Preliminary analysis of the effect of different administration routes of tranexamic acid on blood loss after total hip arthroplasty for female femur neck fractures / 中国骨伤

OBJECTIVE@#To study curative effect of different administration routes of tranexamic acid (TXA) on blood loss of elderly female patients with femoral neck fracture in total hip arthroplasty.@*METHODS@#From December 2015 to January 2018, 77 elderly women with femoral neck fractures undergoing total hip replacement were divided into four groups: group A, group B, group C, and group D. The group A (intravenous medication group) included 21 patients with an average age of (77.10±7.02) years old. The patients in group A received 15 mg/kg TXA intravenously 5 minutes before skin incision and intraoperative infusion of saline into the joint cavity. The group B(local medication group) included 18 cases, with an average age of (73.83±6.56) years old. The patients in group B received saline intravenously 5 minutes before skin incision and intraoperative infusion of 3 g TXA into the joint cavity. The group C (combined medication group) included 19 cases, with an average age of (74.26±6.04) year old. The patients in group C received 15 mg/kg TXA intravenously before operation and intraoperative infusion of 1.5 g TXA into the joint cavity. The group D (control group) included 19 cases, with an average age of (76.69±9.27) years old. The patients in group D received saline intravenously 5 minutes before skin incision and intraoperative infusion of saline into the joint cavity. The postoperative wound drainage volume, hemoglobin value, and the total blood loss calculated according to the height and weight and the hematocrit (HCT) before and after operation were observed and compared.@*RESULTS@#In group A, the postoperative drainage was(111.91±35.02)ml; the change of hemoglobin was(26.86±12.99) g/L; and total blood loss was(628.60±306.78) ml. In group B, postoperative drainage was(108.89±36.61) ml; change of hemoglobin was(26.28±8.59) g/L; and the total blood loss was (584.41±250.86) ml. In group C, postoperative drainage was(102.63±47.36) ml; change of hemoglobin was (26.89±12.47) g/L; and total blood loss was(634.78±384.89) ml. In group D, postoperative drainage was(107.37±40.53) ml; change of hemoglobin was(40.95±12.48) g/L; and total blood loss was(1 005.24±483.37) ml. There were no significant differences among 4 groups in postoperative drainage volume (>0.05). The hemoglobin and total blood loss in group A, B, and C were less than those in the group D(0.05).@*CONCLUSIONS@#Application of TXA can effectively reduce blood loss during perioperative period of total hip arthroplasty for elderly women with femoral neck fracture. The best administration route and dosage should be further studied.

Carotid Plaque Stiffness Measured with Supersonic Shear Imaging and Its Correlation with Serum Homocysteine Level in Ischemic Stroke Patients

OBJECTIVE: To ascertain the feasibility of using shear wave velocity (SWV) in assessing the stiffness of carotid plaque by supersonic shear imaging (SSI) and explore preliminary clinical value for such evaluation. MATERIALS AND METHODS: Supersonic shear imaging was performed in 142 patients with ischemic stroke, including 76 males and 66 females with mean age of 66 years (range, 45–80 years). The maximum, minimum, and mean values of SWV were measured for 129 carotid plaques. SWVs were compared between echolucent and echogenic plaques. Correlations between SWVs and serum homocysteine levels were investigated. Based on neurological symptom, the surrogate marker of vulnerable plaque (VP), binary logistic regression was performed and area under curve (AUC) of homocysteine only and homocysteine combing SWVmean was calculated respectively. RESULTS: Echogenic plaques (n = 51) had higher SWVs than echolucent ones (n = 78) (SWVmin 3.91 [3.24–4.17] m/s vs. 1.51 [1.04–1.94] m/s; SWVmean, 4.29 [3.98–4.57] m/s vs. 2.09 [1.69–2.41] m/s; SWVmax, 4.67 [4.33–4.86] m/s vs. 2.62 [2.32–3.31] m/s all p values < 0.01). Pearson correlation analysis showed that stiffness of plaques was negatively correlated with homocysteine level. R values for SWVmin, SWVmean, and SWVmax were −0.205, −0.213, and −0.199, respectively. Binary logistic regression analysis showed that sex (p = 0.008), low-density lipoprotein (p = 0.015), triglycerides (p = 0.011), SWVmean (p = 0.004), and hyper-homocysteinemia (p = 0.010) were significantly associated with symptomatic ischemic stroke. Receiver operating characteristic curves revealed that SWVmean combing serum homocysteine level (AUC = 0.67) presented better diagnostic value than serum homocysteine only (AUC = 0.60) for symptomatic ischemic stroke. CONCLUSION: Supersonic shear imaging could be used to quantitatively evaluate stiffness of both echolucent and echogenic carotid plaques. More importantly, SWVs of plaques were not only correlated to serum homocysteine level, but also associated with symptomatic ischemic stroke, suggesting that SSI might be useful for understanding more about VP.

A comparative study of patent foramen ovale and white matter lesions in migraine without aura / 西安交通大学学报(医学版)

Objective To explore the effect of patent foramen ovale(PFO)on white matter lesions(WMLs) in migraine without aura(MwoA).Methods Thirty-five patients with MwoA were examined by contrast transcranial Doppler(cTCD)and magnetic resonance imaging(MRI).According to the results of PFO and MRI Flair data,the patients' age,sex and headache characteristics were matched,and the WMLs were compared between the PFO positive group and negative group.Results Seven cases of WMLs were recruited in PFO positive group(19 cases)and the WMLs were distributed in the frontal lobe and/or the parietal lobe.The score ranged from 1 to 7 points.Five cases of WMLs were enrolled in PFO negative group(16 cases)and the WMLs also were distributed in the frontal lobe and/or the parietal lobe.The score ranged from 1 to 3 points.There was no significant difference in WMLs between the groups(P＞ 0.05).Conclusion White matter lesions in migraine without aura are distributed in the frontal lobe and the parietal lobe,and these findings do not support a relationship between PFO and WMLs.

Case-control study on effects of vacuum drainage on perioperative blood loss after total hip arthroplasty for the treatment of femoral neck fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare postoperative blood loss under different negative pressures of drainage after total hip arthroplasty for the treatment of femoral neck fractures.</p><p><b>METHODS</b>From January 1st to December 30th 2013, 74 patients with femoral neck fractures treated with total hip arthroplasty were randomly divided into two groups: high negative pressure drainage group and low negative pressure drainage group. In high negative pressure drainage group, there were 34 cases including 10 males and 24 females, with a mean age of (75.94 ± 9.02) years old, and the patients were treated with 60 kPa negative pressure of drainage. In the low negative pressure drainage group, there were 40 cases including 13 males and 27 females, with an average age of (74.93 ± 8.90) years old, and the patients were treated with 30 kPa negative pressure of drainage. The amount of total drainage, total blood loss, and hemoglobin change were compared between these two groups.</p><p><b>RESULTS</b>All the patients got primary healing without infections. In high negative pressure drainage group,the change of hemoglobin was (41.74 ± 15.69) g/L, total blood loss was (1,217.73 ± 459.50) ml and the drainage volume was (312.94 ± 103.44) ml; while in low negative pressure drainage group,the results were (34.90 ± 12.90) g/L, (904.01 ± 381.58) ml and (129.25 ± 44.25) ml separately. All the results in high negative pressure drainage group were higher than those in the other group. Three days after operation, the change of hemoglobin was (46.00 ± 13.29) g/L and total blood loss was (1,304.72 ± 421.75) ml; while in low negative pressure drainage group, the changes of hemoglobin was (43.87 ± 11.39) g/L and total blood loss was (1,196.78 ± 344.20) ml; there were no statistically significant differences between two groups.</p><p><b>CONCLUSION</b>When placing drainage devices after total hip arthroplasty for the treatment of femoral neck fractures, the level of negative pressure should be chosen according to preoperative level of hemoglobin and HCT in patients. For old patients with femoral neck fracture, low negative pressure is more suitable.</p>

The pharmacological mechanism of gastrodin on calcitonin gene-related peptide of cultured rat trigeminal ganglion / 药学学报

The Chinese herbal medicine Tianma (Gastrodia elata) has been used for treating and preventing primary headache over thousands of years, but the exact pharmacological mechanism of the main bioactive ingredient gastrodin remains unclear. In present study, the effects of gastrodin on calcitonin gene-related peptide (CGRP) and phosphorylated extracellular signal-regulated kinase1/2 (pERK1/2) expression were observed in rat trigeminal ganglion (TG) after in vitro organ culture to explore the underlying intracellular mechanism of gastrodin on primary vascular-associated headache. CGRP-immunoreactivity (CGRP-ir) positive neurons count, positive area, mean optical density and integrated optical density by means of immunohistochemistry stain were compared at different concentrations of gastrodin, which was separately co-incubated with DMEM in SD rat TG for 24 hours. Only at 5 or 10 mmol L(-1) concentration, gastrodin demonstrated significantly concentration-dependent reduction of CGRP-ir (+) expression and its action closed to 1.2 mmol L(-1) sumatriptan succinate. While at 2.5, 20, and 40 mmol L(-1) concentration, gastrodin did not show remarkable effects on CGRP-ir (+) expression. The optimal concentration of gastrodin (5 and 10 mmol L(-1)) similarly inhibited CGRP-mRNA expression level separately compared with 1.2 mmol L(-1) sumatriptan succinate and 10 micromol L(-1) flunarizine hydrochloride, which was quantitatively analyzed by real-time PCR (RT-PCR). pERK1/2 level was examined by Western blotting after co-cultured with optimal concentration of gastrodin and effective specific ERK1/2 pathway inhibitors PD98059, U0126. The result indicated that gastrodin significantly reduced pERK1/2 protein actions similarly to ERK1/2 pathway specific blockade. It suggests ERK1/2 signaling transduction pathway may be involved in gastrodin intracellular mechanism. This study indicates gastrodin (5 and 10 mmol L(-1)) can remarkably reduce CGRP-ir (+) neuron, CGRP-mRNA and pERK1/2 expression level in cultured rat TG, with its actions similar to the effective concentration of sumatriptan succinate, flunarizine hydrochloride and specific ERK1/2 pathway blocker. The intracellular signaling transduction ERK1/2 pathway may be involved in the gastrodin reducing CGRP up-regulation in rat TG after organ culture.

Hypersensitization of alpha-adrenoreceptor of artery smooth muscle in hypertensive rats and hypertensive patients / 药学学报

<p><b>AIM</b>To investigate the hypersensitization of alpha-adrenoreceptor of artery smooth muscle in hypertensive patients and rats and the mechanisms concerned.</p><p><b>METHODS</b>Isometric tension of artery ring segments was recorded by a sensitive myograph system in vitro and the relative amount of alpha-adrenoreceptor mRNA was quantified by a real-time PCR.</p><p><b>RESULTS</b>Noradrenaline (NA)-induced concentration-contraction curve of mesenteric artery segments in spontaneously hypertensive rats (SHR) was more potent than that in Wistar-Kyoto (WKY) rats. The E(max) of NA in SHR was 1.82 times of that of WKY. The concentration-contractile curve induced by NA in great omental arteries of hypertensives significantly shifted toward left and the pD2 value of NA was larger than that of normotensives. After organ culture, the concentration-contractile curves of SD rat mesenteric artery induced by NA shifted toward left with significantly increased E(max). The relative amounts of mRNA for alpha1-adrenoreceptor was increased, but mRNA level for alpha2-adrenoreceptor did not change.</p><p><b>CONCLUSION</b>The sensitivity of alpha1-adrenoreceptor of artery smooth muscle in hypertensive man and rat is enhanced, suggesting alpha1-adrenoreceptor is upregulated.</p>

ERK1/2 pathway involved in the expression of ETB receptors of the culturing smooth muscle cells of rat mesenteric artery / 药学学报

<p><b>AIM</b>To determine the involvement of extracellular signal-regulated kinase 1/2 (ERK1/2) pathway in the expression of endothelin receptor type B (ETB) during culture.</p><p><b>METHODS</b>SB386023, a specific inhibitor for ERK1/2 pathway, was used to define the intracellular signaling pathway for the upregulation of ETB receptors and sarafotoxin 6c (S6c), a selective agonist for ETB receptors, induced contraction in isolated rat superior mesenteric arteries. The contraction was recorded by a sensitive in vitro myograph and the receptor mRNA was quantified by a real-time PCR. The phosphorylated ERK1/2 proteins were analyzed by phosphoELISA assay.</p><p><b>RESULTS</b>S6c induced strong contractile responses of the artery after culture for 24 h, while there was no response to S6c in fresh vessel segments. The enhanced contractile response to S6c paralleled with an increase of mRNA for ETB receptors. The phosphorylated ERK1/2 proteins significantly increased after culture for 3 h. After co-culture with SB386023 for 24 h, S6c-induced contractions significantly decreased with reduction of Emax from (217 +/- 14) % to (127 +/- 23) % (P <0.01). This response paralleled with a decreased level of ETB receptor mRNA.</p><p><b>CONCLUSION</b>ERK1/2 pathway was involved in the up-regulation of ETB receptors on smooth muscle cells isolated from rat mesenteric arteries during culture.</p>

The incidence of dementia among elderly people in Xi' an, China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the incidence of dementia among elderly people in Xi'an and its related risk factors.</p><p><b>METHODS</b>Subjects that had been studied on the prevalence of dementia were follow-up, and the incidence of dementia, Alzheimer disease (AD) , and vascular dementia (VD) were counted by person-years. The clinical diagnosis on dementia,AD and VD were based upon the 3rd Edition of Diagnostic and Statistical of Manual of Mental Disorder, Revised version (DSM-III-R) and NINCDS-ADRDA criteria.</p><p><b>RESULTS</b>2197 subjects of non-dementia being identified in 1998, were re-surveyed in 2001. Out of them, 47 new cases of dementia including 37 cases of AD and 8 cases of VD were identified, with an annual incidence rates of dementia, AD and VD as 0.68%, 0.54% and 0.12% among those of 55 years and over and 0.89%, 0.69% and 0.17% in 65 years and over, respectively. Analysis from single factor logistic regression showed that age and education but not gender were closely related to the occurrence of AD. On the contrary, age, hypertension and stroke were closely related to the occurrence of VD.</p><p><b>CONCLUSION</b>The incidence of dementia in the "Xi' an cohort" was similar to that being reported from other countries. AD and VD were an age-related diseases but education seemed to have had great protective effect while lack of formal education served as risk factor to AD.</p>