Publications by authors named "Yanfang Su"

27 Publications

  • Page 1 of 1

Congenital chloride diarrhea in patient with SLC26A2 mutation - analysis of the clinical phenotype and differential diagnosis.

Pediatr Endocrinol Diabetes Metab 2021 ;27(1):51-56

Endocrinology, Kunming Children's Hospital, China.

Introduction: To analyze the clinical features and SLC26A3 mutation of one patient in our hospital who had congenital loss of chlorine diarrhea (CLD), and to investigate the treatment of the disease and the prognosis.

Material And Methods: By reviewing the literature, analyzing the clinical features and differential diagnosis and investigating the treatment and prognosis, the patient was diagnosed as CLD.

Results: Excessive accumulation of amniotic fluid was observed during pregnancy. The patient was born prematurely with normal body weight. The patient was a 4-month old boy admitted for anorexia, watery diarrhea, electrolyte disorders (hyponatremia, hypokalemia and hypochloremia) and metabolic alkalosis. The patient was also considered to be affected by Batter syndrome. After treating with spironolactone, indomethacin and potassium chloride sustained release tablet, the symptom of watery diarrhea was alleviated, the ingested amount of milk increased gradually and the amount of urine became normal; however, electrolyte imbalance persisted and the frequency of bowel movements remained high. Genetic analysis demonstrated that the patient had a SLC26A3 c.269_270dupAA homozygous mutation in exon 3, leading to a frameshift from 91st amino acid Gly and alteration of the SLC26A3 transmembrane protein sequence, thus resulting in a Cl-/HCO3- exchange barrier. The parents of the patient had normal phenotypes and were all heterozygous carriers of the mutation. Moreover, the patient was diagnosed as CLD. Sodium chloride and potassium chloride rather than spironolactone and indomenthacin were given to the patient to correct the dehydration, so the symptom of watery diarrhea alleviated and the blood gas and electrolyte levels returned to the normal range. In addition, the patients morale was good and the ingested amount of milk was moderate.

Conclusions: Persistent diarrhea and electrolyte disorder in pediatrics are easy to misdiagnose as CLD. Furthermore, it is difficult to identify Batter syndrome, Gitelman syndrome, renal tubular acidosis and CLD. Blood and stool electrolyte detection and SLC26A3 genetic tests are helpful for diagnosis, and sodium chloride and potassium chloride replacement therapy are critical for the patient prognosis.
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http://dx.doi.org/10.5114/pedm.2020.97465DOI Listing
January 2021

The Impact of Policy Measures on Human Mobility, COVID-19 Cases, and Mortality in the US: A Spatiotemporal Perspective.

Int J Environ Res Public Health 2021 01 23;18(3). Epub 2021 Jan 23.

Department of Geography and GeoInformation Science, George Mason University, Fairfax, VA 22030, USA.

Social distancing policies have been regarded as effective in containing the rapid spread of COVID-19. However, there is a limited understanding of policy effectiveness from a spatiotemporal perspective. This study integrates geographical, demographical, and other key factors into a regression-based event study framework, to assess the effectiveness of seven major policies on human mobility and COVID-19 case growth rates, with a spatiotemporal emphasis. Our results demonstrate that stay-at-home orders, workplace closures, and public information campaigns were effective in decreasing the confirmed case growth rate. For stay-at-home orders and workplace closures, these changes were associated with significant decreases ( < 0.05) in mobility. Public information campaigns did not see these same mobility trends, but the growth rate still decreased significantly in all analysis periods ( < 0.01). Stay-at-home orders and international/national travel controls had limited mitigation effects on the death case growth rate ( < 0.1). The relationships between policies, mobility, and epidemiological metrics allowed us to evaluate the effectiveness of each policy and gave us insight into the spatiotemporal patterns and mechanisms by which these measures work. Our analysis will provide policymakers with better knowledge regarding the effectiveness of measures in space-time disaggregation.
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http://dx.doi.org/10.3390/ijerph18030996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908236PMC
January 2021

Congenital chloride diarrhea in patient with SLC26A2 mutation - analysis of the clinical phenotype and differential diagnosis.

Pediatr Endocrinol Diabetes Metab 2020 Nov 16. Epub 2020 Nov 16.

Endocrinology, Kunming Children's Hospital, China.

Introduction: To analyze the clinical features and SLC26A3 mutation of one patient in our hospital who had congenital loss of chlorine diarrhea (CLD), and to investigate the treatment of the disease and the prognosis.

Material And Methods: By reviewing the literature, analyzing the clinical features and differential diagnosis and investigating the treatment and prognosis, the patient was diagnosed as CLD.

Results: Excessive accumulation of amniotic fluid was observed during pregnancy. The patient was born prematurely with normal body weight. The patient was a 4-month old boy admitted for anorexia, watery diarrhea, electrolyte disorders (hyponatremia, hypokalemia and hypochloremia) and metabolic alkalosis. The patient was also considered to be affected by Batter syndrome. After treating with spironolactone, indomethacin and potassium chloride sustained release tablet, the symptom of watery diarrhea was alleviated, the ingested amount of milk increased gradually and the amount of urine became normal; however, electrolyte imbalance persisted and the frequency of bowel movements remained high. Genetic analysis demonstrated that the patient had a SLC26A3 c.269_270dupAA homozygous mutation in exon 3, leading to a frameshift from 91st amino acid Gly and alteration of the SLC26A3 transmembrane protein sequence, thus resulting in a Cl-/HCO3- exchange barrier. The parents of the patient had normal phenotypes and were all heterozygous carriers of the mutation. Moreover, the patient was diagnosed as CLD. Sodium chloride and potassium chloride rather than spironolactone and indomenthacin were given to the patient to correct the dehydration, so the symptom of watery diarrhea alleviated and the blood gas and electrolyte levels returned to the normal range. In addition, the patients morale was good and the ingested amount of milk was moderate.

Conclusions: Persistent diarrhea and electrolyte disorder in pediatrics are easy to misdiagnose as CLD. Furthermore, it is difficult to identify Batter syndrome, Gitelman syndrome, renal tubular acidosis and CLD. Blood and stool electrolyte detection and SLC26A3 genetic tests are helpful for diagnosis, and sodium chloride and potassium chloride replacement therapy are critical for the patient prognosis.
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http://dx.doi.org/10.5114/pedm.2020.100403DOI Listing
November 2020

Effect of a Text Messaging-Based Educational Intervention on Cesarean Section Rates Among Pregnant Women in China: Quasirandomized Controlled Trial.

JMIR Mhealth Uhealth 2020 11 3;8(11):e19953. Epub 2020 Nov 3.

School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.

Background: Consensus exists that appropriate regional cesarean rates should not exceed 15% of births, but China's cesarean rate exceeds 50% in some areas, prompting numerous calls for its reduction. At present, China's 2016 two-child policy has heightened the implications of national cesarean section trends.

Objective: This study leveraged pervasive cellular phone access amongst Chinese citizens to test the effect of a low-cost and scalable prenatal advice program on cesarean section rates.

Methods: Participants were pregnant women presenting for antenatal care at a clinic in Xi'an, China. Assignment was quasirandomized and utilized factorial assignment based on the expecting mother's birthday. Participants were assigned to one of the following four groups, with each receiving a different set of messages: (1) a comparison group that received only a few "basic" messages, (2) a group receiving messages primarily regarding care seeking, (3) a group receiving messages primarily regarding good home prenatal practices, and (4) a group receiving text messages of all groups. Messages were delivered throughout pregnancy and were tailored to each woman's gestational week. The main outcome was the rates of cesarean delivery reported in the intervention arms. Data analysts were blinded to treatment assignment.

Results: In total, 2115 women completed the trial and corresponding follow-up surveys. In the unadjusted analysis, the group receiving all texts was associated with an odds ratio of 0.77 (P=.06), though neither the care seeking nor good home prenatal practice set yielded a relevant impact. Adjusting for potentially confounding covariates showed that the group with all texts sent together was associated with an odds ratio of 0.67 (P=.01). Notably, previous cesarean section evoked an odds ratio of 11.78 (P<.001), highlighting that having a cesarean section predicts future cesarean section in a subsequent pregnancy.

Conclusions: Sending pregnant women in rural China short informational messages with integrated advice regarding both care-seeking and good home prenatal practices appears to reduce women's likelihood of undergoing cesarean section. Reducing clear medical indications for cesarean section seems to be the strongest potential pathway of the effect. Cesarean section based on only maternal request did not seem to occur regularly in our study population. Preventing unnecessary cesarean section at present may have a long-term impact on future cesarean section rates.

Trial Registration: ClinicalTrials.gov NCT02037087; https://clinicaltrials.gov/ct2/show/NCT02037087.

International Registered Report Identifier (irrid): RR2-10.1136/bmjopen-2015-011016.
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http://dx.doi.org/10.2196/19953DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671841PMC
November 2020

Tracking total spending on tuberculosis by source and function in 135 low-income and middle-income countries, 2000-17: a financial modelling study.

Lancet Infect Dis 2020 08 23;20(8):929-942. Epub 2020 Apr 23.

Institute for Health Metrics and Evaluation, Seattle, WA, USA. Electronic address:

Background: Estimates of government spending and development assistance for tuberculosis exist, but less is known about out-of-pocket and prepaid private spending. We aimed to provide comprehensive estimates of total spending on tuberculosis in low-income and middle-income countries for 2000-17.

Methods: We extracted data on tuberculosis spending, unit costs, and health-care use from the WHO global tuberculosis database, Global Fund proposals and reports, National Health Accounts, the WHO-Choosing Interventions that are Cost-Effective project database, and the Institute for Health Metrics and Evaluation Development Assistance for Health Database. We extracted data from at least one of these sources for all 135 low-income and middle-income countries using the World Bank 2019 definitions. We estimated tuberculosis spending by source and function for notified (officially reported) and non-notified tuberculosis cases separately and combined, using spatiotemporal Gaussian process regression to fill in for missing data and estimate uncertainty. We aggregated estimates of government, out-of-pocket, prepaid private, and development assistance spending on tuberculosis to estimate total spending in 2019 US$.

Findings: Total spending on tuberculosis in 135 low-income and middle-income countries increased annually by 3·9% (95% CI 3·0 to 4·6), from $5·7 billion (5·2 to 6·5) in 2000 to $10·9 billion (10·3 to 11·8) in 2017. Government spending increased annually by 5·1% (4·4 to 5·7) between 2000 and 2017, and reached $6·9 billion (6·5 to 7·5) or 63·5% (59·2 to 66·8) of all tuberculosis spending in 2017. Of government spending, $5·8 billion (5·6 to 6·1) was spent on notified cases. Out-of-pocket spending decreased annually by 0·8% (-2·9 to 1·3), from $2·4 billion (1·9 to 3·1) in 2000 to $2·1 billion (1·6 to 2·7) in 2017. Development assistance for country-specific spending on tuberculosis increased from $54·6 million in 2000 to $1·1 billion in 2017. Administrative costs and development assistance for global projects related to tuberculosis care increased from $85·3 million in 2000 to $576·2 million in 2017. 30 high tuberculosis burden countries of low and middle income accounted for 73·7% (71·8-75·8) of tuberculosis spending in 2017.

Interpretation: Despite substantial increases since 2000, funding for tuberculosis is still far short of global financing targets and out-of-pocket spending remains high in resource-constrained countries, posing a barrier to patient's access to care and treatment adherence. Of the 30 countries with a high-burden of tuberculosis, just over half were primarily funded by government, while others, especially lower-middle-income and low-income countries, were still primarily dependent on development assistance for tuberculosis or out-of-pocket health spending.

Funding: Bill & Melinda Gates Foundation.
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http://dx.doi.org/10.1016/S1473-3099(20)30124-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649746PMC
August 2020

Ubiquitin specific peptidase 19 is a prognostic biomarker and affect the proliferation and migration of clear cell renal cell carcinoma.

Oncol Rep 2020 Jun 26;43(6):1964-1974. Epub 2020 Mar 26.

Department of Oncology, Huangshi Central Hospital of Edong Healthcare, Affiliated Hospital of Hubei Polytechnic University, Huangshi, Hubei 435000, P.R. China.

Ubiquitin specific peptidase 19 (USP19) is a member of the USP family and exhibits diverse roles in various biological processes, such as cell differentiation, cell cycle progression and apoptosis. There is limited knowledge regarding the role and impact of USP19 in cancer, particularly clear cell renal cell carcinoma (ccRCC). To examine the function of USP19 in ccRCC, The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus databases were examined to determine USP19 mRNA expression levels. USP19 mRNA levels were significantly lower in ccRCC tissues than in normal tissues. USP19 downregulation was associated with ccRCC progression and poor prognostic outcomes in TCGA cohort. Furthermore, the functional involvement of USP19 in ccRCC was examined using Cell Counting Kit‑8, soft agar, Transwell and wound healing assays in vitro following overexpression or knockdown of USP19 in the Caki‑1 cell line. USP19 overexpression inhibited ccRCC proliferation and migration, whereas USP19 knockdown promoted ccRCC proliferation and migration in vitro. Consistent with these results, it was further demonstrated that USP19 downregulation promoted tumor growth in vivo in a xenograft model. Mechanistically, it was found that USP19 exerted its inhibitory effect on ccRCC proliferation and migration by suppressing the activation of ERK. Collectively, the present findings identified a role for USP19 as a tumor suppressor in ccRCC and demonstrated that USP19 is a potential prognostic biomarker that could be applied in ccRCC therapy.
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http://dx.doi.org/10.3892/or.2020.7565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160536PMC
June 2020

The Effects on Inappropriate Weight for Gestational Age of an SMS Based Educational Intervention for Pregnant Women in Xi'an China: A Quasi-Randomized Controlled Trial.

Int J Environ Res Public Health 2020 02 25;17(5). Epub 2020 Feb 25.

The Children's Hospital and School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China.

Background: The aim of this study was to estimate the effects of maternal text messages on inappropriate weight for gestational age (IWGA) in newborns in rural China.

Methods: Participants were pregnant women presenting for antenatal care at a Maternal and Child Health Center in Xi'an, China during the 2013-2015 period. In total, 2115 women completed the program with follow-up information included in the final analyses. All mothers were divided into four groups, including (1) a control group that received only a few "Basic" messages, (2) a Care-Seeking (CS) message group, (3) Good Household Prenatal Practices (GHPP) message group, and (4) a group receiving all 148 text messages. The primary outcome was IWGA, including small for gestational age (SGA) and macrosomia (weighing ≥4000g at birth). Multivariable logistic regression using an intent-to-treat estimate was utilized.

Results: In total, 19.5% of newborns were IWGA. The risk of IWGA was 23.0% in the control group, 19.6% in the CS group, 18.9% in the GHPP group, and 16.5% in the group with All Texts. Compared to the control group, the odds ratio of IWGA was 0.65 (0.48-0.89) for the group receiving All Texts, which remained statistically significant after performing the Holm-Bonferroni correction. The odds ratio of macrosomia was 0.54 (0.34-0.87) and 0.57 (0.36-0.49) for the Care Seeking message group and the All Texts group, respectively, with statistical significance.

Conclusion: A package of free informational text messages, including advice for good household prenatal practices and care seeking, may prevent the inappropriate weight for gestational age through a protective effect on macrosomia. Advice to encourage care seeking in pregnancy may prevent macrosomia among neonates in rural China as well.
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http://dx.doi.org/10.3390/ijerph17051482DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084866PMC
February 2020

Cardiac Glycoside Compound Isolated from Franch Displays Potent Toxicity against HeLa Cervical Carcinoma Cells through ROS-Independent Autophagy.

Chem Res Toxicol 2019 12 12;32(12):2479-2487. Epub 2019 Nov 12.

State Key Laboratory of Food Nutrition and Safety, Key Laboratory of Industrial Fermentation Microbiology (Ministry of Education), Tianjin Key Laboratory of Industry Microbiology, School of Biotechnology , Tianjin University of Science & Technology , Tianjin 300457 , China.

The current study aimed to examine the anticancer activity of HTF-1, a cardiac glycoside (CG) isolated from Franch, using a cell-based model and to discover the underlying mechanisms with specific focus on autophagy. We found that HTF-1 was able to potently decrease the viability of several cancer cell lines especially for HeLa cervical carcinoma cells. It was discovered that HTF-1 dose dependently induced overproduction of ROS in HeLa cells, and the cell viability can be rescued when adding ROS scavenger -acetyl-l-cysteine (NAC). More, we found that HTF-1 induced ROS-independent autophagy in concentration- and time-dependent manners in HeLa cells. This can be collectively verified by LC3-II and p62 abundance and also eGFP-LC3 puncta assay, bafilomycin clamp experiment, and acidotropic dye fluorescent labeling experiment. Additionally, TEM examination showed more autophagic vacuoles for HTF-1-treated HeLa cells. In HeLa cells, pretreatment with wortmannin (an inhibitor of the initial stages of autophagy to block autophagosome formation, thus, it should weaken the autophagy induction effect of HTF-1) decreased the autophagic flux and partially antagonized cell death induced by HTF-1, indicating that autophagy induced by HTF-1 played a cancer-suppressing role. Furthermore, coadministration of BAF (as a distal inhibitor of autophagy) with HTF-1 demonstrated a synergistic anticancer effect against HeLa cells. We believe that our work will enrich the understanding of CGs and especially anticarcinoma activity, also, pave the way for natural-product-based anticancer drug development.
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http://dx.doi.org/10.1021/acs.chemrestox.9b00318DOI Listing
December 2019

Hepatic IRF2BP2 Mitigates Nonalcoholic Fatty Liver Disease by Directly Repressing the Transcription of ATF3.

Hepatology 2020 05 30;71(5):1592-1608. Epub 2020 Jan 30.

Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Background And Aims: Although knowledge regarding the pathogenesis of nonalcoholic fatty liver disease (NAFLD) has profoundly grown in recent decades, the internal restrictive mechanisms remain largely unknown. We have recently reported that the transcription repressor interferon regulatory factor-2 binding protein 2 (IRF2BP2) is enriched in cardiomyocytes and inhibits pathological cardiac hypertrophy in mice. Notably, IRF2BP2 is abundantly expressed in hepatocytes and dramatically down-regulated in steatotic livers, whereas the role of IRF2BP2 in NAFLD is unknown.

Approach And Results: Herein, using gain-of-function and loss-of-function approaches in mice, we demonstrated that while hepatocyte-specific Irf2bp2 knockout exacerbated high-fat diet-induced hepatic steatosis, insulin resistance and inflammation, hepatic Irf2bp2 overexpression protected mice from these metabolic disorders. Moreover, the inhibitory role of IRF2BP2 on hepatosteatosis is conserved in a human hepatic cell line in vitro. Combinational analysis of digital gene expression and chromatin immunoprecipitation sequencing identified activating transcription factor 3 (ATF3) to be negatively regulated by IRF2BP2 in NAFLD. Chromatin immunoprecipitation and luciferase assay substantiated the fact that IRF2BP2 is a bona fide transcription repressor of ATF3 gene expression via binding to its promoter region. Functional studies revealed that ATF3 knockdown significantly relieved IRF2BP2 knockout-exaggerated hepatosteatosis in vitro.

Conclusion: IRF2BP2 is an integrative restrainer in controlling hepatic steatosis, insulin resistance, and inflammation in NAFLD through transcriptionally repressing ATF3 gene expression.
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http://dx.doi.org/10.1002/hep.30950DOI Listing
May 2020

Effect of Osteoking on the osteogenic and adipogenic differentiation potential of rat bone marrow mesenchymal stem cells in vitro.

BMC Complement Altern Med 2019 Jan 31;19(1):36. Epub 2019 Jan 31.

Yunnan Key laboratory for Basic Research on Bone and Joint Diseases, Kunming University, Kunming, 650214, China.

Background: Bone damage is a condition that affects the quality of life of patients. Mesenchymal stem cells (MSCs) are important for bone repair. Osteoking is a natural compound in traditional Chinese Medicine used to treat bone diseases; however, the effect of Osteoking on the differentiation of MSCs has not been reported. In this study, we aimed to investigate the effect of Osteoking on the osteogenic and adipogenic differentiation potential of rat bone marrow mesenchymal stem cells (rbMSCs).

Methods: The effects of Osteoking on the proliferation and differentiation of rbMSCs were investigated. Different concentrations of Osteoking were prepared, and its cytotoxicity was evaluated by CCK-8 assay. The expression of osteogenic and adipogenic genes were determined, and several staining methods were used to reveal the osteogenic and adipogenic differentiation potential of rbMSCs.

Results: Our results show that appropriate concentrations of Osteoking can enhance osteogenic differentiation of rbMSCs and reduce adipogenic differentiation without any effect on proliferation. This may be related to the changes in related gene expression.

Conclusion: Osteoking enhances osteogenic differentiation and inhibits adipogenic differentiation of rbMSCs. Therefore, Osteoking may have a therapeutic potential for treating bone disease caused by changes in differentiation function of MSCs.
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http://dx.doi.org/10.1186/s12906-019-2435-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357478PMC
January 2019

A cardiac glycoside HTF-1 isolated from Helleborus thibetanus Franch displays potent in vitro anti-cancer activity via caspase-9, MAPK and PI3K-Akt-mTOR pathways.

Eur J Med Chem 2018 Oct 13;158:743-752. Epub 2018 Sep 13.

School of Pharmaceutical Science and Technology, Tianjin University, Tianjin 300072, China. Electronic address:

Experiments have been undertaken and for the first time, we have identified that a new cardiac glycoside (CG) isolated from Helleborus thibetanus Franch. a plant endemic to China, bears potent anti-cancer activity. We have named it as HTF-1. By using in vitro cell models, we have found that HTF-1 induces apoptosis against several types of cancer cells in a concentration- and time-dependent manner. It is able to inhibit cancer cell in proliferation, migration and invasion. HTF-1 causes S cell cycle arrest. Further-on, we have identified that HTF-1 triggers caspase-9 dependent apoptosis pathway and double strand DNA breaks (DSBs). Additionally, HTF-1 activates JNK, but suppresses ERK and PI3K-Akt-mTOR pathways. Collectively, the above-mentioned mechanisms contribute to the anti-cancer activity of HTF-1. It is rare to discover novel anti-cancer CG during the past couple of decades. We believe that our work will enrich the understanding of CGs; also, pave the way for natural product-based anti-cancer drug development.
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http://dx.doi.org/10.1016/j.ejmech.2018.09.019DOI Listing
October 2018

Assessment of Primary Health Care System Performance in Nigeria: Using the Primary Health Care Performance Indicator Conceptual Framework.

Health Syst Reform 2016 Oct;2(4):302-318

Bill & Melinda Gates Foundation , Seattle , WA , USA.

-Health gains oftentimes associated with income growth have been stubbornly slow in Nigeria in the past 25 years. One plausible reason for this stagnation is underperformance in the country's primary health care (PHC) system. The Primary Health Care Performance Indicators conceptual framework is used to examine Nigeria's PHC system and possible causes of underperformance. Analysis was conducted using a variety of sources including recent facility level information from the World Bank Service Delivery Indicators Survey. Results show that Nigeria has a relative abundance of PHC centers, reasonable geographic access to PHC, and relatively high health worker density. However, the performance of the PHC system is hindered by (1) segmented supply chains; (2) a lack of financial access to PHC; (3) a lack of infrastructure, drugs, equipment, and vaccines at the facility level; and (4) poor health worker performance. Altogether, these factors reflect two overarching system-level challenges-financing and governance-that are key root causes of the dysfunctions observed in the PHC system in Nigeria. Compared with peer African countries, Nigeria ranks low on nearly all PHC performance indicators. The government has taken important steps to address these root causes of underperformance, but policy gaps remain in achieving sustainable and equitable provision of PHC for the people of Nigeria.
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http://dx.doi.org/10.1080/23288604.2016.1234861DOI Listing
October 2016

Impact of an SMS advice programme on maternal and newborn health in rural China: study protocol for a quasi-randomised controlled trial.

BMJ Open 2016 08 10;6(8):e011016. Epub 2016 Aug 10.

Vera Solutions, Cambridge, Massachusetts, USA.

Introduction: Expectant mothers in low-income and middle-income countries often lack access to vital information about pregnancy, preparation for birth and best practices when caring for their newborn. Innovative solutions are needed to bridge this knowledge gap and dramatically improve maternal and neonatal health in these settings. This study aims to evaluate the impact of an innovative text messaging intervention on maternal and neonatal health outcomes.

Methods And Analysis: This study offers expectant mothers in rural China a package of free short messages via cell phone regarding pregnancy and childbirth. These messages are tailored to each mother's gestational week. It is hypothesised that delivering these short advice messages to pregnant women can improve maternal and newborn health. The study uses factorial quasi-randomisation to compare psychological, behavioural and health outcomes between 4 groups: 2 groups receiving different sets of short message interventions (ie, good household prenatal practices and healthcare seeking), a group receiving both interventions and a control group. Treatment assignment occurs at the individual level. The primary outcome is newborn health, measured by appropriateness of weight for gestational age. Secondary outcomes include severe neonatal and maternal morbidity as well as psychological and behavioural measures. This study has enrolled pregnant women who attend county maternal and child health centres for their prenatal visits.

Discussion: This pilot is the first large-scale effort to build a comprehensive evidence base on the impact of prenatal text messages via cell phone on maternal and newborn health outcomes in China. The study has broad implications for public health policy in China and the implementation of mobile health interventions in low-resource settings around the world.

Ethics: This study was approved by the Ethics Committee of the School of Medicine at Xi'an Jiaotong University on 18 January 2013.

Trial Registration Number: NCT02037087; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2015-011016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985924PMC
August 2016

miR-17 is involved in Japanese Flounder (Paralichthys olivaceus) development by targeting the Cdc42 mRNA.

Comp Biochem Physiol B Biochem Mol Biol 2016 Jan 6;191:163-70. Epub 2015 Nov 6.

Key Laboratory of Freshwater Aquatic Genetic Resources, Ministry of Agriculture, Shanghai Ocean University, Shanghai 201306, China.

The expression patterns of 197 miRNAs during Japanese flounder metamorphic development were recently analyzed. miR-17 was differentially expressed during the metamorphic period of the Japanese flounder; however, the role of miR-17 in Japanese flounder development has remained elusive to date. Bioinformatics analysis showed that Cdc42 was a putative target of miR-17. Cdc42 is a gene related to cell adhesion, migration, polarity, cytokinesis, growth, actin cytoskeleton, microtubule dynamics and transcription factor activity; thus, Cdc42 may contribute to metamorphic development. In our study, overexpression of miR-17 in FEC cells suppressed Cdc42 expression. The luciferase reporter assay confirmed that Cdc42 was the target of miR-17. The Cdc42 cDNA from the Japanese flounder was cloned and characterized for the first time. The expression of miR-17 was found to be negatively correlated with Cdc42 mRNA expression during temporal development and in the tissues of adult Japanese flounders. These results indicated that the decrease in miR-17 contributed to the up-regulation of Cdc42 during Japanese flounder metamorphosis. Cdc42 gene expression was down-regulated by thyroid hormone during Japanese flounder metamorphosis, whereas miR-17 was significantly up-regulated by thyroid hormone during these stages. These results indicated that miR-17 was a negative regulator of Cdc42.
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http://dx.doi.org/10.1016/j.cbpb.2015.10.005DOI Listing
January 2016

Identification and expression of SRF targeted by miR-133a during early development of Paralichthys olivaceus.

Fish Physiol Biochem 2015 Oct 3;41(5):1093-104. Epub 2015 Jun 3.

Key Laboratory of Freshwater Aquatic Genetic Resources, Ministry of Agriculture, Shanghai Ocean University, 999, Hu-Cheng-Huan Road, Lingang New City, Shanghai, 201306, China.

Serum response factor (SRF) is a MADS-box transcription factor that regulates the expression of genes involved in development, metabolism, cell proliferation, and differentiation. In the present study, we cloned the full-length SRF cDNA which includes the coding region of 1503 bp, a 573-bp 5'untranslated region (UTR) and a 400-bp 3'-UTR. The deduced 501 amino acid sequence of the SRF protein contained a MADS domain and NLS at the N terminus, similar to other organisms, and it also is highly phylogenetically conserved. SRF mRNA is ubiquitously expressed in various tissues, with the highest level in the kidneys, and it is also highly expressed during the embryonic and metamorphic stages. During metamorphosis, the SRF mRNA levels are down-regulated by exogenous thyroid hormone (TH) at 17 dph and by thiourea (TU) at 29, 36, and 41 dph, whereas SRF mRNA levels were significantly up-regulated by the added exogenous TH to the TU-treated larvae at 41 dph, which indicates that thyroid hormone is essential for expression of SRF mRNA, so, higher levels of TH did not result in changes of SRF mRNA levels, while TH deficiency or inhibited by the non-specific TU toxicity cause down-regulation of SRF mRNA, which indicated that TH can indirectly affect the SRF mRNA levels. Meanwhile, using a luciferase reporter assay, we verified that SRF is a common target gene of miR-133a which is a muscle-specific microRNA (miRNA), which indicated that SRF may be involved in the signaling pathway of miRNA that regulates muscle development.
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http://dx.doi.org/10.1007/s10695-015-0071-8DOI Listing
October 2015

The financial impact of the 'zero-markup policy for essential drugs' on patients in county hospitals in western rural China.

PLoS One 2015 19;10(3):e0121630. Epub 2015 Mar 19.

Zhenping County Hospital, Shaanxi, China.

Objective: With a quasi-experimental design, this study aims to assess whether the Zero-markup Policy for Essential Drugs (ZPED) reduces the medical expense for patients at county hospitals, the major healthcare provider in rural China.

Methods: Data from Ningshan county hospital and Zhenping county hospital, China, include 2014 outpatient records and 9239 inpatient records. Quantitative methods are employed to evaluate ZPED. Both hospital-data difference-in-differences and individual-data regressions are applied to analyze the data from inpatient and outpatient departments.

Results: In absolute terms, the total expense per visit reduced by 19.02 CNY (3.12 USD) for outpatient services and 399.6 CNY (65.60 USD) for inpatient services. In relative terms, the expense per visit was reduced by 11% for both outpatient and inpatient services. Due to the reduction of inpatient expense, the estimated reduction of outpatient visits is 2% among the general population and 3.39% among users of outpatient services. The drug expense per visit dropped by 27.20 CNY (4.47 USD) for outpatient services and 278.7 CNY (45.75 USD) for inpatient services. The proportion of drug expense out of total expense per visit dropped by 11.73 percentage points in outpatient visits and by 3.92 percentage points in inpatient visits.

Conclusion: Implementation of ZPED is a benefit for patients in both absolute and relative terms. The absolute monetary reduction of the per-visit inpatient expense is 20 times of that in outpatient care. According to cross-price elasticity, the substitution between inpatient and outpatient due to the change in inpatient price is small. Furthermore, given that the relative reductions are the same for outpatient and inpatient visits, according to relative thinking theory, the incentive to utilize outpatient or inpatient care attributed to ZPED is equivalent, regardless of the 20-times price difference in absolute terms.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0121630PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366182PMC
February 2016

Identification and expression of HDAC4 targeted by miR-1 and miR-133a during early development in Paralichthys olivaceus.

Comp Biochem Physiol B Biochem Mol Biol 2015 Jan 2;179:1-8. Epub 2014 Sep 2.

Key Laboratory of Freshwater Aquatic Genetic Resources, Ministry of Agriculture, Shanghai Ocean University, Shanghai 201306, China.

Histone deacetylase 4, which is a class II histone deacetylase, plays a critical role in development, differentiation of muscle, cell proliferation and metabolism. In our study, we obtained the full-length HDAC4 cDNA, which included the coding region of 3171bp, a 180bp 5'untranslated region (UTR) and a 760bp 3'UTR. The deduced HDAC4 protein contained all known functional domains identified in other organisms. The phylogenetic analysis indicated that Paralichthys olivaceus HDAC4 had the highest identity with the Takifugu rubripes. Tissue distribution analysis indicated that HDAC4 is abundantly expressed in muscle, and its levels are significantly higher in muscle than in other tissues (P<0.01). HDAC4 mRNA levels at 3dph (days post hatching) and 36dph were higher than that in other stages. Exogenous thyroid hormones either directly or indirectly promoted the expression of HDAC4 mRNA during metamorphosis, indicating that HDAC4 might directly or indirectly be regulated by thyroid hormone during muscle development in metamorphosis. To identify the miRNAs targeting HDAC4, we performed a luciferase reporter assay and verified that HDAC4 is a common target gene of miR-1 and miR-133a indicating that HDAC4 might be involved in a signal pathway of microRNA regulating muscle development.
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http://dx.doi.org/10.1016/j.cbpb.2014.08.005DOI Listing
January 2015

Assessing equity of healthcare utilization in rural China: results from nationally representative surveys from 1993 to 2008.

Int J Equity Health 2013 May 20;12:34. Epub 2013 May 20.

School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.

Background: The phenomenon of inequitable healthcare utilization in rural China interests policymakers and researchers; however, the inequity has not been actually measured to present the magnitude and trend using nationally representative data.

Methods: Based on the National Health Service Survey (NHSS) in 1993, 1998, 2003, and 2008, the Probit model with the probability of outpatient visit and the probability of inpatient visit as the dependent variables is applied to estimate need-predicted healthcare utilization. Furthermore, need-standardized healthcare utilization is assessed through indirect standardization method. Concentration index is measured to reflect income-related inequity of healthcare utilization.

Results: The concentration index of need-standardized outpatient utilization is 0.0486[95% confidence interval (0.0399, 0.0574)], 0.0310[95% confidence interval (0.0229, 0.0390)], 0.0167[95% confidence interval (0.0069, 0.0264)] and -0.0108[95% confidence interval (-0.0213, -0.0004)] in 1993, 1998, 2003 and 2008, respectively. For inpatient service, the concentration index is 0.0529[95% confidence interval (0.0349, 0.0709)], 0.1543[95% confidence interval (0.1356, 0.1730)], 0.2325[95% confidence interval (0.2132, 0.2518)] and 0.1313[95% confidence interval (0.1174, 0.1451)] in 1993, 1998, 2003 and 2008, respectively.

Conclusions: Utilization of both outpatient and inpatient services was pro-rich in rural China with the exception of outpatient service in 2008. With the same needs for healthcare, rich rural residents utilized more healthcare service than poor rural residents. Compared to utilization of outpatient service, utilization of inpatient service was more inequitable. Inequity of utilization of outpatient service reduced gradually from 1993 to 2008; meanwhile, inequity of inpatient service utilization increased dramatically from 1993 to 2003 and decreased significantly from 2003 to 2008. Recent attempts in China to increase coverage of insurance and primary healthcare could be a contributing factor to counteract the inequity of outpatient utilization, but better benefit packages and delivery strategies still need to be tested and scaled up to reduce future inequity in inpatient utilization in rural China.
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http://dx.doi.org/10.1186/1475-9276-12-34DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673871PMC
May 2013

New estimates of elasticity of demand for healthcare in rural China.

Health Policy 2011 Dec 19;103(2-3):255-65. Epub 2011 Oct 19.

School of Public Policy and Administration, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an 710061, China.

Background: Only limited empirical studies reported own-price elasticity of demand for health care in rural China. Neither research on income elasticity of demand for health care nor cross-price elasticity of demand for inpatient versus outpatient services in rural China has been reported. However, elasticity of demand is informative to evaluate current policy and to guide further policy making.

Objectives: Our study contributes to the literature by estimating three elasticities (i.e., own-price elasticity, cross-price elasticity, and income elasticity of demand for health care based on nationwide-representative data. We aim to answer three empirical questions with regard to health expenditure in rural China: (1) Which service is more sensitive to price change, outpatient or inpatient service? (2) Is outpatient service a substitute or complement to inpatient service? and (3) Does demand for inpatient services grow faster than demand for outpatient services with income growth?

Methods: Based on data from a National Health Services Survey, a Probit regression model with probability of outpatient visit and probability of inpatient visit as dependent variables and a zero-truncated negative binomial regression model with outpatient visits as dependent variable were constructed to isolate the effects of price and income on demand for health care. Both pooled and separated regressions for 2003 and 2008 were conducted with tests of robustness.

Results: Own-price elasticities of demand for first outpatient visit, outpatient visits among users and first inpatient visit are -0.519 [95% confidence interval (-0.703, -0.336)], -0.547 [95% confidence interval (-0.747, -0.347)] and -0.372 [95% confidence interval (-0.517, -0.226)], respectively. Cross-price elasticities of demand for first outpatient visit, outpatient visits among users and first inpatient visit are 0.073 [95% confidence interval (-0.176, 0.322)], 0.308 [95% confidence interval (0.087, 0.528)], and 0.059 [95% confidence interval (-0.085, 0.204)], respectively. Income elasticities of demand for first outpatient visit, outpatient visits among users and first inpatient visit are 0.098 [95% confidence interval (0.018, 0.178)], 0.136 [95% confidence interval (0.028, 0.245)] and 0.521 [95% confidence interval (0.438, 0.605)], respectively. The aforementioned results are in 2008, which hold similar pattern as results in 2003 as well as results from pooled data of two periods.

Conclusion: First, no significant difference is detected between sensitivity of outpatient services and sensitivity of inpatient services, responding to own-price change. Second, inpatient services are substitutes to outpatient services. Third, the growth of inpatient services is faster than the growth in outpatient services in response to income growth. The major findings from this paper suggest refining insurance policy in rural China. First, from a cost-effectiveness perspective, changing outpatient price is at least as effective as changing inpatient price to adjust demand of health care. Second, the current national guideline of healthcare reform to increase the reimbursement rate for inpatient services will crowd out outpatient services; however, we have no evidence about the change in demand for inpatient service if insurance covers outpatient services. Third, a referral system and gate-keeping system should be established to guide rural patients to utilize outpatient service.
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http://dx.doi.org/10.1016/j.healthpol.2011.09.005DOI Listing
December 2011

A rapid ultra performance liquid chromatography-tandem mass spectrometric method for the qualitative and quantitative analysis of ten compounds in Eucommia ulmodies Oliv.

J Pharm Biomed Anal 2012 Jan 22;57:52-61. Epub 2011 Aug 22.

Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, PR China.

A rapid method for qualitative and quantitative analysis of constituents in Eucommia ulmoides Oliv. was developed by ultra performance liquid chromatography with electrospray ionization-tandem mass spectrometry (UPLC-ESI-MS). Ten compounds including iridoids, phenylpropanoids, and flavonoids were identified and further quantified as marker substances by UPLC-UV using switching UV wavelength within 16min. The separation was carried out on an Acquity UPLC BEH C(18) column with 0.1% formic acid aqueous solution and acetonitrile as the mobile phase under gradient conditions. The developed method was applied to the quality assessment of various E. ulmoides samples, including different medicinal parts, differently processed bark and bark from different habitats. The results showed that the branches of E. ulmoides were not suitable for medicinal use. The process of carbonizing led to significant loss of major components, whereas the process of stir-frying with salt-water enhanced the extraction of chlorogenic acid with negligible loss of the other components. The contents of the investigated compounds varied very remarkably for the bark of E. ulmoides collected from different habitats. This study might provide a comprehensive method for the quality assessment of E. ulmoides.
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http://dx.doi.org/10.1016/j.jpba.2011.08.023DOI Listing
January 2012

Hexaoxygenated flavonoids from Pteroxygonum giraldii.

Nat Prod Commun 2010 Feb;5(2):223-6

School of Pharmaceutical Science and Technology, Tianjin University, Tianjin 300072, PR China.

Two flavonoids with an unusual 2',4',5'-trisubstituted B-ring (1 and 2), four myricetin derivatives (3-methylmyricetin-3'-O-beta-D-xylopyranoside (3), myricetin-3-O-alpha-L-rhamnopyranoside, myricetin-3-O-beta-D-galactopyranoside, and 3-methylmyricetin), and myricetin were isolated from the roots of Pteroxygonum giraldii Damm. & Diels. Their structures were elucidated using various spectroscopic methods and acid hydrolysis. Compound 1 was a new flavonoid and the NMR spectroscopic data of compounds 2 and 3 are reported for the first time.
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February 2010

Phenylpropanoyl esters from Horseweed (Conyza canadensis) and their inhibitory effects on catecholamine secretion.

J Nat Prod 2010 Feb;73(2):270-4

School of Pharmaceutical Science and Technology, Tianjin University, Tianjin 300072, People's Republic of China.

Three unique phenylpropanoyl 2,7-anhydro-3-deoxy-2-octulosonic acid derivatives were isolated from Conyza canadensis (horseweed). Their structures were defined as rel-(1S,2R,3R,5S,7R)-methyl 7-caffeoyloxymethyl-2-hydroxy-3-feruloyloxy-6,8-dioxabicyclo[3.2.1]octane-5-carboxylate (1), rel-(1S,2R,3R,5S,7R)-methyl 7-feruloyloxymethyl-2-hydroxy-3-feruloyloxy-6,8-dioxabicyclo[3.2.1]octane-5-carboxylate (2), and rel-(1R,2R,3R,5S,7R)-methyl 7-feruloyloxymethyl-2-feruloyloxy-3-hydroxy-6,8-dioxabicyclo[3.2.1]octane-5-carboxylate (3). Compound 1 and a 5:3 mixture of compounds 2 and 3 were demonstrated to inhibit the catecholamine secretion induced by acetylcholine with IC(50) values of 94.65 and 42.35 microM, respectively, and to inhibit the catecholamine secretion induced by veratridine and high [K(+)] at a dose of 100 microM in cultured bovine adrenal medullary cells.
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http://dx.doi.org/10.1021/np900670bDOI Listing
February 2010

Six new glucose esters of 3-nitropropanoic acid from Indigofera kirilowii.

Fitoterapia 2008 Sep 4;79(6):451-5. Epub 2008 Jun 4.

School of Pharmaceutical Science and Technology, Tianjin University, Tianjin 300072, PR China.

An investigation of the aliphatic nitrocompounds in Indigofera kirilowii resulted in the identification of two new esters of glucose with 3-nitropropanoic acid and acrylic acid - kirilowin C (1) and kirilowin D (2), together with four new glucose 3-nitropropanoates - kirilowins E-H (3-6). Their structures were identified by spectroscopic data.
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http://dx.doi.org/10.1016/j.fitote.2008.04.006DOI Listing
September 2008

A new labdane diterpenoid arabinoside from Conyza blinii.

Nat Prod Res 2008 Apr;22(6):521-4

School of Pharmaceutical Science and Technology, Tianjin University, Tianjin 300072, P.R. China.

A new diterpenoid glycoside, 14,15-dinor-labdan-13-one-8-O-alpha-L-arabinopyranoside (1), was isolated from Conyza blinii. The structure of this new arabinoside was elucidated on the basis of extensive NMR and HRMS spectroscopy. In addition, the presence of 3R-hydroxyoctadecanoic acid in C. blinii was reported for the first time.
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http://dx.doi.org/10.1080/14786410701592232DOI Listing
April 2008

Acryloylated glucose 3-nitropropanoates from Indigofera kirilowii.

J Nat Prod 2005 Dec;68(12):1785-6

College of Pharmaceutical Sciences and Technology, Tianjin University, Tianjin 300072, People's Republic of China.

Two unique glucose esters of 3-nitropropanoic acid with acryloyl moieties, kirilowin A and kirilowin B, were isolated from the roots of Indigofera kirilowii. Their structures were elucidated by detailed spectroscopic analysis. The two acrylates constitute new additions to the toxic glucose conjugates of 3-nitropropanoic acid in angiosperms.
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http://dx.doi.org/10.1021/np050268+DOI Listing
December 2005

A new nitroethylphenolic glycoside from Semiaquilegia adoxoides.

Fitoterapia 2004 Jun;75(3-4):420-2

College of Pharmaceuticals and Biotechnology, Tianjin University, Tianjin 300072, PR China.

The isolation of a new nitroethylphenolic glycoside, 4-hydroxy-1-(2-nitroethyl) benzene 4-O-(6'-O-beta-D-xylopyranosyl)-beta-D-glucopyranoside (1), from the roots of Semiaquilegia adoxoides is reported.
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http://dx.doi.org/10.1016/j.fitote.2004.01.016DOI Listing
June 2004

Conyzasaponins I-Q, nine new triterpenoid daponins from Conyza blinii.

J Nat Prod 2003 Dec;66(12):1593-9

School of Pharmaceutical Sciences, Toho University, Miyama 2-2-1, Funabashi, Chiba 274-8510, Japan.

Nine new triterpenoid saponins, conyzasaponins I-Q (1-9), were isolated from the aerial parts of Conyza blinii. Their structures were established on the basis of extensive 1D and 2D NMR spectra as well as by chemical degradations. Among these compounds, conyzasaponins M-O (5-7) share a common pentasaccharide unit attached to C-28 of the aglycon, 28-O-beta-d-apiofuranosyl-(1-->3)-beta-d-xylopyranosyl-(1-->4)-[beta-d-apiofuranosyl-(1-->3)]-alpha-l-rhamnopyranosyl-(1-->2)-alpha-l-arabinopyranosyl ester, which contains two apiofuranosyl residues. To the best of our knowledge, they are among the few examples of natural products possessing two apiofuranose units in a single sugar chain.
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http://dx.doi.org/10.1021/np030327oDOI Listing
December 2003