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Background: Buprenorphine-naloxone (BUP-NX) is a first-line treatment for opioid use disorder and has a superior safety profile compared to other forms of opioid agonist therapy. In Canada, restrictions on BUP-NX prescribing were relaxed in 2016, which may have had an effect on rates of diversion and non-prescribed use. We sought to longitudinally examine the reported availability and use of non-prescribed BUP-NX among people who use drugs (PWUD) in an urban Canadian setting., Methods: We collected data from two linked prospective cohorts of PWUD in Vancouver, Canada, and examined self-reported availability and use of non-prescribed BUP-NX over time. We used a multivariable generalized estimating equations model to identify trends and factors associated with the immediate availability (i.e., within 10 min) of non-prescribed BUP-NX., Results: Among 1617 participants between 2014 and 2020, the immediate availability of non-prescribed BUP-NX increased from 16% to 63% (p<0.001). In the multivariable analysis, factors independently associated with immediate BUP-NX availability included calendar year (adjusted odds ratio = 1.19, 95% confidence interval: 1.15-1.23), along with a number of other variables suggestive of more severe substance use disorders. Only 17 participants ever reported use of non-prescribed BUP-NX., Conclusions: We observed that BUP-NX has become increasingly available in the unregulated drug supply in recent years but its use has remained infrequent in this setting. These results suggest that relaxed restrictions on BUP-NX prescribing have not been a major driver of increased non-prescribed use in this population., Competing Interests: Declarations of Interest The authors report no conflicts of interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)

A novel route was created to facilitate the degradation of diethyl phthalate (DEP) upon micellar polyoxometalate (POM) catalysts and H 2 O 2 . The best catalytic activity was obtained using [C 16 H 33 N(CH 3 ) 3 ]H 4 PMo 10 V 2 O 40 (N-hexadecyl-N,N,N-trimethylammonium tetrahydrogen decamolybdo-divanadophosphate, abbreviated as (CTA)H 4 PMoV) with 90.2% degradation efficiency within 30 min, while the chemical oxygen demand (COD) and total organic carbon (TOC) removal efficiency were about 77.7% and 74.3% within 40 min. The highest efficiency was attributed to the concentration of DEP by amphiphilic POM catalyst, coupling with its strong Brønsted acidity and higher redox potential to catalyze esterolysis and oxidation of DEP. This allowed the phthalate acid esters (PAEs) with long carbon chains in super low concentration of 0.03 μM to be efficiently decomposed. The above synergistic effects explored DEP being degraded into ethanol, lactic acid and CO 2 , which were non-toxic to the water surroundings. And the reaction activation energy (Ea) of 12.49 kJ/mol was obtained upon the degradation of DEP with (CTA)H 4 PMoV followed first-order kinetics. Meanwhile, (CTA)H 4 PMoV acted as a heterogeneous catalyst, which showed long duration and higher stability with only 3.7% loss amount during ten recycles., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Spina bifida is a common cause of pediatric neurogenic bladder. It causes renal failure in almost 100% of patients if the associated detrusor sphincter dyssynergia (DSD) is inadequately managed. Detrusor instability and high detrusor pressures (Figure) have been implicated as the major factors predictive of renal damage in these patients. Urodynamic studies provide early identification of "at risk" kidneys so that appropriate intervention can be made. However, the role in post-operative patients of spina bifida who have no clinical manifestations remains unclear., Objective: To study the bladder dynamics in asymptomatic post-operative patients of spina bifida and to determine whether routine urodynamic study is justifiable., Material and Methods: Urodynamics was performed on 15 operated patients of spina bifida who did not have any neurological deficit and were asymptomatic., Results: The mean age of the patients was 4.97 years. None of the patients had any urological complaints with their ultrasonography being normal. None had scars on nuclear scan. Of the 15 patients, 12 (80%) had abnormal findings on urodynamic assessment. Three patients (20%) had detrusor pressures greater than 40 cm of H 2 O. One patient had significant residual urine and detrusor instability., Discussion: The use of urodynamic studies in asymptomatic patients of spina bifida remains controversial, with one school of thought advocating early invasive urodynamic testing. In contrast, some favor noninvasive sonological monitoring, reserving invasive tests only for patients with renal tract dilatation. In our subset of patients none had renal tract dilatation but three patients (20%) had "at risk" bladders. These patients would benefit from early intervention aimed at renal preservation. The study is limited by a small sample size because of the relative rarity of the patient profile included. A further multicenter study with a case-control design could conclusively indicate the role of urodynamic testing in these patients., Conclusion: Patients of spina bifida, even when asymptomatic, have a high incidence of unsafe bladders. Early identification and appropriate measures can protect kidneys from long-term damage, hence urodynamic profiling is mandatory for identification of potentially high-risk bladders., (Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Objective: To report the results of recto sigmoid bladder reservoir (RSBR), a variant of ureterosigmoidostomy (US) in patients with bladder exstrophy (BE) using a three dimensional evaluation system., Patients and Methods: This was a predominantly retrospective evaluation for all patients of BE undergoing RSBR who had completed minimum of 1 year follow-up. The patients were evaluated using a three dimensional system which included evaluation of urinary continence per rectally, status of upper tracts and health related quality of life (HRQOL)., Results: A total of 19 patients (four females) were evaluated. Mean age was 8.4 years, and mean duration of follow-up was 3.4 years. Mean age at RSBR was 5.1 years. Ten patients had good rectal continence. There was occasional minimal urine leak while passing flatus or on straining in nine. All patients had preserved renal function except one. The mean HRQOL score was 129.7 out of maximum of 150.., Conclusions: RSBR gives marked improvement in quality of life in patients of BE. In the literature there is a non-uniformity in the results reporting outcome of US. The presented three dimensional assessment provides a comprehensive way to report the results in the short/long term. If used by other surgeons it would make comparison across centers feasible., (Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Inflammasomes are large multiprotein complexes that have the ability to sense intracellular danger signals through special NOD-like receptors or NLRs. They include NLRP3, NLRC4, AIM2 and NLRP6. They are involved in recognizing diverse microbial (bacteria, viruses, fungi and parasites), stress and damage signals, which result in direct activation of caspase-1, leading to secretion of potent pro-inflammatory cytokines and pyroptosis. NLRP3 is the most studied antimicrobial immune response inflammasome. Recent studies reveal expression of inflammasomes in innate immune response cells including monocytes, macrophages, neutrophils, and dendritic cells. Inflammasome deficiency has been linked to alterations in the gastrointestinal microflora. Alterations in the microbiome population and/or changes in gut permeability promote microbial translocation into the portal circulation and thus directly to the liver. Gut derived lipopolysaccharides (LPS) play a significant role in several liver diseases. Recent advancements in the sequencing technologies along with improved methods in metagenomics and bioinformatics have provided effective tools for investigating the 10(14) microorganisms of the human microbiome that inhabit the human gut. In this review, we examine the significance of inflammasomes in relation to the gut microflora and liver. This review also highlights the emerging functions of human microbiota in health and liver diseases.

Aim: Outcomes of bladder exstrophy patients were studied in numerical terms using scoring systems for continence and health-related quality of life (HRQOL), along with renal function, in short-term follow up., Patients and Methods: Patients who had undergone bladder-preserving exstrophy repairs, either staged or as a single procedure, and those who had been managed by bowel augmentation were included. Continence was assessed according to five variables (max. score 15) and HRQOL assessment was by means of a structured modified questionnaire scored on a Likert-scale model (max. score 150)., Results: A total of 39 patients were followed. Mean age was 8.3 years and mean follow up duration 3 years. Mean HRQOL score was 107.55 (83-133, SD ± 19.31). Mean continence score was 8.73 (6-11, SD ± 1.544)., Conclusions: Evaluation of bladder exstrophy outcomes should not be done merely by reporting the length of dry intervals. If performed in numerical terms as outlined in this series, patients across centres will be comparable over a common assessment protocol. Continence score achieved in this series was low in comparison to the literature due to the strict evaluation protocol., (Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.)

Aim: To determine the usefulness of infra-umbilical mini-vesicostomy in infants with posterior urethral valves (PUV), in developing countries. This new technique facilitates clean intermittent catheterization (CIC) and overnight bladder drainage, which have been effectively used for the treatment of valve bladders in the developed world., Methods: A retrospective analysis of the records of three infants who underwent a mini-vesicostomy between 2005-2009 was done. All were put on CIC in the neonatal period. Monitoring of renal parameters, bladder function and structural changes in the bladder was done before and after 4 years of CIC., Results: All three showed a decrease in upper tract dilatation, improvement in cortical function and improvement of bladder compliance at the end of 4 years. Two patients are on CIC through vesicostomy and can pass a good stream of urine per urethraly, and in one the vesicostomy has been closed., Conclusion: Mini-vesicostomy is a useful option to allow CIC on a long-term basis in children with PUV. There were no complications with this technique in this small group of patients, and it has been well accepted by their families., (Copyright © 2010 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)