Severe Polyethylene Glycol Allergy Considerations for Perioperative Management: A Case Report.

Patients with severe polyethylene glycol (PEG) allergies face broad challenges, especially when presenting to the hospital for surgery, as PEG is used often as an excipient in medications and in medical supplies. Although rare, this allergy is increasingly reported and likely underdiagnosed. We present a patient with known past anaphylactic reaction to PEG and a detailed account of her perioperative course. More broadly, we provide recommendations and resources for the safe management of similar patients with a severe PEG allergy.

Acute Pain Burden and Opioid Dose Requirements after Cesarean Delivery in Parturients with Preexisting Chronic Back Pain and Migraine.

INTRODUCTION: Preexisting chronic pain has been reported to be a consistent risk factor for severe acute postoperative pain. However, each specific chronic pain condition has unique pathophysiology, and it is possible that the effect of each condition on postoperative pain is different. METHODS: This is a retrospective cohort study of pregnant women with preexisting chronic pain conditions (i.e., migraine, chronic back pain, and the combination of migraine + chronic back pain), who underwent cesarean delivery. The effects of the three chronic pain conditions on time-weighted average (TWA) pain score (primary outcome) and opioid dose requirements in morphine milligram equivalents (MME) during postoperative 48 hours were compared. RESULTS: The TWA pain score was similar in preexisting migraine and chronic back pain. Chronic back pain was associated with significantly greater opioid dose requirements than migraine (12.92 MME, 95% CI: 0.41 to 25.43, P=0.041). Preoperative opioid use (P < 0.001) was associated with a greater TWA pain score. Preoperative opioid use (P < 0.001), smoking (P=0.004), and lower postoperative ibuprofen dose (P=0.002) were associated with greater opioid dose requirements. CONCLUSIONS: Findings suggest women with chronic back pain and migraine do not report different postpartum pain intensities; however, women with preexisting chronic back pain required 13 MME greater opioid dose than those with migraine during 48 hours after cesarean delivery.

The roles of different CLE domains in Arabidopsis CLE polypeptide activity and functional specificity.

The CLE (CLVATA3/ESR-related) family of plant polypeptide signaling molecules shares a conserved 14-amino-acid (aa) motif, designated the CLE motif, which recent studies suggest is sufficient for CLE function in vitro. In this study, we report that Arabidopsis CLE proteins can function in a tissue-specific manner and confirm some CLE factors can act through different receptors. Using domain swapping, we show for the first time that the CLE motif likely determines much of the functional tissue-specificity of the proteins in planta. However, we also provide evidence in support of the new view that sequences outside the CLE motif (14 aa) contribute to CLE function and functional specificity in vivo. Additionally, we report that deletion of the putative signal peptide from different CLE proteins completely inactivates CLE function in vivo, whereas exchanging the CLE signal peptides with a conventional signal peptide from a rice glycine-rich cell wall protein also influences CLE function. We thus propose that the CLE motif itself determines its functional tissue-specificity by dictating the direct recognition and interaction of each CLE peptide with its optimal receptor(s), whereas the receptor(s) may be available in a tissue-specific manner. On the other hand, the sequences outside the CLE motif may influence CLE function by affecting the processing of CLE peptides, resulting in a change in the availability and/or abundance of CLE peptides in specific tissues and/or cells.