It is always an important academic and policy issue to understand the impact of hospital distance on Chinese inpatient service demand in rural areas. It employs household survey data collected from 97 villages in Shandong in 2006 and 2008, and investigates the influences of hospital distance on the demand of famars in rural areas. The discrete choice model is constructed to estimate the inpatient service demand function for patients in rural areas. The empirical analysis finds that the hospital distance is significantly affecting Chinese inpatient service demand in the rural areas. The longer the distance increases, the lower the visiting rate drops. In addition, the impact changes with the changes of hospital level; the lower the primary hospital is, the higher the impact would be. It paper provides new evidence for the understanding of the geographical characteristics of medical health care.

Objective To investigate whether unfolded protein response (UPR) plays a role in the pathogenesis of spondyloarthritis (SpA),and to assess UPR-related gene expression in SpA and other arthritis patients.Methods Eighteen patients with SpA,12 with rheumatoid arthritis (RA) and 6 with osteoarthritis (OA) were recruited.Macrophages were isolated from synovial fluid samples by immunomagnetic separation.The expression of UPR-regulated genes,including binding immunoglobulin protein (BiP),glucose-regulated protein 94 (GRP94),C/EBP homologous protein (CHOP),growth arrested and DNA damage-inducible 34 (GADD34),X-box binding protein 1 (XBP-1) and endoplasmic reticulum DnaJ homolog 4 (ERdj4),was tested by real time polymerase chain reaction (PCR).Results Compared with macrophages in OA patients,the expression of BiP and GRP94 mRNA [(6.06 ± 2.08) × 10-2 vs (1.11 ±0.72) × 10-2 for BiP mRNA,11.80(7.30-38.40) × 10-3 vs 1.27(1.02-4.18) × 10-3 for GRP94 mRNA,both P values ＜0.01] was significantly increased in macrophages in SpA patients.XBP1 mRNA was up-regulated [(12.70 ± 5.20) × 10-3 vs (4.14 ± 2.56) × 10-3,p ＜ 0.01] in SpA group as well.UPR-regulated gene expression in SpA patients with HLA-B27 positive or HLA-B27 negative was similar.However,none of UPR-regulated genes showed different expression between the SpA group and RA group except for GADD34 mRNA [7.30 (5.56-15.40) × 10-3 vs 21.30 (12.20-27.60) × 10-3,P =0.009].Conclusions Our data suggest that UPR possibly participates in the pathogenesis of SpA,although the relationship between HLA-B27 and UPR still needs further investigation.

Objective To evaluate the performance of an improved skin prick test in the screening for allergens.Methods A total of 475 patients with chronic urticaria who aged from 3 to 81 years were enrolled in this study,and classified into the control group (n =235) and research group (n =240).Traditional and improved skin prick test were conducted in the control and research group respectively.The allergen detection rate was compared between the two test methods.Results The allergen detection rate was 65.4％ and 67.2％ respectively for the improved and traditional skin prick test,respectively (P ＞ 0.05).House dust mites were the most common sensitizing agent.Conclusion The improved skin prick test can offer reliable evidence for chnical diagnosis with a relatively convenient and safe procedure.

Objective To investigate the effect of different concentrations of TPh on hepatoma cells , cell viability and and its possible mechanisms of anti-tumor.Methods The inhibitory rate of hepatoma cells and cell viability on different concentrations of TPh and time were measured by MTT assay;The morphological changes of apoptosis were observed by Hoechst 33258 straining; Cell cycle distribution was evaluated by flow cytometry (FCM).The protein expression of Bcl-2 and Bax were detected by Western blot analysis.Results MTT assay showed that TPh inhibited the proliferation of HepG-2 cells in a dose-dependent manner, and the inhibitory rate increased with the increase of concentration.The inhibitory rate was 50.9% (P<0.01).The results of Hoechst 33258 staining showed that the fluorescence intensity of hepatocellular carcinoma cells was light blue in fluorescence microscopy and bright blue fluorescence in apoptotic hepatocarcinoma cells, and the apoptosis of hepatocarcinoma cells increased with the increase of drug concentration.The percentage of cells in G0/G1 phase increased with the increase of cell cycle, and the ratio of cells in S phase was decreased in G2/M phase compared with blank control group (P<0.05);Western blot results showed that compared with the blank control group, TPh inhibited the proliferation of Bcl-2 cells in a concentration-dependent manner ( P <0.05 ) , and the number of apoptotic cells increased with the increase of drug concentration (P<0.05), and the ratio of Bcl-2/Bax in the TPh group decreased significantly (P<0.05), and the expression of Bax gene increased. Conclusion TPh inhibits cell proliferation, promotes apoptosis and induces HepG-2 to block G0/G1 phase.Its mechanism may increase the expression of Bax and decrease Bcl-2 protein expression.

Objective To determine the medium-long term functional outcome of arthroscopic repair of type II SLAP lesions with two loops.Methods According to retrospective study,29 cases patients with arthroscopic repairs of isolated type II SLAP lesions were collected from March 2011 to June 2013,the mean patient age at the time of surgery was 31.8 years(range17 to 47 years).All patients with ground anchor suture,and through double loop knot technology to fix SLAP injury.Visual analogue scale(VAS),Kerlan-Jobe Orthopaedic Clinic(KJOC),Roche Shouder function Score(ROWE) were used to determine the function of shoulder joint.The shoulderjoint range of motion before treatment and post treatment were recorded,shoulder joint mobility was recorded,satisfaction survey was done,compared the preoperative and postoperative data to evaluate its clinical effect.Results All patients were available for follow-up of 2.7-5.2 years.Overall,functional outcome was improved from baseline compared with final follow-up for VAS scores((4.3±1.2) points vs.(1.5±0.8) points,t=5.435,P<0.05),KJOC scores((72.1±4.9) points vs.(92.8±5.4) points,t=5.921,P<0.01),and ROWE scores((54.1±12.4) points vs.(84.3±10.2) points,t=7.326,P<0.01).Only a minority of patients feel pain when they did srenuous exercise.According to satisfaction investigation of patients,patient satisfaction was reported in 89.7%,3 cases had not good results,they could not return to previous level of play,including 2 cases were athletes,1 case was not athlete.Conclusion There is no more persistent pain and dysfunction after surgery,a good or excellent medium-long term functional outcome can be anticipated after arthroscopic repair of type II SLAP lesions with two loops.

AIM: To analyze the associated factors of poor vision after phacoemulsification operation.
METHODS:Clinical data of cases with poor vision after cataract phacoemulsification combined with IOL implantation from 341 patients(418 eyes) during Jan. 2015 to Jan. 2016 in our hospital were collected and logistic correlation analyzed.
RESULTS: The incidences of postoperative low vision were 10. 3% for one month after operation. Forty-three eyes were reported low vision, and 41 of 43 the patients with postoperative low vision had fundus oculi disease before operation, which included 20 eyes ( 48. 8%) with age-related macular degeneration, 16 eyes(39. 0%) with diabetic retinopathy, 3 eyes ( 7. 3%) with glaucomatous optic neuropathy, 1 eye(2. 4%) with pathologic myopia of retinopathy and 1 eye ( 2. 4%) with branch retinal vein occlusion.
CONCLUSION: The associated factors of poor vision after phacoemulsification operation are preoperative eye diseases and the nuclear hardness, and preoperative eye diseases may be the main causes of postoperative low vision. Comprehensive examination should be attached importance to, and be careful in the operation to decrease the harm for visual performance.

Objective To investigate the characteristics of contingent negative variation(CNV) in patients with subcortical ischemic vascular cognitive impairment (SIVCI) and their relationship with continuous performance task (CPT) to establish a neuroelectrophysiological index of attention impairment in earlier period of Vascular Cognitive Impair-ment. Methods CNV was assessed in 45 SIVCI patients [30 patients with subcortical ischemic vascular cognitive impair-ment no dementia (SIVCIND ) and 15 patients with subcortical ischemic vascular dementia (SIVD )] and 15 normal con-trol (NC) by using a EB-Neuro ERP Instrument. Results ①CNV in SIVCI group were less regular compared with nor-mal control;CNV in SIVCIND group had decreased Expectancy Wave (EW) amplitudes (9.98± 4.10μV vs. 16.13±2.75μV) and EW areas (14848.10 ± 3199.16 μV · ms vs 20058.87 ± 1025.95 μV · ms) compared with normal control (P<0.05);EW amplitudes (6.25±1.52μV vs. 9.98± 4.10μV) and EW areas (8474.00±3511.94 vs. 14848.10±3199.16μV · ms) of CNV in SIVD group were significantly lower compared with SIVCIND group (P<0.05);However, there was no sig-nificant difference in CNV EW latency among three groups(F(2,57)=1.90,P>0.05);②Pearson correlation\Spearman rank correlation analysis revealed that there were significant, positive correlations between EW latency and CPT Reacting time(R=0.748, P<0.01);there were no significant relationships between CPT missing rate and EW latency(R=0.22,P>0.05)、EW amplitude(R=-0.191,P>0.05)and there were significant, negative correlations between EW area and CPT Reacting time(R=-0.718,P<0.01)、CPT missing rate(R=-0.829 ,P<0.01), EW amplitude and CPT Reacting time(R=-0.616, P<0.01). Conclusion SIVCI patients in early stage have attention deficits in sustained attention and CNV EW ar-ea may be a good neuroelectrophysiological index for sustained attention impairment .

AlM: To study the therapeutic effect of external-route microsurgery forrhegmatogenous retinal detachment.
METHODS: ln 55 patients ( 55 eyes ) with rhegmatogenous retinal detachment, drainage of subretinal fluid, examination of locating the holes, sclera cryotherapy, scleral buckling, and vitreous cavity injection of filtrated air were performed under surgical microscope.
RESULTS:The retinal reattachment occurred in 50 cases after the primary surgery. The final rate of reattachment was 91% during 6 - 12mo follow - up. The retinal reattachment occurred in 1 case ( recurrent retinal detachment) after the secondary surgery and in 4 cases ( recurrent retinal detachment ) after vitrectomy. The eyesight was improved with different degrees in 55 cases.CONCLUSlON: The external- route microsurgery for rhegmatogenous retinal detachment is simple, safe and effective.

Background and purpose:miR-22 has been reported to be down-regulated in gastric cancer, lung cancer, colorectal cancer, and breast cancer. However, its expression in glioma was still poorly known. This study aimed to explicit whether miR-22 suppresses cell proliferation by targeting MTDH, thus to reveal molecular mechanism that miR-22 functions as a tumor suppressor in glioma. Methods:Quantitative real-time polymerase chain reaction (qRT-PCR) was conducted for detecting the expression of miR-22 in gliomas and normal brain tissues. MTDH 3’UTR-luciferase vector was constructed and dual-luciferase reporter gene assay was employed to examine the effect of miR-22 on luciferase activity. U251 cells were transfected with miR-22 mimics, and MTDH siRNA as for postive control, then Western blot was performed to detect the expressions of MTDH protein. The proliferation ability of U251 cells was evaluated by MTT assay. Results:miR-22 was down-regulated in glioma tissues. Glioma patients with relatively high expression of miR-22 showed lower mortality compared with low expression of miR-22 by using Kaplan-Meier survival curves. We demonstrated miR-22 could bind to the 3’ untranslated region (UTR) of MTDH and inhibited the luciferase activity. Western blot showed that the expression of MTDH protein was inhibited by restored miR-22 or siR MTDH in U251 cells. Overexpression of miR-22 or siR MTDH inhibited the proliferation of U251 cells. Conclusion:miR-22 suppresses cell proliferation by targeting MTDH in glioma.

Objective To determine the median effective target effect-site concentration (EC50) of sufentanil inhibiting responses to insertion of laryngeal mask airway (LMA) when combined with propofol in the elderly patients.Methods ASA physical status Ⅰ or Ⅱ patients,aged 66-75 yr,with body mass index of 19-30 kg/m2,scheduled for elective transurethral resection of prostate under general anesthesia,were included in this study.Anesthesia was induced with propofol given by target-controlled infusion.The initial target effect-site concentration (Ce) of propofol was 1 μg/ml,and the Ce was increased by 0.5 μg/ml every 1 min until it was increased to 2 μg/ml and maintained at this level for 5 min.Sufentanil was simultaneously administered by target-controlled infusion.The target Ce of sufentanil was 0.3 ng/ml in the first patient.The concentration of sufentanil was determined using the modified Dixon's up-and-down method.After the patients lost consciousness,LMA was inserted after the target effect-site and plasma concentrations were balanced.The insertion response was defined as positive when MAP and HR increased by 20％ of the baseline value within 5 min after insertion of LMA.The Ce of sufentanil was increased/decreased in the next patient if the insertion response was positive or negative.The ratio between the two successive concentrations was 1.2.The EC50 and 95 ％ confidence interval of sufentanil blunting responses to insertion of LMA was calculated using Probit analysis.Results When combined with propofol,the EC50 (95％ confidence interval) of sufentanil blunting responses to insertion of LMA was 0.160 (0.130-0.188) ng/ml.Conclusion The EC50 of sufentanil inhibiting responses to insertion of LMA is 0.160 ng/ml when combined with propofol in the elderly patients.