Authors' reply

To the editor:We appreciate Raju Vaishya's proposal.Actually,we made an inapposite expression in conclusion of the abstract.There were no evidences to prove that tranexamic acid (TA) could reduce deep vein thrombosis (DVT) and pulmonary embolism (PE) following total knee arthroplasty (TKA).In the text,we also mentioned that concerning the occasional thromboembolic events,most of doctors are reluctant to use TA in TKA.1     

Ultrastructural changes of penile tunica albuginea in diabetic rats

Aim: To clarify the ultrastructural changes of penile tunica albuginea (TA) in streptozotocin (STZ)-induced diabetic rats. Methods: Intraperitoneal injection of STZ was used to induce diabetes mellitus (DM) in 12 Sprague Dawley rats. Ten rats (age and weight-matched) were used as control. Blood samples from the tail snips of the rats were used for the determination of serum glucose levels with SureStep Plus Blood Meter. At week 4 and 10 after the injection, half of the rats in each group were sacrificed and penile samples were obtained from the middle third of the penile shaft for the examination of TA under scanning electron microscopy. Results: In the diabetic group, the serum glucose levels were higher (P<0.01 at both time points) and the TA were thinner (P<0.05) than those of the controls. In the control group, the fibers of TA were rich and arranged regularly and undulated, while in the diabetic group, the fibers were diminished, lost the undulations and were arranged irregularly. Conclusion: In rat     

Prediction of massive transfusion in trauma patients in the surgical intensive care units (THAI-SICU study)

Purpose: After damage control surgery, trauma patients are transferred to intensive care units to restore the physiology. During this period, massive transfusion might be required for ongoing bleeding and coagulopathy. This research aimed to identify predictors of massive blood transfusion in the surgical intensive care units (SICUs). Methods: This is an analysis of the THAI-SICU study which was a prospective cohort that was done in the 9-university-based SICUs in Thailand. The study included only patients admitted due to trauma mechanisms. Massive transfusion was defined as received 10 units of packed red blood cells on the first day of admission. Patient characteristics and physiologic data were analyzed to identify the potential factors. A multivariable regression was then performed to identify the significant model. Results: Three hundred and seventy patients were enrolled. Sixteen patients (5%) received massive transfusion in the SICUs. The factors that significantly predicted massive transfusion were an initial sequential organ failure assessment (SOFA) ≥9 (risk difference (RD) 0.13, 95% confidence interval (CI): 0.03-0.22, p = 0.01); intra-operative blood loss ≥4900 mL (RD 0.33, 95% CI: 0.04-0.62, p = 0.02) and intra-operative blood transfusion ≥10 units (RD 0.45, 95% CI: 0.06 to 0.84, p = 0.02). The probability to have massive transfusion was 0.976 in patients who had these 3 factors. Conclusion: Massive blood transfusion in the SICUs occurred in 5%. An initial SOFA ≥9, intra-operative blood loss ≥4900 mL, and intra-operative blood transfusion 10 units were the significant factors to predict massive transfusion in the SICUs.     

A long-term follow-up study of high tibial osteotomy for medial compartment osteoarthrosis

Objective : To observe the long-term outcome of high tibial osteotomy (HTO) in treating medial compartment osteoarthrosis of knees. Methods: A retrospective study was carried out on 194 patients (215 knees) treated with HTO for medial compartment osteoarthritis at the Orthopaedic Hospital of Kiel University between 1985 and 1996. Resnits: One hundred and sixty-one knees (144 patients) were followed up for 1.5-12 years with an average of 7.5 years and their data were reviewed. The proportion of excellent outcome were 97.3 %, 93.6 % and 78.2 % two, five and over five years after HTO, respectively. The revision rate of total knee arthroplasty (TKA) was 11.8% (19 knees retreated with TKA for HTO failure ). The survivorship analysis of the 19 knees retreated with TKA showed an expected survival rate of 98.7%, 95.0% and 84.1% 2, 5 and 10 years after HTO, respectively. There were 5.6% complications ( 12 /161 ), including five superficial wound infections, one deep infection, five delayed bone healing, and one peroneal nerve palsy. Fifty patients (54 knees ) missed follow-up, among them 10 patients (11 knees) died. Conclusions: HTO is an effective method in treating medial compartment osteoarthritis with a varus knee. Appropriate overcorrection of femorotibial alignment is the key for the success of the operation. But as the long-term effect is concerned, there is a trend of deterioration and some of the patients may have a second operation of revision with TKA.     

Significance of malondialdehyde concentration in seminal plasma of infertile men

Objective: To determine the concentration of malondialdehyde (MDA), product of lipid peroxidation, in seminal plasma and evalu ate its significance. Methods: Ninety-three cases of infertile pa tients were divided into the obstructive azoospermic (12 cases), the non-obstructive azoospermic (15 cases), the oligozoospermic (21 cases), the asthenozoospermic (19 cases), the oligoastheno zoospermic (16 cases) and the oligoasthenoteratozoospermic (10) groups. Eighteen fertile males served as the controls. MDA con centration was assessed by high-performance liquid chromatogra phy (HPLC). Results: With the exception of the obstructive azoospermic group, the MDA concentration in the seminal plasma was significantly different between the control group and the infer tile groups (P<0.01) as well as between the different infertile groups. Conclusion: Determination of MDA concentration in the seminal plasma is helpful to the diagnosis of male infertility induced by overproduction of reactive oxygen species.     

止血带对全膝关节置换术中股骨远端旋转定位时髌骨轨迹的影响

Objective To explore, the influence of tourniquet application on patellar tracking with using the surgical transepieondylar axis as distal femur alignment in total knee arthroplasty (TKA). Methods From December 2002 to August 2008, 349 cases (526 knees) of primary TKA were performed. There were 124 males and 225 females with an average age of 68 years from 33 to 84 years. A total of 387 knees had varus deformity and 94 had valgus deformity. All of prosthesis were rotating platform with posterior cruciate ligament retaining provided by Gemini MK Ⅱ. All patients underwent anterior medial parapatellar approach. The surgical transepieondylar axis had been principally used as the distal femur alignment. Patellar tracking was checked with no thumb test. For maltracking ones, we prefered to use a single retinacular closing stitch at the superior medial arthrotomy and deflate tourniquets. Patellar tracking was checked again. Finally, later-al retinaeular releases (LRR) had been performed to obtain optimizing patellar tracking. Results Intraoper-atively, no thumb test were positive in 138 knees, including patellar subluxation (vaigus deformity) in 12 knees and patellar inclining (74 of valgns deformity and 52 of varus deformity) in 126 knees. After using a single retinacular closing stitch at the superior medial arthrotomy and deflating tourniquets, no thumb test were positive in 40 knees, including patellar subluxation (valgus deformity) in 8 knees and patellar inclining (29 of valgns deformity) in 32 knees. The total rate of LRR was 7.6% (40/526), the rate of LRR in valgus deformity was 39.4% (37/94) and that in yarns deformity and no deformity was 0.7% (3/432). Conclusion There was significant influence of tourniquet application on patellar tracking during the TKA. We were not falsely correcting patellar tracking problems with using a single retinaeular closing stitch at the superior me-dial arthrotomy anti deflating tourniquets intraoperatively and reducing the rate of LRR.     

Benefits of the use of blood conservation in scoliosis surgery

AIM To investigate whether autologous blood transfusion(ABT) drains and intra-operative cell salvage reduced donor blood transfusion requirements during scoliosis surgery.METHODS Retrospective data collection on transfusion requirements of patients undergoing scoliosis surgery is between January 2006 and March 2010. There were three distinct phases of transfusion practice over this time: Group A received "traditional treatment" with allogeneic red cell transfusion(ARCT) in response to an intra- or postoperative anaemia(Hb 8 g/d L or a symptomatic anaemia); Group B received intra-operative cell salvage in addition to "traditional treatment". In group C,ABT wound drains were used together with both intra-operative cell salvage and "traditional treatment".RESULTS Data from 97 procedures on 77 patients,there was no difference in mean preoperative haemoglobin levels between the groups(A: 13.1 g/d L; B: 13.49 g/d L; C: 13.66 g/d L). Allogeneic red cell transfusion was required for 22 of the 37 procedures(59%) in group A,17 of 30(57%) in group B and 16 of 30(53%) in group C. There was an overall 6% reduction in the proportion of patients requiring an ARCT between groups A and C but this was not statistically significant(χ2 = 0.398). Patientsin group C received fewer units(mean 2.19) than group B(mean 2.94)(P = 0.984) and significantly fewer than those in group A(mean 3.82)(P = 0.0322). Mean length of inpatient stay was lower in group C(8.65 d) than in groups B(12.83) or A(12.62).CONCLUSION When used alongside measures to minimise blood loss during surgery,ABT drains and intra-operative cell salvage leads to a reduced need for donor blood transfusion in patients undergoing scoliosis surgery.     

Joint arthroplasty Perioperative Surgical Home:Impact of patient characteristics on postoperative outcomes

AIM:To determine the impact of different characteristics on postoperative outcomes for patients in a joint arthroplasty Perioperative Surgical Home(PSH) program.METHODS:A retrospective review was performed for patients enrolled in a joint arthroplasty PSH program who had undergone primary total hip arthroplasty(THA) and total knee arthroplasty(TKA).Patients were preoperatively stratified based on specific procedure performed,age,gender,body mass index(BMI),American Society of Anesthesiologists Physical Classification System(ASA) score,and Charleston Comorbidity Index(CCI) score.The primary outcome criterion was hospital length of stay(LOS).Secondary criteria including operative room(OR) duration,trans-fusion rate,Post-Anesthesia Care Unit(PACU) stay,readmission rate,post-operative complications,and discharge disposition.For each outcome,the predictor variables were entered into a generalized linear model with appropriate response and assessed for predictive relationship to the dependent variable.Significance level was set to 0.05.RESULTS:A total of 337 patients,200 in the TKA cohort and 137 in the THA cohort,were eligible for the study.Nearly two-third of patients were female.Patient age averaged 64 years and preoperative BMI averaged 29 kg/m2.The majority of patients were ASA score Ⅲ and CCI score 0.After analysis,ASA score was the only variable predictive for LOS(P = 0.0011) and each increase in ASA score above 2 increased LOS by approximately 0.5 d.ASA score was also the only variable predictive for readmission rate(P = 0.0332).BMI was the only variable predictive for PACU duration(P = 0.0136).Specific procedure performed,age,gender,and CCI score were not predictive for any of the outcome criteria.OR duration,transfusion rate,postoperative complications or discharge disposition were not significantly associated with any of the predictor variables.CONCLUSION:The joint arthroplasty PSH model reduces postoperative outcome variability for patients with different preoperative characteristics and medical comorbidities.     

Ultrastructural changes of penile tunica albuginea in diabetic rats

Aim: To clarify the ultrastructural changes of penile tunica albuginea (TA) in streptozotocin (STZ)-induced diabetic rats. Methods: Intraperitoneal injection of STZ was used to induce diabetes mellitus (DM) in 12 Sprague Dawley rats. Ten rats (age and weight-matched) were used as control. Blood samples from the tail snips of the rats were used for the determination of serum glucose levels with SureStep Plus Blood Meter. At week 4 and 10 after the injection, half of the rats in each group were sacrificed and penile samples were obtained from the middle third of the penile shaft for the examination of TA under scanning electron microscopy. Results: In the diabetic group, the serum glucose levels were higher (P＜0.01 at both time points) and the TA were thinner (P＜0.05) than those of the controls.In the control group, the fibers of TA were rich and arranged regularly and undulated, while in the diabetic group, the fibers were diminished, lost the undulations and were arranged irregularly. Conclusion: In rats, DM appeared to impair the penile TA ultrastructures and this impairment could contribute to diabetic erectile dysfunction in part by impairing the veno-occlusive function. (Asian J Andro12004 Dec;6:365-368)