Deep cervical lymph-venous anastomosis(LVA)is a surgical procedure initially developed to treat cervical lymphatic obstruction,such as lymphedema,a condition caused by the accumulation of lymphatic fluid due to blocke...Deep cervical lymph-venous anastomosis(LVA)is a surgical procedure initially developed to treat cervical lymphatic obstruction,such as lymphedema,a condition caused by the accumulation of lymphatic fluid due to blocked or damaged lymphatic vessels.In early 2024,Dr.Qingping Xie from Hangzhou Qiushi Hospital,China,and Dr.Wei F.Chen from the Cleveland Clinic,USA,adapted LVA for the treatment of patients with Alzheimer’s disease(AD).As a VIEWPOINT,they presented a video showcasing the post-surgery cognitive recovery of an 84-year-old AD patient(Xie et al.,2024).展开更多
BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literatu...BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors,inflammatory cytokines,and reduction in anticoagulants leading to a prothrombotic state.AIM To assess the prevalence,risk factors,management,and outcome of ulcerative colitis(UC)patients who develop VTE.METHODS This was a retrospective chart review done in The Gastroenterology Department of The Aga Khan University Hospital.Data was collected from medical records for all patients admitted with a diagnosis of UC from January 2012 to December 2022.RESULTS Seventy-four patients fulfilled the inclusion criteria.The mean±SD of age at presentation of all UC patients was 45 years±10 years whereas for those who developed VTE,it was 47.6 years±14.7 years.Hypertension and diabetes were the most common co-morbid seen among UC patients with a frequency of 17(22.9%)and 12(16.2%),respectively.A total of 5(6.7%)patients developed VTE.Deep venous thrombosis was the most common thromboembolic phenomenon seen in 3(60%)patients.All the patients with UC and concomitant VTE were discharged home(5;100%).CONCLUSION The prevalence of VTE with UC in Pakistani patients corresponds with the international literature.However,multi-centric studies are required to further explore these results.展开更多
BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft ...BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft loss or graft dysfunction.Nevertheless,circumstances may arise where selecting the RK over the left kidney(LK)is unavoidable.Consequently,it is crucial to thoroughly examine the implications of such a choice on the overall transplant outcome.AIM To compare transplant outcomes between recipients of RK and LK while examining the factors that influence these outcomes.METHODS We retrospectively analyzed data from adult patients who received LD kidney transplants involving meticulous patient selection and surgical techniques at our center from January 2020 to December 2023.We included all kidney donors who were over 18,fit to donate,and had undergone diethylenetriamine pentaacetic acid split function and/or computed tomography based volumetry.The variables examined comprised donor and recipient demographics,and outcome measures included technical graft loss(TGL),delayed or slow graft function(SGF),and post-transplant serum creatinine(SC)trends.We used a logistic regression model to assess the likelihood of adverse outcomes considering the donor kidney side.RESULTS Of the 250 transplants performed during the period,56(22%)were RKs.The recipient demographics and transplant factors were comparable for the right and LKs,except that the donor warm and cold ischemia time were shorter for RKs.TGL and SGF each occurred in 2%(n=1)of RKs and 0.5%(n=1)of LKs,the difference being insignificant.These complications,however,were not related to the venous anastomosis.One RK(2%)developed delayed graft function after 48 hours,which was attributable to postoperative hypoxia rather than the surgical technique.The post-transplant SC trend and mean SC at the last follow-up were similar across both kidney sides.CONCLUSION The donor kidney side has little impact on post-transplant adverse events and graft function in LD transplants,provided that careful patient selection and precise surgical techniques are employed.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
BACKGROUND Acute mesenteric ischemia is a life-threatening disease.Intrasplenic gas is an extremely rare finding in such cases.CASE SUMMARY We report a case of a 79-year-old woman with a history of end-stage renal dis...BACKGROUND Acute mesenteric ischemia is a life-threatening disease.Intrasplenic gas is an extremely rare finding in such cases.CASE SUMMARY We report a case of a 79-year-old woman with a history of end-stage renal disease on hemodialysis for approximately 20 years,type 2 diabetes mellitus,and atrial fibrillation who presented with two days of epigastric pain.A computed tomography scan of the abdomen revealed intraperitoneal free air and significant intrasplenic gas.Laparoscopy revealed diffuse intestinal gangrene,and acute superior mesenteric ischemia was diagnosed.The patient died within 24 hours owing to profound shock.CONCLUSION Intrasplenic gas is an extremely rare finding on computed tomography imaging in cases of acute mesenteric ischemia.展开更多
Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequen...Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.展开更多
Advancements in healthcare technology have improved mortality rates and extended lifespans,resulting in a population with multiple comorbidities that complicate patient care.Traditional assessments often fall short,un...Advancements in healthcare technology have improved mortality rates and extended lifespans,resulting in a population with multiple comorbidities that complicate patient care.Traditional assessments often fall short,underscoring the need for integrated care strategies.Among these,fluid management is particularly challenging due to the difficulty in directly assessing volume status especially in critically ill patients who frequently have peripheral oedema.Effective fluid ma-nagement is essential for optimal tissue oxygen delivery,which is crucial for cellular metabolism.Oxygen transport is dependent on arterial oxygen levels,haemoglobin concentration,and cardiac output,with the latter influenced by preload,afterload,and cardiac contractility.A delicate balance of these factors ensures that the cardiovascular system can respond adequately to varying ph-ysiological demands,thereby safeguarding tissue oxygenation and overall organ function during states of stress or illness.The Venous Excess Ultrasound(VExUS)Grading System is instrumental in evaluating fluid intolerance,providing detailed insights into venous congestion and fluid status.It was originally developed to assess the risk of acute kidney injury in postoperative cardiac patients,but its versatility has enabled broader applications in nephrology and critical care settings.This mini review explores VE×US’s application and its impact on fluid management and patient outcomes in critically ill patients.展开更多
BACKGROUND Central venous access is essential for administering chemotherapy in patients with gastrointestinal cancer.Peripherally inserted central catheters(PICC)and totally implantable venous access ports(TIVAP)are ...BACKGROUND Central venous access is essential for administering chemotherapy in patients with gastrointestinal cancer.Peripherally inserted central catheters(PICC)and totally implantable venous access ports(TIVAP)are widely used,but comparative data regarding their impact on catheter-related complications and quality of life(QoL)remain limited.AIM To evaluate the impact of TIVAPs compared with PICC on catheter-related complications and QoL in patients with gastrointestinal cancer undergoing chemotherapy.METHODS This retrospective study included adults with gastrointestinal cancer who underwent central venous access device insertion for chemotherapy at our institution between December 2021 and December 2024.Inclusion criteria encompassed indications for intermittent intravenous chemotherapy,anticipated treatment duration of≥12 weeks,an adequate preoperative hematologic profile,accessible upper body veins,and complete medical records.Patients were excluded if they had an anticipated survival of less than three months,active systemic infection,severe thrombosis or coagulopathy,communication barriers,or an urgent need for dialysis access.Patients were assigned to either the PICC or TIVAP group based on device type.Data collected included demographic variables,cancer characteristics,insertion procedure details,complications,and QoL,assessed via the EuroQol 5-Dimensions-3 levels,visual analogue scale,and the European Organization for Research and Treatment of Cancer QoL Questionnaire-Core 30.RESULTS A total of 346 patients were analyzed.Baseline demographic,clinical,and cancer characteristics were similar between groups.The TIVAP group demonstrated a significantly lower incidence of catheter-related complications than the PICC group,with no pneumothorax occurring in either group.QoL assessments at baseline were comparable.At one month,the TIVAP group exhibited significantly higher EuroQoL Five Dimensions health state scores and QLQ-C30 global health status scores.Multivariate analysis identified TIVAP use,catheter tip placement in the distal superior vena cava/right atrium,prophylactic antibiotic administration,and antimicrobial dressing application as independent protective factors associated with reduced complications and improved QoL.CONCLUSION In patients with gastrointestinal cancer undergoing chemotherapy,TIVAPs are associated with a lower incidence of catheter-related complications and improved QoL than PICCs.Optimal device selection,precise catheter tip positioning,and effective perioperative management are critical for minimizing complications and enhancing patient-reported outcomes during treatment.展开更多
BACKGROUND Living donor liver transplantation(LDLT)is a crucial alternative to deceased donor transplantation,especially in regions with limited access to cadaveric organs.Right lobe graft implantation into the inferi...BACKGROUND Living donor liver transplantation(LDLT)is a crucial alternative to deceased donor transplantation,especially in regions with limited access to cadaveric organs.Right lobe graft implantation into the inferior vena cava(IVC)requires advanced surgical techniques to optimize outcomes and reduce complications.AIM To compare two venous anastomosis techniques—direct polytetrafluoroethylene(PTFE)grafting of V5-V8 veins to the IVC vs triangulation to the right hepatic vein(RHV)—in terms of graft viability and postoperative outcomes.METHODS A retrospective analysis was conducted on 96 patients who underwent LDLT with right lobe grafts between 2014 and 2023.Patients were divided into three groups:(1)No venous outflow reconstruction;(2)PTFE graft direct anastomosis to the IVC;and(3)PTFE graft anastomosis using triangulation to the RHV.Perioperative and postoperative outcomes,including bile duct complications,alanine aminotransferase/aspartate aminotransferase levels,and graft perfusion,were compared across groups.RESULTS Group 3(triangulation to RHV)showed significantly improved venous outflow,fewer complications,and faster normalization of liver function tests.Bile duct complications were highest in group 1(12.8%)and lowest in group 3(7%).Doppler ultrasonography revealed better graft perfusion in group 3 compared to groups 1 and 2.CONCLUSION Triangulation to the RHV improves graft viability,reduces biliary complications,and enhances early postoperative outcomes compared to direct PTFE grafting to the IVC.展开更多
BACKGROUND Wedged hepatic venous pressure(WHVP)is a crucial variable for accurately assessing the hepatic venous pressure gradient(HVPG)and is vital for the diagnosis and prognostic evaluation of patients with portal ...BACKGROUND Wedged hepatic venous pressure(WHVP)is a crucial variable for accurately assessing the hepatic venous pressure gradient(HVPG)and is vital for the diagnosis and prognostic evaluation of patients with portal hypertension(PH).AIM To investigate the anatomical characteristics of balloon-occluded hepatic venous angiography in patients with PH and analyze the relationship between the WHVP and portal venous pressure(PVP).METHODS This retrospective study included 877 patients with PH who met the inclusion criteria from January 2020 to June 2024.Routine and innovative hepatic venous angiography was performed during transjugular intrahepatic portosystemic shunt procedures to measure hepatic venous and PVPs.All patients'angiographic images were collected for analysis.The associations between WHVP and PVP in each group were analyzed via linear regression analysis,and a predictive model was established.RESULTS The 877 patients had a mean age of 52.6±13.0 years,with 582 males and 295 females.Patients were categorized into four groups on the basis of their anatomical structure.All groups showed strong correlations between WHVP and PVP.The regression coefficient between the WHVP and PVP in the hepatic right vein-portal venous angiography group was 0.884(P<0.05);in the hepatic right vein-accessory hepatic venous angiography group,it was 0.721(P<0.05);in the hepatic right vein-middle hepatic venous angiography group,it was 0.344(P<0.05);and in the hepatic right vein-nonangiography group,it was 0.293(P<0.05).CONCLUSION The presence and anatomical classification of hepatic venous collaterals are key factors influencing the relationship between WHVP with and PVP.Based on the different anatomical classifications of hepatic veins,WHVP can be used to estimate PVP,improving the accuracy of PVP prediction.展开更多
Patients with ulcerative colitis(UC)have an increased risk of thromboembolic events,particularly venous thromboembolism(VTE),which encompasses deep vein thrombosis and pulmonary embolism.The incidence of VTE in patien...Patients with ulcerative colitis(UC)have an increased risk of thromboembolic events,particularly venous thromboembolism(VTE),which encompasses deep vein thrombosis and pulmonary embolism.The incidence of VTE in patients with UC is significantly higher than that in the general population,and a retrospective cohort study found that patients undergoing colectomy had a notable risk of developing VTE,with rates reaching as high as 22%among patients exposed to tofacitinib within a month prior to surgery.The GETAID FOCUS study also reported a high prevalence of self-reported VTE in patients with UC,with a pooled prevalence of approximately 12%across various studies.The risk of thromboembolism in UC is multifactorial and influenced by chronic inflammation,a wide range of medications used,potential surgical interventions,and possibly genetic factors or associations that are yet to be fully defined.Recognizing the various contributing factors is crucial for developing effective preventive strategies and improving patient outcomes.展开更多
BACKGROUND Few studies have specifically modeled the risk of venous thromboembolism(VTE)for postoperative hepatocellular carcinoma(HCC)patients,although HCC is the third leading cause of cancer death worldwide.This st...BACKGROUND Few studies have specifically modeled the risk of venous thromboembolism(VTE)for postoperative hepatocellular carcinoma(HCC)patients,although HCC is the third leading cause of cancer death worldwide.This study aimed to develop and validate a nomogram that accurately predicts the risk of VTE in patients after HCC surgery.AIM To develop and validate a nomogram to accurately predict the risk of VTE in postoperative HCC patients by integrating clinical and laboratory risk factors.The model seeks to provide a user-friendly tool for identifying high-risk individuals who may benefit from targeted anticoagulation therapy,thereby improving clinical decision-making and patient outcomes.METHODS Data from patients who underwent HCC surgery at Chongqing University Cancer Hospital in China were analyzed.Through univariate and multivariate logistic regression analyses,independent risk factors for VTE were identified and integrated into a nomogram.The predictive performance of the nomogram was assessed via receiver operating characteristic curves,calibration curves,decision curve analysis and other relevant metrics.RESULTS Of 905 postoperative HCC patients were included in the study.The nomogram incorporated eight independent risk factors for VTE:Karnofsky Performance Scale,base disease,cancer stage(tumor-node-metastasis),chemotherapy,D-dimer concentration,white blood cell count,hemoglobin,and fibrinogen.The C-index for the nomogram model was 0.825 in the training cohort and 0.820 in the validation cohort,indicating good discriminative ability.Calibration plots of the model revealed high concordance between the predicted probabilities and observed outcomes.CONCLUSION We developed and validated a novel nomogram that can accurately estimate the risk of VTE in individual postoperative HCC patients.This model can identify high-risk patients who may benefit from targeted anticoagulation therapy.展开更多
Hepatic portal venous gas(HPVG)is a rare yet clinically significant radiological manifestation characterized by diverse etiologies,unclear pathophysiology,and nonspecific clinical presentations.Its appearance frequent...Hepatic portal venous gas(HPVG)is a rare yet clinically significant radiological manifestation characterized by diverse etiologies,unclear pathophysiology,and nonspecific clinical presentations.Its appearance frequently heralds a severe underlying condition,with a reported mortality rate as high as 75%,earning it the moniker“harbinger of death”.In recent years,with advancements in diagnosis and treatment of HPVG,its mortality rate has been reduced to below 40%.Nevertheless,the infrequency of HPVG,coupled with its complex etiologies and rapid progression,often leaves clinicians failing to provide timely intervention due to a lack of awareness,resulting in the death of patient.Currently,there is no consensus on the standardized diagnosis and treatment strategies for HPVG.The purpose of this review is to synthesize the existing literature on HPVG and to discuss the advancements in understanding its clinical manifestation,etiologies,pathogenesis,diagnostic methods,and treatment strategies,as well as to emphasize the necessity for further research to enhance our comprehension of its pathophysiology and to refine diagnostic and therapeutic approaches.展开更多
BACKGROUND The risk and mortality rate of venous thromboembolism(VTE)following gastrointestinal surgery remain high,and the symptoms are atypical.Therefore,it is necessary to identify the risk factors associated with ...BACKGROUND The risk and mortality rate of venous thromboembolism(VTE)following gastrointestinal surgery remain high,and the symptoms are atypical.Therefore,it is necessary to identify the risk factors associated with the occurrence of VTE following gastrointestinal surgery and to implement appropriate prevention and treatment measures.AIM To assess the efficacy of perioperative anticoagulation for the prevention of postoperative VTE.METHODS This retrospective study enrolled 205 patients who underwent gastrointestinal surgery.In the observation group(n=101),prophylactic anticoagulation was administered via hypodermic injection of low-molecular-weight heparin during the perioperative period,whereas the control group(n=104)only received lowmolecular-weight heparin treatment postoperatively.Blood coagulation parameters and the incidence of VTE of the bilateral lower limbs pre-and post-surgery were compared between groups.Postoperative VTE was transformed into a dichotomous variable,and influencing factors were explored using multivariate logistic regression analyses.RESULTS On the 7th day postoperatively,the incidence of VTE of the bilateral lower limbs was significantly lower in the observation group than in the control group,as were the D-dimer levels(P<0.05).At 1 month postoperatively,the incidence of VTE was significantly lower in the observation group than in the control group(P<0.05).An age≥65 years,a body mass index≥24 kg/m^(2),and malignant diseases of the digestive system were identified as risk factors for the occurrence of postoperative VTE in patients undergoing gastrointestinal surgery.CONCLUSION The incidence of VTE in patients who underwent gastrointestinal surgery peaked within 1 week postoperatively.The findings confirmed perioperative anticoagulation can safely and effectively reduce the incidence of postoperative VTE.展开更多
BACKGROUND The reference ranges for biochemical parameters can fluctuate due to factors like altitude,age,gender,and socioeconomic conditions.These values are crucial for interpreting laboratory data and guide clinica...BACKGROUND The reference ranges for biochemical parameters can fluctuate due to factors like altitude,age,gender,and socioeconomic conditions.These values are crucial for interpreting laboratory data and guide clinical treatment decisions.Currently,there is no established set of reference intervals for cord blood biochemical parameters of newborns in India,particularly in Mumbai.AIM To create cord blood biochemical parameters reference intervals specifically for Mumbai,India.METHODS A cross-sectional study was conducted in an Indian tertiary care hospital.This study focused on healthy newborns with normal birth weight,born to pregnant mothers without health issues.Cord blood samples,approximately 2-3 mL in volume,were collected from 210 term neonates.These samples were divided into fluoride(glucose)and clot activator(serum)tubes and were subsequently analyzed in the institute's biochemical laboratory.The data obtained from the analysis was then subjected to statistical analysis.The result of the Shapiro-Wilk test suggested non-normality in the data distribution.Consequently,nonparametric statistics were utilized for analysis.The Mann-Whitney U test was utilized to compare parameter distributions among different factors,including the infant’s sex,delivery method,maternal age,and obstetric history.A significance level of P<0.05 was considered to indicate statistical significance.RESULTS The following represent the median figures and central 95 percentile reference intervals for biochemical parameters in umbilical cord blood of newborns:Serum direct bilirubin=(0.1-0.55)mg/dL,indirect bilirubin=(0.64-2.26)mg/dL,total bilirubin=(0.62-3.14)mg/dL,creatinine=(0.27-0.76)mg/dL,sodium=(128.19-143.26)mmol/L,chloride=(100.19-111.68)mmol/L,potassium=(1.62-9.98)mmol/L and plasma glucose=(24.75-94.23)mg/dL.Statistically significant differences were observed in serum sodium,potassium,and plasma glucose levels when comparing delivery modes.CONCLUSION This is the pioneering study in which first time,the biochemical reference intervals in cord blood for newborns are established in western India.The values are applicable for newborns from this area.Larger study throughout the country is required.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
Colorectal cancer(CRC),the third most prevalent cancer globally,exhibits a notable association with venous thromboembolism(VTE),significantly impacting patient morbidity and mortality.We delve into the complex pathoge...Colorectal cancer(CRC),the third most prevalent cancer globally,exhibits a notable association with venous thromboembolism(VTE),significantly impacting patient morbidity and mortality.We delve into the complex pathogenesis of cancer-associated thrombosis(CAT)in CRC,highlighting the interplay of clinical risk factors and tumor-specific mechanisms.Our comprehensive review synthesizes the current understanding of CRC’s pro-thrombotic tendencies,examining both general clinical factors(e.g.,age,gender,obesity,prior VTE history)and tumor-specific aspects(e.g.,tumor location,stage,targeted therapies).Key findings illustrate how CRC cells themselves actively contribute to coagulation cascade activation through various procoagulant elements such as tissue factor,cancer procoagulant,and extracellular vesicles.We also explore how CRC influences host cells to adopt a procoagulant phenotype,thereby exacerbating thrombotic risks.This review underscores the role of genetic mutations in CRC(e.g.,KRAS,p53)in modulating coagulation-related protein expression and thrombosis risks.An in-depth understanding of the genetic landscape specific to CRC subtypes is essential for developing targeted anticoagulation strategies and could significantly advance thrombosis prevention while improving the overall management of patients with CRC.This highlights the urgent need for precision in addressing CAT within clinical settings.展开更多
The aim of this study is to analyze the risk factors and clinical characteristics of pulmonary embolism in northern Shaanxi.In this study,162 patients with venous thrombosis admitted between June 2023 and June 2024 un...The aim of this study is to analyze the risk factors and clinical characteristics of pulmonary embolism in northern Shaanxi.In this study,162 patients with venous thrombosis admitted between June 2023 and June 2024 underwent CT pulmonary angiography to investigate the risk factors and clinical characteristics of pulmonary embolism(PE)in northern Shaanxi.The patients were divided into a control group(no PE,n=98)and a study group(PE,n=64)based on the presence or absence of PE.Data were collected using a Case Report Form,and statistical analyses were conducted to summarize clinical features and risk factors,followed by three months of targeted therapy.Significant differences were observed between the two groups in clinical manifestations such as pleural pain,dyspnea,and hemoptysis,as well as in past medical histories(including malignant tumor history and right ventricular dysfunction),physical signs like lung rales,and laboratory parameters such as hemoglobin,albumin,white blood cell count,D-dimer,blood oxygen saturation,total cholesterol,triglycerides,and high-density lipoprotein cholesterol(all P<0.05).Multivariate logistic regression analysis identified pleural pain,dyspnea,malignancy,right ventricular dysfunction,lung rales,D-dimer,white blood cell levels,and blood oxygen saturation as risk factors for PE in patients with venous thrombosis.Following targeted therapy,the proportions of patients with pleural pain,dyspnea,and lung rales decreased significantly,with concurrent reductions in right ventricular end-diastolic inner diameter(RVD),D-dimer,and white blood cell levels,and a significant increase in blood oxygen saturation.These findings suggest that early prevention and intervention based on these risk factors can effectively reduce the incidence of PE in northern Shaanxi.展开更多
Objective:To investigate the risk factors for deep vein thrombosis(DVT)following total hip arthroplasty in elderly patients with femoral neck fractures during the winter.Methods:A total of 162 patients who underwent t...Objective:To investigate the risk factors for deep vein thrombosis(DVT)following total hip arthroplasty in elderly patients with femoral neck fractures during the winter.Methods:A total of 162 patients who underwent total hip arthroplasty were categorized based on the development of DVT within 7 days postoperatively:28 patients formed the DVT group and 134 patients the non-DVT group.Collected data included age,gender,history of glucocorticoid use,diabetes,hypertension,body mass index(BMI),triglyceride(TG)levels,cholesterol(CHOL)levels at admission,operative time,and postoperative bed rest duration.D-dimer(D-D)and fibrinogen(Fg)levels,along with the D-D/Fg ratio,were recorded on the first postoperative day.Group comparisons were performed using t-tests.Logistic regression analysis was conducted to identify independent risk factors,and the predictive value of these factors was evaluated using receiver operating characteristic(ROC)curve analysis.Results:In the DVT group,18 patients had diabetes.Levels of TG(1.78±0.44 mmol/L),CHOL(4.70±1.84 mmol/L),D-D(0.40±0.17 mg/L),and the D-D/Fg ratio(0.24±0.07)were significantly higher than in the non-DVT group(P<0.05).Logistic regression identified TG,CHOL,D-D,and the D-D/Fg ratio as independent risk factors for DVT,with odds ratios of 0.987,2.395,0.8,4.992,and 9.004,respectively(P<0.05).ROC curve analysis yielded areas under the curve(AUCs)of 0.715,0.69,0.614,and 0.726 for TG,CHOL,D-D,and the D-D/Fg ratio,respectively.Sensitivities were 0.643,0.500,0.429,and 0.857,and specificities were 0.694,0.978,0.918,and 0.537,respectively.Conclusion:Elevated levels of TG,CHOL,D-D,and the D-D/Fg ratio are independent risk factors for DVT following total hip arthroplasty in elderly patients.Among these,the D-D/Fg ratio demonstrated the highest sensitivity and may serve as an effective marker for early-stage DVT screening.展开更多
This article introduces and compares risk assessment models for venous thromboembolism in gynecological patients at home and abroad.The models assessed included the Caprini risk assessment model,the G-Caprini risk ass...This article introduces and compares risk assessment models for venous thromboembolism in gynecological patients at home and abroad.The models assessed included the Caprini risk assessment model,the G-Caprini risk assessment model,the Rogers risk assessment model,the Autar risk assessment model,the gynecological patient surgical venous thrombosis risk assessment scale,the Wells score,the COMPASS-CAT thrombus risk assessment model,the Khorana risk assessment model,the Padua risk assessment model,and the Chaoyang model.The purpose of this study is to provide a foundation for developing a risk assessment tool for gynecological venous thromboembolism tailored to Chinese patients and to assist clinical health care workers in selecting appropriate risk assessment tools and guiding individualized prevention measures.展开更多
基金supported by AG057842 from the National Institutes of Health,TRIBA/Physiology Faculty Startup Fund from Augusta University(to FF),and the National Natural Science Foundation of China(82173384)(to MG).
文摘Deep cervical lymph-venous anastomosis(LVA)is a surgical procedure initially developed to treat cervical lymphatic obstruction,such as lymphedema,a condition caused by the accumulation of lymphatic fluid due to blocked or damaged lymphatic vessels.In early 2024,Dr.Qingping Xie from Hangzhou Qiushi Hospital,China,and Dr.Wei F.Chen from the Cleveland Clinic,USA,adapted LVA for the treatment of patients with Alzheimer’s disease(AD).As a VIEWPOINT,they presented a video showcasing the post-surgery cognitive recovery of an 84-year-old AD patient(Xie et al.,2024).
文摘BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors,inflammatory cytokines,and reduction in anticoagulants leading to a prothrombotic state.AIM To assess the prevalence,risk factors,management,and outcome of ulcerative colitis(UC)patients who develop VTE.METHODS This was a retrospective chart review done in The Gastroenterology Department of The Aga Khan University Hospital.Data was collected from medical records for all patients admitted with a diagnosis of UC from January 2012 to December 2022.RESULTS Seventy-four patients fulfilled the inclusion criteria.The mean±SD of age at presentation of all UC patients was 45 years±10 years whereas for those who developed VTE,it was 47.6 years±14.7 years.Hypertension and diabetes were the most common co-morbid seen among UC patients with a frequency of 17(22.9%)and 12(16.2%),respectively.A total of 5(6.7%)patients developed VTE.Deep venous thrombosis was the most common thromboembolic phenomenon seen in 3(60%)patients.All the patients with UC and concomitant VTE were discharged home(5;100%).CONCLUSION The prevalence of VTE with UC in Pakistani patients corresponds with the international literature.However,multi-centric studies are required to further explore these results.
文摘BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft loss or graft dysfunction.Nevertheless,circumstances may arise where selecting the RK over the left kidney(LK)is unavoidable.Consequently,it is crucial to thoroughly examine the implications of such a choice on the overall transplant outcome.AIM To compare transplant outcomes between recipients of RK and LK while examining the factors that influence these outcomes.METHODS We retrospectively analyzed data from adult patients who received LD kidney transplants involving meticulous patient selection and surgical techniques at our center from January 2020 to December 2023.We included all kidney donors who were over 18,fit to donate,and had undergone diethylenetriamine pentaacetic acid split function and/or computed tomography based volumetry.The variables examined comprised donor and recipient demographics,and outcome measures included technical graft loss(TGL),delayed or slow graft function(SGF),and post-transplant serum creatinine(SC)trends.We used a logistic regression model to assess the likelihood of adverse outcomes considering the donor kidney side.RESULTS Of the 250 transplants performed during the period,56(22%)were RKs.The recipient demographics and transplant factors were comparable for the right and LKs,except that the donor warm and cold ischemia time were shorter for RKs.TGL and SGF each occurred in 2%(n=1)of RKs and 0.5%(n=1)of LKs,the difference being insignificant.These complications,however,were not related to the venous anastomosis.One RK(2%)developed delayed graft function after 48 hours,which was attributable to postoperative hypoxia rather than the surgical technique.The post-transplant SC trend and mean SC at the last follow-up were similar across both kidney sides.CONCLUSION The donor kidney side has little impact on post-transplant adverse events and graft function in LD transplants,provided that careful patient selection and precise surgical techniques are employed.
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BACKGROUND Acute mesenteric ischemia is a life-threatening disease.Intrasplenic gas is an extremely rare finding in such cases.CASE SUMMARY We report a case of a 79-year-old woman with a history of end-stage renal disease on hemodialysis for approximately 20 years,type 2 diabetes mellitus,and atrial fibrillation who presented with two days of epigastric pain.A computed tomography scan of the abdomen revealed intraperitoneal free air and significant intrasplenic gas.Laparoscopy revealed diffuse intestinal gangrene,and acute superior mesenteric ischemia was diagnosed.The patient died within 24 hours owing to profound shock.CONCLUSION Intrasplenic gas is an extremely rare finding on computed tomography imaging in cases of acute mesenteric ischemia.
文摘Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.
文摘Advancements in healthcare technology have improved mortality rates and extended lifespans,resulting in a population with multiple comorbidities that complicate patient care.Traditional assessments often fall short,underscoring the need for integrated care strategies.Among these,fluid management is particularly challenging due to the difficulty in directly assessing volume status especially in critically ill patients who frequently have peripheral oedema.Effective fluid ma-nagement is essential for optimal tissue oxygen delivery,which is crucial for cellular metabolism.Oxygen transport is dependent on arterial oxygen levels,haemoglobin concentration,and cardiac output,with the latter influenced by preload,afterload,and cardiac contractility.A delicate balance of these factors ensures that the cardiovascular system can respond adequately to varying ph-ysiological demands,thereby safeguarding tissue oxygenation and overall organ function during states of stress or illness.The Venous Excess Ultrasound(VExUS)Grading System is instrumental in evaluating fluid intolerance,providing detailed insights into venous congestion and fluid status.It was originally developed to assess the risk of acute kidney injury in postoperative cardiac patients,but its versatility has enabled broader applications in nephrology and critical care settings.This mini review explores VE×US’s application and its impact on fluid management and patient outcomes in critically ill patients.
文摘BACKGROUND Central venous access is essential for administering chemotherapy in patients with gastrointestinal cancer.Peripherally inserted central catheters(PICC)and totally implantable venous access ports(TIVAP)are widely used,but comparative data regarding their impact on catheter-related complications and quality of life(QoL)remain limited.AIM To evaluate the impact of TIVAPs compared with PICC on catheter-related complications and QoL in patients with gastrointestinal cancer undergoing chemotherapy.METHODS This retrospective study included adults with gastrointestinal cancer who underwent central venous access device insertion for chemotherapy at our institution between December 2021 and December 2024.Inclusion criteria encompassed indications for intermittent intravenous chemotherapy,anticipated treatment duration of≥12 weeks,an adequate preoperative hematologic profile,accessible upper body veins,and complete medical records.Patients were excluded if they had an anticipated survival of less than three months,active systemic infection,severe thrombosis or coagulopathy,communication barriers,or an urgent need for dialysis access.Patients were assigned to either the PICC or TIVAP group based on device type.Data collected included demographic variables,cancer characteristics,insertion procedure details,complications,and QoL,assessed via the EuroQol 5-Dimensions-3 levels,visual analogue scale,and the European Organization for Research and Treatment of Cancer QoL Questionnaire-Core 30.RESULTS A total of 346 patients were analyzed.Baseline demographic,clinical,and cancer characteristics were similar between groups.The TIVAP group demonstrated a significantly lower incidence of catheter-related complications than the PICC group,with no pneumothorax occurring in either group.QoL assessments at baseline were comparable.At one month,the TIVAP group exhibited significantly higher EuroQoL Five Dimensions health state scores and QLQ-C30 global health status scores.Multivariate analysis identified TIVAP use,catheter tip placement in the distal superior vena cava/right atrium,prophylactic antibiotic administration,and antimicrobial dressing application as independent protective factors associated with reduced complications and improved QoL.CONCLUSION In patients with gastrointestinal cancer undergoing chemotherapy,TIVAPs are associated with a lower incidence of catheter-related complications and improved QoL than PICCs.Optimal device selection,precise catheter tip positioning,and effective perioperative management are critical for minimizing complications and enhancing patient-reported outcomes during treatment.
文摘BACKGROUND Living donor liver transplantation(LDLT)is a crucial alternative to deceased donor transplantation,especially in regions with limited access to cadaveric organs.Right lobe graft implantation into the inferior vena cava(IVC)requires advanced surgical techniques to optimize outcomes and reduce complications.AIM To compare two venous anastomosis techniques—direct polytetrafluoroethylene(PTFE)grafting of V5-V8 veins to the IVC vs triangulation to the right hepatic vein(RHV)—in terms of graft viability and postoperative outcomes.METHODS A retrospective analysis was conducted on 96 patients who underwent LDLT with right lobe grafts between 2014 and 2023.Patients were divided into three groups:(1)No venous outflow reconstruction;(2)PTFE graft direct anastomosis to the IVC;and(3)PTFE graft anastomosis using triangulation to the RHV.Perioperative and postoperative outcomes,including bile duct complications,alanine aminotransferase/aspartate aminotransferase levels,and graft perfusion,were compared across groups.RESULTS Group 3(triangulation to RHV)showed significantly improved venous outflow,fewer complications,and faster normalization of liver function tests.Bile duct complications were highest in group 1(12.8%)and lowest in group 3(7%).Doppler ultrasonography revealed better graft perfusion in group 3 compared to groups 1 and 2.CONCLUSION Triangulation to the RHV improves graft viability,reduces biliary complications,and enhances early postoperative outcomes compared to direct PTFE grafting to the IVC.
基金Supported by Capital Medical University Affiliated Beijing Shijitan Hospital Talent Development Program during the 14th Five-Year Plan,No.2023 LJRCLFQ.
文摘BACKGROUND Wedged hepatic venous pressure(WHVP)is a crucial variable for accurately assessing the hepatic venous pressure gradient(HVPG)and is vital for the diagnosis and prognostic evaluation of patients with portal hypertension(PH).AIM To investigate the anatomical characteristics of balloon-occluded hepatic venous angiography in patients with PH and analyze the relationship between the WHVP and portal venous pressure(PVP).METHODS This retrospective study included 877 patients with PH who met the inclusion criteria from January 2020 to June 2024.Routine and innovative hepatic venous angiography was performed during transjugular intrahepatic portosystemic shunt procedures to measure hepatic venous and PVPs.All patients'angiographic images were collected for analysis.The associations between WHVP and PVP in each group were analyzed via linear regression analysis,and a predictive model was established.RESULTS The 877 patients had a mean age of 52.6±13.0 years,with 582 males and 295 females.Patients were categorized into four groups on the basis of their anatomical structure.All groups showed strong correlations between WHVP and PVP.The regression coefficient between the WHVP and PVP in the hepatic right vein-portal venous angiography group was 0.884(P<0.05);in the hepatic right vein-accessory hepatic venous angiography group,it was 0.721(P<0.05);in the hepatic right vein-middle hepatic venous angiography group,it was 0.344(P<0.05);and in the hepatic right vein-nonangiography group,it was 0.293(P<0.05).CONCLUSION The presence and anatomical classification of hepatic venous collaterals are key factors influencing the relationship between WHVP with and PVP.Based on the different anatomical classifications of hepatic veins,WHVP can be used to estimate PVP,improving the accuracy of PVP prediction.
文摘Patients with ulcerative colitis(UC)have an increased risk of thromboembolic events,particularly venous thromboembolism(VTE),which encompasses deep vein thrombosis and pulmonary embolism.The incidence of VTE in patients with UC is significantly higher than that in the general population,and a retrospective cohort study found that patients undergoing colectomy had a notable risk of developing VTE,with rates reaching as high as 22%among patients exposed to tofacitinib within a month prior to surgery.The GETAID FOCUS study also reported a high prevalence of self-reported VTE in patients with UC,with a pooled prevalence of approximately 12%across various studies.The risk of thromboembolism in UC is multifactorial and influenced by chronic inflammation,a wide range of medications used,potential surgical interventions,and possibly genetic factors or associations that are yet to be fully defined.Recognizing the various contributing factors is crucial for developing effective preventive strategies and improving patient outcomes.
文摘BACKGROUND Few studies have specifically modeled the risk of venous thromboembolism(VTE)for postoperative hepatocellular carcinoma(HCC)patients,although HCC is the third leading cause of cancer death worldwide.This study aimed to develop and validate a nomogram that accurately predicts the risk of VTE in patients after HCC surgery.AIM To develop and validate a nomogram to accurately predict the risk of VTE in postoperative HCC patients by integrating clinical and laboratory risk factors.The model seeks to provide a user-friendly tool for identifying high-risk individuals who may benefit from targeted anticoagulation therapy,thereby improving clinical decision-making and patient outcomes.METHODS Data from patients who underwent HCC surgery at Chongqing University Cancer Hospital in China were analyzed.Through univariate and multivariate logistic regression analyses,independent risk factors for VTE were identified and integrated into a nomogram.The predictive performance of the nomogram was assessed via receiver operating characteristic curves,calibration curves,decision curve analysis and other relevant metrics.RESULTS Of 905 postoperative HCC patients were included in the study.The nomogram incorporated eight independent risk factors for VTE:Karnofsky Performance Scale,base disease,cancer stage(tumor-node-metastasis),chemotherapy,D-dimer concentration,white blood cell count,hemoglobin,and fibrinogen.The C-index for the nomogram model was 0.825 in the training cohort and 0.820 in the validation cohort,indicating good discriminative ability.Calibration plots of the model revealed high concordance between the predicted probabilities and observed outcomes.CONCLUSION We developed and validated a novel nomogram that can accurately estimate the risk of VTE in individual postoperative HCC patients.This model can identify high-risk patients who may benefit from targeted anticoagulation therapy.
文摘Hepatic portal venous gas(HPVG)is a rare yet clinically significant radiological manifestation characterized by diverse etiologies,unclear pathophysiology,and nonspecific clinical presentations.Its appearance frequently heralds a severe underlying condition,with a reported mortality rate as high as 75%,earning it the moniker“harbinger of death”.In recent years,with advancements in diagnosis and treatment of HPVG,its mortality rate has been reduced to below 40%.Nevertheless,the infrequency of HPVG,coupled with its complex etiologies and rapid progression,often leaves clinicians failing to provide timely intervention due to a lack of awareness,resulting in the death of patient.Currently,there is no consensus on the standardized diagnosis and treatment strategies for HPVG.The purpose of this review is to synthesize the existing literature on HPVG and to discuss the advancements in understanding its clinical manifestation,etiologies,pathogenesis,diagnostic methods,and treatment strategies,as well as to emphasize the necessity for further research to enhance our comprehension of its pathophysiology and to refine diagnostic and therapeutic approaches.
文摘BACKGROUND The risk and mortality rate of venous thromboembolism(VTE)following gastrointestinal surgery remain high,and the symptoms are atypical.Therefore,it is necessary to identify the risk factors associated with the occurrence of VTE following gastrointestinal surgery and to implement appropriate prevention and treatment measures.AIM To assess the efficacy of perioperative anticoagulation for the prevention of postoperative VTE.METHODS This retrospective study enrolled 205 patients who underwent gastrointestinal surgery.In the observation group(n=101),prophylactic anticoagulation was administered via hypodermic injection of low-molecular-weight heparin during the perioperative period,whereas the control group(n=104)only received lowmolecular-weight heparin treatment postoperatively.Blood coagulation parameters and the incidence of VTE of the bilateral lower limbs pre-and post-surgery were compared between groups.Postoperative VTE was transformed into a dichotomous variable,and influencing factors were explored using multivariate logistic regression analyses.RESULTS On the 7th day postoperatively,the incidence of VTE of the bilateral lower limbs was significantly lower in the observation group than in the control group,as were the D-dimer levels(P<0.05).At 1 month postoperatively,the incidence of VTE was significantly lower in the observation group than in the control group(P<0.05).An age≥65 years,a body mass index≥24 kg/m^(2),and malignant diseases of the digestive system were identified as risk factors for the occurrence of postoperative VTE in patients undergoing gastrointestinal surgery.CONCLUSION The incidence of VTE in patients who underwent gastrointestinal surgery peaked within 1 week postoperatively.The findings confirmed perioperative anticoagulation can safely and effectively reduce the incidence of postoperative VTE.
文摘BACKGROUND The reference ranges for biochemical parameters can fluctuate due to factors like altitude,age,gender,and socioeconomic conditions.These values are crucial for interpreting laboratory data and guide clinical treatment decisions.Currently,there is no established set of reference intervals for cord blood biochemical parameters of newborns in India,particularly in Mumbai.AIM To create cord blood biochemical parameters reference intervals specifically for Mumbai,India.METHODS A cross-sectional study was conducted in an Indian tertiary care hospital.This study focused on healthy newborns with normal birth weight,born to pregnant mothers without health issues.Cord blood samples,approximately 2-3 mL in volume,were collected from 210 term neonates.These samples were divided into fluoride(glucose)and clot activator(serum)tubes and were subsequently analyzed in the institute's biochemical laboratory.The data obtained from the analysis was then subjected to statistical analysis.The result of the Shapiro-Wilk test suggested non-normality in the data distribution.Consequently,nonparametric statistics were utilized for analysis.The Mann-Whitney U test was utilized to compare parameter distributions among different factors,including the infant’s sex,delivery method,maternal age,and obstetric history.A significance level of P<0.05 was considered to indicate statistical significance.RESULTS The following represent the median figures and central 95 percentile reference intervals for biochemical parameters in umbilical cord blood of newborns:Serum direct bilirubin=(0.1-0.55)mg/dL,indirect bilirubin=(0.64-2.26)mg/dL,total bilirubin=(0.62-3.14)mg/dL,creatinine=(0.27-0.76)mg/dL,sodium=(128.19-143.26)mmol/L,chloride=(100.19-111.68)mmol/L,potassium=(1.62-9.98)mmol/L and plasma glucose=(24.75-94.23)mg/dL.Statistically significant differences were observed in serum sodium,potassium,and plasma glucose levels when comparing delivery modes.CONCLUSION This is the pioneering study in which first time,the biochemical reference intervals in cord blood for newborns are established in western India.The values are applicable for newborns from this area.Larger study throughout the country is required.
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.
文摘Colorectal cancer(CRC),the third most prevalent cancer globally,exhibits a notable association with venous thromboembolism(VTE),significantly impacting patient morbidity and mortality.We delve into the complex pathogenesis of cancer-associated thrombosis(CAT)in CRC,highlighting the interplay of clinical risk factors and tumor-specific mechanisms.Our comprehensive review synthesizes the current understanding of CRC’s pro-thrombotic tendencies,examining both general clinical factors(e.g.,age,gender,obesity,prior VTE history)and tumor-specific aspects(e.g.,tumor location,stage,targeted therapies).Key findings illustrate how CRC cells themselves actively contribute to coagulation cascade activation through various procoagulant elements such as tissue factor,cancer procoagulant,and extracellular vesicles.We also explore how CRC influences host cells to adopt a procoagulant phenotype,thereby exacerbating thrombotic risks.This review underscores the role of genetic mutations in CRC(e.g.,KRAS,p53)in modulating coagulation-related protein expression and thrombosis risks.An in-depth understanding of the genetic landscape specific to CRC subtypes is essential for developing targeted anticoagulation strategies and could significantly advance thrombosis prevention while improving the overall management of patients with CRC.This highlights the urgent need for precision in addressing CAT within clinical settings.
文摘The aim of this study is to analyze the risk factors and clinical characteristics of pulmonary embolism in northern Shaanxi.In this study,162 patients with venous thrombosis admitted between June 2023 and June 2024 underwent CT pulmonary angiography to investigate the risk factors and clinical characteristics of pulmonary embolism(PE)in northern Shaanxi.The patients were divided into a control group(no PE,n=98)and a study group(PE,n=64)based on the presence or absence of PE.Data were collected using a Case Report Form,and statistical analyses were conducted to summarize clinical features and risk factors,followed by three months of targeted therapy.Significant differences were observed between the two groups in clinical manifestations such as pleural pain,dyspnea,and hemoptysis,as well as in past medical histories(including malignant tumor history and right ventricular dysfunction),physical signs like lung rales,and laboratory parameters such as hemoglobin,albumin,white blood cell count,D-dimer,blood oxygen saturation,total cholesterol,triglycerides,and high-density lipoprotein cholesterol(all P<0.05).Multivariate logistic regression analysis identified pleural pain,dyspnea,malignancy,right ventricular dysfunction,lung rales,D-dimer,white blood cell levels,and blood oxygen saturation as risk factors for PE in patients with venous thrombosis.Following targeted therapy,the proportions of patients with pleural pain,dyspnea,and lung rales decreased significantly,with concurrent reductions in right ventricular end-diastolic inner diameter(RVD),D-dimer,and white blood cell levels,and a significant increase in blood oxygen saturation.These findings suggest that early prevention and intervention based on these risk factors can effectively reduce the incidence of PE in northern Shaanxi.
基金supported by grants from the Youth TCM scientific research Project of Heilongjiang Province TCM Administration(ZHY2024-283)the Health and Family Planning Commission of Heilongjiang Province(20240404070039)+1 种基金Heilongjiang Postdoctoral Fund(NO.LBH-Z23257)the Innovative Science Research Fund of Harbin Medical University(also known as Heilongjiang Provincial University's Project of Graduate Scientific Research Business Fees)(2024,Xin Zhang)and the Postdoctoral Program of Heilongjiang Province(NO.LBH-Z23234).
文摘Objective:To investigate the risk factors for deep vein thrombosis(DVT)following total hip arthroplasty in elderly patients with femoral neck fractures during the winter.Methods:A total of 162 patients who underwent total hip arthroplasty were categorized based on the development of DVT within 7 days postoperatively:28 patients formed the DVT group and 134 patients the non-DVT group.Collected data included age,gender,history of glucocorticoid use,diabetes,hypertension,body mass index(BMI),triglyceride(TG)levels,cholesterol(CHOL)levels at admission,operative time,and postoperative bed rest duration.D-dimer(D-D)and fibrinogen(Fg)levels,along with the D-D/Fg ratio,were recorded on the first postoperative day.Group comparisons were performed using t-tests.Logistic regression analysis was conducted to identify independent risk factors,and the predictive value of these factors was evaluated using receiver operating characteristic(ROC)curve analysis.Results:In the DVT group,18 patients had diabetes.Levels of TG(1.78±0.44 mmol/L),CHOL(4.70±1.84 mmol/L),D-D(0.40±0.17 mg/L),and the D-D/Fg ratio(0.24±0.07)were significantly higher than in the non-DVT group(P<0.05).Logistic regression identified TG,CHOL,D-D,and the D-D/Fg ratio as independent risk factors for DVT,with odds ratios of 0.987,2.395,0.8,4.992,and 9.004,respectively(P<0.05).ROC curve analysis yielded areas under the curve(AUCs)of 0.715,0.69,0.614,and 0.726 for TG,CHOL,D-D,and the D-D/Fg ratio,respectively.Sensitivities were 0.643,0.500,0.429,and 0.857,and specificities were 0.694,0.978,0.918,and 0.537,respectively.Conclusion:Elevated levels of TG,CHOL,D-D,and the D-D/Fg ratio are independent risk factors for DVT following total hip arthroplasty in elderly patients.Among these,the D-D/Fg ratio demonstrated the highest sensitivity and may serve as an effective marker for early-stage DVT screening.
基金funded by the National College Students Innovation and Entrepreneurship Training Program(S202310760049).
文摘This article introduces and compares risk assessment models for venous thromboembolism in gynecological patients at home and abroad.The models assessed included the Caprini risk assessment model,the G-Caprini risk assessment model,the Rogers risk assessment model,the Autar risk assessment model,the gynecological patient surgical venous thrombosis risk assessment scale,the Wells score,the COMPASS-CAT thrombus risk assessment model,the Khorana risk assessment model,the Padua risk assessment model,and the Chaoyang model.The purpose of this study is to provide a foundation for developing a risk assessment tool for gynecological venous thromboembolism tailored to Chinese patients and to assist clinical health care workers in selecting appropriate risk assessment tools and guiding individualized prevention measures.
