Predicting the potential mechanism of radix chimonanthi pracecocis in treating osteoarthritis by network pharmacology analysis combined with experimental validation.

ETHNOPHARMACOLOGICAL RELEVANCE: Radix Chimonanthi Pracecocis (RCP), also known as Tiekuaizi, widely used by the Miao community in Guizhou, exhibits diverse biological activities and holds promise for the treatment of osteoarthritis (OA). However, there is a lack of contemporary pharmacological research in this area. AIMS OF THE STUDY: This study aims to explore the potential of targets and mechanisms of RCP in the treatment of OA. MATERIALS AND METHODS: The chemical components of RCP were identified using UPLC-MS/MS, and active components were determined based on the Lipinski rule. RCP and OA-related targets were retrieved from public databases such as TCMSP and GeneCards. Network pharmacology approaches were employed to identify key genes. The limma package (version 3.40.2) in R 4.3.2 was used to screen for differentially expressed genes (DEGs) between OA and healthy individuals in GSE82107. DEGs were analyzed using an independent sample t-test and receiver operating characteristic analysis in GraphPad Prism 9.5.1. Additionally, molecular docking (SYBYL2.1.1) was used to analyze the binding interactions between the active components and target proteins. Finally, we established a papain-induced osteoarthritis (OA) rat model and treated it with RCP aqueous extract by gavage. We validated relevant indicators using real-time fluorescence quantitative polymerase chain reaction, Western blot, immunohistochemistry, and enzyme-linked immunosorbent assays. RESULTS: Seven active components and 53 targets were identified. The results of GO and KEGG enrichment analyses confirmed the significant role of RCP in the regulation of pyroptosis. Hypoxia-inducible factor-1α (HIF-1α) was identified as a key gene involved in the main biological functions. Molecular docking analysis revealed that Praecoxin, Isofraxidin, Esculin, and Naringenin can bind to the nucleotide-binding domain, leucine-rich repeat, and pyrin domain-containing protein 3 (NLRP3) (T-Score >5). Additionally, Praecoxin can bind to HIF-1α (T-Score >5). In vivo experiments demonstrated that RCP significantly affects the NLRP3 inflammasome, which is regulated by the HIF-1α pathway. RCP inhibited pyroptosis and reduced synovial inflammation. CONCLUSIONS: This study confirmed the efficacy of RCP aqueous extract in the treatment of OA and identified seven active components (esculin, dihydrokaempferol, naringenin, praecoxin, carnosol, hydroxyvalerenic acid, isofraxidin) that may play an anti-pyroptosis role in the treatment of OA by downregulating the expression of HIF-1α and NLRP3 inflammasome.

Diagnosis of Acute Aortic Syndromes on Non-Contrast CT Images with Radiomics-Based Machine Learning.

We aimed to detect acute aortic syndromes (AAS) on non-contrast computed tomography (NCCT) images using a radiomics-based machine learning model. A total of 325 patients who underwent aortic CT angiography (CTA) were enrolled retrospectively from 2 medical centers in China to form the internal cohort (230 patients, 60 patients with AAS) and the external testing cohort (95 patients with AAS). The internal cohort was divided into the training cohort (n = 135), validation cohort (n = 49), and internal testing cohort (n = 46). The aortic mask was manually delineated on NCCT by a radiologist. Least Absolute Shrinkage and Selection Operator regression (LASSO) was used to filter out nine feature parameters; the Support Vector Machine (SVM) model showed the best performance. In the training and validation cohorts, the SVM model had an area under the curve (AUC) of 0.993 (95% CI, 0.965-1); accuracy (ACC), 0.946 (95% CI, 0.877-1); sensitivity, 0.9 (95% CI, 0.696-1); and specificity, 0.964 (95% CI, 0.903-1). In the internal testing cohort, the SVM model had an AUC of 0.997 (95% CI, 0.992-1); ACC, 0.957 (95% CI, 0.945-0.988); sensitivity, 0.889 (95% CI, 0.888-0.889); and specificity, 0.973 (95% CI, 0.959-1). In the external testing cohort, the ACC was 0.991 (95% CI, 0.937-1). This model can detect AAS on NCCT, reducing misdiagnosis and improving examinations and prognosis.

Effect of duloxetine on pain relief after total knee arthroplasty: A meta-analysis of randomized controlled trials.

BACKGROUND: Postoperative pain is one of the most feared complications of total knee arthroplasty. Recently, randomized controlled trials have compared the efficacy of duloxetine in patients undergoing total knee arthroplasty. However, there is no definite answer as to the efficacy and safety of duloxetine. METHODS: Randomized controlled trials about relevant studies were searched from PubMed (1996 to July 2022), Embase (1996 to July 2022), and Cochrane Library (CENTRAL, July 2022). RESULTS: Six high-quality studies containing 532 patients met the inclusion criteria. Results show patients in the duloxetine group had better performance in terms of visual analog scale (P < .05), equivalent morphine consumption (P < .05), and length of stay (P < .05). CONCLUSION: Duloxetine can be used to reduce pain after knee arthroplasty in selected patients.

Addressing challenges of an ageing population by rationally forecasting travel behaviours of the elderly: a case study in China.

This research aims to investigate the difference of the travel behaviours of the elderly in different urban areas. On the basis of the results of cluster analysis, the nested logit (NL) model is adopted to investigate the travel decision of the elderly in central urban areas and non-central urban areas. Moreover, it is used to forecast the change of their travel behaviours by implementing the policies of age-friendly society. The results show that the elderly in central urban areas are inclined to decide travel modes in advanced of determining trip chains, while the trip chains are first determined in non-central urban areas. For the central urban areas, the policies mainly affect the choice of travel modes of the elderly, rather than the choice of trip chains. However, for the non-central urban area, the policies simultaneously influence the choice of travel mode and trip chains of the elderly. Based on the results of the forecast, some measures are proposed in this study to meet different travel requirements of the elderly in central urban areas and non-central urban areas.

Is intraoperative corticosteroid a good choice for postoperative pain relief in total joint arthroplasty? A meta-analysis of 11 randomized controlled trials.

BACKGROUND: Effective postoperative analgesia is of great significance for postoperative rehabilitation. This meta-analysis aimed to investigate the efficacy of corticosteroid on pain following total joint arthroplasty. METHOD: PubMed (1996-December 2020), Embase (1996-December 2020), and the Cochrane Library (CENTRAL, December 2020) were searched and a total of 11 randomized controlled trials met our inclusion criteria. RESULTS: Eleven randomized controlled trials met the inclusion criteria. Pooled data indicated the corticosteroid group was effective compared to the control group in terms of the visual analogue scale at rest (P < .05) and movement (P < .05), the total morphine equivalent consumption (P < .05), and the length of stay (P < .05), without increasing the risk of periprosthetic joint infection (P = .74) and the length of stay (P = .32). CONCLUSIONS: Compared to the control group, intraoperative corticosteroid was benefit to the pain management in total joint arthroplasty.

Is preemptive analgesia a good choice for postoperative pain relief in lumbar spine surgeries?: A meta-analysis of randomized controlled trials.

BACKGROUND: Lumbar spine surgery is associated with moderate-to-severe postoperative pain. Adequate pain management during the postoperative period facilitates rehabilitation. Recently, preemptive analgesia has been considered among the important analgesic methods for reducing postoperative pain. However, its efficacy in postoperative pain relief after lumbar spine surgery remains unclear. This study aimed to evaluate the effects of preemptive analgesia on lumbar spine surgery. METHODS: We searched for randomized controlled trials in PubMed (1996 to May 2020), Embase (1980 to May 2020), and Cochrane Library (CENTRAL, May 2020). We included seven studies that evaluated the preemptive analgesic efficacy in lumbar spine surgeries. RESULTS: Seven studies, including 509 patients, met the inclusion criteria. Pooled data revealed that preemptive analgesia is effective for lumbar spine surgeries with respect to the visual analog scale score (P < .05), total morphine equivalent consumption (P < .05), and length of stay (P < .05), without increasing complications (P = .73). CONCLUSIONS: Our findings indicate that preemptive analgesia is safe and effective for lumbar spine surgery.

Is the proximal adductor canal block a better choice than the distal adductor canal block for primary total knee arthroplasty?: A meta-analysis of randomized controlled trials.

BACKGROUND: Total knee arthroplasty is accompanied by moderate to severe postoperative pain. Postoperative pain hampers the functional recovery and lowers patient satisfaction with the surgery. Recently, the adductor canal block (ACB) has been widely used in total knee arthroplasty. However, there is no definite answer as to the location of a continuous block within the ACBs. METHOD: Randomized controlled trials about relevant studies were searched in PubMed (1996 to Oct 2019), Embase (1996 to Oct 2019), and Cochrane Library (CENTRAL, Oct 2019). RESULTS: Five studies involving 348 patients met the inclusion criteria. Pooled data indicated that the proximal ACB was as effective as the distal ACB in terms of total opioid consumption (P = .54), average visual analog scale (VAS) score (P = .35), worst VAS score (P = .19), block success rate (P = .86), and time of catheter insertion (P = .54). CONCLUSIONS: Compared with the distal ACB, the proximal ACB showed similar analgesic efficacy for total opioid consumption, average VAS score, worst VAS score, block success rate, and time of catheter insertion. However, because of the limited number of involved studies, more high-quality studies are needed to further identify the optimal location of the ACB.

Image quality and clinical usefulness of automatic tube current modulation technology in female chest computed tomography screening.

The study was aimed to evaluate the image quality and radiation dose during female chest computed tomography (CT) screening using organ-based tube current modulation technology X-ray combined applications to reduce exposure (XCARE).Five hundred sixty female individuals undergoing chest CT scan were prospectively enrolled and divided into 4 groups based on body mass index (BMI). Then they were randomly and equally divided into control and experimental subgroup and respectively accepted conventional low-dose and XCARE technology spiral CT scan with same parameters. Signal-to-noise ratio and contrast-to-noise ratio were calculated. The quality of the images was evaluated by 2 radiologists using a 5-point scale.Among experimental subgroups of the 4 BMI groups, Signal-to-noise ratios, CT dose index of volume, dose-length product, effective dose, and contrast-to-noise ratio all displayed significant differences, as well as in control subgroups (P < .001). Both the experimental and control subgroups showed an increasing trend in radiation dose with the increasing of BMI. Parameters of image quality and radiation dose displayed no significant differences between control and experimental subgroups in the 4 groups. In multiple linear regression analysis, age and scanning protocol were not associated with radiation dose (P > .05), while BMI was significantly associated with increased CT dose index of volume (P < .05). The display of the lesions for the patients in the control and experimental subgroups of the 4 groups with different BMIs exhibited no statistically significant difference.The same image quality and radiation dose can be obtained using XCARE technology compared to conventional chest CT scans, which can be used regularly in female patients.Advances in knowledge: Using automatic tube current modulation technology to reduce exposure in breast. In this study, we sought a radiation protection method for sensitive tissue in chest CT screening.

Coronary Computed Tomography (CT) Angiography Characteristics of High-Risk Plaque: Correlation with Stress Myocardial Perfusion Imaging in Patients with Moderate Coronary Stenosis.

BACKGROUND The aim of this study was to investigate the ability of coronary computed tomographic angiography (CCTA) characteristics of high-risk plaque (HRP) in moderate stenosis to improve differentiation of myocardial ischemia detected by stress CT perfusion (CTP) imaging. MATERIAL AND METHODS Sixty-two patients with coronary plaques and moderate stenosis confirmed by invasive coronary angiography (ICA) had stress CTP and 26 of these patients were found to have myocardial ischemia. The other 36 patients without myocardial ischemia were defined as controls. Characteristics of major plaques on CCTA images of the ischemia and non-ischemia groups were analyzed and compared. RESULTS Differences between the 2 groups were observed in plaque volume, burden and rough inner surface necrotic core volume, plaque-lipid interface and plaque length. In a multivariable analysis, plaque burden and necrotic core volume were significantly associated with myocardial ischemia: plaque burden odds ratio (OR) was 1.28 (95% confidence interval [CI], 1.12-1.48); necrotic core volume OR was 1.78 (95% CI, 1.03-1.34). Compared with other quantitative measurements, optimized thresholds for plaque burden (area under the curve was 0.852) and necrotic core volume (area under the curve was 0.730) showed significantly higher diagnostic performance for ischemia with threshold values of 60.8% and 11.25 mm³, respectively. CONCLUSIONS CCTA characteristics of major plaques may improve the discrimination of ACS patients with myocardial ischemia on stress CTP.

Comparison of adductor canal block with periarticular infiltration analgesia in total knee arthroplasty: A meta-analysis of randomized controlled trials.

BACKGROUND: Total knee arthroplasty (TKA) is accompanied by moderate to severe postoperative pain. Multimodal analgesia, such as femoral nerve block, periarticular infiltration analgesia (PIA), and patient-controlled intravenous analgesia, have been used for postoperative analgesia. Recently, randomized controlled trials have compared the efficacy of the adductor canal block (ACB) and the PIA in patients undergoing TKA. However, there is no definite answer as to the efficacy and safety of the ACB compared with the PIA. METHOD: Randomized controlled trials about relevant studies were searched from PubMed (1996 to May 2019), Embase (1980 to May 2019), and Cochrane Library (CENTRAL, May 2019). Five studies which compared the ACB with the PIA methods were included in our meta-analysis. RESULTS: Five studies containing 413 patients met the inclusion criteria. There were no significant differences between the ACB and the PIA group in visual analog scale (VAS) score at rest (P = .14) and movement (P = .18), quadriceps muscle strength (P = .95), complications (P = .78), length of stay (LOS) (P = .54), and time up and go (TUG) test (P = .09), While patients in the ACB group had less equivalent morphine consumption (P < .05) compared with the PIA group. CONCLUSIONS: Our pooled data indicated the ACB group reduced the equivalent morphine consumption compared with the PIA group, with no statistically significant differences in the VAS score, quadriceps muscle strength, TUG test, complications, and LOS.

Single shot versus continuous technique adductor canal block for analgesia following total knee arthroplasty: A PRISMA-compliant meta-analysis.

BACKGROUND: An adductor canal block (ACB) provides recognized analgesia following total knee arthroplasty (TKA). This meta-analysis compared the single-injection ACB (SACB) with the continuous-injection ACB (CACB). METHOD: Relevant studies were searched from PubMed (1996-October 2018), Embase (1980-October 2018), and Cochrane Library (CENTRAL, October 2018). Four randomized controlled trials (RCTs), which compared SACB with CACB, were included in our meta-analysis. RESULTS: Four RCTs met the inclusion criteria. Our pooled data indicated that the SACB group had similar efficacy compared with the CACB group in terms of morphine consumption (P = .19), time to first opioid request (P = .32), range of motion (P = .97), and visual analogue scale (VAS) scores at 24 hours at rest (P = .12) and movement (P = .24), without increasing the risk of complications (P = .97) and length of stay (P = .54). CONCLUSION: The SACB technique provides similar analgesia in the 24 hours following TKA compared with CACB, while the CACB method was better over 48 hours.

[Review of high-resolution peripheral quantitative computed tomography for the assessment of bone microstructure and strength].

Trabecular microstructure is an important factor in determining bone strength and physiological function. Normal X-ray and computed tomography (CT) cannot accurately reflect the microstructure of trabecular bone. High-resolution peripheral quantitative computed tomography (HR-pQCT) is a new imaging technique in recent years. It can qualitatively and quantitatively measure the three-dimensional microstructure and volume bone mineral density of trabecular bone in vivo. It has high precision and relative low dose of radiation. This new imaging tool is helpful for us to understand the trabecular microstructure more deeply. The finite element analysis of HR-pQCT data can be used to predict the bone strength accurately. We can assess the risk of osteoporosis and fracture with three-dimensional reconstructed images and trabecular microstructure parameters. In this review, we summarize the technical flow, data parameters and clinical application of HR-pQCT in order to provide some reference for the popularization and extensive application of HR-pQCT.

Comparison of Periarticular Local Infiltration Analgesia With Femoral Nerve Block for Total Knee Arthroplasty: a Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Total knee arthroplasty (TKA) is accompanied by moderate-to-severe postoperative pain. Postoperative pain will hamper functional recovery and lower patients' satisfaction with surgery. Recently, periarticular local infiltration analgesia (LIA) has been widely used in TKA. However, there is no definite answer as to the efficacy and safety of LIA compared with femoral nerve block (FNB). METHOD: Randomized controlled trials about relevant studies were searched from PubMed (1996 to July 2017), Embase (1980 to July 2017), and Cochrane Library (CENTRAL, July 2017). Ten studies which compared LIA with FNB methods were included in our meta-analysis. RESULTS: Ten studies containing 950 patients met the inclusion criteria. Our pooled data indicated that LIA was as effective as the FNB in terms of visual analog scale score for pain at 24 hours (P = .52), 48 hours (P = .36), and 72 hours (P = .27), and total morphine consumption (P = .27), range of motion (P = .45), knee society score (P = .51), complications (P = .81), and length of hospital stay (P = .75). CONCLUSIONS: Our current meta-analysis results demonstrated that there were no differences in efficacy between the FNB and LIA method.

The efficacy of dexamethasone reducing postoperative pain and emesis after total knee arthroplasty: A systematic review and meta-analysis.

BACKGROUND: Total knee arthroplasty (TKA) is gradually emerging as the treatment of choice for end-stage osteoarthritis. In the past, Perioperative dexamethasone treatment is still a controversial subject in total knee arthroplasty. Therefore, we write this systematic review and meta-analysis to evaluate the efficacy of dexamethasone on pain and recovery after Total knee Arthroplasty. MATERIALS AND METHODS: Embase, Pubmed, and Cochrane Library were comprehensively searched. Randomized controlled trials, cohort studies were included in our meta-analysis. Eight studies that compared dexamethasone groups with placebo groups were included in our meta-analysis. The research was reported according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Randomized controlled trials were included in our meta-analysis. RESULTS: Our study demonstrated that the dexamethasone group was more effective than the placebo group in term of VAS score at 24 h(P < 0.00001), 48 h(P = 0.0002); Opioid consumption (P < 0.00001); postoperative nausea (P < 0.00001); and Inflammatory factors of CPR at 24 h (P = 0.003). CONCLUSION: Our meta-analysis demonstrated that dexamethasone decreased postoperative pain, the incidence of POVN, and total opioid consumption effectively which played a critical role in rapid recovery to TKA. However, we still need large sample size, high quality studies to explore the relationship between complications and dose response to give the final conclusion.

Sliding hip screw versus cannulated cancellous screws for fixation of femoral neck fracture in adults: A systematic review.

OBJECTIVE: Femoral neck fracture is considered a difficult fracture to treat and often gives rise to unsatisfactory treatment results. Cannulated cancellous screws (CCS) or a sliding hip screw (SHS) are the mainstream internal fixations used for osteosynthesis of femoral neck fractures. There is a need to integrate existing data through a meta-analysis to investigate the safety and effectiveness of CCS and SHS in the treatment of femoral neck fractures. METHOD: According to the Cochrane Handbook for Systematic Reviews of Interventions, we screened for the relevant studies by searching Google Scholar, the Cochrane Controlled Trials Register, the Cochrane Library, Web of Science, EMBASE, and PubMed. The PICOS criteria was used to make sure the included studies fulfilled the inclusion criteria. RESULTS: Pooled data showed that there were no significant differences between the SHS and CCS groups for the Harris Hip Score. Significant differences were found between the SHS and CCS groups in terms of union time, postoperative complications, blood loss, operation time, incision length and length of hospital stay. CONCLUSIONS: Although the SHS and CCS groups showed similar functional recovery in treatment of femoral neck fracture in terms of the Harris Hip Score, the SHS group showed fewer postoperative complications and faster union time for patients with femoral neck fractures. Therefore, compared with CCS, the use of SHS may be a more effective treatment of femoral neck fractures.

The effect of preoperative training on functional recovery in patients undergoing total knee arthroplasty: A systematic review and meta-analysis.

OBJECTIVE: A meta-analysis to evaluate the efficacy of preoperative training on functional recovery in patients undergoing total knee arthroplasty. METHOD: Randomized controlled trials (RCTs) about relevant studies were searched from PubMed (1996-2017.4), Embase (1980-2017.4), and the Cochrane Library (CENTRAL 2017.4). Nine studies which evaluated the effect of preoperative training on functional recovery in patients undergoing TKA were included in our meta-analysis. Meta-analysis results were collected and analyzed by Review Manager 5.3 (Copenhagen: The Nordic Cochrane Center the Collaboration 2014). RESULTS: Nine studies containing 777 patients meet the inclusion criteria. Our pooled data analysis indicated that preoperative training was as effective as the control group in terms of visual analogue scale(VAS) score at ascend stairs (P = 0.41) and descend stars (P = 0.80), rang of motion (ROM) of flexion (P = 0.86) and extension (P = 0.60), short form 36 (SF-36) of physical function score (P = 0.07) and bodily pain score (P = 0.39), western Ontario and Macmaster universities osteoarthritis index (WOMAC) function score (P = 0.10), and time up and go (P = 0.28). While differences were found in length of stay (P < 0.05). CONCLUSIONS: Our meta-analysis demonstrated that preoperative training have the similar efficacy on functional recovery in patients following total knee arthroplasty compared with control group. However, high quality studies with more patients were needed in future.

Comparison of clinical outcomes with InterTan vs Gamma nail or PFNA in the treatment of intertrochanteric fractures: A meta-analysis.

Intertrochanteric fractures are common injuries in the elderly. Conventional intramedullary nails including Gamma 3 locking nail and proximal femoral nail antirotation (PFNA) were designed for unstable intertrochanteric fractures. The InterTan (IT) nail system, introduced in 2005, has been reported superior biomechanical and clinical outcomes compared with 1-screw nailing system. However, some recent studies have reported that IT did not improve functional recovery in patients with intertrochanteric fractures. Randomized controlled trials (RCTs) or prospective cohort studies were included in our meta-analysis. We used the PRISMA guidelines and Cochrane Handbook to evaluate the quality of included studies to ensure that the pooled data of our meta-analysis were reliable and veritable. Our pooled data analysis demonstrated that IT was as effective as the control group in terms of Harris Hip Score (HHS), blood loss, total complications, union time, length of hospital stay, revision rate, and fluoroscopy time. IT shows less implant cut-out rate and femoral fractures when compared with control groups.

The efficacy of tranexamic acid using oral administration in total knee arthroplasty: a systematic review and meta-analysis.

BACKGROUND: Total knee arthroplasty (TKA) is gradually regarded as an effective choice for end-stage osteoarthritis or rheumatic arthritis. In the past, the management of tranexamic acid (TXA) using intravenous injection or topical application has been extensively researched. However, several studies have reported that oral TXA has an effect on blood loss. Therefore, a meta-analysis should be performed to determine whether oral TXA helps to prevent blood loss. METHODS: Randomized controlled trials or retrospective cohort studies about relevant studies were searched in PubMed (1996-April 2017), Embase (1980-April 2017), and the Cochrane Library (CENTRAL, April 2017). Six studies that compared oral TXA to non-TXA were included in our meta-analysis. Meta-analyses (PRISMA) guidelines, the Cochrane Handbook, and the Jadad scale were used to evaluate the included studies and the results to ensure that the meta-analysis was viable. RESULTS: In accordance with inclusion and exclusion, six studies with 2553 patients (oral TXA = 1386, without TXA = 1167) were eligible and accepted into this meta-analysis. Pooled data indicated that the oral TXA group was effective compared to the without TXA group in terms of hemoglobin (Hb) drop (P < 0.05), blood loss at 24 h (P < 0.05), total blood loss (P < 0.05), and the transfusion rate (P < 0.05). No significant differences were found in the length of hospital stay (P = 0.96) and complications (P = 0.39). CONCLUSION: Compared to the non-TXA group, the oral TXA group showed effects of blood sparing. Considering the cost and effectiveness, oral TXA is useful for TKA.

Comparison of oral versus intravenous application of tranexamic acid in total knee and hip arthroplasty: A systematic review and meta-analysis.

BACKGROUND: Tranexamic acid (TXA) is regarded as one of the most important drugs in reducing blood loss and hemoglobin (Hb) drop after total knee arthroplasty (TKA) or total hip arthroplasty (THA). Treatment with tranexamic acid (TXA) by intravenous application has been discussed extensively. Recently, several studies have reported that oral administration has an effect on blood sparing. Therefore, we performed a meta-analysis to investigate the efficacy and safety between oral TXA and intravenous TXA (IV-TXA) for blood sparing in total knee and hip arthroplasty. METHODS: Randomized controlled trials (RCTs) or retrospective cohort studies (RCSs) about relevant research were searched for by using PubMed (1996-April 2017), Embase (1980-April 2017), and the Cochrane Library (CENTRAL, April 2017). Five studies that compared oral with IV administration of TXA were included in our meta-analysis. Meta-analysis results were collected and analyzed by the software Review Manager 5.3 (Copenhagen: The Nordic Cochrane Center, The Collaboration, 2014). RESULTS: Five studies containing 3474 patients met the inclusion criteria. Our pooled data analysis indicated that oral TXA was as effective as the IV-TXA in terms of the average Hb drop (P = 0.88), total Hb loss (P = 0.57), total blood loss (P = 0.42), transfusion rate (P = 0.16), complications (P = 0.61), and length of hospital stay (P = 1.00). CONCLUSIONS: Compared with the IV-TXA method, oral TXA shows similar blood-sparing efficacy for preventing hemoglobin drop, total hemoglobin loss, and total blood loss following TKA or THA. In addition, no significant differences of transfusion rate, complications, or length of hospital stay were found between the 2 groups. However, because of the limited number of included studies, more studies of high quality are needed to further identify the optimal administration time for oral TXA.