Gaining Insight into Updated MR Imaging for Quantitative Assessment of Cartilage Injury in Knee Osteoarthritis.

PURPOSE OF THE REVIEW: Knee Osteoarthritis (KOA) entails progressive cartilage degradation, reviewed via MRI for morphology, biochemical composition, and microtissue alterations, discussing clinical advantages, limitations, and research applicability. RECENT FINDINGS: Compositional MRI, like T2/T2* mapping, T1rho mapping, gagCEST, dGEMRIC, sodium imaging, diffusion-weighted imaging, and diffusion-tensor imaging, provide insights into cartilage injury in KOA. These methods quantitatively measure collagen, glycosaminoglycans, and water content, revealing important information about biochemical compositional and microstructural alterations. Innovative techniques like hybrid multi-dimensional MRI and diffusion-relaxation correlation spectrum imaging show potential in depicting initial cartilage changes at a sub-voxel level. Integration of automated image analysis tools addressed limitations in manual cartilage segmentation, ensuring robust and reproducible assessments of KOA cartilage. Compositional MRI techniques reveal microstructural changes in cartilage. Multi-dimensional MR imaging assesses biochemical alterations in KOA-afflicted cartilage, aiding early degeneration identification. Integrating artificial intelligence enhances cartilage analysis, optimal diagnostic accuracy for early KOA detection and monitoring.

[Cost-effectiveness analysis of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in treatment of chronic rhinosinusitis].

This study aims to evaluate the effectiveness and economic efficiency of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of chronic rhinosinusitis(CRS). The randomized controlled trial(RCT) of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of CRS was searched against EMbase, PubMed, Cochrane Library, CNKI, VIP, SinoMed, and Wanfang. The efficacy, nasal mucociliary transport time, and safety of the therapy above in the treatment of CRS were analyzed with single-group rate and Meta-analysis, and the economy and sensitivity were evaluated from the perspective of payer. A total of 9 RCTs were included, including 1 145 patients. Meta-analysis showed that compared with Triamcinolone Acetonide Nasal Spray alone, Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of CRS patients increased the effective rate(RR=1.17, 95%CI[1.11, 1.24], P<0.000 01) and shortened the nasal mucociliary transport time(MD=-3.32, 95%CI[-5.86,-0.78], P=0.01), there was no significant difference in the incidence of adverse reactions between the two groups. The incremental cost-effectiveness analysis showed that the treatment costs of the control group and the observation group were 44.15 yuan and 1 044.96 yuan, respectively. In the Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray treatment group, 75.48 yuan was spent to improve the effective rate of CRS by 1%. The one-way sensitivity analysis indicated the days of treatment, the RR of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray, the price of unit preparation of Biyuan Tongqiao Granules, and the effective rate of Triamcinolone Acetonide Nasal Spray alone had great influence on the incremental cost-effectiveness ratio. In conclusion, Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray improves the therapeutic effect on CRS. The probabilistic sensitivity analysis showed that when the willingness to pay was greater than 7 920 yuan(less than 0.1 of GDP per capita 8 098 yuan), the combined therapy was economically superior to the control. Due to the limited number of articles published, it is necessary to carry out a real-world clinical trial of Biyuan Tongqiao Gra-nules and Triamcinolone Acetonide Nasal Spray in the treatment of CRS, so as to compare the cost-effectiveness of Biyuan Tongqiao Granules and Triamcinolone Acetonide Nasal Spray.

Income loss and subsequent poor psychological well-being among the Chinese population during the early COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has had major ramifications for health and the economy at both the individual and collective levels. This study examined exogenous negative changes in household income and their implications on psychological well-being (PWB) among the Chinese population during the COVID-19 pandemic. METHODS: Data were drawn from the early China COVID-19 Survey, a cross-sectional anonymous online survey administered to the general population in China. Self-reported PWB was measured using a 5-point Likert scale with five questions related to the participants' recent psychological state. Hierarchical multiple linear regression was employed to examine whether income loss during the COVID-19 pandemic was associated with poor psychological health. RESULTS: This study included 8,428 adults, of which 90% had suffered from a moderate or severe loss of household income due to the early COVID-19 pandemic. Those who had experienced moderate or severe loss of income scored significantly lower on psychological well-being than those who did not experience income loss (19.96 or 18.07 vs. 21.46; P < 0.001); after controlling for confounders, income loss was negatively associated with PWB scores (moderate income loss: B = - 0.603, P < 0.001; severe income loss: B = - 1.261, P < 0.001). An interaction effect existed between the degree of income loss and pre-pandemic income groups. Specifically, participants in the middle-income group who had suffered severe income loss scored the lowest on PWB (B = - 1.529, P < 0.001). There was also a main effect on income loss, such that participants with varying degrees of income loss differed across five dimensions, including anhedonia, sleep problems, irritability or anger, difficulty with concentration, and repeated disturbing dreams related to COVID-19. CONCLUSIONS: Income loss during the pandemic has had detrimental consequences on psychological well-being, and the magnitude of the impact of income loss on psychological well-being varied according to previous income levels. Future policy efforts should be directed toward improving the psychological well-being of the economically vulnerable and helping them recover from lost income in the shortest time possible.

Severity assessment to guide empiric antibiotic therapy for cholangitis in children after Kasai portoenterostomy: a multicenter prospective randomized control trial in China.

BACKGROUND: Cholangitis is common in patients with biliary atresia following Kasai portoenterostomy (KPE). The prompt use of empiric antibiotics is essential due to the lack of identified microorganisms. The authors aimed to validate a severity grading system to guide empiric antibiotic therapy in the management of post-KPE cholangitis. MATERIALS AND METHODS: This multicenter, prospective, randomized, open-label study recruited patients with post-KPE cholangitis and was conducted from January 2018 to December 2019. On admission, patients were categorized into mild, moderate, and severe cholangitis according to the severity grading system. Patients in the mild cholangitis group were randomized to receive cefoperazone sodium tazobactam sodium (CSTS) or meropenem (MEPM). Patients with severe cholangitis were randomized to treatment with MEPM or a combination of MEPM plus immunoglobulin (MEPM+IVIG). Patients with moderate cholangitis received MEPM. RESULTS: The primary endpoint was duration of fever (DOF). Secondary outcomes included blood culture, length of hospital stay, incidence of recurrent cholangitis, jaundice clearance rate, and native liver survival (NLS). For mild cholangitis, DOF, and length of hospital stay were similar between those treated with CSTS or MEPM (all P >0.05). In addition, no significant difference in recurrence rate, jaundice clearance rate, and NLS was observed between patients treated with CSTS and MEPM at 1-month, 3-month, and 6-month follow-up. In patients with moderate cholangitis, the DOF was 36.00 (interquartile range: 24.00-48.00) h. In severe cholangitis, compared with MEPM, MEPM+IVIG decreased DOF and improved liver function by reducing alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and direct bilirubin at 1-month follow-up. However, recurrence rate, jaundice clearance rate, and NLS did not differ significantly between MEPM+IVIG and MEPM at 1-month, 3-month, and 6-month follow-up. CONCLUSIONS: In patients with post-KPE cholangitis, MEPM is not superior to CSTS for the treatment of mild cholangitis. However, MEPM+IVIG treatment was associated with better short-term clinical outcomes in patients with severe cholangitis.

The incidence of herpes zoster in China: A meta-analysis and evidence quality assessment.

This review aimed to estimate the disease burden of herpes zoster (HZ) in China and explore the application of the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach in studies of disease burden. We searched for the literature of observational studies analyzing HZ incidence in populations of all ages in China. Meta-analysis models were constructed to calculate the pooled incidence of HZ and pooled risks of postherpetic neuralgia (PHN), HZ recurrence, and hospitalization. Subgroup analysis was performed according to gender, age, and quality assessment score. The quality of evidence for incidence was rated using the GRADE system. Twelve studies with a total of 25,928,408 participants were included in this review. The pooled incidence for all ages was 4.28/1000 person years (95% CI 1.22-7.35). It increased with the increasing in age especially for individuals aged ≥60 y, which was 11.69/1000 person years (95% CI 6.56-16.81). The pooled risks of PHN, recurrence, and hospitalization were 12.6% (95% CI 10.1-15.1), 9.7% (95% CI 3.2-16.2), and 6.0/100,000 population (95% CI 2.3-14.2), respectively. The quality of the evidence assessment of the pooled incidence by the GRADE for all ages was 'low'; however, it was 'moderate' for the ≥60 yold subgroup. HZ is a serious public health problem in China and is more significant in individuals older than 60 y. Therefore, an immunization strategy for the zoster vaccine should be considered. The evidence quality assessment by the GRADE approach indicated that we had more confidence in the estimation of aged population.

Simultaneous Determination and Exposure Assessment of Antioxidants in Food-Contact Plastic Materials by HPLC-MS/MS.

Antioxidants are widely used to prevent oxidative degradation of food-contact plastics materials. However, when plastic products come into contact with food, antioxidants may contaminate food. Herein, twenty-three kinds of possible antioxidants were monitored in 257 products of seven polymers. The migration of antioxidants into the food simulants at different temperatures and times was detected by using HPLC-MS/MS. Risk assessment was performed based on the EU, U.S. FDA methods and Monte Carlo simulation. The antioxidants migrated mainly to fatty food simulant, with the highest concentration and occurrence frequency of Irgafos 168, followed byIrganox 1010, Irganox 1076, and Antioxidant LTDP in polyethylene terephthalate, polyvinyl chloride, polypropylene, polyethylene. No antioxidants were detected in polystyrene, polycarbonate, and polyvinylidene chloride. Additionally, antioxidants exhibited the highest detection rate of 0.81 in polyethylene. Risk assessment demonstrated that the antioxidants have no obvious health risk to the exposed population. However, the risk of polypropylene was relatively high compared to other polymers.

Surfactant recovery and efficient separation of PAHs from surfactant solutions by low-cost waste activated sludge and two-stage design optimization.

The treatment and surfactant recovery of soil washing/flushing effluent containing high levels of surfactants and organic pollutants are critical for the surfactant-assisted remediation of soils and waste management due to their complexity and high-potential risks. Combination of waste activated sludge material (WASM) and a kinetic-based two-stage system design was introduced in this study as a novel strategy for the separation of phenanthrene and pyrene from Tween 80 solutions. The results showed that WASM can effectively sorb phenanthrene and pyrene with high affinities (Kd) of 2325.5 L·kg-1 and 9911.2 L·kg-1, respectively. This allowed a high-level recovery of Tween 80 of 90.47 ± 1.86%, with selectivity of up to 69.7. In addition, a two-stage design was constructed, and the results showed an improved reaction time (approximately 5% of equilibrium time in conventional single-stage process) and increased the separation levels of phenanthrene or pyrene from Tween 80 solutions. For instance, the minimal total operating time for the sorption of 99% pyrene from 1.0 g·L-1 Tween 80 was only 23.0 min in the two-stage process compared to that of 480 min with a 71.9% removal level in the single-stage system. Results indicated that the combination of low-cost waste WASH and two-stage design was a high-efficiency and time-saving way to recover surfactants from soil washing effluents.

Water quality assessment of east Tiaoxi River, China, based on a comprehensive water quality index model and Monte-Carlo simulation.

The comprehensive water quality index (CWQI) reflects the comprehensive pollution status of rivers through mathematical statistics of several water quality indicators. Using computational mathematical simulations, high-confidence CWQI predictions can be obtained based on limited water quality monitoring samples. At present, most of the CWQI reported in the literature are based on conventional indicators such as nitrogen and phosphorus levels, and do not include the petroleum hydrocarbons levels. This article takes a typical river in eastern China as an example, based on the 1-year monitoring at 20 sampling sets, a CWQI containing five factors, TN, NH4+-N, TP, ∑n-Alks, and ∑PAHs was established, and further predicted by a Monte-Carlo model. The predicted CWQI for each monitoring section is above 0.7, indicating that most of the monitoring sections are moderately polluted, and some sections are seriously polluted. The Spearman rank correlation coefficient analysis results show that TN, ∑PAHs, and ∑n-Alks are the main factors influencing the water quality, especially the petroleum hydrocarbons have a significant impact on the middle and lower reaches due to shipping. In the future, more attention should be paid to petroleum hydrocarbon organic pollutants in the water quality evaluation of similar rivers.

Power Batteries Health Monitoring: A Magnetic Imaging Method Based on Magnetoelectric Sensors.

With the popularity of electric vehicles, the ever-increasing demand for high-capacity batteries highlights the need for monitoring the health status of batteries. In this article, we proposed a magnetic imaging technique (MIT) to investigate the health status of power batteries nondestructively. This technique is based on a magnetic sensor array, which consists of a 16-channel high-performance magnetoelectric sensor, and the noise equivalent magnetic induction (NEB) of each channel reaches 3-5 pT/Hz1/2@10 Hz. The distribution of the magnetic field is imaged by scanning the magnetic field variation of different positions on the surface. Therefore, the areas of magnetic anomalies are identified by distinguishing different magnetic field abnormal results. and it may be possible to classify the battery failure, so as to put forward suggestions on the use of the battery. This magnetic imaging method expands the application field of this high-performance magnetoelectric sensor and contributes to the battery's safety monitoring. Meanwhile, it may also act as an important role in other nondestructive testing fields.

In Vitro Bioaccessibility and Health Risk Assessment of Arsenic and Zinc Contaminated Soil Stabilized by Ferrous Sulfate: Effect of Different Dietary Components.

Iron-based materials have good stability in reducing the mobility and toxicity of heavy metals, but the behavior and human health risks of heavy metals could be affected by dietary components. This study investigated the effect of typical diets (lettuce, cooked rice and apples) on the bioaccessibility and morphological changes of arsenic (As) and zinc (Zn) in contaminated site after stabilization by ferrous sulfate (FeSO4). The results showed that the bioaccessibility of As and Zn were increased in a co-digestion system of food. The augmented effect on As bioaccessibility mainly occurred in the gastric phase: apple > lettuce > cooked rice (p < 0.05), while the augmented effect on Zn bioaccessibility mainly occurred in the intestinal phase: lettuce > apple > cooked rice (p < 0.05). FeSO4 weakened the dissolution effect of dietary components on As bioaccessibility, and reduced As bioaccessibility in the gastric and intestinal phases by 34.0% and 37.9% (p < 0.05), respectively. Dietary components and Fe fractions influenced the speciation and distribution of As and Zn. FeSO4 reduced the hazard quotient (HQ) and carcinogenic risk (CR) values of the contaminated soil by 33.97% and 33.59%, respectively. This study provides a reference for a better understanding of more realistic strategies to modulate exposure risks of heavy metal-contaminated sites.

Development and assessment of the efficacy and safety of human lung-targeting liposomal methylprednisolone crosslinked with nanobody.

Glucocorticoid (GC) hormone has been commonly used to treat systemic inflammation and immune disorders. However, the side effects associated with long-term use of high-dose GC hormone limit its clinical application seriously. GC hormone that can specifically target the lung might decrease the effective dosage and thus reduce GC-associated side effects. In this study, we successfully prepared human lung-targeting liposomal methylprednisolone crosslinked with nanobody (MPS-NSSLs-SPANb). Our findings indicate that MPS-NSSLs-SPANb may reduce the effective therapeutic dosage of MPS, achieve better efficacy, and reduce GC-associated side effects. In addition, MPS-NSSLs-SPANb showed higher efficacy and lower toxicity than conventional MPS.

Two-dose varicella vaccine effectiveness in China: a meta-analysis and evidence quality assessment.

BACKGROUND: The objectives of this review were to evaluate the vaccine effectiveness (VE) of the two-dose varicella vaccine for healthy children in China and explore the application of the approach of Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) in observational studies on VE. METHODS: We searched for observational studies on two-dose varicella VE for children in China aged 1-12 years that were published from 1997 to 2019, and assessed the quality of each study using the Newcastle Ottawa Scale (NOS). We used meta-analysis models to obtain the pooled two-dose VE, and the studies were divided into subgroups and analysed according to whether or not it was an outbreak investigation and its NOS score. The quality of evidence of VEs were rated by approach of the GRADE system. RESULTS: A total of 12 studies and 87,196 individuals were included. The pooled two-dose VE was 90% (95% confidence interval [CI]: 69-97%). The VE of outbreak studies (87% [95% CI: 76-93%]) was lower than non-outbreak studies (99% [95% CI: 98-99%]). There was no significant difference in VEs by different NOS quality. The quality of the evidence assessment of pooled two-dose VE was "low", which was rated down by one category in limitations and publication bias respectively and rated up by two category in large effect. The quality of evidence assessment in subgroup of NOS score ≥ 7 was "moderate". CONCLUSIONS: The VE of two-dose varicella vaccine is relatively high in preventing varicella, and is recommended for countries which need further control for varicella. However, higher quality evidence is needed as a supplement for stronger recommendations. The approach of GRADE could be applied for rating the quality of evidence in observational study.

Assessment of multiple pathways involved in the inhibitory effect of HCG22 on oral squamous cell carcinoma progression.

LncRNAs have been proposed to be associated with the tumorigenesis and progression of oral squamous cell carcinoma (OSCC). LncRNA HLA complex group 22 (HCG22) was reported to be lowly expressed and associated with poor prognosis in head and neck squamous cell carcinoma (HNSCC). However, the biological role and related mechanism of HCG22 in OSCC have not been characterized. HCG22 expression in OSCC cells was detected by qRT-PCR. Cell proliferation, invasion, and apoptosis were evaluated by Bromodeoxyuridine (BrdU) proliferation assay, Transwell invasion assay, and flow cytometry analysis, respectively. The protein levels of proliferating cell nuclear antigen (PCNA), E-cadherin, Vimentin, Bcl-2, Bax, protein kinase B (Akt), phosphorylated Akt (p-Akt), mammalian target of rapamycin (mTOR), phosphorylated mTOR (p-mTOR), and ß-catenin were detected by western blot. Cell growth evaluation was performed using in vitro colony formation assay and in vivo tumor xenograft assay. We found that HCG22 was weakly expressed in OSCC cells. HCG22 overexpression inhibited cell proliferation and invasion and induced apoptosis in OSCC cells. The levels of PCNA, Vimentin, and Bcl-2 were decreased and E-cadherin and Bax expression was elevated in OSCC cells after HCG22 overexpression. Additionally, HCG22 overexpression inhibited the Akt, mTOR and Wnt/ß-catenin pathways. Activation of Akt, mTOR, and Wnt/ß-catenin pathways attenuated the anti-tumor property of HCG22 in OSCC cells. Furthermore, HCG22 overexpression inhibited the growth of OSCC cells in vitro and in vivo. In conclusion, HCG22 exerted anti-tumor property in OSCC by inhibiting the Akt, mTOR, and Wnt/ß-catenin pathways.

The effects of family physician-contracted service on health-related quality of life and equity in health in China.

BACKGROUND: Family physician-contracted service (FPCs) has been recently implemented in Chinese primary care settings. This study was aimed at measuring the effects of FPCs on residents' health-related quality of life (HRQoL) and equity in health among the Chinese population. METHODS: The study data was drawn from the 2018 household health survey (Shaanxi Province, China) using multistage, stratified cluster random sampling. We measured HRQoL using EQ-5D-3L based on the Chinese-specific time trade-off values set. Coarsened exact matching (CEM) technique was used to control for confounding factors between residents with and without a contracted family physician. The concentration index (C) was calculated to measure equity in health. RESULTS: Individuals with a contracted family physician had significantly higher HRQoL than those without, after data matching (0.9355 vs. 0.8995; P <  0.001). Additionally, the inequity in HRQoL among respondents with a contracted family physician was significantly lower than those without a contracted family physician (Cs of EQ-5D utility score: 0.0084 vs. 0.0263; p <  0.001). CONCLUSIONS: This study highlights the positive effects of FPCs on HRQoL and socioeconomic-related equity in HRQoL. Future efforts should prioritize the economically and educationally disadvantaged groups, the expansion of service coverage, and the competency of family physician teams to further enhance health outcome and equity in health.

Measuring spatial accessibility and within-province disparities in accessibility to county hospitals in Shaanxi Province of Western China based on web mapping navigation data.

BACKGROUND: The Chinese government proposed the "XIAO BING BU CHU CUN, DA BING BU CHU XIAN" initiative in 2016, which states the rate of health care service provided by county hospitals should reach 90% of overall health care service provision. The prerequisite for achieving this goal is that citizens should be able to access county hospitals' services conveniently and impartially. However, little research has been done on the actual levels of the spatial accessibility of citizens to county hospitals in Western China. Therefore, we aimed to measure the spatial accessibility to county hospitals for county residents and to identify any regional disparities in Shaanxi Province in Western China. METHODS: We implemented a novel method - involving utilizing navigation data from the AutoNavi web mapping system (knows as Gaode map in Chinese) - to assess the time and distance from villages and neighborhoods to the county hospitals. The navigation data were collected by request through an application-programming-interface using a web crawler (web data extraction tool) in Python. The shortest driving time and distance were extracted from the navigation data. The travel impedance to the nearest provider (TINP) indicator was used to measure spatial accessibility. RESULTS: The results show that county residents in Western China's Shaanxi Province have poor spatial accessibility to county hospitals. Only 68.8% of villages and neighborhoods are within 60 min travel time (based on driving mode) to a county hospital, while 13.4% of such villages and neighborhoods are beyond 90 min travel time. Moreover, a significant within-province disparity exists, with residents in the central area enjoying the best accessibility to county hospitals, while the northern and southern areas still need improvements in accessibility. CONCLUSIONS: Focused health resource planning is required to improve the spatial accessibility to county hospitals and to eliminate regional disparities. Further studies are called for to integrate the navigation data of web mapping systems with GIS methods to the measure spatial accessibility of health facilities in more complex contexts.

[Effects of retention density on growth, biomass, and economic benefit of Cunninghamia lanceolata plantation]. / 保留密度对杉木人工林生长和生物量及经济效益的影响.

We examined the effects of retention density on plant DBH (diameter at breast height), height, volume growth, stand biomass, and stand economic benefit of Cunninghamia lanceolata plantation by Pingxiang, Guangxi Province. Four treatments of different retention density were set up a 14-year middle-aged Cunninghamia lanceolata plantation, 500, 750 and 1000 trees·hm-2, with stand without thinning as the control (1500 trees·hm-2). Results showed that DBH (20.55 cm), increment in height (15.70 m), and large-diameter timber volume (18.31 m3·hm-2) of the C. lanceolata plantation were the highest in 500 trees·hm-2 treatment. The volume of living trees was the highest in the control (199.63 m3·hm-2), which was significantly higher than that in 500 and 750 trees·hm-2. The biomass of arbor layer and ecosystem, as well as the economic benefit differed significantly across the treatments, with arborous biomass (90.72 t·hm-2), ecosystem biomass (94.97 t·hm-2), and economic benefit (1.184×105 yuan·hm-2) of 1000 trees·hm-2 treatment being significantly higher than others. Reducing stand retention density increased the DBH, plant height, timber diameter, proportion of large diameter timber, average volume and biomass of single timber, but it did not enhance the volume of living trees. The retention density of 1000 trees·hm-2 was the optimum for middle-aged C. lanceolata plantation. Compared with the control, it significantly increased the total stand volume, arbor biomass, ecosystem biomass, and economic benefit by 2.3%, 5.7%, 4.7%, and 5.8%, respectively.

Feasibility Study of the Low-Cost Motion Tracking System for Assessing Endoscope Holding Skills.

BACKGROUND: The ability to hold an endoscope is an important skill for surgeons and assistants performing endoscopic neurosurgery. Motion tracking can provide an objective assessment for surgical skills and may aid in endoscopic neurosurgery. We developed a cost-effective system to study the feasibility of objectively distinguishing performance levels for operating an endoscope. METHODS: The study was divided into 2 parts. First, a video motion tracking analysis tool was built based on a printed mark and free software (Kinovea 0.8.15). Second, the tool was used to distinguish the holding endoscope performance of the robotic arm by experts (surgeon, n = 3) and novice users (residents, n = 6) under both 0' and 30' endoscopes. RESULTS: Through the printed mark and free software, we successfully built a system for video motion tracking. The data analysis showed that for both 0' and 30' endoscopes, the experts had a shorter total distance and depth, smaller average speed and maximum acceleration, and a fewer number of extreme accelerations than their novice counterparts. Compared with experts and residents, the fixed arm had better results. CONCLUSIONS: The simple low-cost video motion tracking system can provide an objective assessment of an endoscope holding skill, which allows for discrimination between an expert and a novice, and can be used by clinical neurosurgeons to select a qualified assistant.

Impact of a 2-dose voluntary vaccination strategy on varicella epidemiology in Beijing, 2011-2017.

BACKGROUND: One-dose voluntary varicella vaccination for children was introduced in Beijing since 1998. In Oct 2012, a second dose varicella vaccine (VarV) was recommended to further decrease varicella disease and the outbreaks. We describe the impact of the 2-dose voluntary vaccination strategy on varicella epidemiology in Beijing, China. METHODS: Varicella incidence rates and outbreak characteristics in 2011-2017 was examined using surveillance data. Varicella vaccination coverage among children born in 2007-2012 was estimated through Beijing children immunization registry system. Vaccine effectiveness (VE) for VarV2 was estimated by screening method. RESULTS: Overall varicella incidence decreased by 37.8% from 103.2 per 100,000 population in 2011 to 64.2 per 100,000 population in 2017. Incidence declines in children aged <15 years with most significantly decrease by 82.3% in children aged 5-9 years, while no significant change happened in adolescent and adults. A total of 251 outbreaks with 3239 outbreak-related cases were reported in 2011-2017, the number of outbreaks decreased significantly by 50.7% from 69 in 2011 to 34 in 2017. The VarV1 coverage ranged from 85.4% to 92.6% among children 4 year of age and the VarV2 coverage ranged from 40.1% to 72.9% among children 6 year of age in the 2007-2012 birth cohort. Overall VE estimates against all varicella disease was 94.4% (95% CI: 89.9-98.9%) for VarV2. CONCLUSIONS: Moderate VarV2 coverage has been achieved in Beijing resulting in remarkable declining of the incidence in children. Varicella outbreaks has not been eliminated suggested that measures such as including a 2-dose varicella vaccination in routine immunization program should be taken in the future.

Cost-effectiveness analysis of pembrolizumab plus chemotherapy with PD-L1 test for the first-line treatment of NSCLC.

BACKGROUND: Pembrolizumab (Pembro) in combination with chemotherapy has been approved for the treatment of pretreated advanced NSCLC in the United States and China for its significant efficacy. However, the cost-effectiveness is unknown considering Pembro's high price. The impact of programmed death ligand 1 (PD-L1) test on the cost-effectiveness is also unknown. The current study assessed the cost-effectiveness of combination therapy for nonsquamous NSCLC from the United States and China public payers' perspective. MATERIALS AND METHODS: A literature-based Markov model was conducted using KEYNOTE-189 trial data to compare cost and quality-adjusted life years (QALYs) of three treatment strategies for nonsquamous NSCLC: Pembro-chemotherapy combination and chemotherapy strategy without PD-L1 test, and treatment strategy according to their PD-L1 status. RESULTS: In base case analysis, the combination strategy generated an additional 0.78 QALYs and 0.59 QALYs over chemotherapy in the United States and China respectively, resulting in an ICER of $132 392/QALY in the United States and $92 533/QALY in China. In the PD-L1 ≥1% base case, the ICERs were $77 754/QALY and $56 768/QALY respectively in the United States and China for PD-L1 test strategy. In the PD-L1 ≥50% base case, the ICERs were $44 731/QALY and $34 388/QALY respectively in the United States and China for PD-L1 test strategy. Lowering Pembro price can also partly decrease the ICERs. CONCLUSION: Compared with chemotherapy, the combination strategy is not cost-effective for the treatment of NSCLC in the American and Chinese health care system at WTP threshold of $100 000/QALY for the United States and $27 351/QALY for China. Using PD-L1 test for patient selection and price reduction could improve the cost-effective probabilities of immunotherapy for nonsquamous NSCLC.

Optimal Starting Age and Baseline Level for Repeat Tests: Economic Concerns of PSA Screening for Chinese Men - 10-Year Experience of a Single Center.

OBJECTIVE: To investigate the optimal age for the baseline serum prostate-specific antigen (PSA) test and for repeat screening and its economic burden in a single center in China. MATERIALS AND METHODS: 35,533 men with PSA screening were retrospectively enrolled in this study. Follow-ups were conducted in 1,586 men with PSA >4 ng/mL, and receiver-operating characteristic (ROC) curves were employed to investigate the optimal cutoffs. RESULTS: ROC analysis indicated that the optimal age for initial PSA screening was 57.5 years (AUC = 0.84), 62.5 years (AUC = 0.902), 60.5 years (AUC = 0.909), and 61.5 years (AUC = 0.890) for individuals with PSA >4 and >10 ng/mL, a diagnosis of prostate cancer (PCa), and clinically significant PCa defined as the focus events, respectively. For Chinese men aged 50-59, 60-69, and >70 years, the initial PSA levels of 1.305 ng/mL (AUC = 0.699), 1.975 ng/mL (AUC = 0.711), and 2.740 ng/mL (AUC = 0.720) might have a PSA velocity >0.75 ng/mL per year during the follow-up. In addition, the total cost amounts to CNY 13,609,260 in these cases, but only 60 of the 35,533 (0.17%) men gained benefit from PSA screening. CONCLUSION: In our opinion, the optimal starting age for initial PSA testing was 57.5 years. The necessity for repeat screening should be based on the first PSA level depending on age. A cost--benefit analysis should be included in population-based screening.