This paper uses the binomial logistic regression model and the 2011 China Health and Retirement Longitudinal Study ( CHALRS) to analyze the influencing factors on the choice of public or private hospitals by mid-dle-aged and elderly patients. The study finds that rural residents are significantly influenced by the self-evaluation of health, on-demand clinic consultation, and the use of basic medical insurance systems. There is a higher probability that patients that are not as healthy and that require clinical consultation or the use of the basic medical insurance sys-tem will choose public hospitals. The study concludes that elderly patients have greater trust in public hospitals when they seek treatment for disease risks. Moreover, the fixed points of medical insurance are concentrated in public hos-pitals, thereby prompting patients to choose public hospitals. It is suggested that the prevention and control of senile diseases be strengthened, the level of hospital consulting services be improved, and the access mechanisms of medi-cal insurance fixed point hospitals be adjusted.

Objective To investigate the role of exosomal microRNA(miR)-191 derived from NaAsO2-transformed cells in proliferation of human liver L-02 cells.Methods The normal wild-type L-02 cells (recipient L-02 cells)were treated with media or exosome derived from 2 μmol/L NaAsO2-transformed L-02 cells.Anti-miR-191 and anti-miR-NC were transfected into NaAsO2-transformed L-02 (T-L-02) cells by lipofectamineTM 2000,respectively,while untreated group was set as control.The expression of miR-191 was detected by qRT-PCR.Cell proliferation was evaluated by CCK-8 assay.Results The proliferation [(207 ± 24)％ vs (105 ± 21)％,t =5.462,P ＜ 0.01] and the expression of miR-191 [(206 ± 25)％ vs (105 ± 20)％,t =4.116,P ＜ 0.05] of recipient L-02 cells were significantly increased in the transformed L-02 cells media (T-CM) treated group compared with in the normal L-02 cells media (CM) group.Several concentrations of exosomes derived from CM did not change the proliferation and miR-191 expression of recipient L-02 cells (F =2.213,2.213,all P ＞ 0.05).Several concentrations of exosomes derived from T-CM increased the proliferation and miR-191 expression of recipient L-02 cells in a dose-response manner (F =10.910,4.553,P ＜ 0.01 or ＜ 0.05).The proliferation [(160 ± 32)％ vs (102 ± 8)％,(203 ± 7)％ vs (111 ± 5)％,t =2.999,18.750,P ＜ 0.05 or ＜ 0.01] of recipient L-02 cells treated with 20 or 50 mg/L exosomes derived from T-CM was higher than that treated with the same concentration of exosomes derived from CM.The expression of miR-191 [(166 ± 13)％ vs (113 ±9)％,(211 ± 55)％ vs (102 ± 8)％,(206 ± 31)％ vs (105 ± 6)％,t =5.611,3.357,5.509,P ＜ 0.05 or ＜ 0.01] of recipient L-02 cells treated with 10,20 or 50 mg/L exosomes derived from T-CM was higher than that treated with the same concentration of exosomes derived from CM.The miR-191 levels of T-L-02 cells [(39 ± 10)％ vs (100 ± 0)％ or (106 ±17)％,all P ＜ 0.01] or exosomes [(30 ± 19)％ vs (100 ± 0)％ or (104 ± 17)％,all P ＜ 0.01] in the anti-miR-191 treated group were significantly lower than that in the untreated group or anti-miR-NC treated group.The exosomes derived from untreated group promoted the proliferation [(395 ± 31)％ vs (100 ± 0)％,t =16.290,P ＜ 0.01] and miR-191 expression [(208 ± 47)％ vs (100 ± 0)％,t =4.015,P ＜ 0.05] of recipient L-02 cells.The proliferation [(157 ± 19)％ vs (395 ± 31)％ or (411 ± 55)％,P ＜ 0.05] and miR-191 expression of [(103 ± 44)％ vs (208 ± 47)％ or (197 ± 37)％,P＜ 0.05 or ＜ 0.01] of recipient L-02 cells treated with exosomes derived from anti-miR-191 treated group were lower than those treated with exosomes derived from untreated group or anti-miR-NC treated group.Conclusion The exosomal miR-191 secreted by NaAsO2-transformed L-02 cells promotes proliferation of normal human L-02 cells.

Objective To explore the effect of exogenous hormones on the pelvic floor function in delivery of term pregnancy using transvaginal 3D ultrasound.Methods Ninety puerperae delivered transvaginally were classified into three groups according to exogenous hormones,natural labor group (n =30),oxytocin group (n =30) and prostaglandin E2 group (n=30).Hiatal diameter and area at resting,Valsalva,levator ani muscle maximum contraction states were obtained in hiatal images and were compared among 3 groups in 42 days postpartum.Results There were no significant differences of hiatal diameter and area at resting,Valsalva,levator ani muscle maximum contraction state between natural labor group and oxytocin group (all P＞0.05).There were significant differences of hiatal diameter and area at resting,Valsalva,levator ani muscle maximum contraction state between prostaglandin E2 group and natural labor group,oxytocin group (all P ＜0.05).Conclusion Different exogenous hormones have different effects on the pelvic floor function in delivery of term pregnancy.The injury of the pelvic floor of using prostaglandin E2 is bigger than natural labor and using oxytocin.And the use of exogenous oxytocin is not significant correlated with pelvic floor function injury.

Objective To analyze the clinical characteristics of structural malformations in one of monochorionic diamnionic twins (MCDA). Methods The clinical data of 77 MCDA patients with structural malformations diagnosed by ultrasound were retrospectively reviewed from January 2012 to May 2017. The distribution of structural malformations, prenatal chromosomal karyotyping and pregnancy outcomes were analyzed. Results (1)Among the 77 MCDA patients with structural malformations, the single malformation accounted for 79％(61/77), the multiple malformations accounted for 21％(16/77). And there were a total of 94 types of malformations, the top three malformations were neurological malformations (32％, 30/94), cardiovascular malformations (29％,27/94) and twin reversed arterial perfusion sequence (TRAPS;10％,9/94). (2)Among the 77 patients with structural malformation, 64 cases (83％, 64/77) were examined for fetal chromosomes, of whom 14 cases (22％,14/64) were examined for fetal chromosomes of both twins, with 1 case (1/14) of discordant fetal chromosome. (3)Among the 77 patients, 4 cases (5％, 4/77) with severe fetal malformations terminated pregnancy. Totally 29 cases (38％, 29/77) with severe malformations were treated with selective fetal reduction, among whom 7 cases (24％, 7/29) experienced unexplained fetal death within 24 hours after the operation;2 cases (7％, 2/29) happened inevitable abortion, and 2 cases (7％, 2/29) underwent unexplained fetal death during the late pregnancy. Of the remaining 44 patients (57％,44/77) with expectant treatment, 13 cases (30％, 13/44) occurred twin transfusion syndrome (Ⅱ-Ⅳ), and were treated with fetoscopic laser occlusion. Eight patients had 2 survival twins, 4 patients delivered 1 survival twin, and 1 patient had dead twins. Conclusions The most common malformations in MCDA twins are the nervous malformations, cardiovascular malformations and TRAPS. The chromosome karyotype of MCDA twins with structural malformations are sometimes discordant, and separate samling of the twins is suggested for prenatal diagnosis. Selective fetal reduction could be given to severe structural malformation in MCDA patients safely and effectively. For non-severe structural malformation in MCDA patients with twin transfusion syndrome, fetoscopic laser occlusion is safe and effective.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.