Risk factors for incident venous thromboembolism in patients with renal tumor and inferior vena cava tumor thrombus: a retrospective case-control study.

BACKGROUND: Venous thromboembolism (VTE) is a principal cause of mortality and adverse oncologic outcomes in patients with renal tumor and inferior vena cava tumor thrombus (RT-IVCTT). However, the preoperative thrombotic risk factors in these patients remain not fully characterized. OBJECTIVES: To identify preoperative thrombotic risk factors in patients with RT-IVCTT. PATIENTS/METHODS: Two hundred fifty-seven consecutive postsurgical patients with RT-IVCTT aged 18-86 years were enrolled between January 2008 and September 2022. Clinicopathological variables were retrospectively reviewed. A multivariate logistic regression model was performed. Preoperative hemoglobin, neutrophils, and serum albumin levels were analyzed as both continuous and categorical variables. RESULTS: VTE was identified in 63 patients (24.5%). On both continuously and categorically coded variables, advanced IVC thrombus (OR 3.2, 95% CI: 1.4-7.0; OR 2.7, 95% CI: 1.2-6.1), renal sinus fat invasion (OR 3.4, 95% CI: 1.6-7.0; OR 3.7, 95% CI: 1.8-7.7), IVC wall invasion (OR 3.6, 95% CI: 1.6-7.9; OR 4.3, 95% CI: 1.9-10.0), IVC blockage status of greater than 75% (OR 5.2, 95% CI: 1.7-15.8; OR 6.1, 95% CI: 1.9-19.7), and higher neutrophils (OR 1.3, 95% CI: 1.0-1.7; OR 2.4, 95% CI: 1.1-5.4) were significantly associated with increased VTE risk in patients with RT-IVCTT. Except hemoglobin, categorically coded serum albumin (OR 0.36, 95% CI: 0.17-0.75) was validated as an independent risk factor for VTE. CONCLUSIONS: This study provided an insight of risk factors contributing to preoperative VTE in patients with RT-IVCTT, which may be beneficial for optimizing strategies to manage VTE in clinical practice.

Analysis of 24-hour Death Risk Factors in Circulatory Failure Patients Treated with Venoarterial Extracorporeal Membrane Oxygenation.

OBJECTIVE: To explore the factors affecting short-term prognosis of circulatory failure patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) treatment. METHODS: A total of 136 patients undergoing VA-ECMO were enrolled in this study and subsequently divided into the death group (n=35) and the survival group (n=101) based on whether death occurred during hospitalisation. Extracorporeal membrane oxygenation (ECMO) running time, length of intensive care unit stay, length of hospital stay, costs, and ECMO complications were then compared between the two groups. RESULTS: The average age of all patients undergoing ECMO was 47.64±16.78 years (53.2±16.20 years in the death group and 45.713±16.62 years in the survival group) (P=0.022). Patients in the survival group exhibited a clear downward trend in lactic acid value following ECMO treatment compared to those in the death group. Total hospitalisation stay was longer in the survival group (35 days) than in the death group (15.5 days) (P<0.001). In the analysis of ECMO complications, the incidence of neurological complications, renal failure, limb complications, and infection were higher in the death group than in the survival group (P<0.05 for all). Specifically, as a risk factor for patient survival and discharge, the occurrence of infection will lead to increased hospitalisation stays and costs (P<0.05 for both). CONCLUSION: Complications such as kidney failure and infection are associated with in-hospital death, and ECMO-related complications should be actively prevented to improve the survival rate of VA-ECMO treatment.

A novel prognostic model for patients with colon adenocarcinoma.

Background: Colon adenocarcinoma (COAD) is a highly heterogeneous disease, which makes its prognostic prediction challenging. The purpose of this study was to investigate the clinical epidemiological characteristics, prognostic factors, and survival outcomes of patients with COAD in order to establish and validate a predictive clinical model (nomogram) for these patients. Methods: Using the SEER (Surveillance, Epidemiology, and End Results) database, we identified patients diagnosed with COAD between 1983 and 2015. Disease-specific survival (DSS) and overall survival (OS) were assessed using the log-rank test and Kaplan-Meier approach. Univariate and multivariate analyses were performed using Cox regression, which identified the independent prognostic factors for OS and DSS. The nomograms constructed to predict OS were based on these independent prognostic factors. The predictive ability of the nomograms was assessed using receiver operating characteristic (ROC) curves and calibration plots, while accuracy was assessed using decision curve analysis (DCA). Clinical utility was evaluated with a clinical impact curve (CIC). Results: A total of 104,933 patients were identified to have COAD, including 31,479 women and 73,454 men. The follow-up study duration ranged from 22 to 88 months, with an average of 46 months. Multivariate Cox regression analysis revealed that age, gender, race, site_recode_ICD, grade, CS_tumor_size, CS_extension, and metastasis were independent prognostic factors. Nomograms were constructed to predict the probability of 1-, 3-, and 5-year OS and DSS. The concordance index (C-index) and calibration plots showed that the established nomograms had robust predictive ability. The clinical decision chart (from the DCA) and the clinical impact chart (from the CIC) showed good predictive accuracy and clinical utility. Conclusion: In this study, a nomogram model for predicting the individualized survival probability of patients with COAD was constructed and validated. The nomograms of patients with COAD were accurate for predicting the 1-, 3-, and 5-year DSS. This study has great significance for clinical treatments. It also provides guidance for further prospective follow-up studies.

Analysis of 24-hour Death Risk Factors in Circulatory Failure Patients Treated with Venoarterial Extracorporeal Membrane Oxygenation

ABSTRACT Objective: To explore the factors affecting short-term prognosis of circulatory failure patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) treatment. Methods: A total of 136 patients undergoing VA-ECMO were enrolled in this study and subsequently divided into the death group (n=35) and the survival group (n=101) based on whether death occurred during hospitalisation. Extracorporeal membrane oxygenation (ECMO) running time, length of intensive care unit stay, length of hospital stay, costs, and ECMO complications were then compared between the two groups. Results: The average age of all patients undergoing ECMO was 47.64±16.78 years (53.2±16.20 years in the death group and 45.713±16.62 years in the survival group) (P=0.022). Patients in the survival group exhibited a clear downward trend in lactic acid value following ECMO treatment compared to those in the death group. Total hospitalisation stay was longer in the survival group (35 days) than in the death group (15.5 days) (P<0.001). In the analysis of ECMO complications, the incidence of neurological complications, renal failure, limb complications, and infection were higher in the death group than in the survival group (P<0.05 for all). Specifically, as a risk factor for patient survival and discharge, the occurrence of infection will lead to increased hospitalisation stays and costs (P<0.05 for both). Conclusion: Complications such as kidney failure and infection are associated with in-hospital death, and ECMO-related complications should be actively prevented to improve the survival rate of VA-ECMO treatment.

Mechanical Properties and Strengthening Mechanism of Dredged Silty Clay Stabilized by Cement and Steel Slag.

The high moisture content and low strength of dredged soft soils result in significant difficulties in directly reutilizing them in engineering. Improving their mechanical properties effectively and achieving re-utilization with the maximum benefit in engineering is the key to disposing of dredged soils with high moisture content. This study investigated the influences of cement and steel slag ratio, moisture content, the maximum particle size of steel slag, and curing age on the compressive strength of dredged silty clay in a plastic flow state. The performance improvement of dredged silty clay stabilized with cement and steel slag was discussed by comparing to related previous studies. The strengthening mechanism of dredged soils stabilized with cement and steel slag was explored by microstructural observation. The results show that when the ratio of cement to steel slag was 9:6; namely, using steel slag to replace 40% of cement, the strength properties of dredged silty clay stabilized by cement and steel slag could ensure the minimum requirements of the project greater then 100 kPa, and their economics could achieve the best results. The finer the particle size of steel slag was, the better the stabilization effect was. The compressive strength of dredged silty clay stabilized by cement and steel slag with particle sizes of less than 0.075 mm was 1.06 times, 1.10 times, and 1.16 times that of 0.25 mm, 1 mm, and 2 mm and increased linearly over curing ages earlier than 28 days. The compressive strength of dredged silty clay stabilized by cement and steel slag cured for 28 days was 2.44 times, 1.59 times, and 1.36 times that of 3, 7, and 14 days, respectively. The evolution of microstructural characteristics showed that the internal pore sizes of dredged soil decreased the structural compactness increased significantly due to the formation of more calcium silicate hydrate and other agglomerated flocculent gel materials from the further reaction between steel slag and cement hydration products. The results of this study can provide technological parameters for the re-utilization of dredged soil stabilized with cement and steel slag.

Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem.

BACKGROUND: Placement of femoral stem in excessive anteversion or retroversion can cause reduced range of motion, prosthetic impingement, and dislocation. The aim of this study was to assess the operative femoral anteversion in patients treated with total hip arthroplasty (THA) and analyze the need of adjusting stem anteversion. METHODS: We retrospectively included 101 patients (126 hips) who underwent cementless THA with a manual goniometer to determine the femoral anteversion between October 2017 and December 2018. The operative femoral anteversion we measured was recorded during THA. We further divided those hips into three subgroups based on the range of operative femoral anteversion: group 1 (<10°), group 2 (10-30°), and group 3 (>30°) and compared the differences of their demographic data. Univariate and multivariate logistic regression were used to identify the influencing factors for the need of neck-adjustable femoral stem. The clinical and radiographic outcomes were also assessed. Perioperative complications were recorded. RESULTS: After THA, the Harris hip scores improved from 52.87 ± 15.30 preoperatively to 90.04 ± 3.31 at the last follow-up (p < 0.001). No implant loosening, stem subsidence, and radiolucent lines were observed on radiographs. No severe complications occurred and no components needed revision at the latest follow-up. The mean operative femoral anteversion was 14.21° ± 11.80° (range, -9 to 60°). Patients with femoral anteversion more than 30° were about 10 years younger than others. Femoral anteversion >30° was more common in patients with developmental dysplasia of the hip (DDH). There were totally 14 hips treated with the neck-adjustable femoral stem. From the univariate analysis, we can observe that female sex, diagnosis of DDH (compared with osteonecrosis), and higher operative femoral anteversion and its value >30° (compared with <10°) are associated with higher rates of using the neck-adjustable femoral stem. However, all these factors were no longer considered as independent influencing factors when mixed with other factors. CONCLUSIONS: This study highlighted the significance of operative femoral anteversion. Identification of abnormal femoral anteversion could assist in adjusting stem anteversion and reduce the risk of dislocation after THA.

Effect of Charlson Comorbidity Index and Treatment Strategy on Survival of Elderly Patients After Endoscopic Submucosal Dissection for Gastric Adenocarcinoma: A Multicenter Retrospective Study.

Background: The optimal treatment strategy for elderly patients with early gastric adenocarcinoma (EGAC) after non-curative endoscopic submucosal dissection (ESD) remains unclear. The purpose of this research was to explore the effectiveness of additional treatments after ESD and the factors affecting survival in elderly patients (≥60 years of age) with EGAC. Methods: A total of 639 elderly patients (≥60 years) treated with ESD for EGAC from 2006 to 2018 were retrospectively reviewed. Positive lymphatic infiltration, submucosal infiltration, and positive/indeterminate vertical resection margins are considered high risk factors in histology. According to the risk of lymph node metastasis in patients with EAGC and the treatment strategies adopted after ESD, patients were divided into three groups: there were 484 patients in group A with low risk, 121 patients in group B with high risk, without additional treatment, and 36 patients in group C with high risk, with additional treatment. The 5- and 8-year survival rate, as well as the prognostic factors of survival rate after ESD was studied. Results: The median follow-up time was 38, 40, and 49 months, respectively. There were 3, 4, and 3 deaths related to gastric adenocarcinoma in groups A, B, and C, while deaths from other diseases were 20, 5, and 3, respectively. There were significant differences in overall survival rates between groups (94.3; 86.4; 81.2%, p = 0.110), but there was no significant difference in disease-specific survival rates (98.4; 92.7; 92.4%, p = 0.016). In the multivariate analysis, the Charlson Comorbidity Index (CCI) ≥ 2 was an independent risk factor for death after ESD (hazard ratio 2.39; 95% confidence interval 1.20-4.77; p = 0.014). Conclusions: The strategy of ESD with no subsequent additional treatment for EGAC may be a suitable option for elderly patients at high risk, especially for CCI ≥ 2.

Health-Related Quality of Life and Its Correlation With Depression Among Chinese Centenarians.

Background: As evidence on depression and health-related quality of life (HRQoL) among the oldest-old is currently limited, this study aimed to re-examine the association between depression and HRQoL among centenarians. Methods: We analyzed cross-sectional data from the China Hainan Centenarian Cohort Study (CHCCS). The 15-item Geriatric Depression Scale (GDS-15) and three-level EuroQol five-dimensions (EQ-5D-3L) were used to evaluate depression and HRQoL, respectively. Poor health states were defined as EQ-5D index <0.665. Based on their GDS-15 score, individuals were categorized into three stages of depression: major depressive disorder (MDD; score ≥10), minor depressive disorder (MnDD; score between 6 and 9), and normal (score ≤ 5). Based on sex and comorbidity stratification, multivariable logistic regression was used to calculate the risk of poor health state in different levels of depression. We also used restricted cubic splines with a knot at 5 points (GDS-15) to flexibly model the association of GDS-15 scores with poor health states. Results: Totally, 1,002 participants were included in this study for analysis. Participants' median age was 102 years, and 82.04% were female. The median EQ-5D index was 0.68 (range: -0.149-1), and the mean VAS and GDS-15 scores were 61.60 (range: 0-100), and 5.23 (range: 0-15), respectively. Centenarians with MnDD and MDD accounted for 38.12 and 9.98%, respectively. While those with poor health states accounted for 45.11%. For every 1-point increase in GDS-15, the risk of poor health state increased by 20% (P < 0.001) after an adjustment for age, gender, ethnicity, marital status, education, residence type, smoking, drinking, weekly exercise, body mass index category, serum albumin, 25-hydroxyvitamin D, C-reactive protein, and comorbidities. MnDD and MDD were independent risk factors for poor health state (MnDD, OR = 2.76, P < 0.001; MDD, OR = 3.14, P < 0.001). The association was more prominent in centenarians without comorbidity. Conclusions: This study demonstrated a negative association between depression and HRQoL in Chinese centenarians, especially in centenarians without comorbidity. Large-scale prospective studies are needed to corroborate our findings and provide more information about the causal inference and internal mechanisms of this association.

[New classification of Crowe type IV developmental dysplasia of the hip].

OBJECTIVE: To compare differences between Crowe IV developmental dysplasia of the hip (DDH) with secondary acetabulum and Crowe IV DDH without secondary acetabulum,and determine whether it is necessary to divide Crowe IV DDH into two subtypes. METHODS: From June 2007 to May 2015,145 hips of 112 Crowe N patients who underwent total hip arthroplasty (THA) using S-ROM stem were divided into two groups: secondary acetabulum formaton group (group A) and no secondary acetabulum formaton group (group B). In group A,there were 12 females, 96 males,with an average age of (39.38 ± 11.19) years old. In group B, there were 2 females, 35 males, with an average age of (38.19 ± 10.92) years old. All the patients were evaluated by using Harris Hip Score. Radiographic evaluations were made preoperatively and during follow up. The differences between two groups were compared on dislocation height, canal flare index (CFI), subtrochanteric shortening osteotomy (SSTO) usage, pre- and post-operation Harris scores, complications. RESULTS: The dislocation height for group A was (4.74 ± 1.57) cm, while the dislocation height for group B was (3.12 ± 1.15) cm. Significantly difference was detected between two groups. The CFI for group A was 2.69 ± 0.68, while the CFI for group B was 3.42 ± 0.79, and the significantly difference was detected between two groups. Harris scores were totally improved from 58.18 ± 15.67 preoperatively to 91.20 ± 3.79 post-operatively and the difference was significant. Pre-operative Harris scores was 58.1 ± 15.3 in group A, 58.3 ± 16.9 in group B. Post-operative Harris scores was 91.0 ± 4.1 in group A, 91.0 ± 5.1 in group B. No significant difference was found on Harris scores between A and B preoperatively and post-operatively. Complications of 4 cases peri-prosthesis fracture, 4 cases dislocation and 4 cases nerve injury occur in group A; While only one case dislocation and one case nerve injury occur in group B. No statistical significance was detected. CONCLUSION: Crowe IV DDH with secondary acetabulum is significantly different from Crowe IV DDH without secondary acetabulum on dislocation height and femoral morphology, which causes the different selections of surgical techniques (SSTO usage or not). These important differences in fundamental parameters indicate the necessity to further divide Crowe IV DDH into IVA and IVB two subtypes.