Postoperative Ultrasound Guided Continuous Femoral Nerve Blockade for Unilateral Total Knee Arthroplasty: A Comparison of 0.125% Bupivacaine and 0.2% Ropivacaine.

CONTEXT: Total knee arthroplasty (TKA) is associated with severe postoperative pain which increases morbidity and mortality. AIMS: The aim of the study was to compare the analgesic efficacy and motor blockade of continuous infusion of 0.125% bupivacaine and 0.2% ropivacaine in femoral nerve block following unilateral TKA and to assess the effectiveness of femoral nerve block. SETTINGS AND DESIGN: One hundred and fifty patients undergoing unilateral total knee replacement surgery were included in this prospective observational comparative study. SUBJECTS AND METHODS: Patients are divided into two groups of 75 each. Femoral nerve catheter was placed at the end of surgery using ultrasound. Postoperative analgesia and motor blockade were compared for the next 24 h using visual analog scale (VAS) score, additional analgesic requirement, and Bromage scale. STATISTICAL ANALYSIS: Student's t-test and Chi-square test were applied. RESULTS: There was no statistically significant difference in pain between the two groups though VAS score (during rest and movement) and opioid consumption were lower in bupivacaine group. Nearly 28.6% patients experienced pain and required additional analgesics. Seventy-two percent among them complained of pain in the popliteal region supplied by sciatic nerve. Eight patients excluded from the study also had pain in the popliteal fossa. There was a statistically significant difference in motor blockade between the two groups at 12, 18, and 24 h after starting infusion. Bupivacaine group had a higher percentage of type three blocks compared to ropivacaine group. CONCLUSION: Continuous femoral nerve block (CFNB) with 0.125% bupivacaine infusion provided better analgesia with denser motor blockade compared to 0.2% ropivacaine infusion. CFNB alone is not sufficient to provide adequate analgesia following unilateral TKA.

Role of human papilloma virus in oral tongue squamous cell carcinoma.

BACKGROUND: Human papilloma virus (HPV) is an important risk factor for head and neck cancer, specifically oropharyngeal cancer, but its association with oral tongue squamous cell carcinoma (SCC) is uncertain. The objectives were to determine the HPV16 prevalence in oral tongue SCCs, its integration status and to correlate the expression of oncogenic proteins with targets. METHODS: In this case-control study with oral tongue SCC cases (n=60) and normal oral mucosa (n=46), HPV positivity was determined by polymerase chain reaction (PCR) using consensus and HPV 16 type specific primers and p16 immunohistochemistry (IHC). The viral integration status was determined with primers specific to the E2 gene and in situ hybridization (ISH). Immunohistochemical analysis of HPV oncogenic proteins (E6, E7) and their target proteins (p53, pRb, cyclinD1, p16, Notch-1, EGFR) proteins was carried out in HPV positive cases. The data was analyzed with SPSS software (v 11.0). Survival analysis was carried out by the Kaplan-Meier method. RESULTS: HPV16 was detected in 48% (n=29) of the cases and none of the controls by PCR assay (p<0.001) while p16 IHC, as a surrogate HPV marker, detected 33% (n=18) of the cases; 18% (n=10) were detected by both the methods. Integration was observed in 83% (n=24) by E2-PCR and 67% (n=18) by ISH. The E6-p53 pathway was active in 33% of the cases; E7-pRb in 52% and both in 11%. HPV positivity was associated with well-differentiated cancers (p=0.041) and low recurrence rate (p=0.014). CONCLUSION: Our study confirms a positive correlation of HPV infection with oral tongue cancer.

Determination of the geographical origin of green coffee by principal component analysis of carbon, nitrogen and boron stable isotope ratios.

In this study we show that the continental origin of coffee can be inferred on the basis of coupling the isotope ratios of several elements determined in green beans. The combination of the isotopic fingerprints of carbon, nitrogen and boron, used as integrated proxies for environmental conditions and agricultural practices, allows discrimination among the three continental areas producing coffee (Africa, Asia and America). In these continents there are countries producing 'specialty coffees', highly rated on the market that are sometimes mislabeled further on along the export-sale chain or mixed with cheaper coffees produced in other regions. By means of principal component analysis we were successful in identifying the continental origin of 88% of the samples analyzed. An intra-continent discrimination has not been possible at this stage of the study, but is planned in future work. Nonetheless, the approach using stable isotope ratios seems quite promising, and future development of this research is also discussed.