Objective:To observe the effects of fluvastatin adjuvant therapy on plasma connective tissue growth factor ( CTGF) and brain natriuretic peptide (BNP) in chronic heart failure (CHF) patients.Methods:Totally 112 cases of chronic heart failure patients were randomly divided into two groups ,and 56 patients in the control group were treated with the conventional method , while 56 cases in the treatment group were given fluvastatin additionally .The course of treatment was 6 months.The clinical effect,and CTGF and BNP levels of the two groups were compared .Results: The efficiency rate of the treatment group was significantly higher than that of the control group with statistical significance (P<0.05).Before the treatment, there was no significant difference in the study indices be-tween the groups (P>0.05).After the treatment, the cardiac function indices (LVEF and FS) and lipid level (HDL-C) in the treat-ment group were increased obviously , which were higher than those in the control group; the cardiac function indices ( LVDD and LVSD) and lipid levels ( TC, TG and LDL-C) in the treatment group were decreased obviously , which were lower than those in the control group, and all the differences had statistical significance (P<0.001).There was no significant difference in adverse drug re-actions between the groups(P>0.05).Conclusion: The conventional treatment combined with fluvastatin is effective in the patients with CHF, which can significantly reduce plasma BNP level and CTGF level .

Objective Calcification and graft failure may occur in aortic valved homografting as a result of immune rejection. This study was designed to examine the effects of immunosuppression in reducing immune rejection response and preventing calcification in rat aortic valved homograft(AVH). Methods Animals were randomly assigned into 3 test groups and 1 control group. SD-Wistar rats in the test groups received AVH of cryopreservation (group A), received AVH of cryopreservation followed by CsA treatment (group B), and received AVH preconditioned with monoclonal antibody against dendritic cells (DcmAb) diluted in 1:5 and cryopreserved then were treated with DcmAb postoperatively (group C), respectively. Rats in the control group(group D) were Wistar→Wistar.Rat AVH with myocardial cuff were transplanted into the abdominal aorta of rats. The rats were sacrificed in batchs at 2, 4, 8, 12 and 16 weeks postoperatively. Blood samples were obzained for detecting the expression of TCR-αβ, CD28. The AVH specimens were obtained for observing the change of endotheliocyte and smooth muscle cells with light and electron microscopes. At the same time, calcium contents of AVH tissues after transplantation were measured. Results As compared with the control group, the expression of TCR-αβ and CD28 in test groups was increased significantly at each time point(P<0.01) and reached peaks 2 to 4 weeks after operation, then gradually reduced and was closed to the level of controls at 12 weeks. Calcium contents of AVH tissues in the test groups was increased gradually since 4 weeks and reached the peak 12 to 16 weeks after operation. No significant difference in calcium level was found in the control group over 5 different periods (P>0.05). Calcium contents of AVH tissues at 4 and 8 weeks postoperatively were (2856±79)μg/g and (3587±168)μg/g in the groups with cryopreservation;(2518±73)μg/g,(3237±187)μg/g in the CsA treatment group;(2176±210)μg/g, (3089±176)μg/g in the DCmAb treatment group; (860±60) μg/g, (870±50) μg/gin the control group. Conclusion The immunosuppressive treatment had substantial effects on AVH calcification as a result of reduction in immune rejection response and delay in the development of calcification.

Objectives:To study the pathological behavior and the value of transforming growth factor β1(TGF-β1) in predicting prognosis in pulmonary hypertension associated with congenital heart disease.　Methods:Lung tissues from 29 patients with congenital heart diseases associated with pulmonary hypertension were examined by surgical biopsy of the lung. All samples were examined for the expression and localization of TGF-β1 by immunohistochemical technique with anti-TGF-β1 antibody.　Results:Twenty-six out of 29 showed positive staining of intracellular endotheliocyte TGF-β1(89.65%),16 samples showed extracellular matrix TGF-β1 staining(55.17%).Statistically, there was significant difference between Ⅰ～Ⅱ and Ⅲ～Ⅵ pathological degrees in extracellular matrix(P<0.05).　Conclusions: TGF-β1 plays an important biological role in the formation of pulmonary hypertension after congenital heart disease. It is conductive in predicting prognosis.

Objective:To explore the competency for the assistant general practitioners in China to provide theoretical support for the construction of the post competence model of assistant general practitioners and training and evaluation of assistant general practitioners.Methods:During January 22 to June 18, 2019, Using snowball sampling method and behavioral event interviews, 23 general practitioners and assistant general practitioners were interviewed in China, including 14 general practitioners in the superior performance group and 9 assistant general practitioners in the average performance group. The interview contents were coded and analyzed, and the statistical methods of t test and rank sum test of two independent samples were used to screen competency characteristics and construct the competence model of assistant general practitioners.Results:The total classification consistency and the total coding reliability coefficient was respectively 0.79, 0.87. 59 competency characteristics of assistant general practitioners were obtained including 3 differentiated competency characteristics "Understanding the medical and health system and related policies", "Critical thinking skills" and "General practitioner clinical thinking" and 10 baseline competency characteristics. There was no statistically significant difference between the average performance group and the superior performance group in the total frequency of competency [(29.4±12.7) times to (23.4±7.0) times, t=1.27, P=0.22]. Conclusion:The preliminary competency characteristics of assistant general practitioners have good reliability and can provide references for further exploration of the competency model.

BACKGROUND AND OBJECTIVES: Appropriate inflammatory response is necessary for cardiac repairing after acute myocardial infarction (MI). Three-Bromo-4,5-dihydroxybenzaldehyde (BDB) is a potent antioxidant and natural bromophenol compound derived from red algae. Although BDB has been shown to have an anti-inflammatory effect, it remains unclear whether BDB affects cardiac remolding after MI. The aim of this study was to investigate the potential role of BDB on cardiac function recovery after MI in mice. METHODS: Mice were intraperitoneally injected with BDB (100 mg/kg) or vehicle control respectively 1 hour before MI and then treated every other day. Cardiac function was monitored by transthoracic echocardiography at day 7 after MI. The survival of mice was observed for 2 weeks and hematoxylin and eosin (H&E) staining was used to determine the infarct size. Macrophages infiltration was examined by immunofluorescence staining. Enzyme-linked immunosorbent assay (ELISA) was used to test the production of cytokines associated with macrophages. The phosphorylation status of nuclear factor (NF)-κB was determined by western blot. RESULTS: BDB administration dramatically improved cardiac function recovery, and decreased mortality and infarcted size after MI. Treatment with BDB reduced CD68+ macrophages, M1 and M2 macrophages infiltration post-MI, and suppressed the secretion of pro-inflammatory cytokines, such as tumor necrosis factor (TNF)-α, interleukin (IL)-1β, monocyte chemoattractant protein (MCP)-1, and IL-6 in the injured hearts. Furthermore, BDB inhibited the phosphorylation of NF-κB in the infarcted hearts. CONCLUSIONS: These data demonstrate, for the first time, that BDB treatment facilitated cardiac healing by suppressing pro-inflammatory cytokine secretion, and indicate that BDB may serve as a therapeutic agent for acute MI.
Animals ; Blotting, Western ; Cytokines ; Echocardiography ; Enzyme-Linked Immunosorbent Assay ; Eosine Yellowish-(YS) ; Fluorescent Antibody Technique ; Heart ; Hematoxylin ; Interleukin-6 ; Interleukins ; Macrophages ; Mice ; Monocytes ; Mortality ; Myocardial Infarction ; Phosphorylation ; Recovery of Function ; Rhodophyta ; Tumor Necrosis Factor-alpha

BACKGROUND AND OBJECTIVES: Appropriate inflammatory response is necessary for cardiac repairing after acute myocardial infarction (MI). Three-Bromo-4,5-dihydroxybenzaldehyde (BDB) is a potent antioxidant and natural bromophenol compound derived from red algae. Although BDB has been shown to have an anti-inflammatory effect, it remains unclear whether BDB affects cardiac remolding after MI. The aim of this study was to investigate the potential role of BDB on cardiac function recovery after MI in mice. METHODS: Mice were intraperitoneally injected with BDB (100 mg/kg) or vehicle control respectively 1 hour before MI and then treated every other day. Cardiac function was monitored by transthoracic echocardiography at day 7 after MI. The survival of mice was observed for 2 weeks and hematoxylin and eosin (H&E) staining was used to determine the infarct size. Macrophages infiltration was examined by immunofluorescence staining. Enzyme-linked immunosorbent assay (ELISA) was used to test the production of cytokines associated with macrophages. The phosphorylation status of nuclear factor (NF)-κB was determined by western blot. RESULTS: BDB administration dramatically improved cardiac function recovery, and decreased mortality and infarcted size after MI. Treatment with BDB reduced CD68+ macrophages, M1 and M2 macrophages infiltration post-MI, and suppressed the secretion of pro-inflammatory cytokines, such as tumor necrosis factor (TNF)-α, interleukin (IL)-1β, monocyte chemoattractant protein (MCP)-1, and IL-6 in the injured hearts. Furthermore, BDB inhibited the phosphorylation of NF-κB in the infarcted hearts. CONCLUSIONS These data demonstrate, for the first time, that BDB treatment facilitated cardiac healing by suppressing pro-inflammatory cytokine secretion, and indicate that BDB may serve as a therapeutic agent for acute MI.

Objective:To survey the competency characteristics of rural general practitioners using behavioral event interview.Methods:The competency characteristics of rural general practitioners were extracted by literature research method, and the behavior event interviews were conducted with 18 rural general practitioners nationwide from January to April 2019. According to the interview results, the items were modified and refined. On this basis, the benchmark competencies and excellent competencies of rural general practitioners were extracted.Results:A total of 45 885-second audio recordings and 174 523-word transcripts were obtained from the interviews. Eight identification competencies and 10 benchmark competencies were extracted. Identification competencies included "professionalism, altruism and dedication, love and compassion, visiting a patient at home, establishing good relationships, achievement-oriented, having expertise, and mastering community population dynamics and health status actively". Benchmark competencies included "diagnosis and treatment of common diseases, basic medical skills, learning consciousness and ability, solving medical problems with traditional Chinese medicine, health care for focal groups, rational administration of drug, referral services, managing chronic non communicable diseases, understanding health care system and related policies, and emergency treatment ability".Conclusions:This study preliminarily obtains the identification competencies and benchmark competencies of rural general practitioners. Managers can improve the service quality of rural general practitioners according to these elements.

Objective:To construct a post competency index system for rural general practice assistant physicians.Methods:On the basis of previous literature research and behavioral event interviews, the questionnaire of Delphi consultation was designed. Two rounds of Delphi expert consultation were conducted from October 2019 to January 2020 to develop an index system of post competency for rural general practice assistant physicians, and the analytic hierarchy process methods was used to calculate the weight of each index.Results:A total of 26 experts were included, with an average age of (48.7±8.6) years and an average working seniority of (22.8±8.8) years. After 2 rounds of consultation, the competency index system was developed, including 6 first level items and 60 seconds level items. The positive coefficient of experts in the 2 rounds was 87% and 100%, respectively; the expert authority coefficient was 0.7-1.0; the coordination coefficient was 0.312 and 0.241, respectively ( P<0.001). According to the order of weight, the first level items were basic medical and health services (0.311 1), basic public health services (0.196 0), medical knowledge and lifelong learning (0.196 0), interpersonal communication and team cooperation (0.138 6), professional quality (0.102 8), information utilization and management ability (0.055 5). The top 2 secondary indexes were clinical expertise (0.079 2), learning awareness and ability (0.055 3). The last 2 secondary indexes were achievement orientation (0.001 6) and inductive thinking (0.002 0). Conclusion:A post competency index system for rural general practice assistant physicians has been preliminary constructed in this study, which may provide reference for the selection, training and assessment of relevant medical workers.

Objective:To investigate the recognition of the post competency index system among rural general practice assistant physicians and its influencing factors.Methods:This study was a cross-sectional survey. A questionnaire survey on the recognition of post competency index system was conducted from October 2020 to September 2021 among rural general practice assistant physicians from 10 provinces/municipalities selected by stratified cluster sampling method. The recognition of rural general practice assistant physicians at all levels of indexs and the factors influencing recognition were analyzed.Results:A total of 1 123 questionnaires were distributed and 1 024 valid ones were collected with a recovery rate of 91.18%. Of the 1 024 respondents, 529 were male(51.7%) and 435 were aged 40-49 years(42.5%), which was the highest proportion by age group. The average overall recognition score of the index system was 4.41, and the scores of the primary indexes were 4.32-4.45. Three primary indexes had the highest recognition scores: professional competence, basic health care services, and interpersonal communication and teamwork. The recognition scores on the second level index were 4.18-4.61, and the proportion of recognition scores greater than 4 was over 80%. There were significant differences in the recognition scores of the index system among assistant physicians with different working years, educational background, professional title and work unit ( F/H=6.41, 14.83, 12.45, 7.53, P<0.01). Educational background(associate degree: B=0.091, P=0.015; bachelor degree and above: B=0.196, P<0.001) and professional title(intermediate professional title and above: B=-0.234, P<0.001) were the independent factors influencing the recognition degree of the index system for rural general practice assistant physicians. Conclusions:The post competency index system is generally recognized by rural general practice assistant physician, and academic qualifications and professional title status may influence its recognition.

Objective:To evaluate the application feasibility of the post competency index system of rural general practice assistant physicians, and to analyze and compare the post competency of rural general practice assistant physicians with different characteristics through a survey among rural general practice assistant physicians in China.Methods:This study was a cross-sectional study. A questionnaire survey was conducted among rural general practice assistant physicians in 10 provinces/municipalities selected by stratified cluster sampling method from October 2020 to September 2021. The post competency scores were self-evaluated based on the post competency index system of rural general practice assistant physicians. The results of the survey were analyzed and the application feasibility of the index system was evaluated.Results:A total of 1 123 questionnaires were distributed and 1 024 valid questionnaires were returned with a recovery rate of 91.2%. Of the 1 024 respondents, 529 were males (51.7%), 435 were aged 40-49 years (42.5%), 434 had a secondary school education or less (42.4%), and 531 were junior practitioners (51.9%). The Cronbach′s α coefficient of the overall questionnaire was 0.987, and the Cronbach′s α coefficient of the first level index ranged from 0.897 to 0.974. The cumulative variance contribution rate of exploratory factor analysis was 72.012%. The confirmatory factor analysis showed χ2/ df=3.926, RMSEA=0.076, CFI=0.858, IFI=0.859, indicating that the model fit was basically good. The average self-evaluation scores of the first level index ranged from 3.95 to 4.25, and the average self-evaluation scores of the second level index ranged from 3.74 to 4.36. There were significant differences in self-evaluation scores of post competency among rural general practice assistant physicians with different working years, professional titles, working units and economic regions( F=4.67, 10.54, 22.16 and 20.90,all P<0.05). People with low self-evaluation scores of post competency had the following characteristics: working 10-19 years, intermediate or above titles, working in community health service centers, located in the eastern region.People with high self-evaluation scores of post competency had the following characteristics: primary professional title, working in the village clinic. Conclusion:The competency index system of rural general practice assistant physicians has good application feasibility,and it can be used to evaluate post competency for the education and training of rural general practice assistant physicians.