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Background: The reductions of perioperative blood loss and inflammatory response are important in total knee arthroplasty. Tranexamic acid reduced blood loss and the inflammatory response in several studies. However, the effect of epinephrine administration plus tranexamic acid has not been intensively investigated, to our knowledge. In this study, we evaluated whether the combined administration of low-dose epinephrine plus tranexamic acid reduced perioperative blood loss or inflammatory response further compared with tranexamic acid alone.Methods: This randomized placebo-controlled trial consisted of 179 consecutive patients who underwent primary total knee arthroplasty. Patients were randomized into 3 interventions: Group IV received intravenous low-dose epinephrine plus tranexamic acid, Group TP received topical diluted epinephrine plus tranexamic acid, and Group CT received tranexamic acid alone. The primary outcome was perioperative blood loss on postoperative day 1. Secondary outcomes included perioperative blood loss on postoperative day 3, coagulation and fibrinolysis parameters (measured by thromboelastography), inflammatory cytokine levels, transfusion values (rate and volume), thromboembolic complications, length of hospital stay, wound score, range of motion, and Hospital for Special Surgery (HSS) score.Results: The mean calculated total blood loss (and standard deviation) in Group IV was 348.1 ± 158.2 mL on postoperative day 1 and 458.0 ± 183.4 mL on postoperative day 3, which were significantly reduced (p < 0.05) compared with Group TP at 420.5 ± 188.4 mL on postoperative day 1 and 531.1 ± 231.4 mL on postoperative day 3 and Group CT at 520.4 ± 228.4 mL on postoperative day 1 and 633.7 ± 237.3 mL on postoperative day 3. Intravenous low-dose epinephrine exhibited a net anti-inflammatory activity in total knee arthroplasty and did not induce an obvious hypercoagulable status. Transfusion values were significantly reduced (p < 0.05) in Group IV, but no significant differences were observed in the incidence of thromboembolic complications, wound score, range of motion, and HSS score among the 3 groups (p > 0.05).Conclusions: The combined administration of low-dose epinephrine and tranexamic acid demonstrated an increased effect in reducing perioperative blood loss and the inflammatory response compared with tranexamic acid alone, with no apparent increased incidence of thromboembolic and other complications.Level Of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Although gender differences in self-efficacy and subjective well-being have been reported in previous studies, little published research has investigated the interrelationships between these variables in adolescents. 648 Chinese adolescents were administered a series of questionnaires to test the hypothesis that self-efficacy mediates the relationship between gender and subjective well-being. The results indicated that adolescent girls had lower general self-efficacy than adolescent boys, which explained girls' lower subjective well-being. The theoretical and practical implications may help parents and educators to strengthen adolescents' happiness. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate citrus tissue's response to varying applications of Fe-EDDHA, zinc (Zn) and manganese (Mn) combinations and the resulting effects on citrus fruit yield and quality in calcareous soil. A field experiment was conducted for three years with satsuma mandarin trees planted in calcareous soil. Four treatments were conducted: (i) control; (ii) soil Fe application; (iii) soil Fe+Zn application; and (iv) soil Fe+Zn+Mn application. Soil available Fe and Zn concentrations were raised through the application of Fe-EDDHA and Zn, whereas the soil available Mn concentration was not increased through the application of Mn. Applying Fe-EDDHA raised the leaf active Fe content significantly without influencing the leaf and fruit Fe concentrations. The Zn concentrations in leaf and fruit decreased when Fe-EDDHA was applied exclusively, but increased when Fe+Zn and Fe+Zn+Mn were applied in the third year. There was no significant difference in leaf and fruit Mn concentrations among all treatments between 2010 and 2012. Soil Fe, Fe+Zn and Fe+Zn+Mn application increased fruit number by 23.5%, 26.7% and 24.9%, respectively, and soil Fe+Zn application increased the yield in 2012. Fruit TSS, TA and Vc content were higher through the application of Fe+Zn and Fe+Zn+Mn in 2012. The results revealed that Fe and Zn play different roles that affect fruit yield and quality in calcareous soil. The citrus yield was mainly affected by Fe, whereas fruit quality was improved by Zn. The application of Fe-EDDHA alone could induce Zn deficiency, so the co-application of Fe-EDDHA and Zn fertilizer was useful for obtaining higher yield and quality in satsuma mandarin in calcareous soil. [ABSTRACT FROM AUTHOR]