Medicine is a practical subject,which requires medical students to deepen and expand the understanding of the theory by clinical training,and establish clinical thinking.In our noviciate reform of obstetrics and gynecology,we have established the new problem-based teaching mode,which is an effective method in fostering the ability of information collection,innovation and practice,and have obtained more satisfactory results.

ObjectiveTo enhance understanding on echocardiographic and clinical characteristics of valve lesions of non-infective endocarditis (NIE), particularly in patients with systemic lupus erythematosus (SLE). Comparative analysis of the diagnostic value of echocardiography was performed in patients with non-infective endocarditis and atypical infective endocarditis (IE).MethodsData from 38 patients with clinically diagnosed NIE in the institution were collected retrospectively during July 2005 and January 2015, including 10 patients with SLE, 10 with rheumatic heart disease, 11 with rheumatoid arthritis, and 7 with hepatitis B. Data of 42 patients diagnosed as atypical IE during the same period were collected as control group. All patients underwent examinations of blood culture, sero-immunological tests, electrocardiogram and echocardiography. Comparison was made between the two groups using SPSS 11.5 software package. ResultsThe difference in blood culture, sero-immunological tests and electrocardiogram was statistically signiifcant between the groups (χ2 value, 26.29, 5.53, and 4.80, respectively, allP<0.05), although there was no statistical difference in results of echocardiography (χ2=0.03,P>0.05). Echocardiography identiifed valvular vegetations in 27 of 38 patients, with NIE with a detection rate of 71.0%; The size of the vegetations ranged from 2 to 7 mm in diameter; Valve vegetations was found in 36 of 42 patients with atypical IE, with a detection rate of 85.7%; the other six cases demonstrated valvular thickening only; in this group, the vegetations ranged from 2 mm to 19 mm in size and were located in the left heart in 28 patients, 8 cases in the right heart. In the case group, two cases of valve lesions in patients with SLE were confirmed by transesophageal echocardiography (TEE), while missed on TEE examination. Nine cases with more than mild valve regurgitation were identiifed. Ten cases were treated with hormones and cyclophosphamide, after which valve lesions resolution was found on serial echocardiography tests with a follow-up period of 5 days to 3 years.Conclusions Echocardiography is capable of detecting valve lesions at early stage in patients with NIE, particularly in patients with SLE. Echocardiography plays a crucial role in identifying the non-infective thrombotic vegetations, guiding clinical treatment and monitoring the therapeutic effects.

Objective:To explore the clinical value of vestibular autorotation test (VAT) in the treatment for otogenic vertigo patients. Method:One hundred and twenty-nine definite otogenic vertigo patients were included. All patients underwent the VAT and caloric test (CT). The results were analyzed statistically. Result:In VAT examination, 89 (69.0%) cases were abnormal. In CT examination, 56 (43.4%) cases were abnormal. In the contrast test of VAT and CT, VAT results were abnormal in 47 (36.4%) patients and CT results were abnormal in 14 (10.9%) patients. The number of patients whose both VAT and CT results were abnormal was 42 (32.6%). The total number of patients with various abnormal results was 103 (79.8%). According to statistical analysis, the abnormal result rate of VAT was higher than that of CT. The abnormal result rate of both VAT and CT was higher than that of each single test. There was statistic significance in the difference (χ²=1.670, P<0.05). Conclusion:For otogenic vertigo patients, their abnormal result rate of VAT is higher than that of CT. VAT and CT can be mutually complementary. The combination of VAT and CT can help to understand the function of semicircular canal in the general and provide reference for the treatment of otogenic vertigo diseases.