Application of valve removal technique in improved endoscopic dacryocystorhinostomy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the efficacy of valve removal technology in improved endoscopic dacryocystorhinostomy.METHODS: Prospective randomized controlled study. A total of 92 patients(98 eyes)with nasolacrimal duct obstruction who underwent endoscopic dacryocystorhinostomy in our hospital from November 2020 to September 2022 were selected as the study subjects and they were randomly divided into group A(traditional group)and group B(improved group). The nasal mucosal flap was preserved after incision of the nasal mucosa in group A, the lacrimal sac flap and nasal mucosal flap were trimmed to an appropriate shape after the incision of the lacrimal sac, and the lacrimal sac flap the nasal mucosal flap were matched up. Group B made a “□” shaped incision on the nasal mucosa to remove the complete square nasal mucosa tissue. After the lacrimal sac was incised, the lacrimal sac mucosa was preserved as much as possible, and then the residual nasal mucosa was trimmed to make the lacrimal sac flap close to but not in contact with the residual nasal mucosa. Furthermore, the intraoperative bleeding volume and surgical duration of two groups of patients were recorded, and follow up until 3 mo postoperative. Nasal endoscopy and lacrimal duct flushing examinations were performed at 1 and 3 mo postoperative, respectively. The proliferation of granulation tissue within 5 mm of the ostial postoperative and the therapeutic effect were observed.RESULTS: At 3 mo postoperatively, 6 patients(7 eyes)who were lost to follow-up were excluded. A total of 44 eyes were included in group A, and 47 eyes were included in group B. The bleeding volume [27.00(22.00, 41.00)mL] and the surgical duration [35.00(33.00, 42.00)min] in group B were significantly lower than those in the group A(P<0.001). At 1 mo postoperatively, granulation tissue hyperplasia was observed within 5 mm of the ostial in 12 eyes of group A. In group B, granulation tissue hyperplasia was observed within 5 mm of the ostial in 1 eye. At 3 mo postoperatively, there were 9 eyes in group A with ostial adhesions but incomplete closure, and 2 eyes with complete closure; group B had 1 eye with mild adhesions at the ostial site and no ostial closure. The postoperative complications in the group B were significantly less than those in the group A(P<0.05), and the therapeutic effect was better than that in the group A(P<0.05).CONCLUSION: The application of valve removal technology in improving endoscopic dacryocystorhinostomy not only significantly reduces intraoperative bleeding and surgical duration, but also effectively reduces postoperative complications and improves surgical efficacy.

Lung isolation-a personalized and clinically adapted approach to control bronchoscopy-associated acute massive airway hemorrhage.

BACKGROUND: The current concept of bronchoscopy-associated massive airway hemorrhage is not accurate enough, and the amount of bleeding as the only evaluation criterion cannot comprehensively evaluate magnitude of the effects and the severity. OBJECTIVE: To propose the concept of bronchoscopy-associated acute massive airway hemorrhage, analyze its impact on patients and highlight the treatment approach of acute massive airway hemorrhage without ECMO support. DESIGNS: A retrospective cohort study. SETTING: Include all patients who received bronchoscopy intervention therapy at Interventional Pulmonology Center of Emergency General Hospital from 2004 to December 2021. PATIENTS: 223 patients met the inclusion criteria. INTERVENTION: Patients were divided into two groups: acute massive airway hemorrhage group (n = 29) and non-acute massive airway hemorrhage group (n = 194). MAIN OUTCOME MEASURES: Perioperative adverse events between two groups were the main outcome. Secondary outcome was the impact of lung isolation on patient in group Acute. RESULTS: The incidence of acute massive airway hemorrhage was 0.11%, and the incidence of non-acute massive airway hemorrhage was 0.76% in this study. There were significant differences in the incidence of intraoperative hypoxemia, lowest SpO2, hemorrhagic shock, cardiopulmonary resuscitation, intraoperative mortality, and transfer to ICU between acute group and non-acute group (P<0.05, respectively). Lung isolation was used in 12 patients with acute massive airway hemorrhage, and only 2 patients died during the operation. CONCLUSION: Bronchoscopy-associated acute massive airway hemorrhage had more serious impact on patients due to rapid bleeding, blurred vision of bronchoscopy, inability to stop bleeding quickly, blood filling alveoli, and serious impact on oxygenation of the lung lobes. Polyvinyl chloride single-lumen endotracheal intubation for lung isolation, with its characteristics of low difficulty, wide applicability and available in most hospitals, may reduce the intraoperative mortality of patients with bronchoscopy-associated acute massive airway hemorrhage. TRIAL REGISTRATION: Chinese Clinical Trial Registry on 13/03/2022. REGISTRATION NUMBER: ChiCTR2200057470.

Risk Factors for Hypocoagulability After Cardiac Surgery: A Retrospective Study.

Hemostatic disturbances after cardiac surgery can lead to excessive postoperative bleeding. Thromboelastography (TEG) was employed to evaluate perioperative coagulative alterations in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), investigating the correlation between factors concomitant with cardiac surgery and modifications in coagulation. Coagulation index as determined by TEG correlated significantly with postoperative bleeding at 24-72 h after cardiac surgery (P < .001). Among patients with a normal preoperative coagulation index, those with postoperative hypocoagulability showed significantly lower nadir temperature (P = .003), larger infused fluid volume (P = .003), and longer CPB duration (P = .033) than those with normal coagulation index. Multivariate logistic regression showed that nadir intraoperative temperature was an independent predictor of postoperative hypocoagulability (adjusted OR: 0.772, 95% CI: 0.624-0.954, P = .017). Multivariate linear regression demonstrated linear associations of nadir intraoperative temperature (P = .017) and infused fluid volume (P = .005) with change in coagulation index as a result of cardiac surgery. Patients are susceptible to hypocoagulability after cardiac surgery, which can lead to increased postoperative bleeding. Ensuring appropriate temperature and fluid volume during cardiac surgery involving CPB may reduce risk of postoperative hypocoagulability and bleeding.

More than blood: app-tracking reveals variability in heavy menstrual bleeding construct.

BACKGROUND: Heavy menstrual bleeding (HMB) is associated with impaired quality of life and may signal serious health problems. Unresolved challenges in measuring menstrual bleeding and identifying HMB have hampered research and clinical care. Self-reported bleeding histories are commonly used but these may be influenced by recall bias, personal beliefs regarding "normal" flow volume, and the experience of other physical symptoms or disruptions to daily life. The potential usefulness of menstrual-tracking mobile applications, which allow real-time user-entered data recording, for assessing HMB has not been studied. We evaluated recall bias in reported period duration, the relationship of tracked period duration and daily flow volume to subsequently reported period heaviness, variation in quality of life associated with increasing period heaviness, and the advantages and limitations of using app-tracked data for clinical and research purposes. METHODS: An online questionnaire was distributed to current users of Clue, a commercially available menstrual health tracking app, asking them to characterize their last period. We compared responses to the user's corresponding Clue app-tracked data. The study sample comprised 6546 U.S.-based users (aged 18-45 years). RESULTS: Increasing reported heaviness was associated with increasing app-tracked period length and days of heavy flow, impaired quality-of-life (especially body pain severity), and disrupted activities. Of those reporting having had a heavy/very heavy period, ~ 18% had not tracked any heavy flow, but their period length and quality-of-life indicators were similar to those who had tracked heavy flow. Sexual/romantic activities were the most affected across all flow volumes. Compared to app-tracked data, 44% recalled their exact period length; 83% recalled within ± 1 day. Overestimation was more common than underestimation. However, those with longer app-tracked periods were more likely to underestimate period length by ≥ 2 days, a pattern which could contribute to under-diagnosis of HMB. CONCLUSION: Period heaviness is a complex construct that encapsulates flow volume and, for many, several other bleeding-associated experiences (period length, bodily impairments, disruptions of daily activities). Even very precise flow volume assessments cannot capture the multi-faceted nature of HMB as experienced by the individual. Real-time app-tracking facilitates quick daily recording of several aspects of bleeding-associated experiences. This more reliable and detailed characterization of bleeding patterns and experiences can potentially increase understanding of menstrual bleeding variability and, if needed, help to guide treatment.

The effects of hysteroscopy and laparoscopy for scar diverticulum resection and suture on blood loss, operation time and antibiotic time.

To evaluate the effect of hysteroscopy and suture on uterine scar diverticulum (CSD) after caesarean section and its influence on blood loss, operation time and antibiotic time. Eighty-nine patients with CSD were divided into observation group (n = 41 cases) and control group (n = 48 cases). Control group received laparoscopic scar diverticulum resection and suture, while the observation group received hysteroscopic resection of scar diverticulum. The operation time of the observation group was longer, while the bleeding volume and antibiotic administration time were significantly lower. The surgical treatment efficiency of the observation group (97.56%) was significantly higher. After treatment, the observation group's diverticulum repair indexes (width, depth and lower uterine muscular layer thickness) were better than those of the control group (p<.05). Hysteroscopic resection of scar diverticulum in CSD reduces intraoperative blood loss and the risk of complications, shortens time of antibiotic administration, and promotes diverticulum repair.Impact StatementWhat is already known on this subject? Uterine scar diverticulum (CSD) after caesarean section, also called postoperative uterine incision defect (PCSD), is due to poor healing of the uterine incision after caesarean section.What do the results of this study add? Hysteroscopic resection of scar diverticulum in CSD has a significant clinical effect, which can effectively reduce intraoperative blood loss and the risk of complications, shorten the time of antibiotic administration, and promote diverticulum repair.What are the implications of these findings for clinical practice and/or further research? Clinical effect of hysteroscopic resection of scar diverticulum in CSD is significant.

Detection of blood stains using computer vision-based algorithms and their association with postoperative outcomes in thoracoscopic lobectomies.

OBJECTIVES: Our goal was to develop high throughput computer vision (CV) algorithms to detect blood stains in thoracoscopic surgery and to determine how the detected blood stains are associated with postoperative outcomes. METHODS: Blood pixels in surgical videos were identified by CV algorithms trained with thousands of blood and non-blood pixels randomly selected and manually labelled. The proportion of blood pixels (PBP) was computed for key video frames to summarize the blood stain information during surgery. Statistical regression analyses were utilized to investigate the potential association between PBP and postoperative outcomes, including drainage volume, prolonged tube indwelling duration (≥5 days) and bleeding volume. RESULTS: A total of 275 patients undergoing thoracoscopic lobectomy were enrolled. The sum of PBP after flushing (P < 0.022), age (P = 0.005), immediate postoperative air leakage (P < 0.001), surgical duration (P = 0.001) and intraoperative bleeding volume (P = 0.033) were significantly associated with drainage volume in multivariable linear regression analysis. After adjustment using binary logistic regression analysis, the sum of the PBP after flushing [P = 0.017, odds ratio 1.003, 95% confidence interval (CI) 1.000-1.005] and immediate postoperative air leakage (P < 0.001, odds ratio 4.616, 95% CI 1.964-10.847) were independent predictors of prolonged tube indwelling duration. In the multivariable linear regression analysis, surgical duration (P < 0.001) and the sum of the PBP of the surgery (P = 0.005) were significantly correlated with intraoperative bleeding volume. CONCLUSIONS: This is the first study on the correlation between CV and postoperative outcomes in thoracoscopic surgery. CV algorithms can effectively detect from surgical videos information that has good prediction power for postoperative outcomes.

Impact of the Tranexamic Acid on Bleeding Amount of Surgical Patient With Degenerative Spinal Disease: A Randomized Blinded Study.

Objective: This study aims to explore the effectiveness and safety of tranexamic acid (TXA) in reducing the bleeding amount of surgical patients with degenerative spinal disease in the perioperative period. Methods: A total of 80 cases of patients, who underwent elective posterior lumbar interbody fusion surgeries under general anesthesia, were enrolled in this study. The age of these patients ranged within 41-69 years old, and the surgical vertebral body segments were ≥2. The ASA classification was Level I or Level II. These patients were divided into two groups using the random number table (n = 40): TXA group and control group (S group). In the TXA group, the skin was incised after the anesthesia induction, and 20 mg/kg of TXA was immediately injected into the vein. The injection continued at a rate of 10 mg·kg-1·h-1 during the surgery, until the surgery was finished. In the S group, IV and pump injection with an equal amount of normal saline (NS) were performed. Then, the RBC, Hb, HCT, AST, ALT, BUN, Cr, PT, TT, APTT, FIB, and D-dimer were measured before the surgery and at 1 day after the surgery, and the SSFQ, intraoperative bleeding amount, homologous transfusion volume, urine volume, infusion quantity, surgical duration, drainage volume at 24 h after the surgery, total bleeding amount and adverse event occurrence at 1 week after the surgery were recorded. Results: The RBC, Hb and HCT at 1 day after the surgery were higher in TXA group than in the S group (average P < 0.05). Intraoperative bleeding, drainage volume at 24 h after surgery, and total blood loss were lower in the TXA group than in the S group (average P < 0.05). The SSFQ score and length of stay were lesser in the TXA group than in the S group (average P < 0.05). The differences in AST, ALT, BUN, Cr, PT, TT, APTT, FIB, and D-dimer at 1 day after the surgery for these two groups of patients had no statistical significance (average P > 0.05). Conclusion: TXA can reduce the bleeding amount of surgical patients with degenerative spinal disease in the perioperative period and decrease the length of stay, but does not increase the occurrence rate of adverse events, thereby promoting postoperative rehabilitation. Clinical Trial Registration: www.chictr.org.cn/index.aspx, identifier: ChiCTR2000033597.

[Value of Head and Neck CT Angiography in the Clinical Evaluation of Intraoperative Bleeding Volume of Carotid Body Tumours].

Objective To investigate the value of head and neck CT angiography(CTA)in the evaluation of intraoperative hemorrhage of carotid body tumours. Methods Head and neck CTA images of 36 patients with carotid body tumours confirmed by pathology were retrospectively analyzed.Patients were divided into two groups based on the intraoperative bleeding volume:<500 ml and≥500 ml groups.The patient's age,sex,Shamblin classification,size of the lesion,number of blood supply arteries,course of the disease,plain scan,and enhanced CT value between two groups were compared and analyzed.Logistics regression equation was established based on the CTA parameters with significant differences between the two intraoperative bleeding volume groups,and combined parameter was acquired.The receiver operating characteristic curve was established based on CTA single and combined parameters. Results The bleeding volume during the operation of carotid body tumors was significantly correlated with the age of patients(P=0.019),the maximum diameter of tumours on axial images(P=0.003),the maximum upper and lower diameters(P=0.004),Shamblin classification(P=0.012),and number of blood supply arteries(P<0.001).The area under the receiver operating characteristic curve of the number of feeding arteries,the maximum diameter of axial images,maximum upper and lower diameters,Shamblin classification,and combined parameters were 0.865,0.781,0.806,0.766,and 0.927,respectively.When the optimal critical value was 0.408,the Youden index was 0.794,and the corresponding accuracy,sensitivity,and specificity were 0.919,0.909,and 0.923,respectively. Conclusions Preoperative head and neck CTA can be used to evaluate the intraoperative blood loss.Combined parameters has the best diagnostic performance compared with single parameters.

Application of elastic compression bandage after first total knee arthroplasty / 中国组织工程研究

BACKGROUND: It is still lack of sufficient clinical evidence whether the patients can benefit from the routine use of elastic bandages after total knee arthroplasty. OBJECTIVE: To explore whether the use of elastic compression bandage after first total knee arthroplasty is beneficial to the prognosis of patients. METHODS: Totally 60 knee osteoarthritis patients who received bilateral knee arthroplasty in the Department of Joint Surgery, West Coast Hospital Branch of Affiliated Hospital of Qingdao University were selected from September 2017 to September 2018. One limb of the patient was covered with a general surgical dressing, while an elastic bandage was applied from the instep to the middle of the thigh (elastic compression bandage group). One limb was covered only with a general surgical dressing (control group). All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. Circumference (thigh, knee and calf), flexural activity (range of motion) and visual analogue scale of the lower extremities were measured at 1, 2, 3 and 7 days after the operation by professionals who were not involved in patient management. Drainage volume 24 hours after operation and the occurrence of complications within 30 days after operation were recorded. RESULTS AND CONCLUSION: (1) At 1, 2, 3, and 7 days after surgery, circumference of thigh, knee and calf was smaller in the elastic compression bandage group than in the control group. Range of motion of the knee was better in the elastic compression bandage group than in the control group (P < 0.001). (2) At 1 and 2 days after surgery, resting visual analogue scale scores were higher in the elastic compression bandage group than in the control group (P < 0.001). At 7 days, resting visual analogue scale scores were lower in the elastic compression bandage group than in the control group (P < 0.001). No significant difference in visual analogue scale scores was found between the two groups at 3 days. Sports visual analogue scale scores in the elastic compression bandage group were higher than in the control group at 1 and 2 days (P < 0.001). However, no significant difference in sports visual analogue scale scores was detected between the two groups at 3 and 7 days. (3) There was no difference in wound-healing complications between the two groups, but the sample size was too small for meaningful statistical analysis. (4) There was a statistically significant difference in drainage volume between the two groups at 24 hours after surgery. (5) No deep infection, venous thrombosis or reoperation occurred within 30 days. (6) It is concluded that the application of elastic compression bandage from the instep to the middle of the thigh after the first total knee arthroplasty can effectively reduce the swelling of the operative limb and postoperative blood loss, increase the flexion and extension of the operative limb, which is conducive to the rapid recovery after the operation. It is worth popularizing and applying.

Value of Head and Neck CT Angiography in the Clinical Evaluation of Intraoperative Bleeding Volume of Carotid Body Tumours / 中国医学科学院学报

To investigate the value of head and neck CT angiography(CTA)in the evaluation of intraoperative hemorrhage of carotid body tumours. Head and neck CTA images of 36 patients with carotid body tumours confirmed by pathology were retrospectively analyzed.Patients were divided into two groups based on the intraoperative bleeding volume:<500 ml and≥500 ml groups.The patient's age,sex,Shamblin classification,size of the lesion,number of blood supply arteries,course of the disease,plain scan,and enhanced CT value between two groups were compared and analyzed.Logistics regression equation was established based on the CTA parameters with significant differences between the two intraoperative bleeding volume groups,and combined parameter was acquired.The receiver operating characteristic curve was established based on CTA single and combined parameters. The bleeding volume during the operation of carotid body tumors was significantly correlated with the age of patients(=0.019),the maximum diameter of tumours on axial images(=0.003),the maximum upper and lower diameters(=0.004),Shamblin classification(=0.012),and number of blood supply arteries(<0.001).The area under the receiver operating characteristic curve of the number of feeding arteries,the maximum diameter of axial images,maximum upper and lower diameters,Shamblin classification,and combined parameters were 0.865,0.781,0.806,0.766,and 0.927,respectively.When the optimal critical value was 0.408,the Youden index was 0.794,and the corresponding accuracy,sensitivity,and specificity were 0.919,0.909,and 0.923,respectively. Preoperative head and neck CTA can be used to evaluate the intraoperative blood loss.Combined parameters has the best diagnostic performance compared with single parameters.

Prognostic value of early glycosylated hemoglobin and blood glucose levels in patients with basal ganglia cerebral hemorrhage.

OBJECTIVE: This study was performed to analyze the relationships of the early glycosylated hemoglobin (GHb) level and blood glucose level (BGL) with prognosis in patients with basal ganglia cerebral hemorrhage (BGCH). METHODS: In total, 186 patients with BGCH were included in this prospective study. The GHb level, fasting BGL, bleeding volume, degree of consciousness disorder, intracerebral hemorrhage (ICH) score, functional outcome in patients with primary ICH (FUNC) score, ICH grading scale (ICH-GS) score, and neurological impairment were recorded during a 30-day observation period. RESULTS: The mean BGCH volume was 58.42 mL. The 30-day mortality rate was 22.32%. The ICH-GS score [odds ratio (OR) = 0.815, 95% confidence interval (95% CI) = 0.504-0.688, R = 0.624] and bleeding volume (OR = 0.882, 95% CI = 0.785-0.918, R = 0.784) were significant predictors of 30-day mortality. The GHb level (OR = 6.138, R = 0.705) and BGL (OR = 1.055, R = 0.418) were independent predictors of 30-day mortality according to the multivariate logistic regression analysis. CONCLUSION: The GHb level and BGL are strong predictors of 30-day mortality in patients with BGCH and accurately predict the prognosis in these patients.

Intraoperative and postoperative effects of TEG-guided platelet transfusion on antiplatelet drug-related intracerebral hemorrhage patients.

Intraoperative and postoperative effects of platelet transfusion on antiplatelet drug-related intracerebral hemorrhage (ICH) patients were investigated. A retrospective study on 82 ICH patients undergoing emergency surgical treatment caused by antiplatelet drugs was conducted. Among them, 51 patients treated with platelet transfusion served as the observation group and 31 patients without platelet transfusion as the control group. The intraoperative and postoperative bleeding volume, blood transfusion volume and the rate of secondary bleeding were compared between observation and control group under the guidance of thromboelastography (TEG). The coagulation routine examination results of the two groups before surgery were in the normal range, but TEG indicated an excessive inhibition of platelet function (platelet inhibition rate >89%). The platelet number after treatment increased significantly in the two groups of patients and it was significantly higher in observation group than that in control group (P<0.05). The intraoperative bleeding volume in observation group was significantly lower than that in control group. The total blood transfusion volume in observation group was significantly lower than that in control group (Z=2.681, P=0.036), the postoperative hematoma residual volume in observation group was significantly lower than that in control group (t=2.145, P=0.035), and the drainage volume in observation group was significantly lower than that in control group (t=2.401, P=0.019). Only 3.92% of the patients in observation group and 19.35% in control group had secondary surgery, and the difference of the recurrence rate of secondary bleeding between the two groups was statistically significant (χ2=3.610, P=0.048). TEG detection indicator can more comprehensively and accurately evaluate the preoperative coagulation function of patients. This study suggests that preoperative platelet transfusion can improve the intraoperative and postoperative bleeding of ICH patients after antiplatelet therapy to some extent, reducing the blood transfusion volume and the secondary bleeding rate.

Impact of intra-peritoneal fat distribution on intra-operative bleeding volume with D2 lymphadenectomy in Chinese patients with gastric cancer.

OBJECTIVE: To explore the quantitative measurements and evaluation of intra-peritoneal fat distribution by MDCT and its significance in predicting intra-operative bleeding volume during D2 lymphadenectomy in gastric cancer (GC) patients. METHODS: From June 2016 to September 2017, GC patients scheduled for open gastrectomy with D2 lymph-node dissection were enrolled. According to the BMI, the subjects were then classified as normal BMI(BMI<25 kg/m2); overweight (BMI = 25-30 kg/m2) and obese (BMI≥30 kg/m2). According to the intraoperative blood loss (IBL), the patients were further separated into high IBL (IBL; ≥ 300 ml) or low IBL (<300 ml). Clinicopathological parameters between the groups were statistically compared and univariate and multivariate analysis were used to identify predictive factors such as intra-peritoneal fat areas (IFA) and intra-peritoneal fat areas ratio (IFAR) for high IBL. RESULTS: A total of 226 patients were included in the study where 53 patients underwent distal while 173 underwent total gastrectomy. According to the BMI classification, there were 25 normal BMI, 108 overweight and 25 obese subjects. According to the IBL, there were 98 high IBL and 128 low IBL subjects. IFA and IFAR were significantly greater in the high IBL group than in the low IBL group. There was no significant difference in any other clinicopathological factors between the high IBL group and the low IBL group. Multivariate analysis revealed that high IFA and IFAR independently predicted high IBL. CONCLUSION: The use of MDCT to evaluate the precise distribution of abdominal fat during preoperative examination can prompt surgeons to develop techniques to decrease intraoperative bleeding in obese patients. Nevertheless, it is yet necessary to be surgically more meticulous when dealing with patients with high IFA or high IFA/IFAR in order to improve the outcome of D2 gastrectomy.

Antenatal 3D power Doppler ultrasound in predicting bleeding volume in patients with placenta previa undergoing cesarean surgery / 中国医学影像技术

Objective: To explore the value of three-dimensional power Doppler ultrasound (3D-PDU) in predicting bleeding volume during cesarean surgery in patients with placenta previa. Methods: Clinical data of 141 patients with placenta previa who underwent 3D-PDU examinations before cesarean surgery and the bleeding volume during cesarean surgery were retrospectively reviewed. The patients were classified into implanted placenta previa group (n=66) and non-implanted placenta previa group (n=75). The differences of vascularization index (VI), flow index (FI), vascularization flow index (VFI) and bleeding volume were compared between the 2 groups, and the correlation was analyzed. ROC curve was used to evaluate the efficacy of each index in predicting bleeding volume during cesarean surgery. Results: Antenatal VI, FI, VFI and bleeding volume of the implanted placenta previa group were higher than those of non-implanted placenta previa group (all P<0.05). In all 141 patients, VI and VFI were positively correlated with the bleeding volume during cesarean surgery (r=0.702, 0.737, both P<0.001). In implanted placenta previa group, VI, FI and VFI were positively correlated with the bleeding volume in cesarean section (r=0.680, 0.492, 0.722, all P<0.001). In non-implanted placenta previa group, VI and VFI were positively correlated with the bleeding volume during cesarean surgery (r=0.861, 0.832, both P<0.001). The area under ROC curve of VI, FI and VFI in all 141 patients were 0.911, 0.798 and 0.937 (all P<0.001), in implanted placenta previa group were 0.966, 0.722 and 0.938 (all P<0.05), while in non-implanted placenta previa group were 0.885, 0.856 and 0.966, respectively (all P<0.001). Conclusion: Antenatal 3D-PDU can be applied in predicting bleeding volume in patients with placenta previa during cesarean surgery.

Efficacy of Preoperative Transcatheter Arterial Embolization for Nasopharyngeal Angiofibroma: A Comparative Study.

OBJECTIVE: This study aimed to retrospectively evaluate the efficacy and safety of preoperative transcatheter arterial embolization (pTAE) for treating nasopharyngeal angiofibroma (NPAF). METHODS: Seventy-four NPAF patients were hospitalized for elective surgical treatment with pTAE (pTAE group, n = 32) or surgical treatment alone (non-pTAE group, n = 42) between January 1990 and December 2013. The following outcome measures were retrospectively analyzed and compared: intraoperative bleeding volume, surgery time (ST), duration of postoperative hospital stay (PHS), and disease recurrence. RESULTS: Among Radkowski stage I patients, those in pTAE group had a slightly higher but not significant bleeding volume than patients in non-pTAE group (344 ± 407 vs. 248 ± 219 mL, P = 0.899); among stage II/III patients, however, patients in pTAE group showed a significantly lower bleeding volume than patients in non-pTAE group (stage II, 829 ± 519 vs. 1339 ± 767 mL, P = 0.035; stage III, 1267 ± 592 vs. 2125  ± 479 mL, P = 0.024). The two groups presented comparable OTs, PHSs, and rates of frontal recurrence (all P>0.05). CONCLUSIONS: pTAE significantly reduces intraoperative bleeding in NPAF patients with Radkowski stage II/III disease, but offers no additional benefits regarding ST, PHS, or recurrence.

Effect and safety of intraarticular infusion combined with intravenous injection of tranexamic acid on hemorrhage in patients underwent total knee replacement / 新乡医学院学报

Objective To assess the effect and safety of intraarticular infusion combined with intravenous injection of tranexamic acid on hemorrhage in patients underwent total knee replacement (TKR).Methods A total of 180 patients who underwent TKR in the People's Hospital of Hebi City from January 2014 to January 2017 were selected.The patients were divided into control group,low dose group and high dose group according to the tranexamic acid dose,60 cases in each group.All patients were treated with tranexamic acid 10 mg · kg-1 by intravenous drip within one hour before operation.After the incisions were sutured,the patients in the control group were treated with physiological saline 100 mL by intraarticular infusion,the patients in the low dose group and high dose group received intraarticular infusion of tranexamic acid 1 and 2 g respectively,the drainage tube was opened after one hour's occlusion.The operation time,hemoglobin level,postoperative blood loss,total blood loss and complications were observed and recorded.Results There was no significant difference in hemoglobin level in the three groups before operation (P ＞ 0.05).The hemoglobin level in the high dose group was significantly higher than that in the low dose group and the control group (P ＜ 0.05),but there was no significant difference in hemoglobin level between the low dose group and the control group at one day after operation (P ＞ 0.05).The hemoglobin level in the low dose group and the high dose group was significantly higher than that in the control group (P ＜ 0.05),and it in the high dose group was significantly higher than that in the low dose group at two days after operation (P ＜ 0.05).There was no significant difference in the operation time in the three groups (P ＞ 0.05).The postoperative blood loss and total blood loss in the low dose group and the high dose group were significantly lower than those in the control group (P ＜ 0.05),and them in the high dose group were significantly lower than those in the low dose group (P ＜ 0.05).The incidence of complications in the control group,low dose group and high dose group was 8.33％ (5/60),10.00％ (6/60) and 8.33％ (5/60) respectively,there was no significant difference in the incidence of complications among the three groups (x2 =0.100,P ＞ 0.05).Conclusion Intraarticular infusion combined with intravenous injection of tranexamic acid can effectively reduce blood loss in patients with TKR.Increasing the dose of intraarticular infusion of tranexamic acid within a certain range can further improve the hemostatic effect,and it does not increase the complications.

A comprehensive assessment of perioperative blood transfusion in liver transplantation / 中国输血杂志

Objective To evaluate the perioperative blood loss and blood transfusion in liver transplantation patients.Methods Retrospectively selected and classified 119 patients with liver transplantation medical recordsaccording to the clinical diagnosis of age,gender.Analyzed (disease)patients' blood coagulation index 24 h before surgery,intraoperative and postoperative perioperative bleeding,and blood red blood cell suspension,frozen plasma,cold precipitation,coagulation factor injection lossplateletpheresis.Results There were no significant differences in the amount of blood loss and the amount of blood preparations duringthe perioperative period of liver transplantation according to the age and sex of patients (P＞0.05);According to the clinical diagnosis of different groups,the diagnostic group (primary liver cancer group,hepatitis B cirrhosis group and severe hepatitis group) patients with a single platelet transfusion dosewas similar (P＞0.05)withsuspended red blood cells (U) at 8.4+11.9,16.2+15.7,18.1+13.5,frozen plasma (U) at 8.2+7.1,18.1+15.6 and 18.2+ 17.9 respectively andcold precipitation (U) at 9.5+ 8.2,17.1 + 16.318.5 + 16.4 (P＜ 0.05);The diagnosis group surgery before and after immediate PT (s) were 15.6+3.8,24.6+4.1,APTT (s) were 44.3+5.8,84.9+9.2,TT (s) were 20.4 +4.5,40.1+6.2,and Fib(s) were 2.6+0.8 and 1.3+0.9 (P＜0.05);however,there was no significant difference in the 24 h PT,APTT,TT and Fib between the two groups after diagnosis (P＞0.05).Conclusion Ascientific,safe and reasonable selection of perioperative blood preparation for clinical diagnosis for different liver transplantation patients is critical to the success rate and prognosis of liver transplantation;the evaluation of coagulation indexes at each interval can help guiding the blood transfusion during liver transplantation.

A new anti-fibrinolytic hemostatic compound 8-O-acetyl shanzhiside methylester extracted from Lamiophlomis rotata.

BACKGROUND: Fibrinolysis prevents blood clots from growing and becoming problematic. Antifibrinolytics are used as inhibitors of fibrinolysis. Aprotinin was doubted after identification of major side effects, especially on kidney. Lysine analogues has their own defects and whether they are adequate substitutes for aprotinin is still under doubt. Lamiophlomis rotata (Benth.) Kudo. was previous found to have hemostatic activity. But the active compound in L. rotata and its hemostatic mechanism were unknown. OBJECTIVES: To find the major hemostatic compound in L. rotata and identify its haemostasis mechanism. METHODS: Traumatic hemorrhage model and coagulant activity assays were monitored in mice and platelets in drug treatment group and control group. Hyperfibrinolysis model was established by intravenous administration of urokinase in mice. Capillary blood clotting time (CBCT), activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen and euglobulin clot lysis time (ECLT) were measured. RESULTS: The anti-fibrinolytic activity come from 8-O-Acetyl shanzhiside methylester (ASM) one of the highest iridoid glycosides contents in TIG extracted from L. rotata. ASM significantly (P<0.05) shorten CBCT and reduced blood loss volume in vivo, but did not influence mice APTT, PT or TT. In particular, it significantly prolonged ECLT in hyperfibrinolysis mice. It indicated that ASM could inhibit fibrinolysis. ASM was also effective in CBCT, traumatic bleeding volume and ECLT in hyperfibrinolysis mice model. CONCLUSIONS: ASM was the major hemostatic compound in L. rotata. The haemostasis mechanism of ASM was achieved by anti-fibrinolytic activity. ASM was a new fibrinolysis inhibitor as iridoid glycoside compound.

Effects of a single rectal dose of Misoprostol prior to abdominal hysterectomy in women with symptomatic leiomyoma: a randomized double blind clinical trial.

BACKGROUND: Fibroma, the most common benign pelvic tumor in women, affects 25 to 30% of women of reproductive age. Primary treatment for patients with symptomatic or large fibroma is surgery. OBJECTIVE: The purpose of this study was to investigate the effect of a single rectal dose of Misoprostol on bleeding during abdominal hysterectomy. METHODS: This double blind randomized clinical trial was conducted with 80 candidates for abdominal hysterectomy, due to uterine myoma, in the Shahid Sadoughi hospital of Yazd in 2012. The aim of this study was to assess the effect of single rectal dose of Misoprostol on peri-operational abdominal hysterectomy bleeding. Following administration of 400 micrograms of Misoprostol in the case group (n=40), predetermined criteria were compared with control group (n=40). RESULTS: Volume of bleeding during the operation was significantly lower in cases where Misoprostol was used. (268.71 ± 156.85 vs. 350.38 ± 152.61 cc in the case and control groups, respectively). Our findings also showed that Hemoglobin (Hb) levels before, 8, and 30 hours following the operation differed significantly (p=0.001), but these changes were similar in both groups. Pre-operative Hb levels were 11.90 ± 1.7 and 11.90 ± 2.0 in the case and control groups, respectively. CONCLUSION: A single rectal dose of Misoprostol has positive effect on reducing peri-operational bleeding in women undergoing abdominal hysterectomy due to symptomatic leiomyoma.

Comparative study of methotrexate and uterine arterial embolization inβ-HCG, bleeding volume and success rate of women with cesarean scar pregnancy after cesarean section / 中国生化药物杂志

Objective To explore comparison between methotrexate and uterine arterial embolization in β-HCG, bleeding volume and success rate of women with cesarean scar pregnancy after cesarean section.Methods 42 patients who were diagnosed with cesarean scar pregnancy after cesarean section were collected.All patients were randomly divided into uterine arterial embolization group and methotrexate group,21 cases in each group corresponding treatment were given respectively, after the treatment, the serum levels of β-HCG, bleeding volume and success rate were detected in all patients.Results After treatment, compared with methotrexate group, the serum level ofβ-HCG was lower in the uterine arterial embolization group,and the difference was statistically significant(P<0.05); the bleeding volume was lower in the uterine arterial embolization group(P<0.05); the success rate was higher in the uterine arterial embolization group(P <0.05).Conclusion Compared with methotrexate,the uterine arterial embolization can significantly reduce the serum level ofβ-HCG in patients with cesarean scar pregnancy after cesarean section,reduce the amount of bleeding, improve the success rate of treatment.