[17ß-estradiol inhibits interleukin-1ß-induced rat nucleus pulposus cell apoptosis through the PI3K/Akt/mTOR signal pathway].

The apoptosis of nucleus pulposus cells (NPCs) is the main cellular process of intervertebral disc degeneration (IVDD). Our previous studies showed that 17ß-estradiol (E2) protects rat NPCs from interleukin-1ß (IL-1ß)-induced apoptosis via the PI3K/Akt signaling pathway. This study was aimed to investigate whether downstream proteins of PI3K/Akt pathway were involved in inhibition of E2 on NPCs' apoptosis. Primary culture of rat NPCs was isolated by trypsin digestion. Being pretreated with E2 and different inhibitors of downstream proteins of PI3K/Akt pathway, the NPCs were treated with IL-1ß. Cellular apoptosis was detected by Annexin V/PI staining. Cell viability was detected by CCK-8. Cell adhesion was evaluated by cell-collagen binding assay. Phosphorylation levels of mammalian target of Rapamycin (mTOR), glycogen synthase kinase-3ß (GSK-3ß) and nuclear factor κB (NF-κB) were detected by Western blot. The results showed that E2 significantly inhibited the IL-1ß-induced apoptosis of NPCs, reversed the decrease of cell viability and adhesion induced by IL-1ß, and inhibited the down-regulation of mTOR phosphorylation level induced by IL-1ß. Rapamycin could block these protective effects of E2. These results suggest that E2 may inhibit IL-1ß-induced NPCs' apoptosis through the PI3K/Akt/mTOR signaling pathway.

Local Infiltration Analgesia Versus Regional Blockade for Postoperative Analgesia in Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Total knee arthroplasty (TKA) is one of the most commonly performed procedures while postoperative analgesia still remains challenging. The efficacy and safety of local infiltration analgesia (LIA) versus regional blockade (RB; epidural analgesia and/or peripheral nerve block) for pain management after TKA are controversial. OBJECTIVES: The purpose of this meta-analysis was to determine whether LIA compared with RB would provide better postoperative pain control, consume less morphine, facilitate early functional recovery, entail a differential risk of side effects and complications, and allow a shorter length of stay. STUDY DESIGN: This meta-analysis pooled all data published in randomized controlled trials (RCTs) examining the efficacy and safety of LIA versus RB following TKA. SETTING: The work was performed at Affiliated Cixi Hospital, Wenzhou Medical University. METHODS: Literature in English was searched using EMBASE, Medline, Cochrane Library, CINAHL, Web of Science, and Scopus from inception to April 2015. RCTs that compared LIA and RB for postoperative analgesia following TKA were included. Methodological quality was assessed using the Cochrane Back Review Group checklist, and a sensitivity analysis was performed. Sixteen RCTs with a total of 1,206 patients were finally included in our study. RESULTS: The results of our meta-analysis indicate that patients managed by LIA showed significantly lower numeric rating scale (NRS) score at rest (WMD: -0.40 [-0.72, -0.07]; P = 0.02) when compared with those managed by RB. Difference of morphine consumption was not significant (WMD: -1.39 [-7.21, 4.44]; P = 0.64) between the 2 groups. In terms of early functional recovery, the LIA group showed more straight leg raise (RR: 2.90 [2.15, 3.93]; P < 0.00001) on the first postoperative day; better range of motion within one week (WMD: 4.33 [2.61, 6.05]; P < 0.00001), but not at 3 months (WMD: 1.98 [-0.02, 3.98]; P = 0.05); and comparable knee society score (WMD: -8.79 [-27.05, 9.48]; P = 0.35). Length of hospital stay of the LIA group was marginally shorter (WMD: -0.25 [-0.49, -0.01]; P = 0.05) than that of the RB group. Risk of side effects and complications were comparable between groups. LIMITATIONS: The lack of a standard criterion regarding the technique details of LIA and heterogeneity resulting from the various analgesic components, dosages, and different administration methods might have posed a bias on the results. CONCLUSION: Our results have indicated that LIA provided better analgesia than RB at rest and preserved quadriceps function in the immediate postoperative period, which may be beneficial to early functional recovery. And its safety profile is reliable. With the biases in our meta-analysis, a rigorous and adequately powered RCT is needed to validate our results. KEY WORDS: Local infiltration analgesia, regional block, peripheral nerve block, epidural analgesia, postoperative analgesia, total knee arthroplasty, meta-analysis, randomized controlled trial.

[Treatment of Bennett's fracture with closed reduction and percutaneous Kirschner wire fixation].

OBJECTIVE: To evaluate clinical effect of new method of percutaneous Kirschner wire fixation in treating Bennett's fracture. METHODS: Thirteen patients with Bennett's fracture were treated with close reduction and percutaneous Kirschner wire fixation. There were male 8 cases and female 5 cases with an average age of 32 years (range from 20 to 45 years). The mean time from injury to operation was 4.3 days (range from 2 to 7 days). External fixation with plaster slab was applied after operation with an average of 35 days (range from 30 to 41 days). The reduction of articular surface, symptom of ache and function of thumb after operation were evaluated. RESULTS: All the patients were followed up with an average of 6.4 months (range from 4 to 9 months). All fractures united and the articular surfaces were reduced well. Only 1 case has mild pain when activity. The grasp force decreased in all patients. CONCLUSION: Close reduction and percutaneous Kirschner wire fixation has advantage such as simply operation, precisely fixation, high potency ratio. The method especially fits Bennett's fracture with small triangular fragment.