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.

Objective To select properly the esophageal metallic stent to treat the dysphagia and strictures of advanced esophageal cancer. Methods To place esophageal metallic stent for 72 cases of advanced esophageal cancer. Results Dysphagia were markedly improved or completely alleviated together with esophageal and mediastinal fistula sealed completely after the procedure. Conclusions The complications will be reduced by the proper selection of esophageal metallic stent and also for resuming of food intake.

Acupuncture Therapy ; history ; instrumentation ; methods ; China ; History, Ancient ; Humans ; Medicine in Literature ; Needles ; history

Objective To investigate the effect of angiotensin 1-7(Ang 1-7) on renal proximal tubular epithelial cell(HK-2) transdifferentiation induced by high glucose.Methods All the raised HK-2 cells were divided into 5 groups: normal control group,high glucose group,high glucose with Ang1-7 group,high glucose with Ang1-7 and A779 group,high glucose with pioglitazone group.Expression of peroxisome proliferator activated receptor-γ(PPAR-γ) and α-smooth muscle actin(α-SMA) was detected by Western blotting,real-time PCR and immunofluorescence.Results The levels of PPAR-γ protein and mRNA in HK-2 cells were significantly increased after treatment with high glucose and Ang 1-7.Expression of α-SMA protein and mRNA was inhibited remarkably after treatment with high glucose and Ang 1-7.These effects of Ang 1-7 on HK-2 cells could be reversed by Mas receptor antagonist A779.Conclusion Ang 1-7 inhibits high glucose-induced expression of o-SMA in HK-2 cells,which is in part through the Mas.

Objective To evaluate the effect of aldosterone (Ald) on glomerular mesangial cells apoptosis and to explore the possible mechanisms.Methods Twenty-four Sprngue-Dawley rats were subcutaneously embedded with osmotic mini-pumps and randomly divided into 3 groups.Aldosterone (1.5 μg/h) was administrated subcutaneouly by osmotic mini-pumps in Ald group,eplerenone (Epl,100 mg·kg-1·d-1) and Ald (1.5 μg/h) was given to Epl group.And normal saline was used in control group (Con group).Systolic blood pressure and urinary albumin excretion rate (UAER) were detected on day 0,7,14,21,28.Blood and kidney samples were harvested on day 28.Plasma creatinine,potassium and aldosterone were measured.Renal paraffin sections were stained by PAS and the morphological changes were evaluated by light microscopy.Apoptosis index of mesangial cells were detected by TUNEL assay.The glomerular mesangial cells (MCs) were cultured in a DMEM-F12 media.MCs apoptosis was evaluated by staining cells with Annexin V and propidium iodide (PI) using flow cytometer.Expression of Bcl-2 and Bax mRNA was examined by RT-PCR.The protein level of Bad or phospho-Bad was measured by Western blotting.Results Ald-infused rats developed hyperaldosteronemia and hypokalemia.Rats in Ald group exhibited significant hypertension and marked albuminuria.Ald group rats showed increased number of TUNEL-positive mesangial cells when compared with control rats (P＜0.05).Aldosterone induced mesangial cells apoptosis in a time-dependent manner.Expression of Bcl-2 mRNA was decreased but Bax mRNA was increased in aldosterone treated MCs compared to that in Con group (P＜0.05).Aldosterone promoted dephosphorylation of cytosolic phospho-Bad compared with vehicle treated cells (P＜ 0.05).However,eplerenone attenuated these effects of aldosterone.Conclusion Aldosterone directly promotes mesangial cells apoptosis,and eplerenone can attenuate this effect of aldosterone.Dephosphorylation of cytosolic phospho-Bad may be the key role in the progression of mesangial cells apoptosis induced by aldosterone.

Objective To investigate the effect of surfactant protein D(SP-D)overexpression on lipopolysaccharide(LPS)-induced monocyte chemoattractant protein-1(MCP-1)expression in human renal proximal tubular epithelial cells(HK-2)and its mechanism. Methods HK-2 cells were treated with LPS at various concentrations (0, 0.1, 1, 2, 5, 10 mg/L)for 8 h and at 5 mg/L for various time points(0, 2, 4, 8, 16, 24 h). Expression of SP-D was detected by Western blotting and real-time PCR. Expression of MCP-1 was determined by ELISA and real-time PCR. Human SP-D cDNA eukaryotic expression vector pEE14-hSP-D was transfected to HK-2 cells. The changes in transfected cells of SP-D protein were observed by Western blotting. Expression of MCP-1 was detected by ELJSA and real-time PCR. Results SP-D was expressed in HK-2 cells. The levels of SP-D protein and mRNA in HK-2 cells were significantly decreased after treatment with LPS(P<0.05). Expression of MCP-1 protein and mRNA was increased remarkably after treatment with LPS(P<0.05). HK-2 cells transfected with pEE14-hSP-D showed up-regulated expression of SP-D. The overexpression of SP-D inhibited the LPS-inducedexpression of MCP-1(P<0.01). Conclusions SP-D inhibits LPS-induced expression of MCP-1 in HK-2 cells. SP-D may play an important role in the modulation of renal inflammation.

Objective · To observe the change of serum complement C1q tumor necrosis factor-related protein1 (CTRP1) level and explore its relationship with serum adiponectin (APN) level in elderly male metabolic syndrome (MS) patients. Methods · Clinical data of 279 male objects (60-90 years old) were analyzed retrospectively, serum CTRP1 and APN levels of all objects were tested by enzyme-linked immuno sorbent assay (ELISA). The patients were divided into three groups, i.e. 105 MS patients (MS group), 90 MS patients combined with hypertension (HMS group), and 84 non-MS patients (control group). All general information, including height, body weight, systolic blood pressure (SBP), diastolic blood pressure, fasting blood glucose, fasting insulin and serum three acyl glycerin (TAG) were recorded, in order to calculate body mass index (BMI) and homeostasis model assessment of insulin resistance (HOMA-IR). Results · Compared with the control group, serum CTRP1 levels of patients in MS group and HMS group both increased, and the latter was more obviously. Serum APN levels of patients decreased obviously in HMS group and MS group. The level of serum CTRP1 was negatively related with the level of serum APN. Conversely, serum CTRP1 level was positively related with blood glucose, BMI, SBP, TAG and HOMA-IR. Conclusion · The level of serum CTRP1 is elevated, while the level of serum APN declines in elderly male MS patients. The serum level of CTRP1 is even higher in HMS patients. Serum CTRP1 level is related to many risk factors of atherosclerosis.

Objective To analysis the risk factors of cardiovascular events during periopemtive period undergoing hand surgery . Methods 197 cases of hand surgery in our hospital from 2009 to 2012 ,aged 21 to 74 years were selected .The general condition ,an-esthesia ,operative time and intraoperative hemodynamics (blood pressure> 20% ) were recorded ,postoperative follow-up and record the occurrence of cardiovascular events ,and factor analysis was carried on .Results In 48 hours ,23 patients were suffered from car-diovascular events ,and the total morbidity rate was 11 .7% ,in which sinus tachycardia was 3 case(1 .52% ) ,atrial fibrillation were 2 cases(1 .02% ) ,premature ventricular contractions were 4 cases(2 .03% ) ,the myocardial ischemia were 11 cases(5 .58% ) ,the angi-na pectoris were 3 cases(1 .52% ) ,the myocardial isehemia was 1case(0 .51% ) .Multiariable Logistic regression analysis showed that ,the influencing factors of perioperative cardiovascular events undergoing hand surgery were were diabetes mellitus (OR=2 .012 ,P=0 .023) ,coronary heart disease (OR=2 .301 ,P=0 .028) ,preoperative ST ischemic changes (OR=2 .942 ,P=0 .031) ,lip-id abnormalities(OR=3 .012 ,P=0 .019) and hemodynamics changes during operation(OR=3 .522 ,P=0 .020) .Conclusion The risk factors of perioperative cardiovascular events independent undergoing hand surgery might be diabetes ,coronary heart disease , preoperative ST ischemic changes ,intraoperative hemodynamic changes .

Objective To evaluate the X-ray characterstics of benign and malignant neoplasms on mammography in order to improve their differeatial diagnostic level.Methods X-ray image changes of 67 malignant breast neoplasms were described by the mammography and in comparision with those of 31 benign masses .Results The accordance percentages between the X-ray and histological examinations for the malignant and benigin neoplasms were shown to be 89.6% and 84.0% respectively. Occurrence of masses with an enhanced density , irregular shape, calcification granules in clusters were found to be indication of a malignent lesion.Conclusion The mamography can provide effective imaging data for differential diagnosis betweren the benign and malignant breast neoplasms.

BACKGROUND:The finite element analysis method is more accurate and fast to construct the three-dimensional model of the human skeleton and design the bone surgical medical instrument.
OBJECTIVE:To establish locking plate model according to the clavicle model, analyze and evaluate stress distribution of locking plate of the finite element model under bending and torsion conditions.
METHODS:Chest scan was carried out in a healthy young adult male by adopting 64-row spiral CT and his two-dimensional image data were gotten. The obtained data were analyzed with Mimics 10.0 software to establish the three-dimensional clavicle finite element model. The clavicle locking fixation plate model was established by applying the UG software. The locking fixation plate was evaluated by utilizing the abaqus software when the plate was bent while down to give force of 200 N, and twisted while 200 N?mm, to simulate the force and analyze the stress distribution of the locking plate.
RESULTS AND CONCLUSION:Based on the original image parameters provided by CT, this experiment produced a three-dimensional model of the clavical titanium plate which fitted better to bones. This model can obtain a single individual, personalized plate by three-dimensional printing technology. The finite element analysis basical y can simulate the actual stress of the plate. For straight plate and“S”-shape plate, in lateral bending and axial torsion loads, the maximum stress distribution of the seven-hole titanium plate is located in the center of the center hole. During actual surgical procedures, clavicle fracture fragments and middle locking hole had stress superposition. If the titanium plate can avoid the stress concentration, it can effectively avoid the occurrence of the broken plate after implantation, provide theoretical guidance for clinical practice, and provide reference and technical route for biomechanical analysis of other types of titanium plate.