Notes

A clear case of hepatic paragonimiasis has been misdiagnosed as hepatocellular carcinoma with split and haemorrhage.
0% vs. 16.7%).

The cannabis consumption-subjective effects link was weaker on blunt-only days compared to vape-only days. Subjective cannabis effects were higher on nicotine co-use days after controlling for cannabis consumption; neither alcohol nor nicotine co-use moderated the cannabis consumption-subjective effects link.

The revised subjective cannabis effects item is a viable alternative to the standard item among young adults who engage in simultaneous alcohol and cannabis use.

Future research focused on characterizing the variability in cannabis effects is needed.
Future research focused on characterizing the variability in cannabis effects is needed.
Changes in federal policy during the COVID-19 pandemic allowing for the use of telemedicine to treat opioid use disorder (OUD) have facilitated innovative strategies to engage and retain people in treatment. Since 2018, the Baltimore City Health Department has operated a mobile street medicine program called Healthcare on The Spot (The Spot) that provides treatment for OUD and infectious diseases. This study describes the transition of The Spot's buprenorphine service to telemedicine during the COVID-19 pandemic and one year treatment retention.

Patients actively engaged in care at the time of transition to telemedicine and patients newly engaged in buprenorphine services through telemedicine were included in this descriptive analysis and assessed at one year for retention.

From March 16, 2020 to March 15, 2021, The Spot provided voice-only buprenorphine treatment services to 150 patients, 70.7% (n=106) male and 80.0% (n=120) Black; 131 were patients who transitioned from in person services and 19 were newly engaged via telemedicine. Vemurafenib Raf inhibitor 80.7% (n=121) of patients remained engaged in treatment at one year, 16.0% (n=24) were lost to follow-up, and 3.3% (n=5) were deceased. Patients newly engaged via telemedicine were more likely to be female and white than those retained from in person services.

The Spot's transition of patients from a street medicine program to telemedicine during the COVID-19 pandemic has implications for future practice. Increased flexibility of service delivery, extended prescription length, and decreased UDT likely contributed to high retention rates and should inform the future structure of low-threshold buprenorphine programs.
The Spot's transition of patients from a street medicine program to telemedicine during the COVID-19 pandemic has implications for future practice. Increased flexibility of service delivery, extended prescription length, and decreased UDT likely contributed to high retention rates and should inform the future structure of low-threshold buprenorphine programs.
Both alcohol use and weight status have been linked to increased mortality risk, but evidence of their joint effect is limited. The goal of this study was to examine the combined effects of alcohol and weight status (BMI classes underweight, normal, overweight, obesity) on mortality using nationally representative data.

Using data from public-use National Health Interview Survey-Linked Mortality Files (NHIS-LMF), 2001-2011, linked to prospective mortality follow-up through December 2015, we used age-period-cohort Cox proportional hazards models to examine all-cause and cause-specific mortality associated with the joint effects of alcohol use and BMI on 209,317 individuals aged 35-85.

Individuals with an underweight BMI status had higher all-cause and cause-specific mortality risks than those with a normal BMI status and light/moderate alcohol intake. All-cause mortality risks were 148% (hazard ratio [HR] 2.48, 95% CI 1.60-3.83) higher in underweight heavy drinkers than light/moderate drinkers with normal BMI status. Obese heavy drinkers had a 16% higher chance of dying from all-cause mortality (HR 1.16, 95% CI 1.00-1.35). Individuals in the unknown alcohol and BMI category have a higher chance of death from all-cause (HR 1.35, 95% CI 1.14-1.59) or cause-specific (CVD HR 1.75, 95% CI 1.14-2.69 and Cancer HR 1.33, 95% CI 1.01-1.76).

Alcohol drinking levels result in heightened all-cause and cause-specific mortality risks; the risks are compounded among underweight, obese, and unknown BMI individuals across all or cause-specific mortality.
Alcohol drinking levels result in heightened all-cause and cause-specific mortality risks; the risks are compounded among underweight, obese, and unknown BMI individuals across all or cause-specific mortality.
Initiating cannabis use at a young age has been linked to problematic and continued cannabis use in adulthood. Given that approximately 1 in 3 adult cannabis smokers report blunt use, it is important to determine if and how age of blunt initiation is associated with current blunt use among adult blunt smokers.

This study uses cross-sectional pooled data from the 2014-2019 National Survey on Drug Use and Health (NSDUH) to examine the association between age of blunt initiation and current blunt use among 62,020 adults who reported lifetime blunt use.

Among lifetime blunt smokers, 51.4% initiated blunt use at 18 years or older, 42.1% initiated blunt use at 14-17 years old and 6.5% initiated blunt use at 13 years or younger. Multivariable logistic regression models revealed that odds of past 12-month (aOR 1.58; 95% CI 1.45 - 1.72), past 30-day (aOR 2.58; 95% CI 2.37 - 2.80) and daily (aOR 3.17; 95% CI 2.61 - 3.86) blunt use were greater among adults who initiated blunt use at 13 years of age or younger relative to those who initiated blunt use at 18 years of age or older, controlling for covariates.

Early onset of blunt use among adolescents is associated with current blunt use in adulthood among lifetime blunt users. Given the adverse health effects associated with blunt use and the prevalence of adult cannabis users who report blunt use, cannabis interventions and policies should be expanded to target blunt use among early initiators.
Early onset of blunt use among adolescents is associated with current blunt use in adulthood among lifetime blunt users. Given the adverse health effects associated with blunt use and the prevalence of adult cannabis users who report blunt use, cannabis interventions and policies should be expanded to target blunt use among early initiators.
Knee extensor strength deficits increase re-injury risk following anterior cruciate ligament reconstruction (ACLR). This study investigated whether isometric strength testing methods are a suitable alternative to isokinetic assessment for identifying knee extensor strength asymmetry.

This study recruited 22 patients at 9-12months after ACLR and 22 healthy controls. The single hop for distance (SHD) and knee extensor strength via isokinetic (60°/s and 120°/s) and isometric (positions of 90°, 60° and 30° of flexion, from full knee extension) methods were assessed. Absolute scores (normalized to body weight) and limb symmetry indices (LSIs) were calculated, with t-tests employed for statistical comparisons.

The SHD LSI was significantly higher (p<0.01) than both isokinetic speeds and the 30° isometric position. No significant LSI differences (p>0.01) existed within isokinetic or isometric test conditions. In ACLR patients, only the 60°/s isokinetic condition was significantly lower (p=0.005) than the 60° isometric condition. When normalized to body weight, the operated limb in ACLR patients was significantly weaker than the non-operated limb during peak isokinetic strength testing at 60°/s (p=0.001) and 120°/s (p=0.010), as well as isometric testing at 30° (p=0.009). Compared with controls, ACLR patients demonstrated significantly lower (p<0.01) mean LSIs across most measures.

Assessment of knee extensor strength via isometric methods appears suitable in the absence of isokinetic testing equipment, though consideration of test angle (30° and 90° knee angles better detect asymmetries similar to isokinetic testing) is important.
Assessment of knee extensor strength via isometric methods appears suitable in the absence of isokinetic testing equipment, though consideration of test angle (30° and 90° knee angles better detect asymmetries similar to isokinetic testing) is important.
Focal chondral defects (FCDs) of the femoral condyle are common. Treatment has heretofore primarily consisted of non-surgical and biological treatments. Focal articular surface replacement (FASR) is an emerging technique utilizing small implants to essentially fill the FCD. Here we report functional outcome and re-operation rates following FASR as a primary treatment for FCDs of the femoral condyles.

Retrospective analysis of a prospectively collected database including 327 FASR procedures was performed to identify patients who underwent FASR of the femoral condyle with a modular cementless metallic implant (HemiCAP
) as a primary procedure. Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), SF-36 Health Status Survey (SF-36) and Visual Analog Scale (VAS) were collected before and 6weeks, 6months, and 4years after surgery. Implant revision and re-operation rate were recorded.

157 patients were included with a mean follow-up of 9.4±1.3years (range 7.0 to 11.4years). The average age was 40.2±5.3years, 85% involved the medial condyle, and the average defect size was 3.6±0.5cm
. Primary FASR resulted in functional improvement on the KOOS (+52%), OKS (+69%) and SF-36 (+50%) scores and a reduction in VAS scores (-70%) at 4-year follow-up. Revision rate was 0.64% and the re-operation rate was 11%.

This retrospective case-series supports primary FASR with HemiCAP
implants as an alternative to biological procedures to treat medium-sized FCDs (2.5-4cm
) of the femoral condyle, although long-term follow-up is necessary to determine if the clinical outcome and low revision rate can be maintained.
This retrospective case-series supports primary FASR with HemiCAPTM implants as an alternative to biological procedures to treat medium-sized FCDs (2.5-4 cm2) of the femoral condyle, although long-term follow-up is necessary to determine if the clinical outcome and low revision rate can be maintained.Emerging Connected and Autonomous Vehicles (CAVs) technology have a ubiquitous communication framework. It poses security challenges in the form of cyber-attacks, prompting rigorous cybersecurity measures. There is a lack of knowledge on the anticipated cause-effect relationships and mechanisms of CAVs cybersecurity and the possible system behaviour, especially the unintended consequences. Therefore, this study aims to develop a conceptual System Dynamics (SD) model to analyse cybersecurity in the complex, uncertain deployment of CAVs. Specifically, the SD model integrates six critical avenues and maps their respective parameters that either trigger or mitigate cyber-attacks in the operation of CAVs using a systematic theoretical approach. These six avenues are i) CAVs communication framework, ii) secured physical access, iii) human factors, iv) CAVs penetration, v) regulatory laws and policy framework, and iv) trust-across the CAVs-industry and among the public. Based on the conceptual model, various system d, self-regulating, and resilient cyber-safe CAV system.
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