Periarticular Ropivacaine Cocktail Is Equivalent to Liposomal Bupivacaine Cocktail in Bilateral Total Knee Arthroplasty.

BACKGROUND: This study compares the effectiveness of 2 commonly used periarticular injection formulations: liposomal bupivacaine and bupivacaine (EXP) and ropivacaine, epinephrine, ketorolac, and clonidine (ROP) in patients undergoing bilateral total knee arthroplasty or unicompartmental knee arthroplasty. METHODS: Twenty-six total knee arthroplasty patients (52 knees) and 3 unicompartmental knee arthroplasty patients (6 knees) undergoing simultaneous, bilateral arthroplasty were randomized to receive periarticular injections in a blinded fashion. Even birth year patients were selected for PAI of EXP in the right knee and ROP in the left knee. This was reversed for odd birth years. Visual analog scale pain scores for each knee and patient perceived difference in knee functional recovery were recorded during physical therapy, throughout the hospitalization. RESULTS: There was no difference in visual analog scale pain scores between the EXP and ROP injected knees at any time point during the first 2 days after surgery. Postoperative pain scores averaged 41.9 mm (range 0-100 mm) for EXP and 43.1 mm (range 0-100 mm) for ROP. Patients were unable to detect a difference in the functional recovery between their knees on postoperative day 0, 1, or 2. No complications as a result of either periarticular injection occurred. CONCLUSION: Periarticular injections of EXP and ROP are equally effective after knee arthroplasty and patients do not appreciate differences between knees as determined by pain score or perceived functional recovery during the first 2 days after bilateral knee arthroplasty. This study demonstrates that a liposomal bupivacaine injection does not add an incremental benefit for pain control compared to a less expensive injection formulation.

Cartilage-like electrostatic stiffening of responsive cryogel scaffolds.

Cartilage is a structural tissue with unique mechanical properties deriving from its electrically-charged porous structure. Traditional three-dimensional environments for the culture of cells fail to display the complex physical response displayed by the natural tissue. In this work, the reproduction of the charged environment found in cartilage is achieved using polyelectrolyte hydrogels based on polyvinyl alcohol and polyacrylic acid. The mechanical response and morphology of microporous physically-crosslinked cryogels are compared to those of heat-treated chemical gels made from the same polymers, as a result of pH-dependent swelling. In contrast to the heat-treated chemically-crosslinked gels, the elastic modulus of the physical cryogels was found to increase with charge activation and swelling, explained by the occurrence of electrostatic stiffening of the polymer chains at large charge densities. At the same time, the permeability of both materials to fluid flow was impaired by the presence of electric charges. This cartilage-like mechanical behavior displayed by responsive cryogels can be reproduced in other polyelectrolyte hydrogel systems to fabricate biomimetic cellular scaffolds for the repair of the tissue.

Use of cholestyramine in the treatment of digoxin intoxication.

The bile acid-binding resin cholestyramine was administered in a dose of 4 g every six hours to a patient with digoxin intoxication. The serum digoxin concentration declined rapidly, and the digoxin half-life decreased from 75.5 hours to 19.9 hours while cholestyramine was administered. All signs and symptoms of toxic reaction subsided during the period of cholestyramine therapy, which correlated with the decline in digoxin concentrations. Cholestyramine and a related agent, colestipol, presumably interrupt the enterohepatic recycling of digoxin to enhance elimination. These agents represent potentially useful adjunctive measures in the management of non-life-threatening digitalis intoxication.

Ferromagnetic thermoseeds: suitable for an afterloading interstitial implant.

Previous studies have shown implantable ferromagnetic thermoseeds to be a promising hyperthermia method. However, migration from the implant site and chemical toxicity caused by corrosion of the thermoseed alloy have proven to be potential hazards. These problems could be overcome by placing the thermoseeds into removable catheters similar to those used for afterloading interstitial brachytherapy. As an additional merit, the method would allow convenient combination of heat and radiation therapy. To test the clinical performance of this method, we compared temperature distributions and biologic effects in canine muscle and transmissible venereal tumors for bare thermoseeds and thermoseeds contained within catheters. We found no significant difference in the heating patterns and similar tissue changes when all implants were removed immediately after heating. More severe tissue changes were present around bare thermoseeds that were retained. This suggests that catheters provide a safe and reliable method for thermoseed hyperthermia which would allow convenient combination with interstitial radiation.

Assessment of butadiene exposure in synthetic rubber manufacturing workers in Texas using frequencies of hprt mutant lymphocytes as a biomarker.

1,3-Butadiene (BD), which is used to manufacture synthetic rubber, is a mutagen and carcinogen. Because past occupational exposures have been associated with an increased risk of leukemia, there has been a dramatic reduction in workplace exposure standards. The health benefits of these reduced levels of occupational exposure to BD will be difficult to evaluate using relatively insensitive traditional epidemiological studies; however, biomarkers can be used to determine whether there are genotoxic effects associated with recent exposures to BD. In past studies of BD-exposed workers in Southeast Texas, we observed an increase in the frequency of lymphocytes with mutations in a reporter gene, hprt. Frequencies of hprt mutant cells correlated with air levels of BD and with the concentration of a BD metabolite in urine. Average exposures to 1-3 parts per million (p.p.m.) of BD were associated with a threefold increase in hprt variant (mutant) frequencies (Vfs). We now report results from a follow-up study of workers in a synthetic rubber plant in Southeast Texas. Thirty-seven workers were evaluated on three occasions over a 2-week period for exposure to BD by the use of personal organic vapor monitors and by determining the concentration of a BD metabolite in urine. The frequency of hprt mutants was determined, by autoradiography, with lymphocyte samples collected 2 weeks after the final exposure measurement. Based on their work locations, the study participants were assigned to high-exposure (N=22) or low-exposure (N=15) groups. The BD exposure, +/-standard error, of the workers in the high-exposure group (1.65+/-0.52 p.p.m.) was significantly greater than the low-exposure group (0.07+/-0.03 p.p.m.; P<0.01). The frequency of hprt mutant lymphocytes was also significantly different in the two groups (high, 10.67+/-1.5 x 10(-6); low, 3.54+/-0.6 x 10(-6); P<0.001). The concentration of the urine metabolite was greater in the high-exposure group, but the difference was not significant. The correlation coefficient between hprt Vf and BD exposure levels was r=0.44 (CI(95), 0.11-0.69; P=0.011). This study reproduced the findings from a previous study at this plant. Although studies of butadiene-exposed workers in other countries have not detected an effect of exposure on frequencies of hprt mutant lymphocytes, we have repeatedly observed this result in our studies in Texas.

Glutathione release by pulmonary alveolar macrophages in response to particles in vitro.

We studied whether cultured rat pulmonary alveolar macrophages (PAM) could release glutathione (GSH) in response to latex beads, quartz, and crocidolite asbestos. PAM were exposed for 2 h to 0-100 micrograms of particles per 1 x 10(6) cells. Both quartz and asbestos produced concentration-dependent increases (up to 8-10-fold) in the amount of GSH recovered in the medium and decreases in the cellular GSH levels. In contrast, latex beads did not produce any changes in GSH levels. We also measured lactate dehydrogenase (LDH) levels as an index of toxicity. Only quartz and asbestos were able to produce increases in LDH levels in the medium. The release of GSH occurred at particle concentrations that did not cause release of LDH. Our results indicated that, in vitro, PAM release GSH in response to toxic particles.

The deceptive nature of root coverage results.

BACKGROUND: The purposes of this article are to: 1) propose a new method of reporting root coverage data; 2) compare existing root coverage techniques using the proposed data analysis method; and 3) discuss additional refinements to root coverage data analysis. Past studies have equated percent defect coverage with root coverage. This gives deceptive information about the magnitude of the residual recession defect. Defect coverage of 67% could actually amount to 92% root coverage. METHODS: The use of mean root lengths will permit the determination of true root coverage data. This should be reported in addition to defect coverage data. Also including frequency data will provide a better assessment of the predictability of the surgical techniques. RESULTS: A comparison table of root coverage studies demonstrates that the connective tissue graft is the most effective and predictable method that has been tested. CONCLUSIONS: Further refinements to data analysis may help researchers identify the determinants of predictable root coverage.

A comparison of porous and non-porous teflon membranes plus demineralized freeze-dried bone allograft in the treatment of class II buccal/lingual furcation defects: a clinical reentry study.

BACKGROUND: The aim of this 9-month reentry study was to compare the regenerative healing using porous (P) and non-porous (NP) teflon barrier membranes plus demineralized freeze dried bone allografts (DFDBA) in Class II buccal/lingual furcation defects. METHODS: Twenty-four patients, 13 males and 11 females, ages 38 to 75 (mean 54 +/- 10), were included in this study. Each patient had adult periodontitis and one Class II furcation defect measuring > or = 3 mm open horizontal probing depth. Twelve patients were randomly selected to receive the NP treatment and 12 received the P membrane. All defects received a DFDBA graft. Measurements were performed by a masked examiner. RESULTS: No statistically significant differences (P>0.05) were found between NP and P groups at any time with respect to any open or closed measure. Improvement in mean open horizontal probing depth was significant for both the NP (2.33 +/- 0.78 mm) and P (2.75 +/- 0.75 mm) groups. Mean clinical attachment level gains at 9 months were significant for both NP (1.50 +/- 1.62 mm) and P (2.50 +/- 2.11 mm) groups. Seventeen of 24 defects had an intrabony component and > or = 50% fill was obtained in 100% of these defects. CONCLUSIONS: The results of this 9-month reentry study comparing the use of porous and non-porous barrier membranes with a DFDBA graft indicate that there were no statistically significant differences between groups. Both groups showed a statistically significant improvement following the treatment of Class II furcation defects in humans.

Predictable multiple site root coverage using an acellular dermal matrix allograft.

BACKGROUND: The primary aim of this randomized, controlled, blinded clinical investigation was to determine if orientation of an acellular dermal matrix (ADM) allograft, basement membrane side against the tooth or connective tissue side against the tooth, affected the percent root coverage. Additional aims were to: 1) compare results of this study with results obtained from other root coverage studies; 2) determine if multiple additional sites could be successfully covered with the same surgery; 3) determine the effect of the procedure on keratinized tissue; and 4) evaluate the amount of creeping attachment obtained. METHODS: Ten patients with 2 Miller Class I or II buccal recession defects > or =3 mm were treated with a coronally positioned flap plus ADM and followed for 12 months. Test sites received ADM with the basement membrane side against the root (AB), while the control sites received the connective tissue side against the root (AC). Multiple additional recession sites were treated with the same flap procedure. RESULTS: Mean baseline recession for the AB sites was 4.2 mm and for the AC sites, 3.7 mm. Mean root coverage of 95% was obtained for both AB and AC sites. Sixty-eight additional Class I or II AB and AC sites obtained about 93% root coverage. The mean increase in keratinized tissue for both treatments was 0.80 mm. No additional root coverage was gained due to creeping attachment between 2 and 12 months. CONCLUSIONS: Treatment with ADM was an effective and predictable procedure for root coverage. The orientation of the material did not affect the treatment outcome for any of the parameters tested.

Hydrolysis of fish oils containing polymers of triacylglycerols by pancreatic lipase in vitro.

Fish oils containing different levels of polymers of triacylglycerols formed during autoxidation were incubated with pancreatic lipase to establish whether these polymers are substrates for lipase hydrolysis. With oils containing low amounts (less than 4%) of triacylglycerol polymers as substrates, both triacylglycerols and polymers of triacylglycerols were almost completely hydrolyzed, and fatty acid monomers and monoacylglycerols were the major lipid products. Under the same incubation conditions, some triacylglycerols remained intact when highly oxidized oils containing 20 or 30% triacylglycerol polymers were the substrate. The fatty acid composition of these residual triacylglycerols was almost identical to that of triacylglycerols present at the start of the assay. When fish oil containing 30% triacylglycerol polymers was incubated with the lipase, the component triacylglycerols and polymers of triacylglycerols were hydrolyzed at similar rates, and fatty acid dimers were detected as a product. It is concluded that the high molecular weight polymers of triacylglycerols present in oxidized fish oils can be hydrolyzed by pancreatic lipase in vitro.

A review of current toothbrush bristle endo-rounding studies.

Rounded toothbrush bristle tips are desirable because they are less likely to abrade hard and soft tissue and restorative materials than sharp-pointed bristles. Studies evaluating different types of toothbrushes have compared the degree of the end-roundness of different brands of toothbrushes, but have yielded conflicting results. Nine studies and three methods of evaluating end-rounding are reviewed in this article. Within the limits of the review, it appears that visual inspection of a bristle tip by scanning electron microscopy or a stereomicroscope at a 45-degree angle is the technique of choice for evaluating end-roundness. Of the 9 studies reviewed, 3 studies that used the 45-degree microscopic techniques provide the most useful information of toothbrush bristle end-roundness to date. Of the brushes compared in these three studies, Crest Complete and Improved Crest Complete toothbrushes were shown to have the highest degree of end-roundness. Future research should include longitudinal studies to clarify the relationship of the degree of end-rounding of toothbrush bristles and soft-and hard-tissue abrasion.

Root coverage using Alloderm acellular dermal graft material.

This report describes a surgical technique for root coverage using an acellular dermal graft material and a coronally positioned flap. Video clips of a root coverage surgery are included using the graft material to cover multiple teeth in the same quadrant. Three additional completed cases are presented in which a mean root coverage of 97% was achieved, resulting in 100% coverage on 9 of 11 teeth. The results from this case series conform with the available evidence on the use of acellular dermal graft material in root coverage procedures.

Hydrophobically-associating cationic polymers as micro-bubble surface modifiers in dissolved air flotation for cyanobacteria cell separation.

Dissolved air flotation (DAF), an effective treatment method for clarifying algae/cyanobacteria-laden water, is highly dependent on coagulation-flocculation. Treatment of algae can be problematic due to unpredictable coagulant demand during blooms. To eliminate the need for coagulation-flocculation, the use of commercial polymers or surfactants to alter bubble charge in DAF has shown potential, termed the PosiDAF process. When using surfactants, poor removal was obtained but good bubble adherence was observed. Conversely, when using polymers, effective cell removal was obtained, attributed to polymer bridging, but polymers did not adhere well to the bubble surface, resulting in a cationic clarified effluent that was indicative of high polymer concentrations. In order to combine the attributes of both polymers (bridging ability) and surfactants (hydrophobicity), in this study, a commercially-available cationic polymer, poly(dimethylaminoethyl methacrylate) (polyDMAEMA), was functionalised with hydrophobic pendant groups of various carbon chain lengths to improve adherence of polymer to a bubble surface. Its performance in PosiDAF was contrasted against commercially-available poly(diallyl dimethyl ammonium chloride) (polyDADMAC). All synthesised polymers used for bubble surface modification were found to produce positively charged bubbles. When applying these cationic micro-bubbles in PosiDAF, in the absence of coagulation-flocculation, cell removals in excess of 90% were obtained, reaching a maximum of 99% cell removal and thus demonstrating process viability. Of the synthesised polymers, the polymer containing the largest hydrophobic functionality resulted in highly anionic treated effluent, suggesting stronger adherence of polymers to bubble surfaces and reduced residual polymer concentrations.

Pushing, pulling, dragging, and vibrating renal epithelia by using atomic force microscopy.

Renal physiologists focus on events that take place on and around the surfaces of cells. Various techniques have been developed that follow transport functions at the molecular level, but until recently none of these techniques has been capable of making the behavior of molecular structures visible under physiological conditions. This apparent gap may be filled in the future by the application of atomic force microscopy. This technique produces an image not by optical means, but by "feeling" its way across a surface. Atomic force microscopy can, however, be modified in a number of ways, which means that besides producing a high-resolution image, it is possible to obtain several types of data on the interactions between the ultrastructural components of cell membranes (such as proteins) and other biologically active molecules (such as ATP). In this review we describe the recent use of the atomic force microscope in renal physiology, ranging from experiments in intact cells to those in isolated renal transport protein molecules, include examples of these extended applications of the technique, and point to uses that the microscope has recently found in other areas of biology that should prove fruitful in renal physiology in the near future.

Poly-3-hydroxybutyrate production by washed cells of Alcaligenes eutrophus; purification, characterisation and potential regulatory role of citrate synthase.

Washed cells prepared from carbon-limited continuous cultures of Alcaligenes eutrophus synthesised poly-3-hydroxybutyrate (PHB) rapidly when supplied with glucose, DL-lactate or L-lactate. Unlike growing cultures, washed cells excreted significant amounts of pyruvate. The combined rates of PHB production (qPHB) and pyruvate excretion (qPyr) were linearly related to the rate of carbon substrate utilisation (qS), showing that washed cells behaved similarly to growing cultures when corrected for the absence of non-PHB biomass production. The addition of formate (as a potential source of NADH and/or ATP) significantly stimulated both qPHB and qPyr, but slightly decreased qS and substantially decreased the flux of carbon through the tricarboxylic acid cycle (qTCA). Citrate synthase activity of broken cells was inhibited by physiological concentrations of NADH, but not of ATP, in a manner that was not reversible by AMP. Citrate synthase was purified and shown to be a "large" form of the enzyme (Mr 227,000), comprising a single type of subunit (Mr 47,000) as found in several other gram-negative aerobes. The potential role of citrate synthase in the regulation of PHB production via its ability to control carbon flux into the tricarboxylic acid cycle is discussed.

The synthesis of a water soluble complement activating polyacrylic acid-IgG polymer.

Polyacrylic acid-IgG polymer (PAA-IgG) activates the classical and alternative pathway of complement as shown by specific Clq-(IgG-PAA) interaction and the generation of C4d, Bb, C3b, C3a and C5a. This water soluble and stable PAA-IgG polymer represents a model substance for the study of humoral and cellular inflammatory mechanisms, mediated by the complement system.