BackgroundStudies have shown that steroids can improve kidney survival and decrease the risk of proteinuria in patients with Immunoglobulin A nephropathy, but the overall benefit of steroids in the treatment of Immunoglobulin A nephropathy remains controversial. The aim of this study was to evaluate the benefits and risks of steroids for renal survival in adults with Immunoglobulin A nephropathy.Methodology and Principal FindingsWe searched the Cochrane Renal Group Specialized Register, Cochrane Controlled Trial Registry, MEDLINE and EMBASE databases. All eligible studies were measuring at least one of the following outcomes: end-stage renal failure, doubling of serum creatinine and urinary protein excretion. Fifteen relevant trials (n = 1542) that met our inclusion criteria were identified. In a pooled analysis, steroid therapy was associated with statistically significant reduction of the risk in end-stage renal failure (RR: 0.46, 95% CI: 0.27 to 0.79), doubling of serum creatinine (RR = 0.34, 95%CI = 0.15 to 0.77) and reduced urinary protein excretion (MD = −0.47g/day, 95%CI = −0.64 to −0.31).Conclusions/SignificanceWe identified that steroid therapy was associated with a decrease of proteinuria and with a statistically significant reduction of the risk in end-stage renal failure. Moreover, subgroup analysis also suggested that long-term steroid therapy had a higher efficiency than standard and short term therapy.

Purpose of the studyThe aim of this study was to perform a meta-analysis to derive precise estimation of the association of interleukin-23 receptor (IL-23R), IL-1 receptor 2 (IL-1R2), IL-12 beta (IL-12B), IL-10 and tumour necrosis factor (TNF)-α polymorphisms with ankylosing spondylitis (AS) susceptibility.Study designA systematic literature search was conducted to identify the relevant studies. Pooled OR with 95% CI was calculated to assess the strength of the association in a fixed or random-effects model.ResultsA total of 13 917 cases and 19 849 controls in 43 eligible studies were included in the meta-analysis. Seventeen single-nucleotide polymorphisms (SNPs) in the abovementioned five cytokine genes were evaluated. The results indicate that the nine SNPs (rs11209026, rs1004819, rs10489629, rs11465804, rs1343151, rs11209032, rs1495965, rs7517847, rs2201841) of IL-23R are associated with AS susceptibility in all study subjects in the allelic model. Moreover, stratification by ethnicity identified a significant association between seven SNPs of IL-23R and AS susceptibility in Europeans and Americans, but not in Asians. In addition, the IL-10–819  C/T and TNF-α−857 C/T polymorphisms also confer susceptibility to AS, especially in Asian population.ConclusionThe results suggested that the genetic susceptibility for AS is associated with the nine SNPs of IL-23R in overall population. In the subgroup analysis, significant associations were shown in European and American population, but not in Asian population. Our results also suggest that IL-10–819  C/T and TNF-α−857 C/T polymorphism might be associated with AS risk, especially in Asian population.

ObjectiveThe objective of this study is to study the spatial effects of health expenditure and health output in China.MethodsUsing the spatial panel data of 31 provinces in China from 2011 to 2018, the spatial weight matrix was introduced to analyze the spatial correlation, and the spatial Durbin model (SDM) was used to investigate the health output effect of health expenditure.ResultsExcluding the number of doctors per thousand, the provincial health expenditure, the number of beds per thousand population, and per capita education level had a positive impact on the regional health output. The health effect of China's health inputs showed a spatial spillover effect.ConclusionDue to the significant spatial effect, the health output of 31 provinces in China benefits not only from the local health inputs, but also from the health inputs of neighboring provinces.SuggestionsThis article puts forward some suggestions based on the conclusion: China should strengthen the health cooperation among neighboring provinces, promote the free flow of various health factors among provinces, make full use of the spillover and interdependence of health investment among provinces, and improve the medical policy environment in China.

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Background: Effective communication between doctors and patients can contribute to a positive therapeutic effect, better patient outcomes and satisfaction. Doctor-patient communication skills are essential skills that all medical students should acquire during their clinical training. This study aimed to explore the doctors-patient communication skills of medical students in China and the potential influence factors. Methods: A cross-sectional study was conducted in WuHu City, China. Our study was a part of the teaching quality evaluation of Wannan Medical College. Medical students who were in their final year of clinical learning and have finished a series of pre-clinical training were invited to participate in the survey. 607 medical students participated in this study. Students' social demographic, work-related characteristics and doctor-patient communication skills were collected. The doctor-patient communication skills were measured using the doctor-patient Communication Behavior Scale. The influencing factors were explored by univariate analysis and multiple linear regression analysis. Results: Compared with the reference population, medical students reported significantly higher scores in total scores for the doctor-patient Communication Behavior Scale for Medical Students.Medical students without doctor-patient communication experiences (β=-11.87, 95%CI=-17.49,-6.24, p<0.01), or without training (β=-3.72, 95%CI=-6.61,-0.83, p<0.05) reported significantly lower total scores. Conclusion: To further promote students’ doctor-patient communication skills, medical universities and colleges should offer students with more practice opportunities and corresponding training, and communication education should run throughout the whole process of medical education.