Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis.

OBJECTIVE: This study aimed to identify the most useful ultrasound (US) features associated with definite neonatal necrotizing enterocolitis (NEC) and their prognostic values, particularly the calculated markers combined with important features. METHODS: A total of 213 suspected NEC cases were collected from the neonatal department of our hospital from January 2015 to August 2017. Each infant received both X-ray and US examinations. RESULTS: No differences were found in sex composition and delivery modes between groups. NEC-positive neonates had poorer prognosis compared to negative ones. The NEC group showed a higher frequency of abnormal signals. US showed higher NEC-related frequencies in different parameters. A variable (named predictor in US [PUS]) with five features was constructed. For NEC diagnosis, this variable provided a much higher area under the curve Q2 (AUC) (0.965) than other parameters. In this model, PUS had a cutoff value of 0.376 with a 0.900 sensitivity and 0.922 specificity. In prognosis, the closest factors were selected to draw a receiver operating characteristic curve, as well as a novel calculated variable US prognostic (USPro) marker. USPro had a much higher AUC (0.86) than other single features and showed a cutoff value of 0.18145, with 0.75 sensitivity and 0.84 specificity. This variable had a weaker power in prognosis when compared with PUS in diagnosis. CONCLUSIONS: The application of abdominal color Doppler US can provide high accuracy and sensitivity in NEC diagnosis and also contribute to its prognosis, without induction of radiation. Suspected neonates should be examined using this technique as early as possible.

Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis

OBJECTIVE: This study aimed to identify the most useful ultrasound (US) features associated with definite neonatal necrotizing enterocolitis (NEC) and their prognostic values, particularly the calculated markers combined with important features. METHODS: A total of 213 suspected NEC cases were collected from the neonatal department of our hospital from January 2015 to August 2017. Each infant received both X-ray and US examinations. RESULTS: No differences were found in sex composition and delivery modes between groups. NEC-positive neonates had poorer prognosis compared to negative ones. The NEC group showed a higher frequency of abnormal signals. US showed higher NEC-related frequencies in different parameters. A variable (named predictor in US [PUS]) with five features was constructed. For NEC diagnosis, this variable provided a much higher area under the curve Q2 (AUC) (0.965) than other parameters. In this model, PUS had a cutoff value of 0.376 with a 0.900 sensitivity and 0.922 specificity. In prognosis, the closest factors were selected to draw a receiver operating characteristic curve, as well as a novel calculated variable US prognostic (USPro) marker. USPro had a much higher AUC (0.86) than other single features and showed a cutoff value of 0.18145, with 0.75 sensitivity and 0.84 specificity. This variable had a weaker power in prognosis when compared with PUS in diagnosis. CONCLUSIONS: The application of abdominal color Doppler US can provide high accuracy and sensitivity in NEC diagnosis and also contribute to its prognosis, without induction of radiation. Suspected neonates should be examined using this technique as early as possible.

Distribution of the Indicator of the Appropriate Admission of Patients with Circulatory System Diseases to County Hospitals in Rural China: A Cross-Sectional Study.

Background: The inappropriate admission of patients with circulatory system diseases (CSDs) have contributed to the rapid increase in hospitalisation rates in China. The purpose of this study is to identify the key indicators of appropriate admission and their distribution by analysing CSD cases. Methods: A total of 794 records of inpatient CSD cases were collected from county hospitals in five counties in midwestern rural China through stratified random sampling and evaluated by using the Rural Appropriateness Evaluation Protocol (RAEP). RAEP has two parts: Indicator A, which represents requirement for services, and Indicator B, which represents diseases severity. Indicator distribution was analysed through frequency analysis. A three-level logistic regression model was used to examine the sociodemographic determinants of the positive indicators of appropriate CDSs admissions. Result: The inappropriate admission rate of CSDs was 33.4% and varied between counties. A2 (Varying dosage/drug under supervision, 58.22%), A8 (Stopping/continuing oxygen inhalation, 38.19%), A7 (Electrocardiogram per 2 hours, 34.22%), A3 (Calculation of intake and output volume, 31.19%) and B14 (Abnormal blood condition, 27.98%) were the top five positive indicators of CSDs. Indicator A (requirements for services) was more active than Indicator B (disease severity). The limitation of the role of Indicator B over time may be attributed to the different policies and environments of rural China and stimulated the increase in inappropriate admission rates. The results of three-level logistic regression suggested that the influence of gender, year, region and disease type on positive indicators should receive increased attention in the evaluation of CSDs admissions. Conclusion: This study found that A2, A8, A7, A3 and B14 were the key indicators and were helpful to determine the appropriate admission of CSDs in rural China. Managers may focus on these indicators, particularly the use of indicator A.

Effect of inappropriate admissions on hospitalization performance in county hospitals: a cross-sectional study in rural China.

BACKGROUND: Inappropriate admissions cause excessive utilization of health services compared with outpatient services. However, it is still unclear whether inappropriate admissions cause excessive use of health services compared with appropriate admissions. This study aims to clarify the differences in the hospitalization performances between appropriately admitted inpatients and inappropriately admitted inpatients. METHODS: A total of 2575 medical records were obtained after cluster sampling in three counties. Admission appropriateness was assessed by appropriateness evaluation protocol (AEP). The propensity score matching (PSM) was computed to match patients in treatment and control group with similar characteristics, and to examine the differences in the utilization of hospitalization services between the two groups. The samples were matched in two major steps in this study. In the first step, total samples were matched to examine the differences in the utilization of hospital services between the two groups using 15 individual covariates. In the second step, PSM was computed to analyze the differences between the two groups in different disease systems using 14 individual covariates. RESULTS: For the whole sample, the inappropriate group has lower expenditure of hospitalization (EOH) (difference = - 0.12, p = 0.003) and shorter length of stay (LOS) (difference = - 0.73, p = 0.016) than the appropriate group. For number of clinical inspection (NCI), it has no statistically significant difference (difference = - 0.39, p = 0.082) between the two groups. Among different disease systems, no significant differences were observed between the two groups among EOH, LOS and NCI, except that the EOH was lower in the inappropriate group than that in the appropriate group for surgical disease (difference = - 0.169, p = 0.043). CONCLUSION: Inappropriate admissions have generated excessive health service utilization compared with appropriate admissions, especially for internal diseases. The departments in charge of medical services and hospital managers should pay high attention to the health service utilization of the inappropriately admitted inpatients. Relevant medical policies should be designed or optimized to increase the appropriateness in health care service delivery and precision in clinical pathway management.

Resveratrol alleviate the injury of mice liver induced by cadmium sulfide nanoparticles.

Cadmium sulfide nanoparticle (Nano-CdS) is a kind of important semiconductor material with special photochemistry property. With the Nano-CdS being widely used, the security problems it caused have been catching more and more attention. This study aims to explore the possible mechanism of liver injury induced by Nano-CdS and whether resveratrol can reduce the damage. In this study, male BALB/C mice were treated with Nano-CdS with a diameter of 20 to 30 nm and a length of 80 to 100 nm. It turned out that the mice liver inflammatory cells infiltrated, the liver tissue and the ultrastructure changed; The activities of T-AOC and GSH were suppressed (n = 6, P < 0.05) and the content of lipid peroxide (MDA) increased (n = 6, P < 0.05). Besides, Nano-CdS decreased the mRNA expression level of Sirt1 and FoxO1 genes in liver tissue (n = 3, P < 0.05). All the changes in the index were reversed by resveratrol. The mRNA expression level of FoxO3a showed no significant difference between the control group and the Nano-CdS group. But under the protection of resveratrol, the mRNA expression level of FoxO3a was higher than that in the control and Nano-CdS groups (n = 3, P < 0.05). Results suggest that Nano-CdS can cause oxidative damages to liver tissues in mice, in which process that the Sirt1 and FoxO1 genes may participate, and the damage can be reversed by resveratrol which may be a potential cure for oxidative damage to nanomaterials.

Effect of integrated urban and rural residents medical insurance on the utilisation of medical services by residents in China: a propensity score matching with difference-in-differences regression approach.

OBJECTIVES: In this study, we aim to evaluate the effect of urban and rural resident medical insurance scheme (URRMI) on the utilisation of medical services by urban and rural residents in the four pilot provinces. SETTING AND PARTICIPANTS: The sample used in this study is 13 305 individuals, including 2620 in the treatment group and 10 685 in the control group, from the 2011 and 2015 surveys of China Health and Retirement Longitudinal Study. OUTCOME MEASURES: Propensity score matching and difference-in-differences regression approach (PSM-DID) is used in the study. First, we match the baseline data by using kernel matching. Then, the average treatment effect of the four outcome variables are analysed by using the DID model. Finally, the robustness of the PSM-DID estimation is tested by simple model and radius matching. RESULTS: Kernel matching have improved the overall balance after matching. The URRMI policy has significantly reduced the need-but-not outpatient care and significantly increased outpatient care cost and inpatient care cost for rural residents, with DID value of -0.271, 0.090 and 0.256, respectively. After robustness test, the DID competing results of four outcome variables are consistent. CONCLUSIONS: URRMI has a limited effect on the utilisation of medical and health services by all residents, but the effect on rural residents is obvious. The government should establish a unified or income-matching payment standard to prevent, control the use of medical insurance funds and increase its efforts to implement URRMI integration in more regions to improve overall fundraising levels.

Changes in inpatients' distribution and benefits under institution level-based quota payment for specific diseases in rural China: An interrupted time-series analysis.

The distribution of patients is increasingly disordered in China, which leads to the waste of medical resources, increase in inpatients' economic burden, and decrease in benefits from health insurance. Institution level-based quota payment for specific diseases represents a typical payment-system reform mode in rural China that rationalizes the distribution of rural inpatients. The aim of this study is to evaluate the effectiveness of this mode by estimating rural inpatients' distribution among hospitals at different levels, per capita cost of hospitalization, and actual compensation ratio and then to provide suggestions to advance this mode. Interrupted time-series analysis was applied to evaluate the effect of the reform mode in the study, and Weiyuan County, Gansu Province, was selected as our sample. Institution level-based quota payment for specific diseases in Weiyuan County has rationalized the distribution of rural inpatients and improved their benefit levels. Further research should be conducted to evaluate the appropriateness of medical services, the health outcomes of rural inpatients, and the sustainability and replicability of the policy.

Effectiveness evaluation of quota payment for specific diseases under global budget: a typical provider payment system reform in rural China.

BACKGROUND: Quota payment for specific diseases under global budget is one of the most typical modes of provider payment system reform in rural China. This study aimed to assess this reform mode from aspects of the total fee, structure of the fee and enrollees' benefits. METHODS: A total of 127,491 inpatient records from 2014 to 2016 were extracted from the New Rural Cooperative Medical Scheme (NRCMS) database in Weiyuan County, Gansu Province. Total fee, actual compensation ratio, out-of-pocket ratio, constituent ratio of the treatment fee, constituent ratio of the inspection and laboratory fee, and length of stay were selected as dependent variables. Both generalized additive models (GAMs) and multiple linear regression models were used to measure the change in dependent variables along with year. RESULTS: Prior to the adjustment of the compensation type, out-of-pocket ratio and length of stay decreased, while total fee, actual compensation ratio, constituent ratio of the treatment fee, and constituent ratio of the inspection and laboratory fee increased. After the compensation type was adjusted, the mean of the total fee increased rapidly in 2015 and remained stable in 2016. The mean length of stay increased in 2015 but decreased in 2016. A comparison of inpatients suffering from diseases covered by quota payments and those suffering from general diseases revealed that total fee, out-of-pocket ratio, and length of stay decreased and actual compensation ratio increased for the former, whereas the opposite was true for the latter. Constituent ratio of the treatment fee and constituent ratio of the inspection and laboratory fee increased for both samples, except for the constituent ratio of the inspection and laboratory fee of quota payment diseases in 2016, which did not change. CONCLUSIONS: Quota payment for specific diseases under global budget had obviously positive effects on cost control in Weiyuan, Gansu. Considering the limited coverage of quota payment for diseases, the long-term effect of this reform mode and its replicability awaits further evaluation.

[Early selection of drought-resistant superior families of Reaumuria soongorica based on the analysis of osmoregulation substances and chlorophyll].

By using 77 families of 3 year-old Reaumuria soongorica seedlings that grew well without injection of any pests and diseases as experimental material, the contents of soluble protein (SP), soluble sugar (SS), proline (Pro) and chlorophyll (Chl) were measured, and their drought resistance was evaluated with principal component analysis and subordinate function method. The results showed that there were great differences in leaf osmolytes and chlorophyll among the 77 families. The soluble protein content varied from 2.14 to 8.60 mg · g⁻¹ FM, the soluble sugar content was from 6.82 to 21.86 mg · g⁻¹ FM, the proline content was from 118.73 to 1494.30 µg · g⁻¹ FM, the chlorophyll a content was from 321.88 to 897.37 µg · g⁻¹ FM, the chlorophyll b content was from 53.65 to 249.04 µg · g⁻¹ FM, chlorophyll (a+b) was from 387.39 to 1146.40 µg · g⁻¹ FM, and the chlorophyll a/b was from 3.46 to 6.42. All drought-resistant indices had significant difference among R. soongorica families, among which the proline content varied most, followed by the soluble sugar content. Evaluated by using the synthesized multi-index, it was found that 12 families showed good drought resistance, with Zhazigou 1-2 and Zhazigou 1-1 performing the best.

[Investigation of intestinal nematode infections in Hongze County, Jiangsu Province].

OBJECTIVE: To understand the situation of intestinal nematode infections and assess the preventive effects, so as to provide the evidence for formulating the further measures of prevention. METHODS: Five villages from 5 townships of different geographical locations were selected and 500 residents of each village were surveyed. The eggs of intestinal nematodes were detected by the Kato-Katz technique, and 50 students and 50 residents per village were investigated by questionnaires about health education. RESULTS: Among 3 011 people detected, 17 persons were infected with intestinal nematodes and the total infection rate was 0.56%. The rates of Ascaris lumbricoides, hookworm, Trichuris trichiura, Enterobius vermicularis, and Trichostrongylus were 0.10%, 0.33%, 0.03%, 0.03% and 0.07%, respectively. The awareness rate of health knowledge was 97.80% and the formation rate of health behavior was 97.00%. CONCLUSION: The infection rates of intestinal nematodes, the awareness rate of health knowledge and the formation rate of health behavior in the population of Hongze County have achieved the criteria of effective control of intestinal parasitic diseases.

[Analysis of malaria situation and discussion of control strategies in Huai'an City, 2014].

OBJECTIVE: To understand the malaria epidemic situation in Huai'an City in 2014, so as to provide the evidence for formulating and adjusting effective strategies and measures to eliminate malaria. METHODS: The reported malaria cases from the Internet Reporting System and the epidemiological data of malaria of Huai'an City in 2014 were collected and analyzed statistically. RESULTS: A total of 56 malaria cases were reported in Huai'an City in 2014 with the incidence of 0.12/10,000, and 43.59% of increasing rate compared with the previous year (39 cases). All these cases were imported from African countries. There were 50 cases of falciparum malaria, 4 cases of ovale malaria, 1 case of quartan malaria and 1 case of mixed infections. All the patients were male and aged 24-59 years. Totally 96.43% of the patients (54 cases) were peasants and 69.64% of them (39 cases) only received junior high school education. The malaria cases were mainly distributed in Huai'an District (32 cases), Xuyi County (8 cases) and Huaiyin District (6 cases), totally accounting for 82.14%. There was no significant seasonal variation in the reporting time of the cases. The median time from onset to seeing a doctor was 2 days and the median time from seeing a doctor to being diagnosed was 1 day. Totally 16.67% of the patients (8 cases) were misdiagnosed when they first visited a doctor. All the patients were laboratory confirmed and all of them received the standard treatment after diagnosis. CONCLUSIONS: There have been no local malaria cases reported from Huai'an City in the last three years. However, the situation of imported malaria is more serious and the species of infected Plasmodium are more diverse. Therefore, to accomplish the aim of malaria elimination in the whole city, it is necessary to further strengthen the multi-sectoral cooperation, health education, malaria screening and professional training to control the imported malaria.

In vitro study of Nucleostemin gene as a potential therapeutic target for human lung carcinoma.

OBJECTIVE: Nucleostemin (NS) is a GTP-conjugated protein located in the nucleoli of stem cells and some cancer cells, and maintains cell self-renewal. We aimed to evaluate NS as a potential target for lung carcinoma gene therapy by investigating NS gene expression and its effect on A549 cell proliferation. METHODS: NS mRNA and protein expression in A549, HepG2, SMMC-7721, HeLa, and U251 cells was analyzed by RT-PCR and western blotting following transfection of NS siRNAs and negative control siRNA (NC). The effect on cell proliferation was also analyzed by MTT assays. RESULTS: NS mRNA and protein were both expressed in A549 cells and four other tumor cell lines; the relative expression levels were similar in all five cell lines. The three pairs of NS siRNA, either transfected alone or cotransfected into A549 cells, could effectively inhibit the expression of NS mRNA and protein. Moreover, the interference ratio showed an obvious concentration-dependent relationship. NS siRNA treatment resulted in significant inhibition of A549 cell proliferation by 35.7%. CONCLUSION: NS gene was not only highly expressed but also played an important role in A549 cell proliferation. Thus, targeting of NS may be a promising novel strategy for the treatment of lung carcinoma.

Effects of repeated exposure to decabrominated diphenyl ether (BDE-209) on mice nervous system and its self repair.

Decabrominated diphenyl ether (BDE-209) is widely used as brominated flame retardants (BFRs). In order to investigate its direct neurotoxic effects on mice and its self repair, mice were repeatedly exposured to BDE-209. Different concentrations of BDE-209 (0, 0.1, 40, 80 and 160mg/kgbw/d) were administered daily to CD-1 Swiss mice by gavage for 15, 30 and 60 days. Body and brain weights were recorded after the exposure. And the self repair was studied. Levels of acetylcholinesterase (TchE), superoxide dismutase (SOD) and malonic dialdehyde (MDA) in brain were analyzed. Experimental results suggested that the nervous system was permanently damaged by BDE-209 through the cholinergic system enzyme.

[Preparation and drug release property of paclitaxel nanoparticles].

OBJECTIVE: To prepare paclitaxel nanoparticles and evaluate its drug release property in vitro. METHODS: The chitosan-poly (lactide) copolymers were synthesized by ring-opening polymerization. Paclitaxel nanoparticles were prepared by the nanoprecipitation method. The encapsulation efficiency of the nanoparticles and the in vitro release of paclitaxel were studied. RESULTS: The nanoparticles were fine and uniform spheres. The encapsulation efficiency of nanoparticles was up to 93.2%. The in vitro release profile showed the slow and stable release rate of paclitaxel. CONCLUSION: This method is simple and the nanoparticles possess good physical performance as sustained release character in vitro.