Bundle para quantificação de perda sanguínea pós-parto vaginal / Bundle para la cuantificación de pérdida sanguínea posparto vaginal / Bundle for quantifying vaginal blood loss after childbirth

Resumo Objetivo Construir e validar o conteúdo de um bundle para quantificação da perda sanguínea pós-parto vaginal. Métodos Estudo metodológico desenvolvido de fevereiro a agosto de 2022, em três etapas: levantamento bibliográfico, construção do instrumento e validação de conteúdo por 14 experts. O instrumento para validação foi composto por 11 itens selecionados a partir de revisão sistemática. Para cada item do bundle aplicou-se escala Likert e para verificar a concordância entre experts, calculou-se o Índice de Concordância. Consideraram-se válidos os itens com concordância acima de 80%. A validação de conteúdo foi realizada em uma única rodada de avaliação. Resultados A versão final do bundle foi composta por nove itens. Os cuidados propostos estão relacionados à quantificação direta do sangramento pós-parto e seu registro, observação da puérpera, a utilização de protocolos institucionais em casos de hemorragia pós-parto, assim como a capacitação da equipe. Conclusão O estudo permitiu construir e validar bundle para quantificação da perda sanguínea pós-parto vaginal, com vistas à melhora do diagnóstico de hemorragia pós-parto.

Resumen Objetivo Elaborar y validar el contenido de un bundle para la cuantificación de pérdida sanguínea posparto vaginal. Métodos Estudio metodológico, llevado a cabo de febrero a agosto de 2022, en tres etapas: análisis bibliográfico, construcción del instrumento y validación de contenido por 14 expertos. El instrumento para validación consistió en 11 ítems seleccionados a partir de revisión sistemática. Se aplicó la escala Likert para cada ítem del bundle; y para verificar la concordancia entre expertos, se calculó el Índice de Concordancia. Se consideraron válidos los ítems con concordancia superior a 80 %. La validación de contenido se realizó en una única ronda de evaluación. Resultados La versión final del bundle consistió en nueve ítems. Los cuidados propuestos están relacionados con la cuantificación directa del sangrado posparto y su registro, la observación de la puérpera, la utilización de protocolos institucionales en casos de hemorragia posparto, así como también la capacitación del equipo. Conclusión El estudio permitió elaborar y validar un bundle para la cuantificación de pérdida sanguínea posparto vaginal, con el fin de mejorar el diagnóstico de hemorragia posparto.

Abstract Objective To construct and validate the content of a bundle to quantify vaginal blood loss after childbirth. Methods This is a methodological study developed from February to August 2022, divided into bibliographic survey, instrument construction and content validity, by 14 experts. The instrument for validity consisted of 11 items selected from a systematic review. For each item in the bundle, a Likert scale was applied, and to check agreement among experts, the Concordance Index was calculated. Items with agreement above 80% were considered valid. Content validity was carried out in a single round of assessment. Results The final version of the bundle consisted of nine items. The proposed care is related to direct quantification of postpartum bleeding and its recording, observation of postpartum women, use of institutional protocols in cases of postpartum hemorrhage as well as team training. Conclusion The study allowed constructing and validating a bundle for quantifying vaginal blood loss after childbirth, with a view to improving postpartum hemorrhage diagnosis.

Comparison of Blood Loss with the Use of Intravenous and Intraarticular Tranexamic Acid Versus Isolated Intraarticular in Primary Knee Arthroplasty / Comparação da perda sanguínea com a utilização do ácido tranexâmico endovenoso e intra-articular versus intra-articular isolado em artroplastia primária de joelho

Abstract Objective The objective of this work is to compare blood loss during primary knee arthroplasty with the use of intravenous and intraarticular (IV + IA) tranexamic acid versus intraarticular (IA) tranexamic acid alone. Methods This is a randomized, double-blind clinical trial. Patients with indication for primary total knee arthroplasty were recruited in a specialized clinic, where they were operated by the same surgeon, always using the same surgical technique. Thirty patients were allocated in the IV + IA tranexamic acid group and 30 patients in the IA tranexamic acid group, according to randomization. Blood loss was compared through hemoglobin, hematocrit, drain volume, and blood loss estimation (Gross and Nadler calculus). Results After collection, data from 40 patients were analyzed, 22 in the IA group and 18 in the IV +IA group. There were 20 losses due to collection error. Between groups IA and IV + IA, there were no significant differences in 24 hours between hemoglobin levels (10.56 vs. 10.65 g/dL; F1.39 = 0.63, p =0.429), erythrocyte (3.63 vs. 3.73 million/mm³; F1.39 = 0.90, p = 0.346); hematocrit (32.14 vs. 32.60%; F1.39 = 1.39, p = 0.240); drainage volume (197.0 vs. 173.6 mL; F1.39 = 3.38 p = 0.069); and estimated blood loss (1,002.5 vs. 980.1; F1.39 =0.09, p = 0.770). The same occurred in comparisons conducted after 48 hours postoperatively. Time was a significant factor for the change of all outcome variables. However, the treatment did not modify the effect of time on these outcomes. No individual presented any thromboembolic event during the work period. Conclusions The use of IV + IA tranexamic acid showed no advantage in reducing blood loss when compared to the use of IA tranexamic acid alone in primary knee arthroplasties. This technique proved to be safe, since no thromboembolic event occurred during the development of the work.

Resumo Objetivo O objetivo desse trabalho é comparar a perda sanguínea durante a artroplastia primária de joelho, com a utilização do ácido tranexâmico endovenoso e intra-articular (EV + IA) versus intra-articular (IA) isolado. Métodos Trata-se de um ensaio clínico randomizado, duplo cego. Pacientes com indicação de artroplastia total primária de joelho foram captados em clínica especializada, onde foram operados pelo mesmo cirurgião, utilizando sempre a mesma técnica cirúrgica. Trinta pacientes foram alocados no grupo ácido tranexâmico EV + IA e 30 pacientes, no grupo IA, conforme randomização. Foi comparada a perda sanguínea através dos níveis de hemoglobina, hematócrito, volume do dreno e estimativa da perda sanguínea (EBL) (cálculo de Gross e Nadler). Resultados Após a coleta, foram analisados os dados de 40 pacientes, sendo 22 do grupo IA isolado e 18 do grupo EV + IA. Ocorreram 20 perdas por erro de coleta. Entre os grupos IA e EV + IA, não ocorreram diferenças significativas em 24 horas entre os níveis de hemoglobina (10,56 vs. 10,65 g/dL; F1,39 =0,63, p = 0,429), eritrócito (3,63 vs. 3,73 milhões/mm3; F1,39 = 0,90, p =0,346), hematócrito (32,14 vs. 32,60%; F1,39 = 1,39; p=0,240), volume de dreno (197,0 vs. 173,6 mL; F1,39 = 3,38; p =0,069) e estimativa de perda sanguínea (EBL) (1.002,5 vs. 980,1; F1,39 = 0,09; p =0,770). O mesmo ocorreu nas comparações realizadas 48 horas pós-operatório. O tempo foi fator significativo para a mudança de todas as variáveis de desfecho. Porém, o tratamento não modificou o efeito do tempo nesses desfechos. Nenhum indivíduo apresentou qualquer evento tromboembólico durante o período do trabalho. Conclusões O uso do ácido tranexâmico EV + IA não demonstrou vantagem em redução de perda sanguínea quando comparado ao uso de ácido tranexâmico IA isolado nas artroplastias primárias de joelho. Esta técnica demonstrou-se segura, visto que nenhum evento trombo-embólico ocorreu durante o desenvolvimento do trabalho.

Risk factor assessment and adverse outcome prediction of placenta accreta in pregnant women after cesarean section complicated with placenta previa: a national multicenter retrospective study / 中华妇产科杂志

Objective:To study the risk factors of adverse pregnancy outcomes for the diagnosis and treatment of pregnancy after cesarean section complicated with placenta previa.Methods:A national multicenter retrospective study was conducted to select a total of 747 pregnant women with the third trimester singleton pregnancy after cesarean section complicated with placenta previa from 12 tertiary hospitals in January 1st to December 31st, 2018. The risk factors of severe adverse outcomes [hysterectomy, intraoperative blood loss ≥1 000 ml, intraoperative diagnosis of placenta accreta spectrum disorders (PAS)] in pregnant women with second pregnancy complicated with placenta previa after cesarean section were investigated by logistic regression analysis. The roles of prenatal ultrasonography and magnetic resonance imaging (MRI) in the prediction of PAS and severe adverse outcomes were observed. According to whether vascular intervention was performed (uterine artery embolization or abdominal aortic balloon occlusion), the pregnant women were divided into the blocked group and the unblocked group, and the maternal and infant perinatal outcomes between the two groups were compared.Results:(1) General information: the hysterectomy rate of 747 pregnant women with second pregnancy complicated with placenta previa after cesarean section was 10.4% (78/747), the intraoperative blood loss ≥1 000 ml in 55.8% (417/747), and PAS was confirmed in 47.5% (355/747). The incidence of uterine rupture was 0.8% (6/747). (2) Analysis of risk factors for severe adverse outcomes: based on binary unconditioned logistic regression univariate and multivariate analysis, the risk factors for hysterectomy were the mode of vascular embolization and intraoperative blood loss. The probability of hysterectomy with uterine artery embolization was 5.319 times higher than that with abdominal aortic balloon occlusion (95% CI: 1.346-21.018). The risk factors of intraoperative blood loss ≥1 000 ml were the number of cesarean section delivery, ultrasonography indicated PAS and suspected PAS, intraoperative PAS and complete placenta previa. The risk factors for intraoperative PAS were uterine scar thickness, ultrasonography indicated PAS and suspected PAS, MRI indicated PAS and suspected PAS, and complete placenta previa. (3) The roles of ultrasonography and MRI in predicting PAS: the sensitivity and specificity of ultrasonography in predicting PAS were 47.5% and 88.4%; the kappa value was 0.279 ( P<0.001), with fair agreement. The sensitivity and specificity of MRI to predict PAS were 79.2% and 97.8%, respectively. The kappa value was 0.702 ( P<0.001), indicating a good agreement. The intraoperative blood loss and hysterectomy rate of pregnant women with PAS indicated by ultrasonography and MRI were significantly higher than those with PAS only by ultrasonography or MRI. (4) Influence of vascular occlusion on pregnancy outcome: there were no significant differences in intraoperative blood loss and incidence of intraoperative bleeding ≥1 000 ml between the blocked group and the unblocked group (all P>0.05). There was no significant difference in intraoperative blood loss between the pregnant women with abdominal aortic balloon occlusion, uterine artery embolization and those without occlusion ( P=0.409). The hysterectomy rate of pregnant women with uterine artery embolization was significantly higher than those with abdominal aortic balloon occlusion [39.3% (22/56) vs 10.0% (5/50), P=0.001]. Conclusions:In the third trimester of pregnancy with placenta previa after cesarean section, MRI examination has better consistency in predicting PAS than ultrasonography examination. Ultrasonography examination combined with MRI examination could effectively predict the hysterectomy rate and intraoperative blood loss. Vascular occlusion could not reduce the amount of intraoperative blood loss. The hysterectomy rate of pregnant women with uterine artery embolization is higher than those with abdominal aortic balloon occlusion.

Clinical efficacy of surgical treatment of refractory hyperthyroidism in 56 patients / 中国基层医药

Methods:The clinical data and follow-up results of 56 patients with refractory hyperthyroidism who underwent laparoscopy or open surgery in Affiliated Nanhua Hospital of University of South China from January 2019 to August 2020 were retrospectively analyzed.Results:Among the 56 patients, there were 6 men and 50 women. Thirty-six (64.3%) patients underwent endoscopic surgery and twenty (35.7%) patients underwent open surgery. The operation time was (132.0 ± 32.0) minutes. Intraoperative blood loss was (32.4 ± 27.8) mL. Postoperative parathyroid hormone level was (27.8 ± 18.3) ng/L. Forty-nine (87.5%) patients showed benign pathology results after surgery. After surgery, 14 (25.0%) patients had hypothyroidism, including 7 (12.5%) patients with hyperthyroidism combined with thyroid cancer. There were no patients with permanent hypothyroidism or recurrent laryngeal nerve paralysis. All patients had a good prognosis and satisfactory surgical results.Conclusion:With the update of preoperative preparation methods for hyperthyroidism, the increasing maturity of thyroid surgery technology, and the use of new energy instruments and technologies, surgical treatment is undoubtedly a good treatment method for patients with refractory hyperthyroidism or a suspected malignant tumor.Objevtives:To investigate the indications and clinical efficacy of surgical treatment in patients with refractory hyperthyroidism.

Quantification of blood loss for the diagnosis of postpartum hemorrhage: a systematic review and meta-analysis / Cuantificación de la pérdida de sangre para el diagnóstico de hemorragia posparto: revisión sistemática y metanálisis / Quantificação da perda sanguínea para o diagnóstico de hemorragia pós-parto: revisão sistemática e metanálise

ABSTRACT Objective: to compare the effectiveness of different diagnostic methods to estimate postpartum blood volume loss. Methods: a systematic review of effectiveness according to PRISMA and JBI Protocol. Searches in PubMed/MEDLINE, LILACS, Scopus, Embase, Web of Science and CINAHL, with descriptor "Postpartum Hemorrhage" associated with keyword "Quantification of Blood Loss". Tabulated extracted data, presented in metasynthesis and meta-analysis was applied to quantitative data. To assess risk of bias, JBI Appraisal Tools were applied. Results: fourteen studies were included, published between 2006 and 2021. Quantification of loss by any method was superior to visual estimation and is highly recommended, however the studies' high heterogeneity did not allow estimating this association. Conclusion: the studies' high heterogeneity, with a probable margin of error given the uncontrolled factors, indicates the need for further studies, however quantification proved to be effective in relation to visual estimate. PROSPERO registration CRD 42021234486.

RESUMEN Objetivo: comparar la efectividad de diferentes métodos diagnósticos para estimar la pérdida de volumen sanguíneo posparto. Métodos: revisión sistemática de efectividad según PRISMA y Protocolo JBI. Búsquedas en bases de datos: PubMed/MEDLINE, LILACS, Scopus, Embase, Web of Science y CINAHL, con el descriptor "Postpartum Hemorrhage" asociado a la palabra clave "Quantification of Blood Loss". Los datos extraídos tabulados fueron presentados en metasíntesis y metanálisis se aplicaron a los datos cuantitativos. Para evaluar el riesgo de sesgo, se aplicaron las herramientas de evaluación de JBI. Resultados: se incluyeron 14 estudios, publicados entre 2006 y 2021. La cuantificación de pérdida por cualquier método fue superior a la estimación visual y es muy recomendable, sin embargo, la alta heterogeneidad de los estudios no permitió estimar esta asociación. Conclusión: la alta heterogeneidad de los estudios, con probable margen de error dado el descontrol de los factores, indica la necesidad de más estudios, sin embargo la cuantificación demostró ser efectiva en relación a la estimación visual. Registro PRÓSPERO CRD 42021234486.

RESUMO Objetivo: comparar a efetividade de diferentes métodos diagnósticos para estimar a perda volêmica sanguínea pós-parto. Métodos: revisão sistemática de efetividade, de acordo com protocolo PRISMA e JBI. Buscas nas bases PubMed/MEDLINE, LILACS, Scopus, Embase, Web of Science e CINAHL, com o descritor "Postpartum Hemorrhage" associado à palavra-chave "Quantification of Blood Loss". Dados extraídos tabulados, apresentados em metassíntese, e aplicou-se metanálise para dados quantitativos. Para avaliar o risco de viés, aplicou-se o JBI Appraisal Tools. Resultados: incluídos 14 estudos, publicados entre 2006 e 2021. A quantificação da perda por qualquer método apresentou superioridade em relação à estimativa visual, sendo altamente recomendada, porém a alta heterogeneidade dos estudos não permitiu estimar essa associação. Conclusão: a alta heterogeneidade dos estudos, com provável margem de erro dado aos fatores não controlados, indica a necessidade de realização de novos estudos, contudo a quantificação se mostrou efetiva em relação à estimativa visual. Registro PROSPERO CRD 42021234486.

Blood Loss Control in Patients with Idiopathic Scoliosis Undergoing Spinal Fusion: Prospective Evaluation of a Cohort / Controle de sangramento em pacientes com escoliose idiopática submetidos a artrodese da coluna: Avaliação prospectiva de uma coorte de pacientes

Abstract Objective This study aimed to identify risk factors for increased perioperative bleeding in scoliosis surgery. Methods This is a prospective cohort study including 30 patients with idiopathic scoliosis undergoing posterior instrumentation using the pedicle screw system at a university hospital. Results Intraoperative blood losses totaled 798.6 ± 340 mL (24.8% of blood volume). Nine subjects presented massive blood loss. On average, hemoglobin dropped by 3.7g/dL, and each patient received 1.4 blood bags. Postoperative blood loss was 693.4±331.1 mL, and the total number of days using a drain was 2.7±0.7. Intraoperatively, the following variables showed significant correlations (p<0.05) with increased bleeding: age, time from diagnosis to treatment, preoperative Cobb angle, amount of curve correction, number of instrumented and fixated levels, total number of screws, and the number of transfused bags. Postoperatively, the following variables had significant correlations (p < 0.05): age, preoperative Cobb angle, length of hospital stay, number of blood bags transfused, and number of levels fixated with screws. Conclusion The variables most contributing to blood loss were age, preoperative Cobb angle, number of blood bags transfused, and number of levels fixated with a screw. Therefore, patients may benefit from surgical treatment while younger and

Resumo Objetivo O objetivo deste estudo é identificar os fatores de risco para o aumento de sangramento perioperatório em cirurgias para tratamento de escoliose. Métodos Estudo de coorte prospectivo incluindo 30 pacientes com escoliose idiopática submetidos à instrumentação posterior com o uso do sistema de parafusos pediculares em um hospital universitário. Resultados As perdas sanguíneas intraoperatórias totalizaram 798,6 ml ±340 ml (24,8% do volume sanguíneo). Houve perda maciça de sangue em 9 pacientes. Em média, a hemoglobina caiu 3,7 g/dl e foram transfundidas 1,4 bolsas de sangue por paciente. A perda sanguínea pós-operatória foi de 693,4 ml ± 331,1ml, e o total de dias utilizando dreno foi 2,7 ± 0,7. No intraoperatório, as seguintes variáveis apresentaram correlações significativas (p < 0,05) com o aumento do sangramento: idade, intervalo entre diagnóstico e tratamento, Cobb pré-operatório, quantidade de correção da curva, número de níveis instrumentados e fixados, número total de parafusos e o número de bolsas transfundidas. No pós-operatório, as seguintes variáveis apresentaram relação (p<0,05): idade, Cobb pré-operatório, tempo de internação, quantidade de bolsas de sangue transfundidas e o número de níveis fixados com parafuso. Conclusão As variáveis que mais contribuíram para a perda sanguínea foram idade, Cobb pré-operatório, quantidade de bolsas de sangue transfundidas e número de níveis fixados com parafuso. Portanto, os pacientes podem se beneficiar do tratamento cirúrgico

Medical management of abnormal uterine bleeding in a tertiary care hospital – A cross-sectional study

Background: Abnormal uterine bleeding (AUB) is a common gynecological disorder among women of reproductive age, interfering with their day-to-day activity. A better understanding of commonly used drugs in the medical management reduces the need of unnecessary surgical procedures and benefits both the patient and health-care providers. Aims and Objectives: This study aims to study the patient characteristics and prescription pattern in the medical management of AUB and to assess the menstrual blood loss by pictorial blood loss assessment chart (PBAC) and the association between different treatment groups with PBAC score. Materials and Methods: A cross-sectional study was conducted at gynecology OPD, Vanivilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, from January 2019 to January 2020 with approval from the Institutional Ethics Committee, BMCRI, Bengaluru. A total of 200 AUB patients on medical treatment were included for the study, demographic data and relevant data on drug prescription were recorded in the case record form. Menstrual blood loss was assessed using PBAC. Association between PBAC score and different medical treatment groups was determined. Results: AUB was observed mostly in the age group of 21–30 years (35.5%), multiparous women (69.5%) were at higher risk of developing AUB, ovulatory dysfunction (44.5%) was the common cause of AUB in reproductive age group. Medical management included hormonal (36.3%), non-hormonal (21%), combined (9.3%), and concomitant medications (33.4%). Median of PBAC score was 75. There was no significant association among different treatment groups and PBAC score. Conclusion: Majority of AUB patients received hormonal treatment had functional causes with normal PBAC score. This study gives an overview of medical management of AUB in a tertiary care hospital.

The Effect of Tranexamic Acid on Haemoglobin Level During Surgeries Around HIP

Background: The aim is to assess effect of tranexamic acid on haemoglobin level during surgeries around hip.Material & Methods:This was a prospective follow up study conducted in Mahender Reddy Institute of medical sciences, Chevella over a period of two years from June 2020 to June 2022. A total number of 123 patients who underwent hip surgeries by four different surgeons were selected for this study. Proximal femoral nailing (PFN) for intertrochantric fractures by surgeon A, dynamic hip screw (DHS) for intertrochantric fractures by surgeon B, total hip replacements by surgeon C and hemiarthroplasty by surgeon D were included for this study. The patients were grouped as treatment and control group. The treatment group and control group were selected by purposive sampling. In the treatment group, the patients undergoing surgeries around hip joint received single dose of intravenous tranexamic acid 10 mg/kg body weight 10 minutes before skin incision and equal volume of saline was injected in the control group. Intra operative blood loss was calculated by galvanometric method, weighing the sponges used and soiled by blood during surgery and measuring the amount of blood collected in suction apparatus used during the surgery. The haemoglobin level assessed post operatively and compared with preoperative haemoglobin level. The amount of fluid collected in the post-operative drain were also measured. Results:In the treatment group, 11 patients out of 16 had blood loss below 300 ml, and 5 patients had blood loss more than 300 ml. In control group 5 patients out of 15 had blood loss below 300 ml. 10 patients had blood loss more than 300 ml. Among the 25 patients of hemiarthroplasty group, 11 out of 13 patients of treatment group had drain below 100 ml on the first post operative day. In control group only 2 patients out of 12 had drain less than 100 ml. In DHS group, in the treatment group, 10 out of 11 patients had preoperative and post operative haemoglobin difference less than 1mg/dl. In control group, 12 out of 12 patients had preoperative and post operative Hb difference more than 1mg/dl.Conclusions:Tranexamic acid administrated before surgical incision is efficient in reducing bleeding during common surgeries around the hip joint. Especially surgery where more amount of blood loss was expected, like total joint replacement and hemiarthroplasty, the drug had shown significant benefit compared with the control group.

Is Menstruation a Valid Reason to Postpone Cardiac Surgery?

Background:Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss. Aims: The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation. Settings and Design: A prospective,matched case?control study which included sixty women of reproductive age group undergoing OHS. Patients and Methods: The surgical blood loss was compared between women who weremenstruating (group?M;n = 25) and their matched controls, i.e., women who were not menstruating (group?NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup?P) and perioperative period (subgroup?PO) was compared to determine the effect of OHS onmenstrual blood loss. Results: The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr?M = 245.6 ± 120.1 ml vs gr?NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr?P = 36.8 ± 4.8 ml vs gr?PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr?P = 4.2 ± 0.6 days vs gr?PO = 4.4 ± 0.6 days, P value = 0.10). Conclusion: Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.

The Role of Tranexamic Acid in the Prevention and Management of Blood Loss in Total Joint Arthroplasty / O papel do ácido tranexâmico na prevenção e gerenciamento da perda de sangue na artroplastia total de articulação

Abstract Objective To collect data on the role played by tranexamic acid in the prevention and management of blood loss in patients undergoing total hip arthroplasty and total knee arthroplasty. Methods In the present prospective, comparative study, 30 patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) were randomly allocated into 1 of 2 groups with 15 patients each. Tranexamic acid was administered by intravenous and topical routes in the study group, but it was not administered in the control group. Preoperative blood parameters, intraoperative and postoperative blood loss, and need for blood transfusion were noted. Statistical analysis was performed using the chisquared test and the independent t-test. Results The study group had statistically significant higher postoperative hemoglobin values (p = 0.03), less difference between pre and postoperative hemoglobin value (p = 0.046), less difference between pre and postoperative packed-cell volume (p = 0.06), less intraoperative measured blood loss (p = 0.015), and less volume of blood collected in the drain (p = 0.0291) compared with the control group. There was also reduced frequency of blood transfusions in the study group (p = 0.0008). Conclusion Tranexamic acid is associated with reduced intra and postoperative blood loss and reduced frequency of blood transfusions in patients undergoing THA/TKA.

Resumo Objetivo Coletar dados sobre o papel desempenhado pelo ácido tranexâmico na prevenção e gerenciamento da perda de sangue em pacientes submetidos à artroplastia total do quadril (ATQ) e à artroplastia total do joelho (ATJ). Métodos Neste estudo prospectivo e comparativo, 30 pacientes submetidos à ATQ ou à ATJ foram alocados aleatoriamente em 1 de 2 grupos com 15 pacientes. O ácido tranexâmico foi administrado por rotas intravenosas e tópicas no grupo de intervenção, mas não foi administrado no grupo controle. Foram observados parâmetros sanguíneos pré-operatórios, perda de sangue intrae pós-operatória e necessidade de transfusão de sangue. A análise estatística foi realizada utilizando-se teste do qui-quadrado e o teste-t independente. Resultados O grupo de intervenção apresentou hemoglobina mais elevada no pósoperatório de forma estatisticamente significante (p = 0,03), menor diferença entre concentração de hemoglobina pré- e pós-operatória (p = 0,046), menor diferença entre volume de células embaladas pré- e pós-operatório (p = 0,06), menor perda de sangue intraoperatória medida (p = 0,015) e menor volume de sangue coletado na drenagem (p = 0,0291) em comparação com o grupo controle. Também houve redução da frequência de transfusões de sangue no grupo de intervenção (p = 0,0008). Conclusão O ácido tranexâmico está associado à redução da perda sanguínea intraoperatória e pós-operatória e à redução da frequência de transfusões de sangue em pacientes submetidos à ATQ/ATJ.

Vacuum Devices for Treating Postpartum Hemorrhage: Indian Innovation, Indian Pride

Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. We focus on two innovations by Indian gynecologists, the Panicker’s vacuum suction cannula and the SR suction cannula. These effective devices are economical and easy-to-use, and help prevent and manage PPH. They can also be used to reduce bleeding in non-PPH indications. These Indian innovations are a matter of pride, and need to be studied extensively in diverse settings. This will help ensure that their benefits can be shared across the world.

Effects of a perioperative whole course composite thermal insulation strategy on complications of cesarean section, maternal coagulation function and serum inflammatory indexes / 中国基层医药

Objective:To investigate the effects of a perioperative whole course composite thermal insulation strategy on complications of cesarean section, maternal coagulation function and serum inflammatory indexes.Methods:A total of 250 pregnant women who were subjected to cesarean section in Zhoushan Hospital between June 2020 and August 2021 were included in this study. The 125 pregnant women who gave birth using a routine simple thermal insulation strategy from June to November 2020 were assigned to the routine simple thermal insulation group, and those who gave birth using a perioperative whole course composite thermal insulation strategy were assigned to whole course composite thermal insulation group. Two groups of pregnant women underwent cesarean section under subarachnoid block. Volume of intraoperative blood loss was recorded. The incidence of complications such as shivering and postoperative infection was calculated. Platelet count, prothrombin time, activated partial thromboplastin time, thrombin time measured before surgery and 48 hours after surgery were compared between the two groups. Peripheral blood white blood cell count, neutrophil count (N%), C-reactive protein, procalcitonin, interleukin-6 measured 48 hours after surgery were compared between the two groups.Results:Volume of intraoperative blood loss in the whole course composite thermal insulation group was significantly lower than that in the routine simple thermal insulation group [(393.84 ± 79.78) mL vs. (434.80 ± 123.49) mL, t = 3.11, P < 0.05). The incidence of shivering and postoperative infection in the whole course composite thermal insulation group was 10.4% (13/125) and 7.2% (9/125), respectively, which was significantly lower than that in the routine simple thermal insulation group [25.6% (32/125), 18.4% (23/125), χ 2 = 9.78, 7.02, both P < 0.05]. At 48 hours after surgery, prothrombin time, activated partial thromboplastin time, thrombin time in the whole course composite thermal insulation group were (10.28 ± 0.48) seconds, (26.97 ± 2.27) seconds, and (14.09 ± 1.36) seconds, respectively, which were significantly shorter than those in the routine simple thermal insulation group [(11.71 ± 0.27) seconds, (27.96 ± 2.25) seconds, (15.91 ± 1.09) seconds, t = 7.34, 3.43, 11.66, all P < 0.05]. At 48 hours after surgery, white blood cell count, neutrophil count, C-reactive protein, procalcitonin, and interleukin-6 in the whole course composite thermal insulation group were (10.38 ± 2.38) ×10 9/L,(0.79 ± 0.06), (52.79 ± 20.73) mg/L, (0.13±0.42) μg/L, and (55.73 ± 24.38) ng/L, respectively, which were significantly lower than those in the routine simple thermal insulation group [(12.24 ± 7.05) × 10 9/L, 0.81 ± 0.05, (65.38 ± 25.92) mg/L, (0.20 ± 0.97) μg/L, (76.22 ± 39.08) ng/L, t = 2.79, 2.92, 4.24, 8.12, 4.97, all P < 0.05]. Conclusion:Perioperative whole course composite thermal insulation strategy can improve the coagulation function of pregnant women who are subjected to cesarean section under subarachnoid block, reduce volume of intraoperative blood loss, and decrease incidence of shivering, inflammatory reaction, and postoperative infection.

Efficacy of laparoscopic myomectomy with a baseball-style suture technique for hysteromyoma / 中国基层医药

Objective:To investigate the efficacy of laparoscopic myomectomy with a baseball-style suture technique in the treatment of hysteromyoma.Methods:Sixty patients with hysteromyoma who received treatment in the Department of Obstetrics and Gynecology, The Second People's Hospital of Hefei, China between July 2018 and July 2020 were included in this study. They were randomly assigned to observation and control groups with 30 patients per group. The observation group was subjected to laparoscopic myomectomy with a baseball-style suture technique. The control group was given laparoscopic myomectomy with a continuous suture technique. Intraoperative indices and postoperative complications were compared between the two groups.Results:Operative time in the observation group was significantly shorter than that in the control group [(98.06 ± 35.41) minutes vs. (119.39 ± 33.65) minutes, t = 2.39, P < 0.05]. Intraoperative blood loss in the observation group was significantly less than that in the control group [(28.33 ± 9.56) mL vs. (46.17 ± 13.08) mL, t = 6.36, P < 0.05]. The percentage of intraoperative needle-hole bleeding in the observation group was significantly lower than that in the control group [16.67% (5/30) vs. 46.67% (14/30), χ 2 = 6.23, P < 0.05). The time to anal exhaust and the time to drainage in the observation group were (19.21 ± 5.77) hours and (59.07 ± 18.85) hours, respectively, which were significantly shorter than (25.39 ± 9.65) hours and (77.22 ± 27.07) hours in the control group ( t = 3.01, 3.02, both P < 0.05). The incidence of postoperative fever in the observation group was significantly lower than that in the control group [3.33% (1/30) vs. 26.67% (8/30), χ 2 = 4.70, P < 0.05]. Conclusion:Laparoscopic myomectomy with a baseball-style suture technique is highly effective on hysteromyoma. It can improve the safety of operation and has a great clinical value.

Preliminary application of the subxiphoid video-assisted thoracoscopic extended thymectomy / 中国基层医药

Objective:To analyze the preliminary effects of subxiphoid video-assisted thoracoscopic extended thymectomy.Methods:We retrospectively analyzed the clinical data of six patients who underwent subxiphoid video-assisted thoracoscopic extended thymectomy in Peking University International Hospital from August 2018 to June 2020.Results:All six patients underwent successful subxiphoid video-assisted thoracoscopic extended thymectomy without conversion to thoracotomy. The rate of R0 resection was 100%. Operative time was (175.50 ± 67.78) minutes, intraoperative blood loss was (40.83 ± 31.37) mL, and postoperative drainage time was (7.17 ± 3.55) days. The total amount of postoperative drainage was (1781.67 ± 1293.53) mL. Postoperative hospital stay was (10.67 ± 6.35) days. The length of hospital stay was (19.67 ± 5.65) days. The Visual Analog Scale score measured after surgery was (2.12 ± 0.48) points. Three patients had grade 1 complications, with an incidence of complications of 50.00%. Grade 3-5 compilations did not occur in any patient. No patient died during the perioperative period.Conclusion:Subxiphoid video-assisted thoracoscopic extended thymectomy is safe and effective and provides a good visual field. The surgical method allows bilateral thoracic surgery, reduces surgical trauma, and has a broad application prospect.

Effects of proximal femoral intramedullary nail antirotation fixation on intertrochanteric fracture of the femur in 34 patients / 中国基层医药

Objective:To investigate the efficacy of proximal femoral intramedullary nail antirotation fixation in the treatment of intertrochanteric fracture of the femur and its effects on Harris hip scores.Methods:Sixty-eight patients with intertrochanteric fracture of the femur who received treatment in Cixi People's Hospital from April 2018 to October 2019 were included in this study. They were randomly assigned to receive dynamic hip screw fixation (control group, n = 34) or proximal femoral intramedullary nail antirotation fixation (observation group, n = 34). Clinical efficacy, Harris score, surgical indicators, and the incidence of complications were compared between the two groups. Results:The response rate was significantly higher in the observation group than in the control group [94.12% (32/34) vs. 76.47% (26/34), χ2 = 5.81, P < 0.05]. The excellent and good rate of hip function as evaluated by Harris hip scores was significantly higher in the observation group than in the control group [91.18% (31/34) vs. 73.53% (25/34), χ2 = 6.05, P < 0.05]. The operative time, blood loss, incision length, and fracture healing time in the observation group were (51.66 ± 10.52) minutes, (120.26 ± 12.29) mL, (8.09 ± 2.62) cm, and (9.86 ± 2.67) weeks respectively, and those in the control group were (78.32 ± 12.23) minutes, (238.45 ± 17.85) mL, (12.95 ± 3.29) cm, and (13.65 ± 3.46) weeks, respectively. There were significant differences in these indices between the two groups ( t = 14.55, 14.03, 14.85, 14.60, all P < 0.05). The incidence of complications was significantly lower in the observation group than in the control group [5.88% (2/34) vs. 23.53% (8/34), χ2 = 6.51, P < 0.05]. Conclusion:Proximal femoral intramedullary nail antirotation fixation is superior to dynamic hip screw fixation in the treatment of intertrochanteric fracture of the femur. The former increases Harris hip score, decreases the incidence of complications, and is of great clinical innovation.

Clinical research on tranexamic acid in reducing perioperative blood loss in geriatric patients with hip fracture / 中华老年医学杂志

Objective:To investigate the efficacy of intravenous infusion of tranexamic acid(TXA)on perioperative blood loss in geriatric patients with hip fracture.Methods:In this retrospective study, 54 out of 95 patients with hip fracture aged from 65 years to 100 years, treated at the Department of Trauma and Osteology, West China Hospital of Sichuan University from June 2020 to June 2021 were finally enrolled.Their clinical data were collected.All patients underwent closed reduction PFNA surgery.They were divided into three groups: (1)Control group(n=18): intravenous infusion of normal saline at 30 min before surgery; (2)Single dose group(n=18): TXA(25 mg/kg)was intravenously injected at 30min before surgery; (3)multiple dose group(n=18): 25 mg/kg of TXA was intravenously injected at 30 min before surgery and 15 mg/kg injected again at 3 h and 6 h after surgery.Total blood loss and the incidence of postoperative deep venous thrombosis among 3 group patients were compared.Results:There were no statistically significant differences in gender, age, preoperative platelets, preoperative activated partial thrombin time and preoperative prothrombin time among control group, single dose group and multiple dose group(all P>0.05). Perioperative blood loss was estimated to be 620(330, 1080)ml, 380(270, 490)ml and 520(190, 750)ml in the control group, single dose group and multiple dose group, respectively, with statistical significance( H=8.666, P<0.05). Total blood loss in single dose group was less than in both control( P<0.05, with statistical significance)and in multiple groups( P>0.05, without statistical significance), and total blood loss in multiple dose group was lower than in control( P>0.05, without statistical significance), and higher than in single dose group( P>0.05, without statistical significance). Color ultrasonography was performed on the 1 st and 7 th day after surgery in 3 groups, and no deep venous thrombosis or pulmonary embolism was found in all groups. Conclusions:Intravenous infusion of TXA at half an hour before surgery can effectively reduce the total peri-operative blood loss without increasing the risk of thrombosis.A multiple preoperative intravenous drip of TXA should be cautious as compared with a single preoperative intravenous drip of TXA.

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.

Effects of modified radical prostatectomy via an extraperitoneal approach on urinary control and sexual function in patients with prostate cancer / 中国基层医药

Objective:To investigate the effects of modified radical prostatectomy via an extraperitoneal approach on urinary control and sexual function in patients with prostate cancer.Methods:Fifty-six patients with stable prostate cancer who received treatment in Deqing People's Hospital between March 2015 and March 2018 were included in this study. They were randomly divided into observation and control groups ( n = 28/group). The observation group was subjected to modified radical prostatectomy via an extraperitoneal approach. The control group underwent standard laparoscopic surgery. Clinical efficacy and the effects of modified radical prostatectomy via an extraperitoneal approach on urinary control and sexual function were compared between the two groups. Results:Amount of blood loss and postoperative drainage were (125.39 ± 11.12) mL and (65.39 ± 10.12) mL in the observation group, and (224.79 ± 14.01) mL and (104.79 ± 15.01) mL in the control group. There were no significant differences in amount of blood loss and postoperative drainage between the two groups ( t = 18.83, 15.67, both P < 0.05). At 1, 3 and 6 months after surgery, the percentage of patients who had urinary control recovery in the observation group was 53.57% (15/28), 78.57% (22/28), 98.21% (27/28), respectively, which were significantly higher than those in the control group [21.43% (6/28), 35.71% (10/28), 67.86% (19/28), χ2 = 4.12, 7.21, 5.01, all P < 0.05]. At 1, 3 and 6 months after surgery, the score of erectile function recovery in the observation group was (15.98 ± 0.28) points, (15.99 ± 0.72) points, and (18.91 ± 0.48) points, which were significantly higher than those in the control group [(17.11 ± 0.34) points, (13.11 ± 0.48) points, (13.41 ± 0.39) points, t = 3.01, 12.89, 15.78, all P < 0.05]. Conclusion:Modified radical prostatectomy via an extraperitoneal approach can improve postoperative urinary control and sexual dysfunction.

Influence of placenta previa type on blood preparation / 中国输血杂志

【Objective】 To explore the corresponding strategies of blood preparation for placenta previa operation in our hospital according to the situation of blood transfusion during and after operation. 【Methods】 Ninety pregnant women with placenta previa (complete, partial or marginal) undergoing the caesarean operation and blood transfusion in our hospital from January 2011 to September 2020 were selected as the research objects. The corresponding data about intraoperative/postoperative blood loss, blood transfusion and blood preparation were collected, analyzed and compared. 【Results】 There was no significant differences in age between complete and marginal placenta previa(P>0.05), but significant differences in intraoperative/postoperative blood loss and the units of blood transfusion (P1 000 mL). The difference between ordering and transfusion units of complete and marginal placenta previa were 0.4 and 0, respectively. When the complete placenta previa was accompanied by placenta increta or placenta percreta, the blood loss was larger (>1 000 mL) and the units of blood transfusion ranged from 4.5 U to 6 U, while the blood loss was generally low (≤1 000 mL) and the units of blood transfusion was concentrated at 3 (2, 4) U without placenta accreta nor implantation.The difference between ordering and transfusion units of complete placenta previa with non-implantation, placenta accreta, placenta increta and placenta percreta were 0.165, 0.33, 0.5 and 1, respectively. 【Conclusion】 For marginal placenta previa, 3U blood is recommended for routine preparation, 3U blood for complete placenta previa with non-implantation or placenta accrete, and 4.5-6U for complete placenta previa with placenta increta or placenta percreta.

Investigation on the incidence and risk factors of fetomaternal hemorrhage syndrome in pregnant women in Changsha / 中国输血杂志

【Objective】 To investigate the incidence and possible risk factors of FMH among pregnant women in Changsha. 【Methods】 A total of pregnant women (6~42 weeks of gestation) who underwent prenatal examinations in our hospital from June 2019 to December 2020 were enrolled as subjects. In this study, the modified Kleihauer-Betke (K-B) test was used for preliminary screening and flow cytometry was applied to confirme initially positive samples to evaluate the incidence of FMH and estimate fetal blood loss. The logistic regression analysis was used to study the risk factors of FMH. 【Results】 The incidence of FMH in pregnant women was 10.45% (183/1 752), the average volume of fetal blood loss was (2.50±3.87)mL, and 0.11% (2/1 752) of the fetal losed blood > 30 mL. Univariate analysis showed that age, twin pregnancy, pregnancy complicated with uterine fibroids, in vitro fertilization, fetal growth restriction, preeclampsia, and number of pregnancies may be risk factors for FMH. Multivariate analysis showed that twin pregnancy (OR 2.274, 95%CI: 1.135-4.458, P<0.05) and preeclampsia (OR 2.341, 95%CI: 1.082-4.837, P<0.05) were independent risk factors for FMH. 【Conclusion】 Maternal age and various physiological and pathological factors during pregnancy may be associated with the risk of FMH, especially twin pregnancy and pre-eclampsia are independent risk factors for FMH.