Predicting postoperative opioid use with machine learning and insurance claims in opioid-naïve patients.

BACKGROUND: The clinical impact of postoperative opioid use requires accurate prediction strategies to identify at-risk patients. We utilize preoperative claims data to predict postoperative opioid refill and new persistent use in opioid-naïve patients. METHODS: A retrospective study was conducted on 112,898 opioid-naïve adult postoperative patients from Optum's de-identified Clinformatics® Data Mart database. Potential predictors included sociodemographic data, comorbidities, and prescriptions within one year prior to surgery. RESULTS: Compared to linear models, non-linear models led to modest improvements in predicting refills - area under the receiver operating characteristics curve (AUROC) 0.68 vs. 0.67 (p < 0.05) - and performed identically in predicting new persistent use - AUROC = 0.66. Undergoing major surgery, opioid prescriptions within 30 days prior to surgery, and abdominal pain were useful in predicting refills; back/joint/head pain were the most important features in predicting new persistent use. CONCLUSIONS: Preoperative patient attributes from insurance claims could potentially be useful in guiding prescription practices for opioid-naïve patients.

Characterization of quinoa (Chenopodium quinoa) fermented by Rhizopus oligosporus and its bioactive properties.

Quinoa is a pseudocereal that contains high quality protein, minerals, vitamins, polyphenols, and phytosterols. In this study, quinoa was fermented by Rhizopus oligosporus (R. oligosporus) up to 5 days and the functional compounds (L-carnitine, GABA, vanillic acid and gallic acid) were analyzed by LC/MS. The amounts of L-carnitine and GABA were 0.13 mg/kg and 540 mg/kg for nonfermented quinoa (NF), 3.15 mg/kg and 1040 mg/kg for fermented quinoa at 3 days (3F), and 1.54 mg/kg and 810 mg/kg for fermented quinoa at 5 days (5F). The vanillic acid and gallic acid were 1.3 and 0.1 mg/kg for NF, 1.55 and 2.37 mg/kg for 3F, and 1.83 and 0.84 mg/kg for 5F, respectively. Total phenolic contents and total flavonoids contents were 41 mg gallic acid (GAE)/kg and 13 mg quercetin equivalent (QE)/kg for NF, 74 mg GAE/kg and 16 mg QE/kg for 3F, and 80 mg GAE/kg and 19 mg QE/kg for 5F, respectively. Antioxidant activity (SC50) was 3.6 mg/mL for NF, 3.4 mg/mL for 3F, and 2.3 mg/mL for 5F. Nitric oxide production on RAW264.7 macrophages of fermented quinoa revealed 29% and 56% inhibition of nitric oxide production for NF and 5F, respectively. Therefore, fermented quinoa can be used as a healthy and valuable food product.

The use of fermented buckwheat to produce L-carnitine enriched oyster mushroom.

L-Carnitine is an essential compound that shuttles long chain fatty acids into mitochondria. The objective of this study was to produce L-carnitine enriched oyster mushroom (Pleurotus ostreatus) using common buckwheat fermented by Rhizopus oligosporus. Mushroom grown on common buckwheat medium contained 9.9-23.9% higher L-carnitine (186.3 mg/kg) than those grown on basal medium without any buckwheat addition. Those grown on fermented common buckwheat medium contained the highest L-carnitine content (201.2 mg/kg). Size index and lightness of mushroom pileus (L*) were also the highest (100.7 and 50.6, respectively) for those grown in medium added with fermented common buckwheat (20%, w/w). Antioxidant activities of both mushroom extracts (1.5 mg/mL) showed the same level as 38.7% for mushroom grown in media added with common buckwheat or fermented common buckwheat. At the treatment concentration of 300 µg/mL, viabilities of murine macrophage cell line Raw 264.7 cells treated with ethanol extract of oyster mushroom grown on buckwheat medium ranged from 58.9 to 67.8%. The oyster mushroom grown on buckwheat and fermented buckwheat medium can be used as one of the substitutes for meat based diets.

Synthesis and characterization of novel astragalin galactosides using ß-galactosidase from Bacillus circulans.

Astragalin (kaempferol-3-O-ß-d-glucopyranoside, Ast) is a kind of flavonoid known to have anti-oxidant, anti-HIV, anti-allergic, and anti-inflammatory effects. It has low solubility in water. In this study, novel astragalin galactosides (Ast-Gals) were synthesized using ß-galactosidase from Bacillus circulans and reaction conditions were optimized to increase the conversion yield of astragallin. Purified Ast-Gal1 (11.6% of Ast used, w/w) and Ast-Gal2 (6.7% of Ast used, w/w) were obtained by medium pressure chromatography (MPLC) with silica C18 column and open column packed with Sephadex LH-20. The structures of Ast-Gal1 and Ast-Gal2 were identified by nuclear magnetic resonance (NMR) to be kaempferol-3-O-ß-d-glucopyranosyl-(1→6)-ß-d-galactopyranoside and kaempferol-3-O-ß-d-glucopyranosyl-(1→6)-ß-d-galactopyranosyl-(1→4)-ß-d-galactopyranoside, respectively. The water solubility of Ast, Ast-Gal1, and Ast-Gal2 were 28.2±1.2mg/L, 38,300±3.5mg/L, and 38,800±2.8mg/L, respectively. The SC50 value (the concentration required to scavenge 50% of the ABTS+) of Ast, Ast-Gal1, and Ast-Gal2 were 5.1±1.6µM, 6.5±0.4µM, and 4.9±1.1µM, respectively. The IC50 values (the half maximal inhibitory concentration) of Ast, Ast-Gal1, and Ast-Gal2 against angiotensin converting enzyme (ACE) were 171.0±1.2µM, 186.0µM, and 139.0±0.2µM, respectively.