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BACKGROUND:In recent years,tranexamic acid has been extensively used to mitigate the substantial blood loss associated with total knee arthroplasty.However,the optimal method of topical application has not yet been established. OBJECTIVE:To evaluate the effectiveness and safety of intraoperative topical application of tranexamic acid combined with physical compression dressing in reducing perioperative blood loss in total knee arthroplasty. METHODS:A retrospective analysis was conducted on 90 patients who underwent total knee arthroplasty at the Honghui Hospital in Xi'an from January 2021 to December 2022.Based on the different topical use methods of tranexamic acid during surgery,patients were divided into three groups,with 30 cases in each group.In the compression dressing group,2 g of tranexamic acid was placed in the articular cavity,and after packing the wound with gauze and cotton pads,a bandage was used to compress the wound.In the periarticular injection group,2 g of tranexamic acid was injected into the surrounding tissue of the articular cavity.In the intra-articular injection group,2 g of tranexamic acid was injected into the articular cavity.The blood loss,operation time,coagulation indicators,inflammatory indicators,and postoperative complications of the three groups were statistically analyzed. RESULTS AND CONCLUSION:(1)In terms of total blood loss,hidden blood loss,and maximum hemoglobin drop,the periarticular injection group had the least amount,and there was no statistically significant difference between the compression dressing group and periarticular injection group(P>0.05).In terms of intraoperative blood loss,the compression dressing group had the least amount,and there were statistically significant differences compared with the periarticular injection group and intra-articular injection group(P<0.05).There was no statistically significant difference in operation time among the three groups(P>0.05).(2)There were no statistically significant differences in coagulation indicators(D-dimer and fibrinogen degradation products)and inflammation indicators(C-reactive protein and erythrocyte sedimentation rate)among the three groups preoperatively and on the first and third days after operation(P>0.05).(3)There was no statistically significant difference observed among the three groups in terms of slow blood flow in the affected limb,intramuscular venous thrombosis,soft tissue swelling,and incidence of wound complications(P>0.05).Additionally,no cases of deep vein thrombosis or pulmonary embolism were detected in any of the groups.(4)The topical application of tranexamic acid combined with compression dressing achieves the same effect as a periarticular injection in terms of simplicity of operation and reduced perioperative blood loss.This method also avoids the trauma caused by repeated punctures and does not increase the incidence of postoperative complications,making it a worthwhile option for clinical promotion.
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OBJECTIVE@#To review the research progress of supraclavicular vascularized lymph node transfer (VLNT).@*METHODS@#The research literature related to supraclavicular VLNT at home and abroad in recent years was extensively reviewed, and the anatomy of supraclavicular lymph nodes, clinical applications, and complications of supraclavicular VLNT were summarized.@*RESULTS@#The supraclavicular lymph nodes are anatomically constant, located in the posterior cervical triangle zone, and the blood supply comes mainly from the transverse cervical artery. There are individual differences in the number of supraclavicular lymph nodes, and preoperative ultrasonography is helpful to clarify the number of lymph nodes. Clinical studies have shown that supraclavicular VLNT can relieve limb swelling, reduce the incidence of infection, and improve quality of life in patients with lymphedema. And the effectiveness of supraclavicular VLNT can be improved by combined with lymphovenous anastomosis, resection procedures, and liposuction.@*CONCLUSION@#There are a large number of supraclavicular lymph nodes, with abundant blood supply. It has been proven to be effective for any period of lymphedema, and the combined treatment is more effective. The more clinical studies are needed to clarify the effectiveness of supraclavicular VLNT alone or in combination, as well as the surgical approach and timing of the combined treatment.
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Humans , Quality of Life , Lymphedema/surgery , Lymph Nodes/blood supply , Lymphatic Vessels/surgery , ExtremitiesABSTRACT
Abstract: To evaluate the early effectiveness of one-stage total knee arthroplasty (TKA) with tibial stem extender for knee arthritis complicated with tibial stress fractures. Methods: Between January 2014 and November 2016, 12 patients (12 knees) with knee arthritis and tibial stress fractures underwent one-stage TKA with tibial stem extender. There were 5 males and 7 females with an average age of 71.5 years (range, 60-77 years). There were 8 cases with osteoarthritis and 4 cases with rheumatoid arthritis. The radiographic examination showed the 6 cases of intra-articular fractures and 6 of extra-articular fractures (including transverse fractures in 4 cases and short oblique fractures in 2 cases); 2 cases complicated with middle and upper fibular stress fractures; all patients of varus deformities. Preoperative Knee Society Score (KSS) clinical score was 31.5±8.4 and functional score was 33.3±9.0. The preoperative range of motion (ROM) of the knee was (65.6±9.6)°. Results: All indexes healed primarily and no wound infection or skin necrosis occurred. All patients were followed up 36.5 months on average (range, 6-52 months). X-ray films showed that all fractures healed at 3-7 months (mean, 4 months); the position of the prosthesis was good, and no loosening or signs of infection occurred. At last follow-up, the KSS clinical score was 90.5±8.9 and functional score was 92.1±7.8; the ROM of the knee was (115.0±9.8)°. All indicators were significantly improved than those before operation ( t=40.340, P= 0.000; t=32.120, P=0.000; t=8.728, P=0.000). Conclusion: One-stage TKA with tibial stem extender for patients with knee arthritis and tibial stress fractures can restore limb alignment, facilitate fracture healing, and obtain the satisfactory early effectiveness.
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Objective:To analyze one case of diabetes allergic to insulin preparations and investigate the role of clinical pharmacist in the treatment. Methods:Different insulin preparations were tried out after the patient was allergic to one kind of insulin preparation. However, the allergic symptoms were not improved significantly. Clinical pharmacist recommended to use glargine combined with oral hypoglycemic drugs instead of insulin containing protamine for the patient. Results:The allergic symptoms of the patient were improved significantly after the drug adjustment in the hypoglycemic program by clinical pharmacist. The blood glucose was controlled and aller-gic symptoms didn't show again during the hospitalization. Conclusion:Clinical pharmacist can participate in the treatment of diabetes allergic to insulin preparations through identifying allergens accurately and improving individual hypoglycemic program using pharmaco-logical knowledge. It is important to improve the clinical diagnosis and treatment, and ensure and promote the safety of medical treat-ment and drug use.
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OBJECTIVE:To investigate the influence of hypoglycemic combined with lipid-lowering statin therapy on lipid profile of mixed dyslipidemia patients with T2DM and TG in 2.3-4.5 mmol/L. METHODS:In total of 80 patients with T2DM and mixed dyslip-idemia of TG in 2.3-4.5 mmol/L in our hospital was determined according to the patient’s age,chronic complications of diabetes and life expectancy. Hypoglycemic(insulin joint oral hypoglycemic drugs,or oral antidiabetic drug alone)treatment was given according to corresponding target,meanwhile statin lipid-lowering therapy was also given. HbA1c,TG,TC,HDL-C and LDL-C were determined and BMI was calculated before treatment. Alipid was reviewed after two weeks,then the difference was compared. RESULTS:Com-pared with before treatment,TG,TC and LDL-C were decreased by 50.28%,42.91% and 44.37% after hypoglycemic combined with lipid-lowering statin therapy,with significant difference(P<0.01). Insulin was the better choice to reduce the level of TG,there was significant difference between insulin treatment and oral hypoglycemic drugs alone (P<0.05). CONCLUSIONS:For T2DM patients with mixed dyslipidemia of TG between 2.3-4.5 mmol/L,hypoglycemic combined with lipid-lowering statin therapy can not only signifi-cantly reduce the levels of TG,TC,LDL-C and TG to 2.3 mmol/L or less,and even normal. Compared with oral hypoglycemic drugs alone,the compliance rate of TG was higher in the combination of insulin and oral hypoglycemic drugs.
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To explore the effect of insulin therapy on serum level of insulin-like growth factor-I(IGF-I)in patients with type 2 diabetes mellitus.The results showed that serum IGF-I level increased[(126.70±51.91 vs 90.04±43.68)μg/L,P<0.01]and was positively correlated with insulin level in patients with type 2 diabetes mellitus after exogenous insulin therapy(r=0.298,P<0.05).