Advances in mesenchymal stem cells therapy for tendinopathies / 中华创伤杂志(英文版)

Tendinopathies are chronic diseases of an unknown etiology and associated with inflammation. Mesenchymal stem cells (MSCs) have emerged as a viable therapeutic option to combat the pathological progression of tendinopathies, not only because of their potential for multidirectional differentiation and self-renewal, but also their excellent immunomodulatory properties. The immunomodulatory effects of MSCs are increasingly being recognized as playing a crucial role in the treatment of tendinopathies, with MSCs being pivotal in regulating the inflammatory microenvironment by modulating the immune response, ultimately contributing to improved tissue repair. This review will discuss the current knowledge regarding the application of MSCs in tendinopathy treatments through the modulation of the immune response.

From viral hepatitis to hepatocellular carcinoma: The role of exosomal microRNAs / 临床肝胆病杂志

Exosomes are nano-sized phospholipid bilayer vesicles containing abundant and complex biomolecules, such as DNA, mRNAs, microRNAs (miRNAs), lipids, and proteins. Exosomes can be secreted and ingested by most types of cells to transfer information through intercellular transport. After uptake by recipient cells, exosomes release bioactive substances to regulate the biological processes of recipient cells, such as promoting tumor growth and metastasis. Changes of exosomes and their contents are associated with a variety of diseases. In recent years, the role of exosomal miRNAs in the development and progression of hepatocellular carcinoma (HCC) caused by viral hepatitis has attracted wide attention, and exosomal miRNAs from different sources play different roles in this process. This article briefly reviews the research on the role of exosomal miRNAs in the development and progression of viral hepatitis-related HCC and proposes that exosomal miRNAs may be the targets for immunotherapy for HCC microenvironment.

Factors affecting the quality of life among patients with gestational diabetes mellitus / 预防医学

Objective@#To investigate the quality of life and its influencing factors among patients with gestational diabetes mellitus (GDM), so as to provide insights into the improvements in the quality of life among patients with GDM.@*Methods@#GDM patients admitted to Department of Obstetrics and Gynecology, Hangzhou First People's Hospital Affiliated to Zhejiang University Medical School from June 2021 to June 2022 were recruited. Participants' demographics, diagnosis and treatment, sleep quality, depression and social support level were collected. Patients' quality of life was evaluated using the Quality of Life Scale for Pregnant Women with Gestational Diabetes Mellitus, and the factors affecting the quality of life were identified among patients with GDM using a multivariable linear regression model.@*Results@#A total of 300 questionnaires were allocated, and 284 valid questionnaires were recovered, with an effective recovery rate of 94.67%. The respondents had a mean age of (32.81±4.93) years, and the mean scores for the quality of life was (92.63±14.10) points. Multivariable linear regression analysis identified depression (β'=-0.293), sleep disorder (β'=-0.177), insulin therapy (β'=-0.316), regular exercise (β'=0.272) and social support level (medium: β'=0.153; high: β'=0.381) as factor affecting the quality of life among GDM patients.@*Conclusions@#GDM patients have a low quality of life. Depression, sleep disorders, insulin therapy, and lack of exercises may cause a decline in the quality of life among GDM patients, and strong social support facilitates the improvements in the quality of life among GDM patients.

Molecular dynamics simulation of force-regulated interaction between talin and Rap1b / 生物医学工程学杂志

The binding of talin-F0 domain to ras-related protein 1b (Rap1b) plays an important role in the formation of thrombosis. However, since talin is a force-sensitive protein, it remains unclear whether and how force regulates the talin-F0/Rap1b interaction. To explore the effect of force on the binding affinity and the dynamics mechanisms of talin-F0/Rap1b, molecular dynamics simulation was used to observe and compare the changes in functional and conformational information of the complex under different forces. Our results showed that when the complex was subjected to tensile forces, there were at least two dissociation pathways with significantly different mechanical strengths. The key event determining the mechanical strength difference between the two pathways was whether the β4 sheet of the F0 domain was pulled away from the original β1-β4 parallel structure. As the force increased, the talin-F0/Rap1b interaction first strengthened and then weakened, exhibiting the signature of a transition from catch bonds to slip bonds. The mechanical load of 20 pN increased the interaction index of two residue pairs, ASP 54-ARG 41 and GLN 18-THR 65, which resulted in a significant increase in the affinity of the complex. This study predicts the regulatory mechanism of the talin-F0/Rap1b interaction by forces in the intracellular environment and provides novel ideas for the treatment of related diseases and drug development.

Research advances of music therapy and its application in the field of burn treatment / 中华烧伤杂志

Different from other trauma, the scar and pigmentation formed after healing of burn wound not only hinder beauty but also easily lead to a series of sequential psychological problems, such as depression and anxiety. Music therapy, as a supplementary treatment, is widely used in many fields including medical and health care and psychological regulation. However, affected by factors such as medical resources, the awareness and acceptance of music therapy among burn treatment workers in China are still low. Based on the clinical characteristics of burns, this paper matches the applicability of music therapy with it, summarizes the supplementary application of music therapy in the field of burn treatment, expounds this natural science with both science and aesthetics, and puts forward feasible suggestions for its future development.

Introduction and analysis of the registration process of Traditional Chinese Medicine as a natural health product in Canada / 国际中医中药杂志

At present, the registration process of Traditional Chinese Medicine (TCM) in Canada is refering to the requirements of Natural Health Products (NHPs). In terms of registration material, both NHPs and TCM include plants, animals and minerals with medicinal components, but the fundamental difference between them is that TCM is guided by the basic theory of TCM. As for the registration classification of TCM in Canada, first of all, judge whether the product to be applied for is NHPs; Secondly, we should clarify the types and ways of registration, mainly including simple application, traditional application and non-traditional application, and provide application forms, label texts, summary reports, evidence, animal tissue forms, finished product specifications and other materials according to different requirements. At present, the successful registration experience of TCM products in Canada mainly mainly includes applying for superior varieties, selecting appropriate application channels, communicating with local health management units and providing sufficient scientific evidence and good clinical application records. The regulations on the registration of NHPs in Canada have not fully considered the particularity of TCM and the registration of TCM products is still facing some difficulties. In the future, we can learn from the registration process and requirements of the Health Canada, promote the interconnection and mutual recognition of the Pharmacopoeia of the People's Republic of China and the NNHPD monographs in Canada, reduce the obstacles to the local application for registration of TCM, and promote the further improvement of the international standards of TCM.

Analysis of Traditional Chinese Medicine regulation in Canada / 国际中医中药杂志

This paper analyzes the laws, regulations and concre measures of Traditional Chinese Medicine (TCM) in Canada, so as to provide reference for TCM products to enter Canada, and for the establishment of TCM regulation system and the improvement of its detailed rules in China. The regulation of TCM in Canadian, on the one hand, supervision is to provide guidance for the protection of consumers' rights and interests, including the guidance of rational drug use and rational purchase for consumers; on the other hand, it is to supervise enterprises, including the safety, effectiveness and quality certification of TCM products, labeling and packaging requirements, as well as the site certification of product manufacturing, packaging, labeling and import. The Ministry of health of Canada takes evidence as the core of evaluation, and ensures the safe and effective use of TCM products in Canada through product and site licensing evaluation. In the supervision of TCM, relevant departments in China should further strengthen the protection of consumers' drug rights and interests, strengthen the construction of TCM registration evidence system, and pay attention to the risk management of drug production quality.

Paeonol regulates phenotypic conversion of macrophages via estrogen receptor-a / 中国药理学通报

Aim To study the effect of paeonol on macrophage phenotvpe conversion based on estrogen receptora (ERa).Methods The macrophage Ml polarization model was established by 100 jjig • L"' LPS and 20 pug • L_1 I FN-7.ELISA was used to examine the effects of paeonol on tumor necrosis factor-a ( TNF-cx ) , interleukin-1 £ ( 1L-1 £ ) , interleukin-10 (IL-10), superoxide dismutase (SOD) , and malondi- aldehyde ( MDA).Western blot was used to detect the expression of M1 phenotvpe markers iNOS, CD86 and M2 phenotvpe markers Arg-1 and CD 163 in macrophages.Further, the methods of blockers and shRNA interference were used to verify whether the effect of paeonol was mediated by ERa.Results ELISA results shower] that paeonol reduced the content of TNF-a, IL- lp and MDA, and increased the content of IL-10 and SOD.Western blot results showed that paeonol reduced the expression of iNOS and CD86 proteins in model group, and increased the expression of Arg-1 and CD163 proteins.Both ERa selective blocker MPP and ERa shRNA reduced the efficacy of paeonol, while ERp selective blocker PHTPP had no significant effect on paeonol.Conclusion Paeonol can induce the transformation of macrophages into M2 type by ERa and alleviate the progression of atherosclerosis.

Short needling for knee osteoarthritis with blood stasis obstruction and its effect on serum inflammatory factors / 中国针灸

OBJECTIVE@#To compare the clinical efficacy and its effect on serum levels of tumor necrosis factor α(TNF-α), interleukin 1β(IL-1β), interleukin 6 (IL-6) and prostaglandin E2 (PGE2) between short needling (close-to-bone needling) and conventional acupuncture for knee osteoarthritis (KOA) with blood stasis obstruction.@*METHODS@#A total of 68 KOA patients with blood stasis obstruction were randomized into a short needling group (34 cases, 3 cases dropped off) and a conventional acupuncture group (34 cases, 3 cases dropped off). The same acupoints (Dubi [ST 35], Neixiyan [EX-LE 4], Binzhong [Extra], Liangqiu [ST 34], etc. on the affected side) were selected in the two groups. In the short needling group, short needling technique was adopted, the needles were slowly inserted and the needle bodies were shaken, thus gradually penetrated to the bone. In the conventional acupuncture group, conventional acupuncture was adopted, the needles were penetrated to the muscle. After qi-arrival, Dubi (ST 35) and Neixiyan (EX-LE 4), Zusanli (ST 36) and Liangqiu (ST 34) were connected with CMNS6-1 electronic acupuncture instrument, with disperse-dense wave, 2 Hz/10 Hz in frequency, the current intensity was based on patients' feeling, the needles were retained for 30 min, at the same time, the knee joint was irradiated for 30 min with a special electromagnetic wave apparatus in the two groups. Once every other day, 3 times a week for 4 weeks. Before and after treatment, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score, knee joint pain visual analogue scale (VAS) score, inflammatory response related indexes (serum TNF-a, IL-1β, IL-6 and PGE2) and knee joint ultrasound were observed，and the clinical effect was evaluated in the two groups.@*RESULTS@#After treatment，the pain, stiffness, function scores and total scores of WOMAC were decreased as compared with those before treatment in the two groups (P<0.05), except for the pain score, the changes of above scores in the short needling group were greater than the conventional acupuncture group (P<0.05). After treatment, the VAS scores, serum levels of TNF-a, IL-1β, IL-6, PGE2 and knee joint synovium thickness, intra-articular effusion were decreased as compared with those before treatment in the two groups (P<0.05), the levels of TNF-a, IL-1β, IL-6 in the short needling group were lower than the conventional acupuncture group (P<0.05). The total effective rate in the short needling group was 87.1% (27/31), which was superior to 83.9% (26/31) in the conventional acupuncture group (P<0.05).@*CONCLUSION@#Short needling could improve the knee joint function, relieve the pain and inflammatory response, improve the knee joint synovium inflammatory response, reduce the knee joint intra-articular effusion for KOA patients, its effect is better than conventional acupuncture.

Identification and analysis of glycosyltransferase in Codonopsis pilosula from different regions based on transcriptome / 药学学报

Lu Dangshen is the geoherb in Shanxi Province. The content of Codonopsis pilosula polysaccharides (CPP) in Lu Dangshen is more than that in other Codonopsis Radix from other regions. Glycosyltransferase is the key enzyme for the synthesis of bioactive components, such as CPP and tangshenoside I. Based on the transcriptome data of C. pilosula [Codonopsis pilosula (Franch.) Nannf.] from different producing areas, this study carried out functional annotation of GO and KEGG, conservative domain analysis, phylogenetic tree analysis and expression pattern analysis of glycosyltransferase genes in C. pilosula to provides a theoretical basis for exploring the mechanism of genuineness formation in Lu Dangshen. In this study, 98 glycosyltransferase genes were screened and identified, which belonged to GT family 1, GT family 2, GT family 90 and other families. By GO functional annotation, it was found that most of the glycosyltransferase genes had catalytic activity. Analysis of KEGG functional annotation showed that C. pilosula glycosyltransferase was mainly involved in glycan organism and terpenoid and polyketone metabolism. Among them, conserved domain of 42 glycosyltransferase genes in GT family 1 was [X]-W-[2X]-Q-[3X]-[LH]-[5X]-[FLTHCGWNS]-[2X]-E-[4X]-[GVP]-[4X]-P-[4X]-Q-[2X]-[NAK]. Phylogenetic tree analysis based on the glycosyltransferase sequence in Arabidopsis thaliana showed that C. pilosula glycosyltransferases were mainly located in Arabidopsis thaliana UGT73, 72 and 85 branches. Gene expression pattern analysis showed that expression of CpUGT73AH2 was higher in Lu Dangshen than that in Baitiaodang and could respond to drought and low temperature stress. In conclusion, a glycosyltransferase gene CpUGT73AH2, which is involved in the metabolism of terpenoids and polyketides and can respond to environmental stress, was screened from the C. pilosula glycosyltransferase family 1, which was used to further study the role of C. pilosula glycosyltransferase in Lu Dangshen. It laid a theoretical foundation for further study on the role of C. pilosula glycosyltransferase in the formation of Lu Dangshen.

Evaluation of clinical efficacy of microwave ablation in situ for thoracic, lumbar and sacral spinal metastases / 中华放射肿瘤学杂志

Objective:To evaluate the clinical outcomes of patients with single spinal metastasis of thoracic, lumbar or sacral vertebra treated with microwave ablation in situ.Methods:For 28 patients with single spinal metastasis of thoracic, lumbar or sacral vertebra, detailed and personal surgical plans were carried out. Instead of en bloc resection, hyperthermia ablation in situ was performed followed by strengthening procedures under the guidance of G-arm fluoroscopy machine. Intraoperatively, spinal cord and nerve root were properly protected. The bone defects were reconstructed by bone cement after the diseased lesions were revomed. All patients were followed up for almost 1 year postoperatively. During follow-up, X-ray and MRI images were obtained, and the level of pain and neurologic outcomes were also examined.Results:All 28 patients successfully received microwave ablation in situ. The average ablation time was approximately 8 minutes and the average amount of bone cement implanted was approximately 10.5 ml. The pain scores of digital pain classification before and 3 months after operation were 7.86±1.58 and 3.07±1.89( P<0.05). The postoperative neurological function of 22 patients was improved than that before operation. No significant changes were observed in 5 patients. The neurological function of the affected limb was relieved, whereas the symptoms of the healthy limb were slightly worse in the remaining case. Conclusions:Microwave ablation in situ is a feasible and effective surgical method for single spinal metastasis of thoracic, lumbar or sacral vertebra. It might possess many advantages, such as clear surgical field, smaller incisions, less bleeding, and safe margins during the operations. Further more, it could significantly relieve pain, restrict tumor growth, and improve the quality of life of patients. It is an innovative and distinctive therapeutic alternative for single spinal metastasis, which deserves widespread application.

Genome-wide analysis of hippocampal transfer RNA-derived small RNAs identifies new potential therapeutic targets of Bushen Tiansui formula against Alzheimer's disease / 中西医结合学报

OBJECTIVE@#Bushen Tiansui formula (BSTSF), a traditional Chinese medicine prescription, has been widely used to treat Alzheimer's disease (AD). However, the mechanisms underlying its effects remain largely unknown. In this study, a rat AD model was used to study the effects of BSTSF on cognitive performance and expression of transfer RNA-derived small RNAs (tsRNAs) in the hippocampus, to determine whether treatment of AD with BSTSF could regulate the expression of tsRNAs, a novel small non-coding RNA.@*METHODS@#To generate a validated AD model, oligomeric amyloid-β@*RESULTS@#The learning and memory deficits of Aβ@*CONCLUSION@#This study identified a previously uncharacterized mechanism underlying the effects of BSTSF in alleviating the learning and memory deficits in Aβ

Concurrent hepatitis D virus infection increases risk of hepatocellular carcinoma in patients with chronic hepatitis B / 临床肝胆病杂志

Concurrent hepatitis D virus (HDV) infection accelerates the progression of liver disease in patients with chronic hepatitis B and particularly increases the risk of hepatocellular carcinoma (HCC). Further studies are still needed to explore the carcinogenic mechanism of HDV, related treatment methods, and their clinical effects. This article reviews the new epidemiological characteristics of HDV-related HCC, the new understanding of the pathogenic mechanism of HDV, and the advances in diagnosis and treatment, which is of great significance to promote the development of accurate HDV detection methods and effective drugs and reduce HDV-related HCC.

Clinical features and risk factors of hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation / 中华血液学杂志

Objective: To explore the relative risk factors, clinical intervention and prognosis of hemorrhagic cystitis (HC) in patients with allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: From January 1 2010 to May 31 2017, 425 patients with allo-HSCT received a retrospective analysis. Results: ①Among the 425 patients, 262 were male and 163 were female. The median age was 26 (2-56) years old. There were 138 cases of acute myeloid leukemia (AML) , 96 cases of acute lymphoblastic leukemia (ALL) , 29 cases of myelodysplastic syndrome (MDS) , 98 cases of severe aplastic anemia (SAA) and 64 cases of chronic myeloid leukemia (CML) . 221 cases of sibling match transplantation, 89 cases of unrelated donor transplantation and 115 cases of haplotype transplantation. ②108 patients (25.41%) developed HC, with the median time of onset of 32 (3-243) days and the median duration of 20 (3-93) days; 33 cases (30.56%) were grade Ⅰ, 49 cases of grade Ⅱ (45.36%) , 21 cases (19.44%) of grade Ⅲ, and 5 cases (4.63%) of grade Ⅳ. ③103 cases of HC were cured, 5 patients were ineffective, 12 patients died and died of transplantation related complications (infection, recurrence, severe acute GVHD, secondary implant failure) . ④Univariate analysis showed that age < 30, type of transplantation, CMV and acute GVHD were associated with the occurrence of HC after allo-HSCT. Multivariate analysis showed that acute GVHD was an independent risk factor for HC after allo-HSCT. Conclusion: Prognosis of HC after allo-HSCT was better after timely treatment.

Study on Pharmacokinetics of Fentanyl Buccal Tablet in Beagle Dogs / 中国药房

OBJECTIVE： To establish a method for blood concentration determination of Fentanyl buccal tablet in Beagle dogs， and to study its pharmacokinetics. METHODS： A total of 6 Beagle dogs were given Fentanyl buccal tablet 1 tablet （675 μg/tablet， buccally）. The blood samples were collected 2， 5， 10， 15， 30， 45， 60， 90， 120， 240， 360， 480， 720 min after administration. After precipitated by methanol， LC-MS/MS method [the determination was performed on Agilent C18 column with mobile phase consisted of methanol-0.02％ formic acid aqueous solution （95 ∶ 5， V/V） at the flow rate of 0.5 mL/min. The sample size was 5 μL and the column temperature was 30 ℃. Mass spectrometric conditions： electrospray ionization source in the multiple reaction monitoring mode was used to detect ions， fentanyl citrate： m/z 337.1→188.0； carbamazepine （internal standand）： m/z 237.1→194.1] was used to determine the blood concentration of fentanyl citrate； the pharmacokinetic parameters were calculated by using DAS 2.0 software. RESULTS： The linear range of fentanyl citrate were 1.0-325.0 ng/mL（r＝0.998）； inter-day RSDs of precision test were lower than 5％ （n＝6）， and intra-day RSDs were lower than 6％ （n＝3）； average recoveries were （94.65±6.32）％-（99.21±3.24）％ （n＝6）. RSDs of matrix effect was lower than 15％ （n＝6）； RE of stability tests were within ±6.2％ （n＝3）. The pharmacokinetic parameters of Fentanyl buccal tablet in Beagle dogs included that tmax was （32.5±6.1） min； t1/2 was （211.8±47.4） min； cmax was （40.3±1.9） ng/mL； CLz/F was （0.006±0.001） L/（min·kg）； AUC0-720 min was （7 564.0±1 576.7） ng·min/mL（n＝6）. CONCLUSIONS： The method is simple， feasible and accurate. Fentanyl buccal tablet have good fast-release and slow-release biphasic release characteristics in Beagle dogs.

Fingerprint analysis and multi-component determination of Leonurus japonicus by high performance liquid chromatography / 药学学报

An HPLC fingerprint and multi-component determination method of Leonurus japonicus was established for comprehensive evaluation and quality control of Leonurus japonicus. The sample was incubated in 70% ethanol in a water bath for 2 h, and the extract was analyzed by HPLC using Kromasil C18 column (250 mm×4.6 mm, 5 μm). The mobile phase consisted of acetonitrile-0.1% formic acid with gradient elution. The flow rate was 1.0 mL·min-1. The temperature of column was 30 ℃. The detection wavelength was 280 nm. HPLC fingerprint of characteristic components of Leonurus japonicus was established. There were 12 common peaks among 25 batches of samples, and 5 of them were identified and determined. Syringic acid, leonurine hydrochloride, rutin, hyperoside or isoquercitrin showed a good linearity in the ranges of 0.426 1-85.22 ng (r = 0.999 9), 7.948-1 590 ng (r = 0.999 3), 10.20-2 040 ng (r = 1.000 0), 2.018-403.6 ng (r = 0.999 9), or 8.704-1 741 ng (r = 0.999 9), respectively. The average recoveries were 99.0%, 97.6%, 97.4%, 96.9% and 98.5% with RSD of 1.1%, 1.8%, 1.4%, 1.5% and 1.3%, respectively. The HPLC characteristic fingerprint of Leonurus japonicus was specific, and this method can simultaneously determine the content of 5 components.

Establishment of influenza risk forecasting model by analytical flow chart method / 预防医学

Objective @#To apply analytical flow chart method to building a model for forecasting the risk of influenza and providing preventive measures.@*Methods @#Surveillance data of influenza in Zhoushan from 2015 to 2018 was collected. Analytical flow chart method was used to evaluate the real-time risk of influenza,which were stratified by the seasonality of influenza,the percentage of influenza-like patients （ILI%） and whether there were effective prevention and treatment measures. The trend-line,warning line and action line of the influenza in 2018 were fit and the risk grades of influenza forecast were defined,which were compared with the actual risk grands during the first 20 weeks in 2018,to evaluate the accuracy of influenza forecast index.@*Results @#Through the analysis of the flow chart,the influenza index was divided into six grades,very high risk（gradeⅠ,n=0）,high risk （gradeⅡ,n=14,ILI%=12.61%±7.54%）,relative high risk （gradeⅢ,n=16,ILI%=7.76%±3.53%）,general risk（gradeⅣ,n=57,ILI%=6.31%±2.26%）,relative low risk （gradeⅤ,n=32,ILI%=5.37%±1.96%）and low risk （grade Ⅵ,n=37,ILI%=4.30%±1.40%）. The concordance rate between the forecast risk and actual risk was 70.00% （14/20）.@*Conclusion @#This influenza forecasting model could well forecast the levels of influenza risk each week.

Fixed-bearing unicompartmental knee arthroplasty for medial compartmental knee osteoarthritis / 中国骨伤

OBJECTIVE@#To evaluate short-term clinical results of fixed-bearing unicompartmental knee arthroplasty (UKA) for patients with medial compartmental knee osteoarthritis.@*METHODS@#From January 2015 to December 2017, 62 patients with medial compartmental knee osteoarthritis were treated by fixed-bearing UKA. Among them, including 19 males and 43 females, aged from 47 to 83 years old with an average of (65.3±8.2) years old. The courses of disease ranged from 5 to 72 months with an average of(19.4±14.3) months. Postoperative complications were observed, VAS score was used to observe degree of pain relief, Hospital for Special Surgery(HSS) score was used to evaluate clinical effects.@*RESULTS@#All patients were followed up from 4 to 40 months with an average of(19.9 ±10.2) months. The incision healed well without blood transfusion, hospital stays ranged from 2 to 10 days with an average of (3.5±1.6) days. No deep infection, dislocation, loosing or per prosthetic fracture occurred after operation, while 1 patient suffered from posterior tibial vein thrombosis. HSS score improved from 69.9±7.2 before operation to 90.1±7.4 at final following-up, and 51 patients obtained excellent results, 9 patients good and 2 moderate. VAS score decreased from 3.8±0.9 before operation to 1.1±0.9 at final following-up.@*CONCLUSIONS@#Fixed-bearing UKA for medial compartmental knee osteoarthritis could obtain short-term clinical results for shorter hospital stay, less complications. with fewer complication and fast recovery.

Effect of tranexamic acid combined flexion position of hip and knee on perioperative bleeding following unilateral total knee arthroplasty / 中国骨伤

OBJECTIVE@#To explore clinical efficacy and safety of application of tranexamic acid for two times combined with postoperative hip and knee on flexion position for reducing blood loss during total knee arthroplasty.@*METHODS@#From January 2015 to January 2018, 90 patients with knee osteoarthritis underwent unilateral total knee arthroplasty, including 33 males and 57 females, aged from 61 to 85 years old with an average of(72.3±6.9) years old. The patients were randomly divided into three groups according to random number table, 30 patients in each group. In group A, there were 11 males and 9 females, aged from 61 to 84 years old with an average of (71.60±6.04) years old, body mass index was (26.04±1.95) kg/m², hemoglobin was(128.57±5.98) g/L, treated by 7.5 mg/kg tranexamic acid was injected intravenously before upper tourniquet, and 7.5 mg/kg tranexamic acid after closure of incision and before loosening tourniquet, meanwhile combined with flexion position of hip for 30° to 45° and flexion position of knee for 60° for 70°. In group B, there were 10 males and 20 females aged from 61 to 85 years old with an average of (72.04±7.47) years, body mass index was (25.92±1.70) kg/m², hemoglobin was (127.58±4.37) g/L, treated by 15 mg/kg tranexamic acid injected intravenously before loosening tourniquet. In group C, there were 12 males and 18 females aged from 62 to 85 years old with an average of (73.23±7.36) years, body mass index was (26.07±1.49) kg/m², hemoglobin was (128.31±5.61) g/L, treated with the same amount of normal saline before loosening tourniquet. Intraoperative bleeding volume, postoperative drainage volume, recessive blood loss, total blood loss volume, blood transfusion cases, activated partial thromboplastin time(APTT), prothrombin time(PT), prothrombin international standardized ratio (PT-INR) and indexes of D-dimer(D-D) were compared among three groups, as well as postoperative deep venous thrombosis and pulmonary embolism were observed among three groups.@*RESULTS@#No incision infection occurred in all 90 patients, and all patients were followed up from 4 to 8 months with an average of 6 months without pulmonary embolism occurred. There was no statistical difference in itraoperative bleeding volume among three groups(F=0.299, =0.742), while there were significant differences in postoperative drainage volume, recessive blood loss, and total blood loss among three groups. The number of blood transfusion were as following, 2 cases in group A, 8 cases in group B, and 16 cases in group C, there were statistically significant differences among three groups(χ² =16.01, 0.05), and no difference in occurrence of lower limb vein thrombosis after operation.@*CONCLUSIONS@#The method of using tranexamic acid before upper tourniquet, after closure of incision and before loosening tourniquet-combined with the flexion position of hip and knee could effectively reduce postoperative drainage volume, recessive bleeding, total blood loss and blood transfusion cases after total knee arthroplasty, while it does not increase risk of deep vein thrombosis and pulmonary embolism.

Characteristics of BK polymavirus infection in kidney transplant recipients / 南方医科大学学报

OBJECTIVE@#To analyze the characteristics of BK polymavirus (BKV) infection and the optimal time window for intervention in kidney transplant recipients (KTRs).@*METHODS@#We retrospectively analyzed the clinical data and treatment regimens in 226 KTRs in our center between January, 2013 and January, 2018. Among the recipients, 157 had a urine BKV load ≥1.0×10 copy/mL after transplantation, and 69 had a urine BKV load below 1.0×10 copy/mL (control group).@*RESULTS@#Among the 157 KTRs, 60 (38.2%) recipients were positive for urine BKV, 66 (42.0%) had BKV viruria, and 31(19.7%) had BKV viremia. The incidence of positive urine occult blood was significantly higher in BKV-positive recipients than in the control group ( < 0.05). The change of urine BKV load was linearly related to that of Tacrolimus trough blood level (=0.351, < 0.05). In urine BKV positive group, the average estimated glomerular filtration rate (eGFR) was below the baseline level (60 mL·min·1.73 m) upon diagnosis of BKV infection reactivation, and recovered the normal level after intervention. In patients with BKV viruria and viremia, the average eGFR failed to return to the baseline level in spite of improvement of the renal function after intervention.@*CONCLUSIONS@#Positive urine occult blood after transplantation may be associated with BKV infection reactivation in some of the KTRs. BKV infection is sensitive to changes of plasma concentration of immunosuppressive agents. Early intervention of BKV replication in KTRs with appropriate dose reduction for immunosuppression can help to control virus replication and stabilize the allograft function.