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 identify the spatio-temporal clustering analysis of mumps in Wenzhou City, Zhejiang Province from 2010 to 2023, so as to provide the basis for improving mumps prevention and control strategies. Methods: Data of mumps cases in Wenzhou City from 2010 to 2023 were collected from the Monitoring and Reporting Management System of Chinese Disease Prevention and Control Information System. The spatio-temporal clustering characteristics of mumps incidence were identified using spatial autocorrelation analysis and spatio-temporal scan analysis. Results: A total of 20 455 mumps cases were reported in Wenzhou City from 2010 to 2023, with an average annual incidence of 17.54/105. There were 12 919 male and 7 536 female cases, with a male-to-female ratio of 1.71∶1. The children aged 5-<10 years had the highest incidence of mumps at 135.29/105. The incidence of mumps showed a downward trend from 46.82/105 in 2010 to 3.59/105 in 2023 (P<0.05). The incidence of mumps peaked from May to July and from November to January during 2010 and 2012, the winter peak became less evident after 2013, and no seasonal trends were observed after 2020. Spatial autocorrelation analysis showed there was a positive spatial correlation of mumps of other years, with the exception of 2018 (all Moran's I >0, all P<0.05). Lucheng District, Longwan District, Ouhai District, Cangnan County and Rui'an City were high-high clustering sites. Spatio-temporal scan analysis showed that the primary clustering area was centered in Nanbaixiang Street, Ouhai District, covering 50 towns (streets), with the clustering time from April 2010 to August 2013; the secondary clustering area was centered in Zaoxi Town, Cangnan County, covering 24 towns (streets), with the clustering time from January 2010 to June 2013. Conclusions The incidence of mumps in Wenzhou City from 2010 to 2023 showed a downward trend. The urban areas, Cangnan County and Rui'an City were the clustering areas.

Adenocarcinoma ; diagnosis ; pathology ; Adult ; Aged ; Bronchoscopy ; methods ; Cooking ; Humans ; Lung Neoplasms ; diagnosis ; pathology ; Male ; Middle Aged ; Occupational Exposure ; Retrospective Studies

Aged ; Female ; Hearing Loss, Bilateral ; diagnosis ; etiology ; Humans ; Osteitis Deformans ; complications ; diagnosis

Objective To evaluate the clinical results of a procedure for treatment of avulsion fracture of posterior cruciate ligament (PCL) using arthroscopic reduction and Orthocord suture.Methods The clinical data of 13 patients who underwent arthroscopic reduction and Orthocord suture fixation for PCL avulsion fracture of the tibial eminence from October 2009 to June 2010 was analyzed retrospectively.Follow-up assessment including Lysholm knee score,and radiographic evaluation.Results All 13 patients achieved follow-up with 10-14 ( 12 ± 2) months.No significant complications were noted,such as swelling,pain or disability of knee.Drawing test was negative.The preoperative Lysholm score in the 13 knees was (72.3 ±2.8) scores,the postoperative Lysholm score was (93.2 ± 1.8) scores,difference was statistically significant (t =15.8,P＜ 0.05 ).Conclusions Treating PCL avulsion fracture with arthroscopic fixation by use of Orthocord suture can restore ligament length,stabilize fragments,promote early motion.

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.

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 .

Objective: To clone the 5＇-flanking region of the human CD34 gene containing transcriptional regulatory sequence (TRS). Methods: According to the registered 5＇-flanking region of CD34 gene, two pairs of primers were designed and net-PCR was used to amplify 661 bp long TRS of CD34 gene. The CD34 TRS fragment was cloned into reported plasmid pEGFP-1. The role of the regulating the specific expression of recombinant plasmid pCD34 EGFP in hematopoietic and non-hematopoietic cells was observed. Results: Restrictive endonuclease identification and DNA sequencing provedthat the CD34 promoter cloned was consistent with the sequence reported to a large extent. It could induce the EGFP gene to express in hematopoietic cell line K562 specifically, while has no effect on hepatocellular carcinoma cell HepG-2. Conclusion: The cloned CD34 gene TRS has the effect of regulating gene expression specifically. The study established the fundament for the construction of specific gene expression vector used in hematopoietic system cells.