Malnutrition and Adverse Outcomes After Surgery for Head and Neck Cancer.

Importance: Patients with head and neck cancer (HNC) have an increased risk of malnutrition, partly due to disease location and treatment sequelae. Although malnutrition is associated with adverse outcomes, there is little data on the extent of outcomes and the sociodemographic factors associated with malnutrition in patients with HNC. Objectives: To investigate the association of race, ethnicity, and payer type with perioperative malnutrition in patients undergoing HNC surgery and how malnutrition affects clinical outcomes. Design, Setting, and Participants: This retrospective cohort study used data from the Premier Healthcare Database to assess adult patients who had undergone HNC surgery from January 2008 to June 2020 at 482 hospitals across the US. Diagnosis and procedure codes were used to identify a subset of patients with perioperative malnutrition. Patient characteristics, payer types, and hospital outcomes were then compared to find associations among race, ethnicity, payer type, malnutrition, and clinical outcomes using multivariable logistic regression models. Analyses were performed from August 2022 to January 2023. Exposures: Race, ethnicity, and payer type for primary outcome, and perioperative malnutrition status, race, ethnicity, and payer type for secondary outcomes. Main Outcomes and Measures: Perioperative malnutrition status. Secondary outcomes were discharge to home after surgery, hospital length of stay (LOS), total cost, and postoperative pulmonary complications (PPCs). Results: The study population comprised 13 895 adult patients who had undergone HNC surgery during the study period; they had a mean (SD) age of 63.4 (12.1) years; 9425 male (67.8%) patients; 968 Black (7.0%), 10 698 White (77.0%), and 2229 (16.0%) individuals of other races; and 887 Hispanic (6.4%) and 13 008 non-Hispanic (93.6%) individuals. Among the total sample, there were 3136 patients (22.6%) diagnosed with perioperative malnutrition. Compared with White patients and patients with private health insurance, the odds of malnutrition were higher for non-Hispanic Black patients (adjusted odds ratio [aOR], 1.31; 95% CI, 1.11-1.56), Medicaid-insured patients (aOR, 1.68; 95% CI, 1.46-1.95), and Medicare-insured patients (aOR, 1.24; 95% CI, 1.10-1.73). Black patients and patients insured by Medicaid had increased LOS, costs, and PPCs, and lower rates of discharge to home. Malnutrition was independently associated with increased LOS (ß, 5.20 additional days; 95% CI, 4.83-5.64), higher costs (ß, $15 722 more cost; 95% CI, $14 301-$17 143), increased odds of PPCs (aOR, 2.04; 95% CI, 1.83-2.23), and lower odds of discharge to home (aOR, 0.34; 95% CI, 0.31-0.38). No independent association between malnutrition and mortality was observed. Conclusions and Relevance: This retrospective cohort study found that 1 in 5 patients undergoing HNC surgery were malnourished. Malnourishment disproportionately affected Black patients and patients with Medicaid, and contributed to longer hospital stays, higher costs, and more postoperative complications.

Correlates of residents' enrolment intention toward inclusive commercial health insurance in China: involvement, perceived benefit, perceived sacrifice, and government participation.

Background: As an application of inclusive finance in health insurance, inclusive commercial health insurance (ICHI) is a new public-private partnership-based health insurance scheme and has been vigorously promoted by the Chinese government in recent years to develop China Multi-level Health Insurance System, a system that aims to seek a mix of public and private sources to provide more affordable financial protection to all levels of society in line with their needs. However, the overall enrolment of ICHI scheme is still at a low level, and little is known about what influences residents' enrolment intentions. The aim of this study was to examine the multidimensional factors influencing residents' behavioral intentions and to develop a multivariate conceptual model to explore the psychographic process in the formation of enrolment intention. Methods: The empirical data used for model validation were obtained from a cross-sectional study conducted in Nanjing, China, a representative pilot city of ICHI scheme in 2022. Exploratory factor analysis, ANOVA, standard multiple regression, and hierarchical multiple regression were mainly employed for hypothesis testing. Results: The findings revealed that involvement, perceived benefit, and perceived sacrifice are all crucial psychographic process factors in the formation of residents' enrolment intentions. Government participation positively moderates the influence path of "perceived benefit-enrolment intention" but negatively moderates the path of "perceived sacrifice-enrolment intention". Moreover, it was discovered that perceived benefit mediates the effect of involvement on enrolment intention, while perceived sacrifice does not. Conclusions: Improving residents' perceived benefit and involvement degree of the product, as well as reducing their perceived sacrifice, are both key to increasing their enrolment intentions. This study also points out that one of the main dilemmas in the current development of ICHI scheme is the low level of involvement among residents, and that optimizing the product design to make it more relevant to residents' lives is a more beneficial strategy to increase overall involvement.

Female perspective: the burden of Alzheimer's disease and other dementias in China from 1990 to 2019 and prediction of their prevalence up to 2044.

Background: Dementia is more prevalent in women than in men across the world, and sex differences are reflected in the burden of dementia borne by women and men. However, a few studies have specifically analyzed the disease burden of dementia in Chinese women. Objective: This article aims to raise awareness of Chinese females with dementia (CFWD), outline an effective response to future trends in China from a female perspective, and provide a reference for the scientific formulation of dementia prevention and treatment policies in China. Methods: In this article, epidemiological data on dementia in Chinese women were obtained from the Global Burden of Disease Study 2019, and three risk factors, namely, smoking, a high body mass index, and a high fasting plasma glucose, were selected for the analysis. This article also predicted the burden of dementia in Chinese women in the next 25 years. Results: The prevalence of dementia, mortality, and disability-adjusted life year rates increased with age in CFWD in 2019. All three risk factors provided by the Global Burden of Disease Study 2019 showed positive correlations for the effect of disability-adjusted life years (DALYs) rates on CFWD. Among them, a high body mass index had the greatest effect (8%) and smoking had the smallest effect (6.4%). Over the next 25 years, the number of CFWD and its prevalence are expected to be on the rise, while mortality is expected to remain relatively stable and decline slightly, but deaths from dementia will continue to increase. Conclusions: The situation arising due to the spread of dementia among Chinese women in the future is going to become a serious issue. To reduce the burden of dementia, the Chinese government should prioritize its prevention and treatment. A multi-dimensional, long-term care system involving families, community, and hospitals should also be established and supported.

Comparison of hospitalization costs for the same adverse reaction associated with different medications.

PURPOSE: Costs of hospitalization due to severe adverse drug reactions (ADRs) were previously estimated within the Veterans Health Administration (VHA), but additional analyses are needed to infer potential interventions to mitigate these negative outcomes. The objective of this study was to compare specific adverse reaction-related hospitalization costs between medications with similar indications. METHODS: Mean hospitalization costs associated with the same ADR symptom were compared for different drugs with similar indications using adjusted generalized linear models with a Bonferroni correction for multiple comparisons as well as a gamma distribution. RESULTS: Overall, hospitalization costs between medications with similar indications were not significantly different for specific adverse reactions. However, gastrointestinal hemorrhage-associated costs were higher for warfarin versus nonsteroidal anti-inflammatory drugs (model estimate of mean cost, $18,114 [range of lower and upper model estimates, $12,522-$26,202] vs $14,255 [estimate range, $9,710-$20,929]). Similarly, the estimated mean hospitalization cost associated with angioedema was higher for losartan versus lisinopril or lisinopril/hydrochlorothiazide: $14,591 (range, $9467-$22,488) versus $8,935 (range, $6,301-$12,669) and $8,022 (range, $5,424-$11,865), respectively. CONCLUSION: Although we found few differences in the cost of hospitalization when comparing drugs with similar indications and the same adverse reaction, there were specific drug-ADR pairs that merit attention and consideration of interventions to improve safe and appropriate medication use. Evaluation of the effect of those interventions on the incidence of ADRs is an area for future study.

Site-specific ecological effect assessment at community level for polymetallic contaminated soil.

Current ecological risk assessment (ERA) is based more on book-keeping than on science especially for terrestrial ecosystems due to the lack of relevance to real field. Accordingly, site-specific ecological effect assessment is critical for ERA, especially at high tiers. This study developed procedures to assess ecological effect at community level based on field data. As a case study, we assessed ecological effect of polymetallic contamination in soil in the surrounding of an abandoned mining and smelting site in Hunan, China. Firstly, Zn was identified as the dominant contaminant in soil and slope gradient (SG) and pH as environmental impact factors using distance-based redundancy analysis(db-RDA). Secondly, sensitive endpoints were screened using correlation analysis between Zn and parameters of plant community composition and functional traits. Thirdly, exposure-effect curves between Zn and screened endpoints were developed by taking SG and pH as covariates using Bayesian kernel machine regression analysis (BKMR), based on which half-effect concentrations (EC50s) and 10 %-effect concentrations (EC10s) of soil Zn for each endpoint were calculated. Finally, site-specific hazardous concentrations (HC50s) of Zn were estimated. It was revealed site-specific EC50s and EC10s for soil Zn ranged 80.5-201 mg kg-1 and 342-893 mgkg-1, respectively, and HC50s based on EC10s and EC50s ranged 104-110 mg kg-1 and 595-612 mg kg-1, respectively, which are more specific and inclusive than those obtained based on crop and vegetable seed germination and seedling growth toxicity experiments.

Incentive mechanism for sharing and using EHR in medical consortiums based on performance evaluation.

Background: The construction of medical consortiums not only promotes active cooperation among hospitals, but also further intensifies active competition among them. The shared use of electronic health records (EHR) breaks the original pattern of benefit distribution among hospitals. Objective: The purpose of this paper is to establish an incentive mechanism for the shared use EHR, and to reveal the incentive effect and mechanism of key factors, and to put forward management suggestions for solving the real conflicts. Methods: We constructed a basic incentive model and an incentive model that introduces performance evaluation as a supervisory signal, based on analyzing the hospital cost function, the hospital benefit function, and the incentive contract function. Finally, the incentive effects of key factors before and after the introduction of performance evaluation were verified and compared using MATLAB simulation method. Results: The profit level and incentive coefficient of hospitals sharing EHR are independent of the amount of one-time government subsidies. Regardless of whether a performance evaluation supervisory signal is introduced or not, the incentive coefficients are increasing functions with respect to ρ, τ, but decreasing functions with respect to ß, δ, γ. After the inclusion of supervisory signal of performance evaluation in the model, the ability of hospitals to use EHR has a higher impact effectiveness on improving both incentive effects and benefit levels. The impact of the value-added coefficient on the level of earnings is consistently greater than it would have been without the inclusion of the performance evaluation supervisory signal. Conclusions: Enhancing the capacity of hospitals to use EHR and tapping and expanding the value-added space of EHR are 2 key paths to promote sustainable shared use of EHR. Substantive performance evaluation plays an important role in stabilizing incentive effects.

First-line sintilimab plus chemotherapy in locally advanced or metastatic esophageal squamous cell carcinoma: A cost-effectiveness analysis from China.

Objective: The study aimed to assess the cost-effectiveness of sintilimab combined with cisplatin plus paclitaxel versus chemotherapy alone as first-line treatment in patients with advanced or metastatic esophageal squamous cell carcinoma from the Chinese healthcare system. Materials and methods: A partitioned survival model was developed based on the ORIENT-15 clinical trial. Drug costs and health state utility were obtained from the literature. Outcomes included the health outcomes in life-years, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio. One-way and probabilistic sensitivity analyses were performed to evaluate the model uncertainty. Result: In overall population, patients given sintilimab plus chemotherapy gained more health benefits (0.90 QALYs vs. 0.61 QALYs), and the cost was more (15,399.21 US$ VS. 7475.58 US$) than that for patients in the chemotherapy group. In the subgroup, patients given sintilimab plus chemotherapy gained more health benefits (0.89 QALYs vs. 0.68 QALYs), and the cost was more (15,656.19 US$ vs. 9,162.77 US$) than that for patients in the chemotherapy group. Compared with chemotherapy, patients receiving sintilimab plus chemotherapy had ICERs of $26,773.68/QALY in the overall population and $30,065.50/QALY in the subgroup, which was above the threshold of WTP. Conclusion: Sintilimab plus chemotherapy was more cost-effective than chemotherapy alone for patients with advanced esophageal cancer from the perspective of the Chinese healthcare system.

[Ecological risk assessment of contaminated soil using improved "Weight of Evidence"approach:A case study of electroplating site in Jingjiang, Jiangsu, China]. / 基于改进的"证据-权重法"评估污染土壤生态风险:以江苏靖江某电镀场地为例.

Ecological risk assessment of soil in contaminated sites provides the scientific basis for accurately developing soil quality standards, confirming remediation targets, and making safe use of contaminated soil. It thus is a critical mean to protect soil health and safety. "Weight-of-Evidence" (WoE) has been widely used in ecological risk assessment due to its systematic, integrated and scientific properties. However, most current WoE approaches are poor in objectivity and comparability because they rely too much on expertise scoring in weighing and the difficulty to collect complete evidence bodies with quantitative and comprehensive information. Focusing on those issues above, we developed an improved framework of WoE approach for ecological risk assessment of contaminated site soil based on the "Four-Step" framework of EPA coupled with the concept of hierarchy. Assessment methods and procedures for each tier were unified. Weights were weighed quantitatively through multiple criteria decision analysis. The relative independence among bodies of evidence was assured by the pre-establishment of hierarchy. The "site specific" was stressed based on matrix trails and field investigation. Finally, a case study in an electroplating site in Jingjiang was conducted to verify the approach. Results of the case study suggested that the approach was practical and that the assessment results were objective, scientific, and accurate.

Esthetic Evaluation and Acceptability of Different Hole Designs on Implant Crowns from the Perspective of Patients and Dentists in China.

PURPOSE: Abutment access hole on dental implant crowns may facilitate crown retrieval and reduce cement overflow but present esthetic obstacle for patients. This study aimed to investigate the esthetic evaluation and acceptability of implant crowns with different hole designs from the perspective of patients and dentists. MATERIALS AND METHODS: Anterior and posterior implant zirconia crowns were fabricated into three types: no hole (NH), 1 mm micro hole (MH), and 2.5 mm regular hole (RH). The NH crown was set as the control, and the anterior and posterior crowns with MH and RH were evaluated. The subjects, who were recruited randomly, were comprised of lay patients (n=60) and professional dentists (n=30). All subjects were invited to evaluate the esthetic performance of MH and RH crowns on a Visual Analog Scale (VAS), rate them from 0 to 10, state their acceptability of these crowns, and label them as acceptable and unacceptable. RESULTS: The ANOVA analysis of the VAS esthetic evaluation showed that the size of the hole, the position of the teeth, and the professional background of the subject significantly and independently affected esthetic perception. Crowns with MH in the posterior position had higher esthetic scores and acceptability compared with crowns with RH in the anterior position, and dentists tended to show higher acceptance and better esthetic rating for crowns with holes compared with lay patients. CONCLUSION: The hypothesis that patients and dentists hold similar esthetic evaluations or acceptability towards implant crown hole designs was rejected. Lay patients had a lower tolerance for venting holes than dentists. Crowns with 1 mm micro holes were more recommendable than crowns with regular abutment access holes from the point of view of satisfying patients' esthetic needs.

Burden and trends of multiple sclerosis in China from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019.

OBJECTIVE: To compare the burden of multiple sclerosis disease indicators in the Asia-Pacific countries, China and globally through the Global Burden of Disease 2019 (GBD2019) Database, and to analyse the changes of multiple sclerosis disease burden in China from 1990 to 2019. STUDY DESIGN: Observational study based on the Global Burden of Disease. SETTING: The relevant incidence, prevalence, death and disability-adjusted life year (DALY) rates and corresponding age-standardised rates (ASRs) and sociodemographic index (SDI) in China, globally and in Asia-Pacific countries were extracted from the GBD2019 Database to further study the age-standardised incidence, prevalence and mortality, and the relationship between DALY rate and SDI. RESULTS: Various disease burden indicators of multiple sclerosis in China are at low level in the world, and the prevalence, incidence and DALY rates have slowly increased from 1990 to 2019. During this period, the age-standardised prevalence rate (ASPR) of multiple sclerosis in China showed an upward trend, while the age-standardised death rate (ASDR), age-standardised DALY rate (ASR-DALY) and age-standardised incidence rate all decreased to varying degrees, which were roughly consistent with the global amplitude changes, and all indicators are similar to most countries in the Asia-Pacific region. As the value of the SDI increases, the ASPR of multiple sclerosis was trending upward, and the ASDR was trending downward. CONCLUSION: Compared with other countries in the Asia-Pacific region, China is in a low state of disease burden indicators. However, as a developing country and the most populous country in the world, the total number of patients is not small, and as a rare disease, the treatment cost is relatively expensive, and the treatment cost of the complications caused by the disease is not low. The construction of the medical security system should be strengthened to reduce its burden on individuals, families and society.

Validity of the ESC Risk Assessment in Idiopathic Pulmonary Arterial Hypertension in China.

Background: The 2015 European pulmonary hypertension (PH) guidelines recommend a risk stratification strategy for pulmonary arterial hypertension (PAH). We aimed to investigate the validation and potential prognostic information in Chinese patients. Methods: The risk assessment variables proposed by the PH guidelines were performed by using the WHO function class, 6-min walking distance, brain natriuretic peptide or its N-terminal fragment, right arterial pressure, cardiac index, mixed venous saturation, right atrium area, pericardial effusion, peak oxygen consumption, and ventilatory equivalents for carbon dioxide. An abbreviated version also was applied. Results: A total of 392 patients with idiopathic PAH (IPAH) were enrolled between 2009 and 2018. After a median interval of 13 months, re-evaluation assessments were available for 386 subjects. The PAH guidelines risk tool may effectively discriminate three risk groups and mortality (p < 0.001) both at the baseline and re-evaluation. Meanwhile, its simplified risk version was valid for baseline and accurately predicted the risk of death in all the risk groups (p < 0.001). At the time of re-evaluation, the percentage of low-risk group has an increase, but a greater proportion achieved the high-risk group and a lesser proportion maintained in the intermediate-risk group. Conclusion: The 2015 European PH guidelines and its simplified version risk stratification assessment present an effective discrimination of different risk groups and accurate mortality estimates in Chinese patients with IPAH. Changes of risk proportion at re-evaluation implicated that natural treatment decisions may not be consistently with goal-oriented treatment strategy.

[Economical nitrogen application rate of winter wheat under rice-wheat rotation in the Yangtze River basin of China]. / 长江流域稻麦轮作条件下冬小麦适宜施氮量.

To promote the rational application of nitrogen fertilizer for winter wheat under rice-wheat rotation in the Yangtze River Basin, we examined the effects of nitrogen application rates (0, 120, 210, 300 kg·hm-2, expressed as N0, N1, N2, and N3 respectively) on soil nitrate content, nitrogen balance of soil-plant system and yield. The results showed that soil nitrate content increased with increasing nitrogen application rates. Under different nitrogen application treatments, all the nitrate was significantly transfered to the 60 cm soil layer till jointing stage. After jointing stage, topdressing nitrogen significantly increased nitrate content in 0-40 cm soil layer under N1 and N2 treatments and that in the 0-60 cm soil layer under N3 treatment. Soil nitrate mainly accumulated in the 0-40 cm soil layer in the mature stage. Results from nitrogen balance analysis showed that nitrogen absorption, residue and loss varied across different growth stages of wheat, with the period from overwintering to jointing being the principal time of apparent nitrogen loss. The amount of plant nitrogen accumulation, inorganic nitrogen residue and soil nitrogen apparent loss all positively correlated with the nitrogen application rate. Based on the comprehensive analysis through Coase principle and marginal revenue of environmental economics, the optimum nitrogen application rate for production, ecology and economic benefits of winter wheat under rice-wheat rotation was 250 kg·hm-2, and the ratio of base fertilizer to jointing fertilizer was 5:5, while the corresponding grain yield was 6840 kg·hm-2.

[Advances in ecological risk assessment of soil in contaminated sites]. / æ±¡æŸ“åœºåœ°åœŸå£¤ç”Ÿæ€é£Žé™©è¯„ä¼°ç ”ç©¶è¿›å±•.

With the rapid urbanization and industrial structure adjustment in China, many contaminated sites have been left for remediation. It is essential to develop and implement ecological risk assessment (ERA) before remediating contaminated sites at a large scale as well as sequential management. In this review, we discussed the key problems in ecological risk assessment of soils in contaminated sites focusing on scientific principles, frameworks, techniques, and approaches, including 1) the site-specific framework, 2) uncertainty of conceptual model, 3) toxic mechanisms of combined contamination in soil, 4) screening of assessment endpoints, and 5) development of assessing approaches and frameworks. Then, two perspectives were addressed: the toxicological mechanism of soil combined pollution including bioavailability of contaminants in soil and their joint effect is the scientific problem in ecological risk assessment of soil in contaminated site; and weight of evidence approach based on USEPA four-step approach and EU Tier approach is applicable for ecological risk assessment in field conditions. Future studies should focus on: 1) the coordination of ecological risk assessment (ERA) framework and risk management framework, 2) conceptual mo-del, 3) process-based reactive transport models for exposure evaluation, 4) ecotoxicological mechanism of combined contamination in site soil, and 5) high ecological level endpoints. The aim of this review was to provide theoretical base and framework for the establishment of local guideline of ecological risk assessment in China.

A privacy protection method for health care big data management based on risk access control.

With the rapid development of modern information technology, the health care industry is entering a critical stage of intelligence. Faced with the growing health care big data, information security issues are becoming more and more prominent in the management of smart health care, especially the problem of patient privacy leakage is the most serious. Therefore, strengthening the information management of intelligent health care in the era of big data is an important part of the long-term sustainable development of hospitals. This paper first identified the key indicators affecting the privacy disclosure of big data in health management, and then established the risk access control model based on the fuzzy theory, which was used for the management of big data in intelligent medical treatment, and solves the problem of inaccurate experimental results due to the lack of real data when dealing with actual problems. Finally, the model is compared with the results calculated by the fuzzy tool set in Matlab. The results verify that the model is effective in assessing the current safety risks and predicting the range of different risk factors, and the prediction accuracy can reach more than 90%.

Systolic Blood Pressure and Socioeconomic Status in a large multi-study population.

The present study used harmonized data from eight studies (N = 28,891) to examine the association between socioeconomic status (SES) and resting systolic blood pressure (SBP). The study replicates and extends our prior work on this topic by examining potential moderation of this association by race and gender. We also examined the extent to which body mass index (BMI), waist circumference (WC), and smoking might explain the association between SES and SBP. Data were available from six race/gender groups: 9200 Black women; 2337 Black men; 7248 White women; 6519 White men; 2950 Hispanic women; and 637 Hispanic men. Multivariable regression models showed that greater annual household income was associated with lower SBP in all groups except Hispanic men. The magnitude and form of this negative association differed across groups, with White women showing the strongest linear negative association. Among Black men and Hispanic women, the association was curvilinear: relatively flat among lower income levels, but then negative among higher income ranges. Education also was independently, negatively related to SBP, though evidence was weaker for race and gender differences in the strength of the association. Higher BMI and WC were associated with higher SBP, and current smoking with lower SBP. Inclusion of these risk factors resulted in only a modest change in the magnitude of the SBP and SES relation, accounting on average about 0.4 mmHg of the effect of income and 0.2 mmHg of the effect of education-effects unlikely to be clinically significant. Further understanding of mechanisms underlying the association between SBP and SES may improve risk stratification in clinical settings and potentially inform interventions aimed at reductions in social disparities in health.

Research and development of mAb drugs in China: a look from policy perspectives.

Background: Monoclonal antibody (mAb) drugs are increasingly important for the pharmaceutical industry across the globe. In China, mAb drug developments face many challenges. Multiple policies have been implemented recently to reinforce support in various areas. This study aims to investigate the latest landscape of mAb drugs in China from policy perspectives encompassing R&D, clinical trials, marketing approval, and talent pools.Methods: Information about mAb drugs approved in the United States, the European Union, Japan, and China by 2017 and mAb-related policies in China were retrieved from government websites and third-party statistical databases for descriptive, statistical, and comparative analysis.Results and discussion: In China, 21 mAb drugs (10 locally-developed and 11 imported) have so far been approved. For the 11 imported mAb drugs in China, the median drug lag in the marketing approval was estimated at 87.1 months, compared with the U.S. (0 months), the EU (8.9 months), and Japan (43.4 months). However, as far as the dramatically changing innovation supporting system in China is concerned, emergence of new biopharmaceutical companies, transformation of the current drug companies and their shift to antibody therapy, and the pooling of high-level talent contribute to mAb development in China. The number of clinical trials and marketing applications and approvals involving mAb drugs is also growing. Favorable policies will continue to play a role in the sustainable development of mAb drugs in China.Conclusion: The research showed that the reform of multiple policies and incentives for attracting/retaining high-level talent has evidently been effective in addressing the drug lag of mAb drugs in China. In future development, China should actively monitor the global R&D outcomes and industrial development trends of mAb drugs and make the policy environment more attractive to enable more mAb drugs to be marketed in China as soon as possible.

Contrast-Based Real-Time Assessment of Microcirculatory Changes in a Fatty Liver After Ischemia Reperfusion Injury.

OBJECTIVES: A fatty liver is known to have impairment of microcirculation, which is worsened after ischemia reperfusion injury (IRI). This makes most fatty grafts unsuitable for transplantation, and in the absence of real time assessment of microcirculation this selection has been at best, random. The aim of this study was to demonstrate the utility of a contrast enhanced ultrasound model in quantitative assessment of the microcirculation of a fatty liver. METHODS: We subjected fatty mice to IRI, and blood flow dynamics were assessed before and after the injury. RESULTS: There was a significant increase in the resistive and pulsatility index of the extrahepatic artery and a significant decrease in velocity of the portal vein. There was also a quantifiable decrease in the intrahepatic blood volume, blood flow, time to peak flow, and perfusion index of mice with fatty liver, suggesting that a fatty liver develops hemodynamic abnormalities after IRI, leading to increased hepatocellular injury. CONCLUSIONS: Hemodynamic abnormalities in liver can be reliably quantified using a contrast, enhanced Doppler ultrasound, which is an inexpensive technique with multiple clinical applications. It can be used to assess the quality of the fatty liver donor graft before organ retrieval; for determining live donor candidacy, for making post-IRI recovery prognosis, and for assessing the effectiveness of therapeutic interventions.

[Relation between social capital factors and self-rated health among Chinese adults].

OBJECTIVE: To examine the relations between factors of social capital and self-rated health among Chinese adults. METHODS: Univariate and multivariate analyses were used, based on 33 610 respondents in cross-sectional data of Chinese Family Panel Studies implemented by Institute of Social Science Survey, Peking University. RESULTS: In the study, 47.4% of the respondents reported "good" in self-rated health. The result of univariate analysis showed that those who took part in any organizations (P<0.001) or had frequent interaction with others (P<0.001) tended to report relatively higher level on self-rated health. After controlling the physical health and demographic factors, the social participation (P<0.01), social interaction (P<0.001) and perceived social equity (P<0.001) were all the correlates of self-rated health among Chinese residents. CONCLUSION: Factors of social capital are important correlates of self-rated health in China, controlling the physical health and demographic factors. self-rated health can indicate people's social health to certain extent.

An epidemiological investigation of off-label anticonvulsant drug use in the Georgia Medicaid population.

PURPOSE: The primary objective was to determine the prevalence of off-label anticonvulsant drug use in the Georgia Medicaid population and establish what percentage of this off-label use is evidence-based. The second objective was to investigate differences in the prevalence of off-label use among anticonvulsants marketed before and after 1993. The third objective was to identify patient and physician characteristics associated with off-label use. METHOD: The study design was a retrospective study utilizing pharmacy, inpatient, outpatient and long-term care claims linked with eligibility files for persons with Georgia Medicaid benefits in 1999 through 2000. An anticonvulsant recipient was considered an off-label anticonvulsant user if their anticonvulsant use did not match age or medical diagnoses in the product label. An evidence-based off-label use was defined as off-label anticonvulsant use supported by at least one randomized controlled clinical trial. Logistic regression analysis was used to identify patient and physician characteristics associated with off-label use. RESULTS: 34 676 (71.3%) of 48 648 patients on one or more anticonvulsants received an off-label prescription for an anticonvulsant. Gabapentin was the anticonvulsant most widely used off-label (86%). After accounting for labeled and all evidence-based uses for the six most frequently prescribed anticonvulsants, there was a moderate to large percentage of anticonvulsant use not supported by any evidence from controlled trials (range: 19.09-57.07%). The most common comorbidities among patients prescribed the top six anticonvulsants were diabetes mellitus, depression, schizophrenia and pain. Anticonvulsants launched after 1993 had a higher prevalence of off-label use than anticonvulsants marketed before 1993. Off-label drug use varied by age with children and adolescents being the most likely to receive an off-label anticonvulsant. Compared with other practitioners, neurologists were more likely to prescribe anticonvulsants off-label. CONCLUSIONS: The anticonvulsant off-label use in the Georgia Medicaid population is very high (71%). Only a modest proportion of these off-label uses are supported by evidence from controlled trials.