Cost-effective Option Research Articles

Techno-economic analysis of a PV/WT/biomass off-grid hybrid power system for rural electrification in northern Morocco using HOMER

The increasing environmental concerns associated with fossil fuels have elevated the significance of sustainable energy sources such as solar, wind, and biomass. This study aims to design a hybrid renewable energy system capable of meeting the annual energy demand of residential areas in Zoumi's circle, estimated at 15545.13 kWh/day. Using HOMER Pro software, we analyze various combinations of renewable resources (solar, wind, biomass) and storage solutions (batteries) to assess their electricity generation, cost implications, and environmental impact. The study identifies an optimal hybrid configuration that includes solar, wind, biomass, batteries, and converters. This integrated system proves to be the most cost-effective option, achieving an energy cost of 0.125 $/kWh and a net present cost (NPC) of 8.29 $ million. It generates 11.14 GWh/year and achieves a 100 % renewable energy ratio, significantly reducing CO2 emissions by approximately 5900 tons/year compared to diesel generators.

Comparing Complication Rates, Costs, and Length of Stay between Unicompartmental and Total Knee Arthroplasty: Insights from a Big Data Analysis Using the National Inpatient Sample Dataset.

Background: Unicompartmental knee arthroplasty (UKA) is increasingly used for knee osteoarthritis due to faster recovery, better range of motion, and lower costs compared to total knee arthroplasty (TKA). While TKA may offer longer-lasting results with lower revision rates, this study compares the relative benefits and limitations of UKA and TKA using the National Inpatient Sample (NIS) database. Methods: This retrospective analysis examined outcomes of elective UKA and TKA procedures from 2016 to 2019, identifying 2,606,925 patients via ICD-10 codes. Propensity score matching based on demographics, hospital characteristics, and comorbidities resulted in a balanced cohort of 136,890 patients. The present study compared in-hospital mortality, length of stay, postoperative complications, and hospitalization costs. Results: The results showed that UKA procedures increased significantly over the study period. Patients undergoing UKA were generally younger with fewer comorbidities. After matching, both groups had low in-hospital mortality (0.015%). UKA patients had shorter hospital stays (1.53 vs. 2.47 days) and lower costs (USD 55,976 vs. USD 61,513) compared to TKA patients. UKA patients had slightly higher rates of intraoperative fracture and pulmonary edema, while TKA patients had higher risks of blood transfusion, anemia, coronary artery disease, pulmonary embolism, pneumonia, and acute kidney injury. Conclusions: UKA appears to be a less-invasive, cost-effective option for younger patients with localized knee osteoarthritis.

Strategic Implementation of Fragile X Carrier Screening in China: A Focused Pilot Study

Fragile X syndrome (FXS) is the leading genetic cause of intellectual disability and autism spectrum disorders. Female premutation carriers exhibit no obvious symptoms during reproductive age, but the premutation allele can expand to full mutation when transmitted to the fetus.. Given the relatively low prevalence but large population, the distinct healthcare system, the middle-income economic status, and low awareness among public and medical professionals, the optimal genetic screening strategy remains unknown. We conducted a pilot study of Fragile X carrier screening in China, involving 22,245 pregnant women and women with childbearing intentions, divided into control and pilot groups. The prevalence of Fragile X carriers in the control group was 1/850, similar to East Asian populations. Strikingly, the prevalence of Fragile X carriers in the pilot group was 1/356, which can be attributed to extensive medical training, participant education, and rigorous genetic counseling and testing protocols. Cost-effectiveness analyses of four strategies—no screening, population-based screening, targeted screening, and our pilot screening—indicated that our pilot screening was the most cost-effective option. A follow-up survey revealed that 55% of respondents reported undergoing screening due to their family history. We have successfully established a standardized system, addressing the challenges of low prevalence, limited awareness, and genetic testing complexities. Our study provides practical recommendations for implementing Fragile X carrier screening in China.

Rehabilitation of the Large Maxillary Defect with the Zygomatic Implant-supported Bar-retained Overdenture

Abstract For both the patient and the dentist, prosthetic rehabilitation of acquired maxillary defects is a significant issue. These flaws lower a person’s quality of life by impairing their appearance and functionality. The patient who underwent subtotal bilateral maxillectomy due to mucormycosis is shown in this clinical report to have a successful recovery with an overdenture supported by zygomatic implants. This case report demonstrates that zygomatic implant-supported overdenture is a realistic, predictable, and cost-effective treatment option for a patient with a large maxillary defect.

Headache Treatment Options.

Family medicine physicians often see headache as the chief complaint when meeting patients within their practice. The goal is to try different treatment modalities without having to send the patient to a specialist. Headaches affect different individuals during their lifetime. Before any treatment begins, it is best that one rules out possible causes of the headache, for example, drug interactions or structural cerebrum conditions. Nonpharmacological treatment is recommended first before attempting a stepwise approach to cost-effective pharmacological treatment options. Pharmacological treatment options should include preventive and on-demand options. A family physician has all the resources to assist patients with different types of headaches.

Cost-effectiveness Analysis of COMT-inhibitors as Adjuvant Treatments to Levodopa in Patients with Advanced Parkinson's Disease

PurposeWe aimed to elicit scientific evidence on the cost-effectiveness of two catechol-O-methyltransferase inhibitors (COMT-i) versus no COMT-i in patients with advanced Parkinson's disease. MethodsA mixed model of the decision tree and a Markov model with three health states by OFF-time level (<25%, ≥25%, and death) was constructed to compare opicapone (OPC), entacapone (ENT), and no COMT-i over a lifetime. A hypothetical cohort of 10,000 patients was created and simulated based on the characteristics of the BIPARK trial subjects. FindingsTwo COMT-i (OPC and ENT) were identified as a cost-effective option compared to no COMT-i. Probabilistic sensitivity analysis showed that over 90% of the simulations proved the robust cost-effectiveness of COMT-i. When the time horizon as the most influential factor decreases to a 5- and 10-year period, COMT-i can be a cost-saving option. Although ENT may be the preferred option over OPC economically because of its lower price, OPC can be acceptable if the drug price is reduced by 17%. ImplicationsAdd-on treatment with COMT-i in patients with PD receiving levodopa/carbidopa appears to be cost-saving compared with not using COMT-i. In the future, it is necessary to evaluate the economic evaluation of COMT-i based on long-term real-world evidence.

Electrical power output potential of different solar photovoltaic systems in Tanzania

This study examines the photovoltaic (PV) energy output and levelized cost of energy (LCOE) in seven regions of Tanzania across five different tilt adjustments of 1 MW PV systems. The one-diode model equations and the PVsyst 7.2 software were used in the simulation. The results reveal variations in energy output and LCOE among the regions and tilt adjustments indicating a strong correlation between PV energy output and solar irradiance incident on the PV panel. For horizontal mounting, the annual energy output ranges from 1229 MWh/year in Kilimanjaro to 1977 MWh/year in Iringa. Among the three optimal tilt adjustments, annually, monthly and seasonal, the last two are predicted to yield larger energy outputs, whereas the two axis tracking configuration consistently provides the maximal energy output in all regions, ranging from 1533 MWh/year in Kilimanjaro to 2762 MWh/year in Iringa. The LCOE analysis demonstrates the cost-effectiveness of solar PV systems compared to grid-connected and isolated mini-grid tariffs. The LCOE values across the regions and tilt adjustments range from $0.07/kWh to $0.16/kWh. In comparison, the tariff for grid-connected solar PV is $0.165/kWh, while for isolated mini-grids; it is $0.181/kWh. The monthly optimal tilt configuration proves to be the most cost-effective option for energy generation in multiple regions, as it consistently exhibits the lowest energy cost compared to the other four configurations. The results provide valuable insights into the performance and economic feasibility of various system setups. Through meticulous simulation and data analysis, we have gained a comprehensive understanding of the factors influencing energy generation and costs in the context of solar photovoltaic systems.

Tailor-made vincristine-liposomes for tumor targeting

To ensure selective targeting based on membrane fluidity and physico-chemical compatibility between the biological membrane of the target cell and the lipid membrane of the liposomes carriers. Lipid-based carriers as liposomes with varying membrane fluidities were designed for delivering vincristine, an anti-tumor compound derived from Madagascar's periwinkle. Liposomes, loaded with vincristine, were tested on prostate, colon, and breast cancer cell lines alongside non-tumor controls. Results showed that vincristine-loaded liposomes with fluid membranes significantly decreased the viability of cancer cell lines compared to controls. Confocal microscopy revealed the intracellular release of vincristine, evidenced by disrupted mitosis-specific labeling of actin filaments in metastatic prostate cell lines. This highlights the crucial role of membrane fluidity in the development of lipid-based drug carriers, offering a promising and cost-effective option for targeting cancer cells as an alternative to conventional strategies.

Evaluación de la sensibilidad y especificidad de la sigmoidoscopia en comparación con la colonoscopia en la detección de actividad inflamatoria intestinal en el seguimiento de pacientes con colitis ulcerosa

IntroductionUlcerative colitis (UC) is a chronic disease characterized by periods of inflammatory activity and remission, which vary from the rectum to the proximal colon. Currently, mucosal healing is a long-term goal in the management of inflammatory bowel disease, with colonoscopy and sigmoidoscopy being the recommended tools for evaluation. ObjectiveTo assess the effectiveness of both examinations in determining the presence of inflammatory activity in the follow-up of patients with UC. MethodsRetrospective observational study analyzing colonoscopies performed as part of the follow-up of UC patients between January 2021 and July 2023 by gastroenterologists from the Inflammatory Bowel Disease Program at the Clínica Universidad de los Andes. The study compared endoscopic and histological activity observed in the rectosigmoid region with that found in the rest of the colon. Sensitivity and specificity were determined using concordance and correlations tests. ResultsA very good concordance and correlation were observed regarding endoscopic findings, with a Kappa index of 0.97 and a Spearman coefficient of 0.97. The Positive Predictive Value (PPV) of sigmoidoscopy for endoscopic activity was 1, and the Negative Predictive Value (NPV) was 0.96. In relation to histological activity, the concordance had a Kappa index of 0.93 and a Spearman coefficient of 0.93, with a PPV of sigmoidoscopy for histological activity being 1 and an NPV of 0.91. ConclusionThis cohort suggests that sigmoidoscopy is a cost-effective option for evaluating mucosal healing in UC patients in symptomatic and biomarker remission. However, complete colonoscopy should be considered in cases of discrepancies with the clinical picture or in colorectal cancer surveillance.

Production of Amylase Enzyme by Aspergillus and Fusarium Species using Sugar Cane Bagasse

Study’s Novelty/Excerpt This study presents insights into the cost-effective production of amylase enzymes using sugar cane bagasse as a substrate, showcasing a significant advancement over traditional synthetic starch substrates. By optimizing production parameters such as incubation time, substrate and inoculum concentrations, pH, and temperature, the research demonstrates the superior amylase yield of Aspergillus niger, Aspergillus flavus, and Fusarium spp. under specific conditions. This work not only highlights the potential of using waste materials for industrial enzyme production but also emphasizes the need for further exploration of the isolates' identities and the industrial applications of the extracted enzymes. Full Abstract Amylases are hydrolytic enzymes produced by some microorganisms and utilized in the hydrolysis of starch. This study aimed to determine the ability of certain fungal isolates isolated from wastes to synthesize the amylase enzyme utilizing synthetic soluble starch and sugar cane bagasse as substrates. Aspergillus niger, Aspergillus flavus, and Fusarium spp., previously identified to have amylolytic activity, were used for the research. The submerged fermentation process was used to produce amylase, with basal medium and sugar cane bagasse as substrates. The incubation time, substrate and inoculum concentrations, pH, and temperature were all optimized. The dinitrosalicylic acid reagent (DNS) technique was used to determine the activity of the amylase generated. Initial production of amylase using soluble starch (20 g (w/v)) as substrate at room temperature and pH 7.0 shows that all the isolates produce amylase better when their concentration (3%) is high but have different incubation periods of 96 hr for Aspergillus niger (8.65±0.21 U/mL/minutes) and Fusarium spp (7.15±0.07 U/mL/minutes), while Aspergillus flavus (7.30±0.14 U/mL/minutes) requires an extended incubation period of 144 hr to produce the product. Further production using sugar cane bagasse and optimization of production parameters of the isolates reveals that Aspergillus niger (4.35±0.07 U/mL/minutes) has an optimum incubation period of 120 hours, an inoculum concentration and substrate concentration of 2% each, and a pH of 6, Aspergillus flavus (6.40±0.28 U/mL/minutes) has an optimum incubation period of 144 hours, with inoculum and substrate concentration of 3% each at neutral pH, Fusarium spp (6.80±0.28 U/mL/minutes) has an optimum incubation period of 168hr., inoculum concentration of 3%, substrate concentration of 2% and a neutral pH-7 and all the isolates have their best yield at temperature of 30oC. In conclusion, using cheap and readily available sugar cane bagasse can be a more cost-effective option for expensive synthetic starch substrates used in amylase synthesis. The study suggests further investigation into the isolates' identities and the extracted enzyme's industrial application.

The challenge of closing the climate adaptation gap for water supply utilities

Many drinking water utilities face immense challenges in supplying sustainable, drought-resilient services to households. Here we propose a quantified framework to perform drought risk analysis on ~5600 potable water supply utilities and evaluate the benefit of adaptation actions. We identify global hotspots of present-day and mid-century drought risk under future scenarios of climate change and demand growth (namely, SSP1-2.6, SSP3-7.0, SSP5-8.5). We estimate the mean rate of unsustainable or disrupted utility supply at 15% (interquartile range, 0–26%) and project a global increase in risk of between 30–45% under future scenarios. Implementing the most cost-effective adaptation action identified per utility would mitigate additional future risk by 75–80%. However, implementing the subset of cost-effective options that generate sufficient tariff revenue to provide a benefit-cost ratio that is greater than 1 would only achieve 5–20% of this benefit. The results underline the challenge of attracting the financing required to close the climate adaptation gap for water supply utilities.

Cross-sectional study examining the association between diet quality and the prevalence of anxiety and depression in UK undergraduate students.

The prevalence of mental health issues among UK undergraduate students is growing, and poor diet quality appears to be a risk factor for poor mental health although with limited research in this area. Therefore, the objective of this study was to examine the cross-sectional associations between diet quality and common mental disorders (CMD) such as depression and anxiety in UK undergraduate students. A cross-sectional survey consisting of demographic information and validated questionnaires (the Short-Form Food Frequency Questionnaire [SFFFQ] and the Hospital Anxiety and Depression Scale [HADS]) was conducted to measure diet quality and anxiety and depression in young adults in 44 UK-based universities. Multiple regression analysis adjusting for confounding factors was used to assess the associations between them. Undergraduate university students (n = 202, 67% female) with a mean age of 20.9 ± 3.6 years and a mean body mass index (n = 170) of 22.6 ± 3.2 kg/m2 took part in the study. Prevalence of anxiety was high, with 40% of the sample having an anxiety score in the severe range (≥12 points) while the prevalence of depression was lower, with 6% of the population having a depression score in the severe range (≥12 points). Diet quality was significantly higher for females than males (p = 0.034) and was poor for 38% of the sample, being more common in males compared to females, although not significantly so (43% and 36%, respectively). Diet quality was inversely associated with anxiety (β = -0.427; p = 0.029) and was more likely to be associated with anxiety in females than males (β = 0.743; p = 0.043). No significant relationship between diet quality and depression was found. Better self-reported health, father's qualification and smoking status were also associated with less anxiety and depression. This research supports other research suggesting that UK universities should explore whether the implementation of dietary interventions and improving the food environment would be a cost-effective option to reduce the high prevalence of anxiety among students.

Catalytic Dehydration of Biomass-Derived Feedstocks to Obtain 5-Hydroxymethylfurfural and Furfural

Biomass-produced furanics, furfural and 5-hydroxymethylfurfural (5-HMF), are considered as vital platform chemicals used in the production of active pharmaceutical ingredients (APIs), commodity goods, and fuels. The primary challenge associated with their production pertains to the high cost involved in scaling up to industrial levels. Consequently, it is essential to explore more cost-effective options that yield efficient end products. In this study, the use of Lewis and Brønsted acids such as HCl and AlCl3 enhances the isomerization of glucose through catalytic dehydration into 5-HMF. It was observed that employing moderate reaction conditions increased the yield of 5-HMF to 44.94 % and 50.60 % respectively, with changes in HCl concentration and AlCl3 mass loading. The suitable conditions to achieve the highest yield of 5-HMF were 100 μL of HCl, 0.75 g of AlCl3, reaction temperature 150 °C, and reaction time 4 h. In the second experiment, corncob was converted into furfural in the presence of 20 % H2SO4, in combination with NaCl as a promoter. The optimal conditions under which a yield of 44.77 % was achieved were as follows: 50 mL of 20 % H2SO4, reaction temperature 140 °C, 0.5 g of NaCl, 5 g of corncob, and reaction time 160 min. Furthermore, a proposed reaction mechanism was outlined to elucidate the pathway for the production of the aforementioned platform chemicals.

Nature-based bioreactors: Tackling antibiotic resistance in urban wastewater treatment

The overuse and misuse of antibiotics have accelerated the selection of antibiotic-resistant bacteria, significantly impacting human, animal, and environmental health. As aquatic environments are vulnerable to antibiotic resistance, suitable management practices should be adopted to tackle this phenomenon. Here we show an effective, nature-based solution for reducing antibiotic resistance from actual wastewater. We utilize a bioreactor that relies on benthic (biofilms) and planktonic microbial communities to treat secondary effluent from a small urban wastewater treatment plant (<10,000 population equivalent). This treated effluent is eventually released into the local aquatic ecosystem. We observe high removal efficiency for genes that provide resistance to commonly used antibiotic families, as well as for mobile genetic elements that could potentially aid in their spread. Importantly, we notice a buildup of sulfonamide (sul1 and sul2) and tetracycline (tet(C), tet(G), and tetR) resistance genes specifically in biofilms. This advancement marks the initial step in considering this bioreactor as a nature-based, cost-effective tertiary treatment option for small UWWTPs facing antibiotic resistance challenges.

EFFECTIVENESS OF TELEMEDICINE HEALTHCARE SERVICES IN RURAL AREAS OF BANGLADESH: A STUDY ON SELECTED VILLAGES

Background: Bangladesh's healthcare system faces challenges in providing equitable access and quality healthcare to rural and remote communities compared to urban areas. To address these issues, the country has incorporated telemedicine into its healthcare system. Aims: This study aimed to assess the effectiveness of telemedicine services in rural Bangladesh. Methods: The study employed a mixed-method approach, including survey questionnaires and in-depth interviews. 100 participants were selected for the questionnaire survey for quantitative data, and 20 in-depth interviews were conducted to collect qualitative data. Results: The findings indicate that telemedicine has garnered a positive reception among rural residents. An overwhelming 86% regarded telemedicine as a cost-effective healthcare option. 44% reported accessing telemedicine services within 10 minutes, demonstrating their accessibility. Furthermore, a majority (54%) expressed satisfaction with telemedicine services. However, dissatisfaction was noted concerning the physical environment of the telemedicine centers. Conclusion: Overall, telemedicine in Bangladesh has proven effective in cost savings and time efficiency and has gained significant acceptance among rural residents. To further improve healthcare accessibility, expanding telemedicine centers to reach every remote union in Bangladesh is imperative. Additionally, raising awareness, providing ICT and telemedicine education, and ensuring affordable and reliable internet connectivity will maximize the potential of telemedicine services, ultimately benefiting underprivileged rural populations. Keywords: healthcare, rural Bangladesh, telehealth, telemedicine

A Short Course of Preoperative Denosumab Injection Followed by Surgery in High-Risk Giant Cell Tumors of the Extremities: A Retrospective Study.

Despite early promising results with denosumab treatment in giant cell tumor of bone (GCTB), recent studies have raised concerns about a high local recurrence rate following preoperative denosumab administration and joint preservation surgery. This retrospective study evaluated data from 25 high-risk GCT patients (Campanacci grade II or III with features like soft tissue extension, pathological fracture, minimal periarticular or subarticular bone) treated with five doses of neoadjuvant denosumab injection followed by either curettage and cementing (n = 13) or joint reconstruction with fibular graft/endoprosthesis (n = 12) between 2014 and 2019. With an average follow-up of 40months, the study found only one patient of local recurrence. All patients were independently ambulant, with a mean MSTS score of 26.32. Subgroup analysis revealed an MSTS score of 27.76 in the joint preservation group, and 24.75 in the excision with reconstruction/prosthetic replacement group (unpaired t-test, p-value < 0.001). Five patients experienced postoperative complications, including two infections, one recurrence, one mediolateral instability in the prosthetic component, and one restriction of wrist movement. A short course of neoadjuvant denosumab, followed by curettage and cementing or wide excision with joint reconstruction/prosthetic replacement, appears to be an effective strategy for high-risk GCTB patients. This approach not only minimizes surgical morbidity but also does not increase the local recurrence rate. The short course regimen may present a cost-effective and practical option in clinical practice.

Therapeutic efficacy of recombinant human growth hormone in children with different etiologies of dwarfism from a pharmacoeconomic point of view.

Treatment outcomes for different causes of childhood dwarfism vary widely, and there are no studies on the economic burden of treatment in relation to outcomes. This paper compared the efficacy and healthcare costs per unit height of recombinant human growth hormone (rhGH) for the treatment of growth hormone deficiency (GHD) and idiopathic short stature (ISS) with a view to providing a more cost-effective treatment option for children. We retrospectively analyzed 117 cases (66 cases of GHD and 51 cases of ISS) of short-stature children who first visited Weifang People's Hospital between 2019.1 and 2022.1 and were treated with rhGH for 1 to 3 years to track the treatment effect and statistically analyzed by using paired t tests, non-parametric tests, and chi-square tests, to evaluate the efficacy of rhGH treatment for GHD and ISS children and the medicinal cost. The annual growth velocity (GV) of children with GHD and ISS increased the fastest during 3 to 6 months after treatment and then gradually slowed down. The GV of the GHD group was higher than that of the ISS group from 0 to 36 months after treatment (P < .05 at 3, 6, 9, and 12 months); the height standard deviation scores (HtSDS) of the children in the GHD and ISS groups increased gradually with the increase of the treatment time, and the changes in the height standard deviation scores (ΔHtSDS) of the GHD group were more significant than those of the ISS group (P < .05 at 3, 6, 9, and 12 months). (2) The medical costs in the pubertal group for a 1-cm increase in height were higher than those of children in the pre-pubertal group at the same stage (3 to 24 months P < .05). The longer the treatment time within the same group, the higher the medical cost of increasing 1cm height. RhGH is effective in treating children with dwarfism to promote height growth, and the effect on children with GHD is better than that of children with ISS; the earlier the treatment time, the lower the medical cost and the higher the comprehensive benefit.

Effect of unbleached and bleached softwood cellulose pulp fibers on poly(lactic acid) properties

Global regulations are guiding society towards more sustainable material solutions. This increasing awareness of the need for environmentally friendly alternatives has led to a greater emphasis on biocomposites, which combine natural fibers with bio-based polymers. This study investigates how bleached softwood pulp fibers (BSWPF) and unbleached softwood pulp fibers (UBSWPF) affect the characteristics of poly(lactic acid) (PLA)-based biocomposites. UBSWPF is a more cost-effective option because it is manufactured with less processing steps than BSWPF. However, it is largely unexplored as a reinforcement in biopolymers. Through investigating the mechanical, thermal, and morphological aspects of the biocomposites, this study showed that UBSWP increased the modulus and impact strength of the PLA biocomposites better than BSWPF. The impact strength, modulus, and tensile strength of PLA-BSWPF and PLA-UBSWPF improved as the fiber content increased. However, a decrease in tensile strength was seen at higher percentages of UBSWPF in PLA. Despite the decrease in tensile strength at higher UBSWPF concentrations, both types of fibers improved the mechanical properties of the biocomposites, demonstrating a potential sustainable reinforcing material for PLA biocomposites.

Early Surgery for Partial Tears of the Ulnar Collateral Ligament May Be More Cost-Effective and Result in Longer Playing Careers Than Nonoperative Management for High-Level Baseball Pitchers: A Decision-Analytic Markov Model–Based Analysis

Background: Nonoperative management versus early reconstruction for partial tears of the medial ulnar collateral ligament (MUCL) remains controversial, with the most common treatment options for partial tears consisting of rest, rehabilitation, platelet-rich plasma (PRP), and/or surgical intervention. However, whether the improved outcomes reported for treatments such as MUCL reconstruction (UCLR) or nonoperative management with a series of PRP injections justifies their increased upfront costs remains unknown. Purpose: To compare the cost-effectiveness of an initial trial of physical therapy alone, an initial trial of physical therapy plus a series of PRP injections, and early UCLR to determine the preferred cost-effective treatment strategy for young, high-level baseball pitchers with partial tears of the MUCL and with aspirations to continue play at the next level (ie, collegiate and/or professional). Study Design: Economic and decision analysis; Level of evidence, 2. Methods: A Markov chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 young, high-level, simulated pitchers undergoing nonoperative management with and without PRP versus early UCLR for partial MUCL tears. Utility values, return to play rates, and transition probabilities were derived from the published literature. Costs were determined based on the typical patient undergoing each treatment strategy at the authors’ institution. Outcome measures included costs, acquired playing years (PYs), and the incremental cost-effectiveness ratio (ICER). Results: The mean total costs resulting from nonoperative management without PRP, nonoperative management with PRP, and early UCLR were $22,520, $24,800, and $43,992, respectively. On average, early UCLR produced an additional 4.0 PYs over the 10-year time horizon relative to nonoperative management, resulting in an ICER of $5395/PY, which falls well below the $50,000 willingness-to-pay threshold. Overall, early UCLR was determined to be the preferred cost-effective strategy in 77.5% of pitchers included in the microsimulation model, with nonoperative management with PRP determined to be the preferred strategy in 15% of pitchers and nonoperative management alone in 7.5% of pitchers. Conclusion: Despite increased upfront costs, UCLR is a more cost-effective treatment option for partial tears of the MUCL than an initial trial of nonoperative management for most high-level baseball pitchers.

The influence of intraoral cryotherapy on postoperative pain and substance P in symptomatic apical periodontitis: randomized clinical study

Cryotherapy is widely utilized in medicine, particularly for pain management. This randomized clinical trial aimed to assess the effect of intraoral cold pack application (cryotherapy) on postoperative pain (POP) and the level of Substance P (SP) in patients with symptomatic apical periodontitis (SAP). Enrolled patients were randomly assigned to either cryotherapy or control group. After adequate anesthesia, access cavity, and biomechanical preparation of the root canal system were completed, the first apical fluid (AF) sample (S1) was obtained. A custom-made intraoral ice-gel pack was applied for 30 min in the cryotherapy group, while no intervention was performed in the control group. The second AF sample (S2) was collected 30 min later in both groups. Patients were asked to complete the Visual Analogue Scale (VAS) questionnaire to assess their POP. Quantification of SP in AF samples was performed using the enzyme-linked immunosorbent assay (ELISA) test. Data were analyzed statistically, revealing a significant reduction in POP and SP levels in the cryotherapy group compared to the control group (P ≤ 0.05). Furthermore, a moderate positive correlation was observed between SP levels and POP (P ≤ 0.05). In conclusion, intraoral cryotherapy represents a simple and cost-effective option for controlling POP and reducing inflammation levels in patients with SAP.