Background
Mesh surgery for stress urinary incontinence or pelvic organ prolapse can result in complications such as mesh exposure, mesh extrusion, voiding dysfunction, dyspareunia, and pain. There ...is limited knowledge or guidance on the effective management for mesh‐related complications.
Objective
To determine the best management of mesh complications; a systematic review was conducted as part of the national clinical guideline ‘Urinary incontinence (update) and pelvic organ prolapse in women: management’.
Search strategy
Search strategies were developed for each indication for referral.
Selection criteria
Relevant interventions included complete or partial mesh removal, mesh division, and non‐surgical treatments such as vaginal estrogen.
Data collection and analysis
Characteristics and outcome data were extracted, and as a result of the heterogeneous nature of the data a narrative synthesis was conducted.
Main results
Twenty‐four studies were included; five provided comparative data and four studies stated the indication for referral. Reported outcomes (including pain, dyspareunia, satisfaction, quality of life, incontinence, mesh exposure, and recurrence) and the reported incidences of these varied widely.
Conclusions
The current evidence base is limited in quantity and quality and does not permit firm recommendations to be made on the most effective management for mesh‐related complications. Robust data are needed so that mesh complications can be managed effectively in the future.
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Systematic review demonstrates that the outcomes following mesh revision surgery are highly variable.
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Systematic review demonstrates that the outcomes following mesh revision surgery are highly variable.
In this review, we provide an overview of the current understanding of the main mechanisms of pharmacological action of essential oils and their components in various biological systems. A brief ...introduction on essential oil chemistry is presented to better understand the relationship of chemical aspects with the bioactivity of these products. Next, the antioxidant, anti-inflammatory, antitumor, and antimicrobial activities are discussed. The mechanisms of action against various types of viruses are also addressed. The data show that the multiplicity of pharmacological properties of essential oils occurs due to the chemical diversity in their composition and their ability to interfere with biological processes at cellular and multicellular levels via interaction with various biological targets. Therefore, these natural products can be a promising source for the development of new drugs.
This study evaluated the association between medication for opioid use disorder (MOUD) and health care utilization over time among a sample of treatment-seeking individuals with opioid use disorder. ...In contrast to previous studies, this study used a novel measure of MOUD adherence, more comprehensive utilization data, and analyses that controlled for detailed individual and social determinants of health.
This study was a secondary analysis of a comparative effectiveness trial (N=570) of extended-release naltrexone versus buprenorphine-naloxone. The outcome of interest was usage of nonstudy acute care, inpatient and outpatient addiction services, and other outpatient services across 36 weeks of assessment. Adherence (percentage of days taking MOUD) was defined as low (<20%), medium (≥20% but <80%), or high (≥80%). A two-part model evaluated the probability of utilizing a resource and the quantity (utilization days) of the resource consumed. A time-varying approach was used to examine the effect of adherence in a given month on utilization in the same month, with analyses controlling for a wide range of person-level characteristics.
Participants with high adherence (vs. low) were significantly less likely to use inpatient addiction (p<0.001) and acute care (p<0.001) services and significantly more likely to engage in outpatient addiction (p=0.045) and other outpatient (p=0.042) services.
These findings reinforce the understanding that greater MOUD adherence is associated with reduced usage of high-cost health services and increased usage of outpatient care. The results further suggest the need for enhanced access to MOUD and for interventions that improve adherence.
A novel output-feedback super-twisting algorithm design is proposed for uncertain multivariable plants. In order to allow global finite-time exact tracking in the presence of a rather general class ...of matched nonlinear disturbances which may depend on measured and/or unmeasured states, the algorithm is designed with variable gains. This represents a significant extension of a recently proposed nondecoupled multivariable super-twisting algorithm, based on state-feedback with fixed gains, to the case of output-feedback with variable gains.
Efforts to translate sub-anesthetic ketamine infusions into widespread clinical use have centered around developing medications with comparable neurobiological activity, but with attenuated ...psychoactive effects so as to minimize the risk of behavioral toxicity and abuse liability. Converging lines of research, however, suggest that some of the psychoactive effects of sub-anesthetic ketamine may have therapeutic potential. Here, we assess whether a subset of these effects – the so-called mystical-type experience – mediates the effect of ketamine on craving and cocaine use in cocaine dependent research volunteers. We found that ketamine leads to significantly greater acute mystical-type effects (by Hood Mysticism Scale: HMS), dissociation (by Clinician Administered Dissociative States Scale: CADSS), and near-death experience phenomena (by the Near-Death Experience Scale: NDES), relative to the active control midazolam. HMS score, but not the CADSS or NDES score, was found to mediate the effect of ketamine on global improvement (decreased cocaine use and craving) over the post-infusion period. This is the first controlled study to show that mystical-type phenomena, long considered to have therapeutic potential, may work to impact decision-making and behavior in a sustained manner. These data suggest that an important direction for medication development is the identification of ketamine-like pharmacotherapy that is selectively psychoactive (as opposed to free of experiential effects entirely), so that mystical-type perspectival shifts are more reliably produced and factors lending to abuse or behavioral impairment are minimized. Future research can further clarify the relationship between medication-occasioned mystical-type effects and clinical benefit for different disorders.
This article is part of the Special Issue entitled ‘Psychedelics: New Doors, Altered Perceptions’.
•Prior data suggest that certain hallucinogen-related psychoactive effects may be therapeutic.•Mystical-type effects were found to mediate the anti-addiction benefits of ketamine.•The mystical-type effects of ketamine and related agents may have clinical relevance, and merit further study.
Background
Anterior compartment prolapse is the most common pelvic organ prolapse (POP) with a range of surgical treatment options available.
Objectives
To compare the clinical effectiveness and ...cost‐effectiveness of surgical treatments for the repair of anterior POP.
Methods
We conducted a systematic review of randomised controlled trials comparing surgical treatments for women with POP. Network meta‐analysis was possible for anterior POP, same‐site recurrence outcome. A Markov model was used to compare the cost–utility of surgical treatments for the primary repair of anterior POP from a UK National Health Service perspective.
Main results
We identified 27 eligible trials for the network meta‐analysis involving eight surgical treatments tested on 3194 women. Synthetic mesh was the most effective in preventing recurrence at the same site. There was no evidence to suggest a difference between synthetic non‐absorbable mesh, synthetic partially absorbable mesh, and biological mesh. The cost–utility analysis, which incorporated effectiveness, complications and cost data, found non‐mesh repair to have the highest probability of being cost‐effective. The conclusions were robust to model inputs including effectiveness, costs and utility values.
Conclusions
Anterior colporrhaphy augmented with mesh appeared to be cost‐ineffective in women requiring primary repair of anterior POP. There is a need for further research on long‐term effectiveness and the safety of mesh products to establish their relative cost‐effectiveness with a greater certainty.
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New study finds mesh cost‐ineffective in women with anterior pelvic organ prolapse.
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New study finds mesh cost‐ineffective in women with anterior pelvic organ prolapse.
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•Molten salts play a very significant role in high-temperature energy processes, like CSPs.•Its use as heat transfer/storage fluids in molten salt oxidation (MSO) technologies is ...analysed.•Thermophysical property data for molten alkali carbonates are analysed.•Influence in processes of accurate data for these properties are discussed.•Analysis includes pure carbonates and relevant mixtures, including their nanosalts.
Molten salts are a very relevant member of industrial fluids for high temperature applications, such as catalytic medium for coal gasification, molten salt oxidation of wastes, heat transfer fluids or latent, sensible heat storage and solar (CSP) or nuclear power station operations. Available data on thermophysical properties, applications and a discussion of the state of the art for molten alkali carbonates and its mixtures like pure Li2CO3, Na2CO3 and K2CO3, mixtures of Li2CO3-Na2CO3, Li2CO3-K2CO3 (binary eutectics) and Li2CO3-Na2CO3-K2CO3 (ternary eutectic) and nanofluids based in these carbonate melts are presented. These melts are especially suitable for application at higher temperature regimes, like those involving high temperature energy storage, coolants or molten salts oxidations of wastes and therefore the accurate knowledge of their most important thermophysical properties is essential for efficient energy transfer and storage, because of their impact on energy efficiency, namely in energy savings and decrease of carbon footprint. From the analysis performed it can be concluded that the scatter of data found for molten alkali carbonates, added to present and future applications, still justifies further studies on these systems, to support their application as alternative engineering fluids. Additionally, some comments on how to improve present situation of methods and measurements are made, especially in the area of thermal conductivity.
Buprenorphine treatment for opioid use disorder may be improved by sustained-release formulations.
To determine whether treatment involving novel weekly and monthly subcutaneous (SC) buprenorphine ...depot formulations is noninferior to a daily sublingual (SL) combination of buprenorphine hydrochloride and naloxone hydrochloride in the treatment of opioid use disorder.
This outpatient, double-blind, double-dummy randomized clinical trial was conducted at 35 sites in the United States from December 29, 2015, through October 19, 2016. Participants were treatment-seeking adults with moderate-to-severe opioid use disorder.
Randomization to daily SL placebo and weekly (first 12 weeks; phase 1) and monthly (last 12 weeks; phase 2) SC buprenorphine (SC-BPN group) or to daily SL buprenorphine with naloxone (24 weeks) with matched weekly and monthly SC placebo injections (SL-BPN/NX group).
Primary end points tested for noninferiority were response rate (10% margin) and the mean proportion of opioid-negative urine samples for 24 weeks (11% margin). Responder status was defined as having no evidence of illicit opioid use for at least 8 of 10 prespecified points during weeks 9 to 24, with 2 of these at week 12 and during month 6 (weeks 21-24). The mean proportion of samples with no evidence of illicit opioid use (weeks 4-24) evaluated by a cumulative distribution function (CDF) was an a priori secondary outcome with planned superiority testing if the response rate demonstrated noninferiority.
A total of 428 participants (263 men 61.4% and 165 women 38.6%; mean SD age, 38.4 11.0 years) were randomized to the SL-BPN/NX group (n = 215) or the SC-BPN group (n = 213). The response rates were 31 of 215 (14.4%) for the SL-BPN/NX group and 37 of 213 (17.4%) for the SC-BPN group, a 3.0% difference (95% CI, -4.0% to 9.9%; P < .001). The proportion of opioid-negative urine samples was 1099 of 3870 (28.4%) for the SL-BPN/NX group and 1347 of 3834 (35.1%) for the SC-BPN group, a 6.7% difference (95% CI, -0.1% to 13.6%; P < .001). The CDF for the SC-BPN group (26.7%) was statistically superior to the CDF for the SL-BPN/NX group (0; P = .004). Injection site adverse events (none severe) occurred in 48 participants (22.3%) in the SL-BPN/NX group and 40 (18.8%) in the SC-BPN group.
Compared with SL buprenorphine, depot buprenorphine did not result in an inferior likelihood of being a responder or having urine test results negative for opioids and produced superior results on the CDF of no illicit opioid use. These data suggest that depot buprenorphine is efficacious and may have advantages.
ClinicalTrials.gov Identifier: NCT02651584.
The oral formulation of the opioid antagonist naltrexone has shown limited effectiveness for treatment of opioid use disorder due to poor adherence. Long-acting injection naltrexone (XR-naltrexone), ...administered monthly, circumvents the need for daily pill taking, potentially improving adherence, and has been shown to be superior to placebo in reducing opioid use over 6 months of treatment. This open-label trial compared the outcomes of patients with opioid use disorder treated with XR-naltrexone or oral naltrexone in combination with behavioral therapy.
Sixty opioid-dependent adults completed inpatient opioid withdrawal and were transitioned to oral naltrexone. They were stratified by severity of opioid use (six or fewer bags versus more than six bags of heroin per day) and randomly assigned (1:1) to continue treatment with oral naltrexone (N=32) or XR-naltrexone (N=28) for 24 weeks. The first dose of XR-naltrexone (380 mg) was administered prior to discharge, with monthly doses thereafter, and oral naltrexone was given in a 50-mg daily dose. All participants received weekly behavioral therapy to support treatment and adherence to naltrexone.
A Cox proportional hazards model adjusting for race, gender, route of use, and baseline opioid use severity indicated that significantly more patients were retained in treatment for 6 months in the XR-naltrexone group (16 of 28 patients, 57.1%) than in the oral naltrexone group (nine of 32 patients, 28.1%) (hazard ratio=2.18, 95% CI=1.07, 4.43).
Patients receiving XR-naltrexone had twice the rate of treatment retention at 6 months compared with those taking oral naltrexone. These results support the use of XR-naltrexone combined with behavioral therapy as an effective treatment for patients seeking opioid withdrawal and nonagonist treatment for preventing relapse to opioid use disorder.
In this work, pilot-scale nanofiltration was used to obtain aqueous solutions rich in hydroxytyrosol and tyrosol from olive oil by-products. A large-scale simple process involving olive mill standard ...machinery (blender and decanter) was used for the olive pomace pre-treatment with water. The aqueous extract was then directly fed to a nanofiltration unit and concentrated by reverse osmosis. Final concentration factors ranged between 7 and 9 for hydroxytyrosol and between 4 and 7 for tyrosol. The final aqueous solution, obtained as retentate stream of reverse osmosis, was highly concentrated in hydroxytyrosol and tyrosol and their concentrations remained stable over at least 14 months.
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