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Polyimide (PI) films are widely used in electronic devices owing to their excellent mechanical and electrical properties and high thermal and chemical stabilities. In particular, PI films play an important role in flexible printed circuit boards (FPCBs). However, one challenge currently faced with their use is that the adhesives used in FPCBs cause a high dielectric loss in high-frequency applications. Therefore, it is envisioned that PI films with a low dielectric loss and Cu films can be used to prepare two-layer flexible copper-clad laminates (FCCLs) without any adhesive. However, the preparation of ultra-thin FCCLs with no adhesives is difficult owing to the low peel strength between PI films and Cu films. To address this technical challenge, an FCCL with no adhesive was prepared via high-power helicon wave plasma (HWP) treatment. Field-emission scanning electron microscopy (FE-SEM), X-ray photoelectron spectroscopy (XPS), and X-ray diffraction (XRD) were tested. Also, the surface roughness of the PI film and the peel strength between the PI film and Cu film were measured. The experimental results show that the surface roughness of the PI film increased by 40-65% and the PI film demonstrated improved adhesion (the peel strength was >8.0 N/cm) with the Cu film following plasma treatment and Cu plating.

A steady-state, high-flux N 2 /Ar helicon wave plasma (HWP) with a small diameter (10 mm) was used to nitride the interior of a slender austenitic stainless steel (ASS) 316L tube at a temperature of 450 °C. N 2 and Ar were fed to a 500 mm long slender tube with 10 mm inner diameter and were ionized inside the tube using a helicon wave in the magnetic field of 2000 G. The microstructure and depth of the nitrided layers, in addition to the morphology and hardness of the nitrided surfaces, were intensively characterized by employing scanning electron microscopy (SEM), optical microscopy (OM), X-ray diffraction (XRD), energy dispersive X-ray spectroscopy (EDS), as well as microhardness tests. The results confirmed that the nitrided layer consisted primarily of the expanded austenite phase γ N , and neither CrN nor iron nitride precipitates. An increasing trend in microhardness was observed in inductively coupled plasma (ICP) and HWP modes; however, the increase in HWP nitriding (up to HV 1820 with a thickness of 14 μm) was approximately 1.5 times greater than that achieved through ICP plasma nitriding. This was owing to the higher N + ion density in the HWP mode. Considering the successful control of N 2 plasma discharge in a slender tube with a small diameter, this study opens up a new avenue for achieving high-yield nitride layers inside slender tubes.

Objective: To assess the associations between tobacco use and health care service utilization in Chinese individuals aged more or equal to 40 years old., Method: This research was a cross-sectional study using data from eight provinces in China, and the final sample consisted of 4,733 observations (4,749 participants) aged more or equal to 40 years old. The dependent variable was health care utilization measured by outpatient and inpatient service utilization. Descriptive statistics were used to summarize the socio-demographic characteristics of the sample according to smoking status. The association between tobacco use and health care service utilization was examined by an instrumental variable (IV) probit model., Results: Of the respondents interviewed in 2020, 3,116 (65.84%) were never smokers, 654 (13.82%) were smokers with the smoking index (SI) <400, and 963(20.34%) were smokers with SI≥400. Smokers with SI <400 reported a 6.80% higher probability of using outpatient services. Smokers with SI <400 and SI≥400 reported a 3.10 and 4.20% higher average probability of using ≥3 outpatient visits than never smokers, respectively. Additionally, smokers with SI <400 and SI≥400 reported a 6.30 and 6.20% higher average probability of using inpatient services than those who had not smoked. Moreover, smokers with SI≥400 were more likely to have had ≥2 hospital visits than nonsmokers., Conclusions: Smokers make greater use of health care services. Control of smoking may ease the burden of related health care utilization., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Song, Jin and Cheng.)

Globally, dyslipidemia is now become a leading risk factor for many adverse health outcomes, especially in the middle-aged and elderly. Recent evidence suggests that exposure to greenness and the relief of a psychological burden may decrease the prevalence of dyslipidemia. The objective of our study was to examine whether a green space can moderate the association between mental health status and dyslipidemia. Our study selected the datasets of depression symptoms, dyslipidemia from the China Health and Retirement Longitudinal Study (CHARLS), and the satellite-based normalized difference vegetation index (NDVI) from the 30 m annual maximum NDVI dataset in China in 2018. Ultimately, a total of 10,022 middle-aged and elderly Chinese were involved in our study. Multilevel logistic regressions were performed to examine the association between symptoms of depression and dyslipidemia, as well as the moderate effect of greenness exposure on the association. Our research suggested that adults diagnosed with depression symptoms were more likely to suffer from dyslipidemia. In addition, the NDVI was shown to moderate the effect of depression on dyslipidemia significantly, though the effect was attenuated as depression increased. Regarding the moderate effect of the NDVI on the above association across age, gender, and residence, the findings presented that females, the elderly, and respondents living in urban areas were at a greater risk of having dyslipidemia, although the protective effect of the NDVI was considered. Likewise, the moderate effect of the NDVI gradually decreased as the level of depression increased in different groups. The current study conducted in China provides insights into the association between mental health, green space, and dyslipidemia. Hence, improving mental health and green spaces can be potential targets for medical interventions to decrease the prevalence of dyslipidemia.

The phase equilibria of the Ag-Ni-Zr ternary system were investigated based on the key experiments coupled with thermodynamic modeling. Thirty ternary alloys were prepared to determine the isothermal sections of the Ag-Ni-Zr system at 500, 700 and 900 °C, respectively, by means of X-ray diffraction (XRD) and scanning electron microscopy equipped with energy dispersive X-ray spectroscopy (SEM/EDS). Based on the thermodynamic descriptions of three binary systems available in the literature as well as the experimental phase equilibrium data obtained from the present work, ten three-phase regions were determined. No ternary compound was found. The maximum solubilities of Ag in the Ni-Zr binary compounds and Ni in the Ag-Zr binary compounds were measured. The substitutional model and sublattice model were used to describe the solution phases and intermediate phases, respectively. Based on the thermodynamic descriptions of three constituent binary systems as well as the experimental phase equilibrium data obtained from the present work, a thermodynamic assessment of the Ag-Ni-Zr system was carried out using the CALPHAD (CALculation of PHAse Diagrams) approach. A set of thermodynamic parameters were obtained and the isothermal sections of the Ag-Ni-Zr system were calculated. The calculated results agree well with the experimental data.

Introduction: Understanding the social determinants that influence adolescent smoking behavior has a meaningful impact on adolescent health. Few studies have simultaneously analyzed the impact of teacher smoking and peer smoking on adolescent smoking. Therefore, the present study aims to investigate the impact of teacher smoking, peer smoking, and other social factors, on adolescent smoking., Methods: The participants were drawn from schools in Beijing, China, in 2011, 2013, and 2015, using a multi-stage random group sampling method. The number of schools selected for each year was 160. The study participants were 57240 adolescents aged 8-19 years. The generalized linear model with a binomial distribution and logarithmic link function was used to estimate the influence of social determinants on adolescent smoking behavior., Results: The results show that both teacher smoking and peer smoking were significantly associated with adolescent smoking. Compared to adolescents whose teachers did not smoke, the prevalence ratio (PR) was 1.28 for adolescents with one teacher who smoked and 1.34 for adolescents with two or more teachers who smoked (95% CI: 1.16-1.41/1.23-1.46, p<0.001/0.001, respectively). Compared to adolescents whose peers did not smoke, the prevalence ratio (PR) was 3.73 for adolescents with one peer who smoked and 8.52 for adolescents with two or more peers who smoked (95% CI: 3.20-4.35/7.48-9.69, p<0.001/0.001, respectively)., Conclusions: Teacher smoking and peer smoking are significant social determinants of adolescent smoking. Prevention programs should concurrently target peer groups, school settings, and individual students., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2022 Cheng X. et al.)

Background: Studies have not provided clear enough evidence on the direct association between cigarette smoking and poverty. This study aims to assess the association of householder smoking with near-poverty households, and the potential mediating effect of NCDs., Methods: A cross-sectional survey was conducted from November 2019 to October 2020 in relatively underdeveloped regions in China. In total, 2,409 households were investigated in areas under the jurisdiction of 24 primary health care (PHC) institutions of eight provinces. Pearson's χ 2 -test was performed, and multivariable logistic regression and extended probit regression models were fitted to examine the association between householder smoking and near-poverty households. Moreover, generalized structural equation modeling was used to explore the mediating effect of NCDs., Results: After adjusting for all other potential confounding factors, compared with households headed by never-smokers, households headed by smokers exhibited significantly elevated risks of being near poverty, with an odds ratio of 2.01 (95% CI: 0.48-0.91). We also found that living in rural areas and having a low education level both had a negative effect on being near poverty. Additionally, NCDs had a significantly positive mediating effect, with a 31.57% effect of householder smoking on near-poverty status mediated by NCDs; the indirect effect was estimated to be 0.17 (95% CI: 0.04-0.31)., Conclusions: Householder smoking significantly elevated the risk of the household being near poverty, and suffering NCDs had a positive mediating effect., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Yang, Chen, Guo, Song, Cheng and Jin.)

Objective: The purpose of this study was to investigate the association between smoking and health-related quality of life among Chinese individuals aged 40 years and older., Method: Using a stratified multistage sampling method, data from 1,543 adults aged 40 years and older were obtained from a household survey conducted in eight provinces in China. The health-related quality of life was quantified based on the utility index obtained using a standardized instrument entitled "The European Five-Dimensional Health Scale (EQ-5D-5L)." Descriptive statistics were used to summarize the demographic characteristics and social factors of the sample according to smoking status. An instrumental variable (IV) probit model was used to estimate the association between smoking status and health-related quality of life., Results: Of the 1,543 participants, 485 (31.43%) were smokers and 1,058 (68.57%) were non-smokers. Smoking was negatively associated with the probability of having a higher quality of life ( p < 0.01). For smokers, the average probability of having a higher quality of life was 11.65% lower than when they did not smoke., Conclusions: These findings suggest that smoking reduces health-related quality of life among Chinese individuals aged 40 years and older. Anti-smoking programs should consider this factor., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Cheng and Jin.)

The mechanism of acceleration, loss, and wave-particle interaction of energetic particles in the magnetosphere is a research content of the Space Plasma Environment Research Facility, which is being built as a user facility at the Harbin Institute of Technology in China. Two magnetic perturbation coils are used to simulate the magnetic storm distortion and excite Alfvén wave perturbation. A capacitor-based pulsed power supply (PPS) system with a modular design is developed to excite the magnetic perturbation coils to generate the required amplitude and duration of the magnetic field. The two magnetic perturbation coils are the CRDI coil and CRDII coil and are excited by one set of PPSs. The PPS for the CRDI coil consists of two modules and can provide a pulsed current of no less than 132 kA at 0.12 ms when the charging voltage is 20 kV, and the duration of the pulsed current from the peak to 10% of the peak is no more than 0.7 ms. The PPS for the CRDII coil consists of five modules and can provide a pulsed current of no less than 16 kA at 0.45, 0.65, 0.8, 0.95, and 1.1 ms, and the duration of the pulsed current from the peak to 10% of the peak is no more than 4.5 ms. The detailed design of the PPSs has been discussed in this paper, and the discharge test of the PPSs is carried out to verify the design of the PPSs.

The Space Plasma Environment Research Facility currently under construction at the Harbin Institute of Technology in China uses four magnetosheath coils (flux cores) and a dipole coil to generate the magnetic field required for the study on the magnetopause magnetic reconnection. Two groups of magnetopause shape control coils (labeled CK coils) are used to slightly adjust the magnetic field distribution on the magnetopause. A capacitive pulsed power supply (PPS) system with a modular design is developed to excite CK coils. The PPS system consists of six sets of PPS with the same principle and structure, which are used to excite six sub-coils of the CK coils, respectively. Each set of PPS consists of ten modules and one local controller, and each module consists of a charger and discharge unit. Each set of PPS can provide a pulsed current of no less than 400 kA for the corresponding sub-coil at 0.11 ms when the charging voltage is 20 kV, and the duration of the pulsed current from the peak to 10% of the peak is no more than 0.6 ms. The detailed design of the PPS is discussed in this paper, and the discharge test of the PPS is carried out to verify the design of the PPS. Because there are acquisition and control devices in the discharge unit, the electromagnetic interference immunity design is also discussed to ensure the normal operation of the PPS.

A magnet system is used in the SPERF to create the magnetic field configuration for simulating the space plasma environment. In this paper, the parameters of the system are designed to achieve the target fields needed by the scaling laws, and the electromagnetic analysis has been performed to validate the results. A procedure to obtain the parameters is proposed based on the investigation into the physical and technological constraints. The vacuum magnetic fields for studying the 3D magnetic reconnection at the magnetopause, Earth's magnetosphere, and 3D magnetic reconnection driven by a plasma gun are computed. In addition, the engineering complexity is reviewed in brief. This research is crucial to the construction of the SPERF, and it is valuable to designing the magnets applied in other fields.

Background: Chronic Kidney Disease - Mineral and Bone Disorder (CKD-MBD) is a significant cause of morbidity among haemodialysis patients and is associated with pathological changes in phosphate, calcium and parathyroid hormone (PTH). In the ACTIVE Dialysis study, extended hours dialysis reduced serum phosphate but did not cause important changes in PTH or serum calcium. This secondary analysis aimed to determine if changes in associated therapies may have influenced these findings and to identify differences between patient subgroups., Methods: The ACTIVE Dialysis study randomised 200 participants to extended hours haemodialysis (≥24 h/week) or conventional haemodialysis (≤18 h/week) for 12 months. Mean differences between treatment arms in serum phosphate, calcium and PTH; and among key subgroups (high vs. low baseline phosphate/PTH, region, time on dialysis, dialysis setting and frequency) were examined using mixed linear regression., Results: Phosphate binder use was reduced with extended hours (- 0.83 tablets per day [95% CI -1.61, - 0.04; p = 0.04]), but no differences in type of phosphate binder, use of vitamin D, dose of cinacalcet or dialysate calcium were observed. In adjusted analysis, extended hours were associated with lower phosphate (- 0.219 mmol/L [- 0.314, - 0.124; P < 0.001]), higher calcium (0.046 mmol/L [0.007, 0.086; P = 0.021]) and no change in PTH (0.025 pmol/L [- 0.107, 0.157; P = 0.713]). The reduction in phosphate with extended hours was greater in those with higher baseline PTH and dialysing at home., Conclusion: Extended hours haemodialysis independently reduced serum phosphate levels with minimal change in serum calcium and PTH levels. With a few exceptions, these results were consistent across patient subgroups., Trial Registration: Clinicaltrials.gov NCT00649298 . Registered 1 April 2008.

Background: Problems of irrational antibiotic use by prescribers are ongoing and have escalated following reductions in the cost of essential drugs policy. In an attempt to improve prescribing practices for village doctors and rational use of essential drugs, a program designed to audit and monitor drug use was established. However, the effects of the program to control antibiotic resistance and changing the village doctors' prescribing behaviors remain largely unknown. This study measured the effect of the program on levels of antibiotic use., Method: Data was collected covering a 22-month period, before, during and after the program was implemented in rural clinics. Segmented regression analysis with interrupted time series (ITS) data was used to examine whether there had been a significant interaction with the onset of the program in September 2011 and levels of antibiotic use from November 2010 to August 2012. Both serial and 12-month lag autocorrelations were controlled for., Results: A noticeable drop about 6.15% per month (95% CI: -13.36%; 1.06%, P = 0.089) for the antibiotic use in outpatients, which is lower of effect size assuming that the program has the immediate impact of the program were captured for the immediate effect of the program. Meanwhile, levels of antibiotic use would have continued to decrease by 1.12% per month (P = 0.034) as they did in the absence of the program., Conclusion: The central finding was that the prescription audit and feedback program was associated with significant decreases (P = 0.034) in antibiotic use after its implementation.

Introduction and Aim: Accurately predicting the prognosis of individual patient is crucial in the management of ACLF. We aimed to establish a specific prognostic model for HBV-related ACLF patients treated with nucleoside analog (NA)., Material and Methods: We prospectively collected 205 ACLF cases diagnosed according to the APASL criteria. A dynamic prognostic model based on APASL criteria was established and validated. To demonstrate that the model is also applicable to those within EASL criteria, we divided the patients into two groups: met APASL criteria only (group A, n = 123); met both APASL and EASL criteria (group B, n = 82). Its prognostic accuracy was also compared with chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score in group B., Results: The model is: R = 0.94 x Bilirubin + 0.53 x evolution of Bilirubin - 0.45 x PT-A - 0.22 x evolution in PT-A -0.1 x PLT + 10 x anti-HBe. The area under receiver operating characteristic curve (AUC) of the model for predicting 90-day mortality was 0.86, which was significantly higher than that of model for end stage liver disease(MELD), MELD-Na, CLIF-SOFA, ΔMELD (7d) and ΔMELD-Na (7d), ΔCLIF- SOFA(7d) (all p &lt; 0.01). The AUC of our model in the validation group was 0.79 which was superior to MELD (0.45) CLIF-SOFA (0.53) score in group B patients (p &lt; 0.01)., Conclusion: In conclusion, the model was superior to the conventional methods in predicting the outcomes of patients with HBV related ACLF treated with NA. It is the first description of a novel prognostic model using consecutive data in patients with HBV-induced acute-on-chronic liver failure (ACLF) treated by nucleoside analogs.

Aim: It is challenging to predict the outcome of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) through existing prognostic models. Our aim was to establish a novel dynamic model to improve the predictive efficiency of 30-day mortality in HBV-ACLF patients., Methods: 305 patients who were diagnosed as HBV-ACLF (derivation cohort, n=211; validation cohort, n=94) were included in this study. The HBV-ACLF dynamic (HBV-ACLFD) model was constructed based on the daily levels of predictive variables in 7 days after diagnosis combined with baseline risk factors by multivariate logistic regression analysis. The HBV-ACLFD model was compared with the Child-Turcotte-Pugh (CTP) score, end-stage liver disease (MELD) score, and MELD within corporation of serum sodium (MELD-Na) score by the area under the receiver-operating characteristic curves (AUROC)., Results: The HBV-ACLFD model demonstrated excellent discrimination with AUROC of 0.848 in the derivation cohort and of 0.813 in the validation cohort (p=0.620). The performance of the HBV-ACLFD model appeared to be superior to MELD score, MELD-Na score and CTP score (P<0.0001)., Conclusion: The HBV-ACLFD model can accurately predict 30-day mortality in patients with HBV-ACLF, which is helpful to select appropriate clinical procedures, so as to relieve the social and economic burden., Competing Interests: CONFLICTS OF INTEREST No potential conflicts (financial, professional, or personal) is relevant to the manuscript.

Human Vγ2Vδ2 T cells monitor isoprenoid metabolism by recognizing foreign (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate (HMBPP), a metabolite in the 2-C-methyl-D-erythritol-4-phosphate pathway used by most eubacteria and apicomplexan parasites, and self isopentenyl pyrophosphate, a metabolite in the mevalonate pathway used by humans. Whereas microbial infections elicit prolonged expansion of memory Vγ2Vδ2 T cells, immunization with prenyl pyrophosphates or aminobisphosphonates elicit short-term Vγ2Vδ2 expansion with rapid anergy and deletion upon subsequent immunizations. We hypothesized that a live, attenuated bacterial vaccine that overproduces HMBPP would elicit long-lasting Vγ2Vδ2 T cell immunity by mimicking a natural infection. Therefore, we metabolically engineered the avirulent aroA(-) Salmonella enterica serovar Typhimurium SL7207 strain by deleting the gene for LytB (the downstream enzyme from HMBPP) and functionally complementing for this loss with genes encoding mevalonate pathway enzymes. LytB(-) Salmonella SL7207 had high HMBPP levels, infected human cells as efficiently as did the wild-type bacteria, and stimulated large ex vivo expansions of Vγ2Vδ2 T cells from human donors. Importantly, vaccination of a rhesus monkey with live lytB(-) Salmonella SL7207 stimulated a prolonged expansion of Vγ2Vδ2 T cells without significant side effects or anergy induction. These studies provide proof-of-principle that metabolic engineering can be used to derive live bacterial vaccines that boost Vγ2Vδ2 T cell immunity. Similar engineering of metabolic pathways to produce lipid Ags or B vitamin metabolite Ags could be used to derive live bacterial vaccine for other unconventional T cells that recognize nonpeptide Ags.

Background: It is unclear whether changing the governance structure of community health centres (CHCs) could affect antibiotic prescribing behaviour., Objective: To explore how changes in governance structure affect antibiotic prescription for children younger than 5 years of age with acute upper respiratory tract infections (AURI) in CHCs in Shenzhen, China., Methods: This study used an interrupted time series design with a comparison series. On 1 June 2009, the Health Bureau of Shenzhen's Baoan District transferred CHCs from a hospital-affiliated model to a self-managed independent model regarding finance, personnel and employee compensation. We collected 23481 electronic medical records of children younger than 5 years of age who were treated for AURI on an outpatient basis 1 year before and 1 year after governance structure reform. We used segmented regression analysis to evaluate the effect of reform on antibiotic prescription., Results: After the reform, the proportion of patients receiving an antibiotic injection per month and the proportion of patients receiving two or more antibiotics conditional on receiving an antibiotic per month decreased 9.17% and 7.34%, respectively (P < 0.01 or P < 0.05). In the intervention series, the proportion of patients receiving an antibiotic injection per month and the monthly average cost of the antibiotics prescribed per patient continued to decrease over time compared with the control series (P < 0.001 or P < 0.05)., Conclusion: This study suggests that governance structure reform can have positive effects on behaviour for antibiotic prescribing. Moreover, this short-term effect might have important implications for further community health reforms in China., (© The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Lyme Borreliosis is an infectious disease caused by the spirochete Borrelia burgdorferi that is transmitted through the bite of infected ticks. Both B cell-mediated humoral immunity and T cell immunity develop during natural Borrelia infection. However, compared with humoral immunity, the T cell response to Borrelia infection has not been well elucidated. In this study, a novel T cell-based assay was developed and validated for the sensitive detection of antigen-specific T cell response to B. burgdorferi. Using interferon-g as a biomarker, we developed a new enzyme-linked immunospot method (iSpot Lyme™) to detect Borrelia antigen-specific effector/memory T cells that were activated in vivo by exposing them to recombinant Borrelia antigens ex vivo. To test this new method as a potential laboratory diagnostic tool, we performed a clinical study with a cohort of Borrelia positive patients and healthy controls. We demonstrated that the iSpot Lyme assay has a significantly higher specificity and sensitivity compared with the Western Blot assay that is currently used as a diagnostic measure. A comprehensive evaluation of the T cell response to Borrelia infection should, therefore, provide new insights into the pathogenesis, diagnosis, treatment and monitoring of Lyme disease.

Eliciting neutralizing antibodies is thought to be a key activity of a vaccine against human immunodeficiency virus (HIV). However, a number of studies have suggested that in addition to neutralization, interaction of IgG with Fc gamma receptors (FcγR) may play an important role in antibody-mediated protection. We have previously obtained evidence that the protective activity of the broadly neutralizing human IgG1 anti-HIV monoclonal antibody (MAb) b12 in macaques is diminished in the absence of FcγR binding capacity. To investigate antibody-dependent cellular cytotoxicity (ADCC) as a contributor to FcγR-associated protection, we developed a nonfucosylated variant of b12 (NFb12). We showed that, compared to fully fucosylated (referred to as wild-type in the text) b12, NFb12 had higher affinity for human and rhesus macaque FcγRIIIa and was more efficient in inhibiting viral replication and more effective in killing HIV-infected cells in an ADCC assay. Despite these more potent in vitro antiviral activities, NFb12 did not enhance protection in vivo against repeated low-dose vaginal challenge in the simian-human immunodeficiency virus (SHIV)/macaque model compared to wild-type b12. No difference in protection, viral load, or infection susceptibility was observed between animals given NFb12 and those given fully fucosylated b12, indicating that FcγR-mediated activities distinct from FcγRIIIa-mediated ADCC may be important in the observed protection against SHIV challenge.

Background: In 2002, the Chinese government launched a new rural health financing policy to provide health insurance (New Cooperative Medical Scheme, NCMS) for its rural population. NCMS, jointly financed by governments and individual households, aims to protect households from impoverishment due to catastrophic health expenditure. In 2011, NCMS covered more than 96% of the rural population. We have systematically searched and reviewed available evidence to estimate the effects of NCMS on health outcomes and on alleviating catastrophic health expenditure., Methods: PubMed, Web of Science with Conference Proceedings, ProQuest Digital Dissertations, CMCI, CNKI, and VIP were searched. We also obtained literature from colleague communications. Quasi-experimental studies regarding the effect of NCMS on health outcomes and catastrophic health expenditure were included. Two independent reviewers screened the literature, extracted the data, and assessed the study quality., Results: Fifteen studies out of the 6123 studies in the literature fulfilled criteria and were included in this review. Twelve studies identified the relationship between NCMS and health outcomes, among which six studies measured sickness or injury in the past four weeks, four measured sickness or injury in the past two weeks, and five measured self-reported health status. Four studies focused on the relationship between NCMS and alleviating catastrophic health expenditure. However, the results from these studies were in conflict: individual studies indicated that NCMS had positive, negative, or no effect on health outcomes and/or the incidence of catastrophic health payments, respectively., Conclusions: We still have no clear evidence that NCMS improves the health outcomes and decreases the alleviating catastrophic health expenditure of the China's rural population. In addition, the heterogeneity among individual studies reminds us that provider payment method reforms, benefit package and information systems around NCMS should be improved in the future.

Objective: To assess unnecessary use and cost of antibiotics for inpatient care for children under 14 years of age with pneumonia, and to identify the cost distribution in relation to different socio-economic status., Setting: The study was hospital-based and cross-sectional., Method: Between July 2007 and June 2008, 226 participants were interviewed in two county hospitals and three township health centers in two counties in rural China. The healthcare facilities provided medical and financial records for all study participants. Appropriateness of antibiotic treatment was assessed, in accordance with guidelines, by a paediatrician from a university teaching hospital, who reviewed all medical records. The cost of unnecessary antibiotics was based on the health facilities' price lists., Results: Unnecessary antibiotic prescriptions occurred in 43% of all patients. The median unnecessary cost of antibiotics was 40 RMB yuan (IQR: 22-100), and this extra cost increased the financial burden for the pneumonia inpatients by 18%. There were no statistically significant differences related to socio-economic categories for unnecessary antibiotics cost (F = 1.43, P = 0.2444)., Conclusion: Unnecessary prescribing of antibiotics use laid an extra burden on children with pneumonia at inpatient care. Implications for policy and practice might be considered regarding incentives, guidelines and training for health care providers.

Human gammadelta T cells expressing the Vgamma2Vdelta2 TCR play important roles in immune responses to microbial pathogens by monitoring prenyl pyrophosphate isoprenoid metabolites. Most adult Vgamma2Vdelta2 cells are memory cytotoxic cells that produce IFN-gamma. Recently, murine gammadelta T cells were found to be major sources of IL-17A in antimicrobial and autoimmune responses. To determine if primate gammadelta T cells play similar roles, we characterized IL-17A and IL-22 production by Vgamma2Vdelta2 cells. IL-17A-producing memory Vgamma2Vdelta2 cells exist at low but significant frequencies in adult humans (1:2762 T cells) and at even higher frequencies in adult rhesus macaques. Higher levels of Vgamma2Vdelta2 cells produce IL-22 (1:1864 T cells), although few produce both IL-17A and IL-22. Unlike adult humans, in whom many IL-17A+ Vgamma2Vdelta2 cells also produce IFN-gamma (Tgammadelta1/17), the majority of adult macaques IL-17A+ Vdelta2 cells (Tgammadelta17) do not produce IFN-gamma. To define the cytokine requirements for Tgammadelta17 cells, we stimulated human neonatal Vgamma2Vdelta2 cells with the bacterial Ag, (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate, and various cytokines and mAbs in vitro. We find that IL-6, IL-1beta, and TGF-beta are required to generate Tgammadelta17 cells in neonates, whereas Tgammadelta1/17 cells additionally required IL-23. In adults, memory Tgammadelta1/17 and Tgammadelta17 cells required IL-23, IL-1beta, and TGF-beta, but not IL-6. IL-22-producing cells showed similar requirements. Both neonatal and adult IL-17A+ Vgamma2Vdelta2 cells expressed elevated levels of retinoid-related orphan receptor gammat. Our data suggest that, like Th17 alphabeta T cells, Vgamma2Vdelta2 T cells can be polarized into Tgammadelta17 and Tgammadelta1/17 populations with distinct cytokine requirements for their initial polarization and later maintenance.

Objective: The purpose of this study was to examine inequalities of access to health care among the urban elderly in northwestern China., Methods: 4441 seniors (over 60 years of age) were drawn from a cross-sectional study conducted in three northwestern Chinese cities. The effects of these factors on the use of health care services (visits to physician and hospitalizations) were estimated using multiple binomial regressions., Results: Overall, 7.6% of the population studied had visited a physician during the past 4 weeks, 10.1% had used inpatient care during the past year, and 7.6% did not use inpatient services despite being referred by doctors for hospital admission during the previous year. Both visits to a physician and non-hospitalization were independently associated with the place of residence and household per capita income; the use of inpatient care services was significantly lower among those with less education, those with lower household per capita income and those without health insurance coverage. Women tended to make more use of outpatient services, but spent less time and money in hospital than men., Conclusion: Our findings indicate a significant inequality of access to health care services among urban seniors in northwestern China. More appropriate health care policies should be developed to achieve the goal of greater equality of access to health care services for all.

Introduction: Human Vgamma2Vdelta2 T cells play important role in immunity to infection and cancer by monitoring self and foreign isoprenoid metabolites with their gammadelta T cell antigen receptors. Like CD4 and CD8 alphabeta T cells, adult peripheral Vgamma2Vdelta2 T cells represent a pool of heterogeneous cells with distinct functional capabilities., Purpose: The aim of this study was to characterize the phenotypes and functions of various Vgamma2Vdelta2 T cell subsets in patients with nasopharyngeal carcinoma (NPC). We sought to develop a better understanding of the role of these cells during the course of disease and to facilitate the development of immunotherapeutic strategies against NPC., Results: Although similar total percentages of peripheral blood Vgamma2Vdelta2 T cells were found in both NPC patients and normal donors, Vgamma2Vdelta2 T cells from NPC patients showed decreased cytotoxicity against tumor cells whereas Vgamma2Vdelta2 T cells from normal donors showed potent cytotoxicity. To investigate further, we compared the phenotypic characteristics of Vgamma2Vdelta2 T cells from 96 patients with NPC and 54 healthy controls. The fraction of late effector memory Vgamma2Vdelta2 T cells (T(EM RA)) was significantly increased in NPC patients with corresponding decreases in the fraction of early memory Vgamma2Vdelta2 T cells (T(CM)) compared with those in healthy controls. Moreover, T(EM RA) and T(CM) Vgamma2Vdelta2 cells from NPC patients produced significantly less IFN-gamma and TNF-alpha, potentially contributing to their impaired cytotoxicity. Radiotherapy or concurrent chemo-radiotherapy further increased the T(EM RA) Vgamma2Vdelta2 T cell population but did not correct the impaired production of IFN-gamma and TNF-alpha observed for T(EM RA) Vgamma2Vdelta2 T cells., Conclusion: We have identified distinct alterations in the Vgamma2Vdelta2 T cell subsets of patients with NPC. Moreover, the overall cellular effector function of gammadelta T cells is compromised in these patients. Our data suggest that the contribution of Vgamma2Vdelta2 T cells to control NPC may depend on the activation state and differentiation of these cells.

Human Vgamma2Vdelta2 T cells are stimulated by prenyl pyrophosphates, such as isopentenyl pyrophosphate (IPP), and play important roles in mediating immunity against microbial pathogens and have potent anti-tumor activity. (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate (HMBPP) has been identified as a metabolite in the 2-C-methyl-D-erythritol-4 phosphate (MEP) pathway for isoprenoid biosynthesis that is used by many bacteria and protozoan parasites. We find that HMBPP is the major Vgamma2Vdelta2 T-cell antigen for many bacteria, including Mycobacterium tuberculosis, Yersinia enterocolitica and Escherichia coli. HMBPP was a 30 000-fold more potent antigen than IPP. Using mutant bacteria, we show that bacterial antigen levels for Vgamma2Vdelta2 T cells are controlled by MEP pathway enzymes and find no evidence for the production of 3-formyl-1-butyl pyrophosphate. Moreover, HMBPP reactivity required only germ line-encoded Vgamma2Vdelta2 TCR elements and is present at birth. Importantly, we show that bacterial HMBPP levels correlated with their ability to expand Vgamma2Vdelta2 T cells in vivo upon engraftment into severe combined immunodeficiency-beige mice. Thus, the production of HMBPP by a microbial-specific isoprenoid pathway plays a major role in determining whether bacteria will stimulate Vgamma2Vdelta2 T cells in vivo. This preferential stimulation by a common microbial isoprenoid metabolite allows Vgamma2Vdelta2 T cells to respond to a broad array of pathogens using this pathway.

Human Vgamma2Vdelta2 T cells play important roles in mediating immunity against microbial pathogens and have potent anti-tumor activity. Vgamma2Vdelta2 T cells recognize the pyrophosphorylated isoprenoid intermediates (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate (HMBPP), an intermediate in the foreign 2-C-methyl-d-erythritol 4-phosphate (MEP) pathway, and isopentenyl pyrophosphate (IPP), an intermediate in the self-mevalonate pathway. Infection with bacteria and protozoa using the MEP pathway leads to the rapid expansion of Vgamma2Vdelta2 T cells to very high numbers through preferential recognition of HMBPP. Activated Vgamma2Vdelta2 T cells produce proinflammatory cytokines and chemokines, kill infected cells, secrete growth factors for epithelial cells, and present antigens to alphabeta T cells. Vgamma2Vdelta2 T cells can also recognize high levels of IPP in certain tumors and in cells treated with pharmacological agents, such as bisphosphonates and alkylamines, that block farnesyl pyrophosphate synthase. Activated Vgamma2Vdelta2 T cells are able to kill most tumor cells because of recognition by T-cell receptor and natural killer receptors. The ubiquitous nature of the antigens converts essentially all Vgamma2Vdelta2 T cells to memory cells at an early age. Thus, primary infections with HMBPP-producing bacteria are perceived by Vgamma2Vdelta2 T cells as a repeat infection. Extensive efforts are underway to harness these cells to treat a variety of cancers and to provide microbial immunity.

gamma delta T cells are inadequately defined both in terms of their migration potential and contribution to antimicrobial immunity. Here, we have examined the migration profile of human blood gamma delta T cells and related cell lines and correlated these findings with their distribution in secondary lymphoid tissues and their function in B-cell cocultures. We find that resting gamma delta T cells are characterized by an inflammatory migration program similar to cells of the innate immune system. However, T-cell receptor (TCR) triggering resulted in the rapid but transient induction of a lymph node (LN)-homing program, as evidenced by functional CCR7 expression and concomitant reduction in expression and function of CCR5 and, to a lesser degree, CCR2. Moreover, the LN-homing program was reflected by the presence of gamma delta T cells in gastrointestinal lymphoid tissues, notably in clusters within germinal centers of B-cell follicles. In line with these findings, V gamma V delta-TCR triggering resulted in prominent expression of essential B-cell costimulatory molecules, including CD40L, OX40, CD70, and ICOS. Furthermore, gamma delta T cells were shown to provide potent B-cell help during in vitro antibody production. Collectively, our findings agree with a role for gamma delta T cells in humoral immunity during the early phase of antimicrobial responses.