PhiHER2: phenotype-informed weakly supervised model for HER2 status prediction from pathological images.

MOTIVATION: Human epidermal growth factor receptor 2 (HER2) status identification enables physicians to assess the prognosis risk and determine the treatment schedule for patients. In clinical practice, pathological slides serve as the gold standard, offering morphological information on cellular structure and tumoral regions. Computational analysis of pathological images has the potential to discover morphological patterns associated with HER2 molecular targets and achieve precise status prediction. However, pathological images are typically equipped with high-resolution attributes, and HER2 expression in breast cancer (BC) images often manifests the intratumoral heterogeneity. RESULTS: We present a phenotype-informed weakly supervised multiple instance learning architecture (PhiHER2) for the prediction of the HER2 status from pathological images of BC. Specifically, a hierarchical prototype clustering module is designed to identify representative phenotypes across whole slide images. These phenotype embeddings are then integrated into a cross-attention module, enhancing feature interaction and aggregation on instances. This yields a phenotype-based feature space that leverages the intratumoral morphological heterogeneity for HER2 status prediction. Extensive results demonstrate that PhiHER2 captures a better WSI-level representation by the typical phenotype guidance and significantly outperforms existing methods on real-world datasets. Additionally, interpretability analyses of both phenotypes and WSIs provide explicit insights into the heterogeneity of morphological patterns associated with molecular HER2 status. AVAILABILITY AND IMPLEMENTATION: Our model is available at https://github.com/lyotvincent/PhiHER2.

Deep learning framework for comprehensive molecular and prognostic stratifications of triple-negative breast cancer.

Triple-negative breast cancer (TNBC) is the most challenging breast cancer subtype. Molecular stratification and target therapy bring clinical benefit for TNBC patients, but it is difficult to implement comprehensive molecular testing in clinical practice. Here, using our multi-omics TNBC cohort (N = 425), a deep learning-based framework was devised and validated for comprehensive predictions of molecular features, subtypes and prognosis from pathological whole slide images. The framework first incorporated a neural network to decompose the tissue on WSIs, followed by a second one which was trained based on certain tissue types for predicting different targets. Multi-omics molecular features were analyzed including somatic mutations, copy number alterations, germline mutations, biological pathway activities, metabolomics features and immunotherapy biomarkers. It was shown that the molecular features with therapeutic implications can be predicted including the somatic PIK3CA mutation, germline BRCA2 mutation and PD-L1 protein expression (area under the curve [AUC]: 0.78, 0.79 and 0.74 respectively). The molecular subtypes of TNBC can be identified (AUC: 0.84, 0.85, 0.93 and 0.73 for the basal-like immune-suppressed, immunomodulatory, luminal androgen receptor, and mesenchymal-like subtypes respectively) and their distinctive morphological patterns were revealed, which provided novel insights into the heterogeneity of TNBC. A neural network integrating image features and clinical covariates stratified patients into groups with different survival outcomes (log-rank P < 0.001). Our prediction framework and neural network models were externally validated on the TNBC cases from TCGA (N = 143) and appeared robust to the changes in patient population. For potential clinical translation, we built a novel online platform, where we modularized and deployed our framework along with the validated models. It can realize real-time one-stop prediction for new cases. In summary, using only pathological WSIs, our proposed framework can enable comprehensive stratifications of TNBC patients and provide valuable information for therapeutic decision-making. It had the potential to be clinically implemented and promote the personalized management of TNBC.

Healthcare-seeking behaviours of patients with acute respiratory infection: a cross-sectional survey in a rural area of southwest China.

OBJECTIVES: This study aimed to assess the healthcare-seeking behaviour and related factors of people with acute respiratory symptoms in the rural areas of central and western China to estimate the disease burden of influenza more accurately. DESIGN: Cross-sectional survey. SETTINGS: Fifty-two communities/villages in the Wanzhou District, Chongqing, China, a rural area in southwest China, from May 2022 to July 2022. PARTICIPANTS: The participants were those who had been living in Wanzhou District continuously for more than 6 months and consented to participate. OUTCOME MEASURES: A semistructured questionnaire was used to determine the healthcare-seeking behaviour of participants, and the dichotomous response of 'yes' or 'no' was used to assess whether participants had acute respiratory symptoms and their healthcare-seeking behaviour. RESULTS: Only 50.92% (360 of 707) of the patients with acute respiratory infection visited medical and health institutions for treatment, whereas 49.08% (347 of 707) avoided treatment or opted for self-medication. The primary reason for not seeing a doctor was that patients felt their condition was not serious and visiting a medical facility for treatment was unnecessary. Short distance (87.54%) and reasonable charges (49.48%) were ranked as the most important reasons for choosing treatment at primary medical and health facilities (80.27%). The primary reasons for which patients visited secondary and tertiary hospitals (7.78% and 8.61%, respectively) were that doctors in such facilities were better at diagnosis (57.14%) and at treatment (87.10%). CONCLUSION: The findings provided in this study indicated that regular healthcare-seeking behaviour investigations should be conducted. The disease burden of influenza can be calculated more accurately when healthcare-seeking behaviour investigations are combined with surveillance in the hospitals.

The Mediating Role of Depression in the Association Between Hearing Impairment and Functional Disability Among Middle-Aged and Older Adults in China.

Background and Objectives: This study aims to explore the association between hearing impairment (HI) and functional disability and to examine whether depression mediates this association. Research Design and Methods: In the study, 11 335 individuals aged 45 years and older were analyzed from the China Health and Retirement Longitudinal Study. The study used logistic regression and Karlson/Holm/Breen's method to examine the correlation between HI, depression, and functional disability. Functional disability was assessed using activities of daily living and instrumental activities of daily living. Results: HI was significantly associated with activities of daily living disability (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.21-1.49) and instrumental activities of daily living disability (OR = 1.57, 95% CI = 1.46-1.68). The mediated effect of depression accounted for 22.80% and 15.17% of the total effect of HI on activities of daily living and instrumental activities of daily living disability, respectively. Additionally, depression partially mediated the effects of HI on specific activities of daily living and instrumental activities of daily living tasks, including bathing (33.23%), toileting (27.50%), doing chores (37.36%), preparing meals (28.04%), shopping (25.81%), taking care of finances (11.82%), and taking medicine (12.71%). Discussion and Implications: HI increased the likelihood of functional disability partially through depression in middle-aged and older adults, suggesting that emphasizing the mental wellness of these people with HI is necessary to prevent impairments in physical function.

Association of Job Characteristics and Burnout of Healthcare Workers in Different Positions in Rural China: A Cross-Sectional Study.

Objectives: Health workers in rural primary care systems are at increased risk of job burnout, but their associations with different positions have received scant attention in the literature. Thus, this study aims to measure job burnout in different positions in rural China and to identify factors associated with it. Methods: A cross-sectional survey was conducted with a total of 15,627 participants from six provinces in China. And job burnout was measured using the Chinese version of the Maslach Burnout Inventory-General Scale (MBI-GS). Multilevel regression analyses were used in examining factors potentially associated with job burnout in different positions. Results: Overall, more than half of providers suffered from moderate burnout. The degree of job burnout varied among different positions. Middle managers showed higher levels personal stress, while general staff showed the lowest interpersonal and self-evaluation dimensions of burnout. Job duty, job capability, job treatment, and career advancement are potential factors affecting these results. Conclusion: Interventions aimed at providing appropriate training and development opportunities, developing relevant career planning and management strategies, and implementing reasonable staffing and job design may be promising strategies for alleviating burnout in different positions and improving health system performance.

Associations between social support and poverty among older adults.

BACKGROUND: With population aging becoming a pressing global concern, social support is more meaningful for older adults. In particular, financial supports, such as health insurance and financial assistance derived from family, all play great role in assistance affairs. Research shows social support possibly has an impact on poverty, but the association between formal and informal supports is unclear. We are aimed at verifying the association between distinct social supports and exploring whether this association would affect poverty alleviation for older adults. METHODS: A total of 2,683 individuals aged 60 years or older who have medical expenses were included in a survey conducted by the China Health and Retirement Longitudinal Study in 2018. A chi-square analysis and an independent samples T test all were used to explore the differences of social supports among old people with different economic condition. A binary logistic regression was aimed at analyzing the association between social supports and poverty for older adults. The structural equation model was established to evaluate the association between formal support and informal support and the mechanism(s) of social supports affecting poverty. RESULTS: The overall average rate of reimbursement for outpatient care was 0.20 with standard deviation 0.22, and the average reimbursement rate of inpatient care for the poor older adults is nearly 5% lower than the average of the non-poor older adults. We found that having private health insurance and higher reimbursement rate of inpatient care were associated with lower likelihood of living in poverty for older adults. Formal support would directly affect poverty, but its impact on poverty through informal support is insignificant even if formal support is negatively associated with informal support. CONCLUSION: A dilemma in reducing the economic burden of disease and receiving family assistance for older adults was revealed, and a more complete health security and higher level of medical expenses compensation would be beneficial to prevent poverty. Optimizing the primary healthcare and increasing the percentage of insurance compensation, policies that focus on the specific cultural values and strengthening the role of supplementary insurance are advantaged for alleviating poverty among older adults.

Preliminary investigation and application of a modified objects memory test in perioperative cognitive evaluation.

Objective: To investigate the applicability of a modified verbal learning test redesigned from the memory subtest of the Syndrom Kurztest (SKT) in perioperative cognitive evaluation. Methods: Patients receiving elective herniorrhaphy and their accompanying family members (set as normal controls), 55-75 years old, were randomly divided into two groups. The two groups received the self-made objects memory test derived from the SKT (SMOT) SMOT or a traditional auditory verbal learning test (AVLT). The cognitive evaluation was administered at the bedside on the day before surgery and the second day after surgery. Results: The SMOT test was administered to 121 subjects, while 107 patients received the AVLT test. After confirming that there was no significant difference in cognitive function between patients and their family members, the results of the SMOT and AVLT tests were compared. The results showed that the "low-score" ratio of the SMOT was significantly lower than that of the AVLT test (P < 0.05), and the influencing factors of the SMOT were less than those of the AVLT test. However, the learning effect of the SMOT was more significant (P < 0.05). Conclusion: This study preliminarily confirms that the SMOT has better applicability to elderly Chinese individuals than AVLT in perioperative cognitive evaluation, but its learning effect should be noted.

The Mediating Role of Depression in Association Between Total Sleep Time and Instrumental Activities of Daily Living in China.

Objectives: This study aims to investigate the mediating role of depression and the moderating effect of gender in the relationship between total sleep time (TST) and instrumental activities of daily living (IADL) in middle-aged and elderly people (aged 45 or above). Methods: The data used in this study is from the China Health and Retirement Longitudinal Study (CHARLS), including a total of 10,460 respondents. Associations between TST, IADL, depression, and gender were analyzed using logistic regression and Karlson, Holm, and Breen (KHB) methods. Results: Short (OR = 1.42, 95% CI = 1.28-1.58 of ≤6 h) and long TST (OR = 1.16, 95% CI = 1.02-1.32 of 8-9 h; OR = 1.35, 95% CI = 1.19-1.54 of >9 h) were both associated with IADL. The mediation effect analyses observed that depression explained 64.80% of the total effect of short TST (≤6 h) and IADL, but was insignificant in long TST (8-9 h and >9 h). Meanwhile, gender has moderating effects on the mediation effect model. Conclusion: The study suggests that health interventions that focused on the dimensions of TST and depression are crucial for preventing functional disability while accounting for gender differences.

The effects of loneliness and social isolation on cognitive impairment-free life expectancy in older adults.

OBJECTIVES: This article aimed to examine the effects of social connection comprising loneliness and social isolation on cognitive impairment-free life expectancy (CIFLE). METHODS: Data on 28,563 older adults (aged 65+) were drawn from the Chinese Longitudinal Healthy Longevity Survey with a median follow-up of 4.00 years. Multistate Markov models were used to estimate the independent and joint effects of social connection with CIFLE. Cognitive impairment was measured by the modified Mini-Mental State Examination. RESULTS: For men and women, respectively, reduced CIFLEs at age 65 associated with loneliness were 0.95 (95% CI: 0.41-1.48) and 1.35 (95%: CI 0.77-1.90) years, and those associated with social isolation were 2.23 (95% CI: 1.67-2.78) and 2.49 (95% CI: 1.67-3.30) years. Compared with those with neither loneliness nor social isolation ('neither' group), older adults at age 65 with both loneliness and social isolation ('both group') lost CIFLEs of 2.68 (95% CI: 1.89-3.48) and 3.51 (95% CI, 2.55-4.47) years for men and women, respectively. Similar patterns were observed in the oldest-old adults (age 85 or over). A growth trend transpired in the difference of the proportion of the remaining CIFLE between 'neither' group and 'both' group with age. CONCLUSION: Loneliness and social isolation are associated with decreased CIFLE in older Chinese adults. Policy makers and the public must be informed that early identification and management of loneliness and social isolation, especially when coexisting, are crucial.

Probiotic mediated intestinal microbiota and improved performance, egg quality and ovarian immune function of laying hens at different laying stage.

In order to investigate the effects of dietary probiotics supplementation on laying performance, egg quality, serum hormone levels, immunity, antioxidant, and gut microbiota of layers at different laying stages, a total of 168 Tianfu green shell laying hens (28-day-old) were randomly divided into 2 treatments: a non-supplemented control diet (NC), and diet supplemented with 10 g/kg of probiotics, respectively. Each treatment had 6 replicates with 14 hens per replicate. The feeding trial lasted for 54 weeks. The results showed that the supplementation of probiotics significantly increased the average egg weight, improved egg quality (p < 0.05) and ovarian development. Meanwhile, probiotics increased the serum hormone levels of E2 and FSH, and antioxidant indices T-AOC and T-SOD (p < 0.05) of laying hens at different laying stages (p < 0.05), decreased the expression of proinflammatory factors including IL-1, IL-6 and TNF-α (p < 0.05). Furthermore, using 16S rRNA sequencing, we observed that the addition of probiotics increased the distribution of Firmicutes, Bacteroidota and Synergistota at early laying period. Meanwhile, Bacteroidota, Actinobacteriota, Verrucomicrobiota and Deferribacterota showed an increasing trend at the peak of egg production. The relative abundance of Firmicutes, Desulfobacterota and Actinobacteriota were significantly increased at the late laying period. Moreover, PICRUSt2 and BugBase analysis revealed that at the late laying period, the probiotics supplementation not only enriched many significant gene clusters of the metabolism of terpenoids and polyketide, genetic information processing, enzyme families, translation, transcription, replication and repair, and nucleotide metabolism, but also decreased the proportion of potential pathogenic bacteria. To sum up, these data show that the addition of probiotics not only improves the performance, egg quality, ovarian development and immune function of laying hens at different laying period, but also improves the gut microbiota of layers, thus enhances production efficiency.

Inequity in the healthcare utilization among latent classes of elderly people with chronic diseases and decomposition analysis in China.

BACKGROUND: Studies have shown chronic disease-based healthcare utilization inequity is common. Hence, exploring this issue can help in establishing targeted measures and protecting the rights and interests of vulnerable groups. Against this background, the purpose of this study is to explore the latent classification of elderly patients with chronic disease and compare healthcare utilization inequity among latent classes. METHODS: This study used the data of 7243 elderly patient with chronic diseases collected from the China Health and Retirement Longitudinal Study in 2018. Latent class analysis was used to classify the patients with chronic diseases, and analysis of variance and [Formula: see text] tests were utilized to test the differences in characteristics among latent classes. Healthcare utilization inequity was measured based on the concentration index (CI), and the CI was decomposed to compare the horizontal index of healthcare utilization among the latent classes. RESULTS: The patients with chronic diseases were divided into five latent classes, namely, the musculoskeletal system, hypertension, respiratory system, digestive system and cardiovascular system groups. Statistically significant differences in social demographic characteristics were observed among the five latent classes (P < 0.05). A pro-rich healthcare utilization inequity for all respondents was observed (outpatient CI = 0.080, inpatient CI = 0.135), and a similar phenomenon in latent classes was found except for the musculoskeletal system group in outpatient visits (CI = -0.037). The digestive system group had the worst equity (outpatient CI = 0.197, inpatient CI = 0.157) and the respiratory system group had the best (outpatient CI = 0.001, inpatient CI = 0.086). After balancing the influence of health need factors, healthcare utilization inequity was almost alleviated. Furthermore, for all respondents, the contribution of health need factors (65.227% for outpatient and 81.593% for inpatient) was larger than that of socioeconomic factors (-21.774% for outpatient and 23.707 for inpatient), and self-rated health status was the greatest contributor (57.167% for outpatient and 79.399% for inpatient). The characteristics were shown in latent classes. CONCLUSIONS: Healthcare utilization inequity still exists in elderly patients with chronic diseases, and the specific performances of inequity vary among latent classes. Moreover, self-rated health status plays an important role in healthcare utilization inequity. Providing financial support to low-income patients with certain chronic diseases, focusing on their physical and mental feelings and guiding them to evaluate their health status correctly could be essential for alleviating healthcare utilization inequity among elderly patients with chronic diseases.

Poverty Vulnerability and Health Risk Action Path of Families of Rural Elderly With Chronic Diseases: Empirical Analysis of 1,852 Families in Central and Western China.

Health poverty has become the most important cause of poverty and return to poverty. Understanding the health risk factors and action paths of poverty in families of rural elderly with chronic diseases is important to alleviate return to poverty because of illness. This study selected families with at least one elderly member (over 60 years old) with chronic diseases (sample size was 1,852 families) in two provinces and four counties in central and western China. The three-stage feasible generalized least square method was adopted, and the appropriate poverty line standard was selected to measure the poverty vulnerability index. A poverty vulnerability index ≥50% was considered to indicate vulnerability. The poverty vulnerability index and actual income status were combined to classify the samples. A structural equation model was established to explore the path of each health risk factor on the entire sample and various types of poverty vulnerabilities. The mean poverty vulnerability of 1,852 families was 0.5974 ± 0.25213, and among which, 1,170 households had a poverty vulnerability value ≥0.5, accounting for 63.17% of the entire sample. The incidence of poverty was higher among people with low vulnerability to poverty. Health shock was the direct cause of poverty for people with potential and avoidance poverty. The mediating roles of family and community significantly differed in various types of poverty vulnerability. The social and economic environment in rural areas should be enhanced in a diversified manner, and the income-generating ability of rural households should be improved based on actual local conditions. Moreover, the prevention and control of poverty vulnerabilities should be diversified and targeted. Policies implemented should be based on people and localities, the causes of poverty and returning to poverty, and the types of poverty vulnerabilities. The use efficiency of medical insurance should be further improved, and the responsibility of medical insurance targeted poverty alleviation must be clarified.

Heterogeneity of Urban and Rural Areas in Association of Fringe Benefits and Depression: A Cross-Sectional Study.

BACKGROUND: Fringe benefits are an important social support in the work scenario, but empirical research on their effect on the mental health of employees is lacking. This study aims to analyse the relationship between different fringe benefits and depression in urban and rural areas. METHODS: Chi-square analysis was used to describe the distribution differences of individual characteristics between urban and rural areas in depression groups. Logistic regression was used to further estimate the relationship between fringe benefits and depression between urban and rural areas. RESULTS: People with free lunch in urban areas are less likely to suffer from depression. People with food subsidies in rural areas are also less likely to suffer from depression. The abnormal result is people with housing subsidies in rural areas are more likely to be depressed. The effects of job type and contract on depression were different between urban and rural areas. CONCLUSIONS: Employers in urban areas should focus on providing free lunch and the quality of lunch, whereas in rural areas, catering subsidies may be a more appropriate way to improve the mental health of employees. The psychological status of rural workers who receive housing subsidies and have contracts also needs attention.

Association amongst social support inside or outside the family and depression symptoms: longitudinal study of urban-rural differences in China.

PURPOSE: The purpose is to analyze the longitudinal association between social support inside and outside the family and depression and the differences between urban and rural areas. METHODS: A total of 11,150 respondents were included from Harmonized China Health and Retirement Longitudinal Study (Harmonized CHARLS). The baseline data and the subsequent two surveys were used to describe the basic characteristics and social support in the urban and rural. The growth curve model was used to analyse the longitudinal association between social support inside and outside the family and depression. RESULTS: People participating in social activities were less likely to suffer from depression while those who had public transfer were more likely to suffer from depression. Respondents who had weekly contact with their children were less likely to suffer from depression. Respondents with larger families were also less likely to suffer from depression, but this effect was significant in rural. As time changes, the association between social activities and depression does not change significantly, only public transfer and family size show a gradually weakening impact on depression in rural areas. The association between the contact with children and depression scores weakens in rural areas but increases in urban areas. CONCLUSIONS: Future dynamic intervention for depression can include holding various beneficial social activities, carrying forward the filial piety culture and improving the level of rural social welfare, protecting the excellent traditional culture, and providing public services for rural special families.

Scale- and Slice-aware Net (S2 aNet) for 3D segmentation of organs and musculoskeletal structures in pelvic MRI.

PURPOSE: MRI of organs and musculoskeletal structures in the female pelvis presents a unique display of pelvic anatomy. Automated segmentation of pelvic structures plays an important role in personalized diagnosis and treatment on pelvic structures disease. Pelvic organ systems are very complicated, and it is a challenging task for 3D segmentation of massive pelvic structures on MRI. METHODS: A new Scale- and Slice-aware Net ( S2 aNet) is presented for 3D dense segmentation of 54 organs and musculoskeletal structures in female pelvic MR images. A Scale-aware module is designed to capture the spatial and semantic information of different-scale structures. A Slice-aware module is introduced to model similar spatial relationships of consecutive slices in 3D data. Moreover, S2 aNet leverages a weight-adaptive loss optimization strategy to reinforce the supervision with more discriminative capability on hard samples and categories. RESULTS: Experiments have been performed on a pelvic MRI cohort of 27 MR images from 27 patient cases. Across the cohort and 54 categories of organs and musculoskeletal structures manually delineated, S2 aNet was shown to outperform the UNet framework and other state-of-the-art fully convolutional networks in terms of sensitivity, Dice similarity coefficient and relative volume difference. CONCLUSION: The experimental results on the pelvic 3D MR dataset show that the proposed S2 aNet achieves excellent segmentation results compared to other state-of-the-art models. To our knowledge, S2 aNet is the first model to achieve 3D dense segmentation for 54 musculoskeletal structures on pelvic MRI, which will be leveraged to the clinical application under the support of more cases in the future.

Effect of BMP6 on the proliferation and apoptosis of chicken chondrocytes induced by thiram.

The development of skeleton system is a complex biological process and be regulated by many transcription factors. Previous studies have shown that BMP6 is involved in skeleton development and other cells transforming to chondrocytes, but it is still not known whether do something to tibial dyschondroplasia (TD) broilers chondrocytes. In this study, RT-PCR revealed that the expression level of BMP6 in TD broiler chondrocytes at 7 days age was significantly decreased compared with normal group (P < 0.05). CCK-8 and EdU assay showed that the proliferation of cells transfected with interference BMP6 was significantly decreased compared with control siRNA, while cell proliferation was significantly increased after overexpression of BMP6. Meanwhile, the proportion of G0/G1 phase cells was significantly increased and the proportion of G2/M phase cells was significantly decreased after interference of BMP6 for 48 h in TD chicken chondrocytes (P < 0.05). In addition, flow cytometry analysis exhibited that interference BMP6 significantly increased apoptosis rate and necrotizing rate of cells. In conclusion, these results suggest that BMP6 plays a positive role in the growth and development of TD broiler chondrocytes. Our findings reveal a new target for TD prevention in broiler chickens.

[Automated grading of glioma based on density and atypia analysis in whole slide images].

Glioma is the most common malignant brain tumor and classification of low grade glioma (LGG) and high grade glioma (HGG) is an important reference of making decisions on patient treatment options and prognosis. This work is largely done manually by pathologist based on an examination of whole slide image (WSI), which is arduous and heavily dependent on doctors' experience. In the World Health Organization (WHO) criteria, grade of glioma is closely related to hypercellularity, nuclear atypia and necrosis. Inspired by this, this paper designed and extracted cell density and atypia features to classify LGG and HGG. First, regions of interest (ROI) were located by analyzing cell density and global density features were extracted as well. Second, local density and atypia features were extracted in ROI. Third, balanced support vector machine (SVM) classifier was trained and tested using 10 selected features. The area under the curve (AUC) and accuracy (ACC) of 5-fold cross validation were 0.92 ± 0.01 and 0.82 ± 0.01 respectively. The results demonstrate that the proposed method of locating ROI is effective and the designed features of density and atypia can be used to predict glioma grade accurately, which can provide reliable basis for clinical diagnosis.

The Impact of Health Care Reform Since 2009 on the Efficiency of Primary Health Services: A Provincial Panel Data Study in China.

Background: Primary health care (PHC) is an important part of health systems in the world and in China. To improve the efficiency of PHC institutions (PHCIs), many countries have implemented reforms, including China's health care reform since 2009. This study aims to evaluate the impact of this reform on the efficiency of PHCIs from the perspective of the whole health system. Methods: Data were collected from China Health Statistical Yearbooks and China Statistical Yearbooks published from 2005 to 2019. By taking the number of beds, health technicians and PHCIs as inputs and the proportion of diagnosis, treatment and admission in PHCIs as outputs, Malmquist DEA was used to evaluate the efficiency change of PHCIs, and panel data regression was performed to analyze the impact of the reform and other factors on such efficiency. The interaction between reform and economic level was also estimated. Results: The MPI in Beijing, Tianjin, Shanghai, Hunan, and Guangdong improved after the reform. The efficiency improvement in Beijing, Tianjin and Shanghai is mainly reflected in the growth of TC, whereas the efficiency improvement in Guangdong and Hunan is mainly reflected in the growth of EC. Meanwhile, the EC and TC in Hebei, Heilongjiang, Shandong, and other provinces deteriorated. The deterioration of MPI in Shanxi, Inner Mongolia and Jilin was mainly attributed to EC. while the deterioration of MPI in Liaoning, Anhui, and Fujian provinces is mainly attributed to TC. Since 2009, the reform exerted a negative impact on MPI (ß = -0.06; P < 0.01), TC (ß = -0.048; P < 0.01) and EC (ß = -0.03; P < 0.01). And such negative impact was weaker in economically developed areas (ß = 0.076; P < 0.01). Conclusions: Attention should be paid to future reforms: China should continue investing in PHCIs, establish a structurally integrated and functionally complementary delivery system and promote the coordination of reform policies to avoid the adverse impacts of other reform policies on PHCIs.

Impact of Adverse Childhood Experiences on Older Adult Poverty: Mediating Role of Depression.

Background: Adverse childhood experiences (ACEs) refer to traumatic events experienced by children in early life, including abuse, neglect, and family dysfunction, which are common worldwide. ACEs are harmful to mental health, and psychological problems can influence personal economic poverty in adulthood. We focused on family dysfunction and discussed the effect of different types of ACEs on poverty and the corresponding mediating effect of depression. Materials and Methods: A total of 9,910 individuals who were 60 years or older from the China Health and Retirement Longitudinal Study in 2014 and 2015 were analysed. The chi-square test was used to compare poverty incidence among subgroups of independent or control variables. Binary logistic regression analysis was used to test the effect of different types of ACEs on depression, and four logistic regression models were established to observe the association between ACEs on older adult poverty and the mediating effect of depression. The path diagram of the direct effect and indirect effect was drawn to test the mediating effect of depression. Results: Early death of father, the male guardian getting upset and witnessing violence of father to mother are the risk factors for older adult poverty, whereas female guardian getting upset, relationship with female guardians and parental quarrel are protective factors for older adult poverty. Furthermore, depression has a partial mediating effect on some factors including early death of father, male guardian getting upset, relationship with female guardian, parental quarrel, and witnessing violence of father to mother. Conclusions: Paternal ACE factors can directly make children more likely to fall into poverty as older adults and can indirectly influence older adult poverty through the partial mediating effect of depression. Assisting poor families, providing psychological counselling, formulating family visit plans, nurturing orphan children under state supervision, and other policies that focus on groups that have experienced paternal ACE events are essential to eliminating the risk factors that influence older adult poverty.

MUSTN1 is an indispensable factor in the proliferation, differentiation and apoptosis of skeletal muscle satellite cells in chicken.

The yield and quality of the skeletal muscle are important economic traits in livestock and poultry production. The musculoskeletal embryonic nuclear protein 1 (MUSTN1) gene has been shown to be associated with embryonic development, postnatal growth, bone and skeletal muscle regeneration; however, its function in the skeletal muscle development of chicken remains unclear. Therefore, in this study, we observed that the expression level of MUSTN1 increased in conjunction with the proliferation of chicken skeletal muscle satellite cells (SMSCs). Knockdown of MUSTN1 in SMSCs downregulated the expression of cell proliferation genes as Pax7, CDK-2 and differentiation-relate genes including MyoD, MyoG, MyHC and MyH1B, whereas it upregulates the expression of cell apoptosis gene (Caspase-3) (P < 0.05). However, the combined analysis of CCK-8 and EdU showed that the cell vitality and EdU-positive cells of the si-MUSTN1 transfected group were significantly lower than those of the negative siRNA group (P < 0.05). In addition, the knockdown of MUSTN1 significantly increased the cell population in the G0/G1 phase and significantly decreased the cell population in the G2/M phase (P < 0.05), whereas the overexpression of MUSTN1 showed opposite effect. Taken together, our findings indicates that MUSTN1 is an important molecular factor that is responsible for regulating muscle growth and development in chickens, particularly, proliferation and differentiation of SMSCs.