The emotional stressors, societal challenges and unique physician specific stressors such as greater risks of contagion, a rapidly evolving practice environment and ever-changing protocols and regulations brought on by the COVID-19 pandemic have placed family physicians at greater risks of physician isolation and loneliness. Establishing and strengthening connections with oneself, peers and patients, and an inclusive and decisive leadership in the Family Medicine fraternity can prevent isolation and loneliness.

BACKGROUND: Diabetic glycometabolism disorder and lipoid metabolism disorder are often reciprocal causation, which cause the reduction of hepatic glycogen and the changes of many plasma factors. Hence, the occurrence of vascular complications in heart, kidney and brain is common. It becomes a hot topic in latest researches to find an effective medicine for the secondary prevention of diabetes.OBJECTIVE: To study the interventional effects of leizhusun' s juice on hepatic glycogen, plasma glucose and blood fat.DESIGN: A randomized and controlled observatory study by employing experimental animals as subjects.SETTING: Laboratory of Pharmacy College of Xianning College.MATERIALS: Totally 40 male Wistar rats with a bodymass of (230 ± 20) g were obtained from the Experimental Animal Center of Wuhan General Hospital of Guangzhou Military Area.METHODS: The diabetic rat model was established by the injection of Alloxan(200 mg/kg) into abdominal cavity in the laboratory of Pharmacy College of Xianning University between September 2002 and June 2003. Leizhusun' s juice(LZS) of different doses(205.70 mg/kg and 436. 40 mg/kg) was respectively perfused into the stomach for 28 days, and healthy rats were used as normal control. Levels of hepatic glycogen(HG) in liver and the factors in plasma were detected.MAIN OUTCOME MEASURES: HG, glucose(Glu), triacylglycerol (TG), non-esterified fatty acid(NEFA), total cholesterol(TC), low-density lipoprotein cholesterol(LDL-c), high-density lipoprotein cholesterol (HDL-c), and malondialdehyde(MDA) contents, and superoxide dismutase (SOD) activitiesRESULTS: The level of Glu in LZS-Ⅱ group(436.40 mg/kg) was (9.65± 1.14) mmol/L, TG was(1. 31 ±0. 18) mmol/L, NEFA was(0. 51 ±0. 04)mmol/L, LDL-c was(0.79 ±0. 19) mmol/L, and MDA was(6.31 ±0. 83)nmol/L, which were significantly lower than Glu of (16. 14 ± 1.59) mmol/L,TG of(1.94 ±0. 31) mmol/L, NEFA of(0.59 ±0. 05) mmol/L, LDL-c of (1.34 ±0.28) mmol/L and MDA of(10.95 ±2.90) nmol/L in experimental control(Model) group( t= 3. 478 - 9. 379, P ＜ 0.01), while the HDL-c was (1.09±0.13) mmol/L, SOD was(39.76±6.23) NU/mL and HG was (6.70 ±0.62) mg/g in LZS-Ⅱ group, which were significantly higher than HDL-c of(0.55 ± 0. 11) mmol/L, SOD of (23.24 ± 3.35) NU/mL and HG of (4.06±1.24) mg/gin Model group( t = 5. 388 - 9. 000, P ＜0.01). Furthermore, the decreasing effect on LDL-c and increasing effect on SOD in both LZS groups had dose-dependence relationship( P ＜ 0.05 -0.01 ).CONCLUSION: LZS significantly decreases plasma Glu, TG, NEFA, LDL-c and MDA levels, but increases HDL-c, SOD and HG levels, which displays obvious antidibetic effects.

AlM:To explore the clinical outcome of trabeculectomy with mitomycin C ( MMC) on glaucoma.
METHODS: A total of 57 patients (95 eyes) of primary glaucoma were randomly divided into two groups, 31 patients ( 54 eyes ) in trabeculectomy with MMC ( T+MMC ) group, which received trabeculectomy with 0. 2mg/mL MMC in surgical sites, and 26 patients ( 41 eyes ) in trabeculectomy ( T ) group. The anterior chamber, bleb, intraocular pressure ( lOP ) and complications were observed. The post-operative follow-up periods ranged between 4 and 6mo.
RESULTS:The mean lOP was 11. 24 ± 3. 73mmHg on 1d in group T+MMC. There was the significant difference compared with preoperative lOP ( P<0. 01 ), while no difference with the group T (P>0. 05). At final follow-up, the lOP was significantly different between group T+MMC and group T (16. 15±3. 62mmHg vs 18. 79±5. 27mmHg, P<0. 05). The rate of bleb formation was 94. 44% and 80. 48%in group T+MMC and T, respectively (P<0. 01). The postoperative complications were seldom, hyphema and corneal edema, and were cured finally.
CONCLUSlON:Trabeculectomy with MMC for glaucoma can effectively reduce postoperative scar formation of the filtration passage and lower the lOP to a target level with fewer complications.

Chronic Disease ; therapy ; Constipation ; diagnosis ; therapy ; Gastrointestinal Transit ; Humans

ObjectiveTo observe the effect of early bilateral limbs rehabilitation on nerve function of stroke patients.Methods60 cases of acute stroke were divided into unilateral group and bilateral group with 30 cases in each group. Cases in bilateral group were treated by training healthy side and sick side limbs alternatively and electric stimulating bilateral limbs at same time. Cases in unilateral group were treated only on sick limbs (both training and electric stimulating). After 4 weeks treatment, neurological deficit evaluation (NDE), motor function and activities of daily living of all cases in two groups were assessed.ResultsAfter treatment, scores of NDE, Fugl-Meyer Motor Assessment Scale and Barthel index of patients of bilateral group were 9.9±4.52, 71.21±22.43 and 78.6 ± 20.17 respectively. Those of patients of unilateral group were 13.46±9.2, 52.21±17.68 and 54.2±16.34 respectively. There was a significant difference between two groups (P<0.01) after 4 weeks treatment.ConclusionEarly rehabilitation can improve nerve function of stroke patients and the effect of bilateral limbs rehabilitation is better than that of unilateral limbs rehabilitation.

Objective To understand whether long term consumption of purified water can cause lead accumulation and enhance lead toxicity in the rats with chronic lead exposure. Methods 104 male SD weaned rats were randomly divided into eight groups,tap water,purified water,tap water plus lead (lead acetate,Pb2+: 50 mg/L ),purified water plus lead (Pb2+: 50 mg /L),tap water plus lead (Pb2+: 200 mg/L ),purified water plus lead (Pb2+: 200 mg/L),tap water plus lead (Pb2+: 800 mg/L),purified water plus lead (Pb2+: 800 mg/L). All were fed with normal food and kept in the same environmental conditions. The blood samples were collected after 4,6,8,10,24 and 28 weeks of lead exposure. The brain,heart,liver,kidney,bone were sampled at the experimental endpoint and the lead concentration was determined with graphite furnace atomic absorption spectrometric method,zinc protoporphyrin (ZPP) level was measured by using surface fluorescence method. Results At the same lead exposure level,no difference of blood lead level was observed between the groups of drinking purified water and tap water,however,the lead level in the organs tissue,including brain,heart,liver,kidney,bone,was significantly higher in the group drinking purified water compared with drinking tap water. The blood ZPP level in rats drinking purified water was also higher than the rats drinking tap water,the significant difference were occurred at low lead level exposure (P

Objective To establish a mathematical model to describe the skeletal class Ⅲ malocclusion of patient dental and basal bone arch form, for providing a data reference and basis for further study. Methods Thirty-five patients with skeletal classⅢmalocclusion were selected in this study for computed tomography CBCT. The data of 3-D image were analyzed, and dental arch marker (Fa) and base bone arch marker (Ba) were determined. The reference plane was determined by least square method. Software Matlab 7.0 was used to calculate two-dimensional coordinate system. Based on this, a mathematical model was established to describe the dental and basal bone arch form and then to validate the mathematical model. Results (1) The mathematical model can be used to describe the dental arch form of skeletal classⅢmalocclusion, maxillary:Y=46.12 [1-(2X/70.99)2]1.052;mandibular:Y=39.16 [1-(2X/64.51)2]1.038. (2) The mathematical model can be used to describe the basal bone arch form of skeletal classⅢmalocclusion, maxillary:Y=43.14 [1-(2X/75.09)2]1.061;mandibular:Y=39.03 [1-(2X/60.63)2]1.021. (3) Fa was located at Ba labial side in the maxilla, the distance was positive. Fa was located at Ba lingual side in the mandibular, and the distance was negative. (4) The fitting correlation coefficient of beta-function curve and each tooth on the dental and basal bone arch of skeletal class Ⅲ malocclusion were greater than 0.7 (P<0.05). Conclusion In this study, the mathematical model can be used to describe the dental and basal bone arch form of the skeletal classⅢmalocclusion, which can guide further research.

Objective: To compare therapeutic effects of clopidogrel and loading dose ticagrelor on aged patients with ST elevation myocardial infarction (STEMI).Methods: A total of 160 aged STEMI patients undergoing emergency percutaneous coronary intervention (PCI) were selected.According to random number table, they were randomly and equally divided into clopidogrel group (received loading dose aspirin and clopidogrel therapy) and ticagrelor group (received loading dose aspirin and ticagrelor therapy).Coronary TIMI flow grade, incidence rate of no-reflow after PCI, and incidence of cardiac adverse events and bleeding events in one month after PCI were compared between two groups.Results: Compared with clopidogrel group after PCI, there was significant rise in percentage of coronary TIMI flow grade 3 (71.25% vs.90.00%), and significant reduction in incidence rate of no-reflow (28.75% vs.10.00%) in ticagrelor group,P<0.05 all.Compared with clopidogrel group on one month after PCI, there were significant reductions in incidence rates of cardiogenic death (13.75% vs.3.75%), in-stent thrombosis (6.25% vs.0) and recurrent myocardial infarction (10.00% vs.1.25%), but significant rise in incidence rate of dyspnea (3.75% vs.12.50%) in ticagrelor group, P<0.05 all.There was no significant difference in incidence of bleeding events between two groups, P>0.05 all.Conclusion: Loading dose ticagrelor can effectively improve coronary blood flow, reduce no-reflow and its safety is good in aged patients with ST elevation myocardial infarction, which is worth extending.

Ginseng is a typical adaptogen which has resistance to various stresses. This effect is related to the hypothalamic-pituitary-adrenal (HPA) axis. As the main active ingredients, saponin has the similar structure to steroids. The regulation characteristics of ginseng saponin on the HPA axis are narrated from the aspects of total saponin and saponin monomers in this paper after the introduction of adaptation definition and HPA axis regulation mechanisms. Pharmacological effects of ginseng saponin and the regulation effect of HPA axis are summarized finally.
Adaptation, Physiological ; Adrenocorticotropic Hormone ; secretion ; Animals ; Corticosterone ; secretion ; Ginsenosides ; isolation & purification ; pharmacology ; Humans ; Hypothalamo-Hypophyseal System ; drug effects ; secretion ; Panax ; chemistry ; Pituitary-Adrenal System ; drug effects ; secretion