Risk-based lung cancer screening in heavy smokers: a benefit-harm and cost-effectiveness modeling study.

BACKGROUND: Annual screening through low-dose computed tomography (LDCT) is recommended for heavy smokers. However, it is questionable whether all individuals require annual screening given the potential harms of LDCT screening. This study examines the benefit-harm and cost-effectiveness of risk-based screening in heavy smokers and determines the optimal risk threshold for screening and risk-stratified screening intervals. METHODS: We conducted a comparative cost-effectiveness analysis in China, using a cohort-based Markov model which simulated a lung cancer screening cohort of 19,146 heavy smokers aged 50 ~ 74 years old, who had a smoking history of at least 30 pack-years and were either current smokers or had quit for < 15 years. A total of 34 risk-based screening strategies, varying by different risk groups for screening eligibility and screening intervals (1-year, 2-year, 3-year, one-off, non-screening), were evaluated and were compared with annual screening for all heavy smokers (the status quo strategy). The analysis was undertaken from the health service perspective with a 30-year time horizon. The willingness-to-pay (WTP) threshold was adopted as three times the gross domestic product (GDP) of China in 2021 (CNY 242,928) per quality-adjusted life year (QALY) gained. RESULTS: Compared with the status quo strategy, nine risk-based screening strategies were found to be cost-effective, with two of them even resulting in cost-saving. The most cost-effective strategy was the risk-based approach of annual screening for individuals with a 5-year risk threshold of ≥ 1.70%, biennial screening for individuals with a 5-year risk threshold of 1.03 ~ 1.69%, and triennial screening for individuals with a 5-year risk threshold of < 1.03%. This strategy had the highest incremental net monetary benefit (iNMB) of CNY 1032. All risk-based screening strategies were more efficient than the status quo strategy, requiring 129 ~ 656 fewer screenings per lung cancer death avoided, and 0.5 ~ 28 fewer screenings per life-year gained. The cost-effectiveness of risk-based screening was further improved when individual adherence to screening improved and individuals quit smoking after being screened. CONCLUSIONS: Risk-based screening strategies are more efficient in reducing lung cancer deaths and gaining life years compared to the status quo strategy. Risk-stratified screening intervals can potentially balance long-term benefit-harm trade-offs and improve the cost-effectiveness of lung cancer screenings.

Insights into the occurrence, spatial distribution, and ecological implications of organophosphate triesters in surface sediments from polluted urban rivers across China.

Organophosphate triesters (tri-OPEs) are a kind of widespread contaminants in the world, particularly in China, which is a major producer and user of tri-OPEs. However, tri-OPE pollution in urban river sediments in China remains unclear. In current work, we carried out the first nationwide investigation to comprehensively monitor 10 conventional and five emerging tri-OPEs in sediments of 173 black-odorous urban rivers throughout China. Concentrations of 10 conventional and five emerging tri-OPEs were 3.8-1240 ng/g dw (mean: 253 ng/g dw) and 0.21-1107 ng/g dw (68 ng/g dw), respectively, and significantly differed among the cities sampled but generally decreased from Northeast and East China to Central and West China. These spatial patterns suggest that tri-OPE pollution was mainly from local sources and was controlled by the industrial and economic development levels in these four areas, as indicated by the significant correlations between tri-OPE concentrations and gross domestic production, gross industrial output, and daily wastewater treatment capacity. Although the tri-OPE composition varied spatially at different sites, which indicated different tri-OPE input patterns, it was commonly dominated by tris(2-chloroethyl) phosphate, tris(2-ethylhexyl) phosphate, and tris(1-chloro-2-propyl) phosphate (conventional tri-OPEs) and bisphenol A-bis(diphenyl phosphate) and isodecyl diphenyl phosphate (emerging tri-OPEs). A risk assessment indicated that tri-OPEs in most sampling sediments had a low to moderate risk to aquatic organisms.

Spatial distribution, conversion, and ecological risk assessment of hexabromocyclododecanes in the sediments of black-odorous urban rivers nationwide in China.

Hexabromocyclododecanes (HBCDs) have become a global pollution problem, particularly in China-a major producer and user of HBCDs. However, little is known about the HBCD pollution status in urban rivers nationwide in China. In this study, we comprehensively investigated the pollution characteristics of HBCDs in 173 sediment samples from black-odorous urban rivers across China. Total HBCD concentrations ranged from not-detected to 848 ng/g dw, showing significant differences among the various sampling cities, but generally increasing from west to east China. This distribution pattern of HBCDs was strongly associated with the local industrial output, gross domestic product, and daily wastewater treatment capacity. α-HBCD was the predominant diastereoisomer in most sediments, with an average proportion of 63.8 ± 18.8 %, followed by γ-HBCD (23.8 ± 19.5 %) and ß-HBCD (12.4 ± 6.49 %), showing a significant increase of the α-HBCD proportions relative to those in HBCD commercial mixtures and an opposite trend for that of γ-HBCD. These results suggested that HBCDs might undergo isomerization from γ- to α-HBCD and biotic/abiotic degradation with preference for γ-HBCD. Of these conversions, the microbial degradation of HBCDs was further verified by the preferential transformation of (-)-α-, (+)-ß-, and (-)-γ-HBCDs and the detection of HBCD-degrading bacteria, including Dehalococcoides, Bacillus, Sphingobium, and Pseudomonas. A risk assessment indicated that HBCDs pose low to moderate risks to aquatic organisms in most black-odorous urban river sediments.

Real-World Utilization, Barriers, and Factors Associated With the Targeted Treatment of Metastatic Colorectal Cancer Patients in China: A Multi-Center, Hospital-Based Survey Study.

Objectives: To explore the utilization, barriers, and factors associated with the targeted treatment of Chinese metastatic colorectal cancer (mCRC) patients. Methods: A total of 1,688 mCRC patients from 19 hospitals in 14 cities were enrolled from March 2020 to March 2021 using stratified, multistage cluster sampling. The use of targeted therapy and any barriers patients experienced were collected. Logistic regression analyses were conducted to identify the factors associated with initiating targeted treatment. Results: About 51.6% of the patients initiated targeted therapy, of whom 44.5%, 20.2%, and 35.2% started first-, second-, and third-line treatment, respectively. The most reported barriers were high medical costs and a lack of belief in the efficacy of targeted therapy. Patients treated in the general hospital, diagnosed at an older age, less educated, and who had a lower family income, no medical insurance, poor health-related quality of life, metastasis outside the liver/lung or systemic metastasis, a shorter duration of mCRC were less likely to initiate targeted therapy. Conclusion: Reduced medical costs and interventional education to improve public awareness could facilitate the use of targeted treatment for mCRC.

Effect of Health Intervention via Web-Based Education on Improving Information-Motivation-Behavioral Skills Related to HPV Vaccination Among Chinese Female College Students.

Objectives: The human papillomavirus (HPV) vaccination rate is generally low in China. This study aimed to assess the effect of web-based education on improving information-motivation-behavior skills related to HPV vaccination among Chinese female college students. Methods: From February to May 2020, female students were recruited from a university and divided into intervention and control groups. The intervention group received 7 days of HPV-related web-based education. Related information were collected using questionnaires in the baseline, 7 days, 1 month, and 3 months after the intervention. Chi-square test and repeated ANOVA were used to compare the differences between the two groups in the four surveys. Results: A total of 449 students (235 in the intervention and 214 in the control group) were included in the analysis. There were no statistical differences in demographic information between the two groups. Compared with the control group, students in the intervention group showed a richer knowledge and subjective norms of HPV vaccination (p < 0.05). Conclusion: The study provides preliminary support for a health intervention via web-based education in increasing HPV vaccination information among female college students.

Abundance, spatial distribution, and characteristics of microplastics in agricultural soils and their relationship with contributing factors.

Agro-ecosystem contamination with microplastics (MPs) is of great concern. However, limited research has been conducted on the agricultural soil of tropical regions. This paper investigated MPs in the agro-ecosystem of Hainan Island, China, as well as their relationships with plastic mulching, farming practices, and social and environmental factors. The concentration of MPs in the study area ranged from 2800 to 82500 particles/kg with a mean concentration of 15461.52 particles/kg. MPs with sizes between 20 and 200 µm had the highest abundance of 57.57%, fragment (58.16%) was the most predominant shape, while black (77.76%) was the most abundant MP colour. Polyethylene (PE) (71.04%) and polypropylene (PP) (19.83%) were the main types of polymers. The mean abundance of MPs was significantly positively correlated (p < 0.01) with all sizes, temperature, and shapes except fibre, while weakly positively correlated with the population (p = 0.21), GDP (p = 0.33), and annual precipitation (p = 0.66). In conclusion, plastic mulching contributed to significant contamination of soil MPs in the study area, while environmental and social factors promoted soil MPs fragmentation. The current study results indicate serious contamination with MPs, which poses a concern regarding ecological and environmental safety.

Sedentary Behavior and Phase Angle: An Objective Assessment in Physically Active and Inactive Older Adults.

The purpose of the present study was to investigate the associations of the objectively assessed total sedentary behavior (SB) amount and SB patterns with phase angle (PhA) in older populations and to conduct a comparison analysis for those who are physically active (meet 150 min/week) and inactive (less than 150 min/week). During May to August 2023, a convenience sampling was used to recruit older adults (aged ≥ 65 years) living in a community in Taiwan. The total SB amount (minutes/day), SB patterns (including SB bouts and breaks), and physical activity were assessed by a triaxial accelerometer. A multifrequency bioelectrical impedance analyzer (BIA) was used to measure PhA. Multiple linear regression analysis was employed to examine the associations between SB and PhA in the total number of participants and stratified in the physically active and inactive groups. For the whole sample (n = 166; mean age: 72.1 ± 5.5 years), the total SB amount and patterns of SB were not associated with PhA. For those physically active, the total SB amount and SB patterns were not associated with PhA. Among those physically inactive, the total SB amount was negatively related to PhA (B: -0.059, 95% CI: -0.118, 0.000). This study underscores the importance of minimizing the total SB amount in physically inactive older adults, providing evidence for future interventions targeting SB and PhA in this population.

Influence of digital finance and green technology innovation on China's carbon emission efficiency: Empirical analysis based on spatial metrology.

The carbon emission efficiency can be employed to estimate the reduction of carbon emissions and sustainable economic development. Carbon emission efficiency is believed to be affected significantly by green technology innovation. In terms of promoting green technology innovation, digital finance enhances the contribution of traditional finance due to its information-based nature. Then, exploring how digital finance and green technology innovation affect carbon emission efficiency will assist in formulating effective policies. Employing the panel data of 285 city samples in China from 2011 to 2017, this study employed the improved NDDF (non-radial directional distance function) to calculate the urban carbon emission efficiency and applied the spatial econometric model to empirically analyze the impact of digital finance and green technology innovation on carbon emission efficiency. Empirical results demonstrate carbon emission efficiency has a significant spatial correlation, and neighboring cities have a spillover effect on local carbon emission efficiency. The synergistic effect of digital finance and green technological innovation plays a significant role in promoting local carbon emission efficiency but suppresses carbon emission efficiency in surrounding cities to some extent. Additionally, the synergy varies based on the city's carbon emission efficiency. Consequently, China should strengthen the integration of digital finance and green technology, and formulate supporting policies and measures according to local conditions to improve the urban carbon emission efficiency, so as to provide the theoretical basis and practical experience for achieving China's goal of "carbon neutralization".

Predicting metachronous liver metastasis in patients with colorectal cancer: development and assessment of a new nomogram.

BACKGROUND: We aimed to develop and validate a nomogram model, which could predict metachronous liver metastasis in colorectal cancer within two years after diagnosis. METHODS: A retrospective study was performed on colorectal cancer patients who were admitted to Beijing Shijitan Hospital from January 1, 2016 to June 30, 2019. The least absolute shrinkage and selection operator (LASSO) regression model was used to optimize feature selection for susceptibility to metachronous liver metastasis in colorectal cancer. Multivariable logistic regression analysis was applied to establish a predictive model through incorporating features selected in the LASSO regression model. C-index, receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA) were employed to assess discrimination, distinctiveness, consistency with actual occurrence risk, and clinical utility of candidate predictive model. Internal validation was assessed with bootstrapping method. RESULTS: Predictors contained in candidate prediction nomogram included age, CEA, vascular invasion, T stage, N stage, family history of cancer, and KRAS mutation. This model displayed good discrimination with a C-index of 0.787 (95% confidence interval: 0.728-0.846) and good calibration, whereas area under the ROC curve (AUC) of 0.786. Internal validation obtained C-index of 0.786, and AUC of validation cohort is 0.784. Based on DCA, with threshold probability range from 1 to 60%; this predictive model might identify colorectal cancer metachronous liver metastasis to achieve a net clinical benefit. CONCLUSION: We have developed and validated a prognostic nomogram with good discriminative and high accuracy to predict metachronous liver metastasis in CRC patients.

Disease knowledge, medical experience, health-related quality of life and health-care costs among patients with advanced colorectal cancer in China: protocol for a nationwide multicentre survey.

BACKGROUND: Colorectal cancer (CRC) is one of the most common cancers in China. Most patients have developed advanced stage at diagnosis, leading to a low 5-year survival rate. To optimise prevention strategies, we planned a survey to evaluate the disease knowledge, medical experience and health-related quality of life (HRQOL) before and after the treatment of CRC, and healthcare costs among patients with advanced CRC in China. METHODS AND ANALYSIS: This is a nationwide, hospital-based, multicentre survey. Nineteen hospitals in seven cities were selected by multistage stratified sampling. Mainland China is divided into seven regions according to the traditional administrative district definition; two cities of each region were selected through simple random sampling, and then one tertiary cancer hospital and one general hospital were selected for each city. More than 4445 patients with CRC in the selected hospitals with stage III or IV will be enrolled in this study. The trained interviewers will collect information through patients' self-report and/or medical records, including demographics and medical history; knowledge about CRC high-risk factors, screening procedure and treatment methods; medical experience on CRC screening, diagnosis and treatment; HRQOL before and after CRC treatment; and costs of CRC. All data will be input by two independent staff and verified using Epidata V.3.1 software. Data validation plan will be made to guide data checking. All statistical analyses will be conducted using SAS V.9.4 and SPSS V.24.0 software. ETHICS AND DISSEMINATION: The study was approved by the ethics committees of Henan Cancer Hospital, the leading participant hospital. Findings of this study will be disseminated through peer-reviewed open-access journals and presented as posters and/or oral sections in national and international conferences. Results will also be popularised to the public via media or the internet.

Impact of climate change on grape berry ripening: An assessment of adaptation strategies for the Australian vineyard.

Compressed vintages, high alcohol and low wine acidity are but a few repercussions of climate change effects on Australian viticulture. While warm and cool growing regions may have different practical concerns related to climate change, they both experience altered berry and must composition and potentially reduced desirable wine characteristics and market value. Storms, drought and uncertain water supplies combined with excessive heat not only depress vine productivity through altered physiology but can have direct consequences on the fruit. Sunburn, shrivelling and altered sugar-flavour-aroma balance are becoming more prevalent while bushfires can result in smoke taint. Moreover, distorted pest and disease cycles and changes in pathogen geographical distribution have altered biotic stress dynamics that require novel management strategies. A multipronged approach to address these challenges may include alternative cultivars and rootstocks or changing geographic location. In addition, modifying and incorporating novel irrigation regimes, vine architecture and canopy manipulation, vineyard floor management, soil amendments and foliar products such as antitranspirants and other film-forming barriers are potential levers that can be used to manage the effects of climate change. The adoption of technology into the vineyard including weather, plant and soil sensors are giving viticulturists extra tools to make quick decisions, while satellite and airborne remote sensing allow the adoption of precision farming. A coherent and comprehensive approach to climate risk management, with consideration of the environment, ensures that optimum production and exceptional fruit quality is maintained. We review the preliminary findings and feasibility of these new strategies in the Australian context.

Concentrations, homolog profiles, and risk assessment of short- and medium-chain chlorinated paraffins in soil around factories in a non-ferrous metal recycling park.

Chlorinated paraffins (CPs) are used as additives in metal processing in the metal smelting industry. Data on CPs in the environment near metal smelting plants are limited. The objectives of this study were to investigate the concentrations and congener profiles of CPs in soil around factories in a non-ferrous metal recycling park located in Hebei, China, and to investigate human exposure to CPs in the soil. The concentrations of short-chain CPs (SCCPs) and medium-chain CPs (MCCPs) were determined by two-dimensional gas chromatography with electron capture negative ionization mass spectrometry. The SCCP and MCCP concentrations in the soil samples were 121-5159 ng/g and 47-6079 ng/g, respectively. Generally, the CP concentrations in soils around the factories were relatively high compared with those near other contaminated sites and in rural and urban areas. There were significant correlations between the MCCP concentrations, some SCCP carbon homologs, and the total organic carbon content (p < 0.05). The major SCCP and MCCP congener groups were C10Cl6-7 and C15-16Cl5, respectively. Hierarchical cluster analysis and principal component analysis indicated that SCCPs and MCCPs in the soil might originate from extreme pressure additives containing CP-42 and CP-52 and CP-containing waste material from the factories. The concentrations in two samples collected near a metal recycling factory posed a moderate risk according to a risk assessment conducted using risk quotients. Further risk assessment showed that the CPs concentrations in soil did not pose significant health risks to either children or adults.

The Design and Evaluation of Clinical Pathway for Disease Management to Maximize Public Health Benefit.

As an implementation strategy, the actual functional scope of clinical pathway (CPW) can be mastered is the basis for evaluating and improving CPW management, which is very important for bridging the evidence-to-practice gap. Here, we propose and discuss a design and evaluation model for CPWs through some theoretical lenses that may help the designer master the actual functional scope of CPWs and accumulate and refine effective key management steps of a specific disease. We can thus determine the best-optimized design with the largest net benefit that allows definition of the core management steps for a specific disease.

Longitudinal assessment of anxiety/depression rates and their related predictive factors in acute ischemic stroke patients: A 36-month follow-up study.

ABSTRACT: This study aimed at investigating the longitudinal changes of poststroke anxiety/depression rates, and their potential risk factors in acute ischemic stroke (AIS) patients.A total of 250 first diagnosis of AIS patients were enrolled and followed for 36 months. Anxiety/depression of patients were assessed using hospital anxiety and depression scale (HADS) at month (M) 0 (M0) and then every 3 months till M36.During 36-month follow-up, both HADS-anxiety score (from 6.9 ±â€Š3.1 at M0 to 8.0 ±â€Š3.5 at M36) and anxiety rate (from 41.2% at M0 to 54.0% at M36) (both P < .01) were increased with time longitudinally. Meanwhile, HADS-depression score (from 6.2 ±â€Š3.0 at M0 to 6.9 ±â€Š3.1 at M36) and depression rate (from 32.4% at M0 to 40.4% at M36) (both P > .05) displayed an upward trend with time longitudinally but without statistical significance. By forward multivariate logistic regression analysis, female, diabetes and higher National Institute of Health Stroke Scale (NIHSS) score independently predicted elevated anxiety risk at M0, M12, M24, and M36 (all P < .05); while longer education duration and hypertension independently predicted raised anxiety risk at M0 and M12 (all P < .05), respectively. Regarding depression, diabetes independently predicted increased depression risk at M0, M12, M24, and M36 (all P < .01); longer education duration independently predicted higher depression risk at M0 and M12 (both P < .05); female independently predicted increased depression risk at M24 and M36 (both P < .01); higher NIHSS score independently predicted raised depression risk at M24 and M36 (both P < .01).Poststroke anxiety and depression are frequent, which deteriorate with time; besides, female, diabetes, NIHSS score, hypertension and education duration independently predicted increased poststroke anxiety or depression risk in AIS patients.

Objective Assessment System for Hearing Prediction Based on Stimulus-Frequency Otoacoustic Emissions.

Stimulus-frequency otoacoustic emissions (SFOAEs) can be useful tools for assessing cochlear function noninvasively. However, there is a lack of reports describing their utility in predicting hearing capabilities. Data for model training were collected from 245 and 839 ears with normal hearing and sensorineural hearing loss, respectively. Based on SFOAEs, this study developed an objective assessment system consisting of three mutually independent modules, with the routine test module and the fast test module used for threshold prediction and the hearing screening module for identifying hearing loss. Results evaluated via cross-validation show that the routine test module and the fast test module predict hearing thresholds with similar performance from 0.5 to 8 kHz, with mean absolute errors of 7.06-11.61 dB for the routine module and of 7.40-12.60 dB for the fast module. However, the fast module involves less test time than is needed in the routine module. The hearing screening module identifies hearing status with a large area under the receiver operating characteristic curve (0.912-0.985), high accuracy (88.4-95.9%), and low false negative rate (2.9-7.0%) at 0.5-8 kHz. The three modules are further validated on unknown data, and the results are similar to those obtained through cross-validation, indicating these modules can be well generalized to new data. Both the routine module and fast module are potential tools for predicting hearing thresholds. However, their prediction performance in ears with hearing loss requires further improvement to facilitate their clinical utility. The hearing screening module shows promise as a clinical tool for identifying hearing loss.

Legacy and alternative plasticizers in surface sediment of black-odorous urban rivers across China: Occurrence, spatial distribution, and ecological risk assessment.

In this study, surface sediment samples from 173 black-odorous urban rivers in 74 cities of China were investigated regarding the occurrence, spatial distribution, and ecological risk of legacy phthalates (LPs) and alternative plasticizers (APs). The total concentrations of Σ7LPs and Σ6APs ranged from 0.0035 to 522 µg/g dw (median: 33 µg/g dw; mean: 60 µg/g dw) and from 0.0015 to 16 µg/g dw (median: 16 µg/g dw; mean: 2.2 µg/g dw), respectively. Di(2-ethylhexyl) phthalate (DEHP), di-n-butyl phthalate (DnBP), and di-iso-butyl phthalate (DiBP) were the dominant LPs, and di-iso-decyl phthalate and di-iso-nonylcyclohexane-1,2-dicarboxylate were the dominant APs. The concentrations and compositions of the LPs and APs varied among different sites and regions, implying location-specific use or production of LPs and APs. The pollutant concentrations in southern and central China were higher than those in northern China. Among the seven regions, Northwest China had the lowest concentrations of LPs and APs. This could be related to industry development level, municipal facilities, and population density. Total organic carbon (TOC) was significantly and positively correlated with the pollutant concentrations, implying that TOC could be an important influencing factor for the distribution of LPs and APs in sediments. The risk quotients of DiBP and DnBP in almost all sediment samples were above 1, indicating the high ecological risks to aquatic organisms. Nevertheless, DEHP, di-methyl phthalate, di-ethyl phthalate, and di-n-octyl phthalate showed low or moderate ecological risks for most sampling sites.

Effect of pharmaceutical care on the treatment of COVID-19: A protocol for systematic review and meta analysis.

BACKGROUND: We aimed to conduct a meta-analysis to assess the effect of pharmaceutical care on the treatment of coronavirus disease 2019 (COVID-19). METHODS: All case-controlled studies related to pharmaceutical care on the treatment of COVID-19 will be included in this review. We will use index words related to pharmaceutical care and COVID-19 to perform literature searches in PubMed, Embase, MEDLINE, CNKI, and Wanfang databases, to include articles indexed as of October 20, 2020 in English and Chinese language. Two reviewers will select trials independently for inclusion and assess trial quality. Two pairs of review authors will independently extract information for each included trials. Primary outcomes are clinical outcomes, average hospital stays, costs, patient satisfaction, and incidence of adverse drug reactions. We will evaluate the risk of bias of the included studies based on Cochrane assessment tool. Revman 5.3 (the Cochrane collaboration, Oxford, UK) will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis. RESULTS: We will provide targeted and practical results assessing the effect of pharmaceutical care on the treatment of COVID-19. CONCLUSION: The stronger evidence about the effect of pharmaceutical care on the treatment of COVID-19 will be provided for clinicians. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020214223 ETHICS AND DISSEMINATION:: There is no need for ethical approval, and the review will be reported in a peer-reviewed journal.

Low-Cost Efficient Magnetic Adsorbent for Phosphorus Removal from Water.

Adsorption using magnetic adsorbents makes the phosphorus removal from water simple and efficient. However, most of the reported magnetic adsorbents use chemically synthesized nanoparticles as magnetic cores, which are expensive and environmentally unfriendly. Replacing the nanomagnetic cores by cheap and green magnetic materials is essential for the wide application of this technique. In this paper, coal-fly-ash magnetic spheres (MSs) were processed to produce a cheap and eco-friendly magnetic core. A magnetic adsorbent, ZrO2 coated ball-milled MS (BMS@ZrO2), was prepared through a simple chemical precipitation method. Careful structural investigations indicate that a multipore structural amorphous ZrO2 layer has grown on the MS core. The specific surface area of BMS@ZrO2 is 48 times larger than that of the MS core. The highest phosphorus adsorption is tested as 16.47 mg g-1 at pH = 2. The BMS@ZrO2 adsorbent has a saturation magnetization as high as 33.56 emu g-1, enabling efficient magnetic separation. Zeta potential measurements and X-ray photoelectron spectroscopy analysis reveal that the phosphorus adsorption of BMS@ZrO2 is triggered by the electrostatic attraction and the ligand exchange mechanism. The BMS@ZrO2 adsorbent could be reused several times after proper chemical treatment.

Economic Evaluation of Hepatitis C Treatment Extension to Acute Infection and Early-Stage Fibrosis Among Patients Who Inject Drugs in Developing Countries: A Case of China.

We aimed to assess the cost-effectiveness of (1) treating acute hepatitis C virus (HCV) vs deferring treatment until the chronic phase and (2) treating all chronic patients vs only those with advanced fibrosis; among Chinese genotype 1b treatment-naïve patients who injected drugs (PWID), using a combination Daclatasvir (DCV) plus Asunaprevir (ASV) regimen and a Peg-interferon (PegIFN)-based regimen, respectively. A decision-analytical model including the risk of HCV reinfection simulated lifetime costs and quality-adjusted life-years (QALYs) of three treatment timings, under the DCV+ASV and PegIFN regimen, respectively: Treating acute infection ("Treat at acute"), treating chronic patients of all fibrosis stages ("Treat at F0 (no fibrosis)"), treating only advanced-stage fibrosis patients ("Treat at F3 (numerous septa without cirrhosis)"). Incremental cost-effectiveness ratios (ICERs) were used to compare scenarios. "Treat at acute" compared with "Treat at F0" was cost-saving (cost: DCV+ASV regimen-US$14,486.975 vs US$16,224.250; PegIFN-based regimen-US$19,734.794 vs US$22,101.584) and more effective (QALY: DCV+ASV regimen-14.573 vs 14.566; PegIFN-based regimen-14.148 vs 14.116). Compared with "Treat at F3"; "Treat at F0" exhibited an ICER of US$3780.20/QALY and US$15,145.98/QALY under the DCV+ASV regimen and PegIFN-based regimen; respectively. Treatment of acute HCV infection was highly cost-effective and cost-saving compared with deferring treatment to the chronic stage; for both DCV+ASV and PegIFN-based regimens. Early treatment for chronic patients with DCV+ASV regimen was highly cost-effective.

The Decade-Long Chinese Methadone Maintenance Therapy Yields Large Population and Economic Benefits for Drug Users in Reducing Harm, HIV and HCV Disease Burden.

Objectives: We aimed to conduct a comprehensive evaluation of the population impact of methadone maintenance treatment (MMT) for its future program planning. Methods: We conducted a literature review of the effects of MMT in China on HIV and HCV disease burden, injecting, and sexual behaviors and drug-related harm during 2004-2015. Data synthesis and analysis were conducted to obtain the pooled estimates of parameters for a mathematical model which was constructed to evaluate the effectiveness and cost-effectiveness of the program. Results: Based on a review of 134 articles, this study demonstrated that MMT is highly effective in reducing crime-related, high risk sexual, and injecting behaviors. The model estimated US$1,037 m which was invested in MMT from 2004 to 2015 has prevented 29,463 (15,325-43,600) new HIV infections, 130,563 (91,580-169,546) new HCV infections, 10,783 (10,380-11,187) deaths related to HIV, HCV and drug-related harm, and 338,920.0 (334,596.2-343,243.7) disability-adjusted life years (DALYs). The costs for each prevented HIV infection, HCV infection, death, and DALY were $35,206.8 (33,594.8-36,981.4), $7,944.7 ($7,714.4-8,189.2), $96,193.4 (92,726.0-99,930.2), and $3,060.6 ($3,022.0-3,100.1) respectively. Conclusion: The Chinese MMT program has been effective and cost-effective in reducing injecting, injecting-related risk behaviors and adversities due to HIV/HCV infection and drug-related harm among drug users.