Adult ; China ; Female ; Humans ; Logistic Models ; Male ; Occupational Health ; statistics & numerical data ; Transients and Migrants ; Young Adult

Objective To investigate whether inhibiting the expression of typeⅠ collagen gene is one of the mechanisms of action of electroacupuncture in improving knee osteoarthritis.Methods Forty male adult SD rats were randomized into normal, model, medication and electroacupuncture group, 10 rats each. A rat model of MIA-induced knee osteoarthritis was made by injecting monomer sodium iodoacetate (MIA) and driving rat movement. After model making, the medication group received an oral gavage of celecoxib dissolved in 10% DMSO and the electroacupuncture group, electroacupuncture at points Zusanli and Yanglingquan. Pain thresholds and the levels of cartilage expression of typeⅠ collagen mRNA were compared between various groups of rats before and after treatment.Results There was a statistically significant difference in pain threshold between the model, medication or electroacupuncture group of rats and the normal group after model making (P<0.01) and between the medication or electroacupuncture group of rats and the model group before sacrifice (P<0.01). There was no statistically significant difference in pain threshold between the medication and andelectroacupuncture groups of rats before sacrifice (P>0.05). There was a statistically significant difference in the expression of typeⅠ collagen mRNA between the model, medication or electroacupuncture group of rats and the normal group (P<0.01) and between the medication or electroacupuncture group of rats and the model group before sacrifice (P<0.01). There was no statistically significant difference in the expression of typeⅠ collagen mRNA between the electroacupuncture and medication groups of rats before sacrifice (P>0.05).Conclusion The mechanisms of actions of electroacupuncture and medication in treating knee osteoarthritis may be related to inhibiting the expression of typeⅠ collagen mRNA.

Objective To develop criteria for trainers of general practitioners in clinical training bases.Methods A primary version of criteria was established through literature review and expert interview.Thirty-two experts with middle-level professional title or above,who had 10 years of working experience or more in general practice,teaching and administration,were invited for 3 rounds of Delphi consultation during March and October 2013.Results The criteria consisted of 3 first-grade indicators and 12 second-grade indicators were established.The first-grade indicators included professional quality,clinical competence and teaching capability.The weight coefficient of first-grade indicators were 0.332 0,0.336 0 and 0.332 0,respectively.For 3 rounds of consultation the activity coefficient of experts was all 100％ ; the authority coefficients of experts were 0.881,0.897 and 0.883,respectively; and the harmonious coefficient of importance of the evaluation were 0.136,0.127 and 0.204,respectively (P ＜ 0.01).Conclusion The established criteria are credible and important for the selection of trainers of general practitioners in clinical bases,which would improve the quality of standardized training for general practitioners.

Objective To establish a set of accreditation standards for trainers of general practitioner (GP) in community health service centers.Methods A modified Delphi expert consultation was conducted during December 2012 and September 2013.Thirty two experts of general practice from different teaching hospitals and community health service centers were invited for three rounds Delphi questionnaires.A set of accreditation standards for GP trainers in primary care was established through data analysis,synthesis and process.Results Expert activity coefficients were 100.0％ for three rounds consultation,the authority coefficients were 0.894,0.882 and 0.893,respectively.The opinion coordination coefficients of experts were 0.156,0.166 and 0.215,respectively (P =0.000).The developed accreditation standards system comprised of three first-grade indicators and 14 second-grade indicators.The weight coefficients of three first-grade indicators,namely professional profiles,clinical competences in primary care and teaching abilities,were 0.339 8,0.335 6 and 0.324 6,respectively.Conclusions The established accreditation standard system is credible,which would appropriately guide the selection of GP trainers in primary care from three dimensions and enhance the quality of standardized training of general practitioners.

Background Optic neuropathy is one of the diabetic eye complications.Rosiglitazone,a peroxisome proliferator activated receptor γ(PPARγ) agonist,plays a very important role in arresting the pathogenesis and development of diabetes.However,the role of PPARγ in diabetic optic neuropathy is unclear.Objective This study was to investigate the protective effect of rosiglitazone against diabetic optic neuropathy and its mechanism.Methods Male Sprague-Dawley rats were randomly divided into the control group,diabetic group and rosiglitazone group,with 10 rats for each group.Diabetic models were induced by injecting 50 mg/kg of streptozotocin via the caudal vein,and rosiglitazone(5 ng/[kg· d])was used in the rats of the rosiglitazone group by intragastric administration every day for four weeks.At the end of the experiment,the fasting blood sugar(FBS) was tested in all the animals.The level of vascular endothelial growth factor(VEGF) in the blood plasma was detected by ELISA.Optical neural tissues were obtained from the rats of each group,and Lauck fast Blue myelin stain was used to examine the morphology of the optical myelin.The expression of neural cell adhesion molecule (NCAM) mRNA and protein in the optic nerve was detected by real time PCR and Western blot,respectively.Results The levels of FBS,blood plasma VEGF,NCAM mRNA and protein in the optic nerve were significantly different among the control group,diabetic model group and the rosiglitazone group after the administration of 5 nmg/(kg · d) rosiglitazone for 4 weeks (F =6.12,P＜0.01 ; F =5.14,P＜0.05 ; F =4.75,P＜0.05 ; F =4.87,P＜0.05).Compared with the control group,the level of FBS significantly increased in the diabetic model group(t =2.26,P＜O.05),and that in the rosiglitazone group significantly declined in comparison with the diabetic model group(t=2.08,P＜0.05).The optic nerve exhibited a normal morphology in the control group as revealed by the Lauck fast Blue myelin staining;however,severe demyelination of the optic nerve and proliferation of glial cells were found in the diabetic model group,and mild demyelination of the optic nerve and proliferation of glial cells were seen in the rosiglitazone group.Blood plasma VEGF was(28.76±4.21)ng/L in the control group and(134.28±11.36)ng/L in the diabetic model group,showing a significant difference between them (t=2.36,P ＜ 0.05).Compared with the model group,the blood plasma VEGF was significantly lower in the rosiglitazone group ([42.67 ± 5.83] ng/L) than that in the diabetic model group (t =2.17,P＜ 0.05).Expression of NCAM mRNA and protein in the optic nerve significantly decreased in the diabetic model group compared with the control group(t =2.21,t =2.58,both at P＜0.05);while those in the rosiglitazone group were significantly elevated in comparison with the diabetic model group(t =2.19,t =2.67,both at P＜O.05).Conclusions Rosiglitazone can protect optic nerve from damage in diabetic rats mainly by downregulating blood plasma VEGF level and upregulating NCAM expression.

Objective To study the application of accreditation standards for trainers of general practitioners (GPs) in community health centers.Methods The questionnaire was designed according to the accreditation standards for GP trainers in community health centers,which involved professional quality,clinical competence in primary care and teaching abilities.According to typical sampling,583 trainers from 56 community teaching bases in Shanghai were selected for the survey.Results Among 583 participants,the effective respondents were 505 with a response rate of 86.6％.The professional quality was highly recognized by the participants,and more than 80％ of trainers met the requirement.For the ability of primary care,81.4％ (411/505),79.8 ％ (403/505) and 69.5 ％ (351/505) of participants were well qualified with the abilities of management for hypertension,type 2 diabetes and coronary heart disease,respectively,while only about 40％ had abilities of management for epilepsy,hypothyroidism and chronic mental diseases.75.4％ (381/505) participants fully mastered the principle of first aid skills and CPR,while only 24.8％ (125/505) had abilities of management for conjunctival foreign body and nasal foreign body,34.5％ (174/505) had the abilities of debridement and gastrolavage.For the index of teaching abilities,most trainers had insufficient teaching capacity and experience in the community.Only 48.5％ (245/505) and 40.2％ (203/505) of trainers were familiar with the teaching methods of cased-based learning and problem-based learning,respectively.Significant difference was found in the scores of teaching abilities among trainers from community health centers in different locations (P ＜ 0.05),such as using appropriate teaching methods (F =3.45,P =0.033),monthly assessment and feedback to students (F =5.14,P =0.006) and ensure at least 4 hours of teaching time every week(F =4.96,P =0.007).No significant differences were found in the scores of professional quality and clinical competences in primary care (P ＞ 0.5).Conclusion The trainers of general practitioners in community health centers meet the requirement of accreditation standards in the aspects of professional quality and clinical competences in primary care,while the teaching abilities remained to be improved and should be strengthened in the future.

Objective:To investigate the efficacy and safety of fecal microbiota transplantation (FMT) in the treatment of irritable bowel syndrome (IBS), and to explore the effects of FMT on the gut microbiota of IBS patients.Methods:From September 2016 to August 2017, at Guangzhou First People′s Hospital, 28 hospitalized IBS patients who underwent FMT treatment were enrolled. Before FMT, four and 12 weeks after FMT, all the IBS patients completed the irritable bowel syndrome quality of life scale (IBS-QOL), irritable bowel syndrome severity scoring system (IBS-SSS) and gastrointestinal symptom rating scale (GSRS). 16S rDNA sequencing was performed before FMT and four weeks after FMT. The effects of FMT on gut microbiota diversity and microbiota structure of IBS patients were analyzed respectively from the level of phylum, family and genus, and linear discriminant analysis effect size (LEfSe) was further used to screen the different bacteria. Paired t test and paired rank sum test were used for statistical analysis. Results:Twelve weeks after FMT, the scores of the six dimensions of IBS-QOL including dysthymia, behavioral disorder, auto imagery, health concerns, eating avoidance, and relationship expansion were all lower than those before FMT (43.750, 22.656 to 56.250 vs. 48.438, 32.031 to 60.938; 37.500, 18.750 to 56.250 vs. 46.429, 21.429 to 62.500; 31.250, 14.063 to 42.188 vs. 31.250, 18.750 to 50.000; 41.667, 27.083 to 56.250 vs. 50.000, 41.667 to 66.667; 54.167, 43.750 to 72.917 vs. 66.667, 58.333 to 83.333; 8.333, 0.000 to 33.333 vs. 16.667, 8.333 to 33.333, respectively), and the differences were statistically significant ( Z=-2.157, -3.429, -2.274, -3.197, -3.042 and -2.329, all P<0.05). Twelve weeks after FMT, the scores of the two dimensions of IBS-QOL including behavioral disorder and relationship expansion were both lower than those of four weeks after FMT (37.500, 18.750 to 56.250 vs. 39.286, 19.643 to 62.500 and 8.333, 0.000 to 33.333 vs. 16.670, 2.083 to 41.667, respectively), and the differences were statistically significant ( Z=-1.998 and -2.110, both P<0.05). Four and 12 weeks after FMT, the scores of IBS-SSS and GSRS were both lower than those before FMT ((190.32±106.51), (201.43±102.48) vs. (245.93±86.10) and 5.50, 4.00 to 9.00 and 5.50, 4.00 to 8.75 vs. 7.00, 6.00 to 9.75), and the differences were statistically significant ( t=4.402 and 3.848, Z=-3.081 and -3.609; all P<0.01). No serious adverse reactions occurred in the patients after FMT. At the phylum level, after FMT the abundance of Verrucomicrobia in the feces of IBS patients was richer than that before FMT (6.74% vs. 0.37%); at the family level, after FMT the abundance of Verrucomicrobiaceae in the feces of IBS patients was richer than that before FMT (6.74% vs. 0.37%); at the genus level, after FMT the abundance of Akkermansia was richer than that before FMT (6.74% vs. 0.37%); and the differences were statistically significant (all Z=-2.589, all P=0.010). The results of LEfSe method indicated that four weeks after FMT the abundance of Akkermansia in the gut microbiota of IBS patients was richer than that before FMT (6.74% vs. 0.37%), and the difference was statistically significant (linear discriminant analysis value=4.5, P=0.049). Conclusions:FMT is safe and effective in the treatment of IBS. The mechanism may be through upregulating the diversity of gut microbiota and changing the structure of gut microbiota of IBS patients.

To study and analyze prevalence condition of hypertension and complicated cardiovascular risk factors in north Fujian rural area .Methods : By cluster sampling , an epidemiological questionnaire and physical ex‐amination were performed among 1784 residents using standardized survey method , who were ≥35 years from six towns and eight villages in north Fujian rural area from Jun 2013 to Mar 2014. Hypertension was diagnosed accord‐ing to The 2010 Chinese Guideline for the Prevention and Treatment of Hypertension , multivariate Logistic regres‐sion was used to analyze independent risk factors for hypertension in these subjects .Results : Prevalence rate of hy‐ pertension was 17.43% (31／1784 ) in north Fujian rural area .After population standardization , it＇s 23. 21%(18.66% in men and 16. 13% in women) , there was no significant difference in prevalence rate of hypertension be‐tween men and women in any age layer , P＞0. 05 all.Multivariate Logistic regression analysis indicated that age , overweight (BMI≥24 kg／m2 ) , high triglyceride and fasting blood glucose were independent risk factors for hyper‐tension in north Fujian rural area (OR＝1.107－2.096 , P＜0. 05 or ＜0. 01).Conclusion : Prevalence rate of hyper‐tension is high in north Fujian rural area , age , overweight , smoking , high triglyceride and fasting blood glucose are the main risk factors .