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

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

Objective: To analyze the characteristics of small airway dysfunction in patients with occupational asthma, and explore the significance of small airway function indicators in the evaluation of occupational asthma. Methods: A total of 53 patients with occupational asthma diagnosed in our hospital from December 2008 to December 2018 were retrospectively collected in May 2020. 55 healthy people were included as the control group (NC group) and 58 bronchial asthma patients as BA group. The general information and baseline pulmonary function (FVC、FEV(1)、PEF) of the subjects were collected, the pulmonary function were reexamined and small airway function (FEF(25%)pred、FEF(50%)pred、FEF(75%)pred、MMEF(25-75%)pred) were tested at the time of diagnosis and remission. Results: There was no significant difference in pulmonary function and asthma control score (ACT) between OA group and BA group (P=0.356, 0.610, 0.364, 0.430, 0.533, 0.759, 0.426, 0.632) . The incidence of small airway dysfunction in OA group was 77.4%. The indexes of small airway function (FEF(25%)pred, FEF(50%)pred, FEF(75%)pred, MMEF(25-75%)pred) were lower than those in the NC group (P<0.001) . The small airway function indexes of mild and moderate OA patients in remission stage were improved (P=0.029, 0.182) , but the abnormal rate of small airway function was still 62.3%, and there was no significant difference compared with those at the time of diagnosis (P=0.091) . Small airway function (MMEF(25-75%)pred, FEF(50%)pred) was correlated with large airway function (FEV(1)% pred, PEF% pred) (P=0.001) . Conclusion: Small airway dysfunction often occurs and persists in patients with occupational asthma, and has a certain correlation with large airway function indexes.
Asthma, Occupational ; Humans ; Lung ; Respiratory Function Tests ; Retrospective Studies

Medical professionalism plays a critical role in training doctors with noble medical ethics and excellent medical skills. Clarifying the connotation of medical professionalism is the only way which must be passed to deepen the research and cultivation of medical professionalism. At present, there is a heated discussion on the medical professionalism in the world. This study will introduce the development history and latest research progress of medical professionalism and summarize the evolution track and characteristics of medical professionalism from three aspects: development period, international authorities' explanations and research framework. Furthermore, this study will also discuss the connotation and development of medical professionalism in the new era of China, in order to provide reference for the cultivation and evaluation of medical professionalism.

With the development and changes of the modern medical system,the public is paying more and more attention to health,and the professionalism of the physicians becomes more and more important.In recent years,studies have found that doctors are often troubled by professionalism dilemmas in clinical practice.This article reviews the literature on the professionalism dilemmas.Firstly,it defines the concept of professionalism dilemmas and points out the hazards of professionalism dilemmas for individuals,teams and the entire medical industry.We can explore the factors that affect the professionalism dilemmas from the intemal and external aspects,and finally put forward some suggestions for effective prevention and improvement of the professionalism dilemmas.First,physicians themselves have to enhance self-reflection ability.Second,medical schools,through training,shouldenhance the ability of physicians to face occupations professionalism dilemmas,Third,medical institutions should give policy support to to protect physicians.Through the study of the professionalism dilemmas of physicians,we should strengthen the professionalism of physicians and enhance the sense of professional responsibility and mission of medical and health personnel so that they can better fulfill their obligations,serve the people's health better and promote the healthy development of the entire medical and health undertaking.