Objective To investigate the utilization of ultrasound monitoring the renal blood flow during extracorporeal membrane oxygenation (ECMO).Methods Twentry one cases,who received veinartery ECMO for heart failure,were examinated by bed-side ultrasound before the ECMO initiated,right after the ECMO initiated,each day after the ECMO initiated,and right after the ECMO weaned.The renal interlobar artery peak velocity (Vmax) was measured,and the renal interlobar artery resistant index (RI) was calculated,as well as the values of the serum creatinine (SCr) and blood urea nitrogen (BUN) were recorded.All the data were compared.Results Compared to the variables right after the ECMO initiated,thc Vmax incrcascd (P ＜ 0.05) two days after ECMO initiated and right after the ECMO weaned,while RI (P ＜ 0.05),SCr (P ＜ 0.05) and BUN (P ＜ 0.05) decreased,there being significant differences (P ＜ 0.05).Conclusions While treating patients with extracorporeal membrane oxygenation,the ultrasound can monitoring the renal blood flow effectively,and provide important parameters for the clinical doctors as the basis of the diagnosis and treatment.

Objective To investigate the anatomical distribution and change of distal deep venous thrombosis in patients with hip fracture,to provide evidence for prevention and treatment of deep vein thrombosis in patients with hip fracture and lower limb deep vein ultrasound examinatio.Methods The clinical data of 383 patients with hip fractures who were admitted in Department of Orthopaedics Trauma,Xi'an Jiaotong University Medical College Red Cross Hospital from July 2014 to April 2018 were analyzed retrospectively.There were 122 males and 261 females,the age range was 17 to 94 years,the median was 78 years,and the interquartile range was 12 years.There were 154 cases of femoral neck fracture,208 cases of femoral intertrochanteric fracture,and 21 cases of femoral subtrochanteric fracture.Deep venous thrombosis was assessed by ultrasonography before and 3-5 days after operation,and the anatomical location and changes of deep vein thrombosis were analyzed.The skewed distribution data were represented by the median and interquartile range.The proportion of the number of deep venous thrombosis case in the anatomical position of the lower extremities was expressed as a percentage.Results Of the 383 patients with hip fracture who had distal deep venous thrombosis before surgery,isolated distal deep vein thrombosis (IDDVT) accounted for 89.30％ (342/383),and multivessel thrombosis accounted for 10.70％ (41/383).In IDDVT,intermuscular venous thrombosis was the most common,and no anterior venous thrombosis occurred.In multivessel thrombosis,two or three of the intermuscular vein,the posterior tibial vein,and the iliac vein were more common.Twenty-eight (7.31％) patients had distal thrombus extension to the proximal end (including 21 cases involving the iliac vein and 7 cases involving the superficial femoral vein),IDDVT accounted for 61.88％ (237/383).The involvement of multiple venous thrombosis accounted for 16.19％ (62/383),62.40％ (239/383) of the distal thrombus position did not change,and 14.62％ (56/383) of the distal thrombus disappeared.Conclusions For patients with hip fracture,the intermuscular vein is the most common site of distal deep venous thrombosis,ultrasound examination of anterior tibial vein is not necessary.Under anticoagulatio(n),7.31％ of distal deep venous thrombosis may extend to the proximal and 14.62％ of distal deep venous thrombosis disappear.For patients with hip fracture complicated with distal deep venous thrombosis in hospital,patients without contraindication of anticoagulation should be treated with anticoagulation at an early stage to prevent the proximal progression or fall off of thrombosis and reduce the risk of distal deep venous thrombosis.

Objective To investigate the relationship between the incidence of deep vein thrombosis (DVT) during hospitalization and the energy of injury in tibial plateau fractures (TPFs).Methods 140 patients were enrolled in the study between September,2014,and October,2017 in Honghui Hospital,Xi'an Jiaotong University.According to the Schatzker classification,the low-energy group (Schatzker Ⅰ-Ⅲ) X-ray showed a simple or lateral fracture or compression fracture of the lateral plateau (n =63);the high-energy group (Schatzker Ⅳ-Ⅵ) X-ray showed the medial tibia or double of the tibial plateau (n =77).Duplex Ultrasonography was performed in lower extremities before and after surgical intervention for DVT evaluation and record the incidence of DVT,the days during hospitalization,the blood loss during surgery and the level of D-Dimer.All patients received mechanical and chemical thromboprophylaxis.The patient was followed up for one month after surgery,and the lower extremity ultrasound was reviewed and recorded.The measurement data were expressed as ((x) ± s),and the categorical variables were expressed in composition ratio.The measurement data were all in accordance with the normal distribution and the variance was uniform.The t-test was used,and the Chi-square test was used for comparison between groups.Results The incidence of thrombosis of tibial plateau fracture in TPFs was 36.43％ and 46.43％ pre-operation and post-operation respectively.The thrombosis incidence was 31.75 ％ (20/63) in the low-energy group and 40.26％ (31/77) in the high-energy group pre-operation.The thrombosis incidence was 44.44％ (28/63) in the low-energy group and 48.05％ (37/77) in the high-energy group post-operation.Statistical analysis showed no significant difference between the two groups pre-operation (P =0.298) and post-operation(P =0.785).The days during hospitalization [(11.94 ± 4.18) d,(9.56 ± 2.54) d],the blood loss during surgery [(208.96 ±224.43) ml,(129.68 ± 142.14) ml] and the level of D-Dimer [(2.39 ± 3.38) mg/L,(1.21 ± 2.32) mg/L] at pre-operation showed differences in the high energy group and the low energy group,respectively.Conclusions The incidence of DVT in TPFs is high during the hospital,but most of DVT is concentrated in the distal to the knee.Although the incidence of high energy injury and low energy injury DVT is not significantly different in TPFs,we should also be alert to the occurrence of DVT.

Objective To investigate the incidence of and risk factors for deep venous thrombosis (DVT) at the uninjured limb during hospitalization in patients with lower extremity fracture. Methods The clinical data were retrospectively analyzed of the 494 patients who had been hospitalized for lower extremity fracture at Department of Orthopedics, Honghui Hospital from September 1, 2014 to October 1, 2017. They were 228 males and 266 females with an average age of 58.9 ± 18.9 years ( from 16 to 94 years ) . 290 fractures occurred proximally to the knee, 101 fractures around the knee and 103 fractures distally to the knee. They received anticoagulant prophylaxis or treatment during hospitalization. After operation, they were examined with Doppler sonography for bilateral lower limbs to detect occurrence of thrombus. The incidence of DVT at the uninjured limb during hospitalization was recorded and its possible risk factors were analyzed statistically. The possible risk factors ( gender, age, fracture type, body mass index, concomitant internal disease, time from injury to surgery, time from surgery to discharge, American Society of Anesthesiologists rating, operation duration, blood loss, fluid infusion volume and D-dimer level ) were screened by single factor logistic regression analysis and the major independent risk factors were determined by multi-factor logistic re-gression analysis.Results DVT occurred at the injured limb during hospitalization in 237 cases ( 47.97%). Of them, 221 ( 44.74%) had peripheral thrombus, 7 central thrombus ( 1.42%) and 9 mixed thrombus ( 1.82%). DVT occurred at the uninjured limb during hospitalization in 98 cases ( 19.84%). Of them, 90 (18.2%) had peripheral thrombus, one central thrombus (0.2%) and 7 mixed thrombus (1.4%). Of the 98 patients with DVT at the uninjured limb, 74 (75.51%) had DVT at both lower limbs and 24 (24.49%) had DVT only at the uninjured limb. Age and D-dimer level one day after surgery were independent risk factors for DVT at the uninjured limb during hospitalization. Conclusions The incidence of actual DVT at the unin-jured limb in patients with lower extremity fracture cannot be ignored in spite of use of anticoagulants for pro-phylaxis or treatment during hospitalization. We should also be aware that age and D-dimer level one day after surgery are independent risk factors for DVT at the uninjured limb during hospitalization.

Objective To investigate the factors associated with preoperative deep venous thrombosis (DVT) in female patients with lower extremity fracture in menstrual phase.Methods A retrospective analysis was conducted of the 119 women with lower extremity fracture in childbearing age who had been treated at Traumatic Orthopaedics Center,Red Cross Hospital,Xi'an Jiaotong University Health Science College from October 2016 to October 2017.Of them,41 were in menstral phase,aged from 20 to 50 years (average,37.1 ± 8.9 years),and 78 were not,aged from 19 to 50 years (average,36.9 ± 8.0 years).The 2 groups were compared in terms of DVT incidence,D-dimer level,prothrombin time,partial prothrombin time,thrombin time,fibrinogen level,and preoperative bed time.Results The patients with menstruation had significantly higher incidence of lower extremity DVT (82.9％) and significantly longer preoperative bed time (9.1 ± 3.4 d) than those without menstruation did (14.1％ and 3.8 ± 2.2 d,respectively) (P ＜0.05).There were no significant differences between the 2 groups in the preoperative coagulation indexes:D-dimer,prothrombin time,partial prothrombin time,thrombin time or fibrinogen (P ＞ 0.05).Conclusions The incidence of preoperative DVT may be high the female patients with lower extremity fracture in menstrual phase,chiefly because of long preoperative bed time.Detection of D-dimer level is of limited significance in the screening for thrombosis in menstrual phase.Menstruation may not be a surgical contraindication.

Objective To investigate the incidence and risk factors of deep venous thrombosis in patients with open fracture of lower extremities.Methods A retrospective study was conducted to analyze the clinical data of 203 patients with open fracture of lower limbs admitted to Department of Orthopaedics and Trauma,Xi'an Jiangtong University Medical College Red Cross Hospital from January 2015 to November 2017.There were 75 males and 45 females,the average age was 47.3 years,and the age ranged from 18 to 63 years.Classification of open fracture sites of lower limbs:open fracture of femoral shaft in 59 cases;open fracture of tibia and fibula in 107 cases;open fracture of ankle in 37 cases.Gustilo classification of open fracture included 34 cases of type Ⅰ,71 cases of type Ⅱ and 98 cases of type Ⅲ.According to whether thrombosis occurs or not,the patients were divided into thrombosis group (n =63) and non-thrombosis group(n =140).The incidence of thrombosis was expressed as percentage (％).The age,fracture degree,injury type,Gustilo classification of open fracture,gender,body mass index (BMI),combined medical diseases,fracture site,preoperative and postoperative D-dimers were subjected to x2 test or Fisher's exact test.The test αt value was taken as 0.05 on both sides.P ＜ 0.05 suggested that the difference was statistically significant.Results The incidence of deep venous thrombosis in 63 cases of open fracture was 31.03％,of 63 DVT patients,5 were central thrombosis (7.93％),17 were mixed thrombosis (26.98％) and 41 were peripheral thrombosis (65.08％).The main type of thrombosis was peripheral thrombosis.There were significant differences in age,fracture degree,injury type and open fracture Gustilo type between the two groups of thrombus group and non thrombus group (P ＜ 0.05).Sex,BMI,internal medical diseases,fracture sites,and D-two polymer before and after operation were not statistically significant (P ＞0.05).Conclusions The incidence of DVT was higher in patients with open fracture of lower extremities,the main type of thrombosis was peripheral thrombosis.Age over 60 years old,high falling injury,2 or more fractures and comminuted fractures,open fractures Gustilo type Ⅲ was associated with DVT.

Objective: To investigate the regularity in and risk factors for perioperative deep venous thrombosis (DVT) and the changes in plasma D-dimer in patients with tibiofibular fracture. Methods: A retrospective analysis was done of the 180 patients with tibiofibular fracture who had been treated at Department of Orthopaedics and Trauma, Xi'an Honghui Hospital from September 2014 to February 2018. They were 114 males and 66 females, aged from 16 to 83 years (average, 47.6 years). The levels of plasma D-dimer were detected at admission, one day preoperation, and 1, 3, 5 days postoperation. B-ultrasound examination of both lower extremities was performed before and after surgery. According to the results of B-ultrasound, the patients were divided into a DVT group and a non-DVT group. The 2 groups were compared in the plasma D-dimer levels measured at different time points. DVT risk factors were screened by univariate analysis, and multivariate logistic regression analysis was used to determine independent risk factors. Results: Of this cohort, 54 cases (30%) developed DVT and 39 cases (21.7%) did preoperation. Of the 39 cases (mixed DVT in one and distal DVT in 38 ones), DVT disappeared in 14 postoperation. Of the 40 cases (22.2%) of postoperative DVT (proximal DVT in one, mixed DVT in one and distal DVT in 38 ones), 15 developed newly postoperation. Multivariate logistic regression analysis showed that age, time from injury to operation, pre-operative and postoperative D-dimer elevation were independent risk factors for DVT in the patients. The D-dimer levels in the DVT group were significantly higher than in the non-DVT group at one day preoperation, and 1, 3, 5 days postoperation (P<0.05). The area under the receiver operating characteristic curve was 0.704. When the critical value of D-dimer was 1.4 mg/L, its sensitivity for DVT diagnosis was 0.944 and its specificity 0.246 (poor). When the concentration of D-dimer was 4.45 mg/L, its sensitivity for DVT diagnosis was 0.574 and its specificity 0.817 (the highest). Conclusions Perioperative DVT may happen in patients with tibiofibular fracture, mostly at the distal end beyond the popliteal vein. Clinically, patients who are advanced in age, have plasma D-dimer elevation at admission and after operation, and have waited long for operation should be alert to the occurrence of DVT. The plasma D-dimer level with a recommended threshold of 4.45 mg/L may have a certain diagnostic value for patients with tibiofibular fracture.

Objective:To investigate the incidence of pre- and post-operative lower extremity deep venous thrombosis (DVT) in hospitalized patients with intertrochanteric fractures and to analyze the relevant risk factors.Methods:A retrospective case-control study was conducted to analyze the data of 218 patients with femoral intertrochanteric fractures admitted to Xi'an Honghui Hospital, Xi'an Jiaotong University from July 2015 to October 2017, including 85 males and 133 females. There were 85 males and 133 females, aged 32-102 years [(76.0±11.9)years]. Of the patients, 213 had open reduction and internal fixation, 4 partial hip arthroplasty, and 1 external fixation. All patients underwent deep venous ultrasound of the lower extremities before and after surgery to determine the occurrence of DVT. DVT of the lower extremities was divided into distal thrombosis, proximal thrombosis and mixed thrombosis. According to the preoperative and postoperative ultrasonography results, the patients were divided into thrombosis group [82 patients (37.6%) before operation, 128 patients (58.7%) after operation] and non-thrombosis group [136 patients (62.4%) before operation, 90 patients (41.3%) after operation]. Location of DVT were recorded before and after operation and outcome was evaluated. All patients were assessed for risk factors associated with thrombosis, including general patient data, time of surgery, tourniquet time, blood transfusion, blood loss, fluid volume, drainage, and serological markers. Multivariate Logistic regression analysis was used for detecting the risk factors.Results:The DVT rate was 37.6% preoperatively and increased to 58.7% postoperatively. The type of thrombosis was mainly distal DVT, which accounted for 86.6% and 90.6% of DVT before and after surgery, respectively. After the operation, 2.8% of the distal DVT extended above the popliteal vein. A total of 23.4% of the patients had no thrombosis before surgery, and distal, proximal, or mixed DVT occurred after surgery (22.0%, 0.5% and 0.9%, respectively). No fatal pulmonary embolism occurred. The univariate analysis showed no statistical differences between the preoperative thrombosis group and non-thrombosis group in terms of age, gender, fracture side, combined diseases, body mass index, American Society of Anesthesiologists (ASA) classification, admission D-dimer, and admission C-reactive protein (CRP) ( P>0.05), but the time from fracture to hospitalization and the time from fracture to surgery were significantly different between the two groups ( P<0.05). There were no statistical differences between the postoperative thrombosis group and the postoperative non-thrombosis group in age, gender, fracture side, combined diseases, body mass index, length of stay, ASA classification, surgical method, operation time, blood transfusion, blood loss, infusion volume, drainage volume, D-dimer on admission, and CRP on admission ( P>0.05), but the time from fracture to admission, time from fracture to surgery, D-dimer before surgery, D-dimer at day 1 after surgery, D-dimer at day 5 after surgery, and CRP at day 5 after surgery showed significant differences between the two groups ( P<0.05). Multivariate analysis results showed the time from fracture to hospitalization ( OR=1.109, 95% CI 1.003-1.225, P<0.05) and the time from fracture to surgery ( OR=1.090, 95% CI 1.007-1.180, P<0.05) were independent risk factors for preoperative DVT. The time from fracture to hospital ( OR=1.137, 95% CI 1.002-1.290, P<0.05) and 1 day postoperative D-dimer ( OR=1.087, 95% CI 1.033-1.142, P<0.05) were independent risk factors for postoperative DVT. Conclusions:For intertrochanteric fractures, distal DVT is the main type of thrombosis. Time from fracture to hospitalization is an independent risk factor of DVT before and after operation, and time from fracture to operation is an independent risk factor of DVT before operation. Early intervention (early admission and early surgery) may reduce the incidence of DVT.

OBJECTIVETo assess the differences in the health promotion demand of practitioners between urban and rural private enterprises by a comparative analysis, and to probe into the more scientific and targeted health promotion measures.

METHODSStratified cluster random sampling and self-designed questionnaire were adopted to survey 852 practitioners in urban and rural private enterprises of a Chinese city.

RESULTSThere were significant differences in practitioners between the two sorts of enterprises in terms of age, length of service, educational level, and forms of employment (P < 0.05 or P < 0.01). The basic knowledge and skills of practitioners in rural private enterprises were worse than those in urban private enterprises(P < 0.05 or P < 0.01). Practitioners in rural private enterprises were significantly less inclined to gain basic health promotion knowledge through enterprise training and network(P < 0.01). The demand of practitioners for health examination and hazard notification was significantly lower in rural private enterprises than in urban private enterprises (P < 0.05).

CONCLUSIONFocused and targeted health promotion should be carried out based on different demand characteristics of practitioners in rural and urban private enterprises.

China ; Data Collection ; Employment ; Health Promotion ; Humans ; Private Sector ; Rural Population ; Surveys and Questionnaires ; Urban Population