Objective To explore the scanning techniques of piriformis and different ultrasonographic characteristics of normal and abnormal piriformis.Methods A total of 40 cases diagnosed with unilateral piriformis syndrome underwent ultrasonic examination.Then ultrasonic scanning techniques of piriformis were summarized.Contours,thickness and smoothness of epimysium and ultrasonic echo of internal muscle texture of piriformis were compared between the normal and abnormal piriformis.The study was approved by the Third Affiliated Hospital Ethics Committee of Zhejiang Chinese Medical University (Approval no.ZSLL-JS-2016-18).Results Interruption of ultrasonic echo of ilium could be considered as ultrasonographic signs for locating piriformis quickly and accurately.Abnormal piriformis in suffering side of patients with piriformis syndrome showed obscure contours and being thicker than the other side [x2 =9.899,P =0.002;(25.81 ± 0.30)mm vs (22.29 ± 0.27)mm,t =13.604,P =0.000].Moreover,there were significant differences in comparing smoothness of epimysium and ultrasonic echo of internal muscle texture of piriformis between the two sides(x2 =23.226,P =0.000;x2 =54.848,P =0.000).Conclusions Interruption of ultrasonic echo of ilium may be an important sign for locating piriformis.Ultrasound can display piriformis clearly and distinguish ultrasonographic images of normal piriformis accurately from abnormal piriformis,which can be taken as an basis imaging for clinical diagnosis of piriformis syndrome.

Medical science has both the characteristics of natural science and humanities.Modem medical education pays more attention to the close association between professional education and humanistic education.How to handle the relationship between infectious disease and humanistic education has become more and more important.In current study,integrating humanistic education in clinical infectious disease teaching not only improved infectious disease teaching effect but also established good medical ethics and increased the comprehensively quality.

Objective To identify the antibiotic resistance, homology of imipenem-resistant Pseudomonas aeruginosa strains isolated from older in Zhejiang Hospital and the carbapenemases determinants of imipenem-resistant strains. MethodsTwo hundred and sixty-two strains of Pseudomonas aeruginosa were isolated through May 2006 to May 2009 from older in Zhejiang Hospitals. K-B method was used to determine the 16 antimicrobial agents resistance of these 262 strains. The MICs of strains to 14 antimicrobial agents were determined by agar dilution and E test method. The coding sequence of Metallo-β-lactamases (MBL) were amplified, PCR products were purified, cloned and sequenced. The homology of these isolates was analyzed by pulse-field gel electrophoresis(PFGE). ResultsOne hundred and four strains of imipenem-resistant Pseudomonas aeruginosa were screened from 262 strains. The resistant rates of 104 isolates of Pseudomonas aeruginosa to ampicillin/sulbactam and cefoperazone/sulbactam were 78.9％ and 35.9％ ; polymyxin E had a minimal resistance of 6.0％ ; minocycline had a resistance rate of 58.3％. The resistant rates to other antimicrobial agents were more than 70.0％. Twelve imipenem-resistant Pseudomonas aeruginosa strains contained MBL gene and two kinds of integron were detected from 10 of these 12 strains. Twelve strains of Pseudomonas aeruginosa belonged to 5 epidemic PFGE-clone. ConclusionAll of the imipenem-resistant Pseudomonas aeruginosa which had cause outbreaks in Zhejiang Hospital. MBL were not the most popular gene type. All of the MBL gene types were VIM-2. The blaVIM-2 gene cassettes located in diflerent class 1 integrons. The integrons dissemination was the most important style of strains spread.

Objective: To establish a rapid bacterial identification and antimicrobial susceptibility testing assay in positive blood cultures, so as to provide insights into timely diagnosis and treatment of bloodstream infections. Methods: A total of 1 154 blood culture samples were collected from inpatients in Zhejiang Hospital from February to May, 2022. The bacterial isolates were enriched and purified using improved separation gel method, and bacterial identification and antimicrobial susceptibility tests were performed using VITEK2 mass spectrometry system and VITEK2 Compact automated microbiology system. The accuracy of the new assay for bacterial identification and antimicrobial susceptibility tests was evaluated with the conventional VITEK 2 compact system as the standard. Results: Of 1 154 blood culture specimens, the conventional VITEK 2 compact system detected 174 positives and 980 negatives. The new assay and the conventional VITEK 2 compact system identified consistent bacterial isolates in 165 out of 174 positive blood culture samples, and the accuracy of bacterial identification was 94.83% for the new assay, with a 99.21% accuracy for identifying Gram-negative bacteria and 82.22% for Gram-positive bacteria. Antimicrobial susceptibility tests were performed in 158 bacterial isolates, and the new assay presented a 90.17% accuracy, with a 90.27% accuracy for Gram-negative bacteria and 89.74% for Gram-positive bacteria. The conventional VITEK 2 compact system required 30 hours and longer to complete bacterial identification and antimicrobial susceptibility tests, and the new assay required 9 to 18 hours. Conclusions The new rapid bacterial identification and antimicrobial susceptibility testing assay shortens the time of bacterial culture, achieves rapid bacterial identification and antimicrobial susceptibility testing in blood culture specimens and has a high accuracy that meets clinical needs, which facilitates rapid diagnosis and treatment of bloodstream infections.

Contracture and spasticity of ankle joints were major sources of disability in neurological impairment including stroke and cerebral palsy, etc. The manual stretching used in physical therapy might be laborious and time-consuming to the therapists and the outcome was dependent on the experience and the subjectiveend feelingof the therapists. A device was developed that could safely stretch the an-kle joint to its extreme positions with quantitative control of the resistance torque and stretching velocity. Furthermore, it could satisfy a strong need for quantitative and objective measures of the impairment and rehabilitation outcome. This was just the meaning intelligent stretching referred to. This article described the origin of the concept of intelligent stretching and its definition, operational principle, and su-periority and weakness, as well as its application in ankle joint spasticity and contracture in patients with stroke and cerebral palsy.

Objective:To develop serious games for pediatrics and to explore the effect of cultivating the clinical reasoning and reflection ability of pediatric trainee nurses.Methods:This was a non-randomized controlled trial study. The convenience sampling method was used to select 88 pediatric trainee nurses in the Second Xiangya Hospital of Central South University from April 2021 to January 2022. They were divided into the control group and the experimental group with 44 cases in each group by the method of random sampling. The control group was given clinical practice teaching in pediatrics according to the practice syllabus. Based on the teaching events of Gagne, the teaching links of serious games were designed, and teaching was carried out to the experimental group. The clinical reasoning and reflection ability, learning satisfaction and self-confidence of the two groups of pediatric trainee nurses before and after teaching were evaluated by the Self-Assessment of Clinical Reasoning and Reflection, Student Learning Satisfaction and Self-Confidence Scale, and examination scores of the two groups of pediatric trainee nurses were evaluated.Results:There was no significant difference in the clinical reasoning and reflection ability, learning satisfaction and self-confidence before teaching between the two groups( P>0.05). The total score of clinical reasoning and reflection evaluation after teaching was (101.13±6.69) points in the experimental group, which was higher than that in the control group (94.57 ± 8.86) points, the difference was statistically significant ( t=-3.92, P<0.05). The learning satisfaction and self-confidence scores after teaching were (20.82 ± 2.16), (33.20 ± 1.47) points in the experimental group, which were higher than those in the control group (19.52 ± 2.30), (31.89 ± 2.44) points, the differences were statistically significant ( t=-2.33, -3.07, both P<0.05). The scores on the theory and skill examination in the experimental group were also better than those in the control group, the differences were statistically significant ( t values were -2.59--2.14, all P<0.05). Conclusions:The serious game teaching method can effectively improve the clinical reasoning and reflection ability, practical learning satisfaction, self-confidence, and graduation performance of pediatric nursing interns, which can provide a reference for the reform of pediatric nursing practice teaching.

Objective To investigate the prevalence of primary drug resistance among HIV-1 patients in Hubei Province from 2020 to 2022, and to provide corresponding basis and data support for HIV antiviral therapy (ART) in Hubei Province. Methods During 2020-2022, plasma samples of HIV-1 infected patients before ART were collected., Patients’ demographic data and baseline laboratory test data were also collected. HIV-1 pol region was amplified by in-house method for sub-type typing and drug-resistant mutation site analysis. Results The pol gene sequence was successfully amplified in 242 of 285 cases, with a success rate of 84.9%. CRF07_BC was the predominant HIV-1 sub-type, accounting for 47.11% (114/242), followed by CRF01_AE, accounting for 25.21% (61/242), sub-type B, accounting for 14.16% (35/242), and CRF55_01B, accounting for 4.13% (10/242). The primary resistance rate was 6.20% (15/242). The mutation site of nucleoside reverse transcriptase inhibitors (NRTIs) was mainly M184V, and the mutation sites of non-nucleoside reverse transcriptase inhibitors (NNRTIs) were mainly E138A/G/EG and V179E. These different mutation sites led to different degrees of drug resistance to 12 drugs. The incidence of drug resistance mutation of CRF55_01B sub-type was significantly higher than that of other sub-types. Conclusion The primary drug resistance rate of HIV-1 infected patients is at a slightly high level in Hubei Province, and close monitoring of primary drug resistance and mutation sites should be strengthened before ART, especially for CRF55_01B sub-type.

Objective: To investigate the clinicopathological and radiological features of benign fibro-osseous lesion (BFOL). Methods: Sixty-five cases of craniofacial BFOL, eight cases of peripheral ossifying fibroma (POF) and one case of low-grade central osteosarcoma diagnosed at Sichuan Provincial People′s Hospital between January 2010 and March 2019 were collected. The clinicopathologic features, hematoxylin-eosin and immunohistochemical (IHC) staining and radiographic features were analyzed. MDM2 gene amplification was detected by FISH in difficult borderline cases. Results: This cohort of BFOLs included 50 cases of fibrous dysplasia (FD), 12 cases of ossifying fibroma (OF), and three cases of juvenile psammomatoid ossifying fibroma (JPOF). The average ages of patients with FD,OF and JPOF were 31.7, 39.2 and 26.0 years respectively. The male to female ratio was 1.0∶1.8.The average age of POF was 47.0 years, with male to female ratio of 1∶7. Patient of low-grade central osteosarcoma was a 48-year-old man. Twenty-seven cases of FD were located in the jaw, and 23 cases were in other craniofacial bones. Nine cases of OF were located in the jaw, and three cases were in the nasal cavity. Two cases of JPOF were in the nasal sinus, and one was in the jaw. All POF were located in the gingiva, and low-grade central osteosarcoma was located in the mandible. The imaging features of FD were luffa-like or ground-glass like signal shadows with poorly defined borders with expansion. OF had clear borders or sclerosing margins. Both JOF and low-grade central osteosarcoma were expansile intraosseously and with focally invasive nodular masses with ground-glass like signal shadows; and POF showed soft tissue mass with bone formation. Histological features of BFOLs showed mixed fibrous and irregular osteoid lesions. FD had no clear relationship with the host bone and no osteoblasts surrounded the bone trabeculae. Osteoblasts rimming was found in OF, and the boundaries of the host bone were clear. JPOF and low-grade central osteosarcoma infiltrated the host bone focally, and the latter showed mild cellular atypia. MDM2 amplification was detected in low-grade central osteosarcoma. Conclusions BFOLs are a group of fibro-osseous lesions with similar morphology in the head and neck and face, but their clinical features and prognosis are different; and their imaging and histological characteristics are also slightly different. Attentions should be given to the combination of clinical, imaging and pathologic features of BFOLs, especially the differential diagnosis between BFOLs and low-grade central osteosarcoma. Molecular detection could be used to assist the diagnosis in difficult cases.