Cost-effectiveness analysis of toripalimab for metastatic or recurrent triple-negative breast cancer

BackgroundToliparibizumab in combination with nab-paclitaxel (T+N) has excellent efficacy inmetastatic or recurrent triple-negative breast cancer (TNBC), but the optimal choice of sequence of therapy is unclear given the trade-offs between quality of life and cost. Cost-effectiveness analyses can quantify these tradeoffs, leading to more informed decisions. Our objective was to assess the societal cost-effectiveness of the T+N regimen for metastatic or recurrent TNBC.MethodsClinical data were extracted from a multicenter, randomized, double-blind trial, TORCHLIGHT (NCT04085276). Patients were randomized into the T+N group or placebo plus nab-paclitaxel (P+N) group. 531 patients from 53 study locations were randomly assigned (T+N, n=353; P+N, n=178) into intend to treat (ITT) population; 200 and 100 patients, respectively had programmed death protein 1 (PD-L1) positive TNBC. A Markov model was established with a 21-day cycle length. Costs were acquired from local hospitals, effect parameters included quality-adjusted life year (QALY) and incremental cost-effectiveness ratio (ICER).ResultsThe cost differences were 47,538.3 CNY in ITT population (T+N, 143,725.67 CNY; P+N group, 96,187.37 CNY) and 29,258.84 CNY in PD-L1+ subgroup (T+N, 100,128.28 CNY; P+N group, 70,869.45 CNY). Meanwhile, the IEs were 0.03409 in the ITT population (T+N, 0.55323 QALY; P+N, 0.51914 QALY) and 0.03409 in the PD-L1+ subgroup (T+N, 0.42327 QALY; P+N, 0.37628 QALY). The ICERs between T+N and P+N groups were 1,394,548.41 CNY/QALY in the ITT population and 622,663.98 CNY/QALY in the PD-L1+ subgroup. We also analyzed the cost-effectiveness of toripalimab could be received in the Chinese medical insurance catalog. If toripalimab could be reimbursed at an 80% rate, the cost differences were changed to 16,598.99 CNY in ITT population (T+N, 112,786.36 CNY; P+N group, 96,187.37 CNY) and 7,704.58 CNY in PD-L1+ subgroup (T+N, 78,574.03 CNY; P+N group, 70,869.45 CNY). Meanwhile, the IEs remained unchanged. The ICERs between T+N and P+N groups were changed to 486,935.82 CNY/QALY in the ITT population and 163,962.96 CNY/QALY in the PD-L1+ subgroup. Sensitivity analyses indicated the stability of the model and the impact of utility.ConclusionAt current drug prices, the T+N group is not more cost-effective than the P+N group, but after incorporating toripalimab into medical insurance, the T+N group will be more cost-effective for patients with PD-L1+ metastatic or recurrent triple-negative breast cancer

Prosedur penyelesaian pembiayaan bermasalah pada akad mudharabah dalam rangka meminimalisir resiko di BMT Amanah Usaha Mulia Magelang

Permasalah kehidupan perekonomian yang sulit, membuat masyarakat berinisiatif untuk membuka usaha sendiri. Mereka membutuhkan suatu bantuan berupa dana untuk memperlancar usahanya, maka BMT Amanah Usaha Mulia Magelang ikut untuk mengembangkan produknya yaitu pembiayaan mudharabah sesuai perkembangan dunia perbankan dalam target peningkatan keuntungan dan menyejahterakan masyarakat. Dengan diberikanya pembiayaan tersebut, terkadang muncul adanya pembiayaan bermasalah dikarenakan ada beberapa faktor diantaranya ketidakmampuan anggota untuk membayar tepat waktu atau jatuh tempo pembayaran diakibatkan karena usaha anggota yang kurang lancar dan lain sebagaianya. Tugas Akhir ini berjudul “ Prosedur Penyelesaian Pembiayaan Bermasalah pada Akad Mudharabah Dalam Rangka Meminimalisir Risiko” Berdasarkan judul tersebut dapat diambil rumusan masalah yaitu apa penyebab terjadinya pembiayaan bermasalah pada BMT Amanah Usaha Mulia Magelang dan bagaimana prosedur penyelesaian pembiayaaan bermasalah pada akad mudharabah di BMT Amanah Usaha Mulia Magelang. Penelitian ini merupakan penelitian lapangan dimana sumber data yang digunakan berasal dari data primer dan sekunder yang diperoleh melalui metode wawancara dengan manajer, bagian pembiayaan dan dokumentasi. Metode yang digunakan dalam penelitian ini adalah deskriptif kualitatif yang bertujuan untuk menggambarkan secara sistematis dan akurat mengenai objek penelitian. Berdasarkan hasil penelitian dapat disimpulkan bahwa penyebab terjadinya pembiayaan bermasalah yaitu faktor internal meliputi kurang telitinya petugas BMT dalam menganalisi data calon anggota, kurang disiplinya dalam penagihan dan eksternal meliputi karakter anggota yang kurang baik, usahanya bangkrut dan terjadinya bencana alam yang tidak terduga. Adapun prosesdur yang digunakan BMT Amanah Usaha Mulia dalam menyelesaian pembiayaan bermasalah pada akad mudharabah dengan cara kekeluargaan atau musyawarah dengan anggota, penjadwalan kembali (rescheduling), persyaratan kembali (reconditioning), pengambilan jaminan (eksekusi), dan write off final. Di BMT Amanah Usaha Mulia dalam penyelesaian pembiayaan bermasalah jarang menngunakan jalur hukum, tetapi sering menggunakan cara kekeluargaan yang dianggap lebih efektif dan eksekusi jaminan apabila anggota tersebut sudah mengalami macet atau bermasalah

Positive Solutions for a Class of Discrete Mixed Boundary Value Problems with the p,q-Laplacian Operator

In this paper, we consider the existence of solutions for the discrete mixed boundary value problems involving p,q-Laplacian operator. By using critical points theory, we obtain the existence of at least two positive solutions for the boundary value problem under appropriate assumptions on the nonlinearity

A Cross-Channel Dense Connection and Multi-Scale Dual Aggregated Attention Network for Hyperspectral Image Classification

Hyperspectral image classification (HSIC) is one of the most important research topics in the field of remote sensing. However, it is difficult to label hyperspectral data, which limits the improvement of classification performance of hyperspectral images in the case of small samples. To alleviate this problem, in this paper, a dual-branch network which combines cross-channel dense connection and multi-scale dual aggregated attention (CDC_MDAA) is proposed. On the spatial branch, a cross-channel dense connections (CDC) module is designed. The CDC can effectively combine cross-channel convolution with dense connections to extract the deep spatial features of HSIs. Then, a spatial multi-scale dual aggregated attention module (SPA_MDAA) is constructed. The SPA_MDAA adopts dual autocorrelation for attention modeling to strengthen the differences between features and enhance the ability to pay attention to important features. On the spectral branch, a spectral multi-scale dual aggregated attention module (SPE_MDAA) is designed to capture important spectral features. Finally, the spatial spectral features are fused, and the classification results are obtained. The experimental results show that the classification performance of the proposed method is superior to some state-of-the-art methods in small samples and has good generalization

Exosome‐derived ANXA9 functions as an oncogene in breast cancer

Abstract Breast cancer (BCA) is one of the most prevalent cancers among women. Emerging evidence has revealed that Annexin A‐9 (ANXA9) plays a crucial function in the development of some cancers. Notably, ANXA9 has been reported to be a new prognostic biomarker for gastric and colorectal cancers. However, its expression and biological function in BCA have not yet been investigated. Using online bioinformatics tools such as TIMER, GEPIA, HPA, and UALCAN, we predicted ANXA9 expression and its correlation with the clinicopathological characteristics of BCA patients. RT‐qPCR and western blot were utilized to measure ANXA9 mRNA and ANXA9 protein expression in BCA patient tissues and cells. BCA‐derived exosomes were identified by transmission electron microscopy. Functional assays were employed to evaluate the biological role of ANXA9 in BCA cell proliferation, migration, invasion, and apoptosis. A tumor xenograft in vivo model was utilized to assess the role of ANXA9 in tumor growth in mice. Bioinformatics and functional screening analysis revealed that ANXA9 was highly expressed in BCA patient tissues, with median ANXA9 expression 1.5‐ to 2‐fold higher than in normal tissues (p  0.05). ANXA9 silencing induced a significant decrease of around 30% in the colony number of BCA cells (p < 0.01). The number of migrated and invaded BCA cells also decreased by around 65 and 68%, respectively, after silencing ANXA9 (p < 0.01). Tumor size was significantly reduced (nearly half) in the LV‐sh‐ANXA9 group relative to the LV‐NC group in the xenograft model (p < 0.01), suggesting that ANXA9 silencing repressed tumor progression in BCA progression in vitro and in vivo. In conclusion, exosome‐derived ANXA9 functions as an oncogene that facilitates the proliferation, migration, and invasiveness of BCA cells and enhances tumor growth in BCA development, which may provide a new prognostic and therapeutic biomarker for BCA patients

Impact of Anthropogenic Activities and Sea Level Rise on a Lagoon System:Model and Field Observations

The long-term geomorphological evolution of a coastal lagoon is driven by hydrodynamic forcing and is influenced by climate changes and human activities. In this study, a numerical model of the Qilihai lagoon (QL) system was established based on field measurements, previous hydrology data and satellite remote sensing measurements, to simulate the geomorphological evolution of QL from 1900 to 2018. The influences of sea level rise, runoff and human activities on the evolution of geomorphology were investigated. The results of the model show that the construction projects including the tide gate, the bridge, reclamation and the straightening or widening of the tidal channel increased the net deposition within the QL system. Furthermore, the spatial distribution of tidal asymmetry during the natural time period was similar to that of the change in bed thickness. However, bed erosion or deposition was not only dependent on tidal asymmetry but it was also affected by the external sediment supply and the discharge of upstream rivers. Moreover, sea level rise had a significant effect on the tidal asymmetry; therefore, it enhanced the accumulation of sediments in the QL system, while runoff had little effect on the tidal asymmetry or geomorphological changes in the system

Enrichment and Purification of Polyphenol Extract from Sphallerocarpus gracilis Stems and Leaves and in Vitro Evaluation of DNA Damage-Protective Activity and Inhibitory Effects of α-Amylase and α-Glucosidase

An efficient preparative separation method for Sphallerocarpus gracilis stems and leaves polyphenols (SGslP) was established in this study. An X-5 macroporous adsorption resin was selected for the purification of the SGslP, and the polyphenol content of the purified SGslP (PSGslP) was increased 5.11-fold from 8.29% to 42.38% after one treatment run. The chemical composition of the PSGslP was analyzed by HPLC-MS/MS, and the predominant compounds were found to be luteolin-7-glucoside, acacetin-7-acetyglycoside and its isomers. In addition, the PSGslP was evaluated in vitro to determine the DNA damage-protective activity and inhibitory effects of α-amylase and α-glucosidase. The results indicated that the PSGslP exhibited significant protective activities against both ROO• and •OH radical-induced DNA damage. Moreover, the PSGslP exerted a dose-dependent inhibition effect on α-glucosidase but no inhibitory effect on α-amylase. These findings indicate that the Sphallerocarpus gracilis stems and leaves are good natural sources of antioxidants and are potent inhibitors of α-glucosidase activity and are potential anti-diabetic inhibitor

Virulence and Molecular Diversity of the Puccinia striiformis f. sp. tritici Population in Xinjiang in Relation to Other Regions of Western China

In recent years, wheat stripe rust caused severe yield losses in western China, especially the Xinjiang Autonomous Region. The population of the stripe rust fungus Puccinia striiformis f. sp. tritici in the vast region had not been well studied. To determine the population structure and compare it with the populations in the neighboring provinces or autonomous regions, P. striiformis f. sp. tritici isolates from Xinjiang, Qinghai, Gansu, Ningxia, and Tibet in western China were characterized by virulence tests with 19 wheat genotypes that are used to differentiate races of P. striiformis f. sp. tritici in China and by genotyping tests with 15 simple-sequence repeat (SSR) markers. In total, 56 races, including 39 previously known and 17 new races, were identified from 308 isolates obtained from the three epidemiological regions covering five provinces, of which 27 previously known and 8 unknown races were detected in Xinjiang, higher than the numbers in either of the other two regions. The races in Xinjiang consisted of those historically and recently predominant races in other regions of China. The P. striiformis f. sp. tritici population in Xinjiang had a higher genetic diversity than populations in other epidemiological regions. Molecular variation among subpopulations within Xinjiang was higher than in other regions. Both virulence and molecular data indicate that the P. striiformis f. sp. tritici population in Xinjiang is related to but more diverse than those in other epidemiological regions. The results show that Xinjiang is an important stripe rust epidemiological region in China, and the information should be useful for control of the disease in the region as well as in other regions

Enrichment and Purification of Polyphenol Extract from Sphallerocarpus gracilis Stems and Leaves and in Vitro Evaluation of DNA Damage-Protective Activity and Inhibitory Effects of α-Amylase and α-Glucosidase

An efficient preparative separation method for Sphallerocarpus gracilis stems and leaves polyphenols (SGslP) was established in this study. An X-5 macroporous adsorption resin was selected for the purification of the SGslP, and the polyphenol content of the purified SGslP (PSGslP) was increased 5.11-fold from 8.29% to 42.38% after one treatment run. The chemical composition of the PSGslP was analyzed by HPLC-MS/MS, and the predominant compounds were found to be luteolin-7-glucoside, acacetin-7-acetyglycoside and its isomers. In addition, the PSGslP was evaluated in vitro to determine the DNA damage-protective activity and inhibitory effects of α-amylase and α-glucosidase. The results indicated that the PSGslP exhibited significant protective activities against both ROO• and •OH radical-induced DNA damage. Moreover, the PSGslP exerted a dose-dependent inhibition effect on α-glucosidase but no inhibitory effect on α-amylase. These findings indicate that the Sphallerocarpus gracilis stems and leaves are good natural sources of antioxidants and are potent inhibitors of α-glucosidase activity and are potential anti-diabetic inhibitor

Development of Strand-Specific Real-Time RT-PCR to Distinguish Viral RNAs during Newcastle Disease Virus Infection

Newcastle disease virus (NDV) causes large losses in the global fowl industry. To better understand NDV replication and transcription cycle, quantitative detection methods for distinguishing NDV genomic RNA (gRNA), antigenomic RNA (cRNA), and messenger RNA (mRNA) in NDV-infected cells are indispensible. Three reverse transcription primers were designed to specifically target the nucleoprotein (NP) region of gRNA, cRNA, and NP mRNA, and a corresponding real-time RT-PCR assay was developed to simultaneously quantify the three types of RNAs in NDV-infected cells. This method showed very good specificity, sensitivity, and reproducibility. The detection range of the assay was between 5.5×102 and 1.1×109 copies/μL of the target gene. These methods were applied to investigate the dynamics of the gRNA, cRNA, and mRNA synthesis in NDV La Sota infected DF-1 cells. The results showed that the copy numbers of viral gRNA, cRNA, and NP mRNA all exponentially increased in the beginning. The viral RNA copy number then plateaued at 10’h postinfection and gradually decreased from 16 h postinfection. No synthesis priority was observed between replication (gRNA and cRNA amounts) and transcription (mRNA amounts) during NDV infection. However, the cRNA accumulated more rapidly than gRNA, as the cRNA copy number was three- to tenfold higher than gRNA starting from 2 h postinfection. Conclusion. A real-time RT-PCR for absolute quantitation of specific viral RNA fragments in NDV-infected cells was developed for the first time. The development of this assay will be helpful for further studies on the pathogenesis and control strategies of NDV