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

Effects of various carbon precursors combination in regulating the molar fraction of P(3HB-co-4HB) using locally isolated Cupriavidus sp. TMT11

The P(3HB-co-4HB) is commonly used for biomedical applications. This is due to the desired mechanical properties as well as biocompatibility, non-genotoxicity, and non-cytotoxicity of this copolymer. However, the production of P(3HB-co-4HB) with a specific 4HB molar fraction is still limited. In this study, carbon precursors at different combinations and concentration ratios have been used in the production of P(3HB-co-4HB) bioplastics using locally isolated Cupriavidus sp. TMT11. The carbon precursors 1,6-hexandiol, 1,4-butanediol, and γ-butyrolactone were used to screen for high cell biomass, PHA content, and 4HB molar fraction through Gas Chromatography (GC) analysis. Generally, the combination of various carbon precursors showed an increase in cell biomass. The carbon combination of 1,4-butanediol and γ-butyrolactone at the ratio of 4:2 and carbon combination of 1,6-hexanediol and γ-butyrolactone at a ratio of 1:5 showed high amount of cell biomass above 0.35 g/L on day 3. Nevertheless, the 4HB molar fraction of both the combination was recorded as 9±0.27 mol% and 14±1.1 mol% respectively. The lowest amount of cell biomass and PHA yield were recorded with the carbon combination of 1,6-hexanediol and 1,4-butanediol with the ratio 5:1 at 0.55±0.13 g/L. However, the highest 4HB molar fraction of 89.37±3.6 mol% 4HB was recorded with this combination. The 4HB molar fraction above 80 mol% was reported with a carbon combination of 1,6-hexanediol +1,4-butanediol at 5:1, 1:1, and 2:4 ratio. The varying combination of carbon precursors biosynthesized a wide range of 4HB molar fractions ranging from 9.07 to 89.37 mol% 4HB

One-year outcomes of patients with ST-segment elevation myocardial infarction during the COVID-19 pandemic

10.1007/s11239-021-02557-6JOURNAL OF THROMBOSIS AND THROMBOLYSI

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

non present

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Search for third-generation scalar leptoquarks in the tτ channel in proton-proton collisions at √s =8 TeV

A search for pair production of third-generation scalar leptoquarks decaying to top quark and τ lepton pairs is presented using proton-proton collision data at a center-of-mass energy of $\sqrt{s}=8$ TeV collected with the CMS detector at the LHC and corresponding to an integrated luminosity of 19.7 fb$^{−1}$. The search is performed using events that contain an electron or a muon, a hadronically decaying τ lepton, and two or more jets. The observations are found to be consistent with the standard model predictions. Assuming that all leptoquarks decay to a top quark and a τ lepton, the existence of pair produced, charge −1/3, third-generation leptoquarks up to a mass of 685 GeV is excluded at 95% confidence level. This result constitutes the first direct limit for leptoquarks decaying into a top quark and a τ lepton, and may also be applied directly to the pair production of bottom squarks decaying predominantly via the R-parity violating coupling λ$_{333}^{′}$

Evidence for Transverse Momentum and Pseudorapidity Dependent Event Plane Fluctuations in PbPb and pPb Collisions

A systematic study of the factorization of long-range azimuthal two-particle correlations into a product of single-particle anisotropies is presented as a function of $p_\mathrm{T}$ and $\eta$ of both particles, and as a function of the particle multiplicity in PbPb and pPb collisions. The data were taken with the CMS detector for PbPb collisions at $\sqrt{s_{\mathrm{NN}}}$ = 2.76 TeV and pPb collisions at $\sqrt{s_{\mathrm{NN}}}$ = 5.02 TeV, covering a very wide range of multiplicity. Factorization is observed to be broken as a function of both particle $p_\mathrm{T}$ and $\eta$. When measured with particles of different $p_\mathrm{T}$, the magnitude of the factorization breakdown for the second Fourier harmonic reaches 20% for very central PbPb collisions but decreases rapidly as the multiplicity decreases. The data are consistent with viscous hydrodynamic predictions, which suggest that the effect of factorization breaking is mainly sensitive to the initial-state conditions rather than to the transport properties (e.g., shear viscosity) of the medium. The factorization breakdown is also computed with particles of different $\eta$. The effect is found to be weakest for mid-central PbPb events but becomes larger for more central or peripheral PbPb collisions, and also for very high-multiplicity pPb collisions. The $\eta$-dependent factorization data provide new insights to the longitudinal evolution of the medium formed in heavy ion collisions