Objective To explore the selection of medical unit and the major influencing factors among residents in Hubei province,to allocate reasonably the health resources and provide reference for developing medical policy.Methods With the method of multi-stage stratified cluster sampling,household survey were done.The multilevel statistical model was used to analyze the influencing factors of the first diagnosed agencies.Results The proportions of residents who chose primary medical institutions as the first diagnosed agencies were 64.5％ in urban areas and 84.3％ in rural areas,and the visiting rate decreased as the level of health care institutions increased.The selection of first diagnosed agencies among patients were related to district (city or village,OR=0.463,95％CI..0.254-0.842),age (OR=1.023,95％CI:1.010-1.036),the educational attainment (OR＞1.000),illness duration in days (OR=0.945,95％CI:0.917-0.973) and number of days in bed (OR=0.854,95 ％ CI:0.825-0.884).Conclusion The residents who chose primary medical institutions as the first diagnosed agencies took a large proportion.District,age,the educational attainment and the illness duration in days had influence on the selection of the first diagnosed agencies among residents.

BACKGROUND: The area of myocardial infarction is the determinative factor of acute myocardial infarction prognosis. Amelioration of blood transportation and replacement therapy can reduce infarction area. Bone marrow mesenchymal stem cells can differentiate into cardiovascular tissue and are easy to obtain. After cultured and expanded in vitro, they can become the ideal cells for cardiovascular replacement therapy.OBJECTIVE: To evaluate the therapeutic effect of intracoronary transplantation of bone marrow mesenchymal stem cells in the treatment of myocardial infarction. DESIGN: Self-control observation taking the patients as subjects.SETTING: Department of Cardiology, Department of Nuclear Medicine,Echocardiogram Room, Nanjing First Hospital Affiliated to Nanjing Medical University.PARTICIPANTS: Totally 20 patients with acute myocardial infarction who received the therapy of bone marrow mesenchymal stem cells transplantation in the Department of Cardiology, Nanjing First Hospital Affiliated to Nanjing Medical University during March 2003 to March 2004 were recurited. Informed consents were obtained from the patients, and the complete postoperative follow up was over 3 months. The patients include 15 male and 5 female, and they were aged (64±10) years.METHODS: All the patients underwent percutaneous coronary intervention (PCI) to treat infarction-related blood vessel. Autologous bone marrow was taken from the patients, then stem cells were extracted to be performed in vitro induction, differentiation and proliferation, and transplanted infarction-related blood vessel through coronary artery at the mean number of (21.7±30.14)× 107 within 2 weeks. Before and 3 months after transplantation of stem cells, patients underwent gated dual-isotopic myocardial perfusion/metabolic imaging (18-fluoro-2-deoxy-glucose, 18F-FDG) examination. Survived and necrotic myocardia were predicted and infarction area was obtained. At the same time, wall motion and heart function index were evaluated with ultrasound cardiography (UCG)examination, and they were re-checked 3 months after operation to evaluate the amelioration of wall motion and heart function index. A 5-point scale was used in the evaluation of gated dual-isotopic myocardial perfusion/metabolic imaging (18F-FDG) examination: point 0: normal, 1: sparse, 2:obviously sparse, 3: defected. Evaluative standard of UCG: point 1: normal,2: reduced, 3: obviously reduced, 4: no ventricular wall motion or paradoxical motion; Wall motion with 2 points or more than 2 points suggests it is improved.MAIN OUTCOME MEASURES: ① Results of gated dual-isotopic myocardial perfusion/ metabolic imaging (18F-FDG-SPECT); ②Infarctionrelated myocardial segment score and heart function index before and after stem cell transplantation of patients in ECG follow-up observation.RESULTS: All the 20 patients participated in the result analysis.Results of gated dual-isotopic myocardial perrusion/metabolic imaging (18F-FDG-SPECT): The myocardial perfusion defect area of 20 patients was significantly reduced after therapy than before therapy [(33±15)%,-(44±18)% ,P ＜ 0.05]; Metabolie defect area was significantly reduced after therapy than before therapy [(33±17)%, (43±21)% ,P ＜ 0.05];Before therapy, there were 199 segments, in which blood flow reperfusion was matched to glycometabolism defect, and they were determined as necrotic myocardium. After therapy, blood flow perfusion metabolism was improved in 79 segments, but blood flow perfusion and glycometabolism were not improved significantly in 120 segments (P ＜ 0.05). Results of UCG: ejection fraction of patients was significantly larger after therapy than before therapy [(53±8)%, (42±7)% ,P ＜ 0.05].CONCLUSION: Intracoronary transplantation of human bone marrow mesenchymal stem cells for treating myocardial infarction is simple to operate. After therapy, the infarction area is obviously reduced, myocardial blood flow perfusion and metabolism of necrotic area improve, myocardial segments without survival determined before operation reduce sigrificantly and the heart function of patients improve.

Objective:To analyze the genomic characteristics of H9N2 subtype avian influenza virus in external environmental specimens collected in Huainan city from February to April, 2016.Methods:Specimens positive for H9N2 nucleic acid (Ct value≤30) were screened by fluorescent PCR and cultivated in chicken embryos to extract RNA. Eight gene segments were amplified and analyzed with whole genome sequencing. The molecular characteristics of each gene segment of Huainan strains were analyzed. A phylogenetic tree was constructed based on the sequences.Results:The hemagglutinin (HA) and neuramidinase (NA) genes of two Huainan H9N2 avian influenza strains and the human-derived strain A/Anhui-Lujiang/39/2018/H9N2 shared the homology of 98.2%-98.3% and 97.2%-94.9% in nucleotide and 98.9%-98.8% and 99.2%-98.6% in amino acid. The other six endogenous genes were highly homologous to those of the A/Anhui/1/2013/H7N9 and A/Anhui/33163/2016/H5N6 strains. The phylogenetic tree showed that two H9N2 subtype avian influenza strains isolated in Huainan city in 2016 belonged to G57 genotype, and the endogenous genes of two Huainan H7N9 isolates and human-derived A/Anhui/1/2013/ H7N9 and A/Anhui/33163/2016/H5N6 strains were G57-like genotype. Amino acid mutations in the HA protein receptor binding domain including S132D, K138T, T189D, V/A190T and Q226L were detected. The " TEI" sequence was deleted from the NA stem region. Amino acid mutations associated with drug resistance including H274Y, R292K and N294S were not detected in the isolates, but they carried the mutations of I550L in PA gene, I368V in PB1 gene, I504V in PB2 gene, P42S in NS1 gene, N30D and T215A in M1 gene and S31N in M2 gene.Conclusions:The two H9N2 viruses isolated in the live poultry market in Huainan city were highly homologous to the A/Anhui-Lujiang/39/2018/H9N2 strain isolated from humans. The three strains were within the same evolutionary branch and belonged to G57 genotype. The endogenous genes of the two H9N2 viruses could recombine with H7N9 and H5N6 subtype avian influenza viruses that caused human infection. Amino acid mutations in the HA protein receptor binding domain, deleted sequences in the NA stem region and increased polymerase activity strengthened the ability of viruses to infect humans and were related to the drug resistance to M2 ion channel inhibitors (adamantane). The two Huainan H9N2 viruses remained sensitive to NA inhibitors (oseltamivir phosphate).

Human papillomavirus (HPV) is the main cause for cervical cancer,anogenital cancers and genital warts.Three HPV vaccines have been licensed abroad.Data from clinical trials showed high efficacy of the HPV vaccines in young women with 90％-100％ vaccine-related HPV diseases prevented.Though efficacy of the vaccine appears lower in older women,this population can still benefit from vaccination.Immunobriging trials show that the two-dose schedule in 9-14 years old girls elicits non-inferior immune response than the three-dose one in young adults.In addition,HPV vaccines can reduce the recurrent rates in CIN2 + patients after therapeutic surgery and the vaccines have cross-protection aganist diseases caused by non-vaccine type HPV.Safety data on HPV vaccines are assuring.Thus HPV vaccine should be widely used in adolescent girls and women of appropriate age groups.