Outcomes after inferior vena cava filter placement in cancer patients diagnosed with pulmonary embolism: risk for recurrent venous thromboembolism.

Venous thromboembolism (VTE) is a common complication in cancer patients and anticoagulation (AC) remains the standard of care for treatment. Inferior vena cava (IVC) filters may also used to reduce the risk of pulmonary embolism, either alone or in addition to AC. Although widely used, data are limited on the safety and efficacy of IVC filters in cancer patients. We performed a retrospective review of outcomes after IVC filter insertion in a database of 1270 consecutive patients with cancer-associated pulmonary embolism (PE) at our institution between 2008 and 2009. Outcomes measured included rate of all recurrent VTE, recurrent PE, and overall survival within 12 months. 317 (25%) of the 1270 patients with PE had IVC filters placed within 30 days of the index PE event or prior to the index PE in the setting of prior DVT. Patients with IVC filters had markedly lower overall survival (7.3 months) than the non-IVC filter patients (13.2 months). Filter patients also had a lower rate of AC use at time of initial PE. There was a trend towards higher recurrent VTE in patients with IVC filters (11.9%) compared to non-filter patients (7.7%), but this was not significant (p = 0.086). The risk of recurrent PE was similar between the IVC filter cohort (3.5%) and non-filter group (3.5%, p = 0.99). Cancer patients receiving IVC filters had a similar risk of recurrent PE, but a trend towards more overall recurrent VTE. The filter patients had poorer overall survival, which may reflect a poorer cancer prognosis, and had greater contraindication to AC; therefore these patients likely had a higher inherent risk for recurrent VTE. A prospective study would be helpful for further clarification on the partial reduction in the recurrent PE risk by IVC filter placement in cancer patients.

Thrombocytopenia and Postpartum Hemorrhage in a Woman with Chromosome 22q11.2 Deletion Syndrome.

Chromosome 22q11.2 deletion syndrome, also known as DiGeorge or velocardiofacial syndrome, is associated with a wide spectrum of phenotypic features. It is known to be associated with severe macrothrombocytopenia. Postpartum hemorrhage is a leading cause of maternal morbidity and mortality globally. Chromosome 22q11.2 deletion syndrome is rare cause of thrombocytopenia that can be a significant risk factor for life-threatening postpartum hemorrhage. We report a case of postpartum hemorrhage in a woman with 22q11.2 deletion syndrome causing severe macrothrombocytopenia.

Malignancies, Particularly B-Cell Lymphomas, Are a Frequent Cause of Mortality in Human Immunodeficiency Virus-1 Patients Despite Highly Active Antiretroviral Therapy.

Human immunodeficiency virus (HIV)-1-infected individuals are affected by diseases at rates above those of their HIV-negative peers despite the increased life expectancy of the highly active antiretroviral therapy era. We followed a cohort of approximately 2000 HIV-1-infected patients for 5 years. The most frequent cause of death in this HIV-1-infected cohort was malignancy, with 39% of all classified deaths due to cancer. Among the cancer deaths, B-cell lymphomas were the most commonly seen malignancy, representing 34% of all cancer deaths. These lymphomas were very aggressive with a median survival of <2 months from time of diagnosis.

The inhibitory effects of silver nanoparticles, silver ions, and silver chloride colloids on microbial growth.

Emerging nanomaterials are of great concern to wastewater treatment utilities and the environment. The inhibitory effects of silver nanoparticles (Ag NPs) and other important Ag species on microbial growth were evaluated using extant respirometry and an automatic microtiter fluorescence assay. Using autotrophic nitrifying organisms from a well-controlled continuously operated bioreactor, Ag NPs (average size=14+/-6 nm), Ag(+) ions (AgNO(3)), and AgCl colloids (average size=0.25 microm), all at 1mg/L Ag, inhibited respiration by 86+/-3%, 42+/-7%, and 46+/-4%, respectively. Based on a prolonged microtiter assay, at about 0.5mg/L Ag, the inhibitions on the growth of Escherichia coli PHL628-gfp by Ag NPs, Ag(+) ions, and AgCl colloids were 55+/-8%, 100%, and 66+/-6%, respectively. Cell membrane integrity was not compromised under the treatment of test Ag species by using a LIVE/DEAD Baclight bacterial viability assay. However, electron micrographs demonstrated that Ag NPs attached to the microbial cells, probably causing cell wall pitting. The results suggest that nitrifying bacteria are especially susceptible to inhibition by Ag NPs, and the accumulation of Ag NPs could have detrimental effects on the microorganisms in wastewater treatment.