Objective:To explore the suitable prostate cancer screening mode under the medical community for primary hospitals.Methods:From April 2021 to April 2022, a total of 16007 male population ≥50 years from 9 branches of the medical community of the second hospital of Yinzhou participated in this study. They were divided into four groups according to age with group 1 of 50-59 years old, group 2 of 60-69 years old, group 3 of 70-79 years old, and group 4 of 80 years old and above. Serum tPSA was added to the routine physical examination, and the screening positive patients were referred to the referral hospital for further diagnosis and treatment under the mode of medical community. We proposed multi-parametric MRI (mpMRI) for those with serum PSA ≥4 ng/ml and suspicious lesions should be scored according to PI-RADS V2. The ultrasound-guided transperineal targeted prostate biopsy was performed for those with PI-RADS ≥3 and those with PI-RADS < 3 but tPSA ≥10 ng/ml. The tPSA follow-up examinations were performed every 6 months for tPSA < 10 ng/ml and PI-RADS < 3 points and once a year for tPSA < 4 ng/ml.Results:Among the 16 007 male population ≥50 years, 2 007(12.54%) were found serum PSA ≥4 ng/ml, and 634(31.59%)were referred to the referral hospital through the medical community system. Combining tPSA and mpMRI, 271 patients underwent ultrasound-guided transperineal targeted prostate biopsy. Among them, 162 were finally diagnosed with PCa, with a biopsy positive rate of 59.78%. The detection rate of PCa in all the subjects was 1.01%. According to the pathological grade, 5(3.08%) were in ISUP group 1, 95(58.64%) in ISUP group 2-3, and 62(38.27%) in ISUP group 4-5. There were 102(62.96%), 39(24.07%) and 21(12.96%) with localized, locally advanced or metastatic PCa, respectively. The levels of tPSA in the four groups were (1.13±1.44)ng/ml, (1.77±3.45)ng/ml, (3.27±17.58)ng/ml, and (4.26±11.48)ng/ml, respectively, with statistically significant differences ( P<0.01). The positive number of biopsy in each group was 1 case(0.06%), 56 cases(0.79%), 81 cases(1.36%) and 24 cases(1.82%) respectively, with statistically significant differences ( P<0.01). The number of ISUP 4-5 grades in each group was 0, 17(30.35%), 29(35.80%), and 16(66.67%) respectively, with statistically significant differences ( P<0.01). Conclusions:Based on the medical community system, according to the tPSA screening results of the primary hospitals, it is feasible and effective to refer suspicious patients to the referral hospitals for mpMRI examination, and screen prostate cancer by ultrasound-guided transperineal prostate fusion biopsy.

ObjectiveTo observe the clinical efficacy of compound Huangbai liquid fomentation on diabetic foot ulcer of Wagner grade 1-2. MethodPatients were classified into the observation group and control group， with 41 cases in either group. The observation group received routine therapy and compound Huangbai liquid fomentation， while the control group was treated by routine therapy and medical silver nanoparticles-containing dressing. Ulcer area， ulcer depth， traditional Chinese medicine （TCM） syndrome score， ankle-brachial index， transcutaneous oxygen pressure， vascular endothelial growth factor， epidermal growth factor， advanced glycation end product， high-sensitivity C-reactive protein， interleukin-6， erythrocyte sedimentation rate， and adverse events were observed before and after treatment in two groups. ResultAfter treatment， the ulcer area， ulcer depth， TCM syndrome score， vascular endothelial growth factor， epidermal growth factor， advanced glycation end product， high-sensitivity C-reactive protein， interleukin-6（IL-6）， and erythrocyte sedimentation rate were lower than those before treatment in two groups （P<0.05）， and ankle-brachial index， transcutaneous oxygen pressure， vascular endothelial growth factor， and epidermal growth factor were higher than those before treatment in two groups （P<0.05）. After treatment， the ulcer area， ulcer depth， TCM syndrome score， advanced glycation end product， high-sensitivity C-reactive protein， IL-6， and erythrocyte sedimentation rate were lower in the observation group than in the control group （P<0.05）， and ankle-brachial index， transcutaneous oxygen pressure， vascular endothelial growth factor， and epidermal growth factor were higher in the observation group than in the control group （P<0.05）. The clinical efficacy of observation group was better than that of the control group （P<0.05）. There was no significant difference in the incidence of adverse events and endpoint events between two groups. ConclusionCompound Huangbai liquid fomentation is effective for diabetic foot ulcer of Wagner grade 1-2， as it is beneficial to the healing of the ulcer. This study provides clinical evidence for the further promotion of Chinese medicine fomentation.

This article discusses an education model that aims to contribute to students' growth and success and develop students' knowledge, abilities, and values based on the concept of outcome-based education (OBE). Under the guidance of this concept, measures have been taken from multiple dimensions, such as adopting a student-centered approach in theory course teaching, forming a team of teaching assistants, strengthening curriculum ideology and politics, optimizing curriculum content design, reforming teaching methods and teaching platforms, and enhancing feedback to teaching. Rehabilitation medicine courses taught with the OBE concept achieved better outcomes than those taught with conventional approaches adopted in the previous years, with satisfaction, acceptance, and recognition rates of higher than 95% among the students, as well as higher excellent and good rates in the end-of-semester tests compared with those of the same course last year. The preliminary exploration of the teaching reform under this model has provided reference for improving the quality of rehabilitation medicine teaching and cultivating modern professional talents in rehabilitation medicine.

In order to compare the setting of difference coefficients in DRG point payment in different cities in Zhejiang province, the implementation rules of DRG point payment issued by 11 cities in Zhejiang province were comprehensively analyzed. It was found that the difference coefficients in different cities could be divided into three categories, including hospital coefficients alone, hospital coefficients and grade coefficients weighted, and weighted by hospital coefficients, grade coefficients, personal burden levels, case mix indexes, and head-to-time ratio. Its setting differences included four aspects: connotation composition, weight distribution, threshold value, and classification of medical institutions. The authors suggested that the adjustment cycle should be set scientifically to dynamically adjust the difference coefficient, and the scientific setting of the difference coefficient should be promoted through provincial coordination.

ObjectiveTo observe the clinical efficacy and safety of traditional Chinese medicine （TCM） external therapeutic protocol of enriching pus for tissue growth （EPTG） in the treatment of Wagner 2-3 diabetic foot ulcer. MethodThe randomized controlled trial （RCT） design was adopted. Patients receiving basic treatment were divided into the EPTG group and the control group （debridement and change of nano-silver medical antibacterial dressing）. Ulcer healing rate， ulcer area， ulcer depth， TCM symptom score， visual analogue scale（VAS）， transcutaneous partial pressure of oxygen， wound blood flow， inflammatory factors ［C-reactive protein （CRP）， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α）］， growth factors ［vascular endothelial growth factor （VEGF）， transforming growth factor-β₁ （TGF-β₁）， and fibroblast growth factor-β （FGF-β）］， adverse events， and outcome events of the two groups before and after treatment were observed. ResultCompared with the conditions before treatment， the ulcer healing rate， ulcer area， ulcer depth， TCM symptom score， VAS score， transcutaneous partial pressure of oxygen， wound blood flow， CRP， IL-6， TNF-α， VEGF， TGF-β₁， and FGF-β were significantly improved （P<0.01）. In terms of the improvement in the ulcer healing rate， ulcer area， ulcer depth， VAS score， transcutaneous partial pressure of oxygen， wound blood flow， CRP， IL-6， TNF-α， VEGF， TGF-β₁， and FGF-β， the EPTG group was superior to the control group （P<0.01）. There were no statistically significant differences in adverse events and outcome events between the two groups. ConclusionThe TCM external therapeutic protocol of EPTG is safe and effective in the treatment of Wagner 2-3 diabetic foot ulcer. It can greatly reduce the area and depth of diabetic foot ulcer， improve the ulcer healing rate and TCM symptom score， relieve the pain of patients， and improve the microcirculatory blood supply in the local ulcer. Its mechanism of action may be related to the reduction of the local inflammatory response of the wound and the improvement of the proliferation of fibroblasts and vascular endothelial cells.

Objective: To investigate the correlation of carriage and expression of quorum sensing(QS) system regulatory genes and virulence genes with drug resistance inPseudomonas aeruginosastrains isolated from clinical sources. Methods: A total of 97 strains ofPseudomonas aeruginosaisolated from various clinical specimens in the laboratory were collected. Firstly, Drug-resistance were detected by the vitek2-compact instrument method and the standard disc diffusion method, 4 QS system-regulated genes and 7 virulence genes were detected by polymerase chain reaction(PCR). After that, the expression of regulatory genes LasI, Rh1 R and virulence genes exoS and PCN were detected by real-time fluorescence quantitative PCR(qRT-PCR), and moreover linearly analysis was used to analyze the correlation of the two types of genes. Results: The resistance rates of 97 strains to 11 antibacterial drugs. The resistance rate of tobramycin, gentamicin, and amikacin was less than 10%, and the minimum amikacin was 2.06%. The resistance rate to the remaining drugs was all above 11%, and the highest was imipenem 25.77%, and 43 strains were multi-drug resistant bacteria, and the respiratory-derived strains were more resistant to antimicrobials. The results of PCR gene detection showed: the detection rates of the four QS system-regulated genes LasI, LasR, Rh1 I and Rh1 R were all 100%; the highest detection rate of 7 virulence genes was exoT 98.97%(96/97),and the lowest was exoU 13.40%(13/97),PCN 43.30%(42/97),and the rest were above 86%. The strains without virulence genes were resistant to 6 antibiotics including ceftazidime, and the strains with 7 virulence genes were only resistant to ceftazidime; among the PCN, exoS, and exoU positive strains, the proportion of non-multidrug resistantPseudomonas aeruginosa(NMDR-PA)was higher; PCN+ strains were more resistant to piperacillin/tazobactam and the difference was statistically significant; compared with exoS+/exoU-strains, the types of antibiotics resistant to exoS-/exoU+ strains decreased significantly. The relative expression levels of regulatory genes rh1 R and LasI in NMDR-PAwere higher and the difference of LasI was statistically significant; the expression of the regulatory gene rh1 R and the virulence gene exoS and the regulatory gene LasI and the virulence gene PCN showed a positive linear relationship. Conclusion The drug-resistance ofPseudomonas aeruginosais still serious and multi-drug resistance. QS system regulatory genes exist in the strain stably, except for exoU and PCN, the other virulence genes exoS, exoT, exoY, ToxA and LasB have higher carrying rates, the regulatory genes rh1 R and LasI positively regulate the expression of virulence genes, both QS system regulatory genes and virulence genes affect drug resistance inPseudomonas aeruginosa.

Objective:To study the efficacy of Shensong Yangxin capsule in the treatment of tachyarrhythmia and its effect on the hemorheology and cardiac function of patients.Methods:From June 2013 to June 2018, 86 patients with tachyarrhythmia who were treated in Taizhou Orthopedic Hospital were enrolled.The patients were divided into control group and observation group according to the random number table method, with 43 cases in each group.The patients in the control group were treated with amiodarone hydrochloride tablets, the patients in the observation group were treated with Shensong Yangxin capsule on the basis of the control group.After 8 weeks, the clinical efficacy, hemorheology and cardiac function of the two groups were compared and analyzed.Results:The total effective rate of the observation group was 93.02%(40/43), which was significantly higher than 76.74%(33/43) of the control group(χ 2=11.064, P<0.05). The plasma viscosity, fibrinogen and hematocrit in the observation group[(1.10±0.20)mPa·s, (1.69±0.36)g/L, (36.94±0.96)%] were lower than those in the control group[(1.51±0.38)mPa·s, (3.02±0.75)g/L, (45.15±1.06)%], the differences were statistically significant between the two groups( t=7.615, 9.463, 11.656, all P<0.05). After treatment, the LVDs and LVDd in the observation group[(39.02±4.68)mm, (53.16±6.42)mm] were significantly higher than those in the control group[(35.48±4.05)mm, (47.99±5.09)mm], the differences were statistically significant between the two groups( t=4.916, 5.064, all P<0.05). Conclusion:Shensong Yangxin capsule has significant therapeutic effect on patients with tachyarrhythmia, which can significantly improve the hemorheology and heart function of patients, and it is safe and worthy of promotion.

Objective: To assess the application of quantitative immunochemical fecal occult blood test (qFIT) in screening of gastrointestinal diseases for health check-up population. Methods: Total 19 633 health check-up subjects, who received qFIT in AiKang Guobin Physical Examination Center from January 2018 to June 2019 qFIT, were enroll in the study. The positive rate of subjects who received qFIT were analyzed. Gastrointestinal endoscopy were used to diagnose gastrointestinal lesions. The application of qFIT in screening gastrointestinal diseases, especially colorectal cancer and precancerous lesions was evaluated. Results: Total 718 (3.66%) subjects were positive for qFIT, among whom 103 (42.3%) underwent gastrointestinal endoscopic examinations. Finally, 33 (42.3%) cases of colon adenoma, 9 (11.5%) cases of peptic ulcer, and 4 (3.1%) cases of colorectal cancer were detected; and other conditions including gastroenteritis and hemorrhoids were were also diagnosed. There were 87 cases whose qFIT were negative performed colon endoscopy, 5 (5.7%) cases of colon adenoma, no colorectal cancer were detected. The mean value of qFIT for colon cancer was higher than that for polyps (3 569±1 085)μg/L vs. (823±106) μg/L, P=0.01]. The detection rate of colon polyps in qFIT positive subjects was higher than that in qFIT negative subjects [32%(33/103) vs.5.7% (5/87)], and the detective rate of colon cancer in qFIT positive subjects was higher than that in qFIT negative subjects [3.9%(4/103) vs.0(0/87)]. Conclusion Quantitative immunochemical fecal occult blood test can improve the detection rate of colorectal cancer and precancerous lesions in screening of gastrointestinal diseases.

Objective: To verify the diagnostic value of adenosine deaminase (ADA) for tuberculous pleural effusion. Methods: Forty-three cases with tuberculous pleural effusion and 163 cases with non-tuberculous pleural effusion were consecutively collected. The concentration of ADA in pleural effusion was determined by enzyme kinetics. The receiver operating characteristic (ROC) analysis curve was used to calculate the optimal cut-off value of ADA for diagnosing tuberculous pleural effusion based on the control groups with non-tuberculous pleural effusion. Meanwhile, the specificity and sensitivity of ADA level for diagnosis of tuberculous pleural effusion were compared with previous reports. Results: The concentration of ADA in tuberculous pleural effusion (median 52.5 U/L) was significantly higher than that in non-tuberculous pleural effusion (median 9.8 and 10.6 U/L) (P＜0.05). With a cut-off level for ADA of 25 U/L, the diagnostic sensitivity and specificity was 88.0% and 91.0%, respectively. A system review analyzed data from 17 studies with QUADAS score ≥10 points and revealed the cut-off value of ADA to be （28.1±12.8） U/L (range 10.2 to 55.8 U/L) with a sensitivity of 89% (95%CI: 87% to 91%) and a specificity of 89% (95%CI: 88% to 91%). Conclusion The specificity and sensitivity of ADA for diagnosis of tuberculous pleural effusions should be up to over 85%, while the cut-off value of ADA from different literature reports were diverse.

Objective: To explore the feasibility and the value of CT enterography (CTE) in the quantitative evaluation of Crohn's disease (CD). Methods: Retrospectively analyzed 49 patients diagnosed as CD by clinical, enteroscopy, pathology, and imaging from April 2016 to June 2017 in Zhongnan Hospital of Wuhan University. All patients underwent routine enteroscopy and standardized CTE. The interval between the two examinations was less than 2 weeks. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured at intervals. The ESR ranged from 2.0 to 97.0 mm/1 h, with an average of (30.6±26.5) mm/1 h, CRP from 0.3 to 143.3 mg/L, and a median of 27.7 mg/L. CD patients were classified into inactive, mild and moderate-severe according to Crohn's disease simplified endoscopic activity score(SES-CD) after enteroscopy. CTE evaluated the site of lesion, the thickness and enhanced patterns of the most severe lesions of the bowel wall, mural enhanced CT value in the portal vein phase, ΔCT value, stenosis, perienteric inflammation, mesenteric hypervascularity (comb sign), enlarged lymph nodes, abdominal abscesses, fistulas, etc. The Chi-square test was used to compare the differences of enhanced patterns among different groups. ANOVA (Analysis of Variance) was used to compare the differences in bowel wall thickness, plain CT values, mural enhanced CT value in the portal vein phase and ΔCT values among different groups. The correlation between CTE parameters and SES-CD or laboratory data was analyzed by Pearson (normal distribution data) or Spearman (skewed distribution data). Results: SES-CD ranged from 1 to 15, with an average of 5.1±2.6. Among 49 cases, 13 were inactive, 19 were mild, and 17 were moderate-severe. There were 25 cases of intestinal obstruction or stenosis, including 24 cases in the active group and 1 case in the non-active group, and the difference was statistically significant (χ²=13.3, P<0.01). The short diameter of lymph nodes was more than 10 mm in 7 patients, all of them were active patients; 32 cases were mesenteric hypervascularity, manifested as "comb sign" , among them, 28 cases were active and 4 cases were non-active, and the difference was statistically significant (χ²=9.3, P<0.01). Perienteric inflammation was manifested in 30 cases, including 27 cases in the active group and 3 cases in the non-active group, and the difference was statistically significant (χ²=10.8, P<0.01). The enhanced patterns of thickened bowel wall in the non-active was dominated by C and D types, while A and B types was mainly in the active group, and the difference was statistically significant (P<0.05); There were significant differences in bowel wall thickness, mural enhanced CT value in the portal vein phase and ΔCT values between different groups (P<0.05), however, the difference of plain CT values between different groups was not significant (P>0.05). Bowel wall thickness, mural enhanced CT value in the portal vein phase and ΔCT values were all moderately correlated with SES-CD (r were 0.564, 0.585, 0.533, respectively; P all <0.01). Bowel wall thickness was positively correlated with ESR and CRP(r were 0.542, 0.452, respectively; P all <0.01). Mural enhanced CT value in the portal vein phase and ΔCT values were not correlated with ESR or CRP (P>0.05). Conclusion The bowel wall thickness, mural enhanced CT value in the portal vein phase and the ΔCT value can be used to accurately assess the activity of CD lesions.