Cost of Treatment for Brain Metastases Using Data From a National Health Insurance.

Purpose: In the United States, brain metastases (BMs) affect 10% to 20% of patients with cancer, presenting a significant health care challenge and necessitating intricate, high-cost treatments. Few studies have explored the comprehensive care cost for BMs, and none have used real insurance claims data. Partnering with a northeastern health care insurer, we investigated the true costs of various brain-directed radiation methods, aiming to shed light on treatment expenses, modalities, and their efficacy. Methods and Materials: We analyzed medical claims from Highmark Health-insured patients in Pennsylvania, Delware, West Virginia, and New York diagnosed with BMs (ICD-10 code C79.31) and treated with radiation from January 1, 2020 to July 1, 2022. Costs for radiation techniques were grouped by specific current procedural terminology claim codes. We subdivided costs into technical and physician components and separated hospital from freestanding costs for some modalities. Results: From January 1, 2020 to July 1, 2022, 1048 Highmark Health members underwent treatment for BMs. Females (n = 592) significantly outnumbered males (n = 456), with an average age of 64.4 years. Each member had, on average, 5.309 claims costing $2015 per claim. Total cost totaled $10,697,749. Per-treatment analysis showed that hippocampal avoidance intensity modulated radiation therapy was the costliest treatment at $47,748, followed by stereotactic radiation therapy at $37,230, linear accelerator stereotactic radiosurgery (SRS) at $30,737, Gamma Knife SRS at $30,711, and whole-brain radiation therapy at $5225. Conclusions: Whole-brain radiation therapy was the least costly radiation technique. Similar per-treatment prices for Gamma Knife and linear accelerator SRS support their use in treating BMs. Stereotactic radiation therapy in general was costlier on a per-use basis than SRS, prompting further scrutiny on its frequent use. Hippocampal avoidance intensity modulated radiation therapy was the costliest radiation therapy on a per-use basis by a moderate amount, prompting further discussion about its comparative cost effectiveness against other radiation modalities. This study underscores the importance of multiple considerations in treating BMs, such as tumor control, survival, side effects, and costs.

"They have their own people": Emotional connections, community belonging, and Chinese gay, bisexual and other men who have sex with men (GBMSM) college students' needs for sexual health support.

Gay, bisexual and other men who have sex with men (GBMSM) college students in China have unique sexual health challenges, including a higher risk of HIV infection, stigma and discrimination against LGBTQ (lesbian, gay, bisexual, transgender, and queer) population, and limited access to LGBTQ-affirmative sexual health support. Nonetheless, previous research or policymaking has rarely addressed the students' needs for sexual health support from their perspectives. This study aims to explore GBMSM college students' perceptions and attitudes to current sexual health resources, the challenges they encounter, and their expectations to acquiring LGBTQ-affirmative sexual health information and services. The exploration was carried out through field visits and in-depth interviews with 26 GBMSM college students and eight relevant stakeholders in five cities in China. Qualitative thematic analysis was applied to the interview transcripts and fieldwork memos. Four themes emerged around the preference and needs of GBMSM students in dealing with their sexual health challenges: the association between tackling sexual health challenges and entering LGBTQ communities, the roles of emotional attachment in shaping the preference for HIV-related care and support, the desired modes of acquiring sexual health support, and the current unmet service needs. We discovered that the information-and-care-seeking behaviors of GBMSM college students are highly influenced by and connected to their participation in online and in-person LGBTQ communities. Due to the overall stigmatizing sociocultural environment of LGBTQ in China, GBMSM college students tend to rely on LGBTQ communities, seeking trust and a sense of belongingness for tackling their sexual health challenges. Conventional school-based sexual health educational programs, which often apply top-down, stigma-and-fear-based, and non-LGBTQ-inclusive teaching strategies, rarely help GBMSM college students to solve sexual health problems in real life. GBMSM college students are eager to have LGBTQ-affirmative "health managers" who can understand their emotional experiences and interpersonal contexts and assist them with sexual health issues. However, such support is generally perceived as limited by the students. Our study highlights these unmet needs of the GBMSM students and emphasizes the importance of developing future LGBTQ-affirmative sexual health programs among Chinese GBMSM college students and young GBMSM in general.

Environmental pollutants induce NLRP3 inflammasome activation and pyroptosis: Roles and mechanisms in various diseases.

Environmental pollution is changing with economic development. Most environmental pollutants are characterized by stable chemical properties, strong migration, potential toxicity, and multiple exposure routes. Harmful substances are discharged excessively, and large quantities of unknown new compounds are emerging, being transmitted and amplifying in the food chain. The increasingly severe problems of environmental pollution have forced people to re-examine the relationship between environmental pollution and health. Pyroptosis and activation of the NLRP3 inflammasome are critical in maintaining the immune balance and regulating the inflammatory process. Numerous diseases caused by environmental pollutants are closely related to NLRP3 inflammasome activation and pyroptosis. We intend to systematically explain the steps and important events that are common in life but easily overlooked by which environmental pollutants activate the NLRP3 inflammasome and pyroptosis pathways. This comprehensive review also discusses the interaction network between environmental pollutants, the NLRP3 inflammasome, pyroptosis, and diseases. Thus, research progress on the impact of decreasing oxidative stress levels to inhibit the NLRP3 inflammasome and pyroptosis, thereby repairing homeostasis and reshaping health, is systematically examined. This review aims to deepen the understanding of the impact of environmental pollutants on life and health and provide a theoretical basis and potential programs for the development of corresponding treatment strategies.

Rituximab with high-dose methotrexate is effective and cost-effective in newly diagnosed primary central nervous system lymphoma.

Induction chemotherapy based on high-dose methotrexate is considered as the standard approach for newly diagnosed primary central nervous system lymphomas (PCNSLs). However, the best combination chemotherapeutic regimen remains unclear. This study aimed to determine the efficacy and toxicities of rituximab with methotrexate (R-M regimen). Consecutive 37 Chinese patients receiving R-M regimen as induction chemotherapy were retrospectively identified from January 2015 to June 2020 from our center in eastern China. Fourteen patients receiving rituximab plus methotrexate with cytarabine (R-MA regimen) at the same period were identified as the positive control group. The response rates, survival, toxicities, length of hospital stay (LOS), and cost were compared. Compared with the R-MA regimen, the R-M regimen showed comparable response rate and survival outcomes, but had fewer grade 3-4 hematological toxicities, shorter LOS, lower mean total hospitalization cost and lower mean total antibiotic cost. Complete remission at the end of induction chemotherapy and ECOG > 3 were independent prognostic factors for overall survival. In conclusion, R-M regimen is an effective and cost-effective combination treatment for PCNSLs, which warrants further evaluation in randomized trials.

[Spatial Distribution, Contamination Assessment, and Sources of Heavy Metals in the Urban Green Space Soils of a City in North China].

To study the condition of urban green space soils in the central parts of a city in North China, the spatial distribution, sources, and pollution levels of heavy metals (Cd, Hg, As, Pb, Cr, Cu, Zn, and Ni) within green space soils in the central urban districts of the city were investigated. The results showed that the soil quality was high overall. The mean concentrations of Cd, Hg, As, Pb, Cr, Cu, Zn, and Ni were 0.172, 0.202, 9.02, 34.7, 57.0, 31.2, 85.7, and 26.3 mg·kg-1, respectively. The mean concentrations of Cd, Hg, Pb, and Zn in urban soils exceeded the background value of the Beijing-Tianjin-Tangshan region. All of the samples' heavy metal concentrations were lower than the risk screening values for soil contamination of development land in the national soil environment quality standards. With respect to the spatial distribution, the concentrations of As, Cr, and Ni were higher in the northwest of the study area, the concentrations of Cd and Zn were higher in the northeast, and the concentrations of Hg, Pb, and Cu were higher in the urban core area. As for the different land use types of the soils, the concentrations of Cd, Zn, and Ni were higher in the enterprise soils, while the concentrations of Hg, Pb, and Cu were higher in park and residential soils. Assessments of soil quality showed that 97.2% of soil samples' Nemerow integrated indices were less than 1, indicating that the soils were clean. Indices of potential ecological risk for all soil samples were less than 80, indicating that they posed a slight ecological risk. Multivariate statistical analysis (correlation and principle component analyses) showed that Cu, Pb, and Hg may originate from an anthropogenic source via the painting of ancient buildings and pesticides used to protect ancient trees. Chromium may originate from natural sources via geochemical activity and soil parent material; Cr, Zn, Ni, and As were derived from mixed sources through human and geochemical activities. The receptor model was used for identification and apportionment of pollution sources of elements over the standard. The contribution rates of sources were as follows:source 2(46.1%), source 3(33.1%), source 1(17.7%), and others (3.1%) for Cd, source 1(93.0%) for Cu, source 1(52.4%), source 3(24.2%), source 2(20.0%), and others (3.4%) for Zn, source 1(56.3%), source 2(37.8%), and source 3(5.8%) for Ni. Sources 1 and 3 were anthropogenic, while source 2 was natural.

Micro-/Macroscopically Synergetic Control of Switchable 2D/3D Photothermal Water Purification Enabled by Robust, Portable, and Cost-Effective Cellulose Papers.

Solar energy, as a renewable and sustainable resource, is considered to be a promising candidate for solving the water shortage through an interfacial solar-to-thermal conversion. Despite tremendous advances are achieved, it is still challenging for limited size, high-cost, and complicated fabrication protocols. More importantly, a favorable 2D/3D structure transformation to adapt to diverse conditions is considered to be very important. Inspired by the transformers with changeable geometries, herein, a large-area polypyrrole chemically functionalized cellulose paper (PPyP) with tunable microstructures and macroscopic geometries is developed via an in situ controlled oxypolymerization reaction. The resulted PPyP enables tunable 2D interfacial solar vaporization and even adapt itself to realization of 3D structures transformation for high-efficient water evaporation of up to 2.99 kg m-2 h-1 under 1 sun via an alternative kirigami/origami approach. Significantly, the PPyP can realize a switchable transformation between 2D and 3D structures to adapt diverse environments, demonstrating significant potentials in environmentally adaptable water purification.

Transition-Metal-Free Sulfuration/Annulation of Alkenes: Economical Access to Thiophenes Enabled by the Cleavage of Multiple C-H Bonds.

A novel, atom economical, and transition-metal-free strategy for the synthesis of thiophenes from substituted buta-1-enes with potassium sulfide has been presented. The reaction achieves double C-S bond formations via cleavage of multiple C-H bonds and provides an efficient approach to access various functionalized thiophenes. Moreover, the strategy can also be used for the synthesis of thiophenes from 1,4-diaryl-1,3-dienes. Mechanistically, DMSO plays a role of oxidant and S3•- in situ generated from K2S is involved.

Conditioning adaptive combination of P-values method to analyze case-parent trios with or without population controls.

Detection of rare causal variants can help uncover the etiology of complex diseases. Recruiting case-parent trios is a popular study design in family-based studies. If researchers can obtain data from population controls, utilizing them in trio analyses can improve the power of methods. The transmission disequilibrium test (TDT) is a well-known method to analyze case-parent trio data. It has been extended to rare-variant association testing (abbreviated as "rvTDT"), with the flexibility to incorporate population controls. The rvTDT method is robust to population stratification. However, power loss may occur in the conditioning process. Here we propose a "conditioning adaptive combination of P-values method" (abbreviated as "conADA"), to analyze trios with/without unrelated controls. By first truncating the variants with larger P-values, we decrease the vulnerability of conADA to the inclusion of neutral variants. Moreover, because the test statistic is developed by conditioning on parental genotypes, conADA generates valid statistical inference in the presence of population stratification. With regard to statistical methods for next-generation sequencing data analyses, validity may be hampered by population stratification, whereas power may be affected by the inclusion of neutral variants. We recommend conADA for its robustness to these two factors (population stratification and the inclusion of neutral variants).

[Bioaccessibility of heavy metal in wild Artemisia annua and its health risk assessment].

In this study, we investigate the bioaccessibility of heavy metals (Cu, Pb, As, Cd and Hg) in wild Artemisia annua and use target hazard quotients (THQ) proposed by US Environmental Protection Agency to assess the health risk under the heavy metal exposure. The results showed that the bioaccessibility of Cu, Pb, As, Cd and Hg in A. annua are 0.77, 0.66, 0.46, 0.68 and 0, respectively, and that the value of THQ for adults and children were 0.030 and 0.025 calculated by risk assessment model. The results indicated that the heavy metals in A. annua were not able to be completely absorbed by human body and that their contents were in a safe range. In this study, by combining the bioavailability of heavy metal and health risk assessment, we assessed the security of heavy metals of wild A. annua, which will provide reference for the standard of heavy metals for medicinal materials.

[Ecological agriculture: future of Good Agriculture Practice of Chinese materia medica].

Based on the ecological and economic problems in Good Agriculture Practice (GAP) of Chinese material medica, we introduced the origin, concept, features and operative technology of eco-agriculture worldwide, emphasizing its modes on different biological levels of landscape, ecosystem, community, population, individual and gene in China. And on this basis, we analyzed the background and current situation of eco-agriculture of Chinese materia medica, and proposed its development ideas and key tasks, including: (1) Analysis and planning of the production pattern of Chinese material medica national wide. (2) Typical features extraction of regional agriculture of Chinese materia medica. (3) Investigation of the interaction and its mechanism between typical Chinese materia medica in each region and the micro-ecology of rhizosphere soil. (4) Study on technology of eco-agriculture of Chinese materia medica. (5) Extraction and solidification of eco-agriculture modes of Chinese materia medica. (6) Study on the theory of eco-agriculture of Chinese materia medica. Also we pointed out that GAP and eco-agriculture of Chinese material medica are both different and relative, but they are not contradictory with their own features. It is an irresistible trend to promote eco-agriculture in the GAP of Chinese material medica and coordinate ecological and economic development.

[Key-point investigation list of traditional Chinese medicinal materials for national survey of Chinese material medica resources].

Base on the traditional Chinese medicinal materials list that include Pharmacopoeia of the People's Republic of China, Dao-di Herbs, the common used herbs, endangered species, to analyze the key-point investigation traditional Chinese medicinal materials list was analysed. Results displayed that the variety number of traditional Chinese medicinal materials in Pharmacopoeia of the People's Republic of China is 894, the variety number of Dao-di Herbs is 495, the variety number of the common use is 326, the variety number of traditional Chinese medicinal materials from endangered species is 280, and during the third national survey of Chinese material medica resources the variety number of traditional Chinese medicinal materials that were analysed is 360. In the list of Dao-di Herbs and common used herbs over 85% are in the list of Pharmacopoeia of the People's Republic of China, in the list of the common used herbs over 80% are in the list of Dao-di Herbs, in the list of Pharmacopoeia of the People's Republic of China and Dao-di Herbs over 10% are in the list of endangered species. The key-point investigation traditional Chinese medicinal materials list includes three part, the first part includes 563 variery traditional Chinese medicinal materials that need to statistics quantity of resource by field investigation, the second part includes 457 variery that need to monitor the changing situation, the third part includes 280 variery that need to estimated endangered situation.

Promoter recognition based on the maximum entropy hidden Markov model.

Since the fast development of genome sequencing has produced large scale data, the current work uses the bioinformatics methods to recognize different gene regions, such as exon, intron and promoter, which play an important role in gene regulations. In this paper, we introduce a new method based on the maximum entropy Markov model (MEMM) to recognize the promoter, which utilizes the biological features of the promoter for the condition. However, it leads to a high false positive rate (FPR). In order to reduce the FPR, we provide another new method based on the maximum entropy hidden Markov model (ME-HMM) without the independence assumption, which could also accommodate the biological features effectively. To demonstrate the precision, the new methods are implemented by R language and the hidden Markov model (HMM) is introduced for comparison. The experimental results show that the new methods may not only overcome the shortcomings of HMM, but also have their own advantages. The results indicate that, MEMM is excellent for identifying the conserved signals, and ME-HMM can demonstrably improve the true positive rate.

The determinants of GP visits in New Zealand.

OBJECTIVE: To identify the characteristics of New Zealanders who utilised primary healthcare services prior to the implementation of the New Zealand Primary Healthcare Strategy (PHCS). METHODS: This paper uses data from the 1996/97 and 2002/03 waves of the nationally representative New Zealand Health Survey to examine the relationship between individual, household and community characteristics and the utilisation of healthcare services by New Zealanders. Multivariate regression models are used to examine the correlation between particular characteristics and whether an individual visited a GP in the previous 12 months, the number of visits made to a GP in the previous 12 months, whether they reported needing to see a GP in the previous 12 months, but failed to do so, and whether they visited a secondary practitioner in the previous 12 months. RESULTS: Gender, age, and ethnicity are all found to be significantly related to healthcare utilisation, even when controlling for a fairly comprehensive set of characteristics. On the other hand, education, marital status, household composition, household income and community deprivation are found to be unrelated to healthcare utilisation. A strong relationship is found between employment status, health status and healthcare utilisation. CONCLUSIONS AND IMPLICATIONS: We do not find any evidence of a relationship between socioeconomic status and healthcare utilisation after controlling for other measures of need. This and other findings suggest that the government subsidies in place prior to the implementation of the 2001 Primary Healthcare Strategy helped to ensure that user charges did not limit service utilisation in New Zealand for groups with lower socioeconomic status.

Assessment of the ability of the antioxidant cocktail-derived from fermentation of plants with effective microorganisms (EM-X) to modulate oxidative damage in the kidney and liver of rats in vivo: studies upon the profile of poly- and mono-unsaturated fatty acids.

The antioxidant cocktail EM-X derived from ferment of unpolished rice, papaya and sea weeds with effective microorganisms (EM) of lactic acid bacteria, yeast, and photosynthetic bacteria is widely available in South-East Asia. Oral administration of a EM-X to rats for 7 days inhibited the ferric-nitrilotriacetic acid (Fe-NTA)-dependent oxidation of fatty acids with protections directed towards docosahexanoic, arachidonic, docosapentanenoic acids, oleic, linoleic and eicosadieonoic acids in the liver and kidney. But only the protections of oxidation to docosahexanoic, arachidonic acid in the kidney were statistically significant. Treatment of rats with EM-X prior to the intraperitoneal administration of Fe-NTA led to a reduction in the overall levels of conjugated dienes (CD) measured in the kidney by 27% and in the liver by 19% suggesting inhibition of lipid peroxidation in these organs. The levels of glutathione and alpha-tocopherol were largely unaffected suggesting that the protection by the regular strength of EM-X was confined to the inhibition of lipid peroxidation in vivo, a point dependent on the concentrations of bioactive flavonoids.