Objective:To evaluate the effectiveness of a rotation training program for primary care general practitioners (GPs) in Taizhou, China, designed around three core competencies.Methods:A longitudinal study was conducted. A total of 111 primary care GPs participating in the 1st to 5th sessions of the Taizhou GP rotation training program at Taizhou Hospital (the designated training center) in Zhejiang Province from July 2022 to December 2024 were included. Based on the World Organization of Family Doctors (WONCA) competency model, combined with literature review and expert consultation, 15 potential training components were identified. A needs assessment survey among primary care GPs was then conducted, leading to the finalization of three core competencies for the training: ①Evidence-based management of common diseases, frequently-occurring diseases, and common symptoms; ②Early identification, management, and referral of critically ill patients; ③Chronic disease management and health promotion capabilities. A 4-month full-time immersion training program was structured around these competencies, comprising three phases: theoretical training (1 week), clinical comprehensive skills training (14 weeks), and primary care practice training (1 week). Assessments included a pre-and post-training theoretical knowledge test and a final clinical assessment. The final assessment utilized a three-station Objective Structured Clinical Examination (OSCE) evaluating patient consultation, clinical reasoning & decision-making, and clinical procedural skills. A self-administered satisfaction survey was also distributed post-training.Results:The 111 participants were predominantly aged 30-49 years (72.1% (80/111)), held bachelor′s degrees (87.4% (97/111)), were licensed physicians (78.4% (87/111)), and had junior or intermediate professional titles (87.4% (97/111)). Post-training theoretical scores were significantly higher than pre-training scores (76.26±7.00 vs. 69.94±6.40, t=-10.45, P<0.001). All participants 100%(111/111) passed the final OSCE assessment. The mean scores for the OSCE stations were: patient consultation 85.99±7.30, clinical reasoning & decision-making 82.72±7.61, and clinical procedural skills 89.60±5.65. Satisfaction rates were 100.0% (111/111) for the overall program, the three-phase design, the core competency training content, theoretical training, clinical skills training, and clinical rotation departments. Satisfaction was 98.2% (109/111) for the 4-month full-time duration, 99.1% (110/111) for the "2+X" clinical rotation model (2 weeks each in General Practice and Emergency Medicine+elective rotations in 4 other departments), and 97.3% (108/111) for the primary care practice base. Conclusions:The competency-based rotation training program for primary care GPs in Taizhou effectively enhanced participants′ theoretical knowledge and clinical practical skills, and achieved high levels of participant satisfaction. This model offers valuable insights for optimizing primary care GP training in similar settings.

Objective:To investigate the clinical effect of local injection of triamcinolone acetonide acetate combined with ultra-pulsed CO 2 fractional laser in the treatment of hypertrophic scars in children. Methods:A randomized controlled study method was used. According to the inclusion and exclusion criteria, the subjects were selected from children with hypertrophic scars admitted to the Children’s Hospital Affiliated to Shandong University from January 2022 to September 2023, and were divided into control group and experimental group using random number table method. The control group was treated with ultra-pulsed CO 2 fractional laser. The experimental group was injected with triamcinolone acetonide acetate injection at multiple points into the scar (the ratio of triamcinolone acetonide acetate injection to 2% lidocoin hydrochloride injection was 1∶1), with a distance between the points as 1 cm, and the injection dose was about 0.1 to 0.2 ml/cm 2 according to the degree of scar protrusion. The maximum dose each time was ≤40 mg. CO 2 fractional laser treatment was performed after 10 minutes of cold compress with ice bag. Scars in both groups were treated 3 times, with an interval of 2 to 3 months. Before the treatment and 6 months after the last treatment, the Vancouver scar scale (VSS) was performed on both groups of scars score, the total score was 0 - 15. The higher the score, the more serious the scar hyperplasia was. Six months after the last treatment, the scar treatment effects of the two groups were comprehensively evaluated and divided into 3 levels: markedly effective, effective and ineffective. The total effective rate =(markedly effective + effective) number of cases/total number of cases ×100%. Patient satisfaction was investigated 6 months after the last treatment and divided into 5 levels: very satisfied, satisfied, average, dissatisfied, and very dissatisfied. Satisfaction rate =(very satisfied + satisfied) number of cases/total number of cases ×100%. The occurrence of adverse reactions was recorded throughout the treatment process. Analysis was performed using SPSS 19.0 software. Measurement data were expressed as Mean±SD, inter-group comparisons were performed using independent samples t-test, intra-group comparisons were performed using paired t-test, counting data were expressed as examples and percentages, and comparisons between the two groups were performed using χ2 test. P<0.05 indicated that the difference was statistically significant. Results:A total of 82 children with hypertrophic scars were included, 33 males and 49 females, aged 1 to 15 years old, with an area of 5 to 45 cm 2. The pathogenic factors were trauma, burns, and surgery. The course of disease was 2 to 30 months. Among them, 41 patients in the control group, 16 males and 25 females; the age was (5.8±1.6) years; 41 patients in the experimental group, 17 males and 24 females, the age was (5.6±1.5) years. There were no significant differences in age, gender, scar area, pathogenic factors and course of disease between the two groups ( P>0.05). There was no significant difference in VSS scores between the experimental group and the control group before the treatment [(9.42±1.35) points vs. (9.06±1.57) points, P>0.05]. Six months after the last treatment, there was a significant difference in VSS scores between the experimental group and the control group [(4.12±0.56) points vs. (5.50±0.75) points, P<0.01]. The VSS scores of children in both groups were significantly lower than those before the treatment ( P<0.01). Six months after the last treatment, the comprehensive evaluation result showed that the total effective rate in the experimental group was higher than that in the control group [92.7%(38/41) vs. 75.6%(31/41), P<0.05]. Six months after the last treatment, the patient satisfaction survey showed that the satisfaction rate in the experimental group was higher than that in the control group [87.8%(36/41) vs. 58.5%(24/41), P<0.01]. The main adverse reactions during treatment included edema erythema, skin ruptures, skin atrophy, and vigorous hair growth. There was no significant difference in the incidence of adverse reactions between the experimental group and the control group [12.2%(5/41) vs. 7.3%(3/41), P>0.05]. Conclusion:Local injection of triamcinolone acetonide acetate combined with ultra-pulsed CO 2 fractional laser is more effective in treating children’s hypertrophic scars. It can significantly improve the appearance of scars, reduce clinical symptoms, with fewer adverse reactions, and high patient satisfaction.

Objective:To evaluate the effectiveness of a rotation training program for primary care general practitioners (GPs) in Taizhou, China, designed around three core competencies.Methods:A longitudinal study was conducted. A total of 111 primary care GPs participating in the 1st to 5th sessions of the Taizhou GP rotation training program at Taizhou Hospital (the designated training center) in Zhejiang Province from July 2022 to December 2024 were included. Based on the World Organization of Family Doctors (WONCA) competency model, combined with literature review and expert consultation, 15 potential training components were identified. A needs assessment survey among primary care GPs was then conducted, leading to the finalization of three core competencies for the training: ①Evidence-based management of common diseases, frequently-occurring diseases, and common symptoms; ②Early identification, management, and referral of critically ill patients; ③Chronic disease management and health promotion capabilities. A 4-month full-time immersion training program was structured around these competencies, comprising three phases: theoretical training (1 week), clinical comprehensive skills training (14 weeks), and primary care practice training (1 week). Assessments included a pre-and post-training theoretical knowledge test and a final clinical assessment. The final assessment utilized a three-station Objective Structured Clinical Examination (OSCE) evaluating patient consultation, clinical reasoning & decision-making, and clinical procedural skills. A self-administered satisfaction survey was also distributed post-training.Results:The 111 participants were predominantly aged 30-49 years (72.1% (80/111)), held bachelor′s degrees (87.4% (97/111)), were licensed physicians (78.4% (87/111)), and had junior or intermediate professional titles (87.4% (97/111)). Post-training theoretical scores were significantly higher than pre-training scores (76.26±7.00 vs. 69.94±6.40, t=-10.45, P<0.001). All participants 100%(111/111) passed the final OSCE assessment. The mean scores for the OSCE stations were: patient consultation 85.99±7.30, clinical reasoning & decision-making 82.72±7.61, and clinical procedural skills 89.60±5.65. Satisfaction rates were 100.0% (111/111) for the overall program, the three-phase design, the core competency training content, theoretical training, clinical skills training, and clinical rotation departments. Satisfaction was 98.2% (109/111) for the 4-month full-time duration, 99.1% (110/111) for the "2+X" clinical rotation model (2 weeks each in General Practice and Emergency Medicine+elective rotations in 4 other departments), and 97.3% (108/111) for the primary care practice base. Conclusions:The competency-based rotation training program for primary care GPs in Taizhou effectively enhanced participants′ theoretical knowledge and clinical practical skills, and achieved high levels of participant satisfaction. This model offers valuable insights for optimizing primary care GP training in similar settings.

Objective:To investigate the clinical effect of local injection of triamcinolone acetonide acetate combined with ultra-pulsed CO 2 fractional laser in the treatment of hypertrophic scars in children. Methods:A randomized controlled study method was used. According to the inclusion and exclusion criteria, the subjects were selected from children with hypertrophic scars admitted to the Children’s Hospital Affiliated to Shandong University from January 2022 to September 2023, and were divided into control group and experimental group using random number table method. The control group was treated with ultra-pulsed CO 2 fractional laser. The experimental group was injected with triamcinolone acetonide acetate injection at multiple points into the scar (the ratio of triamcinolone acetonide acetate injection to 2% lidocoin hydrochloride injection was 1∶1), with a distance between the points as 1 cm, and the injection dose was about 0.1 to 0.2 ml/cm 2 according to the degree of scar protrusion. The maximum dose each time was ≤40 mg. CO 2 fractional laser treatment was performed after 10 minutes of cold compress with ice bag. Scars in both groups were treated 3 times, with an interval of 2 to 3 months. Before the treatment and 6 months after the last treatment, the Vancouver scar scale (VSS) was performed on both groups of scars score, the total score was 0 - 15. The higher the score, the more serious the scar hyperplasia was. Six months after the last treatment, the scar treatment effects of the two groups were comprehensively evaluated and divided into 3 levels: markedly effective, effective and ineffective. The total effective rate =(markedly effective + effective) number of cases/total number of cases ×100%. Patient satisfaction was investigated 6 months after the last treatment and divided into 5 levels: very satisfied, satisfied, average, dissatisfied, and very dissatisfied. Satisfaction rate =(very satisfied + satisfied) number of cases/total number of cases ×100%. The occurrence of adverse reactions was recorded throughout the treatment process. Analysis was performed using SPSS 19.0 software. Measurement data were expressed as Mean±SD, inter-group comparisons were performed using independent samples t-test, intra-group comparisons were performed using paired t-test, counting data were expressed as examples and percentages, and comparisons between the two groups were performed using χ2 test. P<0.05 indicated that the difference was statistically significant. Results:A total of 82 children with hypertrophic scars were included, 33 males and 49 females, aged 1 to 15 years old, with an area of 5 to 45 cm 2. The pathogenic factors were trauma, burns, and surgery. The course of disease was 2 to 30 months. Among them, 41 patients in the control group, 16 males and 25 females; the age was (5.8±1.6) years; 41 patients in the experimental group, 17 males and 24 females, the age was (5.6±1.5) years. There were no significant differences in age, gender, scar area, pathogenic factors and course of disease between the two groups ( P>0.05). There was no significant difference in VSS scores between the experimental group and the control group before the treatment [(9.42±1.35) points vs. (9.06±1.57) points, P>0.05]. Six months after the last treatment, there was a significant difference in VSS scores between the experimental group and the control group [(4.12±0.56) points vs. (5.50±0.75) points, P<0.01]. The VSS scores of children in both groups were significantly lower than those before the treatment ( P<0.01). Six months after the last treatment, the comprehensive evaluation result showed that the total effective rate in the experimental group was higher than that in the control group [92.7%(38/41) vs. 75.6%(31/41), P<0.05]. Six months after the last treatment, the patient satisfaction survey showed that the satisfaction rate in the experimental group was higher than that in the control group [87.8%(36/41) vs. 58.5%(24/41), P<0.01]. The main adverse reactions during treatment included edema erythema, skin ruptures, skin atrophy, and vigorous hair growth. There was no significant difference in the incidence of adverse reactions between the experimental group and the control group [12.2%(5/41) vs. 7.3%(3/41), P>0.05]. Conclusion:Local injection of triamcinolone acetonide acetate combined with ultra-pulsed CO 2 fractional laser is more effective in treating children’s hypertrophic scars. It can significantly improve the appearance of scars, reduce clinical symptoms, with fewer adverse reactions, and high patient satisfaction.

OBJECTIVE To synthesize a polymer PEI-ss-PEG2000-DSPE containing disulfide bond and to prepare as cationic micelle(P-ss-PD) based on branched polyethyleneimine(PEI). To investigate the ability of P-ss-PD micelle to reduce cytotoxicity and improve the transfection efficiency of antisense oligonucleotide(ASO) in human breast cancer cell lines, and to study the anti-tumor effect of P-ss-PD micelle in nude mice. METHODS PEI-ss-PEG2000-DSPE was synthesized by grafting PEG2000-DSPE onto branched PEI with disulfide bond as a connecting arm. P-ss-PD micelle was prepared by ethanol injection method and P-ss-PD/ASO nanocomplex was obtained by combining P-ss-PD micelle with ASO. The particle size and zeta potential of P-ss-PD/ASO nanocomplex at various mass ratios were determined by laser particle size analyzer. Agarose gel retardation assay was used to investigate the binding degree of P-ss-PD/ASO nanocomplex and determine the optimal mass ratio. At the same time, the reduction responsive ability of P-ss-PD micelle was investigated. The cytotoxicity of P-ss-PD micelle was detected by CCK8 kit. The transfection efficiency of P-ss-PD micelle was investigated by flow cytometry and high content cell imaging analysis system in MDA-MB-231 cells. The anti-tumor effect of P-ss-PD micelle was investigated by tumor-bearing nude mice models. RESULTS When the mass ratio was 300∶1, the particle size of P-ss-PD/ASO nanocomplex was the smallest and had a good stability. The average particle size was (58.90 ± 4.08)nm, the average zeta potential was (16.80 ± 1.23)mV, and the morphology was uniform spherical. P-ss-PD/ASO nanocomplex had the reduction responsive ability and could release ASO under highly reductive conditions.In vitro, compared with unmodified branched PEI, the cytotoxicity of P-ss-PD micelle was significantly reduced and the transfection efficiency was significantly increased.In vivo, the tumor growth inhibition rate of P-ss-PD/ASO nanocomplex in tumor-bearing nude mice was more than 50%. CONCLUSION The P-ss-PD micelle prepared in this study is a kind of low toxicity and high transfection efficiency non-viral vector, which has the characteristics of reduction responsive releasing, and shows a promising application in ASO drug delivery.

Methods: (i) Animal experiments. This study conducted experiments using specific pathogen-free (SPF) grade male C57BL/6J wild-type (WT) mice and APP/PS1 double transgenic mice. The animals were divided into three groups: WT group (WT mice, n = 5, receiving distilled water daily), APP/PS1 group (APP/PS1 double transgenic mice, n = 5, receiving distilled water daily), and BSTSD group [APP/PS1 double transgenic mice, n = 5, treated with BSTSD suspension at a dosage of 27 g/(kg·d) for 90 d]. Cognitive function was assessed using the Morris water maze (MWM). Post-experiment, hippocampal tissues were collected for analysis of pyramidal cell and synaptic morphology through hematoxylin-eosin (HE) staining and transmission electron microscopy (TEM). (ii) Cell experiments. The HT-22 cells were divided into control group (untreated), Aβ25-35 group (treated with 20 μmol/L Aβ25-35 for 24 h), icariin group (pre-treated with 20 μmol/L icariin for 60 min, followed by 20 μmol/L Aβ25-35 for an additional 24 h), and icariin + LY294002 group [treated with 20 μmol/L icariin and 20 μmol/L LY294002 (an inhibitor of the phosphoinostitide 3-kinases (PI3K) signaling pathway) for 60 min, then exposed to 20 μmol/L Aβ25-35 for 24 h], and cell viability was measured. Western blot was used to detect the expression levels of synapse-associated proteins [synaptophysin (SYP) and postsynaptic density-95 (PSD-95)] and PI3K signaling pathway associated proteins [phosphorylated (p)-PI3K/PI3K, p-protein kinase B (Akt)/Akt, and p-mechanistic target of rapamycin (mTOR)/mTOR]. Results: (i) Animal experiments. Compared with APP/PS1 group, BSTSD group showed that escape latency was significantly shortened (P < 0.01) and the frequency of crossing the original platform was significantly increased (P < 0.01). Morphological observation showed that pyramidal cells in the hippocampal CA1 region were arranged more regularly, nuclear staining was uniform, and vacuole-like changes were reduced after BSTSD treatment. TEM showed that the length of synaptic active zone in BSTSD treatment group was increased compared with APP/PS1 group (P < 0.01), and the width of synaptic gap was decreased (P < 0.01). (ii) Cell experiments. Icariin had no obvious toxicity to HT-22 cells when the concentration was not more than 20 μmol/L (P > 0.05), and alleviated the cell viability decline induced by Aβ25-35 (P < 0.01). Western blot results showed that compared with Aβ25-35 group, the ratios of p-PI3K/PI3K, p-Akt/Akt and p-mTOR/mTOR in icariin group were significantly increased (P < 0.01), while the protein expression levels of SYP and PSD-95 were increased (P < 0.01). These effects were blocked by LY294002 (P < 0.01). Conclusion BSTSD and icariin enhance cognitive function and synaptic integrity in AD models and provide potential therapeutic strategies through activation of the PI3K/Akt/mTOR pathway.

OBJECTIVE To investigate the improvement effects of 3，5，6，7，8，3′，4′-heptamethoxyflavone （HMF） of Fructus Aurantii on rats with damp blockage of the middle energizer. METHODS The rats were randomly divided into normal group， model group， positive control group （Raceanisodamine tablet， 1 mg/kg）， HMF low-dose， medium-dose and high-dose groups （0.3， 0.6， 0.9 mg/kg）， with 7 rats in each group. Except for the normal group， the other groups were modeled by internal and external composite factors. After successful modeling， the rats in each group were given the corresponding drug or normal saline， once a day， for 14 days. The general behavioral states such as dietary intake， water intake and mental state of the rats were observed， and the fecal water content rate and saliva flow rate were measured. Hematoxylin-eosin （HE） staining was used to observe the pathological and morphology in gastric and small intestinal tissues of rats. The plasma content of aldosterone was detected， and the expression of aquaporins （AQP3） in the gastric tissue of rats was determined. RESULTS Compared with the normal group， the dietary intake and water intake of the model group rats were significantly decreased （P＜0.01）， the fecal water content rate， salivary flow rate， plasma content of aldosterone and the expression of AQP3 in gastric tissue were increased significantly （P＜0.01）. Gastric tissue injury invaded the mucosal muscle layer， resulting in mucosal muscle layer rupture； pathological and morphological changes such as small intestinal villous erosion and glandular structure destruction were observed in the small intestine. Compared with the model group， the dietary intake and water intake of rats were increased in HMF groups； fecal water content rate， salivary flow rate， plasma content of aldosterone， the expression of AQP3 in gastric tissue were decreased， most of the above differences were statistically significant （P＜0.05 or P＜0.01）. The pathological and morphological changes in the gastric and small intestine tissues of rats had been improved to varying degrees. CONCLUSIONS HMF of Fructus Aurantii with dry property HMF could improve the symptoms of rats with damp blockage of middle energizer， the mechanism of which may be associated with reducing the content of plasma aldosterone and down-regulating the expression of gastric AQP3.

Objective To develop a self-assessment scale for medication literacy in patients with coronary heart disease comorbidity diabetes and to test its reliability and validity.Methods According to medication literacy theory model,the initial scale was formed through literature review,the qualitative interview and expert inquiry.Cognitive interview was used to optimize the expression of item text.421 patients with coronary heart disease comorbidity diabetes in a tertiary hospital in Zhejiang province from November 2022 to April 2023 were selected to investigate the reliability and validity of the scale by convenience sampling.Results The self-assessment scale of drug literacy for coronary heart disease comorbidity diabetes mellitus included 23 items in 5 dimensions including acquisition,understanding,communication,evaluation and calculation.The total Cronbach's α coefficient of the scale was 0.911;the retest reliability was 0.948;the average content validity index was 0.997;the correlation coefficients between each dimension and total score of the scale and the calibration scale ranged from 0.485 to 0.926.The exploratory factor analysis was employed to extract 5 common factors,and the cumulative variance contribution rate was 73.753％.Confirmatory factor analysis showed that the scale factor structure was stable.Conclusion The scale has good reliability and validity,and it can be used as an effective tool to evaluate the self-rated medication literacy level of patients with coronary heart disease comorbidity diabetes.

Objective To develop a self-assessment scale of home volume management for patients with chronic heart failure(CHF),and to test its reliability and validity.Methods With the self-care theory as the theoretical framework,the initial scale was developed through literature analysis,qualitative interview and expert consultation.A questionnaire survey was conducted on 598 patients with CHF who were treated or reviewed in a tertiary hospital in Hangzhou from September 2022 to January 2023 to test the reliability and validity of the scale.Results The exploratory factor analysis extracted 4 common factors with the cumulative variance contribution rate of 61.268％.The results of confirmatory factor analysis showed that the main evaluation indicators were all within the acceptable range of the judgment standard.The item-level content validity index ranged from 0.853 to 1.000;the scale-level content validity index/average was 0.951.The Cronbach's a coefficient,half reliability and retest reliability of the overall scale were 0.930,0.723 and 0.867,respectively.Conclusion The self-rating scale of home volume management for CHF patients has good reliability and validity,and it can effectively assess the level of home volume management for CHF patients.

Objective To explore the current situation and influencing factors of caregiver readiness of elderly patients with chronic heart failure.Methods From March 2021 to April 2022,the convenient sampling method was used to select 335 caregivers of elderly patients with chronic heart failure who were hospitalized in 6 hospitals in Hangzhou as the survey subjects.The general information questionnaire,Caregiver Readiness Scale and Caregiver Burden Scale were used to investigate the caregivers of elderly patients with chronic heart failure.Results A total of 326 valid questionnaires were collected.The score of Caregiver Readiness Scale for elderly patients with chronic heart failure was(18.88±6.36),and 61.04%of the caregivers had mild to moderate burden.The results of multiple linear regression analysis showed that the caregiver's age,education level and cumulative care time were the positive influencing factors of the caregiver readiness,and the caregiver burden was the negative influencing factor of the caregiver readiness(P＜0.001).Conclusion The caregiver readiness of elderly patients with chronic heart failure is at a medium level.Caregivers who are older,more educated,have a longer cumulative caregiving time,and have a lighter caregiving burden are more prepared.Medical staff should pay attention to the motivation of caregivers,provide professional support from multiple aspects,and reduce the burden of care,increase readiness level.