An analysis of the present development of general practitioners in China,probed into the bottlenecks found.The paper proposed to set forth from the training,use and incentives of GPs to promote the systematic design of China's GP system.These measures center on the regulation of GPs development,while building a multi-channel and multi-level GP development system.Other recommendations include raising the professional standing and attractiveness of GPs as a discipline,and enhancing GPs capacity building to promote general practitioners development.

AIM: To elucidate the effects of platelet-activating factor (PAF) on eosinophil activation and the action of dexamethasone or theophylline during this process. METHODS: Eosinophils (EOS) from the peripheral blood of normal subjects were isolated. The hypodense eosinopil (HE) and normodense eosinophil (NE) were studied with electron microscopy. The effects of PAF on eosinophil activation and the action of dexamethasone or theophylline during the above process were measured. RESULTS: Hypodense eosinophil had significantly smaller individual granules than normodense eosinophil had. PAF induced eosinophil peroxidase release, and generated. Eosinophils incubated with 10~(-8) mmol/L PAF and 10~(-5) mmol/L dexamethasone released (101.17?10.32) mg/L eosinophil peroxidase (P

Objective To explore the fixation method of tibial helical plate for treatment of proximal and middle one-third of humeral fractures and evaluate the clinical outcome. Methods A review was performed on 15 patients with proximal and middle one-third of humeral fractures treated by tibial helical plate from May 2004 to February 2009. There were 10 males and five females, at age range of 19-65 years ( average 38.0 years). The surgical method was summarized and the shoulder function evaluated.Results The follow-up lasted for 7-24 months (mean 13 months) , which showed bony union in all patients, with mean union time of 4.7 months. There was no implant loosening or failure. According to Neer 's criteria, the result was excellent in seven patients and good in six, with excellence rate of 86.7%.Conclusions Open reduction and internal fixation using tibial helical plate is simple and effective for treatment of proximal and middle one-third of humeral fractures.

Objective To investigate the role of microRNA-490-5p (miR-490-5p) in the regulation of visceral sensitivity in rats with intestinal dysfunction.Methods The lentivirus vector system was used to construct the rno-miRNA-490-5p lentivirus expression vector.The rats were divided into normal group,diarrhea-predominant irritable bowel syndrome (IBS-D) group,lentivirus empty vector group and the siRNA silent group and the latter three groups were model groups.The efficiency of siRNA was measured by real-time polymerase chain reaction (PCR).The rats were gavaged with 10％ India ink,and then the time of first black stool,water content of feces and threshold of expansion capacity caused abdominal elevation or back arching were calculated.The visceral sensitivity of rats after miRNA-490-5p silenced was evaluated with abdominal withdrawal reflex (AWR) score by stimulating with different intensities of colonic dilatation.The abdominal electrical activity of rats stimulated by colonic distension was measured by BL-420F biological and functional experimental system.The change of the tension of rats isolated colon intestinal stimulated with acetylcholine chloride was also detected by BL-420F biological and functional experimental system.T test was used to compare the differences between the model groups and the normal group.One way analysis of variance was performed for multi-group comparison after miRNA-490-5p interfered.For comparison between two groups among multiple groups,least significant difference (LSD) method was used when the variance was equal,and Games-Howell method was used when the variance was unequal.Results The gastrointestinal propulsion time and the threshold of expansion capacity caused abdominal elevation or back arching of model groups were both lower than those of the normal group ((8.54±4.07) hvs (12.33±2.23) h,(0.56±0.08) mL vs (0.84±0.09) mL),and the differences were statistically significant (t =2.62 and 6.37,both P ＜ 0.05).After distension with 0.8 mL and 1.2 mL sodium chloride solution,the AWR scores of model groups were significantly higher than those of the normal group (3.20±0.56 vs 1.20±0.45,3.73±0.46 vs 2.60±0.55),and the differences were statistically significant (t=7.20 and 4.58,both P＜0.01).There was no significant difference in AWR score between the model groups and the normal group when distended with 1.6 mL sodium chloride solution (3.93 ±0.26 vs 3.80 ± 0.45) (P＞0.05).After miRNA-490-5p silenced,gastrointestinal propulsion time of normal group,IBS-D group,lentivirus empty vector group and the siRNA silent group was (11.12±1.01) h,(6.23±3.17) h,(6.09 ± 2.26) h and (12.36±1.97) h,and the differences among four groups were statistically significant (F=10.55,P＜0.01).The abdominal electrical activity of normal group,IBS-D group,lentivirus empty vector group and the siRNA silent group distension stimulated with 0.8 mL and 1.2 mL sodium chloride solution was (64.91 ± 10.50),(101.79 ±11.73),(80.49±1.27),(66.92±3.24) μV,and (105.09±52.40),(131.71± 16.74),(111.00±6.41) and (95.49± 4.2) μV,and the differences among four groups were statistically significant (F=16.82 and 9.14,both P＜0.05).There was no significant difference in abdominal electrical activity amplitude between silenced group and normal group ((66.92±3.24) μV vs (64.91±10.49) μV and (95.49±4.22) μV vs (105.09±2.40) μV) (all P＞ 0.05).After distension with 1.6 mL sodium chloride solution,the abdominal electrical activity amplitudeof silenced group was lower than the other groups,and the differences were statistically significant (F=11.09,P＜0.01).After adding 1∶1 000 acetylcholine chloride added,the tension of colon of normal group,IBS-D group,lentivirus empty vector group and the siRNA silent group increased by 0.71 ± 0.21,0.81±0.06,0.88±0.21 and 0.43±0.07,however there was no significant difference among the four groups (F=2.57,P =0.100).Conclusions Visceral hypersensitivity existed in rats with intestinal dysfunction.miRNA-490-5p may be involved in the regulation of visceral sensitivity.

Objective To explore the clinical effect of IFN combined with adefovir dipivoxil in the treatment of patients with the hepatitis B and hepatitis C overlapping infection.Methods 90 cases of hepatitis B overlapping infection of hepatitis C were divided into control group(n =43) and treatment group(n =47).The control group was treated with IFN,the treatment group was treated with IFN and adefovir dipivoxil.Results The treatment group was better than the control group in the liver function,HBV DNA,HCV RNA.At the 24th weeks,the negative rates of HBV DNA and HCV RNA in the control group were 14 (32.6%) and 18 (41.9%),while there were were 38 (80.9%) and 34(72.3%) in the treatment group.There was significant differences between the two groups(x2 =6.43,5.28,all P ＜ 0.05).Conclusion The clinical efficacy of IFN combined with adefovir dipivoxil for the hepatitis B and hepatitis C overlapping infection patients was significant better than IFN,which is worthy of clinical application.

Objective Atrioventricular block (AVB) is a common and serious arrhythmia. At present, there is no perfect method of treatment for this kind of arrhythmia. The purpose of this study was to regenerate cardiac atrioventricular conduction by autologous transplantation of bone marrow mesenchymal stem cells (MSCs), and explore new methods for therapy of atrioventricular block. Methods Eleven Mongrel canines were randomized to MSCs transplantation (n=6) or control (n=5) group. The models of permanent and complete AVB in 11 canines were established by ablating His bundle with radiofrequency technique. At 4 weeks after AVB, bone marrow was aspirated from the iliac crest. MSCs were isolated and culture-expanded by means of gradient centrifugal and adherence to growth technique, and differentiated by 5-azacytidine in vitro. Differentiated MSCs (1ml, 1.5×107cells) labeled with BrdU were autotransplanted into His bundle area of canines by direct injection in the experimental group, and 1ml DMEM in the control group. At 1-12 weeks after operation,the effects of autologous MSCs transplantation on AVB models were evaluated by electrocardiogram, pathologic and immunohistochemical staining technique. Results Compared with the control group, there was a distinct improvement in atrioventricular conduction function in the experimental group. MSCs transplanted in His bundle were differentiated into analogous conduction system cells and endothelial cells in vivo, and established gap junction with host cardiomyocytes. Conclusions The committed-induced MSCs transplanted into His bundle area could differentiate into analogous conduction system cells and improve His conduction function in canine AVB models.

AIM: To observe the protein expression of vascular endothelial growth factor 1 (VEGF-1) in pulmonary arterial endothelial cells and VEGF-1 gene expression in lung tissue in rats with hypoxia-induced pulmonary hypertension and treated with heparin. METHODS: Twenty four male adult SD rats were randomly divided into three groups (8 rats each): a control group (group A), a group with hypoxia for 4 weeks (group B) and a group with hypoxia for 4 weeks and injected with heparin to abdominal cavity simultaneously (group C). Mean pulmonary arterial pressure (mPAP), right ventricle hypertrophy index (RVHI) and vessel morphometry were measured. The morphology of pulmonary artery was observed by HE staining. The expression of VEGF-1 protein in pulmonary arterial endothelial cells was determined by immunohistochemistry. The level of VEGF-1 mRNA in lung tissue was measured by reverse transcription polymerase chain reaction (RT-PCR). RESULTS: mPAP, RVHI, pulmonary artery remodeling parameters, VEGF-1 protein expression in pulmonary arterial endothelial cells and VEGF-1 gene expression in lung tissue of the three groups from high to low were group B, group C and group A. It was statistically significant when compared between either two groups of the three (P<0.01). Linear correlation analysis showed that VEGF-1 protein was positively correlated with pulmonary artery remodeling parameters (r=0.974, P<0.01), and VEGF-1 mRNA was positively correlated with VEGF-1 protein (VEGF 120 mRNA, r=0.919, P<0.01; VEGF164 mRNA, r=0.896, P<0.01). CONCLUSION: Heparin may down-regulate the expression of VEGF-1 at the levels of transcription and translation, resulting in the inhibitory effect on rats with hypoxia-induced pulmonary hypertension.

Objective To evaluate the dual blood supply of lung adenocarcinoma and squamous cell carcinoma using dualinput perfusion CT.Methods A total of 40 patients confirmed with lung cancer pathologically underwent CT perfusion (CTP) scanning.The pulmonary flow (PF),bronchial flow (BF),perfusion index (PI,PI=PF/[PF+BF])and tumor volume,location were measured and recorded by 2 experienced radiologists.The differences in CTP parameters between lung adenocarcinomas and squamous cell carcinomas,the central lung cancers and peripheral lung cancers were analyzed.The correlation between the tumor volume and CTP parameters was analyzed.Interobserver agreements were assessed with intraclass correlation coefficient (ICC).Results The average of PF,BF and PI of all 40 cases was (54.26± 21.07)ml/ (min · 100 ml),(64.41±22.06)ml/(min · 100 ml) and (43.38±16.07)％,respectively.Tumor histology was consistent with adenocarcinomas in 23 cases and squamous cell carcinomas in 17 cases,lung adenocarcinomas showed lower PI than that of squamous cell carcinomas (t=-2.196,P=0.034).There were 17 peripheral lung cancers and 23 central lung cancers,and the PI of the peripheral lung cancers was higher than that of the central lung cancer (t=2.305,P=0.027).No statistically significant differences were found for BF and PF between two types of lung cancers and central lung cancers and the peripheral cancers (all P＞0.05).Tumor volume was negatively associated with PI (r =-0.39,P=0.01).Good agreement was found between the two observers,the ICC for BF,PF and PI was 0.97,0.93 and 0.91,respectively.Conclusion Dual-input CTP technique can be used to evaluate the differences of blood supply between different pathological types and locations of lung cancer,with PI depending both on tumor size and location.

Group A β-hemolytic streptococcus (GAS),namely Streptococcus pyogenes,is one of the most im-portant human pathogen.GAS can cause skin and mucous membrane superficial infectious diseases,life -threatening invasive disease,toxin -mediated diseases and immune -related diseases.Antibiotic is an effective mean to control GAS infection.The β-lactam antibiotics remain the first -choice treatment for GAS infection and the macrolides are often recommended as a replacement therapy for β-lactam antibiotics allergic patients or a means to blocking GAS exotoxin product.But with the widespread use of macrolides autibiotics,macrolide -resistant GAS spread in the world. This paper will elaborate the situation of macrolide -resistant clones.

Objective To compare everolimus (EVR) with calcineurin inhibitor (CNI) minimization or withdrawal on renal function of liver transplant patients with standard CNI therapy.Methods A search was conducted on databases which included the PubMed,Embase and Cochrane library for randomized controlled trials (RCTs) comparing EVR with CNI with minimization or withdrawal (the EVR group) with standard CNI therapy (the standard CNIs group) on renal function of liver transplant patients.A metaanalysis was performed using RevMan 5.3 software.Results Five RCTs which included 1 264 patients were selected into this study.There were 790 patients in the EVR group and 474 patients in the standard CNIs group.On meta-analysis,the EVR group had significantly better renal function (SMD =0.36,95％ CI 0.09 ～ 0.64,P ＜ 0.05),but higher rates of infection (RR =1.37,95％ CI 1.08 ～ 1.74,P ＜ 0.05),dyslipidemia (RR =2.46,95％ CI 1.79 ～ 3.38) and leukopenia (RR =2.37,95％ CI 1.32 ～ 4.26).No significant differences were found on the mortality and the acute rejection rates between the two groups (all P ＜ 0.05).Conclusions EVR with CNI minimization or withdrawal after liver transplantation provided effective immunosuppression and improved patients' renal function.The treatment increased the rates of infection,dyslipidemia and leukopenia.