Objective To establish the argatroban drug use evaluation(DUE)criteria and provide reference for the rational use of argatroban in clinical practice.Methods Based on the domestic and foreign drug instructions of argatroban,referring to relevant guidelines and literature,the DUE standard rules were established by expert consultation.Using the established standard rules,the medical records of argatroban in the Fuzhou First Hospital Affiliated with Fujian Medical University from August 2020 to August 2022 were evaluated for the rationality of medication.Results A total of 368 medical records were included,the rational rate of drug use was 48.64％,and the irrational drug use was mainly without indications(46.19％)and inappropriate combination of drugs(4.35％).Conclusion The rational rate of argatroban clinical use in the hospital is not high,and the problems mainly include off-indication drug use and unreasonable combination drug use.Through the establishment and clinical application of DUE standard rules,the clinical use of argatroban can be further standardized and the ability of rational drug use can be improved.

Objective:To evaluate the value of preoperative vascular ultrasound parameters in predicting the postoperative lower extremity deep venous thrombosis (DVT) in patients with gynecological malignant tumors.Methods:Ninety-nine patients with gynecological malignant tumors, aged>18 yr, with body mass index<30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective surgery under general anesthesia, were selected. Vascular ultrasound examination was performed before surgery. The flow velocity and diameter of common femoral vein (CFV), deep femoral vein (DFV), popliteal vein (POV), and intermuscular vein (IMV) were recorded. Ultrasound examination of lower limb veins (including anterior tibial vein, posterior tibial vein, IMV, CFV, DFV, POV) were conducted at 1-8 days after surgery to determine whether a DVT occurred. The receiver operating charcateristic curve was used to evaluate the accuracy of each indicator in predicting the lower extremity DVT, and the cut-off value was determined based on the maximum principle of Jorden index. Results:The incidence of lower extremity DVT was 13.1%. The area under the curve (95% confidence interval) of the preoperative CFV flow velocity and diameter, DFV flow velocity and diameter, POV flow velocity and diameter, IMV flow velocity and diameter in predicting the lower extremity DVT were 0.769 (0.616-0.923) and 0.800 (0.644-0.950), 0.797 (0.641-0.954) and 0.771 (0.596-0.945), 0.806 (0.645-0.968) and 0.754 (0.606-0.903), 0.764 (0.615-0.914) and 0.818 (0.645-0.990), respectively ( P<0.05), and the predicted cut-off values were 27.13 cm/s and 11.93 mm, 19.31 cm/s and 10.15 mm, 16.04 cm/s and 8.79 mm, 14.39 cm/s and 8.68 mm, respectively, and the sensitivity and specificity were 90.0%, 71.4% and 90.0%, 74.3%; 90.0%, 74.3% and 90.0%, 68.6%; 90.0%, 82.9% and 90.0%, 72.9%; 90.0%, 70.0% and 80.0%, 87.1%, respectively. Conclusions:Preoperative vascular vascular ultrasound parameters can accurately predict the occurrence of postoperative lower extremity DVT in patients with gynecological malignant tumors.

Objective:To explore the efficacy of subcutaneous injection of granulocyte-macrophage colony-stimulating factor (GM-CSF) in preventing invasive fungal disease (IFD) in patients with multiple myeloma (MM).Methods:The clinical data of 222 patients who were admitted to the Second Hospital of Harbin Medical University from January 2015 to June 2021 were retrospectively analyzed. The patients was given GM-CSF (3-5 μg·kg -1·d -1, GM-CSF group) or granulocyte colony-stimulating factor (G-CSF, 2-5 μg·kg -1·d -1, G-CSF group) when neutrophils (ANC) ≤1.5×10 9/L after induction chemotherapy. Patients were discontinued when white blood cell count (WBC) ≥10.0×10 9/L. The incidence of IFD (including confirmed, clinical and proposed diagnosis) and breakthrough invasive fungal infections was compared between the two groups. Results:The incidence of IFD was 8.1% (18/222) in all patients. The incidence of IFD was 3.5% (3/85) and 10.9% (15/137) in the GM-CSF and G-CSF groups, respectively, and the difference between the two groups was statistically significant ( χ2 = 3.88, P = 0.049). In 9 patients of GM-CSF group receiving fungal infection prophylaxis and in 15 patients of G-CSF group receiving fungal infection prophylaxis, the incidence of breakthrough invasive fungal infections was 0 and 7 cases, respectively, and the difference between the two groups was statistically significant ( P = 0.022). Conclusions:GM-CSF application in MM patients can reduce the incidence of IFD and breakthrough invasive fungal infections.

Objective:To compare the effectiveness and safety of all-suture anchors and single-row suture anchors for rotator cuff repair.Methods:A prospective randomized controlled study was conducted to analyze the clinical data of 50 patients with rotator cuff tear admitted to Second Affiliated Hospital of Zhejiang University School of Medicine between July 2019 and September 2021. They were divided into two groups according to the random table: 25 patients to receive repair with single-row suture anchors (control group) and the other 25 with all-suture anchors (trial group). Visual Analogue Scale (VAS), University of California, Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeons (ASES) score and shoulder range of motion were compared between the two groups before surgery, at 3 months after surgery and at the last follow-up. The rotator cuff retear rate of the two groups was evaluated according to Sugaya classification at 6 months after surgery. Breakage or anchor loosening during surgery, healing of incision and presence of infections or neurological complications after surgery, and change of the anchor position and periosteal reaction at the insertion site at 3 and 6 months after surgery were observed in the two groups.Results:A total of 50 patients with rotator cuff tear were involved in this study, including 17 males and 33 females, aged 40-73 years [(59.1±10.3)years]. All patients were followed up for 6-9 months [(6.7±1.0)months]. The differences in VAS, UCLA shoulder score, ASES score, and shoulder range of motion between the two groups were statistically insignificant before surgery (all P>0.05). The VAS at 3 months after surgery and at the last follow-up in the control group was 2.0 (2.0, 4.0)points and 2.0 (0.0, 2.0)points, respectively, with no statistical differences from 2.0 (2.0, 2.0)points and 2.0 (0.0, 2.0)points in the trial group (all P>0.05). In the control group, the UCLA shoulder score and ASES score at 3 months after surgery and the ASES score at the last follow-up were (25.1±4.5)points, 78.8 (71.6, 85.8)points and 85.8 (85.8, 93.0)points, respectively, with no statistical differences from (26.8±4.7)points, 85.8 (82.3, 85.8)points, and 92.8 (85.8, 100.0)points in the trial group (all P>0.05). At the last follow-up, the UCLA shoulder score of the control group was (29.2±3.9)points, which was lower than that of the trial group [(31.6±2.4)points] ( P<0.05). The differences in shoulder motion between the two groups at 3 months after surgery and at the last follow-up were not statistically significant (all P>0.05). The VAS, UCLA shoulder score, and ASES score at 3 months after surgery and at the last followup in both groups were significantly improved compared to their preoperative values (all P<0.05); further improvements were observed at the last follow-up compared with those at 3 months after surgery (all P<0.05). The rotator cuff retear rate at 6 months after surgery was 16.7% (4/24) in the control group, not statistically different from 4.3% (1/23) in the trial group ( P>0.05). There were no incidences of anchor loosening or breakage during surgery. All incisions were healed after surgery, with no infections or neurological complications. No grades II to III periosteal reactions at the anchor insertion sites were observed in either group at 3, 6 months after surgery. The percentage of patients with grade 0 periosteal reaction at the anchor insertion site at 3 months after surgery was 4.2% (1/24) in the control group, significantly lower than 30.4% (7/23) in the trial group ( P<0.05). Conclusion:All-suture anchors and single-row suture anchors are effective in rotator cuff repair, but the former results in better shoulder function and fewer periosteal reactions in the anchor insertion site in the early stage.

Objective:To explore the effect of comprehensive intraoperative physical intervention to prevent deep vein thrombosis (DVT) of lower extremity in patients with gynecological tumor surgery.Methods:From January 2020 to January 2021, 80 gynecological tumor patients undergoing surgery in Shanxi Provincial People 's Hospital were selected by convenience sampling as the research object. According to the random number table method, the patients were divided into the control group and the intervention group, each with 40 cases. The intervention group used intermittent pneumatic compression device (IPC) combined with graduated compression stockings (GCS) during the operation. In the control group, IPC was used alone for intervention. This study compared the blood flow rate and tube diameter of the lower extremity veins (common femoral vein, deep femoral vein, popliteal vein, and intermuscular vein) , blood coagulation indexes [prothrombin time (PT) , thrombin time (TT) , activated partial thromboplastin time (APTT) , fibrinogen (FIB) and D-dimer]before and after operation and the incidence of lower extremity DVT on the third day after operation between the two groups. Pearson correlation analysis was used to analyze the correlation between postoperative D-dimer and lower extremity venous blood flow rate. Results:There was no significant difference between the two groups of patients in the preoperative lower extremity venous blood flow velocity and diameter ( P>0.05) . The comparison of postoperative lower extremity venous blood flow rate between the two groups were statistically significant ( t=2.217, 4.863, 2.946, 2.397; P<0.05) . The diameters of common femoral vein, deep femoral vein and intermuscular vein between the two groups were statistically different ( t=2.117, 2.756, 2.274; P<0.05) , and there was no significant difference in the diameter of popliteal vein ( P>0.05) . There was no significant difference in PT, TT, APTT, FIB, D-dimer between the two groups of patients before operation ( P>0.05) . The differences in FIB and D-dimer between the two groups of patients were statistically significant ( t=-2.338, -3.554; P<0.05) . The incidence of lower extremity DVT in the intervention group was 2.5% (1/40) on the third day after operation, and the incidence of lower extremity DVT in the control group was 20.0% (8/40) , and the difference was statistically significant (χ 2=6.135, P<0.05) . Pearson correlation analysis showed that postoperative D-dimer and lower extremity venous blood flow rate were negatively correlated ( r=-0.484, -0.442, -0.358, -0.308; P<0.01) . Conclusions:The application of comprehensive intraoperative physical intervention of IPC combined with GCS can reduce the incidence of DVT in the lower extremities of patients with gynecological tumors, and it is worthy of clinical application.

Objective:To explore the effect of intraoperative physical prevention on the occurrence of lower extremity deep vein thrombosis (DVT) in patients with gynecological tumors after operation.Methods:From January to December 2020, convenience sampling was used to select 79 gynecological tumor patients with operations in Shanxi Provincial People's Hospital as the research object. According to the random number table method, the patients were divided into the observation group ( n=40) and the control group ( n=39) . The patients in the control group received graduated compression stocking (GCS) during the operation, and the patients in the observation group were treated with the GCS combined with the plantar arteriovenous pump. The blood coagulation indexes [D-dimer, prothrombin time (PT) , activated partial thromboplastin time (APTT) ], lower extremity (common femoral vein, deep femoral vein) venous diameter and blood flow rate before operation, immediately after operation, and on the third day after operation, and the incidence of DVT on the first day, third day, 1 month and 3 months after the operation were compared between the two groups. Results:Repeated measures analysis of variance showed that there were interaction, between-group and time effects in the comparison of D-dimer, PT, and APTT before operation, immediately after operation, and on the third day after operation between the two groups. There were interactions, between-group, and time effects in the comparison of the diameter of the common femoral vein, the diameter of the deep femoral vein, and the venous blood flow rate. The differences were all statistically significant ( P<0.05) . On the first day, third day, 1 month and 3 months after operation, the incidences of DVT in the observation group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Intraoperative GCS combined with plantar arteriovenous pump can improve postoperative coagulation function in patients with gynecological tumors, accelerate venous blood flow rate of lower extremities, and reduce the incidence of DVT in patients.

Objective:To investigate the clinical features and long-term prognosis of patients co-existing with ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE).Methods:Totally 358 OMA patients were retrospectively analyzed, who had a minimum of 8 years follow-up after laparoscopic cystectomy, which was performed by one professional endometriosis surgery team at Peking Union Medical College Hospital from January 2009 to April 2013. All women were divided into DIE group and non-DIE group, and analysis was performed in preoperative characteristics, surgical findings and postoperative outcomes during follow-up.Results:A total of 358 OMA patients were included, of which 190 patients (53.1%, 190/358) were in the DIE group, while other 168 patients (46.9%, 168/358) in the non-DIE group. The average ages between the two groups were (33.7±5.4), (32.5±5.3) years ( P=0.047), the average parity was (0.4±0.6) times vs (0.3±0.5) times ( P=0.079). There were significant differences in the proportions of moderate to severe dysmenorrhea [67.4% (128/190) vs 56.5% (95/168)], chronic pelvic pain [24.2% (46/190) vs 7.7% (13/168)], and the increase in CA 125 [79.9% (139/190) vs 65.2% (101/168)] between the two groups (all P<0.05). The average operation time in the DIE and non-DIE groups was (75±21) vs (39±36) minutes ( P<0.01). There was a significant difference in adenomyosis presence between the two groups [41.6% (79/190) vs 22.0% (37/168); P=0.001]. All patients were followed up for at least 8 years. At the end of the follow-up, though the DIE group was with higher total rate of disease relapse, yet no significant difference was found between the two groups in statistical comparison [21.6% (41/190) vs 16.1% (27/168); P=0.185]. A total of 41 cases in the DIE group recurred, the recurrence rate of pain was 15.8% (30/190), and the recurrence rate of cyst was 8.4% (16/190); 27 cases had recurrence after operation in the non-DIE group, the recurrence rate of pain was 8.9% (15/168), and the recurrence rate of cyst was 10.7% (18/168). There were no significant differences in the pain recurrence rate ( P=0.067) and cyst recurrence rate ( P=0.460) between the two groups. As for the successfully pregnant patients, live birth rates were 100.0% (65/65) vs 94.4% (68/72) between DIE group and non-DIE groups ( P=0.120). Conclusions:Compared with the non-DIE group, OMA patients with concurrent DIE might have severe pain symptoms, higher probability of abnormal CA 125 levels and more severe pelvic adhesions. Although there are no significant differences in the total recurrence rate and the recurrence rate of various types between the two groups, the proportion of pain recurrence in the DIE group is higher than that in the non-DIE group. In terms of fertility outcomes, patients in the DIE group are with lower likelihood of pregnancy after surgery during the long-time follow-up. DIE has no significant influence on the fertility outcome.

OBJECTIVETo fabricate organic-inorganic composite tissue engineering scaffolds for reconstructing calcified cartilage layer based on three-dimensional (3D) printing technique.

METHODSThe scaffolds were developed by 3D-printing technique with highly bioactive calcium-magnesium silicate ultrafine particles of 1%, 3% and 5% of mass fraction, in which the organic phases were composed of type I collagen and sodium hyaluronate. The 3D-printed scaffolds were then crosslinked and solidified by alginate and CaCl₂ aerosol. The pore size and distribution of inorganic phase were observed with scanning electron microscope (SEM); the mechanical properties were tested with universal material testing machine, and the porosity of scaffolds was also measured.

RESULTSPore size was approximately (212.3 ± 34.2) μm with a porosity of (48.3 ± 5.9)%, the compressive modulus of the scaffolds was (7.2 ± 1.2) MPa, which was irrelevant to the percentage changes of calcium-magnesium silicate, the compressive modulus was between that of cartilage and subchondral bone.

CONCLUSIONThe porous scaffolds for calcified cartilage layer have been successfully fabricated, which would be used for multi-layered composite scaffolds in osteochondral injury.

Bioprinting ; Cartilage ; growth & development ; Materials Testing ; Porosity ; Printing, Three-Dimensional ; Tissue Engineering ; methods ; Tissue Scaffolds ; chemistry

Objective To investigate the changes of mestruation patterns and adverse effects during the treatment of levonorgestrel-releasing intrauterine system (LNG-IUS) for symptomatic adenomyosis in a prospective cohort study. Methods From December, 2006 to December, 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in Peking Union Medical College Hospital were given LNG-IUS. Before and after placement of IUS, all patients′ parameters were recorded, including carrying status of IUS, symptoms and scores of dysmenorrhea, menstruation scores, biochemical indicators, physical parameters, menstruation patterns and adverse effects. Risk factors for changes of menstruation patterns and adverse effects, and their impact on treatment effects were analyzed. Results Totally 1 100 cases met inclusion criteria, with median age 36 years (range 20-44 years), median follow-up 35 months (range 1-108 months). During follow-up changes of menstruation patterns increased significantly with amenorrhea and shortened-menstruation being the most common manifestations. On 3, 6, 12, 24, 36, 48 and 60 months after the placement of LNG-IUS, 0, 5.8%(43/744), 6.9%(47/682), 10.1%(60/595), 17.3%(87/502), 27.2%(104/383) and 29.6%(82/277) patients achieved amenorrhea respectively (P<0.01). Total and subclassification of adverse effects decreased significantly (P<0.01). Within 12 months and >12 months after placement, abdominal pain and body weight increasing ≥5 kg/year were the most common adverse effects. Changes of menstruation patterns, total and subclassifications of adverse effects were neither dependent on patient parameters, treatment modes and treatment effects, nor could predict future LNG-IUS carrying status (all P>0.05). After taking out of LNG-IUS, most changes of menstruation and adverse effects disappeared. Conclusions During the treatment of LNG-IUS for symptomatic adenomyosis, changes of menstruation patterns increase gradually with amenorrhea and shortened-menstruation being the most common manifestations, while adverse effects decrease significantly. Changes of menstruation patterns or adverse effects neither have any risk factor nor have impact on treatment effects.

Objective To investigate treatment effects of levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis with menorrhea in a prospective study. Methods From December 2006 to December 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in outpatient or inpatient clinics of Peking Union Medical College Hospital were given the treatment of LNG-IUS. Before and after placement of LNG-IUS, all the patients′parameters were recorded prospectively, including scores of menstruation blood loss, carrying status of IUS, symptoms and scores of dysmenorrhea, biochemical indicators, physical parameters, menstruation patterns and adverse effects. Changes of pictorial chart scores of menstruation and distribution of anemia during follow-up were analyzed. Results Totally 1 100 women meets inclusion criteria, among which 618 cases (56.18%, 618/1 100) had severe menorrhea, with median follow-up period of 28 months (range 1-60 months), and accumulative carrying rate of 66% at 60 months follow-up. After placement of LNG-IUS, compared with baselines, pictorial chart scores and ratio of menorrhea had decreased significantly (all P<0.01), the scroes of menstruation were 157±34, 94±35, 70±33,67 ± 18, 67 ± 20, 65 ± 19, 66 ± 19, 65 ± 21 at 0, 3, 6, 12, 24, 36, 48 and 60 months respectively. During 24 months after placement of LNG-IUS, pictorial chart scores and distribution of anemia had improved significantly compared with preceding period (all P<0.01). We found no dependent factors predicting improvement of pictorial chart scores of menorrhea, which was neither relevant with simultaneous changes of menstruation patterns nor adverse effects (all P>0.05). Conclusions LNG-IUS is effective for adenomyosis of menorrhea. Improvement of menstruation blood loss is independent on patients characters, menstruation patterns or adverse effects.