OBJECTIVE:The clinical efficacy and safety of preoperative intravenous glucocorticoids in patients undergoing lower limb joint arthroplasty remain controversial.Therefore,we conducted a meta-analysis based on randomized controlled trials to evaluate the efficacy and safety of preoperative intravenous glucocorticoids for clinical treatment using lower limb joint arthroplasty. METHODS:We systematically searched randomized controlled trials on the effects of preoperative intravenous glucocorticoids on the efficacy and safety of lower limb joint arthroplasty in Chinese and foreign databases up to June 2023,including PubMed,Embase,Web of Science,Cochrane Library,WanFang Data,and CNKI.The trial group was injected with intravenous glucocorticoid before operation to control pain.The control group received placebo or intravenous saline.Outcome measures included postoperative resting pain score,postoperative C-reactive protein,postoperative 5-m walking test pain score,length of hospital stay,operation time,postoperative morphine opioid supplemental dose,postoperative nausea and vomiting reaction,and postoperative periprosthesis infection complications. RESULTS:(1)A total of nine randomized controlled trials included 613 patients(n=311 in the glucocorticoid group,n=302 in the control group).(2)Compared with the control group,preoperative intravenous administration of glucocorticoids significantly reduced the resting pain scores of patients at 6 and 12 hours after surgery,as well as the pain scores of patients walking for 5 m on the first day after surgery.In addition,the need for additional morphine opioids and postoperative nausea and vomiting were reduced in the glucocorticoid group.The inflammatory C-reactive protein was lower than that of the control group within three days after surgery,and the length of hospital stay was shortened after intravenous glucocorticoid injection(P<0.05).(3)However,there were no significant differences in the incidence of infection after arthroplasty,operation time,and pain scores at 24 and 48 hours between the two groups. CONCLUSION:As an effective perioperative multi-modal analgesia protocol,intravenous injection of glucocorticoids before surgery is an effective and safe method to reduce hyperacute pain and improve joint mobility in patients with lower limb joint arthroplasty.More research is needed to determine the optimal dose and type of glucocorticoids for maximum pain control.

Objective To evaluate the clinical outcome of kidney transplantation from donation after brain death(DBD)donors complicated with acute kidney injury(AKI).Methods Clinical data of 216 DBD donors were retrospectively analyzed,and they were divided into the AKI group(n=69)and control group(n=147)according to the Kidney Disease:Improving Global Outcomes(KDIGO)guidelines.Donors in the AKI group were further divided into the KDIGO stage 1 and stage 2-3 subgroups.One hundred and thirty-five recipients were assigned into the AKI group and 288 recipients in the control group.Postoperative recovery of renal function and clinical outcomes of the recipients were recorded.The risk factors of delayed graft function(DGF)were identified.Results The highest serum creatinine(Scr)level,Scr level before procurement,the highest blood sodium level and blood sodium level before procurement in the AKI group were higher than those in the control group.The application duration of vasopressors in the AKI group was longer than that in the control group.In the AKI group,the amount of fluid resuscitation within 48 h was higher,the HCO3-level at admission was lower,and the incidence of diabetes insipidus and hypotension was higher than those in the control group.The highest Scr level and the Scr level before procurement in KDIGO stage 2-3 donors were significantly higher than those in KDIGO stage 1 counterparts(all P＜0.05).Compared with the control group,the incidence of DGF and acute rejection was higher,the proportion of continuous renal replacement therapy was higher,the Scr level within postoperative 90 d was higher,and the urine amount within postoperative 3 d was less than those of recipients in the AKI group.Compared with KDIGO stage 1 recipients,KDIGO stage 2-3 recipients had higher Scr levels at postoperative 3,4,5 and 15 d,and less urine amount at postoperative 2 d(all P＜0.05).Univariate analysis showed that donor age,the highest Scr level,the highest blood sodium level and the amount of fluid resuscitation within 48 h were the risk factors for DGF in recipients after kidney transplantation.Multivariate analysis showed that donor age was the independent risk factor for DGF in recipients after kidney transplantation(all P＜0.05).Conclusions For the application of DBD donors complicated with AKI,active organ maintenance should be performed to alleviate AKI.It exerts no effect upon graft function and survival rate at postoperative 6 months,which may achieve equivalent efficacy as non-AKI donors and may be used as a source of extended criteria donor kidneys.