The utilisation of polygenic scoring models may enhance the clinician’s ability to risk stratify an inflammatory bowel disease patient’s individual risk for venous thromboembolism(VTE)and guide the appropriate usage...The utilisation of polygenic scoring models may enhance the clinician’s ability to risk stratify an inflammatory bowel disease patient’s individual risk for venous thromboembolism(VTE)and guide the appropriate usage of VTE thromboprophylaxis,yet there is a need to validate such models in ethnically diverse populations.展开更多
Pain is a common complaint among patients seeking medical care.If left un-treated,pain can become chronic,significantly affecting patients’quality of life.An accurate diagnosis of the underlying cause of pain is cruc...Pain is a common complaint among patients seeking medical care.If left un-treated,pain can become chronic,significantly affecting patients’quality of life.An accurate diagnosis of the underlying cause of pain is crucial for effective treatment.Chronic venous insufficiency(CVI)is frequently overlooked by pain physicians.Moreover,many pain physicians lack sufficient knowledge about CVI.CVI is a common condition resulting from malfunctioning or damaged valves in lower limb veins.Symptoms of CVI,ranging from mild to severe,include pain,heaviness,fatigue,itching,swelling,skin color changes,and ulcers in the lower limbs.Recently,it has become more widely known that these symptoms can be attributed to CVI.Even slight or mild CVI can cause related symptoms.Pain physicians primarily consider neuromusculoskeletal disorders when assessing patients with leg pain,and often neglect the possibility of CVI.In clinical practice,when pain physicians encounter patients with unresolved leg pain,they must assess whether the patients exhibit symptoms of CVI and conduct tests to differ-entiate CVI from other potential causes.展开更多
BACKGROUND Venous thromboembolism(VTE)is a potentially fatal complication of hepatectomy.The use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the...BACKGROUND Venous thromboembolism(VTE)is a potentially fatal complication of hepatectomy.The use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative bleeding.Therefore,we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after hepatectomy.AIM To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after hepatectomy.METHODS The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively analyzed.Patients were divided into two groups according to whether or not they developed VTE after hepatectomy,as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower extremities.Clinicopathological factors,including demographic data and perioperative D-dimer values,were compared between the two groups.Receiver operating characteristic curve analysis was performed to determine the D-dimer cutoff value.Univariate and multivariate analyses were performed using logistic regression analysis to identify significant predictors.RESULTS In total,234 patients who underwent hepatectomy were,of whom(5.6%)were diagnosed with VTE following hepatectomy.A comparison between the two groups showed significant differences in operative time(529 vs 403 min,P=0.0274)and blood loss(530 vs 138 mL,P=0.0067).The D-dimer levels on postoperative days(POD)1,3,5,7 were significantly higher in the VTE group than in the non-VTE group.In the multivariate analysis,intraoperative blood loss of>275 mL[odds ratio(OR)=5.32,95%confidence interval(CI):1.05-27.0,P=0.044]and plasma D-dimer levels on POD 5≥21μg/mL(OR=10.1,95%CI:2.04-50.1,P=0.0046)were independent risk factors for VTE after hepatectomy.CONCLUSION Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the postoperative period.展开更多
BACKGROUND Cerebral venous sinus thrombosis(CVT)is rare cause of cerebrovascular disease.The incidence is 0.5%of all stroke.The majority of affected patients are young adults(mean age:35-40 years)with mild to moderate...BACKGROUND Cerebral venous sinus thrombosis(CVT)is rare cause of cerebrovascular disease.The incidence is 0.5%of all stroke.The majority of affected patients are young adults(mean age:35-40 years)with mild to moderate disabilities.Poor outcome with severe disability is seen in 13%of cases.Early diagnosis and treatment are important for good outcomes and preventing complications.Treatment options are limited and mostly based on consensus.NeuroAiD II™(MLC901;Moleac Pte,Ltd,Singapore)has a potential beneficial role in post-stroke recovery,by aiding the natural brain recovery process.CASE SUMMARY MLC901 consists of nine natural herbal ingredients.Studies have shown its safety profile and aid in post stroke recovery.The aim of this case series was to demonstrate the potential role of MLC901 in stroke recovery of patients with cerebral venous sinus thrombosis(CVST)who received MLC901 in addition to standard of care.The prescribed dose of MLC901 is 400 mg/cap two capsules,three times a day.Data from these patients were prospectively collected at baseline and at monthly visits,for a duration of 3 mo.Outcome measures included adherence to therapy,side effects,National Institutes of Health Stroke Scale,Glasgow Coma Scale,modified Rankin Scale,and the Short Orientation-Memory-Concentration Test.MLC901 was well tolerated and no side effects were reported.All patients were stable with improved condition.CONCLUSION This case series highlights the potential therapeutic effects of MLC901 on CVST and provides support for further studies.展开更多
BACKGROUND To date,this is the first case of a paradoxical embolism(PDE)that concurrently manifested in the coronary and lower limb arteries and was secondary to a central venous catheter(CVC)thrombus via a patent for...BACKGROUND To date,this is the first case of a paradoxical embolism(PDE)that concurrently manifested in the coronary and lower limb arteries and was secondary to a central venous catheter(CVC)thrombus via a patent foramen ovale(PFO).CASE SUMMARY Here,we report a case of simultaneous coronary and lower limb artery embolism in a PFO patient carrier of a CVC.The patient presented to the hospital with acute chest pain and lower limb fatigue.Doppler ultrasound showed a large thrombus in the right internal jugular vein,precisely at the tip of the CVC.Transthoracic and transesophageal echocardiography confirmed the existence of a PFO,with inducible right-to-left shunting by the Valsalva maneuver.The patient was administered an extended course of anticoagulation therapy,and then the CVC was successfully removed.Percutaneous PFO closure was not undertaken.There was no recurrence during follow-up.CONCLUSION Thus,CVC-associated thrombosis is a potential source for multiple PDE in PFO patients.展开更多
The World Journal of Cardiology published an article written by Kuwahara et al that we take the pleasure to comment on.We focused our attention on venous congestion.In intensive care settings,it is now widely accepted...The World Journal of Cardiology published an article written by Kuwahara et al that we take the pleasure to comment on.We focused our attention on venous congestion.In intensive care settings,it is now widely accepted that venous congestion is an important clinical feature worthy of investigation.Evaluating venous Doppler profile abnormalities at multiple sites could suggest adequate treatment and monitor its efficacy.Renal dysfunction could trigger or worsen fluid overload in heart disease,and cardio-renal syndrome is a well-characterized spectrum of disorders describing the complex interactions between heart and kidney diseases.Fluid overload and venous congestion,including renal venous hypertension,are major determinants of acute and chronic renal dysfunction arising in heart disease.Organ congestion from venous hypertension could be involved in the development of organ injury in several clinical situations,such as critical diseases,congestive heart failure,and chronic kidney disease.Ultrasonography and abnormal Doppler flow patterns diagnose clinically significant systemic venous congestion.Cardiologists and nephrologists might use this valuable,noninvasive,bedside diagnostic tool to establish fluid status and guide clinical choices.展开更多
Protein C(PC)is a key component of the vitamin K-dependent coagulation pathway.It exerts anticoagulant effects by inactivating factors V and VIII.Acquired or inherited PC deficiency results in a prothrombotic state,wi...Protein C(PC)is a key component of the vitamin K-dependent coagulation pathway.It exerts anticoagulant effects by inactivating factors V and VIII.Acquired or inherited PC deficiency results in a prothrombotic state,with presentations varying from asymptomatic to venous thromboembolism.However,there has been an increasing number of reports linking PC deficiency to arterial thromboembolic events,such as myocardial infarction and ischemic stroke.This editorial focuses on the association between PC deficiency and thromboembolism,which may provide some insights for treatment strategy and scientific research.展开更多
Background: Venous thromboembolism (VTE) is a major public health problem due to its increasing frequency, mortality and management cost. This cost may require major financial efforts from patients, especially in deve...Background: Venous thromboembolism (VTE) is a major public health problem due to its increasing frequency, mortality and management cost. This cost may require major financial efforts from patients, especially in developing countries like ours where less than 7% of the population has health insurance. This study aimed to estimate the direct cost of managing VTE in three reference hospitals in Yaoundé. Methods: This was a cross-sectional retrospective study over a three-year period (from January 1st 2018 to December 31 2020) carried out in the Cardiology departments of the Central and General Hospitals, and the Emergency Centre of the city of Yaoundé. All patients managed during the study period for deep vein thrombosis and pulmonary embolism confirmed by venous ultrasound coupled with Doppler and computed tomography pulmonary angiography respectively were included. For each patient, we collected sociodemographic and clinical data as well as data on the cost of consultation, hospital stay, workups and medications. These data were analysed using SPSS version 23.0. Results: A total of 92 patient’s records were analysed. The median age was 60 years [48 - 68] with a sex ratio of 0.53. The median direct cost of management of venous thromboembolism was 766,375 CFAF [536,455 - 1,029,745] or $1415 USD. Management of pulmonary embolism associated with deep vein thrombosis was more costly than isolated pulmonary embolism or deep vein thrombosis. Factors influencing the direct cost of management of venous thromboembolism were: hospital structure (p = 0.015), health insurance (p 0.001), type of pulmonary embolism (p = 0.021), and length of hospital stay (p = 0.001). Conclusion: Management of VTE is a major financial burden for our patients and this burden is influenced by the hospital structure, health insurance, type of pulmonary embolism and length of hospital stay.展开更多
Background: Venous thromboembolism (VTE) is among the leading causes of hospital-related disability-adjusted life years lost. We aimed to determine the prevalence and determinants of functional capacity impairment six...Background: Venous thromboembolism (VTE) is among the leading causes of hospital-related disability-adjusted life years lost. We aimed to determine the prevalence and determinants of functional capacity impairment six to twelve months after an acute VTE event. Methods: This was a cross-sectional study conducted between January and April 2021 in two referral hospitals of Yaoundé, including consenting adult patients admitted to these hospitals six to twelve months ago for VTE. We excluded dead patients and those with any comorbidity or symptoms limiting physical activity. The functional outcome was assessed with the six-minute walk test. Functional capacity impairment was defined as walking distance lower than the expected value. Results: We included 27 cases in this study with a mean age of 53.2 ± 14.4 years. The prevalence of functional capacity impairment was 29.6% (95% CI: 14.8 - 48.1). Factors associated with poor functional outcome were obesity (OR: 59.5;95% CI: 4.6 - 767.2;p - 207.4;p = 0.017), massive PE (OR: 30;95% CI: 2.5 - 354;p = 0.004), and poor adherence to treatment (OR: 30.3;95% CI: 2.5 - 333.3;p = 0.004). Conclusion: Functional capacity impairment is common in the medium-term after VTE and factors associated with this poor outcome are obesity, the severity of the VTE, and poor adherence to treatment.展开更多
A dural arteriovenous fistula(DAVF) is an abnormal linkage connecting the arterial and venous systems within the intracranial dura mater. A basicranial emissary vein DAVF drains into the cavernous sinus and the ophtha...A dural arteriovenous fistula(DAVF) is an abnormal linkage connecting the arterial and venous systems within the intracranial dura mater. A basicranial emissary vein DAVF drains into the cavernous sinus and the ophthalmic vein, similar to a cavernous sinus DAVF. Precise preoperative identification of the DAVF location is a prerequisite for appropriate treatment. Treatment options include microsurgical disconnection, endovascular transarterial embolization(TAE), transvenous embolization(TVE), or a combination thereof. TVE is an increasingly popular approach for the treatment of DAVFs and the preferred approach for skull base locations, due to the risk of cranial neuropathy caused by dangerous anastomosis from arterial approaches. Multimodal magnetic resonance imaging(MRI) can provide anatomical and hemodynamic information for TVE. The therapeutic target must be precisely embolized in the emissary vein, which requires guidance via multimodal MRI. Here, we report a rare case of successful TVE for a basicranial emissary vein DAVF, utilizing multimodal MRI assistance. The fistula had vanished, pterygoid plexus drainage had improved, and the inferior petrosal sinus had recanalized, as observed on 8-month follow-up angiography. Symptoms and signs of double vision, caused by abduction deficiency, disappeared. Detailed anatomic and hemodynamic assessment by multimodal MRI is the key to guiding successful diagnosis and treatment.展开更多
Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically...Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.展开更多
BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing,there is still no“gold standard”for the implantation technique.AIM To identify the implantation te...BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing,there is still no“gold standard”for the implantation technique.AIM To identify the implantation technique that should be favored.METHODS Two hundred central venous port-implanted patients in a tertiary hospital were retrospectively evaluated.Patients were assigned into two groups according to the access method.The first group comprised patients whose jugular veins were used,and the second group comprised patients whose subclavian veins were used.Groups were evaluated regarding age,sex,application side,primary diagnosis,active follow-up period in the hospital,chemotherapy agents administered,number of complications,and the Clavien-Dindo severity score.The distribution of the variables was tested with the Kolmogorov-Smirnov test and the Mann-Whitney U test.Theχ^(2) test was used to analyze the variables.RESULTS There was no statistically significant difference between the groups regarding age,sex,side,number of chemotherapy drugs,and duration of port usage(P>0.05).Only 2 patients in group 1 had complications,whereas in group 2 we observed 19 patients with complications(P<0.05).No port occlusion was found in group 1,but the catheters of 4 patients were occluded in group 2.One port was infected in group 1 compared to three infected ports in group 2.Two port ruptures,two pneumothorax,one revision due to a mechanical problem,one tachyarrhythmia during implantation,and four suture line problems were also recorded in group 2 patients.We also showed that it would be sufficient to evaluate and wash ports once every 2 mo.CONCLUSION Our results robustly confirm that the jugular vein route is safer than the subclavian vein approach for central venous port implantation.展开更多
With the widespread adoption of ultrasound guidance,Seldinger puncture techniques,and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years,an incr...With the widespread adoption of ultrasound guidance,Seldinger puncture techniques,and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years,an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices(TIVADs)in the upper arm.This approach has the advantage of completely avoiding the risks of hemothorax,pneumothorax,and neck and chest scarring.Medical specialties presently engaged in this study in China include internal medicine,surgery,anesthesiology,and interventional departments.However,command over implantation techniques,treatment of complications,and proper use and maintenance of TIVAD remain uneven among different medical units.Moreover,currently,there are no established quality control standards for implantation techniques or specifications for handling complications.Thus,this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach,reduce complication rates,and ensure patient safety.This consensus elaborates on the technical indications and contraindications,procedures and technical points,treatment of complications,and the use and maintenance of upper-arm TIVAD,thus providing a practical reference for medical staff.展开更多
BACKGROUND Central venous catheters(CVCs)often cause life-threatening complications,especially CVC-related bloodstream infection(CVC-BSI)and catheter-related thrombosis(CRT).Here,we report an unusual case of misplaced...BACKGROUND Central venous catheters(CVCs)often cause life-threatening complications,especially CVC-related bloodstream infection(CVC-BSI)and catheter-related thrombosis(CRT).Here,we report an unusual case of misplaced CVC-induced emphysematous thrombophlebitis,a rare but potentially lethal form of CRT and CVC-BSI characterized by both thrombosis and gas formation.CASE SUMMARY A 48-year-old male presented to the emergency room of a local hospital with sudden-onset headache and coma for 4 h.Computed tomography(CT)revealed right basal ganglia hemorrhage,so emergency decompressive craniotomy was performed and a CVC was inserted through the right subclavian vein for fluid resuscitation during anesthesia.Two days later,the patient was transferred to the intensive care unit of our hospital for further critical care.On day 9 after CVC insertion,the patient suddenly developed fever and hypotension.Point-of-care ultrasound(POCUS)demonstrated thrombosis and dilatation of the right internal jugular vein(IJV)filled with thrombosis.Ultrasonography also revealed that the CVC tip had been misplaced into the IJV and was surrounded by gas bubbles,which manifested as hyperechoic lines with dirty shadowing and comet-tail artifacts.Further CT scan confirmed air bubbles surrounding the CVC in the right neck.The final diagnosis was septic emphysematous thrombophlebitis induced by a misplaced CVC and ensuing septic shock.The responsible CVC was removed immediately.The patient received fluid resuscitation,intravenous noradrenaline,and a 10-d ultra-broad spectrum antibiotic treatment to combat septic shock.Both CVC and peripheral venous blood cultures yielded methicillin-resistant Staphylococcus cohnii.The patient was gradually weaned off vasopressors and the symptoms of redness and swelling in the right neck subsided within 7 d.CONCLUSION Emphysematous thrombophlebitis is a fulminant and life-threatening CVC-BSI associated with thrombosis and gas formation in the vein.A misplaced CVC may facilitate the development of emphysematous thrombophlebitis.POCUS can easily identify the artifacts produced by gas and thrombosis,facilitating rapid diagnosis at the bedside.展开更多
BACKGROUND Portal hypertension(PHT)in patients with alcoholic cirrhosis causes a range of clinical symptoms,including gastroesophageal varices and ascites.The hepatic venous pressure gradient(HVPG),which is easier to ...BACKGROUND Portal hypertension(PHT)in patients with alcoholic cirrhosis causes a range of clinical symptoms,including gastroesophageal varices and ascites.The hepatic venous pressure gradient(HVPG),which is easier to measure,has replaced the portal venous pressure gradient(PPG)as the gold standard for diagnosing PHT in clinical practice.Therefore,attention should be paid to the correlation between HVPG and PPG.METHODS Between January 2017 and June 2020,134 patients with alcoholic cirrhosis and PHT who met the inclusion criteria underwent various pressure measurements during transjugular intrahepatic portosystemic shunt procedures.Correlations were assessed using Pearson’s correlation coefficient to estimate the correlation coefficient(r)and determination coefficient(R^(2)).Bland-Altman plots were constructed to further analyze the agreement between the measurements.Disagreements were analyzed using paired t tests,and P values<0.05 were considered statistically significant.RESULTS In this study,the correlation coefficient(r)and determination coefficient(R2)between HVPG and PPG were 0.201 and 0.040,respectively(P=0.020).In the 108 patients with no collateral branch,the average wedged hepatic venous pressure was lower than the average portal venous pressure(30.65±8.17 vs.33.25±6.60 mmHg,P=0.002).Hepatic collaterals were identified in 26 cases with balloon occlusion hepatic venography(19.4%),while the average PPG was significantly higher than the average HVPG(25.94±7.42 mmHg vs 9.86±7.44 mmHg;P<0.001).The differences between HVPG and PPG<5 mmHg in the collateral vs no collateral branch groups were three cases(11.54%)and 44 cases(40.74%),respectively.CONCLUSION In most patients,HVPG cannot accurately represent PPG.The formation of hepatic collaterals is a vital reason for the strong underestimation of HVPG.展开更多
Inflammatory bowel disease(IBD),including Crohn’s disease(CD)and ulcerative colitis(UC),is a chronic inflammatory disease of the digestive tract with increasing prevalence globally.Although venous thromboembolism(VTE...Inflammatory bowel disease(IBD),including Crohn’s disease(CD)and ulcerative colitis(UC),is a chronic inflammatory disease of the digestive tract with increasing prevalence globally.Although venous thromboembolism(VTE)is a major complication in IBD patients,it is often underappreciated with limited tools for risk stratification.AIM To estimate the proportion of VTE among IBD patients and assess genetic risk factors(monogenic and polygenic)for VTE.METHODS Incident VTE was followed for 8465 IBD patients in the UK Biobank(UKB).The associations of VTE with F5 factor V leiden(FVL)mutation,F2 G20210A prothrombin gene mutation(PGM),and polygenic score(PGS003332)were tested using Cox hazards regression analysis,adjusting for age at IBD diagnosis,gender,and genetic background(top 10 principal components).The performance of genetic risk factors for discriminating VTE diagnosis was estimated using the area under the receiver operating characteristic curve(AUC).RESULTS The overall proportion of incident VTE was 4.70%in IBD patients and was similar for CD(4.46%),UC(4.49%),and unclassified(6.42%),and comparable to that of cancer patients(4.66%)who are well-known at increased risk for VTE.Mutation carriers of F5/F2 had a significantly increased risk for VTE compared to non-mutation carriers,hazard ratio(HR)was 1.94,95%confidence interval(CI):1.42-2.65.In contrast,patients with the top PGS decile had a considerably higher risk for VTE compared to those with intermediate scores(middle 8 deciles),HR was 2.06(95%CI:1.57-2.71).The AUC for differentiating VTE diagnosis was 0.64(95%CI:0.61-0.67),0.68(95%CI:0.66-0.71),and 0.69(95%CI:0.66-0.71),respectively,for F5/F2 mutation carriers,PGS,and combined.CONCLUSION Similar to cancer patients,VTE complications are common in IBD patients.PGS provides more informative risk information than F5/F2 mutations(FVL and PGM)for personalized thromboprophylaxis.展开更多
Background:The benefits associated with sports compression garments are thought to be closely related to enhanced blood flow.However,findings are equivocal,possibly due to heterogeneity in the techniques used for meas...Background:The benefits associated with sports compression garments are thought to be closely related to enhanced blood flow.However,findings are equivocal,possibly due to heterogeneity in the techniques used for measuring blood flow,the garment types used,and the pressures applied.This study combined Doppler ultrasound and near-infrared spectroscopy technologies to provide the first comprehensive assessment of the effects of 3 sports compression garment types on markers of venous return and muscle blood flow at rest.Methods:Resting lower-limb blood flow measures(markers of venous return,muscle blood flow,and muscle oxygenation)of 22 elite,junior,male basketball players(age=17.2±0.9 years,mean±SD)were assessed in 4 separate conditions:no compression(CON),compression tights(TIGHTS),compression shorts(SHORTS),and compression socks(SOCKS).Markers of venous return(cross-sectional area,time-averaged mean and peak blood flow velocity,and venous blood flow)were measured via Doppler ultrasound at the popliteal and common femoral veins.Muscle blood flow and muscle oxygenation were measured in the gastrocnemius medialis and vastus lateralis using near-infrared spectroscopy.Results:Popliteal markers of venous return were higher in TIGHTS compared to CON(p<0.01)and SHORTS(p<0.01),with SOCKS values higher compared with CON(p<0.05).Common femoral vein markers of venous return were higher for all conditions compared to CON(p<0.05),with TIGHTS values also higher compared to SOCKS(p<0.05).Gastrocnemius medialis blood flow was higher for TIGHTS compared to CON(p=0.000),SOCKS(p=0.012),and SHORTS(p=0.000),with SOCKS higher compared to SHORTS(p=0.046).Vastus lateralis blood flow was higher for TIGHTS compared to CON(p=0.028)and SOCKS(p=0.019),with SHORTS also higher compared to CON(p=0.012)and SOCKS(p=0.005).Gastrocnemius medialis oxygenation was higher for TIGHTS compared to CON(p=0.003),SOCKS(p=0.033),and SHORTS(p=0.003),with SOCKS higher compared to CON(p=0.044)and SHORTS(p=0.032).Vastus lateralis oxygenation was higher for TIGHTS compared to CON(p=0.020)and SOCKS(p=0.006).Conclusion:Markers of venous return,muscle blood flow,and muscle oxygenation are increased with sports compression garments.TIGHTS are most effective,potentially because of the larger body area compressed.展开更多
BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease worldwide.Studies have shown a strong association between nonalcoholic steatohepatitis(NASH)cirrhosis and portal vein...BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease worldwide.Studies have shown a strong association between nonalcoholic steatohepatitis(NASH)cirrhosis and portal vein thrombosis.Specifically,there is paucity of data on the association of NASH and venous thromboembolism(VTE),with one such study predicting a 2.5-fold increased risk for VTE compared to other liver diseases in hospitalized patients.The mechanism is believed to be a hepatocellular injury,which causes a chronic inflammatory state leading to the unregulated activation of procoagulant factors.There has been no prior analysis of the degree of steatosis and fibrosis(measured using transient elastography,commonly known as FibroScan)in NASH and its association with VTE.AIM To examine the association between the degree of hepatic steatosis and fibrosis,quantified by transient elastography,and the incidence of VTE in patients with NASH.METHODS In our case-control study,we included patients with a documented diagnosis of NASH.We excluded patients with inherited thrombophilia,hemoglobinopathy,malignancy,alcohol use disorder,autoimmune hepatitis,and primary biliary cirrhosis.The collected data included age,demographics,tobacco use,recreational drug use,medical history,and vibration controlled transient elastography scores.VTE-specific data included the location,type of anticoagulant,need for hospital stay,and history of VTE recurrence.Steatosis was categorized as S0-S1(mild)and S2-S3(moderate to severe)based on the controlled attenuation parameter score.Fibrosis was classified based on the kilopascal score and graded as F0-F1(Metavir stage),F2,F3,and F4(cirrhosis).χ^(2) and Mann-Whitney U tests were used for the qualitative and quantitative variable analyses,respectively.Furthermore,we performed a logistic regression using VTE as the dependent variable.RESULTS A total of 415 patients were analyzed,and 386 met the inclusion criteria.51 and 335 patients were included in the VTE and non-VTE groups,respectively.Patients with VTE had a mean age of 60.63 years compared to 55.22 years in the non-VTE group(P<0.014).Patients with VTE had a higher body mass index(31.14 kg/m²vs 29.30 kg/m²)and a higher prevalence of diabetes mellitus(29.4%vs 13.1%).The history of NASH was significantly higher in the VTE group(45.1%vs 30.4%,P<0.037).Furthermore,moderate-to-severe steatosis was significantly higher in the VTE group(66.7%vs 47.2%,P<0.009).Similarly,the F2-F4 fibrosis grade had a prevalence of 58.8%in the VTE group compared to 38.5%in the non-VTE group(P<0.006).On logistic regression,using VTE as a dependent variable,diabetes mellitus had an odds ratio(OR)=1.702(P<0.015),and F2-F4 fibrosis grade had an OR=1.5(P<0.033).CONCLUSION Our analysis shows that NASH is an independent risk factor for VTE,especially deep vein thrombosis.There was a statistically significant association between the incidence of VTE,moderate-to-severe steatosis,and fibrosis.All hospitalized patients should be considered for medical thromboprophylaxis,particularly those with NASH.展开更多
Objective To determine incidence and risk factors for venous thromboembolism(VTE)development of in-hospital VTE in urological inpatients who underwent non-oncological surgery in a tertiary hospital in China.Methods Co...Objective To determine incidence and risk factors for venous thromboembolism(VTE)development of in-hospital VTE in urological inpatients who underwent non-oncological surgery in a tertiary hospital in China.Methods Consecutive 1453 inpatients who were admitted to a non-oncological urological ward in the tertiary hospital from January 1,2018 to December 31,2018 were enrolled in the study,and the VTE events were diagnosed by ultrasound or computed tomographic pulmonary angiography.Patients’occurrence of VTE and characteristics which may contribute to the development of VTE were collected and analyzed as incidence and risk factors.Results The incidence of VTE in non-oncological urological inpatients is 2.3%.In our cohort,patients who experienced previous VTE(adjusted odds ratios[aOR]14.272,95%CI 3.620-56.275),taking anticoagulants or antiplatelet agents before admission(aOR 10.181,95%CI 2.453-42.256),D-dimer(max)≥1μg/mL(aOR 22.456,95%CI 6.468-77.967),lower extremity swelling(aOR 10.264,95%CI 2.242-46.994),chest symptoms(aOR 79.182,95%CI 7.132-879.076),operation time of more than or equal to 180 min(aOR 10.690,95%CI 1.356-84.300),and Caprini score(max)of more than or equal to 5(aOR 34.241,95%CI 1.831-640.235)were considered as risk factors for VTE.Conclusion In this study,we found that the incidence of VTE in non-oncological surgery was about 2.3%,which was higher than some previous studies.Risk factors could be used for early detection and diagnosis of VTE.展开更多
Objective:The clinical grading system for varicoceles is subjective and dependent on clinician experience.Color Doppler ultrasound(US)has not been standardized in the diagnosis of varicoceles.We aimed to determine if ...Objective:The clinical grading system for varicoceles is subjective and dependent on clinician experience.Color Doppler ultrasound(US)has not been standardized in the diagnosis of varicoceles.We aimed to determine if US measurement of varicocele could be predictive of World Health Organization(WHO)varicocele grade.Methods:Men who presented for either scrotal pain or infertility to a tertiary men’s health clinic underwent physical examination,and varicoceles were graded following WHO criteria(0Zsubclinical,1,2,3).US was used to measure largest venous diameter in the pampiniform plexus bilaterally at rest and during Valsalva maneuver.Receiver operator characteristic curve analysis was used to determine if resting diameter,diameter during Valsalva,or change in diameter between at rest and during Valsalva provided the highest sensitivity and specificity for determining clinical grade.Threshold values for diameter were determined from these receiver operator characteristic curves.Results:A total of 102 men(50 with clinical varicocele and 52 with subclinical varicocele)were included.Diameter at rest was the best ultrasonographic discriminator between subclinical and clinical varicoceles(area under the curve[AUC]Z0.67)with a diameter threshold of 3.0 mm(sensitivity 79%,specificity 42%).Diameter during Valsalva had the greatest AUC for determining clinical Grades 1 versus 2(AUCZ0.57)with diameter threshold of 5.7 mm(sensitivity 71%,specificity 33%).For differentiating between Grades 2 and 3,diameter at rest had the greatest AUC of 0.65 with a threshold of 3.6 mm(sensitivity 71%,specificity 58%).Conclusion:Our results corroborate other studies that have shown a weak correlation between US and clinical grading.The use of diameter during Valsalva was less predictive than diameter at rest and was only clinically significant in differentiating between Grade 1 and 2 varicocele.A standardized method for determining clinically relevant varicoceles on US would allow for improved patient counseling and clinical decision-making.展开更多
文摘The utilisation of polygenic scoring models may enhance the clinician’s ability to risk stratify an inflammatory bowel disease patient’s individual risk for venous thromboembolism(VTE)and guide the appropriate usage of VTE thromboprophylaxis,yet there is a need to validate such models in ethnically diverse populations.
基金Supported by The National Research Foundation of Korea Grant Funded by The Korea Government(MSIT),No.00219725.
文摘Pain is a common complaint among patients seeking medical care.If left un-treated,pain can become chronic,significantly affecting patients’quality of life.An accurate diagnosis of the underlying cause of pain is crucial for effective treatment.Chronic venous insufficiency(CVI)is frequently overlooked by pain physicians.Moreover,many pain physicians lack sufficient knowledge about CVI.CVI is a common condition resulting from malfunctioning or damaged valves in lower limb veins.Symptoms of CVI,ranging from mild to severe,include pain,heaviness,fatigue,itching,swelling,skin color changes,and ulcers in the lower limbs.Recently,it has become more widely known that these symptoms can be attributed to CVI.Even slight or mild CVI can cause related symptoms.Pain physicians primarily consider neuromusculoskeletal disorders when assessing patients with leg pain,and often neglect the possibility of CVI.In clinical practice,when pain physicians encounter patients with unresolved leg pain,they must assess whether the patients exhibit symptoms of CVI and conduct tests to differ-entiate CVI from other potential causes.
基金This study was reviewed and approved by the Ethics Committee of the Kobe University Graduate School of Medicine(Provided ID Number:B210306).
文摘BACKGROUND Venous thromboembolism(VTE)is a potentially fatal complication of hepatectomy.The use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative bleeding.Therefore,we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after hepatectomy.AIM To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after hepatectomy.METHODS The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively analyzed.Patients were divided into two groups according to whether or not they developed VTE after hepatectomy,as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower extremities.Clinicopathological factors,including demographic data and perioperative D-dimer values,were compared between the two groups.Receiver operating characteristic curve analysis was performed to determine the D-dimer cutoff value.Univariate and multivariate analyses were performed using logistic regression analysis to identify significant predictors.RESULTS In total,234 patients who underwent hepatectomy were,of whom(5.6%)were diagnosed with VTE following hepatectomy.A comparison between the two groups showed significant differences in operative time(529 vs 403 min,P=0.0274)and blood loss(530 vs 138 mL,P=0.0067).The D-dimer levels on postoperative days(POD)1,3,5,7 were significantly higher in the VTE group than in the non-VTE group.In the multivariate analysis,intraoperative blood loss of>275 mL[odds ratio(OR)=5.32,95%confidence interval(CI):1.05-27.0,P=0.044]and plasma D-dimer levels on POD 5≥21μg/mL(OR=10.1,95%CI:2.04-50.1,P=0.0046)were independent risk factors for VTE after hepatectomy.CONCLUSION Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the postoperative period.
文摘BACKGROUND Cerebral venous sinus thrombosis(CVT)is rare cause of cerebrovascular disease.The incidence is 0.5%of all stroke.The majority of affected patients are young adults(mean age:35-40 years)with mild to moderate disabilities.Poor outcome with severe disability is seen in 13%of cases.Early diagnosis and treatment are important for good outcomes and preventing complications.Treatment options are limited and mostly based on consensus.NeuroAiD II™(MLC901;Moleac Pte,Ltd,Singapore)has a potential beneficial role in post-stroke recovery,by aiding the natural brain recovery process.CASE SUMMARY MLC901 consists of nine natural herbal ingredients.Studies have shown its safety profile and aid in post stroke recovery.The aim of this case series was to demonstrate the potential role of MLC901 in stroke recovery of patients with cerebral venous sinus thrombosis(CVST)who received MLC901 in addition to standard of care.The prescribed dose of MLC901 is 400 mg/cap two capsules,three times a day.Data from these patients were prospectively collected at baseline and at monthly visits,for a duration of 3 mo.Outcome measures included adherence to therapy,side effects,National Institutes of Health Stroke Scale,Glasgow Coma Scale,modified Rankin Scale,and the Short Orientation-Memory-Concentration Test.MLC901 was well tolerated and no side effects were reported.All patients were stable with improved condition.CONCLUSION This case series highlights the potential therapeutic effects of MLC901 on CVST and provides support for further studies.
基金Supported by Natural Science Foundation of Guangdong Province,No.2021A1515011267and Guangzhou Municipal Science and Technology Bureau,No.2023A03J0984.
文摘BACKGROUND To date,this is the first case of a paradoxical embolism(PDE)that concurrently manifested in the coronary and lower limb arteries and was secondary to a central venous catheter(CVC)thrombus via a patent foramen ovale(PFO).CASE SUMMARY Here,we report a case of simultaneous coronary and lower limb artery embolism in a PFO patient carrier of a CVC.The patient presented to the hospital with acute chest pain and lower limb fatigue.Doppler ultrasound showed a large thrombus in the right internal jugular vein,precisely at the tip of the CVC.Transthoracic and transesophageal echocardiography confirmed the existence of a PFO,with inducible right-to-left shunting by the Valsalva maneuver.The patient was administered an extended course of anticoagulation therapy,and then the CVC was successfully removed.Percutaneous PFO closure was not undertaken.There was no recurrence during follow-up.CONCLUSION Thus,CVC-associated thrombosis is a potential source for multiple PDE in PFO patients.
文摘The World Journal of Cardiology published an article written by Kuwahara et al that we take the pleasure to comment on.We focused our attention on venous congestion.In intensive care settings,it is now widely accepted that venous congestion is an important clinical feature worthy of investigation.Evaluating venous Doppler profile abnormalities at multiple sites could suggest adequate treatment and monitor its efficacy.Renal dysfunction could trigger or worsen fluid overload in heart disease,and cardio-renal syndrome is a well-characterized spectrum of disorders describing the complex interactions between heart and kidney diseases.Fluid overload and venous congestion,including renal venous hypertension,are major determinants of acute and chronic renal dysfunction arising in heart disease.Organ congestion from venous hypertension could be involved in the development of organ injury in several clinical situations,such as critical diseases,congestive heart failure,and chronic kidney disease.Ultrasonography and abnormal Doppler flow patterns diagnose clinically significant systemic venous congestion.Cardiologists and nephrologists might use this valuable,noninvasive,bedside diagnostic tool to establish fluid status and guide clinical choices.
文摘Protein C(PC)is a key component of the vitamin K-dependent coagulation pathway.It exerts anticoagulant effects by inactivating factors V and VIII.Acquired or inherited PC deficiency results in a prothrombotic state,with presentations varying from asymptomatic to venous thromboembolism.However,there has been an increasing number of reports linking PC deficiency to arterial thromboembolic events,such as myocardial infarction and ischemic stroke.This editorial focuses on the association between PC deficiency and thromboembolism,which may provide some insights for treatment strategy and scientific research.
文摘Background: Venous thromboembolism (VTE) is a major public health problem due to its increasing frequency, mortality and management cost. This cost may require major financial efforts from patients, especially in developing countries like ours where less than 7% of the population has health insurance. This study aimed to estimate the direct cost of managing VTE in three reference hospitals in Yaoundé. Methods: This was a cross-sectional retrospective study over a three-year period (from January 1st 2018 to December 31 2020) carried out in the Cardiology departments of the Central and General Hospitals, and the Emergency Centre of the city of Yaoundé. All patients managed during the study period for deep vein thrombosis and pulmonary embolism confirmed by venous ultrasound coupled with Doppler and computed tomography pulmonary angiography respectively were included. For each patient, we collected sociodemographic and clinical data as well as data on the cost of consultation, hospital stay, workups and medications. These data were analysed using SPSS version 23.0. Results: A total of 92 patient’s records were analysed. The median age was 60 years [48 - 68] with a sex ratio of 0.53. The median direct cost of management of venous thromboembolism was 766,375 CFAF [536,455 - 1,029,745] or $1415 USD. Management of pulmonary embolism associated with deep vein thrombosis was more costly than isolated pulmonary embolism or deep vein thrombosis. Factors influencing the direct cost of management of venous thromboembolism were: hospital structure (p = 0.015), health insurance (p 0.001), type of pulmonary embolism (p = 0.021), and length of hospital stay (p = 0.001). Conclusion: Management of VTE is a major financial burden for our patients and this burden is influenced by the hospital structure, health insurance, type of pulmonary embolism and length of hospital stay.
文摘Background: Venous thromboembolism (VTE) is among the leading causes of hospital-related disability-adjusted life years lost. We aimed to determine the prevalence and determinants of functional capacity impairment six to twelve months after an acute VTE event. Methods: This was a cross-sectional study conducted between January and April 2021 in two referral hospitals of Yaoundé, including consenting adult patients admitted to these hospitals six to twelve months ago for VTE. We excluded dead patients and those with any comorbidity or symptoms limiting physical activity. The functional outcome was assessed with the six-minute walk test. Functional capacity impairment was defined as walking distance lower than the expected value. Results: We included 27 cases in this study with a mean age of 53.2 ± 14.4 years. The prevalence of functional capacity impairment was 29.6% (95% CI: 14.8 - 48.1). Factors associated with poor functional outcome were obesity (OR: 59.5;95% CI: 4.6 - 767.2;p - 207.4;p = 0.017), massive PE (OR: 30;95% CI: 2.5 - 354;p = 0.004), and poor adherence to treatment (OR: 30.3;95% CI: 2.5 - 333.3;p = 0.004). Conclusion: Functional capacity impairment is common in the medium-term after VTE and factors associated with this poor outcome are obesity, the severity of the VTE, and poor adherence to treatment.
基金funding from the National Natural Science Foundation of China (Grant No.81771242)the Shanghai Pujiang Program (Grant No.20PJ1402200)。
文摘A dural arteriovenous fistula(DAVF) is an abnormal linkage connecting the arterial and venous systems within the intracranial dura mater. A basicranial emissary vein DAVF drains into the cavernous sinus and the ophthalmic vein, similar to a cavernous sinus DAVF. Precise preoperative identification of the DAVF location is a prerequisite for appropriate treatment. Treatment options include microsurgical disconnection, endovascular transarterial embolization(TAE), transvenous embolization(TVE), or a combination thereof. TVE is an increasingly popular approach for the treatment of DAVFs and the preferred approach for skull base locations, due to the risk of cranial neuropathy caused by dangerous anastomosis from arterial approaches. Multimodal magnetic resonance imaging(MRI) can provide anatomical and hemodynamic information for TVE. The therapeutic target must be precisely embolized in the emissary vein, which requires guidance via multimodal MRI. Here, we report a rare case of successful TVE for a basicranial emissary vein DAVF, utilizing multimodal MRI assistance. The fistula had vanished, pterygoid plexus drainage had improved, and the inferior petrosal sinus had recanalized, as observed on 8-month follow-up angiography. Symptoms and signs of double vision, caused by abduction deficiency, disappeared. Detailed anatomic and hemodynamic assessment by multimodal MRI is the key to guiding successful diagnosis and treatment.
文摘Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.
文摘BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing,there is still no“gold standard”for the implantation technique.AIM To identify the implantation technique that should be favored.METHODS Two hundred central venous port-implanted patients in a tertiary hospital were retrospectively evaluated.Patients were assigned into two groups according to the access method.The first group comprised patients whose jugular veins were used,and the second group comprised patients whose subclavian veins were used.Groups were evaluated regarding age,sex,application side,primary diagnosis,active follow-up period in the hospital,chemotherapy agents administered,number of complications,and the Clavien-Dindo severity score.The distribution of the variables was tested with the Kolmogorov-Smirnov test and the Mann-Whitney U test.Theχ^(2) test was used to analyze the variables.RESULTS There was no statistically significant difference between the groups regarding age,sex,side,number of chemotherapy drugs,and duration of port usage(P>0.05).Only 2 patients in group 1 had complications,whereas in group 2 we observed 19 patients with complications(P<0.05).No port occlusion was found in group 1,but the catheters of 4 patients were occluded in group 2.One port was infected in group 1 compared to three infected ports in group 2.Two port ruptures,two pneumothorax,one revision due to a mechanical problem,one tachyarrhythmia during implantation,and four suture line problems were also recorded in group 2 patients.We also showed that it would be sufficient to evaluate and wash ports once every 2 mo.CONCLUSION Our results robustly confirm that the jugular vein route is safer than the subclavian vein approach for central venous port implantation.
文摘With the widespread adoption of ultrasound guidance,Seldinger puncture techniques,and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years,an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices(TIVADs)in the upper arm.This approach has the advantage of completely avoiding the risks of hemothorax,pneumothorax,and neck and chest scarring.Medical specialties presently engaged in this study in China include internal medicine,surgery,anesthesiology,and interventional departments.However,command over implantation techniques,treatment of complications,and proper use and maintenance of TIVAD remain uneven among different medical units.Moreover,currently,there are no established quality control standards for implantation techniques or specifications for handling complications.Thus,this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach,reduce complication rates,and ensure patient safety.This consensus elaborates on the technical indications and contraindications,procedures and technical points,treatment of complications,and the use and maintenance of upper-arm TIVAD,thus providing a practical reference for medical staff.
基金Supported by Foundation of Guizhou Science and Technology Department,No.QIANKEHEZHICHEN[2022]YIBAN179Foundation of Kweichow Moutai Hospital,No.MTyk2022-12+1 种基金Foundation of Department of Health of Guizhou Province,No.gzwkj2021-036Guizhou Education Department,No.QIANJIAOHEKYZI[2018]239.
文摘BACKGROUND Central venous catheters(CVCs)often cause life-threatening complications,especially CVC-related bloodstream infection(CVC-BSI)and catheter-related thrombosis(CRT).Here,we report an unusual case of misplaced CVC-induced emphysematous thrombophlebitis,a rare but potentially lethal form of CRT and CVC-BSI characterized by both thrombosis and gas formation.CASE SUMMARY A 48-year-old male presented to the emergency room of a local hospital with sudden-onset headache and coma for 4 h.Computed tomography(CT)revealed right basal ganglia hemorrhage,so emergency decompressive craniotomy was performed and a CVC was inserted through the right subclavian vein for fluid resuscitation during anesthesia.Two days later,the patient was transferred to the intensive care unit of our hospital for further critical care.On day 9 after CVC insertion,the patient suddenly developed fever and hypotension.Point-of-care ultrasound(POCUS)demonstrated thrombosis and dilatation of the right internal jugular vein(IJV)filled with thrombosis.Ultrasonography also revealed that the CVC tip had been misplaced into the IJV and was surrounded by gas bubbles,which manifested as hyperechoic lines with dirty shadowing and comet-tail artifacts.Further CT scan confirmed air bubbles surrounding the CVC in the right neck.The final diagnosis was septic emphysematous thrombophlebitis induced by a misplaced CVC and ensuing septic shock.The responsible CVC was removed immediately.The patient received fluid resuscitation,intravenous noradrenaline,and a 10-d ultra-broad spectrum antibiotic treatment to combat septic shock.Both CVC and peripheral venous blood cultures yielded methicillin-resistant Staphylococcus cohnii.The patient was gradually weaned off vasopressors and the symptoms of redness and swelling in the right neck subsided within 7 d.CONCLUSION Emphysematous thrombophlebitis is a fulminant and life-threatening CVC-BSI associated with thrombosis and gas formation in the vein.A misplaced CVC may facilitate the development of emphysematous thrombophlebitis.POCUS can easily identify the artifacts produced by gas and thrombosis,facilitating rapid diagnosis at the bedside.
文摘BACKGROUND Portal hypertension(PHT)in patients with alcoholic cirrhosis causes a range of clinical symptoms,including gastroesophageal varices and ascites.The hepatic venous pressure gradient(HVPG),which is easier to measure,has replaced the portal venous pressure gradient(PPG)as the gold standard for diagnosing PHT in clinical practice.Therefore,attention should be paid to the correlation between HVPG and PPG.METHODS Between January 2017 and June 2020,134 patients with alcoholic cirrhosis and PHT who met the inclusion criteria underwent various pressure measurements during transjugular intrahepatic portosystemic shunt procedures.Correlations were assessed using Pearson’s correlation coefficient to estimate the correlation coefficient(r)and determination coefficient(R^(2)).Bland-Altman plots were constructed to further analyze the agreement between the measurements.Disagreements were analyzed using paired t tests,and P values<0.05 were considered statistically significant.RESULTS In this study,the correlation coefficient(r)and determination coefficient(R2)between HVPG and PPG were 0.201 and 0.040,respectively(P=0.020).In the 108 patients with no collateral branch,the average wedged hepatic venous pressure was lower than the average portal venous pressure(30.65±8.17 vs.33.25±6.60 mmHg,P=0.002).Hepatic collaterals were identified in 26 cases with balloon occlusion hepatic venography(19.4%),while the average PPG was significantly higher than the average HVPG(25.94±7.42 mmHg vs 9.86±7.44 mmHg;P<0.001).The differences between HVPG and PPG<5 mmHg in the collateral vs no collateral branch groups were three cases(11.54%)and 44 cases(40.74%),respectively.CONCLUSION In most patients,HVPG cannot accurately represent PPG.The formation of hepatic collaterals is a vital reason for the strong underestimation of HVPG.
基金The UK Biobank was approved by North West-Haydock Research Ethics Committee(REC reference:16/NW/0274,IRAS project ID:200778).
文摘Inflammatory bowel disease(IBD),including Crohn’s disease(CD)and ulcerative colitis(UC),is a chronic inflammatory disease of the digestive tract with increasing prevalence globally.Although venous thromboembolism(VTE)is a major complication in IBD patients,it is often underappreciated with limited tools for risk stratification.AIM To estimate the proportion of VTE among IBD patients and assess genetic risk factors(monogenic and polygenic)for VTE.METHODS Incident VTE was followed for 8465 IBD patients in the UK Biobank(UKB).The associations of VTE with F5 factor V leiden(FVL)mutation,F2 G20210A prothrombin gene mutation(PGM),and polygenic score(PGS003332)were tested using Cox hazards regression analysis,adjusting for age at IBD diagnosis,gender,and genetic background(top 10 principal components).The performance of genetic risk factors for discriminating VTE diagnosis was estimated using the area under the receiver operating characteristic curve(AUC).RESULTS The overall proportion of incident VTE was 4.70%in IBD patients and was similar for CD(4.46%),UC(4.49%),and unclassified(6.42%),and comparable to that of cancer patients(4.66%)who are well-known at increased risk for VTE.Mutation carriers of F5/F2 had a significantly increased risk for VTE compared to non-mutation carriers,hazard ratio(HR)was 1.94,95%confidence interval(CI):1.42-2.65.In contrast,patients with the top PGS decile had a considerably higher risk for VTE compared to those with intermediate scores(middle 8 deciles),HR was 2.06(95%CI:1.57-2.71).The AUC for differentiating VTE diagnosis was 0.64(95%CI:0.61-0.67),0.68(95%CI:0.66-0.71),and 0.69(95%CI:0.66-0.71),respectively,for F5/F2 mutation carriers,PGS,and combined.CONCLUSION Similar to cancer patients,VTE complications are common in IBD patients.PGS provides more informative risk information than F5/F2 mutations(FVL and PGM)for personalized thromboprophylaxis.
文摘Background:The benefits associated with sports compression garments are thought to be closely related to enhanced blood flow.However,findings are equivocal,possibly due to heterogeneity in the techniques used for measuring blood flow,the garment types used,and the pressures applied.This study combined Doppler ultrasound and near-infrared spectroscopy technologies to provide the first comprehensive assessment of the effects of 3 sports compression garment types on markers of venous return and muscle blood flow at rest.Methods:Resting lower-limb blood flow measures(markers of venous return,muscle blood flow,and muscle oxygenation)of 22 elite,junior,male basketball players(age=17.2±0.9 years,mean±SD)were assessed in 4 separate conditions:no compression(CON),compression tights(TIGHTS),compression shorts(SHORTS),and compression socks(SOCKS).Markers of venous return(cross-sectional area,time-averaged mean and peak blood flow velocity,and venous blood flow)were measured via Doppler ultrasound at the popliteal and common femoral veins.Muscle blood flow and muscle oxygenation were measured in the gastrocnemius medialis and vastus lateralis using near-infrared spectroscopy.Results:Popliteal markers of venous return were higher in TIGHTS compared to CON(p<0.01)and SHORTS(p<0.01),with SOCKS values higher compared with CON(p<0.05).Common femoral vein markers of venous return were higher for all conditions compared to CON(p<0.05),with TIGHTS values also higher compared to SOCKS(p<0.05).Gastrocnemius medialis blood flow was higher for TIGHTS compared to CON(p=0.000),SOCKS(p=0.012),and SHORTS(p=0.000),with SOCKS higher compared to SHORTS(p=0.046).Vastus lateralis blood flow was higher for TIGHTS compared to CON(p=0.028)and SOCKS(p=0.019),with SHORTS also higher compared to CON(p=0.012)and SOCKS(p=0.005).Gastrocnemius medialis oxygenation was higher for TIGHTS compared to CON(p=0.003),SOCKS(p=0.033),and SHORTS(p=0.003),with SOCKS higher compared to CON(p=0.044)and SHORTS(p=0.032).Vastus lateralis oxygenation was higher for TIGHTS compared to CON(p=0.020)and SOCKS(p=0.006).Conclusion:Markers of venous return,muscle blood flow,and muscle oxygenation are increased with sports compression garments.TIGHTS are most effective,potentially because of the larger body area compressed.
基金This protocol was developed,reviewed,and sanctioned by the joint institutional review board at MetroWest Medical Center under Approval No.2020-035.
文摘BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease worldwide.Studies have shown a strong association between nonalcoholic steatohepatitis(NASH)cirrhosis and portal vein thrombosis.Specifically,there is paucity of data on the association of NASH and venous thromboembolism(VTE),with one such study predicting a 2.5-fold increased risk for VTE compared to other liver diseases in hospitalized patients.The mechanism is believed to be a hepatocellular injury,which causes a chronic inflammatory state leading to the unregulated activation of procoagulant factors.There has been no prior analysis of the degree of steatosis and fibrosis(measured using transient elastography,commonly known as FibroScan)in NASH and its association with VTE.AIM To examine the association between the degree of hepatic steatosis and fibrosis,quantified by transient elastography,and the incidence of VTE in patients with NASH.METHODS In our case-control study,we included patients with a documented diagnosis of NASH.We excluded patients with inherited thrombophilia,hemoglobinopathy,malignancy,alcohol use disorder,autoimmune hepatitis,and primary biliary cirrhosis.The collected data included age,demographics,tobacco use,recreational drug use,medical history,and vibration controlled transient elastography scores.VTE-specific data included the location,type of anticoagulant,need for hospital stay,and history of VTE recurrence.Steatosis was categorized as S0-S1(mild)and S2-S3(moderate to severe)based on the controlled attenuation parameter score.Fibrosis was classified based on the kilopascal score and graded as F0-F1(Metavir stage),F2,F3,and F4(cirrhosis).χ^(2) and Mann-Whitney U tests were used for the qualitative and quantitative variable analyses,respectively.Furthermore,we performed a logistic regression using VTE as the dependent variable.RESULTS A total of 415 patients were analyzed,and 386 met the inclusion criteria.51 and 335 patients were included in the VTE and non-VTE groups,respectively.Patients with VTE had a mean age of 60.63 years compared to 55.22 years in the non-VTE group(P<0.014).Patients with VTE had a higher body mass index(31.14 kg/m²vs 29.30 kg/m²)and a higher prevalence of diabetes mellitus(29.4%vs 13.1%).The history of NASH was significantly higher in the VTE group(45.1%vs 30.4%,P<0.037).Furthermore,moderate-to-severe steatosis was significantly higher in the VTE group(66.7%vs 47.2%,P<0.009).Similarly,the F2-F4 fibrosis grade had a prevalence of 58.8%in the VTE group compared to 38.5%in the non-VTE group(P<0.006).On logistic regression,using VTE as a dependent variable,diabetes mellitus had an odds ratio(OR)=1.702(P<0.015),and F2-F4 fibrosis grade had an OR=1.5(P<0.033).CONCLUSION Our analysis shows that NASH is an independent risk factor for VTE,especially deep vein thrombosis.There was a statistically significant association between the incidence of VTE,moderate-to-severe steatosis,and fibrosis.All hospitalized patients should be considered for medical thromboprophylaxis,particularly those with NASH.
基金The authors thank the 12th ward in Xiangya Hospital,Changsha,China,for providing a platform for this research,all nurses in 12th ward for their help and cooperation in data collection,and Prof.Jiabi Qin for his statistical guidance.
文摘Objective To determine incidence and risk factors for venous thromboembolism(VTE)development of in-hospital VTE in urological inpatients who underwent non-oncological surgery in a tertiary hospital in China.Methods Consecutive 1453 inpatients who were admitted to a non-oncological urological ward in the tertiary hospital from January 1,2018 to December 31,2018 were enrolled in the study,and the VTE events were diagnosed by ultrasound or computed tomographic pulmonary angiography.Patients’occurrence of VTE and characteristics which may contribute to the development of VTE were collected and analyzed as incidence and risk factors.Results The incidence of VTE in non-oncological urological inpatients is 2.3%.In our cohort,patients who experienced previous VTE(adjusted odds ratios[aOR]14.272,95%CI 3.620-56.275),taking anticoagulants or antiplatelet agents before admission(aOR 10.181,95%CI 2.453-42.256),D-dimer(max)≥1μg/mL(aOR 22.456,95%CI 6.468-77.967),lower extremity swelling(aOR 10.264,95%CI 2.242-46.994),chest symptoms(aOR 79.182,95%CI 7.132-879.076),operation time of more than or equal to 180 min(aOR 10.690,95%CI 1.356-84.300),and Caprini score(max)of more than or equal to 5(aOR 34.241,95%CI 1.831-640.235)were considered as risk factors for VTE.Conclusion In this study,we found that the incidence of VTE in non-oncological surgery was about 2.3%,which was higher than some previous studies.Risk factors could be used for early detection and diagnosis of VTE.
文摘Objective:The clinical grading system for varicoceles is subjective and dependent on clinician experience.Color Doppler ultrasound(US)has not been standardized in the diagnosis of varicoceles.We aimed to determine if US measurement of varicocele could be predictive of World Health Organization(WHO)varicocele grade.Methods:Men who presented for either scrotal pain or infertility to a tertiary men’s health clinic underwent physical examination,and varicoceles were graded following WHO criteria(0Zsubclinical,1,2,3).US was used to measure largest venous diameter in the pampiniform plexus bilaterally at rest and during Valsalva maneuver.Receiver operator characteristic curve analysis was used to determine if resting diameter,diameter during Valsalva,or change in diameter between at rest and during Valsalva provided the highest sensitivity and specificity for determining clinical grade.Threshold values for diameter were determined from these receiver operator characteristic curves.Results:A total of 102 men(50 with clinical varicocele and 52 with subclinical varicocele)were included.Diameter at rest was the best ultrasonographic discriminator between subclinical and clinical varicoceles(area under the curve[AUC]Z0.67)with a diameter threshold of 3.0 mm(sensitivity 79%,specificity 42%).Diameter during Valsalva had the greatest AUC for determining clinical Grades 1 versus 2(AUCZ0.57)with diameter threshold of 5.7 mm(sensitivity 71%,specificity 33%).For differentiating between Grades 2 and 3,diameter at rest had the greatest AUC of 0.65 with a threshold of 3.6 mm(sensitivity 71%,specificity 58%).Conclusion:Our results corroborate other studies that have shown a weak correlation between US and clinical grading.The use of diameter during Valsalva was less predictive than diameter at rest and was only clinically significant in differentiating between Grade 1 and 2 varicocele.A standardized method for determining clinically relevant varicoceles on US would allow for improved patient counseling and clinical decision-making.
