Objective:To figure out the characteristics of annual medical expenditure for rural residents and its distribution among different population.Methods:The individual annual medical service utilization information was summarized after dealing with the database of the 2014 new rural cooperative medical system by Excel.It prescribed the clustering of medical expenditure by Lorenz curve and Gini index.Descriptive statistics and x2 test were used to compare the characteristics and distribution of the annual medical expenditure among rural residents.The Chi-square test was conducted to compare the differences of the population distribution.Results:The costliest 5％ patients accounted for approximately 68％ of total health care expenditure.The annual total expenditure was 16628 yuan per capita among high-cost population,while low-cost population were 108 yuan.The Gini index of medical expenditure for rural residents was 0.81.Among female and population over 45 years old,the proportion of high-cost population was higher than 5％.People living near provincial road,in flatlands or areas where the ability of township hospital was limited were nore likely to expense higher medical costs,known as 6.40％,5.50％ and 5.80％ separately.Conclusion:Clustering of medical expenditure for rural residents was remarkable,while the expenditure among high-cost,medium-cost and low-cost population were quite different.The elderly,female and primary population living in areas where the ability of township hospitals were limited were more likely to generate high medical costs.

Objective To investigate the significance of metastasis associated lung adenocarcinoma transcript 1 (MALAT1) in the occurrence and development of non-small cell lung cancer(NSCLC).Methods Eighty-six NSCLC lung tissue samples and 86 corresponding adjacent tissues were collected.Real-time quantitative polymerase chain reaction (RT-PCR) was used to detect MALAT1 mRNA expression.The correlation analysis of the gender,age,carcinoma embryonic antigen (CEA),clinical stage,and the degree of differentiation was performed.Results MALAT1 expression levels showed an average 2.16-fold increase in NSCLC lung tissues(87.23 ±9.72) when compared with adjacent tissues(40.38 ± 5.49),the difference was statistically significant (t =7.894,P ＜ 0.01).There was no significant difference between gender,age,histological type,tumor diameter,CEA level in terms of MALAT1 expression (P ＞ 0.05).There was significant differences between pathological stage (Ⅰ stage =52.38％ (11/21),Ⅱ stage =76.00％ (19/25),Ⅲ stage =97.50％ (39/40),x2 =11.839,P =0.042),tumor differentiation (High differentiated =39.13％ (9/23),moderately differentiated =74.47％ (35/47),low differentiated =100％ (16/16),x2 =15.383,P =0.032)and lymph node metastasis (with =97.22％ (35/36),no =46.00％ (23/50),x2 =23.947,P =0.030).Conclusion MALAT1 might be involved in the development of NSCLC,and could be an auxiliary diagnosis marker.

Objective To learn the suitability and validity of readmission service at counties and townships in rural China.Methods Seven pilot counties were randomly selected from the eastern,middle and western areas of China,and five diseases of the respiratory infection and cerebral system were set as the targets,while 600 target inpatient readmitted who had any of the five target diseases from 2012 to 2013 in such counties were selected from the NRCMS database.With expert consultation and empirical evaluation,the fitness of the days of stay at township hospital and necessity of hospitalization at county hospitals were evaluated for such target inpatients.Results 64.7％ of the target inpatients were found with unfit days of stay at township hospitals,mostly too short;59.0％ of the target inpatients' hospitalization at county hospitals were found with serious risk factors during their hospitalization;18.5％ of the inpatients were found with unnecessary hospitalization.Conclusions Hierarchical medical system can enhance the efficiency of the heahhcare system,but the current validity of readmission is poor,so is the fitness of days of stay at township hospitals,and the quality of the referral pattern.These problems mostly result from poor medical competence at township hospitals and high autonomy of patients in seeking medical service anywhere in the country.

Objective To explore the reasons and preventive measures for the postoperative complications of hilar cholangiocarcinoma.Methods The clinical features,diagnosis,surgical therapy,postoperative complications and follow-up result were retrospectively analyzed on 89 cases of hilar cholangiocarcinoma admitted into our hospital from January 2008 to September 2014.Surgical approach:47 cases of radical resection including hepatoduodenal ligament skeletonized resection in 18 cases; concurrent partial hepatectomy in 29 cases,palliative resection in 17 cases,biliary tract drainage in 25 cases.There were 6 cases receiving partial portal vein resection and reconstruction.Results Among 89 patients there were 93 postoperative complications.Biliary complications developed in 22 cases (24.7％,22/89) including bile leakage in 13 cases (14.6％),biliary tract infection in 7 cases,anastomotic stricture in 2 cases.Wound infection in 19 cases,lung infection in 4 cases,ascites in 31 cases,pleural effusion in 10 cases,liver abscess in 1 case,intraabdominal bleeding in 2 cases,postoperative gastrointestinal bleeding,intestinal fistula,liver failure and multiple organ failure (MODS) developed in one each cases.One case died of MODS with the mortality of 1.1％.Conclusions Postoperative complications were common in hilar cholangiocarcinoma combined liver resection and/or vascular resection and reconstruction.Bile leakage is the most frequently seen necessitating long term proper drainage.

Objective To evaluate the long-term effectiveness of different-dose of botulinum toxin A (BTXA) therapy on axillary hyperhidrosis.Methods Total 86 patients with axillary hyperhidrosis were self-controlled.One group of left axillary was injected with a low-dose of BTXA,50U.Another group of right axillary was injected with a high-dose of BTXA.A total dose of 200 U of BTXA was used per axilla.Patients were followed-up for 29 months.To investigate the effect of two methods,we analyzed two ranked data by rank sum test and x2 test to judge the disparities of the therapeutic effect.Results The results showed that the relapse-free interval of two groups with axillary hyperhidrosis was significant difference through the statistical analysis (P ＜ 0.05).Conclusions High-dose of BTXA treatment is capable of prolonging the antihidrotic effect on axillary hyperhidrosis.

Objective To examine clusters of anti-nuclear antibodies (ANA) and their associations with clinical features in patients with systemic lupus erythematosus (SLE).Methods It was a retrospective study.113 SLE patients were reviewed from March 2010 to May 2012 in Department of Rheumatology,Jinhua Central Hospital.ANA and specific autoantibodies to 15 kinds of nuclear antigens were tested by indirect immunofluorescence assay (IIF) and line immunoassay (LIA) respectively.Hierarchical clustering method was performed to analyze specific clusters of ANA profiles in SLE.Chi-square tests were used to investigate relationship between antibody clusters and clinical features of SLE.Results The positive rate of LIA for ANA was 97.3％,consistent with IIF method,and the total accordance rate of the both methods was 98.2％.Thirteen kinds of antigen-specific antibodies were detected in SLE patients by LIA.Clustering analysis for these antibodies showed three specific clusters in SLE,Nuc/His/dsDNA cluster (C1),low-Ro/low-La cluster (C2),and Ro/Sm/RNP cluster (C3),accounting for 36.3％,24.8％,38.9％ of the total cases respectively.There were significant difference of AST levels among three clusters [(32.62 ± 21.92)U/L,(25.56 ± 16.63) U/L,(50.41 ± 60.86) U/L respectively for C1,C2 and C3].High incidences of chronic cutaneous lupus,abnormal renal indicators and inflammatory synovitis were found in all three clusters.Besides,there were significant differences among three clusters for the incidences of chronic cutaneous lupus (39.0％,39.3％,63.6％ respectively for C1,C2,C3) and leukopenia/lymphopenia (56.1％,25.0％,56.8％ respectively for C1,C2,C3) (P ＜ 0.05).Patients in Ro/Sm/RNP cluster showed higher incidences of lupus nephritis (43.2％/26.8％ or 39.3％); patients in low-Ro/low-La cluster showed low risk of hypertension (7.1％/19.5％ or 22.7％) ; patients in Nuc/His/dsDNA cluster showed high incidences of thrombocytopenia (41.5％/21.4％ or 25.0％) and high risk of lung or upper respiratory tract infection (46.3％/28.6％ or 29.5％),but low incidence of neurologic symptoms (0％/ 3.6％ ％ or 11.4％).Conclusion Three characterized ANA clusters are identified in SLE patients in this pilot study.Different clusters are associated with certain clinical features and complications ofSLE.However,the correlations found in this study need to be investigated further in larger populations.

Objective To study the effect and value of hepatoarterical catheter chemotherapy in treating gastric carcinoma with liver metastasis. Methods A total of 31 cases of gastric carcinoma with liver metastasis undergoing radical operation were preoperatively randomly divided into 2 groups: Regional infusion chemotherapy (treatment group, 17 cases) and peripheral venous chemotherapy (control group, 14 cases). Results The short-term effectiveness of the treatment group was 88.3 %(15/17). The survival rates of 1, 2, 3 year were 88.2 %, 62.7 %, 28.9 %, respectively. However, the short-term effectiveness of the control group was 28.6 %(4/14). The survival rates of 1, 2, 3 year were 68.1 %, 38.9 %, 13.0 %, respectively. There was obvious difference between the two groups (χ~2 = 12.87, P <0.05;χ~2 =5.511, P<0.01). Conclusion Hepatoarterical catheter chemotherapy is effective for gastric carcinoma with liver metastasis undergoing radical operation and has less toxic side effects.

Bromodomain and extra-terminal domain(BET)Bromodomain has become a new target for the treatment of cancers and other human disorders. Nowadays,several classes of its potent and selective small-molecule inhibitors have been identified,many of which are in clinical trials. Preclinical and clinical data have shown that BET Bromodomain inhibitors have good prospects. Howev-er,there are potential therapeutic deficiencies,such as drug resistance. At present,attempts are being made to develop BET Bromodo-main inhibitors and degraders based on polypharmacology,combining BET Bromodomain with other targets of different mechanisms. In this paper,small-molecule kinase/BET inhibitors,small-molecule histone deacetylases(HDAC)/BET inhibitors and BET protein degraders are reviewed,which may provide guidance for further research on BET protein.

Objective: To prepare the lithium-doped poly-glycerol sebacate (PGS-Li) scaffold using the specific effects of lithium ions and the excellent performance of PCS, and to provide the basis for its application prospects in cementation tissue engineering scaffold. Methods: The scaffolds were divided into two groups. The PGS-Li scaffolds prepared by adding lithium phosphate during the PGS cross-linking process were used as PGS-Li group, and the PGS scaffolds synthesized by the equal-purification of sebacic acid and glycerol were used as PGS group. The molecular weights of the scaffolds in two groups were determined by gel permeation chromatography. The structures of the scaffolds in two groups were analyzed by fourier transform infrared spectroscope. The surface morphology and the porosities and the pore sizes of the scaffolds in two groups were observed by scanning electron microscope. X-ray photoelectron (XPS) spectroscope and inductively coupled plasma optical emission spectrometer were used to determine the Li ion contents in the scaffolds in two groups. Thermogravimetric analyzer was used to analyze the thermal stabilities of the scaffolds in two groups. Contact angle measuring instrument was used to compare the hydrophilicities of the scaffolds in two groups. In vitro weight loss test was used to determine the degradation rates of the scaffolds in two groups. The OCCM-30 cells were divided into experimental group (added with PGS-Li scaffold extract), PGS group (added with PGS scaffold extract) and blank control group (added with DMEM culture medium). MTT assay was used to detect the proliferation activities of cells in various groups at different time (24, 48 and 72 h); the cell morphology was observed by calcein-AM staining. Results: The gel permeation chromatography results showed that the molecular weight of the PGS-Li scaffold was slightly larger than that of the PGS scaffold. The specific absorption peak of phosphate was detected in the fourier infrared spectrum of the PGS-Li scaffold. The scaffolds in two groups had irregular three-dimensional network structures under scanning electron microscope∗ and the pore size was 20- 160 /im, the porosity of PGS scaffold was (53. 92 ±2. 18) %∗ and the porosity of PGS-Li scaffold was (53. 58± 1. 73)% ? there was no statistical difference between two groups ( P> 0.05). The XPS results showed that a peak appeared at 54. 9 eV in PGS-Li group, which coincided with the Li Is binding energy, while the inductively coupled plasma emission spectrometer results showed that the Li ion content in the PGS-Li scaffold was 0.084%. The thermogravimetric analysis results showed that PGS-Li scaffolds began to degrade at a higher temperature and ceased at a lower temperature compared with PGS scaffolds. The contact angle measurement results indicated that both the materials were hydrophilic materials; the contact angle of PGS scaffold meterial was 78. 26 ±2. 00 , and the contact angle of the PGS-Li scaffold material was 69. 78 ±1.15 ; there was statistical difference between two groups (P0. 05). The calcein-AM staining results showed the green fluorescence in the OCCM-30 cells in PGS and PGS-Li groups, and there were no significant changes in the morphology of cementoblasts. Conclusion: PGS-Li scaffolds have similar composition and structure to PGS scaffolds, and have better performance in hydrophilicity and thermal stability. PGS-Li scaffolds have no effect on the proliferation of cementoblasts and have broad application prospects in cementum tissue engineering.

Objective To investigate the clinical outcomes of surgical excision combined with recom binant interferon aipha-2b in the treatment of acral malignant melanoma (MM). Methods Fifteen patients with acral MM admitted to the department since 2004 were recruited into this study. The tumors varied from 1.8 mm to 3.9 mm in invasion depth. Thin tumors with an invasion depth of 1.8 - 2.0 mm were excised with a margin of lcm beyond the tumors, and those with an invasion depth of 2.0 - 3.9 mm were excised with a margin of 2 cm beyond the tumors. After excision, 4 cases of minor excision were sutured directly, 10 cases of large excision were repaired with adjacent skin grafts and flaps, 1 patient with the involvement of the first metatarsophalangeal joint underwent toe amputation followed by the repair of planta wound surface with the remaining skin on the dorsa of toes. Patients received intramuscular recombinant interferon alpha-2b for 3 months (3 million units daily for the first 3 days and 6 million units for the remaining days) following operation. Results There were 6 cases of MM in situ and 9 cases of invasive MM in this study. All the skin grafts and flaps survived. Within the 3-year follow up, relapse was observed only in 1 patient with invasive MM. Recovery was achieved in the functions of feet in all patients. Conclusion The excision of tumors with a margin determined by tumor thickness plus intramuscular interferon alpha-2h may improve the survival of patients with cutaneous MM in planta pedis with avoidance of amputation.