Decreased Opioid Prescription With Low Pain Scores After Urethroplasty: Using a Simplified, Multimodal, Opioid Minimization Pain Protocol.

OBJECTIVE: To implement a simplified, opioid-minimized, multimodal pain management (MPM) protocol and assess its effectiveness of reducing opioid dispersion while maintaining low postoperative complications, patient-reported pain, and patient-reported interference with quality of life (QOL) for men undergoing urethroplasty. METHODS: Ninety-five men at a single academic center from October 2020 to October 2023 received a urethroplasty. We retrospectively reviewed the prior standard pain management (SPM) cohort before August 2021, then prospectively studied the MPM cohort after August 2021. For the SPM cohort, we collected postoperative day (POD) 1 pain scores from our Electronic Medical Record (EMR). For the MPM cohort, we obtained a validated pain and QOL assessment in the early postoperative period. The SPM cohort's POD 1 pain scores were compared with the MPM cohort's POD 2 pain scores. Opioid dispensation records were queried from the Prescription Monitoring Program. RESULTS: Seventy-five morphine milligram equivalent fewer opioids in the MPM cohort were prescribed than the SPM cohort (0 (interquartile range [IQR]: 0-0) vs 75 (IQR:0-150), P < .001, respectively). Patients with opioid discharge prescriptions fell from 50% in the SPM cohort to 11% in the MPM cohort (P < .001). Early postoperative pain scores remained low and showed no significant difference between the cohorts. Pain's interference with QOL measures remained low. Complications were rare across both cohorts. CONCLUSION: This simplified, multimodal analgesia protocol effectively decreases postoperative pain and opioid dispersion without affecting QOL outcomes after urethroplasty. This pain regimen can be easily adopted to decrease the use of postoperative opioids in men undergoing urethroplasty.

The Necessity of Incorporating an Interposition Flap During Vesicovaginal Fistula Repair: Can Modifying the Method of Vaginal Repair Serve as a Substitute? A Randomized Clinical Trial.

PURPOSE: Traditionally, an omental flap is employed to reduce the risk of recurrence of vesicovaginal fistula (VVF) repair. In this study, we employed a modified surgical technique wherein the vaginal defect was closed using Connell sutures, without incorporation of an omental flap, aiming to mitigate potential complications. MATERIAL AND METHOD: Between 2010 to 2018, the current randomized clinical trial was conducted on 52 women who were candidates for open fistula repair. The patients were randomly allocated into two groups. In one group, the conventional method of fistula repair was performed involving an omental flap, while in the other group, we used a modified approach with a variation in the vaginal wall closure technique. In-hospital variables, including the length of surgery, hospital stay, and occurrences of ileus, were recorded. Patient follow-up extended for one year, with assessments conducted one, six, and twelve months postoperatively. These evaluations encompassed pad test to ascertain success rates and identify any potential complications. RESULTS: The final analysis comprised 49 patients, with an average age of 46.5 years. Baseline characteristics were comparable between the two groups (P-values > 0.05). The modified technique was associated with significantly reduced surgical duration (P = ˂ 0.001), and shorter hospital stays (P < 0.001). Ileus occurrence was reduced, but it was not significant(P = 0.856). However, the success rate showed no significant difference between the groups, with a success rate of 100% for the modified technique compared to 91.6% for the classic O'Conner method (P = 0.288). CONCLUSION: Based on the findings of this study, vaginal wall closure using Connell sutures during VVF repair demonstrates a success rate equivalent to the classic approach involving an omental flap. Moreover, this technique presents a reduced incidence of adverse effects, along with decreased surgical duration, hospital stay, and postoperative ileus.

Impaired synaptic transmission in dorsal dentate gyrus increases impulsive alcohol seeking.

Both human and animal studies indicate that the dentate gyrus (DG) of the hippocampus is highly exploited by drug and alcohol abuse. Yet, it is poorly understood how DG dysfunction affects addiction-related behaviors. Here, we used an animal model of alcohol use disorder (AUD) in automated IntelliCages and performed local genetic manipulation to investigate how synaptic transmission in the dorsal DG (dDG) affects alcohol-related behaviors. We show that a cue light induces potentiation-like plasticity of dDG synapses in alcohol-naive mice. This process is impaired in mice trained to drink alcohol. Acamprosate (ACA), a drug that reduces alcohol relapse, rescues the impairment of dDG synaptic transmission in alcohol mice. A molecular manipulation that reduces dDG synaptic AMPAR and NMDAR levels increases impulsive alcohol seeking during cue relapse (CR) in alcohol mice but does not affect alcohol reward, motivation or craving. These findings suggest that hindered dDG synaptic transmission specifically underlies impulsive alcohol seeking induced by alcohol cues, a core symptom of AUD.

Functional and radiographic comparison of subtalar arthroereisis and lateral calcaneal lengthening in the surgical treatment of flexible flatfoot in children.

PURPOSE: One of the most widespread diseases of children's orthopaedic problems is flatfoot. If conservative therapy failed, surgical treatment would be indicated. Lateral calcaneal lengthening (LCL) and subtalar arthroereisis (SA) are two types of operations used to correct symptomatic flexible flatfoot (FFF). The purpose of this study is to compare the functional and radiographic features of these two surgical procedures. PATIENTS AND METHODS: In this prospective randomized clinical trial study, we recruited 66 patients between 2018 and 2019. For clinical assessment, American Orthopedics Foot and Ankle Society (AOFAS), visual analog scale (VAS), subtalar motion, presence of medial longitudinal arch, and family satisfaction were measured. Evaluation of radiographic angles was based on AP (AP Tal-1Met) and Lat (Lat Tal-1Met) view of Talus-1st metatarsal angle (Meary's angle) and calcaneal pitch. RESULT: There was no significant difference between the two types of surgery regarding Lat Tal-1Met and AP Tal-1Met. The significantly larger angle in the LCL group was calcaneal pitch (P value < 0.001). AOFAS significantly increased from 68.71 ± 5.70 to 87.87 ± 7.14 (P value < 0.001) and from 67.28 ± 6.01 to 86.14 ± 7.56 (P value < 0.001) in LCL and SA respectively. Family satisfaction was significantly higher in the SA (8.14 ± 0.97) comparing to LCL (7.29 ± 0.86) at the latest follow-up (P value < 0.001). CONCLUSION: While both groups have substantial improvement in clinical and radiographic aspects, the SA technique is less-invasive, rapid symptom relief, and has early weight-bearing capacity. TRIAL REGISTRATION: IRCT20180823040853N1.

Oxidative-antioxidative status and hepatic and renal factors following melatonin administration in castrated and intact dogs.

BACKGROUNDS: Melatonin has significant antioxidant and hepatoprotective effects in normal and oxidative stress conditions. The aim of the present study was to assess the effects of melatonin on antioxidant, hepatic, and renal factors in intact and castrated dogs. Twenty male mixed-breed adult dogs were aligned in an experimental randomized and controlled trial. The dogs were randomly divided into four equal groups: melatonin, castrated, castrated and melatonin, and control. They were treated with melatonin (0.3 mg/Kg, once daily, orally) immediately after the castration for 1 month and their blood samples were collected weekly from 2 days after treatment with melatonin. RESULTS: Treating castrated dogs with melatonin increased the level of glutathione peroxidase, superoxide dismutase, and catalase compared with that of the control and castrated groups. The malondialdehyde level increased significantly following castration. Melatonin treatment decreased malondialdehyde concentration in the castrated dogs. Castration increased the level of alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase significantly in comparison with that of the control group. Treating the castrated dogs with melatonin decreased significantly liver enzymes compared with those of the castrated dogs. Blood urea nitrogen and creatinine levels increased in the castrated dogs in comparison with that of the control group. CONCLUSIONS: The administration of melatonin in castrated dogs increased antioxidant activity and decreased oxidation products, compared with those of the castrated and untreated dogs, without adverse effects on liver enzymes and kidney function.

CONTEXTE: La mélatonine possède des effets anti-oxydants et hépato-protecteurs dans les conditions normales et dans les situations de stress oxydant. L'objectif de la présente étude est d'évaluer les effets de la mélatonine sur des facteurs anti-oxydants, hépatiques et rénaux chez des chiens intacts et castrés. Vingt chiens mâles adultes de race croisée ont été utilisés dans un essai expérimental randomisé avec groupe témoin. Les chiens ont été attribués au hasard à quatre groupes de même effectif : mélatonine, castré, castré et mélatonine, et témoin. Ils ont été traité par la mélatonine (0.3 mg/kg, une fois par jour, par voie orale) immédiatement après la castration, pendant un mois ; des échantillons sanguins ont été collectés une fois par semaine à partir du deuxième jour de traitement par la mélatonine. RÉSULTATS: Le traitment par mélatonine chez les chiens castrés augmente les niveaux de glutathion peroxydase, de superoxyde dismutase, et de catalase par comparaison avec les niveaux chez les groupes témoin et castré. Le niveau de malondialdéhyde augmente de façon significative après la castration. Le traitement par mélatonine diminue la concentration de malondialdéhyde chez les chiens castrés. La castration augmente significativement les niveaux de phosphatase alcaline, d'aspartate aminotransférase, et d'alanine aminotransférase par comparaison à ceux du groupe témoin. Le traitement des chiens castrés par la mélatonine diminue de façon significative les enzymes hépatiques par comparaison à ceux des chiens castrés. Les taux sanguins d'azote uréique et de créatinine augmentent chez les chiens castrés comparé à ceux des chiens témoins. CONCLUSIONS: L'administration de mélatonine à des chiens castrés augmente l'activité anti-oxydante, et diminue les produits d'oxydation, par comparaison avec les chiens du groupe castré et non traité, sans effets indésirables sur les enzymes hépatiques et sur la fonction rénale.

Changes in thyroid hormones, leptin, ghrelin and, galanin following oral melatonin administration in intact and castrated dogs: a preliminary study.

BACKGROUND: Melatonin regulates metabolism and metabolism related hormones in mammalians. Castration has some adverse effects on the metabolic hormones of dog. This study was conducted to determine the effects of oral melatonin administration on metabolic hormones, as well as to compare changes of these hormones after administration of melatonin in castrated and intact dogs. Twenty healthy mixed breed mature male dogs were divided randomly into four groups (n = 5): melatonin (3 mg/10 kg(, castrated, castrated and melatonin treated, and negative control. Blood sample was collected from jugular vein weekly for 1 month. RESULTS: T3 and T4 hormones had a significant decrease within 1 month following administration of melatonin. No significant change was observed in concentration of FT3 and FT4 hormones. Leptin and ghrelin hormones also had a significant decrease in this period. Leptin and ghrelin had a more significant decrease in "non-castrated and melatonin treated" group compared to "castrated and melatonin treated" group. Galanin had a significant decrease but this neurotransmitter had no significant change in "non-castrated and melatonin treated" group in comparison to "castrated and melatonin treated" group. CONCLUSIONS: It seems that daily administration of melatonin capsule in all dogs can probably decrease concentration of T3 and T4 hormones and balance other metabolic hormones following castration. METHODS: The dogs underwent castration, melatonin treatment and blood sampling.

Effect of angiotensin II type 1 receptor blockade on kidney ischemia/reperfusion; a gender-related difference.

BACKGROUND: Renal ischemia/reperfusion (I/R) injury may be related to activity of reninangiotensin system (RAS), which is gender-related. In this study, it was attempted to compare the effect of angiotensin II (Ang II) receptor type 1 (AT1R) blockade; losartan in I/R injury in male and female rats. MATERIALS AND METHODS: Male and female Wistar rats were assigned as sham surgery, control I/R groups treated with vehicle, and case I/R groups treated with losartan (30 mg/kg). Vehicle and losartan were given 2 hours before bilateral kidney ischemia induced by clamping renal arteries for 45 minutes followed by 24 hours of renal reperfusion. RESULTS: The I/R injury significantly increased the serum levels of blood urea nitrogen (BUN) and creatinine (Cr), and kidney tissue damage score in both genders. However, losartan decreased these values in female rats significantly (P < 0.05). This was not observed in male rats. CONCLUSION: Losartan protects the kidney from I/R injury in female but not in male rats possibly because of gender-related difference of RAS.