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.
Summary Objective Disruptions of extracellular matrix (ECM) homeostasis are key events in the pathogenesis of osteoarthritis (OA). MicroRNA-140 (miRNA-140) is expressed specifically in cartilage and ...regulates ECM-degrading enzymes. Our objective in this study was to determine if intra-articular injection of miRNA-140 can attenuate OA progression in rats. Design miRNA-140 levels in human normal and OA cartilage derived chondrocytes and synovial fluid were assessed by polymerase chain reaction (PCR). After primary human chondrocytes were transfected with miRNA-140 mimic or inhibitor, PCR and western blotting were performed to quantify Collagen II, MMP-13, and ADAMTS-5 expression. An OA model was induced surgically in rats, and subsequently treated with one single intra-articular injection of miRNA-140 agomir. At 4, 8, and 12 weeks after surgery, OA progression were evaluated macroscopically, histologically, and immunohistochemically in these rats. Results miRNA-140 levels were significantly reduced in human OA cartilage derived chondrocytes and synovial fluid compared with normal chondrocytes and synovial fluid. Overexpressing miRNA-140 in primary human chondrocytes promoted Collagen II expression and inhibited MMP-13 and ADAMTS-5 expression. miRNA-140 levels in rat cartilage were significantly higher in the miRNA-140 agomir group than in the control group. Moreover, behavioural scores, chondrocyte numbers, cartilage thickness and Collagen II expression levels in cartilage were significantly higher, while pathological scores and MMP-13 and ADAMTS-5 expression levels were significantly lower in the miRNA-140 agomir group than in the control group. Conclusion Intra-articular injection of miRNA-140 can alleviate OA progression by modulating ECM homeostasis in rats, and may have potential as a new therapy for OA.
•Alkaline exchange membrane direct formate fuel cell (AEM DFFC) has been proposed.•The peak power density of the AEM DFFC is as high as 250mWcm−2 at 80°C.•The high performance is attributed to the ...use of the Pd/C catalyst and QAPSF membrane.•The operating stability is verified with a constant current discharge at 100mAcm−2.
This paper reports on a single alkaline exchange membrane direct formate fuel cell (AEM DFFC) consisting of a carbon-supported palladium catalyst at the anode, a quaternized polysulfone membrane, and a non-precious Fe–Co catalyst at the cathode. It is demonstrated that the AEM DFFC yields a peak power density of 130mWcm−2 with 5M potassium formate (HCOOK) at 80°C. It is further shown that with the addition of KOH to the anolyte, the peak power density rises to as high as 250mWcm−2 at the same operating temperature. In addition, the AEM DFFC was also tested at 100mAcm−2 for more than 130h and no significant degradation in performance is found. The results reported in this work suggest that formate salt (HCOOM, M+=Na+ or K+) is a potential fuel for alkaline-type direct liquid fuel cells.
Seventy-two barrows (Landrace x Large White, initial BW of 4.9 ± 0.3 kg and 17 ± 3 d old) were used to determine if dietary chito-oligosaccharides can replace antibiotics as a means to reduce signs ...associated with infection in weaned pigs challenged with Escherichia coli. Pigs were assigned to 1 of 4 treatments in a randomized complete block design using 6 pens per treatment with 3 pigs per pen. The treatments consisted of pigs fed the unsupplemented corn-soybean meal diet challenged or unchallenged with E. coli K88 and pigs fed the same diet supplemented with 160 mg of chito-oligosaccharides or 100 mg of cyadox/kg and challenged with E. coli K88. On d 7, 1 group of pigs fed the unsupplemented diet, as well as all pigs fed diets containing chito-oligosaccharides or cyadox, were orally dosed with 30 mL of an alkaline broth containing E. coli K88. Another group of pigs fed the unsupplemented diet was orally dosed with 30 mL of sterilized alkaline broth. Fecal consistency was visually assessed each morning from d 7 to 14. Blood samples were collected at 0, 24, 48, and 168 h postinfection. On d 14 postchallenge, all pigs were killed to evaluate intestinal morphology and determine E. coli concentrations in the intestine. During the postchallenge period (wk 2), unsupplemented pigs challenged with E. coli had decreased (P < 0.05) BW gain, feed intake, fecal consistency, villus height, villus height:crypt depth ratio, and plasma IGF-1, and increased (P < 0.05) diarrhea incidence, E. coli counts in the intestine, plasma interleukin-1β, plasma IL-10, and IGA-positive cells in the jejunal and ileal lamina propria, compared with unchallenged pigs. Supplementation with cyadox largely mitigated these effects. Although chito-oligosaccharide reduced the incidence of diarrhea, the growth performance of E. coli-challenged pigs supplemented with chito-oligosaccharide was not better than that of unsupplemented pigs challenged with E. coli. Therefore, chito-oligosaccharide, at the amount used in this experiment, does not seem to be an effective substitute for antibiotics as a growth promoter for newly weaned pigs challenged with E. coli.
Temporal and spatial changes to the water quality of Dianchi Lake in southwest China were investigated using monthly monitoring data from 2005 to 2012. Dianchi Lake is divided into two parts, Caohai ...Lake and Waihai Lake, by a man-made dike. Caohai Lake lies at the north of Dianchi Lake, while Waihai Lake is the main water body of Dianchi Lake and accounts for 96.7% of the whole area of the lake. Based on the analysis of total phosphorus (TP), total nitrogen (TN), and chlorophyll a (Chl a) concentrations, it was determined that, in Caohai Lake, the annual concentrations of these variables ranged from 0.19-1.46 mg L super(-1), 6.11-16.79 mg L super(-1), 0.06-0.14 mg L super(-1), respectively. In addition, the annual concentrations of TP, TN and Chl a in Waihai Lake ranged between 0.13 and 0.20 mg L super(-1), 1.82 and 3.01 mg L super(-1), and 0.04 and 0.09 mg L super(-1), respectively. Cluster analysis (CA) classified the 10 monitoring sites into two clusters (cluster A and cluster B) based on similarities of water quality characteristics. Our data revealed that the current status of water quality within Caohai Lake was much worse than that of Waihai Lake. Water quality was seriously degraded during the economic boom near the period of the "Eleventh Five-Year Plan" (2005-2010), and gradually improved from 2010 to 2012 because of the "standard emission directive to industry". The main factors that influenced the spatial and temporal changes to water quality were natural factors including lake evolution and regional characteristic as well as human factors such as pollution load into the lake and management strategies that were already adopted. Some activities and regulations were implemented to enhance the lake environment by controlling wastewater emissions and establishing regulations to protect the lakes in the Yunnan Province. However, problems with institutional fragmentation (horizontal and vertical), simple treatment methods, low-intensity investment in pollution control, and lack of meaningful endogenous pollution control strategies were still present in the lake management strategy. To solve these problems, suitable control measures are needed, especially considering the current old-age status of Dianchi Lake. The fundamental improvement of the water quality within Caohai Lake was dependent on the measures taken in the upper reaches of the Caohai Watershed, including further recovery of submerged plants, resource utilization by floating plants and the reinforcement of sediment disposal. Management strategies for endogenous pollution in Waihai Lake were mainly dependent on restocking algae-eating fish and the ecological restoration of macrophytes. In this way, the swamping trend and the ageing process that is occurring in Dianchi Lake can be stunted. And the management strategies would be a contribution to the management of water conflicts between mankind and ecosystems in similar lakes.
Reliable noninvasive methods are needed to identify endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) to facilitate personalized therapy. Previous computed tomography (CT) scoring system ...has limited and inconsistent performance in identifying eosinophilic CRSwNP. We aimed to develop and validate a radiomics-based model to identify eosinophilic CRSwNP.
Surgical patients with CRSwNP were recruited from Tongji Hospital and randomly divided into training (n = 232) and internal validation cohort (n = 61). Patients from two additional hospitals served as external validation cohort-1 (n = 84) and cohort-2 (n = 54), respectively. Data were collected from October 2013 to May 2021. Eosinophilic CRSwNP was determined by histological criterion. The least absolute shrinkage and selection operator and the logistic regression (LR) algorithm were used to develop a radiomics model. Univariate and multivariate LR were employed to build models based on CT scores, clinical characteristics, and the combination of radiological and clinical characteristics. Model performance was evaluated by assessing discrimination, calibration, and clinical utility.
The radiomics model based on 10 radiomic features achieved an area under the curve (AUC) of 0.815 in the training cohort, significantly better than the CT score model based on ethmoid-to-maxillary sinus score ratio with an AUC of 0.655. The combination of radiomic features and blood eosinophil count had a further improved performance, achieving an AUC of 0.903. The performance of these models was confirmed in all validation cohorts with satisfying predictive calibration and clinical application value.
A CT radiomics-based model is promising to identify eosinophilic CRSwNP. This radiomics-based method may provide novel insights in solving other clinical concerns, such as guiding personalized treatment and predicting prognosis in patients with CRSwNP.
Cf/C–TaC composites, which possesses excellent anti-ablation properties, are potential candidate materials for applications in the extreme environments associated with hypersonic flight and rocket ...propulsion. In this paper, Cf/C–TaC0.89 composites were prepared by chemical vapor infiltration to achieve a TaC matrix with a C/Ta atomic ratio of 0.89. The isothermal oxidation behavior of the composites at 1200–1600 °C was investigated, and the minimum time for the self-healing of microcracks on the composite surface was calculated based on the oxidation process obeying either a parabolic or a linear law. The results indicate that the oxidation process is controlled by surface kinetics in the initial 0–10 min at 1200–1400 °C and 0~5 min at 1500–1600 °C even if a dense oxide layer is formed. After that, the controlling mechanism becomes the diffusion of oxidative gases in a TaCxOy layer, a diffusion barrier layer existed in the oxidation of refractory carbides. The formation of the TaCxOy layer is attributed to the low C/TaC ratio of the TaC0.89 phase and the diffusion behavior of O atoms in Ta octahedral interstitial sites.
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•TaC with a C/Ta atomic ratio of 0.89 were deposited in Cf/C–TaC0.89 composites by CVI.•Oxidation behavior of the composites at 1200–1600 °C was investigated.•The self-healing behavior of microcracks in the composites was analyzed.•The effect and formation mechanism of a diffusion barrier layer of TaCxOy layer were discussed.
Two experiments were conducted to evaluate the efficacy of feeding an Escherichia coli (E. coli) derived phytase to pigs fed P deficient, corn-soybean meal diets. In Exp. 1, one hundred and twenty ...crossbred piglets (9.53±0.84 kg) were allocated to one of five treatments which consisted of four low P diets (0.61% Ca, 0.46% total P and 0.24% non-phytate P) supplemented with 0, 500, 1,000, or 20,000 FTU/kg E. coli phytase as well as a positive control formulated to be adequate in all nutrients (0.77% Ca, 0.62% total P and 0.42% non-phytate P). The treatments were applied to six pens with four pigs per pen for 28 days. In Exp. 2, ten crossbred pigs (19.66±1.16 kg) fitted with ileal T-cannula were used in a nutrient balance study. The pigs were assigned to treatments similar to those used in Exp. 1 in a doubly replicated 5×4 incomplete Latin square design (5 diets with 4 periods). Each period consisted of a 5-d adjustment period followed by a 3-d total collection of feces and urine and then a 2-d collection of ileal digesta. Supplementation with phytase linearly increased (p<0.05) weight gain, feed intake, feed efficiency, bone breaking strength and fat-free dry and ash bone weight. There were linear increases (p<0.01) in the apparent ileal digestibility (AID) of DM, GE, CP, Ca, total P, inositol hexaphosphate (IP6) and some AA with increasing dose of E. coli phytase. Pigs fed 20,000 FTU/kg had a greater (p<0.05) AID of IP6 (80% vs 59% or 64%, respectively) than pigs fed diets with 500 or 1,000 FTU/kg phytase. There were linear increases (p<0.05) in the total tract digestibility of Ca, total P, Na, K, Mg, and Zn as well as in the retention of Mg and Zn with increased phytase dose. The retention and utilization of Cu, and the total tract digestibility of CP and Cu quadratic increased (p<0.05) with increased phytase dose. In conclusion, supplementation of 500 FTU of phytase/kg and above effectively hydrolyzed phytate in low-P corn-soybean diets for pigs. In addition, a super dose of phytase (20,000 FTU/kg) hydrolyzed most of the IP6 and consequently further improved mineral use, protein utilization and performance.
The distance of 6-minute walk test (D6MWT) has been widely used in the assessment of functional status in patients with COPD, while very little attention has been paid to the role of steps of ...6-minute walk test (S6MWT). The purpose of this study was to investigate the relationship between S6MWT and other physiologic parameters of COPD.
Seventy patients with stable COPD were enrolled consecutively in this cross-sectional study. Pulmonary function tests, including spirometry, impulse oscillometry (IOS) and the single-breath diffusing capacity of the lungs for carbon monoxide (DL
), were carried out at rest. Quality of life was assessed by health-related quality of life (HRQoL) questionnaires, including modified Medical Research Council dyspnea scale (mMRC), St George's Respiratory Questionnaire, Chronic Obstructive Pulmonary Disease Assessment Test (CAT) and Clinical Chronic Obstructive Pulmonary Questionnaire. Both steps and distance were measured in the following 6-minute walk test (6MWT).
Both S6MWT and D6MWT showed significant correlation with spirometry, IOS, DL
parameters and HRQoL questionnaires score. Both pre- and post-6MWT inspiratory capacity showed significant correlation with S6MWT (ρ=0.338,
=0.004; ρ=0.359,
=0.002, respectively), whereas did not correlate with D6MWT (ρ=0.145,
=0.230; ρ=0.160,
=0.189, respectively). In stepwise multiple regression analysis, mMRC grade, age and CAT score remained as significant predictors in the final model for D6MWT (adjusted
=0.445,
<0.01). DL
and CAT score remained as significant predictors in the final model for S6MWT (adjusted
=0.417,
<0.01).
S6MWT is efficient in the evaluation of functional status and quality of life in COPD and has significant correlation with various parameters indicating disease severity. Additionally, S6MWT might be better in predicting lung hyperinflation in COPD compared with D6MWT.
ABSTRACT
High variability in amino acid (AA) content and digestibility among sources of distillers dried grains with solubles (DDGS) create challenges for nutritionists when using it in precision ...nutrition feeding programs. The objective of this meta-analysis was to develop prediction equations for standardized ileal digestible content (SIDC) of AA in DDGS for poultry. A meta-analysis based on 86 observations from 19 publications was conducted to develop equations for predicting SIDC of AA based on chemical composition in DDGS. A mixed model was used to develop prediction equations for SIDC of AA, and a backward selection of variables was conducted based on chemical composition of DDGS. Each total AA content was the best predictor of SIDC for all indispensable AA. The prediction equations for SIDC of Met and Lys were y = -0.12 + 1.05 × Met (R2 = 0.899) and y = -0.22 + 0.91 × Lys (R2 = 0.870), respectively. The prediction equations for SIDC of Met and Lys using data from broiler chick assays were y = -0.16 + 1.12 × Met (R2 = 0.809) and y = -0.24 + 0.90 × Lys (R2 = 0.731), respectively, and equations derived from rooster assay data for Met and Lys were y = -0.05 + 0.97 × Met (R2 = 0.996) and y = -0.20 + 0.97 × Lys (R2 = 0.982), respectively. For all the prediction equations, the intercept (=0) and slope (=1) were not different (P > 0.10) between predicted and observed SID AA values, indicating high accuracy of the models. In conclusion, equations for predicting SIDC of AA in DDGS were developed and showed that total concentration of each AA was the best predictor of SDIC. These prediction equations can be used by animal nutritionists to more accurately estimate SIDC of AA among DDGS sources in diet formulations for precision poultry nutrition feeding programs.
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