Resident doctor is the beginning period of a doctor career. Resident standardization training is the basement period for the clinical ability training and is the important part for medical students after graduation education. Vascular ultrasonography belongs to ultrasound medicine and has its own discipline characteristics. The diagnosis accuracy of vascular ultrasonography largely depends on the accumulation of basic knowledge of multiple clinical sciences , standardization of operation techniques and especially the accurate application of hemodynamic theory. According to the discipline characteristics of vascular ultrasonography, we train the residents from the following five aspects: basic theory knowledge, operation techniques, clinic thinking ability, sciences research ability, communica-tion and team work ability. On the basis of practice, we explore the establishment of standardized training mode for medical professionals of vascular ultrasnography in China, training practical, innova-tive and independent talents, to provide reference for improving the professional level of vascular ultra-sound in our country.

Objective To investigate the feasibility and effectiveness of internal jugular vein (IJV) intervention therapy in patients with cerebral venous sinus thrombosis (CVST)with color Doppler ultrasound (CDU). Methods Twelve patients with CVST diagnosed by CDU and the 13 IJV lesions (localized luminal stenosis in 9 cases,venous long-segment slender in 2 cases,and right IJV localized luminal stenosis,and long-segment slender on the left in 1 case)confirmed by magnetic resonance venography (MRV)and/ or digital subtraction angiography (DSA)were enrolled retrospectively. CDU examinations were used at 1 week before and after IJV intervention therapy,6 months,1 year,and 2 years. The changes of the maximum diameter and the maximum velocity (V max )of the IJV were compared. The success rate and the long-term efficacy of the intervention therapy were analyzed. Results One week after treatment,the CDU examinations showed that the diameter of IJV stenosis in 13 IJV were increased significantly compared with those before procedure (4. 7 ± 2. 1 mm vs. 2. 3 ± 1. 3 mm;t = 5. 325,P < 0. 01). The velocity of blood flow of IJV was improved compared with before procedure (localized stenosis in 10 IJV[50 ± 15 cm/ s vs. 87 ± 24 cm/ s];t = 6. 285,P < 0. 01). Six of the 12 patients were followed up for a mean of 18 ± 7 months, two patients had restenosis after balloon dilatation. Conclusions For CVST patients with IJV lesions,the preliminary observation has indicated that IJV intervention therapy may improve the lesion lumen and hemodynamics. However,the intervention therapy,especially after balloon dilatation,the incidence of restenosis is higher. CDU can be used as an objective evaluation means for the long-term efficacy of IJV stenosis.

Objective To test serum decoy receptor 3 (DcR3) concentration in patients with rheumatoid arthritis (RA),and analyze its clinical significance.Methods The serum from 180 RA patients,29 osteoarthritis (OA) patients,60 systemic lupus erythematosus (SLE) patients,30 Sj(o)gren's syndrome (SS) patients and 100 healthy donators were selected.The serum DcR3 concentrations of the two groups were detected by enzyme-linked immunosorbent assay (ELISA).The correlation between serum DcR3 levels and clinical features of patients with RA were investigated.T test,x2 test and Spearman's correlation analysis were used for statistical analysis with software SPSS 16.0.Results Serum DcR3 levels in RA patients [(202±261)ng/ml] were significantly higher than those of the healthy controls [(32±31) ng/ml,t=5.33,P＜0.01],OA patients [(90±33)ng/ml,t=1.998,P＜0.01],SLE patients [(41±56)ng/ml,t=3.19,P＜0.01],and SS patients [(25±31) ng/ml,t=2.50,P＜0.01].The DcR3 cut value was 45.86 ng/ml for the diagnoses of RA,the sensitivity and specificity was 0.991 and 0.765 respectively.The levels of serum DcR3 in RA patients were related with rheumatoid factor (RF) IgM,RF-IgG,anti-cyclic citrullinated peptide antibodies (anti-CCP) and C3.Conclusion Serum DcR3 level is significantly elevated in RA and it is significantly associated with immunological index of RA including RF-IgM,RF-IgG,C3 and anti-CCP antibody,which may be a factor for unfavorable prognosis of RA patients.

Objective To investigate whether HSP90α could be a sensitive and specific serum biomarker for the diagnosis and progression of lung cancer. Methods In the present study, different secretomic analy-ses on the two human lung adenocarcinoma cell lines CL1-0 and CL1-5 with low and high metastatic poten-tial, respectively, were performed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and ma-trix-assisted laser desorption/ionization time-of-flight mass spectrometry. The candidate biomarker was con-firmed by Western blotting, and was further analyzed in 224 serum samples including 141 lung cancer, 37 benign pulmonary diseases, as well as 46 healthy individuals using ELISA assay. Results HSP90α was sig-nificantly upregulated in the CM of CL1-5 cells. It was found that the levels of HSP90α were specifically ele-vated in the sera of non-small cell lung cancer compared with other groups. At the cut-off point 0.535 on the receiver operating oharacteristie curve, HSP90α could comparatively discriminate lung cancer from benign lung disease and healthy control groups with sensitivity of 0. 817, specificity 0. 919 and total accuracy 80. 14%. Conclusion HSP90α may be a potential useful serum biomarker for discriminating lung cancer from benign lung diseases and healthy individuals and staging of non-small cell lung cancer.

Objective To evaluate the short-term and long-term effects in patients of carotid artery subtotal or complete occlusion after carotid endarterectomy ( CEA) using vascular ultrasound. Methods A total of 107 consecutive patients were diagnosed as carotid artery occlusive disease with DSA and treated with CEA at Beijing Xuanwu Hospital,Capital Medical University from January 2005 to January 2014 were enrolled retrospectively. Sixty-three of them had subtotal occlusion ( the carotid artery stenosis rate 95% to 99%) and 44 had complete occlusion. The occurrence of perioperative complications of all patients was documented. The follow-up study used outpatient follow-up and telephone tracking. The patients of surgical recanalization were followed up with ultrasound at 1 week, 3, 6, 12, and 24 months after procedure. The clinical prognosis, restenosis, vascular structure and hemodynamic changes of the patients after CEA were documented. Results (1) Of the 107 patients,86 (80. 4%) achieved recanalization after procedure and 21 (19. 6%) did not. The incidence of stroke and death was 4. 7% (5 cases) within 30 days after procedure,among them the incidence of subtotal occlusion group was 4. 8% ( n=3 cases) and the complete occlusion group was 4. 5% (2 cases). (2) Within one week after procedure,the peak systolic velocity ( PSV) ,end diastolic velocity ( EDV) ,and pulsatility index ( PI) of the ipsilateral middle cerebral artery in the recanalization patients increased significantly (120 ± 39 cm/s vs 60 ± 17 cm/s,50 ± 18 cm/s vs 33±11cm/s,and0.96±0.20vs0.67±0.14,respectively).Thereweresignificantdifferences(allP<0. 01). Carotid artery ultrasound showed that the local vessel diameters of the original lesions in the recanalization patients were widened as compared with preoperation (4. 4 ± 1. 1 and 3. 6 ± 1. 0 mm). There was significant difference (P<0. 01). (3) Sixty-nine patients with recanalization were followed up for 1 to 60 months( the median time was 12 months) . One to six months after procedure,the patency rate of the patients was 95. 6%(n=66),>6 to 12 months was 94. 2%(n=65),>12 to 24 months was 94. 2%(n=65),and more than 2 years was 91. 3%(n=63). Conclusion Vascular ultrasound can conduct short-term and long-term follow-up for carotid artery occlusive disease after CEA. The degree of blood flow improvement should be identified and restenosis should be found in time after procedure.

ObjectiveTo analyze the correlated clinical significance by testing the serum tumor necrosis factor like ligand-1A(TL1A) levels of patients with rheumatoid arthritis(RA). MethodsThe serum from 100 RA patients and 50 healthy controls were selected. The serum TL1A concentrations of the two groups were detected by ELISA. The correlations between serum TL1A levels and clinical features or laboratory examinations of RA patients were investigated. Mann-Whitney U test, t-test, x2 test and Spearman correlation analysis were used for statistical analysis. ResultsThe levels of serum TL1A in RA patients [(959±1146) pg/ml]were significantly higher than those of the healthy controls[(529±154) pg/ml, t=3.683,P＜0.01]. The levels of serum TL1A in RA patients with positive rheumatoid factor(RF),occult rheumatoid factor immunoglobulin G (HRF-IgG) and anti-cyclic citrullinated peptide antibodies (anti-CCP)[(962±1043 ), ( 833±1104 ), (908±1115 ) pg/ml, respectively]were significantly increased when compared to those in RF, HRF-IgG and anti-CCP negative RA patients[(628±r343), (576±134),(628±401) pg/ml, respectively, t=3.224, 1.317, 1.003; P＜0.05]. The positive rates of RF, HRF-IgG and anti-CCP in the TL1A positive group(90％, 42％, 85％) were significantly higher than those of the TL1A negative group (56％, 11％,33％) (x2=-0.372, -2.402, -2.774; P＜0.05). ConclusionThe level of serum TL1A is significantly elevated in RA and it is significantly associated with auto-antibodies in RA including RF, HRF-lgG and antiCCP antibody, which may be a factor for unfavorable prognosis of RA patients.

Objective To evaluate and follow-up the effection of vertebral artery origin stenting (VAOS) by color Doppler flow imaging(CDFI) and assess the rate of restenosis after stenting. Methods One hundred and thirty-five patients with stenosis of vertebral artery origin segment underwent stent input,135 pieces of stent was input in vertebral artery origin segment with moderate or severe stenosis,in which 70 bare metal stent(BMS) and 65 drug-eluting stent(DES). The diameter of VAOS, peak systolic velocity (PSV),end diastolic velocity (EDV) and resistence index(RI) of segment at origin and cervical vertebral were evaluated before and every 1,3,6, 12 month after VAOS by CDFI. The incidence of restenosis were calculated,and the factors of restenosis were analysed by COX regression. Results The diameter of VAOS was improved from (1.20±0.38) mm to (2.61±0.49) mm after stent procedure ( P = 0. 000), PSV and EDV also decreased from (296.02 ± 113.86)cm/s to ( 113.47 ± 36.35 )cm/s and (90.08 ± 47. 59)cm/s to (32. 21 ± 12. 69)cm/s respectively(P=0.000). The PSV and RI in cervical segment were increased from (46. 88 ± 17.46)cm/s to (67.79 ± 24.31 ) cm/s and 0. 54 ± 0. 10 to 0.62 ± 0.09 respectively( P = 0. 000).Over a median 7 months follow up(range 1 to 12 months) ,the cumulative restenosis rate at 3,6,12 month were 7.9% ,16. 9% and 25.0% respectively. DES was the only one negtive predictor of restenosis(OR=0. 388,95% CI:0.162-0.931, P = 0.034),and the factor of residual stenosis contributed to the occurance of restenosis after stenting(OR = 3.758,95% CI:1.498-9.427, P=0.005). Conclusions CDFI is a sensitive and noninvasive examination to follow-up VAOS and detect in-stent restenosis immediately. VAOS has a high rate of restenosis. DES is effective to prevent in-stent restenosis.

Objective Using transcranial Doppler (TCD) to evaluate the effect of selective shunt (SS) during carotid endarterectomy (CEA). Methods TCD was used for intraoperative bilateral middle cerebral artery (MCA) cerebral blood flow continuous monitoring in 169 patients with carotid stenosis treated with CEA. The patients were divided into shunt (n =32)and non-shunt (n = 137) groups according to whether they performed shunt or not. The open approaches of anterior collateral circulation were recorded. The peak systolic velocity (PSV),mean velocity (MV), pulsatility index (PI), and ratio of MV in bilateral MCA were compared after anesthesia, before and after carotid artery occlusion, before and after shunt, and after carotid artery open. Results MV before carotid artery occlusion in the shunt and non-shunt groups were 34.73 ± 13.54 cm/sand 35.32 ± 13.18 cm/s, respectively, and there was no significant difference (P = 0. 825). MV in the shunt group after carotid artery occlusion was significantly decreased in the non-shunt group (P =0. 000). The mean decline rate of MCA MV was 69.34% ± 20. 93%, and it was decreased more significantly than that in the non-shunt group (P=0. 000). The decline rate of MCA MV was increased significantly after shunt operation, the average increase was 35.68 ± 16.69 cm/s (P=0. 000). Conclusions TCD can objectively evaluate the hemodynamic changes before and after shunt operation.

Objective To evaluate the correlation between the types of vertebral artery occlusion and their compensatory hemodynamic changes and posterior circulation ischemia using color Doppler flow imaging combined with transcranial color-coded sonography.Methods From June 2015 to June 2016,A total of 108 patients with vertebral artery occlusion confirmed by vascular sonography,digital subtraction angiography (DSA) or CT angiography (CTA) were enrolled retrospectively.According to the magnetic resonance imaging (MRI)-diffusion weighted imaging (DWI) findings,they were divided into posterior circulation infarction (n=78 in infarction group) and non-posterior circulation infarction (n=30 in TIA group).Color Doppler flow imaging and transcranial color Doppler ultrasonography were used to examine the contralateral vertebral artery extracranial diameter, peak systolic velocity(PSV) and end diastolic velocity(EDV) of bilateral extracranial and intracranial vertebral arteries.The differences of the vertebral artery occlusion types,establishment of collateral circulation and hemodynamic changes of the contralateral vertebral artery were compared between the two groups.Results The patients with single vertebral artery occlusion in the infarction group and TIA group were 69 (88.5%) and 26 (86.7%) respectively;those with bilateral vertebral artery occlusion were 9 (11.5%) and 4 (13.3%) respectively.There was no significant difference in the number of vertebral artery occlusion between the two groups (χ2=0.000,P=1.000).The proportion of patients with vertebral artery occlusion in intracranial segment in the infarction group was higher than that in the TIA group (70.5% [55/78] vs.36.7% (11/30);χ2=10.444,P=0.001).The proportion of patients with the establishment of collateral circulation in the infarction group was lower than that in the TIA group (14.1% [11/78] vs.43.3% (13/30);χ2=10.711,P=0.001).The peak systolic velocity (PSV) and the end diastolic velocity (EDV) of contralateral extracranial vertebral artery in patients with single vertebral artery occlusion in the TIA group were higher than those in the infarction group (65±21 cm/s vs.57±15 cm/s,25±8 cm/s vs.20±7 cm/s,t=2.043 and 2.606 respectively,all P<0.05).Conclusion The establishment of collateral circulation and hemodynamic compensation of the contralateral vertebral artery after vertebral artery occlusion were closely associated with the occurrence of posterior circulation ischemia.

Objective To analyze the correlation of characteristics of carotid artery structure and the incidence of residual stenosis after carotid artery stent (CAS) placement and its influencing factors using color Doppler flow imaging (CDFI).Methods Five hundred and ninety-six cases from January 2013 to December 2015 who underwent CAS (600 pieces of stent) were included in this study.All patients were examined by CDFI within 1 month before and 1 week after carotid artery stenting.The incidence of residual stenosis was analysed.The correlation of residual stenosis and the characteristics of carotid artery lesions and atherosclerotic plaque before stenting were analyzed respectively.Results There was positive correlation between the incidence rates of residual stenosis and irregularly shaped plaque (odd ratios,9.02;95% confidence interval,5.21-15.59,P<0.05),the plaques with calcification in the surface(odd ratios,2.55;95% confidence interval,1.45-4.49,P<0.05),the residual diameter of carotid stenosis less than 1.0 mm(odd ratios,1.61;95% confidence interval,1.06-2.45,P<0.05),which were the independent risk factors for influencing residual stenosis after CAS.Conclusions Choosing a more adaptable stent based on the characteristics of carotid artery lesions and atherosclerotic plaque by CDFI before stenting may be useful for the patients to get best result of revascularization.The rate of residual stenosis may be decreased.