Multimodal analgesia protocol for pain management after total knee arthroplasty: comparison of three different regional analgesic techniques

Objectives:To evaluate three different analgesic techniques, continuous epidural analgesia (EA), continuous intra-articular (IA) infusion analgesia and continuous femoral nerve block (FNB) in postoperative pain management, length of hospital stay (LOS), and time of patient mobilization after total knee arthroplasty (TKA).Methods:Seventy-two patients undergoing TKA were randomly allocated into three groups according to the analgesic technique used for postoperative pain management. Group EA patients received epidural analgesia (control group), group IA received intra-articular infusion and group FNB received femoral nerve block.Results:Upon analyzing the Numerical Rating Scale (NRS) scores at rest, at passive and active movement, up to 3 days postoperatively, we observed no statistically significant differences at any time point among the three groups. Similarly, no association among these analgesic techniques (EA, IA, FNB) was revealed regarding LOS. However, significant differences emerged concerning the time of mobilization. Patients who received IA achieved earlier mobilization compared to FNB and EA.Conclusions:Both IA and FNB generate similar analgesic effect with EA for postoperative pain management after TKA. However, IA appears to be significantly more effective in early mobilization compared to EA and FNB. Finally, no clinically important differences could be detected regarding LOS among the techniques studied.     

A necessary condition for balance of a block design

It is shown that, barring orthogonal designs, a necessary condition for a block design, BD(v, b, N), to be J-balanced is that the rows of its incidence matrix, N, are linearly independent. This strengthens the condition b v known in the literature as FISHER'S inequality. V-balanced block designs are also discussed.     

A system to efficiently maintain embryonic lethal mutations in the flour beetle Tribolium castaneum

 Due to its small size, short life cycle, and easy maintenance, the flour beetle Tribolium castaneum is well suited for the genetic analysis of development. One drawback of Tribolium as a genetic system is, however, the difficulty of keeping embryonic lethal lines. Presently, only few lethal mutations can be kept as balanced stocks. Therefore, heterozygous carriers must be identified anew in every generation in order to maintain a recessive embryonic mutation. To alleviate this problem we have devised a block system that allows the simultaneous processing of many mutant lines or test crosses for visual inspection of larval cuticle phenotypes. Using this technique, one person can maintain about 100 embryonic lethal stocks, which makes feasible the thorough genetic analysis of embryogenesis in this species. Received: 4 November 1998 / Accepted: 7 February 1999     

An upper Kungurian/lower Guadalupian (Permian) brachiopod fauna from the South Qiangtang Block in Tibet and its palaeobiogeographical implications

A brachiopod fauna including 15 species belonging to 14 genera is described from a thin carbonate succession of the Lugu Formation at the Anmu section in the northern part of the South Qiangtang Block, which is about 15 km south to the Longmu Co-Shuanghu Suture. The brachiopod fauna is late Kungurian or early Guadalupian in age in terms of the presence of the brachiopod species Vediproductus punctatiformis, “Cryptospirifer” omeishanensis, and Paraplicatifera regularis. This is also generally consistent with the age indicated by the fusulines (e.g., Cancellina, Chusenella, Monodiexodina, Nankinella, Neofusulinella, Pseudofusulina, and Sphaerulina) from this formation at the nearby Mari and Duoma A (DMA) sections. Palaeobiogeographically, the brachiopod fauna exhibits a typical Cathaysian affinity and all the species are reported commonly from the equivalents in South China and Cimmerian blocks, which strongly suggest that the South Qiangtang Block had drifted to a position in the warm-water or temperate regime close to South China.     

Sequential Anterograde and Retrograde Conduction Block during Radiofrequency Ablation of an Accessory Pathway

We present an interesting image showing sequential loss of anterograde, and subsequently, retrograde conduction during radiofrequency ablation of an accessory pathway. We discuss the possible mechanisms and prior literature concerning this interesting finding.     

High-density lipoproteins mediate small RNA intercellular communication between dendritic cells and macrophages

HDL are dynamic transporters of diverse molecular cargo and play critical roles in lipid metabolism and inflammation. We have previously reported that HDL transport both host and nonhost small RNAs (sRNA) based on quantitative PCR and sRNA sequencing approaches; however, these methods require RNA isolation steps which have potential biases and may not isolate certain forms of RNA molecules from samples. HDL have also been reported to accept functional sRNAs from donor macrophages and deliver them to recipient endothelial cells; however, using PCR to trace HDL-sRNA intercellular communication has major limitations. The present study aims to overcome these technical barriers and further understand the pathways involved in HDL-mediated bidirectional flux of sRNAs between immune cells. To overcome these technical limitations, SYTO RNASelect, a lipid-penetrating RNA dye, was used to quantify a) overall HDL-sRNA content, b) bidirectional flux of sRNAs between HDL and immune cells, c) HDL-mediated intercellular communication between immune cells, and d) HDL-mediated RNA export changes in disease. Live cell imaging and loss-of-function assays indicate that the endo-lysosomal system plays a critical role in macrophage storage and export of HDL-sRNAs. These results identify HDL as a substantive mediator of intercellular communication between immune cells and demonstrate the importance of endocytosis for recipient cells of HDL-sRNAs. Utilizing a lipid-penetrating RNA-specific fluorescence dye, we were able to both quantify the absolute concentration of sRNAs transported by HDL and characterize HDL-mediated intercellular RNA transport between immune cells.