Controversies in CPT® coding in the neonatal intensive care unit: - critical vs. intensive care.

Professional reimbursement to neonatal providers is based on the level of Current Procedural Terminology (CPT®) coding in the NICU, newborn nursery and other areas where neonatal care is provided. Four levels of evaluation and management (E&M) care-critical, intensive, routine-hospital care or normal newborn care can be provided to neonates. The work relative value units (wRVUs) associated with these four levels of care vary widely. This manuscript provides a brief review of basic features associated with each of these four levels with a specific perspective on differences between critical and intensive care codes. Coding and billing are constantly evolving fields with significant variation in interpretation and readers are encouraged to review the current publications on CPT® coding and make an informed decision on the best codes to be used for their patients.

Marijuana: the effects on pregnancy, the fetus, and the newborn.

There is growing evidence that there is an increased use of Marijuana (cannabis) during the perinatal period. This review summarizes pertinent legislation (past and present) and the physiology and pathophysiology of cannabis use during pregnancy. The literature which involves issues concerning cannabis and pregnancy is expanding but at present has many gaps and unanswered questions. The effects on the newborn are significant and treatment recommendations including breastfeeding are presented. Also included is a description of developmental delay during the first 2 years of life in infants exposed to prenatal marijuana. In addition, this commentary discusses the increase use of the newer "synthetic" cannabinoids which have greater psychotropic activity and can cause significant harm.

Coronavirus testing indicates transmission risk increases along wildlife supply chains for human consumption in Viet Nam, 2013-2014

Outbreaks of emerging coronaviruses in the past two decades and the current pandemic of a novel coronavirus (SARS-CoV-2) that emerged in China highlight the importance of this viral family as a zoonotic public health threat. To gain a better understanding of coronavirus presence and diversity in wildlife at wildlife-human interfaces in three southern provinces in Viet Nam 2013-2014, we used consensus Polymerase Chain Reactions to detect coronavirus sequences. In comparison to previous studies, we observed high proportions of positive samples among field rats (34.0%, 239/702) destined for human consumption and insectivorous bats in guano farms (74.8%, 234/313) adjacent to human dwellings. Most notably among field rats, the odds of coronavirus RNA detection significantly increased along the supply chain from field rats sold by traders (reference group; 20.7% positivity, 39/188) by a factor of 2.2 for field rats sold in large markets (32.0%, 116/363) and 10.0 for field rats sold and served in restaurants (55.6%, 84/151). Coronaviruses were detected in the majority of wildlife farms (60.7%, 17/28) and in the Malayan porcupines (6.0%, 20/331) and bamboo rats (6.3%, 6/96) that are farmed. We identified six known coronaviruses in bats and rodents, clustered in three Coronaviridae genera, including the Alpha-, Beta-, and Gammacoronaviruses. Our analysis also suggested either mixing of animal excreta in the environment or interspecies transmission of coronaviruses, as both bat and avian coronaviruses were detected in rodent feces in the trade. The mixing of multiple coronaviruses, and their apparent amplification along the wildlife supply chain into restaurants, suggests maximal risk for end consumers and likely underpins the mechanisms of zoonotic spillover to people.

Coronavirus surveillance of wildlife in the Lao People's Democratic Republic detects viral RNA in rodents

Coronaviruses can become zoonotic as in the case of COVID-19, and hunting, sale, and consumption of wild animals in Southeast Asia facilitates an increased risk for such incidents. We sampled and tested rodents (851) and other mammals, and found Betacoronavirus RNA in 12 rodents. The sequences belong to two separate genetic clusters, and relate closely to known rodent coronaviruses detected in the region, and distantly to human coronaviruses OC43 and HKU1. Considering close human-wildlife contact with many species in and beyond the region, a better understanding of virus diversity is urgently needed for the mitigation of future risks.

Application of criteria developed by the Task Force on Neonatal Encephalopathy and Cerebral Palsy to acutely asphyxiated neonates.

OBJECTIVE: To estimate whether term neonates with acute intrapartum hypoxic ischemic encephalopathy and permanent brain injury satisfied the criteria for causation of cerebral palsy developed by the Task Force on Neonatal Encephalopathy and Cerebral Palsy. METHODS: In this descriptive study, patients in the case group were obtained from a registry of singleton, liveborn, term, neurologically impaired neonates. Entry criteria included a reactive intrapartum fetal heart rate pattern followed by a sudden, rapid, and sustained deterioration of the fetal heart rate that lasted until delivery and an umbilical artery cord pH. All patients in the case group were then assessed to determine if they met the criteria developed by the Task Force on Neonatal Encephalopathy and Cerebral Palsy. RESULTS: Thirty-nine neonates met the entry criteria, and the proportion meeting each essential criterion was as follows: 38 of 39 (97.4%) had umbilical artery pH of less than 7.00 and 30 of 30 (100%) had a base deficit of 12 mmol/L or higher; 33 of 34 (97%) had either moderate or severe encephalopathy; 34 of 36 (94%) had spastic quadriplegia or dyskinetic cerebral palsy or death attributable to brain injury; and 39 of 39 (100%) had no identifiable reason for exclusion. CONCLUSION: Fetuses that underwent a sudden and sustained deterioration of the fetal heart rate and that subsequently were found to have cerebral palsy demonstrated characteristics consistent with criteria developed by the Task Force on Neonatal Encephalopathy and Cerebral Palsy for intrapartum asphyxial injury. LEVEL OF EVIDENCE: III.

Characterization and transcriptional analysis of two gene clusters for type IV secretion machinery in Wolbachia of Armadillidium vulgare.

Wolbachia are maternally inherited alpha-proteobacteria that induce feminization of genetic males in most terrestrial crustacean isopods. Two clusters of vir genes for a type IV secretion machinery have been identified at two separate loci and characterized for the first time in a feminizing Wolbachia. Furthermore, we demonstrated that these operons are transcriptionally active in ovaries and in all other tissues tested, suggesting that T4SS has a significant role in Wolbachia biology. These observations and the identification of homologous vir genes in Wolbachia strains infecting insects or nematodes show that vir genes are conserved among Wolbachia strains whatever the phenotype induced by the bacteria.

Protein profiling of hemocytes from the terrestrial crustacean Armadillidium vulgare.

To establish and maintain a successful infection, microbial pathogens have evolved various strategies to infect the host in the face of a functional immune system. In this context, the alpha-proteobacteria Wolbachia capacities to infect new host species have been greatly evidenced. Indeed, in terrestrial isopods, experimentally transferred Wolbachia invade all host tissues, including immune cells such as hemocytes. To investigate mechanisms that have to be avoided by bacteria to maintain themselves in hemocytes, we characterized the hemocyte proteome of Armadillidium vulgare by a 2D gel electrophoresis approach. Fifty-six proteins were identified and classified into functional groups (stress and immunity, glucose metabolisms, cytoskeleton, others). We focused on immune response and cytoskeleton proteins often exploited by bacteria to invade their host. From the microsequences obtained by mass spectrometry, PCR primers were designed to amplify seven partial cDNAs encoding masquerade, alpha2-macroglobulin, transglutaminase, MnSOD, calreticulin, cyclophilin, and vinculin, confirming their expression in hemocytes.

Causation--fetal brain injury and uterine rupture.

The purpose of this article is to familiarize the reader with the concept of causation and the role of the concept of foreseeability of harm in obstetric malpractice lawsuits. These concepts are incorporated into several hypothetical fetal brain injury and uterine rupture cases. The discussion involves an overview of available scientific evidence used to substantiate or refute whether a child's brain damage or a maternal uterine rupture was in fact related to the obstetric care in question. In the event of the delivery of a depressed newborn, a checklist of scientific evidence to be gathered at the time of delivery is also provided.

Nucleated red blood cell and platelet counts in asphyxiated neonates sufficient to result in permanent neurologic impairment.

OBJECTIVE: Recent research has suggested that a nucleated red blood cell (NRBC) count >or=26 per 100 white blood cells (%) or the development of a platelet count or=26% was: group 1, 10/21 (47.6%); group 2, 0/14 (0%); group 3, 0/12 (0%). Those with a platelet count or=26% than group 3 (p = 0.0135). A platelet count or=26% and/or a platelet count

Bacteriophage WO in Wolbachia infecting terrestrial isopods.

Wolbachia are maternally inherited intracellular alpha-proteobacteria that infect a wide range of arthropods. They are associated with a number of different reproductive phenotypes in arthropods and nematodes. In isopod crustacean, Wolbachia are responsible for feminization of genetic males in many species, and for cytoplasmic incompatibility in two species. In this paper, we report the first detection of phage WO from Wolbachia infecting terrestrial isopods. All Wolbachia strains tested in this study were infected with phage WO. Based on the orf7 phage sequence, we identified three different phage sequences in four Wolbachia strains. The phage of Wolbachia infecting Armadillidium vulgare seems to be not active, unlike other phages WO previously described in arthropods.

Birth asphyxia and cerebral palsy.

There has been a societal presumption that most, if not all, cases of hypoxic ischemic encephalopathy-induced cerebral palsy occur during the 3 hours that are related to the events of labor and delivery; society has tended to overlook the remaining 7000 hours of the pregnancy. As a result of this societal perspective, often times the obstetrician has been targeted unfairly as the person who is responsible for a given child's neurologic injuries. Rather, the entire pregnancy, labor, delivery, and well beyond birth require examination to understand fully the pathophysiologic mechanisms that are responsible for an infant's brain injuries, and their long-term impact on the child.

Armadillidin: a novel glycine-rich antibacterial peptide directed against gram-positive bacteria in the woodlouse Armadillidium vulgare (Terrestrial Isopod, Crustacean).

We report the isolation and the characterization of a novel antibacterial peptide from hemocytes of the woodlouse Armadillidium vulgare, naturally infected or uninfected by Wolbachia, an intracellular Gram-negative bacterium. This molecule displays antibacterial activity against Gram-positive bacteria despite its composition which classes it into the glycine-rich antibacterial peptide family, usually directed against fungi and Gram-negative bacteria. The complete sequence was determined by a combination of Edman degradation, mass spectrometry and cDNA cloning using a hemocyte library. The mature peptide (53 residues) has a 5259 Da molecular mass and is post-translationally modified by a C-terminal amidation. This peptide is characterized by a high level of glycine (47%) and a fivefold repeated motif GGGFH(R/S). As no evident sequence homology to other hitherto described antibacterial peptides has been found out, this antibacterial peptide was named armadillidin. Armadillidin is constitutively expressed in hemocytes and appears to be specific of A. vulgare.

Sexual differentiation traits in functional males with female genital apertures (male symbol fga) in the woodlice Armadillidium vulgare Latr. (Isopoda, Crustacea).

This study reports the results of examination of the gonadal morphology and ultrastructural features of the androgenic hormone (AH)-producing androgenic gland cells of laboratory stocks of functional male woodlice, Armadillidium vulgare, with female genital apertures ( male symbol fga), with and without experimentally induced infections of the sex-ratio-distorting endobacterial parasite, Wolbachia. Males ( male symbol fga) have been reported in wild populations containing individuals infected with this maternally transmitted sex-ratio-distorting parasite. We report a reduction of testicular segment (utricle) number, androgenic gland cell hypertrophy, and electron-dense ultrastructural cytological features in male symbol fga males. The presence of the Wolbachia parasite had no effect on the features we examined. These results suggest that male symbol fga males are produced as the result of a delayed expression/action of the male sex-determining AH which causes a "lag-phase" delay in male differentiation in genetic males and is not due to the presence, in genetic females, of a hypothetical, epigenetic "M" gene as suggested by Rigaud and Juchault. Our results favor the interpretation of males as true genetic (ZZ) males in which the delayed AH action appears to involve cellular AH trafficking pathways which may be controlled by an impaired autosomal gene responsible for AH action.

The glycosylated androgenic hormone of the terrestrial isopod Porcellio scaber (Crustacea).

It appears from grafting experiments that the androgenic hormone (AH) of terrestrial isopods has a narrow species-specificity [J. Crust. Biol. 19 (1999) 684], even if AH of different species shared common epitopes [Gen. Comp. Endocrinol. 125 (2002) 218]. To date only the glycosylated AH of the woodlouse Armadillidium vulgare has been deciphered by us [Ann. New York Acad. Sci. 839 (1998) 111; Eur. J. Biochem. 262 (1999) 727] and [Biochem. Biophys. Res. Commun. 264 (1999) 419] have confirmed the primary structure of this protein. We reported in the present paper the characterization of the AH in another species Porcellio scaber by a combination of microsequencing, mass spectrometry, and molecular cloning. We found only one glycoform which consisted of two peptide chains, A and B, of 31 and 44 amino acids, respectively, with A chain carrying on Asn18 a N-glycosylated moiety, size of which has been determined by MALDI-MS measurements. The expected structure of the glycosylation was proposed. The deduced amino acid sequence of the AH precursor was mainly identical to the one obtained independently by another group [Zool. Sci. 20 (2003) 75]. We also showed that AH gene is exclusively expressed in androgenic glands. Sequence comparison with A. vulgare and P. scaber (population of Japan) AH was discussed.

Organ of Bellonci of an Antarctic crustacean, the marine isopod Glyptonotus antarcticus.

The paired organ of Bellonci protrudes from the optic lobe of the giant Antarctic isopod, Glyptonotus antarcticus. It is linked to the cortex by a broad peduncle. No connection to the cuticle or "sensory pore organ" was found. A cluster of sensory-like cells forms two outer ciliary segments branching into numerous microvilli with microtubules. The putative sensory somata are irregular in shape and contain a very high density of glycogen granules. The two outer segments sprout from two pits of the soma in different directions, forming a right angle. Glial cells wrap around the sensory cells and also delimit lacunae into which bundles of microvilli project. These lacunae contain electron-dense granules of small size and with species-specific patterns. Lacunae and dense granules show features typical of a degeneration process in the sensory cells. This general morphology corresponds to the unilobular type of organ of Bellonci, known in other isopods; it differs from the plurilobular type with onion bodies found in other Crustacea.