Cost-utility analysis of mechanical thrombectomy between 6 and 24 hours in acute ischemic stroke

BACKGROUND: Recently, two randomized controlled trials demonstrated the benefit of mechanical thrombectomy performed between 6 and 24 h in acute ischemic stroke. The current economic evidence is supporting the intervention only within 6 h, but extended thrombectomy treatment times may result in better long-term outcomes for a larger cohort of patients. AIMS: We compared the cost-utility of mechanical thrombectomy in addition to medical treatment versus medical treatment alone performed beyond 6 h from stroke onset in the UK National Health Service (NHS). METHODS: A cost-utility analysis of mechanical thrombectomy compared to medical treatment was performed using a Markov model that estimates expected costs and quality-adjusted life years (QALYs) over a 20-year time horizon. We present the results of three models using the data from the DEFUSE 3 and DAWN trials and evidence from published sources. RESULTS: Over a 20-year period, the incremental cost per QALY of mechanical thrombectomy was $1564 (£1219) when performed after 12 h from onset,$5253 (£4096) after 16 h and $3712 (£2894) after 24 h. The probabilistic sensitivity analysis demonstrated that thrombectomy had a 99.9% probability of being cost-effective at the minimum willingness to pay for a QALY commonly used in the UK. CONCLUSIONS: The results of this study demonstrate that performing mechanical thrombectomy up to 24 h from acute ischemic stroke symptom onset is still cost-effective, suggesting that this intervention should be implemented by the NHS on the basis of improvement in quality of life as well as economic grounds

Increased brain age in adults with Prader-Willi syndrome.

Prader-Willi syndrome (PWS) is the most common genetic obesity syndrome, with associated learning difficulties, neuroendocrine deficits, and behavioural and psychiatric problems. As the life expectancy of individuals with PWS increases, there is concern that alterations in brain structure associated with the syndrome, as a direct result of absent expression of PWS genes, and its metabolic complications and hormonal deficits, might cause early onset of physiological and brain aging. In this study, a machine learning approach was used to predict brain age based on grey matter (GM) and white matter (WM) maps derived from structural neuroimaging data using T1-weighted magnetic resonance imaging (MRI) scans. Brain-predicted age difference (brain-PAD) scores, calculated as the difference between chronological age and brain-predicted age, are designed to reflect deviations from healthy brain aging, with higher brain-PAD scores indicating premature aging. Two separate adult cohorts underwent brain-predicted age calculation. The main cohort consisted of adults with PWS (n = 20; age mean 23.1 years, range 19.8-27.7; 70.0% male; body mass index (BMI) mean 30.1 kg/m2, 21.5-47.7; n = 19 paternal chromosome 15q11-13 deletion) and age- and sex-matched controls (n = 40; age 22.9 years, 19.6-29.0; 65.0% male; BMI 24.1 kg/m2, 19.2-34.2) adults (BMI PWS vs. control P = .002). Brain-PAD was significantly greater in PWS than controls (effect size mean ± SEM +7.24 ± 2.20 years [95% CI 2.83, 11.63], P = .002). Brain-PAD remained significantly greater in PWS than controls when restricting analysis to a sub-cohort matched for BMI consisting of n = 15 with PWS with BMI range 21.5-33.7 kg/m2, and n = 29 controls with BMI 21.7-34.2 kg/m2 (effect size +5.51 ± 2.56 years [95% CI 3.44, 10.38], P = .037). In the PWS group, brain-PAD scores were not associated with intelligence quotient (IQ), use of hormonal and psychotropic medications, nor severity of repetitive or disruptive behaviours. A 24.5 year old man (BMI 36.9 kg/m2) with PWS from a SNORD116 microdeletion also had increased brain PAD of 12.87 years, compared to 0.84 ± 6.52 years in a second control adult cohort (n = 95; age mean 34.0 years, range 19.9-55.5; 38.9% male; BMI 28.7 kg/m2, 19.1-43.1). This increase in brain-PAD in adults with PWS indicates abnormal brain structure that may reflect premature brain aging or abnormal brain development. The similar finding in a rare patient with a SNORD116 microdeletion implicates a potential causative role for this PWS region gene cluster in the structural brain abnormalities associated primarily with the syndrome and/or its complications. Further longitudinal neuroimaging studies are needed to clarify the natural history of this increase in brain age in PWS, its relationship with obesity, and whether similar findings are seen in those with PWS from maternal uniparental disomy

Imaging in patients with glioblastoma: A national cohort study

Background Glioblastoma is the most common malignant brain tumor in adults and has a poor prognosis. This cohort of patients is diverse and imaging is vital to formulate treatment plans. Despite this, there is relatively little data on patterns of use of imaging and imaging workload in routine practice. Methods We examined imaging patterns for all patients aged 15–99 years resident in England who were diagnosed with a glioblastoma between 1st January 2013 and 31st December 2014. Patients without imaging and death-certificate-only registrations were excluded. Results The analytical cohort contained 4,307 patients. There was no significant variation in pre- or postdiagnostic imaging practice by sex or deprivation quintile. Postdiagnostic imaging practice was varied. In the group of patients who were treated most aggressively (surgical debulking and chemoradiation) and were MRI compatible, only 51% had a postoperative MRI within 72 hours of surgery. In patients undergoing surgery who subsequently received radiotherapy, only 61% had a postsurgery and preradiotherapy MRI. Conclusions Prediagnostic imaging practice is uniform. Postdiagnostic imaging practice was variable. With increasing evidence and clearer recommendations regarding debulking surgery and planning radiotherapy imaging, the reason for this is unclear and will form the basis of further work

Abell 1430: A merging cluster with exceptional diffuse radio emission

Diffuse radio emission has been found in many galaxy clusters, predominantly in massive systems which are in the state of merging. The radio emission can usually be classified as relic or halo emission, which are believed to be related to merger shocks or volume-filling turbulence, respectively. Recent observations have revealed radio bridges for some pairs of very closeby galaxy clusters. The mechanisms that may allow to explain the high specific density of relativistic electrons, necessary to explain the radio luminosity of these bridge regions, are poorly explored. We analyse the galaxy cluster Abell 1430 with LoTSS data in detail and complement it with recent JVLA L-band observations, XMM-Newton, Chandra, and SDSS data. Moreover, we compare our results to clusters extracted from the "The Three Hundred Project" cosmological simulation. We find that Abell 1430 consists of two components, namely A1430-A and A1430-B. We speculate that the two components undergo an off-axis merger. The more massive component shows diffuse radio emission which can be classified as radio halo showing a low radio power given the mass of the cluster. Most interestingly, there is extended diffuse radio emission, dubbed as the `Pillow', which is apparently related to A1430-B and thus related to low density intracluster or intergalactic medium. To date, a only few examples for emission originating from such regions are known. These discoveries are crucial to constrain possible acceleration mechanisms, which may allow to explain the presence of relativistic electrons in these regions. Our results indicate a spectral index of $\alpha_{144\,\text{MHz}}^{1.5\,\text{GHz}}=-1.4\pm0.5$ for the Pillow. If future observations confirm a slope as flat as the central value of -1.4 or even flatter, this would pose a severe challenge for the electron acceleration scenarios.Comment: 14 pages, 12 figures, accepted for publication in A&

The spectacular cluster chain Abell 781 as observed with LOFAR, GMRT, and XMM-Newton

Context: A number of merging galaxy clusters show the presence of large-scale radio emission associated with the intra-cluster medium (ICM). These synchrotron sources are generally classified as radio haloes and radio relics. Aims. Whilst it is commonly accepted that mergers play a crucial role in the formation of radio haloes and relics, not all the merging clusters show the presence of giant diffuse radio sources and this provides important information concerning current models. The Abell 781 complex is a spectacular system composed of an apparent chain of clusters on the sky. Its main component is undergoing a merger and hosts peripheral emission that is classified as a candidate radio relic and a disputed radio halo. Methods. We used new LOw Frequency ARay (LOFAR) observations at 143 MHz and archival Giant Metrewave Radio Telescope (GMRT) observations at 325 and 610 MHz to study radio emission from non-thermal components in the ICM of Abell 781. Complementary information came from XMM-Newton data, which allowed us to investigate the connection with the thermal emission and its complex morphology. Results. The origin of the peripheral emission is still uncertain. We speculate that it is related to the interaction between a head tail radio galaxy and shock. However, the current data allow us only to set an upper limit of M < 1.4 on the Mach number of this putative shock. Instead, we successfully characterise the surface brightness and temperature jumps of a shock and two cold fronts in the main cluster component of Abell 781. Their positions suggest that the merger is involving three substructures. We do not find any evidence for a radio halo either at the centre of this system or in the other clusters of the chain. We place an upper limit to the diffuse radio emission in the main cluster of Abell 781 that is a factor of 2 below the current radio power-mass relation for giant radio haloes

Intestinal parasitosis and shigellosis among diarrheal patients in Gondar teaching hospital, northwest Ethiopia

<p>Abstract</p> <p>Background</p> <p>Diarrheal diseases are the major causes of morbidity and mortality in developing world. Understanding the etiologic agents of diarrheal diseases and their association with socio-demographic characteristics of patients would help to design better preventive measures. Thus, this study was aimed to determine the prevalence of intestinal parasites and enteropathogenic bacteria in diarrheic patients.</p> <p>Methods</p> <p>A cross-sectional study involving 384 consecutive diarrheal patients who visited Gondar teaching hospital, Gondar, Ethiopia from October 2006 to March 2007 was conducted. Stool specimens were collected and examined for intestinal parasites and enteropathogenic bacteria following standard parasitological and microbiological procedures.</p> <p><b><it>Results</it></b></p> <p>Intestinal parasites were diagnosed in 36.5% of the patients. The most frequently encountered protozoan parasite was <it>Entamoeba histolytica/dispar </it>(7.3%) followed by <it>Giardia lamblia </it>(5.0%), C<it>ryptosporidium parvum </it>(1.8%) and <it>Isospora belli </it>(1.3%). The dominant helminthic parasite identified was <it>Ascaris lumbricoides </it>(5.5%) followed by <it>Strongyloides stercoralis </it>and <it>Schistosoma mansoni </it>(3.1% each), hookworm infection (1.8%), and <it>Hymenolepis </it>species (1.3%). Multiple infections of intestinal parasites were also observed in 6.3% of the patients. Among the enteropathogenic bacteria <it>Shigella </it>and <it>Salmonella </it>species were isolated from 15.6% and 1.6%, respectively, of the patients. <it>Escherichia coli O57:H7 </it>was not found in any of the stool samples tested. Eighty eight percent and 83.3% of the <it>Shigella </it>and <it>Salmonella </it>isolates were resistant to one or more commonly used antibiotics, respectively.</p> <p>Intestinal parasitosis was higher in patients who live in rural area, in patients who were washing their hands after visiting toilet either irregularly with soap and without soap or not at all, in patients who used well and spring water for household consumption, and in patients who had nausea (<it>P </it>< 0.05). Statistically significant associations were also observed between Shigella infections and patients who were using well and spring water for household consumption, and patients who had dysentery and mucoid stool (<it>P </it>< 0.05).</p> <p>Conclusions</p> <p>The high prevalence of intestinal parasites and <it>Shigella </it>species in diarrheic patients calls for institution of appropriate public health intervention measures to reduce morbidity and mortality associated with these diseases. The rational use of antibiotics should also be practiced.</p

Increased uptake on ^99mTc bone scintigraphy in a case of tumoral calcinosis in a child

Tumoral calcinosis is an idiopathic condition resulting in the periarticular deposition of calcium crystals and salts in soft tissues. It is rare in children, and even rarer in idiopathic form. We present a case of a 2-year-old female with tumoral calcinosis in the supraclavicular region, and, in particular, focus on the pertinent radiological findings with radiography, MRI and bone scintigraphy