On October 25, 2018, the National Health Commission of China issued the National Essential Medicines List (2018 edition) [NEML (2018)]. The NEML (2018) contains 685 drugs, which consist of 417 chemicals and biological products and 268 Chinese patent medicines. Compared to the 2012 version of the NEML, a total number of 165 drugs were added, representing an increase of 31.7%. The biggest increase (90.9%) is in Chinese patent medicines for surgical use. The NEML (2018) set up the category of pediatric medications for the first time, and 11 cancer drugs were added. The NEML (2018) is characterized by: "basic" to "comprehensive" coverage, it includes both Chinese and Western medicines, it now includes pediatric drugs, and more cancer drugs have been added. There are several issues with the new NEML such as the link between the essential medicines system and the medical insurance system and establishment of firm support for implementation.
Hand, foot, and mouth disease (HFMD) is caused by a group of enteroviruses. It infects millions of children in the Southeast Asian area. An accurate forecasting of outbreaks of HFMD could facilitate public health officials to suggest public health actions earlier. Many researchers tried to develop an early warning system for HFMD to lower the damage caused by a HFMD outbreak. The research data based on daily level could help figure out the relationship between HFMD and environmental factors, but nevertheless is difficult to collect. In this study, we collected the daily clinical data from the Shenzhen Health Information Center and multiple environmental factors to analyze the outbreaks of HFMD. Considering the incubation period of HFMD, we fed the previous 60 days' HFMD rates, 7 days' temperature factors and 7 days' air-quality factors into the tree model, XGBoost. The following conclusions were drawn in this study: i) Compared with the model only using the previous HFMD rate and temperature factors, the addition of the air-quality factors could make the model better, improving MAE nearly 16.7%. ii) By analyzing the Pearson correlation, we found that the temperature showed a positive correlation and the air quality showed a negative correlation for the HFMD outbreaks. Improving the air quality, especially decreasing PM2.5 and PM10 could decrease the risk of HFMD outbreaks.
This research aimed to investigate the differential expression of apurinic-apyrimidinic endonuclease 1 (APE1) in hepatocellular carcinoma (HCC) tissues and cells and the effects on proliferation and apoptosis of cancer cells. Immunohistochemical techniques were used to detect the expression of APE1 in 80 cases of HCC and the corresponding paracancerous tissue microarrays; meanwhile, Western blots were used to detect the expression of APE1 in both human HCC BEL-7402, BEL-7405, HCC-9204, Hep3B, HepG2, SMMC-7721 and Huh-7 cells, and normal hepatocyte L-02 cells. The relationship between APE1 expression and clinical pathological characteristics of HCC was statistically analyzed. APE1 shRNA vector was constructed in Hep 3B cells to establish a stably transfected cell line, using Western blots to determine the interference efficiency. Cell proliferation activity was detected with MTT assays, while apoptosis was detected with the Annexin V-FITC/PI double-labeling technique. The expression of APE1 in HCC tissues and cells was significantly up-regulated, and its expression was significantly different from TNM staging and histopathological grading. Down-regulation of APE1 expression significantly reduced the proliferative activity and increased the apoptosis rate of Hep 3B cells. In conclusion, APE1 demonstrates cancer progression potential at the clinical, tissue and cell level. It provides a new idea and theoretical basis for APE1-based clinical diagnosis, prognosis determination and molecular targeted therapy in treatment of HCC.
To compare the clinical outcomes of intrauterine insemination (IUI) with or without ovulation induction (OI), IUI cycles from January 2008 to December 2017 in Zhoushan Maternity and Child Healthcare Hospital were included, consisting of 455 natural cycles and 536 OI cycles. The overall clinical pregnancy rate did not differ between the two groups (P > 0.05). Stratified by OI medications such as clomiphene (CC), human menopausal gonadotropin (HMG) and follicle stimulating hormone (FSH), the pregnancy rates in HMG, CC, CC+HMG, and FSH/FSH+HMG groups were 11.70%, 13.58%, 15.95%, and 13.46%, respectively, but the difference was not significant compared with natural cycles (P > 0.05). Stratified by infertility etiology, the pregnancy rate was significantly higher in stimulated cycles than natural cycles with ovulation disorders (P < 0.01) and unexplained factors (P < 0.01) while it was significantly lower regarding cervical factors (P < 0.01), endometriosis (P < 0.05), male factor (P < 0.01) and other female factors. There was no strong difference of pregnancy rate for biparental causes (P > 0.05). Stratified by age category, women over 35 had higher pregnancy rate in stimulated cycles compared with natural cycles (18.75 vs. 12.24%; P < 0.05), while women under 35 had no significant difference of pregnancy rate between the two groups (13.65 vs 13.05%; P > 0.05). However, there was no significant difference between each ovarian stimulation group and natural cycle group regardless of the infertility causes or age categories. To conclude, IUI-OI could achieve a higher overall pregnancy rate for women over 35 and infertile patients with ovulation disorders and unexplained factors.
Autosomal recessive (AR) non-syndromic hearing loss (NSHL) is the most common form of hereditary deafness. Mutations in the gap junction protein beta 2 (GJB2) gene encoding connexin 26 (Cx26) account for about 50% of cases of ARNSHL. In the current study, a combination of exome sequencing and Sanger sequencing in a Chinese Dong family with ARNSHL allowed identification of a novel compound heterozygous mutation c.240G>C(p. Q80H)/C.109G>A(p.V37I) in exon 2 of the GJB2 gene, which co-segregated with the disease phenotype in this family and was not evident in 100 healthy controls. Bioinformatic analysis revealed that the two mutations in the GJB2 gene were probably pathogenic. Results indicated that the compound heterozygous variants, p.Q80H and p.V37I, in the GJB2 gene are associated with ARNSHL. The Q80H variant was initially identified in patients of Dong Chinese origin with NSHL. The current results broaden the spectrum of GJB2 mutations responsible for NSHL and have important implications for molecular diagnosis, treatment, and genetic counseling for this family.
Surgical resection is still the mainstay of treatment for primary liver cancer (PLC). It is unclear whether three-dimensional visualization (3DV) preoperative evaluation and simulated liver resection would affect the surgical strategies and improve the R0 resection rates of patients with complex PLC when compared with the 2D evaluation using computed tomography or magnetic resonance imaging. In the study, patients with complex PLC who were subjected to laparotomy underwent both 2D and 3DV evaluation before operation. A comparison between the 2D and 3DV evaluation was compared with the gold standard of laparotomy findings. In this study, of 335 patients with complex PLC, 71 were assessed to have resectable tumors. 2D and 3DV assessments determined 63 and 71 patients to have resectable PLC, respectively. At laparotomy 69 of the 71 patients were found to have resectable PLC, but 2 patients were found to be unresectable because of detection of metastatic lesions on laparotomy, which were not detected either by 2D or 3DV preoperative evaluation. The accuracy, false positive and false negative rates of the 2D and the 3DV preoperative assessments in determining tumor resectability were 85.9%, 2.8%, 11.3%, and 97.2% (p < 0.05), 2.8%, 0%, respectively. The 3DV and 2D preoperative evaluation revealed 17 and 13 patients with vascular anomalies, respectively. There were 4 patients with major vascular anomalies not detected by 2D evaluation, whose surgical strategies were modified by 3DV evaluation. These results suggested 3DV preoperative assessment could lead to better in evaluating tumor resectability, with potential benefit in the modification of surgical strategy for patients with complex PLC.
In this study, the clinical effectiveness of the robot-assisted laparoscopic pancreatico-duodenectomy (RPD) and Total laparoscopic pancreaticoduodenectomy LPD were retrospectively reviewed. From December 2013 to September 2017, 20 patients underwent robot-assisted laparoscopic pancreaticoduodenectomy and 80 patients underwent Total laparoscopic pancreaticoduodenectomy. The clinical data of the RPDs and the first 20 LPDs were reviewed retrospectively. There is no difference in operative time, estimated blood loss, length of stay, and rates of complications and mortality between the LPD and RPD group. The next 10 cases in the RPD group had shorter operative times (p = 0.03) than the first 10 cases. The estimated blood loss and length of stay were also lower in the next 10 cases; however, these results did not reach statistical significance. Our results show that LPD and RPD are technically safe and feasible. Comparable results were demonstrated between the two groups, while the robotic system seemed to shorten the learning curve of minimally invasive pancreaticoduodenectomy (PD).
Chronic heart failure (CHF) leads to pulmonary structural remodeling, which may be a key factor for poor clinical outcomes in patients with end-stage heart failure, and few effective therapeutic options are presently available. The aim of the current study was to explore the mechanism of action and pulmonary-protective effects of treatment with Bao Yuan decoction combined with Tao Hong Si Wu decoction (BYTH) on lung structural remodeling in rats with ischemic heart failure. In a model of myocardial infarction (MI) induced by ligation of the left anterior descending (LAD) artery, rats were treated with BYTH. Heart function and morphometry were measured followed by echocardiography, histological staining, and immunohistochemical analysis of lung sections. The levels of transforming growth factor-β1 (TGF-β1), type I collagen, phosphorylated-Smad3 (p-Smad3), tumor necrosis factor-α (TNF-α), toll-like receptor 4 (TLR4), active nuclear factor κB (NF-κB) and alpha smooth muscle actin (α-SMA) were detected using Western blotting. Lung weight increased after an infarct with no evidence of pulmonary edema and returned to normal as a result of BYTH. In addition, BYTH treatment reduced levels of type I collagen, TGF-β1, and α-SMA expression and decreased the phosphorylation of Smad3 in the lungs of rats after MI. BYTH treatment also reduced the elevated levels of lung inflammatory mediators such as TNF-α, TLR4, and NF-κB. Results suggested that BYTH could effectively improve lung structural remodeling after MI because of its anti-inflammatory and anti-fibrotic action, which may be mediated by suppression of the TGF-β1/Smad3 and NF-κB signaling pathways.
In order to investigate the genetic causes of hearing loss in a Chinese proband with nonsyndromic hearing loss and enlarged vestibular aqueduct (EVA), we conducted clinical and genetic evaluations in a deaf proband and her parents with normal hearing. 20 exons and flanking splice sites of the SLC26A4 gene were screened for pathogenic mutations by PCR amplification and bidirectional sequencing. As a control, a group of 400 healthy newborns from the same ethnic background were subjected to SLC26A4 gene screening using the same method. The proband harbored two mutations in the SLC26A4 gene in the form of compound heterozygosity. She was found to be heterozygous for a novel mutation c.574delC (p.Leu192Ter) in exon 5 and for the known mutation c.919-2A>G(c.IVS7-2A>G). Her mother was a heterozygous carrier of the c.919-2A>G mutation, and her father was a heterozygous carrier of the c.574delC and therefore co-segregated with the genetic disease. The c.574delC mutation was absent in 400 healthy newborns. The frameshift mutation causes the leucine (Leu) at amino acid position 192 to become a termination codon, leading to termination of protein sequence coding. This study demonstrates that the novel frameshift mutation c.574delC (p.Leu192Ter) in compound heterozygosity with c.919-2A>G in the SLC26A4 gene is the main cause of deafness in a family. Our study will expand the spectrum of known SLC26A4 mutations in the Chinese population, providing more information on genetic counseling, and diagnosis in hearing loss with EVA.
China has made substantial progress in tackling its Human immunodeficiency virus (HIV) epidemic, however, the number of people living with HIV / acquired immunodeficiency syndrome (AIDS) continues to increase, with the number of all-cause deaths rising. There are a total 75.6 million people living with HIV and 2.39 million people newly infected with HIV as of December 31, 2017 in China. Besides, while the number of new HIV infections continued to decline in 2017 globally, the data from Chinese Center for Disease Control and Prevention (CCDC) show steady increases in new HIV infections in China. The compound annual growth rate (CAGR) of new HIV infections in China from 2012 to 2017 was 10.29%, and the CAGR of AIDS-related deaths was 5.92%. Moreover, there was a sudden increase in new HIV infections in China from January 2018, showing the compound monthly growth rate (CMGR) of 2018 increased by 9.92% compared to 2017. Given the advance of globalization, it is increasingly important to focus on the impact of global integration for HIV/AIDS responses, facing the increasing challenge of key affected populations such as men who have sex with men (MSM), young people and older people. Certainly, comprehensive strategies for prevention, drug treatment, and even functional cure will also be crucial for curbing the HIV epidemic in China in the new era.
Precise diagnosis is a key measurement for malaria control and elimination, traditional microscopy and rapid diagnostic tests cannot satisfy the requirements especially in the low transmission endemic areas or in the malaria elimination phase. Polymerase chain reaction (PCR) with high sensitivity and specificity can be considered as a diagnostic standard while no uniform PCR assay was established due to variations in their performance and lack of formal external quality assurance programs for validation for PCR assays in use. Here, 24 articles including 43 paired comparative evaluations limited to paired comparison of diagnostic performance between real-time PCR and conventional PCR to detect plasmodium in blood samples of human subjects from clinics or the field are systematically summarized. And according to the Landis and Koch classification, nineteen pairs showed almost perfect agreement, followed by 8 pairs of moderate agreement and 4 pairs of good agreement, while the kappa values of 12 pairs couldn't be examined. Moreover, the performance of 14 pairs were completely the same and 8 pairs had no differences, but 14 pairs were significant different including 8 pairs of real-time PCR with better performance than conventional PCR. Therefore, it is still an outstanding issue to choose PCR methods, and more work such as the standardization of materials and methods in use and their availability are needed to settle priority to better promote the role of malaria diagnosis reference laboratories.
The increased co-incidence of tuberculosis (TB) and AIDS is compounded by the emergence of opportunistic infections with non-tuberculous mycobacteria (NTM) in patients with HIV/AIDS, and the treatment for these infections differs from that for TB. The high frequency of NTM strains found in patients infected with HIV raises concerns about accurate species identification before deciding proper treatment. A total of 101 isolates from 2014, 137 from 2015, and 162 from 2016 were subjected to 16S rDNA sequencing to identify the species. Forty-one (41/101, 40.6%) were identified as NTM in 2014, 64 (64/137, 46.7%) were identified as NTM in 2015, and 72 (72/162, 44.4%) were identified as NTM in 2016 in Chinese patients infected with HIV. The species of Mycobacteria isolates needs to be rapidly and accurately identified to determine appropriate antibiotic therapy, and this is especially true for patients infected with HIV.
The current study analyzed the correlation between the use of antibiotics and development of a resistant bacterial infection in 454 patients in intensive care units (ICUs), and this study also examined factors related to development of an infection in order to facilitate more rational use of antibiotics and to reduce the incidence of resistant bacterial infections. Potential subjects were patients who were admitted to the ICU in 2016, and 454 such patients were selected using cluster sampling. Patient information was documented using an original questionnaire, Patients in the ICU with a Resistant Bacterial Infection. The correlation between use of an antibiotic and development of a resistant bacterial infection was examined. The rate of infection significantly increased over time and with receipt of various antibiotics. The development of a resistant bacterial infection was found to correlate with the use of antibiotics. Antibiotics should be used more carefully to reduce the incidence of resistant bacterial infections
This study aimed to clarify the relationship between social cohesion and family care burden. The social capital indicators of Kondo et al. and the short version of the Zarit Care Burden Interview Scale in Japanese (J-ZBI_8) were used. Data were analyzed by multiple regression models. Seventy-one caregivers responded. Factors showing statistical significance in the multiple regression analysis included "receipt of emotional support" (p = 0.009) and "instrumental support provided" (p = 0.010). Social support was suggested to have a possible effect on the care burden of the main caregivers to relate to less burden. The gap between the original ideal loss and the social role caused by providing nursing care is likely to increase the degree of care burden.
Based on prescriptions filled at external pharmacies, prescription surveillance (PS) in Japan has been reporting the estimated numbers of influenza and varicella patients and people prescribed certain drugs since 2009. Every morning, this system estimates the numbers of patients from the numbers of prescriptions filled nationwide for neuraminidase inhibitors, anti-herpes virus drugs, antibiotic drugs, antipyretic analgesics, and multi-ingredient cold medications. Moreover, it can detect "unexplained" infectious diseases that are not explained as infectious diseases monitored by other surveillance systems. Such "unexplained" infectious diseases might be emerging and re-emerging infectious diseases including bioterrorism attacks, which are reportedly difficult to diagnose, at least in early outbreak stages. To ascertain the system's potential benefits, this study examined schemes to detect "unexplained" infectious diseases using PS information. The numbers of patients prescribed the respective drugs are first regressed on the known infectious diseases, time trends, and dummies for day-of-the-week, holidays, and days following a holiday. Known infectious diseases are defined as covered by the National Official Sentinel Surveillance for Infectious Diseases under the Infection Control Law. After the numbers of patients from PS are compared with the predicted numbers of patients, their probabilities of occurrence are calculated. We examined the system's prospective operation from January 2017 through July 2018. The criterion we used to define aberrations varied, from 0.01 to 10-7. For criteria of 0.01 and 10-7 we found 254 and 15 aberrations, respectively. We confirmed its feasibility and effectiveness.