Impact of National Centralized Drug Procurement Policy on Antiviral Utilization and Expenditure for Hepatitis B in China

Background and AimsThe National Centralized Drug Procurement (NCDP) policy was launched in mainland China in April 2019, with entecavir (ETV) and tenofovir disoproxil fumarate (TDF) being included in the procurement list. We conducted the current study to investigate the impact of the NCDP policy on the utilization and expenditures of antiviral therapy for chronic hepatitis B (CHB) in China.MethodsProcurement records, including monthly purchase volume, expenditure, and price of nucleos(t)ide analogs (NAs), were derived from the National Healthcare Security Administration from April 2018 to March 2021. The changes in volumes and expenditures of the first-line NAs and bid-winning products were calculated. The effects of price, volume, and structure related to drug expenditure were calculated by the Addis and Magrini (AM) Index System Analysis.ResultsThe purchase volume of NAs significantly increased from 134.3 to 318.3 million DDDs, whereas the expenditure sharply decreased from 1,623.41 to 490.43 million renminbi (RMB) or 241.94 to 73.09 million US dollars (USD). The proportions of first-line NAs rose from 72.51% (ETV: 69.00%, TDF: 3.51%) to 94.97% (ETV: 77.42%, TDF: 17.55%). AM analysis showed that the NCDP policy decreased the expenditure of all NAs (S=0.91) but increased that of the first-line NAs in the bid-winning list (S=1.13). Assuming the population size of CHB patients remains stable and a compliance rate of ≥75%, the proportion of CHB patients receiving first-line antiviral therapy would increase from 6.36–8.48% to 11.56–15.41%.ConclusionsThe implementation of the NCDP policy significantly increased the utilization of first-line NAs for CHB patients at a lower expenditure. The findings provided evidence for optimizing antiviral therapy strategy and allocating medical resources in China.     

Production of butanol from lignocellulosic biomass: recent advances,challenges, and prospects

Due to energy and environmental concerns, biobutanol is gaining increasing attention as an alternative renewable fuel owing to its desirable fuel properties. Biobutanol production from lignocellulosic biomass through acetone–butanol–ethanol (ABE) fermentation has gained much interest globally due to its sustainable supply and non-competitiveness with food, but large-scale fermentative production suffers from low product titres and poor selectivity. This review presents recent developments in lignocellulosic butanol production, including pretreatment and hydrolysis of hemicellulose and cellulose during ABE fermentation. Challenges are discussed, including low concentrations of fermentation sugars, inhibitors, detoxification, and carbon catabolite repression. Some key process improvements are also summarised to guide further research and development towards more profitable and commercially viable butanol fermentation.

Due to energy and environmental concerns, biobutanol is gaining increasing attention as an alternative renewable fuel owing to its desirable fuel properties.     

Application of Iron Tailings-Based Composite Supplementary Cementitious Materials (SCMs) in Green Concrete

How to treat the iron tailings of mining solid waste with high value is an urgent problem on a global scale. In recent years, the application of iron tailings in the building materials industry has attracted the attention of many scholars. The conversion of iron tailings into green building materials helps achieve carbon neutrality and high-value utilization of solid waste, and promotes sustainable development. Although iron tailings have been extensively studied as supplementary cementitious materials, the performance of concrete is not ideal due to its low activity. In this study, the hybrid supplementary cementitious materials system was prepared by iron tailings, phosphorus slag, and steel slag, and the effects of supplementary cementitious materials type, iron tailings content, iron tailings grinding time, and supplementary cementitious materials content on concrete performance were studied. The compressive properties, iron tailings properties, pore structure, interfacial transition zone, and element distribution of hydration products of concrete were tested by compressive strength tests, X-ray Diffractometer (XRD), X-ray Photoelectron Spectroscopy (XPS), Mercury Intrusion Porosimetry (MIP), Backscattering Electron Tests (BSE), and Energy Dispersive Spectrometer (EDS). The results show that further grinding improves the iron tailings activity. There is a synergistic mechanism between steel slag and phosphorus slag in the composite supplementary cementitious materials, which overcomes the low activity defect of iron tailings and produces concrete with a compressive strength exceeding 40 MPa. The composite supplementary cementitious materials can optimize the interfacial transition zone of the concrete interface and reduce the calcium–silicon ratio of the hydration products. However, it will deteriorate the pore structure of the concrete matrix, cause part of the concrete matrix to be damaged and lead to a loss of compressive strength, and the loss is acceptable. This work broadens the methods of comprehensive utilization of iron tailings and also provides a reference for a more detailed understanding of the properties of iron tailings-based concrete.     

Numerical Investigation of the Influence of Ultimate-Strength Heterogeneity on Crack Propagation and Fracture Toughness in Welded Joints

The mechanical properties of dissimilar metal-welded joint materials are heterogeneous, which is an obstacle to the safety evaluation of key welded structures. The variation of stress–strain conditions at the crack tip caused by mismatch of material mechanical properties in dissimilar metal-welded joints is an important factor affecting crack propagation behavior. To understand the influence of uneven distribution of ultimate strength of the base metal and the welded metal on the crack propagation path, fracture toughness, as well as the mechanical field at the crack tip in the small-scale yield range, the user-defined field variable subroutine method is used to express continuous variation characteristics of welded joint ultimate strength in finite element software. In addition, the J-integral during crack propagation is calculated, and the effect of the ultimate strength on the J-integral and the stress field at the crack tip are analyzed. The results show that as the crack propagation direction is perpendicular to the direction of ultimate strength, the gradient of ultimate strength increases from |G_y|= 50 to |G_y|= 100 MPa/mm, the crack deflection angle increases by 0.018%, and the crack length increases by 1.46%. The fracture toughness of the material decreased slightly during crack propagation. Under the condition that the crack propagation direction is the same as the direction of ultimate strength, the crack propagation path is a straight line. As the gradient of ultimate strength increases from G_x = 50 to G_x = 100 MPa/mm, the crack propagation length decreases by 5.17%, and the slope of fracture toughness curve increases by 51.63%. On the contrary, as the crack propagates to the low ultimate strength side, the crack propagation resistance decreases, the ultimate strength gradient increases from G_x = −100 to G_x = −50 MPa/mm, and the slope of the fracture toughness curve decreases by 51.01%. It is suggested to consider the relationship between crack growth behavior and ultimate strength when designing and evaluating the structural integrity of cracks at the material interface of dissimilar metal-welded joints.     

护理带教中强化护生法律意识方法浅析

随着医疗制度的改革,新的医疗法律法规的出台,以及人们法律意识的提高,病人保护自己就医权力的法律意识也不断增强,对医疗护理服务质量、医疗护理安全都提出了更高的要求.近年来医患、护患纠纷也较前有所增加,其中因护理带教所引发的护理纠纷也时有发生.因此我们护理人员不仅自身要不断强化法律意识,同时在护理带教中,除了要对护生进行基础护理操作和专科护理技术的指导及理论知识的灌输外,还要注重培养和强化护生的法律意识,以提高带教中的安全行为,使护生实习顺利完成.     

侧颅底外科的历史与现状

侧颅底外科近年来越来越受到耳神经学科医师的重视,该文对侧颅底外科的历史、手术径路以及相关技术作一概述,使临床上对其有一个系统的认识。     

Two-year clinical outcomes following lower limb endovascular revascularisation for chronic limb-threatening ischaemia at a tertiary Asian vascular centre in Singapore

INTRODUCTIONPercutaneous transluminal angioplasty (PTA) is commonly used to treat patients with chronic limb-threatening ischaemia (CLTI). This study aimed to examine the mortality and functional outcomes of patients with CLTI who predominantly had diabetes mellitus in a multi-ethnic Asian population in Singapore.METHODSPatients with CLTI who underwent PTA between January 2015 and March 2017 at the Vascular Unit at Singapore General Hospital, Singapore, were studied. Primary outcome measures were 30-day unplanned readmission, two-year major lower extremity amputation (LEA), mortality rates, and ambulation status at one, six and 12 months.RESULTSA total of 221 procedures were performed on 207 patients, of whom 184 (88.9%) were diabetics. The one-, six- and 12-month mortality rate was 7.7%, 16.4% and 21.7%, respectively. The two-year LEA rate was 30.0%. At six and 12 months, only 96 (46.4%) and 93 (44.9%) patients were ambulant, respectively. Multivariate analysis revealed that preoperative ambulatory status, haemoglobin, Wound Ischaemia and foot Infection (WIfI) score, and end-stage renal failure (ESRF) were independent predictors of one-year ambulatory status. Predictors of mortality at one, six and 12 months were ESRF, preoperative albumin level, impaired functional status and employment status.CONCLUSIONPTA for CLTI was associated with low one-year mortality and two-year LEA rates but did not significantly improve ambulation status. ESRF and hypoalbuminaemia were independent predictors of mortality. ESRF/CKD and WIfI score were independent predictors of loss of ambulation at six months and one year. We need better risk stratification for patients with CLTI to decide between initial revascularisation and an immediate LEA policy.     

二价双启动子防龋DNA疫苗的构建及鉴定

目的：构建并鉴定具有在真、原核细胞中均可表达目的抗原并具备强免疫原性、针对致龋菌变形链球菌2种主要毒力因子的DNA疫苗.方法：利用PCR技术从载有变形链球菌gtfB基因的质粒中扩增葡聚糖结合区段（GBR）基因片断;将合成的组织纤溶酶原信号肽序列（tPA-SP）连接到GBR基因的上游;再将此基因（sGBR）定向克隆到载有sSBR基因的双启动子真核表达载体pCN-SSIE上,构建出pCN-SSISG;对重组质粒pCN-SSISG进行酶切图谱分析和DNA序列测定.结果：酶切图谱分析显示,PCR扩增的及插入到pCN-SSIE中的目的基因sGBR片断大小与预期相符;DNA序列测定结果确定：重组质粒pCN-SSISG开放性阅读框架和插入的信号肽序列均正确.结论：成功构建了具有在真核、原核宿主细胞均可表达的具有双启动子的质粒pCN-SSISG.     

Effects of cue validity on attentional selection

Visual attention can be allocated to locations or objects, leading to enhanced processing of information at the specific location (space-based effects) or specific object (object-based effects). Previous studies have observed object-based effects to be smaller and less robust than space-based effects, with large individual differences in their temporal occurrence. Studies on space- and object-based effects are often based on a two-rectangle paradigm in which targets appear at cued locations more often than uncued locations. It is, however, unclear whether and how the target''s spatial probability affects the temporal occurrence of these effects. In three experiments with different cue validities (80%, 50% and 33%), we systematically changed the interval between the cue and the target from 50 to 600 ms. On a group level and for individuals, we examined how cue validity affects the occurrence of object- and space-based effects. We observed that the magnitude and the prevalence of space-based effects heavily decreased with reduced cue validity. Object-based effects became even more sparse and turned increasingly negative with decreasing cue validity, representing a different-object rather than a same-object advantage. These findings indicate that changes in cue-validity affect both space- and object-based effects, but it does not account for the low prevalence and magnitude of object-based effects.