Standardized residency training is the main form of postgraduate medical education.In this article, we analyzed a delayed diagnosed case with Cushing syndrome.The patient saw the doctors in provincial level hospitals for many times within a year, while specialists missed diagnosis by only concerning the symptoms related to their own specialties, instead of integrating all the manifestations.We believe that standardized residency training provides residents a broader horizon of related specialties, which is irreplaceable by fellowship training program, and is the essential of comprehensive analysis of complex clinical situations.Standardized residency training will also be helpful for diminishment of the educational gap between different medical colleges and improvement the medical level of the whole nation.

BACKGROUND:The application of high-frequency ultrasound technology provides an effective tool for the precise assessment of skeletal muscle morphology in the elderly.However,the correlation between the morphological parameters of skeletal muscle obtained and physical activity capacity remains unclear. OBJECTIVE:To explore the correlation between morphological parameters of the gastrocnemius muscle and physical activity capacity in elderly females using high-frequency ultrasound imaging technology,thereby identifying effective predictive indicators for physical activity capacity in the elderly. METHODS:Fifty-nine elderly female subjects over the age of 60 with the ability to live independently were recruited in the communities surrounding Shanghai Sanda University.High-frequency ultrasound images of the subjects'gastrocnemius muscles were collected to obtain the relevant parameters,including muscle thickness,fiber length,pennation angle,and fiber length/muscle thickness(Lf/Tm)index.Physical activity capacity tests were also conducted and relevant indicators included the 10-meter walk test,timed up-and-go test,30-second chair stand test,and grip strength test.Correlation analyses were performed between various morphological parameters and physical activity capacity test indicators. RESULTS AND CONCLUSION:Significant correlations were found between various muscle morphological parameters(P<0.05).The pennation angle showed significant correlations with the 10-meter walking speed(r=-0.35,P<0.05)and timed up-and-go test results(r=0.32,P<0.05).The Lf/Tm index was positively correlated with 10-meter walking speed and grip strength test results(r=0.39,P<0.01;r=0.30,P<0.05),but was negatively correlated with timed up-and-go test results(r=-0.32,P<0.05).All these findings indicate that the pennation angle and Lf/Tm index of the gastrocnemius muscle show a good correlation with physical activity capacity in elderly females,which can serve as effective predictive indicators for physical activity capacity.

Objective To explore the effect of kinesio taping combined with therapeutic exercise on elderly patients with hallux valgus(HV).Methods Thirty-four HV patients over 60 years old were ran-domly selected from the rehabilitation clinic of Shanghai General Hospital and divided into an experi-mental group and a control group.The experimental group comprised 18 patients(8 males,10 fe-males;65.63±2.84 years),while the control group had 16 ones(8 males,8 females;66.09±4.11 years).Both groups underwent a 4-week therapeutic exercise including foot muscle stretching,fascial relaxation,muscle strength training and flexibility exercises,while the experimental group additionally received kinesio taping,using a Y-shaped tape and a lantern-shaped tape to stabilize the alignment of the first metatarsophalangeal joint,so as to enhance circulation and sensory input.Before and after the intervention,the Hallux valgus angle,visual analogue scale(VAS)score,ankle dorsiflexion plan-tarflexion angle,and timed up and go test parameters were recorded and compared between the two groups.Results After 4 weeks of intervention,there was a significant increase in the ankle dorsiflex-ion,plantarflexion and timed up and go test performance,but a significant decrease in the hallux val-gus angle and pain.Moreover,compared with the control group,after the intervention,the experimen-tal group showed a significantly smaller hallux valgus angle(P=0.03),and significantly better timed up and go test performance(P=0.01).Conclusion Therapeutic exercise combined with kinesio taping can further correct the hallux valgus angle and improve the walking function of patients.Therefore,such therapy is worth promoting in the clinical practice.

Bronchial Diseases ; diagnosis ; etiology ; Child, Preschool ; Humans ; Male ; Pulmonary Artery ; pathology

Objective:To evaluate the efficacy of combining extracorporeal shock wave therapy (ESWT) with local anesthesia in treating chronic plantar fasciitis.Methods:Reports of randomized and controlled trials about treating plantar fasciitis using ESWT were sought in the CNKI, Wanfang, Pubmed, Embase, Cochrane Library and Web of Science databases from their inception until October 2018. Each report found was screened by two independent researchers and the characteristics were abstracted. The risk of bias was assessed according to the methods recommended in the Cochrane Handbook. Version 5.3 of the RevMan software was used for the meta-analysis.Results:Eight reports of randomized and controlled trials were identified covering 779 patients treated with shock wave therapy and 710 controls. The meta-analysis showed that ESWT could significantly relieve the pain and improve functioning. Local anesthesia did not affect the outcome. Focued and radial shock wave were both significantly more effective than placebo stimulation, so as the medium and high-intensity.Conclusions:ESWT can significantly relieve the pain and improve the walking ability of patients with chronic plantar fasciitis. The use of local anesthesia during the intervention and different ESWT modes and intensities will not affect its efficacy.