Abstract

INTRODUCTION This study aimed to analyze the efficacy of intravenous administration of tranexamic acid in complex proximal humeral fractures. MATERIALS AND METHODS Sixty-seven patients with displaced 3 and 4 part proximal humerus fractures were randomized into the control (n = 33) and TXA (n = 34) groups. Fifteen minutes before the skin incision, 15 mg/kg body weight of 0.9% sodium chloride solution or TXA was injected intravenously. Open reduction and internal fixation was conducted through a deltoid-pectoral approach with fixed angle locked plating (PHILOS) for all the patients. The patients were followed up 2 months after surgery. Total blood loss, blood test results, blood transfusion rate, and wound complications were analyzed between the two groups. RESULTS Significant differences were observed in intraoperative blood loss and postoperative blood loss during the first 24 h between the two groups. There were no significant differences in postoperative blood loss during the second 24 h, wound complication rates, blood transfusion rate and adverse side effects. And thromboembolic events related with the application of TXA were not noted in the TXA group. CONCLUSION Preoperative administration of tranexamic acid could reduce intraoperative and postoperative blood loss in patients with complex proximal humeral fractures. LEVEL OF EVIDENCE II, prospective comparative study.

Abstract

OBJECTIVE To compare the efficacy and safety between autologous blood products (ABPs) and corticosteroid injections (CSIs) in the treatment of lateral epicondylitis (LE). TYPE Meta-analysis. LITERATURE SURVEY We systematically searched the EMBASE, PubMed, the Cochrane Library and Web of Science to identify randomized controlled trials (RCTs) comparing ABPs versus CSIs for the treatment of LE without language and publication date restriction through April 2015. METHODOLOGY Two investigators independently included and assessed the quality of each eligible study according to the method recommended by the Cochrane Collaboration. Available data about the main outcomes were extracted from each study and heterogeneity was assessed using the Q statistic and the inconsistency index (I2). We also evaluated the publication bias and conducted a subgroup analysis. The Review Manager 5.2 software was used for data syntheses and analyses, the standardized mean difference (SMD) or mean difference (MD) were estimated by using random effects models with 95% confidence interval (CI). To investigate the efficacy among different trial durations, the follow-up times were therefore divided into short (2-4 weeks), intermediate (6-24 weeks) and long term (≥ 24 weeks). SYNTHESIS Ten RCTs (n = 509) were included in this meta-analysis. The pooled analysis showed that CSIs were more effective than ABPs on pain relief (SMD = 0.88; 95% CI = 0.31to1.46%; P = .003) in the short term. However, in the intermediate term, ABPs exhibited a better therapeutic effect for pain relief (SMD = -0.38; 95% CI = -0.70 to -0.07%; P = .02), function (SMD = -0.60; 95% CI = -1.13 to -0.08%; P = .03), DASH (MD = -11.04; 95% CI = -21.72 to -0.36%; P = .04), and Nirschl stage (MD = -0.81; 95% CI = -1.11 to -0.51%; P < .0001). In the long term, ABPs were superior to CSIs for pain relief (SMD = -0.94; 95% CI = -1.32 to -0.57%; P < .0001) and Nirschl stage (MD = -1.04; 95% CI = -1.66 to -0.42%; P = .001). Moreover, for grip strength recovery, there was no significant difference between the two therapies (p > .05). CONCLUSIONS There was limited evidence supporting the conclusion that CSIs were superior to ABPs for pain relief in the short term; however, this result was reversed in the intermediate and long term. ABPs seemed to be more effective at restoring function in the intermediate term. Due to the small sample size and the limited number of high-quality RCTs, more high-quality RCTs with large sample sizes are required to further validate this result.

Abstract

The deleterious effect of perioperative allogeneic blood transfusion in patients with resected lung cancer has been controversial. We conducted this meta-analysis to answer the question of whether perioperative allogeneic blood transfusion adversely affects recurrence and survival in patients with resected lung cancer. Included were 23 studies with 6,474 patients. The result showed allogeneic blood transfusion was significantly associated with earlier recurrence and worse survival in patients with surgically resected lung cancer. We suggest transfusion policy should be stricter in lung cancer patients undergoing resection, especially with early-stage disease. Prospective large-scale studies are still warranted. Copyright 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Abstract

To investigate the efficacy of antepartum administration of three doses of hepatitis B immunoglobulin (HBIg), currently being used in China, 250 pregnant women who were seropositive for hepatitis B e antigen (HBeAg) were randomly divided into study (117 cases) and control groups (133 cases). Subjects in the study group received HBIg 400 IU intramuscularly once a month at the third, second and first month before delivery; subjects in the control group received no antepartum treatment. All neonates received passive-active immunization after birth. The maternal hepatitis B virus (HBV) markers, hepatitis B surface antigen (HBsAg) titres and HBV deoxyribonucleic acid (DNA) levels were measured at week 28 of gestation (before the antepartum treatment) and at labour; the neonatal serum HBV markers were detected at birth and at 12 months after birth. No side-effects were found in any of the women or their neonates. No statistical differences were seen between the maternal HBsAg and HBV DNA levels of the study and control groups at labour nor the protective efficacy rates of postnatal immunoprophylaxis at 12 months after birth (P > 0. 05, respectively). To conclude, antepartum administration of three doses of HBIg for the HBeAg-positive women is inefficacious.