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Policy Forum
  • Yingyao Chen, Yao He, Xunyouzhi Chi, Yan Wei, Lizheng Shi
    Volume 12 (2018) Issue 2 Pages 102-108
    Released: May 13, 2018
    JOURNALS FREE ACCESS

    Health technology assessment (HTA) is a field of scientific policy research that adopts multidisciplinary approaches to conduct systematic evaluation of health technologies and inform decision making. Although achievements have been made by HTA activities among academics, providers, and policy makers, development of the field of HTA in China is fragmented and not yet formally integrated in health policy making processes. All stakeholders need to make more efforts to strengthen HTA knowledge translation and facilitate a decision making process that is based on evidence including HTA findings. This article reviews how the field of HTA has developed in China, analyzes what factors have been influencing China's HTA development, and proposes policy recommendations.

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  • Cuirong Zhao, Chao Wang, Chengwu Shen, Qian Wang
    Volume 12 (2018) Issue 2 Pages 109-115
    Released: May 13, 2018
    [Advance publication] Released: April 15, 2018
    JOURNALS FREE ACCESS

    Fee for services (FFS) is the prevailing method of payment in most Chinese public hospitals. Under this retrospective payment system, medical care providers are paid based on medical services and tend to over-treat to maximize their income, thereby contributing to rising medical costs and uncontrollable health expenditures to a large extent. Payment reform needs to be promptly implemented to move to a prospective payment plan. The diagnosis-related group (DRG)-based case-mix payment system, with its superior efficiency and containment of costs, has garnered increased attention and it represents a promising alternative. This article briefly describes the DRG-based case-mix payment system, it comparatively analyzes differences between FFS and case-mix funding systems, and it describes the implementation of DRGs in China. China's social and economic conditions differ across regions, so establishment of a national payment standard will take time and involve difficulties. No single method of provider payment is perfect. Measures to monitor and minimize the negative ethical implications and unintended effects of a DRG-based case-mix payment system are essential to ensuring the lasting social benefits of payment reform in Chinese public hospitals.

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Review
  • Kimiyo Kikuchi, Rakesh Ayer, Sumiyo Okawa, Mariko Nishikitani, Fumihik ...
    Volume 12 (2018) Issue 2 Pages 116-125
    Released: May 13, 2018
    JOURNALS FREE ACCESS

    Reproductive, maternal, newborn, and child health (RMNCH) care services could be critical entry points for preventing non-communicable diseases in women and children. In high-income countries, non-communicable diseases screening has been integrated into both the medical and public health systems. To integrate these services in low- and middle-income countries, it is necessary to closely examine its effectiveness and feasibility. In this systematic review, we evaluated the effectiveness of integrating gestational and non-gestational non-communicable diseases interventions and RMNCH care among women and children in low- and middle-income countries. This systematic review included randomized and quasi-randomized controlled trials published from 2000 to 2015. Participants included reproductive-age women, children < 5 years old, and RMNCH care providers. The included interventions comprised packaged care/services that integrated RMNCH services with non-communicable disease care. The outcomes were maternal and/or infant mortality and complications, as well as health care service coverage. We analyzed six studies from 7,949 retrieved articles. Yoga exercise (p < 0.01) and nutritional improvements (p < 0.05) were effective in reducing gestational hypertension and diabetes. Additionally, integrating cervical cancer and RMNCH services was useful for identifying potential cervical cancer cases. Interventions that integrate non-communicable disease care/screening and RMNCH care may positively impact the health of women and children in low- and middle-income countries. However, as primary evidence is scarce, further research on the effectiveness of integrating non-communicable disease prevention and RMNCH care is warranted. (Review Registration: PROSPERO International prospective register of systematic reviews (CRD42015023425).)

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Original Articles
  • Lesego Selotlegeng
    Volume 12 (2018) Issue 2 Pages 126-131
    Released: May 13, 2018
    JOURNALS FREE ACCESS

    There has been little evidence of the relationship between children and absence of parents in Botswana literature; and it is still the case that absence of parents increases the risk of injuries to their children. The aim of this study is to investigate the impact of parental migration among left behind young people aged 10 years to 24 years in Botswana and examine patterns of injuries from immigrant families. This is a population-based crosssection from which a dataset was created by compiling data from two different sources for the period of 2010 to 2015. All the variables were transformed into natural logarithms so as to avoid outliers and normalize the variables. All statistical modeling was carried out using Statistical Analysis System version 6.1. Left behind young people were associated with higher risk of injuries especially in motor vehicle accidents 391(40%), fire 264 (27%), and burns 162 (16%) except for drowning, machinery and poisoning. Parental migration is the most important issue in the total number of injuries. Correlation coefficient shows that non-left behind, the greater the chance to be classified under the poisoning cases (r = 0.888) and is lower compared to the left behind (r = 0.471). This study shows clearly that injuries take an insufficiently high toll on children's health and on society. Additionally, if parental migration trends continue, Botswana's burden of injuries are expected to rise in the next 10 years.

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  • Rong Chen, Ping Xu, Fen Li, Peipei Song
    Volume 12 (2018) Issue 2 Pages 132-141
    Released: May 13, 2018
    [Advance publication] Released: April 02, 2018
    JOURNALS FREE ACCESS

    In addition to birth and death, migration is also an important factor that determines the level of population aging in different regions, especially under the current context of low fertility and low mortality in China. Drawing upon data from the fifth and sixth national population census of 287 prefecture-level cities in China, this study explored the spatial patterns of population aging and its trends from 2000 to 2010 in China. We further examined how the large-scale internal migration was related to the spatial differences and the changes of aging by using multivariate quantitative models. Findings showed that the percentage of elder cities (i.e. proportion of individuals aged 65 and above to total population is higher than 7%) increased from 50% to 90% in the total 287 cities within the decade. We also found that regional imbalances of population aging have changed since 2000 in China. The gap of aging level between East zone and the other three zones (i.e. West, Central, and North-east) has considerably narrowed down. In 2000, Eastern region had the greatest number (65) of and the largest proportion (74.7%) of elder cities among all four regions. By 2010, the proportion (87.4%) of elder cities in the eastern region was slightly lower than Central (91.4%), Western (88.2%) and North-east sectors (91.2%). Results from multivariate quantitative models showed that the regional differences of population aging appear to be affected much more by the large-scale internal migration with clear age selectivity and orientation preference than by the impact of fertility and mortality. Population aging is expected to continue in China, which will in turn exacerbate regional imbalances. Policies and implications are discussed to face the challenges that the divergent aging population may present in China.

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  • Ying Liu, Yuyan Zhang, Zhen Ning, Huang Zheng, Yingying Ding, Meiyang ...
    Volume 12 (2018) Issue 2 Pages 142-148
    Released: May 13, 2018
    JOURNALS FREE ACCESS

    Intimate partner violence (IPV) and its association with HIV infection among men who have sex men (MSM) in China are not understood. In this study, 732 MSM recruited from Shanghai, China between March and August 2015 were administered with a questionnaire survey and HIV blood testing. IPV victimization was measured by 25 forced-choice items capturing lifetime experience of physical, sexual, psychological, deprivation or neglect, and other forms of violence. Of them, 179 (24.3%) reported having experienced at least one type of IPV victimization. In separate multivariable analyses, sexual violence was associated with age over 35 years (AOR = 0.26, 95% CI: 0.07-1.02), ever had male-to-male commercial sex (AOR = 2.53, 95%CI: 1.19-5.39), and diagnosis of a sexually transmitted infection (STI) (AOR = 2.14, 95%CI: 0.98-4.66). Both psychological violence (AOR = 2.53, 95%CI: 1.25-5.12)and deprivation or neglect violence (AOR = 1.75, 95%CI: 1.14-2.68) were associated with ever had sex with a casual male partner(s). Having experienced at least one type of IPV victimization was significantly associated with ever had sex with a causal partner(s) (AOR = 1.72, 95%CI: 1.15-2.57) and ever had a diagnosis of a STI (AOR = 1.80, 95% CI: 1.12-2.88). HIV infection was marginally associated with having experienced any form of IPV victimization. IPV victimization is common among MSM, especially young MSM, in China, although its association with HIV infection is not conclusive in our sample. Nonetheless, our findings highlight the importance of the needs of individualized IPV interventions for certain target risk groups of MSM.

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  • Xiao Chang, Kang Lu, Ling Wang, Min Lv, Wenjun Fu
    Volume 12 (2018) Issue 2 Pages 149-156
    Released: May 13, 2018
    [Advance publication] Released: April 02, 2018
    JOURNALS FREE ACCESS

    Diabetic cardiomyopathy (DCM) is one of the main cardiac complications among diabetic patients. According to previous studies, the pathogenesis of DCM is associated with oxidative stress, apoptosis and proliferation of local cardiac cells. It showed, NRG1 can improve the function of mitochondria, and thereby, increasing proliferation and decreasing apoptosis of cardiac muscle cell via ErbB/AKT signaling, also, exert antioxidative function. Besides, NRG1/ErbB pathway was impaired in the DCM model which suggested this signaling played key role in DCM. Astraglaus polysaccharide (APS), one of the active components of Astragalus mongholicus, showed striking antioxidative effect. Here, in this study, our data showed that APS can promote proliferation and decrease apoptosis in AGE-induced DCM cell model, besides, APS can decrease intracellular ROS level, increase activity of SOD, GSH-Px and lower level of MDA and NO in DCM cell model, indicating APS exerted antioxidative function in DCM model cells. Besides, western blot results revealed APS induced NRG1 expressing and the phosphorylation level of ErbB2/4. In addition, the elevated NRG1 promoted AKT and PI3k phosphorylation which indicated APS may exert its function by NRG1/ErbB and the downstream AKT/PI3K signaling. Canertinib is ErbB inhibitor. The effect of APS on proliferation, apoptosis, antioxidation and NRG1/ErbB pathway was partly abolished after the cells were co-treated with APS and canertinib. Taken together, these results suggested APS may display its protective function in DCM cells by activating NGR1/ErbB signaling pathway. And our study increased potential for prevention and therapy to DCM.

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  • Jinfeng Qian, Na Zhang, Jing Lin, Caiyan Wang, Xinyao Pan, Lanting Che ...
    Volume 12 (2018) Issue 2 Pages 157-167
    Released: May 13, 2018
    [Advance publication] Released: April 15, 2018
    JOURNALS FREE ACCESS

    The aim of the current study was to determine the pattern of immune cells and related functional molecules in peripheral blood and at the maternal-fetal interface in women with unexplained recurrent spontaneous abortion (URSA). In part I, 155 women were included and divided into four groups: non-pregnant controls with no history of URSA (NPCs), pregnant controls with no history of URSA (PCs), non-pregnant women with a history of URSA (NPUs), and pregnant women with a history of URSA (PUs). Venous blood samples were collected and analyzed. In part II, 35 subjects with URSA and 40 subjects in the early stage of normal pregnancy who chose to undergo an abortion were recruited. Samples of the decidua were collected, and the proportion of immune cells and the expression of related molecules were evaluated. Peripheral regulatory T cells (Treg cells) increased in PCs compared to NPCs, but in women with URSA the flux of Treg cells disappeared when pregnancy occurred. Levels of interleukin-10 (IL-10), cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), and IL-17 and the ratio of Th17/Treg cells in peripheral blood remained stable among the four groups. At the maternal-fetal interface, the percentage of Treg cells, the level of CTLA-4 of CD4+CD25+CD127lo cells and CD4+Foxp3+ cells were significantly lower in women with URSA compared to controls, respectively. Levels of transforming growth factor-β1 (TGF-β1) mRNA and protein in the decidua significantly decreased in URSA while levels of IL-6 and tumor necrosis factor-ɑ (TNF-ɑ) and the Th17/Treg ratio significantly increased. In conclusion, peripheral Treg cells did not increase in pregnant women with URSA. The decrease in Treg cells and levels of CTLA-4 and TGF-β1 and as well as the increase in levels of IL-6 and TNF-ɑ, and the Th17/Treg ratio at the maternal-fetal interface might contribute to inappropriate maternal-fetal immune tolerance in URSA.

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  • Xinyu Li, Yan Wang, Kun Wang, Yonggui Wu
    Volume 12 (2018) Issue 2 Pages 168-176
    Released: May 13, 2018
    [Advance publication] Released: April 19, 2018
    JOURNALS FREE ACCESS

    Paeoniflorin is the main bioactive components of the root of P.lactiflora Pall., and has been widely used as an anti-inflammation and immunomodulatory agent. However, the effect and mechanisms of Paeoniflorin in diabetic nephropathy (DN) remains to be elucidated. In the present study, streptozotocin (STZ)-induced type 1 diabetic mice model was used to investigate the protective effect of Paeoniflorin and the role of the Janus kinase (JAK) 2/signal transducer (STAT) 3 signaling pathway on DN. After treatment with Paeoniflorin at a dose of 25, 50 and 100 mg/kg once a day for 12 weeks, both the functional and histological damage to diabetic mice kidney had been attenuated significantly. Additionally, these reno-protective effects were associated with alleviating macrophage infiltration and inflammatory factors expression as well as suppression of the JAK2/STAT3 signaling pathway. These data reveal that Paeoniflorin attenuates renal lesions in diabetic mice and these protective effects may be associated with the prevention of macrophage infiltration and inhibition of the JAK2/STAT3 signaling pathway.

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  • Lu Chang, Fang Ye, Quehua Luo, Zewen Wang, Yimin Wang, Zhengyuan Xia, ...
    Volume 12 (2018) Issue 2 Pages 177-184
    Released: May 13, 2018
    [Advance publication] Released: April 15, 2018
    JOURNALS FREE ACCESS

    Both local infiltration analgesia (LIA) and nerve block are common analgesic modalities for pain relief after surgery. The aim of the current study was to investigate the effects of those two modalities on pain behavior and the expression of pro-inflammatory cytokines such as interleukin (IL)-1β and IL-6 and tumor necrosis factor-α (TNF-α) in the spinal cord and dorsal root ganglion (DRG) in a rat model of perioperative fentanyl induced hyperalgesia. Rats were injected with fentanyl (60 μg/kg) 4 times and received a plantar incision after the second injection or they received pre-incision LIA and sciatic nerve block (SNB) or post-incision LIA with levobupivacaine (0.5%, 0.2 mL). Mechanical and thermal nociceptive thresholds were assessed using the tail pressure test and paw withdrawal test on the day before drug injection, 1 and 4 hours after injection, and 1-7 days later. The lumbar spinal cord and dorsal root ganglia were collected from rats in each group to measure IL-1β, IL-6, and TNF-α on the day before drug injection, 4 hours after injection, and 1, 3, 5, and 7 days later. Fentanyl and an incision induced a significantly delayed mechanical hyperalgesia in the tail and thermal hyperalgesia in both hind paws and up-regulation of pro-inflammatory cytokines in the spinal cord and dorsal root ganglia. Rats treated with pre-incision LIA and SNB or post-incision LIA had alleviated hyperalgesia and significantly reduced levels of IL-1β, IL-6, and TNF-α compared to the control group. LIA and SNB partly prevented perioperative fentanyl-induced hyperalgesia and up-regulation of pro-inflammatory cytokines in the spinal cord and dorsal root ganglia.

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  • Zhen Wang, Jianhui Wu, Ang Lv, Chengpeng Li, Zhongwu Li, Min Zhao, Chu ...
    Volume 12 (2018) Issue 2 Pages 185-192
    Released: May 13, 2018
    [Advance publication] Released: April 15, 2018
    JOURNALS FREE ACCESS

    This study sought to evaluate the infiltration tendency of retroperitoneal liposarcoma (RPLS) from a new pathological angle by exploring the infiltration characteristics, which could provide helpful information to facilitate surgical decision-making and prognosis prediction. Concurrently, we aim to identify significant indicators of infiltration. A total of 61 consecutive patients with RPLS at our institution were retrospectively analyzed. All patients received extended surgery. The tumor infiltration characteristics and influencing factors were studied based on the pathological diagnosis. Univariate and multivariate analyses of organ infiltration (OI) and surrounding fat infiltration (SFI) were performed. OI was found in 95 (28.5%) resected organs from 39 (60.7%) patients, and SFI was found in 119 (35.7%) resected organs from 47 (77%) patients. The tumor infiltrated the serosal layer of 13 organs (13/37, 35.1%), the muscularis layer of 18 organs (18/37, 48.6%) and the submucosa of 6 organs (6/37, 16.2%). The percentage of lipoblasts and the rates of necrosis and mitosis were all significantly higher in high-grade tumors (dedifferentiated, round cell, and pleomorphic). A high lipoblast percentage (≥ 20%) was the only independent risk factor for OI. A recurrent tumor and a high-grade tumor were independent risk factors for SFI. In conclusion, RPLS has a high infiltration tendency, such that it frequently infiltrates organs and surrounding fat tissue. Therefore, extended resection of the tumor and the adjacent organs is recommended. The percentage of lipoblasts was associated with the tumor grade and infiltration characteristics; thus, lipoblast percentage may become a new grading factor for RPLS.

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  • Yongwei Huang, Qiang Zhang, Mingfei Yang
    Volume 12 (2018) Issue 2 Pages 193-200
    Released: May 13, 2018
    JOURNALS FREE ACCESS

    Hematoma expansion (HE) is an independent predictor of poor outcome and secondary neurological deterioration in intracerebral hemorrhage (ICH) and is associated with high morbidity and mortality. Noncontrast computed tomography (NCCT) may identify the sites of active extravasation. Therefore, we have attempted to (1) devise a reliable and easy-to-use prediction score to predict the risk of HE in ICH and (2) validate the accuracy of this grading system and perform an independent analysis of HE predictors. We included patients in whom an intracerebral hemorrhage (ICH) occurred in the basal ganglia between Jan. 2015 and Jan. 2018. These patients had undergone a baseline CT scan at Qinghai Provincial People's Hospital within 24 hours after the onset of ICH symptoms. Two observers independently assessed the presence of the island sign, blend sign, or swirl sign on an NCCT scan during patient selection. Patients underwent a baseline NCCT scan and 24-hour NCCT follow-up for analysis of HE. The accuracy of this grading system was assessed. Independent predictors of HE were identified using multivariable regression. Of 266 patients with ICH, 61 (22.93%) presented with the island sign, 63 (23.68%) presented with the blend sign, and 50 (18.80%) presented with the swirl sign. The overall incidence of HE was 37.22% (99/266). Of 125 patients (46.99%) who underwent a baseline CT scan within 6 hours of onset, 141 (53.01%) underwent a scan in 6-24 hours. Multivariable logistic regression analysis identified the hematoma volume (OR, 0.974; P = 0.042), intraventricular hemorrhage (IVH) extension (OR, 3.225; P = 0.003), time from onset to the baseline CT scan (OR, 0.986; P < 0.001), and anticoagulant use or an international normalized ratio (INR) > 1.5 (OR, 3.362; P = 0.006) as closely associated with HE. In conclusion, the grading system demonstrated reliable accuracy at predicting HE. The grading system demonstrated acceptable accuracy in an independent single-institution study. The role of the grading system in predicting HE and poor outcome in patients with ICH is significant. NCCT imaging markers may serve as key markers for HE prediction.

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Brief Report
  • Guiyan Yuan, Rui Zhang, Xuwang Chen, Benjie Wang, Ruichen Guo
    Volume 12 (2018) Issue 2 Pages 201-207
    Released: May 13, 2018
    JOURNALS FREE ACCESS

    An economical, rapid, and sensitive method of gas chromatography-mass spectrometry (GC-MS) was developed and validated to determine the presence of six pesticides (dichlorvos, acetochlor, atrazine, chlorpyrifos, α-endosulfan, and β-endosulfan) in human plasma. The pesticides were extracted with acetonitrile and concentrated using anhydrous sodium sulfate. Then, the target compounds were analyzed and quantified with GC-MS using borneol as an internal standard. Separation was performed on a HP-5MS capillary column (30 m × 0.25 mm × 0.25 µm) with temperature programming. Detection was accomplished under electro-spray ionization (ESI) in selected ion monitoring (SIM) mode. Under optimized conditions, satisfactory linear ranges of 0.05-10 μg/mL were obtained for all of the analyzed pesticides. The linear correlation coefficients were greater than 0.99. The average recovery was between 86.8 and 106.5%. The inter- and intra-day precision ranged from 1.7-14.5% and 4.2-13.8%, respectively. Dichlorvos was unstable in plasma both at room temperature and when frozen. The other five pesticides were stable after storage at – 20°C for 17 days and two freeze-thaw cycles. Thirty-five plasma samples from 15 patients with acute self-poisoning were analyzed using this method. Dichlorvos was found in 13 plasma samples with a mean concentration of 0.289 μg/mL, and atrazine was found in 6 with a mean concentration of 0.261 μg/mL. Acetochlor was found in one plasma sample (0.153 μg/mL). This method is simple, reliable and cost-effective. It takes little time and does not waste solvents, and it can be used to routinely detect six pesticides in patients with acute poisoning.

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Communication
  • Xin Zhao, Peipei Song, Yuhua Zhang, Jiwei Huang
    Volume 12 (2018) Issue 2 Pages 208-210
    Released: May 13, 2018
    JOURNALS FREE ACCESS

    Laparoscopic liver resection (LLR) has garnered attention as a new form of liver surgery. In China, many hepatobiliary surgeons are now encouraging the examination and assessment of LLC in order to improve its outcomes, and several young hepatobiliary surgeons recently shared their clinical experiences and the results of their research in presentations at the Akamon Forum as part of the 118th Annual Congress of the Japan Surgical Society, which was held April 5-7, 2018 in Tokyo, Japan. In China, LLR has gradually improved over the past 20 years, including both expanded indications and improved surgical approaches. However, China is a vast country, and the level of medical care varies nationwide. Medical facilities that can perform advanced laparoscopic techniques are currently limited to those in large cities. Moreover, additional clinical studies of the long-term oncological outcomes of LLR need to be performed in the future.

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  • Xiaoguang Yang, Shenglan Tang, Gavin Yamey, Xu Qian
    Volume 12 (2018) Issue 2 Pages 211-214
    Released: May 13, 2018
    [Advance publication] Released: April 15, 2018
    JOURNALS FREE ACCESS

    China has made impressive achievements in improving maternal and child health (MCH) over the past few decades. This paper uses a policy lens to examine reasons for these achievements as well as barriers to further success. We found that strong governmental commitment and leadership, effective coordination, proactive participation of different stakeholders, and the provision of adequate resources were associated with China's success in improving MCH outcomes. Other low- and middle-income countries can learn valuable lessons from China's experience. These lessons include i) prioritizing MCH on the national development agenda, ii) keeping national ownership over health development cooperation, and iii) establishing effective monitoring, evaluation and accountability mechanisms for MCH programs.

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