Resident training is an important part of after-graduation education for medical students,and is also an important way to cultivate qualified medical talents.With 20 years management experience of resident standardized training,Xuan-Wu Hospital has found 8 aspects,including leaders'attention and implement,process management,base construction,test assessment,24-hour system,guiding teacher system,rewards and punishment system,and scientific research were related to the quality of the resident standardized training.

Objective To evaluate the hemodynamic changes in patients with middle cerebral artery (MCA) stenosis pre- and post-stenting by transcranial color-coded and pulsed-Doppler sonography.Methods Thirty patients with middle cerebral artery stenosis were included.Two-dimensional,color-coded and pulsed-Doppler sonography were used to monitor the morphologic and hemodynamic changes of the MCA before,in the middle of,and after the endovascular stenting operation.All patients were verified by digital substract angiography.Results The hyper-echoic stent grafts and also the size and location of the stent were clearly shown by two-dimensional ultrasonography in 28 patients.The systolic,diastolic and the timeaveraged maximal flow velocities significantly decreased both instantly and 3 - 7 d after the stenting.Specifically,the systolic peak flow velocity of the MCA dramatically decreased immediately after the stenting [(151.43 ± 25.14) cm/s vs (286.13 ± 57.38)cm/s,P ＜0.05],and showed a further decrease after 3 - 7 d [(108.80 ± 9.95) cm/s vs (151.43 ± 25.14) cm/s,P ＜0.05].Conclusions Transcranial color-coded and pulsed-Doppler sonography could be used to evaluate the hemodynamic changes after MCA stenting,and could be considered as the first choice of method for evaluating the therapeutic outcome of stenting.

Objective To investigated the value of intraoperative ultrasonography in guiding the surgical approach,improving the total resection rate of the tumor,and the survival time of patients who underwent resection of cerebral gliomas.Methods One hundred and ninteen patients with cerebral gliomas (pathologically confirmed) comprised the study groups.Patients who underwent intraoperative ultrasoundguided surgery were followed up for 6-60 months.In addition,randomly selected low and high grade cerebral glioma patients (all 30 cases of which were without intraoperative ultrasonography guidance) served as the control groups.Follow up included survival time,and the differences in survival time between the study groups and control groups were statistically analyzed.Results Complete follow-up data were obtained for 101 of 119 cases (84.9％) for a follow-up time of 6 60 months.Total removal of the lesion was achieved in 68 cases (67.3％) and subtotal removal in 33 cases (32.7 ％).Sixty-five cases had partial recurrence (64.4％) and 60 patients died due to tumor recurrence.Survival in patients with low grade gliomas (LGG) was significantly higher than that in patients with high grade gliomas (HGG).Patients with total tumor resection had a longer survival time than patients who had subtotal tumor resection.In the control LGG group,6-month survival was 96.7％,1-year survival was 73.3％,2-year survival was 53.3％,4-year survival was 36.7％ and 5-year survival was 26.7％.In the control HGG group,survival at 6 months,1 year,2 years,4 year and 5 years was 83.3％,36.7％,13.3％,3％,0 respectively.When comparing survival between the control groups and study groups,there was no significant difference at 6 months (P ＞0.05),but survival at 1 year,2 years,4 year and 5 years was different (P ＜0.05).Conclusions Intraoperative ultrasonography-guided resection of cerebral gliomas helps the surgeon to understand the relationship between the lesion and the surrounding structures,helps to protect normal brain tissue and increase the safety of surgery.It is of value in improving the total resection rate of tumors and the patient's survival time.

Objective To measure cerebral circulation time(CCT) of a group of normal adults by contrast-enhanced ultrasound. Methods Forty-seven cases of healthy volunteers without any cardio-cerebral disease history were enrolled in the study. Internal carotid artery and vertebral artery were observed and the blood flow was measured with high frequency probe. Contrast-enhanced agent SonoVue was injected bolus into median cubital vein. CCT was measured and calculated according to the contrast curve analysis. Contralateral CCT measurement was repeated when the blood flow signal resume to the baseline intensity. Cerebral blood volume was then calculated according to CCT and cerebral blood flow. Results All the imaging of carotid vessels was presented clearly in all objects. Cerebral blood flow was 603 ～ 990 ml/min with an average (778 ± 171)ml/min. Bi-lateral CCT was measured successfully,the value ranged 4. 1 ～ 10.2 s with average (6.22 ± 1.47) s. There were no significant differences both in contrast of left and right side of the carotid vessels and in contrast of three dosage groups ( P ＞0.05). The cerebral blood volume was 54～96ml with average (76 ± 27)ml. Conclusions Contrast-enhanced ultrasound can be useful in measurement and calculation of CCT and cerebral blood volume.

Objective To investigate the clinical value of circumferential strain and strain rate in estimating the carotid elasticity. Methods Thirty-five consecutive patients of hypertension were enrolled in this study as the patient group and 36 healthy volunteers whose ages were matched with the patient group were included as controls. The intima-media thickness(IMT) of common carotid arteries of both the patients and controls were measured using RF-Data technique of ultrasound vascular measurement and the following traditional parameters reflecting common carotid elasticity were obtained: pulse wave velocity (PWV),arterial compliance (AC). While the new parameters reflecting vascular strain including endovascular longitudinal strain(EN-LS), endovascular circumferential strain(EN-CS), endovascular longitudinal strain rate(EN-LSR) ,endovascular circumferential strain rate(EN-CSR), adventitial longitudinal strain(EP-LS),adventitial circumferential strain ( EP-CS ), adventitial longitudinal strain rate ( EP-LSR ), adventitial circumferential strain rate(EP-CSR) were collected using the technique of X-strain. All the corresponding parameters were compared between hypertensive group and controls. The correlations between elasticity and hemodynamic parameters were analyzed. Results In the hypertension patients,PWV was higher while AC,EN-CS,EN-CSR,EP-CS and EP-CSR were lower than that of the control group( P ＜0.05). No significant differences were detected in the longitudinal strain and strain rate. In the hypertension group,AC correlated positively with PWV, while EN-CS, EN-CSR, EP-CS and EP-CSR correlated negatively with PWV and positively with AC. Conclusions Circumferential strain and strain rate conform well to the mechanical principle and the characteristic anatomic and histological structure of the vessels and may be used to reflect the early changes of the vascular elasticity.

Objective To investigate the infectious status,etiological spectrum and epidemiological characteristics of rotavirus (group A/B/C),calicivirus (novovirus Ⅰ/Ⅱ,sapovirus),astrovirus and enteric adenovirus in diarrhea cases below 5 years old from 2008 to 2015 in Henan provinces.Methods Totally 2541 stool samples were collected from cases below 5 years old in four sentinel hospitals.All stool specimens were tested for group A rotavirus by double antibody sandwich ELISA method.G/P genotyping of group A rotavirus was determined by nested multiplex PCR.Viral RNA was extracted from all samples and rotavirus (group B/C),calicivirus,astrovirus and enteric adenovirus were detected by two-step reverse transcription-polymerase chain reation (RT-PCR)/PCR.Results One thousand four hundred and twenty-one out of 2 541 samples were positive with a total positive rate of 55 .9%,among which,102 were mixed infection.The isolation rate of rotavirus was 36.0% (914 samples)(group A:785 cases,group B:36 cases,group C:93 cases),calicivirus was 12.1 % (308 samples)(novovirus Ⅰ:64 cases,novovirusⅡ:193 cases,sapovirus:51 cases),astrovirus was 5 .9% (151 samples),enteric adenovirus was 1 .9%(48 samples).The group A rotavirus gene type combinations were composed mainly of G9P[8],G2P[4], G3P[8 ],G1P [8 ]and most cases were identified from September to November and March to May. Novovirus Ⅱ was predominant in calicivirus and most cases were identifed between March and May. Rotavirus or calicivirus infection was mainly among children aged 4—12 months or 3—5 years, respectively.Clinical manifestations included fever,diarrhea,vomiting,dehydration.Gender and region distributions differed according to the types of pathogen.Conclusions Group A rotavirus and novovirus Ⅱare the major viral pathogen in diarrhea cases younger than 5 years old in Henan province.Different viral infections exhibit extinct epidemiologic and clinical characteristics.

Objective To investigate the value of intraoperative contrast-enhanced ultrasound(CEUS) in evaluating pathological grades of cerebral gliomas. Methods Intraoperative CEUS was performed in 33 patients of cerebral gliomas of different pathological grades. Real-time blood perfusion and enhance characteristics of these tumors were observed,quantitative parameters from the automatically derived time-intensity curve (TIC) were obtained, and compared with the tumor microvessel density (MVD) by immunostaining with anti-CD34. Results The time to peak was significantly shorter and the MVD was significantly higher in the high grade cerebral gliomas compared with the low grade ones ( P <0. 05). The time to peak was negatively correlated with the MVD by immunostaining (r = -0.79, P < 0. 05). Conclusions Intraoperative CEUS could be used to observe microvascular perfusion in real-time, and could indirectly reflect the information of MVD in cerebral gliomas, which is of help to grade cerebral gliomas and guide surgical resections.

Objective To evaluate X-ray,CT and MRI findings of soft tissue infections in AIDS. Methods Three cases of soft tissue infections with AIDS were retrospectively analyzed by comparing the imaging findings with pathological results.All patients were performed MRI,X-ray was in 1 case,CT was in 1 case.Results Cellulitis was in 1 case:MRI showed extended thickening of subcutaneous tissues, ill-defined hypointense areas on T_1WI and hyperintensity on T_2WI,and reticular pattern on GRE. Necrotizing fasciitis was in 1 case:MRI showed obvious thickening of subcutaneous tissues and deep fasciae, abnormally increased signal intensity on T_1 and T_2WI.Fluid collections were within muscles and muscles interval on fat-suppressed T2 WI.Tuberculosis was in 1 case:CT demonstrated multiple low density areas in the subcutaneous tissues and clear peripheral rim enhancement.MRI appeared hypointense on T_1WI and hyperintensity on T_2WI,and peripheral rim enhancement following gadolinium injection.Conclusion Infections of soft tissue are common complication in patients with AIDS,radiology is important in early diagnosis and treatment planning in this population.

Chronic kidney disease (CKD) is a serious chronic disease with high incidence, poor prognosis, and a variety of complications. Indoxyl-sulfate (IS) and p-cresol sulfate (PCS) are two typical gut-derived uremic toxins, which are produced by the co-metabolism of intestinal microbes and the host. With the progression of CKD, gut-derived uremic toxins such as IS and PCS accumulate in patients with CKD and thereafter accelerate the progression of CKD. Gut microbiota is closely related with CKD, and targeting gut microbiota to regulate gut-derived uremic toxins synthesis and metabolic pathways may be a promising strategy to delay the progression of CKD. In this paper, the relationship between gut microbiota, gut-derived uremic toxins, and CKD was analyzed, and the strategy to delay the progression of CKD by targeting gut microbiota and uremic toxins metabolism pathway was proposed.

Aging can cause degenerative changes in the function of multiple tissues and organs in the body. Gastrointestinal diseases and intestinal dysfunction are very common in the elderly people. The purpose of this study is to explore the effect of the total extract of Astragalus membranaceus (Fisch.) Bge. on intestinal function and gut microbiota homeostasis in natural aging mice, which will provide clues for further mechanism study. The natural aging mice model is established and animal experiments follow the regulations of the Animal Ethics Committee of Nanjing University of Traditional Chinese Medicine. The overall health of the mice was evaluated by the "frailty index" scoring method. The intestinal absorption and transport function were measured by detecting intestinal glucose absorption capacity, transport time, lipase and amylase activities of aging mice. Intestinal inflammation was assessed by detecting inflammatory cytokines by enzyme-linked immunosorbent assay (ELISA). The pathological changes in the intestines of aging mice were tested by hematoxylin-eosin (H&E) staining and alizarin blue (AB) staining. The qRT-PCR method was used to explore the gene transcription level related with the proliferation and differentiation of intestinal stem cells. Microbiota analysis based on 16S rDNA were used to evaluate the composition of gut microbiota. The results showed that Astragalus had a tendency to reduce the "frailty index" of aging mice, but did not show a significant difference. In some indicators of aging phenotype, Astragalus has the most significant effect on hair loss and physical fitness. In terms of intestinal function, Astragalus could increase intestinal glucose absorption capacity, shorten intestinal transportation time and promote lipase secretion in aging mice. The levels of inflammatory cytokines such as tumor necrosis factor-α (TNF-‍α) in the aging intestinal tissue were reduced after Astragalus administration. Astragalus also ameliorated the pathological degeneration of the intestinal tissue of aging mice by increasing the length of small intestinal villi, the thickness of colonic mucosa and goblet cell number. In addition, Astragalus elevated the expression of genes associated with the proliferation and differentiation in jejunum and modulated gut microbiota, especially restoring the abundance of Lachnospiraceae. Taken together, the above research results demonstrate the total extract of Astragalus as a key factor improving the intestinal function and gut microbiota homeostasis of aging mice.