Regional anesthesia and acute perioperative pain management in thoracic surgery: a narrative review.

Background and Objective: Thoracic surgery causes significant pain which can negatively affect pulmonary function and increase risk of postoperative complications. Effective analgesia is important to reduce splinting and atelectasis. Systemic opioids and thoracic epidural analgesia (TEA) have been used for decades and are effective at treating acute post-thoracotomy pain, although both have risks and adverse effects. The advancement of thoracoscopic surgery, a focus on multimodal and opioid-sparing analgesics, and the development of ultrasound-guided regional anesthesia techniques have greatly expanded the options for acute pain management after thoracic surgery. Despite the expansion of surgical techniques and analgesic approaches, there is no clear optimal approach to pain management. This review aims to summarize the body of literature regarding systemic and regional anesthetic techniques for thoracic surgery in both thoracotomy and minimally invasive approaches, with a goal of providing a foundation for providers to make individualized decisions for patients depending on surgical approach and patient factors, and to discuss avenues for future research. Methods: We searched PubMed and Google Scholar databases from inception to May 2021 using the terms "thoracic surgery", "thoracic surgery AND pain management", "thoracic surgery AND analgesia", "thoracic surgery AND regional anesthesia", "thoracic surgery AND epidural". We considered articles written in English and available to the reader. Key Content and Findings: There is a wide variety of strategies for treating acute pain after thoracic surgery, including multimodal opioid and non-opioid systemic analgesics, regional anesthesia including TEA and paravertebral blocks (PVB), and a recent expansion in the use of novel fascial plane blocks especially for thoracoscopy. The body of literature on the effectiveness of different approaches for thoracotomy and thoracoscopy is a rapidly expanding field and area of active debate. Conclusions: The optimal analgesic approach for thoracic surgery may depend on patient factors, surgical factors, and institutional factors. Although TEA may provide optimal analgesia after thoracotomy, PVB and emerging fascial plane blocks may offer effective alternatives. A tailored approach using multimodal systemic therapies and regional anesthesia is important, and future studies comparing techniques are necessary to further investigate the optimal approach to improve patient outcomes.

Food Hubs as a Means to Promote Food Security in Post-Secondary Institutions: A Scoping Review.

An estimated 20 to 50% of post-secondary students experience food insecurity. Students who are food insecure are more likely to have poor health and lower academic performance relative to food secure peers. Food hubs are physical or digital spaces that provide access to food initiatives and wraparound programs such as employment placement or income support are increasingly of interest as a means to respond to food insecurity. We conducted a scoping review to identify best practices and effective approaches to food hubs that promote food security in post-secondary institutions in North America. The Medline, Embase, CAB Direct and Web of Science databases were searched. A total of 4637 articles were identified and screened by two reviewers. Four articles were included. They encompassed a mix of interventions: a campus pantry and garden, a food rescue program, food literacy-based curriculum and a toolkit to support implementation of interventions on campus. The heterogeneity of studies precluded identification of best practices, but positive impacts of all interventions were noted on metrics such as self-efficacy and greater awareness of food insecurity. The gap in evidence on effective approaches that promote campus food security is a critical barrier to development and implementation of interventions, and should be addressed in future studies.

Trophallaxis and prophylaxis: social immunity in the carpenter ant Camponotus pennsylvanicus.

In social insects, group behaviour can increase disease resistance among nest-mates and generate social prophylaxis. Stomodeal trophallaxis, or mutual feeding through regurgitation, may boost colony-level immunocompetence. We provide evidence for increased trophallactic behaviour among immunized workers of the carpenter ant Camponotus pennsylvanicus, which, together with increased antimicrobial activity of the regurgitate droplet, help explain the improved survival of droplet recipient ants relative to controls following an immune challenge. We have identified a protein related to cathepsin D, a lysosomal protease, as a potential contributor to the antimicrobial activity. The combined behavioural and immunological responses to infection in these ants probably represent an effective mechanism underlying the social facilitation of disease resistance, which could potentially produce socially mediated colony-wide prophylaxis. The externalization and sharing of an individual's immune responses via trophallaxis could be an important component of social immunity, allowing insect colonies to thrive under high pathogenic pressures.

Can Twitter be used to predict county excessive alcohol consumption rates?

OBJECTIVES: The current study analyzes a large set of Twitter data from 1,384 US counties to determine whether excessive alcohol consumption rates can be predicted by the words being posted from each county. METHODS: Data from over 138 million county-level tweets were analyzed using predictive modeling, differential language analysis, and mediating language analysis. RESULTS: Twitter language data captures cross-sectional patterns of excessive alcohol consumption beyond that of sociodemographic factors (e.g. age, gender, race, income, education), and can be used to accurately predict rates of excessive alcohol consumption. Additionally, mediation analysis found that Twitter topics (e.g. 'ready gettin leave') can explain much of the variance associated between socioeconomics and excessive alcohol consumption. CONCLUSIONS: Twitter data can be used to predict public health concerns such as excessive drinking. Using mediation analysis in conjunction with predictive modeling allows for a high portion of the variance associated with socioeconomic status to be explained.

A phase 1 study of ADI-PEG 20 and modified FOLFOX6 in patients with advanced hepatocellular carcinoma and other gastrointestinal malignancies.

PURPOSE: Arginine depletion interferes with pyrimidine metabolism as well as DNA damage repair pathways. Preclinical data indicates that pairing pegylated arginine deiminase (ADI-PEG 20) with fluoropyrimidines or platinum enhances cytotoxicity in vitro and in vivo in arginine auxotrophs. METHODS: This is a single-center, open-label, phase 1 trial of ADI-PEG 20 and modified FOLFOX6 (mFOLFOX6) in treatment-refractory hepatocellular carcinoma (HCC) and other advanced gastrointestinal tumors. A 3 + 3 dose escalation design was employed to assess safety, tolerability, and determine the recommended phase 2 dose (RP2D) of ADI-PEG 20. A RP2D expansion cohort for patients with HCC was employed to define the objective response rate (ORR). Secondary objectives were to estimate progression-free survival (PFS), overall survival (OS), and to explore pharmacodynamics and immunogenicity. Eligible patients were treated with mFOLFOX6 intravenously biweekly at standard doses and ADI-PEG-20 intramuscularly weekly at 18 (Cohort 1) or 36 mg/m2 (Cohort 2 and RP2D expansion). RESULTS: Twenty-seven patients enrolled-23 with advanced HCC and 4 with other gastrointestinal tumors. No dose-limiting toxicities were observed in cohort 1 or 2. The RP2D for ADI-PEG 20 was 36 mg/m2 weekly with mFOLFOX6. The most common any grade adverse events (AEs) were thrombocytopenia, neutropenia, leukopenia, anemia, and fatigue. Among the 23 HCC patients, the most frequent treatment-related Grade ≥ 3 AEs were neutropenia (47.8%), thrombocytopenia (34.7%), leukopenia (21.7%), anemia (21.7%), and lymphopenia (17.4%). The ORR for this group was 21% (95% CI 7.5-43.7). Median PFS and OS were 7.3 and 14.5 months, respectively. Arginine levels were depleted with therapy despite the emergence of low levels of anti-ADI-PEG 20 antibodies. Arginine depletion at 4 and 8 weeks and archival tumoral argininosuccinate synthetase-1 levels did not correlate with response. CONCLUSIONS: Concurrent mFOLFOX6 plus ADI-PEG-20 intramuscularly at 36 mg/m2 weekly shows an acceptable safety profile and favorable efficacy compared to historic controls. Further evaluation of this combination is warranted in advanced HCC patients.

Molecular antifungal defenses in subterranean termites: RNA interference reveals in vivo roles of termicins and GNBPs against a naturally encountered pathogen.

Subterranean termites face strong pathogenic pressures from the ubiquitous soil fungus Metarhizium anisopliae, and rely on innate humoral and cellular, as well as behavioral immune defenses for protection. Reticulitermes termites secrete antifungal enzymes that exhibit strong ß-1,3-glucanase activity associated with Gram-negative bacteria binding proteins (GNBPs), which prevent M. anisopliae from invading the hemocoel where it can evade immune responses. Molecular evolutionary studies of Reticulitermes termicin genes, which code for defensin-like antifungal peptides, suggest that these proteins may be important effector molecules in antifungal defenses. In this study we show that the RNAi knockdown of termicin and GNBP2 expression via the ingestion of dsRNA significantly increases mortality in termites exposed to a naturally encountered strain of M. anisopliae. Termicin and GNBP2 knockdown also decrease external cuticular antifungal activity, indicating a direct role for these proteins in an external antifungal defense strategy that depends on the active dissemination of antifungal secretions among nestmates.

Subterranean termite prophylactic secretions and external antifungal defenses.

Termites exploit environments that make them susceptible to infection and rapid disease transmission. Gram-negative bacteria binding proteins (GNBPs) signal the presence of microbes and in some insects directly damage fungal pathogens with ß-1,3-glucanase activity. The subterranean termites Reticulitermes flavipes and Reticulitermes virginicus encounter soil entomopathogenic fungi such as Metarhizium anisopliae, which can evade host immune responses after penetrating the cuticle. An external defense that prevents invasion of fungal pathogens could be crucial in termites, allowing them to thrive under high pathogenic pressures. We investigated the role of secreted ß-1,3-glucanases in Reticulitermes defenses against M. anisopliae. Our results show that these termites secrete antifungal ß-1,3-glucanases on the cuticle, and the specific inhibition of GNBP associated ß-1,3-glucanase activity with d-δ-gluconolactone (GDL) reduces this activity and can cause significant increases in mortality after exposure to M. anisopliae. Secreted ß-1,3-glucanases appear to be essential in preventing infection by breaking down fungi externally.