Rational distribution of health human resources that can keep,use and manage is the key process to strengthen the rural three-level health service network,and to be sure,the sense of identity plays a pivotal role in it.This study,with qualitative research of sociology and research in historic culture,analyzed the influence of the status quo of social,cultural and historical background on rural doctors as health human resource.Through the field observation and individual in-depth interview,it explored the current condition of relationship mode and interaction way behind village life,analyzed the influences of them upon health human resource,and put forward some suggestions to adapt rural culture environment,following the view of existence determines consciousness of historical materialism.

Objective To survey the service status of rural doctors in Beijing suburb.Methods Twenty one village officials,21 rural doctors and 42 local residents from 21 villages in Beijing Huairou district were selected with purposive sampling method as the objects of this qualitative study.The service status of rural doctors was assessed from four aspects:basic public health service,basic medical service,management ability,responsibility and communication ability.Results All the 21 village clinics provided basic public health services,including hypertension management (100.0％),diabetes management (100.0％);11 clinics (52.4％) also provided vaccination services.Eighteen village doctors (85.7％) assisted township health center to provide signing health service,but were lack of knowledge about the types of service the general practitioners (GPs) should provide.The well performed basic medical services among 21 village clinics included diagnosis and differential diagnosis of common diseases in 19 (90.5％) clinics,home visits in 18 (85.7％) and physical examinations in 15 (71.4％),but the service like trauma management,changing dressing,subcutaneous injection,intravenous infusion were performed less well.The top three most satisfied aspects in the medical service were the service attitude (4.14 points),the quality of service (3.98 points) and service time (3.66 points),and the bottom three were equipment facilities,the types and varieties of drug,and the environment of clinics.In aspect of emergency service,7 village doctors (33.3％) would choose self-referral by patients without preliminary on-site emergency treatment,5 (23.8％) would give on-site emergency treatment before self-referral by patients.In aspect of training needs,18 (42.9％) local residents and 9 (42.9％) village officials considered that it was not necessary to provide training for village doctor because of relatively older age.In aspect of patient's satisfaction,21 village doctors (100.0％),21 village officials (100.0％) and 34 villagers (81.0％) considered that the village doctor had a high professional sense of responsibility and medical ethics,and their doctor-patient communication skills were strong.Conclusion The survey reveals the current service status of village doctors in Beijing suburb,and it is necessary to take comprehensive measures to upgrade the competence of village doctors and to improve the quality of service in village clinics.

Objective:To understand the relationship between life style and chronic disease in rural area. Meth-ods:With purpose sampling method,a total of 60 villagers with chronic diseases in 14 administrative villages in 3 townships in H district were conducted field observation and in - depth individual interview. Interview contents in-cluded the chronic disease of villager,villagers' daily eating habits and composition,the living condition,and the medication situation of patients with chronic disease and so on. Results:The surveyed villagers' chronic disease was closely related to life style,and the too long time of leisure and unreasonable diet structure were the core fac-tors. Conclusion:Healthy life style should be combined with the local property and diet custom. It should use the method of "adjusting measures to local conditions" rather than" copying",put forward villager' s acceptable and feasible life style,abandon daily life,diet structure and other behaviors that influence health,and effectively inter-vene the occurrence and development of disease,to truly improve the health level of villagers.

Objective To investigate the impact of Toxoplasma gondii type I, II and III rhoptry protein 16 (ROP16) on programmed cell death ligand 1 (PD-L1) expression in lung adenocarcinoma cells, and to examine the effects of T. gondii type I ROP16 protein on the relative PD-L1 expression, the relative PD-L1 distribution on the cell membrane surface, and the binding of programmed cell death 1 (PD-1) to PD-L1 in lung adenocarcinoma cells. Methods Lentiviral vectors overexpressing T. gondii type I, II and III ROP16 proteins were generated, and transfected into the human lung adenocarcinoma A549 cell line. A549 cells were used as a blank control group, and A549 cells transfected with an empty lentiviral expression vector were used as a negative control group, while A549 cells transfected with lentiviral vectors overexpressing T. gondii type I, II and III ROP16 proteins served as experimental groups. Stably transfected cells were selected with puromycin and verified using Western blotting, quantitative real-time PCR (RT-qPCR), and immunofluorescence assays. The PD-L1 expression was quantified at translational and transcriptional levels using Western blotting and RT-qPCR assays in A549 cells in the five groups, and the relative PD-L1 distribution was detected on the A549 cell membrane surface using flow cytometry. In addition, the effect of T. gondii type I ROP16 protein on the PD-1/PD-L1 binding was measured in A549 cells using enzyme-linked immunosorbent assay (ELISA). Results The relative ROP16 protein expression was 0, 0, 1.546 ± 0.091, 1.822 ± 0.047 and 2.334 ± 0.089 in the blank control group, negative control group, and the T. gondii type I, II and III ROP16 protein overexpression groups (F = 1 339.00,P < 0.001), and the relative ROP16 mRNA expression was 2.153 ± 0.949, 2.436 ± 1.614, 14.343 ± 0.020, 12.577 ± 0.285 and 15.090 ± 0.420 in the blank control group, negative control group and the T. gondii type I, II and III ROP16 protein overexpression groups, respectively (F = 483.50,P < 0.001). The ROP16 expression was higher in the T. gondii type I, II and III ROP16 protein overexpression groups than in the blank control group at both translational and transcriptional levels (allP values < 0.001). Immunofluorescence assay revealed that T. gondii type I, II and III ROP16 proteins were predominantly localized in A549 cell nuclei. Western blotting showed that the relative PD-L1 protein expression was 0.685 ± 0.109, 0.589 ± 0.114, 1.007 ± 0.117, 0.572 ± 0.151, and 0.426 ± 0.116 in the blank control group, negative control group, and the T. gondii type I, II and III ROP16 protein overexpression groups (F = 9.46,P < 0.05), and RT-qPCR assay quantified that the relative PD-L1 mRNA expression was 1.012 ± 0.190, 1.281 ± 0.465, 1.950 ± 0.175, 0.889 ± 0.251, and 0.230 ± 0.192 in the blank control group, negative control group, and the T. gondii type I, II and III ROP16 protein overexpression groups (F = 14.18,P < 0.05). The PD-L1 expression was higher in the T. gondii type IROP16 protein overexpression group than in the blank control group at both translational and transcriptional levels (both P values < 0.05). Flow cytometry detected that the relative distributions of PD-L1 protein were (10.83 ± 0.60)%, (11.23 ± 0.20)%, and (14.61 ± 0.50)% on the A549 cell membrane surface (F = 28.31, P < 0.05), and the relative distribution of PD-L1 protein was higher in the T. gondii type IROP16 protein overexpression group than in the blank control group and negative control group (both P values < 0.001). ELISA measured significant differences in the absorbance (A) value among the T. gondii type IROP16 protein overexpression group, the blank control group and the negative control group if the concentrations of the recombinant PD-1 protein were 0.04 (F = 10.45, P < 0.05), 0.08 μg/mL (F = 11.68, P < 0.05) and 0.12 μg/mL (F = 52.68, P < 0.05), and the A value was higher in the T. gondii type IROP16 protein overexpression group than in the blank control group and the negative control group (both P values < 0.05), indicating that T. gondii type IROP16 protein promoted the PD-L1/PD-1 binding in A549 cells in a concentration-dose manner. Conclusions T. gondii type IROP16 protein overexpression may up-regulate PD-L1 expression in A549 cells at both transcriptional and translational levels and the relative PD-L1 distribution on the A549 cell membrane surface, and affect the PD-1/PD-L1 binding in a concentration-dependent manner.