Battle of the cost reports. New study from the Blues blames hospitals for rising healthcare costs; hospital groups say insurers are the problem

The Chicago-based Blue Cross and Blue Shield Association last week released a report scrutinizing hospitals' role in healthcare cost inflation, which at 10% last year was the highest in a decade. Blues association President and CEO Scott Serota (left) defended the report, which angered hospital groups.     

Trickle-down theory. Anthem's expensive acquisition of Trigon Healthcare raises question of whether local providers may end up with the bill

Anthem's acquisition of Trigon Healthcare, its largest deal to date at $4 billion in cash and stock, gives the insurer a sturdy foothold in the Southeast while rewarding Trigon's shareholders with a profit. Anthem CEO Larry Glasscock (right) and Trigon CEO Thomas Snead expect a smooth transition. Anthem has taken a pricey step toward becoming the No. 1 Blues plan consolidator. But will local providers end up footing much of the bill?     

The Occurrence of Five Unregulated Mycotoxins Most Important for Traditional Dry-Cured Meat Products

This study investigated the occurrence of 5 unregulated mycotoxins in a total of 250 traditional dry-cured meat products sampled in 2020 and 2021 in five Croatian regions (eastern, northern, central, western, and southern). Aflatoxin B₁ (AFB₁), ochratoxin A (OTA), sterigmatocystin (STC), citrinin (CIT), and cyclopiazonic acid (CPA) concentrations were related to the geographical region of the product’s origin and to local weather. The results revealed the contamination of 27% of samples, namely, STC in 4% of samples in concentrations of up to 3.93 µg/kg, OTA in 10% of samples in concentrations of up to 4.81 µg/kg, and CPA in 13% of samples in concentrations of up to 335.5 µg/kg. No AFB₁ or CIT contamination was seen. Although no statistically significant differences in concentrations of individual mycotoxins across the production regions were found, differences in mycotoxin occurrence were revealed. The eastern and western regions, with moderate climate, delivered the largest number of contaminated samples, while the southern region, often compared with subtropics, delivered the smallest, so that the determined mycotoxins were probably mainly produced by the Penicillium rather than the Aspergillus species. Due to the interaction of various factors that may affect mycotoxin biosynthesis during production, the detected concentrations cannot be related solely to the weather.     

Omental Morgagni-Larrey hernia: an anatomical pictorial essay

This paper reports on a case of an omental diaphragmatic hernia revealed during routine anatomical dissection of an obese 85-year-old male with plethoric appearance of the upper body. The hernial mass, with a size of 12 cm x 9 cm, was detected in the anterior mediastinum. It had a long peduncle originating from the transverse colon and passing through the right sternocostal diaphragmatic opening of Morgagni-Larrey. The whole greater omentum was tightly packed and tumid within the serous hernial sac, but without signs of torquation. To our knowledge, this is the first systematic analysis of the omental hernial anatomy by a step-by-step iconography.     

Diagnosis of intraductal papillary mucinous neoplasm using endoscopic ultrasound guided microbiopsies:A case report

Pancreatic cysts are increasingly diagnosed due to expanding use of cross-sectional imaging,but current diagnostic modalities have limited diagnostic accuracy.Recently,a novel through-the-needle microbiopsy forceps has become available,offering the possibility of obtaining cyst-wall biopsies.We present a case of 41-year-old male with chronic pancreatitis and a 2-cm pancreatic cyst,initially considered a pseudocyst.Subsequently,endoscopic ultrasou-nd guided microbiopsies were successfully obtained,which surprisingly revealed an intraductal papillary mucinous neoplasm of mixed subtype with low grade dysplasia.In conclusion,obtaining biopsies from the wall of the pancreatic cystic lesions with this novel instrument is feasible and,as demonstrated in this case,can possibly alter the clinical outcome.Microbiopsies offered enough cellular material,allowing supplemental gene mutation analysis,which combined with other modalities could lead to a more individual approach when treating pancreatic cysts.However,prospective studies are warranted before routine clinical implementation.     

HCV‐specific T cells in HCV/HIV co‐infection show elevated frequencies of dual Tim‐3/PD‐1 expression that correlate with liver disease progression

Co‐infection of HCV with HIV has been associated with more rapid progression of HCV‐related disease. HCV‐specific T‐cell immune responses, which are essential for disease control, are attenuated in co‐infection with HIV. T‐cell exhaustion has recently been implicated in the deficient control of chronic viral infections. In the current study, we investigated the role of programmed death‐1 (PD‐1) and T‐cell immunoglobulin and mucin domain‐containing molecule‐3 (Tim‐3) expression in T‐cell exhaustion during HCV/HIV co‐infection. We show that in HCV/HIV co‐infection, both total and HCV‐specific T cells co‐express Tim‐3 and PD‐1 in significantly higher frequencies, compared with HCV mono‐infection. Co‐expression of these two markers on HCV‐specific CD8⁺ T cells positively correlated with a clinical parameter of liver disease progression. HCV‐specific CD8⁺ T cells showed greater frequencies of Tim‐3/PD‐1 co‐expression than HIV‐specific CD8⁺ T cells, which may indicate a greater degree of exhaustion in the former. Blocking Tim‐3 or PD‐1 pathways restored both HIV‐ and HCV‐specific CD8⁺ T‐cell expansion in the blood of co‐infected individuals. These data demonstrate that co‐expression of Tim‐3 and PD‐1 may play a significant role in HCV‐specific T‐cell dysfunction, especially in the setting of HIV co‐infection.