Assessment of the incremental prognostic value from the modified frailty index-5 in complete traumatic cervical spinal cord injury.

Frailty, as measured by the modified frailty index-5 (mFI-5), and older age are associated with increased mortality in the setting of spinal cord injury (SCI). However, there is limited evidence demonstrating an incremental prognostic value derived from patient mFI-5. We conducted a retrospective cohort study to evaluate in-hospital mortality among adult complete cervical SCI patients at participating centers of the Trauma Quality Improvement Program from 2010 to 2018. Logistic regression was used to model in-hospital mortality, and the area under the receiver operating characteristic curve (AUROC) of regression models with age, mFI-5, or age with mFI-5 was used to compare the prognostic value of each model. 4733 patients were eligible. We found that both age (80 y versus 60 y: OR 3.59 95% CI [2.82 4.56], P < 0.001) and mFI-5 (score ≥ 2 versus < 2: OR 1.53 95% CI [1.19 1.97], P < 0.001) had statistically significant associations with in-hospital mortality. There was no significant difference in the AUROC of a model including age and mFI-5 when compared to a model including age without mFI-5 (95% CI Δ AUROC [- 8.72 × 10-4 0.82], P = 0.199). Both models were superior to a model including mFI-5 without age (95% CI Δ AUROC [0.06 0.09], P < 0.001). Our findings suggest that mFI-5 provides minimal incremental prognostic value over age with respect to in-hospital mortality for patients complete cervical SCI.

Do Integrated Systems of Stroke Care Improve Symptom to Surgery Times in Patients with Symptomatic Carotid Stenosis? A Single Centre Decision Tree Analysis.

OBJECTIVE: The objective of this study was to examine the impact of an integrated system of stroke care on symptom to surgery times, cost-effectiveness, and quality of life measures in patients with symptomatic carotid stenosis. METHODS: Patients who underwent carotid endarterectomy (CEA) in a regional vascular centre between April 1, 2011, and March 31, 2016, were identified from the National Vascular Registry (NVR). Risk of stroke on medical therapy for each patient was calculated using the Oxford stroke risk calculator. Symptom to surgery times were compared among patients referred from a stroke service providing an integrated stroke care and the stroke service in an adjacent NHS trust which provides standard urgent referral pathway. A decision analytic Markov process model was constructed to determine the cost-effectiveness of CEA versus medical treatment in patients who followed the standard and integrated pathways. This model examined the lifetime costs and health benefits of CEA through each pathway. RESULTS: A total of 376 patients underwent CEA, of whom 243 were managed through the integrated stroke pathway and 133 through the standard urgent referral pathway. Median symptom to surgery time was 11 (0-66) days for the former and 15 (3-90) days for the latter (p < .001). There was no significant difference in peri-operative stroke death rate between integrated (2.1%) and standard (1.5%) pathways (chi-square = 0.14, p = .73). CEA through the integrated pathway improved quality adjusted life expectancy by an additional 0.13 (0.64 QALYs [integrated pathway] to 0.51 QALYs [standard pathway]) and was associated with an incremental lifetime cost benefit of £2203.4. CONCLUSIONS: An integrated stroke system of care is cost-effective and associated with significant improvements in quality adjusted life years.

Molecular genetic and chemical assessment of radix Angelica (Danggui) in China.

The roots of Angelica sinensis (Danggui), a traditional Chinese medicine, have been used for invigorating blood circulation for over 2000 years in China. Three common species of Angelica roots are found in Asia: A. sinensis from China, A. acutiloba from Japan, and A. gigas from Korea. By using a molecular genetic approach, the 5S-rRNA spacer domains of the three species of Angelica were amplified, and their nucleotide sequences were determined. Diversity in DNA sequences among various species was found in their 5S-rRNA spacer domains, which could serve as markers for authentic identification of Angelica roots. In chemical analyses, the main constituents of Angelica roots including ferulic acid and Z-ligustilide were determined by HPLC; roots of A. sinensis were clearly distinct in that they contained approximately 10-fold higher levels of ferulic acid and Z-ligustilide as compared to roots of A. acutiloba and A. gigas. In addition, the amounts of main constituents in roots of A. sinensis varied according to different regions of cultivation and different methods of preservation. The chemical profile determined by HPLC therefore could serve as a fingerprint for quality control of Angelica roots.

[Mortality by age and cause of death in Switzerland: an analysis of cantonal disparities during the period 1978/83-1988/93]. / Mortalite par age et cause de deces en Suisse: une analyse des disparites cantonales durant la periode 1978/83 a 1988/93.

PIP: "During the 1980s, expectation of life at birth increased in all the Swiss cantons, but at very different tempi. The characteristics of the level and trends of mortality in the cantons are described here by the decomposition methods developed by Pollard and Arriaga. The pace of the development of mortality in the cantons is compared, and the particular characteristics observed are accounted for by life table analysis according to age and cause of death. The results show in particular the dominant role [of] economically active ages and beyond in recent mortality trends, and the importance of AIDS and of violent deaths in accounting for differences between cantons." (EXCERPT)^ieng

Bayesian analysis of ROC curves using Markov-chain Monte Carlo methods.

The authors introduce a Bayesian approach to generalized linear regression models for rating data observed in the evaluation of a diagnostic technology. Such models were previously studied using a non-Bayesian approach. In a Bayesian analysis, the difficulties inherent in an ordinal rating scale are circumvented by using data-augmentation techniques. Posterior distributions for the regression parameters- and thereby for receiver operating characteristic (ROC) curve parameters and values, for the area under a ROC curve, differences between areas, etc.-may then be computed by Markov-chain Monte Carlo methods. Inferences are made in standard Bayesian ways. The methods are exemplified by a study of ultrasonography rating data for the detection of hepatic metastases in patients with colon or breast cancer (previously analyzed) and the results compared.