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  • 1
    Language: English
    In: Nephrology, dialysis, transplantation, 1997, Vol.12 (11), p.2355-2364
    Description: Thrombotic complications are common in patients with endstage renal disease and contribute substantially to the morbidity and mortality in this population. The aim of the present study was to: i) determine the prevalence and the extent of hypercoagulability in patients undergoing dialysis treatment by measuring parameters that directly reflect thrombin concentrations; ii) assess changes in coagulation status during haemodialysis (HD); iii) quantify the relative impact of heparin, dialysis and their combined effects on coagulation status and iv) detect factors that modify coagulation haemostasis in dialysis patients. A total of 39 patients (HD: n = 29, CAPD: n = 10) was analysed for procoagulatory and fibrinolytic activity determined by measurements of partial thromboplastin time, prothrombin fragments F1 + 2, thrombin-antithrombin complexes and D-dimer concentrations. HD patients were investigated prior to and during dialysis. A subgroup of patients was infused heparin alone without dialysis or was dialysed without heparin administration. Furthermore, subgroup and correlation analyses were performed for the type of dialysis (HD vs CAPD), dialyzer and shunt, Kt/V, underlying disease and treatment with recombinant erythropoietin (rhEPO). Baseline levels of all parameters-procoagulatory and fibrinolytic--were substantially elevated in all patients, but to a higher degree among those on CAPD. Moreover, haemodialysis treatment increased procoagulatory markers even further, suggesting stimulated coagulation and/or insufficient anticoagulation during dialysis. However, after 3 h of dialysis thrombin concentrations, determined by quantification of prothrombin fragments, were inversely correlated with Kt/V. Selective heparin infusion diminished procoagulatory activity only slightly and incompletely, whereas HD without heparin resulted in excess thrombin accumulation. Finally, subgroup analyses revealed more pronounced thrombin formation among patients treated with polysulfon dialyzers, whereas erythropoietin dosage was positively related with lower procoagulatory activity. A majority of patients on dialysis are in a hypercoagulable state, which is further aggravated by the haemodialysis procedure itself and may not be sufficiently controlled with current anticoagulation regimens. Intensified heparin treatment and the use of rhEPO are likely to improve coagulation haemostasis, whereas the type of dialyzer should be considered as a relevant procoagulatory factor.
    Subject(s): Biological and medical sciences ; Medical sciences ; Blood. Blood coagulation. Reticuloendothelial system ; Pharmacology. Drug treatments ; Age Factors ; Erythropoietin - therapeutic use ; Antithrombin III - analysis ; Humans ; Middle Aged ; Peptide Hydrolases - analysis ; Recombinant Proteins ; Kidney Failure, Chronic - blood ; Partial Thromboplastin Time ; Anticoagulants - pharmacology ; Blood Coagulation ; Adult ; Aged ; Heparin - pharmacology ; Renal Dialysis
    ISSN: 0931-0509
    E-ISSN: 1460-2385
    Source: Alma/SFX Local Collection
    Source: Oxford Journals 2016 Current and Archive A-Z Collection
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  • 2
    Language: English
    In: Clinical chemistry and laboratory medicine, 1998-04-30, Vol.36 (4), p.235-240
    Description: Conventional laboratory investigations of haemostasis like prothrombin time and activated partial thromboplastin time are not useful in predicting and managing intra-operative bleeding complications. In order to establish a possible “perioperative reference range” for thrombin generation prothrombin fragment F1+2 (F1+2) and fibrin degradation (D-dimer) markers, we measured F1+2 and D-dimer concentrations before surgery (but after induction of anaesthesia), 30 minutes into surgery, 10 minutes after the event expected to induce the maximal activation of the haemostatic systems, 90 minutes after surgery and on postoperative days 1 and 2 in 226 consecutive patients. Samples were collected from arterial lines. Twenty patients developed a clinically defined, intraoperative disorder of haemostasis, 206 did not. Patients with an intraoperative disorder of haemostasis had significantly higher preoperative F1+2 and D-dimer concentrations. Preoperative values for F1+2 and D-dimer concentrations above the 75th percentile of patients without an intraoperative disorder of haemostasis indicated a 2.70 to 2.88 fold risk of developing an intraoperative disorder of haemostasis (odds ratios were 3.04, 3.12 and 3.29 for D-dimer, ELISA, F1+2, and D-dimer latex tests, respectively with 95% confidence intervals from 1.20 to 8.46) with negative predictive values of 94%, but positive predictive values of only 16% to 26%. These data suggest that preoperative determination of molecular markers might be helpful in identifying a group of patients at high risk for intraoperative disorder of haemostasis by exclusion of low risk patients. Validation of such an approach requires a prospective trial.
    Subject(s): Blood coagulation ; Biological and medical sciences ; Investigative techniques, diagnostic techniques (general aspects) ; Medical sciences ; Blood Loss, Surgical - prevention & control ; Intraoperative Complications - blood ; Blood Coagulation Disorders - prevention & control ; Fibrin Fibrinogen Degradation Products - metabolism ; Blood Coagulation Disorders - etiology ; Humans ; Middle Aged ; Risk Factors ; Intraoperative Complications - prevention & control ; Male ; Biomarkers - blood ; Hemostasis ; Intraoperative Complications - etiology ; Blood Coagulation ; Peptide Fragments - blood ; Aged, 80 and over ; Blood Coagulation Disorders - blood ; Adult ; Female ; Aged ; Prothrombin - metabolism
    ISSN: 1434-6621
    E-ISSN: 1437-4331
    Source: Alma/SFX Local Collection
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  • 3
    Language: English
    In: British journal of haematology, 1997-04, Vol.97 (1), p.65-75
    Description: The purpose of the present study was to evaluate whether intermittent exposure to a constant dose of doxorubicin selects for multidrug resistance (MDR) in RPMI 8226 human myeloma cells and, if so, to determine the molecular mechanism. In an attempt to approximate clinical doxorubicin treatment in vitro, cells were exposed to a fixed dose of doxorubicin for 4 d alternating with growth in drug-free medium for 17 d. An MDR subline emerged, termed 8226/DOXint5, which was 3-4-fold resistant to doxorubicin, etoposide and m-AMSA, and 1.6-fold resistant to vincristine. Sensitivity to docetaxel, melphalan and cisplatin was normal. Verapamil normalized vincristine sensitivity but had little effect on resistance to the other agents. Cellular uptake and retention of daunorubicin and vincristine were reduced by approximately 10%. The 8226/DOXint5 cells showed diminished DNA topoisomerase IIα expression and increased expression of the multidrug resistance protein MRP. Expression of MDR1/P-glycoprotein was not detected. Immunostaining showed 70% of the cells to over-express the lung-resistance protein LRP. This new MDR myeloma cell line may prove to be a useful model for the development of strategies to overcome low-level, multifactorial MDR, which might be a common phenomenon in clinical myeloma treated with doxorubicin.
    Subject(s): multidrug resistance ; myeloma ; doxorubicin ; Biological and medical sciences ; General aspects ; Medical sciences ; Antineoplastic agents ; Pharmacology. Drug treatments ; Doxorubicin - therapeutic use ; Drug Resistance, Multiple ; Humans ; Drug Resistance, Neoplasm ; Etoposide - therapeutic use ; Antineoplastic Agents - therapeutic use ; Multiple Myeloma - drug therapy ; Verapamil - therapeutic use ; ATP Binding Cassette Transporter, Subfamily B, Member 1 ; Drug Interactions ; Antibiotics, Antineoplastic - therapeutic use ; Vincristine - therapeutic use ; Tumor Cells, Cultured
    ISSN: 0007-1048
    E-ISSN: 1365-2141
    Source: Alma/SFX Local Collection
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  • 4
    Language: English
    In: Swiss medical weekly, 2005-03-05, Vol.135 (9-10), p.151-159
    Description: The diagnostic impact of bone marrow cytology in combination with flow cytometry analysis of aspirate smears and bone marrow histology together with immunohistochemical examination of trephine biopsies was compared in 141 routine cases. Diagnoses achieved by the two methods were concordant in 80.5% of cases. In discordant cases, clinical follow-up data of at least one year confirmed the correctness of cytological and histological diagnoses. For infiltration by malignant disease, both methods were concordant in 86.5% of samples and correlated well for the degree of infiltration (r = 0.64, p 〈0.001). Overall, regression analysis showed a good correlation for cellularity (r = 0.67) lymphopoiesis (r = 0.75), granulopoiesis (r = 0.73) and megakaryopoiesis (r = 0.65) while erythropoiesis displayed a lower degree of correlation (r = 0.43, all p 〈0.001). Regression analysis on all immunological data obtained by flow cytometry (FC) and immunohistochemistry (IHC) showed a good overall linear correlation (r = 0.67, p 〈0.001), but significant differences were found for a few phenotypic markers. Furthermore, the correlation was found to be dependent on IgG subclasses and the fluorochromes used for FC. Thus, analyses with IgG2 antibodies and phycoerythrin (PE) as fluorochrome showed significantly more expression than IHC. In conclusion, cytology and histology, both in association with the respective immunophenotyping, are of equal value in bone marrow diagnostics and should be used in combination. However, in some specific settings, one of the two procedures might be preferable.
    Subject(s): Immunohistochemistry ; Bone Marrow Diseases - diagnosis ; Humans ; Biomarkers - analysis ; Immunophenotyping ; Regression Analysis ; Flow Cytometry ; Biopsy ; Immunoglobulin G - immunology ; Bone Marrow - pathology ; Staining and Labeling ; Antibodies - analysis ; Phycoerythrin ; Bone Marrow Examination - methods
    ISSN: 1424-7860
    E-ISSN: 1424-3997
    Source: Alma/SFX Local Collection
    Source: DOAJ Directory of Open Access Journals - Not for CDI Discovery
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  • 5
    Language: English
    In: BMJ, 2020-08-25, Vol.370, p.m2917-m2917
    Description: AbstractObjectiveTo prospectively assess the construct and criterion validity of ClassIntra version 1.0, a newly developed classification for assessing intraoperative adverse events.DesignInternational, multicentre cohort study.Setting18 secondary and tertiary centres from 12 countries in Europe, Oceania, and North America.ParticipantsThe cohort study included a representative sample of 2520 patients in hospital having any type of surgery, followed up until discharge. A follow-up to assess mortality at 30 days was performed in 2372 patients (94%). A survey was sent to a representative sample of 163 surgeons and anaesthetists from participating centres.Main outcome measuresIntraoperative complications were assessed according to ClassIntra. Postoperative complications were assessed daily until discharge from hospital with the Clavien-Dindo classification. The primary endpoint was construct validity by investigating the risk adjusted association between the most severe intraoperative and postoperative complications, measured in a multivariable hierarchical proportional odds model. For criterion validity, inter-rater reliability was evaluated in a survey of 10 fictitious case scenarios describing intraoperative complications.ResultsOf 2520 patients enrolled, 610 (24%) experienced at least one intraoperative adverse event and 838 (33%) at least one postoperative complication. Multivariable analysis showed a gradual increase in risk for a more severe postoperative complication with increasing grade of ClassIntra: ClassIntra grade I versus grade 0, odds ratio 0.99 (95% confidence interval 0.69 to 1.42); grade II versus grade 0, 1.39 (0.97 to 2.00); grade III versus grade 0, 2.62 (1.31 to 5.26); and grade IV versus grade 0, 3.81 (1.19 to 12.2). ClassIntra showed high criterion validity with an intraclass correlation coefficient of 0.76 (95% confidence interval 0.59 to 0.91) in the survey (response rate 83%).ConclusionsClassIntra is the first prospectively validated classification for assessing intraoperative adverse events in a standardised way, linking them to postoperative complications with the well established Clavien-Dindo classification. ClassIntra can be incorporated into routine practice in perioperative surgical safety checklists, or used as a monitoring and outcome reporting tool for different surgical disciplines. Future studies should investigate whether the tool is useful to stratify patients to the appropriate postoperative care, to enhance the quality of surgical interventions, and to improve long term outcomes of surgical patients.Trial registrationClinicalTrials.gov NCT03009929.
    Subject(s): Abridged Index Medicus
    ISSN: 1756-1833
    E-ISSN: 1756-1833
    Source: Single Journals
    Source: Alma/SFX Local Collection
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  • 6
    Language: English
    Description: Altres ajuts: The research was supported by grants from the Goldschmidt-Jacobson Foundation, University of Basel, Foundation for Research and Education in Anaesthesiology, Switzerland, and VSB fonds (Verenigde Spaar Bankenfonds), Netherlands. To prospectively assess the construct and criterion validity of ClassIntra version 1.0, a newly developed classification for assessing intraoperative adverse events. International, multicentre cohort study. 18 secondary and tertiary centres from 12 countries in Europe, Oceania, and North America. The cohort study included a representative sample of 2520 patients in hospital having any type of surgery, followed up until discharge. A follow-up to assess mortality at 30 days was performed in 2372 patients (94%). A survey was sent to a representative sample of 163 surgeons and anaesthetists from participating centres. Intraoperative complications were assessed according to ClassIntra. Postoperative complications were assessed daily until discharge from hospital with the Clavien-Dindo classification. The primary endpoint was construct validity by investigating the risk adjusted association between the most severe intraoperative and postoperative complications, measured in a multivariable hierarchical proportional odds model. For criterion validity, inter-rater reliability was evaluated in a survey of 10 fictitious case scenarios describing intraoperative complications. Of 2520 patients enrolled, 610 (24%) experienced at least one intraoperative adverse event and 838 (33%) at least one postoperative complication. Multivariable analysis showed a gradual increase in risk for a more severe postoperative complication with increasing grade of ClassIntra: ClassIntra grade I versus grade 0, odds ratio 0.99 (95% confidence interval 0.69 to 1.42); grade II versus grade 0, 1.39 (0.97 to 2.00); grade III versus grade 0, 2.62 (1.31 to 5.26); and grade IV versus grade 0, 3.81 (1.19 to 12.2). ClassIntra showed high criterion validity with an intraclass correlation coefficient of 0.76 (95% confidence interval 0.59 to 0.91) in the survey (response rate 83%). ClassIntra is the first prospectively validated classification for assessing intraoperative adverse events in a standardised way, linking them to postoperative complications with the well established Clavien-Dindo classification. ClassIntra can be incorporated into routine practice in perioperative surgical safety checklists, or used as a monitoring and outcome reporting tool for different surgical disciplines. Future studies should investigate whether the tool is useful to stratify patients to the appropriate postoperative care, to enhance the quality of surgical interventions, and to improve long term outcomes of surgical patients. ClinicalTrials.gov NCT03009929.
    Source: UAB Digital Repository
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  • 7
    Conference Proceeding
    Conference Proceeding
    2006
    ISBN: 9780769526775  ISBN: 0769526772 
    ISSN: 1060-9857 
    Language: English
    In: 2006 25th IEEE Symposium on Reliable Distributed Systems (SRDS'06), 2006-10, p.189-198
    Description: We present Cryptree, a cryptographic tree structure which facilitates access control in file systems operating on untrusted storage. Cryptree leverages the file system's folder hierarchy to achieve efficient and intuitive, yet simple, access control. The highlights are its ability to recursively grant access to a folder and all its subfolders in constant time, the dynamic inheritance of access rights which inherently prevents scattering of access rights, and the possibility to grant someone access to a file or folder without revealing the identities of other accessors. To reason about and to visualize Cryptree, we introduce the notion of cryptographic links. We describe the Cryptrees we have used to enforce read and write access in our own file system. Finally, we measure the performance of the Cryptree and compare it to other approaches
    Subject(s): Tree data structures ; Access control ; Visualization ; File systems ; Laboratories ; Scattering ; Permission ; Public key cryptography ; Computer networks ; Testing
    ISBN: 9780769526775
    ISBN: 0769526772
    ISSN: 1060-9857
    E-ISSN: 2575-8462
    Source: IEEE Electronic Library (IEL)
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