Nomogram for predicting venous thromboembolism after spinal surgery

PURPOSE

This study aimed to establish a nomogram to predict the risk of venous thromboembolism (VTE), identifying potential risk factors, and providing theoretical basis for prevention of VTE after spinal surgery.

METHODS

A retrospective analysis was conducted on 2754 patients who underwent spinal surgery. The general characteristics of the training group were initially screened using univariate logistic analysis, and the LASSO method was used for optimal prediction. Subsequently, multivariate logistic regression analysis was performed to identify independent risk factors for postoperative VTE in the training group, and a nomogram for predict risk of VTE was established. The discrimination, calibration, and clinical usefulness of the nomogram were separately evaluated using the C-index, receiver operating characteristic curve, calibration plot and clinical decision curve, and was validated using data from the validation group finally.

RESULTS

Multivariate logistic regression analysis identified 10 independent risk factors for VTE after spinal surgery. A nomogram was established based on these independent risk factors. The C-index for the training and validation groups indicating high accuracy and stability of the model. The area under the receiver operating characteristic curve indicating excellent discrimination ability; the calibration curves showed outstanding calibration for both the training and validation groups. Decision curve analysis showed the clinical net benefit of using the nomogram could be maximized in the probability threshold range of 0.01-1.

CONCLUSION

Patients undergoing spinal surgery with elevated D-dimer levels, prolonger surgical, and cervical surgery have higher risk of VTE. The nomogram can provide a theoretical basis for clinicians to prevent VTE.

Morphometric Trajectory Analysis for Occipital Condyle Screws

Objectives

Occipitocervical fusion (OCF) is an effective treatment for instability of occipitocervical junction (OCJ). The occipital condyle screw serves as a novel surgical technique for occipitocervical fixation. However, the intraoperative procedures for the occipital condyle screw technique have relied on surgeons’ experience, so the pool of surgeons who are able to perform this surgery safely is limited. The present study aims to evaluate the feasibility and safety of the occipital condyle screw technique using human cadavers and to provide image anatomy for clinical application basis.

Methods

The scientific study comprised 10 fresh‐frozen cadaveric specimens from the anatomy department of Qingdao University. Placement of the occipital condyle screws (3.5 mm diameter and 20.0 mm length) was performed in the 10 fresh‐frozen cadaveric specimens with intact occipitocervical junctions, respectively. Occipitocervical CT was performed for all specimens and the DICOM data was obtained. Occipitocervical CT three‐dimensional (3D) reconstruction was performed for the cadavers. Morphometric analysis was performed on the bilateral occipitocervical junction of 10 cadaveric specimens based on the 3D reconstruction CT images. Detailed morphometric measurements of the 20 occipital condyles screws were conducted including the average length of the screw trajectory, inside and upper tilting angles of screws, distance to the hypoglossal canal, and to the medial wall of occipital condyle.

Results

Placement of the occipital condyle screws into the 20 occipital condyles of the 10 cadaveric specimens was performed successfully and the trajectory of implantation was satisfactory according to 3D CT reconstruction images, respectively. There was no obvious injury to the spinal cord, nerve root, and vertebral artery. The length of the bilateral screw trajectory was, respectively, 20.96 ± 0.91 mm (left) and 20.59 ± 0.77 mm (right) (t = 1.306, P > 0.05). The upper tilting angle of bilateral screws was, respectively, 11.24° ± 0.74° (left) and 11.11° ± 0.64° (right) (t = 0.681, P > 0.05). The inside tilting angle of bilateral screws was, respectively, 31.00° ± 1.32° (left) and 30.85° ± 1.27° (right) (t = 0.307, P > 0.05). The screw's distance to the bilateral hypoglossal canal was, respectively, 4.84 ± 0.54 mm (left) and 4.70 ± 0.54 mm (right) (t = 0.685, P > 0.05). The screw's distance to the medial wall of the bilateral occipital condyle was, respectively, 5.13 ± 0.77 mm (left) and 5.04 ± 0.71 mm (right) (t = 0.384, P > 0.05).

Conclusion

The occipital condyle screw technique can serve as a feasible and safe treatment for instability of the occipitocervical junction with meticulous preoperative planning of the screw entry point and direction based on individual differences. Morphometric trajectory analysis is also an effective way to evaluate the surgical procedure.

[Relationship between domestic violence and posttraumatic stress disorder among women living in the communities of Wuhan city]

Objective: To understand the prevalence of domestic violence and the correlation between domestic violence and posttraumatic stress disorder (PTSD) so as to improve the mental health status of women in Wuhan city of China. Methods: A cross-sectional study was conducted in the community health service center in Wuhan. Participants were women who came to the center for gynecological examination. Data on general condition, social support, injury, epidemiological characteristics of domestic violence and PTSD were gathered. Chi-square, student-t and Cochran-Armitage trend tests were employed to compare the distribution of each characteristic variable between PTSD and non-PTSD group. Binary logistic regression was used to analyze the correlation between domestic violence and PTSD. Results: A total of 1 015 women were effectively surveyed. The life-time incidence rates of events related to domestic, psychological, physical and sexual violence were 29.36%, 28.28%, 6.60% and 3.55%, respectively. The overall prevalence rate of PTSD was 4.73%. Women who suffered from domestic violence had higher risk of PTSD (OR=2.11, 95%CI: 1.04-4.29) than those who never experiencing domestic violence. Women who suffered from psychological or physical violence were 5.06 times more likely to suffer from PTSD (OR=5.06, 95% CI: 1.91-13.42). Conclusion: A strong correlation between domestic violence and PTSD was seen. Victims who suffered from domestic violence should be provided with psychological counseling to reduce the risk of PTSD.

Objective assessment of urban built environment related to physical activity--development, reliability and validity of the China Urban Built Environment Scan Tool (CUBEST)

Background

Some aspects of the neighborhood built environment may influence residents’ physical activity, which in turn, affects their health. This study aimed to develop an urban built environment evaluation tool and conduct necessary reliability and validity tests.

Methods

A 41-item urban built environment scan tool was developed to objectively assess the neighborhood built environment features related to physical activity. Six neighborhoods in Hangzhou were selected from three types of administrative planning units. A pair of auditors independently assessed all of the 205 street segments at the same time. Half of the segments (n = 104) were audited twice by the same auditor after a two-week time interval. Inter-rater reliability was assessed by comparing the audits of paired observers, while intra-rater reliability was evaluated by comparing an auditor’s repeated assessments of the same segments. The construct validity was tested using factor analysis.

Results

The inter-rater reliability for most items was above 0.8. The intra-rater reliability for most items was above 0.4, and was lower than corresponding inter-rater reliability. Six factors were extracted by factor analysis and the factor loading matrix showed good construct validity.

Conclusions

The CUBEST is a reliable and valid instrument that can be used to assess the physical activity-related built environment in Hangzhou, and potentially other cities in China.

Complete fracture-dislocation of the thoracic spine with spontaneous neurologic decompression: a case report

Fracture-dislocations of the thoracic spine without spinal cord injury are very rare. We report a case of a complete T6-7 fracture-dislocation without neurologic deficit in a 61-year-old male Taiwanese. Complicating neurological deterioration on the fifth post-injury day during a nonoperative treatment with a Gardner-Wells skull tong and pelvic belt traction on a Stryker frame was noted. Emergent open reduction and posterior instrumentation with dual Harrington rods of T3 to T9 was performed. At 2-year follow-up examination, a good reduction was maintained and the patient had resumed full activities.

Muscular recovery around the hip joint after total hip arthroplasty

A prospective study was conducted to quantitatively measure the relative muscle torque strengths in 20 consecutive women with unilateral osteoarthritic hips and 20 consecutive men with unilateral osteonecrotic hips before and after primary cementless total hip arthroplasty. Maximal isometric torque strengths in the muscles of flexion, extension, and abduction around the hip joint were measured preoperatively and postoperatively at six months and one year, using a Cybex 340 dynamometer. The results showed improved muscle function after total hip arthroplasty in both diseased and healthy hips. In the diseased hips, all muscle groups improved significantly, from 150 to 250% of the preoperative levels, at six months and one year postoperatively, except in the osteoarthritic women, in whom the improvement at six months was minimal. Preoperatively, all muscle groups in the diseased hips were weaker than those in the uninvolved hips, especially in the osteonecrotic men (51-79% of healthy side). In both groups, however, the torques strengths of the diseased hips had not caught up to the healthy hips in the one-year follow-up period (84-89% in the osteonecrotic male group, and 79-81% in the osteoarthritic female group). The authors recommended that muscle strengthening exercises for the hip should be continued for at least one year, and perhaps longer, after total hip arthroplasty.

Dedifferentiated chondrosarcoma arising from osteochondromatosis. A case report

Multiple hereditary osteochondromata has a higher incidence (5%-25%) of malignant change into chondrosarcoma than solitary osteochondroma (1%-2%); but only less than 10% of all chondrosarcomas may undergo dedifferentiated change into fibrosarcoma or malignant fibrous histiocytoma. We have a case presented here with osteochondromatosis who was found to have dedifferentiated chondrosarcoma arising from pelvic osteochondroma. Radical extra-compartmental resection was done and followed by chemotherapy and radiotherapy. Recurrence was found 3 months later. Early recognition of malignant change and adequate surgical resection with adjuvant therapy may prevent local recurrence and increase the survival rate.

Moyamoya disease manifested initially by repeated attacks of adversive seizure: report of one case

A nine-year-old Chinese boy had suffered from recurrent episodes of adversive seizure for about a year, seizures which affected the left upper limb, with his head and eyes turning toward the left. An acute attack of left upper-limb weakness and central-type facial palsy occurred before his consultation. Cranial computed tomography (CT) revealed infarction of the right frontoparietal area, and increased density in the head of the left caudate nucleus. Cerebral angiographic study demonstrated a typical pattern of moyamoya disease with bilateral stenosis of the supraclinoid portion of internal carotid arteries. Encephaloduroarteriosynangiosis with encephalomyosynangiosis were performed twice, with resulting good patency of blood flow observed in the follow-up angiographic study.