Cost-effectiveness of Magnetic Resonance Imaging in Cervical Clearance of Obtunded Blunt Trauma After a Normal Computed Tomographic Finding

Wu, Xiao; Geng, Bertie; Kalra, Vivek B.; Abbed, Khalid M.; Forman, Howard P.; Sanelli, Pina C.

doi:10.1001/jamasurg.2018.0099

Cited by 28 publications

(18 citation statements)

References 42 publications

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“…Finally, we utilized the best available data on quality-of-life estimates for surgical complications but recognize that these are extrapolations. In accordance with other surgical cost-effectiveness analyses, 28,35 we used QALYs from studies pertaining to Caesarean sections and hernia repair. To support future cost-effectiveness work within general and bariatric surgery, further studies that determine quality-of-life estimates specific to surgical complications are critically needed.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of Staple Line Reinforcement in Laparoscopic Sleeve Gastrectomy

et al. 2021

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Objective: To perform a cost-effectiveness analysis of staple-line reinforcement in laparoscopic sleeve gastrectomy. Summary of Background Data: Exponential increases in surgical costs have underscored the critical need for evidence-based methods to determine the relative value of surgical devices. One such device is stapleline reinforcement, thought to decrease bleeding rates in laparoscopic sleeve gastrectomy. Methods: Two intervention arms were modeled, staple-line reinforcement and standard nonreinforced stapling. Bleed and leak rates and 30-day treatment costs were obtained from national and state registries. Qualityadjusted life-year (QALY) values were drawn from previous literature. Device prices were drawn from institutional data. A final incremental cost-effectiveness ratio was calculated, and one-way and probabilistic sensitivity analyses were performed.Results: A total of 346,530 patient records from 2012 to 2018 were included. Complication rates for the reinforced and standard cohorts were 0.05% for major bleed in both cohorts (P = 0.8841); 0.45% compared with 0.59% for minor bleed (P < 0.0001); and 0.24% compared with 0.26% for leak (P = 0.4812

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of Staple Line Reinforcement in Laparoscopic Sleeve Gastrectomy

et al. 2021

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“…Однак, незважаючи на дуже високу чутливість МРТ при виявленні ушкоджень задньої зв'язки (78,4-100 %), недоліком є значно нижча специфічність (51,5-80,5 %), що може призвести до великої кількості хибнопозитивних результатів у постраждалих із гострою травмою шийного відділу хребта [19]. З іншого боку, низка сучасних досліджень демонструють економічну недоцільність використання МРТ як додаткового інструменту верифікації ступеня і характеру остеолігаментозних змін у пацієнтів з травмою шийного відділу, що також може ускладнювати діагностику [13,32]. Складністю оцінки стану лігаментозного комплексу пояснюються найбільш низькі показники ICC CSISS саме для типів В1, В2 і В3.…”

Section: обговоренняunclassified

Оцінка рівня нестабільності ушкоджень, класифікованих за AOSpine Subaxial Cervical Spine Injury Classification System

Verbov¹

2021

TRAUMA

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Background. The main criteria for determining surgery strategy in patients with traumatic subaxial cervical injury are as follows: the type and degree of damage to the osteo-ligamentous structures of cervical spine that determines the level of instability; the value of spinal cord compression; the state of the sagittal profile. The aim of this study was to assess the degree of instability in different types of cervical spine injuries according to AOSpine Subaxial Cervical Spine Injury Classification System. Materials and methods. We performed a retrospective analysis of Х-ray, computed tomography and magnetic resonance imaging data of 168 patients with traumatic injury of subaxial cervical spine. All of them were hospitalized at the Department of Spinal Cord Pathology of the Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine 2008–2018. We assessed the degree of instability using the Cervical Spine Injury Severity Score and determined the type of damage according to the AOSpine Subaxial Cervical Spine Injury Classification System. Results. We found that the median rate of instability increases progressively with increasing severity of injury type. The widest range of instability values is observed in the compression damage: from 6 points (95% confidence interval (CI): 4.76–6.84) in A1 type to 11 points (95% CI: 9.48–11.81) in A4. For A2 and A3 types, we registered 7 (95% CI: 6.68–7.53) and 8 points (95% CI: 7.97–9.01), respectively. A smaller range of values characterizes flexion-extension injuries. The median progressively increases from B1 type — 13 points (95% CI: 12.4–13.92) to B3 type — 15.5 points (95% CI: 14.5–16.35). The value for B2 is intermediate and is 15 points (95% CI: 13.59–15.52). We registered maximum values in flexion-extension injuries — 18 points, for both B2 and B3 types. C type has the highest level of instability — 17 points (95% CI: 16.58–17.86) and a quite wide range of estimated values: from 13 to 20 points. Conclusions. The general trend is an increase in the level of instability in the range from A1 to C injury subtypes, but even A1 type in some cases are quite unstable and require surgery. In contrast to the classical views, type A injuries are often accompanied by da-mage to the facet joints, which must also be taken into account when determining the individual treatment.

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“…However, patients with embolic stroke of undetermined source may require longterm monitoring to detect paroxysmal AF or silent. Additionally, neither clinical characteristics nor neuroimaging findings alone can reliably classify the underlying cause of CE; in the absence of characteristic imaging features, the clinician may miss diagnosing CE strokes located at extremely unusual locations [5,6]. Therefore, it is necessary to identify biomarkers to distinguish patients with AF-CE from normal controls and can discriminate AF-CE from other types of ischaemic stroke.…”

Section: Introductionmentioning

confidence: 99%

C1QC, VSIG4, and CFD as Potential Peripheral Blood Biomarkers in Atrial Fibrillation-Related Cardioembolic Stroke

Ding

Xing

Bai

et al. 2023

Oxidative Medicine and Cellular Longevity

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Atrial fibrillation (AF) is a major risk factor for ischemic stroke. We aimed to identify novel potential biomarkers with diagnostic value in patients with atrial fibrillation-related cardioembolic stroke (AF-CE).Publicly available gene expression profiles related to AF, cardioembolic stroke (CE), and large artery atherosclerosis (LAA) were downloaded from the Gene Expression Omnibus (GEO). Differentially expressed genes (DEGs) were identified and then functionally annotated. The support vector machine recursive feature elimination (SVM-RFE) and least absolute shrinkage and selection operator (LASSO) regression analysis were conducted to identify potential diagnostic AF-CE biomarkers. Furthermore, the results were validated by using external data sets, and discriminability was measured by the area under the ROC curve (AUC). In order to verify the predictive results, the blood samples of 13 healthy controls, 20 patients with CE, and 20 patients with LAA stroke were acquired for RT-qPCR, and the correlation between biomarkers and clinical features was further explored. Lastly, a nomogram and the companion website were developed to predict the CE-risk rate. Three feature genes (C1QC, VSIG4, and CFD) were selected and validated in the training and the external datasets. The qRT-PCR evaluation showed that the levels of blood biomarkers (C1QC, VSIG4, and CFD) in patients with AF-CE can be used to differentiate patients with AF-CE from normal controls ( P < 0.05 ) and can effectively discriminate AF-CE from LAA stroke ( P < 0.05 ). Immune cell infiltration analysis revealed that three feature genes were correlated with immune system such as neutrophils. Clinical impact curve, calibration curves, ROC, and DCAs of the nomogram indicate that the nomogram had good performance. Our findings showed that C1QC, VSIG4, and CFD can potentially serve as diagnostic blood biomarkers of AF-CE; novel nomogram and the companion website can help clinicians to identify high-risk individuals, thus helping to guide treatment decisions for stroke patients.

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Cost-effectiveness of Magnetic Resonance Imaging in Cervical Clearance of Obtunded Blunt Trauma After a Normal Computed Tomographic Finding

Cited by 28 publications

References 42 publications

Cost-effectiveness of Staple Line Reinforcement in Laparoscopic Sleeve Gastrectomy

Cost-effectiveness of Staple Line Reinforcement in Laparoscopic Sleeve Gastrectomy

Оцінка рівня нестабільності ушкоджень, класифікованих за AOSpine Subaxial Cervical Spine Injury Classification System

C1QC, VSIG4, and CFD as Potential Peripheral Blood Biomarkers in Atrial Fibrillation-Related Cardioembolic Stroke

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