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Objective The objective of this trial was to evaluate the efficacy and safety of topical administration of tranexamic acid (TXA) combined with diluted-epinephrine (DEP) on perioperative blood loss and transfusion in young and middle-aged patients with femoral neck fracture who did not undergo drainage. Methods Sixty patients were enrolled in this trial. In the target group(TXA/DEP group: n=30;18 men and 22 women, mean age 41.36±12.17 years), the surgical sites were injected with 50 mL normal saline mixed with 1 g of TXA with 0.25 mg of DEP at a 1:200,000 dilution (TXA/DEP).In the control group, (TXA group: n=30; 11 men and 19 women; mean age: 43.70±14.63 years), the surgical site was injected with 50 mL normal saline containing 1 g of TXA alone. The main outcome measures were total blood loss(TBL),dominant blood loss(DBL),hidden blood loss(HBL), postoperative hemoglobin (Hb) levels, hematocrit(HCT) and activated partial thromboplastin time(APTT), the secondary measures included transfusion requirements, Harris hip score, satisfactory degree and perioperative complications. Results The results showed that topical combined administration significantly reduced the decrease of hemoglobin among patients in the TXA/DEP group, measured on postoperative day 1 at 123.43±6.84 g/L vs. 118.33±6.30 g/L (TXA/DEP group vs. TXA group) , day 3 as 104.36±8.01 g/L vs. 96.83±7.56g/L, and day 5 as 115.96±6.49 g/L vs. 110.03±7.85 g/L, respectively (p<0.05). The mean HCT levels among patients in the TXA/DEP group were significantly higher than among those in the TXA group, measured on postoperative day 1 at 34.83±1.96% vs. 33.03±2.78% , day 3 as 32.40±2.83% vs. 30.83±2.65%, and day 5 as 38.63±1.56% vs. 37.06±1.99%, respectively (p<0.05). TBL, DBL, and HBL were also significantly reduced in the TXA/DEP group vs. the TXA group, measured at 333.40±42.19 ml vs. 396.30±53.54 ml, 72.33±16.28 ml vs. 91.86±20.10 ml, and 261.06±36.76 ml vs. 304.43±48.68 ml. 2 patients (6.66%) from the TXA/DEP group and 9 (30.00%) from the TXA group received blood transfusions, respectively (p<0.05).The Harris scores and satisfactory degrees among patients in the TXA/DEP group were significantly higher than among those in the TXA group, measured on postoperative day 21, respectively (p<0.05),which did not significantly differ from one another on postoperative3 months, respectively(P＞0.05).Furthermore, four cases in the TXA/DEP group and seven in the TXA group were diagnosed with subcutaneous ecchymosis, five cases in the TXA/DEP group and nine in the TXA group were diagnosed with deep vein thrombosis, and one case in the TXA/DEP group was diagnosed with adverse medicine reaction, those differences did not reach statistical significance (p>0.05). Conclusion Topical administration of TXA with DEP was safer and more effective in reducing blood loss and transfusion than the administration of TXA alone in treating young and middle-aged patients with femoral neck fracture, without increasing the risk of perioperative complications.

BackgroundKnowledge regarding the treatment cost of coronavirus disease 2019 (COVID-19) in the real world is vital for disease burden forecasts and health resources planning. However, it is greatly hindered by obtaining reliable cost data from actual patients. To address this knowledge gap, this study aims to estimate the treatment cost and specific cost components for COVID-19 inpatients in Shenzhen city, China in 2020–2021.MethodsIt is a 2 years' cross-sectional study. The de-identified discharge claims were collected from the hospital information system (HIS) of COVID-19 designated hospital in Shenzhen, China. One thousand three hundred ninety-eight inpatients with a discharge diagnosis for COVID-19 from January 10, 2020 (the first COVID-19 case admitted in the hospital in Shenzhen) to December 31, 2021. A comparison was made of treatment cost and cost components of COVID-19 inpatients among seven COVID-19 clinical classifications (asymptomatic, mild, moderate, severe, critical, convalescent and re-positive cases) and three admission stages (divided by the implementation of different treatment guidelines). The multi-variable linear regression models were used to conduct the analysis.ResultsThe treatment cost for included COVID-19 inpatients was USD 3,328.8. The number of convalescent cases accounted for the largest proportion of all COVID-19 inpatients (42.7%). The severe and critical cases incurred more than 40% of treatment cost on western medicine, while the other five COVID-19 clinical classifications spent the largest proportion (32%−51%) on lab testing. Compared with asymptomatic cases, significant increases of treatment cost were observed in mild cases (by 30.0%), moderate cases (by 49.2%), severe cases (by 228.7%) and critical cases (by 680.7%), while reductions were shown in re-positive cases (by 43.1%) and convalescent cases (by 38.6%). The decreasing trend of treatment cost was observed during the latter two stages by 7.6 and 17.9%, respectively.ConclusionsOur findings identified the difference of inpatient treatment cost across seven COVID-19 clinical classifications and the changes at three admission stages. It is highly suggestive to inform the financial burden experienced by the health insurance fund and the Government, to emphasize the rational use of lab tests and western medicine in the COVID-19 treatment guideline, and to design suitable treatment and control policy for convalescent cases.

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