Trends in Prescribed Central Nervous System Depressant Medications Among Adults Who Regularly Consume Alcohol: United States 1999 to 2014.

BACKGROUND: Although the risks of using central nervous system depressant (CNS-D) medications with alcohol are well documented, little is known about trends in prescribed use of these medications among individuals who regularly consume alcohol (i.e., trends in "concurrent use"). We examined changes in the prevalence of prescribed CNS-D medications among individuals who drank alcohol on 52 or more occasions in the past year ("regular drinking"). CNS-D medications included sedative-hypnotics (subclassified as anxiolytics or sleep medications) and opioids. METHODS: We used 8 cross-sectional cycles of the National Health and Nutrition Examination Survey (1999-2000 to 2013-2014) from participants aged 20 and older (n = 37,709). We used log-binomial regression to examine (i) prevalence trends of prescribed CNS-D medication use, (ii) trend differences by drinking status, and (iii) correlates of CNS-D medication use. RESULTS: Among those who drink regularly, the relative annual increase in prevalence of sedative-hypnotic use was 5.3% (95% CI: 2.7 to 7.9): Anxiolytic and sleep medication use increased annually by 3.7% (95% CI: 0.8 to 6.7) and 11.2% (95% CI: 6.5 to 16.0), respectively. Opioid use trends among those who drink regularly were not statistically significant but were nonlinear. Differences in CNS-D medication trends between those who drink regularly and those who drink infrequently/abstain were not statistically significant. Those who drink regularly were less likely than those who drink infrequently/abstain to use opioids (adjusted relative risk [ARR]: 0.69, 95% CI: 0.60 to 0.78) and anxiolytics (ARR: 0.71, 95% CI: 0.61 to 0.81), but not sleep medications (ARR: 1.04, 95% CI: 0.80 to 1.35). Those aged 40 and older were 2 to 5 times as likely as those aged 20 to 29 to use sedative-hypnotics. CONCLUSIONS: Among those who drink regularly, the prevalence of prescribed sedative-hypnotic use increased and prescribed opioid use remained common. These trends indicate that a substantial portion of the population is at risk of alcohol-related adverse drug reactions-particularly those aged 40 and older.

Palpable breast abnormalities in women under age 40.

Although the prevalence of malignancy in average risk women under age 40 presenting with a palpable breast abnormality is low, the management of benign-appearing palpable abnormalities remains controversial. This study assesses the imaging evaluation, subsequent management, and outcomes of women under age 40 presenting with a palpable area of concern. This study also evaluates the costs, utility, and outcomes of BI-RADS 3 assessment in this patient population. A single institution retrospective case review from July 2010 through June 2013 identified women under age 40 presenting with a new palpable breast abnormality. Diagnostic imaging evaluation was performed. BI-RADS assessments and recommendations were recorded prospectively. Outcome was determined by tissue diagnosis, 2 years of surveillance, or search of the hospital tumor registry. Performance measures were calculated. Among 1440 cases, 1052 were initially assessed as BI-RADS 1 or 2 (73.1%), 184 as BI-RADS 3 (12.8%), 182 as BI-RADS 4 (12.6%), and 22 as BI-RADS 5 (1.5%). In all, 30 breast malignancies were diagnosed (cancer yield 2.1%). All 30 cancers were initially categorized as BI-RADS 4 or 5. No BI-RADS 1, 2, or 3 findings proved malignant. The imaging evaluation sensitivity was 100%, specificity was 87.7%, and accuracy was 87.9%. The negative predictive value was 100% and the positive predictive value was 14.7%. Average risk women under age 40 presenting with a palpable abnormality have a low prevalence of breast cancer. Imaging evaluation has a high sensitivity and negative predictive value, thereby allowing for confident characterization and appropriate management recommendations. For palpable solid masses with benign imaging features in women under age 40, short-term interval follow-up with subsequent periodic imaging or clinical examination for a total of 2 years is a cost-effective and safe alternative to biopsy.

A review of emerging therapeutic potential of psychedelic drugs in the treatment of psychiatric illnesses.

Though there was initial interest in the use of psychedelic drugs for psychiatric treatment, bad outcomes and subsequent passage of the Substance Act of 1970, which placed psychedelic drugs in the Schedule I category, significantly limited potential progress. More recently, however, there has been renewal in interest and promise of psychedelic research. The purpose of this review is to highlight contemporary human studies on the use of select psychedelic drugs, such as psilocybin, LSD, MDMA and ayahuasca, in the treatment of various psychiatric illnesses, including but not limited to treatment-resistant depression, post-traumatic stress disorder, end-of-life anxiety, and substance use disorders. The safety and efficacy as reported from human and animal studies will also be discussed. Accumulated research to date has suggested the potential for psychedelics to emerge as breakthrough therapies for psychiatric conditions refractory to conventional treatments. However, given the unique history and high potential for misuse with popular distribution, special care and considerations must be undertaken to safeguard their use as viable medical treatments rather than drugs of abuse.

Multi-directional mechanical analysis of synthetic scaffolds for hernia repair.

Hernias remain one of the most common ailments to affect men and women worldwide. Surgical mesh materials were first used to reinforce hernia defects during surgery in the late 1950s (Laker, n.d.). Today, there are well over 50 prosthetic meshes available for hernia repair (Brown and Finch, 2010; Bryan et al., 2014; Hope and El-hayek, 2014). With the multitude of available options, surgeons are faced with the challenging task of optimizing mesh selection for each patient. If the mechanics of the mesh are not compatible with the surrounding tissue, mismatch can occur, which can lead to complications such as mesh failure and/or hernia recurrence. Unfortunately, many aspects of synthetic mesh mechanics remain poorly described. Therefore, the purpose of this study was to provide a more complete mechanical analysis of a variety of commercially available prosthetic meshes for hernia repair, including evaluation of meshes in a variety of orientations. Twenty different meshes were subjected to biaxial tensile tests at both 90° and 45° orientations, and results were analyzed for relative strength, strain behavior, and anisotropy. Peak tension and strain values varied dramatically across all mesh types for all directions, ranging between 4.08 and 25.74N/cm and -5% to 10% strain. Anisotropy ratios for the evaluated meshes ranged from 0.33 to 1.89, demonstrating a wide range in relative direction-dependence of mesh mechanics. While further study of prosthetic meshes and better characterization of properties of the human abdominal wall are needed, results of this study provide valuable data that may aid clinicians in optimizing mesh selection for specific patients and repair conditions.