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 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 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 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 assess left ventricular systolic strain in patients with mitral valve replacement (MVR) by speckle tracking echocardiography. Methods Two-dimensional images were acquired from the apical four-chamber view, two-chamber view and long-axis of the left ventricular view in 30 MVR patients (MVR group) and 30 healthy subjects matched by age and gender(control group), and then were analysed off line to evaluate left ventricular systolic strain. The maximum systolic longitudinal strain(LS) of myocardial segments and global longitudinal strain(GLS) were measured in apical views. Left ventricular ejection fraction(LVEF) was calculated using Simpson's method. The correlation between GLS and LVEF was analyzed using Pearson's method. Results Compared with the control group, LS of corresponding segment and GLS in MVR group decreased significantly (P < 0.01), but there were no statistical differences within MVR group(P>0.05). There was a good linear positive correlation between GLS and LVEF in patients (r = 0.710, P <0.01). Conclusions Speckle tracking eehoeardiography is available for measuring left ventricular systolic strain and estimating global systolic function in patients with MVR. Bull's-eye strain map, created by speckle tracking imaging, can achieve an accurate real-time segmental wall motion analysis.

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.

Objective To investigate the clinical value of strain ratio in differential diagnosis of thyroid tumors,compared with the evaluation based on elastography scores.Methods Elastography examinations were performed in 67 patients with 92 thyroid tumors.Ultrasonic elastograms were evaluated according to the four- and five-score system respectively.Strain ratio of the tumor and the surrounding tissue was also calculated.Clinical value of the three evaluations was compared with pathological findings as the reference standard.Results The area under the curve:0.885 for the four-score,0.904 for the five-score,0.961 for the strain ratio.When a cutoff point of 3 was used,four-score and five-score showed a sensitivity of 78.0%,a specificity of 86.3%,an accuracy of 82.6% and a sensitivity of 80.5%,a specificity of 88.2%,an accuracy of 84.8%,respectively.When a cutoff point of 3.57 was introduced,the strain ratio had 92.7% sensitivity,92.2% specificity,92.4% accuracy.Conclusions Strain ratio was more helpful in diagnostic performance of thyroid tumors as a new semi-quantitative method than elastography scores.

Objective To probe the value of using echocardiography in transcatheter closure of ventricular septal defect (VSD).Methods Under transthoracic echocardiography and digital subtraction angiocardiography monitoring and guidance in the operation,the Amplatzer excentric umbrella occluder was used to occlude the perimembranous defects in 15 cases of patients.Results All of the patients were treated successfully,though mitral regurgitations or residual shunts occurred in 6 cases,and disappeared at once after the position and direction of occluder were regulated in 3 and these complications disappeared gradually one month postoperation in other 3 patients.The umbrella separated from VSD in 1 and occluded successfully when manipulated once again.Complete heart block occurred in 2 and disappeared after 3 days.The positions of umbrella were normal and stable and no other complications were discovered when these patients were followed about 10 months the longest.Conclusions Echocardiography plays an important role in transcatheter closure of VSD with the Amplatzer occluder before,during and after operation and in the period of follow up.