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Clinical teaching is the critical stage for medical students turning to qualified doctor.In order to overcome the objective problems of insufficient clinical case resources,using the electronic medical record system to collect cases,the real case library of kidney disease was initially constructed,which was presented in the form of network resources.This case database was applied to assist teaching in the probation of eight year medical students at the undergraduate stage,and the application of the case database was evaluated in the form of questionnaire.It is found that case database is helpful to students' clinical learning,and has the necessity of further improvement and good prospects for popularization.It provides a new idea for clinical teaching.
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Objective To evaluate the efficacy of imipenem-cilastin sodium as subsequent therapy on peritoneal dialysis(PD)-related peritonitis.Methods From January 2007 to December 2010,44 PD-related peritonitis patients in our hospital were enrolled in the study.These patients presented cloudy fluid after 3 days initial treatment,and bacterial culture was Gram-negative bacteria or negative.Thirteen peritonitis episodes were treated with ceftazidime,while 36 episodes with imipenem-cilastin sodium.Efficacy,outcome,pathogen and drug-resistance were analyzed retrospectively.Results The effective rates 2 d later of ceftazidime and imipenem-cilastin sodium were 23.1％ and 72.2％ respectively with significant difference (P＜0.05).Gram-negative bacteria of ceftazidime and imipenem-cilastin sodium groups were 69.4％ and 65.2％ respectively without significant difference (P＞0.05).The cure rates 3 weeks later of ceftazidime and imipenemcilastin sodium groups were 23.1％ and 72.2％ respectively with significant difference (P＜0.05).Conclusion As subsequent therapy for PD-related peritonitis,imipenem-cilastin sodium can improve the cure rate.
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BACKGROUND: Carotid-femoral pulse wave velocity in hemodialysis patients is influenced by multiple factors.OBJECTIVE: To explore the carotid-femoral pulse wave velocity (PWVcf) changes and related factors in maintenance hemodialysis (MHD) patients.DESIGN, TIME AND SETTING: Non-randomized control experiment was performed at the Third Hospital of Peking University from January to August 2006.PARTICIPANTS: A total of 66 MHD patients were selected from Third Hospital of Peking University.METHODS: General clinical conditions, biochemical indexes, PWVcf and subjective nutritional state were evaluated. MHD patients were divided into two groups according to the state of nutrition evaluated with SGA: non-malnutrition (n=49), malnutrition group (n=17). The PWVcf of two groups was compared, and one-way and multiple regression analyses were performed to explore PWVcf-relatest factors.MAIN OUTCOME MEASURES: PWVcf, blood albumin and parathyroid hormone.RESULTS: PWVcf was significantly positively correlated with age (r= 0.284, P< 0.05), systolic blood pressure (r= 0.468, P<0. 001), and pulse pressure (r=0.451, P< 0.001), while negatively correlated with prealbumin (r=0.318, P< 0. 05),plasma-albumin (r=0.263, P< 0.05), parathyroid hormone (r=0.167, P< 0.05), serum creatinine (r=0.347, P= 0.004)and transferring (r=0.284, P < 0.05) before dialysis. Multiple regression analysis demonstrated that pulse pressure and parathyroid hormone were independently related with PWVcf. The PWVcf was significantly increased in malnutrition group compared with non-malnutrition group (P < 0.05). CONCLUSION: Pulse pressure is the major clinical determinants of arterial stiffness in patients with MHD independent of conventional risk factors for cardiovascular disease; Malnutrition and atherosclerosis are common complications of MHD,showing close relationship. The PWVcf was significantly increased in malnutrition patients.
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BACKGROUND:Little data have been available concerning function features of arterial elasticity in patients with chronic kidney disease at 2-5 stage not undergoing dialysis.Studies have demonstrated that carotid-femoral pulse wave velocity(PWVcf) can be used to evaluate arterial elasticity.OBJECTIVE:To explore the changes and influential factors of PWVcf in patients with chronic kidney disease.DESIGN,TIME AND SETTING:A non-randomized controlled experiment was performed at the Department of Nephrology,Peking University Third Hospital from January to August 2006.PARTICIPANTS:166 patients with chronic kidney disease and 28 health persons were selected from Peking University Third Hospital.METHODS:The patients were divided into 3 groups based on the Kidney/Dialysis Outcomes Quality Initiative(K/DOQI) guideline for chronic kidney disease:mild group(at stage 1 to 2),moderate group(at stage 3) and severe group(at stage 4 to 5);the healthy people served as control.Body mass,blood pressure,PWVcf and biochemical indicators were determined to calculate glomerular filtration rate and compare the differences.One-way and multiple regression analyses were used to explore related factors of PWVcf.MAIN OUTCOME MEASURES:PWVcf and influential factors.RESULTS:Compared with control group,the patients had significantly higher levels of systolic blood pressure,diastolic blood pressure,pulse pressure and PWVcf(P