Petersonhahn8679

The causes and pathophysiology of BME are reviewed. Dual-energy CT image acquisition and VNCa postprocessing techniques are also discussed, along with their applications in emergency settings. The authors present potential pitfalls and limitations of these techniques and their possible solutions.©RSNA, 2020.Although US is one of the most used modalities for head and neck imaging, its use in the diagnosis of laryngeal abnormalities is much less widespread. The standard assessment of laryngeal abnormalities currently involves direct laryngoscopy and cross-sectional imaging (either CT or MRI) but rarely US. US is readily available, noninvasive, and radiation free, and it allows real-time imaging (with video for dynamic assessment), higher resolution than that of cross-sectional imaging, and the performance of targeted fine needle aspiration cytology or biopsy. This modality, particularly with the advent of high-resolution US, has been found to be at least comparable to CT or MRI for diagnosis of malignant lesions and benign abnormalities such as vocal nodules, polyps, cysts, and Reinke edema. Furthermore, it has been found to be more sensitive for diagnosis of abnormalities such as small glottic tumors, and its dynamic capability can be used to identify functional abnormalities such as vocal cord palsy. The authors outline the technique of laryngeal US, which includes strategies to avoid calcified laryngeal cartilage by imaging through the thyrohyoid and cricothyroid membranes with a five-sweep strategy supplemented by cine film of the technique. They also provide US images of common laryngeal abnormalities such as tumors with and without extralaryngeal extension; vallecular, thyroglossal, and vocal cord cysts; laryngeal mucoceles; and vocal cord palsy. Online supplemental material is available for this article. ©RSNA, 2020.Background Surgical site infections (SSIs) are recognized complications of surgical procedures. Methicillin-resistant Staphylococcus aureus (MRSA) colonization increases the likelihood of developing SSIs. Decolonization of MRSA has been shown to reduce post-operative SSIs, therefore, the aim of this project was to identify and decolonize MRSA carriers and to tailor perioperative antibiotic prophylaxis to protect those at high risk for SSIs better. Methods In September 2013, a quality improvement process initiative was implemented for pre-operative screening of MRSA nasal carriage for patients undergoing elective neurosurgical procedures. Those identified as colonized received a 10-day decolonization protocol that consisted of oral doxycycline 100 mg twice daily or oral trimethoprim-sulfamethoxazole (TMP-SMX) DS twice daily; oral rifampin 600 mg daily; daily bathing with chlorhexidine; and twice daily use of mupirocin ointment in each nostril and under the fingernails. In addition to cefazolin (weight-based doation irrespective of MRSA carriage state.Background Surgical research is potentially invasive, high-risk, and costly. Research that advances medical dogma must justify both its ends and its means. Although ethical questions do not always have simple answers, it is critically important for the clinician, researcher, and patient to approach these dilemmas and surgical research in a thoughtful, conscientious manner. Methods We present four ethical issues in surgical research and discuss the opposing viewpoints. These topics were presented and discussed at the 39th Annual Meeting of the Surgical Infection Society as pro-con debates. The presenters of each opinion developed a succinct summary of their respective reviews for this publication. Results The key subjects for these pro-con debates were (1) Should patients be enrolled for time-sensitive surgical infection research using an opt-out or an opt-in strategy? (2) Should patients who are being enrolled in a randomized controlled trial (RCT) comparing surgery with a non-operative intervention pay the costs of their treatment arm? (3) Should the scientific community embrace open access journals as the future of scientific publishing? (4) Should the majority of funding go to clinical or basic science research? Important points were illustrated in each of the pro-con presentations and illustrated the difficulties that are facing the performance and payment of infection research in the future. Conclusions Surgical research is ethically complex, with conflicting demands between individual patients, society, and healthcare economics. At present, there are no clear answers to these and the many other ethical issues facing research in the future. Answers will only come from continued robust dialogue among all stakeholders in surgical research.Base excision repair, which is initiated by the DNA N-glycosylase proteins, is the frontline for repairing potentially mutagenic DNA base damage. Several base excision repair genes are deregulated in cancer and affect cellular outcomes to chemotherapy and carcinogenesis. THAL-SNS-032 Endonuclease VIII-like 3 (NEIL3) is a DNA glycosylase protein that is involved in oxidative and interstrand crosslink DNA damage repair. Our previous work has showed that NEIL3 is required to maintain replication fork integrity. It is unknown whether NEIL3 overexpression could contribute to cancer phenotypes, and its prognostic value and use as potential drug target remain unexplored. Our analysis of cancer genomics data sets reveals that NEIL3 frequently undergoes overexpression in several cancers. Furthermore, patients who exhibited NEIL3 overexpression with pancreatic adenocarcinoma, lung adenocarcinoma, lower grade glioma, kidney renal clear cell carcinoma, and kidney papillary cell carcinoma had worse overall survival. Importantly, NEIL3 overexpressed tumors accumulate mutation and chromosomal variations. Furthermore, NEIL3 overexpressed tumors exhibit simultaneous overexpression of homologous recombination genes (BRCA1/2) and mismatch repair genes (MSH2/MSH6). However, NEIL3 overexpression is negatively correlated with tumor overexpressing nucleotide excision repair genes (XPA, XPC, ERCC1/2). Our results suggest that NEIL3 might be a potential prognosis marker for high-risk patients, and/or an attractive therapeutic target for selected cancers.Objective ErYAG laser-activated irrigation (LAI) is an effective method of root canal cleaning, but irrigant extrusion from the apical foramen has been a concern. We aimed to analyze the effects of pulse energy, pulse frequency, and laser tip diameter on intracanal vapor bubble kinetics and periapical pressure generation during LAI with ErYAG laser. Background Irrigant vapor bubble kinetics are one of indices of root canal cleaning efficacy. However, few studies have compared laser pulse conditions to vapor bubble kinetics, in relation to periapical pressure. Methods A plastic root canal model (apical diameter 0.50 mm, 6% taper, 20 mm long) was filled with distilled water, and LAI with ErYAG laser (Erwin AdvErl Unit; 30, 50, or 70 mJ; 10, or 20 pulses per second; laser tip R200T or R600T) was performed with the end of the tip fixed at 15 mm from the root apex. The number, maximum diameter, and velocity of vapor bubbles were analyzed by high-speed video imaging. Pressure generated outside the apical foramen was measured with a pressure sensor. Results Vapor bubble count and maximum diameter increased significantly with pulse energy, pulse frequency, and tip diameter. Vapor bubble velocity increased significantly with pulse frequency, but not with pulse energy or tip diameter. Periapical pressure increased significantly with pulse energy, pulse frequency, and tip diameter. Conclusions The pulse frequency was the single factor that significantly affected all the examined parameters (the number, diameter, and velocity) of vapor bubble kinetics together with the periapical pressure.Use of increased premiums for tobacco users in the small-group market fell to 4.1 percent in 2018 from 17.8 percent in 2017 and 16.2 percent in 2016. This decline, possibly due to increased government oversight, occurred without any significant change in the prevalence of tobacco cessation programs. Thus, fewer workers are subject to tobacco surcharges without being provided cessation resources.Involuntary psychiatric treatment for people with serious mental illness should focus on returning to health instead of reducing danger.This article compares patterns of postacute care-including care provided by skilled nursing facilities, inpatient rehabilitation facilities, and home health agencies-under Medicare Advantage and traditional Medicare. Overall, Medicare Advantage enrollees received less postacute care, both institutional and home health, than traditional Medicare enrollees did for three common conditions.To enhance compensation for primary care activities that occur outside of face-to-face visits, the Centers for Medicare and Medicaid Services recently introduced new billing codes for transitional care management (TCM) and chronic care management (CCM) services. Overall, rates of adoption of these codes have been low. To understand the patterns of adoption, we compared characteristics of the practices that billed for these services to those of the practices that did not and determined the extent to which a practice other than the beneficiary's usual primary care practice billed for the services. Larger practices and those using other novel billing codes were more likely to adopt TCM or CCM. Over a fifth of all TCM claims and nearly a quarter of all CCM claims were billed by a practice that was not the beneficiary's assigned primary care practice. Our results raise concerns about whether these codes are supporting primary care as originally expected.Prices charged for health care services in the commercial insurance market are high and vary widely within and between market areas. As a result, prices have been the focus of much policy debate. We extended the literature on commercial prices by examining state-level price variation in the commercial market, relative to Medicare, for a broader set of states and a wider set of services than had been examined. We assessed the potential impact on provider revenue of setting commercial prices at Medicare rates. Consistent with the existing literature, we found that average commercial prices for inpatient and outpatient facility services were about double Medicare fees, while commercial prices for professional services were about 60 percent higher. Finally, average hospital revenue would fall about 35 percent if commercial prices were limited to Medicare rates, but this would vary widely by state. If Medicaid rates were also increased to match Medicare rates, hospital revenue would likely fall by about 30 percent. Given the potentially large impact, policies to address the market failures that lead to high and variable prices in the commercial insurance sector are needed, but they should be structured to avoid the large disruptions that could occur if there were a very rapid transition to Medicare rates in the commercial market.The US is experiencing a complex substance abuse crisis. Not only has opioid overdose mortality increased sharply, by 400 percent from 1999 to 2017, but opioid use during pregnancy contributed to a 300 percent increase in neonatal abstinence syndrome (NAS)-a postnatal drug withdrawal syndrome in infants that is identified at birth-from 1999 to 2013. States have taken myriad policy approaches to combat the opioid crisis and its consequences, and some states have adopted punitive policies toward prenatal substance use. Using data for the period 2000-14 from the State Inpatient Databases of the Healthcare Cost and Utilization Project, this study examined the effect of state-level policies that treat prenatal substance use as child abuse or neglect on the incidence of NAS, maternal narcotic exposure, and substance use treatment admissions for pregnant women. We employed a difference-in-differences approach to estimate the effect of these policies. We did not find evidence that punitive prenatal substance use policies reduced NAS or maternal narcotic exposure at birth; however, we did find evidence that these policies may deter women from seeking substance use treatment during pregnancy.