Objective To study hemostasis of a new chitosan hemostatic powder. Methods Twenty-four adult SD rats were made the models of l iver injury, male or female, and weighing 210-240 g. They were divided into three groups randomly (n=8) depending on different hemostatic powders. The incision of the l iver was treated with 300 mg Yunnan baiyao (group A1), chitosan hemostatic powder of pH6.5 (group B1) and pH7.5 (group C1), respectively. The bleeding time and bleeding amount were recorded. In vitro, with the modified Ree-White method, 2 mL artery blood from New Zealand whiterabbit was added into the 0.2 mL solution of Yunnan baiyao, chitosan hemostatic powder of pH6.5 and pH7.5 (concentration of 0.2 mg/mL), respectively. The blood coagulation time was recorded. The chitosan blood clots of group B2 and group C2 were observed with scanning electron microscopy (SEM). Results The bleeding time of group A1, group B1 and group C1 was (292 ± 31), (261 ± 23), and (224 ± 28) s, respectively, the bleeding amount was (1.63 ± 0.21), (1.47 ± 0.18), and (1.18 ± 0.17) g, respectively, showing statistically significant differences between groups B1, C1, and group A1 (P lt; 0.05), between group C1 and group B1 (P lt; 0.05). The blood clotting time of group A2, group B2, and group C2 was (653 ± 41), (255 ± 20), and (202 ± 11) s, respectively, showing statistically significant differences between groups B2, C2, and group A2 (P lt; 0.05), between group C2 and group B2 (P lt; 0.05). The SEM showed that the blood cells of group B2 and group C2 gathered around the chitosan. Conclusion Chitosan hemostatic powder of pH7.5 has good hemostasis.
ObjectiveTo systematically review the influence on ovarian reserve function by different hemostatic methods during laparoscopic cystectomy in treatment of ovarian endometrioma (OE).
MethodsDatabases including The Cochrane Library, PubMed, EMbase, CNKI, CBM and WanFang Data were electronically searched, to collect relevant randomized controlled trials (RCTs) about laparoscopic electro coagulation vs. microscopically suture for OE from 1990 to Mar, 2014. Meanwhile, references of included studies were also retrieved manually. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then RevMan 5.2 software was used for meta-analysis.
ResultsA total of 16 RCTs involving 1 236 patients were finally included. The results of meta-analysis showed that the luteinizing hormone (LH) levels after 1 month, 2 months, 6 months and 12 months and estradiol (E2) levels after 2 months, 6 months had no significant differences between the two groups and the E2 level after 12 month of the suture group was significantly lower than that of the electro coagulation group. The levels of follicle stimulating hormone (FSH), LH, E2, antral follicle count (AFC), mean ovarian stromal peak systolic blood flow velocity (PSV) and anti-Mullerian hormone (AMH) in the suture group were significantly superior to those in the electro coagulation group at other follow-up time.
ConclusionCurrent evidence suggests that in treatment of ovarian endometriotic cyst by laparoscopic cystectomy, compared with electro coagulation hemostasis, suture hemostasis has less influence on ovarian reserve function. Due to limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.
Objective To explore the value of wide-awake local anesthesia no tourniquet (WALANT) technique in the treatment of acute Achilles tendon rupture. MethodsIn a prospective randomized controlled trial, 48 patients with acute Achilles tendon rupture who met the criteria between March 2020 and October 2020 were randomly divided into two groups according to 1∶1 distribution, with 24 cases in each group. The study group used WALANT technique and the control group used epidural anesthesia with tourniquet for channel-assisted minimally invasive repair (CAMIR). There was no significant difference between the two groups in gender, age, injured side, cause of injury, distance from broken end of Achilles tendon to calcaneal tubercle, and time from injury to hospitalization (P>0.05). The operating room use time (from patients entering the operating room to leaving the operating room), intraoperative blood loss, hospital stay, and the highest pain score [using Numerical Rating Scale (NRS)] during operation and at 1 day after operation were recorded and compared between the two groups. The tourniquet adverse reactions in the control group were recorded. The functional recovery was evaluated by the scoring method of American Orthopedic Foot and Ankle Society (AOFAS) at 12 months after operation. ResultsThe operation was successfully completed in both groups. The operating room use time and hospital stay in the study group were significantly less than those in the control group (P<0.05), but the difference in the intraoperative blood loss between the two groups was not significant (t=0.429, P=0.670). There was no significant difference in the highest NRS score during operation between the two groups (t=1.671, P=0.101); the highest NRS score in the study group at 1 day after operation was significantly lower than that in the control group (t=?6.384, P<0.001). In the control group, 13 patients had different degrees of tourniquet adverse reactions, including tourniquet regional pain, local swelling, blisters, thigh numbness, and discomfort. The patients in both groups were followed up 12-18 months, with an average of 13.9 months. The motor function of all patients returned to normal at 12 months after operation. The difference in AOFAS scores between the two groups was not significant (t=0.345, P=0.731). There was no complication such as sural nerve injury, local infection, and secondary rupture in both groups. ConclusionThe application of WALANT combined with CAMIR technique in the treatment of acute Achilles tendon rupture has good anesthetic and effectiveness, avoids the adverse reactions of tourniquet, and reasonably saves social medical resources.
OBJECTIVE: To validate the hemostatic properties of collagen sponge made in China. METHODS: The experimental model of superficial cut of liver was established in 20 Sprague-Dawley adult rats, which were divided into two groups randomly. Collagen sponge or gelatin sponge was used to cover the cut respectively. Hemostatic result was observed. Afterwards, standard liver trauma model by resection left front liver lobe was made, wound was treated with collagen sponge or gelatin sponge respectively. Hemostatic result was observed. Concurrent hemostatic time and bleeding amount were noted. At 7, 14 and 20 days after operation, intra-abdominal adhension, infection and healing state of liver were observed by exploratory laparotomy. The histological changes of regenerate liver tissue were observed by microscopy. RESULTS: Collagen sponge adhered to wound well. Concurrent hemostatic time and bleeding amount in collagen sponge group were superior to those of gelatin sponge (P lt; 0.05). The histological examination showed that collagen sponge was absorbed and degraded rapidly, regenerative hepatocytes could be induced. CONCLUSION: Collagen sponge has fine hemostatic properties and can induce regeneration of hepatocytes effectively. It is worth popularizing for its convenience in clinical application and its properties of rapid degradation and absorption.
Objective To evaluate the analgesic efficacy of ultrasound-guided high fascia iliaca compartment block (HFICB) in managing tourniquet-related pain following total knee arthroplasty (TKA). MethodsA prospective randomized controlled trial was conducted involving 84 patients with severe knee osteoarthritis or rheumatoid arthritis who underwent unilateral TKA between March 2024 and December 2024. Patients were randomly assigned to two groups (n=42) using a random number table. In the trial group, ultrasound-guided HFICB was performed preoperatively, with 0.2% ropivacaine injected into the fascia iliaca compartment. No intervention was administered in the control group. Baseline characteristics, including gender, age, surgical side, body mass index, and preoperative visual analogue scale (VAS) scores at rest and during movement, showed no significant difference between the two groups (P>0.05). In both groups, a tourniquet was applied after osteotomy and before pulsed lavage, and removed after the closure of the first layer of the joint capsule. Postoperative assessments were conducted at 6, 12, 24, and 48 hours, including VAS scores at the tourniquet site (at rest and during movement), Bromage motor block scores, Ramsay sedation scores, and Bruggrmann comfort scale (BCS) scores to evaluate patient comfort. Additionally, the average tramadol consumption and incidence of nausea and vomiting within 48 hours postoperatively were recorded and compared. Results In the trial group and control group, VAS scores during movement at the tourniquet site significantly improved at all postoperative time points compared to preoperative levels (P<0.05). VAS scores at rest increased transiently at 6 hours after operation in both groups, and then gradually decreased to the preoperative level. Except that there was no significant difference at 48 hours after operation in the trial group (P>0.05), there were significant differences at other time points of two groups compared to preoperative score (P<0.05). Except for VAS score at rest at 6 hours, VAS score during movement at 48 hours, and BCS comfort score at 48 hours (P>0.05), the trial group showed significantly better outcomes than the control group in terms of VAS score at rest, VAS score during movement, Ramsay sedation scores, and BCS comfort scores at all other time points (P<0.05). No significant difference was found in Bromage motor block scores between the groups (P>0.05). Tramadol was used in 3 patients in the trial group and 7 patients in the control group within 48 hours after operation, the dosage was (133.30±14.19) mg and (172.40±22.29) mg, showing significant difference (P<0.05). Nausea and vomiting occurred in 4 patients (9.5%) in the trial group and 3 patients (7.1%) in the control group, with no significant difference in incidence between groups (P>0.05). ConclusionUltrasound-guided HFICB provides effective analgesia for tourniquet-related pain following TKA, facilitates early postoperative functional recovery of the knee joint, and may serve as a valuable clinical option for postoperative pain management in TKA patients.
Objective
To investigate the hemostasis of thermosensitive chitosan hemostatic film.
Methods
Fifty adult Sprague Dawley rats, male or female and weighing 190-210 g, were made the models of liver injury. The models were randomly divided into 5 groups (n=10) depending on different hemostatic materials. The incision of the liver was covered with the hemostatic materials of 2.0 cm × 1.0 cm × 0.5 cm in size: thermosensitive chitosan hemostatic film (group A), chitosan hemostatic film (group B), cellulose hemostatic cotton (group C), gelatin sponge (group D), and no treatment (group E), respectively. The bleeding time and bleeding amount were recorded. After 4 weeks, the incisions of the liver were observed with HE staining.
Results
Gross observation showed better hemostatic effect and faster hemostatic time in groups A, B, and C; group D had weaker hemostatic effect and slower hemostatic time; group E had no hemostatic effect. The bleeding time and bleeding amount of groups A, B, C, and D were significantly lower than those of group E (P lt; 0.05). The bleeding time and bleeding amount of groups A, B, and C were significantly lower than those of group D (P lt; 0.05), but no significant difference was found among groups A, B, and C (P gt; 0.05). The liver cells of group A had milder edema and ballooning degeneration than other 4 groups through histological observation.
Conclusion
The thermosensitive chitosan hemostatic film has good hemostasis effect on the liver incision of rats.
Three different methods of electrocautery were used to study the effects of electrocoagu-lation on limbs and intraabdominal blood vessel of 6 rabbits. These methods are non-touching, touching and segmental electrocoagulation. The results show that all three methods can satisfactorily stop bleeding of the blood vessel which is smaller than 1. 5mm in diameter. For arteries with the diameter 1.5～2.0mm. the effect of segment electrocoagulation is better than the other methods because it has a long burn end after cautery.
