Efficacy and safety of intravenous tranexamic acid in total shoulder arthroplasty:A meta-analysis

BACKGROUND Total shoulder arthroplasty(TSA)results in a large amount of perioperative blood loss due to severe trauma.AIM To investigate the safety and efficacy of intravenous tranexamic acid(TXA)in TSA.METHODS We searched the PubMed,Cochrane Library,Embase and Web of Science databases for randomized controlled trials(RCTs)on the use of TXA in TSA.And all the results were checked and assessed by Reference Citation Analysis(https://www.referencecitationanalysis.com/).A meta-analysis was performed with Review Manager 5.3 to calculate the odds ratio(OR)or weighted mean difference(WMD)of related outcome indicators.RESULTS A total of 5 RCTs with level 1 evidence were included.There were 369 cases,with 186 in the TXA group and 183 in the placebo group.The meta-analysis showed that TXA can significantly reduce total blood loss during the perioperative period[WMD=-249.56,95%confidence interval(CI):-347.6 to-151.52,P<0.0001],and the incidence of adverse reactions was low(OR=0.36,95%CI:0.16-0.83,P=0.02).Compared with the placebo group,the TXA group had significantly less total haemoglobin loss(WMD=-34.39,95%CI:-50.56 to-18.22),less haemoglobin fluctuation before and after the operation(WMD=-0.6,95%CI:-0.93 to-0.27)and less 24-h drain output(WMD=-136.87,95%CI:-165.87 to-106.49).There were no significant differences in the operation time(P=0.11)or hospital length of stay(P=0.30)between the two groups.CONCLUSION The application of intravenous TXA in the perioperative period of TSA can significantly reduce the total volume of perioperative blood loss and reduce the incidence of adverse reactions,so TXA is worthy of widespread clinical use.

Evaluation of the diagnostic value of total bile acids/platelets in HBV related liver fibrosis

Objective:Explore the diagnostic value of total bile acids/platelets in HBV related liver fibrosis.Methods:160 patients with chronic HBV infection admitted to the Infection Department of the First Affiliated Hospital of Hainan Medical College from February 2021 to December 2022 were selected.They were divided into two groups based on the degree of liver fibrosis detected by liver biopsy:significant liver fibrosis group and non-significant liver fibrosis group.The total bile acid/blood platelet levels and their correlation with liver fibrosis in the two groups were compared and observed,and the efficacy of other non-invasive liver fibrosis diagnostic models was evaluated.Results:(1)Compared with the non-significant liver fibrosis group,the significant liver fibrosis group showed an increase in total bile acid levels,a decrease in platelet levels,and a significant increase in total bile acid/platelet levels(P<0.05).(2)Platelets decrease with the increase of liver fibrosis degree,total bile acids increase with the increase of liver fibrosis degree,and total bile acids/platelets increase with the increase of liver fibrosis degree.(3)The area under the curve(AUC)of total bile acid/platelet,APRI,FIB-4,and elastography in diagnosing the degree of liver fibrosis were 0.69,0.57,0.56,and 0.68,respectively.Conclusions:The diagnostic efficacy of total bile acids/platelets in diagnosing HBV related liver fibrosis is no less than that of other liver fibrosis diagnostic methods,and it is non-invasive,simple,and convenient,which is worthy of further clinical promotion and validation.

Effect of Wheat Based Diet Supplemented with Xylanase on Blood Sugar and Total Protein in Serum of Geese

[Objective] The effects of wheat based diet supplemented with xylanase on blood sugar and total protein in serum of geese were studied. [ Method ] By using the randomized design of single factor, the 1-day-old healthy goslings were divided into 6 groups and fed with corn based diet, wheat based diet and wheat based diet supplemented with xylanase at different concentrations respectively, the contents of blood sugar and total protein in serum were determined. [ Result] The wheat based diet supplemented with xylanase could increase the blood sugar and total protein in serum of geese and wheat based diet supplemented with 0.2% xylanase generated the best effect, which was higher than those of corn based diet group. As for the concentration of protein in serum, wheat based diet supplemented with 0.2% xylanase was significantly different from corn based diet and wheat based diet. [ Conclusion] The wheat based diet supplemented with xylanase could enhance geese production.

Analysis of moisture and total sugar content of Huizao based on surface images

Moisture and total sugar content are two important internal qualities of Huizao.In order to explore their correlation with external qualities,a novel method of moisture and total sugar content analysis was proposed based on surface images.Firstly,five geometric features and seven texture features of Huizao were obtained to be the external quality indexes by digital image processing technology.Secondly,the wrinkle degree as an important index was extracted by marked watershed segmentation algorithm.According to the external quality the Huizao samples were grouped,and the moisture and total sugar content were determined through physical and chemical methods.Lastly,the moisture and total sugar content and twelve external indexes were all processed by step discriminatory analysis.Meanwhile,the regression models of moisture content with short diameter,contrast,and wrinkle degree and total sugar with wrinkle degree were established.The coefficients of the model were 0.9992 and 0.9978 respectively,and all the significance was less than 0.01,which show that the regression equation and regression coefficient effect are highly significant.The results indicate that the moisture and total sugar content of Huizao are greatly correlated with the wrinkle degree.The moisture and total sugar content are the highest when the wrinkle degree is at 2 to 3 grade,and they decrease gradually with the wrinkle degree increasing.Moisture content shows positive correlation with the size of Huizao.The results of model analysis agree well with the experimental results,which can provide valuable reference for improving Huizao grade diversity.

Relationship of nocturnal concentrations of melatonin, gamma-aminobutyric acid and total antioxidants in peripheral blood with insomnia after stroke： study protocol for a prospective non-randomized controlled trial

Melatonin and gamma-aminobutyric acid（GABA） have been shown to regulate sleep. The nocturnal concentrations of melatonin, GABA and total antioxidants may relate to insomnia in stroke patients. In this prospective single-center non-randomized controlled clinical trial performed in the China Rehabilitation Research Center, we analyzed the relationship of nocturnal concentrations of melatonin, GABA and total antioxidants with insomnia after stroke. Patients during rehabilitation of stroke were recruited and assigned to the insomnia group or non-insomnia group. Simultaneously, persons without stroke or insomnia served as normal controls. Each group contained 25 cases. The primary outcome was nocturnal concentrations of melatonin, GABA and total antioxidants in peripheral blood. The secondary outcomes were Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Fatigue Severity Scale, Morningness-Eveningness Questionnaire（Chinese version）, and National Institute of Health Stroke Scale. The relationship of nocturnal concentrations of melatonin, GABA and total antioxidants with insomnia after stroke was analyzed and showed that they were lower in the insomnia group than in the non-insomnia group. The severity of stroke was higher in the insomnia group than in the non-insomnia group. Correlation analysis demonstrated that the nocturnal concentrations of melatonin and GABA were associated with insomnia after stroke. This trial was registered at Clinical Trials.gov, identifier： NCT03202121.

Effect of lactic acid bacteria and propionic acid on conservation characteristics,aerobic stability and in vitro gas production kinetics and digestibility of whole-crop corn based total mixed ration silage

This study was conducted to evaluate the effect of lactic acid bacteria and propionic acid on the fermentation quality, aer- obic stability and in vitro gas production kinetics and digestibility of whole-crop corn based totalmixed ration （TMR） silage. Total mixed ration was ensiled with four treatments： （1） no additives （control）; （2） an inoculant （Lactobacillus plantarum） （L）; （3） propionicacid （P）; （4） propionic acid＋lactic acid bacteria （PL）. All treatments were ensiled in laboratory-scale silos for 45 days, and then subjected to an aerobic stability test for12 days. Further, four TMR silages were incubated in vitro with buffered rumen fluid to study in vitro gas production kinetics and digestibility. The results indicated that all TMR silages had good fermentation characteristics with low pH （〈3.80） and ammonia nitrogen （NH3-N） contents, and high lactic acid contents as well as Flieg points. Addition of L further improved TMR silage quality with more lactic acid production. Addition of P and PL decreased lactic acid and NH3-N contents of TMR silage compared to the control （P〈0.05）. After 12 days aerobic exposure, P and PL silages remained stable, but L and the control silages deteriorated as indicated by a reduction in lactic acid and an increase in pH, and numbers of yeast. Compared to the control, addition of L had no effects on TMR silage in terms of 72 h cumulative gas production, in vitro dry matter digestibility, metabolizable energy, net energy for lactation and short chain fatty acids, whereas addition of PL significantly （P〈0.05） increased them. L silage had higher （P〈0.05） in vitro neutral detergent fiber digestibility than the control silage. The results of our study suggested that TMR silage prepared with whole-crop corn can be well preserved with or without additives. Furthermore, the findings of this study suggested that propionic acid is compatible with lactic acid bacteria inoculants, and when used together, although they reduced lactic acid production of TMR silage, they improved aerobic stability and in vitro nutrients digestibility of TMR silage.

Can tranexamic acid change preoperative anemia management during total joint arthroplasty?

AIM: To investigate the postoperative transfusion and complication rates of anemic and nonanemic total joint arthroplasty patients given tranexamic acid(TXA).METHODS: A cross-sectional prospective study was conducted of primary hip and knee arthroplasty cases performed from 11/2012 to 6/2014. Exclusion criteria included revision arthroplasty, bilateral arthroplasty, acute arthroplasty after fracture, and contraindication to TXA. Patients were screened prior to surgery, with anemia was defined as hemoglobin of less than 12 g/d L for females and of less than 13 g/d L for males. Patients were divided into four different groups, based on the type of arthroplasty(total hip or total knee) and hemoglobin status(anemic or nonanemic). Intraoperatively, all patients received 2 g of intravenous TXA during surgery. Postoperatively, allogeneic blood transfusion(ABT) was directed by both clinical symptomsand relative hemoglobin change. Complications were recorded within the first two weeks after surgery and included thromboembolism, infection, and wound breakdown. The differences in transfusion and complication rates, as well as the relative hemoglobin change, were compared between anemic and nonanemic groups.RESULTS: A total of 232 patients undergoing primary joint arthroplasty were included in the study. For the total hip arthroplasty cohort, 21%(18/84) of patients presented with preoperative anemia. Two patients in the anemic group and two patients in the nonanemic group needed ABTs; this was not significantly different(P = 0.20). One patient in the anemic group presented with a deep venous thromboembolism while no patients in the nonanemic group had an acute complication; this was not significantly different(P = 0.21). For nonanemic patients, the average change in hemoglobin was 2.73 ± 1.17 g/d L. For anemic patients, the average change in hemoglobin was 2.28 ± 0.96 g/d L. Between the two groups, the hemoglobin difference of 0.45 g/d L was not significant(P = 0.13). For the total knee arthroplasty cohort, 18%(26/148) of patients presented with preoperative anemia. No patients in either group required a blood transfusion or had an acute postoperative complication. For nonanemic patients, the average change in hemoglobin was 1.85 ± 0.79 g/d L. For anemic patients, the average change in hemoglobin was 1.09 ± 0.58 g/d L. Between the two groups, the hemoglobin difference of 0.76 g/d L was significant(P < 0.001). CONCLUSION: TXA administration results in low transfusion and complication rates and may be a useful adjunct for TJA patients with preoperative anemia.

EFFECTS OF HARVEST STAGE ON THE TOTAL LIPID AND FATTY ACID COMPOSITION OF FOUR CYLINDROTHECA STRAINS

Four strains of Cylindrotheca (B156, B164, B196, and B200) were harvested at three phases in the growth curve and their total lipid and fatty acid composition were determined. Total lipid reached highest values in the late stationary phase in B156 (24.0%), B164 (26.6%) and B200 (17.3%), in the exponential phase in B196 (15.5%). Saturated fatty acids increased with the development of the culture in B156 and B196, and reached their highest values in the late stationary phase in B156 (41.7%) and B196 (45.1%), in the early stationary phase in B164 (45.4%) and B200 (37.6%). Monounsaturated fatty acids increased with the development of the culture in B196 and B200, and reached their highest values in the late stationary phase in B196 (32.4%) and B200 (32.8%), in the early stationary phase in B164 (31.0%) and in the exponential phase in B156 (29.3%). Polyunsaturated fatty acids decreased in the later phases of the culture in B164, B196 and B200, and peaked in the exponential phase in B164 (29.5%), B196 (42.9%) and B200 (37.3%), and in the early stationary phase in B156 (32.0%).

TOTAL LIPID AND FATTY ACID COMPOSITION OF EIGHT STRAINS OF MARINE DIATOMS

Fatty acid composition and total lipid content of 8 strains of marine diatoms ( Nitzschia frustrula, Nitzschia closterium, Nitzschia incerta, Navicula pelliculosa,Phaeodactylum tricornutum, Synedra fragilaroides ) were examined. The microalgae were grown under defined conditions and harvested at the late exponential phase. The major fatty acids in most strains were 14:0 (1.0%-6.3%), 16:0 (13.5%-26.4%), 16:1n-7 (21.1%-46.3%) and 20:5n-3 (6.5%-19.5%). The polyunsaturated fatty acids 16:2n-4, 16:3n-4, 16:4n-1 and 20:4n-6 also comprised a significant proportion of the total fatty acids in some strains. The characteristic fatty acid composition of diatoms is readily distinguishable from those of other microalgal groups. Significant concentration of the polyunsaturated fatty acid 20:5n-3 (eicosapentaenoic acid) was present in each strain, with the highest proportion in B222 (19.5%).

EFFECT OF LIGHT INTENSITY ON THE TOTAL LIPID AND FATTY ACID COMPOSITION OF SIX STRAINS OF MARINE DIATOMS

The effect of light intensity (1500 lx and 5000 lx) on the total lipid and fatty acid composition of six strains of marine diatoms Cylindrotheca fusiformis (B211), Phaeodactylum tricornutum (B114, B118 and B221) Nitzschia closterium (B222) and Chaetoceros gracilis (B13) was investigated. The total lipids of B13, B114, and B211 grown at 5000 lx were lower than those grown at 1500 lx. No evident changes were observed in B118, B221 and B222. Fatty acid composition changed considerably at different light intensity although no consistent correlation between the relative proportion of a single FA and light intensity. The major fatty acids of the 6 strains were 14:0, 16:0, 16:1(n-7) and 20:5(n-3). Cylindrotheca fusiformis had high percentage of 20:4n-6 (9.2-10.9%). The total polyunsaturated fatty acid in all 6 strains decreased with increasing light intensity. The percentage of the highly unsaturated fatty acid eicosapentaenoic acid (EPA) decreased with increasing light intensity in all strains except Chaetoceros gracilis.

Total DNA of Glycyrrhiza uralensis transformed into Hansenula anomala by ion implantation:Preparing Glycyrrhizic acid in recombined yeasts

Glycyrrhizic acid(GA) in Glycyrrhiza uralensis(G.uralensis) is physiologically active.In this study,the total DNA of wild G.uralensis was randomly transformed into Hansenula anomala by implantation of low-energy Ar^+ and N^+,to produce five recombinant yeast strains relating to biological synthesis of the GA or Glycyrrhetinic acid (GAs).After culturing in liquid medium for 96 h,the resultant GA,18α-GAs and 18β-Gas were determined by reversed-phase high performance liquid chromatography(RP-HPLC),and the corresponding concentrations were 114.49,0.56,and 0.81 mg·L^(-1).After one hundred primers were analyzed with random amplified polymorphic DNA (RAPD),the seven different DNA fragments were produced by the N7059 strain of recombined yeasts,and,the polymerase chain reaction(PCR) verified that one of them came from the genome of G.uralensis,indicating a successful transfer of genetic information by ion implantation.

Optimization of Extraction Process of Total Flavonoids and Chlorogenic Acid from Flos Lonicerae by Orthogonal Experiment

[Objectives]To explore the process of simultaneous extracting total flavonoids and chlorogenic acid from Flos Lonicerae by pressure assisted extraction.[Methods]Based on the single factor experiment,orthogonal experiments were carried out to investigate the effects of solvent concentration,solid-to-liquid ratio,extraction pressure,extraction time and extraction temperature on the extraction rate of total flavonoids and chlorogenic acid.[Results]The results showed that the extraction pressure had a significant effect on the extraction of two kinds of chemical constituents from F.Lonicerae.The optimum process conditions were as follows:solvent concentration was 60%,solid-liquid ratio was 1∶20(g/mL),extraction pressure was 2 MPa,extraction time was 30 min,extraction temperature was 70℃.The process conditions are stable,and the extraction efficiency is higher than that of ultrasonic assisted extraction method.Under the test conditions,the extraction rates of total flavonoids and chlorogenic acids were respectively 15.66%and 3.89%.[Conclusions]This study provides a new theoretical basis for the development and utilization of F.Lonicerae.

Effect of Citric Acid on the Total Monomeric Anthocyanins and Antioxidant Activity of Liquor Made from Unprocessed Purple Leafed TRFK 306 Kenyan Tea Clone

A study was conducted to find out the effect of citric acid on total monomeric anthocyanins and antioxidant activity of liquor made from unprocessed purple-leafed TRFK 306 Kenyan tea, brewed at various time/temperature combinations. Most purple tea consumers usually brew the tea leaves then add some lemon juice before consuming it. Citric acid was used here to mimic the use of lemon juice. Documentation on the quality of such a brew is scanty and the effect of acid on its quality is equally scanty. The current study used brewing time/temperature combinations of 5, 10 and 15 minutes with 70&deg;C and 92&deg;C drinking water. Total monomeric anthocyanins were analysed using UV-1800 spectrophotometer (Shimadzu, Japan) while DDPH method was used to assay for antioxidant activity. Citric acid concentration of 0, 0.1% to 0.5% was used to check their effect on the brews with the highest total anthocyanins and antioxidant activity. The results showed that brewing temperature of 70&deg;C had 9.5 mg/L to 27.7 mg/L, with 5 minutes brewing time being the highest. Temperature of 92&deg;C had 37.5 mg/L to 92 mg/L with 5 minutes brewing time having the highest total monomeric anthocyanins. Antioxidant activity of 92&deg;C brewing temperature ranged from 90.7% to 92.0%. Total monomeric anthocyanins increased with increased citric acid concentration up to 0.3% before it decreases while for antioxidant activity, it decreased with addition of citric acid. It was concluded that for maximum anthocyanins extraction, 5 minutes brewing time is the best while ten minutes brewing time could give optimum antioxidant activity.

Total Synthesis of (-)-Baimuxifuranic Acid

The first total synthesis of (-)-baimuxifuranic acid (1) starting from (-)-carvone has been described. In our studies a surprising allylic oxidation was found in the oxidation of alpha beta-unsaturated aldehyde 5 with silver oxide.

SYNTHESIS AND CHARACTERIZATION OF 2-(2-HYDROXY-3,5-DINITROPHENYLAZO)-7-(4-CHLORO-PHOSPHONPHENYLAZO)-1, 8-DIHYDROXY-NAPHTHALENE-3, 6-DISULF-ONIC ACID (CPAP) AS NEW REAGENT FOR DETERMINATION OF TOTAL PARE EARTHS

This paper reports the synthesis and general properties of the new reagent CPFP. Its dissociation constants have been determined. The characterization in determinating total RE with CPAP reagent has been investigated in detail. Analytic data for synthetic sample are satisfactory.

TOTAL SYNTHESIS OF(-)-3-OXOEUDESMA-1,4,11(13)-TRIEN-7αH-12-OIC ACID

The first total synthesis of(-)-3-oxoeudesma-1,4,11(13)-trien-7αH-12-oic acid 1 has been described.The key step is one-pot reaction involving dehydrogenation and allylic oxidation with selenium dioxide.

Total Synthesis of Gonioflufurone using L-(+)-orD-(-)-tartaric acid as Starting Material

The group of styrylactones isolated from the trees of genus Goniothalamus, has the particular features of the five or six-membered lactone skeleton bearing polyhydroxyl group. A number of novel styryl lactone were found to show moderate to sighficant cytotokicities against several human tumors.Among them, Goniofufurone has been reported by several synthetic studies on the synthesis of it. Herein, we report our study on the synthesis of goniofuforone from the commercially available optical tartaric acid using the addition of ethyl propialate to the intermediate aldehyde as the key step. The synthetic route is as following:

Study on the Total Synthesis of 3-Oxo-9β-Acetoxyilicic Acid─The Synthesis of 9β-Acetoxy-3(4),11(13)-Dien-5αH,7αH-12-Eudesmanoic Acid Methyl Ester

The synthesis of 99-acetoxy-3(4), 11(13)-dien-5αH 7αH-12-eudesmanoic acid methyl ester (2) was achieved from oxycarvone. The key step is the p-toluenesulfonhydrazide assisted reductiv rearrangement reaction

Cold Acclimation-Induced Changes in Total Soluble Protein, RNA, DNA, RNase and Freezing Resistance in Populus tomentosa Cuttings

The changes in the contents of total soluble protein and RNA, the activity of RNase in leaves and branches of Populus tomentosa cuttings at various periods (viz: cold acclimation, deacclimation, chilling stress and the recovery after chilling stress), and the survival rate and the freezing resistance of cuttings during cold acclimation at -3℃ were investigated. Results showed that cold acclimation not only increased the contents of total soluble protein and RNA, the survival rates and the freezing resistance of cuttings, decreased the activity of RNase, but also reduced the declining degree of total soluble protein and RNA contents, and the increasing level of RNase caused by chilling stress as compared with the controls. In addition, cold acclimation augmented the increase in the level of total soluble protein and RNA, and facilitated the decrease of RNase during the recovery periods. Further analysis found that the DNA content of all treatments kept relative stability at various periods. The changes in total soluble protein, RNA and RNase were closely related to the freezing resistance of cuttings. It appears that the increase of RNA content caused by cold acclimation induced decrease of RNase activity may be involved in the accumulation of total soluble protein and the induction of freezing resistance of cuttings.

Perioperative blood management strategies for patients undergoing total knee replacement:Where do we stand now?

Total knee replacement(TKR) is one of the most common surgeries over the last decade. Patients undergoing TKR are at high risk for postoperative anemia and furthermore for allogeneic blood transfusions(ABT). Complications associated with ABT including chills, rigor, fever, dyspnea, light-headedness should be early recognized in order to lead to a better prognosis. Therefore, perioperative blood management program should be adopted with main aim to reduce the risk of blood transfusion while maximizing hemoglobin simultaneously. Many blood conservation strategies have been attempted including preoperative autologous blood donation, acute normovolemic haemodilution, autologous blood transfusion, intraoperative cell saver, drain clamping, pneumatic tourniquet application, and the use of tranexamic acid. For practical and clinical reasons we will try to classify these strategies in three main stages/pillars: Pre-operative optimization, intra-operative and post-operative protocols. The aim of this work is review the strategies currently in use and reports our experience regarding the perioperative blood management strategies in TKR.