Developing a framework for promoting interest and engagement of scholarship of teaching and learning for medical students.

BACKGROUND: The scholarship of teaching and learning (SoTL) is a field of academic research that focuses on improving learning through reflective and informed teaching. Currently, most SoTL-related work is faculty-driven; however, student involvement in SoTL has been shown to benefit both learners and educators. Our study aims to develop a framework for increasing medical students' interest, confidence, and engagement in SoTL. METHODS: A student-led SoTL interest group was developed and a year-round program of SoTL was designed and delivered by student leaders of the group under the guidance of a faculty advisor. Individual post-session surveys were administered to evaluate participants' perceptions of each session. Pre- and post-program surveys were administered to evaluate the program impact. RESULTS: The year-round SoTL program consistently attracted the participation of medical students and faculty. Survey responses indicated strong medical student interest in the program and positive impact of the program. Increased interest and confidence in medical education research were reported by the student participants. The program design provided opportunities for student participants to network and receive ongoing feedback about medical education research they were interested or involved in. CONCLUSION: Our study provides insights for developing a framework that other institutions can reference and build upon to educate and engage students in SoTL.

Optimization of benzene exposure risk assessment: An integrated approach utilizing internal and external concentrations with a focus on biomarkers S-PMA & t, t-MA.

In the majority of occupational settings within China, the concentrations of benzene are observed to fall markedly below the demarcated detection thresholds. Employing traditional risk assessment models, the presence of exceptionally low airborne benzene exposure concentrations may infuse heightened degrees of uncertainty. Consequently, the necessity arises to investigate risk assessment methodologies more apt for the prevalent exposure environment among employees. In the present study, a pharmacokinetic model premised on urinary benzene metabolites (S-PMA and t, t-MA) was employed to ascertain a more precise daily airborne benzene exposure concentration per individual. This value was integrated into the linear multistage model as the 'internal exposure concentration'. In conjunction with the U.S National Environmental Protection Agency's (EPA) inhalation risk assessment model predicated on the external exposure concentration, the Singapore Ministry of Manpower's (MOM) model, and the linear multistage (LMS) model, the carcinogenic and non-carcinogenic effects of benzene were evaluated for 1781 benzene-exposed employees across 76 enterprises in Jiangsu Province. Findings suggest that in the linear multilevel model assessment, the cancer risk levels based on t, t-MA and S-PMA were higher in the printing and recording media reproduction industry, automobile manufacturing industry, general equipment manufacturing industry and the furniture manufacturing industry (median 2.842 × 10-4, 2.819 × 10-4, 2.809 × 10-4, and 2.678 × 10-4), which align more consistently with the actual benzene exposure circumstances of each industry's study participants, with overall risk levels calculated by the linear multistage model exceeding those of the EPA inhalation risk assessment model and the MOM model. This implies that the linear multistage model of internal exposure, based on the reciprocal of benzene biomarkers S-PMA and t, t-MA for airborne benzene exposure, presents enhanced sensitivity and suitability for the current occupational health risk assessment of workers. Without doubt, biomarker-based benzene exposure risk assessment emerges as the optimal choice.

[Traditional application and modern research progress on new foreign medicinal resources].

Chinese medicinal resources are the material basis for the survival and development of traditional Chinese medicine(TCM)and the sustainable development of Chinese medicinal resources is also an important project for the modernization of TCM in China. With the increasing demand for Chinese medicinal resources in China, over-exploitation has destroyed Chinese medicinal resources, resulting in a shortage of many natural medicinal resources in China and making the sustainable development of TCM in trouble. The introduced new foreign medicinal resources have become effective supplement and replacement for Chinese medicinal resources to some extent. However, the development and utilization of new foreign medicinal resources in China are different. To fully understand the development of new foreign medicinal resources in China, this paper, taking 43 new foreign medicinal resources such as Acacia nilotica as objects, sorted out the introduction forms and policies of new foreign medicinal resources, overviewed its current development status in China, summarized the application experience of new foreign medicinal resources in the place of origin, as well as the research progress and problems of new foreign medicinal resources in China and abroad, and analyzed the research situation, which can enrich Chinese medicinal resources and other uses, promote the sustainable development of Chinese medicinal resources, and provide ideas for further development and research of new foreign medicinal resources.

Cost-effective selective deuteration of aromatic amino acid residues produces long-lived solution 1H NMR magnetization in proteins.

Solution NMR studies of large proteins are hampered by rapid signal decay due to short-range dipolar 1H-1H and 1H-13C interactions. These are attenuated by rapid rotation in methyl groups and by deuteration (2H), so selective 1H,13C-isotope labelling of methyl groups in otherwise perdeuterated proteins, combined with methyl transverse relaxation optimized spectroscopy (methyl-TROSY), is now standard for solution NMR of large protein systems > 25 kDa. For non-methyl positions, long-lived magnetization can be introduced as isolated 1H-12C groups. We have developed a cost-effective chemical synthesis for producing selectively deuterated phenylpyruvate and hydroxyphenylpyruvate. Feeding these amino acid precursors to E. coli in D2O, along with selectively deuterated anthranilate and unlabeled histidine, results in isolated and long-lived 1H magnetization in the aromatic rings of Phe (HD, HZ), Tyr (HD), Trp (HH2, HE3) and His (HD2 and HE1). We are additionally able to obtain stereoselective deuteration of Asp, Asn, and Lys amino acid residues using unlabeled glucose and fumarate as carbon sources and oxalate and malonate as metabolic inhibitors. Combining these approaches produces isolated 1H-12C groups in Phe, Tyr, Trp, His, Asp, Asn, and Lys in a perdeuterated background, which is compatible with standard 1H-13C labeling of methyl groups in Ala, Ile, Leu, Val, Thr, Met. We show that isotope labeling of Ala is improved using the transaminase inhibitor L-cycloserine, and labeling of Thr is improved through addition of Cys and Met, which are known inhibitors of homoserine dehydrogenase. We demonstrate the creation of long-lived 1H NMR signals in most amino acid residues using our model system, the WW domain of human Pin1, as well as the bacterial outer membrane protein PagP.

Air pollution and associated health impact and economic loss embodied in inter-provincial electricity transfer in China.

As the largest producer and consumer of coal in the world, China heavily relies on coal resources for thermal power generation. Owing to the unbalanced distribution of energy resources, electricity transfer among regions in China plays a key role in promoting economic growth and ensuring energy safety. However, little is known about air pollution and the related health impacts resulting from electricity transfer. This study assessed PM2.5 pollution and related health and economic losses attributable to the inter-provincial electricity transfer in mainland China in 2016. The results show that a large amount of virtual air pollutant emissions were transferred from energy-abundant northern, western and central China to well-developed and populated eastern coastal regions. Correspondingly, the inter-provincial electricity transfer dramatically reduced the atmospheric levels of PM2.5 and related health and economic losses in eastern and southern China, while increasing those in northern, western and central China. The health benefits attributable to inter-provincial electricity transfer were mainly found in Guangdong, Liaoning, Jiangsu and Shandong, whereas the extra health loss is concentrated in Hebei, Shanxi, Inner Mongolia, and Heilongjiang. Overall, the inter-provincial electricity transfer led to an extra increase of 3600 (95 % CI: 3200-4100) PM2.5-related deaths and 345 (95 % CI: 294-389) million USD of economic loss in China in 2016. The results could assist air pollution mitigation strategies for the thermal power sector in China by strengthening the cooperation between suppliers and consumers of electricity.

Assessment of solar energy potential in China using an ensemble of photovoltaic power models.

Development of solar energy is one of the key solutions towards carbon neutrality in China. The output of solar energy is dependent on weather conditions and shows distinct spatiotemporal characteristics. Previous studies have explored the photovoltaic (PV) power potential in China but with single models and low-resolution radiation data. Here, we estimated the PV power potential in China for 2016-2019 using an ensemble of 11 PV models based on hourly solar radiation at the resolution of 5 km retrieved by the Himawari-8 geostationary satellite. On the national scale, the ensemble method revealed an annual average PV power potential of 242.79 kWh m-2 with the maximum in the west (especially the Tibetan Plateau) and the minimum in the southeast (especially the Sichuan Basin). The multi-model approach shows inter-model spreads of 6 %-7 % distributed uniformly in China, suggesting a robust spatial pattern predicted by these models. The seasonal variation in general shows the largest PV power generation in summer months except for Tibetan Plateau, where the peak value appears in spring because the high cloud coverage dampens the regional solar radiation in summer. On the national scale, the deseasonalized PV power potential shows a high correlation with cloud coverage (R2 = 0.71, p < 0.01) but a low correlation with aerosol optical depth (R2 = 0.08, p < 0.05). Sensitivity experiments show that national PV power potential increases by 0.55 % per 1 W m-2 increase of radiation and 0.79 % per 1 m s-1 increase of wind speed, but decreases by 0.46 % per 1 °C increase of air temperature. These sensitivities provide a solid foundation for the future projection of PV power potential in China under climate change.

Assessment of toxic mechanisms and mode of action to three different levels of species for 14 antibiotics based on interspecies correlation, excess toxicity, and QSAR.

Antibiotics have received much attention owing to their ecotoxicity toward nontarget aquatic creatures. However, the mode of action (MOA) of toxicity against nontarget organisms is unclear in some aquatic organisms. In this study, the comparison of toxicities through interspecies correlations, excess toxicity calculated from toxicity ratio, and quantitative structure-activity relationship (QSAR) was carried out to investigate the MOAs for 14 antibiotics among Daphnia magna, Vibrio fischeri, and Pseudokirchneriella subcapitata. The results showed that interspecies toxicity correlations were very poor between any two of the three species for the 14 antibiotics. The toxicity ratio revealed that most antibiotics exhibited excess toxicity to algae and Daphnia magna but not to V. fischeri, demonstrating that some antibiotics share the same MOA, but some antibiotics share different MOAs among the three different levels of species. P. subcapitata was the most sensitive species, and V. fischeri was the least sensitive species. This is because of the differences in the biouptake and interactions of antibiotics with the target receptors between the three different trophic levels of the species. Molecular docking simulations suggested that the toxicity of antibiotics depends highly on their interactions with target receptors through hydrogen bonds, electrostatic or polar interactions, π bond interactions, and van der Waals forces. QSAR models demonstrated that hydrogen bonding and electrophilicity/nucleophilicity play key roles in the interaction of antibiotics with different receptors in the three species. The toxic mechanisms of antibiotics are attributed to the interactions between electrophilic antibiotics and biological nucleophiles, and hydrogen-bond interactions. These results are valuable for understanding the toxic mechanisms and MOA of the three different levels of species.

Streaming Variational Monte Carlo.

Nonlinear state-space models are powerful tools to describe dynamical structures in complex time series. In a streaming setting where data are processed one sample at a time, simultaneous inference of the state and its nonlinear dynamics has posed significant challenges in practice. We develop a novel online learning framework, leveraging variational inference and sequential Monte Carlo, which enables flexible and accurate Bayesian joint filtering. Our method provides an approximation of the filtering posterior which can be made arbitrarily close to the true filtering distribution for a wide class of dynamics models and observation models. Specifically, the proposed framework can efficiently approximate a posterior over the dynamics using sparse Gaussian processes, allowing for an interpretable model of the latent dynamics. Constant time complexity per sample makes our approach amenable to online learning scenarios and suitable for real-time applications.

Quantification of Local Vessel Wall and Plaque Volume Change for Assessment of Effects of Therapies on Carotid Atherosclerosis Based on 3-D Ultrasound Imaging.

We developed a new method to measure the voxel-based vessel-wall-plus-plaque volume (VWV). In addition to quantifying local thickness change as in the previously introduced vessel-wall-plus-plaque thickness (VWT) metric, voxel-based VWV further considers the circumferential change associated with vascular remodeling. Three-dimensional ultrasound images were acquired at baseline and 1 y afterward. The vessel wall region was divided into small voxels with the voxel-based VWV change (ΔVVol%) computed by taking the percentage volume difference between corresponding voxels in the baseline and follow-up images. A 3-D carotid atlas was developed to allow visualization of the local thickness and circumferential change patterns in the pomegranate versus the placebo groups. A new patient-based biomarker was obtained by computing the mean ΔVVol% over the entire 3-D map for each patient (ΔVVol%¯). ΔVVol%¯ detected a significant difference between patients randomized to pomegranate juice/extract and placebo groups (p = 0.0002). The number of patients required by ΔVVol%¯ to establish statistical significance was approximately a third of that required by the local VWT biomarker. The increased sensitivity afforded by the proposed biomarker improves the cost-effectiveness of clinical studies evaluating new anti-atherosclerotic treatments.

Burden of stroke and its risk factors in Yunnan Province of China, 1990-2017.

BACKGROUND: There is an overall decreasing trend in stroke incidence and an increasing trend in its prevalence. Disease burden of stroke continues to increase with an increase in the absolute number. In-depth analysis of stroke burden trends in remote areas is extremely important. Our aim was to describe the disease burden of and risk factors for stroke in Yunnan, from 1990 to 2017. METHODS: The methodological framework and analytical strategies adopted in the 2017 Global Burden of Disease study were used. RESULTS: Age-standardized mortality associated with stroke decreased from 1.53 per 100 000 in 1990 to 1.14 per 100 000 in 2017. The prevalence of stroke in Yunnan Province increased from 344 per 100 000 in 1990 to 870 per 100 000 in 2017. The age-standardized rates of years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) decreased more significantly for women than for men. The age-standardized rates of DALYs and YLLs of stroke decreased by 24.3 and 28.4%, respectively, from 1990 to 2017, and the rate of YLDs increased by 32.5%. The top three risk factors for stroke were dietary risks, high systolic blood pressure and tobacco consumption, and their percentage contributions to the DALYs of stroke were 67.5, 51.5 and 29.1%, respectively. CONCLUSIONS: The burden of stroke has increased in Yunnan since 1990. The health department should emphasize on the changes of stroke risk factors and advocate healthy diet and living habits for residents.

Economic events and the volatility of government bill rates.

Many studies show that in many countries (especially the G7), volatility in government bill rates far exceeds that in consumption growth rates. This volatility puzzle cannot be predicted by traditional disaster models, in which rare economic disasters are defined as a peak-to-trough percent fall in consumption (or real per capita GDP) by a high threshold (≥10%). For this purpose, we extend the traditional definition of rare economic disasters and propose a novel asset pricing model that models both good and bad events. We define a bad (or good) event as a peak-to-trough absolute decline (or a trough-to-peak absolute rise) in consumption growth rates by a low threshold (<10%). Compared to traditional disaster models, our model contains three improvements. First, model good and bad events, not just bad ones (e.g., rare economic disasters). Second, the event's impact lasts for multiple periods rather than one period. Third, model non-rare economic events. We calibrate the parameters in our model to match the moments from U.S. asset return data. Simulation results indicate that the model can successfully predict the volatility of U.S. government bill rates higher than that of U.S. consumption growth rates.

Returnee Executives, Corporate Social Responsibility, and Stock Price Synchronicity.

Executive characteristics have a significant impact on corporate decision-making, corporate sustainable behavior, and stock market performance, which may influence the corporations' sustainable development in the long run. The role of returnee talents in the corporate sustainable development has received extensive academic attention. Using data of Chinese A-share listed companies over the period of 2008-2018, we find that there is a negative relationship between executives' foreign experience and stock price synchronicity. We also prove that corporate social responsibility (CSR) has a significant mediating effect on the relationship between returnee executives and stock price synchronicity. The returnee executives tend to pursue long-term sustainable activities and improve CSR engagement quality, thereby reducing stock price synchronicity. Our extended analysis reveals that the benefit of returnee executives is more pronounced for non-SOEs and for firms located in regions with a low degree of marketization. This study has some implications for the Chinese firms in relation to their CSR information disclosure behavior, and it gives suggestions to strengthen capital market efficiency for the sustainable development of corporations.

The direct and indirect effects of length of hospital stay on the costs of inpatients with stroke in Ningxia, China, between 2015 and 2020: A retrospective study using quantile regression and structural equation models.

Importance: Length of hospital stay (LOHS) is the main cost-determining factor of hospitalization for stroke patients. However, previous analyses involving LOHS did not consider confounding or indirect factors, or the effects of other factors on LOHS and inpatient costs. Objective: To investigate the direct and indirect effects of LOHS on the hospitalization costs of inpatients with ischemic and hemorrhagic stroke. Design setting and participants: This was a population-based, retrospective, and observational study that analyzed data acquired from the Nationwide Inpatient Sample between 2015 and 2020 relating to ischemic and hemorrhagic stroke in Ningxia, China. Main outcomes and measures: Hospitalizations were identified by the International Classification of Diseases 10th Revision (ICD-10). Inpatient costs were described by the median M (P25, P75). We used a quantile regression model to estimate the linear relationships between a group of independent variables X and the quantile of the explained variable hospitalization cost (Y). A structural equation model (SEM) was then used to investigate the direct and indirect effects of LOHS on inpatient costs. Results: The study included 129,444 patients with ischemic stroke and 15,525 patients with hemorrhagic stroke. The median LOHS was 10 (8-13) days for ischemic stroke and 15 (10-22) days for hemorrhagic stroke. The median M (P25, P75) of inpatient costs was $1020 (742-1545) for ischemic stroke and 2813 (1576-6191) for hemorrhagic stroke. The total effect of LOHS on inpatient costs was 0.795 in patients with ischemic stroke. The effect of yearof discharge (X4) and CCI (X8) on inpatient costs was dominated by an indirect effect through the LOHS. The indirect effect was -0.071 (84.52% of the total effect value) and 0.034 (69.39% of the total effect value), respectively. The total effect of LOHS on inpatient costs in patients with hemorrhagic stroke was 0.754. The influence of CCI on inpatient costs was dominated by an indirect effect through LOHS; the indirect effect value was -0.028 (77.78% of the total effect value). The payment type, surgery, method of discharge, and hospital level also exerted an impact on inpatient costs by direct and indirect effects through the LOHS. Conclusions and relevance: Length of hospital stay (LOHS) was identified as the main factor influencing hospitalization costs. However, other social factors were shown to indirectly influence hospitalization costs through the LOHS. Taking effective measures to further reduce hospitalization costs remains an effective way to control hospitalization costs for stroke patients.

Pharmacokinetics/pharmacodynamics by race: Analysis of a peginterferon ß-1a phase 1 study.

BACKGROUND: Black/African American participants are underrepresented in clinical trials for multiple sclerosis but can experience a greater burden of disease than other racial groups in the United States. A phase 1, open-label, crossover study that demonstrated bioequivalence of subcutaneous and intramuscular injection of peginterferon ß-1a in healthy volunteers enrolled similar proportions of Black and White participants, enabling a post hoc subgroup analysis comparing these groups. METHODS: Peginterferon ß-1a (125 µg) was administered by subcutaneous or intramuscular injection, followed by a washout period before a second injection using the alternative method. The primary pharmacokinetic and pharmacodynamic endpoints were maximum observed concentration (Cmax) and area under the concentration-time curve from hour 0 to infinity (AUCinf) of study drug and serum concentration of neop-terin, respectively. Safety and tolerability were included as secondary endpoints. FINDINGS: This analysis included 70 (51.5%) Black and 59 (43.3%) White participants. Peginterferon ß-1a Cmax was 29.8% higher in Black than in White participants following subcutaneous administration but was similar following intramuscular administration. Mean AUCinf was 31.0% and 11.8% greater in Black than in White participants with subcutaneous and intramuscular administration, respectively. Pharmacodynamics and safety signals were similar between groups, although Black participants reported numerically fewer adverse events. CONCLUSIONS: No clinically meaningful differences were identified between Black and White participants related to peginterferon ß-1a administration, supporting the approved dose of 125 µg/mL peginterferon ß-1a. Future clinical studies should include sufficiently diverse populations to ensure accurate assessments of treatment response. FUNDING: Funding for medical writing support was provided by Biogen (Cambridge, MA, USA).

The Impact of the Long-Term Care Insurance on the Medical Expenses and Health Status in China.

Based on the panel data of China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2015, and 2018, this paper used the difference-in-difference (DID) method to evaluate the implementation effect how the Long-Term Care Insurance (LTCI) policy impacted on the medical expenses and the health status of the middle-aged and elder population. The empirical results show that LTCI has reduced the outpatient and inpatient quantity by 0.1689 and 0.1093 per year, and cut the outpatient and inpatient expenses by 23.9% and 19.8% per year. Moreover, the implementation of LTCI has improved the self-rated health, the activity of daily living (ADL), as well as the mental health. These conclusions verify the implementation value of LTCI system and provide policy implications for the medical reform and the further LTCI implementation in a larger scale.

Quality-of-Life Evaluation among the Oldest-Old in China under the "Active Aging Framework".

China is facing an increasingly contradictory challenge between growing demand for health services for the oldest-old and the unbalanced and inadequate development in the context of rapid population aging. This study sought to evaluate the quality of life of the oldest-old in China under the active aging framework. Health, participation, and security data were sourced from China Statistics/Labor Statistics/Civil Affairs Yearbook 2000-2016 and National 1% Sample Survey Data 2005-2015. Then, we used the current life table, entropy method, coefficient variation, and panel data regression to evaluate the quality of life among the oldest-old and reveal its regional differences and mechanisms. The results show: (1) From 2005 to 2015, the overall quality of life in China steadily improved, and the quality of health, participation, and security of the oldest-old increased by 6.06%, 5.64%, and 47.48%, respectively. (2) Distinct regional disparities exist in the distribution of quality of life for the oldest-old in China; the "east-northeast-middle-west" stepped-declining pattern existed stably. (3) Population and family structure, economic development, and social security were the main reasons for the regional differences in quality of life for the oldest-old. Narrowing the socioeconomic gap between regions, promoting the function of family pension, and improving social old-age service supply will help improve the quality of life of the oldest-old.

Assessment of Risk Factors for Drug Resistance of Dual Anti Platelet Therapy After PCI.

Since aspirin and clopidogrel are the widely and conventionally used drugs to treat acute myocardial infarction after percutaneous coronary intervention (PCI), it is important to explore potential risk factors of their resistance. The platelet aggregation rate with arachidonic acid (AA, PAg-AA%) and adenosine diphosphate (ADP, PAg-ADP%) of 219 PCI patients were measured after standard treatment for 24 h. The disease history and laboratory data (before PCI) were obtained. We found 101 (46.12%) patients to be aspirin-resistant, and PAg-ADP% was the most prominent risk factor of aspirin resistance. Clopidogrel resistance was present in 157 of 219 patients. Patients in the clopidogrel-resistant group carried more CYP2C19*3 or *2, which was associated with higher clopidogrel resistance in this group (69.11%, 47/68) than in the control group (64.29%, 36/56). Platelet count (109/L) and hemoglobin (g/L) were the prominent risk factors of clopidogrel resistance. Among the 219 patients, 98 showed dual antiplatelet drug resistance, for which platelet count (109/L) and monocyte count (g/L) were the risk factors. Aspirin resistance was found to usually accompany clopidogrel resistance.

Behavioral and developmental toxicity assessment of the strobilurin fungicide fenamidone in zebrafish embryos/larvae (Danio rerio).

Strobilurin fungicides are among the most widely used in the world and have characteristics that include high water solubility and toxicity to aquatic organisms. While several studies report on mechanisms of toxicity of strobilurins in fish, there are no data on the sub-lethal toxicity of fish to the fungicide fenamidone. To address this gap, survival and hatch rate, deformities, mitochondrial bioenergetics, expression of oxidative stress and apoptotic genes, and behavior (locomotor activity and anxiolytic-related behaviors) were assessed in zebrafish embryos and larvae following exposure to fenamidone. Fenamidone negatively affected development of zebrafish embryos, causing a delay of hatching time at concentrations of 2.5 and 5 µM. Fenamidone caused morphological deformities in zebrafish, including pericardial edema, yolk sac edema, tail deformities, and spinal curvature. Exposure to 1.5 µM fenamidone reduced surface area of swim bladder in larvae at 6 dpf. Fenamidone significantly reduced oxygen consumption rates of embryos; 5 µM fenamidone decreased basal respiration (~85%), oligomycin induced ATP-linked respiration (~70%), FCCP-induced maximal respiration (~75%) and non-mitochondrial respiration (~90%) compared to controls. Sod2 mRNA levels were decreased by fenamidone in larval fish. Locomotor activity was significantly decreased in zebrafish larvae following exposure to 2 µM fenamidone but there was no evidence for anxiolytic nor anxiety-related behaviors (exposures of 100 nM up to 1.5 µM). This study addresses a data gap for potential risks associated with fenamidone exposure in developing fish.

Three-dimensional ultrasound assessment of effects of therapies on carotid atherosclerosis using vessel wall thickness maps.

We present a new method for assessing the effects of therapies on atherosclerosis, by measuring the weighted average of carotid vessel-wall-plus-plaque thickness change (ΔVWT¯Weighted) in 120 patients randomized to pomegranate juice/extract versus placebo. Three-dimensional ultrasound images were acquired at baseline and one year after. Three-dimensional VWT maps were reconstructed and then projected onto a carotid template to obtain two-dimensional VWT maps. Anatomic correspondence on the two-dimensional VWT maps was optimized to reduce misalignment for the same subject and across subjects. A weight was computed at each point on the two-dimensional VWT map to highlight anatomic locations likely to exhibit plaque progression/regression, resulting in ΔVWT¯Weighted for each subject. The weighted average of VWT-Change measured from the two-dimensional VWT maps with correspondence alignment (ΔVWT¯Weighted,MDL) detected a significant difference between the pomegranate and placebo groups (P = 0.008). This method improves the cost-effectiveness of proof-of-concept studies involving new therapies for atherosclerosis.

Evaluating the cost-effectiveness of catheter ablation of atrial fibrillation.

BACKGROUND: The pursuit of a clearer understanding of the pathogenesis of atrial fibrillation (AFib) and the development of new technology has resulted in a surge of interest in the surgical ablation for AFib. Here, we report our 8-year experience in the surgical treatment and management of AFib alongside, evaluating the cost-effectiveness in southern Mainland China over a 1-year follow-up. METHODS: Data of 3,068 patients from March 2011 through June 2019 was retrospectively extracted from The Provincial National Cardiac Database of Xiangya Second Hospital. The activities considered (and costs calculated) were outpatient consultations, hospital admissions, and drug treatment. Quality of life (QoL) questionnaires were also carried out to assess whether concomitant AFib correction procedures increase risk in patients, or improve patient's QoL. RESULTS: A total of 3,068 patients completed the questionnaires at a minimum of one time-point during the follow-up. The total cost was combined to obtain incremental costs per quality-adjusted life-years (QALYs). The total costs of the AFib catheter ablation group were remarkably higher compared to surgery as usual group. The incremental cost-effectiveness ratio was $76,513,227 (¥542,287,667) per QALY, with an acceptability line graph for cost at 43%. CONCLUSIONS: AFib is an extraordinarily costly and worrisome public health problem. Precision medicine is vital as it provides a platform for the clinical translation of targeted interventions that are designed to help treat and prevent AFib. Thus, to improve the QoL expectancy outcome(s), both therapeutic and surgical interventions should be aimed at addressing the underlying heart disease rather than restoring sinus rhythm.