Primary health care in China: A decade of development after the 2009 health care reform.

Over 40 years ago, primary health care (PHC) was defined in the Alma-Ata Declaration as a critical component of the health care system to address the basic health demand of the people. In China, the Government attaches great importance to health care at the primary level. After the launch of the historical Reform of the Medical and Health Care System in 2009, the PHC system in China has witnessed major progress and breakthroughs, especially in its steadily increased capacity, continuously improved accessibility, and betterment in equality. In this review, we summarized published literatures and official policies, synthesized data from the electronic registration information system of the National Health Commission, national statistical reports, and yearbooks in health care. The review is intended to describe the systematic development of PHC in China in the last decade. The main results include: the solid national policy foundation, increasing number of PHC institutions and workforce, better training of PHC professionals, major achievements in primary health indicators, government financial support to PHC institutions, improved PHC budgeting and insurance coverage, and the advancement of supporting technologies. Challenges and prospects are also discussed.

LncRNA MALAT1 promotes oxidized low-density lipoprotein-induced autophagy in HUVECs by inhibiting the PI3K/AKT pathway.

Emerging evidence suggests that long noncoding RNAs (lncRNAs) are involved in many biological processes, such as cell growth, differentiation, apoptosis, and autophagy. Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1), highly expressed in endothelial cells, is well conserved and implicated in endothelial cell migration and proliferation. However, whether MALAT1 participates in oxidized low-density lipoprotein (ox-LDL)-induced autophagy regulation in human umbilical vein endothelial cells (HUVECs) remains unknown. In this study, we observed that autophagy was upregulated and MALAT1 expression was markedly increased in HUVECs treated with ox-LDL. The ox-LDL-induced autophagy of HUVECs is significantly associated with the PI3K/AKT pathway. Furthermore, we found that MALAT1 overexpression inhibited PI3K, Akt and p70S6K phosphorylation and downregulated RHEB expression, simultaneously increasing ox-LDL-induced autophagy. MALAT1 silencing caused higher phosphorylated PI3K, Akt and p70S6K levels, upregulated RHEB expression and markedly suppressed autophagy. These results indicated that lncRNA MALAT1 promotes ox-LDL-induced autophagy in HUVECs partly through the PI3K/AKT signaling pathway.

MicroRNA­155 promotes ox­LDL­induced autophagy in human umbilical vein endothelial cells by targeting the PI3K/Akt/mTOR pathway.

Endothelial cell autophagy has a protective role in inhibiting inflammation and preventing the development of atherosclerosis, which may be regulated by microRNA (miR)­155. The present study aimed to investigate the mechanisms of autophagy in the development of atherosclerosis. Human umbilical vein endothelial cells model in vitro and using oxidized low­density lipoprotein (ox­LDL) stimulated cells to simulate the atherosclerosis. MiR­155 mimics, miR­155 inhibitors, and a negative control were respectively transfected in human umbilical vein endothelial cells to analyzed alterations in the expression of miR­155. It was demonstrated that overexpression of miR­155 promoted autophagic activity in oxidized low­density lipoprotein­stimulated human umbilical vein endothelial cells, whereas inhibition of the expression of miR­155 reduced autophagic activity. Overexpression of miR­155 revealed that it regulated autophagy via the phosphatidylinositol­3 kinase (PI3K)/RAC­α serine/threonine­protein kinase (Akt)/mechanistic target of rapamycin pathway (mTOR) signaling pathway. A luciferase reporter assay demonstrated that miR­155 directly bound to the PI3K catalytic subunit a and Ras homolog enriched in brain 3'­untranslated region and inhibited its luciferase activity. Therefore, the results of the present study suggested that miR­155 promoted autophagy in vascular endothelial cells and that this may have occurred via targeting of the PI3K/Akt/mTOR pathway. Thus, miR­155 may be considered as a potential therapeutic target for the treatment of atherosclerosis.

MiR-181b regulates autophagy in a model of Parkinson's disease by targeting the PTEN/Akt/mTOR signaling pathway.

OBJECTIVE: Parkinson's disease (PD) is the second most common neurodegenerative disease. Recent studies have shown that dysregulation of microRNA plays an important role in PD, and defects in autophagy are also critically associated with mechanisms underlying PD. We aim to investigate the effect of miR-181b on autophagy, particularly the involvement of miR-181b in the regulation of the phosphatase and tensin homolog (PTEN)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) pathway and neuronal autophagy in a 1-methyl-4- phenylpyridinium iodide(MPP+)-induced cellular model of Parkinson's disease. MATERIALS AND METHODS: We used MPP+ as a tool to construct the PD cell model, using miR-181b mimics or inhibitors to regulate the expression of miR-181b. PC12 cell viability was detected by MTT. The expression of miR-181b was determined by quantitative real-time PCR analysis. The expression of autophagy protein markers (LC3II) and PTEN/Akt/mTOR signaling proteins (PTEN, p-AKT,p-mTOR and p-p70S6K) were determined by Western blotting analysis. RESULTS: The expression of miR-181b and autophagy-related proteins was gradually decreased with increasing MPP+ content. Overexpression of miR-181b significantly decreased the LC3II/GAPDH ratio and increased cell viability compared to the MPP+ treated group, whereas inhibition of miR-181b attenuated these effects. In addition, we observed that PTEN expression was reduced by miR-181b mimics and induced by its inhibitors in MPP+-treated PC12 cells. Additionally, the indicators of AKT/mTOR signaling, phosphorylated (active) AKT, mTOR and p70S6K were both increased by miR-181b mimics and decreased by its inhibitors. CONCLUSIONS: Our results suggest that miR-181b regulates autophagy by targeting the PTEN/Akt/mTOR signaling pathway, thereby affecting cell viability in PD.