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.

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.

This paper assembled immunotherapy methods for neuromyelitis optica spectrum disorder (NMOSD) in recent years, including the treatment of acute stage, the prevention of relapse and the potential immunotherapy. The treatment of acute stage is mainly to inhibit inflammatory response and reduce aquaporin 4 (AQP4) antibody(Ab) titer, and this is done mainly by using high-dose hormone shock therapy and plasmapheresis. Remission treatment is to inhibit the proliferation of T cells and B cells and also remove B cells from the body, for the purpose of reducing the number of relapses. Azathioprine, rituximab and mycophenolate mofetil are mainly given during remission stage. The treatment of NMOSD will become more targeted/specific in the future. The mechanism of action of the new drug is mainly through blocking the binding of pathogenic AQP4-Ab and its antigen (Ag), reducing the generation of pathogenic AQP4-Ab, and blocking the downstream reaction after pathogenic Ab-Ag binding. The new drugs mainly include aquaporumab, tocilizumab, DNA vaccine, anti-CD19 monoclonal Ab (MEDI-551), eculizumab and bevacizumab.

The professional identity formation and development of medical students is a gradual process.Its aim is to offer a reference for further research of medical students' professional identity and the improvement of medical practice education in the current medical environment by analyzing the aspects at home and abroad in the research method and research content of medical students' professional identity formation and measurement as well as the present intervention measures that can cultivate medical students' professional identity formation.

Aim To explore the effect of shikonin on stemness maintance of glioma stem cells ( GSCs ). Methods After the U87-MG cells were cultured and isolated, the sphere cells were identified by immuno-fluorescent staining. The alteration of stemness of GSCs by shikonin treatment(2 μmol·L - 1 ) for 12 h, 24 h and 48 h was valued by morphological detection using optical microscope and sub-sphere forming assay. Mo-reover, the related markers of stem cells, such as CD133, were detected in shikonin treated GSCs by western blot assay. Protein expression of PI3K, p-PI3K, Akt and p-Akt was detected by western blot af-ter shikonin treatment alone. Furthermore, by combi-nation with insulin-like growth factor-1 ( IGF-1), we observed the alteration of stemness maintance of shiko-nin-treated GSCs. Results The presence of neural stem cell related markers CD133 and nestin proved the characteristics of GSCs. Shikonin treatment significant-ly inhibited the morphology of GSCs and the sub-sphere forming. Besides, the reduced expression of CD133 was detected in shikonin treated GSCs. Though, the expression of PI3K and Akt did not change compared with the control group, the expression of p-PI3K and p-Akt was reduced. Furthermore, the combination of IGF-1 markedly attenuated the inhibitory effect of shikonin on stemness maintance of GSCs. Conclusion The stemness maintance of GSCs can be significantly inhibited by shikonin treatment, in which PI3K/ Akt pathway is involved.

Objective To study the mechanism of miR?200c in regulating RMP7?induced increases of blood?tumor barrier(BTB)permeability by targeting Ras homolog gene family member A(RhoA). Methods Endogenous expression of miR?200c was detected by real?time PCR in hu?man cerebral microvascular endothelial cell line hCMEC/D3(ECs)after RMP7 treatment. miR?200c mimic and miR?200c inhibitor were transfect?ed into GECs(ECs with U87 glioma cells co?culturing),respectively. Transfection efficiency of miR?200c mimic and miR?200c inhibitor were de?termined by real?time PCR. HRP flux and TEER assays revealed BTB permeability. The protein expression level of RhoA was assessed by West?ern blotting. The distribution of RhoA was assessed by immunofluorescence microscopy. RhoA luciferase assays were performed using the Dual?Lucif?erase reporter assay system. Results RMP7 significantly induced a decrease in miR?200c expression in GECs of BTB. miR?200c mimic and miR?200c inhibitor were successfully transfected into GECs. Overexpression of miR?200c inhibited endothelial leakage and restored normal transendo?thelial electric resistance values. Simultaneously ,overexpression of miR?200c significantly reduced the protein expression level of RhoA. In addi?tion,immunofluorescence analysis revealed that the distribution of RhoA in the cytoplasm and nuclei of GECs were decreased in miR?200c mimic group. RhoA was one of the direct targets of miR?200c with the specific binding site being located at the seed sequence. The results of miR?200c si?lencing were opposite to that of the miR?200c overexpression group. Conclusion miRNA?200c regulated RMP7?induced increases in BTB perme?ability by targeting RhoA.