China's air quality improvement strategy may already be having a positive effect: evidence based on health risk assessment.

Aiming to investigate the health risk impact of PM2.5 pollution on a heavily populated province of China. The exposure response function was used to assess the health risk of PM2.5 pollution. Results shows that the total number of premature deaths and diseases related to PM2.5 pollution in Shandong might reach 159.8 thousand people based on the new WHO (2021) standards. The health effects of PM2.5 pollution were more severe in men than in women. Five of the 16 cities in Shandong had higher health risks caused by PM2.5 pollution, including LinYi, HeZe, JiNing, JiNan, and WeiFang. PM2.5 pollution resulted in nearly 7.4 billions dollars in healthy economic cost, which accounted for 0.57% of GDP in Shandong in 2021. HeZe, LiaoCheng, ZaoZhuang, and LinYi were the cities where the health economic loss was more than 1% of the local GDP, accounted for 1.30, 1.26, 1.08, and 1.04%. Although the more rigorous assessment criteria, the baseline concentration was lowered by 30 µg/m3 compared to our previous study, there was no significant increase in health risks and economic losses. China's air quality improvement strategy may already be having a positive effect.

Low-Cost Distributed Optical Waveguide Shape Sensor Based on WTDM Applied in Bionics.

Bionic robotics, driven by advancements in artificial intelligence, new materials, and manufacturing technologies, is attracting significant attention from research and industry communities seeking breakthroughs. One of the key technologies for achieving a breakthrough in robotics is flexible sensors. This paper presents a novel approach based on wavelength and time division multiplexing (WTDM) for distributed optical waveguide shape sensing. Structurally designed optical waveguides based on color filter blocks validate the proposed approach through a cost-effective experimental setup. During data collection, it combines optical waveguide transmission loss and the way of controlling the color and intensity of the light source and detecting color and intensity variations for modeling. An artificial neural network is employed to model and demodulate a data-driven optical waveguide shape sensor. As a result, the correlation coefficient between the predicted and real bending angles reaches 0.9134 within 100 s. To show the parsing performance of the model more intuitively, a confidence accuracy curve is introduced to describe the accuracy of the data-driven model at last.

Assessment of Fish Diversity in the Ma'an Archipelago Special Protected Area Using Environmental DNA.

This study aimed to investigate the practical validity of the environmental DNA (eDNA) method for evaluating fish composition and diversity in different habitats. We evaluated the fish composition and diversity characteristics of seven different habitats in the Ma'an Archipelago Special Protected Area in April 2020. The results showed that a total of twenty-seven species of fishes belonging to six orders, eighteen families, and twenty-three genera of the Actinopterygii were detected in the marine waters of the Ma'an Archipelago Special Protected Area. The dominant species in each habitat were Larimichthys crocea, Paralichthys olivaceus, and Lateolabrax maculatus. The mussel culture area had the highest number of species, with 19 fish species, while the offshore bulk load shedding platform had the lowest number of species, with 12 fish species. The rest of the habitat was not significantly different. The results showed that the mussel culture area had the highest diversity index (average value of 2.352 ± 0.161), and the offshore bulk load shedding platform had the lowest diversity index (average value of 1.865 ± 0.127); the rest of the habitat diversity indices did not differ significantly. A comparison with historical surveys showed that the eDNA technique can detect species not collected by traditional methods such as gillnets and trawls. Our study demonstrates the role of eDNA technology in obtaining fish diversity in different habitats and provides a theoretical basis for the continuous monitoring and management of fish biodiversity in protected areas.

Magnetic-Property Assessment on Dy-Nd-Fe-B Permanent Magnet by Thermodynamic Calculation and Micromagnetic Simulation.

Heavy rare-earth (HRE) elements are important for the preparation of high-coercivity permanent magnets. A further understanding of the thermodynamic properties of HRE phases, and the magnetization reversal mechanism of magnets are still critical issues to obtain magnets that can achieve better performance. In this work, the Nd−Dy−Fe−B multicomponent system is investigated via the calculation of the phase diagram (CALPHAD) method and micromagnetic simulation. The phase composition of magnets with various ratios of Nd and Dy is assessed using critically optimized thermodynamic data. γ-Fe and Nd2Fe17 phases are suppressed when partial Nd is substituted with Dy (<9.3%), which, in turn, renders the formation of Nd2Fe14B phase favorable. The influence of the magnetic properties of grain boundaries (GBs) on magnetization reversal is detected by the micromagnetic simulations with the 3D polyhedral grains model. Coercivity was enhanced with both 3 nm nonmagnetic and the hard-magnetic GBs for the pinning effect besides the GBs. Moreover, the nucleation and propagation of reversed domains in core-shell grains are investigated, which suggests that the magnetic structure of grains can also influence the magnetization reversal of magnets. This study provides a theoretical route for a high-efficiency application of the Dy element, realizing a deterministic enhancement of the coercivity in Nd−Fe−B-based magnets.

Cost-effectiveness analysis of vonoprazan versus proton pump inhibitors in the treatment of reflux esophagitis in China.

Background: Proton pump inhibitors (PPIs) have been recommended as standard of care for reflux esophagitis (RE). Vonoprazan (VPZ), a novel potassium-competitive acid blocker (P-CAB), has been approved in China after demonstrating clinical benefit in RE. However, there are not any published literature reported the cost-effectiveness of VPZ compared with PPI in Chinese healthcare setting. Thus, this study aimed to estimate the cost-effectiveness of VPZ compared with PPIs for the treatment of RE patients in China and take advantage of this result to inform healthcare decision-making. Methods: A Markov model was developed to predict the effectiveness and costs of VPZ for 4 weeks and PPI group for 8 weeks in RE treatment over a 5-year time horizon from a healthcare system perspective. Four health states within healing and maintenance phases were defined in the model: mucosa healed, mucosa unhealed, relapse, and death. Transition probabilities including healing rate and relapse rate were derived from a single-arm meta-analysis and mortality were obtained from Chinese life table. Drug costs and other medical expenses were retrieved from China tendering prices and local clinical expert estimation. Utility parameters were derived from published literature. Both health outcomes and costs were discounted at a rate of 5% annually. Quality-adjusted life years (QALYs), direct medical costs and incremental cost-effectiveness ratios were evaluated. Uncertainty was assessed by one-way and probabilistic sensitivity analysis (PSA). Results: The healing rate for VPZ and PPI were 90% (95% CI: 82-97%) and 74% (95% CI: 71-76%) at week 4 respectively and were 94% (95% CI: 88-99%) and 87% (95% CI: 85-88%) at week 8 respectively. Treatment with VPZ resulted in 4.35 QALYs at a total cost of USD 1,354 over 5 years. Compared with the PPI group, treating RE with VPZ was associated with 0.02 QALYs gained and a cost saving of USD 943. Thus, VPZ should be considered as the dominant treatment option. The model results were deemed robust in sensitivity analyses. Conclusions: VPZ generates incremental QALYs at a lower cost compared with PPI, thus could be considered as an optional choice in the treatment of patients with RE.

Promoting and inhibiting: Corporate charitable donations and innovation investment under different motivation orientations--Evidence from Chinese listed companies.

Corporate charitable donations under different motivations will have different effects on innovation investment through different action paths, which provides a new perspective to solve the inconsistency of existing research results. Based on the resource-dependent and principal-agent theories, this paper compares and discusses the relationship between charitable donations and innovation investment under different motivations. Using 2008 ~2019 relevant data of listed companies as research samples, a mixed regression model is established for the hypothesis test, and further examines the state-ownership of its moderating role. The results show that the altruistic motivation-oriented corporate donations have a significant inverted u-shaped effect on innovation investment. The tool motivation-oriented corporate donations have a significant U-shaped effect on innovation investment. Moreover, it is further found that for ST (Special Treatment) corporates with the risk of delisting in the tool motivation-oriented charitable donations type, the corporate charitable donations have a significant negative effect on innovation investment. State-ownership can enhance the inverted U-shaped relationship between altruistic motivation-oriented corporate donations and innovation investment but weaken the U-shaped relationship between tool motivation-oriented corporate donations and innovation investment.

The Temporal and Spatial Changes of Health Inequality in Rural China.

This article estimates the temporal and spatial changes of health inequality in rural China from 2010 to 2018. Based on a panel database of 29,616 rural residents, the Health Utility Index (HUI) and a spatial econometric model are used for analysis. The results show that, on the temporal dimension, the health inequality of rural China first expands and then deflates. On the spatial dimension, the health inequality gradually deflates from eastern to western China. Furthermore, from 2010 to 2018, the high and low-value areas constantly changed among different provinces. After decomposing the causes of health inequality, it is found that behind the health inequality is the difference of socioeconomic-related status. Moreover, narrowing the difference in socioeconomic-related status is the key to improving health inequality.

Experimental investigations on the dissipation process of supersaturated total dissolved gas: Focus on the adsorption effect of solid walls.

Hydropower, which utilizes energy from fast-moving water, can help alleviate the energy crisis and promote economic development. For safety and ecological purposes, dams must discharge periodically. This discharge process, which occurs with the supersaturation of total dissolved gas (TDG), affects the fish and other aquatic organisms living in downstream river areas. Previous studies have shown that the supersaturated TDG dissipation process is closely related to hydraulic properties such as the flow rate, water depth and turbulent kinetic energy. Additionally, the presence of solid walls such as vegetation leaves in water can adsorb dissolved gases in water, thereby promoting the supersaturated TDG dissipation process, and the adsorption effect is closely related to the solid wall material. However, systematic studies on how solid walls in water can quickly absorb dissolved gases from water and rapidly reduce the TDG saturation of water are lacking. Herein, a series of experiments was conducted to study the dissipation process of supersaturated TDG under the action of solid walls in water and to reveal the adsorption effect of solid wall surface properties on dissolved gas. The results showed that the surface roughness and hydrophobicity (contact angle) are the key factors related to the adsorption effect of solid walls on the TDG in water. Generally, the dissipation rate of supersaturated TDG first increased and then decreased with increasing surface roughness. The supersaturated TDG dissipation rate increased monotonically with increasing contact angle. Based on the experimental data, the adsorption coefficient, which represents the adsorption effect of the solid wall for dissolved gas in water, was proposed, and a prediction formula between the adsorption coefficient and the contact angle of the solid wall was established. These results can provide theoretical support for the utilization of the solid wall adsorption effect to mitigate the adverse effects of supersaturated TDG and protect fish.

Expanding Antiviral Prophylaxis During Pregnancy to Prevent Perinatal Hepatitis B Virus Infection: A Cost-effectiveness Study.

BACKGROUND: Mother-to-child transmission (MTCT) cannot be completely prevented by the administration of active-passive immunoprophylaxis in pregnant women with hepatitis B virus (HBV) DNA levels <106 copies/mL. This study will assess the economic outcomes of expanding antiviral prophylaxis in pregnant women with HBV DNA levels <106 copies/mL. METHODS: A decision model was adopted to measure the economic outcomes of expanded antiviral prophylaxis at different cutoff values of HBV DNA in HBsAg(+) pregnant women in the context of the United States and China. The model inputs, including clinical, cost, and utility data, were extracted from published studies. Sensitivity analyses were carried out to examine the uncertainty of the model outputs. Quality-adjusted life-years (QALYs) and direct medical costs were expressed over a lifetime horizon. RESULTS: Compared with standard antiviral prophylaxis at HBV DNA ≥106 copies/mL, expanded antiviral prophylaxis improved the health outcomes, and the incremental cost of expanded antiviral prophylaxis varied from $2063 in pregnant women with HBV DNA ≥105 copies/mL to $14 925 in all HBsAg(+) pregnant women per QALY gained in the United States, and from $1624 to $12 348 in China. The model outcome was considerably influenced by the discount rate, key clinical parameters related to the incidence of MTCT, and efficacy of the prophylaxis strategy. CONCLUSIONS: This study indicates that antiviral prophylaxis using tenofovir among pregnant women with HBV DNA <106 copies/mL may be a cost-effective option, and the cutoff value of the HBV DNA load for antiviral prophylaxis needs to be tailored.

Distribution of malaria patients seeking care in different types of health facilities during the implementation of National Malaria Elimination Programme.

BACKGROUND: China launched the National Malaria Elimination Programme (NMEP) in 2010 and set the goal that all health facilities should be able to diagnose malaria. Additionally, hospitals at all levels could treat malaria by 2015. To provide a reference for the control of imported malaria, a study was conducted on the distribution of malaria patients seeking care in different types of health facilities. METHODS: There were two data sources. One was obtained through the Infectious Diseases Information Reporting Management System (IDIRMS), which only contained the name of health facilities and the number of cases. The other was obtained through multistage stratified cluster sampling. Descriptive statistical analysis was used to investigate the distribution of malaria patients attending different types of health facilities (hospitals, township hospitals, and Centers for Disease Control and Prevention), hospital tiers (county-level, prefecture-level, and provincial-level), and hospital levels (primary, secondary, and tertiary). Chi-square test was also used to compare the proportions of patients seeking care outside their current residence region between different types of hospitals. Point maps were drawn to visualize the spatial distribution of hospitals reporting malaria cases, and flow maps were created to show the spatial flow of malaria patients by using the ArcGIS software. RESULTS: The proportions of malaria patients who sought care in hospitals, township hospitals, and Centers for Disease Control and Prevention were 81.7%, 14.7%, and 3.6%, respectively. For those who sought care in hospitals, the percentages of patients who sought care in provincial-level, prefecture-level and county-level hospitals were 17.4%, 60.5% and 22.1%, correspondingly; the proportions of patients who sought care in tertiary hospitals, secondary hospitals, and primary hospitals were 59.8%, 39.9%, and 0.3%, respectively. Moreover, the proportions of patients seeking care in hospitals within county and prefectural administrative areas were 18.2%, 63.4%, respectively. CONCLUSION: During the implementation of NMEP, malaria patients tended to seek care in tertiary hospitals and prefecture-level hospitals, and more than half of patients could be treated in hospitals in prefecture-level areas. In the current phase, it is necessary to establish referral system from county-level hospitals to higher-level hospitals for malaria treatment.

Age at Initiation and Frequency of Screening to Prevent Esophageal Squamous Cell Carcinoma in High-risk Regions: an Economic Evaluation.

The aim of this study was to identify the economic screening strategies for esophageal squamous cell carcinoma (ESCC) in high-risk regions. We used a validated ESCC health policy model for comparing different screening strategies for ESCC. Strategies varied in terms of age at initiation and frequency of screening. Model inputs were derived from parameter calibration and published literature. We estimated the effects of each strategy on the incidence of ESCC, costs, quality-adjusted life-year (QALY), and incremental cost-effectiveness ratios (ICERs). Compared with no screening, all competing screening strategies decreased the incidence of ESCC from 0.35% to 72.8%, and augmented the number of QALYs (0.002-0.086 QALYs per person) over a lifetime horizon. The screening strategies initiating at 40 years of age and repeated every 1-3 years, which gained over 70% of probabilities that was preferred in probabilistic sensitivity analysis at a $1,151/QALY willingness-to-pay threshold. Results were sensitive to the parameters related to the risks of developing basal cell hyperplasia/mild dysplasia. Endoscopy screening initiating at 40 years of age and repeated every 1-3 years could substantially reduce the disease burden and is cost-effective for the general population in high-risk regions.

Medical system and nutrition improvement for the rural elderly.

BACKGROUND: Insufficient nutrition intake has negatively influenced the health of the elderly in rural China where the problem of population aging is serious. The present study aims to explore whether the medical system, called the New Rural Cooperative Medical System (NRCMS), can improve the rural elderly's nutrition intake and the mechanism behind it. METHODS: The difference in differences (DID) model and the propensity score matching-difference in differences (PSM-DID) model are both performed to investigate the impact of the medical system on nutrition improvement for the rural elderly. Two thousand seven hundred eighty rural elderly samples tracked in 2000 and 2006 from the China Health and Nutrition Survey are analyzed. Indices for the elderly's nutrition intake includes daily average intake of energy, fat, protein, and carbohydrate. RESULTS: The results show that participation in the NRCMS can significantly increase the rural elderly's total energy intake, carbohydrate intake, and protein intake by 206.688 kcal, 36.379 g, and 6.979 g, respectively. A more significant impact of the NRCMS on nutrition intake is observed in the central and near-western where economic development is lagging behind. Also, compared to people of 18-60 age group, such impact is statistically more significant in the elderly for the carbohydrate intake. CONCLUSIONS: The NRCMS can improve the rural elderly's nutrition intake in China. As the population ages rapidly in rural China, the present study provides recommendations on how to improve nutrition and health status of the elderly from the aspect of the medical system.

Development of an Empirically Calibrated Model of Esophageal Squamous Cell Carcinoma in High-Risk Regions.

OBJECTIVE: This study constructs, calibrates, and verifies a mathematical simulation model designed to project the natural history of ESCC and is intended to serve as a platform for testing the benefits and cost-effectiveness of primary and secondary ESCC prevention alternatives. METHODS: The mathematical model illustrates the natural history of ESCC as a sequence of transitions among health states, including the primary health states (e.g., normal mucosa, precancerous lesions, and undetected and detected cancer). Using established calibration approaches, the parameter sets related to progression rates between health states were optimized to lead the model outputs to match the observed data (specifically, the prevalence of precancerous lesions and incidence of ESCC from the published literature in Chinese high-risk regions). As illustrative examples of clinical and policy application, the calibrated and validated model retrospectively simulate the potential benefit of two reported ESCC screening programs. RESULTS: Nearly 1,000 good-fitting parameter sets were identified from 1,000,000 simulated sets. Model outcomes had sufficient calibration fit to the calibration targets. Additionally, the verification analyses showed reasonable external consistency between the model-predicted effectiveness of ESCC screening and the reported data from clinical trials. CONCLUSIONS: This parameterized mathematical model offers a tool for future research investigating benefits, costs, and cost-effectiveness related to ESCC prevention and treatment.

The Effect of Health on Labour Supply of Rural Elderly People in China-An Empirical Analysis Using CHARLS Data.

In China, due to decades of the 'one-child policy' and continuous rural-urban labour migration, real population aging in rural areas is increasing more quickly than in urban areas, and the labour inputs in agricultural production are becoming ever more dependent on the elderly. Using CHARLS data, we examine the effect of health on the labour supply of rural elderly people. We construct a latent health stock index (LHSI) to eliminate measurement bias and then use this one-period lagged LHSI and the Heckman two-stage and the Bourguignon-Fournier-Gurand two-stage method to deal with the simultaneous causality of health and labour decisions and sample selectivity in model estimation. The results show that, in the overall level, the labour force participation and work time of rural elderly people increase significantly with the improvement of health. These effects on the males are sharply greater than on the females and are enhanced with age. In the subdivided agricultural and non-agricultural labour supply, health improvement is positively related with labour force participation of rural elderly and brings an employment allocation from agricultural section to non-agricultural section, especially on the males. However, as the work time, these relations are insignificant and invariant with gender and age.

Cost-effectiveness of novel regimens for Chinese patients with chronic hepatitis C.

OBJECTIVE: Direct-acting antiviral agents (DAAs) have been approved for treating hepatitis C virus (HCV) infection in China. However, they are substantially more expensive. The current analysis will investigate the cost-effectiveness of novel regimens compared with pegylated interferon and ribavirin (PR) therapies for informing Chinese decision-makers. METHODS: A Markov model was developed to measure economic and health outcomes of novel regimens for genotype 1b, 2, 3, and 6 HCV infections compared with PR treatment. Clinical, cost, and utility inputs were gathered from published sources. Discounted quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) are shown. The uncertainty was facilitated by one-way and probabilistic sensitivity analyses. RESULTS: For genotype 1b HCV infection, the combination of paritaprevir, ritonavir, ombitasvir and dasabuvir was cost-saving compared with four competing alternatives. The ICERs of sofosbuvir plus ribavirin for genotypes 2 and 3 were lower than the threshold ($18,234/QALY). Among available strategies for patients with genotype 6, sofosbuvir in combination with ribavirin was the cost-saving alternative compared with PR. The results were robust to sensitivity analyses. CONCLUSIONS: For both genotype 1b and 6 HCV infections in the context of Chinese patients, there were combinations of DAAs that were cost-saving compared with the usual PR treatment, and cost-effective for genotypes 2 and 3.

Short-chain chlorinated paraffin (SCCP) pollution from a CP production plant in China: Dispersion, congener patterns and health risk assessment.

China is the largest chlorinated paraffin (CP) producer in the world. Given that CP production is a major source of short-chain CP (SCCP) pollution in China, the effects of CP production on the environment inside and outside of CP production plants are worth revealing. The concentrations and specific congener group patterns of SCCPs in various environmental matrices, such as air, soil and dust, inside and outside of a chosen CP production plant surrounded by farmlands and villages were analyzed to explore SCCP pollution and transportation behaviors. SCCP concentrations in air (129-1442 ng/m3) and soil (28-554 µg/g) samples inside the CP production plant were dramatically higher than those in air (91-333 ng/m3) and soil (102-441 ng/g) samples outside the CP production plant. Based on the congener abundance patterns among these samples, lighter groups (C10-11 and Cl5-6) were dominant in atmospheric environment, with greater long-range transport potential, whereas heavier groups (C12-13 and Cl7-10) were inclined toward deposition. It was clear that substantial amounts of SCCPs were released from the CP production plant, which contaminated the environment inside and outside of the plant. The daily occupational SCCP exposure of employees in the production hall (21.8 µg/day-kg) exceeded the tolerable daily intake (TDI, 10 µg/day-kg) given by Canadian Environmental Protection Act, suggesting that production employees were confronted with high health risk from SCCP exposure; while daily SCCP exposure of employees in office areas (0.57 µg/day-kg) and residents near the CP plant (1.22-25.5 × 10-2 µg/day-kg) were significantly lower, representing low health risk.

Detecting Wheat Powdery Mildew and Predicting Grain Yield Using Unmanned Aerial Photography.

High-resolution aerial imaging with an unmanned aerial vehicle (UAV) was used to quantify wheat powdery mildew and estimate grain yield. Aerial digital images were acquired at Feekes growth stage (GS) 10.5.4 from flight altitudes of 200, 300, and 400 m during the 2009-10 and 2010-11 seasons; and 50, 100, 200, and 300 m during the 2011-12, 2012-13, and 2013-14 seasons. The image parameter lgR was consistently correlated positively with wheat powdery mildew severity and negatively with wheat grain yield for all combinations of flight altitude and year. Fitting the data with random coefficient regression models showed that the exact relationship of lgR with disease severity and grain yield varied considerably from year to year and to a lesser extent with flight altitude within the same year. The present results raise an important question about the consistency of using remote imaging information to estimate disease severity and grain yield. Further research is needed to understand the nature of interyear variability in the relationship of remote imaging data with disease or grain yield. Only then can we determine how the remote imaging tool can be used in commercial agriculture.

Cost-Effectiveness of Different Strategies for the Treatment of Moderate-to-Severe Ulcerative Colitis.

Background: Knowledge regarding the economic outcomes of anti-tumour necrosis factor-α (anti-TNFα) and oral Janus kinase inhibitor (JAKi) therapies for the treatment of ulcerative colitis (UC) is limited. We conducted this analysis to assess the economic outcomes of anti-TNFα, antiadhesion molecule inhibitors (anti-AMi), and oral JAKi therapies for the treatment of UC from the perspectives of the United Kingdom (UK) and China, which are the representatives of high-income and middle-income regions, respectively. Methods: A Markov model-based economic analysis was performed by incorporating effectiveness and utility data obtained from the literature and costs based on publicly available reports. The UK and Chinese health care perspectives were adopted to evaluate different intervention treatment sequences, including 14 treatment sequences consisting of conventional therapy, tofacitinib, adalimumab, vedolizumab, golimumab, and infliximab. The participants were the patients with moderate-to-severe UC eligible for anti-TNFα, anti-Ami, and JAKi treatment. Cost, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) were reported. Results: Compared to other alternatives comprising adalimumab, golimumab, and infliximab, the use of a treatment sequence comprising tofacitinib and vedolizumab always had better health outcomes. The most cost-effective options in the UK included the sequences comprising tofacitinib and vedolizumab, and the most cost-effective treatment option in China was tofacitinib. There were uncertainties surrounding the results, the key drivers of which being the utility values, effectiveness of conventional therapy, and relative efficacy of the active treatments. Conclusions: The treatment with tofacitinib and vedolizumab for moderate-to-severe UC is likely to be the most favorable cost-effective option in the high-income UK, and tofacitinib is the most cost-effective option in the middle-income China.

Cost Effectiveness of Daclatasvir Plus Asunaprevir Therapy for Chinese Patients with Chronic Hepatitis C Virus Genotype 1b.

BACKGROUND AND OBJECTIVES: Daclatasvir plus asunaprevir has shown superior efficacy and safety for treating hepatitis C virus genotype 1b infection in comparison with pegylated interferon and ribavirin. The objective of this analysis is to investigate the cost effectiveness of daclatasvir plus asunaprevir compared with interferon-α-based therapies from the perspective of the Chinese healthcare system. METHODS: A Markov model was established to measure economic and health outcomes of daclatasvir plus asunaprevir compared with general interferon-α plus ribavirin and pegylated interferon plus ribavirin for hepatitis C virus genotype 1b infection. We also considered the two following scenarios: 24 weeks of daclatasvir plus asunaprevir used as a second-line treatment for ineligible/intolerant and non-responding patients with HCV during 48 weeks of first-line interferon-α plus ribavirin (interferon-α plus ribavirin and daclatasvir plus asunaprevir) or pegylated interferon plus ribavirin (pegylated interferon plus ribavirin and daclatasvir plus asunaprevir) treatment. Clinical costs and utility inputs were derived from the published literature. The incremental cost-effectiveness ratio was shown as costs in US dollars per quality-adjusted life-years gained. Uncertainty was examined by one-way and probabilistic sensitivity analyses. RESULTS: Compared with interferon-α plus ribavirin, pegylated interferon and ribavirin, interferon-α plus ribavirin plus daclatasvir plus asunaprevir, and pegylated interferon plus ribavirin plus daclatasvir plus asunaprevir strategies, daclatasvir plus asunaprevir gained an additional 0.62, 0.32, 0.20, and 0.15 quality-adjusted life-year with increasing costs of US$11,950, US$671, US$8366, and -$3783, respectively. The incremental cost-effectiveness ratios of pegylated interferon and ribavirin, daclatasvir plus asunaprevir, interferon-α plus ribavirin and daclatasvir plus asunaprevir, and pegylated interferon plus ribavirin and daclatasvir plus asunaprevir against the baseline interferon-α plus ribavirin strategy were US$37,930, US$19,233, US$8495, and US$33,031 per quality-adjusted life-year gained. Daclatasvir plus asunaprevir and interferon-α plus ribavirin plus daclatasvir plus asunaprevir were presented as the cost-effective alternatives, and pegylated interferon plus ribavirin and pegylated interferon plus ribavirin and daclatasvir plus asunaprevir strategies dominated. The model outputs were sensitive to a patient's age, discount rate, and the risk ratio between pegylated interferon plus ribavirin and interferon-α plus ribavirin. CONCLUSIONS: Daclatasvir plus asunaprevir in the Chinese setting is likely to be cost effective for treating hepatitis C virus genotype 1b infection.

Rapid Separation of Three Proanthocyanidin Dimers from Iris lactea Pall. var. Chinensis (Fisch.) Koidz by High-Speed Counter-Current Chromatography With Continuous Sample Load and Double-Pump Balancing Mode.

INTRODUCTION: The dried seeds of Iris lactea have been used in traditional Chinese medicine. Previous studies have been focused on irisquinones while other chemical components are rarely reported. OBJECTIVE: To establish an efficient high-speed counter-current chromatography (HSCCC) separation method with continuous sample load (CSL) and double-pump balancing (DPB) mode to isolate proanthocyanidins from I. lactea. METHODS: Firstly, an ethyl acetate extract of I. lactea was pre-fractionated by silica column chromatography for the enrichment of proanthocyanidins. Secondly, the enriched proanthocyanidins sample (EPS) was further fractionated by HSCCC with a two-phase solvent system ethyl acetate:n-butanol:water (9:1:10, v/v/v) using DPB mode. The flow rate of the two phases was 2.2 mL/min, the revolution speed was 900 rpm, the separation temperature was 30 °C and the detection wavelength was 280 nm. Finally, the structures of the three isolated proanthocyanidins were elucidated by spectroscopic methods and compared with published data. RESULTS: Under the optimized conditions, 600 mg of the EPS with six continuous injections (100 mg/time) was fractionated, yielding 57 mg of prodelphinidin B3, 198 mg of procyanidin B3, and 162 mg of procyanidin B1, at purities of 97.2%, 98.1% and 97.3%, respectively. CONCLUSIONS: The HSCCC separation method with CSL and DPB proved to be rapid, convenient and economical, constituting an efficient strategy for the isolation of proanthocyanidins.