Impact of the National Reimbursement Drug List Negotiation Policy on Accessibility of Anticancer Drugs in China: An Interrupted Time Series Study

Objective: Since 2016, the Chinese government has been regularly implementing the National Reimbursement Drug List Negotiation (NRDLN) to improve the accessibility of drugs. In the second round of NRDLN in July 2017, 18 anticancer drugs were included. This study analyzed the impact of the NRDLN on the accessibility of these 18 anticancer drugs in China. Methods: National hospital procurement data were collected from 2015 to 2019. As measurements of drug accessibility, monthly average of drug availability or defined daily dose cost (DDDc) was calculated. Interrupted time series (ITS) analysis was employed to evaluate the impact of NRDLN on drug accessibility. Multilevel growth curve models were estimated for different drug categories, regions or levels of hospitals. Results: The overall availability of 18 anticancer drugs increased from about 10.5% in 2015 to slightly over 30% in 2019. The average DDDc dropped from 527.93 CNY in 2015 to 401.87 CNY in 2019, with a reduction of 23.88%. The implementation of NRDLN was associated with higher availability and lower costs for all 18 anticancer drugs. We found an increasing level in monthly drug availability (β2 = 2.1126), which ascended more sharply after the implementation of NRDLN (β3 = 0.3656). There was a decreasing level in DDDc before July 2017 (β2 = −108.7213), together with a significant decline in the slope associated with the implementation of NRDLN (β3 = −4.8332). Compared to Traditional Chinese Medicines, the availability of Western Medicines was higher and increased at a higher rate (β3 = 0.4165 vs. 0.1108). Drug availability experienced a larger instant and slope increase in western China compared to other regions, and in secondary hospitals than tertiary hospitals. Nevertheless, regional and hospital-level difference in the effect of NRDLN on DDDc were less evident. Conclusion: The implementation of NRDLN improves the availability and reduces the cost of some anticancer drugs in China. It contributes to promoting accessibility of anticancer drugs, as well as relieving regional or hospital-level disparities. However, there are still challenges to benefit more patients sufficiently and equally. It requires more policy efforts and collaborative policy combination

Growth, Nutrient Uptake, and Foliar Gas Exchange in Pepper Cultured with Un-composted Fresh Spent Mushroom Residue

Spent mushroom substrate (SMS) can be used as the component of growing medium for the culture of crop plants. Fresh SMS may have the potential as an alternative to peat to raise horticultural plants. In this study, five container media characterized by the proportions of SMS to commercial peat in 0% (control), 25%, 50%, 75%, and 100% were used to raise pepper (Capsicum annum L.) plants. Initial SMS was found to have low available nitrogen (N) content (<20 mg kg-1) but moderate extractable phosphorus (P) content (900 mg kg-1). In the second month photosynthetic rate was found to decline in the 75% treatment. At harvest in the third month, plants in the 100% treatment nearly died out. The 25% treatment resulted in the highest height (19 cm) and diameter growth (0.3 cm), shoot (0.6 g) and root biomass accumulation (0.13 g), fruit weight (3 g), and shoot carbohydrate content (98 mg g-1), but lowest foliar acid phosphatase activity (30 µg NPP g-1 FW min-1). With the increase of SMS proportion in the substrate, the medium pH and electrical conductance (EC) increased with the decrease of foliar size. The available N and P contents in the substrates showed contrasting relationship with N and P contents in pepper plants. Therefore, fresh SMS cannot be directly used as the substrate for the culture of pepper plants. According to our findings fresh SMS was recommended to be mixed in the proportion of 25% with commercial peat for the culture of horticultural plants

Antimicrobial and Antioxidant Activities of N-2-Hydroxypropyltrimethyl Ammonium Chitosan Derivatives Bearing Amino Acid Schiff Bases

N-2-hydroxypropyltrimethyl ammonium chloride chitosan (HACC), a cationic quaternary ammonium salt polymer exhibiting good solubility in water, is widely used because of its low toxicity and good biocompatibility. Herein, through ion exchange reaction, we prepared N-2-hydroxypropyltrimethyl ammonium chitosan derivatives bearing amino acid Schiff bases with good biological activities. The accuracy of the structures was verified by FT-IR and 1H NMR. The antibacterial activity, antifungal activity, and scavenging ability of DPPH radical and superoxide radical of HACC derivatives were significantly improved compared with that of HACC. In particular, HACGM (HACC-potassium 2-((2-hydroxy-3-methoxybenzylidene)amino)acetate) and HACGB (HACC-potassium 2-((5-bromo-2-hydroxybenzylidene)amino)acetate) showed good inhibitory effect on bacteria and fungi, including Staphylococcus aureus, Escherichia coli, Botrytis cinerea, and Fusarium oxysporum f. sp. cubense. The inhibition rate of HACGB on Staphylococcus aureus and Escherichia coli could reach 100% at the concentration of 0.1 mg/mL, and the inhibition rate of HACGM and HACGB on Botrytis cinerea and Fusarium oxysporum f. sp. cubense could also reach 100% at the concentration of 0.5 mg/mL. Improving antimicrobial and antioxidant activities of HACC could provide ideas and experiences for the development and utilization of chitosan derivatives

Novel 2-Hydroxypropyltrimethyl Ammonium Chitosan Derivatives: Synthesis, Characterization, Moisture Absorption and Retention Properties

Recent years have seen a steady increase in interest and demand for the use of humectants based on biodegradable natural polymers in many fields. The aim of this paper is to investigate the moisture absorption and retention properties of 2-hydroxypropyltrimethyl ammonium chitosan derivatives which were modified by anionic compounds via ion exchange. FTIR, H-1 NMR, and C-13 NMR spectroscopy were used to demonstrate the specific structures of chitosan derivatives. The degrees of substitution for objective products were calculated by the integral ratio of hydrogen atoms according to H-1 NMR spectroscopy. Meanwhile, moisture absorption of specimens was assayed in a desiccator at different relative humidity (RH: 43% and 81%), and all target products exhibited enhanced moisture absorption. Furthermore, moisture retention measurement at different relative humidity (RH: 43%, 81%, and drier silica gel) was estimated, and all target products possessed obviously improved moisture retention property. Specifically, after 48 h later, the moisture retention property of HACBA at 81% RH was 372.34%, which was much higher than HA (180.04%). The present study provided a novel method to synthesize chitosan derivatives with significantly improved moisture absorption and retention properties that would serve as potential humectants in biomedical, food, medicine, and cosmetics fields

Preparation of chitosan derivatives containing aromatic five-membered heterocycles for efficient antimicrobial and antioxidant activities

In this study, nine chitosan derivatives containing aromatic five-membered heterocycles were prepared and the effects of different grafting methods on the biological activities of chitosan derivatives were investigated. The structures of all the compounds were characterized by Fourier Transform Infrared (FT-IR) spectroscopy and Nuclear Magnetic Resonance (NMR) spectroscopy, while the antioxidant, antifungal and antibacterial activities of the chitosan derivatives were tested. The experimental data suggested that the chitosan derivatives had outstanding inhibitory ability against Fusarium graminearum, Fusarium oxysporum f.sp.cucumbrum, Staphylococcus aureus and Escherichia coli. At the same time, some of the compounds showed strong scavenging ability against DPPH radical and superoxide radical. Cytotoxicity experiments have demonstrated that some chitosan derivatives are non-toxic to L929 cells. More importantly, compared to chitosan, these chitosan derivatives have good water solubility and can be used as potential polymers for antifungal and antibacterial biomaterials in agriculture

Phenolic Acid Functional Quaternized Chitooligosaccharide Derivatives: Preparation, Characterization, Antioxidant, Antibacterial, and Antifungal Activity

As a promising biological material, chitooligosaccharide (COS) has attracted increasing attention because of its unique biological activities. In this study, fourteen novel phenolic acid functional COS derivatives were successfully prepared using two facile methods. The structures of derivatives were characterized by FT-IR and 1H NMR spectra. The in vitro antioxidant activity experiment results demonstrated that the derivatives presented stronger 1,1-Diphenyl-2-picryl-hydrazyl (DPPH), superoxide, hydroxyl radical scavenging activity and reducing power, especially the N,N,N-trimethylated chitooligosaccharide gallic acid salt (GLTMC), gallic acid esterified N,N,N-trimethylated chitooligosaccharide (GL-TMC) and caffeic acid N,N,N-trimethylated chitooligosaccharide (CFTMC) derivatives. Furthermore, the antifungal assay was carried out and the results indicated that the salicylic acid esterified N,N,N-trimethylated chitooligosaccharide (SY-TMC) had much better inhibitory activity against Botrytis cinerea and Fusarium graminearum. Additionally, the results of the bacteriostasis experiment showed that the caffeic acid esterified N,N,N-trimethylated chitooligosaccharide (CF-TMC) had the potential ability to inhibit Escherichia coli and Staphylococcus aureus bacteria. Altogether, this study may provide a neoteric method to produce COS derivatives with significantly increased biological activities, which have potential use in food, medicine, and health care products and other related industries

Design and optimization of mRNAs encoding an Anti-TIGIT antibody with therapeutic potential for cancer in TIGIT-humanized BALB/c Mice

mRNA drugs are synthesized using cell-free systems without complex and stringent manufacturing processes, which makes their preparation simple, efficient, and economical. Over the past few years, mRNAs encoding antibodies have been one of the research frontiers of antibody drug development. In cancer immunotherapy, mRNAs encoding immune checkpoint antibodies may be advantageous regarding antibody persistence and durability of the anti-tumor immune response of patients. In our previous study, a candidate antibody—AET2010—targeting the novel immune checkpoint TIGIT was reported. Its anti-tumor activity was also investigated using adoptive transfer of NK-92MI cells in a xenograft mouse model, but the limitations of the model did not facilitate precise evaluation. In the present study, we further investigated the therapeutic potential of AET2010 for cancer in TIGIT-humanized BALB/c mice. Next, we explored the design, synthesis, and optimization of mRNAs encoding AET2010 and ultimately obtained a candidate mRNA (mRNA-BU) with favorable in vitro and in vivo expression levels of active AET2010. Particularly, lipid-nanoparticle-encapsulated mRNA-BU delivered to mice produced AET2010 with significantly higher peak concentration and expression duration than an equivalent dose of original AET2010. This study provides a sound basis for developing novel drugs targeting TIGIT

Synthesis, Characterization, and the Antioxidant Activity of Phenolic Acid Chitooligosaccharide Derivatives

A series of phenolic acid chitooligosaccharide (COS) derivatives synthesized by two mild and green methods were illuminated in this paper. Seven phenolic acids were selected to combine two kinds of COS derivatives: the phenolic acid chitooligosaccharide salt derivatives and the phenolic-acid-acylated chitooligosaccharide derivatives. The structures of the derivatives were characterized by FT-IR and H-1 NMR spectra. The antioxidant experiment results in vitro (including DPPH-radical scavenging activity, superoxide-radical scavenging activity, hydroxyl-radical scavenging ability, and reducing power) demonstrated that the derivatives exhibited significantly enhanced antioxidant activity compared to COS. Moreover, the study showed that the phenolic acid chitooligosaccharide salts had stronger antioxidant activity than phenolic-acid-acylated chitooligosaccharide. The cytotoxicity assay of L929 cells in vitro indicated that the derivatives had low cytotoxicity and good biocompatibility. In conclusion, this study provides a possible synthetic method for developing novel and nontoxic antioxidant agents which can be used in the food and cosmetics industry

Trends in cause-specific readmissions in heart failure with preserved vs. reduced and mid-range ejection fraction

Aims The aim of this study was to investigate whether the readmission of heart failure (HF) patients has decreased over time and how it differs among HF with preserved ejection fraction (EF) (HFpEF) vs. reduced EF (HFrEF) and mid-range EF (HFmrEF). Methods and results We evaluated HF patients index hospitalized from January 2004 to December 2011 in the Swedish Heart Failure Registry with 1 year follow-up. Outcome measures were the first occurring all-cause, cardiovascular (CV), and HF readmissions. A total of 20 877 HF patients (11 064 HFrEF, 4215 HFmrEF, and 5562 HFpEF) were included in the study. All-cause readmission was the highest in patients with HFpEF, whereas CV and HF readmissions were the highest in HFrEF. From 2004 to 2011, HF readmission rates within 6 months (from 22.3% to 17.3%,P = 0.003) and 1 year (from 27.7% to 23.4%,P = 0.019) in HFpEF declined, and the risk for 1 year HF readmission in HFpEF was reduced by 7% after adjusting for age and sex (P = 0.022). Likewise, risk factors for HF readmission in HFpEF changed. However, no significant changes were observed in all-cause or CV readmission rates in HFpEF, and no significant changes in cause-specific readmissions were observed in HFrEF. Time to the first readmission did not change significantly from 2004 to 2011, regardless of EF subgroup (all P-values &amp;gt; 0.05). Conclusions Declining temporal trend in HF readmission rates was found in HFpEF, but all-cause readmission still remained the highest in HFpEF vs. HFrEF and HFmrEF. More efforts are needed to reduce the non-HF-related readmission in patients with HFpEF.Funding Agencies|Swedish National Board of Health and Welfare; Swedish Association of Local Authorities and Regions; Swedish Society of Cardiology</p

Preparation of l-Arginine Schiff Bases Modified Chitosan Derivatives and Their Antimicrobial and Antioxidant Properties

We successfully prepared a series of l-arginine Schiff bases acylated chitosan derivatives, aiming to improve the antioxidant activity and antimicrobial activity of chitosan by introducing a furan ring, pyridine ring, and l-arginine structure. The accuracy of the structures of ten compounds was characterized by FT-IR and H-1 NMR. In terms of DPPH radical scavenging activity, except for compound CR3PCA, the scavenging rate of other compounds was higher than chitosan, especially CRCF and CRBF had strong scavenging abilities. At the same time, in the superoxide-radical scavenging activity assay, CRCF, CRBF, CR3PCA, CR2C3PCA, and CR2B3PCA were comparable to positive control at 1.60 mg/mL. Simultaneously, CRFF, CRCF, and CRBF had a certain inhibitory effect on Botrytis cinerea. Furthermore, the inhibitory effect of CRFF, CRCF, and CR3PCA on Staphylococcus aureus was very well, close to the positive control at 1.00 mg/mL. CRCF and CR2B3PCA showed better inhibitory effects on Escherichia coli than other compounds. The MTT assay was used to determine the cytotoxicity of the chitosan derivatives, which proved their safety to fibroblast cells. In summary, the study indicated that some of these compounds have the potential for further development and utilization in the preparation of antioxidants and antimicrobial agents