Rural health policies are difficult to be implemented at the village level in China.From the perspective of health administrative departments and township health centers, this is due to the lack of the basic conditions of rural health policy and the basic ability of the rural health policy.But from the point of view of village doctors, this is because of the lack of personnel, funding and other embarrassing situations, especially due to crisis and risks are taken to the village clinics and village doctors by the township health centers.In fact, the main reason why the health policy is difficult to land at the village level is that the relationship between the township health centers and village clinics have not been rationalized, as can be specifically seen in weak position of village clinics compared with township health centers.The key to rationalize the relationship between the township health centers and village clinics is to strengthen the development capacity of village doctors, at the same time to get rid of the misunderstanding for village doctors in some of the thinking and policy and strengthen the accountability of primary authorities, and finally open up the relationship between the township health centers and village clinics.

The core problem of current rural health services is a governance problem, that is, how the basic rural health resources can be used more effectively. Based on the study of history and reality, this paper suggests that in the existing “government-market” framework, the village is the third perspective worthy of consideration. Inside the village community, the trust, network and cooperation between people which were based on the traditional rural acquaintances society capital and the institutional resources in the organizations at the primary level will be able to in-crease the degree of organization, thereby reducing the transaction costs between the government or the market and rural residents. The village power will be able to better take advantage of government and market mechanisms, and thus solve the problem of rural health resource utilization more effectively.

Objective To observe the efficacy of acupuncture at Hegu (LI4) in treating central facial palsy due to cerebral ischemia, and to explore the dose-effect correlation and the optimal acupuncture protocol.Method Totally 150 patients with central facial palsy due to ischemic stroke were randomized into four groups to receive acupuncture at Hegu with different stimulation parameters plus the conventional integrated Chinese and Western medicine (group A, B, C, D) according to the acupuncture time and direction, and a control group (group E) only to receive the conventional Chinese and Western medicine treatment. The treatment lasted 14 d. The House-Brackmann facial nerve grading system, Toronto Facial Grading System and facial palsy grading scale were adopted as the evaluation indexes.Result After intervention, the scores of the three indexes were all significantly increased in the five groups (P<0.05), and the inter-group comparisons showed significant differences in comparing the improvement rate (P<0.05).Conclusion The study shows that acupuncture at Hegu is effective in treating central facial palsy due to cerebral ischemia, and with the inverse insertion of the needle and manipulation for 5 min at Hegu should be the optimal protocol regarding the improvement of the symptom score and effective rate.

Objective To observe the clinical efficacy of Tong Du Wen Yang (unblocking the Governor Vessel and warming yang) in treating amyotrophic lateral sclerosis (ALS).Method Twenty-eight eligible ALS patients were randomized into two groups by following the visiting sequence. Thirteen patients in the control group were intervened by orally taking Riluzole tablets; 15 cases in the treatment group were by Tong Du Wen Yang needling in addition to oral administration of Riluzole tablets. Before treatment and after 6-month treatment, the therapeutic efficacies were evaluated by using the Chinese medicine syndrome and sign scoring for Wei-flaccidity diseases and Appel function scale.Result After the treatment, the Chinese syndrome and sign scoring scores for Wei-flaccidity dropped in both groups, and the decrease in the treatment group was more significant than that in the control group (P<0.05). The Appel scores dropped in both groups after the treatment, while the decrease in the treatment group was less significant than that in the control group (P<0.05).Conclusion Tong Du Wen Yang needling plus orally taking Riluzole tablets can produce a more significant efficacy than using Western medication alone in treating ALS.

Ultra-wide-field fluorescein angiography (UWFA) is a novel breakthrough in ocular fundus imaging technology, which can capture a single, high-resolution, 200° wide image of the ocular fundus that traditional fluorescein angiography cannot reach. This technology has important impacts on the screening, diagnosis, staging, treatment and follow-up of vascular diseases involving peripheral retina (such as diabetic retinopathy, age-related macular degeneration, retinal vein occlusion, uveitis and so on).

Objective To explore the effectively of N -acetylcysteine effervescent tablets combined tiotropium bromide powders for inhalation in treatment of patients with acute exacerbation of chronic obstructive pulmonary disease. Methods 72 patients with acute exacerbation of chronic obstructive pulmonary disease were randomly divided into control group(36 cases)and treatment group(36 cases)according to random number table method.In treatment group,patients were given N -acetylcysteine effervescent tablets(600mg,2 times/d,oral)and tiotropium bromide powders for inhalation(18 μg,one time /d)for a month,and in the control group,patients were given tiotropium bromide powders for inhalation (18 μg,one time /d).Pulmonary function and clinical changed symptoms were observed as evaluation index before and after treatment in patients of the two groups Results The total effective rate were 61.1%,83.3% in the treatment group and control group respectively,there was a statistically significant difference (χ2 =4.430,P =0.035).Before the treatment,there was no significant differences between the two groups of patients with pulmonary function(P >0.05).After a month,pulmonary function of patients′FEV1 ,FVC and FEV1 /FVC in the treatment group were (1.9 ±0.6)L,(3.1 ±0.3)L and (67.9 ±8.4)% respectively,which in the control group were (1.6 ±0.5)L,(2.7 ±0.2)L and (59.3 ±7.4)%,there were significant differences(t =2.304,6.564,4.609, P =0.021,0.000,0.000).Conclusion N -acetylcysteine effervescent tablets combined with tiotropium bromide powders for inhalation can improve the clinical curative effect for patients with acute exacerbation of chronic obstructive pulmonary disease,which can be used to improve the patients'clinical symptoms and pulmonary function.

Objective To explore the prognosis value of serum hydrogen sulfide (H2S) concentration and acute physiology and chronic health evaluation HI (APACHE Ⅲ) scores in critically ill patients. Methods The serum H2S levels were measured in 72 cases and 12 controls by spectrophotometry. The APACHE Ⅲ scores of the patients were assessed. The relationship between serum H2S concentration and APACHE H scores and prognosis were analyzed. Results The average serum H2S concentration of the 72 cases was (45. 6 ±17.2) μmol/L The concentration in the survival group was(41. 1 ± 14. 7) μmol/L,and which was significantly lower than in the dead group(62. 8 ±15. 5)μmol/L,(P<0. 01). The average APACHE I score was(43. 6 ±26. 0)of the 72 cases. The APACHE Ⅲ score was(37. 7 ±22. 2) in the survival group,and which was significantly lower than in the dead group (65. 0 ±29. 6) (P <0. 01). The higher of the serum H2S concentration or APACHE Ⅲ scores,the higher mortality of the patients(P <0. 01). Conclusions Serum H2S levels and APACHE Ⅲ scores of critically ill patients have a role in judging the condition and prognosis of the patients.

Acupuncture Therapy ; Anal Canal ; pathology ; Female ; Humans ; Intervertebral Disc Displacement ; complications ; Middle Aged ; Pain ; etiology ; Rectal Diseases ; etiology ; pathology ; therapy

Objective To investigate the relationship between body mass index(BMI)and cardiac structure and function of adult men living in Hebei province.Methods A total of 160 adults were assigned to 4 groups by BMI:normal body weight group(group A,BMI 18.5 to 23.9 kg/m2),overweight group (group B,BMI 24.0 to 27.9 kg/m2),mild obese group(group C,BMI 28.0 to 29.9 kg/m2),and severe obese group(group D,BMI ≥ 30 kg/m2).Left ventricular end-diastolic diameter(EDD),end-systolic diameter(ESD),inter ventricular septal thickness(IVS),left ventricular posterior wall thickness (LVPW),left ventricular mass(LVM),and left ventricular mass index(LVMI)were examined by echocardiography.Early(E)peak diastolic and late(A)diastolic mitral inflow velocity and E/A ratio were measured by Doppler echocardiography.Pulsed wave Doppler tissue image(PW-DTI)of the lateral mitral annulus was performed to evaluate early peak diastolic velocity(Em),late peak diastolic velocity(Am)and Em/Am ratio.Results Compared with group A,EDD,ESD,LNM,LVMI,Am,IVS and LVPW were increased in the other 3 groups(all P ＜ 0.05).E,E/A ratio,Em,and Em/Am ratio were decreased in group B,C,and D(all P ＜ 0.05).Compared with group B,Sm was decreased in group C and D(both P ＜ 0.05).Conclusion Overweight and obesity could contribute to ventricular hypertrophy and deteriorate diastolic function in a BMI dependent manner.Obesity may be also related to decreased Sm.

BACKGROUND:Compared with conservative treatment, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) can rapidly relieve the pain caused by the compression of osteoporotic vertebral body. However, the perfusion of bone cement can not only restore the rigidity of fractured vertebrae, but also theoretical y alter the stress distribution of fractured vertebrae and increase the stress load of adjacent vertebrae, thus causing adjacent intervertebral disc degeneration. ＜br> OBJECTIVE:To observe the effects of PVP and PKP on the adjacent intervertebral disc degeneration and explore the possible mechanism. ＜br> METHODS:A total of 85 patients with osteoporotic vertebral compression fracture were divided into three groups:conservative treatment group (n=23), PVP group (n=42) and PKP group (n=23). ODI scores, DHI, MRII, and peripheral interleukin-1β, interleukin-6, tumor necrosis factor-αlevels were col ected and analyzed at different time points. ＜br> RESULTS AND CONCLUSION:The results showed that, PVP group and PKP group relieved pain effectively, reduced the time in bed, and had a better treatment satisfaction, but there were no significant differences in the scores of ODI scores between PVP group and PKP group at 24 months after discharge (P>0.05). At 24 months after discharge, MRII in the PVP group and PKP group were lower than that in conservative treatment group and before treatment (P＜0.05), while peripheral interleukin-1, interleukin-6, tumor necrosis factor-αlevels were higher (P＜0.05), there were significant differences between PVP group and PKP group (P＜0.05). The disc degeneration adjacent to the fractured vertebral body can be accelerated by PVP and PKP procedures, and the latter is more serious. Interleukin-1, interleukin-6, tumor necrosis factor-αlevels are closely related to the degree of intervertebral disc degeneration.