Essentials
Perioperative blood loss and inflammatory response can significantly affect recovery after surgery.
We studied the effects of multiple‐dose oral tranexamic acid on blood loss and ...inflammatory response.
A postoperative four‐dose regimen brought about maximum reduction in postoperative blood loss.
A postoperative four‐dose regimen reduced inflammatory response and promoted early rehabilitation.
Summary
Background
Tranexamic acid (TXA) can reduce blood loss and the inflammatory response at multiple doses in total knee arthroplasty patients. However, the optimal regimen has not been determined.
Objectives
To identify the most effective regimen for achieving maximum reductions in blood loss and the inflammatory response.
Patients/Methods
Two hundred and seventy‐five patients were randomized to receive a placebo (group A), a single 2‐g oral dose of TXA 2 h preoperatively followed by 1 g of oral TXA 3 h postoperatively (group B), a single dose followed by 1 g of oral TXA 3 h and 7 h postoperatively (group C), a single dose followed by 1 g of oral TXA 3 h, 7 h and 11 h postoperatively (group D), or a single dose followed by 1 g of oral TXA 3 h, 7 h, 11 h and 15 h postoperatively (group E). The primary outcome was total blood loss on postoperative day (POD) 3. Secondary outcomes included a decrease in the hemoglobin level, coagulation parameters, inflammatory marker levels, and thromboembolic complications.
Results
Groups D and E had significantly lower blood loss and smaller decreases in hemoglobin level than groups A, B, and C, with no significant difference on POD 3 between groups D and E. Significantly enhanced coagulation was identified for the four multiple‐dose regimens; however, all thromboelastographic parameters remained within normal ranges. Group E had the lowest inflammatory marker levels and pain, and the greatest range of motion. No thromboembolic complications were identified.
Conclusion
The four‐dose regimen yielded the maximum reductions in blood loss and inflammatory response, improved analgesia, and promoted early rehabilitation. Further studies are required to ensure that these findings are reproducible.
Domestic chickens (Gallus gallus domesticus) fulfill various roles ranging from food and entertainment to religion and ornamentation. To survey its genetic diversity and trace the history of ...domestication, we investigated a total of 4938 mitochondrial DNA (mtDNA) fragments including 2843 previously published and 2095 de novo units from 2044 domestic chickens and 51 red junglefowl (Gallus gallus). To obtain the highest possible level of molecular resolution, 50 representative samples were further selected for total mtDNA genome sequencing. A fine-gained mtDNA phylogeny was investigated by defining haplogroups A-I and W-Z. Common haplogroups A-G were shared by domestic chickens and red junglefowl. Rare haplogroups H-I and W-Z were specific to domestic chickens and red junglefowl, respectively. We re-evaluated the global mtDNA profiles of chickens. The geographic distribution for each of major haplogroups was examined. Our results revealed new complexities of history in chicken domestication because in the phylogeny lineages from the red junglefowl were mingled with those of the domestic chickens. Several local domestication events in South Asia, Southwest China and Southeast Asia were identified. The assessment of chicken mtDNA data also facilitated our understanding about the Austronesian settlement in the Pacific.
Sorbitol dehydrogenase (SDH) catalyses the reversible oxidation of sorbitol, xylitol and ribitol to their corresponding ketoses. In this study, we investigated the expression and role of Arabidopsis ...SDH in salt and osmotic stress tolerance, and abscisic acid (ABA) response. The expression patterns of SDH were investigated using transgenic Arabidopsis plants expressing beta-glucuronidase (GUS) under control of the promoter with the first intron of SDH. qRT-PCR and histochemical assay of GUS activity were used to study SDH expression regulation by ABA, salt and osmotic stress. SDH-overexpression lines of Arabidopsis were used to investigate the role of SDH in salt and osmotic stress, and ABA response. Arabidopsis SDH was predominantly expressed in source organs such as green cotyledons, fully expanded leaves and sepals, especially in vascular tissues of theses organs. SDH expression was inhibited by NaCl and mannitol treatments. Seed germination and post-germination growth of SDH-overexpressing lines exhibited decreased sensitivity to salt and osmotic stress compared to WT plants. The transcript of SDH was induced by ABA. Overexpression of SDH decreased sensitivity to ABA during seed germination and post-germination growth. Expression of AAO3 increased but ABI5 and MYB2 decreased in SDH-overexpressing lines after ABA treatment. This study demonstrates that expression of SDH is regulated by ABA, salt and osmotic stress. SDH functions in plant tolerance to salt and osmotic stress, and ABA response via specific regulating gene expression of ABA synthesis and signalling in Arabidopsis.
Atomic packing of three Fe-based metallic glasses (MGs) has been studied by X-ray diffraction and X-ray absorption fine structure, combining with reverse Monte Carlo (RMC) and ab initio molecular ...dynamics (AIMD) simulations. It is found that the addition of Y and Nb atoms to the binary Fe–B MG mainly stabilizes large high-coordinated polyhedra by substituting the center Fe atoms, promoting the formation of icosahedron-like clusters and their connectivity with high-coordinated polyhedra. Moreover, the heterogeneities in local structures are found to increase due to element segregations of Fe, Y and Nb atoms. The obtained results indicate that the large-sized Y and Nb atoms can frustrate the geometry of competing crystalline phases and improve the atomic packing efficiency, therefore leading to the enhanced glass forming ability.
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One of the critical challenges for long pulse operation of ITER and future fusion reactors is the excessively high heat and particle fluxes on the divertor targets. The divertor detachment offers an ...effective way for the control of steady state heat flux and erosion at the divertor target. Dedicated experiments have been systematically performed for both H-mode and L-mode plasmas on EAST with ITER-like W divertor in the last two years to further advance detachment physics understanding. The detachment is identified by the rollover of divertor peak particle flux near the strike point during the density ramping up, which correlates with the reduction of electron temperature down to 5 eV, the increase of Dδ/Dα ratio and radiated power. It has been demonstrated that the more closed divertor has a lower density threshold at the onset of detachment on EAST. Furthermore, the detachment density threshold will be reduced when the strike point moves towards the divertor corner. The onset of detachment exhibits a strong asymmetry between inner and outer targets, with the inner target accessing detachment at lower density due to the lower electron temperature, as expected. The effects of the heating power and plasma current on the detachment onset were also investigated. The experimental results show that the density at detachment onset is lower in L-mode relative to H-mode, and increases with the heating power. The detachment density threshold normalized to the Greenwald density limit is lower at a high plasma current.
Synchrotron x-ray diffraction reveals a pressure induced crystallization at about 3.4 GPa and a polymorphic transition near 10.3 GPa when compressed a liquid GaIn eutectic alloy up to ~13 GPa at room ...temperature in a diamond anvil cell. Upon decompression, the high pressure crystalline phase remains almost unchanged until it transforms to the liquid state at around 2.3 GPa. The ab initio molecular dynamics calculations can reproduce the low pressure crystallization and give some hints on the understanding of the transition between the liquid and the crystalline phase on the atomic level. The calculated pair correlation function g(r) shows a non-uniform contraction reflected by the different compressibility between the short (1st shell) and the intermediate (2nd to 4th shells). It is concluded that the pressure-induced liquid-crystalline phase transformation likely arises from the changes in local atomic packing of the nearest neighbors as well as electronic structures at the transition pressure.
The secondary β-relaxation is an intrinsic feature in glassy materials. However, its structural origin is still not well understood. Here we report that the β-relaxations in La50Al15Ni35 and ...La50Al15Cu35 metallic glasses (MGs) mainly depend on the vibration of small Ni and Cu atoms in local cages. By using advanced synchrotron X-ray techniques and theoretical calculations, we elucidate that the tricapped-trigonal-prism-like polyhedra with more large La atoms in shells favor the local vibration of center Ni atoms, leading to the pronounced β-relaxation event. In contrast, the in-cage vibration of Cu atoms is somehow suppressed by the appearance of more shell Cu atoms. Nevertheless, they could easily diffuse out of the cages compared with Ni, thus triggering the onset of α-relaxation. This work provides a pathway to understand the different structural relaxation behaviors in MGs and other disordered materials from their local atomic packing and dynamics points of view.
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