The aim of the current study was to review the current state and characteristics of the elderly population in China in the context of aging, difficulties and challenges faced by older people, and efforts of the current Chinese Government in this area. The process of population aging in China began to accelerate in the late 1970s and has continued to increase at a rate of about 3.2% per year since then. This process took more than 45 years in developed countries, while it took only about 27 years in China, and aging may continue to increase for a long time. China is now moving toward a superannuated society due to declining fertility rates and increasing life expectancy. There is a great need for care due to the high disease burden among older people. However, more than 1 million "families have lost their only child", and this number is increasing annually by about 76,000; moreover, there are a large number of "deficient families [with an injured family member]" in China. These families face greater difficulties due to aging and need to rely on society for more support given the lack of care provided by their children or spouses. The current study has focused on improving the quality of life of older people, helping them achieve healthy aging, and to assist the country in further providing care for the elderly.
Dementia, with a high incidence rate, fast-developing syndrome and large disease burden, raises challenges to global health and social systems. In this review, in order to elaborate current management and diagnosis statements of dementia, and provide further reference to improve dementia service system, we stated policies, clinical guidelines and management experiences concerning dementia across the world. According to the existing dementia management policies and plans, most countries focus on the following aspects: timely detection of dementia, improvement of service quality, person-centered and integrated dementia services at all stages, dementia awareness and friendliness, and scientific research of dementia. Detection of dementia requires knowledge of medical history and cognitive examination, while dementia diagnosis requires more professional medical examination results. Regarding different types of dementia, multiple international standards are used in practice. The overall goals of dementia treatments include postponing the process of cognitive decline and reducing pain caused by cognitive decline, behavioral and psychological symptoms of dementia (BPSD). Treatments include pharmacotherapy interventions and non-pharmacotherapy interventions. In the end-of-life, palliative care is required to improve the quality of life of people with dementia, and maintain their functions. Challenges exist in reducing the disease burden of dementia in the situation of aging population. There are policy bottlenecks and shortcomings to overcome providing medical care services for people with dementia. We would like to suggest strengthening continuous integrated dementia services, improving community services and management support, encouraging policy and financial support for nursing workers, and better support in the end-of-life.
Hepatocellular carcinoma (HCC) has been the fifth most common malignancy worldwide and is the second most common cause of tumor-related mortality globally. In China, a high proportion of patients with HCC present with an advanced stage of the disease, so HCC is a major challenge to the healthcare system and a substantial socioeconomic burden. The last decade has witnessed an expansion of the treatment landscape for HCC. Various approaches have been explored as potential conversion therapies for advanced HCC. Despite controversies, mounting data have indicated that successful conversion therapy followed by subsequent surgery is achievable in a population of patients with advanced HCC. This conversion therapy is a safe and promising treatment strategy to prolong long-term outcomes. Based on preliminary research, this review has assembled and summarized current clinical experience with and evidence of the efficacy of conversion therapies followed by subsequent surgery for advanced HCC.
Given an increasing number of children with ASD, the need for inclusive education has rapidly increased in China. Since 2011, children with ASD have been eligible for inclusive education. However, little is known of the implementation process by key personnel. The purpose of the current study was to qualitatively explore elementary school teachers' experiences and perspectives on an inclusive education policy and practice for students with ASD. Participants were from 5 elementary schools in 2 districts in Shanghai. This study consisted of data collection in 2 phases. First, semi-structured, in-depth interviews were conducted with school psychologists and vice principals responsible for students' mental health for implementation of general inclusive education at each school. Second, focus groups of frontline teachers were assembled to hear their firsthand experiences. A thematic analysis was performed. Findings indicated that although all 5 schools had some ASD-related support, training and resources varied depending on whether learning in regular classrooms (LRC) was implemented. Frontline teachers in particular faced challenges implementing LRC, including the limited extent of LRC, tedious implementation procedures, and parents' misconceptions of LRC. Regardless of these challenges, frontline teachers tried to support students with ASD as much as they could. The current findings should help to advance the inclusive education policy in Shanghai, including increasing the availability of inclusive education resources and training for teachers, issuing specific LRC guidance, and reducing ASD-related stigma. This study is among the first to explore the implementation of inclusive education in urban China.
Whether there are differences in the time to onset of drug-induced parkinsonism (DIP) depending on the type of drugs causing DIP remains uncertain, so that question was investigated here using a large real-world database. Fourteen DIP-related drug categories were defined to perform a disproportionality analysis using a large Japanese pharmacovigilance database containing more than 600,000 self-reported adverse events (AEs) recorded between April 2004 and September 2021 to identify AEs indicating "parkinsonism" in association with the defined drug categories. The time from drug administration to the onset of DIP was comparatively analyzed. Results indicated that the median time to onset was shorter than 1 month in more than half of the cases of DIP; it was shortest with peripheral dopamine antagonists (median: 0.1 weeks), followed by benzodiazepine (median: 0.5 weeks), butyrophenone (median: 0.7 weeks), novel antidepressants (median: 2.5 weeks), atypical antipsychotics (median: 3.3 weeks), other antidepressants (e.g., lithium, median: 3.7 weeks), and benzamide (median: 4.5 weeks). In contrast, anti-dementia drugs, tricyclic antidepressants, and antiepileptic drugs resulted in a relatively longer time to onset (median: 9.9, 17.2, and 28.4 weeks, respectively). In addition, a maximum delay of even longer than 2 years was reported for benzamide (846 weeks), anti-Parkinsonism drugs (382 weeks), phenothiazine (232 weeks), atypical antipsychotics (167 weeks), anti-dementia drugs (161 weeks), and benzodiazepines (120 weeks). The current results suggested that the characteristics of the time to onset of DIP may substantially differ depending on the type of drug causing that DIP. This finding may help when diagnosing patients with parkinsonism.
Pseudomonas aeruginosa is a frequent causative agent of post-pneumonectomy empyema-associated broncho-pleural fistula (BPF) and it has a high mortality rate. In recent years, the therapeutic potential of bacteriophage therapy has recognized anew as antimicrobial resistance increases globally. Studies are increasingly reporting the efficacy and safety of bacteriophage therapy for the treatment of multidrug-resistant bacterial infections. However, the clinical efficacy of bacteriophage therapy in empyema has seldom been studied. The current study reports the authors' experience with bacteriophage therapy for a 68-year-old Chinese man who suffered BPF-associated empyema and pneumonia caused by carbapenem-resistant P. aeruginosa. A personalized lytic pathogen-specific two-phage preparation was administered to the patient continuously for 24 days in combination with conventional antibiotics. The treatment was well-tolerated, resulting in clearance of the pathogen and improvement of the clinical outcome. This experience shows that a combined conventional antibiotic treatment with bacteriophage therapy may be effective at alleviating a multidrug-resistant bacterial infection in BPF-associated empyema.
Since COVID-19 was first reported in 2019, the pandemic has posed a great threat to human health. Due to its multiple transmission pathways and virus mutation, this epidemic may be protracted further, and it has already placed a heavy burden on healthcare systems. A strategy needs to be devised to address both needs for COVID-19 treatment and demands for general medical service. A two-wing model of hospital operation, which provides a safe treatment environment for patients, an On duty/On Standby work approach for medical staff, and a reliable surveillance system for hospital operation, is an effective management template to help achieve a balance between multiple demands for medical service in this new era of a long-term war against COVID-19.
Over the past 30 years or so, the body of research on autism spectrum disorders (ASD) in China has grown steadily. With the tireless efforts of government agencies and private organizations, the legitimate rights and interests of children with ASD have been initially guaranteed through a series of education and rehabilitation reforms, yet there are still many challenges to overcome. Many quality studies on the prevalence of ASD have been conducted in recent years, but China has lacked official census data until now. Moreover, there is a general lack of awareness of ASD even among the groups that directly interact with individuals with ASD, namely parents/caregivers, teachers, and doctors. Despite that fact, ASD should be brought to the attention of professionals and policymakers so that they can take appropriate measures, which include i) early comprehensive screening and diagnosis of ASD, ii) improvement of the corresponding policies and regulatory system, and iii) promotion of public awareness of ASD.
Primary care serves as the cornerstone to ensure positive health outcomes for diseases. Autism spectrum disorder (ASD) has attracted more attention as a lifelong neurodevelopmental disorder with a prevalence that is increasing yearly. Although the demand for primary care for ASD is rapidly expanding, there are many challenges that need to be faced. Here, the current status of primary care for ASD in China is described. i) Identification of and care for ASD includes pre-diagnosis, diagnosis and evaluation, and treatment; the complexity of the disease and the lack of public understanding increase delays in diagnosis and treatment. ii) Most instruments, which are indispensable for diagnosing and evaluating ASD, are of foreign origin. iii) Treatments for ASD are based on mainstream Western interventions with complementary approaches. iv) The scale of rehabilitation and educational institutions has gradually grown and their expertise has gradually increased but rehabilitation costs are relatively high.
Dermatofibrosarcoma protuberans (DFSP) is a rare neoplasm derived from fibroblasts. Although the frequency of microsatellite instability (MSI) in skin cancer is reported to be less than 5%, there is only one report of the status of MMR in DFSP. The only analytical report of microsatellite stability in which Promega panel is not used, showed that the frequency of MSI-high, MSI-low and microsatellite stable (MSS) cases was 13.9% (5/36), 16.7% (6/36) and 69.4% (25/36), respectively. Thus, the aim of this study was to evaluate the status of MMR in 36 patients with DFSP diagnosed at Kumamoto University. MSI analysis using the Promega panel showed that all cases were MSS, which indicated the absence of MSI in DFSP. This result indicates that the status of MMR may not be useful for the potential therapeutic application of pembrolizumab and the pathogenesis of DFSP may not involve MSI.