Objective To observe the distribution of aerobic bacteria in conjunctival sac of patients with proliferative diabetic retinopathy and the sensitive antimicrobial agents in order to master the distribution of bacteria in the conjunctival sac and select sensitive antibiotics to decrease the infection rate and improve the therapeutic effect. Methods From March 2013 to August 2016, 248 patients with proliferative diabetic retinopathy were treated with aerobic bacterial culture and antibiotic susceptibility test. The distribution characteristics of aerobic bacteria in conjunctival sac and the sensitivity of antibiotics were observed. Results There were 112 strains in this study, the positive rate was 45.16% (including 8 cases of mixed infection), including 104 strains of gram-positive bacteria, 92.86% of gram-negative bacteria and 7.14% of gram-negative bacteria, the difference was statistically significant differences (P<0.05). Among them, the positive rate of staphylococcus epidermidis higher than other types of strains, the difference were all significant differences (P all<0.05). The sensitivity of vancomycin to gram-positive bacteria 100% was higher than that of, ofloxacin 13.46%,ciprofloxacin 21.15%,gentamicin 69.23% and rifampicin 88.46%, (P all<0.05). The sensitivity of gentamicin to gram-negative bacteria 87.50% was higher than that of rifampicin 0 and vancomycin 12.50%, (P all<0.05). Positive rate of culture results and staphylococcal multidrug resistance rate were 72.94%,31.76%, the incidence of >65 years of age were higher than ≤ 65 years old 30.67%,12.27%, male 51.61%,23.12% than female 25.81%,6.45%, there are basic diseases 69.15%,31.91% were higher than those without underlying diseases30.54%,11.04%, (P<0.05). Staphylococcus number composition ratio, the difference was not statistically significant. Conclusion To strengthen the observation of aerobic bacteria and the sensitivity of commonly used antimicrobial agents in patients with proliferative diabetic retinopathy, especially the high risk population, it is helpful to master the distribution characteristics of bacterial conjunctival sac and sensitive antimicrobial agents, so as to achieve the preoperative conjunctival sac Bacteria and reduce the rate of infection and other purposes.

Objective:To analyze the diagnostic efficacy of targeted biopsy (TB) versus targeted biopsy combined with systematic biopsy (TB+ SB) for patients with multi-parametric magnetic resonance imaging (mpMRI) prostate imaging-reporting and data system (PI-RADS) score of 4-5.Methods:The clinical data of 378 patients with mpMRI PI-RADS score of 4-5 in Nanjing Drum Tower Hospital from January 2018 to February 2020 who received prostate TB+ SB were retrospectively analyzed. Median age was 69 (64, 75) years old, median prostate specific antigen was 9.5 (6.7, 16.3) ng/ ml, and median prostate volume was 34.1 (23.5, 48.4) ml. There were 240 cases with PI-RADS score of 4 and 138 cases with PI-RADS score of 5. Evaluating Gleason score of positive biopsy pathology and using χ 2 test or Fisher exact test to analyze the detection of prostate cancer (PCa) and clinically significant prostate cancer(CsPCa) by TB versus TB+ SB. Results:Of the all 378 cases, 88 cases (23.3%) were negative and 290 cases (76.7%) were positive. The average number of needle for TB was 2.4 per person, while SB was 12 per person. TB and SB had no statistically significant difference in the detection rate of PCa (73.3% vs. 68.3%, P=0.129) and CsPCa (55.8% vs. 49.7%, P=0.094) and in the accuracy (79.1% vs. 77.8%, P=0.658), but had a statistically significant difference in the positive rate (64.2% vs. 23.1%, P < 0.001). The pathological coincidence rate of TB and TB+ SB was 92.3%. There was no statistical difference in the detection rate of PCa (73.3% vs. 76.7%, P=0.275) and CsPCa (55.8% vs. 62.2%, P=0.076) between TB and TB+ SB. The missed diagnosis rate of TB for PCa was 4.5%, for CsPCa was 10.2%. For patients with PI-RADS score of 4, TB had no significant difference in the detection rate of PCa (65.4% vs. 69.2%, P=0.381) and CsPCa (46.7% vs. 52.9%, P=0.171) from TB+ SB. The accuracy of TB was 82.1%. The missed diagnosis rate of TB for PCa was 5.4%, for CsPCa was 11.8%. For patients with PI-RADS score of 5, TB had no significant difference in the detection rate of PCa (87.0% vs. 89.9%, P=0.452) and CsPCa (71.7% vs. 78.3%, P=0.211) from TB+ SB. The accuracy of TB was 73.9%. The missed diagnosis rate of TB for PCa was 3.2%, for CsPCa was 8.3%. Conclusions:For high-risk prostate cancer patients with PI-RADS score of 4-5, TB can obtain a detection effect similar to that of TB+ SB with fewer needles, but there is still the possibility of inaccurate diagnosis and missed diagnosis.

Objective To assess the value of free-hand transperineal multiparametric nagnetic resonance imaging/transrectal ultrasound (mpMRI/TRUS) fusion-guided targeted biopsy (TB) for the diagnosis of prostate cancer(PCa).Methods Patients with elevated PSA level and/or an abnormal DRE finding were recruited prospectively between January 2015 and September 2016.Patients were classified to various scores from 2 to 5 according to prebiopsy mpMRI PI-RADS.Based on free-hand transperineal mpMRI/TRUS fusion-guiding,a 2-cores TB for each cancer-suspicious lesion were carried out and followed 12-cores systematic biopsy (SB) protocol.Pathological findings of biopsy and radical prostatectomy (RP) specimens were analyzed.Results A total of 397 patients were enrolled in this study.The median age of the patients was (68.2 ± 7.4) years old,ranging 42-78 years.The median PSA level was (15.0 ±12.4)ng/ml,ranging 3.0-88.3 ng/ml.DRE showed abnormality in 28 patients(7.1％).The median prostate volume was (41.6 ± 16.4)cm3,ranging 24.6-89.8 cm3.The PCa detection rate of TB was significantly increased compared with SB (44.8 ％ vs.34.8％) (P =0.003),especially in clinically significant PCa (P ＜ 0.001) and intermediate/high-risk PCa (P =0.003),respectively.Of the all 588 mpMRI targeted lesions,277 lesions were positive.A total of 105 index tumors were identified in RP specimens,the locations of TB-proven cancer showed 96.6％ (85/88) in correspondence with the location of the index lesion in RP specimens.Conclusions Free-hand transperineal mpMRI/TRUS fusion-guided TB providing greater detection of intermediate-high risk PCa while limits over detection of low risk PCa.Moreover,TB can reliably predict the location of an index tumor.