Background: Pembrolizumab is a potentially valuable treatment. However, patients, doctors, and healthcare decision-makers are uncertain about its cost-effectiveness and an appropriate pricing for this new therapy. This study aims to appraise the cost-effectiveness of pembrolizumab as a first-line treatment for advanced biliary tract cancer (BTC) patients in China and the United States (US). Methods: A Markov model was constructed from the perspectives of healthcare systems in both China and the US for pharmacoeconomic evaluation. Patient baseline characteristics and key clinical data were sourced from the KEYNOTE-966 trial (ClinicalTrials.gov, NCT04003636). Costs and utilities were collected from drug cost websites and published literature. Cumulative costs (in USD), life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured and compared. Price simulations were conducted under given willingness-to-pay (WTP) thresholds to provide pricing scheme references. The model\'s robustness was analyzed through one-way sensitivity analysis and probabilistic sensitivity analysis. Results: Basic data analysis illustrates that pembrolizumab ($2662.41/100 mg) in combination with chemotherapy regimen was not cost-effective relative to chemotherapy regimens at the WTP threshold of $38,201.19 in China, and the additional cost relative to chemotherapy regimens was $77,114.94 (ICER $556,689.47/QALY) while increasing 0.14 QALYs. Pembrolizumab ($54.71/1 mg) also increased efficacy by 0.14 QALYs in the US, but remained also not cost-effective at the US WTP threshold of $229,044, and the total cost increased by $160,425.24 (ICER $1,109,462.92/QALY). Conclusion: Compared with chemotherapy, pembrolizumab plus chemotherapy reduces the disease of burden. However, at its current price, it may not be a cost-effective treatment for advanced BTC in both China and the US. This study can aid decision-makers in making optimal choices.

BACKGROUND: This study aimed to estimate population-level and state-level lead-attributable mortality burdens stratified by socioeconomic status (SES) class in the USA.
METHODS: Based on the National Health and Nutrition Examination Survey (NHANES), we constructed individual-level SES scores from income, employment, education and insurance data. We assessed the association between the blood lead levels (BLL) and all-cause mortality by Cox regression in the NHANES cohort (n = 31 311, 4467 deaths). With estimated hazard ratios (HR) and prevalences of medium (2-5 μg/dL) and high (≥ 5 μg/dL) BLL, we computed SES-stratified population-attributable fractions (PAFs) of all-cause mortality from lead exposure across 1999-2019. We additionally conducted a systematic review to estimate the lead-attributable mortality burden at state-level.
RESULTS: The HR for every 2-fold increase in the BLL decreased from 1.23 (1.10-1.38) for the lowest SES class to 1.05 (0.90-1.23) for the highest SES class. Across all SES quintiles, medium BLL exhibited a greater mortality burden. Individuals with lower SES had higher lead-attributable burdens, and such disparities haver persisted over the past two decades. In 2017-19, annually 67 000 (32 000-112 000) deaths in the USA were attributable to lead exposure, with 18 000 (2000-41 000) of these deaths occurring in the lowest SES class. Substantial disparities in the state-level mortality burden attributable to lead exposure were also highlighted.
CONCLUSIONS: These findings suggested that disparities in lead-attributable mortality burden persisted within US adults, due to heterogeneities in the effect sizes of lead exposure as well as in the BLL among different SES classes.

暂无摘要。

暂无摘要。

暂无摘要。

Six new species of Cryptochironomus Kieffer, 1918, C.absum Liu, sp. nov., C.beardi Liu, sp. nov., C.dentatus Liu, sp. nov., C.ferringtoni Liu, sp. nov., C.parallelus Liu, sp. nov. and C.taylorensis Liu, sp. nov., are described and illustrated based on adult males. The specimens were collected from various water systems in the United States and preserved by Dr. Leonard Charles Ferrington Jr. An updated key to adult males of all known Cryptochironomus species in the Nearctic region is also provided.

暂无摘要。

暂无摘要。

To discuss the imaging manifestations and the utility of preoperative ultrasonography (US), contrast-enhanced computed tomography (CE-CT) and contrast enhanced magnetic resonance imaging (CE-MRI) in diagnosing the pediatric head and neck lymphatic malformations (HNLMs).
We performed a retrospective review of 170 children who were referred to our hospital in the past 9 years for the treatment of HNLMs.
The diagnostic rates of US, CE-CT and CE-MRI were 93.0% (146/157), 94.7% (143/151) and 100% (45/45), respectively. As in multilocular cases, intracystic septa detection rate was 91.5% (130/142), 50.4% (68/135) and 88.1% (37/42), and which had a statistical difference (χ2 = 25.8131, p < 0.05). US showed capsule contents anechoic in 51.0% (80/157) cases, hypoechoic or mixed echoic in 49.0% (77/157) cases, and flocculent or dotted echo floating in 36.9% (58/157) cases. CT showed low density of the capsule contents without enhancement in 69.5% (105/151) cases and mixed density with enhancement in 30.4% (46/151) cases. Liquid-liquid levers were seen in 8.6% (13/151) cases. MRI showed T1WI high signal and T2WI low signal of the capsule contents without enhancement in 28.9% (13/45) cases and mixed density in 71.1% (32/45) cases. Liquid-liquid levers were seen in 46.7% (21/45) cases. There were statistically significant differences between pure HNLMs and intracystic hemorrhage in capsule content (echo, density, signal), enhancement, and liquid-liquid lever (all p < 0.05). Among US, CE-CT and CE-MRI, intracystic hemorrhage diagnostic accuracy had a statistical difference (χ2 = 25.4152, p < 0.05).
For clinical diagnosis and evaluation of HNLMs, we suggest that US combined with CE-CT for acute cases, and for stable cases, US combined with CE-MRI.

Global agricultural systems face one of the greatest sustainability challenges: meeting the growing demand for food without leaving a negative environmental footprint. United States (US) and China are the two largest economies and account for 39 % of total global greenhouse gases (GHG) emissions into the atmosphere. No-till is a promising land management option that allows agriculture to better adapt and mitigate climate change effects compared to traditional tillage. However, the efficacy of no-till for mitigating GHG is still debatable. In this meta-analysis, we comprehensively assess the impact of no-till (relative to traditional tillage) on GHG mitigation potential and crop productivity in different agroecological systems and management regimes in the US and China. Overall, no-till in China did not change crop yields, although soil CO2 (8 %) and N2O (12 %) emissions decreased significantly, while soil CH4 emissions increased by 12 %. In contrast to Chinese no-till, a significant improvement in crop yields (up to 12 %) was recorded on US cropland under no-till. Moreover, significant decreases in soil N2O (21 %) and CH4 (12 %) emissions were observed. Of the three cropping systems, only wheat showed significant reduction in CO2, N2O and CH4 emissions in the Chinese no-till system. In the case of US, no-till soybean-rice and maize cropping systems demonstrated significant emission reductions for N2O and CO2, respectively. Interestingly, yields of no-till maize in China and rice in US exceeded those of other no-till cereals. In China, no-till on medium-texture soils resulted in significant reductions in GHG emissions and higher crop yields compared to other soil types. In both countries, the relatively higher crop yields under irrigated versus non-irrigated no-till and the significant yield differences on fine textured soils under US no-till are likely due to the substantial N2O reductions. In summary, crop yield disparities from no-till between China and the US were related to the insignificant effects on controlling CH4 emissions and successfully mitigating N2O, respectively. This study comprehensively demonstrates how cropping system and pedoclimatic conditions influence the relative effectiveness of no-till in both countries.