Validity of standard gamble estimated quality of life in acute venous thrombosis

Introduction

The standard gamble is considered the ‘gold standard’ technique for measuring quality of life. We recently used the standard gamble to estimate quality of life in acute venous thrombosis, and found unexpected variability in the responses. The current study aimed to explore the reasons for variability by comparing the standard gamble technique in patients with acute venous thrombosis to other quality of life measurement tools.

Materials and Methods

Thrombosis clinic patients treated for venous thrombosis were eligible to participate. Patients evaluated their current health state by performing a standard gamble interview, reporting on a visual analogue scale, completing the SF-36 and disease specific questionnaires (PEmb-Qol and VEINES-QOL/Sym). Validity was assessed by correlating the standard gamble utilities with the other methods. Test-retest reliability, responsiveness and acceptability were also assessed.

Results

Forty-four patients were interviewed, with 16 attending for a repeat interview. The median standard gamble utility was 0.97 (0.84-1.0), SF-6D 0.64 (0.59 - 0.80) and visual analogue score 70 (60 - 80). Participants with pulmonary embolism had lower standard gamble estimates than those with deep vein thrombosis. There was good discriminant validity in that the standard gamble estimates were not associated with risk taking behavior, negative outlook, sex or education. Test-retest reliability with the standard gamble was moderate and there was evidence of a ceiling effect.

Conclusions

Standard gamble utilities are higher than other methods of measuring quality of life in venous thrombosis. The choice of utility values adopted in studies will impact on future economic studies.     

Evaluation of a chromogenic commercial assay using VWF-73 peptide for ADAMTS13 activity measurement

Introduction

Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy (TMA), related to a severe functional deficiency of ADAMTS13 activity (< 10% of normal). ADAMTS13 activity is thus crucial to confirm the clinical suspicion of TTP, to distinguish it from other TMAs, and to perform the follow-up of TTP patients.

Material and methods

We compared the performance of the commercial chromogenic assay Technozym® ADAMTS13 Activity ELISA (chromogenic VWF73 substrate, Chr-VWF73, Technoclone, Vienna, Austria), to that of our in-house FRETS-VWF73 used as reference method. A large group of 247 subjects (30 healthy volunteers and 217 patients with miscellaneaous TMAs) was studied.

Results

The lower limit of detection of the Chr-VWF73 was 3%, which is well adapted to the clinically relevant threshold for TTP diagnosis (10%). Our results showed a reasonable agreement between FRETS-VWF73 and Chr-VWF73 assays to distinguish samples with an ADAMTS13 activity < 10% from those with an ADAMTS13 activity > 10%. However, Chr-VWF73 assay provided false negative results in ~ 12% of acute TTP patients. Inversely, the Chr-VWF73 assay globally underestimated ADAMTS13 activity in detectable values ranging from 11 to 100% (with a great variability compared to FRETS-VWF73), which may be a concern for the follow-up of TTP patients in remission.

Conclusion

In-house assays developed and performed by expert laboratories remain the reference methods that should be used without limitation to control values provided by commercial assays when needed. Also, the development of an international reference preparation will be crucial to improve standardization.     

标准去骨瓣减压与常规去骨瓣减压治疗重型颅脑外伤的对比研究

目的 探讨标准大骨瓣开颅术在治疗重型颅脑损伤中的临床应用价值.方法 选择64例重型颅脑外伤患者,随机均分为观察组和对照组,各32例,对照组使用常规去骨瓣减压术,观察组使用标准去骨瓣减压治疗,比较两组患者术后颅内压变化情况,以及术后6个月随访的预后情况及并发症.结果 观察组术后1、3、7d颅内压均低于对照组同时间段颅内压水平(P＜0.05),观察组经过治疗后预后良好者为16例,对照组仅为7例,观察组预后良好者比率明显大于对照组(P＜0.05),对照组出现术后脑积水和迟发性血肿比率均高于对照组(P＜0.05).结论 标准去骨瓣减压术治疗重症颅脑外伤,相对于常规去骨瓣减压术而言,能更好的降低患者术后颅内压,且术后疗效相对较好,并发症少,是一种值得推广的手术治疗方法.     

A comparison of visual acuity measured by ETDRS chart and Standard Logarithmic Visual Acuity chart among outpatients

AIM:To compare the results of visual acuity(VA)measured by Early Treatment Diabetic Retinopathy Study(ETDRS)chart,5 m Standard Logarithm Visual Acuity(5 SL)chart,and 2.5 m Standard Logarithm Visual Acuity(2.5 SL)chart in outpatients of age 12-80 y.METHODS:Each patient(totally 2000 outpatients)had both eyes tested with ETDRS chart at 4 m,5 SL chart at 5 m,and 2.5 SL chart at 2.5 m in random order.The VA values of outpatients were categorized by ages.VA values were expressed by log MAR recording method.RESULTS:The mean VA results of ETDRS charts,5 SL,and 2.5 SL chart were 0.52±0.28,0.50±0.30,and 0.46±0.28 log MAR,respectively.There was a statistically significant difference in the three eye charts in the whole group(P<0.001).For all subjects,the correlation of VA tested with three charts was statistically significant(Spearman correlation coefficient=0.944,0.937,0.946,all P<0.001).Bland–Altman analysis shows the 95%limits of agreement between the 5 SL and 2.5 SL chart were-0.182 to 0.210,-0.139 to 0.251,and-0.151 to 0.235 log MAR,respectively.CONCLUSION:The agreement between the three eye charts is not high.The VA measured by 5 SL chart is slightly better than that by ETDRS chart and 5 SL chart would be a suitable alternative when ETDRS chart are not available in the clinical situation.The VA measured by 2.5 SL chart is about 0.5 line better than VA tested with ETDRS chart,which may overestimate VA.     

Are fluorescence-based chlorophyll quantification methods suitable for algae toxicity assessment of carbon nanomaterials?

Using a multiwalled carbon nanotube (MWCNT) and graphene oxide (GO) as representative test materials, we evaluated the applicability of in vivo and in vitro chlorophyll-a (Chl-a) fluorescence quantification methods, which are used in standard algae ecotoxicity tests such as OECD 201 and ISO 8692. In vivo quantification of Chl-a from Raphidocelis subcapitata indicated a significant reduction in Chl-a fluorescence in the presence of MWCNTs due to shading, but a significant autofluorescence from GO caused an overestimation of Chl-a concentration. In vitro Chl-a quantification methods employing a modified acetone and an ethanol extraction protocol reduced the influence of shading and autofluorescence, but both resulted in a significant loss of fluorescence signal in the presence of 100?mgL^?1 MWCNTs (99–100%) and GO (21–52%). Chl-a reduction was dose dependent for both tested carbon-based MNMs (CNMs), but effects were more pronounced for MWCNT, which caused a significant fluorescence reduction (16?±?0.3%) already at 1?mgL^?1. Further study of the CNM–algae–Chl-a interaction processes revealed that CNM can not only interact with live algae, but also efficiently adsorb extracted Chl-a. Our results showed that within 10?min, 95–100% of Chl-a extracted from two algae concentrations were adsorbed to MWCNT, while 35–60% of Chl-a was adsorbed to the GO. This study shows that Chl-a quantification by fluorescence determination is not a suitable method for ecotoxicity testing of CNM. However, a quick screening test for individual MNMs is recommended to determine whether Chl-a adsorption is a significant process prior to selection of a quantification method.     

Controversias en enfermedad cerebrovascular: rt-PA a dosis bajas vs. dosis estándar en el tratamiento del ictus agudo. Una revisión de la literatura

IntroductionThe use of low doses of recombinant tissue plasminogen activator (rt-PA) was initially proposed in Asian countries in response to racial peculiarities related to the functionality of fibrinogen and coagulation factors that potentially increased the risk of intracerebral haemorrhage, and with a view to saving costs. In view of the controversy over the use of rt-PA below the standard dose, we conducted a literature review of studies promoting the use of low doses or comparing different doses of rt-PA.DevelopmentWe reviewed 198 abstracts related to the search terms and the full texts of 52 studies published in the last 30 years. We finally included 13 randomised clinical trials aiming to determine the efficacy and safety of the use of rt-PA at different doses in acute stroke, 14 observational cohort studies, 5 meta-analyses, and 3 systematic reviews.ConclusionsThere is insufficient evidence to classify low doses of rt-PA as superior or at least not inferior to the standard treatment in the management of acute stroke in western populations. More clinical trials are required to determine whether the use of low doses is beneficial in patients with relative contraindications for thrombolytic therapy or other particular circumstances that may increase the risk of intracerebral haemorrhage.     

标准卒中救治流程缩短介入治疗再通时间

目的　分析长海医院标准卒中救治流程对大血管闭塞急性缺血性脑卒中（AIS）介入治疗再通时间的影响。方法　回顾性连续选择2013年9月至2019年12月我院脑血管病中心收治的行血管内治疗的大血管闭塞AIS患者876例,排除病例资料不全者66例,最终纳入810例。按照是否实验施标准卒中救治流程（2018年6月22日）将患者分为研究组（采用标准卒中救治流程,335例）和对照组（未采用标准卒中救治流程,475例）。比较两组患者的入院至进针时间（DNT）、入院至股动脉穿刺时间（DPT）、股动脉穿刺至血管成功再通时间（PRT）,以及血管成功再通[改良脑梗死溶栓（mTICI）分级为2b/3级]率、术后90 d预后良好[改良Rankin量表（mRS）评分为0～2分]率。结果　两组患者性别、年龄及入院时美国国立卫生研究院卒中量表（NIHSS）评分差异均无统计学意义（P均>0.05）。研究组采用静脉溶栓+血管内治疗的患者占比低于对照组［14.3%（48/335）vs 31.2%（148/475）P<0.01］。在行静脉溶栓+血管内治疗的患者中,研究组DNT、DPT、PRT均短于对照组［34.2（28.1,60.4）min vs 53.5（27.0,72.2）min、76.5（55.9,106.4）min vs 97.0（68.9,151.1）min、45.0（37.3,90.4）min vs 78.0（55.4,109.3）min］,差异均有统计学意义（P均<0.01）;研究组的预后良好率、血管成功再通率［分别为66.7%（32/48）、91.8%（44/48）］与对照组［分别为57.4%（85/148）、93.2%（138/148）］相比差异均无统计学意义（P均>0.05）。在直接行血管内治疗的患者中,研究组DPT、PRT也均短于对照组［67.0（50.1,109.0）min vs 87.0（60.8,150.0）min、48.0（43.5,80.8）min vs 74.0（60.3,100.6）min］,差异均有统计学意义（P均<0.01）;研究组的预后良好率、血管成功再通率［分别为54.7%（157/287）、93.0%（267/287）］与对照组［分别为52.3%（171/327）、91.1%（298/328）］相比差异均无统计学意义（P均>0.05）。结论　我院的标准卒中救治流程能显著缩短DNT、DPT和PRT时间,缩短介入治疗再通时间。但血管再通率与良好预后率未显示明显提高。     

Reliability of levator scapulae index in subjects with and without scapular downward rotation syndrome

ObjectivesThe objective of this study was to introduce levator scapulae (LS) measurement using a caliper and the levator scapulae index (LSI) and to investigate intra- and interrater reliability of the LSI in subjects with and without scapular downward rotation syndrome (SDRS).DesignTwo raters measured LS length twice in 38 subjects (19 with SDRS and 19 without SDRS).Main outcome measuresFor reliability testing, intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated.ResultsIntrarater reliability analysis resulted with ICCs ranging from 0.94 to 0.98 in subjects with SDRS and 0.96 to 0.98 in subjects without SDRS. These results represented that intrarater reliability in both groups were excellent for measuring LS length with the LSI. Interrater reliability was good (ICC: 0.82) in subjects with SDRS; however, interrater reliability was moderate (ICC: 0.75) in subjects without SDRS. Additionally, SEM and MDC were 0.13% and 0.36% in subjects with SDRS and 0.35% and 0.97% in subjects without SDRS. In subjects with SDRS, low dispersion of the measurement errors and MDC were shown.ConclusionsThis study suggested that the LSI is a reliable method to measure LS length and is more reliable for subjects with SDRS.     

Fatigue,anxiety and depression overrule the role of oncological treatment in predicting self-reported health complaints in women with breast cancer compared to healthy controls

BackgroundWomen with breast cancer often attribute their health problems as side effects caused by oncological treatments. The aim of the study was to examine and compare self-reported health complaints (SHC) in postmenopausal patients with breast cancer to healthy controls.MethodWomen with breast cancer (N = 196) filled in 5 questionnaires 1–2 years after surgery; SHC Inventory, Functional Assessment of Cancer Therapy-Endocrine Subscale (FACT-ES), Fatigue – Functional Assessment of Cancer Therapy-Fatigue subscale (FACIT-F), Fatigue Visual Analog Scale (Fatigue VAS), and Hospital Anxiety and Depression Scale (HADS). Controls comprised 101 blood donors who reported on the questionnaires except for HADS. Bonferroni adjustment and p < 0.0017 was considered statistically significant for SHC Inventory, p < 0.05 for the remaining questionnaires.ResultsThe patients, mean age 58.0 (SD 9.5), reported significantly more self-reported health complaints, whereof 6 of 29 complaints were significantly elevated compared to the controls, mean age 57.0 (SD 5.8) (p < 0.001). HADS scores in patients fell into normal range, mean 6.3 (SD 5.7). A subgroup of 48 patients experienced more frequent and severe symptoms in all the questionnaires compared to the remaining 148 patients, and the 101 controls. Among the patients, fatigue, anxiety and depression explained 49% of the total variance in self-reported health complaints (p ≤ 0.001).ConclusionMost women with breast cancer (76%) reported health complaints equal to the healthy controls. Fatigue, anxiety and depression, not oncological treatments, were significant predictors for the complaints.     

极低出生体质量儿早期规范补铁的临床观察

目的探讨早期规范补铁对极低出生体质量儿病情转归的影响,以避免发生不可逆的神经系统损伤。方法选择2014年6月-2015年12月在防城港市第一人民医院住院的极低出生体质量儿76例为研究对象,按数字表法随机分为试验组38例和对照组38例,对照组予常规治疗,按指南补铁;试验组也予常规治疗,同时按血清铁(SI)、血清铁蛋白(SF)和总铁结合力(TIBC)水平早期补铁。观察两组感染控制时间、新生儿神经行为评分(NBNA)恢复情况。结果试验组总有效率为84.21%高于对照组的65.79%,两组比较差异有统计学意义(χ~2=4.047,P<0.05)。试验组感染控制时间、NBNA恢复时间、住院时间、住院费用[(6.71±2.47)d、(77.53±9.11)d、(23.63±8.86)d、(19 829.95±12 855.04)元]等均少于对照组[(10.47±3.68)d、(77.66±8.67)d、(31.03±15.35)d、(28 405.82±15 213.96)元],差异均有统计学意义(t=-5.728、-3.933、-2.615、-2.636,均P<0.05)。结论早期规范补铁对极低出生体质量儿病情转归有较好的促进作用,有助于神经系统的发育,缩短住院时间,降低住院费用。