Morphine infusion through Intrathecal Drug Delivery System (IDDS) is widely used to relieve refractory cancer pain. However, continuous escalation of morphine dose caused by opioid tolerance and/or progress of cancer was commonly observed. Combining morphine with medications of different analgesic mechanisms is applied to blunt the rate of morphine increase. The purpose of this study was to determine the analgesic efficacy and safety of combining gabapentin with morphine after IDDS implantation.

This study compared patients that received IDDS implantation from January 1, 2017 to November 10, 2018 in our institute. Key outcomes included change in mean pain score, dose of morphine used in patients, percentage of patients with 30% and 50% reduction in mean pain score, Patient Global Impression of Change scores, breakthrough pain characters and side effects.

34 patients in the combination group (morphine + gabapentin) and 40 patients in the monotherapy group(morphine)were analyzed. The results showed that both therapy groups achieved similar analgesic efficacy, demonstrated by Numerical rating scale (2.42 ± 0.88 vs 2.57 ± 0.85; Combination vs Monotherapy), PGIC and responder status. Mean daily dose of morphine was significantly lower in combination group compared to monotherapy group (3.54 ± 1.29mg vs 4.64 ± 1.28mg, P = 0.007). More patients experienced dizziness and somnolence after receiving combination therapy compared to morphine-alone treatment although no statistical significance was found (P = 0.49).

Addition of gabapentin achieved similar analgesic efficacy with lower dose of morphine compared to morphine alone accompanying with higher incidence of dizziness and somnolence.

Addition of gabapentin achieved similar analgesic efficacy with lower dose of morphine compared to morphine alone accompanying with higher incidence of dizziness and somnolence.

To compare brain magnetic resonance imaging (MRI) using T1 3D Silent and fast T1 3D Gradient-Echo (GRE) BRAin VOlume (known as BRAVO) sequences. The primary aim is to assess the quantitative and qualitative analysis of Silent and BRAVO images by the measurement of the contrast (C), the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR). The second aim is to estimate the subjective sound levels and the specific absorption rate (SAR).

Twenty-two subjects had T1 3D Silent and T1 3D BRAVO sequences added to the standard MR examination. The qualitative analysis of the two sequences was performed by two radiologists independently. The quantitative analysis was performed by placing regions of interest on the cerebrospinal fluid, on the white and grey matter. The C, the CNR and the SNR were calculated for each sequence. After each T1-3D sequence, subjects gave a score rating to evaluate the acoustic noise. Finally, the SAR was evaluated by the digital imaging and communications in medicine (DICOM) tags.

The image quality scores obtained by the two radiologists were higher for BRAVO compared to the Silent. However, qualitatively, the Silent images were similar to BRAVO for diagnostic use. Quantitatively, CNR for GM-CSF was comparable in the two sequences and SNR in CSF was higher in Silent than BRAVO. The acoustic noise of Silent sequence was statistically lower compared with BRAVO. The maximum SAR measured was 1.4W/kg.

3D T1 Silent can be a valid alternative technique to conventional BRAVO to reduce the acoustic noise preserving the diagnostic accuracy. However, radiologists preferred the conventional sequence to Silent.

3D T1 Silent can be a valid alternative technique to conventional BRAVO to reduce the acoustic noise preserving the diagnostic accuracy. However, radiologists preferred the conventional sequence to Silent.Rainfall events induce water quality transformation in river systems influenced by the watershed land use and hydrology dynamics. In this context, an adaptive monitoring approach (AMA) is used to assess non-point sources (NPS) of pollution events, through dissolved organic matter (DOM) contribution. The case study is a monitoring site in a semi-urban watershed characterized by NPS contribution. An integrated quali-quantitative method for DOM based on dissolved organic carbon (DOC) content, spectroscopic techniques of excitation-emission fluorescence (EEF), and UV-visible absorbance is proposed. The results indicate a mix of allochthonous and autochthonous DOM characteristics from NPS sources associated to vegetation area influence (A285/DOC of 15.43 L (g cm)-1 and SUVA254 of 2.11 L (mg m)-1). The EEF signals showed more humic-like than protein-like characteristics with peaks A and C (approximately 5.72 r.u.) more intense than peaks B, T1, and T2 (approximately 4.33 r.u.), indicating NPS from the soil leachate. The absorbance ratio values indicate a mix of organic compounds with greater proportion of refractory characteristics with high aromaticity and molecular weight (approximately A300/A400 of 4.15 and A250/A365 of 4.48), associated with the surface wash-off of accumulated residual and subsurface soil erosion, which contribute to complex organic matter structures. The fluorescence indexes, overall, indicated allochthonous sources with intermediate humic characteristics (FI ≈ 1.43, BIX ≈ 0.65, and HIX ≈ 7.98). The proposed integrated optical property strategy represents an opportunity for better understanding of DOM dynamic assessment for identifying potential mitigation techniques for organic pollution control and improving water quality conditions.The South Korean government is seeking information on the environmental conservation value (ECV) of Cypripedium japonicum, a plant on the first-level priority endangered species list of the Korea Ministry of Environment, as well as on the Red List of the International Union for Conservation of Nature. This research paper aims to assess the ECV by employing contingent valuation (CV) to elicit people’s willingness to pay (WTP) for its conservation. To achieve this aim, in May 2020, a CV survey of 1,000 interviewees in South Korea was carried out employing a closed-ended question. PI3K inhibitor The average household WTP is estimated to be KRW 3,770 (USD 3.07) per annum and secures statistical significance. From a national point of view, using information on the national population, this value comes to KRW 76.72 billion (USD 62.42 million) per year. Although the cost of conserving the species has not yet been accurately estimated, the ECV seems to be larger than the cost of conservation. Thus, it is socially desirable to conserve Cypripedium japonicum, and the conservation should be carried out in a stable and continuous manner.