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Background Despite the availability of free tuberculosis (TB) diagnosis and treatment, TB care still generates substantial costs that push people into poverty. We investigated out-of-pocket (OOP) payments for TB care and assessed the resulting economic burden and economic consequences for those with varying levels of household income in eastern China. Methods A cross-sectional study was conducted among TB patients in the national TB programme networks in eastern China. TB-related direct OOP costs, time loss, and coping strategies were investigated across households in different economic strata. Analysis of Variance was used to examine the differences in various costs, and Kruskal-Wallis tests were used to compare the difference in total costs as a percentage of annual household income. Results Among 435 patients, the mean OOP total costs of TB care were USD 2389.5. In the lower-income quartile, OOP payments were lower, but costs as a percentage of reported annual household income were higher. Medical costs and costs prior to treatment accounted for 66.4 and 48.9% of the total costs, respectively. The lower the household income was, the higher the proportion of medical costs to total costs before TB treatment, but the lower the proportion of medical costs patients spent in the intensive phase. TB care caused 25.8% of TB-affected households to fall below the poverty line and caused the poverty gap (PG) to increase by United States Dollar (USD) 145.6. Patients in the poorest households had the highest poverty headcount ratio (70.2%) and PG (USD 236.1), but those in moderately poor households had the largest increase in the poverty headcount ratio (36.2%) and PG (USD 177.8) due to TB care. Patients from poor households were more likely to borrow money to cope with the costs of TB care; however, there were fewer social consequences, except for food insecurity, in poor households. Conclusions Medical and pretreatment costs lead to high costs of TB care, especially among patients from the poorest households. It is necessary to train health system staff in general hospitals to promptly identify and refer TB patients. Pro-poor programmes are also needed to protect TB patients from the medical poverty trap.

Background Tuberculosis (TB) is still a great challenge to public health in China. Most of the transmission occurs between the onset of symptoms and initiation of treatment. Diagnosis delay is a major barrier to effective management of the disease. Determining the factors associated with patient and provider delay of TB diagnosis and treatment may contribute to TB prevention and control.MethodsA cross-sectional survey of pulmonary tuberculosis registed in the National Tuberculosis programme was conducted in 22 counties of 6 provinces in China. All consecutively registered patients during January to June 2017 were interviewed using a structured questionnaire. The time from the onset of symptoms to the date of diagnosis was analyzed. Bivariate and logistics regression were applied to analyze the risk factors of delay.ResultsThe median time from onset of symptoms to diagnosis was 23 days (interquartile range [IQR]: 5-53days). The risk of delayed diagnosis was higher in the central (OR=3.27, 95%CI 1.39-7.68) and eastern regions (OR=1.48, 95%CI 1.04-2.10) than in the western regions. Rural TB patients have a longer diagnosis delay than those in urban areas (OR=1.44, 95%CI 1.00-2.08). The asymptomatic TB patients had a longer diagnosis delay than TB patients with clinical symptoms (OR=0.20, 95%CI 0.13-0.31).ConclusionsA high propotion of TB patients showed diagnostic delay in China especially in some low economic level areas. Multiple measures should be taken to shorten the delay, such as to increase public awareness of the disease and expansion the quality assured facility in economic less-developed regions.Trial registrationNot applicable

Development of a photosensitizer that can achieve tumor specificity, improve therapeutic efficacy, and reduce side effects remains a challenge for photodynamic therapy (PDT). In this work, a pH-sensitive activatable nanophotosensitizer (SMSN–ZnPc1) has been elaborately designed, which could be readily prepared by using a functionalized zinc(II) phthalocyanine (ZnPc) to conjugate with stellate mesoporous silica nanoparticles (SMSNs) through an acid-sensitive hydrazone bond. Meanwhile, a non-activatable analogue SMSN–ZnPc2 has also been prepared as a negative control. The fluorescence emission and singlet oxygen generation of the photosensitizer are essentially quenched in the intact nanophotosensitizer. However, these properties of SMSN–ZnPc1 can be restored greatly both in acidic solutions and at the cellular level. More importantly, after intravenous administration, SMSN–ZnPc1 can also be selectively activated at the tumor site and exhibit efficient tumor growth inhibition in S180 rat ascitic tumor-bearing KM mice with negligible systemic toxicity. It thus may serve as a promising nanoplatform for cancer diagnosis and targeted PDT.

The paper investigates a two-echelon fresh agricultural products supply chain(FAPSC) consisting of a supplier and a retailer in which the demand of the retailer is both price and quality sensitive. The wholesale price contract and the option contract based on fresh agricultural products quality is researched. The optimal decisions of the FAPSC with and without option contract are analyzed. The result shows that the retailer orders more in the FAPSC with option contract compared to that without option contract. The supplier also has incentives to improve the quality of the fresh agricultural products when the option contract is adopted. The profits of the supplier and the retailer in the FAPSC with option contract are also more than that in the FAPSC without option contract. At last, extensive numerical experiments are conducted to verify the behaviors of the FAPSC members.

Base on 2D barcode DM and QR, a new2D character barcode, is proposed in this paper. It is different with the traditional 2D barcode. It is a character matrix instead of the image barcode. The encoding rules, decoding rules and symbol structure of this character barcode are designed and implemented. Then the error-correcting code is studied and added into the encoded information. Finally the 2D character barcode is verified on PC. The experiments show that the 2D character barcode has very small capacity and can be transmitted as the character message among the mobile terminals. It can well overcome high loss rate when the image of 2D barcode is transmitted as a multimedia message and avoid the problem that some mobile terminals can not support the multimedia messages.

This study was designed to determine the effect of β-conglycinin glycosylation on the thermal aggregation of β-conglycinin and glycinin under extreme conditions of pH and ionic strength and to investigate the effect of glycan chain length (i.e., dextrans with different molecular masses) on the thermal aggregation of soy protein by the Maillard conjugation. It was confirmed that the glycosylation of β-conglycinin can inhibit its thermal aggregation at various pH or ionic strength values. The results highlighted the fact that neutral polysaccharides can suppress the thermal aggregation of protein through changes in hydrophobicity and steric hindrance, regardless of the molecular mass of the polysaccharide, at least within the range of 67 to 150 kDa. The results showed that the glycosylation of β-conglycinin increased its ability to suppress the thermal aggregation of glycinin relative to non-glycosylated β-conglycinin. Thus, the glycosylation of soy protein can be expected to be a practical method used to regulate the thermal aggregation of protein.

Effects of pulsed electric field treatment on browning intensity, antioxidant activity, protein patterns and chemical structure of the bovine serum albumin–dextran copolymer were investigated. Results showed Maillard reaction between bovine serum albumin and dextran was significantly accelerated when the electric field intensity was higher than 10 kV/cm, which was proved by changes in A294, browning, antioxidant activity and electrophoresis tests. At the same time, pronounced changes of chemical structure were found by circular dichroism test. The α-helix, β-sheet, β-turns and random coil were changed from approximately 42.6%, 1.9%, 17.5% and 33.9% to 14.5%, 33.0%, 21.2% and 30.2%, respectively, after treatment at 20 kV/cm for 7.35 ms. All data indicated that pulsed electric field was a means to promote Maillard-based copolymerisation.

Summary The purpose of this study was to characterise the Maillard reaction in a pressurised liquid system containing β-conglycinin and dextran. The rate of browning and the free amino content in this liquid system, with an initial pH of 7.2, were measured after reaction under atmospheric pressure and at 10 MPa. The secondary and tertiary structures of the conjugates were analysed by circular dichroism, showing that the increased pressure accelerated the reaction rate of the free amino groups and reduced the rate of browning. Significant structural changes occurred in the tertiary structure of the conjugates. Additionally, the emulsifying properties of the β-conglycinin–dextran conjugates produced were studied. The emulsifying properties of the conjugates produced at 10 MPa were higher than those made at atmospheric pressure.

Summary The severe acute respiratory syndrome (SARS) epidemic started in November 2002 and spread worldwide. The pathological changes in several human organs of patients with SARS have been extensively described. However, to date, little has been reported about the effects of this infection on the thyroid gland. Femoral head necrosis and low serum triiodothyronine and thyroxine levels, commonly found in patients with SARS, raise the possibility of thyroid dysfunction. We have undertaken this study to evaluate for any potential injury to the thyroid gland caused by SARS on tissue samples obtained from 5 SARS autopsies. The terminal deoxynucleotidyl transferase-mediated dUPT nick end–labeling assay was performed to identify apoptotic cells. The follicular epithelium was found to be damaged with large numbers of cells exfoliated into the follicle. The terminal deoxynucleotidyl transferase-mediated dUPT nick end–labeling assay demonstrated many cells undergoing apoptosis. Follicular architecture was altered and showed distortion, dilatation, and collapse. No distinct calcitonin-positive cells were detectable in the SARS thyroids. In conclusion, both parafollicular and follicular cells were injured. This may provide an explanation both for low serum triiodothyronine and thyroxine levels and the osteonecrosis of the femoral head associated with patients with SARS. Apoptosis may play a role in the pathogenesis of SARS associated coronavirus infection in the thyroid gland.

The effect of dosing time on the bioavailability of carbamazepine immediate-release (IR) tablets was investigated when administered to beagle dogs who were fasting, with co-administration of food (Co-food), and 0.5 h before food and 2 h after food. The study was conducted using a single dose of 200 mg (tablets/solution) with a 2 week washout period in a crossover design. Food intake significantly increased the rate and extent of tablet absorption. The C(max) (µg·ml⁻¹, 8.13/3.65) and t(max) (h, 1.83/0.92) were increased more than two-fold and the AUC₀₋₂₄ (µg·h·ml⁻¹, 20.09/8.19) was 2.5 times that of the values obtained under fasting conditions. The bioavailability of the tablets under fasting conditions was 91.2%, but increased to 223.5%, 182.8% and 148.4% in the Co-food, 0.5 h before food and 2 h after food groups, respectively (p 0.05). Although there was no significant difference in the C(max) or AUC₀₋₂₄ between the treatments with food, the absorption appeared to be reduced to some extent when the tablets were given 2 h after food. The oral bioavailability of CBZ IR tablets was significantly affected by the timing of the food intake. This is maybe favored by the fluctuations in the level of bile salts with the timing of food intake. To obtain acute therapy for a drug with narrow therapeutic window, attention should be given to the dosing time and food intake interactions.

In 1926, Smuts put forward the concept of "holistic". Then, this concept was introduced into the field of nursing. The presentation of system theory, levels and models of people's needs, theory of solving-problem provided the theoretical base for "holistic nursing". Beginning from the definition of health provided by WHO in 1948, many scholars put forward a set of nursing concepts, such as nursing process, theory of goal attainment, holistic human body, etc. In these concepts, the concept of holistic nursing was improved gradually, and finally formed the thought and method which were focused on patients, guided by concept of modern nursing, based on the nursing process, and it applied the systematic nursing process into the clinical nursing and its administration. At present, holistic nursing has been applied widely in the world. Reviewing its history will benefit the understanding of its connotation, and its application in the clinic for further improvement.

Approximately 40% of new chemical entities exhibit poor aqueous solubility and present a major challenge to modern drug delivery system, because of their low bioavailability. Self-emulsifying drug delivery systems (SEDDS) are usually used to improve the bioavailability of hydrophobic drugs. Conventional SEDDS, however, are mostly prepared in a liquid form, which can produce some disadvantages. Accordingly, solid SEDDS (S-SEDDS), prepared by solidification of liquid/semisolid self-emulsifying (SE) ingredients into powders, have gained popularity. This article gives an overview of the recent advances in the study of S-SEDDS, especially the related solidification techniques and the development of solid SE dosage forms. Finally, the existing problems and the possible future research directions in this field are pointed out.

The title compound, C12H21NO3, is an important intermediate for new dopamine transporter inhibitors. The six-membered ring of the azabicyclo[3.2.1]octane system adopts a chair conformation with the hydroxyl group axial. The fused five-membered ring is in an envelope conformation.

The title molecule, C20H24O2, shows a Z configuration with respect to the C=C double bond. The crystal structure is stabilized by intra- and intermolecular O—H...O hydrogen bonds.