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Understanding factors that influence technology diffusion is central to clinical translation of novel therapies. We characterized the pattern of adoption for laser interstitial thermal therapy (LITT), also known as stereotactic laser ablation (SLA), in neuro-oncology using the National Inpatient Sample (NIS) database. We identified patients age ≥ 18 in the NIS (2012–2018) with a diagnosis of primary or metastatic brain tumor that underwent LITT or craniotomy. We compared characteristics and outcomes for patients that underwent these procedures. LITT utilization increased ~ 400% relative to craniotomy during the study period. Despite this increase, the total number of LITT procedures performed for brain tumor was 2 comorbidities (OR 0.64, CI95 0.51–0.79) or to be older (OR 0.92, CI95 0.86–0.99) and more likely to be female (OR 1.35, CI95 1.08–1.69), Caucasian compared to Black (OR 1.94, CI95 1.12–3.36), and covered by private insurance compared to Medicare or Medicaid (OR 1.38, CI95 1.09–1.74). LITT hospital stays were 50% shorter than craniotomy (IRR 0.52, CI95 0.45–0.61). However, charges related to the procedures were comparable between LITT and craniotomy ($1397 greater for LITT, CI95 $−5790 to $8584). For neuro-oncology indications, LITT utilization increased ~ 400% relative to craniotomy. Relative to craniotomy-treated patients, LITT-treated patients were likelier to be young, female, non-Black race, covered by private insurance, or with

Many indices have been developed to assess the impact of scientific publications by investigators, disciplines, and institutions. The h-index has emerged as a leading tool in the assessment of the productivity of authors. Differences in publication and citation opportunity among specialties create inappropriate conclusions when the h-index is used to compare authors across different disciplines. An alternative, the Radicchi index, hf, has been proposed to assess the impact of publications across disciplines. We curated a database of all articles published from 2002 to 2015 from the 3 highest impact factor medical journals: New England Journal of Medicine (NEJM), the Lancet, and the Journal of American Medical Association (JAMA). With this database, articles were categorized into medical subspecialties. We calculated the respective h-index and Radicchi index of each specialty. We found that the Radicchi index eliminated variability associated with publication and citation opportunity between different specialties when compared to the h-index. The Radicchi index is a useful measure of scientific impact and productivity that advances the h-index by allowing interspecialty comparisons. There remains a need to define a researcher's specialty designation especially if he/she conducts multidisciplinary research.

Despite the poor prognosis in patients with type 2 myocardial infarction (MI), no prospective data on risk stratification exists. The aim of this study was to develop and validate a model for prediction of 18-month mortality of among patients with type 2 MI (T2MI) and compare its performance with GRACE and TARRACO scores.The prospective observational study included 712 consecutive patients diagnosed with MI undergoing coronary angiography24 h between January 2017 and December 2018. Diagnosis of T2MI was adjusted according to Third universal definition. A prognostic model was developed by using Bayesian approach and logistic regression analysis with identifying predictors for mortality. The model was validated by bootstrap validation. Comparison performance between scores using Delong test.T2MI was identified in 174 (24.4%) patients. The median age of patients was 69 years, 52% were female. The mortality rate was 20.1% at 18 months. Prior MI, presence of ST elevation, hemoglobin level at admission, Charlson comorbidity index and were independently associated with 18-month mortality. The model to predict 18-month mortality showed excellent discrimination (optimism corrected c-statistic = 0.822) and calibration (corrected slope = 0.893). GRACE and TARRACO scores had moderate discrimination [c-statistic = 0.748 (95% CI 0.652-0.843) and 0.741, 95% CI 0.669-0.805), respectively] and inferior compared with model (p = 0.043 and 0.037, respectively).The risk of mortality among T2MI patients could be accurately predicted by using common clinical characteristics and laboratory tests. Further studies are required with external validation of nomogram prior to clinical implementation.

Injuries from Less-lethal Weapons during the George Floyd Protests In this analysis involving patients treated in Minnesota during protests after George Floyd’s death, 89 patients were identified w...

While atherosclerotic plaque disruption remains the hallmark of type 1 myocardial infarction (T1MI), multiple other mechanisms provoking myocardial supply/demand mismatch (eg, anemia and tachyarrhythmias) are recognized as the potential causes of type 2 myocardial infarction (T2MI). In clinical practice, angiography is underutilized in patients with MI that have typical T2MI triggers, although the presence of these triggers and various forms of atherosclerotic coronary artery disease is not mutually exclusive. We describe a 70-year-old man that developed MI during hospitalization for gastrointestinal bleeding. He was treated conservatively without angiography due to posthemorrhagic anemia, which is a recognized T2MI trigger, and subsequently developed refractory cardiogenic shock. Autopsy revealed atherothrombosis, which is characteristic of T1MI.

Background: Atherothrombosis is the principal mechanism of type 1 (T1) myocardial infarction (MI), while type 2 (T2) MI is typically diagnosed in the presence of triggers (anemia, arrhythmia, etc.). We aimed to evaluate the proportions of T1 vs. T2 MI based on angiographic and clinical definitions, their concordance and prognosis. Methods: Consecutive MI patients [n = 712, 61% male; age 64.6 ± 12.3 years] undergoing coronary angiography were classified according to the presence of atherothrombosis and identifiable triggers. Association of angiographic and clinical MI type criteria with adverse outcomes (Time follow-up was 1.5 years) was evaluated. Predictive ability of GRACE risk score for all-cause mortality was then assessed. Results: Atherothrombosis and clinical triggers were identified in 397 (55.6%) and 324 (45.5%) subjects, respectively. Only 247 (34.7%) patients had “true” T1MI (atherothrombosis+ / triggers−); 174 (24.4%) were diagnosed with “true” T2MI (atherothrombosis− / triggers+), while 291 (40.9%) had discordant clinical and angiographic characteristics. All-cause mortality in T2MI (20.1%) patients was higher than in T1MI (9.3%), P = 0.002. Presence of triggers [odds ratio (OR) 2.4, 95% CI 1.5-3.6, P < 0.0001] but not atherothrombosis [OR 0.8, 95% confidence interval (CI) 0.5-1.3, P = 0.26] was associated with worse prognosis. GRACE score is a better predictor of death in T1MI vs. T2MI: area under curve 0.893 (95% CI 0.830-0.956) vs 0.748 (95% CI 0.652-0.843), P = 0.013 Conclusion: Angiographic and clinical definitions of MI type are discordant in a substantial proportion of patients. Clinical triggers are associated with all-cause mortality. Predictive performance of GRACE score is worse in T2MI patients.

A 56-day feeding trial was conducted to evaluate the effects of supplemented diets with β-glucan (BG) at four levels [0 (D1), 250 (D2), 500 (D3) and 1000 (D4) mg BG kg−1] on red sea bream, Pagrus major. The obtained results revealed a significant increase (P

Ultrasound imaging has found applications in several areas of interventional urology prior to treatment (diagnosis), after treatment (follow-up), and also during treatment (monitoring/guidance). Contrast-enhanced ultrasound (CEUS) imaging and elastographic imaging are the two widely used imaging techniques. CEUS modalities, such as harmonic and multi-pulse imaging, are increasingly applied in interventional urology, because the contrast agents give a clear enhancement of blood vessels in the tissue. Among others, CEUS is used to study the microvasculature of the prostate and kidney for cancer detection to more accurately identify malignant lesions. Elastography is a technique that has been coined in 1991 for the quantification of elastic properties of biological tissue. Various elastographic techniques have been developed, such as Acoustic radiation force imaging (ARFI) and shear wave elastography. These techniques have found various applications in interventional urology such as monitoring the degree of fibrosis in renal allografts after transplantation and the identification of renal masses and prostatic lesions.These enhanced ultrasound modalities represent novel techniques in the evaluation of the prostate and kidney in urology. There are multiple putative benefits of enhanced ultrasound modalities, including improved targeting for prostate biopsy; improved characterization of suspicious renal masses, especially when contrast-enhanced axial imaging (CT or MRI) are contraindicated; and lower cost than CT or MRI. Further investigations and refinements are necessary to define the role of these techniques in current urologic practice.

BACKGROUND: Streptococcus suis infection, an emerging zoonosis, is an increasing public health problem across South East Asia and the most common cause of acute bacterial meningitis in adults in Vietnam. Little is known of the risk factors underlying the disease. METHODS AND FINDINGS: A case-control study with appropriate hospital and matched community controls for each patient was conducted between May 2006 and June 2009. Potential risk factors were assessed using a standardized questionnaire and investigation of throat and rectal S. suis carriage in cases, controls and their pigs, using real-time PCR and culture of swab samples. We recruited 101 cases of S. suis meningitis, 303 hospital controls and 300 community controls. By multivariate analysis, risk factors identified for S. suis infection as compared to either control group included eating "high risk" dishes, including such dishes as undercooked pig blood and pig intestine (OR(1) = 2.22; 95%CI = [1.15-4.28] and OR(2) = 4.44; 95%CI = [2.15-9.15]), occupations related to pigs (OR(1) = 3.84; 95%CI = [1.32-11.11] and OR(2) = 5.52; 95%CI = [1.49-20.39]), and exposures to pigs or pork in the presence of skin injuries (OR(1) = 7.48; 95%CI = [1.97-28.44] and OR(2) = 15.96; 95%CI = [2.97-85.72]). S. suis specific DNA was detected in rectal and throat swabs of 6 patients and was cultured from 2 rectal samples, but was not detected in such samples of 1522 healthy individuals or patients without S. suis infection. CONCLUSIONS: This case control study, the largest prospective epidemiological assessment of this disease, has identified the most important risk factors associated with S. suis bacterial meningitis to be eating 'high risk' dishes popular in parts of Asia, occupational exposure to pigs and pig products, and preparation of pork in the presence of skin lesions. These risk factors can be addressed in public health campaigns aimed at preventing S. suis infection.

While several techniques have been introduced for specifying and acquiring context and quality information associated with Web services, they consider such information representing the whole Web services. However, accessing to context and quality of data resources provided by Web services is crucial. This is particularly relevant for data-intensive Web services of which the context and quality of data resources will strongly impact on the service development and composition. In this paper we contribute an analysis of relationships among context, quality, and relevance, as well as their impact on the design and composition of Web services, in particular at the data resource level. Then, we propose several techniques to incorporate context and quality descriptions into REST APIs and RESTful services publishing. By implementing these features, RESTful Web services could allow the consumer to specify and query context and quality information associated with services and data resources, thus fostering the provision of high relevant data resources. © 2010 Springer-Verlag.