Vein Thrombosis Of Lower Extremity Research Articles

Causal role of circulating inflammatory cytokines in cardiac diseases, structure and function

BackgroundInflammation is implicated in cardiovascular disease (CVD) pathogenesis, but causal roles of specific circulating inflammatory cytokines remain unclear. Mendelian randomization (MR) studies are well-poised to provide etiological insights beyond constraints of conventional research. MethodsWe conducted a large-scale MR study to investigate potential causal relationships of 91 inflammatory proteins with CVD outcomes and cardiac remodeling using summary-level genetic data. Outcomes included coronary artery disease, myocardial infarction, stroke, atrial fibrillation, heart failure, abdominal aortic aneurysm, deep vein thrombosis of lower extremities, pulmonary embolism, cardiac structure and functional parameters. Inverse-variance weighted analysis was undertaken as the primary analysis, with several sensitivity analyses applied. ResultsHepatocyte growth factor (HGF) demonstrated a causal relationship with increased susceptibility to both any stroke (OR 1.111; 95 % CI 1.044 - 1.183; P = 9.50e-04) and ischemic stroke (OR 1.121; 95 % CI 1.047 - 1.200; P = 1.04e-03). Programmed cell death 1 ligand 1 (PD-L1) was negatively associated with atrial fibrillation risk (OR 0.936, 95 % CI 0.901 - 0.973; P = 7.69e-04). CCL20, CDCP1, Flt3L and IL-10RA were identified as causal coronary artery disease risk factors, while LIF and ST1A1 had protective effects. IL-4 and LIF-R demonstrated causal links with right heart functional changes. ConclusionsOur MR study nominates specific circulating inflammatory cytokines as potential targets for CVD treatment and prevention. Further research into mechanisms and clinical translation are warranted.

Observation of the short-term curative effect of using SuperPATH approach to treat elderly femoral neck fractures with schizophrenia.

As China enters an aging society, the incidence of femoral neck fractures is increasing year by year. For some patients, total hip arthroplasty (THA) is the treatment of choice for displaced femoral neck fractures. Schizophrenia is a common combination of elderly patients with femoral neck fractures, and there are few reports on the treatment. This study describes the short-term efficacy of the supercapsular percutaneously assisted (SuperPATH) approach in the treatment of patients suffered with displaced femoral neck fractures combined with schizophrenia. A retrospective analysis of 20 elderly patients with displaced femoral neck fractures combined with schizophrenia who underwent THA using the SuperPATH approach. Record demographic data, postoperative reexamination of X-ray film to observe the position and the loosening condition of the prosthesis, the length of hospitalization, complications in the hospital and after discharge. The Harris score of hip joint function was used to evaluate postoperative hip joint function. The average age of the 20 patients was 73.1 years. All patients were followed up by outpatient clinic or telephone. The follow-up time was 3-12 months, with an average of 9.2 months. There was no incision infection, no tissue structure damage such as important nerves and blood vessels, and no complications such as early dislocation, loosening of the joint prosthesis, and deep vein thrombosis of lower extremities. The efficacy of the last follow-up was evaluated according to the Harris score of hip joint function: an average of 91 points (78-98 points); 13 cases were excellent, 5 cases were good, and 2 cases were fair. The SuperPATH approach has the advantages of less surgical damage, shorter recovery time, good surgical safety, preserving the normal tension of the muscles around the hip joint, and reducing the incidence rate of early postoperative dislocation of the joint prosthesis. The THA of the SuperPATH approach can treat patients with displaced femoral neck fractures combined with schizophrenia safely and effectively.

Retracted: Preventive Effect of Intensive Nursing Intervention of Deep Vein Thrombosis of Lower Extremities in Elderly Patients with Gastrointestinal Tumors after Surgery.

[This retracts the article DOI: 10.1155/2022/2967981.].

The prevalence of deep Venous thrombosis of the lower extremity in hospitalised bedridden orthopaedic patients: a pilot study.

To determine the prevalence of objectively confirmed deep vein thrombosis of lower extremities in bedridden hospitalised orthopaedic patients who received no thromboprophylaxis. The prospective cross-sectional study was conducted at Dr Ruth Pfau Civil Hospital, Karachi, from April to June 2021, and included all patients aged ≥40 years admitted for intended major lower limb surgery and expected to be confined to the bed for at least 4 days. Duplex ultrasound scanning of both legs was used to confirm deep vein thrombosis. Data was analysed using SPSS 22. Of the 104 subjects, 60(57.6%) were males and 44(42.3%) were females. The overall mean age was 51.9±7.4 years. The most common type of fracture was the neck of femur 28(26.9%). The mean delay between the fracture and admission was 6.44±4.9 days. The mean length of hospital stay was 12.76±3.8 days. The overall prevalence of deep vein thrombosis was 16(15.3% and none of these patients had any symptom at all. There was 15.3% prevalence of deep vein thrombosis. Considering that the condition is potentially lethal, routine prophylaxis for all at-risk patients should be encouraged.

Results of the surgical treatment of intra-articular fractures of the distal femur using a retrograde intramedullary technique

Background: Distal femoral fractures are a widely spread problem in traumatology, which can be caused by both a high-energy trauma and a low-energy trauma in senile patients with osteoporosis. The conservative treatment shows little promise. The surgical treatment of patients is still a challenge for orthopedic surgeons regarding both the technical aspect and a high risk of complications. There are several surgical methods with the use of plates and nails, but there is still no universal conception of the surgical treatment.
 Aim: comparative analysis of methods of intramedullary retrograde osteosynthesis and bone osteosynthesis in the treatment of fractures of the distal femur.
 Methods: In this study, we evaluated the treatment results of 46 patients who underwent osteosynthesis for intraarticular fractures of the distal femur using an intramedullary retrograde nail. The evaluation was carried out based on such parameters as the duration of the operation and the time from the moment of injury to the operation, the intraoperative blood loss and the function of the knee joint. On average, the operation time using a retrograde femoral nail was 45 minutes. Reducing the duration of the operation improved the functional results of the treatment. Reducing the operation time when installing a retrograde intramedullary nail was achieved with a relatively simple technique for installing this type of a fixator and the use of minimally invasive approaches.
 Results: On average, the operation time using a retrograde femoral nail was 45 minutes. Reducing the duration of the operation improved the functional results of treatment. Reducing the operation time when installing a retrograde intramedullary nail was due to a relatively simple technique for installing this type of fixator and the use of minimally invasive approaches. One year after the surgery, the following mean values were achieved: 78 (6485) points according to the KSS knee score, 85 (6889) points according to the KSS function score, 3.1 (1.34.2) cm for the severity of pain syndrome according to the VAS scale, 105 (88120) degrees for the flexion in the knee joint. However, a number of post-op complications were observed: deep vein thrombosis of lower extremities was found in 6 (13.1%) patients, formation of a false-joint was seen in 3 (6.5%) patients, 1st grade arthritis of the knee joint was detected in 36 patients (78.2%), 2nd grade arthritis was observed in 10 patients (21.8%). 3rd grade arthritis was not detected. 3.5 years after the operation, none of the patients needed a knee joint replacement.
 Conclusion: Retrograde intramedullary osteosynthesis in type C distal femoral fractures promotes early rehabilitation, a complete recovery of the knee joint function and healing of the fracture, and represents an effective method of treatment.

Incidence and location of deep vein thrombosis of lower extremity following surgery of tibial plateau fracture

<div class="Section1"><p><strong>Background:</strong><strong> </strong>Tibial plateau fractures are commonly seen fractures of lower limb. They are challenging to manage since they are mostly associated with soft tissue injuries. Deep vein thrombosis (DVT) is a significant cause of morbidity and pulmonary embolism can even cause mortality in all hospitalized patients, especially after trauma and lower extremity fracture, which further carries risk of significant morbidity and mortality. We aim to evaluate the epidemiological characteristics of postoperative DVT in tibial plateau fractures.</p><p><strong>Method: </strong>A prospective observational randomized study was performed. A total of 79 patient were included in this study who had proximal tibia fractures. Pre-op ultrasonography was done and post operative ultrasonography was done following proximal tibia plating surgery on day 2. Successive evaluation with USG was done at week 2, week 3 and week 4 for DVT. If DVT is diagnosed it will be managed medically.</p><p><strong>Result: </strong>A total of 79 patients were included in the study, 28 were females and 51 males. 4 out of 79 patients were diagnosed with DVT following surgery of tibial plateau fracture. Predominantly DVT was seen in male patient of elderly age group who had high energy trauma operated by open reduction with duration of surgery of more than 1 hour. 3 out of 4 patients had distal DVT and 1 had proximal DVT.</p><p><strong>Conclusions</strong>: Six risk factors were found to be strongly associated with DVT i.e., old age, male gender, high energy trauma, increased preoperative interval, open reduction and prolonged duration of surgery. These epidemiologic data will be helpful in individual assessment, risk categorisation and development of targeted prevention programs.</p></div>

Effectiveness analysis of MAKO robotic-arm assisted total hip arthroplasty via direct anterior approach for bony fused hips

To investigate the effectiveness of MAKO robotic-arm assisted total hip arthroplasty (THA) via direct anterior approach (DAA) for bony fused hips in ankylosing spondylitis (AS). Between June 2021 and January 2022, MAKO robotic-arm assisted THA via DAA was applied to treat 10 cases (12 hips) of AS with bony fused hips. There were 7 males and 3 females; the age ranged from 30 to 71 years, with an average age of 42.4 years. The duration of AS was 12-35 years, with an average of 21.4 years. The preoperative hip was ankylosed in flexion in 3 cases, with a flexion angle of 20°, 30°, 35°, respectively; 9 cases were ankylosed in extension. The operation time and complications were recorded; the visual analogue scale (VAS) score, Harris score, and Oxford hip scale (OHS) score before and after operation, and postoperative range of motion (flexion, extension, internal rotation, external rotation, adduction, and abduction) were used to evaluate the recovery of joint function; according to the postoperative anteroposterior X-ray film and CT scan of both hip joints, the abduction angle, anteversion angle, the difference between bilateral combined off-set and the lower limb length discrepancy were measured. The operation time ranged from 80 to 190 minutes (mean, 134.6 minutes). All 10 patients were followed up 5-11 months (mean, 7.4 months). There was no serious adverse events such as incision infection, deep vein thrombosis of lower extremities, hip redislocation, aseptic loosening of the prosthesis, or death. At 5 months after operation, the acetabular prosthesis angle of abduction was 37°-45° (mean, 40.3°), anteversion angle was 9°-20° (mean, 15.8°). The difference between bilateral combined off-set was 0-10 mm (mean, 4.3 mm); the lower limb length discrepancy was 0-12 mm (mean, 3.5 mm). At last follow-up, the average range of motion of the hip joint was 89.2° in flexion (range, 80°-100°), 1.7° in extension (range, -5°-10°), 7.1° in internal rotation (range, 0°-15°), 20.4° in external rotation (range, 10°-30°), 7.9° in adduction (range, 0°-20°), and 16.5° in abduction (range, 10°-25°). At last follow-up, the VAS score, Harris score, and OHS score significantly improved when compared with those before operation ( P<0.05). The MAKO robotic-arm assisted THA via DAA can achieve satisfactory results in the treatment of AS with bony fused hip, which has the advantages of accurate prosthesis installation, soft tissue release, and less trauma during operation.

S2188 Streptococcus Bovis Bacteremia and Endocarditis Leading to the Diagnosis of Synchronous Colon and Appendiceal Adenocarcinoma

Introduction: Colon adenocarcinoma has been shown to be associated with appendiceal adenocarcinoma and Streptococcus bovis infection. An association between appendiceal cancer and S. bovis infection has not been reported. This is a case of S. bovis bacteremia prompting colonoscopy and subsequent diagnosis of colon adenocarcinoma and incidental diagnosis of appendiceal adenocarcinoma. Case Description/Methods: A 77-year-old male with a history of metabolic syndrome, coronary artery bypass graft surgery, abdominal aortic aneurysm, heart failure with preserved ejection fraction, and aortic stenosis came to the emergency department for dyspnea and chest pressure. Vital signs were stable with a temperature of 103.2 °F. Physical exam revealed diffuse lung rales and bilateral lower extremity trace edema. Labs are show in the Table. ECG was equivocal for acute myocardial infarction and cardiac catheterization was negative. Blood cultures grew S. bovis. TTE showed no valvular vegetations. TEE showed a mitral valve vegetation consistent with infective endocarditis (IE). Lower extremity vein thrombosis was diagnosed; anticoagulation was started which led to anemia and melena. Colonoscopy showed a large mass in the ascending colon (AC), a large villous appearing mass in the sigmoid colon (SC), multiple polyps, and severe diffuse diverticulosis (Figure A, B). CT abdomen/pelvis showed no evidence of metastasis. He underwent SC and AC resections. Pathology of the SC showed tubulovillous adenoma with high-grade dysplasia and negative for submucosal invasion (Figure C). Pathology of the AC showed well-differentiated appendiceal adenocarcinoma of the distal appendix invading the muscularis propria with appendiceal serosa and fat negative for invasion. Pathology of the AC also showed intramucosal adenocarcinoma without lymphovascular space invasion (Figure D). Lymph nodes were negative for metastasis. Discussion: Appendiceal cancer is rare. It affected only 2900 individuals in the US from 2012-2016. It is usually diagnosed after appendectomy for appendicitis. It has been proposed that patients with appendiceal adenocarcinoma carry an increased risk of colon adenocarcinoma and should be screened with colonoscopy at time of diagnosis. In this case, S. bovis bacteremia and IE prompted a colonoscopy. It remains unknown if there is an association between appendiceal adenocarcinoma and S. bovis infection. This report illustrates one case of concomitant colon and appendiceal adenocarcinoma with S. bovis bacteremia and IE.Figure 1.: Image A: Colonoscopy image showing ascending colon mass with diverticulosis and other polyps. Image B: Colonoscopy image showing sigmoid colon mass. Image C: Histological image of sigmoid colon resection showing tubulovillous adenoma with high-grade dysplasia. Image D: Histological image of right hemicolectomy specimen showing in-situ adenocarcinoma. Table 1. - Laboratory Values Laboratory test Value Reference range Troponin I 4.270 0.000-0.450 ng/mL Lactic acid 2.2 0-2 mmol/L WBC 9.00 4.40-11.00 103/μL

Safety and preventive effects of rivaroxaban and low-molecular-weight heparin on deep vein thrombosis of lower extremity after total hip arthroplasty

Deep vein thrombosis (DVT) is a common complication of skeletal surgery, which can cause disability and death in severe cases. Here, we have compared the preventive effects of rivaroxaban and low molecular weight heparin on DVT of lower extremity after total hip arthroplasty and the safety. A total of 310 patients who received total hip arthroplasty from May 2014 to June 2016 were divided into a rivaroxaban group (n=153) and a low molecular weight heparin group (n=157). The rivaroxaban group was orally administered with rivaroxaban (10 mg, qd) 12 h after surgery for 30 consecutive days, and the other group was subcutaneously injected with low molecular weight heparin calcium injection (0.6 mL, ad) for 7 consecutive days. The incidence rate of lower extremity DVT, drainage blood volume, hemoglobin decline, as well as preoperative and postoperative 7-d prothrombin time (PT), activated partial thromboplastin time (APTT), platelet (PLT) count and D-dimer level of the two groups were compared. The two groups had similar incidence rates of lower extremity DVT, drainage blood volumes and extents of hemoglobin decline (P &gt;0.05). There were no significant differences in the preoperative and postoperative 7-d PT, APTT, PLT counts and D-dimer levels between the two groups (P &gt;0.05). Rivaroxaban and low molecular weight heparin show comparable preventive effects on lower extremity DVT after total hip arthroplasty. Results suggest that rivaroxaban is superior than the low molecular weight heparin in terms of convenient use (oral administration), good compliance and absence of dose adjustment.

Impact of sarcopenia on effectiveness of lumbar decompression surgery in patients with lumbar spinal stenosis

To investigate the impact of sarcopenia on effectiveness of lumbar decompression surgery in patients with lumbar spinal stenosis. The clinical data of 50 patients with lumbar spinal stenosis who met the selection criteria between August 2017 and December 2020 were retrospectively analyzed. According to the diagnostic criteria of the European Working Group on Sarcopenia in Older People (EWGSOP), based on the calculation of the skeletal muscle index (SMI) at the L 3 level, SMI<45.4 cm 2/m 2 (men) and SMI<34.4 cm 2/m 2 (women) were used as the diagnostic threshold, the patients were divided into sarcopenia group (25 cases) and non-sarcopenia group (25 cases). There was no significant difference in gender, age, disease duration, level of lumbar spinal stenosis, surgical fusion level, and comorbidity between the two groups ( P>0.05); the body mass index in sarcopenia group was significantly lower than that in non-sarcopenia group ( t=-3.198, P=0.002). Clinical data of the two groups were recorded and compared, including operation time, intraoperative blood loss, postoperative drainage volume, hospitalization stay, and complications. The visual analogue scale (VAS) scores of low back pain and sciatica and Oswestry disability index (ODI) scores were recorded preoperatively and at last follow-up. The effectiveness was evaluated according to modified MacNab standard. There was no significant difference between the two groups in terms of operation time, intraoperative blood loss, and postoperative drainage volume ( P>0.05). However, the hospitalization stay in sarcopenia group was significantly longer than that in non-sarcopenia group ( t=2.105, P=0.044). The patients were followed up 7-36 months (mean, 29.7 months). In sarcopenia group, 1 case of dural tear and cerebrospinal fluid leakage occurred during operation, as well as 1 case of internal fixator loosening during follow-up; 1 case of incision exudation and poor healing occurred in each of the two groups, and no adjacent segment degeneration and deep vein thrombosis of lower extremity occurred in the two groups during follow-up. There was no significant difference in the incidence of complications (12% vs. 4%) between the two groups ( χ 2=1.333, P=0.513). VAS scores in low back pain and sciatica as well as ODI scores in two groups significantly improved when compared with preoperative results at last follow-up ( P<0.05). The differences of VAS scores in low back pain and ODI scores before and after operation in sarcopenia group were significantly lower than that in non-sarcopenia group ( P<0.05). However, there was no significant difference of that in VAS scores of sciatica between the two groups ( t=-1.494, P=0.144). According to the modified MacNab standard, the excellent and good rate of the sarcopenia group was 92%, and that of the non-sarcopenia group was 96%, showing no significant difference between the two groups ( χ 2 =1.201, P=0.753). Patients with sarcopenia and lumbar spinal stenosis may have longer postoperative recovery time, and the effectiveness is worse than that of non-sarcopenic patients. Therefore, for elderly patients with lumbar spine disease, it is suggested to improve preoperative assessment of sarcopenia, which can help to identify patients with sarcopenia at risk of poor surgical prognosis in advance, so as to provide rehabilitation guidance and nutritional intervention in the perioperative period.

Preventive Effect of Intensive Nursing Intervention of Deep Vein Thrombosis of Lower Extremities in Elderly Patients with Gastrointestinal Tumors after Surgery.

Tumors of the gastrointestinal system, known as gastroenteropapillary neoplasms, are very uncommon yet have a high propensity to progress to cancer. Thromboembolism of the veins (VTE) is a potentially deadly complication of surgery. In the vast majority of cases, deep vein thrombosis (DVT) in the lower extremities is the primary symptom of VTE (DVT). Deep vein thrombosis is more common in critical care units, where the prevalence ranges from 18 to 50 percent. DVT is a common complication after gastrointestinal tumor surgery, and proper nursing care is essential to lowering the risk of VTE. This research was thus done to examine if intensive nursing interventions may reduce the risk of lower limb DVT in elderly patients who had undergone surgery for gastrointestinal malignancies. The data is separated into two categories: control and treatment. As a self-care theory-based intervention strategy, we propose a hybridized KAP (knowledge, attitude, and practice) approach. Using the twin-bound decision tree algorithm (TBDTA), clinical outcomes including survival and patient satisfaction are examined. There was a considerable improvement in the treatment of DVT compared to the control group and a decrease in typical postoperative conditions. The bundles of care treatment have made a significant increase in the quality of nursing care.

Analysis of the Effect of Comprehensive Nursing on Preventing Deep Vein Thrombosis of Lower Extremity in Patients with Long-term Bedridden in Intensive Care Unit

Analysis of the Effect of Comprehensive Nursing on Preventing Deep Vein Thrombosis of Lower Extremity in Patients with Long-term Bedridden in Intensive Care Unit

Clinical application of slope-reducing tibial osteotomy and anterior cruciate ligament revision in patients with abnormally increased posterior tibial slope

To investigate the effectiveness of slope-reducing tibial osteotomy and anterior cruciate ligament (ACL) revision in the treatment of patients with primary ACL reconstruction failure and abnormally increased posterior tibial slope (PTS). The clinical data of 9 patients with primary ACL reconstruction failure and abnormally increased PTS (≥17°) who met the selection criteria between January 2018 and January 2020 were retrospectively analyzed. There were 8 males and 1 female; the age ranged from 21 to 42 years, with a median age of 30 years. Lachman test was positive in 9 patients. Pivot-shift test was negative in 6 cases, degree Ⅰ positive in 2 cases, and degree Ⅱ positive in 1 case. The PTS was (17.78±1.09)° and the anterior tibial translation (ATT) was (11.58±1.47) mm. The International Knee Documentation Committee (IKDC) score was 51.0±3.8, Lysholm score was 49.7±4.6, and Tegner score was 3.7±0.7. The time from primary reconstruction to revision was 12-33 months, with an average of 19.6 months. Slope-reducing tibial osteotomy and ACL revision were performed. The improvement of knee function was evaluated by IKDC score, Lysholm score, and Tegner score; Lachman test and Pivot-shift test were used to evaluate the stability of knee joint. PTS and ATT were measured to observe the morphological changes of knee joint. All the incisions healed by first intention, and there was no complication such as incision infection, fat liquefaction, necrosis, deep vein thrombosis of lower extremities, and neurovascular injury. All 9 patients were followed up 12-36 months, with an average of 25.8 months. At last follow-up, Lachman test and pivot-shift test were negative. IKDC score was 85.0±4.0, Lysholm score was 87.7±2.8, Tegner score was 6.8±0.7, PTS reduced to (9.89±0.60)°, and ATT shortened to (0.91±0.29) mm, which were significantly improved when compared with those before operation ( P<0.05). Slope-reducing tibial osteotomy and ACL revision in the treatment of patients with primary ACL reconstruction failure and abnormally increased PTS has a satisfactory short-term effectiveness. It can improve the stability of knee joint and maintain the normal shape of knee joint.

Short-term effectiveness of novel computer navigation system assisted total knee arthroplasty

To investigate the short-term effectiveness of novel computer navigation system (Knee 3 software; Brainlab, Germany) assisted total knee arthroplasty (TKA). Between July 2020 and December 2020, 19 patients underwent unilateral TKA assisted with Knee 3 software. There were 4 males and 15 females. The mean age was 66.3 years (range, 52-79 years). Eighteen patients were diagnosed with osteoarthritis and 1 patient with rheumatoid arthritis. Sixteen patients had varus knees and 3 patients had valgus knees. Preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain, stiffness, function, and total scores were 12.4±3.4, 2 (1, 4), 22 (18, 29), and 37 (29, 43), respectively. Intraoperatively, the medial and lateral gaps in knee extension and in 90° of knee flexion were recorded. The operation time, intraoperative blood loss, blood transfusion, and complications were recorded. The hip-knee-ankle angle (HKA), lateral distal femoral angle, and medial proximal tibial angle were measured to evaluate lower limb alignment and prostheses's alignment using X-ray films at 6 weeks after operation. Patient's satisfaction rate and WOMAC pain, stiffness, function, and total scores were investigated. Eighteen patients (94.7%) had medial- lateral gap balancing in knee extension, 18 patients (94.7%) had medial-lateral gap balancing in 90° of knee flexion, 19 patients (100%) had medial gap balancing between knee extension and 90° of knee flexion, and 18 patients (94.7%) had lateral gap balancing between knee extension and 90° of knee flexion. The mean operation time was 126 minutes (range, 100-200 minutes). The mean intraoperative blood loss was 205 mL (range, 100-400 mL). Patients were followed up 4-8 months, with an average of 6.2 months. Postoperative complications included 1 deep vein thrombosis of lower extremities and 1 cerebral infarction. X-ray films showed that the mean HKA, lateral distal femoral angle, and medial proximal tibial angle were 179.8° (range, 178°-182°), 83.5° (range, 80°-87°), and 89.5° (range, 87°-93°), respectively. At last follow-up, WOMAC pain, stiffness, function, and total scores were 3.6±1.9, 0 (0, 2), 4 (2, 6), and 9 (5, 10), respectively, which improved when compared with preoperative scores ( P<0.05). Twelve patients were very satisfied with the operation results and 7 patients were satisfied with the operation results. The overall satisfaction rate was 100%. Knee 3 software can help to obtain good gap balancing and optimal lower limb alignment, with high patient's satisfaction and good short-term effecectiveness.

Role and Mechanism of mir-5189-3p in Deep Vein Thrombosis of Lower Extremities

BackgroundThis study is to investigate the role and mechanism of mir-5189-3p in deep vein thrombosis (DVT) in lower extremity. MethodsThe blood samples were collected from Kazakh patients with DVT in lower extremity and were subjected to microRNA sequencing. Bioinformatics were used to identify mir-5189-3p and its target genes. Dual luciferase reporter assay was used to determine the regulatory effect of mir-5189-3p on JAG1. SD rats were randomly divided into normal control, DVT model, hsa-miR-5189-3p mimics and hsa-miR-5189-3p negative control groups. HE staining was used to observe the pathological changes. TUNEL method was used to observe apoptosis. Western blot was used to detect Bax and Bcl-2 protein expression. Real-time quantitative PCR was used to detect JAG1, Notch1 and Hes1 mRNA. ResultsThe target of Has-miR-5189-3p was JAG1. Co-transfection of miR-5189-3p mimics and pmirGLO/JAG1 wild-type plasmid induced significantly decreased luciferase activity. In hsa-miR-5189-3p mimics and hsa-miR-5189-3p negative control groups, there were more nucleated cells in the thrombus tissues, and the organization degree obviously increased. Signs of blood flow recanalization were observed. The apoptosis of hsa-miR-5189-3p mimics and hsa-miR-5189-3p negative control groups was lower than that in DVT model group. Furthermore, mir-5189-3p mimics significantly increased the mRNA levels of JAG1, Notch1 and Hes1. Additionally, mir-5189-3p mimics significantly increased Bcl-2 while decreased Bax protein. Conclusionsmir-5189-3p could inhibit apoptosis and promote thrombus organization in DVT possibly via Notch signaling pathway. Mir-5189-3p can be used as a potential target for DVT treatment.

Influence of intravenous laser blood irradiation on lymphovenous outflow and the state of humoral and cellular immunity in patients with postthrombophlebitic disease of the lower extremities

Post-thrombophlebitis of lower extremities occurs in 14–29 % of cases and develops within the fi rst two years after the episode of deep vein thrombosis of lower extremities in 20–50 % of patients. Objective: to apply intravenous laser blood irradiation (ILBI) for optimizing outcomes in patients with post-thrombophlebitic disease of their lower extremities. Materials and methods. 52 patients were treated with ILBI. They were randomized into two groups by the following clinical criteria: stage of occlusion – 18 patients (Group 1) and stage of recanalization – 34 patients (Group 2). ILBI course included 7 sessions: irradiation power – 3–15 mW, pulse frequency – 80–3000 Hz, exposure time – 5–15 minutes. Parameters of venous outfl ow and inguinal lymph nodes were monitored by ultrasound examination. Radial immunodiffusion was used to determine levels of IgG, IgM and IgA in blood plasma and serum; turbidimetry – to determine immune complexes; T-lymphocytes – by the receptors to erythrocytes. B-lymphocyte level was monitored with luminescence-serological and complementary rosette formation techniques. Results and discussion. A statistically signifi cant increase in linear and volumetric blood fl ow in great vessels was revealed in both groups. In Group 1, linear blood fl ow in the great saphenous vein increased by 5.2 %; volumetric blood fl ow increased up to 113.0 ± 2.14 mL/min (p &lt; 0.01). In Group 2, volumetric blood fl ow slowed down by 4.1 %. Lymph nodes contracted statistically signifi cantly; the medullary layer narrowed up to 0.32 ± 0.05 cm (p &lt; 0.05), level of IgG, IgM and CIC decreased; number of T-lymphocytes increased up to 60.2 ± 1.7 % (p &lt; 0.05). Conclusion. The revealed effects of intravenous laser blood irradiation at the venous outfl ow, lymph nodes and humoral and cellular immunity in patients with post-thrombophlebitic disease of lower extremities give a reason to recommend the implementation of the discussed technique into a wide clinical practice.

Application of Inferior Vena Cava Nanofilter Combined with Thrombolytic Catheter for Intravenous Thrombolysis in Deep Vein Thrombosis of Lower Extremities

Deep vein thrombosis (DVT) of the lower extremities has a high incidence and is insidiously fatal. Detachment of the thrombus can quickly cause death. Early detection and timely treatment are key to the treatment of DVT. This study is the first to report the clinical value of an inferior vena cava nanofilter combined with thrombolytic catheter for intravenous thrombolysis in DVT. The study found that the inferior vena cava nanofilter combined with the thrombolytic catheter has a significant effect on the treatment of DVT, which greatly reduces the circumference difference of the upper and lower legs, reduces the levels of fibrinogen, high-sensitivity C-reactive protein, and D-dimer, reduces the occurrence of complications, and is safe and worthwhile promotion.

Association between Laterality and Location of Deep Vein Thrombosis of Lower Extremity and Pulmonary Embolism.

PurposeThe aim of this study was to investigate the relationship between the anatomical location of thrombi in the lower extremities and the development of pulmonary embolism (PE).MethodsMaterials and We collected and analyzed the data of patients diagnosed with deep vein thrombosis (DVT) of the lower extremities between 2006 and 2015, and included those whose computed tomography (CT) data were available for PE identification. We evaluated the relationship between the laterality and the proximal/distal location of the thrombi in lower extremites and the location of PE.ResultsCT images were available for 388/452 patients with DVT. After excluding 32 cases with bilateral involvement, 356 cases were included for analysis in this study. The ratio of DVT in the left:right leg was 232:124. PEs developed in 121 (52.2%) patients with left-sided DVT and in 78 (62.9%) with right-sided DVT (P=0.052). PEs in the main pulmonary arteries developed in 36 (15.5%) patients with left leg DVT and in 30 (24.2%) with right leg DVT (P=0.045). The most frequent site of thrombosis associated with the development of PE was the left iliac vein (59/199, 29.6%). According to the anatomical segment of the leg affected by DVT, patients with DVT in the right femoral vein (50/71, 70.4%; P=0.016) had the highest rate of occurrence of PE.ConclusionPE develops more frequently in patients with right-sided DVT than in those with left-sided DVT. Therefore, careful observation for the possible development of PE is recommended in cases with right-sided DVT of the lower extremity.

Efficacy and safety of intravenous combined with topical administration of tranexamic acid in reducing blood loss after intramedullary fixation of intertrochanteric femoral fractures

To investigate the efficacy and safety of intravenous combined with topical administration of tranexamic acid (TXA) in reducing blood loss after intramedullary fixation of intertrochanteric femoral fractures by a prospective controlled trial. Patients with intertrochanteric femoral fractures, who were admitted for intramedullary fixation between June 2015 and July 2019, were selected as the study subjects, 120 of whom met the selection criteria. The patients were randomly assigned to 3 groups: intravenous administration group (group A, 41 cases), topical administration group (group B, 40 cases), and combined administrations group (group C, 39 cases). In group A, 4 patients occurred deep vein thrombosis of lower extremity before operation, 1 patient died of myocardial infarction on the 5th day after operation, and 1 patient developed severe pulmonary infection after operation. In group B, 2 patients occurred deep vein thrombosis of lower extremity before operation and 1 patient had iatrogenic fracture during operation. In group C, 3 patients occurred deep vein thrombosis of lower extremity before operation and 1 patient developed pulmonary infection before operation and gave up surgical treatment. All the above patients were excluded from the study, and the remaining 107 cases were included in the analysis, including 35, 37, and 35 cases in groups A, B, and C, respectively. There was no significant difference in gender, age, height, body mass, injury cause, fracture side and type, the interval between injury and operation, and preoperative hemoglobin (Hb), hematocrit between groups ( P>0.05). Intraoperative TXA (15 mg/kg) was injected intravenously in group A at 30 minutes before operation, and 1 g of TXA was injected into the medullary cavity in group B after the proximal femur was grooted and before the intramedullary nail implantation, respectively. TXA was given in group C before and during operation according to the administration methods and dosage of groups A and B. Total blood loss, maximum Hb decrease, blood transfusion rate, operation time, fracture healing time, and the incidence of complications were recorded and compared between groups. The hip joint function were evaluated by Harris score. There was no significant difference in operation time between groups ( P>0.05). The total blood loss, the maximum Hb decrease, and the blood transfusion rate in group B were the highest, followed by group A and group C, and the differences between groups were significant ( P<0.05). No incision infection or pulmonary embolism occurred in the 3 groups after operation. The incidence of anemia in group C was significantly lower than that in groups A and B, the difference was significant ( P<0.05). There was no significant difference in the incidence of subcutaneous hematoma, aseptic exudation, and deep vein thrombosis of lower extremity between groups ( P>0.05). All patients in the 3 groups were followed up 8-35 months, with an average of 16.2 months. The fracture healing time of groups A, B, and C was (6.12±1.78), (5.89±1.63), and (5.94±1.69) months, respectively, and there was no significant difference between groups ( P>0.05). At last follow-up, the Harris scores of the hip joints in groups A, B, and C were 83.18±7.76, 84.23±8.01, and 85.43±8.34, and the difference was not significant ( P>0.05). Preoperative intravenous injection combined with intraoperative topical application of TXA can effectively reduce blood loss and blood transfusion after intramedullary fixation of femoral intertrochanteric fracture, without increasing the risk of deep vein thrombosis, and the efficacy is better than that of intravenous injection or topical administration.

Peripherally inserted central venous catheter in upper extremities leads to an increase in D-dimer and deep vein thrombosis in lower extremities

BackgroundThe purpose of this study is to elucidate the association between peripherally inserted central venous catheter (PICC) in upper extremities and lower extremity deep venous thrombosis (LEDVT) by observing the changes in D-dimer.MethodsThis was a retrospective cohort study with 3452 patients (104 inserted with PICCs and 3348 without PICC) enrolled at the neurology department from April 1, 2017 to April 1, 2020. The patients underwent color Doppler ultrasound (CDU) and D-dimer examinations. LEDVT-related factors and D-dimer value were analyzed before and after PICC insertion. The predictive value of D-dimer for LEDVT was also evaluated.ResultsUnivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 9 times and promoted the increase of D-dimer by 5 times. After risk adjustment, multivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 4 times and tripled the risk of D-dimer increase. The concentration of D-dimer was significantly increased after PICC insertion. D-dimer was unsuitable for excluding venous thrombosis in patients inserted with PICCs.ConclusionsPICC insertion increases the level of D-dimer and the risk of LEDVT. The risks of venous thrombosis need to be assessed in patients inserted with PICCs to ensure the expected clinical outcomes.