Local infiltration analgesia versus femoral nerve block in total knee arthroplasty: a meta-analysis.

INTRODUCTION: Local infiltration analgesia (LIA) and femoral nerve block (FNB) are both used for the pain management after total knee arthroplasty (TKA). Controversy still remains regarding the optimal technique for pain relief in patients undergoing TKA. The purpose of this meta-analysis was to compare the analgesia achieved with LIA and the one from FNB following TKA. HYPOTHESIS: LIA achieves better pain control than FNB in patients with TKA. METHODS: Databases, including Pubmed, EMBASE, the Cochrane Library and Web of Science were comprehensively searched to identify studies comparing LIA with FNB for patients with TKA. Two reviewers independently selected trials, extracted data, and assessed the methodological qualities of included studies. Data were analyzed by RevMan 5.2. RESULTS: Nine RCTs involving 782 patients were included. LIA achieved more rapid pain relief (VAS) at 6h postoperatively [SMD6h=-0.92, 95% CI (-1.38, -0.47)] than FNB. There were no significant differences at 24h and 48h [SMD24h=-0.03, 95% CI (-0.46, 0.40); SMD48h=0.28, 95% CI (-0.35, 0.91)], VAS with activity at 24h and 48h [SMD6h=-0.54, 95% CI (-1.62, 0.54); SMD24h=-0.22, 95% CI (-1.41, 0.96); SMD48h=-0.08, 95% CI (-0.52, 0.69)], opioid consumption at 24h and 48h [SMD24h=-0.24, 95% CI (-0.82, 0.34); SMD48h=0.15, 95% CI (0.25, 0.54)] and length of hospital stay [MD=-0.52, 95% CI (-1.13, 0.09)]. DISCUSSION: LIA may be the better choice in the pain management of TKA for it could achieve fast pain relief and is easier to perform than FNB for patients with TKA. LEVEL OF EVIDENCE: Level II, meta-analysis and systematic review.

Bioengineered skin in diabetic foot ulcers.

OBJECTIVE: Bioengineered skin (BS) has been shown to play an important role in the treatment of diabetic foot ulcers (DFUs). Whether BS in the therapy of DFU can improve the outcomes still remains uncertain. We performed a quantitative meta-analysis of available randomized controlled trials to determine the effectiveness and safety of BS in the treatment of patients with DFUs. DESIGN AND METHODS: Comprehensive search strategies of various electronic databases were used for this study to evaluate the effectiveness and safety between BS and conventional treatment (CT) in patients with DFU, and only randomized controlled trials were adopted in our review. Search terms included 'bioengineered skin', 'tissue-engineering skin', 'human-tissue graft', 'human-skin device', 'living-skin equivalent' and 'diabetic foot', 'diabetic ulcer', 'diabetic wound'. Analysis outcomes included complete wound closure, complications, ulcer recurrence and adverse severe events (ASEs). RESULTS: Seven randomized controlled trials on BS vs. CT were included, and 880 participants met inclusion criteria. Pooled analysis showed a significant effectiveness and safety advantages for BS treatment compared to CT for patients with DFUs. In analysis of complications, only statistically significant difference of infection was noted. And no included trials reported ASEs related to these treatments. CONCLUSIONS: Based on the meta-analysis, patients with DFUs may benefit from the BS because of its high effectiveness and safety and reduced risk for infections in comparison to CT.

Direct electron transfer of Horseradish peroxidase on porous structure of screen-printed electrode.

Disposable hydrogen peroxide biosensor was developed based on the direct electron transfer of horseradish peroxidase (HRP) on porous screen-printed carbon electrodes. Conventional screen-printing process was manually performed to fabricate the planar carbon electrodes, which were endowed with porous surfaces especially after anodizing pretreatment. The cyclic voltammetry experiment indicated a pair of stable and well-defined redox peaks with a formal potential of -0.33 V. And the formal potential was pH-dependent, having a slope of -55.2 mV/pH which indicated one electron transfer. The heterogeneous electron transfer rate constant k(s) was estimated to be 13.28+/-4.80s(-1). Additionally, the sensitivity was 143.3 mAM(-1)cm(-2) and the linear range was from 5.98 to 35.36 microM. In conclusion, the present work achieved the direct electron transfer of HRP on screen-printed electrodes without any promoters. The porous structure of screen-printed carbon electrodes facilitated the direct electron transfer between the active sites of HRP and the electrodes due to large amounts of conductive sites available on the surface for contacting with enzyme molecules. Moreover, the proposed biosensor could be mass-produced at low price, promising for commercial application.