Objectives To describe the factors determining choice of health financing systems. Methods Search words chosen by both health policy experts and the review search coordinators after discussion and pilot. 19 electronic databases, 2 international health institutes websites, 2 grey literature databases, and search engine Google were included in the databases. Any literature about health financing reforms on country level was included. Pre-designed data extraction form was used for collecting the information. The data was analyzed and described by pre-designed analytic framework.Result A total of 59 studies were included in this review. The driving forces included political, economic, social, and health systems factors. Development level of economy was the most crucial factor for transformation of health financing systems. The health system could directly led to the transition between different health systems, both Italy and France transform their financing system from social health insurance to national health system. The key persons such as premier of Thailand and Germany, leader of political and social organization in Israel and Korea are the driving forces of health financing reforms. Conclusion Developing countries can learn from the countries which have achieved universal coverage through health financing reform. Underlying factors influencing formulation of a health financing system need to be considered before taking actions in reforming the current system. Efforts in transforming the health financing systems need to be made from political, economic, and health systems sides.
Objective To investigate the ameliorative effects of the traditional Chinese medicine formula Fuling Yin on heart failure and its potential mechanisms at the mitochondrial level. Methods Ninety SD rats were randomly divided into a blank control group (n=15) and a modeling group (n=75) using a random number table method. A chronic heart failure model was established in the modeling group by intraperitoneal injection of doxorubicin hydrochloride. One rat from the blank control group and five rats from the modeling group were randomly selected to verify the success of modeling. After confirming that the model was successfully established, the rest successfully modeled rats were randomly divided into the model group, positive drug (trimetazidine) group, and Fuling Yin low-, medium-, and high-dose groups (n=14 per group). Treatment groups were administered the respective drugs via gavage daily, while the blank control group and model group received an equal volume of pure water for 4 consecutive weeks. Cardiac function was assessed by echocardiography. Heart weight index (HWI) was calculated. Serum brain natriuretic peptide (BNP) levels and myocardial adenosine triphosphate (ATP) content were detected by enzyme-linked immunosorbent assay. Histopathological changes were observed via hematoxylin-eosin staining. Mitochondrial ultrastructure was examined using transmission electron microscopy. Mitochondrial membrane potential (MMP) and mitochondrial permeability transition pore (mPTP) opening were detected by JC-1 fluorescence probe and colorimetric assay, respectively. The expression of apoptosis-related proteins, peroxisome proliferator-activated receptor-gamma coactivator-1α (PGC-1α), and key proteins of the mitogen-activated protein kinase (MAPK) signaling pathway were determined by Western Blot. Results Compared with the blank control group, the HWI and serum BNP levels in the model group were increased (P<0.01). Compared with the model group, the HWI and serum BNP levels in Fuling Yin groups were decreased (P<0.01). Pathological and ultrastructural observations showed disordered myocardial fiber arrangement, mitochondrial swelling, and cristae rupture in the model group; whereas in the Fuling Yin groups, myocardial pathological injury was alleviated, mitochondrial swelling was reduced, and membrane structure tended to be intact. Regarding mechanism indicators, compared with the model group, the myocardial ATP content increased, the red fluorescence intensity of MMP enhanced, and the mPTP opening degree decreased in the Fuling Yin groups (P<0.01). Additionally, the Bax/Bcl-2 ratio decreased, and caspase-3 protein expression was downregulated (P<0.01). Furthermore, PGC-1α protein expression was upregulated, while the expression of MAPK proteins was downregulated (P<0.01). Conclusions Fuling Yin can alleviate myocardial injury and delay ventricular remodeling in doxorubicin-induced heart failure rats. Its mechanism may be related to regulating the PGC-1α/MAPK signaling pathway to maintain mitochondrial homeostasis, thereby inhibiting mitochondria-mediated cardiomyocyte apoptosis.
Automatic detection of pulmonary nodule based on computer tomography (CT) images can significantly improve the diagnosis and treatment of lung cancer. However, there is a lack of effective interactive tools to record the marked results of radiologists in real time and feed them back to the algorithm model for iterative optimization. This paper designed and developed an online interactive review system supporting the assisted diagnosis of lung nodules in CT images. Lung nodules were detected by the preset model and presented to doctors, who marked or corrected the lung nodules detected by the system with their professional knowledge, and then iteratively optimized the AI model with active learning strategy according to the marked results of radiologists to continuously improve the accuracy of the model. The subset 5?9 dataset of the lung nodule analysis 2016(LUNA16) was used for iteration experiments. The precision, F1-score and MioU indexes were steadily improved with the increase of the number of iterations, and the precision increased from 0.213 9 to 0.565 6. The results in this paper show that the system not only uses deep segmentation model to assist radiologists, but also optimizes the model by using radiologists' feedback information to the maximum extent, iteratively improving the accuracy of the model and better assisting radiologists.