Objective To undertake a systematic review of the economic burden of diabetes in China.Methods Published literatures about the medical cost and economic burden of diabetes in China were searched for analyzing the methodologies and results.Results Altogether 374 articles were identified in the literatures.Review of the articles resulted in the identification of 40 of these that met all criteria.Cost of illness studies and hospitalization expenditure per admission comprised the largest source of the studies.Cost of illness approach,calculations from the national survey's data and the matching method were adopted in most researches and led to variations of result.Conclusions Differences in research methods are the key determinants of variations of the result.Even the same method with different data sources,patient types or investigating spots still contributes to great variations.Without well-accepted standards to guide researchers in their execution of these studies,policymakers and the general publicmust be wary of the methods and data source used in their calculation and subsequent results.

Objective To explore the protective effect of vitamin E on the rabbit bladder after partial outlet obstruction artificially setup. Methods A total of 28 New Zealand white male rabbits were divided into 4 groups (group A in 6,group B in 6,group C in 8 and group D in 8).Group A,B and C were fed a regular diet,and group D were placed on a diet enriched with 600 mg vitamin E.After 4 weeks partial outlet obstruction was created in groups C and D,while group B underwent sham operation. After 4 weeks of obstruction each rabbit was sedated and cystometry was repeated.After cystometry the bladder was weighed.The gene expression of sarcoplasmic endoplasmic reticulum,calcium,magnesium,adenosine triphosphatase (SERCA2) in bladder was detected by using RT-PCR assay,while the protein level of SERCA2 was measured by Western blot analysis. Results All parameters measured were approximately identical in nomal rabbits(Group A) and shum operation rabbits(group B).Thus,these 2 groups were combined as the control group(Group A and B).Partial outlet obstruction resulted in bladder weight increased significantly in obstructed groups given vehicle group C(13.07?1.71)g and those vitamin E group D(11.80?2.01)g,4-fold higher than in the control group (2.81?0.30)g(P

AIM: The effects of selenium dioxide (SeO_2) on proliferation, apoptosis, intracellular reactive oxygen species (ROS) and Ca~(2+) levels in three leukemia cell lines NB4, K562 and HL-60 were investigated. METHODS: Three leukemia cell lines were treated with 3-30 ?mol/L SeO_2. Flow cytometry was used to detect apoptosis rate, and analyze the changes of ROS and Ca~(2+) level within cells. RESULTS: SeO_2 at 10 and 30 ?mol/L inhibited proliferation in three leukemia cell lines. Treatment with 30 ?mol/L SeO_2 for 48 h induced 54.0%, 46.5%, 49.6% apoptosis in NB4, K562, and HL-60 cells, respectively, and also markedly decreased ROS and Ca~(2+) levels among three cell lines. The rate of ROS positive cells in NB4 and HL-60 decreased with the increase in SeO_2 concentrations. ROS was clearly reduced with 30 ?mol/L SeO_2 in K562. Ca~(2+) levels were tardily declined with 10, 30 ?mol/L SeO_2 in NB4 and HL-60 cells. Ca~(2+) levels were clearly reduced with 30 ?mol/L SeO_2 in K562. CONCLUSION: SeO_2 induces apoptosis in three leukemia cells. The declines of intracellular ROS and Ca~(2+) levels are involved in apoptosis induced by SeO_2.

Objective To investigate the development and dynamic changes of host immune response in DBA/2 mice infected with Plasmodium yoelii 17XL. Methods Female DBA/2 mice were infected by intraperitoneal ( i. p. ) injection of 106 P. yoelii 17XL parasitized erythrocytes ( PRBC). Levels of IL-12, IFN-γ, IL-4, IL-10 and P. yoelii 17XL-specific antibody in sera were measured by ELISA. Concentrations of NO in cell supernatants were measured by the Griess reaction. Parasitemia,percentage of mononuclear-macrophages of individual mice were monitored daily, and phagocytosis of mononuclear macrophages was also observed. Results Primary parasitemia in vein blood was developed on day 3 postinfection, which peaked with a level of 46. 9% on day 9. Most mice cleared the infection and survived by day 20 postinfection. From day 6 to day 16, the phagocytosis of PRBC by rodent macrophages was observed on the blood smear. Infected mice had a continuously increased level of IL-12 in serum from day 1 postinfection. Accordingly, high level of IFN-γ was also detected in sera from day 1 postinfection,which peaked on day 6. Infected mice produced higher level of IL-4 and IL-10 in serum on day 6 postinfection, which peaked on day 9 and day 15 postinfection respectively. In addition, splenocytes from infected mice produced significantly higher level of NO on day 6 and 20 postinfection. Level of P. yoelii 17XL-specific IgG was determined in the sera of infected mice with a steadily increased trend after infection, which peaked on day 70 postinfection. Conclusions Effective polarizing of Thl cells is significant in inhibition of parasitemia and eventual clearance of the Plasmodium parasites. Activated mononuclear-macrophages play a key role in inhibiting parasitemia in the early phase of infection with P. yoelii 17XL.

Objective To investigate the genetic diversity of Plasmodium vivax transmission_blocking vaccine candidate antigen (TBV) Pvs25, with P.vivax isolates from Hubei and Zhejiang Provinces, and to compare the genetic polymorphism of Pvs25 with that from Bangladesh. MethodsThe parasite DNA used for the genetic polymorphism assay was obtained from dried filter paper blood spots. The genes were PCR amplified and the products were purified and sequenced directly. Results 45 complete new sequences were analyzed. Only 3 nucleotide changes were found that would result in amino acid substitutions in Pvs25 in comparison with the sequence from P.vivax Sal_I strain. The measurement of nucleotide diversity (?) was remarkably similar for the two populations, indicating that DNA sequences and deduced amino acid sequences were highly homologous among the geographically dispersed isolates or isolates from the same geographical region.Conclusion The results suggest that Pvs25 has limited antigenic polymorphism, especially compared with candidate antigens expressed by hepatic and erythrocytic stage, which may support the development and application of Pvs25_based transmission_blocking vaccine in China.

OBJECTIVE:To provide reference for the rational utilization of narcotic drugs in cancer pain patients. METH-ODS:In retrospective survey,2275 prescriptions of narcotic drugs for cancer pain patients in outpatient and emergency depart-ment of our hospital during 2014-2016 were analyzed statistically in respects of general information,drug amount,consumption sum and DDDs,etc. RESULTS:The proportion of male patients and female patients with cancer pain in our hospital were 65.63%and 34.37% within 3 years,mainly aged 21-90. The consumption amount and sum of narcotic drugs in our hospital increased year by year. Dosage forms were mainly tablet. The consumption amount,sum and DDDs of Morphine hydrochloride sustained-release tablets took up the first places among narcotic drugs. And those of Pethidine hydrochloride injection were the lowest. CONCLU-SIONS:The utilization of narcotic drugs is rational in outpatient and emergency department of our hospital on the whole. Morphine preparations are the predominant analgesic drugs for patients with cancer pain.

To investigate the role of Toll like receptor (TLR) in the activation of dendritic cells (DC) during early Plasmodium yoelii infection of the lethal strain 17XL (P.y 17XL), susceptible BALB/c and resistant DBA/2 mice were infected by i.p.injection of the P.y l7XL-parasitized erythrocytes, and the parasitemia of individua1 mice was monitored by the microscopic examination of blood smear stained with Giemsa.Mice from norma1 and infected groups were sacrificed on 0,3 and 5 days post-infection to collect their spleen cells.And the expressions of TLR-9 and TLR-4 on the cell surface of DCs in spenonocytes of these two strains of mice were assayed by applying flow cytometry to quantitatively analyze the percentages of CD11c+TLR9+ DCs and CD11c+TLR4+ DCs. It was found that the population of CD11c+DCs expressing TLR9 was significantly increased on day 3 and peaked on 5 p.i. in BALB/c (P<0.01) and DBA/2 mice(P<0.01). However, there was no statistical significance between these two strains of mice. Meanwhile, there was no change on the population of CD11c+ DCs expressing TLR4 in BALB/c and DBA/2 mice. These results indicate that TLR9 may contribute to the DC activation during early stages of P.y17XL infection.

Objective:To investigate the relationship between different types of hemorrhagic transformation and serum uric acid in patients with acute cerebral infarction.Methods:The clinical data of 365 patients with acute cerebral infarction in Jinhua Central Hospital of Zhejiang Province from June 2018 to December 2020 were retrospectively analyzed. The clinical data and the serum uric acid level at the time of admission were recorded, and the occurrences of hemorrhagic infarction (HI) and cerebral parenchymal hematoma (PH) were counted. The risk factors of HI and PH in patients with acute cerebral infarction were analyzed by multivariate Logistic regression analysis.Results:Among 365 patients, 328 cases had no hemorrhagic transformation (control group); 37 cases (10.1%) had hemorrhagic transformation, with 20 cases of HI (HI group) and 17 cases of PH (PH group). The uric acid in PH group was significantly lower than that in control group and HI group: (243.59 ± 61.49) μmol/L vs. (307.84 ± 80.12) and (305.45 ± 94.99) μmol/L, and there was statistical difference ( P<0.05); there was no statistical difference in uric acid between control group and HI group ( P>0.05). The patients was divided into 3 groups according to the tertiles of serum uric acid, uric acid ≤ 264.9 μmol/L was in 121 cases (Ⅰ group), 265.0 to 338.8 μmol/L was in 122 cases (Ⅱ group) and ≥338.9 μmol/L was in 122 cases (Ⅲ group). The rate of PH in Ⅲ group was significantly lower than that in Ⅰ group: 0.8% (1/122) vs. 8.3% (10/121), and there was statistical difference ( P<0.05). Taking patients without hemorrhage transformation as a reference, multivariate Logistic regression analysis result showed that diabetes, atrial fibrillation and large-area infarction were independent risk factors of HI in patients with acute cerebral infarction ( P<0.01); the age, large-area cerebral infarction, thrombolytic therapy, platelet count and uric acid were independent risk factors of PH in patients with acute cerebral infarction ( P<0.05 or <0.01). Conclusions:In patients with acute cerebral infarction, higher serum uric acid is independently correlated with lower PH, and has no correlation with HI. Serum uric acid level has certain value in predicting PH.

Objective: To estimate the direct medical cost of severe hand, foot and mouth disease (HFMD) in patients aged less than five years. Methods: A stratified sampling method was used to collect data on severe HFMD cases reported in the National HFMD surveillance database between Jan 1, 2012, and Dec 31, 2013. The sampling was referenced with the national aetiologic distribution of Enterovirus A71 (EV-A71), Coxsackievirus A16 (CV-A16) and other Enteroviruses (OEV) for severe HFMD cases and the included cases were distributed among seven geographic regions (Northeast, North China, Northwest, Central China, Southwest, East China and South China). A nationwide telephone interview using a structured questionnaire was conducted to obtain the direct medical cost and any complications that occurred in patients during the outbreak of laboratory-confirmed HFMD. After excluding the cases who could not recall their medical expenses or complications, a total of 685 cases were included in the analysis. Kruskal-Wallis H test was used to analyze the differences among patients who reported different complications. Multiple linear regression with bootstrap analysis of 500 replicates was used to explore the factors that influenced the direct medical costs. Results: Of 685 patients analyzed, 456 (66.6%) were male and 229 (33.4%) were female. The direct medical costs P₅₀ (P₂₅, P₇₅) were 14 250 (10 301, 20 600) Yuan. In total, 127 (18.5%) patients were diagnosed with severe HFMD patients with respiratory disease, 38 (5.5%) patients were diagnosed with aseptic meningitis, and 378 (55.2%) with encephalitis/brainstem encephalitis/acute flaccid paralysis. Furthermore, 53 (18.5%) patients were diagnosed with myocarditis, 39 (5.7%) with pulmonary hemorrhage/pulmonary edema and 50 (7.3%) with cardiopulmonary failure. The median (interquartile range) direct medical costs were 12 360 (7 313, 16 480) Yuan for severe HFMD patients with respiratory disease, 13 803 (9 064, 19 930) Yuan for aseptic meningitis, 14 438 (11 000, 20 015) Yuan for encephalitis/brainstem encephalitis/acute flaccid paralysis, 14 800 (8 500, 21 218) Yuan for myocarditis, 20 600 (12 500, 31 130) Yuan for pulmonary hemorrhage/pulmonary edema, and 20 043 (12 772, 28 840) Yuan for cardiopulmonary failure (H=17.70, P<0.001). The results of multiple linear regression with bootstrap analysis revealed that the direct medical cost for severe HFMD patients from Central China was 7 881 (95% CI: 3 814-11 949) Yuan higher than that of North China; severe HFMD patients diagnosed with OEV had direct medical costs of 1 987 (95%CI: 206-3 769) Yuan less those associated with EV-A71; severe HFMD patients whose duration of illness was ≥21 d had 20 480 (95% CI: 10 985- 29 974) Yuan higher direct medical costs those whose illness lasted ≤5 d; the direct medical costs for severe HFMD patients with pulmonary hemorrhage/pulmonary edema and cardiopulmonary failure were 7 874 (95%CI: 3 723-12 026) and 9 855 (95% CI: 328- 19 382) Yuan higher, respectively, than that associated with respiratory disease. Conclusion The direct medical costs associated with severe HFMD were found to be substantial. The total cost was affected by the duration of the illness and the severity of any complications.

Objective To evaluate the health related quality of life (HRQoL) for severe hand,foot and mouth disease (HFMD) patients with different complications.Methods A national telephone interview under the EQ-5D proxy2 questionnaire (EQ-SD and EQ-VAS),was conducted to obtain the HRQoL of lab-confirmed severe HFMD patients,aged between six months and five-year-olds from the national communicable disease surveillance system from January 1,2012 to December 31,2013.Results A total of 685 severe HFMD cases were included in the study.A total of 456 (66.6％) of them were males with 75.8％ of them younger than three years old.A total of 337 (49.2％) and 407 (59.4％) of the participants reported that they had problems in mobility or daily activities.A total of 569 (83.1％) and 616 (89.9％) of the cases reported having problems in pain/discomfort or anxiety/depression.The average EQ-5D and EQ-VAS scores were 0.58 ± 0.23 and 53.6 ± 25.7,both were positively associated with the duration of illness.Mean quality adjusted life years loss during the HFMD episode for the severe patients was (15.45 ± 13.75) years/1 000 persons.The QALY losses for severe patients with each of below complication were:respiratory diseases (11.17 ± 8.83) years/1 000 persons,aseptic meningitis (13.56 ± 11.99) years/1 000 persons,encephalitis/brainstem encephalitis/acute flaccid paralysis (AFP) (15.31 ± 12.63) years/1 000 persons,Myocarditis (17.28 ± 18.16) years/1 000 persons,pulmonary hemorrhage/pulmonary edema (17.34 ±14.98) years/1 000 persons,cardiopulmonary failure (25.47 ± 20.53) years/1 000 persons.Among patients with lab confirmed Entero virus A71 (EV71) (16.51 ± 14.48) years/l 000 persons,the QALY loss was seen higher than Coxsackie virus A16 (Cox A16) (13.02± 11.45) years/1 000 persons and other Enter virus (14.74 ± 14.22) years/1 000 persons (Z=11.83,P=0.003).Conclusion The HRQoL loss for severe HFMD patients substantially increased under complications exacerbation and related to the duration of illness.