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German family physicians practice independently in clinics, and provide primary health care services. General practitioners are a type of specialists. The basis for the self-management of German doctors is the homogeneous medical education in Germany. The new round of medical education reform emphasizes the theory and practical training throughout the entire process of medical education. All medical students in Germany need to go to the clinic for internship and be familiar with primary health care models. Post-graduation education sets rotation plans and assessment standards according to the characteristics of general practice specialties, emphasizes the clinical practice time in the clinics, and urges doctors to continue medical education through the payment of medical insurance. This article draws on the German general practitioner training model, proposes to strengthen the enlightenment of general practice education during the education of undergraduate medical colleges, and strengthen the clinical practice of general practitioners and the construction of general practice training bases, as well as improve the ability of the community physician faculties, in order to provide a reference for the training of general practitioners in China.
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Objective:To explore the criteria of general practice doctoral supervisors.Methods:The expert consultation questionnaire was formed by literature analysis. Experts in the field of general medicine from universities and tertiary hospitals in Shanghai were invited to participate in two rounds of Delphi consultation. The consultation content included the basic requirements and the importance evaluation of the selection criteria for general practice doctoral supervisors. Descriptive analysis and Analytic Hierarchy Process (AHP) were used to analyze the results of the study.Results:A total of 29 experts participated in the consultation, all with senior professional titles and doctoral degrees. The positive coefficient and expert authority coefficient of the two rounds of expert consultation were 1.0 and 0.925, respectively. The Kendall coordination coefficient of indicator importance evaluation were 0.436 and 0.397, respectively. The ethics, age, professional title, educational background and academic degree and diploma were considered to be included in the basic qualifications. The optimal standards for supervisor selection included teaching ability, scientific research ability, student training and team promotion ability that subdivided into 13 evaluation indexes.Conclusion:The basic qualifications and optimal standards for general practice doctoral supervisors have been preliminarily developed, which provides reference for selection of qualified general practice doctoral supervisors.
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Objective:To survey the training requirements for doctoral candidates in general practice.Methods:A questionnaire survey was conducted to investigate the requirements for general practice doctorate training; the items included the training target, training objectives and training contents. A total of 130 stakeholders of general practice participated in the survey, including administrators in health committees, general practice educators of medical schools, general practitioners in hospital and community health service centers and students in general medicine. The participants were divided into training unit group ( n=42), employer group ( n=42) and doctor and student group ( n=46). Results:Among all training objectives, the training "general medicine scientific research ability" ranked the first (121, 93.1%); while 114 (87.7%) respondents believed that the training target should be the leading talents in general medicine. Regarding the content of clinical competence training, 86 (66.1%) respondents believed that there was a lack of medical care training for whole life-cycle and whole population currently. The training requirement for acute disease management and referral competence in employer group was significantly higher than the training unit group (χ2=25.73, P<0.01) and the doctor and student group (χ2=24.37, P<0.01). Most survey respondents believed that the doctorate candidates in general medicine should focus on scientific research training in community clinical medicine ( n=110, 84.6%), community preventive medicine and epidemiology ( n=114, 87.7%); 117 (90.0%) respondents believed that clinical research design and methodology training should be strengthened, and 125 (96.2%) respondents believed that clinical teaching thinking training should be strengthened; 108 (83.1%) survey respondents believed that it is necessary for their units to recruit personnel with doctoral degree in general medicine. Conclusion:The training of doctorate candidates in general medicine should aim at cultivating leading talents in general medicine, strengthen the training of clinical scientific research capabilities, and focus on cultivating their comprehensive abilities of "being able to research, be good at teaching, and understand management", so that they can truly become the leaders in this discipline.
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Post-traumatic stress disorder(PTSD) caused by various natural disasters and man-made events has gradually become the highlight of neuroscientists. Sleep disorders after PTSD can impair the effect of treatment and affect the patient's prognosis. In addition, treatment for sleep problems can be effective in improving outcomes for people with PTSD, which indicates that it is significant to pay attention to sleep disorders after PTSD. However, current studies have focused more on the incidence of PTSD and severity of related symptoms after a traumatic event, and less on the occurrence and mechanism of sleep disorders after PTSD. A number of articles on stress and sleep disorders published in recent years provide reliable clues to understand the probable mechanisms of sleep disorders after PTSD. After summarizing the latest research results, this article finds that the occurrence of sleep disorder after PTSD may be related to the changes of connectivity between insula, hippocampus and medial-prefrontal cortex. Apart from that, decline in the mean phase difference of slow spindles in PTSD patients may reflect pathological changes in the thalamic cortical circuit, which may contribute to the objective diagnosis of PTSD and the development of sleep-focused interventions. This paper provides a systematic review of changes in sleep characteristics and possible neural circuitry mechanisms after PTSD from clinical and basic perspectives, which may provide potential directions for future researches on the pathological mechanism of sleep disorders after PTSD and screening novel intervention targets.
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Objective:To evaluate the safety and effectiveness of the accurate puncture during sacral neuromodulation (SNM) guided with 3D printing navigation template based on reconstruction techniques using fusing sacral CT and MRI images.Methods:Totally 42 patients operated with SNM were selected in Renji Hospital, School of Medicine, Shanghai Jiaotong University from July 2016 to August 2017. The patients were randomly divided into control group ( n=22) and experimental group ( n=20) using random number table. The conventional cross-positioning technique under X-ray was used for puncture during SNM in the control group. While in the experimental group, the sacral CT and MRI images were fused for reconstruction and design of the navigation template, printed by 3D technique for the puncture in SNM. The times of punctures, the average time for puncture operation, the time of intraoperative testing of the stimulator device, the minimum onset voltage of the stimulator, the X-ray radiation dose, postoperative curative effect (rate of secondary transformation) and the incidence rate of complications were compared between the two methods using independent-simple t test or χ 2 test. Results:Compared to control group, fewer times of punctures, shorter time needed for puncture operation, shorter time of intraoperative testing of the stimulator, smaller radiation dose and minimum effective voltage were found in the experimental group ( P<0.05). There were 15 and 16 patients who completed the secondary transformation in the control group and experimental group, and there was no significant difference between the two groups (χ2=0.757, P=0.384). There were 3 cases of complications in the control group, including 2 cases of infection and 1 case of bleeding, while no complications in the experimental group. Conclusions:CT and MRI images fusion reconstruction-guided 3D printing navigation template can help perform accurate and safe punctures in SNM. Compared to conventional puncture positioned under X-ray, it can effectively improve the puncture efficiency, and reduce the radiation dose in the operation.
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In medical follow-up studies, longitudinal data and survival data are often accompanied and associated with each other, thus respective analysis of longitudinal and survival data might lead to biased results. Joint model can correct deviations, improve the efficiency of parameter estimation and provide effective inferences by simultaneously processing longitudinal and survival data. It is a popular method in medical research. Joint model has made much progress, whereas the literature about the joint model and its application is limited in China. This paper summarizes the main idea, basic framework, parameter estimation methods of random effect joint model and introduces the analysis on AIDS data set based on the R software package 'JM’ to clarify the advantages of the joint model in processing medical follow-up data and promote the use of the joint model in clinical research.
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Purpose Recently the incidence of bone and joint degeneration is increased,with the increasing of cardiovascular disease complication.This study aims to utilize realtime three-dimensional echocardiography (RT-3DE) in evaluating left ventricular remodeling index (LVRI),to guide treatment and improve the survival rate.Materials and Methods Fifty-seven cases of healthy volunteers (normal control group) and sixty-seven patients with bone and joint degeneration (research group) were respectively divided into two subgroups according to the age.Both groups underwent conventional echocardiography and RT-3DE.The LVRI,left ventricular end diastolic volume index (LVEDVI),left ventricular mass index (LVMI),left ventricular end systolic volume index (LVESVI) and left ventricular ejection fraction (LVEF) measured by different methods were analyzed,and the differences and correlations between groups and within each group were compared.Results The age of normal control group and research group was not significantly different (P＞0.05).The LVMI and LVRI in research group were significantly higher than those in the normal control group with same age (P＜0.05).The LVEDVI,LVMI and LVRI measured by two-dimensional echocardiography and M-mode echocardiography were higher than those measured by RT-3DE,and the difference was statistically significant (P＜0.05).Bland-Altman agreement analysis showed good agreement of measured LVRI using 2D echocardiography and RT-3DE.Conclusion Patients with bone and joint degeneration have left ventricular remodeling.RT-3DE can accurately assess LVRI with the advantages of convenience and lack of radiation,which can be widely used in clinic.
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BACKGROUND:Polysulfone membrane holds good anti-biodegradation ability, but how to use it to prepare hol ow fiber dialysis membrane and its blood compatibility have not been ful y understood. OBJECTIVE:To study the preparation, transfer property and biocompatibility of hol ow fiber dialysis membrane. METHODS:With polysulfone as the film material, diethylene glycol as the porogen, polyvinyl pyrrolidone as the modifier, N, N-dimethylacetamide as the solvent, and the hol ow fiber dialysis membrane was prepared using nonsolvent-induced phase separation. The performance was measured using scanning electron microscopy, ultra-depth three-dimensional microscope imaging and porosity test;the transfer parameters including reject rate and water flux were detected by ultrafiltration device;the blood compatibility was determined through hemolysis test, dynamic clotting time test and platelet adhesion test. Type II medical polyurethane material served as negative control. RESULTS AND CONCLUSION:The section of hol ow fiber dialysis membrane was asymmetric. 17%dialysis membrane showed a porous middle layer, while 19%, 21%and 23%membrane showed a sponge-like middle layer. Under the same membrane area, the density of fiber dialysis membrane was significantly lower than that of the negative control material, and the porosity of fiber dialysis membrane was significantly higher than that of the negative control material (P<0.05). The water volume and water flux of the hol ow fiber dialysis membrane were significantly higher than those of the negative control material (P<0.05). Results from three hemolytic tests showed that the average absorbance values and hemolysis rate of the hol ow fiber dialysis membrane were significantly higher than those of the negative control material (P<0.05). The dynamic clotting time test and the platelet adhesion test revealed that the dynamic clotting time of hol ow fiber dialysis membrane at 20, 40 and 70 minutes was significantly shorter than that of the negative control material (P<0.05). These results suggest that polysiloxane can be used as the membrane material to prepare hol ow fiber dialysis membrane using nonsolvent-induced phase separation, and holds a good biocompatibility, blood compatibility and transfer efficiency.
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OBJECTIVE:To observe the effects of Cholinesterase inhibitor combined with Compound haishe capsule on prog-nosis of patients with Alzheimer’s disease (AD). METHODS:210 AD patients were divided into donepezil group,rivastigmine group,galantamine group,Compound haishe capsule group,donepezil + Compound haishe capsule group,rivastigmine + Com-pound haishe capsule,and galantamine + Compound haishe capsule group,30 cases in each group according to visiting order. Donepezil group received Donepezil hydrochloride tablet 5 mg(4 weeks),po,bid;Compound haishe capsule received Compound haishe capsule 3 casuples,po,tid;donepezil + Compound haishe capsule group received Donepezil hydrochloride tablet 5 mg,po,qd + Compound haishe capsule 3 casuples,po,tid;galantamine+ Compound haishe capsule group received Rivastigmine hydrogen tartrate capsule 1.5 mg,po,bid + Compound haishe capsule 3 casuples,po,tid;galantamine+Compound haishe capsule group received Galantamine hydrobromide tablet 4 mg,po,bid+Com-pound haishe capsule 3 casuples, po, tid. The treatment course for all groups was 3 months. Mini-mental state examination (MMSE),AD dementia rating scale (ADAS-cog) and ability of daily life (ADL score) before and after treatment,and TESS score after treatment in all groups were observed,and the occurrence of ADR was observed. RESULTS:There was no statistical significance in MMSE, ADAS-cog and ADL score between 2 groups before treatment (P>0.05).After treatment, MMSE, ADAS-cog and ADL score in all groups were obviously improved;MMSE scores in ChEI combined with Compound haishe cap-sule groups were obviously higher than appropriate ChEI alone groups and Compound haishe capsule alone group,ADAS-cog and ADL scores were obviously lower than appropriate ChEI alone groups and Compound haishe capsule alone group;TESS scores in-cidence of adverse reactions in Compound haishe capsule alone group or combined with ChEI groups were obviously lower than ap-propriate ChEI alone groups and Compound haishe capsule group,the differences were statistically significant (P<0.05). CON-CLUSIONS:ChEI combined with Compound haishe capsule can effectively improve the mental state of AD patients,cognitive function and life activity,with higher safety.
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Tumor is a neoplasm formed by the abnormal proliferation of local tissue cells under the effects of different tumorigenic factors. Tumor-therapy has always been a difficult clinical issue, while regular cancer treatments, such as radiotherapy, chemotherapy and surgery, have obvious limitations. Earlier studies have shown that some obligate anaerobes or facultative anaerobes have anti-tumor effects, for example, Salmonella typhymurium as facultative anaerobic bacteria can selectively colonize tumors and inhibit their growth. Besides, Salmonella has many advantages in tumor-therapy. In the past decade or two, many researchers have carried out genetic manipulation to attenuate the virulence of Salmonella, to improve their specificity of tumor colonization and specially to use attenuated Salmonella as carriers to deliver a variety of anti-tumor therapeutic molecules, and these genetically modified Salmonella have shown good anti-tumor effects in many animal experiments. Along with further research of Salmonella-mediated antitumor treatment, applications of genetically modified Salmonella for more effective tumor-therapy are promising. We reviewed the anti-tumor mechanisms of Salmonella, the research progress in tumor-therapy using genetically modified Salmonella, and current problems and possible solutions.
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Animals , Humans , Microorganisms, Genetically-Modified , Neoplasms , Therapeutics , Salmonella , Genetics , VirulenceABSTRACT
Objective To analyze the changes of the quality of life of patients with advanced lung cancer accompanied with dyspnea before and af?ter methylprednisolone therapy,so as to investigate the effects of methylprednisolone on the quality of life of the patients. Methods Totally 134 ad?vanced lung cancer patients with dyspnea were divided into two groups,the methylprednisolone group and the control group,according to whether they consented to the use of hormone therapy. All of them were followed with visual analog scale(VAS),the quality of life questionnaire?core 30 (EORTC QLQ?C30)and the quality of life questionnaire?lung cancer module 13(QLQ?LC13)questionnaire. Results At one hour after treatment compared to before treatment,the VAS scores for both groups were significantly decreased(P<0.01),and the score for the methylprednisolone group were lower than the control group(P<0.05). At two weeks after treatment compared to before treatment,social function,emotional function, and overall quality of life scores for both groups were decreased(P<0.05). But the scores of pain,dyspnea,insomnia,loss of appetite,constipation, dysphagia were increased(P<0.05). Compared to the methylprednisolone group,the dyspnea and pain score for the control group was higher(P<0.05). Conclusion Methylprednisolone may improve the quality of life of advanced lung cancer patients with dyspnea in short term and slow down the deteriorating process of their quality of life.
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Objective To further determine the inflammation?associated cytokine changes during endotoxin(LPS)tolerance. Methods Kun?ming mice were divided into groups. The endotoxin tolerance mouse model was established with repeated injection of LPS. Serum levels of tumor ne?crosis factor?α(TNF?α),interleukin?10(IL?10)and IL?17 were determined by ELISA assay. Results The serum concentrations of TNF?α,IL?10 and IL?17 were 2 261.49±1 090.28 pg/mL,7 780.42±2 320.04 pg/mL,and 27.28±13.76 pg/mL in the LPS control group,which were increased significantly compared to the normal healthy control group. The serum concentrations of TNF?α,IL?10 and IL?17 were 1 174.19±450.91 pg/mL, 1 293.26±520.85 pg/mL,and 22.26±11.44 pg/mL in the endotoxin tolerance group. Levels of TNF?αand IL?17 were further decreased by dexameth?asone treatment during LPS tolerance inducing,while the IL?10 level did not change significantly. Conclusion Compared to the status of endotoxin inflammation,levels of TNF?αand IL?10 decreased significantly,while levels of IL?17 were not significantly changed in the status of endotoxin toler?ance. Dexamethasone could further suppress TNF?αand IL?17 levels during endotoxin tolerance inducing.
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Objective:To study the molecular composition of bismuth potassium citrate. Methods:The content of bismuth was de-termined using a volumetric method, the content of potassium was determined by atomic absorption spectrometry, and the content of cit-rate root was determined by ion chromatography. The structure was predicted using 1 HNMR and the crystal structure was studied using X-diffraction test and scanning electron microscopy. The changes in the percentage ratio of the three components were investigated by accelerated stability tests. Results:On the dried basis, the percentage of the three molecular components was bismuth of 35%-38%, potassium of 7%-11% and root citrate of 49%-52%. The NMR spectra and the data indicated that the product had three isomers with the molecular structure of bismuth∶potassium∶root citrate=2∶2∶2. The X-diffraction test and SEM showed that the three forms of amor-phous, monocrystalline and polycrystalline might exist. The percentage ratio of the three elements before and after the stability test was basically stable. Conclusion:Bismuth potassium citrate may have three crystal forms with the percentage of the three structure parts within a certain range, and the structure is relatively stable.
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Objective To study the diarrhea causes and nursing care after kidney transplantation from donation after cardiac death(DCD).Methods The clinical data of 91 patients undergoing kidney transplantations from DCD were retrospectively analyzed from November 2011 to May 2013 in our department,to investigate the incidence of diarrhea and the causes.Results Eighty three cases contracted diarrhea in 91 recipients,with the incidence of diarrhea 91.2%.The use of immunosuppressive agents,intestinal flora,infection and bowel movement dysfunction were all related to the diarrhea.Conclusions The incidence of diarrhea is high and the causes are complex after kidney transplantation from DCD.So nurses should take the appropriate care measures to improve the quality of nursing,avoiding complications and ensuring transplant results based on a different cause of diarrhea.
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ObjectiveTo investigate oral collagen type Ⅱ peptide-cholera toxin B subunit-liposome complex induce tolerance to collagen-induced arthritis (CIA).MethodsDBA/1 mice were divided into four groups,group Ⅰ:normal control,group Ⅱ:CIA control,group Ⅲ:oral collagen type Ⅱ peptidecholera toxin B subunit-liposome complex,and group Ⅳ:for testing IgG2a (on day 14 after primary immunization).Arthritis scores and histopathologic assessment were analyzed.The levels of serum IgG2a were examined by ELISA.ResultsThere was no arthritis development in group Ⅰ.The incidence of arthritis in group Ⅱ was higher than that in group Ⅲ ( 100％ vs 28.6％,P＜0.05).The arthritis score in group Ⅱ was higher than that in group Ⅲ (5.40 vs 0.4,3,P＜0.01).Histopathologic score was higher in group Ⅱ than that in group Ⅲ (16.00 vs 2.85,p＜0.05).Level of serum IgG2a of group Ⅰ was very 1ow(38 ng/ml).Mice of group Ⅱ produced significantly higher level of IgG2a than mice of group Ⅲ (3922 ng/ml vs 3219ng/ml,P＜0.05).IgG2a of group Ⅳ was 98 ng/ml which was significantly higher than that of group Ⅰ (P＜0.01 ).ConclusionOral collagen type Ⅱ peptide-cholera toxin B subunit-liposome complex could inhibit CIA progression through immune tolerance.
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ObjectiveThe aim of this study is to investigate whether oral administration of collagen Ⅱ peptide (250-270)[C Ⅱ (250-270)]-cholera toxin B subunit (CTB)complex could effectively set up oral immune tolerance to collagen-induced arthritis (CIA) in mice. MethodsDBA/1 mice were divided into Ⅰ, Ⅱ, Ⅲ and Ⅳgroups. Group Ⅰ was normal control group. Collagen type Ⅱ emulsified in Freund's complete adjuvant were injected to mice of groups Ⅱ , Ⅲ and Ⅳ twice from the base of the tail. Mice of group Ⅲ were fed with C Ⅱ (250-270)-CTB covalent complex twice after the arthritis was developed. Mice of group Ⅳ were fed with C Ⅱ(250-270) and CTB mix at the 14th day after primary immunization. Visual scores and histopathologic scores of arthritis were recorded. The frequencies of arthritis between the groups were compared usingFisher's exact test. The clinical and histological severity of arthritis were analyzed by ANOVA.Results The frequencies of arthritis in groups Ⅰ , Ⅱ , Ⅲ and Ⅳ were 0, 100％, 100％ and 25％ respectively. Average accumulative scores of arthritis were 0, 5.0±1.7, 10.8±2.8 and 1.0±2.0 respectively. Average accum-ulative histopathological scores of arthritis were 0, 16±8, 32±13 and 7±6 respectively. Conclusion Oral administration of C Ⅱ (250-270) and CTB mix in arthritis mice after C Ⅱ immunization can suppress the onset and severity of arthritis. Oral administration of C Ⅱ (250-270)-CTB covalent complex in the acute stage of arthritis can accelerate arthritis.
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OBJECTIVE: To analyze the utilization of traditional Chinese medicine (TCM) injections in our hospital in order to provide reference for clinical rational use of TCM injection. METHODS: The utilization of TCM injection in our hospital from 2006 to 2008 was statistically analyzed in terms of consumption sum, DDDs and its order. RESULTS: The consumption sum and DDDs of TCM injection in our hospital increased year by year, especially stasis-removing agents and antitumor drug. Over the 3 years the proportion of consumption sum of TCM injections in the total consumption sum were 57.3%, 59.4% and 55.9%, respectively. There was poor synchrony between consumption sum order and DDDs order. CONCLUSION: TCM injections are used rationally in our hospital. In addition, safety reevaluation of TCM injection should be improved.
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Objective To observe the effect of mycophenolate mofetil (MMF),a new type of immunosuppressant,on the immune function in patiens with systemic lupus erythematosus (SLE).Methods The changes of serum lL-6,IL-8,TNF-α,sIL-2,ANA,A-dsDNA and subsets of lymphocytes were observed in patients with SLE before and after treatment with MMF and CTX by ELISA,indirect immunofluorescent assay and flow cytometry,and the effect of MMF and CTX on the functions of hematopoiesis,liver and kidney were also observed.Results Three months after treatment with MMF,the serum levels of IL-6,IL-8,TNF-α,sIL-2,ANA,and A-dsDNA in patients with SLE were significantly decreased,CD3＋,CD4＋ and CD4＋CD45RA＋ cells were significantly increased,and CD8＋,CD4＋CD45RO＋,CD8＋CD45RA＋,CD8＋CD45RO＋ cells were significantly decreased.No remarkable injury was observed on the functions of hematopoiesis, liver and kidney after treatment with MMF.Conclusion MMF can inhibit T and B lymphocytes selectvely and is a new type of immunosuppresant to treat SLE with less toxicity and side-effect.