Surgonomics: the cost dynamics of craniotomy

Prospective payment systems using the diagnostic related group (DRG) mechanism are being phased in for Medicare inpatient hospital care. The purpose of this study was to examine a common neurosurgical procedure (001), craniotomy without trauma, and characterize the cost dynamics of this DRG. All patients (n = 50) treated in this DRG at the Long Island Jewish Medical Center during 1983 had their financial charges exclusive of physician fees examined. The findings were: (a) each hospital service category had wide charge variances around the mean; (b) emergency (ER) admissions were 200% more expensive than nonemergency (non-ER) admissions; (c) ER admissions seemed to have no greater severity of illness than non-ER admissions, but had a significantly different referral pattern (i.e., admission from the ER to a nonneurosurgical service with a subsequent neurosurgical referral); (d) this DRG when grouped into clinical "subproducts" (i.e., craniotomy for tumor, hematoma, hydrocephalus, aneurysm, benign cyst, and other) showed marked charge differences; and (e) the most expensive 25% of patients had five times higher charges than the least expensive 25% for both ER and non-ER admissions. This type of financial analysis may give surgeons a methodology with which to address the problems of cost containment in a more serious manner.     

Human Diversity of Killer Cell Immunoglobulin-Like Receptors and Human Leukocyte Antigen Class I Alleles and Ebola Virus Disease Outcomes

We investigated the genetic profiles of killer cell immunoglobulin-like receptors (KIRs) in Ebola virus–infected patients. We studied the relationship between KIR–human leukocyte antigen (HLA) combinations and the clinical outcomes of patients with Ebola virus disease (EVD). We genotyped KIRs and HLA class I alleles using DNA from uninfected controls, EVD survivors, and persons who died of EVD. The activating 2DS4–003 and inhibitory 2DL5 genes were significantly more common among persons who died of EVD; 2DL2 was more common among survivors. We used logistic regression analysis and Bayesian modeling to identify 2DL2, 2DL5, 2DS4–003, HLA-B-Bw4-Thr, and HLA-B-Bw4-Ile as probably having a significant relationship with disease outcome. Our findings highlight the importance of innate immune response against Ebola virus and show the association between KIRs and the clinical outcome of EVD.     

进展期胃癌多药耐药基因表达的临床意义

目的 探讨多药耐药基因（MDR1基因）在人胃癌组织中的表达及其与临床病理的关系。方法 采用逆转录－多聚酶链反应（RT－PCR）法检测了215例手术切除的进展期胃癌组织中的MDR1基因的表达。实验数据采用SAS软件中的χ^2检验和Fisher’s exact P做统计学处理。结果 MDRI基因的阳性率为31．63％（68／215）,与年龄、性别、组织学类型、分化程度、淋巴结转移、Borromann分型及TNM分期等无关,但在分化差的肿瘤中有增高趋势,如黏液腺癌及印戒细胞癌中达41．67％及50．00％。结论 化疗前胃癌组织中MDRI基因即存在较高的表达率,这为选用化疗药物和MDR逆转剂提供了参考指标,但不能作为制定化疗方案的唯一指标。     

Effect of photobiomodulation therapy on the proliferation phase and wound healing in rats fed with an experimental hypoproteic diet

Lasers in Medical Science - Photobiomodulation therapy (PBMT) has been indicated for enforcement on healing skin wounds. This study evaluated the effects of PBMT on the healing of skin wounds...     

Fractionated carbon dioxide (CO2) laser treatment contributes to trans-nail penetration of rhodamine B and changes of cytokine microenvironment

Lasers in Medical Science - This study is to determine the role of the fractional CO2 laser in topical drug delivery and the impact of local immune responses. Experimental rabbit nails were treated...     

Observation versus radiotherapy with or without temozolomide in postoperative WHO grade II high-risk low-grade glioma: a retrospective cohort study

The optimal adjuvant treatment of high-risk low-grade glioma (LGG) is controversial. We performed this retrospective cohort study to compare three treatments including observation, radiotherapy (RT) alone, and radiotherapy combined with concomitant and adjuvant temozolomide (TMZ) chemotherapy (STUPP regimen) in patients with high-risk LGG. Patients with high-risk (age > 40 or undergoing subtotal resection or biopsy) LGG treated with observation or radiotherapy alone or STUPP regimen after operation were retrospectively analyzed. Survival rates were evaluated by the Kaplan-Meier method; the log-rank test was applied to compare differences between groups. A total of 250 patients met the inclusion criteria. Median follow-up for living people was 70 months. Overall, patients who received radiotherapy with or without temozolomide had better progression-free survival (PFS) and overall survival (OS) when compared with observation (median PFS: observation, 59 months; RT, 82 months; STUPP, not reached; median OS: observation, 96 months; RT, not reached; STUPP, not reached), whereas STUPP regimen did not further prolong PFS or OS than RT alone (PFS, P = 0.203; OS, P = 0.146). In oligodendroglioma (IDH mutant and 1p/19q codeleted) subtype, only STUPP regimen brought longer PFS when compared with observation (P = 0.008). The incidence of grade 3 or 4 neutropenia (P < 0.001) and nausea or vomiting (P = 0.004) was higher in the STUPP group than the figure for the RT alone group. PFS and OS were similarly improved in patients with high-risk LGG receiving RT alone or STUPP regimen. However, only STUPP regimen was able to bring better PFS for oligodendroglioma (IDH mutant and 1p/19q codeleted) subgroup. Longer follow-up time is needed to determine an association with treatment effect in different histological and molecular subgroups.

     

Resumen ejecutivo del Documento de Consenso de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) y de la Asociación Española de Cirujanos (AEC) en profilaxis antibiótica en cirugía

Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and antimicrobial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised.The Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis in surgery to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery.     

Weight-bearing radiographs and cone-beam computed tomography examinations in adult acquired flatfoot deformity

BackgroundOptimal characterization of Adult acquired flatfoot deformity (AAFD) on two-dimensional radiograph can be challenging. Weightbearing Cone Beam CT (CBCT) may improve characterization of the three-dimensional (3D) structural details of such dynamic deformity. We compared and validated AAFD measurements between weightbearing radiograph and weightbearing CBCT images.Methods20 patients (20 feet, right/left: 15/5, male/female: 12/8, mean age: 52.2) with clinical diagnosis of flexible AAFD were prospectively recruited and underwent weightbearing dorsoplantar (DP) and lateral radiograph as well as weightbearing CBCT. Two foot and ankle surgeons performed AAFD measurements at parasagittal and axial planes (lateral and DP radiographs, respectively). Intra- and Inter-observer reliabilities were calculated by Intraclass correlation (ICC) and Cohen’s kappa. Mean values of weightbearing radiograph and weightbearing CBCT measurements were also compared.ResultsExcept for medial-cuneiform-first-metatarsal-angle, adequate intra-observer reliability (range:0.61?0.96) was observed for weightbearing radiographic measurements. Moderate to very good interobserver reliability between weightbearing radiograph and weightbearing CBCT measurements were observed for the following measurements: Naviculocuneiform-angle (ICC:0.47), Medial-cuneiform-first-metatarsal-gapping (ICC:0.58), cuboid-to-floor-distance (ICC:0.68), calcaneal-inclination-angle(ICC:0.7), axial Talonavicular-coverage-angle(ICC:0.56), axial Talus-first-metatarsal-angle(ICC:0.62). Comparing weightbearing radiograph and weightbearing CBCT images, statistically significant differences in the mean values of parasagittal talus-first-metatarsal-angle, medial-cuneiform-first-metatarsal-angle, medial-cuneiform-to-floor-distance and navicular-to-floor-distance was observed (P < 0.05).ConclusionModerate to very good correlation was observed between certain weightbearing radiograph and weightbearing CBCT measurements, however, significant difference was observed between a number of AAFD measurements, which suggest that 2D radiographic evaluation could potentially underestimate the severity of AAFD, when compared to 3D weightbearing CT assessment.