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Objective:To explore the clinical teaching effect of case-based learning combined with diagnosis and treatment guidelines in standardized residency training in the department of rheumatology and immunology.Methods:Forty standardized trainees were randomized into two groups. One was the observation group, which adopted case-based learning combined with diagnosis and treatment guidelines. The other one was the control group, which performed the traditional clinical teaching mode. After 4 weeks, the assessment and satisfaction evaluation were carried out among the two groups. SPSS 19.0 was used for t test and Mann-Whitney test. Results:Students in observation group showed significantly better ability of physical examination and case analysis than those in the control group. The satisfaction degree of the students in the observation group was significantly higher in terms of diagnosis and treatment standard, clinical thinking, problem solving ability, self-learning ability and personal profession benefits than that in the control group.Conclusion:Case-based learning with diagnosis and treatment guidelines is an ideal teaching method combining theory with practice perfectly, which can significantly improve the effect of clinical teaching of standardized residency training in the department of rheumatology and immunology.
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Objectives To investigate the value of oral glucose tolerance (OGTT)-insulin/C peptide release test in early diagnosis of chronic pancreatitis (CP)-associated abnormal glucose tolerance.Methods Sixty patients with CP who were admitted to the Department of Gastroenterology,Changhai Hospital from June 2017 to February 2018 were divided into CP with normal glucose tolerance (CP-NGT),CP with impaired glucose tolerance (CP-IGT),CP with newly diagnosed diabetes(CP-new-DM) and CP with the previous history of diabetes (CP-history-DM) according to previous medical records and data from OGTT-insulin/C peptide release test.The characteristics of glucose metabolism,the changes of blood glucose,insulin and C peptide released among the four groups were compared.Results In 43 cases of patients with CP without diabetes,the abnormal glucose metabolism was detected in 6 cases (14.0％) by fasting blood glucose or glycosylated hemoglobin,and in 30 cases (69.8％) by OGTT-insulin/C-peptide release test.The detection rate of abnormal glucose metabolism was increased by 55.8％.In the group of CP-history-DM,the peak secretion of blood glucose,insulin,C peptide was all at 120 min,and the multiplication of increased release of C peptide (peak/baseline) [4.1 (3.4,4.4) vs (6.1 ± 2.2) 、(6.4 ± 2.5)、(6.8 ± 3.8)],the C peptide area under curve (C-PAUC) [(3.6 ± 1.4)]μg · h-1 · L-1 vs 8.6(7.1,9.7),(8.1 ±3.1),(6.9 ±2.7) μg · h-1 L-1] and the homeostasis model of assessment for β cell (HOMA-β) [24.4 (11.4,37.4) vs 52.4 (44.6,92.1),(89.8 ± 57.2),(72.4 ± 57.0)] were all significantly lower,and the difference was statistically significant(all P＜0.05).In the group of CP-new-DM,the peak of blood glucose was at 60 min,while the peak of insulin,C peptide was at 1 20 min,the early insulin secretion index (/ I30/A G30) [2.2 (0.8,4.2)vs (11.4 ± 9.4)] and insulin secretion sensitivity index-2 (ISSI-2) [256.1 (160.1,340.7) vs (548.5 ± 173.2)] in group of CP-new-DM were significantly lower than those in the group of CP-NGT,and the difference was statistically significant (all P ＜0.05).Conclusions The insulin /C peptide secretion was insufficient in the early stage of CP-related diabetes mellitus.Routine OGTT-insulin / C peptide release test for patients with CP can increase the detection rate of abnormal glucose metabolism.
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Objective To analyze the clinical features of recurrent acute pancreatitis (RAP).Methods The clinical data of patients diagnosed as RAP were collected in Changhai Hospital, the Second Military Medical University between January 2016 to July 2016, and chronic pancreatitis(CP) patients and RAP patients to matching, as control group.A prospective cohort study about the clinical features of RAP and CP was set.The survival analysis model was established by Kaplan-Meier′s method, to calculate the cumulative rate of RAP which progressed into CP.Results The morbidity of male patients was 69.0% in the RAP group(n=100) and 60% in the CP group(n=100).The average first onset age of RAP and CP was 38 and 21 years old, respectively;and the teenagers accounted for 12% and 38.6%.The incidence of diabetes was 49.5% and 9%;and the incidence of fatty diarrhea was 46.6% and 19% of the two groups.The cumulative incidence of CP was 2% within 1 year, 4.6% in 3 years, and 12.4% in 5 years.Conclusions Men has higher morbidity in both RAP group and CP group.RAP patients′ first onset age was older than that of CP.Teenagers had a low incidence in RAP group.The risk of diabetes and fatty diarrhea was lower in RAP group than CP group.A certain proportion of RAP patients can progress to CP.
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Objective to determine the basal levels of several pancreas-related endocrine hormones in patients with chronic pancreatitis.Methods according to inclusion and exclusion criteria,consecutive patients from February 2016 to August 2016 in Department of Gastroenterology,Changhai Hospital,Second Military Medical University and ten healthy control (matched for age and gender) were included.Basal levels of glucagon-like peptide 1,pancreatic polypeptide,Secretin,glucagon,somatostatin between groups of CP vs healthy control,CP with abnormal glycometabolism vs CP with normal glycometabolism and alcoholic CP vs non-alcoholic CP were compared.Results a total of 53 patients with chronic pancreatitis and 8 healthy subjects were included in this study.(1) CP vs healthy controls:the level of secretin in healthy control patients is significant lower than that in CP patients;(2) CP with abnormal glycometabolism vs CP with normal glycometabolism:the level of triglyceride and somatostatin is significant lower than that in CP patients;the prevalence of patients with chronic alcohol consumption and the level of glucagon-like peptide 1 in CP with abnormal glycometabolism is significant higher than that in CP with normal glycometabolism;(3) the prevalence of abnormal glycometabolism in alcoholic CP group is significant higher than that in non-alcoholic CP.The results above are all of statistical significance.Conclusions in addition to dysfunction of islets/3-cells,CP also easily affects the level of other pancreas-related hormones such as secretin,somatostatin and glucagon-like peptide 1.Otherwise,chronic alcohol consumption is also strongly related with abnormal glycometabolism,the mechanism deserves further researches.
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Objective To explore the application of the evidence-based case report method in the standardization training of resident physicians in the department of endocrinology. Methods Fifty-one resi-dents recruited from the endocrinology department were randomly divided into the experiment group (26 cases) and control group (25 cases). The evidence-based case report method was conducted in the ex-peri-mental group, while the traditional clinical teaching mode was applied in the control group. The re-sults of the examination of two groups including the theoretical test and skill test were compared and the question-naire survey was conducted to find out the differences of students' interest in learning, clinical skills and satisfaction. All data were compared using t test. Results There was no significant difference in theoretical test between the two groups (P>0.05). The total score of the skill test in the experimental group was (85.13 ±4.63) and the control group was (76.79 ±3.11) (P=0.000). The students in the experimental group showed that the teaching method had more significant effects on improving their learning interest and initiative, clinical thinking ability, clinical work ability, literature review ability and medical article writing ability. Scores of satisfaction with teaching methods (total score was 10) for experimental group were (9.69 ±0.34), which was also significantly higher than those in the control group (8.01 ±0.39) (P=0.000). Conclusion The application of evidence-based case report teaching method in the standardized training of resident physicians in department of endocrinology is worthy of being perfected and further popularized in clinical teaching work.
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Objective To analysis the clinical features of dorsal pancreas agenesis ( DPA) and the associated diabetes, pancreatitis and other congenital organ malformations.Methods Chinese databases of Sinomed, CQVIP and CNKI using the term of short pancreas, pancreas agenesis, bulbar pancreas and dorsal pancreas, and English databases of PubMed using the term of dorsal pancreas agenesis, short pancreas and pancreas hypoplasia were searched.The clinical manifestation, pancreatic head characteristics and associations with diabetes, pancreatitis and other congenital organ malformations were analyzed.Results Six related publications from Chinese databases were searched and 21 patients were included with 2 cases excluded.Sixty-one publications from English database were searched and 71 patients were included.Thus, a total of 91 patients with DPA were analyzed.Abdominal pain was the most common manifestation, which was reported by 61.5% of the patients. 15.3% patients were identified during regular physical examination. Other manifestations including jaundice, fatigue, abdominal discomfort and diabetes were rare.After removing cases with insufficient information, 39 patients (61.9%) carried abnormal pancreatic head.Prevalence of diabetes or impaired glucose tolerance was 56.7% and the percentage of insulin-dependent diabetes in patients with abnormal glycaemia was 47.3%(n=18).20 patients (26.7%) were associated with pancreatitis, including 15 patients (75.0%) with acute pancreatitis, 1 patient (5.0%) with recurrent pancreatitis, and 4 patients (20.0%) with chronic pancreatitis. Thirty-three patients ( 36.2%) suffered other congenital organ malformations, including 21 patients (63.6%) with splenic malformation, 8 patients (24.2%) with heart malformation, and 17 patients (51.5%) with multi-organs malformations like gastrointestinal malformation, azygos vein and inferior cava vena fusion, duodenal and biliary atresia and renal absence.Conclusions The main diagnostic criteria of DPA was the absence of dorsal pancreatic duct.Diabetes was the most common complication followed by pancreatitis.
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Objective To explore the comparative advantage of Team based learning (TBL) in common diseases teaching among pre-selected trainees for medical non-commissioned officer. Methods 200 trainees were randomly divided into two groups of equal size (each having 100 trainees), one TBL group and another lecture based learning (LBL) group as the control group. The teaching content was both Chapters of High Altitude Illness and Hypertension. In the LBL control group, the traditional lec-ture based teaching and learning manner was followed. In contrast, the trainees in the TBL group were assigned pre-lecture self-learning outline and questions to discuss in advance, team-based group dis-cussion was conducted, and scene simulation with typical disease case analysis were adopted in class. In both groups, the teaching effectiveness were evaluated by both exam test and questionnaire manner. Results It turned out the team based learning model resulted in significantly improved overall trainee assessment scores (88.90 ± 5.28 vs. 76.10 ± 5.12, P<0.05) and higher overall teacher satisfaction scores (8.63 ± 0.85 vs 7.18 ± 0.72, P<0.05), compared to the LBL group. Conclusion TBL model is more effective in improving trainees' capabilities of cultivating team work spirit, self-confidence, learn-ing enthusiasm, problem analysis and knowledge application. TBL model significantly brings more advantage in teaching pre-selected trainees for medical non-commissioned officer.
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This paper explored factors influencing initiatives of clinical teachers in millitary medical university for training clinical undergraduates including work pressure after being transferring to civilian,work pressure,policy orientation,economic pressure,student factor and psychological factor,etc. Meanwhile,this paper explored the incentive mechanism of clinical teachers in millitary medical university for training clinical undergraduates including training and evaluating clinical teach-ing teachers, innovating evaluation criterion and creating sustainable teaching atmosphere (building examples and establishing various incentive systems). All measures taken above was mean to inspire the initiatives of clinical teaching teachers and to ensure the quality of clinical teaching.
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Objective To evaluate the application effect of teaching-picture archiving and communication system (T-PACS) in training image reading ability of eight-year-program students. Methods Sixty students were divided into two groups: control group (applying traditional teaching method) and experimental group (applying traditional teaching method and T-PACS) when doing clinical medical image reading ability training. Making multimedia teaching movie, clinical image reading teaching and establishing image database by T-PACS were used in experiment group. Mean-while, reading room was set up and classroom teaching and problem-oriented assignments were in-creased. Finally objective evaluation of image recognition ability and questionnaire were used to compare the teaching effect. Measurement data were expressed as x±s. Total scores of image reading were am-alyzed by t test. Full score rates were analyzed by X2 test. Results The results showed that the score of medical image reading ability was higher in experimental group (90.08±4.52) than in control group (86.92±4.68) (P=0.010). There were differences in respiratory and orthopedic full score rate (P=0.006;P=0.035). Most students thought that application of T-PACS could effectively improve the teaching and learning quality. Conclusions Application of T-PACS can improve the medical image reading ability of eight-year-program medical students and is worth further promoting.
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Case-based teaching (CBT) on the basis of treatment guidelines was carried out to develop standard medical behavior, improve learning efficiency and students' ability of solving clini-cal problems. In clinical internship teaching, guidelines for common and frequently-occurring respira-tory diseases and CBT were organically combined. Cases were carefully selected and questions were meticulously set. Guidelines were thoroughly analyzed and teaching was reasonably evaluated. There-fore, students' learning interests were initiated and learning efficiency was improved. It not only trained evidence-based medicine thinking of intern students, but also improved the teaching ability of clinical teachers.
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Objective To analyze the changes of the intima-media thickness(IMT)of carotid and femoral arteries, serum advanced glycosylation end-products(AGEs),and AGEs soluble receptor(sRAGE)after intensively controlling blood glucose, blood pressure, and lipid. Methods One hundred and thirty-two type 2 diabetic patients were divided into 3 groups and followed for 5 years: 20 patients were treated with intensive control of blood glucose and blood pressure, 80 patients with intensive control of blood glucose, blood pressure, and lipid; and 32 patients with conventional therapy. AGEs, sRAGE, and IMT of carotid and femoral arteries were measured and compared among different groups. Results The IMT of carotid and femoral arteries and serum level of AGEs were significantly decreased after intensive treatment. The ratio of sRAGE and HbA1C(sRAGE/HbA1C)were negatively correlated with the mean of HbA1Cin the past five years(r=-0.417, P＜0.001)and the fluctuation of HbA1C(r=-0.309,P＜0.001). Multinomial regression analysis showed that AGEs were the important risk factors of IMT of femoral artery(β=0.152,P=0.068). Conclusion Intensive treatment is significant in controlling the growing IMT of carotid and femoral arteries, while decreasing serum level of AGEs.
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Objective To investigate the effects of gabapentin(GBP) on plasma β-endorphin(β-EP) level in the patients with painful diabetic neuropathy(PDN). Methods We detected the plasma β-EP level in 24 PDN patients in the treatment with GBP, 18 PDN patients without GBP treatment, 20 diabetic mellitus patients without PDN and 24 healthy control subjects. Results (1)The level of β-EP in diabetic mellitus patients was lower than in the healthy control(P<0.01). (2)The patients who received GBP had a significant change of β-EP level after treatment(P<0. 01).. Conclusions Gabapentin is effective for the treatment of PDN and its adverse effects are mild. It can lower the plasma β-EP level in the patients with PDN.
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To investigate the effect of high concentration glucose and AGEs on VCAM 1 expression of mouse cardiac microvascular endothelial cells, the VCAM 1 expression was measured by using FACS after the endothelial cells were incubated with high concentration glucose, AGEs alone or combined respectively, the TNF ? level of cultured medium was measured by using RIA. The results showed that the VCAM 1 expression and TNF ? level increased significantly in high concentration glucose and AGEs group and increased more over in combined group. It is suggested that High concentration glucose and AGEs could induce the VCAM 1 expression, and has synergistic action. The increased level of TNF ? coincident with the increased VCAM 1 expression,is probably one of the factors in the mechanism of increased VCAM 1 expression.
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Objective: To evaluate the efficacy and safety of sibutramine,an anti obesity drug, in patients with overweight and simple obesity. Methods: Forty six patients with overweight and simple obesity were randomly assigned to sibutramine or placebo group according to the rule double blind. Results: After a 2 week wash out followed by a 24 week treatment periods, body weight, BMI, waistline and hip of sibutramine group decreased significantly compared with placebo group. The effect was significant at week 4 and advanced at week 8. In sibutramine and placebo group, the total effective rates were 81.82% and 16.67% respectively. The incidence of total adverse effects (thirsty, constipation, headache, agrypnin and so on) in sibutramine group was 27.27% and 11.11% in placebo group. Conclusion: The short term obeservation shows that sibutramine is an effective and safe anti obesity drug in overweight and simple obesity treatment, and the patients compliance is good.
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The relationship between 5-HT receptor and a-adrenoceptor was investigated in rat medullary slice preparations. In 57 nucleus tractus solitarii (NTS) neurons, 47 (82.5%) responded to both serotonin (5-HT) and norepinephrine (NE). After synapse transmission was blocked by perfusion of artificial cerebrospinal fluid (ACSF) with low calcium and high magnesium, 5 in 8 neurons were still sensitive to both 5-HT and NE. On the other hand, 3 in 5 neurons responding only to 5-HT or NA were sensitive to both 5-HT and NE after the synapse transmission blockage. In some neurons which exhibited excitatory or inhibitory responses to 5-HT or NE alone, the responses were inversed when perfused with 5-HT and NE in combination. These results suggest that there may exist an inhibitory interaction between 5-HT receptors and a-adrenoceptors in NTS and that most 5-NT and a-adrenoceptors coexist in the same NTS neurons.