Prognosis of patients with advanced bile tract carcinoma: assessment using the modified-Gustave Roussy Immune Score (mGRIm-s) as a clinico-immunological tool.

BACKGROUND: The emergence of immune checkpoint inhibitors (ICIs) has enhanced survival outcomes for certain patients with advanced biliary tract carcinoma (BTC). Pinpointing those who would benefit most from immunotherapy remains elusive. We investigated the predictive value of the modified Gustave Roussy Immune Score (mGRIm-s) in BTC patients treated with ICIs. METHODS: Data from 110 patients at Chinese People's Liberation Army General Hospital, spanning September 2015 to April 2021, were analyzed. The median follow-up duration was 38.7 months as of December 2023. Risk factors included low albumin, high lactate dehydrogenase, and an elevated neutrophil-lymphocyte ratio. Patients were stratified into low (patients with no risk factors) and high (patients with at least one risk factor) mGRIm-s groups based on these factors. RESULTS: Survival outcomes post-immunotherapy favored the low mGRIm-s group, with significantly improved progression-free survival (PFS) and overall survival (OS) (8.50 months vs. 3.70 months and 21.60 months vs. 8.00 months). COX regression confirmed an elevated risk in the high mGRIm-s group. Subgroup analysis highlighted a notable survival advantage for low mGRIm-s patients receiving first-line immunotherapy. CONCLUSIONS: This study underscores mGRIm-s's potential in predicting immunotherapy response in BTC, paving the way for more targeted approaches.

A Hydrogel Electrolyte toward a Flexible Zinc-Ion Battery and Multifunctional Health Monitoring Electronics.

The compact design of an environmentally adaptive battery and effectors forms the foundation for wearable electronics capable of time-resolved, long-term signal monitoring. Herein, we present a one-body strategy that utilizes a hydrogel as the ionic conductive medium for both flexible aqueous zinc-ion batteries and wearable strain sensors. The poly(vinyl alcohol) hydrogel network incorporates nano-SiO2 and cellulose nanofibers (referred to as PSC) in an ethylene glycol/water mixed solvent, balancing the mechanical properties (tensile strength of 6 MPa) and ionic diffusivity at -20 °C (2 orders of magnitude higher than 2 M ZnCl2 electrolyte). Meanwhile, cathode lattice breathing during the solvated Zn2+ intercalation and dendritic Zn protrusion at the anode interface are mitigated. Besides the robust cyclability of the Zn∥PSC∥V2O5 prototype within a wide temperature range (from -20 to 80 °C), this microdevice seamlessly integrates a zinc-ion battery with a strain sensor, enabling precise monitoring of the muscle response during dynamic body movement. By employing transmission-mode operando XRD, the self-powered sensor accurately documents the real-time phasic evolution of the layered cathode and synchronized strain change induced by Zn deposition, which presents a feasible solution of health monitoring by the miniaturized electronics.

Quantitative assessment of early kidney injury using high frame rate contrast-enhanced ultrasonography in a rabbit model of diabetic nephropathy.

AIM: To explore benefits of high-frame-rate contrast-enhanced ultrasonography (H-CEUS) for early kidney injury in a rabbit model of diabetic nephropathy (DN). METHODS: Diabetic rabbits were induced with alloxan administration and split into 2 groups with or without urinary microalbuminuria after a fatty and sugary diet: diabetic rabbits with nephropathy (Group A) and diabetic rabbits without nephropathy (Group B). The control group (Group C) comprised healthy rabbits. Renal H-CEUS and conventional CEUS (C-CEUS) imaging were conducted. Serum creatinine (SCR), blood urea nitrogen (BUN) and urinary microalbuminuria were measured. RESULTS: SCR and BUN levels were barely changed in Groups B and C (p>0.05), whereas Group A exhibited a rise (p<0.05). Perfusion parameters of the two CEUS modalities showed reduced peak intensity (PI) and ascending slope (AS) and elevated area under the curve (AUC) and time to peak (TTP) in Group A versus Group B (p<0.05) and Group B versus Group C (p<0.05). The arrival time (AT) and descending slope (DS) exhibited little difference among the three groups. H-CEUS had a stronger correlation of perfusion parameters with SCR and BUN than C-CEUS. CONCLUSIONS:  H-CEUS outperforms C-CEUS in diagnosing early renal damage in DN. H-CEUS perfusion parameters demonstrate temporal superiority over routine laboratory indices.

Using a novel strategy to investigate the spatially autocorrelated and clustered associations between short-term exposure to PM2.5 and mortality and the attributable burden: A case study in the Sichuan Basin, China.

Due to the lack of statistical methods, few studies have investigated the spatial autocorrelated distribution in the association between short-term exposure to PM2.5 and mortality and used a statistical manner to explore the association-clustered regions, which play important roles in identifying high-sensitivity/susceptibility regions. The Sichuan Basin (SCB) is one of the most PM2.5-polluted areas, and the extreme economic imbalance may cause considerable spatial heterogeneity and clustering in PM2.5-mortality association. In this work, we used a recently proposed strategy by us to investigate the spatially autocorrelated and clustered association between daily PM2.5 and cardiorespiratory mortality from 2015 to 2019 in 130 counties of the SCB. First, generalized additive models were independently constructed to obtain the county-level association estimations. Then, an estimation-error-based spatial scan statistic was used to detect the association-clustered regions. Third, multivariate conditional meta autoregression was used to obtain the spatially autocorrelated association distribution, based on which the attributable deaths were mapped and their inequality was evaluated using the Gini coefficient and Lorenz curve. Results showed that two significantly association-clustered regions were detected. One is mainly located in the megacity Chengdu where PM2.5 presented a significantly stronger association with no threshold effect at low-level PM2.5 but a threshold at high-level PM2.5. In the other cluster, a threshold effect at low-level PM2.5 but no threshold at high-level PM2.5 were found. The mortality risk at low/middle-level PM2.5 decreased from Chengdu as the center to the surrounding areas. A total of 29,129 (2.0 %) deaths were attributable to the excess PM2.5 exposure. The attributable deaths also decreased from Chengdu as the center to the surrounding areas with Gini coefficients of 0.43 and 0.3 for absolute and relative attributable deaths, respectively. This novel strategy provided a new epidemiological perspective regarding the association and implicated that Chengdu is significantly deserving of more attention regarding PM2.5-related health loss.

Effect of sedated colonoscopy with different cost coverage on improving compliance with colorectal cancer screening in China.

Background: Colorectal cancer is the third most common cancer worldwide. Colonoscopy is the gold standard for colorectal cancer screening. However, the colonoscopy participation rate in China is much lower than that in Europe and the United States. As only non-sedated colonoscopies are offered in colorectal cancer screening programs in China, the absence of sedation may contribute to this gap. Methods: To explore the effect of free and partially participant-paid sedated colonoscopy on improving colorectal screening participation, we conducted a cross-sectional study under the framework of the Cancer Screening Program in Urban China in Xuzhou from May 2017 to December 2020. The Quanshan district was set as the control group and provided free non-sedated colonoscopy, the Yunlong district was set as a partial cost coverage group and offered partially participant-paid sedated colonoscopy, and the Gulou district was set as the full cost coverage group and offered free sedation colonoscopies. Multivariate logistic regression was used for multivariate analysis of colonoscopy participation and colorectal lesion detection rates between the groups. Results: From May 2017 to May 2020, 81,358 participants were recruited and completed questionnaire, 7,868 subjects who met high-risk conditions for CRC were invited to undergo colonoscopy. The colonoscopy participation rates in the control group, partially cost coverage, and full cost coverage groups were 17.33% (594/3,428), 25.66% (542/2,112), and 34.41% (801/2,328), respectively. Subjects in the partial and full cost coverage groups had 1.66-fold (95% CI: 1.48-1.86) and 2.49-fold (95% CI: 2.23-2.76) increased rates compared with those in the control group. The adjusted PARs for the partially and the full cost coverage group was 9.08 (95% CI: 6.88-11.28) and 18.97 (95% CI: 16.51-21.42), respectively. The detection rates of CAN in the control, partial-cost coverage, and full-cost coverage groups were 3.54% (21/594), 2.95% (16/542), and 5.12% (41/801), respectively. There were no significant differences in the detection rates between the group. However, sedated colonoscopy increases costs. Conclusion: Sedated colonoscopy increased colonoscopy participation rates in both the partial and full cost-covered groups. A partial cost coverage strategy may be a good way to increase colorectal cancer participation rates and quickly establish a colorectal cancer screening strategy in underfunded areas.

Exploration of an alternative reconstructed individual patient data-based approach for budget impact analysis of anticancer drugs.

BACKGROUND: The duration of treatment (DOT) of the initial intervention and subsequent treatment is the key to determining the accuracy of anticancer-drug budget impact analysis (BIA) calculations. However, existing studies only use simple assumptions as a proxy for DOT, resulting in a high degree of bias. OBJECTIVES: To enhance the accuracy and reliability of anticancer-drug BIA and solve the problem regarding DOT, we propose an alternative individual patient data (IPD)-based approach that reconstructs IPD from the published Kaplan Meier survival curves to estimate DOT. METHODS: We developed a four-step methodological framework for this new approach, taking the use of pembrolizumab in treating microsatellite-instability-high (MSI-H) advanced colorectal cancer as an example: (1) reconstructing the IPD; (2) calculating the total DOT of the initial intervention and subsequent treatment for each patient; (3) assigning a randomized time and DOT; and (4) multiple replacement sampling and calculation of the mean value. RESULTS: Using this approach, the average DOT for the initial intervention and subsequent treatment in each year of the BIA time horizon can be calculated and used to calculate the resources consumed and costs in each year. In our example, the average DOT for the initial intervention with pembrolizumab from the first to the fourth year was 4.90, 6.60, 5.24, and 5.06 months, respectively, while the average DOT for subsequent treatment was 0.75, 2.84, 2.99, and 2.50 months, respectively. CONCLUSIONS: The reconstructed IPD-based approach can improve the accuracy and reliability of anticancer-drug BIA compared with conventional methods, and can be widely used, especially for anticancer drugs with excellent efficacy.

The cost-effectiveness analysis of serplulimab versus regorafenib for treating previously treated unresectable or metastatic microsatellite instability-high or deficient mismatch repair colorectal cancer in China.

Objective: The aim of this study was to investigate the cost-effectiveness of serplulimab versus regorafenib in previously treated unresectable or metastatic microsatellite instability-high (MSI-H)/deficient mismatch repair (dMMR) colorectal cancer in China. Methods: From the perspective of China's health-care system, a Markov model with three health states (progression free, progression, death) was developed for estimating the costs and health outcomes of serplulimab and regorafenib. Data for unanchored matching-adjusted indirect comparison (MAIC), standard parametric survival analysis, the mixed cure model, and transition probabilities calculation were obtained from clinical trials (ASTRUM-010 and CONCUR). Health-care resource utilization and costs were derived from government-published data and expert interviews. Utilities used to calculate quality-adjusted life years (QALYs) were obtained from clinical trials and literature reviews. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost/QALY gained. Four scenarios were considered in scenario analysis: (a) using original survival data without conducting MAIC; (b) limiting the time horizon to the follow-up time of the clinical trial of serplulimab; (c) adopting a fourfold increase in the risk of death; and (d) applying utilities from two other sources. One-way sensitivity analysis and probabilistic sensitivity analysis were also performed to assess the uncertainty of the results. Results: In the base-case analysis, serplulimab provided 6.00 QALYs at a cost of $68,722, whereas regorafenib provided 0.69 QALYs at a cost of $40,106. Compared with that for treatment with regorafenib, the ICER for treatment with serplulimab was $5,386/QALY, which was significantly lower than the triple GDP per capita of China in 2021 ($30,036), which was the threshold used to define the cost-effectiveness. In the scenario analysis, the ICERs were $6,369/QALY, $20,613/QALY, $6,037/QALY, $4,783/QALY, and $6,167/QALY, respectively. In the probabilistic sensitivity analysis, the probability of serplulimab being cost-effective was 100% at the threshold of $30,036/QALY. Conclusion: Compared with regorafenib, serplulimab is a cost-effective treatment for patients with previously treated unresectable or metastatic MSI-H/dMMR colorectal cancer in China.

Cost-Effectiveness of Recombinant Zoster Vaccine for Adults Aged ≥50 Years in China.

INTRODUCTION: Adjuvanted recombinant zoster vaccine (RZV) was the first vaccine made available for herpes zoster in China. Authors aimed to evaluate its economic and health impacts on Chinese adults aged ≥50 years. METHODS: A lifetime Markov model was developed to compare the cost-effectiveness of RZV with that of no vaccination from a societal perspective. Model inputs were derived from published literature and analyzed in 2022. Outcomes included total costs, quality-adjusted life-years, incremental cost-effectiveness ratio, and number of herpes zoster and herpes zoster-related cases. Sensitivity analyses were performed to examine the robustness of the model results. RESULTS: RZV was more costly than no vaccination by $2.78 billion with an additional 65,008 quality-adjusted life-years gained and could avoid 1,893,530 herpes zoster cases, 295,761 postherpetic neuralgia cases, 51,734 other complications, and 229 herpes zoster-related deaths. Incremental cost-effectiveness ratios of RZV varied in a range of $34,465.5-$51,002.7 per quality-adjusted life-year. RZV for the entire cohort would be cost-effective when discount rate was <2.4%, a waning rate of 2-dose RZV efficacy decreased to <0.8%, the utility of postherpetic neuralgia was <0.496, duration of postherpetic neuralgia was >12.86 months, or the cost of RZV per dose decreased to <$229.6. In a probabilistic sensitivity analysis, the probability of RZV being cost-effective was 43.95%, 59.32%, 45.27%, and 39.50% for people aged 50-59, 60-69, 70-79, and ≥80 years, respectively, with threefold gross domestic product per capita (37,654.5 per quality-adjusted life-year) as the willingness-to-pay threshold. CONCLUSIONS: RZV was most likely to be cost-effective in people aged 60-69 years. A slight decrease in vaccine cost would result in RZV being cost-effective in all people aged ≥50 years.

Cost-Effectiveness and Health Impacts of Different Influenza Vaccination Strategies for Children in China.

INTRODUCTION: Authors aimed to evaluate the economic and health impacts of three influenza vaccines available in China, including trivalent inactivated vaccine, quadrivalent inactivated vaccine, and live attenuated influenza vaccine, for children aged six months to 18 years. METHODS: Two decision-analytic models were developed to simulate four vaccination strategies. Outcomes included total costs from a societal perspective in 2021, quality-adjusted life-year loss, numbers of outpatient and inpatient cases, and deaths avoided using each strategy. Deterministic and probabilistic sensitivity analyses were performed to examine the uncertainty of model inputs. RESULTS: For children aged six months to three years, trivalent inactivated vaccine saved $48 million and avoided a loss of 17,637 quality-adjusted life-years compared with no vaccination. For children aged 3-18 years, quadrivalent inactivated vaccine was cost-effective compared with trivalent inactivated vaccine, with an incremental cost-effectiveness ratio of $32,948.5/quality-adjusted life-year (willingness-to-pay threshold=$37,653/quality-adjusted life-year), which was sensitive to the RR of vaccine effectiveness of quadrivalent inactivated vaccine versus of trivalent inactivated vaccine. When compared with quadrivalent inactivated vaccine, live attenuated influenza vaccine was $1.28 billion more costly but gained an additional 13,560 quality-adjusted life-years; its incremental cost-effectiveness ratio was $123,983.8/quality-adjusted life-year. Live attenuated influenza vaccine would be cost-effective if its vaccine effectiveness was >0.79. Probabilistic sensitivity analysis revealed that quadrivalent inactivated vaccine, trivalent inactivated vaccine, live attenuated influenza vaccine, and no vaccination were cost-effective in 55.94%, 33.09%, 10.97%, and 0% of 10,000 Monte Carlo simulations. CONCLUSIONS: Trivalent inactivated vaccine was cost-effective compared with no vaccination in children aged six months to 18 years. Of the three vaccination strategies for children aged 3-18 months, quadrivalent inactivated vaccine appears to be the most cost-effective.

A Video-Based Augmented Reality System for Human-in-the-Loop Muscle Strength Assessment of Juvenile Dermatomyositis.

As the most common idiopathic inflammatory myopathy in children, juvenile dermatomyositis (JDM) is characterized by skin rashes and muscle weakness. The childhood myositis assessment scale (CMAS) is commonly used to measure the degree of muscle involvement for diagnosis or rehabilitation monitoring. On the one hand, human diagnosis is not scalable and may be subject to personal bias. On the other hand, automatic action quality assessment (AQA) algorithms cannot guarantee 100% accuracy, making them not suitable for biomedical applications. As a solution, we propose a video-based augmented reality system for human-in-the-loop muscle strength assessment of children with JDM. We first propose an AQA algorithm for muscle strength assessment of JDM using contrastive regression trained by a JDM dataset. Our core insight is to visualize the AQA results as a virtual character facilitated by a 3D animation dataset, so that users can compare the real-world patient and the virtual character to understand and verify the AQA results. To allow effective comparisons, we propose a video-based augmented reality system. Given a feed, we adapt computer vision algorithms for scene understanding, evaluate the optimal way of augmenting the virtual character into the scene, and highlight important parts for effective human verification. The experimental results confirm the effectiveness of our AQA algorithm, and the results of the user study demonstrate that humans can more accurately and quickly assess the muscle strength of children using our system.

Development and Validation of a New Comprehensive Assessment Scale of HIV-Related Psychological Distress in China: A Methodological Study.

ABSTRACT: Instruments evaluating HIV-related psychological distress (HRPD) in people living with HIV may lack sensitivity to capture patients' psychological burden. We developed a comprehensive scale measuring HRPD and evaluated its psychometric properties. A mixed-method study was conducted from July 2021 to April 2022; it involved a literature review, semistructured interviews ( n = 15), three rounds of panel discussions, two rounds of Delphi studies ( n = 20), a pilot test ( n = 20) to generate new scale items, and a cross-sectional survey ( n = 659) to evaluate the psychometric properties of the HIV-related psychological distress scale. The scale contains 22 items across 4 subscales (i.e., disease-related distress, treatment adherence distress, identity distress, and disclosure distress). The confirmatory factor analysis revealed high goodness of fit (χ 2 /df = 2.412, comparative fit index = 0.916, incremental fit index = 0.917, and Tucker‒Lewis index = 0.902), showing that the HIV-related psychological distress scale is a reliable (Cronbach's α = 0.871 overall) and valid scale for evaluating HRPD in China and can be used to dynamically evaluate and monitor HRPD levels during patient follow-up.

Low-Cost Hydroxyacid Potassium Synergists as an Efficient In Situ Defect Passivator for High Performance Tin-Oxide-Based Perovskite Solar Cells.

Perovskite solar cells (PSCs) based on SnO2 electron transport layers have attracted extensive research due to their compelling photovoltaic performance. Herein, we presented an in situ passivation of SnO2 with low-cost hydroxyacid potassium synergist during deposition to optimize the interface carrier extraction and transport for high power conversion efficiency (PCE) and stabilities of PSCs. The orbital overlap of the carboxyl oxygen with the Sn atom alongwith the homogenous nano-particle deposition effectively suppresses the interfacial defects and releases the internal residual strains in the perovskite. Accordingly, a PCE of 24.91 % with a fill factor (FF) up to 0.852 is obtained for in situ passivated devices, which is one of the highest values for SnO2 -based PSCs. Moreover, the unencapsulated device maintained 80 % of its initial PCE at 80 °C over 600 h, 100 % PCE at ambient conditions for 1300 h, and 98 % after one week maximum power point tracking (MPPT) under continuous AM1.5G illumination.

Microplastic occurrence and ecological risk assessment in the eight outlets of the Pearl River Estuary, a new insight into the riverine microplastic input to the northern South China Sea.

Estuaries are unique transition zones connecting terrestrial and coastal environments and are recognized as primary conveyors for land-derived plastics to open oceans. Riverine microplastics (MPs) have been commonly investigated using sequential sampling which might not effectively reflect the actual load. In this study, sampling at eight outlets was performed during a complete tidal cycle to estimate the MP flux to the Pearl River Estuarine (PRE) using a concurrent sampling strategy. The MP abundances ranged from 2.90 ± 0.57-5.9 ± 2.27 particles/L. A remarkable difference between tides in MP abundances suggests tidal effect should not be overlooked in assessment. The MP load through the eight outlets was estimated at 304 trillion particles or 1102 tons into the PRE annually. Additionally, similar potential ecological risk assessment among eight rivers implied that environmental threats posed by less urbanized and populated rural areas on the western side have been under-evaluating for decades.

Accuracy of Preoperative Contrast-enhanced Cone Beam Breast CT in Assessment of Residual Tumor after Neoadjuvant Chemotherapy: A Comparative Study with Breast MRI.

RATIONALE AND OBJECTIVES: To compare the accuracy of preoperative contrast-enhanced cone beam breast CT (CE-CBBCT) and MRI in assessment of residual tumor after neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS: Residual tumor assessments in 91 female patients were performed on preoperative CE-CBBCT and MRI images after NAC. The agreements of tumor size between imaging and pathology were tested by Intraclass Correlation Coefficient (ICC). Subgroup analyses were set according to ductal carcinoma in situ (DCIS), calcifications and molecular subtypes. Correlated-samples Wilcoxon Signed-rank test was used to analyze the difference between imaging and pathology in total and subgroups. AUC, sensitivity, specificity, PPV, and NPV were calculated to compare the performance of CE-CBBCT and MRI in predicting pathological complete response (pCR). RESULTS: Comparing with pathology, the agreement on CE-CBBCT was good (ICC = 0.64, 95% CI, 0.35-0.78), whereas on MRI was moderate (ICC = 0.59, 95% CI, 0.36-0.77), and overestimation on CE-CBBCT was less than that on MRI (median (interquartile range, IQR): 0.24 [0.00, 1.31] cm vs. 0.67 [0.00, 1.81] cm; p = 0.000). In subgroup analysis, CE-CBBCT showed superior accuracy than MRI when residual DCIS (p = 0.000) and calcifications (p = 0.000) contained, as well as luminal A (p = 0.043) and luminal B (p = 0.009) breast cancer. CE-CBBCT and MRI performed comparable in predicting pCR, AUCs were 0.749 and 0.733 respectively (p > 0.05). CONCLUSION: CE-CBBCT showed superior accuracy in assessment of residual tumor compared with MRI, especially when residual DCIS or calcifications contained and luminal subtype. The performance of preoperative CE-CBBCT in predicting pCR was comparable to MRI. CE-CBBCT could be an alternative method used for preoperative assessment after NAC.

Assessment of Laryngeal Sensory Function using a Tactile Aesthesiometer in Healthy Adults.

INTRODUCTION: Laryngeal sensory function in healthy adults was assessed through the delivery of tactile stimuli using Cheung-Bearelly monofilaments. METHODS: 37 healthy adults were recruited with 340 tactile stimuli analyzed. Four calibrated tactile stimuli were delivered to three laryngeal sites: false vocal fold (FVF), aryepiglottic fold (AEF), and lateral pyriform sinus (LPS). Primary outcome was the elicitation of laryngeal adductor reflex (LAR). Secondary outcomes were gag, patient-reported laryngeal sensation (PRLS), and perceptual strength. Analysis was performed with mixed effects logistic regression modeling. RESULTS: Positive LAR was observed in 35.7%, 70.2%, and 91.2% of stimuli at LPS, AEF, and FVF respectively. LAR rates were significantly associated with laryngopharyngeal subsite (p < 0.001), tactile force (p = 0.001), age (p = 0.022) and sex (p = 0.022). LAR, gag, PRLS, and perceptual strength significantly increased as a more medial laryngeal subsite was stimulated and as stimulus force increased. Each of the ten years of age increase was associated with 19% reduction in odds of LAR (aOR = 0.81, 95% CI [0.68, 0.97]; p = 0.022). Male gender was associated with a 55% reduction in odds of LAR (aOR = 0.45, 95% CI [0.23, 0.89]; p = 0.022). CONCLUSION: LAR elicitation capability decreases in the male gender, aging, and a more lateral subsite. This study provides insight into the pathophysiology of hypo- and hyper-sensitive laryngeal disorders and is paramount to making accurate diagnostic assessments and finding novel treatment options for various laryngological disorders. Laryngoscope, 133:2525-2532, 2023.

Drug repurposing strategy II: from approved drugs to agri-fungicide leads.

Epidemic diseases of crops caused by fungi deeply affected the course of human history and processed a major restriction on social and economic development. However, with the enormous misuse of existing antimicrobial drugs, an increasing number of fungi have developed serious resistance to them, making the diseases caused by pathogenic fungi even more challenging to control. Drug repurposing is an attractive alternative, it requires less time and investment in the drug development process than traditional R&D strategies. In this work, we screened 600 existing commercially available drugs, some of which had previously unknown activity against pathogenic fungi. From the primary screen at a fixed concentration of 100 µg/mL, 120, 162, 167, 85, 102, and 82 drugs were found to be effective against Rhizoctonia solani, Sclerotinia sclerotiorum, Botrytis cinerea, Phytophthora capsici, Fusarium graminearum and Fusarium oxysporum, respectively. They were divided into nine groups lead compounds, including quinoline alkaloids, benzimidazoles/carbamate esters, azoles, isothiazoles, pyrimidines, pyridines, piperidines/piperazines, ionic liquids and miscellaneous group, and simple structure-activity relationship analysis was carried out. Comparison with fungicides to identify the most promising drugs or lead structures for the development of new antifungal agents in agriculture.

Socio-demographic characteristics and inequality in exposure to PM2.5: A case study in the Sichuan basin, China.

The Chengyu Metropolitan Area (CYMA), located in the Sichuan Basin, is an unevenly developed region with high PM2.5 concentrations and a population of approximately 100 million. Although exposure inequality in air pollution has received increasing concern, no related research has been carried out in the CYMA to date. In this work, we used the concentration index to assess inequality of PM2.5 population-weighted exposure in the CYMA among different subgroups, including age, education, gender, occupation and GDP per capita in the city of residence. Our findings revealed that the non-disadvantaged subgroups (people aged 15-64, people with senior and higher education, people with high-income occupations and residents of cities with high GDP per capita) had a higher PM2.5 exposure in the CYMA, with the concentration indices of -0.03 (95% CI: 0.064, -0.001), -0.14 (95% CI: 0.221, -0.059), -0.15 (95% CI: 0.238, -0.056) and -0.27 (95% CI: 0.556, 0.012), opposite to previous studies in developed countries such as the United States and France. In addition, exposure differences among cities were much larger than those among populations in the CYMA. These findings may benefit the government in identifying disproportionately exposed subgroups in developing regions, and suggest that related measures should initially be carried out for cities exposed to high PM2.5 concentrations rather than for populations exposed to high PM2.5 concentrations.

COVID-19 distributes socially in China: A Bayesian spatial analysis.

PURPOSE: The ongoing coronavirus disease 2019 (COVID-19) epidemic increasingly threatens the public health security worldwide. We aimed to identify high-risk areas of COVID-19 and understand how socioeconomic factors are associated with the spatial distribution of COVID-19 in China, which may help other countries control the epidemic. METHODS: We analyzed the data of COVID-19 cases from 30 provinces in mainland China (outside of Hubei) from 16 January 2020 to 31 March 2020, considering the data of demographic, economic, health, and transportation factors. Global autocorrelation analysis and Bayesian spatial models were used to present the spatial pattern of COVID-19 and explore the relationship between COVID-19 risk and various factors. RESULTS: Global Moran's I statistics of COVID-19 incidences was 0.31 (P<0.05). The areas with a high risk of COVID-19 were mainly located in the provinces around Hubei and the provinces with a high level of economic development. The relative risk of two socioeconomic factors, the per capita consumption expenditure of households and the proportion of the migrating population from Hubei, were 1.887 [95% confidence interval (CI): 1.469~2.399] and 1.099 (95% CI: 1.053~1.148), respectively. The two factors explained up to 78.2% out of 99.7% of structured spatial variations. CONCLUSION: Our results suggested that COVID-19 risk was positively associated with the level of economic development and population movements. Blocking population movement and reducing local exposures are effective in preventing the local transmission of COVID-19.

Reclaiming independence in spatial-clustering datasets: A series of data-driven spatial weights matrices.

Most spatial models include a spatial weights matrix (W) derived from the first law of geography to adjust the spatial dependence to fulfill the independence assumption. In various fields such as epidemiological and environmental studies, the spatial dependence often shows clustering (or geographic discontinuity) due to natural or social factors. In such cases, adjustment using the first-law-of-geography-based W might be inappropriate and leads to inaccuracy estimations and loss of statistical power. In this work, we propose a series of data-driven Ws (DDWs) built following the spatial pattern identified by the scan statistic, which can be easily carried out using existing tools such as SaTScan software. The DDWs take both the clustering (or discontinuous) and the intuitive first-law-of-geographic-based spatial dependence into consideration. Aiming at two common purposes in epidemiology studies (ie, estimating the effect value of explanatory variable X and estimating the risk of each spatial unit in disease mapping), the common spatial autoregressive models and the Leroux-prior-based conditional autoregressive (CAR) models were selected to evaluate performance of DDWs, respectively. Both simulation and case studies show that our DDWs achieve considerably better performance than the classic W in datasets with clustering (or discontinuous) spatial dependence. Furthermore, the latest published density-based spatial clustering models, aiming at dealing with such clustering (or discontinuity) spatial dependence in disease mapping, were also compared as references. The DDWs, incorporated into the CAR models, still show considerable advantage, especially in the datasets for common diseases.

The Lifetime Cost Estimation of Human Papillomavirus-related Diseases in China: A Modeling Study.

OBJECTIVES: To estimate the lifetime treatment costs of patients with human papillomavirus (HPV) infection-related diseases in China and to provide cost estimates for the economic evaluation of HPV intervention strategies. METHODS: We extracted real-world hospital data from 2012 to 2019 and screened for subjects who met the criteria of clinical diagnosis of HPV-related diseases to obtain country-specific inputs into a Markov decision model. The model simulated lifetime treatment costs for HPV from the perspective of a national payer. A 5% discount rate was applied. Costs were converted and inflated to 2020 US dollars (USD). RESULTS: Using 2021 as the base year, the lifetime costs per patient for carcinoma in situ, local metastasis, and distant metastasis cervical cancer are $24,208 (95%CI: 18,793-30,897), $19,562 (95%CI: 14,456-25,567), and $17,599 (95%CI: 10,604-25,807), respectively. For carcinoma in situ, local metastasis, and distant metastasis vaginal cancer, the lifetime costs are $17,593 (95%CI: 14,962-23,596), $17,120 (95%CI: 13,215-22,417), and $22,411 (95%CI: 12,172-22,249), respectively. The base-case lifetime cost per patient for different stages of vulvar cancer/penile cancer/anal cancer/oral cancer/oropharyngeal cancer/laryngeal cancer falls within $17,120-$58,236. CONCLUSIONS: Using real-world data, we calculated lifetime treatment costs of HPV-related cancer in China and found that the lifetime cost for patients exceeded $17,000 for various stages of disease. The national burden of HPV-related disease could be significantly reduced by eliminating HPV infection.