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 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 investigate the effects of keratinocyte growth factor (KGF) and KGF receptor (KGFR) antisense oligonucleotide (ASODN) on cell cycle and apoptosis of HaCat cells. Methods HaCaT cell, an immortalized keratinocyte cell strain, was cultured in vitro. Flow cytometry was used to measure the cell cycle and apoptosis mediated by KGF and ASODN. Results The rates of S phase and apoptosis in the group treated with KGF increased significantly than those in the control group (both P

Objective To evaluate the effectiveness and influencing factors of 131I treatment for cervical lymph node metastases of papillary thyroid carcinoma (PTC).Methods Eighty-nine post-operative PTC patients (24 males,65 females,11-72 years) with cervical lymph nodes as the only site of metastasis (negative serum TgAb,1-4 times of 131I treatment) on 131I planar Rx-WBS or SPECT/CT were retrospectively reviewed.Results of 131I Rx-WBS or SPECT/CT,serum Tg levels under both TSH-suppressed and TSH-stimulated conditions were measured and recorded.CR and PR were recognized as effective therapy.x2 test and logistic regression analysis were used to analyze the data.Results The effective rate of 1-4 times of 131I treatment was 57.30％(51/89),73.03％(65/89),80.90％(72/89),83.15％(74/89),respectively (x2=18.792,P＜0.01).Logistic regression analysis suggested that therapeutic effectiveness was related to the size of metastatic lymph nodes and whether metastatic lymph nodes could be visualized on the post-ablative 131I Rx-WBS or SPECT/CT.Conclusions 131I treatment is an effective modality for PTC patients with cervical lymph nodes as the only site of metastasis.The cumulative effective rate increased within a limited times of treatment.The size of metastatic lymph nodes and whether metastatic lymph nodes could be visualized on the first post-ablative 131I Rx-WBS or SPECT/CT are the key factors for the therapeutic effectiveness.

Objective To investigate the characteristics of cerebral vascular imaging and risk factors of stroke in popu?lation with family history of stroke in rural areas of Ji County, Tianjin. Methods The volunteers with family history of stroke were recruited in the study to undergo computed tomography and computed tomography angiography (CTA) of head as well as physical and laboratory examinations. A total of 281 subjects, including 153 male and 128 female, underwent exami?nation, and were divided into stroke group and non-stroke group. Results The detection rates were significantly higher in male subjects than those of female subjects, including smoking rate, drinking rate, educational level, and decreased level of high density lipoprotein cholesterol (HDL-C), whereas the detection rate of high level of triacylglycerol (TG) was significant?ly higher in female than that of male subjects (P<0.05). There were 38 subjects in stroke group. The age, internal carotid ar?tery calcification rate (ICAC) and internal carotid artery tortuosity (ICAT) rate were significantly higher in stroke group than those of non-stroke group (P<0.05) . The results of multivariate Logistic regression analysis indicated that age, hyperten?sion, ICAC, and ICAT were independent risk factors for stroke. Conclusion For population with family history of stroke, age, hypertension, ICAC and ICAT were risk factors of stroke.

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.