Study on the allocation efficiency of medical and health resources in Hainan Province: Based on the super-efficiency SBM-Malmquist model.

The equity and efficiency of medical and health resource allocation is the key point of health reform in all countries. Poor allocation efficiency of health resources will seriously affect the sustainable and high-quality development of health causes. Hainan Province is the only free trade port with Chinese characteristics in China, which means that Hainan has ushered in a brand-new development under the policy of free trade port. This study aims to adopt policies to improve the efficiency of medical and health resource allocation in Hainan Province and provide references for other regions. In this study, the Super-efficiency SBM and Malmquist models were used to analyze the static and dynamic efficiency of medical and health resource allocation in Hainan Province during 2016-2020. The results showed that, statically, the average efficiency of comprehensive allocation of health resources in Hainan Province from 2016 to 2020 was 0.975, showing poor overall performance and significant regional differences. Dynamically, the average index of allocation efficiency of medical and health resources was 0.934, showing a negative growth trend. The technical efficiency and scale efficiency of health resource allocation efficiency showed positive growth, while the technical progress and pure technical efficiency showed negative growth. It shows that it is influenced by both scale efficiency and technological progress, among which technological progress is the key factor. Therefore, some policy suggestions are put forward to further optimize the allocation of medical and health resources and improve utilization efficiency.

Assessment of durable chemoimmunotherapy response via circulating tumor DNA in advanced esophageal squamous cell carcinoma.

Immune checkpoint inhibitor (ICI)-based therapies have shown promising advances for the first-line treatment of advanced or metastatic esophageal cancer (EC). However, few studies concerning the identification of patients who achieve durable response from ICIs have been previously reported. In the present study, pre- and on-treatment plasma circulating tumor DNA (ctDNA) were analyzed in 10 patients with advanced esophageal squamous cell cancer (ESCC) receiving first-line chemoimmunotherapy. Patients with decreased molecular tumor burden index (mTBI) >7% experienced longer progression-free survival (PFS) and durable clinical benefit (DCB, PFS ≥ 6 months). In addition, five patients showed stable disease at first scan, all three patients with decreased mTBI > 7% achieved DCB, while two cases with decreased mTBI ≤ 7% experienced non-DCB. Our results demonstrate that ctDNA monitor might help identify which ESCC patients respond to chemoimmunotherapy.

A Novel End-to-End Biliary-to-Biliary Anastomosis Technique for Iatrogenic Bile Duct Injury of Strasberg-Bismuth E1-4 Treatment: A Retrospective Study and in vivo Assessment.

Background: An iatrogenic bile duct injury (IBDI) is a severe complication that has a great impact on the physical and mental quality of life of the patients, especially for patients with postoperative benign biliary stricture. The effective measures for end-to-end biliary-to-biliary anastomosis intraoperative are essential to prevent the postoperative bile duct stricture, but also a challenge even to the most skilled biliary tract surgeon. Objective: A postoperative benign biliary stricture is an extremely intractable complication that occurs following IBDI. This study aimed to introduce a novel end-to-end biliary-to-biliary anastomosis technique named fish-mouth-shaped (FMS) end-to-end biliary-to-biliary reconstruction and determine the safety and effectiveness for preventing the postoperative benign biliary stricture in both rats and humans. Methods: In this study, 18 patients with biliary injury who underwent an FMS reconstruction procedure were retrospectively analyzed. Their general information, disease of the first hospitalization, operation method, and classification of bile duct injury (BDI) were collected. The postoperative complications were evaluated immediately perioperatively and the long-term complications were followed up at the later period of at least 5 years. An IBDI animal model using 18 male rats was developed for animal-based evaluations. A bile duct diathermy injury model was used to mimic BDI. The FMS group underwent an FMS reconstruction procedure while the control group underwent common end-to-end biliary-to-biliary anastomosis, a sham operation group was also established. The blood samples, liver, spleen, and common bile duct tissues were harvested for further assessments. Results: In the retrospective study, there was no postoperative mortality and no patient developed cholangitis during the 5-years postoperation follow-up. In the study of IBDI animal models, compared with the control group, the FMS reconstruction procedure reduced the occurrence of benign biliary stenosis, liver function damage, and jaundice. The blood tests as well as morphological and pathological observations revealed that rats in the FMS reconstruction group had a better recovery than those in the control group. Conclusions: An FMS reconstruction procedure is a safe and efficient BDI treatment method.

Divergent Paths, Same Goal: A Pair-Electrosynthesis Tactic for Cost-Efficient and Exclusive Formate Production by Metal-Organic-Framework-Derived 2D Electrocatalysts.

Electrosynthesis of formic acid/formate is a promising alternative protocol to industrial processes. Herein, a pioneering pair-electrosynthesis tactic is reported for exclusively producing formate via coupling selectively electrocatalytic methanol oxidation reaction (MOR) and CO2 reduction reaction (CO2 RR), in which the electrode derived from Ni-based metal-organic framework (Ni-MOF) nanosheet arrays (Ni-NF-Af), as well as the Bi-MOF-derived ultrathin bismuthenes (Bi-enes), both obtained through an in situ electrochemical conversion process, are used as efficient anodic and cathodic electrocatalysts, respectively, achieving concurrent yielding of the same high-value product at both electrodes with greatly reduced energy input. The as-prepared Ni-NF-Af only needs quite low potentials to reach large current densities (e.g., 100 mA cm-2 @1.345 V) with ≈100% selectivity for anodic methanol-to-formate conversion. Meanwhile, for CO2 RR in the cathode, the as-prepared Bi-enes can simultaneously exhibit near-unity selectivity, large current densities, and good stability in a wide potential window toward formate production. Consequently, the coupled MOR//CO2 RR system based on the distinctive MOF-derived catalysts displays excellent performance for pair-electrosynthesis of formate, delivering high current densities and nearly 100% selectivity for formate production in both the anode and the cathode. This work provides a novel way to design advanced MOF-derived electrocatalysts and innovative electrolytic systems for electrochemical production of value-added feedstocks.

Design, step-economical diversity-oriented synthesis of an N-heterocyclic library containing a pyrimidine moiety: discovery of novel potential herbicidal agents.

The synthesis of highly diverse libraries has become of paramount importance for obtaining novel leads for drug and agrochemical discovery. Herein, the step-economical diversity-oriented synthesis of a library of various pyrimidine-N-heterocycle hybrids was developed, in which a 4,6-dimethoxypyrimidine core was incorporated into nine kinds of N-heterocycles. A total of 34 structurally diverse compounds were synthesized via a two-step process from very simple and commercially available starting materials. Further, in vivo biological screening of this library identified 11 active compounds that exhibited good post-emergence herbicidal activity against D. sanguinalis at 750 g ai per ha. More importantly, pyrimidine-tetrahydrocarbazole hybrid 5q showed good to excellent herbicidal activity against five test weeds at the same dosage. Pyrimidine-tetrahydrocarbazole hybrids represent a novel class of herbicidal agents that may become promising lead compounds in the herbicidal discovery process.

Heavy metal concentrations in aquatic organisms (fishes, shrimp and crabs) and health risk assessment in China.

This paper analyzed the spatiotemporal distribution of heavy metals in 6746 samples of aquatic organisms (fishes, shrimp and crabs), to make health risk assessments of six heavy metals (As, Cd, Cr, Cu, Hg and Pb). The results indicated that there were significant differences of heavy metal concentrations between different groups of aquatic organisms, months and provinces. The concentrations of Cd, Cr, Hg and Pb varied greatly within one year, with levels higher in summer and autumn, and lower in spring and winter. Crabs in Shandong, Shanxi, Zhejiang and Shanghai posed a high risk of Cd exposure, with the average Cd level exceeding the limit set by China (0.5 mg/kg, w.w.). In addition, the average TRCd value in sea crab was greater than 10-4, indicating a high cancer risk. However, the average THQ values of the six metals were all below 1 in China, and there was no overall non-carcinogenic risk.

Heavy metals in aquatic products and the health risk assessment to population in China.

In this paper, a total of 62,712 aquatic product samples were collected from 32 provinces of China during 2015-2017. By analyzing the spatial distributions and non-parametric tests of five heavy metals (lead (Pb), mercury (Hg), cadmium (Cd), chromium (Cr), and arsenic (As)) in four aquatic product (fish (n = 44,353), shrimp (n = 8453), crab (n = 5367), and shellfish (n = 4539)), it was found that the concentrations of the five heavy metals in the same aquatic product are significantly different in different regions. Furthermore, we calculated daily estimated intake (EDI) of each of the five heavy metals and assessed non-cancer risk and cancer risk using target hazard quotient (THQ) and target cancer risk (TR), respectively. The results showed that for mean exposure levels, the THQ values in four aquatic products were all below one, meaning that there was no non-carcinogenic risk. For high exposure levels, the hazard index (HI) value exceeded one in fish in North China, which means the potential non-carcinogenic risk should not be ignored. As for cadmium, most of the TR values in crab and shellfish exceed 1 × 10-4 in North China, East China, and South China. For chromium, except for Northeast China, the TR values in fish in other regions exceed 1 × 10-4; it indicated that the cancer risk caused by cadmium or chromium should not be ignored.

Treatment patterns and direct medical costs of metastatic colorectal cancer patients: a retrospective study of electronic medical records from urban China.

Objectives: To describe direct medical costs associated with each line of treatment among metastatic colorectal cancer (mCRC) patients in China.Methods: Electronic medical records between 2011 and 2016 were extracted from 12 tertiary hospitals in China for adult patients who initiated third-line treatment at least nine months before the end of data collection. Direct medical costs included costs of wards, diagnostic tests, surgical procedures, special materials, drugs and others. Costs were assessed by line of treatment, and drug costs were further breakdown for patients receiving chemotherapy alone and those receiving chemo- and biologics-combined therapy.Results: Of the 404 mCRC patients, the mean age was 55 years old and 62% were male. Oxaliplatin- and irinotecan-based regimens dominated first- and second-line treatment, respectively (44 and 37%). From first- to second- to third-line, the proportion of patients receiving targeted biologics increased from 18% at first-line and 12% at second-line to 34% at third-line; median number of treatment cycles reduced from 6 to 4 and to 2. The corresponding mean direct medical costs per person per cycle increased from $2,514 to $2,678 to $5,121. Mean drug costs per cycle increased from $2,314 to $2,673 to $4,316 among patients receiving chemotherapy alone and from $3,245 to $2,717 to $6,533 among patients receiving chemo- and biologics-combined therapy.Conclusions: Before 2017, mCRC patients in China did not receive the maximum benefits of precision medicine breakthroughs. Reduced treatment cycles and increased costs per cycle from first- to third-line suggested poor healthcare resource utilization. With earlier initiation and more treatment cycles, targeted biologics may better demonstrate their effectiveness among Chinese patients. Our findings reflected the urgent need to increase drug accessibility in China before 2017 and underscore that including innovative biologics into Chinese health insurance plans can reduce patients' economic burden and improve the management of mCRC.

Asynchrony of Base-Pair Breaking and Nucleotide Releasing of Helicases in DNA Unwinding.

Helicases harness the energy of nucleotide triphosphate hydrolysis to unwind double-stranded DNA (dsDNA) in discrete steps. In spite of intensive studies, the mechanism of stepping is still poorly understood. Here, we applied single-molecule fluorescent resonant energy transfer to characterize the stepping of two nonring helicases, Escherichia coli RecQ ( E. coli RecQ) and Saccharomyces cerevisiae Pif1 (ScPif1). Our data showed that when forked dsDNA with free overhangs are used as substrates, both E. coli RecQ and ScPif1 unwind the dsDNA in nonuniform steps that distribute over broad ranges. When tension is exerted on the overhangs, the overall profile of the step-size distribution of ScPif1 is narrowed, whereas that of E. coli RecQ remains unchanged. Moreover, the measured step sizes of the both helicases concentrate on integral multiples of a half base pair. We propose a universal stepping mechanism, in which a helicase breaks one base pair at a time and sequesters the nascent nucleotides and then releases them after a random number of base-pair breaking events. The mechanism can interpret the observed unwinding patterns quantitatively and provides a general view of the helicase activity.

Contamination, source identification, and risk assessment of polycyclic aromatic hydrocarbons in the soils of vegetable greenhouses in Shandong, China.

The concentrations of 16 polycyclic aromatic hydrocarbons (PAHs) were analyzed in soil (n=196) and vegetable (n=30) collected from greenhouses, and also in the soil (n=27) collected from agriculture fields close to the greenhouses in Shandong Province, China. The total PAH concentration (∑16PAH) ranged from 152.2µg/kg to 1317.7µg/kg, within the moderate range in agricultural soils of China. Three-ring PAHs were the dominant species, with Phe (16.3%), Ace (13.1%), and Fl (10.5%) as the major compounds. The concentrations of low molecular weight (LMW ≤3 rings) PAHs were high in the east and north of Shandong, while the concentrations of high molecular weight (HMW ≥4 rings) PAHs were high in the south and west of the study area. The PAH level in soils in industrial areas (IN) was higher than those in transport areas (TR) and rural areas (RR). No significant difference in concentration of ∑16PAH and composition was observed in soils of vegetable greenhouses and field soils. PAH concentration exhibited a weakly positive correlation with alkaline nitrogen, available phosphorus in soil, but a weakly negative correlation with soil pH. However, no obvious correlation was observed between PAH concentration and organic matter of soil, or ages of vegetable greenhouses. ∑16PAH in vegetables ranged from 89.9µg/kg to 489.4µg/kg, and LMW PAHs in vegetables positively correlated with those in soils. The sources of PAHs were identified and quantitatively assessed through positive matrix factorization. The main source of PAHs in RR was coal combustion, while the source was traffic in TR and IN. Moreover, petroleum source, coke source, biomass combustion, or mixed sources also contributed to PAH pollution. According to Canadian soil quality guidelines, exposure to greenhouse soils in Shandong posed no risk to human health.

Correlation between dual-axis rotational coronary angiography and intravascular ultrasound in a coronary lesion assessment.

The purpose of this study was to evaluate the accuracy of dual-axis rotational coronary angiography (DARCA) for coronary lesion assessment by directly comparing with intravascular ultrasound (IVUS). From October 2014 to December 2015, 40 patients (58 lesions) who had undergone both DARCA and IVUS were included in the image analysis. The minimum lumen diameter (MLD), lesion length, reference vessel diameter (RVD) and percent diameter stenosis at the same lesion, were identified and assessed. Significant correlation with IVUS was found for DARCA in either lesion length (r = 0.90, P < 0.001) or RVD (r = 0.81, P < 0.001) comparison. DARCA had fair correlation with IVUS for both MLD (r = 0.65, P < 0.001) and diameter stenosis (r = 0.48, P < 0.001). From the Bland-Altman plots, there was a good agreement between DARCA and IVUS regarding MLD (mean difference: -0.23 mm, 95 % limits of agreement: -0.96 to 0.50 mm) and RVD (mean difference: -0.15 mm, 95 % limits of agreement: -0.85 to 0.55 mm), while lesser agreement was found on lesion length (mean difference: -3.39 mm, 95 % limits of agreement: -12.63 to 5.85 mm) and diameter stenosis (mean difference: 4.82 %, 95 % limits of agreement: -17.05 to 26.68 %). There is an adequate correlation and agreement between DARCA and IVUS in coronary lesion assessment.

Benefits, costs, and livelihood implications of a regional payment for ecosystem service program.

Despite broad interest in using payment for ecosystem services to promote changes in the use of natural capital, there are few expost assessments of impacts of payment for ecosystem services programs on ecosystem service provision, program cost, and changes in livelihoods resulting from program participation. In this paper, we evaluate the Paddy Land-to-Dry Land (PLDL) program in Beijing, China, and associated changes in service providers' livelihood activities. The PLDL is a land use conversion program that aims to protect water quality and quantity for the only surface water reservoir that serves Beijing, China's capital city with nearly 20 million residents. Our analysis integrates hydrologic data with household survey data and shows that the PLDL generates benefits of improved water quantity and quality that exceed the costs of reduced agricultural output. The PLDL has an overall benefit-cost ratio of 1.5, and both downstream beneficiaries and upstream providers gain from the program. Household data show that changes in livelihood activities may offset some of the desired effects of the program through increased expenditures on agricultural fertilizers. Overall, however, reductions in fertilizer leaching from land use change dominate so that the program still has a positive net impact on water quality. This program is a successful example of water users paying upstream landholders to improve water quantity and quality through land use change. Program evaluation also highlights the importance of considering behavioral changes by program participants.