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

Automation System Vibration Analysis Taking Environmental Factors into Consideration

This paper aims to investigate the vibration behavior of a propulsion system subjected to hull deformations ina two dimension circumstance. As known that large scale ships have great developments in recent years which could cause much severer conditions among the interaction between the propulsion system and ship hull. Excited forces from thesea waves could make the ship hull deformed which further cause drastic vibrations of the shaft system. As a result, the malfunctions of shaft propulsion system are potential existed as the vibrations of the shaft always exceed its maximum allowable values.This paper establishes a simplified model of the large ship propulsion-hull system to analyze the vibration behavior of the ship propulsion system subjected to the ship hull deformations. The hull deformations were obtained as the excited forces under different sea conditions. Then base on the simplified 2D model, the effects of propeller, supports stiffness, the location of hull excitations, the amplitude of excitations are discussed.

Vibration characteristics analysis on ship propulsion system taking hull deformations into account

Budući da je u brodogradnji očita tendencija izgradnje sve većih brodova, dinamičke interakcije između porivnog sustava i trupa mnogo su oštrije kod velikih nego kod malih brodova. Deformacije brodskog trupa izazvane jakim silama valova mogle bi utjecati na značajke vibracija porivnog sustava preko ležajeva postavljenih na brodu. Pouzdanost i sigurnost porivnog sustava bila bi u opasnosti. U ovom se radu predstavlja matematički model novog pojednostavljenog porivnog sustava u svrhu istraživanja dinamičkih interakcija između brodskog porivnog sustava i deformacija trupa. Deformacije brodskog trupa dobivene su numeričkom analizom kao uzbudne sile pri različitim morskim uvjetima. Zatim su se, na temelju dobivenih deformacija trupa, razmotrili različiti parametri koji su uključivali krutost nosača ležaja u odnosu na karakteristike vibracija porivnog sustava. Rezultati ovoga rada mogu doprinijeti ekonomičnosti i sigurnosti u izgradnji i pogonu brodova.Since an evident tendency of the shipbuilding is that the sizes of ships are larger and larger, the dynamic interactions between the propulsion system and ship hull in large scale ships are much severer than those of the small sized ships. Ship hull deformations caused by the action of heavy excited wave forces could affect the vibration characteristics of the propulsion system through bearings mounted on the ships. The reliability and safety of the propulsion system would be in a dangerous condition. In this paper, a novel simplified hull-propulsion system mathematical model is presented to investigate the dynamic interactions between the ship propulsion and hull deformations. Ship hull deformations were obtained as the excited forces under different sea conditions by numerical analysis. Then, based on the gained hull deformations, variable parameters involving stiffness of support bearings are considered on the vibration characteristics of propulsion. The findings of this work may provide a new insight to keep economy and security in both shipbuilding and ship operation fields

Transcriptomics of Gabra4 knockout mice reveals common NMDAR pathways underlying autism, memory, and epilepsy

Autism spectrum disorder (ASD) is a neuronal developmental disorder with impaired social interaction and communication, often with abnormal intelligence and comorbidity with epilepsy. Disturbances in synaptic transmission, including the GABAergic, glutamatergic, and serotonergic systems, are known to be involved in the pathogenesis of this disorder, yet we do not know if there is a common molecular mechanism. As mutations in the GABAergic receptor subunit gene GABRA4 are reported in patients with ASD, we eliminated the Gabra4 gene in mice and found that the Gabra4 knockout mice showed autistic-like behavior, enhanced spatial memory, and attenuated susceptibility to pentylenetetrazol-induced seizures, a constellation of symptoms resembling human high-functioning autism. To search for potential molecular pathways involved in these phenotypes, we performed a hippocampal transcriptome profiling, constructed a hippocampal interactome network, and revealed an upregulation of the NMDAR system at the center of the converged pathways underlying high-functioning autism-like and anti-epilepsy phenotypes

Prevalence and diagnostic value of non-criteria antiphospholipid antibodies for antiphospholipid syndrome in Chinese patients

BackgroundThe presence of antiphospholipid antibodies (aPLs) plays a pivotal role in the pathogenesis of antiphospholipid antibody syndrome (APS). This study aimed to examine the diagnostic value of a set of non−criteria aPLs and their relevance with APS-related criteria and extra-criteria manifestations.MethodsFrom a prospectively constructed database, consecutive APS patients consisting of 114 primary APS (PAPS group), 54 with APS secondary to SLE (SAPS group), 9 seronegative APS (SNAPS), as well as 209 patients with systemic lupus erythematosus (SLE) and 88 healthy controls were included in this study. Levels of criteria aPLs, baseline information, and APS-related criteria and extra-criteria features were extracted from the database. Serum levels of non-criteria aPLs including aPC IgG/IgM, aPI IgG/IgM, aPE IgG/IgM/IgA, aPG IgG/IgM/IgA, anti-phosphatidic acid (aPA) IgG/IgM, aSM IgG/IgM, and aPS/PT IgG/IgM were analyzed with AESKULISA® ELISA Test Kits.ResultsThe addition of aPC IgG/M, aPI IgG/M, aPE IgG/M/A, aSM IgG/M, and aPA IgG/M to aCL or aβ2GPI IgG/M could significantly increase diagnostic sensitivity and accuracy. A significant difference between PAPS or SAPS and HC was presented in all non-criteria aPLs except for aSM IgM and aPG IgA. Eight out of nine SNAPS patients were positive for at least 1 aPL. Pregnancy morbidity was associated with aSM IgM (r = 0.22) and aSM IgG (r = 0.15). Pre-eclampsia or premature birth was associated with aSM IgG (r = 0.16), aPI IgG (r = 0.22), aPC IgG (r = 0.16), and aPG IgG (r = 0.18). Stroke was associated with aPI IgG (r = 0.2). The clinical association was also observed in DVT with aPS/PT IgG (r = 0.17). Valve lesion was positively associated with aSM IgM (Fisher test p = 0.039), APS nephropathy was associated with aPC IgG (OR 3.797), and livedo reticularis was associated with aPE IgM (OR 15.391).ConclusionAdditional detection of non-criteria aPLs including aPC IgG/M, aPE IgG/M/A, aPI IgG/M, aSM IgG/M, and aPA IgG/M could assist in APS diagnosis. The positivity of certain aPLs was statistically associated with both criteria and extra-criteria APS clinical manifestations

Structural tuning and catalysis of tungsten carbides for the regioselective cleavage of C-O bonds

Tungsten carbides exhibit excellent performance in many heterogeneous processes because of their distinctive catalytic properties. Preparation of tungsten carbides with controllable phase composition relevant to their catalytic behavior is essential yet challenging. In this study, tungsten carbides embedded in carbon spheres (WxC@CS) were fabricated through carburization of organic–inorganic hybrid precursors. W1.25C@CS with rational structure-tuning properties exhibits promising regioselectivity (reaching 91.5%) toward aryl CO bond cleavage, specifically during hydrogenolysis of guaiacol to phenol. A structure reconstruction strategy was adopted to elucidate structure–performance relationship by transforming commercially available bulk WC from inert phase to composition-dependent active catalysts. Combined catalytic and characteristic analyses illustrate that the catalyst performance is dependent on the C-defect structure. The intimate connection between the phenol space time yield and the C/W atomic ratio on the exterior interface of the catalyst was verified. The C/W atomic ratio of 7.2 leads to the optimal catalytic performance. Density functional theory calculations were performed to define the catalytic mechanism at the atomic level. The theoretical analysis suggests an appropriate configuration of surface W and C atoms for activation of hydrogen and guaiacol molecules, rendering the intrinsic active sites for phenol production. This work provides insights into controlling the surface compositions of tungsten carbides to develop efficient CO bond cleavage catalysts, which verifies the importance of hydrogenolysis catalysis in lignin-derived compounds involving complex O-containing guaiacols and phenolics

Serum CHI3L1 as a biomarker of interstitial lung disease in rheumatoid arthritis

BackgroundInterstitial lung disease (ILD) is a relatively prevalent extra-articular manifestation of rheumatoid arthritis (RA) and contributes to significant morbidity and mortality. This study aimed to analyze the association between chitinase-3 like-protein-1(CHI3L1) and the presence of RA-ILD.MethodsA total of 239 RA patients fulfilling the American Rheumatism Association (ACR) 1987 revised criteria were enrolled and subclassified as RA-ILD and RA-nILD based on the results of high-resolution computed tomography scans (HRCT) of the chest. The disease activity of RA was assessed by Disease Activity Score for 28 joints (DAS28) and categorized as high, moderate, low, and remission. Chemiluminescence immunoassays were applied to determine the serum levels of CHI3L1. Univariate analysis was performed and the receiver operating characteristics (ROC) curves were plotted to evaluate the correlation between RA-ILD and CHI3L1.ResultsAmong the eligible RA patients studied, 60 (25.1%) patients were diagnosed with RA-ILD. Compared with RA-nILD, RA patients with ILD had significantly higher median age (median [IQR], 68.00 [62.00-71.75] vs 53.00 [40.00-63.00], p<0.001) and a higher proportion of males (21 (35.0%) vs 30 (16.8%), p=0.003). Notably, differences in DAS28 scores between the two groups were not observed. The serum level of CHI3L1 was significantly higher in RA-ILD patients (median [IQR], 69.69 [44.51-128.66] ng/ml vs 32.19 [21.63-56.99] ng/ml, p<0.001). Furthermore, the areas under the curve (AUC) of CHI3L1 attained 0.74 (95% confidence interval [CI], 0.68-0.81, p<0.001) in terms of identifying patients with RA-ILD from those without ILD. Similar trends were seen across the spectrum of disease activity based on DAS28-ESR.ConclusionOur findings of elevated serum CHI3L1 levels in RA-ILD patients suggest its possible role as a biomarker to detect RA-ILD noninvasively