Background: Gut microbiota are considered to be intrinsic regulators of thyroid autoimmunity. We designed a cross-sectional study to examine the makeup and metabolic function of microbiota in Graves' disease (GD) patients, with the ultimate aim of offering new perspectives on the diagnosis and treatment of GD. Methods: The 16S ribosomal RNA (rRNA) V3-V4 DNA regions of microbiota were obtained from fecal samples collected from 45 GD patients and 59 controls. Microbial differences between the two groups were subsequently analyzed based on high-throughput sequencing. Results: Compared with controls, GD patients had reduced alpha diversity (p < 0.05). At the phylum level, GD patients had a significantly lower proportion of Firmicutes (p = 0.008) and a significantly higher proportion of Bacteroidetes (p = 0.002) compared with the controls. At the genus level, GD patients had greater numbers of Bacteroides and Lactobacillus, although fewer Blautia, [Eubacterium]_hallii_group, Anaerostipes, Collinsella, Dorea, unclassified_f_Peptostreptococcaceae, and [Ruminococcus]_torques_group than controls (all p < 0.05). Subgroup analysis of GD patients revealed that Lactobacillus may play a key role in the pathogenesis of autoimmune thyroid diseases. Nine distinct genera showed significant correlations with certain thyroid function tests. Functional prediction revealed that Blautia may be an important microbe in certain metabolic pathways that occur in the hyperthyroid state. In addition, linear discriminant analysis (LDA) and effect size (LEfSe) analysis showed that there were significant differences in the levels of 18 genera between GD patients and controls (LDA >3.0, all p < 0.05). A diagnostic model using the top nine genera had an area under the curve of 0.8109 [confidence interval: 0.7274-0.8945]. Conclusions: Intestinal microbiota are different in GD patients. The microbiota we identified offer an alternative noninvasive diagnostic methodology for GD. Microbiota may also play a role in thyroid autoimmunity, and future research is needed to further elucidate the role.

The declining number of physician scientists is an alarming issue. A systematic review of all existing programs described in the literature was performed, so as to highlight which programs may serve as the best models for the training of successful physician scientists. Multiple databases were searched, and 1,294 articles related to physician scientist training were identified. Preference was given to studies that looked at number of confirmed publications and/or research grants as primary outcomes. Thirteen programs were identified in nine studies. Eighty-three percent of Medical Scientist Training Program (MSTP) graduates, 77% of Clinician Investigator Training Program (CI) graduates, and only 16% of Medical Fellows Program graduates entered a career in academics. Seventy-eight percent of MSTP graduates succeeded in obtaining National Institute of Health (NIH) grants, while only 15% of Mayo Clinic National Research Service Award-T32 graduates obtained NIH grants. MSTP physician scientists who graduated in 1990 had 13.5 ± 12.5 publications, while MSTP physician scientists who graduated in 1975 had 51.2 ± 38.3 publications. Additionally, graduates from the Mayo Clinic's MD-PhD Program, the CI Program, and the NSRA Program had 18.2 ± 20.1, 26.5 ± 24.5, and 17.9 ± 26.3 publications, respectively. MSTP is a successful model for the training of physician scientists in the United States, but training at the postgraduate level also shows promising outcomes. An increase in the number of positions available for training at the postgraduate level should be considered.

Background Over the past decade, China's systems of medical education and health care have undergone unprecedented reform. Despite these reforms, a trend of declining interest among medical graduates in pursuing careers in clinical practice has persisted. The aim of this analysis is to examine physician workforce production and attrition rates and use current trends to predict whether an adequate and equitable supply of physicians will exist in the future. MethodsWe analysed data about Chinese medical graduates and physicians in clinical practice between 2005 and 2015 using the Chinese National Health and Family Planning Commission reports and yearbooks published by the government of China and the Peking Union Medical College. These sources covered all of China (31 provinces; Hong-Kong and Macao were not included). The international review board of National Yang-Ming University approved this study. Findings From the beginning of 2005 to the end of 2014, China produced 4 314 791 5-year clinical medical graduates and 413 186 5-plus-2 programme (5-year medical education programme plus 2-year graduate programme) medical graduates: total 4 727 977 clinical medical graduates. However, during this period, there was an increase of only 752 233 (15•91%) in the total number of clinical physicians registered in practice. Using demographic data from this 10-year period, we found that the proportion of physicians aged 25-34 years had decreased from 31•3% to 22•6%, and the proportion of physicians aged 60 years and older had increased from 2•5% to 11•6%. Meanwhile, 5-plus-2 programme graduates increased from 4•3% to 11•2%, and rural areas had a shortfall of over 500 000 physicians. Interpretation This study confi rms the high attrition rate among medical graduates and physicians in China over the past 10 years. If this pattern continues, China will suff er a chronic shortage of medical doctors in certain specialties and in rural areas. China's future appears destined to have the chronic care issues that come with an ageing society and require considerable human resources. High physician attrition rates, low physician production, and rapid population growth will only compound the problem.

The development and institution of a national exam would introduce a standard of training throughout Vietnam's medical education system. Further, a substantial portion of a doctor's education is in subjects that are loosely related to medicine. When looking forward it will be important to evaluate whether or not these non-medical subjects detract from the quality of medical training.