Implementation of a Standardized Perioperative Pain Management Protocol to Reduce Opioid Prescriptions in Otolaryngologic Surgery

Objective To evaluate the efficacy of implementing a standardized multimodal perioperative pain management protocol in reducing opioid prescriptions following otolaryngologic surgery. Study Design Retrospective cohort study. Setting County hospital otolaryngology practice. Methods A perioperative pain management protocol was implemented in adults undergoing otolaryngologic surgery. This protocol included preoperative patient education and a postoperative multimodal pain regimen stratified by pain level: mild, intermediate, and high. Opioid prescriptions were compared between patient cohorts before and after protocol implementation. Patients in the pain protocol were surveyed regarding pain levels and opioid use. Results We analyzed 210 patients (105 preprotocol and 105 postprotocol). Mean ± SD morphine milligram equivalents (MMEs) prescribed decreased from 132.5 ± 117.8 to 53.6 ± 63.9 ( P < .05) following protocol implementation. Mean MMEs prescribed significantly decreased ( P < .05) for each procedure pain tier: mild (107.4 to 40.5), intermediate (112.8 to 48.1), and high (240.4 to 105.0). Mean MMEs prescribed significantly decreased ( P < .05) for each procedure type: endocrine (105.6 to 44.4), facial plastics (225.0 to 50.0), general (160.9 to 105.7), head and neck oncology (138.6 to 77.1), laryngology (53.8 to 12.5), otology (77.5 to 42.9), rhinology (142.2 to 44.4), and trauma (288.0 to 24.5). Protocol patients reported a mean 1-week postoperative pain score of 3.4, used opioids for a mean 3.1 days, and used only 39% of their prescribed opioids. Conclusion Preoperative counseling and standardization of a multimodal perioperative pain regimen for otolaryngology procedures can effectively lower amount of opioid prescriptions while maintaining low levels of postoperative pain.

Does Climate Change Affect the Yield of the Top Three Cereals and Food Security in the World?

Climate prediction models suggest that agricultural productivity will be significantly affected in the future. The expected rise in average global temperature due to the higher release of greenhouse gases (GHGs) into the atmosphere and increased depletion of water resources with enhanced climate variability will be a serious threat to world food security. Moreover, there is an increase in the frequency and severity of long-lasting drought events over 1/3rd of the global landmass and five times increase in water demand deficits during the 21st century. The top three cereals, wheat (Triticum aestivum), maize (Zea mays), and rice (Oryza sativa), are the major and staple food crops of most people across the world. To meet the food demand of the ever-increasing population, which is expected to increase by over 9 billion by 2050, there is a dire need to increase cereal production by approximately 70%. However, we have observed a dramatic decrease in area of fertile and arable land to grow these crops. This trend is likely to increase in the future. Therefore, this review article provides an extensive review on recent and future projected area and production, the growth requirements and greenhouse gas emissions and global warming potential of the top three cereal crops, the effects of climate change on their yields, and the morphological, physiological, biochemical, and hormonal responses of plants to drought. We also discuss the potential strategies to tackle the effects of climate change and increase yields. These strategies include integrated conventional and modern molecular techniques and genomic approach, the implementation of agronomic best management (ABM) practices, and growing climate resilient cereal crops, such as millets. Millets are less resource-intensive crops and release a lower amount of greenhouse gases compared to other cereals. Therefore, millets can be the potential next-generation crops for research to explore the climate-resilient traits and use the information for the improvement of major cereals.

Improved Magnesium Cement for Durable Hemp Composite Boards

Hemp concrete is a well-known bio-based building material, but due to its relatively low compressive strength is mainly used as an insulation material with a load-bearing wooden frame. There are possibilities to expand hemp concrete application in construction by substituting traditional lime with magnesium cement. Magnesium oxychloride cement is a material already known for some time and nowadays used in building board production. Strength, lightweight, ease of use are advantages that highlight relatively new magnesium oxychloride type boards compared to traditional sheeting materials such as plywood, gypsum plasterboard and fibre-cement board. Therefore, similar parameters are thought to be reached by producing magnesium oxychloride hemp board. In this work, magnesium cement water resistance was studied and possibilities to improve it was examined by adding fly ash and nanosilica. Among the nanomaterials used in building materials, nanosilica has gained significant interest by performing a beneficial effect in improving the mechanical properties of concretes. In addition, due to its ultrafine size and high chemical reactivity, the performance of nanosilica is much better with a lower amount of admixture required. Results show that applied nanosilica slightly reduced the compressive strength of magnesium cement in a dry state, but at the same time significantly increased its water resistance. Hemp magnesium oxychloride cement board prototype samples were produced and demonstrate promising results for further manufacturing of hemp composite boards.

Mineral Composition in Delactosed Dairy Products: Quality and Safety Status

Mineral elements are ingested through the diet (Li, Be, B, Na, Mg, Al, K, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Se, Sr, Mo, Ag, Cd, Sb, Ba, Tl, Pb, and Bi). Essential minerals have structural, biochemical, nutritional and catalytic functions; therefore, they are fundamental for human health. In this research, thirty commercial delactosed dairy products from different varieties were supplied by various markets in Sicily (Italy), and their mineral contents were determined by using inductively coupled plasma mass spectrometry (ICP-MS) with the following aims: (1) to highlight the differences among various products; (2) to evaluate if it is possibly related to the analyzed samples of their product group; (3) to evaluate the nutritional quality and safety related to intake of these dairy products. Evident differences were found among the samples depending on the type of product. A good separation between mozzarella—on the one hand—and crescenza and primo sale—on the other—was observed. The mozzarella samples were distinguished by the higher Fe, V and Co contents, and the lower amount of Al. Based on shares of the RDA, the analyzed dairy samples are a good source of Ca (up to 58% of the nutrient reference values), with a relatively high concentration of Na (between 5.5% and 22%). Any safety risk for consumers due to exposures to toxic elements through analyzed samples is excluded. The obtained results give reason to expect further insight concerning the direct comparison between the delactosed and non-delactosed product, in order to evaluate if the manufacturing process can affect the content of some mineral.

Effect of Radio-Frequency Treatment on the Changes of Dissolved Organic Matter in Rainwater

Rainwater is a potential source of drinking water, but has various components of dissolved organic matter (DOM). DOM is a reservoir of potential hazards in drinking water. Therefore, a new method is required to purify rainwater as a drinking water source in terms of DOM aspects. A radio-frequency (RF) treatment system is introduced here to purify source water with a small possibility of contamination. RF is generated by applying a frequency of 1.5 MHz through a glass reactor with a diameter of 2 mm which is wrapped by a 2 mm copper wire. The results demonstrate that UV260 value and dissolved organic carbon (DOC) are reduced during RF treatment. DOC was reduced by a lower amount compared to UV260, suggesting the partial transformation of bio-refractory DOM. A fluorescence excitation-emission matrix showed that humic-like substances in rainwater were reduced faster than protein-like ones, indicating that humic-like substances are susceptible to reduction by RF treatment. The results offer information on the use of RF treatment in a rainwater purification process for the production of drinking water.

MicroRNA biogenesis and activity in plant cell dedifferentiation stimulated by cell wall removal

Background Despite the frequent use of protoplast-to-plant system in in vitro cultures of plants, the molecular mechanisms regulating the first and most limiting stages of this process, i.e., protoplast dedifferentiation and the first divisions leading to the formation of a microcallus, have not been elucidated. Results In this study, we investigated the function of miRNAs in the dedifferentiation of A. thaliana mesophyll cells in a process stimulated by the enzymatic removal of the cell wall. Leaf cells, protoplasts and CDPs (cells derived from protoplasts) cultured for 24, 72 and 120 h (first cell division). In protoplasts, a strong decrease in the amount of AGO1 in both the nucleus and the cytoplasm, as well as dicing bodies (DBs), which are considered to be sites of miRNA biogenesis, was shown. However during CDPs division, the amounts of AGO1 and DBs strongly increased. MicroRNA transcriptome studies demonstrated that lower amount of differentially expressed miRNAs are present in protoplasts than in CDPs cultured for 120 h. Then analysis of differentially expressed miRNAs, selected pri-miRNA and mRNA targets were performed. Conclusion This result indicates that miRNA function is not a major regulation of gene expression in the initial but in later steps of dedifferentiation during CDPs divisions. miRNAs participate in organogenesis, oxidative stress, nutrient deficiencies and cell cycle regulation in protoplasts and CDPs. The important role played by miRNAs in the process of dedifferentiation of mesophyll cells was confirmed by the increased mortality and reduced cell division of CDPs derived from mutants with defective miRNA biogenesis and miR319b expression.

Properties of Polysiloxane/Nanosilica Nanodielectrics for Wearable Electronic Devices

Polymer nanodielectrics characterized by good flexibility, processability, low dielectric loss and high dielectric permittivity are materials of interest for wearable electronic devices and intelligent textiles, and are highly in demand in robotics. In this study, an easily scalable and environmentally friendly method was applied to obtain polysiloxane/nanosilica nanocomposites with a large content of nanofiller, of up to 30% by weight. Nanosilica was dispersed both as individual particles and as agglomerates; in nanocomposites with a lower amount of filler, the former prevailed, and at over 20 wt% nanosilica the agglomerates predominated. An improvement of both the tensile strength and modulus was observed for nanocomposites with 5–15 wt% nanosilica, and a strong increase of the storage modulus was observed with the increase of nanofiller concentration. Furthermore, an increase of the storage modulus of up to seven times was observed in the nanocomposites with 30 wt% nanosilica. The tensile modulus was well fitted by models that consider the aggregation of nanoparticles and the role of the interface. The dielectric spectra showed an increase of the real part of the complex relative permittivity with 33% for 30 wt% nanosilica in nanocomposites at a frequency of 1 KHz, whereas the loss tangent values were lower than 0.02 for all tested nanodielectrics in the radio frequency range between 1 KHz and 1 MHz. The polysiloxane–nanosilica nanocomposites developed in this work showed good flexibility; however, they also showed increased stiffness along with a stronger dielectric response than the unfilled polysiloxane, which recommends them as dielectric substrates for wearable electronic devices.

Microbial and Chemical Characteristics of Doogh (Iranian Fermented Milk Drink)

Background. Regarding the increasing public health concerns about the safety of foodstuffs, the current survey was designed to argue the presence of preservatives (e.g., sodium benzoate (SB), potassium sorbate (PS), and natamycin) and also the level of salt and fungi in 148 samples of yoghurt drink “Doogh.” Methods. The enumeration of fungi and determination of salt content of samples were performed according to the standard procedures. Preservative determination was performed by reverse phase high-performance liquid chromatography with UV detection (RV-HPLC-UV). Results. 0.1% of the total analyzed samples was above the permitted level of Iranian standard for SB (0%), while PS was not detected in any of them. Furthermore, natamycin in 0.11% of the analyzed samples had more than the permissible level of Iranian standard. Additionally, about 15% of the tested samples was higher than the Iranian standard level for fungi (<102 CFU/mL). The average amount of salt in the tested Doogh samples and also in the examined Kefir samples was significantly ( P < 0.001 ) lower than the standard amount of salt (<0.8 g/100). Conclusion. In conclusion, the quality of Doogh and Kefir samples were acceptable in terms of salt content. Kefir had a significantly ( P ≤ 0.001 ) lower amount of salt in comparison with Doogh. Taken together, underlining the results of the present study, no significant public health concern would exist respecting the mentioned additives.

Reduced Interleukin-17-Expressing Cells in Cutaneous Melanoma

Characterization of tumor associated lymphocytes (TILs) in tumor lesions is important to obtain a clear definition of their prognostic value and address novel therapeutic opportunities. In this work, we examined the presence of T helper (Th)17 lymphocytes in cutaneous melanoma. We performed an immunohistochemical analysis of a small cohort of primary melanomas, retrospectively selected. Thereafter, we isolated TILs from seven freshly surgically removed melanomas and from three basal cell carcinomas (BCC), as a comparison with a non-melanoma skin cancer known to retain a high amount of Th17 cells. In both studies, we found that, differently from BCC, melanoma samples showed a lower percentage of Th17 lymphocytes. Additionally, TIL clones could not be induced to differentiate towards the Th17 phenotype in vitro. The presence or absence of Th17 cells did not correlate with any patient characteristics. We only observed a lower amount of Th17 cells in samples from woman donors. We found a tendency towards an association between expression by melanoma cells of placenta growth factor, angiogenic factors able to induce Th17 differentiation, and presence of Th17 lymphocytes. Taken together, our data indicate the necessity of a deeper analysis of Th17 lymphocytes in cutaneous melanoma before correlating them with prognosis or proposing Th17-cell based therapeutic approaches.

Highly Porous Composite Scaffolds Endowed with Antibacterial Activity for Multifunctional Grafts in Bone Repair

The present study deals with the development of multifunctional biphasic calcium phosphate (BCP) scaffolds coated with biopolymers—poly(ε-caprolactone) (PCL) or poly(ester urea) (PEU)—loaded with an antibiotic drug, Rifampicin (RFP). The amounts of RFP incorporated into the PCL and PEU-coated scaffolds were 0.55 ± 0.04 and 0.45 ± 0.02 wt%, respectively. The in vitro drug release profiles in phosphate buffered saline over 6 days were characterized by a burst release within the first 8h, followed by a sustained release. The Korsmeyer–Peppas model showed that RFP release was controlled by polymer-specific non-Fickian diffusion. A faster burst release (67.33 ± 1.48%) was observed for the PCL-coated samples, in comparison to that measured (47.23 ± 0.31%) for the PEU-coated samples. The growth inhibitory activity against Escherichia coli and Staphylococcus aureus was evaluated. Although the RFP-loaded scaffolds were effective in reducing bacterial growth for both strains, their effectiveness depends on the particular bacterial strain, as well as on the type of polymer coating, since it rules the drug release behavior. The low antibacterial activity demonstrated by the BCP-PEU-RFP scaffold against E. coli could be a consequence of the lower amount of RFP that is released from this scaffold, when compared with BCP-PCL-RFP. In vitro studies showed excellent cytocompatibility, adherence, and proliferation of human mesenchymal stem cells on the BCP-PEU-RFP scaffold surface. The fabricated highly porous scaffolds that could act as an antibiotic delivery system have great potential for applications in bone regeneration and tissue engineering, while preventing bacterial infections.