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Clinical observation of autologous platelet rich fibrin assisted revascularization of mature permanent teeth
Wu Z, Lin Y, Xu X, Chen Z, Xiang Y, Yang L, Zhang W, Xiao S, Chen X
Head & face medicine. 2023;19(1):9
Abstract
OBJECTIVE To investigate the clinical observation of autologous platelet-rich fibrin (PRF) assisting the revascularization of mature permanent teeth. METHODS Twenty patients with mature permanent teeth were divided into experimental group and control group. The control group was treated with classic revascularization, and the experimental group was treated with PRF-assisted mature permanent tooth revascularization. RESULTS After treatment, the total effective rate of the experimental group (100.00%) was higher than that of the control group (50.00%); the thickness of the root canal wall of the experimental group was higher than that of the control group, and the crown root length was lower than that of the control group; The bite degree, chewing function, color, overall aesthetic score, and satisfaction rate of the patients were higher, and the difference was statistically significant (P < 0.05). CONCLUSION Autologous PRF assists in revascularization of mature permanent teeth, which can achieve ideal results, and promote pulp regeneration.
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Recombinant human thrombopoietin promotes platelet recovery in DCAG-treated patients with intermediate-high-risk MDS/hypoproliferative AML
Chen X, Wang Y, Zang Y, Wei Z, Zhang W, Wei X, Luo G, Chen L, Zhang Y, Xu Z
Medicine. 2023;102(13):e33373
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Abstract
BACKGROUND This study aimed to explore the effects of recombinant human thrombopoietin (rhTPO) on platelet recovery in decitabine, cytarabine, aclarubicin, and G-CSF (DCAG)-treated patients with intermediate-high-risk myelodysplastic syndrome/hypo proliferative acute myeloid leukemia. METHODS Recruited patients were at a ratio of 1:1 into 2 groups: the rhTPO group (DCAG + rhTPO) and control group (DCAG). The primary endpoint was the time for platelets to recover to ≥ 20 × 109/L. The secondary endpoints were the time for platelets to recover to ≥ 30 × 109/L and ≥ 50 × 109/L, overall survival (OS), and progression-free survival (PFS). RESULTS The time required for platelet recovery to ≥ 20 × 109/L, ≥30 × 109/L, and ≥ 50 × 109/L in the rhTPO group was significantly shorter (6.5 ± 2.2 vs 8.4 ± 3.1 days, 9.0 ± 2.7 vs 12.2 ± 3.9 days, 12.4 ± 4.7 vs 15.5 ± 9.3 days, respectively; all P < .05 vs controls). The amount of platelet transfusion in the rhTPO group was smaller (4.4 ± 3.1 vs 6.1 ± 4.0 U, P = .047 vs controls). The bleeding score was lower (P = .045 vs controls). The OS and PFS were significantly different (P = .009 and P = .004). The multivariable analysis showed that age, karyotype, and time for PLT recovery to ≥ 20 × 109/L were independently associated with OS. Adverse events were similar. CONCLUSIONS This study suggests that rhTPO leads to a faster platelet recovery after DCAG treatment, reduces the risk of bleeding, reduces the number of platelet transfusions, and prolongs the OS and PFS.
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The clinical effect of emergency gastroscopy on upper gastrointestinal hemorrhage patients
Ren T, Wei J, Han B, Chen X, Zhong J, Lan F
American journal of translational research. 2021;13(4):3501-3507
Abstract
OBJECTIVE To assess the clinical effects of emergency gastroscopies on acute upper gastrointestinal hemorrhage patients. METHODS 212 patients with acute upper gastrointestinal hemorrhages were randomly divided into an experimental group (n=106) and a control group (n=106). The experimental group underwent emergency gastroscopies, and the control group underwent the traditional treatment. We measured the hemostasis effects, the treatment indexes, and the incidences of adverse reactions to assess the clinical effects. At the same time, we recorded the hemoglobin levels, the rebleeding rates, and the mortality rate to assess the hemostasis effect. RESULTS The hemostasis effect (the total hemostasis effective rate), the treatment index (the hemostasis time, stool occult blood turning negative time, bowel sound recovery time, and the blood transfusion volumes), the hemoglobin levels, the rebleeding rates, and the mortality were better in the EG than they were in the CG (P<0.05). CONCLUSIONS Emergency gastroscopy is an effective treatment for acute upper gastrointestinal hemorrhage patients, because it improves the hemostasis effective rate and the survival rate. Clinical therapy effectively cures the hemorrhages in patients with acute upper gastrointestinal hemorrhages.
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The rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation
Sun G, Fu T, Liu Z, Zhang Y, Chen X, Jin S, Chi F
Scientific reports. 2021;11(1):4599
Abstract
To comparatively study the size of and variation in the 'brain-haematoma' pressure gradient for different surgical methods for hypertensive intracerebral haemorrhage (HICH) and analyse the gradient's influence on surgical procedures and effects of the haemorrhage. Seventy-two patients with HICH treated from 1/2019 to 12/2019 were randomly divided into two groups, namely, the keyhole endoscopy and large trauma craniotomy groups, according to different operative methods. Intraoperative changes in intracranial pressure (ICP) were monitored to calculate intraoperative alterations in the 'brain-haematoma' pressure gradient. Intraoperative characteristics (operative time, bleeding volume, volume of blood transfusion, and haematoma clearance rate) and postoperative characteristics (oedema, postoperative activities of daily living (ADL) scores, mortality rate and rebleeding rate) were compared between the two groups. In the keyhole endoscopy group, ICP decreased slowly; the 'brain-haematoma' pressure gradient was large, averaging 251.1 ± 20.6 mmH(2)O, and slowly decreased. The mean operative time was 83.6 ± 4.3 min, the mean bleeding volume was 181.2 ± 13.6 ml, no blood transfusions were given, the average postoperative haematoma clearance rate was 95.6%, the rate of severe oedema was 10.9%, and the average postoperative ADL score was 85.2%. In the large trauma craniotomy group, ICP rapidly decreased after craniotomy. When the haematoma was removed, the 'brain-haematoma' pressure gradient was small, averaging 132.3 ± 10.5 mmH2O, and slowly decreased. The mean operative time was 232 ± 26.1 min, the mean bleeding volume was 412.6 ± 35.2 ml, the average volume of blood transfusion was 281.3 ± 13.6 ml, and the average postoperative haematoma clearance rate was 82.3%; moreover, the rate of severe oedema was 72.1%, and the average postoperative ADL score was 39.0%. These differences were statistically significant (P < 0.05). Neither the death rate (P > 0.05, 2.7% VS 2.8%) nor rebleeding rate (P > 0.05, 2.7% VS 2.8%) showed any obvious changes. The magnitude and variation in the 'brain-haematoma' pressure gradient for different surgical methods significantly influence surgical procedures and effects of HICH. During keyhole endoscopy surgery, this gradient was relatively large and slowly decreased; the haematoma was therefore easier to remove. Advantages of this approach include a high haematoma clearance rate, decreased bleeding volume, decreased operative time, reduced trauma, decreased postoperative brain oedema and improved postoperative recovery of neurological function.Chinese Clinical Trial Register: ChiCTR1900020655 registration in 12/01/02,019 registration in 28/02/02,020 Number: NCOMMS-20-08,091.
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Early intravenous tranexamic acid intervention reduces post-traumatic hidden blood loss in elderly patients with intertrochanteric fracture: a randomized controlled trial
Ma H, Wang H, Long X, Xu Z, Chen X, Li M, He T, Wang W, Liu L, Liu X
Journal of orthopaedic surgery and research. 2021;16(1):106
Abstract
PURPOSE Elderly patients with intertrochanteric fractures exhibit post-traumatic hidden blood loss (HBL). This study aimed to evaluate the efficacy and safety of reducing post-traumatic HBL via early intravenous (IV) tranexamic acid (TXA) intervention in elderly patients with intertrochanteric fracture. METHODS A prospective randomized controlled study was conducted with 125 patients (age ≥ 65 years, injury time ≤ 6 h) who presented with intertrochanteric fracture from September 2018 and September 2019. Patients in the TXA group (n = 63) received 1 g of IV TXA at admission, whereas those in the normal saline (NS) group (n = 62) received an equal volume of saline. Hemoglobin (Hgb) and hematocrit (Hct) were recorded at post-traumatic admission (PTA) and on post-traumatic days (PTDs) 1-3. HBL was calculated using the Gross formula. Lower extremity venous ultrasound was performed to detect venous thrombosis. RESULTS Hgb on PTDs 2 and 3 was statistically higher in the TXA group than in the NS group. Hct and HBL on PTDs 1-3 were significantly less in the TXA group compared to the NS group. Preoperative transfusion rate was significantly lower in the TXA group compared with the NS group. There was no difference between the two groups with regard to the rates of complications. CONCLUSION Early IV TXA intervention could reduce post-traumatic HBL and pre-operative transfusion rate in elderly patients with intertrochanteric fractures without increasing the risk of venous thrombosis.
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Tranexamic acid reduce hidden blood loss in posterior lumbar interbody fusion (PLIF) surgery
Xu D, Chen X, Li Z, Ren Z, Zhuang Q, Li S
Medicine (Baltimore). 2020;99(11):e19552
Abstract
BACKGROUND Posterior lumbar interbody fusion (PLIF) surgery is associated with significant blood loss; however, few studies have focused on hidden blood loss (HBL) in PLIF or its regulatory factors. The purpose of this study was to explore the HBL in PLIF surgery as well as the influence of tranexamic acid (TXA) on blood loss in PLIF. METHODS We performed a randomized controlled trial (RCT) and recruited patients undergoing PLIF into the study from November 2013 to April 2017. All participants were assigned to one of 2 groups according to a simple equal probability randomization scheme. At the end of PLIF surgery, for patients in the TXA group, the surgical field was immersed in TXA (1 g in 100 mL of saline solution) for 5 min before stitching the wound. For the control group, the surgical field was immersed in the same volume of normal saline. RESULTS In our study, the drainage volume during the first 24 h and the total postoperative drainage volume were significantly lower in patients in the TXA group than in the control group (P = .001). The hematocrit (Hct) of the drainage and calculation of blood contained in the drainage showed similar results. The mean length of hospital stay and rate of blood transfusion in the TXA group were less than those in the control group (P < .05). HBL was responsible for 45.6% of the total blood loss in PLIF, and both of the indicators in the TXA group were much lower than those in the control group. CONCLUSIONS PLIF is associated with massive perioperative HBL, but the application of topical TXA leads to less postoperative blood loss including less HBL, a lower blood product transfusion rate, and a shorter hospital stay for PLIF.
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Observation on therapeutic effect of stereotactic soft channel puncture and drainage on hypertensive cerebral hemorrhage
Mao Y, Shen Z, Zhu H, Yu Z, Chen X, Lu H, Zhong F, Cheng H
Ann Palliat Med. 2020
Abstract
BACKGROUND To evaluate and analyze the therapeutic effect of stereotactic soft channel puncture and drainage on hypertensive cerebral hemorrhage. METHODS Sixty patients with hypertensive cerebral hemorrhage admitted to our hospital from September 2014 to September 2019 were selected for study and randomly divided into study group (n=30) and routine group (n=30) according to admission number. Two groups of patients were given basic treatment after admission, while routine group patients were given small bone window hematoma removal, study group patients were given stereotactic soft channel puncture and drainage, and the clinical effects of the two groups were analyzed. RESULTS The total effective rate of the study group was 96.67%, which was significantly higher than that of the routine group (80.00%), and the difference was statistically significant (P<0.05). The level of independent living in the study group was significantly higher than that in the conventional group, and the level of neurological deficit was lower than that in the conventional group, with statistically significant difference (P<0.05). Before treatment, there was no significant difference in the hematoma volume between the two groups (P>0.05). after treatment for 1, 2 and 4 weeks, the hematoma volume of the two groups decreased, and the hematoma volume of the study group was significantly less than that of the conventional group, with significant difference (P<0.05). There was no difference in CD3+ positive cell rate and CD8+ positive cell rate between the two groups before treatment (P>0.05). After treatment, the CD8+ positive cell rate in the study group was lower than that in the conventional group, and the CD3+ positive cell rate was higher than that in the conventional group, with statistically significant difference (P<0.05). The incidence of postoperative complications such as pulmonary infection, urinary tract infection, liver and kidney dysfunction in the study group was lower than that in the conventional group, and the difference was statistically significant (P<0.05). CONCLUSIONS Stereotactic soft-channel puncture and drainage has the advantages of less trauma, less bleeding, fewer complications and rapid postoperative recovery. It can be used for the treatment of hypertensive cerebral hemorrhage, promote the recovery of neurological function of patients, improve independent living standard and effectively improve prognosis.
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[Application of intravenous injection of tranexamic acid combined with local use of tranexamic acid cocktail in intertrochanteric fracture fixation]
Zhang Q, Xiang C, Chen X, Chen L, Chen Q, Jiang K, Chen L, Li Y, Wei P
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020;34(4):463-468
Abstract
Objective: To explore the efficacy and safety of intravenous injection of tranexamic acid (TXA) combined with local use of TXA cocktail in intertrochanteric fracture fixation with proximal femoral nail antirotation (PFNA). Methods: Patients with intertrochanteric fractures who underwent close reduction and internal fixation with PFNA between February 2018 and March 2019 were enrolled in the study. Among them, 45 patients who met the selection criteria were included in the study and randomly allocated into 3 groups ( n=15). The patients in group A were not received TXA during perioperative period. The patients were intravenously injected of 1.0 g TXA before operation in group B and combined with local use of TXA cocktail during operation in group C. There was no significant difference in the age, gender, body mass index, fracture classification, disease duration, and complications between groups ( P>0.05). The perioperative blood loss and blood transfusion rate, the visual analogue scale (VAS) score before operation and at 12, 24, and 48 hours after operation, the levels of prostaglandin E2 (PGE2) and bradykinin (BK) before operation and at 1 and 3 days after operation, postoperative complications, and the maximum amplitude (MA) of thromboelastogram were recorded and compared between groups. Results: The total blood loss, hidden blood loss, and visible blood loss were significantly lower in groups B and C than those in group A ( P<0.05), and the total blood loss and hidden blood loss were significantly lower in group C than those in group B ( P<0.05). There was no significant difference in the blood transfusion rate, preoperative VAS scores and the levels of PGE2 and BK between groups ( P>0.05). The postoperative VAS scores and the levels of PGE2 and BK were significantly lower in group C than in groups A and B ( P<0.05). There was no significant difference in pre- and post-operative MA of thromboelastogram between groups ( P>0.05). The incidences of postoperative complications were 33.33% (5/15), 20.00% (3/15), and 13.33% (2/15) in groups A, B, and C, respectively, with no significant difference between groups ( chi (2)=1.721, P=0.550). Conclusion: For intertrochanteric fractures, application of intravenous injection of TXA combined with local use of TXA cocktail in PFNA fixation can reduce perioperative blood loss, relieve pain after operation, and do not increase the risk of complications.
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Safety and efficacy of herbal medicine for acute intracerebral hemorrhage (CRRICH): a multicentre randomised controlled trial
Zeng L, Tang G, Wang J, Zhong J, Xia Z, Li J, Chen G, Zhang Y, Luo S, Huang G, et al
BMJ open. 2019;9(5):e024932
Abstract
OBJECTIVE To evaluate the safety and efficacy of removing blood stasis (RBS) herbal medicine for the treatment of acute intracerebral haemorrhage (AICH) within a 6-hour time window. STUDY DESIGN A randomised, multicentre, double-blind, placebo-controlled study performed in 14 hospitals in China. PARTICIPANTS AND INTERVENTIONS Patients with AICH were randomly assigned to receive a placebo, the ICH-1 (Intracerebral Haemorrhage) formula (eight herbs, including the RBS herbs hirudo and tabanus) or the ICH-2 formula (six herbs without the RBS herbs hirudo and tabanus) within 6 hours of ICH onset. OUTCOMES The primary safety outcome was the incidence of haematoma enlargement at 24 hours and at 10 days after treatment. The secondary outcome was the incidence of poor prognosis (mortality or modified Rankin Scale score ≥5) assessed at 90 days after symptom onset. RESULTS A total of 324 subjects were randomised between October 2013 and May 2016: 105 patients received placebo; 108 patients received the ICH-1 formula; and 111 patients received the ICH-2 formula. The incidence of haematoma enlargement at 24 hours was 7.8% in the placebo group, 12.3% in the ICH-1 group and 7.5% in the ICH-2 group; the incidence of haematoma enlargement on day 10 was 1.1% in the placebo group, 1.1% in the ICH-1 group, and 3.1% in the ICH-2 group, with no significant differences among the groups (P>0.05). The mortality rates were 3.8% in the placebo group, 2.8% in the ICH-1 group, and 0.9% in the ICH-2 group; the incidences of poor prognosis were 7.1% in the placebo group, 6.0% in the ICH-1 group and 4.8% in the ICH-2 group at 3 months, with no significant differences among the groups (p>0.05). However, the overall frequency of treatment-emergent adverse events in the ICH-1 group (12.1%) was higher among the three groups (5.8% and 2.8%, respectively, p<0.05). All three cases of serious adverse events were in the ICH-1 group. CONCLUSIONS Ultra-early administration of ICH-1 formula for AICH patients did not exert significant beneficial effects on clinical outcomes but increased the risk of bleeding, which probably resulted from the inclusion of RBS herbal medicines in ICH-1. TRIALREGISTRATION NUMBER NCT01918722.
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Intra-Articular Injection of Tranexamic Acid on Perioperative Blood Loss During Unicompartmental Knee Arthroplasty
Wu J, Feng S, Chen X, Lv Z, Qu Z, Chen H, Xue C, Zhu M, Guo K, Wu P
Medical science monitor : international medical journal of experimental and clinical research. 2019;25:5068-5074
Abstract
BACKGROUND Tranexamic acid (TXA) is safe and effective in total knee arthroplasty (TKA) for the prevention of bleeding. However, the role of TXA during unicompartmental knee arthroplasty (UKA) remains unclear. This study aimed to compare operative blood loss in patients undergoing UKA treated with an intra-articular injection of TXA with controls undergoing UKA without TXA. MATERIAL AND METHODS The prospective study included 101 patients who underwent UKA between January 2014 to March 2018. All patients completed a preoperative routine examination and were randomized to the study group (n=54) and the control group (n-47). The study group was given an articular injection of TXA (1.5 g in 50 ml normal saline) after the fascia was closed; the control group was injected with the same volume of normal saline. Blood volumes were measured from the drainage tube of the two groups during 48 hours. Total blood loss, postoperative drainage, hidden blood loss, blood transfusion rates, postoperative hemoglobin values, indicators of coagulation function, and the rates of wound complications were recorded. RESULTS Total blood loss in the study group was 745.6+/-105.1 ml, total drainage volume was 353.9+/-79.5 ml, and the hidden blood loss was 391.7+/-80.5 ml, which were all significantly lower when compared with the control group (P<0.05). None of the patients in the two groups suffered complications of surgery. CONCLUSIONS Intra-articular injection of TXA significantly reduced the total blood loss in patients who underwent UKA and did not increase the rate of complications.