BackgroundIndividualized opioid titration is recommended for symptom management in patients with advanced cancer, but prospective data from home hospice care remain limited. We evaluated individualized opioid titration in terminally ill cancer patients receiving physician-led home hospice care.MethodsThis prospective observational study included 501 consecutive terminally ill cancer patients who died under the care of a home hospice clinic between January 2020 and December 2025. Opioids were prescribed for cancer-related pain and other opioid-responsive symptoms. When oral administration became difficult, continuous subcutaneous infusion with patient-controlled analgesia (PCA) was used. Final opioid type, route of administration, oral morphine equivalent daily dose (MEDD), and ketamine use were analyzed.ResultsOpioids were administered to 490 patients (97.8%). Continuous subcutaneous infusion was the final route in 437 patients (89.2%). Morphine was the most frequently prescribed opioid (70.4%), followed by hydromorphone (22.2%) and oxycodone (7.1%). Final MEDDs ranged from 10 to 6000 mg/day, demonstrating substantial interindividual variability. Patients aged ≤64 years required significantly higher MEDDs than those aged ≥65 years (P < 0.001), whereas opioid requirements did not differ significantly according to primary cancer site (P = 0.103). Ketamine was required in only 11 patients (2.2%).ConclusionsTerminally ill cancer patients receiving home hospice care showed marked interindividual variability in opioid requirements. These findings support repeated bedside assessment and individualized opioid titration rather than predetermined dose limits or primary cancer site as the cornerstone of patient-centered symptom management.

Urinary retention is a known adverse effect of opioids, but limited information is available on how this adverse event varies among individual opioids. This study evaluated disproportionality signals between major opioids and urinary retention using the Japanese Adverse Drug Event Report database (JADER). We performed a disproportionality analysis of reports submitted between April 2004 and October 2025. Signals were assessed using reporting odds ratios (RORs), 95% confidence intervals (CIs), and the Information Component (IC). Adverse events were identified using the Medical Dictionary for Regulatory Activities/Japanese version (MedDRA/J) term "urinary retention." A sensitivity analysis was conducted using a broader definition of urinary dysfunction that also included "Dysuria." Time to onset was calculated from the start of opioid administration to event onset, and daily doses were converted to oral morphine equivalents. Significant signals were detected for morphine, oxycodone, tramadol, and codeine. Transdermal fentanyl was the only opioid without a detectable signal, even under the broader definition of urinary dysfunction. Among opioids with detected signals and available dose information, urinary retention was reported even at relatively low morphine-equivalent doses, suggesting the need for careful monitoring at the start of opioid therapy. The absence of a signal for transdermal fentanyl may reflect a lower reporting frequency in JADER, but not a lower clinical risk, of urinary retention. Given the limitations of spontaneous reporting systems, these findings are hypothesis-generating and are insufficient to guide opioid selection or switching.

Introduction Manipulation under anesthesia (MUA) is a non-invasive intervention commonly performed after total knee arthroplasty (TKA) for persistent knee stiffness unresponsive to conservative measures. Adjunctive strategies, including periarticular injections and regional anesthesia, have been proposed to improve pain control and outcomes following MUA. This study evaluated whether adductor canal block (ACB) at the time of MUA reduces postoperative opioid use and improves range of motion (ROM). Methods We performed a retrospective review of 83 consecutive patients undergoing MUA after TKA between October 2021 and April 2024 at a single institution. All patients after June 28, 2023 were offered ACB per an initiative set by the institution's Department of Anesthesia. Patients receiving ACB after the initiative were compared to controls prior to the initiative. Five patients were excluded (four lost to follow-up, one due to concomitant open lysis of adhesion), leaving 78 patients: 39 received ACB and 39 served as controls. Demographic variables collected included age, sex, and relevant medical comorbidities. Clinical variables comprised of time to manipulation, pre- and post-manipulation range of motion (ROM), and postoperative opioid prescription data. Results Mean time to MUA was 76.6 days after TKA; controls underwent earlier manipulation (64.2 vs 88.9 days). Pre-manipulation ROM ranged from 4.3°-84.1° in controls and 2.8°-85.5° in the ACB group. At two weeks, ROM improved to 2.5°-102.7° and 1.2°-101.8°, respectively (p=0.821). Eighteen patients (23.1%) received opioid prescriptions within 30 days, most commonly oxycodone 5 mg. Opioids were prescribed to seven (17.9%) of controls and eleven (28.2%) of ACB patients (p=0.345). Mean morphine milligram equivalents were 43.7 (S.D. 115.9) and 70.6 (122.3), respectively (p=0.225). The remaining patients did not require opioid prescriptions during the post-manipulation period. Conclusion MUA resulted in short-term ROM improvement regardless of ACB use. Although the ACB group underwent later manipulation, both groups achieved comparable gains at two weeks. ACB was not associated with reduced opioid prescribing or improved ROM, suggesting no measurable benefit in this setting.

This study evaluated a low-cost hand-held near-infrared (NIR) spectrometer for rapid, nondestructive authenticity screening of seized tablets. Spectra were acquired from 225 tablets across four alprazolam and two oxycodone finished dosage forms, comprising 57 authentic or consistent with authentic (CWA) tablets and 168 not consistent with authentic (NCWA) tablets. The spectra were preprocessed using second-derivative Savitzky-Golay and Standard Normal Variate (SNV), then analyzed using Euclidean distance metrics, and additionally, supervised partial least-squares-discriminant analysis (PLS-DA) and one-class SIMCA models. Authentic and CWA tablets exhibited consistently low spectral intravariability, whereas NCWA tablets showed markedly higher intervariability, enabling complete separation for all six imprints. Under tablet-level leave-one-tablet-out cross-validation, conservative distance thresholds gave 100% correct classification. Taking the falsified tablet as the positive class, PLS-DA achieved 99.4% sensitivity and 100% specificity, while one-class SIMCA achieved 100% sensitivity and 98.2% specificity. The method delivers a definitive CWA versus NCWA decision in under 1 min without sample preparation, offering law enforcement, customs, forensic laboratories, and harm-reduction services a first-line tool to triage high-risk falsified opioids and benzodiazepines.

Gold nanostructures with branched morphologies exhibit strong plasmonic properties, enabling advanced biosensing and biochemical applications. Here, we report a rapid and scalable synthesis of gold nanoflowers (AuNFs) using modified benzenethiols as both reducing and capping agents. Benzenethiols bearing electron-donating substituents promoted rapid Au[3+] reduction and anisotropic branch growth, completing particle formation in less than 10 s without seed preparation or organic-aqueous transfer steps. The resulting AuNFs had abundant plasmonic hot spots and intrinsic Raman reporters, serving as dual-modality probes for colorimetry and surface-enhanced Raman scattering (SERS). When integrated into lateral flow assays, AuNFs markedly enhanced analytical sensitivity. In oxycodone detection, limits of detection reached 4.48 pg/mL (colorimetry) and 0.38 fg/mL (SERS), representing 700-fold and 1,200-fold improvements, respectively, over spherical gold nanoparticles. This performance enabled accurate quantification of oxycodone in plasma samples from murine addiction models. The developed method provides a practical route for preparing high-performance plasmonic nanomaterials for applications in biosensing, catalysis, and analytical chemistry.

Tramadol is frequently co-prescribed with oxycodone or hydrocodone after surgery under the assumption that its dual mechanism of action provides an opioid-sparing benefit. However, evidence supporting this practice is limited and inconsistent. We conducted a secondary analysis of the multicenter IGNITE ADOPT-PGx pragmatic trial of patients undergoing elective surgery who were prescribed oxycodone alone (n = 317) versus tramadol + oxycodone (n = 96), or hydrocodone alone (n = 563) versus tramadol + hydrocodone (n = 42). Co-primary outcomes of this study were cumulative morphine milligram equivalents (MME) consumed during the 10 days following surgery and composite pain scores at day 10 defined as the sum of current pain and average and worst pain in the past 7 days (score ranges from 3 to 15). Inverse probability of treatment weighting (IPTW) was used to adjust for demographic characteristics, comorbidities, and concomitant analgesics. Sensitivity analyses restricted to CYP2D6 normal metabolizers and sites prescribing both monotherapy and combination therapy and subgroup analysis including total knee arthroplasty patients were conducted. Compared to oxycodone alone, the combination of oxycodone and tramadol was associated with higher MME (adjusted mean 205.2 vs 122.5; P < 0.0001) and lower mobility, without meaningful differences in pain scores (adjusted mean 9.6 vs 9.4; P = 0.41). Similar findings were observed for hydrocodone-only vs hydrocodone + tramadol groups. Results were consistent in sensitivity and subgroup analyses. Co-administration of tramadol with oxycodone or hydrocodone was associated with substantially higher total MME and reduced mobility without any demonstrable improvement in pain control.