Cost-Effectiveness and Budget Impact Analysis of Apatinib for Advanced Metastatic Gastric Cancer from the Perspective of Health Insurance System

Objective. This study evaluated the cost-effectiveness of apatinib in patients with chemotherapy-refractory mGC. Patients and Methods. A Markov model was developed to simulate the clinical course of typical patients with chemotherapy-refractory metastatic gastric cancer (mGC). We estimated the 10-year quality-adjusted life-years (QALY), costs, and incremental cost-effectiveness ratios (ICER). Model inputs were derived from the published literature and government sources. Direct costs were estimated from the perspective of the Chinese health insurance system. A scenario analysis for a Patient Assistance Programme (PAP) was performed. Results. Baseline analysis showed that apatinib increased the cost and QALYs by $7859 and 0.192, respectively, relative to conventional chemotherapy, resulting in an ICER of$40,997/QALY gained. When PAP was available, the ICER was $21,132/QALY. Probabilistic sensitivity analyses confirmed that apatinib with PAP achieved nearly 65$22,200. One-way sensitivity analyses demonstrated that the utility of progression-free survival was the most influential factor on the robustness of the model. Budget impact analysis estimated that the annual increase in fiscal expenditures would be approximately 0.45 million dollars. Conclusions. Our analysis suggests that apatinib is likely cost-effective in patients with chemotherapy-refractory mGC when PAP is available

Analysis on vibration response of structure of hydrocyclone under action of internal spiral flow

The numerical modeling and experimental test are carried out to analyze the effects of the coupling between the structure of the hydrocyclone and the internal spiral flow on the structure motion of the hydrocyclone, and the interaction of the fluid and the structure is fully considered. The model of fluid structure interaction (FSI) of the hydrocyclone with variable diameter circular pipe is presented in this paper, and the related numerical simulation and experimental research are also carried out. Using the established fluid-structure interaction model, the dynamic characteristic of the hydrocyclone under the FSI condition is discussed, which obtained the vibration characteristics and the inter facial stress distribution characteristics. The maximum value of deformation is at the small cone-shaped part and the tail part connection of the hydrocyclone. The inter facial stress distribution is showed non symmetric state, and the maximum value of stress is located in the large cone-shaped part. After compared analysis the numerical results and the measured results, the numerical simulation is the same as the distribution trend of the test results at the maximum acceleration and position. The above analysis shows that the two-way FSI calculation model of hydrocyclone with variable diameter circular pipe is reasonable, and the motion characteristics of the structure are changed under the interaction of fluid and structure each other. The influence of the motion of the structure on the flow field of the hydrocyclone cannot be ignored. This is a problem that should be considered in the future design and application of hydrocyclone

OMAE2010-21049 ANALYSIS OF EROSION AND FAILURE IN THE SUDDEN EXPANSION FRACTURING TUBING OF DEEP GAS WELLS

ABSTRACT With the increasing of flow rate during fracturing in deep gas well, the erosion of fracturing tubing is an issue of immense concern to the industry. Based on the Euler-Euler two -fluid theory, the numerical simulations have been performed to predict the flow field in the sudden expansion fracturing tubing. The velocity distributions and sand concentration profiles are obtained, and the simulation results show that separation and reflux come into being in the sudden expansion fracturing tubing when pumping sand slurries at high rate, and the sand concentration increases at some regions. The erosion and failure of the fracturing tubing are relevant to the sand concentration, the velocity and the impact angle. The erosion model was established with the erosion experiment, and the numerical simulation results were used to describe the erosion rate of sudden expansion fracturing tubing according to the established erosion models. The mainly erosion region obtained through the simulation is basically agree with the failure region of tubing during fracturing in deep gas wells

Study on the vibration characteristics of structural of hydrocyclone based on fluid structure interaction

The hydrocyclone of main diameter 28mm with a typical variable diameter pipe structure was selected as the research object, and the interaction of the fluid and the structure was considered on the basis of the hypothesis of small deformation. The two-way fluid structure interaction (FSI) model of the hydrocyclone with variable diameter pipes was presented in this paper, and the related numerical simulation and experimental research was also carried out. The structure vibration characteristics of the structure were analyzed base on the fluid structure interaction, and the vibration characteristics of the structure were obtained. The vibration characteristics of the between the results of numerical simulation and experimental were consistent. Through above analysis showed that the two-way FSI calculation model of hydrocyclone with variable diameter pipe was reasonable. The influence of coupling effect on flow field couldn’t be ignored. The interaction between fluid and structure changed the movement characteristics of the structure, which should be considered in the design and application of hydrocyclone

Rare Copy Number Variants Identify Novel Genes in Sporadic Total Anomalous Pulmonary Vein Connection

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart anomaly. Several genes have been associated TAPVC but the mechanisms remain elusive. To search novel CNVs and candidate genes, we screened a cohort of 78 TAPVC cases and 100 healthy controls for rare copy number variants (CNVs) using whole exome sequencing (WES). Then we identified pathogenic CNVs by statistical comparisons between case and control groups. After that, we identified altogether eight pathogenic CNVs of seven candidate genes (PCSK7, RRP7A, SERHL, TARP, TTN, SERHL2, and NBPF3). All these seven genes have not been described previously to be related to TAPVC. After network analysis of these candidate genes and 27 known pathogenic genes derived from the literature and publicly database, PCSK7 and TTN were the most important genes for TAPVC than other genes. Our study provides novel candidate genes potentially related to this rare congenital birth defect (CHD) which should be further fundamentally researched and discloses the possible molecular pathogenesis of TAPVC

Subgroup Economic Analysis for Glioblastoma in a Health Resource-Limited Setting

BACKGROUND: The aim of this research was to evaluate the economic outcomes of radiotherapy (RT), temozolomide (TMZ) and nitrosourea (NT) strategies for glioblastoma patients with different prognostic factors. METHODOLOGY/PRINCIPAL FINDINGS: A Markov model was developed to track monthly patient transitions. Transition probabilities and utilities were derived primarily from published reports. Costs were estimated from the perspective of the Chinese healthcare system. The survival data with different prognostic factors were simulated using Weibull survival models. Costs over a 5-year period and quality-adjusted life years (QALYs) were estimated. Probabilistic sensitivity and one-way analyses were performed. The baseline analysis in the overall cohort showed that the TMZ strategy increased the cost and QALY relative to the RT strategy by $25,328.4 and 0.29, respectively; and the TMZ strategy increased the cost and QALY relative to the NT strategy by$23,906.5 and 0.25, respectively. Therefore, the incremental cost effectiveness ratio (ICER) per additional QALY of the TMZ strategy, relative to the RT strategy and the NT strategy, amounts to $87,940.6 and$94,968.3, respectively. Subgroups with more favorable prognostic factors achieved more health benefits with improved ICERs. Probabilistic sensitivity analyses confirmed that the TMZ strategy was not cost-effective. In general, the results were most sensitive to the cost of TMZ, which indicates that better outcomes could be achieved by decreasing the cost of TMZ. CONCLUSIONS/SIGNIFICANCE: In health resource-limited settings, TMZ is not a cost-effective option for glioblastoma patients. Selecting patients with more favorable prognostic factors increases the likelihood of cost-effectiveness

miR-21 Is a Promising Novel Biomarker for Lymph Node Metastasis in Patients with Gastric Cancer

Background. Gastric cancer (GC) is an important malignant disease around the world. Abnormalities of microRNAs (miRNAs) have been implicated in carcinogenesis of various cancers. In the present study, we examined miR-21 expression in human gastric cancer with lymph node metastasis and attempted to uncover its relationship with clinicopathologic data, especially with lymph node metastasis. Materials and Methods. The expression levels of miR-21 in the tumor specimens of GC patients were quantified by RT-PCR. The correlation between miR-21 level and multiple clinicopathological factors was then examined by Mann-Whitney test, Kaplan-Meier survival analysis, and operating characteristic (ROC) analysis. Results. The expression level of miR-21 was higher in GC patients with lymph node metastasis than in those without lymph node metastasis (P<0.05). Expression level of miR-21 was significantly correlated with histologic type, T stage, lymph node metastasis and pTNM stage. The overall survival rates in GC patients with low upregulated miR-21 expression were significantly higher than those with high upregulated miR-21 (P<0.05). Conclusion. A close association is implicated between the elevated miR-21and lymph node metastasis, which could potentially be exploited as a practical biomarker for lymph node metastasis in patients with GC

A potential relationship among beta-defensins haplotype, SOX7 duplication and cardiac defects.

OBJECTIVE: To determine the pathogenesis of a patient born with congenital heart defects, who had appeared normal in prenatal screening. METHODS: In routine prenatal screening, G-banding was performed to analyse the karyotypes of the family and fluorescence in situ hybridization was used to investigate the 22q11.2 deletion in the fetus. After birth, the child was found to be suffering from heart defects by transthoracic echocardiography. In the following study, sequencing was used to search for potential mutations in pivotal genes. SNP-array was employed for fine mapping of the aberrant region and quantitative real-time PCR was used to confirm the results. Furthermore, other patients with a similar phenotype were screened for the same genetic variations. To compare with a control, these variations were also assessed in the general population. RESULTS: The child and his mother each had a region that was deleted in the beta-defensin repeats, which are usually duplicated in the general population. Besides, the child carried a SOX7-gene duplication. While this duplication was not detected in his mother, it was found in two other patients with cardiac defects who also had the similar deletion in the beta-defensin repeats. CONCLUSION: The congenital heart defects of the child were probably caused by a SOX7-gene duplication, which may be a consequence of the partial haplotype of beta-defensin regions at 8p23.1. To our knowledge, this is the first congenital heart defect case found to have the haplotype of beta-defensin and the duplication of SOX7