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Objective:To explore the application effect of problem-based learning (PBL) combined with evidence-based medicine (EBM) teaching in clinical practice of hematology department.Methods:The 68 medical students practicing in the hematology department from July 15 to November 8, 2019 were set as the experimental group, and 65 medical students from December 29, 2018 to June 28, 2019 were set as the control group. Patients with pancytopenia were selected in the first week of admission for PBL combined with EBM teaching practice in the experimental group, but in the control group, these students did not take this practice. Theoretical knowledge, case analysis and assessment, were conducted before the students leaving the department. SPSS 22.0 was used for t test. Results:Compared with the control group, the scores of theoretical knowledge and case analysis of medical students in the experimental group were improved to a certain extent, with statistical significance ( P = 0.001, P < 0.001). And the higher the score of teaching practice, the higher the score of theoretical knowledge and case analysis ( P < 0.001). Conclusion:PBL combined with EBM teaching practice can effectively improve students' learning enthusiasm and initiative, also can enhance their clinical thinking ability, then can help improve the teaching quality of the hematology.
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Objective: To discuss the pathogenesis,clinical manifestations,diagnosis,differential diagnosis, treatment,and prognosis of the patient with rituximab (RTX)-induced interstitial lung disease (ILD) (RTX-ILD).Methods:A male patient aged 19 years old was confirmed as classical Hodgkin's lymphoma more than 2 years ago,and received autologous hemopoietic stem cell transplantation (HSCT)when the disease recurred 1 year ago.Two months after HSCT,the maintenance chemotherapy was given every month with 375 mg· m-2 RTX,but the mediastinal recurrence appeared during the period,then the mediastinal residual lesion radiotherapy was done for 10 times.However,8 d after the third RTX chemotherapy,the patient experienced post-exercising tachypnea,fever,cough,chest congestion,and limb weakness.The chest CT scanning results suggested ground gloss opacity on both lungs,and blood gas analysis suggested a hypoxemia.Neither antibacterial nor antifungal treatment worked well.Afterwards,the sequential etiological examination showed the negative results,and the bronchoscope examination showed the normal results as well.Considering about the possibility of RTX-ILD,RTX was stopped immediately and turned to intravenous infusion of methylprednisolone 40 mg per day.Results:Five d later,the symptoms of the patients were improved,and the follow-up methylprednisolone was changed to oral and gradually reduced to discontinuation.Conclusion:RTX-ILD is relatively rare,and its clinical manifestations lack specificity. Hormonotherapy is the main method in treatment of RTX-ILD. The patients sensitive to hormonotherapy have better prognosis than those insensitive to hormonotherapy.
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Objective·To investigate and compare the clinical characteristic of non-organic dyspnea and asthma both with complaint of dyspnea.Methods·Seventy-four consecutive patients with non-organic dyspnea,and 74 age-,height-,weight and sex-matched patients with asthma were recruited for investigation in the study.The self-assessment surveys were conducted for the two groups by means of Hospital Anxiety and Depression Scale,Nijmegen Questionnaire and Athens Insomnia Scale.The words for describing dyspnea,clinical symptoms,effective sleep hours and items of pulmonary function test were collected and analyzed Results·Non-organic dyspnea patients tended to describe psychogenic aspects.Asthma patients tended to describe airflow limitation.Non-organic dyspnea group mainly performed psychogenic symptoms.The sleeping time in non-organic dyspnea group was significantly lower than that in asthma group(P＜0.05).The score of anxiety,depression,Nijmegen Questionnaire,Athens Insomnia Scale,FEV1,FEV1％Pred,FVC％Pred,FEV1/FVC in non-organic dyspnea group were significantly higher than those in asthma group (P＜0.05).There was no significant difference in FVC between two groups(P＞0.05).Conclusion·The non-organic group feel more anxiety,depressed and insomnic than the asthma group.Lung function test of asthma group is often abnormal.To discriminate non-organic dyspnea with asthma,clinicians should pay more attention to emotion,sleep,somatoform symptoms,medical history and so on,and do pulmonary function test,improve the understanding of the characteristics of the two diseases,decrease misdiagnosis and wrong diagnosis.
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Objective To investigate the clinical characteristics and risk factors of pulmonary infection after allogeneic hemato-poietic stem cell transplantation(allo-HSCT) .Methods The clinical data of 37 allo-HSCT patients treated in our transplantation u-nit from 2010 to 2012 were performed the retrospective analysis .Results Among 17 cases of allo-HSCT ,33 case-times of pulmona-ry infection occurred after transplantation ,in which more than twice pulmonary infection occurred in 11 cases ,the total occurrence rate of pulmonary infection was 45 .9% (17/37) .5 cases directly died of pulmonary infection .Only 39 .4% case-times of pulmonary infection had the pathogenic evidence .Fungal infection ,especially Candida albicans ,was predominant .The univariate analysis showed that pulmonary infection was significantly associated with human leucocyte antigen (HLA) non-identical of donor and recip-ient and graft versus host disease(GVHD)(P=0 .041 ,0 .013) ,and had no obvious correlation with the other factors (P>0 .05) . The multivariate analysis showed that the HLA non-identical of donor and recipient and GVHD were significantly associated with the occurrence of pulmonary infection (P=0 .041 ,0 .021) .Conclusion Postoperative pulmonary infection is a common complication following allo-HSCT ,which has larger threat to the patients .HLA non-identical and GVHD are significantly correlated with pulmo-nary infection after allo-HSCT .