Cardiopulmonary bypass(CPB) is associated with thrombocytopenia and platelet dysfunction. The primary cause of acquired platelet defect is thought to be activation and release of alpha granules during CPB. Before CPB, platelet-rich plasma (PRP) was prepared by obtaining the required amount of patient’s whole blood by autologous plateletpheresis. PRP could be reinfused after operation in order to protect the function and quantities of the platelets. On the other hand, PRP could be made into autologous platelet gel (APG). APG contains supraphysiologic amounts of growth factors, and has adequate tensile strength and adhesive ability. Therefore, it can be used for hemostasis in operation, sealing wound and enhancing incision or dehiscent sternal wounds healing.
Objective To evaluate the clinical effectiveness and safety of tranexamic acid (TXA) in arthroscopic rotator cuff repair by meta-analysis. Methods Randomized controlled trials evaluating the clinical effectiveness and safety of TXA use in the perioperative period of arthroscopic rotator cuff repair were identified from the Cochrane Library, PubMed, Embase, VIP Chinese Science and Technology Periodical Database, Chinese National Knowledge Infrastructure, and Wanfang database, with a search time span from the inception of the database to August 2024. Meta-analysis was conducted using RevMan 5.3 software, and mean difference (MD) and risk difference (RD) were used as measures of effect size. Results A total of 7 randomized controlled trials were included. Meta-analysis demonstrated significant differences in good visual clarity [MD=9.10, 95% confidence interval (CI) (4.05, 14.15), P=0.0004] and operative time [MD=−12.07 min, 95%CI (−17.21, −6.93) min, P<0.00001]. There was no significant difference in mean arterial pressure [MD=−1.08 mm Hg (1 mm Hg=0.133 kPa), 95%CI (−3.13, 0.98) mm Hg, P=0.30] or adverse event rate [RD=0.02, 95%CI (−0.01, 0.06), P=0.22] between the two groups. Conclusion TXA is effective and safe in enhancing visual clarity and significantly reducing operative time in arthroscopic rotator cuff repair, without increasing the incidence of adverse events.
Objective To evaluate the effectiveness and safety of intraoperative tranexamic acid use in total shoulder arthroplasty. Methods By searching Cochrane Library, PubMed, Embase, Chongqing VIP, Chinese National Knowledge Infrastructure, Wanfang Database from the establishment of the database to September 2021, randomized controlled trials of intraoperative tranexamic acid use in total shoulder arthroplasty were collected. Outcome indicators were total blood loss, postoperative drainage, hemoglobin reduction, length of operation, length of hospital stay, and formation of hematoma. RevMan 5.3 software was used for meta-analysis. Results Meta analysis results showed that the use of tranexamic acid can reduce total blood loss [weighted mean difference = −246.55 mL, 95% confidence interval (−335.36, −157.75) mL, P<0.000 01], reduce postoperative drainage [weighted mean difference = −134.05 mL, 95% confidence interval (−161.72, −106.38) mL, P<0.000 01], reduce hemoglobin reduction [weighted mean difference = −0.64 g/dL, 95% confidence interval (−0.91, −0.36) g/dL, P< 0.000 01], reduce hematoma formation [risk ratio=0.41, 95% confidence interval (0.22, 0.77), P=0.005]. There was no statistically significant difference in the length of operation and length of hospitalization between patients who used tranexamic acid and those who did not use tranexamic acid (P>0.05). Conclusions Tranexamic acid is effective and safe for patients undergoing total shoulder arthroplasty. It can reduce perioperative bleeding and hematoma formation without increasing the length of surgery and hospitalization.
Objective To investigate the improved reduction technique for depression fractures of the lateral tibial plateau and its effectiveness. Methods Between January 2008 and December 2010, 48 patients (48 knees) with depression fractures of the lateral tibial plateau (Schatzker II or III fractures) were treated. There were 32 males and 16 females with an average age of 45.8 years (range, 16-79 years). All fractures were fresh closed fractures, which were caused by traffic accident in 27 cases, by falling from height in 5 cases, by crushing in 8 cases, and by sustained falls in 8 cases. According to Schatzker classification, 29 cases were classified as type II and 19 cases as type III. The lateral cortex was cut off to expose the depression and compacted cancellous bone was elevated to reset the articular surface. After reduction, autologous iliac bone graft and locking plate internal fixation were used. Results Healing of incision by first intention was achieved in all patients, and no complication occurred. All patients were followed up 1.7 years on average (range, 1-3 years). At last follow-up, the knee extension was ( — 0.5 ± 0.3)°, and the knee flexion was (136.9 ± 8.8)°. X-ray films showed that the fracture healing time was 52 weeks and no breakage of internal fixation occurred. According to Rasmussen clinical score, the results were excellent in 35 cases, good in 10 cases, and fair in 3 cases. According to Rasmussen radiographical score, the results were excellent in 41 cases, good in 7 cases; there were 41 excellent scores and 7 good scores of articular reduction; all gained good recovery of coronal and sagittal alignment and condylar width. The articular surface collapse was (1.0 ± 0.7) mm at immediate postoperatively and (1.2 ± 0.7) mm at last follow-up, showing no significant difference (t= — 1.42, P=0.20), but significant differences were found when compared with that at preoperation [(12.2 ± 8.0) mm, P lt; 0.05]. Conclusion This improved technique can provide a satisfactory effectiveness of fracture reduction and can avoid loss of reduction. The short-term effectiveness is good, but futher follow-up is necessary to determine the long-term results.
Objective To compare the efficacy and safety of aspirin and rivaroxaban in the prevention of venous thromboembolism (VTE) after total knee arthroplasty (TKA). Methods Eight databases were searched, including Cochrane Library, Embase, Web of Science, PubMed, SinoMed, Wanfang, Chongqing VIP, and China National Knowledge Infrastructure. The search period was from the establishment of databases to June 2023. All randomized controlled trials of aspirin and rivaroxaban for the prevention of VTE after TKA were collected, and meta-analysis was conducted using RevMan 5.3 software. Results A total of 7 articles were included, with a publication period from 2014 to 2022, including a total of 714 patients, including 356 in the aspirin group and 358 in the rivaroxaban group. The meta-analysis results showed that the incidence of deep venous thrombosis in the lower limbs of the aspirin group was higher than that of the rivasarb group [relative risk (RR)=1.53, 95% confidence interval (CI) (1.09, 2.16), P=0.01], and the incidence of bleeding complications was lower than that of the rivaroxaban group [RR=0.66, 95%CI (0.52, 0.82), P=0.0003]. There was no statistically significant difference in the incidence of wound complications between the two groups (P>0.05). Conclusion The efficacy of rivaroxaban in preventing VTE after TKA is better than that of aspirin, but there is an increased risk of bleeding complications.
目的 探讨结核病在18氟-脱氧葡萄糖（18F-FDG）正电子发射断层扫描术（PET）中的影像学表现，提高对PET/CT在肺部包块诊断作用的认识，减少误诊。 方法 回顾分析2010年3月收治的1例肺结核合并纵隔淋巴结结核病患者的误诊及诊断治疗经过，分析误诊原因并总结诊治经验，结合文献复习肺部包块在PET/CT中的表现及临床特点。 结果 患者为肺部包块伴纵隔淋巴结包块，胸部CT提示肺癌伴纵隔淋巴结转移，PET/CT也考虑左肺下叶肺癌伴淋巴结转移。最后经纵隔镜淋巴结活检确诊结核，并抗结核治疗好转。 结论 结核等感染性疾病常可导致18F-FDG的摄取增加而造成PET/CT阳性结果，因此在18F-FDG PET/CT呈现阳性结果时须注意鉴别病变良恶性，其中高标准摄入值包块尤其需要注意与结核病相鉴别。
ObjectiveTo isolate and culture cartilage derived stem cells from different subtypes of cartilages, and to identify their characteristics. MethodsCartilage derived stem cells were isolated from different subtypes of cartilages (auricle cartilage, articular cartilage, and intervertebral cartilage) by using adhesive method of fibronectin. The expressions of positive surface markers (CD29 and CD90) and negative surface markers (CD34 and CD45) in cartilage derived stem cells were detected via flow cytometry. The single cell colony-forming efficiency of cartilage derived stem cells was determined by clonal formation unit test; the multipotent differentiation capacity was identified by chondrogensis, osteogenesis, and adipogenesis induction. RT-PCR was used to test the expression of osteogenic, chondrogenic, and adipogenic genes; and bone marrow mesenchymal stem cells (BMSCs) served as control. ResultsThree cell populations were successfully isolated from different subtypes of cartilages, which could express CD29 and CD 90 highly, but did not express CD34 and CD45. After 2 weeks of culture, single cartilage derived stem cell could form single cell colony. In addition, cartilage derived stem cells had high chondrogenesis, osteogenesis, and adipogenesis potentials. After osteogenic induction, the expressions of collagen type Ⅰ and collagen type X in articular and intervertebral cartilage stem cells were significantly higher than those in BMSCs (P<0.05), while there was no significant difference between auricular cartilage stem cells and BMSCs (P>0.05). The expressions of Aggrecan and collagen type Ⅱ in cartilage derived stem cells after chondrogenic induction were significantly higher than those in BMSCs (P<0.05). While the ability of adipogenic differentiation was lower than that in BMSCs, but no significant difference was found (P>0.05). ConclusionCartilage derived stem cells in different subtypes of cartilages possess typical characteristics of stem cells.