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.

ObjectiveTo study the effect of early rehabilitation on disability of motion and cognition.Methods107 patients were randomly divided into two groups,rehabilitation group (51 cases) and control group (56 cases).Patients in rehabilitation group were given regular early rehabilitation,while all patients in both groups were given usual clinical treatment. The Barthel Index (BI), Fugl-Meyer Assessment (FMA), Mini-mental Status Examination (MMSE) were used to evaluate these two groups before and 3 months after treatment. ResultsAfter treatment, the scores of BI, FMA and MMSE were improved significantly(P<0.05) in rehabilitation group compared with that before treatment, so did that of BI, FMA in control group(P<0.05).The scores of BI、FMMS、MMSE in rehabilitation group improved significantly compared with that in control group(P<0.05).ConclusionEarly rehabilitation may obviously improve the motive and cognitive function and increase the quality of living of hemiplegia after stroke.

Objective To evaluate the clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) and pcrcutaneous transhcpatic insertion of biliary stent (PTIBS) for malignant biliary obstruction.Methods PTBD or PTIBS were performed in 56 patients with malignant biliary obstruction, which were aused by hepatic carcinoma (n = 14), biliary duct carcinoma (n = 11), gallbladder carcinoma (n = 5),stomach carcinoma accompanied with metastasis of lymph node (n = 14), carcinoma of ampulla (n = 1 ) or carcinoma of pancreatic head (n = 11 ). The diagnosis was confirmed by ultrasonography, CT or MRI in all patients. The obstructed site was well identified, including high obstruction in 19 patients and lower obstruction in 37 patients. Based on the imaging findings, suitable interventional procedure was employed.Results PTBD or PTIBS were performed successfully in all 56 patients, of them PTBD was adopted in 11,PTIBS in 40 and both PTBD and PTIBS in 5. The serum total bilirubin decreased from (295.65±152.86)μmol/L before the procedure to (151.05 ± 107.36) μmol/L after the procedure, (P < 0.01 ). Postoperative infection could affect the fading of jaundice (P < 0.01 ), but the location of the obstruction carried no relationship with the fading of jaundice (P = 0.063). Conclusion Both PTBD and PTIBS are safe and effective palliative therapies for malignant biliary obstruction, which can markedly relieve patient of jaundice,improve the quality of life and elongate the survival period.

Objective Evaluate the outcome of aortic root reconstruction on the analysis of the risk factors influencing surgical results. Methods Between August 1996 and November 2009, 92 patients(56 men, 36 women) aged from 14 to 77years [mean (44.8 ±1.4) years] with aortic root aneurysm underwent aortic root reconstruction. 72 patients had over moderate aortic valve insufficiency. 47 patients suffered from Marfan syndrome. The aortic pathology was aortic dissection in 45. Bentall technique was used in 59 patients, the button technique in 13, the David I with the Valsalva graft in 6 patients and the aortic valve resuspension in 14 patients. Results The hospital mortality rate was 8.7%. The major complications 31. 7%. 18patients died during the period of follow-up. Late complications among 55 survivors were 12. Univariate predictors of the morbidity were the presence of male, non-Marfan, concomitant procedure, deep hypothermia cardiac arrest, aortic cross clamp time and blood infusion. Risk facts for mortality were emergent or urgent operation, aortic dissection, concomitant procedure, aortic cross clamp time and blood infusion. Multivariate analysis revealed risk factors of concomitant procedure and blood infusion were responsible for both morbidity and mortality. The overall long-term survival rate is (97.1 ±2.0)% at 1-year, (88.1 ±4.7)% at 5-year, (54.0 ±9.2)% at 10-year. The mean for survival time is (9.9 ±0.59) years, 95% confidence interval 8.70 -11.01. Conclusion The aortic root restitution procedures are safe and effective in general. The short and long-term outcome is satisfactory. The button technique is the first choice for reimplantation coronary patch. Valve-sparring aortic root reconstructions show promise in safety and applicability.

Objective To observe the effect of finger-pressing combined with conventional rehabilitation therapy on the recovery of upper limb function after stroke.Methods A total of 60 cerebral stroke patients were randomly divided into an experimental group (n =30) and a control group (n =30).All patients were treated with conventional anti-symptomatic drugs but no anti-spasticity ones.The experimental group was given conventional rehabilitation and finger-pressing therapy,while the control group was given conventional rehabilitation only.Both groups were measured the motor function,using the upper-extremity portion of the Fugl-Meyer Scale,and the mean integrated electromyography (iEMG) output of biceps and flexor carpi radialis after the first finger-pressing treatment and 1 month later,so as to observe the immediate and continuous effects of finger-pressing therapy respectively.Results After the first session of finger-pressing therapy,the average Fugl-Meyer score(FMA) (12.63 ± 4.64) of the experimental group was significantly higher than in a pretest (12.13 ± 4.88) (P ＜ 0.05),while the iEMG of biceps (41.64 ± 9.22) and flexor carpi radialis (37.06 ± 7.02) were lower than before (P ＜ 0.01).One month after the treatment,compared with the control group,the average FMA (25.17 ± 5.93) and iEMG of biceps(34.42 ± 7.55) and flexor carpi radialis sEMG(30.63 ± 5.54) in the experimental group were significantly improved (P ＜ 0.01).Conclusions Finger-pressing therapy has significant and immediate effects in improving the upper extremity spasticity of stroke survivors.Combined with conventional rehabilitation therapy it can effectively reduce the upper extremity spasticity in stroke patients and significantly improve the upper extremity function.The combination is superior to conventional rehabilitation alone.

Objective:To study the role of FDCs-miR-548m-CDK6 axis on clonogenicity in mantle cell lymphoma. Methods:RT-qPCR and Western blot were used respectively to test the expression of miR-548m and CDK6. Bioinformatics assay was applied to predict the targets of miR-548m, and Western Blot was used to test the expression level of CDK6 after miR-548m overexpression or in-hibition. Luciferase report assay was performed to test whether CDK6 was a direct target of miR-548m. Colony forming assay was used to test the colony forming activity in MCL after overexpression of miR-548m or knockdown of CDK6. Results:Cell adhesion to FDCs induced downregulation of miR-548m and CDK6 expression in MCL. Bioinformatics assay revealed that miR-548m could target the 3'-UTR of CDK6 and that a negative correlation exists between the level of miR-548m and the CDK6 expression. Luciferase report as-say confirmed that miR-548m directly targeted 3'-UTR of CDK6. Colony forming assay showed that overexpression of miR-548m or knockdown of CDK6 significantly suppressed MCL colony formation. Conclusion:This study reveals that FDC-enhanced mantle cell lymphoma clonogenicity is mediated by the miR-548m/CDK6 axis.

Objective: This study aims to investigate the correlation between the expression of FoxP3, TGF-β1, and epitheli-al-mesenchymal transition (EMT) in breast cancer and to determine the clinical significance of FoxP3. Methods: The expression of FoxP3, TGF-β1, E-Cadherin, N-Cadherin, Vimentin, and Fibronectin protein were detected in the cancer cells of 74 cases with breast carcinoma via immunohistochemistry. The correlation of FoxP3 protein with clinico-pathologic features of breast carcinoma and the re-lationships among the expressions of FoxP3, TGF-β1, and epithelial-mesenchymal transition (EMT) were analyzed. Results:The ex-pression rates of FoxP3, TGF-β1, and EMT are 36.5%(27/74), 39.2%(29/74), and 40.5%(30/74), respectively. The FoxP3 protein ex-pression in breast cancer is correlated with lymph node metastasis (P<0.05) but not with other clinico-pathological features (P>0.05). The expression of FoxP3 is also correlated with the expression of TGF-β1. Furthermore, TGF-β1 can induce EMT (P<0.05). Conclu-sion:The expression of FoxP3 is correlated with lymph node metastasis and EMT in breast cancer. Therefore, FoxP3 may be a marker for predicting metastasis.

Objective:This study aims to investigate the correlation and significance between the expression of P53 and epitheli-al-mesenchymal transition (EMT) in breast cancer. Methods:The expression patterns of P53, Twist, Snail, E-cadherin, N-cadherin, Vi-mentin, and Fibronectin protein were detected via immunohistochemistry in 63 cases with breast carcinoma. The correlation of P53 pro-tein with clinicopathologic features and survival of breast carcinoma, as well as the relationship between the expression of P53 and EMT, was analyzed. Results:The expression rates of P53, Twist, Snail, and EMT are 44.4%(28/63), 54.0%(34/63), 68.3%(43/63), and 41.3%(26/63), respectively. The P53 protein expression is correlated with tumor grade (P<0.05) but not with other clinicopatholog-ic features (P>0.05). The expression of P53 is also correlated with the expression of Twist and Snail, which are associated with EMT (P<0.05). Multivariate survival analysis reveals that lymph node metastasis, P53, and EMT are independent prognostic factors. Conclu-sion:The expression of P53 is correlated with tumor grade and EMT in breast cancer, which can be used as an independent prognostic factor. Therefore, P53 may be an effective target for breast cancer therapy.

Objective Through clinical observation and research with persistent atrial fibrillation in patients with blood-brain natriuretic peptide ( BNP) level change detection renin, angiotensin Ⅱ, aldosterone, analyze their data, investigate persistent atrial fibrillation ( PAF ) serum brain natriuretic hormone levels change and the relationship between the renin-angiotensin-aldosterone system (RAAS).Methods 80 patients with coronary artery disease in our hospital from December 2013 to October 2015 were selected, randomly divided into experimental principle PAF group (40 cases) and control group ( patients in sinus rhythm,with 40 cases) , BNP, renin, angiotensinⅡ, aldosterone levels were measured in two groups, and left atrial diameter (LAD) measurements.Results Under the same condition of cardiac function, the blood BNP concentration in PAF group was higher than that in control group (P <0.05).The results of the linear regression analysis showed that the correlation coefficient of blood BNP level and AngII concentration in PAF group was 0.301, the correlation coefficient of blood BNP level and LAD indicators in PAF group was 0.373, the concentrations of BNP and RAAS were positively correlated with LVMI, the differences were statistically significant (P<0.05), the blood BNP level was closely related to the level of RAAS in the PAF group (P<0.05).Conclusion Blood BNP concentration was significantly higher in patients with PAF and blood BNP concentration is closely related with the RAAS, LAD indicators, and a positive correlation.

Objective · To investigate the expression of the regulator of calcineurin 1 (RCAN1) and calcineurin A (CnA) in tissues of in-stent restenosis after intervention of arteriosclerosis obliterans (ASO), and to explore the relationship between their expression levels and the occurance of in-stent restenosis. Methods · Superficial femoral arterial tissues were collected from 15 ASO patients undergoing lower extremity amputation for in-stent restenosis in Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University from September 2013 to June 2016. H-E staining and Masson staining were performed on the stenosis tissues, as well as on the proximal and distal tissues, and the morphological changes of these tissues were observed under optical microscope. Western blotting was used to detect the protein levels of RCAN1, CnA and proliferating cell nuclear antigen (PCNA). The distribution of RCAN1 and CnA proteins was observed by immunohistochemistry and immunofluorescence methods. In addition, co-immunoprecipitation was used to validate the protein-protein interaction between RCAN1 and CnA in vascular tissues. Results · The expression of RCAN1 in the distal tissues was significantly elevated compared with the proximal tissues and the stenosis tissues (P<0.05). The expression of RCAN1 in the proximal tissues was higher than that in the stenosis tissues (P <0.05). The expression of CnA and PCNA in the stenosis tissues was significantly elevated compared with the proximal tissues and the distal tissues (P<0.05). Immunohistochemistry and immunofluorescence analyses showed that RCAN1 and CN proteins were mainly expressed in the cytoplasm of vascular smooth muscle cells. Co-immunoprecipitation analysis showed there is protein-protein interaction between RCAN1 and CnA in arterial tissues. Conclusion · The low expression of RCAN1 and the high expression of CnA are probably related to the occurrence of in-stent restenosis.