BACKGROUND Early renal artery thrombosis after kidney transplantation is rare but often leads to graft loss.Prompt diagnosis and intervention are essential,particularly in patients with inherited thrombophilias such a...BACKGROUND Early renal artery thrombosis after kidney transplantation is rare but often leads to graft loss.Prompt diagnosis and intervention are essential,particularly in patients with inherited thrombophilias such as factor V Leiden(FVL)mutation.CASE SUMMARY A kidney transplant recipient with FVL mutation developed an acute transplant renal artery thrombosis.The immediate post-operative Doppler ultrasonography revealed thrombosis of the main and inferior polar renal arteries.Emergent thrombectomy and separate arterial re-anastomoses were performed after cold perfusion with heparinized saline and vasodilator solution.Reperfusion was successful with immediate urine output and gradual improvement in renal function.The patient was discharged on direct oral anticoagulation therapy.CONCLUSION Early detection and surgical intervention can preserve graft function in posttransplant renal artery thrombosis even in patients at high risk.展开更多
Purpose:To evaluate the effects of healthcare failure mode and effect analysis(FMEA)on the prevention of deep venous thrombosis(DVT)in elderly patients undergoing femoral fracture surgery.Methods:Eighty elderly patien...Purpose:To evaluate the effects of healthcare failure mode and effect analysis(FMEA)on the prevention of deep venous thrombosis(DVT)in elderly patients undergoing femoral fracture surgery.Methods:Eighty elderly patients undergoing femoral fracture surgery who did not apply FMEA in Suzhou BenQ Medical Center from June 1,2022 to May 31,2023 were selected as the control group.According to the equal group experiment method,80 elderly patients who were managed using FMEA from June 1,2023 to May 31,2024 were selected as the FMEA group.The control group received traditional nursing management,while the FMEA group applied FMEA to analyze failure causes,calculate Risk Priority Numbers(RPNs),identify failure modes with higher RPNs,analyze the influencing factors,develop improvement measures,and optimize processes.The RPN values and the incidence of DVT,as well as nursing satisfaction scores,were compared in the two groups.Results:Compared with the control group,the total RPN values of the FEMA group decreased significantly,with a reduction rate of 87.0%.Besides,the incidence of DVT was 1.3%in the FMEA group,lower than 10.0%in the control group(8/80).What’s more,the patients in the FMEA group were more satisfied with the nursing service compared with the patients in the control group.Conclusion:The application of the FMEA in elderly patients undergoing femoral fracture surgery has demonstrated its potential to prevent the incidence of DVT,lower RPN values,and improve nursing satisfaction.展开更多
Non-tumoral portal vein thrombosis(PVT)is a frequent and challenging complication in liver transplant candidates.The prevalence reaches up to 26%in patients with cirrhosis on a transplant waiting list.Its severity inc...Non-tumoral portal vein thrombosis(PVT)is a frequent and challenging complication in liver transplant candidates.The prevalence reaches up to 26%in patients with cirrhosis on a transplant waiting list.Its severity increases with liver disease progression and significantly impacts post-transplant outcomes.Advanced PVT increases postoperative mortality to 30%.Effective management requires a multidisciplinary approach,especially in advanced cases.Preoperative strategies emphasize anticoagulation with low molecular weight heparin,while interventional radiology,including transjugular intrahepatic portosystemic shunts,offers alternatives in some cases.Intraoperatively,management is guided by PVT classification systems,ranging from thrombectomy and portal vein reconstruction to non-physiological reconstructions in complex cases.This manuscript explores the management of PVT in liver transplantation candidates,discusses strategies to optimize outcomes,and presents our institutional protocol for addressing this high-risk condition.展开更多
AIM: To evaluate the predictive value of D-dimer as a predictive indicator of portal vein thrombosis (PVT) after portal hypertension surgery in hepatitis B virus-related cirrhosis. METHODS: A prospective study was car...AIM: To evaluate the predictive value of D-dimer as a predictive indicator of portal vein thrombosis (PVT) after portal hypertension surgery in hepatitis B virus-related cirrhosis. METHODS: A prospective study was carried out in 52 patients who had undergone surgery for portal hypertension in hepatitis B virus-related cirrhosis. Changes in perioperative dynamic D-dimer were observed. The sensitivity, specifi city, positive predictive values and negative predictive values of D-dimer were calculated, and ROC curves were analyzed. RESULTS: The D-dimer levels in the group developing postoperative PVT was signifi cantly higher than those in the group not developing PVT (P = 0.001), and the ROC semi-quantitative and qualitative analysis of D-dimer showed a moderate predictive value in PVT (semi- quantitative value Az = 0.794, P = 0.000; qualitative analysis: Az = 0.739, P = 0.001). CONCLUSION: Dynamic monitoring of D-dimer levels in patients with portal hypertension after surgery can help early diagnosis of PVT, as in cases where the D-dimer levels steadily increase and exceed 16 μg/mL, the possibility of PVT is very high.展开更多
Purpose:To reduce the incidence of deep venous thrombosis(DVT)with nursing intervention based on the Autar DVT risk assessment scale among orthopaedic surgery patients.Methods:We recruited 216 orthopaedic surgery pati...Purpose:To reduce the incidence of deep venous thrombosis(DVT)with nursing intervention based on the Autar DVT risk assessment scale among orthopaedic surgery patients.Methods:We recruited 216 orthopaedic surgery patients at our hospital between September 2013 and March 2014.The patients were assigned to intervention and historical control groups based on the time of admission.Using the Autar DVT risk assessment scale,we assessed the DVT risk levels in both groups;the intervention group received the corresponding prophylactic measures while the control group received routine nursing.Results:The DVT incidence rate and the D-dimer level on postoperative day 3 in the intervention group were lower(1.82%;623±225 mg/L,respectively)than that of the control group(9.43%;825±201 mg/L,respectively);both differences were statistically significant(p<0.05).Conclusions:The Autar scale is beneficial when used in orthopaedic surgery patients;corresponding nursing intervention based on Autar scale assessment can prevent DVT effectively.展开更多
OBJECTIVE:To compare the effects of electrical stimulation of different acupoint combinations among postoperative bedridden elderly patients on hemorheology and deep venous blood flow velocity and investigate the role...OBJECTIVE:To compare the effects of electrical stimulation of different acupoint combinations among postoperative bedridden elderly patients on hemorheology and deep venous blood flow velocity and investigate the role of electrical stimulation against deep vein thrombosis(DVT).METHODS:From November 2010 to October 2011,a total of 160 elderly bedridden patients after major surgery were divided into the conventional care group,invigorating and promoting Qi group,blood-activating and damp-eliminating group,and acupoint-combination stimulation group.Whole blood viscosity,plasma viscosity,D-dimer levels,lower limb skin temperature,lower limb circumference,and flow velocities of the external iliac vein,femoral vein,popliteal vein,and deep calf veins in all patients were documented and compared among the four groups.RESULTS:Whole blood viscosity,plasma viscosity,D-dimer levels,and lower limb circumference were significantly reduced in the blood-activating and damp-eliminating group compared with the conventional care group(P<0.05) and were almost equal to those in the acupoint-combination stimulation group(P>0.05).Lower limb venous flow velocities were accelerated in the invigorating and promoting Qi group compared with the other groups,excluding the acupoint-combination stimulation group(P<0.05).CONCLUSION:Hemorheological indices in postoperative bedridden elderly patients were improved after combined electrical stimulation at Yinlingquan(SP 9) and Sanyinjiao(SP 6).Combined electrical stimulation at Zusanli(ST 36) and Taichong(LR 3),on the other hand,accelerated lower limb venous flow.展开更多
BACKGROUND Cerebral venous sinus thrombosis(CVST)is a rare condition in patients with craniopharyngioma following transsphenoidal surgery.CASE SUMMARY A 56-year-old man who underwent transsphenoidal surgery for cranio...BACKGROUND Cerebral venous sinus thrombosis(CVST)is a rare condition in patients with craniopharyngioma following transsphenoidal surgery.CASE SUMMARY A 56-year-old man who underwent transsphenoidal surgery for craniopharyngioma 26 d ago presented gradual headache and cerebrospinal fluid leakage while vomiting 5 d post-discharge and required readmission to our department of neurosurgery.After admission,head imaging examination showed a hyperdense shadow in the superior sagittal sinus and right transverse sinus,edema at the bilateral parietal lobe,and hemorrhage at the left parietal lobe and right occipital lobe;the venous phase of cerebral angiography revealed CVST.The patient was treated immediately by intravenous thrombolysis,endovascular thrombolysis,and mechanical thrombectomy after the definite diagnosis.However,the neurological status of the patient continued to deteriorate and he died on the fourth day after readmission.CONCLUSION For craniopharyngioma undergoing transsphenoidal surgery,it is vital to take an effective strategy to manage the postoperative complications,such as diabetes insipidus,severe electrolyte imbalance,and cerebrospinal fluid leakage.Additionally,the early differential diagnosis of CVST is essential when it develops clinical symptoms,especially in patients following transsphenoidal surgery with a high risk of CVST.Subsequently,the timely and effective treatment of the CVST is critical for preventing neurological deterioration.展开更多
The present study aims to review the evolution of surgical management of portal(PVT) and splanch-nic venous thrombosis(SVT) in the context of liver transplantation over the last 5 decades. PVT is more commonly managed...The present study aims to review the evolution of surgical management of portal(PVT) and splanch-nic venous thrombosis(SVT) in the context of liver transplantation over the last 5 decades. PVT is more commonly managed by endovenous thrombectomy, while SVT requires more complex technical expedients. Several surgical techniques have been proposed, such as extensive eversion thrombectomy, anastomosis to collateral veins, reno-portal anastomosis, cavo-portal hemi-transposition, portal arterialization and combined liver-intestinal transplantation. In order to achieve satisfactory outcomes, careful planning of the surgical strategy is mandatory. The excellent results that are ob-tained nowadays confirm that, even extended, splanch-nic thrombosis is no longer an absolute contraindication for liver transplantation. Patients with advanced portal thrombosis may preferentially be referred to specialized centres, in which complex vascular approaches and even multivisceral transplantation are performed.展开更多
BACKGROUND Long-term chemotherapy for patients with gastric cancer(GC),facilitated by peripherally inserted central catheter(PICC)catheterization,reduces vascular damage and enhances drug delivery efficiency but carri...BACKGROUND Long-term chemotherapy for patients with gastric cancer(GC),facilitated by peripherally inserted central catheter(PICC)catheterization,reduces vascular damage and enhances drug delivery efficiency but carries risks of catheter-related complications.A combination of group psychological nursing and physical mo-vement care significantly mitigates the risk of venous thrombosis and improves psychological well-being,and enhances motor function,underscoring its clinical importance.AIM To assess group psychological and physical movement nursing in preventing venous thrombosis in patients with PICC GC.METHODS Sixty-five GC patients with PICC,admitted from January 2022 to January 2023,were randomly divided into two groups using the lottery method:A control group(n=35,routine nursing)and an observation group(n=30,routine nursing plus psychological nursing and physical movement nursing).Both groups re-ceived continuous care for 2 weeks.Pre-nursing and post-nursing data on psycho-logical state,physical function,chemotherapy-related thrombosis incidence,and cancer-related fatigue were analyzed using SPSS 26.0 and GraphPad Prism 8.0.RESULTS After nursing,both groups showed reduced Hamilton Anxiety Scale scores and increased General Perceived Self-Efficacy Scale scores,with the observation group performing better(P<0.05).The Functional Comprehensive Assessment score for the observation group after nursing was(65.42±2.35)points,lower than the control group’s(62.19±4.33)points(P<0.05).Although no significant difference was observed in the incidence of venous thrombosis between the two groups(χ2=0.815,P=0.367),the observation group had lower incidence.Both groups showed decreased Revised Piper Fatigue Scale scores,with the observation group scoring lower(P<0.05).CONCLUSION Group psychological and physical movement nursing for patients with PICC reduces venous thrombosis risk,improves psychological well-being,cancer-related fatigue,and physical function,making it highly promotable.展开更多
Portal vein thrombosis(PVT)is no longer a definitive contraindication in liver transplants(LTs)[1].Complex vascular reconstructions such as cavoportal hemitransposition(CPHT)[2–5],renoportal anastomosis(RPA)[6,7],and...Portal vein thrombosis(PVT)is no longer a definitive contraindication in liver transplants(LTs)[1].Complex vascular reconstructions such as cavoportal hemitransposition(CPHT)[2–5],renoportal anastomosis(RPA)[6,7],and use of sizable collaterals(pericholedochal varix[8,9],coronary vein,peripancreatic or perigastroesophageal varices[10],right superior colic vein[11],ileocolic vein[12],and left gastric vein[13]),or combined liverpancreas-small bowel transplant[14]are required for portal inflow in patients with total portosplenomesenteric thrombosis.展开更多
BACKGROUND Upper limb venous thrombosis(ULVT)is rarer than lower-extremity deep venous thrombosis,and is related to Paget-Schroetter syndrome,central venous catheterization,and malignancy.There are few reports of pulm...BACKGROUND Upper limb venous thrombosis(ULVT)is rarer than lower-extremity deep venous thrombosis,and is related to Paget-Schroetter syndrome,central venous catheterization,and malignancy.There are few reports of pulmonary embolism(PE)from upper-extremity vein thrombosis due to surgery.Herein,we report two cases of PE that originated from upper limb venous thrombosis on the surgical side in two patients undergoing modified radical mastectomy for breast cancer.These cases challenge the traditional theory that PE originate only from the lower extremities.CASE SUMMARY We describe two female patients,aged 68 and 65 years,respectively,who had undergone modified radical mastectomy for breast cancer.They did not have a central venous catheter and did not undergo preoperative neoadjuvant chemotherapy.They were transferred to the intensive care unit due to symptomatic PE on the first day after surgery.Colour Doppler ultrasound identified fresh thrombosis in their upper limb veins,which was the presumed source of the PE.They all received anticoagulation therapy,and one of them experienced bleeding that required discontinuation of the drug.Ultimately,they were discharged in stable condition.CONCLUSION ULVT as a source of PE after breast cancer surgery cannot be ignored.展开更多
BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the c...BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.展开更多
BACKGROUND Ovarian vein thrombosis(OVT)is a rare condition that most commonly affects postpartum women.It is particularly prevalent in the first 10 days postpartum,a period when women are more prone to developing this...BACKGROUND Ovarian vein thrombosis(OVT)is a rare condition that most commonly affects postpartum women.It is particularly prevalent in the first 10 days postpartum,a period when women are more prone to developing this condition.The right ovarian vein is often affected due to its tortuous nature and less competent valves.OVT presents similarly to acute abdominal conditions,such as acute appendicitis,especially when the right ovarian vein is involved.Given the overlap in clinical presentation,diagnosis requires high-quality imaging techniques and a high degree of suspicion.CASE SUMMARY Herein,we report a rare case of OVT in a young postpartum female who presented to the emergency department with signs and symptoms of acute abdomen.The patient had a history of pulmonary tuberculosis treatment.A provisional diagnosis of a perforated appendix was made,and a lower midline exploratory laparotomy was planned.During surgery,the appendix and inte-stines appeared normal,but a distended and thrombosed right ovarian vein was found.The affected ovarian vein was excised,and the patient was placed on anti-coagulants postoperatively.The recovery was unremarkable,and anticoagulants were continued for six months.CONCLUSION OVT is most commonly seen in the early postpartum period,especially within the first 10 days.Due to its anatomical characteristics,the right ovarian vein is more commonly involved.The clinical presentation of OVT can closely mimic acute abdomen or acute appendicitis,making diagnosis challenging.Accurate diagnosis requires a high index of suspicion and advanced imaging techniques to differentiate OVT from other conditions with similar presentations.展开更多
A 53 year old male presented to his local doctor with an acute knee injury,limited knee movement and a haemoarthrosis.Patient did not have calf tenderness or clinical suspicion for deep vein thrombosis(DVT).He was ref...A 53 year old male presented to his local doctor with an acute knee injury,limited knee movement and a haemoarthrosis.Patient did not have calf tenderness or clinical suspicion for deep vein thrombosis(DVT).He was referred for a routine acute knee magnetic resonance imaging(MRI)scan.This MRI demonstrated a full thickness anterior cruciate ligament tear with additional findings,of a probable incidental DVT.The relevant MRI findings suggestive of DVT in this case included perivascular edema and expanded caliber of the involved medial gastronomical veins on the axial proton density fat suppressed sequence(Figure 1).展开更多
Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and mo...Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and modalities of the interventions and deciding,where possible,to realize them in a single session.Here we describe the case of a patient affected by severe aortic stenosis and associated cardiac comorbidities(coronary artery disease,atrial fibrillation and left appendage thrombosis)that needed a multimodal clinical and interventional strategy to lead him to the best clinical condition for performing transcatheter aortic valve implantation(TAVI).展开更多
Objective:To explore the effect of evidence-based care on lower-limb thrombosis and negative emotions following hip arthroplasty.Methods:A total of 108 patients undergoing hip arthroplasty at our hospital were randoml...Objective:To explore the effect of evidence-based care on lower-limb thrombosis and negative emotions following hip arthroplasty.Methods:A total of 108 patients undergoing hip arthroplasty at our hospital were randomly assigned to the observation group(n=54,evidence-based care)and the control group(n=54,conventional care).Postoperative complications,negative emotions,quality of life,activities of daily living,and patient satisfaction were compared between the two groups.Results:The observation group had a lower incidence of lower-limb thrombosis and overall complications,as well as higher patient satisfaction than the control group(all P<0.05).One month after discharge,patients in the observation group showed significantly lower scores on the Hamilton Anxiety Scale,the Hamilton Depression Scale,and activities of daily living scale,but with increased Generic Quality of Life Inventory-74 scores,compared with before intervention(all P<0.05).Conclusion:Evidence-based care significantly relieves anxiety and depression,reduces the incidence of lower-limb thrombosis,and improves quality of life in patients after hip arthroplasty.展开更多
BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated ...BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated with PH-PVT.METHODS Medical records of patients who underwent hepatic resection for various diseases between February 2014 and December 2023 at Beijing Tsinghua Changgung Hospital affiliated with Tsinghua University(Beijing,China)were retrospectively reviewed.The patients were divided into a PH-PVT group and a non-PH-PVT group.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PH-PVT.RESULTS A total of 1064 patients were included in the study cohort,and the incidence and mortality rates of PH-PVT were 3.9%and 35.7%,respectively.The median time from hepatectomy to the diagnosis of PH-PVT was 6 days.Multivariate analysis revealed that hepatectomy combined with pancreaticoduodenectomy(HPD)[odds ratio(OR)=7.627(1.390-41.842),P=0.019],portal vein reconstruction[OR=6.119(2.636-14.203),P<0.001]and a postoperative portal vein angle<100°[OR=2.457(1.131-5.348),P=0.023]were independent risk factors for PH-PVT.Age≥60 years[OR=8.688(1.774-42.539),P=0.008]and portal vein reconstruction[OR=6.182(1.246-30.687),P=0.026]were independent risk factors for mortality in PH-PVT patients.CONCLUSION Portal vein reconstruction,a postoperative portal vein angle<100°and HPD were independent risk factors for PHPVT.Age≥60 years and portal vein reconstruction were independent risk factors for mortality in PH-PVT patients.展开更多
Objective:To explore the molecular mechanism of tissue factor-positive microparticles(TF-MPs)expression and deep venous thrombosis(DVT)in patients with cervical cancer.Methods:A total of 200 patients with cervical can...Objective:To explore the molecular mechanism of tissue factor-positive microparticles(TF-MPs)expression and deep venous thrombosis(DVT)in patients with cervical cancer.Methods:A total of 200 patients with cervical cancer and benign cervical diseases who were hospitalized in the First Department of Gynecologic Oncology of Gansu Provincial Cancer Hospital from January 2024 to December 2025 were selected,including 100 patients with benign cervical diseases as the control group and 100 patients with cervical cancer as the experimental group.Enzyme-linked immunosorbent assay(ELISA)was used to detect the expression level of TF-MPs in peripheral blood samples from patients with cervical cancer and healthy controls.At the same time,real-time quantitative PCR was used to explore the molecular mechanism of TF-MPs promoting DVT formation.Finally,the formation of DVT in the two groups was observed and recorded,and the incidence of DVT was counted.Results:Experimental measurements showed that the expression levels of TF-MPs,coagulation factors FVII,FX,PT,and inflammatory factors IL-6 and TNF-a in the experimental group were significantly higher than those in the control group(P<0.01);the incidence of DVT in the experimental group was up to 38%,far exceeding the 6%in the control group(P<0.001).Conclusion:Abnormal expression of TF-MPs in patients with cervical cancer is an important risk factor for DVT.Through in-depth analysis of the molecular mechanism of TF-MPs promoting DVT formation,it provides a new perspective and theoretical basis for the prevention and treatment of DVT in patients with cervical cancer.In the future,intervention strategies targeting TF-MPs and their related molecular pathways are expected to become effective ways to reduce the incidence of DVT in patients with cervical cancer.展开更多
BACKGROUND The portal vein thrombosis(PVT)can exacerbate portal hypertension and lead to complications,increasing the risk of mortality.AIM To evaluate the predictive capacity of artificial neural networks(ANNs)in qua...BACKGROUND The portal vein thrombosis(PVT)can exacerbate portal hypertension and lead to complications,increasing the risk of mortality.AIM To evaluate the predictive capacity of artificial neural networks(ANNs)in quan-tifying the likelihood of developing PVT in individuals afflicted with hepatitis B-induced cirrhosis.METHODS A retrospective study was conducted at Beijing Ditan Hospital,affiliated with Capital Medical University,including 986 hospitalized patients.Patients admitted between January 2011 and December 2014 were assigned to the training set(685 cases),while those hospitalized from January 2015 to December 2016 were divided into the validation cohort(301 cases).Independent risk factors for PVT were identified using COX univariate analysis and used to construct an ANN model.Model performance was evaluated through metrics such as the area under the receiver operating characteristic curve(AUC)and concordance index.RESULTS In the training set,PVT occurred in 19.0%of patients within three years and 23.7%within five years.In the validation cohort,PVT developed in 16.7%of patients within three years and 24.0%within five years.The ANN model incorporated nine independent risk factors:Age,ascites,hepatic encephalopathy,gastrointestinal varices with bleeding,Child-Pugh classification,alanine aminotransferase levels,albumin levels,neutrophil-to-lymphocyte ratio,and platelet.The model achieved an AUC of 0.967(95%CI:0.960–0.974)at three years and 0.975(95%CI:0.955–0.992)at five years,significantly outperforming existing models such as model for end-stage liver disease and Child-Pugh-Turcotte(all P<0.001).CONCLUSION The ANN model demonstrated effective stratification of patients into high-and low-risk groups for PVT deve-lopment over three and five years.Validation in an independent cohort confirmed the model's predictive accuracy.展开更多
Objective:To systematically evaluate prediction models for postoperative deep vein thrombosis(DVT)in elderly hip fracture patients and assess their methodological quality and predictive performance.Methods:Following P...Objective:To systematically evaluate prediction models for postoperative deep vein thrombosis(DVT)in elderly hip fracture patients and assess their methodological quality and predictive performance.Methods:Following PRISMA guidelines,we searched eight databases(PubMed,Embase,Cochrane Library,Web of Science,CINAHL,CNKI,Wanfang,VIP)from inception to May 2025.Studies developing or validating DVT prediction models in elderly hip fracture patients were included.Two reviewers independently screened studies,extracted data,and assessed risk of bias and applicability using the PROBAST tool.Results:Eleven studies were included,all conducted in China between 2021 and 2025.Sample sizes ranged from 101 to 504 patients(total n=3,286).Models incorporated 3 to 9 predictors,with D-dimer,age,and time from injury to surgery being most common.All 11 studies(100%)were rated as high risk of bias,primarily due to small sample sizes,lack of validation,and inadequate missing data handling.Applicability concerns were low in 8 studies(72.7%).AUC values ranged from 0.648 to 0.967,with 10 studies(90.9%)reporting AUC>0.7.Meta-analysis identified time from injury to surgery(OR=4.63,95%CI:2.58–6.68),age(OR=1.99),D-dimer(OR=1.51),and Caprini score(OR=1.75)as significant predictors.Conclusion:Current DVT prediction models for elderly hip fracture patients demonstrate acceptable discrimination but are limited by high risk of bias and lack of external validation.Prospective,multicenter studies with rigorous validation are needed to develop clinically applicable models.展开更多
文摘BACKGROUND Early renal artery thrombosis after kidney transplantation is rare but often leads to graft loss.Prompt diagnosis and intervention are essential,particularly in patients with inherited thrombophilias such as factor V Leiden(FVL)mutation.CASE SUMMARY A kidney transplant recipient with FVL mutation developed an acute transplant renal artery thrombosis.The immediate post-operative Doppler ultrasonography revealed thrombosis of the main and inferior polar renal arteries.Emergent thrombectomy and separate arterial re-anastomoses were performed after cold perfusion with heparinized saline and vasodilator solution.Reperfusion was successful with immediate urine output and gradual improvement in renal function.The patient was discharged on direct oral anticoagulation therapy.CONCLUSION Early detection and surgical intervention can preserve graft function in posttransplant renal artery thrombosis even in patients at high risk.
文摘Purpose:To evaluate the effects of healthcare failure mode and effect analysis(FMEA)on the prevention of deep venous thrombosis(DVT)in elderly patients undergoing femoral fracture surgery.Methods:Eighty elderly patients undergoing femoral fracture surgery who did not apply FMEA in Suzhou BenQ Medical Center from June 1,2022 to May 31,2023 were selected as the control group.According to the equal group experiment method,80 elderly patients who were managed using FMEA from June 1,2023 to May 31,2024 were selected as the FMEA group.The control group received traditional nursing management,while the FMEA group applied FMEA to analyze failure causes,calculate Risk Priority Numbers(RPNs),identify failure modes with higher RPNs,analyze the influencing factors,develop improvement measures,and optimize processes.The RPN values and the incidence of DVT,as well as nursing satisfaction scores,were compared in the two groups.Results:Compared with the control group,the total RPN values of the FEMA group decreased significantly,with a reduction rate of 87.0%.Besides,the incidence of DVT was 1.3%in the FMEA group,lower than 10.0%in the control group(8/80).What’s more,the patients in the FMEA group were more satisfied with the nursing service compared with the patients in the control group.Conclusion:The application of the FMEA in elderly patients undergoing femoral fracture surgery has demonstrated its potential to prevent the incidence of DVT,lower RPN values,and improve nursing satisfaction.
文摘Non-tumoral portal vein thrombosis(PVT)is a frequent and challenging complication in liver transplant candidates.The prevalence reaches up to 26%in patients with cirrhosis on a transplant waiting list.Its severity increases with liver disease progression and significantly impacts post-transplant outcomes.Advanced PVT increases postoperative mortality to 30%.Effective management requires a multidisciplinary approach,especially in advanced cases.Preoperative strategies emphasize anticoagulation with low molecular weight heparin,while interventional radiology,including transjugular intrahepatic portosystemic shunts,offers alternatives in some cases.Intraoperatively,management is guided by PVT classification systems,ranging from thrombectomy and portal vein reconstruction to non-physiological reconstructions in complex cases.This manuscript explores the management of PVT in liver transplantation candidates,discusses strategies to optimize outcomes,and presents our institutional protocol for addressing this high-risk condition.
基金Supported by Technology Support Fund of Guangdong Province, No. 2004B35001007
文摘AIM: To evaluate the predictive value of D-dimer as a predictive indicator of portal vein thrombosis (PVT) after portal hypertension surgery in hepatitis B virus-related cirrhosis. METHODS: A prospective study was carried out in 52 patients who had undergone surgery for portal hypertension in hepatitis B virus-related cirrhosis. Changes in perioperative dynamic D-dimer were observed. The sensitivity, specifi city, positive predictive values and negative predictive values of D-dimer were calculated, and ROC curves were analyzed. RESULTS: The D-dimer levels in the group developing postoperative PVT was signifi cantly higher than those in the group not developing PVT (P = 0.001), and the ROC semi-quantitative and qualitative analysis of D-dimer showed a moderate predictive value in PVT (semi- quantitative value Az = 0.794, P = 0.000; qualitative analysis: Az = 0.739, P = 0.001). CONCLUSION: Dynamic monitoring of D-dimer levels in patients with portal hypertension after surgery can help early diagnosis of PVT, as in cases where the D-dimer levels steadily increase and exceed 16 μg/mL, the possibility of PVT is very high.
基金This study was supported by Basic research project from Department of Science in Henan Province,China(Project No.132300410070).
文摘Purpose:To reduce the incidence of deep venous thrombosis(DVT)with nursing intervention based on the Autar DVT risk assessment scale among orthopaedic surgery patients.Methods:We recruited 216 orthopaedic surgery patients at our hospital between September 2013 and March 2014.The patients were assigned to intervention and historical control groups based on the time of admission.Using the Autar DVT risk assessment scale,we assessed the DVT risk levels in both groups;the intervention group received the corresponding prophylactic measures while the control group received routine nursing.Results:The DVT incidence rate and the D-dimer level on postoperative day 3 in the intervention group were lower(1.82%;623±225 mg/L,respectively)than that of the control group(9.43%;825±201 mg/L,respectively);both differences were statistically significant(p<0.05).Conclusions:The Autar scale is beneficial when used in orthopaedic surgery patients;corresponding nursing intervention based on Autar scale assessment can prevent DVT effectively.
基金Supported by the Construct Program of the Key Discipline of State Administration of Traditional Chinese Medicine of the People's Republic of China and by the Science and Technology Development Fund of the Shanghai Municipal Public Health Bureau (No. 2011Y200,2008Y127,and 2005L019A)
文摘OBJECTIVE:To compare the effects of electrical stimulation of different acupoint combinations among postoperative bedridden elderly patients on hemorheology and deep venous blood flow velocity and investigate the role of electrical stimulation against deep vein thrombosis(DVT).METHODS:From November 2010 to October 2011,a total of 160 elderly bedridden patients after major surgery were divided into the conventional care group,invigorating and promoting Qi group,blood-activating and damp-eliminating group,and acupoint-combination stimulation group.Whole blood viscosity,plasma viscosity,D-dimer levels,lower limb skin temperature,lower limb circumference,and flow velocities of the external iliac vein,femoral vein,popliteal vein,and deep calf veins in all patients were documented and compared among the four groups.RESULTS:Whole blood viscosity,plasma viscosity,D-dimer levels,and lower limb circumference were significantly reduced in the blood-activating and damp-eliminating group compared with the conventional care group(P<0.05) and were almost equal to those in the acupoint-combination stimulation group(P>0.05).Lower limb venous flow velocities were accelerated in the invigorating and promoting Qi group compared with the other groups,excluding the acupoint-combination stimulation group(P<0.05).CONCLUSION:Hemorheological indices in postoperative bedridden elderly patients were improved after combined electrical stimulation at Yinlingquan(SP 9) and Sanyinjiao(SP 6).Combined electrical stimulation at Zusanli(ST 36) and Taichong(LR 3),on the other hand,accelerated lower limb venous flow.
文摘BACKGROUND Cerebral venous sinus thrombosis(CVST)is a rare condition in patients with craniopharyngioma following transsphenoidal surgery.CASE SUMMARY A 56-year-old man who underwent transsphenoidal surgery for craniopharyngioma 26 d ago presented gradual headache and cerebrospinal fluid leakage while vomiting 5 d post-discharge and required readmission to our department of neurosurgery.After admission,head imaging examination showed a hyperdense shadow in the superior sagittal sinus and right transverse sinus,edema at the bilateral parietal lobe,and hemorrhage at the left parietal lobe and right occipital lobe;the venous phase of cerebral angiography revealed CVST.The patient was treated immediately by intravenous thrombolysis,endovascular thrombolysis,and mechanical thrombectomy after the definite diagnosis.However,the neurological status of the patient continued to deteriorate and he died on the fourth day after readmission.CONCLUSION For craniopharyngioma undergoing transsphenoidal surgery,it is vital to take an effective strategy to manage the postoperative complications,such as diabetes insipidus,severe electrolyte imbalance,and cerebrospinal fluid leakage.Additionally,the early differential diagnosis of CVST is essential when it develops clinical symptoms,especially in patients following transsphenoidal surgery with a high risk of CVST.Subsequently,the timely and effective treatment of the CVST is critical for preventing neurological deterioration.
文摘The present study aims to review the evolution of surgical management of portal(PVT) and splanch-nic venous thrombosis(SVT) in the context of liver transplantation over the last 5 decades. PVT is more commonly managed by endovenous thrombectomy, while SVT requires more complex technical expedients. Several surgical techniques have been proposed, such as extensive eversion thrombectomy, anastomosis to collateral veins, reno-portal anastomosis, cavo-portal hemi-transposition, portal arterialization and combined liver-intestinal transplantation. In order to achieve satisfactory outcomes, careful planning of the surgical strategy is mandatory. The excellent results that are ob-tained nowadays confirm that, even extended, splanch-nic thrombosis is no longer an absolute contraindication for liver transplantation. Patients with advanced portal thrombosis may preferentially be referred to specialized centres, in which complex vascular approaches and even multivisceral transplantation are performed.
文摘BACKGROUND Long-term chemotherapy for patients with gastric cancer(GC),facilitated by peripherally inserted central catheter(PICC)catheterization,reduces vascular damage and enhances drug delivery efficiency but carries risks of catheter-related complications.A combination of group psychological nursing and physical mo-vement care significantly mitigates the risk of venous thrombosis and improves psychological well-being,and enhances motor function,underscoring its clinical importance.AIM To assess group psychological and physical movement nursing in preventing venous thrombosis in patients with PICC GC.METHODS Sixty-five GC patients with PICC,admitted from January 2022 to January 2023,were randomly divided into two groups using the lottery method:A control group(n=35,routine nursing)and an observation group(n=30,routine nursing plus psychological nursing and physical movement nursing).Both groups re-ceived continuous care for 2 weeks.Pre-nursing and post-nursing data on psycho-logical state,physical function,chemotherapy-related thrombosis incidence,and cancer-related fatigue were analyzed using SPSS 26.0 and GraphPad Prism 8.0.RESULTS After nursing,both groups showed reduced Hamilton Anxiety Scale scores and increased General Perceived Self-Efficacy Scale scores,with the observation group performing better(P<0.05).The Functional Comprehensive Assessment score for the observation group after nursing was(65.42±2.35)points,lower than the control group’s(62.19±4.33)points(P<0.05).Although no significant difference was observed in the incidence of venous thrombosis between the two groups(χ2=0.815,P=0.367),the observation group had lower incidence.Both groups showed decreased Revised Piper Fatigue Scale scores,with the observation group scoring lower(P<0.05).CONCLUSION Group psychological and physical movement nursing for patients with PICC reduces venous thrombosis risk,improves psychological well-being,cancer-related fatigue,and physical function,making it highly promotable.
文摘Portal vein thrombosis(PVT)is no longer a definitive contraindication in liver transplants(LTs)[1].Complex vascular reconstructions such as cavoportal hemitransposition(CPHT)[2–5],renoportal anastomosis(RPA)[6,7],and use of sizable collaterals(pericholedochal varix[8,9],coronary vein,peripancreatic or perigastroesophageal varices[10],right superior colic vein[11],ileocolic vein[12],and left gastric vein[13]),or combined liverpancreas-small bowel transplant[14]are required for portal inflow in patients with total portosplenomesenteric thrombosis.
文摘BACKGROUND Upper limb venous thrombosis(ULVT)is rarer than lower-extremity deep venous thrombosis,and is related to Paget-Schroetter syndrome,central venous catheterization,and malignancy.There are few reports of pulmonary embolism(PE)from upper-extremity vein thrombosis due to surgery.Herein,we report two cases of PE that originated from upper limb venous thrombosis on the surgical side in two patients undergoing modified radical mastectomy for breast cancer.These cases challenge the traditional theory that PE originate only from the lower extremities.CASE SUMMARY We describe two female patients,aged 68 and 65 years,respectively,who had undergone modified radical mastectomy for breast cancer.They did not have a central venous catheter and did not undergo preoperative neoadjuvant chemotherapy.They were transferred to the intensive care unit due to symptomatic PE on the first day after surgery.Colour Doppler ultrasound identified fresh thrombosis in their upper limb veins,which was the presumed source of the PE.They all received anticoagulation therapy,and one of them experienced bleeding that required discontinuation of the drug.Ultimately,they were discharged in stable condition.CONCLUSION ULVT as a source of PE after breast cancer surgery cannot be ignored.
文摘BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.
文摘BACKGROUND Ovarian vein thrombosis(OVT)is a rare condition that most commonly affects postpartum women.It is particularly prevalent in the first 10 days postpartum,a period when women are more prone to developing this condition.The right ovarian vein is often affected due to its tortuous nature and less competent valves.OVT presents similarly to acute abdominal conditions,such as acute appendicitis,especially when the right ovarian vein is involved.Given the overlap in clinical presentation,diagnosis requires high-quality imaging techniques and a high degree of suspicion.CASE SUMMARY Herein,we report a rare case of OVT in a young postpartum female who presented to the emergency department with signs and symptoms of acute abdomen.The patient had a history of pulmonary tuberculosis treatment.A provisional diagnosis of a perforated appendix was made,and a lower midline exploratory laparotomy was planned.During surgery,the appendix and inte-stines appeared normal,but a distended and thrombosed right ovarian vein was found.The affected ovarian vein was excised,and the patient was placed on anti-coagulants postoperatively.The recovery was unremarkable,and anticoagulants were continued for six months.CONCLUSION OVT is most commonly seen in the early postpartum period,especially within the first 10 days.Due to its anatomical characteristics,the right ovarian vein is more commonly involved.The clinical presentation of OVT can closely mimic acute abdomen or acute appendicitis,making diagnosis challenging.Accurate diagnosis requires a high index of suspicion and advanced imaging techniques to differentiate OVT from other conditions with similar presentations.
文摘A 53 year old male presented to his local doctor with an acute knee injury,limited knee movement and a haemoarthrosis.Patient did not have calf tenderness or clinical suspicion for deep vein thrombosis(DVT).He was referred for a routine acute knee magnetic resonance imaging(MRI)scan.This MRI demonstrated a full thickness anterior cruciate ligament tear with additional findings,of a probable incidental DVT.The relevant MRI findings suggestive of DVT in this case included perivascular edema and expanded caliber of the involved medial gastronomical veins on the axial proton density fat suppressed sequence(Figure 1).
文摘Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and modalities of the interventions and deciding,where possible,to realize them in a single session.Here we describe the case of a patient affected by severe aortic stenosis and associated cardiac comorbidities(coronary artery disease,atrial fibrillation and left appendage thrombosis)that needed a multimodal clinical and interventional strategy to lead him to the best clinical condition for performing transcatheter aortic valve implantation(TAVI).
文摘Objective:To explore the effect of evidence-based care on lower-limb thrombosis and negative emotions following hip arthroplasty.Methods:A total of 108 patients undergoing hip arthroplasty at our hospital were randomly assigned to the observation group(n=54,evidence-based care)and the control group(n=54,conventional care).Postoperative complications,negative emotions,quality of life,activities of daily living,and patient satisfaction were compared between the two groups.Results:The observation group had a lower incidence of lower-limb thrombosis and overall complications,as well as higher patient satisfaction than the control group(all P<0.05).One month after discharge,patients in the observation group showed significantly lower scores on the Hamilton Anxiety Scale,the Hamilton Depression Scale,and activities of daily living scale,but with increased Generic Quality of Life Inventory-74 scores,compared with before intervention(all P<0.05).Conclusion:Evidence-based care significantly relieves anxiety and depression,reduces the incidence of lower-limb thrombosis,and improves quality of life in patients after hip arthroplasty.
文摘BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated with PH-PVT.METHODS Medical records of patients who underwent hepatic resection for various diseases between February 2014 and December 2023 at Beijing Tsinghua Changgung Hospital affiliated with Tsinghua University(Beijing,China)were retrospectively reviewed.The patients were divided into a PH-PVT group and a non-PH-PVT group.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PH-PVT.RESULTS A total of 1064 patients were included in the study cohort,and the incidence and mortality rates of PH-PVT were 3.9%and 35.7%,respectively.The median time from hepatectomy to the diagnosis of PH-PVT was 6 days.Multivariate analysis revealed that hepatectomy combined with pancreaticoduodenectomy(HPD)[odds ratio(OR)=7.627(1.390-41.842),P=0.019],portal vein reconstruction[OR=6.119(2.636-14.203),P<0.001]and a postoperative portal vein angle<100°[OR=2.457(1.131-5.348),P=0.023]were independent risk factors for PH-PVT.Age≥60 years[OR=8.688(1.774-42.539),P=0.008]and portal vein reconstruction[OR=6.182(1.246-30.687),P=0.026]were independent risk factors for mortality in PH-PVT patients.CONCLUSION Portal vein reconstruction,a postoperative portal vein angle<100°and HPD were independent risk factors for PHPVT.Age≥60 years and portal vein reconstruction were independent risk factors for mortality in PH-PVT patients.
基金Correlation analysis between TF-MPs expression level and deep vein thrombosis in patients with cervical cancer(Project No.:2023-ZD-69)。
文摘Objective:To explore the molecular mechanism of tissue factor-positive microparticles(TF-MPs)expression and deep venous thrombosis(DVT)in patients with cervical cancer.Methods:A total of 200 patients with cervical cancer and benign cervical diseases who were hospitalized in the First Department of Gynecologic Oncology of Gansu Provincial Cancer Hospital from January 2024 to December 2025 were selected,including 100 patients with benign cervical diseases as the control group and 100 patients with cervical cancer as the experimental group.Enzyme-linked immunosorbent assay(ELISA)was used to detect the expression level of TF-MPs in peripheral blood samples from patients with cervical cancer and healthy controls.At the same time,real-time quantitative PCR was used to explore the molecular mechanism of TF-MPs promoting DVT formation.Finally,the formation of DVT in the two groups was observed and recorded,and the incidence of DVT was counted.Results:Experimental measurements showed that the expression levels of TF-MPs,coagulation factors FVII,FX,PT,and inflammatory factors IL-6 and TNF-a in the experimental group were significantly higher than those in the control group(P<0.01);the incidence of DVT in the experimental group was up to 38%,far exceeding the 6%in the control group(P<0.001).Conclusion:Abnormal expression of TF-MPs in patients with cervical cancer is an important risk factor for DVT.Through in-depth analysis of the molecular mechanism of TF-MPs promoting DVT formation,it provides a new perspective and theoretical basis for the prevention and treatment of DVT in patients with cervical cancer.In the future,intervention strategies targeting TF-MPs and their related molecular pathways are expected to become effective ways to reduce the incidence of DVT in patients with cervical cancer.
基金Supported by The Beijing Hospitals Authority Youth Programme,No.QMl220201802.
文摘BACKGROUND The portal vein thrombosis(PVT)can exacerbate portal hypertension and lead to complications,increasing the risk of mortality.AIM To evaluate the predictive capacity of artificial neural networks(ANNs)in quan-tifying the likelihood of developing PVT in individuals afflicted with hepatitis B-induced cirrhosis.METHODS A retrospective study was conducted at Beijing Ditan Hospital,affiliated with Capital Medical University,including 986 hospitalized patients.Patients admitted between January 2011 and December 2014 were assigned to the training set(685 cases),while those hospitalized from January 2015 to December 2016 were divided into the validation cohort(301 cases).Independent risk factors for PVT were identified using COX univariate analysis and used to construct an ANN model.Model performance was evaluated through metrics such as the area under the receiver operating characteristic curve(AUC)and concordance index.RESULTS In the training set,PVT occurred in 19.0%of patients within three years and 23.7%within five years.In the validation cohort,PVT developed in 16.7%of patients within three years and 24.0%within five years.The ANN model incorporated nine independent risk factors:Age,ascites,hepatic encephalopathy,gastrointestinal varices with bleeding,Child-Pugh classification,alanine aminotransferase levels,albumin levels,neutrophil-to-lymphocyte ratio,and platelet.The model achieved an AUC of 0.967(95%CI:0.960–0.974)at three years and 0.975(95%CI:0.955–0.992)at five years,significantly outperforming existing models such as model for end-stage liver disease and Child-Pugh-Turcotte(all P<0.001).CONCLUSION The ANN model demonstrated effective stratification of patients into high-and low-risk groups for PVT deve-lopment over three and five years.Validation in an independent cohort confirmed the model's predictive accuracy.
文摘Objective:To systematically evaluate prediction models for postoperative deep vein thrombosis(DVT)in elderly hip fracture patients and assess their methodological quality and predictive performance.Methods:Following PRISMA guidelines,we searched eight databases(PubMed,Embase,Cochrane Library,Web of Science,CINAHL,CNKI,Wanfang,VIP)from inception to May 2025.Studies developing or validating DVT prediction models in elderly hip fracture patients were included.Two reviewers independently screened studies,extracted data,and assessed risk of bias and applicability using the PROBAST tool.Results:Eleven studies were included,all conducted in China between 2021 and 2025.Sample sizes ranged from 101 to 504 patients(total n=3,286).Models incorporated 3 to 9 predictors,with D-dimer,age,and time from injury to surgery being most common.All 11 studies(100%)were rated as high risk of bias,primarily due to small sample sizes,lack of validation,and inadequate missing data handling.Applicability concerns were low in 8 studies(72.7%).AUC values ranged from 0.648 to 0.967,with 10 studies(90.9%)reporting AUC>0.7.Meta-analysis identified time from injury to surgery(OR=4.63,95%CI:2.58–6.68),age(OR=1.99),D-dimer(OR=1.51),and Caprini score(OR=1.75)as significant predictors.Conclusion:Current DVT prediction models for elderly hip fracture patients demonstrate acceptable discrimination but are limited by high risk of bias and lack of external validation.Prospective,multicenter studies with rigorous validation are needed to develop clinically applicable models.
