[Economic evaluation of Annao Pills combined with antihypertensive drugs in treatment of primary hypertension: a study based on decision tree model].

The purpose of this study was to evaluate the economics of Annao Pills combined with antihypertensive drugs in the treatment of primary hypertension in the Chinese medical setting. TreeAge pro 2018 was used for cost-effect analysis and sensitivity analysis of the two treatment regimens. The intervention time of the simulation model was 2 weeks. The cost parameters were derived from Yaozhi.com, and the effect parameters were based on Meta-analysis of randomized controlled trial(RCT) involving Annao Pills. The experimental group was treated with Annao Pills combined with anti-hypertensive drugs(nifedipine controlled-release tablets + losartan potassium tablets), and the control group was treated with anti-hypertensive drugs(nifedipine controlled-release tablets + losartan potassium tablets). The basic analysis showed that the incremental cost-effect ratio(ICER) of the two groups was 2 678.67 yuan, which was less than 7.26% of the per capita disposable income in 2022. That is, compared with anti-hypertensive drugs alone, Annao Pills combined with antihypertensive drugs cost 2 678.67 yuan more for each additional patient with primary hypertension. The results of sensitivity analysis verified the robustness of the basic analysis results. The probability sensitivity results showed that when the patient's personal willingness to pay the price was higher than 2 650 yuan, the probability of the regimen in the experimental group was higher, which was consistent with the results of the basic analysis. In conclusion, when the price was higher than 2 650 yuan, Annao Pills combined with anti-hypertensive drugs was more economical than anti-hypertensive drugs alone in terms of improving the response rate of the patients with primary hypertension.

Integrated assessment of PD-L1 expression and molecular classification facilitates therapy selection and prognosis prediction in gastric cancer.

PURPOSE: Targeting the PD-1/PD-L1 pathway has emerged as a novel therapy for cancer. To identify rational candidates for anti-PD-1/PD-L1 immunotherapy in gastric cancer (GC), the abundance of PD-L1 expression was evaluated on a kind of biomarker-based molecular classification for shaping prognosis and treatment planning. METHODS: One hundred and sixty-five GCs were classified into five subgroups using immunohistochemistry (IHC) and in situ hybridization (ISH) methods, based on a panel of seven markers (MLH1, PMS2, MSH2, MSH6, E-cadherin, P53, and Epstein-Barr virus mRNA). The expression of PD-L1 in GC tissues was analyzed immunohistochemically. RESULTS: The five categories (Epstein-Barr virus positivity, microsatellite instability, aberrant E-cadherin, aberrant P53 expression, and normal P53 expression) correspond to the reported molecular subgroups for similar proportions and clinicopathologic characteristics. Survival analysis indicated that subgroups with aberrant E-cadherin expression independently predicted a worse prognosis in GC patients (HR=2.51, P=0.010). The clinical and prognostic profiles produced by this stratification in nonintestinal-type GC were distinguishable from those in intestinal-type. Although PD-L1 was not a significant prognostic factor, that more frequent presence of PD-L1-positive in microsatellite instability tumors than other subtypes (P<0.010) hinted at a prolonged clinical course. Moreover, the lowest level of PD-L1 but the highest of Her2 was observed in the group of aberrant P53, namely it was suggested that there was a negative correlation between PD-L1 and Her2 overexpression. CONCLUSION: Different molecular subtypes in GC may have a tendency to react differently to anti-PD-L1/PD-1 immunotherapy or anti-Her2 therapy. A combination of PD-L1 expression and this cost-effective classification strategy would be helpful for predicting prognosis and promoting personalized therapy in clinical practice.

[Distribution and Risk Assessment of Polycyclic Aromatic Hydrocarbons and Their Derivatives in Wastewater-Receiving Rivers in Beijing].

To analyze the pollution levels and health risk assessment of Polycyclic Aromatic Hydrocarbons (PAHs) and their derivatives (SPAHs) in five typical effluents from sewage treatment plants and receiving rivers in Beijing, the concentrations of PAHs and SPAHs in samples were measured by the combined method of solid extraction and gas chromatography-mass spectrometry. The distribution characteristics were also analyzed. At the same time, the probabilistic health risk was assessed using toxic equivalent factors. The results show that the contamination of PAHs and SPAHs in five typical effluents from sewage treatment plants and receiving rivers in Beijing is 75-584 ng·L-1 and 91-1822 ng·L-1, respectively. These PAHs are dominated by 2-and 3-ring PAHs, which account for 23%-48% of the total PAHs. The SPAHs in this study include three substances:methyl polycyclic aromatic hydrocarbons (MPAHs), oxygenated polycyclic aromatic hydrocarbons (OPAHs), and chlorinated polycyclic aromatic hydrocarbons (ClPAHs). The proportion of OPAHs in total SPAHs is 75%, while the total proportion of MPAHs and ClPAHs is overall low (12% and 13%, respectively). Calculations of the toxicity equivalents of PAHs in five rivers indicate that attention should be paid to high-PAHs pollution during the heating season (December).

Occurrence of parent and substituted polycyclic aromatic hydrocarbons in typical wastewater treatment plants and effluent receiving rivers of Beijing, and risk assessment.

Sixteen polycyclic aromatic hydrocarbons (PAHs) and some typical substituted polycyclic aromatic hydrocarbons (SPAHs) were investigated in wastewater treatment plants (WWTPs) and effluent effluent-receiving rivers in order to indentify the elimination of these compounds in WWTPs, as well as the potantial potential risk in the effluent-receiving rivers. The concentrations of ΣPAHs in the total phase (combined dissolved and adsorbed phases) in influent were between 944.1 and 1246.5 ng·L-1, and ΣSPAHs, including methyl PAHs (MPAHs) and oxygenated PAHs (OPAHs), between 684.9 and 844.9 ng·L-1. Regarding the SPAHs, the concentrations of ΣOPAHs (312.3 ng·L-1) were higher than those of ΣMPAHs (271.8 ng·L-1). The total removal efficiencies of PAHs in the biological treatment processes were between 59% and 68%, and those of SPAHs were a little lower (58-65%). The removal efficiency in the adsorbed phase was higher than in the dissolved phase. The concentrations of PAHs and SPAHs in the effluent were a little higher than in the receiving river. According to a PAH risk assessment of the effluent, 7 carcinogenic PAHs accounted for a relatively high proportion. Benzo[a]pyrene (BaP) and Dibenz[a,h]anthracene (DBA) were major contributors to the TEQs in the effluent of WWTPs, which should be taken into consideration.

Distribution, possible sources, and health risk assessment of SVOC pollution in small streams in Pearl River Delta, China.

The pollution levels of typical semivolatile organic compounds (SVOCs) consisting of 15 polycyclic aromatic hydrocarbons (PAHs), 20 organic chlorinated pesticides (OCPs), and 15 phthalate esters (PAEs) were investigated in small rivers running through the flourishing cities in Pearl River Delta region, China. The concentrations of ∑15PAHs were 2.0-48 ng/L and 29-1.2 × 10(3) ng/g in the water and sediment samples, respectively. The ∑20OCPs were 6.6-57 ng/L and 9.3-6.0 × 10(2) ng/g in the water and sediment samples, respectively. The concentrations of ∑15PAEs were much higher both in the water and sediments. The partition process of the detected SVOCs between the water and sediment did not reach the equilibrium state at most of the sites when sampling. The combustion of petroleum products and coal was the major source of the detected PAHs. The OCPs were mainly historical residue, whereas the new inputs of dichlorodiphenyltrichloroethane (DDT), chlordane, and endosulfan were possible at several sites. The industrial and domestic sewage were the major source for the PAEs; storm water runoff accelerated the input of PAEs. No chronic risk of the SVOCs was identified by a health risk assessment through daily water consumption, except for the ∑20OCPs that might cause cancer at several sites. Nevertheless, the integrated health risk of the SVOCs should not be neglected and need intensive investigations.

Safety assessment of the source water within the Pearl River Delta on the aspect of organochlorine pesticides contamination.

The safety of source water is a noticeable problem in the Pearl River Delta, one of the densely populated areas in China. In this study, 20 individual organochlorine pesticides (OCPs) were investigated in 15 water sources within this area using gas chromatography-electron capture detector, and the hazard risks to human health were assessed in terms of individual OCPs based on daily water consumption according to the standard recommended by the United States Environmental Protection Agency. Results showed that the total OCP concentrations ranged from 2.42 ng l(-1) to 39.52 ng l(-1) during the years 2008 and 2009. The hazard ratios based on both non-cancer and cancer benchmarks were less than 1 for all the water samples, which indicated that individual OCPs posed no risk to human health. However, the risks caused by the combined toxicity of total OCPs in this area should not be ignored.