RESUMO
Objective:To explore the methods of standardized residency training for internal medicine residents in the post-epidemic era, and to provide theoretical basis for improving and optimizing the standardized residency training.Methods:A total of 228 resident physicians from Batch 2017 to Batch 2019 were recruited, and a questionnaire survey was conducted to investigate their basic information, their attitudes and actions in facing the epidemic and the epidemic impact on the occupational planning and rotation plan. Original data of this study were exported through the questionnaire platform "Questionnaire Network", sorted out by Microsoft Excel, and plotted and analyzed by Origin software.Results:Residents of our hospital, socialized medical residents, other unit sponsor residents and combined professional masters willing to go to Hubei for medical support accounted for 100% (30 people), 86% (6 people), 84% (80 people) and 77% (72 people) respectively. Almost all of the residents were willing to learn the knowledge of COVID-19 and to educate the public (99%-100%). Eighty percent (24 people) of the residents of our hospital participated in anti-epidemic, while the proportion of other unit sponsor residents, socialized medical residents and combined professional masters were 46% (44 people), 14% (1 people) and 12% (11 people), respectively. Additionally, 97% (29 people) of our hospital residents, 89% (85 people) of other unit sponsor residents, 86% (6 people) of the socialized medical residents, and 82% (76 people) of the combined professional masters would still like to engage in the clinical work in the future. What's more, the resident physicians who thought that phylaxiology, epidemiology, general practice medicine, traditional Chinese medicine and critical care medicine should be strengthened to train accounted for 98% (221 people), 98% (221 people), 90% (203 people), 70% (158 people) and 60% (135 people) respectively.Conclusion:Most resident physicians have strong awareness and active actions in fighting against the epidemic. In the future, the standardized residency training of physicians should further strengthen the training of phylaxiology, epidemiology, general practice medicine, traditional Chinese medicine and critical care medicine.
RESUMO
Infective endocarditis (IE) refers to the pathogenic microbial infect the endocardium, valves or intima adjacent to the cardiac arteries through the bloodstream with the formation of vegetations. Valves are the most frequently affected sites. Here, we described a 49-year-old female, who admitted to respiratory outpatient department in the Third Xiangya Hospital, Central South University for long time of fever. Chest computer tomography (CT) found a thick wall cavity in the apex of the right lung with smooth wall and fluid plane, without enhancement, which was considered as inflammation and tuberculosis to be excluded. Echocardiography showed vegetations on the aortic valve, where abscess was found on the root. Accidentally in surgery, a patent ductus arteriosus (PDA) was found. The surgeon closed the PDA and performed aortic valve prosthetic valve replacement. Bacterial colony of coccus was found in the pathological tissue, which was consistent with the diagnosis of valvular degeneration with infection. Lung lesion was obviously absorbed after 6 weeks of treatment with vancomycin, which has been confirmed as a sensitive antibacterial drug to Enterococcus faecalis. Overall, the pulmonary lesion was caused by the detachment of bacterial neoplasm of aortic valve, which has passed through the PDA and entered the pulmonary circulation.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Valva Aórtica , Permeabilidade do Canal Arterial , Endocardite , Endocardite Bacteriana , Doenças das Valvas CardíacasRESUMO
Objective To investigate the predictive value of cardiovascular risk factors in coronary atherosclerotic heart disease.Methods A total of 400 patients who underwent coronary angiography (CAG) in our hospital was divided into multiple vascular lesion group,single vascular lesions group,and non-CAD group according to the result of CAG and their clinical data were analyzed retrospectively.The correlation between cardiovascular risk factors and coronary artery lesions was analyzed,and the independent risk factor of CAD was screened by multi-factorial logistic regression analysis.Results There was significant difference in total cholesterol (TC),triglycerides (TG),high density lipoprotein cholesterol (HDLC),fasting blood glucose (FBG),inflammatory cells,carotid artery plaque,brachial-ankle pulse wave velocity (baPWV),high-sensitivity C-reactive protein (Hs-CRP) between the CAD group and the non-CAD group (P ＜ 0.05 or P ＜ 0.01).The number of coronary artery lesion branch was increased significantly when risk factors,such as age,body mass index(BMI),hypertension,diabetes mellitas,smoking,carotid artery plaque,TG,TC,low density lipoprotein cholesterol (LDL-C),FBG,WBC,monocytes (M),neutrophils (N),neutrophils/lymphocytes (N/L),baPWV,and Hs-CRP.Other risk factors including TC,HDL-C,L were decreased with a statistically significant difference (P ＜ 0.05).There was no significant relation among,and left ventricular ejection fraction (LVEF)％.The most significant risk factor was carotid artery plaque that was independently associated with coronary heart disease (b =1.264,P ＜ 0.01),followed by smoking (b =1.204,P ＜0.01),HDL-C (b =1.104,P ＜0.01),TC (b =1.082,P ＜0.01) diabetes mellitus (b =0.956,P ＜0.01),baPWV increased (b =0.741,P ＜0.01),WBC (b=0.721,P ＜0.01),hypertension (b =0.602,P ＜0.01),the age (b =0.538,P ＜0.01),and HsCRP(b =0.421,P ＜ 0.01).Conclusions The results suggest that the hypertension,hyperlipidemia,smoking,age,baPWV,inflammatory cells,Hs-CRP,and carotid artery plaque was a significant independent CHD risk factors.
RESUMO
Objective To investigate the change of serum matix metalloproteinase-2(MMP-2) level and its significance in patients with acute ischemic stroke of different subtypes. Methods Seventy-seven patients with acute ischemic stroke were classified into large-artery atherosclerosis (LAA) (n =29, 37. 66% ), small artery occlusion (SAO, lacunar infarction) (n =23, 29.87%), cardioembolism (CE) (n = 13,16. 88%), stroke of undemonstrated etiology (SUE) (n = 7, 9.09% ), and stroke of other demonstrated etiology (SOE) (n = 5, 6. 49%) according to the TOAST criteria. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of serum MMP-2 in patients with acute ischemic stroke at 24 hours and 7 days, and they were compared with 42 controls. Results The serum MMP-2 levels at 24 hours and 7 days of the onset of symptoms in the acute ischemic stroke group according to the TOAST criteria were 189. 55 ±24.79 and 307.46 ±84. 16 ng/ml respectively, and they were all significantly higher than 159.76 ± 10. 32 ng/ml in the control group (all P <0.05). Among all the TOAST subtypes, SOE and SUE were not analyzed because of the small numbers of cases; among other subtypes, the serum MMP-2 levels at 24 hours of the onset of symptoms in the LAA, SAO and CE groups were 218. 60 ± 13.42,175.21 ±9.92, and 167.26 ±9.7 ng/ml respectively, and they were all significantly higher than those in the control group (all P < 0. 05); at day 7 of the onset of symptoms they were 404.75 ± 10. 30, 293.18 ± 10.91, and 211.81 ±11.14 ng/ml respectively, and they were also significantly higher than those in the control group (all P < 0.05). Among those, the LAA group was increased significantly (P < 0. 01). Conclusions The serum MMP-2 levels were increased in patients with acute cerebral infarction. "l'ne changes of the serum MMP-2 levels in each TOAST subtype group were different. The LAA group increased most significantly, which supported the different views of the etiology of cerebral infarction subtypes. The serum MMP-2 plays an important role in the process of cerebral infarction of the LAA type.