The article analyses the current situation and the problem in training junior faculty process in preclinical medicine education,discussing how to shorten the period of training junior faculty,thus to train a excellent teaching system for preclinical medicine education.

Objective To analyze the clinical and ultrasonographic features of intraductal papillary mucinous neoplasm (IPMN) of the pancreas and to assess the usefulness of transabdominal ultrasonography. Methods Twelve patients with IPMN underwent surgery, including 4 (33.3%)with adenoma and 8(66.7%) with adenocarcinoma. IPMN was classified into 3 categaries by the site of main duct,branch duct and combined type based on the ultrasonographic findings preoperatively. All the clinical presentations and the ultrasonographic imaging findings were analyzed and compared with the histologic diagnosis. Results Of malignant IPMNs,diabetes was presented in 5 cases,elevated CA19-9 was presented in 4 cases and steatorrhea was presented in 2 cases. But these was not presented in benigns. Transabdominal ultrasonography revealed all the cystic or cystic-solid lesions in this study. The mean diameter of the lesions with adenoma was (1.4 ± 0.8)cm (range,0.5 - 2.0 cm) and that with adenocarcinoma was (6.3 ± 6.0)cm (range, 2.0 - 20 cm). The mean diameters of the main duct for the cases with adenomas and adenocarcinomas were (1.0 ± 0.8) cm and ( 1.6 ± 1.0) cm, respectively. Among the adenomas, 3 cases were calssified as branch type and 2 were demonstrated with mural nodules and no colour signals was detected within them. Five of the malignancies were considered as main duct type and 3 were combined type. Seven cases were detected mural nodules and showed abundant colour flow signals within them. Conclusions Transabdominal ultrasonography revealed the pancreatic cystic lesions and dilated ducts of IPMN. Some characteristics should be considered for malignancy: clinical symptoms, tumor size and mural nodules with colour flow signals,which may be helpful for the diagnosis and management of IPMN.

Objective To evaluate the ultrasonic characteristics of nasal bone absence at 16-34 weeks of pregnancy referring to fetal chromosomal anomalies. Methods The ultrasonic findings of the 20 fetuses with nasal bone absence at second or third trimester in Peking Union Medical College Hospital were reviewed referring to chromosomal karyotyping and labor induction or birth outcomes. Results The ultrasound features of the 20 fetuses including:(1) There were 17 fetuses showed bilateral nasal bones absence. The sonographic features were absence of hyper echo of nasal bone underneath the skin on either sagittal or transverse section. There were 5 fetuses showed multiple abnormalities:Four fetuses showed cardiac abnormalities (three showed atrioventricular septal defect, one showed ventricular septal defect, one showed ventricular septal defect with abnormal great vessels). One fetus showed duodenal obstruction′double bulbs′. The other minor abnormalities including short femur and humerus, increasing echogenetic bowels, aberrant right subclavian artery, mild unilateral ventriculomegaly, mild renal pelvic ectasia, outreached tongue, abnormal gestures of hands. (2) There were 3 fetuses showed unilateral nasal bone absence. The sonographic features were absence of hyper echo of either nasal bone on transverse section but with hyper echo on sagittal section. Two fetuses showed cardiac abnormalities (one fetus showed atrioventricular septal defect, one showed ventricular septal defect). The other minor abnormalities including short femur and humerus, hyper echogenetic bowels, increasing thickness of nuchal translucency or nuchal fold. Twelve fetuses were induced labor but only one had biopsy showed accordant result with ultrasound. (3) Karyotyping results:there were 9 of trisomy 21, 1 of 4p-and 7 of normal karyotype fetuses showed bilateral nasal bone absence. There were 2 of trisomy 21 and 1 of normal karyotype fetuses showed unilateral nasal bone absence. (4) Birth outcomes and follow-up:twelve fetuses induced labor but only one fetus had biopsy. Eight fetuses were born until term and 5 fetuses showed normal in follow-up. The results of twelve fetuses showed concordant with ultrasonic ifndings. Conclusions Characteristics of the nasal bone absence are absence of bilateral or unilateral nasal bones. If we ifnd nasal bone absence in prenatally ultrasound screening, the karyotyping should be recommended in order to detect chromosomal abnormalities especially trisomy 21.

Objective The aim of the study was to determine the placenta volume (PV) at 11-13+6 weeks of gestation by three-dimensional ultrasound (3DUS) in combination with birth weight, placenta weight, placenta volume at birth and maternal age, body mass index (BMI) additionally. Methods From June 2011 to July 2012, placental volumes were prospectively measured by VOCAL (Virtual Organ Computer-aided Analysis) method in 129 normal pregnancies of Peking Union Medical College Hospital at 11-13+6 weeks of Gestation, multiples of the median was calculated (MOM) after logarithmic10 transformation referring to different crown-rump length (CRL) groups. The normal pregnancies were selected without any combinations or fetal abnormalities, then recorded the birth weights, placenta diameters and thicknesses and placenta weight at delivery. The maternal basic status was also concluded in the study. Results Correlation analysis results: (1) The transformed placenta volume MOM showed a significant correlation (Spearman rho=0.200, P<0.05) with birthweight but not with placenta weight or placenta volume calculated as ellipsoid (Spearman rho=0.164, 0.112 respectively, P>0.05). (2) The birthweight showed significant correlations with placenta weight, placecnta volume and maternal BMI (Spearman rho=0.478, 0.361, 0.259 respectively, P<0.01). (3) The placenta weight at birth showed a significant correlation with placenta volume at birth (Spearman rho=0.467, P<0.01) and maternal BMI (Spearman rho=0.198, P<0.05). Regression analysis results: (1) Birth weight (g)=1136.9+1530.9×MOM+45.3×BMI-15.0×maternal age (r=0.29, P=0.01<0.05). (2) Placenta weight (g)=88.1+315.3×MOM+10.0×BMI+0.1×maternal age (r=0.27, P=0.02 <0.05). Conclusions The placental volume at 11-13+6 weeks of gestation has significant correlation with birthweight. This might assist in the identification of the high risk pregnancies caring large or low for gestational age fetuses.

Objective To evaluate the diagnostic value of sonographic score in the diagnosis of salivary gland involvement in patients with Sj(o)gren's syndrome(SS). Methods One hundred and three cases (44 cases of SS group and 59 cases of control group) were involved in the study. Parotid and submandibular glands of all the cases were examined by a doctor unawaring of the clinical information. All the off-line images were scored by two doctors seperately. The best threshold and the according diagnostic efficiency were determined by statistical analysis. Results The Kappa coefficient between the two doctors was 0.80.The parotid score,submandibular score and total score of SS group were significantly higher than those of the control group (5.79 ± 2.40 vs 0.46 ± 0.97,5.93 ± 1.58 vs 1.32 ± 1.84,11.64 ± 3.27 vs 1.78 ± 2.33,respectively). According to the ROC curve for the parotid score, submandibular score and total score, the area under the curve were 0.98,0.95,0.99, respectively. The best diagnostic threshold for total score was 8 and under this threshold, the diagnostic sensitivity, specificity, positive and negative predictive values were 93%, 97%, 95%, 95%, respectively. Conclusions The sonographic score including both parotid and submandibular glands is a reliable method with high reproductivity and diagnostic accuracy in the diagnosis of SS salivary gland involvement.

ObjectiveTo evaluate the diagnostic capability of prenatal ultrasound in diagnosis of fetal akinesia deformation sequence (FADS).MethodsThe prenatal sonographic characteristics of 5 fetuses with FADS were analyzed retrospectively.ResultsBoth multiple joint contractures and central nervous system (CNS) anomalies,which include 5 small head circumferences,2 short cerebellar diameters,and 1 flat forehead,were found by prenatal ultrasound in all 5 FADS fetuses.Additional fetal abnormalities such as micrognathia,polyhydramnios,short umbilical cord and intrauterine growth retardation were also observed.The results of fetal chromosome analysis were available in 2 cases indicating normal karyotype.Conclusions Prenatal identification and diagnosis of FADS is possible based on the findings of sonographic examination.

Objective To investigate the clinical value and method of fetal tricuspid regurgitation in the first trimester.Methods Fetuses were performed ultrasonography at 11 to 14 gestational weeks,measuring crown rump length,nuchal translucency and acquiring tricuspid waveform.All the fetuses were followed up until 6 months after birth,including prenatal ultrasound examination,maternal serum biochemistry and karyotype test.Results A total of 262 fetuses were performed ultrasonography in the first trimester,the tricuspid waveform were acquired successfully in 249 (95%).Nine cases with tricuspid regurgitation were detected,including 3 cases of trisomy 21,3 cases with complex heart defects,one case with omphalocele,two resulted in intrauterine death and one case of normal chromosome and phenotype.Conclusions Tricuspid waveform is relatively easier to examine and assessment.Tricuspid regurgitation is a useful first-trimester ultrasound marker for the detection of chromosomal abnormalities,cardiac defects,and adverse pregnancy outcome.

Objective To determine the diagnostic value of two and three dimensional ultrasound in detecting fetal hand malformations. Methods In the retrospectively analysis,the severe fetal hand malformations detected by prenatal ultrasound during the recent three years in our hospital were classified according to the prenatal sonographic characteristics,family history,karyotype analysis and autopsy results,etc.Results Fourteen fetuses with hand-anomaly were detected during the 16-28th week of gestation,both hands were affected in 10 cases,with the same morphology bilaterally in 8 cases.Thirteen cases had other abnormal sonographic findings.They were detected and classified into three categories,Wrist deformity (9 cases),three fetuses were associated with total absence of radius and radial clubhand,and six fetuses had palmar deviated hands,with various etiologies including familial hereditary arthrogryposis multiplex congenita,distal type 1 (AMCD1),amniotic band syndrome,body stalk anomaly,trisomy18 and micromelia.Hand (figer) hypoplasia or aphasia (3 cases),one hand was absent in one fetus without associated anomaly,absence of five fingers with ipsilateral multicystic dysplastic kidney in the second fetus,and the third fetus had split hand/foot malformation (SHFM).Overlapping fingers (4 cases),three of them were trisomy18,and two fetuses had both wrist deformity and overlapping fingers.Conclusions Prenatal two and three dimensional ultrasound play an important role in detecting and diagnosing severe type of fetal hand malformations.

Objective To investigate the diagnostic value of prenatal ultrasonography in the fetal hemivertebra. Methods The ultrasonographic findings of three fetuses with hemivertebra diagnosed in our hospital were reviewed and compared with those of postnatal ultrasonography,other image modalities,and autopsy. Results In all fetuses,a distortion of the spine was observed where only one half of the vertebra could be identified. The parents opted for termination of the pregnancy in one case and the deformity was confirmed by autopsy. The other two fetuses were delivered and in one fetus the diagnosis was confirmed by radiological assessment. Conclusions Hemivertebra can be diagnosed accurately by second-trimester ultrasonography. The prognosis is mostly favorable when no other anomalies are associated. Meticulous examination may disclose the lesion and help decide the fate of pregnancy.

Objective To evaluate the differences among five representative and useful Doppler parameters in the diagnosis of the three common types of renal artery stenosis (RAS). Methods Five Doppler parameters including renal peak systolic velocity (RPSV), renal-aortic ratio (RAR), renal-interlobar ratio (RIR),acceleration time (AT),and resistant index (RI) were measured in 221 patients before renal arteriography. Differences between the groups of patients with various clinical causes of RAS were analyzed by Chi-Squared test. One-way ANOVA or t test were used to compare the means between different groups.The optimal cutoff value was determined with the maximum sum of sensitivity and specificity. Results Of the 442 renal arteries (main and accessory renal arteries) demonstrated at arteriography,214 were normal or stenosed less than 50 %, 204 stenoses 50% - 99 %, and 24 occlusions. RIR, RAR and RI were significantly different between the atherosclerotic and non-atherosclerotic RAS groups (P ＜0.05), while RPSV and AT were not. The optimal cutoff values of RAR,RIR and RI for detecting RAS between the atherosclerotic and non-atherosclerotic groups were much different (2.5 versus 1.9, 5. 1 versus 6.5, 0.57 versus 0.50,respectively) ,but those of RPSV and AT were similar or the same (170 cm/s versus 200 cm/s,51 ms versus 51 ms,respectively). Conclusions In the case of RAS (diameter reduction≥50%),it is advised to establish separate cutoff values of RAR, RIR and RI according to atherosclerotic and non-atherosclerotic RAS, but the same cutoff value of RPSV and AT can be applied. RIR is a good Doppler parameter in the diagnosis of RAS,especially atherosclerotic and fibromuscular dysplasia RAS.