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Venous Cannulation Pain as a Marker of Postoperative Pain Vulnerability: A Pre-Specified Secondary Analysis of a Randomized Controlled Trial
No full textAbstractBackground: Identification of patients at risk and prevention of acute postoperative pain (APOP) are central to individualized anesthesia and analgesia. Venous cannulation pain (VCP) has shown promise as a predictor of APOP. In the PeriOPerative Individualization Trial (POPIT), VCP was evaluated as a pain-sensitivity stratification method to guide anesthesia and reduce postoperative pain. This report presents a predefined secondary analysis with the primary aim to evaluate VCP as a method for postoperative pain prediction. As a secondary aim, we sought to explore factors that influence VCP. Methods: 271 patients were stratified into two cohorts, high-risk (VCP ≥ 2.0) and low-risk (VCP < 2.0), for APOP, based on their VCP. Within each group, patients were randomized to receive either: standard care or opioid-free anesthesia (low-risk cohort), and standard care or multimodal anesthesia with opioids (high-risk cohort). Differences in acute and persistent pain, quality of recovery, postoperative opioid consumption, and proportion of patients experiencing moderate to severe APOP depending on VCP levels were investigated. The predictive capacity of VCP was evaluated and adjusted for in terms of potential confounders. Results: High-risk patients, grading VCP ≥ 2.0 (VAS units) experienced more APOP on the day of surgery (difference 0.9 NRS-units, 95% CI 0.2–1.6, p = 0.009) and after 24 h during movement (difference 0.6 NRS-units, 95% CI 0.0–1.3, p = 0.048). Patients grading VCP < 2.0 had better quality of recovery after 24 hr (difference 7, 95% 1–13, p = 0.002) and lower postoperative opioid consumption (difference 7.5 mg, 95% 5.7–9.3, p < 0.001). The OR for VCP ≥ 2.0 to predict APOP in PACU was 1.76 (95% CI 1.02–3.04, p = 0.043), but in a multivariate model, adjusted for age, VCP ≥ 2, gender, pain catastrophizing, preoperative pain, and pain on the day of surgery, female gender was the only independent predictor of APOP (OR 2.65 (95% CI 1.33–5.29), p = 0.006). Conclusions: Pain during venous cannulation as a predictor of acute pain after surgery was significant in univariate regression, but the results were lost when adjusting for confounders like gender and current pain. However, VCP continues to show potential in associated postoperative recovery outcomes such as opioid consumption. The level of pain associated with venous cannulation is influenced by gender, preoperative pain, and current pain on the day of surgery. Pain sensitivity stratification needs refinement before implementation in clinical practice.Keywords: venous cannulation; postoperative pain; pain prediction; individualization; pain sensitivit
Infectious Complications During Early Treatment of Childhood Acute Lymphoblastic Leukemia—A Comparison Between the ALLTogether and NOPHO ALL-2008 Protocols
No full textIntroduction: Infection remains the most common treatment-related toxicity of childhood ALL, emphasizing the need to identify patients at risk and to tailor treatment strategies accordingly. Aims: The primary aim was to compare infectious toxicity during early treatment for childhood ALL following the ALLTogether and NOPHO ALL-2008 (ALL-2008) protocols, and second, to identify risk factors for infectious toxicity. Methods: A national retrospective matched cohort study was conducted, including 345 patients aged 1–17 years diagnosed with ALL and treated in Sweden according to the ALLTogether or ALL-2008 protocols. Nonparametric tests were used to compare infectious outcomes between protocols, and regression modeling was used to identify risk factors of the infectious outcomes. Results: Treatment following ALL-2008 showed higher infectious toxicity during induction, whereas treatment following ALLTogether showed increased infectious toxicity during consolidation 1. Overall, treatment according to ALL-2008 was associated with a higher incidence of infections. Anthracycline use and young age (1–9 years) were associated with both higher infectious incidence and more severe infectious complications. Dexamethasone was associated with both lower incidence and lower severity of infectious complications as compared to prednisone. Conclusions: A notable shift in the timing of infectious toxicity was observed between the two treatment protocols. Risk factors for infectious toxicity during early treatment include anthracycline use and young age. Dexamethasone as an induction steroid was associated with lower infectious burden, although its effect is difficult to isolate from the simultaneous anthracycline effect. The findings suggest that treatment composition plays a central role in determining both the extent and timing of infectious complications
Octylisothiazolinone—A New Sensitizer in Over-Ear Headphones
No full textBackground: Allergic contact dermatitis (ACD) caused by isothiazolinones is a growing concern, particularly in consumer products. Octylisothiazolinone (OIT) is a potent sensitiser and commonly used as a preservative in rubbers, plastics and coatings, including those found in headphones. Despite increasing regulations on isothiazolinones in cosmetics, their presence in wearable devices remains under-recognised. Aims: This investigation aims to identify OIT as a possible sensitiser in patients with presumed ACD due to over-ear headphones. Methods: Two patients with presumed ACD due to over-ear headphones were patch tested at the Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö. Patch testing included Swedish baseline series, isothiazolinone compounds, and materials from headphones. To identify potential allergens, chemical analysis of components from headphones was conducted using high-performance liquid chromatography (HPLC). Results: Patch testing demonstrated strong positive reactions to OIT in both cases, with additional reactions to acetone extracts of artificial leather and blue plastic foam. OIT remained positive at dilutions as low as 0.00003%. Case 1 also showed positive reactions to MI/MCI. Chemical analysis confirmed OIT in both artificial leather (2.2 mg/g) and plastic foam (0.3 mg/g). Conclusions: These findings contribute to the understanding of ACD by identifying OIT as a potential allergen in over-ear headphones. It calls for further research into the prevalence of OIT in consumer electronics and its role in sensitisation
Dynamic assessment of proliferation to guide response-adapted therapy in the setting of neoadjuvant chemotherapy in ER+/HER2- breast cancer
No full textBiomarkers for evaluating response to neoadjuvant chemotherapy (NACT) in ER+/HER2- breast cancer remain limited. This study explores the impact of NACT on tumor proliferation dynamics and its association with relapse-free interval (RFI) among 175 patients with early ER+/HER2- breast tumors. Proliferation was assessed at baseline, after completing two NACT cycles, and in the residual tumor using Ki67 immunohistochemistry (IHC) and two gene expression assays (GEAs): SSP-Ki67 and AURKA score. Slight to moderate agreement was observed between IHC and GEAs, with IHC-Ki67 consistently classifying more tumors as highly proliferative compared to SSP-Ki67 at both baseline and surgery. Proliferation status at baseline was not prognostic for RFI using either IHC-Ki67 or SSP-Ki67 in our cohort. However, patients with persistently high proliferation after two NACT cycles or in the residual tumor following NACT were at increased risk of relapse, with SSP-Ki67 outperforming IHC-Ki67 in identifying patients with a poorer prognosis. Our results demonstrate that tumor proliferation status measured after brief exposure to NACT or in the residual tumor post-NACT holds prognostic value and may inform the tailoring of post-neoadjuvant treatment strategies in patients with early luminal breast cancer, and that relying on IHC-Ki67 to evaluate treatment response may potentially lead to overtreatment
Sensory pollutants have negative but different effects on nestbox occupancy and breeding performance of a nocturnal raptor across Europe
No full textAnthropogenic noise and artificial light at night (ALAN) are expanding globally, acting as pervasive sensory pollutants that can disrupt wildlife behaviour and reproduction. While most research has focused on diurnal species, the effects of these pollutants on the ecological response of nocturnal predators remain poorly understood. Using data from nine European countries, we investigated the effects of traffic noise, ALAN, and road proximity on nestbox occupancy and reproduction in the Tawny Owl (Strix aluco), a nocturnal raptor widespread across Europe. Traffic noise consistently reduced both nestbox occupancy and reproductive success regardless of road proximity. ALAN also impaired occupancy and reproduction, but its negative effect on reproduction changed based on the proximity to roads. Interestingly, the negative effect of ALAN was stronger in sites further from roads, but it attenuated in their proximity, where owls' hatching success and brood size moderately improved. This finding suggests that near roads, where prey abundance and availability are also generally high, owls may either find the prey regardless of ALAN or they may exploit it to facilitate hunting and brood provisioning. However, vicinity to roads might enhance mortality by vehicle collisions, which represents one of the greatest threats for the conservation of owls. Our findings highlight that anthropogenic noise and the co-occurrence between ALAN and roads can affect settlement decisions and breeding performance in nocturnal raptors, with potential consequences across the food chain. Mitigating anthropogenic noise and promoting nighttime-lighting systems that minimize owls' presence close to roads will represent valuable actions to improve their conservation
A Handwritten Text Recognition Dataset for Ajami Manuscripts in Fulfulde and Hausa
No full textWe present the first ever dataset of manually segmented and transcribed Ajami manuscripts written in Fulfulde and Hausa. The term Ajami refers to modified Arabic-script orthographies in Africa. Existing handwritten text recognition (HTR) and optical character recognition (OCR) models for Arabic-script languages perform poorly on West African manuscripts due to a lack of these manuscripts representation in the models’ pre-training. This leads to models struggling to adapt to Ajami style calligraphy, being unequipped to recognize Ajami specific characters, and being unable to extract certain Arabic-script diacritics which are present in Ajami manuscripts but lacking in many manuscripts for other Arabic-script languages like Arabic and Persian. The latter poses a significant challenge to Ajami HTR. We release the following as an open-source dataset: an ALTO formatting of high-quality images of Fulfulde and Hausa manuscripts, manual segmentation (region and line), and manual transcriptions. Our HTR dataset is also the first to diplomatically transcribe newly Unicode-encoded, special Quranic recitation characters. We evaluate a suite of Arabic-script recognition models specifically for historical manuscripts and find that they produce character error rates of 65–84% when attempting to automatically transcribe our curated manuscripts. Transcriptions produced by the evaluated models are released as well
The additive effect of esketamine and clonidine in patients at high risk for acute postoperative pain undergoing laparoscopic surgery: A randomised controlled trial
No full textObjectiveTo evaluate if adding esketamine and clonidine has positive effects on postoperative pain, postoperative nausea and vomiting, and quality of recovery in patients who are at high risk for postoperative pain.DesignPatient- and assessor-blinded, superiority, randomised controlled trial.SettingSingle centre between 2022 and 2024.Patients125 adult patients, ASA I – II, planned for elective laparoscopic surgery and risk-classified as high risk of pain, based on perceived pain associated with venous cannulation.InterventionPatients were randomised to either an anaesthesia protocol, including an intravenous bolus of esketamine (0.25 mg.kg−1) after induction and clonidine (1 μg.kg−1) during maintenance phase (EC), or standard of care (SOC) no esketamine or clonidine included.MeasurementsPrimary outcome: worst pain intensity in the PACU. Secondary outcomes: worst pain, and proportion having NRS ≥ 4, at 24 h (during rest and movement), worst pain and proportion having NRS ≥ 1, at 3- and 6-months (during rest and movement), postoperative recovery at 24 h, PONV in the PACU and at 24 h. Rescue dose opioids in the PACU was an exploratory outcome.ResultsWorst pain scores in the PACU were 5.7 in the EC group and 5.5 in SOC group (P = 0.78). After 24 h, no difference in postoperative pain (rest; 5.8 vs 6.1, P = 0.35, movement; 6.1 vs 6.2, P = 0.68), postoperative recovery (P = 0.92) or PONV (P = 0.80) was found. Proportion of patients with NRS ≥ 4 in the PACU was 50 % vs 48 % (P = 0.55) and at 24 h 73 % vs 81 % at rest (P = 0.27) and 76 % vs 81 % during movement (P = 0.50). Rescue opioids in the PACU were similar (5.9 mg vs 6.6 mg, P = 0.47). There were no differences in persistent pain at 3 or 6 months at rest (P = 0.72, P = 0.12) or movement (P = 0.48, P = 0.18).ConclusionAdding esketamine and clonidine, as an individualised multimodal anaesthesia strategy, did not influence acute or persistent postoperative pain, early recovery, need of rescue opioids or PONV in patients, who were assessed as high risk for APOP
Poverty in Colonial Africa: An Exploratory Study
No full textRecent studies have challenged earlier narratives of Africa as historically stagnant and impoverished, instead revealing patterns of booms and busts. While this has advanced understanding of long-term growth, significant gaps remain in our knowledge of historical poverty, especially among self-employed rural populations. This chapter uses published social tables to examine rural poverty in six African countries—Botswana, Côte d’Ivoire, Ghana, Kenya, Senegal, and Uganda—between 1920 and 1960. Using the ‘cost of basic needs approach,’ we establish historical absolute national poverty lines and categorize poverty into three levels: absolute, modest, and vulnerable. We then compare subsistence production across rural livelihoods to these benchmarks. This study is the first to use social tables to assess rural poverty across multiple African contexts in the colonial era. Our findings contribute to ongoing debates about poverty persistence and the role of colonial structures in shaping long-term welfare trajectories