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1.
Rohi Shah Nomaan Sheikh Jitendra Mangwani Nicolette Morgan Hamidreza Khairandish 《Journal of Clinical Orthopaedics and Trauma》2021,12(1):138
Demographic projections for hip fragility fractures indicate a rising annual incidence by virtue of a multimorbid, ageing population with more noncommunicable diseases (NCDs). NCDs are characterised by slow progression and long duration ranging from ischaemic cardiovascular disease, cerebrovascular disease, diabetes, chronic obstructive pulmonary disease to various cancers. Management of this disease burden often involves commencing patients on oral anticoagulants to reduce the risk of thromboembolic events. The use of direct oral anticoagulants (DOACs) in clinical practice has increased due to their rapid onset of action, short half-life and predictable anticoagulant effects, without the need for routine monitoring. Safe and timely surgical intervention relies on reversal of anticoagulants. However, the lack of specific evidence-based guidelines for the perioperative management of patients on DOACs with hip fractures has proved challenging; in particular, the accessibility of DOAC-specific assays, justification of the cost-benefit ratio of targeted reversal agents and indications for neuraxial anaesthesia. This has led to potentially avoidable delays in surgical intervention. Following a literature review of the pharmacokinetic and pharmacodynamics of commonly used DOACs in our region including the role of surrogate markers, we propose a systematic, evidence-based guideline to the perioperative management of hip fractures DOACs. We believe this standardised protocol can be easily replicated between hospitals. We recommend that if patients are deemed suitable for a general anaesthesia, with satisfactory renal function, optimal surgical time should be 24 h following the last ingested dose of DOAC. 相似文献
2.
《Clinical Lymphoma, Myeloma & Leukemia》2020,20(8):e461-e467
IntroductionVon Willebrand factor (vWF) cleaving protease ADAMTS-13 has a key role for maintaining normal size of vWF. A deficiency or dysfunction of vWF cleaving protease is associated with ultra large vWF multimers and thrombotic microangiopathy. Patients with cancers have reduced levels of vWF cleaving protease. In this pilot study, we have evaluated whether or not deficiencies of ADAMTS-13 were present in myelodysplastic syndromes (MDS). Moreover, we assessed if a reduction in basal levels of ADAMTS-13 may play a role in the prognosis of MDS.Patients and MethodsWe measured and compared the levels of vWF cleaving protease ADAMTS-13 in 100 patients with MDS and 35 healthy controls. Patients were divided into 2 groups according to the International Prognostic Scoring System: group I consisting of 44 patients with low-risk MDS and group II of 56 patients with high-risk MDS. Patients with high-risk and low-risk MDS presented significantly lower levels of ADAMTS-13 than controls (P < .001 and P = .0177, respectively). High-risk patients had significantly lower levels of ADAMTS-13 when compared with the low-risk group (P < .001).ResultsWe found that reduced levels of ADAMTS-13 have a relationship with overall survival (P < .001). Statistical analysis showed that ADAMTS-13 correlates with cytogenetics (P < .001) and a tendency of slight correlation with platelet count and basal levels of ADAMTS-13 (R, 0.35; P value, 0.001). Moreover, we found that levels of ADAMTS-13 have correlation with response to treatment (P < .001).ConclusionsADAMTS-13 in MDS might represent a surrogate marker of prognosis, response to therapy, or disease progression. Further studies are needed. 相似文献
3.
M. Guillemin H. Cachier C. Chini D. Dabill D. Dahmann F. Diebold A. Fischer H.-H. Fricke J. A. Groves R. Hebisch M. Houpillart G. Israël M. Mattenklott W. Moldenhauer J. P. Sandino C. Schlums E. Sutter E. Tucek 《International archives of occupational and environmental health》1997,70(3):161-172
Object: Diesel soot has been recognized as probably carcinogenic to humans. Elemental carbon (also called black carbon) in soot
is considered at the moment as the most significant surrogate to be measured for assessing the exposure to this pollutant.
Its analysis is done by combustion in an oven and determination of the CO2 formed, after elimination of the organic fraction of the soot by heating and/or by solvent extraction. The analysis allows
determination of both fractions of the soot: “elemental carbon” (EC) and organic carbon␣(OC). The sum of EC and OC is called
TC (total carbon). Method: An informal European coordination group organized two round robin tests on filter samples collected from diluted diesel
emissions. The first round (RRT1) was performed on 13 different samples analyzed by ten laboratories. The range of loading
was 2.5 to 150 μg/cm2 of EC. No evaluation of the precision within laboratories could be made since each laboratory gave only one result per sample.
Therefore a second round (RRT2) was organized with two samples and a blank filter sent in several portions to 11 laboratories.
It should be stressed that each laboratory used its own method and that no standardization was planned at this stage. Results: Results of RRT1 showed that the coefficient of variation between laboratories decreased with higher loading and was around
10% to 15% for EC above about 20 μg/cm2. Dispersion of the results varied and it appeared that the way OC is removed from the soot is probably the most important
factor of influence. The correlation between the laboratories was good as a whole but some systematic differences could be
detected. Besides the different techniques to remove the organic carbon, the pretreatment of the filter by HCl (either as
a vapor or as a solution) to remove the inorganic carbonates (potential interference sources), is probably also a significant
factor of influence in the dispersion of the results between laboratories. It is not yet clear from these results whether
the “environmental” laboratories give different results from the “occupational” laboratories, but it is clear that their objectives
differ since for the “environmentalists”, EC is not a specific marker of diesel immissions, in contrast to the “occupationalists”.
Conclusion: It can be concluded that, although significant differences exist between laboratories they can be attributed mainly to the
narrow distribution of the results within a single laboratory, and that the overall agreement of the results for EC and TC
is fairly good. These results obtained with pure diesel engine emissions, should be complemented by field samples, but they
have already achieved relevant findings in the performance of the procedures used to assess exposure to diesel soot.
Received: 30 December 1996 / Accepted: 21 February 1997 相似文献
4.
We use pulmonary function measurements on pre-adolescent children and indoor air pollution measurements in the homes of these children to illustrate estimation techniques for linear regression models containing independent variables measured with error. In our data set, replicate measures of indoor air pollutant concentrations provide one method of estimating measurement error variances. Surrogate information in the form of cigarettes smoked is also available for the pollutant of interest. Several estimation procedures are presented, and we combine two estimators, one based on surrogate information and one based on replication information, using generalized least squares. 相似文献
5.
Surrogate-reared infant squirrel monkeys were exposed to various conditions of separation from their surrogate. Infants showed significant increases in plasma levels of cortisol when they were placed in an unfamiliar environment during the separation period. Changes in behavior, but not cortisol, were observed under conditions in which the surrogate was removed and the infant left in the home cage. These results differ from those previously obtained with mother-reared infants. It is concluded that surrogate-reared infant squirrel monkeys do not show the same separation response or attachment to their rearing figure as do mother-reared infants. 相似文献
6.
《Journal of psychosomatic obstetrics and gynaecology》2013,34(3):207-219
This paper presents the findings of a pilot survey of 30 infertile couples who presented for in vitro fertilisation treatment at the Monash—Epworth—Queen Victoria Medical Centre. Wives of the couples underwent an extensive pre-treatment interview for demographic information and psychiatric evaluation. In addition, psychometric testing was carried out to provide psychological profiles. Husbands were interviewed separately and completed self-report questionnaires on marital adjustment. Two sub-groups were identified where the diagnosis of infertility was regarded as of organic or ‘idiopathic’ aetiology. Differences between the two sub-groups were found on neuroticism, anxiety, locus of control and dyadic adjustment. At 2 months after treatment great difficulty was experienced in obtaining follow-up responses. Reasons for this are suggested and recommendations for further investigations and supportive therapy are presented. 相似文献
7.
《Seminars in oncology》2016,43(4):464-475
Circulating tumor cells (CTCs), which are captured from blood with anti-epithelial cell adhesion molecule (EpCAM) antibodies, have established prognostic value in specific epithelial cancers, but less is known about their utility for assessing patient response to molecularly targeted agents via measurement of pharmacodynamic (PD) endpoints. We discuss the use of CellSearch (Janssen Diagnostics, LLC, Raritan, NJ) CTC isolation technology for monitoring PD response in early phase trials. We present representative data from three clinical trials with the poly(ADP-ribose) polymerase (PARP) inhibitor veliparib (ABT-888) suggesting that CTCs can be used to measure PD effects. However, while often leading to hypothesis-generating information, our experience points to the difficulty in obtaining sufficient EpCAM-expressing CTCs from patients with advanced disease to reach statistically significant conclusions about PD effects from each trial. Overall, the level of phenotypic heterogeneity observed in specimens from patients with advanced carcinomas suggests caution in the use of cell-surface differentiation marker-based methods for isolating CTCs. 相似文献
8.
David Suarez 《Journal of biopharmaceutical statistics》2013,23(1):170-172
In an adaptive seamless phase II/III clinical trial interim analysis, data are used for treatment selection, enabling resources to be focused on comparison of more effective treatment(s) with a control. In this paper, we compare two methods recently proposed to enable use of short-term endpoint data for decision-making at the interim analysis. The comparison focuses on the power and the probability of correctly identifying the most promising treatment. We show that the choice of method depends on how well short-term data predict the best treatment, which may be measured by the correlation between treatment effects on short- and long-term endpoints. 相似文献
9.
Our aim was to review the studies which assessed potential surrogate endpoints for overall survival (OS) in breast cancer trials. A Literature search in PubMed database of studies which assessed potential surrogate endpoints for OS in breast cancer trials was conducted. The surrogacy was assessed with the German institute of Quality and efficiency in Health Care’s (IWQiG) framework and the Fleming hierarchy. Thirteen studies were identified. At the neoadjuvant setting, two individual patient data (IPD) meta-analyses and one aggregate data meta-analysis assessing surrogacy of pathological complete response (PCR) were identified. Trial-level association was calculated in one study and the squared correlation was 0.24. Therefore PCR was not judged to be valid surrogate for OS at the neoadjuvant setting according to the IWQiG framework and Fleming hierarchy. At the adjuvant setting, one meta-analysis on aggregate data was identified. 2-year DFS was not judged to be valid surrogate for OS at the neoadjuvant setting according to the IWQiG framework and Fleming hierarchy. At the metastatic setting, six meta-analyses based on aggregate data, three IPD meta-analyses and one retrospective study were identified. Within the IPD meta-analyses, at the trial-level association the squared correlation between the potential surrogates and OS ranged from 0.10 to 0.57 and no endpoint was judged to be valid surrogate for OS at the metastatic setting. The level of evidence available supporting a relationship between OS and potential surrogate endpoints in breast cancer trials is low. 相似文献
10.