PCSK9 Inhibitor: Safe Alternative to Fill the Treatment Gap in Statin-Limited Conditions?

Lipid-lowering therapy is of great importance in reducing the burden of atherosclerotic cardiovascular disease. Statins act as first-line therapy in the current lipid management guidelines. However, statin use is limited in (1) statin-induced adverse events, including statin-associated muscle symptoms, new-onset diabetes mellitus, drug-induced liver injuries, acute kidney injuries, cognitive effects, hemorrhagic strokes, and cataracts; (2) special populations, including pregnant and lactating patients, patients with decompensated cirrhosis, and patients on dialysis; (3) coadministration with statin-interactive drugs, such as anti-human immunodeficiency virus drugs, anti-hepatitis C virus drugs, and immunosuppressive drugs. These considerable statin-limited groups are in urgent need of safer alternative lipid-lowering options. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are attracting widespread attention for their documented safety in general populations and superior lipid-lowering properties. Therefore, questions have been raised whether PCSK9 inhibitors could be a safe alternative in patients who are intolerant to statin therapy. In this review, we discuss the safety of PCSK9 inhibitors in statin-limited conditions. We conclude that PCSK9 inhibitors are a safe alternative lipid-lowering therapy in various statin-limited conditions. Furthermore, we identify several limitations in the current literature and suggest future directions, for the refinement of lipid management regimens.

Exploration of village health centres in Northern and Central China: A qualitative study.

OBJECTIVE: China faces issues associated with urban-rural health inequities. This study explores functions of village health centres through a community perspective. Four research questions were asked, including: (a) What are the functions of village health centres? (b) How is medication administered in village health centres? (c) What are the roles of village doctors? (d) What are the evaluation mechanisms of village health centres? DESIGN: In-depth interviews and field observations are used in the study. SETTING: Nine rural villages in two provinces in Northern and Central China. PARTICIPANTS: A total of 93 people across were interviewed. RESULTS: Village health centres are primarily responsible for providing public health services and essential medical care. In addition, village health centres also function as a social venue of a rural community. A centralised medication scheme augments these processes through supplying health centres with affordable medications. Village doctors are expected to take the needs and preferences of their patients into consideration when creating care plans, and must establish trusting rapport with patients by upholding their unique values. This results in care that is convenient, accessible, and person-centred. Village health centres are evaluated through a 2-step process which has direct effects on the amount of government subsidy received. CONCLUSION: Village health centres have multi-faceted functions in rural Chinese communities. Overall, the benefits of village health centres include convenient and timely access to care for rural residents. Improvements can be made in certain areas, such as streamlining provincial medication schemes and adopting a strengths-based model of evaluation.

Genetic characterization of a novel G9P[23] rotavirus A strain identified in southwestern China with evidence of a reassortment event between human and porcine strains.

Group A rotaviruses (RVAs) are important zoonotic pathogens that cause intestinal disease in humans and other mammals. In this study, the novel strain RVA/Pig/China/SC11/2017/G9P[23](SC11) was isolated from fecal samples from a pig farm in Sichuan province, southwestern China. The complete genome was found to be 18,347 bp in length with 11 segments. The genotype constellation of strain SC11 was G9-P[23]-I12-R1-C1-M1-A1-N1-T1-E1-H1, according to whole-genome sequencing analysis. The VP1, VP2, VP4, VP6, NSP1-NSP3, and NSP5 genes of RVA strain SC11 were found to be closely related to those of porcine and/or porcine-like human RVAs. Meanwhile, the VP7 and NSP4 genes of strain SC11 were closely related to genes of human RVAs. However, it was difficult to pinpoint the porcine or human origin of the VP3 gene of strain SC11 based on the available data. These results showed that SC11 originated from a natural reassortment event between human and pig RVA strains, and crossover points for recombination were identified at nucleotides (nt) 109-806 of NSP2. This is the first report of such a reassortant and recombinant RVA strain in the southwestern region of China.