Structural Equation Modeling Analysis of Factors Influencing Family Doctor Contracted Services Based on Survey Data from Changning District, Shanghai.

Objective: Family doctors fulfill the role of gatekeepers in protecting residents' health with contracted services. Providing these valuable services involves multiple causes, relationships, and indirectly observable variables. This study used structural equation modeling to construct a dynamic model of the work of family doctors to provide a basis for incentives. Methods: This study used 2-year follow-up data from a survey of 294 family doctors in Changning District, Shanghai. Data were analyzed using confirmatory factor analysis and structural equation modeling. The measurement model and structural model were defined, identified, verified, integrated, and revised to identify the factors motivating family doctors to provide contracted services. A dynamic path for the family doctor contracted services model was established and eventually modified with six endogenous latent variables: cognition, environmental satisfaction, income satisfaction, support satisfaction, stability, and contracting performance, underpinned by 27 measurement variables. Result: The standardized regression coefficient of the effect of cognition on environmental satisfaction was 0.37 (P < 0.05) and the degree of variation interpretation was 0.14. The effect of cognition on income satisfaction was 0.54 (P < 0.05) and the degree of variation interpretation was 0.29. The effect of cognition on stability was 0.40 (P < 0.01), the effect of environmental satisfaction on stability was 0.12 (P < 0.05), and the effect of income satisfaction on stability was 0.22 (P < 0.05), all with a degree of variation interpretation of 0.369. Finally, the effect of stability on contracting performance was 0.51 (P < 0.05) with a degree of variation interpretation of 0.343. Conclusions: The degree of family doctors' understanding (cognition) of their own work largely determines their behavioral orientation and service effectiveness. These results raise the possibility of enhancing family doctors' work stability and improving the performance of contracted services by increasing the income of family doctors.

Yeast Synthetic Biology for the Production of Lycium barbarum Polysaccharides.

The fruit of Lycium barbarum L. (goji berry) is used as traditional Chinese medicine, and has the functions of immune regulation, anti-tumor, neuroprotection, anti-diabetes, and anti-fatigue. One of the main bioactive components is L. barbarum polysaccharide (LBP). Nowadays, LBP is widely used in the health market, and it is extracted from the fruit of L. barbarum. The planting of L. barbarum needs large amounts of fields, and it takes one year to harvest the goji berry. The efficiency of natural LBP production is low, and the LBP quality is not the same at different places. Goji berry-derived LBP cannot satisfy the growing market demands. Engineered Saccharomyces cerevisiae has been used for the biosynthesis of some plant natural products. Recovery of LBP biosynthetic pathway in L. barbarum and expression of them in engineered S. cerevisiae might lead to the yeast LBP production. However, information on LBP biosynthetic pathways and the related key enzymes of L. barbarum is still limited. In this review, we summarized current studies about LBP biosynthetic pathway and proposed the strategies to recover key enzymes for LBP biosynthesis. Moreover, the potential application of synthetic biology strategies to produce LBP using engineered S. cerevisiae was discussed.

Recent Advances on Feasible Strategies for Monoterpenoid Production in Saccharomyces cerevisiae.

Terpenoids are a large diverse group of natural products which play important roles in plant metabolic activities. Monoterpenoids are the main components of plant essential oils and the active components of some traditional Chinese medicinal herbs. Some monoterpenoids are widely used in medicine, cosmetics and other industries, and they are mainly obtained by plant biomass extraction methods. These plant extraction methods have some problems, such as low efficiency, unstable quality, and high cost. Moreover, the monoterpenoid production from plant cannot satisfy the growing monoterpenoids demand. The development of metabolic engineering, protein engineering and synthetic biology provides an opportunity to produce large amounts of monoterpenoids eco-friendly using microbial cell factories. This mini-review covers current monoterpenoids production using Saccharomyces cerevisiae. The monoterpenoids biosynthetic pathways, engineering of key monoterpenoids biosynthetic enzymes, and current monoterpenoids production using S. cerevisiae were summarized. In the future, metabolically engineered S. cerevisiae may provide one possible green and sustainable strategy for monoterpenoids supply.

Chuanhu anti-gout mixture versus colchicine for acute gouty arthritis: a randomized, double-blind, double-dummy, non-inferiority trial.

BACKGROUND: The Chuanhu anti-gout mixture has been used for many years in the treatment of gout in Chinese Traditional Medicine, and current methods for treatments for acute gouty arthritis have been either less effective or have had serious side effects. METHODS: In this 12-week, double-blind, double-dummy, non-inferiority study, outpatient individuals with newly diagnosed acute gouty arthritis were randomly assigned to receive Chuanhu anti-gout mixture or colchicine. Both the study investigators and the participants were masked to the treatment assignments. The primary outcome was the recurrence rate of acute gouty arthritis, and the secondary outcomes were changes in white blood cells (WHC) and C-reactive protein (CRP). This trial is registered at ISRCTN.org as trial ISRCTN65219941. RESULTS: A total of 176 patients were randomly assigned to receive either the Chuanhu anti-gout mixture or Colchicine. The overall recurrence rates in the Chuanhu anti-gout mixture group (CH group) and the Colchicine group (Col group) were 12.50% vs 14.77% (difference -2.22%, 95% confidence interval (95% CI): -10.78%~6.23%), meeting the predefined non-inferiority criterion of 15%, as did the data for WHC and CRP. The incidence of adverse events (mainly diarrhea) was less in the Col group than in the CH group (2.27% vs 28.41%, 95% CI 0.01~0.26). In addition, changes in blood uric acid, alanine aminotransferase, aspartate aminotransferase and creatinine in the CH group were significantly larger compared to those in the Col group (P<0.05). CONCLUSIONS: The Chuanhu anti-gout mixture was non-inferior to colchicine for the treatment of acute gouty arthritis. The study suggested that the Chuanhu anti-gout mixture can be considered an alternative choice for the treatment of acute gouty arthritis because of its lower incidence of adverse events and its protection of kidney and renal function.