Feasibility analysis of China's medical insurance coverage of assisted reproductive technology.

There are millions of patients experiencing infertility in China, but assisted reproductive technology (ART) is performed at the patient's expense and is difficult to afford. With the sharp decline in China's birth rate, there is a growing controversy over the inclusion of ART in medical insurance (MI). This study aims to explore the feasibility of ART coverage by MI for the first time. We obtained basic data such as the prevalence of infertility, the cost of ART, and the success rate in China with the method of meta-analysis and consulting the government bulletin. Then, we calculated the number of infertile couples in China and the total financial expenditure of MI covering ART. Finally, we discussed the feasibility of coverage, and analyzed the population growth and economic benefits after coverage. According to our research results, it was estimated that there were 4.102-11.792 million infertile couples in China, with an annual increase of 1.189-1.867 million. If MI covered ART, the fund would pay 72.313-207.878 billion yuan, accounting for 2-6% of the current fund balance, and the subsequent annual payment would be 20.961-32.913 billion yuan, accounting for 4-7% of the annual fund balance. This was assuming that all infertile couples would undergo ART, and the actual cost would be lower. The financial input‒output ratio would be 13.022. Benefiting from the inclusion of ART in MI coverage, there would be 3.348-9.624 million new live infants, and 8-13% newborns would be born every year thereafter, which means that by 2050, 37-65 million people would be born. Due to its affordable cost, high cost-effectiveness and favourable population growth, it may be feasible to include ART in MI.

Unexpected Low Temperature Activity with Low N2 O Emission of Stabilized Al-rich Zeolite Beta for Selective Catalytic Reduction of NOx.

The low temperature activity of Fe-loaded zeolites as selective catalytic reduction of NOx by NH3 (NH3 -SCR) catalysts is a critical drawback for practical application. Here, we found unexpected improvement of low temperature activity by our proposed post-synthetic treatment. An Al-rich zeolite beta (Si/Al=5) is employed as the catalyst support, and the parent sample is dealuminated for higher hydrothermal stability, followed by the liquid-mediated stabilization treatment and impregnation. It is found that stabilized samples feature excellent low temperature activity and high N2 selectivity even for a long-term operation, along with the ability to maintain high NOx conversion after aging. The improved SCR activity should be attributed to abundant acid sites in Al-rich framework and better stabilization of monomeric iron species after the stabilization treatment. Furthermore, the low yield of side product N2 O is probably due to the absence of the generation of NH4 NO3 during NH3 -SCR catalyzed by Fe-loaded zeolites.

Relationship between maternal ABO blood groups and pregnancy outcomes: a retrospective cohort study in Dongguan, China.

The purpose of this study was to study the relationship between maternal ABO blood groups and pregnancy outcomes. A total of 29,658 couples in Dongguan were selected as the research subjects. We obtained data on ABO blood groups and pregnancy outcomes and explored the relationship between them through log binomial regression and survival analysis. Compared to mothers with type B blood, the RR of foetal stillbirth in mothers with type A blood was 2.87 (95% CI: 1.70, 4.85), and compared to mothers with type O blood, the RR was 1.72 (95% CI: 1.16, 2.55). Compared with foetuses of other three blood type mothers, foetuses of A blood type mothers have a higher median birth weight (P = 0.011). Other pregnancy outcomes, including preterm birth, macrosomia, caesarean section, multiple births, birth defects, low birth weight, foetal sex, gestational days, birth length, and APGAR score, were not significantly different. The relationship between maternal ABO blood type and pregnancy outcomes was not affected by paternal blood type. More studies are needed to confirm these results.

What is already known on this subject? The relationship between blood type and disease is being increasingly studied. With regard to the relationship between maternal blood type and pregnancy outcomes, some studies have focused on people undergoing in vitro fertilisation. There are few reports on healthy women.What do the results of this study add? Compared to mothers with type B blood, the RR of foetal stillbirth in mothers with type A blood was 2.87 (95% CI: 1.70, 4.85), and compared to mothers with type O blood, the RR was 1.72 (95% CI: 1.16, 2.55). Compared with foetuses of other three blood type mothers, foetuses of A blood type mothers have a higher median birth weight (P = 0.011).What are the implications of these findings for clinical practice and/or further research? This study is the first to explore the relationship between blood type and pregnancy outcomes in healthy women.These results can provide some clues for the study of the mechanism of pregnancy outcomes.

History of induced abortion and the risk of preterm birth: a retrospective cohort study.

OBJECTIVES: To explore the relationship between a history of induced abortion and follow-up preterm birth. METHODS: We performed a retrospective cohort study of 27,176 women aged 19 to 48 years old in the city of Dongguan. Participants were divided into two groups according to the history of induced abortion. We used log-binomial regression to estimate adjusted risk ratios of preterm birth (gestation at less than 37 weeks) and early preterm birth (gestation at less than 34 weeks) for women with a history of induced abortion. Four models adjusted for different baseline data were used to verify the stability of the results. We also performed a subgroup analysis and mediation effect analysis to control for the influence of confounding factors and analyzed the relationship between the number of abortions and subsequent preterm birth. RESULTS: Our study included 2,985 women who had undergone a prior induced abortion. Women who reported having a prior induced abortion were more likely to have preterm births before 37 weeks and 34 weeks, with risk ratios of 1.18 (95% CI 1.02-1.36) and 1.65 (95% CI 1.23-2.21), respectively. The above associations were stable in all models. We also found that a history of induced abortion was independently associated with a higher risk of preterm birth and early preterm birth in the subgroups. After controlling for the indirect effect of demographic data, the direct effect of abortion history on follow-up preterm delivery was still significantly different. The higher the number of abortions, the greater the risk of subsequent preterm birth. CONCLUSIONS: This study suggests that induced abortion increases the risk of subsequent preterm birth.

Developmental status of iron deficiency anemia and factors among preschool children in Dongguan / 中国学校卫生

Objective@#To analyze the influencing factors and physical and mental development of preschool children with iron deficiency anemia in Dongguan, so as to provide a reference for the prevention of iron deficiency anemia among preschool children.@*Methods@#A total of 118 preschool children with iron deficiency anemia who were examined in Dongguan Maternal and Child Health Center from January 2022 to December 2022 were enrolled in the anemia group, and 118 preschool healthy children who were examined in the hospital at the same time were enrolled in the control group. The physical and mental development of the children were evalucded in both groups. Demographic information and household per capita income were collected. The relationship between risk factors and iron deficiency anemia was analyzed by univariate analysis and multiple Logistic regression.@*Results@#The scores of fine motor skills, gross motor skills, adaptability, social communication, language ability and developmental quotient of children in anemia group were significantly lower than those in control group ( t =4.14, 5.46, 5.60, 5.50, 4.90, 5.83, P <0.01). The difference in scores of adaptability, fine motor skills, gross motor skills language ability, social communication and developmental quotient between the two groups increased with age ( F =390.56, 414.63, 437.35, 409.68, 407.20, 404.54, P < 0.05 ). Multivariate Logistic regression analysis showed that household income, history of past digestive disease, gestational age, maternal anemia during pregnancy, maternal education, consumption of meat, eggs and milk, and intake of nuts were all associated with iron deficiency anemia among preschool children in Dongguan ( OR =2.23，2.99，3.99，3.56，3.11，1.68，1.61, P < 0.05 ).@*Conclusion@#The physical and mental development of preschool children with iron deficiency anemia in Dongguan is slower than that of non anemia children of the same age, and the development delay becomes more obvious with increasing age. Attention should be paid to the prevention of iron deficiency anemia among preschool children. It is important to provide reasonable dietary guidance for children with high risk factors such as digestive disease history and prematurity.

History of IUD utilization and the risk of preterm birth: a cohort study.

OBJECTIVE: To explore whether a history of IUD use could increase the risk of subsequent preterm birth. METHODS: We performed a cohort study of 24,496 multipara aged 19-48 years in Dongguan City. Each subject was followed up for 1 year, and 12,508 women obtained pregnancy outcomes. They were divided into 2 groups: 2130 subjects with IUD use history (exposure group), and 10,378 subjects without IUD use history (control group). The exposure group will remove the IUD before pregnancy. The primary outcomes were preterm birth (less than 37 weeks of gestation) and early preterm birth (less than 34 weeks of gestation). We used log-binomial regression to estimate adjusted risk ratios (aRR) of preterm birth and early preterm birth for women with a history of IUD. According to the different adjusted baseline data, three regression models were established, and the propensity matching score method was also used to verify the stability of the results. RESULTS: The delivery rate of women with IUD history was 51.24%, and that of women without IUD was 51.03% (2 = 0.063, P = 0.802). Six hundred and eighty-five women had preterm birth (5.48%, 95% CI 5.08-5.88) and 133 women had early preterm birth (1.06%, 95% CI 0.83-1.24). Compared with the control group, the incidence of preterm birth and early preterm birth in the exposure group were significantly lower. The results are stable in all four models. Subgroup analysis also supported the result. This study also found that the longer the women used IUD before pregnancy, the younger the age of first using IUD, and the shorter the time from condom removal to pregnancy, the lower the incidence of premature birth. CONCLUSION: The women with a history of IUD use are less likely to have premature birth after the IUD is removed. More prospective studies are needed to confirm it.

A novel NAC transcription factor, MdNAC42, regulates anthocyanin accumulation in red-fleshed apple by interacting with MdMYB10.

Anthocyanin pigmentation is an important consumption trait of apple (Malus domestica Borkh.). In this study, we focused on the identification of NAC (NAM, ATAF1/2 and CUC2) proteins involved in the regulation of anthocyanin accumulation in apple flesh. A group of MdNACs was selected for comparison of expression patterns between the white-fleshed cultivar 'Granny Smith' and red-fleshed 'Redlove'. Among them, MdNAC42 was screened, which exhibited a higher expression level in red-fleshed than in white-fleshed fruit, and has a positive correlation with anthocyanin content as fruits ripened. Moreover, overexpression of MdNAC42 in apple calli resulted in the up-regulation of flavonoid pathway genes, including MdCHS, MdCHI, MdF3H, MdDFR, MdANS and MdUFGT, thereby increasing the accumulation of anthocyanins, which confirmed the roles of MdNAC42 in anthocyanin biosynthesis. Notably, MdNAC42 was demonstrated to have an obvious interaction with MdMYB10 either in vitro or in vivo by yeast two-hybrid combined with bimolecular fluorescence complementation, further suggesting that MdNAC42 is an important part of the regulatory network controlling the anthocyanin pigmentation of red-fleshed apples. To the best of our knowledge, this is the first report identifying the MdNAC gene as related to anthocyanin accumulation in red-fleshed apples. This study provides valuable information for improving the regulatory model of anthocyanin biosynthesis in apple fruit.