Identification of Factors Influencing Out-of-county Hospitalizations in the New Cooperative Medical Scheme.

Throughout the duration of the New Cooperative Medical Scheme (NCMS), it was found that an increasing number of rural patients were seeking out-of-county medical treatment, which posed a great burden on the NCMS fund. Our study was conducted to examine the prevalence of out-of-county hospitalizations and its related factors, and to provide a scientific basis for follow-up health insurance policies. A total of 215 counties in central and western China from 2008 to 2016 were selected. The total out-of-county hospitalization rate in nine years was 16.95%, which increased from 12.37% in 2008 to 19.21% in 2016 with an average annual growth rate of 5.66%. Its related expenses and compensations were shown to increase each year, with those in the central region being higher than those in the western region. Stepwise logistic regression reveals that the increase in out-of-county hospitalization rate was associated with region (X1), rural population (X2), per capita per year net income (X3), per capita gross domestic product (GDP) (X4), per capita funding amount of NCMS (X5), compensation ratio of out-of-county hospitalization cost (X6), per time average in-county (X7) and out-of-county hospitalization cost (X8). According to Bayesian network (BN), the marginal probability of high out-of-county hospitalization rate was as high as 81.7%. Out-of-county hospitalizations were directly related to X8, X3, X4 and X6. The probability of high out-of-county hospitalization obtained based on hospitalization expenses factors, economy factors, regional characteristics and NCMS policy factors was 95.7%, 91.1%, 93.0% and 88.8%, respectively. And how these factors affect out-of-county hospitalization and their interrelationships were found out. Our findings suggest that more attention should be paid to the influence mechanism of these factors on out-of-county hospitalizations, and the increase of hospitalizations outside the county should be reasonably supervised and controlled and our results will be used to help guide the formulation of proper intervention policies.

Combined effects of fruit and vegetables intake and physical activity on the risk of metabolic syndrome among Chinese adults.

BACKGROUND: Unbalanced dietary intake and insufficient physical activity (PA) have been recognized as risk factors for metabolic syndrome (MetS). We aimed to examine the independent and combined effects of fruit and vegetables (FV) intake and PA on MetS. METHODS AND FINDINGS: A cross-sectional survey was conducted among residents of China in 2009, with fasting blood samples collected. Participants were divided into sufficient/insufficient FV intake and adequate/ inadequate PA groups according to self-reported questionnaires. MetS was defined using the NCEP-ATPIII criteria. The difference of individual MetS components was compared across different PA or FV groups. Multivariable logistic regression was used to assess association between FV/PA and the risk of MetS. A total of 7424 adults were included in the current study. MetS was prevalent in 28.7% of participants, with 24.7% and 32.9% in male and female, respectively. Compared with those with inadequate PA and insufficient FV intake, participants with the combination of adequate PA and sufficient FV intake had the lowest risk of MetS (OR = 0.69,95%CI: 0.59-0.82), following by the group with adequate PA time but insufficient FV intake (OR = 0.74, 95%CI:0.65-0.83). CONCLUSION: Findings of the current study show that the combination of sufficient FV intake and adequate PA was significantly associated with reduced MetS risk among adult residents of China.

Combined Association of Diet and Cardiorespiratory Fitness with Metabolic Syndrome in Chinese Schoolchildren.

Objective To investigate the combined impact of diet and cardiorespiratory fitness (CRF) on metabolic syndrome (MetS) among Chinese schoolchildren. Methods A cross-sectional study among 615 children (354 boys and 261 girls) aged 9.6 ± 0.6 years was conducted in Wuhan, China, from May to June 2010. Body mass index, waist circumference, CRF, blood pressure, lipids, glucose, and pubertal status were assessed. MetS was defined by the criteria proposed by De Ferranti. Based on data from a food frequency questionnaire, a diet score was created for each food item and then summed. Gender-specific median values were set as the cut-off points for the classification of high and low CRF. Results The highest prevalence of MetS (15.7 %) was observed among participants in the low tertile of diet scores and having a low level of CRF. Multivariate logistic regression showed that the odds ratio for MetS was 0.30 (95 % confidence interval 0.09-1.00) among children in the medium tertile of diet scores with low CRF, 0.24 (0.07-0.89) among those in the high tertile of diet scores with low CRF, 0.07 (0.02-0.33) among those in the low tertile of diet scores with high CRF, and 0.08 (0.01-0.58) among those in the high tertile of diet scores with medium CRF compared with those in the low tertile of diet score with low CRF. Conclusions Findings of the present study suggest that diet and CRF are synergistically associated with the risk of MetS in Chinese schoolchildren.

Associations Between Genetic Variants in 19p13 and 19q13 Regions and Susceptibility to Alzheimer Disease: A Meta-Analysis.

BACKGROUND: Alzheimer disease (AD) has become an epidemic within the growing elderly population and effective therapies of AD have not been discovered. Genetic factors accounted for over 70% of the incidence of AD and the disease-related polymorphisms are located on chromosome 19, which is one of several prominent chromosomes related to the development of AD. Many inconsistent associations between polymorphisms in ABCA7, CD33, and TOMM40 genes and the susceptibility to AD have been suggested by several independent studies. MATERIAL/METHODS: A comprehensive literature search for studies involving the association between gene polymorphisms and AD was performed, and we finally selected 3 genes (4 polymorphisms) for the meta-analysis: ABCA7 (rs3764650), CD33 (rs3865444), and TOMM40 (rs157580, rs2075650). RESULTS: A total of 25 articles investigating 3 genes (4 polymorphisms) were included in the meta-analysis. The pooled results of 4 polymorphisms were all significantly associated with the susceptibility to AD. The pooled effect of ABCA7 rs3764605 allele G was significantly associated with an increased the risk of AD (OR=1.20, 95% CI: 1.14-1.26, P value <0.001). Similarly, our evidence suggested that allele A of TOMM40 rs2075650 polymorphism was a risk factor for AD (OR=2.87, 95% CI: 2.46-3.34, P value <0.001). Alleles A of CD33 rs3865444 and A of TOMM40 rs157580 were both protective factors for AD onset (OR=0.94, 95% CI: 0.90-0.98, P value=0.003; OR=0.62, 95% CI: 0.57-0.66, P value <0.001). CONCLUSIONS" Results from the meta-analysis revealed that the pooled ABCA7 rs376465, CD33 rs3865444, TOMM40 rs157580, and rs2075650 variants were significantly associated with the susceptibility to AD. However, the association differed significantly between Asian and Caucasian groups for SNPs of CD33 rs3865444, TOMM40 rs157580, and rs2075650.

Plumbagin elicits differential proteomic responses mainly involving cell cycle, apoptosis, autophagy, and epithelial-to-mesenchymal transition pathways in human prostate cancer PC-3 and DU145 cells.

Plumbagin (PLB) has exhibited a potent anticancer effect in preclinical studies, but the molecular interactome remains elusive. This study aimed to compare the quantitative proteomic responses to PLB treatment in human prostate cancer PC-3 and DU145 cells using the approach of stable-isotope labeling by amino acids in cell culture (SILAC). The data were finally validated using Western blot assay. First, the bioinformatic analysis predicted that PLB could interact with 78 proteins that were involved in cell proliferation and apoptosis, immunity, and signal transduction. Our quantitative proteomic study using SILAC revealed that there were at least 1,225 and 267 proteins interacting with PLB and there were 341 and 107 signaling pathways and cellular functions potentially regulated by PLB in PC-3 and DU145 cells, respectively. These proteins and pathways played a critical role in the regulation of cell cycle, apoptosis, autophagy, epithelial to mesenchymal transition (EMT), and reactive oxygen species generation. The proteomic study showed substantial differences in response to PLB treatment between PC-3 and DU145 cells. PLB treatment significantly modulated the expression of critical proteins that regulate cell cycle, apoptosis, and EMT signaling pathways in PC-3 cells but not in DU145 cells. Consistently, our Western blotting analysis validated the bioinformatic and proteomic data and confirmed the modulating effects of PLB on important proteins that regulated cell cycle, apoptosis, autophagy, and EMT in PC-3 and DU145 cells. The data from the Western blot assay could not display significant differences between PC-3 and DU145 cells. These findings indicate that PLB elicits different proteomic responses in PC-3 and DU145 cells involving proteins and pathways that regulate cell cycle, apoptosis, autophagy, reactive oxygen species production, and antioxidation/oxidation homeostasis. This is the first systematic study with integrated computational, proteomic, and functional analyses revealing the networks of signaling pathways and differential proteomic responses to PLB treatment in prostate cancer cells. Quantitative proteomic analysis using SILAC represents an efficient and highly sensitive approach to identify the target networks of anticancer drugs like PLB, and the data may be used to discriminate the molecular and clinical subtypes, and to identify new therapeutic targets and biomarkers, for prostate cancer. Further studies are warranted to explore the potential of quantitative proteomic analysis in the identification of new targets and biomarkers for prostate cancer.

Plumbagin induces the apoptosis of human tongue carcinoma cells through the mitochondria-mediated pathway.

BACKGROUND: Plumbagin, a quinonoid constituent isolated from the root of Plumbago zeylanica L., has been proven to possess anti-tumor activity both in vitro and in vivo. However, its anti-tumor properties for human tongue carcinoma have not been reported. This study aimed to investigate the inhibitory effect and the underlying mechanism of plumbagin on the growth of human tongue carcinoma cells. MATERIAL AND METHODS: Cell proliferation ability was detected by EdU incorporation assay and colony formation assay. Cell-cycle distribution was determined by flow cytometric analysis using propidium iodide (PI) staining. Cellular apoptosis was then evaluated by flow cytometry and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Western blotting was applied to assay the expression of Bax and Bcl-2. RESULTS: Plumbagin inhibited the growth and proliferation of Tca8113 cells in vitro in a concentration- and time-dependent manner. The cell cycles of plumbagin-treated Tca8113 cells were arrested at the G2/M phase. Cells treated with plumbagin presented the characteristic morphological changes of apoptosis. The ratio of Bax/Bcl-2 was raised by plumbagin in a concentration-dependent manner. CONCLUSIONS: These results indicate that plumbagin induces the apoptosis of Tca8113 cells through mitochondria-mediated pathway.

Long-term care arrangements in rural China: review of recent developments.

Developing long-term care systems for the elderly has become an increasingly urgent policy issue in China, especially in rural areas. This article provides an overview of the current status of long-term care development in rural China and discussion on the future development of institutional care and its policy implications. Formal long-term care systems are emerging but remain in the preliminary stages of development. Several policy considerations and practical implications deserve further attention: increases in regional and national government funding, integration of long-term care with the acute health care system, and creating more multilevel and multifunctional LTC facilities with a well-trained and skilled workforce.

Socioeconomic status and alcohol use among urban and rural residents in China.

The association between socioeconomic status (SES) and current regular alcohol use was examined separately for urban and rural residents of Hubei, China, using the third Chinese National Health Service Survey conducted in 2003. A probability sample of 15,609 respondents, ages 15 through 101 years, was selected from the study base. Alcohol use was a dichotomized variable (current regular users vs. others). Multivariate analyses incorporated four SES indicators: income, education, occupation, and house size. Investigation of status discrepancy indicated that income was positively associated with the likelihood of current regular alcohol use, whereas education was negatively associated. For both urban and rural residents, likelihood of current regular alcohol use was smallest for those in the highest education and lowest income category. Further research, which factors in quantity and frequency, is needed to understand how alcohol use among Chinese urban and rural populations impacts their health.

Polymorphisms of estrogen-metabolizing genes and breast cancer risk: a multigenic study.

BACKGROUND: Endogenous estrogen plays a very important role in the carcinogenesis and progression of breast cancer. The enzymes involved in the biosynthesis and metabolism of estrogen have been proposed to contribute to this effect. To examine this hypothesis, we conducted a case-control study to investigate the relationship between polymorphisms of genes responsible for estrogen biosynthesis (CYP17, cytochrome P450c17a and CYP19, aromatase cytochrome P450) and estrogen sulfation of inactivation (SULT1A1, sulfotransferase1A1) and the risk of breast cancer in Chinese women. METHODS: This study involved 213 breast cancer patients and 430 matched controls. PCR-based restriction fragment length polymorphism (RFLP) and short tandem repeat polymorphism (STRP) assays were used to detect the mononucleotide transition of CYP17 and SULT1A1 and tandem repeat polymorphism of CYP19. Logistic regression analyses were used to determine OR and 95% CI of each and all three high-risk genotypes, of all three genotypes combined, and of estrogen exposure factors. The relationship between each high-risk genotype and clinicalpathological characteristics were also assessed. RESULTS: The frequency of A2 allele of CYP17 was 49.8% in cases and 49.1% in controls (P = 0.82). The frequency of His allele of SULT1A1 was significantly higher in cases (13.6%) than in controls (9.5%) (P < 0.05). There was also significant difference of the (TTTA) 10 allele of CYP19 which was 12.4% in cases and 8.2% in controls (P < 0.05). When the CYP17 A2 allele, CYP19 (TTTA) 10 and SULT1A1 His allele were considered as the "putative high-risk" genotype, there was an increased risk of breast cancer with the number of high-risk genotypes in a dose-response effect (trend, P = 0.05). In multivariate analysis, the SULT1A1 genotype remained the most significant determinant for breast cancer, with OR = 2.37 (95% CI 1.23-4.74), followed by CYP19, with OR = 1.75 (95% CI 1.27-3.56). The (TTTA) 10 allele of CYP19 was associated with tumor size, and the His allele of SULT1A1 associated with status of lymph node metastasis. CONCLUSIONS: This study supports the hypothesis that breast cancer can be initiated by estrogen exposure and that estrogen metabolizing genes are involved in this mechanism. This multigenic model is useful for identifying individuals who are at higher risks of breast cancer.

[Detection of apoptosis genes differentially expressed in patients with different degrees of benzene poisoning by cDNA microarray].

OBJECTIVE: To investigate the differential expression of apoptosis genes in patients with different degrees of benzene poisoning by cDNA microarray. METHODS: Peripheral mononuclear cells were isolated from seven patients with benzene poisoning of different degrees (suspected 1 case, moderate 2, severe 2), and seven age and sex matched normal control subjects. Total RNA was extracted and purified, followed by reverse transcription to cDNAs with concomitant incorporation of fluorescent dCTP (Cy3 or Cy5). Then 177 genes associated with cell apoptosis were hybridized against the cDNAs probes in microarray. Fluorescent signals were scanned to detect apoptosis genes differentially expressed in patients and normal subjects. RESULTS: Forty one genes were found to be differentially expressed between benzene-poisoned patients and normal controls; among the 41 genes, three were up-regulated among patients with mild to moderate degrees of benzene poisoning and one up-regulated among all patients. The total amount of differentially expressed genes of apoptosis decreased with the aggravation of benzene poisoning. CONCLUSIONS: Differential expression of apoptosis genes was found in patients with benzene poisoning, suggesting a role of altered apoptosis in benzene-induced hematotoxicity.