Objective:To explore the competitive attitude of students of medical college and its influencing factors.Methods:A sample of 382 first to third year medical students was selected with the method of random sampling. The questionnaire consists of three parts: demographics, Competitive Attitude Scale of Chinese Version and Jefferson Scale of Physician Empathy. SPSS 25.0 was applied to perform the statistical analysis. Concrete methods that used involved statistical interpretation, Kruskal-Wallis test, Mann-Whitney U test and Spearman rank sum correlation analysis. Results:The benign competitive attitude of students was 51.00(45.00，56.00) and the excessive competitive attitude was 35.00(31.00，38.00). There was a statistically significant difference in the score of benign competitive attitude among medical students of different grades( H=22.31, P<0.001). There were statistically significant differences in the scores of benign competitive attitudes among the medical students who enjoy teamwork ( Z=-4.53, P<0.001), who had role models to follow in the medical field ( Z=-3.99, P<0.001), and who had careful career planning ( Z=-2.19, P=0.029). There were statistically significant differences in the scores of excessive competitive attitudes among the medical students who enjoy teamwork ( Z=-2.47, P=0.014), who had role models to follow in the medical field ( Z=-2.89, P=0.004), and who had careful career planning ( Z=-2.32, P=0.021). There was a weak positive correlation between empathy and benign competitive attitude ( r=0.20, P<0.001), but a negative correlation between empathy and excessive attitude ( r=-0.36, P<0.001). Conclusions:Medical students had a good competitive attitude. Medical college should pay more attention to improving medical students' sense of teamwork, career planning ability and willingness to learn from role models, guide students to develop a benign competitive attitude and focus on improving their professional quality.

Objective:To evaluate the diagnostic value of targeted biopsy of secondary lesion (SL) in systematic biopsy (SB) combined targeted biopsy for clinically significant prostate cancer (CsPCa).Methods:A retrospective analysis was conducted on the data of patients who underwent systematic biopsy combined target biopsy at Nanjing Drum Tower Hospital from January 2021 to February 2023, and they had at least two Prostate Imaging-Reporting and Data System (PI-RADS) score ≥3 lesions on prostate magnetic resonance imaging. The study included patients with a median age of 70 (65, 76) years old, median prostate specific antigen (PSA) was 9.1 (5.96, 13.62) ng/ml, median prostate volume was 39.1 (29.27, 53.25) ml, and median PSAD was 0.2 (0.15, 0.38) ng/ml 2.The index lesion (IL) was defined as the one with the highest PI-RADS score and SL was defined as the one with the second-highest PI-RADS score. If the two lesions had the same PI-RADS score, the one with larger maximum diameter was IL and the other one was SL. The median maximum diameter of IL and SL were 1.3 (1.06, 1.66) cm and 0.9 (0.69, 1.20) cm, respectively. The median maximum diameter ratio of IL and SL was 1.48 (1.10, 1.91), and the median maximum diameter difference of IL and SL was 0.9 (0.20, 1.89) cm. The IL in peripheral zone was found in 238 patients (62.63%) and SL in peripheral zone was found in 255 patients (67.10%). There were 204 patients (53.68%) having both IL and SL on the same side of prostate. According to the combination of PI-RADS scores of IL and SL, patients were categorized into various groups: 96 patients (25.26%) with IL3 and SL3, 79 (20.78%) with IL4 and SL3, 98 (25.78%) with IL4 and SL4, 21 (5.52%) with IL5 and SL3, 76 (20.0%) with IL5 and SL4, and 10 (2.63%) with IL5 and SL5. Targeted biopsy was performed on at least two of the most significant lesions. Comparison was performed in the detection rate of CsPCa between SB+ IL+ SL and SB+ IL (SL was omitted). To explore the factors influencing the detection rate of CsPCa, a multivariate logistic regression analysis was used. Results:The detection rate of CsPCa in this study was 78.95% (300/380) based on SB+ IL+ SL. After omitting SL target biopsy, the detection rate of CsPCa was 78.16% (297/380, P>0.05) under the condition of SB+ IL. No significant differences were noted between the two groups. The multivariate logistic regression analysis showed that PSA ( OR=1.11, 95% CI 1.05-1.20, P<0.01), prostate volume ( OR=0.98, 95% CI 0.96-0.99, P<0.01), SL maximum diameter ( OR=0.19, 95% CI 0.08-0.50, P<0.01), ratio of IL and SL maximum diameter ( OR=0.34, 95% CI 0.16-0.68, P<0.01), difference of IL and SL maximum diameter ( OR=1.50, 95% CI 1.10-2.29, P<0.05), and PI-RADS score group of IL and SL (IL3 vs. SL3 as the reference, IL4 vs. SL3 OR=4.79, 95% CI 2.21-10.91, P<0.01, IL4 vs. SL4 OR=23.11 95% CI 8.09-85.28, P<0.01, IL5 vs. SL3/4/5 OR=15.28 95% CI 5.21-48.55, P<0.01) were the influencing factors for detection rate of CsPCa. Conclusions:For patients with at least two PI-RADS score≥3 lesions on prostate magnetic resonance imaging, omitting SL can almost maintain the same detection efficacy.

Objective:To evaluate the clinical value of four dimensional ultrasound combined with pelvic floor surface electromyography in the assessment of bladder prolapse in primipara with different delivery modes.Methods:A total of 413 primipara 6-8 weeks after full-term delivery were selected from the obstetrics clinic of the Second Affiliated Hospital of Hainan Medical College from October 2021 to September 2023. They were divided into natural delivery group(349 cases) and cesarean section group(64 cases ). The characteristics of 4D pelvic floor ultrasound in the two groups were analyzed and summarized. Then 64 cases of primipara with pelvic floor surface electromyography were divided into bladder prolapse group (46 cases) and no bladder prolapse group(18 cases). The characteristics of four dimension ultrasound combined with pelvic floor surface electromyography in the two groups were analyzed, and the related risk factors of bladder prolapse were analyzed.Results:The bladder neck mobility and urethral rotation angle in the natural delivery group were higher than those in the cesarean section group (all P<0.05). Compared with the cesarean section group, the incidence of obvious prolapse and urethral infundibulation was higher in the natural delivery group, while the incidence of mild prolapse was lower than that in the cesarean section group (all P<0.05). Bladder neck mobility, urethral rotation angle and levator ani hiatal area in the prolapsed bladder group were higher than those in the non-prolapsed bladder group (all P<0.05). The maximum value of fast muscle stage and the mean value of slow muscle stage in the group with prolapse were lower than those in the group without prolapse (both P<0.05). Univariate Logistic regression analysis found that the risk factors for bladder prolapse were increased birth weight, natural delivery, increased bladder neck mobility, posterior bladder angle was opened, increased urethral rotation angle, increased levator ani hiatal area, decreased maximum value of fast muscle stage and decreased mean value of slow muscle stage. Multivariate Logistic regression analysis showed that increased ani hiatal area ( OR=2.216, P=0.015) and decreased maximum value of tater muscle stage ( OR=0.847, P=0.035) were risk factors for bladder prolapse. Conclusions:Pelvic floor ultrasound combine with pelvic floor surface electromyography can qualitatively and quantitatively evaluate the changes of pelvic floor muscle structure and function in postpartum women, and diagnose bladder prolapse and its degree. The increase of levator ani hiatal area and the decrease of maximum value of tater stage may be the risk factors for bladder prolapse at 6-8 weeks postpartum in primiparas.

Objective The identification of Santali Albi Lignum and its common counterfeits Osyris lanceolata Lignum,Santalum spicatum Lignum was studied to provide experimental basis for the authenticity of this medicinal herb.Methods The identification was carried out using morphological,microscopic,and thin-layer identification methods.The volatile oil of Santali Albi Lignum and its counterfeits were extracted by steam distillation and the volatile oil components were analyzed by gas chromatography-mass spectrometry(GC-MS).The differences of volatile oil components among the three were compared.Results Santali Albi Lignum and its common counterfeits all possessed a sandalwood aroma,but Santali Albi Lignum has abundant oiliness and strong aroma.Osyris lanceolata Lignum aroma exhibits slightly strong odor and slightly camphor flavor,and the smell of Santalum spicatum Lignum is sweet and fragrant.Santali Albi Lignum is greyish-yellow to yellowish-brown in color,while Osyris lanceolata Lignum is generally reddish brown in color,Santalum spicatum Lignum is light yellow to light yellowish-brown,but its surface shows reddish-brown when exposed to air for a long time.In the transection section,the ray width of Santali Albi Lignum is more than 1-2 rows of cells,with occasional 3 rows of cells.The ray width of Osyris lanceolata Lignum is 1-3 rows of cells,while the ray width of Santalum spicatum Lignum is 1-2 rows of cells,mostly uniseriate.In the tangential section,the wood ray of Santali Albi Lignum has a height of 5-15 cells,the wood ray of Osyris lanceolata Lignum has a height of 4-10 cells,while the wood ray of Santalum spicatum Lignum has a height of 4-16 cells.In the radial section,fewer calcium oxalate crystal was found in Santali Albi Lignum,more calcium oxalate crystal was appeared in Osyris lanceolata Lignum,more and larger calcium oxalate crystal was identified in Santalum spicatum Lignum.Genuine and fake sandalwood can be distinguished using sandalwood oil as the thin-layer chromatographic reference.And the volatile oil content of fake Osyris lanceolata Lignum and Santalum spicatum Lignum is lower than that of Santali Albi Lignum.The main components of Santali Albi Lignum are α-santalol and β-santalol.The low content of santalol has been found in Osyris lanceolata Lignum,while α-santalol is extremely low in Santalum spicatum Lignum oil and β-santalol has not been found.Conclusion There are small differences among Santali Albi Lignum and its adulterants in characteristics,microscopical characteristics.But the differences have been found in three-way cross section,thin layer chromatography,volatile oil content and composition characteristics,which can be used for identification of Santali Albi Lignum and its counterfeits.

Escherichia coli is a highly adaptable opportunistic pathogen bacterium that can form biofilms on the surface of implants and generates persistent cells,leading to life-threatening infections that are difficult to treat with antibiotics alone.Therefore,there is a need for an effective E.coli biofilm inhibitor to combat this public health threat.Indole is a novel quorum-sensing signaling molecule of E.coli discovered in recent years,which is of great significance in regulating bacterial growth and biofilm formation,and is a potential target for future research on new anti-biofilm preparations.This article reviews the research progress on the formation of Escherichia coli biofilms,the microbial metabolism of indole and its regulation of Escherichia coli biofilm formation,in order to provide information for clinical treatment and drug development.

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 retrospectively investigate the distribution,molecular epidemiology and carbapenemases-encoding genes of carbapenem resistant K lebsiella pneumoniae(CRKP)in Zhejiang Province.Methods A total of 772 clinical isolates of K.pneumoniae isolated from 9 hospitals in Zhejiang Province in 2011 were selected,and antimicrobial susceptibility testings were carried out with disk diffusion or broth microdilution method.Polymerase chain reaction(PCR)was used to detect resistant genes,and molecular typing was performed by multilocus sequence typing(MLST)and pulsed field gel electrophoresis(PFGE).Results A total of 48 CRKP(6.2%)were screened in 9 hospitals. Carbapenemase-encoding genes were detected in 39 isolates by PCR,among which 37(77.1%)were identified as blaKPC-2and 2 were blaIMP-4.MLST showed that ST11 was the dominant ST type(30, 62.5%).Results of PFGE showed that 48 CRKP can be divided into 15 types.CRKP was found in 6 hospitals except hospitals in Wenzhou,Jiaxing and Shaoxing.Conclusions In 2011,CRKP is distributed in most areas of Zhejiang Province.The production of KPC-2 is the most important carbapenem resistance mechanism and ST11 is the most prevalent ST type.

Objective To observe the impairment effect of retinol binding protein 4(RBP4) on neurocognitive function in diabetic nephropathy(DN) patients with silent cerebral infarction(SCI) and to explore its mechanism.Methods Sixty patients with newly diagnosed DN and 30 healthy volunteers were selected as the study subjects and the DN cases were divided into the complicating SCI group(SCI,n=30) and non-complicating SCI group(NSCI,n=30) according to the imaging results.The degrees of neurological function deficit and Montreal cognitive assessment(MoCA) were evaluated.Serum RBP4 level was determined by ELISA and expressions of Lp-PLA2 and C-X-C chemokine receptor type 4(CXCR4) were determined by Western blot.Results Compared with the NSCI group,the neurocognitive function in the SCI group was subsided,the expression levels of RBP4,Lp-PLA2 and CXCR4 were increased(P＜0.05).The RBP4 level was positively correlated with the neurocognitive function impairment in SCI patients,moreover,there existed a regression correlation between them.Conclusion Serum RBP4 may serve as the predictive factor of DN complicating SCI and is positively correlated with neurocognitive dysfunction.Lp-PLA2/CXCR4 pathway activation may be one of its pathogenesis.

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.

Based on the data from the -, the bibliometric analysis was applied to analyze and evaluate the literature regarding clinical research of acupuncture for ophthalmopathy published between 1954 to 2016, hoping to objectively reflect the disease spectrum and indication of acupuncture for ophthalmopathy. The results showed that the disease spectrum of acupuncture for ophthalmopathy involved 47 specific diseases in 13 types of diseases. The total number of cases was 176 469, and the number of effective cases was 160 662, and the effective rate was 91.0%. The indication of acupuncture for ophthalmopathy included myopia, blepharoptosis and conjunctivitis. The commonly used indications were strabismus, dry eye and ophthalmoplegia, and the secondary indications were optic atrophy, blepharoptosis, oculomotor paralysis, blepharospasm, amblyopia. The most commonly used acupuncture points for ophthalmopathy were Cuanzhu (BL 2), Jingming (BL 1), Taiyang (EX-HN 5), and the most commonly used auricular points were yan (LO), gan (CO) and shen (CO). As for the methods of acupoint combination, local acupoints were mainly selected, combined with distal acupoint to assist treatment.