The incidence and mortality of venous thromboembolism (VTE) are high in critically ill patients, and there is still a risk of VTE and bleeding after the use of fixed-dose low molecular weight heparin (LMWH) for prophylaxis. The level of anti-factor Xa is not up to standard after LMWH prophylaxis in patients with surgery or trauma. The condition of critically ill patients is complicated, and the proportion of patients with low antithrombin III is high, which can affect the prophylactic efficacy of LMWH and contribute to VTE occurrence. There is currently no consensus on whether adjusting LMWH dose according to anti-factor Xa levels can reduce VTE occurrence in critically ill patients. High-quality multicenter randomized controlled studies are needed in the future to establish new approaches for precise prevention of VTE in critically ill patients.

Objective:To analyze the incidence and risk factors of postoperative delirium (POD) in patients with glioma and to explore the association between WHO (World Health Organization) tumor grades and POD.Methods:A second analysis of clinical data from 113 adult glioma patients in a single-center, prospective cohort study of 800 neurosurgery patients was conducted from March 2017 to February 2018 at Department of Critical Medicine (ICU), Beijing Tiantan Hospital, Capital Medical University. Patients were assessed for delirium on the first to third days post surgery (twice a day) using the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU). The patient was divided into delirium group (43 cases) and non-delirium group (70 cases) by whether the patient had had delirium. We collected the patient’s general preoperative information, preoperative condition, early postoperative clinical data, and neurosurgical specialty data (including WHO grades) as potential risk factors that may be associated with the occurrence of POD. The independent risk factors of POD were identified using multivariate logistic regression analysis. In particular, the relationship between WHO glioma grade and POD was explored.Results:In 113 glioma patients who were admitted to the ICU for routine postoperative monitoring, the incidence of POD was 38.1% (43/113). The incidence of POD in patients with WHO grade Ⅰ-Ⅳ gliomas increased with the increase of the WHO grade: 7.7% (1/13), 14.3% (3/21), 22.7% (5/22) and 63.0% (34/57). Among the potential risk factors, age ( OR=1.08, 95% CI: 1.04-1.13, P<0.001), GCS (Glasgow coma scale) score at admission to ICU ( OR=0.80, 95% CI: 0.71-0.90, P<0.001) and the WHO grade of tumor ( OR=2.01, 95% CI: 1.03-3.92, P=0.041) was independent risk factors for POD. Conclusions:The WHO grade of glioma is an independent risk factor for POD. With the increase of tumor grade, the incidence of POD also increases.

Objective To study the effect of warfarin individualized drug regimen based on gene detection on anticoagulation in patients with acute deep vein thrombosis (DVT).Methods From January 2016 to June 2017,62 patients with DVT diagnosed for the first time in vascular surgery of the Affiliated Hospital of Jining Medical College were analyzed retrospectively,including 33 in the individualized group and 29 in the experience group.All patients were diagnosed by Color Doppler Ultrasound (CDUS).Gender,age,the results of the initial international standardized ratio (INR) measurement,the time from the first dose to the INR standard,and whether the INR exceeds the standard in the process of increasing the dose were collected.Results There was no significant difference in sex,age and initial INR between the two groups (P ＞ 0.05).The time of reaching the standard in the individualized group was significantly lower than that in the experience group [(13.8 ± 6.8) d vs (17.6 ± 7.5) d,P ＜ 0.05];There was no significant difference in INR between the two groups (P ± 0.377).Conclusions For the patients with DVT for the first time,the individualized drug regimen of warfarin based on the guidance of gene detection can shorten the time of reaching the standard without increasing the risk of bleeding.