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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Microbial Biofilms in the Bioinformatics Era

Adverse effects of anthropogenic impact on the environment have become conspicuous in the past century and among others include the gradual increase in the global CO2 levels, the contamination of air, soil and water by toxic chemicals, and the emergence of antimicrobial resistance among pathogenic microbial species. Microorganisms partake in an extreme diversity of activities in the environment, and hence, constitute the prime candidates to be investigated in understanding of the progression and effects of the aforementioned environmental hazard scenarios. The spectacular rise of massively parallel sequencing (next generation sequencing, NGS) technologies in mid 2000s initiated a renaissance in microbial ecology by allowing the in situ investigation of environmental samples at metagenome level, largely eliminating prior laboratory culturing steps. Metagenomics has thereby been established as a new interdisciplinary field and methodology, harmonizing the accumulated knowledge in microbial ecology and genetics with the high-throughput environmental DNA sequence data through the means of bioinformatics analysis resources. One of the emerging application areas that require a comprehensive microbial investigation is the study of the effects of toxic chemicals on biota in the environment, namely ecotoxicology. In this PhD thesis, bioinformatics software development and microbial ecological data analysis projects are integrated within the field of ecotoxicology. The objective of the thesis is to implement metagenomics as a robust tool in the field of ecotoxicology to gain both community and molecular level insights. Paper I presents FANTOM (Functional and Taxonomic Analysis of Metagenomes), a graphical user interface (GUI)-based metagenomic data analysis tool that provides various statistical analysis and visualization features for biologists with limited bioinformatics experience. PACFM (Pathway Analysis with Circos for Functional Metagenomics), another GUI-based software tool, is presented in Paper II, and it provides researchers in metagenomics with a novel plot and various biochemical pathway analysis features. Paper III is an exploratory study of the marine biofilms (also known as periphython), constituting the first study to sequence the total genomic DNA content of these microbial communities that inhabit the aquatic environment. The metagenomic analysis of the marine biofilms revealed that Proteobacteria, Bacteroidetes and Cyanobacteria are the most abundant organisms in these biofilm communities. In addition, the functional repertoire within the metagenome involved signatures of anaerobic processes including denitrification and methanogenesis, which suggests the presence of lowoxygen zones within the micro-ecosystem formed by the marine biofilms. Paper III also constituted the pilot study for Paper IV, where an experimental design was set up to investigate the toxic effects of the broad spectrum antimicrobial agent, triclosan, on the marine biofilms. High and low levels of triclosan exposure was shown to cause significant changes in the community structure and the functioning of the marine biofilms. A sulfurbased microbial consortium together with several algal groups were hypothesized to partake in the detoxification of triclosan. Hence, metagenomics is shown to be a powerful research tool in the field of ecotoxicology. This PhD thesis presents novel software tools and applications in the field of metagenomics, combining a wide range of paradigms from several disciplines within a unified solution framework as an attempt to practice and transcend interdisciplinary research

Application of High-Throughput DNA Sequencing Technologies in the Metagenomic Study of Marine Biofilms

Adverse effects of anthropogenic impact on the environment have become conspicuous in the past century and among others include the gradual increase in the global CO2 levels, the contamination of air, soil and water by toxic chemicals, and the emergence of antimicrobial resistance among pathogenic microbial species. Microorganisms partake in an extreme diversity of activities in the environment, and hence, constitute the prime candidates to be investigated in understanding of the progression and effects of the aforementioned environmental hazard scenarios. The spectacular rise of massively parallel sequencing (next generation sequencing, NGS) technologies in mid 2000s initiated a renaissance in microbial ecology by allowing the in situ investigation of environmental samples at metagenome level, largely eliminating prior laboratory culturing steps. Metagenomics has thereby been established as a new interdisciplinary field and methodology, harmonizing the accumulated knowledge in microbial ecology and genetics with the high-throughput environmental DNA sequence data through the means of bioinformatics analysis resources. One of the emerging application areas that require a comprehensive microbial investigation is the study of the effects of toxic chemicals on biota in the environment, namely ecotoxicology. In this PhD thesis, bioinformatics software development and microbial ecological data analysis projects are integrated within the field of ecotoxicology. The objective of the thesis is to implement metagenomics as a robust tool in the field of ecotoxicology to gain both community and molecular level insights. Paper I presents FANTOM (Functional and Taxonomic Analysis of Metagenomes), a graphical user interface (GUI)-based metagenomic data analysis tool that provides various statistical analysis and visualization features for biologists with limited bioinformatics experience. PACFM (Pathway Analysis with Circos for Functional Metagenomics), another GUI-based software tool, is presented in Paper II, and it provides researchers in metagenomics with a novel plot and various biochemical pathway analysis features. Paper III is an exploratory study of the marine biofilms (also known as periphython), constituting the first study to sequence the total genomic DNA content of these microbial communities that inhabit the aquatic environment. The metagenomic analysis of the marine biofilms revealed that Proteobacteria, Bacteroidetes and Cyanobacteria are the most abundant organisms in these biofilm communities. In addition, the functional repertoire within the metagenome involved signatures of anaerobic processes including denitrification and methanogenesis, which suggests the presence of lowoxygen zones within the micro-ecosystem formed by the marine biofilms. Paper III also constituted the pilot study for Paper IV, where an experimental design was set up to investigate the toxic effects of the broad spectrum antimicrobial agent, triclosan, on the marine biofilms. High and low levels of triclosan exposure was shown to cause significant changes in the community structure and the functioning of the marine biofilms. A sulfurbased microbial consortium together with several algal groups were hypothesized to partake in the detoxification of triclosan. Hence, metagenomics is shown to be a powerful research tool in the field of ecotoxicology. This PhD thesis presents novel software tools and applications in the field of metagenomics, combining a wide range of paradigms from several disciplines within a unified solution framework as an attempt to practice and transcend interdisciplinary research

A practical technique in laparoscopic diaphragm pacing surgery: Retrospective analyse of 43 patients

Introduction: Diaphragm pacing stimulation (DPS) is a treatment method used in respiratory failure occurs in diseases such as high-level cervical spinal cord injury, central hypoventilation syndrome and amyotrophic lateral sclerosis. Materials and Methods: A total of 43 patients, who had undergone DPS implantation surgery were evaluated retrospectively. The patients were divided into two groups according to the surgical technique (Group 1: classical surgical technic and Group 2: modified surgical technic) applied. The patients with previous abdominal surgery or percutaneous endoscopic gastrostomy were excluded from the study. Results: The mean operation duration was significantly shorter in modified DPS implantation technic (105.1 min in Group 1 and 87.4 min in Group 2) (P < 0.001). Capnothorax is seen 11% of the cases in classical surgery procedure. In the modified group, capnothorax was not observed. Pneumothorax rate was found similar in both groups. Post-operative atelectasis was determined 16% of the cases in classical surgery procedure and also in the modified group atelectasis was not observed. The complications were higher in classical surgery procedure group but not differed statistically in this study. Total hospitalisation duration was significantly shorter in the modified surgical technique group compared to the other group (8.0 days in Group 1 and 6.0 days in Group 2) (P = 0.03). Conclusion: With modification in DPS implantation surgery, shorter operation and hospitalisation durations, and less complications may be achieved

FANTOM: Functional and taxonomic analysis of metagenomes

Background: Interpretation of quantitative metagenomics data is important for our understanding of ecosystem functioning and assessing differences between various environmental samples. There is a need for an easy to use tool to explore the often complex metagenomics data in taxonomic and functional context

FANTOM: Functional and taxonomic analysis of metagenomes

BackgroundInterpretation of quantitative metagenomics data is important for our understanding of ecosystem functioning and assessing differences between various environmental samples. There is a need for an easy to use tool to explore the often complex metagenomics data in taxonomic and functional context.ResultsHere we introduce FANTOM, a tool that allows for exploratory and comparative analysis of metagenomics abundance data integrated with metadata information and biological databases. Importantly, FANTOM can make use of any hierarchical database and it comes supplied with NCBI taxonomic hierarchies as well as KEGG Orthology, COG, PFAM and TIGRFAM databases.ConclusionsThe software is implemented in Python, is platform independent, and is available at http://www.sysbio.se/Fantom

Pathway-Centric Analysis of the TCGA - NSCLC Transcriptome Data Pertaining to Deceased Patients

Lung cancer among other cancer types is the most prevalent disease with about 1.9 million new cases observed each year and ranks the fifth most common cause of death according to the World Health Organization. Of the two main subtypes of lung cancer, non-small cell lung carcinoma (NSCLC) accounts for the majority of all cases. The two major subtypes of NSCLC, lung squamous cell carcinoma and lung adenocarcinoma are extensively sampled as part of The Cancer Genome Atlas (TCGA) project. In this study, we took a pathway centric focus on the analysis of RNA-Seq data belonging to dead NSCLC patients involved in TCGA. We applied statistical tests comparing subgroups of patients based on varying clinical traits such as tumor pathologic staging and the total number of days passed from diagnosis till death for the subjected patients. We also compared the transcriptome of smokers and nonsmokers to gain insights about the effect of tobacco smoking history on the gene expression patterns of deceased NSCLC patients. Neuroactive ligand-receptor interaction pathway was overrepresented in patients who died at pathologic T2 stage as well as in those lung cancer patients who survived less than a year. Down-regulation of the signaling pathways such as retrograde endocannabinoid, Hippo, AGE-RAGE in diabetic complications, Wnt, and oxytocin was also striking in patients who survived shorter. We show concordant results with previous findings about the down-regulation of nitric oxide synthase in smokers. This study may encourage more focused analyses of the TCGA data with a potential to cast new perspectives onto lung cancer research

Humidity Sensing Properties of Chitosan by Using Quartz Crystal Microbalance Method

WOS: 000309018700033Humidity adsorption kinetics of chitosan films was investigated by quartz crystal microbalance (QCM) technique. In this study, chitosan was synthesized from chitin by deacetylation process in 2.0% (v/v) acetic acid solution and then coated on QCM to measure humidity response. The Langmuir model was used to determine the adsorption rates and Gibbs free energy for various relative humidity between 11% and 94%. The average Gibbs free energy for adsorption was obtained as -12.93 kJ/mol. Our reproducible experimental results show that chitosan films are very sensitive to relative humidity changes at room temperature.TUBITAK (Turkish Scientific and Technological Research Council)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [TBAG 109T240]We would like to thank to Ahmet Emin Eroglu for supporting chitin and Ezel Boyaci for her help during chitosan synthesis. This research was partially supported by TUBITAK (Turkish Scientific and Technological Research Council) under project number TBAG 109T240

Surgical Treatment of a Giant Primary Cardiac Angiosarcoma

Primary cardiac angiosarcoma is a rare tumor, and surgical resection is often required to relieve its symptoms. A 54-year-old male with a large primary cardiac angiosarcoma is described in this case report. The tumor was located in the right atrium and right ventricle. The bulk was resected with the right coronary artery (RCA), and partial right atrium and partial right ventricle resections were performed during cardiopulmonary bypass. The resected tumor measured 15 x 10 x 8 cm, and the histopathological diagnosis was well differentiated primary cardiac angiosarcoma. In the postoperative period, the patient was followed up for 22 months, and radiotherapy and chemotherapy were performed for metastases. The optimal therapy for cardiac angiosarcoma is still controversial, but combined treatment including surgical resection should be considered