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Zoe Brown,Michael Perry,Cameron Killen,Daniel Schmitt,Michael Wesolowski,Nicholas M. Brown 대한고관절학회 2022 Hip and Pelvis Vol.34 No.1
Purpose: Histopathologic analysis of femoral head specimens following total hip arthroplasty (THA) is a routine practice that represents a significant use of health care resources. However, it occasionally results in discovery of undiagnosed hematopoietic malignancy and other discrepant diagnoses such as avascular necrosis. The purpose of this study was to determine the rate of discordant and discrepant diagnoses discovered from routine histopathological evaluation of femoral heads following THA and perform a cost analysis of this practice. Materials and Methods: A review of patients undergoing primary THA between 2004-2017 was conducted. A comparison of the surgeon’s preoperative and postoperative diagnosis, and the histopathologic diagnosis was performed. In cases where the clinical and histopathology differed, a review determined whether this resulted in a change in clinical management. Medicare reimbursement and previously published cost data corrected for inflation were utilized for cost calculations. Results: A review of 2,134 procedures was performed. The pathologic diagnosis matched the postoperative diagnosis in 96.0% of cases. Eighty-three cases (4.0%) had a discrepant diagnosis where treatment was not substantially altered. There was one case of discordant diagnosis where lymphoma was diagnosed and subsequently treated. The cost per discrepant diagnosis was $141,880 and per discordant diagnosis was $1,669 when using 100% Medicare reimbursement and Current Procedural Terminology (CPT) code combination 88304+88311. Conclusion: Histopathologic analysis of femoral head specimens in THAs showed an association with high costs given the rarity of discordant diagnoses. Routine use of the practice should be at the discretion of individual hospitals with consideration for cost and utility thresholds.
Daniel R. Schmitt,Cameron Killen,Michael Murphy,Michael Perry,Joseph Romano,Nicholas Brown 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.3
Background: Antibiotic-loaded bone cement (ALBC) is commonly used in total knee arthroplasty (TKA), especially among high-risk patients. While previous studies have reported on the efficacy of ALBC in reducing the rate of periprosthetic joint infection (PJI), its impact on antibiotic resistance has not been determined. The purpose of this study was to investigate antibiotic resistance among organisms causing PJIs after TKA in which ALBC was utilized. Methods: A retrospective review from December 1998 through December 2017 identified 36 PJIs that met inclusion criteria. Patients with culture-negative infection and unknown cement type were excluded. Patient characteristics, infecting organism, and antibiotic susceptibilities were recorded. ABLC included an aminoglycoside in all cases. Results: There was no difference in the type of PJI between the 2 groups. Staphylococcus species was the most commonly isolated, with 9 of 16 cases (56.3%) using non-ALBC and 14 of 20 (65.0%) cases using ALBC. Of those infected with Staphylococcus , there was no significant difference in antibiotic susceptibilities between groups. Overall, there were only 3 cases where the infecting organism was aminoglycoside resistant (standard cement, 1; ALBC, 2). Conclusions: These results suggest that the use of ALBC does not increase the risk of antibiotic resistance or affect the pattern of infection, even as the use of ALBC continues to increase, particularly among high-risk patients.
HECTOMAP AND HORIZON RUN 4: DENSE STRUCTURES AND VOIDS IN THE REAL AND SIMULATED UNIVERSE
Hwang, Ho Seong,Geller, Margaret J.,Park, Changbom,Fabricant, Daniel G.,Kurtz, Michael J.,Rines, Kenneth J.,Kim, Juhan,Diaferio, Antonaldo,Zahid, H. Jabran,Berlind, Perry,Calkins, Michael,Tokarz, Susa American Astronomical Society 2016 The Astrophysical journal Vol.818 No.2
<P>HectoMAP is a dense redshift survey of red galaxies covering a 53 deg(2) strip of the northern sky. HectoMAP is 97% complete for galaxies with r < 20.5, (g-r) > 1.0, and (r -i) > 0.5. The survey enables tests of the physical properties of large-scale structure at intermediate redshift against cosmological models. We use the Horizon Run 4, one of the densest and largest cosmological simulations based on the standard. Cold Dark Matter (Lambda CDM) model, to compare the physical properties of observed large-scale structures with simulated ones in a volume-limited sample covering 8 x 10(6) h(-3) Mpc(3) in the redshift range 0.22 < z < 0.44. We apply the same criteria to the observations and simulations to identify over-and under-dense large-scale features of the galaxy distribution. The richness and size distributions of observed over-dense structures agree well with the simulated ones. Observations and simulations also agree for the volume and size distributions of under-dense structures, voids. The properties of the largest over-dense structure and the largest void in HectoMAP are well within the distributions for the largest structures drawn from 300 Horizon Run 4 mock surveys. Overall the size, richness and volume distributions of observed large-scale structures in the redshift range 0.22 < z < 0.44 are remarkably consistent with predictions of the standard Lambda CDM model.</P>