The combination of medical humanistic spirit and medical scientific spirit is the sign of the maturity of medicine.The modern medical mode of ' biology-psychology-society-environment' sets new requirements for medical humanistic education.Clinic medical postgraduates,the front -line medical workers,play a very important role in medical work,but they show huge deficiency in interpersonal communication,humanistic knowledge and humanistic possession nowadays.The paper tried to draw some lessons from the successful education mode of George Washington university and discussed practicable methods to improve humanistic education among medical postgraduates aiming at cultivating qualified medical workers who have both noble medical ethics and perfect medical technology and ability.

Objective To investigate the hemodynamic characteristics of superior thyroid artery and its corresponding clinical significance with patients of Graves'hyperthyroidism.Methods Thirty patients with Graves'hyperthyroidism received Doppler ultrasonography.Patients were grouped with different serologic indices at 4 month after radioiodine therapy as relief(R),uncured(U)and hypothyroidism(H).The relationships between thyroid volume(V),superior thyroid artery peak systolic velocity(PSV),end diastolic velocity(EDV),RI,PI and systolic accelerating time(SAT)and the 4-month outcome were analyzed respectively.Results Besides the effect of 24 h-131I uptake rate on patients'short-term outcome,V,PSV and RI were of predominate prognosis value(P＜0.01).PSV and V of group R were positively correlated with 131I dose respectively(r1=0.825,r2=0.697;P＜0.001),while SAT of group R was negatively correlated with 131I dose(r=-0.489,P＜0.05).Conclusions Patients with high V,PSV and RI maybe still suffering hyperthyroidism after regular dosage of 131I therapy.Doses of 131I should be added appropriately for patients with high PSV and V,but short SAT to achieve complete remission,while it should be reduced for patients in opposite condition to avoid occurrence of hypothyroidism.

Objective To evaluate left ventricular regional systolic myocardial function quantitatively before and after coronary artery bypass graft(CABG) in patients with coronary artery disease(CAD) by strain rate imaging(SRI),and determine the effect of CABG.The diagnostic value of two-dimensional echocardiography(2-DE) method and SRI parameter method was compared.Methods The values of systolic strain rate(SRs) at 9 segments supplied by left anteior descending were measured in study group(20 patients with CAD) at 1 d before and 10 d,1 month,3 months and 6 months after CABG.The regional myocardial function befose CABG was analyzed and compared with that of controls,and abnormal segments were found.Then the values of these abnormal segments before and after CABG were compared.Results In control group,SRs displayed a wide and negative peak and was homogeneous in every segments.The SRs peak values decreased,and the homogeneity disappeared in study group.Beginning from 1 month after CABG,the SRs peak values at the graft segments increased in varying degrees,and there was significant difference at basal segments of anterior wall,middle segments of anteroseptal,and middle segments of posteroseptal in the different periods(P

Objective To assess the value of high-frequency color Doppler ultrasound technique combined with hemorheology in detecting early atherosclerosis and monitoring its progression.Methods Twenty-four white big ear rabbits were divided into two groups randomly.Group A (6 rabbits) was fed normal rabbit chow,while group B (18 rabbits) was fed high cholesterol diet and was divided into three subgroups: B1(6 rabbits) with high cholesterol diet for 4 weeks,B2(6 rabbits) for 8 weeks,B3(6 rabbits) for 12 weeks.Intima-media thickness (IMT),diameter of common carotid artery and hemorheology index were observed dynamically and compared with the findings of histological examination.Results IMT of common carotid artery increased gradually in group B at different phases of atherosclerosis.Diameter compensationally enlarged at the early stage,and then stenosed with the progression of atherosclerosis.RBC deformation index of group B began reducing in the second week,but blood viscosity,plasma viscosity,RBC aggregation index and rigidity index gradually increased from the fourth week( P

Objective To evaluate the value of dual‐Doppler imaging technology (referred to as dual‐Doppler modality for short) in assessing left ventricular diastolic function in patients with atrial fibrillation (AF) and normal left ventricular ejection fraction (LVEF) .Methods A total of 40 patients with AF and normal LVEF were enrolled as the AF group ,and 40 healthy volunteers were composed of the control group .①Peak early diastolic transmitral flow velocity (E) and tissue Doppler lateral (L ) mitral annular early diastolic velocity (e′) were measured simultaneously in the particular cardiac cycle by dual‐Doppler modality .②Peak early diastolic transmitral flow velocity (E) and tissue Doppler septal (S) mitral annular early diastolic velocity (e′) were measured simultaneously in the particular cardiac cycle .③ Peak early diastolic transmitral flow velocity (E) and color M‐mode Doppler flow propagation velocity (Vp) were measured simultaneously in the particular cardiac cycle .Then E/e′(L) ,E/e′(S) and E/Vp were calculated , respectively .Results Compared to the control group ,E/e′(L) ,E/e′(S)and E/Vp were all higher in AF group ( P <0 0.5) .Bland‐Altman showed that E/e′(L) ,E/e′(S)and E/Vp measured by the dual‐Doppler modality had better reproducibility and higher intraclass correlation coefficient (ICC) than the conventional Doppler modality .Conclusions The dual‐Doppler modality is valuable for evaluating left ventricular diastolic function in patients with AF and has better reproducibility and more accurate results than the conventional Doppler modality .

Objective To investigate the clinical significance of atrial septal aneurysm(ASA)and the value of echocardiography in detecting ASA. Methods One hundred and fifty-one patients with ASA diagnosed by transthoracic echocardiography(TTE) or transesophageal echocardiography(TEE) were analyzed retrospectively.The patients were divided into two groups:group Ⅰ included 57 patients who had experience of transient ischaemic attack(TIA)or cerebral shock and group Ⅱ included 94 age-and sexmatched patients without those cerebral ischemic event who underwent echocardiography during the same period of time. The following parameters of the ASA were measured:maximal excursion or protrusionbeyond the plane of the atrial septum,direction of protrusion,thickness of the wall,presence of theombi attaching to the wall and other structural abnormalities associated with ASA. Results One hundred and thirty-two of 151 cases(87.42%) located at fossa ovalis of atrial septum. The wall thickness of ASA increased with depth.The extent of bulging and thinkness of wall in group Ⅰ were greater than those in group Ⅱ and more patent foramen ovale(PFO)were observed in group Ⅰ. However,no difference was found in direction of protrusion and incidence of oscillations between the two groups. As to the performance of the two techniques in the evaluation of ASA,TEE showed better result than TTE. Conclusions Echocardiography is a reliable means to detect ASA and its complications. Greater maximal excursion and thicker aneurysm wall of ASA is associated with a higher risk of cerebral ischaemic event.

Objective To evaluate the effect of adenosine triphosphate postconditioning on myocardial ischemia reperfusion injury in rabbits by ultrasound speckle tracking imaging(STI).Methods Forty-two healthy rabbits were randomly divided into three groups averagely:ischemia-reperfusion (IR ) group, ischemia postconditioning(IPost)group,ATP-pharmacological postconditioning(PPost)group.The model of myocardial ischemia reperfusion was established.Echocardiography examinations were conducted before the coronary artery ligatured,after 45 min later and at the end of reperfusion.Pathological examinations were applied to detect the change of which two rabbits randomly selected from each group after the coronary artery ligatured 45 minutes later and the rests after reperfusion of 120 min.Results ①Ischemic and infarct changes could find in the six rabbits which were sacrificed after the coronary artery ligatured 45 minutes later.The same changes also could be found in the three groups after reperfusion,and the damage in IR group was the most significant.②After block of coronary artery,left ventricular ej ection fraction(LVEF) decreased in all groups (P <0.05)and STI index decreased in all groups (P <0.01).③After reperfusion of 1 20 min later,global longitudinal systolic strain rate (GLSrsys ),global longitudinal systolic strain (GLSsys)increased in IPost group and GLSrsys increased in ATP-PPost group,and longitudinal systolic strain rate(SrLsys),longitudinal diastolic strain rate(SrLd),longitudinal systolic strain(SLsys)increased both in IPost group and ATP-PPost group(P <0.05 or P <0.01).Compared in groups,GLSsys,SrLsys, SLsys in IPost group and ATP-PPost group all higher than those in IR group (P <0.05).Conclusions STI can evaluate exactly the global and regional myocardial function of rabbit myocardial infarct-reperfusion model and local index is better than overall index.STI can also detect correctly the protect effects on myocardial reperfusion inj ury of ATP.

Objective To evaluate left ventricular(LV)global and regional systolic function by three-dimensional speckle tracking imaging (3D-STI)in patients with systemic lupus erythematosus (SLE). Methods Twenty-two patients with SLE were selected randomly as SLE group and twenty-two healthy people were included as control group.3D-STI was performed in all participants to get global and regional strain parameters,including global longitudinal peak systolic strain(GLS),global circular peak systolic strain (GCS ),global radial peak systolic strain (GRS ),global area peak systolic strain (GAS ),segmental longitudinal peak systolic strain (SLS),segmental circumferential peak systolic strain (SCS),segmental radial peak systolic strain (SRS),and segmental area peak systolic strain (SAS).The sensitivity and specificity of GCS and GAS reflecting LV systolic function in patients with SLE were analyzed under the receiver operating characteristic (ROC)curve.Results ①The global strain:compared with the control group,GCS and GAS decreased significantly in SLE group (P <0.01),there was no significant change in GLS and GRS(P >0.05).②The regional strain:compared with the control group,the SCS in segments of basal anteroseptal,basal inferoseptal,mid anterior,mid inferosptal,mid anterolateral,apical inferior,apical lateral decreased significantly in SLE group.The SAS of basal anterior,basal inferoseptal,mid inferosptal, mid anterolateral,apical anterioe,apical lateral decreased significantly in SLE group (P <0.01).The SCS in segments of apex and the SAS of mid anterior,apical septal,apex decreased in SLE group (P <0.05).③The ROC curve:the sensitivity and specificity of GCS on detecting the LV systolic dysfunction were 59.1%and 87.5%,and those of GAS were 77.3% and 83.3%,respectively.Conclusions 3D-STI is a convenient and accurate way to early detect LV global and regional systolic dysfunction in SLE patients.

ObjectiveTo evaluate regional and global systolic function of left ventricle (LV) after mitral valve replacement(MVR) of different methods by 2-dimensional strain (2DS).MethodsAccording to the operational method whether preserve the posterior leaflet and its subvalvular apparatus,48 patients who underwent MVR were divided into two groups,the preservation group (group A) and the resection group (group B).Echocardiography was examinated before and after MVR and the apical four-chamber view,two-chamber view and long-axis view of LV were acquired.Regional peak strain (Sp) and global strain (GS) of LV longitudinal movement were analysed by 2DS software.Results①Compared to preoperation,the Sp in basal segment of posterior septum and inferior wall and middle segment of lateral wall in group A increased significantly ( P ＜0.01 or P ＜0.05).The Sp of group B were improved in both basal and middle segments of posterior septum ( P ＜0.05),while declined in middle segment of lateral wall and anterior wall,basal segment of lateral wall and apical segment of anterior wall significantly (P ＜0.01 or P ＜0.05).②Compared with group A,subtractions between preoperative and postoperative Sp of group B decreased in middle segment and apical segment of anterior wall,middle segment of lateral wall and middle segment of inferior wall significantly ( P ＜0.01 or P ＜0.05).③The GS of group A increased significantly ( P ＜0.05),while that in group B tended to reduce with no statistical significance ( P ＞0.05).Compared with group A,subtractions between preoperative and postoperative GS of group B droped significantly (P ＜ 0.05).ConclusionsAppropriate preservation of the posterior leaflet and its subvalvular apparatus has morebeneficial effect in improving the early regional and global function of LV after surgery,which would be recommended in MVR.Early regional and global systolic function of LV after MVR could be accurately evaluated by 2DS relatively,which has the application value of guiding clinical treatment and estimating prognosis.

Objective To evaluate the changes of ventricular synchrony in patients with acute myocardial infarction(AMI)before and after percutaneous coronary intervention(PCI)by speckle tracking imaging(STI).Methods Thirty patients with AMI were examined by traditional echocardiography and STI before and 5 d,1 month after PCI.Myocardial imaging of left ventricular apical long views and parasternal left ventricular short axis views were recorded and stored.The time to peak longitudinal systolic and diastolic strain rate(TS-SRL,TE-SRL)and to peak radial systolic and diastolic strain rate(TS-SRR,TESRR)were measured respectively.The differences of the maximum and minimum systolic and early diastolic peak time(TSL-diff,TER-diff)and the standard deviation(TSL-SD,TER-SD)in 18 longitudinal segments were calculated.And the differences and standard deviation of TS-SRR and TE-SRR(TSR-diff,TSR-SD,TER-diff,TER-SD)were calculated also.These parameters were compared before and after PCI.Results Compared with before and 5 d after PCI,the values of TSL-diff,TSL-SD,TEL-diff and TEL-SD in 1 month after PCI were decreased significantly(P＜0.01).TSR-diff,TSR-SD,TER-diff and TER-SD were decreased also and the differences had statistical significance(P＜0.01).The cardiac synchronized index and LVEF values showed good negative correlation.Conclusions The systolic and diastolic synchrony of left ventricle in AMI patients was abnormal.STI can evaluate left ventricular synchronized function and the changes before and after PCI to assess the effect of PCI.