Pyridostigmine attenuated high-fat-diet induced liver injury by the reduction of mitochondrial damage and oxidative stress via α7nAChR and M3AChR.

Obesity is a major cause of nonalcohol fatty liver disease (NAFLD), which is characterized by hepatic fibrosis, lipotoxicity, inflammation, and apoptosis. Previous studies have shown that an imbalance in the autonomic nervous system is closely related to the pathogenesis of NAFLD. In this study, we investigated the effects of pyridostigmine (PYR), a cholinesterase (AChE) inhibitor, on HFD-induced liver injury and explored the potential mechanisms involving mitochondrial damage and oxidative stress. A murine model of HFD-induced obesity was established using the C57BL/6 mice, and PYR (3 mg/kg/d) or placebo was administered for 20 weeks. PYR reduced the body weight and liver weight of the HFD-fed mice. Additionally, the serum levels of IL-6, TNF-α, cholesterol, and triglyceride were significantly lower in the PYR-treated versus the untreated mice, corresponding to a decrease in hepatic fibrosis, lipid accumulation, and apoptosis in the former. Furthermore, the mitochondrial morphology improved significantly in the PYR-treated group. Consistently, PYR upregulated ATP production and the mRNA level of the mitochondrial dynamic factors OPA1, Drp1 and Fis1, and the mitochondrial unfolded protein response (UPRmt) factors LONP1 and HSP60. Moreover, PYR treatment activated the Keap1/Nrf2 pathway and upregulated HO-1 and NQO-1, which mitigated oxidative injury as indicated by decreased 8-OHDG, MDA and H2 O2 levels, and increased SOD activity. Finally, PYR elevated acetylcholine (ACh) levels by inhibiting AChE, and upregulated the α7nAChR and M3AChR proteins in the HFD-fed mice. PYR alleviated obesity-induced hepatic injury in mice by mitigating mitochondrial damage and oxidative stress via α7nAChR and M3AChR.

Baicalein ameliorated obesity-induced cardiac dysfunction by regulating the mitochondrial unfolded protein response through NRF2 signaling.

BACKGROUND: The mitochondrial unfolded protein response (UPRmt) is the first line of defense against mitochondrial dysfunction in several diseases. Baicalein, which is an extract of Scutellaria baicalensis Georgi roots, exerts mitoprotective effects on metabolic disorders and cardiovascular diseases. However, it remains unclear whether baicalein alleviates obesity-induced cardiac damage through the UPRmt. PURPOSE: The present research designed to clarify the role of baicalein in lipotoxicity-induced myocardial apoptosis and investigated the UPRmt-related mechanism. METHODS: In the in vitro experiment, palmitic acid (PA)-treated AC16 cardiomyocytes were established to mimic obesity-induced myocardial injury. After pretreatment of AC16 cells with baicalein, the levels of cell vitality, apoptosis, mitochondrial membrane potential, mitochondrial oxidative stress, and UPRmt-related proteins were determined. Additionally, AC16 cells were treated with ML385 or siRNA to explore the regulation of the UPRmt by NRF2 signaling. In the in vivo experiment, male db/db mice administered with baicalein for 8 weeks were used to validate the effects of baicalein on cardiac damage induced by obesity, the UPRmt, and the NRF2-related pathway. RESULTS: In AC16 cardiomyocytes, PA dose-dependently increased the expression of UPRmt markers (HSP60, LONP1, ATF4, and ATF5). This increase was accompanied by enhanced production of mitochondrial ROS, reduced mitochondrial membrane potential, and elevated the expression levels of cytochrome c, cleaved caspase-3, and Bax/Bcl2, eventually leading to cell apoptosis. Baicalein treatment reversed UPRmt activation and mitochondrial damage and impeded mitochondrial-mediated cell apoptosis. Moreover, NRF2 downregulation by its inhibitor ML385 or siRNA diminished baicalein-mediated NRF2 signaling activation and UPRmt inhibition and triggered mitochondrial dysfunction. Additionally, NRF2 deficiency more intensely activated the UPRmt, resulting in mitochondrial oxidative stress and apoptosis of PA-induced cardiomyocytes, thus indicating that NRF2 plays a vital role in mitochondrial homeostasis regulation. In the in vivo study in db/db mice, baicalein inhibited the UPRmt, enhanced the antioxidant capacity, and attenuated cardiac dysfunction through a NRF2-activated pathway. CONCLUSION: To our best knowledge, these results provide the first insight that baicalein inhibits the UPRmt to induce a protective effect against lipotoxicity-induced mitochondrial damage and cardiomyocyte apoptosis via activating NRF2 signaling and suggest a new role of NRF2 in UPRmt regulation.

Cost-Effectiveness and Health Impacts of Different Influenza Vaccination Strategies for Children in China.

INTRODUCTION: Authors aimed to evaluate the economic and health impacts of three influenza vaccines available in China, including trivalent inactivated vaccine, quadrivalent inactivated vaccine, and live attenuated influenza vaccine, for children aged six months to 18 years. METHODS: Two decision-analytic models were developed to simulate four vaccination strategies. Outcomes included total costs from a societal perspective in 2021, quality-adjusted life-year loss, numbers of outpatient and inpatient cases, and deaths avoided using each strategy. Deterministic and probabilistic sensitivity analyses were performed to examine the uncertainty of model inputs. RESULTS: For children aged six months to three years, trivalent inactivated vaccine saved $48 million and avoided a loss of 17,637 quality-adjusted life-years compared with no vaccination. For children aged 3-18 years, quadrivalent inactivated vaccine was cost-effective compared with trivalent inactivated vaccine, with an incremental cost-effectiveness ratio of $32,948.5/quality-adjusted life-year (willingness-to-pay threshold=$37,653/quality-adjusted life-year), which was sensitive to the RR of vaccine effectiveness of quadrivalent inactivated vaccine versus of trivalent inactivated vaccine. When compared with quadrivalent inactivated vaccine, live attenuated influenza vaccine was $1.28 billion more costly but gained an additional 13,560 quality-adjusted life-years; its incremental cost-effectiveness ratio was $123,983.8/quality-adjusted life-year. Live attenuated influenza vaccine would be cost-effective if its vaccine effectiveness was >0.79. Probabilistic sensitivity analysis revealed that quadrivalent inactivated vaccine, trivalent inactivated vaccine, live attenuated influenza vaccine, and no vaccination were cost-effective in 55.94%, 33.09%, 10.97%, and 0% of 10,000 Monte Carlo simulations. CONCLUSIONS: Trivalent inactivated vaccine was cost-effective compared with no vaccination in children aged six months to 18 years. Of the three vaccination strategies for children aged 3-18 months, quadrivalent inactivated vaccine appears to be the most cost-effective.

The impacts of the national centralized drug procurement policy on the use of policy-related antibiotic agents: the case of Shaanxi province, China.

OBJECTIVES: The purpose of NCDP policy was to reduce the price of drugs. However, it is unclear that a reduction in the price of a single antibiotic will lead to an increase in other alternatives, which is crucial for antibiotic management. The aim of this study was to evaluate the impact of policy on the consumption of policy-related antibiotic. METHODS: Quasi-experimental interrupted time series methods were used to assess the effects of the policy. RESULTS: After the implementation of the policy, the consumption of the winning products increased rapidly, with a significant difference in growth (ß2 = 88.03). For nonwinning products, the level of purchase volume decreased (ß2=-22.83) in the intervention group, and after adding the comparison group, this number fell further in statistical significance (ß2=-114.53). Among all the nonwinning products, the level of purchase volume (ß2=-73.59) and expenditures (ß2=-346.71) of the generic drugs that passed the conformance evaluation decreased significantly after the policy in the difference model. The purchase volume of J01DC, J01DD and total antibiotics significantly increased in control group compared with the intervention. CONCLUSION: The implementation of the volume-based procurement policy promoted the use of winning products and decreased the usage of its alternative watch antibiotics.

Association of cooking water with the health of middle-aged and elderly Chinese individuals: evidence from a national household longitudinal survey.

Little evidence has demonstrated the association between health conditions and cooking water. The purpose of this study was to explore the relationship, using a representative sample of 10,531 subjects selected from the China Family Panel Study (CFPS). The usage rate of surface-exposed water showed a slight upward trend from 2010 to 2018. The adjusted odds ratio (OR) of chronic diseases with surface-exposed and well water was 1.140 (95% CI: 0.989-1.315) and 0.902 (95% CI: 0.839-0.969), respectively, with reference to tap/purified water. Surface-exposed water increased the likelihood of a worsening health change by 25.5% (OR: 1.255; 95% CI: 1.123-1.411), while well water was associated with poor self-rated health (OR: 1.169; 95% CI: 1.094-1.249). As such, surface-exposed water was associated with chronic diseases and worsening changes in health, and well water was negatively associated with chronic diseases. Although efforts to improve quality of drinking water have been made in China for decades, our conclusions reveal that water quality still remains a critical public livelihood issue among middle-aged and elderly populations. More in-depth research is required on whether the disinfection ingredients of tap water may increase the risk for chronic disease.

Antimicrobial Stewardship Programs in Northwest China: A Cross-Sectional Survey of Perceptions, Involvement, and Perceived Barriers Among Hospital Pharmacists.

Background: Antimicrobial stewardship (AMS) is a key prevention strategy in addressing the global concern of increasing antimicrobial resistance (AMR). Pharmacists are one of the integral members of AMS hospital teams around the world. Toward reducing AMR, a major strategy in China is to improve the capacity and participation of pharmacists in the AMS framework. However, little is known about how hospital pharmacists perceive their position and participation in AMS work, and the barriers to this work in China, especially in the Northwest region. Methods: Region this work describes a cross-sectional, anonymous, online survey study. Hospital pharmacists from five provinces/autonomous regions in northwest China were invited to participate in June and July 2020. Participants completed the survey by using WeChat, a popular social application in China. We purposefully distributed the questionnaire link and QR code to hospital pharmacists through the hospital antimicrobial resistance surveillance network, hospital antimicrobial consumption surveillance network, provincial and city pharmaceutical associations, and hospital pharmacist WeChat groups. Results: Out of 1032 respondents, 93.1% believed that AMS programs promote the judicial prescribing of antimicrobials, 95.5% strongly agreed that AMS could reduce the widespread use of antimicrobials, and 92.3% believed that AMS could improve medical services. Pharmacists were most likely to be involved in AMS through reviewing prescriptions of antimicrobials, intervening in inappropriate prescriptions, and providing feedback on antimicrobial prescriptions and medical orders. Barriers to participating in AMS included workload (59.5% of respondents), ineffective communication between pharmacists and doctors (57.7%), and inadequate knowledge of AMS (47.0%). Differences in responses were found between the five surveyed provinces. A significant association was found between median involvement scores and gender, age, education, level of superiority, experience, and type of hospital (p < 0.05). Conclusion: Pharmacists perceived that AMS programs are important, but that their involvement in related activities is limited in all provinces. Further studies and strategies should consider how to overcome the identified barriers to optimize the participation of pharmacists in AMS programs.

Joint effect of alcohol drinking and tobacco smoking on all-cause mortality and premature death in China: A cohort study.

BACKGROUND: Tobacco smoking and alcohol drinking are associated with several diseases, and studies on the joint effects of smoking and drinking are rare. OBJECTIVE: This study investigates the joint effects of tobacco smoking and alcohol drinking on all-cause and premature mortality in a contemporary cohort. METHODS: The China Health and Retirement Longitudinal Study (CHARLS) is an ongoing nationally representative survey of subjects aged over 45 years in China that was performed every two years for a total of three waves from 2011 to 2015 in China. We used weighted logistic regression models to estimate the joint effects of tobacco smoking and alcohol drinking on all-cause and premature mortality. RESULTS: After adjusting for prespecified confounders, the odds ratios (ORs) of all-cause mortality were 1.51 (95% CI: 1.09-2.10) and 1.47 (95% CI: 1.03-2.08) in smokers and smokers/drinkers, respectively. Compared with nonsmokers/nondrinkers, the OR of smokers/drinkers for premature death was 3.14 (95% CI: 1.56-6.34). In the female subgroup, there was an approximately 5-fold (OR = 4.95; 95% CI: 2.00-12.27) odds of premature mortality for smokers/drinkers compared to nonsmokers/nondrinkers. CONCLUSION: This study found a joint effect of tobacco smoking and alcohol drinking on all-cause and premature mortality among a contemporary and nationally representative cohort in China. Our results suggested that the joint effects were more pronounced in women, but further research is needed.

Impact of the Expert Consensus on Carbapenem Consumption Trends and Patterns in Public Healthcare Institutes: An Interrupted Time Series Analysis, 2017-2020.

Background: Carbapenems are considered the last line of defence against bacterial infections, but their high consumption and the resulting antibacterial resistance are an increasing global concern. In this context, the Chinese health authority issued an expert consensus on the clinical applications of carbapenems. However, the long- and short-term effects of the expert consensus on carbapenem use are not clear. Methods: This study was conducted in Shaanxi, a northwest province of China. We collected all available carbapenem procurement data between January 2017 and December 2020 from the Provincial Drug Centralized Bidding Procurement System. A quasi-experimental interrupted time series analysis was used to evaluate the longitudinal effectiveness of expert consensus by measuring the change in the Defined Daily Dosesper 1,000 inhabitants per day (DID), the percentage of carbapenem expenditures to total antimicrobial expenditure, the total carbapenem expenditure, and the defined daily cost (DDDc). We used Stata SE version 15.0 for data analysis, and p < 0.05 was considered statistically significant. Results: After the distribution of the expert consensus, the level (p = 0.769) and trend (p = 0.184) of DID decreased, but the differences were not statistically significant. The percentage of carbapenem expenditures to total antimicrobial expenditure decreased abruptly (p < 0.001) after the intervention, but the long-term trend was still upward. There was no statistically significant relationship between the release of the expert consensus and carbapenem expenditure in the long term, but there was a decreasing trend (p = 0.032). However, the expert consensus had a positive impact on the economic burden of carbapenem usage in patients, as the level (p < 0.001), and trend (p = 0.003) of DDDc significantly decreased. Conclusion: The long-term effects of the distribution of the expert consensus on the use and expenditure of carbapenems in public health institutions in Shaanxi Province were not optimal. It is time to set up more administrative measures and scientific supervision to establish a specific index to limit the application of carbapenems.

Impact of the zero-mark-up drug policy on drug-related expenditures and use in public hospitals, 2016-2018: an interrupted time series study in Shaanxi.

OBJECTIVE: The aim of this study was to measure the impact of zero-mark-up drug policy (ZMDP) on drug-related expenditures and use in urban hospitals. DESIGN: This was a retrospective observational study of trends in drug expenses and use in the context of the ZMDP using an interrupted time series analysis. SETTING: Twelve hospitals (three tertiary hospitals and nine secondary hospitals) in Xi'an, which is the capital of Shaanxi Province in Western China. DATA AND PARTICIPANTS: The prescription information for all outpatients and inpatients in the study hospitals from January 2016 to April 2018 was used in this study. INTERVENTIONS: The Chinese government announced the policy intervention measure of the ZMDP, which was implemented in all public hospitals as of 1 April 2017. PRIMARY MEASURES: Monthly drug expenditures, monthly medical expenditures, the percentage of drug expenditures among total medical expenditures, the average outpatient drug expenditure per visit, the percentage of prescriptions that include an injection and the percentage of prescriptions that include an antibiotic. RESULTS: Monthly total medical expenses increased in both tertiary and secondary hospitals after the ZMDP was implemented. In tertiary hospitals, the average outpatient drug expenditures per visit showed a slow decreasing trend before the intervention and an increasing trend after the intervention, with statistically significant changes in both the level (p<0.001) and the trend (p=0.02). Secondary hospitals showed a slow increasing trend both before and after the policy implementation, with no significant change in the trend (p=0.205). The proportion of prescriptions, including injections, was over 20% in secondary hospitals and less than 20% in tertiary hospitals, with no significant changes to this indicator observed after implementation of ZMDP. CONCLUSIONS: The effect of the ZMDP on drug-related expenditures and use in Chinese public hospitals was not substantially evident. Future pharmaceutical reform measures should give more consideration to physician prescription behaviours.

A survey of knowledge, attitudes and practices concerning antibiotic prescription for upper respiratory tract infections among pediatricians in 2018 in Shaanxi Province, China.

Objective: The objective of this study was to explore the knowledge, attitudes, and practices concerning antibiotic prescriptions to children with URTIs among pediatricians and to identify barriers to appropriate antibiotic prescription among pediatricians. Methods: An online-based survey was conducted among pediatricians in Shaanxi province, western China, with a population of 38.35 million and an area of 205,600 square kilometers. Results: A total of 472 pediatricians completed this survey, with the response rate of 26.0%. The theoretical knowledge about antibiotics was excellent, with a median score of 8(0-8). However, 30.1% of the respondents still believed that antibiotics are anti-inflammatory drugs. The pediatricians' age, education level, and monthly income and whether had ever received training had significant associations with their knowledge level. The attitude scores were 41.1 ± 3.6, with a ranged of 29-52 points (total score of 55), indicating that most respondents had positive attitudes toward antibiotics. However, 22.7% of the respondents still preferred to use antibiotics for URTIs. It was found that uncertain diagnosis, parent requirements and insufficient time were barriers to appropriate antibiotic prescription. The indiscriminate prescription of antibiotics to children with URTIs was prevalent among pediatricians. Conclusion: Effective integrated interventions should be developed to promote the prudent use of antibiotics among pediatricians.

Antibiotic prescribing practices in secondary and tertiary hospitals in Shaanxi province, western China, 2013-2015.

INTRODUCTION: The irrational use of antibiotics is a major driver of antimicrobial resistance. This study aimed to explore how antibiotics were used in secondary and tertiary hospitals in Shaanxi Province, western China from 2013 to 2015. METHOD: A retrospective study was conducted with a sample of 16 hospitals in Shaanxi Province (2 tertiary and 14 secondary hospitals; 8 public and 8 private hospitals) using a stratified random sampling method. All of the macro data from these hospitals from 2013 to 2015 were analyzed. All collected data were double-entered and analyzed using Excel 2007. RESULTS: The percentage of injectable antibiotic prescriptions was 26.6% of all of the antibiotic prescriptions in the secondary hospitals and 14.2% in the tertiary hospitals. Injectable antibiotic prescriptions in private tertiary hospitals (enter %) were more than two times that of public tertiary hospitals (enter %). In both tertiary and secondary hospitals, the percentage of antibiotic prescriptions for outpatients, emergency patients and inpatients were within the scope of the national standards, while the intensity of antibiotic use was higher than the national standard of 40 DDD/100 bed-days. The prophylactic antibiotic use rate in clean surgery was 40.4% in tertiary hospitals and 60.7% in secondary hospitals, which were both higher than the national standard of 30%. The preventive use rate of antibiotics in private tertiary hospitals (55.00%) was more than two times that of public tertiary hospitals (25.90%), and the rate was also higher in private secondary hospitals (61.50%) than in public secondary hospitals (59.70%). CONCLUSIONS: Substantial antibiotic abuse occurred in the sample Chinese hospitals, especially in secondary hospitals. The government should continue to strengthen the administration of antimicrobial use in hospitals. At the same time, medical professional training and interventions for physicians should be conducted to fundamentally reduce the irrational use of antibiotics.

Preventive Antibiotics for Poststroke Infection in Patients With Acute Stroke: A Systematic Review and Meta-analysis.

AIMS: To determine if preventive antibiotics is effective in poststroke infection in patients with acute stroke in comparison with no prophylaxis. MATERIALS AND METHODS: MEDLINE (1950 to January 2017), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2017) and EMBASE (1974 to January 2017) databases were used to search for randomized controlled trials with intervening measures related to the preventive antibiotics in patients with acute stroke. Besides, the reference lists of the retrieved publications were manually searched to explore other relevant studies. RESULTS: We included 6 randomized controlled trials involving 4110 stroke patients. The study population, study design, intervening measures, and definition of infection were different. Preventive antibiotics significantly reduced the incidence of algorithm-defined infection in patients with acute stroke from 11.14% (220/1975) to 7.43% (149/2006); odds ratio (OR)=0.41; 95% confidence interval (CI), 0.20-0.87; P=0.02. There was no difference in mortality between 2 groups, the mortality in preventive antibiotics group was 17.03% (347/2037) and control group was 16.10% (328/2037); OR=1.07; 95% CI, 0.90-1.27; P=0.44. And preventive antibiotics did not improve the proportion of good outcome, the proportion of good outcome in preventive antibiotics group was 45.47% (909/1999) and control group was 45.76% (913/1995); OR=0.89; 95% CI, 0.62-1.28; P=0.53. None of the studies reported severe adverse relevant to the study antibiotics. CONCLUSIONS: Preventive antibiotics significantly reduced the incidence of algorithm-defined infection in patients with acute stroke, but did not decrease the mortality or improve the proportion of good outcome. Future research should aim to identify the group of stroke patients who will benefit most from antibiotic prophylaxis.

Preparation of hollow iron/halloysite nanocomposites with enhanced electromagnetic performances.

Nanostructures loaded on halloysite nanotubes (HNTs) have attracted global interest, because the nanotubular HNTs could extend the range of their potential applications. In this study, we fabricated a novel nanocomposite with hollow iron nanoparticles loaded on the surface of HNTs. The structure of the iron nanoparticles can be adjusted by ageing time. Owing to the increased remnant magnetization and coercivity values, the nanocomposites loaded with hollow iron nanoparticles showed better electromagnetic performance than that with solid iron nanoparticles. This study opens a new pathway to fabricate halloysite nanotubular nanocomposites that may gain applications in the catalytic degradation of organic pollutants and electromagnetic wave absorption.

Effect of muscarinic receptors agonist in the rat model of coronary heart disease: A potential therapeutic target in cardiovascular diseases.

Cardiac hypertrophy is a one of common type of CHD, responsible for cardiac mortality worldwide. The present study designed to investigate the effect of muscarinic receptors agonist in the rat model of cardiac hypertrophy. A total of 30 male adult Wistar rats having body weight 300-400 gram were equally distributed in two groups (Test group: Rats with Angiotensin II + M3 receptor agonist [acetylcholine]; Reference group: Rats with cardiac hypertrophy induced by Angiotensin II). Rat model of cardiac hypertrophy were induced by Angiotensin II. Effect of M3 receptor agonist on cardiac hypertrophy was evaluated by electrocardiography, hemodynamic and histological assessment. Also, expression of M3 receptor was analyzed using by real-time-PCR and Western blot analysis. Also, vital signs such as pulse rate, and blood pressure were measured. Echocardiographic related variable including ejection fraction were also assessed in both the groups. The results of this study showed acetylcholine attenuates the hypertrophic response triggered by Angiotensin II, by upregulation of M3 receptor. Upregulation of M3 receptor after administration of acetylcholine ameliorates hypertrophic responses induced by angiotensin II. Also acetylcholine treatment prevents Angiotensin II induced increase in level of ANP and ß-myosin, which are responsible for inducing cardiac hypertrophic responses. Moreover, acetylcholine ameliorates Angiotensin II induced cell enlargement by reducing the surface area of cells. Overall finding suggested that acetylcholine improves left ventricle hypertrophy and ejection fraction by activating M3 receptor in heart. The finding of this study gives the new vision to cardiovascular researchers to develop anti- hypertrophy therapy based on M3 receptor.

How does the general public view antibiotic use in China? Result from a cross-sectional survey.

Background Resistance to antibiotics is a major threat to global health and general public play a significant role in the fight against antimicrobial resistance. Objective The present study aimed to identify the knowledge, attitudes, and practice of the general public towards antibiotic use in China. Setting Randomly selected parks in three cities of western, central and eastern China: Xi'an, Changsha, and Nanjing. Method A cross-sectional survey was conducted on a sample of 1400 residents, from January to June 2015. Main outcome measures Knowledge, attitudes and practices scores toward self-medication with antibiotics and compliance with antibiotic regimens. Results The response rate was 86.0% (n = 1204). Only 192 (19.5%) respondents gained a score of 3 or above, and the maximum score of 4, reflecting poor knowledge towards antibiotics. Just over half (54.8%) of respondents incorrectly believed antibiotics were effective against viral infections and only one-third (34.3%) knew that antibiotics were not anti-inflammatories. Nearly half of the respondents (49.0%) had changed the dosage when taking antibiotics, 35.6% switched to another class, 33.4% had not finished the full treatment course and over 60.0% kept leftover antibiotics for future use. Almost half of the respondents (45.7%) stated they had used antimicrobials during the last 6 months and 64.4% of them had self-medicated. Conclusion This study identified serious misconceptions regarding antibiotics use in the Chinese general public. Effective interventions should be developed to provide practical and appropriate advice to effect behaviour change within this population.

Sale of antibiotics without a prescription at community pharmacies in urban China: a multicentre cross-sectional survey.

Objectives: To quantify sales of antibiotics without a medical prescription and to assess the quality of pharmacy services in relation to the antibiotics sold in community pharmacies in urban China. Methods: A multicentre cross-sectional survey of community pharmacies was undertaken in 2015 using the simulated client method. Two clinical case scenarios (paediatric diarrhoea and adult acute upper respiratory infection) were presented at systematically sampled community pharmacies in Eastern (Nanjing), Central (Changsha) and Western China (Xi'an). Results: Of 256 pharmacies, antibiotics were obtained without a prescription from 55.9% (95% CI: 49.5%-62.0%) when paediatric diarrhoea was simulated and from 77.7% (95% CI: 72.1%-82.7%) when adult respiratory infection was simulated. Of the pharmacies where antibiotics were dispensed, 83.9% and 66.3% dispensed after the simulated clients requested or insisted in the case of paediatric diarrhoea and adult respiratory infection, respectively. Significant differences ( P < 0.001, χ 2 test) in inappropriate antibiotic dispensing were found among cities, with 57.7%, 37.3% and 73.7% in the case of paediatric diarrhoea and 60.8%, 80.7% and 96.1% in adult respiratory infection in Nanjing, Changsha and Xi'an, respectively. Pharmacists were available in only 14.8% (95% CI: 10.7%-19.8%) of the pharmacies. The performance of pharmacy staff regarding the provision of information and advice was unsatisfactory. Conclusions: Antibiotics were easily obtained without a prescription in community pharmacies in urban China. Measures to enhance the enforcement of prescription-only regulations and training programmes for pharmacy staff to promote the appropriate use of antibiotics are warranted.

AXIN2 is Associated With Papillary Thyroid Carcinoma.

BACKGROUND: Findings of recent studies have demonstrated a rapid increase of the incidence of papillary thyroid carcinoma (PTC), which accounts for nearly 80% of thyroid cancers. OBJECTIVES: The aim of this study was to explore the association between AXIN2 gene polymorphism and papillary thyroid carcinoma (PTC). PATIENTS AND METHODS: 106 blood samples (56 PTC patients and 50 healthy controls) were drawn from China-Japan Union Hospital in Jilin province, China, during October 2010 to March 2011. A case-control study was designed to examine the association between AXIN2 and PTC. Seven tag single nucleotide polymorphisms (tag SNPs) in AXIN2 were selected and genotyped. Frequencies of different genotypes and alleles were analyzed between the patients and the controls, using the R × C column contingency table χ(2) test. The possible association of haplotypes constructed by the combined effects of two or more loci with PTC was analyzed through the UNPHASED 3.1.4 program. RESULTS: Rs11655966, rs3923086 and rs7591 of AXIN2 showed significant associations with PTC (P < 0.05). The result of haplotypes analysis showed that rs11655966-rs3923086-rs4791169 had statistically significant differences between the two groups (P < 0.05). CONCLUSIONS: Together with the functions of the target genes, we further elucidated that AXIN2 is associated with papillary thyroid carcinoma in the Chinese Han population.

Corrigendum: The Associations Between Maternal Factors During Pregnancy and the Risk of Childhood Acute Lymphoblastic Leukemia: A Meta-Analysis.

Because of the erroneous application of multiple publications, the conclusions of our recent paper (Pediatr Blood Cancer 2015;62:1162-70) were not reliable. The corrected results show that coffee drinking during pregnancy was risk factor for childhood acute lymphoblastic leukemia (OR = 1.44, 95% confidence interval = 1.07-1.92).

The associations between maternal factors during pregnancy and the risk of childhood acute lymphoblastic leukemia: A meta-analysis.

BACKGROUND: Although genetic and environmental factors are considered to be the main causes of acute lymphoblastic leukemia, the associations between maternal factors during pregnancy and the childhood ALL is still unclear. PROCEDURE: In this study, meta-analysis was used. Medline, PubMed, and Web of Science were searched. The result was assessed based on pooled odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: The pooled ORs showed that there were associations between childhood ALL and the birth order (The first vs others, OR = 1.08, 95%CI = 1.00-1.16), the education of pregnant woman (>high school vs ≤ high school, OR = 0.82, 95%CI = 0.77-0.86), smoking (Ever vs never, OR = 1.10, 95%CI = 1.02-1.19). CONCLUSIONS: Our meta-analysis showed that there were important associations between childhood ALL and the birth order, the education of pregnant woman, smoking.

[Association of BRAF(V) 600E mutation with clinical pathological features in papillary thyroid carcinoma: meta-analysis].

OBJECTIVE: To evaluate the association between BRAF(V) 600E mutation and pathological features in papillary thyroid carcinoma (PTC). METHODS: The raleted studies were searched through Medline, PubMed, and Web of Science, and meta-analysis was used to calculate the OR and 95%CI of the study results. RESULTS: A total of 52 studies including 12 029 PTC patients was identified. The prevalence of BRAF(V) 600E mutation in PTC was 57.85%. There was a closed association between the BRAF(V) 600E mutation and pathological features, including advanced TNM stage (OR = 1.89, 95%CI 1.58-2.27), lymph node metastasis (OR = 1.74, 95%CI 1.42-2.14), multifocality (OR = 1.25, 95%CI 1.07-1.46), and recurrence (OR = 2.26, 95%CI 1.25-4.09) of PTC. For Asians with PTC, the association between the BRAF(V) 600E mutation and pathological features was indicated for advanced TNM stage (OR = 1.56, 95%CI 1.24-1.96) and lymph node metastasis (OR = 1.57, 95%CI 1.25-1.99). For Europeans with PTC, the association between the BRAF(V) 600E mutation and pathological features was indicated for advanced TNM stage (OR = 2.63, 95%CI 2.10-3.30), lymph node metastasis(OR = 1.97, 95%CI 1.19-3.25), and multifocality (OR = 1.35, 95%CI 1.01-1.80). CONCLUSION: There were associations between the BRAF(V) 600E utation and advanced TNM stage, lymph node metastasis, multifocality, and recurrence of PTC.