International experiences can provide evidences for general practitioners ( GPs) system building in China. The paper reviews the development of GP systems from several typical countries of different insurance sys-tems, including national health care systems, commercial medical insurance systems, and social medical insurance systems, etc. The factors that influence GPs systems are analyzed. It is found that the control force of health security system on health system, the control force of specialists on health system, the incentive mechanism of general prac-tice, and the development of general medicine influence the establishment of GPs systems. Finally, this paper pro-vide several policy implications:First, in order to meet the needs of public health, a GPs system with Chinese char-acteristics should be established;Second, the core values of general medicine should be promoted to provide public support for the establishment of a GPs system;Third, a sound incentive mechanism should be established for the de-velopment of a GPs system to improve the status of general practitioners;Fourth, the division of general practitioners and specialists should be promoted to improve the development of general medicine.

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in the Western world,and is potentially curable with standard R-CHOP chemoimmunotherapy. We are now in an era that the heterogeneity of DLBCL is defined genetically and molecularly,and rational subset-specific therapeutic targets are guiding clinical trials.Primary mediastinal DLBCL is a unique clinicopathologic entity, and alternatives to R-CHOP may confer superior outcome. Rearrangement of the myc oncogene occurs in 10%of patients with DLBCL, and confers a very poor prognosis with standard R-CHOP, particularly when there is concomitant rearrangement of bcl-2, a condition referred to as double-hit DLBCL. A larger subset of DLBCL demonstrates overexpression of both myc and bcl-2 by immunohistochemistry. Analyze the source of cells by gene expression profile, immunohistochemistry algorithms,or a novel Lymph2Cx platform,provides prognostic information, and guides therapeutic decisions in both relapsed and de novo disease. This article reviews latest research presented at the 57th American Society of Hematology (ASH) annual meeting on the definition of specific subsets of DLBCL and selection of subtype-specific treatment,including novel approaches under investigation. Understanding these key features of the pathology report, and limitations of these assays defining subsets of DLBCL, allows for a precision medicine approach to this disease.

AIM: To study the role of carbon monoxide (CO) in the mechanism of cholecystokinin-octapeptide (CCK-8) for attenuation of acute lung injury (ALI) induced by lipopolysaccharide (LPS). METHODS: Fifty-six adult male rats were randomly divided into seven groups: control group, LPS group, LPS+ZnPP (a specific inhibitor of HO-1) group, LPS+Hemin (Hm, CO donor) group, CCK-8+LPS group, CCK-8+LPS+ZnPP group and CCK-8 group (n=8 for each). Bronchoalveolar lavage was performed 2 h, 6 h and 12 h respectively after treatments. The numbers of polymorphonuclear leukocytes (PMN) in bronchoalveolar lavage fluid (BALF) was detected. The mortality of rats and the structure of lung tissues were observed. MDA and CO contents in lung tissues were also measured. RESULTS: The mortalities of rats were both zero 2 h and 6 h after agent administration. The mortality of rats was higher than control group 12 h after LPS administration. The mortality of rats in LPS+Hm and CCK-8+LPS group were lower than that in LPS group, and its in LPS+ZnPP and CCK-8+LPS+ZnPP group were lower than that in LPS and CCK-8+LPS group, respectively. Lung injury was observed in LPS group. At the same time the number of PMN, MDA and CO content were higher than those in control group. The degree of lung injury, PMN numbers and MDA content were lower, while CO content in LPS+Hm and CCK-8+LPS group were higher than those in LPS group. However, the degree of lung injury, PMN number and MDA content were higher, CO content were lower in LPS+ZnPP and CCK-8+LPS+ZnPP group than those in LPS and CCK-8+LPS group, respectively. CONCLUSION: CCK-8 attenuates the LPS-induced acute lunginjury by means of anti-oxidation and inhibition of PMN aggregation, which are both mediated by CO.

This paper compared the practice and service mode of general practitioners ( GPs) from a selection of typical countries and regions and discovered that GPs from most of the countries were self-employed, with various forms of employment, freedom to practice and work in different institutions;fixed practices were supplemented, and service types were transformed from individual services to the multi-disciplinary team of services. Result: GPs’ free-dom to practice in different institutions requires a certain social environment and circumstances. The multi-disciplina-ry team of practices has become the development direction for the service modes of GPs. GPs have played different roles in establishing the referral system in the health systems of different countries. Consequently, the paper suggests that establishing a diverse and relaxed practice environment to provide conditions for the transformation of the service mode of GPs. The construction of a multi-disciplinary team to promote changes in community service modes was must be strengthened. Health insurance regulations should be encouraged to establish the gatekeeper system and realize a grading of systems. Social capital should be encouraged to organize general medical services to promote the develop-ment of the health care industry.

Objective To evaluate the effect of dexmedetomidine on the quality of recovery from sevoflurane-based anesthesia in the patients undergoing abdominal surgery.Methods Eighty patients of both sexes, aged 30-64 yr, weighing 45-80 kg, with American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective abdominal surgery, were randomly assigned into 2 groups (n =40 each) using a random number table: control group (group C) and dexmedetomidine group (group D).After routine induction of anesthesia, all the patients were tracheally intubated, and mechanically ventilated.Anesthesia was maintained with sevoflurane inhalation and intermittent iv boluses of sufentanil and cisatracurium besylate, and bispectral index values were maintained at 45-60.After induction of anesthesia, dexmedetomidine was infused in a dose of 1 μg/kg over 15 min, followed by a continuous infusion of 0.6 μg · kg-1 · h-1 until 30 min before the end of surgery in group D.Group C received normal saline instead.Heart rate (HR) and mean arterial pressure (MAP) were recorded at the end of surgery, and at 1 min before and after extubation.The emergence time, extubation time, and occurrence of bucking during extubation, and nausea and vomiting, respiratory depression, and agitation during recovery from anesthesia were recorded.Results Compared with group C, MAP and HR were significantly decreased at 1 min before and after extubation, the emergence time and extubation time were shortened, the incidence of bucking, nausea and vomiting, and agitation was decreased, and no significant change was found in the incidence of respiratory depression in group D.Conclusion Dexmedetomidine infused in a dose of 1 μg/kg after routine induction of anesthesia, followed by a continuous infusion of 0.6 μg · kg-1 · h-1 until 30 min before the end of surgery, can significantly increase the quality of recovery from sevoflurane-based anesthesia in the patients undergoing abdominal surgery.

Background and purpose: Renal cell carcinoma is the most common form of kidney cancer, characterized by lack of early symptoms and high malignancy. This study aimed to establish orthotopic nude mice models of human renal cell carcinoma with high success rate and good repeatability. Methods: The four types of methods which were adopted to establish the orthotopic models of renal cell carcinoma were orthotopic injection of 786-0 and ACHN cell suspensions, orthotopic injection of primary cell suspensions obtained from the subcutaneous tumor tissues, renal subcutis orthotopic implantation into renal capsule and surgical subcutis orthotopic implantation into renal fascia. To gain insights into the tumorigenicity and the growth of transplantation tumors, the imageological examination (PET/CT), histological examination (H-E staining, immunohistochemistry staining) and biochemical analysis of blood were carried out. Results: In terms of the subcutaneous transplantation of human renal cell carcinoma models in nude mice, tumorigenic rate of ACHN cells (90%) was higher than that of 786-0 cells (30%). The tumorigenic incidences of 786-0 cell suspensions orthotopic injection, ACHN cell suspensions orthotopic injection, ACHN subcutis cellular suspensions orthotopic injection, ACHN subcutis orthotopic implantation into renal capsule and renal fascia were 33%, 80%, 90%, 100% and 20%, respectively. ACHN subcutis orthotopic implantation into renal capsule was the most effective approach. Imageological and histological results accorded with poorly differentiated renal cell carcinoma. Conclusion: Four orthotopic nude mice models of human renal cell carcinoma were successfully established. Among these methods, ACHN subcutis orthotopic implantation into renal capsule is the most effective approach, which provides an ideal model for the research on biological behavior of human renal cell carcinoma and its treatment.

Objective To explore the technological and therapeutic value of endoscope for removal of hepatobiliary necrosis after liver transplantation.Methods Data of 36 patients with suspected hepatobiliary diseases,who underwent choledochoscopy or duodenoscopy to remove necrosis after liver transplantation,were reviewed.Liver function before and after the treatment were compared.Results Hepatobiliary necrosis located in common bile duct (n =6),intrahepatic bile duct (hilar bile duct included) (n =24) and intraand extra-hepatic duct (n =6).The total success rate was 72.2％ (26/36).Full clearance of bile duct necrosis was accomplished in 16 patients,partial clearance in 15 patients and the necrosis could not be removed in 5 others.The serum bilirubin and transaminase decreased significantly,compared with those before endoscopic treatment (P ＜ 0.05).No serious complications or death related to endoscopy occurred during the treatment.After 6-84 month follow-up,in 17 survivals,3 patients underwent a second liver transplantation with good prognosis.All the survivals had a life of good quality with no placed drainage tube except for one with drainage tube for four years with unstable serum bilirubin.Nineteen patients died from biliary tract related complications or other diseases during the long-term follow-up,among which eleven patients survived beyond four years.Conclusion Endoscopy for hepatobiliary necrosis removal,a minimally invasive method,is effective and safe.

Objective To explore the efficacy and safety of minimal invasive adrenal sparing surgery for the treatment of Cushing syndrome caused by adrenocortical adenoma.Methods Patients who underwent minimal invasive adrenal surgery for adrenocortical adenoma in our institution from January 2010 to December 2015 were retrospectively analyzed.Preoperative, intraoperative, and postoperative variables were reviewed from the database.The mean patient age at diagnosis was 39 years and male:female ratio was 10:111.Of the 121 adenomas, 50 were located in the right adrenal and 71 in the left.The mean tumor size was 2.6 cm.84 cases had hypertension (69.4％), 36 cases had diabetes mellitus (29.8％), and 45 cases had obesity (37.2％).Postoperative follow-up was performed by evaluating adrenal gland function and imaging.Results Mininal invasive partial adrenalectomy was performed in 121 cases and the success rate of operation was 99.2％ (120/121).Sixty-two cases received operation through retroperitoneal approach,and 59 cases were through transperitoneal approach.The median operative time was 50 min with a median blood loss of 50 ml.The mean postoperative hospital stay were (5.0 ± 3.2) days.The vascular injury occurred in 2 cases (1 case in each surgical approach), while the abdominal organ injury occurred in 2 cases with 1 case of spleen injury and 1 case of liver injury (both in transperitoneal approach).Postoperative complications were observed in 6 cases:1 case of deep venous thrombosis, 1 case of wound hematoma, 4 cases of wound infection.Cortisol substitution was given in 2 to 12 months (mean 6.2 months)postoperatively.One year after operation, the remission rate of hypertension, diabetes and obesity was 58.3％ (49/84), 30.6％ (11/36) and 60.0％ (30/45), respectively.Conclusions Minimal invasive adrenal surgery using retroperitoneal and transperitoneal laparoscopic technique can be performed with low morbidity and achieve an excellent outcome.The perioperative hormone therapy may also play an important role.

Objective To analyze the clinical characteristics of epileptic children at early stage,and to explore the high risk factors for children′s refractory epilepsy(RE)in order to provide evidence for the early and timely treatment of RE.Methods A total of 147 epileptic patients with correct diagnosis and reasonable treatment were enrolled.Forty-nine patients were classified as drug non-responsive epilepsy(DNR-EP group).The remaining 98 patients were classified as drug-responsive epilepsy(DR-EP group).With multiple conditional Logistic regression,the clinical characte-ristics between the 2 groups were compared to identify the early predictors for RE.Results Single factor Logistic regression analysis showed that the initial age of onset <1 year,more than 20 seizures before treatment in a week,focal seizures,more than 2 kinds of epileptic seizures,changes in seizure type in the course of disease,neurological impairment,early intellectual disability,abnormal cranial magnetic resonance imaging(MRI),fixed focal abnormalities on video electroencephalogram(VEEG) after seizure-free interval,diffused anomaly of non-epileptic wave in VEEG before treatment,poor response to initial antiepileptic drugs(AEDs) therapy,compliance with the characteristics of epileptic encephalopathy at early stage significantly increased in DNR-EP group.Then multivariate conditional Logistic regression analysis demonstrated that more than 20 seizures before treatment in a week(OR=2.679,P=0.043),more than 2 kinds of epileptic seizures(OR=4.364,P=0.013),fixed focal abnormalities on VEEG after seizure-free interval(OR=3.898,P=0.008),poor response to initial AEDs therapy(OR=2.611,P=0.036),and compliance with the characteristics of epileptic encephalopathy at early stage(OR=6.022,P=0.002) were the risk factors for developing into RE.Conclusions Children are likely to develop into RE if they have more than 20 seizures before treatment in a week,with more than 2 kinds of epileptic seizures,fixed focal abnormalities on VEEG after seizure-free intervals,poor response to initial AEDs therapy,and compliance with the characteristics of epileptic encephalopathy at early stage.

Objective In view of the trend of networking development in modern high education and the characteristics of students' strong self-learning ability, Peking Union Medical College established a multimedia morphological teaching website from 2013 including human anatomy, neuroanatomy, histology and embryology.Methods According to the teaching demand, the use of the ASP script, combined with Mysql database completed the website development, from the interface design to the curriculum, the syllabus, presentations and laboratory videos uploading.Results Through the questionnaire survey, 45% of the students use website more than 3 times a week, and course content column has the highest use frequency (79%).An independent learning platform effect has been achieved.Conclusions After nearly 4 years exploration and practice, multimedia website has become an important part of morphological courses, as a kind of new teaching mode, not only popular for college teachers and students, but also widely used in clinical teaching.