Short-Term Secondary Effects of a School-Based Drug Prevention Program: Cluster-Randomized Controlled Trial of the Brazilian Version of DARE’s Keepin’ it REAL

Prevention Science - This study aimed to evaluate the effectiveness of the drug and violence resistance educational program (PROERD) on short-term secondary outcomes, such as intentions to use...     

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.     

Management of Chylous Ascites After Laparoscopic Nephrectomy for Living Kidney Donor: A Case Report and Literature Review

Kidney transplant is currently the elective treatment of choice for end-stage renal disease. Laparoscopic living donor nephrectomy (LLDN) has substantial advantages over open nephrectomy. Chylous ascites (CA) is a rare surgical complication after the LLDN; there are few reports in the literature.We present a case report of a 58-year-old woman who started CA on the 21st day post operation. The recommended initial therapeutic approach to suspend the fat in the diet and place percutaneous drainage was not enough. It was decided to jointly introduce fasting and total parenteral nutrition with the administration of octreotide, resolving the complication completely in 15 days with no need for the patient to undergo surgery.The conservative management, during the first 4 to 8 weeks after the diagnosis is the best option. Surgery is generally recommended if conservative management fails.The prevalence of CA varied between 0% and 6.2% of LLDNs. In our experience of 87 LLDNs, we only presented 1.15% for this complication. There are 62 cases reported in the international literature. The mean presentation was 14 days after LLDN. All patients underwent conservative treatment, and only 15 patients (24%) went to surgery after the failure of conservative management.It would be highly useful, considering the disparity of the prevalence, if the bibliographic reports detail what hemostatic and sealing techniques are used in an LLDN. In this way it would be possible to identify which factor affects a complication like this one.     

Human papilloma virus (HPV) integration signature in Cervical Cancer: identification of MACROD2 gene as HPV hot spot integration site

Background Cervical cancer (CC) remains a leading cause of gynaecological cancer-related mortality with infection by human papilloma virus (HPV) being the most important risk factor. We analysed the association between different viral integration signatures, clinical parameters and outcome in pre-treated CCs.Methods Different integration signatures were identified using HPV double capture followed by next-generation sequencing (NGS) in 272 CC patients from the BioRAIDs study [{"type":"clinical-trial","attrs":{"text":"NCT02428842","term_id":"NCT02428842"}}NCT02428842]. Correlations between HPV integration signatures and clinical, biological and molecular features were assessed.Results Episomal HPV was much less frequent in CC as compared to anal carcinoma (p < 0.0001). We identified >300 different HPV-chromosomal junctions (inter- or intra-genic). The most frequent integration site in CC was in MACROD2 gene followed by MIPOL1/TTC6 and TP63. HPV integration signatures were not associated with histological subtype, FIGO staging, treatment or PFS. HPVs were more frequently episomal in PIK3CA mutated tumours (p = 0.023). Viral integration type was dependent on HPV genotype (p < 0.0001); HPV18 and HPV45 being always integrated. High HPV copy number was associated with longer PFS (p = 0.011).Conclusions This is to our knowledge the first study assessing the prognostic value of HPV integration in a prospectively annotated CC cohort, which detects a hotspot of HPV integration at MACROD2; involved in impaired PARP1 activity and chromosome instability.Subject terms: Oncology, Molecular medicine, Biomarkers, Molecular biology     

Theoretical potential for endometrial cancer prevention through primary risk factor modification: Estimates from the EPIC cohort

Endometrial cancer (EC) incidence rates vary ~10-fold worldwide, in part due to variation in EC risk factor profiles. Using an EC risk model previously developed in the European EPIC cohort, we evaluated the prevention potential of modified EC risk factor patterns and whether differences in EC incidence between a European population and low-risk countries can be explained by differences in these patterns. Predicted EC incidence rates were estimated over 10 years of follow-up for the cohort before and after modifying risk factor profiles. Risk factors considered were: body mass index (BMI, kg/m²), use of postmenopausal hormone therapy (HT) and oral contraceptives (OC) (potentially modifiable); and, parity, ages at first birth, menarche and menopause (environmentally conditioned, but not readily modifiable). Modeled alterations in BMI (to all ≤23 kg/m²) and HT use (to all non-HT users) profiles resulted in a 30% reduction in predicted EC incidence rates; individually, longer duration of OC use (to all ≥10 years) resulted in a 42.5% reduction. Modeled changes in not readily modifiable exposures (i.e., those not contributing to prevention potential) resulted in ≤24.6% reduction in predicted EC incidence. Women in the lowest decile of a risk score based on the evaluated exposures had risk similar to a low risk countries; however, this was driven by relatively long use of OCs (median = 23 years). Our findings support avoidance of overweight BMI and of HT use as prevention strategies for EC in a European population; OC use must be considered in the context of benefits and risks.     

Repair of the femoral nerve by two motor branches of the obturator nerve: A case report

Complete femoral nerve palsies are uncommon but devastating injuries when they are caused by large nerve defects. Direct repair is usually not possible and nerve grafting renders uncertain outcomes. Recent studies proposed different peripheral nerve transfers as treatment strategies for large femoral nerve defects. We report a clinical application of a nerve transfer to reinnervate the quadriceps muscle with two motor branches of the obturator nerve in a 48 years-old man that was diagnosed with a femoral nerve palsy after resection of a retroperitoneal schwannoma. The branches supplying the gracilis and adductor longus muscles were transferred to the motor branch of the femoral nerve to the quadriceps muscle at 6 months postinjury. At 34 months of follow-up, knee extension was quoted M4. The presented nerve transfer may be feasible, technically simple, and renders good functional outcomes.