Cost-effectiveness of home non-invasive ventilation in patients with persistent hypercapnia after an acute exacerbation of COPD in the UK.

Home non-invasive mechanical ventilation (HMV) with home oxygen therapy (HOT) in patients with persistent hypercapnia following an acute exacerbation of chronic obstructive pulmonary disease delays hospital readmission. The economic impact of this treatment is unknown. We evaluated the cost-effectiveness of HMV in the UK healthcare system using data from a previously published efficacy trial. Quality-adjusted life-years (QALYs) were computed from EQ-5D-5L. Accounting for all direct patient costs HOT-HMV was £512 (95%CI £36 to £990) more expensive per patient per year than HOT-alone. This small increase in cost was accompanied by increased quality of life leading to an incremental cost-effectiveness ratio of £10 259 per QALY. HOT-HMV was cost-effective in this clinical population. Trial registration number: NCT00990132.

Characteristics, Long-term Survival, and Risk Assessment of Pediatric Pulmonary Arterial Hypertension in China: Insights From a National Multicenter Prospective Registry.

BACKGROUND: Registry-based studies of pediatric pulmonary arterial hypertension (PPAH) are scarce in developing countries, including China. The PPAH risk assessment tool needs further evaluation and improvement. RESEARCH QUESTION: What are the characteristics and long-term survival of PPAH in China and what is the performance of the PPAH risk model in Chinese patients? STUDY DESIGN AND METHODS: Patients with PAH were enrolled in the national prospective multicenter registry from August 2009 through December 2019. Children 3 months to 18 years of age at the time of PAH diagnosis were analyzed. RESULTS: A total of 247 children with PAH were enrolled. The median patient age was 14.8 years, and 58.3% of patients were female. Most patients had a diagnosis of PAH associated with congenital heart disease (CHD; 61.5%) and idiopathic or heritable PAH (37.7%). The median time from symptom onset to PAH diagnosis was 24 months. The mean pulmonary artery pressure and pulmonary vascular resistance index were 70.78 ± 19.80 mm Hg and 21.82 ± 11.18 Wood Units·m2, respectively. Patients with CHD-associated PAH experienced a longer diagnostic delay and demonstrated higher pulmonary artery pressure, but better cardiac performance, than those with idiopathic or heritable PAH. An increased number of patients received targeted therapy at the last follow-up compared with baseline. The 5- and 10-year survival rates of the entire cohort were 74.9% and 55.7%, respectively, with better survival in patients with CHD-associated PAH than in those with idiopathic or heritable PAH. Patients with low risk had better survival than those with high risk according to the simplified noninvasive risk score model with weight, function class, and echocardiographic right ventricular size, both at baseline and follow-up. INTERPRETATION: Patients with PPAH in China showed severely compromised hemodynamics with marked diagnostic delay. The long-term survival of PPAH is poor despite the increased usefulness of targeted drugs. The simplified noninvasive risk model demonstrated good performance for predicting survival in Chinese children with PAH. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01417338; URL: www. CLINICALTRIALS: gov.

Isolated systolic hypertension and insulin resistance assessment tools in young and middle-aged Chinese men with normal fasting glucose: a cross-sectional study.

The vital role of insulin resistance (IR) in the pathogenesis of isolated systolic hypertension (ISH) has been expounded at the theoretical level. However, research on the correlation between some specific IR indicators and ISH is still rare, especially at different glycemic statuses. We conducted this study to explore the association between three IR indicators and ISH among young and middle-aged adults with normal fasting plasma glucose (NFG). This large cross-sectional study included 8246 young and middle-aged men with NFG and diastolic blood pressure < 90 mmHg. The homeostasis model assessment for IR (HOMA-IR) index, triglyceride glucose (TyG) index, and the metabolic score for IR (METS-IR) were calculated with the corresponding formula. The proportions of ISH among young and middle-aged men were 6.7% and 4.4%, respectively. After fully adjusting, only HOMA-IR rather than TyG and METS-IR was significantly associated with ISH. Moreover, fully adjusted smooth curve fitting showed that the association between HOMA-IR and ISH were approximately linear in both two age groups (P for non-linearity were 0.047 and 0.430 in young and middle-aged men, respectively). Among young and middle-aged men with NFG, using HOMA-IR instead of noninsulin-dependent IR indicators may have advantages in the hierarchical management of ISH. Further longitudinal research may be needed to determine their potential causal relationship.

Economic impact of spectral body imaging in diagnosis of patients suspected for occult cancer.

BACKGROUND: Based on prior studies spectral CT has shown a higher sensitivity for malignant lesions than conventional CT at the cost of lower specificity. For the radiologists, it also offers a higher degree of certainty in the diagnosis of benign lesions. The objective of this study was to evaluate the economic impact of spectral CT in patients suspected of occult cancer in a medical center in Denmark. METHODS: This study was a secondary analysis using de-identified data from a prospective study of patients receiving a contrast-enhanced spectral CT scan. Based on suggested follow-up examinations on both spectral CT and contrast-enhanced CT, costs from a payer's perspective were determined using unit costs obtained from national databases. RESULTS: The dataset contained 400 patients. Overall, 203 follow-up procedures were eliminated based on spectral data reading. The largest reduction in suggested follow-up procedures was found for the kidney (83%), followed by the liver (66%), adrenal glands (60%), and pancreas (42%). The total estimated costs for suggested follow-up procedures based on spectral data reading were €155,219, 25.2% (€52,384) less than that of conventional CT reading. CONCLUSION: Our results provide support for spectral body imaging as an advanced imaging modality for suspected occult cancer. A substantial number of follow-up diagnostic procedures could be eliminated based on spectral data reading, which would result in significant cost savings.

User Access Management Based on Network Pricing for Social Network Applications.

Social applications play a very important role in people's lives, as users communicate with each other through social networks on a daily basis. This presents a challenge: How does one receive high-quality service from social networks at a low cost? Users can access different kinds of wireless networks from various locations. This paper proposes a user access management strategy based on network pricing such that networks can increase its income and improve service quality. Firstly, network price is treated as an optimizing access parameter, and an unascertained membership algorithm is used to make pricing decisions. Secondly, network price is adjusted dynamically in real time according to network load. Finally, selecting a network is managed and controlled in terms of the market economy. Simulation results show that the proposed scheme can effectively balance network load, reduce network congestion, improve the user's quality of service (QoS) requirements, and increase the network's income.

Characterization of extracellular vitamin B12 producing Lactobacillus plantarum strains and assessment of the probiotic potentials.

We investigated extracellular vitamin B12-producing Lactobacillus strains and their characteristics in tolerance to environmental stresses, gastric acid and bile salts. Two isolates, Lactobacillus plantarum LZ95 and CY2, showed high extracellular B12 production, 98±15µg/L and 60±9µg/L respectively. Extracellular B12 from LZ95 were identified as adenosylcobalamin and methylcobalamin using a combination of solid phase extraction and reverse-phase HPLC, while that from CY2 was adenosylcobalamin. Both strains grew under environmental stresses, and LZ95 exhibited better tolerance to low temperature and high ethanol concentration. LZ95 also showed good viability when exposed to gastric acid (pH 2.0 and 3.0) and bile salts (0.3%) as well as good adhesion to Caco-2 cells. The viability of CY2 was significantly reduced under low pH and exposure to bile salt. Together, extracellular B12 producer LZ95 with good probiotic properties might be a candidate for in situ B12 fortification in the food industry.

Granulocyte colony-stimulating factors in the prevention of febrile neutropenia: review of cost-effectiveness models.

INTRODUCTION: We reviewed the evolution of the methods used in cost-effectiveness analyses of granulocyte colony-stimulating factors (G-CSFs) in the primary and secondary prevention of febrile neutropenia (FN) in patients receiving myelosuppressive cancer chemotherapy. Areas covered: FN is a side effect of myelosuppressive chemotherapy associated with significant morbidity, mortality, and costs. The risk of FN may depend on the drugs used within a chemotherapy regimen, and an FN event may cause chemotherapy dose reductions or delays in subsequent cycles. Expert commentary: More recent pharmacoeconomic models have reflected these clinical observations by modeling sequential chemotherapy regimens to account for FN risk on a per-cycle basis, and by accounting for chemotherapy dose reductions and consequent survival losses.

[Heavy Metals Pollution in Topsoil from Dagang Industry Area and Its Ecological Risk Assessment].

Based on previous studies and field investigation of Dagang industry area in Tianjin, a total of 128 topsoil samples were collected, and contents of 10 heavy metals (As, Cd, Cr, Co, Cu, Pb, Ni, V, Zn and Hg) were determined. The geoaccumulation index and geostatistics were applied to examine the degree of contamination and spatial distribution of heavy metals in topsoil. The assessment on ecological risk of heavy metals was carried out using Hakanson's method, and the main resources of the heavy metals were analyzed as well. It was found that As, Cd and Co had the highest proportions exceeding Tianjin background value, which were 100%, 97.66% and 96.88%, respectively; the heavy-metal content increased to some extent comparing with that in 2004, and the pollutions of As and Cd were the worst, and other metals were at moderate pollution level or below. The ecological risks of heavy metals were different in topsoil with different land use types, the farmland soil in the southwest as well as soils adjacent to the industrial land were at relatively high potential ecological risk level, and the integrated ecological risk index reached up to 1 437.37. Analysis of correlation and principal component showed that traffic and transportation as well as agricultural activities might be the main resources of heavy metals in the area, besides, the industrial activities in the region might also affect the accumulation of heavy metals.

Identification and assessment of potential water quality impact factors for drinking-water reservoirs.

Various reservoirs have been serving as the most important drinking water sources in Zhejiang Province, China, due to the uneven distribution of precipitation and severe river pollution. Unfortunately, rapid urbanization and industrialization have been continuously challenging the water quality of the drinking-water reservoirs. The identification and assessment of potential impacts is indispensable in water resource management and protection. This study investigates the drinking water reservoirs in Zhejiang Province to better understand the potential impact on water quality. Altogether seventy-three typical drinking reservoirs in Zhejiang Province encompassing various water storage levels were selected and evaluated. Using fifty-two reservoirs as training samples, the classification and regression tree (CART) method and sixteen comprehensive variables, including six sub-sets (land use, population, socio-economy, geographical features, inherent characteristics, and climate), were adopted to establish a decision-making model for identifying and assessing their potential impacts on drinking-water quality. The water quality class of the remaining twenty-one reservoirs was then predicted and tested based on the decision-making model, resulting in a water quality class attribution accuracy of 81.0%. Based on the decision rules and quantitative importance of the independent variables, industrial emissions was identified as the most important factor influencing the water quality of reservoirs; land use and human habitation also had a substantial impact on water quality. The results of this study provide insights into the factors impacting the water quality of reservoirs as well as basic information for protecting reservoir water resources.

[Value of cardiopulmonary exercise test in assessment of cardiac function of patients with pulmonary hypertension].

OBJECTIVE: To explore the role of peak oxygen consumption in assessment of heart function of patients with pulmonary hypertension. METHODS: From September 2010 to April 2012, 101 patients [29 male, mean age: (32.6 ± 11.4 )years] with pulmonary hypertension diagnosis by right heart catheterization were enrolled. Correlations among peak oxygen consumption, New York Heart Association (NYHA) class, NT-proBNP, 6 minute walking distance (6MWD) and cardiac index are analyzed. RESULTS: There were 44 cases with NYHA class II (43.6%), 49 cases with NYHA class III (48.5%), mean 6MWD was (421 ± 91 )m, NT-proBNP was (1262 ± 816) ng/L, pulmonary vascular resistance was (1031 ± 582) dyn·s(-1)·cm(-5), CI was (3.5 ± 2.3) L·min(-1)·m(-2), peak oxygen consumption was( 13.8 ± 4.1)ml·min(-1)·kg(-1). 6MWD, pulmonary vascular resistance and peak oxygen consumption were related to CI (r = 0.299, -0.541, 0.341, respectively, all P < 0.05), but NYHA class and NT-proBNP were not correlated to CI. Multiple regression analysis demonstrated that peak oxygen consumption (B = 0.135, P = 0.004) but not 6MWD was correlated with CI after adjusting age, sex and pulmonary vascular resistance. ROC analysis found that the sensitivity and specificity using peak oxygen consumption <15.2 ml·min(-1)·kg(-1) as a cut-off value was 92.6% and 57.5%, respectively, for diagnosing severe heart dysfunction. CONCLUSIONS: The correlation between peak oxygen consumption and CI is better than that of NYHA class, 6MWD, and NT-proBNP with CI. Peak oxygen consumption less than 15.2 ml·min(-1)·kg(-1) could be used to detect reduced CI in patients with pulmonary hypertension.