A systematic review on reporting quality of economic evaluations for negotiated glucose-lowering drugs in China national reimbursement drug list.

BACKGROUND: This study aimed to examine the reporting quality of existing economic evaluations for negotiated glucose-lowering drugs (GLDs) included in China National Reimbursement Drug List (NRDL) using the Consolidated Health Economic Evaluation Reporting Standards 2013 (CHEERS 2013). METHODS: We performed a systematic literature research through 7 databases to identify published economic evaluations for GLDs included in the China NRDL up to March 2021. Reporting quality of identified studies was assessed by two independent reviewers based on the CHEERS checklist. The Kruskal-Wallis test and Mann-Whitney U test were performed to examine the association between reporting quality and characteristics of the identified studies. RESULTS: We have identified 24 studies, which evaluated six GLDs types. The average score rate of the included studies was 77.41% (SD:13.23%, Range 47.62%-91.67%). Among all the required reporting items, characterizing heterogeneity (score rate = 4.17%) was the least satisfied item. Among six parts of CHEERS, results part scored least at 0.55 (score rate = 54.79%) because of the incompleteness of characterizing uncertainty. Results from the Kruskal-Wallis test and Mann-Whitney U test showed that model choice, journal type, type of economic evaluations, and study perspective were associated with the reporting quality of the studies. CONCLUSIONS: There remains room to improve the reporting quality of economic evaluations for GLDs in NRDL. Checklists such as CHEERS should be widely used to improve the reporting quality of economic researches in China.

Adeno-to-squamous transition drives resistance to KRAS inhibition in LKB1 mutant lung cancer.

KRASG12C inhibitors (adagrasib and sotorasib) have shown clinical promise in targeting KRASG12C-mutated lung cancers; however, most patients eventually develop resistance. In lung patients with adenocarcinoma with KRASG12C and STK11/LKB1 co-mutations, we find an enrichment of the squamous cell carcinoma gene signature in pre-treatment biopsies correlates with a poor response to adagrasib. Studies of Lkb1-deficient KRASG12C and KrasG12D lung cancer mouse models and organoids treated with KRAS inhibitors reveal tumors invoke a lineage plasticity program, adeno-to-squamous transition (AST), that enables resistance to KRAS inhibition. Transcriptomic and epigenomic analyses reveal ΔNp63 drives AST and modulates response to KRAS inhibition. We identify an intermediate high-plastic cell state marked by expression of an AST plasticity signature and Krt6a. Notably, expression of the AST plasticity signature and KRT6A at baseline correlates with poor adagrasib responses. These data indicate the role of AST in KRAS inhibitor resistance and provide predictive biomarkers for KRAS-targeted therapies in lung cancer.

Cost-Effectiveness Analysis of Sintilimab Plus Chemotherapy in Advanced Non-Squamous Non-Small Cell Lung Cancer: A Societal Perspective.

INTRODUCTION: The updated ORIENT-11 study demonstrated that sintilimab, when combined with chemotherapy, had promising survival advantage compared to standard chemotherapy alone in the first-line treatment for previously untreated, locally advanced or metastatic non-squamous non-small cell lung cancer (nsNSCLC). This study aims to evaluate the cost-effectiveness of sintilimab plus chemotherapy for advanced nsNSCLC from a Chinese societal perspective. METHODS: A partitioned survival model with a embedded decision tree was developed to assess the economic value of sintilimab plus chemotherapy over a lifetime horizon. Clinical data was captured from the updated ORIENT-11 study, while costs, health productivity losses, and utility values were collected from a nationwide cross-sectional survey in tertiary hospitals across multiple provinces in China. The primary outcomes were measured using the metrics of quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICER). Costs and health outcomes were discounted at an annual rate of 5% per annum. Sensitivity analyses, including one-way and probabilistic sensitivity analyses, subgroup analyses, and scenario analyses, were performed. RESULTS: Compared to standard chemotherapy, treatment with sintilimab plus chemotherapy incurred a mean total cost of $23,979 and gained 0.98 QALYs over the lifetime horizon, resulting in an ICER of $24,568 per QALY gained. The use of sintilimab accumulated direct non-medical costs of $9262 and indirect costs of $6780 over 16 years. Probabilistic sensitivity analyses showed an 84.2% probability of sintilimab plus chemotherapy being cost-effective at a threshold of three times China's per capita gross domestic product in 2022 ($38,201). The model was most sensitive to the discount rate of QALYs and costs, as well as the costs of pemetrexed, sintilimab, and subsequent therapy in progressive disease state. Subgroup analyses indicated favorable incremental net monetary benefits in all subgroups. CONCLUSION: Sintilimab plus chemotherapy is a cost-effective first-line treatment therapy for advanced nsNSCLC in China when compared to standard chemotherapy. These findings, along with the improved progression-free survival and overall survival (OS) observed in ORIENT-11, support the use of this regimen in eligible candidates for advanced nsNSCLC.

EML4-ALK fusions drive lung adeno-to-squamous transition through JAK-STAT activation.

Human lung adenosquamous cell carcinoma (LUAS), containing both adenomatous and squamous pathologies, exhibits strong cancer plasticity. We find that ALK rearrangement is detectable in 5.1-7.5% of human LUAS, and transgenic expression of EML4-ALK drives lung adenocarcinoma (LUAD) formation initially and squamous transition at late stage. We identify club cells as the main cell-of-origin for squamous transition. Through recapitulating lineage transition in organoid system, we identify JAK-STAT signaling, activated by EML4-ALK phase separation, significantly promotes squamous transition. Integrative study with scRNA-seq and immunostaining identify a plastic cell subpopulation in ALK-rearranged human LUAD showing squamous biomarker expression. Moreover, those relapsed ALK-rearranged LUAD show notable upregulation of squamous biomarkers. Consistently, mouse squamous tumors or LUAD with squamous signature display certain resistance to ALK inhibitor, which can be overcome by combined JAK1/2 inhibitor treatment. This study uncovers strong plasticity of ALK-rearranged tumors in orchestrating phenotypic transition and drug resistance and proposes a potentially effective therapeutic strategy.

Blocking methionine catabolism induces senescence and confers vulnerability to GSK3 inhibition in liver cancer.

Availability of the essential amino acid methionine affects cellular metabolism and growth, and dietary methionine restriction has been implicated as a cancer therapeutic strategy. Nevertheless, how liver cancer cells respond to methionine deprivation and underlying mechanisms remain unclear. Here we find that human liver cancer cells undergo irreversible cell cycle arrest upon methionine deprivation in vitro. Blocking methionine adenosyl transferase 2A (MAT2A)-dependent methionine catabolism induces cell cycle arrest and DNA damage in liver cancer cells, resulting in cellular senescence. A pharmacological screen further identified GSK3 inhibitors as senolytics that selectively kill MAT2A-inhibited senescent liver cancer cells. Importantly, combined treatment with MAT2A and GSK3 inhibitors therapeutically blunts liver tumor growth in vitro and in vivo across multiple models. Together, methionine catabolism is essential for liver tumor growth, and its inhibition can be exploited as an improved pro-senescence strategy for combination with senolytic agents to treat liver cancer.

Fluorination Strategy Towards Symmetry Breaking of Boron-centered Tetrahedron for Poly-fluorinated Optical Crystals.

Borate crystals can be chemically and functionally modified by the fluorination strategy, which encourages the identification of emerging fluorooxoborates with a structure and set of characteristics not seen in any other oxide parents. However, the bulk of fluorooxoborates have been found accidentally, rational methods of synthesis are required, particularly for the infrequently occurring poly-fluorinated components. Herein, we reported the use of bifluoride salts as a potent source of fluorine to prepare fluorooxoborates that contain rarely tri-fluorinated [BF3 X] (X=O and CH3 ) tetrahedra and eleven compounds were found. We identified the optical properties of the organofluorinated group [CH3 BF3 ] and their potential for nonlinear optics for the first time. Among these, two non-centrosymmetric components hold potential for the production of 266 nm harmonic coherent light for nonlinear optics, and more crucially, have the benefit of growing large size single crystals. Our study establishes experimental conditions for the coexistence of the diverse functional groups, enabling the production of poly-fluorinated optical crystals.

Breaking the Inherent Interarrangement of [B3O6] Clusters for Nonlinear Optics with Orbital Hybridization Enhancement.

The [B3O6] group as a prime functional unit provides borates with intrinsic properties that are modified by coordination to cations. Inherent [B3O6] cluster structures in borates exclusively made of them have a near-plane configuration, with more than 90% of them having a maximum dihedral angle of zero and the remaining ones being less than 13°. Although such an inherent configuration can produce considerable birefringence for good phase-matching ability, this is not conducive to obtaining high conversion efficiency and beam quality due to the walk-off effects in the nonlinear optical process. In this article, two new borate halides Ca2B3O6X (X = Cl and Br) were reported, in which the confinement effects of distorted halogen-centered secondary building blocks compress the existence space of [B3O6] primitives, resulting in the nonparallel arrangement between [B3O6] clusters in this series. Both compounds show large second harmonic generation effects, and more importantly, the broken inherent interarrangement of [B3O6] clusters makes them a moderate birefringence and small walk-off angle. Their moderate birefringence is due to the large angular alignment between [B3O6] clusters, resulting from the orbital hybridization between the Ca s and the O p orbitals of the terminal O atoms on [B3O6] clusters. Our model supports this viewpoint and offers guidelines for rearranging [B3O6] clusters' arrangements in borates.

Hydroxyfluorooxoborate (NH4)[C(NH2)3][B3O3F4(OH)] for exploring the effects of cation substitution on structure and optical properties.

Cation substitution is a straightforward but effective technique for improving the structure and properties; however, controlling directed substitution still poses significant difficulties. Herein, a metal-free hydroxyfluorooxoborate (NH4)[C(NH2)3][B3O3F4(OH)] has been synthesized using the strategy of heterologous substitution based on the template of A2[B3O3F4(OH)]. Tunable structure and optical properties have been achieved via varied A-site cation substitution. The intrinsic mechanism for this tunability was established by crystallography and theoretical research.

Effect of gap size on the regeneration in Larix principis-rupprechtii plantation.

We conducted a survey on seedlings (height <1 m) and saplings (height ≥1 m, diameter at breast height <5 cm) in 20 gaps of Larix principis-rupprechtii plantations on Guandi Mountains, Shanxi to analyze regene-ration density, growth indicators, and spatial distribution of L. principis-rupprechtii seedlings and saplings under four gap sizes (<60 m2, 60-120 m2, 120-180 m2, and ≥180 m2). The results showed that growth indicators (ground diameter, height) of seedlings and saplings and regeneration density of seedlings were highest in small gaps (14-60 m2). The sapling regeneration density was highest in medium gaps (60-120 m2), and sapling density exceeded seedling density in each size category. L. principis-rupprechtii seedlings and saplings exhibited favorable regeneration in small and medium gaps, while large gaps (120-180 m2) and extra-large gaps (≥180 m2) were unfavorable for L. principis-rupprechtii regeneration. L. principis-rupprechtii seedlings and saplings were mainly distributed within the canopy projection area and along the edge of canopy gap area. Controlling gap size within the range of 14-120 m2 through artificial interventions, such as planting and thinning, could promote the regeneration of L. principis-rupprechtii.

Patient preferences and shared decision making for the traditional Chinese medicine treatment of lung cancer: A discrete choice experiment study.

Background: Traditional Chinese Medicine (TCM), integrating patient preferences into decision-making process, has been widely used in the multimodality therapy of lung cancer. This study aimed to estimate patient preferences for treatment and shared decision-making (SDM) modes concerning inpatient TCM treatment of lung cancer in Shanghai in order to provide a basis for clinical decision-making process on TCM therapy for lung cancer. Methods: This study was conducted among patients (n = 347) from nine tertiary hospitals in Shanghai by discrete-choice experiment (DCE) survey and Shared Decision-Making Questionnaire-patient version (SDM-Q-9) survey. The DCE was developed with the inclusion of the most relevant attributes at appropriate levels for the TCM treatment of lung cancer. The empirical data analyses of patients were performed using mixed logit models. Additionally, subgroup analysis was conducted. Results: In total, 347 respondents completed the questionnaire. All attributes' coefficients were statistically significant for patients' preferences. Patients showed strong preferences for increasing disease control rate, relieving nausea and vomiting, reducing the risk of side effects, and were concerned about monthly out-of-pocket costs. Subgroup analysis indicated that patients with a lower SDM-Q-9 score and those who were satisfied with medical services emphasized more importance of higher disease control rate. Furthermore, most of the patients (90.20%) self-reported a high willingness to use SDM during the decision-making process. Conclusion: In Shanghai, patients mainly preferred SDM and considered disease control rate as the most essential attribute in the TCM treatment of lung cancer. The study findings could underscore the importance of considering patients' preferences and promote SDM.

Li2RbSO4Cl with a Short Ultraviolet Absorption Edge and an Acentric Structure through Assembling Heteroleptic [LiO3Cl] Tetrahedra.

Currently, short-wavelength nonlinear optical materials are urgently needed. Through substituting homoleptic [LiO4] in centrosymmetric LiRbSO4 with heteroleptic [LiO3Cl] tetrahedra, an acentric sulfate chloride, Li2RbSO4Cl, was designed and synthesized by the high-temperature melting method. Li2RbSO4Cl shows a relatively short ultraviolet absorption edge (<200 nm) among newly reported sulfate chlorides. Millimeter-sized crystals were grown due to the congruent melting behavior and high thermal stability of the compound.

Heterologous Isomorphic Substitution Induces Optical Property Enhancement for Deep-UV Crystals: a Case in Rb[B3O3F2(OH)2].

Optical anisotropy is pivotal for optical crystals, and it can be characterized by the maximum algebraic difference in refractive indices. Improving the optical anisotropy, especially for deep-ultraviolet (UV) crystals, is still a challenge and of interest. Herein, a new hydroxyfluorooxoborate, Rb[B3O3F2(OH)2], was obtained by the heterologous isomorphic substitution strategy. Dual enhancement for the band gap and birefringence compared with the parent A[B3O3F2(OH)2] (A = [Ph4P]/[Ph3MeP]) compounds was achieved in Rb[B3O3F2(OH)2]. This considerable enhancement originates from the removal of organic components and the retention of a birefringence-active anionic framework. This enhancement pushes the application region from UV to deep-UV. This discovery not only expands the structural chemistry of borates but also demonstrates the viability of heterologous isomorphic substitution to design deep-UV crystals with enhanced optical property.

Improved Birefringence Activated by Tetrahedra Decorated with a Single Linear Unit.

Performance enhancement induced by structural modification has long been the target in materials science fields. Direct evidence to witness the effectivity of one strategy is challenging and necessary. In this work, a tetrahedra-decoration strategy was proposed to improve the birefringent performance sharply, namely decorating the tetrahedra with a single linear [S2 ] unit. The strategy was verified by comprehensive characterization of two thiogermanates K2 BaGeS4 and K2 BaGeS5 , which crystallize in the same space group, have similar unit cells and the same units arrangements. Theoretical characterization verified that the [GeS5 ] group has much larger polarization anisotropy than [GeS4 ], further demonstrated that the linear [S2 ] led to the sharp birefringence enlargement of K2 BaGeS5 (0.19 vs 0.03 of K2 BaGeS4 ). This work provides a new guiding thought to improve the birefringence performance.

Patient preferences for anti-hyperglycaemic medication for type 2 diabetes mellitus in China: findings from a national survey.

OBJECTIVE: This study aimed to investigate the preferences regarding risks, benefits and other treatment attributes of patients with type 2 diabetes mellitus (T2DM) in China when selecting a second-line anti-hyperglycaemic medicine. METHODS: A discrete choice experiment with hypothetical anti-hyperglycaemic medication profiles was performed using a face-to-face survey administered to patients with T2DM. The medication profile was described using seven attributes: treatment efficacy, hypoglycaemia risk, cardiovascular benefits, gastrointestinal (GI) adverse events, weight change, mode of administration and out-of-pocket cost. Participants chose between medication profiles by comparing attributes. Data were analysed using a mixed logit model with marginal willingness to pay (mWTP) and maximum acceptable risk (MAR) calculated. The preference heterogeneity within the sample was explored using a latent class model (LCM). RESULTS: A total of 3327 respondents from five major geographical regions completed the survey. Treatment efficacy, hypoglycaemia risk, cardiovascular benefits and GI adverse events were major concerns among the seven attributes measured. Weight change and mode of administration were of lesser concern. Regarding mWTP, respondents would pay ¥236.1 (US$36.6) for an anti-hyperglycaemic medication with an efficacy of 2.5% points reduction in HbA1c, while they were willing to accept a weight gain of 3 kg only if they received a compensation of ¥56.7 (US$8.8). Respondents were willing to accept a relatively large increase in hypoglycaemia risk (MAR=15.9%) to improve treatment efficacy from intermediate (1.0% points) to high (1.5% points). LCM identified the following four unobserved subgroups: trypanophobia, cardiovascular-benefits-focused, safety-focused and efficacy-focused and cost-sensitive. CONCLUSION: Patients with T2DM prioritised free out-of-pocket costs, highest efficacy, no hypoglycaemia risk and cardiovascular benefits over weight change and mode of administration. There exists great preference heterogeneity among patients, which should be taken into account in healthcare decision-making processes.

Fructose-1,6-bisphosphatase is a nonenzymatic safety valve that curtails AKT activation to prevent insulin hyperresponsiveness.

Insulin inhibits gluconeogenesis and stimulates glucose conversion to glycogen and lipids. How these activities are coordinated to prevent hypoglycemia and hepatosteatosis is unclear. Fructose-1,6-bisphosphatase (FBP1) is rate controlling for gluconeogenesis. However, inborn human FBP1 deficiency does not cause hypoglycemia unless accompanied by fasting or starvation, which also trigger paradoxical hepatomegaly, hepatosteatosis, and hyperlipidemia. Hepatocyte FBP1-ablated mice exhibit identical fasting-conditional pathologies along with AKT hyperactivation, whose inhibition reversed hepatomegaly, hepatosteatosis, and hyperlipidemia but not hypoglycemia. Surprisingly, fasting-mediated AKT hyperactivation is insulin dependent. Independently of its catalytic activity, FBP1 prevents insulin hyperresponsiveness by forming a stable complex with AKT, PP2A-C, and aldolase B (ALDOB), which specifically accelerates AKT dephosphorylation. Enhanced by fasting and weakened by elevated insulin, FBP1:PP2A-C:ALDOB:AKT complex formation, which is disrupted by human FBP1 deficiency mutations or a C-terminal FBP1 truncation, prevents insulin-triggered liver pathologies and maintains lipid and glucose homeostasis. Conversely, an FBP1-derived complex disrupting peptide reverses diet-induced insulin resistance.

Cs[B3O3F2(OH)2]: discovery of a hydroxyfluorooxoborate guided by selective organic-inorganic transformation.

Selective transformation between organic and inorganic systems is crucial but still remains a challenge. Herein, we demonstrated that selective organic-inorganic transformation is a simple but effective strategy to find new hydroxyfluorooxoborates. By replacing the [Ph4P]/[Ph3MeP] organic cations with Cs atoms, a new hydroxyfluorooxoborate Cs[B3O3F2(OH)2] with three-membered [B3O3F2(OH)2] clusters was synthesized. Theoretical analysis confirmed the effects of different components in the lattice of reported structure on the optical properties.

Finding a Deep-UV Borate BaZnB4 O8 with Edge-sharing [BO4 ] Tetrahedra and Strong Optical Anisotropy.

The polarization modulation of deep-UV light is an important process that incorporates functionality to selectively respond to light-mater interaction. Typically, optical anisotropy is foremost to the use efficiency of deep-UV birefringent crystals. Herein, a new congruently melting polyborate with extremely large birefringence (Δn(001) =0.14@589.3 nm) and band gap (6.89 eV) is discovered as a high performance birefringent crystal, which breaks the current deadlock of deep-UV polyborates that usually show small birefringence. The rigid tetrahedra, including [ZnO4 ] and edge-sharing [BO4 ] tetrahedra, make all the planar [BO3 ] triangles in the lattice adopt preferential arrangement and thereby lead to an extraordinary large birefringence that is larger than all the deep-UV borates with experimentally measured values. Structural analyses with the additional theoretical calculations were used to study the origin of strong optical anisotropy in BaZnB4 O8 .

Were economic evaluations well reported for the newly listed oncology drugs in China's national reimbursement drug list.

PURPOSE: To assess the reporting quality of published economic evaluations of the negotiated oncology drugs listed for China's 2020 National Reimbursement Drug List (NRDL). METHODS: A comprehensive search was conducted to identify economic evaluation studies of negotiated oncology drugs listed in China's 2020 NRDL using the PubMed/MEDLINE, Embase, Web of Science, CNKI, SinoMed, and WanFang Database up to March 31, 2021. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist scored the reporting quality between 0 and 100. A linear regression analysis was employed to examine the influence of various characteristics on the reporting quality scores. RESULTS: Eighty papers were included in the study, with the majority published during the past decade. Furthermore, more than half of the articles (57.5%, or 46 out of 80) were written in English. The average CHEERS score was 74.63 ± 12.75 and ranged from 43.48 to 93.75. The most inadequately reported items included choice of model, characterization of heterogeneity, and discussion, as well as currency, price date and conversion. Higher scores were associated with articles published from 2019 to 2021 and English publications. CONCLUSION: The economic evaluation studies of negotiated oncology drugs listed in 2020 NRDL had moderate reporting quality. The Chinese economic evaluation publications could improve the reporting quality if the CHEERS checklist is consistently implemented. Also, the Chinese journals maybe explore introducing a reporting standard for economic evaluations.

Co-exposure of potentially toxic elements in wheat grains reveals a probabilistic health risk in Southwestern Guizhou, China.

Bijie is located at a typical karst landform of Southwestern Guizhou, which presented high geological background values of potentially toxic elements (PTEs). Recently, whether PTE of wheat in Bijie is harmful to human health has aroused people's concern. To this end, the objectives of this study are to determine the concentrations of PTE [chromium (Cr), nickel (Ni), arsenic (As), lead (Pb), cadmium (Cd), and fluorine (F)] in wheat grains, identify contaminant sources, and evaluate the probabilistic risks to human beings. A total of 149 wheat grain samples collected from Bijie in Guizhou were determined using the inductively coupled plasma mass spectrometer (ICP-MS) and fluoride-ion electrode methods. The mean concentrations of Cr, Ni, As, Cd, Pb, and F were 3.250, 0.684, 0.055, 0.149, 0.039, and 4.539 mg/kg, respectively. All investigated PTEs met the standard limits established by the Food and Agriculture Organization except for Cr. For the source identification, Cr and Pb should be originated from industry activities, while Ni, As, and Cd might come from mixed sources, and F was possibly put down to the high geological background value. The non-carcinogenic and carcinogenic health risks were evaluated by the probabilistic approach (Monte Carlo simulation). The mean hazard quotient (HQ) values in the three populations were lower than the safety limit (1.0) with the exception of As (children: 1.03E+00). However, the mean hazard index (HI) values were all higher than 1.0 and followed the order: children (2.57E+00) > adult females (1.29E+00) > adult males (1.12E+00). In addition, the mean carcinogenic risk (CR) values for Cr, As, Pb, and Cd in three populations were all higher than 1E-06, which cannot be negligible. The mean threshold CR (TCR) values were decreased in the order of children (1.32E-02) > adult females (6.61E-03) > adult males (5.81E-03), respectively, all at unacceptable risk levels. Moreover, sensitivity analysis identified concentration factor (C W ) as the most crucial parameter that affects human health. These findings highlight that co-exposure of PTE in wheat grains revealed a probabilistic human health risk. Corresponding measures should be undertaken for controlling pollution sources and reducing the risks for the local populace.