Volume 94  ·   Issue 01  ·  2014

The doctor and the patient were supposed to be comrades in the same trench with the common goal of defeating the disease. However, in recent years, the relationship between doctors and patients in China has become increasingly tense, and vicious cases of injury to medical staff have occurred from time to time, which seriously disturbs the order of diagnosis and treatment in hospitals and affects the stability of society. According to the website of the National Health and Family Planning Commission (NHP), in 2012, there were 11 cases of malignant medical injuries in China, resulting in 35 casualties, including 7 deaths and 28 injuries^[1]。

This paper aims to evaluate the clinical applyment of "Anatomical fixation" and its long-term efficacy .

Retrospective analysis of clinical data and postoperative follow-up results of 125 patients undogoing EVAR using "anatomical fixation" enrolled in Shanghai Changhai hospitai and Shanghai Changzheng hospitai from January 2008 to January 2013.

The technical success rate was100%, Perioperative complications including Type Ⅰ endoleak occurred in 3 patients (2.4%), 4 cases of type Ⅱ endoleak (3.2%). Incidence of Type Ⅰ endoleak in challenging neck cases was high than non- challenging neck cases, the difference was statistically significant (P<0.001). After 30 days and through current follow-up of 124 successful cases(mean: 26.4±1.5 months, range1-60 months). No rupture of the aneurysm and stent graft migrations occurred. Secondary type Ⅰ endoleak in 2 cases (1.6%), Two cases of secondary type Ⅱ endoleak (1.6%). Left lower extremity arterial thrombosis in 1 case (0.8%), and secondary surgical intervention in 1 case (0.8%). Three cases of deaths in cumulative, 2 patients died died of acute myocardial infarction.At 3 months, a patient died of the contrast-induced nephropathy, renal failure.

The clinical applyment of "Anatomical fixation" enriched the theory of EVAR, completely solved the complication of incidence of stent-graft migration, greatly improve the repair rate of hostile neck cases, expand the indications for EVAR

To establish the three dimensional finite element model of bilateral cervical articular process locking and verify its effectiveness.

A healthy adult male underwent cervical thin-layer computed tomography (CT) scan. The software programs of Simpleware3.0, Geomagic8.0, Hypermesh9.0, Abaqus6.9 and Rhino4.0 were employed to establish a complete C4, C5 segment (including intervertebral disc and ligament tissue) finite element model. A spring force load of 180 n was applied along the direction of cervical curvature. The locking of articular process was simulated. And its effectiveness was compared with previous experiments.

Detailed anatomy structure of cervical spine was established. Simulated bilateral joints in journey finally formed. The load-displacement situations and experiment results of small joint ligament were consistent. And shear forces and displacement differences of modeling was insignificant.

The three dimensional finite element model of bilateral cervical articular process locking has excellent biological fidelity. And it is suitable for clinical applications.

To explore the prevalence and characteristics of main organ involvement in adult patients with polymyositis (PM) or dermatomyositis (DM) and determine their specific relative factors.

Using unified questionnaire, we retrospectively collected the medical records of 1 387 confirmed adult PM/DM patients from 2007 to 2012 at 22 rheumatology centers in China. Statistical analyses were performed with chi-square or Fisher exact test and multivariate analyses with logistic regression.

A total of 1 387 patients were collected with 460(33.2%) PM and 927(66.8%) DM. The female: male ratio was 2.4∶1. Their onset age was( 47±14) years. A total of 1 031(74.3%) patients had organ involvement. The prevalence of pulmonary involvement, arthritis, gastrointestinal and cardiac involvement were 44.6%, 32.3%, 21.9% and 20.3% respectively. The multivariate analysis indicated that older onset age (P<0.01) was positively associated with pulmonary involvement while myalgia (P<0.05) was negatively associated. Fever (P<0.05), weight loss (P<0.05) and Raynaud′s phenomenon (P<0.01) were positively associated with arthritis while muscle weakness (P<0.05) negatively associated. Weight loss (P<0.05), Raynaud′s phenomenon (P<0.01) and muscle weakness (P<0.05) were positively associated with gastrointestinal involvement. Weight loss (P<0.05) and swollen limbs (P<0.05) were positively associated with cardiac involvement.

The prevalence of organ involvement is high in adult PM/DM patients. Our study may aid the diagnosis of organ damage in PM/DM patients.

To describe and compare video endoscopic inguinal lymphadenectomy via hypogastric and limb approach (VEIL-H vs VEIL-L) in patients with invasive vulvar cancer.

From March 2011 to August 2013, 7 women with early-stage vulvar cancer were selected for this integrated procedure with a combination of VEIL-H and VEIL-L in bilateral groins.VEIL-L was performed on limb with old surgical scar in ipsilateral hypogastric area of 3 patients and VEIL-H in contralateral limb.Both novel procedures were performed with triple trocars respectively.The boundaries of inguinal lymph node dissection were the same template of open inguinal lymphadenectomy.Preoperative data, surgical techniques and follow-up outcomes were compared.Standard statistical tests were used.

The combination of VEIL-H and VEIL-L was successfully completed in 7 patients without conversion into open surgery.The great saphenous vein was spared in 13 limbs.No difference existed in mean operative duration, average blood loss volume and median total regional lymph nodes removed in two groups.All nodes were confirmed tumor-free. Mean drain duration was (4.7±1.4) days in the VEIL-H group and (2.7±0.9) days in VEIL-L group respectively (P<0.01). Mean drain volume was (123±55) ml in VEIL-H group and (62±32) ml respectively (P<0.05). Mean postoperative hospital stay was (8.6±2.2) days.No major intraoperative complications occurred. However, hypercarbia in one patient 1 was completely reversible with hyperventilation.Unilateral great saphenous vein was injured in another one.Regarding postoperative complications, one patient suffered lymphocele in VEIL-H side and another had lymphorrhea through drain orifice in VEIL-L side.During a follow-up period of (19±7) months, there was no disease recurrence so far.

The combination of VEIL-H and VEIL-L has the reproducibility and therapeutic potentials in the treatment for patients with vulvar cancer. Both minimal invasive techniques are viable.Although short-term results are encouraging, larger series with a longer follow-up are required to fully evaluate the therapeutic efficacy of VEIL-H and VEIL-L.

To explore the effects of pre-pregnancy body mass index (BMI) upon adverse pregnancy outcomes.

We selected a population-based cohort of 48 867 nulliparous women in mainland China with singleton and full-term deliveries in 2011. The cohort was categorized in accordance with pre-pregnancy BMI as follows: underweight <18.5; normal weight =18.5-23.9; overweight = 24-27.9; obesity ≥28. Logistic regression was used to estimate the association between BMI and adverse maternal, peripartum and perinatal outcomes with normal weight as a reference range.

(1) Overweight and obese women were more likely to have hypertensive disorders with odds ratios of 2.29 and 6.02, gestational diabetes mellitus 2.27, 4.99; (2)the odds ratios for fetal macrosomia increased among women with higher BMI as follows: 0.59, 1.99 and 3.15, whereas only lean women had significantly increased risk of delivering babies with low birth weight (LBW) 1.62; (3)increased BMI was associated with reduced rates of assisted vaginal delivery and increased rates of caesarean section.

As an independent risk factor for adverse maternal and fetal outcomes, pre-pregnancy obesity should be managed properly.

To explore the characteristics of clinical symptoms in Uygur and Han patients with Parkinson′s disease (PD).

The unified Parkinson′s disease rating scale (UPDRS), Hoehn-Yahr, mini-mental state examination (MMSE) scale, Alzheimer disease cooperative study-activities of daily living (ADCS-ADL) and neuropsychiatric inventory (NPI) were administered to 91 Uygur and 173 Han PD patients from Xinjiang Urumqi and surrounding region from June 2008 to September 2011 to compare the characteristics of clinical symptoms between Uygur and Han patients.

The subjects of drug treatment in Han [108 (62.34%)] were more than in Uygur [36 (39.56%), (P<0.05)]. However there were no significant differences in the subjects of effective treatment between two groups (P>0.05). No significant inter-group differences existed in the scores of Hoehn-Yahr (P>0.05). Compare with moderate and severe group in Hoehn-Yahr, there were no significant differences in the scores of ADL, UPDRS Ⅱ and UPDRSⅢ between two groups (P>0.05). The subjects of resting tremor, increased muscle tone and bradykinesia as the presenting symptoms in Uygur [8 (19.05%)] were more than in Han [7 (7.07%), (P<0.05)]. And the subjects of N-type progressive in Uygur [36 (85.71%)] were more than in Han [48 (48.48%), (P<0.05)]. There were no significant differences in other presenting symptoms, initial site, on-off phenomenon and dyskinesia between two groups (P>0.05). No significant differences existed in the scores of MMSE and NPI between two groups (P>0.05).

No significant differences exist in typical motor symptoms, severity of disease, activities of daily living, cognitive dysfuntion and psychiatric symptoms between Uygur and Han. But N-type progressive is more common in Uygur. And the presenting symptoms of resting tremor, increased muscle tone and bradykinesia are also higher in Uygur.

To compare the clinical features of type A aortic dissection (AAD) in patients with Marfan syndrome (MFS) and bicuspid aortic valves (BAV).

Data from patients undergoing surgery for acute AAD between April 2008 and April 2012 at our institute were retrospectively collected. Patients were categorized into MFS group (n= 39) and BAV group (n= 28) to investigate their clinical and prognostic features.

Patients in MFS and BAV groups always experienced the sudden onset of chest pain. MFS patients tended to have younger age [(35±8)y vs (47±13)y, P<0.001], wider aortic sinus [(55.4±9.8)mm vs (42.6±8.6)mm,P<0.01] and higher rate of moderate-to-severe aortic regurgitation (69.2% vs 32.1%,P=0.003). Patients in BAV group were featured with higher rate of moderate-to-severe aortic stenosis. Though the operation procedures were similar in both groups, the 30-day postoperative mortality was significantly higher among BAV patients (25.0% vs 5.1%, P=0.020).

MFS and BAV represent unique subgroups of acute type A aortic dissection. BAV-associated dissection demonstrated strikingly higher postoperative mortality in our study population.

To explore whether cognitive impairment in breast cancer patients after the completion of chemotherapy treatment in comparisons with breast cancer patients without chemotherapy treatment and matched healthy controls.

A neuropsychology battery was applied in all breast cancer patients at our hospital from January 2012 to February 2013. Forty-two breast cancer patients with chemotherapy treatment (CT) underwent neuropsychologic testing before the start of chemotherapy (T1) and after treatment (T2). And 37 patients without chemotherapy treatment (non-CT) and matched healthy controls (HC) underwent the same assessment at matched intervals.

The CT group performed significantly worse on attention, memory and executive function tests at T2 versus T1 (P<0.05). As compared with HC and non-CT groups, the correct numbers of backward, digit symbol, delayed recall and recognition were lower in the CT group (P<0.05). The reacting time of TMT test B, Stroop test B and Stroop test C were longer in the CT group (P<0.05). There was significant time interaction in three groups (P<0.05).

There are longitudinal changes in cognitive functioning of memory, attention and executive functions in breast cancer patients on Chemotherapy.

To explore the natural history of scoliosis after posterior fossa decompression (PFD) in patients with Chiari malformation/syringomyelia and examine the risk factors associated with curve progression.

A retrospective radiographic study was performed at our scoliosis center for 26 patients undergoing PFD for Chiari malformation between January 2002 and December 2007. Their clinical and radiological parameters, including age, curve magnitude, curve pattern, extent of cerebelar tonsil herniation, maximal syrinx/cord ratio, syrinx size and length, were evaluated pre- and postoperatively. Curve progression was defined as an increment of Cobb angle over 5° compared with that of initial curve (progression group); whereas an increment of Cobb angle equal to or under 5° was considered curve stabilization or improvement (non-progression group). All aforementioned parameters at the time of PFD were compared between two groups with Student t and Fisher exact tests.

Their average initial age, curve magnitude and follow-up duration were 10.3±2.4 (6.5-14.7) years, 33.5°±7.7° (20°-45°) and 57.5±26.9 (24-118) months respectively. At the final follow-up, curve improvement or stabilization occurred in 11 (42%) patients. Compared with the non-progression group, significantly greater initial age was observed in the progression group (11.1±2.2 vs 9.2±2.2 years, P=0.041). In addition, the percentage of double major curve was significantly higher in the progression group than that in the non-progression group (26.7% vs 9.1%, P=0.037). With regards to Cobb angle, Risser sign, extent of cerebelar tonsil herniation, maximal syrinx/cord ratio, syrinx length, sagittal parameters and percentage of patients with preoperative neurological signs or symptoms, no significant differences existed between two groups (P>0.05).

PFD may halt curve progression in 42% of patients with Chiari malformation/syringomyelia. And those with older age or double major curves are more likely to experience the progression of scoliosis during the post-PFD course.

To provide guidance to implement effective perioperative cardiopulmonary resuscitation.

A total of 69 perioperative cardiac arrest patients who received Cardiopulmonary resuscitation according to the 2005 guidelines in Sir Run Run Shaw Hospital from January 2005 to June 2012 were included(including emergency operation). According to the results of cardiopulmonary resuscitation, divide these 69 patients in to two groups, Successful resuscitation group(27cases) and failed resuscitation group(42cases). Compare the age, gender, ASA physical status, BMI, type of anesthesia, time that cardiac arrest occurred, cardiac arrest type, amount of bleeding, CPR duration, hypotension duration, defibrillation time, combined cardiovascular disease between successful resuscitation group and failed resuscitation group, calculate the measurement data for the chi-square test and logistic regression, derive factors that affect the success rate of cardiopulmonary resuscitation.

A total of 69 perioperative cardiac arrest patients, according to Logistic regression, ASA Ⅳ-Ⅴ (P=0.029, OR=1.956, CI=1.226-4.809), amount of bleeding more than 1500 ml(P=0.023, OR=1.615, CI=1.245-2.313), CPR duration more than 30 min(P=0.003, OR=3.54, CI=3.313-5.007), hypotension duration more than 30 min(P=0.002, OR=2.782, CI=1.791-4.322), the type of cardiac arrest is pulseless electrical activity(P=0.032, OR=1.419, CI=0.146-1.583).

ASA Ⅳ-Ⅴ, amount of bleeding more than 1500 ml, CPR duration more than 30 min, hypotension duration more than 30 min and pulseless electrical activity are the Independent risk factors of cardiopulmonary resuscitation.

A 17-year-old female was admitted to Zaozhuang Municipal Hospital on July 8, 2013 due to skin discoloration of her limbs for 2 years and skin ulceration of her lower limbs for 1 year. In June 2011, the patient showed spotty changes in the skin of his limbs without obvious trigger, with significant changes in both lower limbs, ankle and dorsum of both feet. He was diagnosed with "vasculitis syndrome" locally, and received "Voltaren and blood circulation activation and blood stasis removal" drug treatment. The symptoms were relieved, and then skin lividae appeared intermittently. In July 2012, liviana reticulata aggravated again, and the skin ulceration of both lower limbs appeared, with obvious pain, and was treated locally, the specifics are unknown. Three months later, the ulcer healed, leaving several scars on the skin. The skin on the surface of the scar was pale, which was aggravated when the weather was hot, and liviosa reticulata was relieved when the weather became cold. In March 2013, the skin of the 2nd, 3rd and 5th toes of the right foot was ulcerated and necrotized, the skin turned dark, and the reticular liviosa was aggravated again. The patient went to the local hospital and was diagnosed with systemic vasculitis and arterial occlusive disease. He was given methylprednisolone 40 mg/d for 7 days and cyclophosphamide 0.4 g once. After that, glucocorticoids were changed to oral administration, and the dose was gradually reduced to the current prednisone 20 mg/d. The effect was not good, and the toe appeared dry gangrene, so he was admitted to hospital for further treatment. There were no other discomfort such as fever, rash, repeated oral ulcers, joint pain, vulvar ulcers, etc. during the course of the disease. Physical examination: body temperature 36.4℃, blood pressure 114/75mmHg (1 mmHg =0.133 kPa), pulse 90 beats/min, glucocorticoid facial appearance, flexural artery and dorsal pedis artery beating, no dry and wet rales in both lungs, heart rate 90 beats/min, uniform rhythm, no pathological murmur, soft abdomen, no tenderness, extensive reticular liviosa-like changes in limbs and skin, low skin temperature at the ends of hands and feet, several yellow-white atrophic scars on the skin of both lower limbs, and ulceration and blackening of the 2nd, 3rd and 5th toes of the right foot (Figure 1)。 Laboratory test: blood routine: white blood cells 13.47×10⁹/L, red blood cells 4.33×10¹²/L, platelets 249×10⁹/L, hemoglobin 124 g/L; Erythrocyte sedimentation rate 9 mm/1 h, C-reactive protein 12.5 mg/L, urine routine negative, stool routine negative, lactate dehydrogenase 271.1 U/L, liver function residue normal, kidney function, ion and blood lipid normal, autoantibody spectrum negative, ANA negative, ANCA negative, anti-proliferating cell nuclear antigen antibody negative, rheumatoid factor, anti-keratin antibody, anti-cyclic citrulline antibody negative, complement and immunoglobulin normal, thyroid function normal, tumor markers negative, anticardiolipin antibody negative, lung CT, heart B-ultrasound and upper abdomen and retroperitoneal B-ultrasound were not abnormal, and both hands microcirculation examination was moderately abnormal (clarity: unclear; exudation + +); Pathological examination of skin biopsy at the rupture of the right lower limb: epidermal atrophy with keratosis, hyperplasia of subepidermal fibrous tissue. Diagnosis: vasculitis liviosa. After admission, aspirin 0.1 g, once/d, dipyridamole 25 mg 3 times/d, alprostadil and salvia miltiorrhiza were treated symptomatically, and prednisone was reduced to 15 mg once/d. The ulcerated toes were washed with 1:500 iodophor and 0.5% nitrofuracillin ointment was given for external use. The liviosa reticulata was improved after 3 weeks (Figure 2), improved and discharged.

To explore the mechanism of hydrogen on the intervention of abdominal aortic aneurysm (AAA).

Healthy male Sprague-Dawley rats were divided into AAA group and AAA intervention group (saturated hydrogen saline administred intraperitoneally once daily). AAA was induced by infiltration of abdominal arota with 0.5 mol/L calcium chloride. Twenty-eight days later, the diameter of the aorta was measured, and the aortic tissue was exercised for histological examination. The protein location and expression of rCklf1 and matrix metalloproteinase 2 (MMP2) in aortic tissue were observed by immunohistochemistry staining. The mRNA expression of rCklf1 and MMP2 underwent real-time PCR.

Dilatation rate of abdominal aorta of AAA group and AAA intervention group was (174±21)% and [(82±23)%, P<0.01] respectively. The tissue relative mRNA expression of rCklf1 was 5.10±0.33 and 1.34±0.29 (P<0.01). The relative mRNA expression of MMP2 was 10.28±0.35 and 2.40±0.97 (P<0.01). The proteins expression of rCklf1 and MMP2 were mainly increased in the damaged elastic fibers of AAA group. Compared with AAA group, the AAA intervention group had less significant positive expression of rCklf1 and MMP2 protein, infiltration of inflammation, destruction and degradation of elastic fibers.

Hydrogen which may contribute to reduce rCklf1 expression prevents infiltration of inflammation and expression of MMP2 thus decreasing destruction and degradation of elastic fibers, therefore ameliorates development of AAA.

To explore the effects of exogenous suppressor of cytokine signaling 3 (SOCS3) in Janus Kinase/Signal transducer and activator of transcription 3 (JAK2/STAT3) signaling pathways and examine the relationship between exogenous SOCS3 and cell proliferation and apoptosis in ectopic endometrial stromal cells.

Ectopic endometrial stromal cells from patients with histopathologically confirmed endometriosis were primarily cultured in vitro. Vimentin staining was used to identify the purity of endometrial stromal cells. Lentiviru containing SOCS3 and GFP (green fluorescent protein) recombinant (LV-SOCS3-GFP) or only GFP gene (LV-GFP) was used to transfect two groups of ectopic endometrial stromal cells from the same patient respectively. They were divided into experimental (EG) and negative (NC) control. The transfection efficiency of lentivirus was measured by GFP fluorescence expression under microscope. And the expressions of SOCS3, STAT3 and JAK2 mRNA and protein were analyzed by real-time polymerase chain reaction (PCR) and Western blot respectively. And phosphorylated JAK2 and STAT3 proteins (p-STAT3 and p-JAK2) were also analyzed by Western blot. Cell cycles and apoptosis were detected by flow cytometry.

The transfection efficiency of lentivirus was over 80% at 72 h post-transfection. Compared with NC, EG showed a higher expression of SOCS3 mRNA (P<0.001). SOCS3 protein level of EG was higher than NC while p-STAT3 protein of EG obviously lower than NC. STAT3, JAK2 and p-JAK2 proteins showed no difference between two groups. The percentage of apoptotic cells in EG was higher remarkably than NC (22.0±1.3)% vs (4.4±1.3)%,P<0.01. Moreover, EG cells showed a G0/G1 arrest compared with NC (87.0±3.7)% vs (76.0±3.7)%,P<0.05.

Exogenous SOCS3 induces cell apoptosis and inhibits cell proliferation in ectopic endometrial stromal cells.

To explore the core controlling genes and their functions and pathways of gamma knife in the treatment of epilepsy in rats.

The temporal epilepsy rats induced by stereotactic technique were irradiated with gamma knife. Total RNA samples were isolated at 3 weeks post-irradiation. After hybridization, washing and staining, the probe arrays were scanned to acquire the gene chip data. The functional categories and affected pathways of differentially regulated genes were analyzed. And the gene co-expression network was constructed to determine the core controlling genes.

The differentiated genes of normal, epileptic and epileptic rats treated with gamma knife were screened by 1.5-fold method. There were a total of 766 union genes. The differentiated up-regulated and down-regulated genes were obtained. These genes were involved in functional categories such as ion transport (P=6.85×10^-24), cell adhesion (P=1.55×10^-8), response to mechanical stimulus (P=7.86×10^-7), potassium ion transport (P=2.63×10^-6) and such pathways as MAPK signaling (P=5.55×10^-6), calcium signaling (P=4.29×10^-5) and TGF-beta signaling (P<0.01), etc. And the core controlling genes from the gene co-expression network included Arf3, Akap5, Omd and Rtn4r, etc.

Gamma knife achieves its antiepileptic effect through modulating target genes involved in different functions and pathways.

To explore the prevalence of hypertensive patients with co-morbid anxiety and/or depression and determine the risk factors of comorbidity in community.

A cross-section study was performed among 807 hypertensive patients in urban and rural community settings of Beijing in 2011. The Composite International Diagnostic Interview, computer assisted personal interview (CIDI-3.0-CAPI) was administrated by face-to-face interview. And the diagnosis of anxiety and depression was made according to the definitions and criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DMS-Ⅳ). The prevalence and related risk factors of hypertensive patients with comorbid anxiety and/or depression were reported.

It was found that 23.3% of patients were accompanied with anxiety and 5.7% with depression in hypertensive patients in community. The risk factors of anxiety included irregular treatment (odds ratio 4.500; 95% confidence interval, 2.431 to 8.331), smoking (1.805; 1.036 to 3.145), manual labor (1.933; 1.223 to 3.053) and two or above stage of hypertension (1.525; 1.041 to 2.234). And the risk factors of depression included irregular treatment (5.333; 1.554 to 18.304), taking reserpine or ingredients containing reserpine (6.667; 1.981 to 22.435) and singlehood (5.000; 1.096 to 22.820).

The prevalence of anxiety is higher than depression in hypertensive patients in community. Irregular treatment is the common risk factor of anxiety and depression. Patients with smoking, manual labor and two or above stage of hypertension are more likely to have a coexistence of anxiety while those unmarried, taking reserpine or ingredients containing reserpine are more likely to suffer from depression.

The incidence of intertrochanteric fractures accounted for 3% ~4% of all fractures and 35.7% of perihip fractures^[1]。 Traditional conservative treatment methods such as traction are mostly used in elderly patients, but long-term bed rest is more likely to lead to a variety of serious life-threatening complications. In recent years, minimally invasive internal fixation surgery (PFNA) has become the preferred method for the treatment of intertrochanteric fractures in the elderly. However, in the course of clinical application, it was observed that although the dominant blood loss during and after operation was relatively small, the occult blood loss was more. Anemia is often one of the important reasons for the low survival rate of elderly patients with hip fracture^[2]。 In this study, the data of elderly patients with intertrochanteric fracture treated with PFNA internal fixation were analyzed, and the amount and impact of occult blood loss caused by surgery were analyzed.

Intervertebral disc herniation is a common and frequently occurring disease in orthopedics, which seriously affects the work and life of patients. At present, its clinical efficacy is still not satisfactory^[1]。 Minimally invasive treatment is another new development field of spinal surgery in recent years. Among them, percutaneous cervical disc nucleoplasty (PCDN) has been gradually accepted by more and more patients with intervertebral disc herniation because of its advantages of less tissue damage, safer and more effective, quick recovery, simple operation and low cost, and has attracted great attention of medical workers at home and abroad.

Venous thromboembolism (VTE) has been widely concerned by clinicians because of its high incidence^[1]。 At present, the international standard treatment regimen for VTE is heparin combined with warfarin anticoagulation^[2]。 For patients with VTE, anticoagulant therapy can improve symptoms and prevent recurrence, but it also increases the risk of bleeding. Studies have shown that the incidence of major hemorrhage complications within 90 days of VTE patients receiving standard anticoagulant therapy can reach 2.4%^[3]。 The occurrence of bleeding events (especially major bleeding) has an important impact on the treatment effect and prognosis of patients. Therefore, it is crucial to establish a risk prediction model for VTE anticoagulant bleeding complications and pre-evaluate the bleeding risk of patients before starting treatment. For the individualized treatment of VTE, reduction of adverse reactions is crucial.