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Urokinase guidelines

Luigi Rossi, Pasquale Libutti, Francesco Casucci, Piero Lisi, Annalisa Teutonico, Carlo Basile, Carlo Lomonte
Catheter-related right atrial thrombosis is a severe and life-threatening complication of central venous catheters in both adult and young patients. Catheter-related right atrial thrombosis can occur with any type of central venous catheters, utilized either for hemodialysis or infusion. Up to 30% of patients with central venous catheter are estimated to be affected by catheter-related right atrial thrombosis; however, neither precise epidemiological data nor guidelines regarding medical or surgical treatment are available...
May 1, 2018: Journal of Vascular Access
Jeppe Meyer, Morten Alstrup, Line J H Rasmussen, Martin Schultz, Steen Ladelund, Thomas H Haupt, Jens Tingleff, Kasper Iversen, Jesper Eugen-Olsen
BACKGROUND: Acutely admitted medical patients are often fragile and in risk of future surgery. The biomarker soluble urokinase plasminogen activator receptor (suPAR) is a predictor of readmission and mortality in the acute care setting. We aimed to investigate if suPAR also predicts acute surgery, which is associated with higher mortality than elective surgery, and if it predicts post-operative mortality. METHODS: A retrospective registry-based cohort study of 17,312 patients admitted to an acute medical unit in Denmark, from 18 November 2013 until 30 September 2015...
February 1, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
M J Duffy, N Harbeck, M Nap, R Molina, A Nicolini, E Senkus, F Cardoso
Biomarkers play an essential role in the management of patients with invasive breast cancer. For selecting patients likely to respond to endocrine therapy, both oestrogen receptors (ERs) and progesterone receptors (PRs) should be measured on all newly diagnosed invasive breast cancers. On the other hand, for selecting likely response to all forms of anti-HER2 therapy (trastuzumab, pertuzumab, lapatinib or ado-trastuzumab emtansine), determination of HER2 expression or gene copy number is mandatory. Where feasible, measurement of ER, PR and HER2 should be performed on recurrent lesions and the primary invasive tumour...
April 2017: European Journal of Cancer
Wilson Petrushnko, Justin S Gundara, Philip R De Reuver, Greg O'Grady, Jaswinder S Samra, Anubhav Mittal
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) continues to be associated with a poor prognosis. This systematic review aimed to summarize the literature regarding potential prognostic biomarkers to facilitate validation studies and clinical application. METHODS: A systematic review was performed (2004-2014) according to PRISMA guidelines. Studies were ranked using REMARK criteria and the following outcomes were examined: overall/disease free survival, nodal involvement, tumour characteristics, metastasis, recurrence and resectability...
August 2016: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Sahela Nasrin, Fathima Aaysha Cader, Md Salahuddin, Tahera Nazrin, Masuma Jannat Shafi
BACKGROUND: Massive pulmonary embolism (PE) is associated with significant mortality, especially if compounded by haemodynamic instability, right ventricular (RV) dysfunction and right atrial (RA) thrombus. Thrombolysis can be lifesaving in patients with major embolism and cardiogenic shock, and accelerates the resolution of thrombus. Only three fibrinolytic agents-namely streptokinase, urokinase, and recombinant tissue plasminogen activator (alteplase) have been approved in the treatment of PE, with studies demonstrating similar safety profiles...
July 28, 2016: BMC Research Notes
Sophie Marguet, Chafika Mazouni, Bram L T Ramaekers, Ariane Dunant, Ronald Kates, Volker R Jacobs, Manuela A Joore, Nadia Harbeck, Julia Bonastre
BACKGROUND: This study investigated the cost effectiveness of guideline-recommended (American Society of Clinical Oncology, European Society of Medical Oncology) urokinase plasminogen activator (uPA)/plasminogen activator inhibitor-1 (PAI-1) biomarkers to guide adjuvant chemotherapy decisions for hormone receptor-positive, node-negative early breast cancer patients at intermediate risk of relapse, in France, Germany, and The Netherlands. METHODS: uPA/PAI-1 testing was compared to chemotherapy for all patients and to no chemotherapy in two age-related subgroups (35-49 and 50-75 years)...
August 2016: European Journal of Cancer
Lyndsay N Harris, Nofisat Ismaila, Lisa M McShane, Fabrice Andre, Deborah E Collyar, Ana M Gonzalez-Angulo, Elizabeth H Hammond, Nicole M Kuderer, Minetta C Liu, Robert G Mennel, Catherine Van Poznak, Robert C Bast, Daniel F Hayes
PURPOSE: To provide recommendations on appropriate use of breast tumor biomarker assay results to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer. METHODS: A literature search and prospectively defined study selection sought systematic reviews, meta-analyses, randomized controlled trials, prospective-retrospective studies, and prospective comparative observational studies published from 2006 through 2014. Outcomes of interest included overall survival and disease-free or recurrence-free survival...
April 1, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Laura Evangelista, Alberto Briganti, Stefano Fanti, Stephen Joniau, Sven Reske, Riccardo Schiavina, Christian Stief, George N Thalmann, Maria Picchio
CONTEXT: Radiolabelled choline positron emission tomography has changed the management of prostate cancer patients. However, new emerging radiopharmaceutical agents, like radiolabelled prostate specific membrane antigen, and new promising hybrid imaging will begin new challenges in the diagnostic field. OBJECTIVE: The continuous evolution in nuclear medicine has led to the improvement in the detection of recurrent prostate cancer (PCa), particularly distant metastases...
July 2016: European Urology
Natalie K Bradford, Rachel M Edwards, Raymond J Chan
BACKGROUND: Guidelines and clinical practice for the prevention of complications associated with central venous catheters (CVC) around the world vary greatly. Most institutions recommend the use of heparin to prevent occlusion, however there is debate regarding the need for heparin and evidence to suggest 0.9% sodium chloride (normal saline) may be as effective. The use of heparin is not without risk, may be unnecessary and is also associated with increased cost. OBJECTIVES: To assess the clinical effects (benefits and harms) of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children...
November 23, 2015: Cochrane Database of Systematic Reviews
Caroline Perez, Amor Khachemoune
Mal de Meleda is a rare autosomal recessive palmoplantar keratoderma (PPK) disease with an estimated prevalence of 1:100,000. Clinically, the onset of the disease is typically soon after birth and features a transgrediens (plantar surface progressing to dorsal surface) and progrediens (worsening with age) pattern of hyperkeratosis of the palms and soles. The disease can feature other potentially disfiguring effects on the hands and feet that can severely impact function. Histologically, the lesions show hyperkeratosis and acanthosis without epidermolysis in the epidermis, accompanied by perivascular lymphocytic infiltrate in the dermis...
February 2016: American Journal of Clinical Dermatology
Catherine A Mazzola, Asim F Choudhri, Kurtis I Auguste, David D Limbrick, Marta Rogido, Laura Mitchell, Ann Marie Flannery
OBJECT: The objective of this systematic review and analysis was to answer the following question: What are the optimal treatment strategies for posthemorrhagic hydrocephalus (PHH) in premature infants? METHODS: Both the US National Library of Medicine and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words relevant to PHH. Two hundred thirteen abstracts were reviewed, after which 98 full-text publications that met inclusion criteria that had been determined a priori were selected and reviewed...
November 2014: Journal of Neurosurgery. Pediatrics
Q Q Zhang, H Xu, M H Zu, Y M Gu, B Shen, N Wei, W Xu, H T Liu, W L Wang, Z K Gao
OBJECTIVES: The aim of this study was to evaluate the strategy and long-term outcomes of endovascular treatment of Budd-Chiari syndrome (BCS) complicated by inferior vena cava (IVC) thrombosis. METHODS: The treatment strategy and outcomes of BCS complicated by IVC thrombosis were retrospectively evaluated in a single-center study. The treatment was aimed at the IVC thrombus, not hepatic vein occlusion. All 133 patients with BCS complicated by IVC thrombosis from February 2003 to March 2013 underwent endovascular treatment...
May 2014: European Journal of Vascular and Endovascular Surgery
M Grunnet, I J Christensen, U Lassen, L H Jensen, M Lydolph, I K Lund, T Thurison, G Høyer-Hansen, M Mau-Sørensen
BACKGROUND: High levels of intact and cleaved forms of the urokinase-type plasminogen activator receptor (uPAR) in both tissue and blood are associated with poor survival in several cancer diseases. The prognostic significance of uPAR in cholangiocarcinoma is unknown. The aims of this study were to determine if pre-treatment serum levels of uPAR forms and a decrease in levels during chemotherapy are predictive of survival in patients with inoperable cholangiocarcinoma. DESIGN AND METHODS: Patients with inoperable cholangiocarcinoma were consecutively included in the training set (n=108)...
May 2014: Clinical Biochemistry
Haïdar Saadoun, Pierre-Jean Lamy, Simon Thezenas, Stéphane Pouderoux, Frédéric Bibeau, Frédéric Montels, Gilles Romieu, Pierre-Emmanuel Colombo, Marian Gutowski, William Jacot
AIMS: Following the introduction of new adjuvant therapies we wanted to reappraise the prognostic and predictive value of uPA/PAI-1 in early breast cancer. PATIENTS & METHODS: This monocentric retrospective study included 652 patients who had curative surgery between 2006 and 2011 and adjuvant treatment decision-making, taking into account uPA/PAI-1 tumor levels. RESULTS: uPA and PAI-1 levels were associated with classical clinicopathological parameters and adjuvant chemotherapy decision, but not with peritumoral vascular invasion (PVI; also known as peritumoral vascular emboli)...
February 2014: Future Oncology
Christina K Park, Bosco A Paes, Kim Nagel, Anthony K Chan, Prashanth Murthy
Thrombotic occlusion of central venous catheters (CVCs) is a common problem in newborns. There is no guideline that systematically addresses the diagnosis, management, and prevention of this complication. The objective of this review is to establish evidence-based guidance for the management of CVC-related thrombosis. A comprehensive search of the scientific literature was conducted from 1948 to 2012. Twenty-six articles fulfilling four criteria - humans, neonates aged below 28 days, CVC insertion, and English language - were included for analysis...
March 2014: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Reineke A Schoot, Elvira C van Dalen, Cornelia H van Ommen, Marianne D van de Wetering
BACKGROUND: The risk of developing a tunnelled central venous catheter (CVC)-related infection ranges between 0.1 and 2.3 per 1000 catheter days for children with cancer. These infections are difficult to treat with systemic antibiotics (salvage rate 24% - 66%) due to biofilm formation in the CVC. Lock treatments can achieve 100 - 1000 times higher concentrations locally without exposure to high systemic concentrations. OBJECTIVES: Our objective was to investigate the efficacy of antibiotic and other lock treatments in the treatment of CVC-related infections in children with cancer compared to a control intervention...
June 25, 2013: Cochrane Database of Systematic Reviews
Volker R Jacobs, Doris Augustin, Arthur Wischnik, Marion Kiechle, Cornelia Höss, Oliver Steinkohl, Brigitte Rack, Thomas Kapitza, Peter Krase
Biomarkers uPA/PAI-1 as recommended by ASCO and AGO are used in primary breast cancer to avoid unnecessary CTX in medium risk-recurrence patients. This study verified how many CTX cycles and CTX-related direct medication costs can be avoided by uPA/PAI-1 testing. A prospective, non-interventional, multi-center study was performed among six Certified Breast Centers to analyze application of uPA/PAI-1 and consecutive decision-making. CTX avoided were identified and direct costs for CTX, CTX-related concomitant medication and febrile neutropenia (FN) prophylaxis with G-CSF calculated...
August 2013: Breast: Official Journal of the European Society of Mastology
Victor F Tapson
Thrombolytic therapy accelerates the dissolution of acute pulmonary embolism and is potentially lifesaving. The goal of this article is to offer a critical analysis of the use of thrombolytic therapy in this setting. Guidelines have been written and modified and new ones have been published over the past several years. Although an evidence base exists, unanswered questions remain. Despite the potential benefit of rapid clot lysis, nonpathologic thrombi are also lysed, so that thrombolytic therapy can cause significant bleeding complications...
June 2013: Seminars in Thrombosis and Hemostasis
N Harbeck, M Schmitt, C Meisner, C Friedel, M Untch, M Schmidt, C G J Sweep, B W Lisboa, M P Lux, T Beck, S Hasmüller, M Kiechle, F Jänicke, C Thomssen
AIM: Final 10-year analysis of the prospective randomised Chemo-N0 trial is presented. Based on the Chemo-N0 interim results and an European Organisation for Research and Treatment of Cancer (EORTC) pooled analysis (n=8377), American Society of Clinical Oncology (ASCO) and Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) guidelines recommend invasion and metastasis markers urokinase-type plasminogen activator (uPA)/plasminogen activator inhibitor-1 (PAI-1) for risk assessment and treatment decision in node-negative (N0) breast cancer (BC)...
May 2013: European Journal of Cancer
Elio Castagnola, Francesca Ginocchio
Device-related bacteremia is the most frequent complication in patients with indwelling central venous catheter. Guidelines recommend treatment based on epidemiology and antimicrobial susceptibility tests, but catheter removal is advocated in the presence of particular clinical conditions or pathogen isolations. Anti-infective drugs might become less effective in the presence of pathogens with increases in minimal inhibitory concentrations or slime production, and sometimes catheter removal is not feasible, for example, in patients with limited vascular sites or in the presence of life-threatening clinical conditions...
February 2013: Expert Review of Anti-infective Therapy
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