Iranian Journal of Public Health
Year:2018 | Volume:47 | Issue:7|Papers Count:27

Background: Non-Communicable disease (NCDs) is a killer of people that needs to urgent actions across the world. Scien-tific evidence is the critical arm for effective interventions. Therefore, we aimed to quantify the trend of four main NCDs’ scientific publication in a 17-yr period, and reflect international collaboration. Methods: This scientometric study on four main NCDs; cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases were carried out through the narrative review in international databases of Scopus from 2000 to 2016. In this way, the number of articles, citations, and international collaboration were assessed, and the frequently used terms on non-communicable diseases were mapped by VOSviewer software. Results: Over the 17 years, 25827 articles about four main NCDs by Iran indexed in Scopus have increasing trend steadily. However, chronic obstructive respiratory publications have slow trend. The number of articles, citations, and h index of cancer-related publications was higher than the others. Diabetes, cardiovascular diseases, and chronic respiratory diseases scientometrics indicators state in next positions, respectively. The most collaborative country was USA in the four areas, and there was not seen region countries’ collaboration in top ten levels. The frequently used terms in NCDs’ articles in order were diabetes, cardiovascular diseases, and breast cancer. Conclusion: Iran provides appropriate face of cancer, diabetes, and cardiovascular diseases publications in the mirror of NCDs’ scientometry. However, there is need for more effort in chronic respiratory diseases researches, and strengthen col-laboration with regional countries.

Background: Transfusion transmissible infections (TTIs) are a common complication of blood transfusion. Evaluation and monitoring the prevalence rate of TTIs in blood donors is a valuable indicator of donor selec-tion and blood safety. We analyzed the trends of these infections among blood donors at Kohgiluyeh and Boy-er-Ahmad transfusion service (KBTC) during 10 years. Methods: Viral screening and confirmatory tests were carried out on 180304 voluntary donations from 2005-2014. The annual prevalence rates of hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV infections per 100000 donations and 95% confidence interval were calculated. Chi-square test was applied to obtain the P-value. Results: The overall prevalence was 0. 13% for HBV and 0. 06% for HCV while there were only three positive cases for HIV. The annual trend fluctuated during the time period studied. Compared to first-time donors, regular and repeat donors were significantly less likely to be positive for these infections. Outstandingly, this study provides first data in TTIs seropositivity rates among blood donors in our region; surprisingly were lower compared to other reports of Iran. Conclusion: The trends of TTIs prevalence in this study provide additional evidence that safety measures em-ployed by the KBTC have been effective in maintaining a safe blood supply. The lower prevalence of TTIs in our study compared with other Iranian studies and also the general population reflects the efficacy of donor selection and education procedures in KBTC.

Background: We compared treatments with the antiplatelets ticagrelor and clopidogrel used in patients with acute myocardial infarction (AMI) during the perioperative period for emergency percutaneous coronary inter-vention (PCI). Methods: A total of 120 patients were selected and randomly divided into control and observation groups (60 patients in each) from 2014-2016 at The Affiliated Hospital of Qingdao University. The patients in the con-trol group received 300 mg clopidogrel and 300 mg aspirin for oral administration, while those in the observa-tion group were given 180 mg ticagrelor and 300 mg aspirin orally prior to the PCI. During the operation, heparinization and a tirofiban micro-pump were used continuously. Results: Coronary artery and peripheral venous blood were extracted from each patient to obtain various pa-rameters of thrombelastogram (TEG), and the maximum platelet aggregation rates in order to compare an-tiplatelet effects. Major adverse cardiac events (MACE) were recorded during the following 6-month follow-up. Analysis of the data showed no differences in terms of the time span between medication intake and stent implantation, or the dosage of heparin and tirofiban used between the two groups. Before stent implantation, and 24 and 48 h after the procedure the average R and K values of TEG in coronary artery blood and periph-eral venous blood samples in the observation group were longer than those in the control group, while the α angle, MA, CI, MARAA and MARADP values were lower (P<0. 05). Conclusion: Ticagrelor can improve antiplatelet treatment for patients with AMI during the perioperative period of emergency PCI.

Background: Although the prevalence of malnutrition among Chinese infants has decreased, micronutrient deficiency is still common. This study aimed to describe and compare the status of micronutrient deficiency and its association with dietary variety and socio-demographic features among infants from urban and rural China. Methods: A cross-sectional study was performed on 1200 children aged 18-month-old from rural villages in Yunnan and an urban city in Shanghai. Information on food intake was obtained from a 24-h dietary recall technique. Anthropometric measures, dietary diversity score (DDS), food variety score (FVS), and mean ade-quacy ratio (MAR) were calculated and compared. Correlations between DDS, FVS, MAR, NAR, and anthro-pometric measures were examined. Results: Compared with urban area, DDS, FVS, and NAR of most micronutrients of infants from rural areas were significantly lower. These data corresponded to significant lower Z-scores of physical growth in rural in-fants. DDS, FVS, and NAR were positively correlated to anthropometric measures. Conclusion: Infants from rural areas consumed a significantly lower amount of micronutrient and had worse anthropometric measures. Both DDS and FVS could be used in dietary assessment studies on children. This is the first research quantified the difference in dietary diversity and micronutrient status of infants in rural and urban areas of China. Our work can potentially serve as a guide to infant feeding recommendations.

Background: We aimed to determine the prevalence of fasciolosis in the definitive hosts (human and livestock) and intermediate (Lymnaea snails) hosts in Kermanshah Province, western Iran from 2014-2016. Methods: The study on animals was descriptive and retrospective one. All daily records of animals slaughtered in the abattoirs were analyzed. For the study of human fascioliasis, 975 serum samples were collected from dif-ferent parts of Kermanshah Province and analyzed using ELISA based on excretory-secretory antigens. Moreo-ver, 4400 Lymnaea snails were collected from 25 habitats. The snails were identified and examined for presence of cercariae by shedding method. Results: Fasciolosis was diagnosed in 1. 7% of slaughtered animals, which was significantly greater than the oth-er species (P<0. 005). There was significant difference (P<0. 001) between the prevalence of fasciolosis and sea-sonal pattern. As for human cases, five cases (0. 5%) were positive for fascioliasis. Regarding the seropositivity to fasciolosis, no significant differences were found for age groups, sex, level of education and occupation. No Fasciola infection was seen in snails of the family Lymnaeidae. Conclusion: The prevalence of Fasciola parasite was lower compared to other provinces. This is probably due to sequential decline in rainfall and hot climate that makes conditions difficult for the snail intermediate host snails and the larval stages of fasciolid trematodes. The habitual food of people is another important point.

Background: Lipoprotein (a) [Lp(a)], as an independent risk factor for cardiovascular disease, is more likely to be genetically determined according to the increasing evidence of epidemiologic and clinical studies in recent years. Peroxisome proliferator-activated receptor (PPAR)γ , the ligand-activated transcription factors, was con-sidered as an indispensable role in the process of lipid metabolism. This study was designed to explore the as-sociations of three single-nucleotide polymorphisms (SNPs) and the haplotypes of the peroxisome proliferator-activated receptor (PPAR)γ gene with the level of Lp(a). Methods: Participants were recruited under the framework of the PMMJS (The Prevention of Metabolic Syn-drome (MS) and Multi-metabolic Disorders in Jiangsu Province of China Study) from Apr 1999 to Jun 2004. Overall, 644 subjects were randomly selected and 3 SNPs of PPARγ gene (rs10865710, rs1805192, rs4684847) were genotyped. Results: After adjusting for age, sex, cigarette smoking, alcohol drinking, waist circumference and body mass index, rs4684847 was significantly associated with Lp (a). The presence of the rs4684847 T allele (CT+TT) have a lower level of Lp (a) than the allele (CC) in the dominant model, mean difference was-27. 30 (95%CI:-52. 88~-1. 73) mg/L, P<0. 05. G-P-T and G-A-T haplotype were associated with lower levels of Lp (a) (P=0. 0041 and<0. 0001), mean difference was 49. 79(95%CI:-97. 52~-2. 06) mg/L and 17. 75(95%CI:-25. 75~-9. 75) mg/L. Conclusion: PPAR gamma polymorphisms (rs10865710, rs1805192, rs4684847) and haplotypes may be the genetic risk factors for Lp (a) level.

Background: We conducted this study among adults with pulmonary tuberculosis (TB) who received treat-ment, in order to determine the risk factors associated with survival of during treatments. Methods: A retrospective cohort study was conducted from 2005-2015 with newly registered TB patients in the Hospital of Masih Daneshvari Doctor, Tehran, Iran. Overall, 5313 patients met our study's cohort defini-tion, but the analysis was performed on 2299 patients (43. 2%) who had a correct address and they could be traced-out by the Medical – registry. Time in days was used in survival model and patients who were still alive (until last follow-up date) considered as censored. To study the effect of risk factors on patients’ survival, the generalized gamma regression model was used. Results: Based on the results of univariate analysis, gender (RR=2 (95% CI: 1. 1− 3. 7), high school education (Relative Risk: RR=0. 3 (95% CI: 0. 2− 0. 7), higher education (RR=0. 3 (95% CI: 0. 1− 0. 9), smoker (RR=2. 5 (95% CI: 1. 4− 4. 2), drug user (RR=2. 4 (95% CI: 1. 4− 4), TB contact (RR=0. 5 (95% CI: 0. 3− 0. 8) and HIV posi-tive (RR=4 (95% CI: 1. 7− 9. 2) affected patients’ survival. Moreover, the results of multivariate analysis showed that, gender (RR=5. 5 (95% CI: 2. 2− 13. 5), age (RR=1. 1 (95% CI: 1− 1. 1), adverse drug effect (RR=2. 5 (95% CI: 1. 2− 5. 4), smoker (RR=3. 3 (95% CI: 1. 2− 9. 4), TB contact (RR=0. 2 (95% CI: 0. 1− 0. 5), diabetic mellitus (RR=3 (95% CI: 1− 8. 3), HIV positive (RR=26 (95% CI: 4. 6− 145. 9) and comorbidities (RR=4. 9 (95% CI: 2− 11. 6) were identified as factors affecting patients’ survival. Conclusion: Our data indicated associated risk factors in TB mortality and could suggest way to progressing national tuberculosis program (NTP) for predicating and plan for effective interventional strategies.

Background: We aimed to investigate the correlations of the inflammatory response factors, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α ), high-sensitivity C-reactive protein (CRP), with patients with post-stroke depression (PSD), so as to provide a basis for the treatment and prevention of PSD for patients. Methods: The clinical laboratory data of 60 patients with PSD in The Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, China from July 2016 to July 2017 and those of another 60 stroke patients with-out PSD admitted in the same period were analyzed retrospectively. The expression levels of inflammatory response factors in the two groups of patients and in PSD patients with different levels of depression were compared and analyzed via statistical methods. Multiple Logistic regression analysis was used to determine whether inflammatory response factors were independent risk factors for PSD patients. Results: The expression levels of IL-6, TNF-α and CRP in patients with PSD were significantly increased compared with those in patients without PSD, and the differences were statistically significant (t=6. 429, t=6. 355, t=5. 792, P<0. 001). The levels of IL-6, TNF-α and CRP had statistically significant differences be-tween any two groups of mild, moderate and severe PSD patients (P<0. 05). Results of multiple Logistic re-gression analysis revealed that the odds ratio (OR) values of inflammatory factors (IL-6, TNF-α and CRP) were 1. 160, 1. 099 and 1. 248, respectively, and the corresponding p values were 0. 020, 0. 039 and 0. 007 in pa-tients of observation group, indicating the above three inflammatory response factors were independent risk factors for PSD. Conclusion: The clinic control on the expression levels of inflammatory response factors (IL-6, TNF-α and CRP) are extremely important for the treatment and prevention of PSD.

Background: Aspergillus fumigatus is a major cause of allergic syndromes, aspergilloma and life-threatening inva-sive infections in immunocompromised hosts. To date, a wide range of mutations in A. fumigatushave been de-scribed conferring azole-resistance, which commonly involves modifications in the cyp51A-gene (substitutions at codons G54, G138, P216, F219, M220, G448 and specifically codon L98 in combination with a 34-bp tan-dem repeat in the promoter region of the gene), the target for azole antifungals. We investigated the prevalence of azole-resistance in clinical A. fumigatus isolates obtained from patients in Iran during 2010 to 2014. Methods: Overall, 172clinical A. fumigatus isolates obtained from patients with underlying disease including transplantation, granulocytopenia, chronic liver disease, chronic obstructive pulmonary disease (COPD) and allergic bronchopulmonary aspergillosis (ABPA). Samples were collected between Jan 2009 and Nov 2014 from five provinces of Iran (Tehran, Shiraz, Isfahan, Khorasan razavi and East Azerbaijan). Antifungal susceptibility test was determined according to EUCAST reference method for itraconazole (ITC), voriconazole (VRC) and posaconazole (POS). All isolates were confirmed by amplification of the partial tubulin gene. Results: Of 172 A. fumigatus isolates tested, six isolates (3. 5%) had high MIC values of ITC (>16 mg/L) and VRC (≥ 4 mg/L). All six isolates showed a multi-resistant phenotype with high MICs of ITC and VRC. Conclusion: We determined in-vitro susceptibility a profile of 172 clinically isolates of A. fumigatus against tria-zole in Iran. Azole-resistance is an emerging problem in A. fumigatus and international surveillance is warranted.

Background: We aimed to investigate the application effects of pulmonary physical therapy on the patients with respiratory failure. Methods: Overall, 132 patients with respiratory failure admitted into the Affiliated Hospital of Medical Collage of Ningbo University from 2013-2017 were enrolled and divided into control group (n=66) and observation group (n=66). Patients in the two groups received conventional physical therapy but those in observation group received pulmonary physical therapy additionally. The ventilation and air-exchanging functions, scores of acute physiology and chronic health evaluation II (APACHE II) and occurrence of complications in patients in the two groups were compared. Results: PaO2, PaCO2, PaO2/FiO2 and estimated FEV2% were greatly improved in patients in the two groups after treatment and those in patients in observation group were better than those in patients in control group; the differences were statistically significant (P=0. 014). There were no statistically significant differences in the scores of APACHE II in patients in the two groups before treatment and at 2 days and 3 days after treatment. Scores of APACHE II of patients in observation group were obviously lower than those of other group at 4 days and 7 days after treatment and the differences were statistically significant (P=0. 015, 0. 029). The total incidence rates of complications in patients in observation group and control group were 7. 57% and 39. 39%, respectively, and the difference was statistically significant (P=0. 021). Conclusion: The treatment of respiratory failure patients with pulmonary physical therapy can greatly improve the ventilation and air-exchanging functions, avoid the occurrence of complications and improve the health condition.

Background: This study aimed to examine the effect of disease management program (DMP) on the patients with first-time ischemic stroke (IS). Methods: A DMP with 4 parts of performance indicators (PIs, including outpatient, emergency department, inpatient and follow-up treatment) was implemented in patients with stroke in 2 hospitals (Hospital T and R) in Shanghai China from 2007-2010. The effect of DMP on the outcome of IS patients was analyzed according to the criteria of the National Institute of Health Stroke Scale (NIHSS). Furthermore, the total effective rate of DMP, average length of stay, hospitalization cost, and cost-effectiveness ratio (CER) between DMP and non-DMP patients were calculated, followed by the cost-effectiveness analysis. Results: The total effective rate of DMP (T: 69. 9%; R: 76. 6%) was significantly (P<0. 05) higher than that of non-DMP (T: 60. 8%; R: 62. 7%) group in the same hospital. In addition, a significant (P<0. 05) difference in effective rate was observed between DMP and non-DMP at the NIHSS score ≥ 7. Furthermore, the average length of stay and hospitalization cost of the patients in DMP group were significantly (P<0. 05) lower than those in non-DMP group. A superior CER was also found in DMP group than non-DMP group. Conclusion: The implementation of DMP for IS can effectively improve the treatment outcome and reduce the average length of stay and hospitalization cost.

Background: We aimed to find a potential earlier diagnostic strategy for acute myocardial infarction (AMI) by investigating the epidemiology and serum metabolic characteristics of AMI patients in comparison with those of chest pain controls (CPCS). Methods: We conducted this prospective, non-randomized, observational study of patients with acute chest pain symptoms presenting to the Emergency Rooms (ER) in The People's Hospital of Guangxi Zhuang Au-tonomous Region, Nanning, Guangxi Province, China from January 2015 to July 2016. We included a cohort of 45 patients with AMI together with 45 age-and sex-matched CPCS. The epidemiology of AMI was collect-ed, and the phenotypic characteristics of the serum metabolite composition of AMI patients were determined using a combination of 1H nuclear magnetic resonance (NMR)-based metabolomics and clinical assays. Results: The epidemiology showed that elderly AMI patients with chest pain syndrome presenting to ER have little awareness of their physical condition and compliance with medication. Significant serum metabolic differ-ences observed between AMI patients and CPCS were highlighted by system differentiations in multiple meta-bolic pathways including anaerobic glycolysis, gluconeogenesis, tricarboxylic acid cycle (TCA cycle), protein biosynthesis, lipoprotein changes, choline and fatty acid metabolisms and intestinal microbial metabolism. Conclusion: The epidemiology and serum metabolic phenotypes observed here demonstrated that integration of metabolomics with other techniques could be useful for better understanding the biochemistry of AMI and for potential AMI molecular diagnosis. We should improve the general public’ s awareness of AMI, including early symptoms, risk factors, emergency responses, and treatments for related comorbidities.

A 32-yr-old man with a 10-yr history of scalp seborrhea referred to Skin and Stem Cell Research Center, Tehran, Iran, in 2015. He suffered from scalp seborrhea. Concurrent gastrointestinal symptoms and the changes in the clini-cal symptoms after consumption of the polyherbal traditional drug called Triphala are discussed. The scalp sebum was measured with a Sebumeter SM815. Gastrointestinal symptoms were followed using a valid questionnaire. After two months of treatment, scalp sebum secretion had decreased substantially. The patient also experienced remarkable improvement in gastrointestinal symptoms. Considering the positive effect of this known and safe polyherbal drug on skin sebum, it is an appropriate option for detailed large-scale clinical trials.

Idiopathic chylous ascites in pregnancy is extremely rare. Here, we report a 24-yr-old patient with idiopathic chylous ascites in pregnancy. The patient was hospitalized in Xiamen Maternity and Child Health Care Hospital, Xiamen China in 2014 due to G1P0 intrauterine pregnancy 39+2 week, LOA, and time of labor. The patient gave birth to a live baby boy (3. 6 kg) by spontaneous vaginal delivery, with complete delivery of placenta. Three hours after delivery, the patient reported abdominal distension and pain, as well as asthma. Later, milky white liquid was drawn from left lower abdomen by puncture. Exploratory laparotomy was performed, and 800 ml milky white liquid was drawn from the abdominal cavity. Subsequently, drainage tube was placed in the ab-dominal cavity, and the abdomen was closed. After the surgery, the patient was given low-fat diet, supplemented with parenteral nutrition support and intravenous injection of antibiotics. Extubation was performed on day 3. On day 7 after surgery, the mother and baby left the hospital without any health problems. No abnormality was observed during six months of follow-ups. Idiopathic chylous ascites in pregnancy may be related to congenital lymphatic system dysplasia, and directly caused by chylous flow from ducts into abdominal cavity induced by progesterone during pregnancy or pressure from enlarged uterus during late pregnancy. After pregnancy, the disease is cured by the release of disease cause and the reduction of thoracic duct pressure.

Dear Editor-in-ChiefRegular resistance training results in consistent improvements in muscle mass, fiber type, glyce-mic control, and muscle mitochondrial function (1-3). Resistance training also leads to an im-provement in disease conditions, such as Type 2 diabetes (4). College students have the best physical and psy-chological condition compared to other stages in their life. However, approximately 600, 000 stu-dents in a healthy nation such as the United States in 2009 have reported some form of disa-bility or medical condition such as attention-deficit/hyperactivity disorder, learning disabili-ties, psychiatric disorders, or chronic illnesses (5, 6). Few studies have investigated the effective-

Dear Editor-in-ChiefIn most legal systems, at the current level of de-velopment of legal relations, there is a tendency view for the damage caused by the deficiency of products, and it existed at the time of its selling period, objectively its producer bears the respon-sibility. Besides, an evident fact that medical means have product’ s character, there is a ques-tion related to damage a patient suffers from a medical means with deficiency, can beside a pro-ducer, also be responsible a health employ-ee/health institution that by using such means caused damage to a patient? It is an undeniable fact that for damage from medical means with deficiency, besides its producer, a health employ-ee should also be responsible, whose quilt can be

Dear Editor-in-ChiefScoliosis is an idiopathic disease characterized by lateral deviation or rotation of the spine, and it is defined as an abnormal lateral curvature of the spine, including spinal rotation and thoracic ky-phosis (1, 2). It usually develops idiopathically in adolescence, but inadequate management throughout one’ s growth makes the condition chronic due to lumbar instability and degenera-tive changes, resulting in functional instability (3). Such structural and functional problems cause physical deformity, and as a result, these prob-lems become coupled with physical limitation,

Dear Editor-in-ChiefSelf-rated health (SRH) refers to the self-rating of an individual’ s overall health status. Inherently, SRH involves subjective judgment, so some studies threw doubts on its reliability. However, SRH was a valid indicator of people’ s health status and has been widely used to measure and monitor health status of young people, middle-aged population, and the elderly people. Much has been re-ported of the factors having effects on SRH. SRH was found to have statistically significant relationships with personality characteristics such as agreeableness, extraversion, conscientiousness,

Dear Editor-in-ChiefThe excessive progression of internet gaming ad-diction results in obsessive feelings that worsen as the individual’ s tolerance develops and duration of use increases, with adolescents often experiencing withdrawal, among other negative effects (1, 2). Internet gaming addiction may also induce insomnia, eating disorders, decreased ability to exercise and overall fitness, depression, and attention deficit hyperactivity disorder (ADHD) (3). Various medical treatments, as well as art therapy, psychotherapy, and exercise therapy, exert positive effects on clinical symptoms of gaming addiction and ADHD (4, 5).

Dear Editor-in-ChiefWe have read with great interest the paper published in Iranian Journal of Public Health in Sep 2016 (1). The authors aimed to evaluate the epidemiologic research priorities in the field of HIV and AIDS in Iran. According to their data be-tween 1996 and 2014, 362 epidemiologic studies were conducted in Iran involving 10, 122, 239 participants. In that paper, the authors discussed the former areas of research and indicated further research topics regarding the Iranian population, in response to a changing epidemiological situa-

Dear Editor-in-ChiefAt the beginning of 2017, a medical error shocked the China society. On Jan 26th, Health and Family Planning Commission of Zhejiang Province in China received a report which said that because of the non-standard medical operation, five patients had got cross-infection of HIV in a Chinese Medicine Hospital in Hangzhou City. Moreover, other patients who involved in this treatment were also at risk of HIV infection.

Dear Editor-in-ChiefDairy sector in Pakistan plays an important role in national economy with annual milk production of about 33 million tonnes, making it fourth largest milk producing country in the world (1). De-spite this, Pakistan is facing a number of problems in quality milk production. Lack of dairy-related education, commercial dairy farming, presence of middleman milk system, lack of financial and infrastructure facilities and absence of appropriate milk adulteration test system at field level (2) result in various health problems such as cholera, skin diseases, hepatitis, blood pressure, and kidney disorders.

Dear Editor-in-ChiefAcupuncture is a treatment method used for two thousand years (1). Auricular acupuncture (AA) is a specific type of acupuncture first described in 2500 BC and is presently executed in National Association Protocol of Acupuncture (NADA, Fig. 1) in 250 hospitals in Great Britain and the United States. NADA Protocol is an evidence-based approach and client-centered (2).

Dear Editor-in-ChiefThe world prevalence of intellectual disability (ID) has been reported to be 1%-3% of general population and most cases are seen in child/adolescent population (1, 2). The lifetime cost for each person with ID is approximately 1000000 dollars (1). In Iran, ID is mostly seen in adolescents and young people (13/1000) (2). Fragile X syndrome (FXS) is the most common cause of X-linked ID (3). According to Centers for Disease Control and Prevention (CDC) re-port, families became concerned about their children symptoms after first year of life and the diagnosis of FXS will be made a year after (4). Re-

Dear Editor-in-ChiefUniversal Health Coverage (UHC) is one of necessities of achieving optimal health and equity in any nation (1). Hence, most leading health systems make their best effort to include maximum mixture of care in their package, increase access to high quality services and increase the coverage of population (2). Such access is necessary to be achieved in all aspects of health, including prevention, treatment, rehabilitation and relief of pains across the suffering patients. UHC counts as a key factor, internationally, therefore, WHO,

Dear Editor-in-ChiefFascia is the soft tissue component of the connective tissue system that encloses and connects muscles, blood vessels, nerves and all structures of the body; it extends from head to toe and creates a continuous network throughout the body. Fascia is a dynamic and active structure which contains a rich vascular and nerve supply and intimately connects with the autonomic nervous system. It plays a mediating role which able to transmit the electrical signals and mechanical tensions in human body. Moreover, fascia is closely related to nourishment of all cells in the body, so any functional impairment in the fascia can have serious effects on human health (1-3).

Dear Editor-in-ChiefSince 2009, China has implemented the “ New Medical Reform” and has achieved remarkable success: China has built the largest basic medical security networks in the world which covered 98% populations and benefiting 1. 3 billion people in 2017; more than 80% of residents can reach the nearest medical center within 15 minutes; the average life expectancy of Chinese people was exceeds 76. 3 years. Undoubtedly, China's health care workers play an important role in the “ New Medical Reform” (1). By the end of 2017, China had 8. 91 million health technicians, including 3. 35 million physicians and 3. 79 million registered nurses. In addition, China has built 30000 hospitals, 94000 township clinics and 7. 85 million beds. In 2017, Chinese medical institutions completed 8. 10 billion medical visits and 240 million inpatients. In recent years, the nurse shortage in China has become more and more acute (2).