Objective To investigate the significance of Human papilloma virus(HPV)typing in the screening of cervical dis-ease.Methods 687 cases of gynecological patients in the hospital were enrolled in the study,whose HPV-DNA genotype was detec-ted by real-time fluorescence quantitative PCR(FQ-PCR).In addition to that,389 healthy women who took gynecological examina-tion in the hospital in the same period were enrolled in the study,HPV-DNA quantitative detection were performed on those people (FQ-PCR were used)firstly,and the persons with more than 5×102 IU/mL HPV-DNA were tested for the HPV-DNA subtype. Results In the 687 cases of gynecological patients,164 cases were HPV positive which accounted for 23.9%;The single-infection patients accounted for 74.3%,mixed infection accounted for 25.6%.The mixed infection included 2 -4 types of infection,among which the double infection was most common.The common type were HPV16,52,58 and 35.In 389 cases of healthy women,29 ca-ses were found HPV positive,which accounted for 7.5%;The single infection accounted for 79.3%,mixed infection accounted for 20.7%,mixed infection included 2-3 types of HPV infection,in which double infection is the most common situation.The common type were HPV52,58,16 and 18.Conclusion HPV infection is the major cause of cervical cancer,HPV detection and typing con-tribute to cervical cancer screening and its prevention.

Objective To investigate the prevalence and main genotypes of carbapenemases in carbepenem‐resistant Enterobacteriaceae (CRE) .Methods A total of 114 strains of CRE were isolated in Shanghai Ruijin Hospital from May 2011 to June 2013 .The diameter of inhibition zone of imipemen or meropenem for these strains was not larger than 22 mm .PCR method was used to screen for the main carbapenemase genes (blaKPC ,blaIMP ,blaVIM ,blaOXA‐48 and blaNDM ) with previously described primers followed by nucleotide sequencing analysis . Conjugation experiments were performed to examine the transferability of plasmids .Pulsed‐field gel electrophoresis (PFGE) was used to show the relatedness of KPC‐2‐producing Enterobacteriaceae .Results Most of the 114 isolates were K lebsiella pneumoniae and Escherichia coli .Of the 114 isolates ,98 was positive for carbapenemases ,specifically ,78 blaKPC‐2‐positive ,15 blaIMP‐4‐positive ,2 blaIMP‐8‐positive ,1 positive for both blaKPC‐2 and blaIMP‐4 and 4 blaNDM‐1‐positive .None of the strains was positive for blaOXA‐48 or blaVIM .About 21 .4% (21/98) of the isolates were conjugated successfully .The 49 blaKPC‐2‐positive K .pneumoniae isolates were grouped into 12 types according to PFGE patterns .Majority (34/49) of these isolates belonged to the same type A .Conclusions BlaKPC‐2 was the primary epidemic genotype of Enterobacteriaceae in Ruijin Hospital ,followed by blaIMP‐4 .NDM‐1 carbapenemase was produced in 4 strains of CRE . Meanwhile , clonal spread of KPC‐2‐producing K . pneumoniae was observed in some departments of our hospital , such as surgical ICU , respiratory medicine and thoracic surgery . Appropriate measures should be taken timely and effectively to prevent the in‐hospital spread of resistant genes .

Silver nanoparticles ( AgNP) , the metallic silver par-ticles with the diameter of 1 ~100 nm are now widely used in many fields. Many researches show that the smaller size of Ag-NP, the stronger toxicity it shows. Generally speaking, AgNP with 20 nm shows strongest toxicity. After entering the body, they are distributed in different organs in the body, and the dis-tribution in the kidney shows a certain gender difference. They also produce some toxic effects after entering body organs. AgNP often exhibit dose effect on the toxicity in vitro cells,while in vivo experiments, their toxic effects change with the different objects and ways of acting. In addition, AgNP can produce toxic effects on reproduction, and may cause parental reproductive activity to deteriorate, and pass the toxic effects to offspring through the placenta to exert a negative influence on the growth and develop-ment of the offspring. The toxicity mechanisms of AgNP are oxi-dative stress injury caused by producing free radicals;metabolic disorders caused by reducing of drug metabolic enzyme activity;and also related gene expression defects and certain molecules, such as transcription factor NF-E2-related factor 2(Nrf2) prote-ase caused by abnormal expression. In short, AgNP can be toxic to organisms, and we must evaluate their biological safety when we use it, to minimize or even avoid the danger it brings about.

The purpose of this study is to investigate the basic situation of self-regulated learning among clinical medical undergraduates in the stage of professional courses and construct a structural model suitable for them to carry out self-regulated learning . Zimmerman's self-regulated learning concept framework was determined as the theoretical basis of this study. A questionnaire survey was performed to identify five main dimensions affecting self-regulated learning including expression of learning intention, self-efficacy, adjustment of learning behavior, management of curriculum strategies, and adaption of learning environment, and then, Amos 24.0 software was used to construct the structural model and draw the conclusion that self-regulated learning in this group centers on the regulation of learning behavior, with learning intention and self-efficacy as sub-centers.

The establishment of outcome-based or competency-based education is an important feature of today's curriculum plans. This paper reviews the development and application of outcome-based education (OBE) in medical education. Based on the concept of OBE, the curriculum framework system of Higher Medical Education is reformed and optimized, and the frameworks of course learning outcome, curriculum teaching theme and curriculum competency are redesigned and determined. Outcome-based curriculum reform reflects the requirements of global healthcare education for medical talents in the new era. Driven by the learning outcomes of postgraduates, the curriculum reform focuses on cultivating the postgraduates' recognition, understanding, analysis and research of the phenomena and problem-solving abilities in medical education by providing courses with different teaching topics, clear learning objectives and requirements. The systematic improvement of teaching quality is helpful to further promote the scientific research of medical education and the cultivation of professional talents in medical education management.

Objective:To investigatethe heterogeneity of career growth recognition amongphysicians at the stage of standardized training and the growth characteristics of clinical physicians in the early stage, and to provide a reference for improving the quality of standardized training.Methods:The trainees who received standardized residency trainingwere randomly selected from three grade A tertiary hospitals in Chongqing, China. Mplus7.4 was used for latent profile analysis to explain the relationship between explicit continuous indicators, and the subtypes of career growth recognition were analyzed.Results:Career growth recognition at the stage of standardized training was classifiedinto three subtypes of all-round growth recognition, high resource and expectation recognition, and unclassified growth recognition, among which the subtype of unclassified growth recognition accounted for the highest percentage of 40.27% (207 trainees).Conclusions:Physicians at the stage of standardized training show obvious uncertainty aboutcareer growth recognition, and it is necessary to strengthen the education on career growth recognition during standardized training and design a development pathway based on the characteristics of career growth recognition.

Objective:To explore the effect of active ruminant thinking training on improving the self-perceived burden and quality of life of patients with end-stage renal disease undergoing hemodialysis.Methods:Using the convenient sampling method, a total of 106 patients with end-stage renal disease undergoing hemodialysis who were treated in Yantai Yuhuangding Hospital from January to December 2019 were selected as the research objects. The patients were divided into the control group and the intervention group by random number table, with 53 cases in each group. The control group received conventional treatment and nursing care, while the intervention group received active rumination thinking training on this basis. The scores of self-perceived burden, perceived stress and self-efficacy were compared between the two groups before and after intervention.Results:After the intervention, the total scores of body burden, emotional burden and self-perceived burden of the intervention group were lower than those of the control group, and the differences were statistically significant ( P<0.05) . The score of perceived stress of the intervention group was lower than that of the control group, and scores of emotional control, reasonable rest, self-care, management of compliance with medication and health problems in the self-efficacy of patients were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The application of active rumination thinking training in hemodialysis patients with end-stage renal disease can reduce the self-perceived burden and perceived pressure of patients and improve the self-efficacy level.

Objective:To investigate the factors affecting the outcome of surgical treatment for femoral intertrochanteric fractures.Methods:A retrospective case series study was conducted for 424 patients with intertrochanteric fractures admitted to four hospitals in Shanghai from January 2014 to December 2016. There were 200 males and 224 females, aged 45-98 years [(77.8±10.5)years]. Normal union was observed in 326 patients (normal union group), and abnormal union was founded in 98 patients including nonunion in 2 patients (abnormal union group). Data were recorded including the age, gender, injury side, AO classification, Evans-Jesen classification, thickness of femoral lateral wall, medial support, tip-apex distance, and screw position within the femoral head. Fracture healing was assessed. Univariate analysis was conducted to examine differences of the above factors between two groups, and Logistic regression was used to screen the main factors affecting fracture union. At the latest follow-up, the hip joint function was estimated according to the Oxford score system.Results:All patients were followed up for 1-3 years [(2.2±0.3)years]. Univariate analysis showed significant differences between two groups regarding the AO classification, Evans-Jesen classification, medial support, tip-apex distance, and screw position within the femoral head ( P<0.05). Multivariate regression analysis revealed that the simple fracture ( OR=1.030), medial support ( OR=0.395), tip-apex distance ≤25 mm ( OR=0.266) and inferior screw position ( OR=0.986) were significantly related to fracture union. The hip function in normal union group was (42.6±4.5)points, better than (35.4±3.2)points in abnormal union group ( P<0.05). Conclusion:The stability of intertrochanteric fracture is the most important factor for fracture union. The medial support, tip-apex distance ≤25 mm and inferior screw position are helpful to promote fracture healing and recovery of hip joint function.

Objective:To analyze the effect of intestinal fluid reinfusion after anterior resection of rectum and preventive ileostomy in patients with low rectal cancer.Methods:A prospective research method was used, and 60 patients with low rectal cancer in Zhejiang Jinhua Guangfu Tumor Hospital from January 2021 to June 2022 were enrolled. The patients were divided into control group (treated with anterior resection of rectum and preventive ileostomy) and observation group (treated with anterior resection of rectum and preventive ileostomy combined with intestinal fluid infusion) by random number table method with 30 cases each. On the next day and 3 months after surgery, the low anterior resection syndrome (LARS) scale was used to evaluate anal function, the patient-generated subjective global assessment (PG-SGA) method was used to evaluate nutritional status, the stoma-quality of life (stoma-QOL) was used to evaluate the quality of life. The complications were recorded.Results:Both groups of patients were successfully completed the scheduled surgery. There were no statistical differences in LARS score and incidence of LARS on the next day after surgery between the two groups ( P>0.05); the LARS score and incidence of LARS 3 months after surgery in observation group were significantly lower than those in control group: (18.63 ± 3.15) scores vs. (24.90 ± 6.11) scores and 23.33% (7/30) vs. 46.67% (14/30), and there were statistical differences ( P<0.01 or <0.05). There were no statistical differences in PG-SGA score and incidence of malnutrition on the next day after surgery between the two groups ( P>0.05); the PG-SGA score and incidence of malnutrition 3 months after surgery in observation group were significantly lower than those in control group: (3.07 ± 0.82) scores vs. (5.13 ± 1.01) scores and 26.67% (8/30) vs. 46.67% (14/30), and there were statistical differences ( P<0.01 or <0.05). There were no statistical differences in the scores of psychological burden, social interaction, stoma management and daily living of stoma-QOL on the next day after surgery between the two groups ( P>0.05); the scores 3 months after surgery in observation group were significantly higher than those in control group: (27.70 ± 4.28) scores vs. (21.47 ± 5.16) scores, (14.33 ± 2.03) scores vs. (11.90 ± 1.64) scores, (14.87 ± 1.92) scores vs. (11.57 ± 2.38) scores and (15.30 ± 1.03) scores vs. (12.37 ± 2.11) scores, and there were statistical differences ( P<0.01). The incidence of complications in observation group was significantly lower than that in control group: 30.00% (9/30) vs. 60.00% (18/30), and there was statistical difference ( χ2 = 5.45, P<0.05). Conclusions:For the patients with low rectal cancer, the anterior resection of rectum and preventive ileostomy combined with intestinal fluid reinfusion can reduce LARS, improve nutritional status, improve quality of life, and also reduce complications.

To implement the strategy of healthy China and promote the construction of "new medicine science", it is urgent to focus on new needs and challenges to advance the reform of medical education curricula in China. Using literature research methods, we summarize the process of modern medical education curriculum reforms in the United States, and discuss the main features of the third-round reforms—introducing the concept of value-based medicine, offering health systems science courses, and promoting the curriculum system reform from the perspectives of learning time, curriculum integration, and learning methods. Based on these features, we put forward the enlightenment for the reform of medical education curricula in China.