Tourniquet Research Articles

Role of Nrf2/HO-1 signaling pathway in remote ischemic preconditioning-induced reduction of lipopolysaccharide-induced acute lung injury in mice

Objective To evaluate the role of nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling pathway in remote ischemic preconditioning-induced reduction of lipopolysaccharide (LPS)-induced acute lung injury (ALI) in mice. Methods Sixty-eight healthy male C57BL/6 mice, aged 6-8 weeks, weighing 22-26 g, were divided into 4 groups (n = 17 each) using a random number table: control group (group C), ALI group, remote ischemic preconditioning group (group RIPC) and brusatol plus remote ischemic preconditioning group (group B+ RIPC). Normal saline 100 μl was intratracheally instilled in group C. ALI was induced by intratracheal instillation of LPS 5 mg/kg in group ALI.Mice in group RIPC were subjected to 6 cycles of 5-min ischemia followed by 5-min reperfusion in the right hindlimbs using a tourniquet, and 1 h later the model of ALI was established.Nrf2 inhibitor brusatol 2 mg/kg (in 100 μl of 1% dimethyl sulfoxide) was intraperitoneally injected every other day for 10 days prior to establishment of the ALI model in group B. Brusatol 2 mg/kg was intraperitoneally injected every other day for 10 days prior to establishment of the ALI model, and remote ischemic preconditioning was performed at 1 h before establishment of the ALI model in group B+ RIPC.Seven mice in each group were selected at 24 h after establishment of the ALI model, and bronchoalveolar lavage fluid (BALF) was collected for determination of protein concentrations and neutrophil count.Mice were then sacrificed and lungs were removed for determination of lung water content, myeloperoxidase (MPO) activity, contents of interleukin-1beta (IL-1β) and tumor necrosis factor-alpha (TNF-α), and expression of Nrf2, HO-1 and high-mobility group box 1 protein (HMGB1) in lung tissues (by Western blot) and for examination of pathological changes (with a light microscope). Results Compared with group C, the lung water content, MPO activity, contents of IL-1β and TNF-α, and neutrophil count and protein concentrations in BALF were significantly increased, and the expression of Nrf2, HO-1 and HMGB1 was up-regulated in group ALI (P<0.05). Compared with group ALI, the lung water content, MPO activity, contents of IL-1β and TNF-α, and neutrophil count and protein concentrations in BALF were significantly decreased, the expression of Nrf2 and HO-1 was up-regulated, and the expression of HMGB1 was down-regulated (P<0.05), and the pathological changes were significantly attenuated in group RIPC.Compared with group RIPC, the lung water content, MPO activity, contents of IL-1β and TNF-α, and neutrophil count and protein concentrations in BALF were significantly increased, the expression of Nrf2 and HO-1 was down-regulated, and the expression of HMGB1 was up-regulated (P<0.05), and the pathological changes were aggravated in group B+ RIPC. Conclusion The activation of Nrf2/HO-1 signaling pathway is involved in remote ischemic preconditioning-induced reduction of LPS-induced ALI in mice. Key words: NF-E2-related factor 2; Heme oxygenase-1; Ischemic preconditioning; Respiratory distress syndrome, adult; Toxoids

Mechanism underlying inhibition of inflammatory responses induced by α7nAChR agonist postconditioning alone or in combination with remote limb ischemic postconditioning during myocardial I/R in rats: the relationship with GSK-3β

Objective To evaluate the relationship between the mechanism underlying inhibition of inflammatory responses induced by α7 nicotinic acetylcholine receptor(α7nAChR)agonist postconditioning alone or in combination with remote limb ischemic postconditioning during myocardial ischemia-reperfusion(I/R)and glycogen synthase kinase-3β(GSK-3β)in rats. Methods Eighty adult male Sprague-Dawley rats, aged 8 weeks, weighing 290-320 g, were divided into 4 groups(n=20 each)using a random number table: I/R group, α7nAChR agonist postconditioning group(group P), remote limb ischemic postconditioning group(group L)and α7nAChR agonist postconditioning plus remote limb ischemic postconditioning group(group P+ L). Myocardial I/R was induced by 30 min occlusion of the left anterior descending branch of coronary artery followed by 120 min reperfusion.Specific α7nAChR agonist PNU282987 2 mg/kg was intravenously injected immediately before reperfusion in group P. In group L, limb ischemia was induced by tourniquet occlusion of bilateral hind paws for 10 min starting from 20 min of myocardial ischemia, and the tourniquet was released at the beginning of reperfusion.Combination of intervention measures previously described in P and L groups was performed in group P+ L.Venous blood samples were taken at 120 min of reperfusion for determination of serum troponin I(TnI)and creatine kinase-MB(CK-MB)concentrations, myocardial infarct size(IS)and expression of phosphorylated GSK-3β [p-GSK-3β(Ser536)], NF-κBp65 and phosphorylated nuclear factor-κBp65(p-NF-κBp65)in myocardial tissues(by Western blot). Results Compared with group I/R, myocardial IS and serum cTnI and CK-MB concentrations were significantly decreased, the expression of p-GSK-3β(Ser9)in ischemic area was up-regulated, and the expression of p-NF-κBp65 in ischemic area was down-regulated in P, L and P+ L groups(P<0.05). Compared with group L, myocardial IS and serum cTnI and CK-MB concentrations were significantly decreased, the expression of p-GSK-3β(Ser9)in ischemic area was up-regulated, and the expression of p-NF-κBp65 in ischemic area was down-regulated in group P+ L(P<0.05). Conclusion The mechanism by which α7nAChR agonist postconditioning alone or in combination with remote limb ischemic postconditioning inhibits inflammatory responses during myocardial I/R may be related to inhibiting GSK-3β activity in rats. Key words: Myocardial reperfusion injury; Inflammation; Glycogen synthase kinase 3; Cholinergic agonists; Extremities; Ischemic postconditioning

Effects of limb ischemic preconditioning on intestinal injury and brain injury induced by hepatic ischemia-reperfusion in rats

Objective To evaluate the effects of limb ischemic preconditioning on intestinal injury and brain injury induced by hepatic ischemia-reperfusion(I/R)in rats. Methods Healthy male Wistar rats, aged 6-8 weeks, weighing 200-250 g, were divided into 3 groups(n=16 each)using a random number table: sham operation group(Sham group), hepatic I/R group(I/R group)and limb ischemic preconditioning group(LIP group). In LIP group, the lower limb blood flow was blocked for 10 min with an elastic rubber tourniquet at the right groin followed by 30-min reperfusion through releasing the tourniquet.Hepatic I/R injury was induced by occlusion of the portal vein, hepatic artery and common bile duct for 30 min followed by reperfusion in I/R and LIP groups.Eight rats in each group were selected at 6 h of reperfusion and samples from the cardiac apex were taken for determination of plasma concentrations of tumor necrosis factor-alpha(TNF-α)and interleukin-10(IL-10)by radioimmunoassay.Then the rats were sacrificed and the small intestine tissues and brain tissues were removed.Intestinal damage was assessed and scored according to Chiu.The activity of myeloperoxidase(MPO)in intestinal mucosa was detected by colorimetric method.The pathological changes of brain tissues were examined under a light microscope.The ultrastructure of brain tissues was observed under an electron microscope.Eight rats in each group were randomly selected at 6 h of reperfusion, and Evans blue(EB)2 mg/kg was injected through the caudal vein over 1 min.Then the rats were sacrificed, brain tissues were removed for measurement of EB content, and the brain water content was calculated. Results Compared with Sham group, Chiu′s score and MPO activity in intestinal tissues were significantly increased, the brain water content and EB content were increased, and the concentrations of TNF-α and IL-10 in plasma were increased in I/R group and LIP group(P 0.05), and the pathological changes of brain tissues were significantly attenuated in LIP group. Conclusion Limb ischemic preconditioning can attenuate intestinal injury and brain injury induced by hepatic I/R, and the mechanism may be related to inhibiting systemic inflammatory responses of rats. Key words: Ischemic preconditioning; Limbs; Reperfusion injury; Liver; Intestine; Brain injuries

Application of tourniquet in civilian trauma: Systematic review of the literature

IntroductionThe effectiveness of a tourniquet (TQ) in case of extremity haemorrhages is well recognised to prevent deaths on the battlefield. However, little is known about the usefulness of TQ in civilian trauma settings, including terrorist attack situations. The aim of this systematic review was to analyse the evidence-based medical literature in order to precise the use of TQ in the management of extremity haemorrhages in civilian setting. MethodsAnalysis of all studies published until 12/31/2016 on the Embase, Medline and Opengrey databases. To be included, studies had to contain descriptions, discussions or experiences of TQ application in civilian setting. The quality of the studies was evaluated using the PRISMA and the STROBE criteria. ResultsOf the 380 studies identified, 24 were included. The overall level of evidence was low. Three thousand and twenty eight TQ placements were reported. Most of them concerned the Combat Application Tourniquet CAT. Haemorrhages implied in the use of TQ were almost exclusively traumatic, most of the time regarding young men (27–44 years old). Effectiveness rates of TQ varied between 78% and 100%. Complications rates associated with the use of TQ remained low, even when used in elderlies or patients with comorbidities. Finally, caregivers reported a common fear of adverse effects, while reported complications were rare (<2%). ConclusionThis systematic review revealed TQ to be an effective tool for the management of extremity haemorrhages in civilian trauma, associated with few complications. Larger studies and dedicated training courses are needed to improve the use of TQ in the civilian standards of care.

Does Pain Have a Role When It Comes to Tourniquet Training?

One of the greatest conundrums with tourniquet (TQ) education is the use of an appropriate surrogate of hemorrhage in the training setting to determine whether a TQ has been successfully used. At our facility, we currently use loss of audible Doppler signal or loss of palpable pulse to represent adequate occlusion of vasculature and thus successful TQ application. We set out to determine whether pain can be used to indicate successful TQ application in the training setting. Three tourniquet systems (a pneumatic tourniquet, Combat Application Tourniquet® [C-A-T], and Stretch Wrap and Tuck Tourniquet™ [SWAT-T]) were used to occlude the arterial vasculature of the left upper arm (LUA), right upper arm (RUA), left forearm (LFA), right forearm (RFA), right thigh (RTH), and right calf (RCA) of 41 volunteers. A 4MHz, handheld Doppler ultrasound was used to confirm loss of Doppler signal (LOS) at the radial or posterior tibial artery to denote successful TQ application. Once successful placement of the TQ was noted, subjects rated their pain from 0 to 10 on the visual analog scale. In addition, the circumference of each limb, the pressure with the pneumatic TQ, number of twists with the C-A-T, and length of TQ used for the SWAT-T to obtain LOS was recorded. All 41 subjects had measurements at all anatomic sites with the pneumatic TQ, except one participant who was unable to complete the LUA. In total, pain was rated as 1 or less by 61% of subjects for LUA, 50% for LFA, 57.5% for RUA, 52.5% RFA, 15% for RTH, and 25% for RCA. Pain was rated 3 or 4 by 45% of subjects for RTH. For the C-A-T, data were collected from 40 participants. In total, pain was rated as 1 or less by 57.5% for the LUA, 70% for the LFA, 62.5% for the RUA, 75% for the RFA, 15% for the RTH, and 40% for the RCA. Pain was rated 3 or 4 by 42.5%. The SWAT-T group consisted of 37 participants for all anatomic locations. In total, pain was rated as 1 or less by 27% for LUA, 40.5% for the LFA, 27.0% for the RUA, 43.2 for the RFA, 18.9% for the RTH, and 16.2% for the RCA. Pain was rated 5 by 21.6% for RTH application, and 3 or 4 by 35%. The unexpected low pain values recorded when loss of signal was reached make the use of pain too sensitive as an indicator to confirm adequate occlusion of vasculature and, thus, successful TQ application.

The Possible Pathophysiological Outcomes and Mechanisms of Tourniquet-Induced Ischemia-Reperfusion Injury during Total Knee Arthroplasty.

Ischemia and reperfusion (I/R) injury induced by tourniquet (TQ) application leads to the release of both oxygen free radicals and inflammatory cytokines. The skeletal muscle I/R may contribute to local skeletal muscle and remote organ damage affecting outcomes after total knee arthroplasty (TKA). The aim of the study is to summarize the current findings associated with I/R injury following TKA using a thigh TQ, which include cellular alterations and protective therapeutic interventions. The PubMed database was searched using the keywords “ischemia reperfusion injury,” “oxidative stress,” “tourniquet,” and “knee arthroplasty.” The search was limited to research articles published in the English language. Twenty-eight clinical studies were included in this qualitative review. Skeletal muscle I/R reduces protein synthesis, increases protein degradation, and upregulates genes in cell stress pathways. The I/R of the lower extremity elevates local and systemic oxidative stress as well as inflammatory reactions and impairs renal function. Propofol reduces oxidative injury in this I/R model. Ischemic preconditioning (IPC) and vitamin C may prevent oxygen free radical production. However, a high dose of N-acetylcysteine possibly induces kidney injury. In summary, TQ-related I/R during TKA leads to muscle protein metabolism alteration, endothelial dysfunction, oxidative stress, inflammatory response, and renal function disturbance. Propofol, IPC, and vitamin C show protective effects on oxidative and inflammatory markers. However, a relationship between biochemical parameters and postoperative clinical outcomes has not been validated.

Cementless knee arthroplasty.

Total knee replacement is a common treatment for advanced knee osteoarthritis. The most common and widespread method is cemented arthroplasty. As in the prosthetic hip a gradual transition from cemented to uncemented fixation techniques occurred over time, increasing interest is growing also around cementless knee fixation, with the theoretical advantages of preserving the bone stock and obtaining a biological fixation avoiding cement fragmentation. On the basis of the actual knowledge, the uncemented knee prosthesis represents an interesting alternative especially for the patient under 65 years of age, with viable bone quality, in which a biological bone-prosthesis fixation is desirable, while avoiding the drawbacks of cement fragmentation and of the possible future revision of a cemented implant. However the weak link remains the tibial fixation, so that technical tips are important to avoid micromovements with subsequent lack of osteointegration. In our experience, gap balancing, mobile bearings and no haemostatic tourniquet well combine with this kind of implant.

Effect of intra-articular injection of tranexamic acid on the effectiveness and safety after blood loss and functional recovery of knee joint arthroplasty

Objective To analyze the impact of blood loss and postoperative functional rehabilitation of primary unilateral total knee arthroplasty (TKA) with application of intra-articular traneamic acid (TXA) injection and clamping the drainage tube for 3 h. Methods From February 2014 to Augest 2015, 110 patients with knee osteoarthritis undergoing primary unilateral TKA were randomly divided into TXA group, first control group and second control group. There were 30 patients in the TXA group, 39 patients in the first control group and 41 patients in the second control group. TXA (2.0 g dissolved in 100 ml normal saline) or placebo (100 ml normal saline) was prepared. Patients in TXA group were injected with TXA (2.0 g dissolved in 100 ml normal saline) into intra-articular by drainage tube before deflation of the tourniquet. Patients in first control group and second control group were injected with normal saline (100 ml) into intra-articular by drainage tube before deflation of the tourniquet. In the TXA group and first control group, the drainage tube was clamped for 3 h immediately after injection. In the second control group, the drainage tube was not clamped. Gender, age, and body mass index (BMI) showed no significant differences among the three groups. Results There was statistically significant difference among the three groups in postoperative drainage volume, hidden blood loss, total blood loss, transfusion volume and rate, degree of knee joint swelling, the incidence of postoperative lower extremity ecchymosis area >1%, ROM and knee association score (KSS) function scores on the fifth day and first month after operation, but postoperative venous thrombus embolism showed no statistically significant difference (P=0.971). Conclusion Injection of TXA (2.0 g dissolved in 100 ml normal saline) into intra-articular by drainage tube before deflation of the tourniquet significantly reduced hidden blood loss and transfusion volume and rate in primary TKA and did not increase the risk of venous thromboembolisms or other adverse events, and it is beneficial to the early functional recovery of knee joint after operation. Key words: Tranexamic acid; Arthroplasty; Knee joint; Blood loss; Functional rehabilitation

Prothrombin levels in yellow fever

Since hemorrhagic manifestations constitute one of the most constant clinical features of yellow fever, we set out to study this diathesis in an attempt to analyze the vascular and physicochemical factors that might explain its causes. Tourniquet tests in 30 patients were negative, hence we decided no capillary fragility existed. Contrary to some statements in the literature, we found that coagulation and bleeding times were considerably increased in some cases, while in others they fell within normal limits. Furthermore we noted at times that both were prolonged, while at other times only the coagulation time was prolonged and the bleeding time was normal. In spite of prolonged bleeding time the platelet counts were maintained between 100,000 and 200,000 in 9 cases so studied.

Analgesic effects of ketorolac/lidocaine compared to dexmedetomidine/lidocaine in intravenous regional anesthesia

Introduction: Intravenous regional anesthesia is known as a safe and reliable technique for anesthesia and reduction of bleeding during limb surgeries. The aim of this study is to compare the addition of ketorolac or dexmedetomidine to lidocaine in intravenous regional anesthesia. Materials and Methods: In this double-blind clinical trial, ninety patients who were admitted for surgery on hand or forearm in Vali-Asr Hospital, Arak city, entered the study. Then, the patients divided into three equal groups. The first group received 3 mg/kg lidocaine 0.5%, the second group received 1 μg/kg dexmedetomidine with lidocaine, and the third group received 30 mg ketorolac with lidocaine. The time to analgesia, pain during surgery, onset of pain after tourniquet deflation, and the pain after tourniquet deflation were measured. Results: The mean duration to analgesia was 7.37 ± 0.67 min in control group, 5.23 ± 0.68 min in dexmedetomidine group, and 4.90 ± 0.76 min in ketorolac group (P = 0.164). In total of 3 times of measurement of pain after injection, the mean visual analog scale in ketorolac group was significantly lower than lidocaine (P = 0.0001) and dexmedetomidine (P = 0.009) groups. In all time intervals after tourniquet deflation, the mean score of pain was significantly lower in ketorolac group. Conclusion: Ketorolac could control the perioperative pain and the pain after tourniquet deflation. It seems that ketorolac is a useful and effective choice for pain relief for patients undergoing intravenous regional anesthesia.

Study on the prognosis of propofol after reperfusion in patients with replantation surgery

Objective To evaluate the influence of different concentrations of propofol on ischemia/reperfusion(I/R) replantation surgery prognosis of patients. Methods Ninety patients that had done replantation surgery were included. All patients were the ASA grade statusⅠor Ⅱ. Ninety patients were randomly divided into three groups(n=30), low concentration group (group L), high concentration group (group H) and control group(group C). All patients in all coracoid single point method brachial plexus, nerve stimulator to locate. Limb were compared in plasma malondialdehyde(MDA), ischemia modified albumin(IMA), concentration of superoxide dismutase(SOD) three indicators. Patients were followed up for a week after surgery were compared the incidence of vascular crisis and survival. Analyzed and summarized the prognosis of different concentrations of propofol anesthesia. Results One hour after anesthesia after tourniquet, the concentration of IMA and MDA in group H and group L were both significantly lower than group C, compare with a significant difference(P<0.05), SOD value in group H after 1 h and L group was significantly lower(P<0.05). After a week of follow-up found that the incidence of vascular crisis in H group and group L were significantly lower than group C, compare with a significant difference[χ2(LC)=4.523, P(LC)=0.033, χ2(HC)=9.871, P(HC)=0.005]. The survival in group H and group L were both significantly higher than finger group C, compare with a significant difference[χ2(LC)=3.857, P(LC)=0.049, χ2(HC)=6.857, P(HC)=0.009]. Conclusions The propofol has played a very good anaesthesia effect in ischemia/reperfusion (I/R) , propofol can improve the survival rate after replantation of I/R, and high concentration of propofol can better improve the prognosis. Key words: Replantation; Propofol; Ischemia/reperfusion

Comparison of the anesthetic effect of ultrasound-guided brachial plexus block by different approaches in distal radius surgery

Objective To compare the anaesthetic effect of ultrasound-guided brachial plexus block by different approaches (interscalene, axillary, supraclavicular) in distal radius surgery. Methods Ninety adult patients undergoing elective surgery for distal radius fracture open reduction and internal fixation, distal radius fracture after implant removal surgery distal radius fracture, were randomly divided into interscalene group(group A), axillary group(group B) and supraclavicular group (group C) for brachial plexus block under ultrasound-guided(n=30). The performance time and complications were recorded. Besides, the onset time and block execution time of median nerve, ulnar nerve, radial nerve, lateral medial cutaneous nerve, forearm medial cutaneous nerve were evaluated. Results There is no significant difference in performance time(P>0.05) and the onset time of pain block in median nerve, radial nerve, lateral medial cutaneous nerve (P>0.05). As for ulnar nerve and medial antebrachial cutaneous nerve, there were no difference in onset time of pain block between group A[(21±6) min] and group C[(20±5) min] (P>0.05), but they were longer than group B[(8±5) min] (P 0.05), but they were longer than group B[(10±6) min] (P<0.05). The complete suceess rate of group B(90%) were higher than other two groups. We found that two patients in group A and one patient in group C were complicated with phrenic nerve block and one patient in group B showed little tolerance of tourniquet. Conclusions Ultrasound-guided axillary brachial plexus block in the distal radius surgery is recommended because of better blockage of ulnar nerve and medial antebrachial cutaneous nerve and fewer complications. Key words: Ultrasound; Brachial plexus block; Distal radius

Comparative study of midazolam, dexmedetomidine, and ketamine as an adjuvant to lidocaine in intravenous regional anesthesia for forearm and hand surgeries

Background Intravenous regional anesthesia (IVRA) is an ideal method of providing anesthesia for minor surgical procedures to the extremities performed on an ambulatory basis. This study aimed to study the effects of adding midazolam, dexmedetomidine, or ketamine as an adjuvant to lidocaine in IVRA during forearm and hand surgeries and examine their benefits and complications. Patients and methods A total of 120 patients were included, aged 40–60 years (American Society of Anesthesiologists physical status I–II), undergoing hand and forearm, from April 2015 to August 2016. Patients were randomly divided into four equal groups. Lidocaine-only group (LL group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg). Lidocaine plus midazolam group (LM group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg) plus midazolam 50 µg/kg added as an adjuvant. Lidocaine plus dexmedetomidine group (LD group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg) plus dexmedetomidine 1 µg/kg added as an adjuvant. Lidocaine plus ketamine group (LK group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg) plus ketamine 0.5 mg/kg added as an adjuvant. The time of onset, duration, and quality of analgesia; levels of sensory and motor block; heart rate; mean arterial blood pressure; and visual analog score were recorded. Adverse effects of hematoma, injection pain, skin erythema, sedation, and hallucinations were recorded. Results The onset time of sensory and motor blocks was significantly shorter in the adjuvant groups LM, LD, LK in comparison with the control group LL. The grade of sensory and motor blocks was significantly better in groups LM, LD, and LK in comparison with the LL group. The onset time of tourniquet pain was significantly shorter in the control group LL in comparison with adjuvant groups LM, LD, and LK. There was a significant increase in fentanyl requirements in the control LL group compared with adjuvant LM, LD, and LK groups. The duration of postoperative analgesia was significantly prolonged in adjuvant groups LM, LD, and LK compared with the control LL group. Hematoma, injection pain, cutaneous erythema, and hallucination were reported as postoperative complications. Conclusion The addition of midazolam, dexmedetomidine, or ketamine to lidocaine for IVRA improved the quality of intraoperative and postoperative analgesia with minimal adverse effects and higher patients and surgeon satisfaction.

Effects of FTY720 pretreatment on lung injury induced by limb ischemia-reperfusion in rats

Objective To evaluate the effects of FTY720 pretreatment on lung injury induced by limb ischemia-reperfusion (I/R) in rats. Methods Thirty healthy male Sprague-Dawley rats, weighing 230-260 g, were divided into 3 groups (n=10 each) using a random number table: sham operation group (group S), I/R group and FTY720 group (group F). Bilateral hind limb I/R was induced by applying rubber band tourniquet high around each thigh for 3 h followed by 3 h of reperfusion.FTY720 was given by intragastric gavage at 3 mg·kg-1·d-1 for 7 consecutive days before I/R in group F, while the equal volume of normal saline was given instead in group I/R.At the end of reperfusion, blood samples were collected from the carotid artery for blood gas analysis, and oxygenation index (OI) was calculated.The rats were then sacrificed and lungs removed for examination of pathological changes (with light microscope) and for determination of apoptosis rate (using flow cytometry) and expression of CCAAT/enhancer-binding protein homologous protein (CHOP), caspase-12, c-Jun N-terminal kinase (JNK), Bcl-2 and Bax protein in lung tissues (using Western blot). Bax/Bcl-2 ratio was calculated. Results Compared with group S, OI was significantly decreased in group I/R, and apoptosis rate was increased, the expression of CHOP, caspase-12, JNK and Bax protein was up-regulated, and the expression of Bcl-2 was down-regulated, and Bax/Bcl-2 ratio was increased in I/R and F groups (P<0.05). Compared with group I/R, OI was significantly increased, apoptosis rate was decreased, the expression of caspase-12, CHOP, Bax and JNK protein was down-regulated, and the expression of Bcl-2 was up-regulated, and Bax/Bcl-2 ratio was decreased in group F (P<0.05). The pathological changes of lungs were significantly attenuated in group F as compared with group I/R. Conclusion FTY720 pretreatment can attenuate lung injury induced by limb I/R in rats, and the mechanism may be related to inhibition of endoplasmic reticulum stress-related cell apoptosis. Key words: Extremities; Reperfusion injury; Respiratory distress syndrome, adult; FTY720

Intramuscular hemangioma mimicking cubital tunnel syndrome: A case report

Hemangioma-induced cubital tunnel syndrome is very rare. Only two cases have been previously reported. We report the case of an 18-year-old boy who had small distension in the left elbow region after exercise with symptoms and signs of cubital tunnel syndrome. Magnetic resonance imaging presented an intramuscular hemangioma on the medial epicondyle. The tumor disappeared during surgery, but after the tourniquet was released, the tumor refilled and then compressed the ulnar nerve. We performed a simple excision of the extra-neural hemangioma and covered it with fat to prevent scarring. No recurrence was observed. However, the vanishing property of the tumor should be considered during surgery.

Effects of the rapid decompression on intervention tourniquet on line via radial artery path of coronary artery

Objective To investigate the effect of the rapid decompression on intervention (TRI) of the TR Band tourniquet on line via radial artery path of coronary artery. Methods 270 postoperative patients with TRI were divided into A, B, C groups according to random number table. TR Band hemostat inflated 17 ml, group A deflated once every 30 min, group B deflated once every 1 hour, group C deflated once every 2 hours, inflated 2 ml each time, each group was deflated 6 times and removed oppression after 12 hours. The differences of postoperative bleeding, the local complications and comfort were observed 24 hours after surgery. Results The difference of patients with postoperative hemorrhage, degree of numbness among three groups was not statistical significant (χ2=0.25-0.78, P > 0.05). Difference of incidence on local fiber scleroma, palm and forearm swelling degree, pain intensity was statistical significant (χ2 =6.35, 7.70, 12.16, P < 0.05). Conclusions TRI rapid decompression does not increase the risk of bleeding in postoperative patients, which not only can reduce fiber scleroma local complications, still can improve the comfort. Key words: Radial artery; Intervention therapy; Oppression; TR Band

Effect of pentazocine on the alteration of cardiac troponin I in leg ischemia/reperfusion induced by tourniquet

Objective To explore the effect of pentazocine on the changes in cardiac troponin I(cTnI) and its association with calcitonin gene-related peptide(CGRP) in tourniquet-induced leg ischemia/reperfusion(I/R). Methods Sixty patients, undergoing elective unilateral leg surgery using tourniquet, under spinal anesthesia, were enrolled and randomly assigned to control group (group C) and pentazocine group(group P)(n=30), in accordance with a random number table. Patients in group P pretreated with pentazocine 0.5 mg/kg before surgery, while only the same volume of saline was infused intravenously in group C at the same schedule. 5 ml of blood samples were collected from cubital vein in a not transfusion arm immediately before inflating tourniquet (T0), 0.5 h(T1) and 24 h(T2) after tourniquet deflation. Serum concentration of cTnI and CGRP were measured by ELISA. Results There was no statistical difference detected in the general information in two groups(P>0.05). Compared with the cTnI at the time of T0 [(0.21±0.06) μg/L] the concentration of cTnI in group C at the time of T1 was not obvious changed(P>0.05), while significantly increased at the time of T2 [(0.28±0.10) μg/L] (P 0.05). No significant change in the concentration of CGRP of group C was detected at the time of T1 and T2(P>0.05), while CGRP in group P was increased significantly at the time of T1[(17.9±2.7) ng/L] and T2[(18.8±2.8) ng/L](P 0.05), cTnI in group P was decreased significantly at the time of T2[(0.22±0.06) μg/L vs (0.28±0.10) μg/L] (P<0.05), CGRP in group P was increased obviously at T1 and at T2(P<0.05). Conclusions The results of this study indicates that pentazocine may attenuate myocardial injury induced by leg I/R tourniquet, in which endogenous CGRP may be associated. Key words: Pentazocine; Tourniquets; Ischemia/reperfusion, Leg; Cardiac troponin I; Calcitonin gene-related peptide

Gauntlets and Glovettes for Digital Surgery

The importance of keeping pathogenic bacteria from traumatic hand injuries is obvious but removing dirt, grease, oil, solvents and other chemicals from injured hands is not always possible. In certain occupations such as construction, workers are exposed to these hazards and when injured injuries (e.g. abrasions, burns, cuts, lacerations, punctures) often present with dirty hands. The technique of using gauntlets and glovettes for digital surgery is presented. This cost effective and pragmatic technique reduces contamination of the surgical field and protects patients from neurovascular damage due to excessive tissue pressure and prolonged application time of forgotten tourniquets.

The effect on intravenous and intra-articular cavity injection of tranexamic acid on recessive loss of blood in primary total knee arthroplasty

Objective The effection of tranexamic acid in recessive loss of blood in primary total knee arthroplasty. Methods One hundred patients having primary total knee arthroplasty were randomly divided into 2 groups, the tranexamic acid group and the control group, with 50 patients in each.the groups, 0.5 g tranexamic acid was infused intravenously within 15 minutes befor skin incision, before deflation of the tourniquet, the tranexamic acid group accepted 0.5 g tranexamic acid and 25 ml intra-articular cavity injection of tranexamic acid intravenously, while an equal volume of normal saline was given instead in the control group.After 2 days, respectively calculate the total amount of blood loss, intraoperative blood loss, postoperative drainage, hidden blood loss and transfusion rates. Results The total amount of blood loss tranexamic acid group and the control group, after the replacement of drainage, hidden blood loss and transfusion rate in the ranexamic acid group were (0.326±0.221) L, (0.048±0.018) L, (0.210±0.113) L, (0.231±0.176) L, 19%, lower than the control group (1.012±0.520) L, (0.056±0.012) L, (0.402±0.231) L, (0.532±0.514) L, 65%, the difference were statistically significantstatistically significant (P<0.05). Conclusion The effects are remarkable in reducing knee arthroplasty hidden blood loss about tranexamic acid. Key words: Primary total knee arthroplasty; Tranexamic acid; Recessive loss of blood; Intravenous; Intra-articular cavity injection

Study of the promoting effects of brief ischemic on fracture healing

Objective To explore the influence of brief ischemic on fracture healing. Methods Two hundred and forty wistar rats (weight was 200 g and half male) were made the right tibial midpiece closed fracture model. 1.0 mm K-wires were used to fix the fractures. Rats were divided into 4 groups. Group A was 24 hours, group B was 48 hours, group C was 72 hours, and group D was the control group. Tourniquet was used on the root of the thigh of right lower limb. Tourniquet was inflated 10 min, then released 10 min, and repeated 3 times to make the brief ischemic model. 48 rats were made brief ischemic at 24 hours after the fracture fixed. Then group A was at every 24 hours, group B was at every 48 hours, and group C was at every 72 hours made brief ischemic. Group D at every 24 hours after the fracture fixed was used tourniquet on the root of thigh of right lower limb each time 1 hour, but the tourniquet was not inflated. Group A, B, and C were made brief ischemic 5 weeks. Group D was tourniquet treated 5 weeks. Group A and D at 1 day, 3 days, 5 days, and 7 days after fracture fixed were detected the serum VEGF. All groups of rats were X-ray examinated and detected of serum VEGF at every two weeks after the fracture fixed. Every two weeks, every group randomly selected 12 rats to do immunohistochemical staining. We used the Image Pro Plus software to quantitative compare the IGF-2 positive cells in the fracture area. Results X-ray results were used three points method for analyzing. The scores of group A, B, and C were significantly higher than group D at 2 weeks, 4 weeks, 6 weeks after fracture fixed (P 0.05). The levels of serum VEGF of group A were significantly higher than group D at 3days, 5days, and 7 days after fracture fixed (P<0.05). The levels of serum VEGF of group B and C were obviously higher than group A and D at 2 weeks (P<0.05), and there was no obvious difference between group B and C (P=0.79, P=0.90, P=0.88). The same result was found between group A and D (P=0.94, P=0.551, P=0.53). There were no significant difference between four groups on the levels of serum VEGF at 8 weeks (P=0.66). Immunohistochemical results were that group B, group C VEGF positive cells were significantly higher than group A and group D at 2 weeks, 4 weeks, 6 weeks (P<0.05). There was no significant difference in group B and group C (P=0.19, P=0.10, P=0.38), or group A and group D (P=0.07, P=0.17, P=0.18). There was no significantly different in four groups at 8 weeks (P=0.08). Conclusions Brief ischemic can promote the healing of fracture and stimulate the expression of VEGF. The mechanism may be related to the signal channels of VEGF and other biological factors. This study will give new idea to clinic for promoting fracture healing. Key words: Brief ischemic; Fracture healing; Promotion effect; Mechanism; Vascular endothelial growth factors; Serum