Recommended 10-Year Follow-Up Strategy for Small Hepatocellular Carcinoma After Radiofrequency Ablation: A Cost-Effectiveness Evaluation.

INTRODUCTION: An optimal follow-up schedule for small (≤3-cm) hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) remains unclear in clinical guidelines. We aimed to assess the cost-effectiveness of follow-up strategies in patients with small HCC after RFA. METHODS: In total, 11,243 patients were collected from global institutions to calculate recurrence rates. Subsequently, a Markov model covering a 10-year period was developed to compare 25 surveillance strategies involving different surveillance techniques (computed tomography [CT], magnetic resonance imaging or ultrasonography [US], and α-fetoprotein [AFP]) and intervals (3 or 6 months). The study endpoint was incremental cost-effectiveness ratio (ICER), which represented additional cost per incremental quality-adjusted life year. Sensitivity analysis was conducted by varying the values of input parameters to observe the ICER. RESULTS: In a base case analysis, the dominant strategy was CT every 3 months during an initial 2 years, followed by semiannual CT, and then switch to biannual the combination of US screening and AFP testing after 5 years (m3_CT-m6_CT-m6_USAFP), with an ICER of $68,570.92 compared with the "not followed" strategy. One-way sensitivity analysis showed the ICER consistently remained below the willingness-to-pay threshold of $100,000.00. In a probabilistic sensitivity analysis, m3_CT-m6_CT-m6_USAFP was the most cost-effective approach in 95.6% of simulated scenarios at a willingness-to-pay threshold. DISCUSSION: For small HCC after RFA, the recommended follow-up strategy is CT, with scans scheduled every 3 months for the first 2 years, every 6 months thereafter, and transition to biannual the combination of US screening and AFP testing after 5 years.

Community-embedded follow-up management intervention for geriatric primary care: a mixed-methods study of an integrated health services model.

BACKGROUND: To propose a community-embedded follow-up management model to provide health services for elderly patients with osteoporosis who live alone. METHODS: Researchers randomly selected 396 people with osteoporosis living alone from five communities in Nantong, China, for the study. These participants were randomly assigned to control and intervention groups. Twenty-four community physicians in five communities provided professional support based on a community-embedded follow-up management model. Participants completed quantitative questionnaires at baseline and after the 6-month follow-up intervention, and some participants underwent semi-structured face-to-face interviews. The primary outcome is the effectiveness of the community-embedded follow-up management model in improving the quality of life of elderly patients with osteoporosis living alone. Based on an objective quantitative assessment, the qualitative study explains and adds essential components of this community-based follow-up management model. RESULTS: The quantitative study showed that scores in physical functioning, ability to perform daily activities, self-efficacy, and mental status were significantly improved in the intervention group compared to the control group (p < 0.05). The most significant improvements were found in "mental status" (p = 0.012) and "self-care skills" (p = 0.003). The qualitative study reported the essential elements of a community healthcare model for older people living alone with osteoporosis, including professional support, personalized services, social support, and empowerment. CONCLUSIONS: Community-embedded follow-up management meets the need for elderly patients with osteoporosis living alone. It helps to improve health perception, promote physical and mental health, and optimize the quality of life in this population. Personalized services and professional support are two major contributing factors to effective embedded follow-up management in the community.

Cost-effectiveness and prognostic model of hepatic arterial infusion chemotherapy for hepatocellular carcinoma with high tumor burden and/or Vp4 tumor thrombus compared with sorafenib: a post-hoc analysis of the FOHAIC-1 trial.

OBJECTIVES: The phase III FOHAIC-1 trial revealed that hepatic arterial infusion of chemotherapy (HAIC) improved overall survival compared to sorafenib in the high-risk hepatocellular carcinoma (HCC). This study therefore set out to evaluate the cost-effectiveness and establish a prognostic clinico-radiological score of HAIC. MATERIALS AND METHODS: A total of 409 patients with high-risk HCC who received HAIC between 2014 and 2020 were included. A Markov model was applied in the cost-effectiveness analysis using data from the FOHAIC-1 trial. In prognosis analysis, a clinico-radiological score was developed using a Cox-regression model and subsequently confirmed in the internal validation and test cohorts. The area under the curve from receiver operator characteristic analysis was used to assess the performance of the clinico-radiological score. RESULTS: HAIC resulted in an incremental cost-effectiveness ratio of $10190.41/quality-adjusted life years compared to sorafenib, which was lower than the willingness-to-pay threshold. Probabilistic sensitivity analysis predicted a ≥99.9% probability that the incremental cost-effectiveness ratio was below the willingness-to-pay. The Cox analysis identified five factors, namely extrahepatic metastasis (m), arterial enhancing type (a), tumor number (nu), albumin-bilirubin index (a), and involved lobe (l), which together comprise the clinico-radiological score (HAIC-manual). Patients were classified into three groups based on the number of factors present, with cutoffs at 2 and 4 factors. The stratified median overall survival for these groups were 21.6, 10.0, and 5.9 months, respectively ( P <0.001). These findings were verified through internal validation and test cohorts with a significance level of P ≤0.01. The time-dependent area under the curve from receiver operator characteristic for the ability of the HAIC-manual to predict survival in 1, 2, and 3 years were 0.71, 0.76, and 0.78, which significantly outperformed existing staging systems. CONCLUSION: HAIC is a promising and cost-effective strategy for patients with high-risk HCC. The clinico-radiological score may be a simple prognostic tool for predicting HAIC treatment.

Evaluation of the Effectiveness of Remote Monitoring to Establish a Community Health Intervention During COVID-19: A Community Intervention Trial.

Background: The widespread use of telemedicine systems and medical information networks has made telemedicine one of the current trends in health care. The purpose of this article is to propose a community health intervention with remote monitoring and teleconsultation during COVID-19 for the prevention and control of COVID-19 at the rural level. Methods: In this intervention study, a randomized group of 1,500 community residents was selected. A questionnaire with acceptable validity and reliability was used to collect data. The study was conducted with the test group itself as a control, and the questionnaire was completed again 6 months after the health intervention through remote monitoring. The extent of the effect of the remote monitoring intervention on community health during COVID-19 was measured. The data were entered into SPSS 26, and the data were analyzed using the K-S normality test, t-test, and chi-square test. Results: After 6 months of the intervention, the differences in mean scores of the test group were statistically significant (p < 0.05) in cognition, perceived benefits, self-efficacy, and behavioral outcomes, with a substantial increase in mean scores for all variables. Conclusions: The application of remote monitoring during COVID-19 in rural communities can influence the health perception, benefit perception, self-efficacy, and behavior of community residents, thus effectively preventing and controlling the spread of COVID-19 in rural communities. It reduces medical barriers for rural areas while meeting.

The Efficacy and Health Economics of Different Treatments for Type 1 Cesarean Scar Pregnancy.

Objectives: To evaluate the efficacy and health economics of four treatments for type 1 cesarean scar pregnancy (CSP). Methods: From January 2009 to December 2018, 326 patients diagnosed with type 1 CSP were examined, among whom 31 received ultrasound-guided local injection of methotrexate (local injection group), 160 patients received uterine artery embolization combined with suction aspiration (UAE group), 25 patients received ultrasound-guided suction aspiration (aspiration group) and 90 received ultrasound-guided local injection of lauromacrogol combined with suction aspiration (lauromacrogol group). Clinical data and outcomes were analyzed. The decision tree model was used to compare the economics of four treatments. Results: The success rate of the local injection group was 71.0% (22/31), which was significantly different from 98.8% (158/160) of the UAE group and 100.0% (90/90) of the lauromacrogol group. The success rate of the aspiration group was 92.0% (23/25), which was significantly lower than that of the lauromacrogol group. The cost-effectiveness ratio was 1,876.53 yuan for the aspiration group, 2,164.63 yuan for the lauromacrogol group, 4,383.56 yuan for the local injection group, and 7,850.81 yuan for the UAE group. The Incremental cost effectiveness ratio (ICER) of the lauromacrogol group to the aspiration group was 5,477.75 yuan, indicating that if the willing to pay of patients was higher than 5,477.75 yuan, the lauromacrogol group had a cost-effectiveness advantage in treating type 1 CSP, compared to aspiration group. On the contrary, aspiration group has a higher cost-effectiveness advantage. The ICER of the lauromacrogol group to the local injection group or the UAE group were both less than 0, indicating that local injection group and UAE group was not cost-effective in the treatment of type 1 CSP. Conclusion: For type 1 CSP, the ultrasound-guided local injection of lauromacrogol combined with suction aspiration and ultrasound-guided suction aspiration, are effective and economical, and the choice between the two can be based on the patient's willing to pay.

Advances in the use of microalgal-bacterial consortia for wastewater treatment: Community structures, interactions, economic resource reclamation, and study techniques.

The rise in living standards has generated a demand for higher aquatic environmental quality. The microalgal community and the surrounding organic molecules, environmental factors, and microorganisms, such as bacteria, are together defined as the phycosphere. The bacteria in the phycosphere can form consortia with microalgae through various forms of interaction. The study of the species in these consortia and their relative proportions is of great significance in determining the species and strains of stable algae that can be used in sewage treatment. This article summarizes the following topics: the interactions between microalgae and bacteria that are required to establish consortia; how symbiosis between algae and bacteria is established; microalgal competition with bacteria through inhibition and anti-inhibition strategies; the influence of environmental factors on microalgal-bacterial aggregates, such as illumination conditions, pH, dissolved oxygen, temperature, and nutrient levels; the application of algal-bacterial aggregates to enhance biomass production and nutrient reuse; and techniques for studying the community structure and interactions of algal-bacterial consortia, such as microscopy, flow cytometry, and omics. PRACTITIONER POINTS: Community structures in microalgal-bacterial consortia in wastewater treatment. Interactions between algae and bacteria in wastewater treatment. Effects of ecological factors on the algal-bacterial community in wastewater treatment. Economically recycling resources from algal-bacterial consortia based on wastewater. Technologies for studying microalgal-bacterial consortia in wastewater treatment.

From inequalities involving exponential functions and sums to logarithmically complete monotonicity of ratios of gamma functions.

In this paper, the authors review origins, motivations, and generalizations of a series of inequalities involving finitely many exponential functions and sums. They establish three new inequalities involving finitely many exponential functions and sums by finding convexity of a function related to the generating function of the Bernoulli numbers. They also survey the history, backgrounds, generalizations, logarithmically complete monotonicity, and applications of a series of ratios of finitely many gamma functions, present complete monotonicity of a linear combination of finitely many trigamma functions, construct a new ratio of finitely many gamma functions, derive monotonicity, logarithmic convexity, concavity, complete monotonicity, and the Bernstein function property of the newly constructed ratio of finitely many gamma functions. Finally, they suggest two linear combinations of finitely many trigamma functions and two ratios of finitely many gamma functions to be investigated.

Some inequalities involving the extended gamma function and the Kummer confluent hypergeometric k-function.

In the paper, the authors present some inequalities involving the extended gamma function and the Kummer confluent hypergeometric k-function via some classical inequalities such as Chebychev's inequality for synchronous (or asynchronous, respectively) mappings, give a new proof of the log-convexity of the extended gamma function by using the Hölder inequality, and introduce a Turán type mean inequality for the Kummer confluent k-hypergeometric function.

Some inequalities for generalized eigenvalues of perturbation problems on Hermitian matrices.

In the paper, the authors establish some inequalities for generalized eigenvalues of perturbation problems on Hermitian matrices and modify shortcomings of some known inequalities for generalized eigenvalues in the related literature.

Some limit properties for a hidden inhomogeneous Markov chain.

This paper presents a general strong limit theorem for delayed sum of functions of random variables for a hidden time inhomogeneous Markov chain (HTIMC), and as corollaries, some strong laws of large numbers for HTIMC are established thereby.

Early assessment of coagulation necrosis after hepatic microwave ablation: a comparison of non-enhanced and enhanced T1-weighted images.

PURPOSE: To compare the technical success and accuracy of hepatic microwave ablation (MWA) using non-enhanced and enhanced T1-weighted imaging early after ablation. Patients were evaluated with regard to the ablation zone and local tumor progression (LTP). METHODS: This retrospective study conducted between September 2014 and December 2015 which consisted of 56 patients with 56 hepatic malignant lesions who underwent percutaneous MWA. Non-enhanced and contrast-enhanced T1-weighted imagings were performed within 2 days after tumor ablation. The efficacy of ablation assessed according to the hyperintense middle zone on non-enhanced T1-weighted images and the non-enhanced area on contrast-enhanced T1-weighted images were compared. The development of LTP during ≥7 months of follow-up served as the end point. RESULTS: On the non-enhanced T1-weighted images, the ablated region had a characteristic two-zone structure featuring a hyperintense middle zone and a surrounding hypointense band. Among the 56 patients, LTP developed in ten including seven lesions, in which both the non-enhanced T1-weighted and portal-phase images showed incomplete tumor ablation. In two of the remaining three patients, incomplete tumor ablation was detected on the non-enhanced T1-weighted images, whereas the corresponding portal-phase images showed complete ablation. In the remaining patient, no residual tumor was detected on either the non-enhanced T1-weighted or the portal-phase images. In the 46 patients without LTP, there was no evidence of residual tumor on the non-enhanced T1-weighted or portal-phase images obtained early after ablation. CONCLUSIONS: Non-enhanced T1-weighted images are useful in assessing the therapeutic efficacy of MWA of liver tumors early after the procedure.

[Risk Assessment and Risk Management of Chemicals in China].

Risk assessment and risk management have been increasingly approved as an effective approach for appropriate disposal and scientific management of chemicals. This study systematically analyzed the risk assessment methods of chemicals from three aspects including health risk, ecological risk and regional risk. Based on the current situation of classification and management towards chemicals in China, a specific framework of risk management on chemicals was proposed by selecting target chemicals, predominant industries and related stakeholders as the objects. The results of the present study will provide scientific support for improving risk assessment and reasonable management of chemicals in China.

Follow-up assessment of two cases of trichloroethylene hypersensitivity syndrome: A case report.

The present study aimed to explore the stability, curability and sequelae of cases of Trichloroethylene (TCE) Hypersensitivity Syndrome (THS), and to investigate the causal allergens of THS. Two cases of THS were followed-up in the current study; both cases were healing following glucocorticoid therapy and were discharged >10 weeks prior to follow-up. A questionnaire investigation, health examination and patch test were performed. Allergens of TCE and its metabolites, including chloral hydrate, trichloroethanol (TCOH) and trichloroacetic acid, were applied in the patch test; 4 controls were included. The two subjects were experiencing itching, pigmentation and xerosis of the skin, and had abnormal results in the ophthalmology Schirmer I test and tear break-up time. The body temperature, liver function, superficial lymph nodes, blood, urine routine and autoimmune antibodies of two subjects were shown to be normal, and no new rashes had appeared. All mass concentration of chloral hydrate and TCOH were positive; 5.0% trichloroacetic acid was weakly positive, 0.5% trichloroacetic acid and all mass concentration of TCE were negative. All patch tests were negative in the 4 control subjects. The results suggest that THS was stable following treatment with glucocorticoid therapy. Dry eye syndrome may continue as a sequelae of THS. The patch test demonstrated that the mechanism underlying THS is delayed-type hypersensitivity induced by TCE. In addition, as the hypersensitivity state in a THS rehabilitee could be sustained over a long period of time, it suggests that the metabolites of TCE, not TCE itself, are responsible for THS. Therefore, patients with THS should avoid contact with TCE and its metabolites, and avoid using hypnotic and anticonvulsive drugs containing chloral hydra as the primary ingredient.

Assessment of drug-induced arrhythmic risk using limit cycle and autocorrelation analysis of human iPSC-cardiomyocyte contractility.

Cardiac safety assays incorporating label-free detection of human stem-cell derived cardiomyocyte contractility provide human relevance and medium throughput screening to assess compound-induced cardiotoxicity. In an effort to provide quantitative analysis of the large kinetic datasets resulting from these real-time studies, we applied bioinformatic approaches based on nonlinear dynamical system analysis, including limit cycle analysis and autocorrelation function, to systematically assess beat irregularity. The algorithms were integrated into a software program to seamlessly generate results for 96-well impedance-based data. Our approach was validated by analyzing dose- and time-dependent changes in beat patterns induced by known proarrhythmic compounds and screening a cardiotoxicity library to rank order compounds based on their proarrhythmic potential. We demonstrate a strong correlation for dose-dependent beat irregularity monitored by electrical impedance and quantified by autocorrelation analysis to traditional manual patch clamp potency values for hERG blockers. In addition, our platform identifies non-hERG blockers known to cause clinical arrhythmia. Our method provides a novel suite of medium-throughput quantitative tools for assessing compound effects on cardiac contractility and predicting compounds with potential proarrhythmia and may be applied to in vitro paradigms for pre-clinical cardiac safety evaluation.

Hermite-Hadamard type inequalities for n-times differentiable and geometrically quasi-convex functions.

By Hölder's integral inequality, the authors establish some Hermite-Hadamard type integral inequalities for n-times differentiable and geometrically quasi-convex functions.

On some Hermite-Hadamard type inequalities for (s, QC)-convex functions.

In the paper, the authors introduce a new notion "[Formula: see text]-convex function on the co-ordinates" and establish some Hermite-Hadamard type integral inequalities for [Formula: see text]-convex functions on the co-ordinates.

[Risk assessment and countermeasures of BTEX contamination in soils of typical pesticide factory].

Soil samples around three representative pesticide factories were collected in Zhangjiakou City, Hebei Province, and analyzed to identify their pollution characteristics and health risk of BTEX by purge-and trap and gas chromatography/mass spectroscopy method. Total concentrations of BTEX in soils in Plant A, B and C ranged from 673.50 to 32 363.50 ng x g(-1), nd to 6 461.80 ng x g(-1) and 461.70 to 8 740.80 ng x g(-1), respectively. Concentrations of detected toluene (4 619.50-7 234.30 ng x g(-1)) and ethylbenzene (364.60-7 944.60 ng x g(-1)) had exceeded the Canadian guidelines for industrial land (370 ng x g(-1) and 82 ng x g(-1)), and concentration of xylene (19 799.40 ng x g(-1)) in dust in production area of Plant A was larger than the Dutch soil intervention value (17 000 ng x g(-1)). While concentrationsn of BTEX around Plant A (Region I ) and Plant B and C (Region II) ranged from nd to 645.81 ng x g(-1), and nd to 309.13 ng x g(-1), respectively, which were below the Canadian guidelines for agricultural land. The non-carcinogenic risk of BTEX in Plant A (2.90E-06 -1.32E-04), B (nd -4.30E-05) and C (1.29E-06 -5.64E-05) were all below 1, which suggested that no obvious health risk existed in each plant. The non-carcinogenic risks in Region I (nd -2.02E-06) and Region II (nd -1.10E-06) were below than 1, and also lower than those in factories. High risk areas were mainly concentrated in the downwind, moreover, soils around villages and towns were also with higher risk. In conclusion, soils and dusts in each factory had been polluted and the quality of agricultural land had been partly deteriorated. Finally, environmental management and occupational protection countermeasures were proposed based on the research results.

[Risk assessment and countermeasures of heavy metals pollution in Wanquan segment of Yanghe River].

In order to investigate heavy metals contamination status in Wanquan segment of Yanghe River, Zhangjiakou, 9 water and sediments samples were collected respectively for analyzing Cu, Ni, Cd, Zn, Cr, Pb, Hg and As, with water quality indicators determined at the same time. The potential ecological risk index (PERI) was then employed to evaluate potential ecological risk of heavy metals in sediments. Results indicated that the concentrations of Cu, Ni, Cd, Zn, Cr, Pb, Hg and As in water samples ranged from 1.28-24.13, 1.13-16.84, 0.08-0.11, 1.80-10.65, 1.40-19.12, 0.13-2.05, 0.06-0.99, 0.46-4.22 microg x L(-1), respectively, which are all below the national water quality standard for the demands of industrial use and agricultural irrigation. Principal component analysis (PCA) was conducted to reveal the relationship between water quality indicators and heavy metals pollution in water samples. Concentrations of Cu, Ni, Cd, Zn, Cr, Pb, Hg and As in sediments ranged from 5.90-110.11, 17.34-56.04, 0.07-0.31, 38.71-116.74, 40.39-85.77, 18.65-22.74, nd-0.047, 0.85-9.98 mg x kg(-1), respectively. The descending order of potential ecological risk intensity caused by different heavy metals was: Cd > Cu > Hg > Ni > As > Pb > Cr > Zn, and the average value of each heavy metal was low, while middle-grade risk level of Cd and Hg were also found in several sites. Among all monitoring sites, the descending order of PERI of all target heavy metals was: YH-07 > YH-03 > YH-09 > YH-02 > YH-06 > YH-04 > YH-05 > YH-01, and the average value reached slight grade, while middle-grade risk level was detected in YH-07. Sampling locations in YH-02-YH-03 and YH-07-YH-09 were found with relatively high ecological risk level because of agricultural and anthropogenic activities, respectively. Finally, three risk management regions were figured out and corresponding countermeasures for improving the environmental quality of the watershed were proposed based on the research results.

[Study on the automatic parameters identification of water pipe network model].

Based on the problems analysis on development and application of water pipe network model, the model parameters automatic identification is regarded as a kernel bottleneck of model's application in water supply enterprise. The methodology of water pipe network model parameters automatic identification based on GIS and SCADA database is proposed. Then the kernel algorithm of model parameters automatic identification is studied, RSA (Regionalized Sensitivity Analysis) is used for automatic recognition of sensitive parameters, and MCS (Monte-Carlo Sampling) is used for automatic identification of parameters, the detail technical route based on RSA and MCS is presented. The module of water pipe network model parameters automatic identification is developed. At last, selected a typical water pipe network as a case, the case study on water pipe network model parameters automatic identification is conducted and the satisfied results are achieved.

[Atomic absorption fingerprint and identification studies of Da Huo Luo pill. I. Exploration of inorganic elements fingerprint for establishment of industrial standard].

The fingerprints for most of Chinese medicines based on their organic compositions have been well established. Nevertheless, there are very few known fingerprints which are based on inorganic elements. In order to identify the Da Huo Luo Dan and its efficiency from other Chinese medicines, the authors attempted to set up a fingerprint which could be determined by the measurement of inorganic elements in Da Huo Luo Dan and other Chinese medicines. In the present study, the authors first employed 28 batches of Da Huo Luo Dan produced by Zhang-Shu Pharmatheutical Company in Jiang Xi Province to screen 12 kinds of inorganic elements measured by atomic absorption spectrophotometer and established the atomic absorption fingerprints. Secondly, the authors tried to identify Da Huo Luo Dan and other Chinese medicines by using the similarly analysis of vectors and the statistical analysis of compositional data. The result showed that the methods the authors used here were predictable to tell the efficiency of Da Huo Luo Dan from others. The authors' study also proves that establishment of standard for quality control by analysis of inorganic elements in Chinese medicines is feasible. The present study provides a new idea and a new technique that serve for the establishment of industrial standards for analysis of inorganic elements fingerprint to explore the effects of Chinese medicines.