ObjectiveTo investigate the genotyping and drug resistance trends of 461 strains of diarrheagenic Escherichia coli (DEC) isolated and identified in Suzhou, Jiangsu Province from 2019 to 2023. MethodsDEC detected in Suzhou in the past 5 years was used as the research subject, and the virulence genotyping was tested by real-time fluorescence quantitative polymerase chain reaction (PCR). The microbroth dilution method was used to perform drug susceptibility test, and the corresponding susceptibility (S), intermediate (I) and resistance (R) results were obtained based on the minimum inhibitory concentration (MIC) values, according to the criteria of United States Clinical and Laboratory Standardization Committee (CLSI) 2017. Differences of DEC drug resistance among different virulence genotypes were compared by χ² test or Fisher exact probability method. ResultsA total of 461 DEC strains were detected in Suzhou from 2019 to 2023, of which the highest proportion was enterotoxigenic Escherichia coli (ETEC) accounting for 45.77% (211/461), followed by enteropathogenic Escherichia coli (EPEC) accounting for 32.32% (149/461) and enteroaggregative Escherichia coli (EAEC) accounting for 20.39% (94/461), while enterohemor-rhagic Escherichia coli (EHEC) and enteroinvasive Escherichia coli (EIEC) were individually distributed. The antimicrobial drug with the highest resistance rate was ampicillin (61.61%), followed by cefazolin (49.89%) and nalidixic acid (44.47%). There were statistically significant differences in drug resistence rates of the three major virulence genotypes of DEC (ETEC, EPEC and EAEC) to ampicillin (AMP), ampicillin/sulbactam (AMS), amoxicillin/clavulanic acid (AMC), cefoxetine (CFX), gentamicin (GEN), streptomycin (STR), tetracycline (TET), nalidixic acid (NAL), and chloramphenicol (CHL), and methotrexate/sulfamethoxazole (SXT). The multi-drug resistance (MDR) rate of DEC was 59.87% (276/461), and the MDR rate of each genotype, from high to low, was EIEC (75.00%), EAEC (71.28%), EHEC (66.66%), EPEC (61.74%) and ETEC (52.86%). ConclusionETEC, EPEC and EAEC are the main genotypes prevalent in DEC in Suzhou in recent years. The drug resistance strains and MDR are still serious, which should arouse wide public health concern and take targeted prevention and control measures.

Objective:To analyze the results of the practice test and formal test of the annual professional proficiency test for residents in 2022, to investigate related influencing factors and the effectiveness of the practice test, and to propose the measures for improving the results of the annual professional proficiency test.Methods:The scores of the annual professional proficiency test were analyzed for 202 residents who participated in the test in 2022, and the data on sex, education background, type of personnel, whether they passed the medical licensing examination, and practice test scores were analyzed to investigate related influencing factors. SPSS 23.0 and GraphPad Prism 8 were used for the chi-square test, the t-test, the one-way of variance, and the Fisher's exact test. A multiple linear regression analysis was used to identify influencing factors, and a Pearson correlation analysis was also performed. Results:The scores of the annual professional proficiency test for 202 residents were normally distributed with the highest number of the residents with a score of 90-99 points and the lowest number of the residents with a score of <70 points. The residents who passed the medical licensing examination had a significantly higher score of the annual professional proficiency test than those who failed the examination ( t=2.87, P=0.005), and the residents who passed the three practice tests had a significantly higher score of the annual professional proficiency test than those who failed the practice tests ( P<0.05). The score of the second practice test, the score of the third practice test, and the passing of medical licensing examination were independent influencing factors for the score of annual professional proficiency test ( R2=0.236, R2=0.201, F=6.60, P<0.05). The correlation analysis showed that the scores of the three practice tests were positively correlated with the final score ( r=0.189, 0.373, and 0.311, P<0.05). Conclusions:Improving the passing rate of medical licensing examination and strengthening pre-examination practice tests can help to improve the score of annual professional proficiency test. At the same time, it is necessary to improve the quality of training through the measures such as strengthening the homogenization management of different types of students, improving the attention and enthusiasm of all levels, and accelerating the construction of question banks.

Objective:To investigate the common disease spectrum of grass-root troops, to provide a basis for meeting the needs for military medical support among officers and soldiers, and to improve targeted training of military general practitioners in grass-root troops.Methods:With reference to International Classification of Diseases (9th edition), a questionnaire survey was conducted to investigate 146 types of diseases among the military doctors in grass-root troops. SPSS 23.0 was used to determine the score of the common degree of each disease, and the mean score of each disease was ranked. At the same time, the Kendell consistency test was used to compare the scores of doctors between different altitudes and troops.Results:Most grass-root military doctors were male graduates aged 20-39 years, among whom 109 (51.90%) did not receive continuing education, and there were 140 doctors (66.67%) belonging to the health company, 11 (5.24%) belonging to the health platoon, 35 (16.67%) belonging to the health clinic, and 24 (11.42%) belonging to the health team. As for the location of the troops, there were 42 doctors (20.00%) in the temperate zone, 56 (26.67%) in the subtropical zone, 57 (27.14%) in the alpine region, 37 (17.62%) in the plains, and 18 (8.57%) on the islands. There were 173 patients with an age of 20-29 years, accounting for 82.38%. The Kendell consistency test showed Kendell's W=0.968 ( χ 2=711.51, P<0.001), suggesting a consistent evaluation of 146 diseases by grass-roots doctors from different altitudes. Conclusion:With reference to the investigation of disease spectrum, it is necessary to formulate characteristic training objectives and contents for the training of military general practitioners, explore the training models and methods for military general practitioners in grass-root troops, promote the construction of military general practitioners during the new military reform, and improve the post competency of military doctors.

With the rapid development of information technology and the change in military education policy in the new era, online teaching has gradually become one of the main approaches to implement the clinical medical education in military teaching hospitals. In this study, the online teaching was performed mainly by pre-recorded teaching, supplemented by online live teaching. Massive open online courses (MOOCs) and the seminar-style teaching were advocated to be used in advanced disciplines. The quality of online teaching was guaranteed through infrastructure provision, teacher arrangement, teaching preparation, teaching interactivity, after-class test, teaching evaluation, supervision, and summary of teaching, which ultimately achieved a good effect. The results of the two-way questionnaires of 26 teachers and 129 students showed that 23.26% (30/129) of students and 65.38% (17/26) of teachers believed that students' learning ability was insufficient. 34.88% (45/129) of students and 23.08% (6/26) of teachers thought that the existing technology could not meet the requirements of online teaching. 55.04% (71/129) of students and 69.23% (18/26) of teachers held the view that the effect of online teaching was inferior to face-to-face teaching. 28.68% (37/129) of students and 57.69% (15/26) of faculty asked for the return of face-to-face education. Therefore, it is necessary to strengthen the construction of smart classroom platforms, establish a well-developed online teaching quality evaluation system, and integrate various innovative teaching modes with the online teaching. In these ways, it is expected to optimize the online teaching of clinical medicine and achieve the goal of online teaching.

Objective:To understand the effect of standardized residency training for residents with different identity types, and put forward targeted optimization and improvement measures to achieve the homogenization of training effect.Methods:Combined with literature review and expert consultation results, a self-designed questionnaire was conducted for 324 residents who completed their courses in 2019 and 2020. The effective recovery rate of the questionnaire was 87.65%. By comparing the passing rate of first-time medical admission and completion examination of different identity types, and the training standards of six core competencies, the training effect conclusion was drawn. T-test and Fisher exact probability test were also made by SPSS 21.0. Results:The passing rates of first-time doctors and completion examinations were higher in professional masters and units than in the general population, with the highest passing rates reaching 100% (10/10) and 97.3% (72/74) respectively. There was no statistical difference between the passing rates of residents with different identity types. The overall standard of the six core competencies of the integrated professional masters was better than that of the society and unit personnel. There were statistical differences between the groups in the training standards of the four abilities of the residents with different identity types in professional literacy ( P=0.048), patient management ( P=0.030), communication and cooperation ( P=0.026) and learning promotion ( P=0.003). There was no significant difference in professional ability ( P=0.131) and teaching ability ( P=0.061). Conclusion:There is no difference in the passing rate of residents with different identity types in a military hospital, which achieves the goal of homogenization training to a certain extent. However, there are obvious differences in the standards of the six core competencies, and further optimization measures need to be explored.

ObjectiveTo determine the pathogenic cause in a foodborne diseases outbreak of Salmonella enteritidis in a company in Suzhou City， and provide evidence for epidemiological investigation and guidance for clinical treatment. MethodsRelevant specimens were examined for Salmonella， Shigella， Staphylococcus aureus and Vibrio parahaemolyticus. Furthermore， for the isolated Salmonella enteritidis， a micro broth dilution method was used for antimicrobial susceptibility testing， and pulsed field gel electrophoresis （PFGE） was used for molecular typing. ResultsA total of 44 strains of Salmonella enteritidis were detected from 43 anal swabs of the patients in the outbreak， 7 anal swabs of canteen employees， 31 retained food specimens and 6 environmental specimens. A total of 15 antimicrobial susceptibility testings showed that the 44 strains had the same antimicrobial resistance spectrum， which was 100% resistant to cefazolin， ampicillin， ampicillin/sulbactam， polymyxin E and nalidixic acid， suggesting a multi-drug resistance to more than three antibiotics. PFGE cluster analysis showed that the 44 strains had a 100% of genetic similarity. ConclusionThe outbreak is caused by the consumption of food contaminated with Salmonella enteritidis. The isolated strains have multi-drug resistance， which could guide appropriate antimicrobial treatment based on the antimicrobial susceptibility testing.

Abdomen/diagnostic imaging* ; Artificial Intelligence ; Body Composition ; Magnetic Resonance Imaging ; Practice Guidelines as Topic

To strengthen the management of residents standardized training process, so as to further improve the homogenized construction of residents standardized training, we constructed a standardized assessment system for residents training process according to the principle of "teaching-examination separation", including a new independent team of examiners, standardization of the assessment process, and expansion of standardized test bank of practical skills and medical cases. Results showed that the rates of attendance, 360-degree evaluation completion, and post-department examination, and annual assessment were all improved. The new assessment system of "teaching-examination separation" for residents standardized training strictly ensures the training quality and plays an active role in promotion of training by tests, being fair and just, and improving the efficiency and homogenization of resident standardized training, which is worthy of further research and popularization.

Objective: To explore the application effect of mixed reality technology in the teaching of hepatobiliary surgery. Methods: A total of 120 professional postgraduates majored in surgery who had received the four-month standardized training of residents in hepatobiliary surgery department of the First Affiliated Hospital of Army Military Medical University and the First Affiliated Hospital of Chongqing Medical University during 2016-2018 were selected and were equally allocated into the control group and the research group via random number table method. Students in the control group were trained with traditional surgical teaching mode and in the research group were trained with three-dimensional visualization model which was constructed by mixed reality. Students in both groups received assessment and questionnaires at the end of training. Results: Scores of theoretical examination and surgical operation assessment of students in the research group were higher than those in the control group (P<0.05). The error rate for separating gallbladder artery and bile duct in the laparoscopic simulated system of students in the research group was significantly lower than that in the control group (P<0.05). Students-teacher satisfaction degree in the research group was higher than that in the control group (P<0.05). Conclusion Using mixed reality technology to construct a three-dimensional visualization model and to implement hepatobiliary surgery teaching enables the trainees to better master anatomical key points in the hepatobiliary system and the hepatobiliary surgical approach, with good feedback.

Objective: To assess the pollution characteristics and risk assessment of carcinogenicity or non-carcinogenicity on heavy metals in PM_2.5 in Shenzhen. Methods: PM_2.5 samples were collected monthly from the year of 2014 to 2015, and analyzed by seasons. 12 heavy metal elements (Pb, Hg, Mn, Sb, Al, As, Be, Cd, Cr, Ni, Se, Tl) in PM_2.5 were detected by ICP-MS spectrometry. Health risk assessment was conducted using the recommended United States Environmental Protection Agency (USA EPA) model. Results: The median of PM_2.5 concentration was 45.10 μg/m³ in Longgang district of Shenzhen. The non-carcinogenecity risks of the metals in PM_2.5 existed in spring, autumn and winter (HQ>1). Three metal elements including As, Mn and Cd have higher HQ levels. The carcinogenecity risk levels in four seasons were winter, autumn, spring and summer, respectively. The carcinogenecity risks in four seasons were between 10^-6 to 10^-4. As, Cr and Cd have higher carcinogenicityrisks. Conclusion The heavy metals in PM_2.5 have both carcinogenecity risk and non-carcinogenecity risk to residents in Longgang district of Shenzhen, the occupational health management must be continuously strengthened, the further research and the measures for prevention and control should be considered.