Feasibility of a tapering opioids prescription program for trauma patients at high risk of chronic consumption (TOPP-trauma): protocol for a pilot randomized controlled trial.

BACKGROUND: Opioid use disorder (OUD) and deaths related to the chronic use of opioids have increased significantly over the last two decades. Chronic consumption of opioids has been documented in many patients with traumatic injuries. Preliminary research findings have shown that interventions using cognitive-behavioral strategies were a promising adjunct in decreasing the burden associated with opioid consumption. Accordingly, the Tapering Opioids Prescription Program in Trauma (TOPP-Trauma) was developed. PURPOSE: To assess the feasibility of the TOPP-Trauma intervention and its research methods; and explore the potential efficacy of TOPP-Trauma in reducing opioid consumption. METHODS: A 2-arm pilot randomized controlled trial (RCT) will be conducted in patients presenting a high risk for chronic opioid consumption. Fifty participants at high risk for chronic consumption of opioid will receive either TOPP-Trauma or an educational pamphlet. The feasibility assessment of TOPP-Trauma will be based on the ability to provide its components as initially planned. Several parameters will be evaluated to determine the feasibility of the research methods, including the adequacy of the sampling pool, the dropout rate, and the ease of data collection. The morphine equivalent dose (MED) per day between both groups will be measured at 6 and 12 weeks. Pain intensity and pain interference with activities will also be evaluated at the same time points. DISCUSSION: This study will provide evidence on the feasibility of a preventive program aimed at reducing chronic opioid use in high risk trauma patients. Information will also be gathered on the methods that should be used to test the efficacy of such programs. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 40263056. Registered 26 May 2018.

Peroxisome proliferator-activated receptor γ activation favours selective subcutaneous lipid deposition by coordinately regulating lipoprotein lipase modulators, fatty acid transporters and lipogenic enzymes.

AIM: Peroxisome proliferator-activated receptor (PPAR) γ activation is associated with preferential lipoprotein lipase (LPL)-mediated fatty acid storage in peripheral subcutaneous fat depots. How PPARγ agonism acts upon the multi-level modulation of depot-specific lipid storage remains incompletely understood. METHODS: We evaluated herein triglyceride-derived lipid incorporation into adipose tissue depots, LPL mass and activity, mRNA levels and content of proteins involved in the modulation of LPL activity and fatty acid transport, and the expression/activity of enzymes defining adipose tissue lipogenic potential in rats treated with the PPARγ ligand rosiglitazone (30 mg kg(-1)  day(-1) , 23 days) after either a 10-h fasting period or a 17-h fast followed by 6 h of ad libitum refeeding. RESULTS: Rosiglitazone stimulated lipid accretion in subcutaneous fat (SF) ~twofold and significantly reduced that of visceral fat (VF) to nearly half. PPARγ activation selectively increased LPL mass, activity and the expression of its chaperone LMF1 in SF. In VF, rosiglitazone had no effect on LPL activity and downregulated the mRNA levels of the transendothelial transporter GPIHBP1. Overexpression of lipid uptake and fatty acid transport proteins (FAT/CD36, FATP1 and FABP4) and stimulation of lipogenic enzyme activities (GPAT, AGPAT and DGAT) upon rosiglitazone treatment were of higher magnitude in SF. CONCLUSIONS: Together these findings demonstrate that the depot-specific transcriptional control of LPL induced by PPARγ activation extends to its key interacting proteins and post-translational modulators to favour subcutaneous lipid storage.

Solvent removal of beryllium from surfaces of equipment made of beryllium copper.

Exposure to beryllium compounds, both by inhalation and skin contact, may result in immune sensitization and chronic beryllium disease. The objective of the present research work was to study the feasibility of removing beryllium compounds from the surfaces of devices made of Be-Cu alloy and to estimate the frequency at which the surfaces had to be rubbed in order to evaluate the likelihood that beryllium can be removed from the surfaces by serial wipe sampling at concentrations exceeding the US Department of Energy (DOE) standard limit of 0.2 microg per 100 cm2. The standard limit was exceeded after successive cleanings of moulds and plates made of Be-Cu alloy with solvents such Citranox, an acidic solvent, Alconox, Z-99 and Fantastik, basic solvents, or more neutral solvents such as Luminox and water. Citranox was the best solvent for extracting beryllium from the tested surfaces, while Alconox seemed to be the second best one. In general, warm water, Luminox and Z-99 seemed to be less efficient for extracting Be from all equipment. The results of the present study suggest that Ghost Wipes, when passed across a surface under the firm pressure of an individual's hand, can be used to detect beryllium contamination. However, they seem to show low reliability for quantification. From a safety standpoint in occupational settings, workers should be offered skin protection and respiratory protection if they have to handle devices made of Be-Cu alloy.