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BackgroundHealthcare in China has significantly improved, meanwhile many  socio-economic risk factors and health conditions factors affect accessibility and utilization of health services in rural areas. Inequity of health service in China needs to  be estimated and reduced. Andersen behavioral model is useful to assess the association of health service utilization with predisposing, enabling, and need factors.MethodsA survey was conducted among 4634 residents of 897 households in 2012. Logistic regression analysis was performed to explore the association of predisposing (age, gender, marital status, ethnicity and family size), enabling (education level, travel time to the nearest health facility, medical expense per capita, and health insurance coverage), and need factors (chronic disease) with the utilization of health services (i.e. physician visit and hospitalization).ResultsWe observed a significant association between need factor (chronic diseases) and health service unitization, after adjusting for all predisposing and enabling factors (physician visits: odds ratio (OR) = 5.87, 95 % confidence interval (CI) = 4.71–7.32; hospitalization: OR = 4.04, 95 % CI = 2.90–5.61, respectively). In addition, age, gender, marital status, family size and education level were significant predictors of health service utilization. The travel time to the nearest health facility was associated with the utilization of physician visits, and expenditure on healthcare was a hindering factor of hospitalization.ConclusionsThe predisposing and enabling factors had a minor impact on health service utilization, while the need factor was a dominant predictor of health service utilization among rural residents in China.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1825-4) contains supplementary material, which is available to authorized users.

Ketamine is an injectable anesthetic and recreational drug of abuse commonly used worldwide. Many experimental studies have shown that ketamine can impair cognitive function and induce psychotic states. Neuroinflammation has been suggested to play an important role in neurodegeneration. Meanwhile, ketamine has been shown to modulate the levels of inflammatory cytokines. We hypothesized that the effects of ketamine on the central nervous system are associated with inflammatory cytokines. Therefore, we set out to establish acute and chronic ketamine administration models in C57BL/6 mice, to evaluate spatial recognition memory and emotional response, to analyze the changes in the levels of the inflammatory cytokines interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) in the mouse hippocampus, employing behavioral tests, Western blot, quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) and immunohistochemistry. Our results showed that ketamine at the dose of 60 mg/kg induced spatial recognition memory deficit and reduced anxiety-like behaviors in mice after chronic administration. Moreover, we found that ketamine increased the hippocampal levels of IL-6 and IL-1β after single, multiple and long-term administration in a dose-dependent manner. However, the expression level of TNF-α differed in the mouse hippocampus under different conditions. Single administration of ketamine increased the level of TNF-α, whereas multiple and long-term administration decreased it significantly. We considered that TNF-α expression could be controlled by a bi-directional regulatory pathway, which was associated with the dose and duration of ketamine administration. Our results suggest that the alterations in the levels of inflammatory cytokines IL-6, IL-1β, and TNF-α may be involved in the neurotoxicity of ketamine.

This paper explores the extent to which music festival attendance is 'universally' motivated or determined by the Chinese cultural and socio-political context.A novel qualitative approach was employed comprising observation of social media conversations and 'chat room' interviews with members of a festival online community. Seven motivators were identified, some similar to those in Western studies but others more specific to festival-goers in mainland China.The culturally specific motivators were identified as 'spiritual escape' and 'spiritual pursuit' and the universal motivators as 'togetherness', 'love of the music', 'novel experience', 'music sharing', and 'educational enrichment'. This paper focuses on the two culturally embedded motivators only.The implications of the study are that, although, growing, there are still very few music festivals featuring 'pop' or 'western' style music and these few are relatively new to Chinese people. Their attendance at them is, therefore, motivated differently to attendees at similar festivals in western countries. These motivating factors are mediated by the particular social, political and cultural factors at work in this complex country. The findings indicate that although many of the motivational factors for attending a music festival appear to be universal there are clearly factors which are culturally bound and therefore unique to the cultural context. These differences appear to be created by the social constraints, rapidly changing economy and the many contradictions inherent in modern mainland China. These conditions create a greater contrast between everyday life in mainland China and the liminal hedonistic space provided by the Festival. Further research is needed to validate theses initial findings within China and to explore how rock music festival motivations differ in other non-western cultures.

N‐Fluorenyl‐9‐methoxycarbonyl‐protected amino acids are used as surfactants for carbon nanotubes and their interactions are modeled using quantum mechanical computations. These surfactants are then converted into enzymatically activated CNT surfactants that create homogeneous aqueous nanotube dispersions on‐demand under constant and physiological conditions (see image).

Optical anisotropy is one of the most fundamental physical characteristics of emerging low-symmetry two-dimensional (2D) materials. It provides abundant structural information and is crucial for creating diverse nanoscale devices. Here, we have proposed an azimuth-resolved microscopic approach to directly resolve the normalized optical difference along two orthogonal directions at normal incidence. The differential principle ensures that the approach is only sensitive to anisotropic samples and immune to isotropic materials. We studied the optical anisotropy of bare and encapsulated black phosphorus (BP) and unveiled the interference effect on optical anisotropy, which is critical for practical applications in optical and optoelectronic devices. A multi-phase model based on the scattering matrix method was developed to account for the interference effect and then the crystallographic directions were unambiguously determined. Our result also suggests that the optical anisotropy is a probe to measure the thickness with monolayer resolution. Furthermore, the optical anisotropy of rhenium disulfide (ReS2), another class of anisotropic 2D materials, with a 1T distorted crystal structure, was investigated, which demonstrates that our approach is suitable for other anisotropic 2D materials. This technique is ideal for optical anisotropy characterization and will inspire future efforts in BP and related anisotropic 2D nanomaterials for engineering new conceptual nanodevices.

Renal fibrosis is a common pathological feature of chronic kidney diseases (CKD) and its development and progression are significantly affected by epigenetic modifications such as aberrant miRNA and DNA methylation. Klotho is an anti-aging and anti-fibrotic protein and its early decline after renal injury is reportedly associated with aberrant DNA methylation. However, the key upstream pathological mediators and the molecular cascade leading to epigenetic Klotho suppression are not exclusively established. Here we investigate the epigenetic mechanism of Klotho deficiency and its functional relevance in renal fibrogenesis. Fibrotic kidneys induced by unilateral ureteral occlusion (UUO) displayed marked Klotho suppression and the promoter hypermethylation. These abnormalities were likely due to deregulated transforming growth factor-beta (TGFβ) since TGFβ alone caused the similar epigenetic aberrations in cultured renal cells and TGFβ blockade prevented the alterations in UUO kidney. Further investigation revealed that TGFβ enhanced DNA methyltransferase (DNMT) 1 and DNMT3a via inhibiting miR-152 and miR-30a in both renal cells and fibrotic kidneys. Accordingly the blockade of either TGFβ signaling or DNMT1/3a activities significantly recovered the Klotho loss and attenuated pro-fibrotic protein expression and renal fibrosis. Moreover, Klotho knockdown by RNA interferences abolished the anti-fibrotic effects of DNMT inhibition in both TGFβ-treated renal cell and UUO kidney, indicating that TGFβ-mediated miR-152/30a inhibitions, DNMT1/3a aberrations and subsequent Klotho loss constitute a critical regulatory loop that eliminates Klotho's anti-fibrotic activities and potentiates renal fibrogenesis. Thus, our study elaborates a novel epigenetic cascade of renal fibrogenesis and reveals the potential therapeutic targets for treating the renal fibrosis-associated kidney diseases.

Background:A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection (CND) emerged and showed well-accepted results with improved cosmetic outcome, accelerated healing, and comforting the patients. This study aimed to evaluate the safety and effectiveness of robotic total thyroidectomy with CND via bilateral axillo-breast approach (BABA), compared with conventional open procedure in papillary thyroid microcarcinoma.Methods:One-hundred patients with papillary thyroid microcarcinoma from March 2014 to January 2015 in Jinan Military General Hospital of People's Liberation Army (PLA) were randomly assigned to robotic group or conventional open approach group (n = 50 in each group). The total operative time, estimated intraoperative blood loss, numbers of lymph node removed, visual analog scale (VAS), postoperative hospital stay time, complications, and numerical scoring system (NSS, used to assess cosmetic effect) were analyzed.Results:The robotic total thyroidectomy with CND via BABA was successfully performed in robotic group. There were no conversion from the robotic surgeries to open or endoscopic surgery. The subclinical central lymph node metastasis rate was 35%. The mean operative time of the robotic group was longer than that of the conventional open approach group (118.8 ± 16.5 min vs. 90.7 ± 10.3 min, P < 0.05). The study showed significant differences between the two groups in terms of the VASs (2.1 ± 1.0 vs. 3.8 ± 1.2, P < 0.05) and NSS (8.9 ± 0.8 vs. 4.8 ± 1.7, P < 0.05). The differences between the two groups in the estimated intraoperative blood loss, postoperative hospital stay time, numbers of lymph node removed, postoperative thyroglobulin levels, and complications were not statistically significant (all P > 0.05). Neither iatrogenic implantation nor metastasis occurred in punctured porous channel or chest wall in both groups. Postoperative cosmetic results were very satisfactory in the robotic group.Conclusions:Robotic total thyroidectomy with CND via BABA is safe and effective for Chinese patients with papillary thyroid microcarcinoma who worry about the neck scars.