Long-Term Suboxone Maintenance Therapy for Opioid Use Disorder: 2 Case Reports

The medical profession is divided in its approach to treating patients with addiction issues, particularly in regards to the treatment of opioid use disorder with Suboxone (buprenorphine/naloxone). Here we present two cases of patients who have achieved over 11 years of sobriety with long-term Suboxone maintenance therapy. Their stories help to demonstrate that Suboxone is a viable long-term treatment option for severe opioid addiction. While life-long Suboxone use can lead to physical dependence on the drug, this is far from simply replacing one addiction with another. Some providers may feel that physical dependence on a medication does not represent appropriate or adequate treatment of opioid use disorder;however, when compared with the grave potential consequences of severe opioid use disorder, the potential benefits of achieving sobriety with Suboxone maintenance far outweigh the risks.

Long-term outcomes in patients initially responsive to selective laser trabeculoplasty

AIMTo determine the long-term effects of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) and the number of medications used up to 5y following treatment in glaucoma patients receiving maximally tolerated medical therapy (MTMT).METHODSThe Wills Eye Hospital Glaucoma Research Center retrospectively reviewed the charts of glaucoma patients who underwent SLT after receiving MTMT. Eyes that did not achieve their target pressure within 3mo following SLT were excluded from the study. Changes in mean IOP and number of glaucoma medications used were analyzed at 1, 3, and 5y following SLT.RESULTSSeventy-five eyes of 67 patients were included in the study. Fifteen eyes that received SLT failed to achieve their target pressure within 3mo and were excluded from the study. The average follow-up time was 37.4mo (±14.4). Mean IOP was significantly reduced 1y after treatment (P=0.005). It was also reduced 3, 5y after treatment without reaching statistical significance (P=0.20 and P=0.072, respectively). There was a significant decrease in mean number of medications used 1, 3, 5y after treatment (P<0.001, P<0.001, and P=0.039, respectively). In the span of 5y, 2 eyes (2.7%) underwent repeat SLT, 7 eyes (9.3%) underwent glaucoma surgery and an additional 3 eyes (4.0%) underwent both.CONCLUSIONSLT significantly reduced the number of glaucoma medications used 5y following treatment in glaucoma patients receiving MTMT. SLT may delay operating-room surgery.

Alcohol,inflammation,and gut-liver-brain interactions in tissue damage and disease development

Chronic inflammation is often associated with alcoholrelated medical conditions. The key inducer of such inflammation, and also the best understood, is gut microflora-derived lipopolysaccharide (LPS). Alcohol can significantly increase the translocation of LPS from the gut. In healthy individuals, the adverse effects of LPS are kept in check by the actions and interactions of multiple organs. The liver plays a central role in detoxifying LPS and producing a balanced cytokine milieu. The central nervous system contributes to anti-inflammatory regulation through neuroimmunoendocrine actions. Chronic alcohol use impairs not only gut and liver functions, but also multi-organ interactions, leading to persistent systemic inflammation and ultimately, to organ damage. The study of these interactions may provide potential new targets for therapeutic intervention.

Clinical analysis of central venous catheter-related infections in patients in the emergency ICU

BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit(EICU)in order to provide the beneficial reference.METHODS:From January 2008 to December 2010,a total of 1 363 patients were subjected to catheterization.In these patients,the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1 363 patients using the central venous catheter.The peak rate of CRI was 10.79%,with an incidence of 3.05 episodes per 1 000 catheter days.Of the147 patients,46.94%had gram-negative bacilli,40.14%had gram-positive cocci,and 12.92%had fungi.Unconditional logistic regression analysis suggests that multiple catheterization,femoral vein catheterization,the application of multicavity catheter,and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.

Ecosystem service availability in view of long-term land-use changes:a regional case study in the Czech Republic

This study aims to analyze how changes in land use influenced the delivery of ecosystem services in Cezava,a South Moravian agricultural region in the Czech Republic,in the period of 1845–2010.An observation of this period covering more than 160 years made it possible to reflect on social forces driving processes of transformation in the country.To capture the landscape multifunctionality and to indicate the environmental quality of the area under study,seven services provided in parallel by arable land,forests,and bodies of water were studied.The quantification of ecosystem services is based primarily on the transfer of values from the existing literature and on chronicle reviews and map analysis.Because looking back to the more distant past is a challenge and reliable information resources are lacking,a simple scoring method defining the functional features of the ecosystems was applied in order to evaluate the change of qualitative characteristics of the observed ecosystems.Besides that,the findings of these integrated assessments were supported by an analysis performed using landscape metrics.A comparison of service provision over the decades revealed that regulating and cultural services were significantly reduced,while provisioning services increased due to the proliferation of arable land,land consolidation,and agricultural intensification.However,a trend of improvement in the delivery of ecosystem services was introduced after 1990.Despite several uncertainties,this study demonstrates that it is possible to analyze long-term land-use trends to generate more meaningful,spatially explicit information,which can form the basis for landscape planning and ecosystem management.

Long-term hydrological impacts of land use/land cover change from 1984 to 2010 in the Little River Watershed,Tennessee

Assessing long-term hydrological impacts of land use/land cover(LULC)change is of critical importance for land use planning and water resource management.The Little River Watershed,Tennessee,is an important watershed supporting drinking water and recreational activities within and around the Great Smoky Mountains National Park in the Unites States.However,the potential hydrological impacts of LULC change,especially urbanization in recent decades,are not quantified.This paper assessed the long-term impacts of LULC change on streamflow and non-point source pollution using the Soil and Water Assessment Tool(SWAT)and a detailed LULC record from 1984 to 2010.The SWAT was first calibrated and validated using observed streamflowin 2010 and then simulated using different LULC patterns in 1984-2010 to quantify the long-term hydrological impacts caused by the LULC change.Simulated results indicated a minor 3%increase in streamflow for the whole watershed from 1984 to 2010,but with a distinct spatial pattern.The increase in streamflow is closely related to urban development.Almost no streamflow increase occurred in the upper watershed within the national park,whereas>10%increase occurred in the lower watershed,especially in areas close to cities.Model simulation also suggested 34.6%reduction in sediment and about 10%reduction in nutrient loads from 1984 to 2010,closely related to the decrease in agricultural land.However,without calibration and validation,the simulated reduction in the sediment and nutrient loads may be problematic because SWAT mainly simulates the static LULC patterns,whereas LULC transitions,such as construction phases,may generate more sediment and nutrient loads.In addition,the simulation also did not account for the sediment and nutrients generated from stream bank erosion.

Analysing the effect of stand density and site conditions on structure and growth of oak species using Nelder trials along an environmental gradient:experimental design,evaluation methods,and results

Background: Most current approaches in forest science and practice require information about structure and growth of individual trees rather than- or in addition to- sum and mean values of growth and yield at forest stand level as provided by classic experimental designs. By inventing the wheel design, Nelder provided the possibility to turn to the individual tree as basic information unit. Such trials provide valuable insights into the dependency of growth on stand density at particular sites.Methods: Here, we present an extension of the original design and evaluation by Nelder.(i) We established Nelder wheels along an environmental gradient through Europe in atlantic climate in Belgium and Germany, Mediterranean climate in Italy, continental climate in Hungary as well as on high land climate in Mexico. Such disjunct Nelder wheels along an environmental gradient can be regarded and analysed as a two-factor design with the factors of site condition and stand density.(ii) We present an advanced statistical approach to evaluate density dependent growth dynamics of trees planted in form of the Nelder design, which considers spatio-temporal autocorrelation.(iii)We prove the usefulness of the methods in improving ecological theory concerning density related productivity,trade-offs between facilitation and competition, and allometric relations between size variables.Results: First evaluations based on remeasured Nelder wheels in oak(Quercus robur L.) show a size growth differentiation during the first observation period. In particular, height growth is accelerated under higher competition indicating facilitation effects. We detect furthermore a high variability in allometric relations.Conclusions: The proposed design, methods, and results are discussed regarding their impact on forest practice,model building, and ecological theory. We conclude that the extended Nelder approach is highly efficient in providing currently lacking individual tree level information.

Malignant Gastric Cancer Cured by Short-Term Chemotherapy and Long-Term Use of Combined Chinese Medicine:A Case Report

Introduction Gastric cancer is still a major health problem and a leading cause of cancer mortality despite the worldwide decline Jn incidence. Surgery Js the only potentially curative treatment for localized gastric cancer and radical gastrectomy with extended lymphadenectomy is now recognized as a reasonably safe procedure in experienced centers.

Long-Term Ecstasy Use May Impair Memory

标题中的ecstasy的第一含义是:狂喜。可是,在本文,ectasy的含义却是“迷幻药”(安非他明的一种)。ecstasy在我们这里也许俗称“摇头丸”,服用者在舞厅里会表现出一种癫狂状态。Ecstasy在英语中俗称club drug,与“摇头丸”异曲同工。文章透露:ecstasy在西方亦属illegal。本文告诉读者,此药有害健康,特别是损害服用者的retrospective(回顾的)memory。】

An Elderly Patient with Advanced Lung Cancer Achieved Long-Term Survival Using Chinese Medicine:An Alternative Treatment Strategy for Cancer Patients Aged 80 or Older without A Tissue Confirmed Diagnosis

Lung cancer is the leading cause of cancerrelated mortality in China.（1＇2） Meanwhile, the average life expectancy in the aging population has increased from 46 years in 1950 to 75 years in 2010.

Optimizing water-saving irrigation schemes for rice(Oryza sativa L.)using DSSAT-CERES-Rice model

Rice is one of the major crops in China,and enhancing the rice yield and water use efficiency is critical to ensuring food security in China.Determining how to optimize a scientific and efficient irrigation and drainage scheme by combining existing technology is currently a hot topic.Crop growth models can be used to assess actual or proposed water management regimes intended to increase water use efficiency and mitigate water shortages.In this study,a CERES-Rice model was calibrated and validated using a two-year field experiment.Four irrigation and drainage treatments were designed for the experiment:alternate wetting and drying(AWD),controlled drainage(CD),controlled irrigation and drainage for a low water level(CID1),and controlled irrigation and drainage for a high water level(CID2).According to the indicators normalized root mean square error(NRMSE)and index of agreement(d),the calibrated CERES-Rice model accurately predicted grain yield(NRMSE=6.67%,d=0.77),,shoot biomass(NRMSE=3.37%,d=0.77),actual evapotranspiration(ETa)(NRMSE=3.83%,d=0.74),irrigation volume(NRMSE=15.56%,d=0.94),and leaf area index(NRMSE=9.69%,d=0.98)over 2 a.The calibrated model was subsequently used to evaluate rice production in response to the four treatments(AWD,CD,CID1,and CID2)under 60 meteorological scenarios which were divided into wet years(22 a),normal years(16 a),and dry years(22 a).Results showed that the yield of AWD was the largest among four treatments in different hydrological years.Relative to that of AWD,the yield of CD,CID1,and CID2 were respectively reduced by 5.7%,2.6%,8.7%in wet years,9.2%,2.3%,8.6% in normal years,and 9.2%,3.8%,3.9% in dry years.However,rainwater use efficiency and irrigation water use efficiency were the greatest for CID2 in different hydrological years.The entropy-weighting TOPSIS model was used to optimize the four water-saving irrigation schemes in terms of water-saving,labor-saving and high-yield,based on the simulation results of the CERES-Rice model in the past 60 a.These results showed that CID1 and AWD were optimal in the wet years,CID1 and CID2 were optimal in the normal and dry years.These results may provide a strong scientific basis for the optimization of water-saving irrigation technology for rice.

Community-based population monitoring for large baleen whales:the case study of Bryde’s whale in Beibu Gulf of China

Citizen science is a popular method for the long-term monitoring of the distribution of wild animals.The application of these methods in different species and environments still poses challenges,especially for aquatic animals.In this study,we investigated the distribution of the Bryde’s whale(Balaenoptera edeni)in the Beibu Gulf of China by using scientific boat-based surveys and citizen science approaches using 2 different methods of data collection.First,we built our mobile app(Whale Guard)and installed it on fishermen’s phones.Second,we used a popular instant messaging app(WeChat)to create an online fisherman community.We found that the mobile phone app collected far fewer reports(5 reports)than the online community group(42 reports,P<0.01).By using a variety of incentives,we maintained the fisherman’s community’s activity without significant user loss(P<0.01).We also found that the locations collected by social media applications in this study were consistent with observations from scientific boat-based transect surveys.The sightings distribution of Bryde’s whales differed from those in previous surveys in that they were present across larger areas.Social media apps reported that 69%of reports was confirmed by more than one person,whereas Whale Guard reports were much lower(0,P<0.001).Community-based citizen science can greatly contribute to the long-term monitoring of Bryde’s whales,and it has successfully overcome the challenges of data accessibility,accuracy,and fragmentation.Our study shows how to appropriately use citizen science in different community groups and community-based approaches make them useful for large baleen whale surveys.

Ultrastable MOF-based foams for versatile applications

Metal-organic frameworks(MOFs)are attractive for promising applications but plagued by difficult recovery and deployment due to their intrinsic nano/micro powder nature.Although significant efforts have been made to develop separable solid matrixes for MOF supporting,the poor loading stability and durability of MOFs still challenge their engineering applications.Here,we present a facile and effective approach to fabricate MOF-based melamine foams(MFs)(denoted as MOFiths)with ultrahigh loading stability and operation stability,easy separation,and high-efficient performance for versatile robust applications.By adopting our approach,numbers of typical fragile MOFs characterized with wide ranges of particle size(from~nm to~μm)can be precisely incorporated into MFs with controllable loading ratios(up to~1,600%).Particularly,the produced MOFiths show excellent capacities for the highly effective and durable water purifications and acetalization reactions.100%of organic pollutants can be rapidly destructed within 10 min by MOFiths initiated Fenton or catalytic ozonation processes under five successive cycles while the maximum adsorption capacity of MOFiths toward Pb(II),Cd(II),and Cu(II)reaches to 422,222,and 105 mg·g^(-1),respectively.This study provides a critical solution to substantially facilitate the engineering applications of MOFs for long-term use in practice.