Recently,the incidence of diabetes mellitus has been increasing;however,current treatment op-tions are limited.As the life expectancy of patients has increased,a range of diabetes mellitus-associated complications with have emerged.Meteorin-like protein(Metrnl)is a novel adipokine closely related to glucose and lipid metabolism,tumor growth,immunity,cognitive function,skeletal muscle repair,and cardiovascular and cerebrovascular functions and involved in the occurrence and development of diabetes mellitus and emerging complications.This study focuses on the current roles and mechanisms of Metrnl in cancer,infections,liver diseases,cognitive function,and disabilities.

Objective:To analyze the relationship between the AXIN2 gene promoter methylation status in breast cancer tissues with the breast cancer-related risk factors, clinicopathological characteristics and the mRNA expression of AXIN2 gene.Methods:The breast cancer tissues and adjacent tissues of 84 breast cancer patients were taken to detect the AXIN2 gene promoter methylation status and the AXIN2 mRNA expression. We used different concentrations of methyltransferase inhibitors 5-Azacytidine (5 -Aza) to treat human breast cancer ZR-75-1 cells, and collected the breast cancer-related risk factors and clinicopathological characteristics.Results:The positive rate of methylation of AXIN2 gene promoter in breast cancer tissues (40.5%) was significantly higher than that of adjacent tissues (19.0%) ( χ2=10.401, P=0.001) . The positive rate of AXIN2 methylation was related to the age at first delivery ( χ2=5.467, P=0.019) and a history of induced abortion ( χ2=8.372, P=0.006) ; the positive rate of AXIN2 methylation was related to lymph node metastasis ( χ2=5.338, P=0.021) , ER expression status ( χ2=9.141, P=0.002) and PR expression status ( χ2=6.918, P=0.009) . In addition, the relative expression of AXIN2 gene mRNA in breast cancer tissues (0.22 ± 0.03) was significantly lower than that in adjacent tissues (0.46 ± 0.06) ( t=3.527, P<0.001) . The relative mRNA expression of the methylation-positive breast cancer tissues (0.13 ± 0.02) was significantly lower than that of the methylation-negative breast cancer tissues (0.29 ± 0.04) ( t=3.616, P<0.001) . After ZR-75-1 cells treated with 5-Aza, the relative expression of AXIN2 gene mRNA increased significantly ( t=3.824, P<0.001) . Conclusion:DNA methylation in the promoter region of the AXIN2 gene is related to the pathogenesis of breast cancer, and has certain clinical application value.

Objective To make a comprehensive analysis of the satisfaction and preferences of rural doctors'incentive measures,and to identify the incentives that need to be optimized.Methods The method of multi-stage stratified random sampling was used to investigate the rural doctors in Shandong province in 2015.This survey called into play the sample mean and standard deviation for descriptive analysis.And according to Maslow's Hierarchy of Needs theory, the scoring and ranking of different levels and specific incentive measures were calculated.The important quadrant model which combined with motivational preference and satisfaction of incentive measures was used to analysis them.Results The top preference for rural doctors was survival demand,scoring 4 284.Among the specific incentives,the top wss lower medical practice risk,scoring 945.75.In combination with satisfaction analysis, 7 incentive measures, including improving welfare and policy assurance, were now in the state of low satisfaction and high preference. Conclusions In terms of demand level,the survival incentive factor tops the needs of rural doctors.In the specific incentive measures, the seven incentives, such as lower practice risk, deserve more attention. Relevant departments should actively improve and implement these seven measures in order to maximize their motivation for rural doctors.

Objective To explore the effects and mechanisms of hepatitis B virus-X protein (HBx) on invasion and migration of hepatocellular carcinoma (HCC) cells.Methods The retrospective cohort study was conducted.The clinicopathological data of 30 patients with liver tumor (20 with HCC and 10 with benign tumor of liver) who were admitted to the Affiliated Hospital of Xuzhou Medical College between July 2014 and July 2015 were collected.HCC tissues of 20 patients with HCC (with history of HBV infection) were collected by surgical resection and peritumoral normal tissues (outside of tumor capsule) of 10 patients with benign tumor of liver (without history of HBV infection) were collected.The expressions of epidermal growth factor receptor 3 (ErbB3)in HCC tissues and peritumoral normal tissues were detected by immunohistochemistry (IHC).The relative expressions of ErbB3 and HBx in HCC tissues and peritumoral normal tissues were detected by Western blot,and relative expressions of ErbB3 in HepG2 of which green fluorescent protein (GFP) and GFP-HBx were respectively transfected were detected.The relative expressions of ErbB3 mRNA in HepG2 transfected by GFP and GFP-HBx were detected by real-time polymerase chain reaction (RT-PCR).The migration and invasion of HepG2 were respectively detected by Transwell assay with and without matrix.The measurement data with normal distribution were represented as $± s.The comparisons between groups were evaluated with the independent-sample t test.Correlation analysis was done by the Pearson test.Results (1) The expressions of ErbB3 were detected by IHC:relative value of mean optical density (MOD) of ErbB3 in HCC tissues of 20 patients with HCC and peritumoral normal tissues of 10 patients with benign tumor of liver were 2.54± 1.33 and O.99±0.29,respectively,with a statistically significant difference (t =6.542,P ＜ 0.05).(2) The relative expressions of ErbB3 and HBx were detected by Western blot:relative expressions of ErbB3 and HBx were respectively 0.79±0.13,1.10±0.28 in HCC tissues of 10 patients with HCC and 1.07±0.17,0 in peritumoral normal tissues of 10 patients with benign tumor of liver,with statistically significant differences (t =3.229,19.486,P＜0.05).The results of Pearson test showed that there was a positive correlation of expression between ErbB3 and HBx in HCC tissues (r=O.637,P＜ 0.05).(3) The relative expressions and transcriptional levels of ErbB3 were detected by Western blot and RT-PCR:relative expressions of ErbB3 in HepG2 of which GFP and GFP-HBx were respectively transfected were O.75±0.11 and 1.10±0.10,respectively,with a statistically significant difference (t=4.291,P＜0.05).The relative expressions of ErbB3 mRNA in HepG2 of which GFP and GFP-HBx were respectively transfected were O.38±0.03 and O.94±0.07,respectively,with a statistically significant difference (t=11.703,P＜O.05).(4) The effects of ErbB3 on migration and invasion of HepG2:numbers of transmenbrane cell in HepG2 of which His and His-ErbB3 were respectively transfected by Transwell assay with matrix were respectively 271± 18 and 463± 31,respectively,with a statistically significant difference (t =8.202,P＜0.05).Numbers of transmenbrane cell in HepG2 of which His and His-ErbB3 were respectively transfected by Transwell assay without matrix were respectively 315±38 and 549±34,respectively,with a statistically significant difference (t =8.310,P＜0.05).Conclusion HBx protein can promote the invasion and migration of hepatocellular carcinoma cells through up-regulating expressions of ErbB3 protein.

Objective To identify the influencing factors for rural doctors′ training effect,and suggest on the improvement of such training.Methods On the basis of rural doctors′ survey,the theory of pre-intervention was used to probe into the influencing factors for such training in five dimensions of attention notice,mega-cognitive strategies,advance organizer,goal orientation,and preparatory information.Results 73.2% of the groups were found with satisfying effect.In the single factor analysis,comparison of training effect involving such factors as age,gender,length of work life and pre-intervention revealed statistical significance(P<0.05).As shown in the logistic regression analysis,High motivation in meta-cognitive strategies,Clear goals in goal orientation,Tiered and categorized training in advance organizers,and Practical learning in preparatory information,as well as variants like age would influence rural doctors′ training effect significantly.Conclusions The key to better training effect lies in better motivation of the trainee,setting correct training goals,emphasis on the practicability of training contents and,the pertinence of the training objects.

Objective To analyze rural doctors′ social mentality with the theory of relative deprivation.Methods 642 rural doctors from 225 villages of 1 5 counties in Shandong were selected for a questionnaire survey.The factor analysis method was used to reduce the scale dimension and simplify the scale.Analysis of rural doctors′vertical and horizontal relative deprivation was made based on different reference groups.Results Rural doctors tend to identify themselves with rural teachers and doctors in township hospitals,and 60.0% identify themselves as the low income group.39.9% of them found a higher income,while 33.5% of them found a higher social status.76.3% of them found their social contributions are higher.91.4% of them hold that villagers benefit from the new healthcare reform policies,while 65.9% of them hold themselves as benefiting from such policies.This indicates a low sense of achievement.Conclusions Compared with the reference groups,rural doctors feel an obvious sense of relative deprivation comparing both horizontally and vertically.They hold themselves as underpaid and have little sense of achievement for the policies.In this consideration,the government should increase subsidies to lift pay for rural doctors,and to identify their legitimacy,in order to stabilize these medical workers.

To study performance problems found in China's essential medicine system.The SmithModel of system implementation was called into play in a systematic collation and analysis for the ideal policies,system implementation agencies,target groups and policy environment in its performance,along with relationships among the four factors.The system is found with a number of loopholes as the system itself is highly idealized,its system objectives set inappropriately,problems found with the four factors,and tension and conflicts among these factors.Given these problems found in its performance,it is inappropriate to make drastic changes to avoid instability of the system at its early stage.Government departments in question are advised to comprehensively analyze the four factors and their relationships then taking effective measures to deal with them and the tension,conflict among them.This can ensure effectively implementation of the essential medicine system.

Objective To comprehensively evaluate prevention and health care services of community health centers in Shandong province since the ongoing health reform and provide policy basis for development of community health services.Methods To study with rank sum ratio method and important quadrant models.Results Seventy-eight percent of community health centers were appraised as“average”.Overall satisfaction of residents for preventive and health services was 2.66 points.Preventive and health services of community health centers are expected to improve.Conclusion Overall prevention and health services of CHS centers were found less than satisfactory.Prevention and health services of CHS centers in regions a and B were poor,which deserves attention of the government health authorities.The government is expected to take actions to promote development of CHS centers for prevention and health care service.

Objective To evaluate the township hospitals'medical service efficiency in Shandong province,and to provide references for the development in township hospitals under the background of the essential medicine system.Methods The method of data envelopment analysis(DEA)was used to analyze the township hospitals' medical service efficiency in Shandong province before and since the implementation of the essential medicine system.Results For the township hospitals in Shandong province in general,their relative efficiency ratio of the medical service efficiency dropped from 66.67% to 53.33% since the implementation of the essential medicine system.In terms of the input and output,the non-DEA effective township hospitals are found with insufficient output as measured by the output indicator,while some input indicators input were found as excessive.Conclusion The low scale efficiency has become the main factor for the low service efficiency of such hospitals since the implementation of the essential medicine system in Shandong province.In order to improve the medical service efficiency,it is important to continue to improve the essential medicine system,increase the medical staff's incentives, improve the fiscal compensation policy,and keep the policy continuity.

Grounded theory was used to summarize and analyze influencing factors and their mechanism on availability of essential medicine.Four factors which influenced the availability of essential medicine were singled out:defective top design in the essential medicine system,interactions among its policies,deviations in the policy implementation by government agencies,and deficiency of supporting policies for the system.The availability of essential medicine in rural areas was influenced by a variety of factors.The ideas and methods of the grounded theory prove helpful for this study.In the future studies,both qualitative and quantitative study should be made to perfect this model formed by the grounded theory,to identify roadblocks and underlying causes in order to provide evidence for improving availability of essential medicine in rural areas.