Objective To investigate the supporting policies of assistant general practioner training program (3 + 2 mode) in Shanghai.Methods Total 53 subjects were involved in 15 in-depth interviews and 5 focus group discussions held from October 2012 to October 2013,including 8 graduates from the specialty of country doctor of Shanghai Institute of Health Sciences,12 country doctors,2 leaders of 3 + 2 mode training hospital,5 leaders of rural community health centers,3 leaders of Shanghai Institute of Health Sciences,9 leaders of Commission of Health and Family Planning in Shanghai suburbs,3 leaders of Shanghai Municipal Commission of Health and Family Planning,1 leader of National Health and Family Planning Commission.Results Three leaders of Shanghai Municipal Commission of Health and Family Planning admitted the training program involved multiple departments and there were no unified supporting policies,2 leaders of Commission of Health and Family Planning in Shanghai suburbs thought the enrollment amount should be appropriately controlled.The exploration of social person (non-formal employees)mode was encouraged by the leaders of Shanghai Municipal Commission of Health and Family Planning.Leaders of rural community health centers strongly recommended to increase the selection and withdrawal mechanism to ensure the quality of students and training.Three leaders of rural Commission of Health and Family suggested to enroll student from other provinces.Leaders of rural community health centers and Shanghai Municipal Commission of Health and Family Planning agreed that qualifying as assistant general practioner was an important target of training which should be obtained before graduation.All 3 + 2 mood trainees had a strong expectation to get a bachelor degree at the same time of completing the training.Leaders of Shanghai Municipal Commission of Health and Family Planning and 3 + 2 mode training hospitals proposed to pay attention to the construction of training base and teacher training.About one third of the 3 + 2 mood trainees,graduates from the specialty of country doctor of Shanghai Institute of Health Sciences and country doctors hoped to get more space for development.Leaders of rural community health centers and Shanghai Municipal Commission of Health and Family Planning considered that the qualification of assistant general practioner should be the minimal recruitment for recruitment of new medical personel.Leaders of Shanghai Institute of Health Sciences and 3 + 2 mode training hospital suggested the relevant departments to support the new country doctors in terms of income,promotion policies and so on.Conclusions The supporting policies of the pilot 3 + 2 training in Shanghai are imperfect.It can be improved from organization,management,training implementation and career development.Effective support policies can help to generalize the 3 + 2 training.

Objective To evaluate the effects of dexmedetomidine on perioperative pulmonary compliance and the expression of Toll?like recep?tor(TLR)?2 and TLR?4 in the peripheral blood during perioperative period in patients undergoing open colorectal cancer radical surgery. Meth?ods Twenty patients with colorectal cancer underwent elective general anesthesia,with ASA gradeⅠ?Ⅱand body mass index(BMI)<30 kg/m2, aged 30 to 68 years old,were enrolled for the study. They were randomly divided into control group(group C,n=10)and dexmedetomidine group (group D,n=10). In group D,dexmedetomidine was infused at a rate of 0.4μg·kg-1·h-1 from the beginning of surgery till 30 min before the end of surgery. The patients in group C received same manipulation as in group D except dexmedetomidine was replaced by normal saline. The mean ar?terial pressure(MAP)and heart rate(HR)were recorded before anesthesia induction(T0),30 min(T2),60 min(T3),and 90 min(T4)after the beginning of surgery,extubation(T6),and 3 min after extubation(T7). Airway pressure and lung dynamic compliance were recorded at T1?T7 time points,respectively. Vein blood samples were drawn to analyze the TLR?2,TLR?4 and tumor necrosis factorα(TNF?α)concentration at T0,T4,T7 and the day after operation(T8),respectively. Results Compared with group C,MAP and HR increased in group D at T6(P<0.05);lung dynamic compliance increased in group D at T4(P<0.05);TLR?2 and TLR?4 concentration in serum decreased in group D at T4, T7 and T8(P<0.05);TNF?αconcentration in serum decreased in group D at T4,T7 and T8(P<0.05). Conclusion Continuous infusion of 0.4μg·kg-1·h-1 dexmedetomidine can help to stabilize hemodynamics,relieve inflammatory stress response,maintain the relative stability of intra?operative hemodynamic parameters,and also can improve the pulmonary dynamic compliance of patients.

China ; epidemiology ; Humans ; Incidence ; Liver Neoplasms ; epidemiology ; mortality

Postoperative delirium is one of the most common postoperative complications in elderly patients,and its pathogeny is related to many factors.Up to now,the neural basis of postoperative delirium is unclear, and whether it will develop to Alzheimer's disease is controversial. Magnetic resonance imaging (MRI), as a noninvasive and quantitative method for the analysis of brain structures and functions,has been gradually applied to a variety of neuropsychopathic disorders in recent years.The purpose of this study is to investigate the use of MRI in the studies of postoperative delirium.

Objective:To evaluate the effect of panaxydol on ventilator-induced lung injury(VILI) in mice, and the relationship with Kelch-like ECH-associated protein 1 (Keap1)/nuclear factor E2-related factor 2 (Nrf2) signaling pathway.Methods:Fifty healthy clean-grade male C57BL/6 mice, aged 6-8 weeks, weighing 20-25 g, were divided into 5 groups ( n=10 each) using a random number table method: control group (group C), VILI group, low-dose panaxydol group (L-PX group, 5 mg/kg), medium-dose panaxydol group (M-PX group, 10 mg/kg) and high-dose panaxydol group (H-PX group, 20 mg/kg). The corresponding doses of panaxydol were intraperitoneally injected for 7 consecutive days once a day in L-PX group, M-PX group and H-PX group. The equal volume of normal saline was given instead in C group and VILI group. Only tracheotomy was performed and animals kept spontaneous breathing for 4 h in group C, and the animals were mechanically ventilated (tidal volume 30 ml/kg, respiratory rate 70 breaths/min, inspiratory/expiratory ratio 1∶2, fraction of inspired oxygen 21%) for 4 h in VILI, L-PX, M-PX and H-PX groups. Blood samples from the femoral artery were collected for arterial blood gas analysis at 4 h of ventilation, and PaO 2 was recorded. The mice were then sacrificed under deep anesthesia, and bronchoalveolar lavage fluid (BALF), lung tissues and serum samples were collected. The concentrations of TNF-α and IL-1β in BALF and serum were measured by enzyme-linked immunosorbent assay. The wet/dry lung weight (W/D) ratio was measured, the protein concentrations in BALF were measured by bicinchoninic acid assay, the pathological changes of lung tissues were examined by HE staining, lung injury was scored, and the level of ROS in lung tissues was detected by DCFH-DA fluorescence probe.The expression of Keap1 and Nrf2 in lung tissues was detected by Western blot. Results:Compared with group C, the PaO 2 was significantly decreased, the lung injury score, W/D ratio, protein concentrations in BALF and concentrations of TNF-α and IL-1β in BALF and serum were increased, the expression of Keap1 and Nrf2 was up-regulated, and the fluorescence of ROS was enhanced in the other four groups ( P<0.05). Compared with group VILI, PaO 2 was significantly increased, the lung injury score was decreased, lung W/D ratio, protein concentrations in BALF, and concentrations of TNF-α and IL-1 β in BALF and serum were decreased, and the fluorescence of ROS was weakened in L-PX, M-PX, and H-PX groups, and the expression of Keap1 was down-regulated, the fluorescence of ROS was weakened, and the expression of Nrf2 was up-regulated in M-PX and H-PX groups ( P<0.05). Compared with group L-PX, PaO 2 was significantly increased, the lung injury score, W/D ratio, protein concentrations in BALF and concentrations of TNF-α and IL-1β in BALF were decreased, the expression of Keap1 was down-regulated, and the expression of Nrf2 was up-regulated and the fluorescence of ROS was weakened in M-PX and H-PX groups ( P<0.05). Compared with group M-PX, PaO 2 was significantly increased, the lung injury score, W/D ratio, protein concentrations in BALF and concentrations of TNF-α and IL-1β in BALF were decreased, the expression of Keap1 was down-regulated, the expression of Nrf2 was up-regulated, and the fluorescence of ROS was weakened in H-PX group( P<0.05). Conclusions:Panaxydol can reduce VILI in mice, and the mechanism may be related to activation of the Keap1/Nrf2 signaling pathway and inhibition of oxidative stress.

OBJECTIVE To investigate the improve-ment functions of flavonoid compounds on temozolomide(TMZ)-,aging-or AD model-induced dysregulation of hip-pocampal NSC lineage progression,retardancy of den-dritic spine maturation in new-born neurons,as well as impairment of hippocampal-related learning and memory.METHODS We applied 30-week-old neural stem cell(NSC)specific promoter Nestin-GFP and NestinCreERT2:Rosa26-LSL-tdTomato transgenic mice and 16-week-old AD model 5XFAD transgenic mice,together with hippo-campal microinjection(ih),endogenous fluorescence trac-ing and immunofluorescent staining.RESULTS Both fla-vonoid compound A and its functional derivative flavo-noid compound B dose-dependently improved TMZ-,aging-or AD-induced defects of hippocampal NSC lin-eage progression and the maturation of dendritic spines of newborn neurons,thereby improving hippocampus related learning and memory.CONCLUSION This paper provides a new idea and treatment strategy for the devel-opment of new flavonoids that can promote neurogene-sis for neurodegenerative diseases and aging.

Objective To evaluate the effects of laparoscopic splenectomy and esophagogastric devascularization(LSPD) vs.open procedure(OSPD) on stress and immune function in patients with portal hypertension due to cirrhosis.Methods From June 2015 to June 2017 a total of 66 patients underwent LSPD or OSPD procedures.Results Plasma cortisol concentration in the LSPD group was lower than that in the OSPD group (Fgroup =18.85,P =0.020).Cortisol concentration in the two groups increased firstly and then decreased with time extension (Ftime =532.08,P =0.000).The level of CD3 +,CD4 +,CD4 +/CD8 + in LSPD group was higher than that in OSPD group,and the level of CD8 + was lower than that in OSPD group (Fgroup =3.55,21.47,154.84,64.29,P ＜ 0.05),the levels of CD3 +,CD4 + and CD4 +/CD8 + in the two groups first decreased and then increased with the extension of time,and the levels of CD8 + increased firstly and then decreased (Ftime =199.22,298.48,864.33,510.23,P ＜ 0.05),the increase range of CD3 +,CD4 +,and CD4 +/CD8 + in LSED group was higher than that in OSPD group (Finteraction =19.27,18.21,79.55,35.21,P ＜ 0.05);there was no statistical significance in the complications such as:rebleeding,thrombosis and splenic fever in the two groups (x2 =0.05,0.67,0.07,0.16,P=0.829,0.413,0.789,0.693).But the postoperative chest/cavity effusion and fever (＞ 38.0 ℃,and ＞ 3 days) is OSPD group is higher than in the LSPD group(x2 =5.49,6.68,P =0.019,0.010).Conclusion LSPD effectively reduces postoperative stress,protects immune function,decreases postoperative pleural and abdominal effusion and fever.

Objective To evaluate the role of tumor budding in the prognostic value of intrahepatic cholangiocarcinoma(ICC) after radical resection.Methods The clinicopathological data of patients undergoing radical resection for intrahepatic cholangiocarcinoma between 2011 and 2016 were retrospectively analyzed.The number of tumor budding was counted in a ×200 microscopic field (0.785mm2).Based on receiver operation curve (ROC),the number of tumor budding ≥ 15 was defined as high-grade group,and ＜ 15 was low-grade group.Multivariate analysis were performed on predictors of the tumor.Results Low-grade group was observed in 32 cases and high-grade group in 50.High-grade group appeared to develop tumors with higher CA199,poor differentiation,larger tumor diameter,advanced stage and high risks of lymphnode metastasis (respectively x2 =5.470,4.359,5.101,4.696,5.960,all P ＜ 0.05).Univariate analysis showed that tumor budding,CA199,differentiation,tumor diameter,T classification and lymphnode metastasis were related to the overall survival of patients with ICC (respectively x2 =11.704,4.876,5.056,5.152,8.442,16.725,all P ＜ 0.05).On multivariable analysis,high-grade group was a significant independent predictor of worse OS (HR =2.707 95％ CI 1.558-4.705,P ＜ 0.001).Conclusions High-grade tumor budding is an important negative prognostic factor for ICC.

Objective Based on Chinese guidelines for the management of ischemic stroke, a standardized stroke management program was performed to provide intensive education and training for medical physicians, aiming to enhance their knowledge and ability for ischemic stroke prevention and treatment, thereby reducing patients′ in-hospital cost and length of stay, and improving patients′ clinical prognosis. Methods This study was conducted in 20 general hospitals throughout Hainan province. A total of 163 physicians from 20 hospitals involved in the management of stroke patients were trained by highly experienced physicians based on the Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2014 and the Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack 2014. Prior to and post the standardized stroke management training, the data of 3218 and 3367 patients with ischemic stroke were respectively collected. Quality of life assessments including the Barthel index (BI) and the modified Rankin Scale (mRS) score of all patients were recorded at baseline and after discharge. The length of stay and in-hospital cost were directly collected from the hospital information system. Results Physicians′ knowledge and ability manifested as testing scores were significantly improved after training (78.2 ± 15.5 vs 55.6 ± 10.7, t=69.1, P<0.01). The average length of stay of post-training patients was significantly shorter than that of pre-training patients ((8.7 ± 0.9) vs (11.7 ± 1.5) days, t=97.9, P<0.01). The average in-hospital cost of post-training patients was significantly less than that of pre-training patients ((7681.7 ± 1397.7) vs (11846.2 ± 2514.6) Yuan, t=82.5, P<0.01). Both BI (68.2 ± 3.2 vs 43.5 ± 5.3, t=227.7, P<0.01) and mRS score (2.74±0.51 vs 3.65±0.71, t=59.5, P<0.01) were significantly improved for post-training patients. Multivariate linear regression analysis illustrated that standardized stroke management was negatively associated with in-hospital cost (r=-0.461, P<0.01), length of stay (r=-0.357, P<0.01) and mRS score (r=-0.298, P<0.01), and was positively associated with levels of BI (r=0.376, P<0.01). Conclusion Standardized stroke management program might be a cost-effective choice for the management of ischemic stroke as it reduces the in-hospital cost and improves patients′BI and mRS levels.

Alzheimer's disease （AD） is the most common form of senile dementia， and its pathogenesis is still unclear. While β-amyloid （Aβ） is considered an important cause of AD， the pathological mechanism of Aβ inducing AD is subject to various controversies. Recent studies have shown that the myeloid cell trigger receptor （TREM2） plays an important role in the pathological process of AD， and it can not only serve as an important receptor for the internalization of Aβ but also become a biological diagnostic biomarker and therapeutic target. Hence， elucidating the structure and function of TREM2 will provide important ideas for the prevention and treatment of AD. This article will provide a systematic review of the structure of TREM2， its impact on microglial cell function， its pathological role in AD， and the current status of targeted TREM2 therapy for AD. These summaries will provide valuable references for basic research on AD.