Search

Background Hypertension is a common chronic disease that seriously endangers the health of the population. The primary-care doctors are the main force in the management of hypertension. However, the doctor-induced therapeutic of inertia greatly affects the achievement of primary-care hypertension control. Objective The aim of this study is to investigate the current status of therapeutic inertia among primary healthcare providers in the diagnosis and treatment process of hypertension, and analyze the causes of therapeutic inertia, providing a reference basis for improving hypertension control rates in China. Methods A simple random sampling method was used to distribute questionnaires to primary healthcare providers in 32 primary healthcare institutions in Tianjin from July to August 2023. The therapeutic inertia in the diagnosis and treatment process of hypertension was evaluated from three dimensions: "soft reasons" and "overestimation of treatment efficacy" as well as "medical insurance policies". Binary Logistic regression analysis was employed to explore the influencing factors of therapeutic inertia. Results A total of 407 questionnaires were distributed in this study, and 386 valid questionnaires were collected, yielding an effective response rate of 94.84%. The average score for primary healthcare providers' knowledge of hypertension diagnosis and treatment was 6 (0.5), with a scoring rate of 61.11% (5.50/9.00). The total score for therapeutic inertia in hypertension management was 48 (7.0), with a scoring rate of 56.55% (45.24/80.00). The scores for the "soft reasons" dimension, "overestimation of treatment efficacy" dimension, and "medical insurance policies" dimension were 26 (4.8), 10 (2.0), and 6 (2.5) respectively, with scoring rates of 51.92% (25.96/50.00), 65.40% (9.81/15.00), and 46.40% (6.96/15.00) respectively. When comparing the average scores of the three dimensions of therapeutic inertia, the "overestimation of treatment efficacy" dimension had the highest score compared to the other two groups (P

BackgroundDespite increasing awareness, silica dust–induced silicosis still contributes to the huge disease burden in China. Worryingly, recent silica dust exposure levels and silicosis risk in Chinese noncoal mines remain unclear. ObjectiveWe aimed to determine recent silica dust exposure levels and assess the risk of silicosis in Chinese noncoal mines. MethodsBetween May and December 2020, we conducted a retrospective cohort study on 3 noncoal mines and 1 public hospital to establish, using multivariable Cox regression analyses, prediction formulas of the silicosis cumulative hazard ratio (H) and incidence (I) and a cross-sectional study on 155 noncoal mines in 10 Chinese provinces to determine the prevalence of silica dust exposure (PDE), free silica content, and total dust and respirable dust concentrations. The qualitative risk of silicosis was assessed using the International Mining and Metals Commission’s risk-rating table and the occupational hazard risk index; the quantitative risk was assessed using prediction formulas. ResultsKaplan-Meier survival analysis revealed significant differences in the silicosis probability between silica dust–exposed male and female miners (log-rank test χ21=7.52, P=.01). A total of 126 noncoal mines, with 29,835 miners and 4623 dust samples, were included; 13,037 (43.7%) miners were exposed to silica dust, of which 12,952 (99.3%) were male. The median PDE, free silica content, total dust concentration, and respirable dust concentration were 61.6%, 27.6%, 1.30 mg/m3, and 0.58 mg/m3, respectively, indicating that miners in nonmetal, nonferrous metal, small, and open-pit mines suffer high-level exposure to silica dust. Comprehensive qualitative risk assessment showed noncoal miners had a medium risk of silicosis, and the risks caused by total silica dust and respirable silica dust exposure were high and medium, respectively. When predicting H and I over the next 10, 20, and 30 years, we assumed that the miner gender was male. Under exposure to current total silica dust concentrations, median I10, I20, and I30 would be 6.8%, 25.1%, and 49.9%, respectively. Under exposure to current respirable silica dust concentrations, median I10, I20, and I30 would be 6.8%, 27.7%, and 57.4%, respectively. These findings showed that miners in nonmetal, nonferrous metal, small, and open-pit mines have a higher I and higher qualitative silicosis risk. ConclusionsChinese noncoal miners, especially those in nonmetal, nonferrous metal, small, and open-pit mines, still suffer high-level exposure to silica dust and a medium-level risk of silicosis. Data of both total silica dust and respirable silica dust are vital for occupational health risk assessment in order to devise effective control measures to reduce noncoal mine silica dust levels, improve miners’ working environment, and reduce the risk of silicosis.

Abstract Post-stroke depression is commonly experienced by stroke survivors and has a significant negative impact on the physical, cognitive, and social functioning of those affected. This study aims to investigate the prevalence of depressive symptoms and their associated factors in Chinese stroke patients. Research samples were selected from the China Health and Retirement Longitudinal Study 2018 survey. Depression was evaluated using the 10-item Center for Epidemiological Studies Depression Scale, with a score ≥ 10 defined as depression. Univariate and multivariable analyses were performed to examine the associations of depressive symptoms with demographics, family relationships, health status, and lifestyle. A total of 963 stroke patients were included and 57.8% of them had depressive symptoms. Depressive symptoms were significantly associated with female sex (OR 1.762, 95% CI 1.235–2.514), lower education level (non-formal education: OR 2.148, 95% CI 1.235–3.737, primary to secondary school education: OR 1.964, 95% CI 1.272–3.033), dissatisfaction with spouse (OR 1.912, 95% CI 1.075–3.401), dissatisfaction with life (OR 1.779, 95% CI 1.080–2.931), dissatisfaction with health (OR 1.592, 95% CI 1.138–2.226), pain (OR 1.392, 95% CI 1.005–1.928) and abnormal sleep (OR 1.557, 95% CI 1.126–2.152). The findings suggest the need for regular depression screening and evaluation after a stroke, and that a well-functioning support system, effective health management, and lifestyle modifications could potentially improve the mental state of stroke patients.

ObjectiveThe aging Chinese population is driving up health care costs, with hospitalizational accounting for a large portion of total health care costs. By 2012, hospitalization costs for people over 60 years of age exceeded outpatient costs, marking a change in the allocation of medical resources. Further research is needed on the factors influencing changes in hospitalizational costs and burden. This paper examines the costs and burden of hospitalization for older adults from a micro perspective, providing new evidence to explain how social, medical, family, personal, and geographic factors affect them.MethodsUtilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), a linear regression model was constructed to investigate the impact of various factors on the hospitalization costs and burden among the older adult in China. To ensure the heterogeneity of the results, the sample was divided into subgroups based on different regions for comparative analysis. Additionally, collinearity among the variables was examined.ResultsThe average hospitalization costs for the older adult are $1,199.24, with a burden score of 0.5. Residence, type of chronic diseases, region, family size, type of health service facility, received distance, smoke and alcoholic significantly affect the out-of-pocket expenses for older adult hospitalizations. In terms of the burden of hospitalization for the older adult, Residence, health insurance, education, type of chronic diseases, region, family size, ethnic, type of health service facility, received distance, smoke, alcoholic and pension significantly impact the hospitalization burden for the older adult.ConclusionThis paper provides a new perspective to explain the factors influencing hospitalizational costs and burden in China. The policy recommendations include expanding health insurance coverage and promoting commercial insurance to enhance the accessibility and financial security of healthcare services. Strengthening primary care is suggested to reduce the burden on hospitals and lower the overall cost of hospitalization. Policies aimed at addressing regional healthcare disparities are proposed, along with targeted support for vulnerable groups, including subsidies and culturally sensitive services.

BackgroundFew studies focus on the equality of pain, and the relationship between pain and death is inconclusive. Investigating the distribution of pain and potential mortality risks is crucial for ameliorating painful conditions and devising targeted intervention measures. ObjectiveOur study aimed to investigate the association between inequalities in pain and all-cause mortality in China. MethodsLongitudinal cohort data from waves 1 and 2 of the China Health and Retirement Longitudinal Study (2011-2013) were used in this study. Pain was self-reported at baseline, and death information was obtained from the 2013 follow-up survey. The concentration index and its decomposition were used to explain the inequality of pain, and the association between pain and death was analyzed with a Cox proportional risk model. ResultsA total of 16,747 participants were included, with an average age of 59.57 (SD 9.82) years. The prevalence of pain was 32.54% (8196/16,747). Among participants with pain, the main pain type was moderate pain (1973/5426, 36.36%), and the common pain locations were the waist (3232/16,747, 19.3%), legs (2476/16,747, 14.78%) and head (2250/16,747, 13.44%). We found that the prevalence of pain was concentrated in participants with low economic status (concentration index –0.066, 95% CI –0.078 to –0.054). Educational level (36.49%), location (36.87%), and economic status (25.05%) contributed significantly to the inequality of pain. In addition, Cox regression showed that pain was associated with an increased risk of all-cause mortality (hazard ratio 1.30, 95% CI 1.06-1.61). ConclusionsThe prevalence of pain in Chinese adults is concentrated among participants with low economic status, and pain increases the risk of all-cause death. Our results highlight the importance of socioeconomic factors in reducing deaths due to pain inequalities by implementing targeted interventions.

Objective: To investigate the prevalence of subthreshold depression among Chinese college students and to explore the related factors. Methods: The research subjects were Chinese college students participating in the “2022 Psychology and Behavior Investigation of Chinese Residents (PBICR-2022)''. Data on respondents' general characteristics, quality of life, perceived pressure, family communication, perceived social support, self-efficacy, and depression status were gathered. To investigate the association between each variable and the risk of subthreshold depression, statistical analyses, including chi-square tests and rank sum tests were conducted. Furthermore, a binary stepwise logistic regression was employed to establish the regression model of the factors related to subthreshold depression among Chinese college students. Results: A prevalence of subthreshold depression of about 39.7 % was found among the 8934 respondents. Logistic regression analysis revealed that respondents who are female, have chronic diseases, are in debt, experience significant impacts from epidemic control policies, have lower self-assessed quality of life, experience challenges in family communication, perceive lower social support, have lower self-efficacy, and feel higher perceived pressure are more likely to develop subthreshold depression compared to the control group. (P

Lonicerae japonicae flos (LJF) and Lonicerae flos (LF) are traditional Chinese herbs that are commonly used and widely known for their medicinal properties and edibility. Although they may have a similar appearance and vary slightly in chemical composition, their effectiveness as medicine and their use in clinical settings vary significantly, making them unsuitable for substitution. In this study, a novel 2 × 3 six-channel fluorescent sensor array is proposed that uses machine learning algorithms in combination with the indicator displacement assay (IDA) method to quickly identify LJF and LF. This array comprises two coumarin-based fluorescent indicators (ES and MS) and three diboronic acid-substituted 4,4′-bipyridinium cation quenchers (Q1–Q3), forming six dynamic complexes (C1–C6). When these complexes react with the ortho-dihydroxy groups of phenolic acid compounds in LJF and LF, they release different fluorescent indicators, which in turn causes distinct fluorescence recovery. By optimizing eight machine learning algorithms, the model achieved 100% and 98.21% accuracy rates in the testing set and the cross-validation predictions, respectively, in distinguishing between LJF and LF using Linear Discriminant Analysis (LDA). The integration of machine learning with this fluorescent sensor array shows great potential in analyzing and detecting foods and pharmaceuticals that contain polyphenols.

BackgroundThe hierarchical medical system is an important measure to promote equitable healthcare and sustain economic development. As the population’s consumption level rises, the demand for healthcare services also increases. Based on urban and rural perspectives in China, this study aims to investigate the effectiveness of the hierarchical medical system and its relationship with economic development in China.Materials and methodsThe study analyses panel data collected from Chinese government authorities, covering the period from 2009 to 2022. According to China’s regional development policy, China is divided into the following regions: Eastern, Middle, Western, and Northeastern. Urban and rural component factors were downscaled using principal component analysis (PCA). The factor score formula combined with Urban–rural disparity rate (ΔD) were utilized to construct models for evaluating the effectiveness of the hierarchical medical system from an urban–rural perspective. A Vector Autoregression model is then constructed to analyze the dynamic relationship between the effects of the hierarchical medical system and economic growth, and to predict potential future changes.ResultsThree principal factors were extracted. The contributions of the three principal factors were 38.132, 27.662, and 23.028%. In 2021, the hierarchical medical systems worked well in Henan (F = 47245.887), Shandong (F = 45999.640), and Guangdong (F = 42856.163). The Northeast (ΔDmax = 18.77%) and Eastern region (ΔDmax = 26.04%) had smaller disparities than the Middle (ΔDmax = 49.25%) and Western region (ΔDmax = 56.70%). Vector autoregression model reveals a long-term cointegration relationship between economic development and the healthcare burden for both urban and rural residents (βurban = 3.09, βrural = 3.66), as well as the number of individuals receiving health education (β = −0.3492). Both the Granger causality test and impulse response analysis validate the existence of a substantial time lag between the impact of the hierarchical medical system and economic growth.ConclusionResidents in urban areas are more affected by economic factors, while those in rural areas are more influenced by time considerations. The urban rural disparity in the hierarchical medical system is associated with the level of economic development of the region. When formulating policies for economically relevant hierarchical medical systems, it is important to consider the impact of longer lags.

Abstract In this letter, the authors develop a wide‐angle Fresnel infrared lens for detecting temperature inside closed switchgear. Based on the structural characteristics of closed switchgear, a frame structure for the lens and a single‐sided installation method were devised. A field test was conducted to simulate temperature diagnosis and monitoring. The results indicate that the lens described in this letter enables satisfactory observation of the internal temperature of closed high‐voltage switchgear.

Abstract In this study, a 34‐MW tubular hydro‐generator was selected as the study example. For the electromagnetic field–circuit coupling analysis model, the effects of the ideal DC voltage and current sources (i.e. two models of the rotor excitation power supply) on the no‐load voltage waveform quality and the damper winding loss calculation results were studied by considering the influence of the electromagnetic induction of the rotor excitation winding. The obtained results provide direct and effective theoretical support and technical reference for improving the accuracy and rationality of the calculation results of the electromagnetic performance parameters and the analysis, design, manufacturing and operating level of such generators.

The PB2 subunit of the RNA polymerase of influenza virus antagonizes interferon signalling. Here, the authors biochemically characterise the molecular interactions that mediate this, and how this impacts viral replication in the context of different influenza subtypes.

Abstract Background Understanding the intention of receiving COVID-19 vaccines is important to inform effective vaccination strategies. This study aimed to investigate such intention, identify the key influencing factors, and determine the most important intention predictors using a theoretically principled model. Methods An online, cross-sectional survey method was implemented in Macao in May 2021. People aged 18 years or above and residing in Macao for 12 months prior to the study were recruited through social media. Intention to receive COVID-19 vaccines and the main constructs of the protection motivation theory and the health belief model were the main measures encompassing threat appraisal, intrapersonal characteristics, cues to action, coping appraisal, past experiences and information seeking behavior. Descriptive statistics, Pearson correlation and multiple linear regression were used for data analysis. Results A total of 552 valid responses were received. Among the respondents, 79.5% aged between 25 and 54 years old, 59.4% were female, and 88% had a bachelor degree or above; 62.3% of the respondents indicated their intention to receive COVID-19 vaccination while 19.2% were hesitant and 18.5% did not have any intention. While 67.0% believed COVID-19 infection was life-threatening, only 19.0% thought they were at risk of getting infected. Control variables such as age, gender, education level, and having travel plans were significantly correlated with intention. Significant associations between intention with perceived severity, perceived susceptibility, maladaptive response reward, self-efficacy, response-efficacy, response cost, social attitude, social norm, past experience and information seeking behavior were identified (P

Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases in women of reproductive age and features complex pathological symptoms and mechanisms. Existing medical treatments have, to some extent, alleviated the deterioration of PCOS. However, these strategies only temporarily control symptoms, with a few side effects and no preventive effect. Phytochemicals extracted from medicinal herbs and plants are vital for discovering novel drugs. In recent years, many kinds of research have proven that phytochemicals isolated from traditional Chinese medicine (TCM) and medicinal plants show significant potential in preventing, alleviating, and treating PCOS. Nevertheless, compared to the abundance of experimental literature and minimal specific-topic reviews related to PCOS, there is a lack of systematic reviews to summarize these advancements in this promising field. Under this background, we systematically document the progress of bioactive phytochemicals from TCM and medicinal plants in treating PCOS, including flavonoids, polyphenols, and alkaloids. According to the literature, these valuable phytochemicals demonstrated therapeutic effects on PCOS supported by in vivo and in vitro experiments, mainly depending on anti-inflammatory, antioxidation, improvement of hormone disorder and insulin resistance (IR), and alleviation of hyperinsulinemia. Based on the current progress, future research directions should emphasize 1) exploring bioactive phytochemicals that potentially mediate bone metabolism for the treatment of PCOS; 2) improving unsatisfactory bioavailability by using advanced drug delivery systems such as nanoparticles and antibody-conjugated drugs, as well as a chemical modification; 3) conducting in-depth research on the pathogenesis of PCOS to potentially impact the gut microbiota and its metabolites in the evolution of PCOS; 4) revealing the pharmacological effects of these bioactive phytochemicals on PCOS at the genetic level; and 5) exploring the hypothetical and unprecedented functions in regulating PCOS by serving as proteolysis-targeting chimeras and molecular glues compared with traditional small molecule drugs. In brief, this review aims to provide detailed mechanisms of these bioactive phytochemicals and hopefully practical and reliable insight into clinical applications concerning PCOS.

BackgroundThe maldistributions of the health workforce showed great inconsistency when singly measured by population quantity or geographic area in China. Meanwhile, earlier studies mainly employed traditional econometric approaches to investigate determinants for the health workforce, which ignored spillover effects of influential factors on neighboring regions. Therefore, we aimed to analyze health workforce allocation in China from demographic and geographic perspectives simultaneously and then explore the spatial pattern and determinants for health workforce allocation taking account of the spillover effect.MethodsThe health resource density index (HRDI) equals the geometric mean of health resources per 1,000 persons and per square kilometer. First, the HRDI of licensed physicians (HRDI_P) and registered nurses (HRDI_N) was calculated for descriptive analysis. Then, global and local Moran's I indices were employed to explore the spatial features and aggregation clusters of the health workforce. Finally, four types of independent variables were selected: supportive resources (bed density and government health expenditure), healthcare need (proportion of the elderly population), socioeconomic factors (urbanization rate and GDP per capita), and sociocultural factors (education expenditure per pupil and park green area per capita), and then the spatial panel econometric model was used to assess direct associations and intra-region spillover effects between independent variables and HRDI_P and HRDI_N.ResultsGlobal Moran's I index of HRDI_P and HRDI_N increased from 0.2136 (P = 0.0070) to 0.2316 (P = 0.0050), and from 0.1645 (P = 0.0120) to 0.2022 (P = 0.0080), respectively. Local Moran's I suggested spatial aggregation clusters of HRDI_P and HRDI_N. For HRDI_P, bed density, government health expenditure, and GDP had significantly positive associations with local HRDI_P, while the proportion of the elderly population and education expenditure showed opposite spillover effects. More precisely, a 1% increase in the proportion of the elderly population would lead to a 0.4098% increase in HRDI_P of neighboring provinces, while a 1% increase in education expenditure leads to a 0.2688% decline in neighboring HRDI_P. For HRDI_N, the urbanization rate, bed density, and government health expenditure exerted significantly positive impacted local HRDI_N. In addition, the spillover effect was more evident in the urbanization rate, with a 1% increase in the urbanization rate relating to 0.9080% growth of HRDI_N of surrounding provinces. Negative spillover effects of education expenditure, government health expenditure, and elderly proportion were observed in neighboring HRDI_N.ConclusionThere were substantial spatial disparities in health workforce distribution in China; moreover, the health workforce showed positive spatial agglomeration with a strengthening tendency in the last decade. In addition, supportive resources, healthcare needs, and socioeconomic and sociocultural factors would affect the health labor configuration not only in a given province but also in its nearby provinces.

Macau, Hong Kong and Singapore are all facing increasing population aging. Those aged 65 and over make up the old-age population. The working-age population refers to the population aged 15 to 64. Conventionally, the burden of population aging is measured by the Old-Age Dependency Ratio, which is the ratio of the old-age population to the working-age population. As life expectancy rises, depending exclusively on age to calculate the burden of aging hinders the development of effective anti-aging strategies. The working-age population's education and the elderly's health affect the aging burden's support and generator, respectively. Including them in the calculation gives us a fuller view of the burden of aging.ObjectiveTo compare the population aging burden in Macau, Hong Kong, and Singapore by including working-age population education and elderly health.MethodsThe overall, working-age and old-age population and proportion, as well as the Old-Age Dependency Ratio of Macau, Hong Kong, and Singapore, were collected from the World Bank database. The life expectancy at 65 was extracted from the 2022 World Population Prospect. The tertiary education rate of the working-age population and the self-rated health status of the old-age population were retrieved from governments' statistical reports. We then calculated the Education-Health Adjusted Old-Age Dependency Ratio, a set of four equations showing the support of the working-age population on the old-age population, where OADRh_t and OADRuh_t represent the burden of healthy and unhealthy old-age population on the working-age population with tertiary education; similarly, OADRh_nt and OADRuh_nt indicate the burden placed on the working-age population without tertiary education by healthy and unhealthy old-age population. Lastly, for comparison with the conventional Old-Age Dependency Ratio, we generated the Weighted Education-Health Adjusted Old-Age Dependency Ratio.ResultsHong Kong has the greatest old-age population proportion and Old-Age Dependency Ratio, yet its growth rates are moderate and stable, ranging from 0 to 4% and 0 to 6%, respectively. Macau and Singapore experienced sharper changes in old-age population proportion and the Old-Age Dependency Ratio, with Macau's Old-Age Dependency Ratio varying between −2.66 and 8.50% and Singapore's ranging from −1.53 to 9.70%. Three cities showed different patterns in four Education-Health Adjusted Old-Age Dependency Ratio indicators. In Macau, the OADRh_nt and OADRuh_nt increased by 0.4 and 6.2, while the OADRh_t and OADRuh_t decreased by 13.5 and 15.3 from 2004 to 2016. In Hong Kong, only the OADRuh_t fell by 9.4, and the other three increased from 2003 to 2015. In Singapore, the OADRh_nt and OADRh_t increased by 3.8 and 1.0, while OADRuh_nt and OADRuh_t decreased by 1.2 and 3.9 from 2007 to 2011. The Weighted Education-Health Adjusted Old-Age Dependency Ratios are all smaller than the conventional Old-Age Dependency Ratio in the three regions, particularly in Singapore. The Weighted Education-Health Adjusted Old-Age Dependency Ratio of Singapore was reduced by 9.5 to 30.5% compared with the conventional Old-Age Dependency Ratio, that of Hong Kong reduced by 6.2 to 22.5%, and that of Macau reduced by 4.4 to 16.1%.ConclusionThis is the first study to compare the aging burden in Macau, Hong Kong, and Singapore in connection to working-age population education and elderly health. With the new assessment, the burden of population aging in three regions has been reduced, showing that improving the education of the working-age population and maintaining older people's wellbeing can assist authorities to deal with population aging, especially in Macau and Hong Kong.

Background: Metastatic colorectal cancer (mCRC) imposes a heavy tumor burden worldwide due to limited availability of therapeutic drugs. Aflibercept, a kind of recombinant protein of the anti-vascular endothelial growth factor (VEGF) family, has been approved in clinical application among mCRC patients since 2012. A comprehensive analysis of the efficacy, safety, and cost-effectiveness of aflibercept in mCRC treatment is necessary.Objective: To evaluate the efficacy, safety, and cost-effectiveness of aflibercept for the treatment of mCRC in order to provide a decision-making reference for the selection of targeted drugs for second-line treatment of mCRC in Hong Kong, Macao, and Taiwan regions of China and the selection of new drugs for medical institutions in these regions.Methods: A systematic retrieve on databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu, as well as relevant websites and databases of health technology assessment including the National Institute of Health and Clinical Optimization, Centre for Evaluation and Communication at the University of York, and the Canadian Agency for Medicines and Health Technology, was conducted. The literature was screened according to the inclusion and exclusion criteria, and data were extracted and analyzed by two authors, while the quality of the literature was assessed.Results: Finally, we included two HTA reports, 11 systematic reviews/meta-analyses, and two cost-effectiveness studies in the rapid health technology assessment. For mCRC patients receiving second-line treatment, aflibercept combined with FOLFIRI significantly increased progression-free survival (PFS) and overall survival (OS) and the objective response rate (ORR) also improved, compared with folinic acid + fluorouracil + irinotecan (FOLFIRI). In terms of safety, mCRC patients who received aflibercept combined with FOLFIRI therapy had a higher incidence of grade 3–4 adverse events than those who received FOLFIRI alone, including anti-VEGF–related adverse events (hypertension, hemorrhagic events, and proteinuria) and chemotherapy-related adverse events (diarrhea, weakness, stomatitis, hand-foot syndrome, neutropenia, and thrombocytopenia). In terms of cost-effectiveness, two economic studies conducted in the United Kingdom and Japan, respectively, found that compared with FOLFIRI, aflibercept combined with FOLFIRI had no cost-effectiveness advantage in mCRC patients receiving second-line treatment.Conclusion: Compared with FOLFIRI treatment, aflibercept combined with FOLFIRI for the second-line treatment of mCRC patients has better efficacy, worse safety, and is not cost-effective. More high-quality clinical studies are required for further exploration of aflibercept’s clinical value. Medical institutions in Hong Kong, Macao, and Taiwan regions of China should be cautious when using or introducing aflibercept plus FOLFIRI as a mCRC treatment.

Abstract Background Due to the increasing ageing population, neurocognitive disorders (NCDs) have been a global public health issue, and its prevention and early diagnosis are crucial. Our previous study demonstrated that there is a significant correlation between specific populations and NCDs, but the biological characteristics of the vulnerable group predispose to NCDs are unclear. The purpose of this study is to investigate the predictors for the vulnerable group by a multi‐omics analysis. Methods Multi‐omics approaches, including metagenomics, metabolomic and proteomic, were used to detect gut microbiota, faecal metabolites and urine exosome of 8 normal controls and 13 vulnerable elders after a rigorous screening of 400 elders in Macao. The multi‐omics data were analysed using R and Bioconductor. The two‐sided Wilcoxon's rank‐sum test, Kruskal–Wallis rank sum test and the linear discriminant analysis effective size were applied to investigate characterized features. Moreover, a 2‐year follow‐up was conducted to evaluate cognitive function change of the elderly. Results Compared with the control elders, the metagenomics of gut microbiota showed that Ruminococcus gnavus, Lachnospira eligens, Escherichia coli and Desulfovibrio piger were increased significantly in the vulnerable group. Carboxylates, like alpha‐ketoglutaric acid and d‐saccharic acid, and levels of vitamins had obvious differences in the faecal metabolites. There was a distinct decrease in the expression of eukaryotic translation initiation factor 2 subunit 1 (eIF2α) and amine oxidase A (MAO‐A) according to the proteomic results of the urine exosomes. Moreover, the compound annual growth rate of neurocognitive scores was notably decreased in vulnerable elders. Conclusions The multi‐omics characteristics of disturbed glyoxylate and dicarboxylate metabolism (bacteria), vitamin digestion and absorption and tricarboxylic acid cycle in vulnerable elders can serve as predictors of NCDs risk among the elderly of Macao. Intervention with them may be effective therapeutic approaches for NCDs, and the underlying mechanisms merit further exploration.

Abstract Background Traditional Chinese medicine (TCM) constitution contributes to predicating disease occurrence and pathological progress. In this study, we investigate the correlation between TCM constitution and neurocognitive function in elderly Macau individuals. Methods A total of 313 older adults from elderly healthcare centers were recruited at random. The data of gender, age, education, sleeping hours, physical activities were collected, and the Geriatric Depression Scale, Hong Kong version of the Montreal Cognitive Assessment (MoCA) and categories of TCM constitution were administered. Results Of the 313 elderly individuals enrolled in this study, 86 (27.48%) were of balanced constitution. Among the other categories of TCM constitution, the most was Yin-deficiency (23.32%), followed by 53 (16.93%) with Phlegm-dampness. The average neurocognitive score of all elderly individuals was 18.01 ± 6.25. After adjusting for all possible confounds, multiple linear regression analysis showed that Qi-depressed constitution and neurocognitive scores were negatively correlated (β = − 2.66, 95%CI − 4.99 ~ − 0.33), Meanwhile, Yin-deficient constitution and neurocognitive scores were negatively correlated (β = − 2.10, 95%CI − 3.73 ~ − 0.47). Compared with balanced constitution, Qi-depressed constitution mainly affected visual–spatial ability dimension (β = − 0.91, 95%CI − 1.54 ~ − 0.28) and naming dimension (β = − 0.64, 95%CI − 1.04 ~ − 0.25), Yin-deficient constitution mainly affected visual space dimension (β = − 0.53, 95%CI − 0.97 ~ − 0.08). Conclusion Qi-depressed and Yin-deficient constitutions are associated with and contributed to the decline of neurocognitive function in senior adults, especially visual–spatial ability and naming dimensions. Further investigations into how TCM constitutions interact with neurocognitive function are needed.

The loss and heat of a self-cooling enclosure-isolated phase bus of large generator are studied by establishing the electromagnetic-fluid-temperature field model of the bus using the finite element method. Factors such as skin effect and eddy loss, the electro-conductivity temperature effect, gas flow, and gravity are considered. The compositive calculation and analysis of the loss and temperature of the self-cooling enclosure-isolated phase bus of a 600 MW generator are conducted, and the data are compared with the test. The results show that the current and loss distribution in the conductor and sheath of the horizontal bus correlate with skin effect. The distribution of the bus temperature around the vertical center axis is symmetric, but the temperature of the top bus is higher than the bottom. If the influence of the acceleration of gravity and heat radiation is not considered, the result will become unreasonable.

ObjectiveTo explore the influence of parents on the medication adherence of their children.Study DesignA cross-sectional online investigation.MethodsA questionnaire with 41 questions was designed based on the health belief model (HBM) distributed and collected online in 28 cities around China through multi-stage stratified sampling. The reliability of the questionnaire was assessed with Cronbach's α coefficient and split-half reliability, and its validity was evaluated with exploratory factor analysis and content validity index. The structural equation model (SEM) was constructed to explore the relationship between the parents' health beliefs and their children's medication adherence. Subgroup analysis was conducted to study the differences between parents with different demographic characteristics (male and female, rural and urban).Results573 questionnaires were included for analysis, with an effective rate of 62.97%. The Cronbach'α coefficient of the questionnaire was 0.821 > 0.6, the split-half reliability was 0.651 > 0.6, the I-CVI of each dimension were >0.78, and the S-CVI/AVE (I-CVI average) was 0.95 > 0.9. The result of the questionnaire exploratory factor analysis met the standard. According to the SEM, self-efficacy (λ = 0.177), perceived susceptibility (λ = −0.244), and perceived severity (λ = 0.243) were direct influencing factors of children's medication adherence. In the subgroup analysis, the model established by each subgroup was consistent with the model established by the overall sample. The absolute values of females' perceived susceptibility, severity, and self-efficacy for their children's medication adherence path coefficients were higher than males'.ConclusionParents' perceived severity and self-efficacy may positively impact on their children's medication adherence, while parents' susceptibility to children's medication non-adherence may negatively impact on children's medication adherence. Objective constraints, perceived barriers, and benefits may in directly impact on children's medication adherence. Women's health beliefs appear to have a more significant impact on their children's medication adherence than men's. It may be an effective strategy to increase their children's medication adherence by improving parents' health beliefs. Medical staff should explain medication adherence knowledge to the parents of children, and inform the children of the possible consequences of non-adherence with medication, to improve the subjective perception of parents on the severity of children's non-adherence with medication, and improve parents' self-efficacy in rational medication for children. In addition, attention should be paid to the mental health of the parents, and more social and psychological support.

Abstract For the pole shoe and damper winding centre line shifted structure that has been gradually applied in hydro‐generator in recent years, this letter selects one real integer and one fractional slot large tubular hydro‐generator as examples. Then revealed the influence trends of different shift degrees on the no‐load voltage waveform quality and the damper winding loss and heat under rated load conditions. Also, it compared these trends with those of the traditional stator skew 1 slot structure. The results show that for integer slot generator, this kind of shift structure can obtain high‐quality no‐load voltage waveform close to the traditional stator skewed 1 slot scheme, and the damper winding loss and heat is significantly smaller than the latter. For fractional slot generators, this kind of shift structure will lead to the deterioration of the no‐load voltage waveform.

Abstract Background Career intention is closely related to the distribution of university graduates across sectors in pharmacy-related field. The aim of the study was to describe career intention and identify its influencing factors among final-year pharmacy undergraduate students in China. Methods A questionnaire study on demographic characteristics, educational situation, family background, occupational value and career intention was conducted among final-year pharmacy undergraduate students at three universities in northwest China. Exploratory factor analysis was used to identify the constructs of occupational value. Multinominal logistic regression was adopted to analyse the factors influencing career intention. Results Among the 275 student participants, 62.6% intended to work in public medical institutions (rural: 44.4%; urban: 18.2%), 26.5% aimed to work in the pharmaceutical industry, 6.5% wanted to work in other sectors in the pharmacy-related field, and 4.4% planned to work in other fields. Their gender, father’s education level, monthly household income per capita, whose opinions were considered most during job selection, the self-gratification factor of occupational value, and employment guidance had significant impacts on students’ career intentions. Conclusion In the Chinese background, the career intention of more than half of the undergraduate pharmacy students was to work in public medical institutions. The career intentions of the overall participants were mainly determined by their gender, family background as well as psychological self-gratification, and they could also be influenced by employment guidance.

Abstract Background There has been great shortage of primary care physicians (PCPs) in China, especially in western areas. Job satisfaction plays a great role in retaining people. The aim of this study is to investigate the job satisfaction of PCPs and associated factors in 11 provinces of western China, thus providing necessary reference values for stabilizing the primary care workforce and improving the quality of primary care services. Method A sample of 2103 PCPs working in western China were surveyed using a stratified, multistage and random sampling method in 2011. The characteristics of participants were recorded by a structured questionnaire. A multilevel model (MLM) and quantile regression (QR) were applied to assess the association between job satisfaction and possible risk factors. Results Of the 2103 doctors surveyed, the overall satisfaction score was 3.26 ± 0.68 (from 1 to 5). MLM indicated that age group, income satisfaction, unit policy approval, personal planning, career attitude, work value and patient recognition were positively correlated with job satisfaction, while turnover intention was negatively correlated with job satisfaction. QR were not completely consistent with MLM and further explored the differences in different job satisfaction score percentiles on each domains. Conclusion This study showed that the job satisfaction of PCPs in western China was not high. The MLM and QR discussed were not entirely consistent, the latter one provided more information and robust results. Measures should be taken in streamlining administration and institute decentralization, creating more opportunities for additional training, raising PCPs’ income, improving the social status of doctors and improving the relationship between doctors and patients.

Abstract Background A novel coronavirus was identified in December, 2019 in Wuhan, China, and traditional Chinese medicine (TCM) played an active role in combating the novel coronavirus pneumonia (NCP) caused by this fast-spreading virus COVID-19. Thus, we aimed to explore TCM characteristics of clinical efficacy to NCP, as well as to optimize Qingfei Paidu decoction (QFPDD) and the recommended formulas to NCP by National Health Commission (NHC). Methods Chinese medical sciences theory and clinical application of TCM were analyzed. A total of 54 NCP patients were observed in a hospital from Wuhan, whose clinical characteristics and utilization of Chinese Medicines (CMs) were described. Paired t test was used to measure the change of patients’ hemogram during hospitalization period, indicating the effect of CMs. Multiple linear regression analysis was applied to explore the factors affecting the length of hospital stay. Network pharmacology analysis was applied to figure out the performance of NHC-recommended formulas of five disease stages at levels of compounds, targets and pathways. Result The average length of hospital stay was 8.96 days. Patients over 45 stayed 9.79 days in hospital in average, longer than 7.64 days of patients under 45. Comparing the hemograms between admission and discharge of hospital, the number of leukocytes, neutrophil, lymphocyte and platelet increased, while the numbers of erythrocytes, hemoglobin concentration and hematocrit decreased. According to the standard coefficients of regression, the factor affecting the length of stay for the most was CMs in category of invigorating spleen and removing dampness (ISRD), followed by administrating CMs, male, and cough. Thirty-two CMs were screened after deleting duplication from QFPDD and NHC-recommended formulas. Compound quercetin, luteolin, kaempferol, acacetin etc., were all involved in the treatment of various disease stages on the compound level both in generality and individuality. Conclusion TCM has a systemic theoretical understanding on the pathological evolution and a positive clinical efficacy on NCP. The CMs of ISRD improved patients’ recovery, suggesting the importance of regulating intestinal function and keeping microenvironmental balance in TCM treatment of NCP. The active compounds from QFPDD and NHC-recommended formulas contribute to recovery of varied disease progresses during TCM treating NCP.

This paper studies a real 36-MW large tubular hydro-generator to solve the transient variation problem of the loss and heat of damper bars during short circuit faults in tubular hydro-generators. The transient analysis method of electromagnetic-temperature fields is adopted to study the transient variation problem of the loss and heat of damper bars during three-phase symmetrical short-circuits, single-phase to ground asymmetrical short-circuits, and phase-to-phase asymmetrical short-circuits under rated operation states. The research work provides valuable findings for improving the level of state analysis, the design and manufacturing processes, and the operation and maintenance of large-scale tubular hydro-generators.

Aimed at a new kind of overheated ablated fault on the pole shoe surface of a large tubular hydro-generator, based on the real site characteristics of the fault with combination of a physical field analysis, this paper reveals the occurrence mechanism of such faults from operational conditions, generator structure, material characteristics, and so on. On the basis of the results, the fault treatment and the generator improvement strategy are proposed. In addition, the treatment method has been applied to a faulty generator, and it successfully eliminating the fault. The research is of great significance for restraining the loss and heat of poles in large tubular hydro-generators as well as improving the safety and reliability of the operation of generators and power grids.

BackgroundTo explore the prevalence and inequality of cognitive impairment among older adults in Macau and the contributions of influencing factors to inequality in cognitive impairment.MethodsThe Montreal Cognitive Assessment (MoCA) was used to measure the prevalence of cognitive impairment. Socioeconomic status scores were used to describe economic level of the subjects. The concentration index was applied to measure the inequality of cognitive impairment associated with socioeconomic status (SES) and decomposed into its influencing factors.ResultsThe prevalence of cognitive impairment was 44.35% in Macau. The concentration index of cognitive impairment among the elderly was −0.165 (95% CI: −0.232 to −0.098), indicating that the prevalence of cognitive impairment was concentrated in households with poor SES. Older age, poor SES, long or short sleep duration, other marital status, poor appetite, no tea/coffee drinking, no religious belief, and depression contributed positively to the inequality of cognitive impairment. Among these factors, SES made the largest contribution to inequality, accounting for 76.74%.ConclusionIn Macau, the prevalence of cognitive impairment among people aged 65 years and older is concentrated among those who are in poor economic conditions. Reducing the gap between the rich and the poor at the source, increasing educational level of low SES population and improving their access to healthcare services will help to improve the inequity of cognitive impairment.

Abstract Anti‐perovskites X3BA, as the electrically inverted derivatives of perovskites ABX3, have attracted tremendous attention for their good performances in multiple disciplines, especially in energy storage batteries. The Li/Na‐rich antiperovskite (LiRAP/NaRAP) solid‐state electrolytes (SSEs) typically show high ionic conductivities and high chemical/electrochemical stability toward the Li‐metal anode, illustrating their great potential for applications in the Li‐metal batteries (LMBs) using nonaqueous liquid electrolyte or all‐solid‐state electrolyte. The antiperovskites have been studied as artificial solid electrolyte interphase for Li‐metal anode protection, film SSEs for thin‐film batteries, and low melting temperature solid electrolyte enabling melt‐infiltration for the manufacture of all‐solid‐state lithium batteries. Transition metal‐doped LiRAPs as cathodes have demonstrated a high discharge specific capacity and good rate capability in the Li‐ion batteries (LIBs). Additionally, the underlying scientific principles in antiperovskites with flexible structural features have also been extensively studied. In this review, we comprehensively summarize the development, structural design, ionic conductivity and ion transportation mechanism, chemical/electrochemical stability, and applications of some antiperovskite materials in energy storage batteries. The perspective for enhancing the performance of the antiperovskites is also provided as a guide for future development and applications in energy storage.

Rural traditional Chinese medicine hospitals bear responsibilities of providing efficient medical services for rural residents. Efficiency assessments have previously been conducted in single province. This study aimed to investigate the technical efficiency of rural traditional Chinese medicine hospitals across China from 2013 to 2018, with the application of super slack-based measure data envelopment analysis. In total, 1219 hospitals covering 28 provinces were included as sample hospitals. Overall, hospitals performed technically less efficiently but presented with an increasing trend. Redundancy and insufficiency existed in health input and output variables, respectively. Notably, optimizing input variables was found to make more substantial improvement in hospital efficiency. Provincial and regional disparities were also observed in hospital efficiency. In conclusion, rural traditional Chinese medicine hospitals have experienced slight improvement in efficiency during the study period, however, their efficiency was still in a relatively low level with ample room for improvement. Meanwhile, regional coordinated development should also be noticed in this process.

Abstract Background The purpose of this study was to evaluate the coverage of HIV health education among rural residents in western China by ascertaining their awareness of HIV/AIDS and its transmission routes, and to investigate how these residents receive health information. Methods A survey was conducted through stratified clustered sampling at 99 county hospitals in 11 provinces in western China. Information was collected on awareness of HIV/AIDS and its transmission routes, as well as residents’ access to health knowledge. Chi-square analysis was used to analyse the differences in HIV/AIDS awareness (knowing of the existence of HIV/AIDS, hereinafter referred to as “HIV awareness rate”) between different subgroups categorized by demographic status, regional factors, and different methods of access to health knowledge. To further analyse the effects of access to health knowledge on HIV awareness, a logistic regression model was established. The relationship between access to health knowledge and transmission routes was also examined using chi-square analysis. Results The HIV awareness rate of the total 9274 participants was 80.9%. There were statistically significant differences between subgroups classified by age (χ 2 = 482.118, p

The wheat seedlings of 6 days old were daily subjected to ultraviolet irradiation (irradiating for 5, 10, 20, 40, and 60 min/day, respectively), Polyethylene glycol 6000 (5, 10, 15, 20, 25% in 1/2 Hoagland solution, respectively), and salinity solution (10, 25, 50, 100, 200 mM in 1/2 Hoagland solution, respectively), while the control group (CK) was supplied only with the Hoagland solution. The wheatgrass was harvested regularly seven times and the total soluble polysaccharides, ascorbic acid, chlorophyll, total polyphenol, total triterpene, total flavonoid, and proanthocyanins content were tested. The antioxidant capacity was evaluated through 2,2′-azino-bis (3-ethylbenzthia-zoline-6-sulfonic acid) (ABTS), 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging ability, and ferric ion reducing power. Technique for order preference by similarity to ideal solution (TOPSIS) mathematical model was adopted to comprehensively assess the functional phytochemicals of the different treatments. The results showed that the accumulation patterns of phytochemicals under abiotic stress were complex and not always upregulated or downregulated. The antioxidant activity and functional phytochemicals content of wheatgrass were significantly affected by both the stress treatments and seedling age, while the latter affected the chemicals more efficiently. The top five highest functional phytochemicals were observed in the 200 mM NaCl treated group on the 21st and 27th day, 25% PEG treated group on the 24th day, 200 mM NaCl treated group on the 24th day, and the group of 40 min/day ultraviolet exposure on 27th day.

Abstract Objective By analyzing the gap of hospitalization service among floating population covered by different medical insurance in Jiangsu Province, this paper aimed to understand the current situation of hospitalized health service utilization (HHSU) among floating population, and to provide policy suggestions for improving HHSU of floating population with different health insurance. Methods The data of this study were obtained from “the National Dynamic Monitoring Survey of Floating Population in 2014”. A total of 12,000 samples of floating population in Jiangsu Province were selected. 57.15% for men and 42.85% for women; 46.95% for those under 30 years old, 39.67% for 30 to 45 years old, 13.38% for over the age of forty-five. Using descriptive statistical analysis, chi-square test, exploratory factor analysis, logistic regression and stepwise multiple linear regression, the paper analyzed the difference of HHSU of floating population with different medical insurance in 2014. This study divided basic medical insurance into 3 categories: MIUE (Medical Insurance of Urban Employee), other medical insurances (including new rural cooperative medical system and the medical insurance for urban residents) and no medical insurance. Results The hospitalization rate of floating population with MIUE (89.95%) was higher than the rate of floating population with other medical insurances (74.76%) and the gap is 15.19%. It was also higher than the rate of floating population with no medical insurance (67.57%) and the gap is 22.38%. (chi-square = 24.958, p = 0.000). 15.34% of floating population with MIUE spent more than 1600 dollars during hospitalization. It was lower than floating population with other medical insurances (16.19%) and no medical insurance (21.62%). The gaps respectively were 0.85 and 6.28% (chi-square = 10.000, p = 0.040). There existed significant differences among hospitalization medical expenses that floating population with different basic medical insurances spent. (chi-square = 225.206, p = 0.000) The type of basic medical insurance had statistical significance on whether the patients were hospitalized (p = 0.003) and whether they were hospitalized (p = 0.014). Logistic regression analysis results showed that “Social structure” (Education, Hukou, Insurance status and Work status) were significantly associated with Should be hospitalized but not and “Education” were significantly associated with Inpatient facilities selection. The stepwise multiple linear regression results presented that “Demography” and “Floating area” influenced In-hospital medical cost and “Social structure” and “Gender” influenced Reimbursement of in-hospital medical cost. Conclusion Medical insurance type affects the hospitalization health service utilization of floating population, including Should be hospitalized but not and Reimbursement of in-hospital medical cost.

Abstract Background In recent decades, many workers from rural areas in China migrated to urban cities in search of a better livelihood. Due to the household registration policy and other financial barriers, more than 40 million of children were left behind in their rural home by their migrated parents in 2015. In this cross-sectional study, we aimed to investigate the influence of being left behind on these children’s physical and mental health. Methods A self-administered questionnaire was completed by participants about their demographic background and health status. Chi-square Test was conducted to investigate the influence. Results A total of 1662 participants responded and completed all the questions in the questionnaire. Significant differences existed between left-behind children group and non-left-behind children group on several health issues such as not going to school due to sickness (p = 0.080), completeness of the vaccination scheme (p = 0.036) and feeling of loneliness (p = 0.039). However, regarding symptoms like fever, cough or respiratory difficulties, diarrhea and twitch, as well as mental health problems like unhappiness and insomnia, no significant difference was found. Gender difference was also demonstrated showing that girls were more vulnerable than boys to certain symptoms and emotional problems. Conclusion This study indicated that both being left-behind and gender had an impact on the children’s health. It is necessary to further reform the household registration system to improve rights of equal access to employment, education and health resources for workers and their children from rural areas in China.

Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many controversies. This study aimed to investigate hemodynamic changes in symptomatic leukoaraiosis using transcranial Doppler ultrasonography and the breath-holding test in a Chinese Han population, from northern China. A total of 203 patients who were diagnosed with ischemic stroke or clinical chronic progressive ischemic symptoms were enrolled in this study, including 97 males and 106 females, with an age range of 43–93 years. The severity of leukoaraiosis was evaluated according to the Fazekas grading scale, and patients were divided into four groups accordingly. Grade 0 was no leukoaraiosis, and grades I, II, and III were mild, moderate, and severe leukoaraiosis, respectively, with 44, 79, 44, and 36 cases in each group. Transcranial Doppler ultrasonography and the breath-holding test were performed. The mean blood flow velocity of the bilateral middle cerebral artery was measured and the breath-holding index was calculated. The breath holding index was correlated with leukoaraiosis severity and cognitive impairment. Patients with a low breath holding index presented poor performance in the Montreal Cognitive Assessment (MoCA) and executive function tests. That is, the lower the breath holding index, the lower the scores for the MoCA and the higher for the trail-making test Parts A and B. These results indicate that the breath-holding index is a useful parameter for the evaluation of cerebrovascular reserve impairment in patients with leukoaraiosis. In addition, the breath-holding index can reflect cognitive dysfunction, providing a new insight into the pathophysiology of leukoaraiosis. This study was approved by the Ethics Committee of the Fifth People’s Hospital of Shenyang, China (approval No. 20160301) and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800014421).

Alveolar macrophage is the predominant cell type in the lung and is thought to be the major target for anti-inflammatory therapy in chronic obstructive pulmonary disease (COPD). Aromatherapy using natural essential oils with anti-inflammatory effects for inhalable administration is a potential complementary and alternative therapy for COPD treatment. The Gardenia jasminoides flower is famous for its fragrance in East Asia and is used for treating colds and lung problems in folk medicine. Therefore, in the present study, flower essential oils from two main medicinal gardenia varieties (G. jasminoides J. Ellis and G. jasminoides f. longicarpa Z.W. Xie & M. Okada) were extracted by hydro-distillation, and their chemical components were analyzed by GC-MS. The anti-inflammatory effects of the two essential oils and their main ingredients were further studied on lipopolysaccharide (LPS)-induced models in murine alveolar macrophages (MH-S). The results indicated that the chemical constituents of the two gardenia varieties were quite different. Alcohol accounted for 53.8% of the G. jasminoides essential oil, followed by terpenes (16.01%). Terpenes accounted for 34.32% of the G. jasminoides f. longicarpa essential oil, followed by alcohols (19.6%) and esters (13.85%). Both the two gardenia essential oils inhibited the LPS-induced nitric oxide (NO) release and reduced the production of tumor necrosis factor-α (TNF-α) and prostaglandin E2 (PGE2) in the MH-S cells. Linalool and α-farnesene dose-dependently reduced the NO release in the MH-S cells. Linalool and α-farnesene did not affect the PGE2 production but regulated the expression of TNF- α. In addition to linalool and α-farnesene, other components in the gardenia flower essential oils appeared to be able to act as anti-inflammatory agents and influence the PGE2 pathway.

Abstract Background Few studies about gender differences in job quality and job satisfaction among medical professionals have been carried out in China. So the objectives of this study were to examine whether and to what extent gender differences existed in job quality and job satisfaction of doctors in rural western China. Methods From 2009 to 2011, a total of 1472 doctors from 103 selected county-level health care facilities in rural western China were recruited into the study. Information about the doctors’ demographic characteristics, job quality, and job satisfaction was collected through a designed questionnaire. Besides examining gender differences in single dimensions of job quality and job satisfaction, principal component analysis was used to construct a composite job quality index to measure the differences in the comprehensive job quality, and exploratory factor analysis was applied to evaluate the differences in the overall job satisfaction. Chi-square test was used to calculate differences between proportions, and t-test was used to compare differences between means. Results Among the doctors, there were 705 males and 767 females (ratio 1:1.09). Male doctors had significantly higher monthly salaries, longer working hours, more times of night shifts per month, longer continuous working hours, and longer years of service at current facilities, and marginally significantly higher hourly wage and longer years of service in current professions. However, female doctors showed greater overall job qualities. Significant and marginally significant gender differences were only found in satisfaction with remuneration compared to workload, the chance of promotion and working environment. But female showed greater satisfaction in the overall job satisfaction and the factor including sub-aspects of working environment, remuneration compared to workload, the chance of promotion, utilization of subjective initiative, and sense of achievement. Conclusions Gender differences in job quality and job satisfaction did exist among doctors in rural western China. The participating female doctors were shown to have better job quality and greater job satisfaction.

Patients with walled-off necrosis (WON) are still challenging to treat safely and effectively. Recently, double-pigtail plastic stents (DPS), bi-flanged metallic stents (BFMS), and lumen-apposing metal stents (LAMS) have been employed with endoscopic ultrasound-guided (EUS-guided) drainage. However, there is little solid evidence to support the effectiveness and safety of using stents. This study aims to compare the outcomes of the LAMS and the PS. Till July 2022, a thorough database search was done, and studies that met the criteria were chosen. By using the RevMan software, the technical and clinical success and other secondary outcomes were calculated. Subgroup analysis was performed between the LAMS and the BFMS. Fifteen studies (two randomized controlled trials and thirteen observational) with 687 patients receiving metal stents and 771 patients receiving plastic stents were selected for final analysis. There was no significant risk of bias or publication bias. The odds ratios (OR) for technical and clinical success were 0.36 (95% confidence interval (95% CI) 0.08, 1.52) and 2.26 (95%CI 1.62, 3.15), respectively. The OR for overall adverse events was 0.74 (95% CI 0.41, 1.34). In subgroup analysis, the LAMS and the BFMS showed the same outcomes. Compared to DPS, LAMS had better clinical outcomes and fewer side effects when treating patients with WON. What is the best endoscopic treatment option for the walled-off necrosis (WON)? A brief comparison of lumen-apposing metal stents (LAMS), bi-flanged metallic stents (BFMS) and double-pigtail plastic stents (DPS) for the treatment of WON patients. How can we limit the adverse events and provide better treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVE:To assess changes in medicine availability and prices as well as subsequent affordability during the early years of the National Essential Medicine System (NEMS) reform in China. METHODS:Data were obtained from four provinces through a field survey conducted in 2010-2011. Outcome measures were percentage availability, delivery efficiency, ratios of local prices to international reference prices (MPRs), and number of days' household income needed to purchase medicines. Prices were adjusted for inflation/deflation and purchasing power parity. RESULTS:Under NEMS, the median MPR for essential medicines decreased from 3.27 times to 1.59 times from 2009 to 2010. The median medicine expenditure under standard treatments in 2010 equaled 1.06 days household income at a low-income level and 0.25 days household income at a middle-income level. A 25.67% reduction was observed in the average number of medicines stocked by primary healthcare facilities in 2011 compared with 2009 and the availability of essential medicines was 66.83%. During 2009-2011, suppliers could respond to 98.24% of the purchasing orders raised by primary healthcare facilities, and 89.32% of the order amounts could be delivered. CONCLUSIONS:The market prices of essential medicines greatly decreased in China after the establishment of NEMS and showed improved affordability in the short term. However, current medicine prices remain high compared to international reference prices. Medicines were often unaffordable for economically backward residents. Future policies still need to target medicine availability as well as affordability.