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

Effect of Water on Deposition, Aggregate Size, and Viscosity of Asphaltenes

The aggregation and structure of polar molecules in nonpolar media may have a profound effect on bulk phase properties and transport. In this study, we investigate the aggregation and deposition of water and asphaltenes, the most polar fraction in petroleum fluids. In flow-line experiments, we vary the concentration of water from 500 up to 175 000 ppm and provide the evidence for clear changes in asphaltene deposition. Differential interference contrast (DIC) microscopy and dynamic light scattering (DLS) are used to measure the size of the aggregates. Rheological measurements are performed to get fixed ideas on the structural changes that water induces at different concentrations. This study demonstrates the significant effect of water on asphaltene aggregation and deposition and explores the molecular basis of water–asphaltene interaction. Our aggregate size measurements show that while asphaltene molecules increase the solubilization of water, there is no increase in the aggregate size. Our aggregation size measurements are different from the reports in the literature

Educational intervention to improve appropriate digoxin therapeutic drug monitoring: a quasi-experimental study

Objectives Our previous retrospecive study evaluating the appropriateness of serum digoxin concentration (SDC) measurements revealed errors in the timing of blood specimen collection in 98% of the tests. The aim of this study is to evaluate the appropriateness of the SDC measurements and the factors involved in inappropriate test-ordering, after training health personnel in digoxin therapeutic drug monitoring. Methods This is a training-based quasi-experimental study. The residents and nurses of the Cardiology Clinic were trained first in December 2017, and refresher training courses were carried out every month throughout the study. The medical data of the inpatients receiving digoxin therapy were recorded prospectively, between January and December 2018. The appropriateness of the physicians' orders for SDC measurement was evaluated according to the criteria of the right indication and right timing of blood collection. The results are presented by descriptive statistics, Student's t-test and chi(2) analysis. Results A total of 232 SDC tests were ordered for 121 patients (age: 71.0 +/- 12.6 years, 56.2% women). Of these orders,129 (55.6%) were considered appropriate: 205 (88.4%) for indication and 129 (62.9%) for blood collection timing. There was a significant correlation between inappropriate order for SDC test and the age of the patient, female gender, impairment of renal function tests, high levels of serum BNP and the number of medications used (P<0.005). Conclusions Approximately a one-half decrease in inappropriate tests compared with our previous study results imply that education has a positive effect on physician behaviour. However, physicians' concerns due to increased risk factors for the patient still play a role in inappropriate test-ordering

SIMPLE: A Novel Scoring System for Predicting Hemodynamically Significant Patent Ductus Arteriosus Without Echocardiographic Evaluation in Extremely Low Birth Weight Infants

Aim: To develop a novel clinical scoring system for predicting hemodynamically significant patent ductus arteriosus (hsPDA) in extremely low birth weight (ELBW) infants

The stimulatory effects of boron on Japanese quail spermatological activity, histopathology, and oxidative stress

This study looked at how spermatogenesis, lipid peroxidation, antioxidant defense mechanisms, and histological changes in testicular, hepatic, and renal tissues were affected by boric acid (H3 BO3) added to mixed feed and drinking water at different concentrations for 14 weeks. For this purpose, 60 male Japanese quails (Coturnix japonica f. domestica) were used. From the age of 35 days, the birds were given boric acid added to regular soybean meal maize mixed feed as well as drinking water. Experimental groups: Control (no additive), F100: 100 mg/kg boric acid into feed, F300: 300 mg/kg boric acid into feed, W100: 100 mg/l boric acid into drinking water, and W300: 300 mg/l boric acid into drinking water. Both primordial (P < 0.001) and mature (P < 0.05) sperm counts increased in F300 and W300 groups. Supplemented boric acid in drinking water (300 mg/l) increased the tubule diameters of the testicle (P < 0.05). Because of the rising levels of boric acid in the feed and water groups, lipid peroxidation levels increased in testicular (P < 0.001), hepatic, and renal tissues (P < 0.01). Glutathione (GSH) levels rose in high boric acid groups in testicular and hepatic tissues (P < 0.001). Different tissues responded differentially to high amounts of boric acid in terms of antioxidant enzyme activity (P < 0.001). As a result, boric acid at high doses showed beneficial effects on spermatological activity; however, continued use caused lipid peroxidation in tissues and some pathological problems in liver tissue

Kefir Prevents Adipose Tissue Growth Through the Induction of Apoptotic Elements in High-Fructose Corn Syrup-Fed Rats

Consumption of high-fructose corn syrup (HFCS) in the diet is a causal factor in the development of abdominal obesity; however, the molecular mechanism behind this association is still up for debate. This study evaluated the metabolic disturbances that are caused by HFCS on adipose tissue as well as the possibility of kefir as a therapy to prevent these metabolic disturbances. Male Wistar rats were divided into four groups: control, kefir, HFCS, and HFCS+kefir. HFCS (20%, w/v) was given in drinking water and kefir (1 mL/100 g body weight) by gastric gavage daily for 8 weeks. Levels of insulin signaling, inflammation, and apoptosis-associated proteins of adipose tissues were determined with Western blot and immunohistochemical techniques. Gene expressions were evaluated with semi-quantitative real-time polymerase chain reaction (qRT-PCR). The indirect terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) method was used to assess changes in apoptotic cells, and hematoxylin/eosin staining to determine adipocyte number and diameter. Accordingly, HFCS boosted protein kinase B (Akt) and p-Akt while reducing nuclear factor κB (NF-κB), and tumor necrosis factor alpha (TNFα) levels and kefir treatment restored Akt induction in HFCS-treated rats despite raising NF-κB, and TNFα. Increased expression of Akt and B-cell lymphoma-2 gene (Bcl2) was contrasted with decreased expression of Nfkb, Tnfa, tumor protein 53 gene (p53), and caspase-8 gene (Casp8). Furthermore, while there was a marked reduction in TUNEL-positive cells in the HFCS group, the number of such cells was greater in the HFCS+kefir group. These results show that HFCS intake suppresses apoptosis in adipose tissues, which may be responsible for tissue development and abdominal obesity and may be reversed with kefir administration due to the activation of apoptosis-associated genes and proteins

Carbon nanotube bundling: influence on layer-by-layer assembly and antimicrobial activity

Peer reviewe

Proteome analysis of the circadian clock protein PERIOD2

Circadian rhythms are a series of endogenous autonomous 24-h oscillations generated by the circadian clock. At the molecular level, the circadian clock is based on a transcription-translation feedback loop, in which BMAL1 and CLOCK transcription factors of the positive arm activate the expression of CRYPTOCHROME (CRY) and PERIOD (PER) genes of the negative arm as well as the circadian clock-regulated genes. There are three PER proteins, of which PER2 shows the strongest oscillation at both stability and cellular localization level. Protein-protein interactions (PPIs) or interactome of the circadian clock proteins have been investigated using classical methods such as two-dimensional gel electrophoresis, immunoprecipitation-coupled mass spectrometry, and yeast-two hybrid assay where the dynamic and weak interactions are difficult to catch. To identify the interactome of PER2 we have adopted proximity-dependent labeling with biotin and mass spectrometry-based identification of labeled proteins (BioID). In addition to known interactions with such as CRY1 and CRY2, we have identified several new PPIs for PER2 and confirmed some of them using co-immunoprecipitation technique. This study characterizes the PER2 protein interactions in depth, and it also implies that using a fast BioID method with miniTurbo or TurboID coupled to other major circadian clock proteins might uncover other interactors in the clock that have yet to be discovered

Aneurysm and Helicobacter pylori relationship: the seropositivity of CagA, VacA and other antigens of Helicobacter pylori in abdominal and ascending aortic aneurysms

Helicobacter pylori is thought to be related to atherosclerosis and aneurysm development. We aimed to detect virulance factors of H. pylori and examine the potential etiopathogenetic relationship between aortic aneurysm and H. pylori, 58 abdominal aortic aneurysm (AAA) and 38 ascending aortic aneurysm (AsAA) cases and 57 Healty control group (HCG) were included. We investigated H.pylori IgG by ELISA and virulance factors by Western-Blot (WB) method. No difference was found between AAA (67.24%), AsAA (73.68%) and HCG (57.89%) for H. pylori IgG (p>0.05). A significant difference was found between AsAA (78.95%) and HCG (57.89%) for H.pylori IgG (p<0.05) by ELISA and a significant difference was found only between AsAA (100%) and HCG (37.5%) for H. pylori IgG in the 45-55 age group by WB. A statistically significant difference was found between AAA and AsAA for VacA and CagA+VacA and CagA+VacA+ UreA antigens and also a significant difference was found between AsAA and HCG for CagA+ UreA antigens (p<0.05). Finally, we suggest that H.pylori VacA has a more important role than CagA in the development of two aneurysms especially in ruptured AAA. New extended studies detecting H. pylori DNA are needed to detect the aetiopathogenesis between aneurysm types and H.pylori