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Purpose of Review Postoperative pain results in multiple undesirable physiologic and psychological outcomes, and it should be managed in a multimodal approach. This article reviews the latest scientific literature of NSAIDs in the treatment of postoperative pain. The goal is to answer the following questions: (1) Are NSAIDs effective in the postoperative period? (2) Are NSAIDs safe in all surgical patients? and (3) Are adverse effects of NSAIDs increased or diminished in the acute postoperative period? Recent Findings NSAIDs are safe and effective in the treatment of postoperative pain, and they should be administered to all postoperative surgical patients unless contraindicated. Summary Based on literature, NSAIDs have been shown to increase patient satisfaction and decrease opioid requirements, minimizing opiate-induced adverse events. They have no increased incidence of adverse effects during the acute postoperative period. NSAIDs and COX-2 inhibitors, however, should be used with caution in colorectal surgery as they are proven to increase the risk of anastomotic leak.

In an effort to combine the anti‐proliferative effect of CUR‐BF2 and CUR compounds with anti‐inflammatory benefits of non‐steroidal anti‐inflammatory drugs (NSAIDs), a library of the bis‐ and mono‐NSAID/CUR‐BF2 and NSAID/CUR conjugates were synthesized by coupling flufenamic acid, flurbiprofen, naproxen, indomethacin, and ibuprofen to diversely substituted hydroxy‐benzaldehydes via an ester linkage, and by subsequent reaction with acetylacetone‐BF2 to form the bis‐ and the mono‐NSAID/CUR‐BF2 adducts. Since conversion to NSAID/CUR by the previously developed decomplexation protocol showed limited success, a set of NSAID/CUR conjugates were independently prepared by directly coupling the NSAIDs with parent curcumin. The bis‐NSAID/CUR‐BF2 and bis‐NSAID‐CUR hybrids exhibited low cytotoxicity in NCI‐60 assay, and in independent cell viability assay on colorectal cancer (CRC) cells (HCT116, HT29, DLD‐1, RKO, SW837, CaCo2) and in normal CR cells (CCD841CoN). By contrast, the mono‐naproxin and mono‐flurbiprofen CUR‐BF2 adducts exhibited remarkable anti‐proliferative and apoptopic activity in NCI‐60 assay most notably against HCT‐116 (colon), OVCAR‐3 (ovarian), and ACHN (renal) cells. Computational molecular docking calculations showed favorable binding energies to HER2, VEGFR2, BRAF, and Bcl‐2 as well as to COX‐1 and COX‐2, which in several cases exceeded known inhibitors. The main interactions between the ligands and the proteins were hydrophobic, although several hydrogen bonds were also observed. A sub‐set of six compounds that had exhibited little or no cytotoxicity were tested for their anti‐inflammatory response with THP‐1 human macrophages in comparison to parent NSAIDs or parent curcumin. Curcumin conjugates of non‐steroidal anti‐inflammatory drugs (NSAID) were synthesized and characterized. Whereas the bis‐NSAID conjugates exhibited low anti‐proliferative activity, the mono‐NSAID/CUR‐BF2 compounds showed remarkable cytotoxicity/apoptotic activity. Various hybrid compounds exhibited favorable binding energies to HER2, VEGFR2, BRAF, Bcl‐2, COX‐1, and to COX‐2. A subset of the bis‐flufenamic acid/CUR conjugates exhibited better anti‐inflammatory response relative to parent NSAIDs with THP‐1 human macrophages.

IntroductionIn recent years, more and more attention has been paid to the risks of using SSRIs. This group of antidepressants may be associated with an increased risk of gastrointestinal bleeding. This risk would be even further increased with concomitant use of NSAIDs. A number of studies have described this interaction, however they reported conflicting results.ObjectivesOur objective was to investigate the risk of gastrointestinal bleeding with SSRIs, with or without NSAID use.MethodsWe performed a literature search, using Pubmed, EMBASE, and Cochrane library, in order to investigate controlled trials, cohort, case-control and cross-sectional studies that reported the incidence of gastrointestinal bleeding s on SSRIs with or without concurrent NSAID use, compared to placebo or no treatment.Results15 case-control studies and 4 cohort studies were included in the analysis. There was an increased risk of gastrointestinal bleeding with SSRIs in the cohort studies and case-control studies. The risk of gastrointestinal bleeding was even further increased with the combined use of both SSRIs and NSAIDs.ConclusionsSSRIs are associated with a modest increase of gastrointestinal bleeding. However, this risk is significantly increased when SSRIs are used in combination with NSAIDs. Psychiatrists should be aware of the hazards in prescribing these medications together.DisclosureNo significant relationships.

Gastric ulcers are commonly caused by improper use of aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), or Helicobacter pylori infection. Anisomeles indica (L.) Kuntze, a traditional herbal medicine enriched with ovatodiolide, possesses potent anti-bacterial and anti-inflammatory properties and has demonstrated efficacy in improving gastric ulcers in animal models. However, its impact on the gut microbial ecosystem remains unclear. This study aimed to evaluate the therapeutic effects of A. indica fractions enriched with ovatodiolide on aspirin-induced gastric ulcers and to investigate their influence on gut microbiota composition. Aspirin-induced gastric ulcers were established in mice, followed by treatment with various A. indica fractions. The severity of gastric ulceration was assessed using histopathological analysis. Additionally, 16S rRNA V3-V4 sequencing and 16S amplicon library construction were performed to characterize gut microbiota composition. Our results showed that mice treated with ovatodiolide-enriched A. indica fractions exhibited significant amelioration of gastric ulcers compared to untreated controls. The treatment also enhanced the relative abundance of beneficial gut microbiota, including Lactobacillus and Adlercreutzia. Furthermore, histopathological examination revealed that A. indica treatment significantly upregulated mucin expression in ulcerated gastric tissues, suggesting a protective role in gastric mucosal integrity. This study provides insights into the mechanisms by which A. indica alleviates gastric ulcers, highlighting its ability to modulate gut microbiota and enhance mucosal protection.

Background The objectives of this study were to evaluate NSAID use over time in patients with axial spondyloarthritis (axSpA) receiving biologic therapy, to determine the prevalence of axSpA remission without NSAIDs, and to identify factors associated with continued NSAID use after one year of follow-up. Methods This is a prospective longitudinal study included 85 patients with axSpA who were diagnosed according to the ASAS criteria and treated with biologics. Assessments were performed at baseline and at 3,6, and 12 months, and disease activity was evaluated with the ASDAS-CRP, BASDAI, and CRP. Data on NSAID use and type were collected, and the ASAS-NSAID index was calculated. This prospective longitudinal study included 85 patients with axSpA, diagnosed according to the ASAS criteria and treated with targeted therapies, regardless of the duration of prior exposure. All patients received targeted therapies. Assessments were conducted at baseline and at 3, 6, and 12 months. Disease activity was evaluated using the ASDAS-CRP, BASDAI, and CRP. Data on NSAID use, type, and dosage were collected, and the ASAS-NSAID index was calculated. At baseline, patients were categorized into two groups according to their NSAID use status, and baseline characteristics were compared accordingly. Results The mean age was 37.46 ± 11 years, with a male predominance (69.4%). Axial radiographic involvement was present in 87.1% of patients. The mean disease duration was 12 years [9–19.25], with a median time from diagnosis to biologic initiation of 3 years [1–8.5]. Thirty-four patients (40%) were in remission. At baseline, 42.3% of the participants used NSAIDs, which significantly declined to 11.5% at M12 ( p  < 0.001). At M12, 36.1% of patients achieved remission, all without NSAIDs. The ASAS-NSAID score significantly decreased over time. Persistent NSAID use at M12 was due primarily to mechanical pain (57.1%) rather than to inflammatory activity (42.9%). Multivariate analysis revealed that mechanical pain was the main factor associated with continued NSAID use. Conclusion Biologic therapy significantly reduces NSAID use and ASAS-NSAID scores in axSpA patients, highlighting the NSAID-sparing effect of bDMARDs. Additionally, NSAID use is not always linked to SpA activity but may be driven by mechanical pain. Clinical trial number Not applicable. Highlights There was a significant reduction in NSAID use among SpA patients recieving biologic therapy: 42.35% at baseline and 11.5% at M12 ( p  < 0.001). A significant decrease in the ASAS-NSAID score ( p  < 0.001) was observed. Mechanical pain was linked to continued NSAID use, regardless of disease activity. At M12, 36.1% of patients were in remission, all of whom were NSAID-free.

Chiral separation, the process of isolating enantiomers from a racemic mixture, holds paramount importance in diverse scientific disciplines. Using chiral separation methods like chromatography and electrophoresis, enantiomers can be isolated and characterized. This study emphasizes the significance of chiral separation in drug development, quality control, environmental analysis, and chemical synthesis, facilitating improved therapeutic outcomes, regulatory compliance, and enhanced industrial processes. Capillary electrophoresis (CE) has emerged as a powerful technique for the analysis of chiral drugs. This review also highlights the significance of CE in chiral drug analysis, emphasizing its high separation efficiency, rapid analysis times, and compatibility with other detection techniques. High-performance liquid chromatography (HPLC) has become a vital technique for chiral drugs analysis. Through the utilization of a chiral stationary phase, HPLC separates enantiomers based on their differential interactions, allowing for the quantification of individual enantiomeric concentrations. This study also emphasizes the significance of HPLC in chiral drug analysis, highlighting its excellent resolution, sensitivity, and applicability. The resolution and enantiomeric analysis of nonsteroidal anti-inflammatory drugs (NSAIDs) hold great importance due to their chiral nature and potential variations in pharmacological effects. Several studies have emphasized the significance of resolving and analyzing the enantiomers of NSAIDs. Enantiomeric analysis provides critical insights into the pharmacokinetics, pharmacodynamics, and potential interactions of NSAIDs, aiding in drug design, optimization, and personalized medicine for improved therapeutic outcomes and patient safety. Microfluidics systems have revolutionized chiral separation, offering miniaturization, precise fluid control, and high throughput. Integration of microscale channels and techniques provides a promising platform for on-chip chiral analysis in pharmaceuticals and analytical chemistry. Their applications in techniques such as high-performance liquid chromatography (HPLC) and capillary electrochromatography (CEC) offer improved resolution and faster analysis times, making them valuable tools for enantiomeric analysis in pharmaceutical, environmental, and biomedical research.

Indomethacin, a widely used NSAID, induces gastric injury via prostaglandin depletion, oxidative stress, and immune imbalance. This study evaluated the gastroprotective effects of Argyreia acuta leaf ethanol extract (EEAAL) in a murine model of indomethacin-induced gastritis. Mice were treated with EEAAL (100-300 mg/kg) or omeprazole following indomethacin administration (50 mg/kg). EEAAL significantly restored gastric pH, reduced acidity and stomach weight, and attenuated oxidative damage by lowering MDA, H2O2, and MPO levels while enhancing GSH, GPx, and GR activity. Immunological markers including WBC count, NBT reduction, phagocytic activity, and immunoglobulin levels, were also normalized. Notably, a satellite group maintained these improvements post-treatment, indicating prolonged efficacy. These findings demonstrate that EEAAL protects against NSAID-induced gastric injury through antioxidant and immunomodulatory mechanisms, supporting its potential as a plant-based therapeutic for gastric disorders.

To update and integrate the recommendations for ankylosing spondylitis and the recommendations for the use of tumour necrosis factor inhibitors (TNFi) in axial spondyloarthritis (axSpA) into one set applicable to the full spectrum of patients with axSpA. Following the latest version of the European League Against Rheumatism (EULAR) Standardised Operating Procedures, two systematic literature reviews first collected the evidence regarding all treatment options (pharmacological and non-pharmacological) that were published since 2009. After a discussion of the results in the steering group and presentation to the task force, overarching principles and recommendations were formulated, and consensus was obtained by informal voting. A total of 5 overarching principles and 13 recommendations were agreed on. The first three recommendations deal with personalised medicine including treatment target and monitoring. Recommendation 4 covers non-pharmacological management. Recommendation 5 describes the central role of non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice drug treatment. Recommendations 6–8 define the rather modest role of analgesics, and disprove glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for axSpA patents with predominant axial involvement. Recommendation 9 refers to biological DMARDs (bDMARDs) including TNFi and IL-17 inhibitors (IL-17i) for patients with high disease activity despite the use (or intolerance/contraindication) of at least two NSAIDs. In addition, they should either have an elevated C reactive protein and/or definite inflammation on MRI and/or radiographic evidence of sacroiliitis. Current practice is to start with a TNFi. Switching to another TNFi or an IL-17i is recommended in case TNFi fails (recommendation 10). Tapering, but not stopping a bDMARD, can be considered in patients in sustained remission (recommendation 11). The final two recommendations (12, 13) deal with surgery and spinal fractures. The 2016 Assessment of SpondyloArthritis international Society-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.

BACKGROUND: How to minimize postoperative pain following spinal surgery has been a great challenge. We hypothesized that topical nonsteroidal anti-inflammatory drugs (NSAIDs) around the incision could relieve postoperative pain following transforaminal lumbar interbody fusion (TLIF) surgery. OBJECTIVE: This study tested the effect of topical NSAIDs around the incision for pain management after TLIF surgery. STUDY DESIGN: A double-blind randomized controlled trial. SETTING: Qilu Hospital of Shandong University. METHODS: Eighty patients who underwent single-level TLIF surgery were randomized into 2 groups. The treatment group received postoperative topical NSAIDs around the incision. The control group received a postoperative topical placebo around the incision. All patients in both groups received postoperative patient-controlled analgesia (PCA) via an analgesia pump. The primary outcome measures were the amount of opioid consumption and pain measurement via the visual analog scale (VAS). The secondary outcome measures were the time of first analgesic demand, operation time, postoperative drain output, side effects of opioids, postoperative stay, and Oswestry Disability Index (ODI) score. RESULTS: The consumption of opioids in the treatment group was significantly less than in the control group at postoperative 12 hours, 12 to 24 hours, and 24 to 48 hours (P < 0.005). The VAS in the treatment group was significantly lower than those in the control group at all assessment times within 72 hours postoperative (P < 0.005). The time of first analgesic demand of PCA in the treatment group was significantly longer than that in the control group (P < 0.005). The side effects of opioids were significantly less in the treatment group than in the control group (P < 0.05). There was no significant difference in operation time, postoperative drain output, postoperative stay, and ODI between the 2 groups (P > 0.05). LIMITATIONS: This was a single-center study for single-level TLIF surgery. CONCLUSION: Postoperative topical NSAID around the incision is a highly effective and safe method for postoperative pain management following single-level TLIF surgery. In our study it reduced postoperative opioid requirements and prolonged the time of first analgesic demand with no increased side effects. KEY WORDS: Transforaminal lumbar interbody fusion, postoperative pain, NSAID, topical NSAID, nonsteroidal anti-inflammatory drug, loxoprofen