Analysis of Incentive Policies and Initiatives on Orphan Drug Development in China: Challenges, Reforms and Implications

OBJECTIVES

Rare diseases are a global public health issue with a more pressing situation in China. Unfortunately, the relevant research and development in this country are still in its infancy, leading to limited drug accessibility. In view of this, the Chinese government has taken a series of countermeasures to promote orphan drug R&D in recent years, which has presented encouraging results. This paper aims to review incentive policies and funding initiatives formulated by the Chinese government and examine their implications on orphan drug R&D.

METHODS

Policies targeting orphan drug R&D during 2012-2022 were retrieved from the relevant official websites, categorized into different themes and analyzed for the contents. Data on government funding, drug approval, clinical trial approval and orphan drug designation were collected through internet search to analyze the implications of those incentive policies and initiatives on orphan drug R&D in China.

RESULTS

A total of 20 relevant policy documents were identified and five major themes were revealed through content analysis, including national strategy, expedited approval, safety and efficacy requirements, data protection and technical support. The government input in orphan drug R&D has witnessed a steady annual increase. Driven by those incentives, the numbers of orphan drugs approved for marketing and drug candidates entering clinical studies are increasing year by year, and more domestic pharmaceutical companies are actively involved in the R&D of orphan drugs.

CONCLUSIONS

Orphan drug development in China is growing rapidly under the stimulation of incentive regulatory policies and more investment in researches. China is working toward a more standardized and comprehensive rare disease ecosystem. However, there are still some challenges, such as the lack of sufficient financial support and the call for systematic legislation on rare diseases, to be addressed for future success.

[Therapeutic Education Programs for the Patient (ETP) undergoing an allogeneic hematopoietic cell transplantation: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]

Patients undergoing an allogeneic hematopoietic cell transplant (allo-HCT) need to understand and adhere to the transplant process as well as post-transplant follow-up requirements. A working group has met during the eleventh edition of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) Practice Harmonization Workshops. The analysis of a survey that was sent to several transplant centers belonging to the SFGM-TC has been used as a milestone to this article. While, post-transplant medical follow-up was comparable from one center to another, nursing care was found to lack harmonization between centers, although, all patients would receive therapeutic education at one time or another regarding potential transplant-related complications. A few centers in France has established a therapeutic education program that was approved by French health authorities. The aim of this work was to set up guidelines to help centers establishing such a program in well-harmonized way.

Deduction with uncertain conditionals (revised & simplified, with examples)

Section 1 of this paper provides an introduction to this new “algebra of conditionals”, addresses various plausibility tests for such an algebra, provides a Venn diagram disproving a supposed counter-example, and answers various other objections raised in the literature about the efficacy of this algebraic extension of logic and conditional probability. Section 2 greatly simplifies the calculation of the implications of a set of conditional propositions or conditional events. These results depend on defining a deductive relation for conditionals (actually two have been found) with the property that the conjunction of two conditionals implies each of its components. That seemingly innocuous property assures that the deductively closed set implied by a finite set of n conditionals with respect to the deductive relation is implied by the single conditional formed by conjoining all n of them. The results are illustrated by solving several examples of deduction with several uncertain conditionals.

Mothers’ experiences of neonatal intensive care: A systematic review and implications for clinical practice

BACKGROUND

Preterm birth is on the rise worldwide. Neonatal intensive care units (NICUs) have enabled many critically ill newborns to survive. When a premature baby is admitted to the NICU, the mother–infant relationship may be interrupted, affecting the mother's mental health.

AIM

To examine the maternal emotions associated with having a child in the NICU and provide suggestions for clinical practice.

METHODS

MEDLINE, CINAHL, PsychARTICLES, and PsychINFO were searched for relevant articles between 2005 to 2019, and six qualitative articles were chosen that explored the experiences of mothers who had a preterm infant in the NICU. The thematic analysis method was used to identify the most common themes.

RESULTS

Four main themes of the experience of mothers who had a preterm infant in the NICU were identified: Negative emotional impacts on the mother, support, barriers to parenting, and establishment of a loving relationship.

CONCLUSION

NICU environment is not conducive to mother-child bonding, but we stipulate steps that health care professionals can take to reduce the negative emotional toll on mothers of NICU babies.

The characteristics and implications of epidemic reports during COVID-19 in the United States

We summarized the basic practices and characteristics of epidemic reporting during the COVID-19 pandemic in the United States. Based on the analysis of the advantages and disadvantages of epidemic data reporting, we put forward some suggestions that should be used for reference and thus improve the epidemic data reports of infectious diseases.

Hospitals' responsibility in response to the threat of infectious disease outbreak in the context of the coronavirus disease 2019 (COVID-19) pandemic: Implications for low- and middle-income countries

The WHO declared the coronavirus disease 2019 (COVID-19) outbreak as a public health emergency of international concern on January 30, 2020, and then a pandemic on March 11, 2020. COVID-19 affected over 200 countries and territories worldwide, with 25,541,380 confirmed cases and 852,000 deaths associated with COVID-19 globally, as of September 1, 2020.¹ While facing such a public health emergency, hospitals were on the front line to deliver health care and psychological services. The early detection, diagnosis, reporting, isolation, and clinical management of patients during a public health emergency required the extensive involvement of hospitals in all aspects. The response capacity of hospitals directly determined the outcomes of the prevention and control of an outbreak. The COVID-19 pandemic has affected almost all nations and territories regardless of their development level or geographic location, although suitable risk mitigation measures differ between developing and developed countries. In low- and middle-income countries (LMICs), the consequences of the pandemic could be more complicated because incidence and mortality might be associated more with a fragile health care system and shortage of related resources.2, 3 As evidenced by the situation in Bangladesh, India, Kenya, South Africa, and other LMICs, socioeconomic status (SES) disparity was a major factor in the spread of disease, potentially leading to alarmingly insufficient preparedness and responses in dealing with the COVID-19 pandemic.⁴ Conversely, the pandemic might also bring more unpredictable socioeconomic and long-term impacts in LMICs, and those with lower SES fare worse in these situations. This review aimed to summarize the responsibilities of and measures taken by hospitals in combatting the COVID-19 outbreak. Our findings are hoped to provide experiences, as well as lessons and potential implications for LMICs.

Modern contraceptive use and intention to use: implication for under-five mortality in Ethiopia

Objective

High under-five mortality has been identified as a major problem in many developing countries including Ethiopia. The main purpose of this study is to examine the effect of modern contraceptive use on under-five mortality in Ethiopia.

Methods

The study draws on data from the 2011 and 2016 Ethiopia Demographic and Health Surveys. The Kaplan-Meier survival function was used to demonstrate the survival probabilities of children while a multivariate analysis using the Cox proportional hazards model was used to estimate the under-five mortality risks for various predictors.

Results

The results show consistently higher survival probabilities for children of mothers who use modern contraceptives for all survival periods. Significant predictors of under-five mortality include modern contraceptive use, tetanus vaccinations, mother's age, child's sex, parity, postnatal checkup, marital status, and source of drinking water.

Conclusion

Modern contraceptive use has a notable implication for the chances of under-five survival in Ethiopia. This underscores the importance of modern contraceptive use in the pursuit of a substantial reduction in under-five mortality in the country.

Operations and structures derived from non-associative MV-algebras

The so-called non-associative MV-algebras were introduced recently by the first author and J. Kühr in order to have an appropriate tool for certain logics used in expert systems where associativity of the binary operation is excluded, see, e.g., Botur and Halaš (Arch Math Log 48:243–255, 2009). Since implication is an important logical connective in practically every propositional logic, in the present paper we investigate the implication reducts of non-associative MV-algebras. We also determine their structures based on the underlying posets. The natural question when a poset with the greatest element equipped with sectional switching involutions can be organized into an implication NMV-algebra is solved. Moreover, congruence properties of the variety of implication NMV-algebras with, respectively, without zero are investigated. Analogously to classical propositional logic, we introduce a certain kind of Sheffer operation and we obtain a one-to-one correspondence between NMV-algebras and certain algebras built up by a Sheffer-like operation together with a unary operation.

Clinical Importance of Low Level of PAPP-A in First Trimester of Pregnancy - An Obstetrical Dilemma in Chromosomally Normal Fetus

BACKGROUND:

A variety of recent evidence exists about the clinical implication of low level of Pregnancy-associated plasma protein A (PAPP-A) in pregnancy. This glycoprotein is a protease, which releases the Insulin-like growth factor from IGFBP 4. Its role is a trophoblastic invasion of decidua, stimulation of cell mitosis and differentiation. It has an immunosuppressive effect in the placenta, inhibition of coagulation and complex role for integration of all these processes in the placenta. Level of PAPP-A (under 0.4 MoM-Multiple of Medians) in first-trimester screening in chromosomally and morphologically normal fetuses, could influence fetal weight, preeclampsia, premature birth and stillbirth. As a result of the complications mentioned above, there is implication on timing, mode of delivery and condition of the newborn.

AIM:

The study aims to evaluate the influence of low PAPP-A, measured in the first trimester on the outcome of pregnancy, with accent disorders which are the result of placental insufficiency. Also, gestational week, mode of delivery and condition of newborn secondary underlying conditions will be evaluated.

MATERIAL AND METHODS:

After given information and consultation about the expectation from the screening, pregnant women with a singleton pregnancy were tested for First Trimester Screening to estimate the risk for Trisomy 21, 13, 18- the most frequent chromosomopathies. After exclusion of chromosomopathies and congenital malformations, one hundred and fourteen patients enrolled in the study. The target group (n = 64) with PAPP-A below 0.4 MoM and control group (n = 50) with PAPP-A equal and above 0.4 MoM. An assessment of mode and time of delivery and presence of small for gestational age newborns, preeclampsia, premature birth and newborn condition at delivery was made.

RESULTS:

The percentage of the patients delivered in term was similar between the target group (n = 64) and the control group (n = 50), 82.81% vs 82.0% respectively. The rate of cesarean section was 29.7 % in the target group vs 32% in the control group. A significant difference was found about elective vs urgent cesarean section in favour of the target group. The difference was present about the complication in pregnancy before delivery, 56% vs 22%, p = 0.023, which were the main indication for cesarean section. The difference in newborn outcome was not significant.

CONCLUSION:

There is a difference in frequency of complications, in the cases with PAPP-A under 0.4 MoM, such as premature birth, preeclampsia compound with SGA fetuses versus the control group. The difference for SGA newborn and premature birth among the groups has statistical significance. The patients delivered with cesarean section were with the main indications SGA or elevated blood pressure, often occurred combined with prematurity. Apgar score and birth weight were similar in target and control group, but the newborns with a birth weight under 2500 g. were more frequent in the target group. Because these results did not show another significance among two groups, probably lower cut-off is needed, combining with another test (Doppler of uterine arteries in the first trimester, biochemical test). Presence of other diseases which could hurt placental function should be emphasised.

Clinical Importance of Low Level of PAPP-A in First Trimester of Pregnancy - An Obstetrical Dilemma in Chromosomally Normal Fetus

BACKGROUND:

Idiopathic epiretinal membrane (iERM) is an avascular proliferation of different types of cells between the posterior vitreous cortex and the internal limiting membrane. That causes visual impairment including blurry, distortion, scotoma. Many studies of iERM were done to describe the clinical characteristics and investigate the histopathology of this disease. Nonetheless, there has not been a study of iERM histopathology in Vietnam.

AIM:

To describe clinical characteristics and histopathological results of idiopathic retinal membrane and the association between them.

METHODS:

A cross sectional decriptive study of 35 iERMs (33 patients) in Vietnam National Institute of Ophthalmology (VNIO).

RESULTS:

High morbidity incidence was in group age >50 years (32/35), female gender (26/35), limited movement works (27/35), and high educational levels (28/35). Distortion was the highest (77.14%), scotoma and floater was less frequent (28.5%, 45.7%). Macular edema in all cases and PVD and exudate were high frequent (65.7%, 62.8%). Symptom duration was 8.2 ± 4.7 months, (1-21 months). Mean of central macular thickness was 468.51 ± 97.24 µm (656-274 µm). Six types of cell were detected, including glial cell (35/35), fibroblast (23/35), myofibroblast (23/35), macrophage (13/35), lymphocyte (5/35) and neutrophil (2/35). The number of cell types in one sample ranged from 1-5 types (2.85 ± 1.28 cell types). Number of cell types were correlated to symptom duration (r = 0.47, p = 0.004, Pearson’s test) and central macular thickness (r = 0.72, p < 0.001, Pearson’s test).

CONCLUSION:

There were 6 types of cells in iERM. Glial cell was the most frequent cell, inflammatory cells (macrophage, lymphocyte, neutrophil) was also detected. The number of cell types was stastitically correlated to symptom duration and CMT.

Consciousness in Piaget: possibilities of understanding

The objective of this article is to analyze the understanding of the concept of consciousness in Piaget. The theme of consciousness is a key concept in Piaget’s theory and he is one of the few psychologists to offer a theoretical structure for the understanding of this theme. Notwithstanding, his proposal for understanding consciousness has been little approached or discussed. Grasp of consciousness, for Piaget, can be understood as the cognitive process of assimilating one’s own functioning or that of the other when interacting with physical objects, people, and oneself. The process of constructing grasp of consciousness is explained by meaningful implication, reflecting abstraction, and equilibration. The dialectics between body and mind and between causality and implication pervade the discussions on consciousness in Piaget’s work. Consensus is not found in the literature with regard to Piaget’s conception of consciousness in virtue of this theme being dealt with at different times in his works with slightly distinct approaches. His works following the 1960s offer new possibilities of understanding the concept of consciousness. Although Piaget moved on in his formulations about consciousness, the essence of his ideas can already be found in his early works.

A selective chemosensor and fluorescence probe for relay recognition of cations and fluoride ions in aqueous media with logic gate function

Cation to anion relay recognition was studied for the first time with sequential specificity (Cu²⁺ → F^- or Co²⁺ → F^-) using a fluorescence "ON-OFF-ON" mechanism. L₁ is a receptor with high selectivity for F^-, Cu²⁺ and Co²⁺ ions in the solution of DMSO/H₂O with a 9:1 vol ratio. Absorption and fluorescence spectra were used to investigate the sensing process. Fluorescent emission intensity of L₁ at 324 is quenched (switch-Off) after the addition of Cu²⁺ and Co²⁺. Surprisingly, complex L₁ + Cu²⁺ or L₁ + Co²⁺ is restored with addition of F^- into the compound (switch-On). Consequently, implication (from emission) and inhibit (from absorption) logic gates are constructed at molecular level. The gates operate in fluorescence and absorption modes when Cu²⁺ and F^- or Co²⁺ and F^- are used as input materials and the fluorescence intensity signal as outputs. Based on reversible and reproducible system, a sequential memory unit with integrated ''Writing-Reading-Erasing-Reading'' behavior, is developed.

A survey of parabens in commercial pharmaceuticals from China and its implications for human exposure

Parabens are widely used as antimicrobial preservatives during pharmaceutical production. However, little information is available regarding the occurrence of parabens in commercial pharmaceuticals and their implications for human exposure. In this study, six commonly used parabens were analyzed by ultra-performance liquid chromatography-tandem mass spectrometry with 100 commercial pharmaceuticals collected from China. Almost all of the pharmaceutical samples contained at least one kind of parabens with the detection frequency of 97%. The concentrations of Σ6parabens (sum of the six parabens) ranged from below MDL to 1256ng/g, with mean and median values of 94.8 and 119ng/g, respectively. Methyl paraben (MeP), ethyl paraben (EtP) and propyl paraben (PrP) were the predominant compounds. Significant positive correlation was observed between concentrations of MeP and PrP, indicating their co-applications in pharmaceuticals. Levels of Σ6parabens varied in different categories of pharmaceuticals and increased with their shelf lives. Based on the measured concentrations and daily ingestion rates of pharmaceuticals, the estimated daily intake (EDI) of parabens was calculated. The median values of EDIpharmaceutical for male adults, female adults and children were 4.05, 4.75 and 9.73ng/kg-bw/day, respectively, which were three orders of magnitude lower than those from foodstuffs and personal care products (PCPs). It was firstly reported that the total exposure dose was 0.326mg/kg-bw/day via foodstuffs, PCPs, and pharmaceuticals for Chinese female adults.