Community health service institutions are the basic tentacles of medical services which directly indicates their relation to the quality and experience of health service.This paper focuses on the behavioral logic of community health service institutions under the background of new medical reform, and looks forward to a perspective on the grassroots practice caused by the reform of medical system through the behavioral analysis of the community health service institutions.The behavioral logic features of the community health service institutions were constructed based on the interview data Nanjing City using the grounded theory.It was found that the realization of public welfare orientation of the aforesaid institutions needs to be completed under the internal and external coordination.The degree of coordination among the interests, orientation, incentives and resource elements will determine the behavior orientation and basic operational practices in the community health service institutions.This study will provide a reference value for the cognition and optimization of healthcare reform policies.

Objective:To observe the influence of sevoflurane and propofol anesthesia on hemodynamics in laparoscopic cholecys-tectomy. Methods:Totally 98 patients with laparoscopic cholecystectomy were randomly divided into P group and S group. P group was with propofol for anesthesia, and S group was with sevoflurane for anesthesia. Before anesthesia, 2min after intubation, 10 min af-ter intubation, 5min and 30min after pneumoperitoneum, and after the surgery, the levels of blood glucose and cortisol, and hemody-namic changes in the two groups were observed, and the incidence of adverse reactions was also studied. Results:2 min and 10 min af-ter the anesthesia, the blood glucose levels in the two groups were significantly lower than those before the anesthesia(P<0.05 or 0. 01), while 30 min after pneumoperitoneum and after the operation, the blood glucose levels were increased(P<0. 01). The blood glucose levels in S group after the operation were much lower than those in P group (P<0. 01). 2 min after intubation, cortisol was decreased in the two groups (P<0. 05 or 0. 01). 5 min after pneumoperitoneum and after the operation, cortisol levels were higher than those before the anesthesia in P group(P<0. 01), and 5 min and 30 min after pneumoperitoneum and after the operation, cortisol levels in S group were lower than those in P group (P<0. 01). HR and SPO2 showed no significant changes in the two groups during the whole process (P>0. 05). 2 min and 10 min after intubation, SBP in the two groups was decreased (P<0. 01), and 5 min and 30 min after pneumoperitoneum, there was notable difference in SBP between the groups (P<0. 01). 2 min and 10 min after intuba-tion, DBP was decreased in the two groups (P<0. 01), and the difference was significant between the groups (P<0. 01). 5 min and 30 min after pneumoperitoneum, DBP in P group had notable difference with that in S group (P<0. 05). The incidence of adverse re-actions in the two groups showed no significant difference (P>0. 05). Conclusion: Sevoflurane anesthesia in laparoscopic cholecys-tectomy can keep stable hemodynamics in the patients, and the anesthetic effect is better than propofol.

Objective:To study the effect of priming technique combined with time limit on shortening the onset time of cisatra-curium besilate. Methods:Totally 112 adult patients undergoing selective operation with general anesthesia were randomly divided into group A, B and C. Fentanyl with the dose of 4 μg·kg-1 and propofol with the dose of 2 mg·kg-1 were used in the three groups as the inducing agents. Group A was first with intravenous injection of cisatracurium besilate 20 μg·kg-1 , and 3 minutes later, the in-ducing agents and cisatracurium besilate with the dose of 80 μg·kg-1 were respectively injected. Group B was first with intravenous injection of cisatracurium besilate with the dose of l00 μg·kg-1 , and 1. 5 minutes later, the inducing agents were injected. Group C was respectively injected with the inducing drugs and cisatracurium besilate with the dose of l00 μg·kg-1 . The T1 percentage before the induction, the time of 90% and 100% inhibition of muscle twitching, the rating of trachea cannula and adverse drug reactions in the three groups were observed and compared. Results:There was no significant difference in the excellent rate of trachea cannula a-mong the three groups (P>0. 05). Compared with group A and B, group C showed no T1 suppression before the induction, while group B with T1 of (9. 8 ± 2. 6) was higher than group A with T1 of (3. 2 ± 1. 5) (P<0. 01). The time of 90% and 100% inhibition of muscle twitching in group C was the longest (P<0. 01), and the incidence of adverse drug reactions in group C was also the highest (P<0. 05). Conclusion:The application of priming principle and time limit can effectively shorten the onset time of cisatracurium be-silate with significant effect and high safety.

Objective To investigate the surgical exposure of the subtemporal approach and explore clinical indications using a minimal-access.Methods Ten adult cadaveric heads fixed with formalin were used in this study.The holes with 3.0 cm × 2.5 cm of zygomatic arch vertically were operated on each head with subtemporal approach.During the anatomical procedures,measured the maximal exposure lengths of tentorial margin,posterior cerebral artery,and anterior border of brain stem,vertical distances between highest structure in the field of view and posterior clinoid process,the shortest distances form the zygomatic arch 1/3 to tentorial edge,sulcus lateralis mesencephali and anterior clinoid process; After tentorium of cerebellum was cut,measured the straight distance form the internal carotid artery to the optic nerve and form the posterior communicating artery to the tentorial edge.Results Oculomotor,trochlear nerve,tentorial edge,superior cerebllar artery.,P1-P2 segment of posterior cerebral artery,ventrolateral surface of mesencephalon and pon higher than root of trigeminal nerve,anterior and posterior clinoid process,posterior communicating artery and anterior choroidal artery,and superior portion of pituitary stalk could be observed via subtemporal approach using a minimal-access.Conclusion 1.The subtemporal approach using a minimal-access can protect the superficial temporal artery and the facial nerve branches especially in the process of the flap formation.It does little damage to the temporallis,reduces the invalid exposure of brain tissue,farthest lowers the damage to the scalp,skull and adjacent tissue ; 2.The subtemporal approach using a minimal-access can obtain the exposure rang.It can see the upper pons,petroclival region,tentorial notch area,ventrolateral brain stem.

BACKGROUND:The eradication therapy of glioma is the major problem, and anti-angiogenesis therapy is a potential treatment of glioma.
OBJECTIVE:To confirm the inhibiting effect of endostatin on angiogenesis in vitro, and to lay the foundation in inhibiting the growth of tumor by endostatin in the future.
METHODS:Endostatin mRNA was extracted from the liver of Wistar rats by Trizol and endostatin cDNA was synthesized by RT-PCR. Endostatin cDNA and pcDNA3 were connected and pcDNA3-Endo recombined plasmid was constructed successful y. The recombinant pcDNA3-Endo was transfected into bone marrow mesenchymal stem cells by Lipofectamine. The expression of endostatin was identified by RT-PCR and western blot analysis. Endostatin proteinum activity was detected by ECV-304 cellproliferation inhibition experiment using MTT assay. The in vitro experiments were divided into four groups:recombinant plasmid group, vector plasmid group, liposome control group and blank control group.
RESULTS AND CONCLUSION:PcDNA3-Endo eukaryon expression plasmid was constructed successful y. Endostatin gene can be transcribed and expressed effectively in vitro by pcDNA3-Endo plasmid. The growth of ECV-304 cellwas inhibited obviously by pcDNA3-Endo. The growth of vascular endothelial cells can be inhibited obviously by endostatin gene.

Objective:To investigate the consumption situation and cognition of health care products in hospitalized patients, ana-lyze the problems in purchasing and use of health care products to provide evidence for the correct selection and rational use of health care products. Methods:The investigation and analysis was conducted with an anonymous questionnaire on awareness and consumption situation of health care products in hospitalized patients. Results:The survey received 129 valid questionnaires, and more than 1/3 re-spondents did not know the differences between health care products and medicines, and 27. 91％ of them treated diseases with health care products, 57. 36％ of them purchased health care products per month, and 96. 12％ of them thought the efficacy of health care products were inconsistent with the advertising efficacy. Conclusion:Patients cannot distinguish health care products from medicines, and lack of trust in the health care products market. Corresponding measures should be performed to help patients purchase and use of health care products and safeguard their legitimate rights and interests.

OBJECTIVE In order to improve the traditional management mode,we try to explore the application of information technology for management of antimicrobial drugs during perioperative period. METHODS Through analysis of our research program case,the differences between the traditional management mode and the information-based management mode were compared by the method of reviewing literature data and analyzing hierarchy process of administration. RESULTS There were obvious limitations in the traditional management mode,but the information-based management mode exhibitsed evident advantages,because it focused on node control and process management. CONCLUSIONS The information-based management mode can establish a long-term management mechanism of antimicrobial drugs during perioperative period,and also can individualizedly implement precise management goal.It is an innovation of the traditional management mode.

Objective:To study the perioral soft tissue characteristics of the subjects with ClassⅡDivisionⅠand various vertical pat-terns. Methods:Lateral cephalograms of 90 adults ( half men, half women) were divided into 3 groups based on GoGn-SN angle:low angle, normal angle and high angle(n=30). The perioral soft tissues were measured and compared for the determination of the vertical skeletal variables influencing soft tissue characteristics. Results: The subjects with low angle showed significantly smaller values than those with high angle for basic lower lip thickness and lower lip length(P<0. 05). Most measurements of soft tissue thickness were greater in men than in women in all groups, especially for basic upper lip thickness and upper lower lip thickness(P<0. 05). Conclu-sion:Orthodontists need to pay more attention to the differences of perioral soft tissue in the subjects with various vertical patters to ob-tain balance of the facial harmony in orthodontic treatment.

Finite element method (FEM) is an effective mathematical method for stress analysis, and has been gradually applied in the study of biomechanics of human body structures. This paper reviews the construction, development, materials assignment and verification of FEM model of cervical vertebra, and it also states the research results of injury mechanism of whiplash injury and biomechanical response analysis of the cervical vertebra using FEM by researchers at home and abroad.
Adult ; Biomechanical Phenomena ; Cervical Vertebrae/physiopathology* ; Finite Element Analysis ; Humans ; Intervertebral Disc/physiopathology* ; Male ; Models, Anatomic ; Soft Tissue Injuries/physiopathology* ; Stress, Mechanical ; Whiplash Injuries/physiopathology*

Objective To investigate the organophosphorus pesticides residues in vegetables in Ji'nan,China.Methods From 2005 to 2007,the residues of ten kinds of organaphosphorous pesticides,including methamidophos,parathion-ethyl, parathionm-ethyl,dichlorvos,phorate,monocrotophos,omethoate,dimethoate,chlorpyrifos,malathion were determined in 8 kinds of vegetables by capillary gas chromatography.Results In the 597 vegetables samples,the total detection rate of organaphosphorous pesticides was 32.66%,in 25.63% of the samples,the contents of organaphosphorous pesticides residues exceeded the national standard limits.In leek,the detection rate was 65.56% and the exceeded limit rate was 52.22%.In addition, more than one kind of pesticide could be detected in one kind of vegetable.The concentration of methamidophos,the most serious pollutant,could reach 114.013 mg/kg.Omethoate could also be detected at 11.807 mg/kg.In this investigation,a downtrend was seen in the rate of exceeding standard limits and the difference in seasons in the detection rate of pesticides residues was also seen. Conclusion The detection rate of high toxic organaphosphorous pesticides in vegetables sampled in this study is higher,it indicates that the situation of pesticides abuse is serious in this area.