Background. Most patients have moderate or severe pain after surgery. Opioids are the cornerstone of treating severe pain after surgery but cause problems when continued long after discharge. We investigated the efficacy of multifunction pain management software (MServ) in improving postoperative pain control and reducing opioid prescription at discharge. Methods. We recruited 234 patients to a prospective cohort study into sequential groups in a nonrandomised manner, one day after major thoracic or urological surgery. Group 1 received standard care (SC, n = 102), group 2 were given a multifunctional device that fed back to the nursing staff alone (DN, n = 66), and group 3 were given the same device that fed back to both the nursing staff and the acute pain team (DNPT, n = 66). Patient-reported pain scores at 24 and 48 hours and patient-reported time in severe pain, medications, and satisfaction were recorded on trial discharge. Findings. Odds of having poor pain control (>1 on 0–4 pain scale) were calculated between standard care (SC) and device groups (DN and DNPT). Patients with a device were significantly less likely to have poor pain control at 24 hours (OR 0.45, 95% CI 0.25, 0.81) and to report time in severe pain at 48 hours (OR 0.62, 95% CI 0.47–0.80). Patients with a device were three times less likely to be prescribed strong opioids on discharge (OR 0.35, 95% CI 0.13 to 0.95). Interpretation. Using an mHealth device designed for pain management, rather than standard care, reduced the incidence of poor pain control in the postoperative period and reduced opioid prescription on discharge from hospital.
MATERIALS AND METHODS: Protein expressions profile of eutopic endometrial tissues from participants with minimal/mild endometriosis in secretory phase were analyzed by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) based proteomics with data-independent acquisition (DIA) workflow. Up-regulated endometrial receptivity associated markers were screened out after metformin treatment in paired endometria. Parallel reaction monitoring (PRM) and immunochemistry were used for validation these markers. Endometria of endometriosis mice model on day 4 of pseudopregnancy were used for measured above screened markers, LIF and integrin avb3 expression.RESULTS: Compared to baseline, 149 differentially expressed proteins were detected in the endometria after metformin therapy. Insulin-like growth factor-binding protein 7 (IGFBP-7), a-antitrypsin (AAT), apolipoprotein D (ApoD), Rho GDP-dissociation inhibitor 1 (Rho-GDI), brain form glycogen phosphorylase (PYGB) and Cathepsin B (CTSB) that associated with endometrial receptivity had up-regulated after metformin therapy (P<0.05); while the expressions of those protein had no significant change in non-received controls. Up-regulated expression of IGFBP-7 and ApoD had been validated by PRM. IGFBP-7 and integrinb3 were up-regulated after metformin treatment in endometria of endometriosis mice model during window of implantation.CONCLUSIONS: Our study revealed that metformin may ameliorate expression of proteins related to endometrial receptivity in women with minimal/mild endometriosis and endometriosis mice model. Metformin could be used as potentially novel therapy to improve endometrial receptivity of infertile women with endometriosis.
Essential facts Respiratory compromise is a critical perioperative complication associated with increased costs and poor outcomes. It is common, costly, deadly and, most importantly, preventable.
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