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AIM: To determine the longitudinal trajectories of anxiety and depression among pregnant women who have experienced pregnancy loss, and to explore the association between post-traumatic stress symptoms (PTSS) related to pregnancy loss and these trajectories. DESIGN: A prospective longitudinal study. METHODS: Between October 2022 and August 2023, pregnant women with a history of pregnancy loss were recruited from four hospitals in Guangdong Province, China. Eligible participants were screened for PTSS related to pregnancy loss upon enrolment. Anxiety and depression symptoms were assessed in early, mid and late pregnancy using the Pregnancy-related Anxiety Questionnaire-Revised 2 and the Patient Health Questionnaire-9, respectively. Latent class growth analysis was employed to categorize anxiety and depression trajectories, and multinomial logistic regression analysis was conducted to examine the association between PTSS and these trajectories. RESULTS: Of the 388 participants included in the analysis, 158 individuals (40.7%) reported high PTSS scores. The best-fitting models identified three trajectories for both anxiety and depression: low (anxiety: 35.6%, depression: 48.7%), moderate (anxiety: 44.8%, depression: 40.5%) and high (anxiety: 19.6%, depression: 10.8%). Pregnant women with high PTSS levels were significantly more likely to experience moderate-to-high trajectories of anxiety and depression compared to those with low PTSS levels. CONCLUSION: Pregnant women who have experienced pregnancy loss exhibit higher incidences of elevated anxiety and depression trajectories. Screening for PTSS and targeted supportive care are recommended to alleviate anxiety and depressive symptoms in this population. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study underscores the importance of early psychological screening and tailored interventions for pregnant women with a history of pregnancy loss. Trauma-informed care should be prioritized to mitigate anxiety and depression trajectories in this vulnerable population. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public involvement.
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PURPOSE: Intertrochanteric fractures undergoing proximal femoral nail antirotation (PFNA) surgery are associated with significant hidden blood loss. This study aimed to explore whether intramedullary administration of tranexamic acid (TXA) can reduce bleeding in PFNA surgery for intertrochanteric fractures in elderly individuals. METHODS: A randomized controlled trial was conducted from January 2019 to December 2022. Patients aged over 60 years with intertrochanteric fractures who underwent intramedullary fixation surgery with PFNA were eligible for inclusion and grouped according to random numbers. A total of 249 patients were initially enrolled, of which 83 were randomly allocated to the TXA group and 82 were allocated to the saline group. The TXA group received intramedullary perfusion of TXA after the bone marrow was reamed. The primary outcomes were total peri-operative blood loss and post-operative transfusion rate. The occurrence of adverse events was also recorded. Continuous data was analyzed by unpaired t-test or Mann-Whitney U test, and categorical data was analyzed by Pearson Chi-square test. RESULTS: The total peri-operative blood loss (mL) in the TXA group was significantly lower than that in the saline group (577.23 ± 358.02 vs. 716.89 ± 420.30, p = 0.031). The post-operative transfusion rate was 30.67 % in the TXA group and 47.95 % in the saline group (p = 0.031). The extent of post-operative deep venous thrombosis and the 3-month mortality rate were similar between the 2 groups. CONCLUSION: We observed that intramedullary administration of TXA in PFNA surgery for intertrochanteric fractures in elderly individuals resulted in less peri-operative blood loss and decreased transfusion rate, without any adverse effects, and is, thus, recommended.
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BACKGROUND: Osteoarthritis (OA) is a common disease that causes pain to many older adults. Because the pathogenesis is not fully elucidated, effective drug therapies are currently lacking. This study aimed to determine how salidroside (Sal)-mediated reduction of osteoarthritis development in mice worked and to identify the underlying mechanism. METHODS: Using in vitro experiments, ATDC5 cells were treated with various concentrations of Sal and interleukin (IL)-1ß for 24 hours to mimic OA. An enzyme-linked immunosorbent assay (ELISA) was conducted to detect the production of pro-inflammatory cytokines and reactive oxygen species (ROS). Western blotting was performed to observe the nuclear factor-kappa B (NF-κB) and nuclear factor erythroid 2-related factor 2 (Nrf2) pathways. In in vivo experiments, pathological examination was used to assess the effects of Sal on alleviating OA progression in mice. Nrf2 signaling and its downstream proteins were further tested by immunofluorescence analysis. RESULTS: The results showed that both pro-inflammatory cytokines and ROS were significantly reduced following Sal treatment in a concentration-dependent manner. Western blotting revealed that Sal could inhibit the expression of the NF-κB/hypoxia-inducible factor-2α pathway and activate the Nrf2/heme oxygenase-1 pathway. In vivo experiments showed that the cartilage surface in the saline-treated group eroded to a greater extent than the Sal-treated groups (p < 0.001). Immunohistochemistry analysis revealed that matrix metallopeptidase (MMP) 9, MMP13, and a disintegrin and metalloproteinase with thrombospondin motifs-5 (ADAMTS-5) decreased expression level. In contrast, collagen-II and aggrecan increased in the Sal-treated groups compared to the saline-treated group. CONCLUSIONS: Our findings indicate that Sal can alleviate OA progression by promoting anti-oxidant expression and inhibiting degradation enzyme expression. These findings suggest that Sal inhibits the NF-κB pathway and its downstream targets through up-regulating the Nrf2 pathway.