Application of modern comprehensive three-dimensional teaching method in clinical practice of respiratory medicine / 中华医学教育探索杂志

Objective To evaluate the effect of modern comprehensive three-dimensional teaching method in clinical practice of respiratory medicine. Method The problem based teaching method PBL (problem-based learning), the standardized patient-based practice SPE/Xs (standardized patient experiences/exam) and Mini clinical examination practice Mini-CEX (Mini clinical examination exercise) method and other methods were organically combined and used in respiratory medicine clini-cal practice, and it was named“modern comprehensive three-dimensional teaching mode”. 60 students were randomly divided into the modern comprehensive three-dimensional teaching method group (30 students) and the traditional teaching method (SBL) (30 students), using the modern com-prehensive three-dimensional teaching method and the SBL breathing internal medicine practice teaching respec-tively. After the teaching, the methods of performance testing and questionnalre survey were used to evaluate the teaching effect of two groups of students. SPSS software was used to compare t test. Results The test results of modern three-dimensional integrated teaching method group was (86.91±4.77), higher than that of the control group (79.00±7.51) points (t=12.4, P=0.026 0). In the subjective questions (such as discourse analysis problem and case), modern three-dimensional integrated teaching group (47.63± 2.14) points is obvi-ously superior to the traditional group (36.00±6.71) points (t=21.6, P=0.001 9). According to the results of the survey, the modern comprehensive teaching method can improve students' subjective initiative and enthusiasm for learning, improve students' ability of comprehensive analysis, promote the formation of clinical thinking, and help students master the basic knowledge and basic skills of respiratory diseases. Conclusions In the respiratory medicine teaching, implementation of modern comprehensive three-dimensional teaching method is helpful to improving the teaching effect.

Differences in clinical features and risk factors of pulmonary thromboembolism between older and younger patients / 中国实用内科杂志

Objective In order to improve diagnosis of pulmonary thromboembolism(PTE),the clinical features of pulmonary embolism between older and younger patients were compared.Methods Totally 105 patients(57 older and 48 younger)with diagnosed PTE were assessed retrospectively.Results There were more risk factors in the elderly as compared with younger group.Phlebitis was the major risk factor in both groups.Other risk factors,such as COPD,immobilization,malignancy and cardiac disease,were more frequent in the elderly;whereas in younger patients,intravenous drug injection and genetic factors were more frequent.Chest pain and hemoptysis were less frequent in older patients whereas syncope occurred more often in the older group."Triplicate symptoms" (including dyspnea,chest pain and hemoptysis)occurred more often in the younger group.Massive PTE occurred more often in the older patients.Severe complications were more frequent in cTnT-positive patients.Conclusion There are more risk factors in the elderly.The clinical presentation of PTE is often atypical in elderly patients,and prone to develop massive PTE.cTnT(Cardiac troponin T)is an independent predictor of prognostic implications in patients with confirmed PTE.

Activation and clonal expansion of T cells in the synovial fluid and peripheral circulation in patients with rheumatoid arthritis / 中华风湿病学杂志

Objective To explore the difference between T cells in the synovial fluid and peripheral blood in patients with rheumatoid arthritis(RA). Method Samples from 22 patients were studied. The differentiation and activation markers expressed on T cell surface were detected by immunofluorscence using flow cytometer. The specific proliferation of collagen Ⅱ and heat shock protein 70 was analyzed using standard 3H-TdR incorporation method. Restricted V beta usage of these T cell was analyzed by semi-quantitied RT-PCR. Results The majority of the T cell subsets in the synovial fluid were demonstrated to be CD4 and CD8 positive cells in which (40?10)% were CD4 positive and (36?16)% were CD8 T cells respectively. The ratio between CD4 and CD8 was much lower than that found in the PBL of RA patients. The percentage of CD3+/CD25+ T cells was (16?6)%. The specific proliferation of collagen Ⅱ and HSP70 to CD3+/CD25+ T cell was higher than that of CD3+/CD25+ negative T cells. The T cell receptor expressed on the T cells from both peripheral blood and synovial fluid were tested for ?? TCR (70?26)%. However, the T cells in the synovial fluid showed V?14,16 and 17 restriction. Conclusion The data here reported indicates that T cell subsets in the synovial fluid and peripheral blood circulation in patients with rheumatoid arthritis are different. The T cells in the synovial fluid demonstrates more activation and higher reactivation to collagen Ⅱ and HSP70. The TCR of T cells showes V?14,16 and 17 restriction.