Presence Of PTS Research Articles

The risk for post-thrombotic syndrome of subjects with deep vein thrombosis in an Indonesian referral hospital: a retrospective cohort study

BackgroundPost-thrombotic syndrome (PTS) is a complication of deep vein thrombosis (DVT) and affects 20–40% of DVT subjects. The risk factor of PTS after DVT is difficult to determine. We aimed to evaluate the incidence of PTS after 3 months of DVT diagnosis and to determine the risk of PTS.MethodsA retrospective cohort study of subjects who developed DVT confirmed by Doppler ultrasound in Cipto Mangunkusumo Hospital from April 2014 until June 2015. The presence of PTS was assessed after 3 months of completed DVT treatment using the Villalta score. Risk factors for PTS were evaluated from medical records.ResultsThere were 91 subjects with DVT with mean age of 58 years. 56% were female. It was dominated by subjects aged ≥ 60 years (45.1%). Hypertension (30.8%) and diabetes mellitus (26.4%) were the major comorbidities in this study. Deep vein thrombosis occurred commonly in unilateral side (79.1%), proximal localization (87.9%), and unprovoked DVT (47.3%). The cumulative incidence of PTS after DVT was 53.8%, 69% of subjects had mild PTS. Heaviness of the leg (63.2%) and edema (77.5%) were the most common symptoms.ResultsThere were 91 subjects with DVT with mean age of 58 years. 56% were female. It was dominated by subjects aged ≥ 60 years (45.1%). Hypertension (30.8%) and diabetes mellitus (26.4%) were the major comorbidities in this study. Deep vein thrombosis occurred commonly in unilateral side (79.1%), proximal localization (87.9%), and unprovoked DVT (47.3%). The cumulative incidence of PTS after DVT was 53.8%, 69% of subjects had mild PTS. Heaviness of the leg (63.2%) and edema (77.5%) were the most common symptoms. Significant risk factors for PTS were unprovoked DVT (adjusted RR 1.67; 95%CI: 1.17–2.04; p = 0.01) and female gender (adjusted RR 1.55; 95%CI: 1.03–1.94; p = 0.04). Age, body mass index, thrombus location, immobilization, malignancy and surgery was not associated with PTS.ConclusionWe conclude that 53.8% of subjects suffered PTS after 3 months of DVT. Unprovoked DVT and female gender were significant risk factors for PTS.

Developing and optimizing a machine learning predictive model for post-thrombotic syndrome in a longitudinal cohort of patients with proximal deep venous thrombosis

BackgroundPost-thrombotic syndrome (PTS) is the most common chronic complication of deep venous thrombosis (DVT). Risk measurement and stratification of PTS are crucial for patients with DVT. This study aimed to develop predictive models of PTS using machine learning for patients with proximal DVT. MethodsHerein, hospital inpatients from a DVT registry electronic health record database were randomly divided into a derivation and a validation set, and four predictive models were constructed using logistic regression, simple decision tree, eXtreme Gradient Boosting (XGBoost), and random forest (RF) algorithms. The presence of PTS was defined according to the Villalta scale. The areas under the receiver operating characteristic curves, decision-curve analysis, and calibration curves were applied to evaluate the performance of these models. The Shapley Additive exPlanations analysis was performed to explain the predictive models. ResultsAmong the 300 patients, 126 developed a PTS at 6 months after DVT. The RF model exhibited the best performance among the four models, with an area under the receiver operating characteristic curves of 0.891. The RF model demonstrated that Villalta score at admission, age, body mass index, and pain on calf compression were significant predictors for PTS, with accurate prediction at the individual level. The Shapley Additive exPlanations analysis suggested a nonlinear correlation between age and PTS, with two peak ages of onset at 50 and 70 years. ConclusionsThe current predictive model identified significant predictors and accurately predicted PTS for patients with proximal DVT. Moreover, the model demonstrated a nonlinear correlation between age and PTS, which might be valuable in risk measurement and stratification of PTS in patients with proximal DVT.

Implementation Of Information Planning and Strategies Industrial Technology 4.0 to Improve Business Intelligence Performance on Official Site APTISI

The Association of Indonesian Private Universities or often called APTISI, has a membership of 4189. Compared to State Universities that only have 372, of course the presence of PTS is definitely a solution amid the lack of equalization of higher education in Indonesia. However, with the existence of problems in improving the quality of education, APTISI as the Association of Indonesian Private Higher Education should be able to make PTS more competitive in all fields, especially the field of information and technology planning strategy (BSPIT) in the current disruption era. In this study, identified at least 3 (three) problems faced. An alternative solution to the problem is to apply the APTISI official site to show the performance of the association’s activities. 5 (five) literature reviews on Industrial Technology 4.0, Business Intelligence and Dashboard were conducted to determine the level of APTISI’s activities in the current disruption era. In designing the system, there are 3 (three) benefits found from a problem formula using the SWOT analysis method. From what has been explained above, the APTISI official site 4.0 industry technologies can disseminate information and improve the performance of APTISI members in the dissemination of information and activities by conducting a validity and reliability test for 100 (one hundred) respondents.

Unmet needs in Head and Neck (H&N) cancer patients: unmet needs, emotional disorders and pain

Background: few is known about head and neck (H&N) patients (pts)’ unmet needs (UNs) and about their association with debilitating symptomatologies that worse quality of life (QoL), adherence to treatments and prognosis. Caregivers (cgs)’ recognition of pts’ needs is much less assessed. The aim of the research was to investigate the main H&N pts’ UNs and their possible link with pain, anxiety, depression and distress. Besides, the study conducted an investigation on cgs’, nurses (nrs)’ and oncologist (onc)’s capacity of understanding pts’ needs, as regards five macro-areas: psychological (PsA), communicative (CmA), physical (PhA), social/health care (ShA) and sexuality (SxA). Methods: we surveyed 100 H&N pts during the active phase of chemotherapeutical treatment; 59 cgs, 6 nrs and 1 onc. The instruments used were: Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), a survey on somatic and emotional symptoms (sx) perceived by pts in the last 24 hours and Supportive Care Needs Survey-short Form (SCNS-SF34). Results: UNs in PsA were associated with somatic and emotional sx (c2=10.213,p<.01); UNs in CmA with pain (c2=5.260,p<.05); UNs in PhA with pain (c2=9.962,p<.01) and somatic and emotional sx (c2=6.760,p<.01); UNs in ShA with distress (c2=4.459,p<.05), anxious symptomatology (c2=4.071,p<.05) and pain (c2=14.733,p<.01); UNs in SxA with anxious symptomatology (c2=7.328,p<.01) and pain (c2=4.833,p<.05). Worry about the future was associated with distress (c2=5.929,p<.05) and anxious symptomatology (c2=17.189,p<.01); incapacity of doing usual things with distress (c2=6.540,p<.05), pain (c2=7.366,p<.01) and anxious symptomatology (c2=4.854,p<.05); concerns about the worries of people close to patient with pain (c2=12.953,p<.01) and depressive symptomatology (c2=4.529,p<.05); lack of energy with pain (c2=22.335,p<.01); fears about cancer spreading with anxious symptomatology (c2=12.815,p<.01); feelings about death and dying with anxious (c2=6.451,p<.05) and depressive symptomatology (c2=5.317,p<.05). As regards cgs, nrs and onc just cgs detected the presence of pts’ UNs in the PsA, in the PhA and in the SxA. There were many missing in the SxA regarding nrs’ and onc’s answers. Conclusions: Several UNs can negatively impact the H&N pts’ QoL. The awareness of such association between somatic, emotional and social aspects of pts’ dissatisfaction can steer health team to a more focused clinical intervention.

Synthesis of a nanocomposite containing a water-soluble polythiophene derivative and gold nanoparticles

This paper reports on a facile method for synthesizing gold nanoparticles (AuNps) with diameter around 5 nm encapsulated with water-soluble polythiophene sulfonate poly[2-(3-thienyl)ethyloxy-4-butylsulfonate] sodium salt (PTS) and their physical–chemical characterization. The synthesis of hybrid materials of polythiophene derivatives and gold nanoparticles is a way to improve the polymer properties, mainly in application for chemical and optical sensing platforms. The AuNps were prepared by reducing gold salt with acid aqueous sodium citrate by the Turkvich method in the presence of PTS, and both PTS and citrate helped to stabilize the AuNps. The suspensions of AuNp:PTS presented good chemical and photostability for long period of storage. The nanoparticles encapsulated with the polymer presented smaller diameters than those obtained using only sodium citrate, according to scanning electron microscopy images. The AuNps obtained were used for fabrication LbL films with commercial chitosan, which were characterized by impedance spectroscopy measurements. The results showed that the charge transfer resistance values (Rct) decrease as the average diameter of the AuNps decreases and the proportion of PTS increases in the nanocomposite. Such increase of the nanocomposite conductivity, given by the low values of Rct, indicates that the novel film architecture developed is promising for chemical sensing applications. © 2016 Wiley Periodicals, Inc. J. Polym. Sci., Part B: Polym. Phys. 2016, 54, 1245–1254

Comparison Of Three Post-Thrombotic Assessment Tools In Young Patients With Deep Venous Thrombosis Demonstrates Significant Variability

IntroductionPost thrombotic syndrome (PTS) is a complication of deep venous thrombosis (DVT) and is characterized by symptoms including pain, itching, heaviness, cramping, and tingling in the affected limb, which may be aggravated by physical activity. The reported prevalence of PTS in children who have had DVT varies widely from 0-70%. One of the explanations for this variability is that there has been no uniform definition or instrument used to assess PTS across studies. Since PTS is one of the most important outcome measurements in children treated for DVT, it is critical that assessment of PTS be standardized so that it is possible to compare one therapeutic approach to another. However, there are several available instruments, and no accepted “gold-standard” for comparison. ObjectivesTo compare the prevalence of PTS as determined by three distinct and commonly accepted PTS measurement scales. We evaluated the Villalta scale, which is a validated instrument for assessing PTS in adult patient, and compared this to two pediatric scales: a pediatric modification of the Villalata scale and the validated Manco-Johnson instrument. MethodsWe prospectively administered three different PTS outcome measurements in patients over the age of 8 years who had a history of radiologically confirmed upper or lower extremity DVT at least two months prior to participation. We chose not to evaluate younger patients since one of the objectives was to compare the adult Villalta scale to the scales developed in pediatrics. The instruments were administered sequentially by study personnel who were trained in using each instrument and blinded to the radiologic studies. A computer randomly chose the order in which they were administered. Results30 subjects (15 females) were enrolled in this study with a mean age of 16.8 yrs (S.D. 4.1 yrs). All but four patients were over the age of 14 years at the time of assessment. The majority of subjects 25/30 had a lower extremity DVT, while 5 had an upper extremity DVT. The average duration since DVT to PTS determination was 3.9 yrs (S.D 3.9 yrs). The proportion of subjects classified as having PTS using the Villalta scale was 13%, which was significant less than either of the other scales in which 73% (Manco-Johnson) and 76% (Modified Villalta) of patients were classified as having PTS, p< 0.00001 (Table 1). The majority of patients with PTS as determined by the modified Villalta scale had mild PTS (16/23). Similarly, the majority of patients with PTS as determined by the Manco-Johnson instrument did not have functionally significant PTS (17/22). [Display omitted] ConclusionsThere was significant discordance in the Villalta scale compared to the two pediatric scales, despite the fact that the majority of the patients were teenagers. This is especially relevant when considering the best measurement to be used in long-term follow-up of these patients, particularly for comparing outcomes of interventional therapies, such as thrombolysis. The primary difference between these instruments is that subjects needed to have a score of ≥5 to be classified as having PTS using the Villalta score (requiring more than one sign or symptom) compared to a score of ≥1 (any abnormal sign or symptom) on the modified and Manco-Johnson scale. This study demonstrates that the presence of PTS, as defined by these scales, is not a well-defined or standardized outcome, particularly when comparing adult and pediatric instruments. Disclosures:No relevant conflicts of interest to declare.

Increased ADAMTS13 activity in patients with venous thromboembolism

Increased levels of inflammatory markers and clotting factors have been related to the pathogenesis and prognosis of venous thromboembolism. In particular, the imbalance between VWF and ADAMTS13 has been described in patients with arterial thrombosis. In this study, 77 patients with previous VTE and 77 matched controls were selected for the evaluation of the inflammatory markers, FVW, ADAMTS 13 and D-dimer. The presences of post-thrombotic syndrome and residual vein obstruction were also assessed in patients. Serum levels of TNF-α and IL-6 were significantly increased in patients compared to controls (median=2.25 vs 1.59pg/mL, P≤0.001; 1.16 vs 0.98pg/ml, P=0.013, respectively). Plasma levels and activity of VWF (median=150.25 vs 95.39U/dL, P≤0.001; 145.26% vs 92.39%, P≤0.001) and ADAMTS 13 (median=1088.84 vs 950.80ng/mL, P≤0.001; 96.03 vs 83.64%, P≤0.001) were also higher in patients. We further analysed the subgroups of patients with higher risk for VTE recurrence or VTE sequelae, defined as the presence of high D-dimer levels, RVO or PTS. All inflammatory markers were significantly higher in patients with increased D-dimer. The presence of PTS or RVO was not associated with higher inflammatory or coagulation parameters. The increased levels of inflammatory markers and VWF may suggest that there is a persistence of inflammatory activity in patients even at long periods after the VTE episode. In this context, it may be postulated that increased levels of ADAMTS13 could represent a compensatory mechanism against persistently increased levels of VWF. Moreover, increased inflammatory activity was associated with increased D-dimer levels, thus it is possible that this inflammatory activity may also be related to the risk of VTE recurrence.

Body mass index is associated with the development of the post-thrombotic syndrome

SummaryPost-thrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT). Little is known about prognostic factors that might identify patients at high risk for the development of PTS. Body mass index (BMI) has been previously reported to be associated to the development of PTS. The aim of this study was to assess the association between BMI and other anthropometric parameters and PTS in a general population of DVT patients.In a prospective cohort study, 83 consecutive patients with objective diagnosis of DVT underwent physical examination. BMI was recorded at baseline and at 12 months, and waist circumference was recorded at 12 months to assess individual patterns of body fat distribution. The presence of PTS at 12 months was ascertained using a validated clinical scale. Sixty-three patients (75.9%) were overweight or obese at 12 months, 60 (72.3%) had a weight gain over 1 year. Twenty patients developed PTS (24.1%). Mean BMI was significantly higher in patients who developed PTS than in patients who did not (29.6 and 27.2 Kg/m2, respectively, p = 0.022). A BMI of &gt; 28 Kg/m2 predicted early onset of PTS (OR 3.54, 95% CI 1.07-12.08, p = 0.017). Neither patterns of fat distribution nor weight gain in 1 year were correlated with PTS (p = 0.918 and p = 0.775, respectively).BMI is significantly correlated with the development of PTS. Patients with DVT should be encouraged to avoid weight gain. Reducing patient weight might be an important strategy to prevent PTS.

749 Survival of patients with liver metastases of colorectal origin treated with percutaneous ethanol injection (PEI) with or without surgery

The purpose of the present study is to evaluate, after four years of observation, the influence of PEI upon the survival (S) of pts with liver metastases from colorectal carcinoma. Between April 91 and December 94, 31 lesions (7 synchronous, 26 metachronous) with a mean diameter of 2.99cm (0.8–6.1) in 24 pts (41, 20 M, mean age 62.4 years, range 49–77) were treated with PEI. Using an ultrasound scanner (AU-590 Esaote-Biomedica), fine needles (Spinal-Icogamma, Ethanoject-TSK 22G), following the usual technique of alcoholization, varying amount of sterile alcohol (0.5–10ccs) at 95° were introduced into the lesions, for the total of 804 alcoholizations. The response was evaluated by means of fine needle echo-guided biopsy (FNAB) carried out at the end of treatment: CR=necrobiosis and absence of CTM; PR=necrobiosis and rare, poorly-conserved, atypical CTM. After the starting of PEI treatment (mean 4–9 months), 10 pts underwent surgery with exeresis ofa total of 15 lesions. 21/24 pts responded to the treatment; of 33 treated lesions, we observed 6 CR (18.1%), 22 PR (66.6%), 3 NC and 2 local PRO. Histological confirmation of the cytologic response was obtained in 14/15 lesions undergone surgical exeresis. 10/24 pts died after a mean S of 13.5 months, in 9 cases due to extrahepatic disease progression. Follow-up of the 14 alive pts is 17.5 months than S in 10 operated pts is 20.6 months, in 14 unoperated pts is 12.5 months. Overall survival is 15.8 months. The comparison between our results and S reported in literature (6–12 months) comprehending any degree of hepatic involvement, is not possible since the criteria of admission are not homogeneous. From a retrospective evaluation of 30 dead pts, followed in our service between ‘84 and ‘90 with liver metastases eligible for PEI but treated only with conventional CT, we observed a mean of S of 13.2 months; the mean follow up of our PEI-treated pts (17.5) has already surmounted that value, thus confirming the real efficacy of PEI. The good result of mean follow-up is undoubtedly supported by the presence of pts undergone surgical exeresis. For this reason we calculated separately the mean S of unoperated pts, getting a result (13.2 months) next to the mean S of the survey group and expected to improve, since it regards still living pts. In conclusion, we observed a real efficacy of PEI upon liver metastases, followed when possible by surgical exeresis; anyway PEI is a valid choice also in unoperable pts as palliative treatment in local control of disease.

Photoisomerization of indolinespirobenzopyran in anionic clay matrices of layered double hydroxides

Sulfonated indolinespirobenzopyran (SP–SO3–) was intercalated into the Mg/Al or Zn/Al layered double hydroxides (LDHs) in the presence of toluene-p-sulfonic acid (PTS). The new intercalates exhibited reversible photoisomerization between SP–SO3– and merocyanine (MC). The presence of PTS was critical for the reversible photoisomerization. MC was very stable and the rate constant of decolorization was <9 × 10–7S–1. SP interacted with non-polar portions between the layers although MC interacted with the polar interior surface of the LDH.

Geschützte Aminooxazoline der Arabinose und Ribose

Protected Aminooxazolines of Arabinose and RiboseThe reaction of D‐arabinose or D‐ribose with cyanamide afforded 2‐amino‐1,2‐oxazolines 1 which were treated with dihydropyran or ethylvinylether. In the presence of PTS the 3′,5′‐di‐THP‐ or 3′,5′‐di‐O‐ethoxyethyl‐D‐arabino‐(ribo)‐furo‐[1′,2′:4,5]‐2‐oxazolines 2 and 3 could be isolated as useful intermediates for the preparation of nucleosides.When the 2‐aminooxazolines are treated with benzyloxycarbonylchloride or its p‐substituted derivatives the N‐3 atom of the oxazoline ring is preferentially substituted. Under these conditions the exocyclic amino function is always replaced and 2‐oxo‐3‐benzyloxycarbonylderivatives 4 are obtained; only traces of the corresponding 2‐aminoderivatives 5 are formed. Treatment of 4 with acetic anhydride, benzoylchloride, and benzoylcyanide, respectively, results in the 3′‐, 5′‐di‐O‐acyl derivatives 6. Mild hydrolysis of the benzyloxycarbonyl group with trifluoroacetic acid yields the 3′,5′‐di‐O‐acyl‐D‐arabino‐(ribo)‐furo‐[1′,2′:4,5]‐2‐oxooxazolidines as further intermediates for the synthesis of nucleosides.

Comparative study of the chemical structure of the disk-like components in the quinoline insolubles

The structural features of the disk-like components in the anisotropic spheres from KP pitch were investigated by molecular weight measurement, NMR and IR spectroscopy, analyses of evolved gases during heat-treatment, and reactivities with phenol. A comparison was made with the corresponding properties of the Isotropic quinoline insoluble matter in the pitch. FT-IR spectra of KP spheres and KPQI indicate the presence of aliphatic C-H bonds, in addition to aromatic bonds in these materials. The ratios of aliphatic/aromatic hydrogen obtained by H-NMR, and evolved ethane analyses after the reductive ethylation, were larger in both cases than the value calculated by assuming that all hydrogens in the original material were aromatic, although it was rather difficult to identify the aliphatic hydrogen in further detail by these methods. By the reaction with phenol in the presence of PTS, one-half of KP sphere-EtBS was made insoluble in benzene. The average molecular weight of the soluble fraction obtained by this treatment was 840, which was nearly equal to that before treatment. The structural features of the disk-like components in the spheres are summarized as follows. 1. (1), The size of aromatic units is distributed over a wider range than the QI from original pitch. The smaller molecules (MW 400) as well as the larger ones (MW 3000) are the main components. 2. (2), The average molecular weight of the spheres is about one-half that of the QI. 3. (3), The major aliphatic hydrogens are located in side chains and the minor ones in methylene bridges. 4. (4), The differences in molecules are aggregated in a nematic regularity. The difference in properties of these two quinoline insolubles, as far as carbonization and graphitization are concerned, are attributable to their structural differences.