Objective To evaluate the regional cardiac function for patients with coronary heart disease (CHD) with multiple tissue Doppler imaging (TDI) parameters in rest state and to discuss the value of regional cardiac function in diagnosing CHD.Methods Forty-seven patients with chief complain of chest pain underwent TDI examination.Maximum systolic velocity (Sm),maximum early diastolic velocity (Em),maximum late diastolic velocity (Am),isovoluminal contraction time (IVCT) and isovoluminal relaxation time(IVRT) of 16 segments of left ventricle were measured.All the patients underwent coronary angiography (CAG) at the same time.CHD was diagnosed by at least one coronary artery with no less than fifty percent diametric stenosis.Segments dominated by coronary artery with fifty to ninety and more than ninety percent diametric stenosis were defined as moderate and severe lesion segments respectively.Others were non-lesion segments.Results There was no significant difference of sex,age,heart rate,CHD risk factors,left ventricular ejection fraction (LVEF) and E/A among non-CHD (13 cases),one-lesion(11 cases),two-lesion (11 cases) and three-lesion (12 cases)(P ＞0.05).Compared with those in non-lesion segments (390sections),Sm,Em and Em/Am decreased and IVRT prolonged in both moderate lesion segments (162 sections) and severe lesion segments (144 sections) (P ＜ 0.01).IVCT prolonged only in severe lesion segments (P ＜0.05),but not in moderate lesion segments.If setting a criterion that no less than three segments with Sm ＜ 2.50 cm/s and IVRT ＞ 87 ms was for CHD diagnosis,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 79.4％ (27/34),84.6％ (11/13),93.1％ (27/29),61.1％(11/18) and 80.9％(38/47).Conclusions In rest state,regional cardiac function of lesion segments in CHD patients shows changes of decreased systolic and diastolic velocity and prolonged isovoluminal time.Analyzing segmental cardiac velocity and time comprehensively may help to diagnose CHD.

Objective To evaluate the coronary lesions with two-dimensional strain echocardiography. Methods Sixty-seven patients with suspected coronary heart diseases who underwent coronary angiography were divided into two groups. Forty-two of them with coronary stenosis ≥70% were considered as patient group, and the other 25 with coronary stenosis ＜50% were regarded as control group. Two-dimensional strain was performed in all patients within 24 h before coronary angiography. Longitudinal systolic strain rate (SRs), early (SRe) and late (SRa) diastolic strain rate, systolic strain (Ss), and time to SRe (T-SRe) were measured and compared. Results Ss, SRs, SRe and SRe/SRa decreased significantly in regions controlled by coronary artery with ≥70% stenosis in patient group compared with those controlled by coronary artery with ＜50% stenosis in control group. SRs and SRe were the independent predictive factors of coronary stenosis ≥70%, and the sensitivity and specificity of SRe ＜0.91 to identify coronary stenosis ≥70% was 72.46% and 89.65%, respectively. Conclusion Two-dimensional strain echocardiography may accurately evaluate the coronary lesions by detecting regional myocardial diastolic function.

The standardized training of medical specialists in China is far from perfect. The training contents, training system, training methods, supervision and assessment methods need to be improved. The First Clinical College of The First Hospital of China Medical University have guided the trainees to strengthen the study of guidelines and consensus by emphasizing the concept of evidence-based medicine (EBM) of training teachers by means of Sino-U.S. exchanges, case discussions and other ways. At the same time, with the help of the modern network education platform and the problem-based learning teaching mode, the concept of EBM education has been further developed, which greatly enhances the ability of specialists to analyze and solve problems, and improves the training effect.

Objective:To investigate the influencing factors of constipation in patients with cerebral hemorrhage, construct a risk prediction model, and verify the predictive effect of the model to scientifically guide subsequent treatment and nursing.Methods:A total of 254 patients with cerebral hemorrhage hospitalized in Affiliated Hospital of Binzhou Medical Collegefrom May 2022 to November 2022 were selected in a prospective cohort study, and they were divided into constipation group ( n = 150) and non-constipation group ( n = 104) according to whether constipation occurred. Univariate analysis and logistic regression were used to analyze the influencing factors of constipation in patients with cerebral hemorrhage, and a risk prediction model was established and a nomogram was drawn. A total of 110 patients with cerebral hemorrhage hospitalized in the same hospital from December 2022 to March 2023 were selected as the validation group, and the Hosmer-Lemeshow test and ROC curve were used to verify the model. Results:In this study, four risk factors of hospital stay, Koubmwater swallowing test score, nutrition and diuretics were finally included to construct a risk prediction model, and the area under the ROC curve of the modeling group was 0.918, the 95% CI was 0.848 to 0.963, the optimal cut-off value was 0.7225, the sensitivity was 0.885, and the specificity was 0.837. External verification results showed a sensitivity of 0.926 and specificity of 0.611. Conclusions:The risk prediction model constructed in this study has good effect and can provide reference for clinical assessment of whether patients with cerebral hemorrhage have the risk of constipation.