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 investigate the principle and measures of prevention and treatment on pancreatic fistula due to pancreatic injury.Method:The clinical data of 131 pancreatic injury patients were analyzed retrospectively.Operation and combined therapy during perioperative were performed.Results:Among 35 cases(26.7%,35/131) with pancreatic fistula,3 cases shaped internal fistula showed by visualization and cured spontaneously after operations,9 cases with pancreatic pseudocyst after operations were treated by Roux-en-Y pancreatic cystojejunostomy,2 cases(5.7%,2/35) died of MODS and abdominal infections.The rest were recovered.The follow-up from 3 months to 5 years showed that there were no cases died of complications related to pancreatic fistula.Conclusions:Operation combined with multiple therapies was effective in the prevention and treatment of pancreatic fistula.

Purpose To investigate the diagnosis and differentail diagnosis of metastatic small cell carcinoma of bone in needle biopsy, especially for the differentail diagnosis with Ewing sarcoma of bone. Methods Clinicopathological informations of 11 cases of metastat-ic small cell carcinoma and 20 cases of Ewing sarcoma were collected, and markers for differentail diagnosis were detected in two groups by immunohistochemistry of EnVision. Results The positive rates of CD99 and FLI-1 were 27. 3% and 54. 5% in metastatic small cell carcinoma group, while the positive rate of CK was 15. 0% in Ewing sarcoma group. Patient′s age, single lesion, expression of CK, vimentin, CD99, FLI-1, CD56 were significantly different in two groups. Conclusions Metastatic small cell carcinoma and E-wing sarcoma share similar histopathologic features in needle biopsy, no single immunohistochemical marker can specifically distinguish small cell carcinoma from Ewing sarcouma. The correct diagnosis should comprehensive analyze clinicopathologic characters and a se-ries of immunohistochemical markers.

Objective To investigate the level of IL-17 and its clinical significance in patients with primary Sj(o)gren's syndrome (pSS) complicated with interstitial lung disease (ILD).Methods IL-17 levels were detected by enzyme linked immunosorbent assay (ELISA) in 53 untreated patients with pSS (25patients with only lacriminal and/or salivary gland involvement,28 with only interstitial lung disease involvement) and 15 healthy controls.The related clinical and laboratory data were recorded.ANOVA,LSDtest and Pearson test were used for statistical analysis.Results There were significant differences between the 3 groups(F=22.504,P=0.000).The mean concentration of sera IL-I7 in the patients with ILD was significantly higher than in patients with only lacriminal or salivary gland involvement (P＜0.05).There was no difference in the levels of sera IL-17 between the patients with only lacriminal and/or salivary gland involvement and healthy controls (P＞0.05).Conclusion Our results show that patients with pSS concomitant with ILD have high serum IL-17 levels,which highlight the role of IL-17 in Sj(o)gren's syndrome interstitial lung injury.

Objective To optimize and establish the methodology for culturing and inducing differentiation of mouse preadipocytes 3T3-L1. Methods The mouse cells 3T3-L1 were incubated in DMEM medium contained with 10%FBS, during which the incubation medium was refreshed every 2 to 3 days. Two methods were used to introduce differentiation, including three-drug combination group and four-drug combination group. The protocol of mediumⅠin three-drug combination group including insulin 10 mg/L, IBMX 0.5 mmol/L and DEX 1.0μmol/L. The protocol of mediumⅠin four-drug combination group including indometacin 0.1 mmol/L based on those of three-drug combination group. Both of them were incubated for 2 days and continuous for 2 times. And medium Ⅱ included insulin 10 mg/L for 2-day culturing and continuous for 2 times. Oil red O staining was used to observe the morphological changes of two groups of cells before and after treatment under inverted microscope. Results Mouse preadipocytes 3T3-L1 appeared in good conditions and grew in a paving stone fashion. These cells covered homogeneously the bottom of incubators, the culture medium refreshed every 2 days. The results of four-drug combination group were better than those of three-drug combination group. After three-drug combination induced differentiation, there was no significant change in cell morphology. Comparing with three-drug combination induced differentiation, four-drug combination was successfully achieved in over 90% of the cell inducing, which were round-shaped, with jacinth ester droplets by oil-red O staining. Conclusion We have optimized the method for culturing and inducing differentiation of mouse preadipocytes 3T3-L1 by adding indometacin on the basis of the three-drug combination induced differentiation.

Objective Type 2 diabetes mellitus ( T2DM) as a common disease around the world becomes a great threat to the health of human beings.The cynomolgus T2DM model, which preferably simulates human T2DM onset and progress, can be beneficial to the drug development and clinical treatment.In the present study, 37 of T2DM-susceptibility SNPs and the extended genome sequences were used to obtain corresponding SNPs in the T2DM cynomolgus monkeys. Methods Firstly, DNA pool screening was conducted.Then, using polymerase chain reaction to amplify and to sequence the cynomolgus homologous sequences.Using DNAStar software to analyze the differences between bases.Finally, we used analysis of variance and F test to calculate the frequency of alleles.We also used the GLM models of SAS software to analyze the association of genotype with fasting plasma glucose and glycosylated hemoglobin.Results SNP661A,SNP661B, SNP343A, SNP343B, SNP343C, SNP565A, SNP565B and SNP565C were found to have a significant difference of allele frequencies between spontaneous cases and controls.Conclusions The findings of this study suggest that SNP661A, SNP661B, SNP343A, SNP343B and SNP343C may play an important role in the establishment of cynomolgus T2DM models.

Objective:To observe the effect of "Qishen Yiqi Droplet" on serum concentrations of high sensitivity C reactive protein(hs-CRP),plasminogen activator inhibitor-1(PAI-1),endothelin-1(ET-1)in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention (PCI).Methods:A total of 100 consecutive ACS patients ready to receive PCI therapy in our hospital from june 2007 to August 2008 were randomly assigned into two groups:Qishen group,n=50,with Qishen Yiqi Droplet 5.0 g three timee a day+conventional therapy after PCI;and Control group,n=50 with conventional therapy after PCI.The concentrations of hs-CRP,PAI-1 and ET-1were detected and compared 24 hours before PCI,and 24 hours,4weeks after PCI between two groups respectively.Results:There were no obvious differences of hs-CRP,PAI-1 and ET-1 24 hours after PCI in two groups.The levels of hs-CRP,PAI-1,ET-1 were lower in Qishen group than in Control group 4 weeks after PCI (0.219±0.143)ng/dl vs.(0.366±0.132)ng/dl,P<0.001,(104.252±26.038)ng/dl vs.(118.419±28.849)ng/ml,P<0.05,and (37.411±12.977)ng/dl vs.(45.755±12.305)pg/ml,P<0.01,respectively.Conclusion:Qishen Yiqi Droplet could decrease the levels of hs-CRP,PAI-1 and ET-1 in ACS patients who underwent PCI,and it might have the protective role in preventing the neointimal hyperplasia and thrombogenesis after stent implantation.

Aim To investigate the effect of ASIC1 a ( acid-sensing ion channel 1 a ) on the pathological change of diabetes complication liver fibrosis and the proliferation and activation of hepatic stellate cell ( HSC-T6 ) stimulated by PDGF-BB under hyperglyce-mia. Methods Diabetes rats model was established by streptozotocin ( STZ) , and liver fibrosis rats model was induced by carbon tetrachloride ( CCl4 ) . Then, the liver extent of damage and the expression of ASIC1 a were observed in the diabetic rats, liver fibrosis rats and diabetes complication liver fibrosis rats. In vitro, after pretreated with amiloride, HSC-T6 was treated with high glucose for 24 h and then stimulated with PDGF-BB for another 24 h. The proliferation and acti-vation of HSC-T6 were observed, and the expression of ASIC1a, α-SMA and collagen Ⅰ were detected by Western blot. Results Compared with the control group, rats from diabetic group induced by STZ, liver fibrosis group induced by CCl4 , and the diabetes com-plication liver fibrosis rats co-induced by STZ and CCl4 were all observed with liver damage at different levels, and tissue injury of complication group was most seri-ous. However, the expression of ASIC1a in the three model groups was significantly increased compared to the control group. ASIC1a level was most obvious in the diabetes complication liver fibrosis rats. Amiloride pretreatment significantly decreased ASIC1 a expression and inhibited PDGF-BB mediated proliferation and the expression ofα-SMA and collagenⅠin HSC-T6 under high glucose environment. Conclusion High ambient glucose aggravates HSC activation and hepatic fibrosis, and this may be related with the increasing expression of ASIC1a.

The effect of electroacupuncture (EA) on TRPM7 mRNA expression of focal cerebral ischemia in rats and further the role of EA in the relationship between TRPM7 and trkA pathway was investigated. Thirty SD rats were randomly divided into 5 groups : normal group, ischemia/reperfusion group, EA treated group (ischemic rats with EA treatment), TE infusion group (ischemic rats with EA treatment and TE buffer infusion), AS-ODN group (ischemic rats with EA treatment and antisense trkA oligonucleotide infusion). The stroke animal model was established by the modified method of middle cerebral artery occlusion. Antisense trkA oligonucleotide that blocked NGFs effects was injected into cerebroventricle before EA. The TRPM7 mRNA was detected by RT-PCR method. The results showed that there were low TRPM7 mRNA levels in cortex and hippocampus in normal group. Compared with normal group, TRPM7 mRNA expression was increased significantly in ischemia/reperfusion group (P<0.05). A significant reduction in the expression of TR-PM7 mRNA was found in EA treated group in contrast to ischemia/reperfusion group (P<0.05). The expression of TRPM7 mRNA in AS-ODN group was remarkably increased compared with EA treated group and TE infusion group (P<0.05). The results indicated that TRPM7 channels in the ischemic cortex and hippocampus in rats might play a key role in ischemic brain injury. EA could reverse the overexpression of TRPM7 in cerebral ischemia/reperfusion rats. And the inhibitory effect of EA on TRPM7 channels might be through trkA pathway.

Objective To investigate the distribution and antibiotic resistance of the pathogens isolated from blood of the inpatients in hematology ward.Methods Antimicrobial susceptibility test was carried out using Kirby-Bauer method.The data were analyzed by WHONET 5.6 software.Results Of the 521 microbial isolates collected,gram-negative bacilli accounted for 47.2％,grampositive cocci 45.7％ and fungi (7.1％).The most frequently isolated microorganisms were coagulase negative Staphylococcus (154),E.coli (88),K.pneumoniae (51),P.aeruginosa (39) and Enterococcus spp (34).ESBLs were produced in about 40.4％ of the K.pneumoniae isolates and 63.4％ of the E.coli isolates.At least 90％ of the E.coli isolates were susceptible to imipenem and meropenem,and at least 70％ susceptible to piperacillin-tazobactam.At least 85％ of the K.pneumoniae strains were susceptible to imipenem and meropenem,and at least 70％ susceptible to levofloxacin,piperacillin-tazobactam and cefoperazone-sulbactam.The percentage of the P.aeruginosa susceptible to ciprofloxacin and tobramycin was at least 90％,and higher than 70％ to levofloxacin,meropenem,imipenem,piperacillin-tazobactam,cefepime,and cefoperazone-sulbactam.More than 90％ strains of the coagulase negative Staphylococcus and Enterococcus were susceptible to linezolid and teicoplanin.Overall,82.5％ of the coagulase negative Staphylococcus isolates were resistant to methicillin.Three E.coli isolates and 4 K.pneumoniae isolates were found resistant to carbapenems,and 14 Enterococcus isolates were resistant to vancomycin.Conclusions Gram-negative bacilli are the major pathogens from blood samples in hematology ward,which show high susceptibility to piperacillin-tazobactam and cefoperazone-sulbactam,imipenem and meropenem.The grampositive cocci show high susceptibility to linezolid and teicoplanin.These data are helpful for empirical antimicrobial therapy.