A case with no administration of protamine to neutralize heparin in aortic valve replacement with cardiopulmonary bypass.

Systemic heparinization is necessary before cardiopulmonary bypass (CPB) in cardiac surgery, and protamine administration to neutralize heparin for hemostasis is required at the end of CPB. Because protamine is an allogeneic protein extracted from the sperm of specific fish, serious adverse reactions can occur during clinical application, with potentially catastrophic outcomes. A male patient received aortic valve replacement with CPB. Severe allergic reactions occurred postoperatively after protamine administration for neutralization. Emergency heparinization and CPB re-establishment were conducted with no further hemostatic treatment with protamine. However, the patient suffered a massive hemorrhage and was treated symptomatically with blood transfusion and rehydration. Following two thoracotomies for hemostasis, the patient healed and was eventually discharged. Protamine is irreplaceable as the only hemostatic that neutralizes heparin for cardiac CPB at present. However, because it is an alloprotein, it can cause serious allergic reactions after entering the human body, and caution should be exercised during the process of its clinical application.

Effect of transcutaneous electrical acupoint stimulation on bone metabolism in patients with immobilisation after foot and ankle fracture surgery: a randomised controlled trial study protocol.

INTRODUCTION: Fracture is a disease with a high incidence worldwide. Foot and ankle fractures are common among fractures of the lower extremities. Foot and ankle fractures usually require surgical fixation and a period of fixed treatment, which can lead to decreased bone density. Although transcutaneous electrical acupoint stimulation (TEAS) is widely used for movement system diseases, there is minimal evidence to show the effectiveness of TEAS on patients after surgical fixation of ankle and foot fractures. This trial aims to evaluate whether TEAS can reduce bone loss in patients with immobilisation after ankle and foot fractures. METHODS AND ANALYSIS: A randomised controlled trial will be conducted in which 60 patients will be randomly divided into two groups: (a) the control group will be treated according to the routine procedures of basic orthopaedics treatment; (b) in the treatment group, bilateral SP36, BL23 and ST36 will be performed on the basis of the control group, and the test will be performed for 30 min every other day for a total of 8 weeks. Bone turnover markers will be used as primary outcome. Secondary outcomes are composed of blood phosphorus, blood calcium and bone mineral density. Treatment safety will be monitored and recorded. ETHICS AND DISSEMINATION: This trial is approved by the Ethics Committee of Beijing University of Chinese Medicine (2020BZYLL0611) and the Ethics Committee of Beijing Luhe Hospital (2020-LHKY-055-02), and inpatients who meet the following diagnostic and inclusion criteria are eligible to participate in this study. TRIAL REGISTRATION NUMBER: ChiCTR 2000039944.

[Expression of IMP3 in osteosarcoma and its clinical significance].

AIM: To analyze the expressional variability of IMP3 between osteosarcoma and osteochondroma and explore its clinical significance. METHODS: Paraffin sections from 68 patients with osteosarcoma and 20 patients with osteochondroma were examined for the expression of IMP3 by SP immunohistochemistry. RESULTS: The negative, weak positive, moderate positive and strong positive expression rates of IMP3 in 68 patients with osteosarcoma were 4.41% (3/68), 22.06% (15/68), 22.74% (19/68), 45.59% (31/68), respectively, which were significantly higher than those in 20 cases of osteochondroma tissues (P<0.01). The positive expression of IMP3 in osteosarcoma was negative correlation with the 3-year survival rate of osteosarcoma patients after the operation (P<0.01). CONCLUSION: The results suggest that IMP3 plays important roles in the tumorigenesis, progress and prognosis of osteosarcoma, and the expression of IMP3 may be an important feature of osteosarcoma.