Medical Care and Payment for Diabetes in China: Enormous Threat and Great Opportunity

Background

The Diabetes Impact Study followed up a large national population-based screening study to estimate the use of and expenditures for medical care caused by diabetes in China and to ascertain the use and cost of essential basic medicines and care.

Methods

In 2009–10, the study team interviewed 1482 adults with diabetes and 1553 adults with glucose tolerance in the normal range from population-based random samples at 12 sites in China. The response rate was 67%.

Findings

After adjusting for age, sex, and urban/rural location, people with diabetes received 1.93 times more days of inpatient treatment, 2.40 times more outpatient visits, and 3.35 times more medications than people with normal glucose tolerance (all p<0.05). Adjusted expenditures for medical care were 3.38 times higher among people with diabetes than among people with normal glucose tolerance (p<0.01, unadjusted 3.97). Persons who were diagnosed with ≥10 years prior to the survey paid 3.75 times as much for medical care as those with ≤5 years of diagnosed diabetes. Among persons with diabetes, 45.2% took medication to control blood sugar, 21.1% took an antihypertensive medicine, 22.4% took daily aspirin, and 1.8% took a statin. Over the three months before the interview, 46.1% of persons with diabetes recalled seeing a doctor, 48.9% recalled a blood pressure measurement, and 54.5% recalled a blood sugar test. Over the year preceding the interview, 32.1% recalled a retinal screening and 17.9% recalled a foot examination.

Conclusions

In China, health care use and costs were dramatically higher for people with diabetes than for people with normal glucose tolerance and, in relative terms, much higher than in industrialized countries. Low-cost generic medicines that would reduce diabetes expenditures were not fully used.     

Genetic diversity of Mycobacterium tuberculosis isolates from Tibetans in Tibet, China

Background

Tuberculosis (TB) is a serious health problem in Tibet where Tibetans are the major ethnic group. Although genotyping of Mycobacterium tuberculosis (M. tuberculosis) isolates is a valuable tool for TB control, our knowledge of population structure of M. tuberculosis circulating in Tibet is limited.

Methodology/Principal Findings

In our study, a total of 576 M. tuberculosis isolates from Tibetans in Tibet, China, were analyzed via spoligotyping and 24-locus MIRU-VNTR. The Beijing genotype was the most prevalent family (90.63%, n = 522). Shared-type (ST) 1 was the most dominant genotype (88.89%, n = 512). We found that there was no association between the Beijing genotype and sex, age and treatment status. In this sample collection, 7 of the 24 MIRU-VNTR loci were highly or moderately discriminative according to their Hunter-Gaston discriminatory index. An informative set of 12 loci had similar discriminatory power with 24 loci set.

Conclusions/Significance

The population structure of M. tuberculosis isolates in Tibetans is homogeneous and dominated by Beijing genotype. The analysis of 24-locus MIRU-VNTR data might be useful to select appropriate VNTR loci for the genotyping of M. tuberculosis.     

Assessing the impact of the biological control agent Bacillus thuringiensis on the indigenous microbial community within the pepper plant phyllosphere

Although biological control agents (BCAs) have been used extensively for controlling insects and pathogens of plants, little is known regarding the effects of such agents on the indigenous microbial communities within the plant phyllosphere. We assessed the effect of the BCA Bacillus thuringiensis (Bt) on the microbial communities within the pepper plant phyllosphere using culture-independent methodologies. Phospholipid fatty acid (PLFA) analysis suggested that the bacterial and fungal biomass were not significantly affected following Bt application. However, principal component analysis of PLFA data indicated that Bt did change the phyllosphere microbial community structure significantly. 16S rRNA gene-directed PCR with denaturing gradient gel electrophoresis (DGGE) also suggested a significant change in the phyllosphere bacterial community structure following Bt inoculation. Phylogenetic analysis of excised DGGE bands suggested a change in bacterial phyla; bands from untreated samples predominantly belonged to the Firmicutes, while Gammaproteobacteria abounded in the treated samples.     

Protonless 13C direct detection NMR: characterization of the 37 kDa trimeric protein CutA1

The major limitation of nuclear magnetic resonance spectroscopy arises from the increase of nuclear transverse relaxation rates with increasing molecular mass. This causes reduction in spectral resolution and coherence transfer efficiency. The use of 2H-labeling to eliminate 1H-mediated relaxation pathways and the constructive use of cross correlation effects (TROSY, CRINEPT) alleviate the phenomenon. An alternative approach is to use direct detection of heteronuclei. Specifically designed 13C direct detection experiments can complement the set of 1H-based NMR experiments commonly used for structure determination providing an additional source of information less affected by the detrimental transverse relaxation effect. We applied this novel methodology to the study of the CutA1 protein (12.3 kDa) from E. coli that forms a homotrimer in solution with a total molecular mass of 37 kDa. In this work we demonstrate that the information available from 13C direct detection experiments makes it possible to completely assign the NMR resonances of the backbone of this 37 kDa trimeric protein without the need of deuteration. The structural and dynamical knowledge obtained for this system may contribute to understand its biological role.     

β-鹅膏毒肽的反相高效液相色谱分离纯化

用反相高效液相色谱,以0.02mol/L醋酸铵-乙腈为流动相的梯度洗脱模式,在295nm吸收值的条件下,灰花纹鹅膏菌Amanitafuliginea的肽类毒素可以被成功的分离和纯化。单个肽类毒素的鉴定是用反相高效液相色谱和质谱同时进行。用这一方法可从灰花纹鹅膏菌中分离纯化出β-鹅膏毒肽(β-amanitin),产量可达到:1158靏/g(干重),产品纯度达98%以上,回收率为95.3%。β-鹅膏毒肽的分子量为919.3Da。这个方法可用于其它鹅膏菌肽类毒素的分离纯化。     

碱裂解法提取质粒DNA的研究

对质粒DNA及其结构、形态和功能进行了综述 ,介绍了碱裂解法提取质粒DNA的基本步骤 ,并对其提取过程中的注意事项进行了剖析 ,分析比较了不同提取方法的优点     

HDAC10 upregulation contributes to interleukin 1β-mediated inflammatory activation of synovium-derived mesenchymal stem cells in temporomandibular joint

Histone deacetylases (HDACs) are important in chronic inflammation, and inflammatory responses affect synovium-derived mesenchymal stem cell (SMSC) function in temporomandibular joint repair. However, the effect of HDACs on SMSC inflammatory activation remains unclear. In this study, temporomandibular joint fibroblast-like synoviocytes obtained from osteoarthritis patients met the minimal mesenchymal stem cell criteria. Interleukin 1β (IL-1β) upregulated IL-6 and IL-8 expression in SMSCs through nuclear factor-κB (NF-κB) pathway activation. IL-6 and IL-8 upregulation were blocked by broad-acting HDAC inhibitors SAHA and LBH589. MC1568 alleviated IL-1β activation of SMSCs, whereas CI994 and FK228 produced a minimal or opposite effect in vitro. We also found HDAC10 was highly associated with localized IL-1β expression in vivo and in vitro. HDAC10 knockdown alleviated IL-1β-mediated SMSC activation and blocked NF-κB pathway activation. Conversely, HDAC10 overexpression promoted IL-6 and IL-8 expression and IL-1β-mediated NF-κB pathway activation. In conclusion, HDAC10 upregulation contributed to IL-1β-mediated inflammatory activation of SMSCs, indicating that HDAC10 may be a novel therapeutic target.     

过表达IL-12调节单核系肿瘤细胞向巨噬细胞分化

构建过表达白细胞介素-12（interleukin-12,IL-12）的THP-1单核系肿瘤细胞模型,从形态学、巨噬细胞表面标志表达水平及吞噬功能3方面探究过表达IL—12能否调节单核系肿瘤细胞向巨噬细胞分化。结果发现,与空白和空载组相比,IL-12组的THP．1细胞界限不明显,散在细胞增多;呈圆形或不规则圆形,偶见毛刺状突起;核仁模糊或消失,核染色质条索状浓集;CD68mRNA和蛋白表达量均升高俨〈0．05）。与空白组相比,CDllbmRNA和蛋白表达量升高不明显俨〉O．05）,但72hCD11b蛋白表达量明显高于相同培养条件下的空载组（P〈O．05）。培养72h后各组细胞吞噬能力比较,IL-12组吞噬率（36．7±1．2）％高于空白组（15．7±3．1）％和空载组（28．O±1．5）％,差异有统计学意义（P〈0．05）。上述结果提示,过表达IL-12可以促进单核系肿瘤细胞向巨噬细胞分化。     

巨噬细胞特异性启动子/抗菌肽PR39基因腺病毒载体的构建及其表达

旨在构建由巨噬细胞特异性启动子调控的抗菌肽PR39基因腺病毒表达载体,检测目的基因在小鼠巨噬细胞RAW264.7中的表达。PCR扩增巨噬细胞启动子/抗菌肽PR39成熟肽基因序列,插入腺病毒穿梭载体pAdTrack中,重组穿梭质粒(pAdTrack-SP/PR39)与腺病毒骨架(pAdEasy-1)共转化大肠杆菌BJ5183,通过细菌内同源重组产生重组腺病毒载体(pAd-SP/PR39)。pAd-SP/PR39经PacI线性化后转染293细胞,包装出重组腺病毒(Ad-SP/PR39)。Ad-SP/PR39感染小鼠巨噬细胞RAW264.7,经RT-PCR和免疫细胞化学检测PR39的靶向表达特异性。成功构建了由巨噬细胞特异性启动子调控的抗菌肽PR39基因腺病毒表达载体。包装出的重组腺病毒仍然能感染小鼠巨噬细胞且高效表达抗菌肽PR39。构建的重组腺病毒能够在巨噬细胞中表达抗菌肽PR39基因,为靶向表达抗菌肽在胞内菌感染治疗中的应用奠定了基础。