Prevalence of youth experiencing homelessness and its association with suicidal thoughts and behaviors: Findings from a population-based study.

Although various studies have examined factors associated with suicidal behaviors among youth, few studies have investigated the association between youth experiencing homelessness (YEH) and suicidal thoughts and behaviors (STBs) using a large nationally representative sample. The objectives of this study were to investigate prevalence of YEH and its association with STBs. Data for this study came from the 2021 Youth Risk Behavior Survey. An analytic sample of 17,033 youth aged 14-18 (51.7 % male) was analyzed using binary logistic regression. Of the 17,033 youth examined, 3 % experienced homelessness during the past 30 days, 21.3 % experienced suicidal ideation, 17.3 % made a suicide plan, and 10.9 % attempted suicide during the past 12 months. Controlling for demographic characteristics and feeling sad or hopeless, YEH was associated with 2.48 times higher odds of experiencing suicidal ideation (AOR=2.48, p<.001), 2.46 times higher odds of making a suicide plan (AOR=2.46, p<.001), and 4.38 times higher odds of making a suicide attempt (AOR=4.38, p<.001). The findings of this study highlight the importance of identifying youth who are at risk of experiencing homelessness to ensure early interventions are put in place to prevent suicidal behaviors.

Cost-effectiveness of edaravone dexborneol versus dl-3-n-butylphthalide for the treatment of acute ischemic stroke: a Chinese health care perspective.

BACKGROUND: Edaravone dexborneol and dl-3-n-butylphthalide are two innovative brain cytoprotective drugs from China that have been approved and widely prescribed for acute ischemic stroke, and the cost of the two drugs are partially paid by the Chinese medical insurance system. This study aimed to investigate and compare the cost-effectiveness of edaravone dexborneol versus dl-3-n-butylphthalide for acute ischemic stroke from the Chinese healthcare system's perspective. METHODS: A model combining a short-term decision tree model with 90 days and a long-term Markov model with a life-time horizon (40 years) was developed to simulate the cost-effectiveness of edaravone dexborneol versus dl-3-n-butylphthalide for acute ischemic stroke over a lifetime horizon. Since the absence of a head-to-head clinical comparison of two therapies, an unanchored matching-adjusted indirect comparison (MAIC) was conducted by adjusting the patient characteristics using individual patient data from pivotal phase III trial of edaravone dexborneol and published aggregated data of dl-3-n-butylphthalide. Health outcomes were measured in quality-adjusted life years (QALYs). Utilities and costs (Chinese Yuan, CNY) were derived from publications and open-access database. One-way and probabilistic sensitivity analyses were performed to evaluate the robustness of results. RESULTS: Compared with patients in dl-3-n-butylphthalide arm, edaravone dexborneol arm was found to be cost-effective in 90 days and highly cost-effective as the study horizons extended. With a similar direct medical cost, patients in edaravone dexborneol arm slightly gained an additional 0.1615 QALYs in life-time. In the long term (40 years), patients in edaravone dexborneol arm and dl-3-n-butylphthalide arm yielded 8.0351 and 7.8736 QALYs with the overall direct medical cost of CNY 29,185.23 and CNY 29,940.28, respectively. The one-way sensitivity analysis suggested that the incremental cost-effectiveness ratio was most sensitive to the price of edaravone dexborneol and dl-3-n-butylphthalide. CONCLUSION: Edaravone dexborneol is a cost-effective alternative compared with dl-3-n-butylphthalide for acute ischemic stroke patients in current medical setting of China.

[Quantitative risk assessment of occupational exposure to PCDD/Fs in the waste incineration industry].

Objective: To analyze the level of PCDD/Fs exposure of occupational workers in the waste incineration industry and explore the risk of occupational exposure. Methods: In September 2021, literature on environmental PCDD/Fs exposure in waste incineration plants published from the establishment of the database to February 10, 2021 was retrieved from CNKI database. A total of 1365 literatures were retrieved, and 7 met the criteria for inclusion. The US Environmental Protection Agency (EPA) inhalation risk model was used to assess and analyze carcinogenic and non-carcinogenic risks of PCDD/Fs exposure among occupational workers in the waste incineration industry. Results: A total of 86 sampling sites were included in incineration plants in 7 regions. The study of Wuhan area showed that the concentration of working environment near the waste incinerator in the same factory was the highest, followed by the rest and office area in the factory. The concentration of PCDD/Fs in waste incinerators was the highest in Southwest China (4880.00-24880.00 pg TEQ/m(3)), and the lowest in Shenzhen (0.02-0.44 pg TEQ/m(3)). According to the cancer risk assessment, with the increase of exposure years, the risk of cancer increased. The highest risk of cancer was found in the waste incineration plants in Southwest China. When the exposure period was 1 year, the risk was moderate (22.40×10(-6)-114.20×10(-6)). When the exposure time was more than 5 years, the risk of cancer was high. In Jinan, workers working near the incinerator had a moderate risk of cancer after five years of exposure. In Zhejiang, workers were at medium risk of cancer after exposure for more than 20 years. Workers in Wuhan, Shanghai, Zhejiang Province, Shenzhen and the Pearl River Delta were still at low risk of cancer after 40 years of occupational exposure. HQ>1 of workers working near the waste incinerators in Jinan, Zhejiang Province and Southwest China, and the qualitative evaluation results showed that the non-carcinogenic risk was unacceptable. Conclusion: There are great differences in PCDD/Fs of occupational exposure in waste incineration industry, and the occupational exposure exceeding the occupational exposure limit has higher carcinogenic and non carcinogenic risks.

Ecological risk assessment and corrective actions for dioxin-polluted sediment in a chemical plant's brine water storage pond.

Despite the known high toxicity of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs, or dioxins), there are few case studies of PCDD/Fs contamination in sediment and there remains much to learn regarding their ecological impact. In this study, we performed an environmental risk assessment of a brine water storage pond near a chemical plant with high PCDD/Fs pollution potential before and after corrective actions. We found PCDD/F accumulation in the pond's fish and crab from the brine water storage pond, and the PCDD/Fs concentrations in biota higher than Taiwan's food safety standard (3.5 pg-TEQ/g). Furthermore, we found a high degree of pollution using different indices, including contamination factor (CF), modified degree of contamination (mCd), and pollution index (PI), in the pond's sediment. Before corrective actions, we also found high risk in the PCDD/F contamination in the sediment using various biological risk indices, including potential ecological risk index (RI) and risk quotient (RQ). After the corrective actions, including institutional/engineering control and remediation, the CF, mCd, and PI had decreased by 20-41 % and RI and RQ by 41-56 %. In addition, despite the slight reduction of pollution and risk index values in the whole pond, significant reduction was observed in the sediment of highly polluted area A owing to the lower disturbing suction dredging. In conclusion, the corrective actions used in this study helped decrease the pollution and ecological risk associated with this site's PCDD/Fs polluted sediment to some extent, suggesting that contamination and risk could be reduced to acceptable levels if these corrective actions are continued.

Transfer of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and polychlorinated biphenyls (PCBs) from oral exposure into cow's milk - part II: toxicokinetic predictive models for risk assessment.

Understanding the transfer of polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) as well as polychlorinated biphenyls (PCBs) from oral exposure into cow's milk is not purely an experimental endeavour, as it has produced a large corpus of theoretical work. This work consists of a variety of predictive toxicokinetic models in the realms of health and environmental risk assessment and risk management. Their purpose is to provide mathematical predictive tools to organise and integrate knowledge on the absorption, distribution, metabolism and excretion processes. Toxicokinetic models are based on more than 50 years of transfer studies summarised in part I of this review series. Here in part II, several of these models are described and systematically classified with a focus on their applicability to risk analysis as well as their limitations. This part of the review highlights the opportunities and challenges along the way towards accurate, congener-specific predictive models applicable to changing animal breeds and husbandry conditions.

Polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) soil contamination in Lausanne, Switzerland: Combining pollution mapping and human exposure assessment for targeted risk management.

In December 2020, high soil concentrations of polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) were discovered across large parts of Lausanne, Switzerland. Concentrations reached up to 640 ng TEQWHO-2005/kg dry weight. The most likely source was a former municipal waste incinerator. A three-step, multidisciplinary approach to human health risk assessment was conducted to determine the potential population exposure to PCDD/Fs and identify appropriate preventive measures. First, exposure scenarios were developed based on contaminated land uses. Second, the toxicological risks of different scenarios were evaluated using a toxicokinetic model estimating increases in blood serum PCDD/F concentrations over background concentrations from the general population's food consumption. Third, a detailed geostatistical mapping of PCDD/F soil contamination was performed. Stochastic simulations with an external drift and an anisotropic model of the variogram were generated to incorporate the effects of distance from emission source, topography, and main wind directions on the spatial distribution of PCDD/Fs in topsoil. Three main scenarios were assessed: i) direct ingestion of soil by children in playgrounds; ii) consumption of vegetables from private gardens by children and adults; and iii) consumption of food from livestock and poultry raised on contaminated soil. The worst exposure scenario involved the consumption of eggs from private hen houses, resulting in PCDD/F concentrations in serum an order of magnitude higher than might normally be expected. No relevant increases in serum concentrations were calculated for direct soil ingestion and vegetable consumption, except for cucurbitaceous vegetables. Combining mapping and exposure scenario assessment resulted in targeted protective measures for land users, especially concerning food consumption. The results also raised concerns about the potential unsafe consumption of products derived from animals raised on land with PCDD/F concentrations only moderately over environmental background levels.

Changes in Polychlorinated Biphenyl Residues in Milk during Lactation: Levels of Contamination, Influencing Factors, and Infant Risk Assessment.

Given the importance of breastfeeding infants, the contamination of human milk is a significant public concern. The aim of this study was to assess the contamination of human milk with dioxin-like PCBs (dl-PCBs) and non-dioxin-like PCBs (ndl-PCBs) in relation to the duration of lactation and other influencing factors, especially the frequency of the consumption of selected foods during pregnancy. Based on this, the health risk to infants was assessed and compared to the tolerable daily intake (TDI). PCB determinations were performed using gas chromatography/mass spectrometry. The ∑ndl-PCB content ranged from 0.008 to 0.897 ng/g w.w., at an average of 0.552 ng/g wet weight, which was 55% of the maximum level according to the EU guidelines for foods for infants and young children. The toxic equivalent (TEQ) was in the range of 0.033-5.67 pg-TEQ/g w.w. The content of non-ortho, mono-ortho, and ndl-PCBs in human milk decreased the longer lactation continued. Moreover, when pregnant women smoked tobacco, this correlated significantly with increases in the concentrations of PCB congeners 156, 118, and 189 in human milk. The human milk contents of PCB congeners 77, 81, 186, 118, and 189 were strongly positively correlated with the amount of fish consumed. The content of stable congeners PCB 135 and PCB 153 increased with age.

Gas chromatography-triple quadrupole mass spectrometry as a cost-effective method for the determination of polychlorinated dibenzo-p-dioxins and furans in contaminated soils.

The aim of this study was to evaluate the performance of gas chromatography (GC)-triple quadrupole mass spectrometry (QqQ, MS/MS) as an alternative to the standard GC-high resolution mass spectrometry (GC-HR/MS) for soils contaminated with polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs). GC-QqQ (MS/MS) using a dynamic multiple reaction monitoring (dMRM) mode was optimized for the quantitative analysis of 17 PCDD/Fs. A comparative study between GC-QqQ (MS/MS) and GC-HR/MS was carried out to validate the results of actual field soil samples. Although GC-HR/MS has excellent sensitivity and selectivity, the validation parameters obtained by GC-QqQ (MS/MS) also met the recommended criteria of the standard method. The results for total and I-TEQ (international toxic equivalent) value of the PCDD/F concentrations of over 86.0 pg/g and 4.3 pg I-TEQ/g, respectively, in actual field soil samples showed good agreement between the two methods, falling within ±25% relative difference. In consideration of the remediation goal (100 pg I-TEQ/g), GC-QqQ (MS/MS) can be an alternative cost-effective method for use in soil remediation research.

Cost-Effectiveness of Elbasvir/Grazoprevir for the Treatment of Chronic Hepatitis C: A Systematic Review.

Objective: This study aims to systematically review recent economic evaluations of elbasvir/grazoprevir (EBR/GZR) for chronic hepatitis C (CHC), to critically appraise the reporting quality and to summarize the results. Methods: A literature search was undertaken using Medline, Embase, the Cochrane Library, EconLit, China National Knowledge Infrastructure, Wanfang Data, and Chongqing VIP to identify original articles containing economic evaluations of EBR/GZR for CHC published between 1 January 2000 and 31 December 2020. The Consolidated Health Economic Evaluation Reporting Standards statement was used to assess the quality of reporting of the articles. Results: Of 93 articles identified, 13 studies fulfilled the inclusion criteria. These studies were conducted in 4 countries, and 8 active interventions were assessed. The target population was patients infected with CHC genotype 1 infection in all studies. Eight out of 13 studies that compared EBR/GZR vs. other direct antiviral agents suggested that EBR/GZR was generally more cost-effective or dominant than daclatasvir/asunaprevir (DCV/ASV), sofosbuvir/velpatasvir (SOF/VEL), ledipasvir/sofosbuvir (LDV/SOF), ombitasvir/paritaprevir/ritonavir + dasabuvir (3D) but not more cost-effective than glecaprevir/pibrentasvir (GLE/PIB). Two studies from China and one study from the USA that compared EBR/GZR vs. pegylated interferon and ribavirin (PegIFN/RBV) consistently indicated that EBR/GZR was generally more cost-effective than PegIFN/RBV. One study from Italy compared EBR/GZR with SOF + PegIFN/RBV and suggested that EBR/GZR had a lower cost and higher effectiveness. One study from France and one study from the USA confirmed that compared with non-therapy for patients with chronic kidney disease, EBR/GZR was cost-effective at commonly accepted current standards. All included studies were of good quality of reporting, with an average score of 21.9 (range 19-23). Conclusion: EBR/GZR for CHC genotype 1 might be cost-effective or dominant compared with PegIFN/RBV and other direct antiviral agents (SOF/VEL, 3D, DCV/ASV, LDF/SOF) or non-therapy. However, under certain assumptions, EBR/GZR was not a cost-effective alternative for CHC patients vs. GLE/PIB.

Cerebral hemodynamic changes assessment by transcranial doppler ultrasound in patients with acute cerebral infarction before and after treatment with butylphthalide.

To assess cerebral hemodynamic changes by transcranial doppler ultrasound in patients with acute cerebral infarction before and after treatment with butylphthalide, A total of 90 patients with acute cerebral infarction admitted to our hospital from January 2019 to January 2020 were selected and equally divided into the control group and the experimental group according to the order of admission. The control group was treated with conventional treatment, while the experimental group was additionally given butylphthalide drug treatment. The experimental group obtained better hemodynamic indexes as compared with the control group (P<0.05). The experimental group yielded a notably higher total clinical effective rate after treatment in contrast with the control group (P<0.05). After treatment, the serum indexes of the experimental group were evidently lower than those of the control group (P<0.05). After treatment, a remarkably lower NIHSS score of the experimental group than the control group was observed (P<0.05). The BI index score of the experimental group after treatment was considerably higher than that of the control group (P<0.05). After treatment, the MMSE score in the experimental group was significantly higher than it was in the control group (P<0.05). The treatment of butylphthalide in patients with acute cerebral infarction can effectively improve the clinical symptoms of the patients and the cerebral hemodynamics of the patients tested by TCD found that this treatment yields an excellent therapeutic effect and is worthy of promotion and application.

Health risk assessment of polychlorinated biphenyls (PCBs) in baby clothes. A preliminary study.

Clothes may contain a large range of chemical additives and other toxic substances, which may eventually pose a significant risk to human health. Since they are associated with pigments, polychlorinated biphenyls (PCBs) may be especially relevant. On the other hand, infants are very sensitive to chemical exposure and they may wear some contact and colored textiles for a prolonged time. Consequently, a specific human health risk assessment is required. This preliminary study was aimed at analyzing the concentrations of PCBs in ten bodysuits purchased in on-line stores and local retailers. The concentrations of 12 dioxin-like and 8 non-dioxin-like PCB congeners were determined by gas chromatography coupled to high resolution mass spectrometry, with detection limits ranging between 0.01 and 0.13 pg/g. The dermal absorption to PCBs of children at different ages (6 months, 1 year and 3 years old) was estimated, and the non-cancer and cancer risks were evaluated. Total levels of PCBs ranged from 74.2 to 412 pg/g, with a mean TEQ concentration of 13.4 pg WHO-TEQ/kg. Bodysuits made of organic cotton presented a total mean PCB concentration substantially lower than clothes made of regular cotton (11.0 vs. 15.8 pg WHO-TEQ/kg). The dermal absorption to PCBs for infants was calculated in around 3·10-5 pg WHO-TEQ/kg·day, regardless the age. This value is > 10,000-fold lower than the dietary intake of PCBs, either through breastfeeding or food consumption. Furthermore, this exposure value would not pose any health risks for the infants wearing those bodysuits. Anyhow, as it is a very preliminary study, this should be confirmed by analyzing larger sets of textile samples. Further investigations should be also focused on the co-occurrence of PCBs and other toxic chemicals (i.e., formaldehyde, bisphenols and aromatic amines) in infant clothes.

Dioxins and dioxin-like PCBs in buffalo milk from the Campania region (Italy): Decreasing trend and baseline assessment over 10 years (2008-2018).

Polychlorodibenzo-p-dioxins, polychlorodibenzo-furans (PCDD/Fs) and dioxin-like polychlorobiphenyls (DL-PCBs) enter the food chain from the environment. In this study, we report the 2008-2018 time-trends in the PCDD/F and DL-PCB contamination of milk from buffaloes fed on local forage in rural areas of the Campania region. Validated according to QA/QC criteria, the dataset (N = 808 on a total of 2068 samples, after excluding follow-up results and outliers) was computed on the upper-bound value pg WHO-TEQ2005 g-1fat. We assessed time-trends and assayed baseline contamination levels, which displayed log-normal distribution. A significant decreasing trend (p < 0.01) was observed from 2008 to 2009 and 2010; the P50-P95 range fell from 2.37-8.48 pg WHO-TEQ2005 g-1fat (N = 393) in 2008 to 1.73-4.61 in 2009 (N = 86) and to 0.67-1.46 in 2010 (N = 42). From 2010 to 2018 (N = 329), no significant variation was found among years and the related dataset fitted a log-normal distribution (p < 0.05). Occurrence descriptors indicated that the baseline contamination of dairy products (mean = 0.54; P50-P95 = 0.47-1.24) in the Campania Region was well below the EU regulatory limit in force (5.5 pg WHO-TEQ2005 g-1fat). Given the Tolerable Weekly Intake of 2 pg WHO-TEQ kg-1 body weight (bw) proposed by the EFSA for PCDD/Fs and DL-PCBs, this level of baseline contamination is discussed with regard to the orientation of food safety and food security risk connected with buffalo mozzarella cheese production.

Antiangiogenic properties of lichen secondary metabolites.

Lichens are symbiotic organisms which are composed fungi and algae and/or cyanobacteria. They produce a variety of characteristic secondary metabolites. Such substances have various biological properties including antimicrobial, antiviral, and antitumor activities. Angiogenesis, the growth of new vessels from pre-existing vessels, contributes to numerous diseases including cancer, arthritis, atherosclerosis, infectious, and immune disorders. Antiangiogenic therapy is a promising approach for the treatment of such diseases by inhibiting the new vessel formation. Technological advances have led to the development of various antiangiogenic agents and have made possible antiangiogenic therapy in many diseases associated with angiogenesis. Some lichens and their metabolites are used in the drug industry, but many have not yet been tested for their antiangiogenic effects. The cytotoxic and angiogenic capacities of lichen-derived small molecules have been demonstrated in vivo and in vitro experiments. Therefore, some of them may be used as antiangiogenic agents in the future. The secondary compounds of lichen whose antiangiogenic effect has been studied in the literature are usnic acid, barbatolic acid, vulpinic acid, olivetoric acid, emodin, secalonic acid D, and parietin. In this article, we review the antiangiogenic effects and cellular targets of these lichen-derived metabolites.

Cost-effectiveness analysis of fruquintinib versus regorafenib as the third-line therapy for metastatic colorectal cancer in China.

OBJECTIVES: The aim of this study is to assess the cost-effectiveness of fruquintinib compared to regorafenib as third-line treatment for patients with metastatic colorectal cancer (mCRC) in China. METHODS: A three-state Markov model with monthly cycle was constructed to estimate lifetime incremental cost-effectiveness ratio (ICER) of fruquintinib versus regorafenib as third-line treatment for patients with mCRC from Chinese health care perspective. Survival analysis was applied to calculate transition probabilities using the data from the clinical trials FRESCO and CONCUR, which were also the data sources accessing probabilities of adverse events. Background mortality rate and drug costs were derived from government published data. Costs for medical services were obtained from real-world data and published literatures. Utilities applied to calculate the quality-adjusted life years (QALYs) were obtained from literature review. One-way sensitivity analysis and probabilistic sensitivity analysis were adopted to verify the robustness of the results. RESULTS: Fruquintinib provided 0.74 QALYs at a cost of CNY 151,058 (USD 22,888), whereas regorafenib provided 0.79 QALYs at a cost of CNY 226,657 (USD 32,224). Compared to fruquintinib, the ICER of regorafenib was CNY 1,529,197/QALY (USD 231,697/QALY) from Chinese health care perspective, which was above the triple GDP per capita of China in 2019 (CNY 212,676) (USD 32,224) as the threshold to define the cost-effectiveness. One-way sensitivity analysis showed the results were generally robust. Cost-effectiveness acceptability curves derived from probabilistic sensitivity analysis demonstrated the probability that fruquintinib was more cost-effective was 100% when the threshold was the triple GDP per capita of China. CONCLUSIONS: Compared to regorafenib, fruquintinib, which leads to forego about 0.05 QALYs and save about CNY 75,599 (USD 11,454), is a cost-effective choice as the third-line treatment for patients with mCRC in China.

Health risk assessment of exposure to polychlorinated dibenzo-p-dioxins/dibenzofurans (PCDD/Fs) and dioxin-like polychlorinated biphenyls (DL-PCBs) in swordfish from the Mediterranean Sea.

Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and dioxin-like polychlorinated biphenyls (DL-PCBs) in fish samples have been investigated in many previous studies. However, the available data regarding this issue in low- and middle-income countries are very scarce, and no study has been performed in Algeria yet. Therefore, this work aimed to determine the levels of PCDD/Fs and DL-PCBs in swordfish (Xiphias gladius) caught in three regions of the Algerian coasts, and the health risk associated with these contaminants was assessed. The PCDD/Fs and DL-PCBs were analyzed in 37 fish samples from Algiers, Bejaia, and Oran using the DR-CALUX bioassay method. The overall mean (and standard deviation) of PCDD/Fs and DL-PCBs concentrations in swordfish from Algiers, Bejaia, and Oran were 0.19 (0.13), 0.27 (0.24), and 0.08 (0.05) pg TEQ g-1 wet weight (ww), respectively, which were lower than the national and European regulatory limits. Daily and weekly intake values of PCDD/F and DL-PCB were higher for the samples from Bejaia (0.45 and 3.15 pg TEQ kg-1 body weight (bw) per day and week, respectively) and for the samples from Algiers (0.31 and 2.17 pg TEQ kg-1 bw per day and week, respectively), which were higher than the tolerable weekly intake of 2 pg TEQ kg-1 bw per week recently established by the European Food Safety Authority. Overall, our findings indicate that swordfish consumption poses a risk to the Algerian consumer.

Long-term nationwide assessment of polychlorinated dibenzo-p-dioxins/dibenzofurans and dioxin-like polychlorinated biphenyls ambient air concentrations for ten years in South Korea.

In this study, seasonal/regional variations of Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/DFs) and dioxin like-polychlorinated biphenyls in the ambient air were monitored for ten years (2008-2017) using a high volume air sampler. As a result of strict regulation enforced by Korea Ministry of Environment in 2008, PCDD/DFs concentrations in the ambient air decreased from 0.051 pg I-TEQ Sm-3 in 2009 to 0.014 pg I-TEQ Sm-3 in 2017 which was comparably associated with cut-down of their emission sources from 880.2 g I-TEQ Sm-3 in 2001 to 24.2 g I-TEQ Sm-3 in 2015; revealing that it was only 2.7% against that of 2001. In 2017, mean TEQ concentration level of PCDD/DFs in the air of South Korea was quite low in comparison to its ambient environmental standards of 0.6 pg I-TEQ Sm-3 for PCDD/DFs. Particularly, the sum of PCDD/DFs in the background revealed the lowest level, however, the fraction of octachlorodibenzodioxin among other isomers exposed at the highest level in this study, suggesting that the ambient air quality in the background being studied was severely and persistently impaired by inflowing unknown sources of any possible anthropogenic transboundary migratory air pollutants. Moreover, this study conducted the scientific analysis of the long-term variations in the ambient air and emission sources using principal component analysis. From this of 10 years long-term nationwide assessments for the PCDD/DFs and dl-PCBs in the ambient air, it is possible to prove that South Korean environmental policy to manage POPs has been successfully conducted for the last ten years.

Cost-effectiveness analysis of fruquintinib for metastatic colorectal cancer third-line treatment in China.

BACKGROUND: In this study, we analyze the cost-effectiveness of fruquintinib as third-line treatment for patients with metastatic colorectal cancer in China, especially after a recent price drop suggested by the National Healthcare Security Administration. METHODS: A Markov model was developed to investigate the cost-effectiveness of fruquintinib compared to placebo among patients with metastatic colorectal cancer. Effectiveness was measured in quality-adjusted life years (QALY). The Chinese healthcare payer's perspective was considered with a lifetime horizon, including direct medical cost (2019 US dollars [USD]). A willing-to-pay threshold was set at USD 27,130/QALY, which is three times the gross domestic product (GDP) per capita. We examined the robustness of the model in one-way and probabilistic sensitivity analysis. RESULTS: Fruquintinib was associated with better health outcomes than placebo (0.640 vs 0.478 QALYs) with a higher cost (USD 20750.9 vs USD 12042.2), resulting in an incremental cost-effectiveness ratio (ICER) of USD 53508.7 per QALY. This ICER is 25% lower than the one calculated before the price drop (USD 70952.6 per QALY). CONCLUSION: After the price negotiation, the drug becomes cheaper and the ICER is lower, but the drug is still not cost effective under the standard of 3 times GDP willing-to-pay threshold. For patients with metastatic colorectal cancer in China, fruquintinib is not a cost-effective option under the current circumstances in China.