General practitioner system is an important part of national health service system.Improving general medical education is an inevitable tendency of modern medical education.General medical science starts late in China.Development of Chinese general practitioner training system and general medical education are relatively insufficient and lack of relevant experiences.This paper introduced family doctor training process of Washington university school of medicine and revealed characteristics of systematization,standardization and pervasive of it to inspire our country to learn from the following aspects:(1) paying fully attention to the important role of general medical science in the national health service system； (2) systematically planning three-step training of general medical education ； (3) implementing general medical education teaching content and teaching staff development.

Purpose:To investigate the relation of cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) to tumor progression of cervical carcinoma. Methods:The expression and localization of COX-2 and iNOS protein in the 25 patients with cervical carcinomas were determined by immunohistochemical and the gene expression of COX-2 and iNOS were examined by reverse-transcription polymerase chain reaction ( RT-PCR). Results:Immunohistochemical staining for COX-2 and iNOS expression was strongly positive in 15 of 25 (60 %) and 20 of 25 (80 %) cases,respectively. Increased COX-2 and iNOS mRNA levels were confirmed by RT-PCR. There was negative correlation between COX-2 expression and tumor cell differentiation(r=-0.420, P

ObjectiveTo provide a new idea for exploring the molecular genetic approach to the pathogenesis of schizophrenia via construction of microRNA-messenger RNA （miRNA-mRNA） regulatory network in schizophrenia. MethodsThe microarray datasets of GSE54578 miRNA expression profiles in peripheral blood and GSE145554 mRNA expression in the anterior cingulate in postmortem brain of schizophrenic subjects were downloaded from Gene Expression Omnibus （GEO） database since July 2021. The GEO2R was used to identify the differentially expressed miRNAs and mRNAs， screen the miRNA with target differentially expressed mRNA， and predict their potential upstream transcription factors. The overlapping genes from the mRNA targeted by the differentially expressed miRNA and the mRNA differentially expressed in GSE145554 dataset were collected. Then the biological features of hub genes were analyzed via Gene Ontology （GO） analysis and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analysis， and the protein-protein interaction （PPI） network and miRNA-mRNA regulatory network of hub genes were constructed. ResultsA total of 8 up-regulated differentially expressed miRNAs with targeted mRNA were screened out in GSE54578 datasets regarding schizophrenia， which involved in the regulation of 10 transcription factors， 247 down-regulated differentially expressed mRNAs were screened out in GSE145554 datasets， and 17 overlapping mRNAs were obtained. GO analysis showed that the target mRNAs were mainly involved in astrocyte differentiation and development. KEGG pathway enrichment analysis showed that the target mRNAs were mainly involved in Rap1 and Ras signaling pathways. PPI network analysis showed that the mRNAs （KRAS and CD28） might be key genes in schizophrenia. ConclusionThe integrated bioinformatics analysis based on GEO database can identify potential susceptibility genes in schizophrenia， and it also contributes to the construction of miRNA-mRNA regulatory network in schizophrenia.

Aim To investigate the neuroprotective effects of osthole(Ost)on the primary cultured cortical neurons transfected with APP595/596 gene and its underlying mechanism.Methods Neonatal mouse cortical neurons were transfected with APP595/596 gene to establish AD cell models for the further study.Then,the cell viability was detected by CCK-8 assay,and the leakage of lactate dehydrogenase(LDH)was assayed by LDH kit to evaluate the injury degree.Transferase-mediated nick end labeling(TUNEL)was used to evaluate the cell apoptosis.The expression of β-amyloid peptide(Aβ)and β-site APP cleaving enzyme 1(BACE1)was measured by immunofluorescence,while the miRNA-107 was measured by RT-PCR.Results Compared to model group,Ost could significantly improve the neurons viability,decrease the LDH release and prevent the apoptosis.Ost also inhibited the expression of Aβ and BACE1 at protein level,while enhanced the expression of miRNA-107 at gene level.Conclusion Ost plays a neuroprotective role in neurons transfected with APP595/596 gene in part through up-regulating miRNA-107.

ObjectiveTo evaluate the clinical outcome of endoscope-assisted combined anterior and posterior procedures for grade-Ⅲ and Ⅳspondylolisthesis.MethodsFrom December 2007 to May 2010,13 patients with grade-Ⅲ and Ⅳ spondylolisthesis were treated with two bilateral decompression,percutaneous pedicle screw restoration,intervertebral bone grafting and plate fixation using microendoscopic discectomy and laparoscopy,including 6 males and 7 females with an average age of 39.8 years(range,18-58 years).Eleven cases were in grade Ⅲ spondylolisthesis and two in Ⅳ.The lesion location was as follows:2 cases were at L4,5 and 11 at L5S1.The clinical outcomes were evaluated according to Oswestry disability questionnaire,and the change of radiographic data including slipping degree,slipping angle and posterior height of intervertebral disc.ResultsThe mean follow-up time was 21 months (range,12-36 months).The mean operative time was 125 min,with a mean blood loss of 415 ml.Slipping degree decreased 56.9％ in average (from preoperative 73.3％±6.1％ to postoperative 16.4％±9.5％),slipping angle decreased 19.6°(from preoperative 27.7°±5.6° to postoperative 8.1°±8.8°),posterior height of intervertebral disc increased 7.1 mm (from preoperative 2.6 ±0.8 mm to postoperative 9.7 ±3.7 mm).The clinical outcomes of the Oswestry disability questionnaire decreased 19.5 (from preoperative 35.8±5.7 to postoperative 16.3±5.2).CT scans demonstrated that solid bony fusion could be obtained in one year after operation.Complications included dural sac tears in 1 case,and superficial incision infection in 1.The results were excellent in 4 cases,good in 8 and fair in 1.ConclusionEndoscope-assisted anterior and posterior procedures for grade-Ⅲ and Ⅳ spondylolisthesis is a reliable method,which can lead to rigid fixation and fusion,and also can achieve thorough decompression and restoration as much as possible.

OBJECTIVETo investigate the alkaloids from Aconitum handelianum.

METHODThe column chromatographic methods were employed for the isolation and purification of the chemical constituents. The structures were elucidated by spectroscopic methods.

RESULTEight diterpenoid alkaloids were isolated and identified as acoforine (1), acoforestinine (2), 14-O-acetylsachaconitine (3), vilmorrianine C (4), vilmorrianine D (5), talatizamine (6), chasmanine (7) and yunaconitine (8).

CONCLUSIONAll compounds were isolated from this plant for the first time.

Aconitum ; chemistry ; Alkaloids ; analysis ; isolation & purification ; Diterpenes ; analysis ; isolation & purification ; Drugs, Chinese Herbal ; analysis ; isolation & purification

Objective To establish the core knowledge system of training orthopedics specialist nurses based on post competency.Methods 40 experts were consulted for two rounds using Delphi methods to establish the core knowledge system of training orthopedics specialist nurses.Results Two rounds of consultation were issued 40,37 questionnaires,37,35 valid questionnaires were recovered respectively. Authority coefficient of two rounds consulting was 0.85 and 0.88 respectively.Coordination coefficient of projects and contents for training was 0.62 and 0.35.Determined core knowledge systems for training orthopedics specialist nurses included theoretical knowledge,skills,professional attitude and other 29 items. Conclusions The established core knowledge system of training orthopedics specialist nurses is reliable and valid,which may provide guidance and reference for the training of orthopedics specialist nurse in future.

Objective To investigate the relationship of benign prostatic hyperplasia(BPH) with abnormal glucose and lipid metabolism in the elderly. Methods A total of 152 elderly patients with BPH were selected as study subjects. The levels of fasting plasma glucose (FPG), 2-hour postprandial glucose (2 hPG), fasting insulin (FINS), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), blood uric acid (UA), and prostate-specific antigen (PSA) were measured. Their systolic blood pressure (SBP) and diastolic blood pressure (DBP) were also measured. Prostate volume (PV) and annual prostate growth rate were calculated, and the International Prostate Symptom Score (IPSS) was assessed. Based on blood glucose, blood lipids, and IPSS, the patients were divided into normal blood glucose group(99 cases) and hyperglycemia group(53 cases), normal blood lipid group(112 cases) and dyslipidemia group(40 cases), and moderate symptom group(91 cases) and severe symptom group(61 cases). The clinical characteristics of patients in each group were compared, and the relationships of abnormal glucose and lipid metabolism with the severity of lower urinary tract symptoms in patients with BPH were analyzed. Results Compared with the normal blood glucose group, patients in the hyperglycemia group had higher age, SBP, annual prostate growth rate, IPSS, and levels of FPG, 2 hPG, FINS, and PSA, larger PV, and lower HDL-C level (P < 0.05). Compared with the normal blood lipid group, patients with BPH in the dyslipidemia group had higher age, SBP, annual prostate growth rate, IPSS, and levels of FPG, FINS, TC, TG, LDL-C, and UA, larger waist circumference and PV, and lower HDL-C level (P < 0.05). Compared with the moderate symptom group, patients in the severe symptom group had higher age, BMI, SBP, annual prostate growth rate, and FPG levels, higher incidence rates of hyperglycemia and dyslipidemia, larger PV, and lower HDL-C levels (P < 0.05). Multivariate Logistic regression analysis indicated that age ≥70 years, SBP ≥140 mmHg, hyperglycemia, dyslipidemia, increased PV, and elevated annual prostate growth rate were all independent risk factors for the occurrence of severe lower urinary tract symptoms in patients with BPH (P < 0.05). Conclusion Elderly BPH is closely related to abnormal glucose and lipid metabolism, and abnormal glucose and lipid metabolism are risk factors for the exacerbation of lower urinary tract symptoms.

Objective:To explore the application effect of nursing intervention based on acceptance and commitment therapy (ACT) in patients with inflammatory bowel disease (IBD) .Methods:Using the convenient sampling method, a total of 71 IBD patients who were hospitalized in Department of Gastroenterology in the Affiliated Tumor Hospital of Harbin Medical University from June 2018 to October 2019 were selected and they were randomly divided into the experimental group (36 cases) and the control group (35 cases) . The control group received routine care, while the experimental group implemented ACT-based nursing intervention on this basis. The self-efficacy, psychological flexibility and quality of life scores of patients of the two groups before and after intervention were compared.Results:Finally, 33 patients in the experimental group and 34 patients in the control group completed the study. After the intervention, Acceptance and Action Questionnaire-2nd Edition score of the experimental group was lower than that of the control group, and the difference was statistically significant ( P<0.01) . After the intervention, scores of Inflammatory Bowel Disease Self-efficacy Scale and Inflammatory Bowel Disease Questionnaire of the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Nursing intervention based on acceptance and commitment therapy can improve psychological flexibility and self-efficacy of IBD patients and improve their quality of life.

Asthma, Occupational ; Breath Tests ; Exhalation ; Humans ; Lung ; Nitric Oxide ; ROC Curve