Objective:To investigate the risk factors for lower extremity deep vein thrombosis (DVT) in patients with bone trauma and their diagnostic efficacy.Methods:A retrospective cohort study was conducted to analyze the clinical data of 108 patients with bone trauma who were admitted to Affiliated Changzhou Second People′s Hospital of Nanjing Medical University from October 2023 to February 2024, including 61 males and 47 females, aged 17-96 years [(55.2±19.5)years]. Based on the results of color Doppler ultrasonography of lower extremities within 96 hours on admission, the patients were divided into DVT group ( n=58) and non-DVT group ( n=50). In DVT group, 42 patients developed lower extremity DVT within 7 days after trauma and the other 16 patients developed lower extremity DVT after 7 days. Basic clinical data including gender, age, body mass index (BMI), underlying diseases, cause of injury, site of fracture, surgery and admission Caprini score, and admission laboratory test indicators including routine coagulation indicators [prothrombin time (PT), international normalized ratio (INR), thrombin time (TT), activated partial thromboplastin time (APTT), fibrinogen (FBG) and D-dimer (D-D)] and four thrombosis indicators [plasma thrombin-antithrombin III complex (TAT), thrombomodulin (TM), tissue-type plasminogen activator-inhibitor 1 complex (tPAIC) and plasmin-alpha2-plasmin inhibitor complex (PIC)] were collected in the two groups. Univariate analysis and multivariate binary Logistic regression analysis were conducted to investigate the correlation between these indicators and incidence of lower extremity DVT in patients with bone trauma and determine the independent risk factors. Receiver operating characteristic (ROC) curve and area under the curve (AUC) of the relevant risk factors were analyzed to evaluate and compare the diagnostic efficacy of the factors for lower extremity DVT in patients with bone trauma and further assess the diagnostic efficacy of the factors for lower extremity DVT within 7 days after bone trauma. Results:Univariate analysis revealed significant correlations of gender, age, Caprini score, D-D, TAT, TM and PIC with incidence of lower extremity DVT in patients with bone trauma ( P<0.01). The results of multivariate binary Logistic regression analysis demonstrated that Caprini score ( OR=1.36, 95% CI 1.12, 1.65, P<0.01), TAT ( OR=1.05, 95% CI 1.00, 1.10, P<0.05), and TM ( OR=1.34, 95% CI 1.02, 1.77, P<0.05) were significantly correlated to incidence of lower extremity DVT in patients with bone trauma. ROC curve analysis indicated that TAT (AUC=0.76, 95% CI 0.67, 0.86) had the highest diagnostic efficiency, followed by TM (AUC=0.72, 95% CI 0.62, 0.81) and Caprini score (AUC=0.72, 95% CI 0.62, 0.82). The combined analysis of all the factors effectively enhanced the diagnostic efficiency for DVT (AUC=0.84, 95% CI 0.77, 0.92). Additionally, TAT (AUC=0.81, 95% CI 0.71, 0.91) demonstrated better diagnostic efficacy for lower extremity DVT within 7 days after bone trauma compared with the Caprini score (AUC=0.72, 95% CI 0.61, 0.83) and TM (AUC=0.71, 95% CI 0.60, 0.83). Similarly, the combined analysis of all the factors also effectively enhanced the overall diagnostic efficacy for lower extremity DVT within 7 days after bone trauma (AUC=0.85, 95% CI 0.77, 0.93). Conclusions:Caprini score, TAT and TM are identified as independent risk factors for lower extremity DVT in patients with bone trauma, and all the three factors demonstrate good diagnostic efficacy. Their combination is found to have statistically significant higher diagnostic efficiency than each individual factor. Furthermore, TAT is proved to be the best in diagnosing lower extremity DVT within 7 days after bone trauma, while the combined analysis of all the risk factors can further improve the diagnostic efficacy.

Objective:To evaluate composite bridge internal fixation in the treatment of limb metaphyseal fractures in children.Methods:From October 2015 to December 2018, 16 children was treated by composite bridge internal fixation for limb metaphyseal fractures at Department of Orthopaedics, The Second People's Hospital of Changzhou. They were 11 boys and 5 girls, aged from 8 to 14 years (average, 11.0 years). Their fractures were located at proximal humerus in 4 cases, at distal femur in 3 cases, at proximal tibia in 3 cases and at distal tibia in 6 cases. According to the Salter-Harris classification, 6 cases were type Ⅱ, 5 cases type Ⅲ and 5 cases type Ⅳ. The time from injury to surgery ranged from 3 to 8 days, averaging 5.3 days. The fracture healing time, postoperative complications (infection and implant failure) and postoperative functional recovery were recorded.Results:This cohort obtained follow-up from 12 to 18 months (average, 13 months). All the children obtained bony union after 2 to 5 months (average, 2.4 months). At the last follow-up, the 4 proximal humeral fractures were evaluated by the Neer scores, giving 4 excellent cases; the 6 distal femoral and proximal tibial fractures were evaluated by the knee function scores of The Hospital for Special Surgery (HSS), giving 5 excellent and one good cases; the 6 distal tibial fractures were evaluated by the Baird scores, giving 5 excellent and one good cases. Follow-ups found no complications like postoperative infection, loosening or breakage of implants, or bone nonunion.Conclusion:Composite bridge internal fixation is a good alternative treatment for children metaphyseal fractures, because it has advantages of minimal invasion, operative simplicity, reliable fixation and limited postoperative complications.

Objective:To investigate the value of neutrophil-to-lymphocyte ratio (NLR) in predicting the prognosis of patients with severe heat stroke.Methods:A retrospective analysis was performed on patients with severe heat stroke hospitalized in the ICU of Changzhou No. 2 People's Hospital from June 2013 to September 2019. The patients were divided into the survival group and death group according to their 30-day survival. The basic data of the patients were recorded. Blood routine, liver and kidney function parameters, troponin, brain natriuretic peptide, myocardial enzyme spectrum, blood coagulation routine, and acute physiology and chronic health evaluation (APACHE)Ⅱ were analyzed within 24 h after admission. Multivariate COX regression analysis was used to screen the risk factors of 30-day death. Spearman correlation test was used to analyze the correlation between NLR and APACHEII score. Receiver operating characteristic (ROC) curves were drawn to assess the predictive value of NLR for the 30-day death in patients with severe heat stroke. Kaplan-Meier survival curve was used to analyze 30-day cumulative survival of high-risk patients.Results:A total of 115 patients with severe heat stroke were included in this study, and they were divided into the survival group ( n=92) and the death group ( n=23) according to the prognosis. NLR in the death group was significantly higher than that in the survival group ( P<0.05). Multivariate COX regression analysis showed that NLR was an independent risk factor for death after adjusting confounders ( HR=1.091, 95% CI: 1.049-1.136, P<0.001). Spearman correlation test showed a correlation between NLR and APACHEII score ( r=0.655, P<0.001). ROC curve analysis showed that NLR had the greatest predictive value for 30-day death, with an area under ROC curve (AUC) of 0.787, a sensitivity of 82.6%, a specificity of 67.4%, and the cut-off value of 7.35. Kaplan-Meier survival analysis curve shows that patients in the below NLR cut-off value group had a significantly higher 30-day survival rate than those in the above NLR cut-off value group ( P<0.001). Conclusions:The increased NLR is a high risk factor for death in patients with severe heat stroke, and helps predict the prognosis of patients with severe heat stroke.

BACKGROUNDTotal knee arthroplasty (TKA) is a successful and frequently performed procedure in orthopedic surgery. The diagnosis of peri-prosthetic joint infection following TKA remains challenging. The present study estimated the usefulness of knee skin temperature (measured by infrared thermography) and serum soluble intercellular adhesion molecule-1 (sICAM-1) in the diagnosis of post-operative knee peri-prosthetic infection.

METHODSPatients were divided into three groups: 21 patients undergoing uncomplicated TKAs, seven with prosthesis infection, and three undergoing TKA revisions. The serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and sICAM-1 as well as the local knee skin temperature were measured pre-operatively and on Days 1 and 7 and at 1, 3, and 6 months post-operatively in Groups 1 and 3. The same parameters were measured in Group 2 at the time of prosthesis infection diagnosis.

RESULTSIn Group 1, the levels of IL-6, CRP, ESR, and knee skin temperature were significantly elevated post-operatively, but returned to baseline levels within 6 months. The sICAM-1 levels were not significantly different. The mean differential temperature (MDT) and levels of siCAM-1, IL-6, CRP, and ESR differed significantly between Groups 1 and 2. The MDT had returned to normal in Group 3 by 6 months post-operatively.

CONCLUSIONSElevations in IL-6, CRP, ESR, and MDT in patients undergoing TKA could be a normal response to surgical trauma, but sustained elevations may be indicative of complications. The knee skin temperature and sICAM-1 may be used as indicators in the diagnosis of knee prosthesis infection following TKA.

Adult ; Aged ; Arthroplasty, Replacement, Knee ; adverse effects ; Blood Sedimentation ; C-Reactive Protein ; metabolism ; Female ; Humans ; Intercellular Adhesion Molecule-1 ; metabolism ; Interleukin-6 ; blood ; Knee Joint ; immunology ; surgery ; Male ; Middle Aged ; Prospective Studies ; Skin Temperature ; physiology ; Thermography ; methods

OBJECTIVE To evaluate the comprehensive value of novel oral anticoagulant drugs （NOACs） after major orthopedic surgery. METHODS The evaluation evidence was collected through literature research； evidence and value：impact on decision-making （EVIDEM） framework was introduced to integrate the evaluation process； the multi-criteria decision analysis （MCDA） method was used to construct a multi-dimensional evaluation system； the weights assigned to each evaluation criterion were determined by the combination of Delphi method and analytic hierarchy process， and the rivaroxaban， dabigatran and apixaban were comprehensively evaluated. RESULTS The clinical comprehensive evaluation system of NOACs after major orthopedic surgery was successfully established， and the final clinical comprehensive evaluation weights of NOACs （rivaroxaban， dabigatran， apixaban） after major orthopedic surgery were calculated， with scores of 0.399 7 for rivaroxaban， 0.244 4 for apixaban， and 0.355 9 for dabigatran， indicating that rivaroxaban demonstrated the highest overall clinical value. Among them， rivaroxaban had the highest weight score in the evaluation of pharmaceutical characteristics， cost-effectiveness and other attributes in a single dimension. In terms of efficacy and safety evaluation， apixaban had the highest weighting score. CONCLUSIONS Among NOACs， rivaroxaban is more suitable for routine anticoagulation management after major orthopedic surgery， especially in terms of pharmacological properties， cost-effectiveness and other attributes.