Tranexamic acid attenuates early post-operative systemic inflammatory response and nutritional loss and avoids reduction of fibrinogen in total hip arthroplasty within an enhanced recovery after surgery pathway.

PURPOSE: Total hip arthroplasty (THA) is an intervention with significant inflammatory response. The impact of additional doses of tranexamic acid (TXA) on inflammatory response, trauma and nutrition parameters, and coagulation and fibrinolysis changes has rarely been reported. METHODS: A prospective double-blind randomized trial was performed on elective primary THA. Ninety-nine adult patients were recruited consecutively from 2019 to 2020. They were randomized to receive single-dose of TXA before incision, another dose of TXA at three hours post-operatively, or another two doses of TXA at three and six hours  post-operatively. The primary outcomes included changes in white blood cell (WBC) counts, creatine kinase (CK), haemoglobin(Hb), and albumin(Alb); the secondary outcomes included coagulation and fibrinolysis parameters. RESULTS: Compared with single-dose TXA, patients received three dose TXA had significantly reduced WBC counts and fibrinogen/fibrin degradation product (FDP) levels, increased albumin and fibrinogen levels, and prolonged PT on post-operative day (POD) three. Though patients received three dose TXA had a tendency that increased Hb, decreased CK, reduced D-D, and prolonged APTT on POD3, it is not statistically significant. And the other measured outcomes on POD1 and POD2W shared a similar statistical result, except PT. The PT is significantly prolonged on POD2W in three dose group compared with single dose. CONCLUSION: Three-dose TXA contribute to attenuate early post-operative systemic inflammatory response and nutritional loss, increase fibrinogen, reduce FDP levels, and prolong PT in THA patients within an ERAS pathway, which may associate with reduced early post-operative haemorrhagic tendency, thrombosis risks, and hypercoagulability.

Regulatory effect of miRNA enfolded in microparticles on endothelial cells / 中国病理生理杂志

Endothelialcellsarethecellsliningtheinnersurfacesofbloodvessels.Theybuildupasinglecell layer and play an important role in the regulation of vascular functions and the maintenance of homeostasis .The activation or injury of endothelial cells is associated with multiple diseases , including hypertension , atherosclerosis, cancer, diabe-tes, etc.Recent studies have found that microparticles are involved in the process of endothelial cell injury , thus playing a part in the development of many diseases .miRNAs enfolded in the microparticles have become importance in recent years . Moreover , recent studies also found that the concentration of the miRNAs enfolded in the microvesicles is higher than that of the miRNAs in the plasma , which means that the microparticles are the main form of miRNAs present in peripheral circula -tory system.This article is to review the recent research progress in microparticle-encapsulated miRNAs and their regulatory effect on endothelial cell injury .