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BACKGROUND: The optimal analgesia for total knee arthroplasty (TKA) requires excellent analgesia while preserving muscle strength. This study aimed to determine the hypothesis that continuous adductor canal block (CACB) combined with the distal interspace between the popliteal artery and the posterior capsule of the knee (IPACK) block could effectively alleviate the pain of the posterior knee, decrease opioids consumption, and promote early recovery and discharge. METHODS: Patients undergoing unilateral, primary TKA were allocated into group CACB+SHAM (receiving CACB plus sham block) or group CACB+IPACK (receiving CACB plus IPACK block). The primary outcome was cumulative opioid consumption. Secondary outcomes included the incidence of postoperative pain originated from the posterior knee, visual analogue scale (VAS) score, range of motion, ambulation distance, and satisfaction for pain management. RESULTS: The incidence of moderate-severe pain of the posterior knee was lower in group CACB+IPACK than that of the group CACB+SHAM at 4 hours (17.1% vs. 42.8%; p = 0.019), 8 hours (11.4% vs. 45.7%; p = 0.001), and 24 hours (11.4% vs. 34.3%; p = 0.046) after TKA. The VAS scores of the posterior knee were lower in group CACB+IPACK than that of the group CACB+SHAM at 4 hours [2 (2) vs. 3 (2-4); p = 0.000], 8 hours [1 (1, 2) vs. 3 (2-4); p = 0.001], and 24 hours [1(0-2) vs. 2 (1-4); p = 0.002] after TKA. The overall VAS scores were lower in group CACB+IPACK than that of the group CACB+SHAM at 4 hours [3 (2, 3) vs. 3 (3, 4); p = 0.013] and 8 hours [2 (2, 3) vs. 3 (2-4); p = 0.032] at rest and 4 hours [3 (3, 4) vs. 4 (4, 5); p = 0.001], 8 hours [3 (2-4) vs. 4 (3-5); p = 0.000], 24 hours [2 (2, 3) vs. 3 (2-4); p = 0.001] during active flexion after TKA. The range of motion (59.11 ± 3.90 vs. 53.83 ± 5.86; p = 0.000) and ambulation distance (44.60 ± 4.87 vs. 40.83 ± 6.65; p = 0.009) were superior in group CACB+IPACK than that of the group CACB+SHAM in postoperative day 1. The satisfaction for pain management was higher in group CACB+IPACK than that of the group CACB+SHAM [9 (8, 9) vs. 8 (7-9); p = 0.024]. There was no difference in term of cumulative opioids consumption between group CACB+IPACK and group CACB+SHAM [120(84-135) vs. 120(75-135); p = 0.835]. CONCLUSION: The combination of CACB and distal IPACK block could decrease the incidences of moderate-severe posterior knee pain, improve the postoperative pain over the first 24 hours after TKA, as well as promoting recovery of motor function. However, the opioids consumption was not decreased by adding distal IPACK to CACB. TRIAL REGISTRATION: This study was registered at Chinese Clinical Trial Registry ( ChiCTR2200059139 ; registration date: 26/04/2022; enrollment date: 16/11/2020; http://www.chictr.org.cn ).

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The water-blocking effect is a serious problem when developing tight sandstone gas reservoirs, which can cause a sharp reduction in gas production. Wettability alteration of near-wellbore sand rock surface from superhydrophilicity to superhydrophobicity is an effective method to decrease capillary pressure. In this study, a superhydrophobic fluorinated nano-emulsion was synthesized via a soap-free emulsion polymerization process using methacryloxyethyl trimethyl ammonium chloride, trifluoctyl methacrylate, and styrene as monomers. The effect of the fluorinated monomer concentration on wettability alteration was evaluated by measuring the contact angle of the formation water droplet on the modified glass slides using nano-emulsions with different fluorinated monomer concentrations. The results showed that the nano-emulsion had a good dispersibility and homogeneous particle size of around 90 nm, and with the increase in fluorinated monomer concentration, the contact angle increased. The contact angle was the largest when the fluorinated monomer mass rate concentration reached 50%. The adsorption of nanoparticles could alter the rock wettability from a super hydrophilic state (θ = 7°) to a superhydrophobic state (θ = 150°). The spontaneous imbibition experiments showed that the formation water adsorption quality of the core decreased by 49.7% after being modified by the nano-emulsion. The nano-emulsion showed a good superhydrophobicity and had the potential to be used to reduce the water-blocking damage in the tight gas reservoirs.

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Objectives: To investigate the effect of flurbiprofen axetil combined with "cocktail" therapy on opioid dosage in patients after total knee arthroplasty (TKA). Methods: The clinical data of 200 patients who underwent TKA in Baoding No.1 Central Hospital hospital from March 2019 to March 2021 were collected for retrospective analysis. All 200 patients were divided into two groups according to their intraoperative anesthesia methods: the control group (100 cases) and the experimental group (100 cases). Patients in the control group were treated with "cocktail" therapy intraoperatively, while those in the experimental group were treated with flurbiprofen axetil combined with "cocktail" therapy intraoperatively. The hip pain scores in resting state and motion state were compared between the two groups at different postoperative time points, and postoperative pain relief, adverse reactions, and patient satisfaction with analgesia were statistically analyzed to evaluate the postoperative quality of life of the patients. Results: A statistically significant difference was observed in the intergroup and temporal effects of pain scores in resting state and motion state between the two groups (p<0.05). By comparison at each time point, the pain scores in the experimental group were significantly lower than those in the control group at the time point T1-T6 in resting and motion states, with a statistically significant difference (p<0.05). The frequency and dosage of remedial medication per capita in the experimental group were significantly lower than those in the control group, with a statistical significance (p<0.05). There was no significant difference in the scores of life quality items between the two groups preoperatively (p>0.05), while the scores of each item in the experimental group were significantly higher than those in the control group postoperatively (p<0.05). The satisfaction degree of the experimental group was significantly higher than that of the control group, showing a statistically significant difference (p<0.05). Conclusions: Flurbiprofen axetil combined with "cocktail" therapy is a safe treatment regimen that can improve the quality of life and safety of patients. With such a regimen, postoperative pain of patients undergoing TKA can be effectively relieved, and the use of opioids can be reduced.

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OBJECTIVES: To identify the precise position of adductor canal; and to determine median effective volume (EV50) for adductor canal block (ACB) by ultrasound. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Anesthesiology, the First Central Hospital of Baoding, China from January 2019 to December 2020. METHODOLOGY: One hundred and ninety subjects were recruited for mapping, the precise location of adductor canal. Twenty-four patients were scheduled to study the EV50 of ropivacaine. Ultrasound was used to identify the anatomical structure of femoral triangle as well as the cephalad and caudad end of adductor canal. By using the up-and-down method to study the effect of nerve block, the EV50 of 0.5% ropivacaine on ACB was quantified. RESULTS: The femoral triangle, the cephalad, and caudad end of adductor canal were clearly shown in the ultrasound images of all subjects. The midpoint between anterior superior iliac spine and the superior margin of patella is in femoral triangle. The cephalad edge of adductor canal is distal to the midpoint between anterior superior iliac spine and the superior margin of patella. The midpoint between the femoral trochanter and the superior margin of patella is in the adductor canal. EV50 of 0.5% Ropivacaine for ACB is 10.79 ml (95% CI, 10.10-11.52 ml). CONCLUSION: The midpoint between the femoral trochanter and the superior margin of patella is in the adductor canal. EV50 of 0.5% ropivacaine for ACB is 10.79 ml (95% CI, 10.10-11.52 ml). Key Words: Adductor canal, Location, Ultrasound, Median effective volume, Nerve block.

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BACKGROUND Multimodal analgesic regimens are well known as the best option for total knee arthroplasty. They include the adductor canal block, combined with local infiltration analgesia and a block of the interspace between the popliteal artery and the capsule of the posterior knee. However, these analgesic techniques all require a large amount of local anesthetics. In this study, we explored whether the quantity of local anesthetics could be decreased by using dexmedetomidine for the adductor canal block. MATERIAL AND METHODS Fifty-four patients scheduled for unilateral, primary total knee arthroplasty were allocated into 2 groups: the ropivacaine group (group R) and the dexmedetomidine group (group RD). Ropivacaine 0.5% was chosen as the initial concentration, and the concentration was decreased or increased according to the response of the previous participant. Based on Dixon's up-and-down method, the median effective concentration was calculated. RESULTS The quadriceps strength was similar between the 2 groups, both at 30 min after adductor canal block and during recovery from general anesthesia in the Postanesthesia Care Unit. None of the patients in this study exhibited bradycardia or hypotension. The median effective concentration of ropivacaine for adductor canal block was 0.29% (95% confidence interval [CI], 0.28-0.31%) in group RD, which was lower than that in group R (0.38% [95% CI, 0.36-0.41%]). CONCLUSIONS This study found perineural dexmedetomidine 1 µg/kg could reduce the median effective concentration of ropivacaine for the adductor canal block.

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OBJECTIVE: To investigate the femoral bone remodeling and long-term effectiveness of total hip arthroplasty (THA) with anatomic medullary locking (AML) prosthesis. METHODS: The clinical data of 24 cases (26 hips) who were treated with THA with AML prosthesis between November 1997 and January 2003 were retrospectively analyzed. There were 12 males and 12 females with an age of 32-69 years (mean, 53.7 years). There were 5 cases (5 hips) of avascular necrosis of the femoral head, 6 cases (7 hips) of secondary osteoarthritis of the hip dysplasia, 6 cases (6 hips) of femoral neck fracture, 2 cases (2 hips) of primary osteoarthritis, 3 cases (3 hips) of revision surgery, 1 case (2 hips) of ankylosing spondylitis, 1 case (1 hip) of femoral head fracture. The patients were followed up at immediate, 6 weeks, 3 months, 6 months, 1 year, and then every year after operation for imaging evaluation (X-ray film was taken immediately after operation to evaluate the femoral isthmus compression, Engh standard was used to evaluate the biological fixation of the femoral shaft prosthesis, and Brooker method was used to evaluate the occurrence of heterotopic ossification); bone reconstruction evaluation [reconstruction of prosthesis and bone interface (type of bone reaction, Gruen zone, incidence, and occurrence time were recorded), reconstruction of bone around prosthesis (proximal femur stress shielding bone absorption was evaluated according to Engh and Bobyn methods, and bone mineral density change rate was measured)]; clinical efficacy evaluation [Harris score for efficacy, visual analogue scale (VAS) score for thigh pain]. RESULTS: All patients were followed up 15 years and 2 months to 20 years and 4 months, with a median of 16 years and 6 months. At immediate after operation, 24 hips (92.3%) had good femoral isthums compression, 24 hips (92.3%) had good bone ingrowth. Heterotopic ossification occurred in 2 patients with degree 1, 2 patients with degree 2, and 1 patient with degree 3 at 3-6 months after operation. Hyperplastic bone reactions were more common in Gruen 2, 3, 4, 5, 6, 10, 11, and 12 zones, mainly occurring at 6-20 months after operation, with the incidence of 3.8%-69.2%, with the highest incidence of spot welding. All absorptive bone reactions were osteolysis, which was common in Gruen 1 and 7 zones, and mainly occurred at 8 years after operation, with an incidence of 42.3%. No clear line (area) or enlarged sign of medullary cavity was observed. Twenty-one hips (80.8%) had 1 degree stress shieding, and 5 hips (19.2%) had 2 degree stress shieding. It mainly occurred at 10-24 months after operation in Gruen 1 and 7 zones. Dual energy X-ray absorptiometry showed that bone mineral density mainly decreased in Gruen 1, 2, 6, and 7 zones, mainly increased in Gruen 3, 4, and 5 zones. Bone mineral density loss progressed slowly after 2 years of operation, and it was stable in 5-8 years, but decreased rapidly in 8-9 years, and stabilized after 10 years. The Harris score increased from 51.1±6.2 before operation to 88.3±5.1 at last follow-up ( t=-21.774, P=0.000). Mild thigh pain occurred in only 2 cases (7.7%) with the VAS score of 2. No aseptic loosening or revision of femoral prosthesis occurred during the follow-up. CONCLUSION: The application of AML prosthesis in THA has a good bone remodeling and a good long-term effectiveness.

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BACKGROUND: Osteosarcoma is a primary malignant bone tumor that frequently occurs in adolescents and children, its high aggressiveness and rapid metastasis often resulting in poor prognoses. In previous studies, Prazosin has been shown to possess anti-proliferative properties against prostate cancer and glioblastoma cells. In our study, we investigated Prazosin's underlying mechanisms and its effects on the biological behaviors of osteosarcoma cells. METHODS: Osteosarcoma cell lines MG63 and 143B were treated with different concentrations of Prazosin, and a CCK8 assay assessed its effect on cell viability. Colony formation, Transwell and flow cytometry assays were used to examine its effects on cell proliferation, cell migration, and cell invasion and apoptosis, respectively. The expression of relevant proteins was then examined using western blotting. RESULTS: Our data showed that Prazosin dose-dependently reduced the viability of MG63 and 143B cells and significantly inhibited their clonogenic ability. Moreover, Prazosin attenuated the cell migration and invasion abilities of MG63 and 143B cells when compared with the NC group. It also accelerated cell apoptosis in mitochondrial pathways by regulating Bcl-2/Bax axis and caspase 3. Furthermore, Prazosin treatment inactivated the Akt/mTOR pathway by down-regulating Akt and mTOR phosphorylation (p-Akt, p-mTOR) and the expression of P70 and cyclin D1. CONCLUSIONS: Our data highlights the fact that Prazosin inhibits cell growth, inhibits the motility of osteosarcoma cells, and promotes apoptosis, suggesting that Prazosin is a potential anti-cancer agent in osteosarcoma therapy.

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Multiple sclerosis (MS) is an inflammatory neurodegenerative disease of the central nervous system (CNS). Evidence about experimental autoimmune encephalomyelitis (EAE), a mouse model of MS, has been shown to modulate disease parameters within exercise intervention. However, these initial studies weren't carried out intensity of exercise in mice. This study explored the impacts of different-intensity swimming training on EAE mice. Female mice were given access to swimming with predetermined weight (moderated-intensity (ME) group is 0% body weight; high-intensity (HE) group is 4% body weight) for 6 weeks, were immunized to induce EAE and then continued swimming until sacrificed. Compared to non-exercise mice, ME training didn't affect EAE clinical symptoms and neuropathology. However, HE swimming attenuated EAE clinical scores, reduced infiltrating cells and demyelination of spinal cords. Analysis of CD4+ T cell subsets from CNS of EAE showed the reduction of Th1 and Th17 populations and an increase of Treg in HE, not ME mice. Accordingly, HE training lead to a decrease of IFN-γ and IL-17 and an increase of IL-10 and TGF-ß. Of note, HE, not ME, swimming induced an increase of brain derived neurotrophic factor in the CNS of EAE. Moreover, HE training upregulated Treg and downregualted antigen-specific T cell proliferation and Th1 and Th17 populations from draining lymph node cells. These results suggest that HE swimming training might have benefits on attenuating the progression and pathological hallmarks of EAE, thus representing an important non-pharmacological intervention for improvement of chronic inflammation or T-cell mediated autoimmunity.

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OBJECTIVE: To summarize the surgical technique and the effectiveness of Becker V-shaped lateral rotation osteotomy in total hip arthroplasty (THA) for Crowe type IV development dislocation of the hip (DDH). METHODS: Between January 2000 and December 2009, 18 patients (22 hips) with Crowe type IV DDH underwent THA. There were 3 males and 15 females with an average age of 54 years (range, 41-75 years). The unilateral hip was involved in 14 cases and bilateral hips in 4 cases. All patients had over anteversion of the femoral neck, with the acetabular anteversion angle of (21.28 +/- 4.87) degrees, the femoral neck anteversion angle of (59.06 +/- 1.44) degrees, and combined anteversion angle of (80.33 +/- 1.55) degrees. All the patients had limb-length discrepancy, ranged from 1.0 to 3.5 cm (mean, 2.5 cm). Before operation, gluteus medius muscle strength was grade 2 in 17 hips and grade 3 in 5 hips; severe or moderate claudication was observed in 13 and 5 patients, respectively. Trendelenburg sign was positive in all patients. Preoperative Harris score was 30.00 +/- 6.32. Cementless prosthesis was used. Becker V-shaped lateral rotation osteotomy and subtrochanteric shortening with overlapping femoral resection were performed, and proximal femoral shaft splitting was performed on 21 hips having narrow bone marrow cavity. RESULTS: All the cases achieved primary healing of incision. No complication of anterior dislocation, deep infection, nerve traction injury, or femoral uncontrolled fracture occurred. All the cases were followed up 3-12 years (mean, 8 years). Postoperative X-ray films showed that the initial fixation result of femoral prosthesis was excellent in 18 hips and good in 4 hips. Bone healing of osteotomy stump was obtained at 3-6 months (mean, 5 months) after operation. Affected limb prolonged for 2.5-3.5 cm (mean, 3.0 cm) at 1 year after operation; limb-length discrepancy was 0.5-1.5 cm (mean, 1.0 cm). The gluteus medius muscle strength was restored to grade 4 in 5 hips and grade 5 in 17 hips. At last follow-up, 13 patients had no claudication, and 5 patients had mild claudication; Trendelenburg sign was negative in 15 cases and was positive in 3 cases; the Harris score was significantly improved to 91.89 +/- 3.22; all showing significant difference when compared with preoperative ones (P < 0.05). At last follow-up, the acetabular anteversion angle, the femoral neck anteversion angle, and combined anteversion angle were (19.33 +/- 4.49), (13.33 +/- 5.70), and (32.67 +/- 5.35) degrees, respectively, all showing significant differences when compared with preoperative ones (P < 0.05). No aseptic loosening, osteolysis, or rediolucent line was found around the femoral component. No implant subsidence, stem varus, or revision occurred. CONCLUSION: Becker V-shaped lateral rotation osteotomy is a safe and predictable method to treat type Crowe type IV DDH.

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