To cite this article: Roumen-Klappe EM, Janssen MCH, van Rossum J, Holewijn S, van Bokhoven MMJA, Kaasjager K, Wollersheim H, den Heijer M. Inflammation in deep vein thrombosis and the development of post-thrombotic syndrome: a prospective study. J Thromb Haemost 2009; 7: 582-7.Summary. Background: The aim of this study was to investigate whether inflammatory markers (interleukin-6 [IL-6] and Creactive protein [CRP]) in the acute phase of deep vein thrombosis (DVT) are associated with elevated venous outflow resistance (VOR), thrombosis score (TS), reflux and the development of clinical post-thrombotic syndrome (PTS). Methods: In 110 patients with a first DVT, plasma concentrations of IL-6 and CRP were determined on the day of admission. VOR, TS and reflux were measured 7 days, 1 and 3 months after diagnosis. After 1 year patients were evaluated for PTS using the Clinical, Etiologic, Anatomic and Pathophysiologic (CEAP) classification and Villalta scale. Results: Median levels of IL-6 and CRP were 7 pg mL )1 and 21 mg L )1, respectively. After 3 months, VOR was elevated in 33 patients (30%), TS in 33 (30%) and reflux in 57 (52%). Incidence of PTS was 36.7% using CEAP ‡ 3 and 35.4% using Villalta-scale ‡ 5. Elevated levels of IL-6 and CRP were related to higher outcomes of VOR after 3 months [relative risks (RR) 2.4 (95% CI 1.5-3.9) and 1.4 (1.1-3.3), respectively] and for IL-6 to TS [1.5 (1.1-2.1)]. For reflux no relation was found. After 90 days, elevated outcomes of VOR, TS and reflux were related to PTS after 1 year. The association of IL-6 and CRP with PTS was weak using the CEAP classification with a RR of 1.2 (0.7-2.2) and 1.8 (0.9-3.3) and absent according to the Villalta scale 0.6 (0.2-1.4) and 1.2 (0.6-2.5), respectively. Conclusion: The results of this study suggest that inflammation might play a role in incomplete thrombus clearance, venous outflow obstruction and the development of PTS after 1 year.

Objective The purpose of this randomized study was to evaluate the influence of immediate multilayer compression bandages before application of elastic stockings in the acute phase of deep-vein thrombosis (DVT) on development of the post-thrombotic syndrome (PTS). Methods Sixty-nine patients with acute symptomatic DVT were randomized to immediate bandaging (n = 34) or no bandaging (n = 35). After reduction of edema sized-to-fit elastic stockings were applied in all patients after 7-14 days. Follow-up visits and non-invasive examinations were planned after 7, 30 and 90 days and 1 year. Venous outflow resistance (VOR) was measured by strain gauge plethysmography. Thrombosis score (TS) and reflux were measured by duplex scanning. After one year patients were evaluated for clinical PTS using both the clinical scale of the CEAP classification and the Villalta score. Results Improvement of clinical symptoms and decrease of leg circumference was better on day 7 in the bandaging group, but after 1 and 3 months clinical symptoms had improved equally in both groups. In 7 patients in the no-bandaging group a bandage was applied after all because of persistent edema after 10 days. There were no differences in VOR, TS and reflux. Using the CEAP classification the incidence of PTS was 39% in patients with bandages and 42% in patients without bandages (RR 0.91,. Using the Villalta score the incidence of PTS was resp. 29 and 33% (RR 0.87, 95% CI 0.41-1.8). There was no difference in severity of PTS. Conclusion Immediate multilayer compression bandaging in the acute phase of DVT is effective in reducing edema and complaints in the first week, but has no effect on thrombus regression, valve incompetence and the development of clinical PTS after 1 year.

In a double-blind controlled clinical trial on 51 patients with subarachnoid hemorrhage, tranexamic acid, 4 gm per day for ten consecutive days, did not favorably affect the outcome. Neither mortality nor rebleeding rates were improved after a follow-up of three months.

eer review is the defining feature of scholarly communication. In a 2018 survey of more than 11,000 researchers, 98% said that they considered peer review important or extremely important for ensuring the quality and integrity of scholarly communication 1. Indeed, now that the Internet and social media have assumed journals' original role of dissemination, a journal's main function is curation. Both the public and the scientific community trust peer review to uphold shared values of rigour, ethics, originality and analysis by improving publications and filtering out weak or errant ones. Scholarly communities rely on peer review to establish common knowledge and credit. Despite decades of calls for study, research on peer review is scarce 2. Current investigations are fragmented, with few connections and limited knowledge-sharing, as manifested by how sparsely these researchers cite each other's papers 3. The most rigorous work is generally restricted to one or a few journals per study, often in the same field. There is a lack of systematic research on how journals manage the process (such as selecting, instructing and rewarding reviewers, managing conflicting reviews, or publishing reviewers' reports); on how to define the quality and utility of individual reviews; and on how to assess peer review (such as who

The hypothesis that the chronic tennis-elbow syndrome is caused by an entrapment neuropathy of the radial nerve (Roles and Maudsley 1972) was put to the test prospectively in ten patients. Detailed orthopaedic, neurological and neurophysiologicai examinations did not reveal any involvement of the radial nerve. It is concluded that this syndrome cannot be explained by an entrapment neuropathy.