Significant reduction of postoperative pain and opioid analgesics requirement with an Enhanced Recovery After Thoracic Surgery protocol

ObjectiveTo evaluate differences in postoperative pain control and opioids requirement in thoracic surgical patients following implementation of an Enhanced Recovery after Thoracic Surgery protocol with a comprehensive postoperative pain management strategy.Material and MethodsA retrospective analysis of a prospectively maintained database of patients undergoing pulmonary resections by robotic thoracoscopy or thoracotomy from January 1, 2017, to January 31, 2019, was conducted. Multimodal pain management strategy (opioid-sparing analgesics, infiltration of liposomal bupivacaine to intercostal spaces and surgical sites, and elimination of thoracic epidural analgesia use in thoracotomy patients) was implemented as part of Enhanced Recovery after Thoracic Surgery on February 1, 2018. Outcome metrics including patient-reported pain levels, in-hospital and postdischarge opioids use, postoperative complications, and length of stay were compared before and after protocol implementation.ResultsIn total, 310 robotic thoracoscopy and 62 thoracotomy patients met the inclusion criteria. This pain management strategy was associated with significant reduction of postoperative pain in both groups with an overall reduction of postoperative opioids requirement. Median in-hospital opioids use (morphine milligram equivalent per day) was reduced from 30 to 18.36 (P = .009) for the robotic thoracoscopy group and slightly increased from 15.48 to 21.0 (P = .27) in the thoracotomy group. More importantly, median postdischarge opioids prescribed (total morphine milligram equivalent) was significantly reduced from 480.0 to 150.0 (P < .001) and 887.5 to 150.0 (P < .001) for the thoracoscopy and thoracotomy groups, respectively. Similar short-term perioperative outcomes were observed in both groups before and following protocol implementation.ConclusionsImplementation of Enhanced Recovery after Thoracic Surgery allows safe elimination of epidural use, better pain control, and less postoperative opioids use, especially a drastic reduction of postdischarge opioid need, without adversely affecting outcomes.     

Inequalities in Tobacco Retailer Compliance Violations Across the State of Oklahoma, 2015–2019

Objective

To evaluate the relationship between compliance check violations, and characteristics of the tobacco retailer and neighborhood social vulnerability in Oklahoma.

Design

This cross-sectional study utilized the US Food and Drug Administration (FDA) Compliance Check Inspections of Tobacco Product Retailers database for 2015–2019. These data were combined with Neighborhood social vulnerability variables using the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index.

Setting

The setting of this study is the state of Oklahoma, USA.

Outcome measures

The outcome variable for this analysis was whether a sale was made to the youth during the compliance check (e.g., violation; yes/no) regardless of the outcome of the violation, and number of violations per a retailer.

Results

We observed a strong association between having a violation and retailer store type, after controlling for socioeconomic vulnerability and percentage of mobile homes. The proportion of a tobacco retailer’s violations also varied by store type.

Conclusions

More targeted enforcements and retailer education by store type may be necessary to increase compliance.

     

超敏C反应蛋白与自发性脑出血患者血肿量及预后的相关性分析

目的探讨超敏C反应蛋白(hs-CRP)与自发性脑出血患者(SICH)血肿量和预后的相关性。方法选取2016-01-2018-10萍乡市人民医院收治的SICH患者162例。将其分为大量血肿组、小量血肿组,选择同时期江西萍乡市人民医院80例门诊体检者为对照组。检测和比较3组入院时hs-CRP水平,比较预后良好和不良患者的hs-CRP水平,评价血清hs-CRP水平与血肿体积、预后的相关性。结果大量及小量血肿组hs-CRP水平显著高于对照组(P<0.01),且大量血肿组hs-CRP水平显著高于小量血肿组(P<0.05)。预后良好组hs-CRP水平显著低于预后不良组(P<0.05)。SICH患者hs-CRP水平与血肿量大小和GOS评分呈正相关(r=0.452,0.433,P<0.05)。结论SICH患者血清hs-CRP水平显著升高,与血肿量大小和预后明显相关。     

H. pylori Infection and Colorectal Cancers by Anatomical Locations

Background: H. pylori infection may play a role in the development of colorectal cancers (CRC). We aimed to examine the association between H. pylori infection and the risk of CRC by anatomical locations. Methods: We conducted a case-control study on 91 incidence cases of CRC and 224 hospital controls. CRC was determined by histopathological examinations. H. pylori IgG antibody in serum was tested. We collected data on the diet, nutrition, and lifestyle by the validated semi-quantitative food frequency and demographic lifestyle questionnaire. The odds ratio and 95% confidence interval (OR (95%CI) were estimated for CRC and its subgroups. Results: Overall 54.95% of CRC cases and 42.41% of the controls were H. pylori-seropositive, OR (95%CI): 1.56 (0.88, 2.74), p for trend=0.115. Positive dose-response association in quartiles, highest vs lowest, was observed for total CRC, OR (95%CI): 2.14 (1.00, 4.58), p for trend=0.049, for proximal colon, OR (95%CI): 1.52 (0.37, 6.25), p for trend=0.571), and for distal colon and rectum cancers combined, OR (95%CI): 2.38 (1.03, 5.50), p for trend=0.039. Conclusions: There is a positive association between H. pylori and colorectal cancers, especially distal colon and rectum cancers combined, but additional research is needed to determine the underlying mechanism of chronic H. pylori infection-induced CRC in humans.     

Igalan from Inula helenium (L.) suppresses the atopic dermatitis-like response in stimulated HaCaT keratinocytes via JAK/STAT3 signaling

Inflammation Research - This study aimed to evaluate the protective effect of igalan, a sesquiterpene lactone isolated from Inula helenium (L.), on inhibiting inflammation, regulating the epidermal...     

Presentation of floating mass transducer and Vibroplasty Couplers on CT and Cone Beam CT

Various titanium coupling elements, Vibroplasty Couplers, maintaining the attachment of the Floating Mass Transducer (FMT) of the active middle ear implant Vibrant Soundbridge (VSB) to the round window, the stapes suprastructure or the stapes footplate are in use to optimally transfer energy from the FMT to the inner ear fluids. In certain cases it is of interest to radiologically verify the correct position of the FMT coupler assembly. The imaging appearance of FMT connected to these couplers, however, is not well known. The aim of this study was to present the radiological appearance of correctly positioned Vibroplasty Couplers together with the FMT using two different imaging techniques. Vibroplasty Couplers were attached to the FMT of a Vibrant Soundbridge and implanted in formalin fixed human temporal bones. Five FMT coupler assemblies were implanted in different positions: conventionally to the incus, a Bell-Coupler, a CliP-Coupler, a Round Window-Coupler and an Oval Window-Coupler. High spatial resolution imaging with Multi-Detector CT (MDCT) and Cone Beam CT (CBCT) was performed in each specimen. Images were blind evaluated by two radiologists on a visual basis. Middle ear details, identification of FMT and coupler, position of FMT coupler assembly and artefacts were assessed. CBCT showed a better spatial resolution and a higher visual image quality than MDCT, but there was no significant advantage over MDCT in delineating the structures or the temporal bone of the FMT Coupler assemblies. The FMT with its coupler element could be clearly identified in the two imaging techniques. The correct positioning of the FMT and all types of couplers could be demonstrated. Both methods, MDCT and CBCT, are appropriate methods for postoperative localization of FMT in combination with Vibroplasty Couplers and for verifying their correct position. If CBCT is available, this method is recommended due to the better spatial resolution and less metal artifacts.     

Hyperbaric oxygen therapy improves angiogenesis and bone formation in critical sized diaphyseal defects

Besides the use of autologous bone grafting several osteoconductive and osteoinductive methods have been reported to improve bone healing. However, persistent non‐union occurs in a considerable number of cases and compromised angiogenesis is suspected to impede bone regeneration. Hyperbaric oxygen therapy (HBO) improves angiogenesis. This study evaluates the effects of HBO on bone defects treated with autologous bone grafting in a bone defect model in rabbits. Twenty‐four New‐Zealand White Rabbits were subjected to a unilateral critical sized diaphyseal radius bone defect and treated with autologous cancellous bone transplantation. The study groups were exposed to an additional HBO treatment regimen. Bone regeneration was evaluated radiologically and histologically at 3 and 6 weeks, angiogenesis was assessed by immunohistochemistry at three and six weeks. The additional administration of HBO resulted in a significantly increased new bone formation and angiogenesis compared to the sole treatment with autologous bone grafting. These results were apparent after three and six weeks of treatment. The addition of HBO therapy to autologous bone grafts leads to significantly improved bone regeneration. The increase in angiogenesis observed could play a crucial role for the results observed. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:513–520, 2015.