AIM: To evaluate the change of retinal thickness and choroidal thickness in patients with diabetic macular edema or retinal vein occlusion- macular edema after intravitreal Ranibizumab injection using spectral domain-optical coherence tomography(SD-OCT),and to identify determinants for the change of different types of macular edema. METHODS: Patients were recruited from March 2016 to July 2017 diagnosed with diabetic macular edema or retinal vein occlusion - macular edema. Subfoveal choroidal thickness (SFCT) and central retinal thickness (CRT) of all eyes were measured by SD - OCT preoperatively and at 1, 3, 6mo after operation. The change of retinal thickness and choroidal thickness after intravitreal ranibizumab injection for macular edema caused by different diseases were evaluated. Moreover, the potential determinants were studied about the change of retinal thickness and choroidal thickness. RESULTS: Thirty-six eyes of 36 patents with macular edema were treated with intravitreal ranibizumab injection. After the intravitreal ranibizumab injection, the CRT and SFCT decreased, when compared with the CRT and SFCT preoperative. There was a significant difference in the change of CRT and SFCT in different time points of following-up (FCRT=40.876, PCRT<0.001; FSFCT=46.319, PSFCT< 0. 001). In diabetic macular edema group, the change of SFCT was associated with the preoperative SFCT, and the change of CRT was correlated with preoperative CRT and the fast blood glucose level. In retinal vein occlusion-macular edema group, the change of SFCT was associated with the preoperative SFCT, the change of CRT was associated with preoperative CRT,the obstructive positions and the onset time of disease. CONCLUSION: Reduction of choroidal thickness and retinal thickness in macular edema caused by different diseases can be detected with SD-OCT after intravitreal injections of ranibizumab. The reduction of choroidal thickness was correlated with the preoperative choroidal thickness. In diabetic macular edema eyes, the reduction of retinal thickness was correlated with preoperative CRT and the fast blood glucose level. Whereas,in retinal vein occlusion-macular edema eyes, the reduction of retinal thickness was correlated with the preoperative CRT, the obstructive positions and the onset time.

Background: Esophageal cancer is associated with substantial disease burden in China, and data on the economic burden are fundamental for setting priorities in cancer interventions. The medical expenditure for the diagnosis and treatment of esophageal cancer in China has not been fully quantified. This study aimed to examine the medical expenditure of Chinese patients with esophageal cancer and the associated trends. Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 37 hospitals in 13 provinces/municipalities across China as a part of the Cancer Screening Program of Urban China. For each esophageal cancer patient diagnosed between 2002 and 2011, clinical information and expense data were extracted by using structured questionnaires. All expense data were reported in Chinese Yuan (CNY; 1 CNY= 0.155 USD) based on the 2011 value and inflated using the year-specific health care consumer price index for China. Results: A total of 14,967 esophageal cancer patients were included in the analysis. It was estimated that the overall average expenditure per patient was 38,666 CNY, and an average annual increase of 6.27％ was observed from 2002 (25,111 CNY) to 2011 (46,124 CNY). The average expenditures were 34,460 CNY for stage Ⅰ, 39,302 CNY for stage Ⅱ, 40,353 CNY for stage Ⅲ, and 37,432 CNY for stage IV diseases (P < 0.01). The expenditure also differed by the therapy type, which was 38,492 CNY for surgery, 27,933 CNY for radiotherapy, and 27,805 CNY for chemotherapy (P < 0.05). Drugs contributed to 45.02％ of the overall expenditure. Conclusions: These conservative estimates suggested that medical expenditures for esophageal cancer in China substantially increased in the last 10 years, treatment for early-stage esophageal cancer costs less than that for advanced cases, and spending on drugs continued to account for a considerable proportion of the overall expenditure.

Background:The increasing prevalence of colorectal cancer (CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment.We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.Methods:We conducted a multicenter,cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014.Each enrolled patient was interviewed using a structured questionnaire.All expenditure data were inflated to the 2014 Chinese Yuan (CNY;1 CNY =0.163 USD).We quantified the overall expenditure and financial burden and by subgroup (hospital type,age at diagnosis,sex,education,occupation,insurance type,household income,clinical stage,pathologic type,and therapeutic regimen).We then performed generalized linear modeling to determine the factors associated with overall expenditure.Results:A total of 2356 patients with a mean age of 57.4 years were included,57.1％ of whom were men;13.9％ of patients had stage Ⅰ cancer;and the average previous-year household income was 54,525 CNY.The overall average direct expenditure per patient was estimated to be 67,408 CNY,and the expenditures for stage Ⅰ,Ⅱ,Ⅲll,and Ⅳ disease were 56,099 CNY,59,952 CNY,67,292 CNY,and 82,729 CNY,respectively.Non-medical expenditure accounted for 8.3％ of the overall expenditure.The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY,which accounted for 59.9％ of their previous-year household income and caused 75.0％ of families to suffer an unmanageable financial burden.Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups (P ＜ 0.05),except for sex.Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more,whereas those with a lower household income and those who underwent surgery spent less (all P ＜ 0.05).Conclusions:For patients in China,direct expenditure for the diagnosis and treatment of CRC seemed catastrophic,and non-medical expenditure was non-ignorable.The financial burden varied among subgroups,especially among patients with different clinical stages of disease,which suggests that,in China,CRC screening might be cost-effective.