Intramedullary administration of tranexamic acid reduces bleeding in proximal femoral nail antirotation surgery for intertrochanteric fractures in elderly individuals: A randomized controlled trial.

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.

Salidroside Protects Chondrocytes against IL-1ß-Induced Injury and Alleviates Osteoarthritis Progression by Activating the Nrf2 Pathway.

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.

Psychological distress in subsequent pregnancy among women with a history of pregnancy loss: A latent profile analysis.

BACKGROUND: Women who have undergone pregnancy loss can experience a range of psychological distress during subsequent pregnancies; however, the outcomes may vary based on individual circumstances. OBJECTIVE: To explore the potential patterns of psychological distress for pregnant women with a history of pregnancy loss, and to investigate the impact of factors related to pregnancy loss on these patterns. METHODS: From October 2022 to August 2023, the participants were recruited from four medical centers in Guangdong Province, China. They completed a questionnaire survey comprising sociodemographic and obstetric characteristics, the Perceived Stress Scale-4 (PSS-4), the Impact of Event Scale-Revised (IES-R), the Pregnancy-related Anxiety Questionnaire-Revised 2 (PRAQ-R2), and the Patient Health Questionnaire-9 (PHQ-9). Latent profile analysis was used to determine optimal patterns of psychological distress. The logistic regression was conducted to assess the associations between the number of pregnancy loss, types of pregnancy loss, inter-pregnancy interval, and distinct psychological distress patterns. RESULTS: A total of 446 pregnant women with a history of pregnancy loss were included for formal analysis. Three distinct profiles were identified, namely the "mild psychological distress" (34.1 %), "moderate psychological distress" (57.8 %), and "severe psychological distress" (8.1 %). Recurrent pregnancy loss was associated with increased risks of both moderate (adjusted odds ratio [aOR] 2.45, 95 % confidence interval [CI]: 1.42-4.24; P = 0.001) and severe psychological distress (aOR 2.93, 95 %CI: 1.25-6.83; P = 0.013). Furthermore, compared to women who conceived after 6 months of pregnancy loss, those who conceived within 6 months of pregnancy loss were more likely to be categorized into the group of moderate psychological distress (aOR 2.00, 95 % CI: 1.21-3.30; P = 0.007). CONCLUSIONS: Approximately two-thirds of pregnant women with a history of pregnancy loss exhibit moderate to severe psychological distress. Such individuals could benefit from early screening and targeted psychological interventions, particularly those who have encountered recurrent pregnancy loss and those who conceive shortly after a pregnancy loss.

Effective adsorption of Pb(ii) from wastewater using MnO2 loaded MgFe-LD(H)O composites: adsorption behavior and mechanism.

Pb(ii) adsorption by MnO2/MgFe-layered double hydroxide (MnO2/MgFe-LDH) and MnO2/MgFe-layered metal oxide (MnO2/MgFe-LDO) materials was experimentally studied in lab-scale batches for remediation property and mechanism analysis. Based on our results, the optimum adsorption capacity for Pb(ii) was achieved at the calcination temperature of 400 °C for MnO2/MgFe-LDH. Langmuir and Freundlich adsorption isotherm models, pseudo-first-order and pseudo-second-order kinetics, Elovich model, and thermodynamic studies were used for exploring the Pb(ii) adsorption mechanism of the two composites. In contrast to MnO2/MgFe-LDH, MnO2/MgFe-LDO400 °C has a stronger adsorption capacity and the Freundlich adsorption isotherm model (R2 > 0.948), the pseudo-second-order kinetic model (R2 > 0.998), and the Elovich model (R2 > 0.950) provide great fits to the experimental data, indicating that the adsorption occurs predominantly via chemisorption. The thermodynamic model suggests that MnO2/MgFe-LDO400 °C is spontaneously heat-absorbing during the adsorption process. The maximum adsorption capacity of MnO2/MgFe-LDO400 °C for Pb(ii) was 531.86 mg g-1 at a dosage of 1.0 g L-1, pH of 5.0, and temperature of 25 °C. Through characterization analysis, the main mechanisms involved in the adsorption process were precipitation action, complexation with functional groups, electrostatic attraction, cation exchange and isomorphic replacement, and memory effect. Besides, MnO2/MgFe-LDO400 °C has excellent regeneration ability in five adsorption/desorption experiments. The above results highlight the powerful adsorption capacity of MnO2/MgFe-LDO400 °C and may inspire the development of new types of nanostructured adsorbents for wastewater remediation.

Enhancing mechanism of arsenic(iii) adsorption by MnO2-loaded calcined MgFe layered double hydroxide.

The use of MnO2/MgFe-layered double hydroxide (MnO2/MgFe-LDH) and MnO2/MgFe-layered double oxide (MnO2/MgFe-LDO400 °C) for arsenic immobilization from the aqueous medium is the subject of this research. Fourier transform infrared spectroscopy, X-ray diffraction, X-ray photoelectron spectroscopy, scanning electron microscopy, and transmission electron microscopy were used to characterise MnO2/MgFe-LDH and MnO2/MgFe-LDO400 °C. Based on our developed method, MnO2 was spread on the clay composites' surfaces in the form of a chemical bond. The clay composite exhibited a good adsorption effect on arsenic. The experimental findings fit the pseudo-second-order model well, indicating that the chemisorption mechanism played a significant role in the adsorption process. Furthermore, the Freundlich model suited the adsorption isotherm data of all adsorbents well. The recycling experiment showed that MnO2/MgFe-LDH and MnO2/MgFe-LDO400 °C exhibited good stability and reusability. In summary, MnO2/MgFe-LDH and MnO2/MgFe-LDO400 °C are promising for developing processes for efficient control of the pollutant arsenic.

Development and Psychometric Validation of the Perinatal Bereavement Care Competence Scale for Midwives.

PURPOSE: The aim of this paper is to develop a scale for measuring the perinatal bereavement care competence of midwives and assess its psychometric properties. METHODS: The Perinatal Bereavement Care Competence Scale was developed in four phases. (1) Item generation: 75 items were formulated based on a literature review and interviews with midwives. (2) Delphi expert consultation: 15 experts evaluated whether the items were clear/appropriate/relevant to the questionnaire dimensions, and the items were optimized. (3) Pilot test: The comprehensibility, acceptability, and time required to complete the questionnaire by midwives were assessed. (4) Evaluation of reliability and validity: The scale was validated by initial item analysis, exploratory and confirmatory factor analyses, and internal consistency reliability and test-retest reliability. RESULTS: The final scale consisted of six dimensions and 25 items: maintaining belief (three items), knowing (four items), being with (six items), preserving dignity (four items), enabling (five items), and self-adjustment (three items). Exploratory factor analysis yielded a six-factor structure that was consistent with the theoretical framework and explained 70.8% of the total variance. Confirmatory factor analysis indicated a good fit for the six-factor model. Cronbach's α for the scale was 0.931, and the test-retest reliability coefficient was 0.968. CONCLUSION: The Perinatal Bereavement Care Competence Scale is a valid and reliable instrument for measuring the competence of midwives in caring for bereaved parents who have experienced perinatal loss.

Efficacy and safety of tranexamic acid for reducing blood loss in elderly patients with intertrochanteric fracture treated with intramedullary fixation surgery: A meta-analysis of randomized controlled trials.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of tranexamic acid (TXA) in elderly patients with intertrochanteric fracture undergoing intramedullary fixation surgery. METHODS: We searched MEDLINE, the Cochrane Library and EMBASE for published randomized clinical trials relevant to use of TXA in elderly patients with intertrochanteric fracture treated with intramedullary fixation surgery. Meta-analysis was performed according to the guidelines of the Cochrane Reviewer's Hand book. RESULTS: Five trials assessing 540 patients were included for meta-analysis. The pooled results showed that the mean total blood loss in TXA group was significant lower than that in the control group (mean difference - 172.83, 95% CI -241.43 to -104.23; p<0.00001, fixed-effect model). The intra- and postoperative transfusion rate for the TXA group was 34.4% (91/264) and for the control group was 49.27% (136/276), and the relative risk was 0.71 (95% CI 0.52 to 0.97; p<0.03, random-effect model) with substantial heterogeneity (I2=63%, p=0.03). The overall incidence of thrombotic events was 6.43% (17/264) in the intravenous TXA group, 7.63% (21/275) in the control group, with no significant difference (relative risk 0.84, 95% CI 0.46 to 1.54; p=0.57, fixed-effect model). CONCLUSION: The present evidence shows that TXA can significantly reduce total and hidden blood loss, transfusion rate, and do not increase the risk of thrombotic events in elderly patients with intertrochanteric fracture undergoing intramedullary fixation surgery. However, the impact of TXA on thrombotic events needs to be researched in more high-quality, large-sample randomized clinical trials. LEVEL OF EVIDENCE: Level I Therapeutic Study.

Quantification and influencing factors of perioperative hidden blood loss during intramedullary fixation for intertrochanteric fractures in the elderly.

INTRODUCTION: We aimed to quantify perioperative hidden blood loss (HBL) and investigate its influencing factors in elderly patients with intertrochanteric fractures (IFs) undergoing intramedullary fixation surgery. MATERIALS AND METHODS: We prospectively collected the clinical data of 200 elderly patients with IFs treated with intramedullary fixation surgery in our hospital between December 1, 2014 and August 31, 2018. The intraoperative visible blood loss, blood transfusion rate, and pre- and postoperative hemoglobin (Hb) levels as well as the general characteristics of the enrolled patients were recorded. A multiple linear regression analysis model (stepwise) was used to identify independent factors affecting perioperative HBL. RESULTS: The mean perioperative HBL was 614.72 ± 368.14 mL, which accounted for 84.05% of the mean total perioperative blood loss (731.37 ± 391.50 mL). The mean preoperative HBL was 368.33 ± 325.57 mL, which accounted for 50.36% of the mean total perioperative blood loss. Patients with fracture types AO/OTA 31-A2.2 to A3.3 had more severe preoperative HBL (median 580.10 mL), and most of them developed mild-to-moderate anemia before the operation, and 27.63% of them received preoperative blood transfusion. Compared with patients operated within 5 days after injury, patients operated over 5 days had lower Hb value at admission (101.56 ± 19.49 vs. 107.28 ± 16.53; P = 0.026) and higher preoperative transfusion rate (25.84% vs. 9.01%; P = 0.001). Multiple linear regression analysis revealed that fracture types AO/OTA 31-A2.2 to A3.3, male sex, right-sided injury, and operation time > 60 min were independently associated with increased perioperative HBL. Tranexamic acid treatment was negatively correlated with perioperative HBL. CONCLUSION: IFs in elderly patients undergoing intramedullary fixation surgery were associated with significant perioperative HBL and anemia. Persistent HBL occurred before the operation and on the first few postoperative days. Surgeons should pay more attention to preoperative HBL in patients with fracture types AO/OTA 31-A2.2 to A3.3 and regularly measure Hb levels preoperatively to avoid anemia. Shortening preoperative time may helps to reduce preoperative blood loss.

Efficacy and Safety of Tranexamic Acid for Controlling Bleeding During Surgical Treatment of Intertrochanteric Fragility Fracture with Proximal Femoral Nail Anti-rotation: A Randomized Controlled Trial.

BACKGROUND: Intertrochanteric fragility fracture (IFF) treated with proximal femoral nail anti-rotation (PFNA) is associated with significant hidden blood loss and high blood transfusion rate. The purpose of the present study was to evaluate the efficacy and safety of tranexamic acid (TXA) in reducing blood loss in these patients. MATERIALS AND METHODS: Consecutive eligible patients were recruited and randomly assigned to a TXA group or a control group. The TXA group received 15 mg/kg body weight of TXA intravenously 15 min before incision and the same dose 3 h later. The control group received 100 mL of saline intravenously 15 min before incision. The efficacy outcomes included the total perioperative blood loss, postoperative transfusion rate, postoperative hemoglobin level, and length of the hospital stay. The safety outcomes were the incidence of thrombotic events and the mortality rate within 6 weeks after surgery. RESULTS: We had 44 patients in the TXA group and 46 patients in the control group for the final analysis. The TXA group had significantly lower total perioperative blood loss than the control group (384.5 ± 366.3 mL vs. 566.2 ± 361.5 mL; P < 0.020). Postoperative transfusion rate was 15.9% in the TXA group versus 36.9% in the control group (P = 0.024). Each group had one patient with postoperative deep venous thrombosis. In the control group, three patients had cerebral infarction, and one patient died within 6 weeks after the operation. CONCLUSION: Intravenous TXA is effective in reducing total perioperative blood loss and transfusion rate in IFF treated with PFNA. No increased risk of thrombotic events was observed with the use of TXA; however, this study was underpowered for detecting this outcome. Further research is necessary before TXA can be recommended for high-risk patients.

Proximal femoral nail antirotation versus hemiarthroplasty in the treatment of senile intertrochanteric fractures: Case report.

BACKGROUND: Primary hemiarthroplasty was recommended by some surgeons as the preferred choice in treating unstable senile intertrochanteric fractures with osteoporosis. However, many studies reported that proximal femoral nail antirotation (PFNA) currently was as an optimal implant for the treatment of different type of intertrochanteric fractures. Which method is better for treating senile intertrochanteric fractures remains controversial due to the insufficient clinical evidences. METHODS: We reviewed all consecutive senile intertrochanteric fractures treated with PFNA or cemented hemiarthroplasty at our institution between July 2010 and March 2015. The primary outcome measures were postoperative complications, reoperation rate and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, postoperative hemoglobin, hospital stay and 1- year mortality. RESULTS: Seventy-one patients in PFNA group and 52 patients in hemiarthroplasty group were included for analysis. There were no significant differences between the two groups regarding to the orthopaedic complications, reoperation rate, surgical time and Harris Hip Score at 1year follow-up. Significant differences were found between PFNA and hemiarthroplasty group in comparison of intraoperative blood loss (P<0.001), transfusion rate, medical complications (P=0.037) and hospital stay (P=0.001). Patients treated with hemiarthroplasty had a trend of higher postoperative 1- year mortality compared to those underwent PFNA but this was statistically not significant (P=0.134). CONCLUSIONS: These findings indicate that PFNA has obvious advantages over hemiarthroplasty in the treatment of senile intertrochanteric fractures. Hemiarthroplasty in treating these fractures is associated with greater surgical trauma and higher incidence of postoperative medical complications.

Operative Versus Nonoperative Treatment for Displaced Intra-Articular Calcaneal Fractures: A Meta-Analysis of Randomized Controlled Trials.

The purpose of the present study was to perform an updated meta-analysis of the operative versus nonoperative treatment of displaced intra-articular calcaneal fractures in adults. We searched the Cochrane Library, MEDLINE, EMBASE, and Google Scholar for eligible studies. All published randomized controlled trials comparing operative with nonoperative treatment for displaced intra-articular calcaneal fractures were eligible. The meta-analysis was performed using RevMan, version 5.0, software. Seven studies assessing 824 patients were eligible for the meta-analysis. The pooled results indicated no significant differences between the 2 groups with regard to the functional results. The incidence of complications was 25.0% (80 of 319) in the operative group and 16.6% (55 of 330) in the nonoperative group (relative risk 1.53, 95% confidence interval 1.13 to 2.08; p = .006) with a significant difference. The rate of subtalar arthrodesis was significantly lower in the operative group than in the nonoperative group. The current evidence is still insufficient to ascertain whether operative treatment is superior to nonoperative treatment for displaced intra-articular calcaneal fractures. Operative treatment can reduce the risk of late subtalar arthrodesis but is associated with a greater risk of complications. The small sample size and the great heterogeneity of the included studies made it difficult to draw conclusions regarding some of the combined results. Furthermore, more high-quality, randomized controlled trials with long-term follow-up data on this issue are required to provide evidence for surgeons to make an informed decision.

Impact of postoperative drainage autologous blood re-transfusion on the coagulation parameters and D-dimer levels of patients after total hip arthroplasty.

BACKGROUND: Postoperative drainage autologous blood re-transfusion (ABT) is an important treatment method that maintains a high haemoglobin (HGB) content and obviates the need for allogeneic blood transfusion in patients after surgery. However, the safety of ABT remains controversial. OBJECTIVES AND METHODS: This study aimed to investigate the safety of postoperative drainage ABT in primary total hip arthroplasty (THA). In this randomized, controlled study, patients undergoing THA were selected and randomly divided into two groups. A device for postoperative ABT was used for the 49 patients in the ABT group, whereas conventional postoperative vacuum drainage was used for the 42 patients in the drainage blood (Drain) group without ABT. The coagulation parameters and D-dimer (DD) levels of the two groups of patients were recorded before surgery (T0) and on postoperative days one (T1), three (T2), seven (T3), and 14 (T4). RESULTS: A within-group comparison after THA showed that the postoperative fibrinogen (FIB) and DD levels were higher than those before surgery in both groups (P < 0.01). A between-group comparison showed that, at different time points, the postoperative drainage blood amount and the coagulation parameters were not significantly different between the two groups. Compared with the Drain group, the DD levels in the ABT group were significantly higher at T1, T2, and T3 (P < 0.05). CONCLUSION: Postoperative drainage ABT did not significantly impact the coagulation parameters of patients after THA. However, the DD levels after ABT significantly increased, which may affect the risk of thrombosis.

Systematic review of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures in older patients.

The purpose of this review was to assess the effectiveness and safety of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures in older patients. We searched the Cochrane Library, MEDLINE and EMBASE for published randomized clinical trials comparing cemented with uncemented hemiarthroplasty for femoral neck fractures. Eight trials assessing 1,175 hips were eligible for meta-analysis. The pooled results showed that there was no significant difference between cemented and uncemented group with regard to the mortality, reoperation rates and postoperational complications. The overall incidence of residual pain at 1 year after operation was 23.6% in the cemented prosthesis and 34.4% in the uncemented, with significant difference (relative risk 0.69, 95% CI 0.53-0.90; P = 0.007; fixed-effect models).The available evidence suggested that compared with uncemented hemiarthroplasty, cemented hemiarthroplasty in treating the elderly with displaced femoral neck fractures was not associated with a higher risk of mortality, reoperation and complications but can reduce the risk of residual pain and provide better functional results.

[Case-control studies on locking plates and dynamic hip screw in treatment of intertrochanteric hip fractures].

OBJECTIVE: To explore the clinical effects of locking plates in the treatment of intertrochanteric hip fractures. METHODS: From February 2006 to December 2008,108 patients with intertrochanteric hip fractures treated with locking plate and DHS were retrospective analyzed. Fifty-one patients were treated with locking plates, including 23 males and 28 females, aged 45 to 86 years old (averaged 66.0 years old); and fifty-seven patients were treated with DHS, including 26 males and 31 females,aged 43 to 81 years old (averaged 64.1 years old). The outcome measures collected for statistical analysis on the following aspects: operative time, blood loss, drainage, healing time, complications and Harris scores. RESULTS: One hundred and eight patients were followed up ranging from 8 to 24 months (averaged 12.5 months). In locking plate group, the operative time was (87 +/- 14) minutes; blood loss was (367 +/- 213) ml; drainage was (63 +/- 14) ml; healing time was (11.9 +/- 3.4) weeks; 7 patients had complications; and the Harriss score was (85 +/- 6). While in DHS group, the operative time was (115 +/- 23) minutes; blood loss was (582 +/- 243) ml; drainage was (98 +/- 16) ml; healing time was (12.4 +/- 2.5) weeks; 9 patients had complications; and the Harriss score was (84 +/- 8). There were no significant differences in the healing time, complications and Harris scores between two groups (P > 0.05),but there were significant differences in the operative time,blood loss, drainage between two groups (P < 0.05). Comparing with DHS group, the locking plate group was of shorter operative time, fewer blood loss and drainage. CONCLUSION: Proximal femoral locking plate is simple, minimally invasive,stable fixation with fewer complications, and is an effective method for intertrochanteric hip fractures.

Systematic review of patellar resurfacing in total knee arthroplasty.

Controversies existing over resurfacing the patella in total knee arthroplasty remain in the literature. The purpose of this review was to evaluate the effectiveness of resurfacing versus nonresurfacing the patella in total knee arthroplasty. We searched the Cochrane Library, MEDLINE and EMBASE for published randomised clinical trials relevant to patellar resurfacing. The relative risk of reoperation was significantly lower for the patellar resurfacing group than for the nonresurfacing group (relative risk 0.57, 95% confidence interval 0.38-0.84, P =0.004). The overall incidence of postoperative anterior knee pain of the 1,421 knees included was 12.9% in the patellar resurfacing group and 24.1% in the nonresurfacing group. The existing evidence indicates that patellar resurfacing can reduce the risk of reoperation with no improvement in postoperative knee function or patient satisfaction over total knee arthroplasty without patellar resurfacing. Whether it can decrease the incidence of anterior knee pain remains uncertain.