The new educational system integrating both medical undergraduate and professional degrees,by integrating the curriculum system rationally,strengthening the clinical practice,innovating the assessment and management mode,establishes and enforces normative resident physician training system to cultivate high-starting point general practitioners led by medical colleges and provide qualified general practitioners,for the purpose of supporting the health reform successfully.

Objective To investigate the prevalences of metabolic disorders of glucose and lipids in the first degree relatives (FDP) of type 2 diabetic patients in Qingdao,China. Methods 1392 subjects were recruited,including 528 T2DM-FDR(parent and/or siblings have T2DM) and 864 NC-FDR(parent and siblings did not have DM). All subjects received both standard 75g oral glucose tolerance test and measurements of body weight,height,waist and hip circumference,percentage of body fat,blood pressure,blood lipid,and plasma uric acid. Results (1) The prevalence of diabetes was higher in DM-FDR than in NC-FDR (24.24% vs 17.01%,P

Objective:To study the mechanism of Qingluo Tongbi Compound (QLT) treating rheumatoid arthritis(RA)by observing miRNA Network of QLT on collagen-induced arthritis ( CIA) mice.Methods:The model of RA was induced by collagenⅡin DBA/1 mice and randomly divided into control group , CIA group, QLT group.Differently expressed miRNAs were detected by miRCURYTM LNA Array.Real-time PCR was applied to verify the reliability of miRNA array.Results:The bioinformatics software and database were applied to predict and analyze target genes.MiRNA array results showed that 221 miRNAs changed in CIA group compared with the control group ,and 169 miRNAs changed in QLT group compared with CIA group.And the results of real-time PCR were consistent with the array.Compared with the control group ,miR-143 was significantly reduced in CIA group ,intervention of QLT obviously upregulated the expression of miR-143.The target genes of miR-143 were significantly stored in VEGF , T cell receptor, MAPK,signaling pathway.Conclusion: Multiple abnormal expression of miRNAs involved in the pathological process of CIA.QLT affected the expression of various miRNAs ,which might be related to immunity ,inflammation,pain pathological process of RA and miR-143 could be a potential target in the treatment.

Objective To explore the effect of continuing care on the intermittent catheterization compliance of patients with neurogenic bladder. Methods From January to December, 2015, 60 patients with neurogenic bladder after spinal cord injury receiving intermittent cathe-terization were randomly assigned to control group (n=30) and intervention group (n=30). The control group received routine discharge in-struction, while the intervention group received continuing care in addition. The intermittent catheterization compliance, residual urine vol-ume, urinary tract infection and quality of life were assessed at discharge and three months after intervention. Results After intervention, the intermittent catheterization compliance was better in the intervention group than in the control group (χ2=7.500, P=0.006). The residual urine volume significantly decreased in both groups (t>12.040, P<0.001), and was less in the intervention group than in the control group (t=-2.190, P=0.032), as well as the urinary tract infection rate (χ2=10.800, P=0.001). The score of quality of life increased significantly after intervention in both groups (t>4.572, P<0.001), and was higher in the intervention group than in the control group (t>5.505, P<0.001). Con-clusion Continuing care could improve the intermittent catheterization compliance, reduce the residual urine volume and the urinary tract in-fection rate, and improve the quality of life in patients with neurogenic bladder after discharge.

Objective To evaluate the therapeutic effect and safety of the rituximab in the treatment of severe rheumatoid arthritis (RA). Methods A total 22 severe RA patients with DAS28＞5.1 were treated with rituximab 500～1000 mg/24week, or placebo/24 week, along with methotrexate (MTX) 10～25 mg/week.Chi-square test was adapted for statistical analysis if the results met the data criteria for the analysis. Rank conversion analysis was used to test the results if the data did not satisfy the Chi-square test. Results Twenty-two patients (93% were females with the median age of 50 yd and the average MTX dosage was 17.6 mg/week ) completed the treatment. The proportion of ACR 20 responders at 72 week was 80%, 60%,57% respectively. Other secondary efficacy endpoints showed that rituximab could provide substantial benefits to patients with RA by reducing clinical signs and disease activity score. The most frequently occurred adverse event was upper respiratory tract infection. Tne second most frequent adverse events were reduction of lymphocytes and elevation of liver enzymes. Most treatment-related adverse events were mild to moderate in severity. Conclusion Rituximab has demonstrated to be effective and is well tolerated by patients in the treatment of active RA.

ObjectiveTo evaluate the relationship between waist to stature ratio (WSR) and hypertension,diabetes,dyslipidemia in Qingdao. MethodsData were collected from a 2001 - 2007 Qingdao area diabetes survey,population-based cross-sectional study,and 30 712 Chinese adults aged ＞ 18 years old were enrolled.Correlation analysis of BMI,WSR,hip circumference,waist circumference,waist to hip ratio (WHR) with blood glucose,blood pressure,blood lipid were conducted.ROC curve analysis in diabetes,bypertension,dyslipidemia and multivariate logistic regression analysis were also conducted.ResultsAnthropometric indicators were related with hypertension,diabetes and dyslipidemia in both men and women.Comparing with other anthropometric indicators,WSR was found to have the largest area under the ROC curve and the best cut-off point of WSR was 0.52.Multivariate logistic regression analysis showed that, after controlling age, disease history, physicalactivity, sex, thediabeteshypertension and dyslipidemia risk OR of WSR≥0.52 were largest.ConclusionsAnthropometric indicators intimately related with cardiovascular risk factors in Qingdao region,and may predict and evaluate the risk of cardiovascular disease.WSR may be the best index for predicting cardiovascular risk factors in Qingdao area.The optimal WSR cut off point for identifying cardiovascular risk factors clustering is 0.52.

This study was aimed to compare the expectorant and antitussive actions ofPlatycodon grandilforum from different production areas in order to provide references for its cultivation and production. The antitussive activities ofP. grandilforum water extract from different areas were investigated through testing the cough times induced by ammonium hydroxide in mice. And the expectorant activities were studied by testing the amount of tracheal phenolsulfonphthalein excretion in mice. The results showed that the minimum effective dose ofP. grandiflorum fromChifeng of Inner Mongolia was 0.2 g·kg-1. Under this dosage,P. grandiflorum fromChifeng of Inner Mongolia can significantly reduce the cough frequency in mice (P < 0.01), and significantly prolong the cough incubation period in mice (P < 0.01).P. grandiflorum fromSichuan province,Shangzhou ofShaanxi province andChongqing can significantly decrease the cough frequency in mice (P < 0.05). P. grandiflorum from Sichuan province,Shangzhou ofShaanxi province andChifeng of Inner Mongolia can significantly increase the phenolsulfonphthalein excretion quantity in mice (P < 0.05). It was concluded thatP. grandilforum was effective for relieving cough and removing sputum. The effect ofP. grandilforum fromChifeng of Inner Mongolia was obviously stronger than that from other areas.

Objective:To analyze the different expressions of miRNAs in peripheral blood of rheumatoid arthritis (RA) patients and the osteoclasts in rats,and to verify the key miRNAs in RA.Methods: The miRNAs expressions in monocyte and the co-cultured osteoclasts,peripheral blood of rheumatoid arthritis (RA) patients and normal were detected by miRCURYTM LNA Array.Real time PCR was applied to verify the reliability of miRNA array.The bioinformatics software and database were applied to predict and analyze target genes.Results: miRNA array results showed that 189 miRNAs changed in RA patients compared with the normal;211 miRNAs were changed in osteoclasts group compared with monocytes group.The expressions of ten miRNAs were all abnormal in RA patients and osteoclasts in rats.The results of Real time PCR were consistent with the array.Results of bioinformatics analysis showed that the target gene of miRNA significantly enriched in signaling pathways such as VEGF,MAPK signaling pathways.Conclusion: Some miRNAs had similar abnormal expressions in different species,and these miRNAs may influence the differentiation of the osteoclasts through regulating the related signal passways.

Objective To explore the effects of continuing care on the quality of sleep and neurological function rehabilitation in patients after stroke. Methods 60 patients with sleep disorder and hemiplegia after stroke discharging from our hospital during January to December 2014 were randomly assigned to control group (n=30) and intervention group (n=30). The control group received routine discharge instruction, while the intervention group received continuing care. They were assessed with Pittsburgh Sleep Quality Index (PSQI), simplified Fugl-Meyer Assessment (FMA) and modified Barthel Index (MBI) were when discharged and 3 months after intervention. Results The scores of PSQI were lower, the scores of FMA and MBI were higher in the intervention group than in the control group 3 months after intervention (P<0.05). The nursing satisfaction was higher in the intervention group than in the control group (P<0.001). Conclusion Continuing care could improve the sleep quality, and promote the neurological function recovery for patients with sleep disorder after stroke.

Objective : o evaluate the association between Crohn's disease (CD) and frailty using a Mendelian randomization (MR) approach, so as to provide the evidence for prevention and control strategies. Methods: Genetic association data for CD were collected through the International Inflammatory Bowel Disease Genetics Consortium, with 20 883 samples and 12 276 506 single nucleotide polymorphism (SNP), and genetic association data for frailty were collected through a meta-analysis including 175 226 samples and 7 589 717 SNPs. A forward MR analysis was performed using the inverse-variance weighted (IVW) method with 37 CD-associated SNPs as instrumental variables, and frailty as the study outcome, and a reverse MR analysis was performed with 13 frailty-associated SNPs as instrumental variables and CD as the study outcome. The heterogeneity was assessed using the Cochran's Q test, and the horizontal pleiotropy was assessed using the MR-PRESSO global test and MR-Egger regression. In addition, the robustness of the results was verified with the leave-one-out. Results: Forward MR analysis results showed that patients with genetically predicted CD had an increased risk of frailty index relative to those without CD (β=0.018, 95%CI: 0.011-0.026, P<0.05). Cochran's Q test detected no heterogeneity (P>0.05), and neither the MR-PRESSO test nor the MR-Egger regression revealed horizontal pleiotropy of instrumental variables (both P>0.05). Leave-one-out analysis showed robustness of the MR analysis results. Reverse MR analysis showed no association between frailty index and the risk of CD (OR=0.740, 95%CI: 0.206-2.661, P>0.05). Conclusions Genetically predicted CD is associated with an increased risk of frailty. It is suggested that screening and prevention of frailty should be reinforced among CD patients.