[Enhanced autophagy activates p38/MEF2C pathway to regulate the expression of synapse-associated proteins and improve the symptoms of autistic rats].

Objective To study the mechanism of p38/myocyte enhancer factor 2C (p38/MEF2C) pathway regulating synapse before and after autophagy intervention in the prefrontal cortex of autistic rats. Methods An animal model of autism was induced by intraperitoneal injection of valproic acid (VPA) at 12.5 days of gestation in Wistar rats. They were treated with normal saline or VPA. The offspring of the saline treatment group served as a control group. The offspring of the VPA treatment group were randomly divided into the model group, 5 mg/kg 3-methyladenine (3-MA) group, and 5 mg/kg rapamycin (Rap) autophagy enhanced group, and the treatment time of each group was from the 35th day of birth to the 42nd day of birth. Western blot analysis was used to detect the protein levels of p38, phosphorylated p38 (p-p38), MEF2C, synaptic vesicle protein (SYN), postsynaptic density 95 (PSD-95), and gephyrin protein in the prefrontal cortex of rats; immunohistochemical staining was used to detect the expression and distribution of SYN, PSD-95 and gephyrin in the prefrontal cortex, and semi-quantitative analysis was performed then. Results Compared with the control group, the developmental and behavioral test showed that the model group had developmental lag and social disorder. Compared with the model group, the Rap group shoed improved social disorder, and the 3-MA group could aggravate social disorder. Compared with the control group, the expression of p38, p-p38, MEF2C was down-regulated, the expression of SYN and PSD-95 protein was up-regulated, and the expression of gephyrin was down-regulated. Compared with the model group, the expression of p38, p-p38, MEF2C in the Rap group was up-regulated, the levels of SYN and PSD-95 protein were down-regulated, and the level of gephyrin protein was up-regulated, while that in 3-MA group was opposite. Compared with the control group, the number of SYN and PSD-95 positive cells in the model group increased, and the number of gephyrin positive cells decreased. Compared with the model group, the number of SYN and PSD-95 positive cells in the Rap group decreased, and the number of gephyrin-positive cells increased, and the 3-MA group was opposite. Conclusion The p38/MEF2C signaling pathway is inhibited in the prefrontal cortex of rats with autism, which can regulate the expression of synaptic related proteins and improve autistic behavior by enhancing autophagy to activate the p38/MEF2C signaling pathway.

The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis.

This systematic review aimed to evaluate the long-term (≥ 5 years) outcomes of bariatric surgery on diabetes remission, microvascular and macrovascular events, and mortality among type 2 diabetes (T2D) patients. Ten articles (one randomized controlled trial and nine cohorts) met the inclusion criteria and were included in this review. Pooled estimates of nine cohort studies showed that surgery significantly increased the diabetes remission (relative risk (RR) = 5.90; 95% CI 3.75-9.28), reduced the microvascular (RR = 0.37; 95% CI = 0.30-0.46) and macrovascular events (RR = 0.52; 95% CI 0.44-0.61), and mortality (RR = 0.21; 95% CI 0.20-0.21) as compared to non-surgical treatment. Available evidence suggests better remission and lower risks of microvascular and macrovascular disease and mortality in the surgery group as compared to non-surgical treatment group in T2D patients after at least 5 years of follow-up.

Essential Public Health Services' Accessibility and its Determinants among Adults with Chronic Diseases in China.

BACKGROUND: Along with three years implementation of health reform in China, this study aimed at providing the up-to-date evidence about the accessibility of essential public health services (EPHS) among adults with chronic diseases (CDs) in both urban and rural areas, as well as determinants in access to EPHS. METHODS: The data were collected from a cross-sectional survey conducted in 2013, which used a multistage stratified random sampling method to select 54 urban communities and 54 rural villages. Hypertension patients and diabetes patients were the target population who are the main beneficiaries of EPHS. Single factor analysis of influencing factors on difference access to EPHS was performed by Chi-Square analysis. Logistic regression analysis was used to determine the predictors of effective management and effective control. RESULTS: Patients with hypertension or diabetes were predominantly middle-aged or older persons and had a mean age of 65.26 year. People with CDs in China have a higher basic accessibility rate in EPHS with more than 90% of them having experience in receiving EPHS. And those who are willing to receive services from doctors have the most positive influence on effective management and control in blood pressure or blood glucose. But unsatisfied quality and equity of EPHS still exist in primary health system. 90% of participants could receive EPHS, but just 44% of them could control their diseases effectively. And participants from cities had the higher rates in effective management (urban: rural = 57%: 50.6%) and effective control (urban: rural = 39.5%: 27.8%). CONCLUSION: People with CDs have a high level in geography and economic accessibility to EPHS, but the effectiveness of health management also needs to be improved, especially for those living in rural areas. Our study highlights the continuing need for improving ability to provide EPHS and the equality among regions. Meanwhile, strengthen health education and promotion for patients with CDs to improve their willingness to receive EPHS is also highlighted.

The use of annual physical examinations among the elderly in rural China: a cross-sectional study.

BACKGROUND: Periodic physical examination is considered helpful in preventing illness and promoting health among the elderly. Limited information is available about the use of annual physical examinations among the elderly in rural areas, however. This research explores the distribution characteristics of annual physical examination use and its determinants among people aged 60 or over in rural China. METHODS: A cross-sectional study was undertaken to estimate distribution characteristics of annual physical examination use and to collect data of sociodemographic characteristics, health knowledge level, and health communication channels. Participants were 1128 people aged 60 or over, randomly selected from four different provinces in the East, Mid-East, Mid-West, and West China. Logistic regression determined the predictors of annual physical examination use. RESULTS: Participants were predominantly aged 60-79 (44.1%) and 70-79 (42.0%). A total of 716 (63.5%) participants underwent annual physical examinations. Those who reported acquiring health knowledge via bulletin boards and village doctors had a higher probability of using annual physical examinations (OR = 3.15 and 1.53). The probability for civil servants/retired having annual physical examinations was 2.16 times higher than for farmers. Those who had an average level of health knowledge had a higher probability of using annual physical examinations than those at the below-average level (odds ratio: 2.07). CONCLUSION: The government and public health institutions should assist farmers to acquire the habit of having annual physical examinations. Traditional channels, such as bulletin boards, should be used to deliver health information. Village doctors should be supported in delivering health information to the elderly in rural areas.

Child health security in China: a survey of child health insurance coverage in diverse areas of the country.

China embarked on an ambitious health system reform in 2009, and pledged to achieve universal health insurance coverage by 2020. However, there are gaps in access to healthcare for some children in China. We assessed health insurance status and associated variables among children under five in twelve communities in 2010: two urban community health centers and two rural township health centers in each of three municipalities located in China's distinctly different East, Central and Western regions. Information on demographic and socio-economic variables and children's insurance status was gathered from parents or caregivers of all children enrolled in local health programs, and others recruited from the local communities. Only 62% of 1131 children assessed were insured. This figure did not vary across geographic regions, but urban children were less likely to be insured than rural children. In multivariate analysis, infants were 2.44 times more likely to be uninsured than older children and children having at least one migrant parent were 1.90 times more likely to be uninsured than those living with non-migrant parents. Low maternal education was also associated with being uninsured. Gaps in China's child health insurance coverage might be bridged if newborns are automatically covered from birth, and if insurance is extended to all urban migrant children, regardless of the family's residential registration status and size.