Objective To offer decision support for reasonable allocation of medical resources by analysis of the present resources allocated.Methods Lorenz curve and Gini coefficient method were called into play.This paper studied such medical resources as the practicing doctors,registered nurses,medical institutions and hospital beds,from both the population distribution and geographical distribution aspects.The purpose is to compare the allocation in these municipalities (Beijing,Tianjin,Shanghai and Chongqing).Results If the Lorenz curve is drawn based on the total population served with such resources,the Gini coefficients indieate relatively balanced allocation of medical institutions,practicing physicians,and registered nurses in the municipalities,and highly balanced allocation of hospital beds.If the curve is drawn based on geographical distribution,the Gini Coefficient indicates relatively balanced allocation of medical institutions allocation in these municipalities,yet considerable difference in the allocation of practicing physicians,registered nurses,and hospital beds.Conclusion The study shows that medical resources allocation in China in these municipalities mirrors the condition of Priority to population density,and neglect of geographical distribution.It also reveals poor equity in the geographical distribution of medical resources,which plagues accessibility of medical resources.

BACKGROUND: Bone marrow mesenchymal stem cells (MSCs) have multi-differentiation potential. In the acute wound, MSCs have been demonstrated to have the potential for differentiating into skin cells. However, there are few reports regarding its differentiation in diabetic wound.OBJECTIVE: To observe the feasibility of differentiation of MSCs into the cells of skin appendages under the microenvironment of diabetic wound.METHODS: MSCs were isolated from the bone marrow of rats, purified and cultured. Third or fourth passage MSCs were selected and labeled with 5-bromodeoxyuridine (5-BrdU). The rats were injected intraperitoneally with single administration of streptozocin to establish diabetes model. After 2 weeks, a round skin wound was made on the dorsal back of rats. BrdU-labeled MSCs at a density of 1×10~9/L were injected into the wound of the rats. The specimens were harvested from the wound tissues to prepare sections at 2 and 3 weeks after transplantation, followed by immunohistochemical staining with BrdU or keratin. RESULTS AND CONCLUSION: BrdU positive cells aggregated in the epidermis, dermis and hypodermia. Some positive cells appeared in the sebaceous glands and sebaceous duct cells and expressed keratin simultaneously in serial sections. During diabetic wound healing, MSCs have the potential to differentiate into the cells of the skin appendages.

Objective To investigate the anti-HBs level in 15 years after vaccination in adults and newborns in Beijing and provide the suggestion for the adult hepatitis B (HB) immunization plan.Methods A serological survey was conducted in 6 705 subjects aged > 1 year old by multistage randomized cluster sampling in Beijing during August 2013 to February 2014.The subjects who had received a 3-dose recombination HB vaccine when they were newborns or adults aged ≥15 years old and did not undergo revaccination were selected.Antibody to hepatitis B surface antigen (anti-HBs) titers and positive rates in 15 years after vaccination were evaluated.Results A total of 129 and 463 subjects who were vaccinated in adults and newborns were enrolled in the study.Based on the self-limited rate(30%) of HBV infection among the general population aged 15 to 59 years, anti-HBs positive rates for the subjects vaccinated in adults were estimated to be 58.6%,62.5 % and 48.4% during 0-4, 5-9 and 10-15years after vaccination respectively.The corresponding median of anti-HBs titers were 288.8, 120.6 and 62.6 mIU/mL.The anti-HBs positive rates for the subjects vaccinated in newborns during 0-4, 5-9 and 10-15 years after vaccination were 83.3%, 47.3% and 43.5%, respectively.The corresponding anti-HBs titers were 71.8, 8.9 and 6.7 mIU/mL.Conclusions The protection afforded by primary immunization with recombination vaccine in adults and newborns lasts at least 15 years.

Objective To establish the GFR reference range of solitary kidney by 99 Tcm?DTPA SPECT imaging and explore factors influencing renal compensation. Methods A total of 108 patients ( 62 males, 46 females, age range:5-83 (47±19) years) with only one functional kidney who underwent 99Tcm?DTPA dynamic imaging from January 2011 to September 2015 were retrospectively analyzed. The GFR was measured to establish the reference range. Meanwhile, the potential influence factors were analyzed, inclu?ding age, gender, location of the functional kidney, removal and causes of the non?functional kidney. Two?sample t test, one?way analysis of variance and Bonferroni test were used. Results The GFR were (71.81± 23.23) ml/min in the 108 patients. There were no significant differences of GFR between male and female patients ( t=0.496) , between patients with left functional kidney and those with right functional kidney( t=0.999), between patients with and without removed non?function kidney(t=-1.966), and among patients with different causes of the non?function kidney( F=1.894;all P>0.05) . The GFR was significant different in different groups based on age( F=13.924, P<0.001) . There was a negative correlation between the GFR and age( r=-0.570, P<0.001) . The GFR CV in different age groups (≤20 years, 20 years60 years) were 37.6%,26.7%,21.3%,30.1%, respectively. Conclusions It is objective and efficient to assess the renal compensation by establishing the reference values for GFR of the solitary kidney. There is a negative correlation between age and renal compensation, and the variation of renal compensation is larger in younger patients.

Objective:To establish a comprehensive and effective scoring model based on ultrasonic characteristics for predicting the restenosis risk after superficial femoral artery stenting, in order to assess the possibility of in-stent restenosis and to provide guidance for the selection of therapeutic strategies.Methods:A retrospective review of a database of 328 patients (381 limbs) undergoing superficial femoral artery stents in Xuanwu Hospital, Capital Medical University from January 2016 to January 2018 was made as a modeling group.In the modeling cohort, the multivariate logistic regression analysis was performed to screen independent risk factors for in-stent restenosis. A predictive scoring model of restenosis risk was established with weighted score of independent risk factors according to the odd ratio values. Based on the best cut-off value of the receiver operating characteristic (ROC) curves, the scoring table was divided into low-risk and high-risk groups of restenosis.Results:Multivariate logistic regression analysis showed that 8 factors were included in the score system to establish the scoring model of in-stent restenosis risk prediction including calcified plaque, peak systolic velocity of popliteal artery<40 cm/s, runoff scores≥4, ankle-brachial index<0.5, female (1 point each); complicated stroke, complicated chronic renal disease, total lesion length 15.0-24.9 cm (2 points each); total lesion length≥25.0 cm (3 points), a total of 12 points in the model. The validation indicated that the scoring system had good predictive value(AUC=0.775, 95% CI=0.727-0.824, P<0.001) and goodness of fit (Hosmer-Lemeshow χ 2=4.921, P=0.766). The agreement with digital subtraction angiography(DSA) was good (Kappa value=0.609). The scoring system was further divided into the low-risk restenosis (0-5 points) and high-risk restenosis (6-12 points) according to the best cut-off value of 5.5, with a sensitivity of 68.1%, a specificity of 74.6%, and the accuracy of 72.7%. Conclusions:The superficial femoral artery in-stent restenosis risk predicting score model based on ultrasonic characteristics may accurately predict the restenosis preoperatively. It provides a theoretical basis for the precise surgical plans.

Objective:To investigate the clinicopathological characteristics and 18F-fluorodeoxyglucose (FDG) PET/CT imaging features of bronchopulmonary neuroendocrine tumors(BP-NETs) with different pathological subtypes. Methods:From January 2013 to May 2018, 280 patients (196 males, 84 females, median age 58 years) with BP-NETs proved by pathology in Henan Provincial People′s Hospital were retrospectively analyzed. Age, gender, smoking history, the location and size of tumor, Ki-67 positive index, thyroid transcription factor-1 (TTF-1), synaptophysin (Syn), chromogranin-A (CgA), CD56, maximum standardized uptake value (SUV max), lymph node metastasis and distant metastasis were compared among 4 pathological subtypes of BP-NETs, including typical carcinoid (TC), atypical carcinoid (AC), small cell lung carcinoma (SCLC) and large cell neuroendocrine carcinoma (LCNEC). One-way analysis of variance, χ2 test, Fisher exact test and Kruskal-Wallis rank sum test were used for data analysis. Results:There were significant differences in age, smoking history, tumor size and location, Ki-67 positive index, CgA, CD56, TTF-1, SUV max and TNM stage among TC( n=59), AC( n=21), SCLC( n=184) and LCNEC ( n=16) groups ( F values: 2.067, 3.358, H values: 17.749-22.351, all P<0.05). SCLC had the largest tumor size (5.5(3.0, 6.8) cm) and the highest proportion of central type (85.3%, 157/184), and were more prone to lymph node metastasis. LCNEC had the oldest age ((66±16) years), the largest proportion of smoking history (14/16) and peripheral type (12/16). CD56 in SCLC (95.7%, 176/184) and LCNEC(15/16) mostly showed positive expression, while the positive expression rates of CgA and TTF-1 were higher in TC and AC (96.6%(57/59), 93.2%(55/59) and 95.2%(20/21), 90.5%(19/21), respectively). The Ki-67 positive index and SUV max of the four subtypes were significantly different, with the highest in SCLC group and the lowest in TC group. Conclusion:Different pathological subtypes of BP-NETs manifest different clinicopathological features and imaging presentation on 18F-FDG PET/CT, which are useful for understanding their characteristics.

Objective:To observe and analyze the function of intestinal barrier in patients with pouchitis, and to explore the role of nucleotide oligomerization domain 2 (NOD2) in ileal pouchitis, so as to provide new ideas for the pathogenesis of pouchitis.Methods:From January 2011 to December 2016, the clinical pathological data of patients with ileal pouch-anal anastomosis who underwent pouch mucosa biopsy at the Endoscopy Center of General Hospital of Tianjin Medical University were retrospectively analyzed. According to the disease activity index of pouchitis, patients were divided into pouchitis group (20 cases) and non-pouchitis group (30 cases). In addition, UC patients who did not undergo surgery were selected as the control group (10 cases). The intestinal structure of patients of the pouchitis group and non-pouchitis group was observed under transmission electron microscope. The positive expression rates of occludin, alpha human defensin and NOD2 in the control group, non-pouchitis group and pouchitis group were detected and calculated by immunohistochemistry. Levene test, independent sample t test and Spearman correlation analysis were used for statistical analysis. Results:Under the transmission electron microscope, the tight junction epithelial structure and microvilli of intestinal mucosal of patients in the pouchitis group were severely injured. The results of immunohistochemistry showed that the positive expression rates of occludin, alpha human defensin and NOD2 in the intestinal mucosa of patients in the pouchitis group were all lower than those of the control group and non-pouchitis groups ((19.3±0.4)% vs. (84.0±0.3)% and (77.9±0.5)%; (60.0±1.3)% vs. (85.0±0.1)% and (77.3±0.4)%; (46.1±1.6)% vs. (72.0±0.7)% and (60.7±0.5)%), and the differences were statistically significant ( t=-8.451, -7.514, -3.943, -2.970, -5.115 and -2.982, all P<0.05). The correlation analysis showed that the expression level of NOD2 was positively correlated with occludin and alpha human defensin ( r=0.671 and 0.628, both P<0.01). Conclusions:Intestinal barrier function is impaired in patients with ileal pouchitis, and NOD2-related intestinal barrier injury may play an important role in the pathogenesis of ileal pouchitis.

Background: The rate of death among people living with HIV/AIDS has decreased significantly as a result of treatment with highly active antiretroviral therapy (HAART). However, the issues of drug induced toxicities and complexity of current HAART regimens has remained of great concern. The aim of this study was to determine factors influencing antiretroviral regimen changes among people living with HIV/AIDS in China. Methods: This retrospective study collected data through face-to-face interviews with people living with HIV/AIDS who were receiving HAART, and gathered relevant information from infectious disease hospitals. The following information were collected: social-demographic characteristics, antiretroviral therapies, CD4 cell counts, virus loads, reasons for changing medication and other related data. Mean and percentages were used to describe the frequency of regimen change among patients, and binary logistic regression was employed to test the factors influencing regimen change. Results: 1,123 people who had experienced regimen change were included in the analysis. On average, patients remained on HAART for 10.2 months before changing regimen, and the average CD4 cell count and viral load (VL) were 383.1 cells/μl and 28,132.4 copies/mL respectively when changing regimen. The reasons for modification were determined as treatment failure (52.5％), adverse reactions (32.3％), and other reasons including pregnancy (15.2％). There are significant differences in regimen change among people with different genders (P<0.001), modes of transmission (P<0.001), duration of HAART (P<0.001) and initial CD4 cell counts (P=0.0024). Males, drug users, people taking long-term medication, and those with lower initial CD4 counts when starting HAART tend to change regimen. Conclusion: Treatment failure was the main reason for the change of HAART regimen. Males, drug users, people on long-term medication and those with lower initial CD4 cell counts when starting HAART were most likely to change regimen.

Objective To analyze epidemiological characteristics of elderly cases with influenza A (H1N1) in Beijing. Methods Descriptive epidemiological methods were used to describe epidemiological characteristics of elderly cases with 2009 influenza A (H1N1) in Beijing. Results The 321 laboratory-confirmed elderly cases with influenza A (H1N1) were reported in Beijing, and the morbidity was 13.2/100 000. The peak of infection occurred during November and December, the cases in this period accounted for 84.7% of the whole year, and 53.0% of them were reported in suburb areas, with the highest morbidity (19.2/100 000) in people beyond 85 years, and the morbidity increased with age (x2 = 7.24, P＜0.01). The mild cases accounted for 63.6 %, severe and critical cases accounted for 36.4%. No significant difference was found between severity and BMI (x2=8.14, P=0.52). Severity was associated with number of chronic diseases (x2= 123.0, P＜0. 01). Conclusions The H1N1 morbidity and proportion of severe cases are high among the elderly in Beijing, more attention should be paid to this population for influenza A (H1N1) prevention and control.

Objective To compare and analyze the occurrence of delayed cerebral ischemia(DCI)after coiling and clipping of intracranial aneurysms, and explore the risk factors of DCI. Methods A total of 236 patients with aneurysms diagnosed by CT angiography (CTA) or digital subtraction angiography (DSA) in Department of Neurosurgery, Tianjin Medical University General Hospital were enrolled in this study from March 2011 to May 2014. Patients were divided into clipping group(n=135) and coiling group(n=101). The clinical characteristics were compared between two groups, including gender, age, medical history, GCS score, Hunt-Hess grade, Fisher grade, WFNS grade, aneurysm location, prognosis and incidence of DCI. Risk factors for DCI were investigated by Logistic regression analysis. Results DCI was occurred in 36 patients (26.7%) underwent clipping operation while in 11 patients (10.9%) underwent coiling operation. The incidence was significantly higher in clipping group compared with that of coiling group (P <0.01). The patients were followed up for 6 months. The poor prognosis rates were 17.0%and 25.7%in clipping group and coiling group, respectively (P>0.01). The overall mortality was 11.0%, the former had a lower mortality rate (5.9% vs. 17.8%, P <0.01). According to Logistic regression analysis, Fisher Grade 3-4, postoperative pulmonary infection and surgical procedure were independent risk factors for DCI (P<0.01). Conclusion DCI is one of the most significant factors for high fatality and morbidity of postoperative aneurysm patients. There is a low occurrence of DCI after coiling compared with that of clipping. If we pay more attention to risk factors associated with the DCI, it will improve the prognosis of postoperative aneurysm patients greatly.