Publications by authors named "Zhiying Zhou"

21 Publications

  • Page 1 of 1

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

Bone-Targeted Extracellular Vesicles from Mesenchymal Stem Cells for Osteoporosis Therapy.

Int J Nanomedicine 2020 15;15:7967-7977. Epub 2020 Oct 15.

Department of Stomatology Medical Center, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People's Republic of China.

Background: Current drugs used for osteoporosis therapy show strong adverse effects. Stem cell-derived extracellular vesicles (EVs) provide another choice for osteoporosis therapy. Mouse mesenchymal stem cells (mMSCs)-derived EVs promote bone regeneration; however, their clinical application is limited due to non-specific tissue targeting. Alendronate specifically targets bone tissue via hydroxyapatite. Therefore, EVs were combined with alendronate to generate Ale-EVs by "click chemistry" to facilitate EVs targeting bone via alendronate/hydroxyapatite binding.

Methods: Ale-EVs were characterized based on size using dynamic light scattering analysis and morphology was visualized by transmission electron microscopy. Hydroxyapatite affinity of Ale-EVs was detected by flow cytometry. Bone targeting of Ale-EVs was tested by ex vivo fluorescent imaging. Cell viability was assessed by using WST-8 reduction assay kit for testing the ability of Ale-EVs to promote mMSCs proliferation. Alkaline phosphatase experiment was used to detect ability of Ale-EVs to promote differentiation of mouse mesenchymal stem cells in vitro. Western blotting and Q-PCR assay were used to detect the early marker of osteogenic differentiation. Antiosteoporotic effects of Ale-EVs were detected in ovariectomy (OVX)-induced osteoporosis rat model. The safety of the Ale-EVs in vivo was measured by H&E staining and serum markers assay.

Results: In vitro, Ale-EVs had high affinity with hydroxyapatite. Also, ex vivo data indicated that Ale-EVs-DiD treatment of mice induced strong fluorescece in bone tissues compared with EVs-DiD group. Furthermore, results suggested that Ale-EVs promoted the growth and differentiation of mouse MSCs. They also protected against osteoporosis in ovariectomy (OVX)-induced osteoporotic rats. Ale-EVs were well tolerated and no side effects were found, indicating that Ale-EVs specifically target bone and can be used as a new therapeutic in osteoporosis treatment.

Conclusion: We used the Ale-N3 to modify mouse mesenchymal stem cells-derived extracellular vesicles by copper-free "click chemistry" to generate a Ale-EVs system. The Ale-EVs had a high affinity for bone and have great potential for clinical applications in osteoporosis therapy with low systemic toxicity.
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http://dx.doi.org/10.2147/IJN.S263756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573321PMC
November 2020

[The efficacy of OM85-BV in the treatment of recurrent upper respiratory tract infection with adenoid hypertrophy and the preliminary exploration of potential therapeutic mechanism].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020 Jun;34(6):499-504

Department of Otolaryngology Head and Neck Surgery,Children's Hospital Affiliated to Zhejiang University Medical College,Hangzhou,310052,China.

To observe the efficacy of OM85-BV in the treatment of recurrent upper respiratory tract infection with adenoid hypertrophy and to explore its possible mechanism. Four hundred and forty-eight children with recurrent upper respiratory tract infection and adenoid hypertrophy were collected. Three hundred and twenty-six patients in the control group were treated with conventional drugs, and one hundred and twenty-two patients in the observation group were treated with OM85-BV+conventional drugs, and the treatment lasted 12 weeks. The sleep obstructive symptoms of adenoid hypertrophy were scored according to OSA-18 before and after the treatment respectively(0, 6, 12 weeks). The symptoms scores and effective rate of treatment between the study and the control group were compared. The patients in the control group and the observation group who were unresponsive to drug treatment received surgery after 12 weeks of drug treatment. The levels of serum IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ and IgE, the ratio of serum CD3, CD4, CD8 in lymphocytes and the ratio of CD4/CD8 were compared between the study and the control group before operation. The levels of HBD-2, IFN-γ, IL-4, IL-6 cytokines in the adenoid were compared between the control group and the observation group. The expression and distribution of adenoid HBD-2, IFN-γ, IL-4, IL-6 were compared between the control group and the observation group. After 12 weeks of treatment, the total effective rate of the observation group was significantly higher than that of the control group, and the improvement of sleep respiratory obstruction symptoms of children with recurrent upper respiratory tract infection and adenoid hypertrophy was also much better than that of the control group. The serum IFN-γ of the observation group was significantly higher than that of the control group, and there was no significant difference in serum IL-2, IL-4, IL-6, IL-10, TNF, IgE between the observation group and the control group. There was no significant difference in serum CD3, CD4, CD8 and CD4/CD8 between the observation group and the control group. In the observation group, the adenoid HBD-2 was significantly higher but IL-4, IFN-γ were significantly lower than that in the control group, and IL-6 had no significant difference compared with the control group. OM85-BV can significantly improve the sleep apnea symptoms but can not rise the level of immune lymphocytes in children with adenoid hypertrophy and recurrent upper respiratory tract infection.OM85-BV can improve the Th1 immune response, enhancing the ability of human body to fight against pathogens and induce the release of HBD-2, increasing the resistance to microorganisms, reducing the bacteria aggregation, weakening the local inflammatory response in adenoids.
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http://dx.doi.org/10.13201/j.issn.2096-7993.2020.06.005DOI Listing
June 2020

Efficient miRNA Inhibitor Delivery with Graphene Oxide-Polyethylenimine to Inhibit Oral Squamous Cell Carcinoma.

Int J Nanomedicine 2020 9;15:1569-1583. Epub 2020 Mar 9.

Stomatological Hospital of Southern Medical University, Department of Prosthodontics, Guangzhou 510260, People's Republic of China.

Background: MicroRNAs (miRNAs) are widely believed to be promising targets for oral squamous cell carcinoma (OSCC) gene therapy. miR-214 has been identified as a promoter of OSCC aggression and metastasis.

Methods: Graphene oxide-polyethylenimine (GO-PEI) complexes were prepared and loaded with a miRNA inhibitor at different N/P ratios. The transfection efficiency of GO-PEI-inhibitor was tested in Cal27 and SCC9 cells. Moreover, the tumor inhibition ability of GO-PEI-inhibitor was measured in an OSCC xenograft mouse model by intratumoral injection.

Results: Here, we show that a GO-PEI complex efficiently delivers a miR-214 inhibitor into OSCC cells and controls the intracellular release of the miR-214 inhibitor. These results indicate that the GO-PEI-miR-214 inhibitor complex efficiently inhibited cellular miR-214, resulting in a decrease in OSCC cell invasion and migration and an increase in cell apoptosis by targeting PTEN and p53. In the xenograft mouse model, the GO-PEI-miR-214 inhibitor complex significantly prevented tumor volume growth.

Conclusion: This study indicates that functionalized GO-PEI with low toxicity has promising potential for miRNA delivery for the treatment of OSCC.
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http://dx.doi.org/10.2147/IJN.S220057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069571PMC
July 2020

Clinical characteristics for conservative therapy of pediatric parapharyngeal abscesses.

Braz J Otorhinolaryngol 2019 Dec 23. Epub 2019 Dec 23.

Children's Hospital of Zhejiang University School of Medicine, Department of Otolaryngology Head and Neck Surgery, Hangzhou, Zhejiang Province, China. Electronic address:

Introduction: The role of surgical drainage versus conservative therapy in treating patients with parapharyngeal abscesses is still a theme of debate.

Objectives: This study aimed to investigate the characteristics associated with good outcomes in pediatric patients with parapharyngeal abscesses treated with conservative therapy.

Methods: This retrospective chart review was performed on children aged 0.3-14 years with the diagnosis of parapharyngeal abscesses confirmed by computed tomography from January 2013 to March 2018. Patients with a severe upper airway obstruction required early intervention, while those in a stable condition initially received conservative therapy with antibiotics. If the patients appeared unlikely to recover, additional surgical drainage was provided. Multivariate logistic regression models were constructed to investigate the clinical characteristics associated with a good response to conservative therapy. A receiver operating characteristic curve was used to identify the age and abscess size cutoff for predicting a successful response.

Results: A total of 48 children were included in the study. Patient age, antecedent illness, and abscess size were significantly associated with a response to therapy (Odds Ratio=1.326, 2.314 and 1.235, respectively). The age cutoff associated with the conservative therapy was 4.2 years (76.9% sensitivity, 68.2% specificity), and the abscess size cutoff associated with the conservative therapy was 23mm (84.6% sensitivity, 77.3% specificity).

Conclusion: The findings suggested that younger age, smaller abscess size, and less frequent antecedent illnesses, such as upper respiratory tract infection and lymphadenitis, could predict a successful response to conservative therapy in pediatric patients with parapharyngeal abscesses.
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http://dx.doi.org/10.1016/j.bjorl.2019.10.015DOI Listing
December 2019

Diagnosis and treatment of deep neck abscess due to congenital piriform sinus fistula in children.

Braz J Otorhinolaryngol 2020 Jan 25. Epub 2020 Jan 25.

Children's Hospital of Zhejiang University School of Medicine, Department of Otolaryngology Head and Neck Surgery, Hangzhou, Zhejiang Province, China. Electronic address:

Introduction: Congenital piriform sinus fistula is a relatively rare type of disease in clinical practice, most occurring during childhood, but doctors have insufficient knowledge regarding this disease, easily misdiagnosing it.

Objectives: This study aimed to identify the characteristics of deep neck abscess due to congenital piriform sinus fistula in children.

Methods: We performed a retrospective study of 21 cases from January 2016 to August 2018 in our hospital. The onset age, clinical characteristics, auxiliary examination and clinical treatment of the patients was summarized to analyze the diagnosis, treatment characteristics and prognosis.

Results: Children from 11 days to 12 years-old were enrolled, with an average age of 3.5 years. Twenty patients had left congenital piriform sinus fistula and 1 had right congenital piriform sinus fistula. Cervical enhanced computed tomography imaging showed gas-liquid equilibrium or air-shadow in the abscesses in 18 cases, and neck ultrasound demonstrated gas echo in the thyroid region in 10 cases. All patients underwent low temperature plasma to seal the internal fistula and returned to the hospital for electronic laryngoscope and neck ultrasound examination at 3 months, 6 months and 1year after the surgery. No recurrence occurred in any patient.

Conclusion: Congenital piriform sinus fistula is an important cause of deep neck abscess in children. The presence of purulent gas-liquid equilibrium or air shadow in cervical-enhanced computed tomography or ultrasound suggests a high possibility of the presence of an internal fistula, and endoscopic low temperature ablation can be done at the same time as the diagnostic endoscopy.
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http://dx.doi.org/10.1016/j.bjorl.2019.12.008DOI Listing
January 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

Contraceptive Use in Adolescent Girls and Adult Women in Low- and Middle-Income Countries.

JAMA Netw Open 2020 02 5;3(2):e1921437. Epub 2020 Feb 5.

Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Importance: Preventing unwanted pregnancy through adequate use of contraceptives among adolescent girls is essential for improving maternal and child health and social well-being.

Objective: To estimate the levels and trends of contraceptive use in adolescent girls (age 15-19 years) compared with adult women (age 20-34 years).

Design, Setting, And Participants: This survey study used data from 261 Demographic and Health Surveys or Multiple Cluster Indicator Surveys conducted in 103 low- and middle-income countries between 2000 and 2017. Modern contraceptive use in 90 countries and unmet need for family planning in 73 countries for adolescent girls and adult women were assessed at country and aggregate levels. Data analyses for this study were conducted between March 2019 and December 2019.

Main Outcomes And Measures: Modern contraceptive use and unmet need for family planning, estimated between adolescent girls and adult women for absolute inequality and relative inequality (defined as the ratio in service use between adult women and adolescent girls). Inequalities by wealth and place of residence in each age group were also assessed.

Results: A total of 832 673 adolescent girls and 2 156 268 adult women were included in the analysis. Adolescent girls were significantly less likely to use modern contraceptives (31.6% [95% CI, 30.3% to 32.8%] vs 43.5% [95% CI, 42.4% to 44.7%]; absolute inequality, 11.9 percentage points [PPs] [95% CI, 11.7 to 12.1 PPs]; relative inequality, 1.38 PPs [95% CI, 1.36 to 1.40 PPs]) and more likely to have an unmet need for family planning (50.8% [95% CI, 49.0% to 52.5%] vs 36.4% [95% CI, 34.9% to 35.8%]; absolute inequality, -14.4 PPs [95% CI, -15.8 to -15.0 PPs]; relative inequality, 0.72 PPs [95% CI, 0.69 to 0.75 PPs]). Contraceptive use generally improved over time (aggregate-level use of contraceptives increased from 17.8% [95% CI, 16.6% to 19.0%] in 2000-2006 to 27.2% [95% CI, 26.6% to 27.8%] in 2013-2017 for adolescents and from 30.9% [95% CI, 29.8% to 32.0%] in 2000-2006 to 40.3% [95% CI, 39.8% to 40.8%] in 2013-2017 for adult women), but inequalities between adolescents and adult women persisted. Aggregate-level prevalence of unmet need for family planning decreased only among adult women (from 45.8% [95% CI, 44.9% to 46.7%] in 2000-2006 to 38.0% [95% CI, 37.3% to 38.7%] in 2013-2017). For adolescents, the prevalence remained at approximately 52% over time. The inequality between the 2 age groups therefore significantly increased from 7.5 PPs (95% CI, 6.5 to 8.4 PPs) in 2000 to 2006 to 14.0 PPs (95% CI, 13.4 to 14.6 PPs) in 2013 to 2017. An increasing gap between adolescent girls and adult women was found in 18 countries for modern contraceptive use and in 20 countries for unmet need for family planning. In India, for example, both age groups had increased percentage of unmet need for family planning over time, from 16.2% (95% CI, 15.9% to 16.6%) in 2006 to 29.8% (95% CI, 29.6% to 30.1%) in 2015 for adult women and from 23.9% (95% CI, 23.0% to 24.9%) to 64.5% (95% CI, 63.3% to 65.7%) among adolescents. Thus, inequality increased from 7.7 PPs (95% CI, 7.2 to 8.2 PPs) in 2006 to 34.7 PPs (95% CI, 34.2 to 35.1 PPs) in 2015.

Conclusions And Relevance: Despite a growing focus on contraception in the past decade with initiatives such as Family Planning 2020, adolescent girls continue to lag behind adult women in contraceptive use. There is a pressing need to develop age-appropriate strategies for increasing access and maintaining contraceptive use in sexually active adolescent girls.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.21437DOI Listing
February 2020

Clinical performance evaluation of the new hematology analyzer Mindray BC-6000.

Int J Lab Hematol 2019 Oct 9;41(5):622-634. Epub 2019 Jul 9.

Department of Laboratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.

Introduction: With the progression of blood analysis technology, hematology analyzers become more complex and diverse. How to choose a superb instrument is a challenge for the laboratories. In the essay, we studied whether the newest BC-6000 hematology analyzer meets the needs of a clinical hematology laboratory.

Methods: Methods comparison was performed using 350 blood samples from patients between different measurement procedures; the basic analytical performance was also tested, including the throughput, carryover, precision, and linearity in different modes. The flagging performances for blasts, immature granulocytes, and NRBC were compared with manual microscopy.

Results: There were minimal carryover (<0.30%) and excellent actual blood linearity for all routinely used parameters concerned by the clinicians (R  ≥ 0.997). Repeatability and reproducibility were satisfactory at all testing levels. The functional sensitivity of leukocytes and platelets in the blood and leukocytes and erythrocytes in body fluid was excellent at the 20% CV level. BC-6000 and XN displayed very high correlations for complete blood count (CBC) parameters and very high consistency for leukocyte differentials and NRBC compared with manual microscopy. BC-6000 showed excellent sensitivity and specificity flagging ability on blasts (82.9% and 82.4%) and NRBC (80.0% and 96.9%). For immature granulocytes, BC-6000 showed excellent sensitivity but common specificity flagging ability (91.7% and 65.6%).

Conclusion: The clinical performance of BC-6000 is excellent, and the analyzer can provide timely and accurate reporting for most of the small- to large-scale laboratories.
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http://dx.doi.org/10.1111/ijlh.13075DOI Listing
October 2019

MicroRNA-214 contributes to regulation of necroptosis via targeting ATF4 in diabetes-associated periodontitis.

J Cell Biochem 2019 09 15;120(9):14791-14803. Epub 2019 May 15.

Department of Stomatology, The First Affiliated Hospital of Jinan University, Guangzhou, P.R. China.

Diabetes and periodontal diseases have a mutual promoting relationship that induces severe tissue damage and cell death. The potential roles of microRNAs (miRNAs) and the type of cell death involved in diabetes-associated periodontitis are obscure. The gingival tissues of patients were obtained and MC3T3-E1 cells were costimulated with high glucose and lipopolysaccharide (LPS). Osseous morphometric analysis was evaluated with micro-CT, and histological characteristics were measured by hematoxylin/eosin and immunohistochemical staining. Cytokine secretion was confirmed by enzyme-linked immunosorbent assay, and reactive oxygen species (ROS) was measured using a DCFH-DA probe kit. Gene expression was measured by real-time quantitative reverse transcription PCR (qRT-PCR), and protein expression was assessed by Western blot and immunofluorescence analysis. The miR-214 level, receptor-interacting serine-threonine protein (RIP) 1, RIP3, and phospho-mixed lineage kinase domain-like (p-MLKL) protein expression were elevated in the inflamed gingival tissues of diabetes-associated periodontitis patients, with activating transcription factor 4 (ATF4) expression showing the opposite effect. The high glucose (22 mM) could not induce significant increase of RIP1, RIP3, and p-MLKL; however, the high glucose and LPS (500-1000 ng/mL) cotreatment resulted in increase in the number of RIP1, RIP3, and p-MLKL in MC3T3-E1 cells. NAC (ROS inhibitor) inhibited RIP1, RIP3, and increased ATF4; however, necrostatin-1 (Nec-1) (RIP1 inhibitor) specifically inhibited the protein expression of RIP1 and RIP3 and had no influence on ATF4. The use of antagomir-214 suppressed the expression of miR-214, RIP1, RIP3, and p-MLKL, but increased ATF4 protein level in glucose and LPS-induced cells. ATF4 knockdown by ATF4 small interfering RNA offset the effect of antagomir-214. RIP1- and RIP3-dependent necroptosis was confirmed in the inflamed gingival tissues of diabetes-associated periodontitis patients and high glucose- and LPS- cotreated cells. It was suggested that miR-214-targeted ATF4 participated in the regulation of necroptosis in vivo and in vitro.
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http://dx.doi.org/10.1002/jcb.28740DOI Listing
September 2019

Study on application of ear correction model to infantile cryptotia.

Int J Pediatr Otorhinolaryngol 2019 Mar 19;118:62-67. Epub 2018 Dec 19.

Department of Otolaryngology Head and Neck Surgery, Children's Hospital Affiliated to Medical College of Zhejiang University, Zhejiang, Hangzhou, Binsheng Road 3333, 310051, China. Electronic address:

Objective: To study the clinical application of ear correction model in infantile cryptotia.

Methods: A total of 108 children including 135 ears were selected from October 2016 to January 2018. The age of the children ranged from 7 days to 840 days, with an average age of 100.88 days. The children were divided into four groups based on age: group A (<28 days), group B (28 days-90 days), group C (90 days-180 days), and group D (>180 days). All the children were corrected by using ear correction models. The effective time, consolidated time and completely corrected time were calculated based on the auricular morphology.

Results: The auricle morphology of the affected ears was nearly the same as the normal after correction by ear correction model. Statistical differences were observed on treatment time between the groups (P < 0.05), except for group B and group C (P > 0.05). In terms of complications, statistical differences were observed between the groups (P < 0.05), except for group A and group B (P > 0.05).

Conclusion: The ear correction model is remarkably effective in infants with cryptotia of not only less than 6 months, but also for children with cryptotia of more than 6 months. Infants under 6 months had shorter treatment time and lower complications, while infants beyond 6 months had more treatment time and higher complications.
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http://dx.doi.org/10.1016/j.ijporl.2018.12.022DOI Listing
March 2019

Urban-rural difference in the associations between living arrangements and the health-related quality of life (HRQOL) of the elderly in China-Evidence from Shaanxi province.

PLoS One 2018 20;13(9):e0204118. Epub 2018 Sep 20.

Monash Business School, Monash University, Melbourne, Australia.

Background: So far limited evidence exist comparing the difference between urban and rural elder residents in relation to how living arrangements correlates to health-related quality of life(HRQOL) of the elderly.

Objective: This study aims to compare the HRQOL of the elderly with four living arrangements: living with spouse only (LS), living alone (LA), living with a spouse and adult children(LSC) and the single elderly living with adult children (SLC) in urban and rural areas of China.

Methods: The data were drawn from the 2013 wave of Chinese National Health Service Survey in Shaanxi Province, which included 11,729 elderly people. The Chinese version of the EQ-5D-3L questionnaire was used to measure the HRQOL. Tobit regression model and logistic regression models were employed to estimate the associations between living arrangements and the HRQOL of the elderly.

Results: The EQ-5D utility scores of the urban elderly with four different living arrangements (LS, LA,LSC and SLC) were 0.9141, 0.8392, 0.8176 and 0.9080, which were almost all higher than their rural counterparts. After controlling other confounding variables, tobit regression estimates showed that the EQ-5D utility scores of the single elderly either living alone or living with adult children were lower than the elderly living with a spouse in urban areas. In rural areas only the single elderly living with adult children were more disadvantaged. Additionally the logistic regression results showed living-alone elderly had worse psychological health and the single elderly living with adult children had worse physical health.

Conclusion: The findings suggest that the urban elderly have better HRQOL than the rural elderly and the elderly with different living arrangements in urban and rural area have different HRQOL. More attention should be given to the poor mental health of the elderly living alone and the worse physical health of the single elderly living with adult children.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204118PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147447PMC
March 2019

Prevalences and trends of chronic diseases in Shaanxi Province, China: Evidence from representative cross-sectional surveys in 2003, 2008 and 2013.

PLoS One 2018 23;13(8):e0202886. Epub 2018 Aug 23.

Centre for Health Economics, Monash University, Clayton, VIC, Australia.

Objectives: Non-communicable diseases, which can refer to chronic diseases that are not caused by infectious agents and can endure for a long time, are currently regarded as a critical public health problem in China. This study aimed to estimate the prevalences of self-reported physician-diagnosed chronic diseases among urban and rural populations aged 15 years and older in Shaanxi Province, China, during 2003-2013 and explore how these changes differ by subpopulation.

Methods: Three independent cross-sectional surveys were implemented in 2003, 2008 and 2013 in Shaanxi Province. A multistage stratified cluster random sampling method was used in each wave to collect representative samples. In total, 10,568 residents in 2003, 15,453 in 2008 and 48,808 in 2013 were included in this analysis. Information on self-reported physician-diagnosed chronic diseases was collected using face-to-face interviews in each survey. Multilevel Poisson regression with robust error variance was employed to calculate the adjusted prevalence ratios to estimate the relative change in chronic conditions in 2008 and 2013, compared to that in 2003.

Results: In 2013, 23.9%/22.1% of urban/rural residents, respectively, reported having at least one chronic condition, which represents an increase from 17.0%/15.1%, respectively, in 2008 and 12.8%/10.9%, respectively, in 2003. Adjusted for socio-demographic characteristics, the prevalence of chronic diseases was significantly higher in 2013 than that in 2003. Among the chronic diseases studied, the prevalence of hypertension and diabetes has increased dramatically over a decade. The increase in chronic diseases occurred mainly among the middle-aged and elderly.

Conclusions: Chronic diseases are highly prevalent and continuously increasing in the adult population in Shaanxi Province from 2003 to 2013. Given its large aging population, China may face a greater chronic disease burden. A national chronic disease surveillance system and screening program should be established to acquire comprehensive information regarding the distribution and trends of chronic diseases.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202886PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107240PMC
February 2019

Exploring status and determinants of prenatal and postnatal visits in western China: in the background of the new health system reform.

BMC Public Health 2017 07 20;18(1):39. Epub 2017 Jul 20.

School of Medicine, Flinders University, Adelaide, Australia.

Background: Prenatal and postnatal visits are two effective interventions for protection and promotion of maternal health by reducing maternal mortality and improving the quality of birth. There is limited nationally representative data regarding the changes of prenatal and postnatal visits since the latest health system reform initiated in 2009 in Shaanxi, China. The aim of this study was to explore the current status and determinants of prenatal and postnatal visits in the background of new health system reform.

Methods: Data were drawn from two waves of National Health Service Surveys in Shaanxi Province which were conducted prior and post the health system reform in 2008 and 2013, respectively. A concentration index was employed to measure the degree of income-related inequality of maternal health services utilization. Multilevel mix-effects logistic regressions were applied to study the factors associated with prenatal and postnatal visits.

Results: The study sample consists of 2398 women aged 15-49 years old. The data of the 5th National Health Services Survey in 2013 showed in the criterion of the World Health Organization (WHO), the percentage of women receiving ≥4 prenatal visits was 84.79% for urban women and 82.20% for rural women, with women receiving ≥3 postnatal visits were 26.48 and 25.29% for urban and rural women respectively. In the criterion of China's ≥ 5 prenatal visits the percentages were 72.25% for urban women and 70.33% for rural women; 61.69% of urban women and 71.50% of rural women received ≥1 postnatal visits. As for urban women, the concentration index of postnatal visit utilization was -0.075 (95% CI:-0.148, -0.020) after the health system reform. The determinants related to prenatal and postnatal visits were the change of reform, women's education, parity and the delivery institution.

Conclusions: This study showed the utilization of prenatal and postnatal visits met the requirement of the WHO, higher than other areas in China and other developing countries after the new health system reform. The new health system reform increased the utilization of postnatal visits in poor urban women and improved the frequency of prenatal and postnatal visits in rural women.
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http://dx.doi.org/10.1186/s12889-017-4601-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5520235PMC
July 2017

Health-related quality of life and its influencing factors for patients with hypertension: evidence from the urban and rural areas of Shaanxi Province, China.

BMC Health Serv Res 2016 07 18;16:277. Epub 2016 Jul 18.

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

Background: Hypertension is an important public health issue in China, but there are few studies on health-related quality of life (HRQoL) for patients with hypertension in China. This study aims to examine the HRQoL as measured by EQ-5D and investigate the factors that influence HRQoL for patients with hypertension in Shaanxi Province, China.

Methods: Data were collected from the Shaanxi's fifth National Health Service Survey conducted in 2013. EQ-5D was employed to measure the HRQoL for patients with hypertension. The Chinese population-based preference trade-off time (TTO) model was used to convert the EQ-5D values. All descriptive analyses, including demographic characteristics, socio-economic status and clinical characteristics, were stratified by urban and rural residence. Tobit regression model was used to investigate the influencing factors of HRQoL.

Results: A statistically significant difference was observed between the EQ-5D utility scores of urban (0.891) and rural hypertension patients (0.870). The urban hypertension patients showed significantly higher utility scores than the rural patients in three of the five dimensions, namely usual activities, pain / discomfort and anxiety / depression. The influencing factors of HRQoL for hypertension patients in China included age, marital status, education level, employment status, physical activity and medical examination. For patients aged 55 years and above, EQ-5D utility score decreased significantly with increasing age. The EQ-5D score increased with higher education level. Married patients showed a higher EQ-5D score than divorced and widowed patients, and employed patients showed a higher score than unemployed and retired patients. Regular physical activity and medical examination had a positive effect on the HRQoL of hypertension patients.

Conclusions: Our study indicated that urban hypertension patients might have higher HRQoL than rural patients in Shaanxi, China. To enhance HRQoL, it is necessary to strengthen the health education for hypertension patients to improve hypertension prevention and to adopt healthy habits such as regular physical activity. It is also important to strengthen the management and monitoring of hypertension in the elderly, and further implement the free medical examination program for the elderly under the public health programs.
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http://dx.doi.org/10.1186/s12913-016-1536-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950775PMC
July 2016

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

Load-bearing capacity and the recommended thickness of dental monolithic zirconia single crowns.

J Mech Behav Biomed Mater 2014 Jul 2;35:93-101. Epub 2014 Apr 2.

Department of Stomatology, Nanfang Hospital, Southern Medical University, No.1838, North of Guangzhou Street, Guangzhou 510515, Guangdong, China. Electronic address:

Purpose: The aim of this study was to evaluate the load bearing capacity and a reasonable thicknesss of dental monolithic zirconia crowns.

Materials And Methods: Polymethyl methacrylate (PMMA) abutment tooth specimens were made by CAD/CAM technic. Monolithic zirconia crowns (MZC), monolithic lithium disilicate crowns (MLC), layered zirconia crowns (LZC) and metal ceramic crowns(MCC), of which the occlusal thickness was 1.5mm were thereafter fabricated and cemented on the abutment tooth specimens. MCC with occlusal thicknesses of 0.6mm, 0.8mm, 1.00mm, 1.2mm were also made. All specimens underwent load-to-fracture test. Weibull parameters (σ0) and (m) were calculated. Fracture modes were also evaluated.

Results: The mean fracture load was 1863.16±116.81 for MLC, 2284.77±355.60 for MCC, 2308.0±510.94 for LZC, 4109.93±610.18 for MZC (1.5mm), 3068.31±233.88 for MZC (1.2mm), 2429.88±315.03 for MZC (1.0mm), 1814.60±68.21 for MZC (0.8mm) and 1308.38±111.38 for MZC (0.6mm). The fracture load of MZC was significantly higher than MCC, LZC and MLC (P<0.05). The fracture loads for MCC with different thickness were significantly different (P<0.05). Similar trend was observed for the characteristic strength (σ0) and Weibull modulus (m). For MZC and MLC, the fracture mode was catastrophic failure. The predominant fracture mode for LZC was catastrophic fracture. The fracture loads of MZC(1.0mm) and MCC were not statistically different (P>0.05).

Conclusions: Monolithic zirconia crowns exhibit higher fracture loads than monolithic lithium disilicate crowns, layered zirconia crowns and metal ceramic crowns. The fracture resistance of monolithic zirconia crowns with a thickness of 1.0mm can be equal to metal ceramic crowns. Doubling the monolithic zirconia core from 0.6mm to 1.5mm increases the fracture resistance of this restorative system threefold.
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http://dx.doi.org/10.1016/j.jmbbm.2014.03.014DOI Listing
July 2014

The effect of urban basic medical insurance on health service utilisation in Shaanxi Province, China: a comparison of two schemes.

PLoS One 2014 16;9(4):e94909. Epub 2014 Apr 16.

Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, Australia.

Background: Urban population in China is mainly covered by two medical insurance schemes: the Urban Employee Basic Medical Insurance (UEBMI) for urban employees in formal sector and the Urban Resident Basic Medical Insurance (URBMI) for the left urban residents, mainly the unemployed, the elderly and children. This paper studies the effects of UEBMI and URBMI on health services utilisation in Shaanxi Province, Western China.

Methods: Cross-sectional data from the 4th National Health Services Survey - Shaanxi Province was studied. The propensity score matching and the coarsened exact matching methods have been used to estimate the average medical insurance effect on the insured.

Results: Compared to the uninsured, robust results suggest that UEBMI had significantly increased the outpatient health services utilisation in the last two weeks (p<0.10), whilst the significant effect on hospitalisation was evident in the CEM method (p<0.10). The effect of URBMI was limited in that although being insured was associated with higher health services utilisation, compared with the uninsured, none of the improvement was statistically significant (p>0.10). It was also found that compared with the uninsured, basic medical insurance enrollees were more likely to purchase inpatient treatments in lower levels of hospitals, consistent with the incentive of the benefit package design.

Conclusion: Basic Medical insurance schemes have shown a positive but limited effect on increasing health services utilisation in Shaanxi Province. The benefit package design of higher reimbursement rates for lower level hospitals has induced the insured to use medical services in lower level hospitals for inpatient services.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0094909PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3989255PMC
February 2015

Effects of titania nanotubes with or without bovine serum albumin loaded on human gingival fibroblasts.

Int J Nanomedicine 2014 6;9:1185-98. Epub 2014 Mar 6.

Guangdong Provincial Stomatological Hospital, Southern Medical University, Guangzhou, People's Republic of China.

Modifying the surface of the transmucosal area is a key research area because this process positively affects the three functions of implants: attachment to soft tissue, inhibiting bacterial biofilm adhesion, and the preservation of the crestal bone. To exploit the potential of titania nanotube arrays (TNTs) with or without using bovine serum albumin (BSA) to modify the surface of a dental implant in contact with the transmucosal area, BSA was loaded into TNTs that were fabricated by anodizing Ti sheets; the physical characteristics of these arrays, including their morphology, chemical composition, surface roughness, contact angle, and surface free energy (SFE), were assessed. The effect of Ti surfaces with TNTs or TNTs-BSA on human gingival fibroblasts (HGFs) was determined by analyzing cell morphology, early adhesion, proliferation, type I collagen (COL-1) gene expression, and the extracellular secretion of COL-1. The results indicate that early HGF adhesion and spreading behavior is positively correlated with surface characteristics, including hydrophilicity, SFE, and surface roughness. Additionally, TNT surfaces not only promoted early HGF adhesion, but also promoted COL-1 secretion. BSA-loaded TNT surfaces promoted early HGF adhesion, while suppressing late proliferation and COL-1 secretion. Therefore, TNT-modified smooth surfaces are expected to be applicable for uses involving the transmucosal area. Further study is required to determine whether BSA-loaded TNT surfaces actually affect closed loop formation of connective tissue because BSA coating actions in vivo are very rapid.
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http://dx.doi.org/10.2147/IJN.S55514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3949701PMC
May 2015

The effects of China's urban basic medical insurance schemes on the equity of health service utilisation: evidence from Shaanxi Province.

Int J Equity Health 2014 Mar 9;13:23. Epub 2014 Mar 9.

Flinders Health Economics Group, School of Medicine, Flinders University, 216 Daws Road, Daw Park, Adelaide, SA 5041, Australia.

Introduction: In order to alleviate the problem of "Kan Bing Nan, Kan Bing Gui" (medical treatment is difficult to access and expensive) and improve the equity of health service utilisation for urban residents in China, the Urban Employee Basic Medical Insurance scheme (UEBMI) and Urban Resident Basic Medical Insurance scheme (URBMI) were established in 1999 and 2007, respectively. This study aims to analyse the effects of UEBMI and URBMI on the equity of outpatient and inpatient utilisation in Shaanxi Province, China.

Methods: Using the data from the fourth National Health Services Survey in Shaanxi Province, the method of Propensity Score Matching was employed to generate comparable samples between the insured and uninsured residents, through a one-to-one match algorithm. Next, based on the matched data, the method of decomposition of the concentration index was employed to compare the horizontal inequity indexes of health service utilisation between the UEBMI/URBMI insured and the matched uninsured residents.

Results: For the UEBMI insured and matched uninsured residents, the horizontal inequity indexes of outpatient visits are 0.1256 and -0.0511 respectively, and the horizontal inequity indexes of inpatient visits are 0.1222 and 0.2746 respectively. Meanwhile, the horizontal inequity indexes of outpatient visits are -0.1593 and 0.0967 for the URBMI insured and matched uninsured residents, and the horizontal inequity indexes of inpatient visits are 0.1931 and 0.3199 respectively.

Conclusions: The implementation of UEBMI increased the pro-rich inequity of outpatient utilisation (rich people utilise outpatient facilities more than the poor people) and the implementation of URBMI increased the pro-poor inequity of outpatient utilisation. Both of these two health insurance schemes reduced the pro-rich inequity of inpatient utilisation.
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http://dx.doi.org/10.1186/1475-9276-13-23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016277PMC
March 2014

Real-time 3D human capture system for mixed-reality art and entertainment.

IEEE Trans Vis Comput Graph 2005 Nov-Dec;11(6):706-21

Interactive and Entertainment Research Center, Level 02-02, Research Techno Plaza, Nanyang Technological University, 50 Nanyang Drive, Singapore 637553.

A real-time system for capturing humans in 3D and placing them into a mixed reality environment is presented in this paper. The subject is captured by nine cameras surrounding her. Looking through a head-mounted-display with a camera in front pointing at a marker, the user can see the 3D image of this subject overlaid onto a mixed reality scene. The 3D images of the subject viewed from this viewpoint are constructed using a robust and fast shape-from-silhouette algorithm. The paper also presents several techniques to produce good quality and speed up the whole system. The frame rate of our system is around 25 fps using only standard Intel processor-based personal computers. Besides a remote live 3D conferencing and collaborating system, we also describe an application of the system in art and entertainment, named Magic Land, which is a mixed reality environment where captured avatars of human and 3D computer generated virtual animations can form an interactive story and play with each other. This system demonstrates many technologies in human computer interaction: mixed reality, tangible interaction, and 3D communication. The result of the user study not only emphasizes the benefits, but also addresses some issues of these technologies.
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http://dx.doi.org/10.1109/TVCG.2005.105DOI Listing
December 2005