Search

Previous prognostic factor models for metastatic renal cell carcinoma (mRCC) have not included erythrocyte sedimentation rate (ESR). We designed the present study to evaluate the prognostic value of ESR for mRCC patients treated with sorafenib. Sorafenib was given to 83 patients with clear cell mRCC. Serum ESR was tested before treatment and every 4 weeks after first administration of sorafenib. Oncological evaluation was carried out every 8 weeks. Analyzed factors included age, sex, performance status, method of nephrectomy, number of metastatic organs, anemia, lactate dehydrogenase, corrected calcium, albumin, baseline ESR level and ESR kinetics status. Kaplan-Meier and Cox regression analyses on progression-free survival (PFS) were carried out. Baseline ESR levels ranged from 3 to 154 mm/h, and 43 (41.0%) patients had an ESR level higher than 40 mm/h. Median PFS was 10.0 months (95% CI 7.6-12.4 months). Dividing the cohort into three groups according to ESR kinetics status, median PFS was 27 months in the decreased ESR group, 12 months in the stable ESR group and 6 months in the increased ESR group. Performance status, time from diagnoses to sorafenib treatment, number of metastatic organs and ESR kinetics were independent predictors for PFS in multivariable Cox regression model analysis, with an area under the curve of 0.865 in a binary logistic regression model of 12-month PFS probability. ESR kinetics can be useful to monitor the treatment response and to predict PFS for mRCC patients treated with sorafenib as second-line therapy. [ABSTRACT FROM AUTHOR]

To investigate the levels and behaviours of the atmospheric radon concentration in Qingdao, a continuous measurement was carried out and recorded hourly over a three-year period from September 2006 to August 2009. Levels and variations were studied on the basis of 16 817 data points, and the trends of diurnal and seasonal variations were also analysed. The average concentration of atmospheric radon over the three years was 5.00 +- 3.01 Bq m[?]3. The average diurnal pattern of radon concentration showed that the daily maximum appears in the early morning, and the daily minimum in the late afternoon, which is driven by the atmospheric stability. The annual pattern features a maximum around December and a minimum around June, which correlates with the origin of air mass brought by the monsoon. [ABSTRACT FROM AUTHOR]

China consists of four customs territories: the mainland, Hong Kong, Macau, and Taiwan. Each customs territory is an independent member of the WTO as well. To strengthen and promote regional economic integration, the mainland, Hong Kong, Macau, and Taiwan have concluded the CEPAs and the ECFA, respectively. The CEPAs and the ECFA are not only RTAs under the WTO, but also administrative agreements of China, which are unprecedented practices in the Multilateral Trading System. The implementation of the CEPAs and the ECFA go smoothly, and have been elevated to national policies of China, which will significantly promote the joint economic prosperity and development of the mainland, Hong Kong, Macau, and Taiwan. [ABSTRACT FROM AUTHOR]

Nasopharyngeal carcinoma (NPC) is one of the most common cancers in southern China. In addition to environmental factors such as Epstein-Barr virus infection and chemical carcinogen exposure, genetic susceptibility has been reported to play a key role in the development of this disease. Interleukin-2 (IL-2) is an immunoregulatory cytokine produced by T cells and plays an important role in antitumor immunity. Variations in the DNA sequence of the IL-2 gene may lead to altered cytokine production and/or activity, and thus modulate an individual's susceptibility to NPC. To test this hypothesis, we investigated whether IL-2 gene polymorphisms and its serum levels are associated with NPC in a Chinese population. We analyzed single-nucleotide polymorphisms of IL-2 gene −330 T/G and +114 T/G in 180 patients with NPC and 200 age- and sex-matched controls, using polymerase chain reaction-restriction fragment length polymorphism and DNA sequencing methods, and serum IL-2 levels were measured by enzyme-linked immunosorbent assay. Serum IL-2 levels were decreased in patients with NPC compared with controls ( p < 0.01). There were significant differences in the genotype and allele frequencies of IL-2 gene −330 T/G polymorphism between the group of patients with NPC and the control group ( p < 0.05). Moreover, genotypes carrying the IL-2 −330 G variant allele were associated with decreased serum IL-2 levels compared with the homozygous wild-type genotype in patients with NPC. Carrying the IL-2 −330 G variant allele was associated with a decreased ability to produce IL-2, which may contribute to NPC susceptibility. [ABSTRACT FROM AUTHOR]

The temporal distribution of polycyclic aromatic hydrocarbons (PAHs) was examined in dated sediments from five lakes in Western China. The surficial concentrations of seven carcinogenic PAHs (BaA, Chyr, BbF, BkF, BaP, DBA and INP, hereafter denoted as PAH7) were highly site-specific. The ΣPAH7 concentrations generally increased from the deep layers to surface sediments. The temporal trends of ΣPAH7 concentrations were clearly different from those reported in developed countries. From 1950s to 1980s, which PAHs started to decrease in developed countries, is the right period that PAHs started to increase rapidly in Western China. The fluxes and mass inventories suggest that the PAH7 input over the past three decades was much more rapidly than it was before the 1980s. Source identification indicates that the PAHs were primarily from biomass burning and domestic coal combustion, and increasing vehicular and/or industrial coal combustion emission was also found. [Copyright &y& Elsevier]

Patterns of space use can provide valuable insights into patterns of activity and social structure of poorly known mammal species. From April 2005 to November 2006 we radiotracked a low-density population of ferret badgers (Melogale moschata) in central China. Fourteen males and 8 females were caught. Nine of these individuals (6 males and 3 females) were followed; mean (± SD) 100% minimum convex polygon (MCP100) home range was 128.3 ± 131.9 ha, with no difference between sexes. For MCP100, neither nightly movement distances nor daily activity patterns revealed significant variation due to sex or season. Core areas (50% minimum convex polygon [MCP50]) were typically located centrally within overall home ranges. Two distinct groups of animals were evident in the radiotracked subpopulation, one consisting of 7 adults and the other composed of at least the 2 remaining collared badgers with field signs of additional badgers from the periphery of our study area. Within each group, home ranges of radiocollared individuals overlapped extensively (62.1% ± 26.5% for MCP100; 59.6% ± 23.0% for MCP95; 37.1% ± 24.5% for MCP50), and up to 4 adults per group shared the same burrow (sett). We consider the implications of our data for understanding of mustelid sociospatial behavior. [ABSTRACT FROM AUTHOR]

Abstract: Most oil reservoirs in the Shengli Oilfield area have entered middle and late development stages after nearly 40-years of production, and they are suitable for applying CO2 EOR and carbon storage techniques. This study is aimed at assessing the potential of CO2 EOR and storage in three large oil fields in the region based on the data of 183 mature oil reservoirs. The assessments include a regional geology assessment, storage site screening, reservoir screening for CO2 EOR and EOR potential and storage capacity calculations. Many mature oil reservoirs are close to the main CO2 sources and have good geographical and geological conditions for CO2 storage. Of 41 reservoirs, 18 are suitable both for EOR and storage while 23 reservoirs were found suitable for storage as depleted oil reservoirs. The total EOR potential could be 999.72×104 t and the CO2 storage potential could reach 9,553.92×104 t. The overall incremental oil recovery rate could be 5.76%. The greater OOIP the oil reservoir has, the greater potential for CO2 EOR and storage it will have, and the more suitable for large-scale storage projects it will be. Those oil reservoirs suitable for CO2 EOR with large OOIP will be the preferred sites for CO2 storage. Many nearly depleted oil reservoirs with large OOIP can be considered as main sites for CO2 storage in the near future. [Copyright &y& Elsevier]

Through an Australia-China climate change bilateral project, we analyzed results of 51-year global offline simulations over China using the Australian community atmosphere biosphere land exchange (CABLE) model, focusing on integrated studies of its surface energy, water and carbon cycle at seasonal, interannual and longer time-scales. In addition to the similar features in surface climatology between the CABLE simulation and those derived from the global land-surface data assimilation system, comparison of surface fluxes at a CEOP reference site in northeast China also suggested that the seasonal cycles of surface evaporation and CO2 flux are reasonably simulated by the model. We further assessed temporal variations of model soil moisture with the observed variations at a number of locations in China. Observations show a soil moisture recharge–discharge mechanism on a seasonal time scale in central-east China, with soil moisture being recharged during its summer wet season, retained in its winter due to low evaporation demand, and depleted during early spring when the land warms up. Such a seasonal cycle is shown at both 50- and 100-cm soil depths in observations while the model only shows a similar feature in its lower soil layers with its upper layer soil moisture varying tightly with rainfall seasonal cycle. In the analysis of the model carbon cycle, the net primary productivity (NPP) has similar spatial patterns as the ones derived from an ecosystem model with remote sensing. The simulated interannual variations of NPP by CABLE are consistent with the results derived from remote sensing-based and process-based studies over the period of 1981–2000. Nevertheless an upward trend from observations is not presented in the model results. The model shows a downward trend primarily due to the constant CO2 concentration used in the experiment and a large increase of autotrophic respiration caused by an upward trend in surface temperature forcing data. Furthermore, we have compared river discharge data from the model experiments with observations in the Yangtze and Yellow River basins in China. In the Yangtze River basin, while the observed interannual variability is reasonably captured, the model significantly underestimates its river discharge, which is consist with its overestimation of evaporation in the region. In the Yellow River basin, the magnitudes of the river discharge is similar between modeled and observed but its variations are less skillfully captured as seen in the Yangtze River region. [ABSTRACT FROM AUTHOR]

The study examined the effects of cropping abandonment and perennial grass growing on soil organic carbon (C) and Nitrogen (N) pools and aggregate stability, by comparing soils under grassland, crop cultivation, perennial grass growing and cropping abandonment in degraded cropland at a sub-alpine site in north-western China. It found that the rapid recovery of particulate organic fraction and carbohydrate in the re-vegetated soils were probably due to higher plant biomass inputs and lower organic matter decomposition compared with those in the cropped soil.

The safety culture in hospitals in China was investigated using a sell-designed questionnaire. A convenience sample of 217 registered nurses responded positively in the areas of the safety of shift change processes, hospital and nursing leadership attention to patient safety, and staff cooperation, among others. However, a punitive safety culture was identified, and registered nurses reported a lack of safety committees, fear of reporting errors, punishment of the person making an error, and underreporting of nursing errors. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Integrated Care (IJIC) is the property of Ubiquity Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Temporal and spatial changes in δ13C and δ15N of particulate organic matter (POM) and Hemiculter leuciseulus were studied in the Yangtze River of China. Isotopic signatures of POM showed seasonal variations, which was assumed to be associated with allochthonous organic input and autochthonous phytoplankton growth. δ13C of H. leucisculus was 1.1% higher than that of POM, which suggested that the food source of H. leucisculus was mostly from the POM. A mass balance model indicated the trophic position of H. leucisculus in the food web of Yangtze River was estimated to be 2.0 - 2.1, indicating that this fish mainly feeds on planktonic organic matter, which agreed with previous gut content analysis. [ABSTRACT FROM AUTHOR]

• A census of the fungal microbiomes of 13 regional Hong Qu varieties was completed. • Fungal community composition and diversity is different in Hong Qu varieties. • 14 biomarker taxa were identified to distinguish regional varieties. • Correlations of fungal abundances and fermentation characteristics were explored. • 10 key fungal genera were found to be responsible for fermentation characteristics. Hong Qu glutinous rice wine (HQ wine) is a traditional alcoholic beverage produced in China by fermenting cooked rice using a fermentation starter prepared with the fungus Monascus purpureus. This starter (Hong Qu , HQ) is made empirically by open spontaneous fermentation that is hard to control and standardize, resulting in inconsistent wine quality. This study investigates representative HQ samples from a large geographic region. It explores fungal microbiome compositions, identifies characteristic differences important for the production of various HQ wine styles, and reveals the key fungi responsible for HQ wine fermentation characteristics. The source of the HQ inoculum was found to be the main factor influencing fungal community composition and diversity, followed by processing technology and geographical distribution. Linear discriminant analysis effect size (LEfSe) uncovered 14 genera as potential biomarkers to distinguish regional varieties of HQ. Significant differences were also found in fermentation characteristics such as liquefying power (LP), saccharifying power (SP), fermenting power (FP), total acid content (TA) and liquor-producing power (LPP). The key fungi responsible for LP (5 genera), SP (3 genera), FP (1 genera), LPP (4 genera), and TA (4 genera) were determined using redundancy correlation analysis. Finally, Spearman's correlation analysis indicated that LPP shows a strong positive correlation with FP and LP, while TA displays a strong negative correlation with FP. The results of this study may be utilized to prepare consistently high quality, next-generation HQ by better controlling fungal community structures, and to design fermentation processes for HQ wines with desirable oenological characteristics. [ABSTRACT FROM AUTHOR]

Twelve microsatellite loci were found from genomic DNA-enriched libraries of the South China tiger ( Panthera tigris amoyensis). The number of observed alleles for each locus in 53 individuals ranged from five to 14; the expected and observed heterozygosity was 0.480 to 0.883 and 0.333 to 0.956, respectively; and the mean polymorphic information content (PIC) was 0.729. These markers would be considered a useful tool for the study of genetic variation in South China tiger in the future. [ABSTRACT FROM AUTHOR]

Background: Telehealth devices are considered with potential to foster improved health outcome for patients with hypertension. However, the longitudinal use trajectories of telehealth devices have not been identified yet, nor has the connection between developmental trajectories of telehealth devices use and health outcome over time. Objective: To identify the longitudinal trajectories of use of telehealth devices among patients with hypertension, characterize features for each trajectory, and to unravel the correlation between longitudinal trajectories of telehealth devices use patterns and BP control outcome. Methods: A total of 122 patients with hypertension were enrolled, portable telehealth device were given to them to monitor blood pressure. Socio-demographics (e.g. name, age, sex, marital status) were collected at baseline. The real-time measured data, including time and both systolic and diastolic blood pressure data, were sent up to cloud platform through the portable device. The latent class growth analysis modeling approach was used to determine the latent trajectory of telehealth use. And the joint trajectory method was used to identify the correlation between the longitudinal trajectories of telehealth use and BP control status. Results: 5 distinct trajectories were finally identified: Persistently low (47.1%), Moderate with decreasing (23.9%), Sharply decreasing (11.2%), High with decreasing (11.3%), Persistently high with increasing (6.6%). However, no statistical significant differences in age, marital status, BP (both SBP and DBP) and BP control status in the first period between the 5 trajectories were found. It provided evidence that strong correlation existed between the longitudinal telehealth devices use patterns and individuals' longitudinal BP control status. Conclusions: The latent trajectories of telehealth use were identified; yet, no predictors of trajectory membership have been found. Although more prove of the causal relationship needs to be revealed in further studies, this study demonstrated that regular monitor has some positive correlation with improved BP control. [ABSTRACT FROM AUTHOR]

Introduction: Worldwide, many countries have established their own gatekeeper system. Tertiary hospitals in China have experienced explosive growth both in the quantity and quality since 2009. However, the healthcare delivery system in China is fragmented for its weak coordination between different faculties. And it was not well prepared for the tremendous and complex needs, especially the grassroots healthcare faculties whittled by the tertiary hospitals. Moreover, it has caused the increasing of total health expenditure and occurrence of catastrophic health expenditure. Policy context and objective: To deal the unreasonable resources distribution among the tertiary-grassroots faculties and urban-rural areas, and establish a high-value healthcare delivery system. In January 2013, the tiered healthcare service delivery was first implemented among Qinghai and Hubei province. Given emerging problems might influence the current policy analysis from different perspective may achieve contrasting results, it is necessary to evaluate the secular effects of the previous pilots and synthesis its experience for the following programs with the similar contextual settings. Targeted population: The New Rural Cooperative Medical System enrollee in the Dangyang. Highlights: A quasi-natural experiment was designed in Dangyang, Hubei province. And the policy were piloted in October 2014, policies related to this reform and claim data from January 2011 to December 2015 were collected from the New Cooperative Medical Scheme (NCMS) enrollees. First, the patients are motivated to take the grassroots faculties for the initial treatment-seeking, with different reimbursement ratio settings varied with the delivery system levels. Second, all the county-level hospitals have to establish the integrated delivery system with more than township faculties. Third, all community healthcare centers should carry out the family doctors system and the grassroots faculties in rural areas should be equipped with a physician good at the Traditional Chinese Medicine. The outcomes indicated the changes in cost and patients flow were included to evaluate its effects and calculated monthly based on the claim data. Policy analysis and interrupted time series analysis model were designed to estimate the before-after changes in the indicators with Stata version 13.0. All the cost data was adjusted according the 2016 China Health Statistics Yearbook. The actual reimburstment ratio and the proportion of total medical expenses in township hospitals increased significantly in the first month of the implementation of the tired medical system policies, and has reversed the orginal downward trend. Meanwhile, the upward trend and level of out-of-pocket has significantly declined. However, the level and trend of proportion of health expenditure and patient visits in health care facilities outside Dangyang did not decreased significantly, so does the average length of stay and average total cost. The proportion of total patient visits in township hospitals increased at first, but not reversed significantly in the long term. Conclusions: Although this policy has not achieved all its expected outcomes temporarily, it has reduce the out-of-pocket cost for patients and improve the effectiveness of the grassroots facilities. Further studies should focus on the more comprehensive evaluation of health system and an appropriate control group should be found. [ABSTRACT FROM AUTHOR]

Background: In China, the increases in caesarean section (CS) rates and in delivery costs have posed questions about the reform of the medical insurance payment system. Case payment is useful in regulating the behavior of health providers and in controlling CS rates and the unreasonable increase in medical expenses. New Cooperative Medical Scheme (NCMS) agencies in Xi County in Henan Province piloted a case payment reform (CPR) in delivery for inpatients. We aim to observe the change in CS rates, compare the changes in delivery-related variables, and find variables related to delivery cost before and after the CPR in Xi County. Methods: A total of 28,314 cases were selected from the Xi County NCMS agency from 2009 to 2010 and from 2014 to 2015. The one-way ANOVA and chi-squared test were adopted to compare the distributions of CS and vaginal delivery (VD) before and after the CPR under different indicators. We applied multivariate linear regressions for the total medical cost of the VD and CS groups and total samples to identify the relationship between medical expenses and variables. Results: The CS rates in Xi County increased from 26.1% to 32.5% after the CPR. The length of stay (LOS), the total medical cost, and the proportion of county hospitals increased in the CS and VD groups after the CPR, which had significant differences. The total medical cost in the CS and VD groups and total samples was significantly influenced by patient age, LOS, and hospital type and had a significant correlation with the CPR in the VD group and total samples. Conclusion: The CPR might fail to control the unreasonable medical expense growth and regulate the behavior of providers, possibly resulting from the unreasonable compensation standard of case payment, prolonged LOS, and the increasing proportion of county hospitals. The NCMS should modify the case payment standard of delivery to inhibit the motivation of providers to render CS services. The LOS should be controlled by implementing clinical guidelines, and a reference system should be established to guide patients in choosing reasonable hospitals. [ABSTRACT FROM AUTHOR]

Background: Most of the integration-related policies are facing implementation problems. During 2012/07-2014/12, we implemented an trial-based intervention in Qianjing, a rural district in southwestern China, to test the effects of an innovative integrated care delivery model targeted for rural patients (RICDM) with hypertension. Using the difference-indifferences analysis, we found that the blood pressure did decrease in treatment group compared to the control group however the health-related quality of life did not, which violated our assumptions. To explore whether the provider performance interfered with the outcomes, we did a process evaluation mainly to compare their behaviors during trial implementation. Methods: All the doctors' behaviors were bimonthly-recorded using diaries, and their attitudes were evaluated using questionnaires adapted from D'Amour's inter-professional collaboration model. We firstly observed the referral amounts and provider communication frequency on four inter-professional cooperation types (village to town, town to county, county to town, and town to village - the former indicated the initiated party). Then we conducted interviews with the doctors, investigating the following aspects that potentially affected the collaboration: willing to cooperate, actual motivation, mutual trust, personal relations and ability to cooperate. All variables were compared between groups before and after intervention. After then we did a regression analysis examining the relations between the cooperation level and the identities of doctors. The implementation degree was also estimated by multiplying the percentage of reach scope for each step of trial process. Results: 120 doctors were included. There were no significant differences between treatment group and control group either on the referral amounts or the communication frequency (all P >0.05). Most of the cooperation aspects showed a low- and middle-level performance (>90%). The collaboration ability in treatment group was significantly higher than control group (P <0.001) after intervention, except for that, there were no differences compared to control group in willingness, motives, mutual trust or personal relationship improvement (all P >0.05). And the doctors from county hospitals showed a lower performance in each of the aspect compared to doctors from town hospitals and village clinics. Associated with the professional identity, the medical staff showed relatively low interests in collaboration compared to primary care professionals. By observing and analyzing the processes of exposure, enrollment, reach and follow-ups, we had found out the implementation degree to be only 61%. For each part, the patient were reached out by 100%, the supplier 72%, and the hospitals 85%. Lessons Learned: The RICDM improved patient health, but did not fully achieve desired effects. We inferred that one possible reason might lied in the providers' reluctance to cooperate. By furtherly investigating into the provider behaviors and implementing process, we had proved our guess and the actual model effect might therefore be underestimated. However the study did not successfully connect the health-related outcomes with the provider behaviors through statistical analysis, so we could not reach a direct conclusion that the incomplete implementation was the exact reason for imperfect model effects. Further studies need to be proposed and also potential bias from provider side should be properly dealt with in the stage of study design. [ABSTRACT FROM AUTHOR]

Background: Cost is a great concern for integrated care. China has been trying to build a hierarchical medical system to integrate services between different medical institutions, so that mild patients can be referred to primary institutions and cost can be cut. Our aim is to explore how much inpatient cost could be saved by the hierarchical medical system. Methods: This study was carried out in Xi County, China, based on the rural inpatient database in 2015. We firstly screen out the inpatient record in county hospitals which could have been in township hospitals based on self-evaluation capability and practical capability of township hospitals and then calculate the difference in cost between township and county hospitals which could have been saved. Self-evaluation capability referred to all the disease that township hospitals thought they could handle by inpatient service and practical capability referred to all the disease that township hospitals actually handled by inpatient service. Results: Under the self-evaluation capacity, 14.90% of the inpatient records in county hospitals could have been in township hospitals and 11.84 million? (5.20% of the total inpatient expenditure within county) could have been saved. Under the practical capability, 6.95% of the inpatient records in county hospitals could have been in township hospitals and 7.15 million? (3.14% of the total inpatient expenditure within county) could have been saved. Discussion: Cost reduction by service integration was limited by the capability of township hospitals. Conclusion: Cost reduction by the hierarchical medical system was small. Lessons learned: Capability improvement of primary medical institutions is a key task for service integration and effectiveness raise. Limitations: We did not compare the inpatient quality and take the patient's willingness into account. Suggestions for future research: Comparison of quality and patient willingness need to be considered in further studies. [ABSTRACT FROM AUTHOR]

Introduction: China has been trying to enhance service collaboration between different levels of medical institutions to lower patient flow and cut down medical expenditure. However, the outcome was poor. Township-County Readmission (TCR) means a patient is firstly admitted to a township hospital and then a county hospital within 30 days for the same disease. Our aim is to explore whether TCR can lower patients' costs in county hospitals. Method: This study was carried out in Qianjiang District, China. Firstly, we selected out TCR patients from the database. Then, we picked out patients who was admitted to county hospitals less than 30 days before TCR (CTCR patients) or after TCR (TCRC patients) for respiratory system disease as our objects. Finally, we compare the former expenditure in county hospital with the latter for TCRC patients and CTCR patients by paired-t test. Result: 74 TCRC patients and 40 CTCR patients of respiratory system disease were screened out. The average of former expenditure in county hospital for TCRC patients was 651.6$, and the latter was 564.0$ (t=-0.467, P=0.643). The average of former expenditure in county hospital for CTCR patients was 594.4$, and the latter was 653.8$ (t=-0.963P=0.339). Discussion: The difference between costs of single county inpatient and costs of county inpatient in TCR is not significant, which means that service provided by township hospitals during TCR is ineffective. Conclusion: Service collaboration between township hospitals and county hospitals didn't achieve the real continuity as wanted, which had enlarged waste and the inefficiency of supply system. Lessons learned: Cutting down the inefficiency during referral is a key task for service collaboration. At least, the patients should not pay for this. Limitation: The sample size was too small and disease severity was not included into the study. Suggestions for future research: More samples should be included. Disease severity needs to be better controlled. [ABSTRACT FROM AUTHOR]

Introduction: Although the Chinese government has been emphasizing importance of the grassroots healthcare system as well as conducting reform in the rural health institutions, the efficiency and the effectiveness of healthcare are still very poor in rural China and the Chinese healthcare delivery system is highly fragmented. All organizations should be under hierarchical structure that is comprised of separate, but interconnected components. Though all these components are supposed to play complementary roles in order to accomplish not only their own tasks but also overall tasks, the division, decentralization and specialization found in complex organizations generally hinder the efficiency and quality goals. Objective: To explore the mechanism of Global Budget of Multi-level Institutions on one certain disease (GBMI) to stimulate health personnel supply integrated care in primary institutions. Theory: A case-control study was carried out in Qianjiang District, Chongqing, China. 4 similar township hospitals were divided into intervention group and control group. The intervention group was implemented by means of Global Budget of Multi-level Institutions (GBMI) on hypertension. The global budget was calculated through the actual costs of all patients with hypertension in the past three years, and the total expense was adjusted by CPI, growth coefficient and inflation factor. A Continuous Service Team (CST) was constructed including village health personnel, general practitioners, public health personnel in township hospital, hypertension specialists in county hospital, coordinator and so on. CST supplied all managed hypertension patients with all preventive and medical care in the fixed global budget. In the healthcare it includes blood pressure monitoring, health education, medical care and doctor visit. The possible budget balance will belong to CST while budget shortfalls would be apportioned into CST. The behavior of rejecting essential services and translating hypertension into other diseases would be punished by discounting the possible budget balance. The intervention period started from 1st July 2012 and will end on 31st December 2013. CST supplied above 10000 personalized health intervention services to 4167 managed patients by December 2012. Method: We have carried out 2 investigations including 300 managed patients per town by multistage stratified random sampling on 1st July and 31st December 2012. The contents of the questionnaire concentrate on the status of health self-assessment, experiences of seeing doctor, doctor visits and individual information. The data of expenditure of all managed patients were exported via Health Insurance Information Management System, and the medical records were collected in medical institutions regularly. Results: In 594 intervened hypotension patients, management rate of hypertension increased from 58.1% to 93.5% (P<0.01), standardized management rate increased from 37.1% to 42.3% (P<0.01) and medication adherence rate increased by 9.3%. The ratio of expenditure in township hospitals to total expenditure increased from 21.3% to 25.4% (P=0.023), which were all higher than those of control group. Standard control rate of hypertension is likely to reach 65% by Dec 2013 by means of Markov Prediction Model with continuous intervention. 38 patients have received continuous clinical services from CST while the average expenditure is 7% lower than that without CPT. Growth rate of hospitalized hypertension patient in county hospital decreased from 15% to 12% while that in township hospital decreased by 6.3%. Conclusion: The CST under GBMI can supply integrated care under the existing total expendture. Although the effect is not significant, a longer intervention period may make it better. The expansion of patients with hypertension could be controlled and the behavior could be changed. The cooperative mechanism established by CST and GBMI between county and village can play positive role in encouraging the health personnel to change concept, strengthening multilevel collaboration and improving effectiveness of service, thus it is in favor of continuity of medical and preventive services in rural China. [ABSTRACT FROM AUTHOR]

The authors reflect on the environmental challenges in China and the solutions to its deteriorating condition. According to the Ministry of Environmental Protection, all the seven major rivers in the country are polluted and that it is recommended for people to avoid contact with them. They argue that intensified mining of mineral resources is brought by economic growth but it also results to severe environmental problems.

The article discusses a study that examined the protective effects of ligustrazine on gentamicin ototoxicity by determining heat shock protein 70 mRNA and protein expression in the cochlear stria vascularis of guinea pigs. The study was done at the Laboratory of Physiology at the Shenyang Medical College in Shenyang, China. It found that the auditory brainstem response threshold rose and then declined with increased time after drug withdrawal. It is concluded that the drug ameliorated gentamicin ototoxicity.

We designed 3 social behavior experiments involving compensation for real estate expropriation. We recruited 88 students at a university in China as our participants, and investigated the impact of third-party punishment on bilateral cooperation in a laboratory setting. The results showed the heterogeneity of human behavior in the different experiment types. In addition, results showed that the potential impact of punishment became more powerful by adding a third party. Finally, a third party had low punishment costs and a significantly higher probability of actually imposing punishment than did a second party. Results showed that, compared with second-party punishment, third-party punishment is more conducive to the maintenance of bilateral cooperation. [ABSTRACT FROM AUTHOR]

Porcine reproductive and respiratory syndrome virus (PRRSV), an important pathogen that affects the pig industry, is a highly genetically diverse RNA virus. However, the phylogenetic and genomic recombination properties of this virus have not been completely elucidated. In this study, comparative analyses of all available genomic sequences of North American (NA)-type PRRSVs (n = 355, including 138 PRRSV genomes sequenced in this study) in China and the United States during 2014–2018 revealed a high frequency of interlineage recombination hot spots in nonstructural protein 9 (NSP9) and the GP2 to GP3 regions. Lineage 1 (L1) PRRSV was found to be susceptible to recombination among PRRSVs both in China and the United States. The recombinant major parent between the 1991–2013 data and the 2014–2018 data showed a trend from complex to simple. The major recombination pattern changed from an L8 to L1 backbone during 2014–2018 for Chinese PRRSVs, whereas L1 was always the major backbone for US PRRSVs. Intralineage recombination hot spots were not as concentrated as interlineage recombination hot spots. In the two main clades with differential diversity in L1, NADC30-like PRRSVs are undergoing a decrease in population genetic diversity, NADC34-like PRRSVs have been relatively stable in population genetic diversity for years. Systematic analyses of insertion and deletion (indel) polymorphisms of NSP2 divided PRRSVs into 25 patterns, which could generate novel references for the classification of PRRSVs. The results of this study contribute to a deeper understanding of the recombination of PRRSVs and indicate the need for coordinated epidemiological investigations among countries. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the effect of protein oxidation on microbial, free amino acids (FAAs) and biogenic amines (BAs) in Chinese dry sausage during processing. Three different batches of Chinese dry sausages were examined: control batch, pro-oxidation batch and anti-oxidation batch. The experimental results revealed that anti-oxidation batch showed the lowest degree of protein oxidation compared with control batch, while the results of the pro-oxidation batch were just opposite. With the increasing protein oxidation, estimated by protein carbonyls and sulfhydryls, microbial content and free amino acid content increased, while BA content decreased. The protein carbonyls were positively correlated with total FAAs (P < 0.01) and total BA content (P < 0.05), while sulfhydryls content was negatively correlated with total FAA content (P < 0.01), total viable counts (P < 0.01), and total BA content (P < 0.01). In conclusion, reduced protein oxidation contributes to improved quality of Chinese dry sausage. This research provided a new strategy to improve the quality of meat product manufacture. [ABSTRACT FROM AUTHOR]

A total of 98 compounds including 20 aldehydes, eight arenes, six acids, 17 alcohols, 13 ketones, nine esters, nine methoxyphenolics, three alkenes, seven alkanes, and six other components were tentatively identified in six Chinese dark teas (CDTs) using gas chromatographyemass spectrometry. Multivariate statistical analysis revealed that dark teas from Yunnan and Guangxi provinces could be classified into one group, and other CDTs belonged to the other cluster. The diagnostic volatile compounds being responsible for CDTs' discrimination were observed as (E,E)-2,4-decadienal, methoxyphenolics, geraniol, aterpineol, 2,4-heptadienal, cis-jasmone, linalool oxides, and 2-nonenal. Furthermore, mature tea leaves were separately fermented using Eurotium cristatum and Aspergillus niger. The results showed that E. cristatum increased the contents of cis-jasmone, a-terpineol, ßionone, nonanal, and 2-pentylfuran, whereas A. niger advanced the levels of geraniol, linalool oxides, 9,12-octadecadienoic acid, and ß-ionone after short-term fermentation. Fungus species may contribute to forming the flavor of Chinese dark teas by affecting the volatile compounds during postfermentation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate systematically the efficacy and safety of COVID-19 vaccines., Methods: PubMed, Embase, Cochrane Library, Clinicaltrial.gov, CNKI, Wanfang Data, China Biomedical Literature Service System, and China Clinical Trial Registry were searched for randomized controlled trials of COVID-19 vaccines published up to December 31, 2020. The Cochrane bias risk assessment tool was used to assess the quality of studies. A qualitative analysis was performed on the results of clinical trials., Results: Thirteen randomized, blinded, controlled trials, which involved the safety and efficacy of 11 COVID-19 vaccines, were included. In 10 studies, the 28-day seroconversion rate of subjects exceeded 80%. In two 10 000-scale clinical trials, the vaccines were effective in 95% and 70.4% of the subjects, respectively. The seroconversion rate was lower than 60% in only one study. In six studies, the proportion of subjects who had an adverse reaction within 28 days after vaccination was lower than 30%. This proportion was 30%-50% in two studies and > 50% in the other two studies. Most of the adverse reactions were mild to moderate and resolved within 24 hours after vaccination. The most common local adverse reaction was pain or tenderness at the injection site, and the most common systemic adverse reaction was fatigue, fever, or bodily pain. The immune response and incidence of adverse reactions to the vaccines were positively correlated with the dose given to the subjects. The immune response to the vaccines was worse in the elderly than in the younger population. In 6 studies that compared single-dose and double-dose vaccination, 4 studies showed that double-dose vaccination produced a stronger immune response than single-dose vaccination., Conclusions: Most of the COVID-19 vaccines appear to be effective and safe. Double-dose vaccination is recommended. However, more research is needed to investigate the long-term efficacy and safety of the vaccines and the influence of dose, age, and production process on the protective efficacy.

Aim: To investigate the impact of enteral nutrition (EN) on the body composition and metabolism in patients with Crohn's disease (CD)., Methods: Sixty-one patients diagnosed with CD were enrolled in this study. They were given only EN (enteral nutritional suspension, TPF, non-elemental diet) support for 4 wk, without any treatment with corticosteroids, immunosuppressive drugs, infliximab or by surgical operation. Body composition statistics such as weight, body mass index, skeletal muscle mass (SMM), fat mass, protein mass and inflammation indexes such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and CD activity index (CDAI) were recorded before and after EN support., Results: The 61 patients were divided into three groups according to CDAI before and after EN support: A (active phase into remission via EN, n=21), B (remained in active phase before and after EN, n=19) and C (in remission before and after EN, n=21). Patients in group A had a significant increase in SMM (22.11±4.77 kg vs 23.23±4.49 kg, P=0.044), protein mass (8.01±1.57 kg vs 8.44±1.45 kg, P=0.019) and decrease in resting energy expenditure (REE) per kilogram (27.42±5.01 kcal/kg per day vs 22.62±5.45 kcal/kg per day, P<0.05). There was no significant difference between predicted and measured REE in active CD patients according to the Harris-Benedict equation. There was no linear correlation between the measured REE and CRP, ESR or CDAI in active CD patients., Conclusion: EN could decrease the hypermetabolism in active CD patients by reducing the inflammatory response.

Aim: To assess the relationship between the P268S, JW1 and N852S polymorphisms and Crohn's disease (CD) susceptibility in Zhuang patients in Guangxi, China., Methods: Intestinal tissues from 102 Zhuang [48 CD and 54 ulcerative colitis (UC)] and 100 Han (50 CD and 50 UC) unrelated patients with inflammatory bowel disease and 72 Zhuang and 78 Han unrelated healthy individuals were collected in the Guangxi Zhuang Autonomous Region from January 2009 to March 2013. Genomic DNA was extracted using the phenol chloroform method. The P268S, JW1 and N852S polymorphisms were amplified using polymerase chain reaction (PCR), detected by restriction fragment length polymorphism (RFLP), and verified by gene sequencing., Results: Heterozygous mutation of P268S in the NOD2/CARD15 gene was detected in 10 CD cases (six Zhuang and four Han), two Han UC cases, and one Zhuang healthy control, and P268S was strongly associated with the Chinese Zhuang and Han CD populations (P = 0.016 and 0.022, respectively). No homozygous mutant P268S was detected in any of the groups. No significant difference was found in P268S genotype and allele frequencies between UC and control groups (P > 0.05). Patients with CD who carried P268S were likely to be ≤ 40 years of age (P = 0.040), but were not significantly different with regard to race, lesion site, complications, and other clinical features (P > 0.05). Neither JW1 nor N852S polymorphisms of the NOD2/CARD15 gene were found in any of the subjects (P > 0.05)., Conclusion: P268S polymorphism may be associated with CD susceptibility in the Zhuang population in the Guangxi Zhuang Autonomous Region, China. In contrast, JW1 and N852S polymorphisms may not be related to CD susceptibility in these patients.

Objective: Heart rate-corrected QT interval (QTc) and QTc dispersion (QTcd) are increased and associated with ventricular arrhythmia and an increase in sudden death in a variety of diseases. This study aimed to examine QTc and QTcd in pulmonary hypertension and assess their relationship with pulmonary arterial pressure., Patients and Methods: A total of 201 patients who had undergone right heart catheterization for a preliminary diagnosis of pulmonary hypertension between December 2003 and July 2008 were included in the study. Resting 12-lead electrocardiogram was recorded. QT interval was measured manually and corrected using Bazett's formula. Patients were divided into groups with mild-to-moderate and severe pulmonary hypertension and a control group according to mean pulmonary arterial pressure., Results: In all observed cases, mean QTc was higher in severe pulmonary hypertension than in controls (428.6 +/- 32.8 ms vs. 411.1 +/- 28.4 ms, P = 0.018) and QTcd was higher in mild-to-moderate (60.1 +/- 17.2 ms) and severe pulmonary hypertension (63.9 +/- 20.5 ms) than in controls (47.3 +/- 10.6 ms) (P = 0.031; P = 0.004). In men, there was no significant difference in mean QTc and QTcd. In women, mean QTc was higher in severe pulmonary hypertension than in controls (436.1 +/- 39.4 ms vs. 407.6 +/- 24.8 ms, P = 0.037) and QTcd was higher in severe pulmonary hypertension (68.5 +/- 20.9 ms) than in both the controls (45.1 +/- 12.6 ms) and patients with mild-to-moderate pulmonary hypertension (58.6 +/- 14.7 ms) (P = 0.002; P = 0.003). In addition, in women with pulmonary hypertension, mean QTc and QTcd were positively correlated to mean pulmonary arterial pressure (r = 0.207, P = 0.03; r = 0.236, P = 0.012)., Conclusions: In women with pulmonary hypertension, mean QTc and QTcd are positively correlated to mean pulmonary arterial pressure and are significantly increased in patients with severe pulmonary hypertension.