The Physician Fee Schedule Was Not Built for High-Cost Supplies and Equipment.

As reimbursement from the Medicare Physician Fee Schedule (PFS) continues to decline, cuts to practice expense relative value units disproportionately impact office-based interventionalists and private practices that rely on high-cost equipment. For 195 codes, specialties such as radiation oncology, vascular surgery, and interventional radiology are paid at rates less than their direct costs calculated by the Centers for Medicare and Medicaid Services itself. While reimbursement in the office-based setting continues to decline, high-cost hospital settings receive more payment for the same services.

Impact of intensive care unit supportive care on the physiology of Ebola virus disease in a universally lethal non-human primate model.

Background: There are currently limited data for the use of specific antiviral therapies for the treatment of Ebola virus disease (EVD). While there is anecdotal evidence that supportive care may be effective, there is a paucity of direct experimental data to demonstrate a role for supportive care in EVD. We studied the impact of ICU-level supportive care interventions including fluid resuscitation, vasoactive medications, blood transfusion, hydrocortisone, and ventilator support on the pathophysiology of EVD in rhesus macaques infected with a universally lethal dose of Ebola virus strain Makona C07.

Annexin A5 binds to lipopolysaccharide and reduces its endotoxin activity.

Unlabelled: Annexin A5 (AnxA5) has a high affinity for phosphatidylserine. The protein is widely used to detect apoptotic cells because phosphatidylserine, a phospholipid that is normally present in the inner leaflets of cytoplasmic membranes, becomes translocated to the outer leaflets during programmed cell death. Here we report the novel observation that AnxA5 binds to Gram-negative bacteria via the lipid A domain of lipopolysaccharide (LPS).

Evaluation of the 3M rapid detection test for respiratory syncytial virus (RSV) in children during the early stages of the 2009 RSV season.

We report the results of the 3M rapid detection respiratory syncytial virus (RSV) assay. This study includes pediatric patient results from nasopharyngeal swabs submitted from October to December 2009. There was a sensitivity of 74% and specificity approaching 100% compared to the PCR-based xTAG respiratory viral panel.

Specific identification of Mycobacterium tuberculosis with the luciferase reporter mycobacteriophage: use of p-nitro-alpha-acetylamino-beta-hydroxy propiophenone.

We have previously described a luciferase reporter mycobacteriophage (LRP) assay that can detect Mycobacterium tuberculosis and characterize mycobacterial drug susceptibility patterns within 24 to 48 h in positive cultures. One drawback of this LRP protocol is the ability of the recombinant mycobacteriophage phAE40 to infect a variety of Mycobacterium species, thus limiting its specificity for the detection of M. tuberculosis.

Paecilomyces sinusitis in an immunocompromised adult patient: case report and review.

A case of fungal sinusitis caused by Paecilomyces lilacinus that was unresponsive to amphotericin B and involved a patient with acute myeloid leukemia is described. Histologic examination of sinus tissue and periorbital bone demonstrated invasion by a fungus with septate hyphae, which was identified in culture as P. lilacinus.

Zygospores: the last word in identification of rare or atypical zygomycetes isolated from clinical specimens.

Three zygomycetes (order Mucorales), isolated from clinical specimens, whose generic or species identification were uncertain, were definitively identified on the basis of the production of zygospores resulting from mating studies. These three isolates were identified as Mucor circinelloides f. circinelloides, Rhizomucor pusillus, and Absidia corymbifera.

The recovery of Mycobacterium avium complex and Mycobacterium tuberculosis from blood specimens of AIDS patients using the nonradiometric BACTEC NR 660 medium.

The ability of the nonradiometric BACTEC NR 660 aerobic 6A blood culture medium to support mycobacterial growth was investigated. During a 19-month period blood cultures from 140 AIDS patients were sent to the microbiology laboratory. After the cultures were incubated for seven days, aliquots of medium from the vials were centrifuged, sediments examined microscopically for mycobacteria, and cultured to mycobacterial media.

The use of 5-fluorocytosine and ketoconazole in the culture of the erythrocytic stages of Plasmodium falciparum and some tumor cell lines.

In vitro culture systems are often contaminated by bacteria and fungi. It is therefore often necessary to supplement culture media with agents such as penicillin/streptomycin, gentamycin or amphotericin B. The latter cannot be used in the in vitro culture of erythrocytic stages of P.

Fusarium solani osteomyelitis with probable nosocomial spread.

A case of Fusarium solani osteomyelitis is reported in a previously healthy adult male who received multiple injuries during an automobile accident. Combined histologic and mycologic data proved it to be a case of hyalohyphomycosis resulting from Fusarium. To the best of the authors' knowledge, this is the first reported case of osteomyelitis resulting from F.

Rapid detection of positive blood cultures with the BACTEC NR-660 does not require first-day subculturing.

An analysis of blood culture data was performed to determine whether subculturing within the first 24 h of incubation decreased the time to detection of positive blood cultures when compared with the routine use of the BACTEC NR-660 system (Johnston Laboratories, Inc., Towson, Md.).

Cefoperazone plus tobramycin versus ticarcillin plus tobramycin in febrile granulocytopenic cancer patients.

Cefoperazone plus tobramycin was compared in a prospective, randomized trial with our standard regimen of ticarcillin plus tobramycin as empiric therapy of fever in granulocytopenic patients with cancer. Patients who received cefoperazone were also given vitamin K (5 mg orally twice a week). Of 39 microbiologically and clinically documented infections treated with ticarcillin plus tobramycin, 28 (72 percent) showed improvement.

Cytologic manifestation of an unusual bacterial form, Simonsiella species.

Puzzling rodlike structures overlying benign squamous cells in exfoliative cytologic specimens from the upper gastrointestinal and respiratory tracts were initially considered to be fungi, protozoa, bronchodilator crystals, hemoglobin tactoids or plastic fragments. Their morphologic similarity to Simonsiella, a gram-negative bacteria frequently found in the oral cavity, was ultimately recognized. Further studies of smears and cultures obtained from the oral cavities of the authors and from the American Type Culture Collection confirmed the nature of the original findings.

A comparative trial of moxalactam plus ticarcillin and clavulanic acid or piperacillin as empiric antibiotic therapy for febrile cancer patients.

Resistance of bacteria to beta-lactam antibiotics remains a difficult clinical problem that can be compounded in infected patients with serious underlying illness, especially those who are immunocompromised. In a prospective randomized safety and efficacy trial, febrile cancer patients received either ticarcillin disodium combined with the beta-lactamase inhibitor clavulante potassium (Timentin, Beecham Laboratories, Bristol, TN) plus moxalactam (T+M), or piperacillin plus moxalactam (P+M) as initial empiric antimicrobial therapy. Sixty-six febrile episodes in 53 patients were studied.

Hymenolepis diminuta: one of three enteric pathogens isolated from a child.

This article describes a case of enteritis in a 3.5-yr-old child with persistent diarrhea and the isolation of three gastrointestinal pathogens, including a rare human pathogen Hymenolepis diminuta (rat tapeworm). This is the first reported case in the northeastern United States in 20 yr and demonstrates that persons living in homes infested with rodents and arthropods are at risk of acquiring this infection.

Association of Blastocystis hominis with signs and symptoms of human disease.

Purged stools from 389 patients were evaluated microscopically for the presence of Blastocystis hominis. A total of five or more B. hominis cells per 40X field were observed in 43 patients (11%), and B.

Evaluation of the AutoMicrobic system Gram-Negative General Susceptibility-Plus Card.

The MICs of 10 antimicrobial agents were determined for 1,000 clinical aerobic and facultatively anaerobic gram-negative bacilli by the 6-h AutoMicrobic system Gram-Negative General Susceptibility-Plus Card (GSC+) (Vitek Systems, Inc., Hazelwood, Mo.) and by an 18-h reference agar dilution method.

Surface cultures and isolation procedures in infants born under unsterile conditions.

Umbilical and axillary skin cultures for bacteria and yeast were obtained within two hours of birth from 108 term infants born vaginally under sterile (52) and nonsterile (56) conditions. The skin of infants born under nonsterile conditions was more frequently colonized (91%) than that of infants born under sterile conditions (66%). The most common skin flora of both groups was Staphylococcus epidermidis, diphtheroids, and Escherichia coli.