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IntroductionThis study aims to investigate the effect of pre-operative intravenous methylprednisolone on post-operative pain control and joint mobility in Chinese patients undergoing single primary total knee arthroplasty.MethodsThis is a prospective, randomized, double-blinded, placebo-controlled single-centre trial. Sixty subjects were randomized into intervention and control group. The peri-operative anaesthetic and analgesic regimes were standardized. The intervention group received 125 mg methylprednisolone intravenously on the induction of anaesthesia. Subjects were assessed at 24, 30 and 48 h after surgery and upon discharge for pain scores and range of movement from the operated knee. Change in C-reactive protein level was calculated. Patient’s satisfaction was recorded. Adverse reactions were documented. Subjects were followed up at 6 weeks, 4 months and 1 year.ResultsRest pain and pain on movement were significantly reduced in the methylprednisolone group at 24 and 30 h after surgery (ANOVA p = 0.030, p = 0.003, p = 0.032, p = 0.010). The methylprednisolone group demonstrated a greater range of movement from the operated knee up to 30 h after surgery (ANOVA p = 0.031). Post-operative C-reactive protein level was significantly less in the methylprednisolone group (p < 0.001). Methylprednisolone group had a higher patient’s satisfaction than the control group (p < 0.01). No adverse effects were noted at the 1-year follow-up.ConclusionPre-operative intravenous methylprednisolone improves post-operative pain and joint mobility after total knee arthroplasty up to 30 h after operation. It results in a higher patients’ satisfaction. It can act as an effective adjunct in the multimodal analgesic regime.Trial registrationClinicalTrials.gov ID: NCT03082092.

Fibromyalgia is a chronic pain syndrome of unclear pathophysiology. It is believed to be a dysfunction of the CNS, but no definite structural lesion has been identified so far. Despite a number of changes in the diagnostic criteria, diagnosis remains a clinical one. Since the 2011 revision of the IASP definition of neuropathic pain, fibromyalgia has been excluded from the diagnosis of neuropathic pain. More recent studies however found newer evidences of pathophysiology including small fiber neuropathy in patients with fibromyalgia. This may challenge the existing consensus and have implications on future diagnosis and management of this condition.

Opioids are increasingly used to control chronic non-cancer pain globally. International opioid guidelines have been issued in many different countries but a similar document is not generally available in Hong Kong. Chronic opioid therapy has a role in multidisciplinary management of chronic non-cancer pain despite insufficient evidence for its effectiveness and safety for long-term use. This document reviews the current literature to inform Hong Kong practitioners about the rational use of chronic opioid therapy in chronic non-cancer pain. It also aims to provide useful recommendations for the appropriate, effective, and safe use of such therapy in the management of chronic non-cancer pain in adults. Physicians should conduct a comprehensive biopsychosocial evaluation of patients prior to the commencement of opioid therapy. When opioid use is deemed appropriate, the patient should provide informed consent within an agreement that specifies treatment goals and expectations. A trial of opioid can be commenced and, provided there is progress towards treatment goals, then chronic therapy can be considered at a dose that minimises harm. Monitoring of effectiveness, safety, and drug misuse should be continued. Treatment should be stopped when opioids become ineffective, intolerable, or misused. The driving principles for opioid prescription in chronic pain management should be: start with a low dose, titrate slowly, and maintain within the shortest possible time.

A recent revision in the definition of neuropathic pain has highlighted this condition as a distinct disease entity. More accurate search for a lesion in the somatosensory nervous system as the pain-generating mechanism will help target the treatment by pharmacological agents. A multidisciplinary approach is recommended, with pharmacotherapy supplemented by psychological therapy and physical rehabilitation, and appropriate interventional treatment for selected refractory cases.

For many years, basic and clinical researchers have taken advantage of the analytical sensitivity and specificity afforded by mass spectrometry in the measurement of proteins. Clinical laboratories are now beginning to deploy these work flows as well. For assays that use proteolysis to generate peptides for protein quantification and characterization, synthetic stable isotope-labeled internal standard peptides are of central importance. No general recommendations are currently available surrounding the use of peptides in protein mass spectrometric assays. The Clinical Proteomic Tumor Analysis Consortium of the National Cancer Institute has collaborated with clinical laboratorians, peptide manufacturers, metrologists, representatives of the pharmaceutical industry, and other professionals to develop a consensus set of recommendations for peptide procurement, characterization, storage, and handling, as well as approaches to the interpretation of the data generated by mass spectrometric protein assays. Additionally, the importance of carefully characterized reference materials-in particular, peptide standards for the improved concordance of amino acid analysis methods across the industry-is highlighted. The alignment of practices around the use of peptides and the transparency of sample preparation protocols should allow for the harmonization of peptide and protein quantification in research and clinical care.

Electromagnetic Vulnerability (EMV) testing of ground vehicles and helicopters is (by necessity) performed in the immediate presence of ground surfaces (natural earth, asphalt, concrete, ship decks, and other finitely conducting grounds). The impact of the nature of these grounds on the EM coupling to the various vehicles being tested is the focus of this work. As one approach to addressing these issues quantitatively, personnel at Redstone Test Center Electromagnetic Environmental Effects (RTC/E3) Division have combined measurements on a semi-canonical physical structure along with EM modeling. In particular, a hollow 25 foot long, 4 foot diameter aluminum cylinder with a finite slot ( 8 in wide) running along its entire length is positioned over (and near to) a finite conducting ground plane. Measurements of the electric fields produced both in the slot aperture and inside the hollow cylinder by an external log period dipole antenna (LPDA) positioned (broadside to the horizontal cylinder) approximately 5 m away radiating both vertical and horizontal polarizations, respectively, are presented and discussed. The entire experimental setup (aluminum cylinder, finite aluminum ground plane, and radiating LPDA) are enclosed inside an RF anechoic chamber (inside dimensions between the respective tips of the anechoic pyramids of approximately 19m x 9.0m x 5.0m). A moment method model (CARLOS) is also developed and the fields in the aperture and inside the cylinder are compared to the measured fields.

In recognition of his outstanding achievements, Dr. Sunshine received multiple awards: the Ames Award for Outstanding Contributions to Clinical Chemistry from the American Association for Clinical Chemistry (1973), a Fulbright Fellowship to the Free University of Brussels (1978), a World Health Organization consultancy (1982), the International Fellowship of the American Association for Clinical Chemistry (1984), and the Distinguished Fellow Award of the American Academy of Forensic Sciences (1995). In recognition of his professional distinction, devoted mentoring, and assistance to colleagues, no less than three professional societies-the International Association for Therapeutic Drug Monitoring and Clinical Toxicology, the International Association for Forensic Toxicology; and the American Academy of Forensic Sciences-established awards for distinction in their fields that are named the Irving Sunshine Award.

Background: CYP2D6 is a highly polymorphic phase I enzyme that metabolizes 20%–25% of clinically used drugs. The objective of this study was to validate a CYP2D6 genotyping assay with the NanoChip® Molecular Biology Workstation. Methods: We genotyped 200 anonymized human DNA samples with the Pyrosequencing® platform at the Medical College of Wisconsin and with the NanoChip platform at Dartmouth Medical School. We compared CYP2D6 genotypes and resolved samples with genotypic discrepancies with the Jurilab CYP2D6 duplication/deletion assay or with traditional DNA sequencing. The Jurilab assay is a long-range PCR assay used to evaluate sequence structures 3′ of the CYP2D7 and CYP2D6 coding regions. For the NanoChip platform, we performed multipad addressing and duplicate runs to test the intra- and intercartridge precision, within- and between-run precision, and reproducibility of the defined genotypes. Results: We used both platforms to genotype all 200 DNA samples for CYP2D6*3, *4, *5, *6, *7, *8, and gene duplication. The 2 methods showed 99.4% concordance in the genotyping results; we found only 8 discrepant genotypes among 1400 DNA analyses. Confirmatory molecular analysis of the discrepant genotypes revealed that the NanoChip assay showed better agreement. The imprecision of the NanoChip method (CV) was 8.9%–17.7%. Conclusions: This validation study of the NanoChip electronic microarray–based CYP2D6 genotyping assay revealed a CV <20% and good concordance with the Pyrosequencing method and a confirmatory sequencing method.

The United States prioritized increasing the number of underrepresented undergraduate students who completed degrees in STEM fields. The ongoing challenge was to create a diverse workforce to maintain the country's global competitiveness. Higher education rolled out intervention programs to help underrepresented students stay on track and graduate with a STEM degree. In the year 2020, New Jersey was dealing with the COVID-19 pandemic. Restricting in-person events helped control the rapid community spread. The decision was to go virtual to avoid canceling the event where the previous STEM Success Academy (SSA) had traditionally offered in-person orientation on the NJCU campus. The qualitative case study was to understand and explore the benefits of the online gamified orientation treatment and probed whether those benefits reflected in student behaviors, the community's creation, the sense of belonging, and the completion rates for the SSA program among the 41 underrepresented undergraduate STEM students. Students worked with their teams to complete various STEM and TEAM challenges. The research revealed that students, life coaches, and volunteer staff reported the scavenger activities were fun and engaging. Students were committed to pursuing their degrees at NCJU after the treatment and felt resources, such as life coaches and supplement instructions, helped students with the program completion. Different motivational factors impacted students' engagements. Overall, the treatment had a positive outcome on commitment, retention, and persistence. Students advised the continuance of the gamified orientation for next year's cohort but preferred it to be in- person.