The author reviewed the development of general practice education in our country,deliberated and summarized the problems about the construction of curriculum system,the ranks of teachers and practice base in general practice education in higher medicine colleges.

Abstract: The high recurrent rate and insufficient protection of anal function in treatment of anal fistula were reviewed in this article. To solve the problems in the treatment of complex fistula-in-ano including ignorance of preoperative assessment and lack of consciousness of preserving anal function, the authors raised the countermeasures to carry out the "gold standard" of preoperative assessment and the system of medical delivery, form the new principle of incision of anal sphincters, collect the high-level evidence-based medicine proof, improve the healing rate and significantly reduce the postoperative continence disturbance, so as to develop a new guideline for the treatment of fistula-in-ano.

Objective:To investigate the application of photoplethysmogram in analyzing the fingertip pulse amplitude volume (PAV)to evaluate the endothelial function in diagnosing coronary heart disease,and to clarify its relationship with the risk factors of cardiovascular diseases.Methods:Total 409 patients with chest pain accepted coronary angiography (CAG)were selected and diveded into positive group (CAG+)(n=288)and negative group (CAG-) (n = 121)according to angiographic results.Fingertip photoplethysmogram was used to analyze the fingertip PAV by the way of applying endothelial function diagnostic after reactive ischemia,and the relationship between the PAV value and the risk factors of coronary heart diseases was analyzed,and the critical reference value of prediction index of coronary heart disease was determined.The risk factors such as age,gender,serum total cholesterol (TC ), low density lipoprotein (LDL ), high density lipoprotein (HDL ), non-HDL, serum triglyceride (TG),hypertension,diabetes,smoking,family history of coronary heart disease,body mass index (BMI)of the subjects in various groups were analyzed,and the relationship between the risk factors of coronary heart disease and PAV was analyzed by Logistic regression analysis.Results:The PAV of patients in CAG+group was significantly lower than that in CAG-group (P <0.01).The peak point of PAV was<1.37,if PAV<1.37 was used to predict the coronary heart disease,the predictive sensitivity,the specificity,the positive prediction and the negative prediction were 74.65%,44.63%, 76.24%, and 42.52%.The Logistic regression analysis showed that PAV was negatively associated with hypertension,smoking history,TG (OR= 1.476,OR=2.002, OR = 1.844;P < 0.01 ). Conclusion: PAV is associated with coronary heart disease and its risk factors (hypertension,smoking history,TG),and PAV=1.37 can be used as the peak point to predict the coronary heart disease.

Objective To investigate the value of the clinical application of fetal testis transplantation with main vessel segment. Methods The testicular transplantation were performed to cure 9 patients suffered from male hyponadism with the fetal testis with main vessel segment as donor tissue. Results Except one, 8 patients had a significantly increased level of serum testosterone, the male secondary sexual characteristics and the sexual desire were improved. The size of testis was larger than before operation. Conclusion Fetal testis transplantation with main vessel segment is a effective method to cure male hyponadism and has great value of clinical application.

Objective To investigate the value of the clinical application of fetal testis for the treatment of male hypogonadism.Method We have performed the testicular transplantation to cure 6 patients suffered from hypogonadism with the fetal testis as donor.Results All patients had a significantly increased level of serum testosterone and the male secondary sexual characteristics and the sexual desire were improved.The size of testis was larger than before operation.Conclusion Testis transplantation with fetal testis as donor is an effective method to cure male hypogonadism and has great value of clinical application for its weak immunogenicity.

Objective To evaluate the expression of adhesion molecules CD62,CD63 and abnormal functional status of platelets in women with preeclmpsia and their relation to progression.Methods The expression of surface antigens CD62,CD63 in peripheral blood and functional status of platelets were measured by flow cytometry in 68 women with preeclmpsia,30 non-pregnant normal women and 52 normal pregnancy women as the controls.Results There was no significant difference among defferent stages in normal pregnant women,but the CD62,CD63 positive platelets were (7 41?1 98)%,(12 99?2 37)% and (36 52?8 92)% respectively for mild,moderate and severe preeclmpsia,it double high (P

Objective To evaluate the efficacy and influence factors of peginterferon combined with ribavirin for the treatment of elderly patients with chronic hepatitis C (CHC).Methods 34 CHC patients aged over 60 years were enrolled in this retrospective study.Virological responses,relapse rate and discontinuation rate were evaluated,and the predictive factors associated with these outcomes were analyzed.Results The proportions of rapid virological response (RVR),early virological response (EVR),end of treatment virological response(ETR),sustained virologic response (SVR) were 26.5％,41.2％,52.9％ and 35.3％,respectively in patients after peginterferon plus ribavirin theraphy,and the relapse rate was 33.3％.The relapse rate was higher in patients with the interferon treatment history than in patients with initial interferon treatment (P＜0.05).The rates of ETR and SVR were lower in CHC patients with diabetes than without diabetes (P＜0.05 or 0.01).The ratio of dose adjustment of peginterferon and ribavirin alone and in combination were 26.5％ (9/ 34),61.8％ (21/34) and 8.8％ (3/34),respectively.The discontinuation rate was 20.6％ (7/34).Multivariate Logistic regression analysis showed that SVR rate was lower in CHC patients with diabetes than in those without diabetes (P＜ 0.05).Conclusions Peginterferon plus ribavirin therapy has a better virological response,but a poor tolerance in CHC patients.Diabetes may be an important risk factor for sustained virologic response in CHC patients.

RNA interference (RNAi) is a newly developed technology. It is the different levels of gene silencing induced by specific degradation of targeted genes in vivo, and both exogenous and endogenous double-stranded RNAs could induce the specific degradation. RNAi has been applied in tumor therapy, viral infection, hepatitis B and many other diseases. siRNA is the effector molecule which induces the RNAi in vivo. But naked siRNA is easily degradated by RNases in vivo, and the half-life is short. Meanwhile, the transfection efficiency of the naked siRNA is comparatively low. So the naked siRNA needs the help of vectors to penetrate the cell membrane and take action. Viral vectors have the potential immunogenicity and mutagenicity in gene therapy. Therefore, non-viral vectors are drawing more and more attention. The latest development of the non-viral vectors is summarized in this review.

Objective To explore the effect of transabdominal posterior rectopexy with resection of the partial rectosigmoid colon on adult rectal prolapse.Methods During the 2006 to 2011,transabdominal posterior rectopexy with resection of the partial rectosigmoid colon was performed on 6 selected adult patients with complete rectal prolapse.Results All patients were cured,the median length of hospital stay was 13.7 days.Followed up for 3-61 months,there was no recurrent case.Conclusions The operation offers a safe and effective alternative to other more complex procedures for the treatment of adult rectal prolapse.The procedure can not only treat the rectosigmoid disease,but also improve the rectosigmoid disease,improve the function of bowel and reduce the recurrence rate.

Objective:To investigate the protective effects of nuclear factor ?B inhibition on liver graft reperfusion injury during transplantation.Methods:Orthotopic liver transplantation using modified cuff technique was established in rats,animals were divided according to the grafts cold storaged in 4℃ Ringer's lactated solution with(PDTC group)or without 0.1 mol/L PDTC(control group)for 6 h.During the early stage of reperfusion,DNA binding activities of NF ?B in liver grafts were analyzed by EMSA(electrophoretic mobility shift assay),mRNA level of TNF ? and ICAM 1 by RT PCR,and activities of ALT and LDH were also detected.Results:NF ?B in liver grafts was activated at early stage of reperfusion during transplantation; PDTC treated liver displayed lower activation of NF ?B 1 h after reperfusion,whereas no difference was shown between 2 groups 6 h after reperfusion.Up regulation of TNF ? and ICAM 1 transcription,high level of ALT and LDH activities were observed in both groups during reperfusion,whereas the transcriptional up regulation and the activities of ALT and LDH in PDTC group were reduced compared with those of control group( P