Dissociation Between the Growing Opioid Demands and Drug Policy Directions Among the U.S. Older Adults with Degenerative Joint Diseases

We aim to examine temporal trends of orthopedic operations and opioid-related hospital stays among seniors in the nation and states of Oregon and Washington where marijuana legalization was accepted earlier than any others. As aging society advances in the United States (U.S.), orthopedic operations and opioid-related hospital stays among seniors increase in the nation. A serial cross-sectional cohort study using the healthcare cost and utilization project fast stats from 2006 through 2015 measured annual rate per 100,000 populations of orthopedic operations by age groups (45–64 vs 65 and older) as well as annual rate per 100,000 populations of opioid-related hospital stays among 65 and older in the nation, Oregon and Washington states from 2008 through 2017. Orthopedic operations (knee arthroplasty, total or partial hip replacement, spinal fusion or laminectomy) and opioid-related hospital stays were measured. The compound annual growth rate (CAGR) was used to quantify temporal trends of orthopedic operations by age groups as well as opioid-related hospital stays and was tested by Rao–Scott correction of χ2 for categorical variables. The CAGR (4.06%) of orthopedic operations among age 65 and older increased (P...) (See full abstract in article

High-resolution magnetic resonance imaging of intracranial aneurysms treated by flow diversion

Object: Flow diverter treatment of intracerebral aneurysms is highly successful and has low rates of morbidity and mortality. Among the primary concerns after endovascular treatment are failure to achieve aneurysm obliteration and recurrence, and close imaging follow-up is required. High-resolution magnetic resonance imaging (HRMRI) is being employed in evaluation of an increasingly wide variety of pathological conditions, but investigations into its use after flow diversion for aneurysm treatment have been limited. We present a brief overview of the literature on the use of HRMRI as a follow-up tool after aneurysm treatment using flow diversion, along with a case series describing three patients in whom we used HRMRI to assess aneurysm treatment response. Case descriptions: Patient 1 presented with an ischemic stroke and was found to have an unruptured ophthalmic segment aneurysm. Patient 2 presented with subarachnoid hemorrhage from a ruptured vertebral artery pseudoaneurysm. Patient 3, on workup for possible metastatic melanoma, was found to have an unruptured posterior communicating aneurysm. All three were treated with flow diversion, and in all three cases HRMRI was used to evaluate aneurysm obliteration on outpatient follow-up. HRMRI offered excellent resolution of the parent vessel, aneurysm sac, and aneurysm wall, demonstrating decreased or loss of flow-related enhancement in the aneurysm lumen and development of aneurysm sac thrombosis. Conclusion: HRMRI is a useful tool to evaluate aneurysm treatment by flow diversion and may represent an alternative to repeat digital subtraction angiography. Keywords: High-resolution MRI, Flow diverter, Aneurys

Inhibitory Effect of on Stroke Recurrence in Small Vessel Disease Patients: A 5-Year Observational Study

We investigated the stroke recurrence rate and the rate of adverse effects induced by an herbal medicine, Chunghyul-dan , administered to patients over a 5-year period. We prescribed 600 mg Chunghyul-dan a day to patients with small vessel diseases and investigated stroke recurrence, adverse effects, and drug compliance for 5 years. The primary outcome was the prevalence of stroke recurrence (in 3, 4, and 5 years). The secondary outcome was the frequency of adverse effects induced by Chunghyul-dan . We recruited 400 patients. Among them, 270, 233, and 195 patients completed 3, 4, and 5 years of follow-up, respectively. Among patients who completed 3, 4, and 5 years of follow-up, cumulative recurrent stroke occurred in 7 (2.6%), 11 (4.7%), and 12 (6.2%) patients. There were no adverse effects. We suggest that Chunghyul-dan might be useful for the inhibition of stroke recurrence by reducing microangiography progression. Further study is needed to confirm our hypothesis