Transcatheter arterial embolisation is efficient and safe for paediatric blunt torso trauma: a case-control study

Abstract Background It remains unclear whether transcatheter arterial embolisation (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. The study aimed to compare the efficacy and safety of TAE performed in paediatric (age ≤ 15 years) and adult patients with blunt torso trauma. Methods This was a single-centre, retrospective chart review study that included blunt torso trauma patients who underwent TAE in the trauma centre from 2012 to 2017. The comparative study was carried out between a ‘paediatric patient group’ and an ‘adult patient group’. The outcome measures for TAE were the success of haemorrhage control and complications and standardised mortality ratio (SMR). Results A total of 504 patients with blunt torso trauma were transported to the trauma centre, out of which 23% (N = 114) with blunt torso trauma underwent TAE, including 15 paediatric and 99 adult patients. There was no significant difference between the use of TAE in paediatric and adult patients with blunt torso trauma (29% vs 22%, P = .221). The paediatric patients’ median age was 11 years (interquartile ranges 7–14). The predicted mortality rate and SMR for paediatric patients were lower than those for adult patients (18.3% vs 25.9%, P = .026, and 0.37 vs 0.54). The rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% in paediatric patients, which was similar to that in adult patients (88%). There were no complications in paediatric patients at our centre. There were no significant differences in the proportion of paediatric patients who underwent surgery before TAE or urgent blood transfusion (33% vs 26%, P = .566, or 67% vs 85%, P = .084). Conclusions It is possible to provide an equal level of care related to TAE for paediatric and adult patients as it relates to TAE for blunt torso trauma with haemorrhage in the trauma centre. Alternative haemorrhage control procedures should be established as soon as possible whenever the patients reach a haemodynamically unstable state.

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Transcatheter Arterial Embolization is an Efficient and Safe for Paediatric Blunt Torso Trauma: A Case Control Study

10.21203/rs.3.rs-50560/v1 ◽

2020 ◽

Author(s):

Masayasu Gakumazawa ◽

Chiaki Toida ◽

Takashi Muguruma ◽

Naoki Yogo ◽

Mafumi Shinohara ◽

...

Keyword(s):

Patient Group ◽

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Trauma Centre ◽

Adult Patients ◽

Unstable State ◽

Paediatric Patients ◽

Significant Difference ◽

Haemorrhage Control ◽

Torso Trauma

Abstract Background: It remains unclear whether transcatheter arterial embolization (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. The study aimed to compare the efficacy and safety of TAE in paediatric patients (age ≤ 15 years) with blunt torso trauma to those of TAE in adult patients. Methods: This was a single-centre, retrospective chart review study that included blunt torso trauma patients who underwent TAE in the trauma centre from 2012 to 2017. The comparative study was carried out between a “paediatric patient group” and an “adult patient group”.The outcome measures for TAE were the success of haemorrhage control and complications and standardised mortality ratio (SMR). Results: A total of 504 patients with blunt torso trauma were transported to the trauma centre. Among them, 23% (N=114) of patients with blunt torso trauma underwent TAE, including 15 paediatric and 99 adult patients. There was no significant difference between the use of TAE in paediatric and adult patients with blunt torso trauma (29% vs. 22%, P=.221). The median age was 11 (IQR 7–14) years for paediatric patients. The predicted mortality (PMR) rate and SMR for paediatric patients were lower than that for adult patients (18.3% vs. 25.9%, P =.026, and 0.37 vs. 0.54). The rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% in paediatric patients, which was similar to that in adult patients (88%). There were no complications in the paediatric patients at our centre. There were no significant differences in the proportion of paediatric patients that underwent surgery before TAE or urgent blood transfusion (33% vs. 26%, P =.566, or 67% vs. 85%, P =.084). Conclusions: It is possible to provide an equal level of care related to TAE for both paediatric and adult patients as it relates to TAE for blunt torso trauma with haemorrhage in the trauma centre. We should prepare alternative haemorrhage control procedures as soon as possible whenever the patients reach a hemodynamic unstable state.

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Transcatheter arterial embolsation is efficient and safe for paediatric blunt torso trauma: a case-control study

10.21203/rs.3.rs-51268/v3 ◽

2020 ◽

Author(s):

Masayasu Gakumazawa ◽

Chiaki Toida ◽

Takashi Muguruma ◽

Naoki Yogo ◽

Mafumi Shinohara ◽

...

Keyword(s):

Patient Group ◽

Case Reports ◽

Trauma Centre ◽

Adult Patients ◽

Unstable State ◽

Trauma Patients ◽

Paediatric Patients ◽

Significant Difference ◽

Haemorrhage Control ◽

Torso Trauma

Abstract Background: It remains unclear whether transcatheter arterial embolisation (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. The study aimed to compare the efficacy and safety of TAE performed in paediatric (age ≤ 15 years) and adult patients with blunt torso trauma. Methods: This was a single-centre, retrospective chart review study that included blunt torso trauma patients who underwent TAE in the trauma centre from 2012 to 2017. The comparative study was carried out between a ‘paediatric patient group’ and an ‘adult patient group’. The outcome measures for TAE were the success of haemorrhage control and complications and standardised mortality ratio (SMR).Results: A total of 504 patients with blunt torso trauma were transported to the trauma centre, out of which 23% (N=114) with blunt torso trauma underwent TAE, including 15 paediatric and 99 adult patients. There was no significant difference between the use of TAE in paediatric and adult patients with blunt torso trauma (29% vs 22%, P=.221). The paediatric patients’ median age was 11 years (IQR 7–14). The predicted mortality rate (PMR) and SMR for paediatric patients were lower than those for adult patients (18.3% vs 25.9%, P=.026, and 0.37 vs 0.54). The rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% in paediatric patients, which was similar to that in adult patients (88%). There were no complications in paediatric patients at our centre. There were no significant differences in the proportion of paediatric patients who underwent surgery before TAE or urgent blood transfusion (33% vs 26%, P=.566, or 67% vs 85%, P=.084).Conclusions: It is possible to provide an equal level of care related to TAE for paediatric and adult patients as it relates to TAE for blunt torso trauma with haemorrhage in the trauma centre. Alternative haemorrhage control procedures should be established as soon as possible whenever the patients reach a haemodynamically unstable state.

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Transcatheter Arterial Embolization is an Efficient and Safe for Paediatric Blunt Torso Trauma: A Case Control Study

10.21203/rs.3.rs-51268/v1 ◽

2020 ◽

Author(s):

Masayasu Gakumazawa ◽

Chiaki Toida ◽

Takashi Muguruma ◽

Naoki Yogo ◽

Mafumi Shinohara ◽

...

Keyword(s):

Patient Group ◽

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Trauma Centre ◽

Adult Patients ◽

Unstable State ◽

Paediatric Patients ◽

Significant Difference ◽

Haemorrhage Control ◽

Torso Trauma

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Transcatheter arterial embolization is efficient and safe for paediatric blunt torso trauma: a case-control study

10.21203/rs.3.rs-51268/v2 ◽

2020 ◽

Author(s):

Masayasu Gakumazawa ◽

Chiaki Toida ◽

Takashi Muguruma ◽

Naoki Yogo ◽

Mafumi Shinohara ◽

...

Keyword(s):

Patient Group ◽

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Trauma Centre ◽

Adult Patients ◽

Unstable State ◽

Paediatric Patients ◽

Significant Difference ◽

Haemorrhage Control ◽

Torso Trauma

Abstract Background: It remains unclear whether transcatheter arterial embolization (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. The study aimed to compare the efficacy and safety of TAE in paediatric patients (age ≤ 15 years) with blunt torso trauma to those of TAE in adult patients. Methods: This was a single-centre, retrospective chart review study that included blunt torso trauma patients who underwent TAE in the trauma centre from 2012 to 2017. The comparative study was carried out between a “paediatric patient group” and an “adult patient group”.The outcome measures for TAE were the success of haemorrhage control and complications and standardised mortality ratio (SMR).Results: A total of 504 patients with blunt torso trauma were transported to the trauma centre. Among them, 23% (N=114) of patients with blunt torso trauma underwent TAE, including 15 paediatric and 99 adult patients. There was no significant difference between the use of TAE in paediatric and adult patients with blunt torso trauma (29% vs. 22%, P=.221). The median age was 11 (IQR 7–14) years for paediatric patients. The predicted mortality (PMR) rate and SMR for paediatric patients were lower than that for adult patients (18.3% vs. 25.9%, P =.026, and 0.37 vs. 0.54). The rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% in paediatric patients, which was similar to that in adult patients (88%). There were no complications in the paediatric patients at our centre. There were no significant differences in the proportion of paediatric patients that underwent surgery before TAE or urgent blood transfusion (33% vs. 26%, P =.566, or 67% vs. 85%, P =.084).Conclusions: It is possible to provide an equal level of care related to TAE for both paediatric and adult patients as it relates to TAE for blunt torso trauma with haemorrhage in the trauma centre. We should prepare alternative haemorrhage control procedures as soon as possible whenever the patients reach a hemodynamic unstable state.

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Association of Low Concentrations of Serum Mannose-Binding Protein with Recurrent Infections in Adults

Clinical and Diagnostic Laboratory Immunology ◽

10.1128/cdli.5.3.319-321.1998 ◽

1998 ◽

Vol 5 (3) ◽

pp. 319-321 ◽

Cited By ~ 26

Author(s):

Vellalore N. Kakkanaiah ◽

Guo Qiu Shen ◽

Emmanuel A. Ojo-Amaize ◽

James B. Peter

Keyword(s):

Patient Group ◽

Binding Protein ◽

Adult Patients ◽

Control Group ◽

Recurrent Infections ◽

Group I ◽

Low Concentrations ◽

Significant Difference ◽

Mannose Binding Protein ◽

Mannose Binding

ABSTRACT Low concentrations of mannose-binding protein (MBP; also known as mannose-binding lectin) are associated with common opsonic defect in immunodeficient children. We compared the concentrations of MBP in the sera of 47 adults with non-human immunodeficiency virus-related recurrent infections (group I) and 50 healthy adult controls. Mean serum MBP concentrations in the patient group did not differ significantly from those in the control group (P < 0.4). Nevertheless, the proportion of individuals with less than 5 ng of serum MBP per ml was significantly larger in the patient group (21%, P = 0.01) than in the control group (4%). Group II consisted of 73 pediatric and 56 adult patients with recurrent infections. Pediatric patients had significantly lower mean concentrations of serum MBP than their controls (P < 0.005), and there was no significant difference between the concentrations in sera of adult patients and adult controls (P < 0.4). Again, the proportion of individuals with less than 5 ng of serum MBP per ml was significantly larger in both pediatric (22%, P = 0.045) and adult (38%,P = 0.000016) patients than in their respective controls (4%). Our results demonstrate that, as in children, low concentrations of serum MBP can be associated with recurrent infections in adults.

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AB0100 EVALUATION OF PGA LEVEL FOR CLINICAL REMISSION WITH BOOLEAN CRITERIA, 10MM OR 20MM?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.288 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1078.1-1079

Author(s):

I. Yoshii

Keyword(s):

Disease Activity ◽

Patient Group ◽

Clinical Remission ◽

Global Assessment ◽

Activity Index ◽

T Test ◽

Mean Values ◽

Significant Difference ◽

Remission Criteria ◽

The Mean

Background:Patient’s global assessment (PGA) is one important component of Boolean composite criteria for remission in treat with rheumatoid arthritis (RA). However, PGA no more than 10mm is sometimes obstacle to attain clinical remission. In recent few years, one opinion that PGA no more than 20mm may be comparable as no more than 10mm.Objectives:The aim of this study is to analyze how difference of these PGA level affect disease activity and daily activities in living, and evaluate which is optimal for the remission with Boolean remission criteria from real world setting.Methods:RA patients who were followed up for more than three years in the institute were picked up in the study. Each patient was monitored with tenderness joint count (TJC), swollen joint count (SJC), PGA, evaluator’s global assessment (EGA), serum C-reactive protein level (CRP), calculated disease activity score with simplified disease activity index(SDAI), Health Assessment Questionnaire Disability Index (HAQ-DI), and pain score using visual analog scale (PS-VAS) every consulted time from the first encounter (Baseline). Patients were classified according to achievement of Boolean remission criteria. Group 1: a patient group who attained Boolean remission wih TJC≦1, SJC≦1, CRP≦1mg/dl, and PGA≦1 (G-1), Group 2: a patient group who could not attained the Boolean remission used in the G-1 evaluation, but could attained another Boolean remission with TJC≦1, SJC≦1, CRP≦1mg/dl, and PGA≦2 (G-2), and Group 3: a patient group who could not attain Boolean remission for neither criterion.Mean values of measured parameters at Baseline and after the Baseline were compared statistically with Student T-test. Mean values of the same parameters in the G-1 and G-2 at the time of attain Boolean remission for each criteria, mean values of each of these parameters thereafter, and changes of these parameters were compared statistically with Student T-test.Results:A total of 438 patients 385 in the G-1 group, 16 in the G-2 group, and 37 in the G-3 group, were recruited. In parameters at Baseline, level of TJC, SJC, PGA, EGA, SDAI, and HAQ-DI in the G-1 was significantly lower than in the G-3, whereas no significant differences in any parameters demonstrated between in the G-2 and G-3. Level of HAQ-DI, and PS-VAS after Baseline in the G-1 was lower than in the G-3, whereas no significant difference of these parameters after Baseline demonstrated between in the G-2 and G-3. TJC, SJC, PGA, and EGA demonstrated significant less level in the G-1 than in the other two groups. The mean SDAI score at the time of first achievement of Boolean remission in the G-1 and G-2 were 1.08 and 2.57, respectively. The mean value of SDAI score after remission in the G-1 and G-2 were 3.35 and 6.44, respectively. These values and PS-VAS including change of the SDAI score demonstrated significant difference between the two groups (p<0.01), whereas HAQ-DI in the two groups demonstrated no significant difference.Conclusion:These results suggested that setting PGA as no more than 10mm should be reasonable for the evaluation of clinical remission with the Boolean criteria.Disclosure of Interests:None declared

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Onyx cost effective for transcatheter arterial embolisation

PharmacoEconomics & Outcomes News ◽

10.1007/s40274-021-7420-x ◽

2021 ◽

Vol 870 (1) ◽

pp. 17-17

Keyword(s):

Cost Effective ◽

Transcatheter Arterial Embolisation ◽

Arterial Embolisation

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Association of Health Insurance Status with Outcomes of Sepsis in Adult Patients: A Retrospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115777 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5777

Author(s):

Gaon-Sorae Wang ◽

Kyoung-Min You ◽

You-Hwan Jo ◽

Hui-Jai Lee ◽

Jong-Hwan Shin ◽

...

Keyword(s):

Health Insurance ◽

Propensity Score ◽

Hospital Mortality ◽

Cohort Analysis ◽

Adult Patients ◽

Multivariate Logistic Regression Model ◽

Insurance Status ◽

Matched Cohort ◽

Health Insurance Status ◽

Significant Difference

(1) Background: Sepsis is a life-threatening disease, and various demographic and socioeconomic factors affect outcomes in sepsis. However, little is known regarding the potential association between health insurance status and outcomes of sepsis in Korea. We evaluated the association of health insurance and clinical outcomes in patients with sepsis. (2) Methods: Prospective cohort data of adult patients with sepsis and septic shock from March 2016 to December 2018 in three hospitals were retrospectively analyzed. We categorized patients into two groups according to their health insurance status: National Health Insurance (NHI) and Medical Aid (MA). The primary end point was in-hospital mortality. The multivariate logistic regression model and propensity score matching were used. (3) Results: Of a total of 2526 eligible patients, 2329 (92.2%) were covered by NHI, and 197 (7.8%) were covered by MA. The MA group had fewer males, more chronic kidney disease, more multiple sources of infection, and more patients with initial lactate > 2 mmol/L. In-hospital, 28-day, and 90-day mortality were not significantly different between the two groups and in-hospital mortality was not different in the subgroup analysis. Furthermore, health insurance status was not independently associated with in-hospital mortality in multivariate analysis and was not associated with survival outcomes in the propensity score-matched cohort. (4) Conclusion: Our propensity score-matched cohort analysis demonstrated that there was no significant difference in in-hospital mortality by health insurance status in patients with sepsis.

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Cytidine Deaminase Residual Activity in Serum Is a Predictive Marker of Early Severe Toxicities in Adults After Gemcitabine-Based Chemotherapies

Journal of Clinical Oncology ◽

10.1200/jco.2009.24.4491 ◽

2010 ◽

Vol 28 (1) ◽

pp. 160-165 ◽

Cited By ~ 86

Author(s):

Joseph Ciccolini ◽

Laetitia Dahan ◽

Nicolas André ◽

Alexandre Evrard ◽

Muriel Duluc ◽

...

Keyword(s):

Drug Exposure ◽

Cytidine Deaminase ◽

Residual Activity ◽

Predictive Marker ◽

Adult Patients ◽

Functional Testing ◽

Simple Test ◽

Increased Risk ◽

Significant Difference ◽

Patients At Risk

Purpose Anticipating toxicities with gemcitabine is an ongoing story, and deregulation in cytidine deaminase (CDA) could be associated with increased risk of developing early severe toxicities on drug exposure. Patients and Methods A simple test to evaluate CDA phenotypic status was first validated in an animal model investigating relationships between CDA activity and gemcitabine-related toxicities. Next, relevance of this test as a marker for toxicities was retrospectively tested in a first subset of 64 adult patients treated with gemcitabine alone, then it was tested in a larger group of 130 patients who received gemcitabine either alone or combined with other drugs and in 20 children. Additionally, search for the 435 T>C, 208 G>A and 79 A>C mutations on the CDA gene was performed. Results In mice, CDA deficiency impacted on gemcitabine pharmacokinetics and had subsequent lethal toxicities. In human, 12% of adult patients experienced early severe toxicities after gemcitabine administration. A significant difference in CDA activities was observed between patients with and without toxicities (1.2 ± 0.8 U/mg v 4 ± 2.6 U/mg; P < .01). Conversely, no genotype-to-phenotype relationships were found. Of note, the patients who displayed particularly reduced CDA activity all experienced strong toxicities. Gemcitabine was well tolerated in children, and no CDA deficiency was evidenced. Conclusion Our data suggest that CDA functional testing could be a simple and easy marker to discriminate adult patients at risk of developing severe toxicities with gemcitabine. Particularly, this study demonstrates that CDA deficiency, found in 7% of adult patients, is associated with a maximum risk of developing early severe toxicities with gemcitabine.

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Determining the efficiency of the Imatinib mesylate and monitoring of relapse and emergence of IM resistance in Algerian adult patients with Chronic Myeloid Leukaemia

South Asian Journal of Experimental Biology ◽

10.38150/sajeb.8(3).p103-108 ◽

2019 ◽

Vol 8 (3) ◽

pp. 103-108

Author(s):

Amel Sebaa ◽

Mustapha Diaf ◽

Sakina Cherif Touil

Keyword(s):

Chronic Myeloid Leukaemia ◽

Myeloid Leukaemia ◽

Imatinib Mesylate ◽

Second Generation ◽

Adult Patients ◽

Second Line ◽

Second Line Therapy ◽

Molecular Responses ◽

Line Therapy ◽

Significant Difference

Imatinib mesylate (IM) shows remarkable clinical activity in patients with Chronic Myeloid Leukaemia (CML). Patients who fail to respond to IM or those who lose their response should be treated with second-generation tyrosine kinase inhibitors (TKIs). The aim of this study was to determine the efficiency of the Indian IM generic (Imatib*CIPLA), and to monitor relapse and emergence of IM resistance. Two hundred and seven adult patients from the Northwestern region of Algeria were diagnosed as CML in chronic phase (CP) and were treated with an Indian generic of IM at 400 mg/day. The IM 600 mg treatment and second-line therapy were prescribed after failure of treatment. Molecular Analysis was performed and BCR-ABL/ABL ratios were determined and standardised according to the international scale using 0.47 as conversion factor. Our findings showed a significant difference in major molecular response (MMR) for patients treated with IM 600 mg compared to IM 400 mg (51.7% vs. 37.6%, p<0.001). In the second line therapy group, there was a significant improvement of MR4.5 compared to the IM group (7.7% vs. 32.6%, p=0.039). Likewise, no significant relationship was found between the median duration of second-generation TKIs deep response and IM 400 mg/day regarding the MR4 (11 vs. 26.5 months, p=0.107) and MR4.5 (20 vs. 32.5 months, p=0.203). The Indian IM generic molecule (Imatib*CIPLA), has shown its efficiency in achieving major and deep molecular responses. Patients treated with the second-generation TKIs showed deep molecular responses with fewer relapses in a shorter median time than those treated with IM.

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