Background: and Purpose The Save ChildS Study demonstrated that endovascular thrombectomy (EVT) is a safe treatment option for pediatric stroke patients with large vessel occlusions (LVOs) with high recanalization rates. Our aim was to determine the long-term cost, health consequences and cost-effectiveness of EVT in this patient population. Methods: In this retrospective study, a decision-analytic Markov model estimated lifetime costs and quality-adjusted life years (QALYs). Early outcome parameters were based on the entire Save ChildS Study to model the EVT group. As no randomized data exist, the Save ChildS patient subgroup with unsuccessful recanalization was used to model the standard of care group. For modeling of lifetime estimates, pediatric and adult input parameters were obtained from the current literature. The analysis was conducted in a United States setting applying healthcare and societal perspectives. Probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set to $100,000 per QALY. Results: The model results yielded EVT as the dominant (cost-effective as well as cost-saving) strategy for pediatric stroke patients. The incremental effectiveness for the average age of 11.3 years at first stroke in the Save ChildS Study was determined as an additional 4.02 lifetime QALYs, with lifetime cost-savings that amounted to $169,982 from a healthcare perspective and $254,110 when applying a societal perspective. Acceptability rates for EVT were 96.60% and 96.66% for the healthcare and societal perspectives. Conclusions EVT for pediatric stroke patients with LVOs resulted in added QALY and reduced lifetime costs. Based on the available data in the Save ChildS Study, EVT is very likely to be a cost-effective treatment strategy for childhood stroke.

Aims: Tryptamine is an amine compound derived from tryptophan by decarboxylation process. This compound can be found in fermented food and beverages, and in human gut and skin as well. This study aims to investigate the effect of tryptamine, on Gram-negative bacteria, namely Escherichia coli, Serratia marcescens and Pseudomonas aeruginosa. Methodology and results: In this study, we used E. coli, S. marcescens and P. aeruginosa due to their relatively observable quorum sensing-regulated phenotype, such as motility, prodigiosin and pyocyanin sequentially. Our results showed that tryptamine started to inhibit the growth and prodigiosin production of S. marcescens at concentration 250 μg/mL, while it inhibits the growth and pyocyanin production of P. aeruginosa at concentration 250 μg/mL and 500 μg/mL, respectively. Tryptamine inhibits both the growth and motility of E. coli at concentration 100 μg/mL. Conclusion, significance and impact of study These results suggest that tryptamine is able to inhibit the growth of E. coli, S. marcescens and P. aeruginosa at relatively high concentration, thus decreases the quorum sensing-regulated phenotypes. It implies that the growth and quorum sensing of Gram-negative bacteria most likely will not be affected by the low concentration of tryptamine that present in the gut.
Tryptamines ; Gram-Negative Bacteria ; Serratia marcescens ; Pseudomonas aeruginosa ; Escherichia coli