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- Zhang, C, et al.
(författare)
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Angiotensin-converting enzyme 2 attenuates atherosclerotic lesions by targeting vascular cells
- 2010
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Ingår i: Proceedings of the National Academy of Sciences of the United States of America. - : Proceedings of the National Academy of Sciences. - 1091-6490. ; 107:36, s. 15886-15891
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Tidskriftsartikel (refereegranskat)abstract
- Angiotensin-converting enzyme 2 (ACE2) is a newly discovered homolog of ACE whose actions oppose those of angiotensin II (AngII). However, the underlying mechanisms by which ACE2 effectively suppresses early atherosclerotic lesions remain poorly understood. Here, we show, both in vitro and in vivo, that ACE2 inhibited the development of early atherosclerotic lesions by suppressing the growth of vascular smooth muscle cells (VSMCs) and improving endothelial function. In a relatively large cohort animal study (66 rabbits), aortic segments transfected by Ad-ACE2 showed significantly attenuated fatty streak formation, neointimal macrophage infiltration, and alleviation of impaired endothelial function. Segments also showed decreased expression of monocyte chemoattractant protein 1, lectin-like oxidized low-density lipoprotein receptor 1, and proliferating cell nuclear antigen, which led to the delayed onset of atherosclerotic lesions. At the cellular level, ACE2 significantly modulated AngII-induced growth and migration in human umbilical vein endothelial cells and VSMCs. The antiatherosclerotic effect of ACE2 involved down-regulation of the ERK-p38, JAK-STAT, and AngII-ROS-NF-κB signaling pathways and up-regulation of the PI3K-Akt pathway. These findings revealed the molecular mechanisms of the antiatherosclerotic activity of ACE2 and suggested that modulation of ACE2 could offer a therapeutic option for treating atherosclerosis.
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- Zhang, Luying, et al.
(författare)
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Balancing the funds in the New Cooperative Medical Scheme in rural China : determinants and influencing factors in two provinces
- 2010
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Ingår i: International Journal of Health Planning and Management. - 0749-6753 .- 1099-1751. ; 25:2, s. 96-118
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Tidskriftsartikel (refereegranskat)abstract
- In recent years, the central government in China has been leading the re-establishment of itsrural health insurance system, but local government institutions have considerable flexibility inthe specific design and management of schemes. Maintaining a reasonable balance of funds iscritical to ensure that the schemes are sustainable and effective in offering financial protectionto members. This paper explores the financial management of the NCMS in China through acase study of the balance of funds and the factors influencing this, in six counties in twoChinese provinces. The main data source is NCMS management data from each county from2003 to 2005, supplemented by: a household questionnaire survey, qualitative interviews andfocus group discussions with all local stakeholders and policy document analysis. The studyfound that five out of six counties held a large fund surplus, whilst enrolees obtained onlypartial financial protection. However, in one county greater risk pooling for enrolees wasaccompanied by relatively high utilisation levels, resulting in a fund deficit. The opportunitiesto sustainably increase the financial protection offered to NCMS enrolees are limited by thefinancial pressures on local government, specific political incentives and low technicalcapacities at the county level and below. Our analysis suggests that in the short term, effortsshould be made to improve the management of the current NCMS design, which shouldbe supported through capacity building for NCMS offices. However, further medium-terminitiatives may be required including changes to the design of the schemes.
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