Alisol B 23-acetate promotes white adipose tissue browning to mitigate high-fat diet-induced obesity by regulating mTOR-SREBP1 signaling.

OBJECTIVE: Obesity is a global health concern with management strategies encompassing bariatric surgery and anti-obesity drugs; however, concerns regarding complexities and side effects persist, driving research for more effective, low-risk strategies. The promotion of white adipose tissue (WAT) browning has emerged as a promising approach. Moreover, alisol B 23-acetate (AB23A) has demonstrated efficacy in addressing metabolic disorders, suggesting its potential as a therapeutic agent in obesity management. Therefore, in this study, we aimed to investigate the therapeutic potential of AB23A for mitigating obesity by regulating metabolic phenotypes and lipid distribution in mice fed a high-fat diet (HFD). METHODS: An obesity mouse model was established by administration of an HFD. Glucose and insulin metabolism were assessed via glucose and insulin tolerance tests. Adipocyte size was determined using hematoxylin and eosin staining. The expression of browning markers in WAT was evaluated using Western blotting and quantitative real-time polymerase chain reaction. Metabolic cage monitoring involved the assessment of various parameters, including food and water intake, energy metabolism, respiratory exchange rates, and physical activity. Moreover, oil red O staining was used to evaluate intracellular lipid accumulation. A bioinformatic analysis tool for identifying the molecular mechanisms of traditional Chinese medicine was used to examine AB23A targets and associated signaling pathways. RESULTS: AB23A administration significantly reduced the weight of obese mice, decreased the mass of inguinal WAT, epididymal WAT, and perirenal adipose tissue, improved glucose and insulin metabolism, and reduced adipocyte size. Moreover, treatment with AB23A promoted the expression of browning markers in WAT, enhanced overall energy metabolism in mice, and had no discernible effect on food intake, water consumption, or physical activity. In 3T3-L1 cells, AB23A inhibited lipid accumulation, and both AB23A and rapamycin inhibited the mammalian target of rapamycin-sterol regulatory element-binding protein-1 (mTOR-SREBP1) signaling pathway. Furthermore, 3-isobutyl-1-methylxanthine, dexamethasone and insulin, at concentrations of 0.25 mmol/L, 0.25 µmol/L and 1 µg/mL, respectively, induced activation of the mTOR-SREBP1 signaling pathway, which was further strengthened by an mTOR activator MHY1485. Notably, MHY1485 reversed the beneficial effects of AB23A in 3T3-L1 cells. CONCLUSION: AB23A promoted WAT browning by inhibiting the mTOR-SREBP1 signaling pathway, offering a potential strategy to prevent obesity. Please cite this article as: Han LL, Zhang X, Zhang H, Li T, Zhao YC, Tian MH, Sun FL, Feng B. Alisol B 23-acetate promotes white adipose tissue browning to mitigate high-fat diet-induced obesity by regulating mTOR-SREBP1 signaling. J Integr Med. 2024; 22(1): 83-92.

Evaluation of PPP-ABS investment environment based on combined weighting of level difference maximization and TOPSIS method.

Asset-backed securitization (ABS) is currently used to refinance public-private partnership (PPP) projects in the infrastructure field. To stimulate the investors' enthusiasm, this study evaluated the investment environment of PPP projects asset-backed securitization (PPP-ABS). Firstly, we established a PPP-ABS investment environment evaluation indicator system based on the literature review and the practice of PPP-ABS. Then, the optimal weights of each indicator were determined by the combined weighting of level difference maximization method, where the subjective weights were determined by the AHP method, and the objective weights were determined by the entropy method. Finally, we evaluated the PPP-ABS investment environment from 2015 to 2022 with the technique for order preference by similarity to ideal solution (TOPSIS) method. The final valuation results are consistent with the actual situation. The results showed that the PPP-ABS investment environment exhibits a stable and upward trend. Under the overall guidance of the government, the approval process, information disclosure and supervisory systems have continued to improve, the number of ABS products issued has continued to grow, and the overall market risk is controllable. However, some problems still need to be solved and improved, including inadequate accounting and tax systems, insufficient liquidity in the secondary market, and the recovery of economic development in the post-COVID-19 era. This study fills the research gap in PPP-ABS. It proves the rationality and feasibility of PPP-ABS and is expected to provide a reference for investors' decision-making and promote the sustainable and healthy development of PPP-ABS.

Intended and unintended effects of e-cigarette taxes on youth tobacco use.

Over the past decade, rising youth use of e-cigarettes and other electronic nicotine delivery systems (ENDS) has contributed to aggressive regulation by state and local governments. Between 2010 and mid-2019, ten states and two large counties adopted ENDS taxes. We use two large national surveys (Monitoring the Future and the Youth Risk Behavior Surveillance System) to estimate the impact of ENDS taxes on youth tobacco use. We find that ENDS taxes reduce youth ENDS consumption, with estimated ENDS tax elasticities of -0.06 to -0.21. However, we estimate sizable positive cigarette cross-tax effects, suggesting economic substitution between cigarettes and ENDS for youth. These substitution effects are particularly large for frequent cigarette smoking. We conclude that the unintended effects of ENDS taxation may considerably undercut or even outweigh any public health gains.

Does energy cost constitute the primary cause of ammonium toxicity in plants?

Nitrate (NO3-) and ammonium (NH4+) are the main nitrogen (N) sources and key determinants for plant growth and development. In recent decades, NH4+, which is a double-sided N compound, has attracted considerable amounts of attention from researchers. Elucidating the mechanisms of NH4+ toxicity and exploring the means to overcome this toxicity are necessary to improve agricultural sustainability. In this review, we discuss the current knowledge concerning the energy consumption and production underlying NH4+ metabolism and toxicity in plants, such as N uptake; assimilation; cellular pH homeostasis; and functions of the plasma membrane (PM), vacuolar H+-ATPase and H+-pyrophosphatase (H+-PPase). We also discuss whether the overconsumption of energy is the primary cause of NH4+ toxicity or constitutes a fundamental strategy for plants to adapt to high-NH4+ stress. In addition, the effects of regulators on energy production and consumption and other physiological processes are listed for evaluating the possibility of high energy costs associated with NH4+ toxicity. This review is helpful for exploring the tolerance mechanisms and for developing NH4+-tolerant varieties as well as agronomic techniques to alleviate the effects of NH4+ stress in the field.

Health risk assessment of groundwater nitrogen pollution in Yinchuan plain.

High nitrogen concentration of groundwater poses a threat to human health. This study evaluated the potential health risk of nitrogen pollution in Yinchuan plain by geostatistical analysis and triangular stochastic model considering different land use types, and identified the uncertainties of the parameters. 163 samples were collected from groundwater wells in different land use types. The results show that the concentration of NO3--N ranges from 0.059 to 450 mg/L, with an average of 22.439 mg/L. Approximately 32% of the samples exceed Grade III threshold (20 mg/L of N). The concentration of NH4+-N ranges from 0.011 to 11 mg/L, with an average of 0.456 mg/L. The concentration of NO2--N ranges from 0.003 to 9.09 mg/L The NO3--N and NH4+-N concentration in the groundwater of the unutilized land use is significantly lowest among all the land types. The concentration of nitrogen is highest in farmland use. The ranking of non-carcinogenic risk under different land types for infants, children, adult males and females is: farmland use > residential land use> unutilized land use. The non-carcinogenic risk value of farmland use is three times as much as that of the residential land use. Drinking groundwater can be potentially harmful to human health, and nitrogen pollutants pose an even greater threat to infant. At the same time, considering the impact of different land use types on groundwater would avoid overestimating or underestimating regional risk value. Triangular stochastic model is more sensitive to data changes and can reduce uncertainty. The contribution rate of nitrate concentration to risk is more than 83%, indicating that random sampling is needed to improve the reliability of evaluation results. The research results of this study will provide a new way to solve the uncertainty in groundwater security management.

Robust pricing for airlines with partial information.

In the spot market for air cargo, airlines typically adopt dynamic pricing to tackle demand uncertainty, for which it is difficult to accurately estimate the distribution. This study addresses the problem where a dominant airline dynamically sets prices to sell its capacities within a two-phase sales period with only partial information. That partial information may show as the moments (upper and lower bounds and mean) and the median of the demand distribution. We model the problem of dynamic pricing as a distributional robust stochastic programming, which minimizes the expected regret value under the worst-case distribution in the presence of partial information. We further reformulate the proposed non-convex model to show that the closed-form formulae of the second-stage maximal expected regret are well-structured. We also design an efficient algorithm to characterize robust pricing strategies in a polynomial-sized running time. Using numerical analysis, we present several useful managerial insights for airline managers to strategically collect demand information and make prices for their capacities in different market situations. Moreover, we verify that additional information will not compromise the viability of the pricing strategies being implemented. Therefore, the method we present in this paper is easier for airlines to use.

A pseudotargeted method based on sequential window acquisition of all theoretical spectra mass spectrometry acquisition and its application in quality assessment of traditional Chinese medicine preparation-Yuanhu Zhitong tablet.

Quality control plays a key role in the application of Chinese materia medica, especially in the preparation of traditional Chinese medicine. A pseudotargeted analysis method using an ultra-high-performance liquid chromatography-quadrupole-time-of-flight-mass spectrometry that was operated in the sequential window acquisition of all theoretical spectra mode was proposed to explore the chemical markers of traditional Chinese medicine preparation. Full-scan-based untargeted analysis was applied to extract the target ions. After data preprocessing, 302 target ions were extracted and used for the subsequent sequential window acquisition of all theoretical spectra analyses. The established sequential window acquisition of all theoretical spectra-based pseudotargeted approaches exhibited good repeatability and a wide linear range. The established method was successfully applied to discover analytical markers for the Yuanhu Zhitong tablet. After multivariate statistical analysis, 94 potential markers were identified. Ten markers were annotated by matching accurate m/z and product ion information obtained from previous reports. It is clearly indicated that the pseudotargeted analysis could make a great contribution to the quality assessment of traditional Chinese medicine preparation as a newly emerging technique.

Cost-effectiveness analysis of glecaprevir/pibrentasvir regimen for treating Chinese patients with chronic hepatitis C genotype 1 and genotype 2 infection.

BACKGROUND: Hepatitis C virus (HCV) infection is an important health threat in China to which direct acting antivirals (DAAs) are very effective. In 2019, another novel DAA glecaprevir/pibrentasvir (GLE/PIB) was officially approved. Knowledge of its cost-effectiveness would be informative for clinical decision-making but has not been evaluated. This study aims to evaluate the cost-effectiveness of GLE/PIB to inform policy-making on drug reimbursement and HCV eradication. METHODS: Markov models were developed from the payers' perspective and simulated the lifetime experience of adult patients chronically infected with HCV genotype 1 or genotype 2. Two regimens, GLE/PIB and pegylated interferon (pegIFN) plus ribavirin (RBV), were compared in cost and quality adjusted life years (QALY) with both outcomes being discounted to 2020 values. The incremental cost-effectiveness ratio (ICER) was computed to reflect the incremental benefit of GLE/PIB versus pegIFN + RBV. The robustness of the model outcomes was examined using deterministic and probabilistic sensitivity analysis (PSA) to identify influential parameters and to assess the probability of GLE/PIB being cost-effective. The GDP per capita in China in 2019 ($10,275) was used as the threshold for cost-effectiveness. RESULTS: For the entire target population, GLE/PIB was the dominant regimen attaining a cost-saving of $255 and 1.17 more QALYs relative to pegIFN + RBV. The finding was more pronounced for HCV genotype 1 infection by saving $1,656 and creating 1.37 more QALYs. At the $10,275 threshold, the probability of GLE/PIB being cost-effective was 99.32% overall and 99.85% for HCV genotype 1 infection. The age of starting DAA treatment, price of pegIFN + RBV, cost of cirrhosis treatment and duration of the GLE/PIB regimen were the five most influential factors. For the patients with HCV genotype 2 infection, the ICER of GLE/PIB was $12,914/QALY with 95% confidence interval of $4,047/QALY to $37,640/QALY. The GLE/PIB regimen statistically cannot be ruled out as a cost-effective option for HCV genotype 2 infection. CONCLUSIONS: GLE/PIB is a cost-effective strategy to treat chronic HCV genotype 1 and HCV genotype 2 infection in China. This regimen should be initiated at a younger age to maximize its value. To achieve national eradication, it may be timely to consider replacing pegIFN + RBV with DAAs, such as GLE/PIB, as the first-line treatment.

Dual-Energy CT-Derived Volumetric Iodine Concentration for the Assessment of Therapeutic Response after Microwave Ablation in a Rabbit Model with Intrahepatic VX2 Tumor.

PURPOSE: To evaluate whether changes in volumetric iodine concentration (VIC) could serve as a suitable predictor of therapeutic response to microwave (MW) ablation in a rabbit intrahepatic VX2 tumor model. MATERIALS AND METHODS: Sixteen intrahepatic VX2 tumors were transplanted in 8 New Zealand White rabbits treated with MW ablation. Contrast-enhanced dual-energy CT scans were obtained at baseline and follow-up. Therapeutic response assessment by modified Response Evaluation Criteria In Solid Tumors (mRECIST), Choi criteria, and VIC changes was performed. An intraclass correlation coefficient (ICC) was used to characterize consistency of assessment results among the criteria used. Technical success was evaluated with explant pathologic findings as a reference. Correlations between technical success and variations in diameter, CT density, and VIC were analyzed. RESULTS: Disease control was observed in 4, 8, and 10 of the 16 tumors per mRECIST, Choi criteria, and VIC changes, respectively. VIC exhibited strong consistency (ICC = 0.807, P < .0001) with Choi criteria. According to explant pathology, technical success was achieved in 10 of the 16 tumors. There was a moderate correlation between VIC changes and technical success (r = 0.532, P = .034), and no correlation was found between technical success and variations in diameter or CT density. CONCLUSIONS: Compared with mRECIST and Choi criteria, dual-energy CT-derived VIC allowed for better prediction of therapeutic response after MW ablation and could provide a potential imaging biomarker of tumor response to MW ablation in patients with hepatocellular carcinoma.

Do High Fidelity Wraparound Services for Youth with Serious Emotional Disturbances Save Money in the Long-Term?

BACKGROUND: Treating youth with serious emotional disturbances (SED) is expensive often requiring institutional care. A significant amount of recent federal and state funding has been dedicated to expanding home and community-based services for these youth as an alternative to institutional care. High Fidelity Wraparound (Wrap) is an evolving, evidence-informed practice to help sustain community-based placements for youth with an SED through the use of intensive, customized care coordination among parents, multiple child-serving agencies, and providers. While there is growing evidence on the benefits of Wrap, few studies have examined health care spending associated with Wrap participation and none have examined spending patterns after the completion of Wrap. Merging health care spending data from multiple agencies and programs allows for a more complete picture of the health care costs of treating these youth in a system-of-care framework. AIMS OF STUDY: (i) To compare overall health care spending for youth who transitioned from institutional care into Wrap (the treatment group) versus youth not receiving Wrap (the control group) and (ii) to compare changes in health care spending, overall and by category, for both groups before (the pre-period) and after (the post-period) Wrap participation. METHODS: The treatment group (N=161) is matched to the control group (N=324) temporally based on the month the youth entered institutional care. Both total health care spending and spending by category are compared for each group pre- and post-Wrap participation. The post-period includes the time in which the youth was receiving Wrap services and one year afterwards to capture long-term cost impacts. RESULTS: In the year before Wrap participation, the treatment group averaged USD 8,433 in monthly health care spending versus USD 4,599 for the control group. Wrap participation led to an additional reduction of USD 1,130 in monthly health care spending as compared to the control group in the post-period. For youth participating in Wrap, these spending reductions were the result of decreases in mental health inpatient spending and general outpatient spending. DISCUSSION: Youth participating in Wrap had much higher average monthly costs than youth in the control group for the year prior to entering Wrap, suggesting that the intervention targeted youth with the highest mental health utilization and likely more complex needs. While both groups experienced reductions in spending, the treatment group experienced larger absolute reductions, but smaller relative reductions associated with participation. These differences were driven mainly by reductions in mental health inpatient spending. Larger reductions in general outpatient spending for the treatment group suggest spillover benefits in terms of physical health care spending. Further analysis is needed to assess how these spending changes impacted health outcomes. IMPLICATIONS FOR HEALTH POLICIES: Wrap or similar programs may lead to reductions in health care spending. This is the first study to find evidence of longer-term spending reductions for up to a year after Wrap participation. IMPLICATIONS FOR FURTHER RESEARCH: Randomized trials or some other source of plausibly exogenous variation in Wrap participation is needed to further assess the causal impact of Wrap on health care spending, outcomes, or broader system-of-care spending.

New classification of liver biopsy assessment for fibrosis in chronic hepatitis B patients before and after treatment.

Liver fibrosis is the net result of dynamic changes between fibrogenesis and fibrolysis. Evidence has shown that antiviral therapy can reverse liver fibrosis or even early cirrhosis caused by hepatitis B virus. However, current evaluation systems mainly focus on the severity of, but not the dynamic changes in, fibrosis. Here, we propose a new classification to evaluate the dynamic changes in the quality of fibrosis, namely: predominantly progressive (thick/broad/loose/pale septa with inflammation); predominately regressive (delicate/thin/dense/splitting septa); and indeterminate, which displayed an overall balance between progressive and regressive scarring. Then, we used this classification to evaluate 71 paired liver biopsies of chronic hepatitis B patients before and after entecavir-based therapy for 78 weeks. Progressive, indeterminate, and regressive were observed in 58%, 29%, and 13% of patients before treatment versus in 11%, 11%, and 78% after treatment. Of the 55 patients who showed predominantly regressive changes on posttreatment liver biopsy, 29 cases (53%) had fibrosis improvement of at least one Ishak stage, and, more interestingly, 25 cases (45%) had significant improvement in terms of Laennec substage, collagen percentage area, and liver stiffness despite remaining in the same Ishak stage. CONCLUSION: This new classification highlights the importance of assessing and identifying the dynamic changes in the quality of fibrosis, especially relevant in the era of antiviral therapy.(Hepatology 2017;65:1438-1450).

Nationwide survey of specialist knowledge on current standard of care (Peg-IFN/RBV) and barriers of care in chronic hepatitis C patients in China.

BACKGROUND AND AIM: Chronic hepatitis C virus (HCV) infection is the leading cause of liver diseases including cirrhosis and hepatocellular carcinoma. In China, it is a major national health problem that demands nationwide coordinated emphasis on prevention and treatment. To inform these initiatives, a nationwide survey was conducted from January to April 2015 to evaluate the knowledge, awareness, and perceived obstacles to HCV care. METHODS: A sample of 1000 HCV specialists across mainland China were recruited. Respondents were asked a series of 30 open-ended single or multiple response and Likert-scale questions about their HCV treatment knowledge, experience, assessment of HCV care status in China, and perceptions about treatment barriers. RESULTS: Sixty percent of the respondents answered incorrectly to more than half of the questions on basic HCV treatment principles. Over half of them incorrectly believed that maintenance therapy should be prescribed for non-responders (72%) and longer treatment duration improved sustained viral response rates (62%), regardless of HCV RNA level changes. Sixty-six percent of them believed that HCV treatment would still be interferon-based therapy in the next 5 years in China. Patient-related barriers, in particular lack of disease awareness, were considered to be the most significant barriers to HCV care. Payer and medical-provider barriers included affordability issues, lack of reimbursement coverage for testing and treatments, and lack of referral to HCV specialists. CONCLUSIONS: Focused and intense patient and provider education should be carried out to increase awareness. More effective direct-acting antivirals should be made available and affordable in China.

Methods for assessing patient-clinician communication about depression in primary care: what you see depends on how you look.

OBJECTIVE: To advance research on depression communication and treatment by comparing assessments of communication about depression from patient report, clinician report, and chart review to assessments from transcripts. DATA: One hundred sixty-four primary care visits from seven health care systems (2010-2011). STUDY DESIGN: Presence or absence of discussion about depressive symptoms, treatment recommendations, and follow-up was measured using patient and clinician postvisit questionnaires, chart review, and coding of audio transcripts. Sensitivity and specificity of indirect measures compared to transcripts were calculated. PRINCIPAL FINDINGS: Patient report was sensitive for mood (83 percent) and sleep (83 percent) but not suicide (55 percent). Patient report was specific for suicide (86 percent) but not for other symptoms (44-75 percent). Clinician report was sensitive for all symptoms (83-98 percent) and specific for sleep, memory, and suicide (80-87 percent), but not for other symptoms (45-48 percent). Chart review was not sensitive for symptoms (50-73 percent), but it was specific for sleep, memory, and suicide (88-96 percent). All indirect measures had low sensitivity for treatment recommendations (patient report: 24-42 percent, clinician report 38-50 percent, chart review 49-67 percent) but high specificity (89-96 percent). For definite follow-up plans, all three indirect measures were sensitive (82-96 percent) but not specific (40-57 percent). CONCLUSIONS: Clinician report and chart review generally had the most favorable sensitivity and specificity for measuring discussion of depressive symptoms and treatment recommendations, respectively.

Endoscopic management for the assessment and treatment of anastomotic bleeding in laparoscopic anterior resection for rectal cancer.

OBJECTIVE: To evaluate the impact of routine intraoperative endoscopy (IOE) on postoperative anastomotic bleeding of laparoscopic anterior resection (LAR) for rectal cancer, and to investigate the value of the IOE in terms of prevention and treatment of postoperative anastomotic bleeding. METHODS: Medical records of the 279 cases of LAR from January 2006 to December 2011 were retrospectively analyzed, of which postoperative anastomotic bleeding occurred in 18. Univariate analysis was taken to determine the possible influencing factors of the bleeding. Then related influencing factors were put into the multivariate logistic regression analysis to ultimately determine the independent influencing factors of anastomotic bleeding. The efficacy of treatments to the anastomotic bleeding was also evaluated. RESULTS: The incidence of anastomotic bleeding after LAR is 6.5% (18/279).The rates of anastomotic bleeding in lower tumor location group and upper tumor location group were 9.2% (16/173) and 1.9% (2/106), respectively, as in intraoperative colonoscopy and nonintraoperative colonoscopy group were 3.3% (5/151), and 10.2% (13/128), respectively. Comparing the location of the tumor, the coefficient of regression and relative risk value for lower tumor were 1.564 and 4.776. Comparing the intraoperative colonoscopy and nonintraoperative colonoscopy group, the value for intraoperative colonoscopy group were -1.085 and 0.338. Sex, age, tumor stage, pathologic type, and preventive ileostomy had no relevance with the anastomotic bleeding. In 18 cases of the anastomotic bleeding, 7 received conservative treatments, 9 underwent endoscopic treatment, and 2 underwent reoperation. All the 18 cases had reached hemostasis. CONCLUSION: IOE is an independent protective factor of anastomotic bleeding after LAR. Endoscopic hemostasis is recommended for an anastomotic bleeding after LAR for rectal cancer with a stapling technique.

Laparoscopic peritoneal dialysis catheter implantation with an intra-abdominal fixation technique: a report of 53 cases.

OBJECTIVE: The purpose of this study was to evaluate the feasibility, the safety, and outcomes of renal replacement therapy with the laparoscopic technique for peritoneal dialysis (PD) catheter implantation with an intra-abdominal fixation. METHODS: Medical records of 53 patients with end-stage renal disease who underwent laparoscopic PD catheter implantation with an intra-abdominal fixation in our department from December 2008 to October 2009 were reviewed retrospectively. Their surgical procedure, operative outcomes, postoperative complications, and follow-up outcomes were analyzed. RESULTS: All patients underwent laparoscopic PD catheter implantation with an intra-abdominal fixation successfully. Neither conversion to open surgery nor major intraoperative complications were observed. The median operative time was 24.2±10.5 minutes. The operative cost was 837.3±107.0 US$. Two patients (3.8%) had catheter obstruction peritonitis 12 and 15 months after surgery, respectively, and both of them had the catheter removed. CONCLUSIONS: Laparoscopic PD catheter implantation with an intra-abdominal fixation of the catheter tip is feasible and safe. It had a low incidence of PD catheter migration and other PD-related postoperative complications with the benefit of minimal invasiveness, a shorter operation time, and quicker postoperative recovery.

Direct and indirect costs and long-term survival of laparoscopic anterior resection for rectal cancer.

BACKGROUND: Few studies evaluate the cost-effectiveness issues of laparoscopic anterior resection (LAR) for rectal cancer. This study evaluates direct and indirect costs of LAR and its long-term survival rate in rectal cancer patients. MATERIAL/METHODS: This prospective nonrandomized controlled trial included 2 endpoints (direct and indirect costs, and disease-free survival). From January 2003 to May 2005, rectal cancer patients admitted to our center were assigned to 2 groups: 87 patients underwent LAR (LAP), while 86 cases received open anterior resection (OPEN). The direct costs were prospectively evaluated. Main indirect cost is productivity loss. The data of direct costs, indirect costs, and the total costs were collected for the minimal cost analysis. RESULTS: Disease-free survival at 65 months in the LAP group and the OPEN group was 78.2% and 74.7%; there was no significant difference between the groups. Median direct costs were not significantly different between the LAP and the OPEN groups. Indirect costs of the LAP group were significantly lower than those of the OPEN group, while total costs were not significantly different. Cost percentage for operations, medications, and hospitalization were 75.90%, 11.28%, and 2.18% in the LAP group; while in the operation group, they were 54.50%, 29.09%, and 3.35%. CONCLUSIONS: Total economic budget for a patient receiving LAR was not significantly increased compared with the conservative method owing to its technical predominance, oncologic safety, as well as frequent bed turnover.

A low-cost light-emitting diode induced fluorescence detector for capillary electrophoresis based on an orthogonal optical arrangement.

In this work, a simple and low-cost miniaturized light-emitting diode induced fluorescence (LED-IF) detector based on an orthogonal optical arrangement for capillary electrophoresis (CE) was developed, using a blue concave light-emitting diode (LED) as excitation source and a photodiode as photodetector. A lens obtained from a waste DVD-ROM was used to focus the LED light beam into an approximately 80 microm spot. Fluorescence was collected with an ocular obtained from a pen microscope at 45 degrees angle, and passed through a band-pass filter to a photodiode detector. The performance of the LED-IF detector was demonstrated in CE separations using sodium fluorescein and fluorescein isothiocyanate (FITC)-labeled amino acids as model samples. The limit of detection for sodium fluorescein was 0.92 microM with a signal-to-noise ratio (S/N) of 3. The total cost of the LED-IF detector was less than $ 50.