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The potential advantages of hydroxyapatite (HA)-coated cementless total knee arthroplasty (TKA) implants are bone stock preservation and biological fixation. Studies comparing the outcomes of HA-coated cementless, non HA-coated cementless (uncemented) and cemented TKA implants reported contradictory data. Our aim was to provide a comparison of the effects of HA coating of tibial stem on the stability and functionality of TKA implants. A systematic literature search was performed using MEDLINE, Scopus, EMBASE and the CENTRAL databases up to May 31st, 2019. The primary outcome was Maximum Total Point Motion (MTPM) of the tibial stem. This parameter is determined by radiosterometric analysis and refers to the migration pattern of the prosthesis stems. The clinical outcomes of the implanted joints were evaluated by the Knee Society Knee Score (KSS) and the Knee Society Function Score (KFS). Weighted mean difference (WMD) with 95% confidence interval (CI) were calculated with the random-effects model. Altogether, 11 randomized controlled trials (RCTs) with 902 patients for primary TKA implants were included. There was a statistically significant difference in the MTPM values with the use of HA-coated and uncoated uncemented implants (WMD = +0.28, CI: +0.01 to +0.56, P<0.001). However, HA-coated stems showed significantly higher migration when compared with the cemented prostheses (WMD = -0.29, CI: -0.41 to -0.16, P<0.001). The KSS values of HA-coated implants were significantly higher than those for the uncemented implants; moreover, KSS and KFS outcome scores were statistically not different between the HA-coated and cemented prosthesis cases. HA-coating yields better stability than other, uncemented prostheses. More importantly, the HA-coating is not outperformed by cemented prosthesis in providing good functional outcome.

ObjectivesHeart rate (HR) is one of the physiological variables in the early assessment of trauma-related haemorrhagic shock, according to Advanced Trauma Life Support (ATLS). However, its efficiency as predictor of mortality is contradicted by several studies. Furthermore, the linear association between HR and the severity of shock and blood loss presented by ATLS is doubtful. This systematic review aims to update current knowledge on the role of HR in the initial haemodynamic assessment of patients who had a trauma.DesignThis study is a systematic review and meta-regression that follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations.Data sourcesEMBASE, MEDLINE, CENTRAL and Web of Science databases were systematically searched through on 1 September 2020.Eligibility criteriaPapers providing early HR and mortality data on bleeding patients who had a trauma were included. Patient cohorts were considered haemorrhagic if the inclusion criteria of the studies contained transfusion and/or positive focused assessment with sonography for trauma and/or postinjury haemodynamical instability and/or abdominal gunshot injury. Studies on burns, traumatic spinal or brain injuries were excluded. Papers published before January 2010 were not considered.Data extraction and synthesisData extraction and risk of bias were assessed by two independent investigators. The association between HR and mortality of patients who had a trauma was assessed using meta-regression analysis. As subgroup analysis, meta-regression was performed on patients who received blood products.ResultsFrom a total of 2017 papers, 19 studies met our eligibility criteria. Our primary meta-regression did not find a significant relation (p=0.847) between HR and mortality in patients who had a trauma with haemorrhage. Our subgroup analysis included 10 studies, and it could not reveal a linear association between HR and mortality rate.ConclusionsIn accordance with the literature demonstrating the multiphasic response of HR to bleeding, our study presents the lack of linear association between postinjury HR and mortality. Modifying the pattern of HR derangements in the ATLS shock classification may result in a more precise teaching tool for young clinicians.

1.1. BackgroundArthritis is a collective term encompassing many diseases with distinct etiologies but common symptoms, such as joint pain and inflammation. Osteoarthritis (OA) and rheumatoid arthritis (RA) are both common forms of arthritis despite of the substantial differences in their etiology and pathomechanism. The prevalence of OA in the population is approximately 10%, which makes it one of the most common chronic diseases. Although epidemiological studies have revealed both endogenous and exogenous risk factors for OA, it is basically a degenerative joint disease, initiated by an injury or repetitive joint stress of the joint [1]. The mechanical damage activates mechanosensitive intracellular signalling in cartilage, which involves the activation of inflammatory processes that may develope structural and symptomatic course of disease [1]. With regards to the etiology, RA is considered as a multifactorial, multigenic autoimmune disease with lower prevalence, affecting 1% of the world’s population [2]. Although the exact pathomechanism is still unknown, the importance of genetic predisposition has been revealed, as polymorphisms of the HLA-DR4 and DR1 locus and cytokine genes have been associated with RA [3]. Additionally, the pathogenetic role of various bacteria and viruses has also been suggested. As a result, abnormal activation, adhesion and migration of T- and B-lymphocytes and macrophages occur, which is accompanied by increased proinflammatory cytokine production (TNF-α, IL-1). As a consequence of the chronic autoimmune inflammation, intensive angiogenesis and pannus formation in the synovium and cartilage damage may develop [3].Owing to the high number of cases, arthritis is of significant public health and economic importance, yet therapeutic options are limited to pain relief, reduction of inflammation and finally, performing orthopedic surgery [4,5]. Today, the “gold standard” therapy for alleviating arthritis-related pain is diclofenac, a nonsteroidal anti-inflammatory drug (NSAID) of the phenylacetic acid class [6,7]. Unfortunately, the side effects of such an effective compound are also significant. Habitual use of diclofenac is associated with the NSAID category risk of dose-related gastrointestinal, cardiovascular, and renal adverse effects; consequently, topical preparations were developed to limit the potentially serious complications of systemic treatments.After the exhaustion of conservative therapeutic options, destruction of articular cartilage, chronic pain, and limited mobility of patients can indicate surgical procedures. According to the severity of the condition, there are three types of surgical interventions that can also be performed consecutively: arthroscopy, osteotomy or joint-replacement procedures, the latter may be unicompartmental or total arthroplasty of the knee [8]. Due to the need for early prosthesis in rheumatoid arthritis and post-traumatic osteoarthritis, implants with a lifespan of 10-15 years often have to be replaced multiple times. Although cementless prostheses offer a solution to this problem, the higher incidence of complications necessitated the elaboration of new techniques such as hydroxyapatite-coating [9,10].1.1.2. OsteoarthritisThe degenerative cartilage damage in OA affects both large and small joints and characterized by continuous progression. Risk factors include female gender, advanced age, obesity, previous injury, repetitive sports activity, and family history of OA [11].

There is growing evidence regarding the role of mitochondrial dysfunction in osteoarthritis (OA) and rheumatoid arthritis (RA). However, quantitative comparison of synovial mitochondrial derangements in these main arthritis forms is missing. A prospective clinical study was conducted on adult patients undergoing knee surgery. Patients were allocated into RA and OA groups based on disease-specific clinical scores, while patients without arthritis served as controls. Synovial samples were subjected to high-resolution respirometry to analyze mitochondrial functions. From the total of 814 patients, 109 cases were enrolled into the study (24 RA, 47 OA, and 38 control patients) between 1 September 2019 and 31 December 2021. The decrease in complex I-linked respiration and dyscoupling of mitochondria were characteristics of RA patients, while both arthritis groups displayed reduced OxPhos activity compared to the control group. However, no significant difference was found in complex II-related activity between the OA and RA groups. The cytochrome C release and H2O2 formation were increased in both arthritis groups. Mitochondrial dysfunction was present in both arthritis groups; however, to a different extent. Consequently, mitochondrial protective agents may have major benefits for arthritis patients. Based on our current study, we recommend focusing on respiratory complex I in rheumatoid arthritis research.

Since electroporation (EP) can increase the permeability of biological membranes, we hypothesized that it offers an opportunity to enhance the transdermal delivery of drugs for intra-articular indications. Our aim was to compare the anti-inflammatory and analgesic efficacy of EP-combined topical administration of diclofenac sodium hydrogel (50 mg mL in 230 µL volume) with that of an equivalent dose of oral (75 mg kg ) and simple topical administration. Arthritis was induced with the injection of 2% λ-carrageenan and 4% kaolin into the right knee joints of male Sprague Dawley rats. EP was applied for 8 min with 900 V high-voltage pulses for 5 ms followed by a 20 ms break. Drug penetration into the synovial fluid and plasma was detected by high-performance liquid chromatography. Leukocyte-endothelial interactions were visualized by intravital videomicroscopy on the internal surface of the synovium. Inflammation-induced thermal and mechanical hyperalgesia reactions, knee joint edema, and inflammatory enzyme activities were assessed at 24 and 48 h after arthritis induction. EP significantly increased the plasma level of diclofenac as compared with the topical controls 10 min after the 2% λ-carrageenan and 4% kaolin injection. Increased leukocyte-endothelial interactions were accompanied by joint inflammation, which was significantly reduced by oral and EP diclofenac (by 45% and by 30%, respectively) and only slightly ameliorated by simple topical diclofenac treatment (by 18%). The arthritis-related secondary hyperalgesic reactions were significantly ameliorated by oral and EP-enhanced topical diclofenac treatments. The knee cross-section area (which increased by 35%) was also reduced with both approaches. However, simple topical application did not influence the development of joint edema and secondary hyperalgesia. The study provides evidence for the first time of the potent anti-inflammatory and analgesic effects of EP-enhanced topical diclofenac during arthritis. The therapeutic benefit provided by EP is comparable with that of oral diclofenac; EP is a useful alternative to conventional routes of administration.

With the rapid spread of COVID-19 worldwide, governments of all countries declared the closure of educational institutions to control its transmission. As a result, institutions were under pressure to offer online education opportunities so that students could continue their education without interruption. The unintended, hasty and unknown duration of the strategy encountered challenges at all pedagogical levels, especially for students who felt stressed out by this abrupt shift, resulting in the decline of their academic performance. Hence, it is necessary to comprehend the approach that might improve students’ involvement and performance in online learning. In this context, the current study used four models to understand the phenomenon: the Task Technology Fit (TTF), the DeLone and McLean Model of Information Systems Success (DMISM), the Technology-to-Performance Chain model (TPC) and the Technology Acceptance Model (TAM). The data for this study were obtained from 404 university students from the top ten universities of Pakistan. The results analyzed using structural equation modeling (SEM) show that learner characteristics positively predict performance through user satisfaction and task technology fit mediating function. Moreover, learner characteristics were also observed to have a significant positive influence on the academic performance of the students, with the mediating functions of user satisfaction and actual usage of the system. Likewise, perceived learning moderated the relationship between learner characteristics and user satisfaction. This research work provides policymakers with a profound framework that emphasizes how employing online learning technologies can strengthen the academic potential of students.