Amorphous-crystalline RuTi nanosheets enhancing OH species adsorption for efficient hydrogen oxidation catalysis.

Anion exchange membrane fuel cells are a potentially cost-effective energy conversion technology, however, the electrocatalyst for the anodic hydrogen oxidation reaction (HOR) suffers from sluggish kinetics under alkaline conditions. Herein, we report that Ru-based nanosheets with amorphous-crystalline heterointerfaces of Ru and Ti-doped RuO2 (a/c-Ru/Ti-RuO2) can serve as a highly efficient HOR catalyst with a mass activity of 4.16 A mgRu-1, which is 19.8-fold higher than that of commercial Pt/C. Detailed characterization studies show that abundant amorphous-crystalline heterointerfaces of a/c-Ru/Ti-RuO2 nanosheets provide oxygen vacancies and unsaturated coordination bonds for balancing adsorption of hydrogen and hydroxyl species on Ru active sites to elevate HOR activity. Moreover, Ti doping can facilitate CO oxidation, leading to enhanced strength to CO poisoning. This work provides a strategy for enhancing alkaline HOR performance over Ru-based catalysts with heteroatom and heterointerface dual-engineering, which will attract immediate interest in chemistry, materials science and beyond.

CircRNA GRB10 is a Novel Biomarker for the Accurate Diagnosis of Lumbar Degenerative Disc Disease.

Lumbar degenerative disc disease (LDDD) is frequently misdiagnosed as other spine conditions, and the accurate diagnosis is challenging. This study was conducted to explore the role of circRNA GRB10 in the accurate diagnosis of LDDD. This study included 60 cases of LDDD, 60 cases of patients with sacroiliac joint pain (SJP), 60 cases of lumbar disc herniation (LDH), 60 cases of piriformis syndrome (PS), 60 cases of entrapment neuropathy (EN) and 60 cases of healthy controls (HCs). Plasma was obtained from each patient before and after treatment. Expression of GRB10 was studied with RT-qPCR. The role of plasma GRB10 in the accurate diagnosis of LDDD was analyzed by ROC curve analysis. Compared to HCs, decreased accumulation of GRB10 RNA was only observed in LDDD group, but not in SJP, LDH, PS and EN groups. With plasma expression level of GRB10 measured before treatment as a biomarker, LDDD patients were separated from SJP, LDH, PS, EN and HC groups. After treatment, increased expression levels of GRB10 were only observed in LDDD group, but not in other groups. Therefore, GRB10 was downregulated in LDDD and may serve as a biomarker for the accurate diagnosis of LDDD.

In Situ Polymerization of Ionic Liquid with Tunable Phase Separation for Highly Reversible and Ultralong Cycle Life Zn-Ion Battery.

Severe Zn dendrite growth and side reactions greatly limit the application of aqueous zinc-ion batteries. Herein, we design a layer of polyionic liquid (PCAVImBr) film with a tunable pore size and charge density on the Zn anode to endow homogenized distribution of an electronic field, acerated Zn2+ permeation, and inhabitation of water entry. Such an optimal combination is achieved via a polymerization induced phase separation strategy, where the enhanced cross-linking density arrests the phase separation in a shallow depth and vice versa. Furthermore, the Zn@PCAVImBr electrode has good plating/stripping reversibility, which retains a 99.6% CE efficiency after 3000 cycles. The symmetric cells can achieve a cycle life of more than 2400 h at different current densities. It is worth mentioning that the NVO//Zn@PCAVImBr full cell can still reach a 91.2% capacity retention after nearly 4000 cycles at a high current of 10 A g-1, and provides new insights for the future research of zinc-ion battery anodes.

Manipulating the Electronic Structure of Graphite Intercalation Compounds for Boosting the Bifunctional Oxygen Catalytic Performance.

Developing highly efficient bifunctional catalysts for the oxygen reduction and oxygen evolution reaction (ORR/OER) can open possibilities for future zinc air batteries (ZABs). Herein, cost-effective and highly conductive few-layer ferric and nickel chloride co-intercalated graphite intercalation compounds (FeCl3 -NiCl2 -GIC) are designed as bifunctional oxygen catalysts for ZAB. The optimized few-layer FeCl3 -NiCl2 -GIC catalyst exhibits a small overpotential of 276 mV at 10 mA cm-2 for the OER and achieves a high onset potential of 0.89 V for the ORR. The theoretical analysis demonstrates the electron-rich state on the carbon layers of FeCl3 -NiCl2 -GIC during the catalytic process favors the kinetics of electron transfer and lowers the absorption energy barriers for intermediates. Impressively, the ZAB assembled with few-layer FeCl3 -NiCl2 -GIC catalyst displays a 160 h cycling stability and a high energy efficiency of 72.6%. This work also suggests the possibility of utilizing layer electronic structure regulation on graphite intercalation compounds as effective bifunctional catalysts for ZABs.

Effects of Platelet-Rich Plasma and Bone Marrow Mesenchymal Stem Cells on Meniscal Repair in the White-White Zone of the Meniscus.

OBJECTIVE: To investigate the role of autologous platelet-rich plasma (PRP) on the repair of meniscal white-white zone injury through promoting the proliferation of canine bone marrow-derived mesenchymal stem cells (BMSCs). METHODS: A total of 24 beagle dogs were selected to construct meniscal white-white zone injury models in both lateral knee joints. All subjects were divided into four groups: control, BMSCs, PRP, and PRP + BMSCs. Immunohistochemistry was applied in the expression detection of type I and type II collagens. HE staining and methylene blue staining were performed to observe the injury of cartilage of lateral femoral condyle in each group. ELISA was used to detect the osteopontin (OPN) content in cartilage of lateral femoral condyle. HE staining and magnetic resonance imaging (MRI) were used to observe the healing of meniscus in each group. Outcome measures include the expression of OPN in the synovial fluid of knee joint, the expression of type I collagen and type II collagen, the healing of meniscus injury, and the damage degree of lateral femoral condyle cartilage. RESULTS: Compared with the control group, the expressions of type I and type II collagens were enhanced in the PRP group and the PRP + BMSCs group. Compared with 1 week before modeling, the expression of OPN was elevated in the control group and the BMSCs group at 3 weeks after modeling. There were no significant differences in the above indicators between the PRP group and the PRP + BMSCs group. According to MRI and pathological section after HE staining, meniscal healing in the PRP group and the PRP + BMSCs group was significantly improved as compared to that of the control group and the BMSCs group (all P < 0.05), and there was no significant difference between the PRP group and the PRP + BMSCs group (P > 0.05). All subjects were divided into the non-healing group and the healing group in accordance with the HE staining results in previous experiment. The injury of cartilage of lateral femoral condyle was significantly heavier in the non-healing group than that in the healing group. CONCLUSION: The application of PRP alone or in combination with BMSCs could promote the clinical healing rate of meniscal white-white zone injury.

Balloon kyphoplasty combined with posterior pedicle screw fixation for the treatment of osteoporotic thoracolumbar burst fractures.

BACKGROUND: Osteoporotic thoracolumbar burst fracture (TLBF) is difficult to treat due to its high rate of postoperative implant failure. This study was designed to evaluate the clinical effect of balloon kyphoplasty with polymethylmethacrylate (PMMA) and posterior pedicle screw fixation for the treatment of osteoporotic TLBF. METHODS: Between February 2012 and May 2016, 24 consecutive patients with osteoporotic TLBFs were included in this study, all of whom suffered incomplete neurologic deficit. They were managed with transpedicular balloon kyphoplasty, PMMA augmentation, and posterior pedicle screw fixation. Scanning with X-ray and computed tomography (CT) were performed to evaluate the kyphotic deformity with the Cobb angle and vertebral body height loss (VBHL) of the injured vertebra. Visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were adopted to assess the pain and dysfunction levels before and after the operation. RESULTS: All participants were followed up for an average of 18 months and those with incomplete neurologic deficit recovered completely. The Cobb angle significantly improved from a preoperative angle of 23.2°±3.6° to 5.3°±2° after operation and to 5.7°±2.2° at the last follow up (P<0.05). The VBHL improved from 56.8%±7.8% before operation to 9.1%±1.6% after operation and to 9.7%±1.9% at the last follow up (P<0.05). The visual analog scale (VAS) score decreased from 8.8±0.9 before operation to 2.5±0.4 after operation and to 1.4±0.4 at the last follow up (P<0.05). The ODI score decreased from 88.6%±3.5% before the operation to 32.3%±3.7% after operation and to 17.5%±1.8% at the last follow up (P<0.05). CONCLUSIONS: Balloon kyphoplasty combined with posterior pedicle screw fixation was an effective treatment for osteoporotic TLBFs. This procedure can reconstruct 3 spinal columns using a single approach with less blood loss, short operation time, and rapid recovery. Ruptures of the posterior vertebral wall should not be a contraindication of this procedure. TRIAL REGISTRATION: Chinese Clinical Trial Registry (NO.: ChiCTR1900026157).

Radiological and clinical outcomes of balloon kyphoplasty for osteoporotic vertebral compression fracture in patients with rheumatoid arthritis.

BACKGROUND: This study was conducted to investigate the outcomes and complications of balloon kyphoplasty (KP) for the treatment of osteoporotic vertebral compression fracture (OVCF) in patients with rheumatoid arthritis (RA) and compare its radiological and clinical effects with OVCF patients without RA. METHODS: Ninety-eight patients in the RA group with 158 fractured vertebrae and 114 patients in the control group with 150 vertebrae were involved in this study. Changes in compression rate, local kyphotic angle, visual analog scale (VAS) and Oswestry disability index (ODI) scores, conditions of bone cement leakage, refracture of the operated vertebrae, and new adjacent vertebral fractures were examined after KP. In addition, patients in the RA group were divided into different groups according to the value of erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and whether they were glucocorticoid users or not to evaluate their influence on the outcomes of KP. RESULTS: KP procedure significantly improved the compression rate, local kyphotic angle, and VAS and ODI scores in both RA and control groups (p<0.05). Changes in compression rate and local kyphotic angle in the RA group were significantly larger than that in the control group (p<0.05), and patients with RA suffered more new adjacent vertebral fractures after KP. The outcomes and complications of KP from different ESR or CRP groups did not show significant differences. The incidence of cement leakage in RA patients with glucocorticoid use was significantly higher than those who did not take glucocorticoids. In addition, RA patients with glucocorticoid use suffered more intradiscal leakage and new adjacent vertebral fractures. CONCLUSIONS: OVCF patients with RA obtained more improvement in compression rate and local kyphotic angle after KP when compared to those without RA, but they suffered more new adjacent vertebral fractures. Intradiscal leakage and new adjacent vertebral fractures occurred more in RA patients with glucocorticoid use. TRIAL REGISTRATION: Retrospectively registered.

Design Strategies of Si/C Composite Anode for Lithium-Ion Batteries.

Silicon-based materials that have higher theoretical specific capacity than other conventional anodes, such as carbon materials, Li2 TiO3 materials and Sn-based materials, become a hot topic in research of lithium-ion battery (LIB). However, the low conductivity and large volume expansion of silicon-based materials hinders the commercialization of silicon-based materials. Until recent years, these issues are alleviated by the combination of carbon-based materials. In this review, the preparation of Si/C materials by different synthetic methods in the past decade is reviewed along with their respective advantages and disadvantages. In addition, Si/C materials formed by silicon and different carbon-based materials is summarized, where the influences of carbons on the electrochemical performance of silicon are emphasized. Lastly, future research direction in the material design and optimization of Si/C materials is proposed to fill the current gap in the development of efficient Si/C anode for LIBs.

Amorphous Bimetallic Oxides Fe-V-O with Tunable Compositions toward Rechargeable Zn-Ion Batteries with Excellent Low-Temperature Performance.

Vanadium oxides have been considered as promising cathode candidates for zinc-ion batteries (ZIBs) because of their high theoretical specific capacity. However, the poor rate performance and the unsatisfactory cycle life resulting from the sluggish electrode kinetics seriously impede their practical implementation. Herein, we report the rational design of amorphous Fe-V-O bimetallic oxides with tunable compositions as cathodes for aqueous ZIBs. The bimetallic Fe-V-O oxides show improved composition-dependent Zn2+ storage performance and superior structural integrity during cycling. The enhanced electrode kinetics is attributed to the superior electronic conductivity of Fe-V-O oxides than pristine V2O5 owing to the introduction of the Fe element and an amorphous crystalline structure, which can provide reduced diffusion paths and more free volume for Zn2+ insertion. As a result, the as-prepared Fe-V-O exhibits outstanding rate capability and impressive cycling stability. Particularly, a stable reversible capacity of 70 mA h g-1 can be still maintained after 2500 cycles at 5 A g-1, corresponding to the high capacity retention of 95%.

Downregulated miR­302d­3p promotes chondrocyte proliferation and migration by regulation of Unc­51­like kinase 1.

Osteoarthritis (OA) is a common musculoskeletal disease and is related to the function of chondrocytes. The aim of the present study was to investigate the effects of miR­302d­3p on chondrocytes. Quantitative PCR (qPCR) was conducted to detect mRNA expression, while western blotting was performed to investigate protein expression in these cells. RNAs mimics, inhibitors and small interfering (si)RNAs were respectively transfected into chondrocytes (CHON­001 cell line), after which, a Cell Counting Kit­8 assay was performed to detect chondrocyte viability. Giemsa staining of the cells was also conducted to analyze the colony formation ability of the cells. Additionally, cell apoptosis was evaluated with an apoptosis detection kit using flow cytometry. A scratch­wound assay was conducted to investigate cell migration. Bioinformatics analysis using TargetScan 7.2 revealed the potential the target gene of microRNA (miR)­302d­3p; a dual luciferase reporter assay determined the target gene. Suppression of miR­302d­3p increased the viability of cells, cell colony number and migration; CHON­001 cell apoptosis was also inhibited. miR­302d­3p mimics decreased the luciferase activity of reporter plasmids containing the wild-type 3'­untranslated region of Unc­51­like kinase 1 (ULK1). siULK1 decreased CHON­001 cell viability and migration. Furthermore, siULK1 promoted the expression of phosphorylated IκΒα and p65, while miR­302d­3p inhibitor suppressed the expression of phosphorylated IκΒα and p65. Inhibition of miR­302d­3p could promote the proliferation and migration, and inhibit the apoptosis of chondrocytes, potentially by upregulating ULK1; thus, inflammation may be suppressed. The findings of the present study suggest miR­302d­3p and ULK1 as potential therapeutic targets for the prevention and treatment of OA.

Synthesis of 3D Hexagram-Like Cobalt-Manganese Sulfides Nanosheets Grown on Nickel Foam: A Bifunctional Electrocatalyst for Overall Water Splitting.

The exploration of low-cost and efficient bifunctional electrocatalysts for oxygen evolution reaction and hydrogen evolution reaction through tuning the chemical composition is strongly required for sustainable resources. Herein, we developed a bimetallic cobalt-manganese sulfide supported on Ni foam (CMS/Ni) via a solvothermal method. It has discovered that after combining with the pure Co9S8 and MnS, the morphologies of CMS/Ni have modulated. The obtained three-dimensionally hexagram-like CMS/Ni nanosheets have a significant increase in electrochemical active surface area and charge transport ability. More than that, the synergetic effect of Co and Mn has also presented in this composite. Benefiting from these, the CMS/Ni electrode shows great performance toward hydrogen evolution reaction and oxygen evolution reaction in basic medium, comparing favorably to that of the pure Co9S8/Ni and MnS/Ni. More importantly, this versatile CMS/Ni can catalyze the water splitting in a two-electrode system at a potential of 1.47 V, and this electrolyzer can be efficiently driven by a 1.50 V commercial dry battery.

(Fe0.2Ni0.8)0.96S tubular spheres supported on Ni foam as an efficient bifunctional electrocatalyst for overall water splitting.

Earth-abundant and efficient bifunctional electrocatalysts for both hydrogen evolution reaction (HER) and oxygen evolution reaction (OER) are highly significant for renewable energy systems. However, the performance of existing electrocatalysts is usually restricted by the low electroic conductivity and the limited amount of exposed active sites. In this work, (Fe0.2Ni0.8)0.96S tubular spheres supported on Ni foam have been prepared by a sulfuration of FeNi layered double hydroxide spheres grown on Ni foam. Benefiting from the unique tubular sphere architecture, the rich inner defects and the enhanced electron interactions between Fe, Ni and S, this electrocatalyst shows low overpotential of 48 mV for HER at 10 mA cm-2 in 1.0 mol L-1 KOH solution, which is one of the lowest value of non-previous electrocatalyts for HER in alkaline electrolyte. Furthermore, assembled this versatile electrode as an alkaline electrolyzer for overall water splitting, a current density of 10 mA cm-2 is achieved at a low cell voltage of 1.56 V, and reach up to 30 mA cm-2 only at an operating cell voltage of 1.65 V.

Ni3S2 nanowires grown on nickel foam as an efficient bifunctional electrocatalyst for water splitting with greatly practical prospects.

It is essential to synthesize low-cost, earth-abundant bifunctional electrocatalysts for both the hydrogen evolution reaction (HER) and oxygen evolution reactions (OER) for water electrolysis. Herein, we present a one-step sulfurization method to fabricate Ni3S2 nanowires directly grown on Ni foam (Ni3S2 NWs/Ni) as such an electrocatalyst. This synthetic strategy has several advantages including facile preparation, low cost and can even be expanded to large-scale preparation for practical applications. The as-synthesized Ni3S2 NWs/Ni exhibits a low overpotential of 81 and 317 mV to render a current density of 10 mA cm-2 for the HER and OER, respectively, in 1.0 mol l-1 KOH solution. The Ni3S2 NWs/Ni was integrated to be the cathode and the anode in the alkaline electrolyzer for overall water splitting with a current density of 10 mA cm-2 afforded at a cell voltage of 1.63 V. More importantly, this electrolyzer maintained its electrocatalytic activity even after continual water splitting for 30 h. Owing to its simple synthesis process, the earth-abundant electrocatalyst and high performance, this versatile Ni3S2 NWs/Ni electrode will become a promising electrocatalyst for water splitting.

Synthesis of 3D-MoO2 microsphere supported MoSe2 as an efficient electrocatalyst for hydrogen evolution reaction.

Many efforts have been devoted to the exploration of non-noble-metal electrocatalysts for the hydrogen evolution reaction (HER) in recent years. Here, we have developed a 3D-MoO2 microsphere supported MoSe2 for HER, via a facile hydrothermal approach followed by selenylation treatment. Loosely stacked MoSe2 layers are formed on the conductive MoO2 surface, and act as active sites for HER. Meanwhile, the metallic inner MoO2 facilitates electron transport for proton reduction. In addition, the MoSe2 could protect the inner MoO2 from the acidic electrolyte in the HER precess. Significantly, the as-synthesized MoO2/MoSe2 exhibits excellent catalytic activity for HER, characterised by a low onset potential of -101 mV vs reversible hydrogen electrode, a small overpotential of 167 mV at a current density of 10 mA cm-2, along with Tafel slope values of 68 mV dec-1, as well as outstanding stability in 0.5 mol L-1 H2SO4.

A comparative analysis of metal allergens associated with dental alloy prostheses and the expression of HLA-DR in gingival tissue.

The present study aimed to provide guidance for the selection of prosthodontic materials and the management of patients with a suspected metal allergy. This included a comparison of the sensitivity of patients to alloys used in prescribed metal­containing prostheses, and correlation analysis between metal allergy and accompanying clinical symptoms of sensitized patients using a patch test. The results from the patch test and metal component analyses were processed to reach a final diagnosis. In the present study, four dental alloys were assessed. Subsequent to polishing the surface of a metal restoration, the components were analyzed using an X­ray fluorescence microscopy and spectrometry. Immunohistochemical analysis, reverse transcription­polymerase chain reaction and western blotting were used to detect the expression levels of human leukocyte antigen (HLA)­DR in gingival tissues affected by alloy restoration, and in normal gingival tissue samples. Positive allergens identified in the patch test were consistent with the components of the metal prostheses. The prevalence of nickel (Ni) allergy was highest (22.8%), and women were significantly more allergic to palladium and Ni than men (P<0.05). The protein and gene expression levels of HLA­DR in the Ni­chromium (Cr) prosthesis group were significantly higher, compared with those in the other groups (P<0.01); followed by cobalt­Cr alloy, gold alloy and titanium alloy. In conclusion, dentists require an understanding of the corrosion and allergy rates of prescribed alloys, in order to reduce the risk of allergic reactions. Patch testing for hypersensitive patients is recommended and caution is required when planning to use different alloys in the mouth.

Therapeutic Efficacy of E-64-d, a Selective Calpain Inhibitor, in Experimental Acute Spinal Cord Injury.

This study aims to investigate the therapeutic effect of calpain inhibitor E-64-d on SCI and to find a new approach to treat SCI. When an SCI rat model was established, it was immediately administered with E-64-d. RT-PCR and Western blotting were used to determine the protein and mRNA levels of calpain 1 and 68-kD NFP. TUNEL staining and NeuN labeling were performed to analyze neuronal apoptosis in the lesion. Immunohistochemistry assay was carried out to observe the expressions of calpain 1 and GFAP. Cyclooxygenase-2 activity was measured to show the immune response status. Locomotor function was evaluated by inclined plane test and Basso, Beattie, and Bresnahan locomotor rating scale. The results showed that calpain 1 was activated after SCI occurred. Treatment with E-64-d decreased expressions of calpain 1 and GFAP, alleviated neuronal apoptosis, inhibited cyclooxygenase-2 activity, and resulted in the promoted locomotor function. Furthermore, combination of E-64-d and MP had better efficacy than did E-64-d or MP alone. E-64-d is expected to be applied to treat SCI, and its alliance with MP may provide a valid strategy for SCI therapy.

Bone formation in rabbit's leg muscle after autologous transplantation of bone marrow-derived mesenchymal stem cells expressing human bone morphogenic protein-2.

BACKGROUND: To test whether autologous transplantation of bone marrow-derived mesenchymal stem cells (BM-MSCs) expressing human bone morphogenic protein-2 (hBMP-2) can produce bone in rabbit leg muscles. MATERIALS AND METHODS: MSCs were isolated from BM of the iliac crest of rabbits and then infected with lentiviral vectors (LVs) bearing hBMP-2 and green fluorescent protein under the control of the cytomegalovirus (immediate early promoter). Differentiation of transduced MSCs to osteoblasts in vitro was evaluated with an alkaline phosphatase activity assay and immuohistochemistry against osteoblast specific markers. MSCs expressing hBMP-2 were placed in an absorbable gelatin sponge, which was then transplanted into the gastrocnemius of rabbits from which MSCs were isolated. Bone formation was examined by X-ray and histological analysis. RESULTS: LVs efficiently mediated hBMP-2 gene expression in rabbit BM-MSCs. Ectopic expression of hBMP in these MSCs induced osteoblastic differentiation in vitro. Bone was formed after the MSCs expressing hBMP-2 were transplanted into rabbit muscles. CONCLUSION: Ectopic expression of hBMP-2 in rabbit MSCs induces them to differentiate into osteoblasts in vitro and to form a bone in vivo.

Computer navigation and total knee arthroplasty.

Research has added evidence in favor of computer-navigated techniques over conventional surgery for total knee arthroplasty (TKA). The goal of the current meta-analysis was to compare the outcome of outliers in mechanical axis and postoperative complications in patients undergoing conventional vs computer-navigated techniques for TKA. English literature searches were performed in PubMed, EMBASE, Web of Science, and the Cochrane Library for studies published between January 2002 and August 2012. Randomized, controlled trials comparing computer navigation with conventional surgery for the measurement of mechanical axes in patients with primary osteoarthritis were considered eligible. Fifteen trials were eligible for inclusion. The baseline demographics of 2089 patients (computer-navigated=1111; conventional=978) were well matched. Publication bias was eliminated using the funnel plot. A mechanical axis of more than 30° was considered to be malalignment and an outlier in limb alignment. A significant increase of 16.9 minutes in mean operative time for computer-navigated TKA was observed (P=.046). Although patients undergoing computer-navigated TKA had fewer outliers in mechanical axis (13.4%) compared with the conventional technique (27.4%), the results did not achieve statistical significance (I2=0.0%; P=1.000). Fewer complications were observed in patients undergoing computer-navigated TKA (4%) compared with conventional TKA (6.5%).

Lower limb amputation and rehabilitation in total joint arthroplasties in the ipsilateral limb.

BACKGROUND: Degenerative joint disease is not uncommon in amputees and reaches the orthopedic surgeon when all other conservative methods to manage these patients have failed. Several case reports describing hip and knee arthroplasties in patients with hip and knee joint diseases or fractures with the distal part amputated, either in the contralateral or ipsilateral limb, exist in literature. OBJECTIVE: This article focuses only on total knee and total hip arthroplasty in amputees who have had severe osteoarthritis of the ipsilateral hip and knee joints. STUDY DESIGN: Literature review. METHOD: Literature search in database and summary of all the cases. RESULTS: All narratives indicate positive outcomes with improvement in physical function and quality of life. CONCLUSION: The reports suggest that slight modifications in surgical procedure and in the rehabilitation protocol as compared to other patients with joint arthroplasties can alleviate pain and make such patients ambulatory and gain maximum range of motion. Therefore, it appears that careful preoperative evaluation and planning tailored to suit individual cases maximizes postoperative good end results beneficial to the patients regardless of age or cause of osteoarthritis.

Single-dose intra-articular morphine after arthroscopic knee surgery: a meta-analysis of randomized placebo-controlled studies.

PURPOSE: The purpose of this quantitative meta-analysis is to appraise the efficacy and side effects of intra-articular morphine in patients undergoing arthroscopic knee surgery. METHODS: The comprehensive literature search, using Medline (1966 to 2013), the Cochrane Central Register of Controlled Trials, and EMBASE databases, was conducted to identify randomized placebo-controlled trials that used single-dose intra-articular morphine for postoperative pain. The relative risk (RR), standardized mean difference (SMD), and their corresponding 95% confidence intervals (CIs) were calculated using statistical software. RESULTS: Twenty-six articles were included in the meta-analysis. The acute postoperative visual analog scale (VAS) pain scores of the morphine group compared with the control group were significantly lower (SMD, -1.16; 95% CI, -1.79 to -0.53; P = .0003). The number of patients requiring supplementary analgesia was also significantly reduced (RR, 0.80; 95% CI, 0.70 to 0.93; P = .008), and there was a significant difference in the time to first analgesic request (SMD, 1.47; 95% CI, 0.49 to 2.44; P = .003) when the morphine group was compared with the placebo group. However, there was no significant difference in side effects between the morphine group and the control group (RR, 0.93; 95% CI, 0.67 to 1.28; P = .65). CONCLUSIONS: The key findings of the present study were that the administration of single-dose intra-articular morphine at the end of arthroscopic knee surgery provided better pain relief, reduced the need for supplementary analgesics, and lengthened the time interval before the first request for additional analgesic medication, all with short-term side effects similar to those of the saline placebo. LEVEL OF EVIDENCE: Level II, meta-analysis of Level I-II studies.