Is autologous blood transfusion drainage necessary after total knee arthroplasty：a meta-analysis / 中国组织工程研究

BACKGROUND: Total knee arthroplasty is a procedure for treatment of knee osteoarthritisa with standardized, mature technology and affirmative efficacy. Total knee arthroplasty can result in overt excessive bleeding, decreased hemoglobin levels, patient mouth infection and other complications. As a new technology, autologous blood transfusion device can effectively reduce the rate of blood transfusion through reinfusing the unwashed and filterable drainage blood after operation. Up to now, no systematic reviews incorporating meta-analyses have found directly sufficient evidence to compare autologous blood transfusion drainage and no drainage after primary total knee arthroplasty. OBJECTIVE: To study the clinical efficacy, safety and potential advantages of the application of autologous blood transfusion device/no drainage based on the meta-analysis. METHODS:PubMed, Embase, the Cochrane Library, CBMdisc, China HowNet, VIP, Wanfang database were searched comprehensively by computer. The search strategies were developed by the way of MeSH terms combining with free words: “total knee replacement” OR “total knee arthroplasty” OR “total knee prosthesis” OR “unicompartmental” OR “unicondylar” OR “unicompartmenta” OR “arthroplasty, replacement, knee” [MeSH terms] AND “autologous blood transfusion” OR “Autotransfusion” OR “blood transfusion, autologous” [MeSH Terms] OR “Intraoperative Blood Salvage” OR “Intraoperative Blood” OR “Postoperative Blood Salvage” OR “Intraoperative Blood Cel Salvage” OR “Operative Blood Salvage” [MeSH Terms]. Data included in the final literature were analyzed using RevMan 5.3.5 software recommended by Cochrane. The main outcome measure was the rate of transfusion. The secondary outcome measures were the average change in hemoglobin, hemoglobin levels at the 3rd day, hospitalization time and intraoperative mouth infection rate. RESULTS AND CONCLUSION:Five randomized controlled trials, a total of 667 patients were enroled. Meta-analysis results showed that there were no significant differences in the transfusion rate (OR=0.73, 95%CI: 0.47-1.13;Z=1.41,P=0.16), average change in hemoglobin (WMD=0.20, 95%CI:-0.28-0.68;Z=0.82,P=0.41), the hemoglobin levels at the 3rdday (WMD=0.41, 95%CI:-0.26-1.09;Z=1.20,P=0.23), hospitalization time (OR=1.01, 95%CI: 0.06-16.27;Z= 0.01,P=1.00), intraoperative mouth infection rate (OR=1.01, 95%CI: 0.06-16.27;Z=0.01,P=1.00) between the postoperative use of autologous blood transfusion and no drainage. These results suggest that the meta-analysis of outcome measures has not provided the evidence-based medical support for the clinical efficacy of autologous blood transfusion device (including blood transfusion rate, the average change in hemoglobin, average hemoglobin change at the 3rd day, hospitalization time). Given the inherent limitations of the quality of the included studies and the publication bias, future high-quality, large-volume, multi-center randomized controled trials are awaited to confirm and update the findings of this analysis.

Efficacy and safety of Qiaoshao Formula () on patients with lifelong premature ejaculation of Gan (Liver) depression and Shen (Kidney) deficiency syndrome: A randomized controlled trial / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the effificacy and safety of Qiaoshao Formula (, QSF) on patients with lifelong premature ejaculation (LPE) of Gan (Liver) depression and Shen (Kidney) defificiency syndrome.</p><p><b>METHODS</b>A total of 60 LPE patients were randomly divided into treatment (QSF) and control (dapoxetine) groups. The treatment group received QSF twice a day and the control group received dapoxetine 1 to 2 h prior to planned sexual intercourse for 4 weeks. The outcomes included intra-vaginal ejaculation latency time (IELT), premature ejaculation diagnostic tool (PEDT), clinical global impression of change (CGIC), scores of Chinese medicine symptoms (CMSS), sex life satisfaction (SLS) and adverse events (AEs).</p><p><b>RESULTS</b>In the treated group, the median IELT was 3 min vs. 1.5 min before and after treatment (P<0.05). PEDT in the treated group was reduced to 11.76±1.68 from 15.83±2.30 after treatment (P<0.05). Besides, patient's SLS was improved from 1.30±0.05 to 6.30±0.04 (P<0.05), and spouse's SLS was increased from 1.30±0.to 6.10±0.06 (P<0.05); CMSS was decrease from 14.86±3.02 to 9.62±2.87 (P<0.05). In addition, no significant AE was observed in both groups.</p><p><b>CONCLUSION</b>QSF may be effective and safe on LPE patients with Gan depression and Shen defificiency syndrome.</p>

[Identification of Ardisiae Japonicae Herba by ITS2 Sequence].

OBJECTIVE: The ITS2 sequence was used to identify Ardisiae Japonicae Herba collected from the market, in order to ensure the medicine quality of the market and to provide a reliable technical method. METHODS: The certified samples, including Ardisia japonica and its adulterants, were 56 samples of 17 species. All the sequences of the samples including six related sequences downloaded from NCBI were analyzed by computing the Kimura 2-parameter (K2P) genetic distance and the neighbor-joining (NJ) phylogenetic tree, then the method of DNA barcoding identification technology of Ardisiae Japonicae Herba based on ITS2 sequence was established. Combined with online comparison of sequences, the method was used to detect 15 samples of Ardisiae Japonicae Herba from the market to distinguish authenticity. RESULTS: The maximum and the average intra-specific K2P genetic distance of Ardisia japonica were all less than the minimum and the average inter-specific K2P genetic distance, and Ardisia japonica and its adulterants could be separated by computing the NJ phylogenetic tree. The identification results of online comparison and DNA barcoding identification were the same. In all of the 15 samples, 13 of them were genuine, and the other two samples were fake. CONCLUSION: The DNA barcoding identification technique method of Ardisiae Japonicae Herba is established based on ITS2 sequence, and it provides a reference method to distinguish the authenticity of Ardisiae Japonicae Herba quickly by gene recognition.

Comparison between autologous blood transfusion drainage and closed-suction drainage/no drainage in total knee arthroplasty: a Meta-analysis / 实用医学杂志

Objective To assess the clinical efficiency , safety and potential advantages of autologous blood transfusion (ABT) drains compared with the closed-suction/no drainage. Methods Pubmed, Embase, Cochrane Library, CBMdisc, CNKI, VIP and WANGFANG were searched comprehensively. The statistical anal-ysis was conducted by using the Cochrane Collaboration review Manager 5.3.5. Results The pooled data of seventeen RCTs including a total of 1 993 patients showed that the patients in the ABT drainage group might benefit from the low rate of blood transfusion [ 16 . 59% and 37 . 47%, OR: 0 . 28 ( 0 . 14 ~ 0 . 55 ); 13 . 05% and 16.91%, OR: 0.73 (0.47 ~ 1.13), respectively]. The ABT drainage and the closed-suction drainage/no drainage have the similar clinical efficiency and safety length of hospital stay and wound infection on days 3 post-operative haemoglobin. Conclusion This systematic review provides the evidence that the ABT drainage offers a safe and efficient alternative to CS/no drainage with the lowered blood transfusion rate.

Regulation of single herb pilose antler on the expression of Smad2 and Smad3 in the cartilage of OA rats: an experimental research / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of single herb pilose antler (PA) on the expression of Smad2 and Smad3 in the cartilage of osteoarthritis (OA) rats.</p><p><b>METHODS</b>One hundred 3-month old female healthy SD rats, (200 +/- 20) g, were recruited and routinely fed for 1 week. They were randomly divided into 5 groups, i.e., the low dose PA group, the high dose PA group, the normal saline control group, the model group, and the normal control group, 20 in each group. The model was prepared using classic Hulth method except the normal control group. After 6-week modeling, the model was confirmed successful by pathologic observation. PA at 0.021 g/100 g and 0.084 g/1 00 g was given by gastrogavage to rats in the low dose PA group and the high dose PA group respectively. Normal saline was administered to those in the normal saline control group. No treatment was given to rats in the normal control group and the model group. Bilateral knee cartilages were harvested at week 2,4, and 6. mRNA and protein expressions of Smad2 and Smad3 were detected by immunohistochemical assay, fluorescent quantitative PCR, and Western blot.</p><p><b>RESULTS</b>OA model was successfully prepared by pathological observation. Results of immunohistochemical assay showed that Smad2 and Smad3 expressed extensively in the cartilage, and located inside the chondrocyte membrane. Compared with the model group, mRNA expression of Smad2 and Smad3 obviously increased in the low dose PA group and the high dose PA group at week 2, 4, and 6, showing statistical difference (P < 0.05). Compared with the same group at week 4 after gastrogavage, mRNA expression of Smad2 and Smad3 obviously decreased in the low dose PA group and the high dose PA group at week 6, showing statistical difference (P < 0.05). Compared with the model group, protein expression of Smad2 and Smad3 obviously increased in the chondrocytes of the low dose PA group and the high dose PA group at week 2 and 4, showing statistical difference (P < 0.01). Compared with the same group at week 2 after gastrogavage, protein expression of Smad2 and Smad3 obviously increased in the low dose PA group and the high dose PA group at week 4, showing statistical difference (P < 0.01). Compared with the same group at week 4 after gastrogavage, protein expression of Smad2 and Smad3 obviously decreased in the low dose PA group and the high dose PA group at week 6, showing statistical difference (P < 0.01).</p><p><b>CONCLUSIONS</b>(1) The pilose antler could repair cartilages by regulating mRNA and protein expressions of Smad2 and Smad3. (2) Up-regulating mRNA and protein expressions of Smad2 and Smad3 might be one of important mechanisms for the pathogenesis of OA.</p>

[Erythrocyte protective effects of ginaton in patients undergoing hypothermic cardiopulmonary bypass].

OBJECTIVE: To investigate the erythrocyte protective effects of Ginaton, a ginkgo biloba extract, in patients undergoing hypothermic cardiopulmonary bypass (CPB). METHODS: Sixty patients, who suffered from rheumatic heart disease of ASA grade II-III and scheduled for mitral valve replacement with intravenous anesthesia, were randomly assigned to two groups equally, the Ginaton group and the control group. They were administered with Ginaton 1 mg/kg and saline respectively via intravenous dripping before open heart surgery before beginning CPB. Blood samples were taken from radial artery at different time points, i.e., before CPB (T1), nasopharyngeal temperature (30-31 degrees C) stabilized stage (T2), nasopharyngeal temperature restoration (36 degrees C) stage (T3), 30 min after CPB (T4) and 3 h after CPB (T5), for determination of malondialdehyde (MDA) and superoxide dismutase (SOD) levels in plasma and erythrocyte (P-MDA, E-MDA, P-SOD and E-SOD), as well as the Na+ -K+ -ATPase and Ca+ -Mg2+ -ATPase activities in erythrocytes. RESULTS: As compared with those at T1, in the control group, P-MDA, E-MDA, and E-SOD at T2-T5 and E-SOD at T2 were higher, but E-SOD at T3-T5 were lower (P < 0.01); while in the Ginaton group P-MDA, E-MDA, and E-SOD at T3-T4 were higher (P < 0.05 or P < 0.01). As compared with those in the control group, the levels of P-MDA and E-MDA at T2-T5 were significantly lower, and E-SOD at T3-T5 were higher (P < 0.05 or P < 0.01). Activities of Na+ -K+ -ATPase and Ca+ -Mg2+ -ATPase significantly increased at T2 and gradually decreased after then in both groups (P < 0.05 or P < 0.01), but those at T2-T5 were significantly higher in Ginaton group than in control group (P < 0.05 or P < 0.01). CONCLUSION: Ginaton displays an erythrocyte protecting effect by way of alleviating the lipid peroxidation in erythrocytes' membrane.

Erythrocyte protective effects of ginaton in patients undergoing hypothermic cardiopulmonary bypass / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the erythrocyte protective effects of Ginaton, a ginkgo biloba extract, in patients undergoing hypothermic cardiopulmonary bypass (CPB).</p><p><b>METHODS</b>Sixty patients, who suffered from rheumatic heart disease of ASA grade II-III and scheduled for mitral valve replacement with intravenous anesthesia, were randomly assigned to two groups equally, the Ginaton group and the control group. They were administered with Ginaton 1 mg/kg and saline respectively via intravenous dripping before open heart surgery before beginning CPB. Blood samples were taken from radial artery at different time points, i.e., before CPB (T1), nasopharyngeal temperature (30-31 degrees C) stabilized stage (T2), nasopharyngeal temperature restoration (36 degrees C) stage (T3), 30 min after CPB (T4) and 3 h after CPB (T5), for determination of malondialdehyde (MDA) and superoxide dismutase (SOD) levels in plasma and erythrocyte (P-MDA, E-MDA, P-SOD and E-SOD), as well as the Na+ -K+ -ATPase and Ca+ -Mg2+ -ATPase activities in erythrocytes.</p><p><b>RESULTS</b>As compared with those at T1, in the control group, P-MDA, E-MDA, and E-SOD at T2-T5 and E-SOD at T2 were higher, but E-SOD at T3-T5 were lower (P < 0.01); while in the Ginaton group P-MDA, E-MDA, and E-SOD at T3-T4 were higher (P < 0.05 or P < 0.01). As compared with those in the control group, the levels of P-MDA and E-MDA at T2-T5 were significantly lower, and E-SOD at T3-T5 were higher (P < 0.05 or P < 0.01). Activities of Na+ -K+ -ATPase and Ca+ -Mg2+ -ATPase significantly increased at T2 and gradually decreased after then in both groups (P < 0.05 or P < 0.01), but those at T2-T5 were significantly higher in Ginaton group than in control group (P < 0.05 or P < 0.01).</p><p><b>CONCLUSION</b>Ginaton displays an erythrocyte protecting effect by way of alleviating the lipid peroxidation in erythrocytes' membrane.</p>

[Brain protective effects of ginkgo biloba leaf extract (ginaton) in patients undergoing hypothermic cardiopulmonary bypass].

OBJECTIVE: To investigate the brain protective effects of Ginkgo biloba leaf extract (Ginaton) in patients who underwent hypothermic cardiopulmonary bypass (CPB). METHODS: Sixty patients with rheumatic heart disease of ASA grade II-III, who were scheduled for mitral valve replacement with intravenous anaesthesia, were randomly assigned to two groups, the Ginaton group (30 patients) treated with Ginaton 1 mg/kg by intravenous dripping before open heart for CPB, and the control group (30 patients) with normal saline instead. Blood was synchronously collected from arteriae radialis and vena jugularis interna at 5 time points, namely, before CPB (T1), nasopharyngeal temperature (lowered to 30-31 degrees C) stabilized stage (T2), nasopharyngeal temperature restoration (36 degrees C) stage (T3), 30 min after CPB (T4) and 3 after CPB (Ts) for determining blood gas, lactate acid concentration, activity of superoxide dismutase (SOD) and malonaldehyde (MDA) content. And the oxygen content in artery (CaO2) and jugular vein (CjvO2), the difference of oxygen contents in arterial and jugular vein (Ca-jvO2), the cerebral oxygen extraction ratio (ERO2) as well as the arteriojugular lactate difference (ADVL) were calculated. RESULTS: After the beginning of CPB, as compared with those in the control group, in the Ginaton group, the reduction of Ca-jvO2 and ERO2 was significantly higher (P < 0.05 or P < 0.01) and the increase of lactate acid, ADVL and MDA were significantly lower, and with a remarkably higher SOD activity (P < 0.01). CONCLUSION: Ginaton could improve cerebral oxygen supply, promote SOD activity to inhibit production of free radicals in patients undergoing CPB, and thus shows an evident protective effect in the brain.

Brain protective effects of ginkgo biloba leaf extract (ginaton) in patients undergoing hypothermic cardiopulmonary bypass / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the brain protective effects of Ginkgo biloba leaf extract (Ginaton) in patients who underwent hypothermic cardiopulmonary bypass (CPB).</p><p><b>METHODS</b>Sixty patients with rheumatic heart disease of ASA grade II-III, who were scheduled for mitral valve replacement with intravenous anaesthesia, were randomly assigned to two groups, the Ginaton group (30 patients) treated with Ginaton 1 mg/kg by intravenous dripping before open heart for CPB, and the control group (30 patients) with normal saline instead. Blood was synchronously collected from arteriae radialis and vena jugularis interna at 5 time points, namely, before CPB (T1), nasopharyngeal temperature (lowered to 30-31 degrees C) stabilized stage (T2), nasopharyngeal temperature restoration (36 degrees C) stage (T3), 30 min after CPB (T4) and 3 after CPB (Ts) for determining blood gas, lactate acid concentration, activity of superoxide dismutase (SOD) and malonaldehyde (MDA) content. And the oxygen content in artery (CaO2) and jugular vein (CjvO2), the difference of oxygen contents in arterial and jugular vein (Ca-jvO2), the cerebral oxygen extraction ratio (ERO2) as well as the arteriojugular lactate difference (ADVL) were calculated.</p><p><b>RESULTS</b>After the beginning of CPB, as compared with those in the control group, in the Ginaton group, the reduction of Ca-jvO2 and ERO2 was significantly higher (P < 0.05 or P < 0.01) and the increase of lactate acid, ADVL and MDA were significantly lower, and with a remarkably higher SOD activity (P < 0.01).</p><p><b>CONCLUSION</b>Ginaton could improve cerebral oxygen supply, promote SOD activity to inhibit production of free radicals in patients undergoing CPB, and thus shows an evident protective effect in the brain.</p>

[Observation on short-term therapeutic effect of zhenggan recipe in treating liver cirrhosis with alpha-feto-protein].

OBJECTIVE: To observe the therapeutic effect of Zhenggan Recipe (ZGR) in treating liver cirrhosis with abnormal Alpha-fetoprotein (AFP), and to explore its mechanism. METHODS: Sixty-four patients of liver cirrhosis with abnormal AFP were randomly divided into the treated group and the control group. All the patients received conventional combined Western medicinal treatment. Besides, additional ZGR was given to the patients in the treated group, one dose every day for orally taken in two times, 6 months as a therapeutic course. Changes in liver function (ALT, GGT, TBIL and ALB), AFP, T-lymphocyte subsets (CD4, CD4/CD8) and iconological examination were observed in the two groups before and after treatment to compared the efficacy. RESULTS: ZGR could effectively lower the AFP level (P < 0.01), and improve the levels of CD4 and CD4/CD8 (P < 0.01 or P < 0.05). CONCLUSION: ZGR can effectively lower the level of AFP, its mechanism might be related to the improving of cellular immune function of the patients.

Observation on short-term therapeutic effect of zhenggan recipe in treating liver cirrhosis with alpha-feto-protein / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the therapeutic effect of Zhenggan Recipe (ZGR) in treating liver cirrhosis with abnormal Alpha-fetoprotein (AFP), and to explore its mechanism.</p><p><b>METHODS</b>Sixty-four patients of liver cirrhosis with abnormal AFP were randomly divided into the treated group and the control group. All the patients received conventional combined Western medicinal treatment. Besides, additional ZGR was given to the patients in the treated group, one dose every day for orally taken in two times, 6 months as a therapeutic course. Changes in liver function (ALT, GGT, TBIL and ALB), AFP, T-lymphocyte subsets (CD4, CD4/CD8) and iconological examination were observed in the two groups before and after treatment to compared the efficacy.</p><p><b>RESULTS</b>ZGR could effectively lower the AFP level (P < 0.01), and improve the levels of CD4 and CD4/CD8 (P < 0.01 or P < 0.05).</p><p><b>CONCLUSION</b>ZGR can effectively lower the level of AFP, its mechanism might be related to the improving of cellular immune function of the patients.</p>

[Experimental study on differentiation of human hepatocarcinoma cells induced by zhengganfang drug serum in vitro].

OBJECTIVE: To study the effect of Zhengganfang (ZGF) drug serum in inducing differentiation of Bel-7402 human hepatocarcinoma cell (HHC) and its influence of the telomerase activity. METHODS: Rats were fed with ZGF decoction to prepare the drug-serum of ZGF, and the drug-serum was used for Bel-7402 HHC culture. Serum of normal rat, was taken as negative control and retinoic acid (RA) as the positive control. Cell proliferation was detected by MTT colorimetric assay, nucleocytoplasm ratio by image assay, alpha-fetoprotein (AFP) by RIA, alkaline phosphatase (ALP) activity and gamma-glutamyl transpeptidase (gamma-GT) by dynamic colorimetric assay and telomerase activity of Bel-7402 cell by PCR-ELISA. RESULTS: Drug-serum of ZGF could inhibit the proliferation of Bel-7402 cell, markedly reduce the nucleocytoplasm ratio and the secretion of AFP, decrease gamma-GT activity, increase ALP activity and suppress the telomerase activity of Bel-7402 cell. CONCLUSION: ZGF can induce the differentiation of Bel-7402 HHC, the main mechanism maybe through the suppression of telomerase activity.

Experimental study on differentiation of human hepatocarcinoma cells induced by zhengganfang drug serum in vitro / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the effect of Zhengganfang (ZGF) drug serum in inducing differentiation of Bel-7402 human hepatocarcinoma cell (HHC) and its influence of the telomerase activity.</p><p><b>METHODS</b>Rats were fed with ZGF decoction to prepare the drug-serum of ZGF, and the drug-serum was used for Bel-7402 HHC culture. Serum of normal rat, was taken as negative control and retinoic acid (RA) as the positive control. Cell proliferation was detected by MTT colorimetric assay, nucleocytoplasm ratio by image assay, alpha-fetoprotein (AFP) by RIA, alkaline phosphatase (ALP) activity and gamma-glutamyl transpeptidase (gamma-GT) by dynamic colorimetric assay and telomerase activity of Bel-7402 cell by PCR-ELISA.</p><p><b>RESULTS</b>Drug-serum of ZGF could inhibit the proliferation of Bel-7402 cell, markedly reduce the nucleocytoplasm ratio and the secretion of AFP, decrease gamma-GT activity, increase ALP activity and suppress the telomerase activity of Bel-7402 cell.</p><p><b>CONCLUSION</b>ZGF can induce the differentiation of Bel-7402 HHC, the main mechanism maybe through the suppression of telomerase activity.</p>