Analyzing the efficiency of Chinese primary healthcare institutions using the Malmquist-DEA approach: Evidence from urban and rural areas.

Background: China has been increasing the investment in Primary Health Care Institutions (PHCIs) since the launch of the New Health Care System Reform in 2009. It is a crucial concern whether the PHCIs can meet residents' need both in urban and rural with the limited government finance, especially encountering the challenge of the COVID-19. This study aimed to reveal the trend of the primary health service efficiency in the past decade, compare the urban-rural differences, and explore relevant factors. Methods: DEA and Malmquist models were applied to calculate the health service efficiency of PHCIs among 28 provinces in China, with the input variables including the number of institutions, number of beds, number of health technicians, and the outputs variables including the number of outpatients and emergency visits, number of discharged patients. And the Tobit model was used to analyze the factors on the efficiency in urban and rural. A sensitivity analysis for model validations was also carried out. Results: The average technical efficiency (TE) of urban PHCIs fluctuated from 63.3% to 67.1%, which was lower than that in rural (75.8-82.2%) from 2009 to 2019. In terms of dynamic efficiency, the urban PHCIs performed better than the rural, and the trends in the total factor productivity change were associated with favorable technology advancement. The population density and dependency ratio were the key factors on TE in both of the urban and rural PHCIs, and these two factors were positively correlated to TE. In terms of TE, it was negatively correlated with the proportion of total health expenditure as a percentage of GDP in urban PHCIs, while in rural it was positively correlated with the urbanization rate and negatively correlated with GDP per capita. Besides, the tests of Mann-Whitney U, and Kruskal-Wallis H indicated the internal validity and robustness of the chosen DEA and Malmquist models. Conclusions: It needs to reduce the health resource wastes and increase service provision in urban PHCIs. Meanwhile, it is necessary to strengthen medical technology and gaining greater efficiency in rural PHCIs by technology renovation.

γ-secretase inhibition combined with cisplatin enhances apoptosis of nasopharyngeal carcinoma cells.

The Notch signaling pathway plays an important role in the proliferation and differentiation of cells. Although recent studies have shown that Notch plays a role in the mechanisms of cisplatin resistance, the mechanism by which Notch plays roles in intrinsic or acquired cisplatin resistance remains unclear. In the present study, poorly differentiated nasopharyngeal carcinoma cells were treated with a γ-secretase inhibitor (DAPT), which led to a decrease in the Notch intracellular domain and inhibition of Notch signaling. Treatment was not sufficient to induce pronounced apoptosis of CNE-2 cells, but did result in the down-regulation of the P-glycoprotein and ERCC1 protein. In contrast, the combined treatment of DAPT and cisplatin induced substantial cell apoptosis compared to cisplatin treatment alone.

Suppression of the notch signaling pathway by γ-secretase inhibitor GSI inhibits human nasopharyngeal carcinoma cell proliferation.

Notch signaling has been suggested to be required for many human cancers. However, the role of Notch signaling in human nasopharyngeal carcinoma cells (NPC) remains unknown. Here, we report that Notch-1, Notch-2, Notch-3 and Notch-4 are all detected in NPC cells. Notch inhibitor, GSI, suppresses the levels of Notch-1, Notch-2 and Notch-4, but not Notch-3. In addition, GSI inhibits NPC cell proliferation by inducing the cell cycle arrest and apoptosis. Furthermore, GSI inhibits the AKT and MEK signaling, without affecting P38 and JNK1/2. Thus, NPC cells may up-regulate Notch signaling to maintain cell proliferation and targeting the Notch signaling pathway may offer a potential alternative strategy for the treatment of NPC.

[The effects on expressions of p53 and PCNA by inhibition of hTERT with siRNA in transplantable model of human laryngeal squamous carcinoma in nude mice].

OBJECTIVE: To investigate the expressions of p53 and PCNA by inhibition of hTERT with siRNA in xenografted laryngeal squamous carcinoma in nude mice. METHOD: pshRNA involved fluorescein gene was synthesized according to the sequence of hTERT cDNA. The xenografted tumor in nude mice was established by using human laryngeal squamous carcinoma cell line (Hep-2). pshRNA packaged by METAFECTENE was transfected into the transplantation tumors. The volumes of the subcutaneous tumor were determined. Fluorescence expression in the tumors was detected by confocal microscopy. The expressions of p53 and PCNA were detected using immunohistochemistry. RESULT: The subcutaneous tumors appeared in all the nude mice after transplantation five days later. The diameter of subcutaneous tumors become 5-7 mm after transplantation. Many green fluorescent cells were observed by confocal microscopy after transfection of pshRNA and blank plasmid. The growth of laryngeal squamous carcinoma in nude mice was significantly decreased as compared with the control group. The proliferation activity was inhibited by 76.50%. The expressions of p53 was upregulated and the expression of PCNA was downregulated. CONCLUSION: The transfection of pshRNA could significantly induce inhibitory effects on growth of laryngeal squamous carcinoma in nude mice and the expression of PCNA could be effectively downregulated. The inhibition of telomerase reverse transcriptase (hTERT) mRNA could upregulate the expression of p53 and promote the apoptosis of carcinoma cells as well as inhibit the proliferation of laryngeal squamous carcinoma cells.