German family physicians practice independently in clinics, and provide primary health care services. General practitioners are a type of specialists. The basis for the self-management of German doctors is the homogeneous medical education in Germany. The new round of medical education reform emphasizes the theory and practical training throughout the entire process of medical education. All medical students in Germany need to go to the clinic for internship and be familiar with primary health care models. Post-graduation education sets rotation plans and assessment standards according to the characteristics of general practice specialties, emphasizes the clinical practice time in the clinics, and urges doctors to continue medical education through the payment of medical insurance. This article draws on the German general practitioner training model, proposes to strengthen the enlightenment of general practice education during the education of undergraduate medical colleges, and strengthen the clinical practice of general practitioners and the construction of general practice training bases, as well as improve the ability of the community physician faculties, in order to provide a reference for the training of general practitioners in China.

Objective:To investigate the expression of CXC chemokine ligand 11 (CXCL11) in gallbladder cancer (GBC) and its effect on cell proliferation and invasion.Methods:The surgically resected specimens of 47 GBC patients were collected in Lihuili Hospital Affiliated to Ningbo University from January 2017 to December 2020. There were 26 females and 21 males, with the age (62.0±8.2) years. The expression of CXCL11 protein in GBC tissues and corresponding paracancer tissues was detected by immunohistochemistry. Associations between CXCL11 expression and clinicopathological features were analyzed. After co-culturing of GBC-SD cells with exogenous CXCL11, cell counting kit-8 (CCK-8) and Transwell assays were performed to detect cell proliferation and invasion ability. The expression and phosphorylation level of phosphatidylinositol 3 kinase (PI3K) and protein kinase B (Akt) were also detected by Western blot.Results:The positive expression rate of CXCL11 in GBC tissues was significantly higher than that in adjacent paracancerous tissues [63.8% (30/47) vs 31.9% (15/47), χ 2=9.59, P=0.002]. Furthermore, CXCL11 expression was significantly associated with tumor stage (χ 2=6.64, P=0.010) and lymph nodal metastasis (χ 2=7.86, P=0.005). CCK-8 assay revealed that the proliferation ability of GBC-SD cells in CXCL11-treated group significantly increased than that in the control group (absorbance value: 0.59±0.06 vs 0.32±0.04, t=9.64, P<0.001). Transwell assay showed that the cell invasion ability in CXCL11-treated group significantly increased than that in the control group [number of transmembrane cells: (133.4±12.3) cells vs (38.6±4.4) cells, t=16.21, P<0.001]. Western blot analysis showed that the relative expression levels of phosphorylated PI3K (p-PI3K) and phosphorylated Akt (p-Akt) in CXCL11-treated group (0.88±0.06 and 0.83±0.04) were significantly higher than those in the control group (0.17±0.04 and 0.23±0.06), and the differences were statistically significant ( t=18.54, P<0.001 and t=15.21, P<0.001). Conclusion:CXCL11 is highly expressed in GBC and closely related to tumor progression. CXCL11 can promote the proliferation and invasion of GBC cells via PI3K/Akt signaling pathway.

Objective:To investigate the serum 25-hydroxyvitamin D [25(OH) D] levels in elderly patients with hip and vertebral compression fractures (VCF).Method:Ninety patients (58 males and 32 females) aged over 60 years with hip fracture and 120 patients (88 males and 32 females) aged over 60 years with VCF admitted in the Aviation General Hospital from January 2017 to June 2019 were enrolled. Serum 25(OH)D levels were measured.Results:Serum level of 25 (OH) D in hip fracture patients was (9.0±6.8) μg/L, the 25 (OH) D level was lower than the normal value(<19.0 μg/L)in 79 patients and<3 μg/L in 24 patients. The level of 25(OH)D in VCF patients was (16.7±10.6) μg/L, the 25 (OH) D level was<19.0 μg/L in 78 patients (65.0%) and <3 μg/L in 10 patients (8.3%). The low level of 25(OH)D was negatively correlated with age in two groups ( r=-0.367, P=0.01; r=-0.313, P=0.04). The mean level of 25 (OH) D in the hip fracture group was lower than that in the VCF group ( t=5.960, P<0.01), and the low 25(OH)D rate in the former group was significantly higher than that in the latter group (χ 2=14.14, P<0.01; χ 2=12.74, P<0.01). The 25(OH)D value of female VCF patients was (14.5±8.8) μg/L, which was significantly lower than that of male patients (22.5±12.9) μg/L ( t=3.882, P<0.01).Among hip fracture patients, the 25(OH)D level in patients with fracture history was (8.3±6.9) μg/L, which was significantly lower than that of patients without fracture history (10.8±6.9) μg/L, and the difference was statistically significamt ( t=2.123, P=0.04). The serum osteocalcin level was (20.5±19.8) μg/L in patients with fracture history, which was significantly higher than that in patients without fracture history [(10.6±5.4) μg/L, t=3.245, P<0.01]. Conclusion:Elderly patients with new hip fractures have more severely low vitamin D level than patients with new VCF, and patients with previous fracture history have lower vitamin D levels than patients without fracture history.

Objective: To investigate eye care behaviors among primary students in Wenzhou during Novel Coronavirus epidemic(COVID-19),and to provide a basis for eye care education and myopia prevention strategy. Methods: A total of 1 127 students from grade one to grade six of six primary schools in Wenzhou were selected to participate in an on-line invistigation regarding class attendance and eye care behaviors during the epidemic, March 6-9, 2020. Results: During the epidemic period, the primary school students in Wenzhou mainly took classes on the Internet (936, 83.1%), and the main learning tools were computers (391, 34.7%) and mobile phones (344, 30.5%), with an average of 3.00 h of online class. On average, students needed 2.00 h to complete homework and 1.00 h of extracurricular reading every day. In addition to learning, the daily use of mobile phone or ipad, computer and TV was 1.00,0.50,1.00 h respectively. Limited by the epidemic situation, the average daily exercise time of students was 0.81 h, including 0.00 h of outdoor activities; the average daily sleep was 9.00 h . During the epidemic period, 553 pupils (49.1%) reported eye discomfort, of which the most common was dry eyes (379, 47.4%). Multivariate Logistic regression analysis showed that the main learning tools of non-electronic products, reading distance > 30 cm or not reading, exercise time >0.5 h and outdoor activity time > 0.5 h were the protective factors of ocular discomfort (P<0.05). More than 2 h homework and recreational screen time higher than 0.5 h were risk factors for ocular discomfort(P＜0.05). Conclusion During the epidemic period, online learning increasedeye strain.Time of electronic devices usage,correct posture for reading,moderate level of ourdan physical activity,as well as prevention and treatment of eye strain should be strictly monitored.

Objective: The objective of this study was to compare the early clinical effects of zirconia all⁃ceramic crowns using two different impression methods. Zirconia ceramic crowns were produced using digital models based on either a silicone rubber impression perfusion model in vitro or a 3D mouth scanner. Methods : A total of 50 patients with a planned restoration of the first permanent molar with zirconia all⁃ceramic crowns after root canal therapy were se⁃ lected and randomly divided into two groups: a digital impression by intraoral 3D scanning group and a digital impres⁃ sion by extraoral scanning after silicone rubber impression group. Zirconia all⁃ceramic crowns were created by CAD/ CAM in both groups. Marginal adaptation, proximal contact, and occlusal contact were compared between groups. Results: There was no significant difference between the two groups in marginal adaptation (P > 0.05). For proximal con⁃ tact and occlusal contact, no significant differences regarding the number of cases for the criteria of level A and level B were found between two groups (P > 0.05), while the misfit value in level B was smaller in the first group than in the second group (P < 0.05). Conclusion Zirconia all⁃ceramic crowns with intraoral 3D scanning show excellent early clinical performance.

Objective : To evaluate the clinical outcomes of all-ceramic crowns whose oral digital impressions were scanned by 3Shape Trios. Methods : All the impressions were scanned by Trios and all the crowns were fabricated according to the standard procedure. The restoration quality were evaluated using modified United States Public Health Service (USPHS) criteria one year after treatment. Restoration integrity、 marginal adaptation、enamel wear、 color satisfaction and gingival index (GI) of the prostheses were evaluated according to the modified USPHS criteria. Results: The clinical 1 year survival rate of 92 porcelain crowns fabricated by 3-shape Trios digital impression and made by CAD/CAM was 100%. The scored A rates of restoration integrity、 marginal adaptation、 enamel wear、 secondary caries、color satisfaction and gingival index of the prostheses were 100%、91.3%、 98%、95.6%、96.7% and 94.7% after 1 year, respectively. Conclusion The clinical outcomes of all-ceramic crowns whose oral digital impressions were scanned by 3Shape Trios and whose crowns were made by CAD-CAM are satisfying.

Objective : To evaluate the clinical outcomes of all-ceramic crowns whose oral digital impressions were scanned by 3Shape Trios. Methods : All the impressions were scanned by Trios and all the crowns were fabricated according to the standard procedure. The restoration quality were evaluated using modified United States Public Health Service (USPHS) criteria one year after treatment. Restoration integrity、 marginal adaptation、enamel wear、 color satisfaction and gingival index (GI) of the prostheses were evaluated according to the modified USPHS criteria. Results: The clinical 1 year survival rate of 92 porcelain crowns fabricated by 3-shape Trios digital impression and made by CAD/CAM was 100%. The scored A rates of restoration integrity、 marginal adaptation、 enamel wear、 secondary caries、color satisfaction and gingival index of the prostheses were 100%、91.3%、 98%、95.6%、96.7% and 94.7% after 1 year, respectively. Conclusion The clinical outcomes of all-ceramic crowns whose oral digital impressions were scanned by 3Shape Trios and whose crowns were made by CAD-CAM are satisfying.

OBJECTIVE:To compare the composition changes of Aurantii fructus before and after fermentation processing and optimize its fermentation processing technology. METHODS:UPLC was conducted to compare the raw and fermentation processed products of same batch of Aurantii fructus,and ensure the chromatographic peaks after fermentation processing. Using peak areas of 4 chromatographic peaks and mildew characteristics of samples as index,fermentation temperature,humidity and time as factor, L9(34)orthogonal test was designed to optimize the fermentation processing technology,and verified it. RESULTS:After fermenta-tion processing,Aurantii fructus obviously showed 2 new monosaccharide glycosides components;the optimized fermentation tech-nology was as follows as fermentation temperature of 30 ℃,humidity of 70% and time of 7 d;verification test results showed RSD of each indicator of decoction pieces prepared by optimized fermentation technology in 3 tests were lower than 2.0%(n=3). CONCLUSIONS:Fermentation processing may lead obvious chemical composition changes in Aurantii fructus;the optimized fer-mentation processing technology can increase the contents of characteristic peaks.

The purpose of this study was to evaluate the necrosis target and imaging potential of necrotic myocardium of 131I-emodin and 131I-emodic acid. The iodogen coating method was used to radioiodinate emodin and emodic acid with iodine-131. Mice model of muscular necrosis and rat model of myocardial infarction(MI)were established to evaluate the necrosis affinity and imaging potential of 131I-emodin and 131I-emodic acid. Mice were sacrificed at 2, 12 and 24 h after injection respectively. The radioactive uptake in major organs and necrotic muscle were calculated by a γ-counter. At 6 h after administration, SPECT/CT imaging of necrotic myocardium in rats, biodistribution detection, histopathological analysis were applied to evaluate their necrosis affinity and imaging potential. The results of biodistribution from mice demonstrated that 131I-emodin and 131I-emodic acid showed peculiar necrosis target and exhibited an obvious clearance of radioactivity from normal organs. On SPECT/CT images, relatively high uptake as a hot spot was shown in the heart of the model rat, while no obvious uptake was observed in the heart of the control rat. The radioactivity ratios of necrotic to normal myocardium of 131I-emodin and 131I-emodic acid amounted up to 9. 72 and 13. 14 by quantitative autoradiography analysis, respectively. These results suggested that 131I-emodin and 131I-emodic acid possess the necrosis target and imaging potential of necrotic myocardium.

The study aimed to separate and identify the metabolites of hypericin in the bile and necrotic tissues in rats. After intravenous injection of 10 mg/kg hypericin, 0-12 h bile of normal rats and 24 h necrotic liver of rats with reperfused hepatic infarction were collected, and metabolites of rats were analyzed by high performance liquid chromatography coupled with electrospray tandemtime of flight mass spectrometry(HPLC-TOF/MS). The prototype(M0)and three glycosylation metabolites(M1, M2, M3)of hypericin in rat bile and the parent compound in rat necrotic liver were detected and identified. Results indicated that prototype and glycosylation of hypericin were the major metabolic form in rat bile and the parent compound was found only in necrotic tissues.