By questionnaire we conducted a cluster sampling survey on 150 general practice meutors in Zhejiang province who completed training program during November 2011 to May 2013.By using Kirkpatrick's four level evaluation methods,we evaluated the training program based on the response level,learning level and behavior level.A total of 141 valid questionnaires were collected.The results showed that 92.2％ of participants (130/141) were satisfied with the training contents,94.3％ (133/141) were satisfied with the teachers,87.9％ (124/141) were satisfied with the training environment,83.7％ (118/141) thought the training contents useful,and 89.4％ (126/141) were satisfied with the training organization.Only 31.2％ (44/141) of participants mastered the knowledge and skills of general practice before training,and the figure increased to 87.2％ (123/141) after training.The results also showed that 67.3％ (95/141) of participants were able to use the knowledge acquired in the training,and 81.6％ (115/141) of them were able to apply the concept of general practice in their teaching practice.These results indicate that general practice mentors are satisfied with the training in the aspects of response,learning and behavior,aud the training program would play a positive role in promoting their performance in teaching practice.

BACKGROUNDIntensive insulin therapy has been found to lessen the progress of diabetic retinopathy (DR) to some extent, while it has also been implicated to be responsible for decrease of DR. We investigated visual function and morphological changes in the macular area in short-term follow-up of patients with type 2 diabetes mellitus after intensive insulin therapy.

METHODSThis was a prospective clinical study of nonproliferative DR patients (102 eyes, 120 patients) undergoing intensive insulin therapy. The Contrast Glare Tester (Takagi CGT-1000) was used to examine contrast sensitivity (CS) and Heidelberg Retina Tomograph (HRT) II and Stratus Model 3000 OCT were used to observe the changes of morphology in the macular area. Follow-up times were pre-intensive therapy, 3 and 6 months post-intensive therapy.

RESULTSCS at low and middle frequencies was higher at 3 and 6 months post-therapy compared with pre-therapy (P < 0.05). Significant differences in CS at low frequency were found between 6 and 3 months post-therapy (P < 0.05). Macular edema index was lower in the first, second, and third rings of the macular area after intensive therapy compared with pre-therapy (P < 0.05). Compared with 3 months post-therapy, the macular edema index was lower in the first, second, and third rings of the macular area at 6 months post-therapy (P > 0.05). No significant differences in the thickness of the first, second, and third rings of the macular area were detected between 3 and 6 months post-therapy and pre-therapy (P > 0.05).

CONCLUSIONCS and macular edema indexes were significantly improved in nonproliferative diabetic retinopathy patients after intensive insulin therapy, but thickness of the macular area was unchanged.

Diabetes Mellitus, Type 2 ; drug therapy ; pathology ; physiopathology ; Follow-Up Studies ; Humans ; Insulin ; therapeutic use ; Macula Lutea ; pathology ; Middle Aged ; Prospective Studies ; Tomography, Optical Coherence ; Vision, Ocular ; physiology

OBJECTIVETo evaluate the effect of the compound of Dan-shen root and azone for scar treatment.

METHODSThe rat skin in vitro and the human skin in vitro and vivo were separately examined their permeability of the mixture of the Dan-shen root and azone. The 301 patients with hypertrophic scar were randomly divided into two groups: one treated with elastic cloth paste (including silicone) contained in Dan-shen root with azone, and the another treated with only elastic cloth paste (including silicone).

RESULTSThe permeability of Dan-shen root with azone, passing through the rat skin in vitro and the human skin in vitro and vivo was significantly higher than both the distilled water and the normal saline (P < 0.05). In the clinical study for treatment of the hypertrophic scars, the efficient rate of the group with the Dan-shen root with azone was significantly higher than the control (91.4% vs. 71.3%) (P < 0.01).

CONCLUSIONThe Dan-shen root with azone could be easier to permeate the skin and more effective to treat the hypertrophic scar.

Adolescent ; Adult ; Aged ; Animals ; Azepines ; pharmacology ; Child ; Child, Preschool ; Cicatrix ; drug therapy ; Drugs, Chinese Herbal ; pharmacology ; Female ; Fibrinolytic Agents ; pharmacology ; Humans ; Male ; Middle Aged ; Phenanthrolines ; pharmacology ; Phytotherapy ; Rats ; Skin ; drug effects ; pathology ; Treatment Outcome

OBJECTIVE: To explore the clinical characteristics and genetic etiology of a consanguineous Chinese pedigree affected with Congenital coagulation factor XII (XII) deficiency. METHODS: Members of the pedigree who had visited Ruian People's Hospital on July 12, 2021 were selected as the study subjects. Clinical data of the pedigree were reviewed. Peripheral venous blood samples were taken from the subjects. Blood coagulation index and genetic testing were carried out. Candidate variant was verified by Sanger sequencing and bioinformatic analysis. RESULTS: This pedigree has comprised 6 individuals from 3 generations, including the proband, his father, mother, wife, sister and son. The proband was a 51-year-old male with kidney stones. Blood coagulation test showed that his activated partial thromboplastin time (APTT) was significantly prolonged, whilst the FXII activity (FXII:C) and FXII antigen (FXII:Ag) were extremely reduced. The FXII:C and FXII:Ag of proband's father, mother, sister and son have all reduced to about half of the lower limit of reference range. Genetic testing revealed that the proband has harbored homozygous missense variant of c.1A>G (p.Arg2Tyr) of the start codon in exon 1 of the F12 gene. Sanger sequencing confirmed that his father, mother, sister and son were all heterozygous for the variant, whilst his wife was of the wild type. By bioinformatic analysis, the variant has not been included in the HGMD database. Prediction with SIFT online software suggested the variant is harmful. Simulation with Swiss-Pbd Viewer v4.0.1 software suggested that the variant has a great impact on the structure of FXII protein. Based on the Standards and Guidelines for the Interpretation of Sequence Variants: A Joint Consensus Recommendation of the American College of Medical Genetics and Genomics (ACMG), the variant was rated as likely pathogenic. CONCLUSION The c.1A>G (p.Arg2Tyr) variant of the F12 gene probably underlay the Congenital FXII deficiency in this pedigree. Above finding has further expanded the spectrum of F12 gene variants and provided a reference for clinical diagnosis and genetic counseling for this pedigree.
Male ; Female ; Humans ; Middle Aged ; Factor XII/genetics* ; Pedigree ; Codon, Initiator ; East Asian People ; Mothers ; Factor XII Deficiency/genetics* ; Mutation

The individual intervention control of risk factors in high-risk population is one of key preventive measures of chronic disease.A total of 312 volunteers consulted physicians in one selected community.And 23 high-risk individuals of chronic disease were screened.The physicians customized the limit or requirement of diet,activity,tobacco and alcohol for each individual and made interventions of life behaviors according to the plans.The results showed that physical state of 20 (87％) of them converted from high-risk to health after interventions.Therefore customized control plan of individual risk factors is an effective control method of chronic disease.

Human tissue kallikrein-binding protein (Kallistatin, KAL), a secretory protein that participates in the regulation of multiple signaling pathways by binding to the extracellular receptor, however, at present has not been reported about the intracellular activity, and whether it has the similar biological activity with extracellular activity. Here we constructed no signal peptide KAL (NSK) into the adeno-associated virus vector to explore the intracellular activity of KAL. Both the endothelial cell and lung cancer cells could express KAL, but not secreted after rAAV2-NSK transfection. The proliferation and migration of human umbilical vein endothelial cells (HUVECs) were inhibited, but the apoptosis rate was not affected. The proliferation rates, mobility and tubule formation of all the three tested lung cancer cells, such as NCI-H446, NCI-H460 and A549, were inhibited to different extents. This cellular study not only confirmed the intracellular activity, but also suggested it may serve as a kind of "balance factor" in multi-targeted controlling, which may provide a new train of thoughts to explain the regulatory contradiction in PI3K-Akt signaling pathways by KAL.

ObjectiveTo understand the epidemiological characteristics of syphilis in Ruian City, so as to provide a scientific basis for developing syphilis prevention and control strategies. MethodsDescriptive epidemiological methods were used to investigate the infection status of syphilis cases reported among the permanent resident population in Ruian City from 2014 to 2023, and its epidemiological characteristics were analyzed. ResultsA total of 5 482 syphilis cases were reported in Ruian from 2014 to 2023, with a male-female ratio of 1∶1.47. The average annual incidence rate from 2014 to 2023 was 37.51/100 000, with a declining trend in the incidence rate among females (APC=-4.78%, P<0.05). The incidence of primary and secondary syphilis decreased, while the proportion of latent syphilis cases increased. No cases of congenital syphilis were reported from 2017 to 2023. The majority of cases (60.29%) were reported among individuals aged 20‒<50 years. In terms of occupation, the highest proportion was found among housekeepers and the unemployed, constituting 42.70% the total cases. Dermatology departments reported the most cases in medical institutions, accounting for 33.38% of the total cases. The most likely route of infection was heterosexual transmission, accounting for 85.84%. ConclusionThe incidence of syphilis among females in Ruian City shows a declining trend, but the overall situation remains concerning. Prevention and control efforts should be intensified among key groups and high-risk populations, along with an enhancement on health education to curb the spread of syphilis.

OBJECTIVETo study the risk factors of perioperative heart failure in the elderly patients with femoral shaft fracture by the regression analysis, so as to provide relevant clinical reference.

METHODSFrom July 2012 to April 2017, 143 elderly patients with femoral shaft fracture who underwent surgical treatment in our hospital were retrospectively studied. Among them, 25 patients with perioperative heart failure included 10 males and 15 females with a mean age of (77.2±12.5) years old; 118 patients without heart failure included 54 males and 64 females with a mean age of (71.1±10.6) years old. The data of the time from injury to operation, hypertension history, heart disease history, disturbance of consciousness, preoperative renal function, operation method, operation time, anesthesia mode, perioperative fluid volume difference, perioperative pain score, postoperative hemoglobin were collected and recorded. The various factors of the two groups were compared, and a multiple factor Logistic regression analysis was performed on the meaningful results in order to identify the independent risk factors.

RESULTSUnivariate analysis showed that age, heart disease history, preoperative renal function and perioperative fluid volume had statistical difference between the two groups(<0.05). Multivariate analysis showed that the independent risk factors of perioperative heart failure were age[=0.016,=2.789(1.208, 6.439)], heart disease history[=0.011,=2.878(1.269, 6.527)], preoperative renal function[=0.043,=2.410(1.027, 5.654)], the perioperative fluid volume difference[=0.022,=4.215(1.230, 14.439)].

CONCLUSIONSThe age, heart disease history, preoperative renal function and perioperative fluid balance are the risk factors of perioperative heart failure in elderly patients with femoral fracture. During the perioperative period, we should pay full attention to and evaluate the hazards of these risk factors and adopt effective and effective prevention and treatment measures.

OBJECTIVETo evaluate the effectiveness and safety of hydroxyethyl starch (HES 130/ 0.4, 60 g/L) in resuscitation during shock stage of burns.

METHODSSixty-six burn patients who were admitted to hospital within 2 hours after burn injury requiring fluid resuscitation were enrolled into this study, and they were randomized into HES( n = 33, with HES as a component of fluid resuscitation) and plasma (P, n = 33, with plasma as a component of fluid resuscitation) groups. HES or plasma was given as colloid within 48 postburn hours (PBH), and only albumin [( 111 +/- 4) , ( 105 +/- 5 ) g for each group] were given to the patients during 3 to 7 postburn days (PBD). Heart rate, blood pressure, central venous pressure (CVP) , urine output per hour were measured, gain/loss of body fluid during the first and second 24 PBH were recorded, serum total protein, albumin, hemoglobin( Hb) , prothrombin time (PT) , fibrinogen; platelet ( PLT) , as well as liver and renal function, allergy and bleeding tendency were determined and observed at corresponding time-points.

RESULTSThere were no obvious differences in heart rate, blood pressure, CVP and urine output per hour within 24 PBH between the two groups (P > 0.05). Also there was no difference in gain/loss of body fluid during the first and second 24 PBH. The content of hemoglobin on 1 ,3, 7,14 PBD ,and the PT, the content of fibrinogen, the number of PLT on 1,3,14 PBD also exhibited no difference between the two groups (P > 0.05). The serum contents of total protein and albumin in HES group were [(31 +/- 3) g/L, (30 +/- 3)g/L ] on 1 PBD, and [(20.4 +/- 3.6) g/L, (18.4 +/-2.3) g/L] on 3 PBD, which were obviously lower than those in P group [(45 +/- 4) g/L, (39 +/- 3) g/L on 1 PBD, and 1 (24.5 +/- 4.3) g/L, (21.3 +/- 3.9) g/L) on 3 PBD, (P <0. 01). Though the serum content of albumin on 7 PBD was similar in the two groups (P > 0.05), the serum total protein in HES group (40 +/- 4) g/L was markedly lower than that in P group [(45 +/- 4) g/L, P < 0.01] . Within 7 PBD, no abnormal bleeding was found in the two groups, and the liver function and renal function were similar. There were 4 cases showing allergic reaction in plasma group while none in HES group.

CONCLUSIONNew type of HES can partially substitute plasma and be used in fluid resuscitation for burn patients. However, plasma protein replenishment should still be emphasized.

Adult ; Burns ; therapy ; Female ; Humans ; Hydroxyethyl Starch Derivatives ; therapeutic use ; Male ; Middle Aged ; Resuscitation ; methods ; Shock ; therapy

OBJECTIVETo explore the influence of silver nanoparticle dressing on prevention of infection and healing of the second degree burn wound.

METHODSOne hundred and ninety-one burn patients with second degree including superficial and deep burn wound were randomly divided into three groups. Group A including 65 cases was treated by silver nanoparticle dressing on wounds, and group B (63 cases) and group C (63 cases) were treated by 1% silver sulfadiazine cream and vaseline gauze on their wounds, respectively. Dressing was changed daily, and wound swab bacterial cultures were performed before and after dressing change, and also wound healing times were recorded in each patient.

RESULTSGroup A and B were similar in their bacterium colonizations on wound after treatment with the silver nanoparticle dressing and 1% silver sulfadiazine cream, and they had a similar effect on reducing bacterium colonization on wound after treatment, while in vaseline gauze group bacterium colonization on wound increased after treatment. In group A the wound healing time of superficial second degree was significantly shorter than those in group B and group C (P < 0.01). In deep second degree wounds the healing time in group A was much shorter than that in group C (P < 0.01), but had no significant difference when compared with group B (P > 0.05).

CONCLUSIONSilver nanoparticle dressing can be used on second degree burn wound and can decrease the risk of wound infection and accelerate wound healing.

Adult ; Anti-Infective Agents, Local ; therapeutic use ; Bandages ; Burns ; therapy ; Female ; Humans ; Male ; Particle Size ; Petrolatum ; therapeutic use ; Silver ; therapeutic use ; Silver Sulfadiazine ; therapeutic use ; Surgical Sponges ; Wound Healing ; drug effects ; Wound Infection ; prevention & control