Network Meta-analysis was employed to compare the efficacy of Chinese medicine injections for activating blood and resolving stasis combined with conventional western medicine in the treatment of acute ischemic stroke and the effects on platelet aggregation rate, fibrinogen(FIB), and hypersensitive C-reactive protein(hs-CRP), with a view to providing evidence-based medicine reference for clinical medication. CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, Cochrane Library, and EMbase were searched for randomized controlled trial(RCT) on the treatment of acute ischemic stroke with Salvia Miltiorrhiza Ligustrazine Injection, Danhong Injection, Shuxuetong Injection, Xueshuantong Injection, Shuxuening Injection, Safflower Yellow Pigment Injection, and Ginkgo Diterpene Lactone Meglumine Injection combined with conventional western medicine. The retrieval time was from database inception to March 18, 2023. The articles were extracted by two researchers and their quality was evaluated. R 4.2.2 was used for network Meta-analysis. A total of 87 RCTs involving 8 580 patients were included. Network Meta-analysis showed that, in terms of reducing National Institutes of Health stroke scale(NIHSS) scores, the surface under the cumulative ranking curve(SUCRA) showed the order of Xueshuantong Injection + conventional western medicine(88.7%) > Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine(73.7%) > Shuxuetong Injection + conventional western medicine(69.7%) > Shuxuening Injection + conventional western medicine(51.8%) > Danhong Injection + conventional western medicine(43.7%) > Safflower Yellow Pigment Injection + conventional western medicine(36.8%) > Ginkgo Diterpene Lactone Meglumine Injection + conventional western medicine(35.3%) > conventional western medicine(1.7%). In terms of improving clinical total effective rate, SUCRA showed the order of Danhong Injection + conventional western medicine(63.0%) > Shuxuening Injection + conventional western medicine(59.0%) > Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine(58.9%) > Safflower Yellow Pigment Injection + conventional western medicine(57.1%) > Xueshuantong Injection + conventional western medicine(56.8%) > Shuxuetong Injection + conventional western medicine(54.6%) > Ginkgo Diterpene Lactone Meglumine Injection + conventional western medicine(50.5%) > conventional western medicine(0.03%). In terms of improving Barthel index, SUCRA showed the order of Danhong Injection + conventional western medicine(84.7%) > Shuxuetong Injection + conventional western medicine(72.4%) > Safflower Yellow Pigment Injection + conventional western medicine(61.6%) > Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine(44.6%) > Ginkgo Diterpene Lactone Meglumine Injection + conventional western medicine(43.2%) > Shuxuening Injection + conventional western medicine(42.2%) > conventional western medicine(1.4%). In terms of reducing platelet aggregation rate, SUCRA showed the order of Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine(82.4%) > Shuxuetong Injection + conventional western medicine(81.6%) > Ginkgo Diterpene Lactone Meglumine Injection + conventional western medicine(40.7%) > Danhong Injection + conventional western medicine(37.3%) > conventional western medicine(8.0%). In terms of reducing FIB, SUCRA showed the order of Danhong Injection + conventional western medicine(81.0%) > Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine(71.9%) > Ginkgo Diterpene Lactone Meglumine Injection + conventional western medicine(70.0%) > Shuxuetong Injection + conventional western medicine(46.7%) > Xueshuantong Injection + conventional western medicine(22.6%) > conventional western medicine(8.7%). In terms of reducing hs-CRP, SUCRA showed the order of Shuxuening Injection + conventional western medicine(89.9%) > Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine(78.8%) > Ginkgo Diterpene Lactone Meglumine Injection + conventional western medicine(52.4%) > Danhong Injection + conventional western medicine(47.6%) > Xueshuantong Injection + conventional western medicine(43.5%) > Shuxuetong Injection + conventional Western medicine(35.6%) > conventional western medicine(2.3%). The results indicated that Xueshuantong Injection + conventional western medicine, Danhong Injection + conventional western medicine, and Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine ranked the top three. Xueshuantong Injection + conventional western medicine had the best effect on reducing NIHSS scores. Danhong Injection + conventional western medicine showed the best performance of improving clinical total effective rate, improving Barthel index, and reducing FIB in the blood. Salvia Miltiorrhiza Ligustrazine Injection + conventional western medicine had the best effect on reducing platelet aggregation rate in the blood. Shuxuening Injection + conventional western medicine had the best effect on reducing hs-CRP. However, more high-quality RCTs are needed for verification in the future to provide more reliable evidence-based medical reference.
Humans ; Medicine, Chinese Traditional ; Ischemic Stroke/drug therapy* ; Network Meta-Analysis ; C-Reactive Protein ; Drugs, Chinese Herbal/therapeutic use* ; Adjuvants, Pharmaceutic ; Diterpenes ; Lactones ; Meglumine

BACKGROUND: We investigated the effect of irrigation fluid on coagulation according to the hemodilution level using rotational thromboelastometry (ROTEM). METHODS: Venous blood was taken from 12 healthy volunteers and divided into four specimen tubes that were diluted to various levels (0%, 10%, 20%, and 40%) using an irrigation fluid composed of 2.7% sorbitol and 0.54% mannitol. RESULTS: Significant prolongation of clotting time was observed in the 40% diluted sample using both INTEM (P = 0.009) and EXTEM (P = 0.001) assays. However, the clot formation time was prolonged significantly in the 10%, 20%, and 40% diluted samples using both INTEM (P < 0.001) and EXTEM (P = 0.002, P < 0.001, and P < 0.001, respectively) assays. A significant decrease of α-angle of INTEM and EXTEM were observed in the 10% (P < 0.001), 20% (P < 0.001 and P = 0.001, respectively), and 40% (P < 0.001) groups compared with the 0% dilution group. The maximum clot firmness (MCF) of INTEM decreased significantly in the 20% (P < 0.001) and 40% (P < 0.001) diluted samples. In the MCF of EXTEM and FIBTEM assays, 10% (P = 0.009 and P = 0.015, respectively), 20% (P = 0.001), and 40% (P < 0.001) samples showed a significant decrease compared with the 0% sample. Nevertheless, most of the ROTEM values were within the reference range, except the 40% sample. CONCLUSIONS: Blood became hypocoagulable when it was diluted in vitro with a fluid composed of 2.7% sorbitol and 0.54% mannitol.
Blood Coagulation ; Healthy Volunteers ; Hemodilution ; In Vitro Techniques ; Mannitol ; Reference Values ; Sorbitol ; Thrombelastography

The omphalomesenteric duct is a link between the primitive midgut and the yolk sac. Normally, the duct obliterates around 6 weeks of gestation, yet varying degrees of incomplete obliteration can take place in 1%–4% of infants. This study described the case of a newborn with a patent omphalomesenteric duct remnant fistula identified at birth with meconium in the umbilical cord. At birth, the infant presented meconium staining and meconium discharged within the umbilical cord. Physical examination and other examinations showed no other specific findings. The omphalomesenteric duct fistula was confirmed through the imaging study (abdominal ultrasonography, gastrografin enema). A surgery was carried out where the remnant was resected. The patient did well and was discharged soon after without complication.
Diatrizoate Meglumine ; Fistula ; Humans ; Infant ; Infant, Newborn ; Meconium ; Parturition ; Physical Examination ; Pregnancy ; Ultrasonography ; Umbilical Cord ; Umbilicus ; Vitelline Duct ; Yolk Sac

PURPOSE: The aims of this study were to identify the clinical characteristics of an anastomotic sinus and to assess the validity of delaying stoma closure in patients until the complete resolution of an anastomotic sinus. METHODS: The subject patients are those who had undergone a resection of rectal cancer from 2011 to 2017, who had a diversion ileostomy protectively or therapeutically and who developed a sinus as a sequelae of anastomotic leakage. The primary outcomes that were measured were the incidence, management and outcomes of an anastomotic sinus. RESULTS: Of the 876 patients who had undergone a low anterior resection, 14 (1.6%) were found to have had an anastomotic sinus on sigmoidoscopy or a gastrografin enema before their ileostomy closure. In the 14 patients with a sinus, 7 underwent ileostomy closure as scheduled, with a mean closure time of 4.1 months. The remaining 7 patients underwent ileostomy repair, but it was delayed until after the follow-up for the widening of the sinus opening by using digital dilation, with a mean closure time of 6.9 months. Four of those remaining seven patients underwent stoma closure even though their sinus condition had not yet been completely resolved. No pelvic septic complications occurred after closure in any of the 14 patients with an anastomotic sinus, but 2 of the 14 needed a rediversion due to a severe anastomotic stricture. CONCLUSION: Patients with an anastomotic sinus who had been carefully selected underwent successful ileostomy closure without delay.
Anastomotic Leak ; Constriction, Pathologic ; Diatrizoate Meglumine ; Enema ; Follow-Up Studies ; Humans ; Ileostomy ; Incidence ; Rectal Neoplasms ; Sigmoidoscopy

Although foreign body ingestion is relatively common in children aged 6 months-3 years, small bowel obstruction rarely develops, and few cases require surgical interventions. We report a case of 12-month-old girl who presented to the emergency department with new-onset seizure after projectile bilious vomiting. The initial diagnosis was seizure caused by hyponatremia based on laboratory findings, plain abdominal radiograph, brain magnetic resonance imaging, and electroencephalography. Despite fluid resuscitation, clinical manifestations did not improve, and severe ileal obstruction was found on computed tomography. Emergency laparoscopy showed a foreign body (a water bead [superabsorbent polymer], 3 cm in diameter) that was subsequently removed by enterotomy. After the surgery, bilious vomiting continued, and gastrografin did not pass on fluoroscopy. The second laparoscopy showed a residual foreign body that was crushed and then removed by minimal enterotomy. She was discharged in good condition 5 days after the second surgery. This case suggests a particular danger of water beads as foreign bodies and the need for differential diagnosis of multiple foreign bodies in children with poor communication skills.
Brain ; Child ; Diagnosis ; Diagnosis, Differential ; Diatrizoate Meglumine ; Eating ; Electroencephalography ; Emergencies ; Emergency Service, Hospital ; Female ; Fluoroscopy ; Foreign Bodies ; Humans ; Hyponatremia ; Infant ; Intestinal Obstruction ; Laparoscopy ; Magnetic Resonance Imaging ; Resuscitation ; Seizures ; Vomiting ; Water

PURPOSE: Meconium-related ileus is common in preterm infants. Without proper management, it can cause necrotizing enterocolitis and perforation requiring emergent operation. This study was conducted to describe the efficacy and safety of ultrasound-guided Gastrografin enema at bedside for preterm infants with meconium-related ileus. METHODS: Between March 2013 and December 2014, this study enrolled preterm infants with birth weight < 1,500 g, who were diagnosed with meconium-related ileus requiring ultrasound-guided Gastrografin enema refractory to glycerin or warm saline enemas. Gastrografin was infused until it passed the ileocecal valve with ultrasound guidance at bedside. RESULTS: A total of 13 preterm infants were enrolled. Gestational age and birth weight were 28.6 weeks (range, 23.9–34.3 weeks) and 893 g (range, 610–1,440 g), respectively. Gastrografin enema was performed around postnatal day 8 (range, day 3–11). The success rate was 84.6% (11 of 13 cases). Three of these 11 infants received a second procedure, which was successful. Among 2 unsuccessful cases, one failed to pass meconium while the other required surgery due to perforation. The time required to pass meconium was 2.8±1.5 hours (range, 1–6 hours). The time until radiographic improvement was 2.8±3.4 days (range, 1–14 days) after the procedure. CONCLUSION: Ultrasound-guided Gastrografin enema at bedside as a first-line treatment to relieve meconium-related ileus was effective and safe for very low birth weight infants. We could avoid unnecessary emergent operation in preterm infants who have high postoperative morbidity and mortality. This could also avoid transporting small preterm infants to fluoroscopy suite.
Birth Weight ; Diatrizoate Meglumine ; Enema ; Enterocolitis, Necrotizing ; Fluoroscopy ; Gestational Age ; Glycerol ; Humans ; Ileocecal Valve ; Ileus ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Meconium ; Mortality ; Ultrasonography

OBJECTIVE: To intra-individually compare 3T magnetic resonance (MR) images obtained with one dose gadoterate meglumine to 1.5T MR using conventional double dose for assessment of chronic myocardial infarction. MATERIALS AND METHODS: Sixteen patients diagnosed with chronic myocardial infarctions were examined on single-dose 3T MR within two weeks after undergoing double-dose 1.5T MR. Representative short-axis images were acquired at three points after administration of gadoterate meglumine. Contrast-to-noise ratios between infarcted and normal myocardium (CNRinfarct-normal) and between infarct and left ventricular cavity (CNRinfarct-LVC) were calculated and compared intra-individually at each temporal scan. Additionally, two independent readers assessed relative infarct size semi-automatically and inter-observer reproducibility was evaluated using intraclass correlation coefficient. RESULTS: While higher CNRinfarct-normal was revealed at single-dose 3T at only 10 minutes scan (p = 0.047), the CNRinfarct-LVC was higher at single-dose 3T MR at each temporal scan (all, p < 0.05). Measurement of relative infarct size was not significantly different between both examinations for both observers (all, p > 0.05). However, inter-observer reproducibility was higher at single-dose 3T MR (all, p < 0.05). CONCLUSION: Single-dose 3T MR is as effective as double-dose 1.5T MR for delineation of infarcted myocardium while being superior in detection of infarcted myocardium from the blood cavity, and provides better reproducibility for infarct size quantification.
Gadolinium* ; Humans ; Magnetic Resonance Imaging* ; Meglumine* ; Myocardial Infarction* ; Myocardium

Analysis errors can occur in the desorbing process of ginkgo diterpene lactone meglumine injection (GDMI) by a conventional analysis method, due to several factors, such as easily crystallized samples, solvent volatility, time-consuming sample pre-processing, fixed method, and offline analysis. Based on risk management, near-infrared (NIR) and mid-infrared (MIR) spectroscopy techniques were introduced to solve the above problems with the advantage of timely analysis and non-destructive nature towards samples. The objective of the present study was to identify the feasibility of using NIR or MIR spectroscopy techniques to increase the analysis accuracy of samples from the desorbing process of GDMI. Quantitative models of NIR and MIR were established based on partial least square method and the performances were calculated. Compared to NIR model, MIR model showed greater accuracy and applicability for the analysis of the GDMI desorbing solutions. The relative errors of the concentrations of Ginkgolide A (GA) and Ginkgolide B (GB) were 2.40% and 2.89%, respectively, which were less than 5.00%. The research demonstrated the potential of the MIR spectroscopy technique for the rapid and non-destructive quantitative analysis of the concentrations of GA and GB.
Chemistry, Pharmaceutical ; methods ; standards ; Drug Compounding ; standards ; Drugs, Chinese Herbal ; analysis ; chemistry ; standards ; Ginkgolides ; analysis ; chemistry ; standards ; Injections ; Lactones ; analysis ; Least-Squares Analysis ; Meglumine ; analysis ; chemistry ; standards ; Reproducibility of Results ; Risk Management ; Spectrophotometry, Infrared ; standards

Healing process in scarring inevitably produces a considerable amount of non-organized dense collagen-rich matrix called scar thus impairing the native structure of skin. Connective tissue growth factor (CTGF) overexpression within healing tissues is known to play an imperative role in collagen production stimulated by transforming growth factor-beta in cutaneous wound healing. Undoubtedly, the knockdown of CTGF expression through siRNA-mediated gene silencing could simply impede the scarring process. However, the less stability and low transfection of siRNAs themselves urge a safe carrier to protect and transfect them into cells at a high rate avoiding toxicities. Here, we developed a degradable poly(sorbitol-co-PEI) (PSPEI), prepared by polymerization of sorbitol diacrylate with low molecular weight polyethylenimine, which has high transfection efficiency but low cytotoxicity, and utilized it in siCTGF delivery to silence the expression of CTGF in an animal model of cutaneous wound healing. Unlike contracted scar in normal healing, there was no or less contraction in the healed skin of mice treated with siCTGF using PSPEI. Histologically, the healed tissues also had distinct papillary structures and dense irregular connective tissues that were lacking in the control scar tissues. This study exemplifies a successful treatment of cutaneous wound healing using a polymer system coupled with RNA interference. Hence, the approach holds a great promise for developing new treatments with novel targets in regenerative medicines.
Animals ; Cicatrix* ; Collagen ; Connective Tissue ; Connective Tissue Growth Factor ; Gene Silencing ; Mice ; Models, Animal ; Molecular Weight ; Polyethyleneimine ; Polymerization ; Polymers ; Regenerative Medicine ; RNA Interference ; RNA, Small Interfering* ; Skin ; Sorbitol ; Transfection ; Wound Healing* ; Wounds and Injuries*

Cutaneous leishmaniasis (CL) is a protozoan disease which is endemic in Iran. It is transmitted by the Phlebotomus sand fly. The eyelid is rarely involved possibly because the movement of the lids impedes the sand fly from biting the skin in this region. Here, we report 6 rare cases of eyelid CL. The patients were diagnosed by skin scraping, culture, and PCR from the lesions. Skin scraping examination showed Leishmania spp. amastigotes in the cytoplasm of macrophages. Culture examination was positive for Leishmania spp. PCR was positive for Leishmania major and Leishmania tropica. The lesions were disguised as basal cell carcinoma, chalazion, hordeolum, and impetigo. The patients were treated with intramuscular meglumine antimoniate (20 mg/kg/day) for at least 3 weeks. They showed a dramatic response, and the lesions almost completely disappeared. We emphasized the importance of clinical and diagnostic features of lesions, characterized the phylogenetic relationship of isolated parasites, and reviewed the literature on ocular leishmaniasis.
Carcinoma, Basal Cell ; Chalazion ; Cytoplasm ; Eyelids* ; Hordeolum ; Humans ; Impetigo ; Iran ; Leishmania ; Leishmania major ; Leishmania tropica ; Leishmaniasis ; Leishmaniasis, Cutaneous* ; Macrophages ; Meglumine ; Parasites ; Phlebotomus ; Polymerase Chain Reaction ; Psychodidae ; Skin