Application of aspirin and low molecular weight heparin in major orthopedic surgery:Meta analysis of a randomized controlled trial

Objective:The perioperative period of major orthopedic surgery is associated with a high risk of thrombosis,but the best chemopreventive agent for thrombosis prophylaxis is still inconclusive.For this reason,this paper evaluated the efficacy and safety of aspirin versus low-molecular heparin using a Meta-analysis.Methods:Ten randomized controlled studies on the application of aspirin and low-molecular heparin for the prevention of deep vein thrombosis in orthopedic major surgery were retrieved by computer searches of PubMed,CochraneLibrary,WebofScience,China Knowledge Network,Wanfang,and Vipul databases according to inclusion and exclusion criteria,and the literature was managed using Endnote software,and the data were analyzed using Revman 5.3 software was used to perform Meta-analysis of the extracted data,focusing on the effects of these two drugs on pulmonary embolism,deep vein thrombosis,major bleeding events,minor bleeding events,wound complications,mortality and blood loss within 90 days after major orthopedic surgery.Results:(1)Ten randomized controlled trials of high quality were included,with a total of 12,974 patients,7,026 in the aspirin group and 5,948 in the low-molecular heparin group;(2)Meta-analysis showed that aspirin had a higher incidence of pulmonary embolism(OR=1.59,95%CI:1.02 to 2.49,P=0.04)and deep vein thrombosis(OR=1.60,95%CI:1.26 to 2.02,P=0.0001)than low molecular heparin;(3)The incidence of major bleeding events(OR=0.85,95%CI:0.47 to 1.55,P=0.60),minor bleeding events(OR=0.79,95%CI:0.55 to 1.12,P=0.18),adverse wound reactions(OR=0.79,95%CI:0.48 to 1.31,P=0.36),mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)in both drug groups,mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)were not statistically significant.Conclusion:Low-molecular heparin was superior to aspirin in the prevention of pulmonary embolism and lower extremity deep vein thrombosis after major orthopedic surgery,but the safety and adverse drug reactions of both groups were basically similar.Based on this,the authors recommend that low-molecular heparin should be preferred for the prevention of deep vein thrombosis in major orthopaedic surgery;however,the inclusion of randomized controlled trials remains limited,necessitating high-quality,large-sample,long-term follow-up clinical studies.

Clinical Application Study of Super-Mini Percutaneous Nephrolithotomy in the Treatment of Kidney Stones

Objective:To observe the clinical efficacy and complication rates of different stone fragmentation techniques in the treatment of kidney stones.Methods:This study selected 100 patients with urinary stones treated at the Third Division General Hospital from 2021 to November 2023 as subjects.The control group(n=50)received conventional percutaneous nephrolithotomy(PCNL)for stone fragmentation,while the research group(n=50)received super-mini percutaneous nephrolithotomy(SMP)treatment.Surgical parameters,stone clearance rates,recurrence rates,and complication rates were compared between the two groups.Results:After treatment,the surgical parameters in the research group were significantly better than those in the control group.The research group had a higher stone clearance rate and lower rates of stone recurrence and complications(P<0.05).Conclusion:Compared with conventional PCNL,SMP shows better clinical outcomes for patients with kidney stones.It improves surgical parameters,increases stone clearance rates,and reduces both stone recurrence and complication rates,making it a valuable technique for clinical reference.

Meta-analysis of efficacy and safety of concurrent or staged bilateral total knee arthroplasty

Objective: To study the safety and efficacy of concurrent bilateral total knee arthroplasty orstaged bilateral total knee replacement using meta-analysis. Methods: The databases of ChinaWanfang, CNKI, PubMed, Cochrane Library, and Web of Science were searched conducted formeta-analysis of the extracted data using Review Manager 5.3 software. Results: ①A total of 18retrospective cohort studies were included, 72 831 patients in the same period group and 103595 patients in the staging group. ②The results of meta showed that in the staging group, theincidence of postoperative cardiac complications[OR= 1.21, 95%CI=(1.10~1.34), P<0.000 1] ,neurological complications[OR=1.67, 95%CI=(1.29~2.16), P<0.000 1], deep vein thrombosis[OR=1.38, 95%CI(1.27~1.50), P<0.000 01], mortality[OR=2.18, 95%CI=(1.67~2.84),P<0.000 01] and perioperative blood loss [OR=246.75, 95%CI=(233.30~260.20)] were lessthan those in the same period group (P<0.000 01);The postoperative deep infection rate in thesame period group [OR=0.61, 95%CI=(0.52~0.71), P<0.000 01] was lower than that in thestaging group;The postoperative superficial infection rate [OR=0.96, 95%CI=(0.66~1.40)],revision rate of joint replacement [OR= 1.04, 95%CI=( 0.96~1.12)], HSS score [OR=0.10,95%CI=(-0.61~0.80), P=0.79] and knee joint activity score [OR=-0.23, 95%CI=(-1.25~0.78)]were not statistically significant between the two groups(P>0.05).Conclusion: Stagingbilateral total knee replacement can more effectively reduce the incidence of perioperativecomplications and reduce the amount of blood transfusion, while concurrent bilateral total kneereplacement can reduce the rate of deep infection. To further compare the efficacy and safety ofconcurrent or staged bilateral total knee arthroplasty, further studies must be conducted in theform of a randomized clinical trial to evaluate the results mentioned in this meta-analysis.

LC-MS/MS method for the quantitation of serum tocilizumab in rheumatoid arthritis patients using rapid tryptic digestion without IgG purification

The quantitation of serum tocilizumab using liquid chromatography tandem-mass spectrometry(LC-MS/MS)method has not been widely applied in clinical settings because of its time-consuming and costly sample pretreatments.The present study aimed to develop a validated LC-MS/MS method for detecting serum tocilizumab by utilizing immobilized trypsin without an immunoglobulin G purification step and evaluate its applicability in the treatment of rheumatoid arthritis(RA)patients administered intravenously or subcutaneously with tocilizumab.The tocilizumab-derived signature peptide was deciphered using a nano-LC system coupled to a hybrid quadrupole-orbitrap mass spectrometer.The serum tocilizumab was rapidly digested by immobilized trypsin for 30 min.The chromatographic peak of the signature peptide and that of the internal standard were separated from the serum digests for a total run time of 15 min.The calibration curve of serum tocilizumab concentration was linear with a range of 2-200 μg/mL.The intra-and inter-day accuracy and relative standard deviation(RSD)were 90.7%-109.4%and<10%,respectively.The serum tocilizumab concentrations in the RA patients receiving intravenous and subcutaneous injections were 5.8-28.9 and 2.4-63.5 μg/mL,respectively.The serum tocilizumab concentrations using the current method positively correlated with those using the enzyme-linked immunosorbent assay,although a systematic error was observed between these methods.In conclusion,a validated LC-MS/MS method with minimal sample pretreatments for monitoring serum tocilizumab concentrations in RA patients was developed.

Deposition of Diamond-Like Carbon Films with Femtosecond KrF Laser Pulses

Hydrogen-free diamond-like carbon (DLC) films with the optical band gaps of 2.0-2.7 e V and the microhardness of 40-55 GPa are deposited by femtosecond KrF laser pulses. The film microstructure of nanometer spheroid is observed. The filrn microhardness is improved with the increase of ion kinetic energy of plasma plume from 300 to 600 eV. The characteristics of DLC film deposition with fs pulses is discussed.