ABSTRACT
OBJECTIVE: The ADA Study was designed to know the usual action guidelines in Spain for the diagnosis and treatment in a cohort of patients who had a recent atherothrombotic event. PATIENTS AND METHODS: Cross-sectional, observational, multicenter epidemiologic study (294 hospitals) with a total of 3,512 patients enrolled. Patients had had an atherothrombotic event in the coronary or cerebral vascular territory in the previous month or were diagnosed of symptomatic peripheral arterial disease within the last 3 months. A total of 237 investigators (155 cardiologists, 113 neurologists, and 79 vascular surgeons) participated in the study. RESULTS: 54.9% of patients in the study had a previous atherothrombotic event. Of these, 63.1% were on antithrombotic therapy; after the second episode, 2.6% of patients were on no preventive therapy. A great disparity and an excessive number of diagnostic tests was found to confirm the diagnosis of the current atherothrombotic event, which is in contrast with a small percentage of patients who had exams performed to confirm or rule out the atherothrombotic involvement in other vascular territories. CONCLUSIONS: An appropriate protocol should be established for the diagnosis and therapy of patients with the likelihood of having clinical manifestations due to an ahterothrombotic event.
Subject(s)
Coronary Artery Disease/diagnosis , Coronary Artery Disease/drug therapy , Intracranial Thrombosis/diagnosis , Intracranial Thrombosis/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Aged , Comorbidity , Coronary Artery Disease/epidemiology , Cross-Sectional Studies , Female , Humans , Incidence , Intracranial Thrombosis/epidemiology , Male , Spain/epidemiologyABSTRACT
Objetivo. El Estudio ADA se diseñó para conocer las pautas de actuación habituales en España para el diagnóstico y tratamiento en una cohorte de pacientes que han padecido un episodio aterotrombótico reciente. Pacientes y método. Estudio epidemiológico transversal, observacional y multicéntrico (294 hospitales) en el que se incluyeron 3.512 pacientes con un episodio aterotrombótico en territorio vascular coronario o cerebral de hasta un mes de antigüedad o diagnosticados de arteriopatía periférica sintomática durante los tres últimos meses. Participaron 347 investigadores (155 cardiólogos, 113 neurólogos y 79 cirujanos vasculares). Resultados. El 54,9 por ciento de los pacientes incluidos presentaron un episodio aterotrombótico previo, y de éstos, sólo el 63,1 por ciento tomaban medicación antitrombótica; después del segundo episodio el 2,6 por ciento seguía sin recibir tratamiento preventivo. Se comprobó una gran disparidad y excesivo número de pruebas diagnósticas para confirmar el diagnóstico del episodio aterotrombótico actual, lo que contrasta con un exiguo porcentaje de pacientes en los que se realizaron exploraciones para confirmar o descartar la afectación aterotrombótica en otros territorios vasculares. Conclusiones. Es necesario protocolizar adecuadamente el proceso diagnóstico y terapéutico en los pacientes susceptibles de presentar manifestaciones clínicas por un proceso aterotrombótico. (AU)
Subject(s)
Aged , Male , Female , Humans , Spain , Comorbidity , Incidence , Platelet Aggregation Inhibitors , Intracranial Thrombosis , Cross-Sectional Studies , Coronary Artery DiseaseABSTRACT
A steady-state, fully noninductive plasma current has been sustained for the first time in a tokamak using electron cyclotron current drive only. In this discharge, 123 kA of current have been sustained for the entire gyrotron pulse duration of 2 s. Careful distribution across the plasma minor radius of the power deposited from three 0. 5-MW gyrotrons was essential for reaching steady-state conditions. With central current drive, up to 153 kA of current have been fully replaced transiently for 100 ms. The noninductive scenario is confirmed by the ability to recharge the Ohmic transformer. The dependence of the current drive efficiency on the minor radius is also demonstrated.
ABSTRACT
BACKGROUND: Clinical and pharmacokinetic data suggest that very low doses of subcutaneous recombinant human erythropoietin (rHuEPO) may be effective in a preoperative autologous blood deposit program. STUDY DESIGN AND METHODS: Fifty-two patients, scheduled for orthopedic surgery, were enrolled in a double-blind and placebo-controlled study. Patients were randomly assigned to the placebo group or to receive 30, 60, or 100 IU per kg of rHuEPO subcutaneously twice a week for 2 weeks before surgery. The dose of rHuEPO that was effective in facilitating the collection of 4 units of blood in the 2 weeks before surgery and that prevented a sharp decrease in hematocrit was determined. RESULTS: Only in patients receiving 100 IU per kg of rHuEPO did the outcome measurements differ significantly from those in the placebo group. With a higher (p < 0.01) cumulative increase in red cell volume during the study period (297 +/- 127 vs. 121 +/- 44 mL), 64 percent of those receiving 100 IU per kg of rHuEPO were able to donate 4 units of blood for autologous use, as compared with 23 percent of the placebo group (p < 0.05). Allogeneic transfusion was avoided, and the preoperative hematocrit and reticulocyte count were significantly higher in the patients receiving 100 IU per kg of rHuEPO (p < 0.05 and p < 0.01, respectively). CONCLUSION: Subcutaneously administered rHuEPO at a dose of 100 IU per kg twice a week for 2 weeks is effective in facilitating the collection of blood for autologous use and may improve the cost-benefit ratio of blood conservation interventions. Doses < or = 60 IU per kg are ineffective in facilitating such collections in this surgical setting.
