A 43-year-old man was diagnosed as massive left occipital lobe hemorrhage with the hematoma expanded into the entire ventricular system. On admission, he was in deep coma with clinical signs of brain herniation and a Glasgow Coma Scale (GCS) score of 4. Vascular malformations were highly suspected since he was young with no history of hypertension. Considering the life-threatening situation, open craniotomy and hematoma evacuation was proposed as the first therapeutic option, but this was refused by his family members for non-medical reasons. In order to save his life, stereotactic aspiration was suggested again and was accepted. UK at an aggressive dosage of 50 000 IU was administered during and after the surgical procedure for 5 days. One month later, this patient gained an excellent recovery with a Glasgow Outcome Scale (GOS) score of 5.

PURPOSE: A pneumatic tourniquet is commonly used in total knee arthroplasty (TKA) to improve surgical field visualisation but may result in quadriceps muscle ischaemia. We performed this study to analyse the effect of the tourniquet on recovery following TKA. MATERIALS AND METHODS: A prospective randomised single-blinded trial was undertaken to examine the effect of the tourniquet on post-operative pain, swelling, blood loss, quadriceps function and outcome following TKA. Twenty patients with osteoarthritis of the knee were randomised to tourniquet or no tourniquet groups. Quadriceps function was assessed using surface electromyography (EMG) during active knee extension. RESULTS: The no tourniquet group had significantly less pain in the early post-operative period compared to the tourniquet group. There was no difference in Oxford knee score, range of motion, or thigh and knee swelling up to 12 months post-operatively. Quadriceps function, measured by surface EMG, was compromised for the first six months post-surgery by tourniquet use. The radiological cement mantle at the bone prosthesis interface at 12-month follow-up was not affected by the absence of a tourniquet. CONCLUSIONS: We believe that it is safe and beneficial for our patients to routinely perform TKA without a tourniquet.
Arthroplasty ; Electromyography ; Follow-Up Studies ; Humans ; Knee ; Osteoarthritis ; Prospective Studies ; Prostheses and Implants ; Quadriceps Muscle ; Range of Motion, Articular ; Thigh ; Tourniquets

OBJECTIVE: To discuss the types of control groups in randomized controlled trials (RCTs) of Chinese herbal medicine (CHM), and to provide suggestions for improving the design of control group in future clinical studies in this therapeutic area. METHODS: A search of the Cochrane Library was conducted in July 2005 to identify RCTs of CHM, and 66 RCTs with CHM for type 2 diabetes mellitus were obtained as the basis for further analysis. RESULTS: Of 66 RCTs with CHM for type 2 diabetes mellitus, 61 (92.4%) trials had both a treatment group and a control group. Twenty-seven (40.9%) RCTs compared CHM plus conventional drug vs conventional drug, 24 (36.4%) compared CHM vs conventional drug, 5 (7.6%) compared CHM vs placebo, 3 (4.5%) compared CHM plus conventional drug vs conventional drug plus placebo, 3 (4.5%) compared CHM plus conventional drug vs other CHM, 1 (1.5%) compared CHM vs no treatment, 1 (1.5%) compared CHM plus placebo vs conventional drug plus placebo, 1 (1.5%) compared CHM vs CHM plus conventional drug vs conventional drug vs placebo, and 1 (1.5%) compared CHM vs conventional drug vs CHM plus conventional drug. CONCLUSION: A variety of control groups were used in RCTs of CHM for type 2 diabetes mellitus, including placebo, active, and no treatment control groups. Justification for selecting particular types of control groups were not provided in the trials reviewed in this study. Different control groups may be appropriate according to the study objectives, and several factors should be considered prior to selecting control groups in future RCTs of CHM. RECOMMENDATIONS: (1) Investigators of CHM who design clinical trials should understand the rationale for selecting different types of control groups; (2) Control groups for RCTs should be selected according to study objectives; (3) Active control groups should select interventions for comparisons that have the strongest evidence of efficacy and prescribe them as recommended; (4) Placebo control groups should select a placebo that mimics the physical characteristics of test intervention as closely as possible and is completely inert; (5) No treatment control groups should only be used when withholding treatment is ethical and objectives outcomes will not be subject to bias due to absent blinding; (6) Crossover control groups may be appropriate in chronic and stable conditions.

Objective To assess the change of left ventricular wall motion at ventricular pacing(VP)by using global circumferential strain (GCS) and segmental circumferential strain of speckle tracking imaging(STI). Methods Seven adult pigs were sedated,followed by median sternotomy and opening of the pericardium. Temporary pacing leads were placed on the right ventricular (RV) epicardium and LV epicardium for RV or LV pacing. A LV short axis view at the mid-level LV was acquired at sinus and VP rhythm. Analysis of circumferential strain by STI was performed offline. The onset of QRS wave was used to characterize the beginning of the cardiac cycle, and the ratio of beginning systolic time, end systolic time and total systolic time to cardiac cycle dyssynchrony was analyzed at sinus and VP rhythm. Results Compared with sinus rhythm,in VP rhythm all of the ratio of the beginning systolic time,end systolic time and total systolic time to cardiac cycle were increased (all P ＜0.05), and the construction of six segments were dyssynchrony,even segmental paradoxical movement. At VP ≥130 beats/min,both LV global and LV segments sometimes showed irregular motion while the EKG remained normal, which included: ( 1 ) multiple construction and diastole in one heart cycle; (2) A large variability of construction amplitude in several consecutive cardiac cycles. Conclusions VP can lead to several kinds of disturbance of left ventricular wall motion, including delay and lengthening of LV systole, dyssynchrony, and irregularity of systole and diastole.

The terms biliary sludge and cholesterol microlithiasis(hereafter referred to as microlithiasis)were originated from different diagnostic techniques and may represent different stages of cholesterol gall-stone disease.Although the pathogenesis of biliary sludge and microlithiasis may be similar,micro-lithiasis could be preceded by biliary sludge,followed by persistent precipitation and aggregation of solid cholesterol crystals,and eventually,gallstone formation.Many clinical conditions are clearly associated with the formation of biliary sludge and microlithiasis,including total parenteral nutrition,rapid weight loss,pregnancy,organ transplantation,administration of certain medications,and a variety of acute and chronic illnesses.Numerous studies have demonstrated complete resolution of biliary sludge in approximately 40％of patients,a cyclic pattern of disappearing and reappearing in about 40％,and progression to gallstones in nearly 20％.Although only a minority of patients with ultrasonographic demonstration of biliary sludge develop gallstones,it is still a matter of controversy whether micro-lithiasis could eventually evolve to cholesterol gallstones.Biliary sludge and microlithiasis are asymp-tomatic in the vast majority of patients;however,they can cause biliary colic,acute cholecystitis,and acute pancreatitis.Biliary sludge and microlithiasis are most often diagnosed ultrasonographically and bile microscopy is considered the gold standard for their diagnosis.Specific measures to prevent the development of biliary sludge are not practical or cost-effective in the general population.Laparoscopic cholecystectomy offers the most definitive therapy on biliary sludge.Endoscopic sphincterotomy or surgical intervention is effective for microlithiasis-induced pancreatitis.Ursodeoxycholic acid can effectively prevent the recurrence of solid cholesterol crystals and significantly reduce the risk of recurrent pancreatitis.

OBJECTIVE: To discuss the quality of reporting in randomized controlled trials (RCTs) of Chinese herbal medicine (CHM), and to provide suggestions for improving the reporting of future clinical studies in this therapeutic area. METHODS: A search of the Cochrane Library was conducted to identify RCTs of CHM. A revised CONSORT checklist designed for CHM clinical studies was implemented. The revised CONSORT checklist contained 63 items, including the following new items added specifically for CHM: (1) "syndrome of disease" based on Chinese medicine theories; (2) rationale of CHM formula; (3) formula composition; (4) preparation form of CHM; (5) quality control of CHM. RESULTS: The overall reporting quality of the RCTs as assessed with the revised CONSORT checklist varied between 19% and 44%, with a median score of 32% (standard deviation 8%). CONCLUSION: The overall quality of reporting of RCTs of CHM evaluated with a revised CONSORT checklist was poor, reflecting the need for improvements in reporting future clinical trials in this area. RECOMMENDATIONS: To improve the quality of reporting of RCTs of CHM, we recommend adopting a revised CONSORT checklist that includes items specific to CHM. We also recommend that editors of CHM journals require authors to use a structured approach to presenting their trials as a condition of publication.

This current study's goal is to summarize the literature regarding Antenatal Depression (AD) in the East Asian countries of Taiwan, China (including Hong Kong and Macau), Japan, and Korea. The main search utilized a Pub med Chinese Electronic Periodical Service (CEPS) literature review using keywords 'AD', and 'Prenatal Depression' with searches for 'Japan', 'Korea', 'Taiwan', 'Hong Kong' and Macau'. The rates of AD in East Asia appear to be relatively close to those in the Western literature, although certain studies showed slightly decreased rates. Many of the risk factors for AD were the same in the Eastern and Western literature. These risk factors included demographic factors such as younger age, smoking, low education and income, and unemployment. Other risk factors were physical symptoms such as menstrual pains and nausea. Finally, psychological factors such as a poor response to the pregnancy, poor spousal support, and poor family support were associated with AD. With regard to treatment, there were no studies examining the administration of psychotropic medications for AD. The literature from East Asia both confirmed many Western findings and made unique contributions to the literature on AD. The treatment of AD in East Asia appears to be an entity which, despite its morbidity, has not been adequately studied.
Asian Continental Ancestry Group ; China ; Demography ; Depression ; Dysmenorrhea ; Electronics ; Electrons ; Far East ; Female ; Hong Kong ; Humans ; Japan ; Korea ; Nausea ; Pregnancy ; Risk Factors ; Smoke ; Smoking ; Taiwan ; Unemployment ; Women's Health

Receptor tyrosine kinase-like orphan receptor 1 (ROR1) is a member of the ROR family consisting of ROR1 and ROR2. RORs contain two distinct extracellular cysteine-rich domains and one transmembrane domain. Within the intracellular portion, ROR1 possesses a tyrosine kinase domain, two serine/threonine-rich domains and a proline-rich domain. RORs have been studied in the context of embryonic patterning and neurogenesis through a variety of homologs. These physiologic functions are dichotomous based on the requirement of the kinase domain. A growing literature has established ROR1 as a marker for cancer, such as in CLL and other blood malignancies. In addition, ROR1 is critically involved in progression of a number of blood and solid malignancies. ROR1 has been shown to inhibit apoptosis, potentiate EGFR signaling, and induce epithelial-mesenchymal transition (EMT). Importantly, ROR1 is only detectable in embryonic tissue and generally absent in adult tissue, making the protein an ideal drug target for cancer therapy.
Animals ; Antineoplastic Agents ; pharmacology ; Embryonic Development ; Humans ; Immunotherapy ; Molecular Targeted Therapy ; Neoplasms ; drug therapy ; enzymology ; Receptor Tyrosine Kinase-like Orphan Receptors ; physiology

A perioperative blood management program is one of a number of important elements for successful patient care in total knee arthroplasty (TKA) and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risk of blood transfusion whilst at the same time maximizing hemoglobin (Hb) in the postoperative period, leading to a positive effect on outcome and cost. An individualized strategy based on patient specific risk factors, anticipated blood loss and comorbidities are useful in achieving this aim. Multiple blood conservation strategies are available in the preoperative, intraoperative and postoperative periods and can be employed in various combinations. Recent literature has highlighted the importance of preoperative Hb optimization, minimizing blood loss and evidence-based transfusion guidelines. Given TKA is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Blood Transfusion ; Bloodless Medical and Surgical Procedures ; Comorbidity ; Humans ; Knee ; Patient Care ; Postoperative Period ; Risk Factors ; Surgeons