Objective To investigate the virulence and drug resistance characteristics of diarrheagenic Escherichia coli isolated from patients with infectious diarrhea in our hospital.Methods The preliminary identification of microbes was carried out by the VITEK-MS microbial mass spectrometry detection system and virulence genes were detected by the multiplex real-time PCR.Five types of diarrhea-genic Escherichia coli(DEC)clinically isolated from patients with infectious diarrhea in our hospital were identified.The drug resist-ance characteristics of DEC strains were detected by the microbroth dilution and E-test.The drug-resistant molecular characteristics were analyzed by the next-generation sequencing and bioinformatics.The Fisher exact probability method was used for statistical analy-sis.Results The detection rate of DEC in our hospital was 11.9%,with enteroaggregative E.coli(EAEC)accounting for 37.5%,a-typical enteropathogenic Escherichia coli(EPEC)accounting for 34.38%,enterotoxigenic E.coli(ETEC)accounting for 25.0%,and enteroinvasive E.coli(EIEC)accounting for 3.12%.None of enterohemorrhagic E.coli(EHEC)strain was detected.The resistance rates of 32 DEC strains to ampicillin,tetracycline,and trimethoprim/sulfamethoxazole were 53.12%,43.75%,and 37.5%,respec-tively.ESBLs(+)strains accounted for 18.75%,and the detection rate of multidrug-resistant strains was 83.83%,significantly higher than that of ESBLs(-)strains(P=0.042).A total of 25 ST genotypes were obtained from 32 DEC strains.The dominant genotypes were ST10(4 strains,12.5%),followed by ST28(2 strains,6.25%),ST31(2 strains,6.25%),ST3153(2 strains,6.25%),and the other 21 genotypes(1 strain,3.13%).One carbapenem resistant strain carrying the blaNDM-1 gene was detected in EAEC.Conclu-sion Four virulence genes such as aggR,pic,astA,and eae,are more common in the DEC of patients with infectious diarrhea in our hospital,with EAEC and EPEC as the main subtypes.The genotypes are highly polymorphic,and multidrug-resistant strains have been detected.

【Objective】 To analyze the environmental monitoring results of NAT laboratory from 2016 to 2019 and evaluate the influence of environmental quality on blood screening. 【Methods】 Monthly/Quarterly environmental monitoring was carried out in NAT laboratory regularly by means of air deposition and surface wiping. The monitoring results were statistically analyzed and comprehensively evaluated in combination with the pool/multiplexNATreactiverate and discriminatory/resolutionrate. 【Results】 A total of 48 batches of environmental monitoring tests were conducted from 2016 to 2019, 11 (25 reactive sites) were unqualified, including 15 reactive sites (60%) as the hallway doorknob or access control, which were the public areas shared with serology laboratory, and these sites were not reactive for 6 consecutive months after intensive cleaning and disinfection. In Nov.2017, the air deposition in biosafety cabinet and surface wiping of Cobas s 201 were reactive, and the restwere the doorknobs. Pearson correlation analysis showed that there was no correlation between the positive rate of environmental monitoring and the detection amount, the pool/ multiplex NAT reactive rate and discriminatory/resolution rate. 【Conclusion】 The accidental environmental pollution in the laboratory is not related to the detection amount and positive rate, indicating that the cleaning and anti-pollution measures are timely and effective to ensure the accuracy and reliability of the screen results. NAT laboratory should gradually establish and improve the environmental monitoring system according to the layout and environment so that the environmental quality meets the testing conditions.

The importance of question bank construction in medical education has been well proved.However,there are still some weaknesses in the clinical teaching assessment question bank,including the inconsistency be-tween assessment and clinical practice,the lack of coherence in question bank updates,and the mismatch be-tween proposition and student learning stage.To address these issues,this article explores a teaching model which connects flipped classroom with student independent proposition and analyzes the advantages of applying flipped classroom to question bank construction.The connection between the two effectively established a regular updating mechanism for question banks,thus improve the construction of question banks in current medical education.It may support the capacity building of students' self-oriented and regulated learning and improve the quality of teaching assessment.

ObjectiveTo evaluate the effectiveness of stone needle thermocompression and massage compared to flurbiprofen gel patch in relieving chronic musculoskeletal pain in the shoulder and back， and to explore the potential mediating mechanism through muscle elasticity. MethodsA total of 120 patients with chronic musculoskeletal pain in the shoulder and back were randomly assigned to either stone needle group or flurbiprofen group， with 60 patients in each. The stone needle group received stone needle thermocompression and massage for 30 minutes， three times per week； the flurbiprofen group received flurbiprofen gel patch twice daily. Both groups were treated for 2 weeks. Pain improvement， as the primary outcome， was assessed using the Global Pain Scale （GPS） at baseline， after 2 weeks of treatment， and again 2 weeks post-treatment. To explore potential mechanisms， a mediator analysis was conducted by measuring changes in superficial and deep muscle elasticity using musculoskeletal ultrasound at baseline and after the 2-week treatment period. ResultsThe stone needle group showed significantly greater pain relief than the flurbiprofen group 2 weeks post-treatment. After adjusting for confounders related to pain duration， the between-group mean difference was -8.8 ［95% CI （-18.2， -0.7）， P＜0.05］. Part of the therapeutic effect was mediated by changes in deep muscle elasticity， with a mediation effect size of -1.5 ［95% CI （-2.0， -0.9）， P = 0.024］， accounting for 17.9% of the total effect. ConclusionStone needle thermocompression and massage can effectively relieve chronic musculoskeletal pain in the shoulder and back， partly through a mediating effect of improved deep muscle elasticity.