Prevalence of and risk factors for surgical site infections after pancreaticoduodenectomy: a systematic review and meta-analysis.

Background: Surgical site infections (SSIs) are one of the most common complications after pancreaticoduodenectomy (PD); however, the global prevalence and risk factors for SSIs after PD remain unknown. Objectives: To investigate the prevalence of and risk factors for SSIs after PD. Methods: The PubMed, Embase, Cochrane Library, Web of Science, and Science Direct databases were systematically searched from inception to 1 December 2022. Observational studies reporting adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of risk factors for SSIs in patients undergoing PD were included. Two independent reviewers in teams performed data extraction, risk of bias assessment, and level of evidence analysis. The pooled results were estimated using a random-effects model. The I 2 statistic and Q χ 2 statistic were used to assess heterogeneity. Funnel plots, Egger's regression test, and the trim-and-fill method were used to determine publication bias. The primary outcomes were identifying risk factors for SSIs after PD. The secondary outcomes were the pooled prevalence rates of SSIs. Results: A total of 98 704 patients from 45 studies were included, and 80% of the studies were considered high quality. The estimated pooled prevalence of SSIs was 23% (0.19-0.27, I 2=97%). The prevalence of SSIs was found to be higher in Japan and lower in USA. Preoperative biliary stenting, higher body mass index (BMI), longer operation time, postoperative pancreatic fistula, soft pancreatic texture, perioperative blood transfusion, and cardiac disease were identified as significant risk factors for the development of SSIs after PD. Additionally, broad-spectrum antibiotics were a significant protective factor against SSIs. Subgroup analysis and sensitivity analysis showed that the results were robust. Conclusion and relevance: The prevalence of SSIs remains high and varies widely among regions. It is necessary to take effective preventive measures and carry out more prospective studies to further verify these results.

Cost-effectiveness analysis of niraparib maintenance therapy in Chinese patients with platinum-sensitive recurrent ovarian cancer.

OBJECTIVES: This study aimed to evaluate the cost-effectiveness of niraparib versus routine surveillance as maintenance therapy for patients with platinum-sensitive recurrent ovarian cancer in China. METHOD: A three-state partitioned survival model that adopted a lifetime horizon with a 4-week cycle length was developed. Efficacy data were derived from the NORA study. Cost and utility data were obtained from published studies and online databases. The cost and health outcomes were discounted at an annual rate of 5%. In this analysis, the primary outcomes included quality-adjusted life-year (QALY) and incremental cost-effectiveness ratio (ICER). The willingness-to-pay (WTP) thresholds were set at 1 to 3 times the gross domestic product per capita of China in 2022 ($12,741 to $38,233/QALY). Sensitivity analyses were conducted to verify the robustness of the model results. RESULTS: In the base-case analysis, niraparib was not found to be cost-effective, with an ICER of $42,888/QALY compared with routine surveillance at the WTP thresholds. One-way deterministic sensitivity analyses indicated that the ICER value was most sensitive to the cost of subsequent treatment in placebo group. The probabilistic sensitivity analysis suggested that at the WTP thresholds, the probability of niraparib being cost-effective was 2.9% to 50.1%. CONCLUSIONS: Niraparib improves the survival benefit of platinum-sensitive recurrent ovarian cancer patients. However, it seems to be less cost-effective, as it has higher costs than routine surveillance at the WTP thresholds. Reasonable dose reduction according to the patient's actual situation or lowering the price of niraparib can improve its cost-effectiveness.

Cost-effectiveness analysis of donafenib versus lenvatinib for first-line treatment of unresectable or metastatic hepatocellular carcinoma.

BACKGROUND: Donafenib and lenvatinib are approved by China National Medical Products Administration and recommended as first-line treatment of Metastatic Hepatocellular Carcinoma (HCC). The aim of this study was to assess the cost-effectiveness of donafenib compared with lenvatinib for first-line treatment of advanced HCC in China. METHODS: A partitioned survival model consisting with three health states was developed to simulate lifetime development of advanced HCC from China healthcare payer's perspective. The lifetime costs, quality-adjusted life-years (QALYs), life-years (LYs), and incremental cost-effectiveness ratio (ICER) were calculated. The efficacy data were obtained from ZGDH3 and REFLECT trials. The cost and health outcomes were discounted at a rate of 5%. Sensitivity and scenario analyses were carried out to explore the variation of model results. RESULTS: Compared with lenvatinib, donafenib incurred more costs of $1500.86 and had 0.139 QALYs gained, resulting in an ICER of $10,790.18/QALY. The probability of being cost-effective was 84.9% at a willingness-to-pay threshold of gross domestic product per capita in 2020 in China ($31,499.2/QALY). Sensitive and scenario analysis results were in line with base-case analysis. CONCLUSIONS: Donafenib appears to be a cost-effective strategy compared with lenvatinib for the first-line treatment of patients with unresectable or metastatic HCC in China.

The Cost Effectiveness of Donafenib Compared With Sorafenib for the First-Line Treatment of Unresectable or Metastatic Hepatocellular Carcinoma in China.

Background: Recent clinical trials have demonstrated that donafenib has superior efficacy and safety compared with sorafenib in Chinese patients with unresectable or metastatic hepatocellular carcinoma (HCC). The objective of this study was to assess the cost effectiveness of donafenib compared with sorafenib for the treatment of patients with unresectable or metastatic HCC in China. Methods: A three-state partitioned survival model was developed to perform a cost-effectiveness analysis comparing donafenib and sorafenib from a Chinese healthcare payer's perspective. The model adopted a lifetime horizon and a 4-week cycle length. Survival data were derived from the ZGDH3 study and fitted with standard parametric functions for extrapolation beyond the trial period. Cost data were obtained from the mean price of publicly listed online bids in 2021 and medical service prices across provinces in China. Utility data were obtained from previous literature. The cost and health outcomes were discounted at an annual rate of 5%. Deterministic and probabilistic sensitivity analyses (PSAs) were carried out to verify the robustness of the model. Results: Compared with sorafenib, donafenib incurred a higher cost (US$22,330.23 vs. US$14,775.92) but yielded more quality-adjusted life years (1.045 vs. 0.861 QALYs). The incremental cost-effectiveness ratio (ICER) for donafenib was US$41,081.52 per QALY gained (ICER = US$13,439.10/QALY). The PSA results indicated that at a willingness-to-pay threshold of 3 times the GDP in China, the probability of donafenib being cost effective was 16.9%. The ICER (US$13,439.10/QALY) decreased when the branded price of sorafenib was used in the model. Conclusions: Donafenib is unlikely to be cost effective compared with sorafenib for the first-line treatment of unresectable or metastatic HCC in China. Reducing the price of donafenib can increase the possibility of it being cost effective in the future.

Enhanced visible-light-driven photocatalytic degradation of tetracycline by 16% Er3+-Bi2WO6 photocatalyst.

The widespread use of antibiotics in drug therapy and agriculture has seriously polluted the aquatic environment. Bismuth tungstate (Bi2WO6) is a new and efficient visible-light catalyst that is simple to prepare, non-toxic, stable, and corrosion resistant. Nonetheless, its efficiency has remained limited, and erbium (Er) mixing has been tested to address this. Here, a new Er3+-mixed Bi2WO6 photocatalyst was successfully prepared through the one-step hydrothermal method; pigments were characterized via XRD, SEM, BET, XPS, Uv-vis, PL and EIS. The results showed that the 16% Er3+-Bi2WO6 photocatalyst is a 250 nm flower-like nanosheet with a specific surface area of 67.1 m2/g and bandgap (Eg) of 2.35 eV, which provides the basis for superior performance. When the concentration of the catalyst was 0.4 g/L, 94.58% of the tetracycline (TC) solution (initial concentration of 10 mg/L) degraded within 60 min under visible light irradiation (λ ≥ 420 nm). ESR and LC-MS were used to identify the free radicals and intermediates for the degradation of TC pollutants; a photocatalytic degradation system and pathway were proposed. This solar-driven system will ultimately reduce resource consumption, providing a sustainable and energy-saving environmental decontamination strategy.

Research on track fastener positioning method based on local unidirectional template matching.

Commonly used fastener positioning methods include pixel statistics (PS) method and template matching (TM) method. For the PS method, it is difficult to judge the image segmentation threshold due to the complex background of the track. For the TM method, the search in both directions of the global is easily affected by complex background, as a result, the locating accuracy of fasteners is low. To solve the above problems, this paper combines the PS method with the TM method and proposes a new fastener positioning method called local unidirectional template matching (LUTM). First, the rail positioning is achieved by the PS method based on the gray-scale vertical projection. Then, based on the prior knowledge, the image of the rail and the surrounding area of the rail is obtained which is referred to as the 1-shaped rail image; then, the 1-shaped rail image and the produced offline symmetrical fastener template is pre-processed. Finally, the symmetrical fastener template image is searched from top to bottom along the rail and the correlation is calculated to realize the fastener positioning. Experiments have proved that the method in this paper can effectively realize the accurate locating of the fastener for ballastless track and ballasted track at the same time.

Highly efficient photocatalytic performance of BiI/Bi2WO6 for degradation of tetracycline hydrochloride in an aqueous phase.

A series of novel BiI/Bi2WO6 nanosheets was successfully synthesized using a simple and efficient one-step hydrothermal method; the obtained specimens were subsequently characterized using X-ray diffraction, scanning electron microscopy, transmission electron microscopy, ultraviolet-visible spectrophotometry, X-ray photoelectron spectroscopy, N2 adsorption/desorption isotherms, Raman spectroscopy, ultraviolet-visible spectroscopy, Fourier-transform infrared spectroscopy, photoluminescence, and electronic impedance spectroscopy testing. The results indicated that the photocatalytic performance of the BiI/Bi2WO6 composites for the degradation of tetracycline hydrochloride (TC) from aqueous media under visible light irradiation (λ > 420 nm) was higher than that of pure Bi2WO6. The 0.8I-BiI/BWO composite (where 0.8 is the I : W molar ratio) presented the best photocatalytic performance of all analyzed specimens, and was able to degrade approximately 90% of the TC in 80 min. In addition, radical-capture experiments have demonstrated that superoxide anion radicals and hydroxyl radicals were the main active species for degrading organic pollutants, and a photocatalytic mechanism for the BiI/Bi2WO6 system was proposed. This study not only provides a method for the simple preparation of BiI/Bi2WO6, but could also present important implications for ecological risk management and prevention against antibiotic pollution.