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 explore the incidence, causes, training courses at high risk and location of the body of training injury in a special force corps, provide evidence for effective prevention of the injury.[Method]A questionnaire on training injuries and relative situations, and review of medical records from Nov 2005 to Oct 2006 were performed in 823 soldiers and officers in a special force corps at Nov 2006. Data were input into computers after quantization, and descriptive analysis was conducted with SPSS 13.0 software. [Result]Of 823 soldiers and officers, 738 (89.67%) experienced one or more injuries in that year, 525 (63.79%) were affected in normal training, 221 (26.85%) lost more than one training day due to the injuries. Confirmed with the medical records, 213 (25.90%) lost more than one training day due to injuries. A total of 1696 injuries occurred in 823 soldiers and offices in that year, of them, 1263 injuries interfered with normal training. Injury rate was 12.78 per 100 per month. 24.12% of injuries were due to over-exertion, 15.86% due to accident and 13.33% due to environmental field. Injury occurred mainly in runing related training courses including 5km running (22.17%) and 400m obstacle running (20.87%), followed by weight lifting (9.67%). The most frequent site of injury was the lower extremities, accounted for 65.74 % of the inj urie s including the foot ( 18.75 %),the ankle (13.50%), the leg (13.56%) and the knee (14.39%), followed by low back (14.21%). [Conclusion]Persistent over-exertion basic training, the courses at high risk of injury, should be improved in focus. Lower extremities and low back, the most frequent locations of injury, should be taken as key points of prevention and treatment of training injury.

[Objective]To explore the clinical characteristic of combined posterior cruciate ligament (PCL) with posterolateral corner (PLC) injuries,and evaluate the technique and outcome of arthroscopic single bundle reconstruction of PCL and reconstruction of PLC with posterior half of biceps femoris tendon.[Method]From Dec. 2001 to Dec. 2004,14 patients (14 knees) with severe posterior and posterolateral rotatory instability were treated surgically in our department,all of them presented III degree positive results of posterior drawer test,positive varus stress test and more than 10 degree of external rotation of the affected knees compared with the intact knees.PCL tear and abnormal opening of posterolateral compartment were seen in all of the 14 knees under arthroscopy.Of them,2 knee were combined with common peroneal nerve injury.All the damaged PCLs were reconstructed with single bundle of autogenous quadrupled hamstring tendons under arthroscopy,and PLCs were reconstructed with the posterior half of biceps femoris tendon tenodesis.[Result]No severe complications occurred in early stage after operation in the 14 patients.All of them were followed up from 12 to 33 months with an average of 21.14?7.26 months.Posterior stabilities were recovered significantly,varus stress test was negative at 30 degree of flexion and full extension,less than 10 degree of external rotation compared with the intact knee in all of the patients.Lysholm score was remarkable improved from 40~60 (mean 47.1?8.25) preoperatively to 70~95 ( mean 86.79?7.23) at follow up(P

[Objective]To evaluate the technique and outcome of arthroscopic reconstruction of anterior cruciate ligament (ACL) with preservation of the remnents.[Method]From June 2005 to May 2006, 28 knees with ACL tear in 28 patients were verified with arthroscopy in this department.Of them,8 knee were combined with lateral meniscus tear and 6 combined with medial meniscus tear. All the damaged ACLs were reconstructed with single bundle of autogenous quadrupled hamstring tendons under arthroscopy without remove of the remnants of ACL. Bioabsorbable interference screw was used for direct anatomic fixation of the reconstructed ligament.[Result]No severe complication occurred in early stage after operation in the 28 patients.All of them were followed up for 12 to 24 months with an average of 18 months. Lysholm score was remarkablely improved from 46～80 (mean 60.75?9.54) preoperatively to 85～100 (mean 95.89?6.24) at the latest follow up (P

[Objective] To investigate the treatment in the use of allograft bone grains combined with autograft bone grafting in giant cell tumor.[Method]From March 1996 to March 2006,24 cases of giant cell tumor closed to knee were verified by pathology in this department,including 11 on thighbone and others on tibia.Before operation allografts was sheared to grains after antigen extracted by repeat freeze thawing and mechanical methods.Giant cell tumor of bone was completely erased in surgical fringe and the defect was thoroughly closed-up with allograft grains combined with cancellous bone autografts.The knee joints exercise was made for 12 weeks with external orthosis fixation.[Result]No severe complication occurred in early stage after operation in the 24 patients.All of them were followed up for 1 to 6 years with an average of 2 years and 8 months.None of them recidivated after the operation,and no insert was taken off for severe rejection,one case showed tolerant pathologic fracture.All the transplantations showed ideal appearance in X-ray photograph and the motion of joints had no significant difference than before.Curative effects were evaluated by Mankin criteria.The outcome was excellent in 20 cases,good in 4 cases.[Conclusion]Bone allograft grains combined with autograft is an effective and few rejection in filling of giant bone defect in surgical operation of giant cell tumor near knee joints.

[Objective]To compare the clinical results between allograft and autograft for treatment of scoliosis in the adolescent.[Method]A retrospective study was made in 63 cases of adolescent patients with scoliosis who were operated on with posterior instrumentation from 1996~2006.These patients were divided into two groups.In group A,32 patients aged 10 to 15 years with an average of 12.2 years,had a mean Cobbs angle of 62?(ranged,38? to 113?),were received allograft bone grafting.The patients were followed up for at least 18 months with an average of 26 months.Clinical and radiographic evaluations were performed.[Results]Operating time and blood loss in group A were less than that in group B(P

[Objective]To observe the curative effect of ectogenic bone inductive factor in treating osteoporotic frature,and provide feasibility pathway and method for clinical treatment.[Method]Sixty cases of osteoporotic fracture from Febuary 2002 to May 2005 were randomly divided into experimental group(30 cases) and control group(30 cases).The experimental group were given 4 ml osteotide a day by intramuscular injection,and 15 days were a course of treatment.The second course of treatment went on after 15 days later when the first course ended.At the same time,no any medicine was given to the control group.The biochemical indicators were detected 2 months later.And after 2,4 and 6 months the union of fracture was observed through radiology.[Result]Four months after operation,radiology examination showed that the rate of union of fracture was 93% and 67% respectively.There was significant difference between the two groups(P

Objective To quantitatively assess left ventricular systolic function in rabbits with dilated cardiomyopathy(DCM) by quantitative tissue velocity imaging (QTVI). Methods Thirty rabbits were divided into two groups: group A(adriamycin group) and group B(sodium chloride group). Group A( n = 20) were given adriamycin 2 mg/kg intravenously once a week for eight weeks (total dose, 16 mg/kg) to induce DCM model, group B were given with the same dose of sodium chloride injection solution. Two dimensional echocardiography and QTVI examination were performed in all rabbits before and three weeks after the administration,respectively. Peak systolic velocity(Vs), peak displacement(D) and other common parameters were analyzed. Results Common parameters assessed after administration in group B did not show significant changes. The QTVI curves of left ventricle myocardium were regular and the value of Vs and D decreased gradually from the basal segments to the apical segments after the administration. The diameters of atrium and ventricle of group A increased,while the ejection fraction and fractional shortening of left ventricle decreased significantly ( P <0. 05 or P < 0.01). The pattern of the curves still had the regularity. But Vs and D value decreased significantly ( P <0. 05 or P <0. 01). Pathology of myocardium samples of group A showed the cardiomyocyte changes like dilated cardiomyopathy, while samples of group B had no significant change. Conclusions QTVI can accurately evaluate regional systolic function of left ventricle in rabbits with dilated cardiomyopathy, therefore provides experimental foundation for clinical observation and treatment.

Objective To evaluate the capability of strain rate imaging(SRI)for monitoring regional systolic deformation and synchronicity of left ventricle after coronary artery bypass graft(CABG)and for evaluating effect of surgery and predicting restenosis.Methods The values of systolic strain rate(SRsys),systolic strain(Ssys)and post systolic strain index(PSI)in 5 segments supplied by left anterior descending coronary artery were measured in study group(60 patients with coronary artery disease)at 1 day before and 10 days,1 month,3 months and 6 months after CABG.Forty healthy participants served as a baseline control group.The regional myocardial function before and after CABG was compared and analyzed.Results The peak values of SRsys and Ssys decreased before CABG in study group.In 52 of the 60 patients,SRsys and Ssys in the graft segments increased gradually and showed statistical significance in most studied segments at 3 and 6 months after surgery.In the above 52 patients,value of PSI increased before CABG and reduced significantly in all analyzed segments at 6 months after surgery.The restenosis of graft artery was suspected in 8 patients by SRI and the positive predictive value was 75%.The diagnosis sensitivity of SRI parameter method was higher than that of 2-dimensional echocardiography and the sensitivity of Ssys was higher than that of SRsys.Conclusions SRI can be used to quantitatively assess the regionsl systolic deformation and synchronicity and monitor the improvement of myocardial function after CABG and determine the effect of surgery and predict restenosis of graft artery.

Objective To evaluate the protective effect of epigallocatechin gallate (EGCG) against interleukin (IL)-17-induced injury to keratinocytes,and to explore its mechanism.Methods Some cultured HaCaT cells were divided into 3 groups to be treated with IL-17 alone at concentrations of 50,70,90 μg/L,respectively,with those receiving no treatment as the blank control group.Some HaCaT cells were divided into 5 groups:IL-17 group treated with 90 μg/L IL-17 alone,IL-17 + EGCG group treated with 90 μg/L IL-17 and 60 μmol/L EGCG,IL-17 + SP600125 group treated with 90 μg/L IL-17 and SP600125 (a JAK signaling pathway inhibitor),IL-17+ EGCG + anisomycin group treated with 90μg/L IL-17,60xmol/L EGCG and anisomycin (a Janus kinase signaling pathway activator),and blank control group receiving no treatment.After different durations of treatment,CCK-8 assay was performed to evaluate cellular proliferative activity,flow cytometry to detect cell apoptosis,enzyme-linked immunosorbent assay (ELISA) to measure expression levels of IL-6,IL-23 and IL-8,and Western-blot analysis to determine protein expressions of c-Jun N-terminal kinase (JNK) and phosphorylated JNK (P-JNK).Results IL-17 promoted cellular proliferation of HaCaT cells,and the proliferation rate,which was correlated with the concentration of IL-17,reached the maximum in the 90-μg/L IL-17 group (P ＜ 0.05).EGCG at 60 μmol/L significantly inhibited cellular proliferation of,promoted apoptosis in,and reduced IL-6,IL-23 and IL-8 expressions in,HaCaT cells induced by 90 μg/L IL-17 (all P ＜ 0.05).Compared with the IL-17 group,the IL-17 + EGCG group and IL-17 + SP600125 group both showed significantly decreased P-JNK expression,cell proliferation rate and IL-6,IL-23 and IL-8 expression levels (all P ＜ 0.05).However,compared with the IL-17 + EGCG group,the IL-17 + EGCG + anisomycin group showed significantly increased protein expression of P-JNK,cell proliferation rate and IL-6,IL-23 and IL-8 expression levels (all P ＜ 0.05).Conclusion EGCG protected against IL-17-induced injury to HaCaT cells,such as abnormal cell proliferation,apoptosis and inflammatory response,likely by inhibiting the JNK signaling pathway.