Tranexamic acid alters the immunophenotype of phagocytes after lower limb surgery

Background: Tranexamic acid (TXA) is an antifibrinolytic agent frequently used in elective surgery to reduce blood loss. We recently found it also acts as a potent immune-modulator in patients undergoing cardiac surgery. Methods: Patients undergoing lower limb surgery were enrolled into the “Tranexamic Acid in Lower Limb Arthroplasty” (TALLAS) pilot study. The cellular immune response was characterised longitudinally pre- and postoperatively using full blood examination (FBE) and comprehensive immune cell phenotyping by flowcytometry. Red blood cells and platelets were determined in the FBE and levels of T cell cytokines and the plasmin-antiplasmin complex determined using ELISA. Results: TXA administration increased the proportion of circulating CD141+ conventional dendritic cells (cDC) on post-operative day (POD) 3. It also reduced the expression of CD83 and TNFR2 on classical monocytes and levels of circulating IL-10 at the end of surgery (EOS) time point, whilst increasing the expression of CCR4 on natural killer (NK) cells at EOS, and reducing TNFR2 on POD-3 on NK cells. Red blood cells and platelets were decreased to a lower extent at POD-1 in the TXA group, representing reduced blood loss. Conclusion: In this investigation we have extended our examination on the immunomodulatory effects of TXA in surgery by also characterising the end of surgery time point and including B cells and neutrophils in our immune analysis, elucidating new immunophenotypic changes in phagocytes as well as NK cells. This study enhances our understanding of TXA-mediated effects on the haemostatic and immune response in surgery, validating changes in important functional immune cell subsets in orthopaedic patients.Dominik F. Draxler, Gryselda Hanafi, Saffanah Zahra, Fiona McCutcheon, Heidi Ho, Charithani B. Keragala, Zikou Liu, David Daly, Thomas Painter, Sophia Wallace, Magdalena Plebanski, Paul S. Myles, and Robert L. Medcal

ALEPH: A detector for electron-positron annihilations at LEP

The design, construction and performace of a large 4pi solid angle detector with soleinoidal magnet is described. The detector serves to study electron-positron annihilation processes at a centre of mass energy between 80 and 200 GeV at the Large electron positron storage ring (LEP) at CERN

Determination of the leptonic branching ratios of the Z

The ratios of the numbers of Z bosons decaying to e+e−, μ+μ− and τ+τ− pairs to the number decaying to hadrons have been measured. The branching ratios and partial widths for each channel were determined and found to be equal, consistent with lepton universality. The mean leptonic branching ratio was found to be 0.0321 ± 0.0013 and the leptonic partial width to be 85.4 ± 5.3 MeV. The partial widths for hadronic decays and for invisible decays were deduced to be 1833 ± 116 MeV and 569 ± 92 MeV, respectively. The number of light neutrino types, assuming only the standard model value for the ratio , was found to be 3.35 ± 0.41

Search for a very light Higgs boson in Z decays

A search has been made for a very light Higgs boson in the processes e+e- → e+e-H and e+e- →μ+μ-H using data collected by ALEPH at the LEP e+e- collider at centre of mass energies close to the Z peak. The mass range between 0 and 57 MeV is unambigously excluded at the 95% confidence level. If we combine this with our previously published analysis, the complete range from 0 to 24 GeV is excluded at 95% CL. The search is extended to light Higgs bosons of the minimal supersymmetric standard model, with the result that all possibilities of coupling are excluded for Higgs masses below 3 GeV

Search for excited neutrinos in Z decay

Excited neutrinos decaying into a neutrino and a photon are searched for in the ALEPH detector at LEP. No evidence is found for Z decay into v̄v∗ or v̄∗v∗ final states. Upper limits are derived on excited neutrino couplings up to excited neutrino masses close to the Z mass. Lower limits on the v∗ mass, independent of the v∗ decay modes, are deduced from the total Z width

Search for excited leptons in Z0 decay

We have looked for evidence of excited lepton production in Z0 decay observed in the ALEPH detector at LEP. We find no ℓℓγγ events and set new limits at 95% CL on ℓ∗ masses at 44.6, 44.6 and 41.2 GeV/c2 for respectively. Observed events in the ℓℓγ channels are consistent with radiative effects and we set limits for the first time on the coupling for ℓ∗ masses in the range up to 86 GeV/c2

A precise determination of the number of families with light neutrinos and of the Z boson partial widths

More extensive and precise results are reported on the parameters of Z decay. On the basis of 20 000 Z decays collected with the ALEPH detector at LEP we find Mz=91.182±0.026 (exp.) ±0.030 (beam) GeV, Γz=2.541±0.056 GeV and σhad0=41.4±0.8 nb. The partial widths for the hadronic and leptonic channels are Γhad=1804±44 MeV, Γe+e−=82.1±3.4 MeV, Γμ+μ−=87.9±6.0 MeV and Γτ+τ−=86.1±5.6 MeV, in good agreement with the standard model. On the basis of the average leptonic width Γℓ+ℓ−=83.9±2.2 MeV, the effective weak mixing angle is found to be sin2θw(Mz)=0.231±0.008. Usin g the partial widths calculated in the standard model, the number of light neutrino families is Nν=3.01±0.15 (exp.)±0.05 (theor.)