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ACS Applied Materials & Interfaces Feb 2021We report the unique actuation characteristics of moisture-driven, fully reversible soft biopolymer films fabricated from silk. The instantaneous actuation is driven by...
We report the unique actuation characteristics of moisture-driven, fully reversible soft biopolymer films fabricated from silk. The instantaneous actuation is driven by the water vapor induced stress gradient generated across the thickness of the film, and it possesses subsecond response and actuation times. The excellent durability and consistent performance of the film without any noticeable fatigue are established by subjecting it to more than a thousand continuous actuation cycles. The weight-lifting capability of the film is fascinating, where a few tens of micrograms of water generate a colossal force required to lift hundreds of milligrams of weight. Several other potential uses of silk fibroin based soft actuators, such as an intelligent textile layer with the crescent-shaped windows that open on perspiring skin and an autonomous crawler, are also demonstrated. Interestingly, even moisture emanating from the human palm triggers the ultrafast actuation process. These silk films are fabricated using a simple facile solution-casting technique, which can be scaled up with relative ease.
Topics: Animals; Bombyx; Fibroins; Particle Size; Silk; Surface Properties; Volatilization
PubMed: 33576225
DOI: 10.1021/acsami.0c17525 -
Lidocaine patches for postcesarean pain control in obese women: a pilot randomized controlled trial.American Journal of Obstetrics &... Jan 2021Obesity increases the risk of opioid-related morbidity. Lidocaine patches have been shown to reduce postoperative pain after noncesarean surgeries. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Obesity increases the risk of opioid-related morbidity. Lidocaine patches have been shown to reduce postoperative pain after noncesarean surgeries.
OBJECTIVE
This study aimed to determine whether the application of lidocaine patches around the cesarean incision in women with obesity reduces the total dose of opioids administered in the first 24 hours after cesarean delivery.
STUDY DESIGN
This was a pilot single-blind randomized controlled trial of 61 women with obesity undergoing cesarean delivery at a community tertiary referral hospital staffed by academic physicians. After cesarean delivery, the allocated patches (either 5% lidocaine patches or placebo patches) were applied superior and lateral to the incision dressing and remained in place for 12 hours. The average cumulative opioid dose received within the first 24 hours after cesarean delivery was measured in morphine milligram equivalents. We also assessed pain and patient satisfaction. A sample size of 60 (30 per group) was determined to be adequate to inform a future appropriately powered randomized controlled trial. The primary outcome of morphine milligram equivalents was compared using the Student t test, and pain scores were compared using the Wilcoxon rank sum test.
RESULTS
Of the 146 women screened between February 2019 and September 2019, 61 consented and were analyzed: 30 women were allocated to lidocaine patch and 31 were allocated to placebo (hydrocolloid patch). Women who were allocated to the lidocaine patch used an average of 87.0 (standard deviation, 35.8) morphine milligram equivalents of opioids in the first 24 hours compared with an average of 83.9 (standard deviation, 27.5) morphine milligram equivalents among women who were allocated to the placebo patch (P=.702). Women who were allocated to the lidocaine vs placebo patches reported median pain scores of 3.0 (interquartile range, 2.1-4.9) and 3.5 (interquartile range, 2.5-5.0), respectively (P=.217). The time to the first dose of opioids, total number of opioid doses, and total morphine milligram equivalents in 48 hours and for the entire hospital stay did not differ. Patient satisfaction with both patches was high and not statistically different.
CONCLUSION
This pilot suggests that 5% lidocaine patches applied superior and lateral to the cesarean incision are not effective at reducing the average total dose of morphine milligram equivalents administered in the first 24 hours after cesarean delivery among women with obesity, and they did not seem to improve median pain scores. An appropriately powered randomized trial would not be expected to demonstrate reduction in opioid use or pain.
Topics: Female; Humans; Lidocaine; Obesity; Pain Measurement; Pain, Postoperative; Pilot Projects; Pregnancy; Single-Blind Method
PubMed: 33451596
DOI: 10.1016/j.ajogmf.2020.100281 -
Cureus Oct 2022The use of antimalarial drugs for prophylaxis is a widespread practice while traveling to underdeveloped nations, particularly those with a high malaria prevalence....
The use of antimalarial drugs for prophylaxis is a widespread practice while traveling to underdeveloped nations, particularly those with a high malaria prevalence. Chloroquine is still one of the most commonly recommended antimalarials, either alone or in combination with others, for prophylaxis. However, its increased use over the past few decades has been associated with many adverse effects, including headaches, dizziness, vomiting, and diarrhea, as well as neuropsychiatric symptoms such as psychosis. Here, we discuss the case of a 30-year-old Asian man who, after starting a 500-milligram (mg) prophylactic dosage of chloroquine per week, developed psychotic symptoms. This case highlights the need to use chloroquine and other antimalarials with care, especially when beginning as a prophylactic measure with the lowest suggested dosage.
PubMed: 36415420
DOI: 10.7759/cureus.30498 -
Surgery Mar 2023Patients prescribed higher opioid dosages are at increased risk of overdose and death without added pain reduction. Increases in opioid prescribing continue to fuel the...
BACKGROUND
Patients prescribed higher opioid dosages are at increased risk of overdose and death without added pain reduction. Increases in opioid prescribing continue to fuel the epidemic. We hypothesized a comprehensive guideline to standardize opioid prescribing would decrease postdischarge dosages for patients experiencing trauma without requiring additional refills.
METHODS
This quasiexperimental study compared opioid prescribing by trauma providers before and after the implementation of a departmental guideline on April 1, 2019, aimed at aligning opioid prescription patterns with Centers for Disease Control and Prevention recommendations. Patients prescribed opioids before implementation were the control group, whereas patients prescribed opioids after were the intervention group. The primary outcome was the proportion of patients receiving ≥50 morphine milligram equivalents per day.
RESULTS
We identified 293 and 280 patients experiencing trauma in the control and intervention groups, respectively. There were no differences between the groups' Injury Severity Score (P = .69) or the frequency of having a procedure performed (P = .80). Total morphine milligram equivalents and maximum morphine milligram equivalents per day were 16% and 25% lower, respectively, in the intervention group compared with the control group (P < .001). The proportion of trauma patients prescribed ≥50 morphine milligram equivalents per day at discharge decreased from 57% to 18% after implementation (P < .001). The proportion of trauma patients prescribed ≥90 morphine milligram equivalents per day also decreased, from 37% to 14% (P < .001). There was no significant increase in the frequency of refill requests (P = .105) or refill prescriptions (P = .099) after discharge.
CONCLUSION
A departmental guideline aimed at optimizing opioid prescription patterns successfully lowers the amount of morphine milligram equivalents prescribed to trauma patients and improves compliance with Centers for Disease Control and Prevention recommendations.
Topics: Humans; Analgesics, Opioid; Patient Discharge; Aftercare; Pain, Postoperative; Practice Patterns, Physicians'; Morphine Derivatives
PubMed: 36371358
DOI: 10.1016/j.surg.2022.07.037 -
Drug Metabolism and Disposition: the... Aug 2021This study aimed to comprehensively investigate the in vitro metabolism of statins. The metabolism of clinically relevant concentrations of atorvastatin, fluvastatin,...
This study aimed to comprehensively investigate the in vitro metabolism of statins. The metabolism of clinically relevant concentrations of atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin, and their metabolites were investigated using human liver microsomes (HLMs), human intestine microsomes (HIMs), liver cytosol, and recombinant cytochrome P450 enzymes. We also determined the inhibitory effects of statin acids on their pharmacological target, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase. In HLMs, statin lactones were metabolized to a much higher extent than their acid forms. Atorvastatin lactone and simvastatin (lactone) showed extensive metabolism [intrinsic clearance (CL) values of 3700 and 7400 µl/min per milligram], whereas the metabolism of the lactones of 2-hydroxyatorvastatin, 4-hydroxyatorvastatin, and pitavastatin was slower (CL 20-840 µl/min per milligram). The acids had CL values in the range <0.1-80 µl/min per milligram. In HIMs, only atorvastatin lactone and simvastatin (lactone) exhibited notable metabolism, with CL values corresponding to 20% of those observed in HLMs. CYP3A4/5 and CYP2C9 were the main statin-metabolizing enzymes. The majority of the acids inhibited HMG-CoA reductase, with 50% inhibitory concentrations of 4-20 nM. The present comparison of the metabolism and pharmacodynamics of the various statins using identical methods provides a strong basis for further application, e.g., comparative systems pharmacology modeling. SIGNIFICANCE STATEMENT: The present comparison of the in vitro metabolic and pharmacodynamic properties of atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin and their metabolites using unified methodology provides a strong basis for further application. Together with in vitro drug transporter and clinical data, the present findings are applicable for use in comparative systems pharmacology modeling to predict the pharmacokinetics and pharmacological effects of statins at different dosages.
Topics: Biotransformation; Cytochrome P-450 Enzyme System; Cytosol; Drug Design; Drug Development; Hepatobiliary Elimination; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Inhibitory Concentration 50; Intestines; Liver; Metabolic Clearance Rate; Microsomes; Network Pharmacology
PubMed: 34045219
DOI: 10.1124/dmd.121.000406 -
Surgery Sep 2022Preoperative chronic opioid use is common, but it is unclear whether complete opioid tapering can be achieved postoperatively without adversely affecting pain control...
BACKGROUND
Preoperative chronic opioid use is common, but it is unclear whether complete opioid tapering can be achieved postoperatively without adversely affecting pain control and quality of life. This study was designed to assess the association between complete opioid tapering after surgery and patient-reported outcomes for pain intensity and pain interference.
METHODS
We identified chronic opioid use patients undergoing a spectrum of nonemergency surgical procedures at a single Veterans Affairs medical institution between December 2017 and 2021. All patients were prospectively followed by a transitional pain service that promoted opioid tapering, assessed opioid use (morphine milligram equivalent), and patient-reported outcomes measurement information system for pain intensity (PROMIS-3a) and pain interference (PROMIS-6b). After stratifying based on whether complete versus partial/no opioid tapering was achieved after surgery, longitudinal changes in patient-reported outcomes and morphine milligram equivalents were compared over time. Independent predictors of complete opioid tapering were assessed using logistic regression models.
RESULTS
In total, 341 surgical patients (91% male, mean age 64 years) with chronic opioid use underwent surgery during the study period, of which 44 (13%) completely tapered off opioids within 60 days after discharge from the hospital. Patients who completely tapered had significant improvement in the change in patient-reported outcomes for pain intensity and interference with significant differences at 30 and 60 days after discharge for both measures when compared to the partial/no taper group (both P < .05). In risk-adjusted analyses, patients with lower baseline morphine milligram equivalents and those staying longer in the hospital were more likely to achieve complete opioid tapering (both P < .01).
CONCLUSION
Complete opioid tapering can be successfully achieved after surgery among patients with chronic opioid use with corresponding improvements in self-reported pain intensity and pain interference. Our results suggest that the highest potential for improving patient-reported outcomes with opioid tapering occurs among patients undergoing orthopedic procedures early after surgical discharge.
Topics: Analgesics, Opioid; Chronic Pain; Female; Humans; Male; Middle Aged; Morphine Derivatives; Opioid-Related Disorders; Pain; Pain, Postoperative; Patient Reported Outcome Measures; Quality of Life; Retrospective Studies
PubMed: 35688743
DOI: 10.1016/j.surg.2022.04.034 -
Global Spine Journal Mar 2022Retrospective case series.
STUDY DESIGN
Retrospective case series.
OBJECTIVES
To evaluate the variability in opioid prescription following primary single-level lumbar microdiscectomy.
METHODS
We retrospectively reviewed consecutive patients who underwent primary single-level lumbar microdiscectomy. Only opioid-naïve patients ≥18 years old were included. Patients who had revision microdiscectomy, multilevel decompression, and/or any complication requiring prolonged hospital stay (>2 days) were excluded. The primary outcomes were the maximum daily dosage of opioids prescribed in morphine milligram equivalents (MME) and the number of pills prescribed (equivalent to 5 mg hydrocodone).
RESULTS
Between 2014 and 2019, 169 patients (90 men, 79 women) met inclusion criteria, with a mean age of 46.9 years. Surgery resulted in a statistically significant improvement in VAS (Visual Analogue Scale) score (6.4 to 2.5, < .01). At discharge, 8 patients (4.7%) did not receive any opioid prescription. Of the remaining 161 patients, 1 patient (0.01%) received hydromorphone, 30 (18.6%) Percocet, 43 (26.7%) oxycodone, and 87 Norco (54.0%). The length of opioid prescription was 6.7 days. The maximum daily dosage of opioids prescribed was 70.4 MME (SD 32.1). The total number of pills prescribed was 89.4 (SD 54.7). Twenty-five patients (15.5%) received a refill prescription. Multivariate analysis demonstrated the operating service, prescriber, and hospital admission were statistically significant predictors of maximum daily MME. The prescriber and hospital admission were statistically significant predictors of total number of pills prescribed.
CONCLUSIONS
We found significant variability in opioid prescription following primary single-level lumbar microdiscectomy. For standard spinal procedures like lumbar microdiscectomy, opioid-prescribing guidelines should be established to standardize postoperative pain management.
PubMed: 32856480
DOI: 10.1177/2192568220950678 -
Critical Reviews in Eukaryotic Gene... 2022We aimed to explore the relationship between free triiodothyronine (FT3) level and severity of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). A...
We aimed to explore the relationship between free triiodothyronine (FT3) level and severity of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). A total of 122 patients with HBV-ACLF who were hospitalized in Beijing You'an Hospital Affiliated to Capital Medical University from September 2018 to February 2020 were included in this study. The FT3 level and the number of organs involved in patients with different stages of liver failure were analyzed. The patients were divided into four groups, Q1, Q2, Q3, and Q4, according to FT3 level. Correlation analysis was used to compare the correlation between FT3 level and Model for End-Stage Liver Disease (MELD) score, chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score, CLIF-consortium organ failure (CLIF-COF) score, and Asian Pacific Association for the Study of the Liver (APASL) acute-on-chronic liver failure (ACLF) Research Consortium (AARC) score. Multiple linear regression, logistic regression and receiver operating characteristic (ROC) curve were used to analyze the effect of FT3 on MELD score. The FT3 level was the lowest in patients with advanced HBV-ACLF, but the highest in patients with early-stage HBV-ACLF (P < 0.01). The more organs involved, the lower the level of FT3 (P < 0.01). The MELD score of Q4 group was the lowest, whereas that of Q1 group was the highest (P < 0.01). Pearson correlation coefficients of FT3 with MELD score, CLIF-SOFA score, CLIF-COF score and AARC score were -0.477, -0.359, -0.347, and -0.391, respectively (P < 0.001). Multiple linear regression analysis showed that the partial regression coefficients of FT3, natural log total bilirubin in milligrams per decaliter {ln[TBIL (mg/dL)]}, natural log creatinine in milligrams per decaliter {ln[CR (mg/dL)]}, and natural log international normalized ratio {ln[INR]} were -0.215, 0.346, 0.231, and 0.667, respectively (P < 0.001). The odds ratio (OR) values of FT3, ln[TBIL (mg/dL)], ln[CR (mg/dL)], and ln[INR] were 0.141 (0.082-0.244), 5.426 (2.697-9.059), 4.535 (2.432-8.455), and 8.642 (6.679-10.267) in the MELD ≥ 30 group compared with MELD < 30 group (P < 0.001). Furthermore, their area under the ROC curve (AUROC) values were 0.739 (0.686-0.792), 0.748 (0.696-0.800), 0.632 (0.562-0.702), and 0.933 (0.903-0.963), respectively (P < 0.001). FT3 level is correlated with the severity of HBV-ACLF, which may be one of the factors to judge the severity of this disease.
Topics: Acute-On-Chronic Liver Failure; End Stage Liver Disease; Hepatitis B virus; Humans; ROC Curve; Severity of Illness Index
PubMed: 35997117
DOI: 10.1615/CritRevEukaryotGeneExpr.2022041680 -
Psychiatric Services (Washington, D.C.) Jan 2023This study analyzed changes in prescription opioid street prices during the COVID-19 pandemic.
OBJECTIVE
This study analyzed changes in prescription opioid street prices during the COVID-19 pandemic.
METHODS
Crowdsourced prescription opioid street prices were obtained from the Researched Abuse, Diversion and Addiction-Related Surveillance System StreetRx Program. Percentage changes in street price per milligram of different opioids between April and December 2020 compared with the same months in 2019 were calculated by using linear regression.
RESULTS
Street prices of high-potency drugs hydromorphone and oxycodone increased 23% and 12% per milligram, respectively. Prices of low-potency drugs hydrocodone and morphine increased 9% and 12% per milligram, respectively. Changes in prices of medications for opioid use disorder were not statistically significant.
CONCLUSIONS
Decreased access to opioid analgesics during the pandemic combined with contributors to opioid demand may have led to increases in street prices of prescription opioids. Measures taken to increase access to medications for opioid use disorder were not associated with changes in those drugs' street prices.
Topics: Humans; Analgesics, Opioid; Pandemics; COVID-19; Opioid-Related Disorders; Illicit Drugs; Prescriptions
PubMed: 35770425
DOI: 10.1176/appi.ps.202100689 -
World Neurosurgery Mar 2023The purpose of this study is to determine if increased postoperative prescription opioid dosing is an isolated predictor of chronic opioid use after anterior cervical...
OBJECTIVE
The purpose of this study is to determine if increased postoperative prescription opioid dosing is an isolated predictor of chronic opioid use after anterior cervical diskectomy and fusion (ACDF).
METHODS
A retrospective cohort analysis of patients undergoing ACDF for degenerative diseases from 2016-2019 at a single institution was performed. Preoperative and postoperative opioid and benzodiazepine prescriptions, including morphine milligram equivalents (MMEs) and duration of use, were obtained from the Pennsylvania Prescription Drug Monitoring Program. Univariate analysis compared patient demographics and surgical factors across groups on the basis of postoperative opioid dose (high: MME ≥90, low: MME <90) and chronicity of use (chronic: ≥120 days or >10 prescriptions). Logistic regressions identified predictors of high opioid dose and chronic use.
RESULTS
A total of 385 patients were included. Preoperative opioid tolerance and tobacco use were associated with high postoperative opioid dose and chronic usage. Younger age correlated with high-dose prescriptions. Increased body mass index and preoperative benzodiazepine use were associated with chronic opioid use. Chronic postoperative opioid use correlated with high-dose prescriptions, change in opioid prescribed, private pay scripts, and more than 1 prescriber and pharmacy. Logistic regression identified high postoperative opioid dose, opioid tolerance, increased body mass index, and no prior cervical surgery as predictors of chronic opioid use. Regression analysis determined younger age, increased medical comorbidities, and opioid tolerance to be predictors for high MME prescriptions.
CONCLUSIONS
High postoperative opioid dose independently predicted chronic opioid use after ACDF regardless of preoperative opioid tolerance.
Topics: Humans; Analgesics, Opioid; Retrospective Studies; Pain, Postoperative; Drug Tolerance; Opioid-Related Disorders; Practice Patterns, Physicians'
PubMed: 36566977
DOI: 10.1016/j.wneu.2022.12.083