Socio-economic inequalities in health service utilization among Chinese rural migrant workers with New Cooperative Medical Scheme: a multilevel regression approach.

BACKGROUND: While reducing inequity in health service utilization is an important goal of China's health system, it has been widely acknowledged that a huge number of rural migrant workers cannot be effectually protected against risks with the New Rural Cooperative Medical Insurance (NCMS). METHOD: Data of the 2016 China Labor-force Dynamic Survey and the Chinese Urban Statistical Yearbook were used. The multilevel regression approach was implemented with a nationally representative sample of rural migrant workers with NCMS. Our study adopted the concentration index and its decomposition method to quantify the inequality of their health service utilization. RESULT: The multilevel model analysis indicated that impact variables for health service utilization were not concentrated, especially the contextual and individual characteristics. The concentration indices of the probability of two weeks outpatient and the probability of inpatient were -0.168 (95%CI:-0.236,-0.092) and -0.072 (95%CI:-1.085,-0.060), respectively. The horizontal inequality indices for the probability of two-week outpatient and the probability of inpatient were -0.012 and 0.053, respectively. CONCLUSION: The health service utilization of rural migrant workers with NCMS is insufficient. Our study highlighted that substantial inequalities in their health service utilization did exist. In addition, their need of health service utilization increased the pro-poor inequality. Based on the findings, our study offered notable implications on compensation policies and benefit packages to improve the equality among rural migrant workers with NCMS.

Cost effectiveness analysis of total laparoscopic hysterectomy versus total abdominal hysterectomy for uterine fibroids in Western China: a societal perspective.

BACKGROUND: As a common female pelvic tumor, uterine fibroids remain the leading cause for hysterectomy in China. Hysterectomy provides a good surgical treatment of uterine fibroids, and it guarantees the removal of all uterine fibroids without lower risk of recurrence. This study compares the cost effectiveness of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) for women with uterine fibroids from a societal perspective. METHODS: An economic analysis was conducted in 392 patients (TLH n = 75; TAH n = 317), including all relevant costs over a 12-month time horizon. Primary outcome was major surgical complications; secondary outcomes were postoperative discomfort symptoms and time of return to normal activities. Clinical, outcomes and costs data were collected from medical records, telephone survey and financial information system. Generalized linear models were used to assess costs and outcomes differences between the two groups. Incremental cost effectiveness ratio (ICER) was used to estimate the cost effectiveness. RESULTS: Mean direct costs were $2,925.71 for TLH, $2,436.24 for TAH, respectively. Mean indirect costs were $1,133.22 for TLH, $1,394.85 for TAH, respectively. Incremental societal costs were $256.86 (95%CI: 249.03-264.69). Mean differences in outcome were: 4.53% (95%CI: 4.35-4.71) for major surgical complications; 6.75% (95%CI: 6.45-7.05) for postoperative discomfort symptoms; 1.27 (95%CI: 1.23-1.30) weeks for time to return to normal activities. ICER of TLH was $5,669.16 (95%CI: 5,384.76-5,955.56) per complication averted, $3,801.54 (95%CI: 3,634.81-3,968.28) per postoperative discomfort symptoms averted and $202.96 (95%CI: 194.97-210.95) per week saved to return to normal activities. CONCLUSIONS: TLH is cost effective compared with TAH in preventing additional complications based on our estimated conservative threshold in China. The findings provide useful information for researchers to conduct further cost effectiveness analysis based on prospective study which can provide stronger and more evidence, in China. In addition, the data may be useful for Chinese health care policy-makers and medical insurance payers to make related health care decisions.

Distinct Disease Severity Between Children and Older Adults With Coronavirus Disease 2019 (COVID-19): Impacts of ACE2 Expression, Distribution, and Lung Progenitor Cells.

BACKGROUND: Children and older adults with coronavirus disease 2019 (COVID-19) display a distinct spectrum of disease severity yet the risk factors aren't well understood. We sought to examine the expression pattern of angiotensin-converting enzyme 2 (ACE2), the cell-entry receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the role of lung progenitor cells in children and older patients. METHODS: We retrospectively analyzed clinical features in a cohort of 299 patients with COVID-19. The expression and distribution of ACE2 and lung progenitor cells were systematically examined using a combination of public single-cell RNA-seq data sets, lung biopsies, and ex vivo infection of lung tissues with SARS-CoV-2 pseudovirus in children and older adults. We also followed up patients who had recovered from COVID-19. RESULTS: Compared with children, older patients (>50 years.) were more likely to develop into serious pneumonia with reduced lymphocytes and aberrant inflammatory response (P = .001). The expression level of ACE2 and lung progenitor cell markers were generally decreased in older patients. Notably, ACE2 positive cells were mainly distributed in the alveolar region, including SFTPC positive cells, but rarely in airway regions in the older adults (P < .01). The follow-up of discharged patients revealed a prolonged recovery from pneumonia in the older (P < .025). CONCLUSIONS: Compared to children, ACE2 positive cells are generally decreased in older adults and mainly presented in the lower pulmonary tract. The lung progenitor cells are also decreased. These risk factors may impact disease severity and recovery from pneumonia caused by SARS-Cov-2 infection in older patients.

Isolation, culture and biological characteristics of multipotent porcine skeletal muscle satellite cells.

Skeletal muscle has a huge regenerative potential for postnatal muscle growth and repair, which mainly depends on a kind of muscle progenitor cell population, called satellite cell. Nowadays, the majority of satellite cells were obtained from human, mouse, rat and other animals but rarely from pig. In this article, the porcine skeletal muscle satellite cells were isolated and cultured in vitro. The expression of surface markers of satellite cells was detected by immunofluorescence and RT-PCR assays. The differentiation capacity was assessed by inducing satellite cells into adipocytes, myoblasts and osteoblasts. The results showed that satellite cells isolated from porcine tibialis anterior were subcultured up to 12 passages and were positive for Pax7, Myod, c-Met, desmin, PCNA and NANOG but were negative for Myogenin. Satellite cells were also induced to differentiate into adipocytes, osteoblasts and myoblasts, respectively. These findings indicated that porcine satellite cells possess similar biological characteristics of stem cells, which may provide theoretical basis and experimental evidence for potential therapeutic application in the treatment of dystrophic muscle and other muscle injuries.

Isolation and biological characterization of a novel type of pulmonary mesenchymal stem cells derived from Wuzhishan miniature pig embryo.

Pulmonary mesenchymal stem cells (PMSCs) have great potential in lung tissue engineering and represent attractive candidates for disease treatment in human and veterinary research. However, a reliable method for isolation and localization of porcine PMSCs in situ is still uncertain. In this study, we successfully isolated PMSCs from Wuzhishan miniature pig embryos in vitro and also attempted to unravel its fundamental differentiation potential and biological characteristics. The isolated PMSCs, which could be cultured and passaged for at least 15 passages, exhibited a typical fibroblast-like morphology and high proliferative potential. Moreover, the PMSCs could express pluripotent marker genes (Oct4 and Nanog) and MSCs-related surface antigens (ß-integrin, CD44, CD71, CD73, CD90, and CD105), while the expressions of CD34 and CD45 were negative. Cell cycle examination showed that the rate of G0/G1 was about 72.1-90.2%. Additionally, the PMSCs not only could be induced to transdifferentiate into mesoblastic cells such as osteoblasts, chondrocytes, and adipocytes in vitro, but also the neural ectoderm and endoderm. Together, these data demonstrate the multiple differentiations potential of PMSCs in vitro, which confers potential use in serving as desirable cell types for lung injury regeneration.

Decomposing socioeconomic inequalities in depressive symptoms among the elderly in China.

BACKGROUND: Accelerated population ageing brings about unprecedented challenges to the health system in China. This study aimed to measure the prevalence and the income-related inequality of depressive symptoms, and also identify the determinants of depressive symptom inequality among the elderly in China. METHODS: Data were drawn from the second wave of the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed with a 10-item Center for Epidemiologic Studies-Depression Scale (CES-D), which was preselected in CHARLS. The concentration index was used to measure the magnitude of income-related inequality in depressive symptoms. A decomposition analysis, based on the logit model, was employed to quantify the contribution of each determinant to total inequality. RESULTS: More than 32.55% of the elderly in China had depressive symptoms. Women had a higher prevalence of depressive symptoms than men. The overall concentration index of depressive symptoms was -0.0645 among the elderly, indicating that depressive symptoms are more concentrated among the elderly who lived in economically disadvantaged situations, favoring the rich. Income was found to have the largest percentage of contribution to overall inequality, followed by residents' location and educational attainment. CONCLUSION: The prevalence of depressive symptoms in the elderly was considerably high in China. There was also a pro-rich inequality in depressive symptoms amongst elderly Chinese. It is suggested that some form of policy and intervention strategies, such as establishing the urban-rural integrated medical insurance scheme, enhancing the medical assistance system, and promoting health education programs, is required to alleviate inequitable distribution of depressive symptoms.

Exploring the nonlinear relationship between body mass index and health-related quality of life among adults: a cross-sectional study in Shaanxi Province, China.

INTRODUCTION: China is a country facing the "double burden" of both obesity and underweight. The objective of this study was to explore the relationship between body mass index (BMI) and health-related quality of life (HRQOL) in adults from Shaanxi Province. METHODS: The data were derived from the fifth Health Service Survey of Shaanxi Province, which was part of China's National Health Service Survey (NHSS), conducted in 2013. The HRQOL was assessed using the three-level EQ-5D questionnaire and scored based on a recently developed Chinese-specific tariff. Semiparametric regression models were adopted to explore the non-linear relationship between continuous BMI and overall HRQOL scores. Logistic regression models were further undertaken to assess the relationship between categorized BMI and five dimensions of HRQOL. RESULTS: Among the study sample (n = 37,902), 77% of men and 75 % of women were assigned to normal weight, according to the WHO International classification. There were statistical significant nonlinear relationships between BMI and HRQOL, with optimal HRQOL achieved at a BMI of near 23 kg/m2 for men and 24 kg/m2 for women. Before BMI reached optimal HRQOL, the EQ-5D utility scores were increasing faster among men than the women, whilst after the BMI value reached the optimal utility scores, women showed a faster decline in utility scores than men. With adjustments for socio-demographic, physical activity and co-morbidities, obese respondents were more likely to suffer from physical rather than mental problems. Underweight respondents were significantly more likely to report having any problems in all five dimensions of the EQ-5D, whilst the magnitudes of odds ratios were consistently larger for men than women. CONCLUSION: There was an inverse U-shaped association between continuous BMI and overall HRQOL scores, meaning that both underweight and obesity were associated with lower HRQOL. The relationship between BMI and HRQOL varied between sexes. Underweight respondents had a higher risk of suffering from both physical and mental problems. Interventions aimed to tackle the prevalence of underweight should be put into action in Shaanxi Province.

Measurement and explanation of socioeconomic inequality in catastrophic health care expenditure: evidence from the rural areas of Shaanxi Province.

BACKGROUND: Policy interventions have been taken to protect households from facing unpredictable economic changes that may cause catastrophe in China. This study aims to estimate the change of overall proportion of households incurring catastrophic health care expenditure (CHE) and its income-related inequality in the rural areas of Shaanxi Province from 2008 to 2013. METHODS: The data were drawn from the National Household Health Service Surveys of Shaanxi Province conducted in the years 2008 and 2013. In total, 3,217 households in 2008 and 13,085 households in 2013 were selected for analysis. A "Capacity to pay" approach was used to measure the incidence of CHE. The concentration index was employed to measure the extent of income-related inequality in CHE. A decomposition method, based on a logit model, was used to decompose the concentration index into its determining components. RESULTS: From 2008 to 2013, the overall proportion of households incurring CHE dropped from 17.19 % to 15.83 %, while conversely, the inequality in facing CHE strongly increased. The majority of observed inequalities in CHE were explained by household economic status and household size in 2013. In addition, the absence of commercial health insurance and having elderly members were also important contributors to inequality in CHE. CONCLUSIONS: Even though we used a conservative method to measure CHE, the overall proportion of households incurring CHE in Shaanxi Province is still considerably high in both years. Furthermore, there exists a strong pro-rich inequality of CHE in rural areas of Shaanxi Province. Our study suggests that narrowing the gap of household economic status, improving the anti-risk capability of small scale households, establishing prepayment mechanisms in health insurance, strengthening the depth of reimbursement and subsidising vulnerable households in Shaanxi Province are helpful for both reducing the probability of incurring CHE and the pro-rich inequality in CHE.

Ultrasonic nebulization extraction assisted dispersive liquid-liquid microextraction followed by gas chromatography for the simultaneous determination of six parabens in cosmetic products.

A simple, rapid, and efficient method of ultrasonic nebulization extraction assisted dispersive liquid-liquid microextraction was developed for the simultaneous determination of six parabens in cosmetic products. The analysis was carried out by gas chromatography. Water was used as the dispersive solvent instead of traditional organic disperser. The experimental factors affecting the extraction yield, such as the extraction solvent and volume, extraction time, dispersive solvent and volume, ionic strength, and centrifuging condition were studied and optimized in detail. The limit of detections for the target analytes were in the range of 2.0-9.5 µg/g. Good linear ranges were obtained with the coefficients ranging from 0.9934 to 0.9969. The proposed method was successfully applied to the analysis of six parabens in 16 cosmetic products. The recoveries of the target analytes in real samples ranged from 81.9 to 108.7%, and the relative standard deviations were <5.3%.

Dynamic ultrasonic nebulisation extraction coupled with headspace ionic liquid-based single-drop microextraction for the analysis of the essential oil in Forsythia suspensa.

INTRODUCTION: Ionic liquids have attracted much attention as an extraction solvent instead of traditional organic solvent in single-drop microextraction. However, non-volatile ionic liquids are difficult to couple with gas chromatography. Thus, the following injection system for the determination of organic compounds is described. OBJECTIVE: To establish an environmentally friendly, simple, and effective extraction method for preparation and analysis of the essential oil from aromatic plants. METHODS: The dynamic ultrasonic nebulisation extraction was coupled with headspace ionic liquid-based single-drop microextraction(UNE-HS/IL/SDME)for the extraction of essential oils from Forsythia suspense fruits. After 13 min of extraction for 50 mg sample, the extracts in ionic liquid were evaporated rapidly in the gas chromatography injector through a thermal desorption unit (5 s). The traditional extraction method was carried out for comparative study. RESULTS: The optimum conditions were: 3 µL of 1-methyl-3-octylimidazolium hexafluorophosphate was selected as the extraction solvent, the sample amount was 50 mg, the flow rate of purging gas was 200 mL/min, the extraction time was 13 min, the injection volume was 2 µL, and the thermal desorption temperature and time were 240 °C and 5 s respectively. Comparing with hydrodistillation (HD), the proposed method was environment friendly and efficient. CONCLUSION: The proposed method is environmentally friendly, time saving, with high efficiency and low consumption. It would extend the application range of the HS/SDME and would be useful especially for aromatic plants analysis.

Non-radical activation of low additive periodate by carbon-doped boron nitride for acetaminophen degradation: Significance of high-potential metastable intermediates.

Metal-free environmental-friendly and cost-effective catalysts for periodate (PI) activation are crucial to popularize their application for micropollutant removal in water. Herein, we report that carbon-doped boron nitride (C-BN) can efficiently activate PI to degrade acetaminophen under very low oxidant doses (40 µM) and over a relatively wide pH range (3-9). As expected, the significant reduction in periodate addition is likely to be due to the higher chemical utilization efficiency achieved by a non-radical oxidation pathway. This involved two main mechanisms, the electron transfer process mediated by the high-potential metastable C-BN-900-PI* complex and singlet oxygen. In this case, the CO groups and defects on the C-BN surface were identified as key active sites for PI activation. Notably, the prepared C-BN-900 had good cycling performance and the degradation efficiency is recovered after simple annealing. The existence of HCO3- and HA significantly inhibited the reaction, whereas Cl-, SO42-, and NO3- had little effect on the degradation of ACE. Overall, this study provides a new alternative method to regulate the non-radical pathway of boron nitride/periodate system.

Ultrasonic nebulisation extraction: extraction column coupled with liquid phase microextraction for analysis of the volatile organic compounds in Foeniculum vulgare Mill. as a model.

INTRODUCTION: As the concentrations of the volatile organic compounds are always low and their matrix is complex, it is necessary to pre-concentrate the volatile organic compounds before analysis. Ultrasonic nebulisation extraction with a self-made extraction column coupled with liquid phase microextraction is developed for the extraction of active constituents from spices. OBJECTIVE: To develop an environmentally compatible extraction technique for the preparation and analysis of the volatile organic compounds from spices. METHOD: The sample is placed into the nebulisation vessel of a nebulisation humidifier and a purging gas is blown through the vessel continuously. When the nebuliser is switched on, a ultrasonic fountain is formed by ultrasonic vibration and the target analytes are transferred from the sample solution to the vapour phase and then concentrated on the extraction solvent in the extraction column. After extraction for 3 min and allowed to stand upright for 5 min, the extract is analysed by GC and GC-MS. Different methods of comparison can then be carried out. RESULTS: Optimum conditions were found to be: 30 µL of n-tetradecane as the extraction solvent, a flow rate for the purging gas of 40 mL/min, a purging time of 3 min and a standing time was 5 min. The contents of constituents in the extract obtained by the proposed method were close to those obtained by hydrodistillation (HD). Moreover, the proposed method achieves higher enrichment efficiency. CONCLUSION: A method was developed for the extraction of volatile organic compounds from spices. The study has shown that it is a fast and environmentally sustainable technique.

Comparing income-related inequality on health service utilisation between older rural-to-urban migrant workers and older rural residents in China: a cross-sectional study.

OBJECTIVES: This study quantifies income-related inequalities in health service utilisation of older rural-to-urban migrant workers, by comparison with older rural residents, and identify with factors giving rise to the inequalities. SETTING: Nationally representative survey conducted in 29 provinces, municipalities and autonomous regions of China. PARTICIPANTS: 952 older rural-to-urban migrant workers and 2676 older rural residents were identified for further analysis. MAIN OUTCOME MEASURES: The probability of 2 weeks outpatient utilisation and inpatient utilisation. DESIGN: Coarsened exact matching was used to control the confounding factors between older rural-to-urban migrant workers and their rural counterparts. Concentration index was used to depict the inequality in health service utilisation, and it can be decomposed proportionally into contributions. RESULTS: The concentration indices of 2 weeks outpatient utilisation of two groups were -0.2061 (95% CI: 0.0193 to 0.1364) and -0.2041 (95% CI: 0.0594 to 0.1469), respectively. The concentration indices of inpatient of two groups were -0.0024 (95% CI: -0.0047 to 0.0639) and -0.1412 (95% CI: 0.0235 to 0.1125), respectively. The contributors of the inequality of 2 weeks outpatient utilisation of two groups were poor self-assessed health (SAH) status and richest group. The contributors of the inequality of inpatient utilisation of the rural elderly were poor SAH, fair SAH and sense of happiness. The horizontal inequality indices for 2 weeks outpatient of two groups were 0.1321 and -0.0.992, respectively. The horizontal inequality indices for the inpatient of two groups were -0.0032 and -0.0396, respectively. CONCLUSIONS: The results illustrated the existence of a socioeconomic gradient in health service utilisation between older rural-to-urban migrant workers and older rural residents. Our studies provided evidences to take full account of the health service needs, contributing to more reliable understandings of inequalities in the health service utilisation. The results may be referential to identify policy priorities conducive to the health policy reform in the process of active ageing in China.

Bradykinin-pretreated Human cardiac-specific c-kit+ Cells Enhance Exosomal miR-3059-5p and Promote Angiogenesis Against Hindlimb Ischemia in mice.

BACKGROUND: Protection of cardiac function following myocardial infarction was largely enhanced by bradykinin-pretreated cardiac-specific c-kit+ (BK-c-kit+) cells, even without significant engraftment, indicating that paracrine actions of BK-c-kit+ cells play a pivotal role in angiogenesis. Nevertheless, the active components of the paracrine actions of BK-c-kit+ cells and the underlying mechanisms remain unknown. This study aimed to define the active components of exosomes from BK-c-kit+ cells and elucidate their underlying protective mechanisms. METHODS: Matrigel tube formation assay, cell cycle, and mobility in human umbilical vein endothelial cells (HUVECs) and hindlimb ischemia (HLI) in mice were applied to determine the angiogenic effect of condition medium (CM) and exosomes. Proteome profiler, microRNA sponge, Due-luciferase assay, microRNA-sequencing, qRT-PCR, and Western blot were used to determine the underlying mechanism of the angiogenic effect of exosomes from BK-c-kit+. RESULTS: As a result, BK-c-kit+ CM and exosomes promoted tube formation in HUVECs and the repair of HLI in mice. Angiogenesis-related proteomic profiling and microRNA sequencing revealed highly enriched miR-3059-5p as a key angiogenic component of BK-c-kit+ exosomes. Meanwhile, loss- and gain-of-function experiments revealed that the promotion of angiogenesis by miR-3059-5p was mainly through suppression of TNFSF15-inhibited effects on vascular tube formation, cell proliferation and cell migration. Moreover, enhanced angiogenesis of miR-3059-5p-inhibited TNFSF15 has been associated with Akt/Erk1/2/Smad2/3-modulated signaling pathway. CONCLUSION: Our results demonstrated a novel finding that BK-c-kit+ cells enrich exosomal miR-3059-5p to suppress TNFSF15 and promote angiogenesis against hindlimb ischemia in mice.

Determinants of Differences in Health Service Utilization between Older Rural-to-Urban Migrant Workers and Older Rural Residents: Evidence from a Decomposition Approach.

BACKGROUND: The widening gap in health service utilization between different groups in mainland China has become an important issue that cannot be avoided. Our study explored the existence of differences and the causes of the differences in the health service utilization of older rural-to-urban migrant workers in comparison to older rural dwellers. Further, our study explored socioeconomic differences in health service utilization. METHODS: The data from the China Labor-Force Dynamic Survey in 2016, the data from the Urban Statistical Yearbook in 2016, and the Statistical Bulletin were used. Our study applied the latest Andersen Model according to China's current situation. Before we studied health service utilization, we used Coarsened Exact Matching to control the confounding factors. After matching, 2314 respondents were successfully matched (859 older rural-to-urban migrant workers and 1455 older rural dwellers). The Fairlie decomposition method was used to analyze the differences and the sources of health service utilization between older rural-to-urban migrant workers and their rural counterparts. RESULTS: After matching, the probability two-weeks outpatient for older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (7.57%). The probability of inpatient for older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (9.07%). Overall, 17.98% of the total difference for two-week outpatient utilization was due to the observed influence factors. Moreover, 71.88% of total difference in inpatient utilization was due to the observed influence factors. Income quantiles (49.57%), health self-assessments (80.91%), and the sex ratio in the community (-102.29%) were significant in the differences in inpatient utilization. CONCLUSIONS: The findings provide important insights into the socioeconomic differences in health service utilization among older rural-to-urban migrant workers and older rural residents in China. These insights urge the government to take full account of the heterogeneity in designing health security system reform and public health interventions targeting vulnerable groups.

Where there is pressure, there is motivation? The impact of challenge-hindrance stressors on employees' innovation performance.

Based on the conservation of resource theory, this manuscript explores the impact mechanism of the challenge and hindrance stressors on innovation performance, introduces emotional atmosphere as a mediation variable, and on this basis, it examines the moderating role of organizational climate on emotional atmosphere and innovation performance. A two-wave survey of 263 subordinates and 29 supervisors who come from multisource field offered support for our model. Results showed that challenge stressors have a positive effect on innovation performance, positive emotional atmosphere mediates the relationship between challenge stressors and innovation performance; hindrance stressors have a negative effect on innovation performance, and negative emotional atmosphere mediates the relationship between hindrance stressors and innovation performance. Organizational climate strengthens the positive relationship between positive emotional atmosphere and innovation performance and weakens the negative relationship between negative emotional atmosphere and innovation performance. This study enriches the existing literature by identifying the impact of stressors on employee innovation performance and has certain practical significance for optimizing the management of enterprises and improving employee innovation performance.

Mitochondrial Cardiomyopathy: Molecular Epidemiology, Diagnosis, Models, and Therapeutic Management.

Mitochondrial cardiomyopathy (MCM) is characterized by abnormal heart-muscle structure and function, caused by mutations in the nuclear genome or mitochondrial DNA. The heterogeneity of gene mutations and various clinical presentations in patients with cardiomyopathy make its diagnosis, molecular mechanism, and therapeutics great challenges. This review describes the molecular epidemiology of MCM and its clinical features, reviews the promising diagnostic tests applied for mitochondrial diseases and cardiomyopathies, and details the animal and cellular models used for modeling cardiomyopathy and to investigate disease pathogenesis in a controlled in vitro environment. It also discusses the emerging therapeutics tested in pre-clinical and clinical studies of cardiac regeneration.

Mesenchymal stem cell-derived extracellular vesicles for immunomodulation and regeneration: a next generation therapeutic tool?

Mesenchymal stem cells (MSCs) can be widely isolated from various tissues including bone marrow, umbilical cord, and adipose tissue, with the potential for self-renewal and multipotent differentiation. There is compelling evidence that the therapeutic effect of MSCs mainly depends on their paracrine action. Extracellular vesicles (EVs) are fundamental paracrine effectors of MSCs and play a crucial role in intercellular communication, existing in various body fluids and cell supernatants. Since MSC-derived EVs retain the function of protocells and have lower immunogenicity, they have a wide range of prospective therapeutic applications with advantages over cell therapy. We describe some characteristics of MSC-EVs, and discuss their role in immune regulation and regeneration, with emphasis on the molecular mechanism and application of MSC-EVs in the treatment of fibrosis and support tissue repair. We also highlight current challenges in the clinical application of MSC-EVs and potential ways to overcome the problem of quality heterogeneity.

Decomposing Differences of Health Service Utilization among Chinese Rural Migrant Workers with New Cooperative Medical Scheme: A Comparative Study.

The New Rural Cooperative Medical Insurance (NCMS) in China has provided benefits for rural migrant workers' health service utilization, but the financial coordination and mutual aid of NCMS is mainly based on the county or district as a unit, leading NCMS with the characteristics of regional segmentation. Our study aims to explore their health service utilization, as well as to decompose differences of the health service utilization into contributors. Data from the China Labor-Force Dynamic Survey in 2016 and Urban Statistical Yearbook in 2016 were used. We used coarsened exact matching to control the confounding factors in order to enhance the comparison of two groups. The Fairlie decomposition method was used to analyze the differences and the sources of health service utilization. Influencing factors of health service utilization for rural migrant workers with NCMS were diversified, especially contextual characteristic and individual characteristics. The proportion of ethnic minorities, the number of medical institutions for 10,000 people in the community, the number of beds for 10,000 people in the city, and the urban service quality index were the major contributors of the differences. The proportion of difference in the health service utilization of rural migrant workers with NCMS caused by health service need were -54.73% and 6.92%, respectively. The inequities of the probability of two weeks outpatient, and the probability of inpatients, were -0.006 and -0.007, respectively. There were substantial differences in the health service utilization between rural migrant workers with NCMS in the county/district and rural migrant workers with NCMS across the county/district. Our results illustrated the inequity from the differences on basis of characteristic effect and the discrimination effect. Our studies clarified that health service needs of should be fully considered, contributing to a more reliable understanding of the health service utilization of rural migrant workers.

Assessing Income-Related Inequality on Health Service Utilization among Chinese Rural Migrant Workers with New Co-Operative Medical Scheme: A Multilevel Approach.

Background: Eliminating inequality in health service utilization is an explicit goal of China's health system. Rural migrant workers with New Rural Cooperative Medical Insurance (NCMS) still face the dilemma of limited health service; however, there is a lack of analysis or measurement on the income-related inequality of health service utilization. Method: The nationally representative data of the China Labor-Force Dynamic Survey in 2016 were used for analysis. Multilevel regressions were used to obtain robust estimates and to account for various covariates associated with health service utilization of rural migrant workers with NCMS. The concentration index and its decomposition method were applied to quantify the income-related inequality of health service utilization of rural migrant workers. Result: The multilevel model analysis indicated that influencing factors of health service utilization were diversified, including gender, city service quality index, type of industry, the per capita annual income, marital status, health self-assessment, the community health index and the number of friends. The concentration indices of the total cost of inpatient and OOP cost of inpatient were 0.102 (95%CI: 0.031, 0.149), and the CI of OOP cost of inpatient was 0.094 (95%CI: 0.007, 0.119), respectively. The horizontal inequality indices of the total cost of inpatient and OOP cost of inpatient were 0.051 and 0.009, respectively. Conclusion: Our study presented a unique opportunity to examine the potential influence factors of health service utilization of rural migrant workers with NCMS, and highlighted that unequal health service utilization is evident among rural migrant workers with NCMS. This study provides important corroborative evidence to take full account of the contribution of each determinant to the inequality and health service needs among rural migrant workers with NCMS, in order to improve the basic medical insurance and social security systems-particularly for some marginal groups in China.