Adherence to thromboprophylaxis guidelines in elderly patients with hospital acquired venous thromboembolism: a case control study.

Venous thromboembolism (VTE) remains the number one preventable cause of hospital acquired mortality and morbidity. Each year, more than 12 million patients are at risk for VTE. The delivery of appropriate and timely VTE prophylaxis is still suboptimal in many healthcare institutions and can lead to increased readmissions, morbidity, as well as costs. To clarify this issue further, we performed a retrospective case control study at our institution to determine if poor adherence to the VTE prophylaxis guidelines could lead to an increase in VTE events. This was a retrospective case control study conducted at Winthrop-University Hospital from January 2007 to December 2011. Exclusion criteria were age < 18 and concurrent use of anticoagulant agents. Out of 322 cases of hospital acquired VTE or readmission with VTE within 30 days of discharge, 289 cases were selected for final analysis and paired with age and sex matched controls. Patients with a hospital acquired VTE or a readmission for VTE within 30 days of discharge had a significantly reduced rate of VTE prophylaxis when compared to the control group (54.0 vs. 79.2 %, p < 0.0001). The VTE risk assessment rate was also lower in the VTE group (77.2 vs. 85.5 %, p = 0.035). No difference was noted in the time to prophylaxis administration between the two groups (34.8 vs. 33.1 h, p = 0.34). Lastly, sequential compression device (SCD) documentation rate was not different: 68/116 (58.6 %) vs. 44/87 (50.6 %), p = 0.32, between the two arms. Low adherence to the American College of Chest Physician (ACCP) guidelines for VTE prophylaxis correlated with an increase in hospital acquired VTE. The decreased adherence may be linked to a lower VTE risk assessment rate, and other barriers including incorrect identification of contraindications to pharmacologic prophylaxis, and poor documentation of mechanical prophylaxis. There was no difference in SCD documentation rate and timeliness to administration of initial thromboprophylaxis between the two groups. Future studies are needed to reassess adherence and documentation rates after system-wide improvements.

Erdheim-Chester disease: a rare cause of recurrent fever of unknown origin mimicking lymphoma.

We report the case of a patient with recurrent fever of unknown origin (FUO) with prominent back pain, hepatosplenomegaly, and abdominal/pelvic adenopathy suggesting lymphoma. A bone biopsy showed histiocytic infiltration. Studies for lymphoma were negative, but immunohistochemical stains were diagnostic of Erdheim-Chester disease (ECD). ECD should be included as a rare cause of recurrent FUO with bone involvement.

Cancer Antigen 72-4 for the Monitoring of Advanced Tumors of the Gastrointestinal Tract, Lung, Breast and Ovaries.

BACKGROUND: Cancer antigen CA72-4 is a tumor marker found to be elevated in a variety of human adenocarcinomas. Using the DRG TM-CA72-4, we quantified the elevation of CA72-4 compared to current United States Food And Drug Administration-approved tumor markers in various cancer types. MATERIALS AND METHODS: We conducted a prospective, single-center study enrolling 96 patients between March 2013 and August 2016 with different locally advanced, unresectable or metastatic cancer known to express CA72-4. Quantification of CA72-4 was performed according to the manufacturer's instructions using the DRG TM-CA72-4 enzyme-linked immunosorbent assay kit and the positivity rates were calculated. RESULTS: CA72-4 expression varied with tumoral site of origin, with the highest positivity rates found in pancreatic and ovarian malignancies. Correlation with clinical activity was also noted in some patients. CONCLUSION: CA72-4 may have a potential role as an adjunct to conventional biomarkers in disease monitoring of pancreatic, ovarian and colorectal carcinomas.

Analysis of proto-oncogene and heat-shock protein gene expression in human derived cell-lines exposed in vitro to an intermittent 1.9 GHz pulse-modulated radiofrequency field.

PURPOSE: Several studies have reported that radiofrequency (RF) fields, as emitted by mobile phones, may cause changes in gene expression in cultured human cell-lines. The current study was undertaken to evaluate this possibility in two human-derived immune cell-lines. MATERIALS AND METHODS: HL-60 and Mono-Mac-6 (MM6) cells were individually exposed to intermittent (5 min on, 10 min off) 1.9 GHz pulse-modulated RF fields at a average specific absorption rate (SAR) of 1 and 10 W/kg at 37 +/- 0.5 degrees C for 6 h. Concurrent negative and positive (heat-shock for 1 h at 43 degrees C) controls were conducted with each experiment. Immediately following RF field exposure (T = 6 h) and 18 h post-exposure (T = 24 h), cell pellets were collected from each of the culture dishes and analyzed for transcript levels of proto-oncogenes (c-jun, c-myc and c-fos) and the stress-related genes (heat shock proteins (HSP) HSP27 and HSP70B) by quantitative reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: No significant effects were observed in mRNA expression of HSP27, HSP70, c-jun, c-myc or c-fos between the sham and RF-exposed groups, in either of the two cell-lines. However, the positive (heat-shock) control group displayed a significant elevation in the expression of HSP27, HSP70, c-fos and c-jun in both cell-lines at T = 6 and 24 h, relative to the sham and negative control groups. CONCLUSION: This study found no evidence that exposure of cells to non-thermalizing levels of 1.9 GHz pulse-modulated RF fields can cause any detectable change in stress-related gene expression.