Objectives:To examine the feasibility and potential efficacy of 5% lidocaine medicated plaster for acute postoperative pain in a parallel, blinded, randomized controlled pilot trial.Methods:Twenty-eight women undergoing elective gynecological surgery with midline incisions were randomly allocated 5% lidocaine medicated patch (Lignopad) or placebo plasters. Postoperative pain at rest and on movement at 24 hours were the primary study endpoints, with secondary endpoints of postoperative pain within the first 48 hours, cumulative morphine consumption (mg), predicted peak flow rate (PFR) (%) and adverse effects. We assessed pain scores at rest and on movement using the visual analogue scale (0–100).Results:The lidocaine patch group had lower postoperative pain scores at rest at 24 hours (mean difference [MD] −15.1, 95% confidence interval [95% CI] −28.3 to −2.0; P = .024) but not on movement at 24 hours (MD −6.4, 95% CI −22.7 to 9.9; P = .445). Compared to placebo, lidocaine may slightly lower cumulative morphine consumption (mg) over time (MD −3.4, 95% CI −6.9 to 0.2; group∗time interaction P = .065). The difference in improvement in the PFR over time after surgery between groups appeared small (group∗time P = .0980). No adverse effects occurred.Conclusions:Lidocaine patch may provide a clinically important reduction in postoperative pain intensity. A larger trial to confirm the efficacy and safety of lidocaine patch is feasible after modifying the inclusion criteria and collecting patient-centered outcomes, such as quality of recovery and patient satisfaction.
Adverse knee pain occurs in 10–34% of all total knee replacements (TKR), and 20% of TKR patients experience more pain post-operatively than pre-operatively. Knee pain is amongst the top five reasons for knee replacement revision in the United Kingdom. The number of TKRs is predicted to continue increasing due to the ageing population. A narrative literature review was performed on the different causes of pain following TKR. A database search on Scopus, PubMed, and Google Scholar was conducted to look for articles related to TKR, pain, and cause. Articles were selected based on relevance, publication date, quality of research and validation. Relevant sections were added to the review. One hundred and fourteen articles were identified and potential causes of TKR pain included: arthrofibrosis, aseptic loosening, avascular necrosis, central sensitization, component malpositioning, infection, instability, nerve damage, overstuffing, patellar maltracking, polyethylene wear, psychological factors and unresurfaced patella. It is important to tailor our approach to address the individual causes of pain. Certain controllable risk factors can be managed pre-operatively to minimize post-operative pain. Risk factors help to predict adverse pain outcomes and identify specific causes. There are multiple causes of pain following TKR. Some factors will require further extensive studies, and as pain is a commonly attributed reason for TKR revision, its underlying aetiologies should be explored. Understanding these factors helps to develop effective methods for diagnosis, prevention and management of TKR pain, which help to improve patient outcomes. Cite this article: EFORT Open Rev 2020;5:534-543. DOI: 10.1302/2058-5241.5.200031
Aims Stiffness is a common complication after total knee arthroplasty (TKA). Pathogenesis is not understood, treatment options are limited, and diagnosis is challenging. The aim of this study was to investigate if MRI can be used to visualize intra-articular scarring in patients with stiff, painful knee arthroplasties. Methods Well-functioning primary TKAs (n = 11), failed non-fibrotic TKAs (n = 5), and patients with a clinical diagnosis of fibrosis 1 (n = 8) underwent an MRI scan with advanced metal suppression (Slice Encoding for Metal Artefact Correction, SEMAC) with gadolinium contrast. Fibrotic tissue (low intensity on T1 and T2, low-moderate post-contrast enhancement) was quantified (presence and tissue thickness) in six compartments: supra/infrapatella, medial/lateral gutters, and posterior medial/lateral. Results Fibrotic tissue was identified in all patients studied. However, tissue was significantly thicker in fibrotic patients (4.4 mm ± 0.2 mm) versus non-fibrotic (2.5 mm ± 0.4 mm) and normal TKAs (1.9 mm ± 0.2 mm, p = < 0.05). Significant (> 4 mm thick) tissue was seen in 26/48 (54%) of compartments examined in the fibrotic group, compared with 17/30 (57%) non-fibrotic, and 10/66 (15%) normal TKAs. Although revision surgery did improve range of movement (ROM) in all fibrotic patients, clinically significant restriction remained post-surgery. Conclusion Stiff TKAs contain intra-articular fibrotic tissue that is identifiable by MRI. Studies should evaluate whether MRI is useful for surgical planning of debridement, and as a non-invasive measurement tool following interventions for stiffness caused by fibrosis. Revision for stiffness can improve ROM, but outcomes are sub-optimal and new treatments are required. Cite this article: Bone Joint J 2020;102-B(10):1331–1340.
Synthetic messenger RNA (mRNA) switches are powerful synthetic biological tools that can sense cellular molecules to manipulate cell fate. However, their performances are limited by high output signal noise due to leaky output protein expression. Here, we designed a readout control module that disables protein leakage from generating signal. Aptamer array on the switch guides the inactive output protein to selfassemble into functional assemblies that generate output signal. Leaky protein expression fails to saturate the array, thus produces marginal signal. In this study, we demonstrated that switches with this module exhibit substantially lower signal noise and, consequently, higher input sensitivity and wider output range. Such switches are applicable for different types of input molecules and output proteins. The work here demonstrates a new type of spatially guided protein selfassembly, affording novel synthetic mRNA switches that promise accurate cell manipulation for biomedical applications.
Kowloon Walled City (hereafter KWC or Walled City), Hong Kong has been described as ‘one of history’s great anomalies’. The territory remained under Chinese rule throughout the period of British colonialism, with neither jurisdiction wishing to take active responsibility for its administration. In the postwar period, the area became notorious for vice, drugs and unsanitary living conditions, yet also attracted the attention of artists, photographers and writers, who viewed it as an instance of anarchic urbanism. Despite its demolition in 1993, KWC has continued to capture the imaginations of successive generations across Asia. Drawing on data from an oral and visual history project on the enclave, alongside images, interviews and observations regarding the ‘second life’ of KWC, this article will trace the unique flow of meanings and reimaginings that KWC has inspired. The article will locate the peculiar collisions of crime and consumerism prompted by KWC within the broader contexts in which they are embedded, seeking out a new interdisciplinary perspective that attends to the internecine spaces of crime, media and culture in contemporary Asian societies.
The queer fandom of female Hong Kong pop singer Ho Denise Wan See (HOCC) from 2009 to mid-2011 is dealt with through the qualitative methodology of in-depth interviews and media ethnography. HOCC, an idiosyncratic cultural producer who dabbles in the politics of ambiguity, creates texts that invite queer interpretations from fans and from queer activists in Hong Kong. Via analyses informed by both queer studies and audience studies, the various creative practices of fans in reshaping their sexual identities via popular culture are explored. These practices are highly political and empowering to a queer audience. However, the intensive rewriting of meanings as queer symbolic creativity and tactics in cultural politics fail to transform into formal institutional politics and more confrontational queer activism. This is so for several reasons. Internally, the hierarchical structure of fan organization, fan proximity to the culture industry, and the top-down encouragement of social charity as the only channel of activism have all reduced the possibility of transforming fans' queer sensibilities into institutional queer politics. Furthermore, Hong Kong, under the influence of three major discourses that seek to discipline and regulate sexualities—traditional Chinese ethics, the British colonial legacy, and the postcolonial revival of rightist Christianity—has a long social history of heterosexist discrimination and a preference for normalizing when striving for queer citizenship. This empirical study examines relations between cultural specificity and fan agency in a non-Western context.
Synthetic messenger RNA (mRNA) switches are powerful tools for in situ cell purification, especially for cells derived from stem cells. However, the retention effectiveness of the target cells is limited by the leaky expression of toxic protein. The elimination efficiency of non‐target cells is also constrained due to the lack of signal amplification. In this study, we designed a novel approach that uses synthetic mRNA switch to convey intracellular marker molecule information into spatially controlled extracellular toxic assembly formation. The approach bypasses the use of toxic protein to ensure high target cell recovery effectiveness. Meanwhile, the marker molecule information is amplified at multiple levels to ensure high non‐target cell elimination effectiveness. Our approach can be tailored to meet various in situ cell purification needs, promising high‐quality in situ cell purification for a wide range of biomedical applications.
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