Role of preoperative administration of tranexamic acid in the treatment of senile proximal humeral fracture with locking plate internal fixation / 中华创伤杂志

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.

Analysis of adverse drug reactions induced by compound Kushen injection in Qingdao central hospital / 国际中医中药杂志

Objective The adverse drug reaction (ADR) reports of compound Kushen injection in Qingdao Central Hospital were analyzed to improve the level of safe and rational use of drugs.Methods We investigated 35 cases of severe ADR reports induced by compound Kushen injection in Qingdao Central Hospital from 2016.09 to 2018.03 retrospectively.Then the type of report,relevance evaluation and prognosis,ADR occurrence and recovered time,involved system/organs and main clinical manifestations were analyzed.Results The new moderate and new severe ADR incident were 51.4％ of 35 ADR reports.Twenty-nine cases of the ADR were occurred 30 minutes after injection.Twenty-three cases of ADR clinical symptoms can be recovered after 30 minutes.The main ADR was the digestive system reaction,followed by the neural system,respiratory system and cardiovascular system.Conclusions It is important to pay attention to the occurrence of compound Kushen injection ADR and strengthen its monitoring.

Hip and pelvic fractures and sciatic nerve injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the influence of hip and pelvic fracture, especially acetabular fracture complicated by sciatic nerve injury on clinical features and prognosis of sciatic nerve injury.</p><p><b>METHODS</b>From January 1987 to January 2000, 17 patients (14 male and 3 female) who had hip and pelvic fractures complicated by sciatic nerve injury were treated with operative reduction and internal fixation and followed up from 10 months to 5 years. The average age was 38 years (ranging 23-56 years). The left extremities were involved in 11 patients and the right in 6. Twelve patients underwent primary exploration and neurolysis and 5 patients underwent secondary operation.</p><p><b>RESULTS</b>Preoperatively, 8 patients were treated with large doses of oral narcotics to control their severe sciatic pain. Three of the 8 patients underwent patient-controlled analgesia and epidural analgesia. After operation, excellent and good rates of reduction and functional recovery of sciatic nerve were 94.1% and 88% respectively. Four patients still had sciatic pain and 2 patients failed to recover. Sciatic nerve function improved within 3-6 months after surgery in 11 patients.</p><p><b>CONCLUSIONS</b>Hip and pelvic fractures can result in sciatic nerve injury, especially common peroneal nerve injury and prognosis is poor. Open reduction and internal fixation combined with nerve exploration and neurolysis should be used as early as possible for severe sciatic pain.</p>

Role of SLB elements presented at 5 UTR of dengue virus on translation and RNA synthesis / 解放军医学杂志

Objective To investigate the effects of SLB elements presented at 5' UTR of dengue virus genome on viral translation and RNA replication.Methods The 5 end of RNA secondary structures of dengue virus genome were predicted using mfold 3.2,and three mutants with different modifications in SLB elements were designed:SLB1,part deletion of the 5' UAR sequence(82-87nt);SLB2,mutation of the sequence on stem(Mut 77G/C);SLB3,mutation of the sequence on stem(M77-78AG/GA),respectively.The mutants described above were constructed by OL-PCR based on DEN-R.luc2A-RP,respectively.Replicon RNAs corresponding to DEN-R.luc2A-RP,DEN-R.luc2AGDD-RP and the 3 mutants mentioned above were in vitro transcribed and equal amounts of RNA were transfected into BHK cells with Lipofectamine 2000.After RNA transfection,the replicons were detected and characterized by RT-PCR,IFA,Renilla Luciferase assay system and real time RT-PCR,respectively.Results It was shown that SLB1 mutant did not significantly affect the translation of the input RNA,but seriously compromised RNA synthesis;SLB2 mutant did not significantly affect the translation of the input RNA either,but its RNA replication was abolished;both the translation and replication of SLB3 mutant were abolished.Conclusion Both the nucleotide sequence and the RNA secondary structure of the second loop and short stem of SLB element are highly conserved.SLB element may play an essential role on viral translation and RNA replication.The findings of present study may set a foundation for elucidating the role of SLB during viral translation and replication.

Latrogenic injuries of radial nerve:A report of 36 cases / 重庆医科大学学报

Objective:To investigate the causes, the prevention and the treatment of iatrogenic radial nerve injuries.Methods: From March 1987 to March 2000 ,the authors treated 36 cases of iatrogenic radial nerve injuries .Of the 36 cases ,33 cases occurred after the orthopaedic operation ,3 cases occurred after the manipulative reduction. 32 cases were treated surgically, and the other 4 cases were treated non-surgically. 8 cases were repaired by epineurial suturing or by epi-fascicular suturing to connect the severed ends of the nerves. 19 cases were treated with neurolysis operation, 8 cases with tendon transfer and 3 cases with palliative treatment. Results: 27 cases were followed up for 1 year to 6 years. The curative effect was assessed according to Zhang Xianzhong"s norm. The recovery of 20 cases were excellent, 4 cases were good, 3 cases were poor.Conclusion:The iatrogenic radial nerve injury can be avoided if the surgeon take a high responsibility and grasp a precise knowledge of pertinent anatomy. At the same time more attention should be paid in operation. Once incurred, the damage can be minimized if it is recognised and treated earlier.