Economic Burden of Opioid-Induced Constipation Among Long-Term Opioid Users with Noncancer Pain

Background

Opioid-induced constipation (OIC) can be a debilitating side effect of opioid therapy and may result in increased medical costs. The published data on the economic burden of OIC among long-term opioid users are limited.

Objective

To assess the economic burden of OIC in patients with noncancer pain in a managed care population in the United States.

Methods

This retrospective study used 2007–2011 data from the Truven Health MarketScan Commercial and Medicare databases. The study included adults with ≥12 months of insurance enrollment before and after starting long-term (≥90 days) use of opioids. Patients were excluded if they had cancer or a diagnosis of drug abuse or drug dependence during the study period, or if they had constipation or bowel obstruction within 90 days before starting opioid therapy during the study period. OIC was identified by International Classification of Diseases, Ninth Edition codes for constipation (564.0) or bowel obstruction (560.x) within 12 months of the initiation of an opioid. Patients with OIC were identified in the nonelderly, elderly (age ≥65 years), and long-term care populations. Differences in costs and healthcare resource utilization were calculated using propensity scoring.

Results

A total of 13,808 nonelderly (age, 48.6 ± 10.4 years; female, 50%) and 2958 elderly patients (age, 78.7 ± 8.1 years; female, 70%) met the study inclusion criteria. Of 401 nonelderly and 194 elderly patients with OIC, 85 patients initiated opioid therapy in a long-term care facility (age, 80.7 ± 11.6 years; female, 77%). After matching by key covariates, patients with OIC had significantly more hospital admissions than patients without OIC (nonelderly, 33% vs 22%, respectively; P <.001; elderly, 51% vs 31%, respectively; P <.001) and longer inpatient stays (nonelderly, 3.0 ± 8.4 days vs 1.0 ± 3.0 days, respectively; P <.001; elderly, 5.2 ± 12.2 days vs 2.1 ± 4.0 days, respectively; P <.001). The group with OIC had significantly higher total healthcare costs than the group without OIC in all 3 study cohorts (nonelderly, $23,631 ± $67,209 vs $12,652 ± $19,717, respectively; elderly, $16,923 ± $38,191 vs $11,117 ± $19,525, respectively; long-term care, $16,000 ± $22,897 vs $14,437 ± $25,690, respectively; all P <.05).

Conclusion

To the best of our knowledge, this is the first study to analyze the economic impact of long-term use of opioids among patients with OIC, using real-world data. The findings underscore the significant economic burden associated with long-term opioid use for noncancer pain in a managed care population. Effective therapies for OIC may reduce the associated economic burden and improve quality of life for long-term opioid users.     

Comparison of electroretinographic responses between two different age groups of adult Dark Agouti rats

AIM: To describe and compare the differences in electroretinographic responses between two different age groups of adult Dark Agouti (DA) rats and to better understand the effect of age on retinal histology and function.METHODS: The electroretinographic responses of two different age groups of adult DA rats were compared. Animals were divided into younger adult DA rats 10-12wk (n=8) and older adult DA rats 17-19wk (n=8). Full field electroretinography (ERG) was recorded simultaneously from both eyes after dark adaption and light adaption and parameters including the positive scotopic threshold response (pSTR), negative scotopic threshold response (nSTR), scotopic a-wave, b-wave, photopic a-wave, b-wave and photopic negative response (PhNR) were compared between groups.RESULTS: The older adult rats displayed lower stimulation thresholds of the STRs (pSTR and nSTR) and higher amplitudes of pSTR, scotopic a-wave and b-wave, photopic b-wave and PhNR amplitudes, with shorter implicit times. Photopic a-wave amplitudes were however higher in the younger adult rats.CONCLUSION:In summary, for the rod system, photoreceptor, bipolar cell and RGC activity was enhanced in the older adult rats. For the cone system, RGC and bipolar cell activity was enhanced, while photoreceptor activity was depressed in the older adult rats. Such age-related selective modification of retinal cell function needs to be considered when conducting ophthalmic research in adult rats.     

Extraction (DSX) from Erigeron breviscapus modulates outward potassium currents in rat retinal ganglion cells

AIM: To investigate the effect of DSX, an active component extracted from Erigeron breviscapus, on the voltage-gated outward K+ channel currents in rat retinal ganglion cells (RGCs) by using electrophysiological method, and to explore the possible mechanisms of DSX on optic nerve protection. METHODS: Outward K+ currents were recorded by using whole-cell patch-clamp techniques on acutely isolated rat RGCs. Outward K+ currents were induced by a series of depolarizing voltage pulses from a holding potential of -70 mV to +20 mV in an increment of 10 mV. RESULTS: Extracellular application of DSX voltage-dependently suppressed both the steady-state and peak current amplitudes of outward K+ currents in rat RGCs. Furthermore, DSX reversibly and dose-dependently inhibited the amplitudes of outward K+ currents of the cells. At +20 mV membrane potential DSX at the concentrations of 0.02 g/L and 0.05 g/L showed no significant effects on the currents. In contrast, DSX at higher concentrations (0.1 g/L, 0.2 g/L and 0.5 g/L) significantly suppressed the current amplitudes. CONCLUSION: These results suggest that DSX reversibly and dose-dependently suppress outward K+ channel currents in rat RGCs, which may be one of the possible mechanisms underlying Erigeron breviscapus prevents vision loss and RGC damage caused by glaucoma.     

肌肽对局灶性脑缺血大鼠bcl-2、bax表达的影响

目的研究肌肽对局灶性脑缺血大鼠缺血皮质区B淋巴细胞瘤/白血病-2(bcl-2)、bcl-2相关蛋白X(bax)表达的影响。方法 30只SPF级雄性SD大鼠随机分为假手术组、模型组和肌肽组,每组10只。模型组和肌肽组以线栓法制作大鼠永久性脑缺血模型,肌肽组于造模后予肌肽水溶液灌胃[1 000 mg/(kg·d)],其余2组予等量生理盐水灌胃。分别于造模后清醒时、24 h、72 h通过神经功能缺损评分观察神经功能,于72 h采用2,3,5-三苯基氯化四氮唑(TTC)染色观察脑梗死体积、HE染色观察病理形态学改变,并用免疫组化法检测bcl-2和bax表达。结果肌肽组神经功能评分72 h较模型组降低(P<0.05);脑组织缺血损伤病理学改变轻于模型组;脑梗死体积72 h较模型组减小(P<0.01);脑缺血后72 h与假手术组相比,模型组bcl-2表达下降、bax表达上升、bcl-2/bax比值下降(均P<0.05);经肌肽处理后bcl-2表达上升、bax表达下降,bcl-2/bax比值上升(P<0.01或P<0.05)。结论肌肽处理能提高bcl-2表达、降低bax表达及提高bcl-2/bax比值,这可能是肌肽发挥神经保护作用的分子机制之一。     

Transmission Risk from Imported Plasmodium vivax Malaria in the China–Myanmar Border Region

Malaria importation and local vector susceptibility to imported Plasmodium vivax infection are a continuing risk along the China–Myanmar border. Malaria transmission has been prevented in 3 border villages in Tengchong County, Yunnan Province, China, by use of active fever surveillance, integrated vector control measures, and intensified surveillance and response.     

Enhancement of thermoelectric performance of PEDOT:PSS films by post-treatment with a superacid

Several methods such as the addition of a polar solvent, an acid as well as various post-treatments have been used to improve the thermoelectric performance of conductive poly(3,4-ethylenedioxythiophene):polystyrene sulfonate (PEDOT:PSS) films. This paper reports a method using a superacid, trifluoromethanesulfonic acid, in methanol to treat PEDO:PSS films to improve their thermoelectric performance. Treatment of PEDOT:PSS films with this superacid in methanol leads to a significant increase in electrical conductivity from 0.7 to 2980 S cm⁻¹ together with a moderate increase in Seebeck coefficient from 17.6 to 21.9 μV K⁻¹, giving a power factor of 142 μW m⁻¹ K⁻², one of the highest values reported in the literature for conductive polymers. The figure of merit (ZT) value is estimated to be 0.19 under optimized conditions. The enhancement of thermoelectric performance, particularly the increase in both electrical conductivity and Seebeck coefficient, is due to the removal of the insulating component and polymer chain realignment giving in turn a denser packing of the conductive PEDOT polymer chains. This post-treatment method would offer an alternative way to improve the thermoelectric performance.

Treatment of PEDOT:PSS films with a superacid results in remarkable improvement of thermoelectric performance with a power factor of 142 μW m⁻¹ K⁻².     

Lithium sulfonate-grafted poly(vinylidenefluoride-hexafluoro propylene) ionomer as binder for lithium-ion batteries

Lithium sulfonate-grafted poly(vinylidenefluoride-hexafluoro propylene) P(VDF-HFP) ionomers are synthesized through covalent attachment of taurine and used as binder for the LiFePO₄ cathode of lithium-ion batteries(LIBs). The incorporation of the ionomer binders will add ionic conducting channels inside the electrodes, and prevent electrolyte depletion during rapid charge–discharge processes. It leads to an improved performance of LIBs using the ionomer binders including cycling stability and rate capability compared to that of LIBs using non-ionic binders (PVDF and PVDF-HFP). Therefore, the lithium sulfonate-grafted P(VDF-HFP) ionomers offer a new route to develop high-power LIBs.

Lithium sulfonate-grafted PVDF-HFP was successfully synthesized and used as binder for lithium ion batteries, improving electrochemical performance.