The Analgesic Efficacy of Intraperitoneal Ropivacaine Versus Bupivacaine for Laparoscopic Cholecystectomy: a Meta-Analysis.

INTRODUCTION: This meta-analysis aimed to compare the analgesic efficacy of intraperitoneal ropivacaine versus bupivacaine for laparoscopic cholecystectomy. METHODS: We searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases from inception through January 2020 and included randomized controlled trials (RCTs) evaluating the analgesic efficacy of ropivacaine versus bupivacaine for laparoscopic cholecystectomy. RESULTS: Five RCTs are included in the meta-analysis. In patients with laparoscopic cholecystectomy, ropivacaine and bupivacaine demonstrated comparable pain scores at 2 h (SMD = -0.22; 95% CI = -0.54 to 0.10; p = 0.18), 4 h (SMD = -0.16; 95% CI = -0.42 to 0.10; p = 0.22), 8 h (SMD = -0.60; 95% CI = -1.19 to -0.01; p = 0.05), and 24 h (SMD = 0.33; 95% CI = -1.19 to 1.84; p = 0.67), as well as time to first analgesic requirement (SMD = 0.10; 95% CI = -0.23 to 0.42; p = 0.56). CONCLUSIONS: Intraperitoneal ropivacaine and bupivacaine have a similar analgesic efficacy for laparoscopic cholecystectomy.

Analgesic comparison between perineural and intravenous dexamethasone for shoulder arthroscopy: a meta-analysis of randomized controlled trials.

INTRODUCTION: The analgesic comparison between perineural and intravenous dexamethasone on interscalene block for pain management after shoulder arthroscopy remains controversial. We conduct this meta-analysis to explore the influence of perineural versus intravenous dexamethasone on interscalene block for pain control after shoulder arthroscopy. METHODS: We have searched PubMed, Embase, Web of science, EBSCO and Cochrane library databases through April 2021 and included randomized controlled trials (RCTs) assessing the effect of perineural and intravenous dexamethasone on interscalene block in patients with shoulder arthroscopy. RESULTS: Five RCTs were included in the meta-analysis. Overall, compared with intravenous dexamethasone for shoulder arthroscopy, perineural dexamethasone led to similar block duration (SMD = 0.12; 95% CI - 0.12 to 0.35; P = 0.33), pain scores at 12 h (SMD = - 0.67; 95% CI - 1.48 to 0.15; P = 0.11), pain scores at 24 h (SMD = - 0.33; 95% CI - 0.79 to 0.14; P = 0.17), opioid consumption (SMD = 0.01; 95% CI - 0.18 to 0.19; P = 0.95) and incidence of nausea/vomiting (OR = 0.74; 95% CI 0.38-1.44; P = 0.38). CONCLUSIONS: Perineural and intravenous dexamethasone demonstrated comparable pain relief after shoulder arthroscopy.

Comparison of mortality and complications between bilateral simultaneous and staged total hip arthroplasty: A systematic review and meta-analysis.

BACKGROUND: Total hip arthroplasty (THA) relieves pain and restores function in patients with severe rheumatoid arthritis and osteoarthritis. Over the past few decades, several authors have attempted to assess the efficacy and safety of simultaneous bilateral THA compared with staged bilateral THA. The purpose of this meta-analysis is to compare the mortalities and complications between simultaneous bilateral THA and staged bilateral THA. METHODS: A literature search to identify eligible studies was undertaken to identify all relevant articles published until August 2018. We included studies that compared simultaneous bilateral THA and staged bilateral THA and their effects on mortality and complications. The outcomes included mortality, the occurrence of deep venous thrombosis (DVT), the occurrence of pulmonary embolism (PE), respiratory complications, cardiovascular complications, digestive system complications and the occurrence of dislocation. Stata 12.0 was used for the meta-analysis. RESULTS: Nineteen studies involving 59,257 patients were identified; among them, 16,758 patients were selected for treatment with simultaneous bilateral THA, and 42,499 patients were chosen for the purpose of staged bilateral THA. The meta-analysis results demonstrated that there was no significant difference between simultaneous bilateral THA and staged bilateral THA in terms of mortality (risk ratio [RR] = 1.15, 95% CI = 0.76, 1.74; P = .520). Compared with staged bilateral THA, simultaneous bilateral THA was associated with a reduction in the occurrence of DVT, PE and respiratory complications (P < .05). There were no significant differences in the cardiovascular complications, digestive system complications or the occurrence of dislocation and infection (P = .057). CONCLUSIONS: We observed that the prevalence of DVT, PE and respiratory complications was considerably lower with the use of simultaneous bilateral THA than with the use of staged bilateral THA. Thus, simultaneous bilateral THA is a considerably safer procedure than staged bilateral THA in selected THA patients.

[Application of free superficial palmar branch of radial artery flap in repairing of soft tissue defect of fingers].

Objective: To evaluate the surgical technique and the effectiveness of the free superficial palmar branch of the radial artery flap to repair soft tissue defect of fingers. Methods: Between June 2014 and June 2017, 10 cases (10 fingers) of soft tissue defects of fingers were repaired with the free superficial palmar branch of the radial artery flaps. There were 8 males and 2 females with an average age of 29.8 years (range, 23-42 years). The causes of injury included the chainsaw cutting injury in 6 cases, the machine crush injury in 2 cases, and the glass scratching in 2 cases. The time from injury to admission was 1-8 hours with an average of 3 hours. The locations were the volar of the middle of index finger in 3 cases, the volar of the distal of index finger in 1 case, the volar of the distal of middle finger in 3 cases, the ulnar side of distal interphalangeal joint of ring finger in 1 case, and the volar of the distal of the little finger in 2 cases. The area of soft tissue defect ranged from 1.8 cm×0.9 cm to 2.8 cm×2.1 cm, and the area of flap ranged from 2.0 cm×1.0 cm to 3.0 cm×2.3 cm. The donor sites were sutured directly. Results: All flaps survived after operation, and the wounds healed by first intention. The incisions of donor site also healed by first intention with a linear scar. All cases were followed up 6-12 months (mean, 9 months). The appearance and texture of the flaps were satisfactory. The pain sensation, warm sensation, and touch sensation of the flap recovered. At last follow-up, the two-point discrimination of the flap was 6-13 mm (mean, 7.5 mm). According to the assessment of the upper limb function issued by tha Hand Surgery Society of Chinese Medical Association, the results were graded as excellent in 8 cases and good in 2 cases. Conclusion: The free superficial palmar branch of the radial artery flap is easy to harvest and anastomose and has small injury. It is an ideal method in repairing of soft tissue defects of fingers.

Knockdown of PRMT1 suppresses IL-1ß-induced cartilage degradation and inflammatory responses in human chondrocytes through Gli1-mediated Hedgehog signaling pathway.

Osteoarthritis (OA) is characterized by articular cartilage degradation and joint inflammation. The purpose of the present study is to elucidate the role of the specific function of PRMT1 in chondrocytes and its association with the pathophysiology of OA. We observed that the expression of PRMT1 was apparently upregulated in OA cartilage, as well as in chondrocytes stimulated with IL-1ß. Additionally, knockdown of PRMT1 suppressed interleukin 1 beta (IL-1ß)-induced extracellular matrix (ECM) metabolic imbalance by regulating the expression of MMP-13, ADAMTS-5, COL2A1, and ACAN. Furthermore, silencing of PRMT1 dramatically declined the production of prostaglandin E2 (PGE2) and nitric oxide as well as the level of pro-inflammatory cytokine IL-6 and TNF-α. Mechanistic analyses further revealed that IL-1ß-induced activation of the Hedgehog/Gli-1 signaling is suppressed upon PRMT1 knockdown. However, the effects of inhibition of PRMT1-mediated IL-1ß-induced cartilage matrix degradation and inflammatory response in OA chondrocytes were obviously abolished by Hedgehog agonist Purmorphamine (Pur). Our data collectively suggest that silencing of PRMT1 exerts anti-catabolic and anti-inflammatory effects on IL-1ß-induced chondrocytes via suppressing the Gli-1 mediated Hedgehog signaling pathway, indicating that PRMT1 plays a critical role in OA development and serves as a promising therapeutic target for OA.

Efficacy of ultrasound in the treatment of osteoarthritis of the knee.

OBJECTIVE: To investigate the effect of ultrasound in the treatment of osteoarthritis of the knee. METHODS: Eighty-seven out- and in-patients with osteoarthritis of the knee (15 men and 72 women) underwent ultrasonic therapy from February to October 2010. The patients were randomly assigned to an ultrasound group (Group A) and a placebo group (Group B). Group A was offered ultrasonic therapy while Group B underwent mock treatment. The visual analogue scale (VAS) and Lequesne scores of the two groups before and after treatment were compared. The data were analyzed by normal distribution, Student's t-test and the rank sum test. The means during and after treatment of the VAS and Lequesne efficacy index of the treatment group were calculated and plotted on a bar graph. RESULTS: Single sample analysis of Groups A and B showed VAS efficacy index: mean = 0.3640, P= 0.000; Lequesne efficacy index, median = 0.3080, P= 0.000, and mean = 0.1000, P= 0.000; Lequesne efficacy index, mean = 0.0364, P= 0.024, respectively. Independent samples t test and rank sum test showed significant differences between the two groups, namely P= 0.000 for both the VAS and Lequesne curative effect indexes. The means of the VAS efficacy index of the treatment group increased during and after treatment. The means of the Lequesne efficacy index of the treatment group showed no apparent decrease by 28 days after treatment. CONCLUSION: Ultrasound treatment significantly alleviates joint symptoms, relieving joint swelling, increasing joint mobility and reducing inflammation, in osteoarthritis patients.