Amount Of Bleeding Research Articles

Comparison of gauze packing, sponge-based, and hemostatic Surgicel wound stasis dressings to treat hemorrhages from grade IV liver injuries: An experimental study

BackgroundUncontrolled bleeding is still the major factor leading to preventable deaths following trauma. This study sought to assess the effectiveness of mini sponge-based wound stasis, cellulose-based local hemostatic, and traditional gauze dressings for the control of hemorrhages resulting from grade 4 liver injuries in rats. MethodsThirty Sprague-Dawley rats were divided into three equal groups. In the first group, a liver laceration was treated with gauze packing. The second group received XStat minisponge dressing (MDS), and the third group was administered a combination of MDS dressing and Surgicel hemostatic agent. After gaining access to the intra-abdominal cavity, a liver laceration measuring 10 mm in length, 5 mm in depth, and extending to the middle lobe was created. The dressings were removed after 2 and 10 minutes to assess the amount of bleeding, and any bleeding was documented again after 48 hours. Intraperitoneal adhesions were evaluated during euthanasia. ResultsAt 2 minutes post-injury, the gauze packing group had an average bleeding volume of 0.97±0.15 mL, compared to 1.08±0.25 mL in the MDS group (P=0.26) and 1.02±0.18 mL in the MDS+Surgicel group (P=0.69). At 10 minutes, the bleeding volumes were 0.13±0.05 mL, 0.22±0.01 mL (P=0.09), and 0.14±0.05 mL (P=0.19), respectively. At 48 hours, significant differences were observed in bleeding volumes (gauze: 0.55±0.18 mL, MDS: 1.15±0.21 mL, MDS+Surgicel: 0.82±0.06 mL, P<0.001). Mortality rates after 14 days were 0% in the gauze packing group, 60% in the MDS group (P=0.001), and 60% in the MDS+Surgicel group (P=0.001). The gauze packing group displayed no adhesions, while the other groups exhibited adhesions in the liver, bowel, omentum, and abdominal wall. ConclusionOur results indicate that, when it comes to managing bleeding in severe liver injuries, traditional gauze packing remains the tried-and-true method, showing superior effectiveness in terms of blood loss and mortality when compared to XStat minisponge dressings and the fibrillar Surgicel hemostatic agents.

11253 Does Prophylactic Tranexamic Acid Prior to Vaginal Hysterectomy Reduce the Amount of Bleeding? A Randomized Control Study

11253 Does Prophylactic Tranexamic Acid Prior to Vaginal Hysterectomy Reduce the Amount of Bleeding? A Randomized Control Study

Периоперационное кондиционирование оксидом азота для предотвращения острого почечного повреждения при кардиохирургических вмешательствах у пациентов с хронической болезнью почек: промежуточные результаты рандомизированного контролируемого исследования DEF

INTRODUCTION: Acute kidney injury (AKI) is a common and serious complication after cardiac surgery performed under cardiopulmonary bypass (CPB). Patients with chronic kidney disease (CKD) are particularly vulnerable to cardiac surgery-associated AKI. Nitric oxide (NO) has great potential for implementing multi-organ protection in cardiac surgery. OBJECTIVES: To test the hypothesis that perioperative nitric oxide conditioning has a good safety profile and reduces the incidence of acute kidney injury during cardiac surgery under cardiopulmonary bypass in patients with chronic kidney disease. MATERIAL AND METHODS: An interim analysis of the results of the single-center prospective randomized controlled trial DEFENDER was conducted. Currently, the study included 96 patients with CKD who underwent cardiac surgery under CPB. Patients was randomized into 2 equal groups consisting of 48 people each. In the experimental group, during the operation and 6 hours after it, 80 ppm NO was delivered through the ventilator and CPB circuits. In the control group, during the operation and 6 hours after it, a standard oxygen-air mixture without NO was delivered through the ventilator and CPB circuits. The end points of the study were: the difference between groups in the incidence of AKI, the incidence of postoperative complications, outcomes and the safety profile of NO therapy. RESULTS: In the experimental group, the incidence of AKI was significantly lower compared to the control group (16,7 и 35,4 %, p = 0.036). In the experimental group, nitrogen dioxide concentration in the gas-air mixture and methemoglobin level were not above the reference range. The groups did not differ in the frequency of blood transfusions, the amount of postoperative bleeding, or the number of platelets on the first day after surgery. CONCLUSIONS: Perioperative nitric oxide conditioning has a good safety profile and reduces the incidence of acute kidney injury during cardiac surgery with CPB in patients with chronic kidney disease.

Comparation of abdominal aortic balloon occlusion versus uterine artery embolization in the treatment of cesarean scar pregnancy

Study objectiveThis study is to uncover the advantages of abdominal aortic balloon occlusion in the uterine curettage treatment for patients with cesarean scar pregnancy (CSP).MethodsTo retrospectively analyze the clinical data of eighty patients with CSP after treatment in our hospital from 01/10/2019 to 01/05/2021. The 80 patients were divided into 2 groups: 41 patients were treated with abdominal aortic balloon occlusion and the control group (n = 39) underwent Uterine artery embolization (UAE). The amount of bleeding during the operation, the operation time of the uterine curettage, the X-ray fluoroscopy time under DSA, the surface dose in radiation, the length of hospital stay (LOS), and the postoperative complications were compared between these 2 groups (type II and type III).ResultsAll the operations successfully retained the uterus. No balloon-related complications occurred in the experimental group. And in the control group, there were 14 cases of fever and 19 cases of pain after UAE. The fluoroscopy time of experimental group and control group were: (type II: (20.3 ± 7.1)s vs. (593.7 ± 284.5)s, p &amp;lt; 0.01), (type III: (21.2 ± 7.2)s vs. (509.8 ± 164.2)s, p &amp;lt; 0.01), the surface dose in radiation: (type II: (1.9 ± 0.7)mGy vs. (248.3 ± 85.9)mGy, p &amp;lt; 0.01), (type III: (2.1 ± 0.8)mGy vs.(252.0 ± 74.9)mGy, p &amp;lt; 0.01), the amount of bleeding during the operation: (type II:30.0(20.0, 50.0)ml vs. 20.0(10.0, 50.0)ml, p = 0.113), (type III:50.0 (17.5,162.5)ml vs. 50.0 (22.5, 72.5)ml, p = 0.623), the operation time of the uterine curettage:(type II: (54.8 ± 19.4)min vs.(43.9 ± 21.9)min, p = 0.071), (type III: (65.2 ± 50.4)min vs.(52.8 ± 20.1)min, p = 0.426), LOS: (type II:(5.4 ± 1.7)d vs.(5.4 ± 1.2)d, p = 0.816), (type III:(5.8 ± 2.4)d vs. (7.0 ± 1.7)d, p = 0.161). The follow-up was more than 3 months. No adverse reaction in the experimental group and 6 patients in the control group presented menstrual volume decrease.ConclusionNo balloon-related complications occurred in the abdominal aortic balloon occlusion and lower radiation exposure for both the operator and patient. And both abdominal aortic balloon occlusion and UAE can effectively reduce the bleeding during uterine curettage in patients with type II and III CSP.

Comparative outcomes of microdebrider adenoidectomy, curettage adenoidectomy through oral cavity under 70 endoscope, and endoscopic transoral low-temperature ablation for adenoid hypertrophy

AimWe aimed to compare the effects of microdebrider adenoidectomy, curettage adenoidectomy through oral cavity under 70°endoscope, and endoscopic transoral low-temperature ablation on adenoid hypertrophy. MethodsA total of 180 children suffering from adenoid hypertrophy hospitalized during November 2019 and November 2023 were allocated to group A (microdebrider adenoidectomy, n = 65), group B (curettage adenoidectomy through oral cavity under 70° nasal endoscope, n = 54), and group C (nasal endoscopic transoral low-temperature adenoid ablation, n = 61). The operation data (operation time and bleeding amount), pain score, postoperative recovery, and complications were compared. ResultsThe operation time of group A was significantly shorter than those of other two groups, while group C had a significantly smaller bleeding amount than those of other two groups (P < 0.05). An incidence rate of secondary bleeding at 6.15 % was detected in group A, without other complications. Group B had an adenoid residual rate of 35.19 % and a recurrence rate of 14.81 %, significantly exceeding those of other two groups (P < 0.05). The soft palate injury rate was 24.59 % in group C, which was raised significantly compared with those of other two groups (P < 0.05). In comparison to other two groups, significant increases in postoperative pain score and pain duration were detected in Group C (P < 0.05). ConclusionThere is no significant difference in the effective rate among the three methods. Nasal endoscopic transoral low-temperature adenoid ablation is recommended as the first choice because of small bleeding amount, few postoperative residuals, and low recurrence rate, but it poses high requirements on the operation of doctors.

Effect of Anesthesia Type on Pain and Hemodynamic Parameters in Cesarean Section Surgery: Randomized Controlled Trial

Background: General and spinal anesthesia are commonly used for cesarean sections, each with implications for both the mother and the fetus. The choice of anesthesia technique depends on various factors. While spinal anesthesia is often preferred for cesarean surgeries due to its well-known benefits, general anesthesia may be chosen in emergency situations. The decision is ultimately based on the safety profile and benefits for both the mother and the fetus. Methods: This clinical trial was conducted at Fatemieh Hospital in Hamadan and involved 60 patients undergoing elective cesarean section. The patients were randomly divided into two groups of 30: One group received spinal anesthesia, and the other group received general anesthesia. Variables such as intraoperative bleeding, the Apgar score of the newborn, postoperative pain, and postoperative systolic and diastolic blood pressure were analyzed and compared between the two groups using SPSS software version 16. Results: The mean age of participants in the spinal and general anesthesia groups was 32 ± 3.5 years and 34 ± 3.4 years, respectively. The results showed that the amount of intraoperative bleeding in the general anesthesia group was higher than in the spinal anesthesia group, but this difference was not statistically significant (P = 0.85, P &lt; 0.05). The Apgar scores at the first and fifth minutes in the spinal anesthesia group were higher than those in the general anesthesia group, but this difference was also not statistically significant (P = 0.32, P &lt; 0.05). Postoperative pain in the spinal anesthesia group was significantly lower than in the general anesthesia group (P = 0.001, P &lt; 0.05). Regarding hemodynamic parameters, systolic blood pressure after the operation was higher in the spinal anesthesia group compared to the general anesthesia group (P &lt; 0.05). Conversely, diastolic blood pressure in the general anesthesia group was higher than in the spinal anesthesia group at all measurement stages, though not statistically significant in some measurements (P &gt; 0.05). Conclusions: The results of our study indicate that spinal anesthesia is a preferable and safer method compared to general anesthesia, based on the parameters examined, particularly in emergency cesarean sections.

Endometrial pattern in women with abnormal uterine bleeding attending a tertiary care centre of Kathmandu

Background: Abnormal uterine bleeding is one of the most common problems among pre and postmenopausal women. Abnormal uterine bleeding is diagnosed when there is a substantial change in frequency, duration, or amountof bleeding during or between periodsin the absence of any organic pathology. The study was perform to assess the endometrial causes of abnormal uterine bleeding and their incidence in different age groups. Materials and methods: It was a cross sectional and descriptive study carried out at a Manmohan medical College &amp; hospital, over a period of two year from 13th April, 2020 to 15th March, 2022. In the study all the endometrial tissue either obtained by endometrial curettage and biopsy or hysterectomy presenting with abnormal uterine bleeding for more than 3 months were included Results: A total of 88 cases were received during this period, out of which there were 78 endometrial tissue samples and 10 hysterectomy specimens. The patient’s age ranged from 20 years to 73years. The pattern of endometrial biopsy are Proliferative (37.5%) and secretory (20.45%) phase endometrium is the most common pattern seen, followed by disordered proliferative endometrium (13.63%), endometrial hyperplasia without atypia (9.09%), Change consistent with Exogenous Hormone (5.68%), Chronic Endometritis (5.68%), Endometrial Polyp(3.40%), Endometrial Hyperplasia with Atypia(2.27%) and Endometrial Carcinoma (2.27%). Conclusions: Patients with abnormal uterine bleeding show a varying spectrum of endometrial pattern. Cyclic endometrium is commonly seen in the reproductive age group whereas hyperplasia and carcinomas are seen in pre/postmenopausal age group. Endometrial biopsy with histopathological examination is a major diagnostic tool in the evaluation of abnormal uterine bleeding.

The Impact of Tranexamic Acid Administration on Bleeding in Total Knee Arthroplasty: A Comparative Analysis Based on Anesthetic Techniques

Purpose: This retrospective study focused on examining the effect of local tranexamic use on postoperative bleeding in TKA surgery with general or spinal anaesthesia. Materials and methods: This study analysed the postoperative bleeding amounts in 95 knees with primary osteoarthritis that underwent TKA between January 2017 and 2023. Patients undergoing TKA under general or spinal anaesthesia were separated into four groups based on whether or not local tranexamic acid was given perioperatively. The postoperative hemogram alterations, drainage volume, and transfusion needs of these patients were assessed. Results: Group 4 saw a significantly higher decline in haemoglobin levels within the first twenty-four hours following surgery distinct from groups 1, 2, and 3 (p1:0.001; p2:0.000; p3:0.001, p0.05). Postoperative hemoglobin values in Group 3 were statistically importantly higher than Groups 1,2 and 4 (p1:0.019; p2:0.003; p

Application and clinical effects in lung bullae resection of CT 3-dimensional reconstruction.

To investigate the value and clinical effect of computed tomography (CT) 3-dimensional reconstruction technology in lung bullae resection. Ninety-eight patients who underwent thoracoscopic surgical resection of lung bullae in our hospital from February 2019 to February 2023 were selected and divided into 2 groups according to the principle of voluntary participation in the clinical trial, of which 43 cases underwent preoperative spiral CT for thin-layer enhancement or planar CT scanning of lung bullae (control group), and 43 cases were imaged with MimicsMedical 21 software for 3-dimensional reconstruction to develop a surgical plan (observation group). To compare the surgery-related indexes, postoperative complications, pain, and analgesic use between the 2 groups, we measured serum creatine phosphokinase and myoglobin levels. The amount of surgical bleeding, drainage volume, hospital stay, and postoperative visual analog scale score of the research group were lower than those of the control group (P < .05), and the duration of analgesic medication was shorter than that of the control group (P < .05), and the levels of serum creatine phosphokinase and myoglobin were lower than those of the control group at 1 and 3 days postoperatively, and the differences were statistically significant (P < .05). Preoperative CT 3-dimensional reconstruction technique can clearly show the anatomical structures around the lung bullae and has its application value for precise lung bullae.

Comparable bleeding and inflammation outcomes between heparin-coated and uncoated minimal invasive extracorporeal circuits in isolated coronary artery bypass surgery - A double-blinded randomized control trial.

Minimally invasive extracorporeal circulation has been shown to be non-inferior or even superior to conventional cardiopulmonary bypass circuits in isolated coronary artery bypass grafting, but there is little evidence whether the addition of a heparin-coated circuit can further reduce the inflammatory response and amount of bleeding in these patients. A single-center randomized control trial enrolled 49 adult patients scheduled to undergo isolated coronary artery bypass grafting with minimally invasive extracorporeal circulation (MiECC) between January 2015 and December 2018. Patients were randomized 1:1 to either the heparin-coated circuit group, or the uncoated (control) circuit group. The primary outcome was chest tube output 18h after weaning from MiECC, and secondary outcomes included inflammatory (TNF-α, IL-6, IL-8, IL-10) and complement (C3a, C4d, C5a, sC5b-9) biomarkers, platelet count and function (D2D, TAT, SDC1, PF4), number of transfused blood products, and 30-day survival. Patients were randomized to undergo myocardial revascularization using heparin-coated circuits (n = 25), and to the uncoated MiECC circuit (n = 24), with comparable baseline demographics. No significant difference was observed in chest tube output and for all secondary outcomes. IL-6 and IL-8 were increased from baseline at 18h after weaning (effect size 0.29 and 0.05, respectively) and sC5b-9 was lower (effect size 0.11) in the heparin-coated than in the uncoated MiECC, although not significantly different. Compared with an uncoated MiECC circuit, heparin-coated MiECC circuit was not associated with a reduction in postoperative bleeding, transfusion, inflammation, complement activation, and platelet biomarkers, following isolated coronary artery bypass grafting.

Analysis of risk factors for intraoperative bleeding in patients with Siewert type II esophagogastric junction adenocarcinoma treated by two minimally invasive surgeries and its influence on prognosis: a retrospective study.

The present study aimed to analyze the independent risk factors for intraoperative bleeding in Siewert II adenocarcinoma of the esophagogastric junction (AEG) using two minimally invasive surgical approaches, namely, the laparoscopy-assisted abdominal trans-hiatal (LTH) method and transthoracic-laparoscopic esophagectomy (TLE). The clinical data of 100 patients with SiewertII AEG admitted to our hospital from October 2017 to October 2020 were retrospectively analyzed. According to the type of surgery, the patients were divided into LTH approach group and TLE approach group. The differences between the clinical characteristics of the patients in different groups and the differences in the intraoperative bleeding and prognosis between different surgical procedures were analyzed and compared using the t-test and chi-squared test. Multiple linear regression was used to identify the independent risk factors affecting the amount of intraoperative bleeding in patients. The results of this study showed that patients in the LTH group had significantly less intraoperative bleeding and operative time and significantly better postoperative recovery than the TLE group. The results of multivariate linear regression showed that the combined trans-thoracic-abdominal approach (P=0.000), advanced age (P=0.014), larger BMI (P=0.000), and larger tumor diameter (P=0.001) were the independent risk factors influencing the increase in intraoperative bleeding. In addition to the conventional factors that affect intraoperative bleeding, such as the patient's general condition, operation time, and tumor size, LTH surgery is another way to avoid intraoperative bleeding for Siewert type II AEG patients and can significantly improve postoperative recovery.

Comparison of Postoperative Outcomes and Long-Term Survival Rates between Patients Who Underwent Robotic and Laparoscopic Complete Mesocolic Excision for Right-Sided Colon Cancer.

Introduction: Right colon cancer often requires surgical intervention, and complete mesocolic excision (CME) has emerged as a standard procedure. The study aims to evaluate and compare the safety and efficacy of robotic and laparoscopic CME for patients with right colon cancer and 5-year survival rates examined to determine the outcomes. Materials and Methods: Patients who underwent CME for right-sided colon cancer between 2014 and 2021 were included in this study. Group differences of age, body mass index, operation time, bleeding amount, total harvested lymph nodes, and postoperative stay were analyzed by the Mann-Whitney U test. Group differences of sex, American Society of Anesthesiology, and tumor, node, and metastasis stage were analyzed by the Chi-squared test. Disease-free and overall survival were assessed using Kaplan-Meier curves with the log-rank Mantel-Cox test. Results: From 109 patients, 74 of them were 1:1 propensity score matched and used for analysis. Total harvested lymph node (P ≤ .001) and estimated blood loss (P = .031) were found to be statistically significant between the groups. We found no statistically significant difference between the groups in terms of disease-free and overall survival (P = .27, .86, respectively), and the mortality rate was 9.17%, with no deaths directly attributed to the surgery. Conclusions: Study shows that minimally invasive surgery is a feasible option for CME in right colon cancers, with acceptable overall survival rates. Although the robotic approach has a higher lymph node yield, there was no significant difference in survival rates. Further randomized trials are needed to determine the clinical significance of both approaches.

The effects of prophylactic administration of tranexamic acid on the operative time and the amount of blood transfused during open fixation of pelvis and acetabulum fractures

BackgroundOrthopedic surgeons face challenges regarding perioperative bleeding during the operations of pelvic and acetabular fracture cases. Although the recently popular tranexamic acid (TXA) has proven to be a useful tool, this study primarily aimed to conduct a retrospective comparative analysis of the results of the prophylactic administration of tranexamic acid during open fixation of pelvis and acetabulum fractures, especially regarding operative time and the amount of blood transfused; and in addition, share the results related to other findings including the management of the erythrocyte suspension use and overall cost as secondary aims and thus providing a comprehensive point of view.MethodsThe files of patients with pelvis or acetabulum fractures admitted to the Emergency Clinic of the Adana City Training and Research Hospital between January 1, 2020, and December 31, 2023, were analyzed retrospectively. The inclusion criteria were as follows: patients aged 18 years or older who had undergone open reduction for pelvis or acetabulum fractures.ResultsThere were 78 files identified for analysis. Among the fractures, 27 were located at the pelvis (34.61%) and 51 at the acetabulum (65.38%). The pelvic fracture cases’ age and preoperative hemoglobulin levels were significantly lower (p = 0.019 and p = 0.006, respectively). When all cases were dichotomized into two groups, ones requiring ICU monitoring and the remaining, there were statistically significant differences in terms of the preoperative hemoglobin levels (p = 0.0446), intraoperative bleeding (p = 0.0134), units of erythrocyte suspension used (p = 0.0066), drain output (p = 0.0301), hospitalization duration (p = 0.0008), and the overall cost (p = 0.0002). The comparison regarding TXA use showed that the use of blood products was significantly higher in the pelvic fractures not treated with TXA (6.44 ± 4.42 units, p = 0.0029). The duration of surgery was shorter for pelvic fractures treated with TXA (98.33 ± 21.76 min, p = 0.047).ConclusionAmong the variables, the amount of intraoperative bleeding emerged as the most correlated element, which strongly suggests that in managing open reduction internal fixation surgeries performed for pelvis and acetabulum fractures, intraoperative bleeding should be considered as the crucial factor. Therefore, the administration of TXA, by effectively reducing the amount of intraoperative bleeding, should be considered as an essential tool for orthopedic surgeons.

Progress and Current Status of Treatment for Lower Limb Varicose Veins

Varicose veins of lower extremities are common venous diseases of lower extremities in clinic [1]. The total number of patients with varicose veins of lower extremities in China has exceeded 100 million, and the incidence rate is about 15% [2]. Therefore, there is a huge number of illnesses and a demand for surgical treatment. At present, the main treatment options for lower limb varicose veins include conservative treatment and surgical treatment. Surgical treatment methods include traditional surgery and minimally invasive surgery. The high ligation and stripping of the great saphenous vein has always been the gold standard for the treatment of lower limb varicose veins. This method is technically mature and clinically effective, but it is a destructive surgery that uses a stripping device to forcefully pull. Therefore, the intraoperative trauma is large, the amount of bleeding is high, and a series of postoperative complications such as hidden nerve damage, subcutaneous congestion, incision bleeding, deep vein thrombosis, etc. are prone to occur. With the increasing demand for skin aesthetics and reducing postoperative complications, minimally invasive surgery has gradually been applied to the treatment of lower limb varicose veins, such as intracavitary laser ablation, intracavitary radiofrequency ablation, Tri Vex minimally invasive rotary cutting, hemodynamic correction, etc. [3]. This article provides a review of the current main treatment methods for lower limb varicose veins, in order to further understand and master the principles and application scope of each treatment method, and to better select personalized treatment plans for varicose vein patients in the future.

Lateral Sacral Artery Perforator Flap as a New Option in Myelomeningocele Reconstruction.

This study aims to present lateral sacral artery perforator (LSAP) flaps as a new option for myelomeningocele reconstruction and to discuss their advantages and disadvantages. Eleven patients were included in the study, and reconstruction was performed with 22 LSAP flaps. Patients were evaluated in age, gender, birth weight, kyphosis status, defect localization and size, flap size, operation time, amount of bleeding, and postoperative complications. Sixteen flaps were raised from the first and 6 from the second LSA. The average time for soft tissue reconstruction was 57 minutes. The mean blood loss was 11.1 mL/kg. No cerebrospinal fluid leakage was detected in any patient. In 1 of the 22 flaps, venous congestion did not completely resolved and resulted in partial necrosis secondary to venous insufficiency. In 2 patients, minimal wound dehiscence was detected in the distal part of the flap. No wound infections, hematomas, donor site complications, or seromas were observed in any patient. Considering that myelomeningoceles are often located in the lumbar region, we think that LSAP flaps will be a new option among other flaps. Additionally, if other flaps are used in the neonatal period, it may be a good alternative for pressure sore reconstruction in the kyphotic area.

Two Patients With Ipsilateral Cerebellar Hemorrhage After Superficial Temporal Artery-Middle Cerebral Artery Bypass Grafting.

To summarize the clinical experience of ipsilateral cerebellar hemorrhage after superficial temporal artery-middle cerebral artery bypass surgery. The clinical data of 2 patients with cerebellar hemorrhage after superficial temporal artery-middle cerebral artery bypass grafting were retrospectively collected, including 1 case with left cerebellar hemorrhage after left cerebral artery bypass grafting and 1 case with right cerebellar hemorrhage after right cerebral artery bypass grafting. The perioperative blood pressure, laboratory, and imaging data were analyzed. All patients had a history of hypertension, and their perioperative blood pressure was stable. Low-density lipoprotein cholesterol and high-density lipoprotein cholesterol were normal before the operation. Cerebral magnetic resonance imaging showed cerebral atherosclerosis and multiple ischemic cerebral infarcts. At 24 hours after surgery, the patients' continuous epidural low drainage was 260 mL and 160 mL, respectively. The amount of cerebellar bleeding was small, and no new sequelae were left after conservative treatment with drugs. Cerebellar hemorrhage after superficial temporal artery-middle cerebral artery bypass grafting is related to perioperative blood pressure fluctuation, hemodynamic changes, hemorrhagic transformation of ischemic lesions, and excessive cerebrospinal fluid drainage. Maintaining stable blood pressure during the perioperative period and avoiding excessive and rapid loss of cerebrospinal fluid after operation can reduce the occurrence of this complication.

Intravenous Tranexamic Acid for Control of Bleeding during External Dacryocystorhinostomy under General Anesthesia: A Randomized Clinical Trial.

To investigate the effect of intravenous tranexamic acid administered prior to external dacryocystorhinostomy (DCR) surgery to decrease intraoperative bleeding under general anesthesia. This was a double-blinded randomized placebo-controlled trial. A total of 70 patients (35 intervention and 35 control) with nasolacrimal duct obstruction (NLDO) who were selected for DCR surgery between September 2021 and September 2022 were included. After clinical examinations and laboratory tests, patients were randomly classified into intervention and control groups. The intervention group received 10 mg/kg intravenous tranexamic acid to a maximum dose of 1 gr 30 minutes before the surgery. Controls received normal saline solution as a placebo. The amount of intraoperative bleeding and surgical time were compared between the two groups. The intervention group included 21 men (60%) and 14 women (40%), while the control group included 19 men (54.3%) and 16 women (45.7%). The mean ages of the participants were 55.46 10.8 years and 58.06 11.28 years in the intervention and control groups, respectively. A significant difference was observed between the two groups in the surgical time analysis (control group: 37.74 9.52 minutes vs intervention: 26.03 10.5 minutes; P 0.001). Additionally, there was a significant difference in the bleeding volume between the intervention (70.66 48.19 ml) and control (47.74 60 ml) groups (P 0.001). Intravenous tranexamic acid administration before the DCR procedure can successfully control bleeding during the surgery.

Clinical effect of XEN gel stent implantation or combined with phacoemusification and intraocular lens implantation on glaucoma

Objective: To evaluate the efficacy and safety of internal XEN gel stent implantation or combined with phacoemusification and intraocular lens (IOL) implantation in the treatment of glaucoma. Methods: It was a retrospective case series study. Forty-five patients (28 males and 17 females; 52 eyes) who had different types of glaucoma treated at the Shenzhen Eye Hospital from December 2021 to June 2023 were included. XEN gel stent implantation (the XEN group) or XEN implantation combined with phacoemusification and IOL implantation (the combined group) were performed in these patients. The postoperative follow-up was 18 months. The observational indexes included the best corrected visual acuity (recorded as the logarithm of the minimum angle of resolution), intraocular pressure (IOP), XEN implantation quadrant, number of IOP-lowering medications, corneal endothelial cell count, operation success rate and surgical complications. The one-way repeated measures of variance, LSD-t test, and rank sum test were used for statistical analysis. Results: There were 28 patients (33 eyes) in the XEN group and 17 patients (19 eyes) in the combined group. The postoperative best corrected visual acuity had no significant change in the XEN group, but improved significantly (0.21±0.30 at 6 months; P<0.05) in the combined group, compared with the preoperative value. The IOP of the two groups at 18 months after surgery [(12.2±3.1) and (11.9±3.9) mmHg (1 mmHg=0.133 kPa)] was significantly lower than that before surgery [(22.1±8.5) and (19.4±10.2) mmHg; P<0.05]. The average number of IOP-lowering medications in all patients was 3 (2, 3) before surgery and 0 (0, 0) at 18 months after surgery. The difference was statistically significant (P<0.05). In the XEN group, the corneal endothelial cell count was (2 387.37±478.22) cells/mm² preoperatively and (2 193.89±311.96) cells/mm² at 12 months. The decrease showed no statistical significance. The XEN gel stent was implanted in the supranasal quadrant in 8 eyes (15.4%), in the inferonasal quadrant in 36 eyes (69.2%), and in the infratemporal quadrant in 8 eyes (15.4%). The operation success rate [complete success rate, 86.5% (45/52); conditional success rate, 9.6% (5/52)] was 96.2% (50/52). The filtering bleb scarring occurred in 9.6% (5/52) of eyes. A small amount of hyphema, postoperative shallow anterior chamber, transient hypertension, and intraoperative drain breakage were found in 7.7% (4/52) of eyes, respectively. A small amount of subconjunctival bleeding was observed in 5.8%(3/52) of eyes. Re-implantation of an XEN gel stent was performed in 5.8% (3/52) of eyes. The intraoperative conjunctival tissue rupture, hypotony macular edema, and drain exposure were observed in 1.9% (1/52) of eyes, respectively. Conclusion: The XEN gel stent implantation or combined with phacoemusification and IOL implantation was effective and safe in treating different types of glaucoma, but its long-term clinical efficacy needs further follow-up observations in multi-center, larger-scale research.

High-risk factors for massive haemorrhage in medical abortion patients with missed miscarriage

BackgroundRecently, the incidence of missed miscarriage has gradually increased, and medical abortion is a common method to terminate a pregnancy. In the process of medical abortion, massive vaginal bleeding takes place, leading to emergency surgical haemostasis. Emergency surgery may produce infection and organ damage. Our study aimed to investigate the high-risk factors for massive haemorrhage during a medical abortion.MethodsA total of 1062 missed miscarriage patients who underwent medical abortion participated in this retrospective study. According to the amount of bleeding, the patients were divided into a massive haemorrhage group and a control group. By comparing the general conditions of the two groups, such as fertility history, uterine surgery history, uterine fibroids, etc., the high-risk factors for massive haemorrhage during medical abortion were identified.ResultsRelative to the control group, the massive haemorrhage group exhibited a higher proportion of patients with a previous artificial abortion (51.9% vs. 38.1%, P = 0.001). Additionally, the massive haemorrhage group had a lower percentage of first-time pregnant women (32.1% vs. 40.4%) and a higher proportion of women with shorter pregnancy intervals (44.9% vs. 33.1%, P = 0.03). Furthermore, there were notable differences between the two groups regarding maximum fibroid size, the duration of amenorrhea, and gestational week (P < 0.05).ConclusionIn this study, we determined that a history of artificial abortion and an amenorrhea duration of > 11 weeks represented high-risk factors for massive vaginal bleeding during medical abortion in missed miscarriage patients.

RNAi targeting LMAN1-MCFD2 complex promotes anticoagulation in mice.

Combined deficiency of coagulation factor V (FV) and factor VIII (FVIII) is a rare bleeding disease caused by variants in either lectin mannose binding 1 (LMAN1) or multiple coagulation factor deficiency 2 (MCFD2) gene. Reducing the level of FVIII by inhibiting the LMAN1-MCFD2 complex may become a new anticoagulant approach. We aimed to find a new therapeutic option for anticoagulation by RNA interference (RNAi) targeting LMAN1 and MCFD2. siRNA sequences with cross-homology between mice and humans were designed based on LMAN1 or MCFD2 transcripts in NCBI and were screened with the Dual-Luciferase reporter assay. The optimal siRNAs were chemically modified and conjugated with three N-acetylgalactosamine molecules (GalNAc-siRNA), promoting their targeted delivery to the liver. The expression of LMAN1 and MCFD2 in cell lines or mice was examined by RT-qPCR and western blotting. For the mice administered with siRNA, we assessed their coagulation function by measuring APTT and the activity of FVIII factor. After administration, siRNAs GalNAc-LMAN1 and GalNAc-MCFD2 demonstrated effective and persistent LMAN1 and MCFD2 inhibition. 7 days after injection of 3mg/kg GalNAc-LMAN1, the LMAN1 mRNA levels reduced to 19.97% ± 3.78%. MCFD2 mRNA levels reduced to 32.22% ± 13.14% with injection of 3mg/kg GalNAc-MCFD2. After repeated administration, APTT was prolonged and the FVIII activity was remarkably decreased. The tail bleeding test of mice showed that the amount of bleeding in the treated group did not significantly increase compared with the control group. Our study confirms that therapy with RNAi targeting LMAN1-MCFD2 complex is effective and can be considered a viable option for anticoagulation drugs. However, the benefits and potential risk of bleeding in thrombophilic mice model needs to be evaluated.