[Analysis on the concept and clinical practice of patient-controlled analgesia in the treatment of cancer pain by Chinese medical providers].

Objective: To investigated the concept and clinical practice of patient-controlled analgesia (PCA) in the treatment of cancer pain. Methods: Doctors, nurses, pharmacists from the oncology department, pain department, or hospice department were investigated using an electronic questionnaire from December 1 to December 31, 2021. In addition to the basic information, there were 26 questions were collected, including the current situation of cancer pain treatment, the concept of medical staff on PCA treatment of cancer pain and the clinical practice of PCA. Results: Questionnaires from 2 872 medical staff were collected from 993 hospitals in 30 provincial administrative units. Only 34.8% (955/2 748) of medical staff considered that the satisfaction rate of cancer pain control was over 75%, and 27.9% (548/1 968) of medical staff convinced that the satisfaction rate of breakthrough pain control was less than 50%. 97.1% (2 439/2 513) of medical staff considered that PCA could be effectively used for cancer pain treatment. The proportion of medical staff in secondary and tertiary hospitals who thought that PCA was applicable to cancer pain that could not be effectively alleviated by standardized non-invasive drug administration was 64.6% (319/494) and 69.1% (1 262/1 826) respectively, which was higher than that in primary hospitals [57.0% (110/193)] (P=0.002). In different occupations, the proportion of nurses who convinced PCA treatment of cancer pain increased the risk of addiction and drug overdose was 62.8% (431/686) and 76.1% (522/686), respectively, which was higher than doctors [39.2% (670/1709) and 58.2% (995/1709), respectively] and pharmacists [49.2% (58/118) and 65.3% (77/118), respectively] (all P<0.001). There was no significant difference in type of pump, route of administration, mode of infusion, protocol for PCA administration and selection of common medication in PCA treatment of cancer pain among different hospitals (all P>0.05). The calculation of continuous infusion dose and rescue dose of PCA was not uniform among different hospitals. After initiation of PCA, 71.7% (1 226/1 709) of hospitals had insufficient analgesia and most of them needed to be adjusted for 1-3 times to achieve satisfactory analgesia. Conclusion: Medical staff have insufficient cognition of PCA treatment of cancer pain and there is a lack of unified guidance in clinical practice. Therefore, it is an urgent need to develop an expert consensus on PCA treatment of cancer pain.

Associations and relative risks of pulmonary hypertension and lung diseases in individuals with methamphetamine use disorder.

OBJECTIVE: Methamphetamine causes considerable short- and long-term adverse health effects. Our aim was to assess the effects of methamphetamine use on pulmonary hypertension and lung diseases at the population level. METHODS: This population-based retrospective study used data from the Taiwan National Health Insurance Research Database between 2000 and 2018 that included 18,118 individuals with methamphetamine use disorder (MUD) and 90,590 matched participants of the same age and sex without substance use disorder as the non-exposed group. A conditional logistic regression model was used to estimate associations of methamphetamine use with pulmonary hypertension and lung diseases such as lung abscess, empyema, pneumonia, emphysema, pleurisy, pneumothorax, or pulmonary hemorrhage. Incidence rate ratios (IRRs) of pulmonary hypertension and hospitalization due to lung diseases were determined between the methamphetamine group and non-methamphetamine group using negative binomial regression models. RESULTS: During an 8-year observation period, 32 (0.2%) individuals with MUD and 66 (0.1%) non-methamphetamine participants suffered from pulmonary hypertension, and 2652 (14.6%) individuals with MUD and 6157 (6.8%) non-methamphetamine participants suffered from lung diseases. After adjusting for demographic characteristics and comorbidities, individuals with MUD were 1.78 times (95% confidence interval (CI) = 1.07-2.95) more likely to have pulmonary hypertension and 1.98 times (95% CI = 1.88-2.08) more likely to have a lung disease, especially emphysema, lung abscess, and pneumonia in descending order. Furthermore, compared to the non-methamphetamine group, the methamphetamine group was associated with higher risks of hospitalization caused by pulmonary hypertension and lung diseases. The respective IRRs were 2.79 and 1.67. Individuals with polysubstance use disorder were associated with higher risks of empyema, lung abscess, and pneumonia compared to individuals with MUD alone, with respective adjusted odds ratios of 2.96, 2.21, and 1.67. However, pulmonary hypertension and emphysema did not differ significantly between MUD individuals with or without polysubstance use disorder. CONCLUSIONS: Individuals with MUD were associated with higher risks of pulmonary hypertension and lung diseases. Clinicians need to ensure that a methamphetamine exposure history is obtained as part of the workup for these pulmonary diseases and provide timely management for this contributing factor.

Effects of Sophy ß-glucan on growth performance, carcass traits, meat composition, and immunological responses of Peking ducks.

The response of Peking ducks to supplements of Sophy ß-glucan was studied. A total of 160 healthy 1-d-old mixed-sex ducklings were randomly allocated to 3 groups: Sophy ß-glucan (n = 80), bacitracin zinc (n = 40), and control (n = 40), which received the same antibiotics-deficient diet supplemented with 1% ß-glucan, 5% bacitracin zinc, or nothing, respectively. During 2 mo of the study, growth performance, carcass composition, and meat quality of Peking ducks were evaluated. Additionally, a separate immunological study was conducted with a total of 105 healthy male Peking ducks in 7 groups (n = 15) and immunized with different doses of ß-glucan (0, 0.5, 2.5, 12.5, and 62.5 µg/duck) and BSA (200 µg/duck). Blood was taken for detection of anti-BSA-IgG antibody and peripheral blood mononuclear cells proliferation assays. Groups subjected to different dietary treatments showed almost no differences in growth performance and slaughter traits except breast muscle percentage and intestinal length. These 2 indicators were significantly higher in the bacitracin zinc group than in the control and ß-glucan groups (P < 0.05). Similarly, chemical compositions, fatty acids, and amino acids of breast muscle were not significantly influenced by the diet. Ducks immunized with Sophy ß-glucan did not have enhanced level of anti-BSA-IgG antibodies but had significant peripheral blood mononuclear cells proliferation compared with unchallenged ducks (P < 0.01). With an increase in the glucan concentration, the proliferative responses approximately linearly increased. These findings indicate that 1% Sophy glucan did not improve duck growth performance, carcass composition, and meat quality significantly under the conditions of the present experiment and mainly had regulatory or enhancing properties on poultry nonspecific cellular immunity.

Investigating the fundamental basis for selectors to improve activated sludge settling.

Aerobic, anoxic, and anaerobic selectors have become popular for controlling filamentous bulking in activated sludge systems; however, selectors are not always successful. Regression analyses of data collected from 48 full-scale wastewater treatment plants, with operating selectors, provided a method for ranking the importance of selector operating and design parameters (with respect to their influence on activated sludge settleability) and suggests optimum numerical ranges for these parameters for best selector performance. Selectors do not appear to control filamentous bulking in long mean cell residence time (MCRT) plants. Further, the elimination of all selector zones may help to control bulking in these plants. However, other design/operating parameters were shown to influence activated sludge settleability in long-MCRT plants. Aerobic selectors in short-MCRT plants can control filamentous bulking, if they are small enough to produce a biochemical oxygen demand (BOD) concentration gradient. Anoxic and anaerobic selectors can control filamentous bulking in short-MCRT plants, if the selector volume is large enough and/or the selector mixed-liquor suspended solids concentration is high enough. These unaerated selector systems do not appear to benefit from a BOD concentration gradient as the aerobic selectors in short-MCRT plants do. Although anaerobic/anoxic selector compartmentalization in these plants appears to improve settleability, this presumably is because of reduced selector short-circuiting.

Changing mesophilic wastewater sludge digestion into thermophilic operation at Terminal Island Treatment Plant.

This paper describes the progress up to June 2000 for thermophilic digestion of wastewater sludge at the Los Angeles, California, Bureau of Sanitation's Terminal Island Treatment Plant. The development of the microorganism culture has followed a course similar to that seen at other successful plants for establishment of a stable, well-balanced thermophilic culture in a large digester, but at an accelerated pace. This study began with rapid heating, increasing the temperature of the 4500 m3 (1.2 mil. gal) digester to the target temperature of 55 degrees C at approximately 3 degrees C/d. A method of feeding to maximize the rate of culture development was used as feeding accelerated to approximately 400 m3/d (0.1 mgd). An initial rise of acid concentration (primarily acetate) was seen. Within two weeks, acid concentration declined and stabilized, indicating that acidogenic and methanogenic microbial communities came into balance. Coliform data indicate that digester disinfection was stably effective from the middle of April. The salmonella tests done to date satisfy the U.S. Environmental Protection Agency (U.S. EPA) class A specification. Testing with helminth ova and enteric viruses before and after the digester shows satisfaction of class A standard for those organisms. The present combination of low volatile fatty acids and low hydrogen sulfide is good news for odor control. The data show increases in volatile solids destruction and estimated gas production, compared with the previous mesophilic operation; however, large uncertainties have been calculated from the data. As the digester is now operating successfully at the current feed rate, there seems to be no barriers to processing the entire sludge production of the plant. Other results indicate that the U.S. EPA requirements for exceptional quality class A biosolids are likely to be achieved.