Withdrawal, but not craving, mediated the effect of drug use severity on the nucleus accumbens' response to drug cues. We did not find similar effects for the neural responses to stimuli unrelated to drugs. Our findings emphasize the central role of withdrawal symptoms as the mediator between the clinical severity of OUD and the brain correlates of sensitization to opioid-related cues. They suggest that in OUD, baseline withdrawal symptoms signal a high vulnerability to drug cues.
Guidelines regarding head and neck surgical care have evolved during the coronavirus-19 (COVID-19) pandemic. Data on operative management have been limited.
We compared two cohorts of patients undergoing head and neck or reconstructive surgery between March 16, 2019 and April 16, 2019 (pre-COVID-19) and March 16, 2020 and April 16, 2020 (COVID-19) at an academic center. Perioperative, intraoperative, and postoperative outcomes were recorded.
There were 63 operations during COVID-19 and 84 operations during pre-COVID-19. During COVID-19, a smaller proportion of patients had benign pathology (12% vs 20%, respectively) and underwent thyroid procedures (2% vs 23%) while a greater proportion of patients underwent microvascular reconstruction±ablation (24% vs 12%,). Operative times increased, especially among patients undergoing microvascular reconstruction±ablation (687 ± 112 vs 596 ± 91 minutes, P = .04). click here Complication rates and length of stay were similar.
During COVID-19, perioperative outcomes were similar, operative time increased, and there were no recorded transmissions to staff or patients. Continued surgical management of head and neck cancer patients can be provided safely.
During COVID-19, perioperative outcomes were similar, operative time increased, and there were no recorded transmissions to staff or patients. Continued surgical management of head and neck cancer patients can be provided safely.
Whether a patient's outcomes are better when receiving nutritional counselling during cardiac rehabilitation (CR) has been scarcely described. We compared changes in weight, waist circumference (WC) and blood pressure (BP) in patients attending CR with and without nutritional counselling.
A retrospective analytical study was conducted in which two groups of patients who completed a phase II CR (36 sessions) were compared CONTROL [n=144, mean (SD) age=59(12)years, 17% females], comprising patients without nutritional counselling (attended between 2003 and 2009), and NUT [n=128, mean (SD) age=60(13)years, 27% females], comprising patients with dietitian-delivered nutritional counselling (attended between 2010 and 2019). Repeated-measures analysis of variance was used to compare changes in weight, WC, and BP during CR between groups. Logistic regression models determined the probability of reducing weight and systolic BP (SBP).
NUT group decreased weight [-1.3(3.1)kg; P<0.0001] and WC [-3.0(3.8)cm; P<0.0001] to a greater extent than CONTROL [weight -0.4(3.1)kg; P=0.51; WC -1.4(4.5)cm; P=0.02]. In CONTROL, 7% reduced≥5% weight and 31% reduced≥10mmHg SBP, whereas, in the NUT group, 18% reduced≥5% weight and 47% reduced≥10mmHg SBP. Patients in NUT (versus CONTROL) were more likely to lose≥5% of weight (odds ratio=4.27, 95% confidence interval=1.69-10.80; P<0.01) and reduce SBP≥10mmHg (odds ratio=3.15, 95% confidence interval=1.58-6.27; P<0.01).
Patients who received nutritional counselling during CR improved anthropometric measures and were more likely to lose weight and reduce SBP than patients without nutritional counselling.
Patients who received nutritional counselling during CR improved anthropometric measures and were more likely to lose weight and reduce SBP than patients without nutritional counselling.Hepatitis C virus (HCV) screening through primary care providers (PCP) might increase linkage to specialized care. This study aimed to calculate HCV testing rate and prevalence of anti-HCV according to socio-demographic factors in primary care in Catalonia, Spain, from 2011 to 2016, and to identify the rate and determinants of attrition at linkage to specialized care. Patient data from 274 primary care centres (3414 PCP) were analysed, including socio-demographic information, morbidity, laboratory tests and treatments (1-Jan-2011 to 31-Dec-2016). Both descriptive and inferential statistics were used to examine HCV testing rate, HCV seroprevalence and rate of attrition at linkage to specialized care. In the study period, there were 839 072 people tested for HCV infection and 21 156 with first-time positive anti-HCV test results. Rate of HCV testing was 143.54/103 pop (95% CI 143.26-143.83). Women had higher HCV testing rate (158.65/103 women [95% CI 158.24-159.07]), compared to men (128.10/103 men [95% CI 127.72-128.49]). The highest HCV testing rate was among people aged 25-34 (284.11/103 pop [CIs 283.10-285.12]). The anti-HCV seroprevalence was 3.62/103 pop (CIs 3.57-3.67). The highest prevalence was found among men (4.20/103 men [CIs 4.12-4.27]), people aged 45-54 (7.19/103 pop [CIs 7.01-7.37]), people aged 75-84 (7.26/103 pop [CIs 6.99-7.53]), Spanish (3.68/103 [CIs 3.61-3.75]), European and Northern Americans (5.64/103 [CIs 5.33-5.96]) and Asians (9.78/103 [CIs 9.21-10.35]). From those who had a positive anti-HCV result, 49.8% (N = 10 528) were not linked to specialized care. Appropriate clinical care pathways and referral systems need to be established to ensure optimal linkage to specialized care for people newly diagnosed with HCV in primary care.
Succinate activates the receptor GPR91 identified in the bladder. The present study aims to unravel the mechanisms of bladder relaxation by succinate and how the receptor is involved in structural and functional changes of the bladder.
Physiological recordings of bladder function were carried out by cystometry and organ bath from C57BL/6 mice, homozygous GPR91
mice,and Sprague-Dawley (SD) rats. GPR91 expression was confirmed by polymerase chain reaction and tissue morphology was examined by light (Masson trichrome) and fluorescence microscopy. Nitric oxide (NO) and ATP secretion were measured.
Bladders of GPR91 KO mice had a greater mass to body weight ratio with a thicker bladder wall compared to C57BL/6 mice. They also displayed increased basal and maximal bladder pressures, and decreased intercontraction intervals, bladder capacity, micturition volume, and compliance. During cystometry, bladders of SD rats and C57BL/6 mice instilled with succinate (10 mM) showed signs of relaxation while bladders of GPR91 KO mice were unresponsive.click here
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