artery aneurysms who presented with an acute DVT. A computed tomography scan of the abdomen and pelvis showed increased dilation of his aneurysmal disease with new resultant compression of the left iliac vein representing acquired MTS. The patient underwent endovascular aneurysm repair of the infra-renal abdominal aortic aneurysm and right common iliac artery aneurysm with a Gore Excluder endoprosthesis in lieu of venous stenting, with resolution of symptoms. Conclusions: Infra-renal aortic and iliac aneurysms causing MTS are extremely rare, and patients at risk for MTS through these mechanisms do not fit the classical demographics associated with this syndrome. Furthermore, this is the first case described in which MTS was treated by addressing the aneurysm through an endoprosthetic approach instead of venous stenting, which is the conventional intervention for MTS. PMID:28260745

Apixaban versus enoxaparin in the prevention of venous thromboembolism following total knee arthroplasty: a single-centre, single-surgeon, retrospective analysis.

PubMed

King, D A L; Pow, R E; Dickison, D M; Vale, P R

2016-09-01

There is a high risk of developing venous thromboembolism (VTE) following total knee arthroplasty (TKA). Conventional thromboprophylactic agents have limitations, such as route of administration, the need for monitoring, narrow therapeutic windows and interactions. Apixaban is a new oral anticoagulant with the potential to overcome these limitations. To report the efficacy and safety of apixaban and low-molecular-weight heparin, enoxaparin, in VTE prophylaxis following TKA. This single-centre, single-surgeon, retrospective analysis included 506 consecutive patients who underwent TKA between 2009 and 2015 and received enoxaparin or apixaban as thromboprophylaxis. Baseline characteristics of patients, in-hospital rates of VTE, total DVT, proximal or distal DVT, pulmonary embolism, bleeding outcomes and mortality were compared between the two groups. In-hospital VTE occurred in 22 (8.9%) patients in the enoxaparin group and 11 (4.5%) patients in the apixaban group (P = 0.049). Nine (3.6%) patients in the enoxaparin group and one (0.4%) in the apixaban group experienced a postoperative drop in haemoglobin ≥20 g/L that either necessitated transfusion of ≥2 units blood, caused haemodynamic instability or both (P = 0.020). Thirty-five patients experienced other bleeding events, with 25 (9.9%) in the enoxaparin group and 10 (4.0%) in the apixaban group (P = 0.009). There were no statistically significant differences in rates of total DVT, proximal or distal DVT, pulmonary embolism or mortality between the groups. Compared with enoxaparin, thromboprophylaxis with apixaban resulted in a lower VTE incidence and fewer haemorrhagic complications. © 2016 Royal Australasian College of Physicians.

AXAF-I Low Intensity-Low Temperature (LILT) Testing of the Development Verification Test (DVT) Solar Panel

NASA Technical Reports Server (NTRS)

Alexander, Doug; Edge, Ted; Willowby, Doug

1998-01-01

The planned orbit of the AXAF-I spacecraft will subject the spacecraft to both short, less than 30 minutes for solar and less than 2 hours for lunar, and long earth eclipses and lunar eclipses with combined conjunctive duration of up to 3 to 4 hours. Lack of proper Electrical Power System (EPS) conditioning prior to eclipse may cause loss of mission. To avoid this problem, for short eclipses, it is necessary to off-point the solar array prior to or at the beginning of the eclipse to reduce the battery state of charge (SOC). This yields less overcharge during the high charge currents at sun entry. For long lunar eclipses, solar array pointing and load scheduling must be tailored for the profile of the eclipse. The battery SOC, loads, and solar array current-voltage (I-V) must be known or predictable to maintain the bus voltage within acceptable range. To address engineering concerns about the electrical performance of the AXAF-I solar array under Low Intensity and Low Temperature (LILT) conditions, Marshall Space Flight Center (MSFC) engineers undertook special testing of the AXAF-I Development Verification Test (DVT) solar panel in September-November 1997. In the test the DVT test panel was installed in a thermal vacuum chamber with a large view window with a mechanical "flapper door". The DVT test panel was "flash" tested with a Large Area Pulse Solar Simulator (LAPSS) at various fractional sun intensities and panel (solar cell) temperatures. The testing was unique with regards to the large size of the test article and type of testing performed. The test setup, results, and lessons learned from the testing will be presented.

Multi-faceted implementation strategy to increase use of a clinical guideline for the diagnosis of deep venous thrombosis in primary care.

PubMed

Kingma, Anna E C; van Stel, Henk F; Oudega, Ruud; Moons, Karel G M; Geersing, Geert-Jan

2017-08-01

A clinical decision rule (CDR), combined with a negative D-dimer test, can safely rule out deep venous thrombosis (DVT) in primary care. This strategy is recommended by guidelines, yet uptake by GPs is low. To evaluate a multi-faceted implementation strategy aimed at increased use of the guideline recommended CDR plus D-dimer test in primary care patients with suspected DVT. This multi-faceted implementation strategy consisted of educational outreach visits, financial reimbursements and periodical newsletters. 217 Dutch GPs (implementation group) received this strategy and included patients. Effectiveness was measured through the following patient-level outcomes: (i) proportion of non-referred patients, (ii) proportion of missed DVT cases within this group and (iii) the proportion of patients in whom the guideline was applied incorrectly. Implementation outcomes ('acceptability', 'feasibility', 'fidelity' and 'sustainability') were assessed with an online questionnaire. Patient-level outcomes were compared with those of patients included by 450 GPs, uninformed about the study's purposes providing information about usual care. 336 (54%) of 619 analyzable implementation group patients were not referred, missing 6 [1.8% (95% confidence interval 0.7% to 3.9%)] DVT cases. Incorrect guideline use was observed in 199 patients (32%). Self-reported acceptability, feasibility and expected sustainability were high. Guideline use increased from 42% to an expected continuation of use of 91%. Only 32 usual care GPs included 62 patients, making formal comparison unreliable. This multi-faceted implementation strategy safely reduced patient referral to secondary care, despite frequently incorrect application of the guideline and resulted in high acceptability, feasibility and expected sustainability. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Low-molecular-weight heparin and intermittent pneumatic compression for thromboprophylaxis in critical patients

PubMed Central

WAN, BING; FU, HAI-YAN; YIN, JIANG-TAO; REN, GUO-QING

2015-01-01

The efficacy and safety of physiotherapeutic prophylaxis for venous thromboembolism in critically ill patients with heparin contraindication remains unclear. In the present study it was hypothesized that physiotherapy prophylaxis with intermittent pneumatic compression (IPC) would be safe and effective for patients unable to receive low-molecular-weight heparin (LMWH). In addition, this study investigated whether a combined therapy of IPC with LMWH would be more effective for the prophylaxis of deep vein thrombosis (DVT) in critical patients. A total of 500 patients were divided into four groups according to the prophylaxis of DVT. The IPC group consisted of 95 patients with heparin contraindication that received IPC treatment; the LMWH group consisted of 185 patients that received an LMWH injection; the LMWH + IPC group consisted of 75 patients that received IPC treatment and LMWH injection; and the control group consisted of 145 patients that received no IPC treatment or injection of LMWH. Each patient was evaluated clinically for development of DVT and the diagnosis was confirmed by Doppler study. Venous thromboembolism was a common complication among the trauma patients with severe injuries. Patients responded positively to the treatment used in the intervention groups. Patients exhibited an improved response to LMWH + ICP compared with IPC or LMWH alone, while no significant difference was detected between the IPC and LMWH groups. These results were applicable to patients that had a Wells score of ≥3; however, no significant differences in DVT incidence were observed among the patients who had a Wells score of <3. In this observational study, LMWH + ICP appeared to be more effective than either treatment alone in treating critically ill trauma patients with severe injuries that are at high risk for VTE and bleeding simultaneously. PMID:26668637

Improvements in health‐related quality of life over 3 years with liraglutide 3.0 mg compared with placebo in participants with overweight or obesity

PubMed Central

Gabriel Smolarz, B.; Meincke, H. H.; Fujioka, K.

2017-01-01

Summary Previously in the SCALE Obesity and Prediabetes trial, at 1 year, participants with obesity (or overweight with comorbidities) and prediabetes receiving liraglutide 3.0 mg experienced greater improvements in health‐related quality of life (HRQoL) than those receiving placebo. The current study extends these findings by examining 3‐year changes in HRQoL. HRQoL was assessed using the obesity‐specific Impact of Weight on Quality of Life‐Lite (IWQOL‐Lite) questionnaire, as well as the Short‐Form 36 v2 (SF‐36) health survey. At 3 years, mean change (±standard deviation) in IWQOL‐Lite total score from baseline for liraglutide (n = 1472) was 11.0 ± 14.2, vs. 8.1 ± 14.7 for placebo (n = 738) (estimated treatment difference [ETD] 3.4 [95% confidence interval (CI): 2.0, 4.7], P < 0.0001). Mean change in SF‐36 physical component summary (PCS) score from baseline for liraglutide was 3.1 ± 7.3, vs. 2.6 ± 7.6 for placebo (ETD 0.87 [95% CI: 0.17, 1.6], P = 0.0156). Mean change in SF‐36 mental component summary score did not significantly differ between groups. Both IWQOL‐Lite total score and PCS score demonstrated an association between greater HRQoL improvement with higher weight loss. Liraglutide 3.0 mg was also associated with improved health utility (Short‐Form‐6D and EuroQol‐5D, mapped from IWQOL‐Lite and/or SF‐36) vs. placebo. Liraglutide 3.0 mg, plus diet and exercise, is associated with long‐term improvements in HRQoL with obesity or overweight with comorbidity vs. placebo. PMID:29045079

Improvements in health-related quality of life over 3 years with liraglutide 3.0 mg compared with placebo in participants with overweight or obesity.

PubMed

Kolotkin, R L; Gabriel Smolarz, B; Meincke, H H; Fujioka, K

2018-02-01

Previously in the SCALE Obesity and Prediabetes trial, at 1 year, participants with obesity (or overweight with comorbidities) and prediabetes receiving liraglutide 3.0 mg experienced greater improvements in health-related quality of life (HRQoL) than those receiving placebo. The current study extends these findings by examining 3-year changes in HRQoL. HRQoL was assessed using the obesity-specific Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire, as well as the Short-Form 36 v2 (SF-36) health survey. At 3 years, mean change (±standard deviation) in IWQOL-Lite total score from baseline for liraglutide (n = 1472) was 11.0 ± 14.2, vs. 8.1 ± 14.7 for placebo (n = 738) (estimated treatment difference [ETD] 3.4 [95% confidence interval (CI): 2.0, 4.7], P < 0.0001). Mean change in SF-36 physical component summary (PCS) score from baseline for liraglutide was 3.1 ± 7.3, vs. 2.6 ± 7.6 for placebo (ETD 0.87 [95% CI: 0.17, 1.6], P = 0.0156). Mean change in SF-36 mental component summary score did not significantly differ between groups. Both IWQOL-Lite total score and PCS score demonstrated an association between greater HRQoL improvement with higher weight loss. Liraglutide 3.0 mg was also associated with improved health utility (Short-Form-6D and EuroQol-5D, mapped from IWQOL-Lite and/or SF-36) vs. placebo. Liraglutide 3.0 mg, plus diet and exercise, is associated with long-term improvements in HRQoL with obesity or overweight with comorbidity vs. placebo. © 2017 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.

Traitement de la neuromyélite optique de Devic durant de la grossesse

PubMed Central

Daouda, Moussa Toudou; Obenda, Norlin Samuel; Assadeck, Hamid; Camara, Diankanagbe; Djibo, Fatimata Hassane

2016-01-01

La neuromyélite optique de Devic est une pathologie inflammatoire démyélinisante du système nerveux central qui affecte électivement la moelle spinale, le nerf optique et les régions cérébrales à haute expression d’antigènes aquaporine 4. Il s’agit d’une pathologie auto-immune sévère due à des auto-anticorps dirigés contre l’aquaporine 4, à taux de morbidité et de mortalité élevé. Contrairement à d’autres pathologies inflammatoires notamment la sclérose en plaques ou polyarthrite rhumatoïde, la grossesse n’exerce aucune influence sur l’activité de la neuromyélite optique d’où la nécessité d’instaurer un traitement de fond durant toute la grossesse. La corticothérapie représente le traitement de premier choix de la neuromyélite optique durant la grossesse. D’autres traitements peuvent également être utilisés notamment le rituximab, certains immunosuppresseurs, les immunoglobulines. Le traitement par immunosuppresseurs ou rituximab est proposé lorsque la corticothérapie au long cours est contre-indiquée ou en cas d’inefficacité à celle-ci ou encore lorsque les effets secondaires sont intolérables. Les immunoglobulines sont administrées en cas de poussées sévères de la neuromyélite optique qui ne répondent pas aux bolus de methylprednisolone. Les immunoglobulines peuvent également être poursuivies seules à la dose 0,4g/kg/j toutes les 6 à 8 semaines jusqu’à l’accouchement. La plasmaphérèse est également une bonne alternative aux bolus de methylprednisolone lorsque les poussées sont très sévères. PMID:27800085

Biomechanical evaluation of potential damage to hernia repair materials due to fixation with helical titanium tacks.

PubMed

Lerdsirisopon, Sopon; Frisella, Margaret M; Matthews, Brent D; Deeken, Corey R

2011-12-01

This study aimed to determine whether the strength and extensibility of hernia repair materials are negatively influenced by the application of helical titanium tacks. This study evaluated 14 meshes including bare polypropylene, macroporous polytetrafluoroethylene, absorbable barrier, partially absorbable mesh, and expanded polytetrafluoroethylene materials. Each mesh provided 15 specimens, which were prepared in 7.5 × 7.5-cm squares. Of these, 5 "undamaged" specimens were subjected to ball-burst testing to determine their biomechanical properties before application of helical titanium tacks (ProTack). To 10 "damaged" specimens 7 tacks were applied 1 cm apart in a 3.5-cm-diameter circle using a tacking force of 25 to 28 N. The tacks were removed from five of the specimens before ball-burst testing and left intact in the remaining five specimens. The application of tacks had no effect on the tensile strength of Dualmesh, ProLite Ultra, Infinit, Ultrapro, C-QUR Lite (<6 in.), Prolene Soft, or Physiomesh, but the tensile strengths were reduced for Bard Mesh, C-QUR, ProLite, and C-QUR Lite (>6 in.). Most of the meshes did not exhibit significantly different tensile strengths between removal of tacks and tacks left intact. Exceptions included C-QUR, Prolene, Ultrapro, and Bard Soft Mesh, which were weaker with removal of tacks than with tacks left intact during the test. Damage due to the application of helical titanium tacks also caused increased strain at a stress of 16 N/cm for all the meshes except C-QUR Lite (>6 in.) and Physiomesh. Many of the meshes evaluated in this study exhibited damage in the form of reduced tensile strength and increased extensibility after the application of tacks compared with the corresponding "undamaged" meshes. Meshes with smaller interstices and larger filaments were influenced negatively by the application of helical titanium tacks, whereas mesh designs with larger interstices and smaller filaments tended to maintain their baseline mechanical properties.

The Project LITE Spectrum Explorer

NASA Astrophysics Data System (ADS)

Brecher, K.; Carr, P.; Garik, P.; Weeks, E.

2002-12-01

We are developing a powerful new software tool which can help students at all levels understand the spectral properties of light. As a recent AAS survey of astronomy faculty members found (The Physics Teacher, 39, 52, 2001), essentially all introductory astronomy courses spend a significant amount of time dealing with the nature of light. Among the most difficult concepts for students to master are Kirchhoff's laws, blackbody radiation, the Stefan-Boltzmann law, Wien's law, the nature and causes of emission and absorption lines, and the relation of spectra to the underlying astronomical and physical processes producing them. Students often seem baffled by the connection between a spectrum seen visually as a color band and the same spectrum plotted graphically as intensity versus wavelength or frequency. The "Spectrum Explorer", a JAVA applet, is being developed as part of "Project LITE: Light Inquiry Through Experiments" to address these issues. It can be used by instructors in lecture presentations and by students learning at home or working in laboratory settings. We will show some of the current capabilities of the software which include simultaneous display of multiple spectra (normalized and non-normalized as a function of either wavelength or frequency) and the ability to manipulate blackbody spectra. Our future development plans include the addition of a variety of spectral data sets (from physics and chemistry as well as from astronomy); computed inputs from basic quantum mechanics (e.g. Zeeman effect in hydrogen) and from astronomical models (e.g. time varying spectra in binary stars); and the ability to test the effect of filters and physical processes (e.g. Rayleigh scattering) on input spectra. The Spectrum Explorer (along with many other applets about both the physical and perceptual nature of light) can be found on the Project LITE web site http://lite.bu.edu. Project LITE is supported by Grant #DUE-0125992 from the National Science Foundation Division of Undergraduate Education.

F-16D Pacer Calibration Techniques (SPEED PACER)

DTIC Science & Technology

2012-07-01

grid line and the trailing cone pressure transducer, conetoZGLh∆ in feet: conetonbnbtoZGLconetoZGL hhh ∆+∆=∆ (D20) The standard day temperature...conetoZGLpH ,∆ , respectively, to the pressure altitude at the zero grid line: nbtoZGLpZGLpnbc HHH ,,, ∆+= (D24) conetoZGLpZGLpconec HHH ,,, ∆+= (D25...the following equation: nbtoLiteGLiteGnbatLiteG hhh −−− ∆+= (D32) The tapeline altitude was also translated to the location of the trailing cone

Delta 181 Sensor Module Command Center

DTIC Science & Technology

1989-09-01

Irot a rtiission perspectixc, operariort of lIte coltiiand center \\\\as, tight Iv coupled to corntrol cot11IrplX Operarll oIr 1lrefrc. bef’ore \\N e...8217, plantnin, It liTe latest alerts, accessed b\\ tile (olosnk cornt- putter displayv program, ss crc placedi ott all telretr\\ data displa\\ 5. 3.3.3 1health...ePackeizer Command echo Detected ,, ,/’ vRF Gomr, nad Center AF! CN Joophbick po~nts rpback Aoonops I Test loopback pairt Fig. 3-3 Major loopback

GLIMMPSE Lite: Calculating Power and Sample Size on Smartphone Devices

PubMed Central

Munjal, Aarti; Sakhadeo, Uttara R.; Muller, Keith E.; Glueck, Deborah H.; Kreidler, Sarah M.

2014-01-01

Researchers seeking to develop complex statistical applications for mobile devices face a common set of difficult implementation issues. In this work, we discuss general solutions to the design challenges. We demonstrate the utility of the solutions for a free mobile application designed to provide power and sample size calculations for univariate, one-way analysis of variance (ANOVA), GLIMMPSE Lite. Our design decisions provide a guide for other scientists seeking to produce statistical software for mobile platforms. PMID:25541688

Methods for Aiding Height Determination in Pseudolite-Based Reference Systems Using Batch Least-Squares Estimation

DTIC Science & Technology

2006-03-01

LocataLite Test Examples. LocataLites have been used in several experimental trials as pilot studies of the system. 1.7.5.1 BlueScope Steel. In this pilot...study, [2], the Locata system is shown to give centimeter level relative positioning precision in a severe multipath en- vironment. The BlueScope ...Using Locata: A pilot study at BlueScope Steel.” Proceedings of the 2004 Annual Meeting of the U.S. Institute of Navigation. Dayton, OH, June 2004. 3

[Application possibilities and initial experience with digital volume tomography in hand and wrist imaging].

PubMed

Goerke, Sebastian M; Neubauer, J; Zajonc, H; Thiele, J R; Kotter, E; Langer, M; Stark, G B; Lampert, F M

2015-02-01

During the last decade, DVT (digital volume tomography) imaging has become a widely used standard technique in head and neck imaging. Lower radiation exposure compared to conventional computed tomography (MDCT) has been described. Recently, DVT has been developed as an extremity scanner and as such represents a new imaging technique for hand surgery. We here describe the first 24 months experience with this new imaging modality in hand and wrist imaging by presenting representative cases and by describing the technical background. Furthermore, the method's advantages and disadvantages are discussed with reference to the given literature. © Georg Thieme Verlag KG Stuttgart · New York.

Deep-vein thrombosis prevention in orthopaedic patients: affecting outcomes through interdisciplinary education.

PubMed

Hohlt, T

2000-01-01

Deep-vein thrombosis (DVT) is a serious problem that affects millions of people annually. Prophylaxis against DVT following major orthopaedic surgery can save lives and health care dollars. Proper application of the prophylactic regimen by nursing and the interdisciplinary team can be a major key in affecting the outcome of the orthopaedic patient. To obtain successful outcomes, the educational needs of each individual in the interdisciplinary team must be met. Also, being aware of each physician's practice patterns, implementing their individual preferences, and ensuring that all equipment is available and used in a consistent manner will enhance the desired outcome.

Distribución espacial de órbitas con diferentes grados de caoticidad en modelos autoconsistentes de satélites galácticos

NASA Astrophysics Data System (ADS)

Muzzio, J. C.; Mosquera, M.

En trabajos anteriores (Carpintero et al., Cel. Mech. Dynam. Astron. 85, 247, 2003), mostramos que las órbitas caóticas son muy importantes en los satélites galácticos. Sin embargo, los únicos modelos autoconsistentes de los que se disponía para ellos eran los de Heggie-Ramamani, cuya función de distribución depende sólo de la energía por lo que no mostraban diferencias entre las distribuciones de sus órbitas regulares y caóticas. Ahora, mediante una aproximación cuadrupolar, hemos logrado construir modelos autoconsistentes de satélites galácticos con distribuciones de velocidades anisotrópicas (lo que indica que sus funciones de distribución no dependen sólo de la energía) y hemos logrado revelar las diferencias entre las estructuras espaciales de las órbitas de distinta caoticidad.

JELC-LITE: Unconventional Instructional Design for Special Operations Training

NASA Technical Reports Server (NTRS)

Friedman, Mark

2012-01-01

Current special operations staff training is based on the Joint Event Life Cycle (JELC). It addresses operational level tasks in multi-week, live military exercises which are planned over a 12 to 18 month timeframe. As the military experiences changing global mission sets, shorter training events using distributed technologies will increasingly be needed to augment traditional training. JELC-Lite is a new approach for providing relevant training between large scale exercises. This new streamlined, responsive training model uses distributed and virtualized training technologies to establish simulated scenarios. It keeps proficiency levels closer to optimal levels -- thereby reducing the performance degradation inherent in periodic training. It can be delivered to military as well as under-reached interagency groups to facilitate agile, repetitive training events. JELC-Lite is described by four phases paralleling the JELC, differing mostly in scope and scale. It has been successfully used with a Theater Special Operations Command and fits well within the current environment of reduced personnel and financial resources.

CIRS and CIRS-Lite as Designed for the Outer Planets: TSSM, EJSM, JUICE

NASA Technical Reports Server (NTRS)

Brasunas, J.; Abbas, M.; Bly, V.; Edgerton, M.; Hagopian, J.; Mamakos, W.; Morell, A.; Pasquale, B.; Smith, W.

2012-01-01

Passive spectroscopic remote sensing of planetary atmospheres and surfaces in the thermal infrared is a powerful tool for obtaining information about surface and atmospheric temperatures, composition, and dynamics (via the thermal wind equation). Due to its broad spectral coverage, the Fourier transform spectrometer (FTS) is particularly suited to the exploration and discovery of molecular species. NASA Goddard's Cassini CIRS FTS has given us important new insights into stratospheric composition and jets on Jupiter and Saturn, the cryo-vo1cano and thermal stripes on Enceladus, and the polar vortex on Titan. We have designed a lightweight successor to CIRS - called CIRS-lite - with improved spectral resolution to separate blended spectral lines (such as occur with isotopes). CIRS-lite includes four key components: (1) high Tc superconductor bolometer/carbon nano-tube (CNT) absorber (approx 87K, YBCO) (2) synthetic diamond beam splitter (approx 140K) (3) moving mirror mechanism with crossed-roller bearings ( approx 110 K) (4) single crystal silicon for the input telescope primary

Cognitive chrono-ethnography lite.

PubMed

Nakajima, Masato; Yamada, Kosuke C; Kitajima, Muneo

2012-01-01

Conducting field research facilitates understanding human daily activities. Cognitive Chrono-Ethnography (CCE) is a study methodology used to understand how people select actions in daily life by conducting ethnographical field research. CCE consists of measuring monitors' daily activities in a specified field and in-depth interviews using the recorded videos afterward. However, privacy issues may arise when conducting standard CCE with video recordings in a daily field. To resolve these issues, we developed a new study methodology, CCE Lite. To replace video recordings, we created pseudo-first-personview (PFPV) movies using a computer-graphic technique. The PFPV movies were used to remind the monitors of their activities. These movies replicated monitors' activities (e.g., locomotion and change in physical direction), with no human images and voices. We applied CCE Lite in a case study that involved female employees of hotels at a spa resort. In-depth interviews while showing the PFPV movies determined service schema of the employees (i.e., hospitality). Results indicated that using PFPV movies helped the employees to remember and reconstruct the situation of recorded activities.

Estimación de pequeñas perturbaciones en satélites geocéntricos como un problema inverso

NASA Astrophysics Data System (ADS)

Zadunaisky, P. E.

El movimiento geocéntrico de un satélite artificial es simulado automáticamente por un sistema de ecuaciones diferenciales de segundo orden que incluyen dos funciones perturbadoras. La primera representa el segundo término del potencial gravitatorio de la Tierra y la segunda corresponde al frenado atmosférico. Asumiendo como conocidas, por hipótesis o por mediciones, la posición y velocidad del satélite en instantes sucesivos se estiman las perturbaciones a intervalos sucesivos por un método determinístico. Para ilustrar el método y comprobar la precisión de nuestros resultados hemos simulado dos ejemplos incluyendo valores conocidos de las perturbaciones que luego comparamos con los resultados de nuestro método. El método puede aplicarse por ejemplo para el intervalo de una revolución satelital lo cual permitiría el diseño inmediato de una maniobra correctiva de la órbita satelital.

Anticoagulant Treatment of Deep Vein Thrombosis and Pulmonary Embolism: The Present State of the Art.

PubMed

Thaler, Johannes; Pabinger, Ingrid; Ay, Cihan

2015-01-01

Venous thromboembolism (VTE), a disease entity comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a frequent and potentially life-threatening event. To date different agents are available for the effective treatment of acute VTE and the prevention of recurrence. For several years, the standard of care was the subcutaneous application of a low molecular weight heparin (LMWH) or fondaparinux, followed by a vitamin K antagonist (VKA). The so-called direct oral anticoagulants (DOAC) were introduced rather recently in clinical practice for the treatment of VTE. DOAC seem to have a favorable risk-benefit profile compared to VKA. Moreover, DOAC significantly simplify VTE treatment because they are administered in fixed doses and no routine monitoring is needed. Patients with objectively diagnosed DVT or PE should receive therapeutic anticoagulation for a minimum of 3 months. Whether a patient ought to receive extended treatment needs to be evaluated on an individual basis, depending mainly on risk factors determined by characteristics of the thrombotic event and patient-related factors. In specific patient groups (e.g., pregnant women, cancer patients, and elderly patients), treatment of VTE is more challenging than that in the general population and additional issues need to be considered in those patients. The aim of this review is to give an overview of the currently available treatment modalities of acute VTE and secondary prophylaxis. In particular, specific aspects regarding the initiation of VTE treatment, duration of anticoagulation, and specific patient groups will be discussed.

Astrossismologia e o satélite COROT

NASA Astrophysics Data System (ADS)

Andrade, L. B. P.; Janot Pacheco, E.

2003-08-01

Este trabalho centra-se em atividades na fase de pré-lançamento do satélite COROT, da agência espacial francesa (CNES), a ser lançado em 2005. O satélite será dedicado à sismologia estelar e à procura de exoplanetas. Nosso programa de trabalho centra-se em dois pontos principais: (1) efetuar uma procura detalhada nos campos COROT de alvos astrofísicos de especial interesse; (2) participar das análises espectroscópicas prévias de alvos selecionados para determinação de parâmetros físicos das estrelas com a maior precisão possível. Na presente etapa, priorizou-se o primeiro ponto do projeto. Foi feito um levantamento geral dos objetos astrofísicos encontrados nos dois campos de observação, centrados em 06H50M e 18H50M, com raios de 10 minutos. Concluiu-se que as estrelas B-Be deverão ser observadas no campo sismológico, enquanto que as anãs brancas deverão sê-lo no campo exoplanetário. Objetos a serem observados foram escolhidos de forma a estarem próximos de alvos principais dos programas centrais do satélite. Paralelamente, estudos e pesquisas bibliográficas foram feitos para compreender os assuntos de interesse principal, ou seja, as pulsações não-radiais de estrelas Ob-Be

PCoD Lite - Using an Interim PCoD Protocol to Assess the Effects of Disturbance Associated with US Navy Exercises on Marine Mammal Populations

DTIC Science & Technology

2015-09-30

1 DISTRIBUTION STATEMENT A. Approved for public release; distribution is unlimited. PCoD Lite - Using an Interim PCoD Protocol to Assess...US National Research Council (NRC 2005). Here, we provide an insight into how the Interim PCoD approach (Harwood et al. 2014, King et al. 2015...illustrate how the interim PCoD protocol can be used to inform the process of determining whether or not Navy activities are likely to have an impact on

Design and analysis of microcontroller system using AMBA-Lite bus

NASA Astrophysics Data System (ADS)

Suan, Wang Hang; Bahari Jambek, Asral

2017-11-01

Advanced Microcontroller Bus Architecture (AMBA) is one of the well-designed on chip communication system. It is designed for right first-time development with many processor and peripherals. In this paper, the different family of AMBA architecture such as AXI, APB, AHB are reviewed. In this work, the AMBA-Lite is used and implemented with a few peripherals and an ARM processor. The work is simulated using Synopsys and demonstrated on the Digilent Nexys4 DDR board and the software use to synthesis the design is Vivado 2016.2.

Oceanic Area System Improvement Study (OASIS). Volume I. Executive Summary and Improvement Alternatives Development and Analysis.

DTIC Science & Technology

1981-09-01

In oceanic areas, the ;n,:. of st,,ta)ie l.ind sites preclude the i;.tallation of lite -cf-ite :4 om au.-nications ano the HF air-ground voice...operatlons. Tl., air-ground i-,ioa runrd-sateliite and satellite-aircraft links) • MICnIIC;ii "l~is, woU) ie uov’i by .ate lite transponders. The trans...CAR by line-of-sight very high frequency ( VRF ) air-ground communications, radr, and ground-based radionavigation aids. However, other parts of this

KSC-07pd3242

NASA Image and Video Library

2007-11-06

KENNEDY SPACE CENTER, FLA. -- The payload canister containing the Columbus Laboratory module and integrated cargo carrier-lite is lifted up toward the payload changeout room on Launch Pad 39A at NASA's Kennedy Space Center. Once in place, the canister will be opened and the cargo transferred inside the payload changeout room. The payload will be installed in space shuttle Atlantis' payload bay.The canister contains the Columbus Lab module and integrated cargo carrier-lite payloads for space shuttle Atlantis on mission STS-122. Atlantis is targeted to launch on Dec. 6. Photo credit: NASA/Dimitri Gerondidakis

Advanced imaging in acute and chronic deep vein thrombosis

PubMed Central

Karande, Gita Yashwantrao; Sanchez, Yadiel; Baliyan, Vinit; Mishra, Vishala; Ganguli, Suvranu; Prabhakar, Anand M.

2016-01-01

Deep venous thrombosis (DVT) affecting the extremities is a common clinical problem. Prompt imaging aids in rapid diagnosis and adequate treatment. While ultrasound (US) remains the workhorse of detection of extremity venous thrombosis, CT and MRI are commonly used as the problem-solving tools either to visualize the thrombosis in central veins like superior or inferior vena cava (IVC) or to test for the presence of complications like pulmonary embolism (PE). The cross-sectional modalities also offer improved visualization of venous collaterals. The purpose of this article is to review the established modalities used for characterization and diagnosis of DVT, and further explore promising innovations and recent advances in this field. PMID:28123971

IONAC-Lite

NASA Technical Reports Server (NTRS)

Torgerson, Jordan L.; Clare, Loren P.; Pang, Jackson

2011-01-01

The Interplanetary Overlay Net - working Protocol Accelerator (IONAC) described previously in The Inter - planetary Overlay Networking Protocol Accelerator (NPO-45584), NASA Tech Briefs, Vol. 32, No. 10, (October 2008) p. 106 (http://www.techbriefs.com/component/ content/article/3317) provides functions that implement the Delay Tolerant Networking (DTN) bundle protocol. New missions that require high-speed downlink-only use of DTN can now be accommodated by the unidirectional IONAC-Lite to support high data rate downlink mission applications. Due to constrained energy resources, a conventional software implementation of the DTN protocol can provide only limited throughput for any given reasonable energy consumption rate. The IONAC-Lite DTN Protocol Accelerator is able to reduce this energy consumption by an order of magnitude and increase the throughput capability by two orders of magnitude. In addition, a conventional DTN implementation requires a bundle database with a considerable storage requirement. In very high downlink datarate missions such as near-Earth radar science missions, the storage space utilization needs to be maximized for science data and minimized for communications protocol-related storage needs. The IONAC-Lite DTN Protocol Accelerator is implemented in a reconfigurable hardware device to accomplish exactly what s needed for high-throughput DTN downlink-only scenarios. The following are salient features of the IONAC-Lite implementation: An implementation of the Bundle Protocol for an environment that requires a very high rate bundle egress data rate. The C&DH (command and data handling) subsystem is also expected to be very constrained so the interaction with the C&DH processor and the temporary storage are minimized. Fully pipelined design so that bundle processing database is not required. Implements a lookup table-based approach to eliminate multi-pass processing requirement imposed by the Bundle Protocol header s length field structure and the SDNV (self-delimiting numeric value) data field formatting. 8-bit parallel datapath to support high data-rate missions. Reduced resource utilization implementation for missions that do not require custody transfer features. There was no known implementation of the DTN protocol in a field programmable gate array (FPGA) device prior to the current implementation. The combination of energy and performance optimization that embodies this design makes the work novel.

Effect of pathological heterogeneity on shear wave elasticity imaging in the staging of deep venous thrombosis

PubMed Central

Liu, Xiaona; Li, Na; Wen, Chaoyang

2017-01-01

Background We aimed to observe the relationship between the pathological components of a deep venous thrombus (DVT), which was divided into three parts, and the findings on quantitative ultrasonic shear wave elastography (SWE) to increase the accuracy of thrombus staging in a rabbit model. Methods A flow stenosis-induced vein thrombosis model was used, and the thrombus was divided into three parts (head, body and tail), which were associated with corresponding observation points. Elasticity was quantified in vivo using SWE over a 2-week period. A quantitative pathologic image analysis (QPIA) was performed to obtain the relative percentages of the components of the main clots. Results DVT maturity occurred at 2 weeks, and the elasticity of the whole thrombus and the three parts (head, body and tail) showed an increasing trend, with the Young's modulus values varying from 2.36 ± 0.41 kPa to 13.24 ± 1.71 kPa; 2.01 ± 0.28 kPa to 13.29 ± 1.48 kPa; 3.27 ± 0.57 kPa to 15.91 ± 2.05 kPa; and 1.79 ± 0.36 kPa to 10.51 ± 1.61 kPa, respectively. Significant increases occurred on different days for the different parts: the head showed significant increases on days 4 and 6; the body showed significant increases on days 4 and 7; and the tail showed significant increases on days 3 and 6. The QPIA showed that the thrombus composition changed dynamically as the thrombus matured, with the fibrin and calcium salt deposition gradually increasing and the red blood cells (RBCs) and platelet trabecula gradually decreasing. Significant changes were observed on days 4 and 7, which may represent the transition points for acute, sub-acute and chronic thrombi. Significant heterogeneity was observed between and within the thrombi. Conclusions Variations in the thrombus components were generally consistent between the SWE and QPIA. Days 4 and 7 after thrombus induction may represent the transition points for acute, sub-acute and chronic thrombi in rabbit models. A dynamic examination of the same part of the thrombus may be helpful for improving the sensitivity and reproducibility of SWE for DVT diagnosis and staging. PMID:28614362

Effect of pathological heterogeneity on shear wave elasticity imaging in the staging of deep venous thrombosis.

PubMed

Liu, Xiaona; Li, Na; Wen, Chaoyang

2017-01-01

We aimed to observe the relationship between the pathological components of a deep venous thrombus (DVT), which was divided into three parts, and the findings on quantitative ultrasonic shear wave elastography (SWE) to increase the accuracy of thrombus staging in a rabbit model. A flow stenosis-induced vein thrombosis model was used, and the thrombus was divided into three parts (head, body and tail), which were associated with corresponding observation points. Elasticity was quantified in vivo using SWE over a 2-week period. A quantitative pathologic image analysis (QPIA) was performed to obtain the relative percentages of the components of the main clots. DVT maturity occurred at 2 weeks, and the elasticity of the whole thrombus and the three parts (head, body and tail) showed an increasing trend, with the Young's modulus values varying from 2.36 ± 0.41 kPa to 13.24 ± 1.71 kPa; 2.01 ± 0.28 kPa to 13.29 ± 1.48 kPa; 3.27 ± 0.57 kPa to 15.91 ± 2.05 kPa; and 1.79 ± 0.36 kPa to 10.51 ± 1.61 kPa, respectively. Significant increases occurred on different days for the different parts: the head showed significant increases on days 4 and 6; the body showed significant increases on days 4 and 7; and the tail showed significant increases on days 3 and 6. The QPIA showed that the thrombus composition changed dynamically as the thrombus matured, with the fibrin and calcium salt deposition gradually increasing and the red blood cells (RBCs) and platelet trabecula gradually decreasing. Significant changes were observed on days 4 and 7, which may represent the transition points for acute, sub-acute and chronic thrombi. Significant heterogeneity was observed between and within the thrombi. Variations in the thrombus components were generally consistent between the SWE and QPIA. Days 4 and 7 after thrombus induction may represent the transition points for acute, sub-acute and chronic thrombi in rabbit models. A dynamic examination of the same part of the thrombus may be helpful for improving the sensitivity and reproducibility of SWE for DVT diagnosis and staging.

Effects of walking in deep venous thrombosis: a new integrated solid and fluid mechanics model.

PubMed

López, Josep M; Fortuny, Gerard; Puigjaner, Dolors; Herrero, Joan; Marimon, Francesc; Garcia-Bennett, Josep

2017-05-01

Deep venous thrombosis (DVT) is a common disease. Large thrombi in venous vessels cause bad blood circulation and pain; and when a blood clot detaches from a vein wall, it causes an embolism whose consequences range from mild to fatal. Walking is recommended to DVT patients as a therapeutical complement. In this study the mechanical effects of walking on a specific patient of DVT were simulated by means of an unprecedented integration of 3 elements: a real geometry, a biomechanical model of body tissues, and a computational fluid dynamics study. A set of computed tomography images of a patient's leg with a thrombus in the popliteal vein was employed to reconstruct a geometry model. Then a biomechanical model was used to compute the new deformed geometry of the vein as a function of the fiber stretch level of the semimembranosus muscle. Finally, a computational fluid dynamics study was performed to compute the blood flow and the wall shear stress (WSS) at the vein and thrombus walls. Calculations showed that either a lengthening or shortening of the semimembranosus muscle led to a decrease of WSS levels up to 10%. Notwithstanding, changes in blood viscosity properties or blood flow rate may easily have a greater impact in WSS. Copyright © 2016 John Wiley & Sons, Ltd.

The predictive value of markers of fibrinolysis and endothelial dysfunction in the post thrombotic syndrome. A systematic review.

PubMed

Rabinovich, Anat; Cohen, Jacqueline M; Kahn, Susan R

2014-06-01

The post thrombotic syndrome (PTS) develops in 20-40% of deep venous thrombosis (DVT) patients. Risk factors for PTS have not been well elucidated. Identification of risk factors would facilitate individualised risk assessment for PTS. We conducted a systematic review to determine whether biomarkers of fibrinolysis or endothelial dysfunction can predict the risk for PTS among DVT patients. Studies were identified by searching the electronic databases PubMed, EMBASE, Scopus and Web of science. We included studies published between 1990 and 2013, measured biomarker levels in adult DVT patients, and reported rates of PTS development. Fourteen studies were included: 11 investigated the association between D-dimer and PTS; three examined fibrinogen; two measured von Willebrand factor; one measured plasminogen activator inhibitor-1; one assessed ADAMTS-13 (A Disintegrin and Metalloprotease with Thrombospondin type 1 repeats) and one measured factor XIII activity. Studies varied with regards to inclusion criteria, definition of PTS, time point and method of biomarker measurement. We were unable to meta-analyse results due to marked clinical heterogeneity. Descriptively, a significant association with PTS was found for D-dimer in four studies and factor XIII in one study. Further prospective research is needed to elucidate whether these markers might be useful to predict PTS development.

Kwf-Grid workflow management system for Earth science applications

NASA Astrophysics Data System (ADS)

Tran, V.; Hluchy, L.

2009-04-01

In this paper, we present workflow management tool for Earth science applications in EGEE. The workflow management tool was originally developed within K-wf Grid project for GT4 middleware and has many advanced features like semi-automatic workflow composition, user-friendly GUI for managing workflows, knowledge management. In EGEE, we are porting the workflow management tool to gLite middleware for Earth science applications K-wf Grid workflow management system was developed within "Knowledge-based Workflow System for Grid Applications" under the 6th Framework Programme. The workflow mangement system intended to - semi-automatically compose a workflow of Grid services, - execute the composed workflow application in a Grid computing environment, - monitor the performance of the Grid infrastructure and the Grid applications, - analyze the resulting monitoring information, - capture the knowledge that is contained in the information by means of intelligent agents, - and finally to reuse the joined knowledge gathered from all participating users in a collaborative way in order to efficiently construct workflows for new Grid applications. Kwf Grid workflow engines can support different types of jobs (e.g. GRAM job, web services) in a workflow. New class of gLite job has been added to the system, allows system to manage and execute gLite jobs in EGEE infrastructure. The GUI has been adapted to the requirements of EGEE users, new credential management servlet is added to portal. Porting K-wf Grid workflow management system to gLite would allow EGEE users to use the system and benefit from its avanced features. The system is primarly tested and evaluated with applications from ES clusters.

Effects of a Foot Pump on the Incidence of Deep Vein Thrombosis After Total Knee Arthroplasty in Patients Given Edoxaban: A Randomized Controlled Study.

PubMed

Sakai, Tatsuya; Izumi, Masahiro; Kumagai, Kenji; Kidera, Kenichi; Yamaguchi, Takayuki; Asahara, Tomohiko; Kozuru, Hideko; Jiuchi, Yuka; Mawatari, Masaaki; Osaki, Makoto; Motokawa, Satoru; Migita, Kiyoshi

2016-01-01

We conducted a randomized clinical trial to compare the effectiveness of the A-V Impulse System foot pump for reducing the incidence of deep-vein thrombosis (DVT) after total knee arthroplasty (TKA) in patients under edoxaban thromboprophylaxis. Patients undergoing primary TKA at our institution between September 2013 and March 2015 were enrolled after obtaining informed consent. The patients were randomized to use the foot pump (n = 58) and not to use the foot pump (n = 62). Both groups were given prophylactic edoxaban. Primary outcomes were any DVT as detected by bilateral ultrasonography up to postoperative day 10 (POD10) and pulmonary embolism (PE) up to POD28. The safety outcomes were bleeding and death of any cause up to POD28. Plasma D-dimer levels were measured before TKA and on POD10 after TKA. Immunoglobulin G (IgG)-class anti-PF4/heparin antibodies were measured using an IgG-specific enzyme-linked immunosorbent assay. The incidences of any DVT up to POD28 were 31.0% and 17.7% in patients with or without the foot pump, respectively. The incidences of major bleeding up to POD28 were 5.1% and 4.8% in patients with or without the foot pump, respectively. Foot pump use did not significantly reduce the incidence of DVTs in patients undergoing TKA under edoxaban thromboprophylaxis. Although seroconversion of anti-PF4/heparin antibodies was confirmed in one-fourth of patients, the seroconversion rates did not differ between patients with (20.7%) or without (25.8%) foot pump use. This study shows that the A-V Impulse system foot pump did not affect the incidence of DVT under edoxaban thromboprophylaxis in patients undergoing TKA. Seroconversion of anti-PF4/heparin antibodies was detected in a significant number of patients who underwent TKA under antithrombotic prophylaxis using edoxaban.

A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators.

PubMed

Williams, Linda; Daggett, Virginia; Slaven, James E; Yu, Zhangsheng; Sager, Danielle; Myers, Jennifer; Plue, Laurie; Woodward-Hagg, Heather; Damush, Teresa M

2016-04-01

Quality indicator collection and feedback improves stroke care. We sought to determine whether quality improvement training plus indicator feedback was more effective than indicator feedback alone in improving inpatient stroke indicators. We conducted a cluster-randomised quality improvement trial, randomising hospitals to quality improvement training plus indicator feedback versus indicator feedback alone to improve deep vein thrombosis (DVT) prophylaxis and dysphagia screening. Intervention sites received collaborative-based quality improvement training, external facilitation and indicator feedback. Control sites received only indicator feedback. We compared indicators pre-implementation (pre-I) to active implementation (active-I) and post-implementation (post-I) periods. We constructed mixed-effect logistic models of the two indicators with a random intercept for hospital effect, adjusting for patient, time, intervention and hospital variables. Patients at intervention sites (1147 admissions), had similar race, gender and National Institutes of Health Stroke Scale scores to control sites (1017 admissions). DVT prophylaxis improved more in intervention sites during active-I period (ratio of ORs 4.90, p<0.001), but did not differ in post-I period. Dysphagia screening improved similarly in both groups during active-I, but control sites improved more in post-I period (ratio of ORs 0.67, p=0.04). In logistic models, the intervention was independently positively associated with DVT performance during active-I period, and negatively associated with dysphagia performance post-I period. Quality improvement training was associated with early DVT improvement, but the effect was not sustained over time and was not seen with dysphagia screening. External quality improvement programmes may quickly boost performance but their effect may vary by indicator and may not sustain over time. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The Safety and Feasibility of Three-Dimensional Visualization Technology Assisted Right Posterior Lobe Allied with Part of V and VIII Sectionectomy for Right Hepatic Malignancy Therapy.

PubMed

Hu, Min; Hu, Haoyu; Cai, Wei; Mo, Zhikang; Xiang, Nan; Yang, Jian; Fang, Chihua

2018-05-01

Hepatectomy is the optimal method for liver cancer; the virtual liver resection based on three-dimensional visualization technology (3-DVT) could provide better preoperative strategy for surgeon. We aim to introduce right posterior lobe allied with part of V and VIII sectionectomy assisted by 3-DVT as a promising treatment for massive or multiple right hepatic malignancies to retain maximum residual liver volume on the basis of R0 resection. Among 126 consecutive patients who underwent hepatectomy, 9 (7%) underwent right posterior lobe allied with part of V and VIII sectionectomy. 21 (17%) underwent right hemihepatectomy (RH). The virtual RH was performed with 3-DVT, which provided better observation of spatial position relationship between tumor and vessels, and the more accurate estimation of the remnant liver volume. If remnant liver volume was <40%, right posterior lobe allied with part of V and VIII sectionectomy should be undergone. Then, the precut line ought to be planned on the basis of protecting the portal branch of subsegment 5 and 8. The postoperative outcome of patients was compared before and after propensity score matching. Nine patients meeting the eligibility criteria received right posterior lobe allied with part of V and VIII sectionectomy. The variables, including the overall mean operation time, blood transfusion, operation length, liver function, and postoperative complications, were similar between two groups before and after propensity matching. The postoperative first, third, fifth, and seventh days mean value of aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), and total bilirubin had no significant difference compared with preoperative value. One patient in each group had recurrence six months after surgery. Right posterior lobe allied with part of V and VIII sectionectomy based on 3-DVT is safe and feasible surgery way, and can be a very promising method in massive or multiple right hepatic malignancy therapy.

Variation in Blood Transfusion and Coagulation Management in Traumatic Brain Injury at the Intensive Care Unit: A Survey in 66 Neurotrauma Centers Participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study.

PubMed

Huijben, Jilske A; van der Jagt, Mathieu; Cnossen, Maryse C; Kruip, Marieke J H A; Haitsma, Iain K; Stocchetti, Nino; Maas, Andrew I R; Menon, David K; Ercole, Ari; Maegele, Marc; Stanworth, Simon J; Citerio, Giuseppe; Polinder, Suzanne; Steyerberg, Ewout W; Lingsma, Hester F

2017-11-21

Our aim was to describe current approaches and to quantify variability between European intensive care units (ICUs) in patients with traumatic brain injury (TBI). Therefore, we conducted a provider profiling survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The ICU Questionnaire was sent to 68 centers from 20 countries across Europe and Israel. For this study, we used ICU questions focused on 1) hemoglobin target level (Hb-TL), 2) coagulation management, and 3) deep venous thromboembolism (DVT) prophylaxis. Seventy-eight participants, mostly intensivists and neurosurgeons of 66 centers, completed the ICU questionnaire. For ICU-patients, half of the centers (N = 34; 52%) had a defined Hb-TL in their protocol. For patients with TBI, 26 centers (41%) indicated an Hb-TL between 70 and 90 g/L and 38 centers (59%) above 90 g/L. To treat trauma-related hemostatic abnormalities, the use of fresh frozen plasma (N = 48; 73%) or platelets (N = 34; 52%) was most often reported, followed by the supplementation of vitamin K (N = 26; 39%). Most centers reported using DVT prophylaxis with anticoagulants frequently or always (N = 62; 94%). In the absence of hemorrhagic brain lesions, 14 centers (21%) delayed DVT prophylaxis until 72 h after trauma. If hemorrhagic brain lesions were present, the number of centers delaying DVT prophylaxis for 72 h increased to 29 (46%). Overall, a lack of consensus exists between European ICUs on blood transfusion and coagulation management. The results provide a baseline for the CENTER-TBI study, and the large between-center variation indicates multiple opportunities for comparative effectiveness research.

The incidence of postoperative thromboembolic complications following surgical resection of intracranial meningioma. A retrospective study of a large single center patient cohort.

PubMed

Hoefnagel, Daphna; Kwee, Lesley E; van Putten, Erik H P; Kros, Johan M; Dirven, Clemens M F; Dammers, Ruben

2014-08-01

Patients with meningiomas carry an increased risk for postoperative venous thromboembolic complications (VTE) including deep venous thrombosis (DVT) and pulmonary embolism (PE). In the present retrospective study we investigated the incidence of VTE and the risk factors involved, in a large cohort of patients surgically treated for an intracranial meningioma at our institution. During the period from January 1997 to January 2009, 581 consecutive patients underwent craniotomy for intracranial meningioma. All patients received low-molecular weight heparins as thromboembolism prophylaxis. Patient demographics and tumor characteristics were gathered via retrospective chart review. Postoperative VTE and hemorrhages were noted. Backward stepwise logistic regression was used to determine the risk factors. 80.6% of meningiomas were WHO grade 1; 15.1% WHO grade 2; 4.3% WHO grade 3. Postoperative VTE were observed in 41 patients (7.2%). Of these, DVT was seen in 20 (3.5%) and PE in 26 patients (4.6%). The thromboembolic complication appeared on average 21.1±29.2 days post surgery. The 90-day mortality rate after VTE was 11.2% (23.1% for PE and 5.0% for DVT). Postoperative hemorrhages requiring surgical treatment were found in 2.9% of patients. Risk factors for VTE were body mass index (p=0.015) for DVT; weight (p=0.001) and bedridden postoperatively (p=0.001) for PE; and weight (p=0.004) and bedridden postoperatively (p=0.003) for VTE in general. There was no relation between tumor grade and thromboembolic complications. The major risk factors for postoperative VTE found in our single center study are patient weight and a bedridden status postoperatively. Prophylactic intervention for this potentially fatal complication should be evaluated against the relative lower risk of postoperative hemorrhages. Copyright © 2014 Elsevier B.V. All rights reserved.

A Systematic Review and Meta-analysis of Thrombotic Events Following Endovenous Thermal Ablation of the Great Saphenous Vein.

PubMed

Healy, Donagh A; Kimura, Shiori; Power, David; Elhaj, Abubaker; Abdeldaim, Yasser; Cross, Keith S; McGreal, Gerard T; Burke, Paul E; Moloney, Tony; Manning, Brian J; Kavanagh, Eamon G

2018-06-09

A systematic review and meta-analysis was performed to determine the incidence of thrombotic events following great saphenous vein (GSV) endovenous thermal ablation (EVTA). MEDLINE, Embase and conference abstracts were searched. Eligible studies were randomised controlled trials and case series that included at least 100 patients who underwent GSV EVTA (laser ablation or radiofrequency ablation [RFA]) with duplex ultrasound (DUS) within 30 days. The systematic review focused on the complications of endovenous heat induced thrombosis (EHIT), deep venous thrombosis (DVT), and pulmonary embolism (PE). The primary outcome for the meta-analysis was deep venous thrombotic events which were defined as DVT or EHIT Type 2, 3, or 4. Secondary outcomes for the meta-analysis were EHIT Type 2, 3, or 4, DVT and PE. Subgroup analyses were performed for both the RFA and EVLA groups. Pooled proportions were calculated using random effects modelling. Fifty-two studies (16,398 patients) were included. Thrombotic complications occurred infrequently. Deep venous thrombotic events occurred in 1.7% of cases (95% CI 0.9-2.7%) (25 studies; 10,012 patients; 274 events). EHIT Type 2, 3, or 4 occurred in 1.4% of cases (95% CI 0.8-2.3%) (26 studies; 10,225 patients; 249 events). DVT occurred in 0.3% of cases (95% CI = 0.2%-0.5%) (49 studies; 15,676 patients; 48 events). PE occurred in 0.1% of cases (95% CI = 0.1-0.2%) (29 studies; 8223 patients; 3 events). Similar results were found when the RFA and EVLA groups were analysed separately. Thrombotic events occur infrequently following GSV EVTA. Given the large numbers of procedures worldwide and the potential for serious consequences, further research is needed on the burden of these complications and their management. Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

Managing iliofemoral deep venous thrombosis of pregnancy with a strategy of thrombus removal is safe and avoids post-thrombotic morbidity.

PubMed

Herrera, Santiago; Comerota, Anthony J; Thakur, Subhash; Sunderji, Shiraz; DiSalle, Robert; Kazanjian, Sahira N; Assi, Zakaria

2014-02-01

Extensive deep venous thrombosis (DVT) during pregnancy is usually treated with anticoagulation alone, risking significant post-thrombotic syndrome (PTS) in young patients. Catheter-directed thrombolysis (CDT) and operative venous thrombectomy have been safely and effectively used in nonpregnant patients, demonstrating significant reduction in post-thrombotic morbidity. This report reviews short- and long-term outcomes of 13 patients with extensive DVT of pregnancy treated with a strategy of thrombus removal. From 1999 to 2013, 13 patients with iliofemoral DVT during pregnancy were offered CDT, pharmacomechanical thrombolysis (PMT), and/or venous thrombectomy. Gestational age ranged from 8 to 34 weeks. Fetal monitoring was performed throughout hospitalization. Radiation exposure was minimized with pelvic lead shields, focal fluoroscopy, and limited angiographic runs. Follow-up included objective vein evaluation using venous duplex and PTS assessment using the Villalta scale. CDT and/or PMT were used in 11 patients. Two patients underwent venous thrombectomy alone, and one patient had operative thrombectomy as an adjunct to CDT and PMT. Each patient had complete or near-complete thrombus resolution and rapid improvement in clinical symptoms. Eight of 11 having CDT or PMT underwent venoplasty and stenting of the involved iliac veins. Twelve of the 13 delivered healthy infants at term. One patient opted for termination of her pregnancy. Mean patient and gestational ages were 26 years and 26 weeks, respectively. Mean follow-up was 1.3 years, with only one recurrence. Duplex ultrasonography demonstrated patent veins in all but one patient and normal valve function in 10 patients. Eleven patients had Villalta scores <5 (considered normal), with a mean score of 0.7. Extensive DVT of pregnancy can be effectively and safely treated with a strategy of thrombus removal, resulting in a patent venous system, normal valve function in many, prevention of PTS, and reduction in recurrence. Copyright © 2014. Published by Mosby, Inc.

Safety of catheter-directed thrombolysis for the treatment of acute lower extremity deep vein thrombosis: A systematic review and meta-analysis.

PubMed

Wang, Li; Zhang, Chuanlin; Mu, Shaoyu; Yeh, Chao Hsing; Chen, Liqun; Zhang, Zeju; Wang, Xueqin

2017-09-01

Despite established guidelines, catheter-directed thrombolysis (CDT) for the management of acute lower extremity deep vein thrombosis (DVT) should not be overstated because the risks of CDT are uncertain. We performed a meta-analysis to comprehensively and quantitatively evaluate the safety of CDT for patients with acute lower extremity DVT. Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE, and Scopus, were searched up to January 2017. The inclusion criteria were applied to select patients with acute lower extremity DVT treated by CDT or compared CDT with anticoagulation. In case series studies, the pooled estimates of safety outcomes for complications, pulmonary embolism (PE), and mortality were calculated across studies. In studies comparing CDT with anticoagulation, summary odds ratios (ORs) were calculated. Of the 1696 citations identified, 24 studies (6 comparing CDT with anticoagulation and 18 case series) including 9157 patients met the eligibility criteria. In the case series studies, the pooled risks of major, minor, and total complications were 0.03 (95% confidence interval [CI]: 0.02-0.04), 0.07 (95% CI: 0.05-0.08), and 0.09 (95% CI: 0.08-0.11), respectively; other pooled risk results were 0.00 for PE (95% CI: 0.00-0.01) and 0.07 for mortality (95% CI: 0.03-0.11). Our meta-analysis of 6 studies comparing the risk of complications and PE related to CDT with those related to anticoagulation showed that CDT was associated with an increased risk of complications (OR = 4.36; 95% CI: 2.94-6.47) and PE (OR = 1.57; 95% CI: 1.37-1.79). Acute lower extremity DVT patients receiving CDT are associated with a low risk of complications. However, compared with anticoagulation, CDT is associated with a higher risk of complications and PE. Rare mortality related to thrombolytic therapy was reported. More evidence should be accumulated to prove the safety of CDT.

Thromboembolism Following Shoulder Arthroscopy

PubMed Central

Schick, Cameron W.; Westermann, Robert W.; Gao, Yubo; Abboud, Joseph A.; Wolf, Brian R.

2014-01-01

Background: Thromboembolism following shoulder arthroscopy is considered an uncommon complication, with fewer than 50 cases reported in the literature. Arthroscopy of the shoulder is one of the most commonly performed orthopaedic procedures, with low associated risks. Purpose: To identify potential risk factors for the development of venous thromboembolism (VTE) following shoulder arthroscopy and to determine the overall incidence of this complication. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective case-control review was performed of patients who developed symptomatic deep venous thrombosis (DVT) or pulmonary embolism (PE) following shoulder arthroscopy. Multiple surgeons from across North America were queried. For every case of DVT or PE identified, 2 control cases of shoulder arthroscopy were analyzed. The incidence of DVT/PE following shoulder arthroscopy was determined. A univariate analysis and a multivariate logistic regression model were conducted to identify any potential risk factors for the development of VTE following shoulder arthroscopy. Results: A total of 17 surgeons participated in this study and had performed a total of 15,033 cases of shoulder arthroscopy from September 2002 through August 2011. Eleven of the 17 participating surgeons had had a patient with a VTE complication during this time frame. The incidence of VTE in the 15,033 cases was 0.15%; 22 patients of the 15,033 patients had a DVT (n = 15) and/or PE (n = 8). Forty-four control cases were also analyzed. Univariate and multivariate analyses were performed. No significant risk factors were identified other than patient positioning. All cases and controls were positioned in the beach-chair position for surgery. Conclusion: The results of this study show that although rare, VTE occurs following shoulder arthroscopy at a rate of 0.15%. The variables analyzed in the cases of VTE compared with the control cases did not show any significant risk factors. All cases were positioned in the beach-chair position. Further analysis of future cases is warranted. PMID:26535285

Pharmacological venous thromboembolism prophylaxis in hospitalized medical patients: a meta-analysis of randomized controlled trials.

PubMed

Wein, Lironne; Wein, Sara; Haas, Steven Joseph; Shaw, James; Krum, Henry

2007-07-23

There is uncertainty regarding which pharmacological agents most effectively prevent venous thromboembolism in hospitalized medical patients. We therefore performed a meta-analysis to determine this. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from 1950, 1966, and 1800, respectively, through June 30, 2006, for randomized controlled trials that involved medical patients comparing unfractionated heparin (UFH) or low-molecular-weight heparin or heparinoid (LMWH) with a control, LMWH with UFH, or selective factor Xa inhibitors with a comparator. Study selection, validity assessment, and data abstraction were performed by 2 independent reviewers (L.W. and S.W.). Data synthesis was undertaken by 1 blinded investigator (S.J.H.). Thirty-six studies were included. Compared with the control, UFH was associated with a reduced risk of deep venous thrombosis (DVT) (risk ratio [RR], 0.33; 95% confidence interval [CI], 0.26-0.42) and pulmonary embolism (RR, 0.64; 95% CI, 0.50-0.82), as was LMWH (RR, 0.56; 95% CI, 0.45-0.70; and RR, 0.37; 95% CI, 0.21-0.64, respectively). A UFH dosage of 5000 U 3 times daily was more effective in preventing DVT than a UFH dosage of 5000 U twice daily when compared with the control (RR, 0.27; 95% CI, 0.20-0.36; vs RR, 0.52; 95% CI, 0.28-0.96). Neither UFH nor LMWH reduced mortality. When directly compared with UFH, LMWH was associated with a lower risk of DVT (RR, 0.68; 95% CI, 0.52-0.88) and injection site hematoma (RR, 0.47; 95% CI, 0.36-0.62), but no difference was seen between the 2 agents in the risk of bleeding or thrombocytopenia. Both UFH and LMWH reduce venous thromboembolic risk in hospitalized medical patients, but neither agent alters mortality. When directly compared, LMWH is more effective in preventing DVT.

SIM Lite Detection of Habitable Planets in P-Type Binary-Planetary Systems

NASA Technical Reports Server (NTRS)

Pan, Xiaopei; Shao, Michael; Shaklan, Stuart; Goullioud, Renaud

2010-01-01

Close binary stars like spectroscopic binaries create a completely different environment than single stars for the evolution of a protoplanetary disk. Dynamical interactions between one star and protoplanets in such systems provide more challenges for theorists to model giant planet migration and formation of multiple planets. For habitable planets the majority of host stars are in binary star systems. So far only a small amount of Jupiter-size planets have been discovered in binary stars, whose minimum separations are 20 AU and the median value is about 1000 AU (because of difficulties in radial velocity measurements). The SIM Lite mission, a space-based astrometric observatory, has a unique capability to detect habitable planets in binary star systems. This work analyzed responses of the optical system to the field stop for companion stars and demonstrated that SIM Lite can observe exoplanets in visual binaries with small angular separations. In particular we investigated the issues for the search for terrestrial planets in P-type binary-planetary systems, where the planets move around both stars in a relatively distant orbit.

Integrating TRENCADIS components in gLite to share DICOM medical images and structured reports.

PubMed

Blanquer, Ignacio; Hernández, Vicente; Salavert, José; Segrelles, Damià

2010-01-01

The problem of sharing medical information among different centres has been tackled by many projects. Several of them target the specific problem of sharing DICOM images and structured reports (DICOM-SR), such as the TRENCADIS project. In this paper we propose sharing and organizing DICOM data and DICOM-SR metadata benefiting from the existent deployed Grid infrastructures compliant with gLite such as EGEE or the Spanish NGI. These infrastructures contribute with a large amount of storage resources for creating knowledge databases and also provide metadata storage resources (such as AMGA) to semantically organize reports in a tree-structure. First, in this paper, we present the extension of TRENCADIS architecture to use gLite components (LFC, AMGA, SE) on the shake of increasing interoperability. Using the metadata from DICOM-SR, and maintaining its tree structure, enables federating different but compatible diagnostic structures and simplifies the definition of complex queries. This article describes how to do this in AMGA and it shows an approach to efficiently code radiology reports to enable the multi-centre federation of data resources.

Enhancing the visibility of injuries with narrow-banded beams of light within the visible light spectrum.

PubMed

Limmen, Roxane M; Ceelen, Manon; Reijnders, Udo J L; Joris Stomp, S; de Keijzer, Koos C; Das, Kees

2013-03-01

The use of narrow-banded visible light sources in improving the visibility of injuries has been hardly investigated, and studies examining the extent of this improvement are lacking. In this study, narrow-banded beams of light within the visible light spectrum were used to explore their ability in improving the visibility of external injuries. The beams of light were induced by four crime-lites(®) providing narrow-banded beams of light between 400 and 550 nm. The visibility of the injuries was assessed through specific long-pass filters supplied with the set of crime-lites(®) . Forty-three percent of the examined injuries improved in visibility by using the narrow-banded visible light. In addition, injuries were visualized that were not visible or just barely visible to the naked eye. The improvements in visibility were particularly marked with the use of crime-lites(®) "violet" and "blue" covering the spectrum between 400-430 and 430-470 nm. The simple noninvasive method showed a great potential contribution in injury examination. © 2012 American Academy of Forensic Sciences.

Te/C nanocomposites for Li-Te Secondary Batteries

NASA Astrophysics Data System (ADS)

Seo, Jeong-Uk; Seong, Gun-Kyu; Park, Cheol-Min

2015-01-01

New battery systems having high energy density are actively being researched in order to satisfy the rapidly developing market for longer-lasting mobile electronics and hybrid electric vehicles. Here, we report a new Li-Te secondary battery system with a redox potential of ~1.7 V (vs. Li+/Li) adapted on a Li metal anode and an advanced Te/C nanocomposite cathode. Using a simple concept of transforming TeO2 into nanocrystalline Te by mechanical reduction, we designed an advanced, mechanically reduced Te/C nanocomposite electrode material with high energy density (initial discharge/charge: 1088/740 mA h cm-3), excellent cyclability (ca. 705 mA h cm-3 over 100 cycles), and fast rate capability (ca. 550 mA h cm-3 at 5C rate). The mechanically reduced Te/C nanocomposite electrodes were found to be suitable for use as either the cathode in Li-Te secondary batteries or a high-potential anode in rechargeable Li-ion batteries. We firmly believe that the mechanically reduced Te/C nanocomposite constitutes a breakthrough for the realization and mass production of excellent energy storage systems.

Quality of life, disability, and body mass index are related in obese patients.

PubMed

Sirtori, Anna; Brunani, Amelia; Liuzzi, Antonio; Pasqualinotto, Lucia; Villa, Valentina; Leonardi, Matilde; Raggi, Alberto

2011-09-01

The aim of this study is to analyze the relationship between health-related quality of life (QoL), disability, and degree of obesity. Adult obese patients (BMI>30) were consecutively enrolled in this cross-sectional observational study. The WHO Disability Assessment Schedule (WHO-DAS II) and the short version of the impact of weight on QoL (IWQoL-Lite) were administered. Spearman's rank correlation analysis was performed. A P value of less than 0.01 was used to set the statistical significance. A total of 117 patients (mean age: 47.4 years, mean BMI: 43.7) were enrolled. Correlations between WHO-DAS II and IWQoL-Lite were between 0.21 and 0.78. BMI between 0.19 and 0.26 correlated with WHO-DAS II and BMI between 0.23 and 0.49 correlated with IWQoL-Lite. In conclusion, low/moderate correlations between BMI index, disability, and health-related QoL measures, and a low association between the two outcome measures are reported, supporting the idea that they underline different and not transposable dimensions.

Mitigation of Angle Tracking Errors Due to Color Dependent Centroid Shifts in SIM-Lite

NASA Technical Reports Server (NTRS)

Nemati, Bijan; An, Xin; Goullioud, Renaud; Shao, Michael; Shen, Tsae-Pyng; Wehmeier, Udo J.; Weilert, Mark A.; Wang, Xu; Werne, Thomas A.; Wu, Janet P.;

[Risk factors of deep venous thrombosis associated with peripherally inserted central venous catheter in upper extremity in ICU].

PubMed

Zhao, Ning; Zhang, Jiale; Jiang, Ting; Chen, Xia; Wang, Jianning; Ding, Chengzhi; Liu, Fen; Qian, Kejian; Jiang, Rong

2017-02-01

To analyze the incidence and its risk factors of peripherally inserted central venous catheter related upper extremity deep venous thrombosis (PICC-UEDVT) in intensive care unit (ICU). Clinical data of the patients received PICCs in ICU of the First Affiliated Hospital of Nanchang University from August 2013 to August 2016 were retrospectively analysed. The inclusion criteria in the study included: the age > 18 years old, catheter indwelling time > 1 week and the complete relevant information. The gender, age, history of deep venous thrombosis (DVT) and PICC; number of illness involved organs; complicated with hypertension, diabetes, infection or not; and acute physiology and chronic health evaluation II (APACHE II), duration of mechanical ventilation; D-dimer, platelet count (PLT), and activated partial thromboplastin time (APTT) were recorded. According to the occurrence of PICC-UEDVT, univariate analysis was performed to identify the risk factors of PICC-UEDVT and variables with statistical difference were selected to do multivariate binary logistic regression analysis for the confirmable independence risk factors. Six patients of the 61 cases occurred PICC-UEDVT with the occurrence rate of 9.8%. Time of occurrence was 9 days, 14 days (2 cases), 22 days, 28 days, 62 days after inserted catheter respectively. Univariate analysis demonstrated that previous DVT, D-dimer and big diameter PICC were risk factors associated with PICC-UEDVT [the previous DVT: 50.00% vs. 7.27%, P = 0.017; D-dimer > 5 mg/L: 66.67% vs. 18.18%, P = 0.021; 5F catheter: 83.33% vs. 29.09%, P = 0.016]. It was shown by multivariate logistic regression analysis that the previous DVT [odds ratio (OR) = 20.539, 95% confidence interval (95%CI) = 1.733-243.875, P = 0.017] and increasing size of catheter (OR = 18.070, 95%CI = 1.317-247.875, P = 0.030) were independent risk factors associated with the development of PICC-UEDVT. For critical patients with a history of DVT and D-dimer > 5 mg/L, especially for those with the catheter placement over 14 days in ICU, clinical staffs should remain on high alert for the development of PICC-UEDVT and take early effective measures to prevent it. Meanwhile the patient's vascular conditions should be precisely assessed using ultrasound before insertion, and the appropriate catheter size be selected to reduce the incidence of PICC-UEDVT. Color Doppler ultrasonography should be used for dynamic monitoring during the indwelling of PICC, so that PICC-UEDVT can be found as early as possible.

Differences in open versus laparoscopic gastric bypass mortality risk using the Obesity Surgery Mortality Risk Score (OS-MRS).

PubMed

Brolin, Robert E; Cody, Ronald P; Marcella, Stephen W

2015-01-01

The Obesity Surgery Mortality Risk Score (OS-MRS) was developed to ascertain preoperative mortality risk of patients having bariatric surgery. To date there has not been a comparison between open and laparoscopic operations using the OS-MRS. To determine whether there are differences in mortality risk between open and laparoscopic Roux-en-Y Gastric Bypass (RYGB) using the OS-MRS. Three university-affiliated hospitals. The 90-day mortality of 2467 consecutive patients who had primary open (1574) or laparoscopic (893) RYGB performed by one surgeon was determined. Univariate and multivariate analysis using 5 OS-MRS risk factors including body mass index (BMI) gender, age>45, presence of hypertension and preoperative deep vein thrombosis (DVT) risk was performed in each group. Each patient was placed in 1 of 3 OS-MRS risk classes based on the number of risks: A (0-1), B (2-3), and C (4-5). Preoperative BMI and DVT risk factors were significantly greater in the open group (OG). Preoperative age was significantly greater in the laparoscopic group (LG). There were significantly more class B and C patients in LG. Ninety-day mortality rates for OG and LG patients were 1.0% and .9%, respectively. Pulmonary embolism was the most common cause of death. All deaths in LG occurred during first 4 years of that experience. Mortality rate by class was A = .1%; B = 1.5%; C = 2.3%. The difference in mortality between class B and C patients was not significant. Univariate analysis in the OG indicated that BMI, age, gender, and DVT risk were significant predictors of mortality. In the LG only BMI and DVT were significant predictors of death. Presence of hypertension was not a significant predictor in either group. Multivariate analysis excluding hypertension found that age was predictive of mortality in the OG while BMI (P = .057) and gender (P = .065) approached statistical significance. Conversely, only BMI was predictive of mortality in the LG with age approaching significance (P = .058). In multivariate analysis DVT risk was not predictive of mortality in either group. There are significant differences in the predictive value of the OS-MRS between open and laparoscopic RYGB. Although laparoscopic patients were significantly older versus the open patients, age was not predictive of mortality after laparoscopic RYGB. BMI trended toward increased mortality risk in both groups. Changes in technique and protocol likely contributed toward no mortality during the last 6 years of our laparoscopic experience. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Resonances and Tides in Natural Satellites Systems. (Breton Title: Ressonâncias e Marés em Sistemas de Satélites Naturais.) Resonancias y Mareas en Sistemas de Satélites Naturales

NASA Astrophysics Data System (ADS)

Callegari, Nelson, Jr.

2006-12-01

In this work we describe some aspects of the dynamics of the mean-motion resonances. Emphasis to the case of resonances between regular satellites of the giant planets will be given, even so some aspects of the physics of the resonances in extra-solar planetary systems are also briefly treated. The role of the resonances in satellites systems is discussed through examples, showing how certain resonances, and its relations with the tidal dissipation effects, can be the key of the explanation of some phenomena still not explained in the Solar System. Amongst some examples we highlight the problem of the resurfacing of Enceladus, the existence of active volcanoes in Io, and the possible existence of the subsurface ocean in Europe. This work has as objective the divulgation of some topics in Celestial Mechanics and Planetary Sciences for an undergraduate public in exact sciences, as Astronomy and Physics, and not their detailed description. Neste trabalho descrevemos alguns aspectos da dinâmica de ressonâncias de movimentos médios. Será dada ênfase maior ao caso de ressonâncias entre satélites regulares dos planetas gigantes, embora alguns aspectos da física das ressonâncias em sistemas planetários extra-solares também sejam discutidos brevemente. A importância do estudo de ressonâncias em sistemas de satélites é discutida mais detalhadamente através de exemplos, mostrando como certas ressonâncias e suas relações com efeitos de dissipação de maré podem ser a chave de parte da explicação de alguns fenômenos ainda não explicados no Sistema Solar. Dentre vários exemplos destacamos o problema da remodelagem da superfície do satélite Enceladus, a existência de vulcões ativos em Io, e a possível existência do oceano subterrâneo em Europa. Este trabalho tem como objetivo a divulgação de alguns tópicos de Mecânica Celeste e Planetologia para um público de nível de graduação em disciplinas na área de exatas, em especial Astronomia e Física, e não a descrição detalhada dos conceitos aqui discutidos. Describimos en este trabajo algunos aspectos de la dinámica de resonancias de movimientos promedio. Será dado un énfasis mayor al caso de las resonancias entre satélites regulares de los planetas gigantes, aunque también son discutidos brevemente algunos aspectos de la física de resonancias en sistemas panetarios extrasolares. La importancia del estudio de las resonancias en sistemas de satélites es discutida más detalladamente através de ejemplos, mostrando cómo ciertas resonancias y los efectos de disipación por mareas pueden ser la clave de parte de la explicación de algunos fenómenos aún no comprendidos en el Sistema Solar. Entre varios ejemplos se destacan el problema de la superficie remodelada del satélite Enceladus, la existencia de volcanes activos en Io y la posible existencia de un océano subterráneo en Europa. Este trabajo tiene como objetivo la divulgación de algunos tópicos en Mecánica Celeste y Planetología para un público universitario de ciencias exactas, en particular Astronomía y Física, y no la descripción detallada de los conceptos aquí discutidos.

DynaGuard: Armoring Canary-Based Protections against Brute-Force Attacks

DTIC Science & Technology

2015-12-11

public domain. Non-exclusive copying or redistribution is...sje ng 462 .lib qua ntu m 464 .h2 64r ef 471 .om net pp 473 .as tar 483 .xa lan cbm k Apa che Ng inx Pos tgre SQ L SQ Lite My SQ L Sl ow do w n (n...k 456 .hm me r 458 .sje ng 462 .lib qua ntu m 464 .h2 64r ef 471 .om net pp 473 .as tar 483 .xa lan cbm k Apa che Ng inx Pos tgre SQ L SQ Lite My

KSC-07pd3243

NASA Image and Video Library

2007-11-06

KENNEDY SPACE CENTER, FLA. -- With umbilical lines still attached, the payload canister containing the Columbus Laboratory module and integrated cargo carrier-lite is lifted up toward the payload changeout room on Launch Pad 39A at NASA's Kennedy Space Center. Once in place, the canister will be opened and the module transferred inside the payload changeout room. The payload will be installed in space shuttle Atlantis' payload bay. The canister contains the Columbus Lab module and integrated cargo carrier-lite payloads for space shuttle Atlantis on mission STS-122. Atlantis is targeted to launch on Dec. 6. Photo credit: NASA/Dimitri Gerondidakis

A Predictable Alternative to a Smile in Six Months?

PubMed

Kalantzis, Elizabeth; Waring, David T; Malik, Ovais H

2017-03-01

The aim of this article is to explore the use of Incognito™ Lite as an alternative to competitors advertising a ‘Smile in Six Months’ or rather short-term orthodontics for improving dental appearance through tooth movement. The focus is on the varied clinical use of this appliance system and its comparative advantages, disadvantages and placement techniques. Some alternatives are discussed and appraised. Two cases successfully treated with Incognito™ Lite are then presented. Clinical relevance: A reliable and predictable tool for aesthetic alignment of teeth, creating a broader range of treatment options for both the clinician and the patient.

Loop Group Parakeet Virtual Cable Concept Demonstrator

NASA Astrophysics Data System (ADS)

Dowsett, T.; McNeill, T. C.; Reynolds, A. B.; Blair, W. D.

2002-07-01

The Parakeet Virtual Cable (PVC) concept demonstrator uses the Ethernet Local Area Network (LAN) laid for the Battle Command Support System (BCSS) to connect the Parakeet DVT(DA) (voice terminal) to the Parakeet multiplexer. This currently requires pairs of PVC interface units to be installed for each DVT(DA) . To reduce the cost of a PVC installation, the concept of a Loop Group Parakeet Virtual Cable (LGPVC) was proposed. This device was designed to replace the up to 30 PVC boxes and the multiplexer at the multiplexer side of a PVC installation. While the demonstrator is largely complete, testing has revealed an incomplete understanding of how to emulate the proprietary handshaking occurring between the circuit switch and the multiplexer. The LGPVC concept cannot yet be demonstrated.

Lupus anticoagulants and antiphospholipid antibodies

MedlinePlus

Blood clots - lupus anticoagulants; DVT - anticoagulants ... Most often, lupus anticoagulants and aPL are found in people with diseases such as systemic lupus erythematosus (SLE). Lupus anticoagulants and ...

Découverte et signification d'une paragenèse à ilménite zincifère dans les métapélites des Jebilet centrales (Maroc)Occurrence and significance of zincian ilmenite in low-pressure metapelites from central Jebilet (Morocco)

NASA Astrophysics Data System (ADS)

Essaifi, Abderrahim; Ballèvre, Michel; Marignac, Christian; Capdevila, Ramon

2001-10-01

A zincian ilmenite paragenesis is found in metapelites from a contact metamorphic zone (central Jebilet, Morocco) induced by the emplacement of microgranitic intrusions. The zincian ilmenite is mainly preserved in syntectonic andalusite porphyroblasts. The growth of zincian ilmenite is related either to sphalerite breakdown during prograde metamorphism, or to the pervasive flow of a mineralizing fluid within the metapelites. The chlorine-rich fluid carried zinc and other metals leached in the microgranites, during its flow to discharge zones which were probably the Jebilet sulfide deposits.

Enoxaparin. A pharmacoeconomic appraisal of its use in thromboembolic prophylaxis after total hip arthroplasty.

PubMed

Dunn, C J; Goa, K L

1996-08-01

Total hip arthroplasty (THA) is a major orthopaedic procedure with a high risk of postoperative thromboembolism. Increasing demand for this type of surgery, together with its high cost, has led to examination of means by which the cost of THA may be minimised. Current clinical opinion favours the use of suitable pharmacological thromboprophylaxis in patients undergoing THA; such prophylaxis may be provided with subcutaneous standard unfractionated heparin (UFH), oral warfarin or subcutaneous low molecular weight heparin (LMWH). Traditionally, LMWHs have been perceived as being more expensive to use than UFH or warfarin because of their relatively high acquisition cost. However, recent pharmacoeconomic data have shown that cost savings are possible when LMWHs are used. This is attributed mainly to reduced frequency of administration, reductions in costs associated with diagnosis and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and the lack of need for laboratory monitoring of blood coagulation parameters. LMWHs have proportionally less anti-factor IIa (antithrombin) activity relative to anti-factor Xa activity than UFH. Enoxaparin, a LMWH with a mean molecular weight of 4 to 5kD, is reported to have approximately 5 times less activity against thrombin than UFH, for equivalent anti-factor Xa activity. Randomised clinical trials in patients undergoing THA have shown enoxaparin to be at least as effective as UFH in the prevention of DVT and PE, with consistent trends towards a lower incidence of DVT with enoxaparin than with UFH. Similar rates of haemorrhagic complications were reported for enoxaparin and UFH in most trials, although a significantly higher total transfusion requirement was reported for UFH than for enoxaparin in a double-blind study. A significantly higher incidence of bleeding was observed with UFH than with enoxaparin in another study, with similar transfusion requirements for both treatment groups. Cost comparisons in which costs were assigned retrospectively to clinical data have shown cost advantages for LMWHs in general over UFH when costs of administration, hospital bed occupancy and laboratory/radiology procedures are calculated. Cost savings with LMWHs were attributed mainly to reductions in the cost of managing thromboembolic complications in patients receiving these drugs. One meta-analysis showed a saving of $US50 000 (1993 figures) for LMWH over UFH (both subcutaneously twice daily) for every 1000 patients. Subcutaneous enoxaparin at a dosage of 30mg twice daily was shown to be more cost effective than oral warfarin in the prophylaxis of DVT and PE in 2 North American studies in which costs were related to outcomes. One study comprised the application of a decision analysis to a hypothetical group of 10 000 patients; an incremental cost effectiveness of $US12 288 (1993 figures) per death averted was reported for enoxaparin. Enoxaparin was also associated with an overall incremental cost effectiveness of $Can29 140 (1992 figures) per year of life saved (YLS) in the other study, in which costs were applied to clinical data obtained retrospectively from 10 randomised trials. Although no cost-effectiveness analyses have been carried out to compare enoxaparin with UFH, a UK cost comparison reported an overall cost saving of pounds 20 per patient (figures from 1989 to 1990) with enoxaparin 40mg once daily subcutaneously over subcutaneous UFH 5000IU 3 times daily. It has also been suggested that the use of once- or twice-daily enoxaparin in preference to UFH may reduce the overall length of hospital stay; a significant difference emerged in 1 analysis (9.9 or 9.5 vs 11.3 days). Pharmacoeconomic data therefore support the use of enoxaparin as an effective thromboprophylactic treatment with potential cost advantages over warfarin and UFH. Cost-effecti

Solar Alpha Rotary Joint (SARJ) Lubrication Interval Test and Evaluation (LITE). Post-Test Grease Analysis

NASA Technical Reports Server (NTRS)

Golden, Johnny L.; Martinez, James E.; Devivar, Rodrigo V.

2015-01-01

The Solar Alpha Rotary Joint (SARJ) is a mechanism of the International Space Station (ISS) that orients the solar power generating arrays toward the sun as the ISS orbits our planet. The orientation with the sun must be maintained to fully charge the ISS batteries and maintain all the other ISS electrical systems operating properly. In 2007, just a few months after full deployment, the starboard SARJ developed anomalies that warranted a full investigation including ISS Extravehicular Activity (EVA). The EVA uncovered unexpected debris that was due to degradation of a nitride layer on the SARJ bearing race. ISS personnel identified the failure root-cause and applied an aerospace grease to lubricate the area associated with the anomaly. The corrective action allowed the starboard SARJ to continue operating within the specified engineering parameters. The SARJ LITE (Lubrication Interval Test and Evaluation) program was initiated by NASA, Lockheed Martin, and Boeing to simulate the operation of the ISS SARJ for an extended time. The hardware was designed to test and evaluate the exact material components used aboard the ISS SARJ, but in a controlled area where engineers could continuously monitor the performance. After running the SARJ LITE test for an equivalent of 36+ years of continuous use, the test was opened to evaluate the metallography and lubrication. We have sampled the SARJ LITE rollers and plate to fully assess the grease used for lubrication. Chemical and thermal analysis of these samples has generated information that has allowed us to assess the location, migration, and current condition of the grease. The collective information will be key toward understanding and circumventing any performance deviations involving the ISS SARJ in the years to come.

Use of wound dressings with soft silicone adhesive technology.

PubMed

Morris, Clare; Emsley, Paulene; Marland, Elizabeth; Meuleneire, Frans; White, Richard

2009-04-01

To evaluate how pain, during and in-between dressing changes, is affected by the introduction of Mepilex Border Lite, a wound dressing manufactured by Mölnlycke Health Care using Safetac soft silicone adhesive technology, to the treatment of different types of paediatric wounds/skin injuries. Wounds/skin injuries that met the criteria for inclusion in the study were dressed with Mepilex Border Lite. Patients were followed for six weeks or until their wounds/skin injuries had healed, whichever occurred earlier. At each dressing change, pain severity before and during dressing removal was rated by the patient and the investigator on a scale from zero (no pain at all) to ten (worst pain ever). Other variables measured included: signs of trauma to wound/skin injury and surrounding skin, the proportion of viable/non-viable tissue, the quantity and appearance of exudate, odour, and clinical signs of infection. At the final dressing change, patients and investigators completed questionnaires to rate the dressing performance. Mean pain severity scores were significantly lower (p < or = 0.003) at the first dressing change than at baseline. Over 99.5 per cent of the Mepilex Border Lite dressing changes were reported to be atraumatic and more than half of the wounds healed within the study period. Conformability, ease of use, ease of removal, patient comfort, and overall experience with the dressing were rated as 'good' to 'very good' at the vast majority of final visit evaluations. This study provides further evidence of the ability of dressings with Safetac soft silicone adhesive technology to minimise trauma and pain and demonstrates the ability of Mepilex Border Lite to overcome the clinical challenges associated with the use of dressings on the wounds/skin injuries of paediatric patients.

LITES and GROUP-C Mission Update: Ionosphere and Thermosphere Sensing from the ISS

NASA Astrophysics Data System (ADS)

Stephan, A. W.; Budzien, S. A.; Chakrabarti, S.; Hysell, D. L.; Powell, S. P.; Finn, S. C.; Cook, T.; Bishop, R. L.

2016-12-01

The Limb-imaging Ionospheric and Thermospheric Extreme-ultraviolet Spectrograph (LITES) and GPS Radio Occultation and Ultraviolet Photometer Co-located (GROUP-C) experiments are scheduled for launch to the International Space Station (ISS) in November 2016 as part of the Space Test Program Houston #5 payload (STP-H5). The two experiments provide technical development and risk-reduction for future space weather sensors suitable for ionospheric specification, space situational awareness, and data products for global ionosphere assimilative models. The combined instrument suite of these experiments offers a unique capability to study spatial and temporal variability of the thermosphere and ionosphere using multi-sensor and tomographic approaches. LITES is an imaging spectrograph that spans 60-140 nm and continuously acquires limb profiles of the ionosphere and thermosphere from 150-350 km altitude. GROUP-C includes a high-sensitivity far-ultraviolet photometer measuring horizontal ionospheric gradients and an advanced GPS receiver providing ionospheric electron density profiles and scintillation measurements. High-cadence limb images and nadir photometry from GROUP-C/LITES are combined to tomographically reconstruct high-fidelity two-dimensional volume emission rates within the ISS orbital plane. The GPS occultation receiver provides independent measurements to calibrate and validate advanced daytime ionospheric algorithms and nighttime tomography. The vantage from the ISS on the lower portion of the thermosphere and ionosphere will yield measurements complementary to the NASA GOLD and ICON missions which are expected to fly during the STP-H5 mission. We present a mission status update and available early orbit observations, and the opportunities for using these new data to help address questions regarding the complex and dynamic features of the low and middle latitude ionosphere-thermosphere system that have important implications for operational systems.

Changes in weight and weight-related quality of life in a multicentre, randomized trial of aripiprazole versus standard of care.

PubMed

Kolotkin, Ronette L; Corey-Lisle, Patricia K; Crosby, Ross D; Kan, Hong J; McQuade, Robert D

2008-12-01

This is a secondary analysis of clinical trial data collected in 12 European countries. We examined changes in weight and weight-related quality of life among community patients with schizophrenia treated with aripiprazole (ARI) versus standard of care (SOC), consisting of other marketed atypical antipsychotics (olanzapine, quetiapine, and risperidone). Five-hundred and fifty-five patients whose clinical symptoms were not optimally controlled and/or experienced tolerability problems with current medication were randomized to ARI (10-30 mg/day) or SOC. Weight and weight-related quality of life (using the IWQOL-Lite) were assessed at baseline, and weeks 8, 18 and 26. Random regression analysis across all time points using all available data was used to compare groups on changes in weight and IWQOL-Lite. Meaningful change from baseline was also assessed. Participants were 59.7% male, with a mean age of 38.5 years (SD 10.9) and mean baseline body mass index of 27.2 (SD 5.1). ARI participants lost an average of 1.7% of baseline weight in comparison to a gain of 2.1% by SOC participants (p<0.0001) at 26 weeks. ARI participants experienced significantly greater increases in physical function, self-esteem, sexual life, and IWQOL-Lite total score. At 26 weeks, 20.7% of ARI participants experienced meaningful improvements in IWQOL-Lite score, versus 13.5% of SOC participants. A clinically meaningful change in weight was also associated with a meaningful change in quality of life (p<0.001). A potential limitation of this study was its funding by a pharmaceutical company. Compared to standard of care, patients with schizophrenia treated with aripiprazole experienced decreased weight and improved weight-related quality of life over 26 weeks. These changes were both statistically and clinically significant.

Is the Moon Illusion a Celestial Ames Demonstration?

NASA Astrophysics Data System (ADS)

Brecher, Kenneth

2010-01-01

To most naked eye observers, the Moon appears larger when seen near the horizon than it does when seen near the zenith. This "Moon Illusion” has been reported from as early as the fourth century BC and has been the subject of hundreds of papers and two books. Its explanation does not lie in the realm of physics (atmospheric refraction) or astronomy (eccentric lunar orbit) but, rather, in the realm of visual perception. Theories for the cause of the effect abound but, at present, there is no universally accepted explanation. Because the effect can be easily observed in many locations and during the course of an academic year, the moon illusion can provide a nice astronomical example that involves both direct observations and theoretical analysis. As part of the NSF funded "Project LITE: Light Inquiry Through Experiments", we have been developing inexpensive experiments and demonstrations that can be done at home. One of these is a miniature version of the classic "Ames Room". The life size version was originally developed by Adelbert Ames, Jr. and can be seen in many science museums. Our "digital” Ames Room has been designed to be printed on heavy paper using an inexpensive inkjet printer from a PDF file that is posted on the Project LITE web site http://lite.bu.edu and then cut and folded to make the room. When viewed through one wall using a commonly available door viewer, it dramatically demonstrates how the eye and brain system assesses the relative size of objects by making comparisons with the surrounding environment in which the objects are placed. In this presentation we will discuss some insights that the Ames Room provides that may offer clues to the correct explanation for the Moon Illusion. Project LITE is supported by the NSF through DUE Grant # 0715975.

Expanding Scales and Applications for 2D Spatial Mapping of CO2 using GreenLITE

NASA Astrophysics Data System (ADS)

Erxleben, W. H.; Dobler, J. T.; Zaccheo, T. S.; Blume, N.; Braun, M.

2015-12-01

The Greenhouse gas Laser Imaging Tomography Experiment (GreenLITE) system is a new measurement approach originally developed under a cooperative agreement with the Department of Energy (DOE) National Energy Technology Laboratory (NETL), Atmospheric Environmental Sciences (AER) and Exelis Inc. (now part of Harris Corp.). The original system design provides 24/7 monitoring of Ground Carbon Storage (GCS) sites, in order to help ensure worker safety and verify 99% containment. The first generation was designed to cover up to 1km2 area, and employs the Exelis Continuous Wave (CW) Intensity Modulated (IM) approach to measure differential transmission. A pair of scanning transceivers was built and combined with a series of retro reflectors, and a local weather station to provide the information required for producing estimates of the atmospheric CO2 concentration over a number of overlapping lines-of-site. The information from the transceivers, and weather station, are sent remotely to a web-based processing and storage tool, which in-turn uses the data to generate estimates of the 2D spatial distribution over the area of coverage and disseminate that information near real-time via a secure web interface. Recently, in 2015, Exelis and AER have invested in the expansion of the GreenLITE transceiver system to 5 km range, enabling areas up to 25 km2 to be evaluated with this technology, and opening new possibilities for applications such as urban scale monitoring. The 5 km system is being tested in conjunction with the National Institute of Standards and Technology at the Boulder Atmospheric Observatory in August of this year. This talk will review the initial GreenLITE system, testing and deployment of that system, and the more recent development, expansion and testing of the 5 km system.

Ibogaine treatment outcomes for opioid dependence from a twelve-month follow-up observational study.

PubMed

Noller, Geoffrey E; Frampton, Chris M; Yazar-Klosinski, Berra

2018-01-01

The psychoactive indole alkaloid ibogaine has been associated with encouraging treatment outcomes for opioid dependence. The legal status of ibogaine in New Zealand provides a unique opportunity to evaluate durability of treatment outcomes. To examine longitudinal treatment effects over a 12-month period among individuals receiving legal ibogaine treatment for opioid dependence. This observational study measured addiction severity as the primary outcome in 14 participants (50% female) over 12 months post-treatment using the Addiction Severity Index-Lite (ASI-Lite) following a single ibogaine treatment by either of two treatment providers. Secondary effects on depression were assessed via the Beck Depression Inventory-II (BDI-II). The Subjective Opioid Withdrawal Scale (SOWS) was collected before and immediately after treatment to measure opioid withdrawal symptoms. Nonparametric comparisons via Friedman Test between baseline and 12-month follow-up for participants completing all interviews (n = 8) showed a significant reduction for the ASI-Lite drug use (p = 0.002) composite score. Reductions in BDI-II scores from baseline to 12-month follow-up were also significant (p < 0.001). Significant reductions in SOWS scores for all participants (n = 14) were also observed acutely after treatment (p = 0.015). Patients with partial data (n = 4) also showed reductions in ASI-Lite drug use scores and family/social status problems. One patient enrolled in the study died during treatment. A single ibogaine treatment reduced opioid withdrawal symptoms and achieved opioid cessation or sustained reduced use in dependent individuals as measured over 12 months. Ibogaine's legal availability in New Zealand may offer improved outcomes where legislation supports treatment providers to work closely with other health professionals.

Increased rate of venous thrombosis may be associated with inpatient dihydroergotamine treatment.

PubMed

Tso, Amy R; Patniyot, Irene R; Gelfand, Amy A; Goadsby, Peter J

2017-07-18

To review whether the incidence of catheter-associated venous thromboses was higher in patients receiving IV dihydroergotamine compared to lidocaine. We retrospectively reviewed all admissions at the University of California, San Francisco Headache Center from February 25, 2008, through October 31, 2014, for age, sex, diagnosis, aura, treatment dose, type of IV line used, days with line, superficial (SVT) or deep venous thrombosis (DVT), and pulmonary embolism (PE). A peripherally inserted central catheter (PICC) or midline catheter was placed in 315 of 589 (53%) admissions. Mean age was 38 years with a range of 6 to 79 years; 121 patients (21%) were ≤18 years old. Seventy-four percent (433 of 589) of patients were female. Of 263 dihydroergotamine admissions using a PICC or midline catheter, 19 (7.2%) had either an SVT or DVT or a PE; 2 patients were diagnosed with both DVT and PE. Of 52 lidocaine admissions using a PICC or midline catheter, none had a thrombotic event ( p = 0.05, Fisher exact test). Age, sex, aura, total dihydroergotamine dose, and number of days with line were not significant predictors of venous thrombosis. IV dihydroergotamine treatment may be associated with an increased risk of catheter-associated venous thrombosis. A low threshold for diagnostic ultrasound investigation is appropriate because anticoagulation therapy was frequently required. © 2017 American Academy of Neurology.

Deep vein thrombosis using noncontrast-enhanced MR venography with electrocardiographically gated three-dimensional half-Fourier FSE: preliminary experience.

PubMed

Ono, Atsushi; Murase, Kenya; Taniguchi, Toshitaka; Shibutani, Osamu; Takata, Satoru; Kobashi, Yasuyuki; Miyazaki, Mitsue

2009-04-01

Three noncontrast-enhanced MR venography techniques are presented for assessing deep vein thrombosis (DVT) at 0.5 T in patients with metallic implants. Two cardiac-gated 3D half-Fourier FSE fresh blood imaging sequences with flow-refocusing pulses (FR-FBI) in the read-out (RO) direction and without FR pulses (non-FR-FBI) were developed for slower-flowing blood. For faster flowing blood, a swap phase-encode arterial double-subtraction elimination (SPADE) technique was developed. The three techniques were assessed both quantitatively using signal-to-noise (SNR) and contrast-noise-ratio (CNR) measurements and qualitatively by subjective image analysis in 15 volunteers. SPADE was compared to FR-FBI in the pelvic veins and FR-FBI was compared to non-FR-FBI in the thigh and calf veins. Both SPADE and FR-FBI techniques produced significantly higher SNRs, CNRs, and image quality in each comparative study (P<0.001). Five patients with metallic implants and confirmed DVT underwent SPADE (pelvic veins) and FR-FBI (thigh and calf veins) examinations and the results were compared to conventional venography. The SPADE and FR-FBI images showed all DVTs from all five patients without interference from implant susceptibility artifacts. The excellent image quality produced by both SPADE and FR-FBI throughout peripheral vasculature demonstrates their promise for detecting DVT in postsurgery patients.

Massive pulmonary embolism caused by internal iliac vein thrombosis with free-floating thrombus formation in the inferior vena cava.

PubMed

Brodmann, Marianne; Gary, Thomas; Hafner, Franz; Tiesenhausen, Kurt; Deutschmann, Hannes; Pilger, Enrst

2012-04-01

Nowadays, compression ultrasonography (CUS) is the gold standard for the routine diagnosis of deep venous thrombosis (DVT). The drawback of CUS is the low sensitivity concerning the diagnosis of isolated pelvic vein thrombosis, especially referring to isolated internal iliac vein and ovarian vein thromboses. Therefore, magnetic resonance (MR) venography has become a valuable alternative. We present the case of a 45-year-old female patient with a massive pulmonary embolism with the indication for thrombolytic therapy due to severe right ventricular overload. We were not able to detect a DVT in the lower limbs of this patient with CUS. However, further DVT workup by MR venography showed a free-floating thrombus formation originating from the right internal iliac veins into the inferior vena cava. Owing to the fact that this thrombus was free floating, surgical removal of the thrombus was scheduled and performed successfully. In some patients it might be important to look for so-called rare causes of pulmonary embolism, even when CUS of the lower limbs does not reveal any DVTs. The diagnostic procedure of choice for these patients seems to be MR phlebography, as iliac and pelvic veins can be evaluated without radiation exposure with this procedure. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

A thrombolytic regimen for high-risk deep venous thrombosis may substantially reduce the risk of postthrombotic syndrome in children

PubMed Central

Goldenberg, Neil A.; Durham, Janette D.; Knapp-Clevenger, R.

2007-01-01

Important predictors of adverse outcomes of thrombosis in children, including postthrombotic syndrome (PTS), have recently been identified. Given this knowledge and the encouraging preliminary pediatric experience with systemic thrombolysis, we sought to retrospectively analyze our institutional experience with a thrombolytic regimen versus standard anticoagulation for acute, occlusive deep venous thrombosis (DVT) of the proximal lower extremities in children in whom plasma factor VIII activity and/or D-dimer concentration were elevated at diagnosis, from within a longitudinal pediatric cohort. Nine children who underwent the thrombolytic regimen and 13 who received standard anticoagulation alone were followed from time of diagnosis with serial clinical evaluation and standardized PTS outcome assessments conducted in uniform fashion. The thrombolytic regimen was associated with a markedly decreased odds of PTS at 18 to 24 months compared with standard anticoagulation alone, which persisted after adjustment for significant covariates of age and lag time to therapy (odds ratio [OR] = 0.018, 95% confidence interval [CI] = < 0.001-0.483; P = .02). Major bleeding developed in 1 child, clinically judged as not directly related to thrombolysis for DVT. These findings suggest that the use of a thrombolysis regimen may safely and substantially reduce the risk of PTS in children with occlusive lower-extremity acute DVT, providing the basis for a future clinical trial. PMID:17360940

Epidural Analgesia after Rib Fractures.

PubMed

Zaw, Andrea A; Murry, Jason; Hoang, David; Chen, Kevin; Louy, Charles; Bloom, Matthew B; Melo, Nicolas; Alban, Rodrigo F; Margulies, Daniel R; Ley, Eric J

2015-10-01

Pain associated with rib fractures impairs respiratory function and increases pulmonary morbidity. The purpose of this study was to determine how epidural catheters alter mortality and complications in trauma patients. We performed a retrospective study involving adult blunt trauma patients with moderate-to-severe injuries from January 1, 2004 to December 31, 2013. During the 10-year period, 526 patients met the inclusion criteria; 43/526 (8%) patients had a catheter placed. Mean age of patients with epidural catheter (CATH) was higher compared with patients without epidural catheter (NOCATH) (54 vs 48 years, P = 0.021), Injury Severity Score was similar (26 CATH vs 27 NOCATH, P = 0.84), and CATH had higher mean rib fractures (7.4 vs 4.1, P < 0.001). Mortality was lower in CATH (0% vs 13%, P = 0.006). Deep vein thrombosis (DVT) rate was higher in CATH (12% vs. 5%, P = 0.036). After regression analysis, we found catheter placement to be a predictor for DVT (adjusted odds ratios 2.80, P = 0.036). Our center noted increased use of epidural catheters in patients who present with moderate-to-severe injuries. Patients with catheters were older and had a mean of 7.4 ribs fractured. The epidural cohort had longer hospital LOS and decreased mortality. In contrast to other studies, DVT rates were increased in patients who received epidural catheters.

[Endovascular treatment of acute iliofemoral deep venous thrombosis - our results with catheter-directed thrombolysis and AngioJet].

PubMed

Berencsi, Anikó; Dósa, Edit; Nemes, Balázs; Hüttl, Kálmán; Legeza, Péter; Oláh, Zoltán; Kristóf, Vera; Acsády, György; Sótonyi, Péter

2017-03-01

Most of the patients with iliofemoral thrombosis treated with anticoagulants only are affected with postthrombotic syndrome (PTS) that worsens the patients' quality of life. In the acute phase of proximal deep venous thrombosis (DVT) catheter-directed (CDT) and pharmacomechanical thrombolysis may be a reasonable alternative therapeutic method. Our aim was to summarize our results using these methods. Since 2009 twenty-four patients with iliofemoral DVT were treated with these endovascular procedures and with stenting at our Institution. The median age of the patients was 35.83 ± 15.9 years, the female: male ratio was approximately 2:1. The mean time between the onset of the symptoms and the procedures was eleven days. CDT alone was performed in 8 patients, thrombus aspiration in addition to CDT using AngioJet device in 16 patients; in 19 cases the procedure was completed with venous stenting. During the follow-up we performed US examinations and estimated the severity of PTS by Villalta-scale. The total recanalization-rate was more than 50%, which even improved during the follow-up. The total lysis time and the amount of used recombinant tissue plasminogen activator decreased significantly by applying the AngioJet. We did not find any severe PTS among our patients during the follow-up visits. Our data suggests that these methods can be used efficiently and safely in the treatment of acute iliofemoral DVT.

Patient's Compliance on the Use of Extended Low Molecular Weight Heparin Post Major Pelvic Surgeries in Cancer Patients at King Hussein Cancer Center.

PubMed

Baba, M; Al-Masri, M; Salhab, M; El-Ghanem, M

2015-01-01

Effective Venous Thrombo-Embolism (VTE) prophylaxis is used in less than 50% of oncology patients despite its wide availability. Low molecular weight heparin (LMWH) as a daily injection is an essential tool for effective prophylaxis against deep vein thrombosis (DVT). Daily outpatient self-injection by the patients or their family members is common practice. The effectiveness of this measure depends on patient compliance. The purpose of this study is to determine the degree of compliance and the factors that affect compliance to the extended out-patient use of prophylactic LMWH for 1 month after major abdominal/pelvic surgeries in cancer patients at King Hussein Cancer Center (KHCC). Following major abdominal/pelvic surgeries, data on 160 cancer patients at KHCC from January 2007 until July 2012 were collected concerning knowledge of DVT and compliance with prophylactic self-injections by answering a questionnaire. We have achieved a high compliance rate, this was explained by the medical team's role in educating the patients about the risk of VTE and the importance of thromboprophylaxis. The compliance with self-injections was directly associated with younger age, employment and higher degree of education. The high compliance rate outside clinical trials can be achieved through comprehensive patient education by a well-qualified medical team, clarification of the importance of DVT prophylaxis and patients' support.

Phlegmasia cerulea dolens

MedlinePlus

Deep vein thrombosis - Phlegmasia cerulea dolens; DVT - Phlegmasia cerulea dolens; Phlegmasia alba dolens ... 2016:chap 81. Kline JA. Pulmonary embolism and deep vein thrombosis. In: Marx JA, Hockberger RS, Walls RM, eds. ...

Concept Study of Optical Configurations for High-Frequency Telescope for LiteBIRD

NASA Astrophysics Data System (ADS)

Hasebe, T.; Kashima, S.; Ade, P. A. R.; Akiba, Y.; Alonso, D.; Arnold, K.; Aumont, J.; Baccigalupi, C.; Barron, D.; Basak, S.; Beckman, S.; Borrill, J.; Boulanger, F.; Bucher, M.; Calabrese, E.; Chinone, Y.; Cho, H.-M.; Cukierman, A.; Curtis, D. W.; de Haan, T.; Dobbs, M.; Dominjon, A.; Dotani, T.; Duband, L.; Ducout, A.; Dunkley, J.; Duval, J. M.; Elleflot, T.; Eriksen, H. K.; Errard, J.; Fischer, J.; Fujino, T.; Funaki, T.; Fuskeland, U.; Ganga, K.; Goeckner-Wald, N.; Grain, J.; Halverson, N. W.; Hamada, T.; Hasegawa, M.; Hattori, K.; Hattori, M.; Hayes, L.; Hazumi, M.; Hidehira, N.; Hill, C. A.; Hilton, G.; Hubmayr, J.; Ichiki, K.; Iida, T.; Imada, H.; Inoue, M.; Inoue, Y.; Irwin, K. D.; Ishino, H.; Jeong, O.; Kanai, H.; Kaneko, D.; Katayama, N.; Kawasaki, T.; Kernasovskiy, S. A.; Keskitalo, R.; Kibayashi, A.; Kida, Y.; Kimura, K.; Kisner, T.; Kohri, K.; Komatsu, E.; Komatsu, K.; Kuo, C. L.; Kurinsky, N. A.; Kusaka, A.; Lazarian, A.; Lee, A. T.; Li, D.; Linder, E.; Maffei, B.; Mangilli, A.; Maki, M.; Matsumura, T.; Matsuura, S.; Meilhan, D.; Mima, S.; Minami, Y.; Mitsuda, K.; Montier, L.; Nagai, M.; Nagasaki, T.; Nagata, R.; Nakajima, M.; Nakamura, S.; Namikawa, T.; Naruse, M.; Nishino, H.; Nitta, T.; Noguchi, T.; Ogawa, H.; Oguri, S.; Okada, N.; Okamoto, A.; Okamura, T.; Otani, C.; Patanchon, G.; Pisano, G.; Rebeiz, G.; Remazeilles, M.; Richards, P. L.; Sakai, S.; Sakurai, Y.; Sato, Y.; Sato, N.; Sawada, M.; Segawa, Y.; Sekimoto, Y.; Seljak, U.; Sherwin, B. D.; Shimizu, T.; Shinozaki, K.; Stompor, R.; Sugai, H.; Sugita, H.; Suzuki, A.; Suzuki, J.; Tajima, O.; Takada, S.; Takaku, R.; Takakura, S.; Takatori, S.; Tanabe, D.; Taylor, E.; Thompson, K. L.; Thorne, B.; Tomaru, T.; Tomida, T.; Tomita, N.; Tristram, M.; Tucker, C.; Turin, P.; Tsujimoto, M.; Uozumi, S.; Utsunomiya, S.; Uzawa, Y.; Vansyngel, F.; Wehus, I. K.; Westbrook, B.; Willer, M.; Whitehorn, N.; Yamada, Y.; Yamamoto, R.; Yamasaki, N.; Yamashita, T.; Yoshida, M.

2018-05-01

The high-frequency telescope for LiteBIRD is designed with refractive and reflective optics. In order to improve sensitivity, this paper suggests the new optical configurations of the HFT which have approximately 7 times larger focal planes than that of the original design. The sensitivities of both the designs are compared, and the requirement of anti-reflection (AR) coating on the lens for the refractive option is derived. We also present the simulation result of a sub-wavelength AR structure on both surfaces of silicon, which shows a band-averaged reflection of 1.1-3.2% at 101-448 GHz.

Obedience lite.

PubMed

Elms, Alan C

2009-01-01

Jerry M. Burger's partial replication of Stanley Milgram's (1963, 1965, 1974) classic experiments on obedience to authority is considered from the viewpoint of a contributor and witness to the original obedience experiments. Although Burger's replication succeeded in terms of gaining the approval of his local institutional review board, it did so by removing a large portion of the stressful circumstances that made Milgram's findings so psychologically interesting and so broadly applicable to instances of real-world destructive obedience. However, Burger has provided an initial demonstration that his "obedience lite" procedures can be used to extend the study of certain situational and personality variables beyond those examined by Milgram. PsycINFO Database Record 2009 APA.

Fourier transform spectroscopy for future planetary missions

NASA Astrophysics Data System (ADS)

Brasunas, John C.; Hewagama, Tilak; Kolasinski, John R.; Kostiuk, Theodor

2015-11-01

Thermal-emission infrared spectroscopy is a powerful tool for exploring the composition, temperature structure, and dynamics of planetary atmospheres; and the temperature of solid surfaces. A host of Fourier transform spectrometers (FTS) such as Mariner IRIS, Voyager IRIS, and Cassini CIRS from NASA Goddard have made and continue to make important new discoveries throughout the solar system.Future FTS instruments will have to be more sensitive (when we concentrate on the colder, outer reaches of the solar system), and less massive and less power-hungry as we cope with decreasing resource allotments for future planetary science instruments. With this in mind, NASA Goddard was funded via the Planetary Instrument Definition and Development Progrem (PIDDP) to develop CIRS-lite, a smaller version of the CIRS FTS for future planetary missions. Following the initial validation of CIRS-lite operation in the laboratory, we have been acquiring atmospheric data in the 8-12 micron window at the 1.2 m telescope at the Goddard Geophysical and Astronomical Observatory (GGAO) in Greenbelt, MD. Targets so far have included Earth's atmosphere (in emission, and in absorption against the moon), and Venus.We will present the roadmap for making CIRS-lite a viable candidate for future planetary missions.

Bispecific light T-cell engagers for gene-based immunotherapy of epidermal growth factor receptor (EGFR)-positive malignancies.

PubMed

Mølgaard, Kasper; Harwood, Seandean L; Compte, Marta; Merino, Nekane; Bonet, Jaume; Alvarez-Cienfuegos, Ana; Mikkelsen, Kasper; Nuñez-Prado, Natalia; Alvarez-Mendez, Ana; Sanz, Laura; Blanco, Francisco J; Alvarez-Vallina, Luis

2018-06-04

The recruitment of T-cells by bispecific antibodies secreted from adoptively transferred, gene-modified autologous cells has shown satisfactory results in preclinical cancer models. Even so, the approach's translation into the clinic will require incremental improvements to its efficacy and reduction of its toxicity. Here, we characterized a tandem T-cell recruiting bispecific antibody intended to benefit gene-based immunotherapy approaches, which we call the light T-cell engager (LiTE), consisting of an EGFR-specific single-domain V HH antibody fused to a CD3-specific scFv. We generated two LiTEs with the anti-EGFR V HH and the anti-CD3 scFv arranged in both possible orders. Both constructs were well expressed in mammalian cells as highly homogenous monomers in solution with molecular weights of 43 and 41 kDa, respectively. In situ secreted LiTEs bound the cognate antigens of both parental antibodies and triggered the specific cytolysis of EGFR-expressing cancer cells without inducing T-cell activation and cytotoxicity spontaneously or against EGFR-negative cells. Light T-cell engagers are, therefore, suitable for future applications in gene-based immunotherapy approaches.

Space Shuttle Projects

NASA Image and Video Library

1994-07-20

The STS-64 patch depicts the Space Shuttle Discovery in a payload-bay-to-Earth attitude with its primary payload, Lidar In-Space Technology Experiment (LITE-1) operating in support of Mission to Planet Earth. LITE-1 is a lidar system that uses a three-wavelength laser, symbolized by the three gold rays emanating from the star in the payload bay that form part of the astronaut symbol. The major objective of the LITE-1 is to gather data about the Earth's troposphere and stratosphere, represented by the clouds and dual-colored Earth limb. A secondary payload on STS-64 is the free-flier SPARTAN 201 satellite shown on the Remote Manipulator System (RMS) arm post-retrieval. The RMS also operated another payload, Shuttle Plume Impingement Flight Experiment (SPIFEX). A newly tested extravehicular activity (EVA) maneuvering device, Simplified Aid for EVA Rescue (SAFER), represented symbolically by the two small nozzles on the backpacks of the two untethered EVA crew men. The names of the crew members encircle the patch: Astronauts Richard N. Richards, L. Blaine Hammond, Jr., Jerry M. Linenger, Susan J. Helms, Carl J. Meade and Mark C. Lee. The gold or silver stars by each name represent that person's parent service.

Combined application versus topical and intravenous application of tranexamic acid following primary total hip arthroplasty: a meta-analysis.

PubMed

Zhang, Pei; Liang, Yuan; Chen, Pengtao; Fang, Yongchao; He, Jinshan; Wang, Jingcheng

2017-02-21

The use of intravenous (IV) or topical tranexamic acid (TXA) in total hip arthroplasty has been proven to be effective and safe in total hip arthroplasty. However, which of these two administration routes is better has not been determined. The combined administration of TXA has been used in total knee arthroplasty with satisfactory results. We hypothesized that combined application of TXA may be the most effective way without increased rate of thrombotic events such as deep vein thrombosis (DVT) and pulmonary embolisms (PE) in patients subjected to primary total hip replacement (THA). A meta-analysis was conducted to compare the efficacy and safety of the combined use of tranexamic acid (TXA) relative to topical or intravenous (IV) use alone for treatment of primary THA. The outcomes included total blood loss, postoperative hemoglobin decline, transfusion rates, and the incidence rates of deep vein thrombosis (DVT) and pulmonary embolisms (PE). We searched electronic databases including PubMed, EMBASE, the Cochrane Library, Web of Science, the Chinese Biomedical Literature database, the CNKI database, and Wanfang Data until September 2016. The references of the included articles were also checked for additional potentially relevant studies. There were no language restrictions for the search. The data of the included studies were analyzed using RevMan 5.3 software. Seven studies met the inclusion criteria, encompassing a total of 1762 patients. Our meta-analysis demonstrated that total blood loss, postoperative hemoglobin decline, and transfusion rates were significantly lower for patients that received the combined treatment compared to patients that received either topical or intravenous administration of TXA. No statistical differences were found in the incidence of deep venous thrombosis (DVT) or pulmonary embolism (PE). The group that received the combined treatment had lower total blood loss, postoperative hemoglobin decline, and transfusion rates without an increased rate of thrombotic events (DVT or PE). The topical or intravenous use of TXA in primary THA is generally considered to be safe and effective. This meta-analysis demonstrated that combined TXA application may be superior to topical or intravenous application of TXA alone. However, larger, high-quality randomized control trials are required for greater confidence in this finding.

Practice patterns in the use of retrievable inferior vena cava filters in a trauma population: a single-center experience.

PubMed

Helling, Thomas S; Kaswan, Sumesh; Miller, S Lee; Tretter, James F

2009-12-01

The use of permanent inferior vena cava filters (IVCFs) offers protection against pulmonary embolism (PE) but increases the long-term risk of deep vein thrombosis (DVT) and does not affect long-term mortality. The use of retrievable IVCFs in trauma patients offers the dual advantage of protection against PE during the risk period and the option of filter removal thus avoiding complications of DVT. Despite the safety of removal, it is likely that many of these retrievable filters are not removed. This was a retrospective, single-center, observational cohort study at a rural level I trauma center. We sought to investigate the number of patients and the circumstances under which retrievable IVCFs were placed and removed. During a 4-year period, 3,455 trauma patients were admitted and 125 patients had retrievable IVCFs placed (71 therapeutic and 54 prophylactic). The most common indications were traumatic brain and spinal cord injuries (66%). During in-hospital filter use, there were 36 new incidences (29%) of PE (1) and DVT (35). Nine patients died before removal. In 40 patients (32%), removal was attempted, and 32 (26%) retrievable IVCFs were successfully removed and in most patients (76%) within 180 days of insertion. Seventeen patients were transferred out of the area for extended care and lost to follow-up. In 55 patients, the filters were not removed. In 20 patients, the surgeon decided against removal. Thirty patients were transferred to extended care or rehabilitation within the community, but they did not return for removal. Thus, of 108/125 patients with follow-up, 76 patients (70%) did not have their IVCFs removed, and 50 patients did not have their IVCFs removed because of the choice of the surgeon, extended care, or rehabilitation. The use of retrievable IVCFs, when necessary, produced predictable protection against PE and DVT complications. Despite the opportunity for removal, most patients, in fact, did not have their filters removed, even when posthospital care could be tracked. The practices of the surgeon, the transfer to extended-care facilities, near or far, and the reluctance to remove long-standing IVCFs contributed to the high-retention rate.

Black-blood thrombus imaging (BTI): a contrast-free cardiovascular magnetic resonance approach for the diagnosis of non-acute deep vein thrombosis.

PubMed

Xie, Guoxi; Chen, Hanwei; He, Xueping; Liang, Jianke; Deng, Wei; He, Zhuonan; Ye, Yufeng; Yang, Qi; Bi, Xiaoming; Liu, Xin; Li, Debiao; Fan, Zhaoyang

2017-01-18

Deep vein thrombosis (DVT) is a common but elusive illness that can result in long-term disability or death. Accurate detection of thrombosis and assessment of its size and distribution are critical for treatment decision-making. In the present study, we sought to develop and evaluate a cardiovascular magnetic resonance (CMR) black-blood thrombus imaging (BTI) technique, based on delay alternating with nutation for tailored excitation black-blood preparation and variable flip angle turbo-spin-echo readout, for the diagnosis of non-acute DVT. METHODS: This prospective study was approved by institutional review board and informed consent obtained from all subjects. BTI was first conducted in 11 healthy subjects for parameter optimization and then conducted in 18 non-acute DVT patients to evaluate its diagnostic performance. Two clinically used CMR techniques, contrast-enhanced CMR venography (CE-MRV) and three dimensional magnetization prepared rapid acquisition gradient echo (MPRAGE), were also conducted in all patients for comparison. All images obtained from patients were analyzed on a per-segment basis. Using the consensus diagnosis of CE-MRV as the reference, the sensitivity (SE), specificity (SP), positive and negative predictive values (PPV and NPV), and accuracy (ACC) of BTI and MPRAGE as well as their diagnostic agreement with CE-MRV were calculated. Besides, diagnostic confidence and interreader diagnostic agreement were evaluated for all three techniques. BTI with optimized parameters effectively nulled the venous blood flow signal and allowed directly visualizing the thrombus within the black-blood lumen. Higher SE (90.4% vs 67.6%), SP (99.0% vs. 97.4%), PPV (95.4% vs. 85.6%), NPV (97.8% vs 92.9%) and ACC (97.4% vs. 91.8%) were obtained by BTI in comparison with MPRAGE. Good diagnostic confidence and excellent diagnostic and interreader agreements were achieved by BTI, which were superior to MPRAGE on detecting the chronic thrombus. BTI allows direct visualization of non-acute DVT within the dark venous lumen and has the potential to be a reliable diagnostic tool without the use of contrast medium.

Varied response of the pulmonary arterial endothelium in a novel rat model of venous thromboembolism.

PubMed

Ji, Ying-qun; Feng, Min; Zhang, Zhong-he; Lu, Wei-xuan; Wang, Chen

2013-01-01

The experimental studies of venous thromboembolism (VTE) as an entity and the response of the pulmonary arterial endothelium after VTE are still rare. The objective of this study was to observe changes in the pulmonary arterial endothelium using a novel rat model of VTE. Rats were allocated to the VTE (n = 54) or control groups (n = 9). The left femoral vein was blocked using a microvessel clip to form deep vein thrombosis (DVT). One, four or seven-day-old thrombi were injected into the right femoral vein to induce DVT-pulmonary thromboembolism (DVT-PTE). The rats were sacrificed 1, 4 or 7 days later (D(n(1,4,7)) P(n(1,4,7)) subgroups (n = 6)), and the lungs were examined using light and electron microscopy. On gross dissection, the rate of DVT formation was higher on day 1 (D(1)P(n): 100%, 18/18) than day 4 (D(4)P(n): 83%, 15/18; χ(2) = 5.900, P = 0.015) or day 7 (D(7)P(n): 44%, 8/18; χ(2) = 13.846, P = 0.000). On gross dissection, the positive emboli residue rate in the pulmonary arteries was lower in the D(1)P(n) subgroup (39%, 7/18) than the D(4)P(n) (73%, 11/15; χ(2) = 3.915, P = 0.048) and D(7)P(n) subgroups (100%, 8/8; χ(2) = 8.474, P = 0.004); however, light microscopy indicated the residual emboli rate was similar in all subgroups. Hyperplasia of the pulmonary arterial endothelium was observed 4 and 7 days after the injection of one-day-old or four-day-old thrombi. However, regions without pulmonary arterial endothelial cells and intra-elastic layers were observed one day after injection of seven-day-old thrombi. This novel model closely simulates the clinical situations of thrombus formation and is ideal to study pulmonary endothelial cell activation. The outcome of emboli and pulmonary arterial endothelial alterations are related to the age and nature of the thrombi.

Factor v leiden mutation in patients with breast cancer with a central venous catheter: risk of deep vein thrombosis.

PubMed

Curigliano, Giuseppe; Mandalà, Mario; Sbanotto, Alberto; Colleoni, Marco; Ferretti, Gianluigi; Bucciarelli, Paolo; Peruzzotti, Giulia; de Braud, Filippo; De Pas, Tommaso; Spitaleri, Gianluca; Pietri, E; Orsi, Franco; Banfi, Maria G; Goldhirsch, Aron

2006-01-01

The objective of this study was to analyze the influence of the prothrombotic factor V Leiden (FVL) and G20210A prothrombin mutations on the frequency of the first episode of catheter-related deep vein thrombosis (DVT) in a cohort of patients with locally advanced or metastatic breast cancer during continuous venous insult (infusion of 5-fluorouracil-based chemotherapy). Between January 1999 and February 2001, we retrospectively analyzed the incidence of first DVT in 300 consecutive patients with locally advanced or metastatic breast cancer treated at a single institution with a combination of chemotherapy administered continuously through a totally implanted access port. We identified 25 women (study group) with catheter-related DVT. For each of the 25 patients, we selected 2 women eligible for identical chemotherapy who had similar age, stage of disease, and prognostic features as a control group. The prothrombotic FVL and prothrombin mutation G20210A genotype analyses were performed in all patients. Analyses were performed on blinded samples, and all patients signed a specific informed consent form. A total of 25 cases (with thrombosis) and 50 frequency-matched controls were evaluated for FVL. Five cases and 2 controls were found with the mutation in the FVL, for incidences of 20% (95% CI, 9%-39%) and 4% (95% CI, 1%-14%), respectively. Thus, the frequency of the mutation was significantly higher in the cases than in controls (P = 0.04), and a logistic regression analysis, adjusted by age, yielded an odds ratio of 6.1 (95% CI, 1.1%-34.3%; P = 0.04). Time from start of infusion chemotherapy to thrombosis was not significantly different between those with the mutation (median, 31 days) and without the mutation (median, 43 days; P = 0.6). Only 1 subject (in the case group) was found with the G20210A mutation in the prothrombin gene. Factor V Leiden carriers with locally advanced or metastatic breast cancer are at high risk of catheter-related DVT during chemotherapy. Clinicians should be aware of this increased risk, and alternative cytotoxic treatments not requiring continuous infusions should be considered for these patients.

Prader-Willi Syndrome Association

MedlinePlus

... his book “Diehards” to PWSA (USA) Buy Here Survey: Vascular Blood Clots, Deep Vein Thrombosis (DVT) and/ ... ages, living or deceased to fill out this survey Learn More Get Involved About Prader-Willi Syndrome ...

Thrombophlebitis

MedlinePlus

... the surface of your skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis, or DVT). Causes include trauma, surgery ... pain in the affected area Redness and swelling Deep vein thrombosis signs and symptoms include: Pain Swelling ...

Deep Vein Thrombosis

MedlinePlus

Deep vein thrombosis, or DVT, is a blood clot that forms in a vein deep in the body. Most ... vein swells, the condition is called thrombophlebitis. A deep vein thrombosis can break loose and cause a serious problem ...

Structural and optical properties of WTe2 single crystals synthesized by DVT technique

NASA Astrophysics Data System (ADS)

Dixit, Vijay; Vyas, Chirag; Pathak, V. M.; Soalanki, G. K.; Patel, K. D.

2018-05-01

Layered transition metal di-chalcogenide (LTMDCs) crystals have attracted much attention due to their potential in optoelectronic device applications recently due to realization of their monolayer based structures. In the present investigation we report growth of WTe2 single crystals by direct vapor transport (DVT) technique. These crystals are then characterized by energy dispersive analysis of x-rays (EDAX) to study stoichiometric composition after growth. The structural properties are studied by x-ray diffraction (XRD) and selected area electron diffraction (SAED) is used to confirm orthorhombic structure of grown WTe2 crystal. Surface morphological properties of the crystals are also studied by scanning electron microscope (SEM). The optical properties of the grown crystals are studied by UV-Visible spectroscopy which gives direct band gap of 1.44 eV for grown WTe2 single crystals.

The efficacy and safety of topical administration of tranexamic acid in spine surgery: a meta-analysis.

PubMed

Luo, Wei; Sun, Ru-Xin; Jiang, Han; Ma, Xin-Long

2018-04-24

We conducted a meta-analysis from randomized controlled trials (RCTs) and non-RCTs to assess the efficacy and safety of tranexamic acid (TXA) in spine surgery. Potentially relevant academic articles were identified from the Cochrane Library, MEDLINE (1966-2017.11), PubMed (1966-2017.11), Embase (1980-2017.11), and ScienceDirect (1985-2017.11). Secondary sources were identified from the references of the included literature. The pooled data were analyzed using RevMan 5.1. Three RCTs and one non-RCT met the inclusion criteria. There were significant differences in total blood loss (MD = - 267.53, 95% CI - 373.04 to - 106.02, P < 0.00001), drainage volume (MD = - 157.00, 95% CI - 191.17 to - 122.84, P < 0.00001), postoperative hemoglobin level (MD = 0.95, 95% CI 0.44 to 1.47, P = 0.0003), and length of hospital stay (MD = - 1.42, 95% CI - 1.92 to - 0.93, P < 0.00001). No significant differences were found regarding transfusion requirement, deep vein thrombosis (DVT), pulmonary embolism (PE), wound hematoma, and infection between the two groups. The present meta-analysis indicated that the topical application of TXA in spinal surgery decreases the total blood loss and drainage volume and preserves higher postoperative hemoglobin level without increasing the risk of DVT infection, hematoma, DVT, and PE.

From dV-Trainer to Real Robotic Console: The Limitations of Robotic Skill Training.

PubMed

Yang, Kun; Zhen, Hang; Hubert, Nicolas; Perez, Manuela; Wang, Xing Huan; Hubert, Jacques

To investigate operators' performance quality, mental stress, and ergonomic habits through a training curriculum on robotic simulators. Forty volunteers without robotic surgery experience were recruited to practice 2 exercises on a dV-Trainer (dVT) for 14 hours. The simulator software (M-score a ) provided an automatic evaluation of the overall score for the surgeons' performance. Each participant provided a subjective difficulty score (validity to be proven) for each exercise. Their ergonomic habits were evaluated based on the workspace range and armrest load-validated criteria for evaluating the proficiency of using the armrest. They then repeated the same tasks on a da Vinci Surgical Skill Simulator for a final-level test. Their final scores were compared with their initial scores and the scores of 5 experts on the da Vinci Surgical Skill Simulator. A total of 14 hours of training on the dVT significantly improved the surgeons' performance scores to the expert level with a significantly reduced workload, but their ergonomic score was still far from the expert level. Sufficient training on the dVT improves novices' performance, reduces psychological stress, and inculcates better ergonomic habits. Among the evaluated criteria, novices had the most difficulty in achieving expert levels of ergonomic skills. The training benefits of robotic surgery simulators should be determined with quantified variables. The detection of the limitations during robotic training curricula could guide the targeted training and improve the training effect. Copyright © 2017. Published by Elsevier Inc.

Postthrombotic syndrome.

PubMed

Pesavento, Raffaele; Bernardi, Enrico; Concolato, Alessia; Dalla Valle, Fabio; Pagnan, Antonio; Prandoni, Paolo

2006-10-01

Despite considerable progress in the diagnosis and treatment of deep vein thrombosis (DVT) of the lower extremities, one of every three patients will develop postthrombotic sequelae within 2 years; these sequelae are severe in approximately 20% of cases and produce considerable socioeconomic consequences. Among factors potentially related to the development of the postthrombotic syndrome (PTS) are older age, obesity, insufficient oral anticoagulant therapy, and recurrent ipsilateral thrombosis. Whether the extent and location of the initial thrombosis are associated with the development of PTS is controversial. Based on recent findings, the lack of vein recanalization within the first 6 months appears to be an important predictor of PTS, whereas the development of transpopliteal venous reflux is not. The diagnosis of PTS can be made on clinical grounds for patients with a history of DVT. The combination of a standardized clinical evaluation with the results of compression ultrasonography and Doppler ultrasound helps diagnose or exclude a previous proximal vein thrombosis. According to the results of recent clinical studies, the prompt administration of adequate compression elastic stockings in patients with symptomatic DVT has the potential to reduce the frequency of late PTS development by half. The management of this condition is demanding and often frustrating. However, when carefully supervised and instructed to wear proper elastic stockings, more than 50% of patients will either remain stable or improve during long-term follow-up. Clinical presentation helps predict the prognosis; the outcome of patients who refer with initially severe manifestations is more favorable than that of patients whose symptoms deteriorate progressively over time.

Air Travel Safety in Postoperative Breast Cancer Patients: A Systematic Review.

PubMed

Co, Michael; Ng, Judy; Kwong, Ava

2018-05-17

Air travel has long been a dilemma in post-breast cancer surgery patients. Anecdotal reports have described adverse outcomes on surgical wound, implants, and lymphedema during air travel. This review aims to evaluate the best evidence from the literature concerning the air travel safety in breast cancer patients. A comprehensive review was performed of the Medline, Embase, CINAHL, and Cochrane databases using a predefined strategy. Retrieved studies were independently screened and rated for relevance. Data were extracted by 2 researchers. We reviewed the best evidence on air travel safety in postoperative breast cancer patients. Evidence was limited in the current literature to suggest adverse effects on postoperative mastectomy wounds and drains by high-altitude travel. Similarly, adverse effects on breast implants were limited to case reports and ex vivo experiments. A systematic review of 12 studies concluded that air travel is not associated with upper limb lymphedema after breast cancer surgery. Deep-vein thrombosis (DVT) is a known complication after air travel; in addition, malignancy itself is a known risk factor for DVT. Evidence of safety to continue tamoxifen during the period of air travel is lacking in the literature. Evidence to support the use of systemic DVT prophylaxis in general postoperative breast cancer patients is also limited. Best evidence from a large retrospective study suggested that mechanical antiembolism devices and early mobilization are the only measures required. Air travel is generally safe in patients after breast cancer surgery. Copyright © 2018. Published by Elsevier Inc.

Development of Extravehicular Visor Assembly (EVVA)

NASA Technical Reports Server (NTRS)

Davis, Kristine

2017-01-01

For the next generation of NASA's space suits, being able to enable an architecture for microgravity and planetary capabilities is required. To support these future missions, we will need exemplary support hardware to be designed, such as a new extravehicular visor assembly (EVVA). This EVVA will carry out its heritage mission of protecting the astronauts' eyes from harmful radiation, giving needed shade, and providing thermal protection, while also incorporating new designs that maximize overhead visibility and incorporate new technology. It will be designed to adapt with xEMU lite, a next-generation suit architecture Completed market research and literature reviews center dotSet up a NASA@Workchallenge "Incorporating Active TintableElectronic Coatings into Next Generation Space Suit Visor." center dotContacted Boeing and AlphaMicron to understand COTS solutions on the market and how they could be applied to the space suit design. oFound that there are many advantages to an active coating because of reduced mechanisms, an inherent dust tolerant design, and auto-sense capabilities. However, the COTS designs are not currently compatible with the xEMU lite form factor, the space environment, and the xEMU lite power requirement. COTS designs can also fail in the off/transparent state. center dotPursuing low TRL funding sources for future development for exploration EVA space suit Boeing 787

How well can future CMB missions constrain cosmic inflation?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Martin, Jérôme; Vennin, Vincent; Ringeval, Christophe, E-mail: jmartin@iap.fr, E-mail: christophe.ringeval@uclouvain.be, E-mail: vennin@iap.fr

2014-10-01

We study how the next generation of Cosmic Microwave Background (CMB) measurement missions (such as EPIC, LiteBIRD, PRISM and COrE) will be able to constrain the inflationary landscape in the hardest to disambiguate situation in which inflation is simply described by single-field slow-roll scenarios. Considering the proposed PRISM and LiteBIRD satellite designs, we simulate mock data corresponding to five different fiducial models having values of the tensor-to-scalar ratio ranging from 10{sup -1} down to 10{sup -7}. We then compute the Bayesian evidences and complexities of all Encyclopædia Inflationaris models in order to assess the constraining power of PRISM alone andmore » LiteBIRD complemented with the Planck 2013 data. Within slow-roll inflation, both designs have comparable constraining power and can rule out about three quarters of the inflationary scenarios, compared to one third for Planck 2013 data alone. However, we also show that PRISM can constrain the scalar running and has the capability to detect a violation of slow roll at second order. Finally, our results suggest that describing an inflationary model by its potential shape only, without specifying a reheating temperature, will no longer be possible given the accuracy level reached by the future CMB missions.« less

Um satélite brasileiro para observação do diâmetro solar

NASA Astrophysics Data System (ADS)

Emilio, M.; Leister, N. V.; Benevides Soares, P.; Teixeira, R.; Kuhn, J.

2003-08-01

Propomos uma missão espacial para medir a forma e o diâmetro solar com o objetivo de ajudar a determinar o potencial gravitacional do Sol e a sua rotação com precisão, testar modelos teóricos de variação de energia e pela primeira vez medir os modos g de oscilação. As observações serão obtidas através do instrumento denominado APT (Astrometric and Photometric Telescope) descrito por Kuhn(1983). A sensibilidade do instrumento é de 0,2 mas em 27 dias para as observações do diâmetro solar feitas a cada minuto. Esta é uma missão de três anos de duração e pode complementar as medidas que serão feitas pelo satélite PICARD (a ser lançado em 2007). Outros parâmetros físicos podem ser obtidos com as mesmas imagens o que certamente interessará à comunidade de física solar. Um primeiro contato foi realizado com a agência espacial brasileira que pretende lançar um satélite científico a cada dois anos.

Evaluation of a Pitot type spirometer in helium/oxygen mixtures.

PubMed

Søndergaard, S; Kárason, S; Lundin, S; Stenqvist, O

1998-08-01

Mixtures of helium and oxygen are regaining a place in the treatment of obstruction of the upper and lower respiratory tract. The parenchymal changes during the course of IRDS or ARDS may also benefit from the reintroduction of helium/oxygen. In order to monitor and document the effect of low-density gas mixtures, we evaluated the Datex AS/3 Side Stream Spirometry module with D-lite (Datex-Engstrom Instrumentarium Corporation, Finland) against two golden standards. Under conditions simulating controlled and spontaneous ventilation with gas mixtures of He (approx. 80, 50, and 20%)/O2 or N2(approx. 21 and 79%)/02, simultaneous measurements using Biotek Ventilator Tester (Bio-Tek Instr., Vermont, USA) or body plethysmograph (SensorMedics System, Anaheim, USA) were correlated with data from the spirometry module. Data were analyzed according to a statistical regression model resulting in a best-fit equation based on density, voltage, and volume measurements. As expected, the D-lite (a modified Pitot tube) showed density-dependent behaviour. Regression equations and percentage deviation of estimated versus measured values were calculated. Measurements with the D-lite using low-density gases are satisfactorily contained in best-fit equations with a standard deviation of less than 5% during all ventilatory modes and mixtures.

Measuring Family Members' Satisfaction with End-of-Life Care in Long-Term Care: Adaptation of the CANHELP Lite Questionnaire.

PubMed

Nadin, Shevaun; Miandad, Mohammed Ali; Kelley, Mary Lou; Marcella, Jill; Heyland, Daren K

2017-01-01

Improving end-of-life care (EOLC) in long-term care (LTC) homes requires quality measurement tools that assess families' satisfaction with care. This research adapted and pilot-tested an EOLC satisfaction measure (Canadian Health Care Evaluation Project (CANHELP) Lite Questionnaire) for use in LTC to measure families' perceptions of the EOLC experience and to be self-administered. Phase 1 . A literature review identified key domains of satisfaction with EOLC in LTC, and original survey items were assessed for inclusiveness and relevance. Items were modified, and one item was added. The revised questionnaire was administered to 118 LTC family members and cognitive interviews were conducted. Further modifications were made including reformatting to be self-administered. The new instrument was pilot-tested with 134 family members. Importance ratings indicated good content and face validity. Cronbach's alpha coefficients (range: .88-.94) indicated internal consistency. This research adapted and pilot-tested the CANHELP for use in LTC. This paper introduces the new, valid, internally consistent, self-administered tool (CANHELP Lite Family Caregiver LTC) that can be used to measure families' perceptions of and satisfaction with EOLC. Future research should further validate the instrument and test its usefulness for quality improvement and care planning.

Measuring Family Members' Satisfaction with End-of-Life Care in Long-Term Care: Adaptation of the CANHELP Lite Questionnaire

PubMed Central

Miandad, Mohammed Ali; Marcella, Jill; Heyland, Daren K.

2017-01-01

Rationale Improving end-of-life care (EOLC) in long-term care (LTC) homes requires quality measurement tools that assess families' satisfaction with care. This research adapted and pilot-tested an EOLC satisfaction measure (Canadian Health Care Evaluation Project (CANHELP) Lite Questionnaire) for use in LTC to measure families' perceptions of the EOLC experience and to be self-administered. Methods and Results Phase 1. A literature review identified key domains of satisfaction with EOLC in LTC, and original survey items were assessed for inclusiveness and relevance. Items were modified, and one item was added. Phase 2 The revised questionnaire was administered to 118 LTC family members and cognitive interviews were conducted. Further modifications were made including reformatting to be self-administered. Phase 3 The new instrument was pilot-tested with 134 family members. Importance ratings indicated good content and face validity. Cronbach's alpha coefficients (range: .88–.94) indicated internal consistency. Conclusion This research adapted and pilot-tested the CANHELP for use in LTC. This paper introduces the new, valid, internally consistent, self-administered tool (CANHELP Lite Family Caregiver LTC) that can be used to measure families' perceptions of and satisfaction with EOLC. Future research should further validate the instrument and test its usefulness for quality improvement and care planning. PMID:28706945

Evaluation of Blood Glucose Meter Efficacy in an Antenatal Diabetes Clinic.

PubMed

McGrath, Rachel T; Donnelly, Vanessa C; Glastras, Sarah J; Preda, Veronica A; Sheriff, Nisa; Ward, Peter; Hocking, Samantha L; Fulcher, Gregory R

2016-02-01

The optimal treatment of diabetes in pregnancy requires accurate measurement of blood glucose levels, in order to minimize adverse outcomes for both mother and neonate. Self-monitoring of blood glucose is routinely used to measure glycemic control and to assess whether treatment targets are being met; however, the accuracy of blood glucose meters in pregnancy is unclear. Pregnant women with gestational, type 1, or type 2 diabetes mellitus were eligible to participate. Nonfasting capillary blood glucose levels were measured in duplicate using the BGStar(®) (Sanofi, Sydney, Australia) and FreeStyle Lite(®) (Abbott, Sydney) blood glucose meters. Venous blood samples were collected and analyzed for plasma glucose, hematocrit, and glycated hemoglobin. Capillary blood glucose was compared with plasma glucose and further assessed according to International Organization for Standardization (ISO) 15197:2013 standards. One hundred ten women were recruited, providing 96 samples suitable for analysis. The mean ± SD laboratory plasma glucose level was 4.6 ± 1.4 mmol/L; the BGStar and FreeStyle Lite capillary blood glucose values were 5.3 ± 1.4 mmol/L and 5.0 ± 1.3 mmol/L, respectively. Both meters showed a positive bias (0.42 mmol/L for the FreeStyle Lite and 0.65 mmol/L for the BGStar). Furthermore, neither meter fulfilled the ISO 15197:2013 standards, and there was a nonsignificant improvement in meter performance at blood glucose levels of ≤4.2 mmol/L. Hematocrit did not affect the results of either blood glucose meter. Clarke Error Grid analysis demonstrated that approximately 70% of the results of both meters would lead to appropriate clinical action. The BGStar and FreeStyle Lite blood glucose meters did not meet ISO 15197:2013 recommendations for blood glucose monitoring systems when assessed in a population of women with diabetes in pregnancy. Clinicians should consider this difference in blood glucose readings when making diabetes-related treatment decisions.

Calcium and vitamin D supplementation is associated with decreased abdominal visceral adipose tissue in overweight and obese adults1234

PubMed Central

Rosenblum, Jennifer L; Castro, Victor M; Moore, Carolyn E; Kaplan, Lee M

2012-01-01

Background: Several studies suggest that calcium and vitamin D (CaD) may play a role in the regulation of abdominal fat mass. Objective: This study investigated the effect of CaD-supplemented orange juice (OJ) on weight loss and reduction of visceral adipose tissue (VAT) in overweight and obese adults (mean ± SD age: 40.0 ± 12.9 y). Design: Two parallel, double-blind, placebo-controlled trials were conducted with either regular or reduced-energy (lite) orange juice. For each 16-wk trial, 171 participants were randomly assigned to 1 of 2 groups. The treatment groups consumed three 240-mL glasses of OJ (regular or lite) fortified with 350 mg Ca and 100 IU vitamin D per serving, and the control groups consumed either unfortified regular or lite OJ. Computed tomography scans of VAT and subcutaneous adipose tissue were performed by imaging a single cut at the lumbar 4 level. Results: After 16 wk, the average weight loss (∼2.45 kg) did not differ significantly between groups. In the regular OJ trial, the reduction of VAT was significantly greater (P = 0.024) in the CaD group (−12.7 ± 25.0 cm2) than in the control group (−1.3 ± 13.6 cm2). In the lite OJ trial, the reduction of VAT was significantly greater (P = 0.039) in the CaD group (−13.1 ± 18.4 cm2) than in the control group (−6.4 ± 17.5 cm2) after control for baseline VAT. The effect of calcium and vitamin D on VAT remained highly significant when the results of the 2 trials were combined (P = 0.007). Conclusions: The findings suggest that calcium and/or vitamin D supplementation contributes to a beneficial reduction of VAT. This trial is registered at clinicaltrial.gov as NCT00386672, NCT01363115. PMID:22170363

Efficacy of the ViziLite system in the identification of oral lesions.

PubMed

Oh, Esther S; Laskin, Daniel M

2007-03-01

Early detection of oral cancer is crucial in improving survival rate. To improve early detection, the use of a dilute acetic acid rinse and observation under a chemiluminescent light (ViziLite; Zila Pharmaceuticals, Phoenix, AZ) has been recommended. However, to date, the contributions of the individual components of the system have not been studied. The present study was done to investigate the efficacy of the individual components of the ViziLite system in providing improved visualization of early oral mucosal lesions. A total of 100 patients, 39 males and 61 females, age 18 to 93 years (mean age, 44 years), who presented to the Virginia Commonwealth University School of Dentistry for dental screening were examined. There were 58 Caucasians, 29 African-Americans, 5 Hispanics, 6 Asians, and 2 of mixed ethnicity. Thirty-five patients smoked, 53 used alcohol, and 25 both smoked and drank. After written consent, the oral cavity was examined under incandescent light for soft tissue abnormalities. After 1-minute rinse with 1% acetic acid, the mouth was re-examined for additional mucosal abnormalities. Then, the mouth was examined once again using the ViziLite system's chemiluminescent light. Any lesions detected by these 3 examinations that were clinically undiagnosable were brush biopsied (Oral CDx) for determination of cellular representation. In the original examination of the 100 patients, 57 clinically diagnosable benign lesions (eg, linea alba, leukoedema) and 29 clinically undiagnosable lesions were detected. After the rinse, 6 additional diagnosable lesions (linea alba) and 3 undiagnosable lesions were found. No additional lesions were detected with the chemiluminescent light. Of the 32 undiagnosable lesions that were brush biopsied, 2 were positive for atypical cellular characterization and warranted further investigation with a scalpel biopsy. Neither of these lesions was found to be premalignant or malignant. Although the acid rinse accentuated some lesions, the overall detection rate was not significantly improved. The chemiluminescent light produced reflections that made visualization more difficult and thus was not beneficial.

Forward modeling of tree-ring data: a case study with a global network

NASA Astrophysics Data System (ADS)

Breitenmoser, P. D.; Frank, D.; Brönnimann, S.

2012-04-01

Information derived from tree-rings is one of the most powerful tools presently available for studying past climatic variability as well as identifying fundamental relationships between tree-growth and climate. Climate reconstructions are typically performed by extending linear relationships, established during the overlapping period of instrumental and climate proxy archives into the past. Such analyses, however, are limited by methodological assumptions, including stationarity and linearity of the climate-proxy relationship. We investigate climate and tree-ring data using the Vaganov-Shashkin-Lite (VS-Lite) forward model of tree-ring width formation to examine the relations among actual tree growth and climate (as inferred from the simulated chronologies) to reconstruct past climate variability. The VS-lite model has been shown to produce skill comparable to that achieved using classical dendrochronological statistical modeling techniques when applied on simulations of a network of North American tree-ring chronologies. Although the detailed mechanistic processes such as photosynthesis, storage, or cell processes are not modeled directly, the net effect of the dominating nonlinear climatic controls on tree-growth are implemented into the model by the principle of limiting factors and threshold growth response functions. The VS-lite model requires as inputs only latitude, monthly mean temperature and monthly accumulated precipitation. Hence, this simple, process-based model enables ring-width simulation at any location where monthly climate records exist. In this study, we analyse the growth response of simulated tree-rings to monthly climate conditions obtained from the 20th century reanalysis project back to 1871. These simulated tree-ring chronologies are compared to the climate-driven variability in worldwide observed tree-ring chronologies from the International Tree Ring Database. Results point toward the suitability of the relationship among actual tree growth and climate (as inferred from the simulated chronologies) for use in global palaeoclimate reconstructions.

Data and Statistics of DVT/PE

MedlinePlus

... Controls Cancel Submit Search the CDC Venous Thromboembolism (Blood Clots) Note: Javascript is disabled or is not supported ... Challenge HA-VTE Data & Statistics HA-VTE Resources Blood Clots and Travel Research and Treatment Centers Data & Statistics ...

Dabigatran

MedlinePlus

Dabigatran comes as a capsule to take by mouth. When dabigatran is used to treat or prevent DVT or PE or to prevent strokes or ... often than prescribed by your doctor.Swallow the capsules whole with a whole glass of water; do ...