https://journal.chestnet.org/article/S0012-3692(12)60129-9/pdf

Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Background Obesity is associated with increased mortality. Weight loss improves cardiovascular risk factors, but no prospective interventional studies have reported whether weight loss decreases overall mortality. In fact, many observational studies suggest that weight reduction is associated with increased mortality. Methods The prospective, controlled Swedish Obese Subjects study involved 4047 obese subjects. Of these subjects, 2010 underwent bariatric surgery (surgery group) and 2037 received conventional treatment (matched control group). We report on overall mortality during an average of 10.9 years of follow-up. At the time of the analysis (November 1, 2005), vital status was known for all but three subjects (follow-up rate, 99.9%). Results The average weight change in control subjects was less than ±2% during the period of up to 15 years during which weights were recorded. Maximum weight losses in the surgical subgroups were observed after 1 to 2 years: gastric bypass, 32%; vertical-banded gastropl...

/pdf/effects-of-bariatric-surgery-on-mortality-in-swedish-obese-1hxcpfu6t3.pdf

Effects of bariatric surgery on mortality in Swedish obese subjects.

https://www.chpso.org/sites/main/files/file-attachments/chest-2008-geerts-381s-453s.pdf

Prevention of Venous Thromboembolism* American College of Chest Physicians Evidence- Based Clinical Practice Guidelines (8th Edition)

Is There an Indication for Therapuetic Anticoagulation for Venous Thromboembolism (VTE) Prophylaxis in Critically Ill H1N1 Influenza A Patients

Objective The spectrum of chronic venous disease (CVD) in adults is well documented, whereas there is a paucity of data published commenting on pediatric CVD. We previously identified that there is often venous reflux present in cases of pediatric lower extremity edema despite an alternative confirmed diagnosis. To further assess the clinical significance of this venous reflux, this study aimed to elicit venous parameters in healthy pediatric controls. Methods Healthy pediatric volunteers aged 5 to 17 years were recruited for venous reflux study. A comprehensive venous reflux study was performed with the patient standing. Vein diameter, patterns of valvular reflux, and accessory venous anatomy were examined in the deep and superficial venous systems. Results Eighteen children including 10 boys and 8 girls were studied. Five volunteers were aged 5 to 8 years, six volunteers were aged 9 to 12 years, and seven volunteers were aged 13 to 17 years. Great saphenous vein (GSV) diameter at the saphenofemoral junction significantly increased with age. Deep vein valve closure time (VCT) did not differ significantly between groups, whereas GSV VCT was significantly higher in the 9- to 12-year age group. Incidental venous insufficiency was identified in 60% of children aged 5 to 8 years (n = 3), 50% of children aged 9 to 12 years (n = 3), and 57% of children aged 13 to 17 years (n = 4). All superficial venous reflux was confined to the GSV; there were no cases of isolated deep venous reflux. Reflux was identified at multiple GSV stations in 60% of children. There was no significant difference in incompetent GSV VCT in comparing children with and without deep venous reflux. Accessory superficial veins were identified in 20% of children aged 5 to 8 years (n = 1), 50% of children aged 9 to 12 years (n = 3), and 43% of children aged 13 to 17 years (n = 3). The presence of an accessory saphenous vein was not associated with deep venous reflux in any patient, and only 29% of those with accessory saphenous venous anatomy had evidence of superficial venous (GSV) reflux. Conclusions The GSV continues to grow in diameter through the teenage years. Incidental valvular incompetence and GSV reflux are common. The presence of accessory saphenous veins is similarly common and not associated with venous reflux. The clinical significance and natural history of this incidental venous reflux remain unclear. Future research should determine whether these changes seen in the pediatric age group lead to CVD during later years of life.

A pilot study of venous duplex ultrasound parameters in healthy children.

La resolution du thrombus veineux est a la source d’une reaction inflammatoire intense precoce, provoquant les lesions de la paroi veineuse. La reponse des tissus aux lesions inclut l’activation de metalloproteinases de la matrice (MMP) et la regeneration des proteines de la matrice extracellulaire. Cette etude a cherche a determiner l’effet de l’inhibition exogene des MMP et de son attenuation potentielle des lesions parietales veineuses precoces. Methodes Des rats ont recu le traitement commencant 24 heures apres une thrombose veineuse par stase due a une ligature pre-occlusive et jusqu’a prelevement au 7 ieme jour. Trois groupes ont ete evalues : (1) groupe controle avec solution salee (NaCl), (2) heparine de bas poids moleculaire (HBPM ; Lovenox, 3 mg/kg par jour sous cutanee), et (3) doxycycline (DOXY, 30 mg/kg par jour per os). La taille des thrombus (mg/mm), les niveaux du facteur α de necrose tumorale (TNF α) et des D-dimere par analyse colorimetrique, ainsi que la numeration de monocytes par immunohistochimie ont ete evalues. L’evaluation de la paroi veineuse comprenait la rigidite evaluee par tensiometrie, l’interleukine 1β (IL-1 β), le niveau de proteines par analyse ELISA, MMP2 et -9 par zymographie, et l’analyse histologique de l’epaisseur intimale (EI). Les comparaisons etaient realisees par rapport au controle par le test t. p Resultats Les tailles de thrombus etaient semblables aux 2 ieme et au 7 ieme jours pour chacun des trois groupes, alors que le taux de TNFα du thrombus etait augmente dans les groupes traites par HBPM et DOXY a deux jours (NaCl = 1.0 ± 0.8, HBPM = 9 ± 3, DOXY = 27 ± 5 pg/mg de proteine, N  = 6-8, p N = 5, p N = 5-7, p N = 4-6, p N = 4-6, p N = 6-8, p Conclusion Le traitement par HBPM ou DOXY n’a pas modifie la taille de la thrombose veineuse profonde, a moderement change la composition du thrombus, et a differemment modifie les lesions de la paroi veineuse, en depit d’une reduction semblable de l’activite precoce en MMP9. D’autres etudes seront necessaires pour determiner si l’inhibition exogene de MMP affecte la fibrose a long terme de la paroi veineuse.

Remodelage de la paroi veineuse après thrombose veineuse profonde : effets des héparines de bas poids moléculaire et de la doxycycline

Regarding "Impact of screening versus symptomatic measurement of deep vein thrombosis in a national quality improvement registry".

developed non-CVC associated DVT were kept. The dependent variable was 90-day VTE, including patients with DVT or PE. Forward stepwise logistic regression identified independent risk factors. ß-coefficients for independent predictors were used to derive a weighted risk-scoring model. Results: Data were available for 7165 patients. The 90-day VTE rate was 1.37%. When controlling for all other variables, including procedural complexity, multivariable logistic regression identified five independent predictors of VTE. These included age 60 (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.09-1.73), current cancer (OR 1.75, 95% CI 1.11-2.78), personal history of VTE (OR 1.90, 95% CI 1.10-3.28), family history of VTE (OR 2.63, 95% CI 1.17-6.21), and central venous catheter (OR 2.52, 95% CI 1.48-4.30). Log odds were used to derive a weighted risk scoring model. The area under the receiver operating characteristic curve of this 5-risk factor model was 0.70, meaning that it explained 70% of the variability in VTE outcome. Of note, previous studies of the 40-point Caprini score showed an area under the receiver operating characteristic curve of 0.68. Conclusions: Our novel risk scoring system predicts 90-day VTE risk as well as the current gold standard. Our model predicts risk based on five risk factors, making it more user-friendly than existing RAMs. Future work will validate this risk score in a separate group of patients.

Thomas W. Wakefield

Papers

Is There an Indication for Therapuetic Anticoagulation for Venous Thromboembolism (VTE) Prophylaxis in Critically Ill H1N1 Influenza A Patients

A pilot study of venous duplex ultrasound parameters in healthy children.

Remodelage de la paroi veineuse après thrombose veineuse profonde : effets des héparines de bas poids moléculaire et de la doxycycline

Regarding "Impact of screening versus symptomatic measurement of deep vein thrombosis in a national quality improvement registry".

Galectin-3 Binding Protein and Galectin-3: Novel Factors Promoting Venous Thrombosis