43 research outputs found

    Das maligne Melanom an der Universitäts-Hautklink Tübingen: Klinische Epidemiologie und operative Therapie 1980 bis 2010

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    In der retrospektive Betrachtung konnte gezeigt werden, dass das Melanom aktuell 10 Jahre später erstdiagnostiziert wird als 1980. In der Altersgruppe der über 60jährigen erkranken mehr Männer als Frauen. Die männlichen Pat. kommen im Durchschnitt 5 Jahre später als die Frauen zur Erstdiagnose. Die Prognose der männlichen Pat. ist schlechter als die der weiblichen, da sie in einem fortgeschrittenem Stadium der Erkrankung zu Erstdiagnose kommen. Häufigster Subtyp des Melanoms ist das SSM und die häufigste betroffene Region ist der Stamm. Die Lokalisation der Unterschenkel bei den weiblichen Pat. hat im beobachteten Zeitraum abgenommen.Dir prognostische Faktor Tumordicke hat zunächst stark abgenommen, hat dann aber Mitte der 1990ziger Jahre wieder leicht zugenommen. Das Melanom wird mit zunehmend kleineren Sicherheitsabständen operiert ohne Nachteil auf das Überleben. Der prognostische Faktor der Mikrometastasen wurde 1996 eingeführt und trug dazu bei, dass seither mehr Pat. dem Stadium III zugeordnet wurden

    New horizons: otitis media research in Australia

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    Otitis media affects nearly all children worldwide. Despite an enormous amount of research, our understanding of this common condition continues to be challenged. New pathogens involved in otitis media are still being identified. The importance of interactions between viral and bacterial infection and the role of new vaccines need to be clarified. The proposal that bacteria can become more resistant to therapy through biofilm formation and intracellular infection could have important implications for treatment. The most important clinical research findings have been summarised in systematic reviews. In developed countries, research supporting “watchful waiting” of otitis media with effusion and acute otitis media have had most impact on evidence-based clinical practice guidelines. Indigenous Australian children remain at risk of more severe otitis media. Research programs targeting this population have been well supported. Unfortunately, interventions that can dramatically improve outcomes have remained elusive. For children at high risk of otitis media, health care services should concentrate on accurate diagnosis, antibiotic treatment of suppurative infections, and scheduled follow-up of affected children. Despite the lack of recent studies, strategies to minimise the impact the hearing loss associated with otitis media are important. Improvements in education, hygiene practices, and living conditions are likely to reduce the incidence and severity of otitis media. Studies of these types of interventions are needed

    Current Trends in the Russian Financial System

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    The papers in the present SUERF Study is a selection of the papers presented at a SUERF Workshop and Special OeNB East Jour Fixe held at Oesterreichische Nationalbank in Vienna on 23 January 2009. In his opening remarks (chapter 2), Ewald Nowotny, Governor of the Oesterreichische Nationalbank referred to Austrian banks? engagement with neighbouring Central and Eastern European Countries. The current crisis should not make people forget the fact that Austrian banks? deep engagement with the neighbouring countries is one of the success stories in Austrian economic history. Since the fall of the Berlin Wall, Austrian banks have become one of the driving forces of the process of structural adjustment, modernization of business practices, and deepening of financial intermediation in the region. At end 2007, in Central Europe, the share of Austrian banks surpassed a fifth of aggregate sector assets, in Southeastern Europe even a third of the respective total. A considerable share of the earnings of Austrian banks comes from banking activities in Central and Eastern Europe. Austrian bankers can claim to be among the pioneer foreign investors in Russia, Ukraine, Kazakstan and Belarus. The international financial crisis has from September 2008 demonstrated Russia?s structural vulnerability. The comprehensive countermeasures by the Russian authorities to assist the banking sector and the economy are characterized by the Governor as worthy endeavours. Chapter 3 is based on the keynote speech by Pekka Sutela, BOFIT, Bank of Finland ?Russian Finance: Drag or Booster for Future Growth?? The author praises the Russian authorities for having made prudent decisions in recent years. The Putin-Kudrin regime chose a stability-oriented macro policy. The very strong increase in the global oil price up to 2008 implied a strong growth in the value of Russian exports and lead to an impressive GDP growth. The author uses the term ?windfall?. The Russian Government decided to pay back practically all foreign debt, much of it ahead of schedule. The regime wanted to bring back what they see as Russian sovereignty and in particular to avoid being dependent on IMF or other foreign financiers. Their policy contributed strongly to an improvement of Russia?s general credit-worthiness and to a growth in foreign reserves. During the 1990s, lack of trust in the rouble had as consequence that the US dollar was applied to a considerable extent in payments between Russians. The stability oriented policy after 2001 contributed to a de-dollarization of the economy up to 2008. It follows from the stability-oriented policy that Russia was relatively well prepared when it was hit by the global financial crisis in 2007?2008. In the autumn of 2008, however, the general public started to withdraw bank deposits and the relative share of foreign exchange deposits increased again. The public shifted towards foreign currency cash assets. The author explains that Russia has a dual economy. The natural resource based sectors are clearly globally competitive but the sectors outside the resource sectors are not. The big resource based companies have relied on foreign markets for their financial needs. The home market is primarily serviced by domestic banks. At the end of September 2008, government-controlled banks had 47.8% of all bank assets. The state maintains banking sector stability primarily through state banks. The author?s answer to the question in the headline is: ?The Russian financial system is rather a drag than a booster for future growth?. In addition, it is unlikely that Russia will become a regional financial centre or an inventionbased society in the foreseeable future. Chapter 4 by Stephan Barisitz, Oesterreichische Nationalbank, is ?Russian Banking in Recent Years: Gaining Depth in a Fragile Environment.? The author shows tables with macroeconomic, monetary and financial indicators for Russia for the years 2002?2008. Key observations are: Strong economic growth, strong dependence on oil prices, inflation problems, recent volatility of private capital in- and outflows. Banking development initially featured rather slow recovery from the financial crisis of 1998, coupled with sluggish reforms. This was followed by a stepped-up pace of institutional and structural adjustments in 2003?2005, which brought about major improvements of banking activities and of the regulatory framework. The return on equity (ROE) of banks was in 2006?2007 above 20%. The solvency ratio of banks declined steadily up to 2008 due to strong growth in bank assets. The oil price driven improvements in Russia?s terms of trade over the period 1998 to 2008 combined with political stability, prudent macroeconomic policies and some successful institutional and structural reforms have supported Russian economic expansion. Not only exports, but also consumption, have driven strong GDP growth. Financial intermediation continued to deepen swiftly in Russia up to the fall of 2008, despite important repercussions of the US subprime crisis. As the interbank market tightened during 2008 and capital outflows increased, Central Bank of Russia reacted quickly with repeated liquidity interventions. Following the continuous oil price decline and pressures on the rouble, Central Bank of Russia intervened extensively in the foreign exchange market and draw down foreign exchange reserves. The controlled depreciation strategy initiated in November 20078 has not stopped the decline in foreign exchange reserves. Due to the still sizable foreign reserves, the relatively high profitability of banking activity and the satisfactory capital adequacy level as shock absorbing factors, Russia seems to be in a better position to handle the financial crisis than many other countries. Chapter 5 by Alexander Lehmann, European Bank for Reconstruction and Development has the headline ?Banks and Financial Reform: Their Role in Sustaining Russia?s Growth.? The paper focuses on the strength of the link between economic growth and financial development. Even in East European transition countries where a positive correlation between finance and growth developed in the 1990s, there was little microeconomic evidence that the financial sector actively supported growth. Investments were overwhelmingly financed through retained earnings, and what little external finance was raised came from foreign direct investment. Around year 2000, this changed. Regulatory improvements, better enforcement and rapid development of individual institutions meant that the financial sector undoubtedly has supported economic growth since year 2000. The disruption to credit growth since 2008 and the simultaneous downturn of the Russian real economy has made the link abundantly clear. EBRD evaluates the progress in structural reforms in transition countries by means of ?transition scores?. The author shows an exhibit which illustrates the development of the EBRD transition score for Russia from 1989 to 2006. It shows that the fastest progress took place from 1995 to 2003. The improvements in the regulatory framework for banking activity supported financial intermediation and Russian banks expanded their balance sheets and diversified into lending to retail customers and SMEs. For corporate investment as a whole, however, the share of new investment financed through bank credit remained relatively small. The sectors that saw sharp increases in investment and accounted for the bulk of capital spending, predominantly benefited from internal cash flows, or benefited from public support or ownership. Chapter 6 by Cyril Pineau-Valencienne, CEO, CPV Conseil, is ?Russian financial institutions and the oil and gas sector: funding and recycling.? The paper first outlines the importance of the oil and gas sector for the Russian economy. Capital expenditures in the sector grew strongly from 1999 to 2007. The huge investments were to a large extent financed by internal operating cash flows and by borrowing in international financial markets. The big oil and gas companies are important customers for foreign banks. The companies also have their own so-called raw material banks but these banks have not played a major role as related parties in the financing of the investments of these groups. The willingness of the oil and gas companies to incur debt denominated in foreign currency must be understood in the light of their revenue structure. Contracts in the global energy markets are primarily denominated in US-dollars and the companies are therefore to a considerable extent able to match currency revenues from exports with currency payments of principal and interest. Recycling of funds related to the oil and gas sector has partly been carried out by the state and by the sovereign funds controlled by the state. Revenue from export duties has been accumulated in the funds and applied in accordance with the funds? investment strategies. Chapter 7 is based on the presentation by Zuzana Fungácová, BOFIT, Bank of Finland ?Risk-taking by Russian banks: do location, ownership and size matter?? The paper is co-authored by Laura Solanko. The rapid growth of the assets of Russian banks has in the last 6?7 years contributed to a decrease in the capital adequacy ratio, thus influencing the ability of banks to cope with risk. In the paper, the authors investigate the relationship between bank characteristics and risk-taking. The banks are divided into different subgroups by size, ownership and location. The authors distinguish between state-controlled, foreign-controlled and domestic private banks. Risk is measured in two different ways: By group-wise comparisons of financial risk ratios i.e. accounting data, and by regression analysis of bank insolvency risk as measured by a Z-score indicator. The average level of financial ratios are all well above the regulatory minima set by Central Bank of Russia. Large banks in Russia have higher insolvency risk than small ones. Foreign-owned banks exhibit higher insolvency risk than domestic banks. State-controlled banks are on average more stable than the private domestic banks. Similar to the case of foreign banks, large state-controlled banks are more stable than the others. Regional banks are significantly more prone to risk-taking than their counterparts in Moscow. Chapter 8 is based on the keynote speech ?Russia?s Financial Crisis: Causes, Consequences, and Prospects? by Zeljko Bogetic, World Bank, Moscow. Until mid-2008, Russia was viewed as a ?safe haven? during turbulent times in global financial markets. Record high oil prices, strong macroeconomic fundamentals, lack of exposure of Russian banks to the US sub-prime mortgage markets, strong ratings and a strong appreciating currency explained the confidence in Russia. After mid-2008 Russia was hit. There was an oil price shock, a sudden stop in capital flows, and a sharp tightening of external borrowing conditions. The paper contains a diagram that documents an almost perfect correlation of the Russian stock index RTS with the price of oil. From the peaks in May-June 2008 to the end of the year, the RTS moved from 2400 to 440 and the oil price from USD 144 per barrel to USD 45 per barrel. The non-oil external current account deficit continued to deteriorate very fast in 2008 as import volumes grew faster than non-oil exports. Incoming FDIs declined and worsened the composition of capital flows towards borrowing. While public external debt remained moderate, private (corporate and bank) debt grew rapidly. In the balance sheets of Russian banks, the loan-deposit ratio increased from approximately 107% in 2005 to 127% in the autumn of 2008, making the banking sector more exposed to the interbank market and to rollover risk. As response to the crisis, the Russian authorities have loosened their monetary stance and provided fiscal support to ease the liquidity crisis. The exchange rate has continuously been managed with progressive widening of the bi-currency corridor. After a gradual depreciation since November 2008, the rouble was devalued in mid January 2009. The speaker described the 2009 outlook for the Russian economy as very uncertain. It is likely that the twin surpluses on the Government budget and the balance of payments current account will disappear, but thanks to the prudent macroeconomic policies in recent years, these deficits can be financed for some time. The speaker reflected on the social impact of the crisis. If the recession in 2009 becomes deeper, it might require an introduction of a fiscal stimulus package focusing on domestic demand and the poorer segments of the population, including strengthening of the unemployment, training and social assistance and possibly well designed public works. Chapter 9 is based on the presentation by Peter Havlik, The Vienna Institute for International Economic Studies (WIIW) ?Russian Economy and the Global Turmoil.? The paper contains very illustrative exhibits that show the development of Russian GDP, exports, imports, inflation, money supply, stock prices and nominal and real exchange rates. Among the Putin administration?s key achievements, he lists improved living standards, rising employment, more FDI inflows, repayment of external debt, ballooning foreign exchange reserves, restoring stability, stronger role of the state but also deteriorating external relations. Despite strong economic fundamentals, Russia has been seriously hit by the global crisis. The Medvedev administration faces serious challenges. It plans to use industrial policy instruments in order to reduce the dependence on energy proceeds. The Government offers targeted support to various public-private partnership projects in the automotive, aviation, shipbuilding and selected high-tech industries. According to the speaker, some of the envisaged industrial policy tools could well be in conflict with WTO rules and make Russia?s WTO accession more difficult. Chapter 10 is based on the workshop contribution by Debora Revoltella, UniCredit Group ?The Russian Banking Sector: What to Expect? The paper is co-authored by Vladimir V.Osakovsky and Valery Invushin. It is divided in three sections: 1) The past: Russian economic renaissance, 2) The crisis: Politics and Economics join forces, and 3) Longer term prospects are brighter. Up to 2008, Russia enjoyed strong growth in domestic investment, consumption and GDP. Prudent fiscal policy and massive capital inflows helped to amass the world?s third largest international reserves. The country was, however, exposed to global commodities prices, a demographic crisis, a rigid labour market and an increasing dependence on foreign sources of funding. The crisis in 2008 was triggered by collapse of global commodities prices, massive capital flight, failures of some large market participants and general loss of confidence abroad and at home. As reaction to the challenges posed by the crisis, the Government and Central bank of Russia initiated corporate debt refinancing assistance, liquidity infusion into the banking system and fiscal stimuli. The authors expect a major restructuring of the Russian banking sector including a considerable reduction of the number of financial institutions

    Programa Monitora e a amostragem em contraste: narrativas da implementação em uma floresta nacional na Amazônia

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    The principal objective of the National Program for Biodiversity Monitoring – Monitora Program is to assess the effectiveness of protected areas at the system level. However, monitoring can also be extended to addressissues relevant to the management of a single area, such as the case of timber management concessions within National Forest. To contribute to and advance the discussion on the use of Monitora protocols to compare areas under different forms of management – in this case control areas with areas under timber management – this article presents the process through with the Monitora program was implemented in the Caxiuanã National Forest. This is the first time that an experimental design has been applied to the four global targets of the program’s forest component. Key stages of this initiative were: project conceptionand development; sampling design; implementation in a conservation area and a timber management area within the National Forest; establishment of institutional arrangements for monitoring support and governance; protocol for training data collectors, including local community members; data collection; and data analysis. We discuss the importance of each of these stages for the effective implementation of science-based biodiversity monitoring with full stakeholder participation, engagement, and support.El Programa Nacional de Monitoreo de la Biodiversidad –Programa Monitora, tiene como principal objetivo evaluar la efectividad de las unidades de conservación. Sin embargo, este monitoreo puede ampliarse para responder preguntas locales de especial interés para el manejo de un áreadeterminada, como las unidades de conservación que tienen áreas designadas para concesiones forestales. Buscando contribuir y ampliar las discusiones sobreel monitoreo mediante la estrategia de contraste entre áreas con diferentes usos, este trabajo presenta el proceso de implementación de los protocolos del Monitora en el Floresta Nacional Caxiuanã, donde, por primera vez, la estrategia de contraste se aplicó íntegramente a las cuatro metas globales del componente forestal. Presentamos aquí las etapas de preparación del proyecto, diseño de muestreo e implementación, considerando un área de conservación y un área de manejo forestal sustentable. También destacamos la importancia de los acuerdos institucionales y un formato de capacitación para monitores locales, combinado con la toma de datos de campo, como estrategias para el buen desempeño del programa. Finalmente, presentamos los resultados alcanzados, discutiendo la importancia de cada paso para un monitoreo efectivo de la biodiversidad.O Programa Nacional de Monitoramento da Biodiversidade – Programa Monitora tem como principal objetivo avaliar a efetividade das unidades de conservação. Entretanto, esse monitoramento pode ser ampliado para responder questões locais de especial interesse para a gestão de uma determinada área, como unidades de conservação que possuem áreas destinadas à concessão florestal. Buscando contribuir e ampliar as discussões sobre o monitoramento utilizando a estratégia de contraste entre áreas com usos diferentes, este artigo apresenta o processo de implementação dos protocolos do Monitora na Floresta Nacional de Caxiuanã, onde, pela primeira vez, a estratégia de contraste foi integralmente aplicada para os quatro alvos globais do componente florestal. Nós apresentamos aqui as etapas de elaboração do projeto, o desenho amostral e a implementação considerando uma área de referência e uma área de manejo florestal madeireiro. Também destacamos a importância dos arranjos institucionais e um formato de capacitação de monitores locais conjugada com a coleta de dados como estratégias para o bom desempenho do programa, discutindo a importância de cada etapa para um efetivo monitoramento da biodiversidade

    Phylogeography and Genetic Variation of Triatoma dimidiata, the Main Chagas Disease Vector in Central America, and Its Position within the Genus Triatoma

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    Chagas disease is a serious parasitic disease of Latin America. Human contamination in poor rural or periurban areas is mainly attributed to haematophagous triatomine insects. Triatoma includes important vector species, as T. dimidiata in Central and Meso-America. DNA sequences, phylogenetic methods and genetic variation analyses are combined in a large interpopulational approach to investigate T. dimidiata and its closest relatives within Triatoma. The phylogeography of Triatoma indicates two colonization lineages northward and southward of the Panama isthmus during ancient periods, with T. dimidiata presenting a large genetic variability related to evolutionary divergences from a Mexican-Guatemalan origin. One clade remained confined to Yucatan, Chiapas, Guatemala and Honduras, with extant descendants deserving species status: T. sp. aff. dimidiata. The second clade gave rise to four subspecies: T. d. dimidiata in Guatemala and Mexico (Chiapas) up to Honduras, Nicaragua, Providencia island, and introduced into Ecuador; T. d. capitata in Panama and Colombia; T. d. maculipennis in Mexico and Guatemala; and T. d. hegneri in Cozumel island. This taxa distinction may facilitate the understanding of the diversity of vectors formerly included under T. dimidiata, their different transmission capacities and the disease epidemiology. Triatoma dimidiata will offer more problems for control than T. infestans in Uruguay, Chile and Brazil, although populations in Ecuador are appropriate targets for insecticide-spraying

    Concentric and Eccentric Pedaling-Type Interval Exercise on a Soft Robot for Stable Coronary Artery Disease Patients: Toward a Personalized Protocol

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    BACKGROUND Cardiovascular diseases are the leading causes of death worldwide, and coronary artery disease (CAD) is one of the most common causes of death in Europe. Leading cardiac societies recommend exercise as an integral part of cardiovascular rehabilitation because it reduces the morbidity and mortality of patients with CAD. Continuous low-intensity exercise using shortening muscle actions (concentric, CON) is a common training modality during cardiovascular rehabilitation. However, a growing clinical interest has been recently developed in high-intensity interval training (HIIT) for stable patients with CAD. Exercise performed with lengthening muscle actions (eccentric, ECC) could be tolerated better by patients with CAD as they can be performed with higher loads and lower metabolic cost than CON exercise. OBJECTIVE We developed a clinical protocol on a soft robot to compare cardiovascular and muscle effects of repeated and work-matched CON versus ECC pedaling-type interval exercise between patients with CAD during cardiovascular rehabilitation. This study aims to ascertain whether the developed training protocols affect peak oxygen uptake (VO), peak aerobic power output (P), and parameters of muscle oxygen saturation (SmO) during exercise, and anaerobic muscle power. METHODS We will randomize 20-30 subjects to either the CON or ECC group. Both groups will perform a ramp test to exhaustion before and after the training period to measure cardiovascular parameters and SmO. Moreover, the aerobic skeletal muscle power (P) is measured weekly during the 8-week training period using a simulated squat jump and a counter movement jump on the soft robot and used to adjust the training load. The pedaling-type interval exercise on the soft robot is performed involving either CON or ECC muscle actions. The soft robotic device being used is a closed kinetic chain, force-controlled interactive training, and testing device for the lower extremities, which consists of two independent pedals and free footplates that are operated by pneumatic artificial muscles. RESULTS The first patients with CAD, who completed the training, showed protocol-specific improvements, reflecting, in part, the lower aerobic training status of the patient completing the CON protocol. Rehabilitation under the CON protocol, more than under the ECC protocol, improved cardiovascular parameters, that is, VO (+26% vs -6%), and P (+20% vs 0%), and exaggerated muscle deoxygenation during the ramp test (248% vs 49%). Conversely, markers of metabolic stress and recovery from the exhaustive ramp test improved more after the ECC than the CON protocol, that is, peak blood lactate (-9% vs +20%) and peak SmO (+7% vs -7%). Anaerobic muscle power only improved after the CON protocol (+18% vs -15%). CONCLUSIONS This study indicates the potential of the implemented CON and ECC protocols of pedaling-type interval exercise to improve oxygen metabolism of exercised muscle groups while maintaining or even increasing the P. The ECC training protocol seemingly provided a lower cardiovascular stimulus in patients with CAD while specifically enhancing the reoxygenation and blood lactate clearance in recruited muscle groups during recovery from exercise. TRIAL REGISTRATION ClinicalTrials.gov NCT02845063; https://clinicaltrials.gov/ct2/show/NCT02845063

    Re-thinking the definition of CPSP: composites of patient-reported pain-related outcomes versus pain intensities alone.

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    ABSTRACT Chronic postsurgical pain (CPSP) is defined by pain intensity and pain-related functional interference. This study included measures of function in a composite score of patient-reported outcomes (PROs) to investigate the incidence of CPSP. Registry data were analyzed for PROs one day and 12 months postoperatively. Based on pain intensity and pain-related interference with function, patients were allocated to the groups "CPSPF" (at least moderate pain with interference), "Mixed" (milder symptoms) and "No CPSPF". The incidence of CPSPF was compared to CPSP rates referring to published data. Variables associated with the PRO-12 score (composite PROs at 12 months; NRS 0-10) were analyzed by linear regression analysis. Of 2319 patients, 8.6%, 32.5% and 58.9% were allocated to the groups CPSPF, Mixed and No CPSPF. Exclusion of patients whose pain scores did not increase compared to the preoperative status, resulted in a 3.3% incidence. Of the patients without pre-existing pain, 4.1% had CPSPF. Previously published pain cut-offs of NRS >0, ≥3 or ≥4, used to define CPSP, produced rates of 37.5%, 9.7% and 5.7%. Pre-existing chronic pain, pre-operative opioid medication and type of surgery were associated with the PRO-12 score (all p<0.05). Opioid doses and PROs 24 hours postoperatively improved the fit of the regression model. A more comprehensive assessment of pain and interference resulted in lower CPSP rates than previously reported. Although inclusion of CPSP in the ICD-11 is a welcome step, evaluation of pain characteristics would be helpful in differentiation between CPSPF and continuation of pre-existing chronic pain

    Trajectories of pain and opioid use up to one year after surgery: analysis of a European registry.

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    BACKGROUND Long-term opioid use after surgery is a crucial healthcare problem in North America. Data from European hospitals are scarce and differentiation of chronic pain has rarely been considered. METHODS In a mixed surgical cohort of the PAIN OUT registry, opioid use and chronic pain were evaluated before surgery, and 6 and 12 months after surgery (M6/M12). Subgroups with or without opioid medication and pre-existing chronic pain were analysed. M12-chronic pain was categorised as chronic postsurgical pain (CPSP) meeting the ICD-11 definition, chronic pain related to surgery not meeting the ICD-11 definition, and chronic pain unrelated to surgery. Primary endpoint was the rate of M12 opioid users. Variables associated with M12 opioid use and patient-reported outcomes were evaluated. RESULTS Of 2326 patients, 5.5% were preoperative opioid users; 4.4% and 3.5% took opioids at M6 and M12 (P<0.001). Chronic pain before operation and at M6/M12 was reported by 41.2%, 41.8%, and 34.7% of patients, respectively (P<0.001). The rate of M12 opioid users was highest in group unrelated (22.3%; related 8.3%, CPSP 1.5%; P<0.001). New opioid users were 1.1% (unrelated 7.1%, related 2.3%, CPSP 0.7%; P<0.001). M12 opioid users reported more pain, pain-related physical and affective interference, and needed more opioids than non-users. The predominant variable associated with M12 opioids was preoperative opioid use (estimated odds ratio [95% confidence interval]: 28.3 [14.1-56.7], P<0.001). CONCLUSIONS Opioid use was low in patients with CPSP, and more problematic in patients with chronic pain unrelated to surgery. A detailed assessment of chronic pain unrelated or related to surgery or CPSP is necessary. CLINICAL TRIAL REGISTRATION NCT02083835
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