bassianolide and Neoplasms

To explore the use of an episode grouper to more accurately identify the complete set of surgical services typically provided in a surgical episode of care and the corresponding range of prices, using colectomy for cancer as the example.. Price transparency is an important policy issue that will require surgeons to better understand the components and cost of care.. This study uses the Episode Grouper for Medicare business logic to construct colectomy surgical episodes of care for cancer using Medicare claims data for the Boston Hospital Referral Region from 2012 to 2015. Descriptive statistics show the mean reimbursement based on patient severity and stage of surgery, along with the number of unique clinicians billing for care and the mix of services provided.. The Episode Grouper for Medicare episode grouper identified 3182 colectomies in Boston between 2012 and 2015, with 1607 done for cancer. The mean Medicare allowed amount per case is $29,954 and varies from $26,605 to $36,850 as you move from low to high-severity cases. The intrafacility stage is the most expensive ($23,175 on average) compared with the pre ($780) and post ($6,479) facility stages. There is tremendous heterogeneity in the service mix.. Episode groupers are a potentially valuable tool for identifying variations in service mix and teaming patterns that correlate with a total price. By looking at patient care holistically, stakeholders can identify opportunities for price transparency and care redesign that have heretofore been hidden.

Topics: Aged; Animals; Bass; Episode of Care; Humans; Medicare; Neoplasms; Surgeons; United States

White perch Morone americana (Gmelin, 1789) from the Chesapeake Bay (USA) watershed have a high incidence of liver disease, including neoplasms of bile duct origin. Fish collected seasonally from spring 2019 to winter 2020 from the urban Severn River and the more rural Choptank River were evaluated for hepatic lesions. Biliary hyperplasia (64.1%), neoplasms (cholangioma and cholangiocarcinoma, 27%), and dysplasia (24.9%) were significantly higher in Severn River fish compared to Choptank River fish (52.9, 16.2, and 15.8%, respectively). Hepatocellular lesions were less common, including foci of hepatocellular alteration (FHA, 13.3%) and hepatocellular neoplasms (1%). There was also a progressive age-related increase in copper-laden granules in hepatocytes, which was a significant risk factor for FHA and could be a source of oxidative stress in the liver. Significant risk factors for biliary neoplasms included age, bile duct fibrosis, and infections by the myxozoan parasite Myxidium murchelanoi, but the prevalence and relative intensity of M. murchelanoi infections did not differ significantly between fish populations. Hepatic disease in this species appears to be chronic and may stem from an age-related accumulation of damage, possibly from parasitic infections and contaminants such as polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs), and copper. Watershed development and exposures to PCBs and PAHs were generally higher for white perch in the Severn River, but similar suites of chemical contaminants were detected in the Choptank River. A broader survey of white perch within and outside Chesapeake Bay may allow determination of the extent of biliary neoplasia in this species.

Topics: Animals; Bass; Bays; Copper; Environmental Monitoring; Neoplasms; Polychlorinated Biphenyls; Urbanization; Water Pollutants, Chemical

Recent surveys of white perch Morone americana from Chesapeake Bay, USA, revealed a high prevalence of hepatic and biliary lesions, including neoplasia, and bile duct parasites. Here, we describe lesions in the liver and gallbladder and evaluate for statistical associations among lesions, parasites, and biomarkers of chemical exposure in fish from 2 tributaries of Chesapeake Bay. Fish were collected from an estuarine site in the Choptank River (n = 122, ages 3-11), a tributary with extensive agriculture within the watershed, and the Severn River (n = 131, ages 2-16), a tributary with extensive urban development. Passive integrative samplers were deployed at the fish collection site and an upstream, non-tidal site in each river for 30 d. Intrahepatic biliary lesions observed in fish from both rivers included neoplasia (23.3%), dysplasia (16.2%), hyperplasia (46.6%), cholangitis (24.9%), and dilated ducts containing plasmodia of Myxidium sp. (24.9%). Hepatocellular lesions included foci of hepatocellular alteration (FHA, 15.8%) and neoplasia in 4 Severn River fish (2.3%). Age of fish and Myxidium sp. infections were significant risk factors for proliferative and neoplastic biliary lesions, age alone was a risk factor for FHA, and Goussia bayae infections were associated with cholangitis and cholecystitis. Lesion prevalence was higher in fish from the Severn River, which contained higher concentrations of PAHs, organochlorine pesticides, and brominated diphenyl ethers. Metabolite biomarkers indicated higher PAH exposures in Severn River fish. This study suggests Myxidium sp. as a promoter of bile duct tumors, but more data are needed to evaluate the biological effects of environmental contaminants in this species.

Topics: Animals; Bass; Bile Ducts; Environmental Monitoring; Fish Diseases; Neoplasms; Parasites; Prevalence; Water Pollutants, Chemical

Operational activities have resulted in mercury in the sediments surrounding Little Bay in Queens, NY. This is adjacent to Fort Totten, a formerly used defense site. Some of the mercury levels in these sediments exceeded New York State screening values. A human health risk assessment was accomplished, based on conservative assumptions. The risk assessment examined the potential for adverse health effects from direct contact with and ingestion of contaminated sediments/surface water and ingestion of biota. Potential exposures to recreational receptors including adults and children were examined. The highest numerical risk results from finfish ingestion and then second for exposure from dermal contact to the sediments. The only exposure pathway showing a hazard quotient greater than unity is finfish ingestion for the child. In summary, overall risk to this mercury exposure is minimal in spite of the state screening value being exceeded.

Topics: Algorithms; Animals; Bass; Brachyura; Environmental Exposure; Flounder; Fundulidae; Geologic Sediments; Humans; Mercury; Models, Theoretical; Mytilus; Neoplasms; New York; Ostreidae; Risk Assessment; Water Microbiology; Water Pollutants, Chemical

An increasing interest in fish species as sentinels of environmental pollution and in carcinogenesis research has led to the identification of diagnostically challenging neoplasms of uncertain cellular origin and the need for additional diagnostic methods. To determine the potential of using commercially available antibodies to intermediate filament proteins on paraffin-embedded fish tissues for immunocytochemistry in tumor diagnosis, the application of three antikeratin antibodies to normal adult tissues from two fish species was assessed. Multiple tissues from 12-14-in. striped bass (Morone saxatilis) and 6-month-old medaka (Oryzias latipes) of both sexes were fixed in Bouin's or formalin fixatives. Formalin-fixed neoplasms from several mammalian species, including cat, dog, hedgehog (Atelerix albiventris, Erinaceus europaeus), rhesus macaque (Macaca mulatta), and sloth bear (Melursus ursinus), were also used as positive controls. Using a strepavidin horseradish peroxidase method on paraffin-embedded tissues, the broad spectrum antibodies AE1/AE3 (Boehringer Mannheim, Indianapolis, IN) and MAK-6 (Triton Biosciences, Alameda, CA), which recognize most of the 19 human cytokeratins, and CAM 5.2 (Becton Dickinson, Mountain View, CA), which recognizes cytokeratins present in human liver, were used as primary antibodies. Epithelia from skin, gills, cornea, bile ducts, renal tubules, gastrointestinal tract, and thymus were strongly positive with AE1/AE3 and MAK-6 in striped bass, but nonepithelial tissues such as bone and muscle were negative. Skin, gills, cornea, and portions of the gastrointestinal tract were strongly positive in medaka with the same antibodies, whereas bile duct, renal, and intestinal epithelia were less so. Tissue digestion improved the intensity of staining, and fixation with Bouin's fixative improved results somewhat compared with formalin fixation.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Bass; Fish Diseases; Immunoenzyme Techniques; Keratins; Neoplasms; Oryzias; Species Specificity