Existing and potential therapeutic uses for N-acetylcysteine: the need for conversion to intracellular glutathione for antioxidant benefits.

Fungi are an understudied, biotechnologically valuable group of organisms. Due to 
the immense range of habitats that fungi inhabit, and the consequent need to compete against a diverse array of other fungi, bacteria, and animals, fungi have developed numerous survival mechanisms. The unique attributes of fungi thus herald great promise for their application in biotechnology and industry. Moreover, fungi can be grown with relative ease, making production at scale viable. The search for fungal biodiversity, and the construction of a living fungi collection, both have incredible economic potential in locating organisms with novel industrial uses that will lead to novel products. This manuscript reviews fifty ways in which fungi can potentially be utilized as biotechnology. We provide notes and examples for each potential exploitation and give examples from our own work and the work of other notable researchers. We also provide a flow chart that can be used to convince funding bodies of the importance of fungi for biotechnological research and as potential products. Fungi have provided the world with penicillin, lovastatin, and other globally significant medicines, and they remain an untapped resource with enormous industrial potential.

The amazing potential of fungi: 50 ways we can exploit fungi industrially

Summary Cancer is one of the major non-communicable diseases posing a threat to world health. Unfortunately, improvements in socioeconomic conditions are usually associated with increased cancer incidence. In this Commission, we focus on China, India, and Russia, which share rapidly rising cancer incidence and have cancer mortality rates that are nearly twice as high as in the UK or the USA, vast geographies, growing economies, ageing populations, increasingly westernised lifestyles, relatively disenfranchised subpopulations, serious contamination of the environment, and uncontrolled cancer-causing communicable infections. We describe the overall state of health and cancer control in each country and additional specific issues for consideration: for China, access to care, contamination of the environment, and cancer fatalism and traditional medicine; for India, affordability of care, provision of adequate health personnel, and sociocultural barriers to cancer control; and for Russia, monitoring of the burden of cancer, societal attitudes towards cancer prevention, effects of inequitable treatment and access to medicine, and a need for improved international engagement.

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Challenges to effective cancer control in China, India, and Russia

Recent studies indicate that Traditional Chinese medicine (TCM) can play an important role in the whole course of cancer treatment such as recovery stages of post-operative, radiotherapy or chemotherapy stages instead of only terminal stage of cancer. In this review, we have summarized current evidence for using TCM as adjuvant cancer treatment in different stages of cancer lesions. Some TCMs (e.g., TJ-41, Liu-jun-zi-tang, PHY906, Coumarin, and Aescine) are capable of improving the post-operative symptoms such as fatigue, pain, appetite, diarrhea, nausea, vomiting, and lymphedema. Some TCMs (e.g., Ginseng, Huang-Qi, BanZhiLian, TJ-48, Huachansu injection, Shenqi fuzheng injection, and Kanglaite injection) in combination with chemo- or radio-therapy are capable of enhancing the efficacy of and diminishing the side effects and complications caused by chemo- and radiotherapy. Taken together, they have great advantages in terms of suppressing tumor progression, relieving surgery complications, increasing the sensitivity of chemo- and radio- therapeutics, improving an organism's immune system function, and lessening the damage caused by surgery, chemo- or radio-therapeutics. They have significant effects on relieving breast cancer-related lymphedema, reducing cancer-related fatigue and pain, improving radiation pneumonitis and gastrointestinal side effects, protecting liver function, and even ameliorating bone marrow suppression. This review of those medicines should contribute to an understanding of Chinese herbal medicines as an adjunctive therapy in the whole course of cancer treatment instead of only terminal stage of cancer, by providing useful information for development of more effective anti-cancer drugs and making more patients "survival with cancer" for a long time.

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The advantages of using traditional Chinese medicine as an adjunctive therapy in the whole course of cancer treatment instead of only terminal stage of cancer

Biochar-based water treatment systems as a potential low-cost and sustainable technology for clean water provision.

Background
Traditional Chinese medicine (TCM) has been widely applied for cancer care in China. There have been a large number of controlled clinical studies published in Chinese literature, yet no systematic searching and analysis has been done. This study summarizes the current evidence of controlled clinical studies of TCM for cancer.

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Traditional Chinese Medicine in Cancer Care: A Review of Controlled Clinical Studies Published in Chinese

Aims: To evaluate the level of patient satisfaction with nursing care in China’s major tertiary hospitals, and to explore patient and hospital level factors associated with patient satisfaction, in order to provide policy implications for the evaluation and improvement of nursing care, toward a patient-centered healthcare system. Background: Patient satisfaction with nursing care has been designated as a key measure of the quality of nursing care and is one of the main focuses of the current healthcare improvement campaign in China. Methods: We participated in the 2021 China National Patient Survey and designed and administered a survey instrument with five domains, to evaluate patient satisfaction with nursing care among 24,971 inpatients from 143 tertiary hospitals across 31 provinces in China. Descriptive analysis and binary logistic regressions were utilized to assess the level of satisfaction and identify key factors related to nursing satisfaction. Results: The overall satisfaction level is high, but satisfaction with health guidance is relatively low. Patients’ sociodemographic characteristics, including age, income, and education, are significantly associated with their satisfaction. Hospital characteristics, such as geographic location, type, and nurse-to-doctor ratio, significantly impact inpatient satisfaction with nursing care. Patients of hospitals in the eastern region, general hospitals, and hospitals with higher nurse-to-doctor ratios are more satisfied with nursing care. Conclusion: More attention should be paid to equitably allocating healthcare resources among different regions, improving the management and competence of non-general hospitals, and strengthening the recruitment and retention of the nursing workforce. Moreover, patient characteristics should be considered when evaluating patient satisfaction across hospitals. Patient and Public Contribution: These findings will help us better understand patients’ satisfaction regarding nursing care in Chinese tertiary hospitals and develop targeted interventions, to establish a patient-centered healthcare system.

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Inpatient Satisfaction with Nursing Care and Its Impact Factors in Chinese Tertiary Hospitals: A Cross-Sectional Study

Importance Patient satisfaction is a crucial indicator for assessing quality of care in healthcare settings. However, patient satisfaction benchmark for cancer hospitals in China is not established. Objective To examine patient satisfaction levels in tertiary cancer hospitals in China, and inter-hospital variations after case-mix adjustment. Design A nationwide cross-sectional hospital performance survey conducted from January to March 2021. Settings At 30 tertiary cancer hospitals in China. Participants A total of 4,847 adult inpatients consecutively recruited at 30 tertiary cancer hospitals were included. Exposures Patient characteristics included demographic characteristics (sex, age, education, and annual family income), clinical characteristics (cancer type, cancer stage, self-reported health status, and length of stay), and actual respondents of questionnaire. Main outcomes and measures Patient satisfaction was measured using 23 items covering five aspects, administrative process, hospital environment, medical care, symptom management, and overall satisfaction. Responses to each item were recorded using a 5-point Likert scale. Patient satisfaction level for each aspect was described at individual and hospital levels. Using multilevel logistic regression, patient characteristics associated with patient satisfaction were examined as case-mix adjusters and inter-hospital variation were determined. Results The satisfaction rates for symptom management, administrative process, hospital environment, overall satisfaction, and medical care aspects were 74.56, 81.70, 84.18, 84.26, and 90.86% with a cut-off value of 4, respectively. Significant predictors of patient satisfaction included sex, age, cancer type, cancer stage, self-reported health status, and actual respondent (representative or patient) (all P < 0.05). The ranking of the hospitals' performance in satisfaction was altered after the case-mix adjustment was made. But even after the adjustment, significant variation in satisfaction among hospitals remained. Conclusions and relevance This study pointed to symptom management as a special area, to which a keen attention should be paid by policymakers and hospital administrators. Significant variation in satisfaction among hospitals remained, implying that future studies should examine major factors affecting the variation. In review, target interventions are needed in low-performing hospitals.

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Patient healthcare experiences of cancer hospitals in China: A multilevel modeling analysis based on a national survey

Objectives To curb the unreasonable growth of medical expenses and reduce the burden of medical treatment, Beijing launched two rounds of comprehensive reform of public hospitals. In the two reforms, the addition of drugs and consumables was canceled successively. This study compared the changes in the direct medical cost of inpatients with coronary heart disease (CHD) in the three stages of two comprehensive public hospital reforms in Beijing and provides data support for health reform policies. Setting CHD diagnosis and treatment data were extracted from the Hospital Information System (HIS) of 33 public hospitals. The total amount and composition of the direct medical expenses of CHD inpatients in the three stages were calculated. Interrupted time series analysis was used to study the instantaneous changes and trend changes in the three stages. Participants The data were obtained from the HIS system of 33 public hospitals above the second level in Beijing. A total of 66,647 medical and diagnosis records and 24,371,139 charge detail records were included. Results After the two reforms, the total cost for CHD inpatients with most clinical classifications and treatment methods decreased. The proportion of drug and consumable costs decreased significantly, whereas the proportion of medical consultation service costs increased. Drug-treated patients were mainly affected by the instantaneous reforms, percutaneous coronary intervention-treated patients were simultaneously affected by instantaneous and trending effects, and coronary artery bypass graft-treated patients were mainly affected by the reform trend. Conclusion The overall change in the direct medical cost of CHD inpatients was consistent with the goal of the comprehensive medical reform of public hospitals in Beijing, which is “total control and structural adjustment.”

The impact of comprehensive public hospital reforms on the direct medical cost of inpatients with coronary heart disease

Background: Danhong injection (DHI) accounts for the highest proportion of drug costs for inpatients with coronary heart disease (CHD). However, if DHI price influences utilization remains unclear. Objective: The objective was to compare changes in the use of DHI for CHD patients during three stages after two comprehensive reforms of public hospitals in Beijing. These findings will provide support for controlling the drug burden of CHD patients and regulating drug use behavior. Research Design: CHD diagnosis and treatment data were extracted from the Hospital Information System (HIS) of 33 public hospitals. Patients were grouped according to different treatment methods and clinical classifications. Changes in the utilization of DHI, including the use rate (the percentage of CHD patients using DHI), number of prescribed units (average number of units of DHI prescribed per hospital stay), and cost of DHI per hospital stay (equal to the unit price multiplied by the number of prescribed units) between the three stages were statistically analyzed. Association rules were applied to identify changes in drug combinations. Results: After the two reforms, the unit price of DHI dropped from $6.46 to $5.61. At the same time, the use rate increased from 20.77 to 24.00%, the number of prescribed units dropped from 29.76 to 29.21, and the cost of DHI per hospital stay dropped from $192.12 to $163.96. The changes in the use rate and number of prescribed units varied among patients with different clinical types and treatment methods, and the cost of CHI per hospital stay was consistent with the overall situation. The variety of drugs used in combination with DHI remained relatively stable. Conclusion: The use rate of DHI for CHD patients increased, indicating increased applications of DHI in clinical practice. Due to the drop in price, the cost of using DHI decreased, and the financial burden of this drug was reduced.

Yue Xu

Papers

Traditional Chinese Medicine in Cancer Care: A Review of Controlled Clinical Studies Published in Chinese

Inpatient Satisfaction with Nursing Care and Its Impact Factors in Chinese Tertiary Hospitals: A Cross-Sectional Study

Patient healthcare experiences of cancer hospitals in China: A multilevel modeling analysis based on a national survey

The impact of comprehensive public hospital reforms on the direct medical cost of inpatients with coronary heart disease

Danhong Injection Price Trend and Its Utilization by Coronary Heart Disease Patients: Evidence From Hospital Records in China