BackgroundHidden blood loss is a major concern for patients undergoing hip surgery for intertrochanteric fracture. The objective of this study was to investigate whether tranexamic acid (TXA) could reduce postoperative hidden blood loss in patients undergoing hip surgery for intertrochanteric fracture.MethodsA total of 77 patients with intertrochanteric fracture were enrolled in this randomized controlled study. Patients received either 200 mL (1 g) of TXA (n = 37) or normal-saline (NS) (n = 40) i.v. before hip surgery using proximal femoral nail anti-rotation (PFNA). Hemoglobin and hematocrit levels were measured preoperatively and postoperatively at day 1 and 3. Visible and hidden blood loss volumes were calculated at postoperative day 3.ResultsOn postoperative day 3, the transfusion rate was significantly lower in the TXA group compared to the NS group, although mean hemoglobin and hematocrit levels were not significantly different between the two groups. However, the estimated hidden blood loss volume (210.09 ± 202.14 mL vs. 359.35 ± 290.12 mL; P < 0.05) and total blood loss volume (279.35 ± 209.11 mL vs. 417.89 ± 289.56 mL; P < 0.05) were significantly less in the TXA group compared to the NS group, respectively.ConclusionTXA significantly reduced postoperative hidden blood loss in patients with intertrochanteric fracture who underwent PFNA.(Registration number: ChiCTR-INR-16008134).

For breast cancer patients who have undergone breast‐conserving surgery, effective treatments to prevent local recurrences and metastases is very essential. Here, a local injectable therapeutic platform based on a thermosensitive PLEL hydrogel with near‐infrared (NIR)‐stimulated drug release is developed to achieve synergistic photothermal immunotherapy for prevention of breast cancer postoperative relapse. Self‐assembled multifunctional nanoparticles (RIC NPs) are composed of three therapeutic components including indocyanine green, a photothermal agent; resiquimod (R848), a TLR‐7/8 agonist; and CPG ODNs, a TLR‐9 agonist. RIC NPs are physically incorporated into the thermosensitive PLEL hydrogel. The RIC NPs encapsulated PLEL hydrogel (RIC NPs@PLEL) is then locally injected into the tumor resection cavity for local photothermal therapy to ablate residue tumor tissues and produce tumor‐associated antigens. At the same time, NIR also triggers the release of immune components CPG ODNs and R848 from thermoresponsive hydrogels PLEL. The released immune components, together with tumor‐associated antigens, work as an in situ cancer vaccine for postsurgical immunotherapy by inducing effective and sustained antitumor immune effect. Overall, this work suggests that photothermal immunotherapy based on local hydrogel delivery system has great potential as a promising tool for the postsurgical management of breast cancer to prevent recurrences and metastases.

ObjectiveTo investigate the incidences of deep vein thrombosis (DVT) before and after operation in inpatients with hip fractures in both lower extremities.Patients and methodsWe collected the clinical data of 463 patients with lower extremities fractures who presented at Xi’an Honghui Hospital between July 1, 2014, and October 31, 2016 and met all the inclusion criteria. Doppler ultrasonography was used to diagnose DVT. The patients were examined preoperatively and postoperatively and divided into the thrombosis and non-thrombosis group according to the ultrasonographic findings. We divided the DVT cases into central, peripheral, and mixed thromboses.ResultsThe incidence of preoperative DVT was 34.98%, and the prevalence of DVT on the uninjured side was 13.60%. This composition ratio increased to 57.23% postoperatively, and the prevalence of DVT on the uninjured side was 25.05%. Age (odds ratio [OR], 1.03; 95% CI: 1.01–1.04; P=0.002), venous thrombosis at admission (OR, 4.05; 95% CI, 2.30–7.13; P=0.000), and the days between the fracture and the operation (OR, 1.10; 95% CI, 1.02–1.20; P=0.020) were the independent risk factors of preoperative DVT. Coronary heart disease (OR, 1.85; 95% CI: 1.18–2.89; P=0.007), venous thrombosis at admission (OR, 22.35; 95% CI: 6.78–73.60; P=0.000), days between fracture and operation (OR, 1.06; 95% CI: 1.01–1.11; P=0.021), and blood loss (OR, 1.002; 95% CI: 1.000–1.003; P=0.014) were independent risk factors of postoperative DVT.ConclusionThe actual incidence of DVT after hip fracture may be underestimated. The incidences of preoperative and postoperative DVTs and the incidence of DVT on the uninjured limb were high.

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The aim of this study was to assess Physical Component Summary (PCS), Mental Component Summary (MCS) of the Mos 36-item Short Form Health Survey (SF-36) score, and the virtual Analogue Scale (VAS) of pain during the treatment period and the complication rate associated with infected nonunion of the tibia managed surgically by bone transport.This is a retrospective analysis of prospectively collected data in a consecutive patient cohort. Patients suffering from infected nonunion of the tibia were treated by bone transport from 2012 to 2014. Follow-up was for at least 2 years after complete osseous consolidation. Standardized treatment included bacterial eradication by segmental resection, bone transport using Ilizarov apparatus, and docking maneuver. The main outcome measurements consisted of the quality of life (PCS and MCS scores) and the VAS of pain during the different stages of therapy. In addition, all complications were documented.Our series comprised 12 men and 3 women with an average age of 36.9 years (range: 20–55 years). All patients previously undergone an average of 2.9 operations (range: 1–6 operations). In all patients, bone defects were present with a mean size of 7.5 cm (range: 3–12 cm), and all patients were suffering from soft tissue defects (range: 5–17 cm2). The mean external fixator time (EFT) was 48 weeks (range: 30–62 weeks) and the mean external fixation index was 43.1 days/cm (range: 33–62 days/cm). All patients achieved bone union, and no recurrence of infection was observed. According to the Paley classification, patients suffered 15 minor and 13 major complications. The average complication rate per patient comprised of 1.0 minor and 0.9 major complications. Bone grafting was required in 6 cases at the docking site. One patient suffered from equinus deformity, and refused any further surgical procedures. We performed 28 operations in 15 patients (average 1.9 operations per patient). After the period of bone transport, PCS and MCS scores increased continuously. After completed consolidation, the average MCS score was comparable to a normal collective, and the average VAS score was 1.87 (range: 0–3).Bone transport is a safe option for the treatment of infected nonunion of the tibia despite the high complication rate. The arduous and demanding nature of this treatment subjects patient to considerable the pain, mental, and physical stress. The average VAS scores, PCS, and MCS scores significantly improve at final follow-up. It is essential to communicate this fact to the patients and their relatives before the application of the frame in order to increase their compliance with the long and emotionally draining treatment.

To evaluate the impact of hypoxia on the angiogenic capability of endothelial cells (ECs), and further investigate whether the cyclooxygenase-2 (COX-2)/prostaglandin E2 (PGE2) signalling is involved in the angiogenic response of ECs to hypoxia. We explored the impact of various periods (1, 3, 6, 12, 24 hrs) of hypoxia (2% O2) on human umbilical vein endothelial cells (HUVECs) in vitro. We observed cell viability, migration, tube formation, analysed COX-2, vascular endothelial growth factor (VEGF), AQP1 mRNA transcription, protein expression and measured PGE2, VEGF protein concentration in cell supernatants. Then we treated HUVECs with COX-2 selective inhibitor NS398, EP1/2 combined antagonist AH6809 and exogenous PGE2 to investigate the role of COX-2/PGE2 signalling in the angiogenic response of ECs to hypoxia. The results demonstrated that short-term hypoxic treatment enhanced HUVECs proliferation, migration, tube formation, significantly up-regulated COX-2, VEGF, AQP1 mRNA level, protein expression and promoted PGE2, VEGF release. The pharmacological inhibition study revealed that exposure of HUVEC to NS398 and AH6809 under hypoxia impaired the biological responses of ECs to hypoxia. Exogenous PGE2 augments the effects of hypoxia on HUVECs, and partially reversed the inhibitory effects of NS398 on HUVECs proliferation and angiogenic capability. Short-term hypoxic treatment enhanced angiogenic capability of ECs, and COX-2/PGE2 signalling may play a critical role in the biological response of ECs to hypoxia.

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