Source imaging of seizure onset predicts surgical outcome in pediatric epilepsy

ObjectiveTo assess whether ictal electric source imaging (ESI) on low-density scalp EEG can approximate the seizure onset zone (SOZ) location and predict surgical outcome in children with refractory epilepsy undergoing surgery.MethodsWe examined 35 children with refractory epilepsy. We dichotomized surgical outcome into seizure- and non-seizure-free. We identified ictal onsets recorded with scalp and intracranial EEG and localized them using equivalent current dipoles and standardized low-resolution magnetic tomography (sLORETA). We estimated the localization accuracy of scalp EEG as distance of scalp dipoles from intracranial dipoles. We also calculated the distances of scalp dipoles from resection, as well as their resection percentage and compared between seizure-free and non-seizure-free patients. We built receiver operating characteristic curves to test whether resection percentage predicted outcome.ResultsResection distance was lower in seizure-free patients for both dipoles (p = 0.006) and sLORETA (p = 0.04). Resection percentage predicted outcome with a sensitivity of 57.1% (95% CI, 34–78.2%), a specificity of 85.7% (95% CI, 57.2–98.2%) and an accuracy of 68.6% (95% CI, 50.7–83.5%) (p = 0.01).ConclusionIctal ESI performed on low-density scalp EEG can delineate the SOZ and predict outcome.SignificanceSuch an application may increase the number of children who are referred for epilepsy surgery and improve their outcome.     

Capturing the value of vaccination within health technology assessment and health economics: Country analysis and priority value concepts

BackgroundA value of vaccination framework for economic evaluation (EE) identified unique value concepts for the broad benefits vaccination provides to individuals, society, healthcare systems and national economies. The objectives of this paper were to work with experts in developed countries to objectively identify three priority concepts to extend current EE.MethodsThe previously developed classification of value concepts in vaccination distinguished 18 concepts, categorised as conventional payer and societal perspective concepts and novel broader societal concepts. Their inclusion in current EE guidelines was assessed. Experts identified eight criteria relevant to decision-making and measurement feasibility, which were weighted and used to score each concept. The relative ranking of concepts by importance and the gaps in guidelines were used to identify three priority concepts on which to focus immediate efforts to extend EE.ResultsThe EE guidelines review highlighted differences across countries and between guidelines and practice. Conventional payer perspective concepts (e.g., individual and societal health gains and medical costs) were generally included, while gaps were evident for conventional societal perspective concepts (e.g., family/caregiver health and economic gains). Few novel broader societal benefits were considered, and only in ad hoc cases. The top-three concepts for near-term consideration: macroeconomic gains (e.g., benefiting the economy, tourism), social equity and ethics (e.g., equal distribution of health outcomes, reduced health/financial equity gaps) and health systems strengthening, resilience and security (e.g., efficiency gains, reduced disruption, increased capacity).ConclusionsGaps, inconsistencies and limited assessment of vaccination value in EE can lead to differences in policy and vaccination access. The three priority concepts identified provide a feasible approach for capturing VoV more broadly in the near-term. Robust methods for measuring and valuing these concepts in future assessments will help strengthen the evidence used to inform decisions, improving access to vaccines that are demonstrably good value for money from society’s point of view.     

针药并用在早发性卵巢功能不全防治中的价值初探

早发性卵巢功能不全的常规西医治法包括激素替代疗法和辅助生殖技术,但均存在一定局限性。针药并用是在中医理论指导下,综合使用针灸和中药的一种综合治疗模式,在防治早发性卵巢功能不全中具有一定价值,不仅可提高临床疗效,还可为优化治疗方案、提高治疗安全性奠定基础。未来应进一步明确针药并用防治早发性卵巢功能不全的内涵,在中医理论指导下制定规范,深化基础研究,阐述相应机制,不断完善针药并用防治POI的体系。     

The fatality and morbidity components of the value of statistical life

The fatality risk–money tradeoff that is the value of a statistical life (VSL) may vary with the nature of the fatality event. While all fatalities involve loss of future life expectancy, the morbidity effects and their duration may differ. This article analyzes fatality risks accompanied by morbidity effects of different duration to disentangle the mortality and morbidity components of VSL using data from the Census of Fatal Occupational Injuries (CFOI). The VSL is comprised of the sum of the value of the fatality risk and the value of the morbidity risk. Labor market valuations of morbidity risks are positive, even for fatalities that are caused by traumatic injuries. The value of the fatality risk is the dominant component of VSL, rather than the value of the morbidity risk.     

ICD-10 anaphylaxis algorithm and the estimate of vaccine-attributable anaphylaxis incidence in Medicare

BackgroundAnaphylaxis is a rare, serious allergic reaction. Its identification in large healthcare databases can help better characterize this risk.ObjectiveTo create an ICD-10 anaphylaxis algorithm, estimate its positive predictive values (PPVs) in a post-vaccination risk window, and estimate vaccination-attributable anaphylaxis rates in the Medicare Fee For Service (FFS) population.MethodsAn anaphylaxis algorithm with core and extended portions was constructed analyzing ICD-10 anaphylaxis claims data in Medicare FFS from 2015 to 2017. Cases of post-vaccination anaphylaxis among Medicare FFS beneficiaries were then identified from October 1, 2015 to February 28, 2019 utilizing vaccine relevant anaphylaxis ICD-10 codes. Information from medical records was used to determine true anaphylaxis cases based on the Brighton Collaboration’s anaphylaxis case definition. PPVs were estimated for incident anaphylaxis and the subset of vaccine-attributable anaphylaxis within a 2-day post-vaccination risk window. Vaccine-attributable anaphylaxis rates in Medicare FFS were also estimated.ResultsThe study recorded 66,572,128 vaccinations among 21,685,119 unique Medicare FFS beneficiaries. The algorithm identified a total of 190 suspected anaphylaxis cases within the 2-day post-vaccination window; of these 117 (62%) satisfied the core algorithm, and 73 (38%) additional cases satisfied the extended algorithm. The core algorithm’s PPV was 66% (95% CI [56%, 76%]) for identifying incident anaphylaxis and 44% (95% CI [34%, 56%]) for vaccine-attributable anaphylaxis. The vaccine-attributable anaphylaxis incidence rate after any vaccination was 0.88 per million doses (95% CI [0.67, 1.16]).ConclusionThe ICD-10 claims algorithm for anaphylaxis allows the assessment of anaphylaxis risk in real-world data. The algorithm revealed vaccine-attributable anaphylaxis is rare among vaccinated Medicare FFS beneficiaries.     

新生儿缺氧缺血性脑病超声、MRI表现及诊断价值研究

目的探讨新生儿缺氧缺血性脑病(HIE)超声(US)、磁共振成像(MRI)表现及诊断价值。方法选定本院2019年3月至2021年3月收诊的80例HIE患儿,按照程度不同分为轻度(28例)、中度(30例)、重度(22例),同期选择30例健康新生儿,均行MRI、US检查。观察MRI、US两种影像学检测方法的诊断结果,比较其脑梗死(CI)、白质软化(PVL)、旁矢状区脑损伤(PBI)、基底节丘脑损伤(BGTI)、选择性神经元损伤(SND)、脑水肿(CE)病理显示情况。并记录MRI的表观扩散系数(ADC)值,以及US的阻力指数(RI)、舒张期峰值血流速度(VD)、收缩期峰值血流速度(VS),分析其相关性。结果(1)MRI的轻度检出率较US高,差异有统计学意义(P<0.05);其中、重度检出率与US相比,差异无统计学意义(P>0.05)。(2)MRI的CI、PVL、BGTI、CE病理显示率与US相比,差异无统计学意义(P>0.05);MRI的PBI、SND病理显示率较US高,差异有统计学意义(P<0.05)。(3)健康体检者、HIE轻度患儿、HIE中度及重度患儿的的ADC值、VD、VS、RI,差异有统计学意义(P<0.05);经Kendall秩相关系数检验,HIE患儿的ADC值与RI、VS呈负相关性,差异有统计学意义(P<0.05)。结论横向对比中,US与MRI部分诊断存在关联性,可相互补充;纵向对比中,MRI的诊断效果整体优于US。     

职业性外照射个人剂量监测中本底值选择的探讨

目的 探讨个人剂量监测中医院不同科室本底值的差异情况。方法 按不同职业类别对医院科室进行分组，并布放跟随本底剂量计，将测得的本底值分别与机关办公室对照本底值进行比较分析。结果 该医院本底剂量水平在0.22~0.33 mSv范围，机关办公室的3个布点办公书柜、办公桌抽屉、办公桌面本底值分别是（0.28±0.02） mSv、（0.28±0.01） mSv、（0.31±0.01） mSv；与机关办公室本底值相比，普放1层、口腔科、放疗中心1层、导管室1层均大于机关办公室（P<0.05），CT区、PET-CT控制室、神经外科、实验室均小于机关办公室（P<0.05），心内科与机关办公室没有统计学差异（P>0.05）。结论 不能使用单一本底值作为一种个职业分类或一个单位的本底值，应对每个科室布放跟随本底剂量计来降低本底值结果的误差。