Ethnic disparities and temporal trends in health resource allocation: a retrospective decadal analysis in Sichuan, a multi-ethnic Province of Southwest China (2009-2019).

BACKGROUND: Research on health resource allocation trends in ethnic minority and impoverished areas in China is limited since the 2009 Medical Reform. This study aimed to investigate the variations and inequalities in health resource distribution among ethnic minority, poverty-stricken, and non-minority regions in Sichuan Province, a multi-ethnic province in Southwest China, from 2009 to 2019. METHODS: The numbers of beds, doctors and nurses were retrospectively sourced from the Sichuan Health Statistics Yearbook between 2009 and 2019. All the 181 counties in Sichuan Province were categorized into five groups: Yi, Zang, other ethnic minority, poverty-stricken, and non-minority county. The Theil index, adjusted for population size, was used to evaluate health resource allocation inequalities. RESULTS: From 2009 to 2019, the number of beds (Bedp1000), doctors (Docp1000), and nurses (Nurp1000) per 1000 individuals in ethnic minority and poverty-stricken counties consistently remained lower than non-minority counties. The growth rates of Bedp1000 in Yi (140%) and other ethnic minority counties (127%) were higher than in non-minority counties (121%), while the growth rates of Docp1000 in Yi (20%) and Zang (11%) counties were lower than non-minority counties (61%). Docp1000 in 33% and 50% of Yi and Zang ethnic counties decreased, respectively. Nurp1000 in Yi (240%) and other ethnic minority (316%) counties increased faster than non-minority counties (198%). The Theil index for beds and nurses declined, while the index for doctors increased. Key factors driving increases in bed allocation include preferential policies and economic development levels, while health practitioner income, economic development levels and geographical environment significantly influence doctor and nurse allocation. CONCLUSIONS: Preferential policies have been successful in increasing the number of beds in health facilities, but not healthcare workers, in ethnic minority regions. The ethnic disparities in doctor allocation increased in Sichuan Province. To increase the number of doctors and nurses in ethnic minority and poverty-stricken regions, particularly in Yi counties, more preferential policies and resources should be introduced.

Biomimetic Cell-Derived Nanoparticles: Emerging Platforms for Cancer Immunotherapy.

Cancer immunotherapy can significantly prevent tumor growth and metastasis by activating the autoimmune system without destroying normal cells. Although cancer immunotherapy has made some achievements in clinical cancer treatment, it is still restricted by systemic immunotoxicity, immune cell dysfunction, cancer heterogeneity, and the immunosuppressive tumor microenvironment (ITME). Biomimetic cell-derived nanoparticles are attracting considerable interest due to their better biocompatibility and lower immunogenicity. Moreover, biomimetic cell-derived nanoparticles can achieve different preferred biological effects due to their inherent abundant source cell-relevant functions. This review summarizes the latest developments in biomimetic cell-derived nanoparticles for cancer immunotherapy, discusses the applications of each biomimetic system in cancer immunotherapy, and analyzes the challenges for clinical transformation.

Remimazolam for the Prevention of Emergence Delirium in Children Following Tonsillectomy and Adenoidectomy Under Sevoflurane Anesthesia: A Randomized Controlled Study.

Purpose: To identify the effectiveness of remimazolam at the end of tonsillectomy and adenoidectomy for preventing emergence delirium in children under sevoflurane anesthesia. Patients and Methods: One hundred and four patients aged 3-7 years scheduled for tonsillectomy and adenoidectomy under sevoflurane anesthesia were recruited. Patients were randomly assigned to receive either remimazolam 0.2 mg kg-1 (intervention, n=52) or 0.9% normal saline (control, n=52) at the end of the procedure. The primary outcome was the incidence of emergence delirium, defined as a Pediatric Anesthesia Emergence Delirium (PAED) score ≥10. Secondary outcomes were peak PAED score, emergence time, postoperative pain intensity, length of postanesthesia care unit (PACU) stay, parental satisfaction, and postoperative behavior changes three days postoperatively. Results: Emergence delirium occurred in 6 of 51 (12%) patients receiving remimazolam versus 22 of 50 (44%) patients receiving saline (risk difference 32% [95% confidence interval, 16% to 49%], relative risk 0.27 [95% confidence interval, 0.12 to 0.60]; P<0.001). The peak PAED scores (median [interquartile range]) were lower in the remimazolam group than in the saline group (7 [6-8] versus 9 [8-11], P<0.001). Likewise, parental satisfaction was improved in the remimazolam group compared with the saline group (9 [8-10] versus 8 [7-8], P<0.001). There was no difference between groups concerning postoperative pain scores, length of PACU stay, or postoperative behavior changes. Conclusion: In children undergoing tonsillectomy and adenoidectomy, administration of remimazolam 0.2 mg kg-1 at the end of the surgery, compared with 0.9% saline, resulted in a significantly lower likelihood of emergence delirium after sevoflurane anesthesia.

Electrochemically Controlled Switchable Copolymerization of Lactide, Carbon Dioxide, and Epoxides.

Electrochemical redox-control is an emerging strategy for the regulation of polymerization process without the addition of external oxidants and reductants, which enables the control over composition, microstructure and properties of the polymer products. In this paper, based on the chemical selectivity of heterometallic Salen-Co-Mn complexes of different valences, an electrochemically switchable strategy was developed for the copolymerization of lactide (LA), CO2 and epoxides. The switchable redox reactions endowed this system with the capability to easily synthesize a multi-block copolymer of polylactide (PLA) and polycarbonate (PC). Moreover, the multi-block copolymer could be further modified by introducing various monomers with different microstructures and functional groups.

One-Pot Precision Synthesis of AB, ABA and ABC Block Copolymers via Switchable Catalysis.

The switchable catalysis using a commercial salenMn catalyst was firstly developed and applied in the one-pot selective copolymerization from anhydrides, epoxides, CO2 and ϵ-caprolactone (ϵ-CL) mixtures for the precise synthesis of AB, ABA and novel ABC block copolymers. The observed unique double switch process comprising three different polymerization cycles was rationalized by theoretical calculations. Surprisingly, the first block turned out to be an efficient macromolecular initiator for the consecutive introduction of carbonate linkages into copolymers, albeit with dominant cyclization with the catalyst alone. Further, through the selective reaction on different epoxides, the switchable copolymerization of up to five monomers was achieved yielding well-defined multi-block copolymers with structural diversity and functionality.

Monomer Controlled Switchable Copolymerization: A Feasible Route for the Functionalization of Poly(lactide).

Switchable polymerization is an attractive strategy to enable the sequential selectivity of multi-block polyesters. Besides, these well-defined multi-block polyesters could enable further modification for wider applications. Herein, based on the reversible insertion of CO2 by Salen-MnIII , a new monomer controlled self-switchable polymerization route was developed. Chemoselective ring opening copolymerization of O-carboxyanhydrides (OCAs) and lactide (LA) was explored without cocatalyst. The sequential conversion of OCAs and LA into the polymer chain could form multi-block polyesters. Based on this strategy, a series of multi-block polyesters with different pendant groups were synthesized. Furthermore, by modifying the propargyl-containing copolymers with quaternary ammonium groups, we have realized antibacterial functionalization of PLA. These results imply the potential application of this strategy for the fabrication of functional polymers for biomedical applications.

A trinuclear salen-Al complex for copolymerization of epoxides and anhydride: mechanistic insight into a cocatalyst-free system.

A rare example of a trinuclear salen-Al complex is reported. Due to the intramolecular interaction, the trinuclear salen-Al complex can catalyze copolymerization with high activity in the absence of any cocatalyst. On the basis of a covalent coordination insertion mechanism, ABC(1)C(2) type tetrablock copolymers were produced using an hydroxyl initiator.