The cost of serial cerebrospinal fluid aspirations between ventricular access device (VAD) and ventriculosubgaleal shunt (VSGS) for treatment of post-hemorrhagic ventricular dilatation (PHVD) in premature infants

Introduction: Ventriculosubgaleal shunts (VSGS) require fewer cerebrospinal (CSF) aspirations than ventricular access devices (VAD) for temporization of post-hemorrhagic ventricular dilatation (PHVD) in preterm infants. Cost of postoperative CSF aspiration has not been quantified. Methods: We reviewed CSF aspiration and laboratory studies obtained in preterm infants with PHVD and VAD at our institution between 2009-2020. Cost per aspiration was calculated for materials, labs, and Medicare fee schedule for ventricular puncture through implanted reservoir. We searched PubMed, Cochrane Library, Embase, CINAHL, and Web of Science for meta-analysis of pooled mean number of CSF aspirations and proportion of patients requiring aspiration. Results: Thirty-five preterm infants with PHVD had VAD placed with 22.2±18.4 aspirations per patient. Labs were obtained after every aspiration per local protocol. Cost per aspiration at our institution was $935.51. Of 269 published studies, 77 reported on VAD, 29 VSGS, and 13 both. Five studies on VAD (including the current study) had a pooled mean of 25.8 aspirations per patient (95%CI:16.7-34.8). One study on VSGS reported a mean of 1.6±1.7 aspirations. 3 studies on VAD (including the current study) had a pooled proportion of 97.4% of patients requiring aspirations (95%CI: 87.9-99.5). Four studies on VSGS had a pooled proportion of 36.5% requiring aspirations (95%CI:26.9-47.2). Frequency of lab draws ranged from weekly to daily. Based on costs at our institution, mean number of aspirations, and proportion of patients requiring aspirations, cost difference ranged between $4,243 to $23,235 per patient and $500,903 to 2.36 million per 100 patients depending on frequency of taps and Medicare locality. Discussion/Conclusion: Lower number of CSF aspirations using VSGS can be associated with considerably lower cost compared to VAD.

Returning Actionable Genomic Results in a Research Biobank: Analytic Validity, Clinical Implementation and Resource Utilization

Over 100 million research participants around the world have had research array-based genotyping (GT) or sequencing (GS), but only a small fraction of these have been offered return of actionable genomic findings (gRoR). Between 2017 and 2021, we analyzed genomic results from 36,417 participants in the Mass General Brigham Biobank and offered to confirm and return pathogenic and likely pathogenic variants (PLPVs) in 59 genes. Variant verification prior to patient recontact revealed that GT falsely identified PLPVs in 44.9% of samples, and GT failed to identify 72.0% of PLPVs detected in a subset of samples that were also sequenced. GT and GS detected verified PLPVs in 1% and 2.5% of the cohort, respectively. Of 256 participants who were alerted that they carried actionable PLPVs, 37.5% actively or passively declined further disclosure. 76.3% of those carrying PLPVs were unaware that they were carrying the variant and over half of those met published professional criteria for genetic testing but had never been tested. This gRoR protocol cost approximately $129,000 USD per year in laboratory testing and research staff support, representing $14 per participant whose DNA was analyzed or $3,224 per participant in whom a PLPV was confirmed and disclosed. These data provide logistical details around gRoR that could help other investigators planning to return genomic results.

Application of hormonal subdoses at the Bai Hui acupoint for estrus synchronization in sheep

Here, the efficiency of applying subdoses of equine chorionic gonadotropin (eCG) and prostaglandin F2α (PGF2α) at the Bai Hui (BH) acupoint for estrus synchronization in sheep was evaluated. Thirty Santa Inês ewes received intravaginal sponges containing 60 mg medroxyprogesterone acetate for 7 days. The animals were divided into five treatments (T) (n=6): T1 (control), 132.5 μg PGF2α (100% of dose) and 300 IU eCG (100% of dose), both intramuscularly (IM); T2, 39.75 μg PGF2α (30% of dose) at the BH acupoint and 300 IU eCG (100% of dose) IM; T3, 132.5 μg PGF2α (100% of dose) IM and 90 IU eCG (30% of dose) at the BH acupoint; T4, 39.75 μg PGF2α (30% of dose) and 90 IU eCG (30% of dose), both at the BH acupoint; and T5, 39.75 μg PGF2α (30% of dose) and 90 IU eCG (30% of dose) both at a false acupoint (IM, at the same location as in T1). After 12 h of sponge removal and hormone application, the ewes were subjected to monitoring for estrus and mating and ultrasound assessments of follicular growth and ovulation time every 12 h. The data were evaluated for normality and subjected to analysis of variance, considering a 5% probability. There were no differences in the percentage of animals in estrus (93.3±9.1%), interval from sponge removal to estrus onset (48.1±6.0 h), interval from sponge removal to estrus end (69.6±5.4 h), duration of estrus (24.0±4.7 h), interval from sponge removal to ovulation (73.7±5.9 h), interval from estrus onset to ovulation (26.5±2.3 h), size of the largest follicle (6.7±0.4 mm), follicular growth rate (0.8±0.1 mm•day-1), number of ovulations (1.3±0.1), and plasma progesterone levels 7 days after ovulation (9.6±2.0 ng•mL-1). The cost of the synchronization protocol per animal was US$ 4.37, 4.12, 2.96, 2.71, and 2.71 for T1, T2, T3, T4, and T5, respectively, with 37.99% cost reduction using PGF2α and eCG at 30% of the conventional doses. Therefore, the application of reduced PGF2α (39.75 μg) and eCG (90 IU) doses at the BH or false acupoint effectively synchronized estrus and reduced protocol cost in sheep, indicating that the conventional doses are overestimated.

HSR19-097: Understanding U.S. Mutational Testing Patterns and Treatment Implications in Gastrointestinal Stromal Tumors (GIST) Patients

Background: In the United States, 3,000–4,000 cases of GIST occur each year. Approximately 80% of newly diagnosed GIST harbor mutations in KIT and up to 10% harbor mutations in PDGFRA, including an activation loop mutation at amino acid 842 that is associated with treatment resistance. Most patients (pts) with metastatic GIST (mGIST) respond initially to imatinib but progress and require alternative lines of therapy. However, pts with a PDGFRα D842V mutation have absolute resistance to imatinib and little to no benefit from other therapies. NCCN and ESMO GIST guidelines recommend routine mutational testing in all pts initiating therapy, though recent publications report low testing rates in this setting. This retrospective chart audit of GIST treaters further examines mutational testing and treatment decisions to better understand current practices and educational needs. Methods: Hematologist/oncologists who practiced in academic or community settings were eligible if they treated ≥5 pts with mGIST in the past 12 months. Respondents were asked to retrieve the last 4 charts of pts with metastatic/unresectable GIST of which ≥1 received ≥3 lines of therapy and answer questions geared toward assessing patient journey from diagnosis and mutation testing through treatment choices and outcomes. Results: 105 U.S. physicians (academic: 32; community: 73) reviewed and answered questions based on 403 patient charts. Overall KIT/PDGFRA mutation testing rates prior to initiating therapy was 59%, with lower rates in community settings. Further, only 34% of surveyed community physicians indicated they always perform mutational testing before initiating therapy despite it being strongly recommended in NCCN Guidelines. Top reasons cited for not performing mutation testing included questionable therapeutic impact, not part of practice’s standard protocol, cost, and lack of tissue. In our data set, 15 pts with a PDGFRα D842V mutation were identified, 12 of whom received imatinib despite known inactivity in this population. In the overall population, pts were primarily sequenced through imatinib, sunitinib, and regorafenib, with community clinicians being less likely to use regorafenib in the third-line setting. Conclusion: Continued education is needed about the role of mutational testing in GIST to ensure optimal treatment, especially among U.S. community oncology practitioners. The data also highlight the need for novel therapies that are effective in PDGFRα D842V-driven GIST.

CySpanningTree: Minimal Spanning Tree computation in Cytoscape

Simulating graph models for real world networks is made easy using software tools like Cytoscape. In this paper, we present the open-source CySpanningTree app for Cytoscape that creates a minimal/maximal spanning tree network for a given Cytoscape network. CySpanningTree provides two historical ways for calculating a spanning tree: Prim’s and Kruskal’s algorithms. Minimal spanning tree discovery in a given graph is a fundamental problem with diverse applications like spanning tree network optimization protocol, cost effective design of various kinds of networks, approximation algorithm for some NP-hard problems, cluster analysis, reducing data storage in sequencing amino acids in a protein, etc. This article demonstrates the procedure for extraction of a spanning tree from complex data sets like gene expression data and world network. The article also provides an approximate solution to the traveling salesman problem with minimum spanning tree heuristic. CySpanningTree for Cytoscape 3 is available from the Cytoscape app store.

Optimization of Energy Heterogeneous Cluster-Head Selection in Farmland WSN

Power consumption is a key point of WSN (Wireless Sensor Network) lifespan. Because of difference among monitoring objects and complex signal channel condition, the power consumption of each node in farmland WSN is uneven, which makes the network performing as multi-level energy heterogeneous. LEACH and its improving algorithms average the power consumption between nodes by clustering and cluster-head switching. But the cluster-head voting brings a lot extra power consumption. To solve this problem, this paper proposes EACHS (Energy Approximation Cluster-Head Selection), an optimized cluster-head selection mechanism that approximates the energy of cluster-head targeting the lowest energy level in the network. When approaching the target, the current cluster-head collects the energy status of all nodes and determines which one becoming the new cluster-head. The simulation results show that, EACHS can balance the network power consumption and reduce most protocol cost, prolong the overall network lifespan.