Poor sample size reporting quality and insufficient sample size in economic evaluations conducted alongside pragmatic trials: a cross-sectional survey.

OBJECTIVES: Economic evaluations based on well-designed and -conducted pragmatic randomized controlled trials (pRCTs) can provide valuable evidence on the cost-effectiveness of interventions, enhancing the relevance and applicability of findings to healthcare decision-making. However, economic evaluation outcomes are seldom taken into consideration during the process of sample size calculation in pragmatic trials. The reporting quality of sample size and information on its calculation in economic evaluations that are well-suited to pRCTs remain unknown. This study aims to assess the reporting quality of sample size and estimate the power values of economic evaluations in pRCTs. STUDY DESIGN AND SETTING: We conducted a cross-sectional survey using data of pRCTs available from PubMed and OVID from 1 January 2010 to 24 April 2022. Two groups of independent reviewers identified articles; three groups of reviewers each extracted the data. Descriptive statistics presented the general characteristics of included studies. Statistical power analyses were performed on clinical and economic outcomes with sufficient data. RESULTS: The electronic search identified 715 studies and 152 met the inclusion criteria. Of these, 26 were available for power analysis. Only 9 out of 152 trials (5.9%) considered economic outcomes when estimating sample size, and only one adjusted the sample size accordingly. Power values for trial-based economic evaluations and clinical trials ranged from 2.56% to 100% and 3.21%-100%, respectively. Regardless of the perspectives, in 14 out of the 26 studies (53.8%), the power values of economic evaluations for quality-adjusted life years (QALYs) were lower than those of clinical trials for primary endpoints (PEs). In 11 out of the 24 (45.8%) and in 8 out of the 13 (61.5%) studies, power values of economic evaluations for QALYs were lower than those of clinical trials for PEs from the healthcare and societal perspectives, respectively. Power values of economic evaluations for non-QALYs from the healthcare and societal perspectives were potentially higher than those of clinical trials in 3 out of the 4 studies (75%). The power values for economic outcomes in Q1 were not higher than those for other journal impact factor quartile categories. CONCLUSION: Theoretically, pragmatic trials with concurrent economic evaluations can provide real-world evidence for healthcare decision makers. However, in pRCT-based economic evaluations, limited consideration, and inadequate reporting of sample-size calculations for economic outcomes could negatively affect the results' reliability and generalisability. We thus recommend that future pragmatic trials with economic evaluations should report how sample sizes are determined or adjusted based on the economic outcomes in their protocols to enhance their transparency and evidence quality.

Bipolar Photoelectrochemistry for Phase-Modulated Optoelectronic Hybrid Nanomotor.

Complex micro/nanorobots may be constructed by integrating several independent, controlled nanomotors for high degrees of freedom of maneuvering and manipulation. However, designing nanomotors with distinctive responses to the same global stimuli is challenging due to the nanomotors' simple structure and limited material composition. In this work, we demonstrate that a nanomotor can be designed with the same principles of electronic circuits, where the motion of semiconductor particles can be controlled with synchronized electric and optical signals. This technique relies on transient bipolar photoelectrochemistry in semiconductor microparticles, where the reaction site selectivity is realized by modulating the light pulse in the time domain. Due to the microparticles' intrinsic resistance and surface capacitance, the nanomotors can be designed as an electronic circuit, enabling distinctive responses to the global electric/optical field and achieving the desired movement or deflection/rotation. This work gives new insight into the manipulation technique for independent and untethered nanomotor control. Ultimately, it exploits the potential for particle sorting based on geometry in time and frequency domain modulation.

Time-dependent efficacy analysis of first-line immunotherapies for advanced non-small cell lung cancer.

BACKGROUND: Many randomized controlled trials (RCTs) and network meta-analyses have demonstrated that the progression-free survival (PFS) and overall survival (OS) of advanced non-small cell lung cancer (NSCLC) patients can be improved through combination immunotherapy or monotherapies. However, time-dependent analysis of the treatment effect is currently lacking. Thus, we aimed to evaluate the efficacy of first-line immunotherapy, and establish a hazard ratio function to reflect the time-varying progression or mortality risk of patients with NSCLC. METHODS: Seventeen clinical trials were selected based on search strategy. Baseline characteristics, including the age, sex, smoking status, geographical region, and Eastern Cooperative Oncology Group (ECOG) performance status of patients, were balanced, resulting in ten immunotherapies from nine appropriate clinical trials to conduct treatment effect comparison. RESULTS: We found that nivolumab plus ipilimumab (nivo + ipi) improved the PFS and OS over time. The hazard ratio of nivo + ipi, relative to that of pembrolizumab, decreased from 1.11 to 0.36 for PFS, and from 0.93 to 0.49 for OS over a 10-year period. In terms of the response to immunotherapy in patients with different PD-L1 expression levels, patients with PD-L1 > = 50% experienced lower rates of progression and a reduced mortality risk over time. The hazard ratio of patients with PD-L1 > = 50% relative to all of the patients decreased from 0.73 to 0.69 for PFS, and from 0.78 to 0.67 for OS. CONCLUSIONS: Based on the fact that time-dependent progression and mortality risk existed during the treatment duration, physicians should select a suitable treatment regimen for patients based on the hazard ratio.

Template-Guided Silicon Micromotor Assembly for Enhanced Cell Manipulation.

Light-driven micro/nanorobots (LMNRs) are tiny, untethered machines with great potential in fields like precision medicine, nano manufacturing, and various other domains. However, their practicality hinges on developing light-manipulation strategies that combine versatile functionalities, flexible design options, and precise controllability. Our study introduces an innovative approach to construct micro/nanorobots (MNRs) by utilizing micro/nanomotors as fundamental building blocks. Inspired by silicon Metal-Insulator-Semiconductor (MIS) solar cell principles, we design a new type of optomagnetic hybrid micromotors (OHMs). These OHMs have been skillfully optimized with integrated magnetic constituent, resulting in efficient light propulsion, precise magnetic navigation, and the potential for controlled assembly. One of the key features of the OHMs is their ability to exhibit diverse motion modes influenced by fracture surfaces and interactions with the environment, streamlining cargo conveyance along "micro expressway"-the predesigned microchannels. Further enhancing their versatility, a template-guided assembly strategy facilitates the assembly of these micromotors into functional microrobots, encompassing various configurations such as "V-shaped", "N-shaped", and 3D structured microrobots. The heightened capabilities of these microrobots, underscore the innovative potential inherent in hybrid micromotor design and assembly, which provides a foundational platform for the realization of multi-component microrobots. Our work moves a step toward forthcoming microrobotic entities boasting advanced functionalities.

Magnetically Manipulated Optoelectronic Hybrid Microrobots for Optically Targeted Non-Genetic Neuromodulation.

Optically controlled neuromodulation is a promising approach for basic research of neural circuits and the clinical treatment of neurological diseases. However, developing a non-invasive and well-controllable system to deliver accurate and effective neural stimulation is challenging. Micro/nanorobots have shown great potential in various biomedical applications because of their precise controllability. Here, a magnetically-manipulated optoelectronic hybrid microrobot (MOHR) is presented for optically targeted non-genetic neuromodulation. By integrating the magnetic component into the metal-insulator-semiconductor junction design, the MOHR has excellent magnetic controllability and optoelectronic properties. The MOHR displays a variety of magnetic manipulation modes that enables precise and efficient navigation in different biofluids. Furthermore, the MOHR could achieve precision neuromodulation at the single-cell level because of its accurate targeting ability. This neuromodulation is achieved by the MOHR's photoelectric response to visible light irradiation, which enhances the excitability of the targeted cells. Finally, it is shown that the well-controllable MOHRs effectively restore neuronal activity in neurons damaged by ß-amyloid, a pathogenic agent of Alzheimer's disease. By coupling precise controllability with efficient optoelectronic properties, the hybrid microrobot system is a promising strategy for targeted on-demand optical neuromodulation.

Colloidal Self-Assembly: From Passive to Active Systems.

Self-assembly fundamentally implies the organization of small sub-units into large structures or patterns without the intervention of specific local interactions. This process is commonly observed in nature, occurring at various scales ranging from atomic/molecular assembly to the formation of complex biological structures. Colloidal particles may serve as micrometer-scale surrogates for studying assembly, particularly for the poorly understood kinetic and dynamic processes at the atomic scale. Recent advances in colloidal self-assembly have enabled the programmable creation of novel materials with tailored properties. We here provide an overview and comparison of both passive and active colloidal self-assembly, with a discussion on the energy landscape and interactions governing both types. In the realm of passive colloidal assembly, many impressive and important structures have been realized, including colloidal molecules, one-dimensional chains, two-dimensional lattices, and three-dimensional crystals. In contrast, active colloidal self-assembly, driven by optical, electric, chemical, or other fields, involves more intricate dynamic processes, offering more flexibility and potential new applications. A comparative analysis underscores the critical distinctions between passive and active colloidal assemblies, highlighting the unique collective behaviors emerging in active systems. These behaviors encompass collective motion, motility-induced phase segregation, and exotic properties arising from out-of-equilibrium thermodynamics. Through this comparison, we aim to identify the future opportunities in active assembly research, which may suggest new application domains.

Cost-effectiveness of first-line immunotherapy for advanced non-small cell lung cancer with different PD-L1 expression levels: A comprehensive overview.

BACKGROUND: Immunotherapies can substantially improve treatment efficacy, despite their high cost. A comprehensive overview of the cost-effectiveness analysis (CEA) of immune checkpoint inhibitors (ICIs) in patients with non-small cell lung cancer based on different tumor proportion scores (TPSs) was conducted. METHODS: PubMed, Embase, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, and NHS Economic Evaluation databases were searched from their inception until August 24, 2022. Data relevant to the CEA results were recorded, and quality assessments conducted based on the Quality of Health Economic Studies (QHES) process. FINDINGS: Fifty-one original studies from seven countries were included. The mean QHES score was 77.0 (range: 53-95). Twenty-seven studies were classified as high-quality, and the rest as fair quality. Pembrolizumab, nivolumab, ipilimumab, atezolizumab, camrelizumab, cemiplimab, sintilimab, tislelizumab, and durvalumab were identified using three TPS categories. While nivolumab plus ipilimumab and pembrolizumab plus chemotherapy were unlikely to be cost-effective in China, the results for the US were uncertain. Atezolizumab combinations were not cost-effective in China or the US, and tislelizumab and sintilimab were cost-effective in China. For TPSs ≥ 50%, the pembrolizumab monotherapy could be cost-effective in some developed countries. Cemiplimab was more cost-effective than chemotherapy, pembrolizumab, and atezolizumab in the US. For TPSs ≥ 1%, the cost-effectiveness of pembrolizumab was controversial due to the different willingness-to-pay thresholds. CONCLUSIONS: None of the atezolizumab combination regimens were found to be cost-effective in any perspective of evaluations. Camrelizumab, tislelizumab, and sintilimab have lower ICERs compared to atezolizumab, pembrolizumab, and nivolumab in China. Cemiplimab may be a more affordable alternative to pembrolizumab or atezolizumab. However, it remains unclear which ICIs are the best choices for each country. Future CEAs are required to select comprehensive regimens alongside randomized trials and real-world studies to help verify the economics of ICIs in specific decision-making settings.

Tunable Self-Thermophoretic Nanomotors with Polymeric Coating.

Thermophoretic micro/nanomotors (MNMs) generate self-propulsion without a chemical reaction. Intrinsically, this promises excellent biocompatibility and is thus suitable for biomedical applications. However, their propulsion efficiency is severely limited due to the poor understanding of the thermophoretic process, which dominates the conversion from thermal energy into mechanical movement. We here developed a series of self-thermophoresis light-powered MNMs with variable surface coatings and discovered obvious self-thermophoresis propulsion enhancement of the polymeric layer. An intrinsically negative self-thermophoretic movement is also observed for the first time in the MNM system. We propose that enthalpic contributions from polymer-solvent interactions should play a fundamental role in the self-thermophoretic MNMs. Quantitative microcalorimetry and molecular dynamics simulations are performed to support our hypothesis. The polymer solvation enthalpy and coating thickness influences on self-thermophoresis are investigated, further highlighting the essential enthalpy contributions to thermophoresis. Our work indicates that surface grafting would be important in designing high-efficiency thermally driven nanorobotic systems for biomedical applications.

Photochromism from wavelength-selective colloidal phase segregation.

Phase segregation is ubiquitously observed in immiscible mixtures, such as oil and water, in which the mixing entropy is overcome by the segregation enthalpy1-3. In monodispersed colloidal systems, however, the colloidal-colloidal interactions are usually non-specific and short-ranged, which leads to negligible segregation enthalpy4. The recently developed photoactive colloidal particles show long-range phoretic interactions, which can be readily tuned with incident light, suggesting an ideal model for studying phase behaviour and structure evolution kinetics5,6. In this work, we design a simple spectral selective active colloidal system, in which TiO2 colloidal species were coded with spectral distinctive dyes to form a photochromic colloidal swarm. In this system, the particle-particle interactions can be programmed by combining incident light with various wavelengths and intensities to enable controllable colloidal gelation and segregation. Furthermore, by mixing the cyan, magenta and yellow colloids, a dynamic photochromic colloidal swarm is formulated. On illumination of coloured light, the colloidal swarm adapts the appearance of incident light due to layered phase segregation, presenting a facile approach towards coloured electronic paper and self-powered optical camouflage.

Self-driven magnetorobots for recyclable and scalable micro/nanoplastic removal from nonmarine waters.

Micro/nanoplastic (MNP) contamination in nonmarine waters has evolved into a notable ecotoxicological threat to the global ecosystem. However, existing strategies for MNP removal are typically limited to chemical flocculation or physical filtering that often fails to decontaminate plastic particulates with ultrasmall sizes or ultralow concentrations. Here, we report a self-driven magnetorobot comprising magnetizable ion-exchange resin sphere that can be used to dynamically remove or separate MNPs from nonmarine waters. As a result of the long-range electrophoretic attraction established by recyclable ion-exchange resin, the magnetorobot shows sustainable removal efficiency of >90% over 100 treatment cycles, with verified broad applicability to varying plastic compositions, sizes, and shapes as well as nonmarine water samples. Our work may facilitate industry-scale MNP removal with affordable cost and minimal secondary pollution and suggests an appealing strategy based on self-propelled micro/nanorobots to sample and assess nanoplastics in aqueous environment.

Ion-exchange enabled synthetic swarm.

Active matters are out-of-equilibrium systems that convert energy from the environment to mechanical motion. Non-reciprocal interaction between active matters may lead to collective intelligence beyond the capability of individuals. In nature, such emergent behaviours are ubiquitously observed in animal colonies, giving these species remarkable adaptive capability. In artificial systems, however, the emergence of non-trivial collective intelligent dynamics remains undiscovered. Here we show that a simple ion-exchange reaction can couple self-propelled ZnO nanorods and sulfonated polystyrene microbeads together. Chemical communication is established that enhances the reactivity and motion of both nanorods and the microbeads, resulting in the formation of an active swarm of nanorod-microbead complexes. We demonstrate that the swarm is capable of macroscopic phase segregation and intelligent consensus decision-making.

Self-rectifying resistance switching memory based on a dynamic p-n junction.

Although resistance random access memory (RRAM) is considered as one of the most promising next-generation memories, the sneak-path issue is still challenging for the realization of high-density crossbar memory array. The integration of the rectifying effect with resistance switching has been considered feasible to suppress the sneaking current. Herein, we report a self-rectifying resistance switching (SR-RS) by a newly discovered Li ions migration induced dynamic p-n junction at the Li-doped ZnO and ZnO layer interface. The Au/Li-ZnO/ZnO/Pt structure exhibits a forming-free and stable resistance switching with a high resistance ratio of R OFF/R ON âˆ¼ 104 and a large rectification ratio ∼106. In the Li-ZnO/ZnO bilayer, the electric field drives the dissociation and recombination of the self-compensated [Formula: see text] complex pairs ([Formula: see text] p-type substitutional defect; [Formula: see text] n-type interstitial defect) through the transport of [Formula: see text] between the two layers, thereby induces the formation of a dynamic p-n junction. Using this structure as a memory stacking device, the maximum crossbar array size has been calculated to be ∼16 Mbit in the worst-case scenario, which confirms the potential of the proposed device structure for the selection-device free and high-density resistance random access memory applications.

AEB-071 Ameliorates Muscle Weakness by Altering Helper T Lymphocytes in an Experimental Autoimmune Myasthenia Gravis Rat Model.

BACKGROUND Myasthenia gravis (MG) is an autoimmune neurological disorder of neuromuscular junctions. In this study we established experimental autoimmune myasthenia gravis (EAMG) rat models to investigate the effects of AEB-071 (AEB), which is a specific inhibitor of protein kinase C that prevents T lymphocyte activation. MATERIAL AND METHODS We utilized animals divided into 4 groups: (1) control rats, (2) EAMG, (3) AEB-071+EAMG, and (4) AZP+EAMG. Drug treatment was continued for 10 days. Ten weeks after immunization we measured body weights, assessed mortality rates, and used Lennon scores to evaluate EAMG grades. We also assessed the proportions of Treg, Th1, Th2, Th17, and lymphocytes using flow cytometry. RESULTS In the absence of drug treatment, we found a significant decline in body weights in the EAMG group in comparison to control rats, and EAMG group rats also had higher Lennon scores (P<0.05). Interestingly, we found that AEB-071 restored the body weight of EAMG rats and the decreased mortality rate compared to AZP treatment. Although a decrease in the number of Treg cells was observed, the proportion of Th lymphocytes was significantly increased in the EAMG group, and AEB-071 treatment decreased the proportion of Th lymphocytes. CONCLUSIONS We concluded that AEB-071 treatment imparts beneficial effects in EAMG rat models by reducing mortality rate and restoring Th lymphocyte balance, and thus may be an attractive candidate for use in MG treatment.

Magnetically separable sulfur-doped SnFe2O4/graphene nanohybrids for effective photocatalytic purification of wastewater under visible light.

In this report, magnetically recoverable sulfur-doped SnFe2O4/graphene (S-SFO/GR) nanohybrids have been successfully developed via a facile solvothermal method. The characterizations on the structural, morphology, and optical properties of the nanohybrids indicate that S-SFO particles are successfully embedded on the GR nanosheets. The photocatalytic activity has been evaluated by photocatalytic degradation of chlorotetracycline under visible light irradiation. Among the composites with various mass ratios, the quasi-first-order rate constant of the nanohybrids formed with 9wt% S in SFO and 15wt% GR (9S-SFO/GR-15) can reach as high as 1.83min-1, which is much higher than that of SFO (0.68min-1) and SFO/GR (0.91min-1), confirming the important role of S and GR for the photocatalytic process. The combination of the three components of S, SFO, and GR has enhanced the visible light absorption capability and inhibited the recombination of photogenerated electron-hole. The 9S-SFO/GR-15 nanohybrids can be recovered easily by a magnet and reused for five times with remained photocatalytic efficiency about 70%. A possible catalytic mechanism explaining the efficient photocatalytic performances of the prepared nanohybrids has been proposed.

Improved Resistance Switching Stability in Fe-Doped ZnO Thin Films Through Pulsed Magnetic Field Annealing.

Five percent of Fe-doped ZnO (ZnO:Fe) thin films were deposited on Pt/TiO2/SiO2/Si substrates by a spin-coating method. The films were annealed without (ZnO:Fe-0T) and with a pulsed magnetic field of 4 T (ZnO:Fe-4TP) to investigate the magnetic annealing effect on the resistance switching (RS) behavior of the Pt/ZnO:Fe/Pt structures. Compared with the ZnO:Fe-0T film, the ZnO:Fe-4TP film showed improved RS performance regarding the stability of the set voltage and the resistance of the high resistance state. Transmission electron microscopy and X-ray photoelectron spectroscopy analyses revealed that the ZnO:Fe-4TP film contains more uniform grains and a higher density of oxygen vacancies, which promote the easier formation of conducting filaments along similar paths and the stability of switching parameters. These results suggest that external magnetic fields can be used to prepare magnetic oxide thin films with improved resistance switching performance for memory device applications.