This article summarizes Professor Shang Lili's experience in diagnosing and treating recurrent respiratory tract infections(RRTIs)in children based on the theory of"internal deficiency and external injury".Professor Shang believes that children are in the stage of growth and development,with delicate organs and insufficient vital energy,which is called"internal deficiency";external pathogens repeatedly invade the human body,resulting in clinical manifestations of both cold and heat,ultimately damaging the body's qi,blood,essence,and spirit,known as"external injury"."Internal deficiency and external injury"leads to repeated infections of pathogens in children and causes physical and mental distress,affecting their growth and development.The theory of"internal deficien-cy and external injury"emphasizes the influence of internal and external factors on RRTIs in children,reflecting the evolution of patho-genesis and guiding clinical staging treatment.During the acute infection period,the treatment of wind heat syndrome is based on the Xin Liang and Qing San methods,while the treatment of wind cold syndrome is based on the Xin Wen and Kai Bi methods.For the mixed deficiency and excess syndrome,various methods such as attacking,supplementing,harmonizing,and supporting should be used,and treatment should be based on syndrome differentiation,with adjustments made according to the symptoms;during the inter-mittent period of infection,Professor Shang aims to assist the righteous qi,taking into account the upper,middle,and lower Jiao,and adopting treatment principles such as nourishing the lungs,spleen,and kidneys.Professor Shang's experience provides useful ideas and methods for the treatment of RRTIs in children.

Objective To explore the correlation of left ventricular systolic function calculated by automated cardiac motion quantification (aCMQ) and three-dimensional quantitative analysis (3DQA). Methods According to LVEF by 3DQA,patients were divided into abnormal cardiac function group(LVEF<50%)and normal cardiac function group(LVEF≥50%).Dynamic images from two chamber view(AP2), four chamber view(AP4)and three chamber view(AP3)of left ventricular long axis were acquired from 32 patients with abnormal cardiac function and 119 normal subjects.AP2 longitudinal strain (AP2LS),AP4 longitudinal strain (AP4LS) and AP3 longitudinal strain (AP3LS) as well as the left ventricular global longitudinal strain (LVGLS) were measured by aCMQ. While left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV) and LVEF were derived through aCMQ automatically calculated region of interest (ROI) driven automation.The correlation of left ventricular systolic function indexes obtained by aCMQ and 3DQA were compared.Results No significant differences were found between the two groups in gender,body mass index(BMI) and age (P > 0.05).LVEF in abnormal group by 3QDA and aCMQ were much lower than those in normal group (P < 0.01).The absolute values of AP2LS,AP4LS,AP3LS and LVGLS in abnormal group were significantly lower than those in normal group (P < 0.01).LVEF by aCMQ in abnormal group was positively correlated with LVEF by 3QDA methods(r =0.91 ,P <0.01);LVEF by aCMQ in normal group was positively correlated with LVEF by 3QDA (r = 0.73,P < 0.01).The left ventricular global longitudinal strain (LVGLS) measured by aCMQ was negatively correlated with LVEF by 3QDA(r = -0.815,P < 0.01).LVEF measured by aCMQ and 3DQA showed high inter-observer and intra-observer agreements in Bland-Altman charts.Conclusions aCMQ has preferable repeatability.Comparing with the traditional measurement method,LVEF measured by aCMQ has higher correlation with that measured by 3QDA.aCMQ can be a new and relatively accurate method to evaluate the left ventricular systolic function.

Objective To investigate the management and prevention of the complications of sigmoid rectal pouch for urinary division after radical cystectomy. Methods The clinical data of 34 patients who underwent a sigmoid rectal pouch procedure were analyzed retrospectively, and the clinical experience was summarized in the management and prevention of the complications of sigmoid rectal pouch for diversion. Results Twenty-six patients were followed up for 2 months to 11 years, and 10 patients lost in follow-up. The early follow-up results were as follows:3 patients had postoperative high fever with unilateral the kidney water, 1 patient had retropubic bleeding and need to stop bleeding, 3 patients suffered from wound split open and were performed relaxation suture, and 1 patient had sigmoid colon rectum bladder fistula 10d after operation. The late follow-up results were as follows:1 patient had urethral neoplasms recurrence, 5 patients developed distance metastases, and 5 patients developed nocturnal incontinence and worn safety pad. There were no hyperchloremic acidosis requiring clinical treatment, hydronephrosis as well as retrograde pelvis infection. Conclusions The operation of sigmoid rectal pouch for urinary division is fairly simple, with no serious complication. It is a better alternative diversion procedure, and should be accepted gradually by patients and surgeons.

Presented in the paper are the necessity,general ideas and principles of building a teaching center for virtual simulation experiment on disaster medicine,covering the teaching modules, capability objectives and education resources deployment among other basics of such a center.The authors propose to build a comprehensive platform for teaching by experimentation,integrating basic clinical skills training to trainings targeted to disaster rescue in view of actual needs in experiments and teaching.This way resources can be shared between the experiment center website and virtual simulation teaching software,promoting a regular,standardized and scientific development of disaster medicine in China.

Objective To observe the effect of clinical first-aid skills training for community doctor. Methods Effect of systematic clinical first-aid skills training and traditional teaching methods were scored by the questionnaire survey in order to compare their difference. Results Through systematic clinical first-aid skills training, the score on contacting the actual work, improving the diagnosis and treatment, analyzing and problem-solving skills, enhancing learning initiative, participation, scientific learning method and self-learning ability, impro-ving clinical thinking, strengthening team spirit and humane education were significantly improved compared to that of the traditional teaching methods (P<0. 01). Conclusion The systematic clinical first-aid skills training is an effective way for community physicians.

In order to strengthen the management of clinical teaching, improve the teaching quality of clinical practice, the advantages of the traditional medical education, teaching reform and medical simulation were further integrated, using PDCA (Plan-Do-Check-Action) cycle model in medi-cal college students' clinical practice training and evaluation. The skills of training and evaluation were optimized and practiced by thechain model of teaching-assistance-guidance to improve the train-ing quality of interns, and make continuous improvement from the angle of teaching, learning and management and with PDCA circulation mode. Practice shows that the application of PDCA circulation management has greatly improved teachers' teaching quality and their own quality, and the students' satisfaction of practice teaching management and clinical teachers has also significantly increased. The effect is obvious.

Objective To measure the pressure-volume changes and uroflow rate,and assess the function of upper urinary tract in sigmoidorcctal pouch patients.Methods Between 2007 and 2011,a to-tal of 10 patients who had a radical cystectomy because of muscle-invasive bladder tumor underwent a Mainz pouch Ⅱ procedure were evaluated.The ureters were implanted into the post walls of the detubularized sigmoid segment at least 30 cm in length.In all cases,sigmoidoscopy was done and the anal pressure was measured preoperatively,and video urodynamic study of sigmoidorectal pouch as well as the intravenous pyelography was conducted after 3 to 6 months postoperatively.Results Video urodynamic study of sigmoidorectal pouch revealed that no reflux up to an average volume of 360 ml (270-532 ml) of the descending colon.The sigmoidal colon pressure was 26 cm H2O during the 3 to 6 months post-operative follow-up.The anal sphincter pressure was 90 cm H2O on average preoperatively and did not change postoperatively.The renal function and upper urinary tract were preserved well.The Qmax was 30 ml/s and the average uroflow rate was 8 ml/s under abdominal strain.All the patients suffered slight incontinence in the first two months and became continent since the 3 month postoperatively with nocturnal voiding one to four times.Conclusions The sigmoidorectal pouch provides a reservoir with a higher capacity,lower pressure without reflux to the upper urinary tract and descending colon and lower metabolic acidosis problem.It is also a good alternative diversion procedure that would preserve upper urinary tract and good quality of life.

Objective To evaluate dual-source dual-energy CT(DSCT) for the differentiation of urinary stone composition in vitro. Methods Ninety-seven urinary stones were obtained by endoscopic lithotripsy and scanned using dual-source dual-energy CT. The stones were divided into six groups according to infrared spectroscopy stone analysis: uric acid ( UA ) stones ( n = 10 ), cystine stones ( n = 5 ), struvite stones( n = 6), calcium oxalate ( CaOx ) stones ( n = 22 ), mixed UA stones ( n=7 ) and mixed calcium stones(n=47). Hounsfield units (HU) of each stone were recorded for the 80 kV and the 140 kV datasets by hand-drawing method. HU difference, HU ratio and dual energy index ( DEI ) were calculated and compared among the stone groups with one-way ANOVA. Using dual energy software to determine the composition of all stones, results were compared to infrared spectroscopy analysis. Results There were statistical differences in HU difference [(-17±13), (229±34),(309 ±45), (512 ±97), (201±64)and (530±71) HU respectively], in HU ratio (0.96±0.03, 1.34 ±0.04, 1.41 ±0.03, 1.47 ±0.03,1.30±0.07, and 1.49 ±0.03 respectively), and DEI( -0.006 ±0.004, 0.064 ±0.007, 0.080 ±0. 007, 0. 108±0.011 ,0. 055 ±0.014 and 0. 112 ±0.008 respectively ) among different stone groups(F=124. 894,407.028, 322. 864 respectively, P ＜0. 01 ). There were statistical differences in HU difference,HU ratio and DE1 between UA stones and the other groups( P ＜ 0. 01 ). There were statistical differences in HU difference, HU ratio and DEI between CaOx or mixed calcium stones and the other four groups (P＜0. 01 ). There was statistical difference in HU ratio between cystine and struvite stones ( P ＜ 0. 01 ). There were statistical differences in HU difference, HU ratio and DEI between struvite and mixed UA stones (P＜0. 05 ). Dual energy software correctly characterized 10 UA stones, 4 cystine stones, 22 CaOx stones and 6 mixed UA stones. Two struvite stones were considered to contain cystine. One cystine stone, 1 mixed UA stone, 4 struvite stones and 47 mixed calcium stones were considered to contain oxalate. Conclusions DSCT has the ability to differentiate urinary stone composition in vitro. With dual energy software, the UA, cystine and mixed UA stones can be differentiated from other types of stones.

Objective To investigate the feasibility and efficacy of transurethral prostate enucleation with 2 μm laser in the treatment of benign prostatic hyperplasia (BPH). Methods One hundred and seven patients with BPH were treated by transurethral prostate enucleation with 2 μm laser under continuous epidural anesthesia or laryngeal mask anesthesia. The patient′s, average age was 67±9 yrs (52 to 85 yrs). Of whom, 10 patients had a history of urinary retention. The mean prostate volume was 72.5±17.6 ml (45 to 158 ml). Two deep trenches were cut at the 5 and 7 o, clock position from the bladder neck to the verumontanum. The incision continued to the urethral mucosa and submucosa along with the verumontanum bilaterally in an arc-shape and ended at the internal arc of urethral sphincter. Then the urethral mucosa at the level of the verumontanum was cut and the surgical capsule plane was identified. A retrograde blunt dissection was made along the surgical capsule plane with the resectoscope sheath front-end, and the sheath was swung from side to side to extend the capsule plane. The significantly enlarged middle lobe was treated with laser vaporization resection. In the same way, a trench was made at the 12 o, clock position, and the lateral lobe were removed by the sheath from the verumontanum level, finally only two cord-like pedicles were kept at the 1 and 11 o, clock position at the bladder neck, so that the removed gland tissue was fixed and hung in the gland fossa. For prostate volume less than 60 ml, the laser vaporization resection was carried out directly. If the prostate volume was greater than 60ml, transurethral resection would be performed instead of laser vaporization resection. With 4% mannitol irrigation, the enucleated prostate tissue was then cut into small pieces and washed out by a Braun plastic bottle through the resectoscope sheath. Intraoperative bleeding, operative time, catheterization time, postoperative voiding status, maximum urinary flow rate (Qmax) and length of hospital stay were recorded and analyzed. Results All patients successfully completed the transurethral prostate enucleation. The average operative time was 74±12 min (45-150 min). Five cases required blood transfusion. There was no recorded urethral stricture and no urinary incontinence except for one patient who recovered 1 mon after the operation. The follow-up time was 2-6 mon. The average Qmax was 6.3±0.6 ml/s before and increased to 17.5±1.5 ml/s after the operation. The international prostate symptom score (IPSS) and quality of life (QOL) were reduced from 26.4±5.5 and 4.6±0.5 to 9.3±2.1 and 2.8±0.3 after the operation, respectively, P<0.01. Postoperative secondary bleeding was not observed. Conclusions Transurethral prostate enucleation with 2 μm laser for BPH is a safe and effective minimally invasive treatment. Its efficacy is superior to open surgery, and even better than TURP.

Objective To investigate the hemodynamic change of venous leakage in venogenic impotence. Methods Thirty-two patients with vasculogenic impotence were evaluated with conventional penile duplex sonography with spectral analysis and color Doppler imaging after intracavernosal injection of PGE1 to induce an erection.The color Doppler appearance of deep dorsal vein of penis,cavernous veins and bulbourethral vein wen observed and the correlativity with resistance index(RI)of cavernous artery were analyzed. Results After five minutes following intracavernous injection,the flow and diameter of the penis vein were continuous increased.The coefficient correlation r between the discharge of deep dorsal vein of penis,cavernous veins and bulbourethral vein with RI of cavernous artery were-0.55,-0.53,-0.24(P＜0.05).Considering the existence of mixed venous leakage,r between the discharge of vein of penis with RI of cavernous artery was-0.88(P＜0.001).Conclusions Higher qualitative ultrasound imaging could demonstrate venous leakage sensitively and assess the location and degree of venous leakage in venogenic impotence initially.