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.

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 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.

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 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.

Objective The aim of this retrospective study was to analyze the role of surgery in the management of limited-stage-Ⅱ small cell lung cancer.Methods A retrospective review of 82 patients with limited-stage Ⅱ small cell lung cancer between January 2001 and December 2009 was performed.The prognostic impact of different therapy and the clinicopathologic factors were analyzed.Using SPSS 16.0 statistical software for data analysis.Log-rank test for the difference of survivale rate.Using the Cox model for muliti-factor survival analysis.Chi-square test for local recurrence and distant metastasis rate.Results The overall median survival time and the 1-,3-,and 5-year overall survival rates were 27.0 months,62.1％,35.9％,and 21.0％,respectively.Median survival was 34.0 months in surgical patients vs 16.0 months in nonsurgical patients (P =0.000).Median survival after lobectomy or pneumonectomy was significantly longer than after wedge resection (P =0.048).However,survival after wedge resection was still significantly longer than survival in nonsurgical patients(P =0.024).Survival analysis confirmed that the operation,chemotherapy and radiotherapy were showed to be independent prognostic factors.The local-regional recurrencer rates of lobectomy or pneumonectomy group was lower than wedge resection group(P =0.030).The distant metastasis rates of lobectomy or pneumonectomy group was lower than nonsurgical grou (P =0.021).Conclusion This study suggests that lobectomy or pneumonectomy combined with adjuvant radio-chemotherapy should be recommended for patients with limited-stage Ⅱ small cell lung cancer.

Objective To investigate the expression of chemokine receptors CXCR1and CXCR2in progressive plaque psoriasis and their clinical significance.Methods Reverse transcription-polymerase chain reaction(RT-PCR)technique was applied to semi-quantatatively analyze CXCR1and CXCR2mRNA expression in peripheral blood polymorphonuclears(PMNs)from30cases of psoriatic patients,14of the30patients which were treated until the70%of skin lesions resolved,and30healthy controls.The correlation between CXCR1/2and psoriatic area and severity index(PASI)was evaluated.Results CXCR1and CX-CR2mRNA levels in PMNs from psoriatic patients were1.30?1.18和1.62?0.97,respectively,which were markedly higher than those in normal controls(0.56?0.36,0.74?0.58,respectively)and treated patients(0.49?0.34,0.51?0.51,respectively.)(P

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 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.

Objectives Todynamicallyobservethechangesofhemodynamicparametersinpatients with severe stenosis of unilateral middle cerebral artery (MCA)by transcranial Doppler ultrasound (TCD) andtoevaluateandanalyzetherelatedfactorsforinfluencingthestenoticprocess.Methods Atotalof 113 consecutive patients with severe stenosis of unilateral MCA screened by TCD and confirmed by computed tomography angiography (CTA)and digital subtraction angiography (DSA)were enrolled retrospectively. They were divided into either a progressive group (n =43 )or a non-progressive group (n=90)according to the variation of MCA hemodynamic parameters. The effects of age,sex,major risk factors for cerebrovascular disease,clinical symptoms,clinical medication,and drug compliance on the stenotic process were documented and analyzed. Results (1)The comparison of detection rate of the risk factors for cerebrovascular disease:The patients with a history of smoking (72. 1%[n=31])in the progressive group was significantly higher than that (51. 1%[n=46])in the non-progressive group (P=0.022). The period of smoking of the patients in the progressive group were longer than that in the non-progressive group (28 ± 12 years vs. 21 ± 10 years,P=0. 011). (2)Comparison of MCA hemodynamic parameters:The distal pulsatility indexes of MCA stenosis at the first diagnosis in the progressive group were all lower than those in the non-progressive group (0. 66 ± 0. 10 vs. 0. 70 ± 0. 13;t= -2. 096,P=0. 038),and the distal pulsatility indexes of MCA stenosis at the end point in the patients of the progressive group were lower than those in the non-progressive group (0. 61 ± 0. 15 vs. 0. 74 ± 0. 15). There were significant differences (t=-2. 718,P= 0. 008). The peak systolic velocity (PSV)of the progressive MCA stenotic segments at the end point in 10 patients of the progressive group was higher than that in the non-progressive group (299 ± 23 cm/s vs. 244 ± 50 cm/s,t=3. 437;P=0. 001),while PSV of MCA in 33 patients with occlusion in the progressive group were significantly lower than those in the non-progressive group (56 ± 18 cm/s vs. 244 ± 50 cm/s,t= -20. 905;P=0. 000). (3)The regular medication:The patients using statins (atorvastatin calcium)were significantly lower than those of the non-progressive group (2. 3%[n=1] vs. 54. 4%[n=49],χ2 =33. 690;P<0. 01). (4)During the follow up period,the recurrence rates of transient ischemic attack and stroke of the progressive group were significantly higher than those of the non-progressive group (27. 9%[n=12]vs. 6. 7%[n=6],32. 6%[n=14]vs. 2. 2%[n=2];all P<0.01). (5)Multivariate Logistic regression analysis showed that smokers (OR,4. 403,95%CI 1. 094-14.017),cerebrovascular event recurrence (OR,10. 648,95%CI 2. 530 -41. 261),and irregularly taking statins (OR,5. 675,95%CI 1. 631-152. 740)were all closely associated with the progress of severeMCAstenosis.Conclusion EvaluationofthehemodynamicchangesofsevereMCAstenosiswith TCD follow up study can be used as an important basis for clinical assessment of the outcomes. Stop smoking and regularly taking statins may help to delay the progress of MCA stenosis.