A review of the yearbook World Health Statistics 2009 revealed the basic features of health spending of member states of the World Health Organization. A review of the policies and experiences of government health spending of the international community points the following findings:this health spending is characteristic of social values deciding government health spending, legislature determines the stable mechanism and priority of government health spending local government shoulders main duties of government health spending, policy objectives of government health spending may be dynamic with stronger function of guidance, greater health financing sources of the government can empower government health spending, a government accountability mechanism should be built for better governance of the health system and for a better social medical assurance system.

Literature review, field survey and data analysis were called into play in this paper for systematic analysis of the basic models and performance of government health spending in China. The paper covered features and problems in China's health spendings and analyzed the growth rate and performance appraisal of such spendings. Recommendations for improved government health spendings include such six aspects as forming a consensus for building a new concept on government spendings, building a stable and sustainable health input mechanism for public finance, expanding government health financing capacity for assured health spendings, building a mechanism of balanced interests in health reform, intensifying health governance and government accountability mechanism, as well as reinforcing the supervision and assessment of government health spending.

Objective: Based on the input-output efficiency evaluation index system of community health service system, analyze the operating efficiency of community health service system in Hunan. Methods:Use the ultra efficiency DEA model to analyze public health service projects and health statistics report data. Results: Community health service resources in Hunan are not fully utilized and the operating efficiency is also unbalanced;decreasing returns to scale occurs in 1/3 cities, which is shown concretely as following: technical efficiency is lower than the scale efficiency and personnel agency input redundancy coexists with service output volume deficiency. Conclusion: Improving the basic quality of community health technical personnel’s and guiding the rational development of community institution scale are the issues need to concern in the process of further perfecting the community health service.

It systematically analyzed the basic framework and key elements of health sector governance,such as,accountability,transparency,participation,integrity and capacity of policy,based on the method of systematic literature review and related theory and practice of governance.It systematically expounded the concepts of each element,the associated policy and managed tools,as well as the authority-responsibility relationship of pluralistic subjects in the governance framework.These five key elements were mutually reinforcing,not only to build the basic framework of the health sector governance,also to determine its policy decision-making pattern,which aimed to identify actual or potential governance problems.Through forming an inclusive and mutually reinforcing governance framework,the coordination among the conflicting or different stakeholders was encouraged by the mode and mechanism which embodied their governing bodies' values.The cooperation and sustainable development way formed to improve the supply of the medical and health services,and the use efficiency of resources.

A 1-year-old boy developed multiple skin-colored nodules on the forehead and extremities when he was 4 months old.Physical examination revealed that his general condition was well with no hepatomegaly,splenomegaly,lymphadenectasis,testicle abnormality or gingival hypertrophy.Pathologically,the epidermis was normal,while the dermis and subcutaneous tissue were diffusely infiltrated with medium-to large-sized deformed cells,which had a small amount of cytoplasm,oval nucleus,irregular shape and fine chromatin.Some infiltrating cells had nuclear groove and nucleoli.Immunohistochemical studies showed that the tumor cells were positive for S-100 protein,CD56,CD123,CD163,CD68,Ki-67 (40％),weakly positive for CD4 (some),but negative for myeloperoxidase,CD1,CD21.Bone marrow smears showed a 24.5％ infltration by monoblasts and promonocytes.A diagnosis of monoblastic sarcoma cutis preceding acute monoblastic leukemia was made.

Objective:To study the inhibitory and apoptosisinducing effect of vitamin E succinate(VES) on androgen-independent prostate cancer cell line PC-3 in vitro.Methods: VES was dissolved with ethanol to obtain VES solution.PC-3 cells of logarithmic growth phase were treated with various concentrations of VES solution(25,50,75,100,and 125mg/L);cells in control group were treated with 1.25% ethanol.MTT method was used to measure the viability and inhibitory rate of cells in each group 24h,48h and 72h after VES treatment;flow cytometry was employed to determine the apoptosis rate of the PC-3 cells.Results: The viability of cells in the experimental groups was significantly lower than that in the control group(P

Objective To assess epidemiological characteristics of metabolic syndrome(MS)and its attributing factors in a resident sample aged over 35 living in both rural and urban areas of Harbin in Heilongjiang province.Methods A cross-over sectional and cluster sampling was carried out in 5 984 residents aged over 35 years living in the rural and urban areas of Harbin.Height,body mass,waist circumference,blood pressure,fasting blood glucose,triglyeeride,and high density lipoprotein cholesterol were determined.In this survey,the prevalence of MS and its attributing factors were analyzed by logistic regression model according to the diagnostic criteria of international diabetes federation in 2005.Results The prevalence of MS in this sample was 24.60%(male 22.49%,female 26.29%),and the standardized prevalence rate was 23.31%(male 22.12%,female 25.19%).Compared to female population,male participants showed a much lower prevalence;and compared to urban area population,rural participants showed a much lower prevalence(26.70% vs 20.05%,P<0.05).The prevalence of MS rose progressively with age in females.The individuals with MS presented increased body mass index,hyperglycemia,and hypertriglyceridemia.Gender,age,employment,education,smoking or drinking habit,and family history of hypertension were identified as maior risk factors of MS.Conclusion The prevalence of MS in a sample of residents aged over 35 in Harbin Was 24.60%.It becomes an public health problem requiring urgent attention for prevention and treatment.

Objective: To analyze the efficiency characteristics and trend of tertiary general public hospitals from both static and dynamic perspectives. Methods: After collecting data of personnel, equipment, assets, health services and other inputs-output indicators from 50 tertiary public hospitals from 2006 to 2012 , this paper uses C2 R-DEA and BC2-DEA models, as well as Malmquist Index model to build suitable analysis model. Results:About 10%~12% of the sample hospitals are in a relatively effective operational state, and the mean values of allocation effi-ciency and scale efficiency are 0. 956 and 0. 943, respectively, which are close to the efficient frontier. The mean values of pure technical efficiency, technical efficiency, cost efficiency and overall efficiency are 0. 796, 0. 784, 0. 714 and 0. 714, respectively, which are relatively poor compared with the efficiency frontier. Moreover, the number of hospitals that are in the state of diminishing returns to scale increased from 7 . 69% to 26 . 31%, while the number of hospitals that are in the state of increasing returns to scale decreased from 80. 77% to 58. 34%. The changes in techno-logical progress, Malmquist productivity index, technical efficiency index, pure technical efficiency index and scale effi-ciency index remained a relatively stable consistency, and showed continuous improvement and steady development trend. Conclusion:Tertiary general public hospitals are facing the transformation of driving force for development and incentive mechanisms. This needs not only to change the management concept and development mode of the hospitals, but also to build evaluation standards of optimum efficiency that are relevant to the structure, process and outcome, in order to pro-mote the transformation of hospital governance and development model that includes the functions of government.

Objective:To investigate changes of nicastrin (NCSTN) downstream molecules in signaling pathways related to cell proliferation and differentiation after silencing the expression of the NCSTN gene in the human immortalized keratinocyte cell line HaCaT.Methods:HaCaT cells were divided into 3 groups: interference group transfected with a specific small interfering RNA (siRNA) targeting NCSTN (NCSTN-siRNA) , negative control group transfected with a negative control siRNA, and blank control group transfected with the equal amount of transfection reagent. Real-time PCR and Western blot analysis were performed to measure the NCSTN mRNA and protein expression in groups, in order to verify the transfection efficiency. Differences in gene expression profiles in HaCaT cells were detected between the interference group and negative control group by using Agilent whole-genome microarray, and differentially expressed genes were identified based on a fold change ≥ 2.0 with a P value ≤ 0.05. Gene ontology (GO) enrichment analysis was employed to identify the roles of the differentially expressed genes, and then to screen out significantly differentially expressed genes associated with proliferation and differentiation of keratinocytes, some of which were verified by real-time PCR. Results:The interference group showed significantly decreased mRNA and protein expression of NCSTN (0.287 ± 0.090, 0.443 ± 0.085, respectively) compared with the negative control group (0.969 ± 0.127, 1.047 ± 0.114, respectively) and blank control group (1.000 ± 0.151, 1.000 ± 0.111, F = 30.787, 31.139, respectively, both P = 0.001) . Whole genome-expression analysis using an Agilent microarray platform revealed 605 downregulated genes and 444 upregulated genes in HaCaT cells in the interference group compared with the negative control group. GO analysis showed that differentially expressed genes were enriched into 4 biological processes, including epithelial development, epithelial cell differentiation, keratinocyte differentiation and keratinization. The significantly differentially expressed genes associated with proliferation and differentiation of keratinocytes, including the Sprouty-related protein with EVH1 domain 2, fibroblast growth factor 7, insulin-like growth factor-binding protein 5, Rho-associated coiled-coil kinase 2 and bone morphogenetic protein 6 genes, were verified by real-time PCR, and the verification results were consistent with the difference trend shown by the microarray results. Conclusion:The loss of NCSTN gene function may affect the normal proliferation and differentiation of keratinocytes by regulating the expression of its downstream molecules in signaling pathways associated with cell proliferation and differentiation.

Objective:To investigate the safety and clinical efficacy of osteotomy after halo pelvic traction in severe scoliosis accompanied with split cord malformation.Methods:The clinical data of 14 patients with severe scoliosis accompanied with split cord malformation admitted to the Department of Spinal Surgery, Guizhou Orthopedic Hospital from August 2015 to August 2019 were retrospectively analyzed.There were 6 males and 8 females, aged (19.8±5.0) years (range:13 to 34 years). All patients received spinal orthopedic surgery after halo pelvic traction for 3 to 7 weeks.The data of traction time, height, Cobb angle in the main curved coronal plane and sagittal plane, lung function and nutritional status of the patient were collected before and after the treatment. Paired t test was used to compare the evaluation indexes. Results:The traction time of the 14 patients was (35.2±8.3)days (range:20 to 49 days), and the height of them increased from (156.7±7.6)cm (range:141 to 166 cm) before traction to (167.0±6.4)cm (range:154 to 177 cm) after traction（ t=-10.49， P<0.01）. The Cobb angle on the main curved coronal plane decreased from (117.4±17.2) ° (range: 91°to 176°) before traction to (56.4±8.1) ° (range:44°to 68°) after traction（ t=13.90， P<0.01）. The sagittal Cobb angle decreased from (92.5±11.6) ° (range:62°to 132°) before traction to (41.7±7.7) °(range:29°to 51°) after traction（ t=12.11， P<0.01）. No complications such as loosening of nailing and infection occurred during traction, and no decrease of nerve function occurred. Nine patients underwent single segment acromial transpedicle osteotomy and five underwent double segment adjacent asymmetric shortening osteotomy. None of the patients underwent longitudinal fracture resection. The lung function and nutritional status were improved after traction and surgery(all P<0.01). Postoperative follow-up was (22.5±9.1)months (range:12 to 36 months). At the last follow-up, the coronal Cobb angle was (56.3±7.1) °, and the sagittal Cobb angle was (37.7±6.5) °, showing no statistically significant difference from the angle after traction( t=0.16, P=0.88; t=2.28, P=0.32). There was no loss of orthopedic angle. None of the patients had internal fixation displacement, loosening or fracture. Conclusion:The treatment of severe scoliosis with accompanied with split cord malformation by halo pelvic traction is safe and effective, which is worthy of further confirmation by large sample study.