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Rationale: Perioperative administration of tranexamic acid has been suggested to reduce bleeding and blood transfusion requirements in patients undergoing orthopedic surgery. Despite being sporadic, the potential risk for thrombotic complications cannot be ignored. However, intracardiac thrombosis associated with tranexamic acid administration is rare. We described a case of circulatory collapse caused by intracardiac thrombosis associated with tranexamic acid administration for a scheduled knee arthroplasty. Patient concerns: A 62-year-old male patient was scheduled for a right knee arthroplasty. He had a history of hypertension and had undergone surgery for treatment of right femur fracture 30 years previously. Other than a high platelet count (498 × 109/L), results of laboratory investigations were within normal limits. The ultrasonic examination of both lower limbs showed no thrombosis. Upon sterilizing the surgical area, tranexamic acid (1.6 g) was intravenously administered after induction of anesthesia and intubation. Then the patient had a sudden circulatory collapse. Through cardiopulmonary resuscitation, the patient recovered spontaneous circulation. Transesophageal echocardiography revealed extensive thrombosis in the right atrium and ventricle. Diagnosis: Circulation collapse caused by intracardiac thrombosis Interventions: Thrombolytic therapy was recommended after urgent multidisciplinary consultation. Thus, urokinase was administered intravenously. Fifty minutes after thrombolysis, the mass in ventricle disappeared. A shrunken mass was observed in the right atrium. After another half an hour, no abnormal echoes were seen in the right heart chambers. Outcomes: The patient was discharged after 43 days without any organ dysfunction. Lessons: This case reminds clinicians that perioperative tranexamic acid administration may increase the risk of thrombosis, which needs focused attention from anesthesiologists. Prompt transesophageal echocardiography examination should be done to allow immediate diagnosis and effective thrombolysis therapy when unexplained cardiac arrest occurs during anesthesia.

BACKGROUND The efficacy of early allograft dysfunction (EAD) definitions in predicting post-transplant graft survival in a Chinese population is still unclear. METHODS A total of 607 orthotopic liver transplants (OLT) have been included in the current study. Model accuracy was evaluated using receiver operating characteristic (ROC) analysis. Risk factors for EAD was evaluated using univariable analysis and multivariable logistic regression model. RESULTS The 3-, 6-, and 12-month patient/graft survival were 91.6%/91.4%, 91.1%/90%, and 87.5%/87.3%, respectively. MELDPOD5 had a superior discrimination of 3-month graft survival (C statistic, 0.83), compared with MEAF (C statistic, 0.77) and Olthoff criteria (C statistic, 0.72). Multivariate analysis of risk factors for EAD defined by MELDPOD5, showed that donor body mass index (P=0.001), donor risk index (P=0.006), intraoperative use of packed red blood cells (P=0.001), hypertension of recipient (P=0.004), and preoperative total bilirubin (P

In the present study, the function of microRNA (miR)‑140‑5p on oxidative stress in mice with atherosclerosis was investigated. A reverse transcription‑quantitative polymerase chain reaction assay was used to determine the expression of miR‑140‑5p. Oxidative stress kits and reactive oxygen species (ROS) kits were used to analyze alterations in oxidative stress and ROS levels. The alterations in protein expression were determined using western blot analysis and an immunofluorescence assay. miR‑140‑5p expression was increased in mice with atherosclerosis with hypertension. Consistently, miR‑140‑5p expression was also increased in mice with atherosclerosis. Upregulation of miR‑140‑5p increased oxidative stress and ROS levels by suppressing the protein expression of nuclear factor erythroid 2‑related factor 2 (Nrf2), sirtuin 2 (Sirt2), Kelch‑like enoyl‑CoA hydratase‑associated protein 1 (Keap1) and heme oxygenase 1 (HO‑1) in vitro. By contrast, downregulation of miR‑140‑5p decreased oxidative stress and ROS levels by activating the protein expression of Nrf2, Sirt2, Keap1 and HO‑1 in vitro. Sirt2 agonist or Nrf2 agonist inhibited the effects of miR‑140‑5p on oxidative stress in vitro. Collectively, these results suggested that miR‑140‑5p aggravated hypertension and oxidative stress of mice with atherosclerosis by targeting Nrf2 and Sirt2.

The effect of oxygen on the thermal degradation of rice straw was investigated with a thermal gravimetric analysis (TGA) reaction system. The TGA curves indicated two sharp mass changes during the process and the reaction could be simplified as occurring in two stages. Oxygen speeds up the thermal degradation of intermediates. A kinetic model was proposed and its corresponding parameters such as activation energies, pre-exponential factors, and reaction orders were determined through experiments conducted in nitrogen gas (N2), 10% oxygen gas (O2), and air at the heating rates of 2, 5, and 10 K/min. The experimental data agreed well with those predicted by the proposed model, which validated the applicability of this model to the design of agricultural waste processing systems.