Adipose-derived stem cell,one type of mesenchymal stem cells,is a promising approach in treating ischemia-reperfusion injury caused by occlusion of the middle cerebral artery.However,its application has been limited b...Adipose-derived stem cell,one type of mesenchymal stem cells,is a promising approach in treating ischemia-reperfusion injury caused by occlusion of the middle cerebral artery.However,its application has been limited by the complexities of the ischemic microenvironment.Hydrogel scaffolds,which are composed of hyaluronic acid and chitosan,exhibit excellent biocompatibility and biodegradability,making them promising candidates as cell carriers.Vascular endothelial growth factor is a crucial regulatory factor for stem cells.Both hyaluronic acid and chitosan have the potential to make the microenvironment more hospitable to transplanted stem cells,thereby enhancing the therapeutic effect of mesenchymal stem cell transplantation in the context of stroke.Here,we found that vascular endothelial growth factor significantly improved the activity and paracrine function of adipose-derived stem cells.Subsequently,we developed a chitosan-hyaluronic acid hydrogel scaffold that incorporated vascular endothelial growth factor and first injected the scaffold into an animal model of cerebral ischemiareperfusion injury.When loaded with adipose-derived stem cells,this vascular endothelial growth factor–loaded scaffold markedly reduced neuronal apoptosis caused by oxygen-glucose deprivation/reoxygenation and substantially restored mitochondrial membrane potential and axon morphology.Further in vivo experiments revealed that this vascular endothelial growth factor–loaded hydrogel scaffold facilitated the transplantation of adipose-derived stem cells,leading to a reduction in infarct volume and neuronal apoptosis in a rat model of stroke induced by transient middle cerebral artery occlusion.It also helped maintain mitochondrial integrity and axonal morphology,greatly improving rat motor function and angiogenesis.Therefore,utilizing a hydrogel scaffold loaded with vascular endothelial growth factor as a stem cell delivery system can mitigate the adverse effects of ischemic microenvironment on transplanted stem cells and enhance the therapeutic effect of stem cells in the context of stroke.展开更多
Background:Health inequity is an important issue all around the world.The Chinese basic medical security system comprises three major insurance schemes,namely the Urban Employee Basic Medical Insurance(UEBMI),the Urba...Background:Health inequity is an important issue all around the world.The Chinese basic medical security system comprises three major insurance schemes,namely the Urban Employee Basic Medical Insurance(UEBMI),the Urban Resident Basic Medical Insurance(URBMI),and the New Cooperative Medical Scheme(NCMS).Little research has been conducted to look into the disparity in payments among the health insurance schemes in China.In this study,we aimed to evaluate the disparity in reimbursements for tuberculosis(TB)care among the abovementioned health insurance schemes.Methods:This study uses a World Health Organization(WHO)framework to analyze the disparities and equity relating to the three dimensions of health insurance:population coverage,the range of services covered,and the extent to which costs are covered.Each of the health insurance scheme’s policies were categorized and analyzed.An analysis of the claims database of all hospitalizations reimbursed from 2010 to 2012 in three counties of Yichang city(YC),which included 1506 discharges,was conducted to identify the differences in reimbursement rates and out-of-pocket(OOP)expenses among the health insurance schemes.Results:Tuberculosis patients had various inpatient expenses depending on which scheme they were covered by(TB patients covered by the NCMS have less inpatient expenses than those who were covered by the URBMI,who have less inpatient expenses than those covered by the UEBMI).We found a significant horizontal inequity of healthcare utilization among the lower socioeconomic groups.In terms of financial inequity,TB patients who earned less paid more.The NCMS provides modest financial protection,based on income.Overall,TB patients from lower socioeconomic groups were the most vulnerable.Conclusion:There are large disparities in reimbursement for TB care among the three health insurance schemes and this,in turn,hampers TB control.Reducing the gap in health outcomes between the three health insurance schemes in China should be a focus of TB care and control.Achieving equity through integrated policies that avoid discrimination is likely to be effective.展开更多
基金supported by a grant from the Excellent Young Scholars Cultivation Project of Fujian Medical University Union Hospital,No.2022XH026(to HC)Joint Funds for the Innovation of Science and Technology in Fujian Province,No.2019Y9058(to XL)the Natural Science Foundation of Fujian Province,No.2020J011017(to XL)。
文摘Adipose-derived stem cell,one type of mesenchymal stem cells,is a promising approach in treating ischemia-reperfusion injury caused by occlusion of the middle cerebral artery.However,its application has been limited by the complexities of the ischemic microenvironment.Hydrogel scaffolds,which are composed of hyaluronic acid and chitosan,exhibit excellent biocompatibility and biodegradability,making them promising candidates as cell carriers.Vascular endothelial growth factor is a crucial regulatory factor for stem cells.Both hyaluronic acid and chitosan have the potential to make the microenvironment more hospitable to transplanted stem cells,thereby enhancing the therapeutic effect of mesenchymal stem cell transplantation in the context of stroke.Here,we found that vascular endothelial growth factor significantly improved the activity and paracrine function of adipose-derived stem cells.Subsequently,we developed a chitosan-hyaluronic acid hydrogel scaffold that incorporated vascular endothelial growth factor and first injected the scaffold into an animal model of cerebral ischemiareperfusion injury.When loaded with adipose-derived stem cells,this vascular endothelial growth factor–loaded scaffold markedly reduced neuronal apoptosis caused by oxygen-glucose deprivation/reoxygenation and substantially restored mitochondrial membrane potential and axon morphology.Further in vivo experiments revealed that this vascular endothelial growth factor–loaded hydrogel scaffold facilitated the transplantation of adipose-derived stem cells,leading to a reduction in infarct volume and neuronal apoptosis in a rat model of stroke induced by transient middle cerebral artery occlusion.It also helped maintain mitochondrial integrity and axonal morphology,greatly improving rat motor function and angiogenesis.Therefore,utilizing a hydrogel scaffold loaded with vascular endothelial growth factor as a stem cell delivery system can mitigate the adverse effects of ischemic microenvironment on transplanted stem cells and enhance the therapeutic effect of stem cells in the context of stroke.
基金supported by the project“Research on Economic Risk of Major Diseases and the Protection Effect Model of Rural Residents in the Central and Western Regions of China”(grant no.71203068)the“Study on the Dynamic Optimization of Catastrophic Health Insurance Reimbursement Modes and the Scale of Fund Expenditure in the Perspective of UHC”(grant no.71573095)both supported by the National Natural Science Foundation of China.
文摘Background:Health inequity is an important issue all around the world.The Chinese basic medical security system comprises three major insurance schemes,namely the Urban Employee Basic Medical Insurance(UEBMI),the Urban Resident Basic Medical Insurance(URBMI),and the New Cooperative Medical Scheme(NCMS).Little research has been conducted to look into the disparity in payments among the health insurance schemes in China.In this study,we aimed to evaluate the disparity in reimbursements for tuberculosis(TB)care among the abovementioned health insurance schemes.Methods:This study uses a World Health Organization(WHO)framework to analyze the disparities and equity relating to the three dimensions of health insurance:population coverage,the range of services covered,and the extent to which costs are covered.Each of the health insurance scheme’s policies were categorized and analyzed.An analysis of the claims database of all hospitalizations reimbursed from 2010 to 2012 in three counties of Yichang city(YC),which included 1506 discharges,was conducted to identify the differences in reimbursement rates and out-of-pocket(OOP)expenses among the health insurance schemes.Results:Tuberculosis patients had various inpatient expenses depending on which scheme they were covered by(TB patients covered by the NCMS have less inpatient expenses than those who were covered by the URBMI,who have less inpatient expenses than those covered by the UEBMI).We found a significant horizontal inequity of healthcare utilization among the lower socioeconomic groups.In terms of financial inequity,TB patients who earned less paid more.The NCMS provides modest financial protection,based on income.Overall,TB patients from lower socioeconomic groups were the most vulnerable.Conclusion:There are large disparities in reimbursement for TB care among the three health insurance schemes and this,in turn,hampers TB control.Reducing the gap in health outcomes between the three health insurance schemes in China should be a focus of TB care and control.Achieving equity through integrated policies that avoid discrimination is likely to be effective.
