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China's healthcare system has undergone extensive changes over recent years and the most recent reforms are designed to shift the emphasis away from hospital based services towards a more primary care based system. There is an increasing recognition that shared decision making needs to play a central role in the delivery of healthcare in China, but there are several significant barriers to overcome before this aspiration becomes a reality. Doctor-patient relationships in China are poor, consultations are often brief transactions and levels of trust are low. Implementing a shared decision making process developed in the Western World may be hampered by cultural differences, although this remains an under-researched area. There is, however, a suggestion that the academic community is starting to take an interest in encouraging shared decision making in practice and indications that the Chinese public may be willing to consider this new approach to healthcare.

In the present study, the divergent properties of IFNGR1 isoforms (IFNGR1-1 and IFNGR1-2) were characterized in Tetraodon nigroviridis. Despite the structural similarities between these proteins, two T. nigroviridis IFNGR1 homologues differ from each other not only in their primary nucleotide and amino acid sequences but also in their syntenic structure. Genomic analysis demonstrates the conservation of synteny between the fish IFNGR1-2s and IFNGR1s in higher vertebrates; conversely, the IFNGR1-1 has no corresponding conservation of synteny with Gallus gallus and Homo sapiens, suggesting that the two genes were derived from two different origins. Additionally, their different sensitivities to mitogens and recombinant T. nigroviridis IFN-γs were observed. Furthermore, ligand-binding analysis strongly supported the model proposed in Danio rerio, which suggests that IFNGR1-1 is the major component of the IFN-γrel receptor complex; IFN-γ most likely binds to both IFNGR1-2 and IFNGR1-1. This study is a further step towards elucidating the teleostean IFN-γ system, which is different from that in mammals.