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The study utilized a cross-sectional design. Data was retrieved from the American Academy of Family Physicians fellowship training directory, including program names, areas of focus, program length, and program descriptions. The collected data was categorized and analyzed based on areas of focus and training duration. The program descriptions were also analyzed qualitatively using Nvivo12 software. A total of 532 programs were included in the study:295 programs (55.5%) were ACGME-certified, while 237 programs (44.5%) were not. The majority of programs, 468 (87.9%), were clinically oriented, while 64 programs (12.1%) were non-clinical. Among ACGME-certified programs, the largest number of programs were in sports medicine (121 programs), followed by geriatrics (52 programs). Among non-certified programs, the largest number of programs was in obstetrics (66 programs), accounting for 27.8% of all non-certified programs. Qualitative research found that fellowship programs were diverse, reflecting the societal demands of healthcare service. Moreover, a significant emphasis was placed on empowering teaching and research abilities.The family medicine fellowship programs in the United States cover a wide range of disciplines and meet both the professional interests of doctors and the needs of patients. As China continues to implement its tiered medical system, it can learn from the experience of the United States and develop general practice subspecialty training programs, thereby improving the service capacity of general practitioners and improve the quality of healthcare.
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Objective:To evaluate the effect of acupuncture with invigorating viscera and purging fu, replenishing qi and nourishing yin for the T2DM patients with qi and yin deficiency syndrome.Methods:A total of 59 patients who met the inclusion criteria from January 1, 2019 to December 31, 2020 in the Endocrinology Department of the Second Affiliated Hospital of Anhui University of Chinese Medicine were divided into the acupuncture group with 30 cases and a control group with 29 cases, according to the random number table method. The control group received conventional hypoglycemic treatment. And the acupuncture group was treated with acupuncture on the basis of the control group treatment. Both groups were treated for 4 weeks. TCM syndrome scores were performed before and after treatment, respectively. Serum IL-6 was measured by ELISA, serum CRP by immunoturbidimetry, and serum fasting blood glucose (FPG), 2 hPG, HbAlc, TC, TG, HDL-C, LDL-C levels by spectrophotometry. The BMI, clinical effect rates were calculated.Results:The total effective rate was 96.7% (29/30) in acupuncture group and 75.9% (22/29) in control group, and the difference was statistically significant ( χ2=5.96, P<0.01). After treatment, the scores of fatigue, dryness of mouth and pharynx, spontaneous sweating and night sweating, shortness of breath and lazy speech in acupuncture group were significantly lower than those in the control group ( t values were 6.02, 4.31, 4.34, 3.63, respectively, all Ps<0.01). The serum CRP level in acupuncture group was significantly lower than that of the control group at 21, 48 d after treatment ( t values were -4.36, -3.75, respectively, all Ps<0.01), and IL-6 level was significantly lower than that of the control group at 14, 21, 28 d after treatment ( t values were -2.92, -5.35, -8.71, respectively, all Ps<0.01). After treatment, the serum TC [(4.62±0.68) mmol/L vs. (5.56±0.72) mmol/L, t=5.16], TG [(1.48±0.42) mmol/L vs. (2.12±0.89) mmol/L, t=3.55], LDL-C [(2.48±0.84) mmol/L vs.(3.02±0.95) mmol/L, t=2.32] in the acupuncture group were significantly lower than those in the control group ( P<0.05), HDL-C [(1.39±0.27) mmol/L vs. (1.26±0.22) mmol/L, t=-2.02] in the acupuncture group was significantly higher than that of the control group ( P<0.05). The serum FPG level at 21 d [(6.12±0.67) mmol/L vs. (6.57±0.61) mmol/L, t=-4.96], 28 d [(5.78±0.52) mmol/L vs. (6.49±0.58) mmol/L, t=-2.70] in acupuncture group were significantly lower than those in the control group ( P<0.01). The 2h PG level at 14 d after treatment [(10.23±1.06) mmol/L vs. (11.76±1.34) mmol/L, t=-4.87], 21 d [(9.05±0.98) mmol/L vs. (10.53±1.24) mmol/L, t=-5.10], 28 d [(7.45±0.69) mmol/L vs. (9.31±0.78) mmol/L, t=-9.71] in the acupuncture group were significantly lower than those in the control group ( P<0.01), and HbA1c level were decreased 14 d [(7.93±0.86)% vs. (8.52±0.97)%, t=-2.47], 21 d [(7.63±0.85)% vs. (8.15±0.92)%, t=-2.26], 28 d [(6.47±0.51)% vs. (7.51±0.62)%, t=-7.05] significantly lower than those in the control group ( P<0.01), BMI [(22.13±1.57) kg/m 2vs. (24.16±1.82) kg/m 2, t=-4.59] 28 d after treatment was significantly lower than that of the control group ( P<0.01). Conclusion:Acupuncture therapy of nourishing viscera and purging fu, nourishing qi and nourishing yin can regulate the disorder of glucose and lipid metabolism in patients with T2DM and syndrome of qi and yin deficiency.
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Objective:To investigate the protective effect of spironolactone on myocardial injury in septic rats and to provide a novel measure for the diagnosis and treatment of sepsis myocardial injury.Methods:Totally 120 male Sprague-Dawley rats were randomly divided into the sham group, cecal ligation and perforation group (CLP group), and spironolactone group. The sham group was only exposed to the cecum by laparotomy. CLP was performed to induce sepsis in the CLP group and spironolactone group. The cecal perforation was ligated and the contents of the intestine were squeezed out. The spironolactone group was administered spironolactone by gavage with a dose of 20 mg/(kg·d) per rat. The sham and CLP groups were given the same dose of saline. The experiment period was 7 days. After the rats were sacrificed, blood was collected and myocardial tissue was removed. The changes of serum TNF-α, IL-6, cTnI and CK-MB levels were detected by ELISA. Cardiac structure and function were detected by echocardiography. The relative apoptosis of left ventricular myocytes in rats was detected by TUNEL staining. The levels of TNF-α, IL-6, Bcl2-associated X protein (Bax), B cell lymphoma 2 (Bcl2) and Caspase 3 in the left ventricle tissue were detected by immunohistochemistry.Results:Compared with the CLP group, the levels of TNF-α and IL-6 in serum and left ventricular tissue were significantly decreased ( P<0.05) and serum levels of cTnI and CK-MB were significantly down-regulated ( P<0.05). Heart rate (HR) and left ventricular diastolic dimension (LVDd) were significantly reduced ( P<0.05), and ejection fraction (EF) and left ventricular fractional shortening (FS) increased significantly ( P<0.05). Ventricular muscle apoptosis was improved ( P<0.05),the level of apoptosis-related protein Bcl2 was increased and the Bax and Caspase3 expression were significantly down-regulated ( P<0.05).The expression of Bcl2 protein, EF and FS in the CLP group were significantly lower than those in the sham group( P<0.05), and the remaining indexes were significantly higher than those in the sham group( P<0.05). Conclusions:Spironolactone can treat sepsis-induced myocardial injury by reducing inflammatory response caused by sepsis, reducing myocardial damage, alleviating ventricular muscle apoptosis, and improving ventricular structure and function.
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Objective@#To identify prognostic factors for mortality in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).@*Methods@#A retrospective study was conducted in 138 patients with initiated CRRT due to AKI who were admitted to the Emergency Intensive Care Unit of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from May 2012 to December 2016. According to whether these patients survived after 28 days, they were divided into the death group (58 cases) and survived group (80 cases). Demographic and clinical parameters were retrieved and compared between the two groups. Logistic multivariate regression analysis was performed to determine the risk factors related to mortality.@*Results@#Of the 138 patients included, 58 patients (42.0%) died after 28 days. Patients in the death group were older, more likely to be male, had a higher score on the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), higher serum lactate level and lower serum creatinine level on admission, higher prevalence of coronary artery disease, and were more likely to be mechanically ventilated or treated with vasopressors. Multivariate logistic regression analysis revealed that age (OR=1.064, 95%CI: 1.022-1.108, P=0.002), APACHEⅡ score (OR=1.127, 95%CI: 1.003-1.265, P=0.044), mechanical ventilation (OR=7.432, 95%CI: 2.183-25.308, P=0.001) and use of vasopressors (OR=24.558, 95%CI: 7.651-78.825, P<0.01) were independent risk factors for mortality.@*Conclusions@#Older age, higher APACHEⅡ score, mechanical ventilation and use of vasopressors are risk factors for mortality in EICU patients with acute kidney injury requiring CRRT.
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Objective To identify prognostic factors for mortality in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).Methods A retrospective study was conducted in 138 patients with initiated CRRT due to AKI who were admitted to the Emergency Intensive Care Unit of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from May 2012 to December 2016. According to whether these patients survived after 28 days, they were divided into the death group (58 cases) and survived group (80 cases). Demographic and clinical parameters were retrieved and compared between the two groups. Logistic multivariate regression analysis was performed to determine the risk factors related to mortality.Results Of the 138 patients included, 58 patients (42.0％) died after 28 days. Patients in the death group were older, more likely to be male, had a higher score on the acute physiology and chronic health evaluationⅡ (APACHEⅡ), higher serum lactate level and lower serum creatinine level on admission, higher prevalence of coronary artery disease, and were more likely to be mechanically ventilated or treated with vasopressors. Multivariate logistic regression analysis revealed that age (OR=1.064, 95％CI: 1.022-1.108,P=0.002), APACHEⅡ score (OR=1.127, 95％CI: 1.003-1.265,P=0.044), mechanical ventilation (OR=7.432, 95％CI: 2.183-25.308, P=0.001) and use of vasopressors (OR=24.558, 95％CI: 7.651-78.825,P<0.01) were independent risk factors for mortality.Conclusions Older age, higher APACHEⅡ score, mechanical ventilation and use of vasopressors are risk factors for mortality in EICU patients with acute kidney injury requiring CRRT.
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Objective To evaluate antimicrobial effect and mechanism of meropenem in the model of PA infection by C.elegans.Methods To evaluate drug effects of PA infection with caenorhabditis elegans by different concentrations of culture medium, determinate the lethal rate of C.elegans.Western blot detected mitogen activated protein kinase ( Mitogen-activated protein kinase MAPK ) activity change, and PCR detected antimicrobial peptide genes expression in C.elegans after PA infection,the effect of meropenem on MAPK activity change and antimicrobial peptide genes expression.Results Compared with the control group (OP-50), the death rate of C.elegans in PA infection group changed significantly (P<0.01). Meropenem showed protective effect after C.elegans infection ( P <0.01 ) .Detection of MAPK kinase activity showed that PA infection caused PMK-1 kinase activation, further study showed that antibiotics meropenem did not affect the activation of PMK-1 kinase (no significant difference).C.elegans antimicrobial peptide gene Lys-1, clec-85, F55G11.7, K08D8.5 activity increased in PA infection (P<0.01).Meropenem promoted the expression of the antimicrobial peptide gene increased (P<0.01),with synergistic effects.Conclusion Our results show that a C.elegans pathogenicity model can be applied screening drug susceptible to pathogens infection quickly and easily.
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Objective To establish a short-term scenario simulation training campus in senior med-ical students before graduation for the sake of a smooth transformation from medical students to residents. Methods There were 101 participants involved in the study . All the participants attended emergency medicine traditional teaching, including 51 fourth-year medical students and 50 fifth-year medical students. The 48 students who took the emergency scenario simulation training course were classified as training camp group while the other 53 students were classified as control group. The control group only participated in the emergency medicine traditional teaching, and the training camp group participated in the emergency sce-nario simulation training course on the basis of control group's routine teaching, including advanced cardiac life support and team collaboration, sepsis and doctor-patient communication, polypnea and crisis manage-ment, disorder of consciousness and interdisciplinary teamwork, multiple injuries and emergency plans, and comprehensive case evaluation. The training camp group was divided into groups and received evaluation of performance on treating emergency simulated case (clinical skills, teamwork, doctor-patient communication) before and after class. The training camp group was received questionnaire survey after class. SAS 9.2 was used to do the t test and descriptive analysis. Results There were no statistically significant differences (P>0.05) between the scores of the performance on clinical skills, teamwork, doctor-patient communication of training camp group and control group before class. The scores of training camp group after class were sig-nificantly better than those of control group (P<0.05). In addition, the course had a high recognition by students. 92% (44/48) students thought the course was contributed to improving the ability of crisis man-agement and clinical practice and were in favor of developing similar courses for senior medical students. Conclusion Scenario simulation training campus can strengthen the cultivation of medical students' com-prehensive thinking, independent clinical decision making, practice skills and communication ability in the final stage of medical education as well as enhancing their self-confidence so as to help them to adapt to the real clinical work.
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<p><b>OBJECTIVE</b>To compare the difference in clinical efficacy on post-stroke motor aphasia among the combined therapy of acupoint application of jieyu plaster and acupuncture, simple acupuncture and simple acupoint application of jieyu plaster.</p><p><b>METHODS</b>Eighty-six patients of post-stroke motor aphasia were randomized into an acupuncture group (28 cases) , an acupoint application gruop (29 cases) and the combined therapy group (29 cases). In the acupuncture group, acupuncture was applied at the Speech No. 1 area and three-tongue needling points, once a day, 6 times a week. In the acupoint application group, jieyue plaster was applied to Yongquan (KI 1) and Laogong (PC 8), once a day, and the bilateral acupoints were selected alternatively. In the combined therapy group, the therapeutic methods of the first two groups were used in combination. The treatment lasted for 4 weeks in the three groups. The speech function score was observed and compared before and after treatment in the three groups and the efficacy was compared among the three groups.</p><p><b>RESULTS</b>The total effective rate was 86.2% (25/29) in the combined therapy group, which was better than 67.9% (19/28) in the acupuncture group and 69.0% (20/29) in the acupoint application group (both P < 0.05). After treatment, the scores of spontaneous conversation, restatement and nomenclature in the speech function were all improved as compared with those before treatment in the three groups (all P < 0.01). The results in the combined therapy group were apparently better than those in the acupuncture group and the acupoint application group (all P < 0.01).</p><p><b>CONCLUSION</b>The combined therapy of acupoint application of jieyu plaster and acupuncture apparently improves the speech function in the treatment of post-stroke motor aphasia and the efficacy is better than that of simple acupuncture or simple acupoint application.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Acupuncture Points , Acupuncture Therapy , Aphasia, Broca , Drug Therapy , Therapeutics , Drugs, Chinese Herbal , Stroke , Treatment OutcomeABSTRACT
Objective To investigate the value of N-termind pro-B-type natriuretic peptide(NT-pro-BNP)in differential diagnosis of dyspnea in emergency department, and to investigate the rapid diagnosis cutoff of dyspnea due to acute congestive heart failure. Methods Ninety. one cases of dyspnea in emergency department recruited from January to June ,2008 were divided into two groups: acute cardiac dyspnea group and none acute cardiac dyspnea group. To evaluate the value of different parameters in differential diagnosis of dyspnea in emergency department and analysis the area under the receiver-operating characteristic of different parameters for the diagnosis of acute cardiac dyspnea. To achieve the best cutoff of different parameters for the diagnosis of dyspnea due to acute congestive heart failure finally. Results Among two groups, NT-pro-BNP (acute cardiac dyspnea vs. none acute cardiac dyspnea,6203.50 ng/L vs. 1410.00 ng/L,P ＜ 0.01), Troponin Ⅰ (acute cardiac dyspnea vs. none acute cardiac dyspnea,0.12 μg/L vs. 0.03 μg/L,P ＜0.01) ,left ventricular ejection fraction(acute cardiac dyspnea vs. none acute cardiac dyspnea,46.25% vs. 65.60%, P ＜ 0.01), left atrial diameter (acute cardiac dyspnea vs. none acute cardiac dyspnea,42.75 mm vs. 36.00 mm,P ＜0.01) had significant difference. NT-pro-BNP at cutoff of ≥3715 ng/L was highly sensitive and specific for the diagnosis of acute cardiac dyspnea. Receiver-operating characteristic analyses demonstrated that NT-pro-BNP and left ventricular ejection fraction was the best diagnostic indices of acute cardiac dyspnea. The area under the receiver-operating characteristic curve of Nt-pro-BNP was 0.828 ± 0.045 (P ＜ 0.01),and left ventricular ejection fraction was 0.829 ± 0.049 (P ＜ 0.01). Correlation analysis showed that NT-pro-BNP was correlated with left ventricular ejection fraction (P ＜ 0.01). The combined test of NT-pro-BNP and left ventricular ejection fraction was performed. Specificity increased to 96.50%, total consistent rate increased to 83.50% ,positive predictive value increased to 91.30%, positive likelihood ratio 17.60, faulse diagnostic rate decreased to 3.50%. Conclusions NT-pro-BNP examination in emergency department was helpful to rapid differential diagnosis of dyspnea. It helped to differentiate the patients with acute congestive heart failure and none acute congestive heart failure causes of dyspnea.