Correction: Thrombotic and bleeding events,mortality, and anticoagulant use among 546,656 hospitalized patients with COVID‑19 in the United States: a retrospective cohort study

Journal of Thrombosis and Thrombolysis -     

Electromyographic evaluation of the gastrointestinal tract in dogs with short bowel syndrome

Seven dogs were subjected to resection of 80% of the total length of the small bowel. Seven pairs of electrodes were implanted in the seromuscular layer of the antrum and remaining small bowel. Electromyographic recordings were obtained during fasting and after milk ingestion. Slow waves were identified in all sites studied and their frequencies were 4.7±0.4/min in the antrum; 17.5±0.58/min in D1; 17.5±0.61/min in D2; 17.43±0.65/min in J1; 17.40±0.62/min in J2; 10.28±0.77/min in I1; and 9.81±0.53/min in I2. The phase III of the migrating motor complex was identified in only one recording. Ingestion of milk caused the appearance of the fed pattern in all recording sites, except the antrum. It is concluded that extensive resection of the small bowel causes reduction of the slow wave frequency in the gut distal to the resection and disappearance of phase III of the migrating motor complex.     

Use of Georges Lopez Institute Preservation Solution IGL-1 in Pancreas Transplantation: A Series of 47 Cases

Background

Graft preservation continues to be one of the main pillars of pancreas transplantation (PT). Surgical complications, possibly caused or facilitated by organ damage during preservation, continue to occur more frequently after PT than for any other abdominal organ. During the past few years, the Georges Lopez Institute preservation solution IGL-1 has been introduced with satisfactory results for the perfusion and cold storage of abdominal grafts such as kidney and liver.

Two-dimensional gel electrophoresis, isoelectric focusing and agarose gel electrophoresis in the diagnosis of multiple sclerosis

Two dimensional gel electrophoresis (2-DE), isoelectric focusing (IEF) and agarose gel electrophoresis (AGE) were used to examine cerebrospinal fluid (CSF) and sera from 22 patients with confirmed multiple sclerosis, 11 patients with probable multiple sclerosis and 20 control patients with non-inflammatory neurological diseases of the central nervous system (CNS). All of the 22 patients with confirmed multiple sclerosis showed abnormal patterns of oligoclonal IgG in all three methods. In the CSF from patients with probable multiple sclerosis, oligoclonal IgG was detectable in 18 percent with AGE, in 72 percent with IEF and 90 percent with 2-DE. No oligoclonal IgG was observed in subjects with non-inflammatory neurological diseases. Many artefacts in IEF, which lead to misinterpretation, are eliminated in the 2-DE system. Based on our observations and this study in particular, it is evident that some patients have IgG changes which can be detected only by 2-DE. The application of research-oriented 2-DE for routine clinical purposes is still limited by its cost and technical complexity.     

Two-dimensional gel electrophoresis of cerebrospinal fluid proteins from patients with various neurological diseases

We subjected cerebrospinal fluid (CSF) samples from over 200 patients with various neurological diseases to two-dimensional electrophoresis. The series included non-inflammatory diseases such as epilepsy, amyotrophic lateral sclerosis, and polyneuropathy; and inflammatory diseases such as multiple sclerosis and neurolues. In the resulting electrophoretograms we considered mainly the region of CSF-specific proteins and the area corresponding to the immunoglobulin light chains. The former, at Mr 35 000-38 000, shows some interesting variations from one CSF to another. Samples from patients with various brain tumors show a specific change. A zone of oligoclonal immunoglobulin light chains appeared in all CSF samples with above-normal gamma-globulin content. These oligoclonal patterns remained constant and characteristic during the course of different diseases for several patients so examined. As expected, differences appeared in the patterns of immunoglobulin light chains from one individual to another, even among a group of patients with the same disease. The extent of the correlation of certain basic patterns with certain diseases cannot yet be determined.     

Prevalence of Posttransplantation Lymphoproliferative Disease in Pediatric Liver Transplant Recipients

Objective

The objective of this study was to identify the incidence of posttransplantation lymphoproliferative disease (PTLD) among children within 1 year after liver transplantation.

Methods

This retrospective review analyzed information in medical charts of pediatric (younger than 18 years of age) recipients of liver transplants between September 2000 and December 2007.

Results

Seventy-one patients underwent a liver transplantation and 7 (9.85%) developed PTLD. Among this group, 6 children were girls and 1 was a boy. The median age at transplantation was 35.14 months. Indications that led the children to have their transplantation were 1 case of hemangioendothelioma, 1 case of autoimmune hepatic cirrhosis, 1 case of alpha-1-antitrypsin deficiency, and 4 cases of biliary atresia. The most frequent symptoms were splenomegaly, diarrhea, and fever. The median time from the first symptoms to the initial treatment was 9.7 days. The standard treatment was withdrawal of immunosuppression and close observation of tacrolimus levels and liver function tests associated with antiviral drugs and chemotherapy. Four among 7 children died; 3 children recovered. All 3 children who recovered has presented at the transplantation center within 5 days of initiation of symptoms (P = .033896).

Conclusion

Despite its rarity, when it occurs, PTLD shows a high mortality rate. Therefore, it is necessary to have interdisciplinary work between the medical team that performs the transplantation and those promoting the primary care to diagnose the disease early and treat it effectively.     

Utility assessment to measure the impact of dry eye disease

Utility assessment is a formal method for quantifying and understanding the relative impact of a given health state or disease on patients. In this article, methodology of utility assessment is explained and illustrated, and results of an original study are reported. The study was conducted to determine utility values (patient preferences) associated with dry eye disease and compare them to other disease utilities, as well as to compare patient and physician assessments of disease. Forty-four patients in the United Kingdom with moderate to severe dry eye were surveyed via interactive utility assessment software. Utility values were measured by the Time Trade-Off (TTO) and Standard Gamble (SG) methods and adjusted to scores from 1.0=perfect health to 0.0=death. Patients reported utilities for: self-reported current dry eye status, self-reported current comorbidities, various dry eye severities, and binocular and monocular painful blindness. Patient's dry eye severity was independently classified by patient and physician assessments. Correlation analyses (Pearson) were performed between patients' current dry eye utilities and the physician-assessed severity. Agreement between self-reported and physician-reported patient severity was analyzed (Kappa). Patients reported higher utilities for their current dry eye condition than for monocular and binocular blindness (SG:0.84>0.60>0.51; TTO:0.67>0.43>0.38). Using TTO, the mean score for asymptomatic dry eye (0.68) was similar to that for "some physical and role limitations with occasional pain" and severe dry eye requiring surgery scored (0.56) similarly to hospital dialysis (0.56-0.59) and severe angina (0.5). Utilities described for scenarios of dry eye severity levels were slightly higher for patients self-reported as mild-to-moderate versus those self-reported as severe. For current dry eye condition, mean utilities for these groups were 0.72 for self-reported mild-to-moderate and 0.61 for self-reported severe. Utilities for dry eye were in the range of conditions accepted as lowering health utilities. Severe dry eye utilities were similar to those reported for dialysis and severe angina, highlighting the impact of dry eye disease on patients.     

Therapeutic impact of 2-[fluorine-18]fluoro-2-deoxy-D-glucose positron emission tomography in the pre- and postoperative staging of patients with clinically intermediate or high-risk breast cancer.

BACKGROUND: Positron emission tomography with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG-PET) is an accurate imaging modality for the staging of breast cancer. The aim of this study was to determine the potential therapeutic impact of pre- and postoperative FDG-PET in patients with clinically intermediate or high-risk breast cancer. PATIENTS AND METHODS: One hundred and fourteen patients with newly diagnosed breast cancer were examined before (73) or after (41) surgery. Patient data were translated into three scoring sheets corresponding to information available before positron emission tomography (PET), after PET and after further diagnostic tests. Three medical oncologists independently reviewed the retrospectively acquired patient data and prospectively made decisions on the theoretically planed treatment for each time point, according to the recommendations of St Gallen Consensus Guidelines 2005. RESULTS: FDG-PET changed the planed treatment in 32% of 114 patients. In 20% of cases, therapeutic intention (curative versus palliative) was modified. Radiation treatment planning was changed in 27%, surgical planning in 9%, chemotherapy in 11% and intended therapy with bisphosphonates in 13% of all patients. CONCLUSION: Based on current treatment guidelines, FDG-PET, as a staging procedure in patients with newly diagnosed clinically intermediate or high-risk breast cancer examined pre- and postoperatively, may have a substantial therapeutic impact on treatment planning.     

Normalization of menstrual cycles and pregnancy after liver transplantation

The objective of the present study is to evaluate the effects of successful liver transplantation on menstrual cycles abnormalities and on reproductive function of women with chronic liver disease. Twelve women with age between 17 and 54 years who underwent liver transplantation were evaluated. The following variables were analyzed: age, etiology of chronic liver disease, pattern of menstrual function and period of amenorrhea before and after transplantation, and occurrence of pregnancy after transplantation. The mean age of patients was 36 +/- 12.6 years. Patients with primary biliary cirrhosis did not have menstrual abnormalities before transplantation. The other patients presented amenorrhea for 3 months to 11 years before the transplantation. Rapid recovery of menstrual function was observed in all patients after the transplantation (3.1 +/- 1.2 months). Two patients became pregnant one and three years after the transplantation. It is concluded from this study that most women who present amenorrhea secondary to chronic liver disease have normal menstrual cycles in approximately three months following liver transplantation and they may become pregnant.     

Hypertension and the kidney

Hypertension is an important and widely prevalent risk factor for the development of chronic kidney disease (CKD), which unfortunately may progress to end-stage renal disease. CKD is a progressive condition that causes significant morbidity and mortality. Diabetes is the leading cause of end-stage renal disease in the Western world. Both hypertension and diabetes are the causative factors for the occurrence of CKD and its consequences. Aggressive control of hypertension and diabetes is indicated to reduce the risk for kidney disease in the community. Certainly, effective control of hypertension is a proven modality to prevent renal disease. The concept of decreasing the systemic blood pressure as well as the intraglomerular pressure has led to the application of rational therapeutic options in patients with renal insufficiency. Although treatment of hypertension alone is critical, drugs that block the renin-angiotensin system have been shown to have special renal (and cardiovascular) benefits. Early detection and treatment of microalbuminuria is an integral part of disease management. This article reviews the pathophysiologic and therapeutic implications of the link between hypertension and the kidney.