Equity and prediction of health resource allocation of traditional Chinese medicine in China.

OBJECTIVE: To analyze the equity of health resource allocation of Traditional Chinese Medicine(TCM) and predict its development during the 14th Five-Year Plan period, and to provide a scientific basis for promoting the improvement of TCM service capacity. METHODS: The Chinese Mainland (excluding Hong Kong, Macao and Taiwan) was divided into the Northeast, Eastern, Central and Western regions, and the number of TCM medical institutions, the number of TCM beds, practitioners (assistants) of TCM and Chinese pharmacists from 2016 to 2020 were selected as evaluation indicators, and the equity of health resource allocation of TCM was evaluated by Concentration index(CI), Theil index(T) and Health resource agglomeration degree (HRAD), and the development of health resource of TCM during the 14th Five-Year Plan period was predicted by grey prediction model GM (1,1). RESULTS: The Concentration index of the number of TCM medical institutions and TCM beds is negative, and the allocation tends to the regions with low economic development level. The Concentration index of practitioners (assistants) of TCM and Chinese pharmacists is positive, and the allocation tends to the regions with higher economic development level. The number of TCM medical institutions, TCM beds, practitioners (assistants) of TCM and Chinese pharmacists' Theil index allocated by geography is larger than that allocated by population, which indicates that the equity of TCM health resources allocated by population is better than that allocated by geography. The number of TCM medical institutions, practitioners (assistants) of TCM and Chinese pharmacists in between regions by population contributed more than 72% to the Theil index, indicating that the inequity mainly comes from between regions. The number of TCM medical institutions, TCM beds, practitioners (assistants) of TCM and Chinese pharmacists in within regions by geography contributed more than 80% to the Theil index, indicating that the inequity mainly comes from within regions. The HRAD in the Eastern and Central regions is greater than 1, indicating that the equity is better by geography. The HRAD in the Western region is less than 1, indicating insufficient equity by geography. The HRAD/PAD of the Central region (except for the number of TCM beds in 2020) is less than 1, indicating that it cannot meet the medical needs of the agglomerated population. The HRAD/PAD of the Western region (excluding for the Chinese pharmacists) is greater than 1, indicating that the equity is better than that of the agglomeration population. CONCLUSION: The number of TCM medical institutions and TCM beds tends to regions with low economic development levels, while the number of practitioners (assistants) of TCM and Chinese pharmacists tends to regions with high economic development levels. The equity of the allocation of TCM health resources by population is better than that by geography, and the inequity of the allocation by geography mainly comes from within region. The allocation of health resources of TCM in the four regions is different, and there is a contradiction between equity and actual medical needs.

[Spatial Distribution of Nitrogen and Phosphorus Nutrients in the Main Stream and Typical Tributaries of Tuojiang River and Fujiang River].

The Tuojiang River and Fujiang River, two important tributaries of the upper reaches of the Yangtze River, have serious water pollution problems, among which nitrogen (N) and phosphorus (P) are the most important pollutants. Therefore, the aim of this study was to identify the influencing factors of water quality in different spaces and provide a scientific basis for the prevention and control of surface water pollution in the upper reaches of the Yangtze River and its tributaries. Water samples of trunk and tributaries in the Tuojiang River and Fujiang River were collected, and the spatial distribution characteristics of water N and P were analyzed. The results showed that the Tuojiang River and Fujiang River showed serious pollution of total nitrogen (TN), with a water quality worse Ⅴ-section proportion as high as 94% and 50%, respectively. Both rivers showed that TN and TP concentrations in the tributaries were higher than those in the main stream. For both rivers, total phosphorus (TP), with moderate pollution, was mainly concentrated in Ⅱ, Ⅲ, and Ⅳ class water quality, whereas the P pollution was more serious for the Fujiang River compared to that of the Fujiang River. For the Tuojiang River, nitrate nitrogen (NN) concentration from upstream to downstream showed a trend of decreasing after the first increase, with the maximum concentration of ammonium nitrogen (AN) exhibiting at the upstream site. In particular, TP concentration increased significantly after rivers flowed through a city. For the Fujiang River trunk stream, TN and NN concentration exhibited a gradually increasing trend from the middle to lower reaches. Generally, our study revealed that TN, TP, and NN in the rivers were affected by water pH and water temperature (T). Therefore, the control of N and P pollution in rivers should pay attention to the influence of water environmental factors.

Clinical efficacy and safety of Aidi injection plus paclitaxel-based chemotherapy for advanced non-small cell lung cancer: A meta-analysis of 31 randomized controlled trials following the PRISMA guidelines.

ETHNOPHARMACOLOGICAL RELEVANCE: As an important Chinese herb injection, Aidi injection is composed of the extracts from Astragalus, Eleutherococcus senticosus, Ginseng, and Cantharis. Aidi injection plus paclitaxel-based chemotherapy is often used to in the treatment of non-small cell lung cancer (NSCLC) in China. AIM OF THE STUDY: The objective of this study is to further confirm whether Aidi injection can improve the tumor responses and survivals, and reveal its safety, optimal usage and combination with paclitaxel. MATERIALS AND METHODS: A meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All randomized controlled trials (RCTs) concerning the Aidi injection plus paclitaxel-based chemotherapy for NSCLC were selected. Main outcomes were objective response rate (ORR), disease control rate (DCR), survivals, quality of life (QOL) and adverse drug reactions (ADRs). All data were extracted by using a standard data extraction form and synthesized through meta-analysis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used for rating the quality of evidence. RESULTS: Thirty-one RCTs involving 2058 patients were included, and most trials had an unclear methodological bias risk. The risk ratio (RR) and 95% confidence intervals (CI) of ORR, DCR, QOL, neutropenia, thrombocytopenia, gastrointestinal toxicity and liver injury were as following: 1.32 (1.20-1.46), 1.14 (1.09-1.20), 1.89 (1.66-2.16), 0.61 (0.51-0.74), 0.62 (0.45-0.87), 0.59 (0.49-0.72) and 0.52 (0.36-0.75). Compared to chemotherapy alone, all differences were statistically significant. Subgroup analysis showed that only with the TP, Aidi injection could increase the ORR and DCR. Treatment with 100 ml, 80 ml or 50 ml/time, and 14 days/2 cycles or 21 days/2-4 cycles, Aidi injection could increase the ORR and DCR, respectively. Sensitivity analysis showed that the results had good robustness. None of the trials reported the overall survivals (OS), progression free survival (PFS). The quality of evidences was moderate. CONCLUSIONS: Current moderate evidence revealed that Aidi injection plus paclitaxel-based chemotherapy, especially TP can significantly improve the clinical efficacy and QOL for patients with stage III/IV NSCLC. Aidi injection can relieve the risk of hematotoxicity, gastrointestinal toxicity and liver injury in patient with NSCLC receiving paclitaxel-based chemotherapy. The optimal usage may be 50 ml/time and 14 days/2 cycles.

Can Aidi injection improve overall survival in patients with non-small cell lung cancer? A systematic review and meta-analysis of 25 randomized controlled trials.

OBJECTIVES: Aidi injection can significantly improve clinical response and reduce radiochemotherapy related toxicity. Can Aidi injection improve the survival in non-small-cell lung cancer (NSCLC)? Therefore, to further reveal it, we systematically evaluated all related studies. METHODS: We collected all studies about Aidi injection for NSCLC in Medline, Embase, Web of Science(ISI), China National Knowledge Infrastructure Database(CNKI), Chinese Scientific Journals Full-Text Database(VIP), Wanfang, China Biological Medicine Database (CBM), Cochrane Central Register of Controlled Trials (CENTRAL), Chinese clinical trial registry (Chi-CTR) and WHO International Clinical Trials Registry Platform (WHO-ICTRP), and US-clinical trials (established to June 2016). We evaluated their quality according to the Cochrane evaluation handbook of randomized controlled trials (RCTs) (5.1.0), extracted data following the PICO principles, and synthesized the data by meta-analysis. RESULTS: We included 25 RCTs involving 2662 patients with NSCLC which most studies had unclear risk of bias. The merged risk ratios (RR) values and their 95% CI of meta-analysis for objective response rate (ORR) and disease control rate (DCR) were as following: 1.19(1.09-1.29) and 1.07(1.03-1.11). The merged RR values and their 95% CI of meta-analysis for the 1-, 2- and 3-year overall survival (OS) rate were as following: 1.23(1.14-1.33), 1.46(1.22-1.74) and 1.67(1.04-2.69). All differences were statistically significant. Subgroup analysis showed that Aidi injection plus different therapies had different effects on 1-, 2- and 3-year OS rate. Sensitivity analysis showed that the RR of ORR, DCR, 1- and 2- year OS rate had good stability, and 3-year OS rate had poor stability. CONCLUSIONS: Available evidences indicate that Aidi injection can significantly improve the clinical response and OS rates in patients with NSCLC and especially, the 1- and 2-year OS rate. But, Aidi injection plus different therapies had different effects on overall survival. It is still unclear whether Aidi injection can improve the PFS and HR.

[Ginsenoside Rh2 induces apoptosis and autophagy of K562 cells by activating p38].

To study the effect of ginseng saponin Rh2 in inducing apoptosis of human leukemia K562 cells, and explore its mechanism from the aspect of autophagy pathway. CCK-8 assay was used to examine the growth inhibition of human leukemia cell lines K562 treated with ginsenoside Rh2; flow cytometry (FCM) was used to detect cell apoptosis; Hoechst staining was used to observe the changes of cell morphological apoptosis; Acridine and MDC staining were used to detect the effects of the Rh2 on autophagy; Western blot and RT-PCR were used to detect the expression levels of the proteins closely associated with autophagy and apoptosis. In order to study the effect of autophagy in proliferation and apoptosis, we used the autophagy inhibitor (3-MA).CCK-8 indicated that Rh2 at low concentration could effectively inhibit the proliferation of leukemia cellsin dose- and time-dependent manners in K562 cells; FCM indicated that Rh2 induced apoptosis; Hoechest staining showed that K562 cells had typical apoptotic morphological changes by treated Rh2; Acridine and MDC staining showed that Rh2 enhanced the green fluorescence and a large number of acidic autophagy vesicles were present; Western blot and RT-PCR results showed that Rh2 increased the expression levels of Beclin-1, LC3A, LC3B, activated Caspase-3 and p-p38 in K562 cells; application of autophagy inhibitors(3-MA) could weaken the inhibition effect of Rh2 on proliferation and induction effect on apoptosis in K562 cells. Ginsenoside Rh2 inhibited the proliferation and induced apoptosis probably through activating p-p38, and inducing cell autophagy signaling pathway in K562 cells.