Objective To observe the clinical application of acute hypervolemic hemodilution (AHH) on patients undergoing surgical resection meningioma and the effects on the reduction of heterologous blood transfusion. Methods 40 scheduled mengingioma surgical patients were randomly divided into group I (AHH, n =20) and group II (control, n =20). All patients had same general anesthetic techniques. Amounts of heterologous blood transfusion and changes of postoperative hemoglobin in two group's were recorded and compared. Results BZ In AHH group 15 patients had no heterologous blood transfusion, 5 patients had 200～400 ml heterologous blood transfused. In control group all patients had 400～800ml heterologous blood transfused. Conclusion Acute hypervolemic hemodilution can significantly reduce the volumes of heterologous blood transfusion in mengingioma surgical patients.

Objective To systematically evaluate the efficacy and safety of intracoronary abciximab administration as compared to intravenous in percutaneous coronary intervention (PCI) .Methods A search was conducted in PubMed ,EMBASE ,OVID ,CBM , CNKI and VIP for the randomized controlled trials (RCTs)of intracoronary abciximab administration versus intravenous in PCI , from the date of their establishment to September 30 ,2013 ,and the domestic relevant papers published in recent 1 year were also searched manually ,the bibliographies of the included studies were searched too .According to the criteria of the cochrane Hand-book ,two reviewers evaluated the quality of the included RCTs and extracted data independently ,and then the extracted data were analyzed by using RevMan 5 .1 software .Results 8 RCTs involving 10 articles with 4 150 patients who treated with PCI were in-cluded .The results of meta-analysis showed that :(1) Compared intravenous administration and intracoronary abciximab administra-tion ,there were no significant differences in the two groups for the major adverse cardiovascular event (MACE) and the mortality (OR=0 .78 ,95% CI 0 .54-1 .14 ,P=0 .20) ,(OR=0 .56 ,95% CI 0 .24-1 .30 ,P=0 .18) .(2)Compared with intravenous adminis-tration ,intracoronary abciximab administration were not associated with any excess of major bleeding complications :(OR=1 .26 , 95% CI 0 .78-2 .02 ,P=0 .35) .Conclusion Compared with standard abciximab regimen of intravenous bolus ,intracoronary admin-istration had equivalent effects in clinical outcomes in patients undergoing PCI ,and did not increase the incidence of bleeding events .

Objective To evaluate the effect of extracorporeal membrane oxygenation(ECMO) for critical acute respiratory distress syndrome(ARDS).Methods Twenty-two patients with critical ARDS were treated with ECMO after failure of conventional ventilation therapy.The PaO_2,PaCO_2,DO_2,VO_2 and hemodynamic parameters were retrospectively analysed.Result PaO_2,DO_2,VO_2 was improved significantly after ECMO.Sixteen patients survived.Conclusion Whenever other treatments fail to improve PaO_2 on critical ARDS patients,ECMO should be considered.

Objective To evaluate the efficacy and safety in the treatment of acetabular fractures via anterior approaches,including ilioinguinal,stoppa,pararectus approach.Methods Systematic literature retrieval was carried out to obtain two-arm and one-arm researches on the treatment of acetabular fractures via any one of the three approaches before May 2017,from pubmed,embase,cochrane library Databases.Data extraction and quality evaluation of studies were performed by 3 investigators independently.A meta-analysis was performed by RevMan 5.3 and Meta-Analyst beta 3.13.Results Totally 22 low to moderate quality studies,including 7 two-arm and 15 one-arm were included.There were 980 patients,including 581 in ilioinguinal approach group,264 in stoppa approach group and 135 in pararectus approach group.Meta-analysis showed the rate of anatomic reduction in stoppa approach was higher than that in ilioinguinal approach (OR=0.58,95％CI:0.36-0.94,P=0.03),which in pararectus approach was higher than that in ilioinguinal approach (0R=2.95,95％CI:1.22-7.10,P=0.02).Compared to the ilioinguinal approach,the operation time in the Stoppa approach was shorter (MD=48.01,95％CI:17.08-78.95,P=0.002),there was no statistically significant difference between pararectus approach and ilioinguinal approach.In addition,there were no statistically significant differences among three approaches in intra-operative blood loss,postoperative functional outcomes and complications.Conclusion The available limited evidence suggests that the rate of anatomical reduction in stoppa and pararectus approach may be higher than ilioinguinal approach.Compared to the ilioinguinal approach,the operation time in the stoppa approach may be shorter.In this field,further rigorous design,baseline parallel,direct comparison controlled studies on this topic are still needed.

OBJECTIVETo explore the effect of ulinastatin in hepatoprotection following extracorporeal membrane oxygenation (ECMO).

METHODSForty patients with ECMO were randomized into two groups to receive ulinastatin treatment or not. Venous blood samples were collected to test ALT and AST levels following ECMO treatment for 12, 24 and 48 h.

RESULTSThe two groups showed no significant difference in liver function indices before ECMO treatment. In both groups, the liver function worsened significantly after a 12-h ECMO treatment, but improved gradually after 24 h. The liver function damages were obviously lessened in ulinastatin group compared to those in patients without ulinastatin treatment (P<0.05). ECMO treatment significantly improved the liver function of the patients.

CONCLUSIONECMO can significantly improve the liver function. The liver function damage reaches the peak level after a 12-h ECMO treatment, and ulinastatin can protect the liver function in patients undergoing ECMO.

Adult ; Extracorporeal Membrane Oxygenation ; adverse effects ; methods ; Glycoproteins ; therapeutic use ; Humans ; Liver ; drug effects ; physiopathology ; Liver Function Tests ; Middle Aged ; Young Adult

Objective To evaluate the clinical outcomes of ilioinguinal approach with short infrapectineal buttress plate fixing posterior column for patients with complex acetabular fractures. Methods Data of 29 consecutive patients (male 22, fe?male 7, age range 25-72 years, average age 53 ± 6.3 years) with complex acetabular who had operated by single ilioinguinal ap?proach with infrapectineal buttress plate from September 2008 to August 2012 were retrospectively analyzed. According to Letour?nel?Judet classifications, there were 4 cases of anterior column and posterior hemi?transverse, 11 cases of associated both?column, 4 of T?shaped and 6 with seagull sign. The acetabular fractures model was printed preoperatively by 3D printing technique for sur?gical simulation, open reduction and internal fixation through single ilioinguinal approach with a short infrapectineal plate fixing posterior column, particularly an ox horn shape K?wire sleeve was developed for drilling and screw insertion using flexible screw?driver. Clinical, radiographic, and functional outcomes assessed by the modified Merle d’Aubigné score were collected. Results Two patients were lost to follow?up, including one patient who died at 15 days postoperative because of pulmonary embolism, and the other one who had moved abroad at 12 months postoperative. The remaining 27 (93%) had a mean follow?up of 40 months (range, 24-75 months). The operating time was 180±35.5 min;the time for the fracture union was 3.5±0.9 month;blood loss during the operating was 500±43.9 ml;no case had fracture re?displacement. At the latest follow?up, radiographic grades were excellent in 17, good in 8, poor in 4, including one poor patient who had a total hip arthroplasty (3%) at 35 months after the internal fixation. The average modified Merle d’Aubigné score was 16 (range, 10-18), and categorized as excellent in 12, good in 8, fair in 5, and poor in 2. Three patients had developed deep venous thrombosis of the lower extremities, and one of them died of pulmonary embo?lism 15 days after operation; two cases of deep venous thrombosis of the lower extremity were found 3-4 days after operation. Thrombosis disappeared 6 months after anticoagulant therapy by warfarin. One case who had superficial wound infection after oper?ation was treated by anti?infection and VSD negative pressure, and incision was healed after one month. One case with poor quality of fracture reduction and seagull sign was treated with total hip arthroplasty after 35 months because of traumatic arthritis. The to?tal complication rate was 24%(7/29). Conclusion In the patient with complex acetabular fractures combining posterior column medial displacement, single Ilioinguinal approach with infrapectineal buttress plates could achieve a stable concentric hip joint, and immediate postoperative ambulation can result in reasonable clinical, radiographic, and functional outcomes.

Objective To investigate the relationship between the incidence of deep vein thrombosis (DVT) during hospitalization and the energy of injury in tibial plateau fractures (TPFs).Methods 140 patients were enrolled in the study between September,2014,and October,2017 in Honghui Hospital,Xi'an Jiaotong University.According to the Schatzker classification,the low-energy group (Schatzker Ⅰ-Ⅲ) X-ray showed a simple or lateral fracture or compression fracture of the lateral plateau (n =63);the high-energy group (Schatzker Ⅳ-Ⅵ) X-ray showed the medial tibia or double of the tibial plateau (n =77).Duplex Ultrasonography was performed in lower extremities before and after surgical intervention for DVT evaluation and record the incidence of DVT,the days during hospitalization,the blood loss during surgery and the level of D-Dimer.All patients received mechanical and chemical thromboprophylaxis.The patient was followed up for one month after surgery,and the lower extremity ultrasound was reviewed and recorded.The measurement data were expressed as ((x) ± s),and the categorical variables were expressed in composition ratio.The measurement data were all in accordance with the normal distribution and the variance was uniform.The t-test was used,and the Chi-square test was used for comparison between groups.Results The incidence of thrombosis of tibial plateau fracture in TPFs was 36.43％ and 46.43％ pre-operation and post-operation respectively.The thrombosis incidence was 31.75 ％ (20/63) in the low-energy group and 40.26％ (31/77) in the high-energy group pre-operation.The thrombosis incidence was 44.44％ (28/63) in the low-energy group and 48.05％ (37/77) in the high-energy group post-operation.Statistical analysis showed no significant difference between the two groups pre-operation (P =0.298) and post-operation(P =0.785).The days during hospitalization [(11.94 ± 4.18) d,(9.56 ± 2.54) d],the blood loss during surgery [(208.96 ±224.43) ml,(129.68 ± 142.14) ml] and the level of D-Dimer [(2.39 ± 3.38) mg/L,(1.21 ± 2.32) mg/L] at pre-operation showed differences in the high energy group and the low energy group,respectively.Conclusions The incidence of DVT in TPFs is high during the hospital,but most of DVT is concentrated in the distal to the knee.Although the incidence of high energy injury and low energy injury DVT is not significantly different in TPFs,we should also be alert to the occurrence of DVT.

Objective To investigate the factors associated with preoperative deep venous thrombosis (DVT) in female patients with lower extremity fracture in menstrual phase.Methods A retrospective analysis was conducted of the 119 women with lower extremity fracture in childbearing age who had been treated at Traumatic Orthopaedics Center,Red Cross Hospital,Xi'an Jiaotong University Health Science College from October 2016 to October 2017.Of them,41 were in menstral phase,aged from 20 to 50 years (average,37.1 ± 8.9 years),and 78 were not,aged from 19 to 50 years (average,36.9 ± 8.0 years).The 2 groups were compared in terms of DVT incidence,D-dimer level,prothrombin time,partial prothrombin time,thrombin time,fibrinogen level,and preoperative bed time.Results The patients with menstruation had significantly higher incidence of lower extremity DVT (82.9％) and significantly longer preoperative bed time (9.1 ± 3.4 d) than those without menstruation did (14.1％ and 3.8 ± 2.2 d,respectively) (P ＜0.05).There were no significant differences between the 2 groups in the preoperative coagulation indexes:D-dimer,prothrombin time,partial prothrombin time,thrombin time or fibrinogen (P ＞ 0.05).Conclusions The incidence of preoperative DVT may be high the female patients with lower extremity fracture in menstrual phase,chiefly because of long preoperative bed time.Detection of D-dimer level is of limited significance in the screening for thrombosis in menstrual phase.Menstruation may not be a surgical contraindication.

Objective To evaluate the clinical outcomes in patients with both column acetabular fractures involvement posterior wall using lag screw through single ilioinguinal approach.Methods Between August 2008 to August 2014,35 consecutive patients with both columns acetabular fractures and fracture also involved posterior wall and fixed by lag screws were retrospectively analyzed.There were 25 males and 10 females.The average age was 44.4+ 12.5 years (range,18-72 years).According to Letournel classifications,the acetabular fracture involved both columns and posterior wall in all cases,and 2 cases with additional seagull sign.The surgeon reduced posterior wall by pressing the fragment through a small tunnel in the soft tissue leaning against the external cortex of iliac bone and fixed the fragment using lag screws from the anterior side.Clinical and functional outcomes were assessed using the modified Merle d'Aubigné scoring system.Radiographic results were evaluated based on Matta scoring system.Results The patients were follow for an average of 44.7+ 18.9 months (range,24-96 months).The average operative time was 257.7±60.4 min (range,160-490 min).The average blood loss during the operating was 742.9±+614.5 ml (range,300-4 000 ml).Loss of reduction of the posterior wall was not found in any case.At the latest follow-up,radiographic results were excellent in 11,good in 19,and poor in 5.The average modified Merle d'Aubigné score was 16.4 (range,13-18).There were 8 cases of excellent,23 cases of good,and 4 cases of fair.Four patients developed deep venous thrombosis of the lower extremities after 3-4 days of operation.Warfarin was used for anticoagulation therapy and thrombi disappeared 6 months postoperatively.One case had superficial wound infection and was treat with vacuum sealed drainage (VSD) and anti-infection therapy.The incision healed without infection after one month.One case with poor quality of reduction and remaining seagull sign was treated with total hip arthroplasty after 35 months because of severe traumatic arthritis.The total reoperation rate was 5.7％ (2/35).latrogenic sciatic nerve injury as well as heterotopic ossification was not found in any case.Conclusion Satisfactory quality of reduction and good clinical outcomes can be achieved in patients with acetabular fractures involved both columns and posterior wall by single ilioinguinal approach and lag screw fixation for posterior wall.Iatrogenic sciatic nerve injury as well as heterotopic ossification was not found in any case.

Objective To investigate the incidence of and risk factors for deep venous thrombosis (DVT) at the uninjured limb during hospitalization in patients with lower extremity fracture. Methods The clinical data were retrospectively analyzed of the 494 patients who had been hospitalized for lower extremity fracture at Department of Orthopedics, Honghui Hospital from September 1, 2014 to October 1, 2017. They were 228 males and 266 females with an average age of 58.9 ± 18.9 years ( from 16 to 94 years ) . 290 fractures occurred proximally to the knee, 101 fractures around the knee and 103 fractures distally to the knee. They received anticoagulant prophylaxis or treatment during hospitalization. After operation, they were examined with Doppler sonography for bilateral lower limbs to detect occurrence of thrombus. The incidence of DVT at the uninjured limb during hospitalization was recorded and its possible risk factors were analyzed statistically. The possible risk factors ( gender, age, fracture type, body mass index, concomitant internal disease, time from injury to surgery, time from surgery to discharge, American Society of Anesthesiologists rating, operation duration, blood loss, fluid infusion volume and D-dimer level ) were screened by single factor logistic regression analysis and the major independent risk factors were determined by multi-factor logistic re-gression analysis.Results DVT occurred at the injured limb during hospitalization in 237 cases ( 47.97%). Of them, 221 ( 44.74%) had peripheral thrombus, 7 central thrombus ( 1.42%) and 9 mixed thrombus ( 1.82%). DVT occurred at the uninjured limb during hospitalization in 98 cases ( 19.84%). Of them, 90 (18.2%) had peripheral thrombus, one central thrombus (0.2%) and 7 mixed thrombus (1.4%). Of the 98 patients with DVT at the uninjured limb, 74 (75.51%) had DVT at both lower limbs and 24 (24.49%) had DVT only at the uninjured limb. Age and D-dimer level one day after surgery were independent risk factors for DVT at the uninjured limb during hospitalization. Conclusions The incidence of actual DVT at the unin-jured limb in patients with lower extremity fracture cannot be ignored in spite of use of anticoagulants for pro-phylaxis or treatment during hospitalization. We should also be aware that age and D-dimer level one day after surgery are independent risk factors for DVT at the uninjured limb during hospitalization.