Pain management in living related adult donor hepatectomy : feasibility of an evidence-based protocol in 100 consecutive donors

Peer reviewedPublisher PD

When Inequality is Equitable: Validity, Propriety and Third Party Allocations

The author summarizes theories of equity and distributive justice that predict actors use legitimate distribution rules to act to maintain or to restore equity. He elaborates those ideas, distinguishing legitimacy based on validity (socially supported) from propriety (acceptance by the focal actor). Experimental research showed strong effects of both types of legitimacy on behavior, with validity having slightly stronger effects.This research was supported by a grant from the National Science Foundation (SOC #7817^3<»), Morris Zelditch, Jr.» Principal Investigator. Computations were supported by a grant from the Office of the Dean of Graduate Studies and Research at Stanford University

A Solve-RD ClinVar-based reanalysis of 1522 index cases from ERN-ITHACA reveals common pitfalls and misinterpretations in exome sequencing

Purpose Within the Solve-RD project (https://solve-rd.eu/), the European Reference Network for Intellectual disability, TeleHealth, Autism and Congenital Anomalies aimed to investigate whether a reanalysis of exomes from unsolved cases based on ClinVar annotations could establish additional diagnoses. We present the results of the “ClinVar low-hanging fruit” reanalysis, reasons for the failure of previous analyses, and lessons learned. Methods Data from the first 3576 exomes (1522 probands and 2054 relatives) collected from European Reference Network for Intellectual disability, TeleHealth, Autism and Congenital Anomalies was reanalyzed by the Solve-RD consortium by evaluating for the presence of single-nucleotide variant, and small insertions and deletions already reported as (likely) pathogenic in ClinVar. Variants were filtered according to frequency, genotype, and mode of inheritance and reinterpreted. Results We identified causal variants in 59 cases (3.9%), 50 of them also raised by other approaches and 9 leading to new diagnoses, highlighting interpretation challenges: variants in genes not known to be involved in human disease at the time of the first analysis, misleading genotypes, or variants undetected by local pipelines (variants in off-target regions, low quality filters, low allelic balance, or high frequency). Conclusion The “ClinVar low-hanging fruit” analysis represents an effective, fast, and easy approach to recover causal variants from exome sequencing data, herewith contributing to the reduction of the diagnostic deadlock

Postoperative opioids: let us take responsibility for the possible consequences.

No abstract availabl

Prevention and Treatment of Chronic Postsurgical Pain: A Narrative Review.

Chronic postsurgical pain affects between 5 and 75% of patients, often with an adverse impact on quality of life. While the transition of acute to chronic pain is a complex process-involving multiple mechanisms at different levels-the current strategies for prevention have primarily been restricted to perioperative pharmacological interventions. In the present paper, we first present an up-to-date narrative literature review of these interventions. In the second section, we develop several ways by which we could overcome the limitations of the current approaches and enhance the outcome of our surgical patients, including the better identification of individual risk factors, tailoring treatment to individual patients, and improved acute and subacute pain evaluation and management. The third and final section covers the treatment of established CPSP. Given that evidence for the current therapeutic options is limited, we need high-quality trials studying multimodal interventions matched to pain characteristics

Transcranial direct current stimulation as a tool for postoperative pain management: a review of the current clinical evidence

Adequate control of acute postoperative pain remains a challenge, and many patients still experience moderate to severe pain. Surgery is also a major cause of chronic pain, which cannot reliably be prevented with available interventions. Current analgesic regimens are also associated with severe side-effects. Consequently, we are in need of new techniques to better manage pain in the perioperative period. Transcranial direct current stimulation (tDCS)—a non-invasive neuromodulation technique—affects pain perception and modulation in human volunteers. Its ease of use, relatively low cost and absence of serious side effects make it an ideal candidate for clinical practice and a recent review concluded that it reduces pain intensity and improves quality of life of chronic pain patients. This article aims to review the clinical evidence for its use as a tool for postoperative pain management. In summary, seven randomized con-trolled trials have included over 310 patients and report encouraging results, most notably a considerable reduction in postoperative opioid use. More studies are need-ed to better establish the place of tDCS in this setting and to determine the optimal stimulation protocols

Opioid-free anesthesia opioid side effects: Tolerance and hyperalgesia.

Opioids are the most potent drugs used to control severe pain. However, neuroadaptation prevents opioids' ability to provide long-term analgesia and produces opposite effects, i.e., enhancement of existent pain and facilitation of chronic pain development. Neuroadaptation to opioids use results in the development of two interrelated phenomena: tolerance and "opioid-induced hyperalgesia" (OIH). Tolerance, a pharmacologic concept, and OIH, a clinical syndrome, have been mostly observed under experimental conditions in animals and in human volunteers. In contrast, their occurrence and relevance in clinical practice remain debated. In perioperative setting, intraoperative administration of high doses of opioids increases postoperative opioid requirements and worsens pain scores (acute tolerance or perioperative OIH). Further, preoperative chronic opioid intake and postoperative long-term use of opioid analgesics beyond the normal healing period have a negative effect on surgical outcome. Conversely, observations of improved patient's recovery after opioid-sparing anesthesia techniques stand as an indirect evidence that perioperative opioid administration deserves caution. To date, perioperative OIH has rarely been objectively assessed by psychophysics tests in patients. A direct relationship between the presence of perioperative OIH and patient outcome is missing and certainly deserves further studies

Chronic postsurgical pain.

A single treatment approach is almost unlikely to solve the problem of CPSP. Consequently, the management of postoperative pain has to become more patients' specific and etiologies sensitive