Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

IgG4-related eosinophilic pleural effusion: a case report

Abstract Background The diagnosis of unilateral eosinophilic pleural effusion (EPE) is difficult, especially for the elderly. IgG4-related disease (IgG4-RD) is a rare cause of EPE. Case presentation An 81-year-old man was admitted to the hospital for dyspnea due to right pleural effusion. Laboratory examination shows elevated IgG4 and eosinophils in both serum and pleural fluid. The patient was diagnosed with IgG4-RD by video-assisted thoracoscopy and pleural biopsy. We found no evidence of other organ involvement except for the EPE and history of prurigo. He was treated with prednisolone 40 mg daily orally and pleural effusion decreased significantly. Conclusion IgG4-RD should be considered in the differential diagnosis of EPE in the elderly. High effusion IgG4 concentration may be an indication of IgG4-related pleural lesions

On the Decision Making for Energy Resources Selection in China

Energy is important to human existence, economic development and society progress, which is also related to safety of a country and sustainable d evelopment of s ociety economy. China is a rapidly developing country, in which the d ecision making about energy selection is criti cal. This paper discusses the alternatives of energy resources of coal, petroleum, natural g as, nuclear energy and renewable energy resources of China. The research makes a decision model for the selection of energy resources for China in the future by the method of Hierarchical Decision Modeling (HDM) by Dundar F. Kocaoglu. The result of the research indicates that rankings o f energy resources are that renewable energy ranks the 1st, coal ranks the 2nd, nuclear energy ranks the 3rd, natural gas ranks the 4th and petroleum ranks the last.The sensitivit y analysis reflects that the most criti cal criterion in the energy selection is current energy infrastructure

The Biphasic Effect of Flavonoids on Oxidative Stress and Cell Proliferation in Breast Cancer Cells

Flavonoids have been reported to play an essential role in modulating processes of cellular redox homeostasis such as scavenging ROS. Meanwhile, they also induce oxidative stress that exerts potent antitumor bioactivity. However, the contradiction between these two aspects still remains unclear. In this study, four typical flavonoids were selected and studied. The results showed that low-dose flavonoids slightly promoted the proliferation of breast cancer cells under normal growth via gradually reducing accumulated oxidative products and demonstrated a synergistic effect with reductants NAC or VC. Besides, low-dose flavonoids significantly reduced the content of ROS and MDA induced by LPS or Rosup but restored the activity of SOD. However, high-dose flavonoids markedly triggered the cell death via oxidative stress as evidenced by upregulated ROS, MDA and downregulated SOD activity that could be partly rescued by NAC pretreatment, which was also confirmed by antioxidative gene expression levels. The underlying mechanism of such induced cell death was pinpointed as apoptosis, cell cycle arrest, accumulated mitochondrial superoxide, impaired mitochondrial function and decreased ATP synthesis. Transcriptomic analysis of apigenin and quercetin uncovered that high-dose flavonoids activated TNF-α signaling, as verified through detecting inflammatory gene levels in breast cancer cells and RAW 264.7 macrophages. Moreover, we identified that BRCA1 overexpression effectively attenuated such oxidative stress, inflammation and inhibited ATP synthesis induced by LPS or high dose of flavonoids possibly through repairing DNA damage, revealing an indispensable biological function of BRCA1 in resisting oxidative damage and inflammatory stimulation caused by exogenous factors

The Biphasic Effect of Flavonoids on Oxidative Stress and Cell Proliferation in Breast Cancer Cells

Flavonoids have been reported to play an essential role in modulating processes of cellular redox homeostasis such as scavenging ROS. Meanwhile, they also induce oxidative stress that exerts potent antitumor bioactivity. However, the contradiction between these two aspects still remains unclear. In this study, four typical flavonoids were selected and studied. The results showed that low-dose flavonoids slightly promoted the proliferation of breast cancer cells under normal growth via gradually reducing accumulated oxidative products and demonstrated a synergistic effect with reductants NAC or VC. Besides, low-dose flavonoids significantly reduced the content of ROS and MDA induced by LPS or Rosup but restored the activity of SOD. However, high-dose flavonoids markedly triggered the cell death via oxidative stress as evidenced by upregulated ROS, MDA and downregulated SOD activity that could be partly rescued by NAC pretreatment, which was also confirmed by antioxidative gene expression levels. The underlying mechanism of such induced cell death was pinpointed as apoptosis, cell cycle arrest, accumulated mitochondrial superoxide, impaired mitochondrial function and decreased ATP synthesis. Transcriptomic analysis of apigenin and quercetin uncovered that high-dose flavonoids activated TNF-α signaling, as verified through detecting inflammatory gene levels in breast cancer cells and RAW 264.7 macrophages. Moreover, we identified that BRCA1 overexpression effectively attenuated such oxidative stress, inflammation and inhibited ATP synthesis induced by LPS or high dose of flavonoids possibly through repairing DNA damage, revealing an indispensable biological function of BRCA1 in resisting oxidative damage and inflammatory stimulation caused by exogenous factors

Research of a Multi-Level Organization Human Resource Network Optimization Model and an Improved Late Acceptance Hill Climbing Algorithm

Complex hierarchical structures and diverse personnel mobility pose challenges for many multi-level organizations. The difficulty of reasonable human resource planning in multi-level organizations is mainly caused by ignoring the hierarchical structure. To address the above problems, firstly, a multi-level organization human resource network optimization model is constructed by representing the turnover situation of multi-level organizations in a dimensional manner as a multi-level network. Secondly, we propose an improved late acceptance hill climbing based on tabu and retrieval strategy (TR-LAHC) and designed two intelligent optimization operators. Finally, the TR-LAHC algorithm is compared with other classical algorithms to prove that the algorithm provides the best solution and can effectively solve the personnel mobility planning problem in multi-level organizations

Solution-Mediated Polymorphic Transformation of Prasugrel Hydrochloride from Form II to Form I

In situ Raman spectroscopy was applied for the analysis of the solution-mediated polymorphic transformation of prasugrel hydrochloride from the metastable form II to the stable form I. The solution concentration during the transition process was monitored by a gravimetric method. The main factors studied were solvent, temperature, solid loading, and agitation speed. Because of the balance between the solubility and the strength of solute–solvent interactions, the transformation rate was highest in ethyl acetate and lowest in butanone at all three temperatures studied (20, 30, and 40 °C). The thermodynamic driving force of the polymorphic transformation from form II to form I was evaluated through solubility measurements of the two forms in ethyl acetate, acetone, and butanone. At increasing temperature, the nucleation induction time and the overall transformation time decreased despite the decreasing driving force. The solid loading seemed to have no effect on the transformation time because of surface nucleation of form I on form II, as determined from the morphology–time profile through polarizing microscope analysis, whereas increasing the agitation rate resulted in a faster polymorphic transformation process. It was confirmed by transformation experiments that the polymorphic transformation from form II to form I is controlled by the nucleation and growth of the stable form I crystal