Systems Biology Analysis of Temporal Dynamics That Govern Endothelial Response to Cyclic Stretch.

Endothelial cells in vivo are subjected to a wide array of mechanical stimuli, such as cyclic stretch. Notably, a 10% stretch is associated with an atheroprotective endothelial phenotype, while a 20% stretch is associated with an atheroprone endothelial phenotype. Here, a systems biology-based approach is used to present a comprehensive overview of the functional responses and molecular regulatory networks that characterize the transition from an atheroprotective to an atheroprone phenotype in response to cyclic stretch. Using primary human umbilical vein endothelial cells (HUVECs), we determined the role of the equibiaxial cyclic stretch in vitro, with changes to the radius of the magnitudes of 10% and 20%, which are representative of physiological and pathological strain, respectively. Following the transcriptome analysis of next-generation sequencing data, we identified four key endothelial responses to pathological cyclic stretch: cell cycle regulation, inflammatory response, fatty acid metabolism, and mTOR signaling, driven by a regulatory network of eight transcription factors. Our study highlights the dynamic regulation of several key stretch-sensitive endothelial functions relevant to the induction of an atheroprone versus an atheroprotective phenotype and lays the foundation for further investigation into the mechanisms governing vascular pathology. This study has significant implications for the development of treatment modalities for vascular disease.

Correlation Between Learning Motivation and Satisfaction in Synchronous On-the-Job Online Training in the Public Sector.

Non-governmental organizations often regard expanding revenue and reducing costs as standard procedures to achieve corporate sustainability, while at the same time considering human resources as important assets. Government agencies have greater flexibility in staffing, and their human resource strategies for employee education and training often use organizational learning to develop operational performance. Training is regarded as a panacea for corporate sustainability and channels have been established to support employees' learning. Curriculum development of synchronous online learning is an approach that requires further investigation. We distributed 360 questionnaires to supervisors and employees of the Taipei City Government, Taiwan. A total of 268 valid copies were retrieved, giving a response rate of 74%. The study results are expected to help public sector employers enhance employee cohesiveness and generate more operational team spirit.

Cost savings analysis of prescription assistance programs at a student-run free clinic.

The Free Clinic at Lubbock Impact (TFC) is a student-run, volunteer free clinic affiliated with Texas Tech University Health Sciences Center in Lubbock, Texas, that provides free weekly health services to the local uninsured patient population. The clinic also helps patients enroll in prescription assistance programs (PAPs) from pharmaceutical companies, which supply eligible patients with certain medications at little or no cost. This study presents a cost savings analysis of TFC patients enrolled in PAPs from February 2019 through February 2020. Cost savings were calculated by matching medication doses and units with the cost per unit for each brand-name medication listed on GoodRx.com at Walgreens pharmacies located in TFC's zip code, 79410. Sixty-one patients received 23 different medications with a total cost savings value of $222,563. Medications were sorted into diabetic, respiratory, and miscellaneous disease categories, for which cost savings totaled $114,110, $60,219, and $48,234, respectively. This study highlights the value of utilizing PAPs at a free clinic to address the barrier of medication cost for uninsured patients in Lubbock, Texas, and surrounding areas.

Systemic argyria with severe anemia (hemoglobin 2.4 g/L).

Argyria is a rare disease in which chronic usage of products with a high silver content leads to deposition of silver granules in organs such as the skin, resulting in a permanent blue-gray discoloration. We present a 68-year-old woman with a 10-year history of chronic anemia of unknown etiology who was admitted for progressive generalized weakness, dyspnea, and a widespread slate-gray tint to her skin. She had previously consumed 1 tablespoon per day of colloidal silver orally for 7 years. Hematologic workup on admission showed the hemoglobin to be 2.4 g/dL with low ferritin and normal copper, zinc, and ceruloplasmin, indicating an iron-deficiency anemia. Differentiating the correct etiology of her anemia and skin discoloration was crucial since argyria can cause pseudocyanosis and microcytic anemia secondary to silver-induced copper deficiency. This case highlights the importance of asking and counseling patients about their nonprescription supplements.

Procedural Trends in Medicare Reimbursement and Utilization for Breast Reconstruction: 2000-2019.

PURPOSE: Development of appropriate reimbursement models for breast reconstruction in the United States requires an understanding of relevant economic trends. The purpose of this study is to evaluate longitudinal patterns in Medicare reimbursement for frequently performed breast reconstruction procedures between 2000 and 2019. METHODS: Reimbursement data for 15 commonly performed breast reconstruction procedures were analyzed using the Centers for Medicare & Medicaid Services Physician Fee Schedule Look-Up Tool for each Current Procedural Terminology code. By utilizing changes to the US consumer price index, monetary data were adjusted for inflation to 2019 US dollars. Inflation-adjusted trends were used to calculate average annual and total percentage changes in reimbursement over time. RESULTS: From 2000 to 2019, average adjusted reimbursement for all procedures fell by 13.32%. All procedures demonstrated a negative adjusted reimbursement rate other than immediate insertion of breast prosthesis, which increased by 55.37%. The largest mean decrease was observed in breast reconstruction with other technique (-28.63%), followed by single pedicle transverse rectus abdominis myocutaneous flap (-26.02%), single pedicle transverse rectus abdominis myocutaneous flap with microvascular anastomosis (-23.33%), latissimus dorsi flap (-19.65%), and free flap reconstruction (-19.36%). CONCLUSIONS: There has been a steady yet substantial decline in Medicare reimbursement for the majority of breast reconstruction procedures over the last 20 years. Given increasing medical costs and the financial uncertainty of the US health care system, an understanding of Medicare reimbursement trends is vital for policymakers, administrators, and physicians to develop agreeable reimbursement models that facilitate growth and economic vitality of breast reconstruction in the United States.

Bony hypertrophy of the forearm in bareback rodeo athletes.

OBJECTIVE: Activities that require increased load bearing are known to cause bony hypertrophy. This phenomenon has been documented in the dominant arm of athletes in sports requiring significant utilization of a single limb. The literature addressing this effect in rodeo athletes, however, is minimal. Studies evaluating rodeo athletes are primarily focused on acute injury management rather than chronic symptoms resulting from changes in bone and soft tissue. We designed a study to evaluate bony hypertrophy in athletes without acute injury. METHOD: Rodeo bareback riders presented with frequent pain in their grip arm, no radiographic evidence of injury, and clinical signs of peripheral nerve compression. Anteroposterior and lateral X-rays taken for initial evaluation in 17 bareback rodeo athletes were retrospectively reviewed. The diameter of bilateral ulnas was measured at its longitudinal midpoint. Ratio of Ulnar Diameters (grip arm/free arm) and Percentage Diameter Difference were calculated. An independent samples t-test was used to assess differences in diameters of grip and non-grip arms. RESULT: The mean ulnar diameter was 18.4 ± 3.5 in the grip arm and 16.6 ± 3.5 in the non-grip arm (p < 0.001). The mean ratio of grip to free arm ulnar diameter was 1.42 ± 0.21 (range = 1.05-1.92). The mean diameter percent difference measured 42.3% (range = 4.7%-92.0%), and the grip arm was observed to have a greater ulnar diameter compared to the non-grip arm. CONCLUSION: There are significant anatomic differences in the grip arm of bareback rodeo athletes compared to the contralateral arm. In cases of persistent pain in the grip arm and no evidence of acute injury, these differences may be relevant to pain symptoms and should be considered as part of the assessment and treatment algorithm.

An Analysis of Procedural Medicare Reimbursement Rates in Hand Surgery: 2000 to 2019.

BACKGROUND: Medicare reimbursement trends across multiple surgical subspecialties have been analyzed; however, little has been reported regarding the long-term trends in reimbursement of hand surgery procedures. The aim of this study is to analyze trends in Medicare reimbursement for commonly performed hand surgeries. METHODS: Using the Centers for Medicare and Medicaid Services Physician and Other Supplier Public Use File, we determined the 20 hand surgery procedure codes most commonly billed to Medicare in 2016. Reimbursement rates were collected and analyzed for each code from The Physician Fee Schedule Look-Up Tool for years 2000 to 2019. We compared the change in reimbursement rate for each procedure to the rate of inflation in US dollars, using the Consumer Price Index (CPI) over the same time period. RESULTS: The reimbursement rate for each procedure increased on average by 13.9% during the study period while the United States CPI increased significantly more by 46.7% (P < .0001). When all reimbursement data were adjusted for inflation to 2019 dollars, the average reimbursement for all included procedures in this study decreased by 22.6% from 2000 to 2019. The average adjusted reimbursement rate for all procedures decreased by 21.92% from 2000 to 2009 and decreased by 0.86% on average from 2009 to 2019 (P < .0001). CONCLUSION: When adjusted for inflation, Medicare reimbursement for hand surgery has steadily decreased over the past 20 years. It will be important to consider the implications of these trends when evaluating healthcare policies and the impact this has on access to hand surgery.

Dermatologic Care for the Uninsured West Texas Population at a Student-run Free Clinic.

We highlight the operations of The Free Clinic at Lubbock Impact, describing its services and the patient population it serves. Dermatology Nights have been an integral part to the clinic, addressing skin conditions that the uninsured and homeless population experience.

Analysis of 20-Year Trends in Medicare Reimbursement for Reconstructive Microsurgery.

BACKGROUND: Microsurgery is being increasingly utilized across surgical specialties, including plastic surgery. Microsurgical techniques require greater time and financial investment compared with traditional methods. This study aimed to evaluate 20-year trends in Medicare reimbursement and utilization for commonly billed reconstructive microsurgery procedures from 2000 to 2019. METHODS: Microsurgical procedures commonly billed by plastic surgeons were identified. Reimbursement data were extracted from The Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services for each current procedural terminology (CPT) code. All monetary data were adjusted for inflation to 2019 U.S. dollars. The average annual and total percentage changes in reimbursement were calculated based on these adjusted trends. To assess utilization trends, CMS physician/supplier procedure summary files were queried for the number of procedures billed by plastic surgeons from 2010 to 2018. RESULTS: After adjusting for inflation, the average reimbursement for all procedures decreased by 26.92% from 2000 to 2019. The greatest mean decrease was observed in CPT 20969 free osteocutaneous flaps with microvascular anastomosis (-36.93%). The smallest mean decrease was observed in repair of blood vessels with vein graft (-9.28%). None of the included procedures saw an increase in reimbursement rate over the study period. From 2000 to 2019, the adjusted reimbursement rate for all procedures decreased by an average of 1.35% annually. Meanwhile, the number of services billed to Medicare by plastic surgeons across the included CPT codes increased by 42.17% from 2010 to 2018. CONCLUSION: This is the first study evaluating 20-year trends in inflation-adjusted Medicare reimbursement and utilization in reconstructive microsurgery. Reimbursement for all included procedures decreased over 20% during the study period, while number of services increased. Increased consideration of these trends will be important for U.S. policymakers, hospitals, and surgeons to assure continued access and reconstructive options for patients.

Fibrin Glue and Its Alternatives in Peripheral Nerve Repair.

Over the past century, many advancements have been made in peripheral nerve repair, yet these reconstructions still remain a challenge. Although sutures have historically been used for neurorrhaphy, they sometimes fail to provide optimal outcomes. As a result, multiple adhesive compounds are currently being investigated for their efficacy in nerve repair. Recently, fibrin glue has shown utility in peripheral nerve repair, and the body of evidence supporting its use continues to grow. Fibrin glue has been shown to reduce inflammation, improve axonal regeneration, and provide excellent functional results. This alternative to traditional suture neurorrhaphy could potentially improve outcomes of peripheral nerve reconstruction.