With the development of the population aging and the shifting of medical paradigm,as well as the deeply expansion of community health services,the importance of general medicine has become more and more evident.This paper describes the development history of general medicine and general medical education at home and abroad,analyzes the main problems of general medical education in China.By studying the characteristics of different models,we provided the basis of literature for the related policies.

Objective To evaluate the value of fecal calprotectin (FC) and stool lactoferrin (SL) for detecting endoscopic activity and monitoring postoperative recurrence of Crohn disease.Methods Publications in Pubmed,Embase,Science Direct,Springer Link,CBM,Cnki,Wan fang and VIP database before January 1 st 2016 were searched manually.Papers were screened according to inclusion and exclusion criteria.Quality assessment was conducted by QUADAS-2 scale.Meta-Disc 1.4 was used to analyze the heterogeneity of included articles.The pooled sensitivity,specificity,positive likelihood,negative likelihood were calculated respectively and the SROC curve was drawn.Stata 12.0 was used to assess the publication bias.Results A total of 19 papers in English language were included.The pooled sensitivities of FC,SL in detecting endoscopic activity and FC in monitoring postoperative recurrence of Crohn disease were 86％ (95％ CI:84％-88％),72％ (95 ％ CI:66％-79％),80％ (95％ CI:75％-84％),respectively.The specificities were 71％ (95％CI:67％-75％),84％ (95％ CI:74％-91％),65％ (95％ CI:59％-70％),respectively.The areas under the SROC curve were 0.865 6,0.834 6,0.811 0 respectively.The cut-off values of FC in detecting endoscopic activity of Crohn disease were set to ＜ 100 μg/g,100-＜200 μg/g or ≥ 200 μg/g with the area under the SROC curve being 0.898 7,0.788 8,0.888 8,respectively.The cut-off values of FC in monitoring postoperative recurrence of Crohn disease were set to 100-＜ 150 μg/g,150-＜200 μg/g or ≥ 200 μg/g with the areas under the SROC curve being 0.677 4,0.859 4 and 0.759 5,respectively.Conclusion FC and SL have higher diagnostic efficiency than C-reaction protein and are worthy of clinical promotion in detecting endoscopic activity and monitoring postoperative recurrence of Crohn disease.However,endoscopy cannot be replaced.

Objective To evaluate the role of serum immunoglobulin G4 (IgG4) in differentiating autoimmune pancreatitis (AIP) from pancreatic cancer(PC).Methods The database,including Medline,EMBASE,Science Direct,Springer link,CBM,Wanfang,VIP and Cnki were searched by computer and the publication date was before April 1,2015.The studies on evaluating the accuracy of IgG4 in differentiating AIP from PC were screened and selected according to strict determined inclusion and exclusion criteria.Quality assessment was made by QUADAS scale.The publication bias were assessed by Stata12.0 software.The heterogeneity of included articles,calculate the pooled sensitivity,specificity,positive likelihood,negative likelihood were anylyzed by Meta-Disc1.4 software,respectively,and draw the summary ROC (SROC) curve.Results A total of 13 English articles were included and 1403 patients were involved.The pooled sensitivity was 74％ (95％ CI 70％ ～ 78％),the pooled specificity was 93％ (95％ CI 91％ ～ 95％),the positive likelihood ratio was 10.74 (95％ CI 7.16 ～ 16.11),the negative likelihood ratio was 0.25 (95％ CI 0.17 ～0.35) and the area under SROC curve was 0.9340.Conclusions IgG4 has high diagnostic efficacy but low misdiagnosis rate in differentiating AIP from PC,which can be used as one of early diagnostic markers for AIP.

Objective To investigate the relationship between single nucleotide polymorphism (SNP) of susceptibility genes CD-KAL1 ,CDKN2A-CDKN2B ,TCF7L2 and HHEX-IDE of type 2 diabetes mellitus and gestational diabetes mellitus (GDM) in Jiangsu region .Methods 185 healthy pregnant women without GDM tendency (control group) and 176 pregnant women with GDM (GDM group) were enrolled .Case-control method and Multiplex SNaPshot SNP genotyping technology were utilized to detect genotypes at SNP loci of CDKAL1 ,CDKN2A-CDKN2B ,TCF7L2 and HHEX-IDE of pregnant women both in the two groups , and all SNP loci were subject to continuous disequilibrium analysis .Results Compared the allele frequencies of pregnant women in GDM group and the control group ,C allele of CDKAL1(rs7754840) was a risk factor for GDM .The risk of suffering GDM of CC genotype carriers was 1 .73 times the non-CC genotype carriers[P<0 .01 ,OR=1 .73 ,95% CI:1 .28-2 .33] .No statistical difference wasfound in gene distribution of detection loci of CDKN2A-CDKN2B(rs10811661),TCF7L2(rs7903146) and HHEX-IDE (rs1111875) .The genotype frequencies of CDKAL1(rs7754840) ,CDKN2A-CDKN2B(rs10811661) ,TCF7L2(rs7903146) and H HEX-IDE(rs1111875) were all accordance with the law of genetic equilibrium .Conclusion CDKAL1(rs7754840) is closely re-lated to GDM susceptibility in Jiangsu region .

Objective To evaluate the performance of electrolyte module in OLYMPUS AU5421 Automatic Biochemical Analy-zer in K+ ,Na+ ,Cl- detection .Methods Electrolyte module in OLYMPUS AU5421 Automatic Biochemical Analyzer was employed to detect K+ ,Na+ ,Cl- ,and their precision ,accuracy ,linearity range ,cross-contamination and the test results of instruments were compared .The linear regression equation and regression coefficients were calculated according to the methods of Clinical and Labo-ratory Standards Institute(CLSI) EP6-A ,EP9-A2 documents .Results The within-run precisions of K + ,Na+ ,Cl- were 0 .328% , 0 .306% ,0 .343% ,respectively ,and their between-run precisions were 0 .780% ,1 .012% ,0 .985% ,respectively .Their regression coefficients of linear equation were all greater than 0 .999 ,and their cross-contamination rate were 1 .066% ,0 .812% and 0 .858% , respectively .Conclusion Electrolyte module in OLYMPUS AU5421 Automatic Biochemical Analyzer modules has advantages of good precision ,accuracy ,linear range ,and low cross-contamination rate .

Objective This study was designed to observe the impact of cigarette cessation on anxiety and depression in patients with coronary heart disease (CHD).Methods A total of 690 cigarette smoking patients with CHD identified by coronary angiography (CAG) were included and analyzed in the study.The mental state were scored with Hamilton anxiety (HAMA) and depression (HAMD) scale both on admission and at 6-month follow-up.The patients were divided into two groups based on the cigarette cessation.The score of mental state between the two groups were compared.The patients were treated with percutaneous coronary intervention (PCI),coronary artery bypass grafting (CABG),or medicine therapy (MT).Results The clinic data and score of mental state were similar at the time of admission (HAMA:10.66±5.53 vs 11.09 ±5.61,P =0.311;HAMD:29.81 ± 10.13 vs 28.94 ± 10.22,P =0.266 4) between the two groups.After 6 months,the proportions of subjects in smoking cession group with anxiety (24.2％ vs 32.3％,P ＜0.05),depression (18.0％ vs 27.5％,P ＜0.05),and anxiety and depression (7.0％ vs 16.2％,P ＜0.001) decreased significantly compared with those in smoking group irrespective of the treatment strategy.Both the HAMA and HAMD scores were lower in smoking cessation group (HAMA:9.83±3.40;HAMD:24.91 ±7.90) than in smoking group (HAMA:10.98 ±4.87;HAMD:27.70 ± 11.16) (all P ＜ 0.001).Conclusions Smoking cessation is good for the relief of anxiety and depression in CHD patient.

Objective:To investigate the expression of inducible costimulatory ( ICOS) and inducible costimulatory ligand ( ICOSL) on peripheral blood mononuclear cells ( PBMCs ) and their clinical relationship with rheumatoid arthritis ( RA ) patients.Methods:Peripheral blood samples were collected from 85 RA patients and 50 HC in this study.Expression of ICOS and ICOSL on PBMC from the subjects were detected by flow cytometry and real-time polymerase chain reaction( RT-PCR).The alteration of ICOS and ICOSL were observed after hormone therapy in 15 patients with RA and the relationship between their expression level and patients′clinical manifestations were analysed.Results:The ICOS and ICOSL mRNA level of RA patients′PBMCs were significantly higher than that in HC.The expression level of ICOS on CD4+T cells was higher than than that in HC[(7.08±4.72)% vs (3.01+1.39)%,P<0.0001].The expression of ICOSL on monocytes[(5.77±3.45)%vs (3.64±1.43)%,P<0.05] and B cells [(5.78± 4.52)%vs (3.97±1.63)%,P<0.05] were significantly elevated in RA patients.In RA patients with active disease,however,ICOSL expression on monocytes and B cells were increased as compared with those in inactive RA patients [ ( 5.45 ±3.50 )% vs ( 4.04 ± 1.55)%,P=0.036],[(6.59 ±5.74)%vs (5.63±4.30)%,P=0.016].Furthermore,after receiving immunosuppressive therapy, the expressions of ICOS and ICOSL were notably reduced as compared with pre-therapy levels on PBMCs from patients [ ( 5.45 ±3.50)%vs (4.04±1.55)%,P=0.036],[(6.59 ±5.74)%vs (5.63±4.30)%,P=0.016].Conclusion:The high levels of ICOS and ICOSL expression were closely correlated with the degree of disease and therapeutic response,suggesting that ICOS/ICOSL pathway may play a critical role in pathogenesis of RA.

Objective To investigate the expression of inducible co-stimulator (ICOS) and inducible co-stimulator ligand (ICOSL) on PBMCs,and the plasma concentrations of soluble forms of ICOSL and their clinical relationship with systemic lupus erythematosus (SLE) patients.Methods Peripheral blood samples were collected from 45 SLE patients and 39 healthy subjects (HC).The expressions of ICOS and ICOSL on peripheral blood mononuclear cells (PBMCs) were detected by flow cytometry.The concentrations of soluble ICOSL were assessed by measured by enzyme linked immunosorbent assay (ELISA).And the relationship between their expression levels and patients' clinical manifestations were analyzed.Levene F test was used for statistical analysis,the comparison between groups was conducted using t test,and the correlation between two variables were tested by Pearson correlation analysis.Results The expression of ICOS on CD4+ and CD8+ T cells were significantly higher than that of the HC [(19.1±1.7)％ vs (14.0±1.5)％,t=2.156,P=0.035],[(10.0± 1.0)％ vs (6.4±1.0)％,t=2.587,P=0.012].The expression of ICOSL on CD14+ mononuclear cells in SLE patients was significantly higher than that in the HC group [(2.94±0.88)％ vs (0.89 ±0.21)％,t=2.152,P=0.04].Plasma ICOSL concentrations in patients with active SLE were significantly higher than those of patients with inactive SLE [(362±25) ng/ml vs (278±15) ng/ml,t=2.356,P=0.025].We also found a significant negative correlation between the soluble ICOSL expression and the surface ICOSL expression on both mononuclear cells and B cells (r=-0.4243,P=0.022;r=-0.4099,P=0.025).MMPI induced an evident reduction in sICOSL levels released from the cells,which was statistically significant in comparison with untreated cells (P＜0.05).Conclusion The up-regulated expressions of ICOS and ICOSL on peripheral lymphocytes and the high levels of plasma concentration of soluble ICOSL are closely correlated with the severity of the disease,suggesting that ICOS/ICOSL pathway may play a critical role in the pathogenesis of SLE.

Chloroplast genome sequences have comprehensive application prospects in DNA barcoding and chloroplast engineering in traditional Chinese medicine. The complete chloroplast genome of Magnolia officinalis sequenced by high-throughput pyrosequencing and a sequencing procedure was established. Fourteen contigs were obtained after de nove assembly. The sequencing percent of coverage was 99.99%. The chloroplast genome is 160 183 bp in size, and has a typical quadripartite structure with the large (LSC, 88 210 bp) and small copy (SSC, 18 843 bp) regions separated by two copies of an inverted repeat (IRs, 26 565 bp each). chloroplast genes were successfully annotated, of which 17 genes located in each IR region. The chloroplast genome features in Magnolia officinalis are nearly identical to those from other Magnoliid chloroplast genomes. Phylogenetic analyses were performed based on 81 shared coding-genes for a total of 9 Magnolia samples of 5 closely related species. Results showed that distinguishing among species was generally straightforward at the species and population level. This study confirmed the effectiveness of our chloroplast genome sequencing procedure. The chloroplast genome can provide distinguishing differences to help identify Magnolia officinalis and its closely related plants.

Objective To investigate the effect of unfractionated heparin (UFH) on the expression of heme oxygenase-1 (HO-1) in intestinal mucosa of mice with sepsis.Methods Thirty-six male C57BL/6J mice were randomly divided into sham group,cecal ligation and puncture (CLP) group and UHF group,n =12 in each group.Model of intestinal injury in sepsis was induced by CLP.In sham group,the mice were exposed without ligation of cecum.In UFH group,the mice were treated intravenously with 8 U of UFH via the tail vein half an hour before the operation and 12 hours after the surgery respectively.Six mice in each group were randomly chosen at 4 hours and 24 hours after operation to collect inferior vena venous blood samples and terminalileum tissues.The serum levels of interleukins (IL-1 β,IL-6),and tumor necrosis factor-α (TNF-α) were determined by enzyme linked immunosorbent assay (ELISA).The serum level of D-lactate was determined by colorimetry.Pathological changes of ileum tissue and Chiu score were observed after hematoxylin eosin (HE) staining.The HO-1 expression was detected immunohistochemically.Results In sham group,no significant changes in the serum levels of IL-1 β,IL-6,TNF-α and D-lactate were observed.Twenty-four hours after the operation,the structure of intestinal mucosa was basically normal without obvious pathology change and no HO-1 positive cells were found.The serum levels of IL-1 β,IL-6,TNF-α,and D-lactate in CLP group were gradually increased,and they were significantly increased as compared with sham group [IL-1 β (ng/L):40.87±2.88 vs.22.60±2.05 at 4 hours,113.73±3.96 vs.22.07±2.74 at 24 hours;IL-6 (ng/L):63.89±3.26 vs.44.89±3.38 at 4 hours,176.56±5.45 vs.45.76±4.02 at 24 hours;TNF-α (ng/L):194.62± 14.13 vs.152.05±6.22 at 4 hours,599.62± 10.20 vs.155.90± 14.18 at 24 hours;D-lactate (mmol/L):0.24± 0.02 vs.0.19 ± 0.01 at 4 hours,0.33 ± 0.04 vs.0.20 ± 0.02 at 24 hours,all P ＜ 0.05].Twenty-four hours after the operation,edema and inflammation in ileal mucosa,intestinal villi structural damage were observed,the Chiu score was significantly higher than those in the sham group [4.5 (3.0-5.0) vs.0 (0-1.0),P ＜ 0.05],and a small amount of HO-1 positive cells were localized in the intestinal mucosa.Compared with CLP group,the serum levels of IL-1 β,IL-6,TNF-α,and D-lactate of UFH group were significantly decreased [IL-1 β (ng/L):31.53 ± 2.90 vs.40.87 ± 2.88 at 4 hours,61.13 ± 2.80 vs.113.73 ± 3.96 at 24 hours;IL-6 (ng/L):51.16 ± 5.68 vs.63.89 ± 3.26 at 4 hours,81.16 ± 4.54 vs.176.56 ± 5.45 at 24 hours;TNF-α (ng/L):171.76± 5.60 vs.194.62± 14.13 at 4 hours,328.48 ± 10.79 vs.599.62± 10.20 at 24 hours;D-lactate (mmol/L):0.21 ±0.01 vs.0.24±0.02 at 4 hours,0.24±0.02 vs.0.33±0.04 at 24 hours,all P ＜ 0.05].Twenty-four hours after the operation,intestinal injury was ameliorated,the Chiu score was significantly lower [1.5 (1.0-5.0) vs.4.5 (3.0-5.0),P ＜ 0.05],and HO-1 positive cells in the intestinal mucosa was remarkably increased.Conclusion UFH can enhance the expression of HO-1 in intestinal mucosa,reduce the release of inflammatory factors,ameliorate the intestinal inflammatory response,and thus play a protective role in intestinal tissue in mice with sepsis.