Cost-Effectiveness of Elbasvir/Grazoprevir for the Treatment of Chronic Hepatitis C: A Systematic Review.

Objective: This study aims to systematically review recent economic evaluations of elbasvir/grazoprevir (EBR/GZR) for chronic hepatitis C (CHC), to critically appraise the reporting quality and to summarize the results. Methods: A literature search was undertaken using Medline, Embase, the Cochrane Library, EconLit, China National Knowledge Infrastructure, Wanfang Data, and Chongqing VIP to identify original articles containing economic evaluations of EBR/GZR for CHC published between 1 January 2000 and 31 December 2020. The Consolidated Health Economic Evaluation Reporting Standards statement was used to assess the quality of reporting of the articles. Results: Of 93 articles identified, 13 studies fulfilled the inclusion criteria. These studies were conducted in 4 countries, and 8 active interventions were assessed. The target population was patients infected with CHC genotype 1 infection in all studies. Eight out of 13 studies that compared EBR/GZR vs. other direct antiviral agents suggested that EBR/GZR was generally more cost-effective or dominant than daclatasvir/asunaprevir (DCV/ASV), sofosbuvir/velpatasvir (SOF/VEL), ledipasvir/sofosbuvir (LDV/SOF), ombitasvir/paritaprevir/ritonavir + dasabuvir (3D) but not more cost-effective than glecaprevir/pibrentasvir (GLE/PIB). Two studies from China and one study from the USA that compared EBR/GZR vs. pegylated interferon and ribavirin (PegIFN/RBV) consistently indicated that EBR/GZR was generally more cost-effective than PegIFN/RBV. One study from Italy compared EBR/GZR with SOF + PegIFN/RBV and suggested that EBR/GZR had a lower cost and higher effectiveness. One study from France and one study from the USA confirmed that compared with non-therapy for patients with chronic kidney disease, EBR/GZR was cost-effective at commonly accepted current standards. All included studies were of good quality of reporting, with an average score of 21.9 (range 19-23). Conclusion: EBR/GZR for CHC genotype 1 might be cost-effective or dominant compared with PegIFN/RBV and other direct antiviral agents (SOF/VEL, 3D, DCV/ASV, LDF/SOF) or non-therapy. However, under certain assumptions, EBR/GZR was not a cost-effective alternative for CHC patients vs. GLE/PIB.

An efficient and low-cost magnetic heterogenous Fenton-like catalyst for degrading antibiotics in wastewater: Mechanism, pathway and stability.

Metal-doped MgFe2O4 spinel ferrite synthesized from saprolite laterite nickel ore was verified as an efficient heterogeneous Fenton-like catalyst for degrading antibiotics including tetracycline (TC) and metronidazole (MNZ) in a "catalyst/oxalic acid (H2C2O4)/visible light (vis)" system. The degradation efficiencies reached over 95% and total organic carbon (TOC) removal efficiencies were nearly 50% of the two antibiotics within 210 min, under the optimal conditions, especially 90% catalytic activity of the fresh catalyst was maintained after five cycles, suggesting the ferrite possessed excellent degrading performance, cycling stability and applicability. Moreover, the degradation mechanism and pathway of TC were elucidated in detail. Results revealed that the [≡Fe(C2O4)3]3- complex ions formed by octahedral Fe3+ in spinel ferrite with oxalate ions on the surface of MgFe2O4, played the key role in production of ·OH radicals which decomposed antibiotic TC into small molecules even mineralized in three pathways. Cost-effective preparation, high catalytic performance and long cycle life may accelerate the practical application of the heterogeneous Fenton-like catalyst.

Research on Practical Intelligent Mode of Digital Image Economy Based on Improved Genetic Multilayer Neural Network.

In the context of economic globalization and digitization, the current financial field is in an unprecedented complex situation. The methods and means to deal with this complexity are developing towards image intelligence. This paper takes financial prediction as the starting point, selects the artificial neural network in the intelligent algorithm and optimizes the algorithm, forecasts through the improved multilayer neural network, and compares it with the traditional neural network. Through comparison, it is found that the prediction success rate of the improved genetic multilayer neural network increases with the increase of the dimension of the input image data. This shows that, by adding more technical indicators as the input of the combined network, the prediction efficiency of the improved genetic multilayer neural network can be further improved and the advantage of computing speed can be maintained.

Analysis of standard accounting method of economic compensation for ecological pollution in watershed.

With rapid development of social industry and agriculture, there is an increasing demand for water resources in a watershed, which leads to a series of serious problems in the watershed such as water resource shortage, water environment deterioration, water resource pollution, etc. This paper builds an econometric model of economic loss due to water pollution in a watershed based on the basic process of standard water pollution compensation calculation of economic loss. The econometric model is used to calculate the amount of compensation for economic loss due to water pollution; a mathematic model method of water environment is applied to calculate the degree of effect on the lower reaches; thus the proportion of the impact on the areas in the lower reaches to overall impact is obtained. The amount of compensation that should be borne by all areas is obtained in combination of amount of compensation for water pollution. Empirical analysis is carried out by taking the Taihu Basin for example, and the standard compensation and the amount of compensation for the economic loss caused by water pollution between different areas along the Jiangnan Canal in the Taihu Basin are defined, which provides scientific and theoretical bases for standard calculation of the water pollution compensation. This provides a theoretical basis for solving the problem of water pollution in the watershed and the contradiction in the development of the watershed, and realizing social equity and harmonious development.

Health assessment of spatial and temporal distribution of arsenic in soils irrigated with reclaimed water.

Reclaimed water is an important water resource for agricultural irrigation. Based on the systematic analysis of experimental data, this paper studies the spatiotemporal transformation and distribution of As in soil-crop system. Through the comparison with groundwater irrigation, reclaimed water irrigation was tested and studied in connection with the greenhouse vegetables in the growing season. The accumulation, distribution and transportation of As in different depths of soil within 7 days after reclaimed water irrigation were analyzed and discussed. The results showed that the concentration of As was the highest on the first day after irrigation; it was the highest at the depth of 100 cm on the third day after irrigation, but its concentration in the topsoil slightly decreased; from the fifth to the seventh day, the concentrations of As in the different layers of soil were almost the same, but it was the highest at the depth of 80-120 cm; and it decreased slightly with the increase in depth when the depth was less than 120 cm. As in soil during the growing season varied as the frequency of irrigation increased. The specific situation was as follows: as the accumulated As in the topsoil increased, the increased As at the depth of 80-120 cm would become less and the concentration of As at 200 cm would fall. Therefore, when the appropriate concentration of reclaimed water is used for irrigation, the concentration of As in the deep layer soil will comply with the standard limits of GB15618-1995 and the irrigation with reclaimed water of appropriate concentration will not cause As pollution.

Changes in the epidemiology of hepatitis A in three socio-economic regions of China, 1990-2017.

BACKGROUND: Hepatitis A (HepA) vaccination and economic transitions can change the epidemiology of HepA. China's Gross Domestic Product (GDP) per capita was known to be inversely associated with the incidence of HepA, but a deeper understanding of the epidemiology of HepA in different socio-economic regions is lacking. We compare the changing epidemiology of HepA in three socioeconomic-geographic regions of China. METHODS: We obtained data on all HepA cases reported through the National Notifiable Disease Reporting System and assessed trends and changes in age-specific incidence rates by age quartile and season. We categorized the country into three regions, the sequential years into five era, compared the incidence, quartile age, seasonal intensity and coverage of HepA of the three regions. Linear regression was performed to analyse trends in incidence of HepA and to analyse the association between coverage and incidence. RESULTS: The annual mean incidences of HepA in the eastern, central, and western regions decreased from 63.52/100 000, 50.57/100 000 and 46.39/100 000 in 1990-1992 to 1.18/100 000, 1.05/100 000 and 3.14/100 000 in 2012-2017, respectively. Decreases in incidence were seen in all age groups in the three regions; the incidence was highest (9.3/100 000) in the youngest age group (0-4 years) of the western region, while in the central region, the age group with the highest incidence changed from 0 to 9 years to adults ≥60 years old. In 2017, the median age of HepA cases was 43 years (Q1-Q3: 33-55), 47 years (Q1-Q3: 32-60) and 33 years (Q1-Q3: 9-52) in the eastern, central, and western provinces, respectively. Seasonal peaks became smaller or were nearly elimination nationwide, but seasonality persisted in some provinces. After the Expanded Program on Immunization (EPI) included HepA vaccine into the routine schedule in 2007, HepA coverage increased to > 80% in the three regions and was negatively association with the HepA incidence. CONCLUSION: The incidence of HepA decreased markedly between 1990 and 2017. A socioeconomic inequity in coverage of HepA vaccine was almost eliminated after HepA vaccine was introduced into China's EPI system, but inequity in incidence still existed in lower socio-economic developed region.

Non-invasive assessment of culture media from goat cloned embryos associated with subjective morphology by gas chromatography - mass spectroscopy-based metabolomic analysis.

Pre-implantation embryo metabolism demonstrates distinctive characteristics associated with the development potential of embryos. We aim to determine if metabolic differences correlate with embryo morphology. In this study, gas chromatography - mass spectroscopy (GC-MS)-based metabolomics was used to assess the culture media of goat cloned embryos collected from high-quality (HQ) and low-quality (LQ) groups based on morphology. Expression levels of amino acid transport genes were further examined by quantitative real-time PCR. Results showed that the HQ group presented higher percentages of blastocysts compared with the LQ counterparts (P < 0.05). Metabolic differences were also present between HQ and LQ groups. The culture media of the HQ group showed lower levels of valin, lysine, glutamine, mannose and acetol, and higher levels of glucose, phytosphingosine and phosphate than those of the LQ group. Additionally, expression levels of amino acid transport genes SLC1A5 and SLC3A2 were significantly lower in the HQ group than the LQ group (P < 0.05, respectively). To our knowledge, this is the first report which uses GC-MS to detect metabolic differences in goat cloned embryo culture media. The biochemical profiles may help to select the most in vitro viable embryos.

Personal exposure and health risk assessment of carbonyls in family cars and public transports-a comparative study in Nanjing, China.

To evaluate passenger health risks associated with inhalation exposure to carbonyl compounds mainly emitted from decoration materials of vehicles, we tested the carbonyl concentrations in interior air of 20 family cars, 6 metro lines, and 5 buses in the city of Nanjing. To assess non-carcinogenic health risks, we compared the data to the health guidelines of China, US Environmental Protection Agency (EPA), and Office of Environmental Health Hazard Assessment (OEHHA), respectively. To assess carcinogenic risks, we followed a standard approach proposed by the OEHHA to calculate lifetime cancer risks (LCR) of formaldehyde and acetaldehyde for various age groups. The results showed that there are formaldehyde, acetaldehyde, and acrolein concentrations in 40, 35, and 50% of family car samples exceeded the reference concentrations (RfCs) provided by Chinese guidelines (GB/T 27630-2011 and GB/T 18883-2002). Whereas, in the tested public transports, concentrations of the three carbonyls were all below the Chinese RfCs. Fifty and 90% of family cars had formaldehyde and acrolein concentrations exceeding the guidelines of OEHHA. Only one public transport sample (one bus) possesses formaldehyde and acetaldehyde concentrations above the chronic inhalation reference exposure limits (RELs). Furthermore, the assessments of carcinogenic risk of formaldehyde and acetaldehyde showed that lifetime cancer risks were higher than the limits of EPA for some family cars and public transports. In the study, buses and metros appear to be relatively clean environments, with total carbonyl concentrations that do not exceed 126 µg/m3. In family cars, carbonyl levels showed significant variations from 6.1 to 811 µg/m3 that was greatly influenced by direct emissions from materials inside the vehicles. Public transports seemed to be the first choice for resident trips as compared to family cars. Graphical abstract ᅟ.

[Pollution Level, Distribution Characteristics and Risk Assessment of 32 PPCPs in Surface Water of Luomahu Lake].

A total of 22 water samples collected from Luomahu Lake were determined using high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS) to evaluate the pollution level,spatial distribution and ecological risk of 32 PPCPs.23 PPCPs were detected in surface water of Luomahu Lake and the total concentrations of 22 samples were 892-1536 ng·L-1.The concentration of norfloxacin (256-707 ng·L-1) was the highest among the detected PPCPs,followed by ketoprofen (85-438 ng·L-1),acesulfame (101-290 ng·L-1) and naproxen (1.9-112 ng·L-1).Spatial differences were found in concentrations of PPCPs in various sampling sites.Concentrations of PPCPs in northeast of Luomahu Lake were higher than those of southwest.Concentration of PPCPs in Fangtinghe River was high and that of Zhangshanzha River was relatively low.The risk assessment of 13 pharmaceutical PPCPs showed that risk quotients (RQs) of norfloxacin were 0.26-0.72,posing medial risk to aquatic ecosystem.Gemifibrozil posed low ecological risks with RQs>0.01 in most sampling sites.RQs of other 11 PPCPs were less than 0.01,posing no ecological risks.The combined risk quotients of 12 PPCPs in water of Luomahu Lake were 0.29-0.75,indicating that those compounds posed an medial risk to aquatic ecosystem.Human health risk assessment showed that the RQs were less than one for 6 selected PPCPs,indicating that these compounds did not appear to pose an appreciable risk to human health by potential environmental exposure from drinking water.

Occurrence, distribution, and risk assessment of alkylphenols, bisphenol A, and tetrabromobisphenol A in surface water, suspended particulate matter, and sediment in Taihu Lake and its tributaries.

The occurrence and distribution of nine selected compounds were investigated in surface water, suspended particulate matter (SPM), and sediment in Taihu Lake and its tributaries. With the exception of 4-Butylphenol, all compounds were detected in at least two phases, and nonylphenol (NP) and 4-tert-Octylphenol (4-OP) were the predominant alkylphenols (APs) in the lake. A significant correlation was observed between NP and 4-OP, indicating that they may share the same source. Moreover, surface water phase was the dominant sink of Bisphenol A (BPA) in the aquatic environment. The concentrations of BPA between the surface water and SPM phases were closely related to each other. In addition, Tetrabromobisphenol A (TBBPA) exhibited relatively higher concentrations and detection frequencies in the SPM. Risk assessment revealed greater risk associated with the surface water than the sediment, indicating that the discharge of industrial wastewater and domestic sewage poses a serious threat to aquatic ecosystems.

Sirolimus Versus Tacrolimus as Primary Immunosuppressant After Renal Transplantation: A Meta-Analysis and Economics Evaluation.

Sirolimus and tacrolimus are the major immunosuppressants for renal transplantation. Several studies have compared these 2 drugs, but the outcomes were not consistent. The aim of this study was to evaluate the efficacy, safety, and pharmacoeconomics of sirolimus and tacrolimus in the treatment of renal transplantation and provide evidence for the selection of essential drugs. Trials were identified through a computerized literature search of PubMed, EMBASE, Cochrane controlled trials register, Cochrane Renal Group Specialized Register of randomized controlled trials, and Chinese Biomedical database. Two independent reviewers assessed trials for eligibility and quality and then extracted data. Data were extracted for patient and graft mortality, acute rejection (AR), and adverse events. Dichotomous outcomes were reported as relative risk with 95% confidence intervals. A decision tree model was populated with data from a literature review and used to estimate costs and QALYs gained and incremental cost-effectiveness. Altogether, 1189 patients from 8 randomized controlled trials were included. The results of our analysis were that tacrolimus reduced the risks after renal transplantation of AR and patient withdrawn. Nevertheless, tacrolimus increased the risk of infection. Pharmacoeconomic analysis showed that tacrolimus represented a more cost-effective treatment than does cyclosporine for the prevention of adverse events after renal transplant. Tacrolimus is an effective and safe immunosuppressive agent, and it may be more cost-effective than cyclosporine for the primary prevention of AR in renal transplant recipients. However, it should be noted that such superiority was reversal when the cost of sirolimus and tacrolimus changed.

Tacrolimus Versus Cyclosporine as Primary Immunosuppressant After Renal Transplantation: A Meta-Analysis and Economics Evaluation.

Tacrolimus and cyclosporine are the major immunosuppressants for renal transplantation. Several studies have compared these 2 drugs, but the outcomes were not consistent. The aim of this study was to evaluate the efficacy, safety, and pharmacoeconomics of cyclosporine and tacrolimus in the treatment of renal transplantation and provide evidence for the selection of essential drugs. Trials were identified through a computerized literature search of PubMed, EMBASE, Cochrane Controlled Trials Register, Cochrane Renal Group Specialized Register of randomized controlled trials, and Chinese Biomedical database. Two independent reviewers assessed trials for eligibility and quality and then extracted data. Data were extracted for patient and graft mortality, acute rejection, and adverse events. Dichotomous outcomes were reported as relative risk with 95% confidence intervals. A decision tree model was populated with data from a literature review and used to estimate costs and quality-adjusted life years gained and incremental cost-effectiveness. Altogether, 6137 patients from 27 randomized controlled trials were included. The results of our analysis were that tacrolimus reduced the risks after renal transplantation of patient mortality, graft loss, acute rejection, and hypercholesterolemia. Nevertheless, tacrolimus increased the risk of new-onset diabetes. Pharmacoeconomic analysis showed that tacrolimus represented a more cost-effective treatment than does cyclosporine for the prevention of adverse events following renal transplant. Tacrolimus is an effective and safe immunosuppressive agent and it may be more cost-effective than cyclosporine for the primary prevention of graft rejection in renal transplant recipients. However, new-onset diabetes should be closely monitored during the medication period.

[Distribution Characteristics and Health Risk Assessment of Thirteen Sulfonamides Antibiotics in a Drinking Water Source in East China].

Trace levels of residual antibiotics in drinking water sources may threaten public health and becomes a serious issue in modern society. Occurrence and distribution of 13 sulfonamides antibiotics in a drinking water source in East China were investigated using solid phase extraction-high performance liquid chromatography-tandem mass spectrometry. The results revealed that all 13 sulfonamides were detected with the total concentrations ranging from 10.5 ng·L-1 to 238.5 ng·L-1. Sulfamethoxazole (SMX) and sulfonamide (SAM) presented the 100% detected frequency, and the maximum concentrations reached 107.0 ng·L-1 and 43.1 ng·L-1, respectively. Sulfonamides contamination levels in the inlet were relatively higher than those in the outlet. The concentration of SMX was substantially unchanged in different positions of drinking water source. Seasonal variation of sulfonamide concentration showed that the concentrations were higher in winter and spring compared with those in summer and autumn. The range of total sulfonamides concentration detected in winter and spring was from 110.8 ng·L-1 to 117.9 ng·L-1, which was 3.6-3.8 times higher than those in summer and autumn. Human health risk characterization of residual sulfonamides in drinking water source was based on the assessment of risk quotients (RQs) for which different life stages were taken into account. The results showed that no sulfonamides had a RQs higher than 1. Trimethoprim (TMP) was the most risky antibiotic to the 0-3 months old infants with RQs reaching 0.001. Although the sulfonamides detected in the drinking water source do not pose any risk to the peoples' health, the implication of long-time exposure and comprehensive risk still deserve attention.

An economic analysis of adult hepatitis B vaccination in China.

BACKGROUND AND OBJECTIVE: With the universal infant hepatitis B vaccination (HepB) program, China has made remarkable achievements to prevent and control hepatitis B. In order to further reduce hepatitis B virus (HBV) infection, the Chinese government is considering implementing a widespread adult HBV vaccination campaign. We performed an economic analysis of two different adult HepB vaccination strategies for 21-59-years-olds: vaccination without screening and screening-based vaccination. METHODS: Cost-benefit analyses were conducted. All 21-59-year-olds were divided into two groups: young adults (ages 21-39) and middle-aged adults (ages 40-59). Costs and benefits were estimated using the direct cost and societal (direct and indirect costs) perspectives. All costs and benefits were adjusted to 2014 US dollars, where future values were discounted at a 3% annual rate. We calculated benefit-cost ratios (BCRs) of the two vaccination strategies for the two different age groups. Sensitivity analyses varied key parameters within plausible ranges. RESULTS: Among young adults, the direct and societal BCRs for a vaccination campaign with no screening would be 1.06 and 1.42; with a screening-based vaccination campaign, the model estimated the direct and societal BCRs would be 1.19 and 1.73. Among middle-aged adults, the direct and societal BCRs for a vaccination campaign without screening would be 0.59 and 0.59; with a screening-based vaccination campaign, the model estimated the direct and societal BCRs would be 0.68 and 0.73. CONCLUSION: The results of our study support a HepB vaccination campaign for young adults. Additionally, a vaccination campaign with screening appeared to provide greater value than a vaccination without screening.

Wearable autonomous microsystem with electrochemical gas sensor array for real-time health and safety monitoring.

Airborne pollution and explosive gases threaten human health and occupational safety, therefore generating high demand for a wearable autonomous multi-analyte gas sensor system for real-time environmental monitoring. This paper presents a system level solution through synergistic integration of sensors, electronics, and data analysis algorithms. Electrochemical sensors featuring ionic liquids were chosen to provide low-power room-temperature operation, rapid response, high sensitivity, good selectivity, and a long operating life with low maintenance. The system utilizes a multi-mode electrochemical instrumentation circuit that combines all signal condition functions within a single microelectronics chip to minimize system cost, size and power consumption. Embedded sensor array signal processing algorithms enable gas classification and concentration estimation within a real-world mixture of analytes. System design and integration methodologies are described, and preliminary results are shown for a first generation SO(2) sensor and a thumb-drive sized prototype system.

Regeneration and reuse of iron catalyst for Fenton-like reactions.

Fenton and Fenton-like reactions employed for oxidative treatment of a typical industrial wastewater generate a large amount of ferric hydroxide sludge which has to be properly disposed at a high cost. This paper presents a simple and cost-effective method for recovering the iron catalyst from the iron hydroxide sludge for oxidative treatment of industrial wastewaters. The sludge was dewatered, dried and baked at 350-400 degrees C for 20-30 min; the residual solids were dissolved in sulfuric acid to form the reusable catalyst for Fenton and Fenton-like reactions. The recovered catalyst was highly effective for the oxidative pretreatment of a fine chemical wastewater to improve its biodegradability; the resulting COD removal and BOD(5)/COD ratio of the treated stream remained nearly unchanged during the time period when the regenerated catalyst was reused six times. The simple and effective catalyst regeneration method will make Fenton and Fenton-like oxidation a more cost-effective wastewater treatment alternative.