Use of insertable cardiac monitors for the detection of atrial fibrillation in patients with cryptogenic stroke in the United States is cost-effective.

Objectives: Atrial fibrillation (AF) is the most common arrhythmia and a major marker of ischemic stroke risk. Early detection is crucial and, once diagnosed, anticoagulation therapy can be initiated to reduce stroke risk. The aim of this study was to assess the cost-effectiveness of employing an insertable cardiac monitor (ICM), BIOMONITOR, for the detection of AF compared to standard of care (SoC) ECG and Holter monitoring in patients with cryptogenic stroke, that is, stroke of unknown origin and where paroxysmal, silent AF is suspected. Materials and methods: A Markov model was developed which consisted of five main health states reflecting the potential lifetime evolution of the AF disease: post cryptogenic stroke (index event), subsequent mild, moderate and severe stroke, and death. Sub-states were included to track a patient's AF diagnostic status and the use of antiplatelet or anticoagulant therapy. AF detection was assumed to result in a treatment switch from aspirin to anticoagulants, except among those with a history of major bleeding. Detection yield and accuracy, clinical actions and treatment effects were derived from the literature and validated by an expert clinician. All relevant costs from a US Medicare perspective were included. Results and conclusions: An ICM-based strategy was associated with a reduction of 37 secondary ischemic strokes per 1000 patients monitored compared with SoC. Total per-patient costs with an ICM were higher (US$90,052 vs. US$85,157) although stroke-related costs were reduced. The use of an ICM was associated with a base-case incremental cost-effectiveness ratio of US$18,487 per life year gained compared with SoC and US$25,098 per quality-adjusted life year gained, below established willingness-to-pay thresholds. The conclusions were found to be robust over a range of input values. From a US Medicare perspective the use of a BIOMONITOR ICM represents a cost-effective diagnostic strategy for patients with cryptogenic stroke and suspected AF.

Interaction of PCBs with thyroid hormone levels and time of hatching in chicken embryos.

The effects of polychlorinated biphenyls (PCB 77, PCB 153, and the mixture Aroclor 1242) on circulating and intracellular thyroid hormone (TH) levels were studied during chicken embryonic development. We observed no influences of PCB 153 on TH availability. Aroclor 1242 caused a transient increase in the T(3) level in the cerebellum at day 16. Clear effects were only seen with PCB 77 around the period of hatching: a severely reduced TH peak, which normally coincides with the stage of internal pipping, and a considerable delay in the moment of hatching.

Polybrominated diphenyl ethers, polychlorinated biphenyls and organochlorine pesticides in sediment cores from the Western Scheldt river (Belgium): analytical aspects and depth profiles.

A rapid and simple analytical method for the determination of organochlorines, such as polychlorinated biphenyls (PCBs) and selected organochlorinated pesticides (OCPs) and organobromines, such as polybrominated diphenyl ethers (PBDEs), in sediment samples was optimised using CRM 536 (PCBs in freshwater sediment). The method involved a hot Soxhlet extraction that reduced the extraction time to 2 h. Elemental sulphur, which is present in sediments and may interfere during the analysis, was removed by means of copper powder added to the sediment during extraction and into the clean-up cartridge. The analysis of PCBs and OCPs was accomplished by gas chromatography with electron capture or mass spectrometric detection. Similar quantitative results for PCB congeners in CRM 536 were obtained using a 50-m capillary column and a 10-m narrow bore column suited for fast analysis. The analysis of PBDEs was done by mass spectrometry in negative chemical ionisation mode. Concentrations of organic pollutants in two sediment cores (approximately 50 cm depth) from the Scheldt river (south of Antwerp, Belgium) showed a relative steady state for PCBs and DDTs, with a slight decrease in the top layers, suggesting a slight decline in their concentrations due to restrictions in their usage. On the contrary, PBDEs were showing an increase in their concentrations in the top layers (up to 270 and 8400 ng/g dry weight for sum of tri- to hexa-BDE congeners and for BDE 209, respectively). This suggests an increasing trend in the concentrations of PBDEs in the Belgian environment.

Accumulation and tissue distribution of selected polychlorinated biphenyl congeners in chickens.

During one to three consecutive periods of 2 weeks, broiler chickens (n = 108) received test dies to which different amount of PCBs (7 congeners) were added. The relationship between exposure time and accumulation of individual congeners in different chicken tissues, such as breast, thigh and abdominal fat tissue, was observed. In all tissues, the vast majority of the PCB accumulation occurred during the first 2 weeks of exposures. After that, PCB concentrations only increased in the abdominal fat tissue of the animals. The individual PCBs were distributed differently in the various tissues. While CBs 28, 118, 138, 153 and 180 accumulated in the chickens, CBs 52 and 101 were metabolized, but no methyl sulphone metabolites of these congeners could be detected. Our results provide information on the absorption, tissue distribution and biotransformation of the individual PCB congeners and confirm the structure-activity relationships for metabolism of PCBs in birds, which are different from those in fish or mammalian species.

Polychlorinated biphenyls in broiler diets: their digestibility and incorporation in body tissues.

The influence of dietary amounts of polychlorinated biphenyls (PCBs) was studied on performance, apparent PCB digestibility and PCB accumulation in broiler chickens that were maintained until 42 days of age. Dietary concentrations of supplemented PCBs, based on the sum of seven reference congeners, ranged from 0 to 12 ng/g, which was below the legal maximum of 200 ng PCBs/g fat in Belgian feeds. PCB ingestion did not significantly affect body weight and feed intake. Apparent PCB digestibility was not influenced by dietary levels of added fat varying between 4% and 8%, but was significantly higher in broilers fed diets containing added PCBs. Accumulation of PCBs in the fat fraction of abdominal adipose tissue and breast and thigh muscle greatly depended upon PCB intake. However, PCB contents in the various body fat fractions within the same animal differed, even within muscle tissues, indicating an unequal PCB distribution in body fats.