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Objective:To explore the efficacy and safety of preoperative application of tranexamic acid (TXA) in the treatment of senile proximal humeral fracture (PHF) with locking plate internal fixation.Methods:A prospective randomized controlled analysis was performed on clinical data of 89 elderly patients with PHF admitted to First Affiliated Hospital of Chongqing Medical University from December 2018 to December 2021. All patients received open reduction and locking plate internal fixation. The patients were divided into TXA group and control group according to the equal probability randomization method. In TXA group, the patients were given 1 g of TXA intravenously at 30 minutes before operation. In control group, the patients were given the same amount of normal saline at the same time. The general data (sex, age, body mass index, bone mineral density, Neer classification, and time from injury to operation), operation time, hospitalization time, and postoperative complications were recorded and compared between the two groups. At 3 months after operation, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and shoulder range of motion (ROM) were used to compare the recovery of shoulder joint function between the two groups. The total blood loss (TBL), visible blood loss (VBL), hidden blood loss (HBL), intraoperative blood loss (IBL), postoperative drainage volume, drainage tube removal time and blood transfusion rate were compared between the two groups.Results:There were 47 patients in TXA group and 42 patients in control group. There were no significant differences in general data between the two groups (all P>0.05). The operation time and incidence of deep vein thrombosis (DVT) showed no significant difference between the two groups (all P>0.05). The hospitalization time was (7.4±2.5)days in TXA group, significantly shorter than (10.9±3.1)days in control group ( P<0.05). The wounds were healed at stage I in the two groups, with no incision infection, pulmonary embolism, cerebral embolism or other critical complications. There were no significant differences in ASES score, Constant-Murley score and shoulder ROM between the two groups at 3 months postoperatively (all P>0.05). In TXA group, the TBL, VBL, HBL, postoperative drainage volume and drainage tube removal time were (341.1±31.2)ml, (198.7±20.2)ml, (142.5±23.8)ml, (38.9±12.9)ml, and (25.6±3.2)hours respectively, while in control group, the TBL, VBL, HBL, postoperative drainage volume and drainage tube removal time were (643.7±42.4)ml, (223.1±28.6)ml, (420.6±31.8)ml, (58.9±16.9)ml, and (37.3±5.3)hours respectively ( P<0.05 or 0.01). There were no significant differences in IBL or blood transfusion rate between the two groups (all P>0.05). Conclusions:For senile PHF treated with locking plate internal fixation, preoperative intravenous infusion of TXA can effectively shorten the hospital stay, without increasing the incidence of DVT or affecting shoulder joint function. Meanwhile, TXA results in reduced TBL, VBL, HBL and postoperative drainage volume and early drainage tube removal, which has good clinical effectiveness and safety.
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Objective To compare the clinical efficacy between bone cement-augmented pedicle screw fixation and bone filling vertebroplasty for stable osteoporotic thoracolumbar burst fracture (TBF).Methods From August 2014 to August 2017,48 patients with stable osteoporotic TBF but no neurological symptoms were treated at Department of Orthopedics,The First Affiliated Hospital to Chongqing Medical University.Those undergoing bone cement-augmented pedicle screw fixation were assigned into Group A while those undergoing bone filling vertebroplasty into Group B.The clinical efficacy was evaluated by comparing visual analogue scale (VAS) for pain assessment,Oswestry disability index (ODI),compression ratio of anterior vertebral height,and cobb kyphotic angle between preoperation and postoperation.The 2 groups were compared in terms of operation time,bone cement consumption,blood loss,hospital stay and relative medical costs.Results Of the 48 patients included in this study,27 were in Group A and 21 in Group B.The 2 groups were comparable as their baseline characteristics were insignificantly different (P ＞ 0.05).At 3 days after operation,the VAS (2.8 ± 1.0) and ODI (26.0 ±3.5) scores for group B were significantly lower than those for group A (4.6 ± 1.3 and 34.3 ± 2.9) (P ＜ 0.05).In group A at 3 months after operation and final follow-up,the VAS (2.9 ±0.9 and 2.3 ±0.7) and ODI (24.7 ±3.1 and 23.1 ±4.6) scores were significantly lower than those at 3 days after operation (4.6 ± 1.3 and 34.3 ± 2.9) (P ＜ 0.05).In group B at 3 months after operation and final follow-up,the VAS (2.8 ±0.9 and 2.3 ± 1.0) and ODI (23.8 ±3.7 and 22.8 ± 5.6) scores were insignificantly better than those at 3 days after operation (2.8 ± 1.0 and 26.0 ± 3.5) (P ＞ 0.05).At 3 days and 3 months after operation and final follow-up,group B had significantly smaller compression ratios of anterior vertebral height (81.1％ ± 3.7％,81.1％ ± 3.4％ and 75.6％ ± 5.8％) than group A did (91.4％ ±4.4％,90.1％ ±2.9％ and 83.5％ ±4.4％) but significantly larger cobb kyphotic angles (17.0° ± 4.0°,18.0° ± 3.5 ° and 22.1 ° ± 3.6°) than group A (14.0° ± 3.2°,14.3° ± 5.5° and 19.2° ± 3.2°) (P ＜ 0.05).The compression ratio of anterior vertebral height and cobb kyphotic angle at the final follow-up in all the patients were significantly improved compared with those at 3 days and 3 months after operation (P ＜ 0.05).Group B had significantly less operation time (51.5 ±7.3 min),blood loss (16.0 ± 8.2 mL),hospital stay (3.4 ±0.9 d) and medical costs per person (34,000 ±4,000 RMB yuan) than group A (91.5 ± 9.8 min,77.4 ± 16.5 mL,8.7 ± 2.2 d and 55,000 ± 9,000 RMB yuan),but significantly larger bone cement consumption (5.1 ± 0.7 mL) than group A (1.9 ± 0.7 mL) (P ＜ 0.05).Conclusion For patients with stable osteoporotic TBF,both bone cement-augmented pedicle screw fixation and bone filling vertebroplasty can lead to similar clinical outcomes,but the latter may have advantages of less invasion,faster recovery and lower medical costs.
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Objective To investigate the interest,cognition degree,participation degree and current situation of the advanced undergraduate clinical students in our college,to discuss the reason for low level of students' scientific research quality,in order to provide the reference to making research training programs for them.Methods The advanced undergraduates of seven-year and five-year clinical program interned in orthopedics department from January to June in 2014 were selected with cluster sampling method,and investigated anonymously by questionnaires and interview.120 students were investigated by questionnaire,and 120 effective questionnaires were taken back.30 students were interviewed.Results The results showed that 90.0 percent (n=108) of students were interested in scientific activity,and 47.5 percent (n=57) of students had participated in scientific lectures.In interviews,students think factors hindering the research on the participation in scientific research are:1)too many courses and heavy school tasks;2) absence of relative knowledge;3) lack of support from college;4) tough condition for scientific training;5) immature management system.Conclusion The advanced undergraduate clinical students had great interest in scientific activity,but had few opportunities to take part in,leading to their low level of scientific research quality.A variety of measures should be taken to bolster their scientific training.
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The present paper is aimed to explore the biological osteoinductive activity of recombinant human bone morphogenetic protein 9 (rhBMP-9) by various biological technologies. In this study, we firstly obtained hBMP-9 cDNA by PCR and inserted it into vector pcDNA4/His Max to reconstruct hBMP-9 eukaryotic expression vector pcDNA4/His Max-BMP-9. Recombinant Chinese hamster ovary (rCHO) cell line expressing high-level rhBMP-9 was reconstructed by co-transfecting the expression vectors pcDNA4/His* Max-hBMP-9 and plasmid pSV2-dhfr into dihydrofolate reductase (dhfr)-deficient CHO cells and the subsequent gene amplification by the methotrexate. We finally obtained a monoclonal cell line expressing the highest level protein. We purified the medium after culturing the highest-producing monoclonal by Ni-NTA His-Bind Resin columns and concentrated to by a Centricon 50 at 4 degrees C and stored at 70 degrees C until it was used. Western blot and SDS-PAGE analyses showed a specific band of about 32kD in pro-region lane and a specific band of about 50kD in pro-region complex lane. Biological activities of rhBMP-9 were tested by colorimetric determination and histochemical staining of Alkaline Phosphatase (ALP) Activity, osteocalcin and oesteopontin for C3H10 T1/2 cells, which were stimulated culture by different concentration (20, 50, 100 microg/mL) of rhBMP-9. The results showed that the rhBMP-9 could induce osteogenic differentiation of mesenchymal stem cells (MSCs) in vitro, and were proportional to the amount. This study can provide experimental data for further tests in vivo and clinical applications.
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Animals , Cricetinae , Humans , CHO Cells , Cricetulus , Growth Differentiation Factor 2 , Pharmacology , Osteogenesis , Recombinant Proteins , Pharmacology , TransfectionABSTRACT
With the rapid development of China's higher education and the intensified reforms in medical and health services,the problems and contradictions are increasingly prominent in ortho-pedic clinical teaching,especially how to improve medical interns' ability to read images. Picture archiving and communication system (PACS)plays an important role in academic education of medi-cal imaging. Case-based learning (CBL)is a team seminar teaching mode that is guided by cases, based on problems,targeted at students,and dominated by teachers. PACS and CBL were perfectly combined in orthopedic clinical teaching to improve teaching efficiency and the outcome was evaluat-ed through a questionnaire. Results showed that this teaching method inspired students' interests in learning,cultivated the orthopedic clinical way of thinking thus achieved better teaching effects.