Problems and countermeasures of teaching reform of neurology in CPPT curriculum / 中华医学教育探索杂志

In recent years, there has been a comprehensive reform of higher medical education in the Medicine School of Wuhan University. According to the need for reform, the teaching of neurology has to be changed from the traditional form to a new form, and be integrated into the clinical pathophysiology and therapeutics (CPPT) courses. Currently neurology in CPPT takes the form of theoretical lectures, case discussions, combined with practical lessons to observe sections under the microscope and clinical practice, for the cultivation of students'!self-learning ability and clinical thinking. In the commissioning process, it exposes some problems in teaching process due to the characteristics of the course in neurology. For example, the knowledge of neuroanatomy is insufficient and review lessons relatively too short, and the teaching effect may be worse due to the fact that teachers have busy clinic work. In addition, students participate in case discussions with less enthusiasm. To solve these problems, we take some measures to promote teaching reform in neurology, such as increasing the review hours of neuroanatomy section in the CPPT neurology, training a group of specialized medical teachers to enrich and stabilize teacher team, adjusting the content and form of discussion class to improve students'!interest and participation, and increasing assistant jobs by the student to assist discussion teaching.

Educational reform centered on independent study / 中华医学教育探索杂志

Reform was made on traditional education mode based on the criterion of undergraduate medical education at home and aboard.The reform includes the changes in teaching content,teaching methods and assessment methods in an aim to establish independent learning mode,cultivate students' self-study ability,initiative spirit and innovation ability.

Clinical significance of changes in maximal expiratory flow in 50 ％ and 25 ％ vita l capacity before and after bronchodilator reversibility testing in asthmatics / 中华全科医师杂志

To explore the clinical significance of changes in maximal expiratory flow in 50％ and 25％ vital capacity (Vmax50％ & Vmax25％) before and after bronchodilator reversibility testing in patients with asthma.Forced expiratory volume in one second (FEV1),Vmax50％ and Vmax25％ were measured before and after bronchodilator reversibility testing in 118 patients with asthma and 82 with chronic obstructive pulmonary disease (COPD).The rate of positive reversibility in Vmax50％ was significantly higher than that in FEV1 in 118 asthmatics (x2 =7.995,P =0.007).The rates of positive reversibility in Vmax50％ and Vmax25％ were significantly higher in asthmatics than those in COPD patients (x2 =9.335,P =0.009).

Clinical significance of small airway function and inflammatory markers in induced sputum among patients with clinically controlled asthma / 中华全科医师杂志

Objective To investigate clinical significance of small airway function and eosinophil (Eos) percentage,levels of eosinophil cationic protein (ECP) and IL-5 in induced sputum among patients with clinically controlled asthma. Methods Sixty-two patients with clinically controlled asthma were selected for the study. Lung function was performed and percentage of Eos, levels of ECP and IL-5 in induced sputum were measured by Wrights' stain, fluorescence immuno-CAP system and ELISA,respectively. Thirty patients of asthma at acute exacerbation period and 20 healthy subjects were selected as controls. Results In 62 patients with clinically controlled asthma, 43 (69. 4% ) showed abnormal small airway function and 19(30. 6% ) normal one. Percentage of Eos [(5. 6 ±2. 9)%], levels of ECP [( 129 ±100) μg/L] and IL-5 [(21± 12) μg/L] in induced sputum were significantly lower in patients with clinically controlled asthma than those of asthma at acute exacerbation period [( 16. 2 ± 9. 7 ) %, ( 362 ±182) μg/L and IL-5(51 ±26) μg/L, respectively] (all P ＜0. 01 ), but significantly higher than those in healthy controls ( all P ＜ 0. 01 ). Percentage of Eos, levels of ECP and IL-5 in induced sputum were significantly higher in patients with clinically controlled asthma with abnormal small airway function than those with normal ane [(6.9±3.1)% vs. (2.0±1.1)%, (148±90) μg/Lvs. (54±29) μg/L and (24 ±12) μg/L vs. ( 13 ± 5 ) μg/L, respectively] ( all P ＜ 0. 01 ). Conclusions Abnormal small airway function and airway inflammation persistently exist in patients with clinically controlled asthma and it may be helpful to guild treatment during clinical control to determine small airway function and inflammatory markers in their induced sputum.

Diagnostic value of plasma N-terminal pro brain natriuretic peptide in elderly patients with acute exacerbation of chronic obstructive pulmonary disease associated with left-heart failure / 中华全科医师杂志

Plasma level of N-terminal pro brain natriuretic peptide (NT-proBNP) was measured for 362 elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), including 97 of AECOPD complicated with left-heart failure and 265 of isolated AECOPD.Results indicated that there was significant difference in plasma level of NT-proBNP between the two groups ( P = 0.000).With a cut-off value of 1643.5 ng/L NT-proBNP, its sensitivity, specificity and accuracy for identifying AECOPD complicated with left-heart failure in the elderly were 84.4%, 85.3% and 85.1%, respectively.It is suggested that assay for plasma NT-proBNP may be helpful to identify left-heart failure in elderly patients with AECOPD.

Study on the relationship between pulmonary arterial hypertension associated with chronic obstructive pulmonary disease and inflammatory reaction / 中国综合临床

Objective To explore the relationship between pulmonary arterial hypertension (PAH)associat-ed with chronic obstructive pulmonary disease (COPD) and inflammatory reaction(inflammatory cell, bs CRP, IL-8 and TNF-α). Methods According to echocardiography results, the patients (systolic pulmonary artery pressure, SPAP>30 mm Hg) were divided into PAH group(n=36), single COPD group(n=32). All of the patients and 30 healthy subjects (control group) were recruited into the study. Lung function, arterial blood gases, cell differentials in induced sputum, and the levels of serum high sensitivity CRP(hs-CRP), IL-8, TNF-α were determined. Results The incidence of PAH associated with COPD were 53% (36/68),including 27% (3/11) of mild PAH,38% (5/13) of moderate PAH and 64% (28/44) of severe PAH and there were significantly differences in the severity of the spirometric abnormality (χ26.020, P<0.05). The mean PASP and right ventricle wall thickness (RVWT) in PAH group were significantly greater in the patients compared to single COPD[PASP: (52±15)mmHg in PAH group and (23±12) mm Hg in single COPD group, t=3.32,P<0.01 ; PVWT: (5.03±1.04 )mm in PAH group and (3.78±0.57)nun in single COPD group, t=2.36, P<0.05]. The levels of total cell count and neutrophils in induced sputum,hs-CRP,IL-8 and TNF-α in PAH group were higher than those in single COPD group and healthy subjects[toal cell count: (2.84±0.56)×109/L in PAH group and (1.73±0.42)×109/L in single COPD group and (0.68±0.21)×109/L in control group; neutrophils: (2.78±0.52)×109/L in PAH group and (2.57± 0.26)×109/L in single COPD group and (0.63±0.21 )×109/L in control group; hs CRP: (32±12) mg/L in PAH group and (23±11)mg/L in single COPD group and (11±4)mg/L in control group; IL-8: (113±34) ng/L in PAH group and (69±24) ng/L in single COPD group and (38±11) ng/L in control group; TNF-α: (206±63)ng/L in PAH group and (153±54)ng/L in single COPD group and (75±26)ng/L in control group (P<0.05)]. PASP in PAH group was negatively correlated with FEV<,1>% (r=-0.48,P<0.01) and was positively correlated with the levels of serium IL-8 and TNF-α, neutrophils in induced sputum respectively(r=0.43,0.56,0. 47,P<0.01). Conclusion Inflammation reaction is responsible for PAH associated with COPD.

Relationship between inflammation and malnutrition in patients with chronic obstructive pulmonary diseases / 中华临床营养杂志

Objective To study the relationship between inflammation and malnutrition in patients with stable chronic obstructive pulmonary disease (COPD).Methods A total of 85 patients with stable COPD and 30 healthy subjects were recruited .All patients were divided into the lower body mass index (BMI,BMI<18.5 kg/m~2) group and normal BMI (BMI=18.5-23.9 kg/m~2) group.Lung function,arterial blood gall,cell differenti-als in induced sputum,and the levels of serum C-reactive protein (CRP),interleukin-8(IL-8),interleukin-6 (IL-6),interleukin-10 (IL-10),and tumor necrosis factor-α(TNF-α) were determined.Results The levels of total cell count and neutrophils in induced sputum were significantly higher in lower BMI group than in normal BMI group and healthy subjects (P<0.05).The forced expiratory volume in 1 second percentage,forced expiratory volume in 1 second/forced vital capacity,and arterial oxygen tension were significantly lower in lower BMI group than in normal BMI group,and the arterial carbon dioxide tension was significantly higher in lower BMI group than in normal BMI group (P<0.05).The levels of serum CRP,IL-8,IL-6,and TNF-α were significantly higher in lower BMI group than those in normal BMI group and healthy subjects (P<0.05).In lower BMI group,BMI was negatively correlated with total cell count (r=-0.492,P=0.0038) and neutrophils (r=-0.501,P=0.0032) in induced sputum and the levels of serum CRP (r=-0.473,P=0.0083),IL-8(r=-0.382,P=0.0421),IL-6(r=-0.422,P=0.0147),and TNF-α(r=-0.416,P=0.0156),respectively.Conclu-sion Local and systemic inflammatory reaction is responsible for malnutrition associated with COPD.

Clinical significance of airway hyperresponsiveness and inflammatory markers in induced sputum in patients with asthma during their remission period / 中国实用内科杂志

Objective To investigate the clinical significance of airway hyperresponsiveness and eosinophil(Eos)percentage and level of eosinophil cationic protein(ECP)in induced sputum in patients with asthma during their remission period.Methods Seventy-six patients with asthma during their remission period were selected.Bronchial challenge test was performed and the percentage of Eos and level of ECP in induced sputum were measured by Wrights' stain and Immuno-CAP System,respectively.Thirty patients with asthma during their exacerbation period and twenty healthy subjects were selected as controls.Results In seventy-six patients with asthma during their remission period,sixty-five(85.5%)showed positive bronchial challenge test and eleven(14.5%)patients showed negative bronchial challenge test.The percentage of Eos and level of ECP in induced sputum in patients with asthma during their remission period were 0.071?0.032 and 131.5 ?g/L respectively;those in asthma group during their exacerbation period and healthy group were 0.198?0.103 vs 0.013?0.007 and 355.3 ?g/L vs 48.0 ?g/L,respectively.There was significant difference in the percentage of Eos and level of ECP in induced sputum between three groups(P

The effect of theophylline on sleep-disordered breathing in patients with stable chronic congestive heart failure / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To determine the prevalence of sleep-disordered breathing in patients with stable, optimally treated chronic congestive heart failure and the effect of short-term oral theophylline therapy on periodic breathing in these patients.</p><p><b>METHODS</b>Patients with stable, optimally treated chronic congestive heart failure were monitored by polysomnography during nocturnal sleep. The effects of theophylline therapy on periodic breathing associated with stable heart failure were observed before and after treatment.</p><p><b>RESULTS</b>Patients were divided into two groups. Group I (n = 21) consisted of individuals with 15 episodes of apnea and hypopnea [as determined by the apnea-hypopnea index (AHI)] per hour or less; Group II (n = 15, 41.7%) individuals had an index of more than 15 episodes per hour. In group II, the AHI varied from 16.8 to 78.8 (42.6 +/- 15.5) in which the obstructive AHI was 11.1 +/- 8.4 and the central AHI was 31.5 +/- 9.6. Group II had significantly more arousals (36.8 +/- 21.3 compared with 19.4 +/- 11.2 in group I) that were directly attributable to episodes of apnea and hypopnea, lower arterial oxyhemoglobin saturation (76.7% +/- 4.6% compared with 86.5% +/- 2.8%) and lower left ventricular ejection fraction (24.2% +/- 8.8% compared with 31.5% +/- 10.6%). Thirteen patients with compensated heart failure and periodic breathing received theophylline orally (at an average dose of 4.3 mg/kg) for five to seven days. After treatment, the mean plasma theophylline concentration was (11.3 +/- 2.5) micro g/ml. Theophylline therapy resulted in significant decreases in the number of AHI (20.8 +/- 13.2 vs. 42.6 +/- 15.5; P < 0.001) and the number of episodes of central apnea-hypopnea per hour (10.1 +/- 7.6 vs. 31.5 +/- 9.6; P < 0.001). Furthermore, the percentage of total sleep time during which arterial oxyhemoglobin saturation (SaO(2)) was less than 90 percent (8.8% +/- 8.6% vs. 23.4% +/- 24.1%; P < 0.05) and the arousals per hour (18.7 +/- 21.2 vs. 36.8 +/- 21.3; P < 0.05) were also lower. There were no significant differences in the characteristics of sleep or obstructive AHI before and after theophylline treatment.</p><p><b>CONCLUSIONS</b>The prevalence of sleep-disordered breathing (mainly periodic respiration or cheyne-stokes respiration with central sleep apnea) is high in patients with stable chronic congestive heart failure. The sleep-disordered breathing episodes are associated with severe nocturnal arterial blood oxyhemoglobin desaturation and excessive arousals. In these patients, oral theophylline therapy may reduce the number of episodes of central apnea and hypopnea and the duration of arterial oxyhemoglobin desaturation during nocturnal sleep.</p>

Relationship between cysteinyl leukotriene metabolism and clinical response to antileukotriene treatment / 中国实用内科杂志

Objective To investigate the relationship between cysteinyl leukotriene and clinical response to antileukotriene treatment,and to help select a clinical pharmacologic scheme.Methods Seventy-eight cases with acute mild-moderate asthma were treated with montelukast in a four-week trial.Asthmatic symptom score,usage of ?_2 receptor agonist,percentage of eosinophil,serumal IgE concentration,spirometry and urinary leukotriene E_4(uLTE_4)were measured pre- and post-treatment.Logistic analysis was used to access the various clinical parameters correlated with the response to montelukast.Results There were 48 responders and 30 nonresponders.The uLTE_4 level from the responders was higher than that of nonresponders(P0.05).Subjects with a uLTE_4 level of ≥1 200 pg/mL were11.5 times more likely to respond to montelukast than those with

Use of inflammatory markers in induced sputum in asthma severity and differential diagnosis / 中国实用内科杂志

Objective To investigate the relationship between the number of eosinophil(Eos)and level of eosinophil cationic protein(ECP)in induced sputum and asthma severity and their value of differential diagnosis.Methods From July 2002 to June 2004,59 asthmatic patients were selected in the People Hospital of Wuhan University.The number of eosinophil and level of ECP were measured by Wrights' stain and Immuno-CAP System.The lung function was also evaluated.The same index was measured in 20 patients with COPD and 10 healthy subjects as control.Results The number of eosinophil in induced sputum in asthmatic patients negatively correlated with FEV_1%(r=-0.65,P

An Analysis of the Application of Antimicrobials in Inpatient s / 医药导报

Objective: To reveal if the use of antimicrobi als is rational in the authors hospital.　Methods: 1 025 cases were investigated retrospectively by systematic sampling from all the inp atients of the year 1997.　Results: 77.8% of the subjects were treated with antimicrobials, of whom, 55.2% treated with 2 or more antimicr obials. Yet only 39 cases had microbiological test before the administration of antimicrobials.　Conclusion: Inappropriate use of antimicr obials exists in the hospital. The management of the use of antimicrobials and c ontinuing education of medical doctors should be enhanced so as to make the use of antimicrobials more rational.