Objective:To investigate the effects and mechanism of metformin on the wound healing of full-thickness skin defects in diabetic rats.Methods:This study was an experimental study. Eighteen 8-week-old male Sprague Dawley rats were divided into control group, diabetes group, and diabetes+metformin group according to complete random grouping method, with 6 rats in each group. The latter two groups of rats were used to create diabetic models, and then four circular full-thickness skin defect wounds with a diameter of 5 mm were made on the back of 18 rats. Metformin F-127 hydrogel was applied only to the wounds of rats in diabetes+metformin group. The wound healing status on post injury day (POD) 7 and 13 was observed and the wound healing rate was calculated. The wound tissue on POD 7 and 13 was collected for hematoxylin-eosin staining to measure the length of re-epithelialized epidermis and calculate the change rates in diameters of epidermal and dermal wounds, for immunohistochemical staining to detect the relative expressions of keratin 10 and proliferating cell nuclear antigen (PCNA), and for Western blotting to detect the protein expressions of keratin 10 and PCNA. The sample size in all the above experiments was 8 except that in the last experiment was 3. The correlations between the relative expressions of keratin 10 and PCNA in wound tissue in three groups of rats and their wound healing rates, and the correlation between the relative expressions of keratin 10 and PCNA in wound tissue were analyzed.Results:On POD 7, the wound healing rates of rats in diabetes group and diabetes+metformin group were 81.48% (77.89%, 85.53%) and 93.04% (92.51%, 94.24%), which were significantly lower than 100% (97.17%, 100%) in control group (with Z values of 2.37 and -3.36, respectively, P<0.05); the wound healing rate of rats in diabetes+metformin group was significantly higher than that in diabetes group ( Z=3.45, P<0.05). On POD 13, the wound healing rates of rats in control group and diabetes+metformin group were both 100% (100%, 100%), which were significantly higher than 94.47% (90.68%, 99.82%) in diabetes group (with Z values of 2.90 and -2.90, respectively, P<0.05). On POD 7, the change rates in epidermal wound diameter of rats in control group and diabetes+metformin group were significantly higher than that in diabetes group (with Z values of 3.36 and -2.74, respectively, P<0.05). The change rates in dermal wound diameter of rats in the three groups were similar on POD 7 and 13 ( P>0.05). The lengths of re-epithelialized epidermis of rats in control group and diabetes+metformin group on POD 13 were significantly longer than that in diabetes group (with Z values of 3.34 and -2.64, respectively, P<0.05). The relative expressions of keratin 10 in wound tissue of rats in diabetes group on POD 7 and 13 were significantly higher than those in control group (with Z values of -3.36 and -3.26, respectively, P<0.05) and diabetes+metformin group (with Z values of 3.36 and 3.15, respectively, P<0.05), and the relative expression of keratin 10 in wound tissue of rats in diabetes+metformin group on POD 7 was significantly lower than that in control group ( Z=3.05, P<0.05); the relative expressions of PCNA in wound tissue of rats in diabetes group on POD 7 and 13 were significantly lower than those in control group (with both Z values of 3.36, P<0.05) and diabetes+metformin group (with both Z values of -3.36, P<0.05). The protein expressions of keratin 10 in wound tissue of rats in control group and diabetes+metformin group on POD 7 as well as that in diabetes+metformin group on POD 13 were significantly lower than those in diabetes group ( P<0.05), and the protein expressions of PCNA in wound tissue of rats in control group and diabetes+metformin group on POD 7 were significantly higher than that in diabetes group ( P<0.05). There was a significant positive correlation between the relative expression of keratin 10 in wound tissue and the wound healing rate in control group and diabetes+metformin group of rats (with r values of 0.78 and 0.71, respectively, P<0.05), there was a significant negative correlation between the relative expression of PCNA in wound tissue and the wound healing rate in diabetes+metformin group of rats ( r=-0.60, P<0.05), and there was a significant negative correlation between the relative expressions of PCNA and keratin 10 in wound tissue of rats in diabetes group and diabetes+metformin group (with r values of -0.41 and -0.49, respectively, P<0.05). Conclusions:The diabetic rats with full-thickness skin defect wound exhibit delayed healing, accompanied by up-regulation of keratin 10 and down-regulation of PCNA in keratinocytes in the wound tissue. Metformin can promote wound healing in diabetic rats with full-thickness skin defects by down-regulating keratin 10 expression and up-regulating PCNA expression in keratinocytes in the wound tissue, and the wound healing rate was positively correlated with the expression of keratin 10 and negatively correlated with the expression of PCNA.

Objective:To evaluate of the general practice residency training bases in Hebei Province.Methods:Based on the 2020 Standardized Residency Training Base Evaluation Index-General Practitioners of Chinese Medical Doctor Association,24 training bases in Hebei Province were assessed;and the satisfaction questionnaire survey and in-depth interview were conducted among 124 general practice trainees who were randomly selected in November 2020. Results:All 24 bases set the general practice department in the hospitals as required. However, the annual outpatient visits in department of general practice were less than 20000 in 45.83% (11/24) bases, only 41.67% (10/24) bases met the teaching requirements of general practice, and 33.33% (8/24) bases fulfilled the provincial target for general practice residency training enrollment; only 3 bases (13.64%) had the pass rate≥85% in medical licensing examination in the previous year. For the training satisfaction, 66.94% (83/124) trainees were satisfied with residency training, and 33.06% (41/124) were moderately satisfied. There was significantly difference in the satisfaction degrees among trainees with different expectations of career prospects (χ 2=24.436, P<0.05). Conclusions:Basically, the management system of general practice residency training bases has been completed and the construction of teaching teams has been standardized in Hebei Province. But the job attraction of general practitioner is inadequate, the training bases need to be strengthened, and the training quality needs to be improved.

Objective:To analyze the current status of faculty development in general practice residency training bases in Hebei Province.Methods:A questionnaire survey with deep interview was conducted among 79 faculty from 24 general practice residency training bases in Hebei Province during November to December 2020.Results:Among 79 participants, 21 were males (26.58%) and 58 were females (73.42%), 41 (51.90%) of whom were aged 31-40 years; 44 (55.70%) were general practitioners, and 35 (44.30%) were specialists. There were no significant differences in sex, age, education background, professional title, between faculty with general practice background and specialist background (all P>0.05); while there were significant differences in job-transfer training, teaching training for general practice, the training form, teaching method grasped, understanding the work contents of general practice, the view and prospect for general practice between general practitioner faculty and specialist faculty (all P<0.05). The score of ward round teaching of general practice faculty was significantly higher than that of specialist faculty ( P<0.05) The interview showed that all faculty members were willing to teach, most of them had increased work pressure after engagement in teaching, and there was lack of incentive policies for teaching in some bases. Conclusions:The current status of faculty development in the general practice residency training base in Hebei Province is basically satisfactory, but there is lack of general practice training for faculty with specialist background; the professional identity of general practitioner need to be enhanced, and their status and treatment need to be improved.

Objective: To assess the effect of health coaching on interventional effect in high-risk population of stroke. Methods: A baseline survey was conducted among 897 residents aged 40 years and above selected by cluster sampling method in a community of Shijiazhuang city from January 2016 to June 2016, and 178 subjects were identified as high risk population of stroke. The high-risk subjects were randomly divided into two groups: the control group (n=89) was given routine health education, while the intervention group (n=89) received health coaching based on motivational interview for 13 months. The behavioral risk factors and self-efficacy scores were compared between two groups before and after intervention. Results: There were no significant differences in behavioral risk factors between the two groups: for hypertension 72 vs. 74 cases (χ²=0.152, P=0.67), for hyperglycocemia 44 vs.48 cases (χ²=0.360, P=0.55), for dyslipidemia 62 vs. 60 cases (χ²=0.104, P=0.75), for smoking 35 vs.32 cases (χ²=0.215, P=0.64), for obesity 50 vs.52 cases (χ²=0.092, P=0.76), for lack of exercises 72 vs.70 cases (χ²=0.139, P=0.71), for atrial fibrillation 14 vs. 16 cases (χ²=0.160, P=0.19). And there was no significant difference in self-efficacy scores between the two groups [(5.3±1.2) vs. (5.6±2.0), t=0.997,P=0.32]. After intervention, there were significant differences between the two groups in behavioral risk factors: for hypertension 25 vs. 34 cases (χ²=19.984, P<0.05) , for hyperglycaemia 16 vs.32 cases (χ²=8.448, P<0.05) , for dyslipidemia 30 vs. 48 cases (χ²=13.216, P<0.05) , for smoking 20 vs.28 cases (χ²=7.583, P<0.05) , for obesity 18 vs.38 cases (χ²=14.158, P<0.05) , for lack of exercises 28 vs. 36 cases (χ²=10.235, P<0.01) , for atrial fibrillation 5 vs. 13 cases (χ²=6.451, P<0.05) . And the self-efficacy scores of intervention group were higher than those of control group[ (8.4±2.1) vs. (6.8±2.2), t=4.852, P<0.01]. Conclusion Health coaching based on motivational interview is beneficial to reduce risk factors and improve self-efficacy in high risk population of stroke, which is worthy of popularization.

Objective To investigate the influence of WeChat + family centered health intervention on the self-efficacy of elderly hypertensive patients in General clinic. Methods A total of 102 elderly hypertensive patients aged≥60 years in General clinic from February 2017 to July 2017 were enrolled.They were divided into experimental group and control group with the table of random number, with 51 cases in each group. The experimental group used the WeChat+ family centered health intervention model,while the control group adopted the traditional health education model.The changes of blood pressure and self-efficacy were evaluated before intervention, 3 months and 6 months after intervention respectively. Results There were no statistic significant difference in blood pressure and self-efficacy total score between the two groups before intervention(P>0.05). At 3 months after intervention,the blood pressure(systolic pressure/diastolic pressure)of the patients were(144.20±4.60), (80.00±5.00)mmHg(1 mmHg=0.133 kPa)in the experimental group,those of which were(154.20±7.16), (87.00±3.81)mmHg in the control group,the differences were statistically significant (t=-2.628,-2.490,P<0.05).At 6 months after intervention,the blood pressure(systolic pressure/diastolic pressure)of the patients were(141.60±6.43),(76.00±4.85)mmHg in the experimental group,those of which were(151.60± 5.94),(85.40±4.56)mmHg in the control group,the differences were statistically significant (t=-2.555,-3.158,P<0.05).There were differences in systolic and diastolic pressure in patients with different groups at different time,and the differences were statistically significant(F=18.668,18.174,P<0.01).The total score of self-efficacy at 3 months and 6 months after intervention was(30.14±0.43),(32.56±0.23)points in the experimental group and (28.14 ± 0.15), (29.40 ± 0.19) points in the control group, the difference was statistically significant(t=9.736, 23.819, P<0.05). The differences in the total score of patients′self-efficacy in different groups at different time had statistically significance (F=2 631.551, P<0.01). Conclusions The WeChat+family centered health intervention model can significantly improve the self-efficacy of the elderly patients with high blood pressure in the General clinic.

BACKGROUND: A retrospective review of the surgical treatment of refractory chest tumors involving the heart or large vessels with cardiopulmonary bypass (CPB). METHODS: To summarize 11 cases of chest tumor patients who had undergone cardiopulmonary bypass surgery from January 2008 to May 2017 in our hospital, and analyze the general condition, clinical characteristics, treatment methods, postoperative hospitalization time, complications and follow-up results of all patients. RESULTS: All 11 patients were operated with cardiopulmonary bypass. Total resection of tumors in 8 cases and most of the excision in 3 cases. 1 case of left atrial metastatic leiomyosarcoma were excised in the left atrium, and then the right lung resection was performed. 1 case of left lung central lung cancer resection through the median sternum incision. 2 cases underwent pulmonary artery repair at the same time, 3 cases underwent partial pericardiectomy and 3 cases underwent pulmonary wedge resection at the same time. All the patients were effectively relieved after the operation. No death rate in hospital and 30 days after operation. 3 cases of postoperative pulmonary infection were recovered after the treatment of antibiotics. 1 case of lymphoma relapsed 6 months after surgery and died one year later. 1 case of pericardial fibrosarcoma had local recurrence and extensive metastasis at 13 months after operation, and died after 15 months. 1 case of pulmonary leiomyosarcoma were found to have local recurrence 15 months after the operation and were relieved after chemotherapy. The remaining 8 patients survived, and no obvious recurrence and distant metastasis were found in the computed tomography (CT) examination. CONCLUSIONS The CPB assisted surgical treatment can be performed for patient of refractory chest tumors involving the heart or large vessels. It can improve the surgical resection rate of refractory chest tumors, effectively alleviate the effects on respiratory and circulatory functions, and significantly prolong the survival period of these patients.
Adult ; Cardiopulmonary Bypass ; adverse effects ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; mortality ; physiopathology ; surgery ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Pulmonary Artery ; diagnostic imaging ; physiopathology ; surgery ; Retrospective Studies

Objective To survey on training for general practice backbone mentors in tertiary hospitals of Hebei province.Methods A questionnaire survey on training status was conducted among general practice backbone mentors in tertiary hospitals of Hebei Province.The survey items included the basic information,knowledge of general practice and its training,suggestions for mentors training and general practice discipline construction in tertiary hospitals.Results Total 208 questionnaires were distributed and 208 were retrieved with a recovery rate of 100％.Among 208 participants,all of them were over the age of 30;202 (97.1％) had bachelor degree or above;202 (97.1％) were attending doctors or above;165 (79.3％) had worked for more than 10 years;169 (81.3％) had no or little knowledge of general practice;159 (76.4％)had not received general practice training before;124 (59.6％) thought that general practitioners were not qualified as "gatekeeper" at present;and 192 (92.3％) worked in the hospitals providing standardized residency training.The training contents in general section were prioritized as clinical skills,community health service development and policy,rules for general practice standardized training,theoretical training,the present situation and countermeasure of general teaching,the doctor-patient relationship and medical ethics.The contents in training method section were prioritized as lecture series of clinical medicine,case discussion,seminar,distance education with classroom teaching.The suggestions for mentors training included:the exploration of standardized training model,perfecting continuing education system for general practice mentors,more attention to the training at community health service centers and the consummation of general practice system.The suggestions for general practice discipline construction were that more attentions should be paid by the government and the hospitals leaders,the general practice departments in tertiary hospitals should closely cooperate with community health service centers in training ofqualified general practitioners.Conclusions The specialists in tertiary hospitals of Hebei province do not have enough knowledge about general practice and do not quite understand the necessity of establishment of general practice department,so the training for general practice mentors should be strengthened and improved.Properly policy and more social resources from the government and the hospitals leaders will be helpful for construction of general practice discipline in general hospital.

Objective To investigate the effects of gefitinib on early embryonic development and expression of abcb4 tumor resistance genes in zebrafish.Methods Zebrafish were adopted as experimental animals and divided into gefitinib group,mixture of doxorubicin and gefitinib group and blank group.Zebrafish embryos of 0.5-1.5 hours after fertilization(0.5-1.5 hpf) were exposed to different concentrations of gefitinib,and then embryo development of zebrafish in 24-120 hpf was observed and the number of death,hatch and malformation was recorded.The embryo mortality was calculated under different concentrations of gefitinib at different time points,and the numerical value of IC50 was calculated;Hatching rates of zebrafish embryo in 48 hpf and 72 hpf and malformation rates of zebrafish embryo in 120 hpf were calculated.The zebrafish embryos exposed to different concentrations of gefitinib in different groups were collected,and the expressionof abcb4 gene in zebrafish embryos was detected by real-time quantitative PCR.Results Gefitinib IC50 in zebrafish embryos was 16.18 μmol/L.Compared with the control group,higher dosage (20 μmol/L) of gefitinib in other two groups significantly decreased hatching rates of embryos,and had obvious embryonic lethal effects and teratogenic effects.Moreover,the mRNA levels of the abcb4 gene in the zebrafish embryos of gefitinib group were not significantly changed,whereas the mRNA levels of the abcb4 gene in mixture of doxorubicin and gefitinib group were significantly different(P＜0.05).Conclusion Gefitinib has no significant effects on the expression of abcb4 tumor resistance gene in early development of zebrafish embryos(P＞0.05),but it can reverse the drug resistant effects of doxorubicin,suggesting that zebrafish can construct tumor resistance model.

Objective To assess the characteristics and satisfaction of outpatients in walk-in clinic of a grade A tertiary hospital.Methods A total of 1 100 outpatients visiting walk-in clinic of the Second Hospital of Hebei Medical University during March 2016 and June 2016 were randomly selected for the questionnaire survey.The self-designed questionnaire included the general information of patients,the satisfaction degree to the walk-in clinic,to special clinics of the hospital or to community clinics and related reasons,and suggestions for further improvement.Results Total 947 valid questionnaires were received with a retrieval rate of 86.09％.Most of participants had one chronic disease (594,62.72％).The satisfaction degree of walk-in clinic (1.78) was higher than that of hospital special clinics (1.93) (P =0.010),in turn the latter(2.33)was higher than that of conmmnity clinics (P ＜ 0.001).The reasons for patient to choose the walk-in clinic were wide range of medications (389,41.08％),reliable quality (285,27.98％),short waiting time (249,26.29％) and so on.Suggestions for improvement of the walk-in clinic were further reducing the waiting time (428,45.20％),need specialists for chronic disease management (210,22.18％),raising reimbursement rate (172,18.16％) and so on.The reasons for patients to choose special clinic were need readjusting prescription (587,61.99％),special disease or drug (427,45.09％).The reasons of dissatisfaction with special clinic were long waiting time (476,50.26％),frequent transfer to multiple departments (221,23.34％),high registration fee (221,23.34％).The reasons for patients to choose community clinic were short distance (350,36.96％),better environment (350,36.96％),short waiting time (184,19.43％).The reason of dissatisfaction with community clinic were low qualification of medical staff (405,42.77％),insufficient medications (392,42.39％);distrusting the quality of drugs (263,27.77％).Suggestions for improvement of the community clinics were upgrading the qualification of medical staff (317,33.47％),enlarging drug variety (298,31.47％),improving medical environment (94,9.93％) and so on.Conclusion Most outpatients visiting walk-in clinic of grade A tertiary hospital are highly satisfied the clinic.To meet the patients' needs the primary medical unit should further improve their overall service.

Objective To analyze the difference of salivary microbiome between the patients with functional dyspepsia and healthy controls.Methods Saliva samples were collected from the patients with functional dyspepsia and healthy control.Genomic DNA of the samples was extracted,and the high-throughput sequencing technology was used to conduct DNA sequence of 16S rRNA-V4 region.Subsequently,all the data were performed by the bioinformatic analysis.Results The salivary microbiome in the functional dyspepsia group was dominated by Proteobacteria,while Bacteroidetes was the top microbiota in the heathy control group.In the functional dyspepsia group,the Chao1 index,ACE index,Shannon index and Simpson index were 1 295,1 351,4.93 and 0.90 respectively.In the healthy control group,the above indexes were 1 001,1 351,5.28 and 0.92 respectively.The PCoA ba sically separated the microbiome composition of the two groups.Sixteen kinds of microbiota were significantly different between two groups using linear discriminant analysis effect size tool,including Bacteroidetes,Prevotella,Prevotellaceae,Neisseria,Betaproteobacteria and Proteobacteria,etc.Conclusion Saliva in the patients with functional dyspesia has characteristic microbiome composition,which is dominated by Proteobacteria,but the richness and diversity between the two groups have no difference.Neisseria is one of the significantly different bacteria between the two groups.