Objective:To analyze the equality of health resource allocation in functional areas of Beijing from 2012 to 2022, so as to provide reference for optimizing the allocation of health resources during the 14th Five-Year Plan and long-term planning.Methods:According to the new urban master plan and the functional positioning of the capital, 16 districts in Beijing were divided into 4 functional regions(capital core area, urban functional expansion area, urban development new area, and ecological conservation area). Based on the analysis of permanent population, the levels of health resources in each region and each administrative district were compared, and the equity of health resources was measured by using the Dagum Gini coefficient.Results:In 2022, the Gini coefficients of medical and health resources in Beijing, including the number of beds, number of health technicians, and number of practicing(assistant) physicians, were 0.71, 0.65, and 0.63, respectively, with no significant change compared to 2012. While the Gini coefficient for equipment priced over 10 000 yuan was 0.75, slightly lower than 0.79 in 2012. The differences in resource allocation mainly came from different regions. The Gini coefficient of the above four indicators in the urban functional expansion area was the lowest, followed by the capital core area, and the Gini coefficient of the ecological conservation area was the highest. The Dagum Gini coefficient of the four indicators of urban development new area showed a decreasing trend year by year.Conclusions:In recent years, there has been no significant change in the overall equality of medical and health resource allocation in Beijing. Only the Gini coefficient of urban development new area has shown a downward trend. It is necessary to further promote the fair and reasonable allocation of medical and health resources among functional areas in Beijing.

Objective To explore the risk factors for intracranial infection in patients after neurosurgery,con-struct and validate a Nomogram prediction model.Methods Data of 978 patients who underwent neurosurgery in a hospital in Nanjing from January 1,2019 to December 31,2022 were retrospectively analyzed.Independent risk fac-tors were screened through logistic univariate and multivariate analyses.Modeling variables were screened through Lasso regression.A Nomogram model was constructed and internally validated by logistic regression.Effectiveness of the model was evaluated with receiver operating characteristic(ROC)curve,calibration curve and decision curve.Results Among 978 patients underwent neurosurgery,293 had postoperative intracranial infection,with an inci-dence of healthcare-associated infection of 29.96％.There was no significant difference in age,gender,proportion of coronary heart disease,cerebral infarction,diabetes and hypertension between the infected group and the non-in-fected group(all P＞0.05).Multivariate logistic analysis showed that postoperative intracranial hypertension,fe-ver,increased neutrophil percentage in blood routine examination,turbid cerebrospinal fluid,positive Pan's test,decreased glucose concentration,abnormal ratio of cerebrospinal fluid/serum glucose,positive microbial culture,absence of indwelling external ventricular drainage tubes,presence of indwelling lumbar cistern drainage tubes,use of immunosuppressive agents,and long duration of surgery were independent risk factors for postoperative intracra-nial infection in patients who underwent neurosurgery(all P＜0.05).Fifteen variables were screened out through Lasso regression.Fourteen variables were finally included for modeling after collinear screening,missing data impu-tation(random forest method)and checking pairwise interaction items.A Nomogram prediction model was con-structed,with the area under ROC curve,sensitivity,specificity,and accuracy of 0.885,0.578,0.896,and 0.704,respectively.Internal validation of the model was conducted.The modeling and validation groups presented similar effects.The calibration curve and decision curve also indicated that the model had good predictive efficacy.Conclusion The constructed Nomogram prediction model for postoperative intracranial infection after neurosurgery is scientific,and the prediction indicators are easy to obtain.The model presents with high stability,reliability,and application value,thus can provide reference for the assessment of postoperative intracranial infection after neuro-surgery.

Objective:To analyze the impact created by the reallocation of a tertiary hospital on the neurosurgery inpatients volume in the functional core area of Beijing as the capital city, for reference to improve the healthcare resource reallocation policy.Methods:The data were obtained from the data sheet of discharged patients and the monthly report of medical statistics in Beijing. The study analyzed the average monthly neurosurgery inpatients volume, surgical beds and bed utilization rate of secondary or higher level hospitals from the core area, a tertiary hospital(hospital A), and as well as three tertiary hospitals(hospitals B, C and D)within 5 kilometers of Hospital A original location before and after the reallocation of Hospitls A. Periods of November 2017 to August 2018 and November 2018 to August 2019 respectively serve as the time frame before and after the relocation of Hospital A.Results:After the reallocation, the average monthly total inpatients volume, inpatients volume from other places, and local inpatients volume of neurosurgery at secondary or higher level hospitals in the core area decreased from 2 238, 1 610 and 628 to 1 526, 996 and 530 respectively. The inpatients volume changes were all statistically different( P<0.001). The number of neurosurgery inpatients in Hospital A and Hospital B increased from 983 and 659 to 1 316 and 934 respectively, as well as the number of neurosurgery inpatients in Hospital C and Hospital D did not change much. After the relocation of Hospital A, the number of surgical beds in secondary or higher level hospitals in the core area was reduced from 5 213 to 4 782, while that of Hospital A increased from 557 to 750, while the other three tertiary hospitals remained unchanged. The changes of bed utilization rate of the 4 hosptials were all less than 7.00%. Conclusions:After the reallocation Hospital A, the neurosurgery inpatient volume in the core area decreased, which was mainly contributed by the decrease of patients from other places, suggesting a positive outcome by the reallocation of healthcare resources in Beijing. On the other hand, it is necessary to study the influence of alternative medical resources on the reallocation effect.

Background: In China, secondary cytoreductive surgery (SCR) has been widely used in ovarian cancer (OC) over the past two decades. Although Gynecologic Oncology Group-0213 trial did not show its overall survival benefit in first relapsed patients, the questions on patient selection and effect of subsequent targeting therapy are still open. The preliminary data from our pre-SOC1 phase II study showed that selected patients with second relapse who never received SCR at recurrence may still benefit from surgery. Moreover, poly(ADP-ribose) polymerase inhibitors (PARPi) maintenance now has been a standard care for platinum sensitive relapsed OC. To our knowledge, no published or ongoing trial is trying to answer the question if patient can benefit from a potentially complete resection combined with PARPi maintenance in OC patients with secondary recurrence. Methods SOC-3 is a multi-center, open, randomized, controlled, phase II trial of SCR followed by chemotherapy and niraparib maintenance vs chemotherapy and niraparib maintenance in patients with platinum-sensitive second relapsed OC who never received SCR at recurrence. To guarantee surgical quality, if the sites had no experience of participating in any OC-related surgical trials, the number of recurrent lesions evaluated by central-reviewed positron emission tomography–computed tomography image shouldn't be more than 3. Eligible patients are randomly assigned in a 1:1 ratio to receive either SCR followed by 6 cyclesof platinum-based chemotherapy and niraparib maintenance or 6 cycles of platinum-based chemotherapy and niraparib maintenance alone. Patients who undergo at least 4 cycles of chemotherapy and must be, in the opinion of the investigator, without disease progression, will be assigned niraparib maintenance. Major inclusion criteria are secondary relapsed OC with a platinum-free interval of no less than 6 months and a possibly complete resection. Major exclusion criteria are borderline tumors and non-epithelial ovarian malignancies, received debulking surgery at recurrence and impossible to complete resection. The sample size is 96 patients. Primary endpoint is 12-month non-progression rate.

Background: Two randomized phase III trials (EORTC55971 and CHORUS) showed similar progression-free and overall survival in primary or interval debulking surgery in ovarian cancer, however both studies had limitations with lower rate of complete resection and lack of surgical qualifications for participating centers. There is no consensus on whether neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) could be a preferred approach in the management of advanced epithelial ovarian cancer (EOC) in the clinical practice. Methods The Asian SUNNY study is an open-label, multicenter, randomized controlled, phase III trial to compare the effect of primary debulking surgery (PDS) to NACT-IDS in stages IIIC and IV EOC, fallopian tube cancer (FTC) or primary peritoneal carcinoma (PPC).The hypothesis is that PDS enhances the survivorship when compared with NACT-IDS in advanced ovarian cancer. The primary objective is to clarify the role of PDS and NACT-IDS in the treatment of advanced ovarian cancer. Surgical quality assures include at least 50% of no gross residual (NGR) in PDS group in all centers and participating centers should be national cancer centers or designed ovarian cancer section or those with the experience participating surgical trials of ovarian cancer. Any participating center should be monitored evaluating the proportions of NGR by a training set. The aim of the surgery in both arms is maximal cytoreduction. Tumor burden of the disease is evaluated by diagnostic laparoscopy or positron emission tomography/computed tomography scan. Patients assigned to PDS group will undergo upfront maximal cytoreductive surgery within 3 weeks after biopsy, followed by 6 cycles of standard adjuvant chemotherapy. Patients assigned to NACT group will undergo 3 cycles of NACT-IDS, and subsequently 3 cycles of adjuvant chemotherapy. The maximal time interval between IDS and the initiation of adjuvant chemotherapy is 8 weeks. Major inclusion criteria are pathologic confirmed stage IIIC and IV EOC, FTC or PPC; ECOG performance status of 0 to 2; ASA score of 1 to 2. Major exclusion criteria are non-epithelial tumors as well as borderline tumors; low-grade carcinoma; mucinous ovarian cancer. The sample size is 456 subjects. Primary endpoint is overall survival.

Objective To assess the predictive value of early phrase echocardiography and cardiac biomarkers in patients with severe sepsis. Methods A retrospective analysis of severe septic patients (patients with acute coronary syndrome and end stage renal disease were excluded) in department of intensive care unit of Capital Medical University Affiliated Beijing Shijitan Hospital from January 2013 to December 2017 was conducted. The acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), myoglobin (MYO), creatine kinase (CK), MB isoenzyme of creatine kinase (CK-MB) within 6 hours after admission, and bedside echocardiography indexes [left ventricular ejection fraction (LVEF), the ratio of the peak blood flow velocity in the early stage of the mitral valve and the peak blood flow rate of the mitral valve (E/A ratio)] within 6 hours after diagnosis were recorded. The differences of indexes between patients with decreased contractile function (LVEF < 0.50) group and normal group, and the difference between dead group and survival group within 28-day were compared. Receiver operating characteristic (ROC) curve and Logistic regression analysis were conducted to assess the early detected prognostic value in severe sepsis patients. Results ① A total of 316 patients were enrolled in the survey period. Decreased cardiac systolic function (LVEF < 0.50) was found in 89 cases (28.2%), and cardiac diastolic function impaired (E/A ratio < 1) in 269 cases (85.1%); while 79 cases (25.0%) had both systolic function and diastolic function impairment. ② NT-proBNP and cTnI were statistically different between cardiac systolic function impaired group and normal group. Further Logistic regression analysis showed that only NT-proBNP was significantly correlated with LVEF [β=-1.311, odds ratio (OR) = 0.269, P < 0.001]. ③ Eighty-two of 316 cases were died in 28-day, and the 28-day mortality rate was 25.9%. Compared with the survival group, the ratio of E/A < 1, APACHEⅡ score, NT-proBNP, cTnI, MYO, CK and CK-MB were significantly increased in death group. The ROC curve analysis showed that the above indexes had diagnosed value for prognosis in severe sepsis patient, among which NT-proBNP and cTnI had higher predictive value [the area under ROC curve (AUC) were 0.920 and 0.901 respectively, both P < 0.001]. Multivariate Logistic regression analysis showed that APACHEⅡ score (β= 0.282, OR = 1.326, P < 0.001) and NT-proBNP (β= 0.402, OR = 1.261, P < 0.001) were independent risk factors for prognosis in patients with severe sepsis. Conclusions The LVEF values measured by echocardiography in early phrase were unrelated to 28-day prognosis. APACHEⅡ score, E/A ratio, NT-proBNP, cTnI, MYO, CK and CK-MB were related to 28-day prognosis. APACHEⅡ scores and NT-proBNP were independent prognostic factors in severe sepsis patient.

OBJECTIVETo investigate Epstein-Barr virus(EBV) infection in Hodgkin's lymphoma (HL) of Uygur patients and related clinicopathological characteristics.

METHODSEBV-encoded small RNA (EBER) was detected in 40 cases of HL and 20 cases of lymphoid reactive hyperplasia by in-situ hybridization. Expression of LMP2A in HL was investigated by immunohistochemistry.

RESULTSEBV was detected in 26/40 (65.0%) of HL and 5/20 of lymphoid reactive hyperplasia (P < 0.05). The expression level of EBER showed significant difference among various histological subtypes of HL (P < 0.05) and between patients with and without B symptom (P = 0.02). However, no difference was found in relation to gender, clinical stage and tumor burden. The expression of LMP2A in the mixed cellularity and nodular sclerosis classical HL associated with EBV infection was 57.7% (15/26). Expression of LMP2A was not detected in lymphoid reactive hyperplasia cases.

CONCLUSIONUyghur patients with Hodgkin's lymphoma have a high infection rate of EBV and distinct clinicopathologic characteristics.

Adolescent ; Adult ; Child ; Child, Preschool ; China ; ethnology ; Epstein-Barr Virus Infections ; Female ; Herpesvirus 4, Human ; isolation & purification ; Hodgkin Disease ; metabolism ; pathology ; virology ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Lymphatic Metastasis ; Male ; Middle Aged ; Pseudolymphoma ; metabolism ; pathology ; virology ; RNA, Viral ; metabolism ; Viral Matrix Proteins ; metabolism ; Young Adult

OBJECTIVETo detect the cytokines levels in serums of patients with trichloroethylene-induced hypersensitivity dermatitis and explore the effect biomarkers associated with this disease.

METHODSTwenty-two patients with TCE-induced hypersensitivity dermatitis, twenty-two healthy TCE-exposed workers from the same workshops with patients and twenty-two comparable unexposed controls were recruited in this study. Eight cytokines in serums from all subjects were detected using Liquid Suspended Biochip; the correlation among the eight cytokines including interleukin (IL)-1β (IL-1β), IL-5, IL-8, IL-10, interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), macrophage chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1β (MIP-1β) and the correlation between IL-5 and eosinophil count were analyzed.

RESULTSThe medians of levels of IL-1β, IFN-γ, IL-5, IL-10, MCP-1, MIP-1β, IL-8 among patients were 0.15, 80.13, 2.95, 6.45, 83.83, 1057.90, 440.22 pg/ml, respectively, which were higher than those among the TCE-exposed workers (0.09, 16.93, 0.11, 0.07, 28.75, 241.07, 28.26 pg/ml, respectively, all P values < 0.01) and unexposed controls (0.09, 3.14, 0.11, 0.07, 25.27, 209.64, 207.34 pg/ml, respectively, all P values < 0.01). The median of level of TNF-α among the patients was 13.26 pg/ml, which was significantly higher than that among TCE-exposed workers (4.87 pg/ml, P < 0.01) but not among unexposed controls; the median of level of IL-5 among the TCE-exposed workers was 0.11 pg/ml, which was significantly higher than that among the unexposed controls (0.11 pg/ml, P < 0.01). The median of levels of IL-8 among the unexposed controls was 207.34 pg/ml, which was significantly higher than that among the TCE-exposed workers (28.26 pg/ml, P < 0.01). In case group, except for correlation of TNF-α and IFN-γ, TNF-α and IL-5, the significant positive correlations were found among any two cytokines (r(IL-1β,IFN-γ) = 0.500, r(IL-1β,TNF-α) = 0.348, r(IL-1β,MCP-1) = 0.537, r(IL-1β,MIP-1β) = 0.477, r(IL-1β,IL-8) = 0.466, r(IL-1β,IL-5) = 0.610, r(IL-1β,IL-10) = 0.626, r(IFN-γ,MCP-1) = 0.460, r(IFN-γ,MIP-1β) = 0.491, r(IFN-γ,IL-8) = 0.322, r(IFN-γ,IL-5) = 0.532, r(IFN-γ,IL-10) = 0.511, r(TNF-α,MCP-1) = 0.325, r(TNF-α,MIP-1β) = 0.283, r(TNF-α,IL-8) = 0.430, r(TNF-α,IL-10) = 0.271, r(MCP-1,MIP-1β) = 0.659, r(MCP-1,IL-8) = 0.526, r(MCP-1,IL-5) = 0.504, r(MCP-1,IL-10) = 0.614, r(MIP-1β,IL-8) = 0.601, r(MIP-1β,IL-5) = 0.451, r(MIP-1β,IL-10) = 0.579, r(IL-8,IL-5) = 0.255, r(IL-8,IL-10) = 0.403, r(IL-5,IL-10) = 0.798, all P values < 0.05). The median of level of IL-5 among the patients with high eosinophils counts was 8.92 pg/ml, which was significantly higher than that among the patients with low eosinophils counts (1.04 pg/ml, P < 0.05).

CONCLUSIONThe abnormal production of IL-1β, IFN-γ, TNF-α, IL-8, MCP-1, MIP-1β, IL-5 and IL-10 was related with the pathogenesis of hypersensitivity dermatitis induced by TCE. These cytokines could be used as referential indexes in the early health surveillance and clinic disease treatment.

Adolescent ; Adult ; Chemokine CCL2 ; blood ; Chemokine CCL4 ; blood ; Dermatitis, Occupational ; blood ; etiology ; Female ; Humans ; Hypersensitivity ; blood ; Interferon-gamma ; blood ; Interleukins ; blood ; Male ; Trichloroethylene ; adverse effects ; Tumor Necrosis Factor-alpha ; blood ; Young Adult

Objective To evaluate the susceptibility of C6 glioma cells to Myxoma virus and the killing effect of Myxoma virus to the C6 glioma cells in vitro.Methods C6 glioma cells were infected with myxoma virus,used death virus as the negative control,5-FU as the positive control,DEMD as blank control.The number of living cells were counted every 24 h,and Western-Blot method,inverted microscope and MTT assay were applicated to observe the cell morphology and survival rate in each group.Results The cell number were decreased rapidly in virus effected group and 5-FU group,with significant differences to the negative and blank control groups.And cells in virus effected group appeared cytopathic effect.Conclusions C6 glioma cells were susceptible to myxoma virus and myxoma virus had killing effect to C6 glioma cells in vitro.