The phenomenon that the listener's reception,perception,and understanding of a sound are dis-turbed by an irrelevant sound is called the auditory masking effect.In the auditory masking effect,the human audi-tory nervous system is able to screen and extract target sounds from different sound sources based on different cues,and filter out unwanted masked sounds.The auditory masking effect is not a simple processing from separation to integration however it is,with a complex internal mechanism.Under energetic masking,acoustic information such as frequency and intensity of target and masher generates coding competition in the auditory periphery.Under infor-mational masking,target sound and masher competes with perceptive and cognitive information in the auditory cen-ter.Informational masking is the focus of masking research,but its mechanism is still controversial.This study studies the neural mechanism of informational masking effect from three factors,including similarity,uncertainty and intelligibility.

The phenomenon that the listener's reception,perception,and understanding of a sound are dis-turbed by an irrelevant sound is called the auditory masking effect.In the auditory masking effect,the human audi-tory nervous system is able to screen and extract target sounds from different sound sources based on different cues,and filter out unwanted masked sounds.The auditory masking effect is not a simple processing from separation to integration however it is,with a complex internal mechanism.Under energetic masking,acoustic information such as frequency and intensity of target and masher generates coding competition in the auditory periphery.Under infor-mational masking,target sound and masher competes with perceptive and cognitive information in the auditory cen-ter.Informational masking is the focus of masking research,but its mechanism is still controversial.This study studies the neural mechanism of informational masking effect from three factors,including similarity,uncertainty and intelligibility.

Voice recognition is a key skill for successful human communication,but patients with voice recog-nition defects often suffer from the inability to accurately identify the speaker's identity.Phonagnosia refers to the difficulty in identifying a speaker by voice alone when hearing ability is not impaired.From the perspective of brain injury,the symptoms can be divided into congenital phonagnosia and developmental phonagnosia,and congenital phonagnosia is related to the dysfunction of the functional connection between the temporal lobe and the amygdala.The damaged brain areas in patients with acquired speech recognition defect mainly include the temporal lobe and the frontal lobe.In the future,more attention should be paid to the screening methods,neural mechanisms and differ-ences between patients with speech recognition deficiency and other patients with hearing and cognitive impairment.

Objective:Based on the current medical environment, to learn about cognition status of doctor-patient relationship among medical students and analyze causes of the tension between doctors and patients.Methods:Using the self-designed questionnaire "Clinical Medical Students' Cognition Survey on Occupational Status and Doctor-Patient Relationship", a cross-sectional survey was conducted on 527 medical students from 5-year and 7-year clinical program in Batch 2014 in a medical university in Heilongjiang Province. The survey mainly analyzed the causes of the tension between doctors and patients from the level of medical staff, patients and their families, hospitals and society. SPSS 22.0 was used for descriptive statistics and chi-square test.Results:The results showed that 93.7% of the medical students believed that the current doctor-patient relationship was not harmonious. There were cognitive differences among medical students in different gender ( P=0.029), first contact clinical grade ( P=0.003) and professional identity ( P<0.001). Conclusion:Medical students have a poor evaluation towards the current doctor-patient relationship. In order to construct harmonious doctor-patient relationship in the future, we can try to take measures such as carrying out relevant courses of doctor-patient communication, improving the medical students' communication skills and enhancing their professional identity.

Objective:To explore the present situation of medical students' professionalism cognition and provide reference for medical personnel training and medical education.Methods:A cross-sectional survey was conducted on medical students among 2 affiliated hospitals of a medical university in H province by cluster sampling. Exploratory factor analysis and reliability and validity test were carried out and a descriptive analysis of the present situation of professionalism was conducted by SPSS 20.0. Amos21.0 software was used for a confirmatory factor analysis on the samples.Results:The measurement scale had good reliability and validity, and the Cronbach alpha coefficient of the scale was 0.901. The average professionalism score of the medical students was about 80 points. The score of "physical and mental status and self-development ability" was the highest (83.65 points), and the lowest score was "academic ability" (72.21 points). There was a little difference in the professionalism cognition between the two hospitals, with significant differences between the dimension "respect and care" and "responsibility".Conclusion:This study has initially formed a medical professionalism measurement scale with good reliability and validity. The professionalism of medical students in the 2 affiliated hospitals of a medical school in Province H is in good condition as a whole. In the future, medical education should pay more attention to the combination of basic professional knowledge and clinical practice of medical students, and change the training model of medical students in order to improve the academic ability of medical students and medical students' overall cognition of professionalism.

Objective:To analyze the clinical characteristics of novel oral anticoagulants (NOAC)-related leukocytoclastic vasculitis (LCV).Methods:PubMed, Embase, ScienceDirect, Ovid, and Scopus databases were searched as of August 2020 and case reports on NOAC-related LCV were collected. Relevant information in patients including gender, age, primary disease, co-existing disease, NOAC application, combined medication, LCV occurrence, treatment and outcome of LCV, and etc. was extracted and analyzed using descriptive statistical method.Results:A total of 13 patients were collected; 6 were from the United States, 2 from Turkey, 2 from Spain, and 3 from Greece, South Korea, and Denmark, respectively. There were 8 males and 5 females, aged 29 to 95 years, and 9 patients were ≥60 years old. Apixaban was applied in 5 patients, rivaroxaban in 5 patients, and dabigatran etexilate in 3 patients. Dose of NOAC was recorded in 7 patients, all of which were within the recommended range of the instructions. Time from taking NOAC to the occurrence of LCV was recorded in 12 patients, ranging from 3-18 days (7-10 days in 7 patients) after the first medication. All 13 patients developed skin lesions, presenting as purpura and/or rash. Skin lesions involved limbs and trunk in 4 patients, lower limbs in 7 patients, lower limbs and trunk in 1 patient, and upper limbs and trunk in 1 patient. Twelve patients underwent skin biopsy at the lesion site; 11 patients had neutrophil infiltration and 1 had only eosinophil infiltration. NOAC was stopped in all the 13 patients after diagnosis of LCV. Among them, other anticoagulants were switched in 12 patients and glucocorticoids were given in 9 patients. Finally, 8 were cured and 5 were improved.Conclusions:NOAC-related LCV usually occurred 7-10 days after the first medication, mainly manifested as purpura and rash and often involved the lower extremities. The prognosis was good after drug withdrawal and appropriate application of glucocorticoid according to patient conditions.

Objective:To analyze the clinical characteristics of novel oral anticoagulants (NOAC)-related leukocytoclastic vasculitis (LCV).Methods:PubMed, Embase, ScienceDirect, Ovid, and Scopus databases were searched as of August 2020 and case reports on NOAC-related LCV were collected. Relevant information in patients including gender, age, primary disease, co-existing disease, NOAC application, combined medication, LCV occurrence, treatment and outcome of LCV, and etc. was extracted and analyzed using descriptive statistical method.Results:A total of 13 patients were collected; 6 were from the United States, 2 from Turkey, 2 from Spain, and 3 from Greece, South Korea, and Denmark, respectively. There were 8 males and 5 females, aged 29 to 95 years, and 9 patients were ≥60 years old. Apixaban was applied in 5 patients, rivaroxaban in 5 patients, and dabigatran etexilate in 3 patients. Dose of NOAC was recorded in 7 patients, all of which were within the recommended range of the instructions. Time from taking NOAC to the occurrence of LCV was recorded in 12 patients, ranging from 3-18 days (7-10 days in 7 patients) after the first medication. All 13 patients developed skin lesions, presenting as purpura and/or rash. Skin lesions involved limbs and trunk in 4 patients, lower limbs in 7 patients, lower limbs and trunk in 1 patient, and upper limbs and trunk in 1 patient. Twelve patients underwent skin biopsy at the lesion site; 11 patients had neutrophil infiltration and 1 had only eosinophil infiltration. NOAC was stopped in all the 13 patients after diagnosis of LCV. Among them, other anticoagulants were switched in 12 patients and glucocorticoids were given in 9 patients. Finally, 8 were cured and 5 were improved.Conclusions:NOAC-related LCV usually occurred 7-10 days after the first medication, mainly manifested as purpura and rash and often involved the lower extremities. The prognosis was good after drug withdrawal and appropriate application of glucocorticoid according to patient conditions.

Gallstone is one of the most common diseases in hepatobiliary, cholesterol gallstone is the most common type of gallstone. One of the important causes of gallstone formation is the precipitation of cholesterol crystals caused by cholesterin supersaturation. Scavenger receptor type BI (SR-BI) is a kind of multifunctional membrane receptor protein, which can mediate the selective uptake of cholesterol in liver and then affect the content of cholesterol in bile. Its role in the formation of gallstone has been initially revealed. In this paper, the relationship between the occurrence of cholesterol gallstones and scavenger receptor type B type I was summarized in order to provide new ideas for the further study of the pathogenesis of gallstone.

Objective:To explore the clinical manifestations, diagnostic characteristics, treatment strategies and outcomes of patients with brucellaperi prosthetic joint infection (PJI).Methods:The medical records of 6 patients with brucella PJI in the First Medical Center of Chinese PLA General Hospital and the Third Hospital of Hebei Medical University from January 2010 to December 2018 were retrospectively analyzed, including 5 males and 1 female, aged 61.5±11.5 years (range 45-79 years) with body mass index 23.0±2.8 kg/m 2 (range 18.4-26.1 kg/m 2). Five cases lived in the countryside, 1 in the city. Four cases were farmers, while two cases were herder and unemployed. One case had contact history in the epidemic area, and 1 case had been in the slaughter industry. Three cases were with knee PJI, of which 1 patient underwent total knee arthroplasty due to knee joint villous nodular synovitis and 2 patients due to knee osteoarthritis. Three patients had hip PJI of which 1 patient underwent total hip arthroplasty due to spondylitis and hip ankylosis and 2 cases due to femoral head necrosis. Three cases were with acute PJI, while other 3 cases were with chronic PJI. Three cases showed fever, while 5 cases had local wounds swelling. A total of 4 cases were complicated with sinus tracts. Five cases had laboratory examinations on the day of admission of which 3 cases had elevated blood C-reactive protein (CRP) and 5 cases with increased erythrocyte sedimentation rate (ESR). Five cases were with increased blood interleukin-6 (IL-6), 2 cases with increased blood alanine transaminase (alanine transaminase, ALT). All cases had varying degrees of restricted movement of the affected joints. The normal range of motion of the hip joint was from 10° to 130°. The average range of motion of 3 patients with hip joint involvement was from 0° to 75°. The normal range of motion of the knee joint was 10°-135°. Three patients with knee joint involvement had an average range from -8° to 67°. One case showed loosening of the right hip prosthesis with infection and 1 case showed local soft tissue swelling. Other cases showed no obvious abnormalities in X-rays. Two patients who underwent frozen pathological examination during the operation had positive pathological neutrophilcounts. Four cases had positive Brucella culture in joint tissues or synovial fluid (1 case with mixed infection) and 2 cases had blood Brucella antibody positive. Results:Among the 3 cases of acute PJI, two of them were treated with debridement, antibiotics, irrigation and retention. One case was treated with two-stage revision. Among the 3 cases of chronic PJI, one was treated with two-stage revision and 2 were treated with one-stage revision. Brucella-specific antibiotics such as rifampicin and doxycycline were used in the antibiotic treatment with the course of antibiotics 3 to 12 weeks. At the time of discharge, the CRP and ESR dropped to the normal range (CRP 0-0.8 mg/dl, ESR 0-20 mm/1 h) in all cases except for the second case. Interleukin 6 was not tested in the sixth case before discharge. In the remaining 5 patients, the blood interleukin 6 fell to the normal range (0-5.9 pg/ml) in 2 cases, and the blood ALT was in the normal range (0-40 U/L) in 4 cases. The body temperature of the second case was 37.3 ℃, while the other cases dropped below 37.3 ℃. In the second case, fever occurred intermittently after surgery. Thus, the incisionwas reddened and swollen and exuded 2 months after the operation. The patient recovered after intravenous infusion of levofloxacin. Until the last follow-up, all patients had no recurrence of infection. Imaging examination comfirmed that the prosthesis was in good position.Conclusion:For patients with Brucella PJI, Brucella culture positive and Brucella antibody positive have specific diagnostic significance. Different surgical strategies will be adopt based on the patient's symptoms and the duration of infection. Surgery combined with Brucella specific antibiotic treatment can usually achieve satisfied therapeutic outcomes.

Objective: To identify the key pathogenic genes of leptin regulating gallbladder contraction and secretion in mice and to reveal the potential molecular mechanism by comprehensive bioinformatics. Methods: The expression profile of GSE3293 was downloaded from Gene Expression Omnibus (GEO) database. The data contained 8 samples, including 4 leptin-treated gallbladder samples and 4 saline-treated gallbladder samples. The most valuable 250 differentially expressed genes (DEGs) were obtained by grouping analysis of GEO online GEO 2 R-TOP 250 software or tools, and further analyzed by bioinformatics. The GO function and KEGG pathway enrichment of DEGs were analyzed by DAVID online software. The protein-protein interaction (PPI) network of DEGs was constructed from STRING database. Results: A total of 250 differentially expressed genes were identified from the GSE3293 dataset, of which 197 genes were up-regulated and 53 genes were down-regulated. GO analysis showed that the biological functions of DEGs were mainly concentrated on MHC class II protein complexes, plasma membrane, extracellular exosome. KEGG pathway analysis showed that these DEGs were mainly involved in tuberculosis, leishmaniasis, cell adhesion molecules, bacteriophages, infection and other signaling pathways. PPI network showed that these DEGs coded proteins interacted strongly, and the first five pairs of DEGs with the strongest correlation were screened out. Conclusions The molecular mechanism of cholelithiasis is predicted from gene level by bioinformatics analysis of function enrichment and PPI of DEGs in mouse gallbladder. However, the function of DEGs still needs a lot of clinical and molecular biological experiments to confirm.