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pioid-based regimens. The AAO-HNS opioid prescribing CPG therefore prioritizes multimodal, nonopioid analgesia as first-line therapy, recommending that opioids be reserved for severe or refractory pain. This state-of-the-art review provides strategies for safely incorporating NSAIDs into acute postoperative pain regimens.Background Action potential alternans can induce ventricular tachyarrhythmias and manifest on the surface ECG as T-wave alternans (TWA) and QRS alternans (QRSA). We sought to evaluate microvolt QRSA in cardiomyopathy patients in relation to TWA and ventricular tachyarrhythmia outcomes. Methods and Results Prospectively enrolled cardiomyopathy patients (n=100) with prophylactic defibrillators had 12-lead ECGs recorded during ventricular pacing from 100 to 120 beats/min. QRSA and TWA were quantified in moving 128-beat segments using the spectral method. Segments were categorized as QRSA positive (QRSA+) and/or TWA positive (TWA+) based on ≥2 precordial leads having alternans magnitude >0 and signalnoise >3. see more Patients were similarly categorized based on having ≥3 consecutive segments with alternans. TWA+ and QRSA+ occurred together in 31% of patients and alone in 18% and 14% of patients, respectively. Although TWA magnitude (1.4±0.4 versus 4.7±1.0 µV, P120 ms (HR, 4.1; 95% CI, 1.3-12; P=0.014) to predict events. Conclusions Microvolt QRSA is novel phenomenon in cardiomyopathy patients that can exist without TWA and is associated with QRS prolongation. QRSA increases the risk of ventricular tachyarrhythmia 4-fold, which merits further study as a risk stratifier.

Meniscus has always been the focus of sport medicine with thousands of articles published annually. Few study has tried to analyze these papers with bibliometric methods. link2 The purpose of this study is to statistically analyze the output of meniscus research and determine emerging research trends and hot spots.

Papers related to the meniscus published from 2010 to 2019 were downloaded from the Web of Science Core Collection. link3 Information about annual publications and journal distribution was analyzed by Excel 2016. Co-occurrence analysis of the countries/regions, institutions, authors, and keywords were performed with CiteSpace V, which was also used to perform a co-cited analysis of the references and generate corresponding knowledge maps as well as detect burst keywords.

A total of 10,066 articles regarding meniscus were published between 2010 and 2019. The number of articles annual about meniscus increased from 786 to 1300.

, the United States, University of Pittsburgh, and LaPrade RF were journal, country, institution, and author with the most publications, respectively. Makris EA et al. in 2011 was the most cited articles, with a citation of 198. Osteoarthritis, tear repair, anterior cruciate ligament, and articular cartilage were keywords with occurrence of more than 500. Meniscal extrusion, scaffold, and tissue engineering were terms with most burst strength.

Meniscus-related publications showed a gradual rising trend from 2010 to 2019. Osteoarthritis, tear repairs, and the anterior cruciate ligament are the current research hot spots. Extrusion and scaffolds may be the frontiers of meniscus research in the next few years.

IV.

IV.

Substance users are among the most highly stigmatized individuals by both the public and health care providers. However, no multidimensional scale for measuring substance use stigma for substance use disorders (SUDs) currently exists in Turkey.

The aim of this study was to determine the validity and reliability of the Turkish version of the Substance Use Stigma Mechanism Scale (SU-SMS).

The study was conducted at the AMATEM (Alcohol and Substance Addiction Treatment Center Clinic). The sample group of this methodological study consisted of 156 participants with SUDs who met the inclusion criteria. "Social-demographics Questionnaire," "The Substance Use Stigma Mechanism Scale," and "Internalized Stigma of Mental Illness Scale" were used for data collection. In the validity-reliability analysis of the scale, language and content validity, explanatory and confirmatory factor analysis, criterion-concurrent validity, Cronbach's alpha coefficient, item-total score correlation, split-half reliability analysis, and test-retest reliability methods were used.

Using exploratory factor analysis, it was found that the SU-SMS has five factors. Its five-factor structure was confirmed using confirmatory factor analysis. Its Cronbach's alpha coefficient was .828, and factor loading was between .402 and .971. Analyses indicated that each of the factors of the Turkish version of the scale had high internal consistency. The test-retest correlation value was .752,

= .000.

It was concluded that the Turkish version of the SU-SMS is a reliable and valid instrument for assessing substance use-related stigma in individuals with SUDs.

It was concluded that the Turkish version of the SU-SMS is a reliable and valid instrument for assessing substance use-related stigma in individuals with SUDs.

The purpose of this study was to evaluate the feasibility and short-term impact of a brief opioid overdose prevention and mitigation training administered to detained youth at risk for witnessing an overdose.

Adolescents seen in the medical clinic in a youth detention center were screened to determine risk for witnessing an overdose. Eligible adolescents completed a pretraining assessment that included opioid witnessing experiences and knowledge of and attitudes toward opioid overdose prevention. Participants completed a one-on-one overdose first aid training, received a naloxone (Narcan) kit at release, and completed a posttraining assessment of knowledge and attitudes. At 1 month and 3 months postrelease, participants completed telephone interviews to report satisfaction and application of training concepts.

A total of 39 adolescent residents participated in this pilot study. Rates of recruitment and retention, as well as high rates of witnessing opioid use and overdose, indicate that opioid overdose prevention interventions are warranted with this population. There were significant changes in knowledge, confidence, and readiness to intervene in an opioid overdose from pre- to posttraining. At follow-up, the majority of participants still possessed their naloxone, and all reported sharing information from the training with others and having a plan if they witnessed an overdose. One participant reported completion of an overdose reversal.

Opioid overdose prevention training with detained youth is feasible and shows promising impacts on knowledge and application, meriting the need for future research.

Opioid overdose prevention training with detained youth is feasible and shows promising impacts on knowledge and application, meriting the need for future research.

Tuberculosis (TB) remains a major global health burden. There still remains a large gap between the notified and estimated incident cases. Extrapulmonary (EP) TB represents 15% of all TB cases and the diagnosis is more challenging due to the paucity of the organism. Smear microscopy is often insensitive and culture methods are prolonged. With the introduction of Xpert MTB/RIF and more recently Xpert Ultra, this has changed TB diagnostics by providing a rapid accessible platform to diagnose TB and identify rifampicin resistance within 2h.

The diagnostic accuracy and the clinical role of Xpert MTB/RIF and Xpert Ultra in the different forms of EPTB.

Whilst significant advances have been made in TB diagnostics, there is still a need to optimize the diagnostic yield of Xpert MTB/RIF and Xpert Ultra in EPTB samples. Research is needed to facilitate standardization and optimal preparation of samples as well as understanding the role of Xpert MTB/RIF and Xpert Ultra in different burden settings. Alongside the current GeneXpert platform, the launch of rapid second-line drug resistance polymerase chain reactions and whole genome sequencing may help tackle the global health burden with a more comprehensive diagnostic approach and appropriate treatment.

Whilst significant advances have been made in TB diagnostics, there is still a need to optimize the diagnostic yield of Xpert MTB/RIF and Xpert Ultra in EPTB samples. Research is needed to facilitate standardization and optimal preparation of samples as well as understanding the role of Xpert MTB/RIF and Xpert Ultra in different burden settings. Alongside the current GeneXpert platform, the launch of rapid second-line drug resistance polymerase chain reactions and whole genome sequencing may help tackle the global health burden with a more comprehensive diagnostic approach and appropriate treatment.

Orbital veins such as the retinal veins and episcleral veins drain into the cavernous sinus, an intracranial venous structure. We studied the effects of acute intracranial pressure (ICP) elevation on episcleral venous pressure, intraocular pressure and retinal vein diameter in an established non-survival pig model.

In six adult female domestic pigs, we increased ICP in 5 mm Hg increments using saline infusion through a lumbar drain. We measured ICP (using parenchymal pressure monitor), intraocular pressure (using pneumatonometer), episcleral venous pressure (using venomanometer), retinal vein diameter (using OCT images) and arterial blood pressure at each stable ICP increment. The average baseline ICP was 5.4 mm Hg (range 1.5-9 mm Hg) and the maximum stable ICP ranged from 18 to 40 mm Hg. Linear mixed models with random intercepts were used to evaluate the effect of acute ICP increase on outcome variables.

With acute ICP elevation, we found loss of retinal venous pulsation and increased episcleral venouive ophthalmic biomarkers to estimate acute ICP elevations following significant neuro-trauma.Diabetic wound infections and pressure ulcers pose a significant challenge to healthcare providers worldwide. The current study provides new and innovative wound care products that reduce inflammation, clear infection, and improve healing in an animal model of pressure ulcers in diabetic rats. Ointment, hydrogel, and nanofiber dressings were synthesized using 5% turmeric, 1% oregano, and 1% chitosan nanoparticles and tested for antibacterial and cytotoxicity in vitro, and wound healing effects in vivo. Turmeric ethanolic extract showed high antioxidant activity compared to Oregano, Chitosan Nanoparticles, and Alginate silver (p-value less then 0.0001). The ointment and hydrogel formulation (5% Turmeric, 1% Oregano, and 1% chitosan) showed lower cytotoxicity compared to the commercial Alginate silver dressing. Ointment, hydrogel formulations, and commercial Alginate silver, showed significant antibacterial activity with 100% efficacy on both Staphylococcus aureus and Escherichia coli (p-value less then 0.0001), compared to nanofibers which showed 50% reduction in bacterial growth (p-value less then 0.0001). The new formulations were tested in a rat model of pressure ulcers. Ointment and nanofibers achieved complete wound healing by day 15 compared to the hydrogel and commercial Alginate silver dressing, which showed higher infection, and the wound remained partially open by day 21. In conclusion, Turmeric, Oregano extracts, and chitosan nanoparticles can be used for effective wound dressings in both diabetic and non-diabetic wounds. At relatively low concentrations, this combination provides a promising new wound treatment formulation that is antibacterial, anti-inflammatory, and antioxidant.