Family Planning Commission Research Articles

The influence of adolescent characteristics toward the knowledge about generation planning in sub-village of family planning

Adolescent knowledge is the optimizing capital of the condition of demographic dividend in Indonesia which will be culminated in 2035. Adolescent behavior such as early marriage, premarital sex, and drug abuse pushed the National Population and Family Planning Commissions’s to implement the Generation Planning “Generasi Berencana (GenRe)” Program for preparing teen family life. This research aims to determine the influence of adolescent characteristics on knowledge about GenRe in the Sub-village of Family Planning Ngepring. The primary data collection method is a census which the unit of analysis are the adolescent individual in Ngepring. Data from the adolescent census are processed by multiple linear regression test. The results showed that adolescent characteristics proved that the significane influences the knowledge about GenRe with a contribution of 50, 5%. The last education of adolescent characteristics (Beta = 0,435; p <0, 01) is stronger in influencing the knowledge about GenRe than gender variable (Beta = 0,147; p <0, 01) and work experience variable (Beta = -0, 195; p <0, 01). This research proves the hypothesis that the education and work experience characteristics affect the knowledge.

Research on Indoor and Outdoor Positioning System for Special Population

Special populations, such as empty-nesters, people with a mental health condition, active children, prison inmates, etc., have a considerable number. The WHO noted that there were 47.5 million people with dementia worldwide in 2016. As the number of people with dementia in low- and middle-income countries continue to increase, it is predicted that the total number of people with dementia will reach 75.6 million in 2030 and reach 135.5 million in 2050. The National Health and Family Planning Commission released the “China Family Development Report (2015)”, which is half of the total number of elderly people. The number of severely mentally disabled patients registered in the country reached 4.297 million, and there were 1, 650 national mental health professional institutions and more than 20, 000 psychiatrists. As of 2012, there were 681 prisons in the country, 300, 000 people in prison, and 1.64 million prisoners. More than 80% of the prisons have established video surveillance systems. The Ministry of Public Security’s “Emergency Release Platform for Children’s Missing Information” is about 100 people abducted every year. The number of missing children who are about one-millionth of a year is not found, and the missing rate is about three-tenths of a million. The real-time positioning of the above-mentioned special population has become the key to solving related problems. Relevant nursing homes, community institutions, mental health institutions, and prisons have become the main demand side.

Preliminary Research of Main Components of Dll4/ Notch -VEGF Signaling Pathway Under High-Glucose Stimulation In Vitro

Objective: To set up high-glucose stressed cell model and investigate the expression of main components of Dll4/Notch-VEGF signaling pathway under high-glucose stimulation. Method: The cells (human umbilical vein endothelial cells, HUVECs) model under high-glucose condition were set up at first, and then the expression of Dll4, Notch1, Notch4 and VEGF in HG-stressed cells with or without Notch pathway blockage were analyzed through RT-PCR and western blot. To observe the cell migration, we also evaluated the Transwell assay. Results: HUVECs stimulated with 30mmol/L HG was chosen as cell model. Results from RT-PCR and western blot showed that HG stimulation induced Dll4, Notch1 and VEGF expression and down-regulated Notch4. The expressions were reversed after Notch pathway blockage, meanwhile, the blockage of Notch pathway inhibited cell migration under HG condition. Conclusions: Function of Notch4 is worth further researching under HG stimulation. Combination therapy by blocking Dll4/Notch and VEGF pathways might provide us a new way for anti-neovascularization. Funding Statement: This work was supported by the research program of Health and Family Planning Commission of 212 Sichuan Province, China (17PJ534). Declaration of Interests: The authors have no conflicts of interest to declare. Ethics Approval Statement: This study performed in accordance with the Declaration of Helsinki and have been approved by ethics committee of Teaching Hospital of Chengdu University of Traditional Chinese Medicine.

SIRT6-Autophagy-Warburg Effect Axis in Papillary Thyroid Cancer

Background: Our previous study has demonstrated SIRT6 promotes aggression and epithelial-mesenchymal transition (EMT) in papillary thyroid cancer (PTC). In this study, we focused on the regulatory axis between SIRT6-Autophagy-Warburg effect. Methods: Autophagy activation was confirmed by Western Blotting, quantitative PCR, immunofluorescence and transmission electron microscopy. Warburg effect was examined by Seahorse XF96 analysis and PET imaging. Regulation of SIRT6 in negatively regulates reactive oxygen species (NRROS) was confirmed by chromatin immunoprecipitation. Findings: We innovatively confirmed overexpression of SIRT6 depleted histone H3 lysine 56 acetylation (H3K56ac) of NRROS in vitro, thus increased reactive oxygen species (ROS). Then, accumulated ROS activated endoplasmic reticulum stress (ER stress), and subsequently induced autophagy. Furthermore, the overexpression of SIRT6 inhibited Glucose Transporter 1 (Glut1) via autophagic degradation, thus ulteriorly suppressed Warburg effect. Treatment of ROS scavenger N-acetyl-L-cysteine (NAC, 5mM) or autophagy inhibitor chloroquine (CQ) both rescued the inhibition of Warburg effect. In addition, higher concentration of NAC (15mM) deepened the inhibited Warburg effect. This concentration-dependent bilateral effects of NAC in this process had been confirmed owe to regulation of AMPK signaling pathway. Finally, we further determined above mechanism in vivo via subcutaneous xenografts in nude mice applied with 18F-FDG PET/CT. Interpretation: We identified a SIRT6-ROS-ERstress-Autophagy-Glut1-Warburg effect axis in PTC, which may provide new target for therapy. In addition, NAC (low concentration) and CQ which previously been considered as tumor inhibitors, have been shown to promote tumorigenesis in PTC with high SIRT6 expression via activation of Warburg effect. Funding Statement: This study was funded by Specialty Feature Construction Project of Pudong Health and Family Planning Commission of Shanghai (Min Ye, Grant No.PWZzb2017-21). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: All participating patients gave their written informed consent. This study was approved by the Ethical Committee of Shanghai Pudong Hospital.

UPF1 Impacts on mTOR Signaling Pathway and Autophagy in Endometrioid Endometrial Carcinoma

Endometrioid endometrial carcinoma (EEC) is one of the most common malignant gynecologic tumors worldwide. Most EEC cases are associated with activities of the mTOR pathway, which regulates protein synthesis, cell growth and autophagy. While Up-Frameshift 1(UPF1) is a key protein factor in the nonsense-mediated mRNA degradation pathway (NMD), its role in carcinogenesis of EEC remains unclear. In this study, we first evaluated the expression level of UPF1 in EEC tissues and cell lines. Then, we investigated the effect of UPF1 on cellular function and mTOR signaling pathway; these effects were further validated in vivo. Finally, its effect on autophagy was evaluated by western blot and GFP-mRFP-LC3 staining. UPF1 expression in the EEC tissue samples was significantly higher than that of matched normal tissue samples. Overexpression of UPF1 promotes migration and invasion of EEC cells. Conversely, depletion of UPF1 suppresses migration and invasion of EEC cells. In addition, overexpression of UPF1 increased the in vivo growth of our EEC xenograft tumor. Finally, UPF1 increased the activity of the mTOR/P70S6K/4EBP1 signaling pathway and inhibited autophagy in EEC cells. These findings suggest that UPF1 functions as an oncogene to promote EEC carcinogenesis. Our findings propose UPF1 as a new potential therapeutic target for EEC. Funding Statement: This study was supported by the Guangdong Science and Technology Department (No.2019A1515012194), The Health and Family Planning Commission of Guangzhou Municipality (No.201707010425)，and Lin He’s Academician Workstation of New Medicine and Clinical Translation. Declaration of Interests: The all authors declare that they have no competing interests. Ethics Approval Statement: All patients provided informed consent, and the study was approved by the ethics committee of Third Affiliated Hospital of Guangzhou Medical University.

Faded Critical Dynamics in Adult Moyamoya Disease Revealed by EEG and fMRI

Criticality is considered a dynamic signature of healthy brain activity that can be measured on the short-term timescale with neural avalanches and long-term timescale with long-range temporal correlation (LRTC). It is unclear how the brain dynamics change in moyamoya disease (MMD). We used BOLD-fMRI for LRTC analysis from 16 hemorrhagic (HMMD) and 35 ischemic (IMMD) patients, and 26 healthy controls. Besides, 11 HMMD, 13 IMMD, and 21 controls of the cohort completed EEG experiments in the eyes-closed (EC), eyes-open (EO), and working-memory (WM) states. Regarding 4 metrics of neural avalanches, both MMD subtypes exhibited subcritical states in the EC state. When switching to the WM state, HMMD remained inactive, while IMMD surpassed controls and became supercritical (P<0.05). Regarding LRTC, the amplitude envelope in the EC state was more analogous to random noise in the MMD patients than in controls. During state transitions, LRTC decreased sharply in the controls but remained chaotic in the MMD (P<0.05). The spatial LRTC reduction distribution based on both EEG and fMRI in the EC state implied that, compared with controls, the two MMD subtypes exhibited mutually independent but overlapping patterns. The regions showing decreased LRTC in both EEG and fMRI were the left supplemental motor area and dorsolateral prefrontal cortex (DLPFC) of HMMD, and right pre-/postcentral gyrus, right DLPFC, and right inferior temporal gyrus of IMMD. This study not only sheds light on decayed critical dynamics of MMD for the first time, but also confirms different neurophysiological processes of its two subtypes. Funding Statement: National Natural Science Foundation of China under Grant no. 81801155 (to Yu Lei), 81771237 (to Yuxiang Gu), and 81761128011 (to Yuguo Yu), Shanghai Science and Technology Committee support under Grant no. 18511102800 (to Yuxiang Gu) and 16JC1420100 (to Ying Mao), Shanghai Health and Family Planning Commission support under Grant no. 2017BR022 (to Yuxiang Gu), Shanghai Municipal Science and Technology 795 Major Project under Grant no. 2018SHZDZX01 (to Yuguo Yu), program for the Professor of Special Appointment (Eastern Scholar) under Grant no. SHH1140004 (to Yuguo Yu) at Shanghai Institutions of Higher Learning, and Fundamental Research Funds for the Central Universities under Grant no. lzujbky-2015-119 (to Lianchun Yu). Declaration of Interests: The authors declare no competing financial interests. Ethics Approval Statement: This study was approved by the Institutional Review Board in our hospital, and conducted in accordance with the Declaration of Helsinki. Informed consent was signed by all subjects of this study.

Deletion of Microfibrillar-Associated Protein 4 Attenuates Left Ventricular Remodeling and Dysfunction in Heart Failure

Background: Cardiac remodeling predisposes the heart to failure (HF) if the burden not solved, and HF is a growing cause of morbidity and mortality worldwide. Cardiac extracellular matrix (ECM) not only by providing structural support, but also a core aspect of myocardial response to various biomechanical stress and HF. Microfibrillar-associated protein 4 (MFAP4) is an integrin ligand and located in the ECM, whose biological functions in heart remain poorly understood. In the current study we aimed to test the role of MFAP4 in cardiac remodeling. Methods: MFAP4-deficient (MFAP4-/-) and wild type (WT) mice were subjected to aortic banding (AB) surgery and isoproterenol (ISO) induced models of cardiac remodeling. And evaluate the functional effect of MFAP4 on cardiac hypertrophy, fibrosis, cardiac electrical remodeling. Findings: The expression level of MFAP4 was increased in animal cardiac remodeling models induced by pressure load and ISO. When challenged with 8 weeks AB or 2 weeks ISO intraperitoneal, MFAP4 -/- mice exhibited lower levels of cardiac fibrosis and fewer ventricular arrhythmias. However, it has no significant effect on cardiomyocyte hypertrophy. Interpretation: These findings are the first to demonstrate an inhibitory role of MFAP4 deficiency on cardiac fibrosis and ventricular arrhythmias, but has no significant effect on hypertrophy response. Funding Statement: This work was supported by grants from the Key Project of the National Natural Science Foundation (No. 81530012); National Key RD Development Center for Medical Science and Technology National Health and Family Planning Commission of the People's Republic of China (The prevention and control project of cardiovascular disease, 2016ZX-008-01); the Fundamental Research Funds for the Central Universities (2042018kf1032). Declaration of Interests: The authors have declared no conflicts of interest. Ethics Approval Statement: All animal studies adhered to the guidelines for the Care and Use of Laboratory Animals published by the United States National Institutes of Health (NIH Publication, revised 2011) and the guidelines of the Animal Care and Use Committee of Renmin Hospital of Wuhan University.

The status quo and prospect of transfer and shift in patients receiving hemodialysis in ChinaThis project was supported by Health and Family Planning Commission of Chongqing Medical Research Project (No. 2016ZDXM008), the outstanding young nurses in Second Hospital Affiliated to Chongqing Medical University (No. 201707), and Hospital Research and Construction Project of Chinese Medical Doctor Association (No. 201522).

Abstract Hemodialysis is the main alternative therapy for patients with end-stage renal disease; most of the hemodialysis centers in China are not designed together with the inpatient ward. During the hospitalization period, hemodialysis patients often move back and forth between wards and hemodialysis rooms because of the treatment needed. Hemodialysis patients are a special group of hospitalized patients, most of them are elderly patients. The overall basic diseases of the patients vary very much, and the cause of the disease is complex. Moreover, the chronic inflammation progresses slowly, and immune function declines. Some of the patient are seriously ill or even hav organ failure. All these factors affect the patients in general. Therefore, the transfer safety of patients during hospitalization is facing great challenges. The researchers reviewed the status of transshipment research in Chinese hemodialysis patients and laid the foundation for the research and development of related handover tools and perfect handover mode in the future.

Minimum wage impacts on wages, employment and hours in China

PurposeThe purpose of this paper is to estimate the causal effect of minimum wages (MWs) on the wages, employment and hours of migrant workers in China, and to show their inter-relatedness and how employers can offset some of the costs through subtle adjustments. This paper also illustrates the importance of disaggregating by region and sex.Design/methodology/approachCausal estimates are provided through difference-in-differences (DID) analysis, and robustness checks through propensity score matching. The analysis is based on micro data at the individual level from the household survey on migrant workers by the National Population and Family Planning Commission, combined with macro data regarding municipalities’ population, GDP and employment information based on the China Economic Information Network database.FindingsMW increases for those paid by the month increased the earnings of both low-wage males and females. However, males tend not to experience an adverse employment effect because part of the cost increase is offset by employers increasing their monthly hours of work. Hours of work do not increase for females, so they experience an adverse employment effect. This highlights the importance of examining cost offsets such as increases in hours of work, as well as analyzing effects separately for males and females.Research limitations/implicationsThe reason behind why employers offset some of the cost increase for males paid by the month by increasing their hours of work, but this cost-offsetting adjustment does not occur for females is uncertain.Social implicationsFor workers paid by the month, employers can offset some of the cost increase by increasing their hours of work, leading to no reductions in employment. But this adjustment occurs only for males. Hours are not increased for females, but they experience reductions in employment. Clearly, MW increases have adverse effects either in the form of employment reductions (for females) or increases in hours of work for the same monthly pay (for males).Originality/valueThis paper provides causal estimates through DID analysis and robustness checks through Propensity Score Matching, and also indicates how employers can offset the cost of MW increases by increasing hours for those paid by the month, resulting in no adverse employment effect for such workers, but an adverse employment effect when such an adjustment does not occur.

Age-specific associations between HIV infection and carotid artery intima-media thickness in China: a cross-sectional evaluation of baseline data from the CHART cohort

Inconclusive results have been reported in studies evaluating the association between HIV infection and subclinical atherosclerosis. Unsolved issues include whether the increased atherosclerosis burden observed in some studies is attributed to greater prevalence of traditional risk factors or HIV infection. Therefore, we evaluated the association of HIV infection with subclinical atherosclerosis as assessed by carotid artery intima-media thickness, while controlling for the effects of traditional risk factors as operationalised by the Framingham risk score (FRS). We did a cross-sectional evaluation of data derived from the baseline assessment of the Comparative HIV and Aging Research in Taizhou (CHART) cohort, an ongoing longitudinal study being done in Zhejiang province, China. HIV-positive and HIV-negative individuals aged 18 years and older were recruited between Feb 1, and Dec 10, 2017, and were frequency-matched for age and sex in a 1:2 ratio. Subclinical atherosclerosis was defined as carotid artery intima-media thickness of 780 μm or higher. Logistic regression was used to assess the associations of HIV-positive serostatus and FRS with subclinical atherosclerosis. 480 of 1425 (36·1%, 95% CI 33·6-38·6) HIV-positive and 784 of 2850 (27·5%, 95% CI 25·9-29·2) HIV-negative individuals had subclinical atherosclerosis (p<0·0001), and these patterns remained significant (adjusted odds ratio [adjOR] 1·72, 95% CI 1·47-2·01) in the adjusted model. After stratifying by age, higher prevalence of subclinical atherosclerosis was observed in HIV-positive than in HIV-negative individuals across the age groups 18-29 years (41 [16·0%] of 256 vs 13 [2·5%] of 512, p<0·0001), 30-44 years (128 [24·0%] of 533 vs 153 [14·4%] of 1066, p<0·0001), and 45-59 years (182 [46·6%] of 391 vs 294 [37·6%] of 782, p=0·0032), but not 60-75 years (163 [66·5%] of 245 vs 324 [66·1%] of 490, p=0·912). Significant negative interaction between HIV-positive serostatus and age on subclinical atherosclerosis was observed (p<0·0001). ORs adjusted for age, sex, and FRS were 8·84 (95% CI 4·50-17·34) for the age group 18-29 years, 2·09 (1·59-2·74) for 30-44 years, 1·54 (1·19-1·98) for 45-59 years, and 1·04 (0·75-1·44) for 60-75 years. Among HIV-positive individuals, none of the HIV-specific variables were significantly associated with carotid artery intima-media thickness estimates except for being antiretroviral therapy naive. HIV infection is associated with subclinical atherosclerosis, independent of classic risk factors. The association is stronger at younger ages, suggesting early onset of subclinical atherosclerosis among young adults. These findings highlight the need to modify HIV/AIDS treatment guidelines to incorporate cardiovascular evaluation in China. China National Science and Technology Major Projects on Infectious Diseases, National Natural Science Foundation of China, and Shanghai Municipal Health and Family Planning Commission.

Antenatal care use and its determinants among migrant women during the first delivery: a nation-wide cross-sectional study in China

BackgroundReasonable use of antenatal care (ANC) services by pregnant women played a crucial role in ensuring maternal and child safety and reducing the risk of complications, disability, and death in mothers and their infants. This study aimed to investigate the ANC use, and to explore the factors associated with ANC use among migrant women during the first delivery in China.MethodsThis study used the data of National Health and Family Planning Commission of People Republic of China in 2014. A total of 1505 migrant primiparous women were included in our current analysis. Frequencies and proportions were used to describe the data. Chi-square tests and multivariate binary logistic regression models were performed to explore the determinants that affect the number of times migrant women used ANC during their first delivery.ResultsOf the 1505 participants, 279 (18.54%) women received the ANC less than 5 times, and 1226 (81.46%) women used the ANC at least 5 times during the first delivery. The multivariate logistic regression model showed that migrant primiparous women with college and above education(P < 0.05;OR = 2.57;95%CI = 1.19–5.55), from the households with higher monthly income (P < 0.01;OR = 2.01;95%CI = 1.30–3.13), covered by maternity insurance(P < 0.01;OR = 2.01;95%CI = 1.28–3.18), with maternal health records (P < 0.001;OR = 2.44;95%CI = 1.61–3.69), migrating across county (P < 0.05;OR = 2.57;95%CI = 1.14–5.81), having migration experience before pregnancy(P < 0.05;OR = 1.37;95%CI = 1.03–1.81) were more likely to use ANC for at least five times.ConclusionsThis study demonstrated that there were still some migrant maternal women (18.54%) who attended the ANC less than 5 times. Targeted policies should be developed to improve the utilization of ANC among migrant pregnant women.

Cost-Effectiveness of an Evidence-Based Standardized Nursing Intervention Model for Immobile Stroke Patients in China

Background: While an evidence-based standardized nursing intervention model (SNIM) for immobile patients can improve clinic outcomes, less is known about the cost-effectiveness of the SNIM. We evaluate the cost-effectiveness of the SNIM for immobile stroke patients in China. Methods: This is a pre-test/post-test study, using propensity score (PS) matching on 5932 patients divided into two groups based on a routine and SNIM nursing care cohort. Total healthcare costs were extracted from the hospital information system, with the health outcome effectiveness of the SNIM measured using the EQ-5D instrument and the cost-effectiveness of the SNIM measured by the incremental cost-effectiveness ratio (ICER) with a time horizon of 3 months. Findings: Compared to routine care, SNIM decreased the total costs of stroke patients CN¥4,600 (95%CI: [-7050, -2151]), while increasing QALY 0.009 (95%CI: [0.005, 0.013]). The ICERs over 3 months was CN¥-- 517,011/QALY (95%CI: [-1111442, -203912]). Subgroup analysis reveals that both the quality of life and cost effectiveness improved significantly for ischemic patients and in tertiary hospitals while for hemorrhagic patients and in non-tertiary hospitals only the quality of life improved significantly. Interpretation: Findings from this first cost-effectiveness analysis in immobile stroke patients provide evidence that an evidence-based SNIM provides significant cost saving, but mainly in ischemic patients and tertiary hospitals. Wider adoption of such SNIM programs may be a sensible approach to reducing the burden of stroke and for immobile patients more generally. Funding Statement: The National Health and Family Planning Commission (Beijing, China) [grant numbers 201502017]. Declaration of Interests: The authors declare no competing interests relevant to this manuscript. Ethics Approval Statement: The study was ethically approved by the authorities of the 25 cooperating hospitals and participants signed a written informed consent before enrollment. For patients with aphasia to consent, consent was signed by a family member.

Differential responses to market competition by private and public hospitals in China: a longitudinal analysis

BackgroundChina launched a nationwide health-care reform in 2009. An important objective of the reform was to improve the health-care service quality by encouraging the entry and development of private hospitals and instilling market competition. The reform has led to a large increase in private hospitals, yet the effect on the hospital market and health-care service quality has not been systematically studied. This study evaluates the effect of the increase of private hospitals on the operations and health-care service quality of incumbent hospitals, and further explores differential responses to market competition between private and public hospitals. MethodsWe obtained administrative hospital panel data from the annual report of medical and health institutions in Chengdu, Sichuan province, China. The data are collected by the National Health and Family Planning Commission and cover all hospitals in Chengdu from 2007 to 2016. We excluded hospitals that recorded zero or missing values for either total revenue or total patient visits. The sample included a total of 603 hospitals, of which 208 were public hospitals. We used fixed-effects estimation by controlling for fixed effects of hospital, year, and district-by-year. We investigated six categories of outcome variables (hospital revenue, patient visits, the number of medical staff, mean yearly hospital expenditure, the number of medical devices, and inpatient mortality rate) and their subcategories. The independent variable was the ratio of the number of new private hospitals in a 10 km radius in a given year to the number of existing hospitals in a 10 km radius in the base year (2007). This variable measures the increase in intensity of competition from private hospital entries to the local hospital market. FindingsWhen the ratio of the number of private hospital entries to existing hospitals increased by 100%, there was a decrease in total revenue of (21·4%, p<0·0001) and patient visits to (23·7%, p<0·0001) incumbent private hospitals. By contrast, for incumbent public hospitals, total revenue only decreased by 1·3% (p=0·839) and patient visits increased by 1·6% (p=0·826). Furthermore, private hospitals cut total expenditure by 18·9% (p<0·0001). Specifically, the number of medical staff decreased by 4·8% (p=0·015) and total wage expenditure decreased by 13·5% (p=0·013). By contrast, public hospitals raised the number of medical staff by 5·3% (p=0·092) and increased the number of medical devices by 14·9% (p=0·048). Finally, inpatient mortality rate decreased in public hospitals by 3·43 deaths per 1000 admissions (p=0·001). By contrast, inpatient mortality rate decreases by 0·119 deaths per 1000 admissions (p=0·855) in private hospitals. InterpretationThe results show that the 2009 health-care reform has intensified hospital competition. Private and public hospitals respond differently to more intense competition: private hospitals reduce expenditure, whereas public hospitals raise health-care service quality. Our findings suggest that future pro-competition reforms need to consider differential responses to market competition between private and public hospitals. FundingJY acknowledges financial support from the Singapore Ministry of Education Academic Research Fund (no. FY2018-FRC3-006).

Medical specialty distribution in China, 2009–17: a longitudinal examination

BackgroundChina's practitioners are responsible for serving the most populous country in the world. Despite the pronounced shortages of areas, such as general practice and paediatrics, little is known about the discrepancies between supply and demand in each specialty. We aimed to examine China's supply of and demand for health care since 2009 to gain an understanding of the progress that reforms have brought about. MethodsWe analysed distribution data regarding licensed medical practitioners and patient visits for all clinical departments between 2009 and 2017 using annual reports and yearbooks provided by the Chinese National Health and Family Planning Commission, which are published by the government of China and the Peking Union Medical College. The institutional review board of the principal investigator's institution approved this study. FindingsFrom 2009 to 2017, the number of registered practicing physicians increased by 48·5%. Inpatient hospitalisations increased by 98·2%, and outpatient visits increased by 69·4%. Internal medicine had a 64·5% inpatient demand–supply gap in growth rate (DSG) and a 6·5% outpatient DSG. For all specialties, negative inpatient DSGs were found in general practice (–36·8%), preventive medicine (–30·5%), stomatology (–12·1%), and aesthetic medicine (–11·9%); negative outpatient DSG was only found in stomatology (–7·6%). General practice has −41·3% outpatient DSG at the hospital level, suggesting patients in need of general practice might no longer go to hospitals, instead favouring more convenient primary care near home. InterpretationA major goal of China's 2009 reforms was to improve the quality of service during primary care visits. Although between 2009 and 2017 most of the departments' growth rates in physician quantity were slower than those of the patients', China's efforts to train more general practices at primary care institutions over this period has so far been an effective means of promoting equal access to health care. FundingRepublic of China Ministry of Science and Technology (MOST 105-2629-S-010-001).

53P - Poor prognostic impact of NTRK2 gene variation in esophageal squamous cell carcinoma

BackgroundEsophageal squamous cell carcinoma (ESCC) is one of the most common malignancies and lack of effective treatment. Gene fusions involving Neurotrophic Tyrosine Receptor Kinase 2 (NTRK2) have been proven across numerous malignancies. Anti-TRK targeted therapies provide opportunity to treat patients with NTRK2 rearranged cancers. Herein, we aimed to determine the variation and potential prognostic impact of NTRK2 in ESCC. MethodsIn 513 ESCCs resected at Zhongshan Hospital, Fudan University, from January 2007 to November 2010, NTRK2 gene variation was analyzed by Fluorescence in situ hybridization (FISH) in tissue microarrays (TMAs). Survival was estimated by Kaplan-Meier method with the log-rank test. Results513 ESCC patients included 420 males and 93 females, ranged in age from 34 to 83 years (mean 61.1 year). The median follow-up time was 36 months (range: 3 to 102 months), the 5-year disease-free survival (DFS) and overall survival (OS) rate for all patients was 32.6 % and 33.1%. The translocation rate of NTRK2 in tumor cells was observed in 11.1% (57/513) and 2.34% (12/513) of patients when the cut-off value was set as low (1% ≤ translocation rate < 15%) and high (rate ≥ 15%), respectively. Survival analysis indicated that patients with high-NTRK2 translocation had a trend poorer DFS (P=0.063) and poorer OS (P=0.042) compared with those without NTRK2 gene translocation. Furthermore, high-NTRK2 translocation (P=0.010) had a lower DFS compared patients without NTRK2 translocation after 18 months. Meanwhile, high-NTRK2 translocation group (P=0.013), and low-NTRK2 translocation group (P=0.024) had a lower OS compared patients without NTRK2 translocation after 22 months. The gene copy number (GCN) alterations of NTRK2 were observed in 36.1% (185/513), 5.8% (30/513), 1.4% (7/513) when the cut-off value was set as≥2, ≥ 3, ≥ 4, respectively. We found that NTRK2 alteration was related to DFS and OS when GCN ≥ 2, it was associated with poorer 5-year survival (DFS, P=0.019, OS, P=0.027). ConclusionsHigh-NTRK2 translocation in ESCC was a poor prognostic parameter especially after 18 or 22 months. Increased GCN of NTRK2 also was a poor prognostic indicator. Low-NTRK2 translocation presented in ESCC, indicating a few ESCC patients might be NTRK-targeted candidates. Legal entity responsible for the studyZhongshan Hospital, Fudan University. FundingNational Natural Science Foundation of China (No. 81702372), Shanghai Natural Science Foundation of China (No. 18ZR1406800), Shanghai Municipal Commission of Health and Family Planning, Key-developing disciplines (No. 2015ZB0201), and Shanghai Municipal Commission of Science and Technology (No. 19441904000). DisclosureAll authors have declared no conflicts of interest.

P573Effects of mobile text messaging on glycemic control in patients with coronary heart disease and diabetes mellitus: a randomized controlled trial

Abstract Background Mobile health interventions hold the prospect to support risk factor and lifestyle modification and are readily scalable in healthcare systems. Purpose We aim to assess whether text messaging program can improve glycemic control in high-risk patients with coronary heart disease (CHD) and diabetes mellitus (DM). Methods The study was a multi-centre randomised clinical trial conducted at 34 clinics in China. 502 individuals with both CHD and DM were recruited and randomly assigned to either the text messaging intervention (n=251) or control group (n=251). The control group received 2 thank-you messages per month in addition to usual care. The intervention group received 6 messages per week for 6 months. Messages provided educational and motivational information related to glucose monitoring, BP control, physical activity and lifestyle recommendations. The primary outcome was change in glycemic hemoglobin (HbA1C) from baseline to 6 months. Results Follow-up rate was 99%. At 6 months, HbA1C was significantly lower in intervention group compared to control group (mean HbA1C 6.7% vs. 7.2%, P&lt;0.001), with a mean change of −0.2% and 0.1% from baseline, respectively (mean absolute change −0.3% [95% CI −0.5 to 0.1]; P=0.003). Significantly more participants in intervention group achieved a HbA1c&lt;7% (69.3% vs. 52.6%; P=0.004), and change in FBG was larger in intervention group (−0.5 vs. 0.1 mmol/L; P=0.011). No differences in SBP, LDL-C, BMI and physical activity were observed. Almost all patients reported messages to be easy to understand (97.1%) and useful (94.1%). Table 1. Primary and Secondary Outcomes Analyses at 6 Month Follow-up Parameter Intervention (N=251) Control (N=251) Mean Difference in Change P value for Baseline 6 Months Mean Change Baseline 6 Months Mean Change (95% CI) Difference in Change Primary Outcome HbA1C level, %, mean (SD) 6.9 (1.4) 6.7 (1.3) −0.2 (1.0) 7.1 (1.4) 7.2 (1.5) 0.1 (1.1) −0.3 (−0.5, −0.1) 0.003 Secondary Outcomes HbA1C level&lt;7%, No. (%) 155 (62.0%) 174 (69.3%) – 139 (56.1%) 132 (52.6%) – 1.2 (1.1, 1.3)a 0.004 FBG, mmol/L, mean (SD) 8.1 (2.7) 7.5 (2.7) −0.5 (2.5) 8.5 (3.0) 8.6 (3.3) 0.1 (3.1) −0.6 (−1.1, −0.2) 0.011 SBP, mmHg, mean (SD) 135.9 (18.4) 134.7 (18.7) −1.4 (17.1) 135.9 (18.1) 132.2 (17.7) −3.5 (17.8) 2.4 (−0.8,5.5) 0.144 LDL-C, mmol/L, mean (SD) 2.6 (0.8) 2.5 (0.7) −0.1 (0.7) 2.6 (0.8) 2.5 (0.8) −0.1 (0.7) 0 (−0.1, 0.1) 0.828 BMI, mean (SD) 26.4 (3.2) 26.3 (3.5) −0.1 (2.1) 26.3 (3.2) 26.0 (3.4) −0.4 (2.5) 0.3 (−0.1, 0.7) 0.213 Physical activity (MET min/wk), 1386 1386 177 1386 1386 322 −70.7 0.784 median (IQR) (693–3066) (918–3612) (2840) (693–3066) (693–3002) (2635) (−574.9, 433.5) Conclusion Use of a simple, culturally sensitive mobile text-messaging program could be an effective and scalable way to improve disease self-management among patients with CHD and DM. Acknowledgement/Funding Research Special Fund for Public Welfare Industry of Health (201502009) from the National Health and Family Planning Commission of China

632P - Patient-derived xenografts (PDX) identify JMJD6 inhibitor as an effective therapeutic medicine in colorectal cancer

BackgroundThe Jmjc-domain-containing protein 6 (JMJD6) is a member of JmjC oxygenases that contain both arginine demethylase and lysine hydroxylase activities. Overexpression of JMJD6 has been reported to be associated with the development of various types of cancers, such as breast, lung, liver, and colon cancer. The present study aimed to explore the inhibitory effect of the small-molecule JMJD6 inhibitor named WL8 obtained by virtual screening on the progression of colorectal cancer. MethodsWL8 was administered to a mouse bearing xenografts of human colorectal cancer tissue, once every 7 days for 3 times. We analyzed the response of tumors from three patients to the JMJD6 inhibitor (11.5mg/kg, intrapertoneally, i.p.), and to FOLFOX (oxaliplatin 12mg/kg, calcium levifolinate 30mg/kg, 5-fluorouracil 55mg/kg, i.p.) or FOLFIRI (irinotecan 40mg/kg, calcium levifolinate 30mg/kg, 5-fluorouracil 55mg/kg, i.p.), as well as to combined usage of JMJD6 inhibitor and FOLFOX or FOLFIRI in PDX models by recording the tumors sizes every 3 or 4 days for 7 times. The differences between groups were analyzed using one-way ANOVA. (i.p. stands for intraperitoneal.). ResultsCompared with FOLFOX or FOLFIRI, WL8 inhibited tumor growth more effectively in the PDX models of three patients (One patient’s partial results are shown in the table). Combinatorial therapies using both JMJD6 and FOLFOX (or FOLFIRI) could further reduced the tumour size.Table: 632PTable: 632PGroup8 Days15 Days22 DaysControl1.8075±0.3950 $^@2.5706±0.2900 #%$^@2.6834±0.0416 #%$^@FOLFOX1.4184±0.20671.3639±0.2381 *@1.3867±0.4155 *^@FOLFIRI1.4712±0.15681.3894±0.4543 *@1.7474±0.0705 *$^@WL80.9656±0.4456 *1.1069±0.4376 *1.1655±0.2884 *%^@WL8+ FOLFOX0.7125±0.0410 *#%0.7767±0.4359 *0.4833±0.0503 *#%$WL8+ FOLFIRI1.0325±0.3903*0.6367±0.1436 *#%0.3900±0.0265 *#%$Relative tumor volumn (on days after first administration, notes: P values are indicated with symbols as follows, * P<0.05 v.s. ctrl; # P<0.05 v.s. FOLFOX; % P<0.05 v.s. FOFIRI; $ P<0.05 v.s. WL8; ^ P<0.05 v.s. WL8+FOLFOX; @ P<0.05 v.s. WL8+FOLFIRI) ConclusionsWe found an small-molecule inhibitor of JMJD6 with impressive therapeutic effects on colorectal cancer in pre-clinical study. Legal entity responsible for the studyThe First Affiliated Hospital of Xiamen University. FundingNational Natural Science Foundation of China, Fujian Provincial Department of Science and Technology, Fujian Provincial Health and Family Planning Commission Foundation of Youth Scientific Research Project, Xiamen Science and Technology Bureau Foundation of Science and Technology Project for the Benefit of the People. DisclosureAll authors have declared no conflicts of interest.

Systematically Analysis of lncRNA and microRNA Dynamic Features and Reveal Diagnostic and Prognostic Biomarkers in Myocardial Infarction

Background: The studies on long non-coding RNAs (lncRNAs) and microRNAs (miRNAs) implicated in myocardial infarction (MI) have increased our understanding of gene regulatory mechanisms of MI. However, the dynamic features of lncRNAs and miRNAs in MI progression have not been investigated at a system level. Methods: Global lncRNA and miRNA expression and functional patterns were examined using time-series gene expression data. To identify early diagnostic and prognostic biomarkers of MI, an efficient computational method for identifying dysregulated lncRNA-miRNA-mRNA competing endogenous RNA triplets (LmiRM-CTs) was developed, and a support vector machine classification model was applied. Findings: We observed that the biggest response of cell stimulus on the transcriptome for mRNAs, lncRNAs and miRNAs all occurred in MI acute phase, and more protein-coding genes responded to cellular stimuli relative to non-coding RNAs. Biological functional analysis indicated that lncRNAs and miRNAs which were very sensitive to environmental changes and unstable during MI progression usually possessed less biological functions. We identified MI dynamic progression-related dysregulated LmiRM-CTs, from which a new panel of candidate diagnostic biomarkers defined by 7 lncRNAs were suggested to have high classification performance for patients with or without MI, and a new panel of prognostic biomarkers defined by 2 lncRNAs were identified with high discriminatory capability for MI patients who developed heart failure from those who did not. Interpretation: This study provides a foundation for understanding dynamic regulation features of lncRNAs and miRNAs during MI progression and facilitates the discovery of early diagnostic and prognostic biomarkers for MI. Funding Statement: This work was supported by the National Natural Science Foundation of China (Grant Nos. 31500675, 61602135), the Innovation Special Fund of Harbin Science and Technology Bureau of Heilongjiang Province (2017RAQXJ203), the Postdoctoral Foundation of Heilongjiang Province (LBH-Q17133) and the scientific research project of Heilongjiang Province Health and Family Planning Commission (Grant Nos. 2016-131). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: Not required.

Inflammation and Endothelial Function Relevant Genetic Polymorphisms and Carotid Plaque in Chinese Population

Background: Inflammation and endothelial function play important roles in the pathogenesis of atherosclerosis. The genetic influence on carotid atherosclerotic plaque is mostly unclear. The aim of current study was to examine the association of carotid plaque with variants in genes involved in inflammation and endothelial function. Methods: This was a multi-center, cross sectional survey in southwestern China from May 2015 to September 2015. The residents aged ≥ 40 years volunteered to participate in face-to-face survey in 8 communities at random. A total of 2377 subjects with high stroke risk population were enrolled. Carotid plaque and plaque phenotype were assessed by carotid ultrasound. Genotypes of 19 variants in 10 genes related to inflammation and endothelial function were examined. Gene-gene interaction was analyzed by generalized multifactor dimensionality reduction (GMDR). Finding: Carotid plaques were found in 852 (35.8%) subjects, 454 (53.3%) had stable plaques, 398 (46.7%) had vulnerable plaques. PPARA rs4253655, HABP2 rs7923349 and IL1A rs1609682 were associated with the carotid plaque presence, and NOS2A rs2297518 and PPARA rs4253655 were associated with vulnerable plaque in univariate analysis. GMDR analysis observed that there was a significant gene-gene interaction among HABP2 rs7923349, ITGA2 rs1991013, IL1A rs1609682 and NOS2A rs8081248, and the high-risk interactive genotype among the 4 variants was independently associated with a higher risk for carotid vulnerable plaque after adjusting the covariates (OR, 2.86, 95% CI: 1.32-7.13, P = 0.003). Interpretation: Prevalence of carotid plaque was very high in the high risk stroke population in southwestern China. Variants in genes involved in endothelial function and inflammation were associated with the carotid plaque and plaque vulnerability. The high-risk interactive genotype among rs7923349, rs1991013, rs1609682 and rs8081248 was independently associated with a higher risk for vulnerable plaque, and might be potential markers for plaque vulnerability. Funding Statement: This study was supported in part by grants from the Scientific Research Foundation of Sichuan Provincial Health Department (Grant No. 16ZD046), the Sichuan Science and Technology Agency Research Foundation (Grant No.2018JY0164), and Universal Application Program, Health and Family Planning Commission of Sichuan Province in China (Grant No.17PJ084). Declaration of Interests: The authors stated: None. Ethics Approval Statement: The survey protocol was reviewed and approved by the Ethics Committee of the participating hospitals (People’s Hospital of Deyang City, Suining Central Hospital, and the Affiliated Hospital of Southwest Medical University), and informed consent was obtained from all participants during recruitment.

Body Mass Change Trajectory and Its Association with Hypertension Among Chinese Adults: A 24-Year Prospective Cohort Study

Backgroud: To evaluate the effect of changes in long-term body mass on risk of hypertension among Chinese adults. Methods: Data were obtained from the China Health and Nutrition Survey (CHNS) from 1991 to 2015. Latent class trajectory analysis (LCTA) was used to capture the changes of BMI trajectory overtime. Hazard risks (HRs) of hypertension among different BMI change patterns were estimated using Cox proportion hazard regression. Findings: 5138 hypertension occurred during 13.7 thousand person years of follow-up. Four body mass trajectory groups were identified as BMI loss, stable, moderate gain and substantial gain. 53.4% of men and 43.1% of women followed 1 of the 2 BMI gain trajectories, in which BMI increased at least 3kg/m2 overtime. BMI gain trajectories were associated with increased risk of hypertension in both male and female, compared with BMI stable trajectory, irrespective of initial BMI and concurrent changes of lifestyle factors. BMI substantial gain increased risk of hypertension by 65% (HR: 1.65, 95%CI: 1.45-1.86) in male and 83% (HR: 1.83, 95%CI: 1.58-2.12) in female. BMI loss was associated with lower hypertension risk in men (HR: 0.74, 95%CI: 0.62-0.89). Similar pattern but smaller association was observed in women. Interpretation: The large majority of Chinese adults are likely to gain BMI and become overweight or obesity in adulthood. The steeper BMI gain greatly increases the risk of hypertension. Greater public health efforts should be made to avoid excessive weight gain and keep long-term weight stabilization, especially for young adults. Funding Statement: This work was supported by Chinese National Key Research and Development Program of China (Grant Number: 2017YFC0907200, 2017YF0907201), National Natural Science Foundation of China (Grant Number: 81230016) and Shaanxi Health and Family Planning Commission (Grant Number: Sxwsjswzfcght2016-013). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: All participants signed the informed consent and this study was approved by the institutional review committees of the National Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, the University of North Carolina at Chapel Hill, and the China–Japan Friendship Hospital, Ministry of Health.