The effect of triple-dose-intravenous tranexamic acid on blood loss in patients undergoing total hip arthroplasty without affecting blood coagulopathy: A prospective thromboelastographic analysis.

OBJECTIVE: This study aimed to assess the safety and efficacy of triple-dose intravenous tranexamic acid (TXA) in patients following total hip arthroplasty (THA) using thromboelastography (TEG). METHODS: One hundred thirty patients undergoing THA were prospectively enrolled in the study. According to the intravenous infusion TXA dose, patients were divided into single-dose (n=65; mean age=60.8 ± 8.1 years) and triple-dose groups (n=65; mean age=61.8 ± 8.6 years). Complete blood count (CBC), conventional coagulation tests (CCT), and TEG were conducted 1 day before the operation, on postoperative day 1 (POD1), and postoperative day 7 (POD7). Color Doppler ultrasonography was performed 1 day before the operation and on POD7. Drainage blood loss, total blood loss (TBL), hidden blood loss (HBL), deep vein thrombosis (DVT) incidence, and blood transfusion rates were calculated and recorded. The CCT, CBC, and TEG parameters were compared between the 2 groups. RESULTS: Single- and triple-dose groups had significantly different hematocrit on POD7 (P < .05). No significant differences were found in CCT and hemoglobin at any corresponding time point between the 2 groups (P > .05). Despite the reaction time (R) on POD1 (P < .05), there were no significant differences in other TEG parameters at any other time point between the 2 groups (P > 0.05). For drainage blood loss and TBL, the triple-dose group had lesser blood loss than the single-dose group (P < .05). However, no significant differences were found for blood transfusion rate, HBL, or incidence of DVT (P > .05). CONCLUSION: Compared with single-dose, triple-dose TXA can be more effective in decreasing blood loss without increasing DVT incidence in patients undergoing THA. Although there is a notable disparity in the R time on POD1, the administration of triple-dose TXA does not substantially impact the coagulation status as assessed by TEG and CCT.

The Study on the Lasing Modes Modulated by the Dislocation Distribution in the GaN-Based Microrod Cavities.

Low-threshold lasing under pulsed optical pumping is demonstrated in GaN-based microrod cavities at room temperature, which are fabricated on the patterned sapphire substrates (PSS). Because the distribution of threading dislocations (TDs) is different at different locations, a confocal micro-photoluminescence spectroscopy (µ-PL) was performed to analyze the lasing properties of the different diameter microrods at the top of the triangle islands and between the triangle islands of the PSS substrates, respectively. The µ-PL results show that the 2 µm-diameter microrod cavity has a minimum threshold of about 0.3 kW/cm2. Whispering gallery modes (WGMs) in the microrod cavities are investigated by finite-difference time-domain simulation. Combined with the dislocation distribution in the GaN on the PSS substrates, it is found that the distribution of the strongest lasing WGMs always moves to the region with fewer TDs. This work reveals the connection between the lasing modes and the dislocation distribution, and can contribute to the development of low-threshold and high-efficiency GaN-based micro-lasers.

Exploring the correlation of metabolites changes and microbial succession in solid-state fermentation of Sichuan Sun-dried vinegar.

BACKGROUND: The traditional Sichuan Sun-dried vinegar (SSV) with unique flavor and taste is believed to be generated by the solid-state fermentation craft. However, how microorganisms and their metabolites change along with fermentation has not yet been explored. RESULTS: In this study, our results demonstrated that the middle and late stages of SSV fermentation were the periods showing the largest accumulation of organic acids and amino acids. Furthermore, in the bacterial community, the highest average relative abundance was Lactobacillus (ranging from 37.55 to 92.50%) in all fermentation stages, while Acetobacters ranked second position (ranging from 20.15 to 0.55%). The number of culturable lactic acid bacteria is also increased during fermentation process (ranging from 3.93 to 8.31 CFU/g). In fungal community, Alternaria (29.42%), Issatchenkia (37.56%) and Zygosaccharomyces (69.24%) were most abundant in different fermentation stages, respectively. Interestingly, Zygosaccharomyces, Schwanniomyces and Issatchenkia were first noticed as the dominant yeast genera in vinegar fermentation process. Additionally, spearman correlation coefficients exhibited that Lactobacillus, Zygosaccharomyces and Schwanniomyces were significant correlation with most metabolites during the fermentation, implying that these microorganisms might make a significant contribution to the flavor formation of SSV. CONCLUSION: The unique flavor of SSV is mainly produced by the core microorganisms (Lactobacillus, Zygosaccharomyces and Schwanniomyces) during fermentation. This study will provide detailed information related to the structure of microorganism and correlation between changes in metabolites and microbial succession in SSV. And it will be very helpful for proposing a potential approach to monitor the traditional fermentation process.

Preoperative Prevalence and Risk Factors For Calf Muscular Vein Thrombosis in Elderly Patients with Hip Fracture.

OBJECTIVE: Increasing evidence has shown that calf muscular vein thrombosis (CMVT) can develop into proximal deep vein thrombosis, even causing pulmonary embolism. However, opinions about the prevalence and risk factors are still controversial. This study aimed to investigate the prevalence and risk factors for CMVT in elderly patients with hip fractures to facilitate their preoperative management. METHODS: We included 419 elderly patients with hip fracture who were treated in the orthopaedic department of our hospital from June 2017 to December 2020. The patients were divided into CMVT and non-CMVT groups based on color Doppler ultrasound screening of the venous system in the lower extremities. Clinical data, such as age, sex, body mass index, time from injury to admission, and laboratory data were collected. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors for CMVT. A receiver operating characteristic curve was used to analyze the predictive effectiveness of the model. Finally, the clinical utility of the model was analyzed using decision curve analysis and clinical impact curves. RESULTS: The prevalence of preoperative CMVT was 30.5% (128/419). Independent predictors of preoperative CMVT identified by univariate and multivariate logistic regression analyses were sex, time from injury to admission, American Society of Anesthesiologists (ASA) classification, C-reactive protein (CRP) level, and D-dimer level (p < 0.05). The area under curve (AUC) was 0.750 (95% CI: 0.699-0.800, p < 0.001) and the sensitivity and specificity were 0.698 and 0.711, respectively, which meant the prediction model has a good efficacy in the prediction of CMVT risk. In addition, the fitting degree of the prediction model was also good (Hosmer-Lemeshow χ2 = 8.447, p > 0.05). The clinical utility of the model was verified using decision curve analysis and clinical impact curves. CONCLUSION: Sex, time from injury to admission, ASA classification, CRP level, and D-dimer levels are independent preoperative predictors of CMVT in elderly patients with hip fractures. Measures should be taken for patients with these risk factors to prevent the occurrence and deterioration of CMVT.

Prevalence of incidental thyroid abnormalities in patients with degenerative cervical spondylosis: a retrospective cross-sectional magnetic resonance imaging study.

Background: Incidental thyroid abnormalities found on magnetic resonance imaging (MRI) of the neck are not uncommon. This study aimed to investigate the prevalence of incidental thyroid abnormalities in the cervical spine MRI of the degenerative cervical spondylosis (DCS) population indicated for surgery and to identify patients who require additional workup based on the recommendations of the American College of Radiology (ACR). Methods: All consecutive patients with DCS and indications for cervical spine surgery from October 2014 to May 2019 in the Affiliated Hospital of Xuzhou Medical University were reviewed. All MRI scans of the cervical spine routinely include the thyroid. Cervical spine MRI scans were retrospectively evaluated for the prevalence, size, morphologic characteristics, and location of incidental thyroid abnormalities. Results: A total of 1,313 patients were included in the analysis, 98 (7.5%) of whom were found to have incidental thyroid abnormalities. The most frequent thyroid abnormality was thyroid nodules (5.3%), followed by goiters (1.4%). Other thyroid abnormalities included Hashimoto thyroiditis (0.4%) and thyroid cancer (0.5%). There was a statistically significant difference in age and sex between patients with DCS with and without incidental thyroid abnormalities (P=0.018 and P=0.007). Stratified by age, the results showed that the highest incidence of incidental thyroid abnormalities was found in patients aged 71 to 80 years (12.4%). Eighteen patients (1.4%) needed further ultrasound (US) and relevant workups. Conclusions: Incidental thyroid abnormalities are common in cervical MRI, with a prevalence of 7.5% identified in patients with DCS. Incidental thyroid abnormalities are large or have suspicious imaging features, and further evaluation with a dedicated thyroid US examination should be completed before cervical spine surgery is undertaken.

Fermentation of grapefruit peel by an efficient cellulose-degrading strain, (Penicillium YZ-1): Modification, structure and functional properties of soluble dietary fiber.

In the study, a highly efficient cellulose-degrading strain was screened, which was identified as a fungus in the genus Penicillium sp., named YZ-1. The content of soluble dietary fiber was greatly increased by the treatment of this strain. In addition, the effects of soluble dietary fiber from high-pressure cooking group (HG-SDF), strain fermentation group (FG-SDF) and control group (CK-SDF) on the physicochemical structure, and in vitro hypolipidemic activity were investigated. The results showed that the physicochemical structure of the raw materials was improved after fermentation, and FG-SDF exhibited the loosest structure, the highest viscosity and thermal stability. Furthermore, compared to CK-SDF and HG-SDF, FG-SDF showed the most significant improvement in functional properties, including cholesterol adsorption capacity (CAC), inhibition of pancreatic lipase activity (LI) and mixed bile acid adsorption capacity (BBC). Overall, these findings will provide new insights into dietary fiber modification and improve the comprehensive use value of grapefruit by-products.

Intraindividual variance of lower limb rotation in patients with bilateral knee osteoarthritis.

Purpose: To determine the side-to-side difference in intraindividual rotation alignment of patients with bilateral varus-type knee osteoarthritis (OA) and compare it with control subjects. Methods: This retrospective study enrolled 60 patients with bilateral varus-type knee OA and 50 control subjects. All cases underwent bilateral lower limb CT angiography. Bilateral femoral and tibial rotation alignment were measured, and the overall lower limb rotation was calculated by two different methods. Method 1 was calculated by subtracting angle of the femoral torsion from the tibial torsion and method 2 was determined by relative rotation of the femoral neck angle to bimalleolar angle. The intraindividual variance and differences between the two groups were analyzed. Results: Both OA and control samples showed significant differences between right and left for all measurements. Femoral torsion for control group was 10.4 ± 5.5°, tibial torsion was -22.1 ± 6.1°, and overall leg rotation by method 1 was -15.6 ± 7.2° and method 2 was -11.7 ± 8.2°. Femoral torsion, tibial torsion, method 1, and method 2 in the patients with OA were 8.2 ± 6.3°, -18.6 ± 4.1°, -14.9 ± 7.9°, and -10.4 ± 7.6°, respectively. Patients with OA showed a more pronounced retroversion in the femur (p = 0.008) and more internal rotation in the tibia (p < 0.001). No statistical significance of both methods was found between the two groups. Patients with OA had a greater median side-to-side absolute difference in all measurements, though the differences of both two methods of overall lower limb rotation were not statistically significant. Conclusions: The discrepancy of side-to-side differences of bilateral lower limb rotation ought to be noticed with caution in diagnosing and treating rotational deformities of the lower limb, especially for patients with bilateral knee OA.

Optimal Design of Electrode Topology of Dielectric Elastomer Actuators Based on the Parameterized Level Set Method.

Dielectric elastomer actuators (DEAs) are widely used to drive soft machines, and optimal design is required in more advanced designs of soft robots. In this research article, a computational approach is originally proposed and validated for the topology optimization of electrodes of DEAs. The nonlinear finite elements of absolute nodal coordinate formulation are applied to model the dynamic electromechanical behaviors of DEAs. The parameterized level set method is employed to optimize the electrode topology of DEAs. Then, the method of system-wise equivalent static load is employed to convert the optimization problem of dynamic responses into the static one. Based on the sensitivity analysis, the normal velocity field for optimizing the electrode topology is derived. Finally, two case studies are presented to validate the proposed optimization approach. The experimental test is also performed, and the measured results are compared with the numerical ones to further validate the proposed methodology.

Non-weight-bearing short knee radiographs to evaluate coronal alignment before total knee arthroplasty.

BACKGROUND: Whole leg radiograph (WLR) is the gold standard in assessing lower limb alignment before total knee arthroplasty (TKA) although in practice, non-weight-bearing short knee radiographs (NWB SKRs) are used by most medical institutions. The objective of this study was to determine whether the femorotibial angle (FTA) could be used to evaluate lower limb alignment on limited NWB SKRs. We also investigated whether FTA alignment measurements on NWB SKRs and WLRs differed depending on the direction of knee deformity. METHODS: In all, 105 knees which underwent both NWB SKR and WLR were included. Measurement of hip-knee-ankle angle (HKA) was obtained through WLR, while the FTA was found using NWB SKR (FTASKR) and WLR (FTAWLR). All knees were divided into three groups based on the HKA. The Kappa statistic was used to compare the agreement of categorical alignment variables between the HKA and FTASKR. The agreement of the measurements obtained from the two radiographs was made using Bland-Altman plots and intraclass correlation coefficient (ICC). Pearson correlation coefficient and simple linear regression analysis were also conducted to evaluate the correlation between different angles. RESULTS: The agreement for categories of lower limb deformity was rated excellent (kappa =0.804, P<0.001). The Bland-Altman plot showed that the mean difference for the FTASKR and FTAWLR was 4.4°. There was an excellent correlation (r=0.861, P<0.001) and good reliability (ICC, 0.607) between the FTASKR and HKA. For the varus group, there was a good correlation between the FTASKR and HKA (r=0.650, P<0.001); however, there were no significant correlations between the FTAS KR and HKA in the neutral (r=0.106, P=0.543) and valgus groups (r=0.322, P=0.102). CONCLUSIONS: For outpatient follow-up, we found that the FTA on NWB SKRs is an acceptable means for classifying knee alignment (varus, neutral, or valgus). The measurement on NWB SKR also showed excellent correlation and good agreement with the HKA. For varus knees, NWB SKR measurements showed the best correlation with the HKA. However, for neutral and valgus knees, NWB SKR measurements were insufficient for conducting a reliable calculation and quantification of coronal alignment of the lower limb.

Gender Differences do not Influence the Blood Coagulopathy in Patients Undergoing Total Knee Arthroplasty: A Retrospective Thromboelastography Analysis.

OBJECTIVE: Deep vein thrombosis (DVT) is one of the severe complications after total knee arthroplasty (TKA). Gender has been considered to influence the incidence of the thrombosis formation in TKA patients. However, it remains controversial which gender would be more prone to form thrombosis. The aim of this study was to assess the effects of gender differences on coagulation status after TKA via the thromboelastography (TEG). METHODS: A total of 57 male patients who underwent primary TKA from September 2015 to January 2021 were included in this study. According to the matching principle of age, body mass index (BMI), and anticoagulation treatment, 60 female patients were selected. The conventional coagulation tests, routine blood tests, and thromboelastography were conducted before the operation, 1 day and 7 days after the operation. In addition, Doppler ultrasound was also performed 1 day before the operation and at the 7 days after the operation. The parameters of conventional coagulation tests, routine blood tests, and thromboelastography were compared between the two groups. RESULTS: There were no significant differences in the blood transfusion rate, the incidence of DVT during the perioperative period, D-dimer (D-D), fibrin degradation products (FDP), hemoglobin (HB), hematocrit (HCT), prothrombin time (PT), activated partial thromboplastin time (APTT), and C-reactive protein (CRP) at any corresponding time point between the male group and the female group (P > .05). There were no significant differences in neutrophil-to-lymphocyte ratio (NLR) preoperatively; however, there were significant differences in NLR 1 day after the surgery and 7 days after the surgery between the two groups (P < .05). There were significant differences in reaction time (R) and α angle 1 day after the surgery between the two groups (P < .05), but there were no significant differences in other TEG indexes at any corresponding time point between the two groups (P > .05). Binary logistic regression analysis demonstrated that gender, age, BMI, tourniquet application time were not independent predictors (P > .05). CONCLUSION: Gender differences have no significant influence in TKA patients with regard to conventional coagulation tests and thromboelastography.