Objective To assess the awareness and knowledge about chronic obstructive pulmonary disease ( COPD ) among community general practitioners and general practice residency trainees in Shanghai.Methods Questionnaire was designed and used to investigate the knowledge of COPD among 59 general practitioners from 10 community health centres and 75 general practice trainees in Shanghai from July to September 2012.Results Of the 134 respondents, 49 were male and 85 were female with average age of (30.4 ±8.0) years.In the self-evaluation of “the knowledge about COPD”, “the diagnosis of COPD”,“the differential diagnosis of COPD and asthma”, “the interpretation of lung function report”, “aerosol using method”, “method about absorption apparatus”, “the side effects of bronchodilator”, “COPD rehabilitation” and “long term oxygen therapy, the rates of knowledge mastery were 61.9% ( 83/134 ) , 81.3%(108/133), 83.6% (112/134), 59.0% (79/134), 83.6% (93/134), 35.8% (48/134), 61.2%( 82/134 ) , 56.7% ( 76/134 ) and 61.2% ( 72/134 ) .Except interpretation of “lung function report”, the sores of all items in self-evaluation of the community general practitioners were higher than those of residency trainees ( all P<0.01 ) .Among the COPD related questions, the hightest accuracy rate was 93.3%(125/134) ( smoking cessation can attenuate the declined lung function) and the lowest accrurcy rate was 16.4% ( 22/134 ) ( the differential diagnosis of COPD and asthma ) .Compared with the general practice residents, community general practitioners got lower scores in question “how differentiate COPD from asthma” (6.8%vs.24.0%,χ2 =7.136, P=0.008) and got higher scores in question“the treatment of moderate COPD” (55.9%vs.30.7%,χ2 =8.655, P=0.003).More than half [56.7%(76/134)] of respondents thought that“it is necessary to develop COPD screening in community”, and 20.1%(27/134) thought that“absolutely necessary”.Conclusion The awareness and knowledge about COPD among the community general practitioners and general practice residency trainees are not satisfectory. The future training should focus on the risk factors, the differential diagnosis and treatment of COPD.

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 determine the neuronal damage or loss and gliosis at the cellular level in spinocerebellar ataxia type 3/Machado-Joseph disease(SCA3/MJD), and evaluate the potential use of neuron-specific enolase (NSE) and protein S 100 B(S100B) serum concentrations as biochemical markers. Methods Serum concentrations of NSE and S100B were measured in 102 SCA3/MJD patients and 100 healthy subjects matched by sex and age. The correlations between both markers and age, age of onset, disease duration, CAG repeat size, scores of international cooperative ataxia rating scale(ICARS), and scale for the assessment and rating of ataxia(SARA) were analyzed. Results Compared with the healthy controls, patients with SCA3/MJD had higher NSE serum concentrations [(6.95±2.83)ng/mL vs (4.83±1.70) ng/mL, P<0.05] and higher S100B serum concentrations [(0.07±0.06) ng/mL vs (0.05±0.02) ng/mL, P<0.05]. In the SCA3/MJD patients group, NSE levels presented a positive correlation with age, disease duration, ICARS scores and SARA scores, whereas S100B levels did not correlate with age, age of onset, disease duration, ICARS scores and SARA scores. CAG repeat size did not correlate with the NSE levels and S100B levels in different age groups of SCA3/MJD patients. Conclusion Serum NSE might be a useful marker to monitor disease progression and represent the degree of severity of a certain disease. Elevated S100B serum concentrations in patients compared to healthy controls may suggest an application of this protein as a peripheral marker of brain impairment in SCA3/MJD.

Objective To investigate the influence on biological characteristics in human pancreatic cancer cells after beding transfected by two anti-carcinoma miRNAs at the same time.Methods Pancreatic cancer cells PANC1,SW1990 and normal pancreatic cells AR42J were transfected by miR-34a and(or) miR-let7 by liposome.Cells transfected with negative control miRNA (miR-NC) and untransfected were as controls.The expression of miR-34a and miR-let7 were detected by real-time fluorescent quantitative RT-PCR.The cell proliferation was detected by MTT test and the migration and invasion were evaluated by transwell assay.The apoptosis rate was measured by flow cytometric analysis.Results After being transfected with miRNAs,the expression of miR-34a and miR-let7 in double transfection group (miR-34a and miR-let7 were transfected at the same time),miR-34a transfection group,miR-let7 transfection group was significantly up-regulated than those in miRNA-NC transfection group and untransfected group in PANC1 cells,SW1990 cells and AR42J cells,repectively.The difference which was statistically significant (P ＜0.05)indicating that cells were successfully transfected.The cell proliferation in double transfection group of PANC1 cells and SW1990 cells were (0.665 ± 0.01,0.6375 ± 0.03),which were significantly inhibited compared with (0.974 ± 0.03,0.971 ±0.05) in miR-NC group and (0.8875 ±0.05,0.8625 ±0.06) in miR-let7 group.The difference was statistically significant(P ＜ 0.05).The cell proliferation activity in double transfection group was lower than those in miR-34a group (0.795 ±0.06,0.7925 ±0.06),but did not have statistically significant difference.There was no significant change in AR42J cells.Cell invasion assay showed that the number of PANC1 cells permeating substrate membrane in miR34a group (103.7 ± 3.28) and miR-let7 group (100.7 ± 1.76) were significantly fewer than miR-NC group (231.3 ±2.6) and untransfected group (153.7 ±2.6).The number of cells permeating substrate membrane in double transfection group(61.67 ± 3.18)was fewer than miR-34a group and miR-let7 group,respectively.The difference was statistically significant (P ＜ 0.01).The migration test had consistent results with invasion test.The changes of invasion and migration in SW1990 cells were similar to those in PANC1 cells.The apoptosis rate of PANC1 cells in miR-34a group,miR-let7 group,double transfection group,miR-NC group and untransfected group was (16.66 ± 1.27) ％,(15.46 ± 0.33) ％,(23.35 ± 1.80) ％,(9.33 ± 0.31) ％ and (8.83 ± 0.36) ％ respectively.Single transfection group had higher apoptosis rate than miR-NC group and untransfected group (P ＜0.05).Double transfection group had a significantly higher apoptosis rate than miR-let7 group (P ＜ 0.05),while there was no significant difference between double transfection group and miR-34a group.Conclusions The cell proliferation,invasion and migration in double miRNAs transfected pancreatic cancer cells were significantly down-regulated compared with those in single miRNA transfected cells,while apoptosis rate in double miRNAs transfection group was higher than single miRNA transfection group.Thus,the combination of two anti-cancer miRNAs may exert a more significant synergistic antitumor effect.

Objective To evaluate the effectiveness of mini clinical evaluation exercise (miniCEX) in community rotation of general practice residency training.Methods Forty nine general practice residency trainees,who participated in community rotation during July 2012 to July 2014 in 3 community teaching bases,were randomly divided into two groups:25 trainees in intervention group received conventional teaching and additional 2 rounds of mini-CEX in one month,and 24 trainees received conventional teaching only.The changes of self-evaluation scores of clinical competence after the community rotation were evaluated.Focus group discussions of 8 trainees and 8 teachers from intervention group were also adopted in January to February 2013 to assess the effectiveness of mini-CEX.Results Three trainees withdrew in the study and the interventional group completed 232 mini-CEXs.The self-evaluation scores of clinical competence were elevated in all items in interventional group after community rotation (from 7.03 ± 0.68 to 7.30 ±0.77 in medical history,from 7.00 ± 0.83 to 7.18 ± 0.88 in physical examination,from 7.42 ± 1.20 to 7.52 ± 0.76 in humanistic qualities,from 6.79 ± 0.82 to 7.12 ± 0.70 in clinical judgment,from 6.85 ± 1.06 to 7.18 ± 0.81 in counseling skills,from 6.85 ± 1.15 to 7.12 ± 0.96 in organization,from 7.09 ±0.81 to 7.33 ±0.69 in overall competence),while in control group,scores of humanistic qualities (from 7.74 ± 0.89 to 7.60 ± 0.97),clinical judgment (from 6.94 ± 0.77 to 6.77 ± 1.10) and organization/efficiency (from 6.94 ± 0.96 to 6.80 ± 0.76) were declined.Mter adjusting self-evaluation score before rotation,the increased scores in clinical judgment(7.12 ±0.70 vs.6.77 ± 1.10,F =4.339,P =0.042) and organization (7.12 ± 0.96 vs.6.80 ± 0.76,F =4.336,P =0.042) of intervention group were significantly higher than those of control group.In focus group discussions both trainees and teachers recognized that mini-CEX would enhance clinical competence,be more comprehensive in assessing and adaptable in training program than former rotation tests.The major concerns of using mini-CEX were subjective rating process,non-unified rating standards and insufficient teaching ability.Conclusions Application of mini-CEX in community rotation of general practice residency training can enhance clinical competency of trainees.

Objective To study the effectsof rehabilitative training on neural function and the expression of glial fibrillary acidic protein (GFAP) and ionized calcium binding adaptor molecule-1 (Iba-1) in rats after traumatic brain injury.Methods A left hemisphere traumatic brain injury model was established in ninety Sprague-Dawley rats.They were then randomly divided into a rehabilitation training group,an immobilization group and a free-running group,with 30 rats in each group.Another thirty rats received sham injury as the shamoperated group.Beginning 4 days post-operation the rats of the rehabilitation training group were given balancing,rotating and walking exercises three times daily,15 min/time,6 d/week.The immobilization group was fixed in mesh cages.The rats of the free-running and sham-operated groups were reared in normal cages without any special training exercise.The rats of all 4 groups were given neural and motor function tests to assess the functional outcome.Immunofluorescence staining was used to evaluate the expressions of GFAP (the marker of astrocytes) and Iba-1 (the marker of microglia) in the cortex close to the iujured region at 3 days,1 week,2 weeks,3 weeks and 4 weeks after injury.Results The average neural and motor function test scores in the rehabilitation training group were significantly better than those in the immobilization and free-running groups at the 2nd week and thereafter.The average scores in the free-running group were significantly better than those in the immobilization group at the 4th week after injury.The immunofluorescence staining showed that the expression of GFAP was lowest in the rehabilitation group at the 2nd week and thereafter.Iba-1 expression was significantly lower only at the 3rd week and beyond.Conclusion Rehabilitative training can improve nerve function recovery in rats after traumatic brain injury,and the functional enhancement may be partially attributed to the downregulation of activated astrocytes and microglia.

Objective To study the main risk factors related to the incidence of tuberculosis in China and to provide di -rections and basis for the protection of tuberculosis .Methods The results of 25 studies on the main risk factors of tubercu-losis of Chinese people from 2000 to 2012 were analyzed by meta-analysis method .Results The pooled odds radio values and 95%CI of history of exposure to pulmonary tuberculosis , smoking, marriage, contact with people, Bacille Calmette-Guerin (BCG)vaccination scar, BCG vaccination, low body mass index(BMI) , family history of tuberculosis, exposure to dust and to chemical fumes under working conditions were as follows:3.14(2.74-3.59),1.23(1.14 -1.33),3.05 (2.10-4.45),2.08(1.76-2.26),0.39(0.32 -0.47),0.58(0.46 -0.73),2.95(2.40 -3.64),2.56(1.82 -3.59),2.58(2.04-3.26),and 4.81(1.99-11.60).Conclusion Then History of exposure to pulmonary tuberculosis , smoking, marriage, contact with people , low BMI, family history of tuberculosis , exposure to dust and to chemical fumes under working conditions are considered to be the risk factors of pulmonary tuberculosis .While BCG vaccination scar and BCG vaccination are considered to be the protective factors of pulmonary tuberculosis .

[Objective] To investigate the possible effect of microRNA-374 (miR-374) expression on tumor cells' proliferation and invasion and particular mechanism.[Methods] MiR-374 overexpression lentiviral vector (Lv-miR-374) and a control lentiviral empty vector (LEV) were stably transfected into human glioma U251 and U87 cells,to evaluate the effect of miR-374 on cell proliferation and invasion ability.Target relationship between miR-374 and PTTG were researched by dual luciferase report gene assay.Expression level of correlative signaling pathways of the downstream gene protein was analyzed by Western blot.[Results] We revealed that the overexpression of miR-374 dramatically suppressed glioma cell growth and invasion in vitro.Target relationship between miR-374 and PTTG was confirmed by dual luciferase report gene assay.And decreased protein expression of PTTG,bFGF,AKT,MMP2,and p70S6K was consistent with the effect of miR-374 overexpression.[Conclusion] Decreased miRNA-374 is an unfavorable prognosis marker and promotes glioma cell growth and invasion via direct targeting PTTG.Our findings provide new insights into the role of miR-374 in the development of gliomas,and implicate the potential application of miR-374 in cancer therapy.

To study the anticoagulant effect of Xiang-Qi-Tang (XQT),the mice model of endotoxemia was established to detect the expression of coagulation factors and their regulatory proteins in serum and aorta.The results showed that XQT could decrease the expression of TF and increase the expression of tPA in the aorta of mice with endotoxemia,and also decrease the expression of sEPCR in the serum.We further found that XQT caused the decrease of sEPCR through the regulation of PKC δ and ADAM17 to contribute the anticoagulation in mice.This study may provide a new strategy for treating endotoxin-induced disease and provide evidences for further researching the pharmacological action of XQT.

Objective To investigate the effect and mechanism of artesunate on renal ischemia-reperfusion injury (IRI) in rat. Methods Twenty-five SD rats were randomly divided into the sham operation group (Sham group), model group (IRI group), low-dose artesunate group (ART-L group), high-dose artesunate group (ART-H group) and NLRP3 inflammasome inhibitor group (INF39 group), with 5 rats in each group. The levels of serum creatinine (Scr), blood urea nitrogen (BUN) and pathological damage of renal tissue were analyzed. The levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in serum were quantitatively measured. The expression level of IL-1β in renal tissues was determined by immunohistochemical staining. The expression levels of pyroptosis-related proteins were detected by fluorescent staining and Western blot. Results Compared with the Sham group, the levels of Scr and BUN were higher, the renal tissue injury was aggravated, the expression levels of TNF-α, IL-6 and IL-1βwere higher, and the expression levels of kidney injury molecule (KIM-1), pyroptosis-related protein NOD-like receptor protein 3 (NLRP3), cysteinyl aspartate specific proteinase (Caspase-1), Gasdermin D (GSDMD) and IL-1β proteins were higher in the IRI group. Compared with the IRI group, the levels of Scr and BUN were decreased, the renal tissue injury was mitigated, the expression levels of TNF-α, IL-6 and IL-1β were down-regulated, and the expression levels of KIM-1, NLRP3, Caspase-1, GSDMD and IL-1β proteins were down-regulated in the ART-L, ART-H and INF39 groups. Conclusions Artesunate may inhibit pyroptosis induced by NLRP3 inflammasome, down-regulate the expression levels of pyroptosis -related proteins, reduce the release of inflammatory factors after renal IRI and alleviate renal IRI.