Objective To improve the training system of the combined education mode between professional master degree students of clinical medicine and resident standardization training (RST) in Zhe-jiang province, and improve the professional quality of medical graduate students. Methods A question-naire was designed through literature review and expert interview, and the data of 77 clinical training post-graduates were collected, and the effect of the training was evaluated by taking the reaction level, learning level, behavior level and achievement level of Ke's evaluation as the breakthrough point. Statistical analysis was performed by SPSS 20.0, and the mean score was used as the standard deviation. The scores were compared with t test, and the scores of multiple groups were made variance analysis. Results The RST attitude value in reaction layer was 9.26±1.08, RST content value was 29.29±4.36, RST teacher enthusiasm value was 11.13±2.17, RST experience value was 17.38±3.10, which indicated that residents' overall satisfaction to RST was high, but the satisfaction on teachers, evaluation and compensation was relatively low;The grade difference before and after RST in learning layer was statistically significant (P<0.05), indicating that before and after RST the grades were obviously improved, and the sense of belonging is high. The behave layer showed the residents' behavior changed obviously before and after RST (P<0.05), and their abilities in various aspects such as ward round and dealing with common diseases were largely improved;The result layer showed 77 graduate students had no medical accident and complaint , and all of them passed the annual assessment and participated in the research projects. Conclusion In general, RST graduate students are relatively satisfied with the plan, content and methods of the training, on the other hand, there are problems such as the absence of timely information feedback, teachers' poor enthusiasm, lack of effective competition mechanism, etc. Kirkpatrick Model made a comprehensive and objective eval-uation on graduate students RST from a overall perspective, and it can be introduced into the effectiveness evaluation for graduate students RST.

[Objective]To summarize Professor CHEN Hua's experience in treating children with recurrent respiratory tract infection(RRTI)based on"Yin deficiency,blood stasis and heat accumulation".[Methods]Through following Professor CHEN's clinical treatment and summarizing the cases information,the clinical experience and prescription characteristics of Professor CHEN in the treatment of children with RRTI were summarized and sorted out through clinical evidence.[Results]Professor CHEN considers that children with RRTI is caused by wind,phlegm,blood stasis and deficiency,and the pathogenesis is deficiency of the lung and spleen,phlegm and blood stasis obstructing venation,extending and not healing,and accumulation of blood stasis and heat.He puts forward the differentiation and treatment of RRTI from Yin deficiency,blood stasis and heat accumulation,and summarizes the diagnosis and treatment experience of paying attention to wind evil,dispelling wind and relieve symptoms;adjusting measures in accordance with three categories,nourishing Yin and clearing blood stasis;detailed differentiation of deficiency and substance,appropriate use of harmonious method;taking care of middle-Jiao and strengthening the spleen and stomach.The case involved a patient with RRTI,which was diagnosed as a condition of Yin deficiency with concurrent phlegm and blood stasis obstruction.Professor CHEN implemented a staged treatment plan,focusing on nourishing Yin,clearing stasis,which spanned the middle and later stages of the disease.During the prolonged stage,the treatment aimed at nourishing Yin and reducing fever,resolving phlegm and dispelling stasis.In the recovery stage,the focus shifted to nourishing Yin and reducing fever,invigorating the spleen and replenishing Qi.The therapeutic effect was significant.[Conclusion]Professor CHEN inherits the characteristics of pediatrics of Zhejiang school of traditional Chinese medicine,distinguishing and treating children with RRTI from"Yin deficiency,blood stasis and heat accumulation",and the curative effect is remarkable,which has high practical value in guiding clinical practice.

Objective To observe the changes of mRNA expression related to kidney yang deficiency and the ul-trastructure of hypothalamus in Lewis rats, and further study the constitution of kidney yang deficiency in Lewis rats.Meth-ods Ten 7-8-week old SPF male Lewis rats and twenty 7-8-week old SPF male Wistar rats were used in this study.The rats received subcutaneous injection of hydrocortisone to establish kidney yang deficiency model.The expressions of TNF-α, IFN-γ, IL-10, CRH, MR and GR mRNA in the hypothalamus of the two groups were detected and the ultrastructural changes of hypothalamus and adrenal gland were observed to compare the differences between the two groups, and to ex-plore the mechanism of kidney yang deficiency constitution in the Lewis rats.Results Compared with the normal Wistar rats, the expressions of GR and IL-2 mRNA in the hypothalamus were significantly increased ( P<0.01 ) , while the ex-pressions of CRH, TNF-α, IFN-γand IL-10 mRNA were significantly decreased in the Lewis rats (P<0.01).The zona fasciculata of the adrenal cortex was slightly thinner, the mitochondria were slightly swollen and the amount of mitochondria was decreased.The nuclei of hypothalamic neurons were larger, and the mitochondria, neuron synapses and secretory vesi-cles in the presynaptic neurons were decreased.Conclusions There are abnormal expression of immune-related cytokines and CRH mRNA, and ultrastructural changes in the hypothalamus and adrenal gland of Lewis rats with kidney yang defi-ciency.Such changes may be related to the functional imbalance of the hypothalamus-pituitury-adrenal axis.

Objective To discuss the relationship between echogenicity and fat content in renal tumor.Methods 52 renal tumors were examined with preoperative ultrasonography,all tumors were 3 cm in diameter or less.The tumor echogenicity was classified as echogenicity increasement type (including hyperechoic and slightly hyperechoic) and echogenicity decreasement type (hypoechoic).The relationship between echogenicity and adipose staining in tumor were analyzed.Results In 18 cases pathologically proved benign renal tumor,14(77.8 ％) of the tumors were hyperechoic and were angiomyolipoma(AMLs),4(22.2％) of the tumors were hypoechoic including 2 poor fat AMLs and 2 rare benign tumors,slightly hyperechoic case was not detected.In 34 cases malignant renal tumors,27(79.4％) of the tumors were slightly hyperechoic including 22 clear cell renal cell carcinomas (RCCAs) and 5 papillary RCCAs,7 (20.6％) of the tumors were hypoechoic including 2 clear cell RCCAs,3 papillary RCCAs and 2 chromophobe RCCAs.Hyperechoic case was not detected.The adipose staining of 41 cases of echogenicity increasement type was all positive,in the 11 cases of echogenicity decreasement type,9 tumors were adipose staining negative,while the other 2 tumors were positive,and there were statistically significant between two groups (P ＜0.05).Conclusions Echogenicity was obviously correlate with fat content in renal tumor.Tumors containing rich fat appear to be increased in echogenicity,tumors without fat content appear to be decreased in echogenicity.

OBJECTIVE: To analyze the growth arrest and DNA damage gene 45( GADD45) mRNA expression in peripheral blood of radiation workers,and its relationship with exposure dose. METHODS: Using a typical sampling method,97 radiation workers from a hospital of Guangdong were selected as radiation group,48 hospital administrative staff without exposure to radiation and other occupational hazard factors were selected as control group. The real-time quantitative polymerase chain reaction was used to detect GADD45 mRNA expression of two groups. With the use of thermoluminescence dosimetry,we detected and collected personal dose data of radiation group over the past year. RESULTS: The GADD45 mRNA relative expression of the radiation group was higher than that of the control group( P < 0. 01).There was no correlation between GADD45 mRNA relative expression and factors such as personal dose,sex,age,length of service,smoking,and alcohol drinking( P > 0. 05). CONCLUSION: The ionizing radiation can lead to up-regulation of GADD45 mRNA expression in peripheral blood of radiation workers,but there was no linear relationship between GADD45 mRNA expression and its personal dose.

Background The thyroid gland is one of the organs sensitive to ionizing radiation, and there are few studies on the effects of long-term exposure to low doses of ionizing radiation on the thyroid gland of radiation workers. Objective To investigate thyroid abnormalities in workers in medical radiology departments in Guangdong Province and to identify potential influencing factors of thyroid abnormalities. Methods A total of 1657 radiation workers from 48 hospitals in Guangdong Province were selected as survey subjects using convenience sampling, and their personal dose monitoring results and health examination information were retrospectively analyzed to determine the factors affecting thyroid abnormalities. Results The M (P₂₅, P₇₅) of thyroid absorbed dose (D_T) was 1.55 (0.65, 3.96) mGy in the 1657 investigated workers. The attribute-specific medians of D_T were 1.29, 1.38, 1.99, and 3.51 mGy for departments of diagnostic radiology, interventional radiology, radiotherapy, and nuclear medicine, respectively; and 1.10, 1.55, and 1.80 mGy for job titles of nurse, technician, and physician, respectively. Differences in D_T by gender, age, years of radiological work, age of radiation exposure onset, occupational category, and job title were statistically significant (Z=−6.35, H=708.52, 918.20, 31.19, 95.64, 39.28, P<0.05). The positive rate of thyroid abnormalities in investigated workers was 46.53% (771/1657). Among them, the positive rate of abnormal thyroid function was 22.87% (379/1657), that of abnormal thyroid morphology was 33.98% (563/1657), and that of thyroid nodule was 26.55% (440/1657). The differences in thyroid abnormality rates by gender, age, years of radiation work, age of radiation exposure onset, D_T, and job title of radiation workers were statistically significant (χ²=51.89, 49.64, 20.54, 18.29, 12.07, 16.16, P<0.05). The differences in abnormal thyroid function positive rate by gender, age of radiation exposure onset, and job title were statistically significant (χ²=26.21, 6.21, 8.32, P<0.05). The differences in the positive rates of abnormal thyroid morphology and nodules were statistically significant by gender, age, years of radiological work, age of radiation exposure onset, D_T, and job title (abnormal thyroid morphology, χ²=40.24, 64.17, 37.63, 15.17, 19.28, 15.05; nodules, χ²=31.41, 77.98, 42.11, 19.16, 21.70, 13.52, P<0.05). The positive rates of thyroid abnormality, thyroid morphology abnormality, and nodules all showed a linear increasing trend with increasing age, years of radiation work, and age of radiation exposure onset (P<0.05). The results of logistic regression analysis indicated that the factors influencing thyroid abnormalities were female (OR=2.17, 95%CI: 1.72-2.74), increased years of radiological work (OR=1.04, 95%CI: 1.03-1.06), onset of radiation exposure in age groups of 30-34 and ≥35 years (OR=1.63, 95%CI: 1.12-2.37; OR=2.58, 95%CI: 1.74-3.29), and working in department of diagnostic radiology (OR=1.40, 95%CI: 1.07-1.84). Conclusion Long-term exposure to low doses of ionizing radiation has an effect on thyroid abnormalities in medical radiation workers. Among them, being female, physicians, and working in department of diagnostic radiology are at a higher risk of abnormal thyroid function; being female, increased years of radiation work, and radiation exposure onset at age ≥30 years are associated with a higher risk of reporting abnormal thyroid morphology.