Investment Case for a Comprehensive Package of Interventions Against Hepatitis B in China: Applied Modeling to Help National Strategy Planning.

BACKGROUND: In 2016, the first global viral hepatitis elimination targets were endorsed. An estimated one-third of the world's population of individuals with chronic hepatitis B virus (HBV) infection live in China and liver cancer is the sixth leading cause of mortality, but coverage of first-line antiviral treatment was low. In 2015, China was one of the first countries to initiate a consultative process for a renewed approach to viral hepatitis. We present the investment case for the scale-up of a comprehensive package of HBV interventions. METHODS: A dynamic simulation model of HBV was developed and used to simulate the Chinese HBV epidemic. We evaluated the impact, costs, and return on investment of a comprehensive package of prevention and treatment interventions from a societal perspective, incorporating costs of management of end-stage liver disease and lost productivity costs. RESULTS: Despite the successes of historical vaccination scale-up since 1992, there will be a projected 60 million people still living with HBV in 2030 and 10 million HBV-related deaths, including 5.7 million HBV-related cancer deaths between 2015 and 2030. This could be reduced by 2.1 million by highly active case-finding and optimal antiviral treatment regimens. The package of interventions is likely to have a positive return on investment to society of US$1.57 per US dollar invested. CONCLUSIONS: Increases in HBV-related deaths for the next few decades pose a major public health threat in China. Active case-finding and access to optimal antiviral treatment are required to mitigate this risk. This investment case approach provides a real-world example of how applied modeling can support national dialog and inform policy planning.

[Clinical symptoms effect of Tripterygium Glycosides Tablets alone or combined with methotrexate in treatment of rheumatoid arthritis: a Meta-analysis].

To systematically review the improvement effects of Tripterygium Glycosides Tables( TGT) alone or in combination with methotrexate( MTX) on the clinical signs and symptoms of rheumatoid arthritis( RA),and provide a basis for the rational use of TGT in clinic,in the current study,six literature databases including CNKI,Wan Fang,VIP,PubMed,EMbase,and Cochrane Library,were systematically searched,according to the inclusion and exclusion criteria. Review Manager 5.3 software was used to input the literatures,and we assessed the risk bias on the level of outcome indicators for each included literature. A total of 18 literatures were included,and the classification results showed that: compared with MTX,TGT alone can reduce the number of joint swelling( MD =0. 18,95%CI[-1.06,1.42],P = 0.78) and joint tenderness( MD =-0.06,95% CI[-1.69,1.56],P = 0.94) in RA patients with the same effect as MTX. In terms of drug combination,TGT combined with MTX had an advantage over MTX alone in lessening the morning stiffness time( MD = 18. 24,95% CI[12. 64,23. 84],P < 0. 000 01) of RA,joint tenderness( MD = 2. 65,95% CI[1. 85,3. 44],P<0.000 01) and joint swelling( MD = 3.01,95% CI[2.09,3.39],P< 0.000 01). In conclusion,this Meta-analysis suggest that TGT alone was superior to MTX in improving joint swelling and tenderness in RA patients,TGT combined with MTX may improve the clinical manifestation of RA patients better than MTX alone.

USP22 suppresses the NLRP3 inflammasome by degrading NLRP3 via ATG5-dependent autophagy.

The NLRP3 inflammasome is involved in a diverse range of inflammatory diseases. The activation of inflammasomes must be tightly regulated to prevent excessive inflammation, and the protein ubiquitination system is reported to be one of the ways in which inflammasome activation is regulated. However, the deubiquitination regulatory mechanisms of inflammasome activation remain elusive. Here, we demonstrated that USP22 (ubiquitin specific peptidase 22) promotes NLRP3 degradation and inhibits NLRP3 inflammasome activation. USP22 deficiency or in vivo silencing significantly increases alum-induced peritonitis and lipopolysaccharide-induced systemic inflammation. Mechanistically, USP22 inhibits NLRP3 inflammasome activation via the promotion of ATG5-mediated macroautophagy/autophagy. USP22 stabilizes ATG5 via decreasing K27- and K48-linked ubiquitination of ATG5 at the Lys118 site. Taken together, these findings reveal the role USP22 plays in the regulation of NLRP3 inflammasome activation and suggest a potential therapeutic target to treat NLRP3 inflammasome-related diseases.Abbreviations: ATG5: autophagy related 5; ATP: adenosine triphosphate; CASP1: caspase 1; IL18: interleukin 18; IL1B/IL-1ß: interleukin 1 beta; LPS: lipopolysaccharide; NLRC4: NLR family, CARD domain containing 4; NLRP3: NLR family, pyrin domain containing 3; PYCARD/ASC: PYD and CARD domain containing; TNF/TNF-α: tumor necrosis factor; USP22: ubiquitin specific peptidase 22.

Congenital Diaphragmatic Hernia: Considerations for the Adult General Surgeon.

The contemporary pillars of congenital diaphragmatic hernia (CDH) management include prenatal diagnosis for multidisciplinary care coordination and counseling, medical optimization after birth, and elective (not emergent) operative repair after stabilization, allowing for improvement in pulmonary hypertension and maturation of lungs. Lung hypoplasia and pulmonary hypertension in infants with CDH represent a medical emergency, not one that necessitates immediate surgery. Many infants surviving CDH repair have significant morbidities that may persist into adulthood. Rare cases of previously occult CDH may present acutely in the older child or adult with nonspecific gastrointestinal or pulmonary symptoms.

Effective mitigation strategy in early stage of COVID-19 pandemic in China.

In the past five months, success in control the national epidemic of coronavirus disease 2019 (COVID-19) has been witnessed in China. The implementation of public health measures accounts for the success which include different interventions in the early or later stages of the outbreak. It is clear that although not all measures were universally effective worldwide, their achievements have been significant. More solidarity is needed to deal with this global pandemic with more learning and understanding. Understanding which of the public health interventions implemented in China were effective may provide ideas for international epidemic control.

[Clinical observation of acupuncture combined with sertraline hydrochloride tablets on tumor-related depression].

OBJECTIVE: To compare the clinical effects of acupuncture combined with sertraline hydrochloride and simple sertraline hydrochloride on tumor-related depression. METHODS: Sixty patients with tumor-related depression who met the inclusion criteria were randomly assigned to an observation group and a control group, 30 patients in each group. The routine treatment in department of oncology were given in both groups, oral sertraline hydrochloride (25 mg daily for the first 5 days, then 50 mg daily) was given in the control group; on the basis of the treatment in the control group, and acupuncture was applied at Hegu (LI 4), Neiguan (PC 6), Taichong (LR 3), Shenmen (HT 7)，etc. in the observation group，twice a week .The two groups were treated continuously for 4 weeks. The Hamilton depression scale (HAMD) score and the quality of life score (QLQ-C30 questionnaire) were compared between the two groups before and after treatment. RESULTS: After treatment, the HAMD scores in the two groups were significantly lower than those before treatment (both P<0.05), and the HAMD scores in the observation group were lower than those in the control group (P<0.05). In the observation group, the symptom scores of fatigue, pain, nausea and vomiting, dyspnea, insomnia, loss of appetite, constipation, and diarrhea were significantly lower than those before treatment (all P<0.05), and the physical, cognitive, emotional function, and the overall quality of life score were significantly higher than those before treatment (all P<0.05); in the control group, the symptom scores of insomnia decreased compared with that before treatment (P<0.05), and the emotional function and overall quality of life score were higher than those before treatment (both P<0.05); in addition to economic difficulties, roles and social functions, the other scores after treatment in the observation group were significantly improved than those in the control group (all P<0.05). CONCLUSION: The combination of acupuncture and sertraline hydrochloride tablets is better than simple sertraline hydrochloride in the treatment of tumor-related depression, and it can improve the accompanying symptoms and improve quality of life.

[Analysis of high-dose dexamethasone in different cycles on efficacy and safety of newly diagnosed ITP].

OBJECTIVE: To compare the efficacy and safety of high-dose dexamethasone in treating new-diagnosed primary immune thrombocytopenia (ITP) in monocycle, di-cycle, tri-cycle. METHODS: Divided by the ratio of 1:1:1, 93 newly diagnosed patients were randomly accepted monocycle (Group A:dexamethasone 40 mg once a day, from day1 to day4), dicycle (Group B:dexamethasone 40 mg once a day, from day 1 to day 4, day 15 to day 18), tri-cycle (Group C:dexamethasone 40 mg once a day, from day 1 to day 4, day 15 to day 18, day 29 to day 32) of high-dose dexamethasone treatment. Its efficacy and safety on the patients in three groups were compared. RESULTS: Ninety-three newly patients with new-diagnosed ITP were divided into Group A, B, and C, 31 patients in each group. In terms of short-term benefits, there was no statistically significant difference among the 7th and 14th day complete response rate after end of treatment. However, there was statistically significant difference after the end of treatment on the 7th day response rate (41.9% vs 70.0% vs 90.0%, P<0.01) and the 14th day response rate (16.1% vs 36.70% vs 63.3%, P< 0.01); in terms of long-term benefits, there was no statistically significant difference among the 120-day response rate, the complete response rate within the treatment on the 60th, 90th and 120th day and the relapse rate at 90th and 120th day; however, there was statistically significant difference among the 60- day response rate (10.0% vs 26.6% vs 53.3%, P<0.01), 90-day(0.0% vs 13.3% vs 30.0%, P<0.01) and 60-day relapse rate(88.9% vs 73.3% vs 46.7%, P<0.01). Mostly of the treatment-related adverse reactions in the three groups were mild, and most patients are tolerable. CONCLUSIONS: Although the complete response rate of ITP patients did not improved by increasing the cycle of high-dose dexamethasone, but improved response rate in three months, and adverse reactions were tolerable, which could be used as a reference for clinical use.

Moving towards a better path? A mixed-method examination of China's reforms to remedy medical corruption from pharmaceutical firms.

OBJECTIVES: Few studies have systematically examined the effects of the existing regulations for alleviating corruption in China. This study assesses the effectiveness of China's reforms to curb medical corruption. METHODS: We used mixed methods for the evaluation of existing countermeasures. First, qualitative informant interviews based on the Donabedian model were conducted to obtain experts' evaluation of various kinds of countermeasures. Second, using data from 'China Judgements Online', we analysed the trend of occurrence and the characteristics of the medical corruption cases in recent years to reflect the overall effects of these countermeasures in China. RESULTS: Since 1990s, China has implemented three main categories of countermeasures to oppose medical corruption: fines and criminal penalties, health policy regulations, and reporting scheme policy. Information from the interviews showed that first the level of fines and criminal penalties for medical corruption behaviours may not be sufficient. Second, health policy regulations are also insufficient. Although the National Reimbursement Drug List and Essential Drug List were implemented, they were incomplete and created additional opportunities for corruption. Moreover, the new programme that centralised the purchase of pharmaceuticals found that most purchasing committees were not independent, and the selection criteria for bidding lacked scientific evidence. Third, the reporting scheme for commercial bribery records by the health bureau was executed poorly. In addition, quantitative online data showed no obvious decrease of institutional medical corruption in recent years, and most criminals have been committing crimes for a long time before getting detected, which further demonstrated the low effectiveness of the above countermeasures. CONCLUSIONS: Although existing countermeasures have exerted certain effects according to Chinese experts, more rigorous legislation and well-functioning administrative mechanisms are needed. Fundamentally, financial incentives for hospitals/physicians and the health insurance system should be improved.

Community-based integration of management of non-communicable diseases in China.

Non-communicable diseases (NCDs) are a leading cause of deaths and of disease burden in China. This paper analyzes the rationale and implications of a community-based approach to a better coordinated NCDs care and management system in China. As argued by the author, the buildup of an integrated NCDs care delivery system is feasible now and large health expenditures will be saved if more stable outpatients with NCDs could be shifted to community health facilities to receive their medications. However, the key issues remain in building a general practitioner led (GP-led) primary care delivery system in China. Some prominent issues include the shortage of quality generalists, lack of proper incentives and management mechanisms, and the absence of patients and provider, and restrictive arrangements in basic health insurance policies. Even with these hard-to-solve issues, some recent reform initiatives for integrated NCDs care delivery in some localities have demonstrated originality and creativeness in developing better coordination between primary and secondary NCDs care. However, without large-scale public sector reform, innate issues with human resource development, income distribution and financing of public healthcare providers cannot be solved. It may take a long time to see deep integration of primary and secondary NCDs care in China.

Colorectal Cancer Mortality Characteristics and Predictions in China, 1991-2011.

BACKGROUND: To identify the epidemiological characteristics of colorectal cancer mortality in China during the period of 1991-2011, and forecast the future five-year trend. MATERIALS AND METHODS: Mortality data for colorectal cancer in China from 1991 to 2011 was used to describe epidemiological characteristics in terms of age group, gender, and rural/urban residence. Trend surface analysis was performed to analyze the geographical distribution of colorectal cancer. Four models including curve estimation, time series modeling, gray modeling and joinpoint regression were applied to forecast the trends for the future five years. RESULTS: Since 1991 the colorectal cancer mortality rate increased yearly, and our results showed that the trend would continue to increase in the ensuing 5 years. The mortality rate in males was higher than that of females and the rate in urban areas was higher than in rural areas. The mortality rate was relatively low for individuals less than 60 years of age, but increased dramatically afterwards. People living in the northeastern China provinces or in eastern China had a higher mortality rate for colorectal cancer than those living in middle or western China provinces. CONCLUSIONS: The steadily increasing mortality of colorectal cancer in China will become a substantial public health burden in the foreseeable future. For this increasing trend to be controlled, further efforts should concentrate on educating the general public to increase prevention and early detection by screening. More effective prevention and management strategies are needed in higher mortality areas (Eastern parts of China) and high-risk populations (60+ years old).

[Effect of shallow needling combined with acupoint application on the acute stage of peripheral facial paralysis].

OBJECTIVE: To search for an effective therapy for the acute stage of peripheral facial paralysis. METHODS: One hundred and twenty cases of facial paralysis patients were randomly divided into an observation group and a control group, 60 cases in each group. Both groups were treated with routine medication, and the observation group was treated with shallow needling combined with acupoint application using self-made "acupoint application formula for facial paralysis" on the basis of the routine medication. The acupoints of Yifeng (TE 17), Wangu (GB 12), Dicang (ST 4), Jiache (ST 6), Yangbai (GB 14), Taiyang (EX-HN 5), Qianzheng (EX-HN 17), Cuanzhu (BL 2) in affected side and Hegu (LI 4) in healthy side were selected as main acupoints for shallow needling, and Qianzheng (EX-HN 17), Dicang (ST 4), Yangbai (GB 14) and Wangu (GB 12), or Jiache (ST 6), Taiyang (EX-HN 5), Quanliao (SI 18) and Yifeng (TE 17) were selected for acupoint application. The cure rate and the course of cured patients in both groups were compared. RESULTS: The cure rate of 88.3% (53/60) in observation group was superior to that of 66.7% (40/60) in control group (P < 0.01). The course of cured patients in observation group was obviously shorter than that of control group (P < 0.01). CONCLUSION: On the basis of routine medication, shallow needling combined with acupoint application can improve the therapeutic effect and shorten the course for acute stage of peripheral facial paralysis.