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This paper focuses on the practical necessity of discipline-integrated PBL curriculum in cultivating clinical thinking ability of college students majoring in clinical medicine. Through the teaching process of group discussion of some real and complete cases, this paper explains in detail how to cultivate medical students' clinical thinking ability by discipline-integrated PBL curriculum, discusses the implementation of ideological and political education associated with clinical medicine by heuristic teaching from close touching with clinical case and implicitly infiltration of the socialist core values such as dedication and integrity, and elaborates the humanistic quality and psychological comfort levels of medical students by being close to clinical patients. After five years of teaching practice, the teaching effect of discipline-integrated PBL curriculum has been approved by the national clinical medicine professional certification experts and praised by students. We believes that the development of discipline integrated PBL curriculum in medical college can strengthen students' problem-based autonomous learning ability, significantly improve the two-way integration ability between basic medical courses and basic medicine, and significantly build students' clinical thinking and clinical decision-making ability.
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Objective@#To study the relationship between the average hearing of different frequencies and the audiometry staging in patients with Meniere′s disease.@*Methods@#A total of 259 patients from 1996 to 2016 were collected .All patients underwent pure tone audiometry, of which 93 patients underwent 3 000 Hz audiometry. The patients were divided into five groups according to the frequencies of hearing(Ⅰ: 500, 1 000, 2 000, 3 000 Hz; Ⅱ: 250, 500, 1 000, 2 000, 3 000 Hz; Ⅲ: 250, 500, 1 000, 2 000; Ⅳ: 500, 1 000, 2 000, 4 000 Hz; Ⅴ: 500, 1 000, 2 000 Hz), then calculated the average audiometry and made the hearing staging. The obtained data were analyzed by chi-square test and Bonferroni correction was performed among the groups, P<0.05 was defined as a statistically significant criterion.@*Result@#There were no significant difference between the five groups(P=0.441>0.05).@*Conclusions@#The choice of different pure tone audiometry frequency has no significant effect on the hearing staging. It would be more likely upstaging when plus 250 Hz. There is no statistically significant difference in staging between the latest guidelines and the 1995 guidelines.500, 1 000 and 2 000 Hz are recommended when 3 000 Hz examine is not available.
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Objective@#To analyze the correlation between the changes of fibrinogen and the treatment effect of all-frequency sudden deafness, and to explore the individualized treatment strategy for the use of Batroxobin.@*Methods@#Patients with all-frequency sudden deafness who were admitted to Department of Otorhinolaryngology, People′s Hospital of Peking University, from January 2010 to September 2016 were selected. All patients were given standard treatment and regular use of Batroxobin. Value of fibrinogen on D1 (before treatment) / D3 / D7 (±1) and D14 (±2) were recorded, at the same time, the correlation between the changes of fibrinogen and prognosis of all-frequency sudden deafness by the audiograms of onset and after-treatment of all patients were analyzed. Independent t-test was used to analyze normal distributed measurement data and chi square linear trend test was used to analyze the curative effect of different fibrinogen groups.@*Results@#A total of 148 patients were included, the outcomes were worst when the patient′s fibrinogen was below 2 g/L or above 4 g/L before treatment, ineffective rate were both 50%. The fibrinogen was lowest when the treatment came to the third day. Normally, the patient′s prognosis was best when this value waved between 0.7 and 0.9 g/L, with a total effective rate between 73.9% and 83.3%. The fibrinogen value of the 7th day was a good indicator of the outcome, and Fib7 value was significant lower in patients of effective group than ineffective ones ((1.25±0.37)g/L vs (1.38±0.35) g/L, t=-0.27, P=0.04). Patients found a best recovery when Fib7 was below 1 g/L, and the higher the Fib7 value, the higher the inefficiency (χ2=7.55, P=0.01). Batroxobin showed safety during the treatment and found no complications.@*Conclusion@#The change of fibrinogen in the process of all-frequency sudden deafness is closely related to the curative effect.
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Objective To investigate the spiral CT features of solid pseudopapillary tumor of pancreas (SPTP).Methods Spiral CT features of 34 SPTP cases confirmed by surgery and pathology were analyzed retrospectively.Results There were 30 females and 4 males.Tumors located in the tail,head,body and neck of the pancreas were respectively in 14,11,6 and 3 cases.The maximum diameter was 2.0-20.0 cm,with an average of 6.5 cm.There were 29 cases of solid-cystic mass with a CT value of 12.6-21.3 HU and 5 cases of solid mass with a CT value of 24.5-42.8 HU;Complete capsule were observed in 24 cases,while incomplete capsule were observed in 10 cases;15 cases were found with tumor calcification,13 with hemorrhage and 2 cases with liver metastasis.After dynamic enhancement,the solid part and capsule showed progressive and slight enhancement in the arterial phase with a CT value of 30.1-43.6 HU,and slight enhancement in portal phase with a CT value of 41.2-68.9 HU,and persistent enhancement in delayed phase with a CT value of 48.2-63.8 HU.Conclusions Spiral CT features of SPTP are characterized by progressive enhancement of solid mass in enhanced scan.
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OBJECTIVE@#To compare the vertigo controlling situation between the endolymphatic sac decompression(ELSD) and semicircular canal occlusion (SCO) in stage 4 Ménière disease.@*METHOD@#Fourteen patients who underwent endolymphatic sac decompression and 9 patients who underwent semicircular canal occlusion from 2009 to 2013 were followed. All patients has complete preoperative examination and postoperative follow-up.@*RESULT@#The vetigo control of the patients underwent endolymphatic sac decompression: completely control 35.7%; basic control 28.6%; partly control 14.3%; the vetigo control of the patients underwent semicircular canal occlusion: completely control 88.9%; basic control 11.1%.@*CONCLUSION@#ELSD and SCO are alternative methods for the patients of stage 4. SCO has a much highter complete vertigo control rate. For the patients without practical listening, SCO is a better choice.
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Humans , Endolymphatic Sac , General Surgery , Meniere Disease , General Surgery , Otologic Surgical Procedures , Methods , Semicircular Canals , General Surgery , Vertigo , General SurgeryABSTRACT
OBJECTIVE@#To investigate the effecacy of cochlear implantation (CI) improving hearing of Lermoyez's syndrome, we retrospectively analyzed a case of Lermoyez's syndrome whose left ear was extremely severe sensorineural deafness and right ear was severe sensorineural deafness.@*METHOD@#The patient had completed preoperative audiological examination , vestibular function and imaging examination, then was carried out bilateral endolymphatic sac decompression and left side CI. Follow up after the surgery.@*RESULT@#The vertigo could be controlled very well after the bilateral endolymphatic sac decompression surgery, but the hearing loss couldn't be control, so CI was carried out to improve hearing and speech recognition rate. The contralateral hearing also improved significantly after the operation.@*CONCLUSION@#Endolymphatic sac decompression can effectively control. Ménière's disease in patients with vertigo attacks. CI can improve patients' hearing, and speech recognition rate and, also could improve the quality of life. CI was the first choice for the patient of 4 stage Ménière's disease.
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Humans , Cochlear Implantation , Deafness , Decompression, Surgical , Ear, Inner , Endolymphatic Sac , Hearing , Hearing Loss , Hearing Loss, Sensorineural , Meniere Disease , Therapeutics , Quality of Life , Retrospective Studies , VertigoABSTRACT
Medical imaging inspection technology is a practical major obligatory course for college students in medical imaging major.In order to overcome the defects of traditional teaching,we try to improve teaching methods,to carry out opening laboratory system,and to establish picture archiving and communication system ( PACS ) laboratory for the cultivation of applied talents of medical imaging.
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Objective To improve spiral CT diagnosis and differential diagnosis of small amounts of traumatic subarachnoid hemorrhage(TSAH).Methods SCT features of 105 cases with small amounts of TSAH , which were demonstrated by SCT reexaminations , were retrospectively analyzed. Results The distributions of small amounts of TSAH included cerebral longitudinal fissure cistern in 47 cases, cerebral lateral fissure cistern in 30 cases , cerebral surface sulcus in 22 cases, tentorium of cerebellum in 6 cases. There were 12 cases of small amounts of TSAH with contusion and laceration of brain , Subdural hematoma or bone fracture of skull.Conclusions Spiral CT scan has important value in qualitation and level diagnosisa of small amounts of TSAH.
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OBJECTIVE Identify the effect of Brandt-Daroff exercises for positional vertigo with atypical positioning nystagmus.METHODS 11 cases of positional vertigo during 2006～2007 with atypical positioning nystagmus when carrying Dix-Hallpike and roll test,the nystagmus had the follwing characters:poly-positions,atypical direction,long lasting(more than 3 mins),no fatigue.After ruling out centrul neural system disorders,the patients were instructed to do Brandt-Daroff exercises 2-3 times/day,and 6-10 times every time.RESULTS After doing the exercises for 3-4 days,the vertigo of all the 11 cases were all relieved.After 1-2 weeks,10 cases were cured,syptom of the other 1 was relieved significantly,and the nystagmus was alleviated.CONCLUSION Cases with atypical positioning nystagmus may present a different kind of BPPV related with the otolith and vestibular nerve disease.Brandt-Daroff exercises was a good method for the atypical positioning nystagmus cases.
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Objective To study CT findings of the giant mass in lesser peritoneal sac.Methods Thirty cases of the giant mass in lesser peritoneal sac proved by surgery and biopsy were examined by CT scan.Results There were four cases of gastrointestinal stromal tumor (three in stomach and one in duodenum) , two cases of pancreatic cancer , one case of pancreatic cyst-solid papilloma , three cases of non-function neuroendocrine carcinoma in pancreas , two cases of pancreatic peudocyst and one case of mesenterial lymphoma. Conclusion Based on the typical imaging findings ,CT can accurately diagnosis the giant mass in lesser peritoneal sac.
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Objective To study CT findings of duodenal malignant tumor.Methods Plain and contrast-enhanced CT date of 20 patients with duodenal malignant tumor proved by pathology were retrospectively analysed.Results There were three adenocarcinomas, two lymphomas, three malignant gastrointestinal stromal tumors, three ampulla carcinomas, eight carcinomas of head of pancreas, one pancreatic nonfunction neuroendocrine cell carcinoma. Duodenal adenocarcinoma manifested as local irregular constriction of cavity accompanied with soft tissue mass. After enhancement, the mass manifested as moderate enhancement. Lymphoma manifested as extensive duodenal wall thickening or extracavity mass,after enhancement,the mass was manifested as mild enhancement. Malignant gastrointestinal stromal tumor manifested as massive mass with heterogeneous marked enhancement,ileus was not obvious. Ampulla carcinoma manifested as local soft tissues mass with mild and moderate enhancement in the media of duodenal descent part, intrahepatic and extrahepatic biliary duct dialated. Carcinoma of head of pancreas involving duodenum manifested as duodenal medial wall roug,mass in the head of pancreas with no enhancement, intrahepatic and extrahepatic biliary duct dilated. Pancreatic nonfunction neuroendocrine cell carcinoma involving duodenum manifested as massive mass with marked enhancement in the head of pancreas,there was indistinction between mass and duodenum, intrahepatic and extrahepatic biliary duct were non-dilation.Conclusion CT scan plays an important role in the diagnosis of duodenal malignant tumor.