Long-term opioid medication profile of European adult spinal deformity patients: minimum five years follow-up study.

BACKGROUND CONTEXT: There remains significant variability in the use of postoperative opioids. On one end, it is proven that appropriate pain control is a critical aspect of patient management; on the other end, past few decades have been associated with major increases in opioid-related overdoses and addiction treatment. We hypothesized that several pre- and postoperative risk factors affecting long-term opioid use could be identified. PURPOSE: Evaluation of factors associated with minimum 5-year postoperative opioid use following adult spinal deformity surgery. STUDY DESIGN/SETTING: Prospectively followed study group database. PATIENT SAMPLE: Adult spinal deformity patients who underwent elective spine surgery between 2009 and 2016 were included. OUTCOME MEASURES: Opioid usage or otherwise at minimum 5 years follow-up. Use of nonopioid analgesics, weak and strong opioids METHODS: Retrospective analysis of patients undergoing elective spinal deformity surgery. A total of 37 factors comprising patient characteristics, radiographic measurements, operative details, preoperative and early postoperative opioid use, and mechanical complications and revisions were analyzed. Details on identified factors were provided. RESULTS: A total of 265 patients (215F, 50M) from five sites were included. The mean follow-up duration was 68.4±11.7 (60-102) months. On average, 10.6±3.5 levels were fused. Preoperatively, 64 (24.2%) patients were using opioids. The rate of opioid users increased to 33.6% at 6 weeks and decreased to 21.5% at 6 months. During follow-up, there were patients who discontinued opioids, while others have started and/or restarted using opioids. As a result, 59 (22.3%) patients were still on opioids at the latest follow-up. Multivariate analyses showed that factors independently affecting opioid use at an average of 68 months postoperatively, in order of significance, were opioid use at sixth weeks, preoperative opioid use and opioid use at sixth months with the odds ratios of 2.88, 2.51, and 2.38 respectively. At these time points, factors such as age, number of comorbidities, tobacco use, the time of the last prior spine surgery and postoperative sagittal plane alignment affected opioid usage rates. CONCLUSIONS: Opioid usage at 6 weeks was found to be more predictive of long-term opioid use compared to preoperative use. Patients should be well informed to have realistic expectations regarding opioid use when considering adult spinal deformity surgery.

Exploring Potential Regulatory Anesthetic Drugs Based on RNA Binding Protein and Constructing CESC Prognosis Model: A Study Based on TCGA Database.

Objective: To investigate the differential expression of RBPs in cervical squamous cell carcinoma (CESC), analyze the regulatory effect of narcotic drugs on RBPs, and establish the prognostic risk model of CESC patients. Methods: RNA-SEQ data and clinical case data of cancer and normal samples from CESC patients were obtained from the Cancer Genome Atlas (TCGA) database and Genotype-Tissue Expression (GTEx) database. Differentially expressed RBPs were screened by R language and enriched. The CMAP database is used to predict the anesthetic drugs that regulate the differential expression of RBPs. The prognostic risk score model was constructed by COX regression analysis. Risk score of each CESC patient was calculated and divided into high-risk group and low-risk group according to the median risk score. The prediction efficiency of prognostic risk model was evaluated by Kaplan-Meier (KM) analysis and receiver operating characteristic (ROC) curve, and the correlation between prognostic risk model and clinical characteristics was analyzed. Immunohistochemistry was used to detect the expression of RNASEH2A and HENMT1 in tissues. Results: There were 65 differentially expressed RBPs in CESC. Five anesthetics, including benzocaine, procaine, pentoxyverine, and tetracaine were obtained to regulate RBPs. Survival analysis showed that seven genes were related to the prognosis of patients, and the CESC risk score model was constructed by COX regression. The risk score can be used as an independent prognostic factor. RNASEH2A and HENMT1 are up-regulated in tumors, which can effectively distinguish normal tissues from tumor tissues. Conclusion: It is found that different anesthetic drugs have different regulatory effects on the differential expression of RBPs. Based on the differentially expressed RBPs, the prognostic risk score model of CESC patients was constructed. To provide ideas for the formulation of individualized precise anesthesia scheme and cancer pain analgesia scheme, which is helpful to improve the perioperative survival rate of cancer patients.

O julgamento de adolescentes varejistas do tráfico de drogas no Brasil: uma análise de processos judiciais / Legal sentences of adolescents for small-scale drug trafficking in Brazil: an analysis of judicial decisions / Sentencias judiciales contra adolescentes del microtráfico de drogas en Brasil: un análisis de las decisiones judiciales

Resumo (analítico) O objetivo do artigo é analisar os processos judiciais relativos ao ato infracional de tráfico de drogas, em Petrolina-PE (2011-2014), com base na revisão analítica das instituições e leis historicamente voltadas para a menoridade, segundo a Theory of Sentencing. Apreciou-se o conteúdo social das variáveis legais e extralegais, analisando o efeito cumulativo dos determinantes das sentenças. As decisões judiciais mais encontradas foram extinção processual e absolvição. Medidas socioeducativas de advertência, liberdade e semiliberdade são mais recorrentes que a internação. No entanto, há disparidades das sentenças em casos análogos e imputação de penas análogas em casos díspares. Conclui-se que o sistema penal é produtor e reprodutor de desigualdades sociais e a punição é percebida e utilizada como técnica de controle e transformação de adolescentes pobres apreendidos com pequenas quantidades de drogas.

Abstract (analytical) The purpose of this article is to analyze the legal sentences for drug trafficking offense in Petrolina, a city in the state of Pernambuco, in the period 2011-2014 based on the analytical review of institutions and laws that have historically targeted minorities and the Theory of Sentencing. The social content of legal and extralegal variables was analyzed, analyzing the cumulative effect of determinants for the sentences. The most frequent judicial decisions were procedural extinction and acquittal. Socioeducational measures of warnings, dropping of all charges and suspended sentences are more common than imprisonment. However, there are disparities in sentences for similar cases and the handing down of analogous sentences in disparate cases. It is concluded that the penal system is a producer and reproducer of social inequalities and punishment is perceived and used as a technique for the control and transformation of poor adolescents who are caught with small amounts of drugs.

Resumen (analítico) El objetivo del artículo es analizar los procesos judiciales de tráfico de drogas, en Petrolina-PE (2011-2014) de adolescentes, basado en la revisión analítica de las instituciones y leyes históricamente orientadas hacia las minorías y la Theory of Sentencing. Se apreció el contenido social de las variables legales y extralegales, analizando el efecto acumulativo de los determinantes de las sentencias. Las decisiones judiciales más encontradas fueron la extinción procesal y la absolución. Las medidas socioeducativas de advertencia, libertad y semilibertad son más recurrentes que la internación. Sin embargo, hay disparidades de sentencias en casos análogos e imputación de penalización análogas en casos dispares. Se concluye que el sistema penal es productor de desigualdades sociales y el castigo es percibido y utilizado como técnica de control y transformación de adolescentes pobres incautados con pequeñas cantidades de drogas.

E-salud educación virtual en la prevención del consumo de sustancias psicoactivas / E- health: prevention of the consumption of psychoactive substances using virtual education

La utilización de herramientas virtuales para la salud ha sido estudiada desde diversos enfoques. Esta revisión narrativa se propone identificar el conocimiento generado con respecto a la educación virtual en la prevención del consumo de sustancias psicoactivas, para lograr este objetivo se analizó la producción científica que hay al respecto, seleccionando textos que trabajarán específicamente las herramientas virtuales en el tema de las adicciones, debido a que el uso de drogas evidencia un aumento en los ámbitos internacional, nacional y local en su mayoría en población juvenil (que es también el público que hace mayor uso de las Tecnologías de la Información y la Comunicación), en tanto que las iniciativas educativas virtuales para este fin se han centrado más en las herramientas (Internet y teléfonos móviles) que en el público, en la metodología y en los contenidos; los principales hallazgos apuntan a destacar que la prevención del consumo de sustancias psicoactivas puede lograrse mediante la educación virtual, pues las acciones formativas y las estrategias innovadoras redundarían en la adopción de hábitos saludables, puede concluirse que falta evidencia científica que lo sustente debido a que se requiere de evaluaciones de impacto de los programas y la inclusión de padres y educadores.

The use of virtual tools for health has been studied from many ways. This narrative research has as aim to know the scientific knowledge about virtual education in prevention of consumption of psychoactive substances (SPA), to achieve this objective, the scientific production was analyzed, selecting texts that specifically talk about the virtual tools in the subject of addictions, because use of drugs is increasing in international, national and local ambit mostly in the youth population (which is the public that makes greater use of ICT), while the virtual educational initiatives for this purpose have focused more on tools (Internet, ICT and mobile phones) than in people, methodologys and contents, in conclusion is not enough scientific evidence in virtual educational strategies for the SPA consumption prevention, that have been implemented, evaluated and planned for parents and educators.

Miniaturized hollow fibre assisted liquid-phase microextraction and gas chromatography for determination of trace concentration of sufentanil and alfentanil in biological samples.

A simple and highly sensitive method that involves miniaturized hollow fibre assisted liquid-phase microextraction with gas chromatography-flame ionization detector was developed for the determination of trace concentration of sufentanil and alfentanil in biological samples. These drugs were extracted from 5 ml of aqueous solution with pH 10.0 into an organic extracting solvent (1-octanol) impregnated in the pores and lumen of a hollow fibre. After extraction for a prescribed time, 2.0 µl of the extraction solvent was injected directly in to the GC injection port. Under the optimized conditions, (1-octanol as extracting solvent, stirring rate of 700 rpm, 15% (w/v) salt addition, pH 10.0 and 25 min sampling time at 50 °C) large enrichment factors of 535 and 420 were achieved for sufentanil and alfentanil, respectively. Dynamic linear ranges were in the range of 0.05 to 500 ng/ml for sufentanil and 0.1 to 500 ng/ml for alfentanil. Limits of detection 0.01 and 0.02 ng/ml were obtained for sufentanil and alfentanil, respectively. The percent relative intra-day and inter-day standard deviations were found to be less than 8.4% (n = 5). Finally, this method was successfully applied for the separation, preconcentration and determination of trace concentration of sufentanil and alfentanil in plasma and urine samples.

Narcomenudeo: un neologismo para describir la venta de estupefacientes / Narco-retailing: a neologism to describe the sale of narcotic drugs / Narcovarejo: um neologismo para descrever a venda dos estupefacientes

El narcomenudeo se considera un fenómeno multicausal, que se manifiesta en los entornos próximos a los puntos de venta de sustancias estupefacientes, ligado a manifestaciones de conflictividad social, de violencia y de criminalidad. Los comportamientos de los actores involucrados en la compra, venta y consumo de drogas ilícitas propician alteraciones a la convivencia pacífica de los habitantes de esos sectores, tanto en su ámbito individual como colectivo. Esta investigación tuvo por objetivo identificar la estructura y funcionamiento del fenómeno del narcomenudeo a partir de un método de inteligencia policial, para asesorar la toma de decisiones de los comandantes de Policía en la planeación y prestación del servicio, así como en la interacción con las autoridades político-administrativas. La indagación permitió identificar las propiedades del narcomenudeo y las características de la organización delincuencial que monopoliza la actividad criminal en la ciudad de Pereira (Risaralda), Colombia. La metodología que se utilizó para la construcción subjetiva del fenómeno del narcomenudeo fue de carácter descriptivo cuali-cuantitativo, bajo la teoría de las representaciones sociales con enfoque fenomenológico. El narcomenudeo es un fenómeno asociado al mercado del narcotráfico, estructurado con el propósito de favorecer y maximizar las ganancias de un actor ilegal, basándose en un modelo organizacional que le garantiza estabilidad y protección al asentarse en el territorio, lo que se acompaña de mecanismos para constreñir el comportamiento colectivo de las personas

The so-called retail drug-dealing or retail narco-business is a multi-cause phenomenon taking place at the vicinities of points-of-sale where narcotic drugs and psychotropic substances are sold, in association with social conflictivity, violence, and criminality manifestations. The behavior of actors involved in the sale, purchase and use of illegal drugs promotes disturbances affecting the pacific co-existence of the inhabitants in these sectors, in both their individual and collective environment. The purpose of this investigation was to identify the structure and functioning of the retail-drug dealing phenomenon from a policy intelligence method, in order to provide Police commanders with advice in their decision-making regarding planning and service rendering, as well as their interaction with political-administrative authorities. Fact-finding helped identify the drug dealing properties and the features of the criminal organization having monopolized this criminal activity in the city of Pereira (Risaralda), Colombia. The methodology used for the subjective construction of the retail narco-business was of a descriptive qualification and quantification nature, based on the theory of social representations with a phenomenological approach. The phenomenon of retail drug-dealing is associated to the drug trafficking market; it is structured for the purpose of favoring and minimizing the profits of an illegal actor based on an organizational model that will secure him both stability and protection at the time of settling in the territory, together with mechanisms leading to constrain people’s collective behavior

O narcovarejo é considerado um fenômeno multicausal, aquele se manifesta nos ambientes próximos aos pontos da venda das substâncias estupefacientes, ligado às manifestações de conflito social, da violência e da criminalidade. Os comportamentos dos atores envolvidos na compra, na venda e no consumo de drogas ilícitas causam alterações à convivência pacífica dos habitantes daqueles setores, tanto quanto em seu espaço individual quanto coletivo. Esta pesquisa teve pelo objetivo identificar a estrutura e a operação do fenômeno do narcovarejo a partir de um método de inteligência policial, para recomendar à tomada de decisão dos comandantes da Polícia no planejamento e fornecimento do serviço, bem como na interação com as autoridades político-administrativas. A indagação permitiu identificar as propriedades do narcovarejo e as características da organização criminal que monopoliza a atividade criminal na cidade de Pereira (Risaralda), Colômbia. A metodologia que foi usada para a construção subjetiva do fenômeno do narcovarejo foi do caráter descritivo qualitativo-quantitativo, sob a teoria das representações sociais com um enfoque fenomenológico. O narcovarejo é um fenômeno associado ao mercado do narcotráfico, estruturado a fim favorecer e maximizar os ganhos de um ator ilegal, sendo baseado em um modelo organizacional que lhe garanta a estabilidade e a proteção ao ser baseado no território, que é acompanhado por mecanismos para restringir o comportamento coletivo das pessoas