Opsonophagocytosis of fluorescent polystyrene beads coupled to Neisseria meningitidis serogroup A, C, Y, or W135 polysaccharide correlates with serum bactericidal activity

We developed a polysaccharide-specific flow cytometric opsonophagocytic assay (OPA) for the simultaneous measurement of functional antibody to Neisseria meningitidis serogroups A, C, Y, and W135. OPA titers significantly correlated with serum bactericidal assay titers for all serogroups tested (mean r = 0.96; P < 0.001). OPA could be used in meningococcal vaccine evaluation.     

Atypical lipid-dependent Malassezia species isolated from dogs with otitis externa

During a survey of the occurrence of Malassezia species in the external ear canals of dogs with chronic otitis externa, lipid-dependent Malassezia species were isolated in three dogs. These species were identified as Malassezia furfur and M. obtusa but showed atypical assimilation patterns. To our knowledge, this is the first report of the isolation of lipid-dependent species of the genus Malassezia in association with canine otitis.     

Isolation of Malassezia furfur from a cat

During a survey of the occurrence of Malassezia species in the external ear canals of cats without otitis externa, Malassezia furfur was isolated. This is the first report of the isolation of M. furfur from cats.     

Improvement in Breast Reconstruction Disparities following Medicaid Expansion under the Affordable Care Act

Background

 Under the Affordable Care Act, Medicaid expansion effective 1 January 2014 aimed to increase access to health care. We sought to determine the association of Medicaid expansion with disparities in utilization of breast reconstruction.

Methods

Non-Hispanic Black (NHB) and White (NHW) breast cancer patients undergoing mastectomy +/? reconstruction between 2010 and 2017 were selected from the National Cancer Database. Annual trends for utilization of breast reconstruction by race, income, and education were evaluated by Medicaid expansion status using difference-in-differences regression analyses. Medicaid expansion was categorized by expansion date as early (2010–2013), 2014 (1/2014), late (after 1/2014), or no expansion.

Results

Of 443,607 patients, 36.3% (n = 161,128) underwent reconstruction, 13.1% (n = 58,249) were NHB, 16.8% (n = 74,430) had median income < $40,227, and 17.1% (n = 75,718) were in the lowest education quartile. In non-expansion states, lower proportions of NHB patients underwent reconstruction than NHW patients in all years, with the smallest disparity (NHB% ? NHW%) (? 6.4%) in 2017. Decreases in disparities between NHB and NHW patients were seen with the smallest difference observed in 2014 (? 2.5%) in early-expansion states, in 2017 (? 0.7%) in 1/2014 expansion states, and in 2017 (? 4.5%) in late-expansion states. Similar findings for convergence of reconstruction utilization rates for the lowest two education levels and lowest two income quartiles were found with Medicaid expansion, with no convergence seen in non-expansion states over the study period.

Conclusions

Some improvement in breast reconstruction disparities followed Medicaid expansion. Failure to improve parity without Medicaid expansion should be a consideration with any modifications to Medicaid access.

     

Influence of bispectral index monitoring on fentanyl requirements during total intravenous anesthesia for major gynecological surgery]

OBJECTIVE: To determine the influence that bispectral index (BIS) monitoring of hypnosis might have on need for analgesia during surgery under total intravenous anesthesia provided by bolus administration of fentanyl. PATIENTS AND METHOD: Prospective, randomized and partially double-blind study of 40 patients undergoing major gynecological surgery under total intravenous anesthesia with propofol and fentanyl. In the BIS group (n = 20) propofol administration was adjusted to maintain BIS between 40 and 60. In the control group (n = 20) standard doses were given: 10 mg/kg-1/h-1 after anesthetic induction and for 5 minutes, 8 mg/kg-1/h-1 over the next 5 minutes and 6 mg/kg-1/h-1 throughout the rest of the operation. All patients received intravenous bolus administration of 150 or 75 microg of fentanyl to maintain analgesia whenever systolic blood pressure and heart rate increased 20% over baseline. We compared propofol and fentanyl requirements, intraoperative changes in BIS, and awakening from anesthesia. RESULTS: Patient and surgical characteristics were similar in both groups. BIS monitoring allowed propofol administration to be decreased a mean 24% during maintenance of anesthesia, and this in turn was associated with a significant increase in mean dose of fentanyl (415 microg versus 253 microg in the BIS and control groups, respectively; p = 0.01). Mean values of BIS were higher in the BIS group (46.4 versus 42.2; p = 0.04) and patients in the BIS group awoke sooner (in 7.7 min versus 11.1 min; p = 0.01) and tended to report less pain upon arrival at the postanesthetic recovery room, although the difference was not statistically significant. CONCLUSIONS: BIS monitoring of depth of hypnosis can influence requirements for fentanyl during total intravenous anesthesia by bolus dosing for maintenance of analgesia. This is probably due to changes in the administration of propofol made possible by BIS monitoring.     

Guidelines of the Spanish Society of Cardiology for clinical practice in exercise testing

Most exercise testing is performed in adults with known or suspected ischemic heart disease. In the last few years cardiac imaging techniques have been applied in this field, improving the information obtained with the procedure. However, the exceptions to this rule are emerging rapidly not only in healthy people (asymptomatic individuals, athletes, handicapped people) but also in cardiac patients (advanced congestive heart failure, hypertension, rhythm disorders, congenital heart disease, etc.). All the-se issues justify the need for a multidisciplinary consensus document in Spain.This paper reviews and updates the methodological aspects of the stress test, including those related to oxygen consumption measurements. The main aim of this review was to determine the role of exercise testing in the evaluation of ischemic heart disease as well as the applications of imaging stress testing. The usefulness of this test in other non-ischemic cardiac disorders and in selected subsets of healthy people is also reviewed.