Comparison of Periarticular Infiltration and Combination Delivery of Local Anesthetics for Reducing Pain and Opioid Consumption after Total Knee Arthroplasty.

Surgical-site delivery of local anesthetics decreases pain and opioid consumption after total knee arthroplasty (TKA). The optimal route of administration is unknown. We compared local anesthetic delivery using periarticular soft-tissue infiltration to delivery using a combination of preimplantation immersion and intra-articular injection (combination treatment). The records of patients who underwent unilateral, cemented, primary TKA with spinal anesthesia and adductor canal blocks at a single Veterans Affairs Medical Center were retrospectively reviewed. Three subgroups were compared, including controls who did not receive additional local anesthetics, patients who received periarticular infiltration, and patients who received combination treatment. Mean daily pain scores and mean 24-hour opioid consumption on postoperative days (PODs) 0 and 1 were calculated, and analysis of variance was used to assess for significant differences. Factors that were associated with lower pain scores and opioid consumption were then identified using multivariate stepwise regression. There were 26 controls, 25 periarticular infiltration patients, and 39 combination patients. The periarticular infiltration cohort had significantly lower mean pain scores and opioid consumption than controls on POD 0, but not on POD 1. The combination cohort had significantly lower mean pain scores and opioid consumption than controls on PODs 0 and 1. There were no significant differences between the infiltration and combination groups on either day. Multivariate regression analysis showed that infiltration was associated with significantly decreased opioid consumption on both days and decreased pain on POD 0. Combination treatment was associated with significantly decreased pain and opioid consumption on both days. Both local anesthetic periarticular infiltration and combination treatment are associated with decreased pain and opioid consumption after TKA. The stronger effects of the combination treatment compared with periarticular infiltration on POD 1 suggests that combination delivery may have a longer duration of action.

A Simple Method Associated With Reduced Opioid Consumption After Total Knee Arthroplasty.

BACKGROUND: Most patients experience moderate to severe pain after total knee arthroplasty (TKA). We hypothesized that intraoperative treatment of cut bone surfaces with local anesthetic (preimplantation immersion anesthesia, PIA) would lead to decreased postoperative pain and opioid consumption. METHODS: Records of 76 patients who underwent unilateral, cemented TKA were retrospectively reviewed. For PIA patients, surgical wounds were immersed in local anesthetic solution immediately prior to component implantation. Both PIA (n = 43) and control (n = 33) groups received multimodal pain management, including intra-articular local anesthetic injections. Endpoints were opioid consumption and mean pain scores for postoperative day (POD) 0, 1, and 2. Demographic, medical, and social factors were included in multivariate analyses. RESULTS: PIA patients reported significantly lower mean pain scores than controls on PODs 0 and 1 (both P < .005). Pain scores on POD 2 were similar. PIA patients used 45%-33% less opioids on PODs 0, 1, and 2 (all P < .005). POD 0 pain scores showed a significant interaction between PIA treatment and preoperative opioid use (P = .013). On POD 1, PIA was the only factor associated with lower mean pain scores (P < .001). No factors were significant for POD 2. PIA was the only factor associated with lower postoperative opioid consumption on PODs 0 and 2 (both P < .005). For POD 1, PIA and increasing age (both P ≤ .005) were associated with lower postoperative opioid consumption. CONCLUSION: PIA was associated with significant reductions in opioid use and mean pain scores after TKA.

Mediterranean, invasive, woody species grow larger than their less-invasive counterparts under potential global environmental change.

PREMISE OF THE STUDY: Revealing biological differences between invasive and noninvasive species is essential for predicting species' distribution changes with global environmental change. While most research has focused on differences between invasive and noninvasive species under favorable conditions using herbaceous species, invasive woody angiosperms are also of great ecological concern. Our study focused on how growth and allocation may change for invasive and noninvasive, mediterranean, woody angiosperms under future conditions caused by global change, specifically increased nitrogen deposition and drought. METHODS: We tested how seedling functional traits differed between invasive and noninvasive woody angiosperms under different experimental conditions in a greenhouse setting. We compared growth rates and allocation patterns using two levels of soil nitrogen and three levels of watering. We also examined trait log response ratios to increases in nitrogen and increases in water. Our study sampled angiosperm trees and shrubs, incorporating congeneric/confamilial relationships through 13 phylogenetically controlled contrasts. KEY RESULTS: Three functional traits were highly and positively associated with plant invasiveness for most conditions studied: seedling plant mass, leaf area, and height. Invasive species also had significantly higher root mass ratios at low water regardless of nitrogen input. Invasive and noninvasive species had similar log response ratios to increases in nitrogen and watering for studied traits. CONCLUSIONS: Mediterranean, woody, invasive species' larger mass, leaf area, and early height advantage under elevated nitrogen input and increased root production in drought conditions may lead to increased invasion of these species with expected global climate change.

Trophic stimulation of articular chondrocytes by late-passage mesenchymal stem cells in coculture.

Coculture of mesenchymal stem cells (MSCs) with articular chondrocytes (ACs) increases glycosaminoglycan (GAG) accumulation compared to monoculture. MSCs might (1) differentiate into ACs (progenitor role) and/or (2) stimulate AC matrix metabolism (trophic role). MSCs lose the ability to undergo chondrogenesis after extended passaging. We hypothesized that MSCs act predominantly as progenitors, and that late-passage MSCs without chondrogenic potential would be unable to increase GAG in coculture. Early- and late-passage human MSCs (hMSCs) were grown in pellet monoculture under chondrogenic conditions and in pellet coculture with bovine ACs. Chondrogenesis was assessed with GAG quantification, safranin-O staining, and quantitative PCR (qPCR). Contributions of human and bovine cells were assessed with species-specific qPCR and human-specific immunostaining. Late-passage hMSCs did not undergo chondrogenesis in monoculture with chondrogenic stimuli or in coculture with ACs. Early-passage hMSCs underwent chondrogenesis only in response to chondrogenic stimuli. Coculture pellets in both cases accumulated as much GAG/DNA as monoculture AC pellets. Aggrecan transcription was not increased in coculture. Late-passage hMSCs that do not undergo chondrogenesis are capable of stimulating GAG accumulation in coculture with ACs. This supports a trophic effect of hMSCs on ACs. hMSCs may have therapeutic utility even after prolonged passaging.

Hybridization between invasive Spartina densiflora (Poaceae) and native S. foliosa in San Francisco Bay, California, USA.

Rapid evolution in contemporary time can result when related species, brought together through human-aided introduction, hybridize. The significant evolutionary consequences of post-introduction hybridization range from allopolyploid speciation to extinction of species through genetic amalgamation. Both processes are known to occur in the perennial cordgrass genus, Spartina. Here we report the existence of a third recent Spartina hybridization, discovered in 2002, between introduced S. densiflora and native S. foliosa in San Francisco Bay, California, USA. We used nuclear and chloroplast DNA analysis and nuclear DNA content with chromosome counts to examine plants of morphology intermediate between S. densiflora and S. foliosa in a restored marsh in Marin County, California. We found 32 F(1) diploid hybrids and two triploid plants, all having S. densiflora and S. foliosa as parents; there is also evidence of a genetic contribution of S. alterniflora in some hybrids. None of these hybrids set germinable seed. In 2007 we found a hybrid over 30 miles away in a marsh where both parental species occurred, suggesting hybridization may not be a localized phenomenon. The presence of diploid and triploid hybrids is important because they indicate that several avenues existed that may have given rise to a new allopolyploid species. However, such an event is now unlikely because all hybrids are targets of eradication efforts.

High seedling relative growth rate and specific leaf area are traits of invasive species: phylogenetically independent contrasts of woody angiosperms.

Understanding causal factors of exotic species invasions is important not only for prevention and prioritizing control efforts, but also for providing valuable insights into the underlying biology of contrasting life-history strategies. In seedling growth analyses, invasive woody species were compared with less-invasive woody species commonly cultivated in California using phylogenetically corrected procedures (12 phylogenetically independent contrasts). Invasive species were hypothesized to have higher seedling relative growth rates (RGRs) and specific leaf areas (SLAs) than did related less-invasive species. In phylogenetically independent contrasts conducted among taxa within families, high seedling RGRs and SLAs have significant positive associations with woody plant invasiveness. For contrasts containing species invasive in mediterranean regions, invasive species had significantly larger root biomass allocation than did less-invasive species. Optimization of fast seedling growth (high RGR) associated with opportunistic resource acquisition (high SLA) and increased root allocation to survive summer drought may be critical for the success of plant invaders in regions with mediterranean climates.

Evolution of genome size in pines (Pinus) and its life-history correlates: supertree analyses.

Genome size has been suggested to be a fundamental biological attribute in determining life-history traits in many groups of organisms. We examined the relationships between pine genome sizes and pine phylogeny, environmental factors (latitude, elevation, annual rainfall), and biological traits (latitudinal and elevational ranges, seed mass, minimum generation time, interval between large seed crops, seed dispersal mode, relative growth rate, measures of potential and actual invasiveness, and level of rarity). Genome sizes were determined for 60 pine taxa and then combined with published values to make a dataset encompassing 85 species, or 70% of species in the genus. Supertrees were constructed using 20 published source phylogenies. Ancestral genome size was estimated as 32 pg. Genome size has apparently remained stable or increased over evolutionary time in subgenus Strobus, while it has decreased in most subsections in subgenus Pinus. We analyzed relationships between genome size and life-history variables using cross-species correlations and phylogenetically independent contrasts derived from supertree constructions. The generally assumed positive relation between genome size and minimum generation time could not be confirmed in phylogenetically controlled analyses. We found that the strongest correlation was between genome size and seed mass. Because the growth quantities specific leaf area and leaf area ratio (and to a lesser extent relative growth rate) are strongly negatively related to seed mass, they were also negatively correlated with genome size. Northern latitudinal limit was negatively correlated with genome size. Invasiveness, particularly of wind-dispersed species, was negatively associated with both genome size and seed mass. Seed mass and its relationships with seed number, dispersal mode, and growth rate contribute greatly to the differences in life-history strategies of pines. Many life-history patterns are therefore indirectly, but consistently, associated with genome size.

Toward a causal explanation of plant invasiveness: seedling growth and life-history strategies of 29 pine (Pinus) species.

We studied 29 pine (Pinus) species to test the hypothesis that invasive species in disturbed habitats have distinct attributes. Seedling relative growth rate (RGR) and measures of invasiveness were positively associated across species as well as within phylogenetically independent contrasts. High RGR, small seed masses, and short generation times characterize pine species that are successful invaders in disturbed habitats. Discriminant analysis and logistic regression revealed that RGR was the most significant factor among these life-history traits separating invasive and noninvasive species. We also explored the causes of differences in RGR among invasive and noninvasive species. While net assimilation rate, leaf mass ratio, and specific leaf area (SLA) were all found to be contributing positively to RGR, SLA was found to be the main component responsible for differences in RGR between invasive and noninvasive pines. We investigated differences in SLA further by studying leaf anatomy, leaf density, and leaf thickness. We also evaluated relative leaf production rate as an important aspect of SLA. We proposed a hypothetical causal network of all relevant variables.