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Brown adipose tissue undergoes rapid postnatal development to mature and plays a crucial role in thermoregulation and energy expenditure, which protects against cold and obesity. Herein, it is shown that the expression of Trim21 mRNA level of interscapular brown adipose tissue elevates after birth, and peaks at P14 (postnatal day 14). Trim21 depletion severely impairs the maturation of interscapular brown adipose tissue, decreases the expression of a series of thermogenic genes, and reduces energy expenditure. Consistently, the loss of Trim21 also leads to a suppression of white adipose tissue "browning", in response to cold exposure and a ß-adrenergic agonist, CL316,243. In addition, Trim21-/- mice are more prone to high-fat diet-induced obesity compared with the control littermates. Taken together, the study for the first time reveals a critical role of Trim21 in regulating iBAT postnatal development and thermogenesis.
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Tejido Adiposo Pardo , Tejido Adiposo Blanco , Animales , Ratones , Tejido Adiposo Pardo/metabolismo , Tejido Adiposo Blanco/metabolismo , Metabolismo Energético/genética , Obesidad/genética , Obesidad/metabolismo , Termogénesis/genéticaRESUMEN
BACKGROUND: Both tuberculosis (TB) and diabetes mellitus (DM) are major public health problems threatening global health. TB patients with DM have a higher bacterial burden and affect the absorption and metabolism for anti-TB drugs. Drug-resistant TB (DR-TB) with DM make control TB more difficult. METHODS: This study was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. We searched PubMed, Excerpta Medica Database (EMBASE), Web of Science, ScienceDirect and Cochrance Library for literature published in English until July 2022. Papers were limited to those reporting the association between DM and treatment outcomes among DR-TB and multidrug-resistant TB (MDR-TB) patients. The strength of association was presented as odds ratios (ORs) and their 95% confidence intervals (CIs) using the fixed-effects or random-effects models. This study was registered with PROSPERO, number CRD: 42,022,350,214. RESULTS: A total of twenty-five studies involving 16,905 DR-TB participants were included in the meta-analysis, of which 10,124 (59.89%) participants were MDR-TB patients, and 1,952 (11.54%) had DM history. In DR-TB patients, the pooled OR was 1.56 (95% CI: 1.24-1.96) for unsuccessful outcomes, 0.64 (95% CI: 0.44-0.94) for cured treatment outcomes, 0.63 (95% CI: 0.46-0.86) for completed treatment outcomes, and 1.28 (95% CI: 1.03-1.58) for treatment failure. Among MDR-TB patients, the pooled OR was 1.57 (95% CI: 1.20-2.04) for unsuccessful treatment outcomes, 0.55 (95% CI: 0.35-0.87) for cured treatment outcomes, 0.66 (95% CI: 0.46-0.93) for treatment completed treatment outcomes and 1.37 (95% CI: 1.08-1.75) for treatment failure. CONCLUSION: DM is a risk factor for adverse outcomes of DR-TB or MDR-TB patients. Controlling hyperglycemia may contribute to the favorite prognosis of TB. Our findings support the importance for diagnosing DM in DR-TB /MDR-TB, and it is needed to control glucose and therapeutic monitoring during the treatment of DR-TB /MDR-TB patients.
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Diabetes Mellitus , Tuberculosis Resistente a Múltiples Medicamentos , Humanos , Diabetes Mellitus/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Antituberculosos/uso terapéutico , Factores de Riesgo , Resultado del TratamientoRESUMEN
Fabricating PMN-PT composites, the core component of high-frequency (> 30 MHz) transducers, remains challenging due to their poor machinability and ultrasmall kerfs. This urgent problem is significantly impeding the development of PMN-PT ultrasonic transducers for use in clinical research, biomedical sciences, and nondestructive testing (NDT). In this study, high-quality PMN-0.3PT/epoxy 1-3 composites at 30 and 50 MHz were manufactured using a modified picosecond (1.5 ps) laser technique. Their performance was thoroughly analyzed, which was comparable to that with low-stress dry plasma etching. There were fewer microcracks around PMN-PT pillars. The minimum kerf was less than [Formula: see text], and the highest aspect ratio was larger than 7.5. The microdomain morphology and hysteresis loops of PMN-PT pillars further confirmed that composites still maintained excellent piezoelectric performance and suffered fewer damages during laser cutting. The characterization results exhibited a large electromechanical coupling (>0.77), a high dielectric constant (>1600), and a relatively low acoustic impedance (< 17 Mrayls). The ultrasonic transducers with center frequencies of 30 and 50 MHz were designed and prototyped to validate the performance of composites. The transducers showed broad bandwidth (>80%), high two-way insertion loss (IL) (>-23 dB), and imaging resolution superior to [Formula: see text]. Finally, the C-scan experiments of IC chips were also used to further illustrate the applicability of transducers. These encouraging results further demonstrated that ultrafast laser technology will bring more accessible and affordable methods for fabricating high-frequency PMN-PT composite transducers with excellent performance.
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Osteoarthritis (OA) is the most common joint disease and the leading cause of disability in elderly individuals. Despite rapid advances in imaging techniques, early OA diagnosis remains a clinical challenge. In the present study, the feasibility of early OA diagnosis was explored via near-infrared spectroscopy (NIRS) combined with aquaphotomics. Synovial fluid samples from 65 cases of OA categorized as mild, moderate, and severe according to theKellgrenandLawrence classification criteria were analyzed via NIRS. The 1st overtone of water (1300-1600 nm) was considered as the research object for an aquaphotomics model, and aquagrams of the mild, moderate, and severe OA cases were generated using 12 water absorption patterns for early OA diagnosis.The aquaphotomics results exhibited clear differences in the region of 1300-1500 nm, and the number of hydrogen bonds of different water species (1412,1424, 1482, and 1496 nm) evidently correlated with OA occurrence and development. With OA progression, the absorption intensity of water molecules without hydrogen bonds (1412 nm/1424 nm) became stronger, while the absorption intensity of water molecules with four hydrogen bonds (1482 nm/1496 nm) decreased.These results together reveal that the established accurate and rapid early OA diagnosis model based on NIRS combined with aquaphotomics is effective and feasible, and that the number of hydrogen bonds can be used as a biomarker for early OA diagnosis.
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Osteoartritis , Espectroscopía Infrarroja Corta , Humanos , Anciano , Espectroscopía Infrarroja Corta/métodos , Fenómenos Químicos , Enlace de Hidrógeno , Agua/químicaRESUMEN
BACKGROUND: OS is the most frequent malignant bone tumor with a poor prognosis. TRIM21 has been reported to play a critical role in OS by regulating the expression of the TXNIP/p21 axis and inhibiting the senescence of OS cells. AIM: Investigation of the molecular mechanism of tripartite motif 21 (TRIM21) in osteosarcoma (OS) would shed light on the understanding of the pathogenesis of OS. OBJECTIVE: This study aimed to explore the mechanism regulating the protein stability of TRIM21 in the process of OS senescence. METHODS: Human U2 OS cells were used to establish stable cells overexpressing TRIM21 (induced by Dox) or knocking down TRIM21. The co-immunoprecipitation (co-IP) assay was used to examine the interaction between TRIM21 and HSP90. Immunofluorescence (IF) assay was used to observe colocalization in OS cells. Western blot analysis was applied to detect the protein expression, and quantitative real-time PCR (qRT-PCR) assay was used to test the mRNA expression of corresponding genes. SA-ß-gal staining was used to evaluate OS senescence. RESULTS: In this study, we verified the interaction between HSP90 and TRIM21 using a co-IP assay. Knockdown or inhibition of HSP90 with its inhibitor 17-AAG accelerated the degradation of TRIM21 by the proteasome in OS cells. CHIP E3 ligase mediated this degradation of TRIM21, with the knockdown of CHIP rescuing the downregulation of TRIM21 induced by 17-AAG. TRIM21 inhibited OS senescence and downregulated the expression of senescence marker p21, while CHIP exhibited an opposite regulatory role on p21 expression. CONCLUSION: Taken together, our results demonstrated that HSP90 is responsible for the stabilization of TRIM21 in OS and that the CHIP/TRIM21/p21 axis controlled by HSP90 affects the senescence of OS cells.
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Senescencia Celular , Proteínas HSP90 de Choque Térmico , Osteosarcoma , Humanos , Benzoquinonas/farmacología , Línea Celular Tumoral , Lactamas Macrocíclicas/farmacología , Osteosarcoma/genética , Osteosarcoma/metabolismo , Proteínas HSP90 de Choque Térmico/antagonistas & inhibidores , Proteínas HSP90 de Choque Térmico/genética , Proteínas HSP90 de Choque Térmico/metabolismo , Inhibidor p21 de las Quinasas Dependientes de la Ciclina/metabolismoRESUMEN
Enhanced piezoelectric, dielectric properties and thermal stability in ternary relaxor-PbTiO3 based ferroelectric crystals are expected to develop the next-generation of electromechanical devices. However, due to their increased disorder compared to other ferroelectrics, designing a controllable phase boundary structure and engineered domain remains a challenging task. Here, we construct a monoclinic heterophase coexisting in a ternary Pb(In1/2Nb1/2)O3-Pb(Mg1/3Nb2/3)O3-PbTiO3 single crystal with optimized composition and an ultrahigh piezoelectric coefficient of 1400 pC N-1, to quantify the correlation between spontaneous nanopolarity and phase heterogeneity, in an attempt to understand the origin of the exceptional functionalities. By designing an in situ high-resolution spectroscopic-microscopic technique, we have observed Ma and Mc heterophase mixtures spatially separated by the monoclinic heterophase boundary (MHB), which are responsible for the ferroelectric-dominated and relaxor-ferroelectric-dominated nanodomain structure, respectively. Internal energy mapping from optical soft mode dynamics reveals the inhomogeneous polarization and local symmetry on both sides of the MHB. Various molecular polarizabilities and localized octahedral distortions correlate directly with monoclinic regions and electromechanical contribution. This work clarifies the heterogeneity between structure, energy, and polar order and provides a new design freedom for advanced relaxor ferroelectrics.
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Transparent ferroelectric crystals with high piezoelectricity are challenging to build because of their complex structure and disordered domains in rhombohedral relaxor ferroelectrics. There are eight domains along the <111> direction, which cause light scattering. In this study, perfect transparency is achieved along the [110] and [001] directions in [110]-poled rhombohedral 0.72Pb(Mg1/3 Nb2/3 )O3 -0.28PbTiO3 (PMN-PT) crystals, which have a high d31 value of 1700 pC N-1 and a high electro-optic coefficient γ33 of 320 pm V-1 . This implies that the [110]-oriented rhombohedral PMN-0.28PT crystal can realize the mode of transverse modulation, whereas the [001]-oriented PMN-0.28PT crystal is more suitable for the longitudinal mode. Through piezoresponse force microscopy (PFM), it is confirmed that the [110]-poled rhombohedral PMN-PT crystals form 71° layered domains, which are similar to the 109° layered domains of the [001]-oriented transparent crystal. Combined with PFM and birefringence microscopy, the degradation of domains and thickness dependence of piezoelectricity provide clear evidence for the relationship between the engineered domain structures and piezoelectric properties, which should be considered in the design of piezoelectric or electro-optic devices with excellent performance. This work enriches the research on ferroelectric domain engineering for excellent transparency and high piezoelectricity to provide new ideas for photoacoustic devices.
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A decrease of piezoelectric properties in the fabrication of ultra-small Pb(Mg1/3Nb2/3)-x%PbTiO3 (PMN-x%PT) for high-frequency (>20 MHz) ultrasonic array transducers remains an urgent problem. Here, PMN-31%PT with micron-sized kerfs and high piezoelectric performance was micromachined using a 355 nm laser. We studied the kerf profile as a function of laser parameters, revealing that micron-sized kerfs with designated profiles and fewer micro-cracks can be obtained by optimizing the laser parameters. The domain morphology of micromachined PMN-31%PT was thoroughly analyzed to validate the superior piezoelectric performance maintained near the kerfs. A high piezoresponse of the samples after micromachining was also successfully demonstrated by determining the effective piezoelectric coefficient (d33*~1200 pm/V). Our results are promising for fabricating superior PMN-31%PT and other piezoelectric high-frequency (>20 MHz) ultrasonic array transducers.
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BACKGROUND: Syndactyly type II (synpolydactyly, SPD) is a rare autosomal dominant inherited disease with higher incomplete penetrance. Currently, several variants in HOXD13 and one deletion in FBLN1 have been associated with SPD. However, the causative variants in several SPD families and their etiological mechanism are still largely unknown. METHODS: Whole exome and PCR-sanger sequencing followed by two-point linkage analysis were performed to identify the pathogenic variant in a six-generation Chinese pedigree. Homology modeling in combination with the RNAi and qRT-PCR experiments was used for revealing the pathogenic mechanism of the TTC30B variant. RESULTS: A six-generation SPD family was reported. The affected subjects in this family had no other clinical malformation beyond SPD. A rare missense variant c.1157C>T [p.Ala375Val] (chr2:178416368, hg19) in TTC30B was demonstrated to be responsible for this SPD family. The modeling structure indicated that the Ala375 was evolutionarily and structurally conserved. The variant p.Ala375Val was predicted to be deleterious for protein structure and/or stability. Two-point linkage analysis resulted in a maximum LOD score of 3.1444 (Pâ¯=â¯0.000071). Furthermore, we found that TTC30B was regulated by the Shh signaling pathway and the abnormal expression of TTC30B will affect the activation of the Shh signaling pathway in human retinal pigment epithelial cells. CONCLUSIONS: This study demonstrates for the first time that an IFT (intraflagellar transport) - related gene TTC30B is implicated with SPD.
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Pueblo Asiatico/genética , Proteínas del Citoesqueleto/genética , Mutación/genética , Linaje , Sindactilia/genética , Secuencia de Aminoácidos , Secuencia de Bases , Secuencia Conservada/genética , Ciclohexilaminas/farmacología , Proteínas del Citoesqueleto/química , Evolución Molecular , Femenino , Proteínas Hedgehog/metabolismo , Humanos , Masculino , Modelos Moleculares , Transducción de Señal , Sindactilia/diagnóstico por imagen , Tiofenos/farmacologíaRESUMEN
PURPOSE: The objectives of the present study were to characterize the clinical isolates prevailing in the northeast of Jiangsu and to investigate the mode of transmission. The study also aimed to explore the extent to which Mycobacterium tuberculosis strains contributed to drug resistance and the possible factors related to the recent transmission. PATIENTS AND METHODS: We consecutively enrolled 912 culture-confirmed pulmonary tuberculosis (TB) cases from 1 January 2013 to 31 December 2014 in Lianyungang City, which is located in the center of China's vast ocean area and the northeast of Jiangsu province. Isolates were genotyped using 15-locus mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing. The Hunter-Gaston discrimination index (HGDI) was used to estimate the discriminatory power and diversity of molecular markers. RESULTS: Among 741 successfully genotyped isolates, 144 (19.43%) strains formed 46 clusters, while 597 (80.57%) isolates had the unique MIRU pattern. The total HGDI for all 15 loci was 0.999. The average cluster size was 3 (2-13) patients. The estimated proportion of recent transmission was 13.34%. Patients with unfavorable treatment outcomes were infected with clustered strains at a higher proportion than were those with favorable treatment outcomes (adjusted OR: 1.78, 95% CI: 1.14-2.85, P=0.012). CONCLUSION: The probability of recent TB transmission was relatively low in the study site, while the cases mainly arose from the activation of previous infection. Spatial analysis showed that strains forming larger clusters had the characteristics of regional aggregation.
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RATIONALE: For traumatic upper limb amputees, the prohibitive cost of a custom-made prosthesis brings an insufferable financial burden for their families in developing countries. Three-dimensional (3D) printing allows for creating affordable, lightweight, customized, and well-fitting prosthesis, especially for the growing children. PATIENT CONCERNS: We presented a case of an 8-year-old boy, who suffered a traumatic right wrist amputation as result of a mincing machine accident. The patient was immediately sent to the emergency orthopedics department after the accident. DIAGNOSES: He was diagnosed as severed mangled limb crash injury at the level of the right wrist with a Mangled Extremity Severity Score of 8. INTERVENTIONS: A wrist disarticulation was performed and a 3D-printed prosthetic hand was designed and manufactured for this child. A personalized prosthetic rehabilitation training was applied after the prosthesis installation at 6 months postoperatively. The function of the prosthesis was evaluated at 1-month and 3-month follow-up using the Children Amputee Prosthetics Projects (CAPP) score and the University Of New Brunswick Test Of Prosthetic Function for Unilateral Amputees (UNB test). OUTCOMES: The materials cost <20 dollars. The printing took <8âhours and the component assembling was completed within 20 minutes. During the 3-month follow-up, the child's parents were satisfied with the prosthesis and the UNB test showed the significantly improved function of the prosthesis. LESSONS: This novel 3D-printed upper limb prosthesis in a child with the traumatic wrist amputation might serve as a practical and affordable alternative for children in developing countries and those lacking access to health care providers. A personalized prosthetic rehabilitation needs to be undertaken and more clinical studies are warranted to validate the potential superiority of similar 3D-printed prostheses.
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Amputación Traumática/terapia , Miembros Artificiales , Impresión Tridimensional , Diseño de Prótesis , Niño , Mano , Humanos , MasculinoRESUMEN
Genetic factors affect host susceptibility to pathogens. In this population-based case control study, we explored the genetic polymorphisms of IL-17, TLR4 and miR-146a in association with pulmonary tuberculosis in a Chinese Han population. We recruited 1601 pulmonary tuberculosis patients matched with 1526 healthy controls and genotyped twelve functional single nucleotide polymorphisms (SNPs). After the correction for multiple comparisons, two SNPs (rs10759932 and rs2737190) in the TLR4 gene remained significant. Individuals carrying the rs2737190-AG genotype (vs. AA) had a significantly increased risk of either clinical tuberculosis (OR: 1.31, 95% CI: 1.11-1.53) or sputum smear-positive tuberculosis (OR: 1.35, 95% CI: 1.13-1.61). Stratification analysis revealed that the effects of genetic variations on tuberculosis were more evident among non-smokers. People with haplotype TLR4 rs10983755G-rs10759932C had a significantly increased risk of tuberculosis (OR: 3.43, 95% CI: 2.34-5.05). Moreover, we found that SNPs of rs3819024 in IL-17A and rs763780 in IL-17F were weakly related to a prognosis of tuberculosis. Our results suggest that genetic polymorphisms of IL-17 and TLR4 may play a role in host susceptibility to tuberculosis in the Chinese Han population. More work is necessary to identify specific causative variants of tuberculosis underlying the observed associations.
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Predisposición Genética a la Enfermedad/genética , Interleucina-17/genética , MicroARNs/genética , Polimorfismo de Nucleótido Simple/genética , Receptor Toll-Like 4/genética , Pueblo Asiatico/genética , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Riesgo , Tuberculosis Pulmonar/genéticaRESUMEN
BACKGROUND AND AIM: Hepatoprotectants are routinely prescribed in China to prevent anti-tuberculosis drug-induced liver injury (ATLI). However, their biological mechanisms have not yet been clearly demonstrated. This study aims to evaluate the preventive effects of Silybum marianum against drug-induced liver injury among tuberculosis patients and to provide clinical guidelines for tuberculosis management in China. METHODS: A randomized controlled trial was performed in Jiangsu, China. Tuberculosis patients were randomly allocated to the experimental group (anti-tuberculosis therapy plus S. marianum capsule) or the control group (anti-tuberculosis therapy plus vitamin C tablet). The primary outcomes were the occurrence of probable and possible ATLI, the peak aspartate aminotransferase/alanine aminotransferase ratio and the maximum altered alkaline phosphatase or gamma-glutamyl transferase. RESULTS: The final analysis comprised 183 cases in the experiment group and 187 cases in the control group. The risk of developing probable ATLI was not significantly different between the two groups. During the follow-up period, 43.72% of cases in the experiment group and 35.83% of cases in the control group were determined to have possible ATLI (relative risk = 1.23, 95% confidence interval: 0.94-1.54). When using a more strict definition of possible ATLI, the adjusted relative risk (95% confidence interval) was 1.76 (1.14-2.56). The risks of adverse drug reactions, prolonged treatment length, taking second-line tuberculosis drugs, and the clearance of tuberculosis bacteria were similar between the two groups. CONCLUSIONS: No significant preventive effect of silymarin was found for either lowering the risk of liver injury or boosting the positive outcomes. Worse, we even found a potential risk of liver damage caused by the hepatoprotectant.
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Antituberculosos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Fitoterapia , Sustancias Protectoras/administración & dosificación , Silybum marianum , Silimarina/administración & dosificación , Adulto , Alanina Transaminasa/sangre , Fosfatasa Alcalina/sangre , Aspartato Aminotransferasas/sangre , Biomarcadores/sangre , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sustancias Protectoras/efectos adversos , Riesgo , Silimarina/efectos adversos , gamma-Glutamiltransferasa/sangreRESUMEN
The clinical relevance of aberrant DNA methylation is being increasingly recognized in breast cancer. The present study aimed to evaluate the promoter methylation status of seven candidate genes and to explore their potential use as a biomarker for the diagnosis of breast cancer. A total of 70 Chinese patients with breast cancer were recruited, and matched with 20 patients with benign breast disease (BBD). Methylation-specific polymerase chain reaction was performed to measure the methylation status of selected genes. The protein expression of candidate genes was determined by immunohistochemistry. Hypermethylation of Breast cancer 1, early onset; DNA repair associated (BRCA1), glutathione S-transferase pi 1 (GSTP1), cyclin dependent kinase inhibitor 2A, O-6-methylguanine-DNA methyltransferase, phosphatase and tensin homolog, retinoic acid receptor beta 2 and cyclin D2 was observed to be more common in cancerous tissues (24.3, 31.4, 40.0, 27.1, 48.6, 55.7 and 67.1%, respectively) as compared with BBD controls (0.0, 0.0, 20.0, 25.0, 40.0, 40.0 and 45.0%, respectively). Immunohistochemical analysis demonstrated a correlation between the methylation of the target gene and downregulation of protein expression. When BRCA1 and GSTP1 were combined as the biomarker, the area under the receiver operating characteristic curve reached 0.721 (95% confidence interval, 0.616-0.827). The present findings indicated that promoter methylation of cancer-related genes was frequently observed in patients with breast cancer and was associated with various clinical features. Hypermethylation of BRCA1 and GSTP1 may be used as promising biomarkers for breast cancer.
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OBJECTIVE: This study aims to describe the findings from a massive endoscopic screening program in a high-risk area of China and to evaluate the prognosis of patients diagnosed through endoscopic screening compared with those diagnosed at usual hospital visits because of illness. METHODS: In 2006, an early detection and treatment program was initiated in Yangzhong county, China. Local residents aged 40-69 years were eligible for free endoscopic screening. Endoscopic examination was performed with Lugol's iodine staining, followed by biopsies. Patients diagnosed with esophageal or gastric cancer were referred for treatment and followed to assess their long-term survival status. RESULTS: From 2006 through 2012, we screened 12453 participants, including 5334 (42.8%) men and 7119 (57.2%) women. The average age was 52.8 ± 8.0 years. We detected 166 patients with upper digestive tract cancers, including 106 cancers in the esophagus (detection rate: 0.85%) and 60 cancers in the stomach (detection rate: 0.48%). Of these patients, 98.11% with esophageal cancer and 100% with gastric cancer were defined as at the early stage. In the process of follow-up, 17 patients died from cancer-related causes, and the median survival time was greater than 85 months. The overall survival rates for 1, 3 and 5 years were 98.0%, 90.0% and 89.0%, respectively. A significant positive effect was observed for the long-term survival of patients diagnosed through massive endoscopic screening. CONCLUSIONS: In a high-risk population, massive endoscopic screening can identify early stage carcinoma of esophageal and gastric cancers and improve patients' prognosis through early detection and treatment.
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Detección Precoz del Cáncer , Endoscopía/métodos , Neoplasias Esofágicas/patología , Esofagoscopía/métodos , Neoplasias Gástricas/patología , Adulto , Anciano , China/epidemiología , Neoplasias Esofágicas/epidemiología , Neoplasias Esofágicas/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/mortalidad , Tasa de SupervivenciaRESUMEN
OBJECTIVE: China has implemented a free-service policy for tuberculosis. However, patients still have to pay a substantial proportion of their annual income for treatment of this disease. This study describes the economic burden on patients with tuberculosis; identifies related factors by comparing two areas with different management models; and provides policy recommendation for tuberculosis control reform in China. METHODS: There are three tuberculosis management models in China: the tuberculosis dispensary model, specialist model and integrated model. We selected Zhangjiagang (ZJG) and Taixing (TX) as the study sites, which correspond to areas implementing the integrated model and dispensary model, respectively. Patients diagnosed and treated for tuberculosis since January 2010 were recruited as study subjects. A total of 590 patients (316 patients from ZJG and 274 patients from TX) were interviewed with a response rate of 81%. The economic burden attributed to tuberculosis, including direct costs and indirect costs, was estimated and compared between the two study sites. The Mann-Whitney U Test was used to compare the cost differences between the two groups. Potential factors related to the total out-of-pocket costs were analyzed based on a step-by-step multivariate linear regression model after the logarithmic transformation of the costs. RESULTS: The average (median, interquartile range) total cost was 18793.33 (9965, 3200-24400) CNY for patients in ZJG, which was significantly higher than for patients in TX (mean: 6598.33, median: 2263, interquartile range: 983-6688) (Z = 10.42, P < 0.001). After excluding expenses covered by health insurance, the average out-of-pocket costs were 14304.4 CNY in ZJG and 5639.2 CNY in TX. Based on the multivariable linear regression analysis, factors related to the total out-of-pocket costs were study site, age, number of clinical visits, residence, diagnosis delay, hospitalization, intake of liver protective drugs and use of the second-line drugs. CONCLUSION: Under the current "free of diagnosis and treatment" policy, the financial burden remains heavy on tuberculosis patients. Policy makers need to consider appropriate steps to lessen the burden of out-of-pocket costs for tuberculosis patients in China and how best to improve service delivery for poor patients.
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Modelos Teóricos , Tuberculosis/economía , Tuberculosis/terapia , Anciano , China , Costo de Enfermedad , Femenino , Gastos en Salud , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis MultivarianteRESUMEN
A layered cobaltite Ba(x)CoO2 (x = 0.19, 0.28, 0.30, 0.33) was synthesized by an ion exchange technique from the layered Na(x)CoO2 precursors. The phase composition and physical properties were investigated. Ba(x)CoO2 is isomorphic to the precursor Na(x)CoO2. The magnetic susceptibility of Ba(x)CoO2 decreases with increasing barium content and shows a Curie-Weiss-like behavior at temperatures above 50 K. The resistivity is sensitive to the barium content. As the barium content increases from 0.19 to 0.33, a crossover from a semiconducting behavior to a metallic behavior was observed. The Seebeck coefficient of Ba(x)CoO2 is insensitive to the barium content due to the tradeoff effect between the carrier concentration and the Co(4+) content, while the thermal conductivity increases with the increasing barium content from 0.19 to 0.33 owing to the ordered state of Ba ions between the CoO2 layers.