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| 4. |
- Augulyte, Lijana, et al.
(författare)
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Chemical and Ecotoxicological Assessment of Selected Biologically Activated Sorbents for Treating Wastewater Polluted with Petroleum Products with Special Emphasis on Polycyclic Aromatic Hydrocarbons
- 2008
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Ingår i: Water, Air and Soil Pollution. - : Springer. - 0049-6979 .- 1573-2932. ; 195:1-4, s. 243-256
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Tidskriftsartikel (refereegranskat)abstract
- A chemical and ecotoxicological assessment of treatment of wastewater that had been polluted with petroleum products using only Activated Sludge (AS) and four biologically activated sorbents (BASs), consisting of activated sludge plus: coal-based activated carbon (-C1), coconut shell-based activated carbon (-C2), zeolite (-Z), and anthracite (-A) were conducted. The efficiency and robustness of the four wastewater treatment systems were evaluated by calculating the reduced total petroleum hydrocarbon (TPH) and polycyclic aromatic hydrocarbon (PAH) contents and the acute ecotoxicity of the effluents. The chemical analysis showed that the combined treatment systems were very effective for reducing the total petroleum hydrocarbon and readily bioavailable PAH contents. The most efficient systems were the BAS-C1 and -C2, which removed 60–88% and 99.5–99.6% of TPH and PAH, respectively. The activated sludge-only treatment was the least effective for purifying the wastewater. Chemical oxygen demand was reduced by >90% by all carbon-based BASs (BAS-C1, BAS-C2 and BAS-A). Shifts in the relative composition of the individual PAHs were identified in samples taken before and after treatment. Algal and bacterial bioassays showed that the toxicities of effluents following treatment by all four systems (except AS for algae) were reduced by more than 80% and 90%, respectively. However, crustacean tests indicated that the carbon-based BASs reduced the toxicity [V tox(50)] only by 19–67%. Our results indicated that the combination of sorption and biodegradation processes have great potential in the treatment of petroleum products polluted wastewater and is less sensitive for inhibitors of the biological process than treatments in which activated sludge alone is used. The assessment of chemical and ecotoxicological endpoints provided valuable information, but contrasting results for one of the assays indicates that further analysis on the capacity of the different treatment systems is warranted.
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- Belch, Jill J. F., et al.
(författare)
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Results of the randomized, placebo-controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheral arterial disease (CASPAR) trial
- 2010
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Ingår i: Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. - : Elsevier BV. - 0741-5214. ; 52:4, s. 825-833, 833.e1-2
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Tidskriftsartikel (refereegranskat)abstract
- The combination of clopidogrel plus ASA did not improve limb or systemic outcomes in the overall population of PAD patients requiring below-knee bypass grafting. Subgroup analysis suggests that clopidogrel plus ASA confers benefit in patients receiving prosthetic grafts without significantly increasing major bleeding risk.
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| 11. |
- Hull, Russell D., et al.
(författare)
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Benefit-to-harm ratio of thromboprophylaxis for patients undergoing major orthopaedic surgery
- 2014
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Ingår i: Thrombosis and Haemostasis. - 0340-6245 .- 2567-689X. ; 111:2, s. 199-212
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Tidskriftsartikel (refereegranskat)abstract
- Surgeons consider the benefit-to-harm ratio when making decisions regarding the use of anticoagulant venous thromboembolism (VIE) prophylaxis. We evaluated the benefit-to-harm ratio of the use of newer anticoagulants as thromboprophylaxis in patients undergoing major orthopaedic surgery using the likelihood of being helped or harmed (LHH), and assessed the effects of variation in the definition of major bleeding on the results. A systematic literature search was performed to identify phase II and phase III studies that compared regulatory authority-approved newer anticoagulants to the low-molecular-weight heparin enoxaparin in patients undergoing major orthopaedic surgery. Analysis of outcomes data estimated the clinical benefit (number-needed-to-treat [NNT] to prevent one symptomatic VIE) and clinical harm (number-needed-to-harm [NNH] or the NNT to cause one major bleeding event) of therapies. We estimated each trial's benefit, to-harm ratio from NNT and NNH values, and expressed this as LHH = (1/NNT)/(1/NNH) = NNH/NNT, Based on reporting of efficacy and safety outcomes, most studies favoured enoxaparin over fondaparinux, and rivaroxaban over enoxaparin. However, when using the LHH metric, most trials favoured enoxaparin over both fondaparinux and rivaroxaban when they included surgical-site bleeding that did not require reoperation in the definition of major bleeding. The exclusion of bleeding at surgical site which did not require reoperation shifted the benefit-to-harm ratio in favour of the newer agents. Variations in the definitions of major bleeding may change the benefit-to-harm ratio and subsequently affect its interpretation. Clinical trials should attempt to improve the consistency of major bleeding reporting.
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| 12. |
- Hull, Russell D., et al.
(författare)
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State-of-the-art review : Assessing the safety profiles of new anticoagulants for major orthopedic surgery thromboprophylaxis
- 2009
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Ingår i: Clinical and applied thrombosis/hemostasis. - : SAGE Publications. - 1076-0296 .- 1938-2723. ; 15:4, s. 377-388
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: The safety and efficacy of new anticoagulants are often initially tested for venous thromboembolism (VTE) prevention in patients undergoing major orthopedic surgery. Concern among surgeons about the risks for bleeding may result in suboptimal use of thrombophylaxis. OBJECTIVE: To evaluate the definitions used to define bleeding outcomes in studies of new anticoagulants and to examine the influence the definition has on the perceived bleeding risk of thromboprophylaxis. METHODS: The MedLine database was searched for phase III studies of new anticoagulants versus the standard comparator, enoxaparin, in patients undergoing major orthopedic surgery. RESULTS: The definitions for major bleeding outcomes varied widely both across and within clinical trial programs of new anticoagulants. Studies which did not include surgical site bleeding in their definition for major bleeding showed lower major bleeding rates in comparison to those that did include this outcome. Other factors that influenced the rate of major bleeding included the timing of prophylaxis initiation in relation to surgery and the dose of anticoagulant therapy. The wide range of definitions used for major bleeding made it difficult to compare bleeding risk among studies of new anticoagulants. CONCLUSIONS: The definitions of bleeding events that clinical trials of thromboprophylaxis use in their assessment of new anticoagulants strongly influences each drug's perceived safety profile and may underestimate bleeding risks. Clinical studies of new anticoagulants urgently need standardization of bleeding definitions to allow intertrial comparability and to ensure consistent reporting of clinically relevant outcomes.
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- Liapis, C. D., et al.
(författare)
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European continuing medical education in vascular surgery : 5-year results of congresses approved by the Union Européenne des Médecins Spécialistes Section of Vascular Surgery
- 2007
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 26:4, s. 361-366
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Continuing medical education (CME) can be defined as ''educational activities that serve to maintain, develop, or increase the knowledge, skills and professional performance of a physician to provide services for patients, the public, or the profession''. CME is a major professional responsibility. The European Board of Vascular Surgery of the Union Européenne des Médecins Spécialistes (UEMS) Section of Vascular Surgery has, through its European Vascular CME (EVCME) Committee, accredited 74 congresses during the 5-year period from 2000-2004. METHODS: Official evaluation forms were completed by the congress participants for a personal appraisal of the quality of the activities. The data in this manuscript focused on questions that were the most relevant and of the greatest interest to the participants. A statistical analysis of the results was performed utilizing ANOVA and Robust tests of equality of means as well as a posthoc analysis for further investigation, and non parametric Wilcoxon signed ranks test. RESULTS: The educational needs of participants regarding new diagnostic and therapeutic modes were stated as ''important'' and ''extremely important'' in the responses at over 80% in total. Over 75% of the participants answered ''extremely important'' and ''important'' to the question ''how important is evidence-based practice to your practice''. CONCLUSION: This survey indicates that the EVCME approved congresses had a positive impact for the vascular surgeon by updating overall knowledge on vascular surgery; the majority of comments by the participants also indicates that EVCME is fulfilling its aim to bring as much evidence-based practice as possible into the daily work schedule of the surgeon by turning knowledge acquired by CME into performance of the participants.
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| 15. |
- Liapis, C. D., et al.
(författare)
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Vascular training and endovascular practice in Europe
- 2009
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 37:1, s. 109-15
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the influence of the status of vascular surgery (VS) training paradigms on the actual practice of endovascular therapy among the European countries. METHODS: An email-based survey concerning vascular surgery training models and endovascular practices of different clinical specialties was distributed to a VS educator within 14 European countries. European Vascular and Endovascular Monitor (EVEM) data also were processed to correlate endovascular practice with training models. RESULTS: Fourteen questionnaires were gathered. Vascular training in Europe appears in 3 models: 1. Mono-specialty (independence): 7 countries, 2. Subspecialty: 5 countries, 3. An existing specialty within general surgery: 2 countries. Independent compared to non-independent certification shortens overall training length (5.9 vs 7.9 years, p=0.006), while increasing overall training devoted specifically to VS (3.9 vs 2.7 years, p=0.008). Among countries with independent certification an average of 76% of aortic and 50% of peripheral endovascular procedures are performed by vascular surgeons, while the corresponding values, for countries with a non-independent certification, are 69% and 36% respectively. Countries with independent vascular certification, despite their lower average endovascular index (procedures per 100,000 population), reported a higher growth rate of aortic endovascular procedures (VS independent 132% vs VS non-independent 87%), within a four-year period (2003-2007). Peripheral endovascular procedures, though, have similar growth rates in both country groups (VS independent 62% vs VS non-independent 60%). CONCLUSIONS: In European countries with VS as an independent specialty, vascular surgeons have a shorter total training period but spend more time in VS training, although they may not undertake a greater proportion of the endovascular procedures their countries appear to have adopted endovascular technologies more rapidly compared to the ones with non-independent VS curricula. Whether such differences influence patient outcomes requires investigation in future studies.
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| 16. |
- Länne, T, et al.
(författare)
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Diameter and compliance in the male human abdominal aorta: influence of age and aortic aneurysm
- 1992
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Ingår i: European Journal of Vascular Surgery. - 0950-821X. ; 6:2, s. 178-184
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Tidskriftsartikel (refereegranskat)abstract
- In this study changes in the diameter and compliance of the distal abdominal aorta (76 healthy Caucasian males, 5-71 years old) were determined non-invasively and related to age by means of an ultrasound phase-locked echo-tracking system. The diameter of the aorta increased not only in the period between 5 and 25 years of age, but also by about 30% between the ages of 25 and 71. The pressure diameter curves at 25, 51 and 70 years were non-linear with flattening between 90 and 110 mmHg, and the slope of the curves declined with age. Thus, the pressure strain elastic modulus (Ep) and stiffness (beta) increased (i.e. compliance decreased) in an exponential manner according to age. A group of 37 males with aneurysmal widening of the distal abdominal aorta had a significant increase in Ep when compared to an age-matched control group. Furthermore, the ranges for both Ep and beta were much larger in the aneurysm group than in the control group, indicating diversity in the pathogenesis of the disease. The non-invasive ultrasonic method of phase-locked echo-tracking is an appropriate method for studying compliance in major arteries under a variety of pathophysiological conditions.
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| 17. |
- Länne, T, et al.
(författare)
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Noninvasive measurement of diameter changes in the distal abdominal aorta in man
- 1992
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Ingår i: Ultrasound in Medicine and Biology. - 0301-5629. ; 18:5, s. 451-457
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Tidskriftsartikel (refereegranskat)abstract
- An ultrasound phase-locked, echo-tracking system was used to determine the dynamic properties of the distal abdominal aorta in 10 Caucasian male subjects (mean age, 25 years). Recordings were made at rest and during the blood pressure increase resulting from isometric exercise. The pressure diameter curve was nonlinear with an inflection at about 90-110 mmHg. Above this pressure range, the vessel was stiffer (less compliant), but the pressure diameter relationship was roughly linear above as well as below the inflection. Individual pressure diameter curves showed hysteresis, i.e., the aorta had a smaller diameter during expansion than during retraction at corresponding pressures. The pressure strain elastic modulus (Ep) and stiffness (beta) were at rest [Mean Arterial Pressure (MAP), 81 mmHg] 0.70 10(5) N/m2 and 6.0, respectively. During isometric exercise (MAP, 122 mmHg), Ep increased significantly by 91% and stiffness (beta) nonsignificantly by 27%. The variability of the compliance determinations was 5% when the ultrasonic system was combined with intra-arterial blood pressure measurements and less than 7% when combined with auscultatory blood pressure measurements. It is concluded that the phase-locked, echo-tracking system fulfills clinical requirements for routine measurements of vascular compliance.
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| 18. |
- Mätzsch, Thomas, et al.
(författare)
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No transplacental passage of standard heparin or an enzymatically depolymerized low molecular weight heparin
- 1991
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Ingår i: Blood Coagulation and Fibrinolysis. - 1473-5733. ; 2:2, s. 273-278
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Tidskriftsartikel (refereegranskat)abstract
- In 21 women who had an abortion by hysterotomy between the 15th and 23rd week of pregnancy, the possibility that unfragmented heparin or low molecular weight heparin (LMWH) passed the placental barrier to the foetus was studied. Laboratory analyses included amidolytic assays of factor Xa inhibitory activity (XaI), antithrombin III (ATIII) and a direct measurement of heparin-like substances in plasma with a competitive binding assay. The ATIII concentration in foetal plasma was about 20% of that in normal human plasma and varied considerably between individuals (2-27%). The XaI activity did not differ between the two treated groups, but the mean XaI activity of the combined groups differed from zero (P less than 0.05). If the XaI activity was corrected for the ATIII concentration, the heparin activities no longer differed significantly from zero. As the concentration of heparin-like substances were above the detection limit (0.35 microgram/ml) in 6/16 analysable samples of foetal plasma, a further 15 women who had not received any heparin were included as controls. In 12/14 analysable foetal plasmas heparin-like substances in concentrations above 0.35 micrograms/ml could be detected. Determination of heparin activity in foetal plasma is thus difficult due to the influence of endogenous ATIII on heparin assays. In conclusion, this study did not demonstrate any evidence for the passage of heparin or LMWH across the placental barrier. No differences were detected whether unfragmented heparin or LMWH had been given to the mothers. Our results also indicate the presence of an endogenous glycosaminoglycan in foetal plasma.
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| 24. |
- Tengborn, Lilian, et al.
(författare)
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Recurrent thromboembolism in pregnancy and puerperium. Is there a need for thromboprophylaxis?
- 1989
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Ingår i: American Journal of Obstetrics and Gynecology. - 1097-6868. ; 160:1, s. 90-94
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Tidskriftsartikel (refereegranskat)abstract
- By sending a questionnaire (response rate 93%) to 321 women with a history of venous thromboembolism and previous coagulation tests, 72 patients were identified who had a total of 87 pregnancies after the thromboembolic episode. The main aim of the study was to analyze the influence of prophylaxis during pregnancy and delivery on the development of further thromboembolic complications. During pregnancy there was no difference in frequency of thromboses between the group given prophylaxis (n = 20) and the group not receiving it (n = 67). At delivery the frequency of thrombosis was 5.3% among the 57 women given prophylaxis and 11.1% among the 30 without prophylaxis, a difference that is not significant. The implication of these findings is discussed both concerning the indications for giving prophylaxis and concerning the problem of designing relevant prophylactic trials.
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