Objective To investigate the current distribution of radiotherapy resources in Gansu Province, evaluate the equity of resource allocation, and provide a scientific basis for optimizing regional resource allocation. Methods A questionnaire survey was carried out to assess radiotherapy resources in medical institutions across Gansu Province, China. The equity of radiotherapy resource distribution and associated disparities were assessed using the Gini coefficient, Lorenz curve, and Theil index. Results A total of 23 medical institutions in Gansu Province provided radiotherapy services, comprising 39 radiotherapy devices and 438 professionals, of whom medical physicists accounted for 16.9%. The radiotherapy frequency was 0.47 cases per thousand population. The Gini coefficients for radiotherapy resource distribution ranged from 0.38 to 0.56 by population and from 0.52 to 0.70 by geography. The Theil index for radiotherapy resources ranged from 1.36 to 3.67. Conclusion Radiotherapy resources in Gansu Province were insufficient, and the capacity of radiotherapy service was suboptimal. The equity of radiotherapy resource allocation by geography was worse than that by population. Therefore, it is imperative to address the shortage of radiotherapy resources, strengthen the professional workforce, enhance the capacity radiotherapy service and resource utilization, optimize resource allocation, and promote regional equity in radiotherapy provision in Gansu Province.

BACKGROUND:Mesenchymal stem cells show extremely therapeutic potential for radiation-induced lung injury through delivering exosomes.Age is a primary factor affecting the function and biological efficacy of mesenchymal stem cells.OBJECTIVE:To investigate the protective effects of exosomes derived from bone marrow mesenchymal stem cells of different mouse ages on radiation-induced lung injury in mice.METHODS:Bone marrow mesenchymal stem cells of young mice and old mice were obtained by whole bone marrow adherent culture.The exosomes were isolated from the supernatant of passage 3 bone marrow mesenchymal stem cells.Ten 2-month-old C57BL/6J mice were randomly selected as the control group after anesthesia and not irradiated.The remaining 30 2-month-old C57BL/6J mice were used to establish a mouse radiation-induced lung injury model and were randomly divided into three groups.Exosomes derived from bone marrow mesenchymal stem cells of young mice,exosomes derived from bone marrow mesenchymal stem cells of old mice,and PBS were injected through the tail vein,respectively.The survival rate of mice was monitored.The lung function,lung inflammation and fibrosis were assessed at 1 and 12 weeks after irradiation.RESULTS AND CONCLUSION:(1)The concentrations of particles and proteins in exosomes derived from bone marrow mesenchymal stem cells of young mice were higher than those in exosomes derived from bone marrow mesenchymal stem cells of old mice.(2)Compared with the control group,the survival rate of mice in the PBS group was low,and lung inflammation was obvious at week 1 after irradiation,and the levels and mRNA expressions of interleukin-1β,interleukin-6,and tumor necrosis factor-α were increased.Collagen deposition in lung tissues was observed at week 12 after irradiation,and the mRNA level of E-cadherin was decreased,while the mRNA levels of α-smooth muscle actin,transforming growth factor-β1,and β-catenin were increased.(3)Compared with the PBS group,the survival rate of mice in the exosome group was significantly improved,and the level of proinflammatory factors and their mRNA expression were reduced at week 1 after irradiation,the mRNA level of E-cadherin was increased,and the mRNA levels of α-smooth muscle actin,transforming growth factor β1 and β-catenin were reduced at week 12 after irradiation.(4)Among all the above indicators,the therapeutic effect of exosomes derived from bone marrow mesenchymal stem cells of young mice was better than that of exosomes derived from bone marrow mesenchymal stem cells of old mice.(5)The results showed that exosomes derived from bone marrow mesenchymal stem cells of young mice contained more particles and proteins,and the effect of alleviating early inflammation and late fibrosis of radiation-induced lung injury in mice was better than that of exosomes derived from bone marrow mesenchymal stem cells of old mice.

BACKGROUND:Mesenchymal stem cells show extremely therapeutic potential for radiation-induced lung injury through delivering exosomes.Age is a primary factor affecting the function and biological efficacy of mesenchymal stem cells.OBJECTIVE:To investigate the protective effects of exosomes derived from bone marrow mesenchymal stem cells of different mouse ages on radiation-induced lung injury in mice.METHODS:Bone marrow mesenchymal stem cells of young mice and old mice were obtained by whole bone marrow adherent culture.The exosomes were isolated from the supernatant of passage 3 bone marrow mesenchymal stem cells.Ten 2-month-old C57BL/6J mice were randomly selected as the control group after anesthesia and not irradiated.The remaining 30 2-month-old C57BL/6J mice were used to establish a mouse radiation-induced lung injury model and were randomly divided into three groups.Exosomes derived from bone marrow mesenchymal stem cells of young mice,exosomes derived from bone marrow mesenchymal stem cells of old mice,and PBS were injected through the tail vein,respectively.The survival rate of mice was monitored.The lung function,lung inflammation and fibrosis were assessed at 1 and 12 weeks after irradiation.RESULTS AND CONCLUSION:(1)The concentrations of particles and proteins in exosomes derived from bone marrow mesenchymal stem cells of young mice were higher than those in exosomes derived from bone marrow mesenchymal stem cells of old mice.(2)Compared with the control group,the survival rate of mice in the PBS group was low,and lung inflammation was obvious at week 1 after irradiation,and the levels and mRNA expressions of interleukin-1β,interleukin-6,and tumor necrosis factor-α were increased.Collagen deposition in lung tissues was observed at week 12 after irradiation,and the mRNA level of E-cadherin was decreased,while the mRNA levels of α-smooth muscle actin,transforming growth factor-β1,and β-catenin were increased.(3)Compared with the PBS group,the survival rate of mice in the exosome group was significantly improved,and the level of proinflammatory factors and their mRNA expression were reduced at week 1 after irradiation,the mRNA level of E-cadherin was increased,and the mRNA levels of α-smooth muscle actin,transforming growth factor β1 and β-catenin were reduced at week 12 after irradiation.(4)Among all the above indicators,the therapeutic effect of exosomes derived from bone marrow mesenchymal stem cells of young mice was better than that of exosomes derived from bone marrow mesenchymal stem cells of old mice.(5)The results showed that exosomes derived from bone marrow mesenchymal stem cells of young mice contained more particles and proteins,and the effect of alleviating early inflammation and late fibrosis of radiation-induced lung injury in mice was better than that of exosomes derived from bone marrow mesenchymal stem cells of old mice.

Objective To analyze the adverse reaction reports （ADRs） of drug-induced liver injury in recent ten years, explore the characteristics and related rules of drug-induced liver injury, and provide reference for clinical safe drug use. Methods ADRs in our hospital from 2011 to 2021 which belonged to drug-induced liver injuries were collected, and Pareto analysis was carried on. Results In 259 ADR reports, the most common type of drug-induced liver injury was hepatocellular injury （37.84%）. The age of drug-induced liver injury was mainly over 46 years, totaling 195 （75.28%）. Drugs were mainly distributed in cardiovascular system medicine （44.02%）, anti-infective medicine （23.94%）and anti-tumor medicine （11.58%）. Among the cardiovascular drugs, atorvastatin calcium 40mg and over 40mg were the highest proportion, with 53 cases （46.49%）. The main anti-infectious drugs were cephalosporins （29.03%）, carbapenem （19.35%）， antifungal （17.74%）and quinolones （11.29%）. Adverse reactions occurred within 6 days （69.88%）, the duration of adverse reactions was 1-2 weeks （31.66%）, and most patients were improved （47.88%） or cured （37.07%）. Conclusion For middle-aged and elderly patients, when the application of cardiovascular system drugs, anti-infective drugs or anti-tumor drugs, it is necessary to monitor the liver function changes of patients for at least 6 days. If there are abnormalities, the drugs should be stopped or given treatment in time, to avoid the progress of drug-induced liver injury.

Objective:To analyze the iodine nutrition status of pregnant women in Weihai City before and after (2022, 2023) the iodine deficiency disorders (IDD) intervention, evaluate the effectiveness of intervention measures, and provide a scientific basis for adjusting IDD prevention strategies in the city.Methods:In May 2023, the intervention action of IDD was carried out for pregnent women in Weihai City. In April 2022 and December 2023, respectively, a cross-sectional survey method was conducted in four districts (cities) of Weihai City. Each district (city) was divided into five areas (east, west, south, north, and central) each year, and one township (street) was selected from each areas. At least 20 pregnant women were selected from each township (street) as survey subjects, and their household salt samples and random urine samples were collected to measure salt iodine and urinary iodine concentrations, and to compare the test results.Results:A total of 922 household salt samples were tested, including 530 iodized salt samples and 469 qualified iodized salt samples. The median salt iodine was 24.00 mg/kg. The coverage rate of iodized salt, the qualified rate of iodized salt, and the consumption rate of qualified iodized salt were 57.48%, 88.49%, and 50.87%, respectively. No significant difference was observed in medians salt iodine between 2022 (24.26 mg/kg) and 2023 (24.00 mg/kg, Z = - 1.58, P = 0.113). However, the coverage rate of iodized salt and the consumption rate of qualified iodized salt in 2023 werehigher than those in 2022 [73.72% (373/506) vs 37.74% (157/416), 65.22% (330/506) vs 33.41% (139/416), χ 2 = 120.90, 92.40, P < 0.001]. A total of 922 urine samples were collected from pregnant women, with a median urinary iodine of 135.90 μg/L. The median urinary iodine of pregnant women in 2022 was 113.55 μg/L. There was a statistically significant difference in medians urinary iodine among different regions ( H = 27.91, P < 0.001). The median urinary iodine of pregnant women in 2023 was 153.00 μg/L. There was no statistically significant difference in medians urinary iodine among different regions ( H = 3.33, P = 0.343). The medians urinary iodine of pregnant women in Huancui District, Wendeng District, and Rushan City in 2023 (156.60, 155.00, 140.85 μg/L) were higher than those in 2022 (93.60, 110.00, 110.70 μg/L), and the differences were statistically significant ( Z = - 5.44, - 4.92, - 5.99, P < 0.001). The median urinary iodine of pregnant women in Weihai City in 2023 showed a statistically significant difference compared to 2022 ( Z = - 7.62, P < 0.001). Conclusions:The IDD intervention measures in Weihai City have achieved good results, and the coverage of iodized salt, the consumption rate of qualified iodized salt, and the iodine nutrition level of pregnant women have improved. We should continue to implement intervention measures, improve the iodine nutrition level of key populations, and maintain a sustained elimination of IDD.

Objective:To assess the efficacy and safety of Tacrolimus（TAC）in combination with glucocorticosteroid（GC）for treating IgA vasculitis nephritis（IgAVN）in children.Methods:A retrospective analysis was conducted on pediatric patients who were diagnosed with IgAVN from January 2015 to January 2022 in Children's Hospital of Hebei Province.The patients presented with nephrotic-range proteinuria or persistent urine protein（>0.5g/24 h）despite adequate glucocorticoid and other treatments in patients who do not reach massive proteinuria levels.They were treated with TAC combined with GC. The following laboratory parameters were obtained for outcome assessment: 24-hour urinary protein excretion, serum albumin, serum creatinine levels, and fasting blood glucose measurements. The efficacy and adverse reactions of TAC were summarized.Results:A total of 97 children (55 males and 42 females) were included. The average age of diagnosis of IgA vasculitis was (8.65±2.46) years, and 95.9% of the children developed renal involvement within 30 days after diagnosis. Pathological examination of renal puncture: 5 cases of grade Ⅱa, 2 cases of grade Ⅱb, 31 cases of grade Ⅲa, 57 cases of grade Ⅲb, and 2 cases of grade Ⅳb.Remission rate at 3 months was 96.9%（94/97）.Three patients failed to achieve clinical remission who were treaed with other immunosuppressants.After 1, 3, 6 and 12 months of TAC treatment, the urine protein levels of 94 children were lower than those before treatment, and the differences were statistically significant ( P < 0.05), showing a gradual downward trend. Serum albumin levels were higher than those before treatment, and the differences were statistically significant ( P < 0.05), showing a gradual upward trend.After 3 months and 6 months of TAC treatment, the serum creatinine and fasting blood glucose of the children increased. With the remission of the disease, TAC dosage decreased, the mean values of serum creatinine and fasting blood glucose decreased after 12 months of treatment.The average treatment time of TAC was (10.8±2.6) months, the average follow-up time was (3.33±1.56) years, and the longest follow-up time was 8 years. During the follow-up period, there were no serious adverse reactions such as gastrointestinal discomfort, liver function damage and severe infection. After stopping GC and TAC treatment, 80 children got sustained remission. Conclusion:The combination of TAC and GC has been proved to be effective in treating IgAVN in children.The overall effective rate is high,and clinical remission can be achieved quickly with relatively mild adverse reactions.

Objective:To analyze the association between household and leisure-time physical activity (HLPA) and the risk of cardiometabolic multimorbidity (CMM) in the elderly.Methods:This retrospective cohort study utilized three longitudinal datasets from the Chinese Longitudinal Healthy Longevity and Happy Family Study (CLHLS-HF) covering 2008-2018, 2011-2018, and 2014-2018. A total of 10 876 participants aged ≥65 years who completed at least one follow-up were enrolled for cohort analysis. The general data, lifestyle, histories of chronic diseases, and physical examination results were collected. The HLPA score was utilized as an indicator to assess the degree of HLPA participation of the study subjects, the subjects were divided into 4 groups by quartile of HLPA score (Q1, Q2, Q3, and Q4), and were stratified jointly by sex, type of residence and household income; stratified Cox regression was applied to analyze the association between HLPA score and the risk of CMM morbidity, and Cox regression combined with restricted cubic spline (RCS) model was utilized to analyze the dose-response relationship between HLPA score and CMM morbidity.Results:The cohort was observed for a total of 51 630.24 person-years, with a median follow-up time of 3.95 (2.57, 6.04) years, with 576 new cases of CMM and an incidence density of 11.16 per 1 000 person-years. Compared with the HLPA score Q1 group, the risk of CMM morbidity was significantly reduced by 31%, 41%, and 44% in the elderly in the Q2 ( HR=0.69, 95% CI: 0.53-0.90), Q3 ( HR=0.59, 95% CI: 0.45-0.77) and Q4 ( HR=0.56, 95% CI: 0.42-0.74) groups, respectively (all P<0.05). The HLPA score was non-linearly associated with CMM morbidity ( P for nonlinear=0.010), with the risk of CMM morbidity decreasing with the increase of HLPA score, with a significant downward trend up to the median, after which the decline leveled off. There was an interaction between the HLPA score and exercise ( P for interaction=0.016); there was a negative association between the HLPA score and the risk of CMM morbidity in the no-exercise population ( HR=0.65, 95% CI: 0.52-0.80, P<0.001). Conclusion:There is a nonlinear negative association between HLPA and the risk CMM morbidity in elderly in China, and interventions focused on those who do not exercise may yield better results.

Objective To explore the influencing factors of immune-associated thyroid dysfunction caused by sintilimab treatment in solid tumors and construct a prediction model.Methods Medical records of patients diagnosed with solid tumors and treated with sintilimab at Peking University People's Hospital(Xizhimen Campus,Tongzhou Campus,Shijiazhuang Campus)from January 2023 to September 2024 were collected to explore the influencing factors that caused immune-related thyroid dysfunction using univariate and multifactorial binary logistic regression analyses and to establish a prediction model.The predictive effect of the model was assessed using the receiver operating characteristic(ROC)curve.Results A total of 120 patients were included,and 33 presented with immune-related thyroid dysfunction.Multifactorial logistic regression analysis revealed that thyroid-stimulating hormone(TSH)[OR=2.470,95%CI=(1.279,4.771)]and treatment cycles[OR=1.298,95%CI=(1.117,1.509)]were independent risk factors for the occurrence of immune-associated thyroid dysfunction,and the difference was statistically significant(P＜0.05).The area under the ROC curve was(0.897±0.043)[95%CI=(0.813,0.981)],the Yoden index was 0.703,and the model prediction accuracy was 86.5%.Conclusion The risk of immune-related thyroid dysfunction caused by sintilimab is high,and TSH and treatment cycle are the influencing factors,and the constructed model has certain predictive value and is of reference significance.

Objective:To construct and verify a risk prediction model for pulmonary infection in patients with aneurysmal subarachnoid hemorrhage (aSAH) after craniotomy and clipping, providing theoretical basis and practical guidance for improving the quality of postoperative care.Methods:Using the convenience sampling method, a retrospective selection was made of 397 patients with aSAH after craniotomy and clipping who were hospitalized in the Department of Neurosurgery of Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) from January 2019 to December 2023 as the modeling group. They were randomly divided into the training set and the test set at a ratio of 7:3, with 278 cases in the training set and 119 cases in the test set. Patients were divided into the infection group and the non-infection group based on whether they developed pulmonary infection. Univariate analysis was used to model the risk factors of pulmonary infection after aSAH craniotomy and clamping in the group, and Lasso regression was used to construct a predictive model. A total of 119 patients with aSAH admitted to the neurosurgery department of the same hospital from January to April 2024 were selected for the external validation of the model. The predictive effect of the model was evaluated through the receiver operating characteristic (ROC) curve.Results:In the modeling group, there were 216 male patients and 181 female patients. The incidence of pulmonary infection was 38.54% (153/397). Finally, five influencing factors, namely stroke, Hunt-Hess classification, mechanical ventilation, indwelling nasogastric tube and the timing of initiating enteral nutrition, were included to construct a predictive model. The areas under the ROC curves of the nomogram prediction models of this model in the training set, test set, and external validation group were 0.859(95% CI 0.791-0.928), 0.843(95% CI 0.796-0.890), and 0.800(95% CI 0.711-0.889), respectively. The calibration curve shows that the model's prediction fits well with the actual situation and has a high degree of calibration. Decision curve analysis indicates that this model has high clinical application value under different risk thresholds. Conclusions:The risk prediction model for pulmonary infection in patients after craniotomy and clipping with aSAH has good discrimination and calibration, which can provide reference for medical staff to identify high-risk patients at an early stage and take preventive intervention measures.