Stroke is one of the most common causes of death and few pharmacological therapies show benefits in ischemic stroke. In this study, 290 patients aged 40-75 years old with first onset of acute ischemic stroke (more than 24 hours but within 14 days) were treated with standard treatments, and then were randomly allocated into an intervention group (treated with resuscitating acupuncture) and a control group (treated using sham-acupoints). Primary outcome measures included Barthel Index (BI), relapse and death up to six months. For the 290 patients in both groups, one case in the intervention group died, and two cases in the control group died from the disease (p = 0.558). Six patients of the 144 cases in the intervention group had relapse, whereas 34 of 143 patients had relapse in the control group (p < 0.001). The mean values for BI at six months were 70.25 ± 20.37 and 57.43 ± 19.61 for the two groups, respectively (p < 0.01). Acupuncture resulted in a significant difference between the two groups for the National Institute of Health Stroke Scale (NIHSS), not at two weeks (7.03 ± 3.201 vs. 8.13 ± 3.634; p = 0.067), but at four weeks (4.15 ± 2.032 vs. 6.35 ± 3.131, p < 0.01). The Chinese Stroke Scale (CSS) at four weeks showed more improvement in the intervention group than that in the control group (9.40 ± 4.51 vs. 13.09 ± 5.80, p < 0.001). Stroke Specific Quality of Life Scale (SS-QOL) at six months was higher in the intervention group (166.63 ± 45.70) than the control group (143.60 ± 50.24; p < 0.01). The results of this clinical trial showed a clinically relevant decrease of relapse in patients treated with resuscitating acupuncture intervention by the end of six months, compared with needling at the sham-acupoints. The resuscitating acupuncture intervention could also improve self-care ability and quality of life, evaluated with BI, NIHSS, CSS, Oxford Handicap Scale (OHS), and SS-QOL.

BackgroundTotal knee arthroplasty (TKA) is associated with significant perioperative blood loss and need for transfusion. This study aimed to evaluate the effectiveness and safety of tranexamic acid (TXA) to reduce perioperative blood loss in patients receiving TKA.Material/MethodsA total of 92 patients who accepted unilateral TKA from May 2012 to May 2013 randomly received either 15 mg/kg TXA in 100 mL normal saline solution (TXA group, n=46) or the same amount of normal saline solution (placebo group, n=46) at 15 min before the tourniquet was loosened. The following data were recorded: intraoperative blood loss; post-operative drainage at 12 h; total drainage amount; hidden blood loss; total blood loss; transfusion volumes; number of transfusions; post-operative hemoglobin at 1, 3, and 5 days; D-dimer; number of lower limb ecchymoses; and deep vein thrombosis (DVT).ResultsA total of 81 patients were available for analysis (TXA group, n=41; placebo group, n=40). Post-operative12-h drainage, post-operative 24-h D-dimer values, total drainage volume, hidden blood loss, total blood loss, and the rate of postoperative ecchymosis were lower in the TXA group than in the placebo group (p<0.05). The post-operative 3-day Hgb was higher in the TXA group than in the placebo group (p=0.000). The rate of transfusion and DVT was similar in both groups (n.s.).ConclusionsPerioperative blood loss could be reduced after TKA by intravenously injecting 15 mg/kg TXA at 15 min before the tourniquet was loosened. The application of TXA is not associated with increased risk of DVT.

BackgroundTo date, a regional approach using local anesthetics has become a popular analgesic method for arthroscopy. The optimal postoperative analgesia method for shoulder arthroscopy is still debated.ObjectiveThis study was designed to evaluate the effect and safety of using ketorolac in combination with a multimodal drug regime (ropivacaine, morphine, and triamcinolone acetonide) after shoulder arthroscopy.MethodsA total of 60 patients were included in a pilot study and patients were randomized into an experimental group (n=30) and a control group (n=30). The following parameters were used to evaluate pain relief levels postoperatively: the Visual Analog Scale (VAS) at 1, 3, 6, 12, 24, and 48 hours postoperatively, morphine consumption, and initial analgesic desired time. Complications were also recorded.ResultsExcept for 1 hour postoperatively, patients in the experimental group experienced lower VAS scores during the first 48 hours postoperatively (P<0.05). The VAS score in both groups increased after 3 hours postoperatively and peaked at 12 hours postoperatively (2.54±0.86 vs 3.25±1.18). The VAS scores on movement in the experimental group were lower than those in the control group at 24 or 48 hours postoperatively (P=0.004, 0.001). A total of 18 (60.0%) patients in the experimental group required no additional analgesia, compared with 10 (33.3 %) in the control group (P=0.035). The mean rescue analgesia was 11.40±5.56 mg in the experiment group, while 16.57±8.48 mg in the control group (P=0.016). The initial analgesic desired time was delayed significantly in the experimental group (16.50±14.57 hours vs 8.9±6.32 hours, P=0.000).ConclusionAdding ketorolac to intra-articular injection analgesia is a safe and effective method to improve pain relief after shoulder arthroscopy, and further prospective controlled trials are necessary to allow definite treatment recommendations.

MiR‐20a has been reported as a key regulator to pro‐inflammatory factor release in fibroblast‐like synoviocytes (FLS), which caused rheumatoid arthritis (RA). However, the molecular mechanism of miR‐20a in RA remains to be further elucidated. This study aimed to investigate the roles of miR‐20a in RA pathology. RA (n = 24) and osteoarthritis (OA, n = 20) and normal healthy tissues (n = 16) were collected from operation. TargetScan and dual‐luciferase reporter were performed to predict and confirm the potential binding sites of miR‐20a on ADAM metallopeptidase domain 10 (ADAM10). Pearson's analysis was adopted to evaluate the correlation between miR‐20a and ADAM10 expression. It was found that MiR‐20a was downregulated in RA tissues, and overexpressed miR‐20a inhibited cell viability, migration and invasion, and the expression of inflammatory factors in RA‐FLS MH7A cells. ADAM10 was identified as the target gene of miR‐20a, and upregulation of ADAM10 reversed the inhibitory effects of miR‐20a. In conclusion, miR‐20a inhibits the progression of RA‐FLS as well as the inflammatory factor expression by targeting ADAM10.

This report describes the regular use of acupuncture treatments for a patient with hypertension who could not tolerate the side effects of the antihypertensive agents. The patient received 60 acupuncture treatments in the course of 12 weeks, during which time his overall wellbeing improved, his blood pressure reduced and the side effects of antihypertensive drugs were removed. Although acupuncture plus the drug appeared to have a substantial synergistic effect that was weakened when the drug was discontinued, acupuncture may still play a role in the management of hypertension, especially for patients who cannot tolerate the side effects of antihypertensive agents.