A comparison of pain scores and medication use in patients undergoing single-bundle or double-bundle anterior cruciate ligament reconstruction.

BACKGROUND: No gold standard exists for the management of postoperative pain following anterior cruciate ligament reconstruction (ACLR). We compared the pain scores and medication use of patients undergoing single-bundle (SB) or double-bundle (DB) ACLR in the acute postoperative period. Pain and medication use was also analyzed for spinal versus general anesthesia approaches within both surgery types. METHODS: We assessed 2 separate cohorts of primary ACLR patients, SB and DB, for 14 days postoperatively. We used a standard logbook to record self-reported pain scores and medication use. Pain was assessed using a 100 mm visual analogue scale (VAS). Medications were divided into 3 categories: oral opioids, oral nonsteroidal anti-inflammatories and acetaminophen. RESULTS: A total of 88 patients undergoing SB and 41 undergoing DB ACLR were included in the study. We found no significant difference in VAS pain scores between the cohorts. Despite similar VAS pain scores, the DB cohort consumed significantly more opioid and analgesia medication (p = 0.011). Patients who underwent DB with spinal anesthesia experienced significantly less pain over the initial 14-day postoperative period than those who received general anesthesia (p < 0.001). CONCLUSION: Adequate pain relief was provided to all ACLR patients in the initial postoperative period. Patients in the DB cohort experienced more pain, as evidenced by the significant diffrence in consumption of opioids and acetaminophen, than the SB cohort. Patients who underwent spinal anesthesia experienced less pain in the acute postoperative period than those who received general anesthesia.

CONTEXTE: Il n'existe pas de norme établie pour la prise en charge de la douleur postopératoire après la reconstruction du ligament croisé antérieur (RLCA). Nous avons comparé les scores de douleur et le recours aux analgésiques chez des patients soumis à une RLCA simple faisceau (SF) ou double faisceau (DF) durant la période postopératoire immédiate. La douleur et l'utilisation des analgésiques ont aussi été analysées en rapport avec l'anesthésie utilisée, rachidienne ou générale, dans les 2 types de chirurgie. MÉTHODES: Nous avons évalué 2 cohortes distinctes de patients soumis à une RLCA primaire, SF et DF, pendant les 14 premiers jours postopératoires. Les patients ont consigné leurs scores de douleur et leur utilisation d'analgésiques dans des carnets de bord standard. La douleur était évaluée au moyen d'une échelle analogique visuelle (ÉAV) de 100 mm. Les analgésiques étaient regroupés sous 3 catégories, soit opiacés oraux, antiinflammatoires non stéroïdiens oraux et acétaminophène. RÉSULTATS: En tout, 88 patients soumis à une RLCA SF et 41 à une RLCA DF ont été inclus dans l'étude. Nous n'avons observé aucune différence significative quant au score de douleur à l'ÉAV entre les cohortes. Malgré des scores de douleur similaires à l'ÉAV, la cohorte soumise à l'intervention DF a utilisé significativement plus d'opiacés et autres analgésiques (p = 0.011). Comparativement aux patients sous anesthésie générale, les patients soumis à l'intervention DF sous anesthésie rachidienne ont éprouvé significativement moins de douleur au cours des 14 premiers jours postopératoires (p < 0.001). CONCLUSION: Tous les patients qui ont subi une RLCA ont obtenu un soulagement adéquat de leur douleur durant la période postopératoire initiale. Les patients de la cohorte DF ont éprouvé davantage de douleur, comme en témoigne la différence significative de consommation d'opiacés et d'acétaminophène comparativement à la cohorte SF. Les patients qui ont subi une anesthésie rachidienne ont éprouvé moins de douleur pendant la période postopératoire immédiate, comparativement aux patients sous anesthésie générale.

Introduction of a classification system for patients with patellofemoral instability (WARPS and STAID).

PURPOSE: The primary purpose of this paper is to introduce the WARPS/STAID classification system for patellofemoral instability. The secondary purpose is to establish the validity and reliability of the WARPS/STAID classification system. METHODS: Patients (n = 31) with a confirmed diagnosis of patellofemoral instability underwent a thorough knee history and physical examination with 3 raters. The raters graded each component of the WARPS/STAID classification system on a visual analogue scale (VAS). A single Global VAS WARPS/STAID score was graded after all other components of the classification system were completed. Intraclass correlation coefficient (ICC 2, 3) was calculated for each metric of the classification scale and for the Global score. Concurrent validity was assessed by correlating the WARPS/STAID score with the Kujala score. Subjects were assigned to one of three categories (WARPS, STAID, or mixed characteristics) according to the Total WARPS/STAID score to determine the level of agreement between the three raters. RESULTS: Intraclass correlation coefficient (ICC 2, 3) of the WARPS/STAID classification continuum ranged between 0.73 and 0.91 for the individual metrics of the classification. The ICC (2, 3) for the Global WARPS/STAID score was 0.75. The mean Kujala score (m = 61, SD 18) was significantly correlated with the total WARPS/STAID score (r = 0.387, p < 0.05). The majority of subjects were assigned to either the WARPS or STAID categories. CONCLUSION: This study introduced the WARPS/STAID classification system and established both validity and reliability in subjects with patellofemoral instability. LEVEL OF EVIDENCE: II.

Test-retest reliability of the infant car-seat challenge.

OBJECTIVE: To evaluate how a single infant car-seat challenge (ICSC) predicts subsequent respiratory physiology in premature infants. STUDY DESIGN: Prospective observational study of infants born at <37 weeks gestational age. Subjects underwent three ICSCs and we evaluated clinical characteristics, pass rate, and predictive value of a single ICSC pass. RESULT: Completed three ICSCs on 60 subjects. Seven failed initial ICSC (11.7%). Those who failed had lower birth weights. Of the 53 that initially passed, 47 passed two subsequent tests (89%). Those who passed an initial test and failed a subsequent test had lower weights at each ICSC. CONCLUSION: Our results indicate that passing an ICSC is highly predictive of passing subsequent ICSCs. Lower weights at birth and at the time of ICSC were associated with increased risk of failure. We recommend including low birth weight as an inclusion criterion for ICSCs.

Initial validity and reliability of the Banff Patella Instability Instrument.

BACKGROUND: Patellofemoral instability is a well-recognized problem, but there are currently no published patient-reported quality of life outcome measures that are disease specific for the treatment of this population. PURPOSE: To establish the content validity, initial construct validity, and initial reliability of the Banff Patella Instability Instrument (BPII). STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: The content of the BPII was validated using a modified 3-stage Ebel procedure and analysis of floor and ceiling effects. As a measure of internal consistency, the Cronbach α was utilized to assess how reliably the 32 items of the questionnaire measured a similar construct. Test-retest reliability of the BPII was calculated using an intraclass correlation coefficient (ICC). Construct validity was evaluated on 150 questionnaires completed by patients with a confirmed diagnosis of patellofemoral instability. A one-way between-group analysis of variance was employed to determine if the BPII was able to differentiate between patients presenting at the initial orthopaedic consultation relative to patients presenting at 6 months and 12 months postoperatively. RESULTS: Content validity was clearly established as each item in the BPII achieved a minimum of 83.3% agreement (range, 83.3%-100%) for relevance among the expert panelists. The average agreement was 96.9%; 24 items achieved 100% agreement. There was no evidence of floor or ceiling effects. Reliability (internal consistency) of the BPII was established at the initial orthopaedic consultation (α = .91), 6 months postoperatively (α = .97), and 12 months postoperatively (α = .97). Test-retest analysis resulted in an ICC of 0.98 between tests. Construct validity was established as there was a statistically significant difference in BPII scores at the initial orthopaedic consultation and 6-month and 12-month postoperative appointments (F2,146 = 75.62; P < .001). CONCLUSION: The BPII demonstrates content validity, strong initial reliability, and a statistically significant level of construct validity in patients with patellofemoral instability. This population includes patients with recurrent patellofemoral instability as well as surgically stabilized patients.

A potent novel anti-HIV protein from the cultured cyanobacterium Scytonema varium.

A new anti-HIV protein, scytovirin, was isolated from aqueous extracts of the cultured cyanobacterium Scytonema varium. The protein displayed potent anticytopathic activity against laboratory strains and primary isolates of HIV-1 with EC50 values ranging from 0.3 to 22 nM. Scytovirin binds to viral coat proteins gp120, gp160, and gp41 but not to cellular receptor CD4 or other tested proteins. This unique protein consists of a single 95-amino acid chain with significant internal sequence duplication and 10 cysteines forming five intrachain disulfide bonds.

Enhanced antitumor efficacy of cisplatin in combination with ALRT1057 (9-cis retinoic acid) in human oral squamous carcinoma xenografts in nude mice.

Cisplatin (DDP) is commonly used to treat head and neck tumors. Therapy frequently fails due to development of DDP resistance or toxicities associated with DDP therapy. In this study, effects of ALRT1057 [9-cis retinoic acid (9-cis RA)] on DDP cytotoxicity were studied in a human oral squamous carcinoma xenograft model. Mice bearing xenografts were dosed p.o. daily 5 days/week with 30 mg/kg 9-cis RA and/or i.p. twice weekly with 0.3-0.9 mg/kg DDP. Maximum tolerated doses of 9-cis RA and DDP were approximately 60 and >/=2.9 mg/kg, respectively, under their dosing schedules and routes of administration. Control tumors grew rapidly with mean doubling times of 4 +/- 1 days and reached mean volumes of 1982 +/- 199 (SE) mm3 after 24 days. DDP at doses of 0.3, 0.45, and 0.9 mg/kg inhibited tumor growth by 28, 47, and 86%, respectively, 24 days after tumor cell implantation. Thirty mg/kg 9-cis RA inhibited tumor growth by 25%. In combination, 0.3 mg/kg DDP + 30 mg/kg 9-cis RA inhibited tumor growth by 68%; 0.45 mg/kg DDP + 30 mg/kg 9-cis RA inhibited growth by 78%. These decreases were greater than those that would have been produced by either agent summed separately. Of importance, at doses of 9-cis RA that enhanced DDP cytotoxicity, no change in dose tolerance was observed as compared to tolerances observed for either agent alone, indicating that 9-cis RA increased sensitivity to DDP without altering systemic toxicity. In addition, 9-cis RA profoundly altered squamous cell carcinoma phenotypes by suppressing squamous cell differentiation, resulting in tumors with increased numbers of basal cells. In contrast, DDP selectively depleted proliferating basal cells from carcinomas. In combination, morphological changes produced by 9-cis RA alone predominated, suggesting a possible basis for enhanced DDP sensitivity in tumors exposed to both agents. These data demonstrate that 9-cis RA enhances tumor sensitivity to DDP, and suggest that this combination should be tested in Phase I-II clinical trials for its potential for improving anticancer therapy of squamous cell cancers.

Retinoid-induced suppression of squamous cell differentiation in human oral squamous cell carcinoma xenografts (line 1483) in athymic nude mice.

Retinoids are promising agents for therapy of squamous cancers. In vitro, retinoids decrease expression of differentiation markers in head and neck squamous carcinoma cells. Little information is available on effects of retinoids on head and neck squamous carcinoma cell xenograft growth in vivo. To address this issue, head and neck squamous carcinoma cells (line 1483) were established as xenografts in nude mice. Control tumors grew rapidly with doubling times of 4-6 days to mean volumes of 1696 mm3 after 24 days. Histological analyses indicated the formation of well-differentiated squamous carcinoma cells exhibiting pronounced stratification (basal and suprabasal cells) and keratinization (keratin pearls) with abundant stroma. Cytokeratin 19 expression was restricted to the basal cell layers, and cytokeratin 4 expression was abundant in suprabasal cells. Mice were treated daily with 30 mg/kg 9-cis retinoic acid, 20 mg/kg all-trans-retinoic acid, or 60 mg/kg 13-cis retinoic acid by p.o. gavage on a schedule of 5 days/week over 4 weeks. Low micromolar (1.48-3.67 microM) and nanomolar (200-490 nM) concentrations of 9-cis retinoic acid and all-trans-retinoic acid were measured in plasmas and xenografts, respectively, 30 min after dosing. Retinoid treatment produced a marked suppression of the squamous cell differentiation of tumor cells manifest by decreased keratinization, loss of stratification, and accumulation of basal cells. This was accompanied by large decreases in the number of CK4-positive cells and concomitant increases of CK19-positive cells. REtinoic acid receptor-beta expression was also increased by 2.9-9.7-fold after chronic retinoid treatment. 9-cis retinoic acid and all-trans-retinoic acid decreased tumor volumes by 23 +/- 5 (SE) and 19 +/- 3%, respectively (P < or = 0.05); 13-cis retinoic acid was inactive. These retinoids did not decrease the rate of exponential tumor growth but increased the latent period until exponential growth began. These studies demonstrate that retinoids do not universally decrease tumor growth but profoundly suppress squamous cell differentiation in vivo in this xenograft model.