Efficacy of ultrasound assisted catheter-directed thrombolysis compared to catheter-directed thrombolysis in vitro.

BACKGROUND: Catheter-directed thrombolysis (CDT) is an effective and safe endovascular method used in critical limb ischemia and many other thromboembolic events. Ultrasound-assisted catheter-directed thrombolysis (US-CDT) is an emerging technique considered to accelerate thrombolysis and therefore is supposed to improve outcome. PURPOSE: To evaluate the efficacy of US-CDT in comparison to standard CDT in vitro. MATERIAL AND METHODS: A total of 69 sets of human venous blood were evaluated, each comprising a tube just treated with CDT, a tube treated with US-CDT, and a control tube. All tubes were kept under physiological conditions. Except for the controls, in all tubes 5 mg of tissue-type plasminogen activator was administered over the predetermined treatment interval. Thrombus mass was weighted at the end of the lysis intervals at 6 h or 24 h, respectively. RESULTS: CDT led to a mean thrombus reduction of 32% and ultrasound-assisted lysis led to a mean thrombus reduction of 41% (P < 0.001 for both). Thrombus reduction was significantly higher after US-CDT compared to CDT (P = 0.001). The better efficacy of US-CDT was mostly already apparent at early phases during thrombolysis and did further mildly increase over time (r = 0.24; P = 0.047). CONCLUSION: In vitro US-CDT is significantly superior to standard CDT; this effect is apparent at an early timepoint of lysis and slightly further increases over time.

Psychometric properties of three single-item pain scales in patients with rheumatoid arthritis seen during routine clinical care: a comparative perspective on construct validity, reproducibility and internal responsiveness.

OBJECTIVE: To investigate the construct validity, reproducibility (ie, retest reliability) and internal responsiveness to treatment change of common single-item scales measuring overall pain in patients with rheumatoid arthritis (RA) and to investigate the corresponding effect of common pain-related comorbidities and medical consultation on these outcomes. METHODS: 236 patients with RA completed a set of questionnaires including a visual analogue scale (VAS), a numerical rating scale (NRS) and a verbal rating scale (VRS) measuring overall pain before and immediately after routine medical consultation as well as 1 week after the patient's visit. Construct validity and retest reliability were evaluated using the Bravais-Pearson correlation while standardised response means (SRM) were calculated for evaluating internal responsiveness. Differences in the perception of pain were calculated using dependent samples t-tests. RESULTS: In the total sample, construct validity was good across all three time points (convergent validity of pain scales: rT1-T3=0.82-0.92, p<0.001; discriminant validity as correlation of pain scales with age: rage=0.01-0.16, p>0.05). In patients maintaining antirheumatic treatment, retest reliability of pain scales was confirmed for all scales and across time points (rVAS=0.82-0.95, rNRS=0.89-0.98, rVRS=0.80-0.90, p<0.001), while the internal responsiveness of scales to a change in treatment was low across all scales (SRM=0.08-0.21). The VAS especially suggested a change in pain perception after medical consultation in patients maintaining therapy. CONCLUSIONS: The VAS, NRS and VRS are valid and retest reliable in an outpatient clinical practice setting. The low pain scales' internal responsiveness to treatment change is likely to be due to the short follow-up period. Patients with RA maintaining antirheumatic therapy seem to experience less pain after medical consultation.