We analyzed the characteristics of postgraduate education in military universities in America and Japan,including idea of education development and system of administration,and drew on the useful experiences in this regard for military universities in China.The topic is practically significant for current reformation and development of postgraduate education in military universities in China.

Continuity of care is one of the core attributes of primary care, which interacts with first-contact, accessibility, coordination and comprehensiveness in a mutual, supportive, and strengthening way to form an interactive mechanism of primary care.This paper first reviews the current literature on definitions and concepts of continuity of care, ascertain the key elements of continuity, and pinpoint the relationship between the dominant and recessive elements.Then, it defines the connotations of continuity of care and their boundaries in the context of primary care, according to the principles of controllability, exhaustion and exclusiveness.Finally it conceptualizes the primary care continuity to lay the foundation for further studies on operationally defining the primary care attributes of general practice.

Accessibility is one of the core attributes of primary care, which is closely associated with first-contact, positively interacts with comprehensiveness, and is very influential to continuity and coordination.This paper first reviews the current literature on definition and concept of accessibility and highlights the characteristics and contents of primary care accessibility, then simplifies the overlapping between accessibility and other core attributes of primary care, and finally provides the definition of primary care accessibility and its core elements to lay the foundation for the development of measurement and evaluation tools for the core attributes of general practice.

Objective To study the benefits and drawbacks of endoscopic thyroidectomy via breast approach by using gasless anterior neck skin lifting method.Methods A total of 21 patients with thyroid diseases were enrolled in this study,including 16 cases of nodular goiter and 5 cases of primary hyperthyroidism.All the cases underwent endoscopic subtotal thyroidectomy through breast approach while the operational space was established by using an abdomen suspending device and 2 Kirschner pins to mechanically suspend and retract the anterior neck skin.Results The endoscopic subtotal thyroidectomy was completed successfully in all of the cases without conversion to open surgery.The mean operation time was 82.5 minutes(ranging from 57 to 125 minutes).Intraoperative blood loss was less than 20 ml.Post-operational recovery was satisfying in all the patients.Drainage volume averaged 80.6 ml(50 to 150 ml).The patients were followed up for 1 to 12 months after the operation,during which no complications occurred.Conclusions Endoscopic thyroidectomy via breast approach using gasless anterior neck skin lifting method is a safe and low-cost procedure.By using the method,CO2 insufflation-related complications can be avoided.Although the operational space established by this method is relatively small,the operation can be completed without much difficulies.

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.

Hyperhomocysteinemia, which is an independent risk factor for atherosclerosis, may cause aberrant methylation and dysregulation of gene expression, but the characteristics of the aberrant methylation and its key links involved in its pathogenic mechanisms are still poorly understood. The effect of hyperhomocysteine on DNA methylation in vascular smooth muscle cells, its characteristics and the underlying mechanism of Hcy-induced changing in DNA methylation patterns were investigated. Clinical relevant concentrations of homocysteine was added into the cultured vascular smooth muscle cells of the Homo sapien umbilical vein for 24 h. The level of SAM and SAH was detected by HPLC. The activity of SAH Hydrolase was detected by real-time quantitative reverse transcription-PCR and Western blotting analysis. The level and patterns of DNA methylation were measured by endogenous C-5 DNA methyltransferase(C-5 MT-ase) activity and capacity of genomic DNA to accept methyl groups and methylation-dependent restriction analysis. The results indicated that an increased Hcy concentration induced elevated SAH, declined SAM and the ratio of SAM/SAH, reduced expression of SAH Hydrolase, but increased activity of C-5MT-ase. The methylation status of gDNA analyzed by methyl-accepting capacity of gDNA uncovered a demethylation process in gDNA, or homocysteine-caused hypomethylation in gDNA.With different methylation-dependent restriction endonucleases, the aberrant demethylation was found to prefer C↓CGG sequences to CpG islands. The impacts of different dosage of Hcy showed that the varied detrimental effects of Hcy could be attributed to different concentrations via different mechanisms. In mild and moderate hyperhomocysteinemia, the Hcy may primarily influence the epigenetic regulation of gene expression through the interference of transferring methyl-group metabolism, while in more higher Hcy concentration, the notorious impacts may be more directly caused via oxidative stress, apoptosis, inflammation etc.

AIM:To observe the effects of gastric bypass surgery on the levels of serum total bile acid in the obese diabetic patients and rats .METHODS: Anthropometric data of obese diabetic patients with gastric bypass surgery from June 2011 to June 2016 were collected in the First Affiliated Hospital of Jinan University .Obese diabetic animal mo-del was established in SD rats by high-fat diet feeding combined with intraperitoneal injection of low-dose streptozocin .Gas-tric bypass surgery or sham operation was performed on the rats with successful modeling .The levels of serum total bile acid were measured by a Hitachi automatic biochemistry analyzer , and the content of hepatic cholesterol 7α-hydroxylase (CYP7A1) was detected by ELISA.The expression of hepatic CYP7A1 and small heterodimer partner (SHP) at mRNA and protein levels was determined by real-time PCR and Western blot, respectively.RESULTS:The serum levels of total bile acid were significantly increased in postoperative obese diabetic patients and rats as compared with control groups .Gas-tric bypass surgery inhibited rat hepatic CYP 7A1 content, mRNA level and protein level , but stimulated hepatic SHP ex-pression.CONCLUSION:Total serum bile acid increases in both patients and rats after gastric bypass surgery by non -typical bile acid synthesis pathway .

Objective To explore the causes and management of postoperative complications of laparoscopic Roux-en-Y gastric bypass (LRYGB).Methods The retrospective cross-sectional study was conducted.The clinical data of 450 patients with metabolic diseases who underwent LRYGB between June 2004 and November 2016 were collected,including 283 (58 in hospital consultation) in the First Affiliated Hospital of Jinan University,140 in the Jihua Hospital Affiliated to Jinan University and 27 in the Zhengzhou Hospital of Jinan University.Observation indicators:situations of surgical completion,follow-up situations,occurrence,treatment and prognosis of complications.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications once at month 1,3,6 and 12 within 1 year postoperatively and once every year after 1 year postoperatively up to March 2017.Measurement data with skewed distribution were described as M (range).Count data were evaluated by the ratio,and comparison between groups was analyzed using the chi-square test.Results All the 450 patients with metabolic diseases underwent successful LRYGB,including 50 receiving LRYGB during surgical internship period and 400 receiving LRYGB after surgical internship period,without conversion to open surgery.All the 450 patients were followed up for 70 months (range,1-153 months).Twenty-seven patients had postoperative complications,with an incidence of 6.00％ (27/450).The incidence of postoperative complications was 20.00％(10/50) in 50 patients receiving LRYGB during surgical internship period and 4.25％ (17/400) in 400 patients receiving LRYGB after surgical internship period,with a statistically significant difference (x2 =16.86,P＜ 0.05).Of 27 patients with postoperative complications,1 was complicated with fulminant acute pancreatitis and died from multiple organ failure at day 15 postoperatively,5 with intra-abdominal bleeding,2 with anastomotic leakage,3 with gastrojejunal anastomosis stenosis,2 with gastrojejunal anastomosis ulcer,1 with improper anastomosis,1 with respiratory failure,1 with umbilicus infection,3 with internal hernia,2 with dumping syndrome,6 with weight-loss failure (1 refused to undergo revision surgery),and patients with postoperative complications were improved or cured by surgery or conservative treatment except one death.Conclusions The incidence of complications in patients receiving LRYGB after surgical internship period is significantly reduced,and complications needs to make the individualized treatment plan.

OBJECTIVETo evaluate the clinical efficacy and safety of three-port transumbilical endoscopic cholecystectomy performed using conventional laparoscopic instruments.

METHODSThirty-two patients undergoing three-port transumbilical endoscopic cholecystectomy using conventional laparoscopic instruments (group A) with 3 ports around the umbilicus were compared with 96 patients (group B) receiving the conventional 4-port routine endoscopic cholecystectomy.

RESULTSAll the procedures were successfully completed without conversion to open laparotomy. In group A, the procedures were completed smoothly in 30 cases while 2 cases required another port (5 mm) punctured below the xyphoid due to severe adhesion around the cyst. The median operating time was 39.7∓5.2 min in group A, significantly longer than that in group B (25.3∓3.3 min, P<0.001), but the patients in group A obtained better cosmetic results (P<0.001); the median blood loss, recovery time of postoperative intestine function, length of postoperative hospital stay, and the rate of use of postoperative painkillers were comparable between the two groups. Bile leakage or other postoperative complications occurred in none of cases in the two groups.

CONCLUSIONIn cases without severe adhesion around the cyst, three-port transumbilical endoscopic cholecystectomy using conventional laparoscopic instruments is a safe and feasible alternative to routine endoscopic cholecystectomy with better cosmetic results.

Adult ; Aged ; Aged, 80 and over ; Cholecystectomy, Laparoscopic ; methods ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Umbilicus ; surgery ; Young Adult