MSCs-derived apoptotic extracellular vesicles promote muscle regeneration by inducing Pannexin 1 channel-dependent creatine release by myoblasts / 国际口腔科学杂志·英文版

Severe muscle injury is hard to heal and always results in a poor prognosis. Recent studies found that extracellular vesicle-based therapy has promising prospects for regeneration medicine, however, whether extracellular vesicles have therapeutic effects on severe muscle injury is still unknown. Herein, we extracted apoptotic extracellular vesicles derived from mesenchymal stem cells (MSCs-ApoEVs) to treat cardiotoxin induced tibialis anterior (TA) injury and found that MSCs-ApoEVs promoted muscles regeneration and increased the proportion of multinucleated cells. Besides that, we also found that apoptosis was synchronized during myoblasts fusion and MSCs-ApoEVs promoted the apoptosis ratio as well as the fusion index of myoblasts. Furthermore, we revealed that MSCs-ApoEVs increased the relative level of creatine during myoblasts fusion, which was released via activated Pannexin 1 channel. Moreover, we also found that activated Pannexin 1 channel was highly expressed on the membrane of myoblasts-derived ApoEVs (Myo-ApoEVs) instead of apoptotic myoblasts, and creatine was the pivotal metabolite involved in myoblasts fusion. Collectively, our findings firstly revealed that MSCs-ApoEVs can promote muscle regeneration and elucidated that the new function of ApoEVs as passing inter-cell messages through releasing metabolites from activated Pannexin 1 channel, which will provide new evidence for extracellular vesicles-based therapy as well as improving the understanding of new functions of extracellular vesicles.

Effect of reimbursement policy of basic medical insurance on the treatment level and cost of hemophilia A patients in China / 中华医院管理杂志

Objective:To explore the influence of differentiated outpatient reimbursement policies of basic medical insurance in some areas of China on the treatment level and medical expenses of adult hemophilia A patients.Methods:The outpatient reimbursement policies of hemophilia A in 5 cities(NB, XM, TJ, SY and ZZ)were systematically reviewed and compared. The basic characteristics, dosage of coagulation factors and medical expenses of hemophilia A patients in the 5 cities in 2018 were collected retrospectively to explore the influence of outpatient reimbursement policy on the treatment level and medical expenses of patients, and the differences of medical expenses between on-demand treatment and prophylaxis treatment were analyzed.Results:The reimbursement policies for hemophilia A outpatients in different regions were quite different. NB medical insurance had the best treatment, mainly reflected in the high reimbursement rate, no capping line(only urban employee medical insurance), and could be connected with major illness insurance; XM and TJ were relatively good, SY and ZZ were not ideal. The level of reimbursement of patients was also affected by their types of insurance. Adult patients of ZZ and SY were mostly covered by basic medical insurance for urban and rural residents, and their medical insurance benefits were relatively poor. In terms of treatment level, NB patients received the highest proportion of prophylaxis treatment(21 cases, 72.4%), followed by XM(8 cases, 26.7%), TJ(10 cases, 20.0%), and SY(5 cases, 10.2%), and no patients in ZZ received prophylaxis treatment. The areas with good reimbursement policy for outpatients were also accompanied by higher treatment costs, and the costs of prophylaxis treatment groups in each city were higher than those of the on-demand treatment group.Conclusions:At present, there are obvious differences in outpatient reimbursement treatment of hemophilia A patients in some areas of China. The standardization of patients receiving treatment is greatly affected by the level of medical insurance reimbursement. The improvement of reimbursement treatment will significantly improve the treatment level of patients, and also accompanied with higher medical expenses. The expenses of prophylaxis treatment group are higher than those of on-demand treatment group. It is suggested to further narrow the differences of reimbursement levels in different regions, and to improve the treatment level of patients with severe illness insurance, so as to reduce the burden of hemophilia A patients.

The prevalence and related direct medical costs of chronic complications among patients with type 2 diabetes in China / 中华内分泌代谢杂志

Objective To estimate the prevalence and related direct medical costs of chronic complications,especially cardiovascular diseases,cerebrovascular diseases,and nephropathy in patients with type 2 diabetes mellitus (T2DM) in China.Method Data were extracted from the hospital information system(HIS) database of 4 top level Chinese hospitals from January 1st,2012 to May 31st,2017.Patients with T2DM were identified through international classification of diseases,tenth version (ICD-10) diagnosis supplemented with Chinese descriptions.The prevalences of complications including cardiovascular diseases,cerebrovascular diseases,nephropathy,diabetic foot,lower extremity vascular diseases,diabetic retinopathy,and diabetic neuropathy were estimated among all identified patients with T2DM.The costs per hospitalization and per outpatient visit under the primary diagnoses of each chronic complication were further estimated.Results There were 61 139 patients with T2DM,with mean age of(62.1 ± 13.6) years,50.5％ being males.66.8％ of them had chronic complications,and patient suffered from more than 2 complications on average.The most common complication was nephropathy (30.5％),followed by diabetic neuropathy (26.8％),diabetic retinopathy (26.3％),cardiovascular disease (24.9％),and cerebrovascular disease (19.2％).The cost per hospitalization was highest for cardiovascular disease(21 176 yuan),followed by diabetic foot disease(18 999 yuan) and cerebrovascular disease (16 583 yuan).The cost per outpatients visit varied from 826 to 976 yuan across different complications except for lower extremity vascular diseases (522 yuan).Conclusions The majority of patients with T2DM suffered from chronic complications.The occurrence and development of chronic complications,especially cardiovascular diseases,cerebrovascular diseases,and nephropathy,led to increased direct medical costs among patients with T2DM.Effective interventions,such as regular physical examinations and proper glycemic control,should be implemented to prevent complications among the diabetic patients.