Trend and Equity in Maternal and Child Health Resource Allocation in China Since the New Health System Reform: A Nationwide Study from 2008 to 2020.

Purpose: China has made considerable efforts to promote the development of maternal and child health (MCH) care since the new health system reform in 2009. This study aims to evaluate the trend and equity of MCH resources allocation in China from 2008 to 2020 and provide a reference for rational distribution of MCH resources. Methods: Data were collected from the China Health Statistics Yearbook and China Statistics Yearbook. The number of MCH hospitals, licensed (assistant) physicians, registered nurses and beds were selected for the measurement of the equity of MCH resources allocation. The Health Resource Agglomeration Degree and Theil index were used in evaluating MCH resource allocation equity and to compare differences among regions. Results: From 2008 to 2020, the average annual growth rates for MCH hospitals, beds, licensed (assistant) physicians, and registered nurses were 0.72%, 6.95%, 5.04%, and 9.57%, respectively. However, regional disparities in the equity of MCH resource allocation have been identified. Although the western region has shown growth in MCH resource allocation by geography, the agglomeration degree of the four indicators remains less than 1, significantly lower than the average value of greater than 2 in the eastern region. Additionally, the equity of human resource allocation in the western region is lower than the equity in the allocation of institutions. In the densely populated eastern region, the equity of MCH resource allocation by population is decreasing, with the agglomeration degree of all four indicators below 1 in 2020. The disparity in healthcare resource allocation within regions is the main cause of inequitable MCH resource allocation in China. Conclusion: The allocation of MCH resources in China has improved since 2009, however, geographic equity needs further improvement, particularly in densely populated regions. Population and geographic balances should be considered in the development and implementation of MCH resource allocation policies, and improving intraregional equity should be the focus.

DeepMDSCBA: An Improved Semantic Segmentation Model Based on DeepLabV3+ for Apple Images.

The semantic segmentation of apples from images plays an important role in the automation of the apple industry. However, existing semantic segmentation methods such as FCN and UNet have the disadvantages of a low speed and accuracy for the segmentation of apple images with complex backgrounds or rotten parts. In view of these problems, a network segmentation model based on deep learning, DeepMDSCBA, is proposed in this paper. The model is based on the DeepLabV3+ structure, and a lightweight MobileNet module is used in the encoder for the extraction of features, which can reduce the amount of parameter calculations and the memory requirements. Instead of ordinary convolution, depthwise separable convolution is used in DeepMDSCBA to reduce the number of parameters to improve the calculation speed. In the feature extraction module and the cavity space pyramid pooling module of DeepMDSCBA, a Convolutional Block Attention module is added to filter background information in order to reduce the loss of the edge detail information of apples in images, improve the accuracy of feature extraction, and effectively reduce the loss of feature details and deep information. This paper also explored the effects of rot degree, rot position, apple variety, and background complexity on the semantic segmentation performance of apple images, and then it verified the robustness of the method. The experimental results showed that the PA of this model could reach 95.3% and the MIoU could reach 87.1%, which were improved by 3.4% and 3.1% compared with DeepLabV3+, respectively, and superior to those of other semantic segmentation networks such as UNet and PSPNet. In addition, the DeepMDSCBA model proposed in this paper was shown to have a better performance than the other considered methods under different factors such as the degree or position of rotten parts, apple varieties, and complex backgrounds.

[Expression of B7-H1 on peripheral myeloid dendritic cells in patients with HIV infection and its correlation with diseases progression].

OBJECTIVE: To investigate the features of B7-H1 expression on peripheral myeloid dendritic cells (mDCs) in patients with HIV infection and evaluate the correlations between B7-H1 expression and disease progression. METHODS: Peripheral blood samples from 82 treatment-naïve patients with HIV infection, 28 viral complete responders (CRs) under antiretroviral therapy (ART) and 14 healthy controls (HCs) were collected. Flow cytometry was applied to investigate the expression of B7-H1 on mDCs and CD4 cell counts. Plasma HIV-1 viral load was detected by bDNA. RESULTS: The frequency of B7-H1 expression on mDCs were 14.15% +/- 2.63%, 3.31% +/- 0.51% and 0.52% +/- 0.10% in AIDS patients, asymptomatic HIV infected individuals and HCs respectively. As compared with HCs, B7-H1 was significantly up-regulated on mDCs in HIV/AIDS patients. The order was as follows: AIDS patients > asymptomatic HIV infected individuals > HCs (all P < 0.05). Interestingly, the expression of B7-H1 on mDCs in long-term nonprogressors (LTNPs) was 3.12% +/- 1.14%. And it was lower than that in typical progressors (TPs) [8.12% +/- 1.37% (P = 0.001)]. Moreover, the expression of B7-H1 was negatively correlated with CD4 cell counts and positively correlated with plasma viral load in these patients (r = -0.631, P < 0.01 and r = 0.482, P < 0.01 respectively). The expression of B7-H1 on mDCs was significantly lower in ART complete responders than that in AIDS patients (6.59% +/- 1.43% vs 14.15% +/- 2.63%) (P < 0.01). Expression of B7-H1 on mDCs decreased markedly in patients whose CD4 cell counts greatly elevated after a successful antiretroviral treatment. CONCLUSION: The expression of B7-H1 on mDCs is significantly up-regulated in HIV/AIDS patients. With a close correlation with disease status, it acts as a marker of disease progression.

[HIV-1 subtype and the distribution in Yunnan province].

OBJECTIVE: To understanding the genetic subtype and its population and regional distribution of HIV-1 strains circulating in Yunnan province. METHODS: 788 plasma specimens collected in 2008-2009 from 15 distracts of Yunnan, were enrolled. Viral RNA were extracted and subjected to RT-PCR. 1584 bp full length gag gene, 3147 bp full length pol gene and 558 bp env (C2V3) fragment were amplified and directly sequenced. Full length gag and pol genes were connected together as a complete genetic region (location on HXB2: 790 - 5096) for genotyping. RESULTS: Of the 788 plasma specimens, a total number of 1728 genomic sequences including 599 gag, 564 pol and 525 env (C2V3) were successfully amplified and sequenced, with genotype of 617 samples identified. The subtypes of HIV-1 strains circulated in Yunnan were with the order of constituent ratio CRF08_BC (50.2%), CRF01_AE (25.0%), unknown recombinant forms (10.2%), CRF07_BC (9.2%), subtype C (2.9%) and subtype B (B') (2.4%). The distributions of subtypes showed significant regional differences and could be roughly divided into two forms:the CRF08_BC predominant areas represented by Lincang and Kunming, and the areas with CRF08_BC together with CRF01_AE coexistence, represented by Dehong and Xishuangbanna. The unknown recombinant forms accounted for more HIV infection in ethnic minorities (17.0%) than in ethnic Han (6.7%, P < 0.01). The distribution of subtypes varied significantly in the two primary routes of transmission for those infected through heterosexual contact. CRF08_BC and CRF01_AE were the dominant subtypes, accounting for 52.7% and 29.1% respectively. However, in IDUs, CRF08_BC strains accounted for half of the infection, while only 4.5% of the infections were caused by CRF01_AE, CRF07_BC while the unique recombinant forms were responsible for 15.5% infections. Of the 63 unknown recombinant forms, most (74.6%) were B (B') recombinant with C, while 25% were mosaic B and/or C fragments on the bases of CRF01_AE genome. CONCLUSION: The subtypes of HIV-1 strains circulated in Yunnan were complicated under the significant differences of regions, ethnics or routes of transmission.

Identification and characterization of two new HIV type 1 Unique (B/C) recombinant forms in China.

Recombination was most important in the generation of new viral strains and in the increase of HIV diversity. There were more and more new HIV-1 strains. Not only circulating recombinant forms (CRFs) but also unique recombinant forms (URFs) have been reported around the world. CRF07_BC and CRF08_BC were the two predominant CRFs circulated in Yunnan Province, southwest China. In the present study, we identified two new HIV Type 1 unique (B/C) recombinant gorms in Yunnan Province by nucleotide sequencing in two halves of HIV genome. Although the genomic structures of the two B/C recombinants were different from previously identified CRFs (CRF07_BC and CRF08_BC) and URFs in Yunnan Pprovince, they have several common recombination sites with CRF07_BC and CRF08_BC.

Prevention of mother-to-child transmission of HIV-1 using highly active antiretroviral therapy in rural Yunnan, China.

OBJECTIVE: To demonstrate that the use of highly active antiretroviral therapy (HAART) to interrupt transmission of HIV-1 from mother to baby is effective, safe, and feasible in a remote rural region of China. METHODS: Between November 2005 and May 2009, we enrolled 279 HIV-1-infected pregnant women to receive HAART to interrupt transmission of HIV-1 to their newborns across 16 counties in Yunnan. All women were started on triple combination therapy and submitted to regular blood draws to monitor CD4 T cells and viral load in their blood plasma. Infants received a single dose of nevirapine at birth and 1 or 4 weeks of zidovudine depending on the length of the mother's regimen. Exclusive formula feeding was recommended, and families were provided with 12-month supply of formula. Mothers and infant pairs were followed for 12-18 months postdelivery. RESULTS: Of 279 enrolled HIV-infected women, 222 (79.6%) were identified and started treatment by 28 weeks of pregnancy. Viral load was undetectable at time of delivery for 62.4% (136 of 218) at delivery, with a mean 1.76 log viral load reduction between enrollment and delivery. Two of 193 babies (1.0%) who have already been tested became infected with HIV-1. Seven of 223 babies have died. By Kaplan-Meier analysis, cumulative one-year survival was 96.3%. CONCLUSIONS: The project demonstrated that HAART for all infected pregnant women is effective with a vertical transmission rate of approximately 1%. Thus, this project provides a model for China to scale up its efforts to prevent mother-to-child transmission of HIV-1.