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OBJECTIVE To evaluate the econ omical efficiency of daratumumab combined with lenalidomide and dexamethasone （D-Rd） regimen versus lenalidomide and dexamethasone （Rd） regimen alone in the treatment of transplant- ineligible newly diagnosed multiple myeloma （TNE-NDMM）. METHODS From the perspective of China ’s health system ，a partitioned survival model with three health states of progression free survival ，disease progression and death was established by using the published MAIA test data and relevant literature data. The model cycle was 28 days and the simulation time limit was 20 years. The incremental cost-effectiveness ratio （ICER）was calculated using quality-adjusted life years （QALY）as the output index. Sensitivity analysis was performed for key parameters. RESULTS The results of basic analysis showed that the ICER of D-Rd regimen versus Rd regimen was 2 719 038.08 yuan/QALY，far exceeding 3 times of GDP per capita in 2021（242 928 yuan）. The results of single factor sensitivity analysis showed that cost discount rate ，progression-free survival utility value ，utility discount rate，the cost of daratumumab and lenalidomide had a greater impact on ICER. Probabilistic sensitivity analysis suggested that the probability of economic advantage of D-Rd regimen was always 0 within the WTP range of 0-1 200 000 yuan. CONCLUSIONS Compared with Rd regimen ，D-Rd regimen has no cost-effectiveness advantage for the treatment of TNE-NDMM under the WTP of 3 times GDP per capita of China .
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OBJECTIVE From the perspective o f China ’s h ealth service system ，to ev aluate the cost-effectiveness of sintilimab combined with chemotherapy in the first-line treatment of advanced or recurrent non-small cell lung cancer （NSCLC），so as to provide reference for the selection of clinical medication plan and medical and health decision-making. METHODS Based on the ORIENT-11 study data ，a partitioned survival model was established ，and the model period was 21 days to simulate the death of 99％ of the patients. Using quality-adjusted life years （QALY）as an output indicator ，the cost-effectiveness of sintilimab combined with chemotherapy （trial group ）versus chemotherapy alone （control group ）in the first-line treatment of advanced or recurrent NSCLC was evaluated. Cost and utility were discounted using 5％ discount rate ；sensitivity analysis and scenario analysis were used to verify the robustness of the underlying analysis results. RESULTS Under the premise that 3 times of the per capita gross domestic product （GDP）of China in 2020 was used as the threshold of willingness-to-pay （WTP），the patients in the trial group obtained more utility （0.482 QALY）and also spent nearly twice as much as the control group. The incremental cost-effectiveness ratio（ICER）was 334 974.41 yuan/QALY. Univariate sensitivity analysis showed that progression-free survival status utility value ， pemetrexed price ，utility discount rate ，cost discount rate and sintilimab price had a greater impact on ICER. The results of probability sensitivity analysis showed that when the WTP threshold was 3 times of China ’s per capita GDP in 2020，the probability of the trial group ’s plan being cost-effective was 6.5％. The results of the scenario analysis verified the robustness of the underlying analysis results. CONCLUSIONS On the premise of taking 3 times of China ’s per capita GDP in 2020 as the WTP threshold ， sintilimab combined with chemotherapy is not cost-effective for first-line treatment of advanced or recurrent NSCLC compared with chemotherapy alone.
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Objective To investigate the effect of Liu-Shen-Wan on transplanted tumors in mice with colon cancer based on the polarization of M2 macrophages in the tumor microenvironment. Methods We established a subcutaneous transplantation tumor model of mice with CT26 colon cancer. Mice were randomly divided into vehicle, oxaliplatin, and oxaliplatin combined with Liu-Shen-Wan groups. Treatment was administered for three weeks, and tumor volume was measured. All mice were weighed during the administration. After the end of the treatment, the mice were dissected and tumors were photographed and weighed. Spleen index was calculated. The expression levels of IFN-γ and IL-12P40 in serum and related blood biochemical indices were measured. The expression levels of M2 macrophage polarization indices, namely, IL-10 and TGF-β, in serum and tumor tissues were detected. The infiltration degree of M2 macrophages in each group was observed by immunohistochemical experiments. Results The tumor volume and mouse weight in the oxaliplatin combined with Liu-Shen-Wan group significantly decreased compared with those in the vehicle group. The spleen index increased, and the expression levels of IFN-γ and IL-12P40 in serum also significantly increased. The mice had no obvious side effects after the drug treatment. In addition, the expression levels of IL-10 and TGF-β in the serum and tissues of mice in the oxaliplatin combined with Liu-Shen-Wan group significantly decreased. The expression levels of CD68 and CD206 in tumor tissues also decreased. Conclusion The anti-tumor effect of Liu-Shen-Wan on the transplanted tumors of mice with colon cancer is related to the inhibition of M2 macrophage polarization in the tumor microenvironment.
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BACKGROUND: Special anatomical location makes eye lens expose to stressful situation in a long term. Whether the environmental stress can up-regulate the expression of heat shock proteins in human lens epithelial cells? Whether the synthesis increase occurs in the level of trenscdption or translation, remains unclear.OBJECTIVE: To observe the expression and location of heat shock protein 27 (HSP27) in human lens epithelial cells under the conditions of high temperature and oxidative stress, and to investigate the pathogenesis of the cataract.METHODS: Human lens epithelial cells cultured in vitro were exposed to heat (45 ℃) and oxidative stress (50 mmol/L H_2O_2) for 30 minutes, respectively, then allowed to recover normal conditions. At different intervals (0, 2, 4, 6, 16, 24 hours),immunocytochemistry and reverse transcription polymerase chain reaction were used to determine the expression and localization of HSP27.RESULTS AND CONCLUSION: HSP27 was shown to express in both physiological and stressful conditions. The expressions of HSP27 mRNA and protein ware remarkably increased at 2 hours following heat and oxidative stress, and reached the peak at 6 hours. HSP27 could maintain a high level for 16 hours. The stress-induced HSP27 protein positive particles transferred from the cytoplasm to the nucleus, and gradually shift back to the cytoplasm along time. It is proved that HSP27 exists in lens epithelial cells and can be increased after stress. The data suggested it may play an important protective role in lens epithelial cells in respond to cellular stress.
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BACKGROUND: Special anatomical location makes eye lens expose to stressful situation in a long term, so it needs persistent protection to resist stress. Heat shock proteins (HSPs) exert self-protective defensive effect under the stress.OBJECTIVE: To observe the changes in mRNA expression of HSPs in the lens under the condition of exogenous stress.DESIGN: Repeated measurement, controlled observation trial.SETTING: Department of Ophthalmology, First Hospital Affiliated to Jiamusi University.PARTICIPANTS: Human lens endothelial cells B3 (LEC-B3) were obtained from the Department of Ophthalmology, First Hospital Affiliated to China Medical University. Reverse transcription-polymerase chain reaction (RT-PCR) kit was purchased from Bao Biotechnology Company, Japan.METHODS: This experiment was carried out in the Laboratory of Congenital Malformation, Ministry of Public Health,China Medical University between September 2003 and September 2004. LEC-B3 of the exponential growth was used for the experiment. Thermal or oxidative stress on LEC-B3 cells were produced by 30-minute exposure at 45 ℃ or incubated for 30 minutes in DMEM supplemented with 50 mmol/L H2O2. Some stressful cells were allowed to recuperate after exposure to stress in normal culture medium at 37 ℃ for 0, 2, 4, 6, 16 and 24 hours, separately. The expressions of HSP27 and HSP70 in the LEC-B3 were detected by RT-PCR.MAIN OUTCOME MEASURES: The expressions of HSP27 and HSP70 in LEC-B3.RESULTS: HSPs existed in both physiological and stressful situation. The levels of HSPmRNA were increased 2 hours after both stresses. But the expressions of HSP27 and HSP70 got to the summit at different intervals from 2 hours to 6 hours in each group. Subsequently, they were decreased gradually in each group, but they all could maintain a high level at 16 hours.CONCLUSION: Stressful environment induces the over-expressions of HSP27 mRNA and HSP70 mRNA in LEC-B3. This may play an important protective role in lens epithelial cells in responding to cellular stress.