National Essential Medicines List and policy practice: A case study of China’s health care reform

BACKGROUND: In 2009, China implemented the national essential medicines system by enacting the National Essential Medicines List 2009. According to the policy of this system, primary health care institutions can only stock and use essential medicines on the prescribed List. Meanwhile, each province can choose to make its own list of supplemented medicines. The goal of the study is to provide suggestions for emerging problems and identify future policy-making trends. METHODS: In this study, we statistically analyzed the National Essential Medicines List 2009 and lists of supplemented medicines of all 29 provinces. We also examined the rationality of such medicines based on the DELPHI method and literature review, after which we studied the provincial supplements in relation to the national essential medicines system. RESULTS: We demonstrated that the National Essential Medicines List 2009 provides a comprehensive coverage of diseases as well as reasonable varieties of drugs for their treatment. The average number of supplemented medicines in 29 provinces is 207, with each medicine included in 2.9 provincial lists on average. Only 2.6% supplemented medicines are included by more than half of the provinces (>15), indicating great regional variance. Among the 32 most frequently supplemented medicines, only 18 meet the selection principles, including two with strict usage restrictions. CONCLUSION: The structure and selection of the National Essential Medicines List 2009 are relatively reasonable. The main problems, however, include the excessive and non-scientific selection of medicines on the supplemented medicines list. The function of the provincial lists of supplemented medicines has not been achieved, which has influenced the effectiveness of the national essential medicines system in China

Resveratrol reduces inflammatory response and detrimental effects in chronic cerebral hypoperfusion by down-regulating stimulator of interferon genes/TANK-binding kinase 1/interferon regulatory factor 3 signaling

Inflammatory responses induced by chronic cerebral hypoperfusion (CCH) play a critical role in the progression of vascular dementia. Stimulator of interferon genes (STING) signaling function as a key mediator of inflammation and immunological responses in the central nervous system (CNS), and resveratrol (RES) exerts potent anti-inflammatory effects. However, the role of STING signaling and the relationship between RES and STING signaling in persistent hypoperfusion-induced cerebral inflammation remain unclear. In this study, Sprague–Dawley rats were subjected to either Sham or bilateral common carotid artery occlusion (2VO) surgery and received RES or vehicle daily by intraperitoneal injection for 4 or 8 weeks. Morris’s water maze was used for the analysis of cognitive function. The neuroinflammatory responses in white matter and hippocampus of the rat brain were assessed by Western blot, Immunofluorescence staining, and qRT-PCR analyses. Myelin integrity, neutrophil infiltration, and microglia proliferation were assessed by Immunohistochemistry and histologic analysis. We demonstrated that after CCH, neurons, microglia, and astrocyte under endoplasmic reticulum (ER) stress upregulated the expression of STING, TANK-binding kinase 1 (TBK1), and the transcription factor interferon regulatory factor 3 (IRF3), as well as translocation of IRF3 into the nucleus. These were accompanied by infiltration of neutrophils, activation of microglia, and overproduction of proinflammatory mediators. Improvements in cognitive deficits were related to reduced hippocampal neuronal cell death and increased myelin integrity in RES-treated rats. The neuroprotective effects of RES were associated with suppression of the expression of tumor necrosis factor-alpha (TNF-α), intercellular adhesion molecule 1 (ICAM-1), VCAM-1, interferon-β (IFN-β), and IL-1β, likely through mitigation of the STING/TBK1/IRF3 pathway. These inhibitory effects exerted by RES also inhibited the levels of myeloperoxidase, reduced excess expression of reactive astrocytes, and activated microglia. In conclusion, the STING/TBK1/IRF3 axis may be critical for proinflammatory responses in cerebral tissue with persistent hypoperfusion, and RES exerts its anti-inflammatory effects by suppressing STING/TBK1/IRF3 signaling

Influence of average radii of RE3+ ions on phase structures and thermal expansion coefficients of high-entropy pyrosilicates

High-entropy pyrosilicate element selection is relatively blind, and the thermal expansion coefficient (CTE) of traditional β-type pyrosilicate is not adjustable, making it difficult to meet the requirements of various types of ceramic matrix composites (CMCs). The following study aimed to develop a universal rule for high-entropy pyrosilicate element selection and to achieve directional control of the thermal expansion coefficient of high-entropy pyrosilicate. The current study investigates a high-entropy design method for obtaining pyrosilicates with stable β-phase and γ-phase by introducing various rare-earth (RE) cations. The solid-phase method was used to create 12 different types of high-entropy pyrosilicates with 4–6 components. The high-entropy pyrosilicates gradually transformed from β-phase to γ-phase with an increase in the average radius of RE3+ ions (r¯(RE3+)). The nine pyrosilicates with a small r¯(RE3+) preserve β-phase or γ-phase stability at room temperature to the maximum of 1400 ℃. The intrinsic relationship between the thermal expansion coefficient, phase structure, and RE–O bond length has also been found. This study provides the theoretical background for designing high-entropy pyrosilicates from the perspective of r¯(RE3+). The theoretical guidance makes it easier to synthesize high-entropy pyrosilicates with stable β-phase or γ-phase for the use in environmental barrier coatings (EBCs). The thermal expansion coefficient of γ-type high-entropy pyrosilicate can be altered through component design to match various types of CMCs

Somatic mutation landscape of a meningioma and its pulmonary metastasis

Abstract Background Extracranial metastasis (ENM) of meningiomas is extremely rare, and typically occurs several years after a primary tumor is diagnosed. However, the genetic changes underlying ENM events have not yet been investigated. Case presentation A 58-year-old male patient was sent to the emergency room of our hospital because of a sudden fall. Magnetic resonance imaging detected a mass at the right frontal sagittal sinus. He underwent tumor resection and recovered well, but post-operative computed tomography revealed three lumps on the right side of his chest. Thoracic surgery was performed to remove two of the lumps. Pathological findings revealed that the brain and lung tumors were grade I meningiomas. The patient received no additional radiation or chemotherapy post-surgery, and there was no sign of tumor recurrence in the brain or progression of the remaining lump in the chest 1 year after surgery. We performed whole exome sequencing of the patient’s blood, primary brain tumor, and lung metastatic tumor tissues to identify somatic genetic alterations that had occurred during ENM. This revealed that a frameshift deletion of the neurofibromin 2 gene likely drove formation of the meningioma. Surprisingly, we found that the brain tumor was relatively homogeneous and contained only one dominant clone; both the pulmonary metastasis and the original brain tumor were derived from the same clone, and no obvious additional driver mutations were detected in the metastatic tumor. Conclusion Although ENM of meningiomas is very rare, brain tumor cells appear to be more adaptable to tissue microenvironments outside of the central nervous system than was commonly thought

Effects of calcination and acid treatment on improving benzene adsorption performance of halloysite

In this paper, calcination and subsequent acid treatment were performed on halloysite to investigate their effects on dynamic benzene adsorption performance. Calcination at 800 degrees C had little effect on halloysite's tubular morphology, but it caused dehydroxylation and phase separation of amorphous SiO2 and Al2O3. The occurrence of dehydroxylation resulted in removal of hydroxyl groups, which reduced halloysite's hydrophilicity, leading to an improvement in the halloysite's affinity for hydrophobic benzene molecules. The dynamic benzene adsorption capacity increased from 68.1 mg/g in the original halloysite to 103.6 mg/g in the calcined halloysite. The acid treatment after pre-calcination preserved the halloysite's tubular morphology and introduced massive micropores as a result of the rapid dissolution of Al2O3 layers. The emergence of these massive micropores substantially improved the specific surface area and dynamic benzene adsorption capacity of the acid-treated calcined halloysite, which reached 472.3 m(2)/g and 204.2 mg/g, respectively. In addition, the recycling efficiency of the acid-treated calcined halloysite for benzene adsorption reached 92.5%, thus displaying good regeneration performance. These results demonstrate that calcination and subsequent acid treatment play important roles in promoting the halloysite's benzene adsorption performance, which makes the resulting halloysite a promising adsorbent for the treatment of volatile organic compounds

Tailoring Structure and Surface Chemistry of Hollow Allophane Nanospheres for Optimization of Aggregation by Facile Methyl Modification

International audienceAllophane, an earth-abundant and easy-to-be-synthesized hollow nanospherical material, readily loses its unique pore structure via irreversible aggregation of particles upon drying, which mainly results from capillary stress in the unsaturated inner cavity. To tackle this problem, we develop a strategy for tailoring the capillary stress and thus the aggregation state of allophane by introducing methyl moieties onto the inner surface during preparation. Combined spectroscopic results verified the formation of methyl-allophane with methyl groups only on its inner surface. The presence of a reflection at approximately 33 Å in the X-ray diffraction pattern, ascribed to the interference between particles, indicated an increased structural order in methyl-allophane. The thermal analysis data revealed a decrease of the inner-surface hydrophilcity. The Brunauer-Emmett-Teller (BET) specific surface area increased from 269 to 523 m$^2$/g after methyl modification. An aggregation model, in contrast with that of allophane, was proposed based on the microscopic and small-angle X-ray scattering results to explain these observed changes. This work exhibited that substitution of silanol by methyl on the inner surface of allophane leads to improvement of structural order by eliminating the presence of oligomeric silicates and decreases the hydrophilicity, resulting in the reduction of the capillary stress in the inner cavity and thus the inhibition of irreversible aggregation of particles during drying. The insight into the mechanisms underneath the above mentioned changes upon methyl modification unraveled in this work is helpful for addressing the common aggregation issue of other nanomaterials

Constructing Hierarchically Porous Nestlike Al2O3-MnO2@Diatomite Composite with High Specific Surface Area for Efficient Phosphate Removal

In this work, Al2O3-MnO2@diatomite composite (AM-Dt) was prepared by a simple hydrothermal method. This composite was formed by using diatomite as a porous substrate to support Al2O3 and MnO, nanoparticles. It exhibited hierarchically porous structures and a high specific surface area (352 m(2)/g). The maximum phosphate adsorption capacity of AM-Dt was 63.7 mg of P/g of (Al2O3-MnO2), which is 6 times greater than those of Al2O3 coated diatomite, Al2O3, and Al2O3-MnO2. The composite also showed superior adsorption efficiency, high structural stability, and selectivity for phosphate in the presence of interfering anions (Cl-, NO3-, and CO32-). With the help of X-ray photoelectron spectroscopy and P K-edge X-ray absorption nearedge structure analysis, it can be concluded that electrostatic attraction and formation of surface complexes via phosphate bonding with Al2O3 and MnO2 were the main adsorption mechanisms. The facile preparation method, excellent adsorption performance, and cost effectiveness suggested that this composite possesses a promising potential for phosphate removal from contaminated water

Identification of the occurrence of minor elements in the structure of diatomaceous opal using FIB and TEM-EDS

The occurrence of minor elements in the structure of biogenic diatomaceous opal-A is an important issue because it is closely related to biogeochemical processes driven by the precipitation, sedimentation, and storage of diatoms, as well as to the properties and applications of diatomite, which is the sedimentary rock composed of diatomaceous opal-A. However, to date, there is no direct microscopic evidence for the existence of minor elements, such as Al, Fe, and Mg, in the structure of diatomaceous opal-A, because such evidence requires observation of the internal structure of frustules to exclude the disturbance of impurity minerals, which is technically challenging using conventional techniques. In this work, transmission electron microscopy (TEM) and scanning electron microscopy (SEM) combined with energy-dispersive X-ray spectroscopy (EDS) mapping analysis were performed on diatomaceous opal-A from three typical diatomite specimens that were pretreated using focused ion beam (FIB) thinning. This technique produces a slice of a diatom frustule for direct TEM observation of the internal structure of the diatomaceous opal-A. The results of this work clearly indicate that minor elements, such as Al, Fe, Ca, and Mg, conclusively exist within the siliceous framework of diatomaceous opal-A. The contents of these minor elements are at atomic ratio levels of 1 (minor element)/10000 (Si) - 1/100, regardless of the genus of the diatoms. The occurrence of minor elements in the internal structure is likely through biological uptake during biosynthesis by living diatoms. Moreover, surface coatings composed of aluminosilicates on diatom frustules are common, and the contents of elements such as Al and Fe are tens or hundreds of times higher in the coatings than in the internal siliceous structure of diatomaceous opal-A. The discovery of the incorporation of the above-mentioned minor elements in the diatomaceous opal-A structure, both in the internal Si-O framework and on the surface, updates the knowledge about the properties of diatomite

Efficient Removal and Recovery of Ag from Wastewater Using Charged Polystyrene-Polydopamine Nanocoatings and Their Sustainable Catalytic Application in 4‑Nitrophenol Reduction

This study addresses the long-standing challenges of removing and recovering trace silver (Ag) ions from wastewater while promoting their sustainable catalysis utilization. We innovatively developed a composite material by combining charged sulfonated polystyrene (PS) with a PDA coating. This composite serves a dual purpose: effectively removing and recovering trace Ag+ from wastewater and enabling reused Ag for sustainable applications, particularly in the catalytic reduction of 4-nitrophenol (4-NP) to 4-aminophenol (4-AP). The PS–PDA demonstrated exceptional selectivity to trace Ag+ recycling, which is equal to 14 times greater than the commercial ion exchanger. We emphasize the distinct roles of different charged functional groups in Ag+ removal and catalytic reduction performance. The negatively charged SO3H groups exhibited the remarkable ability to rapidly enrich trace Ag ions from wastewater, with a capacity 2–3 times higher than that of positively-N+(CH3)3Cl and netural-CH2Cl-modified composites; this resulted in an impressive 96% conversion of 4-NP to 4-AP within just 25 min. The fixed-bed application further confirmed the effective treatment capacity of approximately 4400 L of water per kilogram of adsorbent, while maintaining an extremely low effluent Ag+ concentration of less than 0.1 mg/L. XPS investigations provided valuable insights into the conversion of Ag+ ions into metallic Ag through the enticement of negatively charged SO3H groups and the in situ reduction facilitated by PDA. This breakthrough not only facilitates the efficient extraction of Ag from wastewater but also paves the way for its environmentally responsible utilization in catalytic reactions