AIM To characterise venous thromboembolism(VTE) in gastrointestinal cancer and assess the clinical utility of risk stratification scoring. METHODS We performed a retrospective analysis using electronic patient records...AIM To characterise venous thromboembolism(VTE) in gastrointestinal cancer and assess the clinical utility of risk stratification scoring. METHODS We performed a retrospective analysis using electronic patient records of 910 gastro-oesophageal(GO) cancer and 1299 colorectal cancer(CRC) patients referred to a tertiary cancer centre to identify the incidence of VTE, its relationship to chemotherapy and impact on survival.VTE risk scores were calculated using the Khorana index. Patients were classified as low risk(0 points), intermediate risk(1 to 2 points) or high risk(3 points). Data was analysed to determine the sensitivity of the Khorana score to predict VTE. RESULTS The incidence of VTE was 8.9% for CRC patients and 9.7% for GO cancer patients. Pulmonary emboli(PE) were more common in advanced than in localised CRC(50% vs 21% of events respectively) and lower limb deep vein thrombosis(DVT) were more common in localised than in advanced CRC(62% vs 39% of events respectively). The median time to VTE from cancer diagnosis was 8.3 mo for CRC patients compared to 6.7 mo in GO cancer. In localised CRC median time to VTE was 7.1 mo compared with 10.1 mo in advanced CRC. In contrast in GO cancer, the median time to VTE was 12.5 mo in localised disease and 6.8 mo in advanced disease. No survival difference was seen between patients with and without VTE in this cohort. The majority of patients with CRC in whom VTE was diagnosed had low or intermediate Khorana risk score(94% for localised and 97% in advanced CRC). In GO cancer, all patients scored either intermediate or high risk due to the primary site demonstrating a limitation of the risk assessment score in discriminating high and low risk patients with GO cancers. Additional risk factors were identified in this cohort including surgery, chemotherapy or hospital admission. Overall, 81% of patients with CRC and 77% of patients with GO cancer had one or more of these factors within 4 wk prior to diagnosis VTE. These should be factored into clinical risk assessment scores. CONCLUSION The Khorana score has low sensitivity for thrombotic events in CRC and cannot discriminate low risk patients in high risk cancer sites such as GO cancer.展开更多
BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of...BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of existing risk scores in patients.these METHODS A total of 1252 elderly patients with AF and ACS comorbidities(≥65 years old)were consecutively enrolled from January 2015 to December 2019.All patients were followed up for one year.The predictive performance of risk scores in predict-bleeding and thromboembolic events was calculated and compared.ing RESULTS During the 1-year follow-up,183(14.6%)patients had thromboembolic events,198(15.8%)patients had BARC class≥2 bleeding events,and 61(4.9%)patients had BARC class≥3 bleeding events.For the BARC class≥3 bleeding events,discrimina-tion of the existing risk scores was low to moderate,PRECISE-DAPT(C-statistic:0.638,95%CI:0.611-0.665),ATRIA(C-statistic:0.615,95%CI:0.587-0.642),PARIS-MB(C-statistic:0.612,95%CI:0.584-0.639),HAS-BLED(C-statistic:0.597,95%CI:0.569-0.624)and CRUSADE(C-statistic:0.595,95%CI:0.567-0.622).However,the calibration was good.PRECISE-DAPT showed a higher in-tegrated discrimination improvement(IDI)than PARIS-MB,HAS-BLED,ATRIA,and CRUSADE(P<0.05)and the best decision curve analysis(DCA).For thromboembolic events,the discrimination of GRACE(C-statistic:0.636,95%CI:0.608-0.662)was higher than CHA2DS2-VASc(C-statistic:0.612,95%CI:0.584-0.639),OPT-CAD(C-statistic:0.602,95%CI:0.574-0.629)and PARIS-CTE(C-statistic:0.595,95%CI:0.567-0.622).The calibration was good.Compared to OPT-CAD and PARIS-CTE,the IDI of the GRACE score slightly improved(P<0.05).However,NRI analysis showed no significant difference.DCA showed that the clinical practic-of thromboembolic risk scores was similar.ability CONCLUSIONS The discrimination and calibration of existing risk scores in predicting 1-year thromboembolic and bleeding events were unsatisfactory in elderly patients with comorbid AF and ACS.PRECISE-DAPT showed higher IDI and DCA than other risk scores in predicting BARC class≥3 bleeding events.The GRACE score showed a slight advantage in predicting throm-botic events.展开更多
Primary thrombocytopenic purpura is ahemorrhagic disease induced by rapid de-struction of blood platelets throughautoimmunity. The authors treated 10 casesof the disease with modified MinorDecoction of Bupleurum with ...Primary thrombocytopenic purpura is ahemorrhagic disease induced by rapid de-struction of blood platelets throughautoimmunity. The authors treated 10 casesof the disease with modified MinorDecoction of Bupleurum with good resultsas reported in the following:展开更多
Dear Editor,I am Dr. Jungyul Park from the Division of Oculoplasty, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea. I am writing to present a case of direct approach to thrombosed superi...Dear Editor,I am Dr. Jungyul Park from the Division of Oculoplasty, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea. I am writing to present a case of direct approach to thrombosed superior ophthalmic vein of recalcitrant indirect carotid cavernous fistula which was failed to treat with multiple conventional embolization treatment. To our knowledge this is very challenging procedure to the ophthalmologist, and not well described in literatures, especially in thrombocythemia patient with thrombosed superior ophthalmic vein.展开更多
background Although less common in adults,venous thromboembolism(VTE)in children is a highly morbid,preventable adverse event.While VTE has been well studied among pediatric hospitalized and trauma patients,limited wo...background Although less common in adults,venous thromboembolism(VTE)in children is a highly morbid,preventable adverse event.While VTE has been well studied among pediatric hospitalized and trauma patients,limited work has been done to examine postoperative VTE in children undergoing surgery.Methods Using data from National Surgical Quality Improvement Project Pediatric database(NSQIP-P)from 2012 to 2016,a retrospective cohort analysis was performed to determine the incidence of,and risk factors for,VTE in children undergoing surgery.Additionally,the relationships between VTE and other postoperative adverse outcomes were evaluated.results Of 361384 pediatric surgical patients,378(0.10%)were identified as experiencing postoperative VTE.After controlling for patient and surgical factors,we found that American Society of Anesthesiologists(ASA)class of II or greater,aged 16-18 years,non-elective surgery,general surgery(compared with several other surgical specialties),cardiothoracic surgery(compared with general surgery)and longer operative time were significantly associated with VTE in pediatric patients(p<0.001 for each comparison).Furthermore,a majority of adverse events were found to be associated with increased risk of subsequent VTE(p<0.001).Conclusion In a large pediatric surgical population,an incidence of postoperative VTE of 0.10%was observed.Defined patient and surgical factors,and perioperative adverse events were found to be associated with such VTE events.展开更多
To the Editor:Venous thromboembolism(VTE)is a common complication following orthotopic liver transplantation(OLT),with an incidence of 2.8-8.6%,[1-3]which affects the quality of life of post-transplant patients.Curren...To the Editor:Venous thromboembolism(VTE)is a common complication following orthotopic liver transplantation(OLT),with an incidence of 2.8-8.6%,[1-3]which affects the quality of life of post-transplant patients.Current VTE risk assessment tools,such as the Caprini score,have limitations when applied to this population,underscoring the necessity of developing an early VTE risk assessment model tailored for OLT recipients.展开更多
Objective To analyze in vitro the effect of mesenchymal stem cells(MSCs)on secreting cytokines by T lymphocytes and ratio of CD4+CD25+T cells from patients with immune thrombocytopenia(ITP).Methods Human bone marrow-d...Objective To analyze in vitro the effect of mesenchymal stem cells(MSCs)on secreting cytokines by T lymphocytes and ratio of CD4+CD25+T cells from patients with immune thrombocytopenia(ITP).Methods Human bone marrow-derived MSCs were isolated by Ficoll Hypaque and cultured for proliferating to passage cells.Allogeneic T展开更多
文摘AIM To characterise venous thromboembolism(VTE) in gastrointestinal cancer and assess the clinical utility of risk stratification scoring. METHODS We performed a retrospective analysis using electronic patient records of 910 gastro-oesophageal(GO) cancer and 1299 colorectal cancer(CRC) patients referred to a tertiary cancer centre to identify the incidence of VTE, its relationship to chemotherapy and impact on survival.VTE risk scores were calculated using the Khorana index. Patients were classified as low risk(0 points), intermediate risk(1 to 2 points) or high risk(3 points). Data was analysed to determine the sensitivity of the Khorana score to predict VTE. RESULTS The incidence of VTE was 8.9% for CRC patients and 9.7% for GO cancer patients. Pulmonary emboli(PE) were more common in advanced than in localised CRC(50% vs 21% of events respectively) and lower limb deep vein thrombosis(DVT) were more common in localised than in advanced CRC(62% vs 39% of events respectively). The median time to VTE from cancer diagnosis was 8.3 mo for CRC patients compared to 6.7 mo in GO cancer. In localised CRC median time to VTE was 7.1 mo compared with 10.1 mo in advanced CRC. In contrast in GO cancer, the median time to VTE was 12.5 mo in localised disease and 6.8 mo in advanced disease. No survival difference was seen between patients with and without VTE in this cohort. The majority of patients with CRC in whom VTE was diagnosed had low or intermediate Khorana risk score(94% for localised and 97% in advanced CRC). In GO cancer, all patients scored either intermediate or high risk due to the primary site demonstrating a limitation of the risk assessment score in discriminating high and low risk patients with GO cancers. Additional risk factors were identified in this cohort including surgery, chemotherapy or hospital admission. Overall, 81% of patients with CRC and 77% of patients with GO cancer had one or more of these factors within 4 wk prior to diagnosis VTE. These should be factored into clinical risk assessment scores. CONCLUSION The Khorana score has low sensitivity for thrombotic events in CRC and cannot discriminate low risk patients in high risk cancer sites such as GO cancer.
基金supported by the National Clinical Research Center for Geriatric Diseases(No.NCRCGPLAGH-20190003)the Chinese Cardiovascular Health Alliance-Advanced Fund(No.2019-CCAACCESS-054).
文摘BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of existing risk scores in patients.these METHODS A total of 1252 elderly patients with AF and ACS comorbidities(≥65 years old)were consecutively enrolled from January 2015 to December 2019.All patients were followed up for one year.The predictive performance of risk scores in predict-bleeding and thromboembolic events was calculated and compared.ing RESULTS During the 1-year follow-up,183(14.6%)patients had thromboembolic events,198(15.8%)patients had BARC class≥2 bleeding events,and 61(4.9%)patients had BARC class≥3 bleeding events.For the BARC class≥3 bleeding events,discrimina-tion of the existing risk scores was low to moderate,PRECISE-DAPT(C-statistic:0.638,95%CI:0.611-0.665),ATRIA(C-statistic:0.615,95%CI:0.587-0.642),PARIS-MB(C-statistic:0.612,95%CI:0.584-0.639),HAS-BLED(C-statistic:0.597,95%CI:0.569-0.624)and CRUSADE(C-statistic:0.595,95%CI:0.567-0.622).However,the calibration was good.PRECISE-DAPT showed a higher in-tegrated discrimination improvement(IDI)than PARIS-MB,HAS-BLED,ATRIA,and CRUSADE(P<0.05)and the best decision curve analysis(DCA).For thromboembolic events,the discrimination of GRACE(C-statistic:0.636,95%CI:0.608-0.662)was higher than CHA2DS2-VASc(C-statistic:0.612,95%CI:0.584-0.639),OPT-CAD(C-statistic:0.602,95%CI:0.574-0.629)and PARIS-CTE(C-statistic:0.595,95%CI:0.567-0.622).The calibration was good.Compared to OPT-CAD and PARIS-CTE,the IDI of the GRACE score slightly improved(P<0.05).However,NRI analysis showed no significant difference.DCA showed that the clinical practic-of thromboembolic risk scores was similar.ability CONCLUSIONS The discrimination and calibration of existing risk scores in predicting 1-year thromboembolic and bleeding events were unsatisfactory in elderly patients with comorbid AF and ACS.PRECISE-DAPT showed higher IDI and DCA than other risk scores in predicting BARC class≥3 bleeding events.The GRACE score showed a slight advantage in predicting throm-botic events.
文摘Primary thrombocytopenic purpura is ahemorrhagic disease induced by rapid de-struction of blood platelets throughautoimmunity. The authors treated 10 casesof the disease with modified MinorDecoction of Bupleurum with good resultsas reported in the following:
文摘Dear Editor,I am Dr. Jungyul Park from the Division of Oculoplasty, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea. I am writing to present a case of direct approach to thrombosed superior ophthalmic vein of recalcitrant indirect carotid cavernous fistula which was failed to treat with multiple conventional embolization treatment. To our knowledge this is very challenging procedure to the ophthalmologist, and not well described in literatures, especially in thrombocythemia patient with thrombosed superior ophthalmic vein.
文摘background Although less common in adults,venous thromboembolism(VTE)in children is a highly morbid,preventable adverse event.While VTE has been well studied among pediatric hospitalized and trauma patients,limited work has been done to examine postoperative VTE in children undergoing surgery.Methods Using data from National Surgical Quality Improvement Project Pediatric database(NSQIP-P)from 2012 to 2016,a retrospective cohort analysis was performed to determine the incidence of,and risk factors for,VTE in children undergoing surgery.Additionally,the relationships between VTE and other postoperative adverse outcomes were evaluated.results Of 361384 pediatric surgical patients,378(0.10%)were identified as experiencing postoperative VTE.After controlling for patient and surgical factors,we found that American Society of Anesthesiologists(ASA)class of II or greater,aged 16-18 years,non-elective surgery,general surgery(compared with several other surgical specialties),cardiothoracic surgery(compared with general surgery)and longer operative time were significantly associated with VTE in pediatric patients(p<0.001 for each comparison).Furthermore,a majority of adverse events were found to be associated with increased risk of subsequent VTE(p<0.001).Conclusion In a large pediatric surgical population,an incidence of postoperative VTE of 0.10%was observed.Defined patient and surgical factors,and perioperative adverse events were found to be associated with such VTE events.
文摘To the Editor:Venous thromboembolism(VTE)is a common complication following orthotopic liver transplantation(OLT),with an incidence of 2.8-8.6%,[1-3]which affects the quality of life of post-transplant patients.Current VTE risk assessment tools,such as the Caprini score,have limitations when applied to this population,underscoring the necessity of developing an early VTE risk assessment model tailored for OLT recipients.
文摘Objective To analyze in vitro the effect of mesenchymal stem cells(MSCs)on secreting cytokines by T lymphocytes and ratio of CD4+CD25+T cells from patients with immune thrombocytopenia(ITP).Methods Human bone marrow-derived MSCs were isolated by Ficoll Hypaque and cultured for proliferating to passage cells.Allogeneic T
