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2.
Int J Colorectal Dis ; 37(8): 1799-1806, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35796873

RESUMO

PURPOSE: With increased awareness of the opioid epidemic, understanding contributing factors to postoperative opioid use is important. The purpose of this study was to evaluate patient and perioperative factors that contribute to postoperative opioid use after colorectal resections and their relation to pre-existing pain conditions and psychiatric diagnoses. METHODS: A retrospective review was conducted identifying adult patients who underwent elective colorectal resection at a single tertiary center between 2015 and 2018. Patient demographics, preoperative factors, surgical approach, and perioperative pain management were evaluated to determine standard conversion morphine milligram equivalents required for postoperative days 0 to 3 and total hospital stay. RESULTS: Five hundred and ninety-two patients: 46% male, median age 58 years undergoing colorectal resections for indications including cancer, inflammatory bowel disease, and diverticulitis were identified. Less opioid use was found to be associated with female gender (ß = - 42), patients who received perioperative lidocaine infusion (ß = - 30), and older adults (equivalents/year) (ß = - 4, all p < 0.01). Preoperative opioid use, preoperative abdominal pain, epidural use, and smoking were all independently associated with increased postoperative opioid requirements. CONCLUSIONS: In this study of patients undergoing elective colorectal resection, factors that were associated with higher perioperative opioid use included male gender, smoking, younger age, preoperative opioid use, preoperative abdominal pain, and epidural use. Perioperative administration of lidocaine was associated with decreased opioid requirements. Understanding risk factors and stratifying postoperative pain regimens may aid in improved pain control and decrease long-term dependency.


Assuntos
Analgésicos Opioides , Neoplasias Colorretais , Dor Abdominal , Idoso , Analgésicos Opioides/efeitos adversos , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Lidocaína/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Fumar/efeitos adversos
3.
Am J Public Health ; 110(9): 1304-1307, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32783737

RESUMO

The University of Iowa Mobile Clinic (UIMC) is an interdisciplinary student-run free medical clinic founded in 2002. UIMC provides free health screenings, education, and basic services to underserved populations in Iowa: immigrants, refugees, migrant farmworkers, individuals experiencing homelessness, low-income individuals, and people who live in rural communities. Forty-four percent of patients surveyed use UIMC as their only source of care. Ninety-seven percent of patients surveyed rate care as excellent or good. UIMC is a crucial safety net health care resource in Iowa to improve health equity.


Assuntos
Atenção à Saúde/métodos , Área Carente de Assistência Médica , Unidades Móveis de Saúde/organização & administração , Estudantes de Ciências da Saúde , Educação em Saúde , Pessoas Mal Alojadas , Humanos , Iowa , Pessoas sem Cobertura de Seguro de Saúde , Refugiados , População Rural , Migrantes
4.
Stem Cell Reports ; 8(6): 1770-1783, 2017 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-28552605

RESUMO

Oligodendrocyte precursor cells (OPCs) offer considerable potential for the treatment of demyelinating diseases and injuries of the CNS. However, generating large quantities of high-quality OPCs remains a substantial challenge that impedes their therapeutic application. Here, we show that OPCs can be generated from human pluripotent stem cells (hPSCs) in a three-dimensional (3D), scalable, and fully defined thermoresponsive biomaterial system. We used CRISPR/Cas9 to create a NKX2.2-EGFP human embryonic stem cell reporter line that enabled fine-tuning of early OPC specification and identification of conditions that markedly increased the number of OLIG2+ and NKX2.2+ cells generated from hPSCs. Transplantation of 50-day-old OPCs into the brains of NOD/SCID mice revealed that progenitors generated in 3D without cell selection or purification subsequently engrafted, migrated, and matured into myelinating oligodendrocytes in vivo. These results demonstrate the potential of harnessing lineage reporter lines to develop 3D platforms for rapid and large-scale production of OPCs.


Assuntos
Diferenciação Celular , Células Precursoras de Oligodendrócitos/citologia , Células-Tronco Pluripotentes/citologia , Animais , Materiais Biocompatíveis/química , Encéfalo/metabolismo , Sistemas CRISPR-Cas/genética , Técnicas de Cultura de Células , Linhagem Celular , Reprogramação Celular , Genes Reporter , Proteína Homeobox Nkx-2.2 , Proteínas de Homeodomínio/genética , Proteínas de Homeodomínio/metabolismo , Humanos , Camundongos , Camundongos Endogâmicos NOD , Camundongos SCID , Proteínas Nucleares , Células Precursoras de Oligodendrócitos/metabolismo , Células Precursoras de Oligodendrócitos/transplante , Fator de Transcrição 2 de Oligodendrócitos/genética , Fator de Transcrição 2 de Oligodendrócitos/metabolismo , Células-Tronco Pluripotentes/metabolismo , Alicerces Teciduais/química , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismo , Transplante Heterólogo , Proteínas de Peixe-Zebra
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