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Introduction: China's organised health system has remained outdated for decades. Current health systems in many less market-oriented countries still adhere to traditional administrative-based directives and linear planning. Furthermore, they neglect the responsiveness and feedback of institutions and professionals, which often results in reform failure in integrated care. Complex adaptive system theory (CAS) provides a new perspective and methodology for analysing the health system and policy implementation. Methods: We observed the typical case of Qianjiang's Integrated Health Organization Reform (IHO) for 2 years to analyse integrated care reforms using CAS theory. Via questionnaires and interviews, we observed 32 medical institutions and 344 professionals. We compared their cooperative behaviours from both organisational and inter-professional levels between 2013 and 2015, and further investigated potential reasons for why medical institutions and professionals did not form an effective IHO. We discovered how interested parties in the policy implementation process influenced reform outcome, and by theoretical induction, proposed a new semi-organised system and corresponding policy analysis flowchart that potentially suits the actual realisation of CAS. Results: The reform did not achieve its desired effect. The Qianjiang IHO was loosely integrated rather than closely integrated, and the cooperation levels between organisations and professionals were low. This disappointing result was due to low mutual trust among IHO members, with the main contributing factors being insufficient financial incentives and the lack of a common vision. Discussion and Conclusions: The traditional organised health system is old-fashioned. Rather than being completely organised or adaptive, the health system is currently more similar to a semi-organised system. Medical institutions and professionals operate in a middle ground between complete adherence to administrative orders from state-run health systems and completely adapting to the market. Thus, decision-making, implementation and analysis of health policies should also be updated according to this current standing. The simplest way to manage this new system is to abandon linear top-down orders and patiently wait for an explicit picture of IHO mechanisms to be revealed after complete and spontaneous negotiation between IHO allies is reached. In the meantime, bottom-up feedback from members should be paid attention to, and common benefits and fluid information flow should be prioritised in building a successful IHO. [ABSTRACT FROM AUTHOR]

Androgenetic alopecia (AGA) is a common cause of hair loss in adults. We aimed to compare the efficacy and safety of topical generic 5% new minoxidil foam (NMF) versus 5% minoxidil Rogaine® foam in male patients with AGA. A randomized, double-blind, controlled, phase III, equivalence trial in 10 centers in China between December 25, 2019, and June 28, 2021, was performed. In total, 417 men patients (≥18 years) with AGA were randomized to receive 5% NMF (211 patients) or 5% Rogaine® foam (206 patients) 1 g two times daily for 24 weeks. The primary outcome was the changes in nonvellus target area hair counts (TAHC) from baseline to week 24. Equivalence was concluded if the 95% confidence interval (CI) for the treatment difference between the 5% NMF and Rogaine® groups was within (−8.00, 8.00). After 24 weeks of treatment, the mean difference in the change of nonvellus TAHC between the 5% NMF group and the Rogaine® group was −3.85 ± 1.62 hair/cm2 in full-analysis set (FAS) and −3.96 ± 1.68 hair/cm2 in per-protocol set (PPS), and the 95% CI of mean difference was (−7.03, −0.67) in FAS and (−7.26, −0.66) in PPS. No significant differences were found between the two groups in hair diameter, the ratio of terminal hair to vellus hair, the global photographic assessment by investigators, and adverse events (all P > 0.05). 5% NMF is as effective as Rogaine® in increasing hair density and hair diameter in AGA patients and was found to be safe. This trial is registered with CTR20191708. [ABSTRACT FROM AUTHOR]

This retrospective study was conducted to examine the development and current status of pediatric liver transplantation (LT) in western China. Clinical, demographic, morbidity, and mortality data were collected to analyze. It included 260 consecutive pediatric LTs performed at three centers in western China between January 2000 and May 2019. Kaplan‐Meier graft survival rates at 1, 3, 5, and 10 years were 82.1%, 77.2%, 76.6%, and 76.6%, respectively; corresponding patient survival rates were 84.7%, 80.7%, 80.0%, and 80.0%, respectively. More patients underwent living donor liver transplantation (LDLT; n = 188 (73.4%)) than deceased‐donor liver transplantation (DDLT; n = 68 (26.6%)). Survival was better after LDLT (91.5%, 86.6%, and 80.6% at 1, 3, and 5 years, respectively) than after DDLT (80.9%, 72.4%, and 63.9%, respectively; P <.05). Biliary atresia was the leading LT indication (n = 141 (55.1%)), followed by metabolic disease (n = 36 (14.1%)), which was associated with the best recipient survival (88.5% at 5 years). The transplant era and graft‐to‐recipient body weight ratio (GRWR) also significantly predicted overall survival. Survival rates at 5 years were worst in 2000‐2005 (54.5%) and best for GRWRs of 0.8%‐4% (80.4%). The development of pediatric LT in western China began slowly, but the quantity and quality of pediatric LT has progressed in recent years. This procedure is now a promising and reliable treatment for children with end‐stage liver disease in western China. [ABSTRACT FROM AUTHOR]

Purpose: This nested case-control study aimed to evaluate the association of candidate genetic variants with statin-induced myotoxicity in Chinese patients with coronary artery disease (CAD). Methods: One hundred forty-eight Chinese patients experiencing statin-induced myotoxicity were included in our study, and 255 patients without muscular side effects served as controls. Five SNPs in CYP3A5, SLCO1B1, and APOE were genotyped. The effect of genetic variants on statin-induced myotoxicity was assessed. Results: Patients who carried at least one SLCO1B1 521C allele had a higher risk for myotoxicity (OR = 1.69, 95%CI = 1.07-2.67, P = 0.024). Significant association was found between SLCO1B1 521C mutant allele mutation and risk of myotoxicity in individuals that received rosuvastatin (OR = 3.67, 95%CI = 1.42-9.47, P = 0.007). However, non-significant association was observed between 521C mutant allele and risk of myotoxicity ( P > 0.5) in patients that received atorvastatin and simvastatin. The other four single nucleotide polymorphisms (SNPs), namely rs776746, rs2306283, rs7412, and rs429358, showed no significant association with any statin induced myotoxicity ( P > 0.5). Conclusions: SLCO1B1 (rs4149056, 521T > C) is associated with statin-induced myotoxicity in Chinese patients with coronary artery disease. In addition, SLCO1B1 521C mutant allele increased the risk of rosuvastatin-associated myotoxicity. [ABSTRACT FROM AUTHOR]

Dental age estimation is of great importance for individual identification in forensic medicine and many other fields of study. Among them, tooth eruption is a parameter developmental morphology that can be determined by clinical examinations or by dental X-rays. The purpose of present research is to study the chronological course of third molars eruption in a Chinese population and compare that with other ethnic population for age estimation. A total of 1135 conventional orthopantomograms from 506 male and 629 female northern Chinese subjects aged between 11 and 26 years were analyzed. The eruption status of the third molars was assessed using the developmental stages described by Olze et al. Results showed that the third molars 18, 28, 38 and 48 in the stage A showed significant younger average age in males than in females. The Olze's stage A could be used as a reference stage to determine whether a male or female northern Chinese is likely to be equal or above age 16, with 99.6-100% and 97.4-98.1% of correct predictions, respectively. The stage D was found to be a useful marker for diagnosing age under 16 years, with 98.9-100% and 100% of correct predictions in males and females, respectively. There were some significant differences of the chronological course of the third molars eruption in different ethnic groups, which indicated that population-specific standards could enhance the accuracy of forensic age estimation based on third molar eruption. [ABSTRACT FROM AUTHOR]

Magnesium sulfate (MgSO 4), a leaching agent for ion-absorption rare earth (RE) ores, can reduce the production of ammonia nitrogen wastewater and supply magnesium (Mg) for soil. Three novel solid extractants, i.e., 2,2′-(1,4-phenylenebis(oxy))dioctanoic acid (PPBOA), 2,2′-(1,2-phenylenebis(oxy))dioctanoic acid (OPBOA) and 2,2′-(1,3-phenylenebis(oxy))dioctanoic acid (MPBOA) were synthesized and used to enrich RE by extraction-precipitation strategy, which showed better selectivity and faster equilibrium. The precipitation rates of PPBOA, OPBOA and MPBOA on RE could reach 95.1%, 93.5% and 96.7% at the large liquid/solid phase ratio (450/1). Meanwhile, the purities of RE in the stripping solutions reached 96.1 wt%, 94.1 wt% and 96.2 wt%. Chemical oxygen demand (COD) values of raffinates from OPBOA and MPBOA were 56 mg/L and 69 mg/L, being lower than that of China national emission standard (100 mg/L). The concentration of enriched RE solution by MPBOA was 238.0 g/L, solid extractant and MgSO 4 raffinate could be recycled. Unlabelled Image • Three solid carboxylic acids are synthesized as solid extractants. • The strategy contributes to eliminating the ammonia nitrogen pollution. • The strategy has the larger liquid/solid phase ratio and greater enrichment ability. • Chemical oxygen demand (COD) values of raffinates are low. • Solid extractants and MgSO 4 raffinate in the strategy can be recycled. [ABSTRACT FROM AUTHOR]