Community-oriented medical education is featured by an emphasis on primary health care and population care as well as community-based care. It emphasizes the major problems encountered in the rural areas. This article has described the basic principles and curricular features of community-oriented medical education. The implementation and practice of education reform towards community-oriented medical education at Jiujiang University Medical College has also been introduced. The college puts teaching contents reform first followed by teaching methods. Students' clinical skills and reasoning skills were strengthened in the reform. According to requirements of community-oriented medical education, educational programs and curriculum have been changed. The concept of general medicine has been introduced in the practice of the reformed program.

In the present research, two Chinese rhesus monkeys were inoculated intravenously with 5000 TCID50 of SIVmac239. The changes in the numbers of CD4+T lymphocyte in peripheral blood,plasma viral loads, proviral DNA and humoral antibodies against virus were periodically monitored during 121 days. At the early stage of infection, proviral DNA had been detected in PBMCs, and infectious SIVmac239 virus had been isolated from PBMCs. At the same period, the numbers of CD4+T lymphocytes were significantly decreased, and maintained at low level during the 121-day period of infection. Plasma viral loads reached the peak at week 2 post-inoculation and kept at a steady state subsequently. Moreover, antibodies against viral proteins were detected from plasma. All the results showed that the two Chinese rhesus monkeys had been infected with SIVmac239 successfully. This animal model can be applied for further AIDS researches.

Objective To investigate the prevalence of Alzheimer's disease (AD) in first-degree relatives of patients with affective disorders,and to evaluate the risk of AD in first-degree relatives of the patients with affective disorders.Methods Patients with affective disorders meeting DSM-Ⅳ-TR criteria (affective disorders group) and their healthy spouses (conrol group) were recruited in this study (n=109 each).The first-degree relatives inclusion criteria were biological relatives of both probands aged over 55 years.Subjects were investigated by neuropsychological assessment,imaging and clinical examinations,and were diagnosed as AD according to the criteria of the United States of America neuropathy language disorders and stroke research institute and Alzheimer's disease and Related Disorders Association (NINCDS-ADRDA).Results 284 first-degree biological relatives of affective disorders patients and 274 first-degree relatives of control group were selected.There were no statistically significant differences in demographic characteristics of the first-degree relatives between the two groups.The prevalence of Alzheimer's disease in the first-degree relatives had a significant difference between affective disorders group and control group [10.6％ (30/284) vs.4.4％ (12/ 274),x2=7.47,P=0.006].The prevalence of AD in the first-degree relatives was higher in bipolar disorder and depressive disorder patients than in control group [11.2％ (14/125) vs.4.4％(12/274),20.0％ (15/75) vs.4.4％(12/274),x2=6.80,20.56,OR=2.60,4.63,both P＜0.05],while there was no significant difference in the prevalence of AD in the first-degree relatives between mania patients and control group [1.1％ (1/87) vs.4.4％ (12/274),x2 =1.99,P＞0.05].Conclusions There is a high risk for Alzheimer' s disease in first-degree relatives of patients with affective disorders,particularly in first-degree relatives of patients with depression and bipolar disorders.

Objective To summarize the clinical characteristics, follow-up and prognosis of Kawasaki disease (KD) in infants under 3 months. Method The clinical data of infants under 3 months diagnosed with KD during January 2009 to December 2013 were analyzed retrospectively. Results In a total of 1504 cases diagnosed with KD during during the study period, there were 40 (2.66%) infants under 3 months (30 males and 10 females). Except for fever, the frequencies of the other 5 main clinical manifestations were less than 50%. Laboratory tests suggested inflammatory reactions, thrombocytosis, anemia, and so on. Coronary artery disease was found in 32 cases (80%), including 24 cases of coronary artery dilatation, 8 cases of coronary artery aneurysm and 3 cases of coronary giant aneurysm. By the end of the follow-up period, there were no myocardial ischemia, myocardial infarction and death in all the patients; coronary artery diameter was normal in 37 cases (92.5%); 3 cases of giant coronary artery aneurysm still had coronary artery aneurysm and thrombosis. Conclusion The clinical manifestations of KD in little infants were atypical, the incidence of coronary artery disease is high, and color doppler echocardiography should be performed in time.

Objective To describe early clinical experience with the new amplatzer ductal occluder Ⅱ (ADO Ⅱ) for transcatheter patent ductus arteriosus(PDA) in children.Methods Twelve children were diagnosed as PDA from Jan.2013 to Apr.2014 in Guangzhou Children and Women's Hospital.All the children who were treated with the ADO Ⅱ had the indication of a successful interventional therapy successfully.The size of device was chosen according to aortographic and transthoracic echocardiography(TTE) results and pulmonary pressure.The device was delivered in a consequent or reverse way depending on the type of PDA,the minimal diameter of PDA and the size of duct ampulla.The device was delivered in a reverse way in ten patients,and two in a consequent way before detaching the device.Another aortogram was performed in order to check the position and form of the device,the velocities of blood flow in left pulmonary artery and the descending aorta though TTE and whether there was a residual shunt.All patients were examined by TTE in 24 hours after surgery and discharged without any complications 2 days later.The patients were programmed for the cardiologic consult including an TTE and electrocardiogram in 1,3,6 and 12 months after discharge.Results Twelve patients(7 male,5 female) with a median age of(1.59 ± 1.10) years(range 0.53-4.47 years),a median weight of (9.52 ± 3.41) kg(range 5.5-18.3 kg),a median pulmonary blood flow/systemic blood flow (Qp/ Qs) of 1.64 ± 0.45 (range 1.33-2.85),a median pulmonary artery systolic pressure (32.50 ± 10.05) mmHg (range 23-58 mmHg,1 mmHg =0.133 kPa),and the minimum (2.40 ±0.68) mm (1.6-3.8 mm),underwent transcatheter ductal closure with the ADO Ⅱ.Device sizes used were 3 mm ×4 mm(n =7),3 mm ×6 mm(n =3),6 mm ×6 mm (n =2),respectively and delivered with 4 or 5 F delivery catheters.The median fluoroscopy time was (6.39 ± 4.16) min(range 3.2-18.2 min).Complete ductal occlusion was achieved by the end of the procedure in 10 patients.The TTE showed good position of the occlusion and the velocities of blood flow in left pulmonary artery and the descending aorta were in a normal range.There was a trivial residual shunt after the surgery of 2 patients.No residual shunt was found after 24 hours in all 12 patients.In 1 case,the patient had a descending aortic obstruction with pressure gradient of 11 mmHg.Three months after surgery,the pressure descended to 10 mmHg by TTE.Complete ductal occlusion without aortic arch or left pulmonary artery stenosis had been identified in other 11 remaining patients on TTE follow-up of 6 months of 3 patients and 12 months of 6 patients.Conclusions The ADO Ⅱ achieves excellent ductal closure rates through low profile delivery systems in small infants and children with moderate and small PDA or morphologically varied PDAs.It is simple in use with few complications.Occlusion design allows closure with arterial or venous approach and delivery with 4 or 5 F delivery catheters.The children who used arterial approach,transthoracic echocardiography TTE is recommended to replace aortic angiography,so as to avoid puncturing the aorta and reduce vascular injury.

Objective To evaluate the clinical value of plate fracture of comprehensive rehabilitation training for in-tertrochanteric fractures occur locking plates (LCP) after treatment. Methods Future hospital treatment of in-tertrochanteric fracture were randomly divided into two groups , control group of patients were treated with locking plate internal fixation pressure treatment, the observation group treated with joint comprehensive rehabilitation training on basis of the contral group. Results Postoperative follow-up found that patients in the control group had broken the lock plate 11 cases, 17 cases of loose steel, steel broken nails 14 cases, the observation group were two cases, four cases, three cases, the observation group after 1 year in pain, function, range of motion Harris score comparison dominant. Conclusion Clinically joint comprehensive rehabilitation training through the use of standardized surgical procedure can reduce intertrochanteric fracture fixation locking plate fracture incidence.

Objective To reversing methicillin-resistant Staphylococcus(MRS) to methicillin-susceptible Staphylococcus(MSS) by changing nutritional conditions and continuous transfer of culture .Methods MRS trains separating from clinical specimens were cultured in different conditions ,continuous cultural transfer ,and drug sensitive test were proceeded periodically to observe the phe-notypic and chemical reaction change of MRS .The mecA gene were detected of the original and mutant strains by polymerase chain reaction(PCR) ,then the gene sequenced and compared .Results 53 MRS strains were studied .6 strains were phenotype successful-ly converted to MSS in different cultural conditions ,among them mecA gene was undetected in 2 strains ,and down expressed in 4 strains .Conclusion The MRS strains separated from clinical specimens may revert to MSS by culture under different nutritional conditions .The mecA gene of MRS may be lost or lower expressed and the MRS and mutant strains may be different in genomics .

Objective: To investigate the clinical efficacy of Jiuwei-Zhenxin granules and buspirone hydrochloride tablets for geriatric anxiety patients. Methods: A total of 136 elderly anxiety patients who met the inclusion criteria were randomly divided into two groups with 68 patients in each group. Patients in the control group were treated with butyrocyclone hydrochloride tablets, while the patients in the treatment group were treated with Jiuwei-Zhenxin granules on the basis of control group. Both groups were treated for 4 weeks. The average R-R interval standard deviation at 24 h (SDNN), the standard deviation of the mean normal R-R interval value for every 5 minutes in 24 h (SDANN) and mean square root of inter-period difference between adjacent R-R at 24h (RMSSD) were measured by heart rate variation analyzer. The 5-hydroxytryptamine (5-HT), norepinephrine (NE) and dopamine (DA) were detected using ELISA. The HAMA scale was used to evaluate anxiety and adverse reactions. Results: After treatment, the SDNN (132.04 ± 30.17 ms vs. 107.23 ± 23.44 ms, t=16.901), RMSSD (70.12 ± 21.85 ms vs. 46.43 ± 20.09 ms, t=20.367) and SDANN (136.45 ± 27.18 ms vs. 125.62 ± 20.92 ms, t=6.945) of the treatment group were significantly higher than those of the control group (P<0.01). The serum 5-HT (119.69 ± 10.24 ng/L vs. 142.26 ± 13.71 ng/L, t=21.523), NE (126.47 ± 20.15 ng/L vs. 205.84 ± 23.12 ng/L, t=35.776), DA (130.12 ± 15.95 ng/ml vs. 156.47 ± 15.09 ng/ml, t=14.198) were significantly lower than those of the control group (P<0.01). The HAMA scores of the treatment group at week 1, 2, 3 and 4 after treatment were significantly lower than those of the control group (t=2.105, 4.116, 4.270, 3.369, P<0.05). Conclusions The Jiuwei-Zhenxin granules combined with buspironone hydrochloride tablets can reduce the anxiety of elderly anxiety patients, and its mechanism may be related to regulating the body's neurotransmitter to inhibit autonomic nervous dysfunction and reduce anxiety.

Objective:To evaluate the clinical performance of anti-peptidylarginine deiminase 2 (PAD2) and anti-PAD4 antibodies combined testing in a Chinese rheumatoid arthritis (RA) cohort.Methods:A total of 148 RA inpatients and 35 patients with non-RA arthritis as controls (DC) were recruited from November, 2018 to November, 2019 in Peking University People′s Hospital. In addition, a total of 44 healthy controls (HC) who went to Peking University People′s Hospital for annual physical examination were collected from June 2019 to July 2019. The α-PAD2 and α-PAD4 level in clinical specimens were determined by ELISA. Statistical analysis was performed by the Mann-Whitney U test, the Kruskal-Wallis (KW) test, the χ 2 test or the Fisher′s Exact Test, as necessary. Correlation analysis were performed by logistic regression. Results:α-PAD2 and α-PAD4 were present in 26.4% (39/148) and 20.9% (31/148) patients with RA, 5.7% (2/35) and 5.7% DC (2/35) and 4.5% (2/44) and 2.3% HC (2/44), respectively. α-PAD4-positive RA patients displayed significantly longer disease duration compared to α-PAD4-negative RA patients (17.3±13.2 years vs 8.6±10.2 years, P<0.001). α-PAD4-positive RA patients showed a significantly higher incidence of interstitial lung disease (ILD) compared to those without α-PAD4 (54.8% vs 25.6%, P=0.002). No associations between α-PAD2 and ILD were found ( OR: 0.797, P=0.579). In contrast, significant associations between α-PAD4 and ILD were found ( OR: 3.521, P=0.002). In seropositive RA, α-PAD4 displayed a weak correlation with ILD ( OR: 2.324, P=0.046), but this association was greatly enhanced when combined with α-PAD2 [anti-PAD2 (-)] ( OR: 4.059, P=0.007). Conclusions:The findings delineate the clinical relevance of α-PAD2 and α-PAD4 in RA and suggest that the combined testing for α-PAD2 and α-PAD4 may provide additional diagnostic value to the current clinically available assays in RA, in particular in identifying patients at risk of RA-ILD.

Objective:This study aimed to revise the Constitution in Chinese Medicine Questionnaire(Elderly Edi-tion)(CCMQ-EE),as well as evaluate its reliability and validity.The objective was to provide a more accurate Chinese medicine constitution identification tool for geriatric health management and help further research on the relationship between geriatric diseases and constitution type,etc.Methods:The Delphi method and a cross-sectional survey of the elderly population were used.From April to October 2021,experts in different fields were invited to participate in the questionnaire,and items were revised through the experts'ratings and feedback.From December 2021 to February 2022,the revised CCMQ-EE was validated in the elderly population.Results:The coefficients of variation of rationality and importance scores decreased to less than 0.25 in the third round of Delphi.The Kendall coordination coefficients of rationality and importance in the third round were 0.15 and 0.17(P=.031 and P=.007,respectively).The revised CCMQ-EE was established with 34 items.The factor loadings of subscales were between 0.39 and 0.92,and the fitting effects of other subscales were acceptable,except for the inherited special constitution.The Cronbach alpha and test-retest reliability coefficients of each subscale ranged from 0.65 to 0.83,and 0.66 to 0.96,respectively.The composite reliability and average variance extraction were between 0.66 and 0.84,and between 0.32 and 0.57,respectively.The reliability and validity of the revised CCMQ-EE were acceptable or satisfactory.Conclusion:The revised CCMQ-EE was developed through a three-round Delphi process and internal team discussion.After the verification in the elderly in Beijing area,its measurement performance was good.The updated questionnaire can probably replace the initial version to better promote health management and help healthy aging by identifying the constitution type of the elderly.