Abstract Background: Several studies have found that ultrasound-guided transversus abdominis plane (TAP) block is useful for pain management with bariatric surgery. In this study, we have examined perioperative pain management and opioid needs of totally robotic (TR) Roux-en-Y gastric bypass and sleeve gastrectomy patients who had or did not have a TAP block as part of their enhanced recovery after bariatric surgery protocol and multimodal analgesia (MMA) regimen. Materials and Methods: The study was a retrospective analysis of 149 primary totally robotic bariatric surgeries performed with ( n = 75) or without ( n = 74) TAP block between April 2022 and December 2022. Measures included: (1) patient characteristics, (2) surgical outcomes, and (3) early and late postoperative (PO) pain intensity and cumulative opioid needs. Pain scores and opioid usage were assessed in the post-anesthesia care unit (PACU) and the first 24 h of the hospital stay. Results: Patient characteristics, operative time, time in PACU, and length of stay did not significantly differ between patients who had a TAP block and those who did not. Pain scores (early or late) did not differ significantly with or without TAP block, nor did 24-h opioid consumption (6.24 and 6.23 morphine milliequivalents) or the number of patients requiring opioids for pain management (37% vs. 42%, respectively). Surgery expenses were significantly higher with TAP block due to the added costs of the procedure ($713.31). Conclusion: TAP block had no additive benefit to our MMA regimen in reducing PO pain and opioid usage.

Three classes of semi-fluorinated aromatic ether polymers, namely: perfluorocyclobutyl (PFCB), perfluorocycloalkenes (PFCA), and fluorinated arylene vinylene ether (FAVE), which are mostly amorphous have been reported via step-growth polymerization of fluoroalkenes. Unlike traditional fluoropolymers which have higher degree of crystallinity and are plagued by lack of solubility in common organic solvents, these uncured semi-fluorinated polymers are readily soluble in most organic solvents resulting in improved processability. In addition, all three semi-fluorinated polymers are versatile and can be custom-designed and fabricated into linear, telechelic, alternating and segmented-block, and network polymers, facilitating applications in optics, optoelectronic, photonics, proton exchange membranes, sensors, and fuel cells. Major aim of this timely review is to provide account of synthetic opportunities these semi-fluorinated offer in various applications.

Correction for 'Visible-light unmasking of heterocyclic quinone methide radicals from alkoxyamines' by Patrick Kielty et al., Chem. Commun., 2019, 55, 14665-14668, DOI: 10.1039/C9CC08261A.

Target concentration is typically not considered in drug discovery. However, if targets are expressed at relatively high concentrations and compounds have high affinity, such that most of the drug is bound to its target, in vitro screens can give unreliable information on compound affinity. In vivo, a similar situation will generate pharmacokinetic (PK) profiles that deviate greatly from those normally expected, owing to target binding affecting drug distribution and clearance. Such target-mediated drug disposition (TMDD) effects on small molecules have received little attention and might only become apparent during clinical trials, with the potential for data misinterpretation. TMDD also confounds human microdosing approaches by providing therapeutically unrepresentative PK profiles. Being aware of these phenomena will improve the likelihood of successful drug discovery and development.

ObjectivesColorectal polyp cancers present clinicians with a treatment dilemma. Decisions regarding whether to offer segmental resection or endoscopic surveillance are often taken without reference to good quality evidence. The aim of this study was to develop a treatment algorithm for patients with screen-detected polyp cancers.DesignThis national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between 2000 and 2012. Multivariate regression analysis was used to assess the impact of clinical, endoscopic and pathological variables on the rate of adverse events (residual tumour in patients undergoing segmental resection or cancer-related death or disease recurrence in any patient). These data were used to develop a clinically relevant treatment algorithm.Results485 patients with polyp cancers were included. 186/485 (38%) underwent segmental resection and residual tumour was identified in 41/186 (22%). The only factor associated with an increased risk of residual tumour in the bowel wall was incomplete excision of the original polyp (OR 5.61, p=0.001), while only lymphovascular invasion was associated with an increased risk of lymph node metastases (OR 5.95, p=0.002). When patients undergoing segmental resection or endoscopic surveillance were considered together, the risk of adverse events was significantly higher in patients with incomplete excision (OR 10.23, p<0.001) or lymphovascular invasion (OR 2.65, p=0.023).ConclusionA policy of surveillance is adequate for the majority of patients with screen-detected colorectal polyp cancers. Consideration of segmental resection should be reserved for those with incomplete excision or evidence of lymphovascular invasion.

Objectives: This study compared the short term (24 month) clinical outcomes in a prospective, comparative case series of participant selected hamstring autograft and synthetic (LARS) ACL reconstructions. Methods: 64 ACL reconstructed participants (32 hamstring,32 LARS), completed a “goal-oriented” rehabilitation protocol. They were assessed for joint laxity (KT1000), clinical outcome (IKDC Knee Examination) and activity (Tegner Activity Scale-TAS) pre-operatively and at 12,16,20 and 24 weeks, and at 12 and 24 months post-operatively. Results: KT 1000 results did not differ significantly between the 2 treatment groups at 24 months. Differences were noted in joint laxity measurements between the 2 groups at varying time points. The LARS group had immediate stability of the joint at 12 weeks followed by a gradual increase in laxity over the follow-up period, while the hamstring group showed an increase in laxity up to 16-20 weeks, followed by a gradual decrease over the follow-up period. The LARS group had significantly higher TAS scores in the early post-operative period, but there was no significant difference between the 2 groups at 12 months and beyond. At 24 months, 32 of the hamstring group and 30 of the LARS group achieved IKDC Scores “A” or “B”. There were 5 reported graft failures (15.6%) in the LARS group between 7 and 22 months post-op, and none in the hamstring group. Conclusion: ACL reconstruction using synthetic (LARS) grafts produced earlier return of some activities compared to autograft reconstructions, but this difference was no longer evident by 12 months post-op. When the substantially differing failure rates are taken into consideration, this early benefit does not appear to justify their use in place of autografts for ACL reconstruction.