A Prospective Randomized Study Analyzing Preoperative Opioid Counseling in Pain Management After Carpal Tunnel Release Surgery.

PURPOSE: Prescription opioid misuse has become increasingly prevalent in the United States. Preoperative opioid counseling has been proposed to decrease opioid consumption after surgery. This study aimed to evaluate the effect of preoperative opioid counseling on patients\u27 pain experience and opioid consumption after carpal tunnel release (CTR) surgery. METHODS: A prospective comparison of consecutive patients scheduled to undergo CTR surgery was conducted. Patients were randomized to receive either formal preoperative opioid counseling or no counseling. All operations were performed with the same miniopen CTR surgical technique, and the same number of opioids were prescribed after surgery. Daily opioid pill consumption, pain levels, and any adverse reactions were recorded. RESULTS: During the day of surgery and the first day following surgery, patients in the group with counseling reported significantly fewer prescribed opioid pills consumed compared with patients in the group without counseling, while experiencing no significant difference in pain level experience. In addition, patients in the group with counseling reported a significantly lower number of total pain pills consumed over the course of the study than the group without counseling. No major adverse reactions were noted in either group. CONCLUSIONS: Preoperative opioid counseling was found to result in a significant decrease in overall opioid consumption after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II

Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures.

Volar locked plating is the most frequently utilized method for internal fixation of distal radial fractures. The overall complication rate for volar plating of distal radial fractures appears to be relatively low compared with other operative fixation methods. Carpal tunnel syndrome is the most commonly reported complication. However, this may occur after a distal radial fracture regardless of treatment method, with reported rates ranging from 0% to 20% with conservative management and 0% to 14% with volar plating. Extensor tendon rupture has been reported at rates of 0% to 4% and is the most frequent complication requiring plate removal. Variable-angle volar locking plates may be associated with fewer implant-related complications as a result of their greater degree of screw placement customization compared with fixed-angle volar locking plates

ROLE OF H-2 LYMPHOCYTE-DEFINED AND SEROLOGICALLY-DEFINED COMPONENTS IN THE GENERATION OF CYTOTOXIC LYMPHOCYTES

The cell-mediated lympholytic capability of mouse spleen cells stimulated in mixed lymphocyte culture is determined by lymphocyte-defined (LD) and serologically-defined (SD) antigenic differences present during sensitization. Cells which are activated by LD differences alone are markedly less effective in causing lysis of target cells. This lack of cytotoxicity is shown to be, at least in part, due to the inability of LD differences to allow the efficient generation of cytotoxic lymphocytes. SD antigens not only serve as good targets for CML but are also shown to be important for the generation of cytotoxic lymphocytes during the mixed lymphocyte culture

Mutations in hepatitis C virus E2 located outside the CD81 binding sites lead to escape from broadly neutralizing antibodies but compromise virus infectivity.

Broadly neutralizing antibodies are commonly present in the sera of patients with chronic hepatitis C virus (HCV) infection. To elucidate possible mechanisms of virus escape from these antibodies, retrovirus particles pseudotyped with HCV glycoproteins (HCVpp) isolated from sequential samples collected over a 26-year period from a chronically infected patient, H, were used to characterize the neutralization potential and binding affinity of a panel of anti-HCV E2 human monoclonal antibodies (HMAbs). Moreover, AP33, a neutralizing murine monoclonal antibody (MAb) to a linear epitope in E2, was also tested against selected variants. The HMAbs used were previously shown to broadly neutralize HCV and to recognize a cluster of highly immunogenic overlapping epitopes, designated domain B, containing residues that are also critical for binding of viral E2 glycoprotein to CD81, a receptor essential for virus entry. Escape variants were observed at different time points with some of the HMAbs. Other HMAbs neutralized all variants except for the isolate 02.E10, obtained in 2002, which was also resistant to MAb AP33. The 02.E10 HCVpp that have reduced binding affinities for all antibodies and for CD81 also showed reduced infectivity. Comparison of the 02.E10 nucleotide sequence with that of the strain H-derived consensus variant, H77c, revealed the former to have two mutations in E2, S501N and V506A, located outside the known CD81 binding sites. Substitution A506V in 02.E10 HCVpp restored binding to CD81, but its antibody neutralization sensitivity was only partially restored. Double substitutions comprising N501S and A506V synergistically restored 02.E10 HCVpp infectivity. Other mutations that are not part of the antibody binding epitope in the context of N501S and A506V were able to completely restore neutralization sensitivity. These findings showed that some nonlinear overlapping epitopes are more essential than others for viral fitness and consequently are more invariant during earlier years of chronic infection. Further, the ability of the 02.E10 consensus variant to escape neutralization by the tested antibodies could be a new mechanism of virus escape from immune containment. Mutations that are outside receptor binding sites resulted in structural changes leading to complete escape from domain B neutralizing antibodies, while simultaneously compromising viral fitness by reducing binding to CD81

Portraits of buildings

Thesis (M.S.V.S.)--Massachusetts Institute of Technology, Dept. of Architecture, 1981.MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH.Includes bibliographies.The photography of architecture is more than a simple tool to record facts about specific buildings. Photography can be used to communicate insights and perceptions about the role of architecture in society and our personal relationship to the architectural environment. This is a study of certain artists, and photographers who have broadened the concept of documentation of architecture. Photographic documents provide factual information as well as personal attitudes and expressive statements. The personal observations of artist/photographers are vital to a wider understanding of the built environment. A wider understanding is a necessary prerequisite to improving that environment.by Robert H. ALter.M.S.V.S

Clearing algorithms and network centrality

I show that the solution of a standard clearing model commonly used in contagion analyses for financial systems can be expressed as a specific form of a generalized Katz centrality measure under conditions that correspond to a system-wide shock. This result provides a formal explanation for earlier empirical results which showed that Katz-type centrality measures are closely related to contagiousness. It also allows assessing the assumptions that one is making when using such centrality measures as systemic risk indicators. I conclude that these assumptions should be considered too strong and that, from a theoretical perspective, clearing models should be given preference over centrality measures in systemic risk analyses