Follicular unit grafting in chronic ulcers: a valuable technique for integrated management

Abstract Chronic ulcers significantly affect the quality of life of patients and impose a high cost on the healthcare system. The therapeutic management should be comprehensive, taking into consideration the etiological diagnosis of the wound and the characteristics of the wound bed when deciding on a therapeutic proposal appropriate to the healing phase, correcting factors that delay healing. During the epithelialization phase, repair techniques with grafts are recommended to shorten re-epithelialization time, improve the quality of scar tissue, and achieve adequate pain management. Currently, due to the reported benefits of skin appendages, the technique of follicular unit auto-grafting obtained with a scalp punch is among the chosen strategies for wound repair. This is a minimally invasive, outpatient practice, whose technique has advantages over the donor site, patients recovery and well-being.

Bacteriemia asociada a catéteres venosos centrales no tunelizados en niños en hemodiálisis crónica / Bacteremia associated with non-tunneled central venous catheters in children undergoing chronic hemodialysis

Introducción. La infección asociada a catéter venoso central (CVC) es la principal complicación que presentan los pacientes en hemodiálisis en los que se usa este tipo de acceso. Objetivo. Estimar la incidencia de bacteriemia asociada a CVC no tunelizado, analizar la frecuencia de agentes causales y explorar factores de riesgo asociados en niños en hemodiálisis. Población y métodos. Estudio retrospectivo realizado en niños en hemodiálisis por CVC no tunelizado entre el 1 junio de 2015 y el 30 de junio de 2019. Para evaluar factores de riesgo predictores de bacteriemia asociada a CVC, se realizó regresión logística. Los factores de riesgo independiente se expresaron con odds ratio con sus respectivos intervalos de confianza del 95 %. Se consideró estadísticamente significativo un valor de p <0,05. Resultados. En este estudio se incluyeron 121 CVC no tunelizados. La incidencia de bacteriemia fue de 3,15 por 1000 días de catéter. El microorganismo aislado con mayor frecuencia fue Staphylococcus epidermidis (16 casos, 51,5 %). La infección previa del catéter fue el único factor de riesgo independiente encontrado para el desarrollo de bacteriemia asociada a CVC no tunelizado (OR: 2,84; IC95%: 1,017,96; p = 0,04). Conclusiones. El uso prolongado de los CVC no tunelizados para hemodiálisis crónica se asoció con una incidencia baja de bacteriemia. Los gérmenes grampositivos predominaron como agentes causales. La presencia de infección previa del CVC aumentó en casi 3 veces el riesgo de bacteriemia asociada a CVC en nuestra población pediátrica en hemodiálisis.

Introduction. Central venous catheter (CVC)-related infection is the main complication observed in patients undergoing hemodialysis with this type of venous access. Objective. To estimate the incidence of non-tunneled CVC-related bacteremia, analyze the frequency ofcausative agents, and explore associated risk factors in children undergoing hemodialysis. Population and methods. Retrospective study in children receiving hemodialysis via a non-tunneled CVC between June 1 st, 2015 and June 30 th, 2019. A logistic regression was carried out to assess risk factors that were predictors of CVC-related bacteremia. Independent risk factors were described as odds ratios with their corresponding 95% confidence interval (CI). A value of p < 0.05 was considered statistically significant. Results. A total of 121 non-tunneled CVCs were included in this study. The incidence of bacteremia was 3.15 per 1000 catheter-days. The most commonly isolated microorganism was Staphylococcus epidermidis(16 cases, 51.5%). Prior catheter infection was the only independent risk factor for the development of bacteremia associated with non-tunneled CVC (OR: 2.84, 95% CI: 1.01­7.96, p = 0.04). Conclusions. Prolonged use of non-tunneled CVCs for chronic hemodialysis was associated with a low incidence of bacteremia. Gram-positive microorganisms prevailed among causative agents. A prior CVC infection almost trebled the risk for CVC-related bacteremia in our pediatric population receiving hemodialysis.

Primary hyperparathyroidism in pregnancy: a case report highlighting uncommon complication / Hiperparatiroidismo primario en el embarazo: reporte de caso destacando una complicación infrecuente

Abstract Primary hyperparathyroidism (PHPT) is characterized by elevated levels of calcium and parathyroid hormone (PTH). However, the interpretation of diagnostic tests, such as serum calcium and PTH levels, is complex in pregnant women. The aim of this report is to present a case of PHTP in a pregnant adolescent, with a special emphasis on an uncommon complication, as well as diagnostic and treatment strategies. A 17-year-old pregnant female presented with hyper emesis gravidarum and neurological symptoms, leading to the diagnosis of cerebral venous thrombosis. Further investigations revealed hypercalcemia and persistently elevated PTH levels, consistent with PHPT. After local ization studies, the patient underwent an emergency parathyroidectomy with a diagnosis of parathyroid ad enoma. During follow-up, intrauterine growth restric tion and severe preeclampsia developed, necessitating an emergency cesarean section. Both the mother and neonate had favorable outcomes. PHPT is an infrequent condition in the pregnant population, and its diagnosis can be challenging due to the overlap of symptoms with normal physiological changes during pregnancy. The occurrence of uncom mon complications, such as thrombotic phenomena, highlights the need for a comprehensive approach to ensure early detection and management. In most cases, parathyroidectomy is the treatment of choice.

Resumen El hiperparatiroidismo primario (HPTP) se caracteriza por niveles elevados de calcio y hormona paratiroidea (PTH). Sin embargo, la interpretación de pruebas diag nósticas, como los niveles de calcio sérico y PTH, es compleja en mujeres embarazadas. El objetivo de este re porte es presentar un caso de HPTP en una adolescente embarazada, con especial hincapié en una complicación infrecuente, así como en las estrategias diagnósticas y de tratamiento. Una mujer embarazada de 17 años presentó hiperé mesis gravídica y síntomas neurológicos, lo que llevó al diagnóstico de trombosis venosa cerebral. Posterio res investigaciones revelaron hipercalcemia y niveles persistentemente elevados de PTH, consistentes con HPTP. Tras la realización de estudios de localización, la paciente fue sometida a una paratiroidectomía de emergencia con diagnóstico de adenoma de paratiroi des. Durante el seguimiento, se desarrolló restricción del crecimiento intrauterino y preeclampsia grave, lo que resultó en la necesidad de realizar una cesárea de emergencia. Tanto la madre como el neonato evolucio naron favorablemente. El HPTP es una condición infrecuente en la población embarazada y su diagnóstico puede ser desafiante por la superposición de síntomas con los cambios fisiológicos normales del embarazo. La aparición de complicaciones infrecuentes, como fenómenos trombóticos, resalta la necesidad de un abordaje integral para garantizar la detección y el manejo temprano. En la mayoría de los casos, la paratiroidectomía es el tratamiento de elección.

Marcadores trombogénicos en pacientes con trombofilia hereditaria

Fundamento: la trombofilia hereditaria se define como la tendencia genéticamente determinada al tromboembolismo venoso, entidad con una incidencia importante a nivel mundial. Desde el laboratorio pudieran explicarse un gran porcentaje de estos eventos de trombosis. Objetivo: caracterizar desde el punto de vista clínico humoral las trombofilias hereditarias e identificar la posible relación entre marcadores bioquímicos alterados de trombosis y su recurrencia. Método: se realizó un estudio descriptivo y transversal en el laboratorio de hemostasia del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, en el periodo de un año. Se tuvo como referencia 39 pacientes: 26 con eventos trombóticos egresados de los Servicios de Angiología, Cirugía Cardiovascular y Neurología, y 13 sin evento conocido, familiares de primera línea de aquellos pacientes que resultaron con marcadores de trombofilia positivos durante el estudio. Las variables clínicas analizadas fueron: edad, sexo, antecedentes personales y familiares de trombosis y número de eventos trombóticos en el paciente. Se calcularon media, desviación estándar y porcentajes. Resultados: el déficit de proteína S ocupó el primer lugar con 22 (56,4 %). La combinación de parámetros alterados que predominó fue el déficit de proteína C y S con 8 (20,5 %). En el 64,1 % se encontraron dos o más marcadores alterados; se muestran similares porcentajes en pacientes con 1, con 2 dos o más eventos de trombosis. Conclusión: la trombofilia se presentó como una enfermedad que afecta fundamentalmente a mujeres, en edades intermedias de la vida. En pacientes asintomáticos con antecedentes familiares de evento trombótico, sin aparente causa, los marcadores de laboratorio orientan el enfoque diagnóstico. La presencia de dos o más marcadores trombogénicos positivos inclina a la ocurrencia de eventos trombóticos en esta población.

Foundation: hereditary thrombophilia is defined as the genetically determined tendency to venous thromboembolism, an entity with a significant incidence worldwide. A large percentage of these thrombosis events could be explained from the laboratory. Objective: to characterize hereditary thrombophilias from a humoral clinical point of view and to identify the possible relationship between altered biochemical markers of thrombosis and its recurrence. Method: a descriptive and cross-sectional study was carried out in the hemostasis laboratory of the Saturnino Lora Provincial Teaching Hospital of Santiago de Cuba, over a period of one year. 39 patients were used as a reference: 26 with thrombotic events discharged from the Angiology, Cardiovascular Surgery and Neurology Services, and 13 without a known event, first-line relatives of those patients who had positive thrombophilia markers during the study. The clinical variables analyzed were: age, sex, personal and family history of thrombosis and number of thrombotic events in the patient. Mean, standard deviation and percentages were calculated. Results: protein S deficiency ranked first with 22 (56.4 %). The combination of altered parameters that predominated was protein C and S deficiency with 8 (20.5 %). Two or more altered markers were found in 64.1 %; similar percentages are shown in patients with 1, 2 or more thrombosis events. Conclusion: thrombophilia was presented as a disease that mainly affects women, at intermediate ages of life. In asymptomatic patients with a family history of thrombotic event, without apparent cause, laboratory markers guide the diagnostic approach. The presence of two or more positive thrombogenic markers suggests the occurrence of thrombotic events in this population.

Catheter-related thrombosis in a neonatal intensive care unit: a case-control study

Introduction: Catheter-related thrombosis (CRT) accounts for most thrombotic events in the neonate. Objective: Investigate CRT frequency, association with days of catheter use until diagnosis, and number of catheters used, in a single-center Neonatal Intensive Care Unit. Methods: A case-control study that included 14 cases and 42 controls. Data collection occurred between January 2017 and December 2020 in a public NICU. Crude odds ratios (COR) were calculated. The study complied with ethical standards from national guidelines. Results: Two hundred and ninety-four neonates used central venous catheters, of which 14 (4.7%) were diagnosed with CRT. Catheter in use when diagnosis was made was centrally inserted central catheters in 8 (57.1%). Before diagnosis, the cumulative duration of catheter use was 34.5 days and the median number of catheters used was three. A higher SNAPPE-II (COR 1.03; 95% CI 1.01-1.06; p=0.03), cumulative days of catheter use >30 (COR 19.11; 95% CI 2.28-160.10; p=0.007) and number of catheters used ≥3 (COR 7.66; 95% CI 1.51-38.70; p=0.01) were associated with CRT. Conclusion: CRT cases were associated with clinical severity; number of catheters and cumulative days of catheter use. We suggest that screening for thrombosis should be performed in neonates who need a long time of catheter use and more than three catheters. Reducing the duration and number of venous catheters used will help to reduce CRT.

Aneurisma de la vena yugular interna, presentación de caso en adulto / Internal jugular venous aneurysm in an adult: case report

Se presenta el caso de una paciente de 77 años, en quien, durante una cirugía de resección de tumor cutáneo, se observa incidentalmente aumento de volumen cervical derecho de características dinámicas. El hallazgo corresponde a un aneurisma de la vena yugular interna derecha, diagnóstico de mayor frecuencia en población pediátrica, habitualmente de curso benigno.

A 77-year-old woman in whom, during a skin tumor resection surgery, a right cervical swelling with dynamic characteristics was observed. The finding is compatible with an aneurysm of the right internal jugular vein, more commonly obsered in children, usually with a benign course.

Serial values of hematologic variables and deep venous thrombosis: Red cell distribution width is associated with deep venous thrombosis

Abstract Introduction As 30 to 50% of deep venous thrombosis (DVT) cases remain idiopathic, an increased focus on hematologic variables may therefore reveal novel correlates of DVT. Very few studies have investigated the association of hematological parameters with DVT and the causal relationship between them is still to be elucidated. Therefore, we aimed to investigate the association between serial values of hematologic variables and DVT. Methods Complete blood count parameters were serially measured at baseline and then at approximately 3-month intervals for 12 months in 152 adults with the first episode of DVT and 152 age- and sex-matched controls. The odds ratio (OR) with the 95% confidence interval (95%CI) was calculated as a measure of association between hematological parameters and DVT. Results The red cell distribution width (RDW) was the only hematologic variable which showed an independent and consistent association with DVT at all time points (multivariable-adjusted OR [95%CI] 3.38 [1.28 - 8.91] at baseline, 2.24 [0.85 - 5.92] at 3 months and 2.12 [0.81 - 5.55] at 12 months for RDW > 14.0%). This association was higher for provoked DVT than unprovoked DVT and for DVT plus pulmonary embolism than DVT alone. No significant correlation was found between the high RDW and classical thrombotic risk factors, except malignancy. Conclusions We demonstrated an independent and consistent association of the high RDW with the first episode of DVT in adult patients. The study was probably underpowered to evaluate the association between the high RDW and recurrent DVT. Further large studies with long follow-up are needed to confirm this association.

Efectividad de una estrategia educativa en la prescripción de la tromboprofilaxis adecuada en un servicio de Medicina Interna de un hospital general / Effectiveness of an educational strategy in increasing the prescription of adequate thromboprophylaxis in the internal medicine service of general hospital

RESUMEN Objetivo Determinar el impacto de una intervención educativa sobre la frecuencia de prescripciones médicas adecuadas de tromboprofilaxis en un servicio de medicina de un hospital general. Material y métodos Estudio quasi experimental, en el cual en la fase pre-intervención se obtuvieron las frecuencias de indicación de tromboprofilaxis adecuada por parte de los médicos del servicio de medicina. Se realizó una intervención educativa de 8 semanas a este mismo grupo de médicos. En la fase post intervención se midió la frecuencia de la tromboprofilaxis adecuada a los 2 y 4 meses después de la intervención. Resultados La intervención educativa se implementó en 112 médicos residentes de las especialidades de medicina. La totalidad de prescripciones fueron hechas por los médicos residentes de primer año y refrendadas por su médico supervisor. Previamente a la intervención se obtuvieron 47 (44,35%) prescripciones adecuadas, 13 (12,26%) subóptimas, 4 (3,77%) inadecuadas y 42 (39, 62%) ausencia de prescripción. Luego de la intervención se obtuvieron a los 2 meses subsiguientes: 78 (75,72%) prescripciones adecuadas, 7 (6,79%) subóptimas, 4 (2,91%) inadecuadas y 15 (14,58%) ausencias de prescripción, habiendo diferencia significativa con el nivel basal. A los 4 meses subsiguientes postintervención se obtuvieron: 86 (83,49%) adecuada, 5(4,85%) subóptima, 2 (1,94%) inadecuada y 10 (9,72%) ausencia de prescripción, habiendo diferencia significativa con el nivel basal. No hubo aumento en la frecuencia de sobre uso. Conclusiones La aplicación de una estrategia educativa al personal médico fue efectiva en el incremento de las prescripciones de tromboprofilaxis correctamente indicadas en un servicio de medicina. No se encontró sobreuso de la tromboprofilaxis luego de la intervención.

SUMMARY Objective To determine whether an educational intervention strategy would improve the frequency of medical prescriptions for adequate thromboprophylaxis in a medicine service. Methods Quasi-experimental study, in which in the pre-intervention phase the frequencies of indication of appropriate thromboprophylaxis by physicians from the medicine service were obtained. An 8-week educational intervention was carried out with this same group of doctors. In the post-intervention phase, the frequency of adequate thromboprophylaxis was measured at 2 and 4 months after the intervention. Results The educational intervention was implemented in 112 resident physicians in medicine specialties. All prescriptions were made by the first-year resident physicians and endorsed by their supervising physician. Prior to the intervention, 47 (44.35%) adequate prescriptions were obtained, 13 (12.26%) suboptimal, 4 (3.77%) inadequate, and 42 (39, 62%) no prescription. After the intervention, the following 2 months were obtained: 78 (75.72%) adequate prescriptions, 7 (6.79%) suboptimal, 4 (2.91%) inadequate and 15 (14.58%) no prescriptions, there being a significant difference with the baseline level. At the subsequent 4 months post-intervention, the following were obtained: 86 (83.49%) adequate, 5 (4.85%) suboptimal, 2 (1.94%) inadequate and 10 (9.72%) no prescription, with a difference significant with the baseline level. There was no increase in the frequency of overuse. Conclusions The application of an educational strategy to medical personnel was effective in increasing correctly indicated thromboprophylaxis prescriptions in a medical service. No overuse of thromboprophylaxis was found after the intervention.

Cardiovascular events associated with thalidomide and prednisone in leprosy type 2 reaction

Abstract Background: Thalidomide is the drug of choice for the treatment of type 2 leprosy reactions and is often associated with corticosteroids. The use of these drugs in multiple myeloma is associated with the risk of cardiovascular events, but there have been few studies assessing this risk in leprosy patients. Objective: To evaluate the occurrence of cardiovascular events in patients with multibacillary leprosy and their correlation with the use of thalidomide and prednisone. Methods: Analytical cross-sectional study of all patients diagnosed with multibacillary leprosy treated at the Dermatology Service between 2012 and 2022, using electronic medical records. Thromboembolic vascular events, both arterial and venous, including acute myocardial infarction, were considered. The main independent variable was the concomitant use of thalidomide and prednisone during follow-up. Results: A total of 89 patients were included, of which 19 used thalidomide and prednisone concomitantly. There were five cardiovascular events (26.3%), three of which of deep venous thrombosis. The combined use of medications was associated with the events (PR = 6.46 [3.92 to 10.65]; p<0.01). Study limitations: Small number of events, single-center retrospective study. Conclusion: The hypothesis of an association between cardiovascular events and the concomitant use of thalidomide and prednisone is supported, but more robust prospective studies are required for a better assessment.

Imaging features of severe unilateral transverse sinus and sigmoid sinus thromboses and efficacy and safety of intravascular interventional therapy in them / 中华神经医学杂志

Objective:To summarize the imaging features of severe unilateral transverse sinus and sigmoid sinus thromboses, and evaluate the efficacy and safety of intravascular interventional therapy in them.Methods:Thirty-seven patients with severe unilateral transverse sinus and sigmoid sinus thromboses clinically mainly manifested as intracranial hypertension and accepted endovascular intervention in Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University from June 2012 to September 2022 were chosen; their clinical data were retrospectively analyzed and imaging features were summarized. Short-term efficacy was evaluated according to blood flow restoration degrees and pressure gradient reduction in the occlusive sinus and modified neurological symptoms before and after endovascular intervention. Hospitalized complications were observed; safety and long-term efficacy were evaluated according to postoperative clinical follow-up and imaging results 6-12 months after endovascular intervention.Results:(1) Preoperative brain MRI and (or) CT showed different degrees of swelling of the brain tissues, with the affected side as the target; mixed signals/density shadow could be seen in the blocked transverse sinus and sigmoid sinus; venous cerebral infarction or post-infarction cerebral hemorrhage could be combined in some patients. MRV, CTV and DSA showed poor or completely occluded transverse sinus and sigmoid sinus while normal in the contralateral side; obvious thrombus filling-defect was observed in the occluded venous sinus after mechanical thrombolysis. (2) Occlusive sinus blood flow was restored in all patients after endovascular intervention, and pressure gradient of the occlusive segment decreased from (16.6±3.3) mmHg before to (2.8±0.8) mmHg after endovascular intervention. Before discharge, clinical symptoms of all patients were significantly improved (modified Rankin scale [mRS] scores of 0 in 30 patients, 1 in 5 patients, 2 in 1 patient and 3 in 1 patient), and 2 patients had unilateral limb movement disorder (muscle strength grading III and IV, respectively). All patients received clinical follow-up for (9.6±3.0) months. At the last follow-up, neurological function obviously improved compared with that before endovascular intervention, without new neurosystem-related symptoms (mRS scores of 0 in 30 patients, 1 in 6, and 2 in 1 patient). In 34 patients received MRV or DSA follow-up, 28 had complete recanalization of occlusive sinus and 6 had partial recanalization, without obvious stenosis or recurrent occlusion.Conclusions:Severe unilateral transverse sinus and sigmoid sinus thrombosis can cause local intracranial venous blood stasis, and then cause "increased regional venous sinus pressure", which is manifested as unilateral brain tissue swelling and even venous cerebral infarction or post-infarction cerebral hemorrhage. Early diagnosis and endovascular intervention can obviously improve the prognosis of these patients, enjoying good safety.

Association of cerebral venous outflow with first-pass effect in anterior circulation large vessel occlusion accepted mechanical thrombectomy / 中华神经医学杂志

Objective:To explore the association of cerebral venous outflow assessed by CT angiography (CTA) with first pass effect (FPE) in patients with acute anterior circulation large vessel occlusion accepted mechanical thrombectomy (MT).Methods:A retrospective analysis was performed; patients with acute anterior circulation large vessel occlusion accepted MT and CTA in Department of Neurology, Affiliated Hospital of Xuzhou Medical University from July 2018 to June 2021 were consecutively enrolled. Cerebral venous outflow in baseline CTA was evaluated using Cortical Vein Opacification Score (COVES). Patients were categorized into either FPE or non-FPE groups based on recanalization of occluded vessels after initial MT. General information, clinical features, radiological data, and surgery-related data between the 2 groups of patients were collected and compared. Significant variables ( P<0.1) from univariate analysis were included into a multivariable Logistic regression model to explore the relation between COVES and FPE. Predictive value of COVES in FPE was assessed using receiver operating characteristic (ROC) curve. Results:Out of the 143 patients enrolled in this study, 52 were into the FPE group and 91 were into the non-FPE group. Compared with the non-FPE group, the FPE group had higher COVES scores, higher proportion of patients with good cerebral venous drainage (COVES≥3), smaller core infarct volume, and shorter time from femoral artery puncture to vessel recanalization, with significant differences ( P<0.05). Multivariable Logistic regression analysis revealed that COVES was still corelated with FPE after adjusting covariates such as baseline NIHSS scores, core infarct volume, and time from femoral artery puncture to vessel recanalization ( OR=0.730, 95% CI: 0.567-0.940, P=0.015). ROC curve demonstrated that the combined model of COVES with aforementioned factors (COVES scores+baseline NIHSS scores+core infarct volume+time from femoral artery puncture to vessel recanalization) had an area under the curve of 0.757 (95% CI: 0.672-0.841, P<0.001), with sensitivity of 61.5% and specificity of 78.0%. Conclusion:Favorable cerebral venous drainage is an independent predictor for successful FPE in patients with acute anterior circulation large vessel occlusion accepted MT.

Application evaluation of hydrocolloid silver-containing dressing and Jiedu Shengji ointment / 中国现代医生

@#Objective To explore the clinical effect of hydrocolloid silver-containing dressing combined with Jiedu Shengji ointment in the nursing of venous ulcer wounds of lower limbs.Methods A total of 84 patients with venous ulcer wounds of lower limbs admitted to the wound ostomy clinic of Jiading Central Hospital,Shanghai University of Medicine&Health Sciences from October 2022 to May 2023.Patients were divided into observation group and control group according to the method of single and double days of admission,with 42 cases in each group.The patients in two groups were treated with"three-step dressing change",the patients in control group were treated with conventional external dressing,and the patients in observation group were treated with reticular hydrocolloid silver dressing and Jiedu Shengji ointment for local use.The nursing effects of the two groups were compared.Results The total effective rate of observation group was higher than that of the control group(P<0.05).The wound healing time,treatment time and dressing change times in the observation group were lower than those in control group(P<0.05).The levels of interleukin(IL)-6 and IL-8 in observation group were lower than those in control group(P<0.05).The score of self-conscious pain in observation group was lower than that in control group(P<0.05).The total nursing satisfaction rate of observation group was higher than that of control group(P<0.05).Conclusion"Three-step dressing change"is an effective wound treatment method in the nursing care of patients with deep venous ulcer of lower limbs.It can further accelerate the wound healing process and effect with the local use of reticular hydrocolloid silver-containing dressing and Jiedu Shengji ointment.

Study on the effect of prolonging the use time of non-corng needles in totally implantable venous access ports in patients with breast cancer / 中国现代医生

Objective To explore the feasibility and safety of prolonging the use time of non-corng needles in totally implantable venous access ports for patients with breast cancer.Methods A total of 100 breast cancer patients implanted in the chest wall totally implantable venous access ports of Zhejiang Cancer Hospital in June to December 2022 were randomly divided equally into 7-day group and 8-day group by means of random number table according to the time of removing the non-destructive needle.Catheter function evaluation,catheter-related complications,comfort evaluation and cost calculation were used for investigation and analysis.Results In both groups,blood was returned from the infusion port catheter and the catheter flushed smoothly.There were 1 case of local skin allergy in 7-day group and 2 cases in 8-day group.In the comfort evaluation,comfort accounted for 86%in 7d group and 90%in 8d group,and the difference was not statistically significant(P>0.05).The maintenance cost of the infusion port per capita in the 7d group was higher than that in the 8d group,and the difference was statistically significant(P<0.05).Conclusion Under certain circumstances,after evaluation by nurses,the use time of non-corng needles in totally implantable venous access ports of breast cancer patients can be appropriately prolonged,which can improve work efficiency and reduce costs.

Clinical application of thromboelastography in the prevention of lower extremity intermuscular venous thrombosis after knee arthroscopy / 中国输血杂志

【Objective】 To explore the guiding value of thromboelastography (TEG) in the formulation of personalized anticoagulation regimen after knee arthroscopy. 【Methods】 A total of 50 patients who underwent knee arthroscopy in our hospital from April to August 2023 were randomly divided into two groups. Twenty-seven patients with routine anticoagulation were selected as the control group, and 23 patients with personalized anticoagulation were selected as the experimental group. Conventional anticoagulation was a prophylactic dose of low molecular weight heparin calcium (LMWHC) selected according to body weight, once a day to 7 days after surgery. Personalized anticoagulation was performed according to the prophylactic dose of LMWHC until postoperative day 3. On postoperative day 3, LMWHC was changed to aspirin according to the TEG return index (MA>70 mm, α Angle >72°, K value <1 min), and the initial prophylactic dose was 100 mg/d. LMWHC was changed to rivaroxaban when R<5 min, and the prophylactic dose was 10 mg/d until postoperative day 7. Patients with hypocoagulation or subcutaneous ecchymosis stopped the drug first, and if it was further aggravated, component blood transfusion was performed according to the TEG results. The difference of Caprini score in perioperative period, the correlation between TEG and CCT on postoperative day 1, and the accuracy of predicting thrombosis on postoperative day 7 were compared between the two groups using the receiver operating characteristic curve (ROC). 【Results】 There was a significant difference in Caprini score between the two groups at 7 days after operation (P<0.05), suggesting that the adjustment of anticoagulant drugs in the experimental group was effective at 3 days after operation. Pearson correlation evaluation showed that there was a strong positive correlation between maximum coagulation intensity (MA) in TEG and platelet (Plt) in CCT at day 1 after surgery (P<0.05). Thrombosis was found in the control group at 7 days after operation, all of which were CMVT and disappeared after therapeutic antithrombotic therapy. MA was included in the ROC curve for model analysis. The area under the ROC curve (AUC) of the control group was 0.819, and the AUC of the experimental group was 0.508. It was found that the control group model had higher accuracy in predicting the formation of CMVT. 【Conclusion】 Individualized anticoagulation under TEG monitoring can effectively reduce the occurrence of CMVT after knee arthroscopy, which has guiding value for anticoagulation and thrombosis prevention.

A laboratory model for evaluating the risk of thrombosis in patients with chronic venous insufficiency / 中国输血杂志

【Objective】 To explore the predictive value of combined thromboelastography(TEG), coagulation index and platelet parameters in evaluating the risk of thrombosis in patients with chronic venous insufficiency(CVI). 【Methods】 A total of 359 patients with CVI were enrolled in our hospital from November 2020 to March 2022, and divided into VTE group and non-VTE group according to the occurrence of venous thromboembolism (VTE).The baseline characteristics of the two groups and the value of combined TEG, coagulation index and platelet parameters in predicting the risk of VTE in patients with CVI were analyzed. The risk factors were screened by univariate logistic regression analysis, and the prediction model was constructed by multivariate logistic regression. The performance of the model was evaluated by area under the curve (AUC) and sensitivity specificity. 【Results】 Compared with the non-VTE group, the R value (3.27±0.71 vs 3.87±1.16, P<0.05), the prothrombin time (PT)(11.08±3.02 vs 12.86±3.48, P<0.001)and the platelet distribution width (PDW) (12.01±3.87 vs 13.98±3.20, P<0.001)of the VTE group decreased, while fibrinogen (Fib) (3.46 vs 3.10, P<0.05) and D-dimer (DD) (3.00 vs 1.12, P<0.001)increased. It was found that the area under the ROC curve of the thrombosis prediction model based on PT, DD, R value, Fib and PDW was 0.842 8, with the sensitivity and specificity of 36.78% and 95.59%, respectively. The decision curve analysis(DCA)indicated that patients would benefit when the model′s predicted probability ranged from 0.1 to 0.7. 【Conclusion】 The combination of TEG, coagulation index and platelet parameters is effective in predicting the risk of VTE in patients with CVI.

Evaluation of Risk Factors of Venous Thromboembolism in Patients Undergo-ing Gynecological Surgery and Establishment of a Modified Score Model / 实用妇产科杂志

Objective:To study the risk factors of venous thromboembolism(VTE)and the predictive value of the improved VTE score model to identify the risk of VTE in gynecological surgery patients.Methods:From Janu-ary 1,2020 to December 31,2022,41 patients with VTE after gynecological surgery were selected as the VTE group,and a total of 164 patients with adjacent gynecological surgeries during the same period were selected as the non-VTE group with a ratio of 1 :4.Univariate and multivariate Logistic regression analysis were used to ana-lyze the risk factors of VTE after gynecological surgery,and a modified VTE risk factor rapid assessment model(referred to as the improved VTE score model)was constructed.The receiver operating characteristic(ROC)curve was used to study the predictive value for VTE for in gynecological surgery,and compared with the Caprini score model(Caprini table for short).Results:①Multivatiate Logistic regression analysis showed that there were independent risk factors for postoperative VTE in gynecology surgery(OR＞1,P＜0.05),including age≥60 years,BMI≥28 kg/m2,malignant tumors,surgery time＞3 hours,history of thrombosis,and the increased D-di-mer difference before and after surgery.②The Area under Curve(AUC)of ROC was 0.963 in the improved VTE score model with a Youden index 81.10％,sensitivity 87.80％and specificity 93.29％.The AUC of the Caprini score model was 0.888 with Youden index 63.41％,sensitivity 73.17％and specificity 90.24％.The improved VTE score model the Caprini score model identified 92.68％and 85.37％of VTE patients as high-risk or ex-tremely high-risk,respectively,but the difference was not statistically significant(P＜0.05).Conclusions:More attention should be paid to the six independent risk factors for postoperative VTE in gynecology surgery.The two score models showed a similar identified level.However,the improved VTE score model is more simple and easier to operate,has better practicality,and has certain clinical promotion value.

Comparative analysis of domestic Octoparms and imported Celect inferior vena cava filter in interventional treatment of venous thromboembolism / 实用放射学杂志

Objective To compare and analyze the application value of domestic Octoparms and imported Celect inferior vena cava filter(IVCF)in the interventional treatment of venous thromboembolism(VTE).Methods Forty patients with VTE were randomly divided into Octoparms group(experimental group)and Celect group(control group)according to the double-blinded method of the central random system.All the patients underwent filter placement,catheter-directed thrombolysis and filter retrieval.The primary end point was the success of filter placement and retrieval,and the secondary end point included indwelling complications such as the occurrence of pulmonary embolism(PE)and filter tilt and migration.Results Forty patients were enrolled in this study,22 patients and 18 patients were divided into the experimental group and the control group,respectively.Among them,11 cases were identified with right lower extremity deep vein thrombosis,29 cases with left lower extremity deep vein thrombosis,17 cases with PE,and 6 cases with inferior vena cava thrombosis.The success rate of IVCF placement was 100%in all participants.Immediately after filter place-ment,the angle of filter tilt was(3.8±2.3)° in the experimental group and(4.9±2.8)° in the control group(t=1.44,P=0.16).Filter retrieval was successful in 21 cases(21/22,95.5%)of the experimental group and 17 cases(17/18,95.5%)of the control group.There was no significant difference between the two groups(t=0.14,P=0.89).The mean indwelling time of filter was(8.0±2.1)days in the experimental group and(9.7±3.1)days in the control group(t=0.73,P=0.47).The angle of filter tilt was(5.3±3.4)° in the experimental group and(5.7±7.7)° in the control group(t=0.19,P=0.85).There was no significant difference for filter placement and retrieval between the two groups(t=0.48 and 2.00,P=0.06 and 0.64,respectively).There were no complications of filter migration,strut penetration or new PE in both groups.Conclusion The application value of domestic Octoparms and impor-ted Celect IVCF is similar in interventional treatment of VTE.

The influence of specialized nurses′ assistance mode on the maintenance ability of PICC catheter in nursing hospital from the perspective of combination of medical care and nursing care / 中国实用护理杂志

Objective:To evaluate the effect of nursing specialist nurses′ assistance on the ability of nursing home nurses to maintain venous catheter under the vision of combination of medical care and nursing care, providing reference for carrying out specialized nursing assistance work in grassroots hospitals.Methods:This study was an experimental study. According to Miller′s pyramid theory, a model of specialist nurse assistance was established with specialized technology as the core. From January to December 2021, three nursing hospitals in Suzhou were assisted. Convenience sampling method was used to investigate the ability of intravenous catheter maintenance, the incidence of central venous catheter maintenance defects, the incidence of central venous catheter complications and unplanned extubation, and the satisfaction of doctors and patients before and after help.Results:Totally 86 nurses were included, aged (33.17 ± 2.31) years old. After the help, the theoretical and operational skill scores of nurses in the nursing home were (89.77 ± 2.11) and (92.75 ± 1.62) points, respectively, which were significantly higher than those before the help (60.84 ± 2.71) and (79.81 ± 1.68) points, and the differences were statistically significant ( t=-84.96, -52.12, both P<0.05). Among the maintenance defects of central venous catheter in nursing homes, incomplete labeling, film wrapping, blood seepage, catheter discounting, non-standard film fixing, and incomplete information of extended care were 9.95% (21/211), 8.53% (18/211), 2.84% (6/211), 6.16% (13/211), 4.74% (10/211), 2.37% (5/211) after help, all lower than 50.57% (89/176), 43.18% (76/176), 14.20% (25/176), 25.57% (45/176), 18.18% (32/176), 11.93% (21/176) before help. The differences were statistically significant ( χ2 values were 14.00 to 77.81, all P<0.05). The incidence of medical adhesive related skin injury, catheter obstruction complications and unplanned extubation were 4.44% (4/90), 3.33% (3/90) and 2.22% (2/90), respectively, which were lower than 20.51% (16/78), 15.38% (12/78) and 11.54% (9/78) before help. The differences were statistically significant ( χ2=8.81, 6.06, 4.50, all P<0.05). Doctors′ satisfaction with nurses and patients′ satisfaction with nursing work were 96.43%(27/28) and 93.75%(45/48), respectively, both higher than 71.43%(20/28) and 72.73%(32/44) before help, and the differences were statistically significant respectively ( χ2=4.77, 5.97, both P<0.05). Conclusions:From the perspective of combination of medical care and nursing care, the maintenance and assistance of intravenous catheters by the team of intravenous therapy nurses in nursing hospitals can effectively reduce the incidence of central venous catheter complications and unplanned extubation, improve the maintenance ability of intravenous catheters of nurses in nursing hospitals, and help to improve the quality of nursing care in nursing hospitals.

Comparison of the predictive value of venous thromboembolism assessment tools in medical inpatients / 中国实用护理杂志

Objective:A comparison was made between the predictive efficacy of the Padua Score and the simplified Assessment Scheme Recommended by Chinese experts (hereinafter referred to as the Simplified Method) for the risk assessment of venous thromboembolism (VTE) in medical inpatients, aiming to provide a reference for the clinical selection of appropriate risk assessment tools.Methods:A retrospective cohort study was conducted, selecting 42 257 internal medicine inpatients discharged from Peking University Shenzhen Hospital between May 1, 2021, and April 30, 2022, using a convenience sampling method. Data collected included general information upon admission, VTE-related information, occurrences of VTE during hospitalization, and results from the two assessment tools. The predictive efficacy of the tools was evaluated by plotting ROC curves and calculating AUC, sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy.Results:Among 42 257 patients, there were 21 065 male and 21 192 female participants, aged (55.04 ± 15.17) years old. The incidence rate of VTE among medical inpatients was 2.24% (948/42 257). The AUC for Padua Score and the Simplified Method in medical patients were 0.735 (95% CI 0.717-0.753) and 0.582 (95% CI 0.561-0.602), respectively. Sensitivities were 49.4% and 18.2%, specificities were 89.6% and 98.1%, positive predictive values were 9.9% and 17.7%, negative predictive values were 98.7% and 98.1%, and predictive accuracy were 88.7% and 96.3%, respectively. The departments with the highest incidence rates of VTE during hospitalization were rehabilitation medicine, emergency, neurology, geriatrics, and respiratory medicine. Within these departments, the AUC values for the Padua Score and the Simplified Method were as follows: 0.864 and 0.612, 0.782 and 0.653, 0.792 and 0.664, 0.850 and 0.551, 0.867 and 0.664, respectively. Conclusions:The Padua Score demonstrated better predictive efficacy compared to the Simplified Method. However, the Simplified Method had more accessible assessment criteria and could serve as an initial VTE risk screening tool in emergency situations or when complete data are not available.

Establishment of animal model of cervicofacial venous malformations with external jugular vein in sheep / 实用口腔医学杂志

Objective:To establish the animal model of cervicofacial venous malformations(VMs)by surgical reconstruction of exter-nal jugular vein in sheep.Methods:The external jugular veins of 5 sheep were dissected,and the position,course,branch and exter-nal diameter were observed and measured.The models of VMs with draining and returning veins were constructed by suturing or constric-ting the proximal part of main trunk and ligating or constricting the distal part of the jugular or branch veins.The animal model was eval-uated by Doppler ultrasound,gross observation and histological observation at the 4th week after surgery.Results:The external jugular veins of sheep is in the lateral side of bilateral neck,and the main trunk is formed by the maxillary vein and lingual facial vein.The ex-ternal diameter ranges from 6 to 12 mm,with an average external diameter of 9.3 mm.Immediately after the external jugular vein was sutured and narrowed at the proximal part of the main vein,the distal part of the vein branch was ligated or narrowed,the blood flow speed slowed down and the veins in the model area bulged.4 weeks after surgery,gross observation showed that most veins narrowed and thrombosis was formed in part of the venous lumen.The central region of some specimens was dilated,and the peripheral collateral veins were dilated in some models.Doppler ultrasonography showed that the lumens of most veins were dilated and the returning veins and the inflow veins were narrowed.Colored blood flow was seen in the lumen.Histological observation showed that the structure of vein endothelium and wall was close to the normal vein,and the vein vessel wall of some specimens was thickened.Conclusion:The VMs model estab-lished by external jugular vein of sheep basically meets the re-quirements and is expected to be used in the therapeutic meth-odology research of cervicofacial VMs.