Development and validation of a predictive nomogram for lower extremity deep vein thrombosis dislodgement in orthopedic patients.

Objective: To analyze the risk factors of lower extremity deep venous thrombosis (DVT) detachment in orthopedic patients, and to establish a risk nomogram prediction model. Methods: The clinical data of 334 patients with orthopedic DVT admitted to the Third Hospital of Hebei Medical University from January 2020 to July 2021 were retrospectively analyzed. General statistics included gender, age, BMI, thrombus detachment, inferior vena cava filter window type, filter implantation time, medical history, trauma history, operation, use of tourniquet, thrombectomy, anesthesia mode, anesthesia grade, operative position, blood loss during operation, blood transfusion, immobilization, use of anticoagulants, thrombus side, thrombus range, D-dimer content before filter implantation and during removal of inferior vena cava filter. Logistic regression was used to perform univariate and multivariate analysis on the possible factors of thrombosis detachment, screen out independent risk factors, establish a risk nomogram prediction model by variables, and internally verify the predictability and accuracy of the model. Results: Binary logistic regression analysis showed that Short time window filter (OR = 5.401, 95% CI = 2.338-12.478), lower extremity operation (OR = 3.565, 95% CI = 1.553-8.184), use of tourniquet (OR = 3.871, 95% CI = 1.733-8.651), non-strict immobilization (OR = 3.207, 95% CI = 1.387-7.413), non-standardized anticoagulation (OR = 4.406, 95% CI = 1.868-10.390), distal deep vein thrombosis (OR = 2.212, 95% CI = 1.047-4.671) were independent risk factors for lower extremity DVT detachment in orthopedic patients (P < 0.05). Based on these six factors, a prediction model for the risk of lower extremity DVT detachment in orthopedic patients was established, and the risk prediction ability of the model was verified. The C-index of the nomogram model was 0.870 (95% CI: 0.822-0.919). The results indicate that the risk nomogram model has good accuracy in predicting the loss of deep venous thrombosis in orthopedic patients. Conclusion: The nomogram risk prediction model based on six clinical factors, including filter window type, operation condition, tourniquet use, braking condition, anticoagulation condition, and thrombosis range, has good predictive performance.

[FU Li-xin's experience in treatment of vertigo with "regulating the middle jiao, opening gate and relaxing tendon" method of acupuncture].

The paper introduces professor FU Li-xin's theoretic ideas and experience in treatment of vertigo. Professor FU believes that this disease is closely related to the blockage of qi movement in the middle jiao, opening-closing disarrangement in the pivot, "gate" obstruction, malnutrition of brain orifice and decreased blood flow in the nape. Based on the holistic idea of qi movement in traditional Chinese medicine and the circulatory theory of western medicine, the characteristics of the specific acupuncture therapy for "regulating the middle jiao, opening gate and relaxing tendon" are summarized. Using the layered needling technique at Zhongwan (CV 12) and "gate points" in the neck region, the tendon-bone needling technique with modified "dark tortoise seeking hole" at local tendon blockage points, vertigo is cured through regulating qi in the middle jiao, opening gate and nourishing marrow, relaxing tendon and harmonizing the mind.