Objective To explore the relationship between fractional anisotropy (FA) of corticospinal tract (CST) and motor function in stroke patients using diffusion tensor imaging (DTI). Methods From January, 2013 to October, 2016, 36 stroke patients were evaluated with Fugl-Meyer Assessment (FMA), Japan Upper Limb Function Test and DTI before and eight weeks after rehabilitation. FA in posterior limb of internal capsule, cerebral peduncle and pons were obtained, including ipsilesional and contralesional CST. Results The FA values within three sections of CST were significantly lower in the ipsilesional side than in the contralesional side both before and after rehabilitation (t>5.330, P<0.001). In posterior limb of internal capsule, the FA value increased after rehabilitation (t=-3.415, P<0.05), and no significant dif-ference was found in the other two sections (t<1.653, P>0.05) in the ipsilesional side, as well as in all the sections in the contralesional side (t<1.021, P>0.05). The FA values were positively correlated with the scores of FMA and Japan Upper Limb Function Test in all the sections both before and after rehabilitation (r>0.43, P<0.05), especially the relationship between the FA value and the score of Japan Upper Limb Function Test in the posterior limb of internal capsule (r=0.67). Conclusion DTI can be used to evaluate CST injury and the relationship be-tween CST injury and motor function.

Objective To understand the effect of standardized training for resident doctors and to improve its evaluation method. Methods A questionnaire survey was made among 89 resident doctors including 46 directors and 46 matrons. Kirkpatrick Model was used to analyze the question-naires in four dimensions including reaction layer,learning layer,behavior layer and achievement layer. Data of reaction layer were analyzed by ANOVA and data of learning layer and behavior layer were compared by paired t-test. Results Reaction layer:the overall satisfaction of the resident doc-tor for training is about 4.09. Learning layer:There were significantly statistical differences in the test scores before and after training(P=0.00). Behavior layer:There were significantly statistical differences in resident doctor’s ability and quality before and after training (P=0.00). Achievement layer:both the complaint rate and the accident rate of the 89 resident doctors were 0 while all of them passed the practicing physician exam. Conclusions Standardized training can improve the quality and ability of resident doctors. Kirkpatrick evaluation model can reflect the effect of the standardized training for resident and is a good tool to analyze the effectiveness of standardized training for resident.

Objective To observe the relationship between injury of corticospinal cord tract (CST) in basal ganglia and upper limb func-tion after stroke using diffusion tensor imaging (DTI). Methods 18 stroke inpatients hospitalized from January, 2013 to July, 2015 accepted DTI, and their upper limb function was evaluated with simple Fugl-Meyer Assessment and Japan Upper Limb Function Test. The fractional anisotropy (FA) of CST in basal ganglia of affected and unaffected sides were compared, and the correlation between FA of affected CST and upper limb motor function were analyzed. Results The FA was significantly less in the affected CST than in the unaffected CST (t=-21.09, P<0.001). The FA of the affected CST correlated with the scores of simple Fugl-Meyer Assessment (r=0.570, P<0.05) and Japan Upper Limb Function Test (r=0.509, P<0.05). Conclusion CST is injured after stroke, which may related to the upper limbs motor function impairment.

Objective: To analyze evolution and research hot sports of sports intervention on youth health promotion, and to provide the theoretical data for the researchers to make sure their future research directions. Methods: The Web of Science was searched through with core collection database to obtain original articles in this domain on November 10th 2018, and 1 242 articles were selected as research samples. Citespace was used to analyze the following data, including co-word, cited-reference, cite-author and so on. Results: Research on this domain was performed in 43 countries. The leading 5 countries of publishing papers were as follows: USA,Australia,England, Canada and Holland, accounting for 1 017 articles published, occupying 81.9% of the published papers. The most productive organizations were in USA and Australia. The team of Luban DR and Pate RR was most representative in this domain. Recently more and more researchers were paying attention to sport intervention of adolescents. The leading issues were about: application of intelligent electronic products in intervening adolescents’ health, the positive effect of sports environment on adolescents’ participation in sports and the sport intervention of adolescent’s brain. Conclusion We must recognize that the field in sports intervention among adolescents is still in its infancy and shows huge potential for further improvement. Scientists from the United States and Australia are leading the world in this field. It’s important for China to participate and refer to their cutting-edge researches, and to invest in specific sports intervention strategies paving the road to good health among adolescents.

Objective To investigate the benefits of replanning after induction chemotherapy(IC) by analyzing the dosimetric impact of IC on intensity-modulated radiotherapy(IMRT)for locally advanced nasopharyngeal carcinoma(NPC)and the dosimetric characteristics of replanning after IC, and to provide data for the rational design of clinical radiotherapy plans. Methods 16 NPC patients underwent contrast-enhanced CT scan once before and after IC.Target volumes were delineated and the chemotherapy plans were created,defined as Plan-1 and Plan-2,respectively. Then the target structure after IC was copied to Plan-1, generating the third plan, defined as Plan-1-2. The paired t-test was used to compare the dosimetric parameters between Plan-1 and Plan-1-2 and between Plan-2 and Plan-1-2. Results Plan-1 vs. Plan-1-2:Plan-1-2 showed significantly reduced D meanof target volume compared with Plan-1(P<0.05). Plan-1-2 significantly increased D meanand D maxof the spinal cord(P<0.05),although significantly reduced D mean of the brain stem and D maxof the temporal lobes compared with Plan-1. Plan-1-2 also had significantly reduced conformity index(CI)and significantly increased homogeneity index(HI)for the target volume compared with Plan-1(P<0.05). Plan-2 vs. Plan-1-2:Compared with Plan-1-2, Plan-2 significantly increased D meanand D minof gross tumor volume(GTV)and primary GTV(P<0.05)and significantly reduced D meanof the temporal lobes and D maxand D meanof the spinal cord(P<0.05), with D max decreased to 430.48 cGy;Plan-2 had significantly increased CI and significantly reduced HI for the target volume compared with Plan-1-2(all P<0.05). Conclusions IMRT plan-1 after IC has worse dosimetric distribution,while replanning after IC has more dosimetric benefits.

Objectives To evaluate the long-term outcomes of childhood low-or intermediate-risk neuroblastoma (NB) and their relevant prognostic factors. Methods A total of 70 new cases of low-or intermediate-risk NB diagnosed and treated by NB-99 protocol between 1999 and 2008 were analyzed retrospectively. Results Of these 70 NB patients, fourteen patients were in low-risk group and 56 were in intermediate-risk group. Sixty-seven patients reached complete remission (CR) or very good partial remission and 3 (5%) achieved partial remission. Ten patients relapsed. One patient occured second malignant neo-plasm. No patients died of chemotherapy-related adverse events or infections. The 5 year overall survival rate was 85.9%, event-free survival rate was 81.0%. Bone marrow infiltration, age at diagnosis, stage, lactate dehydrogenase level had a significant effect on prognosis. Conclusion Develop cytogenetic and molecular biology tests and pretreatment risk stratification are im-portant for further improvement of treatment protocol.

OBJECTIVETo analyze clinical manifestations and genetic mutation in a child with severe short stature and other malformations.

METHODSThe child has undergone history taking and physical examination. Genome DNA was extracted from peripheral blood samples of the proband and her family members. Candidate genes were captured with Agilent SureSelect and sequenced on an Illumina platform. Suspected mutation was verified by Sanger sequencing.

RESULTSThe patient, a six-year-and-10-month old girl, presented with non-symmetrical short stature, dysmorphism, abnormalities of limbs and spine, amblyopia of left eye, and cataract of right eye, in addition with frequent respiratory infection and micturition. Laboratory testing suggested 25-hydroxy vitamin D deficiency (18.9 ng/mL). Spine X-ray showed multiple malformations with centrums. Her mother also featured short stature (138 cm). Her aunt had short stature (130 cm) and limb-length discrepancy. Her little brother was 2.5 years old, and his height was 81 cm (-3.4 SD). Exome sequencing revealed a heterozygous mutation c.184C to T (p.Arg62Trp) in the proband and her mother. The same mutation was not found in her father and brother.

CONCLUSIONThe patient was diagnosed with X-linked chondrodysplasia punctata 2. Mutation of the EBP gene probably underlied the disease in this family.

Health service is an important part of the integrated development of the Yangtze River Delta. Taking the cooperation practice between Shanghai Tenth People′s Hospital and Suzhou Yinshanhu Hospital as an example, this article introduced the multi-agent cooperation mode of the loose medical alliance including the government, urban hospitals and cross provincial grassroots medical institutions. Among them, the local government provided policy, fund guarantee and guidance, the urban hospital exported management ideas, medicine talents and technologies, and the primary hospital conducted dual training by inviting in and going out to achieve double growth. Through the high gap cooperation between tertiary hospital and primary hospital, Yinshanhu hospital had been comprehensively developed. The loose medical alliance with multi subject coordination and cross region could give full play to the advantages of the loose healthcare alliance mode, achieve multi-win, and have reference significance for promoting the regional integration of medical and health services in the Yangtze River Delta.

Objective To explore the effectiveness of building block assembly games in the upper limb functional exercise of school-aged children with peripherally inserted central catheter catheterization.Methods Using convenience sampling,90 catheterized children who met the inclusion criteria in the pediatric ward of a tertiary hospital in Henan Province from November 2022 to April 2023 were selected as research subjects.They were randomly divided into an experimental group and a control group,with 45 cases in each group.The experimental group participated in building block assembly games in addition to conventional ball-gripping exercises,while the control group engaged solely in conventional ball-gripping exercises.The compliance rates of upper limb exercises,time average peak flow rate of axillary vein of the catheterization side,and the incidence of catheter-related complications were compared between the 2 groups.Results During the study,2 cases in the experimental group and 3 in the control group dropped out,resulting in 43 cases in the experimental group and 42 in the control group.The compliance rate of upper limb exercises in the experimental group during hospitalization was 93.03％,significantly higher than 64.29％in the control group(P＜0.001).On the third day after catheterization,the time average peak flow rate of axillary vein of the catheterization side was(5.58±1.24)cm/s and(5.37±1.24)cm/s on the seventh day in the experimental group,compared to(3.87±1.06)cm/s and(3.56±0.81)cm/s,respectively,in the control group.These differences were statistically significant(P＜0.001).The incidence of catheter-related thrombosis in the experimental group was 4.65％,significantly lower than 21.43％in the control group(P=0.021).The rates of bleeding at the puncture site and catheter displacement in the experimental group were both 4.65％,compared to 7.14％and 4.76％,respectively,in the control group.These differences were not statistically significant(both P＞0.05).Conclusion Incorporating building block assembly games into routine ball-gripping exercises can improve the compliance of upper limb exercises in children with PICC placement,improve the blood flow velocity in the axillary vein of the catheterization upper limb,and reduce the incidence of catheter-related thrombosis,without increasing the risk of bleeding at the puncture site or catheter displacement.

Objective To evaluate the clinical application value of three-dimensional medical image guided ultrasound in the chemotherapy of huge hepatic hemangioma.Methods Seventy-six cases were enrolled in a randomized control study.All cases were randomly divided into two groups (group A and group B).In group A,all cases underwent treatment based on the traditional two-dimensional medical images.Under the assistance of three-dimensional medical image information,preoperative treatment planning was performed in group B.After puncture treatment,therapeutic efficacy was evaluated by color ultrasound during follow-up.Results For treating huge hepatic hemangioma (tumor diameter ≥ 10.0 cm),the insertion number and pingyangmycin dosage in the group B were less than those in the group A [(6.2± 0.5)times vs (9.3±0.6) times,t=24.467,P=0.035;(99.2±8.0) mg vs (148.8±9.6) mg,t=34.613,P=0.029].The success rate of first treatment in the group B was higher than that in group A [73.6％(28/38) vs 100％(38/38),x2=131.91,P=0.032].Conclusion For huge hepatic hemangioma,the three-dimensional medical image information can be applied to reduce the insertion number and anesthetics dosage,improving the success rate of first treatment and therapeutic effect.