The association of pre-operative body pain diagram scores with pain outcomes following total knee arthroplasty.

OBJECTIVE: Approximately 20% of total knee arthroplasty (TKA) recipients have suboptimal pain relief. We evaluated the association between pre-surgical widespread body pain and incomplete pain relief following TKA. METHOD: This prospective analysis included 241 patients with knee osteoarthritis (OA) undergoing unilateral TKA who completed questionnaires preoperatively and up to 12 months post-operatively. Questionnaires included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale and a body pain diagram. We derived the number of non-index painful body regions from the diagram. We used Poisson regression to determine the association between painful body regions identified preoperatively and both WOMAC pain at follow-up and improvement in pain as defined by the minimal clinically important difference (MCID). RESULTS: Mean subject age was 66 years (SD 9), and 61% were females. Adjusting for age, sex, co-morbid conditions, baseline pain, pain catastrophizing, and mental health, we found that more widespread body pain was associated with a higher likelihood of reporting 12-month WOMAC pain score >15 (relative risk [RR] per painful body region 1.39, 95% CI 1.18-1.63) and a greater likelihood of failing to achieve the MCID (RR 1.47, 95% CI 1.16-1.86).). Pain catastrophizing was an independent predictor of persistent pain and failure to improve by the MCID (RR 3.57, 95% CI 1.73-7.31). CONCLUSIONS: Pre-operative widespread pain was associated with greater pain at 12-months and failure to reach the MCID. Widespread pain as captured by the pain diagram, along with the pain catastrophizing score, may help identify persons with suboptimal TKA outcome.

Ultrastructural studies in the Rhodophyta. I. Development of mitotic spindle poles in Apoglossum ruscifolium, Kylin.

The ultrastructure of somatic mitosis in the germlings of Apoglossum ruscifolium, Kylin, fixed from its natural habitat, was examined to investigate spindle-pole development and the role of the 'polar ring'. It was found that the polar ring originates from a special nuclear pore raised above a small projection of the nuclear envelope. The initiation of mitotic polarity takes the form of changes in the nuclear envelope. These are: close crowding of pores, heavy deposition of electron-opaque material and attachment of microtubules. No such phenomena are to be observed in the equatorial regions of the nuclear envelope, which persists throughout mitosis. The next stage is the development of 'clear zones', which become filled with microtubules excluding all other structures, notably ribosomes, at both poles. At pre-metaphase, microtubules begin to be extended from the clear zones through polar fenestrae in the nuclear envelope into the nucleus itself. With subsequent development of the intranuclear spindle, the microtubules in the clear zones show signs of degeneration. At metaphase, the polar regions of the nuclear envelope begin to return to their normal condition. After metaphase, the polar rings degenerate. Thus it is primarily the nuclear envelope, via its polar modifications, which begins the organization of the mitotic spindle. The capabilities of nuclear pores are summarized. In the Discussion, the polar rings are compared with procentrioles; since they appear to have a passive role in spindle-pole organization, it is suggested that they may represent an evolutionary stage prior to the procentriole. The origin of the centriole ultimately from a nuclear pore is presented as an hypothesis. It is concluded to be unlikely that the polar ring is a degenerate centriole, and therefore it is proposed that the red algae never had centrioles in the course of their evolution. Thus the view of the non-flagellate ancestry of the red algae is supported.