Characteristics of Deep Venous Thrombosis in Isolated Lower Extremity Fractures and Unsolved Problems in Guidelines: A Review of Recent Literature

Deep venous thrombosis (DVT) has been characterized by a disorder of venous return caused by abnormal blood clotting in deep veins. It often occurs in the lower limbs and is a common complication in orthopaedics. Therefore, relevant professional organizations domestic and overseas had formulated and constantly updated relevant guidelines to prevent the occurrence of DVT. According to the management strategy of the guidelines, the incidence of DVT can be significantly reduced. However, due to the variety of fractures types, the guidelines cannot expound precautions and characteristics of DVT for all fracture types at present, and there are other related unresolved problems. For example, there is still a lack of consistent optimal strategies for the management of DVT following isolated lower extremity fractures with a higher incidence. The best anticoagulant strategies for patients with upper limb fractures, pediatric fractures, and those combined with other injuries are rarely described in orthopaedic guidelines, but such fractures are common in clinical orthopaedics. The long‐term complications after DVT, such as post‐thrombotic syndrome, are not well‐understood. In the absence of clear guidance, orthopaedic surgeons often resort to empiric anticoagulation or conservative treatment, so the prevention effects of DVT are inconsistent. The purpose of this review is to summarize the characteristics of DVT events after isolated lower extremity fractures and to discuss the unsolved issues in the guidelines by reviewing the previous literature and tracing the history of DVT discovery, to provide more scientific and comprehensive recommendations for the prediction and prevention of DVT.     

JNK pathway‐associated phosphatase in acute ischemic stroke patients: Its correlation with T helper cells,clinical properties,and recurrence risk

ObjectiveJKAP modifies T‐cell immune response and inflammation, also involves in cardia‐cerebrovascular disease etiology. This study intended to explore JKAP''s relation with T‐helper 1 (Th1), T‐helper 17 (Th17) cell levels, clinical properties, and recurrence‐free survival (RFS) in acute ischemic stroke (AIS) patients.MethodsA total of 155 AIS patients were analyzed. Serum JKAP, interferon‐gamma (IFN‐γ), and interleukin‐17A (IL‐17A) were detected by ELISA; then blood Th1 and Th17 cells were quantified by flow cytometry. Besides, 30 healthy subjects were enrolled as controls to detect JKAP, Th1, and Th17 cells.ResultsJKAP level was lower (p < 0.001), Th1 cells were not differed (p = 0.068), but Th17 cells were elevated in AIS patients versus controls (p < 0.001). Meanwhile, JKAP was negatively correlated with Th1 cells (p = 0.038), Th17 cells (P<0.001), IFN‐γ (p = 0.002), and IL‐17A (p < 0.001) in AIS patients. JKAP was negatively associated with the National Institutes of Health Stroke Scale (NIHSS) score (p < 0.001), but Th17 cells (p = 0.001), IFN‐γ (p = 0.035), and IL‐17A (p = 0.008) levels were positively associated with NIHSS score. Additionally, accumulating RFS was numerically longer in patients with JKAP Quantile (Q) 4 than patients with JKAP Q1–Q3 (p = 0.068), and numerically better in patients with JKAP Q3–Q4 than patients with JKAP Q1–Q2 (p = 0.069), but without statistical significance.ConclusionJKAP correlates with lower Th1 and Th17 cell percentages as well as milder disease severity.     

术前平均血小板体积预测老年食管鳞癌患者术后生存情况的价值

目的:探讨术前平均血小板体积(MPV)预测老年食管鳞癌患者术后生存情况的价值。方法:纳入2014年1月-2016年12月在我院接受手术治疗的259例老年食管鳞癌患者作为研究对象,绘制术前MPV预测老年食管鳞癌患者术后生存情况的ROC曲线，获得术前MPV的最佳诊断截点，根据术前MPV的最佳诊断截点将所有患者分为两组，Logistic模型估计每个患者的倾向性评分，运用1∶1最近邻居倾向性匹配评分(PSM)法将两组中的倾向性评分最为相近的两个患者进行配对，比较匹配前后两组间各临床病理指标的均衡性，Kaplan-Meier生存分析比较匹配后两组患者术后无病生存率和总生存率，Cox回归模型进行敏感性分析，验证匹配后术前MPV对老年食管鳞癌术后生存情况的预测价值。结果:259例老年食管鳞癌患者术后1年、3年、5年无病生存率和总生存率分别为60.3%、41.9%、25.1%和86.1%、62.6%、43.2%，ROC分析结果显示，术前MVP预测老年食管鳞状细胞癌患者术后生存情况的AUC 为 0.835(95%CI:0.776~0.897)，最佳诊断截点为12.7 fL，相应的灵敏度和特异度分别为83.6%和85.4%，根据术前MPV的最佳诊断截点，将所有患者分别分为MPV≥12.7 fL组112例(43.2%)和MPV<12.7 fL组147例(56.8%)，采用1∶1最近邻居 PSM法，结果两组共65对匹配成功，匹配后两组肿瘤直径、胸膜粘连、TNM/T分期、淋巴结转移、淋巴结转移数目、脉管癌栓6个指标比较均无明显差异，两组间各指标分布的均衡性得到了明显的提高(P>0.05)，Kaplan-Meier生存分析显示，匹配后MPV≥12.7 fL组患者术后1年、3年、5年无病生存率明显低于MPV<12.7 fL组(51.6%、23.8%、18.5% vs 66.5%、48.8%、32.7%，χ2/P=5.789/0.024)，MPV≥12.7 fL组患者术后1年、3年、5年总生存率明显低于MPV<12.7 fL组(85.6%、51.8%、32.5% vs 92.5%、72.8%、51.7%，χ2/P=5.674/0.026)，Cox回归分析显示，老年食管鳞癌患者术前MVP每增加1 fL，患者术后5年内肿瘤复发转移的风险增加0.895倍，患者术后5年内死亡的风险增加1.016倍。结论:MPV作为活化血小板的评价指标可用于评估老年食管鳞癌患者术后的生存情况，并且具有较高的预测价值。     

胃肠道间质瘤组织TNC、CD55表达与临床病理特征及预后的关系

目的:探究胃肠道间质瘤组织中肌腱蛋白C(Tenascin-C,TNC)和CD55的表达及其与临床病理参数和预后之间的关系。方法:65例手术切除且经病理诊断为原发性胃肠道间质瘤组织样本,采用免疫组化的方法检测组织中TNC和CD55的表达,分析TNC和CD55表达与患者临床病理参数的关系;采用Kaplan-Meier生存曲线分析TNC、CD55的表达与患者预后的关系。结果:胃肠道间质瘤组织中TNC高表达率为27.7%(18/65),TNC的表达与肿瘤分化程度和TNM分期相关(均P<0.05);Kaplan-Meier生存曲线结果显示,胃肠道间质瘤组织TNC高表达的患者生存率较低。胃肠道间质瘤组织中CD55高表达率为24.6%(16/65),CD55的表达与胃肠道间质瘤肿瘤大小、远处转移以及TNM分期均相关(均P<0.05);Kaplan-Meier生存曲线结果显示,胃肠道间质瘤CD55低表达的患者术后生存率较高。结论:胃肠道间质瘤组织中TNC和CD55均存在表达,表达与胃肠道间质瘤患者的患者预后密切相关,TNC和CD55有可能成为胃肠道间质瘤预后评估的潜在标志物。     

改良Van Herick前房角宽度评估法的临床观察

目的：探讨在Van Herick法基础上更方便准确评估前房角宽度的方法。方法：纳入2021-01/12于我院就诊的年龄相关性白内障患者58例69眼，参考Van Herick法分为房角宽度≥1/2颞侧角膜厚度(CT)组(37例44眼)和&#x003C;1/2CT组(21例25眼)，应用超声生物显微镜测量中央前房深度和周边房角度数。结果：房角宽度≥1/2CT组和&#x003C;1/2CT组患者中央前房深度有明显差异(2.64±0.27 mm vs 2.23±0.29 mm，P&#x003C;0.01)，且两组间上方、颞侧、下方和鼻侧象限房角度数均有明显差异(P&#x003C;0.01)。房角宽度≥1/2CT组患者上方与下方象限房角度数无显著差异(P&#x003E;0.05)，其余各象限房角度数均有差异(P&#x003C;0.05)； 房角宽度&#x003C;1/2CT组患者上方与鼻、颞侧象限，下方与颞侧象限房角度数均有差异(P&#x003C;0.05)。结论：裂隙灯下采用Van Herick法评估颞侧房角宽度，同时评估下方象限房角宽度，可以更简单、快速、准确地评估前房角的整体情况。     

肺炎支原体肺炎患儿血清microRNA-21和microRNA-221水平变化及与炎症因子、T淋巴细胞亚群的相关性

目的 探讨肺炎支原体肺炎（MPP）患儿血清microRNA-21（miR-21）和microRNA-221（miR-221）的水平变化及与炎症因子、T淋巴细胞亚群的关系。方法 选取2017年1月—2019年1月邯郸市中心医院就诊的MPP患儿120例为研究对象（MPP组），另选取本院同期体检的健康儿童100例为对照组（CON组）。比较两组研究对象血清miR-21和miR-221的水平差异，并分析二者与患儿外周血中炎症因子［白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）］和T淋巴细胞亚群（CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺）之间的相关性。结果 MPP组血清miR-21和miR-221水平高于CON组（P <0.05）。MPP组外周血CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺低于CON组，而IL-6、IL-8、TNF-α的水平高于CON组（均P <0.05）。MPP组血清miR-21和miR-221与患者外周血CD3⁺（r =-0.494和-0.656，P =0.037和0.014）、CD4⁺（r =-0.621和-0.554，P =0.015和0.031）、CD8⁺（r =-0.772和-0.476，P =0.003和0.043）、CD4⁺/CD8⁺（r =-0.545和-0.660，P =0.023和0.014）均呈负相关，而与TNF-α（r =0.787和0.619，P =0.000和0.015）、IL-6（r =0.530和0.598，P =0.035和0.029）、IL-8（r =0.665和0.614，P =0.012和0.017）均呈正相关。结论 MPP患儿血清miR-21和miR-221水平升高，且与患儿T淋巴细胞亚群水平的降低、炎症因子水平的升高有一定的相关性，监测两者的水平变化有助于评估MPP患儿的免疫状态和炎症反应，并为合理制订治疗方案提供帮助。     

急性心肌梗死患者血清miR-423-5P，Bcl-2 和LC3-II 水平表达与预后相关性研究

目的 探讨血清miR-423-5P，Bcl-2 和LC3-II 对急性心肌梗死(acute myocardial infarction，AMI)患者预后的影响。方法 筛选2017 年3 月～ 2018 年10 月收治于邯郸市第一医院心内科的122 例AMI患者为研究对象，根据随访期间（一年）是否发生主要不良心血管事件（major adverse cardiovascular events，MACE）分为MACE组（n=43）和非MACE组（n=79），同期体检健康志愿者（n=50）作为对照组，分别采用聚合酶链式反应（polymerase chain reaction，PCR）和酶联免疫吸附测定（enzyme linked immunosorbent assay，ELISA）检测患者血清miR-423-5P，Bcl-2 和LC3-II 表达水平。比较两组患者血清miR-423-5P，Bcl-2 和LC3-II 的表达差异，并用受试者工作特征(receiver operator characteristic, ROC) 曲线图分析对急性心肌梗死患者预后的价值。结果 对照组miR-423-5P（0.91±0.12），Bcl-2（1.13±0.21ng/ml）和LC3-II（0.73±0.16 ng/ml）均低于MACE组（1.42±0.22，4.25±0.34 ng/ml，1.25±0.31g/ml）和非MACE组（1.13±0.11，2.01±0.28ng/ml，1.21±0.06 ng/ml），差异均具有统计学意义（F=151.155，1 880.468，115.625，均P ＜ 0.05）；MACE 组血清mIR-423-5P 和Bcl-2 表达均高于非MACE 组，差异具有统计学意义（t=9.716, 39.093，均P ＜ 0.05），两组间血清LC3-II 的表达差异无统计学意义（t=1.113, P>0.05）。ROC 曲线显示，miR-423-5P，Bcl-2 预测急性心肌梗死患者预后的曲线下面积分别为0.813 和0.776，截断值分别为1.213 和4.012 ng/ml，灵敏度分别为0.721 和0.702，特异度分别为0.734和0.737；二者联合检测时，曲线下面积、灵敏度和特异度分别为0.852, 0.832，0.827。结论 血清mIR-423-5P，Bcl-2水平与急性心肌梗死患者预后密切相关，有可能成为判断预后的标志物，且两者联合应用的效果优于单独应用。