BACKGROUND:Tranexamic acid administered either in intra-articular route or in intravenous route can significantly reduce blood loss during total knee arthroplasty. Recent studies are stil controversial in application mode of tranexamic acid in the clinic.
OBJECTIVE:To compare the clinical outcomes of tranexamic acid in intra-articular route and intravenous route during total knee arthroplasty.
METHODS:PubMed, OVID, Web of Science, and EMBASE were searched to identify randomized control ed trials concerning the comparison of tranexamic acid in intra-articular route and intravenous route during total knee arthroplasty published before 1 May 2015. Transfusion rate, hemoglobin decline, drainage volume and thromboembolic complication rate were considered as indexes to evaluate the clinical effect, for meta-analysis.
RESULTS AND CONCLUSION:Six randomized control ed trials involving 847 patients were included. Meta-analysis results showed no significant difference between intra-articular and intravenous administration of tranexamic acid in terms of transfusion rate, hemoglobin decline, drainage volume, total blood loss, and thromboembolic complication rate. Subgroup analysis for dose regimen showed that when occlusion time of drainage tube was<2 hours. Intra-articular route of tranexamic acid showed high drainage volume and hemoglobin decline compared with the intravenous route of tranexamic acid (P<0.01). Results confirmed that during total knee arthroplasty, clinical effects of intra-articular and intravenous routes of tranexamic acid are similar during total knee arthroplasty. Moreover, it is recommended that occlusion of drainage tube can be conducted for 2 hours in intra-articular route of tranexamic acid.

Objective To study the level changes of matrix metalloproteinase-9 (MMP-9)and its clinical significance in patients with progressive ischemic stroke(PIS).Methods 136 cases of acute ischemic stroke including 46 cases of PIS and 90 cases of non-PIS,were studied.56 healthy subjects were selected into control group.MMP-9 level was measured by ELISA at 2,7 and 14 day after admission.The neurologic dysfunction score was observed.Results The MMP-9 level was ( 249.43 ± 63.76)μg/L,( 271.50±72.08 )μg/L,and (183.20 ±66.69)μg/L in PIS group,while it was (158.81±49.18 )μg/L,( 188.67±57.96 )μg/L,and ( 93.86 ±22.16)μg/L in non PIS group and was (88.60±15.93 )μg/L in control group at 2,7 and 14 days of admission.The MMP-9 level of PIS group at 2,7 and 14 day and the level in non PIS group at 2 and 7 day were higher than that of control group(P＜0.01 ).The MMP-9 level of PIS group was higher than that of different phrase of PIS group (P＜0.01 ).Linear X2 showed that the increase of MMP-9 level would increase the risk of ischemic stroke progression( X2=38.96,P＜0.01 ).Conclusion The remarkable increase of MMP-9 in patients with progressive ischemic stroke may be the indepent risk factor of the progression of ischemic stroke.

Objective To evaluate the effect of propofol preconditioning on endoplasmic reticulum stress induced by hypoxia-reoxygenation (H/R) in HEPG2 cells.Methods HEPG2 cells were randomly divided into 4 groups using a random number table:control group (group C),propofol group (group P),H/R group and H/R + propofol preconditioning group (group PP).In group C,the cells were cultured routinely for 42 h.In group H/R,after being cultured routinely for 6 h,the cells were exposed to 1％ O2 + 5％ CO2 + 94％ N2 for 12 h followed by 12 h reoxygenation.In group PP,the cells were cultured for 6 h in the culture medium containing propofol 10 μmol/L (final concentration),and then H/R was induced.The cell viability was detected by MTT assay.The expression of immunoglobulin heavy chain-binding protein (BIP),C/EBP homologous protein (CHOP) and activated caspase-3 was determined by Western blot.The expression of BIP,CHOP and caspase-3 mRNA was determined by RT-PCR.Results Compared with group C,the cell viability was significantly decreased,and the expression of BIP,CHOP and activated caspase-3 protein and mRNA was up-regnlated in H/R and PP groups,and no significant changes were found in the parameters mentioned above in group P.Compared with group H/R,the cell viability was significantly increased,and the expression of BIP,CHOP and activated caspase-3 protein and mRNA was down-regulated in PP group.Conclusion Propofol preconditioning can promote the cell proliferation and attenuate H/R injury to HEPG2 cells through inhibiting endoplasmic reticulum stress.

Purpose To explore the apoptosis mechanism of human ovarian cancer cells SKOV3 processed with ultrasound (US) combined with photodynamic therapy (PDT), with self-contained lactic acid/glycolic acid (PLGA) microbubbles (MBQDs/PLGA) containing quantum dots (QDs) as a photosensitizer. Materials and Methods MBQDs/PLGA was prepared with double emulsion method, and MTT was used to compare the cytotoxic activity difference between QDs and MBQDs/PLGA, to determine the proper treatment condition. SKOV3 cells were treated under selective conditions, cell damage manifestation was observed with HE staining, and double staining flow cytometry was used to detect cell apoptosis. Results When cells were treated with PDT with energy density of 180.0 J/cm2 and US with sound intensity of 0.5 W/cm2 (1.0 MHz, 10 s), cell deformation could be observed under a microscope in both US-PDT-MBQDs/PLGA group and PDT-MBQDs/PLGA group, and cell connections were absent between cells;transmission electron microscope showed dense chromatin gathered along the nuclear membrane, with the formation of apoptotic bodies also be displayed. Maximum apoptosis rate was (22.17±0.38)% Conclusion MBQDs/PLGA-mediated PDT contains proliferation inhibition effect for SKOV3 cells, which can be synergied with low-power ultrasonic irradiation due to sonoporation effect.

Objective To explore the current status of social support and its influence factors among MSM in Chongqing .Meth‐ods The status of social support was measured by Social Support Rating Scale(SSRS) in 803 males who have sex with man (MSM) .Results Eight hundred and three MSM were selected as the subjects ,whose average overall scores of social support were 29 .240 ± 6 .228 .Increasing with the growth of the number of friends in gay circles ,MSM tended to obtain more social supports . SSRS score displayed that MSM with features like same gender sexual orientation ,infecting STDs ,only child and did not have regu‐lar homo sex partners got lower social support(P<0 .05) .Conclusion Their social support system should be improved .Therefore , the quality of life and social support will be improved ,thus to maintain their physical and mental health .

Objective To investigate the diagnostic value of transgastric peritoneal endoscopy in diagnosis of ascites with unknown origin.Methods Endoscopy was introduced into peritoneal cavity through gastric wall in 23 patients with exudative ascites which was able to be diagnosed by routine methods and biopsy was made through endoscopy to get pathological diagnosis.Results Definite diagnosis was made in 22 patient (95.7%),of which 12 (54.6%) were malignant tumors,8 (36.4%) were tuberculosis peritonitis,1 (4.5%) was spontaneous peritonitis associated with liver cirrhosis and 1 (4.5%) was eosinophilic enteritis.Conclusion Natural orifice transluminal endoscopy combined with biopsy is an effective and accurate procedure for diagnosis of ascites of unknown canses.

Objective To investigate the diagnostic value of trans-gastric peritoneoscopy with technique of natural orifice transluminal endoscopic surgery(NOTES)for tuberculosis peritonitis.Methods Clinical data of 20 patients with tuberculosis peritonitis diagnosed by trans-gastric peritoneoscopy via NOTES were retrospectively analyzed.Results All diagnoses were confirmed by biopsy.The findings of peritoneoscopy were defined as miliary type with miliary nodes scattered in ascites and on peritoneum,adhesive type with thickening of peritoneum and adhesion between peritoneum and intestines,cheese-like type with parietal peritoneal ulcer and cheese-like substances,and mixed type with 2 or 3 of above mentioned types.Positive findings in other laboratory examinations were hemoglobin decrease in 10(50％)patients,blood sedimentation rate increase in 16(80％),C reactive protein increase in 13(65％),CA125 increase in 18(90％),and positive tuberculin test in 9(45％).Abnormal findings were detected by chest X-ray in 8(40％)patients,by abdominal ultrasonography examination in 2(10％),by abdominal CT in 7(35％),and by colonoscopy in 1(5％).No abnormal results were found in all patients in anti-tuberculosis antibody test,ascites bacteria culture and gastroscopy.Conclusion Trans-gastric peritoneoscopy via NOTES with biopsy is effective for diagnosis of tuberculosis peritonitis.

Objective To evaluate the effect of propofol on the endoplasmic reticulum stress-mediated apoptosis during focal cerebral ischemia-reperfusion (I/R) in rats.Methods Eighty adult male Sprague-Dawley rats,weighing 240-280 g,were randomly divided into 4 groups (n =20 each):shame operation group (group S) ; focal cerebral I/R group (group FCIR); propofol pretreatment group (group P); intralipid pretreatment group (group Ⅰ).Focal cerebral I/R was induced by 4 h middle cerebral artery occlusion followed by reperfusion.Propofol was infused at a rate of 12 mg· kg-1 · h-1 starting from 30 min before ischemia until 15 min of ischemia in group P,while intralipid was given instead of propofol in group I.Neurological deficit scores (NDSs) were measured at 6 h of reperfusion in 10 rats chosen from each group and the rats were then sacrificed.Their left brains were removed for determination of brain water content.The left 10 rats were sacrificed and their brains were immediately removed for determination of the expression of C/EBP homologous protein (CHOP),Bcl-2,and activated caspase-3 in the left hippocampi by Western blot.Results Compared with group S,NDSs and brain water content were significantly increased,the expression of CHOP and activated caspase-3 was up-regulated,and the expression of Bcl-2 was down-regulated in group FCIR,NDSs was increased in group P (P ＜ 0.05).Compared with group FCIR,NDSs and brain water content were significantly decreased,the expression of CHOP and activated caspase-3 was down-regulated,and the expression of Bcl-2 was up-regulated in group P,and no significant change was found in each parameter in group Ⅰ (P ＞ 0.05).Conclusion Propofol can reduce focal cerebral I/R injury through inhibition of the endoplasmic reticulum stress-mediated apoptosis in rats.

Objective To study the inhibitory effect of fluorouracil combined with DDP on the growth of human osteosarcoma cell line MG-63,and to explore its influence on the expressions of transient receptor potential vanilloid 5 (TRPV5 )and transient receptor potential vanilloid 6 (TRPV6 )proteins.Methods The MG-63 cells were cultured by the density of 5 × 104 mL-1 .Fluorouracil group,DDP group,fluorouracil+ DDP group and control group containing 10% FBS were set up.The inhibitory rates of growth of MG-63 cells at different time were detected by CCK-8 assay.The apoptosis of MG-63 cells after treated with different drugs was determined by Hoechst staining Kit.The immunocytochemical staining was used to treatent to detect the expressions of TRPV5 and TRPV6 before and after treatment.Results Fluorouracil and DDP both inhibited the growth of MG-63 cells in a time-and dose- dependent manner.There were a lot of black particles in the MG-63 cells and the cells were smaller,aging or death when they were exposed to fluorouracil or DDP.Compared with 24 h group,the inhibitory rates of proliferation of MG-63 cells after treated with the sigle drug of fluorouracil or DDP for 48 and 72 h were increased significantly (P <0.05).Compared with control group,the apoptotic rates of MG-63 cells in fluorouracil group and DDP group 24,48,and 72 h after treatment were increased (P < 0.01)in a time-dependent manner. The expression levels of TRPV5 and TRPV6 in MG-63 cells 72 h after treatment of fluorouracil and DDP were decreased significantly compared with before treatment (P < 0.05 ). Conclusion Fluorouracil, DDP and fluorouracil combined with DDP could significantly inhibit the proliferation of MG-63 cells,induce the apoptosis, and decrease the expression levels of TRPV5 and TRPV6.

Objective To investigate Smoothened (Smo) expression in endothelial cells of synovial tissues in active rheumatoid arthritis (RA),and the expression of Sonic Hedgehog (Shh) signaling pathwayassociated factors after TNF-α treatment in EA.hy926 cells,and the effects of specific inhibitor of Smo (cyclopamine) on the apoptosis of EA.hy926 cells.Methods The Smo expression in endothelial cells in synovial tissue from 4 RA patients and 4 patients with traumatic or meniscal injury (with no arthritis,act as control group) were detected by immunohistochemistry assay.EA.hy926 cells were treated with different concentrations of TNF-α or TNF-α together with different concentrations of cyclopamine,and Shh,Ptch1,Smo,Gli1 mRNA expression levels were detected by real time-PCR.EA.hy926 cells were co-cultured with three different concentrations of cyclopamine for 24 hours before the addition of TNF-α and ActinomycinD (ActD).The cell survival rate was detected using CCK-8,and the population of apoptotic cells was detected using a flow cytometry.T-test and one-way ANOVA were used for statistical analysis.Results The positive expression rate of Smo in endothelial cells of synovial tissue in RA group was (81±23)％,which was higher than that in the control group (20±17)％ (P＜0.05).After being treated with TNF-α,the expressions of Shh and Smo mRNA in EA.hy926 cells increased,while the expression of Gli1 mRNA decreased (P＜0.05),and the expression of Ptch1 mRNA did not change significantly (P＞0.05).The expressions of Shh,Smo and Gli1 mRNA were down-regulated (P＜0.05).EA.hy926 cells treated with different concentrations of cyclopamine (2,4 and 8 μmol/L) showed a significant decrease in cell viability,in cell survival rates (57±6)％,(44±8)％ and (32±5)％ compared with that of TNF-α/ActD group (64±6)％ (P＜0.05),and cell apoptosis rates [(12.4±3.3)％,(14.5±2.7)％ (15.7±2.4)％] compared with that of TNF-α/ActD group (7.1±1.3)％ (P＜0.05).Conclusion Shh pathway is activated in endothelial cells of synovial tissue in active RA.The apoptosis in endothelial cells is promoted after cyclopamine treatment.Shh pathway may play an important role in the antiapoptotic regulatory mechanism of endothelial cells.