Pregabalin and pain after total knee arthroplasty: a double-blind, randomized, placebo-controlled, multidose trial.

BACKGROUND: Pregabalin may reduce postoperative pain and opioid use. Higher doses may be more effective, but may cause sedation and confusion. This prospective, randomized, blinded, placebo-controlled study tested the hypothesis that pregabalin reduces pain at 2 weeks after total knee arthroplasty, but increases drowsiness and confusion. METHODS: Patients (30 per group) received capsules containing pregabalin (0, 50, 100, or 150 mg); two capsules before surgery, one capsule twice a day until postoperative day (POD) 14, one on POD15, and one on POD16. Multimodal analgesia included femoral nerve block, epidural analgesia, oxycodone-paracetamol, and meloxicam. The primary outcome was pain with flexion (POD14). RESULTS: Pregabalin did not reduce pain at rest, with ambulation, or with flexion at 2 weeks (P=0.69, 0.23, and 0.90, respectively). Pregabalin increased POD1 drowsiness (34.5, 37.9, 55.2, and 58.6% in the 0, 50, 100, and 150 mg arms, respectively; P=0.030), but did not increase confusion (0, 3.5, 0, and 3.5%, respectively; P=0.75). Pregabalin had no effect on acute or chronic pain, opioid consumption, or analgesic side-effects. Pregabalin reduced POD14 patient satisfaction [1-10 scale, median (first quartile, third quartile): 9 (8, 10), 8 (7, 10), 8 (5, 9), and 8 (6, 9.3), respectively; P=0.023). Protocol compliance was 63% by POD14 (50.0, 70.0, 76.7, and 56.7% compliance, respectively), with no effect of dose on compliance. Per-protocol analysis of compliant patients showed no effect of pregabalin on pain scores. CONCLUSIONS: Pregabalin had no beneficial effects, but increased sedation and decreased patient satisfaction. This study does not support routine perioperative pregabalin for total knee arthroplasty patients. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: http://www.clinicaltrials.gov/ct2/show/study/NCT01333956.

A field studies and modeling approach to develop organochlorine pesticide and PCB total maximum daily load calculations: case study for Echo Park Lake, Los Angeles, CA.

Echo Park Lake is a small lake in Los Angeles, CA listed on the USA Clean Water Act Section 303(d) list of impaired water bodies for elevated levels of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) in fish tissue. A lake water and sediment sampling program was completed to support the development of total maximum daily loads (TMDL) to address the lake impairment. The field data indicated quantifiable levels of OCPs and PCBs in the sediments, but lake water data were all below detection levels. The field sediment data obtained may explain the contaminant levels in fish tissue using appropriate sediment-water partitioning coefficients and bioaccumulation factors. A partition-equilibrium fugacity model of the whole lake system was used to interpret the field data and indicated that half of the total mass of the pollutants in the system are in the sediments and the other half is in soil; therefore, soil erosion could be a significant pollutant transport mode into the lake. Modeling also indicated that developing and quantifying the TMDL depends significantly on the analytical detection level for the pollutants in field samples and on the choice of octanol-water partitioning coefficient and bioaccumulation factors for the model.

Support needs of brain tumour patients and their carers: the place of a telephone service.

Although the survival rate for many cancers has improved over the past two decades this has not happened for most patients with a primary malignant brain tumour. Numbers of patients diagnosed with this condition each year are small, and as expertise is often very limited, information, advice, and support can be difficult for patients and carers to access. The role of the appropriately trained nurse in meeting these needs has been well researched and published literature supports the development of such roles. The use of the telephone for providing information and support has become more common in recent years. The Regional Cancer Centre in the west of Scotland covers a wide geographical area and it was considered appropriate to initiate such a service for patients and their carers in that area to provide easier access to specialist knowledge and advice and subsequently improve continuity of care. This article discusses some of the support and informational needs of patients with brain tumours and their carers, which highlight reasons for introducing the telephone service in this cancer centre. The results of a 2-year audit of the service will be also be presented.

Transplacental flecainide therapy for fetal supraventricular tachycardia in a twin pregnancy.

We present the case of a twin pregnancy in which 1 fetus developed hydrops secondary to supraventricular tachycardia at 30 weeks' gestation. Transplacental flecainide administration successfully treated the condition without evidence of maternal or fetal side-effects. The case raises ethical and possibly legal issues that present when 1 fetus in a twin pregnancy develops a condition the management of which could cause complications to the other twin and/or the mother.

Protection against lethal Sendai virus infection by in vivo priming of virus-specific cytotoxic T lymphocytes with a free synthetic peptide.

The only peptide of Sendai virus that is recognized by cytotoxic T lymphocytes (CTL) in B6 mice was found with (i) the use of recombinant vaccinia virus constructs containing separate genes of Sendai virus and (ii) a set of overlapping peptides completely spanning the identified nucleoprotein (NP) gene product. This immunodominant NP peptide is recognized by Sendai virus-specific CTL that are known to have therapeutic effects in vivo. By subcutaneous immunization, this peptide induced Sendai virus and NP peptide-specific CTL memory responses in vivo. Most importantly, mice that had been immunized with this peptide were protected against a lethal virus dose, indicating that viral peptides can be used as antiviral T-cell vaccines. The induction of T-cell memory by free peptide immunization potentially has wide applicability in biology and medicine, including protection against infectious disease.