ABSTRACT
Sepsis is a life-threatening condition originated from the accumulation of endotoxin in blood in response to infection (e.g., bacterial infection, COVID-19), and then aggravating by the systemic inflammatory responses, microcirculation disorders and oxidative stress, ultimately resulting in the dysfunction of multiple organs. Herein, advanced multi-lamellar microspheres (CPG-Ln-MSs) with cascade endotoxin adsorption and oxidative stress relief functions are constructed as an alternative adsorbent for hemoperfusion therapy towards sepsis. The CPG-Ln-MSs achieve effective endotoxin absorption (nearly 455.3 EU/g) and show excellent broad-spectrum radical scavenging activity for treating oxidative stress triggered by endotoxin accumulation. Specifically, the structural integrity of the multi-layered structure plays a vital role in promoting the efficiency of endotoxin removal and the subsequently scavenging of reactive oxygen species. Hemoperfusion simulation experiments demonstrate that the CPG-Ln-MSs could effectively remove endotoxin with a ratio of 92%, and the following oxidative stress state could be well alleviated, as confirmed by the reduced H2O2 and MDA levels in septic blood. Furthermore, endogenous antioxidants could be restored (recover SOD and CAT activity to 96.9 and 10.1 U/mL, respectively) and the red blood cells could be protected from oxidative damage. This study provides a promising therapeutic strategy and guides the design of future for septic blood purification.
ABSTRACT
BACKGROUND: Physical therapy is regarded as an essential aspect in achieving optimal outcomes following total knee arthroplasty (TKA). The coronavirus disease 2019 (COVID-19) pandemic has made face-to-face rehabilitation inaccessible. Virtual reality (VR) is increasingly regarded as a potentially effective option for offering health care interventions. This systematic review and meta-analysis investigate VR-based rehabilitation's effectiveness on outcomes following TKA. METHODS: From inception to May 22, 2021, PubMed/Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, Scopus, PsycINFO, Physiotherapy Evidence Database, China National Knowledge Infrastructure, and Wanfang were comprehensively searched to identify randomized controlled trials (RCTs) evaluating the effect of VR-based rehabilitation on patients following TKA according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Eight studies were included in the systematic review, and seven studies were included in the meta-analysis. VR-based rehabilitation significantly improved visual analog scale (VAS) scores within 1 month (standardized mean difference [SMD]: -0.44; 95% confidence interval [CI]: -0.79 to -0.08, Pâ=â0.02), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) within 1 month (SMD: -0.71; 95% CI: -1.03 to -0.40, Pâ<â0.01), and the Hospital for Special Surgery Knee Score (HSS) within 1 month and between 2 months and 3 months (MD: 7.62; 95% CI: 5.77 to 9.47, Pâ<â0.01; MD: 10.15; 95% CI: 8.03 to 12.27, Pâ<â0.01; respectively) following TKA compared to conventional rehabilitation. No significant difference was found in terms of the Timed Up and Go (TUG) test. CONCLUSIONS: VR-based rehabilitation improved pain and function but not postural control following TKA compared to conventional rehabilitation. More high-quality RCTs are needed to prove the advantage of VR-based rehabilitation. As the COVID-19 pandemic continues, it is necessary to promote this rehabilitation model.