Showing papers by "National Health and Family Planning Commission published in 2013"

Biological features of novel avian influenza A (H7N9) virus

Abstract: Human infection associated with a novel reassortant avian influenza H7N9 virus has recently been identified in China. A total of 132 confirmed cases and 39 deaths have been reported. Most patients presented with severe pneumonia and acute respiratory distress syndrome. Although the first epidemic has subsided, the presence of a natural reservoir and the disease severity highlight the need to evaluate its risk on human public health and to understand the possible pathogenesis mechanism. Here we show that the emerging H7N9 avian influenza virus poses a potentially high risk to humans. We discover that the H7N9 virus can bind to both avian-type (α2,3-linked sialic acid) and human-type (α2,6-linked sialic acid) receptors. It can invade epithelial cells in the human lower respiratory tract and type II pneumonocytes in alveoli, and replicated efficiently in ex vivo lung and trachea explant culture and several mammalian cell lines. In acute serum samples of H7N9-infected patients, increased levels of the chemokines and cytokines IP-10, MIG, MIP-1β, MCP-1, IL-6, IL-8 and IFN-α were detected. We note that the human population is naive to the H7N9 virus, and current seasonal vaccination could not provide protection.

Characterization of Regional Influenza Seasonality Patterns in China and Implications for Vaccination Strategies: Spatio-Temporal Modeling of Surveillance Data

Abstract: Background The complexity of influenza seasonal patterns in the inter-tropical zone impedes the establishment of effective routine immunization programs. China is a climatologically and economically diverse country, which has yet to establish a national influenza vaccination program. Here we characterize the diversity of influenza seasonality in China and make recommendations to guide future vaccination programs.

Traumatic scratch injury in astrocytes triggers calcium influx to activate the JNK/c-Jun/AP-1 pathway and switch on GFAP expression

Abstract: Astrocyte activation is a hallmark of central nervous system injuries resulting in glial scar formation (astrogliosis). The activation of astrocytes involves metabolic and morphological changes with complex underlying mechanisms, which should be defined to provide targets for astrogliosis intervention. Astrogliosis is usually accompanied by an upregulation of glial fibrillary acidic protein (GFAP). Using an in vitro scratch injury model, we scratched primary cultures of cerebral cortical astrocytes and observed an influx of calcium in the form of waves spreading away from the wound through gap junctions. Using the calcium blocker BAPTA-AM and the JNK inhibitor SP600125, we demonstrated that the calcium wave triggered the activation of JNK, which then phosphorylated the transcription factor c-Jun to facilitate the binding of AP-1 to the GFAP gene promoter to switch on GFAP upregulation. Blocking calcium mobilization with BAPTA-AM in an in vivo stab wound model reduced GFAP expression and glial scar formation, showing that the calcium signal, and the subsequent regulation of downstream signaling molecules, plays an essential role in brain injury response. Our findings demonstrated that traumatic scratch injury to astrocytes triggered a calcium influx from the extracellular compartment and activated the JNK/c-Jun/AP-1 pathway to switch on GFAP expression, identifying a previously unreported signaling cascade that is important in astrogliosis and the physiological response following brain injury.

Insufficient radiofrequency ablation promotes epithelial-mesenchymal transition of hepatocellular carcinoma cells through Akt and ERK signaling pathways

Abstract: Background Residual tumor progression after insufficient radiofrequency ablation (RFA) has been recently reported. However, whether epithelial-mesenchymal transition (EMT), which is a key process that drives cancer metastasis, is involved in the tumor progression after insufficient RFA is not well understood.

Mothers of Autistic Children: Lower Plasma Levels of Oxytocin and Arg-Vasopressin and a Higher Level of Testosterone

Abstract: Background: Autism is a pervasive neurodevelopmental disorder,thought to be caused by a combination of genetic heritability and environmental risk factors. Some autistic-like traits have been reported in mothers of autistic children. We hypothesized that dysregulation of oxytocin (OXT), Arg-vasopressin (AVP) and sex hormones, found in autistic children, may also exist in their mothers. Methods: We determined plasma levels of OXT (40 in autism vs. 26 in control group), AVP (40 vs. 17) and sex hormones (61 vs. 47) in mothers of autistic and normal children by enzyme immunoassay and radioimmunoassay, respectively and investigated their relationships with the children’s autistic behavior scores (Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC)). Results: Significantly lower plasma concentrations of OXT (p,0.001) and AVP (p,0.001), as well as a higher level of plasma testosterone (p,0.05), were found in mothers of autistic children vs. those of control. The children’s autistic behavior scores were negatively associated with maternal plasma levels of OXT and AVP. Conclusions: These results suggest that dysregulation of OXT, AVP and/or testosterone systems exist in mothers of autistic children, which may impact children’s susceptibility to autism.

Basolateral Amygdala Lesion Inhibits the Development of Pain Chronicity in Neuropathic Pain Rats

Abstract: Background: Chronicity of pain is one of the most interesting questions in chronic pain study. Clinical and experimental data suggest that supraspinal areas responsible for negative emotions such as depression and anxiety contribute to the chronicity of pain. The amygdala is suspected to be a potential structure for the pain chronicity due to its critical role in processing negative emotions and pain information. Objective: This study aimed to investigate whether amygdala or its subregions, the basolateral amygdala (BLA) and the central medial amygdala (CeA), contributes to the pain chronicity in the spared nerve injury (SNI)-induced neuropathic pain model of rats. Methodology/Principal Findings: (1) Before the establishment of the SNI-induced neuropathic pain model of rats, lesion of the amygdaloid complex with stereotaxic injection of ibotenic acid (IBO) alleviated mechanical allodynia significantly at days 7 and 14, even no mechanical allodynia at day 28 after SNI; Lesion of the BLA, but not the CeA had similar effects; (2) however, 7 days after SNI when the neuropathic pain model was established, lesion of the amygdala complex or the BLA or the CeA, mechanical allodynia was not affected. Conclusion: These results suggest that BLA activities in the early stage after nerve injury might be crucial to the development of pain chronicity, and amygdala-related negative emotions and pain-related memories could promote pain chronicity.

Inactivation of the novel avian influenza A (H7N9) virus under physical conditions or chemical agents treatment

Abstract: In the spring of 2013, a novel avian-origin influenza A (H7N9) virus in Eastern China emerged causing human infections. Concerns that a new influenza pandemic could occur were raised. The potential effect of chemical agents and physical conditions on inactivation of the novel avian influenza H7N9 virus had not been assessed. To determine the inactivation effectiveness of the novel avian influenza A (H7N9) virus under various physical conditions and chemical treatments, two H7N9 viruses A/Anhui/1/2013 and A/Shanghai/1/2013 were treated by varied temperatures, ultraviolet light, varied pHs and different disinfectants. The viruses with107.7 EID50 were exposed to physical conditions (temperature, ultraviolet light and pH) or treated with commercial chemical agents (Sodium Hypochlorite, Virkon®-S, and Ethanol) respectively. After these treatments, the viruses were inoculated in SPF embryonated chicken eggs, the allantoic fluid was collected after 72–96 hours culture at 35°C and tested by haemagglutination assay. Both of the tested viruses could tolerate conditions under 56°C for 15 minutes or 60°C for 5 minutes, but their infectivity was completely lost under 56°C for 30 minutes, 65°C for 10 minutes, 70°C, 75°C and 100°C for 1 minute. It was also observed that the H7N9 viruses lost their infectivity totally after exposure of ultraviolet light irradiation for 30 minutes or longer time. Additionally, the viruses were completely inactivated at pH less than 2 for 0.5 hour or pH 3 for 24 hours, however, viruses remained infectious under pH treatment of 4–12 for 24 hours. The viruses were totally disinfected when treated with Sodium Hypochlorite, Virkon®-S and Ethanol at recommended concentrations after only 5 minutes. The novel avian influenza A (H7N9) virus can be inactivated under some physical conditions or with chemical treatments, but they present high tolerance to moderately acidic or higher alkali conditions. The results provided the essential information for public health intervention of novel H7N9 avian influenza outbreak.

Acupuncture for the treatment of drug addiction.

Abstract: Over the last four decades, there has been an increasing interest in acupuncture treatment of substance abuse around the world. Three important steps can be identified in this field. Dr. Wen of Hong Kong was the first (1972) to report that acupuncture at four body points and two ear points combined with electric stimulation can relieve opioid withdrawal signs in the addicts. The second major step was made by Dr. M. Smith in New York, the head of the National Acupuncture Detoxification Association (NADA) of the United States, who finalized a protocol (1985), using only ear points without electric stimulation for the treatment of cocaine dependence. The recent advance in this field was made by Dr. Han of the Peking University, Beijing, who characterized a protocol (2005), using electric stimulation of identified frequencies on body points to ameliorate heroin withdrawal signs and reduce relapse of heroin use. In this chapter, the efficacy of acupuncture and related techniques for the treatment of drug dependence in experimental settings and clinical practice will be reviewed, and the possible mechanisms underlying this effect be discussed.

External Quality Assessment for Avian Influenza A (H7N9) Virus Detection Using Armored RNA

Abstract: An external quality assessment (EQA) program for the molecular detection of avian influenza A (H7N9) virus was implemented by the National Center for Clinical Laboratories (NCCL) of China in June 2013. Virus-like particles (VLPs) that contained full-length RNA sequences of the hemagglutinin (HA), neuraminidase (NA), matrix protein (MP), and nucleoprotein (NP) genes from the H7N9 virus (armored RNAs) were constructed. The EQA panel, comprising 6 samples with different concentrations of armored RNAs positive for H7N9 viruses and four H7N9-negative samples (including one sample positive for only the MP gene of the H7N9 virus), was distributed to 79 laboratories in China that carry out the molecular detection of H7N9 viruses. The overall performances of the data sets were classified according to the results for the H7 and N9 genes. Consequently, we received 80 data sets (one participating group provided two sets of results) which were generated using commercial (n = 60) or in-house (n = 17) reverse transcription-quantitative PCR (qRT-PCR) kits and a commercial assay that employed isothermal amplification method (n = 3). The results revealed that the majority (82.5%) of the data sets correctly identified the H7N9 virus, while 17.5% of the data sets needed improvements in their diagnostic capabilities. These "improvable" data sets were derived mostly from false-negative results for the N9 gene at relatively low concentrations. The false-negative rate was 5.6%, and the false-positive rate was 0.6%. In addition, we observed varied diagnostic capabilities between the different commercially available kits and the in-house-developed assays, with the assay manufactured by BioPerfectus Technologies (Jiangsu, China) performing better than the others. Overall, the majority of laboratories have reliable diagnostic capacities for the detection of H7N9 virus.

Systematic review of interventions on antibiotic prophylaxis in surgery in Chinese hospitals during 2000-2012.

Abstract: Objective To systematically review intervention studies on antibiotic prophylaxis in clean or clean-contaminated surgery in Chinese hospitals from 2000 to 2012. Methods Published peer reviewed articles, unpublished documents and reports, and gray literature were identified through searching CNKI, CBM, VIP, PubMed (MEDLINE), WHO database, and the official websites of the Ministry of Health of China, provincial health authorities and medical university internal publications. Results Eighty-two studies were identified. Circulation and localization of central rules, regulations and guidelines; clinical pharmacists’ involvement; technical, administrative, and managerial strategies were the mostly adopted interventions. Except one study, all claimed effectiveness of interventions. Limited effects were observed for non-indicated clean surgery. Huge gaps still existed between the international agreed guidelines and the claimed best performance following interventions. The following were critical to have more effective interventions: recognition, acceptance, and enforcement strategies of rules, regulations, and guidelines; intervention persistence and intensity; health information system; removal of health system perverse incentives; patient–doctor relationship; public education; and access to unbiased medicines information. A total 4 of 82 studies were pre–post studies with control; all others were simple pre–post studies without control. Simple measurement of the outcome indicators as an average for pre–post intervention groups and changes in between failed to distinguish the real intervention effect from confounding factors, and failed to adjust underlying trends. Conclusions Interventions on surgical antibiotic prophylaxis in Chinese hospitals during 2000–2012 brought limited positive effects. There are still huge gaps between the Chinese situation and internationally agreed standards. More advanced study methodologies are needed to have better documentation of evidence of the most effective interventions.

Making hospitals in China smoke-free: a prospective study of implementing the new standard.

Abstract: OBJECTIVES In the run-up to all Chinese health care facilities becoming smoke-free, the feasibility of the new standard was assessed by monitoring its implementation in a sample of Chinese hospitals. METHODS Forty-one hospitals across 20 provinces were asked to ban smoking inside the hospital and provide advice and referral to stop-smoking treatment. Smoking status of more than 24,000 members of staff at 21 hospitals was surveyed at baseline (April 2009) and at follow-up (October 2010). Surveys monitored implementation of several specific aspects of the new standard to identify potential barriers to nationwide implementation. RESULTS All hospitals managed to implement the ban and most set up smoking cessation clinics. Routine recording of patients' smoking status proved more difficult to implement. The hospitals improved significantly in 8 out of 11 monitored policy parameters. Smoking prevalence among staff decreased from 14.8% to 10.7% (p < .001), suggesting an important collateral benefit of making hospitals smoke-free. Outdoor smoking areas facilitated the indoor ban. Staff education emerged as the key priority. CONCLUSIONS The smoke-free standard is feasible even in a country with a widespread acceptance of smoking inside health facilities. Several challenges need to be addressed when the new standard is disseminated across China.

Comparison of Electroacupuncture in Restrained and Unrestrained Rat Models

Abstract: Acupuncture and electroacupuncture (EA) are widely used to treat a variety of diseases including pain. In preclinical research, EA is usually applied by inserting acupuncture needles into the hindlimbs of rats restrained in small tubes or bags. This restrained model of EA not only causes stress-like behaviors but also is limited in stimulating locations and intensities. In 2004, a novel, unrestrained model of EA was introduced. However, these two EA methods have never been directly compared regarding their analgesic effects and other features such as stress. In the present study, we reported similar analgesic effects between restrained and unrestrained EA in rats of acute inflammatory pain induced by intraplantar injection of CFA. In addition, rats receiving unrestrained EA showed less significant stress-like behaviors and tolerated higher current intensity. These advantages suggest that this unrestrained EA method can replace the traditional restrained procedure with similar analgesic effects and allow for more choices of stimulating intensities and locations.

Comprehensive reform of community health service in east, middle and west regions of China: from patients’ perspective

Abstract: Objectives To analyze the satisfaction of patients with community health service (CHS) and the changes of the CHS delivered before and after the new health reform in different regions of China, and to put forward relevant policy recommendations for CHS development. Methods Twelve community health centers were selected by random sampling in each of the eight typical cities in the east, middle and west regions of China. Questionnaire survey was conducted among patients visiting these institutions during daily work hours. Results The proportions of the participants who stated that the medical environment, service attitude and medical skills of the doctors were improved were higher in the west region than those of the east and middle regions; but the percentage of patients who held that the drug price had lowered was higher in the east region than those of the middle and west region, the differences were of statistical significance ( P P Conclusions The comprehensive CHS reform should take the opinions of patients into account; essential drug system should be consolidated continually; and the reform of the payment system should be promoted by actively cooperating with the health insurance organizations.

Health professionals’ perspective on the impact of community health care reform in different regions of China

Abstract: Objective Changes in supplying community health services, degree of satisfaction, and policy suggestions are presented from the perspectives of health professionals in different regions of China with the purpose of further facilitating comprehensive reform of community health services. Methods Based on geographic location and economic level of development, eight cities were selected and 12 community health service institutions were chosen by random sampling from each city. A questionnaire survey was conducted by the health professionals. Results With respect to working enthusiasm, reduction in antibiotic drug use, social image and trust of patients, more health professionals in middle and western China showed positive feedbacks than those in eastern China. With respect to preliminary results of the reform, performance and salary, and health care insurance policies, health professionals’ satisfaction levels in middle and western China were higher than in eastern China. The health professionals in middle and western China were more concerned about equipment, infrastructure and increasing training opportunities. The health professionals in both eastern and middle China accentuated improving the variety of essential drugs covered by health insurance, while health professionals in eastern China suggested performance-related payment reform. Conclusions The performance of health professionals in middle and western China was improved more significantly through comprehensive reform than that of health professionals in eastern China. For health professionals in middle and western China, it is essential to strengthen infrastructure and increase professional training, while health professionals in middle and eastern China would like to see an increase in the variety of essential drugs, and those in eastern China require strengthening performance-related payment reform.

Complete Genome Sequence of an H12N8 Avian Influenza Virus Isolated from Wild Bird Feces in Hunan East Dongting Lake National Nature Reserve.

Abstract: An H12N8 subtype avian influenza virus (AIV) was isolated from a wild bird in China in 2011. It is the first report of isolation of the H12N8 subtype AIV in Asia. Phylogenetic analysis results suggested it is a reassortant, and all eight gene segments belong to the Eurasian gene pool.

Current Development of Neonatal - Perinatal care in china:

Abstract: Neonatal medicine in China has undergone a dramatic growth in recent two decades. Achievements are corroborated by significant reduction of maternal death below 25/100,000 deliveries, eradication of neonatal tetanus, reduction of neonatal mortality below 10 per 1,000 live births, and under 5 years children's mortality below 15 per 1,000, in most regions, which have fulfilled the millennium development goals for women and children's health initiated in the year 1990-2000. The most important progression in recent 4-5 years is the establishment of a new rural cooperative medical scheme as universal health insurance policy for public health from government resource that significantly enhanced capacity and quality of neonatal special care outreaching low level, community-based health service for women and infant care. This review briefly summarizes the progression related clinical experiences, approaches, limitations, outcome and challenges in neonatal respiratory diseases in relation to measures and policies conducted by public health care resources, and impact of social, cultural and economic factors. 1. General trend of neonatal-perinatal care As one of the highest populated countries of the world, China undergoes a dramatic transition in maternal and infant health care as nation-wide population reached 1.34 billion by 2010 • It has never been in China in the contemporary history, that women and children's health care has reached such a high level that both maternal and infants death rate overtly reduced to what the global millennium development goals (MDG) set forth in early 90's2, i.e., maternal death below 25/100,000 deliveries, eradication of neonatal tetanus, reduction of neonatal mortality below 10 per 1,000 live births, and under 5 years children's mortality below 15 per 1,000, in most regions· • The changes are underscored by the facts that over two and a half decade, neonatal special care service, or neonatal intensive care units (NICU) from fewer than 10 in major metropolitan city based children's or maternity hospitals to more than 300 in most of sub-provincial perinatal care centers of maternity or general hospitals. Their capacity and quality also transformed from very low level of service standard in early 90's to nowadays modernized in both space and facilities, along with widely implemented continuing medical education programs in general and specific aspect of neonatology relevant to strategy for community-based care. In the early 90's in China, neonatal mortality was above 60/1,000 live birth or more in average whereas in rural and remote regions of most provinces, it was 2-3 times as higher3·6 . Maternal death was also at very high level (> 50/100,000 deliveries) in rural regions. As economic booming, from the year 2000, there initiated several nation-wide programs as campaigns aiming at reducing both maternal death and neonatal mortality, specifically related to tetanus, birth asphyxia, congenital anomalies, infections, and prematurity related pathologies. Among these efforts were subsidiaries for hospitalized deliveries, delivery room resuscitation, community-based perinatal care system, regional high risk pregnant and neonatal transport, neonatal intensive care, post-neonatal infancy and early childhood follow up and developmental pediatrics, etc. Significant and continuous investment was paid off at subprovincial regional, county and township maternal hospital obstetric and pediatric services, for hospital construction and refurbishing, that functioned properly so that most of the rural residents were eligible to the essential and decent health care. However, new problems occurred along with the old ones such as high costs and long term burden for rural and low income families in face with substantial costs on modern technology based perinatal care, shortage of health care professionals, and lacking of experience in keeping service standard. However, the efforts returned with great success in implementation of community-based maternal and infant health care as infrastructure, fulfilling global MDG initiatives, so that more resources were able to relocate in community perinatal care center based on both prenatally obstetric and postnatally neonatal ward and NICU-centered care system. There are also dilemmas in terms of delivery related risk of maternal and neonatal death as to whether home delivery should be maintained in some regions where centralized hospital delivery for those in normal condition would not be necessary, or would elimination of township hospital/clinic delivery reduce pregnant and delivery complications and death risks, or should transportation of pregnant mother at high risk instead of newborn be more cost-effective, etc. Journal of Neonatology The most prominent advances are the establishment of health insurance to cover all prenatal, delivery and neonatal care, which functions effective in almost all rural regions, significantly reduced maternal death at delivery and neonatal and infant death reaching the MDG primary end point. Among many clinical measures, advanced respiratory care technologies are widely adopted, which contributed significantly to the reduction in hospitalized neonatal deaths, in line with the perinatal care which significantly reduced risks of pregnancy and delivery related neonatal and post-neonatal morbidity and mortality . Challenges remain as substantial numbers of very preterm newborns not receiving adequate treatment exist because of vast variations of neonatal outcomes in relation with regional policy, resource and practice in obstetrics and neonatology· • Predominant causes of neonatal death are shifted to prematurity with very lower gestational age (<30 weeks), very low birth weight ( < 1,500 g), congenital anomaly, infection, among others in most part of China, whereas malnutrition remains in some regions where economic development is retarded and fundamental maternal and infant health care significantly below the national average. Accessibility and availability of neonatal special care tend to be vital in resource limited regions, and count for high death rate of very immature infants. Current, preterm birth in major city level Ill maternity hospitals is close to 10-12% of the total in-hospital deliveries, but national average Vol.27, No.4, October December 2013 (which should include level II and I clinic deliveries, and home delivery, as a whole) may be as low as 4-5% (Table 1 ). There have been several important national projects/ programs that exerted significant impact on neonatalperinatal care system. 1) Nation-wide campaign in reduction of maternal death and eradication of neonatal tetanus, which should have completed in 2012 with fewer than 25 per 100,000 deliveries and 1-2 tetanus per 100,000 live births, respectively. The efforts for both maternal and neonatal/infant deaths remain persisted as provincially organized \"maternal and infant health scheme\", assessed annually by a panel of experts from policy maker, funding management, public health care, clinical obstetrics and pediatrics/neonatology, especially in mid-land, northand southwest provinces and autonomous regions in 2012-2015, enacted prefectural and county level enforcement of each of the programs and insurance coverage and subsidiary outreaching to each and every family in township or village. 2) Two phases of neonatal resuscitation program were introduced in some of the underdeveloped provinces, under the auspices of industrial based education funds endowed to Ministry of Health, in collaboration with American Heart Association, American Pediatrics Academy, and Chinese Society Table 1. Birth population and estimated preterm birth rate in China in 2010