Randomized Prospective Comparative Study of Adductor Canal Block vs Periarticular Infiltration on Early Functional Outcome After Unilateral Total Knee Arthroplasty

BackgroundTotal knee arthroplasty (TKA) is associated with significant postoperative pain. Effective pain relief is essential for early postoperative rehabilitation. Periarticular infiltration (PAI) and adductor canal block (ACB) have become popular modes of pain management after TKA. Our aim is to compare their efficacy and impact on early functional outcome in patients undergoing TKA.MethodsA single-blinded randomized controlled trial, 100 patients undergoing unilateral primary TKA for symptomatic osteoarthritis were allocated to either of the 2 groups (50 in each arm): postoperative ultrasound-guided single shot of ACB (group A) or intraoperative PAI (group B). All patients underwent TKA without patella resurfacing under spinal anesthesia. Preoperative workup, surgical technique, and postoperative management were standardized for all the patients. Patients were assessed for pain using visual analogue scale at 6, 12, and 24 hours after surgery; hemoglobin level preoperatively and postoperatively on day 1 to calculate blood loss; hospital stay; tourniquet time; operative time; and postoperative complications by an independent observer blinded to the group allocation.ResultsPatients were matched for age, gender, American Society of Anesthesiologists grade, and deformity. Visual analogue scale (scale 0-10) between PAI and ACB at 6, 12, and 24 hours were significantly different (P < .05) with higher scores seen in patients with ACB at all time points. Tourniquet time and operative time were significantly longer in the PAI than ACB. No significant difference in hospital stay was observed. No complications occurred during the study.ConclusionPAI achieves better pain control as compared to ACB in patients undergoing unilateral TKA.     

Imaging utilization in the era of the hospitalist

OBJECTIVE: We sought to determine whether hospitalists specifically reduce inpatient radiologic testing and radiology costs, which to our knowledge has not previously been studied. We examined the number of radiologic studies ordered, total cost of radiology utilization, cost per patient, mean length of stay, and readmission rates for hospitalists and nonhospitalists across the top-10 discharge diagnosis related groups for hospitalists from October 2000 to September 2001. CONCLUSION: We found no decreases in the utilization of radiology resources by hospitalists. Given the increasing volume and importance of radiology in clinical decision making, there will be increased pressure to justify the costs of these studies. We believe that more data should be collected about the use of radiology resources.     

Characterization of the role of CD8+T cells in breast cancer immunity following mammaglobin-A DNA vaccination using HLA-class-I tetramers

INTRODUCTION: Mammaglobin-A(mam-A) is expressed in over 80% of human breast tumors. We recently reported that mam-A DNA vaccination resulted in breast cancer immunity in a preclinical model. Here we investigated whether mam-A HLA-class-I tetramers could be used to monitor and define the role of CD8(+)cytotoxic T-lymphocytes(CTL) in mediating breast cancer immunity following mam-A DNA vaccination. STUDY DESIGN: Mam-A DNA vaccination was performed in HLA-A2(+)huCD8(+ )transgenic mice. HLA-A2 tetramers carrying the immunodominant mamA2.1 peptide were used to monitor CD8(+)CTL. Human breast cancer colonies were developed in immunodeficient SCID-beige mice. ELISPOT was used to correlate frequency of mamA2.1 tetramer(+)CD8(+)T cells and IFN-gamma production [spots per million cells (spm)] in human subjects. RESULTS: Vaccination of HLA-A2(+)huCD8(+) mice with mam-A DNA vaccine, but not empty vector, led to the expansion of mamA2.1 tetramer(+)CD8(+)T-cells in peripheral blood (<0.5% pre-vaccination compared to >2.0% post-vaccination). CD8(+)T cells from vaccinated mice specifically lysed UACC-812(HLA-A2(+)/mam-A(+), 25% lysis) but not MDA-MB-415(HLA-A2(-)/mam-A(+)) or MCF-7(HLA-A2(+)/mam-A(-)) breast cancer cells. Adoptive transfer of purified CD8(+)T cells from vaccinated mice into immunodeficient SCID-beige mice with established human breast cancer colonies led to tetramer(+)CD8(+ )T-cell infiltration with regression of UACC-812 but not MCF-7 tumors. HLA-A2(+) breast cancer patients revealed increased frequency of mamA2.1 tetramer(+)CD8(+ )T-cells compared to normal controls (2.86 +/- 0.8% vs. 0.71 +/- 0.1%, P = 0.01) that correlated with the IFN-gamma response to mamA2.1 peptide (48.1 +/- 20.9 vs. 2.9 +/- 0.8 spm, P = 0.03). CONCLUSIONS: CD8(+ )T-cells are crucial in mediating breast cancer immunity following mam-A DNA vaccination. Mam-A HLA-class-I tetramers can be effectively used to monitor development of CD8(+ )T-cells following mam-A vaccination.     

Application of principal component and hierarchical cluster analysis to classify fruits and vegetables commonly consumed in Ireland based on in vitro antioxidant activity

The purpose of this study was to gain insights into the variations in antioxidant profiles between fruits and vegetables using pattern recognition tools; classification was achieved based on global antioxidant activity, levels of antioxidant groups (total phenolics, total anthocyanins, ascorbic acid) and quality parameters (instrumental colour, moisture). Six vegetables (broccoli, carrot [organic and intensively grown], butterhead lettuce, red onion, yellow onion) and eight fruits (blueberries, cherry tomato, cranberries, red grapes, green pepper, raspberry, red pepper and strawberry) commonly consumed in Ireland were analysed. Antioxidant activity (ARP) and concentrations of bioactive compound groups differed according to sample type. Berry fruits had the highest antioxidant activity (1.51-2.97 (g/L)⁻¹). By contrast, vegetables were quite low in antioxidant activity (0.14-0.39 (g/L)⁻¹). Interrelationships between the parameters analysed and the different fruits and vegetables were investigated by principal component analysis (PCA) and hierarchical cluster analysis (HCA). PCA revealed that the first two components represented 62% of the total variability in antioxidant activity and different antioxidant groups. HCA classified samples into four main groups on the basis of the measured parameters.     

Managing Endodontic Patients with Severe Gag Reflex by Glossopharyngeal Nerve Block Technique

Introduction

Gagging is a protective reflex, but when the gag reflex becomes abnormally active, it poses a difficulty for the dentist because it hinders all aspects of dental procedures including diagnosis, radiography, and any form of active procedure.

Methods

In this case report, to overcome this difficulty the authors used a glossopharyngeal nerve block technique that is used by anesthetists and otolaryngologists, but its endodontic use has gone previously unreported.

Results

Response to gag reflex decreases after successful glossopharyngeal nerve block.

Conclusions

The glossopharyngeal nerve block technique is a relatively safe, simple, and easy to master technique as compared with general anesthesia for treating a patient with an exaggerated gag reflex. The glossopharyngeal nerve block technique may be used in dental procedures in patients with an exaggerated gag reflex or when performing procedures in the posterior aspect of the mouth. Due caution should be exercised to prevent inadvertent intravascular administration of local anesthetic when using this procedure.