A 63-year-old man presented with non-pruritic urticaria for 14 months,fever of unknown origin for nearly 12 months,and arthralgias of both lower limbs for 10 months.The fever,which was unrelated to the occurrence of skin lesions,appeared once a week on average,and might be as high as 39 ℃.Physical examination revealed irregular fever and lymphadenopathy in both inguinal and axillary regions.Skin lesions,consisting of rosecolored,slightly elevated plaques and papules,affected the trunk,both upper extremities and thighs.Skin biopsy showed perivascular infiltration of neutrophils and lymphocytes in the superficial dermal layer.Laboratory examination exhibited leukocytosis,elevated erythrocyte sedimentation rate and increased C-reactive protein level.Serum protein electrophoresis revealed an IgM-κ component in the γ-globulin zone.Radiographic examination suggested slight hepatosplenomegaly and hepatic cysts.Positron emission tomography/computed tomography (PET-CT) revealed bilateral knee joint effusion,degeneration of cervical vertebrae and lumbar vertebrae,as well as lymphadenectasis in both axillary,inguinal and popliteal regions as well as around external iliac vessels.Wholebody bone scan showed abnormalities of bilateral shoulder joints,elbow joints and knee joints,which were suggestive of arthritis.A diagnosis of Schnitzler syndrome was made.The patient was given prednisone 30 mg per day,and body temperature returned to normal with the improvement of condition on the second day.Subsequently,glucoside tripterygium total 20 mg thrice daily was additionally given,and the dose of prednisone was gradually decreased to 15 mg per day,with a satisfactory control of condition,disappearance of fever,skin eruptions or other discomfort,and marked relief of ostalgia and arthralgia.

General practice is the core of primary care, and it has become the fundamental part of some high-valued health care system. The function-orientated definition of primary care comprise of five core attributes, which are first-contact, accessibility, continuity, coordination and comprehensiveness of service. This paper started from the definition of general practice and sought to clarify and summarize the definitions, contents and functions of its five core attributes;meanwhile, the high-performance functional mechanism of health care system was also explored. On this basis, four suggestions are put forward: The basic medical health care system should be renamed primary care system;Five core attributes of primary care should be emphasized when strengthening the primary care system; the primary care system should be improved, and the key points are the number of general practitioners (GPs), payment system, primary care purchasing, educational system of GPs and etc.;The management system and service process should be developed which would benefit the implementation of the core attributes of primary care at an organizational level.

The embryo quality and endometrial receptivity is the two important factors that affects human implantation. Many patients with infertility caused by the disorder of endometrial receptivity fails in embryo implantation. Improving the receptivity of endometrium to improve clinical pregnancy rate has become a hot issue of research in recent years. In this paper, the current use of drugs and surgery on the measures to improve the receptivity of endometrium was summarized, in order to provide references for improving the success rate of assisted reproductive technology.

Objective To evaluate the educational effectiveness of feedback debriefing in clinical training.Methods Forty medical students and fifteen teachers were enrolled in the 2015 after-internship clinical training,which was newly designed to obtain the debriefing part.The test scores and single technical practices were collected and analyzed,before and after the training.DASH scoring system was used to evaluate the effect of debriefing in the team simulation.Results were statistically analyzed by SAS 9.2(SAS institute Inc).Quantitative data were described by x ± s,while qualitative data were described by number and/or constituent ratio.Student's t test and Wilcoxon rank sum test were applied as needed.A P-value ＜ 0.05 was considered to be significant.Results The scores of the students before and after the assessment were (41.88 ± 8.54) vs.(65.06 ± 13.83),and the difference was statistically significant(P=0.000).Individual skills before and after the course had a different degree of improvement.The average DASH-scores evaluated by the students,teachers and supervisors were (39.3 ± 2.12) (very good),(35.1 ± 4.18) (good) and (37.2 ± 3.03)(very good),separately.Conclusions Potent debriefing helps to improve the effectiveness of simulationbased clinical training.

Objective To study the prevention and treatment effect of ω-3 fatty acids on intestinal mucosa in critical illness. Methods Forty patients including severe trauma, infection shock were enrolled as experimental group, while 30 healthy people as control group. At the same time, the patients in expermental group were randomly divided into group A and group B(20 cases each). While the patients were. Treated with low calorie parenteral nutrition totally, those in group A received ω-3 fatty acids additionally. The plasma concentrations of dimnine oxidase (DAO), endotoxin were detected by spectrophotography, and TNF-α was detected by ELISA. Results After treatment the concentration of DAO, endotoxin, TNF-α in group A and that of endotoxin in group B decreased significantly (P<0.05 ). While there was no significant difference of endotoxin levels between group A and group B. After therapy, DAO and TNF-α levels in group A were sig-nificantly lower than those in group B (P<0.05 ). The concentrations of DAO and TNF-α in group B were also significantly higher than those in control group (P<0.05). Conclusion ω-3 fatty acids can prevent and treat critical intestinal mucosa effectively.

Objective:The objective of this study was to evaluate and compare the core attributes of the four general practice models in Guangzhou, Dongguan and Shenzhen, and to provide the suggestions for strengthening the general practice functions. Methods: We used the two stage sampling method in this study. Firstly, three CHCs in Guangzhou, two in Dongguan and two in Shenzhen, and the general medical outpatient department in the Shenzhen Hospital of the University of Hong Kong were selected. Secondly, we used the convenience sam-pling method to perform investigation. A PCAT-AE modified Chinese edition was adapted to measure the patients’ primary care experience. A total of 1 712 patients participated in the questionnaire survey, the number of which 1 645 copies were valid. Results: Generally, the general practice core attributes’ total scores from that hospital were higher than those from Guangzhou communities (55. 3 vs. 45. 9, P<0. 05), Dongguan commu-nities (55. 3 vs. 49. 2, P<0. 05) and the Shenzhen communities (55. 3vs. 51. 7, P<0. 05). Conclusion:The primary care implementation was different in accordance with the characteristics of regions, and the general practice core attributes had different characteristics in different models. It could constantly improve the primary care services to each model’s specific circumstances.

Objective:The general practice attributes constitute a basis for the high primary care performance. In this paper, the general practice attributes are measured, their influencing factors are analyzed, the causes of exist-ing problems are explored, and suggestions are straight forwarded to strengthen the general practice function. Meth-ods:In this study, a PCAT-AE modified Chinese edition was adopted. The research was conducted into 8 community health centers and the general outpatient clinic of the University of Hong Kong, Shenzhen Hospital. They were eligi-ble adult patients who could communicate properly and had visited the same general practitioners at least three times. One-to-one interviews were conducted and a total of 1 712 patients participated in the survey, a number of which 1 645 effective samples were considered for analysis. Results: The total general practice attributes score was 49. 0. The first-contact score of 69 . 8 , continuity score being 63 . 1 and the cultural competence score of 51 . 2 were relatively high. The scores for the access (40. 8) and community orientation (31. 0) were relatively low. The general practice attribute scores were influenced by the social demographic and health characteristics, and the health care service uti-lization. Also, the general practice core attributes were positively related to the patient satisfaction (OR>1). Con-clusion:Comparing to the numbers in the developed countries, the general practice attribute scores were still low in China. Therefore, to strengthen the general practice function, works could be done at the individual, organization and system levels.

Objective To investigate the effects of acyl and deacyl ghrelin on the expressions of PI3Kp85α,Akt/PKB and GLUT4,the key factors in insulin receptor signaling pathway of insulin resistance in skeletal muscle cells.Methods Insulin resistance models were made by palmitic acid induced rat L6 myoblasts.Successful models were divided into acyl ghrelin group,deacyl ghrelin group,PI3K inhibitor(LY) + acyl ghrelin group,LY + deacyl ghrelin group and control group with corresponding interventions for 24h.The glucose uptake of all group was measured through laser confocal microscopy and flow cytometry.Expressions of phosphorated/total PI3Kp85α,phosphorated/total Akt and cell membrane/total GLUT4 of skeletal muscle cells were measured by Western blot,and PI3Kp85α,Akt,GLUT4 mRNA expression were detected by real-time PCR.Results Induced L6 myoblasts differentiation and insulin resistance model were successfully established.Acyl and deacyl ghrelin could increase glucose uptake for 1.25 and 1.28 folds compared to control group,and the phosphorated and total PI3Kp85α expressions were 1.78 and 1.89 folds to control group,and phosphorylated/total Akt and cell membrane/total GLUT4 were 1.84 and 1.80 folds to control group.The PI3Kp85α,Akt/PKB and GLUT4 mRNA expression were also upregulated compared to control group.The above indexes of LY + acyl or deacyl ghrelin group decreased significantly compared to acyl and deacyl ghrelin group without LY.Conclusions Acyl and deacyl ghrelin can both improve insulin resistance in skeletal muscle cells,increasing the glucose uptake under insulin-stimulation,and up-regulated the phosphorated PI3Kp85α,phosphorated Akt/PKB,and cell membrane GLUT4 relative protein expressions and mRNA expressions.PI3K inhibitor,LY294002,can inhibit the above improvement effect of acyl and decyl ghrelin.

Objective To discuss the diagnostic methods and management of ruptured abdominal aortic (aneurysm)(AAA) and to analyse the main factors that influence prognosis.Methods The clinical data of 15 cases of ruptured infrarenal AAA treated in our hospital from 1998~2004 were retrospectively analysed. The main clinical manifestations were abdominal pain and/or back pain,low blood pressure or shock, and (pulsating) abdominal mass. 8 cases were diagnosed by DSA and/or sCTA; Doppler ultrasonic examination (suggested) rupture of abdominal aortic aneurysm in 2 cases; 2 cases had known history of AAA prior to (rupture); and 3 cases were diagnosed during operation. All of the patients underwent surgical operation. (Successful) clamping of the abdominal aorta above the neck of AAA was accomplished in 13 cases. Of these, the aorta was occluded below the diaphragm in 4 cases, and below the renal arteries in 9 cases.Results Seven cases(46.6%) died in the perioperative period. 2 died of blood loss from aneurysm that ruptured into the free abdominal cavity, 1died of myocardial infarction 5 days postoperatively, 2 died of respiratory failure 3 days and 7 days postoperatively, and 2 died of renal failure 4 days and 8 days after operation. Severe (complications) did not develop in the remaining patients.Conclusions Patients who present with the trilogy of abdominal pain and/or back pain, low blood pressure or shock and pulsating abdominal mass can be (diagnosed) easily. CT and Doppler ultrasonic examination are indicated for patients with questionable diagnosis and have stable vital signs. Operation is effective treatment for ruptured AAA. The crux of the operation is to mack an aortic occlusion proximal to the site of rupture of aorta to effectively control bleeding. Patients with rupture of AAA into the free peritoneal cavity or those with acute myocardial infarction, acute renal failure or respiratory complications had poor prognosis.

Polymorphism, Genetic ; Gene Frequency ; China ; Genetics, Population ; Microsatellite Repeats/genetics*