Objective To assess the impact of tranexamic acid on visible and hidden blood loss after the preliminary unilateral total hip arthtoplasty (THA).Methods The study involved 60 patients who received primary unilateral THA due to femoral neck fracture from March 2010 to September 2011.They were 18 males and 42 females,at 58 to 86 years of age (average 74.5 years).They were divided into Group A (n =20),not given tranexamic acid,Group B (n =20),given tranexamic acid in operation,Group C (n =20),given tranexamic acid at preoperative one hour according to stratified random method.Total red blood cell loss,visible red blood cell loss,and hidden red blood cell loss in each group were calculated.Results Visible red blood cell loss in Groups A,B,and C was (95.4 ± 17.7) ml,(45.5 ± 11.5) rnl,and (45.3 ± 8.4) ml respectively.Moreover,difference of visible red blood cell loss was significant between Groups A and B (P ＜ 0.05),but insignificant between Groups B and C (P ＞ 0.05).Hidden red blood cell loss in Groups A,B,and C was (322.4 ± 57.7) ml,(203.8 ±46.6) ml,and (137.6 ± 34.7) ml respectively,with significant difference between Groups A and B (P＜0.05) and between Groups B and C (P＜0.05).Conclusions Tranexamic acid reduces the visible and hidden blood loss in primary unilateral THA significantly.While tranexamic acid administered at preoperative one hour gains advantage of less hidden blood loss over the intraoperative administration.

Adrenal Gland Diseases ; diagnosis ; pathology ; therapy ; Female ; Hemorrhage ; diagnosis ; pathology ; therapy ; Humans ; Infant, Newborn ; Magnetic Resonance Imaging ; Male ; Prognosis ; Tomography, X-Ray Computed

Objective To compare the curative effects between domestic and imported monosialotetrahexosyl ganglioside sodium (GM 1) on neonatal hypoxic ischemic encephalopathy(HIE).Methods 104 neonates with HIE were randomly divided into Shenjie group(domestic GM 1,53 cases )and Pharma group (imported GM 1,51 cases).At the basic of conventional therapy,the two groups received domestic or imported GM 1 20 mg /d intravenous infusion for 7～ 28 d,rspectively.The curative effects and adverse reaction were observed.Results The total effective rates in Shenjie group and Pharma group were 98.11% and 88.24%,respectively.There was no significant difference between the two groups.While,there was no obvious adverse reaction in the two groups.Conclusion Both the domestic and imported GM 1 have the same good curative effects and safety on neonatal HIE.

Objective To compare the clinical outcomes and safety of synchronous vs staged bilateral total hip arthroplasty (THA).Methods Fifty-eight cases (116 hip joints) undergone bilateral THA from January 2008 to January 2010 were reviewed retrospectively.Follow-up period was postoperative 2 years,including synchronous bilateral THA in 29 cases (synchronous group) and staged bilateral THA in 29 cases (staged group).The two patient groups were compared in aspects of total operation time,total amount of blood loss,total amount of blood transfusion,duration and cost of hospitalization,postoperative discrepancy in bilateral leg length,preoperative and postoperative function score and perioperative complications.Results During the follow-up,no complications of incision infection,deep vein thrombosis and prothesis dislocation or loosening were noted.And postoperative delirium symptoms occurred only in four cases (three in synchronous group and one in staged group).There were no statistical differences between synchronous group and staged group in aspects of total operating time [(117.9 ± 23.8) minutes vs (124.1 ± 18.8) minutes],total amount of blood loss [338.1 ml (180-720 ml) vs 303.9 ml (200-600 rnl)],total amount of blood transfusion [227.6 ml (0-800 ml) vs 189.7 ml (0-400 ml)],postoperative function score.However,differences of the following data were considered statistical significance between synchronous group and staged group:expense of hospitalization [9.5 ten thousand yuan (7.0-11.3 ten thousand yuan) vs 10.5 ten thousand yuan (8.8-11.0 ten thousand yuan)],length of hospitalization [(12.1 ±3.2) days vs (20.1 ±3.5) days],postoperative discrepancy in bilateral leg length [(0.11 ± 0.22) cm vs (0.42 ± 0.44) cm].Conclusions Synchronous bilateral THA is safe and feasible as far as the patients' physical condition is allowed,perioperative management is rational and physicians have mature surgical techniques.Moreover,it gains advantage over staged bilateral THA considering cost of hospitalization,length of hospitalization and postoperative discrepancy in bilateral leg.

Objective To outline the classification of spinal tuberculosis based on MRI findings (Southern Medical University classification,SMU classification) and explore its use in the diagnosis,surgical protocols.Methods The MRI data from 230 cases with spinal tuberculosis were analyzed retrospectively.Our classification system was based on clinical and radiological criteria (abscess formation,disc degeneration,vertebral collapse,kyphosis,sagittal index,instability and neurological problems).The surgical strategies were made according with this classification.Results Two hundred and thirty cases with spinal tuberculosis were classified into the 5 types.There were signal change type (type Ⅰ) in 28 cases,abscess formation type (type Ⅱ) in 39,vertebral collapse type (type Ⅲ) in 78,canal compression type (type Ⅳ) in 46 and kyphosis type (type Ⅴ) in 39 respectively.In type I lesion,25 patients had been followed up.Twenty patients were treated medically.Recurrence of tuberculosis was found in 2 cases.Surgical meticulous debridements were done in 5 cases without recurrence.In type Ⅱa lesion,6 patients were treated medically.The other 6 patients underwent surgical meticulous debridement with recurrence occurred in one patient.There was no difference between medical and surgical treatment regarding outcomes in patients with type Ⅰ and Ⅱa lesion.In type Ⅱb-Ⅴ,surgical treatments were carried out according to the pathological changes.There was no difference between medical and surgical treatment regarding outcomes in the patients with type Ⅱb-Ⅴ.Conclusion The SMU classification helps in differentiating the various manifestations of spinal tuberculosis and appears to correlate with the surgical treatment of spinal tuberculosis.We believe that this new classification system can be used as a practical guide in the treatment of spinal tuberculosis.

This paper firstly introduced concept,advantages,disadvantages,and application prospect of free indexing. Then the theoretical feasibility of applying free indexing in the images of TCM ancient literatures was discussed with the combination of their characteristics.In the end,the article made examples to illustrate the application of free indexing in related subjects.

OBJECTIVE To analyze the major reasons of wound infection after external fixator application and then introduce management measures to prevent following wound infections. METHODS Totally 542 patients adopting external fixators between May 2005 and May 2007 were retrospectively reviewed. All the external fixator-related infections were inspected and the excretions from these infected wounds were collected to perform bacterial culturing. RESULTS The total infection rate of these 542 patients after external fixator application was 2.77%. Among them, six were infected with the bacteria in distraction osteogenesis group and the infection rate was 8.82%; three were infected in bone un-union and bone defect group and the infection rate was 5.36%; whilest the common fracture-fixing group got the lowest infection rate of 0.39%. CONCLUSIONS Wire-crossing positions are the most frequently infected sites after external fixation and the drug-resisted bacteria are the most commonly detected pathogens. Thus, increasing the stability of fixators, enhancing the infection supervision of operation environment, draining the wound thoroughly and using antibiotics rationally are the most effective managing measures to prevent external fixator-related infections in orthopedics.

Objective To investigate the anti-inflammatory activity of the main active ingredients in the dried stem bark of Daphne giraldii Nitsche.Methods Severialchemical compounds like vladinol D, pinoresinol, daphneticin, daphnoretin, daphnetin, giraloid A and giraldoid B were isolated from the stem barks. The CCK-8 experiemnts were analyzed for the cytotoxicity study. The cells were divided into the control group, the model group and the treatment group according to random number table method. The control group and the model group were added with 50μl culture medium. Moreover, treatment group was added with different concentrations (50.00, 25.00, 12.50, 6.25, 3.12μg/ml) of the solutions of giraloid A, giraldoid B and daphneticin. Then, RAW264.7 cells were treated with 50μl LPS (4μg/ml) for 24 h in the model group and treatment group. Griess reagent was used to determine the amount of NO release, and the secretion of TNF-α was detected by ELISA kit.Results Cytotoxicity test indicated that giraldoid A (50.00μg/ml), giraldoid B (50.00μg/ml) and daphneticin (50.00μg/ml) showed noobvious cytotoxicity. Giraldoid B (12.50, 25.00, 50.00μg/ml) could inhibit the production of NO (271.86% ± 20.92%, 256.48% ± 20.92%, 199.31% ± 15.16%vs.358.62% ± 28.64%) and  TNF-α (647.87% ±115.79%, 618.42% ± 87.52%, 588.33% ± 87.94%vs. 1035.06% ± 58.29%) in RAW264.7 induced by LPS compared with the model group. Giraldoid A (25, 50μg/ml) could inhibit the production of NO (234.99% ± 34.28%, 167.36% ± 25.76% vs.358.62%±28.64%) and TNF-α (691.76% ± 60.37%, 534.01% ± 41.60% vs. 1035.06% ± 58.29%) in RAW264.7 induced by LPS compared with the model group. Daphneticin (12.5, 25, 50μg/ml) could inhibit the production of NO (283.89% ± 36.69%, 243.08% ± 48.19%, 225.92% ± 33.67% vs.358.62% ± 28.64%) and TNF-α (713.77% ± 121.96%, 670.62% ± 18.70% vs. 1035.06% ± 58.29%) in RAW264.7 induced by LPS compared with the model group.Conclusions Giraldoid A, giraldoid B and daphneticin exhi bited anti-inflammatory effect through inhibiting the release of NO and the production of TNF-α in RAW264.7 induced by LPS.

Objective To investigate the clinical features of invasive pneumococcal disease (IPD) and the antimicrobial susceptibility of invasive Streptococcus pneumoniae (Sp). Methods The clinical features of 54 children with IPD and the antimi-crobial susceptibility of 54 invasive Sp isolates were retrospectively analyzed from 2009 to 2012. Results The ratio of boys to girls in IPD was 1.35:1. Most of the children with IPD were within 2 years old. Few of the children had the onset in summer. Most of the children were diagnosed with septicemia, followed by meningitis. All of the children had middle or high fever. Forty-four children had an increased white blood cell count and 42 children had an increased C-reactive protein.β-lactam antibiotics was most frequently used in clinics, followed by vancomycin. Most of invasive Sp were resistant to penicillin. Multiple drug resis-tance was common in invasive Sp. Conclusions The incidence of IPD has seasonal difference. The clinical manifestations of IPD are diverse, with septicemia being the most common. The resistant rate to penicillin is high in invasive Sp.

Objective To evaluate the left atrial function and to explore its determinants in patients with hypertrophic cardiomyopathy by three-dimensional echocardiography (3DE).Methods 46 patients with HCM (obstructive HCM:25 cases,nonobstructive HCM:21 cases) and 46 healthy cases (controls) were enrolled in this study.Time-volume curve of left atrium was acquired by 3DE in all subjects.Left atrial maximal volume (LAVmax),left atrial minimal volume (LAVmin) and left atrial presystolic volume (LAVp) were acquaired.Left atrial volume index (LAVI),left atrial expansion index (LAEI),left atrium emptying fraction (LAEF),left atrium passive emptying fraction (LAPEF) and 1eft atrium active emptying fraction (LAAEF) were calculated.Comparative analysis between two groups was taken .The Spearman correlation analysis and multiple linear regression analysis between left atrial volume index (LAVI) with interventricular septal thickness (IVSd),left ventricular outflow tract peak gradient (LVOT-PG),mitral regurgitation (MI), left ventricular diastolic function (LVDF) were analyzed respectively .Results Compared to the controls LAVmax (45.67 ±11.96)ml,LAVmin (20.48 ±6.80)ml,LAVp (24.48 ±9.31)ml,LAVI 25.63 ±6.52, LAEI (1.32 ±0.49)%,LAEF (55.25 ±8.06)%,LAPEF (35.90 ±7.00)%and LAAEF (30.20 ±10.13)%, the patient with HCM had a significantly larger LAVmax (81.45 ±24.24)ml,LAVmin (44.60 ±18.96)ml, LAVp (61.00 ±21.64) ml and LAVI 45.39 ±14.17,there were significant differences among the groups (t=8.978,8.123,9.227,8.436,all P<0.01),lower LAEI(0.95 ±0.43)%,LAEF (46.15 ±11.12)%, LAPEF (25.64 ±9.09)%,there were significant differences among the groups (t=-3.865,-4.493,-6.504,all P<0.01),and slightly lower LAAEF (28.20 ±9.26)%,there were no significant differences among the groups (t=-0.656,P>0.01).There were significant positive correlation between LAVI and IVSd,LVOT-PG,MI,LVDF respectively (r=0.704,0.517,0.640,0.701,all P<0.01).Multiple linear regression analysis demonstrated that IVSd , LVOT-PG, MI and LVDF were correlated factors of LAVI (absolute standardized coeffients =0.264,0.515,0.614,0.341,all P<0.05).Conclusions 3DE could evaluate the left atrial volume and function in patients with HCM , with increased left atrial volume and decreased reservioer,conduit and booster pump function .Mitral regurgitation,obstruction of left ventricular outflow tract,left ventricular diastolic dysfunction and the thickness of left ventricular wall contributed to left atrial dysfunction at different levels ,among which mitrial regurgitation contributed the most .