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Archives of Physical Medicine and... Jun 2024To analyse influencing factor and establish a prediction model for delayed behavior of early ambulation after surgery for varicose veins of lower extremity (VVLE).
OBJECTIVE
To analyse influencing factor and establish a prediction model for delayed behavior of early ambulation after surgery for varicose veins of lower extremity (VVLE).
DESIGN
A prospective case‒control study.
SETTING
VVLE patients were recruited from two local hospitals.
PARTICIPANTS
498 patients with VVLE were selected by convenience sampling and divided into a training set and test set.
INTERVENTIONS
Not applicable.
MAIN OUTCOME MEASURES
Participants were collected information before surgery and followed up until the day after surgery, then divided into a normal and delayed ambulation group. Propensity score matching (PSM) was applied in all participants by type of surgery and anaesthesia. All information of two groups were compared using logistic regression, back propagation neural network (BPNN) and decision tree models. The accuracy, sensitivity, specificity, and area under the curve (AUC) of three models were compared to determine the optimal model.
RESULTS
A total of 406 participants were included after PSM. The AUCs of training sets of logistic regression, BPNN and decision tree models were 0.850, 0.932, and 0.757, respectively. The AUCs of test sets were 0.928, 0.984, and 0.776, respectively. BPNN was the optimal model. SSRS score, preoperative 30-second sit-stand test score, CEAP grade, MCMQ score and whether you know the need for early ambulation, in descending order of the result of BPNN model. A probability value greater than 0.56 indicated delayed early ambulation.
CONCLUSIONS
Clinicians should pay more attention to those with lower SSRS score, poor lower limb strength, higher CEAP grade and poor medical coping ability, and make patients aware of the necessity and importance of early ambulation, thereby assisting decision-making regarding postoperative rehabilitation. Further research is needed to improve the method, add more variables and transform the model into a scale to screen and intervene in the delay behavior of early ambulation of VVLE in advance.
PubMed: 38909739
DOI: 10.1016/j.apmr.2024.06.004 -
Medical Ultrasonography Jun 2024Chronic venous disease is a common pathology characterized by valvular incompetence and venous hypertension. The venous network of the lymph nodes at the Scarpa triangle...
AIM
Chronic venous disease is a common pathology characterized by valvular incompetence and venous hypertension. The venous network of the lymph nodes at the Scarpa triangle connects the superficial and the deep venous systems. This study aimed to describe infrainguinal intranodal venous dilatations and to evaluate the connection with peripheral venous disease.
MATERIAL AND METHODS
The study included 183 subjects (116 women, 67 men) who underwent Doppler ultrasound examinations of the venous system of the inferior limb in the context of chronic venous disease. The diagnosis of lymph node varices was based on well-defined criteria and the severity of the lymph node varices was established using an original classification.
RESULTS
There was a statistically significant, moderately strong association, between the presence of intranodal varices and the great saphenous vein reflux (φ=0.341, p=0.000). There was a moderate-to-high positive correlation between intranodal varices and the chronic venous disease stage (rrb=0.457, p=0.000).
CONCLUSIONS
Patients with more advanced stages of chronic venous insufficiency have a higher probability of presenting intranodal varices. Lymph node venous network identification could considerably impact clinical decision-making and treatment choices.
PubMed: 38909378
DOI: 10.11152/mu-4390 -
Phlebology Jun 2024The aim of this study was to understand the prevalence of chronic venous disease (CVD) of lower limbs in young men at high-altitude in Xizang, and to provide prevention...
OBJECTIVES
The aim of this study was to understand the prevalence of chronic venous disease (CVD) of lower limbs in young men at high-altitude in Xizang, and to provide prevention measures.
METHODS
The convenient sampling method was used to conduct a questionnaire survey among males aged 18 to 40 above an altitude of 3000 meters in Xizang in April 2023. The contents of the questionnaire included basic information, symptoms of CVD of lower limbs, protection status and training needs. Multivariate logistic regression model was calculated to evaluate the risk factors for CVD.
RESULTS
A total of 350 survey questionnaires were received, and 326 valid samples were collected. The prevalence of CVD of lower limbs (C1-C6) was 37.42% (95%CI: 32.17%-42.68%), the ratio of C0 to C5 were 62.58%, 27.30%, 3.07%, 4.60%, 2.15% and 0.31%, respectively, no one reached C6. The top three symptoms of CVD were lower limb fatigue (18.10%), heaviness (15.34%) and pain (13.19%). 46.01% of respondents were unaware of CVD, and 12.88% of respondents did not have any protective measures of CVD. Multivariate logistic regression showed that age (OR = 1.076, 95%CI: 1.018-1.137, = .009), preference for spicy food (OR = 1.747, 95%CI: 1.083-2.818, = .022), unbalanced diet (OR = 1.877, 95%CI: 1.049-3.358, = .034) and physical exercise (OR 0.610, 95%CI: 0.377-0.986, = .044) were the independent risk factors for CVD.
CONCLUSIONS
This study provided data on the prevalence of CVD in young men at high-altitude and the risk factors for CVD. The findings of this study may facilitate the development of individualized clinical assessments and targeted prevention programs.
PubMed: 38901455
DOI: 10.1177/02683555241263920 -
Journal of Medical Ultrasonics (2001) Jun 2024Varicose veins in the lower extremities are dilated subcutaneous varicose veins with a diameter of ≥ 3 mm, caused by increased venous pressure resulting from...
PURPOSE
Varicose veins in the lower extremities are dilated subcutaneous varicose veins with a diameter of ≥ 3 mm, caused by increased venous pressure resulting from backflow of blood due to venous valve insufficiency (Gloviczki in Handbook of venous disorders: guidelines of the American venous forum, Hodder Arnold, London, 2009). When diagnosing varicose veins, the shape and thickness of the blood vessels should be accurately visualized in three dimensions. In this study, we investigated a new method for numerical evaluation of vascular morphology related to varicose veins in the lower extremities, using a photoacoustic imaging (PAI) system, which can acquire high-resolution and three-dimensional images noninvasively.
METHODS
Nine patients with varicose veins participated in the study, and their images were captured using an optical camera and PAI system. We visualized the vascular structure, created a blood presence density (BPD) heat map, and examined the correlation between BPD and location of varicose veins.
RESULTS
The obtained photoacoustic (PA) images demonstrated the ability of this method to visualize vessels ranging from as small as 0.2 mm in diameter to large, dilated vessels in three dimensions. Furthermore, the study revealed a correlation between the high-density part of the BPD heat map generated from the PAI images and the presence of varicose veins.
CONCLUSION
PAI is a promising technique for noninvasive and accurate diagnosis of varicose veins in the lower extremities. By providing valuable information on the morphology and hemodynamics of the varicose veins, PAI may facilitate their early detection and treatment.
PubMed: 38900399
DOI: 10.1007/s10396-024-01470-8 -
Phlebology Jun 2024This study compares Endovenous Laser Ablation (EVLA) alone versus combined with ultrasound-guided foam sclerotherapy (UGFS) for Great Saphenous Vein (GSV)...
This study compares Endovenous Laser Ablation (EVLA) alone versus combined with ultrasound-guided foam sclerotherapy (UGFS) for Great Saphenous Vein (GSV) insufficiency. Sixty patients were randomly allocated to EVLA or EVLA-UGFS groups which focused on GSV occlusion rates, complications, additional treatments, and quality of life (QoL) changes. Among 55 participants, the EVLA group had higher 12-month occlusion rates (92.3% vs. 75.8%, = 0.11). Nervous injury (NI) was rarer in EVLA-UGFS (3.4% vs. 23.1%, = 0.04). No significant difference in other complication rates ( > 0.05). QoL improved in both groups ( < 0.001). EVLA-UGFS required more subsequent procedures (24.1% vs. 7.7%, = 0.03). EVLA and EVLA-UGFS effectively treat GSV insufficiency, enhancing QoL. The combined method reduces NI risk but may require more follow-up procedures.
PubMed: 38889758
DOI: 10.1177/02683555241263224 -
Phlebology Jun 2024Impaired venous return is observed in healthcare professionals who spend long periods standing and sitting. This descriptive cross-sectional study was conducted to...
Photoplethysmography-based assessment of varicose vein-related risk factors, exercise health beliefs, and venous refill time in healthcare professionals working in operating rooms and outpatient clinics.
BACGROUND
Impaired venous return is observed in healthcare professionals who spend long periods standing and sitting. This descriptive cross-sectional study was conducted to evaluate varicose vein-related risk factors, exercise health beliefs, and venous refill time in healthcare professionals working in operating rooms and outpatient clinics by photoplethysmography.
METHOD
The study sample consisted of 100 healthcare professionals without a diagnosis of peripheral venous insufficiency. Data were collected using a descriptive characteristics form, the Health Belief Model Scale for Exercise, the Short-Form McGill Pain Questionnaire, and photoplethysmography.
RESULT
This study found that OR nurses had shorter venous refill times and experienced more pain due to prolonged standing, despite their high health beliefs about exercise.
CONCLUSION
Healthcare professionals working in operating rooms should be screened for venous insufficiency and trained regarding the practices to prevent venous insufficiency, such as lying down, elevating legs, and using elastic stockings.
PubMed: 38887802
DOI: 10.1177/02683555241258308 -
Pharmacotherapy Jun 2024The CRC-VTE trial conducted in China revealed a significant occurrence of venous thromboembolism (VTE) in patients following colorectal cancer (CRC) surgery, raising...
BACKGROUND
The CRC-VTE trial conducted in China revealed a significant occurrence of venous thromboembolism (VTE) in patients following colorectal cancer (CRC) surgery, raising concerns about implementing thromboprophylaxis measures. The present study aimed to identify and analyze inappropriate aspects of current thromboprophylaxis practices.
METHODS
This study performed an analysis of the CRC-VTE trial, a prospective multicenter study that enrolled 1836 patients who underwent CRC surgery. The primary objective was to identify independent risk factors for VTE after CRC surgery using multivariate logistic regression analysis. Furthermore, among the cases in which VTE occurred, the appropriateness of thromboprophylaxis was assessed based on several factors, including pharmacologic prophylaxis, time to initiate prophylaxis, drug selection, drug dosage, and duration of pharmacologic prophylaxis. Based on the analysis of the current state of thromboprophylaxis and relevant clinical guidelines, a modified Delphi method was used to develop a clinical pathway for VTE prophylaxis after CRC surgery.
RESULTS
In this analysis of 1836 patients, 205 (11.2%) were diagnosed with VTE during follow-up. The multifactorial analysis identified several independent risk factors for VTE, including age (≥70 years), female sex, varicose veins in the lower extremities, intraoperative blood transfusion, and the duration of immobilization exceeding 24 h. None of the patients diagnosed with VTE in the CRC trial received adequate thromboprophylaxis. The main reasons for this inappropriate practice were the omission of thromboprophylaxis, delayed initiation, and insufficient duration of thromboprophylaxis. We developed a specialized clinical pathway for thromboprophylaxis after CRC surgery to address these issues.
CONCLUSIONS
This study offers a comprehensive nationwide evaluation of existing thromboprophylaxis practices in patients after CRC surgery in China. A specialized clinical pathway was developed to address the identified gaps and improve the quality of care. This clinical pathway incorporates explicit, tailored, detailed recommendations for thromboprophylaxis after CRC surgery.
PubMed: 38884415
DOI: 10.1002/phar.2945 -
Clinical Case Reports Jun 2024This study highlights the first documented cases of angiokeratoma of Fordyce following laser hair removal (LHR) emphasizing the importance of patient selection and...
KEY CLINICAL MESSAGE
This study highlights the first documented cases of angiokeratoma of Fordyce following laser hair removal (LHR) emphasizing the importance of patient selection and careful laser use. It underscores the importance of understanding LHR-associated risks, particularly for patients with darker skin. The efficacy of topical rapamycin as an alternative treatment for angiokeratomas is also discussed.
ABSTRACT
Laser hair removal (LHR) has emerged as a widely accepted method for achieving long-term hair reduction. While generally considered safe, it is important to study the possible adverse events to optimize patient care. Here, we present a unique case report of angiokeratoma of Fordyce, a rare vascular lesion, following LHR. Two patients experienced the development of these lesions subsequent to LHR treatment sessions, characterized by a severe burning sensation during the procedure. Interestingly, both individuals exhibited varicose veins on their legs, suggesting a potential risk factor for this complication. Our findings highlight the importance of understanding the mechanisms underlying LHR-induced adverse events and the need for further research to elucidate associated risk factors and management strategies. This case report serves to enhance awareness among clinicians and emphasizes the significance of patient counseling regarding the potential side effects of LHR.
PubMed: 38883221
DOI: 10.1002/ccr3.9077 -
Cureus May 2024Colonic varicose veins are very rare and are usually discovered incidentally during colonoscopy or when complications occur, such as lower gastrointestinal (GI)...
Colonic varicose veins are very rare and are usually discovered incidentally during colonoscopy or when complications occur, such as lower gastrointestinal (GI) bleeding. The primary cause of colonic varices is usually portal hypertension secondary to liver disease or very rarely due to pancreatic disease (e.g., pancreatic adenocarcinoma). Varicose veins secondary to cirrhosis are often seen in the upper GI tract but rarely in the lower GI tract. Here, we report a 54-year-old woman who presented with colonic varices due to decompensated alcoholic cirrhosis. The main intention of this case report was to raise awareness of the possibility of developing colonic varices from liver cirrhosis and to promptly identify and manage its side effects due to the major complication which is lower GI bleeding.
PubMed: 38883036
DOI: 10.7759/cureus.60490 -
Journal of Pharmacy & Bioallied Sciences Apr 2024May-Thurner syndrome (MTS) is an anatomical condition of external luminal compression of common iliac vein due to a partial obstruction of the common iliac vein between... (Review)
Review
May-Thurner syndrome (MTS) is an anatomical condition of external luminal compression of common iliac vein due to a partial obstruction of the common iliac vein between common iliac artery and lumbar vertebra causes deep-vein thrombosis, venous hypertension, and chronic venous insufficiencies. In this article, we review present evidence of the clinical diagnosis and management of MTS. Here, we conducted a literature review of studies on MTS. We also reviewed different clinical features, presentation, diagnostic methods, and therapeutic procedure for this condition. Most studies mentioned the diagnosis of this condition is performed by color Doppler, computed tomographic angiography, venography, and problem-solving cases by intravascular ultrasound technique. Nonsurgical methods of management are first line, and vascular surgery is reserved for refractory cases. Multiple modalities are required to reach the diagnosis of MTS, and noninvasive intervention radiology methods are the first line of management. This review highlights the presentations of MTS and outlines diagnostic procedure and management.
PubMed: 38882842
DOI: 10.4103/jpbs.jpbs_1135_23