Patients with moderate-to-severe rheumatoid arthritis have a heavy financial burden. The cost-effectiveness of introducing tofacitinib to the current treatment sequence for patients with moderate-to-severe rheumatoid arthritis who have inadequate response or intolerance to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs-IR) in China remains unknown.
 
  The objective of this study was to assess the cost-effectiveness of introducing tofacitinib into the current treatment sequence in China for patients with moderate-to-severe rheumatoid arthritis who have csDMARDs-IR.
 
  A Markov model was constructed from the perspective of the Chinese healthcare system to compare treatment sequences with and without first-line tofacitinib for patients with rheumatoid arthritis with csDMARDs-IR. The treatment sequence without tofacitinib included adalimumab, etanercept, recombinant human tumor necrosis factor receptor-Fc fusion protein, infliximab, and tocilizumab. Costs were derived from publicly availaberapy was $US5588.14 per QALY gained.
 
  Using the WHO-recommended ICER acceptability threshold of ≤ 1-time per capita Gross Domestic Product (GDP), our analysis suggests that the introduction of tofacitinib into the current treatment sequence for moderate-to-severe RA patients with csDMARDs-IR in China was a cost saving option as first- and second-line treatment, and cost-effective as a third-line treatment option. Of note, use of tofacitinib as first- and second-line treatment post-csDMARDs-IR appeared to be cost saving.
 Using the WHO-recommended ICER acceptability threshold of ≤ 1-time per capita Gross Domestic Product (GDP), our analysis suggests that the introduction of tofacitinib into the current treatment sequence for moderate-to-severe RA patients with csDMARDs-IR in China was a cost saving option as first- and second-line treatment, and cost-effective as a third-line treatment option. Of note, use of tofacitinib as first- and second-line treatment post-csDMARDs-IR appeared to be cost saving.Many developing countries apply technology-based discharge standards that set quantitative limits on pollutant discharges. These standards do not inherently consider ambient constraints and, therefore, cannot guarantee to protect aquatic life from hazardous pollutants. It is a challenge for developing countries to enforce water-quality-based limits for wastewater discharges and guarantee the intended use of water. This study aims to develop a strategy that suits the needs of developing countries for a transition from technology-based discharge standards to water-quality-based discharge limits. To this end, a pilot monitoring program was carried in the Gediz River Basin in Turkey. Surface water, industrial, and urban wastewater samples were collected and analyzed for 45 priority pollutants identified by the European Union and 250 national river basin specific pollutants. The monitoring results revealed that the environmental quality standards (EQSs) were exceeded for 8 priority, and 28 specific pollutants. This finding indicated that the existing technology-based discharge standards are not satisfactory to guarantee the intended water quality, and there is a need for adopting a new strategy for the implementation of water-quality-based discharge limits in Turkey. As a widely applied approach for determining water-quality-based discharge limits, firstly, conservative mass balance with and without consideration of mixing zone was evaluated. The results indicated that this approach was not applicable due to the receiving environment concentrations being higher than the EQSs. As an alternative approach, the dilution methodology, which considers the level of dilution occurring at the immediate discharge point, was tested. The results proved that the dilution methodology is the most appropriate strategy for developing countries with relatively poor surface water quality to improve the water quality to the level where the conservative mass balance approach can be applicable.Arsenic (As) contamination of aquatic and soil environments is a global concern, highlighting the importance of As removal via high-efficiency and low-cost removal technologies.  https://www.selleckchem.com/products/bay-1816032.html  In the present study, novel trimetallic biochar was developed through pyrolyzing corn straw impregnated with inexpensive metal Fe/Al/Zn (hydr)oxides. The results of SEM, FTIR, and XRD verified the formation of metal oxyhydroxides on the surface of the modified biochars, and the modification increased the specific surface area (SSA), total pore volume (TPV), and surface charge of the Fe/Al/Zn (hydr)oxides modified biochar (FAZ-CB). Compared with the original biochar, higher sorption rates and capacities was observed for the FAZ-CB. The maximum As (V) adsorption capacities of FAZ-CB reached 82.9 mg g-1. A pot experiment showed that application of FAZ-CB decreased bioavailable As fractions in the red soil significantly reduced the uptake of As by arugula in edible part and root (42.6 and 56.8%, respectively). The present study demonstrated the superiority of FAZ-CB in the As(V) immobilization in red soil, suggesting that it is a promising candidate for practical application for As immobilization. Therefore, FAZ-CB can be used as a promising functionalized biochar to remediate As contaminated red soil.Excessive growth of filamentous green algae in rivers has attracted much attention due to their functional importance to primary production and carbon cycling. However, comprehensive knowledge of how filamentous green algae affect carbon cycling, especially the CH4 emissions from river ecosystems, remains limited. In this study, incubation experiments were conducted to examine the factors regulating CH4 emissions from a eutrophic river with dense growth of filamentous green algae Spirogyra through combinations of biogeochemical, molecular biological, and stable carbon isotope analyses. Results showed that although water dissolved oxygen (DO) in the algae+sediment (A+S) incubation groups increased up to 19 mg L-1, average CH4 flux of the groups was 13.09 μmol m-2 day-1, nearly up to two times higher than that from sediments without algae (S groups). The significant increase of sediment CH4 oxidation potential and methanotroph abundances identified the enhancing sediment CH4 oxidation during Spirogyra bloom. However, the increased water CH4 concentration was consistent with depleted water [Formula see text] and decreased apparent fractionation factor (αapp), suggesting the important contribution of Spirogyra to the oxic water CH4 production.