The manuscript introduced the overview, training objectives, policy advantages, training process,curriculum, examination of the Australian College in Rural and Remote Medicine and further contrasted that with China's domestics.The authors held that Australia's training is better targeted due to its colleges tailored to this end;the training duration for general practitioners of rural and remote areas is longer,and the training schedule is reasonable;the curriculum design and training content are more targeted;and the homogeneous training is better achieved as its examination is run by the college in a standardized manner.The authors therefore hold that China should develop detailed regulations for general practitioners from rural and remote areas and explore the feasibility of setting up second-level disciplines institutes for internal medicine, surgery, gynecology and obstetrics, pediatrics and general at national and provincial level.

The benefits of early enteral nutrition (EEN) during critical illness have been widely accepted by global experts. To popularize this new concept and provide standardized, reasonable and effective EEN therapy for critically ill patients in China, more than 20 experts from throughout the country discussed and developed this consensus. We used the GRADE approach for consensus development, focusing on important clinical issues such as nutrition assessment, initiating mode, route selection and tolerance monitoring of EEN support therapy for current critically ill patients. This consensus would be certainly help for intensive care physicians in the clinical application of EEN support therapy for critically ill patients.
China ; Consensus ; Critical Care ; Critical Illness ; Enteral Nutrition ; Humans

Aim To evaluate the protective effects of salvianolic acid B on the ISO-induced myocardial is-chemic injury model of rats and the influence of regula-ting NLRP3 associated protein on myocardial ischemia. Method All rats were randomly divided into control group, model group and Sal B 5, 10, 15 mg · kg-1 groups. For 7 days, rats in Sal B groups were given by introperitoneal injection of 5, 10, 15 mg·kg-1 Sal B, rats in control group and model group were given the same volume of normal saline. Rats were subcutane-ously multi-point injected ISO ( 30 mg · kg-1 ) for 2 days on the fifth administrating day. The myocardial protective effect of Sal B was evaluated from electrocar-diogram( ECG), myocardial tissue pathological chan-ges, serum myocardial enzymes, oxidation index and inflammatory cytokine, myocardial tissue of NLRP3 related protein expression. Results Sal B could re-duce the degree of myocardial tissue necrosis and the infiltration of inflammatory cells, reduce T-wave values of ECG(P<0. 05 or P<0. 01). Compared with model group, CK values, GOT values and IL-1β values of rats in different dose groups were significantly lower, and MDA values and LDH values of rats in middle-and high-dose groups were significantly lower ( P<0. 05 or P<0. 01 ) . However, T-SOD values of rats middle-and high-dose groups were significantly higher ( P <0. 05 or P<0. 01). Meanwhile,the NLRP3, Caspase-1 and IL-1β protein level in myocardial tissue of the rats in different dose groups compared with model group had reduced ( P <0. 05 or P <0. 01 ) . Conclu-sion Sal B has protective effects on myocardial ische-mic rats, its mechanism may be related with inhibition of decreasing the expression of NLRP3 inflammasome associated protein, which can suppress the generation of inflammatory cytokines.

The preliminary metabolic profile of total diterpene acid (TDA) isolated from Pseudolarix kaempferi was investigated by using in vivo and in vitro tests. Pseudolaric acid C2 (PC2) was identified as the predominant metabolite in plasma, urine, bile and feces after both oral and intravenous administrations to rats using HPLC-UV and HPLC-ESI/MS(n), and demethoxydeacetoxypseudolaric acid B (DDPB), a metabolite proposed to be the glucoside of PC2 (PC2G), as well as pseudolaric acid C (PC), pseudolaric acid A (PA), pseudolaric acid A O-beta-D glucopyranoside (PAG), pseudolaric acid B O-beta-D glucopyranoside (PBG) and deacetylpseudolaric acid A (DPA) originated from TDA could also be detected. It was demonstrated by tests that the metabolism of TDA is independent of intestinal microflora, and neither of pepsin and trypsin is in charge of metabolism of TDA, TDA is also stable in both pH environments of gastric tract and intestinal tract. The metabolites of TDA in whole blood in vitro incubation were found to be PC2, DDPB and PC2G, which demonstrated that the metabolic reaction of TDA in vivo is mainly occurred in blood and contributed to be the hydrolysis of plasma esterase to ester bond, as well as the glucosylation reaction. These results clarified the metabolic pathway of TDA for the first time, which is of great significance to the in vivo active form and acting mechanism research of P. kaempferi.
Animals ; Chromatography, High Pressure Liquid ; Diterpenes ; metabolism ; Glucosides ; metabolism ; Hydrolysis ; Mass Spectrometry ; Metabolic Networks and Pathways ; Pinaceae ; chemistry ; Rats

Objective: To observe the characteristics of dynamic changes of lysophosphatidic acid (LPA) levels in cerebrospinal fluid (CSF) in patients with subarachnoid hemorrhage (SAH) and its relationship with cerebral vasospasm (CVS) and to explore the pathogenesis of CVS. Methods: Sixty-seven patients with SAH diagnozed by clinical and accessory examinations were selected. The LPA levels in CSF were measured at 24 hours, day 7,14, and 28 respectively after the onset of symptoms,and they were compared with a control group. The correlation between LPA levels and CVS on the time course was also observed at the same time. Results: Of the 67 patients with SAH, a total of 29 patients (43.3%) occurred CVS, the average time of occurrence was 6. 6 days. There was no significant difference between the LPA levels in CSF in patients with SAH and the control group at 24 hours after the onset of symptoms; they were significantly higher than the control group at day 7 (P ＜0. 001); they were significantly higher than the control group at day 14 (P ＜ 0. 001), but they were significantly lower than those at day 7 (P ＜ 0. 01); they decreased to baseline at day 28, and there was significant difference compared with the control group. There was no significant difference between the LPA levels in the CVS group and those in the non-CVS group at 24 hours, they were significantly higher than those in the non-CVS group at day 7 (P ＜0. 001), they were still significantly higher than those in the non-CVS group at day 14 (P ＜0. 01); and there was no significant difference between the 2 groups at day 28. Conclusions: The LPA levels in CSF in patients with SAH increased significantly from day 7 to day 14 after the onset of symptoms, and they had obvious association with CVS on the time course. The detection of the LPA levels in CSF may have important significance in predicting the occurrence of CVS.

OBJECTIVETo improve the ability of recognizing, diagnosing and treatment for the femoral shaft fractures combined with ipsilateral occult femoral neck fractures, and reduce the rate of loss-diagnosis.

METHODSBy retrospective study of 50 patients who sustained ipsilateral femoral shaft and neck fractures from March 1998 to October 2003, 9 cases were femoral shaft fractures combined ipsilateral femoral neck fractures. The neck fractures were diagnosed separately before, during and after operation. Among the 9 cases, 5 cases treated with reconstructive intramedullary nail to fix both shaft and neck fractures; 3 cases were treated with retrograted intramedullary nail to fix shaft fractures and with canulated screws to fix neck fractures; another one was sustained two operations, after the fixation of shaft by intramedullary nail, the neck fracture was found, the neck fracture was fixed with canulated screws anterior and posterior of the nail.

RESULTSNine cases were followed up for average 20 months. All femoral shaft fractures were united during 6 months; and all neck fractures were united during 3 months.

CONCLUSIONSFemoral shaft fractures combined with ipsilateral occult femoral neck fractures have a high rate of loss-diagnosis during the early stage after injure, the orthopaedic surgeons should consider the femoral neck fracture by analyzing the mechanism of high energy injury patient with femoral shaft fracture. The occult femoral neck fractures can be diagnosed by CT scan before operation. During and after the operation of fixing the femoral shaft fractures, the femoral neck should be observed intensively to identify the exist of fractures.

Adult ; Femoral Fractures ; complications ; diagnostic imaging ; surgery ; Femoral Neck Fractures ; complications ; diagnostic imaging ; surgery ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVETo compare the clinical effect of rotary self-locking intramedullary nail (RSIN) and intramedullary interlocking nail (IIN) for the treatment of fresh femoral shaft fracture.

METHODSThe radiological records of 60 fresh femoral shaft fractures (41 stable fractures and 19 unstable fractures) were retrospectively analyzed. Among them, 49 were male and 11 were female. The average age was 33.5 years old (range from 12 to 68 years old). All cases were fresh fracture with no important blood vessel or nerve injury, which were taken operation with RSIN on IIN respectively in 2 h-7 d after injury. The patients in IIN group began functional movements at postoperative 4 to 5 days and could bear the weight of 10-15 kg. The patients in RSIN group could began functional exercises after the wound healed and bear partly weight after 6 weeks. Both groups were contrasted on the biomechanics, operation procedure, fracture healing time, functional recovery and operative indication.

RESULTSBoth groups were followed-up for average 13 months. IIN group: the average healing time of closed femur fracture was 16 weeks while that of open fracture was 20 weeks. The healing rate was 100% and the malunion rate was 7.9%. The excellent and good rate of functional recovery was 93.3% including excellent in 27 cases, good in 1, fair in 1 and bad in 1. RSIN group: the average healing time of closed femur fracture was 16 weeks while open fracture was 23 weeks. The healing rate was 87% and the malunion rate was 18.2%. The excellent and good rate of functional recovery was 83.3% including excellent in 23 cases, good in 2, fair in 3 and bad in 2. No implant break and nonunion happened. The differences between two groups in healing time, deformity-union rate and the rate of the twice operation were statistically significant.

CONCLUSIONIIN provides a reliable and practical alternative method for the treatment of all kinds of femoral shaft fracture and its important complication is fewer than RSIN group. RSIN also has a good curative effect in its own indication.

Adolescent ; Adult ; Aged ; Bone Nails ; Female ; Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; methods ; Fracture Healing ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Objective: This study compared the outcomes of single blastocyst transfer cycles, using day- 5 poor-quality blastocysts and day-6 high-quality blastocysts. Methods: We analyzed 462 frozen-thawed embryo transfer (FET) cycles performed at our center from January 2014 to December 2019. The cycles were divided into two groups: a day-5 poor-quality blastocyst transfer group (group A) and a day-6 high-quality blastocyst transfer group (group B). The clinical outcomes were tested. Results: In groups A and B, respectively, the clinical pregnancy rate (CPR; 61.65% vs. 67.17%, p=0.258), implantation rate (IR; 61.65% vs. 67.17%, p=0.258), and live birth rate (LBR; 69.51% vs. 77.83%, p=0.134) showed no significant differences. Moreover, when day-3 embryo quality was considered, the CPR, IR, and LBR were also similar in group A and group B (p>0.05). Conclusion The clinical outcomes of day-5 poor-quality blastocysts and day-6 high-quality blastocysts were similar, suggesting that the developmental speed of the embryo might be more important than embryo quality for the clinical outcomes of single blastocyst transfer in FET cycles.

OBJECTIVETo evaluate the clinical effect of surgical resection of the severe heterotopic ossification (HO) after the open reduction internal fixation (ORIF) of acetabular fractures.

METHODSFive cases of severe HO after the ORIF of acetabular fractures were treated by surgical resection from October 2005 to April 2007. All patients were male, the average age was 34 years (22 to 45 years). The average time of HO after ORIF of acetabular fractures was 14.2 months (3 to 30 months). The original surgical approaches were: Kocher-Langenbeck approach as 4, ilioinguinal combined K-L approach as 1. According to the Brooker classification, there were 4 patients with IV degree and 1 with III degree. The average total movement for all the 5 patients was 8 degrees. All patients received one time radiation therapy before or after operation, the dosage was 7-8 Gy. The surgical approach was Kocher-Langenbeck for all patients. During operation the nerve stimulator was used to explore the sciatic nerve and carefully protected it, resected all HO bone and removed all implants. For one patient, because of confusion between femoral head and acetabulum, total hip replacement were performed. The joint exercise (passively and actively) began from the second day after operation, and at the same time, all patients took the indomethacin to prevent the occurrence of HO.

RESULTSAll patients were followed up for 4 to 22 months. There was no recurrence of HO, the average total movement for all the 5 patients was 160 degrees.

CONCLUSIONEarly surgical resection and combined with radiation and indomethacin for the severe HO after the ORIF of acetabular fractures can obtain excellent results.

Acetabulum ; injuries ; Adult ; Follow-Up Studies ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Ossification, Heterotopic ; etiology ; surgery ; Postoperative Complications ; surgery ; Treatment Outcome

BACKGROUNDGlycemic control prevents onset and progression of diabetes-related long-term complications. The objective of this study was to demonstrate that twice daily insulin lispro low mix 25 is noninferior to twice daily human insulin mix 30/70 in achieving glycemic control as measured by hemoglobin A1c (HbA1c), from baseline to endpoint, in patients with type 1 or 2 diabetes.

METHODSIn this phase IV, crossover, open-label, multicenter study, 117 Chinese patients with diabetes were randomly assigned to one of two treatment sequence groups. One group received 12-week treatment with twice daily human insulin mix 30/70 followed by 12-week treatment with twice daily insulin lispro low mix 25, while the other group received the reverse treatment sequence. HbA1c, baseline-to-endpoint change in HbA1c, proportion of patients achieving target HbA1c

RESULTSA statistically significant reduction (P -0.3%). No statistically significant differences between treatments were observed for any of the secondary efficacy measures. The incidence of treatment-emergent adverse events and hypoglycemia between the two treatments and treatment sequence groups was similar. Three serious adverse events were reported (human insulin mix 30/70 group: 2 patients (1.7%, hypoglycemic coma and cardiac failure); insulin lispro low mix 25 group: 1 patient (0.9%, stroke)). All serious adverse events were resolved and no patients died during the study.

CONCLUSIONThe results support noninferiority of twice daily insulin lispro low mix 25 versus twice daily human insulin mix 30/70 in HbA1c control in Chinese patients with type 1 or 2 diabetes.

Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Diabetes Mellitus, Type 1 ; drug therapy ; metabolism ; Diabetes Mellitus, Type 2 ; drug therapy ; metabolism ; Drug Administration Schedule ; Female ; Glycated Hemoglobin A ; metabolism ; Humans ; Hypoglycemic Agents ; administration & dosage ; Insulin ; administration & dosage ; analogs & derivatives ; Insulin Lispro ; Male ; Middle Aged ; Young Adult