Purpose: To evaluate the early response of chemoradiotherapy (CRT) in nasopharyngeal carcinoma (NPC) based on intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and three-dimensional pseudo-continuous arterial spin labeling (3D pCASL). Materials and methods: Forty patients diagnosed with NPC were recruited and divided into complete remission (CR) and partial remission (PR) group after CRT. All patients underwent IVIM and ASL and the related parameters was obtained. These parameters include pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), average blood flow ( BFavg), minimum blood flow (BFmin), and maximum blood flow (BFmax). Student’s t test was used to compare the difference in ASL and IVIM derived parameters between CR and PR. The Areas under curve (AUC) of the receiver operating characteristic (ROC) was used to analyze the diagnostic performance of each parameter of ASL and IVIM to the treatment outcome. Results: the D value of IVIM in CR group was lower than that of the PR group ( P = 0.014),. Among the parameters of ASL, the BFavg and BFmax of the CR group were higher than those of the PR group(p = 0.004,0.013), but the BFmin had no statistical significance in the two groups（P = 0.54）. AUC of D, BFavg, and BFmax is about 0.731, 0.753, and 0.724, respectively, all of their combined AUC diagnosis was 0.812. Conclusion: The early response of NPC after CRT can predict by IVIM’s diffusion parameters and ASL-related blood flow parameters.

Background Health equity has persistently been a global concern. How to fairly and appropriately allocate health resources is a research hotspot. While Western China is relatively backward economically and presents difficulties for the allocation of health resources, little attention has been given to the equity of resource allocation there. This study analysed the equity of allocation of beds, physicians and nurses in Western China from 2014-2018 to provide targeted guidance for improving the equity of health resource allocation. Methods Data for 2014-2018 obtained from the Statistical Yearbook (2015-2019) of provinces (autonomous regions and municipalities) were used to analyse health resource allocation in terms of beds, physicians and nurses in Western China. The Lorenz curve and Gini coefficient were calculated to evaluate equity in the population dimension and geographic dimension. The Theil index was used to measure the inequity of the three indicators between minority and nonminority areas. Results The number of beds, physicians and nurses in Western China showed an increasing trend from 2014-2018. The Lorenz curve had a smaller curvature in the population dimension than in the geographic dimension. The Gini coefficients for health resources in the population dimension ranged from 0.044 to 0.079, and in the geographic dimension, the Gini coefficients ranged between 0.614 and 0.647. The above results showed that the equity of health resource allocation was better in the population dimension than in the geographic dimension. The Theil index ranged from 0.000 to 0.004 in the population dimension and from 0.095 to 0.326 in the geographic dimension, indicating that the inequity in health resource allocation was higher in the geographic dimension. The intergroup contribution ratios of the Theil index in both the population and geographic dimensions were greater than 60%, indicating that the inequity in resource allocation was mainly caused by intergroup differences, namely, the allocation of health resources within the province. Among them, the inequity of physicians and nurses allocation was the most obvious. Conclusions From 2014 to 2018, the total amount of health resources have improved in Western China. However, health resource allocation in Western China was still inequitable in the population and geographic dimensions, and the inequity of health resource allocation in the geographic dimension showed a tendency to worsen. Meanwhile, although the inequity of human recourse allocation was alleviated in 2018 compare with 2014, the inequity of human resource distribution within provinces was still obvious. The government can increase the number of health resources and improve the accessibility of health resources by increasing financial investment, strengthening humanistic care for health workers, and establishing internet hospitals.

目的 分析在校大学生进食障碍(eating disorder,ED)倾向状况.方法 采用简单随机抽样方法选取2020年2月广西医科大学275名在校大学生作为调查对象,对其进行问卷调查.分别将瘦身倾向维度分值≥14分、＜14分者纳入ED倾向组、非ED倾向组.结果 ED倾向组、非ED倾向组人数分别为22人、253人,分别占8.00％、92.00％.ED倾向组与非ED倾向组的瘦身倾向(t=22.974)、身体不满(t=6.266)、贪食(t=2.397)、完美主义(t=2.008)、恐惧成熟(t=3.889)、内感受意识(t=3.347)、无效感(t=2.680)得分比较,差异有统计学意义(P＜0.05).不同性别、居住地调查对象的瘦身倾向、身体不满得分比较,差异均有统计学意义(P＜0.05).结论 在校大学生进食情况总体处于健康水平,达到ED倾向标准的人数较少,ED倾向的发生涉及生理、心理、社会等多源性因素.

目的 探讨单、双指数模型扩散加权成像(diffusion weighted imaging,DWI)及三维伪连续动脉自旋标记(three dimensional pseudo-continuous arterial spin labeling,3DpCASL)技术在复发性鼻咽癌近期疗效预测中的潜在价值.材料与方法 前瞻性纳入34例复发性鼻咽癌患者,所有患者于治疗前行常规MRI、传统单指数模型DWI检查(b=0、800 s/mm2)和基于体素内不相干运动成像的双指数模型多b值DWI以及3DpCASL检查,治疗结束后行常规MRI检查.根据实体瘤疗效评估标准1.1将患者分为应答组(完全缓解和部分缓解)和无应答组(疾病稳定和疾病进展).比较两组间表观扩散系数(apparent diffusion coefficient,ADC)、慢速扩散系数(slow diffusion coefficient,Dslow)、快速扩散系数(fast diffusion coefficient,Dfast)、灌注分数(perfusion fraction,f)、肿瘤血流量(tumor blood flow,TBF)和相对肿瘤血流量(relative TBF,rTBF)值之间的差异.同时,根据治疗前后靶病灶退缩情况计算肿瘤消退率,并利用Spearman相关分析探索各参数与肿瘤退缩率之间的相关性.采用AUC值评估各参数的诊断价值.结果 应答组基线ADC及Dslow值明显低于无应答组(P<0.001).应答组基线TBF及rTBF值明显高于无应答组(P<0.001).治疗前ADC、Dslow值与肿瘤消退率呈负相关,治疗前TBF及rTBF值与肿瘤消退率呈正相关.ROC分析显示,ADC、Dslow、TBF及rTBF预测复发性鼻咽癌近期疗效的AUC值分别为0.944、0.940、0.765、0.779.结论 单、双指数模型DWI及3DpCASL参数能准确预测复发性鼻咽癌近期疗效,尤其是ADC和Dslow预测效能最佳,为复发性鼻咽癌近期疗效的早期精准预测提供无创技术手段和有效量化指标.

目的 探讨体素内不相干运动扩散加权成像(IVIM-DWI)及三维伪连续动脉自旋标记(3D-pCASL)技术定量参数在局部晚期鼻咽癌(LANPC)诱导化疗(IC)近期疗效中的预测价值.方法 搜集2020年12月至2021年12月经病理活检证实的Ⅲ～Ⅳa期鼻咽癌(NPC)患者53例,均行IC,于治疗前行IVIM-DWI及3D-pCASL扫描,IVIM参数包括:真实扩散系数(D)、灌注相关扩散系数(D*)、灌注分数(f);3D-pCASL参数包括血流量平均值(BFmean)、血流量最小值(BFmin)、血流量最大值(BFmnax).所有患者治疗前后均行常规MRI平扫+增强扫描.根据实体肿瘤疗效评估标准(RECIST 1.1)分为完全缓解组(CR)(n=25)和非完全缓解组(nCR)(n=28).比较两组间各参数的差异,对有统计学意义的参数绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC).结果 CR组治疗前D值较nCR组低(P＜0.001),CR组治疗前BFmean值及BFmax值较nCR组高(P均＜0.001),其余各参数均无统计学意义.D值、BFmean值、BFmax值及联合指标新预测因子(PRE)预测LANPC IC近期疗效的AUC分别为0.811、0.867、0.877及0.907.结论 IVIM-DWI与3D-pCASL作为无创性功能磁共振技术可对LANPC患者IC近期疗效进行预测,对于指导临床进行个体化治疗具有较大意义.

建立整合型医疗服务体系是当今世界医疗卫生体制改革的趋势和重点.随着体系建设的推进,各国在一定程度上形成了具有自身特色的整合型医疗服务体系或模式,与之相对应的评价体系或标准也应运而生.文章通过阐述国内外整合型医疗服务体系实施的评价指标体系或标准,讨论存在的问题并提出建议,为我国构建科学、统一的整合型医疗服务体考核评价体系,有序开展相关评估工作,推动卫生事业发展提供参考.

Background: The incidence and mortality of Nasopharyngeal carcinoma (NPC) are much higher in Guangxi than the national average, which causes high economic burden for society and the patients. Moreover, the out-of-pocket (OOP) ratio of NPC patients is under-researched. This research aimed to study the OOP ratio and the influencing factors, so as to improve the current healthcare policies. Methods: The data were provided by Guangxi Health Commission (GXHC). The generalized additive model (GAM) was used to describe the trend of OOP ratio of NPC patients from 2014 to 2020. The univariate regression analysis was used to describe on the relationship between different variables and the patient's OOP ratio to cost per stay (CPS). And single-factor meaningful independent variables were used for multivariate Tobit regression to analyze factors influencing OOP ratio to CPS among NPC patients in Guangxi. Results: 44,382 hospitalization summary reports (HSRs) from 46 hospitals were included in the study. It shows the OOP ratio fluctuating between at 36-40% around 2014–2020. Univariate Tobit regression analysis showed that age, marital status, medical payment methods and length of stay (LOS) influenced OOP ratio. Multivariate Tobit regression analysis showed that younger patients (40), single patients, patients with Urban Resident Basic Medical Insurance System (URBMIS) and New Rural Cooperative Medical Insurance System (NRCMIS) and patient with LOS ≥ 15 days have higher OOP ratio. Conclusions: This study highlights that it is important to take measures to reduce the OOP ratio of NPC in Guangxi. Furthermore, it is necessary to strengthen the multi-level medical security system with social medical assistance as the bottom line, set up self-payment caps for low-income groups.

目的:探讨体素内不相干运动扩散加权成像(IVIM-DWI)与三维准连续动脉自旋标记(3D pCASL)技术在鼻咽癌临床分期中的应用价值.方法:搜集2019年10月-2020年10月我院确诊为鼻咽癌的初诊患者100例,所有患者均行鼻咽部MRI常规序列、IVIM-DWI和3D pCASL序列扫描,并对患者进行临床总分期、TNM分期(AJCC第8版分期系统)及高、低级别分组.分析IVIM-DWI相关参数真实扩散系数(D)、灌注相关扩散系数(D?)、灌注分数(f)值及3D pCASL参数最大血流量(BFmax)值与鼻咽癌各临床分期间的相关性及高、低级别组间各参数的差异.结果:T分期与D值呈负相关(r=-0.25,P<0.05),N分期与D值呈负相关(r=-0.31,P<0.05).临床总分期与D、f值呈负相关(r=-0.41、-0.19,P<0.05).T分期低级别组的D值显著高于高级别组,N分期低级别组的D、D?值显著高于高级别组,临床总分期低级别组的D、f值显著高于高级别组,而低级别组的BFmax值显著低于高级别组,差异均有统计学意义(P值均<0.05).BFmax值与D?值呈负相关(r=-0.052,P>0.05),与f值呈正相关(r=0.043,P>0.05).D值在鼻咽癌T分期、N分期、临床总分期中的诊断效能较低,但均高于其他参数,ROC曲线下面积分别为0.621、0.642、0.683.结论:IVIM-DW和3D pCASL在鼻咽癌分期中具有一定指导意义,且IVIM-DWI的诊断效能高于3D pCASL.

城市医疗联合体作为构建整合型医疗服务体系、开展医疗联合体建设工作、实现医疗资源整合的重要载体之一.近年来在国家指导下,各地建设工作不断推进,涌现出许多实践典型案例.各地为评估与检验其城市医疗联合体的实际建设情况与成效,所对应的评价考核研究及实践工作亦相继展开.本文在明晰城市医疗联合体概念与特点的基础上,通过阐述国内外城市医疗联合体考核评价的相关研究及实践,讨论存在的问题并予以思考,为城市医疗联合体考核评价的后续研究提供借鉴和指引.

目的:分析社区医养结合服务发展的制约因素,为各地发展医养结合服务提供参考.方法:使用扎根理论分析法,对政府工作人员及社区医养结合服务机构工作人员进行半结构化访谈,借助Nvivov12.0质性分析软件,对访谈记录进行分析.结果:社区医养结合服务开展的限制因素包括政府、服务机构、专业人才、服务对象四个主范畴.政府范畴包括权责不清、保险覆盖面不全、财政倾斜不合理等;服务机构范畴包括收费标准不明晰、服务场地受限、缺乏经验、技术支撑不足、硬件设施不足等;专业人才范畴包括执业环境不佳、人才激励力度不足、人才培训短缺等;服务对象范畴包括不良传统思维禁锢.结论:社区医养结合服务发展的制约因素相互影响,共同作用,阻碍了社区医养结合的发展,应出台针对性措施,政府、机构、社会共同努力,促进我国社区医养结合服务发展.

目的:构建公立医院决策机制评价指标体系,推动公立医院现代医院管理制度建设.方法:结合理论研究与医院运行实际情况,提取公立医院决策机制评价备选指标,进行两轮Delphi专家咨询论证筛选,构建现代医院管理制度下的公立医院决策机制评价指标体系.结果:两轮专家函询应答率均为100％,专家权威系数为0.8465,专家协调系数分别为0.197(P<0.001)和0.212(P<0.001);最终构建指标体系包括政治因素、决策主体及决策范围、决策沟通协调机制、决策科学性、决策民主性、决策合法性、决策的事后控制7个一级指标,现代医院管理制度、党委领导下的院长负责制、党务院务公开、重大事项公示听证、决策容错纠错等主要指标在内的24个二级指标.结论:初步构建出现代医院管理制度下公立医院决策机制评价指标体系;将公立医院决策机制定性研究与定量研究相结合,为健全公立医院决策机制提供理论与实证依据.

Purpose: To identify the factors influencing inpatient satisfaction by fitting the optimal discriminant model. Patients and Methods: A cross-sectional survey of inpatient satisfaction was conducted with 3888 patients in 16 large public hospitals in Zhejiang Province. Independent variables were screened by single-factor analysis, and the importance of all variables was comprehensively evaluated. The relationship between patients' overall satisfaction and influencing factors was established, the relative risk was evaluated by marginal benefit, and the optimal model was fitted using the receiver operating characteristic curve. Results: Patients' overall satisfaction was 79.73%. The five most influential factors on inpatient satisfaction, in this order, were: patients' right to know, timely nursing response, satisfaction with medical staff service, integrity of medical staff, and accuracy of diagnosis. The prediction accuracy of the random forest model was higher than that of the multiple logistic regression and naive Bayesian models. Conclusion: Inpatient satisfaction is related to healthcare quality, diagnosis, and treatment process. Rapid identification and active improvement of the factors affecting patient satisfaction can reduce public hospital operating costs and improve patient experiences and the efficiency of health resource allocation. Public hospitals should strengthen the exchange of medical information between doctors and patients, shorten waiting time, and improve the level of medical technology, service attitude, and transparency of information disclosure.

随着我国经济发展以及人口老龄化趋势的不断加剧,老年人对医养结合的需求逐渐增多.由于我国国情具有特殊性,社区医养结合的3个主要供应方(医院、养老机构、社区)必将发挥主要影响作用.然而,从目前的研究来看,广西乃至全国关于社区医养结合的有关政策还需进一步完善.本文基于利益相关者理论,分析广西社区医养结合有关政策,查找政策工具存在的不足,并据此提出参考性建议.

目的 分析2009～2019年广西城乡医疗救助基金收支现状,探寻优化对贫困群众开展医疗救助的对策.方法 收集2009～2019年广西城乡医疗救助基金收入、支出、结余、救助人员情况等数据,分析城乡医疗救助基金收支现状.结果 2009～2019年,广西城乡医疗救助基金收入和支出年均增长率分别为15.5％和19.3％.财政补助收入是每年医疗救助基金收入的主要来源,占本年收入的90％以上.2009～2019年医疗救助基金结余率最高超过了40％;基金累计结余总体过高,除2015年外,其他年份累计结余率都超过15％;截至2019年底,年末滚存结余约有12.94亿元.结论 医疗救助基金收支虽持续增长,但收支十分不平衡;城乡医疗救助基金收入以财政补助收入为主,筹资模式单一;医疗救助基金总体结余过大,未得到充分利用.

对广西食用植物油质量安全水平和污染程度进行监测评价.2016—2017 年对广西14 个地级市共抽检监测食用植物油3 821 份,按照GB/T 5009 检测酸价、过氧化值、浸出油溶剂残留、黄曲霉毒素B1 、总砷、铅和苯并(a)芘,并依据 GB 27 16—2005 对食用油进行评价.结果表明:抽检食用植物油总合格率为92.04％;2016、2017年食用植物油合格率分别为96.70％和91.22％,差异有统计学意义(P＜0.05).从种类看,玉米油、芝麻油和其他食用植物油合格率分别为100％、93.75％和99.61％.花生油合格率最低,为87.83％,黄曲霉毒素B1 超标是花生油不合格的主要原因,检出率为8.85％.从包装看,预包装食用植物油的合格率(99.70％)明显高于散装(83.72％),差异有统计学意义(P＜0.05).食用植物油生产加工环节的合格率最低,为88.01％.广西玉米油、芝麻油和其他食用植物油相对而言抽检合格率较高,花生油合格率较低,应加强花生油的抽检监测和监督管理,通过严格落实生产经营者主体责任,积极引导消费者科学理性消费,持续深化小油坊专项治理,不断强化质量安全控制技术研究,逐步推进广西食用植物油安全水平稳步提升.

Background: To achieve the goal “health equity for all", equitable and reasonable allocation of health resources is the basic material guarantee. As an area which owns more developing provinces and minority nationality region than other regions in China, the western China should get more attention in the health resources allocation while there was not. Methods: Lorentz curve, Gini coefficient and Theil index were used to analyze the health resources allocation which including number of health institutions, number of beds, (assistant) medical practitioners, registered nurses in the western China from 2014 to 2018 from two dimension: population and geography. Results: The total health resources shows an increasing tendency from 2014-2018; The Gini coefficients for health resources by population dimension were ranged from 0.057 to 0.13, in geography dimension the Gini coefficients ranged between 0.61 and 0.64. Meanwhile, the Lorentz curve in population dimension had a smaller curvature than in geography dimension; In two dimensions, the intra-group contribution rate of the Theil index was higher than the inter-group. Conclusion: The equity of health resources allocation should be further improved, especially the allocation of health institutions. Moreover, the access to health resources should also by improve by a diversity method.

目的 评价广西市级妇幼保健院的效率及其变动情况,探讨其中存在的问题,为促进广西市级妇幼保健院科学发展提供参考依据.方法 系统收集广西15家市级妇幼保健院2015-2017年卫生技术人员数量、年门诊人次等投入—产出指标,采用数据包络分析(DEA)-CCR和BCC模型计算相对效率,运用超效率模型对效率值进行排序,再通过Malmquist指数模型分析效率的动态变化.结果 2015年6家妇幼保健院为DEA有效,2016年5家DEA有效,2017年4家DEA有效.2015-2017年,广西市级妇幼保健院全要素生产率指数为0.962,7家市级妇幼保健院的生产率有所改进,8家有所下降.结论 各市妇幼保健院发展不平衡,现有妇幼卫生资源总体利用效率不高;全要素生产率整体呈下降趋势,效率变化为全要素生产率变化的主要原因;技术水平有待提高,应采取针对性措施打通技术堵点.

目的 在现代医院管理制度框架下,探讨新型公立医院决策机制的构建.方法 运用文献研究法了解国内外医院决策机制的研究现状,并结合相关医政政策分析其存在的问题.结果 目前,我国公立医院决策机制存在院长决策权力过于集中,党组织作用发挥有限;“重大问题”界限不清,决策主体不明确;组织保障体系不完善,决策监督机制不健全等问题.结论 公立医院需明确决策相关方的权责,完善约束机制;明确决策程序和议事规则;畅通职工参与决策的渠道,完善决策监督机制.

目的 了解广西市场销售食用农产品的质量安全状况,为指导食用农产品监管提供参考依据.方法 根据《国家食品安全抽检计划》和《国家食品安全监督抽检实施细则》,随机抽取2016-2017年广西市售食用农产品1 629批次,检测重金属、农药残留和兽药残留指标,通过计算合格率、超标倍数和暴露比值来评价安全风险.结果 抽检监测食用农产品1 629批次,总体合格率97.05％,其中蔬菜、水果、畜禽肉类、水产品和鲜蛋类合格率分别为96.49％、98.85％、98.43％、94.55％和91.67％.农药残留超标是主要不合格原因,占50.00％.蔬菜类中毒死蜱最大超标31倍,铅最大超标17倍;畜禽肉类检出兽药恩诺沙星最大超标3.01倍;水果中氧乐果最大超标6倍.蔬菜中氧乐果、氟虫腈、毒死蜱和克百威等4种农药及水产品中镉的最大暴露比值均大于2,畜禽肉中兽药污染物的最大暴露量比值均小于1.结论 广西市售食用农产品总体合格水平较高,农药残留超标成为主要不合格原因,蔬菜中部分农药暴露比值较高,需进一步引起重视和加强监管.

Purpose: We developed a contrast agent for targeting E-selectin expression. We detected the agent using magnetic resonance imaging (MRI) in vivo in nude mice that had undergone nasopharyngeal carcinoma (NPC) metastasis. Methods: Sialyl Lewis X (sLeX) was conjugated with ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles. Hydrodynamic size, polydispersity index, and ζ-potential of USPIO-polyethylene glycol (PEG) nanoparticles and USPIO-PEG-sLeX nanoparticles were measured. Component changes in nanoparticles of USPIO, USPIO-PEG, and USPIO-PEG-sLeX were analyzed by thermogravimetric analysis and Fourier-transform infrared spectroscopy. A model of NPC metastasis to inguinal lymph nodes in nude mice was used to investigate characteristics of the USPIO-PEG-sLeX nanoparticles in vivo. We investigated the ability of the T2* value, change in T2* value (ΔT2* value), and enhancement rate (ER) to assess accumulation of USPIO-PEG-sLeX nanoparticles quantitatively in mice of a metastasis group and control group. Four MRI scans were undertaken for each mouse. The first scan (t0) was done before administration of USPIO-PEG-sLeX nanoparticles (0.1 mL) via the tail vein. The other scans were carried out at 0 (t1), 1 (t2), and 2 hours (t3) postinjection. The mean optical density was used to reflect E-selectin expression. Results: sLeX was labeled onto USPIO successfully. In vivo, there were significant interactions between the groups and time for T2* values after administration of USPIO-PEG-sLeX nanoparticles. Six parameters (T2* at t2, ΔT2* at t1, ΔT2* at t2, ER at t1, ER at t2, and ER at t3) were correlated with the mean optical density. Conclusion: USPIO-PEG-sLeX nanoparticles can be used to assess E-selectin expression quantitatively. Use of such molecular probes could enable detection of early metastasis of NPC, more accurate staging, and treatment monitoring.