Is the Cost-Effectiveness of Stroke Thrombolysis Affected by Proportion of Stroke Mimics?

Background and Purpose- Differentiating ischemic stroke patients from stroke mimics (SM), nonvascular conditions which simulate stroke, can be challenging in the acute setting. We sought to model the cost-effectiveness of treating suspected acute ischemic stroke patients before a definitive diagnosis could be made. We hypothesized that we would identify threshold proportions of SM among suspected stroke patients arriving to an emergency department above which administration of intravenous thrombolysis was no longer cost-effective. Methods- We constructed a decision-analytic model to examine various emergency department thrombolytic treatment scenarios. The main variables were proportion of SM to true stroke patients, time from symptom onset to treatment, and complication rates. Costs, reimbursement rates, and expected clinical outcomes of ischemic stroke and SM patients were estimated from published data. We report the 90-day incremental cost-effectiveness ratio of administering intravenous thrombolysis compared with no acute treatment from a healthcare sector perspective, as well as the cost-reimbursement ratio from a hospital-level perspective. Cost-effectiveness was defined as a willingness to pay <$100 000 USD per quality adjusted life year gained and high cost-reimbursement ratio was defined as >1.5. Results- There was an increase in incremental cost-effectiveness ratios as the proportion of SM cases increased in the 3-hour time window. The threshold proportion of SM above which the decision to administer thrombolysis was no longer cost-effective was 30%. The threshold proportion of SM above which the decision to administer thrombolysis resulted in high cost-reimbursement ratio was 75%. Results were similar for patients arriving within 0 to 90 minutes of symptom onset as compared with 91 to 180 minutes but were significantly affected by cost of alteplase in sensitivity analyses. Conclusions- We identified thresholds of SM above which thrombolysis was no longer cost-effective from 2 analytic perspectives. Hospitals should monitor SM rates and establish performance metrics to prevent rising acute stroke care costs and avoid potential patient harms.

Effect of Synthesis Time and Composition on Magnetic Properties of FeCo Nanoparticles by Polyol Method.

This study investigated the effect of synthesis time and composition on magnetic properties of FeCo nanoparticles. Fe75Co25, Fe66Co34, Fe52Co48 nanoparticles were synthesized by the polyol method. The saturation magnetization of Fe75 Co25, Fe66Co34, Fe52Co48 nanoparticles was 178 emu/g, 191 emu/g and 197 emu/g, respectively. The coercivity of Fe75 Co25, Fe66Co34, Fe52Co48 was 113 Oe, 131 Oe and 89.2 Oe respectively. The synthesis time of Fe52Co48 nanoparticles was also varied (2 h and 3 h) to determine the optimal synthesis time. The saturation magnetization of Fe52Co48 synthesized for 2 h, 3 h was 243 emu/g, 202 emu/g, respectively. The coercivity of Fe52Co48 synthesized for 2 h and 3 h was 46 Oe and 111 Oe, respectively. The highest saturation magnetization and lowest coercivity was obtained using a synthesis time of 2 h. Based on these results, it was confirmed that Fe52Co48 had the highest saturation magnetization and lowest coercivity among all of the compositions tested, and optimal synthesis time was 2 h.

Facile Approach for Metallic Precursor Engineering for Efficient Kesterite Thin-Film Solar Cells.

Kesterite-based Cu2ZnSn(S,Se)4 (CZTSSe) thin-film solar cells (TFSCs) are a promising candidate for low-cost, clean energy production owing to their environmental friendliness and the earth-abundant nature of their constituents. However, the advancement of kesterite TFSCs has been impeded by abundant defects and poor microstructure, limiting their performance potential. In this study, we present efficient Ag-alloyed CZTSSe TFSCs enabled by a facile metallic precursor engineering approach. The positioning of the Ag nanolayer in the metallic stacked precursor proves crucial in expediting the formation of Cu-Sn metal alloys during the alloying process. Specifically, Ag-included metallic precursors promote the growth of larger grains and a denser microstructure in CZTSSe thin films compared to those without Ag. Moreover, the improved uniformity of Ag, facilitated by the evaporation deposition technique, significantly suppresses the formation of detrimental defects and related defect clusters. This suppression effectively reduces nonradiative recombination, resulting in enhanced performance in kesterite TFSCs. This study not only introduces a metallic precursor engineering strategy for efficient kesterite-based TFSCs but also accelerates the development of microstructure evolution from metallic stacked precursors to metal chalcogenide compounds.

Effects of multi-layer graphene capping on Cu interconnects.

The benefits of multi-layer graphene (MLG) capping on Cu interconnects have been experimentally demonstrated. The resistance of MLG capped Cu wires improved by 2-7% compared to Cu wires. The breakdown current density increased by 18%, suggesting that the MLG can act as an excellent capping material for Cu interconnects, improving the reliability characteristics. With a proper process optimization, MLG capped Cu interconnects could become a promising technology for high density back end-of-line interconnects.

Mortality of septic knee arthritis in Korea: risk factors analysis of a large national database.

This study aimed to analyze the risk factors for mortality of septic knee arthritis in Korea through a large nationwide data research. The National Health Insurance Service-Health Screening database was used to analyze 89,120 hospitalizations for septic knee arthritis between 2005 and 2018. In-hospital, thirty-day, and ninety-day mortality, and their association with patient's demographic factors, various comorbidities (i.e., cerebrovascular disease, congestive heart failure, and myocardial infarction) and Charlson Comorbidity Index (CCI) were assessed. Secondary outcomes of complications (osteomyelitis, knee arthroplasty, recurrence) were analyzed. The number of hospitalization with septic knee arthritis increased from 1847 cases in 2005 to 8749 cases in 2018. There was no significant difference in mortality after diagnosis of septic knee arthritis between years. The risk of mortality in patients who hospitalized with septic knee arthritis increased in comorbidities like Congestive heart failure, dementia, myocardial infarction, chronic kidney disease. Hazard ratio (HR) decreased in patients who have comorbidities such as rheumatoid arthritis, liver disease, rheumatologic disease. HR for mortality in septic knee arthritis increased in patients with CCI more than 1. The risk factors for mortality in all periods were male sex, old age, high CCI, comorbidities such as congestive heart failure, dementia, myocardial infarction, chronic kidney disease. Efforts to reduce mortality should be concentrate more on patients with these risk factors.

High-performance laser mode-locker with glass-hosted SWNTs realized by room-temperature aerosol deposition.

We preserve optical nonlinear properties of single-walled carbon nanotubes (SWNTs) within SiO2-host employing aerosol deposition (AD) that guarantees the formation of dense ceramic thick films at room temperature without combustion and solubility limitation of the SWNTs. The intact nonlinearity is verified with transmittance check, Raman spectrometry and electron microscopes. As a saturable absorption device, the SiO2-SWNT composite film successfully mode-locks fiber lasers inducing high-quality output pulses with the measured pulse duration and repetition rate of 890 fs and 9.52 MHz, respectively. After experiencing the intracavity power higher than 20 dBm, the hosted SWNTs are survived to function as the pulse formers.

Multi-tissue transcriptomic analysis reveals that L-methionine supplementation maintains the physiological homeostasis of broiler chickens than D-methionine under acute heat stress.

The objective of this study was to compare the effects of supplementation with two methionine isoforms, L-methionine (L-Met) or D-methionine (D-Met), on transcriptome expression in broiler chickens under acute heat stress. A total of 240 one-day-old chicks were randomly assigned to one of four treatments in a 2 × 2 factorial arrangement: thermo-neutral vs. acute heat-stress and L-Met vs. D-Met supplementation. On day 14, the heat-stressed group was exposed to 32°C for 5 h, while the others remained at 25°C. Six chicks were randomly selected per treatment and total RNA was isolated from whole blood, ileum, and liver tissues. Two RNA samples from each tissue of each treatment group were randomly selected and pooled in equal amounts. A total of 1.87 billion raw reads obtained from 36 samples (four treatments × three tissues × three composited replicates) were mapped to the reference genome build (Gallus_gallus-5.0) and used to identify differentially expressed genes (DEGs) using DESeq2. Functional enrichment of DEGs was tested using DAVID. Comparing the two isoforms of supplemented methionine, two, three, and ten genes were differentially expressed (> 1 or < -1 log2 fold change) in whole blood, ileum, and liver, respectively. A total of 38, 71, and 16 genes were differentially expressed in response to the interaction between heat stress and Met isoforms in the blood, ileum, and liver, respectively. Three-tissue-specific DEGs were functionally enriched for regulation of cholesterol homeostasis and metabolism, glucose metabolism, and vascular patterning. Chicks fed with L-Met had lower immune (e.g., IL4I1 and SERPINI1) and intestinal angiogenic responses (e.g., FLT1 and FGD5), and stable glucose and lipid metabolism (e.g., PCK1 and LDLR) under heat stress conditions. In conclusion, unlike D-Met, L-Met supplementation seems to help maintain physiological homeostasis and enhances cellular defense systems against external stresses like high environmental temperature.

Incidence and risk factors analysis for mortality after total knee arthroplasty based on a large national database in Korea.

This study aimed to analyze the rates and risk factors of postoperative mortality among 560,954 patients who underwent total knee arthroplasty (TKA) in Korea. The National Health Insurance Service-Health Screening database was used to analyze 560,954 patients who underwent TKA between 2005 and 2018. In-hospital, ninety-day, and one-year postoperative mortality, and their association with patient's demographic factors and various comorbidities (ie., cerebrovascular disease, congestive heart failure, and myocardial infarction) were assessed. In-hospital, ninety-day and one-year mortality rates after TKA were similar from 2005 to 2018. The risk of in-hospital mortality increased with comorbidities like cerebrovascular disease (hazard ratio [HR] = 1.401; 95% confidence interval [CI] = 1.064-1.844), congestive heart failure (HR = 2.004; 95% CI = 1.394 to 2.881), myocardial infarction (HR = 2.111; 95% CI = 1.115 to 3.998), and renal disease (HR = 2.641; 95% CI = 1.348-5.173). These co-morbidities were also independent predictors of ninety-day and one-year mortality. Male sex and old age were independent predictors for ninety-day and one-year mortality. And malignancy was risk factor for one-year mortality. The common preoperative risk factors for mortality in all periods were male sex, old age, cerebrovascular disease, congestive heart failure, myocardial infarction, and renal disease. Malignancy was identified as risk factor for one-year mortality. Patients with these comorbidities should be provided better perioperative care.

Broilers fed a low protein diet supplemented with synthetic amino acids maintained growth performance and retained intestinal integrity while reducing nitrogen excretion when raised under poor sanitary conditions.

The present study investigated the effects of supplementing a low protein (LP) diet supplemented with key essential amino acids (AA) to broilers on growth performance, intestinal tract function, blood metabolites, and nitrogen excretion when the animals were maintained under various sanitary conditions for 35 D after hatching. Three hundred eighty-four one-day-old male broilers (Ross 308) were randomly allotted to groups that received one of 6 dietary treatments in a 2 × 3 factorial arrangement (i.e., 2 environmental conditions and 3 dietary treatments) to give 8 replicates per treatment. Broilers were challenged with 2 environmental conditions (sanitary vs. poor sanitary). The dietary treatments were (1) high protein (HP) diet, (2) LP diet, and (3) LP diet with synthetic key essential AA (LPA): the LP diet was supplemented with synthetic AA up to the required levels for broilers. On day 14, birds consumed the LP diet impaired growth performance compared with those fed the HP diet, while the average daily weight gain-to-feed conversion ratio of birds fed the LPA diet improved to the level of birds fed the HP diet under poor sanitary conditions (P < 0.05). Broilers raised under poor sanitary conditions and fed the LP diet displayed higher (P < 0.05) zonula occludens (ZO-1) expression on day 14 than broilers fed either the HP or LPA diet. Under sanitary conditions, birds fed HP and LPA diets showed higher villus height and crypt depth compared with those of broilers fed the LP diet on day 35. Moreover, broilers raised in the poor sanitary environment had higher (P < 0.05) serum endotoxins than those raised in the sanitary environment. Broilers fed the LPA diet showed reduced (P < 0.05) nitrogen excretion on days 14 and 35 compared with those fed the LP and HP diets independent of the environment. In conclusion, the LPA diet did not impair growth performance under poor sanitary conditions for 14 D after hatch while resulting in lower nitrogen excretion in any environment conditions throughout the experiment.

Association of parental education with tooth loss among Korean Elders.

OBJECTIVE: There are few reports showing an association between childhood socioeconomic circumstances and tooth loss among the elderly. The purpose of this study was (i) to examine the association between early childhood socioeconomic position (parental education level) and tooth loss and (ii) to determine the relative effects of the subjects' education level, occupation, and income on tooth loss in Korean elders. MATERIAL AND METHODS: Data from the fourth and fifth Korea National Health and Nutritional Examination Survey on 8814 Korean elders (age ≥65 years) were analyzed. Demographic factors (age, survey year, marital status, and residence area), health behaviors (dental check-up during the past year and cigarette smoking), and the presence of a somatic health problem (diabetes) were included in our gender-specific analyses. Tooth loss was defined as edentulism or severe tooth loss (<20 teeth). For our analyses, chi-square test and Student's t-tests and multiple logistic regressions were performed. RESULTS: A low parental education level was associated with elevated odds of edentulism (OR = 1.87 for father's education and 1.52 for mother's education among male elders and OR = 1.73 for father's education and 1.55 for mother's education among female elders) and with severe tooth loss (OR = 1.58 for father's education and 1.53 for mother's education among male elders and OR = 1.25 for father's education and 1.48 for mother's education among female elders). The association between parental education level and tooth loss was attenuated after adjusting for the subject's education level, occupation, and income. Relative magnitude of attenuation varied with personal factors (education > income > occupation). In a fully adjusted model, father's education level was significantly associated with edentate status (OR = 1.96 for male elders and 1.46 for female elders), but not with severe tooth loss. CONCLUSION: Our results indicate that early life socioeconomic circumstances measured by the father's education level were independently associated with the edentate status of Korean elders.

Retrovirus-mediated gene transfer and expression of EGFP in chicken.

Here, we successfully demonstrate expression of the EGFP (enhanced green fluorescence protein) gene in chickens using replication-defective MLV (murine leukemia virus)-based retrovirus vectors encapsidated with VSV-G (vesicular stomatitis virus G glycoprotein). The recombinant retrovirus was injected beneath the blastoderm of non-incubated chicken embryos (stage X). After 12 days incubation, all of the eight living embryos assayed were found to express this vector-encoded EGFP gene, which was under the control of the RSV (Rous Sarcoma Virus) promoter, in diverse organ tissues, including head, beak, neck, wing, hock, tail, toes, heart, amnion, and yolk sac. Surprisingly, despite the presumed cytotoxicity of EGFP, some embryos hatched and survived and these had prominent green fluorescent spots, both in internal organs and externally.